Clinical study of the changes in homeostasis during the course of acute poisoning in patients treated with hemoperfusion北大核心CSCD

Objective To observe the effects of hemoperfusion on homeostasis in patients with acute poisoning. Methods The data of 26 acute poisoning patients treated with hemoperfusion were retrospective analyzed. The clinical data included blood pH, PvCO2, PvO2, blood lactate, potassium, free-calcium, bicarbonate and blood glucose assayed and recorded at 0 min, 30 min and 120 min after hemoperfusion. The statistical software SPSS 18. 0 was utilized to analyze the statistical differences in the above biomarkers among three different intervals after hemoperfusion. Results At the beginning of hemoperfusion therapy, levels of homeostasis indicators were pH (7. 36 ± 0. 05), PvCO2 (41. 0 ± 8. 8) mmHg, PvO2 (37. 0 ± 11. 8) mmHg, lactate (1.35 ± 1.00) mmol/L, potassium (3.1 ±0.5) mmol/L, sodium (136.3 ± 4.8) mmol/L, free-calcium (0.95 ±0.11) mmol/L, blood glucose (7.90 ±3.47) mmol/L, bicarbonate (22. 8 ± 3. 3) mmol/L. At 30 min, the levels of those were (7. 36 ± 0. 04), (40. 0 ± 5. 7) mmHg, (41.0±7.5) mmHg, (1.11±0.57) mmol/L, (3.1 ±0.4) mmol/L, (137.3±5.4) mmol/L, (0. 94 ±0. 12) mmol/L, (6. 20 ± 1. 55) mmol/L, (22. 2 ±2. 3) mmol/L, respectively. At 120 min, the levels of those were (7. 35 ± 0. 06), (38. 0 ± 6. 7) mmHg, (46. 0 ± 7. 9) mmHg, (0. 69 ± 0. 52) mmol/L, (3.0±0.4) mmol/L, (137.3±5.0) mmol/L, (0.97±0.10) mmol/L, (5.88±1.43) mmoL/L, (22. 0±2. 2) mmol/L, respectively. Apparently, there were significant statistical difference in PvO2 lactate and blood glucose (P < 0. 05) among three different intervals, and no significant statistical differences in other indicators (P > 0.05). Conclusions There were no significant effects of hemoperfusion on relevant indicators in acute poisoning patients.     

血小板活化与炎症反应在高血压患者中的改变及其相关性研究

目的 探讨高血压患者血小板活化与炎症反应的改变及其相关性.方法 选择61例原发性高血压患者(高血压组)和64例阵发性室上性心动过速患者(对照组),测定其血清超敏C-反应蛋白(hs-CRP)及平均血小板体积.结果 高血压组患者血清hs-CRP浓度[(3.51±1.95)mg/L]明显高于对照组[(1.15±0.77)mg/L],差异有统计学意义(P＜0.05),平均血小板体积大于对照组[分别为(11.19±2.18)fl与(9.20±2.31)fl],差异有统计学意义(P＜0.05),两者之间呈线性相关(r=0.452,P=0.003).结论 高血压患者存在炎症反应及血小板活化,作为炎症反应及血小板活化的两个观察指标,两者相互作用具有相关性,与高血压的发生发展有密切关系.

Abstract：

Objective To investigate the changes and correlation between platelet activation and inflammatory response in patients with essential hypertension(EH). Methods Sixty-one patients with essential hypertension and sixty-four patients with paroxysmal supraventricular tachycardia as control group were enrolled in the study. The levels of high sensitivity C reactive protein ( hs-CRP ) and mean platelet volume ( MPV ) were measured and compared between the control group and the essential hypertension group. Results Compared with the control group,the levels of hs-CRP and MPV in the EH group were significantly higher( [3.51 ± 1.95]mg/L vs [ 1.15 ± 0. 77 ] mg/L, P ＜ 0. 05 ). The MPV in the EH group was significantly higher than that in the control group ( [ 11.29 ± 2. 18 ] flvs [ 9. 20 ± 2. 31 ] fl, P ＜ 0. 05 ). The level of hs-CRP positively correlated to the level of M PV (r = 0. 452, P = 0. 003 ). Conlusions There were inflammatory response and platelet activation in patients with EH and the serum levels of hs-CRP and MPV is correlated with the development of essential hypertension.     

