踝臂指数评价脂代谢异常患者下肢外周动脉病多因素临床研究

目的:通过测量踝臂指数(ABI)评价我国脂代谢异常患者下肢外周动脉病(PAD)的患病情况.方法:多家研究中心住院的4548例脂代谢异常患者进行踝臂指数测定并收集流行病学资料,对PAD进行多因素临床研究.结果:在4548例脂代谢患者中PAD患病率25.79%,年龄、吸烟、肥胖、CAD、糖尿病和高血压等危险因素与脂代谢异常患者PAD患病率有关.不同类型血脂代谢异常患者PAD患病率差别有统计学意义(P《0.05).结论:PAD在脂代谢患者中常见,有其他危险因素的患者患病率有明显增加.ABI可应用于高危人群的筛查和监测.     

高血压患者踝臂指数的临床研究

目的 探讨门诊高血压患者群中下肢外周动脉疾病(peripheral artery disease,PAD) 的发病情况.方法 对238例门诊高血压患者进行踝臂指数(ankle-brachial index,ABI))测定,ABI≤0.9表明合并有PAD.结果 在238例高血压患者中PAD患病率为23.53%,年龄、吸烟、肥胖、冠心病、糖尿病等危险因素与高血压患者PAD患病率有关.结论 高血压患者有较高的PAD发生率,ABI的测定有利于高血压合并PAD的高危患者的早期诊断与识别.     

糖尿病患者下肢动脉病变危险因素分析

目的 通过踝肱指数(ABI)检查,探讨糖尿病患者下肢外周动脉病变(PAD)的患病率,并分析影响ABI的危险因素.方法 对长寿区人民医院2007年6月至2008年12月住院糖尿病患者112例,使用多普勒血管超声仪检测ABI,同时检测血脂、HbA1C等;通过回归分析探讨影响ABI的危险因素.结果 112例糖尿病患者中,ABI降低组(ABI<0.9)13例(11.6%);ABI升高组(ABI≥1.3)6例(5.3%);ABI正常组(0.9≤ ABI< 1.3)91例(83.1%).与ABI正常者相比,ABI降低组患者年龄更大,病程更长,收缩压、TC、LDL-C更高;多因素Logistic逐步回归分析显示,年龄是导致ABI降低的独立危险因素,而病程和LDL-C是导致ABI升高的危险因素.结论 通过ABI检测发现,大约11.6%的糖尿病患者存在PAD;合并糖尿病PAD的患者血压、血脂代谢紊乱更为明显.因此,对门诊和住院糖尿病患者,应常规进行ABI检测以早期发现糖尿病PAD;严格控制血压、血脂对于预防糖尿病PAD至关重要.     

2型糖尿病患者外周血管病变的相关因素分析

目的:分析糖尿病患者外周血管病变(PAD)的相关危险因素,评价踝肱指数(ABI)的临床应用价值。方法:检测215例2型糖尿病患者的ABI,ABI<0.9为PAD,ABI≥0.9为正常。结果:PAD组与正常组比较,年龄、病程、糖化血红蛋白、尿蛋白及收缩压的差异有统计学意义;ABI与年龄、病程、收缩压、尿蛋白呈负相关(分别为r=-0.471,P=0.000;r=-0.302,P=0.000;r=-0.244,P=0.003;r=-0.219,P=0.001)。年龄、尿蛋白是ABI的独立影响因素(P均<0.01)。结论:高龄、病程、高血压、蛋白尿是ABI下降的危险因素,年龄及蛋白尿为ABI独立影响因素。通过ABI筛查,可早发现、早诊断、早治疗PAD。     

老年患者肾小球滤过率和微量蛋白尿与外周动脉疾病的关系

目的探讨老年患者肾小球滤过率(estimated glomerular filtration rate,eGFR)和微量蛋白尿(microalbuminuria,MA)与外周动脉疾病(peripheral arterial disease,PAD)之间的关系。方法对328例住院老年患者测定踝臂指数(ankle brachial index,ABI)、尿白蛋白/肌酐比值(urinary albumin/creatinine ratio,UACR)、肌酐(creatinine,Cr)、血脂、空腹血糖(fasting plasma glucose,FPG)和糖化血红蛋白(glycosylated hemoglobin,HbAlc)等指标,并收集心血管危险因素和心脑血管疾病史。UACR≥30 mg.g-1定义为MA,根据中国简化MDRD公式计算eGFR,eGFR<60 mL.min-1.1.73 m-2为eGFR降低,ABI<0.9定义为PAD。结果 328例老年患者中,PAD患病率为21.0%,24.4%的患者UACR增高,25.9%的患者eGFR降低。与非PAD患者比较,PAD患者年龄偏大,收缩压(systolic blood pressure,SBP)、糖化血红蛋白(HbAlc)和UACR增高(P<0.05或<0.01)。相关分析显示UACR与ABI值呈负相关(r=-0.323,P=0.000),eGFR与ABI值呈正相关(r=0.185,P=0.001)。Logistic回归分析显示,与非MA患者比较,MA与PAD有关,危险比〔OR(95%CI)〕为3.613(2.035～6.415)(P=0.000),调整年龄、性别和传统心血管危险因素后,MA仍与PAD有关,OR(95%CI)为3.033(1.601～5.748)(P=0.001),eGFR降低对PAD无影响。结论老年人PAD患病率较高,MA患者发生PAD的风险增加。     

