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南昌大学学报（医学版）

南昌大学学报（医学版）

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Acta Academiae Medicinae Jiangxi
本刊是一份医学综合性学术期刊，创刊于1956年11月。1981年起改公开发行，1993年第2期开始向国外发行。现刊为双月刊。主旨为反映学院医疗、教学和科研水平，注重学术质量和社会效益，积极为繁荣医学事业服务。主要报道基础医学、临床医学、预防医学等方面的学术内容，刊登相关论文及信息。系国家科技部中国科技论文统计源期刊和中国医学核心期刊，以及“中国期刊方阵”双效期刊。
  • 发文量：10297
  • 被引量：1524
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  • 国内刊号/CN：36-1323/R
    国际刊号/ISSN：2095-4727
  • 发行周期：月刊
    邮发代号：44-138
  • 主管单位：南昌大学
    主办单位：南昌大学
南昌大学学报（医学版）-联系信息
  • 主编：辛洪波
  • 电话：0791-86361259
  • 邮箱：ndyxb@ncu.edu.cn
  • 地址：江西省南昌市八一大道461号
  • 邮编：330006
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南昌大学学报（医学版） >2021年第6期

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  • 摘要：目的：观察乳腺导管内癌（ductal carcinoma in situ，DCIS）中 Ki-67的表达情况及其与不同组织学分级及分子分型之间的关系。方法采用免疫组织化学 EnVision 两步法检测60例 DCIS 组织中雌激素受体（ER）、孕激素受体（PR）、人类表皮生长因子受体（HER-2）、增殖细胞核杭原 Ki-67的表达，按照免疫表型分为4种类型：腺腔 A型[（ER（＋）和（或）PR（＋）、HER-2（－）、Ki-67低表达（＜14％）]、腺腔 B 型[分为 HER-2（＋）和 HER-2（－）型， HER-2（－）型：ER（＋）和（或）PR（＋）、HER-2（－）、Ki-67高表达（≥14％）；HER-2（＋）型：ER（＋）和（或）PR（＋）、HER-2（＋）、Ki-67任何水平]、HER-2过表达型[ER（－）、PR（－）、HER-2（＋）]和三阴型[ER（－）、PR（－）、HER-2（－）]。比较 Ki-67表达与 DCIS 组织学分级及分子分型的关系。结果Ki-67在低级别至高级别 DCIS 中的表达依次增高，差异有统计学意义（P ＜0．01）。Ki-67在腺腔 A 型、腺腔 B 型、三阴型、HER-2过表达型中的表达依次升高，差异有统计学意义（P ＜0．01）。DCIS 分子分型与组织学分级有关联（P ＜0．01），腺腔 A 型和腺腔 B 型以低、中级别 DCIS 为主，三阴型及 HER-2过表达型以高级别 DCIS 为主。结论Ki-67是 DCIS 一项重要的预后指标， Ki-67纳入分子分型指标进一步对腺腔 A 型及腺腔 B 型 DCIS 进行分型是对单纯用 ER、PR、HER-2进行分型的完善和补充，有利于临床实施有效的个体化治疗方案。%ABSTRACT:Objective To observe the expression of Ki-67 in ductal carcinoma in situ(DCIS) and its relationships to histological grade and molecular classification.Methods The expression of estrogen receptor(ER),progesterone receptor(PR),Ki-67 and HER-2 was detected in 60 cases of DCIS by using immunohistochemistry(EnVision method).According to the immunopheno-types,four subtypes were classified:luminal A subtype[ER(+)/PR(+),HER-2(-),Ki-67 ex-pression<14%),luminal B subtype(HER-2(-)subtype:ER(+)/PR(+),HER-2(-),Ki-67 ex-pression≥14%;HER-2(+)subtype:ER(+)/PR(+),HER-2(+),any Ki-67 expression),HER-2-overexpressing subtype(ER(-),PR(-),HER-2(+)],and triple negative subtype[ER(-), PR(-),HER-2(-)].The relationships of Ki-67 expression to histological grade and molecular classification of DCIS were analyzed.Results The expression of Ki-67 significantly increased from low to high histological grade of DCIS(P <0.01).Moreover,Ki-67 expression successively increased in luminal A subtype,luminal B subtype,triple negative subtype and HER-2-overex-pressing subtype of DCIS(P <0.01).The molecular classification of DCIS was related to the his-tological grade(P <0.01).Low-and middle-grade DCIS were predominant in luminal A subtype and luminal B subtype.But high-grade DCIS was predominant in HER-2-overexpressing subtype and triple negative subtype.Conclusion Ki-67 is an important prognostic indicator in DCIS.New molecular classification including Ki-67 as an index is a supplement for the classification of lumin-al A subtype and luminal B subtype of DCIS with ER,PR and HER-2.It is advantageous for clini-cal implementation of individualized treatment regimen.
  • 摘要：ABSTRACT:Objective To measure the preoperative levels of P-selectin in serum and peritoneal fluid in patients with ovarian cancer,and to explore its clinical significance.Methods The preop-erative levels of P-selectin in serum and peritoneal fluid were measured by EL1SA in 60 cases of ovarian cancer(study group),30 cases of benign ovarian tumors(control group 1)and 30 healthy subjects(control group 2).The relationships between levels of P-selectin and clinicopathologic features of ovarian cancer were analyzed.Results The median levels of P-selectin in serum[(29.9± 7.2)μg· L-1 ]and peritoneal fluid in study group were,respectively,were significantly higher than those in control group 1 and control group 2(P <0.05),P-selectin in peritoneal fluid[(32.5± 7.1)μg·L-1 ]significantly higher than in control group 1(P <0.05).There were no significant differences in serum and peritoneal fluid P-selectin levels among serous carcinoma,mucinous car-cinoma and endometrioid carcinoma.However,serum and peritoneal fluid P-selectin levels in ovar-ian cancer patients with lymph node metastasis were significantly higher than those in ovarian cancer patients without lymph node metastasis(P <0.05),and those in patients with stage Ⅲ-Ⅳovarian cancer were significantly higher than those in patients with stage Ⅰ-Ⅱ ovarian cancer (P <0.05).Conclusion Serum and peritoneal fluid P-selectin levels significantly increase in pa-tients with ovarian cancer,suggesting that P-selectin may be involved in tumor invasion and me-tastasis.Therefore,P-selectin can be used as a potential marker for the diagnosis and treatment of ovarian cancer.%目的：测定卵巢癌患者术前血清和腹腔液中 P-选择素（P-selectin）水平，并探讨其临床意义。方法采用酶联免疫吸附试验（EL1SA）检测术前60例卵巢癌患者（研究组）及30例卵巢良性肿瘤（对照组1）和30例健康体检者（对照组2）的血清和腹腔液中 P-selectin 水平，对3组的所测值进行比较，并分析其与卵巢癌临床病理特征的关系。结果研究组血清P-selectin 水平[（29．9±7．2）μg·L－1]显著高于对照组1和对照组2（P ＜0．05），腹腔液中 P-selectin 水平[（32．5±7．1）μg·L－1]明显高于对照组1（P ＜0．05）。浆液性癌、黏液性癌和内膜样癌中血清和腹腔液中 P-selectin水平差异均无统计学意义；发生淋巴结转移的卵巢癌者血清和腹腔液中 P-selectin 的水平显著高于未发生转移者（P ＜0．05），Ⅲ—Ⅳ期卵巢癌者亦显著性高于Ⅰ—Ⅱ期者（P ＜0．05）。结论卵巢癌患者血清和腹腔液中 P-selectin 水平显著性升高，提示P-selectin可能参与肿瘤的侵袭和转移，可以作为卵巢癌诊断和治疗的潜在标志物。
