高血压病的康复医疗及其对左室舒张功能的影响

目的：观察中西医结合康复医疗对高血压病患的降压疗效，并探讨其对左室舒张功能的影响。方法：82例高血病人被随机分为常规治疗组(30组)，康复治疗组(常规治疗 中药茶饮 康复运动，52例)。用多普勒超声心动图测定高血压病患治疗前后左室舒张功能(二尖瓣血流E峰值、A峰值、E／A比值)。结果：①2周内和1年内血压控制率康复组均高于对照组(P＜0．01)，1年内并发症的发生率康复组低于对照组(P＜0．05)；②对症状的改善，康复组优于对照组(P＜0．01)；③治疗前后两组左室舒张功能均有改善，康复组改善更明显(P＜0．01)。结论：中西医结合康复医疗较单纯西药降压治疗在控制血压、改善症状、降低并发症等方面有更明显效果；且更能改善左心室的舒张功能。     

糖护士型手机血糖仪与YSI分析仪及拜安康血糖测试系统结果比对分析

目的：通过对比分析糖护士型手机血糖仪与YSI葡萄糖乳酸分析仪、拜安康血糖测试系统的血糖结果,了解三者之间的差异,从而评价糖护士型手机血糖仪对血糖测试的准确性。方法抽取中南大学湘雅医院和中南大学湘雅二院通过日常采血进行快速血糖测试值初筛,符合入选标准和浓度要求的受试者共200例,采用试验产品与对照产品同时测试的对比验证,选择YSI葡萄糖乳酸分析仪、拜安康血糖测试系统进行对比试验,并对糖护士型手机血糖仪的准确性进行评估。结果糖护士型手机血糖仪与参考方法YSI葡糖葡萄糖乳酸分析仪（r=0.991）、拜安康血糖测试系统（r=0.981）的检测结果均具有良好的线性相关性,在测试范围≤4.2 mmoL/L时,100%的偏差范围全部在0.83 mmol/L以内,测试范围〉4.2 mmoL/L时,100%的偏差范围全部在20%以内,95%的偏差范围全部在15%以内。结论糖护士型手机血糖仪与参考方法YSI葡萄糖乳酸分析仪测试血糖结果具有一致性,与同类产品拜安康血糖测试系统具有等效性,适合医疗机构的快速血糖测试、糖尿病患者或其他人群的自我血糖监测。     

冠心病患者CP感染与IL-6, TNF-α和CRP水平及其关系

目的: 观察冠心病(CHD)患者肺炎衣原体(CP)感染与IL-6、TNF-α和CRP的变化,探讨CP 感染与炎症的关系,以进一步了解感染和炎症在CHD发病中的作用. 方法: 采用酶联免疫吸附法(ELISA)、放射免疫法(RIA)及免疫透射比浊法(ITT),分别测定80例CHD患者和30例健康对照组血清中CP特异性抗体IgG和炎症标志物肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)的水平. 结果: ① CHD组血清CP特异性抗体IgG阳性率及滴度均显著高于对照组(P<0.05);② CHD组血清IL-6, TNF-α和CRP的水平均显著高于对照组(P<0.05);③血清CP特异性抗体IgG阳性组IL-6、TNF-a和CRP的水平均明显高于阴性组(P<0.05);④ CP感染分别与IL-6、TNF-a和CRP间呈显著正相关(P<0.05). 结论: CP感染与IL-6、TNF-α和CRP在CHD发病关系密切.     

胎盘早期剥离的早期诊断(附46例临床分析)

目的 :探讨发病诱因、临床表现和超声检查对胎盘早期剥离 (PA)的诊断意义。方法 :对 1995年 1月～2 0 0 1年 12月我院 4 6例PA患者作回顾性分析。结果 :早产率 5 6 .6 2 % ,围产儿死亡率 4 1.3% ,新生儿青紫窒息 2 8.2 6 %。产后出血、子宫卒中各 15 .2 2 % ,DIC、失血性休克各 8.70 %。该组产前诊断率 5 4 .35 % ,B超检出率 6 0 .98%。临床表现主要为阴道流血 ,下腹疼痛 ,子宫张力增高。结论 :PA严重威胁母儿生命 ,应结合诱因、临床表现和B超等辅助检查尽早对其作出正确诊断。     

