脑卒中患者转化生长因子与细胞黏附因子检测及分析

中华内科杂志，２０００，３９（５）：３０９－３１１． 对脑卒中患者（脑出血３０例，脑血栓３０例，男、女患者各占一半，年龄５７岁至７０岁）进行外周血转化生长因子（ＴＧＦ－β１）和细胞黏附因子（ｓＩＣＡＭ－１）水平的测定并对其进行分析，并以３０名健康献血员作为对照。结果脑出血患者外周血ＴＧＦ－β１民的水平为（１７±２）μｇ／Ｌ，对照组为（３７±５）μｇ／Ｌ（Ｐ＜０．０１），而ｓＩＣＡＭ－１水平分别为（５４７±８０）μｇ／Ｌ和（２４８±５４）μｇ／Ｌ（Ｐ＜０．０１）；脑血栓患者外周血ＴＧＦ－β１水平为…     

急性心肌梗塞溶栓治疗中纤溶酶原的变化

对１１例ＡＭＩ溶栓治疗患者的血清ＰＬＧ含量进行了动态观察，治疗前血清ＰＬＧ含量为０．３７±０．１４ｇ／Ｌ，明显高于正常对照组。溶栓治疗后２￣２４ｈＰＬＧ含量较溶栓前明显下降（Ｐ〈０．０１），溶栓后血清ＣＫ和ＣＫ－ＭＢ峰值明显提前。     

扩张型心肌病患者血清甘胆酸的动态分析

为探讨扩张型心肌病（ＤＣＭ）患者血清甘胆酸（ＣＧ）的变化，本文动态观察了２７例ＤＣＭ患者与３０例血型心肌病（ＩＣＭ）患者的血甭ＣＧ浓度及其他肝功能指标，结果：当心功能由Ⅳ级减轻至Ⅱ级（ＮＹＨＡ分级）时，ＤＣＭ组ＣＧ由１０．８２±．ｌｍｇ／Ｌ分别降至７．７７±２．５２ｍｇ／ｌ和３．３７±１．０５ｍｇ／Ｌ分别降至７．７７±１．０５ｍｇ／Ｌ；ＩＣＭ组ＸＣＧ由５．４６±１．２ｍｇ／Ｌ分别降至４．２３±０．     

L—精氨酸对异丙肾上腺素致害心肌的影响

目的研究Ｌ－精氨酸（Ｌ－Ａｒｇ）对异丙肾上腺素（ＩＳＰ）致害心肌的影响。方法大鼠分四组;①ＩＳＰ组ＩＳＰ４０ｍｇ／ｋｇ／ｄａｙ×２,皮下注射;②对照组体重匹配的大鼠注射同容量的生理盐水;③Ｌ－Ａｒｇ组腹腔注射Ｌ－Ａｒｇ１５ｇ／ｋｇ／ｄａｙ×２;④ＩＳＰ＋Ｌ－Ａｒｇ组。结果ＩＳＰ处理的大鼠心重／体重比值、心肌内ＮＯ、钙的水平以及血清ＬＤＨ水平高于对照组（Ｐ＜００１）,而心肌中ＧＳＨ－ＰＸ及Ｌ－Ａｒｇ水平低于对照组（Ｐ＜００１）结论Ｌ－Ａｒｇ可部分逆转ＩＳＰ致心肌肥厚,心肌中ＮＯ、钙、Ｌ－Ａｒｇ、ＧＳＨ－ＰＸ及血清ＬＤＨ水平的变化     

惠尔血联用静脉丙种球蛋白对白血病化疗后感染的影响

为了更好地治疗和预防急性白血病（ＡＬ）患者化疗后的继发感染，４４例初治ＡＬ患者被分成惠尔血联用静脉丙种蛋白组（ｒｈＣ－ＣＳＦ－ＩＶＩＧ）、惠尔血组（ｒｈＧ－ＣＳＦ）和对照组进行临床研究。结果显示：（１）ｒｈＧ－ＣＳＦ－ＩＶＩＧ组和ｒｈｇ－ＣＳＦ组的发热持续天数，周转血白细胞数（ＷＢＣ）〈２．０×１０＾９／Ｌ以及中性粒细胞数（ＡＮＣ）〈０．５×１０＾９／Ｌ的持续天数均明显小于对照组（Ｐ值均小于０．０     

