盐酸丁哌卡因硬膜外阻滞对肝酶谱及血浆蛋白参数的影响

应用盐酸丁哌卡因硬膜外阻滞后．测定术毕、术后２４小时印术后一周肝酶谱及血浆蛋白参数动态变比，并与利多卡因进行比较。结果表明：丁哌卡因组（丁组）ＡＬＢ、ＣＰ、ＣＨＥ与术前对照组比较术毕和术后２４小时降低（Ｐ＜０．０１和Ｐ＜０．０５）α－ＡＴ在术毕和术后２４小时增高（Ｐ＜０．０５）。ＡＫＰ和γ－ＣＴ分别在术毕和术后２４小时增高（Ｐ＜０．０５和Ｐ＜０．０１）。术后一周各项指标恢复正常。利多卡因组（利组）仅α－ＡＴ术后２４小时增高（Ｐ＜０．０５）。丁组与利组两组间比较结果：ＣＰ和ＡＤＡ在术毕有显著性差异（Ｐ＜０．０１和Ｐ＜０．０５）。     

胆道梗阻后肝脏自由基损伤及粉防己碱保护作用的实验研究

目的　观察胆道梗阻后肝脏的自由基损伤和粉防己碱（ Ｔｅｔ） 的保护作用。方法　复制大鼠胆道梗阻模型,每日给予 Ｔｅｔ ３０ ｍｇ／ｋｇ 体重灌胃,动态观测肝组织丙二醛（ Ｍ Ｄ Ａ） 和超氧化物歧化酶（ Ｓ Ｏ Ｄ） 含量及血清 Ｔ Ｂｉｌ、 Ａ Ｌ Ｔ、 Ａ Ｌ Ｐ、 Ｇ Ｇ Ｔ 含量。结果　胆道梗阻后,血清 Ｔ Ｂｉｌ、 Ａ Ｌ Ｔ、 Ａ Ｌ Ｐ、 Ｇ Ｇ Ｔ 水平逐渐升高,肝组织 Ｍ Ｄ Ａ 含量逐渐升高, Ｓ Ｏ Ｄ 逐渐减少,各梗阻组与对照组比较, Ｐ＜ ０ ．０５ 。各 Ｔｅｔ 治疗组与同时相梗阻组比较,血清 Ｔ Ｂｉｌ、 Ａ Ｌ Ｔ、 Ａ Ｌ Ｐ、 Ｇ Ｇ Ｔ 水平下降（ Ｐ＜ ０ ．０５） ;肝组织 Ｍ Ｄ Ａ 含量减少（ Ｐ＜０ ．０１） , Ｓ Ｏ Ｄ 含量升高（ Ｐ＜ ０ ．０５） 。肝组织 Ｍ Ｄ Ａ 含量与血清 Ａ Ｌ Ｔ、 Ａ Ｌ Ｐ 含量变化呈明显正相关,ｒ 值分别为０ ．９４９ 和０ ．８４３（ Ｐ＜ ０ ．０１） 。结论　自由基损伤可能是胆道梗阻导致肝损害的重要机制之一, Ｔｅｔ对胆道梗阻所致肝损害有明显保护作用。     

辽宁绝经妇女骨密度与绝经年限、体重关系研究

目的　研究绝经年限、体重对辽宁地区绝经后女性不同部位骨密度的影响。方法　测定共９６ 例绝经后妇女腰椎（Ｌ２～４）、股骨颈（Ｎｅｃｋ）、大转子（Ｔｒｏｃｈ）、Ｗａｒｄ＇ｓ 区的ＢＭＤ,同时测定了血ＡＬＰ、血尿钙、肌肝（Ｃｒ）等指标,分析其相互关系。结果　１． 绝经后妇女各部位的ＢＭＤ 不同。２．Ｌ２～４的ＢＭＤ与体重（Ｗ ）、血小板、尿Ｃａ／Ｃｒ呈正相关（Ｐ＜ ０．０１、Ｐ＜ ０．０５、Ｐ＜ ０．０１）。与绝经年限的自然对数（ＰＦＮＬ）、ＡＬＰ呈负相关（Ｐ＜ ０．０１、Ｐ＜ ０．０１）。３．Ｎｅｃｋ 区ＢＭＤ 与体重、血小板呈正相关（Ｐ＜ ０．０１、Ｐ＜ ０．０５）,与ＰＦＮＬ呈负相关（Ｐ＜ ０．０５）。４．Ｗａｒｄ＇ｓ 区ＢＭＤ 与体重、血小板、尿Ｃａ／Ｃｒ 呈正相关（Ｐ＜ ０．０１、Ｐ＜ ０．０５、Ｐ＜ ０．０５）,与ＰＦＮＬ及ＡＬＰ呈负相关（Ｐ＜ ０．０１、Ｐ＜ ０．０５）。５． 大转子区骨密度与体重、血小板、转氨酶呈正相关（Ｐ＜ ０．０１、Ｐ＜ ０．０１、Ｐ＜ ０．０５）,与ＡＬＰ呈负相关（Ｐ＜ ０．０１）。结论　体重、绝经年限、尿Ｃａ／Ｃｒ、血小板及血ＡＬＰ能影响骨密度。     

