HLA全相合异基因造血干细胞移植与免疫抑制剂治疗重型再生障碍性贫血的比较

背景：国外有报道显示异基因造血干细胞移植和免疫抑制疗法治疗急性重型再生障碍性贫血的有效率及总生存期相当,但两种疗法治疗后的生活质量及治疗费用方面的差异报道较少。 目的：回顾性分析同胞HLA全相合异基因造血干细胞移植与免疫抑制疗法治疗急性重型再生障碍性贫血的疗效。 方法：入选2004-07/2010-10在南京鼓楼医院血液科行同胞HLA全相合异基因造血干细胞移植的7例及行免疫抑制疗法的16例急性重型再生障碍性贫血患者,每3个月定期进行随访。 结果与结论：异基因造血干细胞移植组在粒细胞和血小板恢复时间,脱离输血时间,治疗后3个月总有效率及治疗后12个月完全缓解率均优于免疫抑制疗法组,但治疗后12个月总有效率差异无显著性意义。异基因造血干细胞移植组与免疫抑制疗法组的总生存率分别为86%与81.3%,两组比较差异无显著性意义。治疗1年后两组患者总体健康状况及功能健康状况均提示良好,两组住院费用差异无显著性意义。     

经皮椎体成形和后凸成形治疗老年骨质疏松性椎体骨折的比较

背景：经皮椎体成形和椎体后凸成形作为两种微创治疗技术在骨质疏松性椎体压缩骨折方面的应用多年,但争议颇多,且各有利弊。 目的：比较经皮椎体成形与经皮椎体后凸成形在治疗骨质疏松性椎体压缩性骨折方面的疗效。 方法：纳入100例患者,其中40例患者选择经皮椎体后凸成形手术,60例患者选择经皮椎体成形手术。治疗前按疼痛目测类比评分评定患者的疼痛程度;术后疼痛目测类比评分为术后1周。并摄X射线片测量测量椎体前缘与后缘比。 结果与结论：两组患者治疗后疼痛目测类比评分都有明显下降,与术前比较差异有显著性意义(P < 0.05);两组患者治疗后椎体高度恢复较治疗前差异有显著性意义,但矫形效果比较,差异无显著性意义(P < 0.05)。治疗后并发症骨水泥渗漏的发生率经皮椎体成形组为35%,经皮椎体后凸成形组为12.5%,两组比较并发症发生率差异有显著性意义(P < 0.05)。经皮椎体成形与经皮椎体后凸成形均可显著缓解骨质疏松性椎体压缩性骨折患者的疼痛;经皮椎体成形组通过术前术中使脊椎过伸可部分恢复椎体高度,经皮椎体成形与经皮椎体后凸成形两组矫形效果差异无显著性意义。     

EST联合LC与开腹手术治疗胆囊胆总管结石的临床对比分析

目的 比较EST联合LC与开腹胆囊切除、胆总管切开取石、T管引流术治疗胆囊结石合并胆总管结石的结果，评价EST联合LC治疗胆囊结石合并胆总管结石的价值。方法 回顾性分析77例胆囊结石合并胆总管结石的治疗方法和结果。其中23例行内镜十二指肠括约肌切开联合腹腔镜胆囊切除术（EST＋LC）。54例开腹胆囊切除、胆总管切开取石、T管引流术（OC＋OCHTD），比较二者的治疗成功率、术后并发症发生率、胃肠功能恢复时间、住院时间、住院费用等，进行统计学分析。井对出院后情况进行随访。结果 两组病例的治疗成功率、并发症发生率无显著性差异（P〉0．05），但EST＋LC组术后并发症严重程度较轻。EST＋LC组的胃肠功能恢复时间、住院时间较OC＋OCHTD组明显缩短（P〈0．05）。两组病例的住院治疗费用无显著性差异（P〉0．05）。术后42例病例获得随访，随访时间5～25个月（平均14．6个月），均无胆管结石复发或胆管炎发生。结论 EST联合LC是一种安全、有效、可行的的微创治疗方法，具有创伤小，术后恢复快，住院时间短的优点．     