抗精浆免疫抑制物抗体的补体结合功能测定及临床意义

目的探讨抗精浆免疫抑制物抗体（ＳＰＩＭ－Ａｂ）的作用机理。方法用补体结合试验（ＣＦＡ）测定了不明原因不育症患者ＳＰＩＭ－Ａｂ的补体结合功能，并与血清Ｃ３、Ｃ４、ＣＨ５０之间的关系进行了比较。结果２９例血清ＳＰＩＭ－Ａｂ阳性患者ＣＦＡ值为６．４２±１．５５Ｕ／ｍｌ，明显低于７１例血清ＳＰＩＭ－Ａｂ阴性患者的８．１１±１．６２Ｕ／ｍｌ（Ｐ＜０．０１）和３０例对照组的８．６０±１．８０Ｕ／ｍｌ（Ｐ＜０．０１）。且血清ＳＰＩＭ－Ａｂ水平与血清Ｃ３、Ｃ４、Ｃ５０呈显著的负相关（Ｐ＜０．０５～０．０１）。结论ＳＰＩＭ－Ａｂ能够与ＳＰＩＭ形成免疫复合物，激活补体，并可能对精子和受精卵产生免疫损伤，干扰生育。     

急性缺血性脑梗塞患者脑脊液中β2—微球蛋白含量的变化

测定４４例急性缺血性脑梗塞（ＡＩＣＩ）患者和２４例正常对照者脑脊液（ＣＳＦ）β２微球蛋白（β２ＭＧ）的含量。结果：ＡＩＣＩ组ＣＳＦβ２ＭＧ的含量（１．５０±０．３８ｍｇ／Ｌ）明显高于正常组（１．１４±０．３２ｍｇ／Ｌ）；８例严重偏瘫的大片梗塞患者ＣＳＦβ２ＭＧ含量升高更著（１．９１±０．３４ｍｇ／Ｌ）；ＡＩＣＩ组中２０例患者治疗后ＣＳＦβ２ＭＧ含量（１．１８±０．３０ｍｇ／Ｌ）明显低于治疗前（１．４６±０．３９ｍｇ／Ｌ）。作者推测ＡＩＣＩ患者ＣＳＦβ２ＭＧ含量升高可能与中枢神经系统内发生免疫反应有关。     

冠心病与血清铁,血脂含量变化的关系

探讨血清铁、血脂浓度变化与冠状动脉硬化性心脏病（冠心病）的关系。对２６例急性心肌梗塞（ＡＭＩ）患者、３５例心绞痛（ＡＧ）患者及３０例健康者（对照组）进行血清铁和血脂〔胆固醇（ＴＣ），甘油三酯（ＴＧ），高密度脂蛋白（ＨＤＬ）〕含量测定。结果表明：ＡＭＩ及ＡＧ两组患者的血清铁及ＴＣ、ＴＧ明显高于对照组；而ＨＤＬ显著低于对照组；相关分析表明，血清铁与ＴＧ含量呈显著正相关（ｒ＝０．３１，Ｐ＜０．０５），血清铁与ＨＤＬ的含量呈负相关（ｒ＝０．６２，Ｐ＜０．０１）。提示：血清铁的升高可能是冠心病易患因素之一。     

