老年不稳定型心绞痛患者外周血内脏脂肪素水平的改变及意义

目的观察内脏脂肪素在老年不稳定型心绞痛(UA)外周血水平的变化,探讨其与炎症因子及相关黏附分子之间的相关性。方法比较UA患者44例(观察组)及稳定型心绞痛(SA)42例(对照组)两组血脂指标、内脏脂肪素、炎症性因子、可溶性血管细胞间黏附分子(sVCAM)-1、可溶性细胞间黏附分子(sICAM)-1水平;并采用Pearson相关检验对内脏脂肪素与肿瘤坏死因子(TNF)-α、sVCAM-1、sICAM-1进行相关性分析。结果两组血脂指标总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、白细胞介素(IL)-10水平无显著差异(均P>0.05);观察组内脏脂肪素、VCAM-1、sICAM-1、TNF-α水平显著高于对照组(P<0.05);相关性分析显示UA患者内脏脂肪素水平与TNF-α(r=0.693,P<0.01)、sVCAM-1(r=0.722,P<0.01)及sICAM-1(r=0.708,P<0.01)呈正相关。结论 UA患者体内内脏脂肪素水平比SA患者高,并且与TNF-α、VCAM-1、sICAM-1呈正相关,说明内脏脂肪素与血管内皮损伤有关,可作为预测不稳定斑块的指标。     

血清同型半胱氨酸、高敏C反应蛋白水平与冠心病的关系

目的探讨血清同型半胱氨酸(HCY)、高敏C反应蛋白(hs-CRP)水平与冠心病(CHD)患者病情严重性和冠状动脉病变支数的关系。方法选取疑似或已确诊CHD接受冠脉造影的197例患者,其中急性心肌梗死(AMI)51例、不稳定型心绞痛(UA)56例、稳定型心绞痛(SA)40例、非冠心病(NCHD)50例。采用循环酶法测定HCY,乳胶增强免疫比浊定量法测定hs-CRP水平。结果SA组、UA组、AMI组HCY及hs-CRP水平均高于NCHD组(P<0.0 1);UA组、AMI组HCY水平高于SA组(P<0.01);hs-CRP水平AMI组>UA组>SA组(P<0.01);随着冠状动脉病变的发展,单支病变、双支病变到三支病变,HCY、hs-CRP的水平也随之升高(P<0.05),且二者与冠脉病变支数相关(r分别为0.498、0.679,P<0.01);CHD患者血清HCY与hs-CRP呈正相关(r=0.880,P<0.01)。结论血清HCY和hs-CRP水平与CHD病情严重性及冠脉病变支数相关,HCY与hs-CRP具有相关性。联合检测血清HCY和hs-CRP水平,可更好地了解病情、指导治疗及判断预后。     

替罗非班联合瑞舒伐他汀治疗不稳定型心绞痛患者的疗效及安全性评价

目的评价替罗非班联合瑞舒伐他汀治疗不稳定型心绞痛(UA)患者的临床疗效及安全性。方法 89例UA患者随机分为治疗组和对照组。对照组采用常规治疗方式,治疗组在对照组的基础上加用替罗非班治疗,治疗1个疗程后比较治疗前后两组患者的可溶性OX40配体(OX40L)、超敏C反应蛋白(hs-CRP)、细胞间黏附分子-1(s ICAM-1)、血管细胞黏附分子-1(s VCAM-1)及P-选择素(s P-selectin)的水平,住院期间主要不良心脏事件(MACE)及安全性指标的情况。结果治疗1个疗程后,两组患者的OX40L、hs-CRP、s ICAM-1、s VCAM-1、s P-selectin水平较治疗前均明显降低(P<0.05或P<0.01),治疗后两组比较差异有统计学意义(P<0.05或P<0.01)。两组患者住院期间的MACE和出血时间无显著差异(P>0.05)。结论替罗非班联合瑞舒伐他汀对UA具有较好的治疗作用,而且不增加出血事件发生率,是一种安全有效的辅助治疗方法。     