中西医结合在上消化道出血治疗中综合效果观察

目的 观察中西医结合在上消化道出血治疗中综合效果.方法 选择我院2009年1月～11月收治的50例消化道出血患者,随机分为观察组和对照组各25例,对照组采用单纯西药治疗,观察组采用中西医结合治疗.比较分析两组的综合效果.结果 观察组总有效率为96.0%,对照组总有效率为68.0%,两组间比较,有显著性差异(χ2=4.8780,P<0.05).两组不良反应发生率分别为8.0%和12.0%,组间无显著性差异(χ2=0.1818,P>0.05).观察组恢复时间为(1.8±0.6)d,对照组为(3.4±0.7)d,组间有显著性差异(t=8.6772,P<0.001).结论 中西医结合在上消化道出血治疗中疗效满意,且安全可靠,患者恢复快,值得临床推广使用.     

尺骨茎突骨折是否愈合对桡骨远端骨折术后关节功能的影响

背景:桡骨远端骨折合并尺骨茎突骨折临床中比较常见,对于有手术适应证的桡骨远端骨折一般选择切开复位钢板内固定手术,但对于尺骨茎突骨折的治疗一直存在争议。目的:观察尺骨茎突骨折愈合与否对桡骨远端骨折内固定术后腕关节功能恢复的影响。方法:选择2016年6月至2019年1月安徽医科大学第二附属医院收治的39例桡骨远端骨折伴尺骨茎突骨折患者,其中男24例,女15例,年龄23-67岁,均接受桡骨远端锁定钢板内固定治疗,随访复查X射线片判定桡骨远端骨折愈合情况。根据末次随访时尺骨茎突愈合情况分为愈合组(n=20)和未愈合组(n=19),依据X射线片比较两组间的掌倾角、尺偏角和桡骨高度,并与健侧进行对比;检测腕关节屈伸活动范围、前臂旋转活动范围和Gartlant-Werley腕关节功能评分。研究获得安徽医科大学第二附属医院伦理委员会批准。结果与结论:①愈合组术后腕关节尺侧疼痛1例,未愈合组尺侧疼痛2例,组间比较差异无显著性意义(P>0.05);两组桡骨骨折愈合时间比较差异无显著性意义(P>0.05);②末次随访时,愈合组与未愈合组的掌倾角、尺偏角均小于健侧(P<0.05),桡骨高度与健侧比较差异无显著性意义(P>0.05);两组间上述指标比较差异均无显著性意义(P>0.05);③末次随访时,愈合组与未愈合组的腕关节背伸、屈曲活动范围均小于健侧(P<0.05),前臂旋转活动范围与健侧比较差异无显著性意义(P>0.05);两组间上述指标比较差异均无显著性意义(P>0.05);④末次随访时,两组Gartlant-Werley腕关节功能评分优良率比较差异无显著性意义(P>0.05);⑤结果表明,尺骨茎突骨折是否愈合对桡骨远端骨折内固定术后腕关节功能的恢复无明显影响,故临床中尺骨茎突骨折可仅行保守治疗。     

氯沙坦对慢性肾炎蛋白尿患者的肾脏保护作用研究

目的 研究氯沙坦对慢性肾小球肾炎蛋白尿患者肾脏的保护作用.方法 将48例患者血压控制于130/80 mmHg以下,稳定1周后随机分为两组:氯沙坦治疗组24例,50 mg每日一次;苯那普利组24例,10 mg每日一次.疗程12周,观察治疗前后24h尿蛋白、肾功能、血钾、血尿酸的变化及不良反应的发生情况.结果 氯沙坦与苯那普利均能显著降低尿蛋白,治疗前后差异有显著性,P<0.05,而两组间无显著差异,P>0.05;两组血压于治疗前后无显著性变化;对肾功能的影响,于第4周结束时两组治疗均无明显改变,但在12周结束时两组治疗前后均出现显著差异,P<0.05,两组间比较差异无显著性,P>0.05;氯沙坦能明显降低血尿酸,且无干咳、高血钾等不良反应.结论 氯沙坦治疗慢性肾小球肾炎安全、有效,具有非降压依赖性降低蛋白尿、保护肾功能的作用.     

