1999年 · 第112卷第07期

OBJECTIVE To examine the relationship between coronary heart disease (CHD) and serum lipid, plasma homocysteine (HCY) as well as the factors related to HCY metabolisms. METHODS The mutation of the 677C→T transition of 5, 10-methylenetetrahydrofolate reductase (MTHFR) was determined by PCR-based assay. Whole-blood and plasma folate and plasma vitamin B12, as cofactors of MTHFR, were determined by radio-immunologic assay. Plasma HCY was determined by HPLC. RESULTS Patients with CHD had elevated plasma HCY concentrations (17.38±1.94 mumol/L vs 10.25±1.57 mumol/L, P<0.01). In patients with myocardial infarction (MI) and family history (FH) of CHD, plasma HCY were elevated even higher (P<0.05). Plasma HCY concentrations had significant non-linear inverse correlation with plasma folate and B12 concentrations, i.e. the lower the serum folate or B12 concentrations, the higher the plasma HCY concentrations (P<0.01). Patients with homozygous mutants had higher plasma HCY concentrations. Patients with CHD had increased serum Chol and LDL-C and Apo-B levels (P<0.01, P<0.05 and P<0.05 respectively). But plasma HCY concentrations had no correlation with serum lipid levels. 24.1% of the patients had high lipid and high HCY level, 25.9% had high lipid level and normal HCY level, 20.4% had normal lipid and high HCY level, and 29.6% had normal lipid and HCY level. CONCLUSIONS HCY may have strong association with the genesis of CHD. Low plasma folate and B12 concentrations may induce Hyperhomocysteinemia [HH(e)]. Plasma HCY concentrations have no correlation with serum lipid levels, so HCY may be an independent risk factor. CHD may be induced by different mechanisms and can be classified into hyperlipidemia, HH(e) and normolipidemia, and normohomocysteinemia.

OBJECTIVE To evaluate factors influencing electrocardiogram (ECG) stress test. METHODS The treadmill stress test and coronary angiogram (CAG) records were reviewed retrospectively in 435 consecutive patients with chest pain between 1991 and 1997. There were 44 cases with normal CAG but positive exercise stress test results (false-positive, Group A), and 33 cases with both negative CAG and negative exercise test (true-negative, Group B). The baseline ECG, echocardiogram, abnormal systolic blood pressure response and history of diabetes mellitus and hypertension in the two groups were compared. RESULTS There was no significant difference between the two groups with respect to age, gender, and antianginal medication. More patients in Group A had hypertension (52.3% vs 27.3%, P<0.05) and diabetes mellitus (15.9% vs 0%, P<0.05). Left ventricular (LV) hypertrophy in baseline ECG and by echocardiogram was more often present in Group A (25.0% vs 3.0%, P<0.05; 36.4% vs 12.1%, P<0.05). There were no significant differences between the two groups with respect to maximal heart rate, maximal systolic blood pressure (BP), metabolic equivalents, postexercise systolic BP, termination for exercise test, baseline ECG with bundle branch block and ST depression. CONCLUSIONS Our results suggest that LV hypertrophy and a history of hypertension or diabetes mellitus are the main factors influencing ECG stress test for detecting coronary heart disease.

OBJECTIVE To determine the relationship between remodeling and dysfunction of left ventricle (LV) and the expression of the angiotensin Ⅱ AT1 receptor mRNA after myocardial infarction (MI) in rats. METHODS Nine MI rats (Group A) and 8 sham-operated rats (Group B) were studied by both Doppler echocardiography and Dot blot using Digoxingenin-labelled cDNA probes. RESULTS Compared with Group B, Group A showed the increase in LV internal diastolic diameter (0.87±0.06 mm vs 0.66±0.03 mm, respectively, P<0.01) and volume (0.73±0.09 ml vs 0.51±0.05 ml, P<0.01). In addition, thinning of anterior wall, thickening of posterior wall, increasing of peak early filling velocity (peak E), decreasing of late filling velocity (peak A) and increasing of the E/A were demonstrated in MI rats 7 weeks after MI. The levels of the cardiac angiotensin Ⅱ AT1 receptor mRNA in Group A were higher than those of Group B (2.2-fold). CONCLUSIONS Seven weeks after MI in rats, character of LV remodeling and dysfunction were developed and the expression of cardiac angiotensin Ⅱ AT1 receptor mRNA was increased.

