特发性胆汁淤积性肝炎患儿胆盐输出泵基因突变的检测

目的对特发性胆汁淤积性肝炎患儿的胆盐输出泵(BSEP)基因进行突变筛查。方法特发性胆汁淤积性肝炎患儿90例,采用聚合酶链反应—单链构象多态性(PCR-SSCP)检查结合DNA测序技术,检测BSEP基因的第7、8、11、12、14、15、18、21、26号外显子的突变情况。针对发现的突变位点,在71例健康婴儿中进行筛查以排除基因多态性。结果在2例患儿BSEP基因的第7外显子上检测到相同的杂合突变c.499G>T,导致基因编码的BSEP蛋白的第167位丙氨酸(Ala)被丝氨酸(Ser)所替代(p.A167S)。该位点的突变未在71例健康婴儿中发现,排除了BSEP基因的多态性。结论在特发性胆汁淤积性肝炎患儿中,发现一种新的BSEP基因突变,位点为c.499G>T。     

Short‐term Effect of Upstream Administration in Comparison to Deferred Injection of Tirofiban on Patients with Acute ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Background

High bolus dose tirofiban has been demonstrated to provide greater inhibition of platelet aggregation, but the most appropriate timing of its administration remains unknown.

Objectives

To evaluate the efficacy of upstream vs. deferred administration of tirofiban in patients with acute ST‐segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) on clinical outcomes.

Methods

The 660 patients with acute ST‐segment elevation myocardial infarction undergoing primary percutaneous coronary intervention were divided into upstream (n = 330, administration of tirofiban to all patients in emergency room) and deferred groups (n = 330, treatment of patients with large thrombus burden or no‐reflow phenomenon in cardiac catheterization laboratory during PCI). The primary end‐points were death, nonfatal myocardial infarction (MI), stent thrombosis (ST), revascularization of targeted vessels (TVR) or major adverse cardiac events (MACE) at 1 month and 6 months following PCI, with safety end‐point at 7 days.

Results

Compared with that of the deferred group, there was a significant increase of left ventricular ejection fraction (LVEF) in the upstream group within 7 days (55.5 ± 6.6% vs. 54.6 ± 7.9%, P = 0.011). The rates of 7‐day and 1‐month MACE in the upstream group were lower than those in the deferred group (1.5% vs. 4.2%, 3.3% vs. 7.0%, P = 0.037 and 0.034, respectively). However, there were higher tendencies for major and minor bleedings in the upstream group (1.8% vs. 0.9%, 2.7% vs. 1.5%, P = 0.315 and 0.280, respectively).

Conclusion

To the Chinese patients with acute myocardial infarction undergoing primary PCI, upstream administration of tirofiban was slightly superior to deferred injection for short‐term clinical outcomes.

     

阿托伐他汀强化降脂对冠心病患者血管内皮功能及颈动脉内膜中层厚度的影响

目的 观察冠心痛患者强化降脂后,血管内皮功能和颈动脉内膜中层厚度(CIMT)的变化.方法 随机将148例冠心痛患者分为阿托伐他汀常规剂量(10 mg/d)组72例,强化降脂(40 mg/d)组76例;分别于用药前及用药6个月后采空腹静脉血,测定总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C),高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG);以超声观察CIMT及肱动脉内皮依赖性舒张功能(FMD)的变化.结果 强化降脂组治疗后6个月,CIMT由用药前(1.52±0.19)mm降至用药6个月时的(1.42±0.20)mm,且治疗后与常规剂量组(1.51±0.19)mm比较差异有统计学意叉(均P＜0.05);两组FMD升高,TC、LDL-C水平降低,治疗后6个月的强化降脂组比常规剂量组更明显(P＜0.01).结论 强化降脂治疗能更有效地降低TC和LDL-C水平,改善内皮功能,降低CIMT,并具有良好的安全性.     

