吸烟与非吸烟哮喘患者诱导痰的比较

目的观察吸烟轻度支气管哮喘患者诱导痰中炎症细胞的变化以了解吸烟对轻度支气管哮喘患者气道炎症及气道反应性的影响。方法随机抽取23例吸烟的轻度支气管哮喘患者定为吸烟组（A组）及随机抽取23例非吸烟的轻度支气管哮喘患者定为非吸烟组（B组），两组治疗前进行肺功能测定、气道反应性试验及诱导痰细胞分数计数。结果两组呼气峰流量（PEF）、第一秒用力呼气容积占预计值百分比（FEV1％）及气道反应性差异无统计学意义（P〉0．05）；A组患者诱导痰中中性粒细胞高于B组（P〈0．01），且经相关分析显示诱导痰中的中性粒细胞数量与PEF及FEV1（％）呈负相关（P〈0．01），而与气道反应性呈正相关（P〈0．01）。结论吸烟哮喘患者气道中的中性粒细胞比非吸烟哮喘患者气道中的中性粒细胞增多，且与PEF及FEV1（％）呈负相关，而与气道反应性呈正相关。     

轻度哮喘患者在支气管激发试验前后小气道功能及弥散功能的改变

目的 探讨轻度支气管哮喘（简称哮喘）患者在支气管激发试验（BPT）前后小气道和弥散功能的变化。方法 采用前瞻性研究方法，对临床上疑为哮喘的患者（出现发作性喘息、胸闷、咳嗽，胸片正常，基础肺功能在正常范围）行BFF，BFF阳性者为哮喘组，BFF阴性者为对照组。于BFF前后进行肺容量、通气功能及弥散功能检查，比较哮喘组和对照组试验前后肺功能的变化。结果 （1）激发前，哮喘组和对照组第1秒用力呼气容积占预计值百分比（FEV1％）、1秒率（FEV1／FVC）、用力肺活量占预计值百分比（FVC％）、肺活量占预计值百分比（VC％）、肺总量占预计值百分比（TLC％）、功能残气量占预计值百分比（FRC％）、残气量占预计值百分比（RV％）和残气量／肺总量（RV／TLC）等指标比较差异无统计学意义（P均〉0．05）。激发后，哮喘组FEV1／FVC和FVC％较对照组显著下降（P均〈0．01），而FRC％（P〈0．05），RV％（P〈0．01）和RV/TLC（P〈0．01）较对照组显著增加。哮喘组激发前后FEV1／FVC和FVC％下降率显著高于对照组（P均〈0．01），TLC％，RV％和RV／TLC增加率显著高于对照组（P均〈0．01）。（2）激发前哮喘组最大呼气中期流速（FEE25%-75％）（P〈0．05）、在75％肺活量位时的最大呼气流速（V^·max75％）（P〈0．01）、在50％肺活量位时的最大呼气流速（V^·max50％）（P〈0．05）均较对照组显著下降。激发后上述指标及在25％肺活量位时的最大呼气流速（V^·max25％）较对照组显著降低（P均〈0．01）。哮喘组激发前后FEE25％-75％，V^·max75％，V^·max50％和Vmax25％下降率显著高于对照组（P均〈0．01）。（3）激发前后哮喘组和对照组一氧化碳弥散功能无显著差异。结论 轻度哮喘患者BFF前肺功能虽然在正常范围，但小气道功能较气道反应性正常患者降低；BFF后存在大气道和小气道功能障碍，弥散功能正常。     

哮喘控制测试与肺功能在哮喘管理中的相关性研究

目的：探讨哮喘控制测试（asthmacontroltest,ACT）和肺功能检测在支气管哮喘患者管理中的相关性。方法：将ACT应用于哮喘患者78例。在哮喘患者应用ACT和药物治疗时、应用ACT6个月结束时测定第1秒用力呼气量（FEV1）、FEV1占预计值百分比（FEVI％预计4／t）,呼气峰流量（PEF）、PEF占预计值百分比（PEF％预计值）,同时测定ACT评分。结果：应用ACT前FEVI％预计值为55．63±18．25,PEF％预计值为56．72±17．11,ACT评分16．12±3．41。应用ACT6个月后,FEV1％预计值为76．73±14．62,PEF％预计值79．21±15．5l,ACT评分22．54±2．76。治疗前与治疗后差异有统计学意义（t=12．5818．31,均P〈O．01）;ACT与FEVI％和PEF％,具有良好相关性（r=0．82,r=0．81均P〈0．01）结论：ACT与肺功能相结合能有效用于支气管哮喘患者的管理,ACT与肺功能在哮喘中有相关性。     

