血栓通联合弥可保治疗糖尿病周围神经病变34例疗效观察

糖尿病周围神经病变（DPN）是糖尿病常见的慢性并发症之一，病程在10年以上者患病率高达40％～80％，发生率占糖尿病患者总数的4％～5％，但经神经电生理检测，其患病率可高达90％以上，严重影响患者的生活质量。甚至可以致残。近年来，我们采用弥可保与血栓通联合治疗糖尿病神经病变患者34例，取得良好效果，现报告如下。     

冠心病患者血浆白细胞介素10、18和C反应蛋白的变化及其意义

目的:探讨血浆白细胞介素(IL)-10,IL-18和C反应蛋白(CRP)在冠心病(CHD)发病过程中的作用及其临床意义。方法:采用酶联免疫双抗体夹心法(ELISA)对106例CHD患者[急性心肌梗塞(AMI)36例,不稳定型心绞痛(UAP)30例,稳定型心绞痛40例(SAP)]和32例正常人血浆中IL-10,IL-18和CRP的浓度进行检测。并根据Gensini积分,106例CHD患者又被分为A组(Gensini积分26分)、B组(Gensini积分26~54分)和C组(Gensini积分54分),对各组上述指标进行比较。结果:CHD患者的SAP组、UAP组、AMI组血浆IL-10水平依次为[(115.56±53.11)pg/ml、(86.00±30.55)pg/ml、(72.38±19.55)pg/ml],IL-18水平依次为[(217.53±95.83)pg/ml、(327.93±80.36)pg/ml、(430.28±71.62)pg/ml]和CRP水平依次为[(0.61±0.38)mg/L、(0.84±0.44)mg/L、(1.72±0.67)mg/L],均分别显著高于正常对照组[(49.58±19.82),(154.97±88.65),(0.46±0.34)mg/L,P均0.05]。冠心病C组血浆IL-18(389.21±93.55),CRP(0.86±0.48)水平明显高于B组[(331.32±106.59),(0.62±0.38)]及A组[(250.20±106.89),(0.42±0.34)];B组的显著高于A组的(P均0.05)。结论:虽然IL-10作为冠心病的保护因子水平升高,但不足以阻止冠心病的发生、发展,IL-18和CRP水平与冠心病的发生发展相关,其水平的检测对冠心病诊断及病情判断有重要意义。     

围生期心肌病发病相关因素的研究

Objective To explore the risk factors of peripartum cardiomyopathy (PPCM). Methods A total of 82 PPCM and 100 normal delivery females were randomly recruited in the current study. Echocardiographic, cTNI,high sensitive C-reaction protein(hs-CRP) ,NT-proBNP were measured. Fifty-two patients were followed up for a mean of 6 months. Results The PPCM patients (29. 5 ± 6. 4) yrs were older than the controls (25. 2 ± 5. 8) yrs (P<0.01) . Compared to the controls, the PPCM patients showed higher blood pressure (146.9/98. 8 mm Hg v. s. 130. 2/80. 1 mm Hg, P < 0. 01) , higher proportion of cesarean section (65. 9% v. s. 51. 0% , P < 0. 05) and complicated infection(75. 6% v. s. 10. 0% ,P <0. 01). The level of leucocyte(11.0 × 109/L) ,cTNI(0. 17 μg/L), hs-CRP(28. 2 mg/L)and NT-proBNP(650. 1 ng/L) were significantly higher in the PPCM patients compared with control(8. 8 × 109/L,0. 06μg/L,6. 2 mg/L and 110. 5 ng/L,P <0. 01). Hs-CRP was positively related with NT-proBNP(r = 0. 67, P < 0. 01). After average of 6 months of treatment, left ventricular ejection fraction enhanced from 32. 2% to 50. 6%. NT-proBNP significantly declined from 650. 1 ng/L to 225.6 ng/L(P <0. 01). Multiple linear regression analysis showed that diastolic pressure (P < 0. 05), LVED (P < 0. 05) and hs-CRP (P < 0. 05) were the independent predictors for declined NT-proBNP. Conclusions Inflammatory plays an important role in the development of peripartum cardiomyopathy.     

围生期心肌病发病相关因素的研究

目的 探讨围生期心肌病(PPCM)发病的相关因素.方法 时82例PPCM患者进行流行病学调查,检查心脏彩超,测定肌钙蛋白I(cTNI)、高敏C-反应蛋白(hs-CRP)、N末端B型利钠肽(NT-proBNP)等指标,并随机对其中52例患者进行了平均6个月的随访.对照组选用同期住院的正常分娩患者.结果 PPCM患者与对照组相比,年龄较大[分别为(29.5±6.4)岁和(25.2±5.8)岁,P<0.01],血压较高(分别为146.9/98.8 mm Hg和130.2/80.1 mm Hg,P<0.01),剖宫产比例较高(分别为65.9%和51.0%,P<0.05),合并感染率明显升高(分别为75.6%和10.0%,P<0.01),实验室检查白细胞(分别为11.0×109/L和8.8×109/L,P<0.01)、cTNI(分男q为0.17μg/L和0.06μg/L,P<0.01)、hs-CRP(分别为2 8.2ms/L和6.2 mg/L,P<0.01)、NT-proBNP(分别为650.1 ng/L和110.5 ns/L,P<0.01)明显升高,hs-CRP和NT-proBNP呈正相关(r=0.67,P<0.01).经过平均6个月的治疗,平均射血分数由32.2%提高至50.6%,NT-proBNP明显下降(治疗前、后分别为650.1 ng/L和225.6 ng/L,P<0.01),NT-proBNP下降的独立影响因素为舒张压下降(P<0.05)、左心室舒张末径缩小(P<0.05)和hs-CRP下降(P<0.05).结论 炎症反应在围生期心肌病发病中起了重要的作用.     

