注入内毒素后家兔体温及血浆内毒素水平动态变化的研究

为研究注入内毒素后家兔体温的变化及血浆内毒素浓度变化的动态过程,为内毒素血症的干预治疗提供实验依据.经家兔注射内毒素5μg/kg建立内毒素血症动物模型,以体温计动态测定家兔肛温变化,采用EDS-99内毒素定量测试系统检测不同时相血浆内毒素水平,发现注入内毒素后0.5h体温值明显升高,此后各时相与正常组比较均有明显的差异(P<0.05),于48h始恢复正常.血浆内毒素水平明显高于正常组,于注射后24h和72h两次出现高峰值(369.17±93.75)EU/ml、(301.53±69.65)EU/ml,于168h自然恢复至正常水平(0.73±0.35)EU/ml.结果表明注入内毒素后48h内体温呈持续增高,表现为发热反应;外源性内毒素在家兔体内自然清除率缓慢,代谢周期约1周.     

慢性乙型肝炎患者血清sCD14的水平与肠源性内毒素血症的关系

目的 探讨慢性乙型肝炎（慢乙肝）患者血清中sCD14的水平与继发肠源性内毒素血症的关系。方法 以ELISA法检测60例慢乙肝患者血清sCD14和TNF-(水平,同时,应用基质显色法定量检测了患者血浆内毒素水平并将三者与对照组进行比较。结果 轻度慢乙肝（A组）患者血清sCD14水平与对照组无显著差异（P>0.05）,中度慢乙肝（B组）和重度慢乙肝（C组）sCD14水平均显著高于对照组（P<0.01）;慢乙肝继发肠源性内毒素血症者血清中sCD14s为（4.8±2.3）(g/ml,而无继发肠源性内毒素血症者其sCD14为（2.9±1.9）(g/ml,两者之间有显著差异 ( P<0.01)。A组患者血清中sCD14水平为（3.0±1.7）(g/ml,而TNF-(为（4.69±2.75）ng/ml,两者之间无显著相关性（γ= 0.76,P>0.05）;而B组和C组其sCD14水平分别为（5.2±2.1）(g/ml和（6.9±3.4）(g/ml,TNF-(分别为（9.48±6.15）ng/ml和（14.23±8.29）ng/ml,B组、C组的sCD14水平分别与自身组TNF-(有显著相关性（γ=0.87,P<0.01;γ=0.91,P<0.01）。结论 慢乙肝继发肠源性内毒素血症者sCD14水平显著升高,说明sCD14水平可显著提高慢乙肝患者对内毒素的敏感性,LPS与sCD14结合,诱导单核-巨噬细胞产生TNF-(,从而损伤肝细胞。     

双歧三联活菌联合乳果糖治疗肝硬化肠源性内毒素血症临床研究

目的 研究双歧三联活菌联合乳果糖治疗肝硬化肠源性内毒素血症的临床效果.方法 整群选择该院2014年2月-2016年9月收治的肝硬化肠源性内毒素血症患者92例为研究对象,随机分为两组.给予对照组患者常规治疗,观察组在对照组基础上接受双歧三联活菌联合乳果糖治疗.对比两组患者治疗前后血浆内毒素、 肝功能及治疗效果.结果 对照组患者治疗前后内毒素分别为(0.41±0.05)、(0.29±0.06)EU/mL;观察组分别为(0.40±0.06)、(0.17±0.04)EU/mL,两组患者治疗后均较治疗前有所改善,观察组改善幅度大于对照组,差异有统计学意义(P<0.05);观察组治疗后AST、ALT、TBil分别为(46.79±4.85)U/L、(46.69±5.12)U/L、(43.69±3.77)μmol/L优于对照组的(60.15±6.31)U/L、(55.81±6.45)U/L、(50.56±5.23)μmol/L,差异有统计学意义(P<0.05).结论 双歧三联活菌联合乳果糖治疗肝硬化肠源性内毒素血症可起显著降低血浆内毒素水平、改善肝功能的作用.     