呼和浩特市流动人群艾滋病知识、态度和行为调查分析

目的　了解呼和浩特市流动人群对艾滋病（AIDS）相关知识的知晓情况、态度和行为状况。方法　本次调查选择长途卡车（长卡）司机和建筑工人2类人群,长卡司机采用定点抽样的方法,持续数周,直到完成所需样本量。建筑工人采取分层整群抽样,在各层内随机抽取建筑公司所需要的工地全部工人作为调查对象。对上述2种人群采用问卷调查方式收集相关的信息。结果　共调查长卡司机681人,其艾滋病传播途径知识知晓率为61.1%,非传播途径知识的知晓率- UNGASS指标（UNGASS指标:联合国艾滋病特别会议构建的核心指标）为13.5%。在工作、生活和学习中对艾滋病患者或感染者持歧视态度比率为71.1%。共调查建筑工人678人, 其艾滋病传播途径知识知晓率为56.6%,非传播途径知识的知晓率- UNGASS指标为13.0%。在工作、生活和学习中对艾滋病患者或感染者持歧视态度比率为74.8%。两类人群近1年有商业性行为的比例均在10%以上。结论　呼和浩特市流动人群对AIDS的相关知识的知晓率处于较低水平,且存在传播艾滋病性病的危险。对其实施干预的重点是普及艾滋病相关知识和提供安全套。     

Septal Dyskinesia and Global Left Ventricular Dysfunction in Pediatric Wolff‐Parkinson‐White Syndrome with Septal Accessory Pathway

LV Dysfunction in WPW Syndrome. Introduction: Echocardiographic studies have shown that some patients with Wolff‐Parkinson‐White (WPW) syndrome have myocardial dyskinesia in the segments precociously activated by an accessory pathway (AP). The aim of the present study was to determine the extent to which the AP contributes to global left ventricular (LV) dysfunction. Methods: Electrophysiological and echocardiographic data from 62 children with WPW (age at diagnosis = 5.9 ± 4.2 years) were retrospectively analyzed. Results: The left ventricular ejection fraction (LVEF) of patients with septal APs (53 ± 11%) was significantly lower than that of patients with right (62 ± 5%) or left (61 ± 4%) APs (P = 0.001). Compared to patients with normal septal motion (n = 56), patients with septal dyskinesia (n = 6) had a reduced LVEF (61 ± 4% and 42 ± 5%, respectively) and an increased LV end diastolic dimension (P < 0.001 for both comparisons). Multivariate analysis identified septal dyskinesia as the only significant risk factor for reduced LVEF. All 6 patients with septal dyskinesia had right septal APs, and a preexcited QRS duration that was longer than that of patients with normal septal motion (140 ± 18 ms and 113 ± 32 ms, respectively; P = 0.045). After RFA there were improvements in both intraventricular dyssynchrony (septal‐to‐posterior wall motion delay, from 154 ± 91 ms to 33 ± 17 ms) and interventricular septal thinning (from 3.0 ± 0.5 mm to 5.3 ± 2.6 mm), and a significant increase in LVEF (from 42 ± 5% to 67 ± 8%; P = 0.001). Conclusion: The dyskinetic segment activated by a right septal AP in WPW syndrome may lead to ventricular dilation and dysfunction. RFA produced mechanical resynchronization, reverse remodeling, and improvements in LV function. (J Cardiovasc Electrophysiol, Vol. 21, pp. 290–295, March 2010)     

山东省嘉祥县地方性氟中毒流行病学调查研究

目的了解山东省嘉祥县地方性氟中毒流行现状。方法采用流行病学抽样调查方法,对嘉祥县的郭庄等7个地方性氟中毒病村的居民饮水含氟量、8～12岁儿童氟斑牙检出情况、25岁以上成人临床与X线氟骨症检出情况及8～12岁儿童与成人尿氟水平进行调查。结果7个病村饮水含氟量有6个超过国家标准(≤1．0 mg/L),最高者达9．67 mg/L；8～12岁儿童及成人尿氟几何均值平均分别为3．52、4．49 mg/L,均明显超过正常上限值(1．50 mg/L)；8～12岁儿童氟斑牙检出率平均为73．1%,缺损率21．3%,氟斑牙指数1．60,病情最重的郭庄村氟斑牙检出率达93．9%,缺损率和氟斑牙指数分别为53．7%、2．45；对94例25岁以上成年人进行临床检查与X线拍片,临床氟骨症检出率及X线阳性检出率均为53．2%,并出现2例临床3度与8例X线Ⅲ期氟骨症患者,病情以郭庄村最重,氟骨症阳性检出率高达78．9%。结论嘉祥县地方性氟中毒病情仍然较重,尚未达到有效控制要求,应加大防治工作力度,以期早日摆脱高氟危害。     

