干细胞移植改善股骨头坏死缺血状态的实验及临床效应：20只模型兔及188例患者资料分析

BACKGROUND: Ischemic femoral head necrosis is caused by local vascular injury and blood-supply insufficiency. There exists no optimal treatment for the ischemic femoral head necrosis. Thus, the improvement of the blood supply to the femoral head seems to be a key point for the treatment. OBJECTIVE: To verify the curative effects of autologous bone marrow mesenchymal stem cell transplantation induced vascular regeneration on the improvement of ischemic femoral head necrosis via animal experiments and clinical observations. DESIGN: Contrast animal experiment and self-controlled clinical observation. SETTING: Cell Therapy Center, the 463 Hospital of Chinese PLA. MATERIALS AND PARTICIPANTS: ① Animals: Twenty Japanese white rabbits in either gender and weighing 3.0-4.0 kg were purchased from Animal Experimental Center, General Hospital of Shenyang Military Area Command of Chinese PLA. The animal experiments were coincident with the ethical standards. ② Participants: 188 patients with ischemic femoral head necrosis (335 hips) having whole following-up data were selected from Cell Therapy Center, the 463 Hospital of Chinese PLA from July 2004 to July 2007. There were 113 males and 75 females, and their ages ranged from 18 to 72 years. Diagnosis was done by using X-ray photographs, nuclide scanning, MRI and CT examinations. All patients provided the informed consent, and the study was approved by the local research ethics committee. METHODS: ① Animal experiments: The experiment was carried out at the Animal Experiment Center, General Hospital of Shenyang Military Area Command of Chinese PLA from January to June 2004. Ischemic femoral head necrosis models were established at both hindlimbs by using liquid-nitrogen refrigeration. The right side was regarded as transplantation group and the left one as control group. Mononuclear cells extracted from bone marrow were poured in the right femoral artery, while saline was poured in the left femoral artery. ②Clinical observations: Mononuclear cells were separated from autologous bone marrow of patients with ischemic femoral head necrosis after density gradient centrifugation. MAIN OUTCOME MEASURES: ①Four weeks later, angiogenesis at both femoral arteries was observed by arteriography by using digital subtraction anglography (DSA). Moreover, bilateral femoral head samples underwent pathological sections to observe bone regeneration and repair of femoral head 4 and 12 weeks later. ②Items including hip pain, walking distance and gait, abduction and internal rotation function changes of hip joint were observed in 3, 6, 12 and 24 months after stem cell transplantation in media femoral circum flex artery, lateral femoral circum flex artery and obturator artery. In 6 months after stem cell transplantation, angiogenesis and blood supply of femoral head were observed by using arteriography. In 6, 12 and 24 months after stem cell transplantation, morphological and ischemic changes of femoral head were observed by using CT, X-ray and MRI examinations. Harris scores were used to evaluate function of hip joint before and in 3, 6, 12 and 24 months after stem cell transplantation. RESULTS: Animal experiment: Twenty rabbits were involved in the final analysis. ① DSA-arteriography results: In 4 weeks after transplantation, blood-supply arteries in femoral head of right hindlimb in the transplantation group were more than those in the control group. ② Pathological results: In 12 weeks after transplantation, cartilage, lamellar bone and bone trabecula in the left femoral head were repaired remarkably, but left femoral head necrosis was not improved. Clinical observations: 188 patients were involved in the final analysis. ① Improvement of symptoms: Among 188 patients, 164 (87.3%) had remission of hip pain, 147 (78.4%) had function improvement, and 150 (80.0%) had elongation of walking distance. ② Imaging changes: At 6 months after transplantation, DSA-arteriography in 12 patients demonstrated that blood-supply arteries in femoral head were increased and thickened remarkably as compared with those before transplantation, and the blood flow was rapid. At 12-24 months after transplantation, lesion of bone matrix in 24 patients was improved under the X-ray, CT and MRI examinations. ③ Harris scores of hip joint: The scores at 6, 12 and 24 months after transplantation were significantly higher than those before transplantation (t= -3.423, -6.714, -9.039, P < 0.01). CONCLUSION: Autologous bone marrow mesenchymal stem cell transplantation can effectively improve and treat ischemic femoral head necrosis.     

