慢型克山病患者血栓素与前列腺环素变化观察

目的 观察慢型克山病患者血栓素B2（TXB2）、6-酮-前列腺环素F1α（6-Keto—PGF1α）水平变化，探讨其在克山病心力衰竭发生发展中的作用。方法 选择慢型克山病患者37例，根据心脏功能分为慢Ⅱ组和慢Ⅲ、Ⅳ组，并以34例健康人作为对照。取空腹静脉血，用消炎痛-EDTA·Na2防凝，采用放射免疫法测定血浆TXB2、6-Keto—PGF1α水平，并观察血浆硒（Se）水平和血压变化。结果 ①克山病组收缩压和舒张压均低于对照组（P〈0．01），慢Ⅲ、Ⅳ组低于慢Ⅱ组（P〈0．01），心力衰竭越重血压降低越明显；②克山病组Se水平低于对照组（P〈0.01），慢Ⅲ、Ⅳ组低于慢Ⅱ组（P〈0．01）；③克山病组TXB2水平明显低于对照组（P〈0．01），慢Ⅲ、Ⅳ组低于慢Ⅱ组（P〈0．01）；④慢Ⅲ、Ⅳ组6-Keto—PGF1α水平低于对照组（P〈0．01），慢Ⅱ组与对照组比较差异无统计学意义（P〉0．05）。结论 慢型克山病患者血压、TXB2和6-Keto—PGF1α水平变化与心功能相关联。     

克山病患者肝炎及柯萨奇病毒感染的观察

目的 通过测定慢型、潜在型克山病患者血清中肝炎及柯萨奇病毒抗体的水平，探讨克山病病毒感染学说。方法 选择黑龙江省富裕县克山病病区慢型、潜在型克山病患者34例，健康人32例。病毒抗体的测定采用ELISA方法，统计学使用病例对照研究的方法。结果 C型肝炎抗体(HCV—IgM)阳性的OR是9．54(95％信赖区间1．07～∞)，有统计学意义。结论 从C型肝炎病毒抗体(HCV—IgM)的阳性率在克山病患者中明显增高的这一结果推测，C型肝炎病毒的感染可能在克山病的发生、发展中起一定的作用。     

慢型克山病血管内皮功能与抗氧化功能变化观察

目的 观察慢型克山病患者血管内皮功能与抗氧化功能变化，探讨在克山病发生发展中的作用。方法 选择慢型克山病39例，并以病区30例健康人作对照，取空腹静脉血，测定血浆内皮素（ET）、血清一氧化氮（NO）含量、一氧化氮合成酶（NOS、iNOS和cNOS）活性，超氧化物岐化酶（RBC SOD）及红细胞谷胱甘肽过氧化物酶（RBC GSH—Px）活性及脂质过氧化物（LPO）含量。结果 克山病患者ET及NO含量明显高于对照组（P〈0．01），心衰越重升高越明显（P〈0．01）。NOS、iNOS和cNOS活性明显高于对照组（P〈0．001），NOS和iNOS活性与ET及NO相一致（P〈0．05）。克山病患者RBC GSH—Px及RBCSOD活性比对照组明显降低（P〈0．01），慢Ⅱ组低于慢Ⅲ、Ⅳ组（P〈0．01）；LPO含量比对照组明显升高（P〈0．01），GSH—Px／LPO及SOD／LPO比值变小（P〈0．01）。结论 克山病血管内皮功能与抗氧化功能降低．这种改变在克山病心肌损伤发生发展中具有重要意义。     

潜在型及慢型克山病患者血清一氧化氮水平检测分析

目的：探讨一氧化氮（Nitric Oxidce,NO)和克山病病变间的关系。方法：检测了陕西省黄陵县30例潜在型，慢型克山病患者血清硒含量和NO水平，健康对照分别选自黄陵县克山病病区和西安市非病区。结果：（1）克山病患者组与病区健康对照组血清硒水平显著低于非病区健康对照组（P＜0．05）；克山病患者组与病区健康对照组血清硒水平相比差异无显著意义（P＞0．05）。（2）克山病患者血清NO水平显著高于病区健康对照组（P＜0．05），但克山病患者组与非病区健康对照组之间相比差异无显著意义（P＞0．05）。（3）心功能不全Ⅰ级到Ⅲ级的克山病患者血清NO水平随心衰程度的加重而升高，当心功能不全达Ⅳ级时，血清NO水平下降，结论：NO在克山病患病心肌损伤和心力衰竭的发生和发展中起一定作用。     

