钙离子ATP酶2a基因修饰的骨髓干细胞移植治疗大鼠心肌梗死后心力衰竭的研究

目的比较肌浆网钙离子ATP酶2 a(SERCA2 a)基因治疗,骨髓干细胞(MSC)移植以及SERCA2 a基因修饰的细胞移植治疗慢性缺血性心力衰竭的效应,评价MSC作为治疗基因的细胞载体策略的可行性。方法制作心力衰竭大鼠模型并随机分为4组。SERCA2 a基因治疗组(组Ⅰ,7只),MSC细胞移植组(组Ⅱ,7只),基因修饰的细胞移植组(组Ⅲ,8只),腺病毒空载体对照组(组Ⅳ,7只)。检测各组SERCA2 a基因,蛋白表达及活性。超声心动图及有创血流动力学评价心脏功能。HE染色观察心室形态。结果组Ⅰ,组Ⅱ,组Ⅲ比对照组Ⅳ心功能和血流动力学明显改善。治疗后组Ⅱ(2.9 mm±0.2 mm)和组Ⅲ(3.0 mm±0.1 mm)大鼠室壁厚度增加,心室腔减小。治疗后14d组Ⅰ,组Ⅱ与组Ⅲ射血分数(EF)为26.6%±3.9%,20.6%±5.0%,25.6%±2.7%。短轴缩短率(FS)分别为13.3%±2.0%,10.1%±2.5%,12.1%±1.0%(P<0.05)。治疗后21 d组Ⅰ,组Ⅱ与组ⅢEF分别为19.7%±5.0%,21.4%±5.2%,26.6%±4.1%,FS分别为9.7%±2.5%,10.7%±2.6%,12.8%±2.2%(P<0.05)。组Ⅳ治疗后14 d EF无变化,治疗后21 d EF下降了6.6%±4.0%。组Ⅰ和组ⅢSERCA2 a基因,蛋白表达及酶活性均高于组Ⅱ和组Ⅳ(P<0.01)。结论MSC移植和SERCA2 a基因修饰的细胞移植组大鼠呈现稳定持续的心功能改善作用。MSC可以作为治疗基因的有效转移载体。     

胸腔镜与引流术治疗非小细胞肺癌伴恶性胸腔积液对比研究

目的评价胸腔镜术在综合治疗肺癌伴恶性胸腔积液中的临床价值和手术适应证。方法53例非小细胞肺癌并恶性胸腔积液患者被单盲随机分为胸腔镜手术组(胸腔镜组)和闭式引流术组(引流组),两组均应用泰素联合伯尔定方案行全身化疗4个疗程观察,以胸腔积液疗效,生存质量和生存率为评价指标。结果胸腔镜组胸液控制有效率为92.3%,完全缓解率为88.5%;引流组有效率为59.3%,完全缓解率为44.4%,差异有统计学意义(P<0.05);每组治疗前后KPS评分差值的中位数在胸腔镜组为30分,均数为33.5±11.3,引流组中位数为20分,均数为24.07±10.5,两组差异有统计学意义(P<0.05)。随访到2005年8月,随访率100%,胸腔镜组中位生存时间为20个月,1年生存率65.4%,2年生存率38.5%,3年生存率22.4%;引流组中位生存时间为15个月,1年生存率59.3%,2年生存率25.9%,3年生存率14.8%,两组差异无统计学意义(P>0.05)。结论在非小细胞肺癌并恶性胸腔积液的综合治疗中,胸腔镜胸膜剥除术在有效控制恶性胸腔积液、提高患者生存质量方面明显优于胸腔闭式引流术,但在生存率方面无明显差异。除Ⅳ级胸腔积液外,Ⅰ、Ⅱ、Ⅲ级均为手术适应证。     

