肾病患者血清透明质酸、Ⅲ型前胶原、胶原Ⅳ及层粘蛋白测定的临床意义

目的 :探讨肾病患者血清中透明质酸 (HA)、 型前胶原 (PC )、 型胶原 (C- )、层粘蛋白 (L N)的水平与肾功能的关系。方法 :将患慢性肾脏疾病而肾功能正常的病人、慢性肾功能不全的病人、尿毒症病人及正常人分为 A、B、C、D组 ,留清晨空腹血 ,查血清中上述 4种物质的浓度。结果 :1血清 HA:C组 >B组 >A组 >D组 ,差异有显著性 (P <0 .0 1) ,HA变化与 Cr呈正相关 (B、C组 r值分别是 0 .87,0 .6 8) ;2血清 PC :C组 >B组 >A组 >D组 ,差异有显著性 (P <0 .0 1) ,PC 与 Cr呈正相关 (B、C组 r值分别是 0 .79,0 .72 ) ;3血清 C- :A组与 D组比较无差异 ,B组、C组与 D组比较差异有显著性 (P <0 .0 1,P <0 .0 0 1) ,B、C组间比较差异有显著性 (P <0 .0 0 1) ,C- 与 Cr呈正相关 (B、C组 r值分别是 0 .72 ,0 .82 ) ;4血清 L N:A组与 D组比较无差异 ,B组、C组与 D组比较差异有显著性 (P <0 .0 1,P <0 .0 0 1) ,B、C组间比较差异有显著性 (P <0 .0 0 1) ,L N与 Cr呈正相关 (B、C组 r值分别是 0 .84 ,0 .75 )。结论 :HA、PC 在 Cr升高前即有明显改变 ,可作为诊断早期肾功能不全的依据。 HA、PC 、C- 及 L N可作为反映不同时期肾功能恶化的指标。     

心理应激教育对康复期精神分裂症的作用对照研究

目的 :探讨心理应激教育对康复期精神分裂症预防复发的作用。方法 :将入组患者随机分为A、B、C三组 ,在给予相同药物治疗原则的基础上 ,A组给以心理应激教育和心理教育 ,B组给以心理教育 ,C组不进行任何教育 ,12周后开始随访 ,期限为一年。用简明精神病量表 (BPRS)、护士用住院病人观察量表 (NOISE -3 0 ) ,简易应对方式问卷评定病情和应激能力的变化情况。结果 :(1)A组患者复发率明显低于B、C两组 (χ2 =4 3 6,P <0 0 5;χ2 =13 2 9,P <0 0 1) ,B组低于C组 (χ2 =4 15,P <0 0 5)。(2 )BPRS总分三组患者随访前后差异均有显著性 (P <0 0 5～P <0 0 1) ,随访后三组间比较差异均有显著性 (P <0 0 5～P <0 0 1)。(3 )教育前后A、B两组积极因素分、消极因素分和病情总估计评分差异均有显著性 (P <0 0 1)。以A组改变更为明显。A组消极因素分低于B组 (P <0 0 1) ,A、B两组积极因素分、病情总估计评分明显高于C组 (P <0 0 1) ,消极因素分明显低于C组 (P <0 0 1)。随访后 ,A、B两组织极因素分、病情总估计平分均高于C组 (P <0 0 1) ,消极因素分均低于C组 (P <0 0 1) ,A组消极因素分低于B组 (P <0 0 5)。 (4)教育后简易应对方式问卷评定 :积极维度分A组高于B、C两组 (P <0 0 5,P <0 0 1) ,随访后     

急性心肌梗死并高血压的临床特点

目的为了解急性心肌梗死 (AMI)并高血压的临床特点 ,以提高防治效果。方法对北京医院 2 14例经监护病房确诊的AMI患者 ,按是否合并高血压分为A组 (合并组 12 4例 )和B组 (不合并组 90例 )对比其例数、并发症、与病死率及冠状动脉造影结果。结果A组发生心肌梗死的机会比B组高 ,有显著性差异 (P <0 .0 5 ) ,A组发生心源性休克、急性心力衰竭、严重心律失常及急性期病死率 (<8w)较B组高 ,有显著性差异 (P <0 .0 5 ) ,A组冠状动脉造影结果以多支病变为主较B组高 ,有显著性差异 (P <0 .0 5 )。结论高血压是影响AMI预后的高危因素。     

