类风湿关节炎之从肝论治

类风湿关节炎(RA)是以侵蚀性、对称性多关节炎为主要临床表现的慢性、全身性自身免疫性疾病。与祖国医学的痹证相对应。《内经》中有"肝主筋"、"膝为筋之府"、"手足肝之分野"等论述。对于类风湿关节炎(RA)从肝论治之中医辨证的提出,主要从中医学理论基础,RA的病因特点以及RA的论治等方面加以阐述。中医学肝功能包括与RA发病相关的关节、筋脉、肌肉和脏腑,其与人体正常的气血津液代谢关系密切。     

Unique Correlation Between Mutated Citrullinated Vimentine IgG Autoantibodies and Markers of Systemic Inflammation in Rheumatoid Arthritis Patients

Rheumatoid arthritis (RA) is the most common inflammatory systemic autoimmune disease, primarily affecting the peripheral joints. Anti-mutated citrullinated vimentin autoantibodies (anti-MCV) of IgG isotype were shown to be a useful diagnostic marker of RA especially in RA patients who were anti-cyclic citrullinated protein autoantibodies (anti-CCP) negative. Nevertheless, published data correlates rheumatoid factor (RF), anti-CCP or anti-MCV antibodies with either erythrocyte sedimentation rate (ESR) or serum C-reactive protein (CRP) as markers of disease activity, not investigated the possible correlations of RA autoantibodies towards ESR and CRP in comparison. Herein, we aim to evaluate the usefulness of anti-MCV as a dependable marker in established RA compared with anti-CCP and RF antibodies and to examine correlations between RF, anti-CCP and anti-MCV antibodies towards ESR and serum CRP. Serum RF-IgA, RF-IgM, anti-CCP and anti-MCV levels were measured in 30 patients with RA and 40 patients with other autoimmune diseases (non-RA) compared with 20 normal subjects. Specificity, sensitivity and AUC for RF antibodies, anti-CCP and anti-MCV were calculated towards RA diagnosis. Our results showed that ESR and CRP had significantly higher values in both RA and non-RA patients compared with our healthy controls with observed significant increment in RA patients compared with non-RA patients. An important finding from our study is that 33.3 % of RA patients were anti-CCP negative but being positive towards anti-MCV. Also, in-between 36.7 up to 40 % of RA patients were RF-IgA and RF-IgM negative while being anti-MCV positive. Anti-MCV antibodies showed the highest specificity and sensitivity (97.5 and 86.6 %, respectively) towards RA diagnosis with the highest AUC value (0.920) compared with anti-CCP and RF antibodies. Correlation analyses revealed that there was no significant correlation between ESR along with CRP towards RF-IgA, RF-IgM and anti-CCP while profound highly significant correlation exhibited between ESR and CRP towards anti-MCV data (r = 0.879 and 0.994, respectively). Thus, our data suggest that the assessment of serum anti-MCV autoantibodies along with ESR and CRP considered as a simple laboratory regime for monitoring RA patients to assess and follow-up disease activity. The addition of anti-MCV autoantibodies to serologic markers in the ACR/EULAR classification criteria for RA will add points for patients with negative anti-CCP and RF antibodies.     

Serum Paraoxonase Levels In Patients with Acute Liver Disease

Paraoxonase is an anti-oxidant enzyme, which circulates in the plasma, tightly bound to HDL. This enzyme is known to be synthesized in the liver. This study was carried out in order to ascertain the diagnostic utility of this enzyme in acute liver disease. Serum basal as well as salt (NaCl) stimulated paraoxonase was estimated in 50 patients with an established diagnosis of acute liver disease and also in 50 healthy blood donors. Paraoxonase levels were significantly lower in patients as compared with controls (P < 0.05). The ‘receiver operating characteristic’ plot showed that this enzyme has a high degree of sensitivity and specificity for the diagnosis acute liver disease. Serum PON is likely to emerge as an additional test of liver function, as it encompasses three different attributes of hepatic function namely, synthetic capacity, detoxication and secretory functions.     

Serum Urea:Albumin Ratio as a Prognostic Marker in Critical Patients With Non-Chronic Kidney Disease

Routine laboratory investigations play an important role in estimating the risk of mortality in intensive care unit (ICU) patients. The significance of urea:albumin ratio (UAR) in predicting the stay and mortality of ICU patients is not known. It is a retrospective study of patients admitted to ICU (n = 412) with non-chronic kidney disease (non-CKD). Receiver-operating characteristics (ROC) analysis for predicting mortality was carried out to find area under curve (AUC) and threshold levels. Analysis of survival probability was carried out by Kaplan–Meier method and Log-rank test. The AUC to predict mortality were 0.695, 0.767 and 0.791 for serum albumin, urea and UAR, respectively. The threshold levels for albumin, urea and UAR were 2.8 g/dL, 53 mg/dL, and 23.44 mg/g, respectively. The highest odds ratio (OR) of 9.75 to predict mortality at threshold level was observed for UAR, while OR were 7.0 and 3.62 for serum urea and albumin, respectively. The serum urea above and albumin below threshold level were associated with increase in ICU stay of >3 days but the highest OR of 4.73 to predict stay of >3 days was observed for UAR. Kaplan–Meier survival analysis shows significant (p < 0.001) difference at the threshold value of UAR. Serum urea and albumin are found to be an independent predictor for the mortality and stay; however an increased UAR value is the best parameter in predicting mortality and stay in ICU patients with non-CKD illness.     

