血清HCY及OX—LDL水平与急性脑梗死的相关性分析

目的探讨同型半胱氨酸（homocysteine，HCY）及氧化低密度脂蛋白（oxidized low density lipoprotein，OX—LDL）与急性脑梗死（acute cerebral infaretion，ACI）的相关性。方法选择2009年1月至2010年5月我院住院ACI患者175例为ACI组，同期健康体检者100例为对照组。将ACI组按梗死直径分为小梗死组35例，巾梗死组54例，大梗死组86例。以酶循环法检测受检者血清中HCY水平，用ELISA法检测OX—LDL水平。结果ACI各组吸烟及高血压、高皿脂和糖尿病的检出率均高于对照组，且差异均有统计学意义（P均〈0．01）。ACI各组血清HCY及OX—LDL水平均高于对照组，且差异均有统计学意义（P均〈0．01），且组间两两比较差异亦均有统计学意义（P均〈0．01）。ACI患者血清HCY与OX—LDL含量呈正相关（r=0．901，P〈0．05），且含量高低与病情严重程度有密切天系。结论血清HCY、OX—LDL水平与ACI的发生发展有明显的相关性。     

Experimental immunotherapeutic approaches for atherosclerosis

Therapeutic options in atherosclerosis have largely been limited to the control of risk factors, such as hypercholesterolemia, hypertension, or diabetes. However, atherosclerosis is a chronic inflammatory disease in which dyslipidemia and inflammation are equally involved in disease pathogenesis. Moreover, abundant epidemiological and experimental evidence point to an important modulatory role of innate and adaptive immunity in atherogenesis, providing novel therapeutic targets for this disease. Indeed, there is now accumulating data in animal models demonstrating the potential for immunotherapeutic approaches to treat atherosclerosis. These include both general and antigen-specific ways of modulating immune functions, and they show great promise for the development of alternative and/or adjuvant therapies for atherosclerosis.     

血清对氧磷酯酶联合氧化低密度脂蛋白在缺铁性贫血的临床意义

目的探讨血清对氧磷酯酶1（PON1）在缺铁性贫血中的意义。方法测30例缺铁性贫血（IDA）患者血清PON1和氧化低密度脂蛋白（OX-LDL）的水平，并与33例健康对照组比较。结果30例IDA患者PON1值为78．9±6．4U／L，明显低于对照组PON1（147．1±8．2U／L）；而OX-LDL水平为640．1±168．9μg/L，明显高于健康对照组（390．9±199．6μg／L），差别具有统计学意义（P〈0．01）。相关性分析发现，IDA组PON1活性与OX-LDL含量存在明显的负相关（r=-0．598，P〈0．01）。结论PON1活性下降，OX-LDL升高．提示IDA患者体内抗氧化防御体系缺陷，脂质发生过氧化反应，存在动脉粥样硬化的高风险。     

三七皂苷对氧化低密度脂蛋白损伤血管内皮细胞保护作用的研究

目的:研究三七皂苷(PNS)对氧化低密度脂蛋白(Ox-LDL)损伤血管内皮细胞的保护作用。方法:体外培养人脐静脉内皮细胞(HUVEC),加入100mg·L-1Ox-LDL造成细胞损伤,同时加入不同浓度PNS进行干预。观察形态学变化;采用MTT法测定细胞活性;比色法检测细胞上清液中乳酸脱氢酶(LDH)的释放量;硝酸还原法和放射免疫法分别测定HUVEC培养上清液中一氧化氮(NO)、内皮素(ET)含量。结果:各剂量PNS可使作用Ox-LDL的HUVEC形态趋于正常。与正常对照组比较,HU-VEC经Ox-LDL作用后,细胞活性显著下降,LDH的释放量显著升高;300、100、30mg·L-1PNS显著升高细胞活性,抑制LDH释放。HUVEC经Ox-LDL作用后,与正常对照组比较,培养上清液中NO含量显著降低,ET含量显著升高;300、100mg·L-1PNS显著升高NO含量,300mg·L-1PNS显著降低ET含量。结论:PNS对Ox-LDL损伤的血管内皮细胞具有一定的保护作用,可调节内皮细胞活性物质NO、ET的分泌。     

