改良法肾自动活检术在重度腹水肾病患者中的应用价值

随着利用自动活检枪在B超引导下行经皮肾脏穿刺活组织检查技术(简称肾自动活检术)的成熟，其应用范围逐渐扩大。1997年1月至2003年4月我们对46例既往被列为相对穿刺禁忌的肾病综合征(NS)伴有重度腹水患者采用改良法肾自动活检术进行肾活检，成功率高，并发症少。现报道如下。     

Bcl-2、Bax在狼疮肾炎患者肾组织中的表达及意义

目的研究细胞凋亡调节蛋白(Bcl-2及Bax)在狼疮肾炎(LN)患者肾组织的表达情况及与LN肾脏病理改变的关系。方法2003-012003-04对广西医科大学第一附属医院的44例活动期LN患者用免疫组化方法检测肾组织中Bcl-2、Bax的表达,观察它们与LN肾脏病理改变的关系。结果(1)LN肾小球Bcl-2及Bax表达均增高,与肾小球细胞增殖程度及增殖细胞核抗原(PCNA)阳性细胞数呈正相关。(2)LN肾间质Bcl-2表达增高,与间质炎症细胞浸润程度正相关。(3)LN肾小管Bax表达增高,与肾小管间质病变呈正相关。结论LN肾组织存在Bcl-2、Bax蛋白异常表达。Bcl-2高表达在LN肾小球细胞增殖及肾间质炎症细胞浸润过程中可能起重要作用。Bax在肾小管过度表达与肾小管间质病变有关。     

HLA-DR4基因与广西地区汉族IgA肾病关联性的研究

目的研究HLA—DR4等位基因与广西汉族IgA肾病的关系。方法采用聚合酶链反应一序列特异性引物法(PCR-SSP),对30名广西汉族IgA肾病患者及60名汉族正常人的HLA—DR4基因频率进行检测。结果广西汉族IgA肾病组的HLA-DR4基因频率与正常对照组比较,差异无统计学意义。广西汉族HLA—DR4基因阳性IgA肾病患者的临床、病理预后指标与广西汉族HLA—DR4基因阴性IgA肾病患者无明显差异。结论HLA—DR4基因与广西汉族IgA肾病的发病无关。     

高压氧促进骨形成加速骨折愈合

背景:尽管大多数骨折能够治愈,但仍有5%-10%最后发展为骨不连,临床试验证实高压氧可以通过血液循环显著提高体内动脉血氧分压,促使新陈代谢,加速骨愈合。目的:探讨高压氧干预不同时间对家兔股骨骨折愈合的影响和相关机制。方法:12只新西兰大白兔建立股骨骨折模型,随机分成高压氧治疗1个月组、高压氧治疗2个月组、常氧治疗1个月组、常氧治疗2个月组,每组3只。高压氧治疗组于术后第1天开始将所有动物置入高压氧动物仓中行高压氧治疗1,2个月,采用酶联免疫吸附法检测血清骨钙素、Ⅰ型胶原C端肽水平,苏木精-伊红染色观察骨折愈合情况。结果与结论:(1)治疗1个月时,高压氧组血清骨钙素、Ⅰ型胶原C端肽水平与常氧组无明显差异(P> 0.05);治疗2个月时,与常氧组比较,高压氧组血清Ⅰ型胶原C端肽水平明显减少(P <0.001)、骨钙素水平明显上升(P <0.01);(2)治疗1个月时,高压氧组与常氧组病理损伤程度无差异,治疗2个月时,高压氧组病理损伤程度较常氧组明显减轻;(3)结果表明,高压氧治疗2个月可有效提高骨形成指标骨钙素水平,提示可能促进成骨细胞形成进而对骨折愈合有积极作用。     

