乙型肝炎血清HBV-DNA水平与肝纤维化相关性及临床价值

目的 研究慢性乙型肝炎血清HBV-DNA水平与肝纤维化四项指标的相关性。方法 用实时荧光定量PCR法检测血清HBV-DNA水平、用化学发光法检测肝纤维化四项指标:透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(CⅣ),统计分析其相关性。结果 90例乙型肝炎患者血清HBV-DNA水平取对数后平均值为5.28±1.41 IU/mL,HA平均水平为196.37±89.42 mg/ml,LN平均水平为149.52±33.26μg/ml,PCⅢ平均水平为137.28±27.93μg/ml,CIV平均水平为86.56±19.72μg/ml,均显著性地高于健康对照,差异有统计学意义(P＜0.01)。实验组血清HBV-DNA水平与肝纤维化四项指标之间未发现直线相关性(P＞0.05)。结论 慢性乙型肝炎患者血清肝纤维化四项指标明显升高,但患者血清HBV-DNA与肝纤维化指标之间没有显著的直线相关关系。     

慢性乙型肝炎患者血清HBV DNA水平与肝纤维化指标的相关性研究

目的 探讨慢性乙型肝炎患者血清HBV DNA水平与肝纤维化指标间的相互关系及临床意义.方法 检测120例慢性乙型肝炎患者血清HBV DNA水平和肝纤维化指标透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅵ型胶原(Ⅳ-C)和层粘连蛋白(LN),并统计分析两者间的相关性.依血清HBV DNA水平将患者分为＜105拷贝/ml、≥105拷贝/ml 2组,并对组间肝纤维化指标进行t检验.结果 慢性乙型肝炎患者血清HBV DNA、HA、PCⅢ、Ⅳ-C、LN含量均高于正常上限,HBVDNA与HA、PCⅢ、Ⅳ-C、LN间呈直线相关(r=0.537,P=0.033;r=0.764,P=0.002;r=1.120,P=0.001;r=1.014,P=0.001),2组间肝纤维化指标比较差异有统计学意义(P＞0.05).结论 慢性乙型肝炎患者血清HBV DNA与肝纤维化指标间有相关性,随着患者体内病毒载量的增高,肝纤维化指标也呈增加趋势,抗病毒治疗和抗纤维化治疗对其同等重要.     

肝纤维化指标在慢性肝炎患者血清检测中的意义

目的:探讨检测肝纤维化指标在慢性肝病中的临床价值.方法:对105例慢性肝病患者检测血清透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原( PCⅢ)和Ⅳ型胶原(Ⅳ - C).结果:慢性肝炎轻度、中度、重度及肝硬化患者各指标依次升高,以慢性肝炎重度及肝硬化患者为最高,彼此间均有非常显著性差异(P＜0.01),各组与健康对照组比较均有非常显著性显异(P＜0.01).结论:肝纤维化指标测定对慢性肝病肝纤维化及早期肝硬化具有一定的诊断价值.     

安络化纤丸联合胸腺肽a1治疗HBV-DNA阴性慢性乙型肝炎肝纤维化临床观察

目的 探讨延缓HBV-DNA阴性慢性乙型肝炎从肝纤维化向肝硬化发展的治疗方法.方法 治疗组口服安络化纤丸,皮下注射胸腺肽a 1,对照组常规护肝治疗,观察治疗前后的肝功能(ALT、AST、ALB、TBil)、血清肝纤维化指标(HA、IVC、PⅢ NP、LN)、肝脏纤维化超声半定量积分和随访1年内HBV-DNA阳转、肝功能反弹情况及肝硬化发生情况.结果 治疗组治疗后与治疗前比较肝功能指标改善明显,肝纤维化指标HA、IVC明显降低(P<0.01),肝纤维化超声半定量积分明显下降(P<0.01),1年内肝功能反弹明显减少,HBV-DNA阳转及肝硬化发生较少.结论 安络化纤丸联合胸腺肽a 1治疗HBV-DNA阴性慢性乙型肝炎具有一定的抗肝纤维化作用,并可抑制HBV-DNA阳转延缓向肝硬化发展.     

