2001年 · 第114卷第11期

Objective To explore the relationship between vitamin D receptor (VDR) gene polymorphisms and bone mineral density (BMD) in patients with type 2 diabetes mellitus (DM) and to better understand the pathogenesis of osteoporosis. Methods Ninety seven patients with type 2 DM were recruited for this study. BMD was measured by single photon absorptiometry at the lower one third of the nondominant radius and ulna. Polymorphisms of the VDR gene were analyzed by DNA amplification with polymerase chain reaction (PCR) and endonuclease digestion with Bsm I. Results The respective frequencies of VDR genotypes were BB 18.6%, Bb 27.8% and bb 53.6%. The Z scores of the three groups were -1.57± -0.60, -1.45 ± -0.67 and -1.41 ± -0.81, respectively. Although the BMD of the Bb genotype DM patients was higher than that of BB genotype DM patients and lower than that of bb genotype DM patients, there were no significant differences. Conclusion These findings suggest a small influence of VDR gene polymorphism on the BMD of patients with type 2 DM. Further study on the value of VDR genotypes in the pathogenesis of osteoporosis in diabetes mellitus is still needed. Chin Med J 2001; 114(11):1213-1215

Objective To determine the effect of thinking on intracranial blood flow velocities. Methods Transcranial Doppler (TCD) was used to measure the blood flow velocities of the cerebral arteries, when 10 normal persons were at rest and during thinking. Results The mean flow velocities (MFVs) of the cerebral arteries during thinking were significantly higher than those at rest, especially in the MCA and ACA. The MFVs were raised from between 10.3% to 14.3%. Conclusions Thinking can increase the blood flow velocities of cerebral arteries significantly. Chin Med J 2001; 114(11):1211-1212

Objective To study the mirror writing in elderly patients with senile dementia and vascular dementia. Methods Thirty-three senile dementia patients and 30 vascular dementia patients were studied. Age- and education-matched 63 healthy elder people were included in control groups. Ten items for determination of handedness, Mini Mental Status Examination (MMSE), Global Deterioration Scale (GDS) and the written language of Chinese Aphasia Examination Scale (draft) were adopted to examine all patients. Hachinski Ischemic Scale was used for differentiation between senile dementia and vascular dementia. Results Seventeen (51.51%) of senile dementia patients and 23 (76.60%) of vascular dementia patients were mirror writiers. In the corresponding control groups, these numbers were found to be 2 (6. 06%) and 7 (23. 30%) respectively. The occurrence rate of mirror writing in senile dementia group and vascular dementia group was markedly higher than in the normal controls (P < 0.01). The severity of mirror writing in senile dementia group (5.69 ± 3.74) was higher than in vascular dementia group (3.75 ± 2.99, P < 0.05). But the educated level of senile dementia group was higher than that of the vascular dementia group (12.52 ±4.12 years vs 9.97±3.53 years). Conclusions The percentage of mirror writing in the two diseased groups was higher than in the control group. Mirror writing could be used for the screening of the degradation of brain function in dementia patients and the results may indirectly reflect the degree of dementia. Chin J Ceriatr 2001; 20: 175-177.

Objective To investigate the association of cylomegalovirus with atherosclerosis. Methods The presence of cylomegalovirus (CMV) nucleic acids was demonstrated in carotid and coronary arteries of patients with and without atherosclerosis by polymerase chain reaction (PCR). CMV was detected by PCR in the blood of patients with and without atherosclerosis. Results 83.3%-86.7% of the samples obtained from atherosclerotic patient arterial walls were shown to contain viral nucleic acids (CMV), CMV could be found among 6.7% of patients’ arterial wall without atherosclerosis, significant difference can be found between them (P < 0.01). In blood CMV could be found in 42.4% of patients with atherosclerosis, in the control group, only 3% of samples had CMV, P < 0.01. Conclusion CMV plays an important role in the pathologic process of the atherosclerosis and the atherosclerotic cerebral infarction. Chin Med J 2001; 114(11):1208-1210

