1998年 · 第37卷第Z1期

Objective　To compare the effects of Xuezhikang and Simvastatin in patients with primary hyperlipidemia. Methods　108 patients with primary hyperlipidemia were randomly divided into two groups. Group 1,53 patients, took 4 Xuezhikang capsules per day （1.2g/day） for 8 weeks and Group 2, 55 patients took Simvastatin 10 mg per day for 8 weeks. At the end of 8 weeks, the lipid levels were compared with those of the baseline in each group. Results　In Group 1, the serum levels of total cholesterol （TC）, low-density lipoprotein （LDL） cholesterol and trigly cerides （TG） decreased by 23.0％, 28.0％ and 28.1％（P＜0.001）, and in Group 2 reduced by 23.3％, 29.5％ and 29.5％（P＜0.001） respectively. The serum levels of high-density lipoprotein （HDL） cholesterol after taking Xuezhikang increased by 5.0％（P＞0.05） and after taking Simvastatin increased by 14.3％（P＜0.01）. No significant differences, however, were found between the two groups in TC, LDL cholesterol, TG, and HDL cholesterol. The side effects of Xuezhikang were less than those of Simvastatin. Conclusion　Xuezhikang made in China is a safe, effective and well toleraled lipid modulator.

Objective To study the genetic mode of familial hypertension. Methods　63 pedigrees of 140 nuclear families were included. Familial hypertension was investigated by segregative analysis using computer program. Results　There was an evidence of a vertical transmission for familial hypertension. A segregative ratio of dominant inheritance was considered A×U and A× A mating type. The data suggested that familial hypertension is an autosomal dominant hereditary disease, the genetic modes of familial hypertension differ according to the different mating types of the patients, and the disease has a genetic heterogeneity. Conclusion　The results provide insight into the inheritance of familial hypertension in China.

Objective　To improve the identification of chronic thromboembolic pulmonary hypertension. Methods　We restrospectively analysed the clinical data of 72 patients with chronic thromboembolic pulmonary hypertension （CTEPH）.Results　Arterial blood gases showed a decrease in PaO2 and PaCO2, and an increase in P（A-a） O2. There were 80.3％ of unsymmetrical pulmonary hyperlucencies on chest radiograph and 76.4％ of right ventricular hypertrophy on electrocardiograph, 92.5％ and 97.1％ of right atrial and right ventricular enlargement, respectively. 11.1％ of pericardial effusion was noted on echocardiograph, and Doppler examination showed a rise in pulmonary arterial pressure in 98.5％ of patients. The mean pulmonary arterial pressure was 6.50±1.80 kPa （48.75±13.50 mmHg） by right cardiac catheterization. The incidences of pulmonary embolism were 100％ both on pulmonary angiography and on radionuclide lung perfusion scan. 43.1％ of patients had a history of deep venous disorders and 75.0％ showed positive findings by radionuclide venography in the lower extremities. The diagnosis was not made before hospitalization in 90.3％. Conclusion　The understanding of clinical manifestations and laboratory findings of CTEPH is important to improve the diagnosis of CTEPH.

Objective To examine whether or not peripheral blood mononuclear cells （PBMCs） from steroid-resistant （SR） asthmatics express different profiles of cytokines from their steroid-sensitive （SS） counterparts, particularly after treatment with steroid. Method In situ hybridization was used to detect the mRNA from PBMCs.Results PBMCs from SR patients did not differ significantly from those of SS in the expression of interleukin （IL-4） mRNA or IL-5 mRNA （P＞0.05）. There was no difference in the number of PBMCs expressing IL-4 mRNA and IL-5 mRNA （P＞0.05） between incubation in the absence or presence of dexamethasone （DXM, 10-7mol/L） in SR. SS patients had a significant decrease in the number of PBMCs expressing IL-4 mRNA and IL-5 mRNA （P＜0.01） after culturing in the presence of DXM when compared with incubation in media alone. Conclusion Our findings indicate that SR asthma is associated with a dysregulation of the expression of the genes encoding for IL-4 and IL-5.