α干扰素对慢性乙型肝炎患者血清肝纤维化和肝功能指标的影响

目的:研究α-干扰素(α-IFN)对慢性乙型肝炎(CHB)患者血清肝纤维化和肝功能指标的影响.方法:对55例CHB患者予IFNα-2a(因特芬)500万U肌注,隔日1次,连续治疗6个月.治疗后3个月、6个月检测血清肝纤维化指标:透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C);肝功能指标:总胆红素(TB)、ALT、AST.结果:治疗后3个月、6个月CHB患者血清HA、LN、PCⅢ、Ⅳ-C及ALT、AST水平均显著低于治疗前(P均＜0.05或0.01),治疗6个月上述各指标均显著低于治疗3个月(P均＜0.05).结论:α-IFN可改善CHB患者的肝纤维化水平和肝功能.     

贞芪扶正胶囊联合阿德福韦对慢性乙肝患者细胞免疫功能及抑制HBV复制的影响

目的:研究贞芪扶正胶囊联合阿德福韦对慢性乙型肝炎患者细胞免疫功能及抑制乙肝病毒复制的影响.方法:将2012年1月～2014年4月期间我院消化内科收治的100例慢性乙型肝炎患者纳入研究对象,采用随机数字表法分为观察组和对照组,观察组患者接受贞芪扶正胶囊联合阿德福韦酯治疗,对照组患者接受阿德福韦酯治疗,比较两组患者的乙肝病毒复制情况、肝纤维化指标以及细胞免疫功能指标.结果:(1)HBV复制情况:观察组患者HBV-DNA拷贝数和耐药率均明显低于对照组[(3.21±0.57) vs.(8.19±1.17)×104,4.62％ vs.15.38％],HBV-DNA转阴率明显高于对照组(93.85％vs.73.85％);(2)肝纤维化指标:观察组透明质酸酶(HA)、层黏连蛋白(LN)、Ⅳ型胶原(ⅣC)、Ⅲ型前胶原(PⅢNP)水平均低于对照组(125.21±27.32 vs.160.65±25.78,105.65±16.52 vs.138.42±23.32,124.20±25.42vs.140.53±25.52,162.28±37.25 vs.187.17±37.58);(3)细胞免疫功能:观察组CD4+、CD4/CD8、CD16/65+ NK均明显高于对照组(43.62±5.65 vs.32.67±4.51,2.12±0.34 vs.1.32±0.24,22.56±4.28 vs.13.45±2.12),CD8+T明显低于对照组(23.27±2.90 vs.29.41±3.75).结论:贞芪扶正胶囊联合阿德福韦治疗有助于抑制HBV复制,缓解肝脏纤维化,改善细胞免疫功能,提高治疗效果.     

拉米夫定对慢性乙型肝炎患者白细胞介素-6和肝纤维化指标的影响

目的 观察拉米夫定治疗对慢性乙型肝炎患者血清白细胞介素-6(It-6)和肝纤维化指标的影响。方法 64例慢性乙型肝炎患者随机分为对照组(n=32)和拉米夫定治疗组(n=32),分别在治疗前和治疗后的第6个月用ELISA法检测血清IL-6水平和肝纤维化指标。结果 拉米夫定治疗6个月后患者的血清IL-6水平显著低于对照组[(84.5±12.6)pg/mL、vs(105.7±15.8)pg/mL,P<0.05)],肝纤维化指标血清透明质酸、Ⅳ型胶原和层黏蛋白也明显降低[透明质酸：(172.7±60.7)u/L、vs(221.7±71.8)u/L,P<0.05;Ⅳ型胶原：(102.6±47.5)u/L vs(132.6±26.9)u/L,P<0.05;层黏蛋白：(112.2±20.7)u/L vs(139.2±27.2)u/L,P<0.01)]。结论拉米夫定可抑制慢性乙型肝炎患者IL-6的释放,具有抗纤维化的临床疗效。     

