慢性阻塞性肺疾病大鼠肺内白细胞介素-8和肿瘤坏死因子-α与气道炎症的关系研究

目的　探讨白细胞介素 8(IL 8)在慢性阻塞性肺疾病 (COPD)发病机制中的作用。方法单纯熏香烟法建立COPD模型 ,支气管肺泡灌洗计数支气管肺泡灌洗液 (BALF)中细胞计数和百分比 ,酶联免疫吸附法 (ELISA)测定BALF和血清中的IL 8与肿瘤坏死因子 α(TNF α)浓度 ,肺组织切片行苏木素 伊红染色观察形态学改变 ,采用图像分析系统定量测定肺平均内衬间隔 (MLI)、平均肺泡数 (MAN)和肺泡腔面积与总面积比 (PAA)。结果　COPD组MLI、PAA比正常对照组增高 ,而MAN低于对照组 ,差异有统计学意义 (P <0 0 1)。与正常对照组比较 ,COPD组BALF中IL 8浓度 [(114 5±15 7)pg/ml对 (2 59 4± 2 0 1)pg/ml ,P <0 0 1]、TNF α浓度 [(80 5± 9 5)pg/ml对 (14 5 9± 17 3 )pg/ml ,P <0 0 1]、白细胞总数 [(1 64± 0 12 )× 10 8/L对 (5 76± 0 2 9)× 10 8/L ,P <0 0 1]、中性粒细胞绝对计数 [(0 0 99± 0 0 65)× 10 8/L对 (1 2 6± 0 2 5)× 10 8/L ,P <0 0 1]、中性粒细胞百分比 [(5 9± 3 6) %对(2 1 8± 3 7) % ,P <0 0 5]均增高 ,差异有统计学意义。COPD组血清中IL 8浓度亦比对照组增高[(45 2± 13 5)pg/ml对 (85 7± 7 0 )pg/ml ,P <0 0 1]。COPD组BALF中IL 8浓度与BALF中白细胞总数、中性粒细胞百分     

IL-8 IL-17与支气管哮喘发病关系的研究

目的　探讨白介素 - 8(IL - 8)及白介素 - 17(IL - 17)在支气管哮喘发病机制中的作用。方法　搜集 30例支气管哮喘急性发作期患者治疗前后及其缓解期和 2 0例健康者的静脉血 ,离心后取血清 ,采用酶联免疫吸附实验 (ELISA)法测定血清中IL - 8、IL - 17的浓度 ,同时测定出所有受试者 (急性期治疗前后、缓解期、正常人 )外周血中性粒细胞计数。结果　支气管哮喘急性发作期患者血清IL - 8浓度 (70 1 5 3± 12 1 34)pg/L与缓解期 (2 2 8 5 3± 5 7 5 8)pg/L及对照组 (2 0 2 87± 31 14 )pg/L比较 ,均有极显著差异 (P <0 0 1)。支气管哮喘急性发作期患者血清IL - 17浓度 (76 0 1± 4 35 )pg/L与缓解期 (2 0 85± 3 6 8)pg/L及对照组 (16 30± 3 0 8)pg/L比较 ,均有极显著差异 (P <0 0 1)。支气管哮喘急性发作期患者外周血白细胞计数 (12 34±2 9)× 10 9/L与缓解期 (5 9± 1 39)× 10 9/L及对照组 (3 87± 0 83)× 10 9/L比较 ,均有极显著差异 (P <0 0 1)。支气管哮喘急性发作期患者治疗后 ,血清IL - 8浓度 (4 2 2 6 7± 88 9)pg/L明显低于治疗前 ;血清IL -17浓度 (4 4 0 2± 4 82 )pg/L也明显低于治疗前。血清IL - 8、IL - 17浓度与外周血中性粒细胞计数呈正相关(γ =0 6 34、γ =0 5 94 )。     

血白细胞计数在评价急性有机磷农药中毒程度中的临床价值

目的　探讨急性有机磷农药中毒患者中毒程度和血白细胞计数 ,尤其是与中性粒细胞计数之间的关系。方法　回顾性分析 1 997～ 2 0 0 2年间急诊收入院的急性有机磷农药中毒患者 ,统计入院时的末梢血白细胞计数。结果　重度中毒患者白细胞计数 >1 2× 1 0 9/L者占 89.7%,中性粒细胞计数>9× 1 0 9/L者占 92 .3%;死亡患者中白细胞总数 >1 4× 1 0 9/L者占 69.7%,中性粒细胞计数 >1 1× 1 0 9 L者占 73.9%。均明显高于轻度和中度患者组。白细胞数和中性粒细胞数正常者无 1例死亡。结论　白细胞计数和中性粒细胞计数对了解中毒程度 ,判断预后及转归有重要意义     