Association of the 12669G&gt;A Apolipoprotein B Gene Polymorphism with Apo-B Serum Level and Lipid Profile in Patients with Coronary Artery Disease Comparing with Individuals Without Coronary Artery Disease in Zanjan Population of Iran

Atherosclerosis is a pathologic disorder which has an important role in the occurrence of coronary heart disease. It is determined as a focal, inflammatory proliferative response to several types of endothelial damage. Apolipoprotein B which is a requirement in the sustenance of cholesterol homeostasis, and is the major protein component of low density lipoprotein, characterized by multitude polymorphic sites, one of which (12669G>A) is related to the levels of serum lipid profiles, coronary artery disease and/or myocardial infarction. One Common polymorphism which is more important in this process is 12669G>A that is appraised in this research. We recruited 80 patients from the Mousavi hospital, Zanjan, Iran, diagnosed with coronary artery disease by the clinician on the basis of clinical symptoms, echocardiogram result, and angiography. Seventy-seven healthy individuals without any evident symptoms of Coronary stenosis and any past history of the disease were taken as controls from the general population. We carried out PCR using specific primers. Then, we digested PCR product by RFLP. Lipid parameters by biochemical methods and Apolipoprotein B serum level by immunoturbidometry method were done. Genotype frequencies for 12669G>A polymorphism were determined: 55 % R+R+, 45 % R+R? in case group, and 55.8 R+R+, 44.2 % R+R? in controls. The R?R? genotype was not seen. There was no significant relationship between this polymorphism and the risk of Coronary stenosis (P = 0.6). In the present study, higher plasma levels of cholesterol and low density lipoproteins in the subjects with R+R? genotype were found while there was no association between this polymorphism and coronary stenosis with ≥50 % in the Zanjan population.     

冠心病患者血浆同型半胱氨酸变化及叶酸的干预治疗

目的 了解血浆同型半胱氨酸(Homocysteine,Hcy)、叶酸和维生素(Vit)B12水平与冠心病的关系;观察叶酸干预治疗高Hcy血症的疗效．方法 经冠脉造影确诊的冠心病患者97例、亚冠心病患者58例及完全正常3l例,用高效液相色谱法测血浆Hcy水平,用放免法测血浆叶酸和VitB12浓度．其中高Hcy血症病人每天服用叶酸5mg,观察4周和8周后血浆Hcy水平变化．结果 冠心病和亚冠心病患者血浆Hcy水平明显高于正常人,叶酸和VitB12水平则明显下降;冠心病患者冠脉病变支数越多,血浆Hcy升高和叶酸、VitB12下降越明显;叶酸治疗高Hcy血症患者4周和8周,分别使血浆Hcy水平下降12．5％和38．5％．结论 冠心病和亚冠心病患者血浆Hcy水平明显升高,高Hcy血症是冠心病的危险因素之一．血浆Hcy水平变化与冠脉病变程度正相关．叶酸干预治疗可使高Hcy血症患者血浆Hcy浓度明显降低．     

系统性红斑狼疮患者血清铁蛋白水平检测

用酶联免疫吸附试验测定２８例系统性红斑狼疮（ＳＬＥ）患者血清铁蛋白水平，结果表明，与正常对照比较ＳＬＥ患者血清铁蛋白水平增高，但治疗前后血清铁蛋白改变无显著性，与疾病活动指数无显著相关性．这些结果提示ＳＬＥ患者存在有异常铁代谢，本文对此进行了讨论．     

Association of Inflammatory Biomarker C-Reactive Protein, Lipid Peroxidation and Antioxidant Capacity Marker with HbF Level in Sickle Cell Disease Patients from Chattisgarh

This study was undertaken to determine the association of inflammatory biomarker, oxidative stress and antioxidant capacity marker with fetal haemoglobin (HbF) level among sickle cell trait and sickle cell disease (SCD) patients in Chattisgarh. The study group consisted of 51 SCD (SS) patients with painful episode, 49 SCD (SS) patients with steady state, 50 sickle cell trait (AS) and 50 controls. Malondialdehyde (MDA), CRP, total antioxidant power (FARP), total thiol and HbF levels were quantified. We found a significant positive (p < 0.0001) association between CRP and MDA levels and its inverse association with HbF level in SS patients. We also observed that antioxidant capacity had significantly positively (p < 0.0001) associated with HbF level. The protective effect of HbF was found, because the increase in HbF levels resulted in decrease in lipid peroxidation and inflammation in SCD patients. A decrease in the HbF level and its antioxidant capacity has been associated with the pathogenesis of SCD. These finding may explain the high level of HbF is ameliorating oxidative stress and inflammation in SCD patients.     

