哮喘儿童嗜酸细胞阳离子蛋白含量变化与其肺功能的关系

采用 Pharmacia Uni CAP系统检测 2 5例哮喘患儿急性发作期及 17例治疗后血及诱导痰嗜酸细胞阳离子蛋白 ( ECP)的含量 ,计数静脉血嗜酸粒细胞 ( Eos) ,测定肺通气功能 FEV1 。结果 :急性发作期哮喘血 Eos( 0 .2 75± 0 .2 63)× 10 9/L 较正常升高 ( 0 .0 68± 0 .0 2 8)× 10 9/L,P<0 .0 1;血 ECP浓度 ( 16.0 9± 13.68μg/L)高于正常对照和治疗后 ( 3.78±1.77μg/L;4.2 4± 2 .5 6μg/L) ,P<0 .0 1。发作期痰液 ECP浓度 ( 78.68± 5 3.95 μg/L)明显高于治疗后 ( 2 2 .5 4± 15 .83μg /L) ,P<0 .0 1。哮喘患儿血 Eos计数与血 ECP浓度存在显著正相关 r=0 .5 716,P<0 .0 1;与痰 ECP浓度无相关 r=0 .2 792 ,P>0 .0 5。血、痰 ECP含量与FEV1 呈显著负相关 r=-0 .430 9、-0 .40 5 0 ,P均 <0 .0 5。提示 ECP在哮喘气道炎症机理中起作用 ,是临床评价哮喘活动的指标之一     

临床控制的哮喘患者小气道功能和诱导痰炎性标志物测定的临床意义

目的 检测临床控制的哮喘患者小气道功能和诱导痰嗜酸细胞（Eos）、嗜酸细胞阳离子蛋白（ECP）和IL-5水平,探讨其临床意义.方法 对62例临床控制的哮喘患者做肺功能测定,并分别采用瑞氏染色、荧光免疫法和ELISA检测诱导痰Eos数量、ECP和IL-5水平.选择30例急性发作期哮喘患者和20例健康者作为对照组.结果 62例临床控制哮喘患者中,小气道功能异常43例（69.4%）,正常19例（30.6%）,诱导痰Eos数量（5.6±2.9）%、ECP（129±100）μg/L、IL-5（21±12）μg/L,显著低于急性发作期哮喘组（P＜0.01）,但显著高于健康对照组（P＜0.01）.小气道功能异常哮喘患者诱导痰Eos数量（6.9±3.1）%、ECP（148±90）μg/L、IL-5（24±12）μg/L,显著高于小气道功能正常患者[痰Eos（2.0 ±1.1）%,ECP（54 ±29）μg/L、IL-5（13 ±5）μg/L,P＜0.01].结论 临床控制的哮喘患者小气道功能异常和气道炎症持续存在,测定患者小气道功能和诱导痰炎性标志物有助于指导哮喘治疗.     

孟鲁司特联合布地奈德治疗中度哮喘的临床研究

目的：观察孟鲁司特联合布地奈德治疗中度哮喘的临床疗效。方法：选取中度哮喘急性发作患者60例,随机分为3组,孟鲁司特组（10mg/d）,布地奈德组（200-400μg/d）,孟鲁司特＋布地奈德组（5mg/d＋200-400μg/d）各20例。记录患者哮喘症状并评分;观察三组的临床症状缓解程度及时间,测定治疗前及治疗8周后的肺功能状态。结果：孟鲁司特联合吸入布地奈德组白天、夜间哮喘发作均弱于两药单独使用组,孟鲁司特联合吸入布地奈德组咳嗽、喘息、胸闷等临床症状缓解时间明显短于单独使用组,肺功能状态得道明显改善。结论：孟鲁司特联合吸入布地奈德可以显著缓解中度哮喘患者的哮喘症状,值得临床大力推广及积极应用。     

