慢性阻塞性肺疾病并发肺外系统疾病调查

目的近年来,国外大量研究发现,慢性阻塞性肺疾病(COPD)常合并其他系统性疾病,如冠心病、高血压病和糖尿病。国内尚缺乏这方面的资料分析。本研究目的是调查北京2所医院的COPD患者合并冠心病、高血压病或糖尿病的患病率。方法分析了2007年1月~2009年5月间因慢性阻塞性肺疾病(COPD)急性发作住院的患者468例。冠心病诊断条件是根据既往有心肌梗死病史或冠状动脉造影提示冠状动脉狭窄。结果全部468例COPD患者,男性319例,女性149例,年龄70.6±9.2岁,FEV147.7%±18.9%预计值。单纯COPD有214例(45.7%),COPD合并肺外疾病有254例(54.3%),其中冠心病73例(15.6%),高血压病200例(42.7%),糖尿病80例(17.1%)。高血压是COPD并发冠心病的危险因素[odds ratio(OR):3.163,95%可信区间(95%CI):1.431~6.991];年龄(OR:1.042,95%CI:1.012~1.073)和体质指数(OR:1.122,95%CI:1.049~1.200)是COPD并发高血压的危险因素;C反应蛋白(OR:1.020,95%CI:1.005~1.034)和体质指数(OR:1.163,95%CI:1.062~1.274)是COPD并发糖尿病的危险因素。结论 COPD并发其他疾病在国内也很常见,年龄、体质指数和CRP是其高危因素。     

严重左心室扩张患者行经皮冠状动脉介入治疗和冠状动脉旁路移植术的对比研究

目的 对比严重左心室扩张(LVD)患者行经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)的近期和远期临床结果.方法 选择2003年7月至2005年9月在我院接受PCI或CABG治疗的严重LVD患者251例,分析不同血运重建方式对住院和随访期间不良心脑血管事件(MACCE)的影响.结果 严重LVD患者接受PCI治疗101例,CABG治疗150例,其中PCI组的住院MACCE发生率低于CABG组[3.0％ (3/101)比10.7％ (16/150),P=0.024],住院病死率分别为2.0％、8.7％(P=0.028).PCI组和CABG组分别随访(516±182)d和(515±231)d(P=0.967),分别有99例(98.0％)和136例(90.7％)完成随访.两组随访MACCE发生率PCI组、CABG组分别为18.2％ (18/99)、9.6％ (13/136)差异无统计学意义(P=0.054),PCI组再次血运重建率(14.1％、14/99)比CABG组高(0.7％、1/136,P＜0.01),两组随访死亡[4例(4.0％)比12例(8.8％),P=0.151]、心肌梗死[2例(2.0％)比1例(0.7％),P=0.781]和脑卒中[2例(2.0％)比0例(0.0％),P =0.176]的发生率相当.结论 严重LVD患者接受PCI安全可行,其住院病死率较低,远期预后与CABG相当,但再次血运重建率较高.     

Nonfatal child pedestrian injury in two urban cities of Guangdong Province, China: results from a cross-sectional survey

Objective To describe the epidemiological characteristics of nonfatal child pedestrian injuries and provide information to help understand an important public-health problem.Methods This was a school-based,cross-sectional questionnaire survey.The sample (42 750 children) was obtained from two urban cities of Guangdong Province,China,using multi-stage randomized sampling.Information was collected by the respondents self-reporting in the classroom.Results The incidence rate of nonfatal child pedestrian injuri...     

