炎琥宁雾化吸入对支气管哮喘急性发作期患者临床症状和炎症反应的影响

目的观察炎琥宁雾化吸入对支气管哮喘急性发作期患者临床症状和炎症反应的影响。方法将100例支气管哮喘急性发作期患者随机平均分为常规治疗组(对照组)和炎琥宁雾化吸入+常规治疗组(观察组)。分别在治疗前和治疗3天后对患者第1s用力呼气容积(FEV1)占预计值%(FEV1%)、FEV1/FVC%和最大呼气流量(PEF)个人最佳值%(PEF%)进行检测,并对患者血中IL-4、IL-5和IL-13水平进行测定。结果两组患者在治疗3天后肺功能指标(FEV1%、FEV1/FVC%及PEF%)及血中IL-4、IL-5和IL-13水平均有显著改善,差异均有统计学意义(P<0.05)。与对照组相比较,观察组患者肺功能指标(FEV1%、FEV1/FVC%及PEF%)及血中TNF-α、IL-4、和IL-13水平改善更加显著,差异均有统计学意义(P<0.05)。结论炎琥宁雾化吸入可以有效的改善支气管哮喘急性发作期患者的肺功能状态,同时炎琥宁对支气管哮喘相关的炎症反应亦有显著的抑制作用。为进一步推广炎琥宁雾化吸入治疗支气管哮喘奠定了临床基础。     

支气管哮喘患者呼出气一氧化氮与血IgE和肺功能水平的相关性

目的探讨支气管哮喘患者呼出气一氧化氮水平(FeNO)与血IgE、肺功能中第1秒用力呼气量占预计值百分比(FEV1%)水平及相关性。方法选取70例支气管哮喘患者(34例为急性发作期、36例为缓解期)、30例正常对照者分别测定FeNO、外周血清总IgE及FEV1%水平进行统计学分析。结果 70例确诊支气管哮喘患者的FeNO、血IgE和FEV1%水平分别与30例正常对照者比较,差异有统计学意义(P<0.05);哮喘缓解期患者FeNO、血IgE较急性期患者显著下降,FEV1%回升,但哮喘缓解期患者与正常对照者比较,FeNO及血IgE差异仍有统计学意义(P<0.05),FEV1%差异无统计学意义(P>0.05);哮喘患者FeNO水平与血IgE含量呈正相关(r=0.648、P<0.05),而与FEV1%呈负相关(r=-0.436、P<0.05)。结论哮喘患者FeNO及血IgE水平均显著升高,且两者变化呈正相关,FeNO及血IgE含量变化与哮喘患者病情严重程度密切相关,动态检测可为临床提供有意义的参考指标。而FEV1%仅于哮喘急性发作期明显变化,在缓解期与健康人无特异改变,说明FEV1%不能作为气道炎症程度的评价。     

细辛脑注射液雾化吸入对支气管哮喘急性发作期疗效

目的:观察细辛脑注射液雾化吸入对支气管哮喘急性发作期的临床疗效。方法:将支气管哮喘急性发作期患者随机分为对照组和治疗组(各60例),对照组给予传统治疗和沙丁胺醇、布地奈德联合雾化吸入;治疗组在前者治疗基础上将雾化液中的沙丁胺醇和布地奈德剂量减半,同时加入细辛脑注射液。将两组治疗72h前后的临床症状、体征、动脉氧分压(PaO2)及第1s用力呼气容积(FEV1)、呼气峰流速(PEF)变化进行比较。结果:对照组和治疗组总体有效率分别为76.7%、95.0%,差异存在统计学意义(χ2=7.535,P=0.024)。与对照组比较,治疗组的PaO2、FEV1及PEF指标改善更为明显(t=2.035~3.163,均P<0.05)。结论:细辛脑注射液雾化吸入对支气管哮喘急性发作期患者疗效确切,与沙丁胺醇和布地奈德联合雾化具有协同作用,安全方便,可以较快缓解症状。     