姚奇蔚治疗慢性萎缩性胃炎经验

姚奇蔚教授、主任医师 ,从医六十余年 ,对中医药治疗慢性萎缩性胃炎颇有研究 ,积累了丰富的临床经验 ,笔者亲聆教导 ,获益颇丰 ,现将本人学习心得介绍如下 :1　辨证论治慢性萎缩性胃炎属中医学胃脘痛、嘈杂、吞酸等范畴 ,姚老认为慢性萎缩性胃炎病因多为胃阴不足 ,病位在胃。胃为阳土 ,喜润恶燥 ,病久多寒湿化热 ,燥热伤阴 ,或气郁日久化火伤阴。唐容川说 :“胃燥不能食 ,食少不能化 ,譬如釜中无水 ,不能熟物也。”引起胃阴不足的原因 :一为嗜食辛辣食物或过嗜烟酒 ,二为肝气郁结化火乘胃。临证常见胃阴不足、脾胃虚弱、脾胃湿热等证。胃阴…     

胎膜早破425例临床分析

目的 探讨不同孕周、不同破膜时间胎膜早破与剖宫产及母儿并发症的关系。方法 对425例胎膜早破的临床资料进行回顾性分析。结果 剖宫产率、绒毛膜羊膜炎发病率、新生儿发病率和病死率与胎膜早破孕周、破膜至分娩时间密切相关。孕周越小剖宫产率越低而绒毛膜羊膜炎发病率、新生儿发病率和病死率越高；破膜24～48小时内分娩者剖宫产率最低，破膜72小时内分娩孕妇其绒毛膜羊膜炎发病率各组内无显著性差异。当破膜超过72小时时，绒毛膜羊膜炎的发病率显著升高。死胎和新生儿死亡均发生在孕37周以前。结论 对胎膜旱破患者应根据不同孕周、破膜时间的长短采取不同的治疗方案以减少围生期并发症。     

光散射成像与彩色多普勒血流显像在乳腺占位性病变诊断中的对比研究

目的:比较光散射成像(diffused optical tomography,DOT)与彩色多普勒血流显像(color doppler flow imaging,CDFI)在乳腺占位性病变鉴别诊断中的应用价值?方法:对79例,85个乳腺占位性病灶术前分别行CDFI和超声DOT检查,以手术病理为金标准,对比分析CDFI和超声DOT对乳腺肿块良恶性的诊断结果?结果:DOT诊断乳腺恶性病灶的敏感度92.1%, 特异度87.2%,准确度89.4%,CDFI诊断乳腺恶性病灶的敏感度73.6%,特异度76.6%,准确度75.3%;脉冲多普勒中根据血流的阻力指数(resistance index,RI)诊断乳腺恶性病灶的敏感度57.9%,特异度85.1%,准确度72.9%?联合CDFI和脉冲多普勒诊断乳腺恶性病灶的敏感度为55.2%,特异度为89.4%,准确度为71.7%?结论:DOT在鉴别诊断乳腺占位性病变良恶性中的准确度高于CDFI,值得临床推广应用?     

