急性心肌梗死患者血浆肾上腺髓质素与内皮素的测定及其临床意义

应用放射免疫法测定40例急性心肌梗死（AMI）和30例正常对照者的血浆肾上腺髓质素（ADM）和内皮素（ET－1）水平；同时，用彩色超声心动图测定40例AMI患者的左室射血分数。结果：AMI组血浆ADM水平显著高于正常对照（P＜0．05）；AMI患者按心功能分组，各组间血浆ADM差异有显著性（P＜0．05）。AMI组血浆ADM水平与ET－1呈显著正相关（γ=0.5743,P＜0．01），左室射血分数呈显著负相关（γ＝－0．6152，P＜0．01）。认为ADM参与了AMI及心力衰竭的病理生理过程，血浆ADM升高可能与ET－1升高有关。     

梅毒患者细胞免疫的研究

目的：探讨T淋巴细胞亚群、可溶性白介素2受体和肿瘤坏死因子α在梅毒发病机制中的作用。方法：应用流式细胞仪和双抗体夹心ELISA法对86例梅毒患者Ｔ淋巴细胞亚群（CD3^ 、CD4^ 、CD8^ ）、可溶性白介素2受体（sIL-2R)及肿瘤坏死因子α（TNF－α）水平进行检测，并对其相关性进行分析。结果：梅毒患者CD4^ 及CD4^ ／CD8^ 比值明显低于正常人对照组（P＜0．01），CD8^ 显著高于正常人对照组（P＜0．05），而CD3^ 与正常人对照组无显著性差异（P＞0．05）；活动期梅毒CD4^ /CD8^ 比值低于恢复期（P＜0．05）。活动期梅毒及非活动期梅毒患者血清sIL-2R水平均明显增高（P＜0．01），且活动期高于非活动期（P＜0．01）。活动期梅毒患者血清TNF－α水平高于非活动期及正常对照组（P＜0．01），且活动期高于非活动期（P＜0．01）。活动期梅毒患者CD4^ 、CD8^ 与sIL-2R和TNF－α水平呈正、负相关。结论：本研究提示梅毒患者存在细胞免疫功能抑制现象，且T淋巴细胞功能的紊乱和TNF－α及sIL-2R水平的改变与梅毒的发病有密切关系。     

血浆内皮素和降钙素基因相关肽与慢性萎缩性胃炎相关性研究

目的 探讨血浆内皮素（ET），降钙素基因相关肽（CGRP）含量与慢性萎缩性胃炎（CAG）的关系。方法 选取CAG患者118例为CAG组，慢性浅表性胃炎（CSG）30例为CSG组，健康体检者30例为对照组，用放免法检测空腹静脉血ET，CGRP含量。结果 （1）CAG组血浆ET水平明显高于CSG组和对照组（P＜0．01），CGRP水平明显低于CSG组和对照组（P＜0．01）；CSG组血浆ET水平高于对照组，CGRP水平低于对照组，但与对照组比较差异无统计学意义（P＞0．05）。（2）轻，中，重度CAG患者之间血浆ET含量差异有统计学意义（P＜0．05）。血浆CGRP含量除中，重度CAG间差异无统计学意义（P＞0．05）外，其余组间的差异有统计学意义（P＜0．05）。（3）CAG患者血浆ET与CGRP含量呈显著负相关（r=-0.214,P=0.02)。结论 ET，CGRP可能参与CAG的病理生理过程，其含变化可能与萎缩程度有关。     

CD3单抗和淋巴细胞功能相关抗原-1对狼疮肾炎外周血单个核细胞的共刺激作用

目的：探讨CD3单抗（mAb)和淋巴细胞功能相关抗原－1单抗（LFA－1mAb)对狼疮肾炎（LN）患者外周血单个核细胞（PBMC）的共刺激作用。方法：2例LN患者被分为活动期（n=14)和非活动期（n=15)，以12例健康献血员为对照，观察CD3mAb或（和）LFA－1mAb共刺激及阻断1－磷酯酰肌醇3－激酶（PI3－K）对体外培养96h后PBMC增生和IL－2产生的影响。PBMC提取采用Ficoll密度梯度离心法，细胞增生实验采用^3H-TdR掺入法，IL－2测定采用ELISA法。结果：PBMC培养96h后，自然生长的LN非活动期和活动期PBMC ^3H-TdR掺入量和IL－2合成与正常对照无明显差异（P值均＞0或0．05）；与自然生长的PBMC相比，CD3mAb单独处理增加了LN非活动期（P值均＜0．05）和活动期（P值均＜0．05）PBMC^3H-TdR掺入量和IL－2合成。而单独CD3mAb对正常对照PBMC^3H-TdR掺入量和IL－2合成没有影响（P值均＞0．05）。与CD3mAb单独处理组相比，CD3mAb和LFA－1mAb共刺激均增加了LN活动期（P值均＜0．05）和非活动期（P值均＜0．05）及正常对照（P值均＜0．05）PBMC ^3H-TdR掺入量和IL－2合成；与对照组相比，CD3mAb和LFA－1mAb共刺激后活动期（P值均＜0．01）和非活动期（P值均＜0．01）PBMC^3H-TdR掺入量和IL－2合成均增加，但活动期效应明显强于非活动期（P＜0．01）。PI3－K特异抑制剂Wortmannin(WT)的加入明显抑制了CD3mAb和LFA－1mAb共刺激诱导的PBMC增生和IL－2的分泌效应（P＜0．01，P＜0．01）。结论：CD3和FLA－1对狼疮肾炎PBMC具有共刺激作用，这种共刺激作用可能参与了狼疮肾炎T、B细胞的异常活化，阻断共刺激传递信号分子PI3－K则能抑制CD3和LFA－1介导的共刺激作用。     