帕罗西汀对应激抑郁模型大鼠脑区蛋白激酶PKA、PKC和CaMKII活力的影响

目的 探讨帕罗西汀对应激抑郁模型大鼠脑区蛋白激酶PKA、PKC和CaMKII活力的影响.方法 将成年雄性SD大鼠随机分为6组:对照组(Ⅰ)、抑郁模型组(Ⅱ)、抑郁模型 给药1次组(Ⅲ)、抑郁模型 给药1周组(Ⅳ)、抑郁模型 给药2周组(Ⅴ)和抑郁模型 给药4周组(Ⅵ).抑郁模型为强迫大鼠游泳4周.采用同位素法检测蛋白激酶PKA、PKC和CaMKII的活力.结果 (1)在海马,Ⅱ、Ⅲ、Ⅳ、及Ⅴ组大鼠PKA[分别为(3.92±0,23)×10-2,(3.68±0.092)×10-2,(3.56±0.1)×10-2,和(3.52±0.18)×10-2]和CaMKII[分别为(12.89±0.31)×10-2,(15.08±2.07)×10-2,(16.32±2.87)×10-2,和(17.00±1.52)×10-2]活力明显低于Ⅰ组[PKA(5.63±0.41)×10-2;CaMKII(48.91±1.86)×10-2]和Ⅵ组[PKA(4.92±0.36)×10-2;CaMKII(46.74±1.34)×10-2(P<0.01或P<0.05);Ⅱ组大鼠PKC的活力[(0.55±0.017)×10-2]明显低于对照组[(1.48±0.27)×10-2](P<0.01),各用药组大鼠海马PKC活力与对照组比较差异无统计学意义(P>0.05)(2)在前额叶皮质,Ⅱ、Ⅲ,Ⅳ组大鼠PKA活力[分别为(0.9±0.027)×10-2,(0.92±0.081)×10-2,(0.92±0.028)×10-2]与对照组[(0.99±0.072)×10-2]比较差异无统计学意义(P>0.05);而V[(1.14±0.045)×10-2和Ⅵ[(1.27±0.040)×10-2组的PKA活性则显著高于其它四组(P<0.01);Ⅱ和Ⅲ组的PKC活性[分别为(0.15±0.013)×10-2,(0.14±0.007)×10-2)]均显著高于对照组[(0.099±0.0007)×10-2]和其它用药组(P<0.01),Ⅳ组PKC活性[(0.1±0.0006)x10-2]与Ⅰ组比较差异无统计学意义(P>0.05),Ⅴ和Ⅵ组PKC活性[分别为(0.077±0.0005)×10-2,(0.03±0.00017)×10-2]显著低于Ⅰ组(P<0.01);模型组[(6.84±0.22)×10-2]和各用药组[分别为(6.68±0.23)×10-2,(6.89±0.15)×10-2,(6.55±0.14)×10-2,(6.53±0.13)×10-2]的CaMKII活性显著低于埘照组[(16.57±0.19)×10-2](P<0.01).结论 帕罗西汀长期用药逆转慢性应激所致大鼠海鸟PKA、PKC和CaMKII活力降低,而对前额叶皮质PKA、PKC和CaMKII活力改变的作用复杂.     

卵巢癌细胞对T细胞信号转导途径JAK-STAT的影响

目的　通过研究卵巢癌细胞对T细胞信号转导途径JAK STAT的影响 ,探讨其在卵巢癌免疫抑制中的作用。方法　分别采用MTT、流式细胞术、逆转录 聚合酶链反应 (RT PCR)方法观察 3株卵巢癌细胞 (OVCAR3、CAOV3和SKOV3)培养上清液对CD8+ T细胞增殖和细胞周期及分泌细胞因子的影响 ;运用Western印迹方法检测在卵巢癌细胞培养上清液作用后CD8+ T细胞中JAK1、JAK3蛋白的表达和STAT3、STAT5的活化状态。结果　 (1 ) 3株卵巢癌细胞培养上清液皆能抑制CD8+ T细胞增殖 ,并使其阻滞在G1 /G0 期 ,分泌的细胞因子IFN γ显著降低 ,而白细胞介素 (IL) 1 0显著增高 ;(2 )与对照组比较 ,OVCAR3、CAOV3和SKOV3细胞培养上清液均能抑制CD8+ T细胞中JAK3的表达 ,JAK3蛋白平均吸光度 (A)值分别为 0 396± 0 0 1 2 ;0 40 0± 0 0 1 0 ;0 41 6± 0 0 1 5 ;0 656± 0 0 1 5 ;STAT5的活化也明显受抑 ,STAT5蛋白平均A值分别为 0 2 2 0± 0 0 1 0 ;0 2 1 6±0 0 0 5 ;0 2 2 3± 0 0 0 6 ;0 390± 0 0 0 1 ;对JAK1的表达无影响 ,只有OVCAR3细胞培养上清液使STAT3的活化受抑 (0 2 1 0± 0 0 1 0 ;0 393± 0 0 0 7)。结论　卵巢癌能抑制CD8+ T细胞信号转导途径JAK STAT的活化 ,从而抑制其增殖与活化 ,这可能是卵巢癌     