OBJECTIVE To investigate the prevalence of anti-endothelial cell antibodies and its possible role in the pathogenesis in lupus nephritis. METHODS Sera from 58 patients with lupus nephritis were studied. Cellular enzyme linked immunoabsaborbent assay was used to detect anti-endothelial cell antibodies, and immunoblotting technique was performed to determine its specific endothelial target antigens. RESULTS 36.2% of the patients with lupus nephritis had elevated IgG isotype anti-endothelial cell antibodies. The association was revealed between the presence of anti-endothelial cell antibodies (AECA) and some laboratory and renal biopsy features, such as thrombocytopenia, higher serum IgG level, lower serum C3 level, higher erythrocyte sedimentation rate (ESR), presence of anti-nuclear antibody (ANA), anti-dsDNA antibodies and glomerular thrombosis. Anti-endothelial cell antibodies were consisted of a group of heterogeneous antibodies, and reacted with different endothelial cell antigens which ranged from 12-90 kD in molecular size in immunoblot. A correlation was demonstrated between heavy proteinuria (>3.5 g/24 hr) and the existence of antibodies against both 27 and 29 kD endothelial cell antigens, an association between the presence of glomerular capillary thrombi and antibody against the 29 kD endothelial cell antigen was also found. CONCLUSIONS Lupus nephritis patients with anti-endothelial cell antibodies showed a complex autoimmune disorder and clinical disease activity, and the results also provided an indirect evidence that anti-endothelial cell antibodies might contribute to the pathogenesis of lupus nephritis.

OBJECTIVE We have reported previously that cerulein-induced edematous pancreatitis would transform into hemorrhagic pancreatitis by administration of endothelin-1 in rats. In the present study, we tried to protect rat model from developing into hemorrhagic pancreatitis with BQ123 (an ETA receptor antagonist). METHODS The rat model was made by 5-hour restraint water-immersion stress and two intraperitoneal injections of cerulein (40 micrograms/kg) at hourly interval. BQ123 (3 or 6 mg/kg) was administered intravenously 30 minutes before and 2 hours after the first cerulein injection. RESULTS Acute hemorrhagic pancreatitis was induced in all rats treated with cerulin + stress. The score for pancreatic hemorrhage was 2.4±0.2 in this group. In the rats pretreated with BQ123, the score was reduced to 1.0±0.0, pancreas wet weight and serum amylase activity were significantly reduced, and histologic alterations in the pancreas lightened, also the local pancreatic blood flow improved without affecting the systemic blood pressure. CONCLUSIONS These results suggest that endothelin-1 should play a role in aggravating the development of acute hemorrhagic pancreatitis, through its action on the pancreatic microcirculation.

OBJECTIVE Ischemia and reperfusion insults may induce anti-injury response in the sick brain cells, in which regulative genes involved in programmed cell death (PCD) may be activated at the same time. It is attempted to obtain more solid evidence to support the above hypothesis even though the mechanism and pathway of PCD in brain cells after cerebral ischemia has not been identified yet. METHODS Focal ischemic model in rats and dot plot hybridization were used to make an observation on the level of bcl-2 mRNA and Bax mRNA expression in the hippocampus cells after a focal ischemic injury, compared to the controls in a pseudo-operation. RESULTS Bcl-2 mRNA was remarkably overexpressed in hippocampus area on the ischemic side after 2 hours' ischemia and then 24 hours' reperfusion, but the expression of Bax mRNA was increased without statistically significance. The findings suggested that there was an obvious increase of the expression of the bcl-2 mRNA in the vulnerable area of the brain after a focal ischemia. CONCLUSIONS Bcl-2 may promote the survival of neuron but Bax may induce apoptosis of the cells in hippocampus area of this model. It is also suggested the biologic therapeutic studies, e.g., up-regulation of the expression of the bcl-2 mRNA or down-regulation of expression of the Bax mRNA should be further performed, which may induce the tolerance of the brain cells to the ischemic insult.