妊娠期肝内胆汁瘀积症的治疗与围产儿预后关系的探讨

目的 :评估熊去氧胆酸 (UDCA)、地塞米松 (DX)治疗妊娠期肝内胆汁瘀积症 (ICP)的疗效及围产儿预后情况。方法 :12 6例患者随机分为UDCA组 (A组 )、DX组 (B组 )和对照组 (C组 ) ,各 4 2例 ,A、B、C 3组血清胆汁酸TBA(10～ 5 0μmol/L)分别为A1组 30例、B1组 2 7例、C1组 2 9例 ;TBA >5 0 μmol/L分别为A2 组 12例、B2 组 15例、C2 组 13例。A组给予UDCA 10 0mg ,3次 /d ,14d为 1个疗程 ;B组给予DX 3mg ,3次 /d ,10d后逐渐减量而停药 ;C组给予口服维生素C 0 .2 g ,连续服用 14d。结果 :A、B组患者治疗后皮肤瘙痒症状明显减轻 (P <0 .0 5 ) ,C组瘙痒症状无变化 ;A、B 2组治疗后血TBA明显下降 (P <0 .0 5 ) ;A2 组下降程度大于B2 组 (P <0 .0 5 ) ,C组稍上升 (P >0 .0 5 ) ;3组内早产、胎儿窘迫、新生儿窒息的发生率与TBA值呈正相关 ,A、B组的发生率明显低于C组 ,差异有显著性 (P <0 .0 5 ) ,A、B组内TBA值低的组 (A1、B1组 )早产、胎儿窘迫、新生儿窒息发生率差异无显著性 (P >0 .0 5 ) ,TAB值高的组 (A2 、B2 组 )早产、胎儿窘迫、新生儿窒息的发生率差异有显著性 (P <0 .0 5 )。结论 :UDCA、DX均能有效治疗ICP ,减少早产、胎儿窘迫、新生儿窒息的发生率 ,对于TBA值高的患者 ,UDCA疗效优于DX ,仅口服维生     

一氧化碳中毒迟发性脑病的临床预防

目的　探讨临床治疗措施对一氧化碳中毒迟发性脑病的预防。方法　将 130例一氧化碳中毒患者随机分为A、B、C 3组 ,A组采用纳络酮、低分子肝素、高压氧治疗 ;B组采用胞二磷胆碱、醒脑注射液、高压氧治疗 ;C组采用胞二磷胆碱、醒脑注射液治疗。结果　A组昏迷时间与B、C组对比 ,B组与C组对比 ,明显缩短 ,有显著性差异 (P <0 .0 5或P <0 .0 1) ;本组 130例患者中 ,共发生迟发性脑病15例 ,发生率为 11.5 % ,迟发性脑病发生率A组与B、C组对比 ,B组与C组对比 ,明显降低 ,有显著性差异 (P <0 .0 5或P <0 .0 1)。结论　选择有效的药物 ,及早应用高压氧和充足的疗程是迟发性脑病临床预防的关键。     

急性重症胆管炎手术时机选择的临床研究

目的　探讨急性重症胆管炎 (ACST)的最佳手术时机。方法　分析 4 33例ACST病人各手术时机的病死率。按术前处理及手术时机的差异分为 :①在入院 4h内经抗休克治疗好转 ,8h内立即手术 (A组 ) 10 1例 ;②在入院 4h内经抗休克治疗好转 ,超过 8h后作延迟手术 (B组 ) 93例 ;③在入院 4h内经抗休克治疗不好转 ,8h内立即手术 (C组 ) 10 8例 ;④在入院 4h内经抗休克治疗不好转 ,超过 8h后作延迟手术 (D组 ) 6 1例 ;⑤入院后未作抗休克治疗 ,1h内立即手术 (E组 ) 70例。结果　A组病死率为 1.0 % ,B、C组病死率分别为 10 .8%、11.1% ,与A组比较差异有显著性 (P值均 <0 .0 5 ) ;D、E组病死率分别为 75 .4 %、70 .0 % ,与A组病比较差异有极显著性 (P值均 <0 .0 1)。结论　在入院 4h内经抗休克治疗好转 ,8h内立即手术是降低ACST病死率的最佳手术时机     