Objective To study the changes of pulmonary functions in elderly patients with chronic obstructive pulmonary disease (COPD). Methods 89 elderly subjects were selected: group I, 20 healthy non-smokers; group Ⅱ, 9 non-smokers with COPD; group Ⅲ, 20 ex-smokers with mild COPD; group Ⅳ, 20 ex-smokers with moderate COPD; group, 20 ex-smokers with severe COPD. The groups Ⅲ, Ⅳ and V were all composed of people abstaining from smoking for > 10 years. Pulmonary functions were determined routinely and followed for 10 years. Results Comparison between the values of pulmonary functions at the beginning and end of a 10- year follow-up showed very significant difference in the groups of Ⅲ, Ⅳand Ⅴ. Among the parameters examined, FEV1, PEF, MMEF, and MVV showed significant increases in these 3 groups (P < 0.05 or P < 0.01), while FVC showed significant increase (P < 0.05) only in group Ⅲ and Ⅳ. Comparison between the pulmonary functions of the elderly non-smokers with COPD and healthy elderlyb non-smokers showed that VC, FEV1, PEF, MMEF, RV and RV/TLC values at the end of the follow-up were all significantly different from those at the beginning (P < 0.01). Conclusions The lung functions change with the increase of age. The changes in the non-smoking elderly COPD patients were more significant than in the healthy nonsmoking elder. The pulmonary functions at the end of the follow-up period were significantly worse than those at the beginning in the elderly COPD patients even though they had abstained from smoking for 10 years. The pulmonary functions in patients with different severity of COPD did not show significant difference. Chin J Geriatr 2001; 20: 168-170.

Objective To assess the prevalence of mitochondrial tRNA leu(UUR) gene mt 3243 A→G mutation and ND-1 gene mt 3316 G→A mutation in Chinese type 2 diabetes. Methods 716 randomly selected, unrelated patients with type 2 diabetes were screened for the mutation with a PCR-RFLP technique. Results Three individuals with mitochondrial tRNA leu(UUR) gene mt 3243 A→G mutation were identified, representing approximately 0.4% of the type 2 patients screened. Further screening of first-degree relatives of these 3 patients identified another 4 affected carriers. In comparison with type 2 diabetic patients without the mutation, these 7 carriers of the mt3243 mutation had: 1) an earlier diagnosis age of diabetes (38.0 ± 10.1 year vs 53.4±10.0 year, P<0.001); 2) lower Body Mass Index (BMI) (19.5±2.0 kg/m2 vs 24.9 ± 10.9 kg/m2, P<0.0001); and 3) lower post-challenge insulin levels (Area under the curve of insulin levels during the Oral Glucose Tolerance Test (OGTT), 2946 ± 1647.2 μIU•mr-1 vs 7469 ± 6647.7 μIU•ml-1, P <0.01). ND-1 gene mt 3316 G→A mutation was found in 16 patients with type 2 diabetes (2.2%) and 5 out 181 controls (2.7%) with normal glucose tolerance. Therefore, the frequency of the mutation was not different in patients and controls. Moreover, clinical characteristics such as age of onset of diabetes, BMI, and insulin levels were not different between diabetic patients with the mt 3316 mutation and those without it. Conclusions In this large cohort of Chinese Type 2 diabetes, the prevalence of mitochondrial tRNA leu(UUR) gene mt 3243 A→G mutation was 0.4%, and the ND-1 gene mt 3316 G→A mutation is a polymorphism unrelated to diabetes. Chin Med J 2001; 114(11):1205-1207

Objective To investigate the epidemiology of hyperthyroidism in three rural communities with different iodine intake after universal salt iodization (USI) since 1996 as well as the influence of USI on the incidence of hyperthyroidism. Methods Inhabitants in Panshan community did not take iodized salt whereas inhabitants in Zhangwu and Huanghua communuities have taken iodized salt since 1996. The thyroid function, thyroid autoantibodies, urinary iodine concentration and thyroid B ultrasound were performed in 1103, 1584 and 1074 subjects respectively in the three communities and the number of hyperthyroidism patients between 1991 and 1999 was collected to calculate the yearly average incidence of hyperthyroidism. Results The median urinary iodine concentrations in Panshan, Zhangwu and Huanghua were 103 μg/L, 375 μg/L and 615 μg/L, respectively (P < 0.05). The prevalence of active hyperthyroidism was 1.6%, 2.0% and 1.2% (P >0.05) and the prevalence of subclinical hyperthyroidism was 3.7%, 3.9% and 1.1%, respectively. Comparing the yearly average incidence of hyperthyroidism of 1996~1999 with that of 1991~1995, a significant increased incidence in Panshan, while a slight but insignificant elevated one in Zhangwu and a fixed one in Huanghua were found. Conclusion USI can not result in a raise of the prevalence of active hyperthyroidism as well as subclinical hyperthyroidism. The increase of iodine intake is not the only explanation for the rising of the incidence of hyperthyroidism. Chin J Endocrinol Metab 2001; 17; 197-201.

