血清sFas和sFasL在系统性红斑狼疮诊治中的应用

目的　旨在探讨血清sFas和sFasL的变化在系统性红斑狼疮 (SLE)临床诊治中的应用。方法　采用ELISA法检测 39例SLE患者和 2 0例健康人血清中sFas和sFasL的水平。结果　SLE患者血清中的sFas和sFasL的水平分别为 (16± 4 0 ) μg/L和 (0 0 8± 0 0 3) μg/L。健康人血清中的sFas和sFasL的水平分别为 (3 1± 1 1) μg/L和 (0 0 5± 0 0 1) μg/L ,二者经统计学检验有非常显著的差异 (P <0 0 1)。活动期患者和缓解期患者血清中的sFas水平分别为 (2 0± 5 ) μg/L和 (10± 2 ) μg/L ,前者较后者明显增高 ,P <0 0 1。sFasL的水平活动期患者和缓解期患者之间无显著性差异 ,P >0 0 5。结论 :sFas及sFasL参与了SLE的发病 ,且可作为SLE活动性的实验诊断指     

拉米夫定治疗慢性乙型肝炎40例

目的 :研究拉米夫定治疗慢性乙型肝炎抗病毒及临床疗效。方法∶将 78例HBVDNA含量为阳性的慢性乙型肝炎 ,随机分为治疗组 40例 ,对照组 38例 ,两组均采用基本护肝对症治疗 ,治疗组加用拉米夫定 10 0mg口服 ,每日 1次 ,疗程 1年 ,观察其血清病毒学指标、肝功能及临床转归。结果∶两组治疗前HBVDNA含量均值分别为 (2 .6± 0 .94)× 10 6拷贝 /ml和(2 .7± 0 .89)× 10 6拷贝 /ml(P >0 .0 5 ) ,治疗后治疗组有 37例 15d后转为 0拷贝 /ml,3例 1月后转为 0拷贝 /ml,1年后持续为 0拷贝 /ml,对照组仅有 3例在半年后转为 0拷贝 /ml,其余 35例持续 1年均为阳性 ,两组比较差异有显著性 (P <0 .0 1)。治疗组与对照组血清转换率分别为 18.7% (6 / 32 )和 6 % (2 / 31) ;两组治疗前血清丙氨酸转氨酶 (ALT)分别为 (198± 11)U/L和(187± 14)U/L(P >0 .0 5 ) ,1年后分别为 (2 3± 2 )U/L和 (119± 13)U/L(P <0 .0 1)。治疗组和对照组总胆红素 (TBil)的改变治疗前分别为 (4 5± 5 .1) μmol/L和 (4 3± 6 .0 ) μmol/L(P >0 .0 5 ) ,治疗后TBil恢复正常比例分别为 10 0 % (19/ 19)和 2 9% (5 /17) ,(P <0 .0 1)。治疗组ALT降至正常后一直持续到 1年 ,无再次入院者 ,无 1例死亡 ,亦无不良反应 ;对照组ALT水平反复波动 ,持     

系统性红斑狼疮患者血清γ干扰素诱导的蛋白10表达水平与疾病活动的关系

目的　探讨血清γ干扰素诱导的蛋白 10 (IP 10 )水平 ,与红斑狼疮 (SLE)疾病活动的关系及其在SLE肾损伤中的可能作用。方法　收集了 112例SLE患者及 4 0名正常健康人和 30例类风湿性关节炎 (RA)患者血清。应用ELISA测定血清IP 10水平。结果　SLE活动组血清IP 10水平 (5 0 8 7± 2 5 2 4 ) μg/L较非活动组 (32 2 2± 95 9) μg/L和对照组 (12 4 9± 4 1 3) μg/L明显升高 (P<0 0 0 1)。活动性狼疮肾炎 (LN)组IP 10水平 (5 5 0 9± 2 0 6 1) μg/L与活动性无肾损伤组 (35 4 8±10 5 3) μg/L及对照组比较其差异均具有统计学意义 (P <0 0 0 1)。特别是Ⅲ型和Ⅳ型LN患者血清IP 10水平 (6 2 9 85± 16 4 ) μg/L升高最为显著 ,与Ⅱ型和Ⅴ型LN(30 2 9± 2 0 7 1) μg/L相比其差异具有统计学意义 (P <0 0 1)。另外 ,血清IP 10水平随着SLE疾病活动水平明显升高 ,与总的SLEDAI评分密切相关 (r=0 6 312 ,P <0 0 0 1) ,与SLEDAI肾评分亦密切相关 (r =0 6 880 ,P <0 0 0 1)。结论　以上结果表明IP 10可能在SLE肾损伤中起着十分重要的作用 ,血清IP 10水平与SLE疾病活动密切相关 ,可作为SLE疾病活动、尤其是监测狼疮肾损伤的重要指标。     