LFA-1共刺激诱导狼疮性肾炎外周血单个核细胞IL-10表达的研究

目的：探讨淋巴细胞功能相关抗原－１（ＬＦＡ－１）对活动性狼疮肾炎（ＬＮ）外周血单个核细胞（ＰＢＭＣ）白介素 １０（ＩＬ－１０）的调节作用。方法：利用半定量 ＲＴ－ＰＣＲ技术观察 ＬＦＡ－ １共刺激对活动性 ＬＮ患者 ＰＢＭＣ ＩＬ－１０ ｍＲＮＡ表达的影响。结果：单独抗ＣＤ３抗体（３０ ｎｇ／ｍｌ）能诱导ＬＮ 患者ＰＢＭＣ ＩＬ－１０ ｍＲＮＡ轻微表达（０．４３＋０．０３ｖｓ ０．５５±０．４４,Ｐ＜０．０５）而在抗ＣＤ３抗体（３０ ｎｇ／ｍｌ）存在的情况下,抗ＬＦＡ－１抗体（２ μｇ／ｍｌ,相当于ＬＦＡ－１配体）共刺激时明显增加了ＰＢＭＣ ＩＬ—１０ ｍＲＮＡ表达（１．３１±０．０８ｖｓ ０．５５＋０,０４,Ｐ＜０．０１）。ＬＦＡ－１中和抗体明显抑制了这种共刺激诱导的ＩＬ—１０ ｍＲＮＡ表达（１．３１±０．０８ｖｓ ０．６４ ±０．０３,Ｐ＜０．０１）。抗ＬＦＡ－１抗体单独刺激时并不引起 ＩＬ－１０ ｍＲＮＡ表达变化（Ｐ＞０．０５）。结论：ＬＦＡ－１作为共刺激分子诱导 ＩＬ－ １０ ｍＲＮＡ表达可能是其参与 ＬＮ发病的机制之一。     

瘢痕疙瘩患者外周血淋巴细胞粘附分子CD_(44)表达

为了了解对瘢痕疙瘩患者血清中免疫球蛋白及外周淋巴细胞（ＰＢＬＣ）ＣＤ４４表达，应用全自动蛋白分析系统及流式细胞仪，进行了测定。结果显示：ＩｇＧ、ＩｇＭ、补体Ｃ３显著高于健康对照组，Ｐ值分别为：Ｐ＜０．０１，Ｐ＜０．０５和Ｐ＜０．０５，而ＩｇＡ则相反，Ｐ＜０．０５。ＰＢＬＣＣＤ４４表达显著高于健康对照组，Ｐ＜０．００１。实验结果揭示：免疫反应可能是瘢痕疙瘩病理过程中不容忽视的重要因素。     

