2型糖尿病合并Hp感染者游离脂肪酸水平及氧化应激反应的观察

目的通过检测2型糖尿病合并幽门螺旋杆菌(Hp)感染者血清游离脂肪酸(FFA)、丙二醛(MDA)水平及超氧化物歧化酶(SOD)活性,观察Hp感染对FFA水平及氧化应激反应的影响及相关性。方法选择临床确诊的住院和门诊2型糖尿病患者160例及对照组50例,检测14C尿素呼气试验(14C-UBT),采用美国贝克曼库尔特AU680全自动生化分析仪检测FFA水平(酶联法)及血清SOD活性(比色法),采用上海现科752可见分光光度计(532nm)检测血清MDA水平(TBA法)。结果 2型糖尿病组与对照组比较,血清FFA、MDA水平及SOD活性差异具有统计学意义(t=6. 293～13. 457,P <0. 01)。Hp感染组与Hp非感染组比较,血清FFA水平、MDA水平及SOD活性差异具有统计学意义(t=4. 061～8. 227,P <0. 01)。2型糖尿病合并Hp感染者血清FFA水平与血清MDA水平呈显著正相关(r=0. 482,P <0. 01),与血清SOD活性呈显著负相关(r=-0. 409,P <0. 01)。结论 2型糖尿病合并幽门螺旋杆菌感染者,机体内游离脂肪酸水平显著升高及氧化应激反应增强,且具有显著相关性,此可能是幽门螺旋杆菌感染加剧2型糖尿病病情的原因之一。     

抗幽门螺旋杆菌治疗对急性脑梗死患者氧化应激水平及预后的影响

目的探讨抗幽门螺旋杆菌(Hp)治疗对急性脑梗死(ACI)患者氧化应激水平及预后的影响。方法ACI患者125例,常规做14C尿素呼气试验检测Hp感染情况。将84例Hp感染患者随机分为治疗组42例和对照组42例,两组均给予常规药物治疗,治疗组加用抗Hp治疗。采用酶联免疫吸附法检测所有患者血清氧化型低密度脂蛋白(ox-LDL)和超氧化物歧化酶(SOD)水平,观察两组患者治疗前后ox-LDL和SOD变化,观察其神经功能恢复情况,随访半年、1年统计脑梗死复发率。结果 125例ACI患者中Hp感染率为67.2%。随着Hp感染程度加重,血清ox-LDL水平升高(F=16.143,P0.01),SOD水平下降(F=55.686,P0.01)。治疗组治疗后血清ox-LDL水平较对照组降低,SOD水平较对照组升高(P0.01)。治疗组神经功能恢复总有效率高于对照组(P0.01)。治疗组半年及1年脑梗死复发率均低于对照组(P0.05)。结论 Hp感染是ACI的重要危险因素,积极抗Hp治疗,可显著降低脑梗死患者体内氧化应激反应,提高治疗的有效率,并可降低其短期内脑梗死的复发率。     

原发性高血压并发颈动脉粥样硬化患者血清HCY水平与氧化应激的相关性

目的通过观察原发性高血压(EH)患者颈动脉内膜中层厚度(CAIMT)和血清同型半胱氨酸(HCY)、丙二醛(MDA)水平及超氧化物歧化酶(SOD)活性,探讨EH并发颈动脉粥样硬化(CAS)患者血清HCY与氧化应激的相关性。方法选择2014-01~2016-12在该院就诊的266例EH患者为研究对象,以同期体检健康者50名作为对照组。检测CAIMT(彩色多普勒超声仪)和血清HCY(循环酶法)、MDA(TBA法)水平及SOD活性(比色法),并进行统计学对比分析。结果 (1)EH患者并发CAS发生率为62.8%(167/266),与其年龄、病情及病程有关,与性别差异无关。(2)EH并发CAS组与对照组比较,血清HCY和MDA水平显著升高(t=7.118、6.326,P0.05),SOD活性显著降低(t=12.809,P0.01)。(3)血清HCY水平与MDA水平呈显著正相关(r=0.493,P0.05),与血清SOD活性呈显著负相关(r=-0.562,P0.05)。结论EH并发CAS患者血清HCY水平显著升高,氧化应激反应增强,血清HCY水平与氧化应激显著相关。     

枯草杆菌联合四联疗法补救对老年幽门螺杆菌感染者的疗效

目的探讨枯草杆菌联合四联疗法补救对老年幽门螺杆菌(Hp)感染者的疗效。方法选择2014年2月至2016年2月都江堰市医疗中心消化内科收治的Hp感染治疗失败需要接受补救治疗的老年患者100例,随机分为观察组50例,对照组50例。对照组使用含阿莫西林、呋喃唑酮、兰索拉唑和胶体果胶铋四联疗法治疗,观察组在此基础上联合枯草杆菌进行治疗。比较两组患者的血清超氧化物歧化酶(SOD)、丙二醛(MDA)和一氧化氮(NO)表达水平,以及两组治疗后的Hp转阴率、不良反应发生情况。结果治疗后,观察组Hp转阴率显著高于对照组,差异有统计学意义(P0.05);两组患者治疗前血清SOD、MDA及NO水平差异无统计学意义(P0.05);治疗后,两组患者血清SOD、NO水平均明显上升,MDA水平明显下降,且观察组SOD、NO水平显著高于对照组,MDA水平明显低于对照组,差异均有统计学意义(P均0.05);两组患者的不良反应发生率差异无统计学意义(P0.05)。结论枯草杆菌联合四联疗法补救对老年Hp感染者的疗效较好,不良反应较少,患者可以耐受,值得推广应用。     

