子宫腺肌病异位内膜细胞的凋亡及其调控蛋白Bcl-2表达的研究

目的研究子宫腺肌病在位和异位内膜腺体和间质细胞凋亡及Bcl-2的调控作用。方法子宫腺肌病（简称腺肌病）27例,对照组（肌瘤组）32例。应用免疫组化方法检测在位和异位内膜腺体和间质细胞Bcl-2的表达;采用脱氧核糖核苷酸末断转移酶介导的缺口末端标记（TUNEL）技术测定子宫内膜细胞的凋亡数（凋亡细胞数/10个高倍视野）。结果腺肌病组异位内膜腺体和间质细胞的凋亡数较其在位内膜均显著降低（腺体细胞P〈0.001,间质细胞P=0.001）。两组在位内膜腺体和间质细胞中Bcl-2表达均呈周期性变化,其染色强度增生期均显著高于分泌期（P〈0.05）。腺肌病组异位腺体和间质细胞中Bcl-2染色强度均高于其同期在位内膜,（P=0.035,P=0.016）。腺肌病组内膜细胞凋亡数与Bcl-2表达呈负相关。结论与在位内膜相比,腺肌病患者异位内膜细胞凋亡显著减少。Bcl-2可能是抑制腺肌病内膜细胞凋亡的重要因素之一。     

强化胰岛素对糖尿病合并急性脑出血患者血清炎症因子TNF-α、IL-1表达的影响

目的探索强化胰岛素治疗对糖尿病合并急性脑出血患者血清炎症因子肿瘤坏死因子（TNF-α）、白细胞介素-1（IL-1）表达的影响。方法62例糖尿病合并急性脑出血患者随机分为强化胰岛素治疗30例（强化治疗组）及常规胰岛素治疗32例（常规治疗组）,检测治疗过程中血糖控制情况及治疗后第3天、第7天、第14天血清炎症因子TNF-α、IL-1的表达量。结果强化治疗组血糖达标率高,治疗后第3天、第7天血清TNF-α、IL-1量较常规治疗组明显减低（P〈0．01）,但治疗第14天两组血清TNF-α、IL-1量差异无显著性。结论糖尿病合并急性脑出血患者强化胰岛素治疗较常规胰岛素治疗能更好地控制血糖并减少炎症介质TNF-α、IL-1的释放。     

基层医院开展射频消融术治疗室上性心动过速21例体会

目的：通过总结本院射频消融术（RFCA）治疗阵发性室上性心动过速（PVST）21例的临床资料,探讨这一技术在基层医院开展的疗效及安全性。方法：回顾分析本院行射频消融术治疗阵发性室上性心动过速21例患者的临床资料。结果：房室结折返性心动过速（AVNRT）14例,房室折返性心动过速（AVRT）7例,手术未成功2例,并发急性心包填塞1例,成功率90.5%,并发症率4.8%,无复发病例。结论：射频消融术是根治阵发性室上性心动过速的一项有效、安全微创手术,可以在各级基层医院开展。     

以红皮病起病伴神经系统损害的高嗜酸性粒细胞综合征1例

1 临床资料 1.1 患者第1次住院情况:患者,男,73 岁,因"全身皮疹1年"于2016年3月入住我院皮肤科.入院前1年,患者无明显诱因全身出现绿豆至鸽蛋大小丘疹、红斑,部分融合成片,上覆大量白色鳞屑,于当地医院治疗后全身红斑、丘疹消退,斑块变薄,鳞屑减少.8 +个月前,患者皮损再次加重,全身出现潮红、肿胀,自行予"...     

Expression of integrin β3 and osteopontin in endometrium of patients with adenomyosis