两种微创术式治疗肝外胆管结石的临床对比分析

目的 探讨腹腔镜胆囊切除、胆总管切开探查术（LC--CBDE）与内镜下括约肌切开术联合腹腔镜胆囊切除术（EST-LC）两种微创术式治疗肝外胆管结石的临床疗效。方法 1999年6月至2006年2月采用两种微创术式治疗肝外胆管结石63例，LC—CBDE组41例、EST-LC组22例。比较两组病人的手术时间、术中出血量、术后肠道功能恢复时间、术后疼痛视觉模拟评分（VAS）、术后住院天数、并发症发生率、结石清除率等指标。结果 LC—CBDE组与EST—LC组两组间手术时间、术中出血量、术后肠道功能恢复时间、术后疼痛视觉模拟评分（VAS）、并发症发生率、结石清除率等指标的差异无显著性（P〉0．05）；LC—CBDE组住院天数较EST—LC组短，差异具非常显著性（P〈0．01）。结论 LC—CBDE与EST—LC两种微创术式治疗肝外胆管结石均具有创伤小、疼痛轻、出血少、胃肠功能恢复快、并发症少、疗效确切等优点，值得推广，但选择哪一术式需具体分析病情并根据术者腹腔镜手术技巧、内镜操作熟练程度而定。     

自我暴露与合并阿普唑仑治疗恐怖症对照研究

对２１恐怖症病人采用自我暴露疗法与合并阿普唑仑进行对照研究。发现两组疗效无显著性差异。合并阿普唑仑可以帮助降低焦虑，提高对自我暴露治疗的依从性，但不能提高效疗。     

被动式音乐治疗辅助治疗抑郁症的临床研究

目的 探讨被动式音乐治疗辅助治疗抑郁症的疗效.方法 将90例抑郁症患者随机分为研究组和对照组,研究组在对照组基础上辅以被动式音乐治疗.采用汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)分别观察疗效,连续观察8周.结果 在治疗第1周,两组HAMD和HAMA评分均下降,但两组间有显著性差异(t=4.39,6.43;P＜0.05).第2周末开始两组间HAMD和HAMA评分差异无显著性.第8周末两组显效率分别为93.3％和86.7％,差异无统计学意义.结论 被动式音乐治疗辅助治疗抑郁症起效快.     

盐酸米诺环素软膏治疗重度慢性牙周炎临床疗效评价

目的 评价盐酸米诺环素软膏治疗重度慢性牙周炎临床疗效.方法 40例重度慢性牙周炎患者随机平分为两组,对照组采用盐酸克林霉素治疗,观察组采用盐酸米诺环素治疗.结果 两组患者的GI、SBI 、PD与治疗前比较显著下降(P<0.05),观察组与对照组比较有显著性差异(P<0.05).两组不良反应情况对比无显著性差异(P>0.05).结论 用盐酸米诺环素处理牙周炎病变牙根面,可促进牙周膜细胞在牙根面的附着和增殖,使根面恢复生物相容性,提高牙周炎的治疗效果,不良反应少,值得临床推广应用.     

病毒唑治疗肾综合征出血热对肌酸磷酸激酸同工酶 …

目的 探讨治疗肾综合征出血热（ＨＦＲＳ）时,病毒唑对肌酸磷酸激酶同工酶（ＣＫ－ＭＢ）的影响。方法 对１５５例肾ＨＦＲＳ患者在进行较大剂量Ｒｉｂａｖｉｒｉｎ双盲 随机对照治疗中对血清ＣＫ－ＭＢ进行了动态观察,并将ＨＦＲＳ各期、各型病毒唑治疗组与对照组ＣＫ－ＭＢ水平进行了比较。结果 两组病例从发热期开始ＣＫ－ＭＢ明显升高,恢复期时逐渐恢复正常,病毒唑组发热期逐渐恢复正常,病毒唑组发热期ＣＫ－ＭＢ明显低     

