甲状腺癌患者血清促甲状腺激素和甲状腺激素表达水平及临床意义

目的:探讨甲状腺癌患者血清促甲状腺激素和甲状腺激素表达水平及临床意义。方法:应用电化学发光方法检测甲状腺癌组、甲状腺良性病变组和正常对照组血清促甲状腺激素(TSH)和甲状腺激素(TT3、FT3、TT4、FT4)水平。结果:①血清TSH在三组中比较有统计学意义(P〈0.001),甲状腺癌组血清TSH水平(3.56±0.93ulU/ml)明显高于甲状腺良性病变组(2.82±0.70ulU/ml)和正常对照组(2.04±0.56ulU/ml);TSH与肿瘤病理分期和肿瘤大小呈正相关(P<0.05)。②血清FT3、FT4水平在三组中有统计学意义(均P〈0.001),甲状腺癌组FT3、FT4水平处于较低水平,二者均明显低于甲状腺良性病变组和正常对照组(P<0.001);FT3与肿瘤病理分期和淋巴结转移呈负相关(P<0.05)。③TT3和TT4水平在三组之间比较均无统计学意义(P>0.05)。结论:高水平TSH可增加甲癌复发的危险性。低甲状腺激素水平在甲状腺癌形成中可能起到一定的作用,因此可以将其作为预测甲癌复发的重要指标之一。     

MCP-1和VEGF与冠心病患者冠脉病变程度的关系及介入前后的变化和意义

目的:探讨单核细胞趋化蛋白1(MCP-1)和血管内皮生长因子VEGF与冠心痛患者冠脉病变程度的关系及介入前后的变化和意义.方法:选择经冠状动脉造影确诊的冠心痛患者105例,根据病变程度分为单支病变组(A组)、双支病变组(B组)和多支病变组(C组),同时选择经冠状动脉造影确诊的正常时照组35例(D组),采用双抗体夹心ELISA法洲定术前术后血清MCP-1和VEGF水平.结果:1.血清MCP-1水平测定结果冠心病组明显高于正常对照组,三支病变组高于双支病变组,双支病变组高于单支病变组,支架置入术后显著高于术前,差异均有统计学意义(P<0.01),对照组术前术后相比差异无统计学意义(P>0.05).2血清VEGF水平测定结果显示:冠心病组明显高于正常对照组,三支病变组高于双支病变组和单支病变组,差异均有统计学意义(P<0.01),双支病变组与单支病变组间差异无统计学意义(P>0.05),支架置入术后较术前显著降低(P<0.01),术后冠心病组与对照组相比差异无统计学意义(P>0.05),对照组术前术后差异无统计学意义(P>0.05).结论:冠心病患者血清MCP-1、VEGF水平与冠脉病变程度密切相关,介入治疗可影响冠心病患者血清MCP-1水平的升高和VEGF水平降低,监测血清中MCP-1和VEGF水平变化可了解治疗效果和炎症程度.     

血清同型半胱氨酸、高敏C反应蛋白及肱踝脉搏波传导速度与冠心病患者冠脉病变程度的相关性研究

目的:探讨血清同型半胱氨酸(Hcy)、高敏C反应蛋白(hs-CRP)及肱踝脉搏波传导速度(baPWV)与冠心病患者冠脉病变程度的相关性。方法:选取2015年6月-2017年10月期间承德医学院附属医院收治的疑似冠心病的患者324例为研究对象,根据冠状动脉造影结果分为冠心病组213例与非冠心病组111例,根据不同冠脉病变程度将冠心病组分为单支病变组87例,双支病变组74例,多支病变组52例,检测并对比所有患者血清Hcy、hs-CRP水平及baPWV值,分析Hcy、hs-CRP水平及baPWV值与冠心病患者冠脉病变程度相关性。结果:冠心病组患者血清Hcy、hs-CRP水平及baPWV值较非冠心病组升高(P0.05)。冠心病组不同冠脉病变程度患者血清Hcy、hs-CRP水平及baPWV值整体比较差异有统计学意义(P0.05),多支病变组与双支病变组患者血清Hcy、hs-CRP水平及baPWV值高于单支病变组,且多支病变组高于双支病变组,差异有统计学意义(P0.05)。经Pearson相关性分析显示,Hcy、hs-CRP及baPWV均与冠心病患者冠脉病变程度呈正相关(P0.05)。结论:冠心病患者血清Hcy、hs-CRP水平及baPWV值高于非冠心病者,且血清Hcy、hs-CRP水平及baPWV值随着冠心病患者冠脉病变程度的加重而升高,与冠脉病变程度呈正相关。     