Objective To investigate the expression of integrin β3 and osteopontin(OPN) in eutopic and ectopic endometrium of adenomyosis. Methods From January 2007 to July 2008, the endometrium specimens were collected from 43 patients with adenomyosis undergoing hysterectomy in Peking University First Hospital. Eutopic endometrium were 11 in proliferative phase and 32 in secretory phase (18 cases in mid-secretory phase) were collected. Ectopic endometriums were also collected. In the mean time, it was chosen 41 cases with pure subserous uterine myoma or cervical intraepithelial neoplasia (CIN) Ⅱ-Ⅲ treated by hysterectomy as controls including 12 endometrium in proliferative phase and 29 endometrium in secretory phase (19 cases in mid-secretory phase). The expression of Integrin β3 subunit and OPN in the endometrium were assessed by immunohistochemical staining and quantitative real-time polymerase chain reaction. Results (1)Immunohistochemical staining showed that positive staining of integrin β3 and OPN were present predominantly in eutopic and ectopic endometrial glandular epithelium. There was significant different protein expression of integrin β3 and OPN, which were 1.6±0.8 and 1.7±0.7 in eutopic endometrium,1.7±0.7 and 1.8±0.9 in ectopic endometrium,2.1±0.9 and 2.0±0.9 in control endometrium (P<0.05). The protein expression of integrin β3 and OPN in eutopic endometrium of adenomyosis in the proliferative phase(0.8±0.4 and 0.7±0.3) were remarkably lower than those of the secretory phase(1.8±0.8 and 1.9±0.8,P<0.01). The protein expression of integrin β3 and OPN in the endometrium of controls in the proliferative phase(1.0±0.4 and 1.0±0.4) were significantly lower than those of the secretory phase(2.5±0.7 and 2.5±0.7)(P=0.000). In the mid-secretory phase, the protein expression of integrin β3(2.0±0.9) and OPN (2.1±0.8)in eutopic endometrium of adenomyosis were significantly lower than that of control endometrium(2.7±0.5 and 2.7±0.7)(P<0.01). (2)The mRNA expression level of integrin β and OPN in eutopic and ectopic endometrium were assessed by quantitative real-time PCR(result was shown by median index). It was observed that integrin β3 mRNA and OPN mRNA were significantly lower in the eutopic endometrium of adenomyosis (4.69 and 4.23), when compared with ectopic endometrium(7.96 and 14.84)and controls (13.47 and 17.40) (P<0.05). Eutopic endometrium had higher mRNA expression of integrin β and OPN mRNA in the secretory phase (5.54 and 11.40) than that in the proliferative phase(2.69 and 3.30) (P<0.01).The mRNA expression level of integrin β and OPN of control endometrium in the proliferative phase (3.12 and 4.75)were significantly lower than that in the secretory phase(19.94 and 21.00, P=0.000). The mRNA expression of integrin β and OPN were 10.10 and 14.34 in the mid-secretory phase, which were significantly lower than 21.50 and 24.18 in control endometrium(P<0.05). Conclusions High expression of integrin β3 and OPN in ectopic endometrium of adenomyosis may cause endometriotic lesions; abnormal expression of integrin β3 and OPN in the endometrium of adenomyosis during the implantation window may contribute to infertility in some patients.     

冠心病患者脂代谢生化参数及斑块特征与冠脉CTA血流储备分数的相关性

探讨冠心病患者冠脉CT血管成像（CTA)血流储备分数（FFRCT）与斑块特征、脂代谢、蛋白酶分泌的相关性。方法 选取2019年1月—2020年6月在重庆市急救医疗中心接受冠脉CTA检查的冠心病患者54例,根据FFRCT值分为FRCT值＞0.80组32例,FFRCT值≤0.80组22例。测定FFRCT 及斑块特征参数（斑块长度、最小管腔面积、斑块总体积、脂质斑块体积、纤维斑块体积、钙化斑块体积）、脂代谢指标［低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）的含量,采用酶联免疫吸附法测定趋化素（Chemerin）、网膜素-1（Omentin-1）］、蛋白酶指标［基质金属蛋白酶（MMP）-2、MMP-9、组织蛋白酶K（CatK）、金属蛋白酶组织抑制剂（TIMP）-1、TIMP-2］。结果 FFRCT值＞0.8的冠心病患者的斑块长度、斑块总体积、脂质斑块体积及血清LDL-C、Chemerin、MMP-2、MMP-9、CatK含量均明显低于FFRCT值≤0.80的冠心病患者（P＜0.05）,血清HDL-C、Omentin-1、TIMP-1、TIMP-2含量明显高于FFRCT值≤0.80的冠心病患者（P＜0.05）,纤维斑块体积、钙化斑块体积、最小管腔面积与FFRCT值≤0.80的冠心病患者比较差异无统计学意义（P＞0.05）。FFRCT值与斑块长度、斑块总体积、脂质斑块体积、LDL-C、Chemerin、MMP-2、MMP-9、CatK具有负相关关系,与HDL-C、Omentin-1、TIMP-1、TIMP-2具有正相关关系。结论 冠心病患者FFRCT降低与斑块增大及稳定性下降、脂代谢紊乱、蛋白酶活性增加密切相关     

腹壁子宫内膜异位症179例诊治分析

目的探讨腹壁子宫内膜异位症(简称内异症)的临床特点及治疗。方法回顾性分析2006年1月至2017年12月北京大学第一医院诊治的179例腹壁子宫内膜异位症患者,分析患者的病史、症状、辅助检查、术中情况、手术疗效、复发率及临床特点之间的相关性。并按发病部位分为皮下型及肌肉型,是否合并盆腔子宫内膜异位症分为单纯组及合并内异症组,比较各组的临床特点。结果腹壁子宫内膜异位症平均发病年龄(33.8±4.4)岁,发病时间在剖宫产术后1个月～12年,中位数2年(1～4年),自出现症状至手术确诊时间为1个月～14年,中位数2年(1～4年)。179例患者中,96%(172/179例)的患者有不同程度的周期性下腹部切口周围疼痛及触痛包块的典型症状;75例患者检测了CA125,平均(30.3±18.0)U/ml,其中22例升高;超声诊断符合率73.2%(131/179)。皮下型和肌肉型分别占61.5%(110/179)和38.5%(69/179),合并内异症组占10.1%(18/179)。合并内异症组和肌肉型患者病灶大、术中需要放置补片的比例高(27.8%,5/18)。179例患者均手术治疗,随访时间10～132个月,33例失访。手术有效率100%(146/146),复发率6.2%(9/146),症状复现中位时间1年(0.75～3.5年)。结论腹壁内异症根据典型的症状、体征常可正确诊断,手术治疗是最佳选择,病灶位于肌层和合并盆腔内异症的患者病灶较大,术中必要时使用补片修补。