慢性肝病患者血浆内皮素、内毒素及肿瘤坏死因子水平的研究

目的探讨慢性肝炎、肝硬变患者血浆内皮素（ET），内毒素（ETM）及肿瘤坏死因子（TNF-α）的变化及致病机制，以及它们之间相互关系．方法正常人20例，慢性肝炎20例，肝硬变48例．采用特异性放免分析法测定血浆ET和TNF－α含量．用基质显色法鲎试验定量检测血浆ETM含量．结果①肝硬变组血浆ET，ETM，TNF－α水平明显高于正常人和慢性肝炎组（P＜0．01）．②肝硬变合并肝肾综合征和食管静脉曲张者血浆ET水平高于腹水和不伴腹水者（P＜0．01）．③ET水平的增高与ETM，TNF－α水平呈显著相关性（r=0．614，P＜0．01）．结论ET参与肝硬变发病，与门脉高压形成密切相关，ET的生物学效应与ETM，TNF－α密切相关．     

葛根素对梗阻性黄疸患者肾功能的保护作用观察

目的 观察葛根素对梗阻性黄疸（OJ）患者肾功能的保护作用。方法 OJ伴肾功能损害患者56例,随机分为术后常规处理组（A组）和葛根素防治组（B组）各28例。另选28例无黄疸的需要手术治疗的肝胆疾病患者为对照组（C组）。观察术前及术后各组血浆内皮素（ET）及肾功能指标的变化。结果 肌酐清除率（Cor）与ET呈负相关（r=-0．80,P〈0．01）。与术前1d相比。术后第7天,B组ET显著降低（P〈0．05）。肌酐清除率（Ccr）显著升高（P〈0．01）;A组手术前,后两指标差异无显著性（P均〉0．05）。术后7d,A、B两组ET、Ccr差异显著（P均〈0．05）。结论 葛根索可降低OJ患者的血浆ET含量,改善肾脏组织的血液灌流量,对肾功能损害有一定的防治作用。     

内皮素变化及心钠素对哮喘影响的实验研究

目的 研究哮喘豚鼠血浆及支气管肺泡灌洗液中（BALF）内皮素（ET－1）含量的变化及外源性心钠素（ANF）对ET－1的影响。方法 采用放射免疫分析法测定哮喘豚鼠血浆及BALF中ET－1和cGMP含量及给哮喘豚鼠输注不同剂量ANF后血浆及BALF中ET－1和cGMP含量。结果 哮喘豚鼠组血浆及BALF中ET－1显高于正常对照组（P＜0．01）。输注ANF后血浆及BALF中ET－1水平明显下降（P＜0．01），并呈剂量依赖性；cGMP水平明显升高（P＜0．01），亦呈剂量依赖性。结论 ET－1在哮喘发病中起有重要作用；ANF具有抑制ET－1合成及分泌的作用，拮抗其生物效应，可望成为治疗哮喘的一种新方法。     

系统性红斑狼疮患者血浆11—去氢—血栓烷B2测定及其临床意义

目的 观察系统性红斑狼疮（SLE）患者体内血小板活化状态。方法 采用酶联免疫吸附法（ELISA）检测32例SLE患者血浆11－去氢－血栓烷B2（DH－TXB2）,同时测定TXB2,并与对照组比较。结果 与对照组比较,SLE患者血浆DH－TXB2、TXB2均显著增高（P＜0．01及P＜0．05）,且DH－TXB2增高程度明显高于TXB2,对对照组无重叠,肾受累者显著高于无肾脏受累者（P＜0．05）,经治疗者显著低于初发未治疗者（P＜0．01）,但仍高于对照组（P＜0．05）。血浆TXB2与DH－TXB2浓度与疾病活动指数均呈正相关（r1＝0．478,P＜0．05及r2＝0．530,P＜0．01）。结论 血浆DH－TXB2水平测定是准确反映血小板活化的指标,SLE患者体内血小板高度活化。     