脑梗塞并发多器官衰竭患者肿瘤坏死因子含量的观察

目的：检测脑梗塞并发多器官功能衰竭（ＭＯＦ）患者血清肿瘤坏死因子（ＴＮＦ）的含量变化并探讨其意义。方法：单纯急性脑梗塞患者（ＡＣＩ组）２１例，脑梗塞并发多器官功能衰竭患者（ＭＯＦ组）２４例（其中伴上消化道出血１１例，心功能衰竭７例，肾功能衰竭６例）。采用放射免疫方法检测２组患者血清ＴＮＦ的含量。结果：脑梗塞并发ＭＯＦ组ＴＮＦ含量〔（２．４７±０．３９）μｇ／Ｌ〕明显高于ＡＣＩ组〔（１．８９±０．２４）μｇ／Ｌ〕，Ｐ＜０．０１。脑梗塞并发ＭＯＦ组中各亚组间ＴＮＦ〔上消化道出血组（２．５３±０．４３）μｇ／Ｌ，心功能衰竭组（２．０１±０．２８）μｇ／Ｌ，肾功能衰竭组（２．４１±０．３２）μｇ／Ｌ〕差异显著（Ｐ均＜０．０１），尤以上消化道出血组升高明显。结论：ＴＮＦ参与了脑梗塞并发上消化道出血的发病；监测ＴＮＦ变化有助于对脑梗塞并发ＭＯＦ患者的病情观察和预后估计。     

脑胶质瘤患者白细胞介素6和血小板衍化生长因子的变化

探讨白细胞介素６（ＩＬ－６）和血小板衍化生长因子（ＰＤＧＦ）在脑胶质瘤发病机理中的作用及临床意义。用酶联免疫吸附试验和生物活性法检测了２７例脑胶质瘤患者手术前后脑脊液（ＣＳＦ）中ＩＬ－６和ＰＤＧＦ的含量，并与对照组比较，结果脑胶质瘤患者ＣＳＦ中ＩＬ－６，ＰＤＧＦ含量（２．０４±０．０２μｇ／Ｌ，（１９１±２１）×１０＾３Ｕ／Ｌ）平均高于对照组（０．５１±０．０１μｇ／Ｌ，（４１±９）×１０＾３Ｕ／     

Use of crystepin in combination with obsidan in patients with diabetes mellitus with arterial hypertension

Examination included 70 patients with diabetes mellitus in combination with arterial hypertension of different origin (II stage essential hypertension and symptomatic renal arterial hypertension). Crystepin (2-3 tablets per 24 h) in combination with beta-adrenoblocker obsidan (40-80 mg/24 h) was used for treatment. Basic hemodynamic parameters and the state of the renin-aldosterone system were determined. The hemodynamic hypotensive effects in these patients due to the influence of the above therapy are uniform and depend on the form of attendant arterial hypertension. The hypotensive effect of crystepin used in combination with obsidan was more pronounced in patients with diabetes and II stage essential hypertension than that in those with diabetes and renal hypertension. The concentration of aldosterone and renin activity of blood plasma in patients with diabetes and arterial hypertension during treatment with crystepin and obsidan had no regular connection with the hemodynamic parameters.     

硝酸甘油联合托拉塞米在高血压危象并发急性肺水肿患者的应用

目的研究硝酸甘油联合托拉塞米治疗高血压危象合并急性肺水肿的效果。方法选取我院收治的高血压危象合并急性肺水肿患者80例作为研究对象。随机分为对照组40例,采用托拉塞米治疗;试验组40例,采用硝酸甘油联合托拉塞米治疗。比较两组患者治疗效果、临床指标改善程度及并发症发生率。结果治疗后对照组患者血压、呼吸频率及氧分压改善程度均低于试验组,且治疗有效率(77.5%)低于试验组(92.5%),差异显著(P0.05);对照组患者并发症发生率(20.0%)高于试验组(7.5%),差异显著(P0.05)。结论采用硝酸甘油联合托拉塞米在治疗高血压危象合并急性肺水肿安全性高,可减少并发症,改善治疗效果,提高患者生活质量。     

