注射用还原型谷胱甘肽治疗酒精性肝病患者前后ALT、AST、GGT的变化

目的观察注射用还原型谷胱甘肽（阿拓莫兰）注射液治疗酒精性肝病患者前后血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、γ-谷氨酰转移酶（GGT）的变化。方法49例酒精性肝病患者随机分为对照组（24例）和治疗组（25例）,两组患者均在戒酒的基础上给予甘草酸二铵、丹参等基础治疗。治疗组加用阿拓莫兰,疗程21d。分别采集患者治疗前后的血清标本,做ALT、AST、GGT检测。结果两组治疗后与治疗前比较,ALT、AST、GGT明显改善,差异有统计学意义（P〈0．05）;两组治疗后比较,治疗组ALT、AST、GGT改善明显[分别为（42±9）U／L比（99±53）U／L、（49±19）U／L比（135±42）U／L、（67±217）U／L比（189±47）U／L],差异有统计学意义（P〈0．05）。结论阿拓莫兰治疗酒精性肝病疗效确切,ALT、AST、GGT指标改善明显。     

特发性肺纤维化和结节病患者基质金属蛋白酶的变化及其临床意义

Objective To detect the levels of matrix metalloprotease(MMP)-1 and MMP-7 in the serum and the bronchoalveolar lavage fluid(BALF)of patients with idiopathic pulmonary fibrosis(IPF)and sarcoidosis(Stage Ⅱ),and therefore to investigate the significance of these changes in the pathogenesis of IPF. Methods Forty-four clinically confirmed cases of IPF were recruited,with the patients'age ranging from 46 to 70 years(58±9 years).Twenty patients with sarcoidosis,aged 35 to 65(50±12)years,were also studied.Enzyme-linked immunoabsorbent assay was used to detect the levels of MMP-1 and MMP-7 in the serum and the BALF samples. Results In the serum of patients with IPF,the level of MMP-1 [3.78 (0.14-13.44) μLg/L]was lower than that in patients with sarcoidosis[7.79(4.67-10.68)μg/L(z=-3.53,P<0.01)],but the level of MMP-7[7.83(3.57-14.37) μg/L]was higher than that in patients with sarcoidesis[4.04(0.06-9.94)μg/L(z=-3.84,P<0.01)].In the BALF of patients with IPF,the level of MMP-1 [1.09(0.04-5.14)μg/L]was lower than that in patients with sarcoidosis [2.08(0,05-4.16)μg/L(z=-1.53,P>0.05)],but the level of MMP-7[3.75(1.10-9.87)μg/L]was highet than that in patients with sarcoidosis[1.16(0.02-4.47)μg/L(x=-5.33,P<0.01)].The serum level of MMP-7 in patients with IPF was negatively correlated with the diffusing capacity of carbon monoxide(r=-0.56,P<0.01)and the percentage of neutrophils(r=-0.47,P<0.01).The level of MMP-7 in the BALF showed a negative correlation with diffusing capacity of carbon monoxide(r=-0.31,P <0. 05). Conclusions The results suggest that MMP-1 may be increased in the inflammatory phase as compared to the matrix remodeling phase of lung fibrosis, while MMP-7 may be increased in the matrix remodeling phase rather than in the inflammatory phase. MMP-7 may act as an important indicator for the severity of IPF.     

