变态反应性支气管-肺烟曲菌病的临床研究进展

变态反应性支气管-肺烟曲菌病(ABPA)与烟曲菌感染引起的变态反应相关，临床上常常表现为哮喘症状，若未得到有效治疗可发生肺组织持续性破坏，故ABPA的早期治疗十分重要。然而，ABPA在哮喘患中的检出率仅占5％左右，因此早期诊断颇为困难，常易误诊为肺结核、霉菌性肺炎和肺癌等。本就其临床研究进展作一简要介绍。     

变态反应性支气管肺曲霉病27例临床分析

目的:探讨两种类型变态反应性支气管肺曲霉病(allergic bronchopulmonary aspergillosis,ABPA)的临床特点,做到ABPA的早诊断早治疗。方法:分析2009年4月至2014年5月南京医科大学第一附属医院呼吸科确诊的27例ABPA患者的临床资料,分为变态反应性支气管肺曲霉病-血清IgE增高型(ABPA-S)组和变态反应性支气管肺曲霉病-中心支气管扩张型(ABPA-CB)组;比较两组患者的临床症状、实验室检查及肺功能特点。结果:两组患者在年龄、性别、症状等方面差别无统计学意义。但ABPA伴中央支气管扩张组的嗜酸粒细胞和血清总IgE水平比血清IgE增高型的ABPA组升高(P0.05),而第一秒用力呼气容积占预计值百分比则降低(P0.05)。结论:ABPA易被延误诊治,伴中央支气管扩张的ABPA为疾病的严重阶段。早期诊断治疗可延缓疾病进展。目前ABPA有效的治疗用药是糖皮质激素和伊曲康唑。     

变应性支气管肺曲霉病误诊5例分析

目的探讨变应性支气管肺曲霉病（ABPA）的临床特征、影像学特点、诊断和治疗方法,提高对ABPA的认识。方法回顾分析5例ABPA被误诊为其他疾病的临床资料。结果 5例中分别被误诊为支气管哮喘,支气管扩张,肺部感染。结论 ABPA主要临床特点为常有哮喘病史,肺部影像学显示存在中心性支气管扩张,对哮喘合并支气管扩张的患者高度警惕ABPA的可能,提高对本病的认识,减少误诊。     

变应性支气管肺曲霉病四例临床分析并文献复习

目的总结变应性支气管肺曲霉病(ABPA)的临床特点、诊断及治疗方法。方法结合文献资料分析我科2009年至2014年确诊的4例ABPA的临床病例。结果 ABPA常发生于支气管哮喘和囊性肺纤维化的患者。临床主要表现为喘息发作、发热、咳嗽、咳痰等症状,实验室检查表现为快速烟曲霉皮试阳性,总血清Ig E水平和曲霉特异的Ig E和Ig G水平上升,以及嗜酸粒细胞增加等;胸部影像学表现为反复的肺部游走性浸润影和中心性支气管扩张等。治疗包括糖皮质激素和伊曲康唑抗真菌治疗。结论临床上ABPA容易误诊误治,对于未控制的支气管哮喘患者或哮喘患者伴有急性肺浸润,应考虑该病的可能。早期诊断和合理治疗可以减少ABPA造成的肺损伤,改善患者的预后。     

变态反应性支气管肺曲霉病1例并文献复习

目的总结分析变态反应性支气管肺曲霉病（ABPA）的临床特点,以提高对ABPA的认识,做到早诊断、早治疗。方法对1例确诊的ABPA患者的病史、临床表现、胸部CT、实验室检查结果及疗效并结合有关文献进行回顾性分析。结果本例患者有哮喘病史,在诊断ABPA之前至少被误诊12年。回顾性分析至2008年5月份以前国内可检索到的ABPA病例共91例,均有误诊,误诊时间为3个月-40年,被误诊为的疾病有肺结核、肺炎、肺癌、Wegener肉芽肿等,误诊为肺结核最为常见。临床症状无特异性,特征性的中央型支气管扩张对诊断ABPA有重要意义。结论我国ABPA报道病例较少,尚无国内的诊治指南。临床上ABPA极易误诊,应该提高对ABPA的诊断意识,若患者有气喘表现,肺部出现游走性浸润影、中央型支气管扩张,可进一步查总IgE、烟曲菌特异性IgE、烟曲菌过敏原皮试等以便早确诊及治疗。     

变态反应性支气管肺曲菌病患者的治疗

目的讨论变态反应性支气管肺曲菌病的治疗.方法 根据患者临床表现结合检查结果进行诊断并治疗.结论 目前ABPA患者主要依靠药物治疗.     

过敏性支气管肺曲霉菌病两例报告并文献复习

目的 提高对过敏性支气管肺曲霉菌病(ABPA)的认识,以期对ABPA患者做到早期诊断和治疗.方法 对2例ABPA患者的临床资料进行描述、分析.结果 ABPA患者的临床表现与支气管哮喘有很多相似之处,早期很容易漏诊,ABPA最终可导致不可逆的肺纤维化,所以对ABPA做到早期诊断和治疗很重要.目前ABPA有效的治疗用药是糖皮质激素和伊曲康唑.结论 ABPA易被延误诊治,所以当临床遇到难治性哮喘或哮喘合并肺部阴影时应当警惕ABPA的可能.     

变态反应性支气管肺曲霉菌病30例临床分析

目的 分析变态反应性支气管肺曲霉菌病的临床特征.方法 回顾性分析30例ABPA患者的临床表现、影像学表现特征.结果 30例患者均有不同程度的咳嗽、咯痰和喘息症状,肺CT示中心性支气管扩张.治疗后20例治愈,8例症状好转.结论 掌握ABPA的临床特征和影像学表现可有效避免误诊.     

两种曲霉菌相关性哮喘临床诊治特点对比分析

目的提高对两种曲霉菌相关性哮喘———变应性支气管肺曲霉病（ABPA）和真菌致敏性严重哮喘（SAFS）的认识,减少误诊和漏诊。方法回顾性对比分析23例ABPA患者和7例SAFS患者的临床资料。结果ABPA患者和SAFS患者哮喘病史、喘息、胸闷气急等哮喘发作症状、嗜酸性粒细胞百分比、C反应蛋白（CRP）、血清总IgE、烟曲霉特异性IgE、PaCO2、HCO3-比较差异均有统计学意义（均P＜0.05）。SAFS患者CT表现无特异性,而ABPA患者胸部CT表现为中心性支气管扩张、黏液栓、迁移性肺浸润影等。糖皮质激素联合抗真菌治疗ABPA和SAFS效果明显。然而ABPA和SAFS治疗后复发率高,尤其是ABPA,7例患者在治疗过程或停药后复发。结论SAFS较ABPA更易被误诊、漏诊,对于严重、难治性哮喘合并或不合并胸部CT表现异常的患者,均应常规行真菌学相应检查。激素联合抗真菌治疗对于ABPA和SAFS均有显著疗效,但两者均易复发,定期随访对于早期发现疾病进展、反复十分必要。     

变态反应性支气管-肺烟曲菌病

变态反应性支气管-肺烟曲菌病(Allergic bronchopulmonary aspergillosis,ABPA)是一种严重阻塞性肺部疾病的综合征,以哮喘和囊性纤维化最为常见。ABPA的名称由Hinson在1952年提出,临床主要表现为气喘,咳痰,发热,血液嗜酸性细胞增多,胸片浸润性阴影,痰培养烟曲菌生长。ABAP的早期诊断与治疗十分重要,但诊断颇为困难,可误诊为肺结核,霉菌性肺炎和肺癌等。本就其临床研究进展作一简要介绍。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.