肝衰竭并发多系统侵袭性真菌感染临床分析

目的分析肝衰竭并发多系统侵袭性真菌感染（invasive fungal infections,IFI）的临床特征。方法回顾性分析1985年1月—2009年12月我院收治的肝衰竭并发多系统IFI患者的临床资料,总结临床特点,分析抗真菌疗效影响因素。结果发生2个系统以上IFI共73例。其中发生2个系统IFI54例（74．0％）,3个系统16例（21．9％）,4个系统3例（4．1％）。患者在发生真菌感染前均有使用抗生素史。以肺部感染最为多见（36．5％）,其次为消化道（22．8％）、泌尿道（19．8％）、血液（11．4％）及腹腔（9．6％）。共分离菌株84株,其中酵母样菌62株（73．8％）,为最常见菌株。60例（82．2％）在不同系统中分离出1种菌株,10例（13．7％）分离出2种菌株,2例（2．7％）分离出3种菌株,1例（1．4％）分离出4种菌株。抗真菌治疗有效率为35．6％,基础疾病治愈好转率为21．9％。抗真菌疗效与是否并发肝性脑病和抗真菌药物使用时间是否〉14d有关。结论对于肝衰竭患者,应注重多系统IFI的监测。对于肝衰竭并发多系统IFI,应在重视基础疾病治疗的基础上,合理选用抗真菌药物并维持适当的疗程。     

血清脂蛋白与冠状动脉病变的关系

目的:探讨血清脂蛋白水平与冠脉病变程度之间的关系。方法:回顾性分析311例行选择性冠状动脉造影的患者,其中267例冠心病(CHD)患者分为稳定型心绞痛(SAP)和急性冠脉综合征(ACS)组,分别测定总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C),低密度脂蛋白胆固醇(LDL-C),载脂蛋白AI(Apo-AI),载脂蛋白B(Apo-B),脂蛋白a(Apoa),计算出LDL/HDL-C和TG/HDL。比较各组血清脂蛋白水平的差异及与冠状动脉病变程度的相关性,并与44例冠脉造影正常组比较。结果:CHD组HDL-C、Apo-AI较对照组显著降低;ACS组较SAP组HDL-C、Apo-AI显著降低(P0.01)。血浆Apo-B水平越高,患者冠状动脉病变血管数越多。结论:HDL-C、Apo-AI与冠脉病变程度具有负相关关系;而Apo-B水平与冠状动脉硬化范围呈正相关。     

妊娠相关血浆蛋白-A与OX40配体共同高表达在急性冠状动脉综合征中的临床意义

目的:探讨急性冠状动脉综合征(ACS)患者血清妊娠相关血浆蛋白-A(PAPP-A)水平与可溶性OX40配体(sOX40L)及单核细胞表达OX40L水平之间的相关性.方法:应用双抗夹心酶联免疫测定法(ELISA)分别对冠状动脉造影正常对照组(30例)、稳定型心绞痛(SA)组(60例)、不稳定型心绞痛(UA)组(50例)、急性心肌梗死(AMI)组(30例)患者血清PAPP-A及sOX40L水平进行检测,采用流式细胞术检测患者血单核细胞表达OX40L水平.结果:血清sOX40L、PAPP-A水平UA组[(15.7±4.9)μg/L,(25.4±6.8)mg/L]及AMI组[(17.1±5.3)μg/L,(26.3±5.6)mg/L]明显高于SA组[(3.4±1.4)μg/L, (9.6±2.1)mg/L]及对照组[(3.9±1.3) μg/L,(8.5±2.8)mg/L];循环血单核细胞表达OX40L UA组[(25.6±5.5)MFI]及AMI组[(29.4±6.3)MFI]明显较SA组[(10.6±2.8)MFI]及对照组[(11.1±3.5)MFI]高.ACS患者血清PAPP-A水平与sOX40L及单核细胞表达OX40L呈显著正相关(r1=0.54, r2=0.51; P<0.0001);ACS患者血清PAPP-A、sOX40L水平及单核细胞表达OX40L均与冠状动脉复杂狭窄程度呈正相关(r1=0.56, r2=0.55, r3=0.40; P<0.001).结论:ACS患者血清PAPP-A水平与sOX40L及单核细胞表达OX40L相关,二者共同高表达提示冠状动脉斑块不稳定,可能是ACS活动性标志物.     