颈动脉内-中膜厚度对冠状动脉病变的预测价值

目的:探讨颈动脉内-中膜厚度对冠状动脉病变的预测价值。方法:根据冠状动脉造影结果,将183例行冠状动脉造影的患者分为3组:正常组59例为冠状动脉造影阴性;A组54例冠状动脉狭窄率50%;B组70例冠状动脉狭窄率≥50%。根据冠状动脉病变数量将124例冠状动脉狭窄的患者进一步分为单支病变组40例,双支病变组38例和多支病变组46例。所有患者行颈动脉超声检查,测量颈动脉内-中膜厚度。结果:A组、B组的颈动脉内-中膜厚度和冠脉积分(Gensini评分)均明显高于正常对照组,且B组颈动脉内-中膜厚度和Gensini评分均较A组明显增加,差异均有统计学意义(P0.05)。随着冠状动脉狭窄程度的加重,颈动脉内-中膜厚度和Gensini评分逐渐增加。多支病变组、双支病变组IMT值和Gensini评分均显著高于单支病变组(P0.05),而双支病变组与多支病变组比较差异均无统计学意义(P0.05)。颈动脉IMT厚度与冠状动脉病变数量相关性不大,与Gensini评分呈显著性正相关(P0.01)。结论:颈动脉内-中膜厚度能较好地预测冠状动脉病变程度,但不能预测冠状动脉病变范围。     

冠心病患者介入治疗前后血清IL-18、sCD40L和hs-CRP水平的变化及其意义

目的：探讨冠心病患者血清白介素18（Interleukin-18,IL-18）、白细胞分化抗原40配体（CD40L）、及高敏C反应蛋白（hs-CRP）水平在经皮冠状动脉介入术治疗前后的变化和意义。方法：选择经冠状动脉造影确诊的冠心病患者85例,根据病变程度分为单支病变组（n=32）、双支病变组（n=28）和多支病变组（n=25）,采用双抗体夹心ELISA法测定PCI术前术后血清IL-18、CD40L和hs-CRP水平。结果：血清IL-18水平测定结果：多支病变组高于双支病变组,双支病变组高于单支病变组;支架置入术后显著高于术前,差异均有统计学意义（P〈0.01）。血清CD40L水平测定结果：多支病变组高于双支病变组和单支病变组,差异均有统计学意义（P〈0.01）,双支病变组与单支病变组间差异无统计学意义（P〉0.05）;支架置入术后较术前显著升高,差异有统计学意义（P〈0.01）。血清hs-CRP水平测定结果：多支病变组高于双支病变组,双支病变组高于单支病变组;支架置入术后显著高于术前,差异均有统计学意义（P〈0.01）。结论：冠心病患者血清IL-18、CD40L和hs-CRP与冠脉病变程度密切相关,介入治疗可使冠心病患者血清IL-18、CD40L和hs-CRP水平升高,监测血清中IL-18、CD40L和hs-CRP水平变化可了解治疗效果和炎症程度。     

血尿酸水平与冠状动脉病变程度的关系探讨

目的:探讨血尿酸(SUA)水平与冠状动脉病变程度的关系。方法:将268例疑似冠心病(CHD)患者,经冠状动脉造影分为冠心病组198例和非冠心病组70例;冠心病组又分为单支病变组80例,双支病变组56例,三支病变组62例。分别检测各组研究对象血尿酸含量,同时记录年龄、性别、吸烟、高血压、糖尿病、血尿酸及冠状动脉造影结果,分析血尿酸与已知冠心病主要危险因素、冠状动脉病变程度的相关性。结果:冠心病组血尿酸水平(395.35±84.40)μmol/L,显著高于非冠心病组(282.20±66.68)μmol/L(P<0.05)。单支病变组(338.48±77.36)μmol/L、双支病变组(399.62±84.36)μmol/L、三支病变组(445.16±92.20)μmol/L,血尿酸水平呈递增趋势,各组之间的差异有统计学意义。结论:血尿酸水平可反映冠状动脉病变严重程度。降尿酸治疗有望成为心血管疾病防治的一种新途径。     