  • 摘要：ABSTRACT:Objective To compare the difference between psychological age and chronological age in community elderly in Nanchang,and to investigate the factors influencing psychological age.Methods The general biological and social characteristics(gender,age,education level,health status,environment satisfaction,recreational activities,difficulties,setbacks,etc.)were investiga-ted in Nanchang community residents aged 60 years or older.The psychological age was measured using the Psychological Aging Self-Check Scale.Results Among the 110 community elderly resi-dents investigated,psychological age was less than chronological age in 106(96.36%,psychologi-cal age was less than 60 years).Furthermore,the psychological test scores increased with age(F=3.409,P =0.020).The factors influencing psychological age included age,health status,environ-mental satisfaction,recreational activities,difficulties and setbacks.Conclusion In general,the psychological age is less than chronological age in Nanchang community elderly.The main reasons leading to the difference include health status,environmental satisfaction,frequency of recreation-al activities,difficulties,and setbacks.Therefore,the physical health should be more concerned, social support and humanistic care should be given and social activities should be encouraged to promote the mental health of the elderly.%目的：比较南昌市社区老年人心理年龄与实际年龄的差异，探讨影响其心理年龄的因素。方法以南昌市部分社区60岁及以上老年人作为调查对象，对调查对象的一般生物学、社会学特征（包括性别、年龄、文化程度、健康状况、环境满意度，娱乐活动、困难与挫折等）等信息和数据进行采集，并采用《心理衰老的自我测查》量表对老年人心理年龄进行测试评分。结果96．36％（106／110）的老年人其心理年龄比实际年龄小（即小于60岁），不同年龄组心理测试得分不同，有随着年龄增加而增大的趋势（F ＝3．409，P ＝0．020）。影响心理年龄的因素有老年人的健康状况、环境满意度、娱乐活动、困难与挫折、年龄。结论南昌市社区老年人整体上心理年龄偏年轻，导致心理年龄与实际年龄差异主要原因有健康状况、对环境满意度、参加的娱乐活动频率和经历困难挫折，应多关注老年人身体健康状况，在社会大环境上给予社会支持和人文关怀，鼓励老年人积极参与社会活动，促进老年人心理健康。
  • 摘要：肺癌是当今最常见的恶性肿瘤之一，各国的肺癌发病率和病死率近年都有明显增高趋势。肺癌高发与吸烟、空气污染、职业暴露、精神、遗传、饮食以及既往慢性肺部疾病等风险因素有关。本文介绍了几种常见的慢性肺部疾病，包括慢性阻塞性肺疾病、肺结核、特发性肺纤维化、硅沉着病等，总结了其与肺癌的关系，并试图阐明引起肺癌的可能的分子生物学机制，为探讨肺癌的病因提供依据。%Lung cancer is one of the most common malignant tumors.In the recent decades,the incidence and mortality of lung cancer have significantly increased in all countries.The high inci-dence of lung cancer is associated with smoking,air pollution,occupational exposure,mental stress,heredity,diet and chronic lung diseases.This review introduces several common chronic lung diseases,including chronic obstructive pulmonary diseases,tuberculosis,idiopathic pulmona-ry fibrosis,silicosis,etc.In addition,this paper summarizes the relationship of chronic lung disea-ses to lung cancer and attempts to clarify the molecular biological mechanisms,which can provide a basis for investigating the etiology of lung cancer.
  • 摘要：Heart failure(HF)is associated with a morbidity and mortality.Cardiac resynchro-nization therapy(CRT)and implantable cardiac defibrillator(ICD)treatment can improve clinical symptoms,reduce rehospitalization rate,ameliorate heart remodeling and increase survival rate in patients with HF.Left ventricular systolic dyssynchrony can be assessed by phase analysis of ga-ted myocardial perfusion imaging(GMPI).Myocardial viability and left ventricular systolic syn-chrony can be assessed by gated positron emission tomography(PET).Sympathetic nerve function can be assessed by cardiac neuroreceptor imaging with 123 I-meta-iodobenzyl guanidine(123 I-MIBG) and 11 C-hydroxyephedrine(11 C-HED).%心力衰竭发病率和病死率很高，心脏再同步治疗（CRT）和植入式心律转复除颤器（ICD）治疗能够改善心力衰竭患者的临床症状，降低患者的再住院率，改善心脏重构，并提高患者的生存率。门控心肌灌注显像（GMPI）相位分析技术可以评价左心室收缩不同步性，门控正电子发射型计算机断层（PET）心肌代谢显像可以评估心肌存活和左心室收缩的同步性，123 I-间位碘代苄胍（123 I-MIBG）和11 C-羟基麻黄碱（11 C-HED）的心脏神经受体显像可以评价心力衰竭患者的心脏交感神经功能。
  • 摘要：The percutaneous catheter ablation is an imperative treatment for ventricular tachy-cardia.Conventional mapping techniques require haemodynamic stabilization during ongoing tach-ycardia.The non-inducibility of ventricular tachycardia,poor induction reproducibility,haemody-namic instability,and multiple ventricular tachycardias with frequent spontaneous changes in mor-phology preclude mapping the ventricular tachycardia.In order to overcome these limitations,sub-strate mapping in sinus rhythm has been developed and used by many centers.This review sum-marizes the new progress in the ablative treatment of ventricular tachycardia with a substrate mapping approach.%经导管消融治疗室性心动过速（室速）是临床一项主要的治疗手段。传统的标测技术要求室速发作时患者的血流动力学必须稳定。若室速不易诱发、室速状态不易维持、血流动力学不稳定以及频繁自发的多形性室速，是影响传统标测方法准确性的重要原因。为了突破这一系列局限性问题，许多中心越来越注意发展窦性心律下的基质标测。本文将近期内应用基质标测进行器质性室速指导消融的新进展进行综述。
  • 摘要：目的：运用鱼骨图分析影响肠造口人生活质量的因素，为进一步提高其生活质量提供指导。方法动态追踪105例行永久性结肠造口人的资料。建立信息库，每月随访1次，持续追踪1年，了解造口人基本信息、术后并发症、造口护理情况、心理状况等，采用鱼骨图法对造口人肠造口术后生活质量的影响因素进行分析和评价。结果影响肠造口人生活质量的因素包括医生、护士、造口人及家属、社会支持。结论采用鱼骨图法能对生活质量的影响因素进行全面有效分析，了解肠造口人术后生活状态的原因，为其自我管理和护理提供全面、有效的指导。%Objective To analyze the factors influencing the quality of life of patients with per-manent colostomy using fish-bone diagram,and to provide guides for improving the quality of life of patients with permanent colostomy.Methods Data of 105 patients with permanent colostomy were dynamically tracked,and the database was established.The follow-up was performed once per month for 1 year to know the basic information,postoperative complications,nursing situation and psychological status of patients.In addition,the factors influencing the quality of life of pa-tients with permanent colostomy were analyzed and evaluated using fish-bone diagram.Results The factors influencing the quality of life of patients with permanent colostomy included doctors, nurses,patients and their families,and social supports.Conclusion Fish-bone diagram can be used for comprehensively and effectively analyzing the factors influencing the life of quality,un-derstanding the state of life and providing guides for self-management and nursing in patients with permanent colostomy.
