深圳市2000—2016年初治耐药结核病流行趋势分析

目的 探讨深圳市初治耐药结核病流行趋势变化，为耐药结核病防控策略调整提供理论依据。方法 对2000—2016年深圳市登记的所有涂阳肺结核病患者进行痰检，以罗氏培养阳性菌株进行菌型鉴定和耐药检测，采用Joinpoint regression program软件计算年度变化百分比并进行趋势检验。结果 共检测17 857株结核分枝杆菌，其中初治单耐利福平733株（4.10%），初治单耐异烟肼1 457株（8.16%），初治同时耐异烟肼、利福平541株（3.03%）。2000—2006年深圳市初治利福平耐药结核分枝杆菌检出率以每年9.29%的平均速率下降（P=0.03）；2007—2014年以每年0.72%的平均速率波动（P=0.06）；2015—2016年以每年30.22%的平均速率下降（ P=0.14）；2000—2011年深圳市初治异烟肼耐药结核分枝杆菌检出率以每年4.22%的平均速率下降（P=0.01）；2012—2014年以每年5.70%的平均速率上升 （P=0.61）；2015—2016年以每年18.25%的平均速率再次下降（ P=0.36）；2000—2008年深圳市初治同时对异烟肼、利福平耐药结核分枝杆菌检出率以每年1.94%的平均速率波动，呈下降趋势（ P=0.57）；2009—2011年以每年9.28%的平均速率下降（P=0.81）；2012—2016年以每年8.39%的平均速率上升（P=0.58）。结论 深圳市初治耐药结核病流行均呈阶段性变化，其中对利福平、异烟肼单耐药率在波动中呈下降趋势，而对利福平、异烟肼同时耐药率近年来呈上升趋势，主要原因为传播导致的原发性耐药增多，应该调整深圳市防控策略，把重点转移至加强耐药结核病传染源的隔离，特别是耐多药结核病患者。     

论异烟肼与维生素B_6的配伍

异烟肼与维生素B6同用是多年来临床用药中的争论性问题。争论焦点；（1）两药是否需要同用；（2）维生素B6在什么情况下使用；（3）同用是否会使异烟肼降效。维生素B6是脂肪代谢和氨基酸代谢的辅酶，VB6缺乏时可致末稍神经炎，大剂量（每日500mg以上）应用异烟肼可致周围神经炎，如四肢感觉异常、位反射迟钝、肌肉轻瘫等，与维生素B6缺乏极其相似。可能由于异烟朕与维生素B6结构类似，竞争同一酶系统以致妨碍了维生素B6的利用或异烟讲与维生素Bs结合成复合物而排出，引起维生素B。缺乏所致。l什么槽况不加取维生素B。常规应用异烟讲（0…     

低密度脂蛋白氧化修饰过程中脂氢过氧化物的变化及外源性抗氧化剂的影响

用Ｃｕ￣（２＋）引发ＬＤＬ的氧化修饰，用ＦＯＸ法测定脂氢过氧化物（ＬＯＯＨ），观察了ＬＤＬ氧化修饰过程中ＬＯＯＨ的变化及外源性抗氧化剂维生素Ｅ和Ｃ的作用。结果显示ＬＤＬ氧化过程中ＬＯＯＨ的变化可分为三个阶段：首先ＬＯＯＨ有一段稳定不变的时间（延迟期），接着ＬＯＯＨ急剧上升（扩增期）；最后达到最大值并开始呈现下降趋势（降解期）。根据ＬＯＯＨ变化的动力学曲线可以求出ＬＤＬ氧化修饰的如下参数：ＬＯＯＨ基础值；延迟期时间；ＬＤＬ最大氧化速率和ＬＯＯＨ最大值。外源抗氧化剂维生素Ｅ和Ｃ的加入，可使延迟期的时间延长，但不影响ＬＯＯＨ的基础值、最大值和氧化速率。     

利福平、异烟肼在肺结核合并糖尿病患者中的血药浓度分析

目的观察利福平、异烟肼在肺结核合并糖尿病患者中的血药浓度，同时观察其疗效。方法收集肺结核合并糖尿病患者46例（观察组）及单纯肺结核患者53例（观察组）。两组患者均口服利福平0．45g，1次／d；异烟肼0．3g，1次／d；同服乙胺丁醇和吡嗪酰胺。采用高效液相色谱法分别测定利福平和异烟肼的血药浓度，并复查痰涂片找抗酸杆菌及胸部x片。结果两组患者痰菌阴转率、病灶显著吸收率及利福平血清药物浓度低于治疗浓度比例差异均有统计学意义（均P〈0．05），但异烟肼血清药物浓度低于治疗浓度所占比例差异无统计学意义（P〉0．05）。结论肺结核合并糖尿病患者的抗结核治疗疗效较单纯肺结核要差，可能与利福平血清药物浓度低于正常治疗范围有关。     

