2111例老年住院患者患病情况调查分析

目的调查了解武警总医院老年住院患者的患病情况及有关影响因素，为武警部队老年患者疾病的预防和治疗提供科学依据。方法以2000—2005年在武警总医院住院的武警部队老年住院患者2111例为研究对象，对其患病情况及影响因素进行回顾性研究。结果（1）2000—2005年武警总医院老年住院患者患病比例占前5位的疾病是：心血管系统疾病、消化系统疾病、内分泌代谢疾病、泌尿系统疾病、神经系统疾病，且近年其患病比例均有逐年上升趋势。（2）武警部队老年住院患者中患3种以上系统疾病的占60．7％，随着年龄增加比例逐渐增大。（3）不同年龄、性别、级别老年武警部队住院患者系统别患病比例有不同特点。结论武警部队老年患者常见疾病以心血管系统疾病、消化系统疾病、内分泌代谢疾病、泌尿系统疾病、神经系统疾病为主，患病比例与年龄、性别以及吸烟、饮酒等多种因素有关，应采取综合干预措施，改善和提高老年人健康水平。     

自由基损伤与幽门螺杆菌相关性胃病

幽门螺杆菌自1983年warren和Marshall发现后一直备受关注,现已确定,幽门螺杆菌(Hρ)与胃炎、消化性溃疡、胃腺癌和黏膜相关性淋巴样组织淋巴瘤有关.幽门螺杆菌胃部感染,可直接或间接产生自由基,引起胃黏膜上皮细胞损伤、坏死形成溃疡,另外,自由基导致胃黏膜细胞增生、凋亡失衡,对生物大分子如脂质、蛋白质及DNA造成伤害,从而诱发胃癌.     

Vaginal trichomoniasis among HIV patients attending primary health care centers of Jos,Nigeria

ObjectiveTo determine the prevalence of trichomonal infection in HIV/AIDS and non-HIV control group of patients in a population of women with abnormal vaginal discharge.MethodsWe conducted a simple cross-sectional study. Primary health care centers in Jos metropolis and Jos University Teaching Hospital, during December 2006 to December 2007. Seven hundred high vaginal swabs were collected; 350 from HIV positive and another 350 from HIV-negative control group of patients with abnormal vaginal discharge attending primary health care centers in Jos metropolis and analysed for microscopy and culture in Jos University Teaching Hospital. Data on epidemiologic indices from the patients, using structured interviewer-administered questionnaires were collected.ResultsThe rate of trichomoniasis among all participants in the study was 17% (n=120/700). The prevalence rate of trichomoniasis among persons with HIV was 24% while it was found to be 10.3% among HIV negative controls. The difference was statistically significant (χ² =23.172; df=1; P<0.05). The rate of co-infection of Trichomonas vaginalis (T. vaginalis) in bacterial vaginosis was 42% (n=50/120), while it was 24% (n=29/120) in candidiasis. The singles had a 35% high rate of trichomonal infection. The infected women had a median age of 26 years, and a median number of 3 intra-vaginal sex partners per week.ConclusionsThere was a significant statistical difference in prevalence of T. vaginalis between HIV/AIDS group and non-HIV(control) group of patients in the study (P<0.05). Local HIV prevention strategies should target such women with trichomonal infection for intervention efforts, especially in HIV endemic area of sub-continent of Africa to further reduce the burden of HIV in the population.     

幽门螺杆菌临床菌株克拉霉素耐药性及耐药基因突变位点分析

摘要：目的：了解贵阳地区幽门螺杆菌（Helicobacter pylori,Hp）临床菌株对克拉霉素耐药性及克拉霉素耐药相关基因突变情况,为耐药性的快速检测提供依据。方法：采用琼脂稀释法对临床分离鉴定的Hp菌株,进行体外抗生素敏感试验,了解贵阳地区Hp临床株对克拉霉素耐药状况。选取Hp克拉霉素耐药的临床菌株10株、克拉霉素敏感的临床菌株4株和质控菌株2株,进行23S rRNA基因功能区V区片段的PCR扩增和测序,与GenBank中公布的Hp菌株相关序列进行比对分析。结果：贵阳地区Hp临床分离株对克拉霉素的耐药率达30.9%。贵阳地区10株Hp耐药菌的23S rRNA基因片段的碱基突变包括T2183C（10/10）、T2245C（9/10）、 A2144G（6/10）、C2196G（1/10）、A2204G（1/10）,4株敏感菌株在2183、2245、2196和2204位点也存在碱基差异,2144位点的基因突变仅存于耐药菌株中。结论：贵阳地区Hp克拉霉素耐药率较高,耐药菌株23SrDNA与耐药性相关的基因突变主要为A2144G。     