高敏C反应蛋白、血浆脑钠肽与急性冠脉综合征严重程度的关系

目的探讨急性冠脉综合征（ACS）患者冠状动脉粥样硬化程度与高敏C反应蛋白（hs-CRP）、血浆脑钠肽（BNP）的相关性。方法选择143例冠心病患者分为稳定型心绞痛（SA）组、不稳定型心绞痛（UA）组和急性心肌梗死（AMI）组。采用Leaman积分法评价冠脉病变的严重程度,同时测定患者血浆BNP、hs-CRP水平和左室射血分数（LVEF）,分析血浆BNP、hs-CRP水平与冠心病临床严重程度及冠脉造影Leaman积分之间的关系。结果ACS各组hs-CRP、BNP值、冠脉Leaman积分均显著高于稳定型心绞痛组,ACS各组LVEF低于SA组,AMI组hs-CRP、BNP显著高于不稳定型心绞痛组（P〈0.01）。ACS组血浆BNP水平与LVEF呈负相关（r=-0.499 0,P〈0.01）,与血管病变支数呈正相关（r=0.347 0,P〈0.05）,与冠脉积分呈正相关（r=0.798 4,P〈0.01）。结论ACS患者血浆BNP、hs-CRP与冠脉病变程度存在相关性,BNP、hs-CRP水平可反映心肌受损的程度。     

老年骨折延迟愈合患者血清IGF-1、sICAM-1、sVCAM-1、β-CTX水平的表达及临床意义

目的探讨老年骨折延迟愈合患者血清胰岛素样生长因子(IGF)-1、人可溶性细胞间黏附分子(s ICAM)-1、血清可溶性血管细胞黏附分子(s VCAM)-1和I型胶原羧基端肽β特殊序列(β-CTX)水平及临床意义。方法老年骨折延迟愈合患者60例作为研究组,另选取同期收治的骨折正常愈合老年患者60例作为对照组。分别于骨折后1、6、12 w应用双抗体酶联免疫吸附试验检测血清IGF-1、s ICAM-1、s VCAM-1和β-CTX水平,并对比不同年龄、不同骨折类型骨折延迟愈合患者血清IGF-1、s ICAM-1、s VCAM-1和β-CTX水平,采用Pearson相关分析IGF-1、s ICAM-1、s VCAM-1和β-CTX水平与年龄、骨折类型的相关性。结果骨折后6 w、12 w两组患者血清IGF-1和β-CTX水平较骨折后1 w升高,s ICAM-1、s VCAM-1水平较骨折后1 w降低(P<0.05),研究组血清IGF-1和β-CTX水平低于对照组,s ICAM-1、s VCAM-1水平高于对照组(P<0.05)。骨折后6 w、12 w 60~70岁组血清IGF-1和β-CTX水平高于>70岁组,s ICAM-1、s VCAM-1水平低于>70岁组(P<0.05)。闭合性骨折、开放性骨折患者各时间段血清IGF-1、s ICAM-1、s VCAM-1和β-CTX水平比较无统计学意义(P>0.05)。骨折延迟愈合患者血清IGF-1和β-CTX与年龄呈负相关(r=-0.523,-0.571,P=0.018,0.015),血清s ICAM-1、s VCAM-1与年龄呈正相关(r=0.489,0.478,P=0.022,0.025),血清IGF-1、s ICAM-1、s VCAM-1和β-CTX与骨折类型无相关性(P>0.05)。结论老年骨折延迟愈合患者血清IGF-1、β-CTX明显降低,s ICAM-1、s VCAM-1明显升高,其水平与骨折延迟愈合密切相关,是反映骨折延迟愈合的良好指标。     

稳心颗粒对不稳定型心绞痛病人hs-CRP、IL-6、TNF-α及sICAM-1的影响

目的研究稳心颗粒对不稳定型心绞痛(UA)病人高敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及细胞间黏附分子-1(sICAM-1)的影响。方法采用ELISA法测定48例不稳定型心绞痛病人、36例稳定型心绞痛(SA)病人和20名健康者(对照组)血清hs-CRP、IL-6、TNF-α、sICAM-1及血管细胞黏附分子-1(sVCAM-1)浓度。对UA病人予以稳心颗粒每次9g,口服,每日3次,疗程8周~12周,观察治疗前后hs-CRP、IL-6、TNF-α、sICAM-1及sVCAM-1的变化。结果UA组病人hs-CRP、IL-6、TNF-α、sICAM-1及sVCAM-1水平高于SA组(P<0.05)和对照组(P<0.01),而SA组与对照组比较无统计学意义(P>0.05)。治疗后UA病人血清hs-CRP、IL-6、TNF-α、sICAM-1及sVCAM-1水平显著降低(P<0.05)。结论UA病人体内存在着炎性反应,可能与其冠状动脉病变的不稳定性有关,稳心颗粒具有抗炎、稳定斑块等作用。     