OBJECTIVE To investigate the relationship between diabetes mellitus (DM) including impaired glucose tolerance (IGT) and the factors of age, menopause, and pregnancy. METHODS A systemic epidemiological survey was conducted in 5153 women, aged 20 years and above. RESULTS The prevalence of DM was 4.58%, and IGT 12.83%. In those subjects with DM less than 59 years old and those with IGT less than the age of 49, the prevalence was parallel to the increase of age. Ten years might lead the IGT subjects into DM. Moreover, the prevalence of DM and IGT after menopause were significantly high. It was found that the prevalence of DM and IGT in mothers who had conceived giant baby was significantly higher than that of the others. CONCLUSIONS Therapeutic emphasis should be laid on the population of women in the age between 50 and 59, while the management of IGT women is equally important. The early intervention of IGT subjects in the age between 40 and 49 is essential in decreasing the prevalence of DM. Disorders of the endocrine system during climacteric might play an important role in the development of DM and IGT. Moreover, the mothers who have conceived giant babies are at great risk for DM, and thus, this population should be closely monitored.

OBJECTIVE To identify factors associated with very long survival among all cancer cases diagnosed at age 19 years or younger registered by the Cancer Data Service at the University of Kansas Medical Center in Kansas City, Kansas, U.S.A. in the 40-year period between 1944 and 1983, with follow-up to 1993. METHODS There were 2720 pediatric patients with 2750 cancers who were studied. Forty-four types of cancer were grouped into 11 diagnostic categories. Diagnosis years spanned four eras: 1944-1953, 1954-1963, 1964-1973, and 1974-1983. Cases were compared using specific characteristics and were divided into short-term and long-term survivors with the division generously set at seven years. The proportions of the long-term survivors were compared by specific characteristics. RESULTS Among the diagnostic categories, leukemias were the most common (29.8%), followed by CNS tumors (15.2%), and Hodgkin's disease (9.0%). Male to female ratio was 4:3; average age at diagnosis was 8.83±6.08 years. Long-term survivors totaled 1148 (41.7%). Prognosis was better in cases diagnosed in earlier stages and in later eras. Proportion of long-term survivors increased from 18.7% in era I to 52.6% in era IV. Improvement of survival was statistically significant in most diagnostic categories. CONCLUSIONS This study shows continuing improvement of survival during four consecutive eras for childhood and adolescent cancer. Early diagnosis was associated with better survival. Unstaged cases decreased over time reflecting progress in diagnostic techniques. Many patients died before seven years after diagnosis. Those who survived more than seven years had excellent survival. Pediatricians can expect to participate in the care of these patients long after the original dianosis and treatment.

OBJECTIVE To evaluate the effect of recombinant human granulocyte colony stimulating factor (rhG-CSF) on accelerating neutrophil recovery and decrease fatal infections for childhood acute myeloid leukemia (AML). METHODS From November 1992 to March 1997, 45 patients were enrolled into our study and 15 were newly diagnosed. All were treated with high dose chemotherapy combined with rhG-CSF. RESULTS Of 15 newly diagnosed patients, 13 achieved complete remission (CR) after one course of therapy and 2 achieved CR after two courses of therapy. For newly diagnosed patients, the durations of absolute neutrophil counts (ANC)<0.5 x 109/L were 5 days and 10 days in rhG-CSF group and control group respectively (P<0.05). The incidences of infection of these two groups were 40% and 60% respectively (P<0.05). As for patients who received intensive therapy, the durations of ANC<0.5 x 109/L were 5 days and 8 days in rhG-CSF group and control group, respectively (P<0.05), and the incidences of infection were 25% and 44.4% respectively (P<0.05). CONCLUSIONS The application of rhG-CSF in children with AML after chemotherapy may hasten the hematopoietic recovery. The duration of neutropenia was shortened by 3-4 days, and the incidence of fatal infection was reduced. rhG-CSF does not stimulate AML growth in vivo.

