慢性乙型肝炎患者血清sCD14的水平与肠源性内毒素血症的关系

目的 探讨慢性乙型肝炎（慢乙肝）患者血清中sCD14的水平与继发肠源性内毒素血症的关系。方法 以ELISA法检测60例慢乙肝患者血清sCD14和TNF-(水平,同时,应用基质显色法定量检测了患者血浆内毒素水平并将三者与对照组进行比较。结果 轻度慢乙肝（A组）患者血清sCD14水平与对照组无显著差异（P>0.05）,中度慢乙肝（B组）和重度慢乙肝（C组）sCD14水平均显著高于对照组（P<0.01）;慢乙肝继发肠源性内毒素血症者血清中sCD14s为（4.8±2.3）(g/ml,而无继发肠源性内毒素血症者其sCD14为（2.9±1.9）(g/ml,两者之间有显著差异 ( P<0.01)。A组患者血清中sCD14水平为（3.0±1.7）(g/ml,而TNF-(为（4.69±2.75）ng/ml,两者之间无显著相关性（γ= 0.76,P>0.05）;而B组和C组其sCD14水平分别为（5.2±2.1）(g/ml和（6.9±3.4）(g/ml,TNF-(分别为（9.48±6.15）ng/ml和（14.23±8.29）ng/ml,B组、C组的sCD14水平分别与自身组TNF-(有显著相关性（γ=0.87,P<0.01;γ=0.91,P<0.01）。结论 慢乙肝继发肠源性内毒素血症者sCD14水平显著升高,说明sCD14水平可显著提高慢乙肝患者对内毒素的敏感性,LPS与sCD14结合,诱导单核-巨噬细胞产生TNF-(,从而损伤肝细胞。     

急性重症胰腺炎时血浆内毒素和TNFα水平变化及生长抑素的治疗作用

目的　观察生长抑素 (施他宁 )对重症急性胰腺炎的治疗效果及其对急性胰腺炎患者血浆内毒素和 TNF︿水平的影响。方法　 36例急性重症胰腺炎患者随机分为 A、B两组 ,A组采用施他宁治疗 (治疗组 ) ,B组给予一般常规治疗 (对照组 ) ,于第 1～ 7天抽血测定血清淀粉酶、血浆内毒素和 TNF︿。结果　急性胰腺炎患者入院第一天的血浆内毒素 (A/ B组 :0 .95± 0 .2 2 / 0 .96± 0 .2 7IU/ ml)和 TNF︿水平 (A/ B组 :0 .87± 0 .2 7/ 0 .86± 0 .2 1 ng/ ml)均明显高于健康人 (内毒素 /TNF︿:0 .1 1± 0 .0 3 IU/ ml/ 0 .0 4± 0 .0 2 ng/ ml) ;治疗组患者血清淀粉酶、血浆内毒素和 TNF︿水平下降速度明显快于对照组。结论　急性胰腺炎患者早期均存在不同程度的内毒素血症及血浆TNF︿水平升高 ,生长抑素治疗急性重症胰腺炎疗效肯定 ,治疗组患者血浆内毒素和 TNF︿水平下降均明显快于对照组。     

噻庚啶抗内毒素休克的作用

目的　研究噻庚啶抗内毒素休克作用和机制。方法　静脉注射脂多糖 (LPS) 5mg/kg复制大鼠内毒素休克模型 ,Northern杂交分析TNFαmRNA表达 ,放免法测定血浆TNFα 的含量 ,黄嘌呤 黄嘌呤氧化酶法测定血浆SOD活性 ,TBA法测定血浆MDA含量 ,激光扫描共聚焦显微技术测定单细胞内游离Ca2 + 浓度 ([Ca2 + i])。结果　噻庚啶显著提高休克大鼠的平均动脉血压 (MABP)及 2 4h的存活率 ,抑制LPS诱导的大鼠肝脏TNFαmRNA的表达这 (18+ 10vsLPS +saline 38± 10 ,P <0 0 1)和血浆TNFα 水平 [(7 8± 2 4 ) μg/LvsLPS +saline (2 1 5± 3 2 )μg/L ,P <0 0 1) ],提高血浆SOD活性 [(10 37 2± 112 8)NU/LvsLPS +saline (6 15 4± 92 6 )NU/L ,P <0 0 1],降低血浆MDA的含量 [(5 2± 1 1) μmol/LvsLPS +saline (9 8± 1 5 ) μmol/L ,P <0 0 1],并能显著抑制TNFα诱导的内皮细胞 [Ca2 + ]i 升高。结论　噻庚啶通过抑制TNFα 基因表达 ,抑制脂质过氧化和防止细胞内Ca2 + 超载具有良好的抗内毒素休克作用。     