维生素E对小鼠日本血吸虫病肝纤维化的治疗作用及其机制

目的: 探讨维生素E (Vit E)抗小鼠日本血吸虫病肝纤维化作用及其机制. 方法: 用日本血吸虫尾蚴皮肤敷贴法感染小鼠,构建日本血吸虫病肝纤维化模型,以肝纤维化达Ⅱ级或Ⅱ级以上作为开始Vit E治疗标志. 实验分5组: 正常对照组、模型组及Vit E高、中、低剂量组(每日150, 50, 5 mg/kg), 8 wk末处死动物,HE和VG染色对肝组织进行病理学检查,分光光度法检测肝组织丙二醛(MDA)含量和超氧化物歧化酶(SOD)活性,免疫组化SP法检测肝星状细胞(HSC)标记物α-平滑肌动蛋白(α-SMA)表达,RT-PCR方法检测肝脏α1(I)型前胶原mRNA表达. 结果: Vit E降低模型组肝脏MDA含量[(5.00±0.31) μmol/g vs (11.66±1.84) μmol/g, P＜0.05],提高SOD活性[(249.84±26.22) μkat/g vs (120.11±42.61) μkat/g, P＜0.05];减少α-SMA阳性表达 [(0.41±0.02) vs (0.68±0.02), P＜0.05];降低肝脏胶原含量[(0.23±0.01) vs (0.60±0.11), P＜0.05]和α1(I)型前胶原基因表达[(0.28±0.01) vs (0.85±0.15), P＜0.05]. 结论: Vit E具有抗小鼠日本血吸虫病肝纤维化作用,其机制与抗脂质过氧化作用、抑制HSC活化和增殖、降低α1(I)型前胶原基因表达和胶原合成有关.     

拉米夫定加重组乙肝疫苗治疗慢性乙型肝炎62例

目的:探讨拉米夫定联合重组乙肝疫苗(rHBV)治疗慢性乙型肝炎临床疗效并观察肝脏纤维化指标的改变。方法:慢性乙型肝炎患者62例,口服拉米夫定100mg/d,同时肌注rHBV10μg,每月2次,12个月,观察治疗0、6、12个月肝功能、乙肝5项指标、HBV-DNA定量、血清肝纤维化指标透明质酸(HA)、层粘蛋白(LN)、型前胶原(PIIINP)和型胶原(C)的变化。结果:拉米夫定加乙肝疫苗治疗12个月,可显著抑制HBV-DNA复制,使大多数患者肝功能恢复正常。结论:拉米夫定加rHBV是治疗慢性乙型肝炎的一种较为有效的方法。     

乙肝抗纤丸对慢性乙型肝炎血清肝纤维化指标的影响

目的:观察乙肝抗纤丸对慢性乙型肝炎血清肝纤维化指标的影响及临床疗效观察.方法:将120例慢性乙型肝炎、肝炎肝硬化患者随机分成治疗组和对照组各60例.治疗组给予口服乙肝抗纤丸3 g口服,3次/d,治疗168 d;对照组给予维生素类护保药物对症治疗168 d.观察治疗前及治疗后168 d两组患者肝功能(ALT、TBIL、ALB)、血清纤维化指标(HA、LN、PCⅢ、C-Ⅳ)变化.结果:治疗组ALB水平的变化在治疗前后具有显著差异(P＜0.01),治疗后与对照组比较亦有显著差异(P＜0.01).治疗组与对照组比较血清肝纤维化指标明显好转(P＜0.05).结论:乙肝抗纤丸可提高血清ALB,使血清肝纤维化指标下降,改善肝功能、防治肝纤维化.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.