膜型热循环双重血浆滤过治疗难治性高脂血症的护理

目的探讨膜型热循环双重血浆滤过（DFPP-thermal）治疗难治性高脂血症的临床效果及护理方法。方法对17例高脂血症患者实施DFPP-thermal治疗22例次。留取治疗前后的血标本，比较治疗前后血浆TC、TG、LDL、HDL和清蛋白水平的变化。治疗前做好心理护理，选择合适的血管通路，充分抗凝；治疗中严密监测并记录生命体征的变化和仪器显示的各种参数。结果血浆TC、TG、LDL水平与治疗前比较下降显著（均P〈0．01），而治疗前后HDL、清蛋白无明显改变（均P〉0．05）。治疗过程中未发生低血压等不良反应。11例患者主诉治疗后症状改善。结论DFPP-thermal血浆滤过疗法能显著改善难治性高脂血症患者的临床症状及血脂生化指标，护理干预措施可提高该治疗的安全性。     

氟伐他汀联合非诺贝特治疗糖尿病合并高血脂的临床疗效观察

目的探讨氟伐他汀联合非诺贝特治疗糖尿病合并高血脂的临床疗效。方法60例糖尿病合并高血脂患者随机分为治疗组及对照组各30例,两组患者均予常规降血糖治疗,对照组予氟伐他汀40mg,每晚一次,口服;治疗组同时加用非诺贝特200mg,每晚一次,口服。疗程8周。比较两组的疗效及两组患者治疗前后血脂和血糖的变化情况。结果治疗后治疗组患者的有效率达96．7％,明显高于对照组的疗效,差异具有显著性（Х^2=8．537,P〈0．05）。治疗8周后,两组患者的TC、TG、LDL—C、2hPG水平均较治疗前明显下降（P〈0．05）,且治疗组患者的TC、TG、LDL—C、2hPG水平较对照组降低更显著（P〈0．05）。而两组患者的HDL—C水平均较治疗前明显升高（P〈0．05）,且治疗组患者的HDL—C水平较对照组升高更显著（P〈0．05）。结论氟伐他汀联合非诺贝特治疗糖尿病合并高血脂的临床疗效确切,能够显著降低血脂及血糖水平,值得临床推广和应用。     

绞股蓝总苷颗粒改善高脂血症C57BL/6J小鼠脂代谢的研究

为评价绞股蓝总苷颗粒以及其与他汀联用的降血脂作用,采用高脂饲料诱导构建高脂血症C57BL/6J小鼠模型。随机分为空白组、模型组、阳性药组(Lip,10 mg/kg)、绞股蓝总苷颗粒低、中、高剂量组(L、M、H,90,120,180 mg/kg),联合组(Lip+H,180 mg/kg+10 mg/kg)。连续给药4周后检测血脂成分、血清ALT、AST及载脂蛋白B(Apo B)含量,H&E染色观察小鼠肝脏病理变化,利用RT-PCR法和Western blot法测定三磷酸腺苷结合盒转运体A1(ABCA1)、肝X受体(LXRα)、胆固醇7α-羟化酶(CYP7A1)和B族Ι型清道夫受体(SR-BΙ)等肝脏胆固醇代谢关键因子蛋白、基因表达水平。结果显示绞股蓝总苷颗粒能显著降低小鼠体重、腹部脂肪质量及血清总胆固醇(TC)、AST水平,并修复受损小鼠肝细胞;联合组能显著降低小鼠TC水平,效果优于绞股蓝总苷颗粒高剂量组和阳性药单用组。此外,绞股蓝总苷颗粒能显著升高ABCA1的蛋白水平,同时上调ABCA1、CYP7A1和SR-BΙ的基因表达。实验结果表明,绞股蓝总苷颗粒能够显著降低血脂,且与阿托伐他汀联用后降脂效果提高,并可降低血清转氨酶,初步探索其降脂机制可能是通过参与胆固醇逆转运调节TC含量。     