胃肠功能性疾病的抑郁因素分析及治疗

目的 :观察抗抑郁治疗对伴有抑郁症状的胃肠功能性疾病 (FGD)患者的治疗效果。方法 :将 4 1例伴有抑郁症状的FGD患者随机分为盐酸氟西汀治疗组 (A组 )、普瑞博思或得舒特治疗组 (B组 ) ,随机选 2 0例不伴有抑郁症状的FGD患者给予普瑞搏思或得舒特治疗作为C组。疗程均为 4周。结果 :治疗前Zung积分A组与B组相比P >0 .0 5 ,差异不显著。治疗后Zung积分A组与B组相比P <0 .0 1,差异显著。治疗前后 3组的平均症状分均明显下降 ,但以A、B组的分数下降更明显。组间疗效判定分对比A组与B组比较P <0 .0 1;C组与B组比较P <0 .0 1。结论 :在胃肠功能性疾病患者中有部分患者合并精神心理障碍因素 ,对有抑郁倾向的患者抗抑郁治疗可以获得较好疗效 ,其他药物治疗的疗效不如抗抑郁治疗的疗效     

星状神经节阻滞伍配地塞米松治疗过敏性鼻炎临床观察

目的　探讨星状神经节阻滞 (SGB)伍配地塞米松治疗过敏性鼻炎的临床效果以及对穿刺部位疼痛发生状况的影响。方法　将 12 0例过敏性鼻炎经SGB治疗时伍配地塞米松 ,按地塞米松不同途径给药分组 ,即 :注射伍用 (A组 ,n=60 )、口服配伍 (B组 ,n =60 ) ,设 60例不伍用药 (C组 )为对照组 ,观察各组临床疗效及穿刺部位疼痛状况。结果　A组和B组的总有效率明显高于C组 (P均 <0 .0 5 ) ,但A组与B组比较差异无显著性 (P >0 .0 5 )。A组穿刺部位疼痛发生率及疼痛程度在 1、2周、2 0d后明显低于B组、C组 (P <0 .0 5或 0 .0 1) ,而B组与C组差异无显著性 (P >0 .0 5 )。结论　SGB治疗过敏性鼻炎伍配地塞米松疗效满意 ,可有效地减少穿刺部位疼痛的发生。     

慢性阻塞性肺病合并肺部感染患者IL-6、IL-8、TNF—α测定的临床意义

目的　探讨老年慢性阻塞性肺病 (COPD)患者合并肺部感染时外周血细胞因子的白细胞介素6 (IL- 6 )、白细胞介素 8(IL- 8)、肿瘤坏死因子 (TNF-α)的变化 ,及其与感染的相互关系。方法　采用放射免疫法检测 IL- 6、IL- 8,酶联免疫吸附试验法检测 TNF-α水平。分别检测了 3 1例正常人 (A组 ) ,47例老年 COPD合并肺部感染急性期 (B组 ) ,3 5例老年 COPD合并肺部感染好转期 (C组 )患者外周血 IL- 6、IL- 8和 TNF- α的水平。结果　B组的血 IL- 6及 IL- 8的水平明显高于 A组 (P <0 .0 1 ) ,而 C组 IL- 6、IL8水平高于 A组 ,低于 B组 (P <0 .0 5 ) ;B组的 TNF- α水平最高 ,C组次之 ,分别与 A组比较均有显著统计学意义 (P <0 .0 1 ) ,B组与 C组比较 ,也有显著差异 (P <0 .0 5 )。结论　细胞因子 IL- 6、IL8、TNF- α水平与老年 COPD合并肺部感染的严重程度有关 ,并且三者之间呈正相关 ,对其监测有利于疾病的分期 ,可作为观察疗效和判断预后的可靠指标。     

高血压病伴脑梗塞体内脂质过氧化反应与血液流变学的关系

目的 :探讨高血压病伴脑梗塞的血液流变学与氧自由基系统的改变、相互关系及其临床意义。方法 :将高血压病伴脑梗塞者 6 8例作为A组 ;高血压病伴短暂性脑缺血发作 47例为B组 ;单纯高血压病 42例为C组。检测各组的血液流变学变化和血浆丙二醛 (MDA)、超氧化物歧化酶 (SOD)活性。结果 :A组的全血粘度低切、全血粘度高切、血细胞比容 (Hct)、MDA高于B组和C组 (P <0 .0 1) ,B组的各项指标高于C组 ,但差异无显著性 (P >0 .0 5 ) ;A组的SOD低于B组 ,B组低于C组 ,但差异无显著性 (P >0 0 5 ) ;A组的SOD/MDA低于B组 ,B组低于C组 (各组间P <0 .0 1)。A组的SOD/MDA与Hct存在负相关 (r =-0 .82 0 7,P <0 0 1)。结论 :高血压病发展为伴脑梗塞与血液流变学改变及体内脂质过氧化作用有关 ,MDA的升高和SOD、SOD/MDA的降低、血粘度增加和红细胞变形能力降低参与了其病理生理过程 ,而这两方面可能互为因果。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.