脓毒症早期大鼠下丘脑-垂体-肾上腺轴超微结构变化与功能的关系

目的 观察脓毒症早期下丘脑-垂体-肾上腺(HPA)轴结构及功能的变化,并探讨其相互关系.方法 雄性SD大鼠30只,按随机数字表法均分为正常对照组、假手术组和脓毒症组.采用盲肠结扎穿孔术(CLP)制作脓毒症大鼠模型,术后6 h取血并处死动物,检测血浆促肾上腺皮质激素(ACTH)、皮质酮(CoRT)以及下丘脑促肾上腺皮质激素释放激素(CRH)水平;透射电镜下观察HPA轴的超微结构改变.结果 脓毒症组血浆ACTH、CORT和下丘脑CRH水平均明显高于正常对照组和假手术组[ACTH(pmol/L):5.78±0.36比1.94±0.31、2.51±0.10;CORT(nmol/L):88.48±4.47比22.02±1.62、34.20±2.51,CRH(μg/L):101.92±6.61比61.65±6.05、66.65±4.03,P＜0.05或P＜0.01].透射电镜下观察:脓毒症组大鼠下丘脑粗面内质网囊状扩张、脱颗粒,高尔基体肿胀,垂体ACTH细胞分泌颗粒增多,肾上腺组织脂滴减少.结论 脓毒症早期大鼠HPA轴处于过度激活状态,血浆ACTH、CORT和下丘脑CRH水平明显升高;HPA轴的超微结构明显改变,且与功能变化有密切联系.

Abstract：

Objective To observe the changes in ultrastructure and function of hypothalamicpituitary-adrenal axis (HPAA), and to approach the relationship between them in early stage of sepsis in rats. Methods Thirty male Sprague-Dawley (SD) rats were randomly divided into normal control group,sham group, sepsis group. The sepsis model was reproduced by cecal ligation and puncture (CLP). The rats were sacrificed after collection of blood at 6 hours after CLP, and the levels of adrenocorticotropic hormone (ACTH) and corticosterone (CORT) in the plasma, and the corticotropin release hormone (CRH) in the tissue of hypothalamus were detected. The histopathological changes in HPAA were observed with transmission electron microscopy. Results The levels of ACTH and CORT in plasma, and the CRH in hypothalamus tissue of sepsis group were increased in the early stage of sepsis compared with the normal control group or sham group [ACTH (pmol/L): 5. 78 ± 0. 36 vs. 1.94 ±0.31, 2. 51 ± 0.10; CORT (nmol/L), 88.48±4.47 vs. 22.02±1.62, 34.20±2.51; CRH (μg/L): 101. 92±6. 61 vs. 61.65±6.05,66. 65±4. 03, P＜0. 05 or P＜0. 01]. The changes in ultrastructure of the hypothalamus, pituitary and adrenal were also found. In sepsis group, the ultrastructure of hypothalamus was as follows. Rough endoplasmic reticulum expansion and degranulation of rough endoplasmic reticulum, and swelling of Golgi complex were found. A large number of endocrine granules could be seen in ATCH cells in the pituitary with depletion of adrenal lipid droplets. Conclusion In septic rats, the HPAA was excessively activated, and ACTH and CORT in plasma, and CRH in hypothalamus were significantly increased in early stage of sepsis.The changes in ultrastructure of HPAA were obvious, and the change in function was closely related to the ultrastructural changes.     

不同年龄段的正常糖耐量人群血糖值及其相关因素分析

目的 分析不同年龄段正常糖耐量(NGT)者血糖水平及相互关系.方法 选择上海市杨浦区部分街道流行病学调研2098例30岁以上居民,根据糖耐量(OGTT)检测中空腹血糖值(FPG)和2 h血糖值(2 hPG),诊断为NGT、糖耐量低减(IGT)、空腹血糖受损(IFG)、IGT合并IFG(IGT/IFG)、糖尿病(DM),将NGT者按年龄分成5组,观察各年龄组的血糖水平,用稳态模式分析胰岛β细胞功能指数(HBCI),并对其进行统计学分析.结果 在NGT中60～69年龄组FPG值(5.17±0.48)mmol/L、糖化血红蛋白(HbA1c)(6.01±0.62)%较50～59年龄组FPG值(5.09±0.44)mmol/L、HbA1c值(5.95±0.66)%高(t值分别为2.06、2.48,P均<0.05).60～69年龄组FIG值较40～49年龄组FPG值(5.01±0.47)mmol/L高(t=2.26,P<0.01),50～59年龄组FPG值较40～49年龄组高(t=2.48,P<0.01),5组按年龄从小至大比较,空腹胰岛素(FINS)值变化无明显规律;60岁以上HBCI较60岁以下的HBCI值下降,差异有统计学意义(F值为33.75,P<0.01).结论 NGT人群随着年龄的增长,FPG、HbAlc可能增高.