Comparison of palanosetron, granisetron and ondansetron as anti-emetics for prevention of postoperative nausea and vomiting in patients undergoing middle ear surgery

The objective of the study was to compare the efficacy of palanosetron (0.25 mg), granisetron (3.0 mg) and ondansetron (8.0 mg) used as anti-emetics for the prevention of postoperative nausea/vomiting in patients undergoing middle ear surgery. The study was done among 75 adult patients (age group 30-45 years) of which 50 were males and rest (25) females, all of ASA I and ASA II. The patients were randomly allocated into 3 equal groups: Group I (n = 25) received injection palanosetron (0.25 mg) IV, group II (n = 25) received injection granisetron (3 mg) IV and group III (n = 25) received injection ondansetron (8.0 mg) IV at the end of the surgical procedure. A standard general anaesthesia technique was employed. Emetic episodes and safety assessments were performed during two periods of 0-6 hours in the postanaesthesia care unit and 6-24 hours in the ward after anaesthesia. The incidence of emesis-free patients during the 0-6 hours period was 100% for group I; 72% for group II and 56% for group III. During the 6-24 hours period incidence of emesis-free patients were 96% for group I; 56% for group II and 32% for group III. So to conclude, a single dose of palanosetron (0.25 mg) is a superior anti-emetic to granisetron (3.0 mg) or ondansetron (8.0 mg) in complete prevention of postoperative nausea and vomiting after middle ear surgery during the first 24 hours period.     

不同硬膜外给药方式对全子宫切除患者术后镇痛效果的比较

目的　比较不同硬膜外给药方式对子宫切除手术患者术后镇痛效果的影响。方法　对75例择期子宫全切手术的患者 ,随机单盲分为 3组 ,每组 2 5例 ;Ⅰ组为空白对照组 ,切皮前 10min于硬膜外中加用生理盐水 10ml。Ⅱ组切皮前 10min于硬膜外中加用 2 %利多卡因 10ml(其中每ml含芬太尼 2 5 μg) ,后于硬膜外中持续泵入罗哌卡因和芬太尼混合液 (罗哌卡因 0 12 5 % ,芬太尼 2 μg/ml)至手术结束 (速度 9ml/h)。Ⅲ组切皮前 10min于硬膜外中加用 2 %利多卡因 10ml(其中每ml含芬太尼 2 5 μg ,氟哌啶 0 15mg) ,后于硬膜外中持续泵入罗哌卡因和芬太尼的混合液 (罗哌卡因 0 12 5 % ,芬太尼 2 μg/ml) ,至手术结束 (速度 9ml/h)。所有患者均于气管插管全麻下手术。 3组患者均于手术结束后自控硬膜外镇痛 (PCEA) ,微电脑泵为BaxterAP Ⅱ。自控镇痛液为罗哌卡因和芬太尼的混合液 (罗哌卡因浓度 0 12 5 % ,芬太尼 2 μg/ml) ,预充 5ml,背景剂量 3ml/h ,单次自控镇痛 (PCA)剂量 2ml/次 ,锁定时间 10min ,限量 16ml/h ,术后镇痛维持 4 8h。结果　第 1个 2 4h自控镇痛的视觉模拟(VAS)评分静息时Ⅰ组为 2 2分± 1 5分 ,Ⅱ组为 1 4分± 0 78分 ,Ⅲ组为 1 1分± 1 1分 ;Ⅰ组与Ⅱ组比较P <0 0 5 ,I组与Ⅲ组比较P <0 0 1     

顺铂联合重组人白介素-2治疗乳腺癌胸腔积液的临床观察

目的观察胸腔注射白介素-2（IL-2）和顺铂＋IL-2分别治疗乳腺癌恶性胸腔积液的疗效。方法50例乳腺癌伴恶性胸腔积液患者置入胸腹腔引流管（16F）,充分引流出胸水后随机分成两组：IL-2组：50万IU／次,每周2次,连用2周：顺铂＋IL-2组：顺铂40mg／m2＋IL-250万IU,2次／周,连用2周。结果顺铂＋IL-2组有效率92．6％,明显高于IL-2组的43．5％（P〈0．01）。顺铂＋IL-2组胃肠道不适较IL-2组明显。结论顺铂联合lL-2胸腔灌注治疗乳腺癌恶性胸腔积液疗效满意．不良反应可耐受。     