梗阻性黄疸时胆道内压力和门静脉血流与IL-2、sIL-2R及T淋巴细胞亚群变化的关系探讨

为探讨梗阻性黄疸患者败血症的发生机理，研究了３７例梗阻性黄疸（Ａ组）和９０例胆囊结石（Ｂ组）患者的胆道内压力、门静脉血流速度与白细胞介素－２（ＩＬ－２）、可溶性白细胞介素－２受体（ｓＩＬ－２Ｒ）及Ｔ淋巴细胞亚群的关系。Ａ组又分为急诊手术组（Ａ１）、择期手术组（Ａ２）、＞６０岁组（Ａ３）和＜６０岁组（Ａ４）４个亚组。结果显示：Ａ及Ａ１～４各组术前ＣＤ３＋、ＣＤ４＋、ＣＤ８＋值均显著低于术后１０天值（Ｐ＜０．０５或Ｐ＜０．０１），ｓＩＬ－２Ｒ显著高于术后１０天值（Ｐ＜０．０１）。Ａ１组术前ｓＩＬ－２Ｒ极显著高于Ａ及Ａ２～４组（Ｐ＜０．０１）。相关分析显示胆道内压力与ＩＬ－２、ＣＤ３＋、ＣＤ４＋及ＣＤ８＋呈负相关，与ｓＩＬ－２Ｒ呈正相关（Ｐ＜０．０１），门静脉血流速度与ＩＬ－２呈正相关（Ｐ＜０．０１）。由此表明梗阻性黄疸感染与宿主细胞免疫功能降低密切相关。     

糖尿病患者肾血流与内皮素及降钙素基因相关肽关系

目的为了解内皮素（ＥＴ）及降钙素基因相关肽（ＣＧＲＰ）与糖尿患者不同阶段时肾血流的关系。方法肾彩色多普勒超声检查确定为糖尿病肾血流正常组（Ａ组）１５例、糖尿病肾血流减少组（Ｂ组）１５例，正常对照组１８例。分别采血测定血浆ＥＴ－１和ＣＧＲＰ浓度。结果Ａ组ＥＴ－１水平低于正常对照组（Ｐ＜０．０１），Ｂ组ＥＴ－１水平高于正常对照组（Ｐ＜０．０１）。二组ＥＴ－１水平与肾动脉收缩期峰值血流速度（Ｖｍａｘ）、肾动脉血流量（Ｑ）呈负相关（Ｐ＜０．０１），与尿白蛋白排泄率（ＵＡＥＲ）呈正相关（Ｐ＜０．０５）。二组的ＣＧＲＰ水平均低于正常组（Ｐ均＜０．０１），但Ａ与Ｂ组的ＣＧＲＰ水平差异无显著性（Ｐ＞０．０５）。未发现ＣＧＲＰ水平与Ｖｍａｘ、Ｑ和ＵＡＥＲ呈相关关系。结论ＥＴ－１在糖尿病不同阶段时对肾血流量的病理生理作用可能不同；糖尿病患者呈现低ＣＧＲＰ血症，但它对不同阶段的糖尿病肾血流的影响尚有待探讨。     

PCR-SSCP法检测小儿原发性肾病综合征载脂蛋白E基因多态性

目的探讨小儿原发性肾病综合征（ＮＳ）脂质代谢紊乱机制。方法测定了６８例小儿ＮＳ及１２０例健康对照组７项血脂指标，采用聚合酶链反应－单链构象多态性（ＰＣＲ－ＳＳＣＰ）技术检测其载脂蛋白Ｅ（ＡｐｏＥ）基因多态性。并采用ＳＤＳ－ＰＡＧＥ检测ＮＳ组尿蛋白类型。结果所有７项指标在携不同ＡｐｏＥ等位基因（Ａｐｏε２、Ａｐｏε３及Ａｐｏε４）的患儿之间均无显著性差异（Ｐ＞０．０５），而携Ａｐｏε３等位基因型的选择性蛋白尿（ＳＰＵ）组血总胆固醇（ＴＣ）、甘油三酯（ＴＧ）显著高于同型的非选择性蛋白尿组（ＮＳＰＵ）（Ｐ＜０．０５）。ＮＳＰＵ组的Ａｐｏε２等位基因频率显著高于健康儿童组（１２．９６％ｖｓ５．００％，Ｐ＜０．０５）。结论小儿原发性ＮＳ的脂质紊乱主要与其蛋白代谢异常有关而与ＡｐｏＥ基因多态性无明显关系。但携Ａｐｏε２等位基因的ＮＳＰＵ患儿有进行性肾脏损害的可能。     