癫痫一号方联合卡马西平治疗风痰闭窍型癫痫的临床研究

目的探讨癫痫一号方联合卡马西平对风痰闭窍型癫痫病人血清超氧化物歧化酶(SOD)、丙二醛(MDA)及同型半胱氨酸(Hcy)的影响。方法选取我院收治的风痰闭窍型癫痫病人96例作为研究对象,随机分为观察组和对照组,对照组给予卡马西平治疗,观察组在对照组基础上联合癫痫一号方治疗。观察两组临床疗效、中医症状积分、血清SOD、MDA、Hcy水平及不良反应发生情况。结果观察组总有效率显著高于对照组(P0.05)。治疗后两组中医症状各项积分显著低于治疗前(P0.01),且观察组显著低于对照组(P0.01)。治疗后两组SOD水平显著高于治疗前(P0.01),且观察组显著高于对照组(P0.01);治疗后两组MDA、Hcy水平显著低于治疗前(P0.01),且观察组显著低于对照组(P0.01)。结论癫痫一号方联合卡马西平治疗可有效改善风痰闭窍型癫痫病人临床症状和血清SOD、MDA、Hcy水平,提高临床疗效。     

急性脑梗死患者MDA、H_2O_2、SOD和ABTS的表达及临床意义

目的探讨急性脑梗死患者血清丙二醛(MDA)、过氧化氢(H_2O_2)、超氧化物歧化酶(SOD)和抗氧化性(ABTS)的活性情况及临床意义。方法选取2017年3月至2018年8月期间西安市第九医院收治的ACI患者96例作为观察组,同时选取经影像学检查无异常的健康者96例作为对照组。根据观察组患者的不同的神经功能缺损程度,将其分为轻度脑梗死组33例、中度脑梗死组31例、重度脑梗死组32例;同时根据不同的脑梗死面积,将其分为小梗死组34例、中梗死组32例、大梗死组共30例。检测所有入组对象的血清MDA、H_2O_2、SOD和ABTS的活性情况。对比观察组和对照组的血清MDA、H_2O_2、SOD、ABTS水平,同时对比不同神经功能缺损程度以及不同脑梗死面积患者的血清MDA、H_2O_2、SOD、ABTS水平。结果观察组血清MDA、H_2O_2水平明显高于对照组,血清SOD水平和ABTS活性水平均低于对照组,差异有统计学意义(t=12.759～18.723,P <0.05);轻度组、中度组及重度组的血清MDA、H_2O_2、SOD、ABTS指标进行组间对比,差异有统计学意义(F=2.544～3.851,P <0.05);中度组与重度组MDA、H_2O_2水平高于轻度组,SOD、ABTS水平低于轻度组,比较差异有统计学意义(均P <0.05)。重度组MDA、H_2O_2水平高于中度组,SOD、ABTS水平低于中度组,比较差异有统计学意义(均P <0.05)。小梗死组、中梗死组及大梗死组的血清MDA、H_2O_2、SOD、ABTS指标进行组间对比,差异有统计学意义(F=2.675～3.597,P <0.05)。中梗死组与大梗死组MDA、H_2O_2水平高于小梗死组,SOD、ABTS水平低于小梗死组,比较差异有统计学意义(均P <0.05)。大梗死组MDA、H_2O_2水平高于中梗死组,SOD、ABTS水平低于中梗死组,比较差异有统计学意义(均P <0.05);梗死面积与急性梗死轻度(r=0.704,P <0.05)、中度(r=0.712,P <0.05)、重度(r=0.723,P <0.05)呈正相关。结论神经功能缺损程度越高的ACI患者血清MDA、H_2O_2水平越高,SOD、ABTS活性水平越低。在临床管理中,对ACI患者血清MDA、H_2O_2、SOD、ABTS水平进行检测,可有效识别患者的病情程度,对临床诊断、预后防治具有一定的临床意义。     