白细胞计数对早期急性心肌梗死的诊断价值

目的:探讨WBC计数在急性心肌梗死(acute myocardial infarction,AMI)中的早期诊断价值。方法:选择AMI早期就诊患者47例(胸痛时间<2h,肌红蛋白阴性,无其他炎症相关疾病),分别于入院即刻和胸痛发生后4~8h、12~24h采集静脉血,分别检测WBC、C反应蛋白(CRP)、心肌肌钙蛋白I(cTNI)与肌红蛋白(Mb)。并于出院后3~12个月,跟踪监测WBC 3次,取其平均值作为自身对照。同时检测健康人群WBC和CRP作正常对照。结果:AMI胸痛发作2h内,在Mb阴性时,WBC即开始升高(9.12±2.18)×109/L,显著高于自身对照(6.49±1.09)×109/L和正常对照组(5.97±1.24)×109/L(P<0.01)。但中性粒细胞与自身对照相比差异无统计学意义(P>0.05);CRP与对照组相比差异无统计学意义(P>0.05)。在Mb和cTNI阳性后WBC和CRP显著升高(P<0.01),在12~24h达峰值,分别为(12.46±5.28)×109/L和(50.9±21.3)×109/L,同时中性粒细胞也显著升高(P<0.01)。结论:AMI发作早期,Mb和cTNI阴性时,WBC即显著升高,因此WBC计数对早期AMI有一定的诊断价值。     

中性粒细胞减少症感染的治疗

1　定义　　白细胞减少症 :ＷＢＣ在 4 0× 1 0 9/Ｌ以下。中性粒细胞减少症 :中性粒细胞绝对值在 2 0× 1 0 9/Ｌ以下。粒细胞缺乏症 :中性粒细胞绝对值在 0 5× 1 0 9/Ｌ以下[1] 。有人将粒细胞减少分为 :轻度 :中性粒细胞绝对值 ( 1 0～ 1 .5)×1 0 9/Ｌ;中度 :中性粒细胞绝对值 ( 5～ 1 .5)× 1 0 9/Ｌ ;重度 :中性粒细胞绝对值 0 5× 1 0 9/Ｌ。发热 :口探一次 38 3℃或 38℃以上持续 1ｈ。感染程度和粒细胞绝对值和持续时间长短有关 ,粒细胞少于 1 0 0 0感染机会增加。少于 50 0感染危险较大 ,少于 1 0 0危险极大。2　特点患者…     

动脉路去白细胞滤器在体外循环中的临床应用

目的　观察常规瓣膜手术患者体外循环 (CPB)中应用动脉路去白细胞滤器的临床使用效果及对炎症介质的影响。方法　 30例风心病患者随机分为试验组和对照组 ,各 15例 ,试验组使用动脉路去白细胞滤器LG6 ,对照组使用常规的国产动脉过滤器。测定血细胞计数及分类、血浆丙二醛 (MDA)、髓过氧化物酶 (MPO)、白介素 - 1β(IL - 1β)和白介素 - 8(IL - 8) ,动脉血气分析。观察两组术前、注射鱼精蛋白后和术后 4h的氧合指数及气道压力。用Swan -ganz导管监测肺血管压力及阻力。结果　白细胞计数 :实验组 -右房 (8.4 7± 2 .0 1)× 10 9/L、左房(7.96± 2 .2 7)× 10 9/L(P >0 .0 5 ) ,对照组右房 (10 .6 9± 2 .4 7)× 10 9/L、左房 (9.6 7± 1.98)× 10 9/L(P <.0 0 1)。血小板和红细胞压积两组无差异。术后肺氧合指数 (PaO2 /FiO2 × 10 0 )两组间无统计学差异。术后其它肺参数如肺血管阻力 (PVR)、平均肺动脉压 (MPAP)、肺毛细血管楔压 (PCWP)和气道压力等两组间无统计学差异。血浆MDA ,MPO ,IL - 1β和IL - 8两组间无统计学差异。结论　CPB中应用动脉路去白细胞滤器可暂时减少循环血液中的白细胞和中性粒细胞数量 ,减少再灌注过程中白细胞的肺内滞留 ,对术后肺功能没有明显的保护作用。     

