C-反应蛋白及纤维蛋白原对急性冠状动脉综合征的影响

目的通过观察C-反应蛋白及纤维蛋白原的水平变化，探讨炎症标记物在急性冠状动脉综合征中的关系及临床意义。方法ACS组122例，其中急性心肌梗死亚组46例，不稳定性心绞痛亚组76例，选择稳定性心绞痛66例作对照组。分别采用速率散射比浊法及热沉淀比浊法测定血清CRP及FIB。结果ACS组CRP高于SAP组[（18．82±17．32）mg／Lvs（1．96±0．88）mg／L，P〈0．05]，AMI亚组明显高于UAP亚组与SAP组[（28．74±23．19）mg／Lvs（11．03±10．17）mg／L、（1．96±0．88）mg／L，P〈0．011，UAP亚组高于SAP组[（11．03±10．17）mg／Lvs（1．96±0．88）mg／L，P〈0．05]。ACS组FIB高于SAP组[（3．55±1．33）g／Lvs（2．46±2．77）g／L，P〈0．051，AMI亚组明显高于UAP亚组与SAP组[（3．98±1．46）g／Lvs（3．23±1．02）g／L、（2．46±2．77）g／L，P〈0．011，UAP亚组高于SAP组[（3．23±1．02）g／Lvs（2．46±2．77）g／L，P〈0．05]。结论炎症参与了ACS患者的发病过程，冠心病患者血清CRP和FIB水平增高可作为ACS的危险信号，同时也可以作为CHD患者危险分层的重要生化监测指标。     

炎症和纤溶异常在急性冠脉综合征中的意义

目的探讨炎症反应和纤溶系统异常在急性冠脉综合征(ACS)中的意义。方法选自住院病人217例。分为急性心肌梗死(AMI)组、无ST段抬高性心肌梗死(NSTEMI)组、不稳定性心绞痛(UA)组、稳定性心绞痛(SA)组和正常对照组(CO)。分别测定各组C反应蛋白(CRP)和纤维蛋白原(Fg),并进行比较。结果AMI(17.62±8.43)mg/L和(4.35±1.08)g/L、NSTEMI(16.53±7.89)mg/L和(3.92±0.96)g/L、UA(12.87±5.76)mg/L和(3.85±0.93)g/L和SA(7.94±3.76)mg/L和(3.51±0.89)g/L组CRP和Fg浓度明显高于CO组,AMI组明显高于UA和SA组,UA组明显高于SA组。结论炎症反应和纤溶系统异常在ACS的发生中起重要作用,CRP和Fg水平可作为ACS严重程度的判断指标之一。     

C-反应蛋白与纤维蛋白原联合检测对心绞痛患者心血管病事件发生的预测价值

目的:探讨血C-反应蛋白(CRP)与纤维蛋白原(FIB)联合检测对心绞痛患者心血管病事件发生的预测价值。方法:临床纳入冠心病(CHD)患者100例,根据患者心绞痛的发病类型分为稳定型心绞痛(SAP)组(50例)以及不稳定型心绞痛(UAP)组(50例),同时纳入50例健康体检者作为对照组。分别检测各组患者血液中CRP以及FIB水平。患者出院后对其进行为期3个月的临床随访,观察3个月内SAP与UAP组患者心血管事件的发生情况。结果:SAP组CRP与FIB水平分别为(3.10±0.53)mg/L、(3.45±0.37)g/L,UAP组CRP与FIB水平分别为(5.63±0.76)mg/L、(4.30±0.43)g/L,对照组CRP与FIB水平分别为(2.55±0.35)mg/L、(2.63±0.20)g/L。SAP组与UAP组CRP、FIB水平均明显高于对照组(P<0.05),UAP组CRP、FIB水平均明显高于SAP组(P<0.05);UAP组3个月内心血管事件发生率为81.08%,SAP组3个月内心血管事件发生率为21.21%,差异有显著性(P<0.05);联合检测发现CRP与FIB水平均升高的患者,3个月内心血管事件的发生率显著高于CRP与FIB均正常者(P<0.05)。结论:CRP与FIB水平与CHD心绞痛患者的严重程度有着密切的关系,而进行CRP与FIB联合检查,能够预测心血管病事件的发生。     