中国北方汉族人群IL-17F基因His161Arg多态性与心肌梗死的关联

目的 探讨interleukin-17(IL-17F)基因His161Arg单核苷酸多态性与中国北方汉族人群心肌梗死的相关关系.方法 采用聚合酶链反应-限制性片段长度多态性技术对1 068例心肌梗死的患者和985例对照组进行检测,分析IL-17F基因His161Arg单核苷酸多态性的基因型和等位基因分布情况.结果 IL-17F基因His161Arg单核苷酸多态性三种基因型TT型、TC型和CC型在心肌梗死分布频率分别为76.3%、17.9%和5.8%,在对照组分别为75.8%、16.6%和7.6%,两组间的基因型分布皆符合Hardy-Weinberg平衡定律,三种基因型在两组间的分布差异无统计学意义(P>0.05).T等位基因在心肌梗死组和对照组间的分布频率分别为85.3% 和84.2%,差异亦无统计学意义(P=0.33).按性别和年龄等进行亚组分析显示,IL-17F基因His161Arg单核苷酸多态性的基因型和等位基因频率在心肌梗死组和对照组间的差异无统计学意义(P>0.05).结论 IL-17F基因His161Arg单核苷酸多态性与中国北方汉族人群心肌梗死的发病可能无相关关系.     

杞蓟制剂对非酒精性脂肪性肝炎大鼠肝组织肝型脂肪酸结合蛋白的影响

[目的]研究肝型脂肪酸结合蛋白(L-FABP)在大鼠非酒精性脂肪性肝炎(NASH)形成中的作用及杞蓟制剂对其影响。[方法]采用高脂饮食复制大鼠NASH模型。实验分为正常对照组、空白模型组、杞蓟制剂防治组、复方蛋氨酸胆碱片对照组。原位杂交和Western免疫印迹技术检测各组大鼠肝组织L-FABP mRNA和蛋白表达的变化。[结果]与正常对照组相比,空白模型组大鼠肝组织L-FABP mRNA和蛋白表达明显增强(P0.01);与空白模型组相比,杞蓟制剂防治组和复方蛋氨酸胆碱片对照组大鼠肝组织L-FABP mRNA和蛋白表达减弱(P0.01),杞蓟制剂作用优于复方蛋氨酸胆碱片(P0.05或P0.01)。[结论]L-FABP mRNA和蛋白表达增强引起脂质代谢失衡,参与NASH的发病。杞蓟制剂能调节L-FABP mRNA和蛋白的表达是通过调节脂质代谢来防治NASH的作用机制之一。     

贵州省水城县地方性氟中毒病区骨软化畸形儿童铝氟及其他微量元素水平检测分析

目的 对贵州省水城县勺米乡与纸厂乡结合部地方性氟中毒(简称地氟病)村聚集性骨软化畸形儿童进行氟(F)、铝(Al)等多种元素测定,结合临床表现进行病因学诊断.方法 2008年11月,对水城县纸厂乡与勺米乡结合部地氟病村寨骨软化畸形少年儿童聚集病例(病例组),在严格质量控制基础上,采集14个病例和同县非地氟病区13个同龄对照(对照组)的任意1次尿和枕部贴皮头发,进行氟(F)、铝(Al)、镉(Cr)、锰(Mn)、铁(Fe)、铜(Cu)、锌(Zn)、砷(As)、硒(Se)、锶(Sr)、钡(Ba)10种元素检测,数据用PEMS 3.1医学软件统计包进行处理.结果 病例组尿中F、Al、Mn、Cu、Sr、Se水平(1.18 mg/L,112.6 μg/L,6.62、29.86 mg/L,177.5、4.23ng/L)与对照组(0.48、47.1、2.04、16.61 mg/L,55.17、15.52 ng/L)比较,差异均有统计学意义(t值分别为4.592、2.486、4.850、2.210、2.078、2.912,P均＜0.05).病例组头发中Al、Mn、As、Sr、Ba、Fe、Se水平(59.27、5.26、0.956、1.497、1.287、297.13、0.454 mg/kg)与对照组(18.69、0.72、1.094、0.621、0.675、69.022、1.323 mg/kg)比较,差异有统计学意义(t值分别为4.583、6.318、3.309、2.704、5.606、6.294,P均＜0.05).病例组尿中F与Al、Zn、As、Se的相关系数(r)均＞0.662(P均＜0.05),Al与Cu、Zn、As、Sr、Ba、Se的r均＞0.674(P均＜0.05),Se与Mn、Ba、Cu、Zn、Sr、As的r均＞0.694(P均＜0.05),Mn、Sr、As、Ba彼此之间r均＞0.550(P均＜0.05).病例组头发中Al与Mn、Cr、Fe、Cu、As、Se的r均＞0.732(P均＜0.05),Ba与Mn、Cr、Fe、Sr,Mn与Cr、Fe,Cr与As,Cu与Sr的r均＞0.686(P均＜0.05);对照组尿Cu与Zn、Se、Ba,Zn与Se、Ba,Cr与Mn、Ba的r均＞0.516(P均＜0.05);对照组头发中Al与Mn、Fe、Cu、As、Se,Se与Fe、Cu、As,Fe与Mn、Cu、As,Cu与Zn、As,Zn与As的r均＞0.739(P均＜0.05).病例组尿F与Se的r(0.762)与对照组(-0.469)比较,差异有统计学意义(u=2.079,P＜0.05).结论 水城县纸厂乡与勺米乡结合部地氟病病村寨骨软化畸形儿童的氟、铝负荷过高,尿和头发多种元素水平及其相关性分析与地方性铝氟中毒Al、F水平引起多种元素水平变化及其相关性呈网络样加强的现象一致,结合病人生活环境,有与铝氟中毒相同的骨X线表现,可诊断为地方性铝氟中毒.病人尿和头发Se水平降低及与F、Al等相关性有显著差异的生物学意义有待进一步探讨.