系统性红斑狼疮血清同型半胱氨酸检测的临床意义

目的 :探讨血清同型半胱氨酸 (Hcy)检测对系统性红斑狼疮 (SLE)患者的临床意义。方法 :应用荧光偏振免疫分析法 (FPIA)测定 68例SLE患者和 40例正常人的血清Hcy水平 ,并与常用实验室指标ANA、抗ds DNA、抗DNP作比较。结果 :SLE患者血清Hcy水平为 ( 17 17± 4 0 5 ) μmol/L ,活动期SLE组血清Hcy水平为( 18 64± 3 63 ) μmol/L ,缓解期SLE组血清Hcy水平为 ( 16 45± 4 60 ) μmol/L ,分别与正常对照组的 ( 10 12± 3 15 )μmol/L相比较差异均有极显著性 (P <0 0 1) ,活动期与缓解期血清Hcy水平相比较差异有显著性 (P <0 0 5 ) ;SLE患者在ANA阳性组血清Hcy水平 ( 17 3 6± 4 0 3 ) μmol/L较ANA阴性组 ( 12 99± 1 94) μmol/L有极显著增高 (P <0 0 1) ;在抗ds DNA阳性组血清Hcy水平 ( 18 3 8± 3 60 ) μmol/L较阴性组 ( 16 2 9± 4 61) μmol/L差异有显著性 (P<0 0 5 ) ;抗DNP阳性组 ( 18 10± 3 0 4) μmol/L与阴性组 ( 16 2 8± 4 3 9) μmol/L血清Hcy水平比较差异有显著性 (P<0 0 5 )。结论 :血清Hcy水平在SLE患者中明显升高 ,提示Hcy检测对SLE有临床意义     

辛伐他汀对非高脂血症2型糖尿病患者一氧化氮和C反应蛋白的影响

目的　探讨非高脂血症 2型糖尿病 (T2DM)患者血清一氧化氮 (NO)和C反应蛋白 (CRP)的变化及辛伐他汀对其影响。方法　 12 5例非高脂血症T2DM患者随机分为常规治疗组和辛伐他汀组。辛伐他汀组在常规治疗的基础上加辛伐他汀 2 0mg ,每晚 1次。用化学法和免疫比浊法分别测定治疗前及治疗 1、2、3和 6个月后血清NO和CRP含量 ,以 6 0例正常人为对照。结果　非高脂血症的T2DM患者血清NO浓度明显低于正常人 [(9.6 3± 3.2 1) μmol/Lvs(13.87± 4 .76 ) μmol/L ,P <0 .0 5 ];而血清CRP含量显著高于正常人 [(4.11± 1.6 3)mg/Lvs(2 .36± 1.5 7)mg/L ,P <0 .0 5 ]。辛伐他汀治疗 1个月后NO显著升高 [(9.6 3± 3.17) μmol/Lvs(11.2 6± 2 .87) μmol/L ,P <0 .0 5 ],2个月后CRP也显著降低 [(4.13± 1.82 )mg/Lvs(3.32± 1.76 )mg/L ,P <0 .0 5 ]。结论　非高脂血症T2DM患者也存在着动脉内皮功能损伤和动脉内膜的慢性炎症反应 ,辛伐他汀治疗可减轻这些患者内皮损伤和动脉内膜的炎症反应。     

