乙型肝炎患者血脂、血清前白蛋白和总胆汁酸变化的意义

目的探讨乙型肝炎患者血脂、血清前白蛋白和总胆汁酸的变化规律,了解其与病情及预后的关系。方法在230例乙型肝炎患者[其中急性肝炎43例,慢性肝炎91例(轻度25例,中度32例,重度34例),重型肝炎33例,肝炎肝硬化63例]和50例正常人,测定血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、血清前白蛋白(PA)、白蛋白(ALB)、总胆汁酸(TBA)水平。结果各组总胆汁酸水平较正常对照组升高,差别有显著性意义(P<0·05);慢性肝炎组、肝硬化组、重型肝炎组患者血清甘油三脂、总胆固醇、HDL-C、血清前白蛋白、白蛋白水平均较正常对照组降低,差别有显著性意义(P<0.05);各项血脂水平随着肝功能损害的加重而降低(慢性肝炎重度组和中度组显著低于轻度组,重型肝炎组显著低于慢性肝炎组和肝硬化组)。结论检测乙型肝炎患者血脂、血清前白蛋白和总胆汁酸水平,对了解肝功能状态和估计预后均有一定的意义。     

慢性乙肝患者血清血脂及载脂蛋白水平检测的临床意义

目的 检测慢性乙肝患者血清总胆固醇(TC)、甘油三酯(TG)、载脂蛋白A(apoA)、载脂蛋白B(apoB)水平变化,并探讨其临床意义.方法 采用全自动生化分析仪检测患者血清TC、TG、apoA和apoB,同时检测凝血酶原时间(PT),并与正常对照组比较分析.结果 TC、apoB在乙肝轻度组、中度组有所上升(P＜0.05),但在重度组和乙肝肝硬化组则明显下降(P＜0.01).TG在轻度组、中度组、重度组有所上升(P＜0.05),在乙肝肝硬化组却明显下降(P＜0.01).慢性乙肝各组血清apoA与正常对照组相比较均有不同程度的下降(P＜0.05),以乙肝肝硬化组下降最为明显(P＜0.01).乙肝肝硬化组血清apoA与PT呈明显负相关(r=-0.99,P＜0.01).结论 血清血脂及载脂蛋白的水平可反映肝细胞功能状态,可作为提示慢性乙肝病情严重程度的指标.     

hsCRP、apoB/apoA1、血脂表达与早发冠心病急性冠脉综合征的关系

目的观察hsCRP、apoB/apoA1、血脂表达与早发冠心病急性冠脉综合征的关系。方法采用随机平行对照方法纳入2014年2月至2018年2月于清远市人民医院收治的110例早发冠心病急性冠脉综合征患者为观察组,另选取因胸痛同期住院经冠状动脉造影证实冠脉病变为阴性的118例非冠心病患者为对照组。统计两组患者一般资料,抽取空腹肘静脉血,采用全自动生化分析仪检测血脂载脂蛋白A1(apoA1)、载脂蛋白B(apoB)、超敏C反应蛋白(hsCRP)及血糖(GLU)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、非高密度脂蛋白胆固醇(non-HDL-C)、尿酸(UA)、血肌酐(Scr)水平。采用多因素Logistic回归分析法分析早发冠心病急性冠脉综合征的独立影响因素,分析hsCRP、apoB/apoA1、血脂表达与早发冠心病急性冠脉综合征的关系。结果两组年龄、体质指数(BMI)、UA及糖尿病病史所占比例比较差异无统计学意义(P0.05);观察组男性、吸烟史、饮酒史、冠心病家族史、高血压病史所占比例显著高于对照组(P0.05),且Scr、GLU水平显著高于对照组(P0.05)。两组LDL-C、apoB水平比较差异无统计学意义(P0.05);观察组血清hsCRP、TC、TG、non-HDL-C、apoB/apoA1水平显著高于对照组(P0.05),apoA1、HDL-C水平显著低于对照组(P0.05)。多因素Logistic回归分析结果显示,除男性、吸烟史、冠心病家族史外,hsCRP、TG、HDL-C、non-HDL-C、apoA1、apoB/apoA1均为早发冠心病急性冠脉综合征的独立影响因素(P0.05)。结论 hsCRP、TG、non-HDL-C、apoB/apoA1在早发冠心病急性冠脉综合征患者外周血中水平明显升高,apoA1、HDL-C在其外周血中明显降低,上述因子可作为该病预测指标。     