关于住院病案修改和修改原则的讨论

文章重点围绕住院病历的修改问题提出以下几点意见:1住院病历是非常重要的医疗资料,修改是保证书写质量的基本方法2修改的形式和方法依据住院病历质量内涵的不同有不同的要求3修改是通过多种形式和不同级别医务人员共同完成4修改必须在一定的限制和原则基础上进行。     

动脉触摸法在锁骨下静脉置管术中的改良定位价值

目的探讨动脉触摸法在锁骨下静脉置管术中的定位应用价值。方法共124例研究对象,并随机分为传统定位法和动脉触摸定位法组（改良组）。动脉触摸定位法组通过参照触摸锁骨下动脉进行穿刺点定位。结果传统定位法组发生误穿动脉5例,动脉触摸定位法组未发生误穿动脉。两组误穿动脉发生率比较差异有统计学意义（χ^2=5.210,ν=1,P=0.022）。传统定位法组的穿刺失败率高于动脉触摸定位法组（χ^2=3.916,ν=1,P=0.048）。结论动脉触摸定位法可有效降低锁骨下静脉穿刺失败率及避免误穿动脉的发生,在将来临床工作中应予以推荐。     

不良心境与冠心病患者血清氧化低密度脂蛋白相关性

目的探讨不良心境对冠心病(CHD)患者血清氧化低密度脂蛋白(ox-LDL)浓度影响,及其相关性。方法110例住院冠心病患者和40名健康体检者(对照组)作为研究对象。用焦虑自评量表(SAS)、抑郁自评量表(SDS)、焦虑状态-特质问卷(STAI)制定不良心境标准。以不良心境标准为分组依据,将入组的CHD患者分为严重不良心境组(31例)、一般不良心境组(37例)、无明显不良心境组(42例)。酶联免疫吸附试验(ELISA)法测CHD患者血清ox-LDL的水平。用t检验和Pearson直线相关分析法进行统计分析。结果1.严重不良心境组、一般不良心境组、无明显不良心境组CHD患者血清ox-LDL水平[分别为(0.63±0.20)mg/L,(0.52±0.14)mg/L,(0.51±0.11)mg/L]明显高于正常对照组[(0.44±0.19)mg/L],严重不良心境组CHD患者的血清ox-LDL浓度明显高于一般不良心境组、无明显不良心境组,差异有显著性(P<0.05)。一般不良心境组、无明显不良心境组血清ox-LDL差异无显著性(P>0.05);2.严重不良心境组CHD患者血清ox-LDL浓度与不良心境显著正相关(r=0.398,P<0.05)。3.冠心病患者血清ox-LDL与总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)浓度呈显著正相关(r=0.395~0.459,P<0.05),与高密度脂蛋白胆固醇(HDL-C)呈显著负相关(r=-4.07,P<0.05)。结论不良心境能促进CHD的发生发展,是诱发CHD的危险因素。     

Oxidized LDL metabolites with high family risk for premature cardiovascular disease

