阿托伐他汀对高脂大鼠血小板功能的干预研究

目的：分析高脂血症大鼠血小板功能的变化,探讨阿托伐他汀对高脂血症大鼠血小板功能的影响。方法：34只Wistar大鼠随机分为正常对照组、高脂血症模型组和阿托伐他汀（10mg/kg）干预组,4周后检测3组大鼠的血脂：胆固醇（CHO）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）的水平。应用流式细胞术检测血小板表面α-颗粒膜蛋白（CD62P）的表达、酶联免疫法测定血浆中α颗粒膜蛋白-140（GMP-140）浓度。结果：与正常对照组相比,高脂血症组CHO、LDL水平显著升高、HDL/CHO明显降低,CD62P及GMP140水平明显升高。阿托伐他汀干预组在降低CHO、LDL水平的同时,显著降低了GMP140及CD62P水平。结论：高脂血症能够促使血小板活化,阿托伐他汀在调脂治疗的同时,抑制了血小板的活化。     

高脂血症大鼠血小板活化功能分析

目的分析高脂血症大鼠血小板功能的变化。方法24只Wistar大鼠随机分为正常对照组、高脂血症模型组，4周后检测两组大鼠的血脂：总胆固醇（CHO）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）水平。应用流式细胞术检测血小板表面a-颗粒膜糖蛋白（CD62P）的表达、酶联免疫法测定血浆中α颗粒膜蛋白．140（GMP140）浓度。所有数据采用Excel软件建库，SPSS11．5统计软件进行分析。结果正常对照组与高脂血症组CHO、TG、LDL-C、HDL-C，CHO分别是1．846mmol／L VS 13．779mmol／L、0．999mmol／L vs 0．746mmol／L、0．164mmol／L vs 10．680mmol／L、0．583mmol／L vs 0．195mmol／L。CD62P、GMP140水平分别为10．089％ vs 25．169％、10．665ng/mL vs 27．045．g／mL。结论高脂血症能够促使血小板活化。     

阿托伐他汀对高脂血症患者血小板CD62p的影响

目的 :探讨阿托伐他汀对高脂血症患者血小板活化功能的影响。方法 :测定 3 0例高胆固醇血症和混合性高脂血症患者 (治疗组 )降脂治疗前和治疗 (阿托伐他汀 2 0mg/d) 4周、8周后及 3 0例健康者 (对照组 )的总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇及血小板表面激活标记物CD62p。结果 :治疗组患者CD62p较对照组明显增高 (P <0 .0 1) ,阿托伐他汀治疗 4周、8周后CD62p较治疗前明显下降 (P<0 .0 1)。结论 :阿托伐他汀治疗高胆固醇血症患者 ,在降脂的同时 ,可抑制血小板活性     

瑞舒伐他汀与阿托伐他汀对不稳定型心绞痛患者内皮功能和GMP140的影响

目的 观察瑞舒伐他汀与阿托伐他汀治疗对不稳定型心绞痛患者内皮功能和血小板活化的影响.方法 入选不稳定型心绞痛患者67例,分为瑞舒伐他汀组(34例)和阿托伐他汀组(33例).两组患者均常规使用抗心肌缺血和抗凝、抗血小板药物治疗,瑞舒伐他汀组加用瑞舒伐他汀钙10 mg/晚;阿托伐他汀组加用阿托伐他汀20 mg/晚,均连续服用1个月.另入选健康成人30例作为对照组.用酶联免疫吸附法(ELISA)检测治疗前后血清GMP140和采用超声检测肱动脉血流介导的内皮舒张功能(FMD)的变化.结果 与对照组相比,两组不稳定型心绞痛患者血清中GMP140水平均显著增高,FMD明显降低(P＜0.01).经治疗1个月后,两组不稳定型心绞痛患者低密度脂蛋白和GMP140显著下降,FMD明显改善.同阿托伐他汀组患者相比,瑞舒伐他汀组GMP140降低更明显[(7.73±4.62)vs(5.62±3.26) pg/mL,P ＜0.05].结论 瑞舒伐他汀和阿托伐他汀均可降低不稳定型心绞痛患者血小板的活化,改善肱动脉内皮功能,但瑞舒伐他汀降低血小板活化更显著.     

