100例高脂血症早期肾损害患者肾功能联检结果分析及治疗效果观察

目的　探讨肾功能联检对原发性高脂血症早期肾损害的诊断价值及辛伐他汀和非诺贝特对高脂血症早期肾损害的治疗效果。方法　将 10 0例原发性高脂血症患者随机分为辛伐他汀组和非诺贝特组各 5 0例。两组患者均在服药前及服药后 8、2 4周查血脂及血 β2 - MG,取随意尿查 β2 - MG、Alb、Ig G(下称肾功能联检 ) ;并与 5 0例血脂正常的健康人 (对照组 )比较。结果　原发性高脂血症患者血、尿β2 - MG、尿 AL b及尿 Ig G均高于对照组 ,各指标均有显著性差异 (P<0 .0 0 1) ;与非诺贝特组比较 ,辛伐他汀组血清 TC、L DL - C明显降低 (P<0 .0 5 )。治疗后 8、2 4周辛伐他汀组血 β2 - MG,尿 β2 - MG、Alb、Ig G降低 ,与非诺贝特组比较 ,P<0 .0 1。结论　肾功能联检有助于早期发现原发性高脂血症亚临床肾脏损害 ;辛伐他汀在降低血 TC、升高 HDL- C的同时亦能降低 TG、尿蛋白 ,且对肾脏有保护作用     

氯沙坦对老年高血压患者血液流变学和肾结构的影响

目的观察氯沙坦对老年高血压患者血液流变学、肾血流及肾结构的影响。方法老年高血压患者63例,观察组43例,服用氯沙坦50~100mg/d;对照组(复方降压片组)20例,疗程12~17月,分别测定治疗前后血液流变学指标、肾血流及肾血管管壁厚度、内径。结果氯沙坦治疗后患者血液流变学指标有不同程度的下降,肾血流改善、肾动脉管壁厚度明显变薄(P<0.01),动脉内径增大(P<0.05)。结论氯沙坦在有效降压的同时,可有效地降低老年高血压患者的血液黏度,降低肾动脉血管阻力,增加肾血流量,改善肾血管结构。     

氯沙坦对老年高血压病患者肾功能的影响

目的　探讨氯沙坦治疗 1年后对老年高血压病患者肾功能的影响。方法　应用生化和放射免疫分析技术测定 2 0名健康者 (对照组 )和 3 4例老年高血压病患者 (服用氯沙坦前后 )的肾功能指标 ,并进行比较。结果　高血压病组治疗前BUN、Scr水平与对照组比较无明显变化 (P >0 .0 5 ) ,而尿Alb、IgG、β2 MG水平均显著性升高 ,差异有显著性 (P <0 .0 5 ) ;高血压病组尿Alb、IgG治疗后与治疗前比较显著降低 (P <0 .0 5 ) ,血浆BUN、Scr ,血、尿 β2 MG无明显变化 (P >0 .0 5 )。结论　提示氯沙坦能有效降低老年高血压病患者微量蛋白尿 ,具有肾脏保护作用     

氯沙坦对原发性高血压β2-微球蛋白影响

目的　探讨血管紧张素Ⅱ受体阻断剂氯沙坦对原发性高血压所致尿 β2 微球蛋白 ( β2 MG)异常的影响。　方法　原发性高血压病人 5 5例 ,随机分为两组 ,治疗组 30例 ,应用氯沙坦。对照组 2 5例 ,应用拜新同 (硝苯地平缓释片 )。分别于服药 4周、8周、12周后测定尿 β2 MG。　结果　氯沙坦明显降低尿 β2 微球蛋白含量 (P <0 0 1)。　结论　氯沙坦适用于原发性高血压 β2 微球蛋白升高的病人 ,对肾脏有保护作用。     

充血性心力衰竭病人治疗前后血、尿β2微球蛋白的变化

目的 :观察充血性心力衰竭 (CHF)前后血、尿β2 -微球蛋白 (MG)水平的变化。方法 :采用放射免疫分析法检测对照组 30例 ,CHF组 6 0例心衰前 ,后血、尿 β2 - MG水平。结果 :心衰缓解后血β2 - MG水平明显下降 (P<0 .0 1)。尿 β2 - MG水平明显增高 (P<0 .0 0 5)。治疗前血 β2 - MG与心搏量 ,左室射血分数呈负相关。结论 :检测血、尿 β2 - MG水平对于评价心功能有重要的临床意义     

测定肾动脉狭窄患者尿微球蛋白的临床意义

目的　评价测定肾动脉狭窄患者尿微球蛋白的临床意义。方法　根据肾动脉造影结果 ,将 12 1例入选患者分为严重狭窄组 (肾动脉内径减少 >70 % ) 5 2例 ,轻度狭窄组 (内径减少 <70 %但 >5 0 % ) 3 1例及对照组 3 8例。测定各组尿α1 微球蛋白 (α1 MG )和 β2 微球蛋白 ( β2 MG)。结果　严重狭窄组患者尿 β2 MG较轻度狭窄组及对照组显著升高 (P <0 .0 0 1)。经多因素统计分析后 ,尿 β2 MG升高与严重肾动脉狭窄 (P =0 .0 0 0 )、左室射血分数减低 ( <0 .5 )、糖尿病、服用钙离子拮抗剂与利尿剂等因素相关。严重狭窄组尿α1 MG较其他 2组升高 (P =0 .0 12 ) ,但未高于正常上限。结论　尿 β2 MG较血清肌酐更能反映早期肾脏缺血。严重肾动脉狭窄 ( >70 % )患者多伴尿微球蛋白升高 ,提示合并肾小管功能障碍。对于这部分患者应及早进行肾动脉介入治疗     