Objective　To investigate the correlation of HLA-DR gene with susceptibility and clinical manifestations of sarcoidosis. Method　Fifty-five patients with sarcoidosis and 106 normal subjects were investigated by using allele group specific polymerase chain reaction technique （PCR）. Results　The gene frequency of HLA-DR5 increased significantly in patients with sarcoidosis （P＜0.01）, but that of HLS-DR7 decreased （P＜0.05）. Gene frequencies of HLA-DR9 and HLA-DR5 increased remarkably in male patients and in patients with stage Ⅰ and stage Ⅱ a, respectively （P＜0.05）. Conclusion　HLA-DR gene might contribute to the susceptibility and differently clinical manifestations of sarcoidosis.

Objective　To determine the eradication rate of Helicobacter pylori （HP） infection using omeprazole 20 mg twice daily, clarithromycin 500 mg twice daily and amoxicillin 1000 mg twice daily for one or two weeks, in comparison with colloidal bismuth subcitrate 240 mg twice daily, amoxicillin 1000 mg twice daily and metronidazole 400 mg twice daily for two weeks. Methods　141 patients with Hp associated chronic gastritis or duodenal ulcer were randomly divided into 3 groups. Group Ⅰ（n＝48） was treated with triple therapy （omeprazole, clarithromycin and amoxicillin） for 1 week, Group Ⅱ （n＝47） treated with triple therapy for two weeks, Group Ⅲ （n＝46） treated with colloidal bismuth subcitrate, amoxicillin and metronidazole for 2 weeks. The Hp status was determined by rapid urease test and histology of Warthin-Starry silver stain. Results　The eradication rates of Group Ⅰ, Group Ⅱ and Group Ⅲ were 89.6％, 95.7％ and 71.7％ respectively. The difference between Group Ⅰ and Group Ⅲ or between Group Ⅱ and Group Ⅲ was significant. There was no significant difference in the eradication rates between Group Ⅰ and Group Ⅱ. Side effects in Group Ⅲ was more frequent than in Group Ⅰ and Ⅱ. Although 21.1％ of the patients in Group Ⅰ and Ⅱ experienced a metallic taste, none discontinued in medication. Conclusion　Our results show that triple therapy with omeprazole, clarithromycin and amoxicillin is an effective and well tolerated treatment for eradication of Hp infection and may be an alternative to the old standard triple therapy.

Objective　To investigate the mechanism by which Helicobacter pylori induces gastric mucosal damage. Method　The gastric epithelial apoptotic index （AI） of normal mucosa and H. pylori positive gastritis before and after anti-H. pylori treatment was studied using terminal transferase-mediated dUTP nick end labeling （TUNEL）. Results　The mean of AI was 7.1±1.6 in 31 patients with H. pylori positive gastritis and was significantly higher than 1.3±0.6 in 16 normal controls （P＜0.001）. After the eradication of H. pylori AI fell significantly to the normal level （P＜0.001）. In persisting H. pylori positive gastritis, the AI showed no significant change. There was no correlation between the AI and the severity of gastritis. Conclusion H. pylori infection could induce gastric epithelial apoptosis, which may be an important mechanism in the pathogenesis of gastric mucosal damage in H. pylori.