  • 摘要：ABSTRACT:Objective To observe the effects of controlled hypotension,controlled low central venous pressure(CVP)and their combination on intraoperative blood loss,portal clamping time and hepatorenal function in patients undergoing hepatectomy.Methods Sixty patients who re-quired hepatectomy for liver cancer were randomly divided into four groups,with 15 patients in each group.All patients received general anesthesia and tracheal intubation.In addition,patients in group A,B,C and D were given controlled hypotension(mean arterial pressure(MAP),(8.00-10.67)kPa;CVP,(0.490-0.980)kPa),controlled low CVP(CVP,(0.098-0.392)kPa;MAP,≥10.67 kPa),controlled hypotension plus controlled low CVP(CVP,(0.098-0.392)kPa;MAP, (8.00-10.67)kPa)and maintained CVP(CVP,(0.490-0.980)kPa;MAP,≥10.67 kPa),respec-tively.Intraoperative blood loss,portal clamping time,operation time,and postoperative hemoglo-bin(Hb)level and hematocrit(HCT)were compared among the four groups.Furthermore,hepatic function indexes serum bilirubin and plasma albumin,and renal function indexes blood urea nitro-gen(BUN)and creatinine(Cr)were measured before operation and 1 and 3 days after operation. Results Compared with group D,intraoperative blood loss was reduced,portal clamping time and operation time were shortened,and postoperative Hb level and HCT were increased in group A,B and C(P < 0.05).Compared with group A or B,intraoperative blood loss was reduced,portal clamping time was shortened,and postoperative Hb level and HCT were increased in group C (P <0.05).No significant differences in hepatorenal function indexes were found among the four groups before operation and 1 and 3 days after operation(P >0.05).Conclusion Both controlled hypotension and controlled low CVP,especially their combination,can reduce intraoperative blood loss,shorten portal clamping time,and have no effect on hepatorenal function in patients undergo-ing hepatectomy.%目的：观察控制性降压、控制性低中心静脉压（CVP）及控制性降压联合控制性低 CVP 对肝切除术患者术中出血量、肝门阻断时间及肝肾功能等的影响。方法将60例行肝切除术的肝癌患者按随机数字表法分为 A、B、C、D 4组，每组15例。4组患者均行气管插管全身麻醉。A 组术中采取控制性降压[控制平均动脉压（MAP）为8．00～10．67 kPa、CVP 为0．490～0．980 kPa]，B 组采取控制性低 CVP（控制 CVP 为0．098～0．392 kPa、MAP≥10．67 kPa），C 组采取控制性降压联合控制性低 CVP（控制 CVP 0．098～0．392 kPa、MAP 为8．00～10．67 kPa），D组为对照组（维持 CVP 为0．490～0．980 kPa、MAP≥10．67 kPa）。比较4组患者手术一般情况[术中出血量、肝门阻断时间、手术时间、术后血红蛋白（Hb）及血细胞比容（HCT）等指标]；术前，术后1、3 d 肝功能相关指标（血清胆红素、血浆清蛋白、凝血酶原）及肾功能相关指标[尿素氮（BUN）水平、肌酐（Cr）]的变化。结果A、B、C 3组术中出血量、肝门阻断时间及手术时间均低于 D 组，术后 Hb、HCT 显著高于 D 组（均 P ＜0．05）；C 组术中出血量、肝门阻断时间均低于 A、B 组，术后 Hb、HCT 均高于 A、B 组（均 P ＜0．05）。4组患者术前，术后1、3 d，肝、肾功能相关指标比较差异均无统计学意义（均 P ＞0．05）。结论控制性降压、控制性低 CVP 及控制性降压联合控制性低CVP 3种降压方式均可降低肝切除术患者术中出血量，缩短肝门阻断时间，但控制性降压联合控制性低 CVP 效果更为显著，且对术后肝、肾功能均无显著影响，临床应用安全。
  • 摘要：Objective To understand the effects of conventional hemodialysis(HD),high-flux hemodialysis(HFD)and online hemodiafiltration(HDF)on microinflammatory state in mainte-nance hemodialysis(MHD)patients with end-stage renal disease(ESRD).Methods Sixty MHD patients with blood C-reactive protein(CRP)and interleukin-6(IL-6)levels higher than normal who were hemodialyzed over 1 year were randomly divided into three groups:HD group,HFD group and HDF group,with 20 patients in each group.The levels of CRP and IL-6 were detected before the first hemodialysis,after the first hemodialysis and after hemodialysis for 2 months.Re-sults The CRP levels decreased after hemodialysis for 2 months in HDF group(P <0.05).The IL-6 levels decreased after hemodialysis for 2 months in HFD group,as well as after the first he-modialysis and after hemodialysis for 2 months in HDF group(P <0.05).Compared with HFD group,the decreased percentages of CRP and IL-6 increased in HDF group(P <0.01).Conclusion Microinflammatory state exists in MHD patients.Compared with HD,HDF and HFD,especially HDF,can reduce the microinflammation in MHD patients.%目的：了解常规血液透析（HD）、高通量血液透析（HFD）、联机血液透析滤过（HDF）对终末期肾病维持性血液透析（MHD）患者微炎症状态的影响。方法选择血透室透析龄超过1年的 MHD 患者60例（患者血液 CRP、IL-6水平均高于正常），将其按随机数字表法分为 HD 组、HFD 组、HDF 组，每组20例。分别检测3组患者首次透析前（T前）、首次透析后（T后）及透析2个月后（T2个月）的 CRP、IL-6水平。结果与 T前比较，HDF 组 T2个月 CRP 明显下降（P ＜0．05），HFD 组 T2个月、HDF 组 T后及 T2个月 IL-6均明显下降（P ＜0．05），HDF 组 T2个月 CRP、IL-6下降百分比高于 HFD 组（P ＜0．01）。结论MHD 患者存在微炎症状态，HDF 及 HFD 较 HD 可减轻患者体内微炎症状态，且 HDF 的效果更好。
  • 摘要：Objective To explore the mutations of p53 gene and its relationships to chemother-apeutic effect and survival in patients with acute non-lymphoblastic leukemia(ANLL).Methods The mutations of p53 gene were detected by PCR and sequencing in 45 ANLL patients.Clinical and laboratory indexes were compared between patients with p53 mutations and patients without p53 mutations.Results Among the 45 ANLL patients,p53 mutations were found in 6(13.3%). There were no significant differences in the gender,age,leukocyte count and platelet count be-tween patients with p53 mutations and patients without p53 mutations at initial diagnosis(P >0.05).The complete remission rate in patients with p53 mutations was significantly lower than that in patients without p53 mutations(P =0.022),and the overall survival in patients with p53 mutations was significantly shorter than that in patients without p53 mutations(P =0.000).Con-clusion Patients with p53 mutations have low remission rate,short survival,and poor response to remission induction chemotherapy.The mutations of p53 gene are closely correlated with the prognosis of ANLL.%目的：观察急性非淋巴细胞白血病（ANLL）中 p53基因突变情况及其与化疗疗效、患者生存期的关系。方法应用聚合酶链式反应及测序检测45例初诊 ANLL 患者 p53基因突变情况，分析比较 p53突变组与无突变组患者的临床及实验室指标。结果45例 ANLL 患者中6例检测到 p53基因突变，突变率为13．3％。2组患者初诊时的年龄、性别、外周血白细胞计数及血小板计数差异均无统计学意义（P ＞0．05）。突变组患者诱导缓解化疗的CR 率明显低于无突变组（P ＝0．022），OS 明显短于无突变组（P ＝0．000）。结论p53基因突变患者对诱导缓解化疗反应差、缓解率低、生存期短；p53基因突变与 ANLL 患者的预后密切相关。