Abstract：

Objective To compare the glucose levels and associated factors among the normal glucose tolerance subjects with different age.Methods Totally a community-based population of 2098 residences aged above 30 years Were tested with OGTT,and classified into normal glucose tolerance group(NGT),impaired glucose tolerance group(IGT),impaired fasting glucose group(IFG),both IGT and IFG group(ICT/IFC),anddiabetes group(DM) according to fasting and 2 hours glucose level(2 hPG).The subjects in NGT group were further divided into 5 groups according to different ages.The levels of blood glucose and HBCI in different groups and subgroups were measured and analyzed statistically. Results For patients in NGT,the FPG([5.17.±0.48]mmol/L vs.[5.09±0.44]mmol/L,P<0.05)and HbA1c([6.01±0.62]%vs.[5.95±0.66]%.P<0.05)in group aged 60-69 Were higher than that in group aged 50-59.The FPG in group aged 60-69 was also higher than those in group aged 40-49([5.17±0.48]mmol/L vs.[5.00±0.47]mmol/L,P<0.01),and the FPG in group aged 50-59 Was also higher than those in group aged 40-49([5.09±0.44]mmol/L vs..[5.00±0.47]mmol/L,P<0.01).There was no correlation between age and FINS,while a tendency of decreasing HBCI could be observed along with increasing of age(F=33.75,P<0.05).Conclusion In NGT subjects,the FPG and HbA1 C inereased along with age.     

缬沙坦联合辛伐他汀对早期糖尿病肾病大鼠肾脏的保护作用

目的 探讨降脂药辛伐他汀及血管紧张素Ⅱ受体拮抗剂类药物缬沙坦对早期糖尿病肾病大鼠肾脏的保护作用.方法 用链脲佐菌素(STZ)诱导糖尿病肾病大鼠模型,将SD大鼠随机分成5组,每组10只:正常对照组(C组)、糖尿病肾病组(D组)、缬沙坦组(X组)、辛伐他汀组(Z组)和缬沙坦及辛伐他汀联合组(L组).5周末检测5组大鼠血糖(BG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、血尿素氮(BUN)、肌酐(SCr)、肌酐清除率(Ccr)、尿白蛋白排泄率(UAER)等指标的变化;利用透射电子显微镜观察肾脏足细胞超微病理结构.结果 D组与C组比较,BG[分别为(20.3±3.2)、(6.1±0.4)mmol/L]、HbA1c[分别为(7.18±0.47)%、(3.37±0.15)%]、TC[分别为(2.69±0.35)、(1.28±0.24)mmol/L]、TG[分别为(3.09±0.37)、(1.18±0.25)mmol/L]明显升高(P均＜0.05);D组Ccr[(0.89±0.19)ml/min]较C组[(1.27±0.33)ml/min]和X、Z、L组显著下降(P＜0.05),D组大鼠UAER[(19.87±3.85)μg/24 h]明显高于C组[(3.67±1.01)μg/24 h](P＜0.05),X、Z、L组大鼠UAER显著低于D组(P＜0.05),而L组改善尤其显著(P＜0.05);D组的足细胞足突严重融合,X、Z、L组仅少量足突融合较D组改善,而L组改善尤其显著.结论 缬沙坦及辛伐他汀单用及联合应用,尤其是联合用药对早期糖尿病大鼠肾脏有保护作用.

Abstract：

Objective To explore the protection of valsartan combined with simvastatin on kidney in early diabetic nephropathy rats. Methods Diabetic nephropathy rats model were induced by streptozocin (STZ) ,the experimental rats were randomly divided into 5 groups: control (group C), diabetic nephropathy (group D) ,diabetes treated with valsartan (group X) ,diabetes treated with simvastatin (group Z) ,and diabetes treated with combined valsartan and simvastatin ( group L). Blood glucose (BG), HbA1c, blood cholesterol ( TC), trigalloylglycerol ( TG ), blood ureanitrogen ( BUN ), serum creatinine (SCr) , urinary albumin excretion rate (UAER) were measured, and the podocyte ultrastructure was observed by transmission electronic microscopy. Results The levels of BG, HbA1c,TC,TG and UAER in group D increased significantly compared togroup C(BG:[20.3 ±3.2]mmol/L vs [6.1 -±0. 4]mmol/L;HbA1c:[7.18 ±0.47]% vs [3.37 ±0. 15]% ;TC: [2. 69 ±0. 35] mmol/L vs [1.28 ±0. 24] mmol/L;TG: [3.09 ±0. 37] mmol/L vs [1.18 ±0. 25]mmol/L) (P ＜ 0. 05 ). Creatinine clearance rates (Ccr) in group D ( [0. 89 ± 0. 19] ml/min ) decreased significantly compared to group C( [1.27 ±0. 33] ml/min) ,as well as group X,Z and L( Ps ＜ 0. 05 ). UAER in group D was significantly higher than that in group C ( [19. 87 ±3. 85] μg/24 h vs [3. 67 ± 1.01] μg/24 h) (P ＜ 0. 05 ), as well as group X, Z and L ( P ＜ 0. 05 ), and the improvement in group L was particularly significant ( P ＜ 0. 05 ). The projections of podocyte in group D severely syncretized, there were slightly improvement in group X, Z and L compared to group D, and the improvement in group L was remarkable. Conclusion The treatment with valsartan, simvastatin and their combination will effectively protect the kidney in early diabetic nephropathy rats,and the effect of using the combination therapy is much better.     