Objective To investigate the antimicrobial susceptibility of Streptococcus pneumoniae carried in the nose among children in Beijing and the distribution of serotypes, and to analyze the risk factors for nasal carriage of penicillin non-susceptible S. pneumoniae. Methods A disk diffusion test was applied to detect the antimicrobial susceptibilities of S. pneumoniae to erythromycin, trimethoprim-sulfamethoxazole, chloramphenicol and tetracycline. The E test was applied to determine the minimal inhibitory concentrations of penicillin, cefuroxime, cefotaxime, augmentin and imipenem. S. pneumoniae isolates were serotyped by the Quellung reaction. Results S. pneumoniae that was resistant to penicillin or cefuroxime was not found, but S. pneumoniae intermediate resistant to penicillin and cefuroxime accounted for 8.2% and 2.1%, respectively. All of the isolates were susceptible to cefotaxime, augmentin and imipenem. S. pneumonia that was resistant to erythromycin, trimethoprim-suffamethoxazole and tetracycline were extremely numerous, accounting for 72%, 70% and 79%, respectively. Five serotypes (19, 6, 14, 23, 17) accounted for 54.7%, and nontypabltes accounted for 20.6% of all the S. pneumoniae. Previous history of otitis media was a risk factor we found for nasal carriage of penicillin non-susceptible S. pneumoniae. Conclusions Continued surveillance of the antimicrobial susceptibilities of S. pneumoniae is necessary. A larger scale investigation is needed to identify if the 7 or 9-valent conjugate pneumococcal vaccine is appropriate for Chinese children. Chin Med J 2001; 114(11); 1196-1200

Objective To elucidate the imaging characteristics of spongiform leukoencephalopathy induced by heroin and the diagnostic value of MRI examination. Methods Eleven cases of heroin addiction were examined by MRI. The sequences included T1-rweighted imaging (T1WI), T2-weighted imaging (T2WI) and fast fluid-attenuated inversion recovery pulse sequence (Flair). Results Bilateral symmetrical lesions were located in the white matter of the cerebrum and cerebellum, the internal capsule in all cases, and the callosum in 6 cases. Elliptical lesions in the mesencephalon were found in two cases. These lesions were shown as hypointense signals on T1WI and hyperintense signals on T2WI and Flair's imaging. Cerebellar white matter suffered more severely, but the dentate nuclei were not invaded. Conclusion Heroin-induced spongiform leukoencephalopathy has characteristic patterns in MRI, which are very specific to this form of the disease. Chin Med J 2001; 114(11):1193-1195

Objective To investigate a simple and effective procedure for compound traumatic hand. Methods Since 1995, 12 patients were repaired by one pedicled doulbe toes transplantation, of which modified halluce wrap-around flap and second toe was done in 4 cases; double palmar flap from halluce and second toe in 6 cases; foot dorsal flap and halluce palmar flap in 2 cases. Of total cases, primary repair had 5 patients; delayed repair 4 patients and secondary repair 3 patients. Comprehensive rehabililation was done postoperatively. Results All transplants survived in 12 cases successfully, Arterial crisis occurred postoperatively in two cases. The flap survived after surgical exploration and corresponding treatment. During one year period follow-up, appearance of reconstructed fingers was good, and total active movement of reconstructed fingers averaged 140 degree. Two-point discrimination at the palmar side averaged 8 mm. The reconstruction of hands gained normal abduction in 3 cases and mild dysfunction in 1 cases. There was no obvious enlargement in transplanted flap with mean two-point discrimination 12 mm. Conclusions One pedicled double toes transplantation only have one set of vessel anastomosesed, which supplied two sets of tissues. The strategy is simple, safe and practical. Ensurance of double supply and reflow system and maintaining normal space of first web are key points of the operation. Chin J Hand Surg 2001; 17: 145-147.