环孢素A血浓度监测在异基因骨髓移植中的意义

观察６９例异基因骨髓移植患者，探讨环孢素Ａ（ＣｓＡ）谷浓度与急性移植物抗宿主病（ａＧＶＨＤ）和ＣｓＡ相关毒副作用之间的关系。结果表明，Ⅱ～Ⅳ度ａＧＶＨＤ发生率为３６．２３％；Ⅱ～Ⅳ度ａＧＶＨＤ的发生与植活时的ＣｓＡ谷浓度相关（Ｐ＝０．０３１８）；若谷浓度低于１５０μｇ／Ｌ，Ⅱ～Ⅳ度ａＧＶＨＤ发生率增加（Ｐ＜０．０５）；当ＣｓＡ谷浓度高于２００μｇ／Ｌ时，ＣｓＡ相关的肝、肾毒副作用发生率明显上升（Ｐ＜０．０５）。认为将ＣｓＡ谷浓度尤其是植活时的谷浓度维持在１５０～２００μｇ／Ｌ，可以提高ＣｓＡ的效果，并降低ＣｓＡ的肝、肾毒副作用发生率。     

CsA顺序用药对移植肾早期功能的影响

１９９２年１月～１９９５年５月，分别对７８例及３２例肾移植患者术后立即应用ＡＬＧ和ＯＫＴ_３，随机选择８０例术后立即应用ＣｓＡ的患者为对照组，以了解ＣｓＡ顺序用药对移植肾早期功能的影响。结果显示：ＡＬＧ组和ＯＫＴ_３组急性排斥反应（ＡＲ）发生率分别为１１．５％和１２．５％，ＣｓＡ组为２３．８％（Ｐ＜０．０５），急性肾小管坏死（ＡＴＮ）ＡＬＧ组和ＯＫＴ_３组分别为５．１％和６．３％，ＣｓＡ组为１５．１％（Ｐ＜０．０５），移植肾功能３天正常率ＡＬＧ组和ＯＫＴ_３组分别为８３．３％和６８．８％，ＣｓＡ组为５７．５％（Ｐ＜０．０５）。证实ＣｓＡ顺序用药可有效地预防ＡＲ和ＡＴＮ的发生，促进移植肾功能的早期恢复。     

术后早期低总胆固醇血症在预测肝切除术后严重并发症中的价值

目的：探讨术后早期低总胆固醇血症在预测肝切除术后严重并发症中的价值。方法回顾性分析2009年至2011年间接受肝切除术的350例患者术后早期血总胆固醇水平与术后严重并发症之间的关系。结果受试者工作特征曲线提示术前总胆固醇/术后5d内总胆固醇谷值比（以下简称术前/术后总胆固醇比）对术后严重并发症有预测价值,其曲线下面积为0．84（95％可信限0．78～0．90,P＝0．029）。依据该曲线,术前/术后总胆固醇比的诊断值为1．69;其敏感性为73．4％,特异性为85．2％。多因素分析显示术前/术后总胆固醇比＞1．69为术后严重并发症的独立危险因素。结论术后早期低总胆固醇血症对肝切除术后严重并发症有较好预测价值。     

Influence of hypercholesterolemia on patient and graft survival in recipients of kidney transplants

AIM: The aim of this retrospective, single centre study, was to study the effect of pre- and post-transplant serum total cholesterol (TC) on patient and graft survival. We also sought to see whether patients who had very high TC (>8 mmol/L) had a higher incidence of graft failure and patient mortality compared with those whose cholesterol was only moderately elevated. METHODS: Records of 935 cadaver kidney transplants between 1984 and 1998 were examined. Patients were placed into three groups based on TC level: <5.5 mmol/L (group 1), 5.5-8 mmol/L (group 2) and >8 mmol/L (group 3). The mean TC value from the first five post-transplant years was taken to seek a correlation between TC and post-transplant events. RESULTS: The mean graft follow-up was 66.9 +/- 50.1 months, ranging from 0.1 to 191 months, while mean patient follow-up was 83.8 +/- 50.1 months, ranging from 0.5 to 191.6 months. Pre-transplant TC was available in 201 patients (21.5%), and post-transplant data was available (for first 5 yr) in 655 patients (70%). During the study period, 220 patients (23.5%) had died, 285 (30.5%) of the grafts had failed during the follow-up, while 129 (13.8%) of the patients died with a functioning graft. We found significantly longer survival of patients having a pre-transplant TC below 5.5 mmol/L vs. patients whose pre-transplant TC was above 5.6 mmol/L (p = 0.02). We also compared patients who had very high pre-transplant TC (>8 mmol/L) level with those whose TC was moderately elevated (5.5-8 mmol/L) and found that there was no higher incidence of graft failure (p = 0.77) nor patient mortality (p = 0.83). No difference could be found in graft survival based on pre-transplant TC. We also did not find a detrimental influence of post-transplant TC on the patient or graft survival. Diabetes mellitus (p = 0.006) and age over 50 yr (p = 0.007) affected patient survival, while low cyclosporine levels (p = 0.02) and acute rejection episodes (p = 0.009) affected graft survival. The mode of dialysis and time on dialysis prior to transplantation did not affect patient and graft survival. CONCLUSIONS: We found significantly greater survival of patients having a pre-transplant TC below 5.5 mmol/L. No difference could be found in graft survival based on pre-transplant TC. Post-transplant TC did not adversely affect patient or graft survival.     