不同病情冠心病患者血清心型脂肪酸结合蛋白与颈动脉内膜中层厚度的关系分析

目的:探讨不同病情冠心病患者血清心型脂肪酸结合蛋白(H-FABP)与颈动脉内膜中层厚度(IMT)的关系。方法:选择内蒙古科技大学包头医学院第一附属医院老年科收治的冠心病患者60例,其中稳定型心绞痛(SAP)和急性冠脉综合征(ACS)各30例,根据冠状动脉病变支数将患者分为单支病变组19例、双支病变组19例和多支病变组22例;根据患者冠状动脉血管狭窄程度分为轻度病变组22例、中度病变组17例和重度病变组21例,选择同期健康体检者30例作为对照组。比较各组颈动脉IMT及血清H-FABP水平,并分析其相关性。结果:ACS组颈动脉IMT及血清H-FABP水平显著高于SAP组和对照组,SAP组颈动脉IMT及血清H-FABP水平显著高于对照组(P<0.05)。不同冠状动脉病变支数、病变程度冠心病患者颈动脉IMT及血清H-FABP水平整体比较差异有统计学意义(P<0.05),多支病变组和双支病变组血清H-FABP水平比较无统计学意义(P>0.05)。Spearman相关分析显示,冠心病患者血清H-FABP水平与颈动脉IMT呈正相关(r=0.754,P<0.05)。结论:冠心病患者血清H-FABP水平与颈动脉IMT异常升高,其水平随冠状动脉病变程度加重而升高,且两者呈正相关。     

甲状腺功能5 项检测在妊娠期妇女中的应用

目的:分析甲状腺功能5项检测在妊娠期妇女中的应用价值,为制定妊娠期妇女的甲状腺功能指标的参考值范围提供依据。方法:选取2013年8月~2014年12月我院收治的826例健康妊娠妇女(实验组)与794例非妊娠育龄妇女(对照组)为研究对象。采用电化学发光法检测甲状腺功能5项指标,即三碘甲腺原氨酸(TT3)、甲状腺素(TT4)、促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4),比较两组甲状腺功能异常率,并比较5项指标在妊娠早、中、晚期妇女与对照组中的差异。结果:(1)实验组甲状腺功能异常的发生率(39.10%)显著高于对照组(17.63%),差异有统计学意义(P0.05);(2)实验组FT4、TT4水平随着妊娠期的进展逐渐降低,TSH水平逐渐升高,且均低于对照组水平,差异有统计学意义(P0.05);而各妊娠期FT3、TT3水平比较差异无统计学意义,但均略低于对照组(P0.05)。结论:甲状腺功能5项指标检测应作为妊娠期妇女的孕期必查项目之一,且制定早、中、晚期妊娠期妇女的甲状腺功能5项指标参考值范围十分必要。     