氯沙坦对老年高血压患者血液流变学和肾结构的影响

目的 观察氯沙坦对老年高血压患者血液流变学、肾血流及肾结构的影响.方法 老年高血压患者63例,观察组43例,服用氯沙坦50～100 mg/d;对照组(复方降压片组)20例,疗程12～17月,分别测定治疗前后血液流变学指标、肾血流及肾血管管壁厚度、内径.结果 氯沙坦治疗后患者血液流变学指标有不同程度的下降,肾血流改善、肾动脉管壁厚度明显变薄(P＜0.01),动脉内径增大(P＜0.05).结论 氯沙坦在有效降压的同时,可有效地降低老年高血压患者的血液黏度,降低肾动脉血管阻力,增加肾血流量,改善肾血管结构.     

硝苯地平控释片对老年高血压患者肾功能的影响

目的 研究拜新同对老年高血压患者肾血流动力学和肾脏功能的影响。方法 对28例老年高血压患者进行拜新同治疗前后肾功能指标的自身相比。采用核素肾功能检查和彩色多普勒超声肾血流动力学检测及血，尿生化指标的检查，测定肾小球滤过率（GFR）和肾动脉主干，段动脉及叶间动脉的收缩期最大血流速度（VS），舒张期最低血流速度（VD），阻力指数（RI），血流峰加速时间（AT）和血尿素氮（BUN），肌酐（Cr),血β2－MG，尿β2－MG，尿白蛋白。结果 拜新同治疗12周后，患者的诊室血压收缩压平均下降0．25，舒张压平均下降0．17，24小时平均收缩压下降了0．17，24小时平均舒张压下降0．15，均达到了目标血压，治疗前后对比有显著差异（P均＜0．001）。肾脏超声检查肾血流各项指标亦有显著性改变，肾动脉主干，肾段动脉及叶间动脉的VS，VD显著增高（P＜0．01），RI及AT减低，P值均＜0．01。核素肾动态检测GFR，用药后GFR明显增加（P＜0．001）。而尿白蛋白，尿β2－MG和Cr用药后明显下降，有显著性差异，血β2－MG，BUN均无明显改善。结论 拜新同在有效降低血压的同时，可降低肾脏血管阻力，使肾血流量和GFR明显增高。尿白蛋白，尿β2－MG和Cr用药后明显下降，患者的肾功能得到改善。是一种理想的对肾功能有所考虑的降压药。     

氯沙坦对原发性高血压患者内皮功能及肾功能的影响

目的:观察氯沙坦对原发性高血压患者血一氧化氮(NO)、内皮素(ET)、血尿微球蛋白(β2MG)、尿微量白蛋白的影响。方法:将60例患者分为A组(氯沙坦组n=30)和B组(福辛普利组n=30),进行血NO、ET、β2MG、尿微量白蛋白及血肌酐等检查。2组治疗前后相互比较。结果:2组治疗前后血NO、ET、β2MG、尿微量白蛋白均有显著性差异(P<0.05)。而血尿素氮、肌酐治疗前后差异无显著性(P>0.05)。A组B组组间比较差异无显著性(P>0.05)。结论:氯沙坦同福辛普利相类似,均具有血管内皮及肾脏保护作用。     

糖尿病患者血、尿微球蛋白变化及血微球蛋白与肾小球滤过率的相关性研究

目的　观察糖尿病患者血、尿 β2 微球蛋白 (β2 MG)、尿α1 微球蛋白 (α1 MG)水平变化 ,探讨血 β2 MG与肾小球滤过率 (GFR)之间的相关关系。方法　采用放射免疫分析法及99Tcm—二乙三胺五醋酸 (99Tcm—DTPA)肾动态显像法对 44例糖尿病患者和 2 0名正常人进行血 β2 MG、尿 β2 MG、尿α1 MG及GFR检测及对照分析。结果　 (1)病程 <1年和 >10年糖尿病患者血 β2 MG与GFR有明显的负相关性 (P <0 .0 1) ;(2 )糖尿病患者血、尿 β2 MG及尿α1 MG水平均高于对照组 ,其尿α1 MG水平增高更明显 (P <0 .0 1) ;(3)病程 <1年的糖尿病患者其GFR值高于对照组 ,病程 >10年者其GFR低于对照组。结论　GFR与血 β2 MG具有一定相关性 ,尿α1 MG作为早期诊断糖尿病肾病的指标其灵敏性高于血、尿 β2 MG。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.