中西医结合治疗慢性肺源性心脏病合并心力衰竭的临床分析

目的分析丹参注射液联合多巴胺治疗慢性肺心病合并心力衰竭的临床疗效。方法选择我科2007年1月—2009年12月收住的慢性肺心病心力衰竭患者92例。对照组用吸氧、抗感染、祛痰、平喘、强心、利尿、纠正水电解质平衡失调等综合治疗。治疗组在上述基础上用丹参注射液联合多巴胺,1次/d,10d为1个疗程。结果治疗组46例,显效31例,有效12例,无效3例,总有效率93.5%;对照组46例,显效21例,有效14例,无效11例,总有效率76.1%。两组总有效率比较差异有统计学意义(P0.05)。结论在常规治疗肺心病心力衰竭的基础上,联合使用丹参注射液加多巴胺注射液可提高疗效。     

Myocardium reperfusion injury

The phenomenon of ischemia/reperfusion injury is described in the experimental models of acute myocardial infarction（AMI）,causing additional functional and structural damage to the acute reperfused myocardium,and ischemic preconditioning refers to the myocardial ischemia after a long period of reperfusion before one or several shortoccasional duplication of myocardial ischemia /reperfusion1,which can increase myocardial ischemic tolerance.The therapeutic strategies for AMI have focused on myocardial ischemia /reperfusion injury,which accounts for a significant part of the final infarct size.Although experiments in the last 20 years have reported that pharmacological interventions at reperfusion might reduce myocardial reperfusion injury,this could not be confirmed in human studies.An alternative to chemical modifiers,postconditioning（brief repeated periods of ischemia applied at the onset of reperfusion） is another method proven to be efficient in animal models and to be confirmed in recent human studies.This simple method,applied in the first minute of reperfusion,reduces the final infarct size by 30%-50%.This review will focus on the mechanisms,pharmacological preconditioning,postconditioning technique,which is easily applicable in human patients in the setting of AMI.     

118例儿童急性肾损伤预后因素的临床分析

目的 探讨影响儿童急性肾损伤（AKI）预后的危险因素。 方法 回顾性分析118例AKI患儿的一般资料、病因、临床特点、实验室检查、肾组织病理及治疗情况,分析其与预后的关系。 结果 纳入本研究的118例AKI患儿中,男83例,女35例,中位年龄为7.5岁,其中＜3.0岁组33例,占28.0%;3.0～7.0岁组21例,占17.8%;＞7.0岁组64例,占54.2%。118例患儿的AKI分期为1期62例,占52.5%;2期38例,占32.2%;3期18例,占15.3%。AKI患儿的常见病因主要有感染性和免疫性疾病（39.8%）、肾血管病（27.1%）和循环障碍（11.9%）。总住院病死率为21.2%。多因素非条件Logistic回归分析提示机械通气、败血症或感染性休克、严重酸中毒和WBC＞20.0×109/L是AKI患儿死亡的独立危险因素,OR值分别为51.75、14.76、11.38和8.51（均P ＜ 0.05）。 结论 儿童AKI的主要病因是感染性和免疫性疾病、肾血管病和循环障碍。机械通气、败血症或感染性休克、严重酸中毒和WBC＞20.0×109/L是AKI患儿死亡的独立危险因素。     

hi-FGF-2对离体大鼠心缺血/再灌注损伤的拮抗作用

目的 观察高相对分子质量成纤维细胞生长因子-2(hi-FGF-2)对离体大鼠心肌缺血/再灌注损伤的影响.方法 利用Langendorff装置将大鼠心脏给予缺血30 min,再灌注60 min处理.再灌的前10 min经灌流液分别给以生理盐水、hi-FGF-2以及低相对分子质量FGF-2(lo-FGF-2,10μg/10 ml生理盐水).测定左心室收缩压(LVSP)、左心室发展压(LVDP)、左室内压最大变化速率(±dp/dtmax)以及冠脉血流量;采用免疫荧光法检测外源性FGF-2在心肌内的分布和细胞膜上vinculin的变化.结果 与生理盐水组比较,hj-FGF-2和lo-FGF-2两组的心功能包括LVSP、LVDP、±dp/dtmax以及冠脉血流量均显著升高(P＜0.05或0.01);外源性hi-FGF-2或lo-FGF-2在再灌注1 h后广泛分布于心肌.与生理盐水组比较,hj-FGF-2和lo-FGF-2两组的心肌可见密集完整的vinculin荧光染色.结论 hi-FGF-2和lo-FGF-2一样对心肌缺血/再灌注损伤具有拮抗作用.     

肝活检发现肝吸虫虫体1例报告

肝吸虫病通常是以检获虫卵为确诊依据,而笔者有1例是在肝活检时发现肝吸虫虫体获得确诊,现报告如下。     

经纤维支气管镜肺活检对弥漫性间质性肺疾病的诊断价值

目的探讨经纤维支气管镜肺活检（TBLB）对弥漫性间质性肺疾病（D ILD）的诊断价值。方法报道168例D ILD患者,其中行TBLB病理检查确诊45例（26.79%）,分析患者性别、病理诊断构成比及误诊情况等。结果 45例患者中,误诊为非特异性肺炎8例,肺结核6例,肺癌5例,肺淋巴瘤4例,肺动脉高压3例,气道中心纤维化2例;女性患者明显多于男性（27 vs 18,P〈0.01）。D ILD患者中特发性间质性肺炎最多（32例）,其次是结缔组织病相关D ILD（8例）、结节病（5例）。结论 TBLB是诊断D ILD的有效手段,对D ILD的鉴别诊断和分类诊断有重要意义。     

