苦参碱联合甘利欣注射液治疗慢性乙型肝炎72例疗效观察

目的：观察苦参碱联合甘利欣注射液治疗慢性乙型肝炎的临床疗效。方法：将135例慢性乙型肝炎患者随机分为两组,治疗组72例采用苦参碱联合甘利欣注射液治疗,对照组64例采用拉米夫定治疗,6个月后观察两组患者肝功能、乙肝病毒标志物的变化,并判断疗效。结果：与治疗前相比,两组均能显著降低ALT和AST含量,提高A／G比值（P〈0．01）;在降低ALT和AST含量方面,治疗组明显优于对照组（P〈0．05）;两组比较,对照组Hbv—DNA阴转率高于治疗组（P〈0．05）,治疗组HbeAg阴转率优于对照组（P〈0．01）;治疗组临床总有效率88．9％,对照组为75．O％,两组比较差异具有显著性（P〈0.05）。结论：苦参碱联合甘利欣注射液不但能抑制病毒复制,且可促进HBV复制标志物阴转,并在HBeAg阴转方面明显优于拉米夫定,同时该药还可降低转氨酶,改善肝功能多种作用。     

胸腺肽与拉米夫定治疗慢性乙型肝炎20例疗效观察

目的 观察胸腺肽与拉米夫定治疗慢性乙型肝炎疗效。方法 50例慢性乙型肝炎HBeAg、HBV—DNA阳性、肝功能异常的患者随机分为治疗组20例和对照组30例。治疗组每周3次用胸腺肽40mg肌肉注射或静脉滴注1次，疗程3个月；拉米夫定100mg，每日1次口服，疗程12个月。对照组用拉米夫定100mg，每日1次口服，疗程12个月。两组治疗前及治疗开始每1个月检测1次肝功能，每3个月检测1次HBV—DNA定量及乙肝病毒血免疫学标志物（HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc）等项目以综合评价疗效。结果 慢性乙型肝炎患者经胸腺肽和拉米夫定治疗后，ALT等生化指标较治疗前明显改善（P〈0．05），HBeAg转阴率40％，HBV—DNA转阴率60％。治疗期间患者可有轻度不良反应（1例轻度腹泻．3例头昏，1周内自行缓解）。结论 胸腺肽与拉米夫定治疗慢性乙型肝炎有明显提高临床疗效，改善肝功能，抑制病毒复制的作用，是治疗慢性乙型肝炎安全、经济、有效的方法。     

慢性乙型肝炎患者血清HBV DNA与病毒复制水平相关性分析

目的:通过检测180例慢性乙型肝炎患者血清HBV DNA和HBV-M含量,探讨不同类型慢性乙型肝炎患者病毒复制水平与HBV标志物(HBV-M)模式及肝损害程度的关系。方法:2000年8月～2003年8月我院传染科收治住院的慢性乙型肝炎180例,采用荧光定量PCR方法检测HBVDNA血清含量,同时检测HBV血清标志物及TBil、ALT、AST。结果:血清HBeAg阳性组HBV DNA含量(106.35±1.84)显著高于HBeAg阴性组(104.73±1.88)(P<0.01),而不同HBVDNA水平患者的TBil、ALT、AST差别无显著性(P>0.05)。结论:血清HBeAg的存在影响HBV DNA的水平变化,血清HBV DNA含量与TBil、ALT、AST水平无明显关系。     

拉米夫定合苦参素治疗HBeAg阳性慢性乙型肝炎92例

目的：观察拉米夫定联合苦参素治疗HBeAg阳性慢性乙型肝炎的疗效。方法：将178例随机分为拉米夫定＋苦参素治疗（治疗组）92例，拉米夫定治疗（对照组）86例，疗程48周。比较两组治疗后的ALT、AST、HBV-DNA水平，ALT、AST复常率，HBeAg及HBV-DNA24周、48周阴转率。结果：治疗后两组ALT、AST、HBV-DNA水平均较治疗前明显下降（P〈0．01）。与对照组相比，治疗组ALT、AST、HBV-DNA下降更为明显（P〈0．05），ALT、AST复常率显著升高（P均〈0．05），HBeAg和HBV—DNA24周、48周阴转率也明显升高（P均〈0．05）。结论：拉米夫定联合苦参素治疗HBeAg阳性慢性乙型肝炎疗效优于单用拉米夫定治疗。     