肥厚型心肌病患者左房射血力变化的超声研究

目的：评价肥厚型心肌病（HCM）患者的左房射血力并探讨其意义。方法：使用超声技术测量56例HCM患者和33例正常对照的左房射血力,根据HCM患者左室舒张功能受损程度不同依次分为Ⅰ、Ⅱ、Ⅲ、Ⅳ组。结杲：左房射血力,Ⅱ、Ⅲ组高于正常对照组、Ⅰ组和Ⅳ组,其中Ⅱ组又高于Ⅲ组（P均〈0．05）;肺静脉口A波峰值流速,Ⅱ、Ⅲ、Ⅳ组明显高于正常对照组及Ⅰ组,其中Ⅱ组又高于Ⅳ组（P均〈0．05）;左房泵血量,Ⅱ、Ⅲ组高于正常对照组（P均〈0．05）。结论：多数肥厚型心肌病患者左房射血力代偿性增加,左房射血力受心室顺应性等因素影响。     

子宫内膜异位症患者血清中ENA-78的表达

OBJECTIVE: To investigate the role of serum epithelial neutrophil-activating peptide-78 (ENA-78) in the pathogenesis of endometriosis. METHODS: Serum concentrations of ENA-78 were measured by means of enzyme-linked immunosorbent assay (ELISA) in 42 patients with endometriosis (20 in stages I and II and 22 in stages III and IV) in comparison with 25 women without endometriosis (control group). RESULTS: Serum concentrations of ENA-78 were significantly higher in endometriosis group than in the control group (2.97+/-1.91 ng/ml vs 0.72+/-0.24 ng/ml, P>0.001), and ENA-78 levels in stages III and IV were significantly higher than those in stages I and II (4.48+/-1.25 ng/ml vs 1.30+/-0.74 ng/ml, P>0.001). Significant difference in ENA-78 levels between follicular phase and luteal phase was found in neither of the groups. CONCLUSION: Patients with endometriosis have elevated serum ENA-78 levels, which might be a pathogenic factor of endometriosis.     

Electroanatomical systems to guided circumferential pulmonary veins ablation for atrial fibrillation: initial experience from comparison between the Ensite/NavX and CARTO system

Background The circumferential pulmonary vein ablation (CPVA) has been proved effective for atrial fibrillation (AF) treatment and is becoming more widely accepted and practiced. This study aims to evaluate the characteristics of the CARTO and the Ensite/NavX system and draw a comparison between them on the aspects of procedural parameters and clinical effectiveness.Methods Seventy-five cases with paroxysmal or chronic symptomatic AF were randomly assigned to CPVA procedure guided by the Ensite/NavX system (group Ⅰ, n=40) and by the CARTO system (group Ⅱ, n=35). After successful transseptal procedure, the geometry of left atrium was created under the guidance of the two systems. Radiofrequency energy was applied to circumferentially ablate tissues out of pulmonary veins’ (PVs’) ostia. In cases with chronic AF, linear ablation was applied to modify the substrate of left atrium （LA）. The endpoint of the procedure was complete PVs isolation. Results Seventy-five cases underwent the procedure successfully. The total procedure and fluoroscopic durations in group Ⅱ were significantly shorter than in group Ⅰ ［(150±23) min and (18±17) min versus (170±34) min and (25±16) min, P=0.03 and 0.04, respectively］. There was no significant difference in the fluoroscopic and procedure durations for geometry creation between group Ⅰ and group Ⅱ ［(8±4) min and (16±11) min versus (5±4) min and (14±8) min, respectively］. The fluoroscopic durations for CPVA were (15±5) min in group Ⅰ versus (10±6) min in group Ⅱ (P=0.05), and the CPVA procedural durations were significantly shorter in group Ⅱ than in group Ⅰ ［(18±11) min versus (25±10) min, P=0.04］. AF was terminated by radio frequency delivery in 14 cases (35%) in group Ⅰ versus 5 cases (14%) in group Ⅱ (P=0.035). After CPVA complete PV isolation was attained in 26 cases (65%) in group Ⅰ versus 11 cases (31%) in group Ⅱ (P=0.004). During a mean follow-up of 7 months, 32 (80%) cases in group Ⅰ and 24 (69%) cases in group Ⅱ were arrhythmia-free (P=0.06). One case developed pericardium effusion and another one case was found to have intestinal artery thrombosis in group Ⅱ. One case had moderate hemothorax in group Ⅰ. All the complications were cured by proper treatment. No PV stenosis was observed. Conclusions The CPVA procedure for atrial fibrillation is effective and safe. Although there is difference between the CARTO and the Ensite/NavX system, the CPVA procedure guided by either of them yields similar clinical results.     

