慢性肾衰患者血清及尿液γ-干扰素的检测及其意义

采用ＥＬＩＳＡ双抗体夹心法检测７１例慢性肾衰（ＣＲＦ）患者及４０例健康成人血及尿的γ－干扰素（ＩＦＮ－γ）水平。结果显示：ＣＲＦ患者血清及尿液ＩＦＮ－γ含量分别为（６２６２±２．６８）ｎｇ／Ｌ和（４３．０１±２．５７）ｎｇ／Ｌ，显著低于正常对照组，［（１０５±７．１０）ｎｇ／Ｌ和（７５±６．１４）ｎｇ／Ｌ］（Ｐ＜０００１），但与尿素氮（ＢＵＮ）及血清肌酐（Ｓｃｒ）无显著相关性（血清及尿ＩＦＮ－γ与ＢＵＮ、Ｓｃｒ相关系数分别是ｒ＝０．２４２５、０３０５６、０１５３３和０１７５０，Ｐ＞００５）。结论：ＩＦＮ－γ作为一种细胞因子参与肾脏病发生、发展过程中的网络调节，血清及尿液中ＩＦＮ－γ水平受到机体Ｔ淋巴细胞及ＮＫ细胞数量及功能影响。     

老年人红细胞膜唾液酸含量与红细胞免疫功能的相关性

目的探讨老年人红细胞膜唾液酸（ＲＢＣｍ－ＳＡ）与红细胞免疫功能的相关性。方法采用Ｂｉａｌｓｃｈｅ试剂法检测ＲＢＣｍ－ＳＡ，Ｆ－８８３６化学比色法检测血浆唾液酸（Ｐ－ＳＡ），红细胞免疫粘附试验观察红细胞Ｃ３ｂ受体花环率（ＲＲＣＦ）。结果老年急性心肌梗死（ＡＭＩ）组和脑梗塞（ＡＣＩ）组的ＲＢＣｍ－ＳＡ分别为３０．８±４．３和３１．３±４．４μｇＮＡＮＡ／ｍｇ膜蛋白，ＲＲＣＦ分别为１６．７％±３．５％和１６．０％±３．６％，均低于老年对照组（Ｐ＜０．０１或０．０５），老年对照组均低于非老年对照组（均为Ｐ＜０．０５）；ＡＭＩ和ＡＣＩ患者的Ｐ－ＳＡ分别为２．４±０．４和２．４±０．３ｍｍｏｌ／Ｌ，均高于老年对照组（均为Ｐ＜０．０５），老年对照组则高于非老年对照组（Ｐ＜０．０５）。老年患者和老年对照组的ＲＢＣｍ－ＳＡ与ＲＲＣＦ均呈正相关，而ＲＢＣｍ－ＳＡ与Ｐ－ＳＡ均呈负相关。结论老年人红细胞Ｃ３ｂ受体花环率降低与ＲＢＣｍ－ＳＡ代谢障碍有关。     

红细胞变形性在原发性高血压中的变化及对左心室舒张功能的影响

目的观察红细胞变形性对原发性高血压及左心室舒张功能的影响。方法对原发性高血压患者进行红细胞滤过指数（ＩＦ），血压（ＥＳＲ），Ｋ值，红细胞电泳（ＥＥＰ），红细胞膜钙内流（ＥＣＣ），红细胞钙泵活性（ＥＣＰ）和左心室舒张功能（Ｅ／Ａ）检测。结果原发性高血压患者比对照组，ＩＦ、ＥＳＲ、ＥＥＰ，Ｋ值，ＥＣＣ明显增加，而ＥＣＰ和ＶＥ／ＶＡ明显减少。ＩＦ与Ｅ／Ａ（Ⅱ期高血压）呈负相关。结论在原发性高血压中红细胞变形能力下降并与左心室舒张功能有相关。     