Association of Elevated Serum Lipoprotein(a), Inflammation,Oxidative Stress and Chronic Kidney Disease with Hypertension in Non-diabetes Hypertensive Patients

Hypertension is the most common cardiovascular risk factor. Lipoprotein(a) [Lp(a)], inflammation, oxidative stress and chronic kidney disease (CKD) exacerbate the response to tissue injury and acts as markers of the vascular disease, especially in glomerulosclerosis. We compared the clinical characteristics of 138 non-diabetes hypertensive women (ndHT) patients with 417 non-diabetes normotensive subjects and tested the association of hypertension with Lp(a), inflammation, CKD and oxidative stress by using multiple logistic regression. BP, BMI, waist circumference, creatinine, Lp(a), inflammation and malondialdehyde levels were significantly higher and CKD state in the ndHT patients (p < 0.05). Multiple logistic regression showed hypertension associated with increased Lp(a), inflammation, ORs and 95 % CIs were 2.52 (1.33, 4.80), 2.75 (1.44, 5.27) after adjusting for their covariates. Elevated serum Lp(a) and inflammation levels concomitants with increased oxidative stress and CKD were the major risk factors associated with hypertension and implications for the increased risk of HT and vascular disease.     

108例病毒性肝炎患者血清补体的研究

报告１０８例病毒性肝炎患者血清总补体（ＣＨ＿（５０））和Ｃ＿３值的检测结果：急性肝炎的ＣＨ＿（５０）为６８．４±６．１３单位／ｍｌ，Ｃ＿３为１３０．２±６．６７ｍｇ％，均高于正常组（ＣＨ＿（５０）为４８．５±５．７５单位／ｍｌ，Ｃ＿３为１０２±５ｍｇ％），Ｐ＜０．０１；其他类型的肝炎患者组的补体均低于正常组，Ｐ＜０．０１．补体的含量与Ｔ细胞花环（Ｅｔ花环）呈中度相关，与ＧＰＴ呈高度相关，因此测定ＣＨ＿（５０）和Ｃ＿３可作为衡量患者机体免疫功能和判断病毒性肝炎预后的指标之一。     

Effect of Hemodialysis on Plasma Myeloperoxidase Activity in End Stage Renal Disease Patients

End stage renal disease (ESRD) patients on hemodialysis (HD) have an increased oxidative stress, with a high risk of atherosclerosis and other co-morbid conditions. Recent studies have suggested that myeloperoxidase (MPO)—mediated oxidative stress may play a role in the pathogenesis of cardiovascular complications in dialysis patients. Furthermore, dialysis treatment ‘per se’ can aggravate oxidative stress. Hence this study was designed to determine whether HD leads to an alteration in the plasma levels of MPO and malondialdehyde (MDA), a marker of oxidative stress in ESRD patients on maintenance HD. To study the effect of HD, plasma MPO and MDA were determined before and after HD in forty ESRD patients (24 men and 16 women, age between 8 and 71 years, median being 40.5 years) on maintenance HD. Plasma MPO and MDA were assayed by spectrophotometric methods. Haematological and other biochemical parameters were obtained from patients’ case records. Plasma MPO and MDA levels were significantly higher after HD when compared with pre-dialysis levels (p < 0.05). There was no correlation between MPO and MDA (r = 0.184, p = 0.10) and other biochemical parameters (p > 0.05). However, there was a significant correlation between MPO and MDA with haemodialysis vintage (p < 0.05). In univariate regression analysis duration of HD (β = 1.470, p = 0.045, β = 0.388, p = 0.013), was independently associated with MPO and MDA. Although HD is indispensable for survival of patients with ESRD, it is fraught with undesirable side-effects, such as an increase in the plasma MPO and MDA levels. The elevated levels of MPO contribute to the increased oxidative stress as free radicals are produced by the reaction catalyzed by it.     

音乐在PCI术后早期急性心肌梗死患者中的应用

目的:探讨音乐应用于PCI术后早期急性心肌梗死患者的作用,促进患者康复.方法:便利抽样100名PCI术后AMI患者,分对照组和音乐组各50例,采用《HAD》和《AIS》调查并记录患者实验前后血压、心率、呼吸.结果:音乐组患者焦虑、睡眠质量、血压、心率、呼吸得分差值下降多于对照组,但抑郁得分较对照组高(P＜0.05).结论:音乐可缓解患者的焦虑,提高睡眠质量,维持血压、心率、呼吸处于相对较低水平.但音乐可释放抑郁情绪,应注意心理护理.     