低剂量不同浓度盐水对于失血休克家兔血流动力学的影响

目的：研究不同浓度盐水（4.5％与7.5％）对非控制性失血性休克家兔早期复苏效果的影响,尤其是对家兔血流动力学的影响。方法将32只家兔随机分成4组,每组8只,分别为假手术组（SHAM组）、休克未治疗组（SWT组）、4.5％盐水复苏组（4.5％组）、7.5％盐水复苏组（7.5％组）,麻醉后建立非控制性失血性休克模型,在设定时间内,使用预定方案进行液体复苏,监测不同时间点（0min、30min、60min、90min）家兔血流动力学指标（左心室内压（left intraventricular systolic pressure,LVSP）、左心室压力上升或下降的最大速率（the maximal change rate of left intraventricular pressure,±dp/dtmax）的变化情况。结果（1）30min时,SWT、4.5％组、7.5％组各组数值与SHAM组比较,均发生明显改变（P＜0.05）,这三组两两比较无统计学差异（P＞0.05）,表明休克模型复制成功;（2）三种血流动力学指标实验过程中变化趋势比较一致,60min、90min时,SWT组与其他三组相比较,LVSP、±dp/dtmax值明显减小（P＜0.05）;60min时,7.5％组的LVSP、±dp/dtmax值明显大于4.5％组,差异有统计学意义（P＜0.05）;90min时,7.5％组数值略大于4.5％组,但是差异无统计学意义（P＞0.05）。结论采用液体复苏可以改善家兔的血流动力学指标;与4.5％高渗盐水相比,7.5％高渗盐水在改善非控制性失血性休克家兔血流动力学方面作用更为明显,为临床失血性休克伤员的救治提供了一定的数据支持。     

32P-胶体磷酸铬联合p53基因治疗恶性胸腔积液的临床研究

目的观察32P-胶体磷酸铬联合p53基因治疗恶性胸腔积液的近期疗效及毒副作用。方法 42例确诊为单侧恶性胸腔积液的患者,随机分为实验组和对照组。实验组用重组人p53腺病毒注射液联合32P-胶体磷酸铬治疗,对照组单用32P-胶体磷酸铬。所有治疗每月一次,治疗两次后评价疗效。结果实验组总有效率(CR+PR)为81.0%,对照组总有效率(CR+PR)为47.6%。实验组与对照组比较,差异具有统计学意义(x2=5.081,P<0.05)。结论 32P-胶体磷酸铬与p53基因联合治疗可以有效地控制恶性胸腔积液。     

恩丹西酮复合纳络酮预防硬膜外吗啡副作用的临床观察

目的 :观察恩丹西酮、纳络酮联合用药预防硬膜外吗啡镇痛引起的副作用的临床疗效。方法 :选择 80例妇科手术病人随机分为 3组 :A组为对照组 ,B组为恩丹西酮组 ,C组为纳络酮组 ,D组为恩丹西酮复合纳络酮组。所有病人在手术后接受硬膜外吗啡镇痛 ,B、D两组病人在术毕静推恩丹西酮 8mg,C、D两组病人在硬膜外用吗啡的同时加用纳络酮 0 .4mg。结果 :四组病人 48h内镇痛效果无显著性差异 ;B、C、D三组病人术后恶心呕吐 ,皮肤瘙痒发生率与A组相比较有显著性差异(P <0 .0 5 ) ,尤其D组特别明显 ;C、D组尿潴留发生率与A、B两组比较有非常显著性差异 (P <0 .0 1 )。结论 :恩丹西酮与纳络酮联合用药 ,在不改变术后吗啡镇痛效果的同时 ,有效地控制了吗啡引起的副作用     