脓毒症早期大鼠下丘脑-垂体-肾上腺轴超微结构变化与功能的关系

Objective To observe the changes in ultrastructure and function of hypothalamicpituitary-adrenal axis (HPAA), and to approach the relationship between them in early stage of sepsis in rats. Methods Thirty male Sprague-Dawley (SD) rats were randomly divided into normal control group,sham group, sepsis group. The sepsis model was reproduced by cecal ligation and puncture (CLP). The rats were sacrificed after collection of blood at 6 hours after CLP, and the levels of adrenocorticotropic hormone (ACTH) and corticosterone (CORT) in the plasma, and the corticotropin release hormone (CRH) in the tissue of hypothalamus were detected. The histopathological changes in HPAA were observed with transmission electron microscopy. Results The levels of ACTH and CORT in plasma, and the CRH in hypothalamus tissue of sepsis group were increased in the early stage of sepsis compared with the normal control group or sham group [ACTH (pmol/L): 5. 78 ± 0. 36 vs. 1.94 ±0.31, 2. 51 ± 0.10; CORT (nmol/L), 88.48±4.47 vs. 22.02±1.62, 34.20±2.51; CRH (μg/L): 101. 92±6. 61 vs. 61.65±6.05,66. 65±4. 03, P＜0. 05 or P＜0. 01]. The changes in ultrastructure of the hypothalamus, pituitary and adrenal were also found. In sepsis group, the ultrastructure of hypothalamus was as follows. Rough endoplasmic reticulum expansion and degranulation of rough endoplasmic reticulum, and swelling of Golgi complex were found. A large number of endocrine granules could be seen in ATCH cells in the pituitary with depletion of adrenal lipid droplets. Conclusion In septic rats, the HPAA was excessively activated, and ACTH and CORT in plasma, and CRH in hypothalamus were significantly increased in early stage of sepsis.The changes in ultrastructure of HPAA were obvious, and the change in function was closely related to the ultrastructural changes.     

毒鼠强浓度在人体内变化规律研究

Objective To study the variation of blood concentration of tetramine in human body with acute tetramine intoxication treated with three different protocols and the levels in human body after discharge from the hos-pital. Methods The blood concentration of tetramine was determined by gas chromatography-mass spectrometry (GC-MS). All 101 patients of acute tetramine intoxication were divided into 3 groups (routine comprehensive treat-ment group,hemoperfusion group,blood transfusion group) according to their blood concentration of tetramine and clinical symptoms. The patients were followed up to monitor the tetramine levels in a year. Results The level of tet-famine in blood was decreased from 33.0(1.7～115.0)μg/L to 18.0(0.3～47.6)μg/L in routine comprehensive treatment group. The total decrement was 45.5 %. The level was decreased from 108.0 (54.0～290.0)μg/L to 26.0 μg/L in hemoperfusion group. The total decrement was 75.9%. The decrement was 20.0%～45.0% after each he-moperfusion. The level was slightly high after 24 h of hemoperfusion. The total decrement in blood transfusion group was 33.5%～60.0%. The level was <0.3μg/L in all 25 out-patients 1 year after their intoxication. Conclusion Routine comprehensive treatment,hemoperfusion,blood transfusion are effective in the treatment of acute tetramine intoxication. The degradation of tetramine in human body is slow.     

毒鼠强浓度在人体内变化规律研究

Objective To study the variation of blood concentration of tetramine in human body with acute tetramine intoxication treated with three different protocols and the levels in human body after discharge from the hos-pital. Methods The blood concentration of tetramine was determined by gas chromatography-mass spectrometry (GC-MS). All 101 patients of acute tetramine intoxication were divided into 3 groups (routine comprehensive treat-ment group,hemoperfusion group,blood transfusion group) according to their blood concentration of tetramine and clinical symptoms. The patients were followed up to monitor the tetramine levels in a year. Results The level of tet-famine in blood was decreased from 33.0(1.7～115.0)μg/L to 18.0(0.3～47.6)μg/L in routine comprehensive treatment group. The total decrement was 45.5 %. The level was decreased from 108.0 (54.0～290.0)μg/L to 26.0 μg/L in hemoperfusion group. The total decrement was 75.9%. The decrement was 20.0%～45.0% after each he-moperfusion. The level was slightly high after 24 h of hemoperfusion. The total decrement in blood transfusion group was 33.5%～60.0%. The level was <0.3μg/L in all 25 out-patients 1 year after their intoxication. Conclusion Routine comprehensive treatment,hemoperfusion,blood transfusion are effective in the treatment of acute tetramine intoxication. The degradation of tetramine in human body is slow.     