踝臂指数评价高危患者外周动脉疾病的价值

目的观察高危患者合并外周动脉疾病（PAD）的发病情况,探讨踝臂指数在临床上的应用价值。方法选取393例高危患者,收集相关临床资料并检测相关生化指标,采用科林动脉硬化检测仪测量受试者的ABI值,应用SPSS13.0统计软件进行数据分析和处理。结果高危患者中合并PAD者为121例,总的患病率为30.8%,女性PAD的患病率明显高于男性（39.8%∶18.6%,P〈0.01）。PAD组年龄、总胆固醇、2型糖尿病显著高于非PAD组（P〈0.05或P〈0.01）,多因素Logistic回归分析显示,性别、年龄、2型糖尿病是高危患者伴PAD的危险因素。结论踝臂指数是筛查高危患者伴PAD的简单易行又可靠的指标,性别、年龄、2型糖尿病是高危患者踝臂指数降低的危险因素。     

踝肱指数在老年2型糖尿病外周动脉疾病中的临床应用价值

目的:评价踝肱指数(ABI)在老年2型糖尿病(T2DM)伴外周动脉疾病(PAD)中的临床应用价值。方法:454例老年T2DM患者按ABI分为PAD组(ABI<0.9)81例,非PAD组(0.9≤ABI≤1.3)373例,比较2组的临床特征,并分析ABI的相关影响因素。结果:与非PAD组相比,PAD组年龄、尿酸(UA)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、尿微量白蛋白(U-Alb)均升高,而高密度脂蛋白胆固醇(HDL-C)、ABI均降低(P<0.05～P<0.01)。老年T2DM患者的ABI与年龄、病程、UA、TC、LDL-C、U-Alb均呈负相关关系(P<0.05～P<0.01),与HDL-C呈正相关关系(P<0.05);多元线性逐步回归分析显示,年龄、TC、LDL-C、U-Alb是ABI的影响因素。结论:ABI是筛查老年T2DM伴PAD简单、易行、无创且可靠的指标,年龄、TC、LDL-C、U-Alb是ABI降低的主要危险因素。     

慢性肾炎患者周围动脉病的危险因素研究

目的 应用踝-臂指数(ABI)测量,观察慢性肾炎(CGN)患者下肢外周动脉疾病(PAD)的发生情况,并对其危险因素进行分析.方法 对147例CGN患者测量ABI,ABI≤0.9诊断PAD;根据ABI结果把患者分为PAD组与非PAD组,两组患者均行心电图、血生化、24 h尿蛋白定量和血常规检查.结果 147例CGN患者中有25例发生PAD,发生率为17.0%.PAD组与非PAD组患者的心肌缺血、心肌梗死史、脑卒中病史及间歇性跛行的发生率间差异均有统计学意义(P＜0.01).两组患者在年龄、体质指数、血红蛋白、血浆清蛋白、血总胆固醇、高密度脂蛋白、低密度脂蛋白、血尿酸、血钙、血磷方面差异无统计学意义(P＞0.05);而在收缩压、舒张压、三酰甘油、血糖、血尿素氮、血肌酐、24 h尿蛋白定量方面差异有统计学意义 (P＜0.05).多元逐步回归分析表明,ABI的独立正相关因素是收缩压(B=0.045,P＜0.05)、血肌酐(B=0.063,P＜0.05)和24 h尿蛋白定量(B=0.481,P＜0.05).结论 CGN患者易发生PAD,有PAD的CGN患者心血脑管病变的发生率增高; ABI测量诊断PAD能间接反映CGN患者心脑血管疾病发生的危险性.     

血尿酸与2型糖尿病下肢血管病变相关性分析

目的:探讨血尿酸(Uracid,UA)与2型糖尿病(T2DM)下肢血管病变的相关性。方法:T2DM患者202例,根据踝肱比(ABI)进行分组:ABI≤0.9为外周动脉疾病(PAD)组,ABI>0.9为对照组,对患者年龄、性别、血压、病程、UA、肌酐(Cr)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、胆固醇(TC)、低密度脂蛋白(LDL-C)及高密度脂蛋白(HDL-C)等多重动脉粥样硬化危险因素进行多变量分析。结果:Logistic回归分析表明,T2DM患者合并PAD组血清UA水平升高,其与年龄、血压、TC、LDL-C是T2DM合并PAD的危险因素。UA等影响因素的多元逐步回归分析结果显示,UA与血Cr、PAD、TG具有相关性。结论:T2DM患者合并PAD时血清UA水平升高,因此应重视对血尿酸的干预。     

踝臂指数与老年冠心病患者发生心血管事件的相关性

目的:探讨踩臂指数与老年冠心病患者发生心血管事件的相关性。方法:483例(年龄≥60岁)经冠脉造影诊断的冠心病患者,分为PAD组(ABI≤0.9,n=144)和非PAD组(ABI>0.9,n=339),随访1年。结果:PAD组共发生心血管事件(心血管死亡、非致死性心肌梗死、不稳定心绞痛住院、冠状动脉血运重建)49例(34.0%),高于PAD组的59例(17.4%);(P=0.001)。预测心血管事件的独立危险因素为:ABI(OR=2.45),糖尿病(OR=2.01),年龄(OR=1.74),陈旧心肌梗死(OR=1.65)。结论:ABI是预测老年冠心病患者发生心血管事件的独立危险因素。     

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.     

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…     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.