Objective To investigate the effectiveness of pinacidil, an opener of ATP-sensitive K+ channels, in protecting the myocardium of immature rabbit hearts from ischemic reperfusion injury. Methods Rabbit hearts underwent 30 min of global normothermic ischemia followed by 30 min of reperfusion on the modified Langendorff apparatus. Fifty-two isolated hearts of 3-4 week-old immature rabbits were divided into 4 groups randomly. During ischemia, 3 different cardioplegic solutions were administered intermittently by infusion every 15 min (20-25 ml each time in all groups). Group 1: control group (n = 13); group 2: Krebs-Henseleit (K-H) solution with potassium (16 mmol/L) (n = 13); group 3; K-H solution with potassium (16 mmol/L) and pinacidil (50 μmol/L) (n = 13); group 4: K-H solution with potassium (16 mmol/L), pinacidil (50 μmol/L) and glibenclamide (10 μmol/L) (n = 13). The pre-ischemic and post-ischemic myocardial functions were assessed by the percentage recovery of the left ventricular developed pressure (LVDP); the left ventricular end-diastolic pressure (LVEDP); both the positive peak and negative peaks of the first derivative of the left ventricular pressures (± dp/dtmax); coronary flow; the level of creatine kinase (CK), lactic dehydrogenase (LDH) and aspartate transcarbamoylase (AST) in coronary sinus venous effluent; and by myocardial ultrastructural changes. Results Before myocardial ischemia, there were no significant differences among the four groups in any of the parameters mentioned above. Post-ischemic recovery of LVDP, LVEDP, ± dp/dtmax, coronary flow, the level of CK, LDH and AST, and myocardial ultrastructural changes were better in group 3 than those in the three other groups. Conclusions As a new and effective composition, pinacidil can significantly improve myocardial protection from cardioplegia for immature rabbit hearts. Chin Med J 2001; 114(11):1184-1188

Objective To estimate the value of aortic valves and combined mitral valve replacement with retrograde perfusion in beating hearts. Methods Continuous retrograde coronary sinus perfusion with beating hearts was used in 83 patients undergoing aortic valve or aortic valve combined with mitral valve replacement, without application of cardioplegia. After aortic valve replacement, the retrograde perfusion was changed to antegrade perfusion for mitral valve replacement or correction of the other deformities (group A). Cold blood cardioplegia solution (15℃) was infused at intervals in 20 cases (group B). The following parameters were tested: lactate, ET, CTn-T and MDA in blood; myocardial ultra-structure; and cardiac rhythm and cardiac output (CO). Results All biochemical values increased after cardiopulmonary bypass (P < 0.05 - 0.01). Empty and beating heart sinus rhythm was maintained in group A. Myocardial ultrastructure did not change significantly. The pump was stopped smoothly as the surgical procedure finished. No postoperative low cardiac output syndrome or arthythmia was observed. Eight-one patients recovered smoothly, two died from renal failure or infective shock. When the pump stopped, all patients in group B were supported by 5-10 μg•kg-1•min-1 dopamine. Transient pacing was used in 9 patients. One patient died from low cardiac output syndrome. Conclusion This method is a good myocardial protection which simulates physiologic status. It is applicable to aortic valve and combined mitral valve replacement of patients with large heart or heart failure and long time aortic cross-clamping. Ideal clinical effect can be achieved. Chin Med J 2001; 114(11):1180-1183

Objective To report our operative experience with aortic root replacement in 231 patients with aortic root aneurysm and discuss the current indications, methods, and surgical techniques. Methods Between January 1994 and August 1999, a group of 231 consecutive patients underwent aortic root replacement at our hospital, with 13 being treated on an emergency basis. There were 189 men and 42 women, ranging in age from 14 to 69 years. The diameter of the aneurysm varied from 4.5 to 11 cm. Among this group, 145 had isolated aortic root aneurysms, 65 suffered from DeBakey type Ⅰ aortic dissection, and the remaining 21 were diagnosed as having DeBakey type Ⅱ aortic dissection. Aortic valve regurgitation occurred in all cases. Aortic root replacement was performed with composite valved graft in 229 patients, and in 2 patients the aortic valve was preserved. Results The hospital mortality rate was 3.03% (7 patients). Early complications included re-exploration for bleeding in 6 patients, pericardial effusion in 9, as well as cerebral infarction, pleural effusion, and pneumothorax in 2 patients each. One hundred and seventy-five patients (78.12%) were followed up, with a mean follow-up time of 15.7 ± 13.1 months (range, 2 weeks to 65 months). One patient died from lower-limb embolism and renal dysfunction 3 months postoperatively. Three patients died from postoperative anticoagulation accidents. The preoperative and postoperative mean left ventricular end-diastolic diameters were significantly different (68.1 ± 9.4 mm, range 54 to 112 mm; vs 54.8±8.2 mm, range 38 to 88 mm; P<0.001). Conclusions Once a diagnosis of acute aortic root dissecting aneurysm is made, the patient should undergo surgery as soon as possible if the general conditions permit. Aortic aneurysm without dissection or with chronic dissection should be operated if the diameter of the aneurysm is greater than 5 cm. Chin Med J 2001; 114(11):1176-1179