大豆、硒和螺旋藻对氟铝联合中毒大鼠血红蛋白的影响

目的 观察大豆、硒、螺旋藻对氟铝联合中毒大鼠血红蛋白(Hb)的改变.方法 84只SD大鼠,按体质量随机分为对照组、高铝组、高氟组、高氟铝组、高氟铝强化大豆组、高氟铝强化硒组、高氟铝加螺旋藻组,每组12只.对照组、高铝组的饲料含氟量为5.2 mg/kg,含铝量为6.8 mg/kg,其他各组的含氟量为106mg/kg,含铝量为19.7 mg/kg;对照组、高氟组的饮水含氟量为0.69 mg/L,含铝量为0.20 mg/L,其他各组的含氟量为0.69 mg/L,含铝量为90.2 mg/L).饲养90 d后,取全血测定Hb.结果 对照组、高氟组、高铝组、高氟铝组的Hb分别为(160.8±6.3)、(142.2±15.9)、(156.1±4.9)、(145.2±6.2)g/L.氟对Hb有影响(F=29.56,P<0.05).高氟铝组、高氟铝加大豆组、高氟铝加硒组、高氟铝加螺旋藻组的Hb水平分别为(145.2±6.2)、(150.7±17.7)、(156.8±14.5)、(154.5±17.8)g/L,虽然Hb水平有升高,但差异无统计学意义(χ2=3.304,P>0.05).结论 高氟能引起大鼠血红蛋白不同程度的降低,过量铝对大鼠Hb无影响;铝没有拮抗或加强氟中毒对大鼠Hb的干扰作用.大豆、硒和螺旋藻均对氟铝联合中毒大鼠Hb有升高趋势,但未见明显的拮抗作用.     

Behavioral Effects of Ethanol in Cerebellum Are Age Dependent: Potential System and Molecular Mechanisms

Background: Adolescent rats are less sensitive to the motor‐impairing effects of ethanol than adults. However, the cellular and molecular mechanisms underlying this age‐dependent effect of ethanol have yet to be fully elucidated. Method: Male rats of various ages were used to investigate ethanol‐induced ataxia and its underlying cellular correlates. In addition, Purkinje neurons from adolescent and adult rats were recorded both in vivo and in vitro. Finally, protein kinase C (PKCγ) expression was determined in 3 brain regions in both adolescent and adult rats. Results: The present multi‐methodological investigation confirms that adolescents are less sensitive to the motor‐impairing effects of ethanol, and this differential effect is not because of differential blood ethanol levels. In addition, we identify a particular cellular correlate that may underlie the reduced motor impairment. Specifically, the in vivo firing rate of cerebellar Purkinje neurons recorded from adolescent rats was insensitive to an acute ethanol challenge, while the firing rate of adult cerebellar Purkinje neurons was significantly depressed. Finally, it is demonstrated that PKCγ expression in the cortex and cerebellum mirrors the age‐dependent effect of ethanol: adolescents have significantly less PKCγ expression compared to adults. Conclusions: Adolescents are less sensitive than adults to the motor‐impairing effects of ethanol, and a similar effect is seen with in vivo electrophysiological recordings of cerebellar Purkinje neurons. While still under investigation, PKCγ expression mirrors the age effect of ethanol and may contribute to the age‐dependent differences in the ataxic effects of ethanol.     

短期持续皮下胰岛素输注对新诊断2型糖尿病患者胰岛功能、胰岛素抵抗和血管内皮细胞损伤的作用及其机制

目的 探讨短期持续皮下胰岛素输注(CSII)对新诊断2型糖尿病(T2DM)患者β细胞功能、胰岛素抵抗(IR)和血管内皮细胞损伤的作用及机制.方法 对10例新诊断T2DM患者进行2周CSII.CSII前后,依次进行静脉糖耐量试验(IVGTT)和高胰岛素正葡萄糖钳夹试验.用血清可溶性E选择素(sE-selectin)评价血管内皮细胞损伤.用血清超敏C反应蛋白(hsCRP)和可溶性CD_(14)(sCD_(14))评价机体的炎症状态.结果 (1)与治疗前比较,CSII后IVGTT各时点血糖值、血糖曲线下面积、糖化血红蛋白、胆固醇和LDL-C水平下降(P<0.05或<0.01).(2)与治疗前比较,CSII后IVGTT各时点(空腹胰岛素除外)胰岛素增加、胰岛素曲线下面积增大、急性胰岛素分泌增加(P<0.05或<0.01).(3)与治疗前比较,CSII后葡萄糖输注率[由(3.46±1.66)mg·kg~(-1)·min~(-1)升高到(7.14±2.37)mg·kg~(-1)·min~(-1)]和稳态模型评估的基础胰岛β细胞功能(HOMA-β)升高,HOMA胰岛素抵抗指数(HOMA-IR)下降(P<0.05或0.01).(4)与治疗前比较,CSII后患者血清sE-selectin、sCD_(14)和hsCRP下降(除hsCRP外,P<0.01).结论 短期胰岛素强化治疗有利于恢复新诊断T2DM患者胰岛功能、减轻IR、修复血管内皮细胞损伤和改善糖、脂代谢,其机制可能与机体炎症状态的减轻有关.