危重症患者血清降钙素原测定对细菌感染的诊断价值

Objective To evaluate the clinical value of serum procalcitonin (PCT) in the diagnosis of bacte-rial infections in the critically ill patients. Methods A loud d 100 cases of critical patients were divided into bacteri-al infection group(56 cases) and non-bacterial infection group(44 cases). Serum PCT was measured by immunolu-minometric assay. Results The concentration of PCT in bacterial infection group(21.54 ±5.72) μg/L, was signifi-cantly higher than non-bacterial infection group (11. 95±4. 58)μg/L (t =2.291,P<0.05);The APACHE Ⅲ score of bacterial infection group(62. 44 ± 19. 55) cent was significantly higher than non-bacterial infection group(44. 56 ± 25. 88) cent(t = 2. 195 ,P < 0. 05). The concentration of PCT of 1.0μg/L and 2. 0 p.g/L compared to the former sensitivity (96. 5) % higher than the latter (55.2) % (X2 = 3. 94, P < 0. 05), the former specificity (41.7) % lower than the latter (95.8)% (X2 = 4. 02 ,P < 0. 05);1.5μg/L as a positive standard Youden index and the Agreement (83.0 % ,0. 65), were significantly higher than 1 μg/L and 2 μg/L(71.7%, 0. 38 ;73.6% ,0. 51) (X2 = 3.84, X2=3. 90,X2 = 3.992 = 3.91 ,P < 0. 05);The concentration of PCT in death group (38. 9 ±12. 6)μg/L was signifi-canfly higher than the survival group(11.8± 8. 3) μg/L(t =2. 398 ,P <0. 05). Conclusion Serum PCT has clinical values in the diagnosis and therapy of bacterial infections in the critical patients.     

抗心律失常药物作用的新靶点M3R/IKM3

目的研究心脏M₃受体/M₃受体介导的钾通道与心律失常的关系，寻找抗心律失常药物的新靶点。方法 分别以结扎大鼠左冠状动脉前降支所致急性心律失常模型和膜片钳技术为基础，观察M₃受体的干预作用及作用机制。结果M₃受体阻断剂4DAMP(4-diphenylacetoxy-n-methylpiperidine-methiodide)加重结扎大鼠冠状动脉前降支所致心律失常，而M₃受体激动剂胆碱能明显对抗其作用。其他亚型受体阻断剂，M₁受体阻断剂(prienzepine)、M₂受体阻断剂(methotramine)和M₄受体阻断剂(tropicamide)对结扎大鼠左冠状动脉前降支所致急性心律失常无影响。在膜片钳实验中发现，胆碱可激活一种延迟整流钾电流(IK_M3)，此电流可被M₃受体阻断剂4DAMP明显抑制。而M₁，M₂和M₄受体阻断剂对胆碱介导的电流无作用。结论胆碱通过激动心肌M₃受体诱发一外向钾电流(IK_M3)，并在维持心脏离子通道平衡中起重要作用。M₃受体/IK_M3可能是抗心律失常新靶点。     

温阳活血化痰法对充血性心力衰竭大鼠神经内分泌系统的影响

目的:研究温阳活血化痰法对异丙肾上腺素(ISO)诱导的充血性心力衰竭大鼠神经内分泌系统的影响,探讨该法防治CHF心肌重塑的作用机理.方法:采用ISO皮下注射法制备CHF模型,进行血流动力学及病理形态学检测,采用放免法测定血浆血管紧张素Ⅱ(AngⅡ)、醛固酮(BLD)及心钠素(ANP)水平.结果温阳活血化痰法能提高CHF模型大鼠dp/dtmin、dp/dtmax和LVSP水平、降低LVEDP水平;降低心脏重量指数,减少血浆AngⅡ、BLD和ANP含量.结论:改善CHF大鼠心肌收缩和舒张功能,拮抗神经内分泌系统的激活,可能是温阳活血化痰法防治CHF心肌重塑的作用机理之一.     

强直性脊柱炎并骨质疏松97例临床观察

研究强直性脊柱炎(AS)骨质疏松和骨量减少的发生情况、相关因素及与骨代谢指标的关系.选97例AS患者作为观察组,分别检测其血沉(ESR)、C-反应蛋白(CBP)、HLA-B27、血钙(Ca)、血磷(P)、碱性磷酸酶(ALP),并进行全身疼痛评分、中医症状积分评定和晨僵时间、BATH功能指数(BASFI)、病情活动指数(BASDI)、颌柄距、指地距、枕墙距、Schober试验、胸阔活动度、脊柱活动度;用双能X线法(DEXA)测定腰椎、股骨颈、股骨转子部、Ward's三角区骨密度(BMD),检测骨钙素(BGP)、降钙素(H-CT)、甲状旁腺激素(PTH);42例检测了尿脱氧吡啶啉(D-Pyr).选102名健康人作为对照组,分别测定其腰椎、股骨颈、股骨转子部、Ward's三角区骨密度(BMD),31例检测了BGP、PTH、D-Pyr、Ca、P、ALP.结果AS患者发生骨质疏松者42例(42.27%),骨量减少者36例(37.11%);AS患者BGP较对照组显著降低,并与腰椎、股骨近端BMD呈正相关.PTH、尿D-Pyr较对照组显著增高,并与股骨近端BMD呈负相关.AS患者中急时相反应物ESR与腰椎、股骨近端BMD呈显著负相关,CBP与AS患者腰椎、股骨颈、三角BMD呈显著负相关,ESR、CRP与尿D-Pyr呈显著的正相关.腰椎BMD与全身疼痛评分、中轴关节压痛指数呈负相关性,股骨近端BMD与指地距、BASFI、BASDAI呈显著负相关,与Schober试验、脊柱活动度呈显著正相关.AS患者的腰椎BMD与HLA-B27显示了负相关性.表明骨质疏松或骨量减少在AS中普遍存在,其发生与遗传、废用、免疫炎症等因素相关.AS患者骨代谢的失衡以骨生成的减少、骨吸收的增加为特点;PTH的增高及免疫炎性反应与AS患者骨吸收的增加有关.     