自体静脉移植与胰岛素样生长因子-Ⅰ重建勃起反射通路的实验研究

目的 探讨自体静脉移植结合使用胰岛素样生长因子-Ⅰ(IGF-Ⅰ)重建勃起反射通路的可行性。方法 将48只雄性成年SD大鼠随机分成4组,每组12只。Ⅰ组:假手术组,只找到双侧海绵体神经(CN)即关闭切口;Ⅱ组:CN离断组,切除大鼠双侧CN约5 mm及其侧支;Ⅲ组:静脉移植 IGF-Ⅰ组,在Ⅱ组的基础上,用大鼠自体静脉移植桥接缺省的CN,并向移植静脉管腔内注射IGF-Ⅰ;Ⅳ组:静脉移植 生理盐水组,用等量的生理盐水代替Ⅲ组的IGF-Ⅰ。4个月后,阿朴吗啡试验评估大鼠的勃起功能;然后在大鼠阴茎海绵体内注射荧光金,对CN逆行追踪。结果 Ⅲ组的勃起率达92％(11/12),明显高于Ⅱ组(50％)和Ⅳ组(O％),P<0.01。荧光显微镜下计数,Ⅲ组盆神经节中荧光金阳性着色细胞数明显多于生理盐水组和CN切断组(P<0.01)。结论 自体静脉移植结合使用IGF-Ⅰ,是一种有效的治疗因CN损伤而致勃起功能障碍的新方法。     

联合检测血清和胸水中多项肿瘤标志物对良恶性胸水的鉴别诊断价值

目的：探讨联合检测血清、胸水（胸腔积液）中人组织多肽特异性抗原（TPS）、可溶性肿瘤坏死因子受体（sTNFR）、恶性肿瘤生长因子（TSGF）、癌胚抗原（CEA）、神经元特异性烯醇化酶（NSE）、细胞角质蛋白19片断（CYFRA21-1）对良恶性胸腔积液的鉴别诊断价值。方法：79例临床已确诊的胸腔积液患者（恶性47例,结核性32例）的血清和胸腔积液采用酶免疫法进行TPS、sTNFR、TSGF、CEA、NSE、CYFRA21-1含量测定。结果：恶性胸腔积液患者的6种肿瘤标志物水平均明显高于良性疾病组,差异有统计学意义（P〈0.05）。联合检测血清及胸腔积液6项指标,平行试验对恶性胸腔积液诊断的敏感度为95.7%,特异度为59.4%,准确度为81.0%,Youden指数为0.6,较检测单一指标提高了诊断的敏感度、准确度及Youden指数;序列试验则对恶性胸腔积液诊断的敏感度为48.9%,特异度为93.8%,准确度为67.1%,Youden指数为0.4,较检测单一指标提高诊断的特异度、准确度及Youden指数。结论：联合检测血清、胸腔积液中TPS、sTNFR、TSGF、CEA、NSE、CYFRA21-1对良恶性胸腔积液的鉴别诊断有重要价值,能提高诊断准确率。     

心率对中心动脉脉压、反搏波增压的影响

目的研究心率对中心动脉脉压、反搏波增压(AUG)的影响。方法选择行冠状动脉造影检查的患者294例,测量中心动脉脉压、反搏波增压及即时心率,按心率(HR)分为三组:HR≤60次/min组,6080次/min组,组间进行比较。结果 294例患者中能够测量出反搏波增压的为207例,占入选观察对象的70.4%。随心率的增加,中心动脉脉压、反搏波增压呈下降趋势。HR≤60次/min组中心动脉脉压与6080次/min组比较均P<0.05;HR≤60次/min组AUG与6080次/min组比较均P<0.05。结论进行有关中心动脉脉压和反搏波增压研究时,应考虑心率的影响。     

流式细胞术检测胸腔积液和外周血T淋巴细胞亚型及比例的研究

目的:探讨流式细胞技术检测恶性、结核性胸腔积液(PE)和外周血中T淋巴细胞亚型及比例的临床意义.方法:用流式细胞技术检测53例为结核性胸腔积液(PE)、62例为恶性积液患者和17例单纯性漏出液的胸水中的T淋巴细胞亚型及比例.结果:结核性胸腔积液患者胸水中淋巴细胞总数高于恶性胸腔积液或单纯漏出性胸腔积液患者(P=0.032),差异有统计学意义.亚型分析表明主要为T淋巴细胞,其中结核性和单纯漏出性胸腔积液的CD4+T细胞和CD4+/CD8+比值明显高于恶性胸腔积液(均为P＜0.05),而恶性胸腔积液患者的CD8+T细胞则明显高于结核性和单纯漏出性胸腔积液的患者(P=0.006).不同细胞亚型在结核性、恶性和单纯漏出性胸腔积液中无明显差别(P＞0.05).结论:结核性和单纯漏出性PE中CD4+T细胞和D4+/CD8+比值高于恶性肿瘤的患者,可作为鉴别诊断的参考.     