肝硬化患者血清胰岛素样生长因子-I测定及其临床意义

目的　探讨肝硬化患者血清胰岛素样生长因子 I(IGF I)测值改变及其与肝功能Child分级间的关系。方法　 45例肝炎后肝硬化患者及 34例健康对照者应用免疫放射法测定血清IGF I值 ,比较IGF I在正常人与肝硬化以及肝功能不同Child级别组中的变化。结果　肝硬化患者的血清IGF I值 (2 45 .5 3± 94.0 9)ng/ml明显低于正常组 (6 7.98± 6 5 .97)ng/ml,P <0 .0 0 1,且随肝功能Child分级的增高而进行性下降。 结论　IGF I测值与肝功能状况有明显的相关性 ,测值低于 30ng/ml则临床预后不良。研究结果提示血清IGF I测定是一项重要的肝功能状况评估的检测指标     

转化生长因子β1和肿瘤坏死因子α在门静脉高压症发病中的意义

目的　研究转化生长因子 β1 (TGFβ1 )和肿瘤坏死因子 α(TNFα)在门静脉高压症 (门脉高压 )发病中的作用。　方法　应用酶联免疫分析方法对 5 0例门脉高压患者 (其中 2 0例伴腹水形成 )、5 0例正常对照者进行TGFβ1 和 TNFα的检测。　结果　对照组血清 TGFβ1 和 TNFα为 12 .32± 3.2 9ng/ml,94.74± 49.30 pg/ml,门脉高压组分别为 19.2 1± 5 .87ng/ml,140 .85± 5 3.47pg/ml(P<0 .0 5 ) ;门脉高压伴腹水者为 18.44± 5 .89ng/m l,16 7.34± 38.6 2 pg/ml,不伴腹水者为 2 0 .6 8± 6 .73ng/ml,10 1.5 4± 2 8.2 4pg/m l,两者比较 TGFβ1 差异无显著性 ,而有腹水者 TNFα高于无腹水者 (P<0 .0 5 )。　结论　 TGFβ1 和 TNFα水平升高在肝硬化门脉高压发病的病理生理机制中起作用。     

自制灌注液在大鼠肝缺血再复流中的作用

目的 :研究自制灌注液在大鼠肝脏低温灌注再复流过程中对肝细胞和肝窦内皮细胞的影响。方法 :运用大鼠肝脏原位低温灌注再复流模型 ,行在体原位低温灌注 ,大鼠 10 2只。随机分成 4组 ,每组 2 4只 ,对照组 (C组 ) 2 4只仅行全肝血流阻断 2 0min ,余各组分别用 0℃乳酸林格氏液 (A组 )、0℃自制灌注液 (B组 )、0℃UW液(D组 )灌注 2 0min ,各组在恢复血流 0 ,30 ,12 0 ,72 0min分别处死 6只 ,取血液和肝脏检测。观察低温灌注及再复流后血清透明质酸 (HA)、TNF -α、ALT、AST和肝组织学变化。其余 6只SD大鼠 (S组 )作正常对照。结果 :C组再复流 30 ,12 0 ,72 0min血清HA浓度为 (12 6 .8± 2 0 .8)ng/ml、(2 5 0 .0± 2 4 .1)ng/ml、(2 90 .4± 37.0 )ng/ml,分别高于乳酸林格氏液灌注组 [(6 8.0± 11.6 )ng/ml、(14 2 .9± 30 .1)ng/ml、(2 0 0 .0± 17.5 )ng/ml]和自制灌注液灌注组 [(6 7.5± 6 .7)ng/ml,(6 3.3± 16 .2 )ng/ml,(6 2 .1± 14 .6 )ng/ml]及UW液组 [(6 6 .3± 8.8)ng/ml,(6 6 .6± 2 1.2 )ng/ml,(5 8.8± 11.0 )ng/ml],差异均有高度显著性意义 (P <0 .0 5 ) ;自制灌注液灌注组与UW液灌注组血清HA浓度在再复流 30 ,12 0 ,72 0min均无显著性差异 (P >0 .0 5 )。再复流 30、12 0min时C组血清TNF     