糖尿病患者急性心肌梗死后早期血脂变化

目的分析糖尿病患者急性心肌梗死（AMI）后早期血脂水平变化。方法连续入选318例AMI住院患者,检测入院后24h内血脂水平。根据患者是否合并2型糖尿病分为AMI非糖尿病组（n=238）及AMI糖尿病组（n=80）,比较两组患者血脂水平差异。结果两组患者AMI早期,除载脂蛋白A（apoA）外,总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白B（apoB）水平均无统计学差异（P均〉0.05）。结论糖尿病患者急性心肌梗死后早期,除apoA外,血脂水平与非糖尿病患者无显著差异。     

红细胞分布宽度对冠心病再狭窄的预测作用及其与脂质的关系

目的 探讨红细胞分布宽度对冠心病再狭窄的预测作用及其与脂质的关系。方法 回顾性分析2018年1月至2020年1月因冠心病在我院接受经皮冠状动脉介入治疗（PCI）术以及于术后12个月复查的94例患者的临床资料,根据结果分为支架内再狭窄（ISR）组（27例）和非ISR组（67例）。检测患者红细胞分布宽度（RDW）和脂质各指标水平,分析各指标与冠心病的关系。结果 非ISR组的RDW值小于ISR组（P<0.05）。ISR组甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、非高密度脂蛋白胆固醇（non-HDL-C）、载脂蛋白A1(apoAl)和载脂蛋白B(apoB)/apoA1比值均高于非ISR组（P<0.05）。Logistic回归分析结果显示RDW、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、apoA1和apoB为冠心病患者术后ISR的危险因素（P<0.05）。apoA1、RDW和HDL-C的灵敏度均较高,non-HDL-C、apoB以及apoA1/apoB的特异度均较高。结论 冠心病患者PCI术后,不仅要重视控制LDL-C水平,还要重视根据RDW、non-HDL...     

血脂指标对冠心病危险性预测的性别差异

目的:通过对血脂指标与冠心病发病之间关系的探讨,阐明各种血脂指标对冠心病危险性的预测价值是否存在性别差异。方法:对1997年9月2004年6月在我科行选择性冠状动脉造影术（SCA）的患者资料进行回顾性分析。根据造影结果各分为两组:冠心病（CAD+）组和对照（CAD-）组。造影前1 d空腹抽取静脉血,测定血脂水平。结果:共分析6806例患者,其中男性4881例,女性1925例。根据造影结果分组,女性CAD-组有811例,CAD+组有1114例。男性CAD-组有1255例,CAD+组有3626例。女性两组间的总胆固醇（TC）、甘油三酯（TG）、载脂蛋白B（apoB）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）及非高密度脂蛋白胆固醇（non-HDL-C）相差非常显著（均P<0.01）,而载脂蛋白A（apoA）及TC/HDL-C无显著差异（均P>0.05）;男性两组间的TC（P<0.01）、HDL-C（P<0.01）、LDL-C（P=0.05）及nonHDL-C（P<0.01）相差显著,而TG、apoA、apoB及TC/HDL-C无显著差异（均P>0.05）。应用Logistic回归模型对年龄及各项血脂指标进行多因素分析。女性患者只有apoB进入方程,男性患者中只有TC进入方程。结论:预示冠心病发病的最有价值的血脂指标在男性及女性分别是血清TC和apoB。     