稳定型与不稳定型心绞痛患者颈动脉硬化斑块新生血管超声造影特点的对比研究

目的:探讨稳定型与不稳定型心绞痛患者颈动脉粥样硬化(CAS)斑块内新生血管超声造影(CEUS)特征性改变。方法:对临床经心电图、动态心电图或平板运动试验心电图诊断的冠心病患者111例,其中稳定型心绞痛(SA)患者53例,不稳定型心绞痛(UA)患者58例,分别进行颈动脉彩色多普勒超声及CEUS检查,使用声学定量分析软件(Sono Liver)对图像进行分析,比较斑块达峰时间、最大峰值强度比、曲线下面积,分析斑块内新生血管与SA及UA的相关性,并行血清高敏C反应蛋白(hs-CRP)检测进行对比。结果:UA与SA患者CAS斑块内新生血管显像特征存在差异,UA患者CAS斑块内新生血管等级评分较SA患者中明显增高:UA组斑块内新生血管发生率明显高于SA组(P0.05),UA组达峰时间更快、最大峰值强度比及曲线下面积更大,与SA组相比有统计学意义(P0.05);血清hs-CRP浓度UA组也较SA组升高(P0.05);CAS斑块内新生血管等级评分与血清hs-CRP浓度水平呈正相关。结论:CEUS技术观察CAS斑块内新生血管等级评分,为临床对UA进行早期预测及干预,以及对UA预后的判断提供重要的依据。     

急性冠状动脉综合征病人VEGF与VCAM-1水平及其与斑块稳定性的研究

目的观察急性冠状动脉综合征病人血清血管内皮生长因子(VEGF)和血管细胞黏附分子-1(VCAM-1)等指标的水平,探讨两者与斑块稳定性的关系及其临床意义.方法根据临床诊断将研究对象分为急性冠状动脉综合征组(ACS组,30例)和稳定劳累性心绞痛组(SAP组,25例),另设健康对照组(30名),测定上述观测者入院血清VEGF、VCAM-1、肌酸激酶(CK)及其同工酶(CK-MB)的水平.结果 ACS组病人血清VEGF、VCAM-1、CK﹑CK-MB水平均显著高于SAP组和健康对照组.血清VEGF的水平与血清VCAM-1水平和CK-MB水平之间有相关性(r＝0.233,P＜0.05;r＝0.547,P＜0.01),与CK水平之间无相关性(r＝-0.139,P>0.05).结论急性冠状动脉综合征的早期VEGF和VCAM-1血管水平明显升高,对判定斑块稳定性具有一定价值.     

心绞痛病人冠状动脉血管超声特征及与血清炎性因子水平的相关性分析

目的探讨心绞痛病人冠状动脉血管超声特征及与血清炎性因子水平的相关性。方法将37例病人按美国心脏协会(AHA)诊断标准和病人心绞痛临床症状分为稳定型心绞痛组(16例)和不稳定型心绞痛组(21例),检测病人血清超敏C反应蛋白(hs-CRP)水平和血管内超声(IVUS)相关指标及相关性。结果稳定型心绞痛组病变血管斑块类型主要为纤维性斑块,不稳定型心绞痛组主要为脂质性斑块,两组比较差异有统计学意义(P0.05)。不稳定型心绞痛组参考部位重构指数(RI),病变部位斑块面积(PA)、血管弹力膜面积(EEMA)、管腔面积狭窄率(LAS)及偏心指数(EI)与稳定型心绞痛组比较,差异均有统计学意义(P0.05)。两组血清hs-CRP水平比较,差异有统计学意义(P0.05),且不稳定型心绞痛病人EEMA和RI与hs-CRP呈正相关(r=0.623,P=0.003;r=0.537,P=0.012)。结论不稳定型心绞痛病人病变血管以偏心分布的脂质性斑块为主,且有较大的斑块面积和易发生正性重构,病人血清hs-CRP水平与血管重构密切相关。     

内皮微粒与冠心病相关性研究

目的:探讨血浆内皮微粒(EMP)与冠心病的相关性。方法:冠心病组367例,其中稳定型心绞痛(SA)119例,急性冠状动脉综合征(ACS)248例,后者含不稳定型心绞痛(UA)158例,急性心肌梗死(AMI)90例。非冠心病组166例。ELISA法测定血浆ET-1,流式微球技术检测血浆EMP。结果:冠心病组ET-1、EMP水平升高,呈正相关(r=0.233,P=0.001)。ACS组EMP(547.405)显著高于非冠心病组(148.185)及SA组(429.890),亚组分析中UA组EMP(551.660)升高最为显著;冠心病冠状动脉病变支数与EMP无明显相关;AMI患者EMP与BNP、TnT、TnI间无明显相关;EMP与ACS患者短期预后相关(r=0.280,P<0.01)。结论:血浆EMP水平可反映冠心病内皮功能障碍,与冠心病的发生、冠状动脉斑块的不稳定性有关。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

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.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.