Satisfaction with upper-extremity surgery in individuals with tetraplegia

OBJECTIVE: To measure the satisfaction of individuals with tetraplegia with their upper-extremity reconstructive surgery. DESIGN: Survey. SETTING: Two Spinal Cord Injury Model Systems centers. PARTICIPANTS: Sixty-seven individuals with spinal cord injury at the C4 through C8 motor level (107 arms). INTERVENTIONS: Participants had upper-extremity surgery to improve function. The surgical procedures included tendon transfers for elbow extension, wrist extension, hand grasp, and pinch or hand grasp neuroprosthesis. MAIN OUTCOME MEASURE: A survey was mailed to participants, who were asked to respond to statements such as, "If I had it to do over, I would have the hand/arm surgery again," using a 5-level Likert scale (ranging from strongly agree to strongly disagree). RESULTS: Seventy percent of the participants were generally satisfied with the results of their upper-extremity surgery, 77% reported a positive impact on their lives, 68% reported improvements in activities of daily living (ADLs), 66% reported improved independence, 69% reported improvement in occupation, 71% reported improved appearance or neutral, 78% reported their hand worked as well (or neutral) as it did when surgery was first performed, and 86% reported postoperative therapy as being beneficial. CONCLUSIONS: Upper-extremity surgery had a positive impact on life, increased ability to perform ADLs and to be independent, and improved quality of life.     

Observations with Rabenid in patients with locomotor disease

By examining 139 patients suffering from locomotor diseases the author could observe the characteristic accompanying diseases as well as high uric acid level in 40 cases. She analyses the current opinions on hyperuricaemia and reports on her observations with uricosuric and antithrombotic coated Rabenid tablet (RG). She found sulfinpyrazone to be effective and valuable in the examined indication field.     

Satisfaction with medical rehabilitation in patients with orthopedic impairment

OBJECTIVE: To examine patient satisfaction after orthopedic impairment at 80 to 180 days after inpatient rehabilitation. DESIGN: Retrospective design examining records from facilities subscribing to the Uniform Data System for Medical Rehabilitation (UDSmr). SETTING: Information submitted to UDSmr from 1997 to 1998 by 177 hospital and rehabilitation facilities from 40 states. PARTICIPANTS: The sample (N=7781) was 72.63% female and 88.60% non-Hispanic white, with a mean age +/- standard deviation of 73.07+/-11.81 years, and average length of stay (LOS) of 13.84+/-10.48 days. INTERVENTION: Usual rehabilitation care.Main outcome measures Level of satisfaction 80 to 180 days after discharge as well as motor, cognitive, and subscale ratings for the FIM trade mark instrument. Predictor variables included gender, age, English language, marital status, discharge setting, LOS, rehospitalization, FIM gain, and primary payer. RESULTS: A logistic regression model was used to predict patient satisfaction at follow-up. Five statistically significant (P<.05) variables were found and correctly classified 94.9% of the patients. Discharge motor FIM rating, rehospitalization, age, patient's primary language, and discharge setting were associated with increased satisfaction. Discharge motor FIM ratings were significantly associated with increased satisfaction in patients with joint replacements and lower-extremity fractures. CONCLUSION: unctional and demographic variables were identified as predictors of satisfaction in patients with orthopedic impairments.     

Persistence with antimuscarinic therapy in patients with overactive bladder

Overactive bladder (OAB) is a chronic condition, which impacts patients' health and quality of life. The primary symptoms of OAB are distressing and may interfere with work, psychosocial and sexual functioning. OAB also is associated with increased risk of urinary tract infections, fractures from falls, skin infections and depression. Patient's concerns about the effects of incontinence on lifestyle highlight the need to restore continence. The mainstay of treatment is antimuscarinic drug therapy, which may often produce only modest reductions in OAB symptoms and may be accompanied by bothersome adverse effects, leading to poor adherence to prescribed medications. Successful treatment of OAB depends on persistence with the prescribed medication, and efficacy and tolerability are key influencers of persistence. New antimuscarinic agents are now available for treating OAB that significantly improve symptoms of incontinence, urgency and frequency with few adverse effects. An improved efficacy and tolerability profile should result in greater patient satisfaction and persistence with therapy during long-term therapy.