马方综合征主动脉根部瘤手术治疗84例经验

目的探讨马方综合征合并主动脉根部瘤手术时机、手术方法和疗效总结。方法1995年2月至2004年10月手术治疗马方综合征主动脉根部瘤84例,其中主动脉夹层41例(DebakeyⅠ型32例、DebakeyⅡ型9例),根部瘤合并中～重度主动脉瓣关闭不全52例,根部瘤直径平均68mm±14mm;术前心功能(NYHA)Ⅰ～Ⅱ级43例,Ⅲ级30例,Ⅳ级11例。本组施行Bentall手术68例,Wheat手术6例,Cabrol手术5例,主动脉瓣替换加升主动脉成形术5例。其中急诊手术28例,择期手术56例。同期施行二尖瓣成形术3例,二尖瓣替换术3例。结果全组术后死亡3例,病死率3.57%。5例失访,76例随访3～117个月(平均55个月±31个月)。心功能Ⅰ～Ⅱ级74例,Ⅲ级2例。结论Bentall手术是治疗马方综合征根部瘤的首选方法,远期随访效果良好。     

Clinical significance of serum cardiac troponin T in patients with congestive heart failure

Objective To determine whether the level of serum cardiac troponin T (cTnT) was increased in patients with congestive heart failure (CHF). Methods This study consisted of 265 patients with CHF and 75 healthy people. Serum cTnT was measured by electrochemiluminescence immunoassay using an Elecsys 1010 automatic analyzer. Results cTnT concentration was 0. 181±0. 536 ng/mL in CHF patients and 0. 003±0. 001 ng/mL in controls (P&lt;0. 001). Patients were categorized according to the levels of heart function and left ventricular ejection fraction (LVEF). In the first group consisting of 105 patients with LVEF≤35%, cTnT was 0. 311±0. 221 ng/mL. In the second group of 106 patients with LVEF&gt;35%, cTnT was 0. 07±0. 0 5ng/mL (P&lt;0. 01). In patients with NYHA class Ⅰ, Ⅱ, Ⅲ and Ⅳ, cTnT values were 0. 062±0. 022 ng/mL, 0. 113±0. 121 mg/mL, 0. 191±0. 231 mg/ml and 0. 384±0. 211 mg/mL, respectively (class Ⅰ vs class Ⅱ P&gt;0.05, class Ⅱ vs clas s Ⅲ P&lt;0. 01, class Ⅲ vs class Ⅳ P&lt;0. 01). A negative correlation was observed between serum cTnT concentration and LVEF in 265 patients with CHF ( r=-0. 493, P&lt;0. 001). Conclusions This study shows that the level of serum cTnT is increased in patients with CHF and that the increased level indicates the severity of CHF.     

Brainstem auditory evoked potentials in patients with delayed encephalopathy after acute carbon monoxide poisoning

Objective:To evaluate the changes of brainstem auditory evoked potential (BAEP) in patients with delayed encephalopathy after acute carbon monoxide poisoning. Methods: BAEPs were performed in 32 controls and 40 patients. Wave Ⅰ , Ⅱ , Ⅲ ,Ⅳ, Ⅴ latencies and Ⅰ-Ⅲ , Ⅲ-Ⅴ , Ⅰ-Ⅴ interpeak latencies were measured, respectively. Results: Abnormalities of BAEPs in 13 patients (13/40, 32 ％). Among the13 abnormal BAEPs, 3 displayed prolongation of latency to waves in one side, no potential in another side; 5 displayed a similar abnormality which was bilateral prolongation of latency to waves ;and another 5 displayed unilateral latency delay. Compared wave Ⅰ , Ⅱ , Ⅲ , Ⅳ, Ⅴ latencies and Ⅰ-Ⅲ , Ⅲ-Ⅴ , Ⅰ-Ⅴ interpeak latencies in the patients and the controls, there were no significant differences (P＞0.05). Conclusion: BAEPs can be used for evaluating the diagnostic and prognostic values in the cases of delayed encephalopathy after acute carbon monoxide poisoning.