Objective: Considering the importance of primary prevention of Cardiovascular Disease (CVD) from childhood, especially in children with high family risk for premature atherosclerosis, and also the importance of oxidized LDL in the process of atherosclerosis, the main metabolites of ox-LDL i.e. Malondialdehyde (MDA) and Conjugated diene (CDE) have been measured in children of high risk families and compared with a control group.Methods: Children and adolescents (6–18 years) of parents with premature myocardial infarction (Ml ≤ 55y in men and ≤ 65y in women), were selected as the case group. The control group included neighbors of the case group matched for age and socioeconomic status. All samples have been selected by simple random sampling. Both the case and control groups were divided in two subgroups : those with a total cholesterol and/or LDL-C ≥95th centile and those with normal lipid levels. Each subgroup consisted of 32 subjects, so 128 subjects were studied (64 in the case and 64 in the control group). MDA and CDE were measured by spectrophotometry using molar absorbivity. Data were analyzed by SPSS_v10/Win software using ANOVA, Bon-ferroni, Scheffe-Duncan, Tukey-HSD, and the Student’s t-test.Result: The mean MDA value in the case and control groups was significantly different (1.84 ± 0.43 vs. 1.67 ± 0.41 Μmol/L, p=0.03), but this difference was not significant regarding the mean CDE level (0.50 ± 0.05 vs. 0.47 ± 0.04 Μmol/ L, p>0.05). The mean MDA level in the case group with hyperlipidemia was significantly higher than that in the case group without hyperlipidemia (1.985 ± 0.516 vs. 1.690 ± 0.366, Μmol/L, P=0.02) and also higher than control group with or without hyperiipidemia (1.985 ± 0.516 vs. 1.720 ± 0.389,1.615 ± 0.429 Μmol/L respectivety, P<0.05). The mean CDE level in the case group with hyperiipidemia was significantly higher than the case group without hyperlipidemia (0.542 ± 0.034 vs. 0.494 ± 0.049 Μmol/L, P=0.04) and higher than the control group with or without hyperiipidemia (0.542 ± 0.034 vs. 0.464 ± 0.051, 0.484 ±0.048 Μmol/L respectively, p<0.05). In case boys with hyperiipidemia, the mean MDA (2.03 ± 0.2 Μmol/L) and the mean of CDE (0.56 ± 0.04 Μmol/L) was significantly higher than other subgroups (P<0.05).Conclusion: Considering the increased susceptibility of LDL to oxidation in children with high family risk for premature CVD, special attention should be paid to consumption of foods and seasoning containing antioxidants from childhood especially in high risk families.     

大豆异黄酮对体外血管内皮细胞氧化损伤保护作用的形态学观察

目的：从形态学角度观察大豆异黄酮（SI）对氧化修饰低密度脂蛋白（ox-LDL)诱导的血管内皮细胞（ECV）损伤的保护作用。方法：体外培养人脐静脉血管内皮细胞（ECV），将细胞分为5组，即氧化损伤对照组（ox-LDL），氧化损伤加入维生素E对照组（VE＋ox-LDL），氧化损伤加入大豆异黄酮低，中，高浓度组（SL－L＋ox-LDL，SI－M＋ox-LDL，SI－H＋ox-LDL。用ox-LDL作用于加入VE及不同浓度SI孵育24h的内皮细胞，继续培养24h，测定各组细胞活力（MTT），观察各组细胞一般形态和超微结构的变化。结果：加入VE及SI各浓度组细胞MTT（OD值）明显高于ox-LDL组，差异有显著性（P＜0．01）；而VE ox-LDL组与（SL－L，M，H）＋ox-LDL组间，MTT（OD值）无显著性差异（P＞0．05）。光镜观察结果显示ox-LDL组细胞收缩，变圆，细胞间隙增宽，而加入VE及SI可使细胞形态有不同程度的恢复，细胞间隙减小。扫描电镜观察显示ox-LDL组细胞膜有破损，细胞表面绒毛减少甚至消失，加入VE及SI可使细胞恢复近似正常状态，铺片良好，胞膜完整，细胞间有突起互相连接。结论：SI对血管内皮细胞氧化损伤具有一定的保护作用，而且SI与VE之间无显著性差别。     

Postoperative paraplegia secondary to the use of oxidized cellulose (Surgicel)

Iatrogenic paraplegia after thoracic surgery is a devastating complication. In this report, the authors present a case of paraplegia in a toddler after the resection of a mediastinal neuroblastoma. In this case, the paraplegia was caused by spinal cord compression after migration of oxidized cellulose into the spinal canal.