  • 摘要：ABSTRACT:Objective To investigate the expression and significance of chemokine receptor 5 (CCR5)and its ligands in tear film and ocular surface of patients with dry eye disease.Methods Forty-four patients with dry eye disease were divided into two groups:sicca syndrome group(17 cases)and non-sicca syndrome group(27 cases).In addition,20 healthy subjects were selected as the control group.The concentrations of CCL3,CCL4 and CCL5 were measured using enzyme-linked immunosorbent assay.The expression of CCL3,CCL4 and CCL5 and the density of CCR5 +cells were determined using immunohistochemistry.The percentages of CCR4 + CD4 + ,CCR5 +CD4+ and CCR6+CD4+ cells in conjunctival epithelium were detected using flow cytometry.Fur-thermore,the correlation between chemokine levels and tear film and ocular surface parameters was analyzed in sicca syndrome group.Results Compared with non-sicca syndrome group,the ex-pression of CCL3,CCL4 and CCL5 and the percentages of CCR5+CD4+ and CCR6+CD4 + cells in conjunctival epithelium significantly increased in sicca syndrome group(P <0.01).Compared with healthy subjects,the expression of CCL3,CCL4 and CCL5 and the percentages of CCR5 +CD4+ and CCR6 +CD4+ cells in conjunctival epithelium significantly increased in patients with dry eye disease(P <0.05 or P <0.01).The expression of CCL3,CCL4 and CCL5 was positively correlated with tear clearance rate(r=0.446,0.693 and 0.656,respectively,P <0.05)and corneal goblet cell density(r=0.712,0.768 and 0.780,respectively,P <0.05).Conclusion The expres-sion of CCR5 and its ligands increases in the tear film and ocular surface of patients with dry eye disease.CCL5 expression is correlated with the severity of dry eye disease.%目的：探讨泪膜和眼表趋化因子受体5（CCR5）及其配体在干眼症中的表达和临床意义。方法选择干眼症患者44例，其中干燥综合征患者（干燥综合征组）17例，非干燥综合征患者（非干燥综合征组）27例。以健康体检者20例作为对照组。对3组分别采用酶联免疫吸附法检测 CCL3、CCL4和 CCL5表达水平，免疫组织化学法检测结膜上皮 CCL3、CCL4、CCL5表达水平和 CCR5＋细胞密度，流式细胞术检测结膜上皮 CCR4＋CD4＋、CCR5＋CD4＋和 CCR6＋CD4＋细胞比例。对干燥综合征组 CCL3、CCL4、CCL5表达水平与检测指标的相关性进行分析。结果干燥综合征组结膜上皮 CCL3、CCL4和 CCL5表达水平均显著高于非干燥综合征组，非干燥综合征组、干燥综合征组结膜上皮 CCL3、CCL4和 CCL5表达水平则均显著高于对照组（均 P ＜0．01）。干燥综合征组 CCR5＋CD4＋、CCR6＋CD4＋细胞比例明显高于非干燥综合征组，非干燥综合征组、干燥综合征组 CCR5＋CD4＋、CCR6＋CD4＋细胞比例则均显著高于对照组（P ＜0．05或 P ＜0．01）。干燥综合征组 CCL3、CCL4、CCL5表达水平与泪液清除率、结膜杯状细胞密度均呈正相关（r ＝0．446、0．693、0．656、0．712、0．768和0．780，均 P ＜0．05）。结论CCR5及其配体在干眼症泪膜和眼表中的表达均显著增高，CCL5表达可能与干眼症严重程度有关。
  • 摘要：目的：探讨早期结外鼻型 NK／T 细胞淋巴瘤[ENKL]的治疗方法。方法对6年来诊治的24例早期（Ⅰ／Ⅱ）ENKL 瘤患者进行回顾性分析，比较单纯放疗与放化疗结合的疗效。结果7例患者接受单纯放疗，17例患者接受 CHOP 方案化疗联合局部放疗。放化疗结合组有效率为82．4％，显著高于单纯放疗组的42．9％（P ＝0．021）。2组中位总生存时间分别为35．5和39．5个月，差异无统计学意义（P ＝0．714）。结论放疗与化疗相结合的方法治疗 ENKL 疗效较好。
  • 摘要：Neonatal hypoxic-ischemic encephalopathy (HIE)is a kind of hypoxic-ischemic brain damage (HIBD)induced by hypoxia after perinatal asphyxia,which is a major cause of death and neurologic disability in children.Although tremendous progress has been made in providing life-support therapy in neonatal intensive care unit,the incidence of serious consequences including death,cerebral palsy,epilepsy and other cognitive,developmental and behavioral problems remains high.Therefore,it places a large burden on patients,their families,and society.In recent years,ex-tensive researches on molecular mechanisms and potential therapy targets of HIE have been per-formed in experimental animals and human infants.Based on the traditional treatment strategies, this review will focus on the recent advances in the main cellular and molecular mechanisms of HIBD and new therapeutic strategies,which can provide reference for the clinical treatment of HIE.%新生儿缺氧缺血性脑病（HIE）是指由于围产期窒息后缺氧导致的脑缺氧缺血性损害，是造成新生儿死亡和婴幼儿神经功能障碍的主要原因。虽然新生儿重症监护室（NICU）在生命支持治疗方面取得了巨大的进展，但HIE 带来的严重后果包括死亡、脑瘫、癫痫以及其他显著的认知、发育和行为障碍等问题的发生率仍然很高，给病人、家庭和社会带来了沉重的负担。近年来，国内外研究者们从动物模型和人类婴儿着手，开展了大量有关 HIE 的分子机制和相应治疗靶点的研究。本文将在讨论传统治疗策略的基础上，进一步就近年来国内外缺氧缺血性脑损伤（HIBD）的主要细胞和分子机制及新的治疗策略作一综述，以期为 HIE 的临床治疗提供参考。
  • 摘要：目的：建立检测九味肾清颗粒中黄芪甲苷含量的高效液相色谱-蒸发光散射（HPLC-ELSD）法。方法以黄芪甲苷为测定指标，色谱柱为依利特 Hypersil ODS 5μm，4．6 mm×250．0 mm，流动相为乙腈-水（38∶62）；流速1．0 mL·min－1，漂移管温度110℃；载气流量2．59 L·min－1。结果黄芪甲苷对照品线性范围为1．7588～17．5880μg，回归方程为 Y ＝1．3528X ＋4．7859，r ＝0．9997，平均回收率为101．51％，RSD 为2．91％。结论HPLC-ELSD 法可以准确地进行定量分析，可用于九味肾清颗粒的质量控制。%Objective To establish a high performance liquid chromatography-evaporative light scattering detection (HPLC-ELSD)method for determining the content of astragaloside in Shenq-ing granules.Methods The HPLC-ELSD of astragaloside was performed on the Hypersil ODS chromatography column (4.6 mm×250.0 mm,5 μm)with acetonitrile-water (38∶62)at a flow rate of 1.0 mL·min-1 .The drift tube temperature was set at 110 ℃,with a carrier gas flow rate of 2.59 L· min-1 .Results The linear range of astragaloside reference substance was 1.758 8-17.588 0 μg.The re-gression equation wasY=1.352 8X+4.785 9 (r=0.999 7).The average recovery rate was 101.51%, with a RSD of 2.91%.Conclusion The HPLC-ELSD method is accurate for quantitative analysis of astragaloside and can be used for controlling the quality of Shenqing granules.
  • 摘要：ABSTRACT:Objective To investigate the inhibitory effect of 11,12-didehydro-3,19-cyclophos-phate andrographolide on the proliferation,invasion and migration of gastric cancer SGC7901 cells and its mechanism of action.Methods SGC7901 cells were treated with 11,12-didehydro-3,19-cy-clophosphate andrographolide (20,40,60,80 and 100 μmol·L-1 )for 24,48 and 72 hours,respec-tively.Control cells received the vehicle only.Cell proliferation and viability were measured by MTT assay.After treatment for 24 hours,invasion assay was conducted using transwell cham-bers.After treatment for 48 hours,the expression of cell proliferation and migration-related pro-teins Akt,p-AKT,JNK,p-JNK,MMP-2 and MMP-9 was detected by Western blot.Results Compared with control group,11,12-didehydro-3,19-cyclophosphate andrographolide treatment significantly inhibited the proliferation of SGC7901 cells in a time- and concentration-dependent manner (P <0.01).Furthermore,treatment with 11,12-didehydro-3,19-cyclophosphate androgra-pholide (40 μmol·L-1 )significantly decreased the migration and invasion of SGC7901 cells,com-pared with control group(P <0.01).Moreover,treatment with 11,12-didehydro-3,19-cyclophos-phate andrographolide (40 μmol · L-1 )for 48 hours significantly reduced the expression of p-AKT,p-JNK,MMP-2 and MMP-9,compared with control group.Conclusion The treatment with 11,12-didehydro-3,19-cyclophosphate andrographolide can decrease the proliferation,inva-sion and migration of gastric cancer SGC7901 cells through inhibiting the expression of p-AKT,p-JNK,MMP-2 and MMP-9 proteins.%目的：研究脱水穿心莲内酯衍生物[11，12-脱水-二（2-氯乙基）氨基-3，19-环磷酸酯穿心莲内酯]抑制胃癌SGC7901细胞增殖、侵袭及迁移的作用，并探讨其可能的作用机制。方法取 SGC7901细胞，加入11，12-脱水-二（2-氯乙基）氨基-3，19-环磷酸酯穿心莲内酯中，分别设置20、40、60、80和100μmol· L－15个药物浓度组；不加11，12-脱水-二（2-氯乙基）氨基-3，19-环磷酸酯穿心莲内酯的单纯细胞为空白对照组，分别置于培养箱孵育24、48、72 h；采用 MTT 法检测细胞增殖与细胞活力；采用 Transwell 小室测定24 h 后 SGC7901细胞的侵袭能力，并通过蛋白免疫印迹（Western blot）法检测48 h 细胞增殖与迁移相关蛋白 Akt、p-AKT、JNK、p-JNK、MMP-2、MMP-9的表达情况。结果与空白对照组相比：20、40、60、80和100μmol·L－15个药物浓度组能明显抑制 SGC7901细胞增殖，并呈时间和浓度依赖性（P ＜0．01）。空白对照组迁移和侵袭能力无显著变化，11，12-脱水-二（2-氯乙基）氨基-3，19-环磷酸酯穿心莲内酯（40μmol·L－1组）处理 SGC7901细胞迁移和侵袭能力较空白对照组明显减弱（P ＜0．01）。采用11，12-脱水-二（2-氯乙基）氨基-3，19-环磷酸酯穿心莲内酯（40μmol·L－1）处理 SGC7901细胞48 h后，可明显抑制 p-AKT、p-JNK、MMP-2及 MMP-9的表达水平。结论11，12-脱水-二（2-氯乙基）氨基-3，19-环磷酸酯穿心莲内酯可降低胃癌 SGC7901细胞的增殖、侵袭和迁移能力，其作用机制可能是通过抑制 p-AKT、p-JNK、MMP-2、MMP-9蛋白的表达。