LDL-C/HDL-C、apoB/apoA1比值与冠心病的相关分析

目的探讨低密度脂蛋白胆固醇(LDL-C)/高密度脂蛋白胆固醇(HDL-C)、载脂蛋白B(apoB)/载脂蛋白A1(apoA1)比值与冠心病的相关性。方法分析147例经冠脉造影确诊的冠心病病人(冠心病组)及102例冠脉造影阴性者(对照组)的常规血脂及冠脉造影结果,计算LDL-C/HDL-C、apoB/apoA1比值及冠脉Gensini积分。结果冠心病组LDL-C/HDL-C、apoB/apoA1比值显著高于对照组(P0.01),冠心病组血脂比值的异常率均明显高于单项血脂的异常率。LDL-C/HDL-C、apoB/apoA1比值与冠脉狭窄程度呈正相关(P0.01)。结论 LDL-C/HDL-C、apoB/apoA1比值对冠心病的早期预防和诊断有较大的临床价值,优于各单项血脂指标。     

帕金森病及帕金森综合征病人血脂水平的临床分析

目的探讨帕金森病(Parkinson’s disease,PD)及帕金森综合征(PDS)病人血脂水平情况。方法回顾性分析纳入的82例PD、62例PDS病人及80例对照组的血脂水平,研究指标包括血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(apoA1)、载脂蛋白B(apoB)及脂蛋白(a)[LP(a)]。结果PD组及PDS组的ApoA1、ApoB、LDL-C、TG水平均低于对照组,差异有统计学意义,3组间HDL-C、TC、LP(a)无统计学意义。结论低水平的ApoA1、ApoB、LDL-C、TG可能是PD及PDS的危险因素。     

载脂蛋白比值、BMI与冠状动脉狭窄程度关系分析

目的探讨血浆载脂蛋白比值(apoAl/apoB)、BMI与冠状动狭窄程度的关系。方法将拟接受冠脉造影术检查的1079例患者作为研究对象,冠脉造影结果按Gensini积分评价,根据冠脉造影术结果将所有研究对象分成冠心病组(940例,积分0分)和对照组(139例,积分为0分);再根据Gensini积分将冠心病组分成三个亚组:轻度病变组(342例,1分≤积分30分),中度病变组(345例,30分≤积分60分),重度病变组(253例,积分≥60分)。测量患者身高、体重,检测血脂水平,计算体重指数(BMI)、apoAl/apoB值。结果冠心病组患者年龄高于对照组(P0.05),高血压病、糖尿病、吸烟、冠心病家族史比例均高于对照组(P0.05);BMI、TC、TG、LDL、apoB、Lp(a)、HCY水平均高于对照组(P0.05),HDL、apoAl、apoAl/apoB均低于对照组(P0.05)。冠心病患者Gensini积分与年龄、高血压病史、糖尿病史、吸烟史、冠心病家族史、BMI、TC、TG、LDL、apoB、LP(a)、HCY呈正相关(P0.05),与HDL、apoAl、apoAl/apoB呈负相关(P0.05)。高血压病史、糖尿病史、冠心病家族史、高BMI、高LDL、高apoB、高Lp(a)是冠心病的独立危险因素,apoAl、apoAl/apoB是冠心病的保护因素。结论低apoAl/apoB值或高BMI是冠心病的危险因素,能在一定程度上反映冠状动脉狭窄的严重程度,预测冠心病的风险。     

apoB/apoA1与冠状动脉病变的相关性分析

目的探讨载脂蛋白B(apoB)、载脂蛋白A1(apoA1)、apoB/apoA1与冠状动脉狭窄程度的相关性。方法共收集304例行冠脉造影术的病人,其冠脉病变的严重程度用冠脉病变支数及Gensini积分表示,分析其血脂水平及载脂蛋白与冠脉病变的关系。结果冠脉病变组中总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)与冠脉病变Gensini积分呈正相关,高密度脂蛋白胆固醇(HDL-C)、apoA1与冠脉病变Gensini积分呈负相关。TC、LDL-C与冠脉病变支数呈正相关,apoA1与冠脉病变支数呈负相关。结论冠心病病人的血清载脂蛋白与其冠脉病变程度密切相关,以apoA1对冠脉病变的预测性最强。     

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.     

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.     

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.     

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。     

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。     

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     

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.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.