男性脂肪肝患者的性激素水平分析

目的　探讨男性脂肪肝患者性激素的变化。方法　应用美国 ACS:180化学发光免疫分析仪测定 5 8例男性脂肪肝患者血清性激素水平 ,并与正常对照组比较。结果　 5 8例患者血清雌二醇 ( E2 )均值为 180 .3± 16.7pmol/ L ,睾酮( T)均值为 8.2± 1.8nmol/ L。E2 / T比值为 2 1.98± 2 .5 6,均明显高于对照组。总胆汁酸 ( TBA)增高 ,A/ G降低的脂肪肝患者的性激素紊乱程度重于正常组的脂肪肝患者。血清 E2 增高 ,T降低与肝功能损害程度一致。结论　男性脂肪肝患者血清 E2 增高 ,T降低和 E2 / T失衡 ,反应脂肪肝患者的肝功能代偿状况 ,具有一定的临床意义     

血浆皮质醇在病毒性肝炎及肝硬化中的临床意义

本文对100例各型病毒性肝炎及肝硬化病人血浆皮质醇的变化进行了观察,提示血浆皮质醇在病毒性肝炎中无重要临床意义,但和肝硬化的代偿及失代偿程度明显相关。肝硬化代偿期轻度升高,失代偿期明显升高,其均值为129.60±175.61μg/L,显著高于对照组(15.6±5。70μg/L),说明慢性肝病高皮质醇血症主要发生于肝硬化肝功能失代偿期。     

重度心衰患者甲状腺激素水平的变化

目的　通过对重度心力衰竭 (CHF)患者甲状腺激素水平异常变化并将之与正常人的对照研究 ,探讨甲状腺激素血浆浓度与慢性心力衰竭的关系及临床意义。方法　利用彩色超声诊断仪等测定 3 2例按NYHA分级为Ⅲ～Ⅳ级的心功能不全患者 ,将心脏扩大、射血分数 (EF) <3 5 %者纳入研究组 ;并设对照组 1 6例。所有研究对象的甲状腺素浓度均采用放免法测定。结果　重度心衰患者与对照组比 :T3 血浆浓度降低 ,分别为 (0 .76± 0 .0 8)nmol L和 (1 .3 2± 0 .1 1 )nmol L(P <0 .0 5 ) ;T4 血浆浓度有增高的趋势 ,分别为 (1 2 6 .2 1± 1 0 .45 )nmol L和 (1 2 1 .3 4± 8.83 )nmol L(P >0 .0 5 ) ;TSH血浆浓度无差别 ,分别为 (6 .1 8± 0 .72 )mIU L和 (6 .3 7± 0 .6 9)mIU L (P >0 .0 5 ) ;rT3 血浆浓度增高 ,分别为 (0 .45± 0 .0 4 )nmol L和 (0 .3 4± 0 .0 4 )nmol L (P <0 .0 5 ) ;T3 rT3 降低 ,分别为 1 .6 9± 0 .2 1和 3 .88± 0 .41 (P <0 .0 1 )。结论　重度心衰时 ,常伴有甲状腺激素水平的异常变化 ,表现为T3 的降低、rT3 的增高等。     