Objectives To evaluate the efficacy of teprenone on the healing of gastric ulcer and investigate its mechanisms in ulcer healing. Methods　One hundred and six patients with active gastric ulcer proven by endoscopy were recruited into this open, randomized, controlled, and multicentre clinical trial. Fifty-eight patients in Group A were given teprenone 50 mg thrice daily and cimetidine 800 mg at bedtime, and the other 48 patients cimetidine 800 mg at bedtime alone. All patients were examined by endoscopy to evaluate ulcer healing at the end of the 4th week and those whose ulcers had not yet healed were continuously treated till the end of the 8th week and were reexamined by endoscopy. Two pieces of tissue samples were taken from the gastric antral mucosa to measure the contents of hexosamine in gastric mucosa before and after the treatment. Tests of blood, urine and feaces as well as hepatic and renal functional tests were carried out before and after the treatment. Results　At the end of the 4th week, 72.4％ （42/58） of those on cimetidine＋teprenone and 52.1％ （25/48） on cimetidine alone had ulcers healed in comparison to 93.1％ （54/58） and 89.6％ （43/48） respectively after 8 weeks. The difference was significant at the end of the 4th week, indicating that the ulcer healed more rapidly in the combined treatment group. The stage S2 achievement rates were 34.5％ （20/58） and 10.4％ （5/48） after 4 weeks （P＜0.05） respectively, indicating that the quality of ulcer healing was much better in the combined group. The gastric mucosal hexosamine contents increased significantly after the treatment （17.79±2.00 μg/mg） as compared to that before the treatment （14.27± 2.47 μg/mg） in the combined treatment group, indicating that teprenone stimulates the synthesis of macromolecular glycoprotein in the healing process of gastric ulcer. Conclusion　It is reasonable to administer teprenone, an agent increasing mucosal resistance, concurrently with H2 blockers in the treatment of active gastric ulcer.

Objective To study the paraffin-embedded liver tissue from 60 biopsied or autopsied cases, including 20 cases of acute mild hepatitis, chronic active hepatitis, and active cirrhosis. Methods Immunohistochemical double labelling technique was used by using polyclonal anti-Fas and anti-Fas ligand. The detection rates for Fas and Fas ligand were 76.7％ （46/60） and 70.0％ （42/60）, respectively. Fas antigen was located in the cytoplasm of hepatocytes. Fas ligand was expressed mainly in infiltrating lymphocytes in portal or periportal areas （34/42, 80.9％）, and also in some cytoplasm of hepatocytes （25/42, 59.5％）. Results The distribution of Fas ligand-positive hepatocytes was similar to that of Fas-positive hepatocytes in liver tissue.The positive cells were scattered in the intralobular in acute mild hepatitis, but they were more commonly aggregated in periportal areas, especially near the edges of the piecemeal necrosis region or in infiltrating mononucleocytes in chronic active hepatitis and active cirrhosis. Double labelling studies showed that both Fas and Fas ligand might be expressed in the same or different hepatocytes of the same area. Conclusion Fas-Fas ligand system may play an important role in liver cell injury due to hepatitis B virus infection.

Objective To study the seroepidemiology of post-transfusion hepatitis C virus （HCV） infection prospectively from April 1993 to November 1994 in four medical schools in China, namely, Peking Union Medical College （PUMC）, Western China Medical University （WCMU）, Shanghai Medical University （SMU）, and Beijing Medical University （BMU）. Methods A screening test on anti-HCV was performed on the healthy donors of the four groups.Results Anti-HCV positive rate was found to be 14.9％ in " professional", 5.60％ in rural, and 0.42％ in urban volunteer donors. The positive rate of anti-HCV in blood recipients, followed up for more than 3 months after transfusion, was different among the four institutes, being 15.34％ （14/91） in PUMC, 24.59％ （15/61） in WCMU, 13.18％ （12/91） in SMU and 1.53％ （1/65） in BMU respectively. During the same period, the post-transfusion hepatitis B virus infection rate decreased as compared with that in the past. Conclusion The screening test on anti-HCV in blood donors does not appear to completely prevent post-transfusion HCV infection.

