Effects of valsartan with or without benazepril on blood pressure,angiotensin Ⅱ,and endoxin in patients with essential hypertension

AIM：To eveluate the effects of valsartan(Val)with or without benazepril(Ben)on blood pressure and plasma levels of angiotensin(Ang Ⅱ)and digoxin-immunoreactive factors(endoxin)in patients with essential hypertension. METHODS:Ninety patients with essential hypertension were randomly divided into 3 groups(n=30 per group):Ben group(Ben 10 mg/d,po);Val group(Val 80mg/d,po);combination drug therapy group(Val 80mg/d Ben 10mg/d,po);all patients were treated for 12 weeks.Age and sex-matched 20 normal subjects were served as control group.RESULTS:The levels of plasma endoxin and ang Ⅱ in patients with essential hypertension were remarkably higher than those in normal subjects.The levels of plasma ang Ⅱ and endoxin were all obvious positive correlation with systolic blood pressure(SBP)and diastolic blood pressure(DBP)(Ang Ⅱ:r=0.5151,0.7978;endoxin:r= 0.4706,0.7274,respectively),within 6 weeks of drug intervene,SBP and DBP were remarkably decreased in 3 groups.After 6 weeks,SBP and DBP were continuously decreased in Ben group and Val Ben group,but not in Val group.Level of plasma AngⅡ was remarkably decreased as SBP and DBP decreased in Ben group and Val Ben group;level of plasma AngⅡ was remarkably increased in Val group.CONCLUSION:Val with or without Ben remarkably decreased SBP and DBP in patients with essential hypertension within 6 weeks.Antihypertensive efficacy was weakened after long-term use of Val alone.The antihypertensive effect of Val Ben group was the most remarkable among 3 groups and could avoid the side effects of high plasma AngⅡ.     

B型利钠肽检测在急诊呼吸困难病因鉴别中应用价值的探讨

目的 探讨B型利钠肽(BNP)在急诊呼吸困难病因鉴别中的应用价值.方法 测定155例急诊呼吸困难患者血浆BNP浓度,并与超声心动图左心室射血分数(LVEF)及E/A值进行相关性分析.以不同BNP浓度为临界值,计算其诊断心源性呼吸困难的敏感性及特异性.结果 心源性呼吸困难组BNP浓度[(764±275)ng/L]与LVEF及E/A值呈明显负相关,且明显高于非心源性呼吸困难组[(113±59)ng/L](P＜0.01).以BNP浓度100、300、500 ng/L为临界值,其诊断心源性呼吸困难的敏感性分别为100.0%、92.2%、80.0%;特异性分别为73.9%、90.8%、100.0%.结论 BNP检测用于急诊呼吸困难病因初步筛查具有重要意义,低水平的BNP临界浓度(＜100 ng/L)有助于排除心源性呼吸困难,高水平的BNP(＞500 ng/L)临界浓度有助于确定心源性呼吸困难,BNP浓度区间100～500 ng/L对于诊断和排除心源性呼吸困难都有一定局限性.

Abstract：

Objective To explore the value of plasma brain natriuretic peptide (BNP)level in differentiating etiology of dyspnea in emergency patients. Methods The plasma BNP levels in 155 emergency patients with dyspnea were assayed. The correlation between BNP levels and left ventricular ejection fraction(LVEF) and E/A respectively. Sensitivity and specificity in differentiating etiology of dyspnea were calculated based on different levels of BNP. Results The BNP levels in cardiogenic dyspnea group were negatively correlated with LVEF and E/A respectively (P ＜ 0.01). They were also significantly higher than those in noncardiogenic dyspnea group (P ＜ 0.01).The sensitivity in diagnosing cardiogenic dyspnea at different critical BNP levels (100 ng/L,300 ng/L,500 ng/L)was 100.0%,92.2%,80.0%,and the specificity was 73.9%,90. 8%,100.0% respectively. Conclusions Plasma BNP level has significant value in preliminarily differentiating etiology of patients with dyspnea. Lower BNP level (＜ 100 ng/L) is helpful in excluding cardiogenic dyspnea and higher BNP level (＞500 ng/L) is helpful in confirming cardiogenic dyspnea. However,BNP level between 100 ～ 500 ng/L isdeficient in confirming and excluding cardiogenic dyspnea.     