Effects of 1.5% glycine infusion on the nonelectrolyte components of serum in dogs

Plasma dilution resulting from absorption of a 1.5% glycine solution is difficult to evaluate on the basis of changes in serum sodium alone. In a canine animal model the effects of infusion of a 1.5% glycine solution and a 0.9% saline solution on the nonelectrolyte components of serum were compared with a noninfused control group. The outcome measurements included total serum protein, serum albumin, serum cholesterol, serum globulin, plasma fibrinogen, and serum osmolality. The infusion of each solution resulted in a significantly lower concentration in plasma proteins and cholesterol compared with the control group. The lowest concentration of plasma proteins and cholesterol occurred in the saline infusion group. The dilution produced by saline infusion was consistent with a distribution of the infused fluid in the extracellular compartment. The dilutional effect was less in the glycine solution infused group, which suggested partial distribution of residual free water from the glycine solution in the intracellular space as well as the extracellular compartment. Since plasma proteins are confined primarily to the intravascular compartment, the changes in the concentration of plasma proteins and cholesterol indicate the amount of dilution of the extracellular fluid.     

心血管疾病患者记监测日记对血脂水平的影响

目的探讨降低心血管疾病伴高血脂患者血脂水平的有效方法。方法将40岁以上伴高血脂的心血管疾病出院患者83例随机分为两组。对照组(43例)出院后接受常规电话随访及院外健康教育;观察组(40例)在此基础上,使用自制的血脂监测日记记录每日的生活方式及阶段血脂变化。干预1年后比较两组患者的血脂水平。结果干预1年后,观察组总胆固醇、三酰甘油及低密度脂蛋白胆固醇3项指标与对照组比较,差异有统计学意义(均P<0.01)。结论心血管疾病患者记血脂监测日记对控制血脂水平有一定的作用。     

Differential impact of aging and gender on lipid and lipoprotein profiles in a cohort of healthy Chinese Singaporeans

Aim： To evaluate the impact of age and gender on lipid and lipoprotein profiles and the burden of dyslipidemia in a cohort of healthy Chinese Singaporean. Methods： A total of 1 775 healthy Chinese, 536 men and 1 239 women aged between 30 and 70 years old were involved in the present study. Results： Gender differences in all lipid and lipoprotein levels were clearly evident. Singaporean Chinese men have significantly higher levels of total cholesterol （TC）, triglyceride （TG）, low density lipoprotein-cholesterol （LDL-C） and total cholesterol/high density lipoprotein-cholesterol （TC/HDL-C）, and lower levels of HDL-C than women. Although lipid and lipoprotein levels in men did not change in the different age groups, those in women, especially TC, LDL-C and TC/HDL-C, were significantly higher in older women （〉 50 years old） than corresponding levels in younger women （30-46 years old）. Furthermore, TG was significantly correlated with lipids and lipoproteins differently in men and women. If 100 mg/dL of LDL-C were to be adopted as the therapeutic cut-off level, then the burden of care will be huge as approximately 90% of both Chinese men and women have LDL-C greater than 100 mg/dL. Condusion： In light of the findings of the present study, we suggest that preventive measures to promote the reduction in risk of coronary heart disease （CHD） must address the high proportion of men and women with high LDL-C, and that these measures should take into account both the gender and age factors. For men, reduction of high cholesterol must start early in life, whereas for women, steps must be taken earlier to mitigate the anticipated sharp increase in risk, especially after menopause.     

