2008年宁夏中卫市沙坡头区人间布鲁杆菌病调查与分析

目的 调查宁夏中卫市沙坡头区布鲁杆菌病(简称布病)的流行现状及特征.方法 2008年采取分层随机抽样的方法,对宁夏中卫市沙坡头区布病重点人群进行流行病学调查,应用琥红平板凝聚试验(RBPT)和试管凝集试验(SAT)进行血清学检测,按照<布鲁氏菌病诊断标准及处理原则>(GB 15988-1995)诊断病例.结果 共调查10个乡镇布病重点人群2480人,检测血清604人份,布病感染者28例,感染率为4.64%(28/604).检出布病患者15例,均为奶牛饲养人员,检出率为2.48%(15/604);饲养人员感染率最高,为6.45%(26/403).结论 宁夏中卫市沙坡头区存在人间布病的流行,患病与职业有关.     

程序性细胞凋亡基因单核苷酸多态性与慢性乙型肝炎患者干扰素早期病毒学应答的相关性

Objective To investigate the relationship between the single nucleotide polymorphisms (SNP) of programmed cell death-1 (PD-1) gene and early virologic response of interferon-α (IFN-α) in patients with chronic hepatitis B (CHB). Methods A total of 135 CHB patients were prospectively enrolled in this study. SNP of PD-1.1 and PD-1.2 genes were examined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in these patients.Then its relationship with early virologic response to IFN-α treatment was analyzed. The data were analyzed by x2 test. Results Among the 135 patients, 33 (24.4%) achieved early virologic response to IFN-α. There were 35, 77, and 23 patients with AA, AG, GG genotgpe of PD-1.1. The early virologic response was achived in 5(14.3%), 25(32.5%) and 3(13.0%) among patients with AA,AG, GG genotypes of PD-1.1, respectively. There were statistically different (x2 = 6. 258, P =0. 044). The subjects with AG genotype showed higher response rate than those with AA or GG genotypes (x2 = 6. 246, P= 0. 012). However, the early virologic response rates were not significant different among subjects with AA, AG or GG genotype of PD-1. 2 ( x2= 3.957, P= 0. 138).Conclusion SNP of PD-1.1 gene may be used as a marker to predict the early virologic response to IFN-α treatment in Chinese CHB patients.     

老年气管支气管结核的纤维支气管镜检查（附17例分析）

本文分析６０岁以上老年人经纤维支气管镜（纤支镜）病理证实的气管支气管结核１７例。与青年人相比，老年患者发热较少，胸片正常者较多，纤支镜下文气管管腔明显狭窄者较多，而干酪坏死样改变较少。对于老年人新近发生的咳嗽尤其伴有痰血者，经积极抗炎１个月无效，不论胸片是否异常，应及时作纤支镜检查。此对支气管结核有决定性意义。     

髂动脉支架植入联合股-腘动脉转流术治疗Ⅲ型Leriche综合征

2007年3月至2008年11月,我院采取术中同时行髂动脉腔内成形和支架植入联合股-腘动脉转流术,治疗Ⅲ型Leriche综合征老年病人11例,均取得了较好的效果. 1 资料与方法 1.1 一般资料本组男性9例,女性2例,年龄71～88岁,平均76岁;11条肢体均严重缺血.主要临床症状:间歇性跛行4例(跛行距离＜50 m),静息痛7例(其中2例合并肢端溃疡).主要伴发病:5例同时伴有高血压、冠心病和糖尿病;2例同时伴有高血压、脑梗死和糖尿病、冠心病;2例伴有冠心病;1例伴有脑梗死,1例伴有糖尿病.术前腹主动脉、双下肢动脉CTA显示:右侧髂、股动脉病变8例;左侧髂、股动脉病变3例.     