肺癌及肺炎患者血清脂联素检测分析

目的 研究脂联素在肺癌、肺炎患者血清中的水平,探讨其与疾病的关系及意义.方法 应用酶联免疫吸附试验方法检测70例肺癌患者(肺癌组)、65例肺炎患者(肺炎组)、60例健康体检者(健康对照组)的血清脂联素水平,对3组结果进行统计学处理并分析.结果 脂联素在健康对照组、肺炎组、肺癌组中的血清含量依次减少[分别为(11.46±6.93)、(9.69 ±6.12)、(5.91±4.49)mg/L],健康对照组与肺癌组比较差异有统计学意义(P＜0.01);肺炎组与肺癌组比较差异有统计学意义(P＜0.01).结论 脂联素在肺癌患者血清中含量的降低表明脂联素与肺癌的发生发展密切相关,其或许有可能成为治疗和检测肺癌的重要指标.

Abstract：

Objective To study serum levels of adiponectin in patients with lung cancer and pneumonia and to explore its relationship with clinical disease and significance. Methods Enzyme-linked immunosorbent assay (ELISA) was used to detect 70 cases of lung cancer, 65 patients with benign lung diseases and 60 normal controls in the serum adiponectin levels, and the results were analyzed statistically. Results In healthy controls and benign lung disease group, serum adiponectin levels were higher than the lung cancer group. Serum adiponectin levels in healthy controls, benign lung disease group, and lung cancer group decreased in turn[(11.46 ±6.93)mg/L, (9.69 ±6.12) mg/L, (5.91±4.49) mg/L]. Between healthy control group and the lung cancer group there was significant difference (P＜0.01); between benign lung disease group and the lung cancer group there was significant difference (P＜0.01 ) too. Conclusion The low level of serum adipinectin in patients with lung cancer indicates that adiponectin is closely related with the development of lung cancer, and it might be used as an important indicator for the detection of treatment of lung cancer.     

2型糖尿病肾病患者血清C肽水平变化的意义

目的 探讨2型糖尿病肾病患者血清C肽水平变化的意义.方法 选取住院2型糖尿病患者120例,按尿白蛋白排泄率大小分成3组,正常白蛋白尿组34例,微量白蛋白尿组40例,临床白蛋白尿组46例,同时设血糖正常健康组30例.测各组空腹血糖、糖化血红蛋白(HbA1c)、空腹血清C肽(FCP),并进行比较分析.结果 微量白蛋白尿组和临床白蛋白尿组患者血清C肽与正常健康组比较,差异有统计学意义[(1.27±0.5)μg/L和(0.32±0.16)μg/L比(2.39±0.22)μg/L,P＜0.01];血清C肽水平与尿白蛋白排泄率呈负相关(r=-0.745,P＜0.01).结论 血清C肽水平的下降可能参与2型糖尿病肾病发生发展.

Abstract：

Objective To investigate the change of serum C-peptide level in type 2 diabetic nephrosis patients. Methods We recruited 120 patients with type 2 diabetes. The level of fasting plasma glucose (FBG), glycated hemoglobin (HbA1c), fasting C-peptide (FCP) and urinary albumin excretion rate (UAER) were measured.According to UAER, 120 patients were divided into Group Ⅰ: normal albuminuria group, 34 patients; Group Ⅱ:microalbuminuria group, 40 patients; Group Ⅲ: clinical albuminuria, 46 patients. At same time, we selected 30 healthy people as control group. Results The level of C-peptide decreased significantly in Group Ⅱ and Group Ⅲ compared with that of control group (P ＜0.01 ). The difference of C-peptide level between Group Ⅱ, Group Ⅳ and Group Ⅰ was statistically significant (P ＜ 0.01 ). The level of C-Peptide and urinary albumin excretion rate was negatively correlated (R = -0. 745 ,P ＜ 0. 01 ). Conclusion The decline of serum C-pcptide may be involved in the development of type 2 diabetic nephropathy.     

危重患者血浆中性粒细胞明胶蛋白酶相关载脂蛋白浓度的测定及其临床意义

Objective To detect the concentration of plasma neutrophil gelatinase-associated lipocalin (NGAL) and the clinical significance in critically ill patients. Methods Fifty-four critically ill patients in ICU were enrolled in the present study with 23 health persons as controls. Plasma NGAL concentration was measured by enzyme-linked immunosorbent assay (ELISA) on the 1 st and 7th day from 54 adult patients in ICU and the controls (control group). Results The plasma NGAL concentrations of ICU patients were significantly higher than those of the controls (P ＜0.001 ). NGAL concentrations were no significant difference between the Death group and the Survival group on the 1 st day(P = 0. 259). But there was a markedly significant difference in Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores (P ＜0. 001 ). The APACHE Ⅱ scores on the 7th day significantly decreased in the improved patients (P =0.019) and showed a subtle tendency of increase in the deteriorated patients ( P =0.403) in comparison to the first day. The plasma NGAL levels followed the same trends, but showing a significant increase even in deteriorated patients ( P = 0. 016 and P= 0. 034, respectively). Conclusions The plasma NGAL concentrations of critically ill patients is significantly increased. Combined with APACHE Ⅱ scores,it can provide useful and available data of the disease state of critically ill patients.     