急性白血病患者血清sICAM-1的水平变化及其意义

目的探讨急性白血病患者血清可溶性细胞间粘附分子 - 1(sICAM 1)的水平变化及其临床意义。方法采用酶联免疫吸附试验法 (ELLSA)测定 5 0例急性白血病患者的血清sICAM 1含量 ,比较其水平在不同病理状态下的变化。结果初诊治疗前的急性淋巴细胞白血病 (ALL)、急性非淋巴细胞白血病 (ANLL)、不缓解或复发ALL及ANLL患者的血清sICAM 1测定值分别为 (10 5 8± 114) μg/L、(10 0 8± 84) μg/L、(885± 146 ) μg/L、(910± 174) μg/L ,与完全缓解或部分缓解组ALL组 (5 6 7± 15 5 ) μg/L、ANLL的 (493± 76 ) μg/L及正常对照组的 (5 78± 16 8) μg/L相比 ,其差异有非常显著性意义 (P <0 .0 1) ;而处于相同病理状态的ALL与ANLL患者血清sICAM 1水平比较 ,其差异未见显著性意义 (P >0 .0 5 )。结论血清sICAM 1含量升高与急性白血病的化疗效果及预后不良有关     

拉米夫定治疗失代偿性肝炎后肝硬化疗效观察

目的 :观察拉米夫定治疗慢性乙型肝炎所致的失代偿性肝硬化的临床疗效和安全性。方法 :31例失代偿性肝炎后肝硬化患者在综合护肝治疗的基础上分两组 ,治疗组加用拉米夫定口服 10 0mg ,每日 1次 ,疗程平均 2 5 .5个月 ,对照组不作任何抗病毒治疗。结果 :治疗组在 6个月后所有患者的临床症状、生化学及病毒学指标都较对照组有明显的改善 ,治疗 12个月后血清总胆红素从 (5 1.7± 2 9.6 ) μmol/L降至 (2 5 .9± 6 .4 ) μmol/L (P <0 .0 1) ;血清白蛋白从 (2 7.9± 3.4 ) g/L增至 (36 .3±2 .9) g/L (P <0 .0 1) ;Child Pugh分级计分从 9.4± 1.6降至 6 .1± 0 .9(P <0 .0 1)。HBVDNA全部阴转 ,与对照组比较差异有非常显著性 (P <0 .0 0 1) ,结论 :拉米夫定通过抑制乙型肝炎病毒的复制 ,可显著改善慢性乙型肝炎所致的失代偿性肝硬化患者的肝功能 ,且无明显不良反应。     

脑梗死患者血浆胆红素和氧化低密度脂蛋白水平变化及意义

目的　探讨脑梗死患者血浆胆红素浓度和氧化低密度脂蛋白 (ox-LDL)含量的变化以及它们在脑梗死中的作用。方法　用钒酸盐氧化法和酶联免疫吸附法 (ELISA)分别测定 75例急性期脑梗死患者血浆胆红素浓度和ox -LDL水平 ,并与 30例其他疾病对照组及 4 6例正常对照组进行比较。结果　 (1)脑梗死患者血浆胆红素浓度为 (11 8± 4 3) μmol L ,咀显低于其他疾病对照组 (14 9± 4 7) μmol L及正常对照组 (15 5± 5 5 ) μmol L ,差异有显著性 (P <0 0 1) ;脑梗死患者血浆ox -LDL水平为 (6 2 5 3± 2 5 7 2 )μg L ,明显高于其他疾病对照组 (4 71 9± 195 0 ) μg L及正常对照组 (4 32 7± 184 4 ) μg L ,差异有显著性(P <0 0 1)。 (2 )大梗死灶组血浆胆红素浓度 (9 5± 3 1)mol L明显低于中梗死灶组 (10 3± 4 4 ) μmol L和小梗死灶组 (12 7± 5 0 ) μmol/L ,P <0 0 1。而大梗死灶组血浆ox -LDL水平 (6 80 4± 2 4 7 1) μg L明显高于中梗死灶组 (5 81 5± 2 6 3 5 ) μg L和小梗死灶组 (5 0 4 2± 2 2 5 7) μg L ,P <0 0 1。 (3)胆红素降低程度和ox -LDL增高程度与神经功能缺损程度密切相关。 (4 )经相关分析 :脑梗死时总胆红素与血浆ox -LDL水平呈负相关 (r=- 0 5 93,P <0 0 1) ,总     