脑出血和脑梗死患者止、凝血分子标志物的检测及意义

应用ELISA法对60例脑梗死患者,30例脑出血患者和对照组50例健康体检查进行血浆TM,ET－1,P－selection,D-Dimer测定,PC活性以发色底物法测定,结果发现,脑梗死组TM,ET－1,P-selection含量显著高于对照组（P＜0．05或P＜0．01）,脑出血组PC活性及D－Dmier含量均显著高于对照组（P＜0．05或P＜0．01）,TM,ET－1含量增高提示脑梗死患者有较严重的血管内皮损伤,P－selection含量增高则提示脑梗死患者血小板被激活,为临床抗血小板聚集及保护血管内皮治疗提供了理论依据,,而高水平的PC和D－Dimer则说明脑出血患者存在抗凝系统及纤溶系统的异常。     

稳定型和不稳定型心绞痛患者血浆内皮素的改变及钙拮抗剂对其影响

目的：探讨冠心病心绞痛发病中内皮素（ET）的作用及钙拮抗剂对冠心病心绞痛患者血浆ET水平的影响。方法：采用放免法测定35例稳定型心绞痛（SA组）、30例不稳定型心绞痛（UA组）及30例健康人（对照组）血浆ET含量，同时测定34例口服硝苯吡啶、24例口服地尔硫患者用药15d后血浆ET含量。结果：UA组血浆ET含量明显高于SA组（P＜0．001），两组均高于对照组（均P＜0．001），硝宋吡啶、地尔硫草均能降低冠心病患者血浆ET水平（与治疗前相比P＜0．001），其中硝苯毗院作用尤为显著，治疗后患者血浆ET水平降至正常（与对照组相比P＞0．05），地尔硫革尚不能使冠心病患者血浆ET水平降至正常（与对照组相比P＜0．001）。结论：ET在冠心病心绞痛的发病中有重要作用，钙桔抗剂硝本毗埃、地尔硫均能降低心绞痛患者血浆ET水平，前者作用强手后者。     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

小剂量垂体后叶素合并硝酸甘油治疗咯血

目的评价小剂量垂体后叶素联合硝酸甘油治疗咯血的疗效及不良反应。方法将50例咯血患者随机分为两组,治疗组在常规治疗基础上（n=26）应用小剂量垂体后叶素联合硝酸甘油;对照组（n=24）在常规治疗基础上仅应用小剂量垂体后叶素。分析其疗效及不良反应。结果48小时后治疗组有效率96.15％（25／26）,对照组有效率58.33％（14／24）,差异有统计学意义（P=0.012）;治疗组对血压影响小,无统计学意义（P〉0.05）,对照组能引起血压升高的副作用（P〈0.05）;治疗组出现头晕头痛、胸闷、心悸、腹痛、腹泻、恶心呕吐、出汗、面色苍白等不良反应比对照组少,差异有统计学意义（P〈0.05）。结论小剂量垂体后叶素联合硝酸甘油治疗中量咯血比垂体后叶素单药治疗中量咯血疗效明显提高,且能减少垂体后叶素不良反应。     

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.     

Complications associated with the treatment of haemophiliacs with inhibitors

To examine the safety profile of products used to treat inhibitor patients unresponsive to factor VIII, a review of published clinical experience was performed. The products evaluated were activated prothrombin complex concentrates (aPCCs), such as AUTOPLEX® T, porcine factor VIII and recombinant activated factor VII (rVIIa). Safety characteristics included potential for transmission of infectious agents, anamnesis, thrombogenicity, thrombocytopenia and allergic reactions. While viral transmission has been virtually eliminated, the risk is theoretically higher with plasma-derived products such as aPCC and porcine factor VIII than with rVIIa, although contamination of cultured cells is a concern. Anamnesis occurs with aPCCs and porcine factor VIII, and may induce resistance to further therapy with porcine factor VIII. Thrombosis and disseminated intravascular coagulation are very infrequently reported in patients exposed to aPCCs and rVIIa, and never with porcine factor VIII. The latter is occasionally associated with thrombocytopenia, but this uncommonly limits treatment with this agent. Lastly, allergic reactions occur with about equal frequency with all products, but anaphylaxis is mainly a concern after administration of porcine factor VIII. In conclusion, products currently available are reasonably safe. Considerations such as efficacy, availability, ease of administration and cost must also be considered in making treatment choices.