低密度脂蛋白氧化修饰过程中脂氢过氧化物的变化及外源性…

有Ｃｕ＾２＋引发ＬＤＬ钠氧化修饰，用ＦＯＸ法测定脂氢送氧化物（ＬＯＯＨ），观察了ＬＤＬ氧化修饰过程中ＬＯＯＨ的变化有外源性抗化剂维生素Ｅ和Ｃ的作用。结果显示ＬＤＬ氧化过程中ＬＯＯＨ的变化可分为三个阶段；首先ＬＯＯＨ有一段稳定不变的时间（延迟期）接着ＬＯＯＨ急剧上升（扩增期）最一达到是值并开始呈现下降趋势（降解期）根据ＬＯＯＨ变化的动力学曲线可以求出ＬＤＬ氧化修饰的如下参数；ＬＯＯＨ基础值；延 期时     

兔血浆异烟肼反相高效液相色谱分析及药代动力学研究

目的 建立兔血浆中异烟肼（Isoniazid,INH）的反相高效液相色谱分析方法（reversed-phase high-performance liquid chromatography,RP-HPLC）.研究其静脉给药后兔体内血浆药代动力学参数.方法 以Agilent ZORBAX SB-C18柱（5μm,4.6mm×250mm）为INH的分析柱,流动相为0.02 mol·L-1磷酸二氢钾缓冲液（H3PO4调pH4.0）：乙腈=55：45;流速1.0 mL·min-1;柱温：35C,血浆经桂皮醛衍生化后325nm波长下检测.8只新西兰大白兔分别按INH 11.43 mg·kg-1静滴,RP-HPLC法检测血浆药物浓度.所得血药浓度数据经DAS软件拟合分析.结果 INH在0.05～20μg·mL-1血浆浓度范围内线性关系良好（r=0.99989）,最低检测浓度为50ng·mL-1,平均提取回收率为100％,日内、日间变异系数（RSD =5）分别为1.2％ ～4.3％和2.5％ ～4.4％.INH在兔体内药代动力学过程符合双隔室模型（权重系数为1/cc）,T1/2=（1.92 ±0.80）h,Cmax=（9.70±1.38）mg·L-1,AUC（0-∞）=（20.97±3.11）mg· （h·L）-1.结论 本研究建立的兔血浆异烟肼HPLC方法具有较高的灵敏度、精密度和特异性,适用于兔体内药代动力学的研究.兔体内异烟肼药代动力学过程符合双隔室模型,体内药代谢动力学参数为异烟肼其它剂型的研究提供参考.     

异烟肼引起癫痫样发作一例

异烟肼引起癫痫样发作一例王继业（广西桂林市第三人民医院）关键词癫痫；异烟肼１病例介绍患者女性，３８岁，于１９９５年６月因咳嗽、咳痰、胸痛一个月，伴午后低热一周，在外院诊断为“肺结核”。６月２１日开始服异烟肼０．３ｇ，利福平０．４５ｇ，乙胺丁醇０．７５...     

氟嗪酸治疗耐药肺结核29例

多种耐药结核病（ＭＤＲ－ＴＢ）患者对异烟肼、利福平等常规化疗效果差，痰菌不易阴转，传染期长，给临床治疗带来了很大困难。为此，我们选择一组经ＳＨＲＺ／ＨＲＥ（Ｓ：链霉素，Ｈ：异烟肼，Ｒ：利福平，Ｚ：吡嗪酰胺；Ｅ：乙胺丁醇）方案治疗失败的病例，分析ＭＤＲ...     

肾移植术后并发结核的诊治(附10例报告)

（１）目的 探讨肾移植病人并发结核的临床特点及诊治方法。（２）方法 对１０例肾移植病人并发结核的发病特点、诊断方法及治疗效果进行了回顾分析。术后病人常规进行硫唑嘌呤（Ａｚａ）、泼尼松（Ｐｒｅｄ）二联，或环孢霉素Ａ（ＣｓＡ）、Ａｚａ、Ｐｒｅｄ三联免疫抑制治疗；１０例病人均根据临床表现，结合Ｘ线检查、ＰＣＲ扩增结核杆菌ＤＮＡ及组织学检查确诊为结核菌感染。给予异烟肼、利福平、乙胺丁醇，或异烟肼、利福平、     

安定、维生素B6联合治疗重度异烟肼中毒2例

安定、维生素Ｂ６联合治疗重度异烟肼中毒２例解放军１７医院（８４２０００）张全德新疆库车县医院陈淑文近年有报道单用安定（ＤＺ）或维生素Ｂ６治疗异烟肼（ＩＮＨ）中毒获得成功［１，２］。我们联合应用以上２药救治重度异烟肼中毒２例成功，报告如下。例１：女，２...     

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.