  • 摘要：目的：探讨结肠癌患者血清脂肪因子水平变化的临床意义。方法选择结肠癌患者96例（结肠癌组），其中 Dukes 病理临床分期 A 期26例，B 期20例，C 期28例，D 期22例。选择同期健康体检的30例健康成人作为对照组。采用免疫酶联吸附法（ELISA）法检测血清脂联素、内脂素、抵抗素、瘦素水平。分析结肠癌患者血清脂肪因子的变化以及与 Dukes 病理分期的关系、不同浓度脂肪因子的结肠癌患者3年生存率的差别。结果与对照组比较，结肠癌患者血清抵抗素、内脂素和瘦素水平升高，脂联素水平降低（均 P ＜0．05）。与 Dukes 分期 A—B 期患者比较，C—D 期患者血清抵抗素、内脂素和瘦素水平明显升高，脂联素水平明显下降（均 P ＜0．05）。低质量浓度和高质量浓度内脂素结肠癌患者3年累积生存率分别为80．52％和65．30％（P ＝0．044）；低质量浓度和高质量浓度瘦素结肠癌患者3年累积生存率分别为82．60％和64．30％（P ＝0．049）；低质量浓度和高质量浓度抵抗素结肠癌患者3年累积生存率分别为80．43％和60．00％（P ＝0．0436）；低质量浓度和高质量浓度脂联素结肠癌患者3年累积生存率分别为60．20％和80．50％（P ＝0．0266）。结论血清脂肪因子的检测对结肠癌患者具有病情判断和预后评估的价值。%ABSTRACT:Objective To explore the clinical significance of changes in serum adipocytokine levels in patients with colon cancer.Methods Serum levels of adiponectin,visfatin,resistin and leptin were detected by ELISA in 96 patients with colon cancer(Dukes’stage A in 26,Dukes’ stage B in 20,Dukes’stage C in 28 and Dukes’stage D in 22)and 30 healthy controls.The rela-tionship between serum adipocytokine levels and Dukes’stages was analyzed.In addition,the 3-year survival rate was compared among patients with different adipocytokine concentrations.Re-sults Compared with healthy controls,serum levels of resistin,visfatin and leptin increased and serum levels of adiponectin decreased in patients with colon cancer(P <0.05).Compared with pa-tients with Dukes’stage A or B colon cancer,serum levels of resistin,visfatin and leptin increased and serum levels of adiponectin decreased in patients with Dukes’stage C or D colon cancer(P <0.05).The 3-year survival rates were,respectively,80.52% and 65.30% in patients with low and high concentrations of visfatin(P =0.044),82.60% and 64.30% in patients with low and high concentrations of leptin(P =0.049),80.43 and 60.00% in patients of low and high concentrations of resistin(P =0.043 6),and 60.20% and 80.50% in patients with low and high concentrations of adiponectin(P =0.026 6).Conclusion The measurement of serum adipocytokines is valuable for condition judgment and prognosis evaluation in patients with colon cancer.
  • 摘要：目的：探讨快速康复理念（fast-track surgery，FTS）对腹腔镜结肠癌切除术后疼痛、炎症反应和胃肠功能的影响。方法将46例结肠癌患者按随机数字法分为观察组和对照组，每组23例。2组均行腹腔镜下结肠癌切除术，观察组围术期采用 FTS 治疗，对照组采用传统治疗。比较2组术后首次排气时间、肠鸣音恢复时间及术后下地时间，术前及术后 VAS 评分，术后1 d 白细胞、红细胞、白蛋白及球蛋白水平。结果观察组术后首次排气时间、肠鸣音恢复时间及术后下地时间均较对照组显著缩短（P ＜0．05）；术后 VAS 评分较对照组显著减少（P ＜0．05）；术后红细胞、球蛋白和白蛋白水平均显著高于对照组，而白细胞水平显著低于对照组（P ＜0．05）。结论腹腔镜结肠癌切除术后施行快速康复治疗措施，有利于降低患者疼痛，提高免疫能力，降低炎症反应程度，同时促进胃肠蠕动，缩短内环境恢复时间。%Objective To investigate the effects of fast-track surgery(FTS)on pain,inflamma-tory response and gastrointestinal function after laparoscopic colorectal cancer resection.Methods Forty-six patients with colon cancer underwent laparoscopic colorectal cancer resection.In the perioperative period,these patients were randomly assigned to receive either FTS treatment(ob-servation group,n = 23)or traditional treatment(control group,n = 23).Postoperative anal ex-haust time,bowel sound recovery time and ambulation time were compared between the two groups.Furthermore,VAS score was recorded before and after operation.Moreover,white blood cell count,red blood cell count,and levels of albumin and globulin were measured 1 day after op-eration.Results Compared with control group,anal exhaust time,bowel sound recovery time and ambulation time were shortened,VAS score and white blood cell count were decreased,and levels of albumin and globulin and red blood cell count were increased in observation group after opera-tion(P <0.05).Conclusion FTS treatment following laparoscopic colorectal cancer resection can relieve pain,improve immune function,reduce inflammatory response,promote gastrointestinal peristalsis,and shorten internal environment recovery time in patients with colorectal cancer.
  • 摘要：系统评价 n-3多聚不饱和脂肪酸对预防室性心律失常、心源性猝死发生的作用。方法以“室性心律失常”“心室颤动”“心源性猝死”“n-3不饱和脂肪酸”等为检索词，通过 Cochrane Library、Pubmed、EmBase、CNKI、万方数据库及临床试验注册网站（时间为从建库至2014年11月）进行检索，对检索到的随机对照试验进行质量评估后，采用 Review Manger5．2统计软件进行 Meta 分析。结果共纳入符合入选标准的8个随机对照试验（RCT），试验组（服用 n-3多聚不饱和脂肪酸）患者共16343例，对照组（服用安慰剂）患者共16336例，终点事件为室性心律失常、心源性猝死的发生率。Meta 分析结果显示，饮食中含有 n-3多聚不饱和脂肪酸的试验组在预防室性心律失常、心源性猝死方面与对照组比较差异无统计学意义（OR＝0．87，95％CI 0．62～1．21，P ＝0．41）；在近期有心肌梗死发生的患者中，服用鱼油组室性心律失常、心源性猝死的发生率降低（OR＝0．68，95％CI 0．53～0．87，P ＝0．002）。结论n-3多聚不饱和脂肪酸可能只对近期有心肌梗死的患者发生室性心律失常、心源性猝死有预防作用。
  • 摘要：目的：了解江西省美沙酮维持治疗门诊（以下简称 MMT 门诊）工作人员的职业倦怠现状及其相关影响因素，为有效降低职业倦怠和改善其身心健康提供依据。方法采用定量问卷调查法对江西省所有 MMT 门诊工作人员进行普查，职业倦怠影响因素采用χ2检验、非条件 Logistic 回归进行分析。结果江西省124名 MMT 门诊工作人员的职业倦怠发生率为48．39％，以轻度职业倦怠为主占45．97％，中度职业倦怠占2．42％，未见重度职业倦怠情况出现。工作倦怠状态以情感衰竭为主。单因素研究结果显示，年龄和工作年限对情感衰竭维度有一定影响，30～39岁年龄段、工作年限4～6年的工作人员情感衰竭倦怠情况显著（P ＜0．05）。多元逐步非条件 Logistic回归结果显示，学历、月平均收入对 MMT 门诊工作人员的职业倦怠有影响，学历越低、月收入越高，越容易发生职业倦怠。结论江西省 MMT 门诊工作人员整体处于轻度工作倦怠状态，主要表现为情感衰竭。提示应重点关注较年轻、工作年限相对较少、学历低和月收入高者等人群，并同时进行相应干预。%ABSTRACT:Objective To explore the status of occupational burnout and its influencing factors in staff of methadone maintenance treatment(MMT)clinics in Jiangxi province,and to provide a basis for effectively reducing occupational burnout and improving their physical and psychological health.Methods The medical staff of MMT clinics were surveyed using the quantitative ques-tionnaire.The factors influencing occupational burnout were analyzed usingχ2 test and uncondi-tional logistic regression.Results The prevalence of occupational burnout was 48.39% among the 124 staff of MMT clinics.The mild and moderate burnout accounted for 45.97% and 2.42%, respectively.No severe burnout occurred in the staff.The main job burnout status was emotional exhaustion.Univariate study showed that the age and working time were related to the emotional exhaustion,which was obvious in clinic staff aged 30-39 years with 4-6 years of work experience (P <0.05).Multiple stepwise logistic regression showed that education background and average monthly income had influence on occupational burnout in staff of MMT clinics.The lower the ed-ucation and the higher the monthly income,the higher the incidence of occupational burnout.Con-clusion The staff of MMT clinics in Jiangxi province were overall in a state of mild job burnout, which mainly manifests as emotional exhaustion.The attention should be focused on the younger staff with shorter work time,lower education and higher monthly income,and the corresponding intervention should be perform to prevent and reduce occupational burnout.