支气管哮喘患者肺功能与转化生长因子β1关系的研究

目的观察哮喘患者急性发作期、缓解期的肺功能和血清转化生长因子β1（TGF—β1））的变化,探讨其临床意义。方法对55例支气管哮喘急性发作期和50例缓解期患者作常规肺通气功能检测,同时用酶联免疫吸附试验（ELISA）测定其血清TGF-β1水平,并设30例健康者作为对照组。结果哮喘急性发作期、缓解期血清TGF-β1水平均低于对照组,有统计学差异（P〈0．01,P〈0．05）,其中急性发作期血清TGF-β1水平明显低于缓解期和对照组（P〈0．01）;急性发作期肺功能指标FEV1％、FEV1／FVC明显低于缓解期和对照组（P〈0．01）,FEF50、FEF75在急性发作期与缓解期比较差异无统计学意义（P〉0．05）;TGF—β1与FEV1％、FEV1／FVC、FEF50、FEF75呈显著正相关（P〈0．01）。结论血清TGF-β1降低与肺功能减退和哮喘发作有直接关系,提示TGF-β1是反映气道炎症程度的可靠指标。反映小气道功能的FEF50、FEF75在急性发作期与缓解期变化不大,缓解期患者仍存在小气道功能异常,提示缓解期气道炎症持续存在。     

支气管哮喘患者小气道阻塞程度及可逆性研究

目的探讨支气管哮喘患者激发试验前后及舒张试验前后小气道功能的变化。方法采用前瞻性研究方法,对31例已确诊为支气管哮喘的患者行支气管激发试验,激发试验阳性患者予以沙丁胺醇气雾剂吸人,15min后再测定患者肺功能。选择同时期条件匹配的28例气道高反应性升高但不能诊断为哮喘的非哮喘患者作为对照,比较两组间激发试验前后及使用支气管舒张剂后小气道功能指标的差异。结果①激发前和激发后,哮喘组最大呼气中期流速（MMEF）、用力呼气25％肺活量的瞬间流量（FEF25％）、用力呼气50％肺活量的瞬间流量（FEF50％）和用力呼气75％肺活量的瞬间流量（FEF75％）均显著低于非哮喘组（P〈0．01）。舒张后FEF25％和FEF50％在丽组间差异有统计学意义（P〈0．05）,但MMEF和FEF75％在两组间差异元统计学意义（P〉0．05）。②哮喘组激发前后第一秒用力呼气容积占预计值百分比（FEV1％）、MMEF、FEF25％、FEF50％和FEF75％的下降率显著高于非哮喘组（P〈0．01）,舒张前后MMEF、FEF25％、FEF50％和FEF75％的上升率也显著高于非哮喘组（P〈0．001）,而FEVt％的上升率在两组间差异无统计学意义。③哮喘组激发前后及舒张前后MMEF和FEF75％的变异率要显著高于FEV1％（P〈0．01）。非哮喘组激发前后MMEF和FEF75％的变异率也要显著高于FEV1％（P〈0．05）,但舒张前后变异率差异无统计学意义（P〉0．05）。结论支气管哮喘患者小气道功能要低于其他原因所致的气道高反应性患者,小气道阻塞的可逆性要高于其他原因所致的气道高反应性患者。支气管哮喘患者大、小气道均存在可逆性阻塞,小气道阻塞的可逆程度要高于大气道。     

哮喘患者血清及BALF中CCSP的测定与临床研究（摘要）

目的通过测量支气管哮喘患者治疗前后支气管肺泡灌洗液（BALF）及血清clara细胞分泌蛋白（CCSP）水平的变化，明确clara细胞及其分泌蛋白在哮喘发病中的作用，探讨内源性抗炎机制，完善哮喘的气道炎症理论．方法选择健康对照组15例，哮喘急性发作期和缓解期病人各15例，留取静脉血和支气管肺泡灌洗液，用ELISA方法分别测定血清和BALF上清液中CCSP的水平，同时测定患者肺功能用力肺活量（FVC）、1s用力呼气容积的肺活量（FEV1）及呼气中段流量（MMEF），并对结果进行统计学分析．结果哮喘急性发作组和哮喘缓解组血清及BALF上清液CCSP水平显著低于健康对照组P〈0．05，哮喘急性发作组和哮喘缓解组血清及BALF上清液CCSP水平无统计学差异；哮喘急性发作组肺功能FEV1、FVC、MMEF显于低于哮喘缓解组及健康对照组P〈0．01，哮喘缓解组及健康对照组肺功能FEV1、FVC、MMEF值无统计学差异；[第一段]     