毒鼠强浓度在人体内变化规律研究

Objective To study the variation of blood concentration of tetramine in human body with acute tetramine intoxication treated with three different protocols and the levels in human body after discharge from the hos-pital. Methods The blood concentration of tetramine was determined by gas chromatography-mass spectrometry (GC-MS). All 101 patients of acute tetramine intoxication were divided into 3 groups (routine comprehensive treat-ment group,hemoperfusion group,blood transfusion group) according to their blood concentration of tetramine and clinical symptoms. The patients were followed up to monitor the tetramine levels in a year. Results The level of tet-famine in blood was decreased from 33.0(1.7～115.0)μg/L to 18.0(0.3～47.6)μg/L in routine comprehensive treatment group. The total decrement was 45.5 %. The level was decreased from 108.0 (54.0～290.0)μg/L to 26.0 μg/L in hemoperfusion group. The total decrement was 75.9%. The decrement was 20.0%～45.0% after each he-moperfusion. The level was slightly high after 24 h of hemoperfusion. The total decrement in blood transfusion group was 33.5%～60.0%. The level was <0.3μg/L in all 25 out-patients 1 year after their intoxication. Conclusion Routine comprehensive treatment,hemoperfusion,blood transfusion are effective in the treatment of acute tetramine intoxication. The degradation of tetramine in human body is slow.     

妊娠期糖尿病患者血清Betatrophin含量检测及其与机体糖脂代谢紊乱的关系

目的探讨妊娠期糖尿病(GDM)患者血清Betatrophin含量与机体糖脂代谢紊乱的关系。方法前瞻性选取2018年12月至2020年1月在庆阳市人民医院进行糖耐量筛查并确诊为GDM的孕妇117例作为GDM组,同期在本院进行糖耐量筛查的健康孕妇100例作为正常对照组。比较2组孕妇的血清Betatrophin含量、外周血糖代谢指标(空腹血糖、空腹胰岛素、胰岛β细胞分泌功能、胰岛素抵抗指数)、脂质代谢指标[总胆固醇(TC)、载脂蛋白A1(Apo-A1)、载脂蛋白-B(Apo-B)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]水平差异。采用Pearson检验评估GDM孕妇血清Betatrophin与糖脂代谢紊乱程度的相关关系。结果GDM组孕妇血清中Betatrophin的含量为(309.47±38.66)pg/mL,高于正常对照组孕妇[(217.66±25.73)pg/mL],差异有统计意义(P<0.05)。GDM组孕妇的空腹血糖、空腹胰岛素、胰岛素抵抗指数分别为(5.47±0.71)mmol/L、(12.37±1.95)pmol/mL、(2.88±0.35),高于正常对照组孕妇[(4.38±0.56)mmol/L、(7.54±0.92)pmol/mL、(1.34±0.19)],胰岛β细胞分泌功能为(140.64±17.29),低于正常对照组孕妇(161.33±18.51),差异有统计意义(P<0.05)。GDM组孕妇的TC、Apo-B、LDL-C水平分别为(5.98±0.7)mmol/L、(1.76±0.21)g/L、(2.98±0.37)mmol/L,高于正常对照组孕妇[(5.60±0.76)mmol/L、(1.54±0.18)g/L、(2.62±0.34)mmol/L],Apo-A1、HDL-C水平为(0.91±0.10)g/L、(1.70±0.19)mmol/L,低于正常对照组孕妇[(1.12±0.14)g/L、(1.96±0.24)mmol/L],差异有统计意义(P<0.05)。相关性分析发现,GDM孕妇血清Betatrophin含量与糖代谢指标空腹血糖、空腹胰岛素、胰岛素抵抗指数呈正相关(r=0.827、0.716、0.704),与胰岛β细胞分泌功能呈负相关(r=-0.793);与脂质代谢指标TC、Apo-B、LDL-C水平呈正相关(r=0.665、0.684、0.833),与Apo-A1、HDL-C水平呈负相关(r=-0.711、-0.675,P<0.05)。结论GDM孕妇血清Betatrophin含量可客观反映机体糖脂代谢紊乱程度,是病情评估的简便指标之一。     

妊娠高血压综合征患者外周血中胎儿细胞的检测与免疫状况研究

目的 研究孕妇外周血中胎儿细胞种类、数量及免疫状况与妊娠高血压综合征(PIH)的关系,探讨PIH的发病机制.方法 (1)采用流式细胞术比较3种不同方法:CD71、HbF/I抗原(血红蛋白F/血型I抗原)和HbF/CA(血红蛋白F/碳酸酐酶)分别检测孕妇外周血中胎儿有核红细胞(fNRBCs).(2)同时检测孕妇组和PIH组的免疫学指标:淋巴细胞亚群、细胞因子等.结果 (1)3种方法CD71、HbF/I抗原、HbF/CA检测胎儿红细胞PIH患者组[百分比中位数(95%可信上限)分别为6.56(11.37)%、0.09(0.16)%、0.6(0.11)%]与正常孕妇组[分别为1.58(3.35)%、0.04(0.08)%、0.02(0.06)%]差异均具有统计学意义(Z值分别为:-5.31、-2.97、-4.13,P值均＜o.01).(2)PIH组的淋巴细胞亚群和TNFα及IL-6,除CD8 (30.2±7.1)%与正常孕妇组(31.0±7.1)%差异无统计学意义(P=0.620)外,CD3(76.4±8.5)%、CD4(42.6±6.4)%、CD4/CD8(1.5±0.4)%、CD19(10.5±3.9)%、CD16/CD56(12.2±7.7)%、TNF-α(1.4±0.6)μg/L及IL-6(89.6±12.9)μg/L和正常孕妇组[分别为CD3(70.4±8.3)%、CD4(35.3±6.9)%、CD4/CD8(1.2±0.4)%、CD19(8.2±2.8)%、CD16/CD56(20.5±8.9)%、TNF-α(0.5±0.2)μg/L及IL-6(22.0 4±5.7)μg/L]之间差异均具有统计学意义(P＜0.001).结论 孕妇外周血中fNRBCs的数量增多引起的免疫状况的改变均可能是PIH发生发展的重要因素.     