脑出血患者血浆去甲肾上腺素、乙酰胆碱与自主神经功能障碍的相关性研究

目的：研究脑出血患者急性期血浆去甲肾上腺素（norepineprine,NE）、乙酰胆碱（acetylcholine,Ach）的水平与自主神经功能障碍的相关性。方法：分析45例不同部位初发脑出血患者和38例健康人,分别在入院后第2、10天清晨抽取患者空腹静脉血3 ml于预冷的抗凝管中,4 ℃低温离心,取上清液置-70 ℃以下低温保存。分别采用液质联用法、酶联免疫吸附法测定脑出血组及对照组血浆NE及Ach水平;记录患者自主神经功能障碍的临床表现;应用自主神经症状量表（autonomic symptom profile,ASP）对脑出血组及对照组进行评估;采用美国国立卫生研究院卒中量表（national institutes of health stroke scale,NIHSS）对患者神经功能缺损程度进行评分。结果：脑出血组第2、10天血浆NE水平[（1.71±0.25）、（1.53±0.26） ng/ml]明显高于对照组（0.54±0.13） ng/ml,差异有统计学意义（P=0.006、P=0.003）,而血浆Ach水平[（76.88±12.38）、（71.75±12.73） ng/L]明显低于对照组（105.61±14.27） ng/L,差异有统计学意义（P=0.005、P=0.008）,脑出血组血浆NE、Ach水平第2、10天比较,差异无统计学意义（P=0.054、P=0.342）;脑出血组ASP评分明显高于对照组,差异有统计学意义（P=0.002、P=0.01０）,脑出血组ASP评分与血浆NE、Ach水平存在统计学相关性（r=0.770,P=0.042;r=-0.868,P=0.011）。脑出血组第10天NIHSS评分明显低于第2天,差异有统计学意义（t=5.91,P=0.008）。结论：脑出血患者急性期血浆NE水平明显升高而血浆Ach水平明显降低,血浆NE及Ach水平的变化可能与自主神经功能障碍有关联。     

血清midkine检测在非小细胞肺癌辅助诊断及预后评估中的价值

目的探讨血清中期因子（S-MK）检测对非小细胞肺癌（NSCLC）辅助诊断的价值。方法选择NSCLC患者120例（观察组）,同期因肺部良性肿瘤住院的患者62例（肺良性肿瘤组）及健康对照组64例,采用ELISA法测定观察组患者术前及术后（S-MK）水平,以及肺良性肿瘤组和健康对照组的S-MK水平。结果NSCLC组（术前）S-MK水平为（285.70±20.52）pg/ml,高于肺良性肿瘤组（211.88±15.69）pg/ml和健康对照组（189.06±12.92）pg/ml（t=2.402、3.257,均P＜0.01）。NSCLC组（术后1个月时）S-MK水平（218.26±10.77）pg/ml,低于术前（285.70±20.52）pg/ml,差异有统计学意义（t=3.303,P＜0.01）。结论NSCLC患者S-MK水平升高,且术后出现一定程度的下降,S-MK水平可作为一种临床肿瘤标志物,为NSCLC的诊断、疗效评价提供一定的依据。     

本院2005年常见慢性病患者血浆内毒素含量的测定与临床意义

目的探讨不同疾病患者血浆内毒素的含量及内毒素检测的临床意义。方法用鲎试剂定量动态比浊法检测患者和健康对照者血浆内毒素含量,对其血浆内毒素平均值进行对比分析。结果50例正常人血浆内毒素含量为(3.29±1.82)pg/ml,54例肝硬化患者内毒素阳性率为48.1%,平均内毒素含量为75.02pg/ml。31例发热、6例白血病、16例支气管肺炎、42例肺癌、9例肝炎和10例肝癌患者组血浆内毒素阳性率分别为67.7%、66.7%、68.8%、100%、31.6%和60.0%,内毒素平均值分别为73.47、29.47、239.45、259.42、8.69和17.34pg/ml,与正常对照组相比除支气管肺炎和肝炎组外,均有显著性差异。不同肝病之间及肺炎和肺癌之间均无显著性差异。结论检测血浆内毒素含量有助于早期判断感染性疾病及是否存在内毒素血症,有利于临床尽早诊治疾病。     

细胞因子 IL-17A 与免疫性血小板减少症发病关系的初步研究

目的 通过观察免疫性血小板减少症（ITP）患者外周血中辅助性 T（Th）细胞相关细胞因子水平的变化,探讨其与 ITP 发病的关系。 方法 应用微量样本多重蛋白定量技术（CBA）检测和比较 35 例慢性 ITP 患者和 30 例健康体检者（正常对照组）外周 血中 IL-2、IL-4、IL-6、IFN-γ 和 IL-17A 的水平。 结果 ITP 患者外周血 IL-17A 水平较正常对照组显著升高,两组 IL-17A 的水平 分别为（6.767±1.066）pg/ml 和（1.679±0.253）pg/ml,比较有统计学差异（P＜0.01）;而患者外周血 IL-2、IL-4、IL-6、IFN-γ 水平与 正常对照组相比均无统计学差异（均 P ＞0.05）。血小板计数≥20×109/L 的患者外周血 IL-17A 水平为（8.217±1.477）pg/ml,血小板 计数＜20×109/L 的患者外周血 IL-17A 水平为（5.238±1.490）pg/ml,两者间比较无统计学差异（P ＞0.05）。 结论 慢性 ITP 患者 外周血 IL-17A 水平异常升高,提示 Th17 细胞和 IL-17A 可能在 ITP 的发生、发展中发挥重要的作用。     

