家族性幼年强直性脊柱炎的临床表现及基因分析

目的分析家族性幼年强直性脊柱炎（JAS）的临床表现特点及基因分析，提高对JAS的认识。方法对一家族性AS中57名幼儿、儿童进行体检、血尿常规、生化检测、血清学HLA—B27测定、X光骨盆平片、X光腰椎片、骶骼关节CT等检查，并进行基因及亚型分析。结果被检家族中＜16岁57名，RF阴性，CRP8．5mL／dL，血清学HIA—B27阳性8人，临床诊断JAS 2人，均为男性，年龄15、16岁；HLA—B27基因阳性6人（血清学HLA—B27均阳性），检出阳性率明显高于临床诊断JAS者，亚型分析均为HLA—B2704。结论JAS临床症状于年长儿童表现明显，基因分析对早期诊断尤显重要。     

强直性脊柱炎检测HLA—B27、ASO、RF、CRP的临床意义

目的 探讨HLA—B27、ASO、RF、CRP检测在强直性脊柱炎(AS)诊断与鉴别诊断中的意义。方法 抽取ED-TA(K2)抗凝血2ml，采用磁珠酵素免疫法检测HLA—B27，采用胶乳凝集法检测ASO、RF、CRP。结果 31例正常健康者HLA—B27、ASO、RF、CRP检测结果均为阴性。108例疑似AS患者中，HLA—B27阳性率为30．6％(33／108)。33例HLA—B27阳性患者中，ASO阳性率为6．1％(2／33)，RF阳性率为3．0％(1／33)，CRP阳性率为12．1％(4／33)。结论 HLA—B27的检测可明确AS诊断，特别是在不典型AS诊断中具有重要的临床价值。ASO、RF检测可用于AS的鉴别诊断。疑似AS患者HLA—B27阳性者中，其活动期的CRP比率较低。     

强直性脊柱炎患者HLA—B27抗原表达与临床的相关性分析

目的分析HLA—B27抗原与AS的临床相关性。方法对386例住院患者采用流式细胞术方法,选择136例健康献血者作为对照,检测2组患者T淋巴细胞膜上的HLA—B27抗原。结果136例健康献血者中HLA—B27阳性率为11．0％,386例AS患者的HIA—B27抗原表达阳性率90．7％。其中表达阳性者发病年龄为（23．4±7．3）岁,表达阴性者为（37．8±13．6）岁,2组患者比较差异有统计学意义（P〈0．05）;男女患者HIA—B27抗原表达阳性率分别为92．7％（280／302）和83．3％（70／84）,2组比较差异无统计学意义（P〉0．05）;与AS患者疾病活动性有关的检验指标（ESR,CRP,PLT）在B27阳性组均明显升高（P〈0．05）。髋关节病变的严重程度与HIA—B27抗原阳性表达相关（P〈0．01）;AS患者的HLA—B27抗原表达阳性者周围关节累及和关节外表现最多见的分别为膝关节炎、踝关节炎和葡萄膜炎、肠炎。结论AS患者与HLA—B27抗原表达有着很强的相关性;采用流式细胞技术检测临床As患者T淋巴细胞HLA—B27表达有助于诊断和鉴别诊断,也有利于临床病情严重程度和预后的判断。     

HLA—B27表达阴性的早中期强直性脊柱炎患者调查

目的：对4年多在我院门诊和病房确诊的早中期强直性脊柱炎（AS）患者进行HLA—B27检测的结果做了对比分析,以了解本地HLA—B27表达阴性与表达阳性的确诊早中期AS患者之间有何差异。方法：采用流式细胞术检测确诊的298例早中期AS患者的HLA-27抗原。研究样本来源于2006年9月～2011年2月在我院临床诊断为早中期AS的患者。结果：临床确诊的早中期AS患者中,HLA—B27表达阴性患者,男女比例约为3．3：1;HIJA—B27表达阳性患者．男女比例约为2．9：1,HLA—B27阴性患者与同性别阳性患者平均年龄比较,差异无统计学意义（P〉0．05）。临床确诊的早中期AS患者中,HIJA—B27表达阴性患者各年龄段的阴性率比较,差异无统计学意义（P〉0．05）,HLA—B27表达阳性患者各年龄段的阳性率比较,差异无统计学意义（P〉O．05）。结论：本地HLA—B27表达阴性与表达阳性的确诊早中期AS患者之间,男女比例、平均年龄、HLA—B27阳性率和阴性率无显著差异。在临床诊断时,对HLA—B27表达阴性的疑似患者也要给予同样的重视,以免漏诊和误诊。     

泌尿生殖道淋球菌、解脲支原体及沙眼衣原体感染特点分析

目的探讨泌尿生殖道疾病患者中NG、UU和CT感染现状及其特点。方法利用实时荧光定量PCR技术对1319例患者进行UU、NG、CT病原体DNA定量检测。结果1319例患者中，UU检测阳性率49．8％（360／723），其中男性阳性率28．8％，女性阳性率51．4％，二者有显著性差异（P〈0．01）；NG检测阳性率17．6％（43／245），其中男性阳性率22．2％，女性阳性率17．0％，感染率性别差异无统计学意义；CT检测阳性率11．1％（39／351），其中男性阳性率16．3％，女性阳性率10．4％，感染率性别差异无统计学意义。阳性患者年龄分布，女性患者20～30岁最高，男性患者主要集中在20—40岁，其中31～40岁人群阳性率略高于20～30岁。结论非淋菌性尿道炎发病率高，女性高于男性，发病率高峰女性年龄小于男性。     

