A型性格对中老年原发性高血压患者早期肾功能损害的影响及贝那普利的保护作用

目的 探讨A型性格对中老年原发性高血压患者早期肾功能损害的影响及贝那普利对其的保护作用.方法 根据A型性格量表,在中老年原发性高血压患者中筛查出80例A型性格(A型性格组)和80例非A型性格(非A型性格组),给予贝那普利干预治疗,初始计量10 mg/d,剂量递增,使血压达标,在1个月内使最大剂量增至20 mg/d,服药6个月.采集一般临床资料并分别在治疗前、后测定患者血浆的血管紧张素Ⅱ(AngⅡ)、尿微量白蛋白排泄率(UAER)、尿β2-微球蛋白(β2-MG).结果 两组年龄、性别、体质指数(BMI)、尿素(BUN)、肌酐(Cr)、收缩压及舒张压差异无统计学差异(均P>0.05).A型性格组较非A型性格组AngⅡ[(60.3±11.6)mg/L与(55.8±10.2)mg/L]、UAER[(83.3±23.3)μg/min与(75.7±16.3)μg/min]、β2-MG[(75.6±24.5)mmol/L与(66.0±19.4)mmol/L]增高,差异均有统计学意义(t值分别为2.598、2.603、2.742,P值分别为0.016、0.012、0.008);2组的A型性格分值与AngⅡ、UAER、β2-MG呈正相关(r值分别为0.361、0.198和0.202,P值分别为0.002、0.015、0.021),经多元逐步回归分析,AngⅡ为其独立危险因素(β=0.291,t=2.793,P=0.008).用药后2组的收缩压、舒张压、AngⅡ、UAER及β2-MG均显著下降,并且2组中AngⅡ的变化值与UAER(r=0.373,P=0.005;r=0.282,P=0.032)及B2-MG(r=0.385,P=0.003;r=0.279,P=0.039)的变化值亦呈正相关.结论 A型性格可通过应激系统加重中老年原发性高血压患者早期肾功能损害,贝那普利对其具有较好的保护作用.     

丹红注射液与贝那普利联合治疗早期糖尿病肾病疗效观察

将54例早期DN患者随机分为观察组:应用丹红注射液联合贝那普利;对照组:应用贝那普利。结果:与治疗前比较,两组患者治疗后UAER、UACR、β2-MG均显著下降,且观察组下降更为明显,差异均有统计学意义(P0.05)。结论:丹红注射液联合贝那普利在治疗早期DN的临床疗效优于贝那普利。     

硝苯地平和贝那普利对高血压患者肾脏功能的影响

目的探讨硝苯地平和贝那普利对高血压患者肾脏功能的影响。方法将90例高血压患者随机分成硝苯地平组、贝那普利组和联合治疗组各30例,硝苯地平组给予30 mg/d硝苯地平控释片口服,贝那普利组给予10 mg/d贝那普利片口服,联合治疗组给予30 mg/d硝苯地平控释片+10 mg/d贝那普利片口服,连续治疗12周。测定患者治疗前和治疗6周、12周末时的血压,24 h尿白蛋白、β2-微球蛋白(β2-MG)含量以及外周血中尿素氮(BUN)、肌酐(SCr)水平。结果三组治疗后血压、SCr和BUN水平均显著降低(P均<0.05),但组间降压幅度无统计学差异(P>0.05)。24 h尿白蛋白和β2-MG均较治疗前显著降低,且联合治疗组较单药组下降幅度更明显(P均<0.05)。结论硝苯地平和贝那普利单独用于治疗高血压可减少尿白蛋白水平,保护肾脏功能,两药联合效果更佳。     

