浅谈肺结核的预防控制方法

目的分析肺结核预防和控制的方法及效果。方法选择我所收治的60例肺结核患者作为研究对象。按时间顺序将患者,将其分为观察组和对照组,每组各30例。对照组采用常规防治方法,观察组采用现代结核病防治策略,对两组患者的临床防治效果进行对比分析。结果观察组中共有3例患者感染肺结核,感染率为10%;对照组中共有21例感染肺结核,感染率为70%。两组数据对比,差异具有统计学意义(P0.05)。结论在肺结核防治工作中,采用现代结核病防治策略能够非常有效地对肺结核予以控制,降低了感染率,此外还能实现较为显著的临床治疗效果。     

黄绿青霉素对低硒低蛋白大鼠心肌损伤的初步观察

目的 观察黄绿青霉素(CIT)对低硒低蛋白大鼠心肌损伤的特点.方法 40只4周龄Wistar大鼠,雌雄符半,体质量60～80 g,按2×2析因设计随机分为常硒常蛋白无毒素组、常硒常蛋白加毒素组、低硒低蛋白无毒素组和低硒低蛋白加毒素组(将低硒低蛋白合为一种因素考虑),每组10只.分别采用常硒常蛋白和低硒低蛋白饲料喂养大鼠至第10周后,加毒素组大鼠饲料中投予CIT(5 mg·kg-1·d-1)继续喂养至第16周.观察各组大鼠的毛色、摄食、体质量增长情况,计算心脏质量指数,观察心肌病理变化,检测血清硒、白蛋白水平、肌酸激酶(CK)和谷胱甘肽过氧化物酶(GSH-Px)活性以及心肌超氧化物歧化酶(SOD)活性.结果 硒、蛋白和CIT对大鼠体质量、血清硒、白蛋白水平、心脏质量指数、血清CK、GSH-Px活性和心肌SOD活性的影响不存在交互作用(F值分别为0.000、1.210、0.625、0.981、2.785、0.074、0.001,P均>0.05);硒、蛋白对大鼠血清硒、白蛋白水平、心脏质量指数和血清GSH-Px活性的主效应有统计学意义(F值分别为507.698、87.734、4.201、109.389,P均<0.05);CIT对大鼠体质量、血清硒、白蛋白水平、心脏质量指数、血清CK活性的主效应有统计学意义(F值分别为10.929、4.371、26.108、24.844、4.439,P均<0.05).低硒低蛋白两组的血清硒水平[(70.4±40.0)、(87.7 ±59.6)μg/L]低于常硒常蛋A两组[(446.1±74.8)、(502.1±39.2)μg/L,P均<0.05];低硒低蛋白两组的血清白蛋白水平[(34.36±1.28)、(33.38±2.48)g/L]低于常硒常蛋白两组[(40.69±1.30)、(38.71±2.15)g/L,P均<0.05];相同硒和蛋白水平下,加毒素组的心脏质量指数[(4.14±0.36)×10-3、(4.39 ±0.53)×10-3]高于无毒素组[(3.56±0.26)×10-3、(3.80±0.28)×10-3,P均<0.05];低硒低蛋白加毒素组的血清CK活性[(2.54 ±0.56)kU/L]低于低硒低蛋白无毒素组[(3.37±0.67)kU/L,P<0.05].低硒低蛋白两组的血清GSH-Px活性>(408.1±412.6)、(510.5 ±392.0)U/L[低于常硒常蛋白两组[(1667.8±102.2)、(1731.5±144.4)U/L,P均<0.05].电镜结果显示,常硒常蛋白加毒素组大鼠部分心肌细胞闰盘断裂,各带连接断裂,部分区域心肌细胞有溶解现象,有水肿表现;低硒低蛋白无毒素组大鼠心肌细胞膜结构改变不明显,核周围肌丝结构消失,可见大量絮状物质沉积;低硒低蛋白加毒素组大鼠心肌细胞肌节各带结构不很清晰,核旁线粒休嵴轻度疏松,偶见空泡变,大量弥漫性肌质网扩张.结论 CIT是诱导大鼠心肌细胞损伤的主要因素,低硒低蛋白加重病变,但独立致病作用较弱.