Dyslipidemia during sirolimus therapy in patients after liver transplantation

INTRODUCTION: Sirolimus (SRL) is an immunosuppressive agent of potential benefit in clinical liver transplantation (LTX). One of the major side effects of SRL is hyperlipidemia, which is reported in up to 44% of patients. In this report, we describe the lipid profiles of 20 stable liver transplant recipients who received SRL for immunosuppression. METHODS: The study group received SRL in combination with tacrolimus and/or mycophenolate mofetil (MMF). The control group was administered calcineurin inhibitor (CI) and MMF. Fasting serum cholesterol level, high-density lipoproteins (HDL) and low-density lipoproteins (LDL) were measured regularly. Furthermore, the total cholesterol/HDL ratio and the LDL/HDL ratio were evaluated. Diabetes and hypertension were monitored as well. RESULTS: In the SRL group, hypercholesterolemia was found in three patients (15%) and hypertriglyceridemia in two patients (10%). There was no marked difference from the control group, although a higher association of SRL with hyperlipidemia was described in the literature. Furthermore, HDL and LDL levels were similar in both groups, as well as total cholesterol/HDL ratio and LDL/HDL ratio. Diabetes and hypertension had a similar incidence in both the groups. Thus, there was no difference concerning the cardiovascular atherosclerosis risk between the immunosuppressive protocol with SRL or with CI. DISCUSSION: The results of our retrospective study demonstrated that the immunosuppressive regimen can potentially influence the incidence of hyperlipidemia in patients after LTX. SRL in combination with tacrolimus and/or MMF had no higher incidence of hyperlipidemia than CI and MMF. The combination of immunosuppressive therapy with low dose and low levels of each immunosuppressive agent could decrease the risk of atherosclerosis and its complications in long-term survivors after LTX.     

营养性高脂血症对雄性新西兰兔睾丸和阴茎发育的影响

目的:探讨营养性高脂血症对雄性新西兰兔睾丸和阴茎发育的影响。方法:雄性新西兰兔36只,随机分为实验组(n=20)和对照组(n=16),高脂饲料建立营养性高脂血症动物模型。全自动生化分析仪检测外周血总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C);放射免疫法检测外周血睾酮(T)、黄体生成素(LH)和卵泡刺激素(FSH);HE染色观察睾丸和阴茎发育的形态学改变。结果:与对照组比较,实验组TC、TG、LDL-C明显升高,T、LH和FSH水平明显降低,差异有极显著性(P<0.01);与对照组比较,实验组阴茎长度缩短(P<0.05),睾丸系数下降(P<0.01)。光镜下睾丸生精上皮破坏明显,阴茎组织有明显的脂肪细胞沉积。结论:幼年起摄入大量高脂食物极易诱发营养性高脂血症,并可造成下丘脑-垂体-性腺轴功能紊乱,导致阴茎发育短小,睾丸生精上皮破坏。     

妊娠合并急性胰腺炎42例的临床特征及诊疗分析

目的 分析妊娠合并急性胰腺炎(acute pancreatitis in pregnancy, APIP)的临床特征并总结诊疗经验。方法 对2013年1月—2019年12月同济大学附属第一妇婴保健院收治的42例APIP患者的资料进行回顾性分析。结果 24例为轻症胰腺炎（mild acute pancreatitis, MAP）组,14例为中重症胰腺炎（moderate to severe pancreatitis, MSAP）组,4例为重症胰腺炎（severe pancreatitis, SAP）组。其中SAP组的血淀粉酶、尿淀粉酶、C反应蛋白明显高于MSAP和MAP组,血钙值低于MSAP组和MAP组,38例病例发生于孕晚期。24例为高脂血症性胰腺炎,6例为胆源性疾病性胰腺炎,12例为特发性胰腺炎。高脂血症性胰腺炎中三酰甘油和胆固醇的值明显高于特发性和胆源性胰腺炎。产后CT和产前的MRI均可正确的诊断胰腺炎。B超的诊断的正确率偏低,仅为38%。42例急性胰腺炎合并妊娠孕妇经治疗均痊愈,新生儿仅有1例死亡。结论 高脂血症是妊娠合并胰腺炎的首要病因及影响预后的重要因素,早期诊断和个体化治疗,可以提高APIP患者的母儿结局。     