FeNO检测在评价老年支气管哮喘疗效中的应用价值

目的 分析呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)水平对老年支气管哮喘治疗效果的评估价值.方法 选取120例老年支气管哮喘患者(急性发作期组74例、缓解期组46例)及60例健康老年人(对照组)作为研究对象,对比3组第1秒用力呼气容积(FEV1)占预计值的百分比、FEV1/用力肺活量(FVC)值及FeNO值差异,并分析急性发作期患者治疗前、后不同时间的肺功能指标、哮喘控制(ACT)评分及FeNO水平的变化情况.结果 急性发作期组FEV1％、FEV1/FVC水平明显低于缓解期组和对照组(P＜0.05),FeNO水平明显高于缓解期组和对照组(P＜0.05);缓解期组FEV1％、FEV1/FVC水平明显低于对照组(P＜0.05),FeNO水平明显高于对照组(P＜0.05).急性发作期老年支气管哮喘患者治疗后1、3、6个月的FEV1％、FEV1/FVC、ACT评分均较治疗前明显升高(P＜0.05),FeNO水平较治疗前明显降低(P＜0.05).急性发作期老年支气管哮喘患者的FeNO水平与ACT评分呈负相关(r=-0.519,P＜0.001).结论 FeNO是反映老年支气管哮喘急性期炎症损伤的重要指标,其变化对于评估哮喘的临床转归具有重要参考价值.     

支气管哮喘患者外周血中IL-33水平的检测及其在支气管哮喘发病机制中的作用

目的：检测支气管哮喘患者外周血中血清白细胞介素33(IL-33) 的水平,探讨其与哮喘患者肺功能、免疫球蛋白 E(IgE)的关系及其在支气管哮喘发病机制中的作用。方法：选择50 例支气管哮喘患者作为实验组,均行肺功能及IgE水平检测,依据血清IgE水平将哮喘患者分为IgE升高组(n=25)和IgE正常组(n=25),另外选取20名健康对照者作为健康对照组,采用ELISA 法检测受试者外周血中血清IL-33 水平,比较健康者和哮喘患者急性发作期及临床控制期血清IL-33水平、第1秒用力呼气容积(FEV1)和呼气峰流速(PEF);分析IL-33水平与肺功能和IgE水平的相关性。结果：支气管哮喘急性发作期患者血清IL-33水平明显高于健康对照组(P<0.05);IgE升高组患者血清IL-33高于IgE正常组(P<0.05);临床控制期患者血清IL-33水平低于急性发作期者 (P<0.05),但高于健康对照组(P<0.05)。哮喘急性发作期患者血清IL-33与患者FEV1和PEF均呈明显负相关关系(r=－0.413,P=0.003;r=－0.504,P<0.001);哮喘临床控制期患者血清IL-33水平与患者FEV1和PEF 亦呈负相关关系(r=－0.386,P=0.006;r=－0.324,P=0.022)。结论： IL-33作为一种炎性因子参与了哮喘的免疫-炎症反应机制,并可能加剧哮喘患者肺功能恶化。     

哮喘患者呼气峰流速自我监测对气道炎症变化的影响

目的:探讨哮喘患者呼气峰流速(PEF)自我监测对降低气道炎症的效果。方法:招募中日友好医院呼吸与危重症医学科哮喘专病门诊60例支气管哮喘非急性发作期患者,随机分成对照组和观察组,2组均行规范化治疗,观察组在对照组的基础上进行自我监测PEF,比较2组患者治疗3个月后呼出气一氧化氮(FeNO)及外周血嗜酸粒细胞计数(EOS)指标的变化。结果:观察组和对照组治疗后的FeNO水平和外周血EOS水平均较治疗前显著降低(均P<0.01)。观察组FeNO下降的幅度与对照组相比,差异有统计学意义(P<0.05)。结论:哮喘患者自我监测呼气峰流速对降低气道炎症有帮助。     

支气管哮喘症状长期缓解患者肺功能与气道炎症的关系

目的:探讨支气管哮喘临床症状长期缓解患者肺功能与气道炎症的关系。方法:20例成年支气管哮喘临床缓解期患者行肺功能测定,酶联免疫吸附法(ELISA)测定外周血干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)水平,并与47例健康体检者进行比较。结果:哮喘缓解期患者(FEV1/FVC)%<70%者13例,FEV1<80%预计值者14例,FEV1、PEF、FEF25、FEF50、FEF75显著低于对照组(P<0.01)。哮喘患者血浆IL-4水平显著高于对照组(P<0.01),IFN-γ/IL-4显著降低(P<0.05)。IFN-γ/IL-4与FEV1、PEF呈显著负相关(P<0.01)。结论:临床症状长期缓解的哮喘患者仍可能存在肺功能损害,气道炎症和Th1/Th2平衡紊乱持续存在。     