纵隔淋巴结肿大的特发性肺纤维化患者生存率随访研究

目的评价纵隔淋巴结肿大对特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)患者基质金属蛋白酶-7(matrix metalloproteinase-7,MMP-7)表达及生存率的影响。方法将29例IPF患者分为纵隔淋巴结肿大组和无纵隔淋巴结肿大组,记录患者确诊时的临床指标,测定血清及支气管肺泡灌洗液(bronchoalveolar larvage fluid,BALF)中MMP-7水平,随访患者的生存情况,绘制Kaplan-Meier生存曲线,进行Log-rank检验。采用Cox多元回归分析影响预后的因素。结果 IPF患者中纵隔淋巴结肿大者占44.8%(13/29)。纵隔淋巴结肿大的IPF患者肺一氧化碳弥散量占预计值百分比(DLCO%)、静息状态动脉血氧分压(PaO2)水平低于无淋巴结肿大者,差异均有统计学意义(P值分别为0.002、0.036);而血清MMP-7的水平高于无淋巴结肿大者,差异有统计学意义(P=0.010)。在平均随访的24.3个月内,伴有纵隔淋巴结肿大IPF患者的中位生存期低于无纵隔淋巴结肿大IPF患者的中位生存期,差异有统计学意义(23.0个月VS.38.0个月,P<0.05)。单因素分析显示血清MMP-7水平、吸烟及纵隔淋巴结肿大是影响IPF患者预后的危险因素(P值分别为0.013、0.048和0.010),Cox多元回归分析显示纵隔淋巴结肿大是影响IPF预后的危险因素〔HR=4.69,95%CI(1.437,15.307),P=0.01〕。结论纵隔淋巴结肿大的IPF患者较无纵隔淋巴结肿大的IPF患者血清MMP-7水平增高,而且预后差,纵隔淋巴结肿大是影响IPF患者预后的危险因素之一。     

注射用还原型谷胱甘肽治疗酒精性肝病患者前后ALT、AST、GGT的变化

T、AST、GGT改善明显[分别为(42±9)U/L比(99±53)U/L、(49±19)U/L比(135±42)U/L、(67±217)U/L比(189±47)U/L],差异有统计学意义(P<0.05).结论 阿拓莫兰治疗酒精性肝病疗效确切,ALT、AST、GGT指标改善明显.     

侵袭性牙周炎治疗前后龈沟液中RANKL配体和骨保护素水平的变化

目的 检测龈沟液中RANKL配体(receptor activator of nuclear factor kappaB ligand,RANKL)和骨保护素(osteoprotegerin,OPG)水平,探讨龈沟液中RANKL、OPG及RANKL/OPG与侵袭性牙周炎的关系.方法 选择广泛型侵袭性牙周炎患者30例,分别在治疗前、治疗后2月和4月进行临床指标检测,并用滤纸条法收集治疗前后龈沟液样本,ELISA法检测RANKL和OPG浓度.结果 治疗后,各项临床指标均显著好转,RANKL浓度明显降低,OPG水平明显升高,RANKL/0PG比值显著降低.结论 治疗前后龈沟液中RANKL、OPG及RANKL/OPG比值变化明显,提示龈沟液中RANKL及OPG浓度,及RANKL/OPG比值有望作为临床检测牙周炎是否处于活跃期的客观指标.     

骨科患者伤口分泌物病原菌分布及药敏277例分析

[目的]分析骨科患者伤口分泌物病原菌分布及药敏试验,为骨科临床医生合理治疗及控制医院感染提供依据。[方法]将2009年1月至2013年12月我院277例门诊和住院骨科患者的伤口分泌物标本接种于血平板、巧克力平板,按《全国临床检验操作规程》3版要求分离纯菌,用法国生物梅里埃公司API鉴定和K-B法做药敏试验。[结果]185株伤口分泌物病原菌中检出前5位的病原菌是阴沟肠杆菌36株占19.5%,金黄色葡萄球菌32株占17.3%,表皮葡萄球菌29株占15.7%,大肠埃希菌26株占14.1%,铜绿假单胞菌20株占10.8%。大肠埃希菌26株,产ESBLs阳性占26.9%（7/26株）,主要革兰阴性杆菌对氨苄西林和头孢唑林的耐药率最高;未发现革兰氏阴性杆菌对头孢哌酮/舒巴坦和亚胺培南耐药。耐甲氧西林金黄色葡萄球菌检出率为21.9%,耐甲氧西林表皮葡萄球菌检出率为20.7%,且对青霉素的耐药率较高,未发现耐万古霉素的葡萄球菌。[结论]阴沟肠杆菌和金黄色葡萄球菌是创伤患者伤口优势菌种,而且细菌耐药性高;临床医生应合理制定治疗方案,选择使用有效的抗菌药物。     