中西医结合治疗支气管哮喘发作期临床研究

目的 观察中西医结合治疗支气管哮喘发作期的疗效。方法 将l60例支气管哮喘发作期患者随机分为中西医结合治疗组和西医对照组，治疗前后对疗效及外周血嗜酸性粒细胞（EOS）、血清IgE、血浆内皮素（ET）、1秒钟用力呼气容积（FEV1）、1秒钟用力呼气容积占预计值百分比（FEV1％）等指标进行观察。结果 治疗组总有效率98．75％，与对照组78．25％比较，差异有显著性（P〈0．05），两组治疗后EOS、IgE和ET均较治疗前明显下降，差异均有显著性（P〈0．05），且治疗组治疗后EOS、IgE与对照组治疗后比较，差异有显著性（P〈0．05）。结论 采用中西医结合治疗支气管哮喘发作期的疗效优于单纯西药治疗，且经济实惠，值得进一步研究和推广。     

甲双咪胍吸入治疗支气管哮喘的临床研究

为评价H2R激动剂甲双咪胍（impromidine）在哮喘气道炎症防治中的作用，应用该药治疗哮喘患者18例，观察治疗前和治疗6周后肺功能（FEV1％）、支气管高反应性（BHR）和血清嗜酸粒细胞阳离子蛋白（ECP）水平变化。结果发现各指标均有显著改善，FEV1％显著上升（P＜0．05），BHR显著下降（P＜0．05～0．01），ECP显著降低（P＜0．01）。结果提示甲双咪胍可主要作为抗气道炎症药物用于哮喘防治，具有良好的临床应用价值。     

哮喘急性发作患者呼出气冷凝液中NO2^-浓度检测的临床意义

目的：探讨哮喘急性发作患者呼出气冷凝液（EBC）中亚硝酸盐（NO2^-）浓度与哮喘病情严重程度、炎症反应间的关系。方法：62例支气管哮喘急性发作期患者,按病情程度分为轻、中、重度哮喘组,并选择同期24例健康者作为健康对照组,检测并比较各组第一秒钟用力呼气量占预计值百分比（FEV1％）;用EBC收集仪器采集标本,采用分光光度法测定NO2^-的吸光度,根据标准曲线计算NO2^-浓度,并对各组NO2^-浓度进行比较。结果：健康对照组与不同程度哮喘组患者EBC中NO2^-浓度、FEV1％检测值比较差异均有统计学意义（P〈0．05）,轻、中、重度哮喘组患者NO2^-浓度明显高于健康对照组,FEV1％值明显低于健康对照组,差异均有统计学意义（P〈0．01）。哮喘患者EBC中NO2^-浓度与FEV1％呈负相关（r=-0．522,P〈0．01）。结论：哮喘急性发作期患者EBC中NO2^-浓度显著升高,与病情严重程度相关,提示NO2^-可作为监测支气管哮喘炎症的有效指标。     

祛风平喘汤治疗支气管哮喘89例

目的观察祛风平喘汤治疗支气管哮喘的疗效，及对患者肺功能、外周血嗜酸粒细胞记数（EOS）、血清IgE的影响。方法用祛风平喘汤（荆芥、防风、麻黄、黄芩、黄芪、川芎等）治疗支气管哮喘89例。并设对照组（普米克加万托林）。检测患者治疗前后FEV1（第一秒用力呼气容积）、EOS（外周血嗜酸粒细胞记数）、血清IgE（免疫球蛋白E）。结果两组疗效有显著性差异（P〈0．05），治疗后，两组EOS、IgE均明显降低（P〈0．01）。结论祛风平喘汤对支气管哮喘有明确的疗效，并有降低外周血嗜酸粒细胞记数（EOS）、血清IgE水平的功效。     

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.