基于心肺运动试验客观定量评估的个体化运动在高血压患者中的应用

目的探讨基于心肺运动试验(CPET)客观定量评估的个体化运动在高血压患者中的应用及对血压、血压变异性、脂代谢和脉搏波波形特征的影响。方法选取2019年1月至2019年6月济宁医学院教职工中的40例高血压患者,男23例,女17例,年龄(48.5±4.6)岁,年龄范围为40~58岁。采用随机数表法将患者随机分为常规组和CPET组,每组20例。常规组给予常规生活方式干预,CPET组在常规组的基础上给予基于CPET客观定量评估的个体化运动。观察两组患者干预前后静息血压、血清低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、总胆固醇、甘油三酯、24 h收缩压标准差(24 hSSD)、24 h舒张压标准差(24 hDSD)、日间收缩压标准差(dSSD)、日间舒张压标准差(dDSD)、夜间收缩压标准差(nSSD)、夜间舒张压标准差(nDSD)和桡动脉脉搏波切迹幅度。结果 CPET组干预后收缩压[(126.8±8.2)mmHg(1 mmHg=0.133 kPa)]和舒张压[(75.3±6.1)mmHg]水平均低于常规组[(132.1±6.2)mmHg、(79.7±6.4)mmHg],差异有统计学意义(P<0.05)。CPET组患者干预后LDL-C[(2.2±0.5)mmol/L]、总胆固醇[(4.8±0.6)mmol/L]、甘油三酯[(1.2±0.4)mmol/L]水平均显著低于常规组[(3.4±0.4)mmol/L、(5.3±0.7)mmol/L、(1.8±0.3)mmol/L],HDL-C[(1.5±0.2)mmol/L]高于常规组[(1.1±0.1)mmol/L],差异均有统计学意义(P<0.05)。CPET组干预后24 hSSD[(10.3±4.3)mmHg]、dSSD[(11.6±3.8)mmHg]、nSSD[(9.5±4.1)mmHg]、24 hDSD[(9.7±2.8)mmHg]、dDSD[(11.2±3.3)mmHg]、nDSD[(8.2±2.8)mmHg]水平低于常规组[(13.4±5.4)mmHg、(14.3±4.8)mmHg、(12.1±3.4)mmHg、(12.4±3.4)mmHg、(13.0±4.2)mmHg、(10.1±3.8)mmHg],差异有统计学意义(P<0.05)。CPET组干预后脉搏波切迹幅度高于常规组,差异有统计学意义(P<0.05)。结论基于CPET客观定量评估的个体化运动用于高血压干预可改善患者的血压控制效果,降低血压变异性,改善脂代谢,增加脉搏波切迹幅度,改善血管弹性水平,具有临床推广价值。     