Objective To study the clinical and pathological characteristics of microscopic polyangiitis (MPA) with renal medium artery involvement. Methods Hospitalized patients with MPA in recent two years were reviewed retrospectively and their clinicopathological features were compared between patients with and without renal medium artery involvement. Results 32 MPA patients were confirmed by renal biospy. Seven cases were with renal medium artery involvement and 25 cases were without renal medium artery involvement. Of these 25 cases, all had crescent formation and 19 fulfilled the diagnosis of crescentic glomerulonephritis, 9 of focal segmental necrosis glomerulonephritis; 21/25 patients had acute renal failure with an average course of 10 weeks; 8 out of 21 cases achieved complete remission after treatment. Seven MPA patients with renal medium artery involvement presented segmental fibrinoid necrosis of the major branch of arcuate artery; the glomerular ischemia was predominant, but crescentic lesions were mild, none of them had crescentic glomerulonephritis; 6 patients had acute renal failure with an average course of 4 weeks, 5 out of 6 cases achieved complete remission after treatment. In comparison, MPA with renal medium artery involvement had a shorter course (P < 0.05), less crescentic glomerulonephritis in ARF (P < 0.01) and more patients achieved complete remission from ARF after intensive immunosuppressive therapy (P <0.05). Conclusions About 20% of MPA patients have renal medium artery involvement. Because of extensive renal ischemia, these patients proceed to ARF faster and respond to therapy better. Chin J Nephrol 2001; 17: 231-234.

Objective To investigate the roles of fructose-1, 6-diphosphate (FDP)-added total parenteral nutrition (TPN) in septic animals and stressed patients. Methods Thirteen adult dogs were randomly assigned to one of two study groups 6 hours after the induction of severe intra-abdominal infection. Group TPN (n = 6) received 70 kcal• kg-1 • d-1 of nonprotein calorie (NPC) and 0.56 g • kg-1 • d-1 of nitrogen. 1 g/kg of FDP was also infused to the animals in group TPN + FDP (n = 7) everyday. In the clinical study, the control group received routine TPN, while the study group (n = 16) was treated with TPN plus FDP (5 g, two times a day) for 7 days. Results In dogs with TPN support, plasma ATP levels were not changed significantly, while the value in the TPN + FDP group increased significantly from 0.18 μmol/L to 0.46 μmol/L at 24 h and 0.51 μmol/L at 48 h (P < 0.01). Muscular ATP increased markedly in the TPN + FDP group. Muscular creatine phosphate values were not significantly changed in the TPN group, but the values increased in the TPN + FDP group from 4.06 μmol/g•wt at the beginning to 4.93 μmol/g•wt at 24 h and 5.60 μmol/g•wt at 48 h (P < 0.05), with a cytochrome oxidase increase in immunohistochemistry stain. In the clinical study, plasma ATP levels increased and urinary 3-methylhistidine production significantly decreased with an improved value for positive accumulative nitrogen balance in the FDP-infused group. Conclusion Our results suggest that total parenteral nutrition support with the supplement of fructose-1, 6-diphosphate has a positive role in body energy production and protein metabolism in septic animals and stressed patients. Chin Med J 2001; 114(11):1171-1175