血清MMP-2、CRP水平对不稳定性心绞痛的诊断及预后判断价值

目的 :探讨血清基质金属蛋白酶 - 2 (MMP- 2 )及 C-反应蛋白 (CRP)定量测定对不稳定性心绞痛 (U A)的诊断及预后判断价值。　方法 :对 46例 UA患者、2 5例稳定性心绞痛 (SA )患者及 2 2例健康志愿者分别进行血清MMP- 2及 CRP酶联免疫测定。　结果 :U A组入院时血清 MMP- 2水平明显高于 SA组及对照组 ,分别为 (4 70 .8±5 1.4) ng/ ml、(32 9.6± 5 4.0 ) ng/ ml及 (2 46 .5± 2 6 .8) ng/ m l(P<0 .0 1)。 UA组入院时血清 CRP水平明显高于 SA组及对照组 ,分别为 (3.6± 0 .4) μg/ m l、(0 .9± 0 .1) μg/ m l及 (0 .7± 0 .1) μg/ m l(P<0 .0 1)。UA组病情稳定后血清MMP- 2及 CRP水平明显降低 ,分别为 (35 0 .4± 41.8) ng/ m l、(0 .9± 0 .3) μg/ ml(P<0 .0 1)。 U A组有 7例发生急性冠状动脉事件 (ACE) ,SA组未发现 ,且 ACE组入院时血清 MMP- 2、CRP水平分别为 (5 0 3.7± 30 .3) ng/ ml、(4 .1± 0 .3) μg/ ml,明显高于 U A组入院时平均 MMP- 2、CRP水平 (P<0 .0 5 )。　结论 :血清 MMP- 2、CRP水平可能对 UA具有一定的诊断及预后判断价值     

生长激素对全身麻醉肿瘤坏死因子的影响

目的　探讨生长激素对全身麻醉引起肿瘤坏死因子 (TNFα)增高的改善作用。方法　雄性成年Wistar大鼠 4 0只 ,平均分两组。一组生长激素 (Saizen) 1U/kg ,皮下注射 ,连续 3日 ;对照组生理盐水 1ml/kg。腹腔苯巴比妥麻醉后腹主动脉插管。测血TNFα0小时、1小时、2小时、4小时 4时相值。结果　对照组TNFα2 60 80±69 2 1ng/ml,2 4 0 4 1± 7 5 2ng/ml,2 4 5 2 8± 4 0 2 8ng/ml;生长激素组分别为 12 0 4 2± 3 0 72ng/ml,10 0 4 3±2 0 5 2ng/ml,13 0 5 2± 3 0 4 6ng/ml。均有明显统计学差异。 结论　生长激素对全身麻醉引起TNFα增高具有明显改善作用。     

内毒素介导Kupffer细胞脂多糖受体CD14的表达

目的　观察内毒素刺激下肝Kupffer细胞 (KCs)膜上脂多糖 (LPS)受体CD14的表达及其在细胞因子分泌中的作用。方法　从Wistar大鼠肝组织中分离出KCs ,培养 12h并调整细胞浓度为 1× 10 6/ml/孔 ,将细胞分为 2组。①LPS组 :每孔加入不同浓度LPS(0、10 0ng/ml ,1、10 0 μg/ml) ;②PI PLC组 :每孔先加入 1U磷脂酰肌醇特异性磷脂酶C(PI PLC)后再加入不同浓度LPS。用兔抗鼠CD14抗体和异硫氢酸荧光素 (FITC)标记的羊抗兔IgG对KCs进行免疫染色 ,流式细胞仪 (FCM)测定FITC阳性KCs数及其荧光强度(FI) ,并用酶联免疫法或放免法测定培养液中TNFα和IL 6的含量变化。结果　随着LPS浓度增加 ,LPS组FITC阳性细胞数显著增多 ,其FI逐渐增强 ,培养液中TNFα和IL 6的含量也逐渐增高 (P <0 .0 1) ;PI PLC组FITC阳性细胞数及FI较LPS组明显减少和减弱 ,培养液中TNFα和IL 6的含量在低浓度LPS刺激时差异无显著性 (P >0 .0 5 ) ,在高浓度LPS时刺激时才明显增加 (P <0 .0 5 )。结论　LPS能上调KCsCD14表达 ,同时伴有多种细胞因子分泌 ;PI PLC对内毒素介导KCs分泌细胞因子有一定抑制作用     

时间分辨荧光免疫分析法定量检测HBsAg的临床意义

目的 :探讨时间分辨荧光免疫分析法 (TRFIA)定量检测乙肝表面抗原 (HBsAg)的临床意义。方法 :对 3 5 8份乙肝病毒感染者血清标本采用TRFIA法定量检测HBsAg的含量。结果 :急性乙肝组血清HBsAg的含量为 2 0 . 8± 18 . 5 μg/ml ,慢性乙肝组、肝硬化组、肝癌组HBsAg含量分别为 5 . 3± 8 . 7μg/ml ,4 . 5± 7 . 2 μg/ml ,4 .1± 6 . 3 μg/ml,与急性乙肝组相比较差别显著 (P <0 0 1)。HBeAg(+ )组HBsAg含量为 2 6 .8± 18 . 2 μg/ml ,抗HBe(+ )组HBsAg含量为 3 . 6± 4 . 1μg/ml ,两组比较存在显著差异 (P <0 . 0 1)。结论 :采用TRFIA法定量检测HBsAg能较直观地反映乙肝病毒感染者体内乙肝病毒复制的活跃程度 ,结合乙肝其它血清学指标检查 ,对乙肝的病程监测及药物疗效判断具有一定帮助。     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.