危重患者血浆中性粒细胞明胶蛋白酶相关载脂蛋白浓度的测定及其临床意义

Objective To detect the concentration of plasma neutrophil gelatinase-associated lipocalin (NGAL) and the clinical significance in critically ill patients. Methods Fifty-four critically ill patients in ICU were enrolled in the present study with 23 health persons as controls. Plasma NGAL concentration was measured by enzyme-linked immunosorbent assay (ELISA) on the 1 st and 7th day from 54 adult patients in ICU and the controls (control group). Results The plasma NGAL concentrations of ICU patients were significantly higher than those of the controls (P ＜0.001 ). NGAL concentrations were no significant difference between the Death group and the Survival group on the 1 st day(P = 0. 259). But there was a markedly significant difference in Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores (P ＜0. 001 ). The APACHE Ⅱ scores on the 7th day significantly decreased in the improved patients (P =0.019) and showed a subtle tendency of increase in the deteriorated patients ( P =0.403) in comparison to the first day. The plasma NGAL levels followed the same trends, but showing a significant increase even in deteriorated patients ( P = 0. 016 and P= 0. 034, respectively). Conclusions The plasma NGAL concentrations of critically ill patients is significantly increased. Combined with APACHE Ⅱ scores,it can provide useful and available data of the disease state of critically ill patients.     

缺氧诱导因子1α和血管内皮细胞生长因子在非霍奇金淋巴瘤中表达的研究

目的 研究缺氧诱导因子1α(H1F-1α)、血管内皮细胞生长因子(VEGF)、微血管密度(MVD)在淋巴瘤患者淋巴结中的表达及其与淋巴瘤的关系.方法 采用免疫组化方法测定28例淋巴瘤患者及(试验组)27例淋巴结炎患者对照组淋巴结组织中的HIF-1α、VEGF、MVD表达.结果 试验组和对照组MVD、VEGF、HIF-1α水平差异有统计学意义[分别为是(57.2±10.7)%比(38.3±11.2)%、(38.5±6.6)%比(21.3±6.3)%、(39.2±4.5)%比(24.5±4.8)%,均P＜0.05].结论 非霍奇金淋巴瘤患者淋巴结中HIF-1α、VEGF、MVD水平均较淋巴结炎患者增高,HIF-1α可能通过调节VEGF的水平从而促进新生血管的形成.

Abstract：

Objective To examine the expression of plasma hypoxia-inducible factor 1 alpha (HIF-1 α),vascular endothelial growth factor (VEGF) and microvessel density (MVD) of patients with NHL. Methods Totally 28 cases in NHL group( group A) and 27 cases in control one( group B) were enrolled. We examined the expression of HIF-1α, VEGF and MVD in tissue samples with immunohistochemical stain of two groups respectively.Results The levels of HIF-1α, VEGF and MVD in the two groups respectively with significant statistical difference. Conclusions The levels of HIF-1 α, VEGF and MVD in patients with NHL is higher than that of in lymphadenitis. It's possible that HIF-1α can promote MVD via adjusting VEGF level.     

失血性休克患者D-二聚体水平的变化及与弥漫性血管内凝血的关系

目的 探讨失血性休克患者D-二聚体水平的变化及与失血性休克后弥漫性血管内凝血(DIC)之间的关系.方法 将58例失血性休克患者分为并发DIC组(12例)和未并发DIC组(46例),另选取20例健康成人为正常对照组.正常对照组采外周静脉血4次,其余组分别于休克后1、3、5、7 d空腹采集外周静脉血,全自动乳胶微粒增强免疫比浊分析方法 测定血浆D-二聚体水平.结果 休克后1、3、5、7 d非DIC组D-二聚体[(1108.42±229.69)、(948.85±216.32)、(836.96±193.82)、(728.92±183.85)μg/L]及DIC组[(1254.49±289.65)、(1477.95±446.79)、(1665.81±652.36)、(1965.21±859.87)μg/L]均明显高于正常对照组[(169.32±45.78)μg/L],差异有统计学意义(均P＜0.01),失血性休克后3、5、7 d非DIC组血浆D-二聚体水平持续降低(P＜0.01),而DIC组D-二聚体水平持续升高(P＜0.01);休克后3、7 d时DIC组D-二聚体水平与正常对照组及非DIC组比较差异均有统计学意义(P＜0.01).结论 休克后急性期D-二聚体的升高程度与休克后DIC的发生密切相关,测定失血性休克患者急性期外周血浆D-二聚体水平变化对预测休克后DIC的发生具有一定价值.

