长期服用缬沙坦对高血压患者动脉形态和功能的影响

目的:探讨长期服用缬沙坦对高血压患者动脉形态及功能的影响。方法:以彩色多普勒超声检测颈动脉内膜-中层厚度(IMT),测定未受干预状态下、肱动脉反应性充血时及含服硝酸甘油后颈动脉内径。按血清总胆红素(TBil)水平将89例患者分为低血清胆红素水平组(A组,n=58)和高血清胆红素水平组(B组,n=31),比较2组IMT和颈动脉内径的变化。连续服用缬沙坦36mo后检测颈动脉IMT和3种状态下的颈动脉内径,并与治疗前比较。结果:89例患者血清TBil水平均在正常范围内,A组TBil水平显著低于B组,A组IMT值显著高于B组。服用缬沙坦8wk后血压能控制在140/90mmHg以下且保持平稳。治疗36mo后,A、B组的颈动脉IMT较治疗前均显著降低。A组治疗前肱动脉反应性充血时颈动脉内径的变化率显著低于B组,治疗后均显著升高;含服硝酸甘油后颈动脉内径的变化在治疗前后无显著意义。结论:血清胆红素对动脉形态与功能具有保护作用。血管紧张素Ⅱ受体拮抗药缬沙坦在平稳降压的同时,能保护血管内皮细胞,改善血管内皮依赖性舒张功能,延缓甚至逆转IMT的进展。     

新生儿行为神经测定联合儿心量表在预测胆红素神经毒性中的价值探讨

目的探讨新生儿行为神经测定（NBNA）联合儿心量表在预测胆红素神经毒性中的价值。方法将2006年1～12月收治的足月无缺氧、窒息病史的高胆红素血症患儿76例，根据脑干听觉诱发电位（ABR）表现分成A、B、C三组，比较三组患儿治疗前、治疗后7、14d的NBNA总分及随访至1岁行儿心量表检测的发育商（DQ），分析NBNA及儿心量表与ABR的相关性。结果与A、B组比较，C组NBNA及儿心量表明显异常，可见NBNA及儿心量表与ABR的异常密切相关。结论NBNA联合儿心量表是预测胆红素神经毒性的良好指标。     

新生儿血清胆红素与肌酸激酶同工酶的关系

目的观察新生儿血清胆红素与肌酸激酶同工酶(CK-MB)的关系,探讨新生儿血清胆红素与心肌损害的关系。方法对40例正常新生儿、40例生理性黄疸新生儿、40例病理性黄疸新生儿的CK-MB水平进行测定并比较。结果正常组新生儿的CK-MB水平与生理性黄疸组、病理性黄疸组的比较差异均有统计学意义(P<0.01),生理性黄疸组与病理性黄疸组间差异亦有统计学意义(P<0.01)。结论高胆红素可引起心肌损害,血清CK-MB可作为胆红素对心肌细胞损伤的一个重要生化指标。     

肝复康滴丸对大鼠利胆作用的实验研究

目的:观察肝复康滴丸对大鼠的利胆作用,为临床应用提供理论依据。方法:利用胆管引流法测定肝复康滴丸对大鼠胆汁流量及胆固醇和胆红素分泌的影响。结果:肝复康滴丸各剂量组各个时间点均能增加胆汁流量,以中剂量组药后1h差异最为显著(P<0.01);各剂量组胆汁中胆红素及胆固醇含量均不同程度的降低,以中剂量组的差异最为显著(P<0.01)。结论:肝复康滴丸能增加胆汁流量,抑制胆固醇和胆红素的分泌,提示肝复康滴丸具有利胆作用。     

Hematin and Bilirubin Binding to Human Serum Albumin and Newborn Serum

ABSTRACT. In jaundiced newborn infants, hemolytic disease is considered a risk factor for kernicterus due to the suspected competition between bilirubin and other hemoglobin breakdown products for albumin binding. We have studied the effect of hematin on bilirubin-albumin binding using the peroxidase assay and a light-scattering technique for measuring unbound bilirubin. Our results show that hematin does not affect bilirubin-albumin binding. To determine if other albumin binding functions are affected by hematin, we used a microdialysis rate technique employing two ligands, diazepam and monoacetyldiaminodiphenyl sulfone (MADDS). Hematin does not utilize the diazepam binding function of albumin, but does decrease the albumin binding of MADDS. The results of this study indicate that the MADDS and bilirubin binding functions are not identical. The clinical usefulness of reserve albumin equivalent determination using MADDS is discussed.     