虫草肾康胶囊防治肾综合征出血热急性肾功能衰竭的临床观察

目的观察虫草肾康胶囊对肾综合征出血热（ＨＦＲＳ）急性肾功能衰竭（肾衰）的防治作用。方法将１５０例ＨＦＲＳ患者随机分为治疗组（７６例）和对照组（７４例）。两组均按不同病期给予病毒唑抗病毒,及以平衡盐液为主的综合治疗,治疗组加用虫草肾康胶囊（２７ｇ／次,每日３次）,用至多尿期结束。结果治疗组少尿发生率为１３０％（６／４６）,少尿持续２７±１６天,多尿持续６８±２９天,尿蛋白平均５１±２３天消失,血清肌酐（Ｓｃｒ）平均１０９±６２天恢复正常;在治疗５天、１０天时,治疗组血与尿β２微球蛋白水平均显著低于对照组;治疗组严重并发症发生率为１８４％（１４／７６）,治愈率为９４７％（７２／７６）,对照组分别为３３８％（２５／７４）、８７８％（６５／７４）。两组以上各项除治愈率外,余差异均有显著意义（Ｐ＜０．０１或Ｐ＜０．０５）。结论虫草肾康胶囊可减少ＨＦＲＳ急性肾衰的发生率,缩短急性肾衰的病程,从而降低患者的透析需要率,减少并发症,提高治愈率,且使用安全、方便,值得临床推广应用。     

Carcinogenicity studies with medroxalol hydrochloride in rats and mice

The carcinogenic potential of medroxalol hydrochloride, an antihypertensive agent with beta 1 adrenergic cardiac blocking properties, and beta 2 and some alpha 1 vasodilating activity, was studied by dietary administration. Long Evans rats were treated for 2 years and CD-1 mice for 18 months at dosages of 0, 50, 250 or 500 mg/kg/day. Medroxalol did not produce any evidence of a tumorigenic effect in the Long Evans rat, but graying of pigmented hair was noted at 250 and 500 mg/kg/day and is probably related to melanin binding of the drug. In the CD-1 mouse, there was a dose related increase in uterine leiomyomas that was statistically significant (p less than 0.05) at doses of 250 and 500 mg/kg/day. The incidence at 50 mg/kg/day was not different from control. Endometrial stromal sarcomas were observed only in treated mice, and pairwise comparison with controls indicated a statistically significant difference (p less than 0.05) only at the lowest dosage (50 mg/kg/day). The latter finding may not be related to treatment since there was no dose response and the incidence in the two higher dose groups was neither statistically significant nor higher than occasionally seen in other control groups.     

基因重组干扰素α—2b治疗肾综合征出血热的临床观察

目的了解基因重组干扰素α－２ｂ治疗肾综合征出血热（ＨＦＲＳ）早期患者的临床疗效。方法将１４６例发病５日以内单纯发热期的ＨＦＲＳ患者随机分为治疗组与对照组各７３例。对照组给予以平衡盐液为主的综合治疗，治疗组同时另加用基因重组干扰素α－２ｂ１×１０６ＩＵ／ｄ，肌注，每日１次，疗程３天。结果在病毒血症的改善、减轻病情、越期、肾功能恢复、血小板复常及减少并发症诸方面，治疗组均显著优于对照组（Ｐ＜００５）。治疗组均治愈，而对照组死亡４例，病死率为５４７％。未发现干扰素的副作用。结论基因重组干扰素α－２ｂ治疗ＨＦＲＳ早期（≤５病日）患者，能减轻脏器损伤、缩短病程、提高治愈率。     