Abstract：

Objective To explore the relation between traumatic disseminated intravascular coagulation (DIC) with the levels of plasma D-Dimer(D-D) in hemorrhagic shock. Methods Totally 58 hemorrhagic shock patients were divided into DIC group( 12 cases) and non-DIC group(46 cases). Twenty healthy people were enrolled as the control group. Venous blood was collected only one time in the control group. But in other groups, venous blood was collected on 1,3, 5 and 7 day after shock. The D-D concentrations were measured by automated latex enhanced immunoassay. Results D-D level in the DIC group and non-DIC group were both higher than those in the control group. Furthermore, D-D level in the DIC group was remarkably higher than that in the non-DIC group. The plasma D-D of the DIC group were remarkably higher than that of the non-DIC group. Plasma D-D levels had significantly positive correlations during all time phases. Conclusions The D-D levels are not only relevant to the severity of shock but also closely to the occurrence of DIC after shock. The detection of plasma D-D levels can predict the occurence of DIC.     

2型糖尿病患者血浆内皮素测定及其意义初探

Objective This study aimed to determine the change of plasma endothelin (ET) in patients with diabetes meUitus .Methods 42 diabetic patients and 50 normal people were included in our study.The diabetic patients were divided into 2 groups, one group with vascular complications, and the other one without. The plasma ET, blood pressure,fasting blood glucose and other intems were measured in these people. Result The plasma ET level was found to be greatly elevated in diabetic patients comparing with the normal people and ET level of diabetic patients with vascular complication was much higher than patients without complications. The plasma ET level had positive correlation with systolic pressure in diabetic patients. Conclusion The result indicated that the high level of plasma ET might play an improtant role in the occurrence and development of vascular complication. The level of plasma ET should be routinely measured in diabetic patients. The patients with high - level plamsa ET should take therapeutic measures to prevent the occurrence of vascular complication.     

高敏C反应蛋白与冠状动脉易损斑块的相关性研究

目的 探讨冠心病患者冠状动脉粥样硬化斑块性质及偏心性,与高敏C反应蛋白(hs-CRP)的相关性,评价hs-CR在预测冠状动脉易损斑块中的临床价值.方法 冠心病患者104例,其中稳定型心绞痛(SA)亚组28例、不稳定型心绞痛(UA)亚组54例、急性心肌梗死(AMI)亚组22例.所有患者均行冠状动脉造影术.对其中单支病变患者行血管内超声(IVUS)检查,以明确其冠状动脉粥样硬化斑块的性质和偏心性.另外选择冠状动脉造影正常者20例为对照组.所有患者同时采用乳胶增强免疫比浊法测定血清中hs-CRP的浓度.结果 ①AMI组、UA组、SA组和NS组血清hs-CRP水平,分别为(7.25±4.26)、(3.12±1.83)、(1.27±0.78)和(0.54±0.22)mg/L,两两比较,差异均有统计学意义(P＜0.01).②软斑块组(42例)纤维斑块组(13例)、钙化斑块组(12例)血清hs-CRP水平分别为(4.25±1.64)、(2.57±1.28)、(1.27±0.53)mg/L,差异有统计学意义(P＜0.01).向心性斑块组(19例)和偏心性斑块组血清hs-CRP水平分别为(2.03±1.76)mg/L与(3.58±2.37)mg/L,差异有统计学意义(P＜0.05).结论 hs-CRP参与了冠心病的发生发展,可作为冠状动脉病变程度及病情变化的预测因子,辅助冠心病的诊疗.血清hs-CRP水平有可能间接反映斑块的性质及其偏心程度,有助于判断斑块的易损性.