HLA—B27抗原检测在强直性脊柱炎诊断中的价值

目的探讨HLA-1327抗原在强直性脊柱炎（AS）诊断中的意义。方法采用流式细胞术检测疑为AS患者淋巴细胞HLA—B27抗原阳性所表达情况。结果疑为AS患者353例，HLA—B27阳性139例，男女阳性比例3．34：1，确诊为AS112例，阳性率90．2％。结论AS与HLA—B27强相关，多发于青少年且男多于女，对疑为AS的患者进行HLA—B27抗原检测有助于AS的诊断及鉴别诊断。     

天水地区HLA—B27基因高分辨分型与强直性脊柱炎相关性分析研究

目的：研究天水地区HLA—B27基因高分辨分型与强直性脊柱炎（Ankylosing Spondylits,AS）相关性的分析研究。方法：采用序列特异性引物聚合酶链反应（PCR～SSP）技术对天水地区As患者进行HIA—B27基因高分辨分型。结果：采用PCR—SSP法对天水地区疑似AS进行HLA—B27检测,共发现87例阳性。对阳性者用PCR—SSP法进行HLA-B2701—43基因高分辨分型;其中HIA—B270430例,占阳性总人数的34．48％;HLA—B270555例,占阳性总人数的63．22％;HLA—B27072例,占阳性总人数的2．30％,该基因型是国内首次在AS患者中发现。结论：初步发现天水地区AS患者与HLA—B2704、HLA—B2705有强相关性,偶见HLA—B2707阳性的AS患者,符合亚洲人特点。     

类风湿关节炎患者HLA-DR4/1亚型与抗环瓜氨酸肽抗体的关系

[目的]探讨类风湿关节炎（rheumatoid arthritis，RA）患者HLA—DR4／1分子与血清抗环瓜氨酸肽（cyclic citrullinated peptide，CCP）抗体之间的关系。[方法]收集118例RA患者，以序列特异性引物聚合酶链反应（PCR—SSP）技术对上述患者进行HLA—DR4／1分型，酶联免疫吸附试验（ELISA）方法检测患者血清抗CCP抗体水平。[结果]在118例RA患者中，35例患者HLA—DR4阳性，其中DRB1^＊0405阳性20例；5例患者HLA—DR1阳性。在118例RA患者中，抗CCP抗体阳性有90例。其中，在40例HLA—DR4／1 阳性的RA患者中，抗CCP抗体阳性的占82．5％（33／40）；在其余78例HIA—DR4／1阴性RA患者中，73．1％（57／78）抗CCP抗体阳性。HLA～DR4／1阳性患者与HLA—DR4／1阴性患者抗CCP抗体的阳性率差异无统计学意义（P=0．255）。而20例HLA—DRB1^＊0405阳性的RA患者抗CCP抗体阳性者19例，HLA—DRB1^＊0405阳性RA患者抗CCP抗体阳性率高于其他HLA—DR4／1亚型阳性的RA患者，也高于HLA—DR4／1阴性患者。[结论]RA中HIJA—DRB1^＊0405基因与抗CCP抗体具有一定的相关性。     

HLA—B27与急性前葡萄膜炎相关性的临床研究

目的：应用SSP—PCR(Sequence special prime—polymerase chain reaction)基因检定技术时急性前葡萄膜炎(acute anterior uveitis，AAU)患者HI。A—B27基因进行检测，并且时HLA—B27阳性与阴性患者临床特征加以分析。方法：采用SSP—PCR基因检定技术检测98例AAU患者及82例正常人样本的HLA—B27基因。并对HLA—B27阳性与阴性患者临床特征进行观察。结果：98例AAU患者样本中有57例样本呈HLA—B27阳性，82例正常人样本有4例样本呈HLA—B27阳性，阳性率分别为58．2％和4．9％。经χ^2检验，χ^2=41．33，P＜0．005，二组间有显著差异。HLA—B27阳性患者多见于男性，单眼多见，粉尘状KP，发病时视力下降明显，易于复发，且并发症少为其特征，激素治疗效果佳。结论：采用SSP—PCR基因检定技术测定HLA—B27快速、简单、准确性高、客观性强，值得推广和应用。HLA—B27与急性前葡萄膜炎有着高度相关性。HLA—B27阳性患者与阴性患者在临床特征上有着一定程度的差异。     

广州市天河口岸2010-2012年流感监测结果分析

摘要：目的了解天河口岸2010—2012年出入境人群流感流行特征,为科学防控疫情及进一步开展疫情预测预警提供依据。方法对2010—2012年天河121岸有流感样症状的出入境人员采鼻咽拭子,提取病毒RNA,采用荧光RT—PCR方法检测季节性甲型流感、乙型流感病毒核酸;同时进行流行病学个案调查。结果共采集鼻咽拭子1074份,其中流感病毒核酸阳性219份,总阳性率20．4％,各年度阳性率无差异。季节性H3型流感阳性96例,占43．8％,甲型H1N1流感阳性54例,占24．7％,乙型流感阳性69例,占31．5％,各年度流行优势株不同。总体男性样本阳性率18．8％（1181627）,女性样本阳性率22．6％（101／447）,阳性率无性别差异;0～5岁年龄组阳性率最低,为9．9％,与其他年龄组有显著差异;大陆居民样本阳性率21．9％（152／693）,港澳台样本阳性率15．4％（27／175）,其他国家样本阳性率19．4％（40／206）,阳性率无差异。总体冬（12—2月）、春（3～5月）季阳性率最高,分别为27．6％和25．1％。结论2010～2012年,天河口岸流感流行强度处于正常水平,各年度阳性率无差异;流行毒株为甲型H1N1流感、季节性H3型流感及B型流感病毒,各年度的流行优势株不同;流感季节性高峰在冬春季,峰值出现在I~3月和5～7月,呈双峰型或单峰型。     

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.