冠心病患者血浆血栓前体蛋白及D-二聚体的检测

目的 :了解血栓前体蛋白 (TpP)及D 二聚体 (D Dimer)的检测在冠心病中的临床应用价值。方法 :6 5例冠心病患者分为急性心肌梗死 (acutemyocardialinfarction ,AMI) 2 2例 ,不稳定型心绞痛 (unstableanginapectoris,UAP) 2 7例和稳定型心绞痛 (stableanginapectoris,SAP) 16例三组 ,采用酶联免疫吸附法 (ELISA)检测各组血浆中的TpP及D Dimer含量。结果 :TpP :AMI组为 (9 4± 3 3)mg/L ,UAP组为 (3 4± 1 9)mg/L ,SAP组为 (2 8± 1 5 )mg/L。AMI组明显高于UAP组 (P <0 0 1) ,UAP组高于SAP组 (P >0 0 5 ) ;D Dimer:AMI为 (1 2 7± 0 5 4 )mg/L ,UAP组为 (0 94± 0 4 1)mg/L ,SAP组为 (0 4 3± 0 2 5 )mg/L ,AMI组高于UAP组 ,UAP组高于SAP组 ,差别均有显著意义 (P <0 0 1)。结论 :TpP和D Dimer的联合检测对急性心肌梗死具有早期诊断和鉴别诊断价值。     

冠心病患者血中C-反应蛋白、纤维蛋白原和白细胞的临床意义

目的　探讨C -反应蛋白 (CRP)、纤维蛋白原 (FIB)及白细胞 (WBC)总数与冠心病 (CHD)的关系。方法　测定 4 0例CHD患者和 18例可疑冠心病 (KP)患者的CRP、FIB含量和WBC总数。CHD组患者又分为 3组 ,稳定型心绞痛 (SAP) 16例 ,不稳定型心绞痛 (UAP)级 12例 ,急性心肌梗死 (AMI)组 12例。比较CHD和KP组AMI、UAP、SAP与KP组之间各项指标的差异。结果　CHD的CRP、FIB和WBC水平明显高于KP组 (P <0 .0 5 ;AMI、UAP组的CRP、FIB和WBC水平明显高于KP组 (P <0 .0 1;P <0 .0 5 ) ;但SAP和KP之间的CRP、FIB和WBC水平相比无显著性差异 (P >0 .0 5 )。结论　CRP、FIB和WBC水平的增高与CHD的发生有关 ,它们可作为评价冠状动脉病变严重程度的一个参考指标     

急性冠脉综合征患者脂蛋白(a)水平与其近期预后的相关性研究

目的探讨脂蛋白(a)〔LP(a)〕水平与急性冠脉综合征(ACS)患者近期预后的相关性。方法选取228例ACS患者,分为急性心肌梗死(AMI)亚组107例和不稳定型心绞痛(UAP)亚组121例;选取同期住院的92例稳定型心绞痛(SAP)患者为SAP组。比较各组LP(a)水平、血脂水平及主要心脏不良事件(MACE)发生率,分析LP(a)水平与ACS患者近期预后的相关性。结果 (1)AMI亚组、UAP亚组、SAP组的LP(a)水平分别为(365.5±74.8)mg/L、(348.6±69.4)mg/L、(279.0±38.8)mg/L,三组间的LP(a)水平比较,差异有统计学意义(F=49.760,P<0.05)。(2)AMI亚组、UAP亚组、SAP组的MACE发生率分别为39.25%、41.32%、7.61%,三组间的MACE发生率比较,差异有统计学意义(χ2=33.004,P<0.05)。(3)LP(a)水平≥300 mg/L组的多支病变率和MACE发生率(分别为88.32%、43.65%)高于LP(a)水平<300 mg/L组(分别为35.48%、19.35%),差异均有统计学意义(P<0.05)。结论 ACS患者存在血脂代谢紊乱,LP(a)水平较SAP患者明显升高;LP(a)水平可能与冠脉病变程度和ACS患者的近期预后相关。     