胰岛素强化治疗肝硬化合并糖尿病患者的疗效观察

目的 探讨肝硬化合并糖尿病患者应用胰岛素强化治疗后血糖及临床指标的变化特点。方法 以首都医科大学附属北京佑安医院2018年11月~2021年7月收治的肝硬化合并糖尿病患者共52例为研究对象,分为代偿期肝硬化组(n=16)和失代偿期肝硬化组(n=36),在糖尿病饮食基础上进行胰岛素强化治疗。在基线及强化治疗1周后进行空腹血糖、餐后2h末梢血糖、肝功能、凝血功能和血常规等指标评估。结果 代偿期肝硬化组经过胰岛素强化治疗1周后,与基线比较,lnALT、空腹血糖及餐后2h末梢血糖均明显下降(3.45±0.58IU/L vs 3.71±0.99IU/L,7.32±1.55mmol/L vs 12.29±1.93mmol/L,9.89±1.84mmol/L vs 28.30±1.45mmol/L;P均＜0.05)。失代偿期肝硬化组经过胰岛素强化治疗1周后,与基线比较,lnALT、空腹血糖及餐后2h末梢血糖均明显下降(3.04±0.89IU/L vs 3.36±1.00IU/L,8.63±2.95mmol/L vs 13.76±3.04mmol/L,12.87±1.77mmol/L vs 27.98±2.14mmol/L; P均＜0.05),白蛋白明显上升(32.61±4.49g/L vs 29.39±5.66g/L;P＜0.05),但餐后2h末梢血糖仍高于代偿期肝硬化组(P＜0.05)。两组胰岛素强化治疗前后比较,谷草转氨酶(AST)、总胆红素(TBil)、胆碱酯酶、凝血酶原活动度、白细胞计数、血红蛋白和血小板计数差异无统计学意义(P均＞0.05)。结论 胰岛素强化治疗能够有效降低肝硬化合并糖尿病患者血糖,对于失代偿期肝硬化患者仍需更长时间的监测及调整才能使血糖达标。     

非胰岛素依赖型糖尿病患者血浆性激素水平改变及其与血管并发症关系的研究

本文报道95例非胰岛素依赖型糖尿病患者(48例男性、47例绝经期后女性,均为50岁以上)及93例非糖尿病人(43例男性、50例绝经期后女性、均为50岁以上)血浆睾酮(T)及雌二醇(E_2)测定结果,表明男性患者血浆T降低(P<0.05),女性患者E_2,E_2/T降低(P均<0.025)。 男性患者E_2/T(比值×10~3以下同)≥9时,高血压患病率成倍增高(P<0.025),男性冠心病组E_2,E_2/T高于无冠心病组(P分别<0.05,<0.005),提示E_2/T增高可能足男性患者大血管病变的一个易患因素。女性患者E_2/T<1或≥80时冠心病患病率明显增高(P<0.025),提示E_2/T过低或过高均可能与女性患者冠心病患病率增高有关。 男、女性患者E_2/T与视网膜病患病率之间均未发现明显相关。     

血清总胆汁酸、丙氨酸氨基转移酶和血清天门冬氨酸氨基转移酶在肝硬化疾病中的应用

目的:探讨肝硬化患者血清总胆汁酸(TBA),血清丙氨酸氨基转移酶(ALT)和血清天门冬氨酸氨基转移酶(AST)的变化和临床意义。方法:用全自动生化分析仪测定67例肝硬化患者(代偿期30例,失代偿期37例)的血清TBA,AST和ALT的活性。同时设立正常对照组,TBA测定采用酶比色法,AST和ALT测定采用速率法。结果:肝硬化失代偿期患者血清TBA,AST和ALT分别为(109.8±80.6)μmol/L,(215.5±106.9)U/L,(196.8±103.7)U/L。肝硬化代偿病期人血清TBA,AST和ALT分别为(37.6±23.9)μmol/L,(43.7±23.9)U/L,(50.9±26.6)U/L,正常对照组TBA,AST和ALT分别为(11.9±7.3)μmol/L,(19.3±10.9)U/L,(23.3±11.6)U/L。肝硬化失代偿期组TBA,AST和ALT明显比正常对照组高(P<0.01),肝硬化代偿期组TBA明显高于对照组(P<0.01)。结论:在肝硬化患者的诊断中,TBA灵敏性高于AST和ALT,肝硬化失代偿期患者血清AST高于ALT,可能因为肝硬化失代偿期患者肝脏损伤重。     

肝硬化患者高生长激素血症的临床意义

本文报告50例肝硬化患者空腹血清生长激素检测结果,52％患者的生长激素水平升高;代偿期均值为3.47±2.64μg/L,失代偿期均值为14.33±13.17μg/L,后者明显高于前者(t=3.25,P<0.01)。本文检测结果表明肝硬化患者血清生长激素水平升高与肝病严重程度成正相关。检测肝硬化患者的血清生长激素水平,有助估价肝功能状况,指导临床治疗。对伴有高生长激素血症患者尚须注意糖代谢紊乱。     