蜂胶对糖脂代谢的调节作用及机制研究进展

蜂胶具有广泛的生物学活性和药理学活性。论述了蜂胶对高脂血症及糖尿病的防治作用及调节糖、脂代谢的作用机制,以期为蜂胶在高脂血症及糖尿病防治领域的进一步研究和开发利用提供参考。     

Effect of detoxification, removing stasis and nourishing yin method on corticosteroid-induced hyperlipidemia in patients with systemic lupus rythematosus

Objective:To observe the effect of TCM therapy for detoxification,removing stasis,and nourishing yin on corticosteroid-induced hyperlipemia in patients with systemic lupus erythematosus (SLE),and to investigate its mechanism.Methods:One hundred and seventy patients with SLE were randomly assigned to the integrative medicine group (IM group) and the Western medicine group (WM group),85 in each group.Also,30 healthy subjects selected from blood donors were enrolled in the normal control (NC) group.All patients were treated mainly with prednisone, while those in the IM group were given TCM therapy additionally,and the therapeutic course for both groups was 6 successive months.The changes of serum total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-G),low density lipoprotein cholesterol (LDL-C),very low density lipoprotein cholesterol (VLDL-C) and apolipoprotein A (ApoA) were determined and observed.A 2-year follow-up study was carried out in 16 patients of the WM group and 25 of the IM group.Results:Before treatment,no significant difference had been found among the three groups in the serum levels of lipids and lipoproteins.After the 6-month treatment,as compared with the WM group,the IM group showed lower levels of TC,TG,LDL-C,and VLDL-C (P<0.05 or P<0.01) and higher levels of HDL-C and ApoA (P<0.05).A similar effect was also shown by the follow-up study in the IM group (P<0.05 or P<0.01). Conclusion:TCM therapy for detoxification,removing stasis,and nourishing yin can effectively regulate the levels of serum lipids and lipoproteins in preventing and treating SLE patients with corticosteroid- induced hyperlipemia.     

基于中医传承辅助平台探讨赵笑东主任治疗高脂血症用药规律

[目的]基于中医传承辅助平台,总结赵笑东主任临床治疗高脂血症的处方规律,探讨赵主任对吴门中医的传承与创新。[方法]收集2017年1月1日至2020年1月1日在苏州市中医医院赵笑东主任门诊就诊,并且诊断为“高脂血症”的患者的处方。筛选出符合标准的处方,对其中的中药进行规范,并录入中医传承辅助平台,经统计分析得出赵主任治疗高脂血症的治法治则、用药特色和规律。[结果]共筛选出152首处方,189味中药,使用次数最多的药物为蒲黄、姜黄、泽泻、莱菔子等。性味多为甘温,归经多属肝、脾。通过关联分析,得出最核心的药物组合为：蒲黄-姜黄、蒲黄-泽泻、姜黄-泽泻、蒲黄-姜黄-泽泻、莱菔子-蒲黄。通过新方分析,生成新处方11个。[结论]数据挖掘提示赵主任治疗高脂血症喜用甘温,重视肝脾,治疗原则以祛邪为主,兼以扶正,用药灵活,随证应变,对吴门医派治疗高脂血症的学术思想进行了传承创新。     

中国人混合型高脂血症患者脂蛋白脂酶常见基因变异的筛查

目的 研究中国人混合型高脂血症（CHL）患者脂蛋白基因变异情况。方法 应用多聚酶链反应（PCR）对广东地区156例混合型高脂血症患者脂蛋白脂酶基因的多态性进行了研究,检测的LPL基因突变位点有：-93T→Asn及Asn291→Swer突变。结果 156例混合型高脂血症患者均未检出上述突变基因。结论 在欧洲白种人存在的与混合型高脂血症相关联的LPL常见的基因变民可能与中国人混合型高脂血症无关。