  • 摘要：1 临床资料 患者男，39岁，2011年3月10日因车祸致左下肢疼痛、肿胀、伤口出血，活动功能障碍，于当地医院给予清创缝合、骨牵引及相关对症处理，并于次日在当地医院行左大腿切开减压术，效果欠佳于第3日转入南昌大学第一附属医院治疗。入院查体：T 38．5℃，P 109次·min－1，R 22次·－1，BP 118／80 mmHg（1 mmHg＝0．133 kPa），推入病房，心肺未见明显异常，左足踝、左大腿及小腿肿胀，可见多处张力性水泡，皮下淤青，左大腿可触及骨擦感、畸形，活动功能障碍，左踝关节背伸障碍，左足背动脉脉搏未触及。
  • 摘要：近年来巨大胃石症发病率在我国呈逐年上升的趋势，发生率约为0．4％，其临床表现为上腹部不适、腹痛、便血、恶心、呕吐等症状，继续发展可出现胃溃疡、出血、穿孔及幽门梗阻等并发症，易发生在老年、消化不良、既往有消化性溃疡病史等患者中，可能与这些患者胃动力下降、排空延迟、调节功能下降有关［1］。有些患者因症状不典型，易误诊、漏诊。南昌大学第二附属医院2014年10月28日收治1例巨大胃石症患者，现对其临床资料及相关文献进行回顾性分析，以便对巨大胃石症的临床药物、内镜、腹腔镜治疗做进一步深入了解，报告如下。
  • 摘要：ABSTRACT:Objective To investigate the relationships of peripheral blood T-lymphocyte sub-sets to the coronary score of Gensini and the severity of coronary atherosclerosis(AS)in elderly patients with coronary heart disease(CHD).Methods Fifty-two cases of CHD were divided into three groups according to the coronary score of Gensini:group A(5-20,17 cases),group B(21-40, 20 cases)and group C(>40,15 cases).The percentages of CD3 + ,CD4 + and CD8 + T cells and the ratio of CD4+ to CD8+ T cells were determined by flow cytometry.The differences among the three groups were evaluated,and the relationship between peripheral blood T-lymphocyte cells and AS severity(Gensini coronary score)was analyzed.Results Compared with group A,the per-centages of CD3+ T cells,CD4+ T cells and CD4+/CD8 + ratio significantly increased in both group B and group C(P <0.05).Compared with group B,the percentage of CD4 + T cells signifi-cantly increased in group C(P < 0.05).The percentage of CD4+ T cells and CD4 +/CD8 + ratio were positively correlated with Gensini coronary score(r = 0.702 and 0.472,respectively;P <0.05).Conclusion The level of CD4+ T cells is associated with the severity of coronary AS and may contribute to the clinical judgment in elderly patients with CHD.%目的：探讨老年冠心病（CHD）患者外周血 T 淋巴细胞亚群与冠状动脉 Gensini 评分及与冠状动脉粥样硬化（AS）病变程度的关系。方法将52例 CHD 患者根据冠状动脉 Gensini 评分结果分为 A 组（5～20分，17例）、B组（21～40分，20例）和 C 组（＞40分，15例）。采用流式细胞分析仪测定3组白细胞分化抗原分化群（CD）3＋、CD4＋、CD8＋ T 淋巴细胞百分率及 CD4＋／CD8＋比值，评价各组间差异，并对外周血 T 淋巴细胞亚群与冠状 AS 病变程度（冠状动脉 Gensini 评分）进行相关性分析。结果与 A 组比较，B、C 2组 CD3＋、CD4＋ T 淋巴细胞百分率及CD4＋／CD8＋比值均明显升高（均 P ＜0．05）；与 B 组比较，C 组 CD4＋ T 淋巴细胞百分率明显升高（P ＜0．05）。CD4＋ T 淋巴细胞百分率、CD4＋／CD8＋比值与冠状动脉 Gensini 评分均呈正相关（r＝0．702、0．472，均 P ＜0．05）。结论老年 CHD 患者冠状 AS 病变严重程度与 CD4＋ T 淋巴细胞水平有关，检测其水平有助于临床病情判断。
  • 摘要：ABSTRACT:Objective To investigate the clinical efficacy of thoracic paravertebral block (TPVB)in patients undergoing thoracoscopic radical surgery for lung cancer.Methods Forty lung cancer patients scheduled for thoracoscopic radical surgery were randomly assigned to receive either general anesthesia alone(group G,n = 20)or in combination with TPVB(group GP,n =20).All patients received inhalational agents for maintenance of anesthesia after intravenous anes-thesia induction and tracheal intubation.Patients in group GP underwent TPVB guided by nerve stimulator at T4-5 before anesthesia induction.Patients in group G received no treatment before anesthesia induction.After operation,patients received patient-controlled intravenous analgesia (PCIA)with sufentanil.The visual analogue scale(VAS)scores were recorded 2,24 and 48 hours after operation.The times of pressing patient-controlled intravenous(PCI)pump and the volume of background infusion were recorded 24 and 48 hours after operation.The incidence of postopera-tive adverse reactions (nausea,vomiting,lethargy and respiratory depression)was observed in both groups.Venous blood samples(2 mL)were collected before and 24 hours after operation,and serum levels of vascular endothelial growth factor(VEGF)and matrix metalloproteinase-9(MMP-9)were measured by ELISA.Results Compared with group G,VAS scores decreased 2 and 24 hours after operation and times of pressing PCI pump and volume of background infusion re-duced 24 and 48 hours after operation in group GP(P <0.05).The difference in VAS scores was not significant between the two groups 48 hours after operation(P >0.05).Furthermore,the inci-dence of postoperative adverse reactions in group G(35.0%)was not significantly different from that in group GP(30.0%)(P >0.05).No respiratory depression occurred in both groups.Before operation,no significant differences in serum levels of VEGF and MMP-9 were found between the two groups(P >0.05).,However,the levels of VEGF and MMP-9 significantly increased after operation,and the increase in group G was more obvious than that in group GP(P <0.05).Con-clusion The combination of TPVB and general anesthesia is superior to general anesthesia alone for postoperative analgesia and inhibition of serum VEGF and MMP-9 levels in patients undergo-ing thoracoscopic radical surgery for lung cancer.