Abstract：

Objective To observe the serum level changes of high-sensitivity C-reactive protein in every group patients with Coronary artery disease (CAD), to observe the conrrelation between atherosclerotic plaque and serum levels of hs-CRP and to explore the role of hs-CRP in pathogenesy and therapy. Methods One hundred and four patients ( male 66, female 38 ) with CAD were enrolled in this study. These patients included stable angina (SA) (28), unstable angina (UA) (54) and acute myocardium infarction(22). All patients underwent coronary angiography. Intravascular ultrasound (IVUS) was performed in single-artery lesion patients. In addition, 20 patients with normal CAG served as control. Serum hs-CRP level of all patients was measured by emulsion reinforced immunoturbidimetry (ITM). Results Serum levels of hs-CRP are statistically different in AMI, UA, SA and NS groups (P＜0.01). Serum levels of hs-CRP were statistically higher in soft plaque group than those in fibrous plaque group and calcified plaque group (P＜0.01). In fibrous plaque group, serum levels of hs-CRP were significantly higher than those in calcified plaque group respectively. Conclusions hs-CRP plays an important role in the development of CAD and can be considered as a predict factor in the diagnosis of CAD. Serum levels of hs-CRP is related to some plaque characters such as eccentricity and vulnerability.     

瘦素 内皮素 一氧化氮与糖尿病视网膜病变的关系

目的　探讨瘦素、内皮素 (ET)、一氧化氮 (NO)在糖尿病视网膜病变 (DR)发生、发展中的作用。方法 :采用酶联免疫吸附法分别测定 5 4例糖尿病患者 (DM)和 4 4名健康志愿者 (对照组 )血中瘦素含量 ,对 DM组行直接放射免疫法、硝酸还原酶法分别测定血 ET和 N O的含量 ,比较并分析其相关关系。结果 :1血清瘦素含量患者组 (13± 4 ) μg/ L 较对照组 (6± 4 ) μg/ L 显著升高 (P<0 .0 0 1) ;非增生性视网膜病 (BDR)组 (16± 6 ) μg/ L 较无视网膜病 (NDR)组 (7± 4 ) μg/ L 显著升高 (P<0 .0 5 ) ;增生性视网膜病 (PDR)组 (40± 8) μg/ L 较 BDR组 (16±6 ) μg/ L 显著升高 (P<0 .0 1)。 2随病程的进展患者组血 NO含量显著下降 (P=0 .0 0 13)且血 ET含量显著升高(P<0 .0 0 1)。 3直线相关分析表明 DR患者血清瘦素含量与血浆 ET含量呈正相关 (r=0 .80 4 ,P<0 .0 0 0 1) ,与血清 NO水平呈负相关 (r=- 0 .779,P<0 .0 0 0 1)。结论　 DR患者血清瘦素含量升高可提示 DR病变的严重程度 ,其升高与 ET呈正相关而与 NO呈负相关 ,表明视网膜缺血 ,而且其升高可能诱导 DR患者新生血管生成 ,为DR的早期干预治疗提供了新思路     

卡维地洛对糖尿病心肌病患者左心室功能及血清瘦素水平的影响

目的 探讨卡维地洛对糖尿病心肌病患者血清瘦素水平及左心室功能的影响.方法 选择40例新诊断的糖尿病心肌病伴心功能不全患者,随机分为两组,对照组给予常规治疗,卡维地洛组(治疗组)在常规治疗基础上加用卡维地洛口服.于治疗前及治疗6个月后检测血清瘦素和胰岛素水平,及心脏超声检查.结果 卡维地洛组治疗后的瘦素水平及胰岛素抵抗指数分别为(7.18 ±2.06) μg/L、(2.92±0.62),较治疗前下降(P＜0.05),而对照组治疗前后差异无统计学意义(P＞0.05).治疗后卡维地洛组LVEF、E/A比值[分别为(46.9±6.8)％、(1.05±0.07)]增加,LVMI、LVEDd[分别为(108±6)g/m2、(51.8±5.7)mm]下降,与治疗前比较以及与对照组治疗后比较,差异均有统计学意义(均P ＜0.05).结论 卡维地洛能降低糖尿病心肌病患者血清瘦素水平,改善胰岛素抵抗及左心室功能.     

