大豆低聚糖对高脂大鼠脂质过氧化的影响

大豆低聚糖对实验性大鼠高脂血症的防治研究结果证明：能降低血清总胆固醇（ＴＣ）（Ｐ＜０．０５），提高血清高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）（Ｐ＜０．００１），提高ＨＤＬ－Ｃ／ＴＣ比值（Ｐ＜０．００１），降低血清甘油三酯（ＴＧ）水平（Ｐ＜０．００１）；降低心肌组织过氧化脂质（ＬＰＯ）水平（Ｐ＜０．０１），提高心肌组织超氧化物歧化酶（ＳＯＤ）活性（Ｐ＜０．０１），有抑制脑组织过氧化损伤的趋势。结果提示：大豆低聚糖具有降低高脂大鼠血脂水平，拮抗过氧化损伤的作用。     

川芎嗪对冠心病患者脂质过氧化作用及血液流变学的影响

对４２例冠心病患者应用川芎嗪治疗前后的血清脂蛋白代谢、过氧化脂质、抗氧化酶活性及血液流变学进行了对照观察。结果表明：①血清ＴＧ、ＴＣ、（ＬＤＬ＋ＶＬＤＬ）－Ｃ值及ＴＣ／ＨＤＬ－Ｃ比值均明显降低（Ｐ〈０．０１，Ｐ〈０．０５），而ＨＤＬ－Ｃ则显著升高（Ｐ〈０．０５）；②ＭＤＡ水平显著降低（Ｐ〈０．０１），ＳＯＤ及ＧＡＴ活性明显提高（Ｐ〈０．０５，Ｐ〈０．０１）；③血浆粘度、红细胞压积和纤维蛋白原均降低     

冠心病心力衰竭患者血甲状腺激素的变化

目的：探讨甲状腺激素与冠心病心力衰竭的关系。方法：运用放射免疫法测定冠心病非心力衰竭患者（３２ 例）、冠心病心力衰竭患者（５６ 例）及健康者（４０ 例）血浆游离甲状腺素（ Ｆ Ｔ４）、游离三碘甲状腺原氨酸（ Ｆ Ｔ３ ）及促甲状腺素（ Ｔ Ｓ Ｈ）,分别用酶法及透射比浊法测定血浆总胆固醇（ Ｔ Ｃ）、高密度脂蛋白胆固醇（ Ｈ Ｄ Ｌ Ｃ）、低密度脂蛋白胆固醇（ Ｌ Ｄ Ｌ Ｃ）及载脂蛋白 Ａ Ｉ（ａｐｏ ＡⅠ）、载脂蛋白 Ｂ（ａｐｏ Ｂ）。结果：冠心病非心力衰竭组血浆 Ｔ Ｃ、 Ｌ Ｄ Ｌ Ｃ明显高于健康对照组（ Ｐ ＜ ０．０５）, Ｈ Ｄ Ｌ Ｃ 显著低于健康对照组（ Ｐ ＜ ０．０５）;冠心病心力衰竭组血浆 Ｔ Ｃ、 Ｌ Ｄ Ｌ Ｃ 及ａｐｏ Ｂ明显高于健康对照组（ Ｐ ＜ ０．０５～０．０１）;血浆 Ｈ Ｄ Ｌ Ｃ及 ａｐｏ ＡⅠ显著低于健康对照组（ Ｐ ＜ ０．０５）;血浆 Ｆ Ｔ３低于健康对照组及冠心病非心力衰竭组（ Ｐ ＜ ０．０５～０．０１）。冠心病患者及健康人各血脂成份与 Ｆ Ｔ３、 Ｆ Ｔ４ 及 Ｔ Ｓ Ｈ 均无明显相关性（ Ｐ ＞ ０．０５）。结论：冠心病心力衰竭患者体内 Ｆ Ｔ３ 降低, Ｔ３ 可能安全有效地用于治疗此类患者值得进一步研究。     

