多囊卵巢综合征临床分型与中医证型的相关性分析

目的 探讨多囊卵巢综合征(polycystic ovarian syndrome,PCOS)患者不同临床分型与中医证型的相关性.方法 将132例多囊卵巢综合征患者根据睾酮(T)水平及体质量指数(BMI),分为高雄组、非高雄组及肥型、瘦型、正常型;根据中医四诊分类,将PCOS患者辨证分型,主要分为肾虚肝郁证、肾虚血瘀证、肾虚痰阻证、肝郁血瘀证、脾虚痰湿证、肝经湿热证、痰瘀互结证七大证.观察不同的临床分型与中医证型的规律.结果 132例PCOS患者中,肾虚肝郁证45.5％,肾虚血瘀证11.3％,肾虚痰阻证1.5％,肝郁血瘀证16.7％,脾虚痰湿证0.8％,肝经湿热证9.1％,痰瘀互结证15.1％;肥型18.9％,瘦型18.9％,正常型62.2％.BMI从低到高的证型依次为肾虚肝郁证、肝郁血瘀证、肝经湿热证、肾虚血瘀证、肾虚痰阻证、脾虚痰湿证、痰瘀互结证.T水平从低到高依次为肥型、正常型、瘦型.不同中医证型、体型、雄激素水平无明显差异(P>0.05),组间无统计学意义.结论 肾虚肝郁证临床较为多见,PCOS病理因素主要与虚、郁、瘀、痰相关.肝郁者的BMI偏低,形态多瘦,而痰湿者的BMI较高,形体多肥.瘦型PCOS患者T水平较肥型高.不同中医证型分类与T水平无关.     

多囊卵巢综合征临床证型证候分布特点的初步研究

目的:根据多囊卵巢综合征患者的临床症状,探讨其证型、证候分布特点。方法:对118例患者的临床症状进行统计分类,观察PCOS患者证型、证候分布特点。结果:证型分布研究结果显示,肝郁化火型,占47.46%,痰湿型占21.19%,肾虚型占11.02%,血瘀型占8.47%,其他兼证占11.86%。证候分布研究结果显示,月经稀发者占83.05%;闭经者占11.02%;月经先期和紊乱者占5.93%;不孕者占29.66%。结论:肝火型及痰湿型是PCOS的主要证型,月经稀发和闭经是PCOS月经异常的最常见表现形式。     

补肾化痰方联合地屈孕酮治疗肾虚痰湿证多囊卵巢综合征临床观察

目的 :观察补肾化痰方联合地屈孕酮治疗肾虚痰湿证多囊卵巢综合征(PCOS)的临床疗效。方法 :纳入肾虚痰湿证PCOS患者58例,采用补肾化痰方治疗,每个月经周期的第22天加服地屈孕酮片,每日10 mg,连服7 d。评价患者治疗前后血压、体质量指数、腰围、臀围、腰臀比,激素水平(促黄体生成素/促卵泡生成素、泌乳素、雌二醇、总睾酮、性激素结合球蛋白、硫酸脱氢表雄酮、雄烯二酮、游离雄激素指数),血脂水平(总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、载脂蛋白A1、载脂蛋白B、脂蛋白a),葡萄糖耐量试验、胰岛素释放试验、胰岛素抵抗指数。结果:与治疗前比较,治疗后体质量指数、腰围、臀围、游离雄激素指数、总胆固醇、空腹胰岛素水平显著下降(P0.05),性激素结合球蛋白、高密度脂蛋白胆固醇水平显著升高(P0.05),治疗后胰岛素释放试验胰岛素高峰明显提前。结论:补肾化痰方联合地屈孕酮治疗肾虚痰湿证PCOS可改善患者代谢异常情况,特别对肥胖、血脂代谢异常、性激素结合球蛋白、游离雄激素指数指标疗效显著。     