Objective To investigate the clinical and phthological manifestations of light chain nephropathy (LCN) and primary amyloidosis (AL). Methods Twenty-five patients with AL (19 male, 6 female) and 6 with LCN (3 male, 3 female) were hospitalized from 1990 to 2000. Their clinical findings, laboratory results and pathological changes were reviewed. Results Most of the cases with AL or LCN presented edema at first onset. Proteinuria was found in 96% of AL patients and 66.7% of LCN patients, of which 75% was nephrotic syndrome. 56% of AL and 83.3% of LCN had renal insufficiency. Enlarged kidney was found in about 50% of all the patients. Renal tubulointerstitial impairment occurred frequently (> 60%). Anemia and hepatosplenomegaly were most common extra-renal manifestations. Under light microscopy, LCN characteristically showed mesangial nodular sclerosis. Linear staining of monoclonal κ or γ light chain along the tubular basement membrane and in the nodules was found in all LCN samples. AL showed glomerular, tubulointerstitial and blood vessel deposition of amorphous material. Positive congo red stain and the diagnostic apple green birefringence under polarized light were observed in AL samples, meanwhile immunostaining of serum amyloid A protein was negative. Six AL patients were accompanied by multiple myeloma and 2 LCN accompanied by Waldenstrom's macroglobulinemia (WM) with obviously elevated serum IgM. Conclusions AL and LCN are not rare diseases. Most common clinical features are proteinuria and nephrotic syndrome. Many patients have varying degrees of renal impairment. Extra-renal symptoms are multiple. Pathological examination provides important indication for diagnosis and differential diagnosis. Chin J Nephrol 2001; 17: 213-216.

Objective To detect the virus in the feces and sera of patients in an outbreak of enterically transmitted non-A, non-E hepatitis, and this review covers the epidemiologic features and experimental infection of this novel virus. Data sources Data sources come from our own work on this subject, published and unpublished. Study selection Mainly our own work is included, and related literature is collected. Results In an outbreak of enterically transmitted non-A-E hepatitis among students, a total of 381 cases (60.7%) were documented. Viral fragments identical to transfusion transmitted virus (TTV) were detected in both serum and stool samples. Asymptomatic virus carriers among the staff had positive serum (32.1%) and feces (24.6%), clearly a potential source of infection. This viral infection prevalence in 2 remote villages in northern and southern China was 9.2% and 10.6%, respectively, suggesting that China is an endemic area. In this study, groups of 3 Rhesus monkeys were infected via oral or intravenous inoculation with patient feces. Two additional monkeys were infected by passage. The virus was detected in serum, peripheral blood mononuclear cell (PBMC), liver, spleen and small intestine, while the virus positive single strand, which might be a replicative intermediate, was only in liver, intestine and PBMC of all animals. Conclusions This nonenveloped DNA virus might be transmitted both by blood and enteric routes. Considering its wide distribution and high prevalence, we suppose that nonparenteral transmission is more important. Chin Med J 2001; 114(11):1201-1204

Objective To explore the relationship between eosinophils, T lymphocyte, leukotreine (LT) and exercise-induced asthma (EIA). Methods In 32 asthmatic patients (13 with EIA and 19 asthmatic without EIA) and 8 normal persons, serum eosinophil cationic protein (ECP) and activated T lymphocyte (CD2+ 5%) in peripheral blood were measured at the time before and 10, 60 minutes after exercise testing. The maximum minute ventilation () were also measured. Another 22 non-smoking asthmatic patients with EIA and 10 normal subjects were enrolled for measuring urinary Ieukotriene E4 levels before and 2 hours after exercise. EIA patients received zafirlukast 20 mg twice a day for three days. Standardized exercise challenge was performed after 72 hours of medication. Results There was a linear relationship between ECP, CD25+% and the forced expiratory volume in one second (FEV1) in asthmatic group (r = -0.79 and -0.61 all P <0.01). Expressions of IL-4 mRNA, IL-5 mRNA CD25+ %and serum ECP levels showed no significant difference at all testing points between two asthmatic groups, meanwhile, also showed no difference among three groups. Urinary LTE4 levels in EIA group increased significantly two hours after exercise. Zafirlukast significantly reduced AUG0~60 min and the percentage of maximum fall in FEV1 and accelerated the falling FEV1 to return to pre-exercise baseline. Conclusions Hyperventilation during exercise may not be the cause leading to EIA, neither did the activation of T lymphocytes, IL-4 and IL-5 gene expression nor ECP. Leukotreine may play an important role in the pathogenesis of EIA. Chin J Tuberc Respir Dis 2001; 24: 360-364.