潜慢型克山病患者柯萨奇B组病毒特异性IgM的检测

目的研究柯萨奇Ｂ组病毒（ＣｏｘｓａｃｋｉｅｖｉｒｕｓＢ,ＣＶＢ）感染与克山病发病的关系。方法采用间接酶联免疫吸附法（ＥＬＩＳＡ）对陕西省黄陵县克山病病区潜、慢型克山病患者血清ＣＶＢ１－６ＩｇＭ和ＣＶＢ１－６ＩｇＧ进行检测。结果①潜在型、慢型克山病组血清ＣＶＢ１－６ＩｇＭ抗体阳性率明显高于非病区健康对照组（２８．５７％ｖｓ７．５％,Ｐ＜０．０５）,但明显低于心肌炎组（６０．００％,Ｐ＜０．０５）。②潜、慢型克山病组血清ＣＶＢ１－６ＩｇＧ抗体阳性率明显高于非病区健康对照组（３８．１０％ｖｓ７．５％,Ｐ＜０．０５）,但与心肌炎组比较无明显差异。结论病区潜、慢型克山病患者有ＣＶＢ感染存在     

克山病患者血清前胶原末端肽水平及其临床意义

目的观察克山病患者血清前胶原末端肽水平的变化,探讨心肌纤维化在不同类型克山病病程中的临床意义。方法采用放射免疫分析法测定35例慢型克山病、33例潜在型克山病及31例健康对照者血清Ⅰ型前胶原氨基端肽(PⅠNP)、Ⅲ型前胶原氨基端肽(PⅢNP)水平,用超声心动图测量左室收缩与舒张功能参数。结果克山病患者血清PⅠNP和PⅢNP水平均显著高于正常对照(t值分别为5.60、6.04,P均<0.001);PⅠNP/PⅢNP比值亦高于正常(t=2.33,P<0.05)。慢型克山病患者血清PⅠNP水平明显高于潜在型克山病患者和正常对照(q值分别为8.25、11.60,P均<0.01);PⅢNP水平则高于正常对照(q=6.34,P<0.01)而低于潜在型克山病患者(q=2.72,P>0.05);PⅠNP/PⅢNP比值亦明显高于潜在型患者和正常对照(q值分别为9.22、7.81,P均<0.01)。在慢型克山病患者,心功能越差,血清PⅠNP水平及PⅠNP/PⅢNP比值越高,PⅠNP/PⅢNP比值、PⅠNP与二尖瓣血流舒张早期流速/心房收缩期流速(VE/VA)、左室射血分数(LVEF)呈负相关(r值分别为-0.4502、-0.4608,P<0.01和-0.3936、-0.3904,P<0.05)。结论克山病患者心肌组织胶原合成增加;潜在型克山病Ⅰ、Ⅲ型胶原均明显增加;慢型克山病主要为Ⅰ型胶原合成增加;血清PⅠNP水平及PⅠNP/PⅢNP比值与左心功能改变有关;血清PⅠNP、PⅢNP可作为心肌纤维化的血清学指标,在临床上为判断克山病的心肌纤维化和心功能现状提供间接依据。     

黄芪总黄酮对柯萨奇B3病毒感染心肌细胞钠电流的作用

目的探讨黄芪总黄酮（TFA）对嗜心性柯萨奇B3病毒（CVB3m）感染心肌细胞钠电流的作用。方法采用体外培养小鼠新生心肌细胞方法,建立柯萨奇B3病毒感染心肌细胞模型,采用全细胞膜片钳记录技术记录心室肌细胞钠电流（INa）。结果应用黄芪总黄酮（TFA）组与柯萨奇B3病毒感染模型组相比较,INa峰值从（-7．79±1．53）nA下降到（-5．64±1．67）nA,差异有统计学意义（P〈0．01,n=6）。结论黄芪总黄酮可显著降低柯萨奇B3病毒感染心肌细胞钠电流的幅值。     