孟鲁司特钠对哮喘慢性持续期患儿IL-2、肿瘤坏死因子及肺功能的影响

目的观察孟鲁司特钠对哮喘慢性持续期患儿IL-2、肿瘤坏死因子及肺功能的影响。方法随机选择门诊处于哮喘慢性持续期的患儿52例,随机分为两组,治疗观察1年。观察治疗前后IL-2、肿瘤坏死因子及肺功能的变化。结果孟鲁司特钠组患儿血IL-2升高、肿瘤坏死因子含量降低,各项肺功能指标明显提高,治疗前后比较差异有统计学意义（P〈0.05）。结论孟鲁司特钠能降低气道高反应性,增强免疫因子IL-2、降低致炎性肿瘤坏死因子含量,调节Th1/Th2平衡。     

孟鲁司特联合吸入糖皮质激素治疗儿童哮喘40例疗效观察

目的:探讨孟鲁司特联合吸入糖皮质激素治疗儿童哮喘的临床效果。方法:选取支气管哮喘患儿共80例,随机分为观察组和对照组。观察组患儿给予布地奈德吸入治疗,吸入剂量为20μg/d,同时给予孟鲁司特,5岁以下患儿4 mg/次,6岁以上患儿5 mg/次,1次/d,每晚服用。对照组不给予孟鲁司特治疗,其他同观察组。两组在试验期间如有哮喘急性发作,可给予支气管扩张剂,合并有细菌感染的给药有效抗生素。两组患儿均连续治疗3个月。观察两组患儿在治疗期间临床症状和体征改善情况。结果:观察组总有效率(95.0%)显著高于对照组(75.0%),差异有统计学意义(P<0.05)。结论:孟鲁司特联合吸入糖皮质激素治疗儿童哮喘临床效果显著,值得借鉴。     

孟鲁司特治疗咳嗽变异性哮喘的临床评价

目的评价孟鲁司特对咳嗽变异性哮喘的临床应用价值及意义。方法对2006年9月至2008年8月本院的80例CVA患儿随机分成2组,治疗组加用孟鲁司特,观察2组的疗效．复发情况及对外周血嗜酸细胞（Eos）计数的影响。结果2组CVA患儿在咳嗽缓解时间上,治疗组比对照组明显缩短,复发率降低,而且Eos计数较治疗前明显减少,经统计学分析（P〈0.01）差异有显著意义。结论孟鲁司特治疗CVA疗效肯定,复发率低,并可促使外周血中嗜酸粒细胞减少,减轻气道炎症,值得儿科临床大力推广。     

沙美特罗替卡松联合孟鲁司特钠对初入高原咳嗽变异性哮喘患者的疗效分析

目的:观察沙美特罗替卡松(沙美特罗替卡松粉吸入剂)联合孟鲁司特钠(孟鲁司特钠片)对初入高原地区人员咳嗽变异性哮喘(CVA)的治疗效果。方法:将60例临床诊断为CVA的患者随机分为两组。试验组30例,沙美特罗替卡松(50/250μg吸入,2次/d)联合孟鲁司特钠(10mg口服,1次/d);对照组30例,沙美特罗替卡松(50/250μg吸入,2次/d)。治疗4周后比较两组患者的肺功能1s呼气流量占预计值百分比(FEV1%)、PEFR变异率、哮喘控制测试评分(ACT),8周后比较复发率。结果:经治疗后试验组肺功能FEV1%较对照组均显著提高(P<0.05),试验组PEFR日内变异率、ACT评分显著改善(P<0.05);8周后,试验组复发率明显下降。结论:沙美特罗替卡松联合孟鲁司特钠能有效改善初入高原地区咳嗽变异性哮喘人员的肺功能,降低气道敏感性,减少复发率。     