冠心病患者介入治疗前后血清IL-18、sCD40L 和hs-CRP 水平的 变化及其意义

目的:探讨冠心病患者血清白介素18(Interleukin-18,IL-18)、白细胞分化抗原40配体(CD40L)、及高敏C反应蛋白(hs-CRP)水平在经皮冠状动脉介入术治疗前后的变化和意义。方法:选择经冠状动脉造影确诊的冠心病患者85例,根据病变程度分为单支病变组(n=32)、双支病变组(n=28)和多支病变组(n=25),采用双抗体夹心ELISA法测定PCI术前术后血清IL-18、CD40L和hs-CRP水平。结果:血清IL-18水平测定结果:多支病变组高于双支病变组,双支病变组高于单支病变组;支架置入术后显著高于术前,差异均有统计学意义(P<0.01)。血清CD40L水平测定结果:多支病变组高于双支病变组和单支病变组,差异均有统计学意义(P<0.01),双支病变组与单支病变组间差异无统计学意义(P>0.05);支架置入术后较术前显著升高,差异有统计学意义(P<0.01)。血清hs-CRP水平测定结果:多支病变组高于双支病变组,双支病变组高于单支病变组;支架置入术后显著高于术前,差异均有统计学意义(P<0.01)。结论:冠心病患者血清IL-18、CD40L和hs-CRP与冠脉病变程度密切相关,介入治疗可使冠心病患者血清IL-18、CD40L和hs-CRP水平升高,监测血清中IL-18、CD40L和hs-CRP水平变化可了解治疗效果和炎症程度。     

氨曲南联合恩替卡韦对肝硬化原发性腹膜炎患者血清甲状腺激素水平及临床疗效的影响

目的:探讨氨曲南联合恩替卡韦对乙肝肝硬化原发性腹膜炎患者血清甲状腺激素水平及临床疗效的影响。方法:选择于我院就诊的乙肝肝硬化原发性腹膜炎患者60例,根据电脑生成的随机数字表将所有患者随机分为实验组和对照组,每组各30例,对照组患者给予氨曲南进行治疗,实验组患者在对照组的基础上联合应用恩替卡韦进行治疗。比较治疗前后两组患者血清甲状腺激素、中性粒细胞比例、血白细胞及腹水细胞水平,并对治疗前后两组患者的体重、腹围及24 h尿量进行记录。结果:与治疗前相比,两组患者血清TSH水平、体重、腹围均降低,FT3、FT4、T3、T4水平及24 h尿量升高(P0.05);与对照组相比,实验组患者血清TSH水平、体重、腹围较低,FT3、FT4、T3、T4水平及24h尿量较高(P0.05);临床总有效率较高(P0.05)。结论:氨曲南联合恩替卡韦对乙肝肝硬化原发性腹膜炎具有较好的临床疗效,推测其机制与改善甲状腺激素水平,降低炎症反应有关。     

On the origin of the Hirudinea and the demise of the Oligochaeta

The phylogenetic relationships of the Clitellata were investigated with a data set of published and new complete 18S rRNA gene sequences of 51 species representing 41 families. Sequences were aligned on the basis of a secondary structure model and analysed with maximum parsimony and maximum likelihood. In contrast to the latter method, parsimony did not recover the monophyly of Clitellata. However, a close scrutiny of the data suggested a spurious attraction between some polychaetes and clitellates. As a rule, molecular trees are closely aligned with morphology-based phylogenies. Acanthobdellida and Euhirudinea were reconciled in their traditional Hirudinea clade and were included in the Oligochaeta with the Branchiobdellida via the Lumbriculidae as a possible link between the two assemblages. While the 18S gene yielded a meaningful historical signal for determining relationships within clitellates, the exact position of Hirudinea and Branchiobdellida within oligochaetes remained unresolved. The lack of phylogenetic signal is interpreted as evidence for a rapid radiation of these taxa. The placement of Clitellata within the Polychaeta remained unresolved. The biological reality of polytomies within annelids is suggested and supports the hypothesis of an extremely ancient radiation of polychaetes and emergence of clitellates.     