妊娠期糖尿病患者母血及脐血中subfatin和spexin水平的变化及其临床意义

目的探讨妊娠期糖尿病患者母血、脐血中subfatin和spexin水平的变化及其临床意义。方法前瞻性选取2019年1月至2020年3月同济大学附属第一妇婴保健院门诊建卡以及住院分娩的妊娠期糖尿病的妇女75例,及其所分娩的新生儿75例,为妊娠期糖尿病组;同时在选取糖耐量正常妊娠期妇女及其所分娩的新生儿各80例为对照组。测定两组产妇的葡萄糖、胰岛素、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿酸水平,采用酶联免疫吸附试验(ELISA)试剂盒测定母血、脐血中的subfatin和spexin水平,受试者工作特征(ROC)曲线分析母血、脐血中subfatin和spexin在妊娠期糖尿病中诊断的价值。结果妊娠期糖尿病组患者的母血、脐血葡萄糖、胰岛素、HOMA-IR、TC和TG水平为(5.86±0.42) mmol/L、(5.76±0.63)μU/mL、2.47±1.21、(5.37±1.19) mmol/L、(1.29±0.43) mmol/L,均显著高于对照组[(5.37±0.33) mmol/L、(3.97±0.45)μU/mL、1.16±0.78、(4.96±0.919) mmol/L、(0.86±0.29) mmol/L],差异均有统计学意义(P <0.05),妊娠期糖尿病组中LDL-C、HDL-C、尿酸水平与对照组相比,差异无统计学意义(P> 0.05);妊娠期糖尿病组中口服糖耐量试验前、分娩结束时母血、脐血subfatin水平为(14.27±4.52)、(7.54±1.17)、(8.59±2.23) ng/mL,均明显高于对照组[(4.13±0.93)、(3.26±0.78)、(6.29±1.27) ng/mL],差异均有统计学意义(P <0.05);妊娠期糖尿病组患者口服糖耐量试验前、分娩结束时母血、脐血spexin水平为(2.55±0.48)、(1.94±0.39)、(1.87±0.25) ng/mL,均显著低于对照组[(3.92±0.99)、(3.17±0.82)、(2.94±0.73) ng/mL],差异均有统计学意义(P <0.05)。ROC曲线分析结果显示,母血subfatin和spexin、脐血中subfatin和spexin诊断妊娠期糖尿病的曲线下面积为0.924(95%CI:0.875~0.934,P <0.001)、0.901(95%CI:0.849~0.9515,P <0.001)、0.858(95%CI:0.796~0.920,P <0.001)和0.799(95%CI:0.724~0.873,P <0.001),灵敏度为86.49%、81.57%、78.38%和75.68%,特异度为72.75%、75.68%、84.59%和89.24%。结论妊娠期糖尿病患者母血、脐血中subfatin水平升高,spexin降低,可以作为诊断妊娠期糖尿病的分子标志物。     

加减大柴胡汤干预肝胃郁热型2型糖尿病合并高尿酸血症的临床研究

目的观察大柴胡汤加减治疗肝胃郁热型2型糖尿病(T2DM)合并高尿酸血症(HUA)的临床疗效。方法前瞻性纳入2019年1月至2020年7月期间中国中医科学院广安门医院南区内分泌科收治的100例肝胃郁热型T2DM合并HUA患者。按照随机数字表法,将其分为2组。治疗组50例在常规西药治疗的基础上加服大柴胡汤,对照组50例予常规西药治疗,2组疗程均为12周。比较2组患者中医证候疗效。比较2组患者治疗前、治疗后12周血尿酸(UA)、血糖[空腹血糖(FBG)、餐后2 h血糖(2 hPG)]、糖化血红蛋白(HbA1c)、血脂谱[甘油三酯(TG)、总胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)]、体重指数(BMI)、空腹胰岛素(FINS)及胰岛素抵抗指数(HOMA-IR)变化。结果治疗组证候改善总有效率为89.6%,明显高于对照组的50.0%,差异有统计学意义(P<0.001)。2组患者治疗前UA、FBG、2 hPG、HbA1c、FINS、HOMA-IR、BMI、TG、TC及LDL-C水平比较,差异无统计学意义(P>0.05)。治疗组患者治疗后12周UA、FBG、2 hPG、HbA1c、FINS、HOMA-IR、TG、TC及LDL-C水平分别为(287.62±46.06)μmol/L、(7.13±0.78)mmol/L、(9.67±0.79)mmol/L、(7.10±0.64)%、(10.74±3.38)mU/L、6.04±1.32、(1.54±0.51)mmol/L、(4.13±0.64)mmol/L、(2.32±0.58)mmol/L,显著低于对照组[(343.51±40.58)μmol/L、(7.86±1.08)mmol/L、(10.49±1.50)mmol/L、(7.83±0.68)%、(12.60±5.39)mU/L、7.84±2.12、(1.89±0.53)mmol/L、(4.68±0.98)mmol/L、(2.89±0.97)mmol/L],差异均有统计学意义(P<0.05)。治疗后12周治疗组BMI较对照组有所下降[(27.34±2.46)kg/m2vs.(28.56±3.39)kg/m2],但差异无计学意义(P>0.05)。结论大柴胡汤加减能有效纠正肝胃郁热型T2DM合并HUA患者的血糖、尿酸、脂代谢紊乱及减轻胰岛素抵抗,明显改善本病患者的临床症状。     