%目的：评价胸椎旁神经阻滞（TPVB）用于胸腔镜下肺癌根治术的临床效果。方法将40例择期拟在全身麻醉下行胸腔镜下肺癌根治术的患者按随机数字表法分为2组：单纯全身麻醉组（G 组）和 TPVB 复合全身麻醉组（GP 组），每组20例。2组患者均选择静脉麻醉诱导气管插管，采用静吸复合麻醉维持。GP 组于麻醉诱导前在神经刺激器引导下行 T4—5椎旁神经阻滞；G 组麻醉诱导前不给予任何处理。2组患者均于术毕使用舒芬太尼自控静脉镇痛，分别于术后2、24、48 h 时记录镇痛情况（VAS 评分）、术后24及48 h 患者静脉自控（PCI）泵按压次数以及背景输注总量；观察2组患者术后不良反应（恶心、呕吐、嗜睡及呼吸抑制）的发生率。并分别于术前及术后24 h时采集患者静脉血2 mL，采用 Elisa 法检测血清血管内皮生长因子（VEGF）和基质金属蛋白酶-9（MMP-9）的水平。结果GP 组术后2、24 h 的 VAS 评分，术后24、48 h PCI 泵按压次数及背景输注总量均明显低于 G 组（均 P ＜0．05）；2组48 h 时 VAS 评分比较差异无统计学意义（P ＞0．05）。G 组术后不良反应发生率为35．0％，GP 组为30．0％，2组比较差异无统计学意义（P ＞0．05）。2组均未出现呼吸抑制。2组术前血清 VEGF 及 MMP-9水平比较差异无统计学意义（P ＞0．05）；术后24 h 均较术前明显升高，G 组较 GP 组升高的更明显（均 P ＜0．05）。结论与单纯全身麻醉比较，PTVB 复合全身麻醉用于胸腔镜下肺癌根治术患者术后镇痛效果佳，并可抑制患者术后血清 VEGF 和 MMP-9水平的升高。
  • 摘要：目的：探讨延续护理模式在老年性白内障患者术后护理中的应用情况。方法选取老年白内障患者112例，均行手术治疗，随机分为试验组84例，对照组28例。2组患者住院时均行常规护理模式，试验组出院后行延续护理模式。评估2组患者出院时、出院2个月、出院12个月术后视力、生活质量评分、患者满意度、术后并发症发生情况，并使用焦虑自评量表（SAS）和抑郁自评量表（SDS）对患者进行问卷调查，了解患者焦虑、抑郁发生情况。结果2组患者视力情况、生活质量评分、满意度比较，出院时、出院2个月，差异无统计学意义（P ＞0．05）；出院12个月比较，试验组各项指标均优于对照组，差异有统计学意义（P ＜0．05）。2组术后并发症情况比较，试验组出院2个月后各项并发症发生率明显低于对照组，差异有统计学意义（P ＜0．05）。2组患者 SAS、SDS 评分比较，出院时、出院2个月，差异不明显（P ＞0．05）；出院12个月 比 较，试验组评分明显低于对照组，差异有统计学意义（P ＜0．05）。结论延续护理模式能明显提高老年患者术后疗效，减少并发症的发生，改善患者心理上不良影响，是目前护理工作继续发展的必然趋势，是深化护理体制改革的重要方法之一，也是推动社区护理与医院住院常规护理对接的有效途径之一。
  • 摘要：5-羟色胺（5-HT）系统参与机体疼痛的调节，具有抑制疼痛及促进疼痛发生的双重作用。5-HT 的不同作用由不同部位的不同受体亚型介导，大体表现为在中枢系统发挥疼痛抑制作用，在外周则发生疼痛促进作用。此外，5-HT 的功能在某些中医中药疗法的起效机制中也有所体现。
  • 摘要：吗啡是目前临床治疗中、重度疼痛最常用和有效的阿片类药物。然而，患者长期、反复使用吗啡容易产生药物依赖性，并且停药后可出现严重的戒断症状。这不仅给患者增加了痛苦，而且也在很大程度上限制了吗啡的临床应用。硫化氢（hydrogen sulfide，H2 S）是近年来备受生物医学关注的一种新型气体分子，具有分子量小、不通过受体发挥作用、可以自由通过细胞膜及生成受内源性关键酶的调节等特性。有研究［1］发现，给予外源性 H2 S 或干扰内源性 H2 S 生成，可通过改变细胞内 H2 S 水平并进一步影响相关信号通路调控，从而发挥治疗疾病的作用。有学者［2-3］通过建立吗啡依赖细胞模型和动物模型，证实给予外源性 H2 S 或促进内源性 H2 S生成可在一定程度上阻断吗啡依赖形成，其机-制可能与 H2 S 抑制吗啡诱导的环磷酸腺苷（cyclic aden-osine monophosphate，cAMP）信号通路上调有关。本文就 H2 S 调控 cAMP 信号通路与干预吗啡依赖形成关系的研究进展作一综述。
  • 摘要：目的：通过单次和多次口服1类创新药阿托伐他汀钙／阿昔莫司缓释胶囊，评价其在中国健康人体内的耐受程度和安全范围，为创新药物下一步临床试验提供安全的剂量范围和制定临床给药方案的依据。方法采用随机单中心临床研究，将38名健康受试者随机分为 A（10例）、B（10例）、C（10例）和 D（8例）4组，每组分别单次给予阿托伐他汀钙／阿昔莫司缓释胶囊1粒（260 mg，含阿托伐他汀钙10 mg＋阿昔莫司250 mg）、2粒、3粒和4粒；在完成单次给药安全性良好的基础上，将相对应剂量的4组再进行多次给药的耐受性试验。观察受试者用药前后生命体征、心电图及实验室检查的变化，并记录不良事件。结果单次和多次给药耐受性试验的受试者用药前后生命体征、心电图无改变，实验室检查表明无器质性损伤；单次给药有11例、多次给药有15例受试者在口服药物15 min 后出现不同程度的斑疹或红疹，未经处理自行消退，评价为阿昔莫司的扩张血管不良反应。结论中国健康人体对阿托伐他汀钙／阿昔莫司缓释胶囊在260～1040 mg 剂量范围内单、多次给药安全性和耐受性良好，最大耐受剂量为1040 mg，推荐多次给药剂量为520～780 mg（2～3粒）。%ABSTRACT:Objective To evaluate the tolerance and safety of single and multiple oral adminis-tration of atorvastatin calcium/acipimox sustained-release capsules in Chinese healthy volunteers, and to provide a safe dose range for clinical trials and a basis for development of clinical adminis-tration regimen.Methods A randomized single-center clinical trial was performed to study the tolerance of atorvastatin calcium/acipimox sustained-release capsules.Thirty-eight healthy volun-teers were randomly divided into four groups:group A (n=10),group B (n=10),group C (n=10),and group D (n=8).Each group was given single administration of 1,2,3 and 4 atorvastatin calcium/acipimox sustained-release capsules,respectively.Each capsule contained atorvastatin cal-cium 10 mg and acipimox 250 mg.On the premise of safe single administration,the tolerance of multiple administration of atorvastatin calcium/acipimox sustained-release capsules was analyzed. Vital signs,electrocardiogram and laboratory test findings were observed before and after admin-istration.In addition,adverse events were recorded.Results No changes in vital signs and elec-trocardiogram were found and no organic injuries were observed before and after single and multi-ple administration of atorvastatin calcium/acipimox sustained-release capsules.Different degrees of maculae or rash occurred 15 minutes after oral administration but spontaneously subsided with-out treatment in 11 volunteers who received single administration and 15 volunteers who received multiple administrations.The adverse side effect occurred from the blood vessel dilation caused by acipimox.Conclusion Single and multiple administration of atorvastatin calcium/acipimox sus-tained-release capsules in a range from 260 to 1 040 mg are safe and well tolerated in Chinese healthy volunteers (maximum tolerated dose 1 040 mg).The recommended doses of multiple ad-ministration of atorvastatin calcium/acipimox sustained-release capsules range from 520 to 780 mg(2-3 capsules).