利巴韦林与α-IFN治疗偏肺病毒感染引起的小儿毛细支气管炎效果研究

目的 分析利巴韦林与α-IFN治疗偏肺病毒(metapneiimovirus,MPV)感染引起的小儿毛细支气管炎的临床治疗指标及疗效的影响.方法 选取2010年8月-2015年8月于就诊的210例偏肺病毒感染引起的小儿毛细支气管炎患者,按照随机数字表法分为三组:对照组(n=70)采用激素、支气管扩张等常规方法治疗;利巴韦林组(n=70)采用传统治疗方法伴以利巴韦林静点治疗;α-IFN组(n=70)采用传统治疗方法伴以α-IFN肌注治疗,两两比较不同组别的临床治疗指标及疗效的情况.结果 利巴韦林组及α-IFN组与对照组相比,在咳嗽、喘息、肺部罗音消失时间和住院天数明显缩短(P＜0.05).利巴韦林组及α-IFN组与对照组相比,总有效率提高显著(P＜0.05).结论 利巴韦林与α-IFN在治疗偏肺病毒感染引起的小儿毛细支气管炎上,具有改善临床治疗指标、提高总有效率的作用.     

Use of erythropoietin in the treatment of anemia induced by ribavirin/interferon in patients with hepatitis C

We are presenting 20 patients with hepatitis C, who developed anemia on interferon alpha-2b/ribavirin treatment and were treated with recombinant human c alpha. Median age was 43 years (range 25-72). Four patients received previous treatment. Interferon-alpha-2b was given at six million units three times a week to 10 patients and at three million units three times a week to five patients. PEG-interferon-alpha-2b (80-120 mug/week) was given to five patients. The dose of ribavirin was 800-1200 mg/day (19 patients) and 200 mg/day (one patient with renal failure). Duration of an interferon/ribavirin treatment was 6-12 months. Baseline median hemoglobin was 13.3 g/dl (range 12.2-15.8); median hemoglobin nadir: 9.8 g/dl (range 8.4-11.2). On erythropoietin, the hemoglobin increased to median 11.7 g/dl (range 9.6-12.8). The ribavirin dose had been decreased to 800 mg in four patients, to 600 mg in four patients, to 400 mg in one patient. Thirteen patients responded to interferon/ribavirin treatment, six patients (all genotype 1) did not. Of the 13 initial responders 11 had sustained response, one still under treatment and two patients relapsed. In conclusion, in our patients with chronic hepatitis C treated with interferon/ribavirin combination therapy, erythropoietin was beneficial in the treatment of ribavirin-induced anemia.     

HLA-A、B基因多态性与遵义地区汉族人群肾综合征出血热的相关性研究

目的 探讨HLA-A、B基因多态性与遵义地区汉族人群肾综合征出血热(HFRS)的关联性.方法 采用群体研究方法,应用聚合酶链反应-序列特异性引物(PCR-SSP)技术对100例肾综合征出血热患者和100例健康对照者进行HLA-A、B基因分型,比较其等位基因频率(GF),并计算其相对危险度(RR).结果 肾综合征出血热患者组中,HLA-A*31、B*58的等位基因的基因频率分别为4%、l2.5%,较健康对照组的0、5%明显增高,两组比较差异具有统计学意义(X2值分别为6.380和7.792,P<0.05,RR值分别为18.47、2.91);患者组中HLA-B*40等位基冈的基因频率(11%)显著低于健康对照组(19%),两者之问差异具有统计学意义(X2=6.095,P<0.01,RR值为0.47).结论 研究提示在遵义地区汉族人群中,初步认为HLA-A*31、B*58基因与HFRS呈正相关,HLA-B*40基因与HFRS呈负相关.     

Role of erythrocytes as a reservoir for ribavirin and relationship with adverse reactions in the early phase of interferon combination therapy for chronic hepatitis C virus infections