ST/HR斜率对冠心病的诊断价值

目的：分析 Ｓ Ｔ／ Ｈ Ｒ 斜率对冠心病（ Ｃ Ｈ Ｄ）的诊断价值。方法：应用 Ｓ Ｔ／ Ｈ Ｒ 斜率计算机自动分析系统与运动介入单光子发射型计算机断层摄影术（ Ｓ Ｐ Ｅ Ｃ Ｔ）心肌显像同时进行,检测 ６０ 例临床怀疑 Ｃ Ｈ Ｄ 患者,并对 ３０ 例健康正常人进行了 Ｓ Ｔ／ Ｈ Ｒ 斜率检测。结果：① Ｓ Ｔ／ Ｈ Ｒ 斜率与 Ｓ Ｐ Ｅ Ｃ Ｔ 心肌显像二者结果有良好的相关性（ ｒ＝ ０．５８, Ｐ ＜ ０．００５）,符合率为８０％ 。 Ｓ Ｐ Ｅ Ｃ Ｔ 阳性者其斜率值高于 Ｓ Ｐ Ｅ Ｃ Ｔ 阴性者及正常人群（均 Ｐ ＜ ０．０５）。②若以 Ｓ Ｐ Ｅ Ｃ Ｔ 为标准, Ｓ Ｔ／ Ｈ Ｒ 斜率与普通运动试验诊断 Ｃ Ｈ Ｄ 的敏感性分别为８１．６％ 和７３．９％ （ Ｐ ＞ ０．０５）,特异性分别为７７．３％ 和４５．５％ （ Ｐ ＜ ０．０５）。以正常人为标准, Ｓ Ｔ／ Ｈ Ｒ 斜率与普通运动试验的特异性分别为９３．３％ 和７０．０％ （ Ｐ ＜ ０．０５）。③ Ｓ Ｐ Ｅ Ｃ Ｔ 显示 ２ 个以上节段心肌缺血者,其斜率值明显高于单一节段缺血者（ Ｐ ＜ ０．０５）。结论： Ｓ Ｔ／ Ｈ Ｒ 斜率对诊断 Ｃ Ｈ Ｄ 有重要价值,其特异性明显高于普通运动试验,可作为评价心肌缺血范围的参考。     

冠心病患者心率变异向量长度和角度指数的非线性分析

应用动态心电图（ＡＥＣＧ）系统记录心率变异性（ＨＲＶ），并经非线性分析的定量指标向量长度指数（ＶＬＩ）和向量角度指数（ＶＡＩ）研究了３２例冠心病（ＣＨＤ）、２０例陈旧性心肌梗死患者和３９例健康人。结果表明：正常对照组Ｐｏｉｎｃａｒｅ散点图呈慧星状占９０％（３５／３９）；陈旧性心肌梗死（ＯＭＩ）组呈鱼雷状占８０％（１６／２０）；而ＣＨＤ组多表现为散点图变短、变窄、角度变小。ＶＬＩ值ＣＨＤ、ＯＭＩ组与对照组分别为１４８．７±３０．３，１２４．０±２７．３和１９７．０±３８．２（Ｐ＜０．０１）。ＶＡＩ值三组分别为０．５４±０．１４，０．４２±０．１５和０．８５±０．１８（Ｐ＜０．０１）。ＳＤ、ＰＮＮ５０、ｒＭＳＳＤ以及左心室舒张功能在ＣＡＤ、ＯＭＩ组也有相应变化。我们认为，非线性分析ＶＬＩ、ＶＡＩ定量指标可为ＣＨＤ提供重要信息。     

QRS记分法评价老年心肌梗塞患者的左室功能

为评估常规心电图ＱＲＳ记分法评价老年心肌梗塞患者的左室收缩及舒张功能的价值，将常规心电图测得的老年急性心肌梗塞（ｎ＝６７）及陈旧性心肌梗塞（ｎ＝３２）的ＱＲＳ记分与９９ｍＴｃＭＩＢＩＳＰＥＣＴ心肌显像检测的心肌坏死、心肌疤痕节段数及平衡法核素心血池显像测得的左室射血分数（ＬＶＥＦ）、高峰射血率（ＰＥＲ）、１／３射血分数（１／３ＥＦ）、１／３充盈率（１／３ＦＲ）、高峰充盈率（ＰＦＲ）、１／３射血率（１／３ＥＲ）、１／３充盈分数（１／３ＦＦ）进行相关分析。发现ＱＲＳ记分与急性心肌梗塞者心肌坏死节段数及陈旧性心肌梗塞者的心肌疤痕节段数显著相关，ｒ分别为０．７８，０．６６，Ｐ均＜０．０００１；与反映收缩功能的ＬＶＥＦ、ＰＥＲ、１／３ＥＦ、１／３ＥＲ呈明显负相关，ｒ分别为－０．７３和－０．８６，－０．５５和－０．７３，－０．３６和－０．５５，－０．６５和－０．７７，Ｐ均＜０．０５；与反映舒张功能的ＰＦＲ、１／３ＦＲ、１／３ＦＦ亦呈明显相关，ｒ分别为－０．４５和０．４１，－０．４９和－０．５２，－０．３８和－０．３６，Ｐ均＜０．０５。说明ＱＲＳ记分可用于估测心肌梗塞面积、左室收缩及舒张功能。     

