钩端螺旋体病神经系统病变的发病机理与治疗探讨(附105例临床分析)

本文报道105例钩端螺旋体病神经系统病变,认为本病的发生可能为钩端螺旋体或钩端螺旋体L型直接损伤了神经组织或供血血管,引发变态反应致间质性炎症病理改变及内毒素等病理作用。甲硝哒唑易透过血脑屏障,能损伤钩体DNA,其疗效优于青霉素,可减少钩端螺旋体病神经系统后发症。     

洪灾区钩端螺旋体宿主动物及健康人群感染情况的流行病学研究

目的:了解洪灾区钩端螺旋体宿主动物的带菌情况及人群的免疫水平. 方法:应用柯素夫培养法作牛尿和鼠肾钩体培养.显微凝集试验(microscopic agglutination test,MAT)作钩体及人群钩体感染的血清学分群(型).结果:灾区、临灾区及新建移民点的鼠密度分别为6.95%,6.28%及8.67%;鼠肾钩体培养阳性率分别为4.63%,1.35%和3.13%;牛尿培养阳性率分别为5.88%,5.98%和1.75%;分离的菌株主要为黄疸出血型及犬型;人群钩体抗体阳性率分别为45.91%,62.30%和58.67%,明显高于全省及全国的平均感染率;其主要血清学分型依次为黄疸出血、秋季热、犬型、泼摩那型、巴达维亚型;人群抗体阳性率无年龄差异.结论:3个不同区域的宿主动物鼠和牛中均有钩体带菌,人群钩体隐性感染率水平较高,宿主动物和人群感染的主要血清群相吻合,主要为黄疸出血型.     

问号钩端螺旋体致病物质及其作用机制研究进展

问号钩端螺旋体(简称钩体)感染引起的钩体病是全球流行最广的人兽共患病.由于问号钩体无外毒素,所含有的内毒素样物质也不能合理地解释其致病性,故问号钩体致病机制至今未明.近年国外学者分别报道了问号钩体内鞭毛、一些糖脂或糖肽类物质、溶血素、部分外膜蛋白分别与体外生存、侵袭力、粘附宿主细胞、细胞膜损伤、诱导炎症因子和细胞凋亡等有关,从而与问号钩体致病密切相关.研究资料还提示,问号钩体致病机制可能与传统的细菌主要以内、外毒素致病有明显差异.     

中西医结合治疗钩端螺旋体病神经系统后发症

报道６０２例钩端螺旋体病神经系统后发症病变，认为本病的发生可能为钩端螺旋体直接伤神经组织或供血血管引发变态反应，肺、肝、肾和心肌等组织出现间持性炎症。单纯和西药治疗，对钩病神经系统后发症治疗缓慢。采用辨病与辩证相结合，以中药清热燥湿，化瘀通同化血管再通。合用庆大霉素，以根治病原其疗效优于和西药。     

海南省钩端螺旋体病地理流行病研究：Ⅲ.主要的临床表现和控制措施

本文报告海南省８５０例钩体病的主要临床表现和若干控制措施评估。病人的临床分型以流感伤寒型为主（７６．０％），病死率亦低（１．１％）；肺出血型、黄疸出血型和肾型的构成比虽小，但病死率高，依次为４４．８％、２１．１％和１７．７％。眼和神经系统后发症分别为６．０％、２．０％。     

钩端螺旋体膜蛋白研究进展

问号钩端螺旋体（Leptospira interrogans）在全球分布广泛，危害极大，已发现25个血清群，273个血清型。钩体病是世界上流行最广的人兽共患病之一，人体感染后，轻者似感冒，重者可有明显的肝、肾、肺及中枢神经系统损害，甚至死亡。至少已发现200多种动物为问号钩端螺旋体携带者，动物大多呈隐性感染，钩体在感染动物中可长期存在，持续随尿排出，污染水源和土壤。目前的疫苗通常采用灭活的全菌，而血清学诊断通常采用活菌，主要抗原成分是菌体表面的脂多糖（LPS），不幸的是不同血清型钩体LPS的抗原性不一样。象沙门菌一样，LPS的不同反映出钩体对宿主的不同适应性，每一动物宿主都与特定的钩体血清型相联系。如大鼠与Ietemhemorchagiae，小鼠与Ballum，牛与Hardio，猪与Pomona、Bratislava，而狗倾向于Canicola。LPS的宿主特异性可能是钩体免疫逃避的机制，允许钩体长期呆在动物的肾脏中而不引起炎症反应。     