康复治疗对老年血管性痴呆患者认知功能障碍影响研究

目的:研究讨论血管性痴呆老年患者临床治疗过程中实施康复治疗方案对认知功能障碍的影响.方法:搜集病例时段为2019年1月至2021年6月期间,总计搜集30例血管性痴呆老年患者纳入研究,按照抽签评分方法对老年患者实行分组处置,15例老年患者为一组,组别为对照组、讨论组,分别给予常规西医治疗、康复治疗,针对组间临床治疗效果进...     

改良森田疗法在精神分裂症患者康复护理应用的研究进展

精神分裂症患者的认知、情感、行为的纠正需要多方面的综合治疗及康复手段,而改良森田疗法注重面对现实,以目的 、行为准则,各项作业疗法利于患者的全面康复,能增强患者的能动性、提高患者自信心、改善生活质量,促进更好地回归家庭和社会.文章就改良森田疗法在精神分裂症患者康复护理的实施特点、康复目标、实施内容、康复效果等方面进行了...     

Interplay Between Inflammation and Hemostasis in Patients with Coronary Artery Disease

Coronary artery disease (CAD) is a global epidemic currently. This study was planned to evaluate markers of inflammation and hemostasis and their possible association, if any, in patients with CAD. The study was carried out in 60 patients with acute myocardial infarction (AMI) and 60 age and gender matched controls. The following parameters were assayed in all study subjects-inflammatory-interleukin (IL)-10, high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor (TNF)-α, fibrinogen; hemostatic-fibrinogen, fibrin D-dimer and a novel risk factor—homocysteine. Inflammatory markers (hs-CRP, TNF-α and IL-10), fibrinogen, fibrin D-dimer and homocysteine levels were significantly higher in the patients with AMI, as compared with controls. A positive correlation was observed between D-dimer and the inflammatory markers—hs-CRP and TNF-α. Upon multivariate analysis, TNF-α emerged as the best determinant of CAD in our study. Our results indicate that there is a possible interplay of inflammation and hemostasis in CAD, underlining their synergistic role in the pathogenesis of CAD.     

胰岛素样生长因子1与冠心病病变程度的关系

目的为了研究冠心病发病的机制. 方法测定了16例正常人血清胰岛素样生长因子1(IGF1)水平和40例冠心病患者血清IGF1水平,且把冠心病患者血清IGF1水平与冠脉造影的血管病变支数进行了比较分析. 结果冠心病患者外周血IGF1水平显著低于正常人(分别为27.23±15.48 μg/L和48.02±33.43 μg/L,P＜0.01);且在冠脉造影血管病变支数增加时其血清IGF1水平下降变得更加明显. 结论 IGF1可能参与了冠心病的病理生理过程.     

Study of Serum Homocysteine, Folic Acid and Vitamin B12 in Patients with Preeclampsia

The present study was carried out to evaluate the occurrence of association between homocysteine, folic acid and vitamin B(12) in patients with preeclampsia. Fifty preeclamptic patients from gynecology ward were studied for estimation of serum homocysteine, folic acid and vitamin B(12) over a period of October 2007 to June 2010. Serum homocysteine and folic acid, and vitamin B(12) were determined by means of Immulite 1000 analyzer. The statistical analysis of study group of preeclampsia compared with normotensive control group, showed significant alterations in serum homocysteine, folic acid and vitamin B(12) concentrations in preeclampsia. Inverse association between serum homocysteine and folic acid, and vitamin B(12) levels were observed in preeclampsia. The present study found hyperhomocysteinemia and deficiency of folic acid and vitamin B(12) along with increased blood pressure as a risk factor for cardiovascular disease (CVD) in preeclampsia.     

肝肾疾病患者血清转铁蛋白和铜蓝蛋白含量的分析

对肝肾疾病进行转铰蛋白(Transferren简称TF)和铜蓝蛋白(Ceruloplasmin简称CP)测定,结果表明:各组肝炎病人的TF均显著低于正常组,且谷丙转氨酶异常和HBsAg阳性者TF含量明显低于正常者,TF可作为判断肝病预后的一个指标。肾炎病人的TF也比正常人低,CP含量各组不一,肝癌患者的CP(52.44±8.73mg％)显著高于正常人(46.75±7.92mg％),乙型肝炎病人和正常组间未见差异.肝豆状核变性患者CP非常显著低于正常人,故检测CP有助于鉴别肝硬化和肝癌,同时对临床诊断肝豆状桉变性提供一项可靠的客观指标.