帕金森病患者外周血TNF-α浓度和IL-6质量浓度的检测及分析

为观察肿瘤坏死因子 (TNF α)和白细胞介素 6(IL 6)在帕金森病 (PD)患者血清中的变化 ,采用放射免疫法测定PD组 ( 3 0例 ) ,其他神经系统免疫疾病组 (OND) ( 2 2例 ) ,正常对照组 (HC) ( 2 4例 )血清中TNF α的浓度和IL 6的质量浓度。结果 :PD患者血清中TNF α浓度〔( 1 3 .83± 4.47) pmol/L〕与OND组〔( 1 7.5 3± 7.2 5 )pmol/L〕、HC组〔( 1 6.5 7± 3 .0 5 )pmol/L〕比较均明显降低 (P <0 .0 5 )。PD患者血清中IL 6质量浓度〔( 1 1 2 .80± 2 5 .1 3 ) μg/L〕与OND组〔( 1 78.5 3± 42 .78) μg/L〕、HC组〔( 1 3 6.2 2± 1 7.40 ) μg/L〕比较均明显降低 (P <0 .0 0 1 )。PD组间比较 ,其结果与年龄、病程及分型无关。本研究结果表明PD患者存在外周血细胞因子的改变 ,提示免疫机制可能参与了PD的发病过程。     

原发性高血压病人白细胞计数分析

为探讨原发性高血压病人与自身血循环中白细胞计数的关系 ,设原发性高血压组和正常对照组 ,均采静脉血进行白细胞计数分析。原发性高血压组白细胞计数 (6 .84± 1.38)× 10 9/L与对照组 (4.70± 1.6 5 )× 10 9/L ,有显著差异 (P <0 .0 1)。提示原发性高血压病人血循环中白细胞计数较正常人偏高。     

哮喘儿童治疗前后血清嗜酸细胞阳离子蛋白水平的变化

目的 :探讨嗜酸细胞阳离子蛋白 (ECP)在儿童哮喘发病中的作用。方法 :采用 Pharm acia U ni CAP系统检测 2 5例哮喘患儿急性发作期及 17例治疗后血清 ECP的含量 ,计数静脉血嗜酸粒细胞 ,测定肺通气功能 FEV1 。结果 :急性发作期哮喘血嗜酸粒细胞 (0 .2 75± 0 .2 6 3)× 10 9/ L 较正常升高 (0 .0 6 8± 0 .0 2 8)× 10 9/ L,P <0 .0 1;血清 ECP浓度 (16 .0 9± 13.6 8) μg/L 高于正常对照和治疗后 (3.78± 1.77) μg/ L;(4 .2 4± 2 .5 6 ) μg/ L,P <0 .0 1。哮喘患儿血嗜酸粒细胞计数与血 ECP浓度存在显著正相关 (r =0 .5 716 ,P <0 .0 1)。血清 ECP含量与 FEV1 呈显著负相关 (r =- 0 .430 9,P <0 .0 5 )。结论 :ECP在哮喘气道炎症机制中起作用 ,反映哮喘活动情况 ,是临床评价哮喘嗜酸细胞炎症的参考指标之一     

白细胞计数对急性心肌梗死住院病死率的预测价值

目的探讨白细胞计数与急性心肌梗死患者临床特点和住院病死率之间的关系。方法收集首都医科大学宣武医院1993年~2005年初发急性ST段抬高心肌梗死患者资料,1056例患者按照白细胞计数>10×109/L和≤10×109/L分为2组,对2组临床特点、并发症和住院病死率进行比较。结果白细胞升高组平均年龄(61.3±12.7)岁较对照组〔(64.3±11.3)岁〕低,差异有统计学意义(P<0.001);CKMB(肌酸激酶MB同工酶)峰值〔分别为(2137.6±1543.4)IU/L和(1410.1±1183.9)IU/L〕,差异有统计学意义(P<0.001)、心源性休克(分别为6.0%和2.3%,P<0.01)和心律失常(分别为41.5%和29.4%,P<0.001)的发生率更高;住院病死率显著高于对照组(分别为136.%和7.6%,P<0.01)。Logistic回归显示WBC计数增高与住院死亡率相关。结论白细胞计数是预测心肌梗死短期预后的可靠指标。     

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.