Abstract：

Objective To ohserve the rat myocardial damage induced by citreoviridin(CIT)in the status of combined selenium and protein deficiency.Methods According to 2×2 factorial design,forty 4-week-old healthy Wistar rats were randomly divided into four groups.i.e.combined selenium and protein adequate with no CIT and with some CIT groups(Se+Pro+CIT-.Se+Pro+CiT+),combined selenium and protein deficiency with no CIT and with some CIT groups(Se-Pro-CIT-,Se-Pro-CIT+).The numbers of male and female were fifty-fifty.Theserats were fed with combined selenium and protein adequate and combined selenium and protein deficiency fodder until the 16th week. Cardiac toxicity of CIT was evaluated by general state of health, heart weight index, myocardial pathological change, the levels of selenium and the activities of glutathion peroxidase (GSH-Px) and creatine kinase (CK) in serum, and the activity of superoxide dismutase(SOD) of myocardium. Results The interaction effects of combined selenium and protein deficiency and adequate CIT on body weight, serum levels of selenium and albumin, heart weight index, the activities of CK and GSH-Px in serum and SOD of myocardium were statistically not significant(F= 0.000, 1.210, 0.625, 0.981, 2.785, 0.074, 0.001, all P> 0.05). The main effects of combined selenium and protein on the levels of serum selenium and albumin, heart weight index and the activity of GSH-Px in serum were statistically significant(F = 507.698, 87.734, 4.201, 109.389, all P < 0.05). The main effects of CIT on body weight, the levels of serum selenium and albumin, heart weight index and the activity of CK in serum were statistically significant(F = 10.929, 4.371, 26.108, 24.844, 4.439, all P < 0.05). The mean levels of serum selenium of Se-Pro- groups [(70.4 ± 40.0), (87.7 ± 59.6 )μg/L] were lower than those of Se+Pro+ groups [(446.1 ± 74.8),(502.1 ± 39.2)μg/L, all P < 0.05]. The mean levels of serum albumin of Se-Pro- groups [(34.36 ± 1.28 ), (33.38 ±2.48)g/L] were lower than those of Se+Pro+ groups[(40.69 ± 1.30), (38.71 ± 2.15)g/L, all P < 0.05]. The mean levels of heart weight index of CIT+ groups[(4.14 ± 0.36) × 10-3, (4.39 ± 0.53) x 10-3] were higher than those of CIT-groups[(3.56 ± 0.26) x 10-3, (3.80 ± 0.28) x 10-3, all P < 0.05] respectively at the same levels of selenium and protein. The mean levels of CK in serum of Se-Pro-CIT+ group[(2.54 ± 0.56)kU/L] was lower than that of Se-Pro-CIT- group [(3.37 ± 0.67 )kU/L, P < 0.05]. The mean levels of activity of GSH-Px in serum of Se-Progroups[(408.1 ± 412.6), (510.5 ± 392.0)U/L] were lower than those of Se+Pro+ groups[(1667.8 ± 102.2),(1731.5 ± 144.4)U/L, all P < 0.05]. In Se+Pro+CIT+ group, there was part of intercalary disc of cardiac myocytes fragmented;the conjunctions between myoeytes were broken;in some region, cardiac myocytes became edematous,even dissolved. In Se-Pro-CIT- group, the change of cardiac myocytes membrane structures was not obvious;filament structure was disappeared around nucleus;deposition of mass floccule could be seen. In Se-Pro-CIT+ group,the structure of sarcomeres was not obvious;mitochondrial cristae was loosened;cavities in myocytes could be seen occasionally;there were lots of disseminated sareoplasmic reticulum extending. Conclusions .CIT is the main risk factor in inducing myocardial damage. The deficiency of combined selenium and protein can aggravate the damage,but its independent pathogenic effect is weak.     

针刀镜联合富血小板血浆治疗膝骨关节炎30例

目的 观察针刀镜联合富血小板血浆治疗膝骨关节炎的临床疗效。方法 回顾性分析2021年1月-2022年3月长春中医药大学附属医院骨科中心收治的30例采用针刀镜联合富血小板血浆治疗的膝骨关节炎患者。手术当天及术后1周、2周给予患者富血小板血浆关节腔注射治疗。疗前及疗后3周、8周、3个月均行VAS评分和Lysholm评分,比较患者末次随访与疗前评分差异;统计患者疗后不良反应发生率及疗后3周、8周、3个月有效率。结果 30例患者均获得3个月以上随访,平均3.5个月。所有患者末次随访VAS评分、Lysholm评分结果均好于疗前,差异具有统计学意义（P <0.05）;所有患者疗后均无不良反应发生,末次随访总有效率达97%。结论 针刀镜联合富血小板血浆治疗膝骨关节炎能够减轻患者疼痛,缓解临床症状,改善膝关节功能,是治疗膝骨关节炎安全、有效的治疗方法。     