妊娠期肝内胆汁淤积症胎儿胆汁酸水平与肺表面活性物质的相关性研究

Objective To explore the relationship between total bile acid(TBA)concentration and fetal pulmonary surfactant in intrahepatic cholestasis of pregnancy(ICP).Methods Fifry five patients with ICP(ICP group)who received cesarean section from April 2008 to February 2010 in Second Xiangya Hospital,Central South University,were recruited.The general conditions of the neonates within 7 days after birth in ICP group were recorded.Those with fetal distress,neonatal asphyxia,or neonatal respiratory distress syndrome were referred as pathological neonates, others were referred as normal neonates. Over the same period, 23 healthy gravidas were recruited as control group. Enzymatic method was used to detect the TBA concentrations in maternal blood, cord blood and amniotic fluid. ELISA was employed to measure the urfactant protein A (SP-A) concentration in cord blood. High performance liquid chromatography system was used to detect the concentrations of phesphatidylcholine (PC),phosphatidylinositol (PI),lysophosphatidylcholine ( LPC), and sphingomyelin(SM) in amniotic fluid. Results ( 1 ) The concentrations of TBA in maternal blood, cord blood and amniotic fluid were ( 30. 1 ± 7.9 ), (9. 3± 3. 3 ) and (4. 4 ± 1.5 ) mmol/L in ICP group, (4. 8 ± 2. 2), (4. 9 ± 0. 9) and ( 1.4 v 1.1 ) mmol/L in control group, respectively. The differences between the two groups were significant ( P ＜ 0. 05 ). ( 2 ) The SP-A concentration in cord blood in ICP group was ( 29. 5 ± 6. 4 ) μg/L, significantly higher than that in control group, which was ( 22. 6 ± 7. 4 )μg/L ( P＜ 0. 05 ). ( 3 ) There were 20 pathological neonates and 35 normal neonates in ICP group. In pathological neonates, the concentrations of TBA and SP-A in cord blood were (10.9 ± 2.2) mmol/L,(37.0 ± 5.9 ) μg/L, respectively; and were ( 8.0 ± 2. 8 ) mmol/L, ( 26. 7 ± 4. 8 ) μg/L in normal neonates. The differences were significant (P＜ 0. 05 ). (4) There was a positive correlation between TBA concentration in cord blood and in maternal blood ( r1 = 0. 706, P＜0. 05 ). The TBA concentration in cord blood was positively correlated with SP-A concentration as well ( r3 = 0. 494,P ＜ 0. 05 ). (5) The PC and PI concentrations in amniotic fluid were (65.4 ± 7.2) mg/L and ( 3. 8 ± 0. 6 ) mg/L in ICP group, ( 69. 7 ±3.7) mg/L and (4. 3 ± 0. 7 ) mg/L in control group, respectively. The differences were significant (P ＜0. 05 ). The concentration of LPC in amniotic fluid in ICP group was (4. 8 ±0. 9) mg/L, significantly higher than that in control group (P＜0. 05), which was (4. 2 ±0. 6) mg/L. The concentration of SM in amniotic fluid was (3.5±0. 8) mg/L in ICP group, (4. 0 ± 0. 5 ) mg/L in control group, with no significant difference ( P＞0. 05 ). (6) The ratio of PC/LPC in ICP group ( 14. 2± 3. 2 ) was significantly lower than that in control group ( 16. 9 ± 2. 5 ) ( P＜ 0. 05 ). ( 7 ) The TBA concentration in cord blood was negatively correlated with PC and PI concentrations (r1 = -0. 561, r2 = -0. 407, P ＜ 0. 05 ), and had no correlation with LPC concentration (r3 = 0. 260, P＞ 0. 05). Conclusions ( 1 ) The fetal TBA concentrations in both cord blood and amniotic fluid of patients with ICP was higher than those of healthy gravidas, they were also positively correlated with maternal TBA concentration. (2) ICP resulted in the change of fetal pulmonary surfactant and this change was associated with TBA concentrations in both cord blood and amniotic fluid.     

骨肉瘤中PD-1和CTLA-4的表达与患者临床病理特征及预后的相关性

目的探讨PD-1和CTLA-4在骨肉瘤中的表达及其临床病理意义。方法收集2007—2016年南部战区总医院初诊初治骨肉瘤患者58例,运用免疫组织化学EnVision法检测PD-1、CTLA-4蛋白的表达。结果PD-1阳性31例(53.4%),阴性27例(46.6%);CTLA-4阳性19例(32.8%),阴性39例(67.2%);PD-1和CTLA-4双阳性12例(20.7%),双阴性20例(34.5%),单阳性26例(44.8%)。PD-1阳性与是否行新辅助化疗、肿瘤复发和转移有关,PD-1阳性患者无病生存期及总生存期更短(P<0.05);CTLA-4阳性与Ennecking分期较晚有一定关联(P=0.051);PD-1和CTLA-4双阳性表达较双阴性和单阳性患者术后复发和转移比例显著升高(P<0.05),且生存期更短(P<0.05)。结论PD-1和CTLA-4阳性表达的患者预后不良,双阳性患者的预后较差,可作为骨肉瘤免疫治疗的有效依据。     

妊娠期心脏病心力衰竭的处理和分娩时机的探讨

目的：探讨妊娠合并心力衰竭（心衰）的孕期处理、分娩时机的选择及其对母婴预后的影响。方法：回顾性分析356例妊娠期心脏病患者的发病情况,心衰的发生率、治疗效果,分娩方式与时机等资料。结果：356例妊娠期心脏病中有136例(38.20%)发生心衰,其中中重度心衰76例（55.88%）;风湿性心脏病（风心病）较先天性心脏病（先心病）易发生心衰;孕前未行心脏手术治疗的风心病患者较先心病易发生心衰,孕前已行心脏手术治疗的风心病孕妇中重度心衰发生率明显较孕前未行手术治疗者下降（P<0.05）;孕期心衰控制良好组与不良组比较,前者对妊娠、分娩的耐受性好,能顺利度过妊娠、分娩、产褥期。结论：风心病和先心病是妊娠期心力衰竭的主要原因,孕前特别是风心病患者行心脏手术治疗,可显著改善妊娠期心功能,妊娠期密切监视心功能,妊娠晚期控制心衰后及时终止妊娠。有利于孕妇和围产儿的预后。