血清瘦素与慢性乙型肝炎合并酒精性肝病肝纤维化的关系

目的 研究血清瘦素与慢性乙型肝炎合并酒精性肝病(CHB+ALD)肝纤维化的关系.方法 选择CHB+ALD患者17例、肝硬化(LC)15例、慢性乙型肝炎(CHB)19例,以12例男性健康受试者(NC)为对照组.采用ELISA法测定各组血清瘦素水平,同步检测血清肝纤维化指标透明质酸(HA)、层粘连蛋白(IN)、前胶原蛋白(PCⅢ)和Ⅳ型胶原(Ⅳ-C),对结果进行分析.结果 CHB+ALD组血清瘦素水平(6.79±24.12)μg/L高于对照组(4.27±7.18) μg/L(P＜0.05),单纯CHB组差异无统计学意义,CHB+ALD组患者肝纤维化四项指标高于单纯CHB组及NC组;CHB+ALD组血清瘦素水平与血清肝纤维化四项指标呈正相关(P＜0.05或P＜0.01).结论 血清瘦素是CHB+ALD患者肝纤维化形成的促进因子之一.     

女性不孕症的血清瘦素检测及其临床意义

目的对常见女性不孕症的血清瘦素含量进行检测和分析,为临床诊断提供依据。方法采用放射免疫法检测187例不孕女性的血清瘦素含量,以正常生育女性50例做对照。结果卵巢功能障碍组、抗精子抗体阳性组、子宫内膜异位症组、正常生育对照组血清瘦素含量分别为21.14±2.52μg/L、17.39±3.02μg/L、20.77±2.36μg/L、12.05±2.01μg/L。卵巢功能障碍组、抗精子抗体阳性组、子宫内膜异位症组与正常生育对照组血清瘦素含量比较,均有显著性差异(P<0.01)。结论瘦素与卵巢功能障碍、抗精子抗体阳性、子宫内膜异位症等女性不孕症有密切关系。     

重组人生长激素在老年人肺部感染治疗中的应用

目的 探讨重组人生长激素(rhGH)在老年患者肺部感染治疗中的应用价值.方法 53例肺部感染老年患者随机分为观察组(25例)和对照组(28例),观察组应用小剂量rhGH(0.1 U·Kg-1·d-1)于入院后第二天起每晚皮下注射,疗程10 d;对照组给予等量的注射用水;两组其他治疗相同,包括抗感染、氧疗、营养支持等.观察两组疗效、治疗前后体重指数(BMI)、血清生长激素、胰岛素样生长因子-1、白蛋白、瘦素水平等变化情况.结果 观察组总有效率88.0%,对照组为60.7%,两组比较差异有统计学意义(P＜0.05);观察组治疗后体重指数、血清白蛋白、生长激素、胰岛素样生长因子-1、瘦素水平分别为:(26.I±4.1)kg/m2、(38.4±6.6)g/L、(7.0±0.9)μg/L、(27.3±6.1)μg/L、(6.9±1.1)μg/L,与对照组治疗后的(21.8±3.4)kg/m2、(29.5±5.1)g/L、(4.0±0.4)μg/L、(22.0±3.8)μg/L、(3.8±0.8)μg/L相比较,差异均有统计学意义(均P＜0.05).结论 重组人生长激素辅助治疗老年人肺部感染,能改善患者的营养状态,提高治疗效果.     

膀胱癌术后热灌注化疗对胰岛素样生长因子、肿瘤坏死因子含量的影响

目的探讨膀胱癌术后进行热灌注化疗对胰岛素样生长因子（IGF）、肿瘤坏死因子（TNF）的影响。方法回顾性分析64例膀胱移行细胞癌患者,术后进行膀胱热灌注化疗（热化疗组）和灌注化疗（化疗组）各32例;治疗前、治疗后2周、治疗后4周监测IGF、TNF的变化。结果治疗前、治疗后2周、治疗后4周热化疗组IGF分别为（65．97±5．25）μg/L、（49．93±1．98）μg/L、（36．82±1．89）μg/L;化疗组IGF分别为（61．87±5．41）μg／L、（57．86±2．18）μg/L、（48．68±2．26）μg/L。热化疗组TNF分别为（2．32±0．36）μg/L、（3．84±0．31）μg/L、（8．79±0．46）μg/L;化疗组TNF分别为（2．21±0．19）μg/L、（2．89±0．47）μg/L、（3．87±0．61）μg/L。热化疗2周对细胞因子浓度的影响比化疗组明显,并随治疗时间的延长其影响愈加明显,差异均有统计学意义（均P〈0．05）。结论热灌注化疗可更好地调节机体的免疫状态,对抑制膀胱癌的生长和复发具有重要意义。     