On the ontogeny of the haptor and the evolution of the Monogenea

Data on the ontogeny of the posterior haptor of monogeneans were obtained from more than 150 publications and summarised. These data were plotted into diagrams showing evolutionary capacity levels based on the theory of a progressive evolution of marginal hooks, anchors and other attachment components of the posterior haptor in the Monogenea (Malmberg, 1986). 5 + 5 unhinged marginal hooks are assumed to be the most primitive monogenean haptoral condition. Thus the diagrams were founded on a 5 + 5 unhinged marginal hook evolutionary capacity level, and the evolutionary capacity levels of anchors and other haptoral attachement components were arranged according to haptoral ontogenetical sequences. In the final plotting diagram data on hosts, type of spermatozoa, oncomiracidial ciliation, sensilla pattern and protonephridial systems were also included. In this way a number of correlations were revealed. Thus, for example, the number of 5 + 5 marginal hooks correlates with the most primitive monogenean type of spermatozoon and with few sensillae, many ciliated cells and a simple protonephridial system in the oncomiracidium. On the basis of the reviewed data it is concluded that the ancient monogeneans with 5 + 5 unhinged marginal hooks were divided into two main lines, one retaining unhinged marginal hooks and the other evolving hinged marginal hooks. Both main lines have recent representatives at different marginal hook evolutionary capacity levels, i.e. monogeneans retaining a haptor with only marginal hooks. For the main line with hinged marginal hooks the name Articulon-choinea n. subclass is proposed. Members with 8 + 8 hinged marginal hooks only are here called Proanchorea n. superord. Monogeneans with unhinged marginal hooks only are here called Ananchorea n. superord. and three new families are erected for its recent members: Anonchohapteridae n. fam., Acolpentronidae n. fam. and Anacanthoridae n. fam. (with 7 + 7, 8 + 8 and 9 + 9 unhinged marginal hooks, respectively). Except for the families of Articulonchoinea (e.g. Acanthocotylidae, Gyrodactylidae, Tetraonchoididae) Bychowsky's (1957) division of the Monogenea into the Oligonchoinea and Polyonchoinea fits the proposed scheme, i.e. monogeneans with unhinged marginal hooks form one old group, the Oligonchoinea, which have 5 + 5 unhinged marginal hooks, and the other group form the Polyonchoinea, which (with the exception of the Hexabothriidae) has a greater number (7 + 7, 8 + 8 or 9 + 9) of unhinged marginal hooks. It is proposed that both these names, Oligonchoinea (sensu mihi) and Polyonchoinea (sensu mihi), will be retained on one side and Articulonchoinea placed on the other side, which reflects the early monogenean evolution. Except for the members of Ananchorea [Polyonchoinea], all members of the Oligonchoinea and Polyonchoinea have anchors, which imply that they are further evolved, i.e. have passed the 5 + 5 marginal hook evolutionary capacity level (Malmberg, 1986). There are two main types of anchors in the Monogenea: haptoral anchors, with anlages appearing in the haptor, and peduncular anchors, with anlages in the peduncle. There are two types of haptoral anchors: peripheral haptoral anchors, ontogenetically the oldest, and central haptoral anchors. Peduncular anchors, in turn, are ontogenetically younger than peripheral haptoral anchors. There may be two pairs of peduncular anchors: medial peduncular anchors, ontogentically the oldest, and lateral peduncular anchors. Only peduncular (not haptoral) anchors have anchor bars. Monogeneans with haptoral anchors are here called Mediohaptanchorea n. superord. and Laterohaptanchorea n. superord. or haptanchoreans. All oligonchoineans and the oldest polyonchoineans are haptanchoreans. Certain members of Calceostomatidae [Polyonchoinea] are the only monogeneans with both (peripheral) haptoral and peduncular anchors (one pair). These monogeneans are here called Mixanchorea n. superord. Polyonchoineans with peduncular anchors and unhinged marginal hooks are here called the Pedunculanchorea n. superord. The most primitive pedunculanchoreans have only one pair of peduncular anchors with an anchor bar, while the most advanced have both medial and lateral peduncular anchors; each pair having an anchor bar. Certain families of the Articulonchoinea, the Anchorea n. superord., also have peduncular anchors (parallel evolution): only one family, the Sundanonchidae n. fam., has both medial and lateral peduncular anchors, each anchor pair with an anchor bar. Evolutionary lines from different monogenean evolutionary capacity levels are discussed and a new system of classification for the Monogenea is proposed.In agreeing to publish this article, I recognise that its contents are controversial and contrary to generally accepted views on monogenean systematics and evolution. I have anticipated a reaction to the article by inviting senior workers in the field to comment upon it: their views will be reported in a future issue of this journal. EditorIn agreeing to publish this article, I recognise that its contents are controversial and contrary to generally accepted views on monogenean systematics and evolution. I have anticipated a reaction to the article by inviting senior workers in the field to comment upon it: their views will be reported in a future issue of this journal. Editor