PCT、PE在SAP患者合并感染治疗中的应用

目的：探讨降钙素原（PCT）和内毒素（PE）在重症急性胰腺炎（SAP）患者合并感染治疗中的临床意义。方法选择2011年5月-2013年5月收治入院的86例SAP患者,随机分为两组,PCT或内毒素指导组（病例组43例）和预防性抗生素治疗组（对照组43例）。每天监测两组患者血清PCT、内毒素水平,PCT临界值为0.5μg/L,内毒素为0.01 EU/ml,病例组当临床感染的体征和症状出现且PCT〉0.5μg/L或内毒素升高达＞0.01 EU/ml时开始抗生素治疗,当临床症状和体征的改善且PCT下降到〈0.5μg/L或内毒素下降达〈0.01 EU/ml时超过3d停用抗生素。在对照组抗生素治疗预防给药2周,如果临床感染的体征和症状仍存在,继续抗生素治疗直到感染的临床症状和体征消失3d,比较两组患者抗生素治疗时间、住院时间、并发症、生存率、住院费用等指标,并进行统计学分析。结果病例组并发症发生率明显少于对照组,生存率明显高于对照组,且比较差异有统计学意义（P＜0.05）;病例组抗生素治疗时间,住院时间均较对照组抗生素组短,两组比较差异有统计学意义（P〈0.01）,病例组住院费用也明显低于对照组（P〈0.01）。结论监测PCT、内毒素指导SAP患者合并感染治疗中是有用的指标,有利于减少抗生素的使用时间,减少细菌耐药和缩短住院时间并降低住院费用。     

43例儿童单纯性肠梗阻血浆内毒素水平研究

目的：检测小儿不同程度肠梗阻血浆内毒素水平,探讨小儿肠梗阻程度与内毒素血症之间关系。方法以重庆医科大学附属儿童医院2011年1月至2014年5月收治儿童肠梗阻患儿（43例）及对照组腹股沟疝患儿（25例）作为研究对象,采用鲎试验检测方法分别检测不同时点对照组（n＝25）、单纯不全性肠梗阻组（n＝20）、单纯完全性肠梗阻未发生肠坏死组（n＝23）血浆内毒素水平。结果各组血浆内毒素水平分别为：对照组（6．53±14．96）EU／mL ,单纯不全性肠梗阻组治疗前后（4．40±1．15） EU／mL和（4．20±1．20）EU／mL、单纯完全性肠梗阻未发生肠坏死组手术前后（4．09±1．31）EU／mL和（3．70±1．46）EU／mL ,经检验各组间差异无统计学意义。结论无腹腔感染及肠坏死的肠梗阻患儿无明显内毒素血症,与梗阻程度无明显相关性。     

急性重症胰腺炎时血浆内毒素和TNFα水平变化及生长抑素的治疗作用

目的　观察生长抑素 (施他宁 )对重症急性胰腺炎的治疗效果及其对急性胰腺炎患者血浆内毒素和 TNF︿水平的影响。方法　 36例急性重症胰腺炎患者随机分为 A、B两组 ,A组采用施他宁治疗 (治疗组 ) ,B组给予一般常规治疗 (对照组 ) ,于第 1～ 7天抽血测定血清淀粉酶、血浆内毒素和 TNF︿。结果　急性胰腺炎患者入院第一天的血浆内毒素 (A/ B组 :0 .95± 0 .2 2 / 0 .96± 0 .2 7IU/ ml)和 TNF︿水平 (A/ B组 :0 .87± 0 .2 7/ 0 .86± 0 .2 1 ng/ ml)均明显高于健康人 (内毒素 /TNF︿:0 .1 1± 0 .0 3 IU/ ml/ 0 .0 4± 0 .0 2 ng/ ml) ;治疗组患者血清淀粉酶、血浆内毒素和 TNF︿水平下降速度明显快于对照组。结论　急性胰腺炎患者早期均存在不同程度的内毒素血症及血浆TNF︿水平升高 ,生长抑素治疗急性重症胰腺炎疗效肯定 ,治疗组患者血浆内毒素和 TNF︿水平下降均明显快于对照组。     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

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.