  • 摘要：目的：探讨大蒜素（DT）诱导 MDA-MB-231细胞凋亡的作用及其机制。方法用人乳腺癌细胞株 MDA-MB-231细胞随机分为正常对照组、DT 组（于培养基中加入终质量浓度为20μg·mL－1 DT 作用细胞48 h）紫杉醇（PTX）组（PTX 1μg·mL－1）和 DT＋PTX 组。MTT 法检测细胞存活率，流式细胞术检测细胞凋亡率，RT-PCR 和Western blot 检测 puma、bax 及bcl-2基因的表达。结果DT＋PTX 组 MDA-MB-231细胞增殖抑制率明显高于DT 组、PTX 组[（57．8±2．85）％比（25．45±1．58）％、（29．86±2．33）％，P ＜0．01]。DT＋PTX 组 MDA-MB-231细胞凋亡率明显高于 DT 组、PTX 组[（53．5±3．25）％比（24．7±1．45）％、（27．8±2．26）％，P ＜0．01]。DT＋PTX组细胞中 PUMA、Bax 蛋白上调及 Bcl-2蛋白表达下调的程度大于 DT 组、PTX 组（P ＜0．05）。结论DT、PTX 合用可显著提高对 MDA-MB-231细胞增殖抑制作用，诱导凋亡，两药合用具有协同抗肿瘤作用。%ABSTRACT:Objective To investigate the effects of diallyl trisulfide(DT)on the proliferation and apoptosis of human breast cancer MDA-MB-231 cells and its mechanisms of action.Methods Cultured MDA-MB-231 cells were randomly divided into the control,DT-treated groups(20 μg· mL-1 ),PTX-treated group(1 μg·mL-1 ),and PTX(1 μg·mL-1 )+DT(20μg·mL-1 )group;in-cubated for 48 hours.Detected the cell viability by MTT;Detected the apoptosis rate of cells by flow cytometry analysis,Detected the mRNA and protein expressions of puma,bax and bcl-2 in the MDA-MB-231 cells by RT-PCR or Western blot.Results In diallyl trisulfide ,paclitaxel and diallyl trisulfide combined paclitaxel treated MDA-MB-231 cells,the cell proliferation inhibition rate of each group were(25.45±1.58)%、(29.86±2.33)% and (57.8±2.85)%.diallyl trisulfide or paclitaxel could inhibit the proliferation of MDA-MB-231 cells and combination of diallyl trisul-fide and paclitaxel showed a synergic inhibitory effect on the proliferation(P <0.01).In Diallyl Trisulfide,paclitaxel and diallyl trisulfide combined paclitaxel treated MDA-MB-231 cells,the ap-optosis rate of each group were(24.7±1.45)%、(27.8±2.26)% and (53.5±3.25)%.diallyl tri-sulfide or paclitaxel could induced apoptosis of MDA-MB-231 cells,and combination of diallyl tri-sulfide and paclitaxel resulted in significant increased apoptosis of MDA-MB-231 cells(P <0.01). Compared with DT or PTX group,up-regulated the mRNA and protein expressions of PUMA andbax,and down-regulated the mRNA and protein expressions of bcl-2(P <0.05).Conclusion Combined Diallyl Trisulfide and paclitaxel have a synergistic relation in both inhibition of MDA-MB-231 cells growth and induction of apoptosis.
  • 摘要：目的：研究经口盲探气管插管方法对患者血流动力学及应激反应的影响。方法选择需全身麻醉手术患者50例，根据气管插管方法的不同，分为盲探组（T 组）和喉镜组（C 组），各25例，监测并记录入室（T0）、插管前（T1）、插管后3 min（T2）、插管后60 min（T3）2组患者平均动脉压（MAP）、心率（HR）的变化，并于 T0、T3两时点测血糖（Glu）、血清皮质醇浓度（Cor），记录插管完成时间及次数，术后咽痛、声嘶等并发症。结果2组患者的MAP、HR 在 T2时点比较差异有统计学意义[（88．6±11．0）mmHg 比（101．8±10．4）mmHg，t＝4．383，P ＜0．01；（70．9±9．8）次·min－1比（79．7±14．4）次·min－1，t＝2．539，P ＜0．05]。Glu、Cor 在 T3时点比较 T 组明显低于C 组[（6．2±1．4）mmol·L－1比（7．5±1．3）mmol·L－1，t＝3．359，P ＜0．01；（380．1±111．3）nmol·L－1比（450．8±129．5）nmol·L－1，t＝2．071，P ＜0．05]。2组并发症无明显差别。结论盲探气管插管对患者的血流动力学及应激反应影响较小。%ABSTRACT:Objective To study the effect of blind orotracheal intubation on haemodynamics and stress reaction.Methods Fifty patients who required operation under general anesthesia were randomly divided into blind orotracheal intubation group (group T)and laryngoscopic tracheal in-tubation group (group C),with 25 patients in each group.Mean arterial pressure (MAP)and heart rate (HR)were determined on admission to operating room (T0),before intubation (T1), at 3 minutes after intubation (T2),and at 60 minutes after intubation (T3).Furthermore,levels of blood glucose (Glu)and serum cortisol (Cor)were measured at T0 and T3.Moreover,time to intubation completion,frequency of intubation,and complications (pharyngalgia,hoarseness,etc.) were recorded in both groups.Results The MAP and HR in group T((88.6±11.0)mmHg and (70.9 ± 9.8)beats· min-1 minutes,respectively)were markedly lower than those in group C ((101.8±10.4)mmHg and (79.7±14.4)beats·min-1 ,respectively)at T2 (P <0.05).In addi-tion,levels of blood Glu and serum Cor in group T ((6.2 ± 1.4)mmol · L-1 and (380.1 ± 111.3)nmol·L-1 ,respectively)were significantly lower than those in group C ((7.5±1.3)mmol·L-1 and (450.8 ± 129.5)nmol· L-1 ,respectively)at T3 (P < 0.05).No significant differences in complications were found between the two groups.Conclusion The blind orotracheal intubation has little effect on haemodynamics and stress reaction.
  • 摘要：目的：观察右美托咪定复合丙泊酚瑞芬太尼靶控全身麻醉在腹腔镜全子宫切除术中的应用对血流动力学及围术期不良反应的影响。方法将60例行腹腔镜下全子宫切除术的患者（年龄30～60岁，ASA 分级Ⅰ—Ⅱ级，无心血管病史）按麻醉用药的不同分为 D 组和 C 组，每组30例。D 组在麻醉诱导前15 min 泵注盐酸右美托咪定注射液0．5μg·kg－1，并持续泵注盐酸右美托咪定注射液0．2μg·kg－1·h－1至手术结束前40 min 停药；C 组泵注等容量的0．9％氯化钠注射液。观察2组用药前（T0），给药15 min 后（T1），插管时（T2）、气腹完成时（T3），拔管时（T4）和拔管后30 min（T5）的血流动力学指标[心率（HR）、收缩压（SBP）、舒张压（DBP）]，手术时间、脑电双频指数（BIS）值，丙泊酚注射液、枸橼酸芬太尼注射液、盐酸右美托咪定注射液的使用量，围术期不良反应[HR 减慢＜50次·min－1，拔管呛咳、术后恶心呕吐、寒颤，苏醒延迟（＞30 min）]发生率。术后30 min 对2组进行视觉模拟评分法（VAS 法）评分。结果与 C 组比较，D 组丙泊酚注射液、枸橼酸芬太尼注射液使用量均明显减少，HR 减慢＜50次·min－1发生率则明显升高，T1—T5时点 SBP、DBP、HR 和拔管呛咳、术后恶心呕吐、寒颤发生率及术后30 min VAS 得分均明显降低（均 P ＜0．05）。结论右美托咪定复合丙泊酚、瑞芬太尼联合靶控输注用于妇科腹腔镜下全子宫切除术可减少患者术中的应激反应，维持患者的循环稳定，减少麻醉药物使用量，降低围术期不良反应发生率。%ABSTRACT:Objective To observe the effects of dexmedetomidine combined with propofol and remifentanil target-controlled infusion(TCI)for general anesthesia on hemodynamics and periop-erative adverse reactions in laparoscopic hysterectomy.Methods Sixty patients without history of cardiovascular disease(ASA Ⅰ-Ⅱ,30-60 years old)who received laparoscopic hysterectomy were randomly divided into two groups,with 30 patients in each group.Patients in group D were in-fused with dexmedetomidine injection(0.5 μg·kg-1 )15 minutes before anesthesia induction and then given the maintenance dose of dexmedetomidine injection(0.2 μg·kg-1 ·h-1 )until 40 mi-nutes before the end of operation.Patients in group C were infused with the equal volume of 0.9% sodium chloride injection.Heart rate (HR),systolic blood pressure (SBP)and diastolic blood pressure(DBP)were recorded before administration(T0),15 min after administration(T1), at intubation(T2),at the end of pneumoperitoneum(T3),at extubation(T4),and 30 min after ex-tubation(T5).Furthermore,operation time,bispectral index(BIS),dosages of propofol,fentanyl citrate and dexmedetomidine hydrochloride injection,and incidences of perioperative adverse reac-tions(HR<50 beats·min-1 ,extubation cough,postoperative nausea and vomiting,shivering,and recovery time>30 min)were observed in both groups.In addition,VAS score was compared be-tween the two groups 30 min after operation.Results Compared with group C,dexmedetomidine infusion significantly decreased the usage amount of propofol and fentanyl citrate injection,SBP, DBP and HR at T1-T5,incidences of extubation cough,nausea,vomiting and shivering,and post-operative VAS score,and obviously increased the incidence of HR<50 beats·min-1 (P <0.05). Conclusion Dexmedetomidine combined with propofol and remifentanil TCI for general anesthe-sia can relieve intraoperative stress response,maintain circulation stability,reduce anesthetic us-age,and decrease the incidence of perioperative adverse reactions in laparoscopic hysterectomy.

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