新疆阜康地区哈汉两民族血脂含量及有关影响因素的研究

为了研究不同民族间血脂水平的差异及其影响因素，我们抽样调查新疆阜康地区哈、汉两民族７５０名男女血脂水平及有关影响因素。结果显示：哈族血清总胆固醇（ＴＣ）、高密度脂蛋白固醇（ＨＤＬ－Ｃ）及低蜜度脂蛋白胆固醇（ＬＤＬ－Ｃ）水平显著高于汉族（Ｐ＜０．００１），而甘油三酯（ＴＧ）水平及动脉粥样硬化指数（ＡＩ）显著低于汉族（Ｐ＜０．０５）。哈、汉两民族ＨＤＬ－Ｃ随年龄变化趋势存在显著差异。吸烟与ＨＤＬ－Ｃ呈负相关，与ＴＧ呈正相关；肥胖对两性的ＨＤＬ、ＬＤＬ均有影响，女性尤其显著；多因素分析显示舒张压与ＴＣ、ＬＤＬ－Ｃ相关。结论：哈、汉两民族间血脂水平存在显著差异，且年龄、吸烟、体重指数、舒张压等均对血脂代谢产生影响。     

妇女血脂水平与性激素变化的关系

目的探讨妇女血脂水平与性激素变化的关系,了解性激素在冠心病发病机制中的作用。方法绝经前、围绝经期、绝经后妇女共６０８例,分别测定雌二醇（Ｅ２）、孕酮（Ｐ）、促卵泡生成素（ＦＳＨ）、黄体生成素（ＬＨ）、血清胆固醇（ＴＣ）、甘油三酯（ＴＧ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）及低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）水平。结果绝经后妇女Ｅ２水平较绝经前期及围绝经期妇女明显下降（Ｐ＜０．０１）,后两者无明显差异（Ｐ＞０．０５）,绝经后与围绝经期妇女的ＦＳＨ及ＬＨ均较绝经前期妇女明显升高（Ｐ＜０．０１）,绝经后期较围绝经期组升高更明显,两者相比有显著差异（Ｐ＜０．０１）。绝经前期与围绝经期妇女的血脂水平无显著差异（Ｐ＞０．０５）,绝经后期与绝经前期相比,ＴＣ、ＴＧ、ＬＤＬ－Ｃ水平升高,ＨＤＬ－Ｃ水平下降（Ｐ＜０．０５）。绝经后妇女Ｅ２与ＴＣ、ＬＤＬ－Ｃ水平呈负相关,与ＨＤＬ－Ｃ水平呈正相关。结论妇女血脂异常改变与体内性激素水平下降有关。     

甲状腺功能亢进患者血清脂质变化的临床研究（附26例临床分析）

对甲状腺功能亢进（甲亢）患者２６例，健康对照组２１例，分别测定空腹１２小时以上血清游离三碘甲状腺原氨酸（ＦＴ３）、游离甲状腺素（ＦＴ４）、胆固醇总量（ＴＣ）、甘油三酯（ＴＧ）及高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）。结果（ｘ±ｓ），甲亢患者血清ＦＴ３为（３３．９２±１５．２６）ｐｍｏｌ／Ｌ，ＦＴ４为（４９．２３±１１．４９）ｐｍｏｌ／Ｌ，ＴＣ为（２．８９±０．２３）ｍｍｏｌ／Ｌ，ＴＧ为（０．９９±０．３８）ｍｍｏｌ／Ｌ，ＨＤＬ－Ｃ为（０．９１±０．２６）ｍｍｏｌ／Ｌ。甲亢组ＴＣ、ＴＧ明显低于健康对照组（Ｐ＜０．０１～０．０５）。随着ＦＴ３、ＦＴ４水平的升高，ＴＧ反而降低，且呈显著的负相关（ｒ＝－０．４０，Ｐ＜０．０１；ｒ＝０．５１３，Ｐ＜０．０５）。甲状腺功能亢进时，甲状腺激素（ＴＨ）影响血清脂质的变化，且ＴＨ与血脂呈负相关。     