应用高分辨率自由呼吸导航全心磁共振成像技术无创性评价冠状动脉舒张性能的初步研究

目的 分析自由呼吸导航全心MR冠状成像技术进行舌下含服硝酸甘油试验评价冠状血管舒张性能的可行性.方法 对18例志愿者,使用自由呼吸导航全心MR冠状动脉成像序列,完成舌下含服硝酸甘油前以及含服后的扫描,分别测量2次扫描的冠状动脉管腔截面积,测量节段包括左主干、左前降支近段、左回旋支近段及右冠状动脉近段,计算冠状动脉血管扩张率,并进行统计分析.结果 18例志愿者均完成使用硝酸甘油前后的扫描,无明显不适及过敏反应.全心自由呼吸导航MR冠状动脉成像能有效显示硝酸甘油的冠状动脉舒张效应,冠状动脉主要分支均可见扩张,硝酸甘油服用前/后的截面积测量如下:右冠状动脉近段为(11.7±4.4) mm2/(16.5±6.1) mm2 (P<0.05),左主干为(16.6±4.3) mm2/(23.2±7.2) mm2 (P<0.05),左前降支近段为(12.9±4.3) mm2/(17.8±6.7) mm2 (P<0.05),左回旋支近段为(10.6±3.0) mm2/(14.3±4.8) mm2 (P<0.05).服用硝酸甘油后冠状动脉血管的总体扩张率为(37.24±15.33)%.结论 自由呼吸导航全心MR冠状动脉成像技术能显示硝酸甘油诱导的冠状动脉血管扩张反应,有望成为一种无创性评价冠状动脉舒张能力的方法.     

老年慢性肾衰患者血液透析的疗效分析

目的 评估老年慢性肾衰患者血液透析的临床疗效。方法 总结92例老年慢性肾衰患者血液透析治疗后的生存率和死亡原因，心脑血管并发症的发生情况及与透析充分性和营养状况相关的指标。结果 老年血液透析患者的长期存活率逐步提高，死亡原因主要为心血管疾病、感染及严重营养不良，常见心血管并发症为低血压，透析充分性和营养情况有改善，但血清白蛋白仍明显低于非老年组。结论 施行个体化的透析和治疗，积极改善营养，减少感染，有助于减少老年透析患者的并发症发生和提高生存率。     

离子对液相色谱法测定人血浆中替米沙坦的浓度及药动学研究

目的建立测定人血浆中替米沙坦浓度的高效液相色谱方法,并用该法研究替米沙坦片在健康人体内的药动学。方法色谱柱为Sh im-pack VP-ODS(150mm×4.6mm),流动相为乙腈-0.05%戊磺酸钠-0.05 mol.L-1磷酸二氢钾(50∶25∶25),荧光检测,激发波长为305nm,发射波长为365nm。结果血浆样品在3.05~610.0μg.L-1内线性相关(r=0.9999,n=5)。平均绝对回收率为85.1%(RSD=1.63%),相对回收率大于95.0%,日间和日内相对标准差小于10.0%。10名男性健康志愿者单次口服80mg替米沙坦片后,其药代动力学参数分别为:t1/2(19.8±5.66)h,cm ax(310.7±91.6)μg.L-1,tm ax(1.01±0.40)h。结论此方法准确,灵敏,适于体内药物分析;药动学参数为临床合理用药提供理论依据。     

脑靶向性鼻腔给药的研究进展

鼻腔给药作为脑靶向给药的途径之一,可有效地使通过其他给药途径不易透过血脑屏障的药物绕过血脑屏障,靶向递送到脑部,为中枢神经系统疾病的治疗提供一种极有发展前景的给药途径.现从药物由鼻腔到脑的转运方式、影响因素、剂型、评价方法以及增强脑靶向性的方法等方面,对近年来鼻腔给药脑靶向性的研究进展进行综述.