肾衰康抗肾间质纤维化的实验研究

目的 :探讨中药肾衰康延缓慢性肾衰竭进展的机制。方法 :采用 5 / 6肾切除方法制成大鼠慢性肾衰竭模型 ,并设假手术组。治疗组灌服肾衰康 ,对照组 (病理组 )及假手术组灌服自来水 ,90 d后比较 3组尿素氮(BUN)、血肌酐 (SCr)、血清转化生长因子 β1(TGFβ1)、纤维连接蛋白 (FN)及层黏蛋白 (L N) ,同时观察肾脏病理改变。结果 :治疗组 BU N(11.2 6± 2 .96 ) mm ol/ L 及 SCr(95 .2 6± 7.99) μm ol/ L 均显著低于对照组 BUN(18.33± 3.93) mm ol/ L 及 SCr(12 7.90± 2 3.2 9) μmol/ L(P均 <0 .0 1) ;治疗组 TGFβ1(4 .5 9± 0 .90 ) μg/ L 及FN(9.76± 1.88) mg/ L均低于对照组 TGFβ1(8.16± 3.14 )μg/ L和 FN(32 .11± 12 .5 0 ) mg/ L (P均 <0 .0 1) ;L N(16 .6 7± 9.6 5 )μg/ L亦较对照组 (2 2 .2 7± 6 .80 )μg/ L低 (P<0 .0 5 )。对照组肾间质增宽并有明显的纤维化病变 ;治疗组病变较轻 ,间质无明显纤维化 ,仅少数肾小球节段性系膜增多或节段性硬化。结论 :肾衰康能降低血中 TGFβ1、FN及 L N,减轻肾脏损害 ,抑制间质纤维化 ,从而延缓慢性肾衰竭的进展。     

不稳定型心绞痛患者血清肌钙蛋白Ⅰ的变化

目的 :对比观察不稳定型心绞痛与稳定型心绞痛患者血清中肌钙蛋白 (c Tn )升高与心脏事件的关系。方法 :对 5 0例不稳定型心绞痛患者 (U AP)、2 0例稳定型心绞痛患者及 2 0例健康人分别进行血清 c Tn 及肌酸激酶同工酶 (CK MB)测定 ,并观察住院期间心脏事件发生率。结果 :12 0例稳定型心绞痛患者 c Tn 定量为 (8.6 4± 3.12 )μg/ L ,CK MB值为 (14.5 0± 4.5 0 ) U / L ;U AP组 c Tn 定量为 (14.2 1± 4.2 6 )μg/ L ,CKMB值为 (16 .5 2± 5 .46 ) U / L ,c Tn 比较 P<0 .0 1,而 CK MB比较 P>0 .0 5。 2以 c Tn ≥ 10μg/ L为分界值 ,则 5 0例 U AP患者中 19例 c Tn 明显升高〔(16 .78± 4.5 2 ) μg/ L〕,同时测定 CK MB值为 (16 .82±4.2 1) U/ L;余 31例 c Tn 为 (9.12± 0 .18) μg/ L,其 CK MB值为 (16 .13± 4.5 0 ) U/ L;c Tn 比较 P<0 .0 1,而CK MB比较 P>0 .0 5。 3不稳定型心绞痛患者中 c Tn 升高组急性心肌梗死、心脏性猝死、顽固性心绞痛的发生率明显高于 c Tn 正常组。结论 :c Tn 对判断 UAP患者预后具有较高的预测价值。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.