Lipid profile change after bariatric surgeries: laparoscopic gastric plication versus mini gastric bypass

Introduction: Bariatric surgeries are known to have profound effects on lipid profile. Laparoscopic gastric plication (LGP) has been shown to have a comparable effect on weight loss rather than Roux-en-Y gastric bypass (RYGB) and mini gastric bypass (MGB). But the post-operative effect on lipid profile is not well-compared. We aimed to compare post-operative lipid profile change after LGP and MGB.

Methods: In a retrospective analysis, we reviewed 91 patients for at least 12 months. Patients were assigned to undergo either LGP (71 patients) or MGB (20 patients). Preoperative and postoperative visits were accomplished and weight, BMI, fasting blood glucose (FBG) and lipid profile including triglyceride (TG), and total cholesterol (TC) levels were repeatedly measured. Follow up rate for the first year was 100%.

Results: LGP significantly decreased both TG and TC levels in each follow up (all p values <?.05). The same trends were observed in BMI reduction, total body weight loss percentage, and FBG. When comparing either TC or TG level between LGP and MGB, there was just one statistically significant result in TG reduction at 6 months (p value?=?.042) while MGB showed more reduction. All other variables in different follow up visits were not significantly different between two techniques.

Conclusions: LGP would result in lipid profile improvement lasting at least for one year. Lipid-lowering effect seems to be similar between LGP and MGB. This lipid-lowering property and weight reduction might be indicative that LGP is an alternative for RYGB and MGB in selective patients.     

茵陈合剂对麻醉豚鼠肝胆汁泌量及其成分的影响

目的：观察茵陈合剂对麻醉豚鼠肝胆汁分泌的作用。方法：选用健康豚鼠36只，随机分为6组：即非用药对照组、茵陈合剂组、茵陈组、陈皮组、陈皮油组、熊去氧胆酸组（ursodoxycholic acid，UCDA）。每组6只，建立豚鼠胆管引流模型。各组豚鼠于给药后30min、60min、90min、120min收集胆汁标本，分别测定各组豚鼠胆汁流量、胆汁中总胆汁酸及胆汁中胆固醇的含量。结果：与非用药对照组相比，茵陈合剂用药30min后能显著地促进正常豚鼠胆汁流量、胆汁总胆汁酸和胆固醇的分泌。结论：茵陈合剂能改善正常豚鼠的胆汁分泌。     

Cholesterol granuloma of the kidney mimicking a tumour.

Introduction Cholesterol granulomas are lesions consisting of cholesterolcrystals and foreign body giant cells [1]. Lipid disturbancesare thought to play a role in their aetiology. They are rarehistological     

比色法测定胆固醇氧化酶酶活

根据实验结果和理论计算确定检测体系中胆固醇的质量浓度为 0 .3 87mg/mL ,表面活性剂的质量浓度为 0 .2 g/dL ,确定过氧化氢浓度与反应液吸光度之间的定量关系 .在此基础上 ,建立了比色法测定胆固醇氧化酶酶活的方法 .     

Effect of Peritoneal Dialysis Solution Type on Serum Lipid Levels in End-Stage Renal Disease

Among the different cardiovascular risk factors, lipid abnormalities dominate the high mortality in chronic ambulatory peritoneal dialysis patients. So far, no data comparing the effect of standard glucose-containing, amino acid-containing, and icodextrin-containing peritoneal dialysis solutions on serum lipid concentrations in a chronic ambulatory peritoneal dialysis population are available. To determine the effect of peritoneal dialysis solutions on parameters of lipid metabolism, 67 subjects who had continued their usual dialysis for the last six months were enrolled in the study. Group A consisted of 18 patients who were receiving only glucose-based peritoneal dialysis solutions, group B consisted of 18 patients who were receiving glucose and amino acid-based peritoneal dialysis solutions, and group C consisted of 31 patients who were receiving glucose and icodextrin-based peritoneal dialysis solutions. Serum lipid parameters including total cholesterol, low-density lipoprotein, high-density lipoprotein, triglyceride, and lipoprotein (a) were determined in all groups. No significant difference in serum lipid parameters was found between groups A, B, and C. These results demonstrate the lack of the effect of amino acid or icodextrin-based peritoneal solutions on dyslipidemia of CAPD patients.