噻托溴铵联合沙美特罗替卡松对支气管哮喘患者炎症因子指标及不良反应的影响

目的 探讨噻托溴铵联合沙美特罗替卡松对支气管哮喘患者炎症因子指标及不良反应的影响。方法 选取2018年9月至2020年5月本院收治的107例支气管哮喘患者作为研究对象,按照随机数字表法分为研究组（n=53）和对照组（n=54）。对照组采用沙美特罗替卡松治疗,研究组采用噻托溴铵联合沙美特罗替卡松治疗。比较两组炎症因子指标[白细胞介素-5(IL-5)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)、白细胞介素-13(IL-13)]、呼出气一氧化氮（FeNO）、呼气峰流量（PEF）、第1秒用力呼气容积（FEV1）水平及不良反应情况。结果 治疗后,两组IL-5、IL-8、IL-10及IL-13水平均低于治疗前,且研究组低于对照组（P<0.05）。治疗后,两组FeNO均低于治疗前,PEF、FEV1均高于治疗前,且研究组FeNO低于对照组,PEF、FEV1均高于对照组（P<0.05）。两组不良反应发生率比较差异无统计学意义。结论 噻托溴铵联合沙美特罗替卡松可降低支气管哮喘患者的血清炎症因子及FeNO水平,有利于改善气道症状,且安全性较高,值得临床推广运用。     

苏沈九宝汤对支气管哮喘急性发作患者Th1/Th2因子的影响

目的 观察苏沈九宝汤治疗支气管哮喘急性发作期的临床疗效和对Th1/Th2因子的影响。方法 选取2022年2月至2023年5月于浙江中医药大学附属四省边际中医院诊治的98例支气管哮喘急性发作期患者,根据随机数字表法将其分为治疗组和对照组,每组各49例。对照组患者给予吸氧、雾化等常规治疗,治疗组患者在对照组基础上加用苏沈九宝汤。比较两组患者的临床疗效、中医证候积分、肺功能指标[第一秒用力呼气量（forced expiratory volume in first second,FEV1）、呼气流量峰值（peak expiratory flow,PEF）]和实验室指标[白细胞介素（interleukin,IL）-4、IL-13、γ干扰素（interferon-γ,IFN-γ）、免疫球蛋白E（immunoglobulin E,IgE）]。结果 治疗组患者的总有效率显著高于对照组（χ2=9.287,P=0.010）;治疗后,两组患者的中医证候积分、血清IL-4、IL-13、IgE水平均显著低于本组治疗前,FEV1、PEF、IFN-γ水平均显著高于本组治疗前（P<0.05）,治疗组患者的中医证候积分、血清IL-4、IL-13、IgE水平均显著低于对照组,FEV1、PEF、IFN-γ水平均显著高于对照组（P<0.05）。结论 苏沈九宝汤治疗支气管哮喘急性发作,可显著提高临床疗效,降低患者的炎症因子水平,改善肺功能。     

支气管哮喘患者诱导痰上清白细胞介素-17及38的表达水平及其临床意义

目的 探讨支气管哮喘患者诱导痰上清白细胞介素(IL)-17、IL-38水平及其临床意义.方法 选取40例支气管哮喘患者作为观察组,40例健康体检者作为对照组,单次采集对照组患者的诱导痰上清,并分别于哮喘急性发作期与治疗缓解期时采集观察组的诱导痰上清.分别比较两组诱导痰上清中IL-17、IL-38水平,并分析观察组IL-17、IL-38与各肺功能指标间的相关性.结果 观察组患者哮喘急性发作期时诱导痰上清中的IL-17水平高于缓解期水平及对照组,IL-38水平低于缓解期水平及对照组(P<0.05);观察组患者哮喘治疗缓解期时IL-38水平也低于对照组(P<0.05).急性发作期,哮喘患者诱导痰上清中IL-17水平与IL-38水平呈负相关,IL-17水平与第1秒用力呼气量(FEV1)、用力肺活量(FVC)、FEV1/FVC、呼气流量峰值(PEF)、用力呼气50%肺活量的瞬间流量(FEF50%)、用力呼气75%肺活量的瞬间流量(FEF75%)、FEV1与预测值百分比、PEF与预测值百分比、FEF50%与预测值百分比呈负相关,IL-38水平与以上指标均呈正相关(均P<0.05).而临床缓解期哮喘患者IL-17、IL-38水平与以上各肺功能指标均无相关性(P>0.05).结论 支气管哮喘患者诱导痰上清IL-17水平升高,IL-18水平降低,IL-17、IL-38可能参与哮喘的发病,且在一定程度上反映哮喘的严重程度.     

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.     

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.     

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.