OBJECTIVE To investigate the role of dobutamine stress echocardiography in evaluating cardiac β-adrenergic receptor (β-AR) function and responsiveness in children. METHODS Left ventricular ejection fraction (EF), fractional shortening (FS), left ventricular end systolic volume index (ESVI), the ratio of systolic blood pressure and ESVI (SP/ESVI) were measured by dobutamine stress echocardiography (DSE) in 30 children with β-AR hypersensitivity, 15 children with dilated cardiomyopathy and 30 normal children respectively. RESULTS Before pharmacological stress, EF and FS were 0.72 and 0.39 respectively in β-AR hypersensitivity group versus 0.70 and 0.35 respectively in control group. There was no difference of the indices between the two groups (P > 0.05). SP/ESVI was 0.76, higher than the value of 0.66 in control group (P < 0.05); EF, FS and SP/ESVI were 0.41, 0.15 and 0.10 respectively, which were significantly lower than those in control group. After dobutamine stress of 5 μg·kg -1·min-1 and 10 μg·kg-1·min-1, EF, FS and SP/ESVI were significantly increased in patients with β-AR hypersensitivity and there were no changes in children with dilated cardiomyopathy compared with values of baseline. CONCLUSIONS Cardiac β-AR function and responsiveness can be evaluated by dobutamine stress echocardiography.

OBJECTIVE To evaluate the reproducibility of ThermoscanTM, an infrared emission detection ear thermometer, and to establish the normal reference range of ear temperature in Chinese neonates. METHODS Neonates were recruited from the inpatients population with exclusion of those suffering from infections. RESULTS Forty-nine neonates were recruited with 1,115 temperature taking sessions. Mean left ear temperature was 36.64 ℃±0.35 ℃. Mean right ear temperature was 36.64 ℃±0.37 ℃. Clinical repeatability for left and right ear was 0.17 ℃ and 0.17 ℃, respectively. CONCLUSIONS Thermoscan produced reproducible results in Chinese neonates. The normal range of ear temperature for Chinese neonates is 35 ℃ to 37 ℃. Ear temperature >37.8 ℃ should be regarded as fever.

Purpose To summarize the results of gene analysis for five types of glycophorin (GP) variants found in a screening survey conducted in several regions of Southern China. Data sources Papers cited in Chinese biochemical and biomedical literatures with a bibliographic review of articles relevant to hematology and biochemistry. Study selection All GP variant reports of our research group published during 1991-1997 were included. Data extraction Data concerning 5 types of GP variants found in Southern China were briefly abstracted. GP variant frequencies with their phenotypes among 3 districts and those among Han, Li, Buyi and Yao ethnic groups were calculated. Results Five phenotypes of GP variants [Sta, MiⅢ, MiⅤ (J.L.), MiⅥ and a novel case] were identified from 180 unrelated healthy individuals (Hunan, Hainan) and 222 residents of a tertian malaria hyperendemic area (Guizhou), using immunoblotting techniques, Southen hybridization and PCR-direct sequencing. Conclusions These five types of GP variants were first reported in China. There were some differences in the geographical distribution of GP variants among Hunan, Hainan and Guizhou districts. Mi III GP was commonly found in national minorities of Li and Buyi, while the frequency of Sta GP occurrence was considerably higher in Han ethnic group. The frequency of GP variants in a malaria hyperendemic area of Guizhou Province does not depend upon the severity of tertian malaria morbidity.

OBJECTIVE To analyze the 40 years' experience of intestinal atresia and to introduce a new design of long-oblique anastomosis for disproportional loops of the intestine. METHODS A total of 449 cases of congenital atresia of the small intestine were classified into three groups according to the embryopathology: high group (145 cases), including duodenal and high jejunal atresia; middle group (288), including ileo-jejunal atresia; and low group (16), including terminal ileal atresia. To analyze the survival rate and mode of treatment, we assigned the cases into 3 groups according to the year of admission: 1) 1956-1969 (173 cases), under the general pediatric surgical care; 2) 1970-1985 (147), under the specialty neonatal surgical care; and 3) 1986-1996 (129), with additional use of total parenteral nutrition. RESULTS The ileojejunal atresia group (middle group) had the highest mortality rate (47.6%). The overall mortality rate decreased as the time went by, dropping from 64.7% in the early years down to 18.6% in the recent years, and no hospital death occurred in the recent couple of years. CONCLUSIONS Besides the improvement of neonatal surgical techniques, selecting a proper surgical procedure according to the embryopathology is essential to the reduction of mortality. The long-oblique anastomosis is particularly acceptable in China at present for marked disproportional loops.