替米沙坦对高血压病人胰岛素抵抗的影响

目的 比较替米沙坦和氯沙坦对高血压病人胰岛素抵抗的影响.方法 42例高血压病人经过4周单盲安慰剂导入期后被随机分为2组,实验组给予替米沙坦80 mg,每天1次,对照组给予氯沙坦50 mg,每天1次,疗程8周;比较两组病人治疗前后空腹血糖、空腹胰岛素和胰岛素敏感指数的变化.结果 两组病人治疗前后空腹血糖变化无统计学差异,实验组治疗后空腹胰岛素和胰岛素敏感指数与治疗前比较差异有统计学意义(P<0.01);对照组治疗后空腹胰岛素和胰岛素敏感指数与治疗前比较差异无统计学意义(P>0.05);实验组治疗前后空腹胰岛素和胰岛素敏感指数变化值与对照组比较差异有显著性(t=6.59、6.98,P<0.01).结论 治疗剂量替米沙坦具有提高高血压病人的胰岛素敏感指数,改善高血压病人胰岛素抵抗的作用.     

对脾生理功能的东西医学比较研究

主要从东洋医学和西洋医学角度,对脾脏的生理功能进行了比较研究。1)“脾主运化”功能,类似于西洋医学中胰脏的外分泌功能所起的消化作用。“脾在液为涎”功能,可以认为与西洋医学中唾液含有的消化酶amylase和ptyalin对淀粉所起的消化作用,在功能作用上和胰脏的消化功能,在某种程度上相类似。2)“脾主统血”功能,与西洋医学中认为的脾脏(spleen)贮藏循环血液中1/3以上血小板,并参与止血机制的作用,在某种程度上相类似。3)“脾主肌肉及四肢”的观点,和饮食物在胰脏的外分泌功能作用下被充分消化吸收,把营养素供给全身是人体维持正常生理功能的作用,有一定关系。4)“脾主升清”,“脾在志为思”,“脾在窍为口,其华在唇”等观点,与西洋医学的胰脏或脾脏没有直接关系。     

外生性十二指肠平滑肌肉瘤的影像诊断(附6例报告)

目的　评价各种影像检查方法对外生性十二指肠平滑肌肉瘤的诊断价值。方法　外生性十二指肠平滑肌肉瘤 6例 ,均行消化道钡餐造影 ,B超检查 ,CT检查和 /或MR检查和血管造影检查。结果　所有病例均经手术病理证实为外生性平滑肌肉瘤。上消化道造影表现为外压性改变 ,2例可见肠道外不规则钡斑 ,B超显示上腹实性肿块 ,CT、MR显示为实性肿块 ,2例可见肿块与十二指肠相连 ,血管造影表现为多血供肿瘤 ,由胃十二指肠动脉和肠系膜上动脉的分支右、中结肠动脉供血。结论　外生性十二指肠平滑肌肉瘤的诊断应在消化道作钡餐的基础上联合应用CT和 /或MR及血管造影检查。     

CYP11β1 (11-beta-hydroxylase) deficiency in congenital adrenal hyperplasia

Objective : To review experience of CYP11β1 deficiency (previously known as 11β-hydroxylase) at the Royal Children's Hospital, Melbourne, Victoria.
Methodology : A retrospective case review was conducted from 1974 to 1995 with five cases identified.
Results : Age of presentation ranged from 1 day to 7 years. Presentation was with ambiguous genitatia at birth (two females), simple virilization (two males) and suspected early puberty in mid childhood (one female). Associated clinical features were hypertension (three cases) and tall stature with markedly advanced bone age (four cases). Biochemical abnormalities consistent with CYP11β1-deficiency were elevated urinary tetrahydro-11-deoxycortisol ( n = 5) and elevated serum 11-deoxycortisol ( n = 3). Additional abnormalities were elevated 17-hydroxyprogesterone ( n = 3), elevated androstenedione ( n = 4) and elevated dehydroepiandrosterone sulphate ( n = 4). The clinical features and investigations suggested CYP11β1-classical deficiency in four patients and CYP11β1-non-classical deficiency in one patient.
Conclusions : The five cases of CYP11β1-deficiency demonstrate a spectrum of clinical abnormalities, with diagnostic difficulties in two cases and delayed presentation in three cases. Prompt diagnosis of CYP11β1-deficiency is facilitated greatly by the availability of a gas chromatography-mass spectrometry instrument and is essential to avoid the long-term effects of hypertension and hyperandrogenism.     

430例老年睡眠情况调查分析

目的调查分析老年人睡眠不良的发生情况,为改善其睡眠质量提供临床治疗依据。方法对年龄>65岁的老年人430例进行匹兹堡睡眠质量指数的测定和睡眠特征及影响因素分析。结果老年人睡眠差的占总体的58.37%。老年人睡眠不良以睡眠时间减少,睡眠效率降低,睡眠障碍多,催眠药物使用多为特点。结论老年人群睡眠不良发生率高,应采用针对性的干预措施来改善睡眠。     