替诺福韦酯治疗HBeAg阳性慢性乙型肝炎患者的疗效及对肝功能指标的影响

目的探讨替诺福韦酯治疗HBeAg阳性慢性乙型肝炎患者的疗效及对肝功能指标的影响。方法选取2017年2月至2018年3月本院收治的126例HBeAg阳性慢性乙型肝炎患者,按照年龄、性别组间具有可比性原则分为对照组与观察组,各63例。对照组予以恩替卡韦治疗,观察组予以替诺福韦酯治疗,比较两组治疗前后肝功能指标及ALT复常率、HBV DNA转阴率、HBeAg转阴率。结果治疗后,两组AST、ALT、TBiI均低于治疗前,且观察组低于对照组,ALB高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05);观察组ALT复常率、HBV DNA阴转率、HBeAg转阴率均高于对照组,差异有统计学意义(P<0.05)。结论相比恩替卡韦治疗,替诺福韦酯治疗HBeAg阳性慢性乙型肝炎患者,可有效改善肝功能,提高HBV DNA阴转率及HBeAg阴转率。     

替比夫定治疗乙型肝炎e抗原阳性慢性乙型肝炎48周疗效观察和安全性评价

目的观察比较替比夫定与阿德福韦酯治疗乙型肝炎e抗原（HBeAg）阳性慢性乙型肝炎（CHB）48周的疗效和安全性。方法将100例HBeAg阳性CHB患者按随机分组方法纳入治疗组（49例）和对照组（51例）。治疗组每天口服替比夫定600 mg,对照组每天口服阿德福韦酯10 mg,疗程均为48周。治疗前和治疗第12、24和48周分别检测血清乙型肝炎病毒DNA（HBV DNA）定量、血清乙型肝炎病毒（HBV）标志物和血清丙氨酸转氨酶（ALT）水平。比较两组48周时HBV DNA水平、HBV DNA转阴率、HBeAg血清转换率、ALT复常率和不良事件发生率。结果治疗48周时,治疗组的HBV DNA水平显著低于对照组[（2.94±0.58）vs（3.52±0.97）]（P〈0.01）,HBV DNA转阴率优于对照组（65.3%vs 41.2%）（P〈0.01）,HBeAg血清转换率无明显差异（18.4%vs 11.8%）（P〉0.05）,ALT复常率无明显差异（73.5%vs 68.6%）（P〉0.05）,不良事件发生率无明显差异（53.1%vs 52.9%）（P〉0.05）。结论对HBeAg阳性慢性乙型肝炎患者治疗48周,替比夫定对HBV的抑制效果优于阿德福韦酯,而血清HBeAg转换率、ALT复常率和不良反应发生率差异无统计学意义。     

白花香莲解毒方联合恩替卡韦治疗慢性乙型肝炎疗效分析

目的观察白花香莲解毒方联合恩替卡韦治疗慢性乙型肝炎的疗效。方法将60例慢性乙型肝炎患者随机平均分为两组,每组各30例。对照组患者均服用恩替卡韦进行治疗,观察组患者均服用白花香莲解毒方联合恩替卡韦进行治疗,分别观察两组患者治疗前和治疗后肝功能的变化情况,HBV DNA和HBeAg的阳性例数。结果治疗后观察组患者的ALT、AST下降均较对照组显著,差异有统计学意义(P0.05);治疗后观察组患者HBV DNA的阳性例数明显少于对照组,转阴率大于对照组(P0.05)。结论白花香莲解毒方联合恩替卡韦治疗慢性乙型肝炎患者,可显著改善肝功能,提高病毒转阴率。     