The effect of early coronary reperfusion on left ventricular remodeling and systolic function in patients with acute myocardial infarction

The effect of nutritional status of patients with stable chronic obstructive pulmonary disease on the strength of respiratory muscles

Effects of insulin resistance and insulin secretion on the development of type Ⅱ diabetes mellitus

Antrophloroduodenal dyscoordination in functional dyspepsia studied by color Doppler flow imaging

Two doses of recombinant interferon alpha 2a in treating chronic hepatitis C ：a randomized comparative study

Comparison of the effects of Xuezhikang with simvastatin on lipid profile modification in patients with hypercholesterolemia

This supplementary issue in English of the Chinese Journal of Internal Medicine is intended to serve as an international medium for physicians who are interested in internal medicine in China. The Chinese Journal of Internal Medicine is directed by the executive committee of the Chinese Society of Internal Medicine and first appeared in 1953 in Beijing.It has been listed in the Index Medicus and other 7 international retrieval systems. Regular contributions come from all over the country and their scope covers widely such specialties as endocrinology, cardiology,neurology,rheumatology,gastroenterology, communicable and parasitic iseases,hematology,nephrology, and respirology. The journal has been published monthly in Chinese since 1955. Its editorial board consists of 62 members and has 87 reviewers in different specialties. The journal has been awarded prizes in different occasions in China for its contributions to the development of internal medicine.

In recent years, the incidence of unstable angina pectoris （UAP） in hospitalized patients due to coronary artery disease （CAD） is increasing. oth anti-ischemic and anti-thrombotic agents are essential for UAP. They are highly effective in suppressing anginal symptoms,but fail to relieve or circumvent atherosclerotic obstructive lesions. Both early mortality and development of acute myocardial infarction （AMI） in patients with UAP have been significantly reduced with proper use of anti-platelet and anti-coagulant agents （either alone or in combination）, and might be further ecreased by newer specific thrombin inhibitors （hirudin, hirulog） and platelet glycoprotein （GP） Ⅱ b/ Ⅲ a receptor antagonists. Considering the definite role of intracoronary thrombosis in initiating of UAP and acute reocclusion after percutaneous transluminal coronary angioplasty （PTCA）, and also the high efficacy of thrombolytic therapy in the Q-wave AMI, it is reasonable to speculate that thrombolytic therapy might have beneficial results in the management of UAP. Yet angiographic and clinical trials have demonstrated that either thrombolytic therapy alone or prophylactic thrombolysis as an adjunct to PTCA should not be routinely recommended in the acute management of UAP.

Genetic alterations in the pathogenesis of haematological malignancies may act by two general mechanisms. The first mechanism involves structural alterations of normal genes with the generation of novel genes, the protein products of which act on the host cells to induce the characteristics of malignancies. This may be due to fusion of these genes to other genes with the formation of chimeric genes, or mutations of these genes. The second mechanism involves the inactivation or deletion of genes （tumour suppressor genes or antioncogenes）, the proteins of which suppress malignancies. Investigations of the genetic alterations in haematological malignancies are important in many aspects. Firstly, these mechanisms illustrate important principles in molecular oncogenesis. Secondly, the knowledge of these genetic alterations allows rapid and accurate diagnosis to be made. Thirdly, these molecular changes can be used to formulate methods for detection of minimal residual disease. Finally, they may be targets of treatmen.

Cilia are minute structures present on the surface of respiratory and other epithelial cells which beat continuously and automatically. Ciliary beating creates a continuous movement of the surface peri-epithelial fluid which is often responsible for the normal functioning of the mucosa. Ciliary abnormalities could therefore lead to multi-system diseases. Patients with primary ciliary dyskinesia could potentially develop recurrent sinotrachrobronchitis, bronchiectasis, serous otitis media, hydrocephalus, and male infertility. The assessment of cilia has, however, received little attention until recently and generally involve elaborate methods which require complex and expensive technology. This brief article therefore discusses the application of the saccharine test, light microscopy assessment of ciliary beat, and transmission electron microscopy assessment of ultrastructure of cilia. The rationale and indications for light microscopy assessment are also listed along with illustrations which show ciliary structure, equipment required for sampling and assessment of cilia, and transmission electron micrographs of ciliary ultrastructural abnormalities.