CagA和IL-9在幽门螺杆菌感染伴消化性溃疡和胃息肉患者中的表达及其作用研究

背景:研究表明幽门螺杆菌(Hp)感染与消化性溃疡(PU)和胃息肉(GP)的发生相关。细胞毒素相关蛋白A(CagA)是Hp致病的重要毒力因子,而白细胞介素-9(IL-9)是具有抗炎效应的细胞因子。目的:探讨CagA、IL-9在Hp感染伴PU和GP患者中的表达及其作用。方法:纳入2013年1月-2014年3月于惠东县人民医院就诊的Hp感染伴PU(Hp+PU组)或Hp感染伴PU和GP患者(Hp+PU+GP组),无Hp感染的慢性胃炎患者作为对照组。采用ELISA法检测血清CagA、IL-9水平;采用免疫组化法检测胃黏膜组织CagA、IL-9表达。结果:Hp+PU组、Hp+PU+GP组血清CagA水平均显著高于对照组(P0.01),血清IL-9水平均显著低于对照组(P0.01),且Hp+PU+GP组血清IL-9水平显著低于Hp+PU组(P0.05)。Hp+PU组、Hp+PU+GP组CagA+患者比例均显著高于对照组(P0.05);三组患者中,CagA+患者血清IL-9水平均显著低于CagA-患者(P0.01),Hp+PU+GP组CagA+患者血清IL-9水平显著低于Hp+PU组和对照组CagA+患者(P0.05)。Hp+PU组、Hp+PU+GP组胃黏膜CagA阳性面积比值显著高于对照组(P0.01),Hp+PU+GP组又显著高于Hp+PU组(P0.05)。Hp+PU组、Hp+PU+GP组胃黏膜IL-9阳性面积比值显著低于对照组(P0.05),Hp+PU+GP组又显著低于Hp+PU组(P0.01)。结论:CagA+Hp感染可能与PU和GP的发生有关。IL-9参与了Hp感染诱导的免疫应答,且可能对Hp感染所致的PU和GP具有抑制作用。     

老年甲状腺功能异常患者糖脂代谢特征及与氧化应激的关系

目的探讨老年甲状腺功能异常状态下糖、脂代谢特征及其与氧化应激的关系。方法选择在该院确诊的老年甲状腺功能异常患者104例,甲亢组54例,甲减组50例,健康组(对照组)50例;青年甲状腺功能异常患者98例,甲亢组51例,甲减组47例,均行糖耐量试验(OGTT)并测定血脂,游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(STSH)等甲状腺功能指标,空腹血浆测定丙二醛(MDA)和超氧化物歧化酶(SOD),氧化型低密度脂蛋白(OX-LDL)水平,并进行比较分析。结果老年甲亢组1 h血糖(PG)、2 h PG明显高于对照组(P0.05),1 h PG明显高于青年甲亢组(P0.01)。老年甲亢血脂各组分均低于对照组(P0.05或P0.01);除血清高密度脂蛋白-胆固醇(HDL-C)和载脂蛋白(Apo A)1外,其余指标均高于青年组(P0.05或P0.01)。老年甲减患者甲减组HDL-C低于老年对照组(P0.05),除Apo A1外,其余血脂指标均高于老年对照组(P0.05或P0.01);总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、Lp(a)明显高于青年甲减组(P0.05或P0.01)。老年甲亢组MDA、SOD明显高于老年对照组和青年甲亢组(P0.01),MDA与FT4独立相关。老年甲减组MDA、SOD、OX-LDL显著高于老年对照组,MDA、OX-LDL明显高于青年甲减组(P0.01),MDA与LDL-CFT4独立相关。老年和非老年甲亢组、甲减组SOD/MDA均显著低于对照组,老年组低于青年组。结论老年甲亢患者氧化应激发生于氧化损伤程度与糖脂代谢紊乱有关,甲减患者主要与脂代谢紊乱有关。     

慢性阻塞性肺疾病SOD、CAT、MDA改变及临床意义

目的探讨慢性阻塞性肺疾病(COPD)病人超氧化物歧化酶(SOD)、过氧化氢酶(CAT)活性和丙二醛(MDA)含量的变化及其临床意义.方法观察了20例急性期、12例缓解期COPD病人和10例健康老年人,采用放射免疫法和分光光度测定法测定血清SOD、CAT活性和MDA含量,1秒钟用力肺活量实测值/预计值百分比(FEV1.0%).结果①COPD组MDA含量高于对照组(P＜0.05),但是SOD、CAT含量明显低于对照组(P＜0.01).急性期病人的SOD、CAT活性低于缓解期(P分别＜0.05,＜0.01),MDA含量显著高于缓解期(P＜0.01).②SOD活性与MDA含量呈显著直线负相关(r＝-0.48P＜0.001),MDA含量与FEV1.0%呈显著直线负相关(r＝-0.38P＜0.01).结论COPD病人MDA含量增高,而SOD、CAT活性降低,且MDA水平与病情严重度一致,氧化/抗氧化失衡在COPD的发病机制中起一个重要的作用.     

神经元特异性烯醇化酶在急性脑梗死中的应用

目的探讨神经元特异性烯醇化酶(NSE)在急性脑梗死(ACI)中的临床价值。方法选择急性脑梗死患者60例(ACI组),检测患者入院第2天和治疗14 d后血清NSE,并与健康体检对照组40名清晨检测的NSE进行比较。结果 ACI组治疗前血清NSE水平显著高于对照组(P0.01),病灶大、病情重者NSE水平显著升高(P0.01)。ACI组治疗后NSE水平明显低于治疗前(P0.01)。结论 ACI患者血清NSE水平明显升高,对梗死灶大小及病情评估具有重要价值。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.