红外光谱与计算机对比软件对不同生地黄的快速鉴别

目的:对野生和栽培生地黄及不同贮藏年限的生地黄(2000、2002年采收)以及"道地(河南)和非道地(其他省份)"生地黄药材进行快速鉴别研究.方法:利用傅里叶红外光谱技术(FT-IR)结合对比软件,并借助计算机运用归一化图谱辅助处理技术.结果:野生和栽培生地黄红外吸收光谱有明显的差异;对不同贮藏年限生地黄的识别率为100%;"道地和非道地"生地黄既有整体差异,又有个体交叉,识别率高于90%.结论:该方法具有快速、准确等特点.     

四逆加人参汤治疗心肌梗死后无症状性心肌缺血--附21例临床分析

目的:研究四逆加人参汤治疗心肌梗死后无症状性心肌缺血(SMI)的临床效果.方法:43例心肌梗死后无症状性心肌缺血患者按收治先后随机法分为予四逆加人参汤治疗的治疗组21例,予单硝酸异山梨酯治疗的对照组22例.观察其治疗前后血压、心率和24h动态心电图改变,并随访3个月,了解无症状性心肌缺血复发情况.结果:治疗组用药后SMI总持续时间较对照组明显降低(P＜0.05),治疗组用药后的心肌缺血总负荷亦较对照组明显降低(P＜0.01);随访3个月后,对照组的SMI发作次数及总持续时间、心肌缺血总负荷和RPP均比用药后升高(均P＜0.01),但治疗组与用药后比较均无明显升高(均P＞0.05),且治疗组无明显不良反应.结论:四逆加人参汤治疗心肌梗死后无症状性心肌缺血是安全有效的,且SMI复发少,值得临床推广.     

自制中药药带治疗慢性原发性肾小球肾炎376例

目的:观察自制中药药带治疗慢性原发性肾小球肾炎的临床疗效.方法:选择慢性原发性肾小球肾炎患者376例,采用数字表随机分为两组,治疗组200例和对照组176例.治疗组给予中药药带外敷肾俞穴,2周为1疗程,使用2个疗程后进行统计学处理评定疗效.对照组口服潘生丁、至灵胶囊、雷公藤多甙等,疗程同治疗组.结果:经治疗2个～3个疗程后,两组临床疗效比较差异有显著性意义,治疗组优于对照组(P＜0.01).结论:融滋肾、温阳、益气化瘀、利湿为一体的自制中药药带,可以调整机体免疫功能,减少炎症介质分泌,具有一定的临床价值,用于治疗慢性原发性肾小球肾炎可获得满意疗效.     

苍耳子对小鼠脾淋巴细胞蛋白质组影响的双向电泳分析

目的观察苍耳子对致敏小鼠脾淋巴细胞蛋白质表达的影响.方法NIH小鼠正常组腹腔注射生理盐水,造模组和治疗组均注射羊红细胞(SRBC)致敏,治疗组经致敏后以苍耳子水煎剂灌胃,处理4 d后,分离小鼠脾淋巴细胞;提取总蛋白,双向凝胶电泳(2-DE)后,以计算机图像分析软件分析电泳图谱.结果致敏会引起多种蛋白质表达发生变化,而苍耳子可逆转其中部分蛋白质的变化.结论苍耳子可改善由致敏引起的小鼠脾淋巴细胞中部分蛋白表达的变化.     

穴位注射治疗呼吸系统过敏性疾病22例

过敏性鼻炎、过敏性哮喘是临床最常见的呼吸系统过敏性疾病.近年来,笔者采用肺俞穴位注射治疗该病,疗效比较满意,总结如下.     

Pivotal study of iodine-131-labeled chimeric tumor necrosis treatment radioimmunotherapy in patients with advanced lung cancer.

PURPOSE: Tumor necrosis treatment (TNT) uses degenerating tumor cells and necrotic regions of tumors as targets for radioimmunotherapy. Previous studies in animal tumor models and clinical trials have demonstrated that when linked to the therapeutic radionuclide iodine-131, recombinant chimeric TNT antibody ((131)I-chTNT) can deliver therapeutic doses to tumors regardless of the location or type of malignancy. Therapeutic efficacy and toxicity of (131)I-chTNT in advanced lung cancer patients were studied in this pivotal registration trial. PATIENTS AND METHODS: Patients with advanced lung cancer were treated with systemic or intratumoral injection of (131)I-chTNT in eight oncology centers in China. The objective response rate (ORR) was assessed as the primary end point. RESULTS: All 107 patients who were entered onto the study and completed therapy had experienced treatment failure after prior radiotherapy or chemotherapy a mean of three times. The results showed an ORR of 34.6% (complete response, 3.7%; partial response, 30.8%; no change, 55.1%; and progressive disease, 10.3%) in all patients and 33% in 97 non-small-cell lung cancer patients. A biodistribution study demonstrated excellent localization of the radioactivity in tumors in both systemically and intratumorally injected patients. The most obvious adverse side effect was mild and reversible bone marrow suppression. CONCLUSION: Radioimmunotherapy with (131)I-chTNT was well tolerated and can be used systemically or locally to treat refractory tumors of the lung.