超声引导射频治疗加无水酒精注射联合肝动脉栓塞治疗肝癌的临床研究

目的：探讨超声引导多方法联合动脉栓塞（TAE）治疗肝癌的临床价值。方法：在超声引导下对198例肝癌患者行多电极射频治疗加无水酒精瘤内注射联合TAE治疗，同时观察治疗组与单纯TAE对照组治疗前后的肿瘤血供变化，声像图特征等与临床疗效的关系。结果：治疗组术后瘤周及瘤内血流信号完全消失和减少率92．93％；肿瘤缩小率91．93％，AFP转阴率82．54％，术后随访年，2年累计生存率分别为87．31％、78．68％，远高于单纯TAE组的59．46％和31．53％。结论：超声引导多方法联合TAE技术是治疗肝癌的有效方法，超声为观察治疗前后肝癌血供状态，声像图变化及与临床疗效关系提供主要依据，对指导治疗，判定疗效有着重要意义。     

心力衰竭临床表现的随龄特点

目的：对比分析不同年龄心力衰竭常见的临床特点，为临床诊断和治疗老年心力衰竭提供依据。方法：将704例45岁以上心力衰竭患者按年龄分为3组，45-59岁为老年前期组，60-79岁为老年组，80岁以上为高龄组。分别对其临床表现进行对比分析。结果：不同年龄组心衰各有特点，随着年龄，出现多方面的不同：（1）舒张性心衰及心源性休克的比例亦显著增加；(2)年龄越大，症状越不典型；（3）随着年龄，心脏增大的比例逐渐降低，单纯心率增快比例显著增加；肺部阳性体征明显增加，哮鸣音和湿罗音的比例显著增多；（4）辅助检查的阳性率逐渐增加，尤其是高龄心衰肺部X线检查、心电图Ptf-V1阳性对早期诊断和治疗有很大帮助；（5）肺、肾、脑、消化道、各种栓塞等并发症显著增加。结论：不同年龄心衰临床表现各具特点，年龄越大，临床表现越不典型，尤其是高龄老人，一旦出现心衰，往往起病急、病情重，易在短期内并发重要脏器严重并发症，预后不良；早期辅助检查对高龄心衰诊断有较大帮助；不同年龄心衰治疗应区别对待。     

脑脊液总钙及离子钙的测定

目的 在不同环境下测定脑脊液离子钙及其影响因素。方法 用离子电极法测定离子钙和用终点法测定总钙。结果 用于血液离子钙的校正公式不适用于脑脊液离子钙的校正。结论 通过实验我们推出了用于脑脊液离子钙的校正公式，并适用于临床检验。     

The effect of platelets upon factor Xa-catalyzed activation of factor VII in vitro

The authors have investigated the ability of platelets to enhance factor Xa-catalyzed activation of factor VII. Unstimulated platelets were without effect, whereas freeze/thawed platelets substantially enhanced activation. Antifactor V antibodies did not diminish the enhancement. Platelets activated by thrombin, collagen, or calcium ionophore A23187 also enhanced factor Xa-catalyzed activation of factor VII. In contrast to their lack of effect upon freeze/thawed platelets, antifactor V antibodies abolished augmented factor VII activation induced by activated platelets. Adding exogenous factor Va to unstimulated platelets failed to enhance factor Xa-catalyzed activation of factor VII, nor did adding exogenous factor Va to activated platelets augment activation beyond that observed with activated platelets alone. These observations can be interpreted as follows: (1) factor Va does not function as a cofactor for factor Xa-catalyzed activation of factor VII; (2) anionic phospholipids are a known cofactor for factor Xa-catalyzed activation of factor VII, and freeze/thawed platelets probably enhance activation by making anionic phospholipids on disrupted platelet membranes available to function as a cofactor; (3) the presumed binding of factor Xa to exogenous factor Va on unstimulated platelets is insufficient in itself to augment factor Xa-catalyzed activation of factor VII; (4) activated platelets augment factor Xa-catalyzed factor VII activation because activation allows both factor Xa to bind to released platelet factor V(a) and makes available a surface membrane component, probably anionic phospholipids, with which the bound factor Xa interacts.     