高血压性肾损害患者血清HCY、尿液β_2-MG水平变化及意义

目的观察高血压性肾损害患者血清同型半胱氨酸（HCY）和尿液β2微球蛋白（β2-MG）水平变化,探讨二者在高血压性肾损害诊断中的临床应用价值。方法选择高血压性肾损害患者79例为观察组,健康对照者70例为对照组,分别检测其血清HCY和晨尿β2-MG水平。计算观察组血清HCY和尿β2-MG阳性率。结果观察组男性患者血清HCY水平为（19.8±14.9）μmmol/L、女性为（16.9±8.7）μmmol/L,均高于对照组男性的（9.6±8.0）μmmol/L和女性的（8.6±6.2）μmmol/L,P均〈0.05。观察组男性患者尿β2-MG水平为（0.76±0.38）mg/L、女性为（0.73±0.44）mg/L,均高于对照组男性的（0.42±0.26）mg/L和女性的（0.34±0.12）mg/L,P均〈0.05。观察组患者血清HCY阳性率男性84.2%、女性72.7%,β2-MG阳性率男性93.0%,女性为100%。结论高血压性肾损害患者血清HCY和尿β2-MG升高。检测血清HCY和尿β2-MG水平有助于诊断高血压性肾损害。     

阿托伐他汀治疗高血压早期肾损害

目的 探讨阿托伐他汀对高血压早期肾损害的影响.方法 对55例经氨氯地平降压治疗达到高血压1级及以下标准的高血压患者随机分为实验组(n=27)和对照组(n=28),实验组予以阿托伐他汀10 mg/d和氨氯地平,对照组只给予氨氯地平.两组治疗前及治疗后12周检测24 h动态血压、空腹血脂和尿微量白蛋白(MAU)、尿β2-微球蛋白(β-2-MG)、N-乙酰-β-D氨基葡萄糖苷酶(NAG).结果 两组治疗后12周,24 h收缩压(SBP)和舒张压(DBP)、白昼和夜间SBP及DBP均较治疗前明显下降(P均＜0.01),但实验组下降更为显著(P均＜0.01),SBP和DBP平滑指数也优于对照组(P均＜0.01).治疗前后两组血脂无明显变化(P＞0.05);实验组MAU、β-2-MG和NAG较治疗前显著下降[MAU:(42.2±14.9)vs实验后 (18.2±12.1) mg/L,β-2-MG:(6.2±1.4)vs实验后 (3.5±0.8)mg/L,NAG:(28.5±14.7)vs实验后 (17.9±9.5)U/L,P均＜0.01],并低于同期的对照组(P＜0.01),对照组仅MAU较治疗前下降(P＜0.01).结论 阿托伐他汀具有一定的协同降压作用,并可能改善高血压早期肾损害的相关指标.     

阿托伐他汀对高血压患者早期肾损害的影响

将90例高血压早期肾损害患者随机分为两组,对照组采用常规治疗,观察组在此基础上加用阿托伐他汀.治疗前、治疗后3个月检测并比较两组的血脂、尿微量白蛋白(MAU)、β2微球蛋白(β2-MG)、N-乙酰-β-D氨基葡萄糖苷酶(NAG)水平.结果两组治疗后尿MAU、β2-MG、NAG均下降(P<0.05),但观察组下降幅度大于对照组(P<0.05).提示阿托伐他汀对高血压早期肾损害患者具有肾保护作用.     

心踝血管指数与高血压早期肾损害的相关性研究

目的:探讨心踝血管指数(CAVI)与高血压早期肾损害的相关性。方法:入选60例高血压患者进行CAVI检测,同时测定尿微量白蛋白(MAU)、β2-微球蛋白(β2-MG)、N-乙酰-β-D氨基葡萄糖苷酶(NAG)水平;分析CAVI与MAU、β2-MG及NAG的相关性。结果:CAVI升高患者尿MAU、β2-MG及NAG均显著升高(均P<0.05);相关性分析显示CAVI与尿MAU、β2-MG及NAG呈显著正相关(r分别为0.681、0.912、0.853,均P<0.05)。结论:CAVI与高血压早期肾损害指标有显著相关性,可作为高血压患者早期肾损害评价指标之一。     