阿托伐他汀对改善陈旧心肌梗死患者血管内皮功能的研究

目的研究阿托伐他汀对陈旧性心肌梗死(OMI)患者血管内皮的作用。方法将60例OMI患者随机分为安慰剂(C)组和阿托伐他汀(P)组,分别测定血总胆固醇(TC)、三酰甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血管内皮素(ET)及一氧化氮(NO)浓度的变化,比较血小板表面α颗粒膜蛋白(GMP-140)的表达及内皮依赖性扩张百分率(FMD%),和非内皮依赖性百分率(GTN%)。结果P组阿托伐他汀治疗6周后,TC含量较治疗前下降29%,LDH-C下降35%,HDL-C升高3%,但甘油三酯(TG)水平无明显变化,内皮功能得到了明显的改善,GMP-140表达受到抑制,而这种表达抑制与血胆固醇水平的改变无关。结论阿托伐他汀可以通过调脂及抑制血小板的活性参与血管内皮功能的改善,老年急性心肌梗死(AMI)患者服用阿托伐他汀可能通过改善内皮功能达而到降低心脑血管事件发生率的目的。     

阿托伐他汀联合非诺贝特治疗混合性高脂血症大鼠的疗效及其安全性

目的 探讨阿托伐他汀与非诺贝特联合应用治疗混合性高脂血症大鼠的疗效及安全性.方法 将大鼠随机分为N组(正常对照组)、C组(高脂对照组)、A组[阿托伐他汀1.8 mg/(kg·d)]、AFF组[阿托伐他汀0.9 mg/(kg·d)+非诺贝特18 mg/(kg·d),早晚分开灌胃]、AFHX组[阿托伐他汀0.9 mg/(kg·d)+非诺贝特9 mg/(kg·d)]及AFHD组[阿托伐他汀0.9 mg/(kg·d)+非诺贝特18 mg/(kg·d)],造模4周,用药4周.分别检测血脂、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、肌酸激酶(CK)及肝脏病理学检查.结果 ①各用药组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)及脂蛋白(a)均降低(P＜0.01),而联合用药组更加有效的升高高密度脂蛋白胆固醇(HDL-C)水平(P＜0.01)和降低TG水平(P＜0.01);②各用药组CK水平升高(P＜0.05),但以AFHD组升高的最为显著;③各用药组ALT和AST的水平均升高(P＜0.01),以AFHD组较为显著,AFHX组次之(P＜0.05),但仍较C组降低(P＜0.05);④AFHD组和AFF组可以更加有效的控制肝指数、肝脏脂肪变性和炎症活动度评分(P＜0.05).结论 阿托伐他汀与非诺贝特联合可增强全面调脂疗效、控制肝脏脂肪变性和非酒精性脂肪性肝炎的发生;二者联合应用时采用合适剂量,并早晚分开给药,可以减少药物性肝损害和骨骼肌损害的发生.     

阿托伐他汀对高脂蛋白血症患者血小板活性因子的影响

目的 探讨阿托伐他汀对高脂蛋白血症患者血小板活性CD63、CD62P表达和动脉粥样硬化的影响及机制. 方法 测定60例高脂蛋白血症在常规治疗基础上,服用阿托伐他汀20 mg,治疗12周前后血小板活性CD63、CD62P水平的变化. 结果 60例患者经阿托伐他汀治疗12周后血小板CD63、CD62P测定值显著低于治疗前水平(P＜0.05). 结论 阿托伐他汀通过抗血小板活化、抗炎等机制对防治动脉粥样硬化及稳定斑块起着重要的作用.     