Lipopolysaccharide enhances CD11b/CD18 function but inhibits neutrophil aggregation

Human neutrophils are primed in the presence of complexes of lipopolysaccharide (LPS) with its serum binding protein (LBP) in a manner dependent on CD14. Cellular consequences of priming include increased responsiveness, the upregulation of surface proteins including the adhesive integrin CD11b/CD18 (Mac-1), the increased binding of certain ligands to CD11b/CD18, and the concurrent shedding of the L-selectin homing receptor. Because expression of both CD11b/CD18 and L-selectin is obligatory for formyl peptide-stimulated neutrophil aggregation in vitro (Simon et al, Blood 82:1097, 1993), we have examined the consequences of bacterial endotoxin on the expression of neutrophil adhesive molecules. We observed that the exposure of neutrophils to LPS/LBP, while enhancing the surface numbers and adhesive function of CD11b/CD18 for latex particles, did not induce aggregation. In contrast, as the LPS/LBP concentration increased (ED50 = 30 ng/mL LPS/LBP), the ability of neutrophils to aggregate decreased in parallel with the shedding of L-selectin. Moreover, when L-selectin adhesive activity was blocked by treatment with Fab fragments of Dreg- 200, aggregation was inhibited to an extent roughly proportional to the available L-selection. Blocking of LPS/LBP with CD14-specific monoclonal antibodies suppressed L-selectin shedding and preserved formyl peptide-stimulated aggregation. Taken together, the data suggest that inhibition of neutrophil aggregation by LPS/LBP is related to the expression of L-selectin via CD14 rather than LPS inhibition of CD11b/CD18 function during cellular stimulation.     

围生期缺血缺氧性脑病的微 RNA生物标志物筛选研究

目的研究围生期缺血缺氧性脑病( HIE)的微 RNA(miRNA)生物标志物的筛选情况。方法通过动态队列研究法获取 2020年 1月至 2021年 1月深圳市龙华区中心医院 144例 HIE病儿作为受试者。将其根据病情严重程度的差异分作轻度 HIE组 42例、中度 HIE组 62例以及重度 HIE组 40例,另取同期该院 50例健康新生儿作为对照组。分别采集所有新生儿脐带血进行测序比较分析差异表达 miRNA,筛选 3个和 HIE相关的 miRNA作为早期预测 HIE的生物标志物,并分析各组新生儿上述 3个 miRNA表达情况的差异。采用 Spearman相关性分析明确 HIE病情严重程度和 miRNA表达的关系。此外,将所有 HIE病儿按照是否合并脏器损伤分为合并脏器损伤组 102例以及未合并脏器损伤组 42例,比较两组上述 3个 miRNA表达情况的差异。此外,检测并比较 HIE组和对照组血清诱导型一氧化氮合酶( iNOS)、内皮素 -1水平。结果 miRNA芯片通过扫描、分析以及标准化处理,结果发现 miRNA芯片共检测 miRNA达 921种。相较于对照组, HIE病儿血浆中有 29种 miRNA表达异常升高, 26种 miRNA表达异常下降,选择差异有统计学意义的 miRNA实施生物学信息分析,发现了 miR-4472、miR-5195-3p以及 miR6794-5p可能具有潜在的预测 HIE作用。重度 HIE组 miR-4472、miR-5195-3p以及 miR-6794-5p表达水平分别为 0.71±0.12、2.34±0.28、2.24±0.24,均高于对照组的 0.20±0.04、0.78±0.15、0.47±0.11和轻度 HIE组的 0.37±0.08、0.92±0.18、0.89±0.15以及中度组的 0.55±0.09、1.45±0.23、1.46±0.20,且轻度 HIE组、中度 HIE组 miR-4472、miR-5195-3p以及 miR-6794-5p表达水平均高于对照组,中度 HIE组 miR-4472、miR-5195-3p以及 miR-6794-5p表达水平均高于轻度 HIE组(均 P<0.05)。 HIE病儿病情严重程度和 miR-4472、miR-5195-3p、miR-6794-5p表达均呈正相关关系(均 P<0.05)。合并脏器损伤 HIE病儿 miR-4472、miR-5195-3p、 miR-6794-5p表达水平分别为 0.60±0.09、2.05±0.18、1.70±0.31,均高于未合并脏器损伤组的 0.46±0.03、1.58±0.12、1.37±0.23(均 P<0.05)。 HIE组血清 iNOS及内皮素 -1水平均高于对照组(均 P<0.05)。结论 HIE的 miRNA生物标志物包括 miR-4472、miR5195-3p、miR-6794-5p,且上述 miRNA表达水平和病儿病情严重程度以及脏器损伤有关,值得临床重点关注。