中西药物对多囊卵巢综合征生殖和代谢功能的影响

为探讨石英毓麟汤配合氯米芬对肾虚血瘀型多囊卵巢综合征 (PCOS)患者生殖与代谢功能的调节作用 ,采用放射免疫法对 35例 PCOS患者治疗前后及 15例月经周期正常的健康妇女进行血清瘦素 (leptin)、促卵泡激素 (FSH)、黄体生成素 (L H)、睾酮 (T)、胰岛素 (INS)的测定。比较治疗前后及其与对照组的血清 leptin、FSH、L H、T、INS水平的差异 ,并分析 leptin与 FSH、L H、T、INS的相关性。结果表明 :高 L H血症、高 INS血症、高 T血症及高 leptin血症是 PCOS患者四种重要的生化改变 ;石英毓麟汤配合氯米芬可以从生殖和代谢两方面 ,调节肾虚血瘀型 PCOS患者失调的内环境 ,促使其恢复生殖功能和能量代谢的平衡 ;肾虚和血瘀是 PCOS的两个重要中医病机     

多囊饮治疗多囊卵巢综合征临床研究

目的:通过对多囊卵巢综合征(PCOS)患者进行流行病学调查,为探寻该病病因提供可靠依据。应用补肾疏肝法的多囊饮治疗肾虚肝郁证患者,并评价其临床疗效。方法:①采用随机数字表法选取PCOS患者60例,同时选取因急性病、早孕、阴道炎就诊的非PCOS患者30例,填写流行病学调查表;②对PCOS组中30例肾虚肝郁证患者采用多囊饮(菟丝子、白芍、淫羊藿、柴胡等)治疗,连续治疗6个月。结果:①发现患者母亲异常月经史、家族早秃病史及发病前情绪影响为该病发病的相关因素(P<0.05);②经多囊饮治疗的30例患者中,有效率为86.7%,妊娠率为62.5%,月经改善有效率为83.3%,治疗前后差异均具有统计学意义(P<0.05)。内分泌六项指标中LH、LH/FSH、基础体温、体质量指数及卵巢多囊样形态治疗前后差异均有统计学意义(P<0.05)。结论:①患者母亲异常月经史、家族早秃病史及发病前情绪影响为该病的相关因素。②运用多囊饮治疗肾虚肝郁证PCOS患者具有较好的临床疗效。     

补肾活络方治疗多囊卵巢综合征肾虚血瘀证的临床研究

目的探讨补肾活络方治疗多囊卵巢综合征(PCOS)肾虚血瘀证的疗效与机制。方法 78例PCOS肾虚血瘀证患者随机分为治疗组40例与对照组38例,治疗组给予补肾活络方口服,对照组给予达英-35口服,共治疗3个月,疗程结束后观察疗效和性激素睾酮(T)、黄体生成素(LH)、促卵泡素(FSH)以及卵巢体积、卵泡数目等指标。结果治疗组与对照组患者有效率分别为97.5%、78.9%,治疗组疗效优于对照组(P<0.05)。2组患者T、LH、LH/FSH较治疗前相比均显著降低(P<0.05),2组患者卵巢体积均显著缩小、卵泡数目降低,治疗组各项指标均优于对照组(P<0.05)。结论补肾活络方治疗PCOS肾虚血瘀证疗效优于达英-35,该方治疗PCOS肾虚血瘀证的机制可能与降低T、LH,调整内分泌紊乱有关。     

肥胖与非肥胖型多囊卵巢综合征患者的临床特征

目的:探讨肥胖与非肥胖型多囊卵巢综合征(PCOS)患者的临床特征。方法:筛选PCOS患者50例,根据体重指数(BMI)把PCOS患者分为肥胖组26例,非肥胖组24例,对比两组患者早卵泡期或闭经状态下各项性激素、体重指数、各个时点的血糖水平以及胰岛素水平,计算胰岛素敏感指数(ISI)、胰岛素抵抗指数(IRI)。结果:PCOS患者肥胖组糖负荷后血糖水平、胰岛素水平及胰岛素抵抗指数高于非肥胖组,血清胰岛素敏感指数低于非肥胖组,血清睾酮水平高于非肥胖组,黄体生成素(LH)水平低于非肥胖组(P<0.05)。结论:PCOS患者性激素有不同改变,肥胖者以睾酮升高为主,非肥胖者以黄体生成素升高为主要变化,肥胖加重胰岛素抵抗,更容易出现糖耐量异常。     