水蛭素对大鼠随意型皮瓣存活的影响

目的 研究水蛭素对大鼠背部超长随意型皮瓣存活的影响.方法 采用改良大鼠"McFarlane flap"模型,将实验动物随机分为水蛭素实验组(水蛭素组)和生理盐水对照组(生理盐水组),水蛭素组局部注射3 ml(30 ATU)水蛭素,生理盐水组则注射3 ml生理盐水,连续注射7 d后分别检测两组皮瓣的存活面积百分比,并取皮瓣近、中、远段(即Ⅰ、Ⅱ、Ⅲ区)组织做光镜观察,免疫组化法检测血管内皮生长因子(VEGF)和碱性成纤维细胞因子(bFGF)的表达.结果 术后7 d,水蛭素组皮瓣的存活面积百分比为(69.52±3.23)%,生理盐水组为(50.36±2.37)%,水蛭素组显著高于生理盐水组,差异有统计学意义(P＜0.01);水蛭素组皮瓣坏死与存活并存的Ⅱ区,组织水肿、炎性细胞浸润情况明显比生理盐水组轻.水蛭素和生理盐水组皮瓣Ⅱ区的新生血管计数分别为(28.24±4.23)个/mm2和(17.45±5.43)个/mm2,两组比较差异有统计学意义(P＜0.05).通过计算累积吸光度A值(IA),得到水蛭素和生理盐水组VEGF阳性量分别为9262.23±896.99和4938.05±1623.67,bFGF阳性量分别为5122.83±1176.12和2779.45±472.00,水蛭组VEGF及bFGF的表达均高于生理盐水组,差异均有统计学意义(P＜0.01).结论 水蛭素可能通过体内一系列复杂的调控通路,最终增加VEGF、bFGF表达,促进皮瓣新生血管增生,改善皮瓣血供,减轻炎性反应,降低缺血皮瓣的坏死率,从而提高大鼠随意型皮瓣的存活.

Abstract：

Objective To investigate the effect of Hirudin on random skin flap survival in rats.Methods 24 SD rats were randomly divided into control group and experimental group. The "McFarlane flap(3 cm ×9 cm)" rat models were established on the rat dorsum. 3 ml Hirudin (30 ATU) was injected into the flap in the experimental group, while 3 ml saline in the control group. The injection was performed for 7 days. The flap survival area in the two groups was measured. The tissue samples were taken from proximal( Ⅰ ), middle( Ⅱ ) and distal( Ⅲ ) portions of flaps for histologic study. The VEGF and bFGF expression was also detected with immunohistochemistry method. Results 7 days after operation, the flap survival rate was ( 69.52 + 3.23 )% in the experimental group, while ( 50.36 ± 2.37 )% in control group,showing a significant difference between the two groups ( P ＜ 0.01 ). In the middle portion, tissue edema and infiltration of neutrophils in experimental group was markedly slighter than that in control group. The VEGF and bFGF expression and neovascularization was enhanced markedly in experimental group.Conclusions Hirudin can increase the survival of random pattern skin flaps. It may increase the VEGF,bFGF expression through a series of complex regulatory pathway. Then flap neovascularization is promoted and the flap blood supply is increased.     

Bilhaut-Cloquet术治疗复拇畸形的临床效果和常见并发症分析

目的 评价Bilhaut-Cloquet术治疗先天性复拇指畸形的临床效果,探讨分析其常见并发症的原因.方法 2006年至2009年,对15例先天性复拇指畸形患儿分别采用经典和改良Bilhaut-Cloquet术进行治疗,随访观察术后并发症并对疗效进行评价.结果 术后15例获得1～20个月的随访,平均6个月.参照Kawabata评分标准:采用经典Bilhaut-Cloquet术者5例,优1例,良3例,差1例;采用改良Bilhaut-Cloquet术者10例,优6例,良3例,差1例.两组中指甲畸形明显者9例,瘢痕挛缩、增生者5例.结论 Bilhaut-Cloquet术是治疗复拇指畸形的有效治疗术式,适合于Ⅰ型对等型多拇;Ⅱ型以上的多拇采用改良Bilhaut-Cloquet术更有利于指间关节(IP)关节活动度的恢复.除了重视关节活动度、稳定性和侧偏畸形的矫正外,指体外观尤其是指甲的精确重建应当得到进一步的重视.