阿托伐他汀 瑞舒伐他汀治疗冠心病伴高脂血症临床疗效分析

目的比较阿托伐他汀、瑞舒伐他汀在治疗冠心病伴高脂血症方面的临床疗效。方法选择2009年8月—2010年10月在我院心内科住院的150例冠心病伴高脂血症患者,随机分为观察组(瑞舒伐他汀组)和对照组(阿托伐他汀组)2组,比较2组患者治疗前后总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TC)的变化。结果观察组患者TC、TG、LDL-C下降幅度比对照组更大,观察组HDL-C升高幅度较对照组大,2组比较差异显著(P<0.01)。结论阿托伐他汀、瑞舒伐他汀治疗冠心病伴高脂血症,同等剂量下,瑞舒伐他汀的调脂作用比阿托伐他汀更明显。     

阿托伐他汀改善高LDL-C相关血小板活化异常的临床研究

 目的  探讨口服阿托伐他汀对高LDL-C血症相关的血小板异常活化功能的改善作用,阐明他汀类药物降低临床事件的新机制。方法  从2012年11月至2013年7月于华山医院门诊就诊人群中,纳入LDL-C≥4.14 mmol/L同时三酰甘油(triglycerides,TG) <1.7 mmol/L且未经调脂治疗和抗血小板治疗者作为研究对象,作为阿托伐他汀治疗组(AT组),从体检中心招募健康志愿者作为对照组。测定血小板最大聚集率(maximal platelet aggregation,MPAG),全血流式细胞检测法测定血小板活化标志物CD62p (P-选择素)和PAC-1 (GpⅡbⅢa)水平。对患者予以标准他汀治疗(阿托伐他汀20 mg/天),并于治疗后1个月、2个月随访检测以上指标。结果  AT组共纳入40例,其中33例完成研究;对照组纳入并完成35例。两组人群基线资料(年龄、性别、BMI、吸烟史、血压、冠心病家族史、血糖)无明显差异;AT组患者服用阿托伐他汀治疗后,TC、TG、LDL-C均明显下降(P<0.05);基线时AT组血小板最大聚集率与对照组相似(33.03%±15.87% vs.29.05%±17.75%,P=0.102),采用他汀治疗2个月后,AT组患者血小板最大聚集率较基线显著下降但差异无统计学意义(P=0.073)。治疗前AT组CD62p和PAC-1均高于对照组(1.72±0.96 vs.0.90±0.77,P<0.001;4.33±2.42 vs.2.63±2.03,P<0.01);阿托伐他汀治疗2个月后,CD62p和PAC-1分别为0.85±0.72和1.50±1.07,与治疗前比较,两者表达均明显下降(P<0.05)。结论  临床上阿托伐他汀可以改善高LDL-C相关的血小板活化。     

瑞舒伐他汀与阿托伐他汀对不稳定型心绞痛患者CRP、GMP140和内皮功能影响

目的：观察瑞舒伐他汀与阿托伐他汀治疗对不稳定型心绞痛患者C反应蛋白（CRP）、颗粒膜蛋白-140（GMP140）和内皮功能的影响。方法：选择不稳定型心绞痛患者66例,随机分为治疗1组和治疗2组,每组33例。另选择同期健康查体者25例作为对照组。调查所有受试者的一般资料包括年龄、性别以及对照组和治疗组治疗前后CRP、GMP140、肱动脉舒张功能（FDM）。结果：治疗1、2组治疗后总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）降低,高密度脂蛋白胆固醇（HDL-C）升高,差异有统计学意义（P〈0.05）;治疗1组治疗后TC、LDL-C较治疗2组降低,差异有统计学意义（P〈0.05）;治疗1、2组治疗前CRP、GMP140高于对照组,FDM低于对照组,差异有统计学意义（P〈0.05）;治疗1、2组治疗后CRP、GMP140降低,FDM升高,差异均有统计学意义（P〈0.05）;治疗1组治疗后GMP140较治疗2组降低,差异有统计学意义（P〈0.05）。结论：瑞舒伐他汀与阿托伐他汀均能降低不稳定型心绞痛患者炎症反应、血小板聚积,改善患者血脂状况和内皮功能,且瑞舒伐他汀降低血小板聚积作用更明显。     

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.