肝硬化和十二指肠溃疡患者血浆生长抑素及前列腺素E2的变化和比较

目的观察十二指肠溃疡及肝硬化患者胃肠粘膜保护性激素--血浆生长抑素(SS)和前列腺素E2(RGE2)含量的变化。方法用放免法检测正常人20例，十二指肠溃疡(Du)和肝硬化患者各20例血浆SS和PGF2含量。结果血浆SS正常人为(39.5±9.3)μg/L,Du组为(24.1±4.4)μg/L，肝硬化患者为(20.3±7.6)μg/L。血浆PGE2正常人为(2617±344)μg/L,Du组为(2102±507)μg/L，肝硬化患者为(1308±273)μg/L，Du及肝硬化病人血浆SS和PGE2含量比正常人降低(均P＜0.01)。结论Du和肝硬化患者血浆SS和PGE2含量均减少，后者比前者减少更显著，这可能是Du和肝硬化门脉高压性胃肠病发病的重要因素之一。     

碘普罗胺对行冠状动脉介入术的急性冠状动脉综合征患者肾功能的影响

目的：研究低渗非离子型造影剂碘普罗胺对行冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者肾功能的影响。方法：158例接受PCI术的ACS患者分为2组：肾功能正常组（88例）和肾功能轻度异常组[70例,血清肌酐（SCr）水平120.45～232.05μmol/L]。测定2组患者PCI术前及术后24h、48h、7d的血尿素氮（BUN）、SCr水平。结果：肾功能正常组BUN水平在PCI术前与术后24h、48h、7d分别为（5.45±1.65）mmol/L、（5.60±1.58）mmol/L、（5.55±1.70）mmol/L及（5.48±1.81）mmol/L。PCI术前与术后BUN水平比较差异均无统计学意义（P〉0.05）。肾功能轻度异常组BUN水平在PCI术前与术后24h、48h、7d分别为（7.83±3.14）mmol/L、（8.43±3.37）mmol/L、（8.76±2.97）mmol/L及（8.11±3.18）mmol/L,PCI术前与术后BUN水平比较差异无统计学意义（P〉0.05）。肾功能正常组SCr水平PCI术前与术后24h、48h分别为（82.54±23.57）μmol/L、（85.48±22.47）μmol/L及（86.51±21.72）μmol/L;肾功能轻度异常组SCr水平PCI术前与术后24h、48h分别为（176.25±28.47）μmol/L、（181.71±25.54）μmol/L及（187.34±27.46）μmol/L。2组SCr水平在PCI术前术后比较差异均无统计学意义（P〉0.05）。肾功能均于PCI术后7d恢复至术前水平。结论：低渗非离子型造影剂碘普罗胺对接受PCI术的ACS患者的肾功能无明显影响。     