反相高效液相色谱法测定体外培育牛黄中胆红素的含量

目的建立反相高效液相色谱法测定体外培育牛黄中胆红素的含量。方法固定相:HypersilC18色谱柱(4.6mm×250mm,10μm);流动相:二甲基亚砜-乙腈-0.5mol.L-1醋酸铵溶液(用冰醋酸调节pH值为5.3)(6∶6∶7);流速1.0mL.min-1;检测波长:452nm。结果胆红素在0.028~0.450mg.mL-1的浓度范围内,线性关系良好(r=0.9999);胆红素平均回收率(n=9)分别为98.8%(RSD=0.68%),98.3%(RSD=1.55%),99.0%(RSD=0.77%)。结论该含量测定方法快速,准确,有效,可用于体外培育牛黄的质量控制。     

血清胆红素水平与冠状动脉粥样硬化的关系

目的：研究血清胆红素水平与冠状动脉粥样硬化的关系。方法：选取66例临床疑诊冠心病而择期行冠状动脉造影的病人。同时记录患者血清总胆红素。按照血管狭窄支数以及Gensini评分来评价冠脉血管病变严重程度。结果：Gensini积分的第一4分位组患者血清总胆红素水平明显高于第二、三、四4分位组（P〈0.05）。结论：血清总胆红素与冠脉病变的严重程度呈一定的负相关性。     

冠心病患者血清胆红素和尿酸的变化及相关性

目的：观察冠心病患血清胆红素，尿酸含量变化及其临床意义。方法：采用比色法及酶法测定39例冠心病患及30例健康（对照组）血清胆红素，尿酸含量。结果：冠心病患血清直接胆红素，尿酸含量较对照组明显升高（P＜0．01），血清间接胆红素含量明显低于对照组（P＜0．01），血清总胆红素与对照组比较差异无显性（P＞0．05）；心肌梗死组血清总胆红素，直接胆红素，间接胆红素及尿酸含量与心肌缺血组比较无显性差异（P＞0．05）；心肌缺血组心功能Ⅲ-Ⅳ级患血清尿酸含量较心功能Ⅰ-Ⅱ级患升高显（P＜0．05），血清总胆红素，直接胆红素，间接胆红素含量变化与心功能分级关系不明显；经相关分析，冠心病患血清总胆红素，直接胆红素，间接胆红素与尿酸含量间无相关性（P＞0．05）。结论：胆红素，尿酸在冠心病的发病中可能起重要作用。     

Effect of melanin, oxyhemoglobin and bilirubin on transcutaneous bilirubinometry

To determine the effect of skin pigments on transcutaneous bilirubinometer readings, we measured the effect of bilirubin, melanin, and oxyhemoglobin solutions on transcutaneous bilirubinometer readings in vitro. Our results showed that the variability of the readings in vitro was related to the instrument's non-linear response to bilirubin and melanin concentration and an inacurate oxyhemoglobin correction factor. These factors should be considered in developing a more accurate non-invasive method of monitoring serum bilirubin concentration.     

The role of enteral nutrition in the reversal of parenteral nutrition-associated liver dysfunction in infants

Background

Liver dysfunction in children dependent on parenteral nutrition (PN) is well established, and the extent of hyperbilirubinemia has been shown to correlate with morbidity and mortality. The aim of this study was to assess whether increasing provisions of enteral nutrition can improve PN-associated hyperbilirubinemia over time.

Methods

A retrospective review was conducted on infants in our institution's Short Bowel Syndrome Clinic from 1999 to 2004. Inclusion criteria included PN duration more than 1 month, serum direct bilirubin more than 3 mg/dL while on PN, and tolerance of full enteral nutrition with eventual discontinuation of PN. Paired t tests were used for statistical analyses.

Results

Twelve infants were identified with a PN duration of 5 ± 1 months. Five patients underwent liver biopsy while on PN, and histological evidence of cholestasis was found on all specimens. Peak total and direct bilirubin levels were 10.5 ± 1.9 and 7.0 ± 1.6 mg/dL, respectively, and occurred at time of PN discontinuation. Only 2 patients had improvement in serum bilirubin levels before initiation of full enteral nutrition. After initiation of full enteral nutrition and discontinuation of PN, all patients achieved permanent normalization of bilirubin levels by 4 months (P < .05) after a 1-month plateau phase. Alkaline phosphatase levels approached reference range within this time but were not significant.

Conclusion

These data demonstrate for the first time that although PN-dependent infants can achieve normalization of marked hyperbilirubinemia with enteral nutrition, the improvement in liver function usually begins only after full enteral nutrition is tolerated and PN is withdrawn. These findings support the aggressive weaning of PN to enteral nutrition in infants with short bowel syndrome.