231例冠心病患者病毒感染临床分析

用酶联免疫吸附试验法检测冠心病（CAD）患者和健康人巨细胞病毒（HCMV）、流感病毒（IV）、呼吸道合胞病毒（RSV）、单纯疱疹病毒（HSV）、柯萨奇病毒（CoxV）的血清抗-IgM抗体。结果CAD患者的HCMV—IgM及IV—IgM阳性率明显高于健康者（P〈0．01）。CAD患者中,急性心肌梗死患者的HCMV—IgM阳性率显著高于心绞痛、隐匿性CAD患者（P〈0．05）。88．4％的HCMV—IgM阳性患者合并两种以上病毒感染。提示CAD患者HCMV—IgM及IV—IgM检出率较高;急性CAD患者的。HCMV-IgM检出率显著高于慢性者;CAD患者的病毒感染绝大多数是混合感染。且以HCMV感染为主。     

血清sICAM-1／sVCAM-1水平与上皮性卵巢癌关系的研究

目的探讨血清可溶性细胞间黏附分子-1／血管细胞黏附分子-1（sICAM-1／sVCAM—1）在上皮性卵巢癌中的临床意义。方法利用ELISA法检测健康妇女血清sICAM-1／sVCAM-1浓度并确定其血清正常值范围。同时测定良性卵巢肿瘤和上皮性卵巢癌患者血清sICAM-1／sVCAM-1浓度并分析其与上皮性卵巢癌患者临床病理资料的关系。结果血清sICAM-1和sVCAM-1平均浓度和阳性率卵巢上皮癌组显著高于良性卵巢瘤组和正常对照组（P〈0．05）；临床Ⅱ～Ⅳ期显著高于临床1期卵巢癌患者（P〈0．05）；淋巴结转移阳性者显著高于淋巴结转移阴性者（P〈0．01）；组织分化程度Ⅲ级显著高于Ⅰ、Ⅱ级（P〈0．01）；卵巢癌组术后显著低于术前（P〈0．005）。而sICAM-1和sVCAM—1浓度和阳性率与卵巢癌病理组织学类型无关。单因索生存分析sICAM11和sVCAM11水平与患者不良预后有关；多因素生存分析sICAM-1和sVCAM—1水平与预后无关。结论sICAM—1／sVCAM—1检测可能有助于监测和判断上皮性卵巢癌患者的病情。     

多囊卵巢综合征患者血清sICAM-1水平变化及意义

目的探讨多囊卵巢综合征（PCOS）患者血清可溶性细胞间黏附分子-1（sICAM-1）水平与脂代谢相关性。方法将96例PCOS患者以体重指数（BMI）≥124kg／m^2为肥胖标准,分为肥胖A组（FA组）和非肥胖A组（NA组）;以腰臀比（WHR）≥0．8为肥胖标准,分为肥胖B组（FB组）和非肥胖B组（NB组）。分别测定血清sICAM-1、TG、TC、HDL-C、LDL-C、Apo A1、Apo B、Lp—a水平。采用多元线性回归Enter法分析sICAM-1与脂代谢的相关性。结果FA、FB组血清sICAM-1均水平高于NA、NB组（P均〈0．05）,FA组TG明显高于NA组（P〈0．05）,FB组TC、LDL—C明显高于NB组（P〈0．05）;血清sICAM-1水平与TC、LDL-C水平呈正相关（r=0．945,P〈0．05）。结论PCOS患者血清sICAM-1水平及脂代谢异常与肥胖有密切联系,PCOS患者sICAM-1水平随着LDL—C、TC水平增高而升高;积极治疗和监测PCOS肥胖患者,可以防止和减少其心血管疾病的发生。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.