冠心病病人N端前脑钠肽检测的临床意义

目的观察不同临床类型冠心病病人的血清N端前脑钠肽(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度的差异及其与心肌坏死标记物的相关性,并探讨其临床意义。方法经冠状动脉造影证实的冠心病病人106例,按临床类型分为:急性心肌梗死28例,不稳定型心绞痛36例,稳定型心绞痛42例。对照组22例非冠心病者。采用电化学发光法测定血清NT-proBNP浓度,同时定量测定急性心肌梗死病人的肌钙蛋白I(cardiac troponin I,cTnI)。结果急性心肌梗死组、不稳定型心绞痛组、稳定型心绞痛组和对照组血清NT-proBNP浓度分别为(573±126)ng/L,(276±65)ng/L,(42±23)ng/L,(37±24)ng/L。急性心肌梗死组NT-proBNP与cTnI呈正相关(r=0.913,P<0.01)。结论不同临床分型的冠心病病人的血清NT-proBNP浓度存在差异,NT-proBNP可反映心肌缺血的程度。     

自体外周血干细胞移植治疗血液恶性肿瘤231例临床观察

目的观察自体外周血干细胞移植(APBSCT)治疗血液恶性肿瘤的疗效。方法2001年3月至2007年2月对第三军医大学新桥医院231例血液恶性肿瘤患者施行APBSCT,其中急性淋巴细胞白血病(ALL)45例,急性髓性白血病(AML)34例,非霍奇金淋巴瘤(NHL)100例,霍奇金淋巴瘤(HD)31例,多发性骨髓瘤(MM)21例,观察临床疗效和并发症。结果除1例ALL外,230例患者移植后造血功能均快速重建。ALL首次完全缓解(CR1)28例患者中无病存活(DFS)13例,带病存活4例,死亡11例;ALL二次缓解(CR2)17例患者中DFS3例,带病存活4例,死亡10例。AMLCR120例患者中DFS11例,带病存活3例,死亡6例;AMLCR214例患者中DFS6例,带病存活2例,死亡6例。NHLCR159例患者中DFS43例,带病存活7例,死亡9例;NHLCR230例患者中DFS18例,带病存活5例,死亡7例;NHL未缓解(NR)11例患者中DFS2例,带病存活4例,死亡5例。HDCR110例患者中DFS10例;HD部分缓解(PR)15例患者中DFS12例,带病存活3例;HD疾病复发(RE)6例患者中DFS3例,带病存活2例,死亡1例。MM21例患者中DFS7例,带病存活6例,死亡8例。结论APBSCT是一种安全有效的血液肿瘤治疗方法。     

鼻内镜手术治疗慢性侵袭性真菌性鼻窦炎45例

目的探讨鼻内镜下治疗慢性侵袭性真菌性鼻窦炎的疗效。方法在鼻内镜下对45例慢性侵袭性真菌性鼻窦炎患者行鼻窦清创术,部分病例加行下鼻道开窗术,彻底清除鼻窦病变组织及鼻病变黏膜和骨质,充分开放鼻窦,术后应用大扶康冲洗术腔,并定期行鼻内镜检查。结果随访6个月至6年,治愈41例,复发4例。复发病例经再次鼻内镜手术后治愈,无手术并发症。结论鼻内镜下鼻窦清创术是治疗侵袭性真菌性鼻窦炎的重要手段,术后定期复查并辅以大扶康术腔冲洗,疗效良好。     

输注利妥昔单抗时不良反应的预防和护理

利妥昔单抗（美罗华）是一个主要针对B细胞表面CD20分子的嵌合型单克隆抗体。由鼠抗CD20单抗的288轻链和重链可变区及人的轻链和重链恒定区组成的人源化的嵌合抗体,能以极高的亲和力与B淋巴细胞上的CD20结合,通过抗体依赖的细胞介导细胞毒作用及补体介导的细胞毒作用,最终导致细胞凋亡。     

基因芯片在耳鼻咽喉-头颈外科学中的应用

基因芯片(gene chip)是20世纪90年代发展起来的一种新型实用的高新生物技术.其突出特点是具有高度的并行性、多样性、微型性和自动化,已成为高效、快速、大规模获取相关生物信息的重要手段.     

神经生长因子基因转染联合强化铁营养防治豚鼠爆震性聋的实验研究

Objective To study the protective effects of adenovirus-mediated human beta-nerve growth factor gene (hNGFβ) transfer combined with iron fortified nutrition on blast hearing damage in guinea pigs. Methods Deafness was induced by blast (172dB SPL) in 35 healthy guinea pigs. Seven days after noise exposure, 10 guinea pigs were inoculated with adenovirus-mediated hNGFβ (Ad-hNGFβ) into the perilymphatic space (the gene group), another 10 guinea pigs were given hNGFβ combined with iron fortified nutritional diet (the combination group), still another 10 guinea pigs were inoculated with artificial perilymphatic fluid (APF), and 5 guinea pigs served as control, given neither medicine nor noise exposure. Auditory brainstem response (ABR) threshold shifts were monitored in the guinea pigs before blast exposure and after gene transfer. Changes in cochlear morphology were examined with immunohistochemical and HE staining. Results One week after successful inoculation of hNGFβ, it was noted that Ad-hNGFβ protein was expressed in each turn of the cochlea, and its intensity was almost equal. After gene transfer in the combination group and the gene group, ABR threshold shifts at week 1 and 4 were significantly smaller than those of the APF group. HE staining showed that the number of the spiral ganglion cells in the combination group and the Ad-hNGFβ group was significantly higher than that of the control group after 4 weeks (P<0.01). Conclusions Ad-hNGFβ combined with iron fortified nutritional diet was effective in the prevention and treatment of blast hearing damage of cochlear hair cells.     

强化铁营养对抗稳定噪声致聋作用的实验研究

目的：探讨应用强化铁营养对抗稳态噪声致聋作用的可能性。方法：４０只健康幼龄Ｗｉｓｔａｒ大鼠按随机化原则分为两组，每组２０只：Ａ组喂标准饲料；Ｂ组喂强铁化饲料。将Ａ、Ｂ两组大鼠同时暴露于１１０ｄＢＳＰＬ２０～１００００Ｈｚ稳态白噪声，持续４０ｍｉｎ。根据暴露前后听性脑干反应（ＡＢＲ）阈差值判定听力阈移，扫描电镜及光镜下观察耳蜗显微结构和听毛细胞表面超微结构变化。结果：暴露后２ｈ，３ｄ和１１ｄ的Ｂ组听力阈移值显著小于Ａ组；暴露后２１ｄ，虽然两组听力阈移均数值的差异无显著意义，但Ａ组ＡＢＲ阈值均数仍显著大于该组大鼠噪声暴露前平均听阈。扫描电镜下观察，暴露后２ｈ的Ａ组大鼠外毛细胞静纤毛出现严重扭曲、倒伏、排列紊乱等病理变化，３ｄ后，上述病变明显减轻，２１ｄ后，部分听毛细胞静纤毛排列紊乱仍未能完全恢复。在Ｂ组大鼠，外毛细胞静纤毛暴露２ｈ后有轻度扭曲及排列紊乱，３ｄ后这些病变基本恢复，２１ｄ后外毛细胞静纤毛形态完全恢复正常。结论：强化铁营养具有对抗稳态噪声听损伤作用，其机制可能与其对含铁酶类活性的增强作用有关。