急性冠脉综合征患者发病前感染发生情况调查

目的　观察冠心病患者急性发病前感染发生情况及急性冠脉综合征 (ACS)患者C反应蛋白(CRP)水平。方法　 2 0 0 1年 10月～ 2 0 0 2年 4月 ,采用病例对照研究的方法 ,共调查上海市 16所二、三级医院心内科住院的稳定型心绞痛 (SAP)、不稳定型心绞痛 (UAP)及急性心肌梗死 (AMI)患者 184 7例 ;将UAP和AMI患者合并为ACS组 (114 3例 ) ,SAP患者作为对照 (SAP组 ,6 4 4例 )。结果　ACS组急性发病前感染发生率(4 2 .4 3% )显著高于SAP组 (2 7.33% ,P <0 .0 1) ;发病前病因谱主要是上呼吸道感染和肺炎 ,大部分ACS患者的感染均发生在急性发病前 2周内 (78.76 % ) ,而SAP患者的感染时间无特殊分布 ;ACS组CRP增高患者的比例(6 1.0 6 % )高于SAP组 (4 2 .35 % ,P =0 .0 0 1) ,ACS组CRP增高者中 5 8.75 %有发病前感染史 ,而CRP正常者中仅 4 0 .98% (P <0 .0 5 )。结论　ACS患者的急性起病与发病前急性感染可能存在相关性 ,而CRP作为炎症标志对ACS的发生有预测价值。     

可溶性黏附分子在冠状动脉粥样硬化不同临床表现中的水平

可溶性黏附分子在冠状动脉粥样硬化的形成发展中起着重要作用。本研究测定不同临床表现的冠状动脉粥样硬化患者可溶性血管细胞黏附分子(VCAM-1)、细胞间黏附分子(ICAM-1)、E-选择素及P-选择素的水平,并与冠脉造影正常者进行了比较。分别采集43例急性心肌梗死(AMI)患者、45例不稳定性心绞痛(UAP)患者、34例稳定性心绞痛(SAP)患者及29例冠脉造影正常者(对照组)的静脉血标本。AMI组VCAM-1水平(799.8±26.3μg/L)显著高于UAP组(644.2±26.7μg/L)、SAP组(526±32.5μg/L)及对照组(270±26.8μg/L)。与SAP组及对照组相比,UAP组…     

凝血因子检测对肝脏疾病的临床应用

[目的 ]探讨肝脏疾病对凝血机制和纤溶活化功能的影响 ,分析其与肝脏损害程度的关系。[方法 ]采用ACL - 2 0 0型美国库尔特全自动血凝仪分别检测肝炎 33例 ;肝硬化 4 0例 ;肝癌 2 8例 ;正常人 4 0例 ,血凝血酶原时间 (PT)、活化部分凝血活酶时间 (APTT)和纤维蛋白原 (FIB ) ;采用胶体金方法测定血浆D -二聚体。[结果 ]肝炎组的PT(1 3.6± 1 .0 6 )s ,APTT (32 .4± 4 .5 7)s ,FIB(2 .5 7± 0 .4 6 )g/L ,D -二聚体 (0 .89± 0 .2 2 )mg/L ;肝硬化组PT (1 7.7± 5 .6 0 )s ,APTT(4 3.4± 1 3.3)s,FIB (2 .1 0± 0 .88)g/L ,D -二聚体 (2 .4 6± 0 .6 1 )mg/L ;肝癌组PT(1 5 .0 5± 2 .74 )s,APTT (36 .8± 5 .5 5 )s ,FIB(3.5 0± 1 .1 6 )g/L ,D -二聚体 (2 .31± 0 .8)mg/L ;它们与正常组PT(1 3.0 2± 0 .6 2 )s ;(APTT32 .0± 2 .0 )s;FIB (2 .81± 0 .78)g/L ;D -二聚体 (0 .4 5± 0 .1 1 )mg/L比较有不同程度的差异。 [结论 ]不同病程肝脏疾病患者PT、APTT、FIB、D -二聚体均可异常 ,其中肝硬化患者的各项指标变化最为显著。     

急性心肌梗死血清C反应蛋白检测临床意义探讨

目的:探讨急性心肌梗死(AMI)患者C反应蛋白(CRP)水平变化及临床意义。方法:测定69例AMI患者和73例稳定型心绞痛(SAP)患者的CRP水平,并随访和监测AMI患者住院期间及3个月的主要不良心脏事件(MACE)。结果:AMI组CRP水平为(33.5±10.6)mg/L,明显高于对照组(14.8±2.3)mg/L(P<0.01);AMI患者住院期间MACE发生率13.0%,3个月总MACE发生率24.6%;发生MACE患者CRP水平(42.67±11.5)mg/L,明显高于无MACE者的(22.47±6.63)mg/L(P<0.01)。结论:CRP升高是AMI患者预后不良的危险因素之一,检测CRP水平对AMI患者的近期预后有一定的判断价值。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.