血清嗜酸粒细胞阳离子蛋白在儿童慢性咳嗽诊断中的意义

目的 探讨血清嗜酸粒细胞阳离子蛋白（ECP）在儿童慢性咳嗽尤其与哮喘相关的慢性咳嗽诊断中的临床意义。方法 测定117例5～16岁慢性咳嗽患儿的血清ECP和肺功能，其中哮喘发作组53例，哮喘缓解组30例，咳嗽变异型哮喘组22例，鼻后滴流综合征（PNDS）组12例；另设24例健康儿童为对照组。结果 血清ECP水平在哮喘发作组及咳嗽变异型哮喘组均显著高于正常对照组（P〈0．01）；哮喘缓解组、PNDS组与正常对照组比较差异无统计学意义（P均〉0．05）。各组最大呼气峰流速（PEF）预计值、一秒钟用力呼气容积（FEV3）预计值、用力肺活量（FVC）预计值哮喘发作组与正常对照组比较差异有统计学意义（P均〈0．01）；哮喘缓解组、PNDS组与正常对照组比较差异无统计学意义（P〉0．05）；咳嗽变异型哮喘组PEF与正常对照组比较差异无统计学意义（P〉0．05），FEV3、FVC与正常对照组比较差异有统计学意义（P均〈0．01）。结论 ECP是导致气道炎症和组织损伤的重要介质，血清ECP水平可反映气道高反应性发展的早期阶段，在反映病情严重程度方面具有特异性及敏感性。ECP可作为慢性咳嗽鉴别诊断的一个参考指标．可用于筛选不典型哮喘。     

血浆生物活性分子内皮素1浓度的检测可作为评价介入封堵先天性心脏病房间隔缺损患者疗效的指标

目的:探讨介入封堵房间隔缺损(ASD)前后患者血浆内皮素1(ET-1)浓度的变化及其临床意义.方法:检测40例成功接受介入封堵治疗的ASD患者的术前、术后30 min和术后3天血浆ET-1浓度.结果:无论ASD患者的肺动脉压是否升高,其血浆ET-1的浓度均明显高于正常对照组;术前ASD患者血浆ET-1浓度与PASP、Qp/Qs和ASD最大伸展径呈正相关,r分别为0.868、0.746、0.670(P均＜0.01);ASD患者术后30 min和术后3天的血浆ET-1浓度较术前明显下降,术后3天的血浆ET-1浓度较术后30 min进一步下降.结论:介入封堵ASD后,患者的肺血管内皮功能得到改善,血浆ET-1浓度的检测可以作为评价介入封堵ASD疗效的指标.     

蜂胶口胶防龋作用初步研究

目的 通过蜂胶口胶对变形链球菌、牙菌斑及唾液 ｐＨ值的影响,初步探讨蜂胶口胶的防龋作用与机理。方法 选择３～４岁儿童,分别在使用蜂胶。胶前后进行口腔变形链球菌的半定量测定,牙菌斑指数及唾液ｐＨ值的检测。结果 观察组使用蜂胶口胶后变形链球菌数量显著减少,牙菌斑指数降低,唾液ｐＨ值高于对照组。结论 蜂胶口胶抑制变形链球菌的生长繁殖,影响牙菌斑的形成,并升高唾液ｐＨ值,在龋病的预防上有开发价值。     

脑钠肽对老年肺心病患者早期诊断及预后评价的临床意义

目的 研究脑钠肽(BNP)对老年肺心病(PHD)患者早期诊断及预后评价的临床意义.方法 根据心脏超声检查测定肺动脉平均压力(MPAP),将120例老年慢性阻塞性肺部疾患(COPD)患者分为MPAP正常组、MPAP升高组、PHD稳定期组、PHD加重期组.测定各组血浆BNP、血气分析及心功能指标,比较其治疗后随访12个月的再入院率.结果 BNP与MPAP存在直线相关关系(r=0.901,P<0.01),Cox回归分析显示BNP为预后因素(P<0.01).结论 BNP对老年PHD患者具有早期诊断及预后评价的临床价值.     

Immunohistochemical analysis of Fas and FLIP in prostate cancers

Fas‐mediated apoptosis is considered a principal pathway for apoptosis induction in normal and cancer cells. Expression of Fas has been reported in prostate tissues several times, but the data were not consistent. Expression of FLICE‐like inhibitory protein (FLIP), an inhibitor of Fas‐mediated apoptosis, has not been studied by immunohistochemistry in prostate tissues. The aim of this study is to explore whether alterations of Fas and FLIP expression occur in prostate cancer tissues. We analyzed the expression of Fas and FLIP in 107 prostate adenocarcinoma tissues by immunohistochemistry using a tissue microarray approach. Normal glandular cells of the prostates strongly expressed both Fas and FLIP proteins. Prostate intraepithelial neoplasm also showed a strong Fas immunoreacitity. Fas expression was strongly positive in 60 cancers (56.1%), but the remaining 47 cancers showed no (6.5%) or markedly decreased (37.4%) Fas immunostaining compared with the normal glandular cells of the same patients. By contrast, FLIP expression was strong in most (103/107; 96.3%) of the cancers, and only four cancers (3.7%) showed decreased immunoreactivities compared with the normal cells. The decreased expression of Fas was not associated with pathologic characteristics, including FLIP expression, size of the cancers, age, Gleason score and stage. The decreased expression of Fas in a large fraction of prostate cancers compared with their normal cells suggested that loss of Fas expression might play a role in tumorigenesis in some prostate cancers possibly by inhibiting apoptosis mediated by Fas.