We investigated the relationship between serum ribavirin concentrations and clearance, as well as therapeutic efficacy and adverse reactions, in 97 Japanese patients with chronic hepatitis C virus infections treated with a 6-month course of high-dose alpha2b interferon (6 million units/day) plus ribavirin (600 to 800 mg/day) combination therapy. This randomized trial showed that the saturation of ribavirin uptake after taking ribavirin capsules does not occur within a dose range of 600 to 800 mg/day, which is a standard dosage used clinically in Japan. Serum ribavirin concentrations and clearance did not correlate with sustained virological response rates. Fourteen patients discontinued therapy because of adverse reactions, and sustained virological response rates were significantly reduced by discontinuation of therapy, while dose reduction of ribavirin did not alter the therapeutic effects. Ribavirin concentrations after 1 week and ribavirin clearance were significantly correlated with discontinuation of ribavirin; however, a multiple-regression analysis revealed that only hemoglobin concentration, but not ribavirin clearance, was a significant factor for discontinuation of therapy (odds ratio, 0.514; 95% confidence interval, 0.311 to 0.85; P = 0.0095). It appears that peripheral erythrocytes may act as a reservoir for ribavirin and regulate serum ribavirin levels in the very early phase of treatment.     

Renoprotective effect of a dopamine D3 receptor antagonist in experimental type II diabetes

Diabetic nephropathy is the leading cause of end-stage renal disease. Dopamine receptors are involved in the regulation of renal hemodynamics and may play a role in diabetes-induced hyperfiltration. To test this hypothesis, we investigated the renal effect of a dopamine D3 receptor antagonist (D3-RA) in hypertensive type II diabetic SHR/N-cp rats. Lean and obese SHR/N-cp rats were randomly assigned to D3-RA, angiotensin-converting enzyme inhibitor (ACE-i), or D3-RA+ACE-i treatment or control conditions. Treated animals were given the D3-RA A-437203 (10 mg/kg/body weight (BW)/day) or the ACE-i trandolapril (0.3 mg/kg BW/day) or a combination of both. At 6 months following perfusion, fixed kidneys were analyzed by morphological and stereological methods. Indices of renal damage (glomerulosclerosis, glomerulosclerosis damage index (GSI), tubulointerstitial and vascular damage), glomerular geometry and functional variables such as urinary albumin excretion, glomerular filtration rate, blood pressure, blood chemistry and BW were determined. The GSI (score 0-4) was significantly higher (P<0.05) in untreated diabetic animals (1.62+/-0.3) compared to nondiabetic controls (0.4+/-0.2) and the treatment groups (D3-RA: 0.31+/-0.12; ACE-i: 0.29+/-0.1; combination treatment: 0.12+/-0.01). Urinary albumin excretion (mg/24 h) was higher in untreated diabetic controls (102+/-19) compared to nondiabetic controls (31+/-12) and the treatment groups (D3-RA: 44+/-15; ACE-i: 41+/-13; combination treatment: 15+/-8). Mean glomerular volume was higher in untreated diabetic animals compared to nondiabetic controls and to the treatment groups. Desmin expression, a marker of podocyte damage, was elevated in untreated diabetic controls and diminished in all treatment groups. These data suggest that in a model of type II diabetes, the dopamine D3-RA had a beneficial effect on renal morphology and albuminuria, which was comparable in magnitude to that of ACE-i treatment.     

The time-course of ribavirin-provoked changes of basal and AMPH-induced motor activities in rats

The time-course of changes of basal and amphetamine (AMPH)-induced locomotor and stereotypic activities in adult male Wistar rats after a single ribavirin injection was studied. In the first set of experiments, 10, 20 or 30 mg ribavirin/kg body weight (b.w.) were injected i.p. to rats and their basal motor activities were recorded every 10 min for 2 h and compared with those of saline-treated controls. In the second set of experiments, the animals were pretreated with ribavirin and 20 min later i.p. injected with AMPH (1.5 mg/kg b.w.). The controls received AMPH 20 min after the saline injection. Motor activity was recorded after the first injection and until 120 min after AMPH administration. Ribavirin did not significantly affect the time-course of either basal locomotor or stereotypic activities. Pretreatment with any of the applied ribavirin doses decreased the AMPH-induced hyperlocomotor response. However, the most pronounced effect was observed with ribavirin doses of 20 mg/kg and 30 mg/kg when administered during the first 10 min and 30 min after the AMPH injection respectively. In contrast, the stereotypic activities of these animals were only slightly changed. These results indicate a different susceptibility of regions in the basal ganglia to ribavirin.