问号钩端螺旋体胶原酶体内和体外的活性研究

目的 通过检测致病性钩端螺旋体(钩体)胶原酶在体内、外的活性,探讨问号钩体黄疸出血群赖型赖株(赖株)假定的胶原酶(LA0872)在钩体病出血中的可能作用.方法 在大肠杆菌中克隆、表达重组赖株la0872,并行相关鉴定及蛋白酶学活性检测.比较不同毒力菌株赖株、赖株减毒株和双曲钩体三宝垄群montevalerio型Monte Valerio株钩体胶原酶的基因序列特异性及转录和酶活水平的差异.测定豚鼠和沙鼠赖株感染模型的血清胶原酶活性水平变化.结果 成功构建的重组质粒经酶切和测序鉴定显示位点连接正确,插入序列与GenBank公布的la0872序列完全一致,并证实其具有胶原酶活性;不同毒力菌株中的钩体胶原酶基因序列一致,转录和酶活水平均无显著性差异;豚鼠和沙鼠感染赖株后,宿主体内血清胶原酶活性水平与未感染赖株动物比较差异无统计学意义(P>0.05).结论 首次表达和鉴定了有活性的钩体胶原酶,但其在钩体病出血中的作用尚待证实和探讨.     

南平市钩端螺旋体病调查研究

目的：通过对南平市钩端螺旋体病流行状况、疫源地类型、宿主动物、钩体菌群、临床表现、疫苗接种情况等调查，基本掌握我市钩体病流行规律，为当今农业生产结构下提出针对防治对策。方法：收集并分析南平市钩体历年疫情、临床资料，开展疫区类型、宿主动物、钩体菌群等调查。结果：南平市地理环境、气侯、植被等适宜钩端螺旋体菌生长。44年来流行曲线呈波浪型，5-11月为流行期，九十年代后以浦城县流行为主，总发病率呈下降趋势。疫源地有三种生境类型。流行形式以稻田型为主。农村男性青壮年受感染发病最多。宿主动物以黄毛鼠、黑线姬鼠、褐家鼠为主，分离出14群钩体菌株，而且带菌率高。近年猪宿主作用下降。病人血清检出13群钩体感染，健康人群检出14群钩体抗体，隐性感染率15．15％。“福建新丙五价”钩体菌苗的安全性及免疫效果是肯定的，完全可以预防相应菌群疫区钩体病流行。结论：南平市存在钩体自然疫源地．是福建省较严重的钩体流行疫区，有明显季节高峰，宿主动物种类多，流行菌群有14群，稻田型流行为主，病例临床表现复杂，疫情虽然呈下降趋势，凶险型病例增多，“福建新丙五价”钩体菌苗可以预防相应菌群疫区钩体病流行，但是防治工作仍然任重而道远。     

钩端螺旋体L型脑动脉炎20例分析

采用甲硝哒唑治疗钩端螺旋体Ｌ型脑动脉炎２０例，结果痊愈８例，显效８例，有效４例。认为甲硝哒唑容易透过血脑屏障，可破坏钩端螺旋体ＤＮＡ结构，杀灭钩端螺旋体及Ｌ型，可减少钩体病后发症，疗效显著。     

利用基因芯片对赖型钩体毒力基因差异表达与致病相关性的探讨

目的 通过对连续动物传代和试管培养的赖型钩端螺旋体部分致病基因表达差异性的检测,分析赖型钩端螺旋体特异性基因表达与毒力改变之间的联系,了解赖型钩端螺旋体致病过程和发病机制.方法 将27只豚鼠分为3组(n=9),分别经腹部皮下接种1 mL体内培养钩体(体内培养组)、体外培养钩体(体外培养组)或钩体培养基(培养基组),接种钩体浓度为108/mL并处于对数生长期.在接种后15d内观察其发病和死亡状况,测量其体温体质量变化情况,并于接种后第15d将存活豚鼠处死,测量脏器系数,了解经不同环境培养的钩体的毒力情况;以赖型钩端螺旋体标准株DNA为模板,采用PCR技术扩增出所选特定基因作为探针,使用点样仪进行芯片点样.分别提取经豚鼠体内连续数代培养的钩端螺旋体RNA与EMJH培养基中培养的钩端螺旋体RNA,逆转录后分别使用Cy5和Cy3进行荧光标记,并与基因芯片进行杂交.扫描后通过分析两种荧光强度的比值,了解赖型钩端螺旋体相关毒力基因的差异表达情况.结果 接种后,体内培养组豚鼠存活率为0％,体外培养组豚鼠存活率为88.9％,培养基组豚鼠全部存活;体内培养组豚鼠较其余两组豚鼠体温升高(P＜0.05)、体质量下降(P＜0.05);体内培养组豚鼠心、肺、肾的脏器系数较体外培养组及培养基组豚鼠更大(P＜0.05);解剖后,体内培养组豚鼠肺部出血情况较其余两组更为严重;通过基因芯片,检测到溶血素基因以及其他与钩体生存致病能力相关的基因呈现出不同程度的改变,溶血素基因LA1027、LA1029、LA4004、LA3050、LA3540、LA0327、LA0378、LA1650、LA3937、O抗原连接酶基因LA2089、鞭毛动力蛋白基因LA3576、外膜蛋白基因LA0011及Loa22基因上调.结论 赖型钩体经连续体内培养后毒力增高,钩体毒力变化与其基因表达差异存在联系,了解这些基因的变化意义对阐明钩体的致病机制有重要意义.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.