黄绿青霉素对低硒低蛋白大鼠心肌组织形态结构的影响

目的 观察黄绿青霉素(CIT)对低硒低蛋白大鼠心肌组织形态结构的影响.方法 将48只Wistar 雄性大鼠按2×2析因设计分为4组:低硒低蛋白加毒素组、低硒低蛋白无毒素组、常硒常蛋白加毒素组和常硒常蛋白无毒素组,每组12只.首先用常硒常蛋白或低硒低蛋白饲料喂养大鼠2个月,然后加毒素各组饲料中另加入8 mg·kg-1·d-1 CIT喂养2个月,再以加入10 mg·kg-1·d-1 CIT的饲料喂养2周,而无毒素各组继续喂饲原饲料.在实验终期将大鼠麻醉后进行股动脉放血处死,称量心脏质量,计算心脏质量指数,光镜下观察心肌组织病理学变化.结果 低硒低蛋白加毒素组、低硒低蛋白无毒素组、常硒常蛋白加毒素组和常硒常蛋白无毒素组心脏质量指数分别为( 3.65±0.45)×10-3、(3.05±0.19)×10-3、(3.83±1.06)×10-3、(3.31±0.52)× 10-3.析因分析结果显示,CIT因素对大鼠心脏质量指数有明显影响作用(F=8.524,P＜0.05),而“硒+蛋白”因素未见明显影响作用(F=1.347,P＞0.05),且二者间不存在交互作用(F=0.048,P＞0.05).光镜下低硒低蛋白加毒素组大鼠心肌细胞血管周围出现纤维组织增生,细胞中出现明显的收缩带；低硒低蛋白无毒素组大鼠出现少量心肌细胞固缩；常硒常蛋白加毒素组大鼠心肌细胞出现坏死灶,并伴有炎性细胞浸润,出现较多固缩细胞；常硒常蛋白无毒素组大鼠心肌细胞群排列整齐,层次清晰,结构完好.结论 CIT可引起大鼠心肌组织变性坏死,低硒低蛋白也可造成大鼠心肌组织轻微损伤,而两因素叠加在一起时心肌损伤较严重.     

黄绿青霉素对低硒低蛋白大鼠心肌损伤的生化检测

目的 观察黄绿青霉素(CIT)对低硒低蛋白大鼠心肌损伤在生化水平上的特点.方法 48只4周龄Wistar雄性大鼠,2×2析因设计,按体质量随机分为4组:低硒低蛋白加CIT组、低硒低蛋白组、常硒常蛋白加CIT组、常硒常蛋白组,每组12只.分别采用低硒低蛋白和常硒常蛋白饲料喂养大鼠至第12周后,加毒素组大鼠饲料中加入8mg·kg-1·d-1 CIT喂养至第20周,再加量至10 mg·kg-1·d-1 CIT继续喂养至22周,股动脉采血及取心脏,检测血清肌钙蛋白Ⅰ(Tn-Ⅰ)、白蛋白水平,肌酸激酶(CK)、谷胱甘肽过氧化物酶( GSH-Px)以及心肌超氧化物歧化酶(SOD)活性,总抗氧化能力(T-AOC).结果 “硒+蛋白”与CIT对大鼠终来体质量、白蛋白和Tn-Ⅰ存在交互作用(F值分别为8.186、6.160、19.183,P均＜0.05),对12周大鼠体质量,22周血清GSH-Px、CK水平以及心肌SOD、T-AOC活性的影响不存在交互作用(F值分别为1.633、1.987、0.075、0.474、1.145,P均＞ 0.05).在低硒低蛋白背景下,加CIT组血清白蛋白和Tn-Ⅰ水平[(42.88±1.19)g/L,(668.6±55.8) ng/L]均低于无CIT组[(47.59±1.05)g/L,(989.3±49.2)ng/L,P均＜0.05].“硒+蛋白”对12周大鼠体质量、22周血清GSH-Px活性以及心肌SOD、T-AOC有影响(F值分别为96.860、58.086、4.475、25.485,P均＜0.05).低硒低蛋白两组12周大鼠体质量[(186.33±7.89)、(197.83±7.89)g]均低于常硒常蛋白两组[(274.08±7.89)、(265.42±7.89)g,P均＜0.05];低硒低蛋白两组[(317.5±102.6)、(296.9±90.5)U/L]血清GSH-Px活性均低于常硒常蛋白两组[(926.1±110.9)、(1181.7±85.9) U/L,P均＜0.05];低硒低蛋白两组心肌SOD活性[ (65.22±5.91)×106、(62.68±5.61)× 106 U/kg]均低于常硒常蛋白两组[(74.07±7.24)×106、(80.07±5.91)×106 U/kg,P均＜0.05];低硒低蛋白两组心肌T-AOC活性[(1.138±0.086)×106、(0.806±0.081)× 106U/kg]均低于常硒常蛋白两组[(1.688±0.105)×106、(1.163±0.086)×106 U/kg,P均＜0.05].结论 低硒低蛋白模型复制成功,CIT对低硒低蛋白大鼠心肌损伤在生化水平未发现有规律性效应,有待进一步研究确定.