Abstract：

Objective To evaluate the clinical outcomes of Bilhaut-Cloquet surgical procedure for the treatment of thumb duplication, and investigate the causes of common complications. Methods Bilhaut-Cloquet procedure and modified Bilhaut-Cloquet procedure were carried out in 15 children with congenital thumb duplication during 2006 to 2009. The patients were follow-up postoperatively to observe any complications and assess the results using Kawabata evaluation criterion. Results The 15 children were follow-up for 1 to 20 months (6 months on average) postoperatively. According to Kawabata evaluation criterion, the Bilhaut-Cloquet procedure achieved excellent results in 1 cases, good in 3 cases, and poor in 1 cases. Modified Bilhaut Cloquet procedure achieved excellent results in 6 cases, good in 3 cases, and poor in 1 case. Nine cases had apparent nail deformity and 5 cases were accompanied by cicatricial contracture and hyperplasia. Conclusion The Bilhaut-Cloquet technique is an effective procedure for the treatment of thumb duplication, especially suitable for type Ⅰ thumb duplication. Modified Bilhaut-Cloquet procedure is more conducive to the recovery of IP range of motion when used in type Ⅱ or more severe thumb duplication. Besides joint range of motion, stability, and correction of lateral deviation, appearance of the thumb especially accurate nail restoration should acquire more attention.     

BCG制剂降低原发性肾病综合征医院感染率的临床研究

目的：观察卡介苗（BCG）制剂卡介菌多糖核酸（BCG－PSN）在治疗原发性肾病综合征（PNS）时的医院感染率降低情况。方法：对96例住院患采用随机对照组方法观察比较BCG－PSN治疗组和对照组的医院感染率及尿蛋白量下降程度的变化情况。结果：BCG－PSN治疗组的医院感染率为8．5％，对照组为26．5％，两组间比较在统计学上有显性差异。而尿蛋白量在BCG短疗程治疗中下降程度无差异。结论：BCG－PSN可明显降低PNS的医院感染率。     

B细胞淋巴瘤/白血病-2蛋白在狼疮性肾炎肾组织表达及意义

目的 研究细胞凋亡调节蛋白B细胞淋巴瘤／白血病-2(Bel-2)在狼疮性肾炎(LN)患者肾组织的表达情况，探讨其与LN肾组织病理改变的关系及意义。方法 以免疫组化方法检测44例活动期LN患者肾组织中Bel-2蛋白、增殖细胞核抗原(PCNA)的表达，观察其与LN肾组织病理改变的关系。结果 ①增殖型LN肾小球内Bel-2及PCNA阳性细胞数均增高，且与球内细胞增殖程度呈正相关；②LN肾间质细胞Bel-2表达增高，与间质炎症细胞浸润程度正相关。结论 增殖型LN肾组织中Bel-2蛋白异常表达与病理改变有关，肾组织中Bel-2的过多表达对LN肾小球细胞增殖及间质炎症细胞浸润可能起重要作用。     

慢性胆囊炎伴窦性心动过缓及心肌缺血手术前后心电图改变93例的临床分析

目的探讨慢性胆囊炎伴有窦性心动过缓及心肌缺血发生比率及其术后的心电图改变。方法手术前后常规行心电图检查，对心电图异常者定期随访。对经手术及病理证实的２５０例慢性胆囊炎病人手术前后心电图所示的窦性心动过缓与心肌缺血性改变进行临床分析。结果窦性心动过缓５３例、心肌缺血４６例。随访资料完全者９３例，其中恢复正常８５例，好转３例，无改变５例。治愈好转率达９５％。结论慢性胆囊炎对心脏确有一定影响，对慢性胆囊炎，特别是已有心电图异常改变时，应积极手术治疗。