蝮蛇抗栓酶对不稳定型心绞痛病人血浆TXB_2、6-K-PGF_(1α)的影响

50例不稳定型心绞痛病人被随机分为治疗组(蝮蛇抗栓酶0.01U/kg,VD,1/d,n=25)和安慰组(n=25)。治疗组治疗后血浆6-K-PGF_(?)浓度明显增高(从38.52±11.08增至46.16±7.32,P<0.01),TXB_2及T/P 比值明显降低(分别从347.19±54.80降至309.79±84.45,从9.01±4.95降至6.71±11.53;P 分别<0.001,<0.01)。安慰组前后血浆6-K-PGF_(?)、TXB_2浓度及 T/P 比值无显著性差异(P 均>0.05)。治疗组与安慰组相比,血浆6-K-PGF_(?)浓度增高(46.16±7.32比37.78±8.16,P<0.05),TXB_2浓度及 T/P 比值降低(348.94±64.42比309.79±84.45,9.24±7.84比6.71±11.52;P 均<0.05)。这些结果揭示血浆6-K-PGF_(?)(PGI_2)浓度的增高、TXB_2(TXA_2)浓度及 T/P 比值的降低可能是蝮蛇抗栓酶治疗不稳定型心绞痛的重要机制之一。     

心得安与氯沙坦对慢性肝病患者肾素-血管紧张素-醛固酮系统作用的研究

对46例慢性肝病(包括17例中度慢性肝炎、14例代偿期肝硬化、15例失代偿期肝硬化伴腹水)患者用放射免疫法检测基础状态下的血浆血管紧张素-Ⅱ(AT-Ⅱ)和醛固酮(Ald)水平,并对其中24例患者作了速尿激发试验,12例作了心得安抑制试验,14例作了氯沙坦抑制试验。研究心得安与氯沙坦对肾素-血管紧张素-醛固酮系统(RAAS)的影响,以便为肝硬化治疗提供新的思路。结果:慢性肝炎中度(CH-中度)和肝硬化代偿期(CLC)患者血浆AT-Ⅱ水平与正常人无明显差异,而Ald醛固酮显著增高;失代偿性肝硬化(DLC)伴腹水患者血浆AT-Ⅱ、Ald均显著高于正常人水平(AT-Ⅱ为190.90±147.48 vs 46.65±5.27 ng/ml,Ald为568.00±70.70 vs 86.00±37.50 ng/ml);经速尿激发后,所有受试者血浆AT-Ⅱ、Ald均在原有基础上进一步上升;口服心得安以后,血浆AT-Ⅱ均显著下降;但口服氯沙坦以后,血浆AT-Ⅱ则显著上升。提示:失代偿期肝硬化患者血浆AT-Ⅱ和Ald水平显著升高,与腹水形成有密切关联;速尿可刺激肾素释放,升高血浆AT-Ⅱ、Ald水平,故不宜滥用;心得安与氯沙坦可分别作用于β受体(βR)和AT-Ⅱ1型受体(AT-Ⅱ1R),而抑制肾素-血管紧张素-醛固酮系统的活性,在肝硬化治疗中可能发挥良好的作用。     

不同临床类型肝癌男性患者血清性激素水平测定的比较分析

本文对临床Ⅱ期的原发性肝细胞癌(HCC)男性患者硬化型14例,单纯型16例的血清睾酮(T)、雌二醇(E_2)水平及E_2/T比值进行测定。结果显示:单纯型HCC血清T、E_2水平及E_2/T比值与正常对照组比较无显著差异(分别P>0.10,P>0.10,P>0.50);硬化型HCC与单纯型和正常对照组比较,血清T水平明显降低(分别P<0.05,P<0.01),E_2水平明显增高(P<0.05,P<0.05),E_2/T比值明显升高(分别P<0.01,P<0.01)。硬化型HCC血清性激素变化与肝硬化相似。作者分析了两型HCC血清性激素水平差异的原因。     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.