干细胞移植改善股骨头坏死缺血状态的实验及临床效应：20只模型兔及188例患者资料分析

背景：缺血性股骨头坏死由于股骨头局部滋养血管损伤、供血不足致病，迄今尚无最佳治疗方案，改善股骨头血液供应成为治疗本病的关键。 目的：通过动物实验和临床观察，验证自体骨髓问充质干细胞移植血管再生技术改善股骨头坏死缺血状态的效果。 设计：对比动物实验和自身对照临床观察。 单位：解放军第四六三医院细胞治疗中心。 资料：①动物：选用日本大耳白兔20只，雌雄不拘，体质量3．0—4．0kg，购于沈阳军区总医院动物实验中心。此动物实验符合动物伦理学要求。②对象：选择2004—07／2007—07在解放军第四六三医院细胞治疗中心住院的具有完整随访资料的缺血性股骨头坏死患者188例（335髋），男113例，女75例，年龄18-72岁。均经髋关节X线摄片、核素扫描、MRI、CT检查确诊；对治疗和实验知情同意。实验经医院伦理委员会批准。 方法：①动物实验：实验于2004—01／2004—06在沈阳军区总医院动物实验中心完成。采用液氮冷冻股骨头缺血性坏死模型建立方法，双后肢股骨头均制作缺血模型，右侧为移植组，左侧为对照组。抽取骨髓，将所获单个核细胞经右股动脉注入；同法将生理盐水注入左侧股动脉内。②临床观察：密度梯度离心缺血性股骨头坏死患者自体骨髓，分离单个核细胞。行旋股内、旋股外及闭孔动脉干细胞移植术。 主要观察指标：①4周后行DSA动脉造影观察双侧血管新生情况。4，12周后取双侧股骨头标本，行病理切片观察新骨再生及股骨头修复程度。②于移植后第3，6，12，24个月观察患者髋关节疼痛、行走间距及步态、髋关节外展与内旋功能变化。于干细胞移植后6个月行股骨头供血动脉造影术，观察血管新生及股骨头供血动脉充盈情况。于干细胞移植后6，12，24个月行CT，X射线，MRI检查，观察股骨?     

肺栓塞的诊断与治疗

肺栓塞(pulmonary embolism,PE)是以各种栓子阻塞肺动脉系统为其发病原因的一组疾病或临床综合征的总称,包括肺血栓栓塞征、脂肪栓塞综合征、羊水栓塞,空气栓塞等.肺血栓栓塞症(pulmonary thromboembolism,PTE)为来自静脉系统或右心的血栓阻塞肺动脉或其分支所致疾病,以肺循环和呼吸功能障碍为其主要临床和病理生理特征.PTE为PE的最常见类型,占PE中的绝大多数,通常所称PE 即指PTE.引起PTE的血栓主要来源于深静脉血栓形成(deep venous thrombosis,DVT).PTE常为DVT的并发症.     

厄贝沙坦与硝苯地平片联用治疗高血压临床观察

据2002年中国高血压病患病统计，目前我国成人高血压患病率已达18．8％，全国高血压总人数已近1．6亿。因高血压病引起的各种并发症，是引发脑血管疾病死亡的重要原因。因此，如何有效防治高血压，减少或降低由高血压引起的各种并发症，是提高我国人口素质，降低心脑血管疾病死亡率的重要措施。自2006年起，采用血管紧张素受体拮抗剂（ARB）厄贝沙坦联用硝苯地平片治疗原发性高血压患者100例，经临床观察效果良好，报告如下。     

糖尿病合并肺结核36例临床分析

糖尿病并发症已经成为糖尿病致残、致亡的主要原因。糖尿病多合并心脑血管疾病、周围神经病变、感染等，合并肺结核病也比较多见，2005—2009年本院共收治糖尿病合并肺结核36例，有关资料分析如下。     

自发性气胸的诊断和治疗

一、病因 根据有无原发疾病,自发性气胸可分为原发性和继发性两种类型. 诱发气胸的因素多为剧烈运动、咳嗽、提重物或上臂高举、举重运动或用力大便等.据统计约50%～60%病例找不到明显诱因,有6%左右患者甚至在卧床休息时发病.     