苦参碱注射液联合护肝片治疗儿童慢性乙型肝炎临床研究

目的观察苦参碱注射液和护肝片合用治疗儿童慢性乙型肝炎的临床疗效。方法采用随机数字表法将142例慢性乙型肝炎患儿分为3组,其中联合组47例,苦参碱组47例,护肝片组48例。分别采用苦参碱注射液及护肝片联用、苦参碱和护肝片单用治疗6月,于疗前,疗后1月、3月、6月动态检测丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)和乙肝病毒学指标(HBV DNA和HbeAg),随访症状、体征改善情况。结果 1)3组ALT和AST均随治疗时程延长呈下降趋势(时间因素),P=0.000;联合组下降幅度优于单用药组(分组因素),P=0.000;2)联合组HBV DNA(χ2=9.346,P=0.009)和HbeAg(χ2=9.683,P=0.008)转阴率高于2单用药组;3)联合组黄疸、纳差和乏力症状改善优于单用药组。结论苦参碱注射液和护肝片均能有效治疗儿童慢性乙型肝炎,但联合用药对改善肝功能及HBV DNA、HBeAg转阴率有协同作用。     

益肾健脾清化方结合恩替卡韦对慢性HBeAg阳性乙型肝炎患者细胞免疫功能的影响研究

目的 探讨慢性乙型肝炎病毒e 抗原（HBeAg）阳性乙型肝炎患者服用益肾健脾清化方结合恩替卡韦后对血清细胞免疫功能辅助性Th1/Th2 细胞因子及其肝功能的影响。方法 选取2018 年1 月至2019 年12 月余姚市人民医院感染科收治的慢性HBeAg 阳性乙型肝炎患者120 例,分为对照组（采用恩替卡韦治疗）与治疗组（采用益肾健脾清化方+恩替卡韦治疗）,每组各60 例。两组分别治疗12 周,观察治疗前后肝功能中的谷丙转氨酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆红素（TBIL）、白蛋白（ALB）;血清Th1/Th2 细胞因子γ 干扰素（IFN-γ）、白介素IL-12、IL-4、IL-13;HBeAg 阴转率、HBeAg 血清学转换率及HBV DNA 阴转率的变化。结果 治疗12 周后,治疗组肝功能ALT、AST、TBIL、ALB 指标均明显优于对照组（P＜0.05）,同时治疗组对血清Th1 中的IFN-γ、IL-12指标上升值优于对照组（P＜0.05）,而血清Th2 中IL-4、IL-13 指标下降值亦优于对照组（P＜0.05）,说明治疗组更利于血清Th1/Th2 细胞因子平衡,从而提高患者免疫水平。在HBeAg 阴转率、HBeAg 血清学转换率及HBV DNA阴转率上,治疗组效果与对照组比较无明显提高,差异无统计学意义（P＞0.05）。结论 益肾健脾清化方可有效调节血清中Th1/Th2 细胞因子功能的平衡,同时能改善慢性HBeAg 阳性乙型肝炎患者肝功能,可一定程度提高HBeAg 阴转率及HBeAg 血清学转换率。     

苦参碱联合复方甘草酸苷治疗乙肝病毒的临床观察

目的观察苦参碱联合复方甘草酸苷治疗慢性乙型肝炎的临床疗效。方法选择75例慢性乙型肝炎患者随机分为2组，40例为治疗组，35例为对照组，2组均给予复方甘草酸苷治疗；治疗组加用苦参碱治疗。用药8周后观察2组临床症状、体征、肝功能、HBeAg阴转率等的变化。结果2组治疗后在临床症状、体征改善方面无显著性差异。但在肝功能恢复及HBV标志物变化方面治疗组明显优于对照组。治疗后治疗组和对照组ALT复常率分别为90.00％和68．57％（P〈0.05），TBiL复常率分别为87.50％和62.86％（P〈0.05）；HBeAg阴转率分别为30.00％和5.71％（P〈0.01），HBV-DNA阴转率分别为37.50％和8.57％（P〈0.01），HBeAg／抗-HBe血清转换率分别为17.50％和2.86％（P〈0.05）。结论苦参碱联合复方甘草酸苷能有效地恢复肝功能、抑制HBV-DNA复制，对治疗慢性乙型肝炎有明显疗效。     

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.