缬沙坦对高血压并发肾功能损害及左室肥厚的影响

目的 研究缬沙坦对原发性高血压(EH)患者的降压作用和对左心室肥厚(LVH)及肾功能的影响.方法 选择60例EH合并LVH及肾功能损害患者,口服缬沙坦80～160 mg/d,疗程12周.观察血压、不良反应,治疗前后测血脂、血糖、肾功能,并作二维超声心动图检测,采用自身前后对照的方法.结果 EH患者经缬沙坦治疗后收缩压、舒张压显著下降(P≤0.01),舒张末期室间隔厚度、舒张末期左室后壁厚度、左室重量指数较治疗前明显下降(P≤0.01).24 h尿白蛋白、24 h尿蛋白、血尿素氮均较治疗前明显下降(P≤0.01).结论 缬沙坦治疗EH安全有效,并且可逆转LVH及保护肾功能.     

吗啡、乌拉地尔静脉缓注治疗急性肺水肿疗效分析

急性心源性肺水肿是临床危重急症，需积极抢救。我们观察在常规治疗的基础上采用小剂量吗啡与乌拉地尔联合静脉缓慢推注，其抢救成功率令人满意，且对心率无恶性影响。     

阿托伐他汀对不稳定型心绞痛患者巨噬细胞集落刺激因子及氧化低密度脂蛋白的影响

目的观察阿托伐他汀对不稳定型心绞痛患者巨噬细胞集落刺激因子及氧化低密度脂蛋白的影响。方法采用酶联免疫法检测试验组和对照组的血清M-CSF、ox-LDL水平。结果2组治疗后各指标较治疗前有显著性差异(P<0.05),而试验组血清M-CSF、ox-LDL下降幅度明显大于对照组(P<0.05)。试验组治疗前M-CSF与ox-LDL成正相关(r=0.49,P<0.05),治疗后M-CSF下降幅度与ox-LDL下降幅度亦呈正相关(r=0.61,P<0.05)。结论阿托伐他汀可明显降低不稳定型心绞痛患者血清M-CSF、ox-LDL水平,抑制了炎症过程,稳定了斑块。     

围生期心肌病发病相关因素的研究

Objective To explore the risk factors of peripartum cardiomyopathy (PPCM). Methods A total of 82 PPCM and 100 normal delivery females were randomly recruited in the current study. Echocardiographic, cTNI,high sensitive C-reaction protein(hs-CRP) ,NT-proBNP were measured. Fifty-two patients were followed up for a mean of 6 months. Results The PPCM patients (29. 5 ± 6. 4) yrs were older than the controls (25. 2 ± 5. 8) yrs (P<0.01) . Compared to the controls, the PPCM patients showed higher blood pressure (146.9/98. 8 mm Hg v. s. 130. 2/80. 1 mm Hg, P < 0. 01) , higher proportion of cesarean section (65. 9% v. s. 51. 0% , P < 0. 05) and complicated infection(75. 6% v. s. 10. 0% ,P <0. 01). The level of leucocyte(11.0 × 109/L) ,cTNI(0. 17 μg/L), hs-CRP(28. 2 mg/L)and NT-proBNP(650. 1 ng/L) were significantly higher in the PPCM patients compared with control(8. 8 × 109/L,0. 06μg/L,6. 2 mg/L and 110. 5 ng/L,P <0. 01). Hs-CRP was positively related with NT-proBNP(r = 0. 67, P < 0. 01). After average of 6 months of treatment, left ventricular ejection fraction enhanced from 32. 2% to 50. 6%. NT-proBNP significantly declined from 650. 1 ng/L to 225.6 ng/L(P <0. 01). Multiple linear regression analysis showed that diastolic pressure (P < 0. 05), LVED (P < 0. 05) and hs-CRP (P < 0. 05) were the independent predictors for declined NT-proBNP. Conclusions Inflammatory plays an important role in the development of peripartum cardiomyopathy.     

风心病合并便血误诊1例

患者女性,61岁。因腹痛、腹泻3d,便血1d于2005年8月25日入我院消化内科。入院前3d,无明显原因出现腹痛,阵发性绞痛,以脐周明显,伴腹泻,4~5次/d,稀糊状便,无里急后重感,排便上腹痛可缓解。1d前,出现鲜红血便,约10余次,量少伴右腹痛明显,乏力、心悸,尿量减少。既往风湿性心脏病史