地塞米松对卵蛋白所致哮喘大鼠下丘脑-垂体-肾上腺皮质轴及骨代谢的影响

目的：观察地塞米松对卵蛋白（Ovalbumin,OVA）所致哮喘大鼠的不同阶段（撤停前、撤停中、撤停后）下丘脑-垂体-肾上腺皮质轴（HPA轴）及骨代谢的影响。方法：90只大鼠随机分为正常对照组、哮喘模型组和地塞米松干预组,每组30只。每组根据处死时间的不同（实验第49、77、91天）随机各分为3个亚组,每组10只。以卵蛋白注射致敏结合卵蛋白雾化激发的方法建立大鼠哮喘模型。实验第35天开始,地塞米松干预组大鼠腹腔注射地塞米松0.5mg/kg,至实验第48天（撤停前阶段）;第49天开始按照每周0.1mg/kg的剂量递减地塞米松用量,至实验第76天（撤停中阶段）;第77天停用地塞米松,观察至实验第90天（撤停后阶段）。哮喘模型组及地塞米松干预组同时每周2次给予1%OVA生理盐水溶液雾化吸入。检测不同阶段各组大鼠脾脏及肾上腺指数、血清皮质酮（CORT）、血浆促肾上腺皮质激素（ACTH）、下丘脑促肾上腺皮质激素释放激素（CRH）及血浆骨钙素（BGP）含量。结果：（1）第49天,正常对照组、哮喘模型组、地塞米松干预组大鼠脾脏指数分别为1.504±0.213、1.548±0.208、1.254±0.239,肾上腺指数分别为0.132±0.039、0.108±0.027、0.065±0.017,CORT含量分别为（2301±628）、（1658±486）和（235±160）ng/L,ACTH含量分别为（62.7±17.4）、（32.7±17.2）和（19.7±8.8）ng/L,CRH含量分别为（5.77±2.01）、（4.20±1.87）和（3.40±1.28）ng/（mg.prot）,BGP含量分别为（5.22±2.14）、（3.64±1.40）和（0.65±0.62）μg/L。哮喘模型组ACTH及CRH含量均明显低于正常对照组（P（0.01,P（0.05）;地塞米松干预组CRH含量明显低于正常对照组,其他各项指标明显低于正常对照组和哮喘模型组（均P〈0.01）。（2）第77天,正常对照组、哮喘模型组、地塞米松干预组大鼠脾脏指数分别为1.515±0.169、1.567±0.180）、1.287±0.380,肾上腺指数分别为0.112±0.058、0.100±0.027、0.069±0.022,CORT含量分别为（2433±379）、（1905±410）和（355±239）ng/L,ACTH含量分别为（65.3±31.0）、（38.4±11.7）和（39.6±14.9）ng/L,CRH含量分别为（5.05±1.62）、（4.15±1.39）和（3.04±1.37）ng/（mg.prot）,BGP含量分别为（2.63±0.96）、（2.50±1.20）和（0.79±0.53）μg/L。哮喘模型组CORT含量明显低于正常对照组（P〈0.01）;地塞米松干预组除ACTH外其他各项指标均明显低于正常对照组和哮喘模型组（P〈0.05或0.01）。（3）第91天,正常对照组、哮喘模型组、地塞米松干预组大鼠脾脏指数分别为1.463±0.190、1.786±0.316、2.278±0.412,肾上腺指数分别为0.112±0.021、0.110±0.020、0.093±0.017,CORT含量分别为（2627±509）、（2318±364）和（2212±400）ng/L,ACTH含量分别为（63.0±33.5）、（48.8±19.9）和（30.7±19.1）ng/L,CRH含量分别为（5.39±1.40）、（3.80±0.94）和（3.67±1.09）ng/（mg.prot）,BGP含量分别为（4.58±2.19）、（3.21±1.34）和（1.93±0.91）μg/L。哮喘模型组脾脏指数明显高于正常对照组（P〈0.01）,CRH含量明显低于正常对照组（P〈0.01）;地塞米松干预组脾脏指数明显高于正常对照组和哮喘模型组（P〈0.01）,肾上腺指数、ACTH、BGP含量明显低于正常对照组和哮喘模型组（P〈0.05,P〈0.01）,CORT和CRH含量明显低于正常对照组（P〈0.05,P〈0.01）。结论：地塞米松干预对哮喘模型大鼠HPA轴具有很强的抑制作用,干预的不同阶段对HPA轴相关指标的抑制作用不同,并均抑制骨代谢。     

血必净注射液对急性呼吸窘迫综合征患者肾上腺皮质功能影响的前瞻性研究

目的研究血必净注射液对急性呼吸窘迫综合征（ARDS）患者肾上腺皮质功能状态的影响。方法采用前瞻性研究方法,将重症监护病房（ICU）收治的急性呼吸窘迫综合征（ARDS）患者随机分为血必净组和对照组,对照组按照常规治疗,血必净组在常规治疗基础上加用血必净注射液100ml,每日两次,治疗7d。分别于纳入研究当日及研究结束时（第8日）静脉注射促肾上腺皮质激素250μg,放免法测定注射前、注射后30min,60min血浆皮质醇水平（TO,T30,T60）,计算T30或T60的最大值与110的差值（ATmax）,以△T．max≤284．4nmol／L作为相对肾上腺皮质功能不全诊断标准。记录治疗前后APACHEII评分,急性肺损伤Murray评分,器官功能障碍Marshall评分,记录ACTH反应性（△Tmax）,肾上腺皮质功能不全发生率,并检测外周血白介素6（IL-6）,白介素10（IL-10）水平变化。结果治疗后血必净组Murray评分[（1．7±0．9）比（1．9±0．6）,P〈0．05）]及器官功能障碍Marshall评分[（2．9±2．7）比（6．3±4．1）,P〈0．01],外周血IL-6[（3．4±1．9）ng／L比（8．9±10．2）ng／L,P〈0．01],IL—10[（1．5±0．8）ng／L比（4．2±4．8）ng／L,P〈0．01]及肾上腺皮质功能不全发生率（46．7％比80．6％）明显低于对照组,△Tmax[（328．4±278．3）μmol／L比（172．8±110．8）μmol／L]高于对照组（P均〈0．01）。结论血必净注射液降低ARDS肾上腺皮质功能不全发生率,改善脏器功能状态。