曹玲仙教授论治多囊卵巢综合征的辨证特色及其分型与性激素的关系

目的:以名老中医曹玲仙教授辨证治疗多囊卵巢综合征(PCOS)的学术思想基础为蓝本,探讨PCOS临床中医辨证规律、证候特点及其与生殖内分泌的关系。方法:收集曹教授临床诊疗PCOS病例病史资料,详细记录症状、体征、辨证分型结果;采用Logistic回归分析法、模糊C聚类及Fisher判别分析法对PCOS中医证候进行研究,并分析各证型与性激素的关系。结果:127例确诊PCOS患者经曹教授临床辨证分型为肾虚证42例、肾虚痰阻证47例和肾虚肝郁证38例。采用Logistic回归分析法对PCOS中医证候进行二次分型,即先将肾虚证分离出来,再对剩余的兼夹证进行第二次分型,正确率分别为90.5%和92.9%;模糊C聚类算法对PCOS兼夹证分型的总正确率为90.6%,Fisher判别分析法对PCOS兼夹证分型的总正确率为87.1%。各证型组性激素比较,肾虚肝郁证的血清泌乳素(PRL)显著高于肾虚证。结论:临床辨治PCOS的中医证候以兼夹证多见,肾虚、痰湿、肝郁为基本证候;肝郁和PRL升高有一定关联性。     

多囊卵巢综合征中医分类与性激素及胰岛素水平相关性研究

目的找出多囊卵巢综合征（PCOS）患者中医证类与性激素及胰岛素的相关性。方法将100例多囊卵巢综合征患者利用中医四诊分类,观察治疗前后卵泡早期血清胰岛素及性激素水平,测定血清促黄体生成素（LH）、促卵泡生成素（FSH）、泌乳素（PRL）、雌二醇（E2）、孕酮（P）、睾酮（T）、硫酸脱氢表雄酮（DHEAS）以及雄烯二酮（A）。结果将就诊的100例PCOS患者中,脾虚痰湿证47.73%,肾虚肝郁证31.82%,肾虚血瘀证11.36%,痰瘀互结证9.09%。LH、FSH水平、LH/FSH比值以及E2、P水平各证组间比较,差异无统计学意义;肾虚血瘀组T水平与脾虚痰湿组比较,差异有统计学意义（P〈0.05）;肾虚肝郁组与其他证型相比,PRL水平显著升高（P〈0.05）;脾虚痰湿组胰岛素、HOMA-IR水平较肾虚肝郁组显著增高（P〈0.05）。结论PCOS肾阴虚与T水平升高有相关性;痰湿阻滞与PCOS胰岛素抵抗有一定的相关性。     

滋肾养精法对肾虚证多囊卵巢综合征腹腔镜术后患者瘦素及性激素含量的影响

目的观察滋肾养精法对肾虚证多囊卵巢综合征(PCOS)腹腔镜术后患者瘦素及性激素含量的影响。方法将60例肾虚证PCOS患者随机分为治疗组和对照组,各30例,对照组给予腹腔镜手术治疗,治疗组在对照组治疗方法的基础上加用滋肾养精中药治疗,1个疗程后检测2组患者的瘦素、促黄体生成素(LH)、促卵泡生成素(FSH)、睾酮(T)、催乳素(PRL)、雌二醇(E2)、孕酮(P)水平的变化,并分析其相关性。结果治疗组瘦素、LH/FSH、T水平均较对照组显著降低(P0.05),P水平显著升高(P0.05);治疗组PRL,E2与对照组比较差异无统计意义(P0.05)。结论在肾虚证PCOS患者腹腔镜术后运用滋肾养精中药,对改善血清性激素水平和生殖健康具有一定的作用;瘦素可能是PCOS治疗中一种新的检测指标。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.