一氧化氮水平、低钠血症和心功能对肝肾综合征发病的影响

目的 分析慢性重型肝炎伴肝肾综合征患者(HRS)经血浆置换(PE)治疗前后的肝肾功能、电解质、心功能、一氧化氮(N0)水平,研究NO、低钠血症和心功能与肝肾综合征的关系。方法 纳入我院2008年1月至2011年1月慢性重型肝炎伴HRS患者共20例,经3次PE治疗,分PE前、第1次PE、第2次PE、第3次PE、PE后1d、PE后3d共6次测量血压、心率和24h尿量。并同期采集患者血液,测定肝肾功能、电解质、血氨、NO、心肌肌钙蛋白(cTnT)、脑钠肽(BNP)、醛固酮、白细胞介素-6、肿瘤坏死因子-α和血液学指标,以PE前数据为基础数据,将每个时间点数据与基础数据进行对比分析。结果 HRS患者NO在PE后1d为(78±24) μmol/L,PE后3d为(85±29) μmol/L,均低于PE前的(113±26) μmol/L(均P＜0.05);血清肌酐在PE后1d为(142±42) μmol/L,低于PE前的(191±43) μmol/L(P＜0.05),PE后3d为(221±105) μmol/L,高于PE前(P＜0.05);在PE前、中、后,HRS患者表现为低钠血症,血青醛固酮均高于参考值范围。HRS患者的cTnT和BNP均高于参考值范围。终末期肝病模型评分、胆红素、尿素、半胱氨酸蛋白酶抑制剂C及血氨在PE期间出现降低,PE后迅速升高。HRS患者的收缩压和24h尿量经过PE治疗,表现为下降的趋势。研究结束有8例患者院内死亡,12例患者出院。结论 NO不是HRS发生的惟一因素,低钠血症和心功能衰竭可能是HRS发生的关键因素之一。     

E-Cad MMP-7与胃癌生物学行为的关系

目的探讨胃癌组织中E-钙黏素（E-Cad）和基质金属蛋白酶-7（MMP-7）的表达及其与胃癌生物学行为的关系。方法采用免疫组化（S-P）法检测E-Cad和MMP-7在62例胃癌组织及20例正常胃组织中的表达水平,分析E-Cad和MMP-7在二者中表达的差异,并结合临床病理资料进行综合分析。结果胃癌与正常胃组织中E-Cad和MMP-7的表达差异有统计学意义（P〈0.01）,在胃癌组织中E-Cad的表达较正常组织显著降低,而MMP-7的表达较正常组织显著增强;E-Cad、MMP-7的表达水平与胃癌的浸润深度、淋巴结转移、分化程度密切相关,E-Cad和MMP-7表达呈明显负相关性（r=-0.26,P=0.039）。结论 E-Cad、MMP-7的表达和胃癌的生物学行为有密切的相关性。     

Dimethylarginine dimethylaminohydrolase 1 regulates nerve growth factor-promoted differentiation of PC12 cells in a nitric oxide-dependent but asymmetric dimethylargenine-independent manner

There are significant morphological and biochemical alterations during nerve growth factor (NGF)-promoted neuronal differentiation, and the process is regulated by molecules, including nitric oxide (NO). Dimethylarginine dimethylaminohydrolase (DDAH) is thought to play a critical role in regulating NO production via hydrolyzing the endogenous NO synthase (NOS) inhibitor asymmetric dimethylarginine (ADMA). Thus, we tested the role of DDAH in NGF-promoted differentiation of PC12 (pheochromocytoma) cells. The present results show that both mRNA and protein levels of DDAH1 were increased, whereas those of DDAH2 were decreased, during NGF-promoted cell differentiation. Both the DDAH activity and the ADMA level in cultured medium were unchanged in this process. NGF promoted neurite formation and induced the expression of microtubule-associated protein 2 (MAP2), a neuronal marker, which were both significantly repressed by DDAH1 silence with small interfering RNA but not by DDAH2 silence. The expressions of three isoforms of NOS were markedly upregulated after NGF stimulation with a time course similar to that of DDAH1, which were attenuated by DDAH1 silence. Conversely, overexpression of DDAH1 accelerated neurite formation in PC12 cells, concomitantly with upregulating the expression of three NOS isoforms. In summary, our data reveal the critical regulatory effect of DDAH1 on NGF-promoted differentiation of PC12 cells in an NOS/NO-dependent but ADMA-independent manner.     

鼻咽癌调强适形放疗前后动态增强特征的研究

目的探讨鼻咽癌调强适形放疗前后MRI动态增强灌注成像的时间-信号变化特征。方法选择初诊未治疗鼻咽癌患者326例,于调强放疗前后行MRI动态增强扫描,分析病灶放疗前后的时间-信号强度变化的曲线特征。结果鼻咽癌放疗前动态增强曲线多呈速升-速降型或速升-平台型,放疗后动态增强曲线多呈缓慢上升型或缓升-平台型。结论调强适形放疗不仅可以缩小鼻咽癌的肿瘤体积,治疗其局部侵犯和淋巴结转移,同时可有效抑制肿瘤的血管生成,降低肿瘤活性。