缬沙坦及贝那普利联合用药对高血压患者尿微量白蛋白的影响

目的观察血管紧张素II受体拮抗剂（ARB）类药物缬沙坦及血管紧张素转换酶抑制剂（ACEI）类药物贝那普利联合用药与大剂量单药（缬沙坦或贝那普利）对原发性高血压患者尿微量白蛋白（MAU）的影响。方法此研究为随机双盲实验。将119名有微量白蛋白尿的原发性高血压患者随机分为贝那普利组（10mg/d,n=42）、缬沙坦组（160mg/d,n=37）和联合用药组（贝那普利5mg/d＋缬沙坦80mg/d,n=40）。半量治疗4周后能耐受者增加至目标剂量,随访4周。分别于研究开始、治疗4周、8周时测定MAU和血压。结果治疗8周后降压幅度为：贝那普利组〔n=35,（15.8±3.4）/（10.0±1.8）mmHg〕,缬沙坦〔n=35,（14.7±3.7）/（9.8±1.6）mmHg〕,联合用药组〔n=38,（15.3±3.6）/（10.2±1.4）mmHg〕,3组比较血压差异无统计学意义;MAU降低幅度为：贝那普利组〔（65.4±9.5）mg/24h〕,缬沙坦〔（67.8±11.5）mg/24h〕,联合用药组〔（95.8±12.2）mg/24h〕,联合用药组较单药组效果显著,P均〈0.01。结论缬沙坦和贝那普利联合用药较加大剂量单药治疗的血压控制无差异,但对高血压患者的肾脏保护作用更强。     

黄芪注射液治疗原发性高血压肾损害的临床观察

目的观察黄芪注射液对原发性高血压肾损害患者可明显降低尿微量白蛋白的排泄,对肾脏起协同保护作用。方法将原发性高血压肾损害患者随机分成常规治疗组和黄芪注射液治疗组,各45例,均给予低盐优质蛋白饮食,减轻体重,戒烟,避免使用肾毒性药物,予血管紧张素转换酶抑制剂(ACEI)及钙离子拮抗剂(CCB)降压治疗,黄芪注射液组在上述基础上予黄芪注射液40 ml加入5%葡萄糖液250 ml静滴,1/日,疗程4周。监测2组治疗前后的血压、血肌酐、尿素氮、血脂、尿白蛋白排泄率、尿β2-微球蛋白。结果治疗后黄芪注射液组较常规治疗组在尿白蛋白排泄率(UAER)[(68.67±14.28)mg/24 h vs.(80.87±14.77)mg/24 h,P0.05]、尿β2-微球蛋白(β2-MG)[(2.21±0.55)mg/L vs.(3.42±0.67)mg/L,P0.05]明显降低。黄芪注射液组治疗后总胆固醇[(4.69±0.62)mmol/L vs.(5.23±0.61)mmol/L,P0.05]、三酰甘油[(1.47±0.09)mmol/L vs.(1.54±0.10)mmol/L,P0.05]、LDL-C[(2.95±0.12)mmol/L vs.(3.02±0.12)mmol/L,P0.05]明显降低,两组患者的血压均较治疗前明显降低(P0.05)。结论黄芪注射液组UAER、尿β2-MG较常规治疗组均有明显下降,证明黄芪注射液结合常规降压治疗可进一步降低高血压微量白蛋白的排泄,提示黄芪在肾脏保护方面与常规西药具有协同作用。     

前列地尔联合贝那普利对老年高血压肾损害患者血压和肾功能的改善作用

目的探讨前列地尔联合贝那普利对老年高血压肾损害患者血压和肾功能的改善作用。方法选择260例原发性高血压患者,随机分为对照组(无肾损害者)和观察组(有肾损害者),每组130例。对照组患者在常规降压治疗的基础上,给予贝那普利治疗;观察组患者应用前列地尔联合贝那普利进行治疗。观察两组患者临床疗效、治疗前后血压改善程度,检测血肌酐(Scr)、尿素氮(BUN)、24 h尿蛋白及肌酐清除率(Ccr)水平评估患者肾脏功能改善状况,应用肾动脉阻力指数(RI)和搏动指数(PI)评估患者肾内血流动力学状况。结果观察组有效率〔73.85%(96/130)〕,明显高于对照组〔73.85%(96/130),P<0.05〕。观察组治疗后收缩压、舒张压、RI和PI均低于对照组(P<0.05);观察组治疗后Scr、BUN和24 h尿蛋白均低于对照组(P<0.05),观察组治疗后Ccr〔(75.33±4.12)ml/min〕,明显作用高于对照组〔(72.80±5.09)ml/min,P<0.05〕。结论前列地尔联合贝那普利对老年高血压肾损害患者血压及肾功能均有显著改善作用。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.