Abstract：

Objective To investigate the levels of trace elements such as fluorine(F), and aluminium (Al)etc. of osteomalacia malformation children and to make etiological diagnosis in reference with clinical manifestations.Methods Urine and occipitalia hairs of 14 diseased children(patient group) from endemic fluorosis area and 13 healthy children(control group) from non-endemic area were included in the study on November, 2008, and contents of 10 elements of fluorine(F), aluminum(Al), chromium(Cr), manganese(Mn), ferrum(Fe), cuprum(Cu), zinc(Zn), arsenic (As), selenium(Se), strontium(Sr), and barium(Ba) were tested. The data were analyzed with medical soft package PEMS 3.1. Results Urinary contents of F, Al, Mn, Cu, Sr, and Se(1.18 mg/L, 112.6 μg/L,6.62,29.86 mg/L, 177.5,4.23 ng/L) in patient group were significantly different from those in control group (0.48,47.1,2.04,16.61 mg/L, 55.17,15.52 ng/L, t = 4.592,2.486,4.850,2.210 2.078,2.912, all P＜ 0.05); Hair contents of Al, Mn, As, Sr, Ba, Fe, and Se in patient group(59.27,5.26,0.96,1.50,1.29,297.13,0.45 mg/kg)were significantly different from those of control group( 18.69,0.72,1.09,0.62,0.68,69.02,1.323 mg/kg, t = 4.583,6.318,3.309,2.704,5.606,6.294, all P ＜ 0.05); in patient group, the correlation coefficients of urinary Fe to Al,Zn, As, and Se were all bigger tan 0.662(all P＜ 0.05), those of urinary Se to Mn, Ba, Cu, Zn, Sr, and As were all bigger than 0.694(all P＜ 0.05), those among urinary Mn, Sr, As, and Ba were bigger than 0.550(all P＜0.05), those of hair Al to Mn, Cr, Fe, and Cu were bigger than 0.732(all P＜ 0.05), those of hair Ba to Mn,Cr, Fe, and Sr, and of hair Mn to Cr and Fe, and those between Cr and As, between Cu and Sr were all bigger than 0.686 (all P ＜ 0.05). In control group, the correlation coefficients of urinary Cu to Zn, Se, and Ba, those of Zn to Se and Ba, and those of Cr to Mn and Ba were all bigger than 0.516(all P ＜ 0.05), those of hair Al to Mn,Fe, Cu, As, and Se, and those of hair Se to Fe, Cu, and As, those of hair Fe to Mn, Cu, and As, those of hair Cu to Zn and As, and that between Zn and As were bigger than 0.739(all P ＜ 0.05). The correlation coefficient of urinary F to Se in patient group(0.762) was significantly different from that in control group( - 0.469, u = 2.079,P ＜ 0.05). Conclusions The burden of F and Al of osteomalacia malformation children in endemic fluorosis area of Shuicheng county is too high. The contents of multi-elements in urine and hairs and their correlation are coincident with high levels of Al and F and they cause network increase of multi-element content changes and their correlation. According to bone X-ray features combining with the living environment, the diagnosis of endemic Al-F fluorosis can be made. The biological significance of reducing urinary and hair Se levels and the correlations of F and Al need to be further studied.     