145例血尿患者的尿红细胞形态结果分析

[目的]通过对血尿患者尿红细胞形态结果的分析,探讨尿红细胞形态对血尿来源诊断的意义。[方法]检测本院确诊为肾小球疾病和非肾小球疾病患者血尿中的红细胞数目和形态,比较不同疾病血尿红细胞的分布情况。[结果]肾小球性疾病77例,检出畸形红细胞63例,混合形红细胞10例,正形红细胞4例;非肾小球性疾病68例,检出正形红细胞56例,畸形红细胞7例,混合形红细胞5例。肾小球性血尿患者检测出尿畸形红细胞为81.8%,而非肾小球性血尿患者则仅有10.3%,两组对比差异有统计学意义（P〈0.01）。[结论]尿红细胞形态对区分血尿来源、鉴别肾小球性血尿和非肾小球性血尿具有一定的临床应用意义。     

检测阴道分泌物诊断细菌性阴道病的2种方法对比分析

细菌性阴道病(bacterial vaginosis,BV)是一种由一些厌氧菌和兼性厌氧菌(主要是加德纳菌属、Prevotella属、拟杆菌属、动弯杆菌属、革兰阳性球菌、支原体属)的过度增殖以及正常菌群(乳酸杆菌)的减少或缺失所引起的多细菌性紊乱疾病[1],是育龄妇女最常见的阴道感染性疾病之一.据文献报道,感染率为30%～50%,发病率在10%～30%,患者例数远远高于阴道滴虫、霉菌等感染人数,且易复发[2].在妇科BV会引起宫颈炎、慢性盆腔炎、双侧输卵管阻塞而致不孕等;在产科BV可导致胎膜早破、羊膜腔感染、绒毛膜羊膜炎、产后子宫内膜炎、新生儿感染等.BV诊断的金标准是Amsel临床诊断标准(简称Amsel标准)[3].但在临床实践中操作较为繁琐,影响因素较多,且阳性标准难以统一.笔者采用BV Set试剂盒检测阴道分泌物,与Amsel标准进行对比分析,现将结果报道如下.     

特发性肺纤维化和结节病患者基质金属蛋白酶的变化及其临床意义

Objective To detect the levels of matrix metalloprotease(MMP)-1 and MMP-7 in the serum and the bronchoalveolar lavage fluid(BALF)of patients with idiopathic pulmonary fibrosis(IPF)and sarcoidosis(Stage Ⅱ),and therefore to investigate the significance of these changes in the pathogenesis of IPF. Methods Forty-four clinically confirmed cases of IPF were recruited,with the patients'age ranging from 46 to 70 years(58±9 years).Twenty patients with sarcoidosis,aged 35 to 65(50±12)years,were also studied.Enzyme-linked immunoabsorbent assay was used to detect the levels of MMP-1 and MMP-7 in the serum and the BALF samples. Results In the serum of patients with IPF,the level of MMP-1 [3.78 (0.14-13.44) μLg/L]was lower than that in patients with sarcoidosis[7.79(4.67-10.68)μg/L(z=-3.53,P<0.01)],but the level of MMP-7[7.83(3.57-14.37) μg/L]was higher than that in patients with sarcoidesis[4.04(0.06-9.94)μg/L(z=-3.84,P<0.01)].In the BALF of patients with IPF,the level of MMP-1 [1.09(0.04-5.14)μg/L]was lower than that in patients with sarcoidosis [2.08(0,05-4.16)μg/L(z=-1.53,P>0.05)],but the level of MMP-7[3.75(1.10-9.87)μg/L]was highet than that in patients with sarcoidosis[1.16(0.02-4.47)μg/L(x=-5.33,P<0.01)].The serum level of MMP-7 in patients with IPF was negatively correlated with the diffusing capacity of carbon monoxide(r=-0.56,P<0.01)and the percentage of neutrophils(r=-0.47,P<0.01).The level of MMP-7 in the BALF showed a negative correlation with diffusing capacity of carbon monoxide(r=-0.31,P <0. 05). Conclusions The results suggest that MMP-1 may be increased in the inflammatory phase as compared to the matrix remodeling phase of lung fibrosis, while MMP-7 may be increased in the matrix remodeling phase rather than in the inflammatory phase. MMP-7 may act as an important indicator for the severity of IPF.