孟鲁司特治疗小儿支气管哮喘的疗效及对IL-5、IL-10与肺功能的影响

目的 探讨孟鲁司特治疗小儿支气管哮喘的临床疗效,及对哮喘患儿血清IL-5、IL-10的表达和肺功能的影响,以探讨IL-5、IL-10在哮喘发病机制中的可能作用.方法 64例小儿支气管哮喘患者根据治疗方法不同随机分为治疗组和对照1组各32例,其中对照组给予常规吸入激素治疗,治疗组在对照组的基础上加孟鲁司特,并随机选择健康体检患儿28例作为健康对照2组,观察孟鲁司特治疗小儿支气管哮喘的疗效以及治疗前后患儿肺功能的变化情况,并同时采用酶联免疫吸附试验(ELISA)检测两组患者的IL-5、IL-10和IgE的表达水平.结果 治疗组的总有效率明显高于对照1组,且治疗组的肺功能改善明显优于对照1组,其中治疗组IL-10的表达水平明显低于对照1组及对照2组,而IL-5及IgE的表达水平则明显高于对照1组及对照2组(P＜0.05).且孟鲁司特治疗不同程度哮喘患儿的IL-10、IgE水平随着疾病程度的加重,其表达水平也呈逐渐升高(P＜0.05),而IL-5的表达水平随着疾病程度的加重而明显降低(P＜0.05).结论 孟鲁司特治疗小儿支气管哮喘疗效确切,明显改善患儿肺功能,可能与哮喘有关细胞因子IL-5、IL-10有关.     

孟鲁司特治疗小儿支气管哮喘的疗效及对IL-5、IL-IO与肺功能的影响

目的探讨孟鲁司特治疗小儿支气管哮喘的临床疗效,及对哮喘患儿血清IL-5、IL-10的表达和肺功能的影响,以探讨IL-5、IL-10在哮喘发病机制中的可能作用。方法64例小儿支气管哮喘患者根据治疗方法不同随机分为治疗组和对照1组各32例,其中对照组给予常规吸入激素治疗,治疗组在对照组的基础上加孟鲁司特,并随机选择健康体检患儿28例作为健康对照2组,观察孟鲁司特治疗小儿支气管哮喘的疗效以及治疗前后患儿肺功能的变化情况,并同时采用酶联免疫吸附试验（EusA）检测两组患者的IL-5、II-10和IgE的表达水平。结果治疗组的总有效率明显高于对照1组,且治疗组的肺功能改善明显优于对照1组,其中治疗组IL-10的表达水平明显低于对照1组及对照2组,而IL-5及IgE啦的表达水平则明显高于对照1组及对照2组（P〈O．05）。且孟鲁司特治疗不同程度哮喘患儿的IL-10、IgE水平随着疾病程度的加重,其表达水平也呈逐渐升高（P〈0．05）,而IL-5的表达水平随着疾病程度的加重而明显降低（P〈0．05）。结论孟鲁司特治疗小儿支气管哮喘疗效确切,明显改善患儿肺功能,可能与哮喘有关细胞因子IL-5、IL-10有关。     

雾化吸入布地奈德联合孟鲁司特钠治疗小儿咳嗽变异性哮喘疗效分析

目的：分析小儿咳嗽变异性哮喘行雾化吸入布地奈德联合孟鲁司特钠治疗的效果。方法选取咳嗽变异性哮喘120例患儿临床资料进行回顾性分析,根据治疗时所用不同治疗方案分成2组,将行单纯布地奈德雾化吸入治疗54例患儿设为对照组,将行雾化吸入布地奈德联合孟鲁司特钠治疗66例患儿设为观察组,对2组炎症因子、肺功能指标及不良反应情况进行对比。结果观察组炎症因子（TNF-α、IL-4、IL-8、IgE）水平均比对照组低（P＜0.05）;观察组在2组治疗后心功能指标水平均改善基础上,其改善幅度比对照组显著（P＜0.05）;观察组总不良反应率6.06%和对照组9.26%对比差异无统计学意义。结论小儿咳嗽变异性哮喘行雾化吸入布地奈德联合孟鲁司特钠治疗可降低患儿炎症因子水平,改善肺功能,安全有效,具临床推广及应用价值。     

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.