miR-221/222在肝癌细胞抵抗内质网应激凋亡中的作用

目的 研究内质网应激对miR-221/222的调控及其在肝癌细胞抵抗内质网应激诱导细胞凋亡中作用.方法 采用miR-221/222抑制物和miR-221/222类似物分别阻断或模拟内源性miR221/222的功能,并利用Western blot和流式细胞技术分析内质网应激条件下miR-221/222对肝癌细胞周期和凋亡的调控作用.结果 内质网应激诱导miR-221/222表达下调,miR-221/222类似物和抑制物分别抑制和促进内质网应激诱导的p27Kip1表达上调,干扰p27Kip1不仅抑制了内质网应激诱导的肝癌细胞G0/G1期阻滞,也促进了内质网应激介导的肝癌细胞凋亡.结论 内质网应激诱导miR-221/222下调能够通过促进p27Kipl表达对内质网应激条件下肝癌细胞周期和凋亡起重要调控作用.

Abstract：

Objective To investigate the role of miR-221/222 in inhibiting endoplasmic reticulum stress-induced human hepatocarcinoma cells apoptosis. Method miR-221/222 mimics and inhibitors were used to mimic or block the function of endogenous miR-221/222 respectively. Western blot and flow cytometry were used to test the effects of miR-221/222 on cell cycle and apoptosis under endoplasmic reticulum stress in human hepatocellular carcinoma cells. Results Endoplasmic reticulum stress resulted in miR-221/222down-regulation in human hepatocellular carcinoma cells. miR-221/222 mimics and inhibitors inhibited and promoted respectively endoplasmic reticulum stress-mediated p27Kip1 induction. Moreover, p27Kip1 suppression not only resulted in reduction in the fraction of G1 phase cells, but also promoted the endoplasmic reticulum stress-mediated apoptosis in human hepatocellular carcinoma cells. Conclusions miR-221/222 were downregulated by endoplasmic reticulum stress in human hepatocellular carcinoma cells, which subsequently protected human hepatocellular carcinoma cells against endoplasmic reticulum stress-induced apoptosis through p27KiP1 regulation.     

股动脉压迫气囊的设计与应用研究

目的探讨股动脉压迫气囊在经股动脉介入术后的安全性、有效性及应用价值。方法将174例经股动脉介入诊断及治疗术后患者随机分为常规压迫组（93例）与气囊压迫组（81例）,常规压迫组采用常规的压迫止血法,气囊压迫组采用股动脉压迫气囊压迫止血法,观察两组患者血管并发症、下肢制动时间及腹胀、腰痛等不良反应的发生率。结果气囊压迫组血管并发症、下肢制动时间及腹胀、腰痛发生率显著低于常规压迫组。结论 经股动脉介入治疗术后通过股动脉压迫气囊法进行压迫止血,可明显减少血管穿刺后的并发症,缩短下肢制动时间,值得临床推广应用。     

大肠黑变病35例临床分析

目的探讨大肠黑变病的致病因素和临床特点。方法回顾性分析我院2007年1月～2011年6月经结肠镜和病理检查确诊的35例大肠黑变病患者的临床资料、内镜及病理特点。结果 35例患者中,有慢性便秘症状者28例,服用泻药者32例,合并增生性息肉3例,合并管状腺瘤1例,合并直肠腺癌1例。结论大肠黑变病病因与长期服用泻药及慢性便秘有关,并与大肠腺瘤和大肠癌相关。     

前列地尔联合腺苷蛋氨酸治疗病毒性肝炎高胆红素血症疗效观察

目的观察前列地尔联合腺苷蛋氨酸治疗病毒性肝炎高胆红素血症的临床疗效及安全性。方法选取符合病毒性肝炎诊断标准、血清总胆红素（TBIL）〉171.1μmol/L的住院患者72例,随机分为治疗组与对照组,两组均用腺苷蛋氨酸治疗,治疗组加用前列地尔,疗程为4周。观察患者治疗前后症状变化及TBIL、ALT、γ-GT指标变化。结果治疗组总有效率显著优于对照组（94.12%vs 76.32%,P〈0.05）;两组患者临床表现和肝功能（TBIL、ALT、γ-GT）均较治疗前有明显改善（P〈0.05）,治疗后治疗组TBIL下降幅度与对照组比较有显著性差异（P〈0.01）,而ALT和γ-GT下降幅度与对照组比较差异无统计学意义（P〉0.05）。治疗期间两组病例均未出现不良反应。结论前列地尔联合腺苷蛋氨酸治疗病毒性肝炎高胆红素血症具有较好的疗效和安全性。