干细胞移植改善股骨头坏死缺血状态的实验及临床效应:20只模型兔及188例患者资料分析

背景:缺血性股骨头坏死由于股骨头局部滋养血管损伤、供血不足致病,迄今尚无最佳治疗方案,改善股骨头血液供应成为治疗本病的关键.目的:通过动物实验和临床观察,验证自体骨髓间充质干细胞移植血管再生技术改善股骨头坏死缺血状态的效果.设计:对比动物实验和自身对照临床观察.单位:解放军第四六三医院细胞治疗中心.资料:①动物:选用日本大耳白兔20只,雌雄不拘,体质量3.0～4.0 kg,购于沈阳军区总医院动物实验中心.此动物实验符合动物伦理学要求.②对象:选择2004-07/2007-07在解放军第四六三医院细胞治疗中心住院的具有完整随访资料的缺血性股骨头坏死患者188例(335髋),男113例,女75 例,年龄18～72岁.均经髋关节X线摄片、核素扫描、MRI、CT检查确诊;对治疗和实验知情同意.实验经医院伦理委员会批准.方法:①动物实验:实验于2004-01/2004-06在沈阳军区总医院动物实验中心完成.采用液氮冷冻股骨头缺血性坏死模型建立方法,双后肢股骨头均制作缺血模型,右侧为移植组,左侧为对照组.抽取骨髓,将所获单个核细胞经右股动脉注入;同法将生理盐水注入左侧股动脉内.②临床观察:密度梯度离心缺血性股骨头坏死患者自体骨髓,分离单个核细胞.行旋股内、旋股外及闭孔动脉干细胞移植术.主要观察指标:①4周后行DSA动脉造影观察双侧血管新生情况.4,12周后取双侧股骨头标本,行病理切片观察新骨再生及股骨头修复程度.②于移植后第3,6,12,24个月观察患者髋关节疼痛、行走间距及步态、髋关节外展与内旋功能变化.于干细胞移植后6个月行股骨头供血动脉造影术,观察血管新生及股骨头供血动脉充盈情况.于干细胞移植后6,12,24个月行CT,X射线,MRI检查,观察股骨头区形态学及缺血状态变化.于干细胞移植前,移植后3,6,12,24个月进行髋关节Harris评分评价髋关节功能.结果:动物实验结果:①20只兔均进入结果分析.②DSA动脉造影结果:移植后4周移植组兔右后肢股骨头区供血动脉较对照组股动脉明显增多.③病理结果:移植后12周右侧股骨头软骨、板层骨及骨小梁明显修复,左侧股骨头坏死无改善.临床观察:188例患者均进入结果分析.①症状改善:188例患者中髋关节疼痛缓解164例(87.3%),关节功能改善147例(78.4%),行走间距延长150例(80.0%).②影像学改变:移植后6个月12例患者DSA动脉造影显示,股骨头供血动脉较移植前明显增多、增粗,血流速度增快;12～24个月后X射线平片,CT,MRI检查24例患者坏死的股骨头区可见骨质病变获得改善.③髋关节Harris评分:干细胞移植后6,12,24个月高于移植前,差异有非常显著性意义(t=-3.423,-6.714,-9.039,P﹤0.01).结论:经动脉自体骨髓间充质干细胞移植可改善股骨头坏死缺血状态,是治疗缺血性股骨头坏死的有效手段.     

飞行员酒后引发急性胰腺炎1例

临床上诱发急性胰腺炎病因较多 ,如酗酒、暴饮暴食及胆道梗阻等 ,笔者曾遇 1例因酒后诱发急性胰腺炎 ,现报道如下。1　临床资料　　患者男性 ,40岁 ,飞行员。既往有胆囊结石病史。该患因于 1 999年 1 0月 2 0日晚餐时饮用大量啤酒 ,2 2时出现上腹部剧烈疼痛 ,阵发性加剧 ,伴有恶心、呕吐、发热、呼吸困难等症状 ,而来我院就诊。查体 :血压正常 ,体温 38℃ ,脉搏 90次 /分 ,呼吸 2 0次 /分 ,腹壁紧张 ,压痛遍及全腹 ,肠鸣音减弱 ,双肺呼吸音减弱 ,有小水泡音。实验室检查 :血清淀粉酶 >1 6 3.5μｍｏｌ·ｓ-1/Ｌ。 2 4ｈ尿淀粉酶 >1 0 2 9.0 …     

固本益肠片金歧并用治疗慢性结肠炎34例

我院于１９９７年４月～１９９８年１２月应用固本益肠片联合金歧杆菌制剂金双歧治疗慢性结肠炎３４例,取得较好效果。现报告如下：１临床资料 笔者将符合慢性结肠炎诊断标准的６４例,随机分为两组：实验组３４例,男１９例,女１５例,年龄１８～７０岁。对照组３０例,男１     

4年来糖尿病教育质量评估

当前糖尿病 (ＤＭ)已成为严重威胁人类健康的主要疾病之一 ,糖尿病控制如何很大程度上取决于患者对所患疾病的认知程度。我院内分泌科自 1997年 7月以来坚持每月一次的社区内糖尿病患者教育 ,现已进行 4年 ,统计参加听课人数已达 30 0 0人次 ,收效很大 ,现将一些方面评估如下。1　资料与方法1·1　资料　我们从坚持长期听课的患者中随机抽取4 8名作为追踪分析对象 ,其中 2型ＤＭ 4 5名 ,1型ＤＭ3名 ,患者年龄 33～ 71岁。1·2　方法　我们从血糖控制水平、年平均治疗费用、血糖检测频度三个方面进行统计比较。其中血糖控制水平分良好 (空腹…