呼气末正压对COPD合并呼吸衰竭患者病情影响的研究

目的探讨不同水平的呼气末正压（PEEP）对COPD并呼吸衰竭患者病情的影响。方法选择2007年10月至2009年2月确诊为COPD并呼吸衰竭需机械通气治疗的患者40例,随机分为A组（20例,PEEP5cm H2O）,B组（20例,PEEP10cm H2O）。监测两组患者呼吸支持后动脉血气、气道压力、血流动力学的变化。结果（1）动脉血气：两组患者上机后0.5h、24h动脉血气指标分别比较无差异,P〉0.05。（2）气道压力：上机后0.5h、24hB组气道峰压、气道平台压较A组明显升高,P〈0.05.（3）血流动力学：上机后0.5h、24hA、B两组患者的心率、平均动脉压、外周循环阻力指数变化无差异,P〉0.05;上机后0.5hA、B两组患者心排血量指数、左心做功指数、胸液水平变化无差异;但上机24h后B组上述3个指标较A组下降,P〈0.05。结论COPD并呼吸衰竭患者机械通气治疗时低水平PEEP是有益且安全的;避免高水平的PEEP给患者带来负面效应。     

以高钙性肾病为突出表现的原发性甲状旁腺功能亢进1例

以高钙性肾病为突出表现的原发性甲状旁腺功能亢进１例大连医科大学附属第二医院肾内科（１１６０２３）尹永红麻军患者男，４２岁。以多饮、多尿２年，恶心、呕吐３个月为主诉入院。２年前出现烦渴、多饮，每日饮水量７５００～１００００ｍｌ，多尿、夜尿增多。未介意。...     

扩张型心肌病血浆降钙素基因相关肽水平变化及其意义

为研究扩张型心肌病（DCM）患者血浆降钙素基因相关肽（CGRP）水平的变化规律及意义，采用放射免疫分析法测定35例DCM患者及30例对照者的血浆CGRP水平。结果：DCM组血浆CGRP水平明显高于对照组（P＜0．05），与左室射血分数是显著负相关（r＝－0．79，P＜0．001），与肺动脉压力呈显著正相关（r＝0．87，P＜0．001），20例DCM患者治疗后血浆CGRP水平明显降低（P＜0．05）。提示血浆CGRP水平增高程度与病情严重程度一致，系作为重要的防御和代偿机制参与DCM充血性心力衰竭的病理生理过程。     

经纤支镜钳取血凝块治疗大咯血全肺不张2例

1982年以来,我们收治大咯血引起全肺不张2例,经纤支镜钳取和抽吸血凝块复张。报道如下。例1:男,50岁,工人。因反复咯血29天入院。急性重病容,无明显气促,气管轻度左移,左下肺呼吸音明显降低。心率100次/分,律齐,心音增强。P_2>A_2,心尖区可闻及Ⅱ～Ⅲ级收缩期吹风样杂音。     

冠心病心绞痛患者血浆肿瘤坏死因子α和基质金属蛋白酶-9变化及其临床意义

目的探讨肿瘤坏死因子α(TNF-α)及基质金属蛋白酶-9(MMP-9)在冠心病心绞痛发病机制中的作用。方法选择冠状动脉造影确诊的心绞痛患者80例,分为稳定型心绞痛(SAP)组39例,不稳定型心绞痛(UAP)组41例,30例冠状动脉造影正常者作为对照组。采用酶联免疫吸附(ELISA)法检测血浆TNF-α、MMP-9水平。结果 UAP组血浆TNF-α、MMP-9水平为(26.95±6.02)ng/L、(23.79±4.67)mg/L,显著高于SAP组的(23.64±5.87)ng/L和(19.56±4.51)mg/L(P<0.05),两组TNF-α、MMP-9均明显高于对照组[(16.53±5.45)ng/L、(15.45±4.28)mg/L(P<0.05)]。结论炎症反应可能参与冠心病的发病过程,血浆TNF-α与MMP-9对预测冠心病心绞痛存在和发展有重要临床意义。     

A Study on Changes of the Plasma Endothelin Level in Patients with Dilated Cardiomyopathy

Objectives To evaluate the changes of the plasma endothelin level in patients with dilated cardiomyopathy, and to investigate the relationship between the plasma endothelin level and the severity of heart failure, heart size, left ventricular function and with or not with pulmonary arterial hypertension; the changes of the plasma endothelin level before and after treatment. Methods The plasma endothelin level of 30 patients with DCM, 30 healthy control subjects, and their LVEF, PAP, heart size, plasma endothelin level before and after treatment were determined. Results The plasma endothelin level in DCM group was significantly higher than that in control group ( 135.93 ± 70. 65pg/mL) vs(43.65 ± 12.07pg/mL), P < 0.05 ; there was a correlation between ET level and heart size ( r = O. 4580, P = 0. 0109 ) ; there was a significant negative correlation between LVEF of DCM and ET level( r = -0. 6922 ,P =0. 0021 ) ;and it was a significant positive correlation between ET level and pulmonary arterial hyperten