辛工他汀和非诺贝特对混合型高血脂症的疗效比较

目的：研究辛作他汀对半有血清甘油三酯升高的高胆固醇血症患的调脂作用。方法：３８例混合型高血脂患被随机分为辛伐他汀（１０ｍｇ,１次／日）组,非诺贝特（１００ｍｇ,３次／日）组。结果：①服药后４周,辛伐他汀和非诺贝特均能降低ＴＣ,（Ｐ〈０．０１,〈０．０５）;②辛伐他汀降低血清ＬＤＬ－Ｃ的作用强于非诺贝特（Ｐ〈０．０２）;③辛伐他汀明显降低ＴＧ（Ｐ〈０．０１）,增加Ａｐｏ－Ａ１（Ｐ〈０．０５）。结     

载脂蛋白E基因多态性与冠心病关系的研究

目的：探讨载脂蛋白Ｅ（ａｐｏＥ）基因多态性在冠心病（ＣＨＤ）发生发展中的作用及其对血脂质、脂蛋白水平的影响。方法：应用聚合酶链反应技术和遗传学方法,测定９３ 例ＣＨＤ患者和９４例正常对照者的ａｐｏＥ基因型;按常规方法测定血浆脂质、脂蛋白水平。结果：共发现５ 种ａｐｏＥ基因型,分别为Ｅ３／３、Ｅ３／２、Ｅ４／３、Ｅ４／２和Ｅ４／４。ＣＨＤ组ａｐｏＥ４／３ 基因型和ε４ 等位基因频率及总胆固醇（ＴＣ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）均显著高于对照组（均Ｐ＜ ０．０１）,ａｐｏＡＩ的水平高于对照组（Ｐ＜ ０．０５）,其他血脂指标无显著性差异（ Ｐ＞ ０．０５）。在ＣＨＤ组各亚型之间,ＴＣ、ＬＤＬ－Ｃ和ａｐｏＡＩ水平之间存在显著性差异（Ｐ＜ ０．０５）。结论：ａｐｏＥε４ 等位基因是ＣＨＤ重要的遗传易患因素,ａｐｏＥ基因多态性亦影响血ＴＣ、ＬＤＬ－Ｃ和ａｐｏＡＩ水平。     

尼尔雌醇替代治疗对绝经后妇女 脂及血流变的影响

目的观察尼尔雌醇替代治疗对绝经后妇女血脂及血液流变学的影响。方法对３６例绝经后妇女用尼尔雌醇进行替代治疗,剂量为每半月２ｍｇ,共６月,最后７ｄ加用安宫黄体酮８于用药前和治疗６月后分别测血脂及血液流变学指标。结果尼尔雌醇替代治疗６月后血总胆固醇（ＴＣ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）、ＴＣ／高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）、ＬＤＬ－Ｃ／ＨＤＬ－Ｃ均明显下降（Ｐ〈０．０１）,ＨＤＬ－Ｃ明显升高（Ｐ〉     

血脂康和辛伐他汀对高胆固醇血症调脂作用的比较

目的研究血脂康对高胆固醇血症患者的调脂作用并与辛伐他汀比较。方法２８例高胆固醇血症患者随机分为两组，服药前及服药后４、８周测定血脂。结果（１）服药后４周ＴＣ分别降低了２０７％和２２５％（Ｐ值均＜０００１）；血脂康降低血清低密度脂蛋白胆固醇（ＬＤＬＣ）作用与辛伐他汀相似，ＬＤＬＣ水平分别降低了２８２％和３３％（Ｐ值均＜００１）；（２）血脂康明显降低１７４％的血清ＴＧ水平（Ｐ＜００５）；（３）服血脂康和辛伐他汀４周后，载脂蛋白（Ａｐｏ）Ａ１却分别增加了１２７％和１３６％（Ｐ值均＜００１）；ＡｐｏＢ水平均下降了８％左右（Ｐ＜００５）；分别使脂蛋白（ａ）［Ｌｐ（ａ）］水平降低了３１３％（Ｐ＜００１）和２７８％（Ｐ＜００５）；（４）除了治疗８周后Ｌｐ（ａ）水平进一步下降外，两种药物治疗８周后的调脂作用与４周比较无明显差异。结论血脂康能显著降低Ⅱａ和Ⅱｂ型高胆固醇血症患者血清ＴＣ和ＬＤＬＣ，其作用与辛伐他汀相等；血脂康降低ＴＧ作用优于辛伐他汀     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。