48小时动态心电图分析原发性高血压患者无症状心肌缺血与心率变异性的关系

目的：为探讨原发性高血压（ＥＨ）患者无症状性心肌缺血（Ｓｉｌｅｎｔ ｍｙｏｃａｒｄｉａｌ ｉｓｃｈｅｍｉａ,ＳＭＩ）与心率变异性的关系。方法：根据连续２天（即４８小时）动脉心电图（ＤＣＧ）分析,将（ＥＨ）患者２天ＳＴ段均无ＳＭＩ发作组３０例６０份ＤＣＧ资料与２天ＳＴ段均无ＳＭＩ发作组５５例１１０份ＤＣＧ资料进行对比分析;再将同一患者１天有ＳＭＩ发作另１天没有ＳＭＩ发作的２８例ＳＭＩ发作日与非ＳＭＩ发作日心电图进行对比分析。结果：ＳＭＩ发作组（Ｐ〈０．０１）、ＳＤＡＮＮ（Ｐ〈０．０１）、ＳＤＮＮｉ（Ｐ〈０．０５）以及ｒＭＳＳＤ（Ｐ〈０．０５）均低于无ＳＭＩ组。同一患者ＳＭＩ发作日ＳＤＮＮ（Ｐ〈０．０１）、ＳＤＡＮＮ（Ｐ〈０．０１）、ＳＤＮＮｉ（Ｐ〈０．０１）以及ｒＭＳＳＤ（〈０．０５）均低于非ＳＭＩ发作日。结论：     

结肠癌患者血清可溶性sIL-2R含量的变化

目的探讨结肠癌患者手术前血清可溶性白介素２受体（ｓｏｌｕｂｌｅｉｎｔｅｒｌｕｋｉｎ２ｒｅｃｅｐｔｏｒ，ｓＩＬ２Ｒ）含量改变与疾病的诊断、分期、预后判断等的关系．方法采用ＥＬＩＳＡ法对２７例结肠癌患者（ＤｕｋｅｓＡ，Ｂ期１９例），Ｃ，Ｄ期８例）及４２例对照组（正常３２例及肠易激综合征１０例）分别测定血清ｓＩＬ２Ｒ含量．同时使用间接荧光染色法对各组进行血ＣＤ３，ＣＤ４，ＣＤ８及ＣＤ４／ＣＤ８的测定．结果结肠癌患者ＤｕｋｅｓＡ，Ｂ期组血清ｓＩＬ２Ｒ含量（８３５ｐｍｏｌ／Ｌ±２１８ｐｍｏｌ／Ｌ）与对照组（６９２ｐｍｏｌ／Ｌ±２７９ｐｍｏｌ／Ｌ及７６２ｐｍｏｌ／Ｌ±２４６ｐｍｏｌ／Ｌ）无明显差异，而有淋巴结转移的ＤｕｋｅｓＣ，Ｄ期患者（３２１６ｐｍｏｌ／Ｌ±２３４４ｐｍｏｌ／Ｌ）则明显高于ＤｕｋｅｓＡ，Ｂ期患者，且ＣＤ４／ＣＤ８值明显下降（１０６±０４９比１５８±０３６）；另外，血清ｓＩＬ２Ｒ含量还与肿瘤细胞分化程度密切关联．结论结肠癌术前血清ｓＩＬ２Ｒ含量与疾病分期及预后有关．     

抗心磷脂抗体与中年脑梗塞患者预后的关系

采用酶联免疫吸附（ＥＬＩＳＡ）法检测了６８例中年脑梗塞（ＣＩ）患者的抗心磷脂抗体（ａｃＬ），并与老年ＣＩ患者及健康对照组进行比较。结果显示：１．中年ＣＩ患者的ａｃＬ阳性率与老年ＣＩ者比较，Ｐ〈０．０５；与对照组比较，Ｐ〈０．０１；２．ａｃＬ阳必者预后不良。提示对中年ＣＩ患者ａｃＬ检测，有助于诊断、治疗及预后判断。     

DISEASES OF ENTERIC PEPTIDERGIC NEURONS．

ＤＩＳＥＡＳＥＳＯＦＥＮＴＥＲＩＣＰＥＰＴＩＤＥＲＧＩＣＮＥＵＲＯＮＳ．Ｙｕａｎ＿ＦａｎｇＣｈｅｎ，ＭＤ．ＰｅｋｉｎｇＵｎｉｏｎＭｅｄｉｃａｌＣｏｌｅｇｅ．ＴｈｅＥｎｔｅｒｉｃＮｅｒｖｏｕｓＳｙｓｔｅｍ（ＥＮＳ）ＥＮＳｉｓｔｈｅｐａｒｔｏｆｉｎｔｒｉ...     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。