非酒精性脂肪肝对急性心肌梗死患者预后的影响

目的探讨急性心肌梗死(acute myocardial infarction, AMI)并发非酒精性脂肪肝(non-alcoholic fatty liver disease, NAFLD)患者血脂、血清炎性因子水平变化,及NAFLD对AMI预后的影响。方法 AMI患者712例,其中350例有NAFLD者为观察组,362例无NAFLD者为对照组。比较2组入院时年龄,性别比例,体质量指数(body mass index, BMI),合并高血压、2型糖尿病情况,ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)及非STEMI比率,冠状动脉病变支数,行经皮冠状动脉介入术(percutaneous coronary intervention, PCI)比率,药物治疗情况以及血清肌钙蛋白I(cardiac troponin I, cTnI)、尿酸(uric acid, UA)、同型半胱氨酸(homocysteine, Hcy)、C反应蛋白(C-reactive protein, CRP)、总胆固醇(total cholesterol, TC)、三酰甘油(triacylglycerol, TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)、白细胞计数(white blood cell count, WBC),D-二聚体(D-dimer, D-D)、血小板/淋巴细胞比值(platelet lymphocyte ratio, PLR);随访观察主要心脑血管不良事件(major cardiovascular and cerebrovascular adverse events, MACCE)发生率及生存时间;Pearson相关分析SYNTAX积分与UA等指标的相关性。结果观察组BMI[(29.00±1.41)kg/m^2]、合并2型糖尿病比率(60.57%)、SYNTAX积分[(24.50±2.37)分]及血清TC[(5.67±0.63)mmol/L]、TG[(2.31±0.27)mmol/L]、LDL-C[(3.13±0.51)mmol/L]、UA[(502.20±31.51)μmol/L]、Hcy[(16.91±1.85)μmol/L]、CRP[(22.30±0.37)mg/L]、WBC[(13.08±2.09)×10^9/L]、D-D[(1.36±0.32)g/L]、PLR(191.34±8.15)均高于对照组[BMI:(27.00±1.69)kg/m^2,合并糖尿病比率:41.99%,SYNTAX积分:(19.60±3.95)分,TC:(5.02±0.35)mmol/L,TG:(1.91±0.40)mmol/L,LDL-C:(2.38±0.55)mmol/L,UA:(446.20±51.08)μmol/L,Hcy:(13.63±1.50)μmol/L,CRP:(13.20±0.33)mg/L,WBC:(11.16±0.98)×10^9/L,D-D:(0.95±0.26)g/L,PLR:158.85±8.35](P<0.05);2组年龄,性别比例,合并高血压比率,冠状动脉病变支数,STEMI、非STEMI、PCI比率,阿司匹林等药物应用比率,血清HDL-C、cTnI水平比较差异无统计学意义(P>0.05);观察组MACCE发生率(9.71%)高于对照组(5.52%)(P<0.05),中位生存时间(14.5个月)较对照组(15.4个月)短(P<0.05);Pearson相关分析显示,SYNTAX积分与UA(r=0.876,P<0.001)、Hcy(r=0.736,P<0.001)、CRP(r=0.278,P=0.038)、TC(r=0.644,P<0.001)、TG(r=0.641,P<0.001)、LDL-C(r=0.633,P<0.001),BMI(r=0.599,P<0.001)、PLR(r=0.456,P<0.001)均呈正相关。结论 NFALD可能加剧AMI患者炎性反应,增高血脂,加重冠状动脉血管狭窄程度,增加MACCE发生率,影响AMI患者预后。     

原发性高血压与载脂蛋白CⅢ-455 C基因量的关系

目的 探讨载脂蛋白CⅢ(ApoCⅢ)-455区域T-C的改变及ApoCⅢ-455C基因量的不同与原发性高血压的关系.方法 选取606例研究对象,分为原发性高血压组(306例)和非原发性高血压组(300例).2组中再按照其是否伴有高甘油三酯血症(TG≥1.69 mmol/L),分为原发性高血压伴高甘油三酯血症亚组90例(A组)、原发性高血压不伴高甘油三酯血症亚组216例(B组)、单纯高甘油三酯血症组51例(C组)和非原发性高血压非高甘油三酯血症亚组249例(D组).应用实时定量PCR法测定ApoCⅢ-455C基因的含量.所有研究对象均测定血浆总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A(ApoA)、载脂蛋白B100(ApoB100)、ApoCⅢ、载脂蛋白E(ApoE)、血糖和血浆胰岛素,并测量腰围.结果 B组与D组ApoCⅢ-455C基因的含量差异无统计学意义(45.16±5.97与46.21±6.13,P>0.05).A组与B组比较,血浆ApoCⅢ、ApoB100和ApoCⅢ-455C基因的含量明显增高(0.14±0.03)g/L、(95.00±15.69)g/L、28.13±4.11与(0.09±0.03)g/L、(81.22±11.87)g/L、45.16±5.97(P均<0.01)],血浆LDL-C[(2.54±0.61)mmol/L与(2.15±0.41)mmol/L]和ApoE[(0.05±0.01)g/L与(0.04±0.01)g/L]也明显增高(P均<0.05).结论 ApocⅢT-455C基因的量与原发性高血压无关.     

非糖尿病维持性血液透析患者血清hs-CRP、Hcy、MPO水平及其与颈动脉硬化的相关性分析

目的 探讨非糖尿病维持性血液透析患者血清hs-CRP、Hcy、MPO水平及其与颈动脉硬化的相关性.方法 回顾性选取2018年3月至2020年3月张家口市第一医院血液透析科收治的90例非糖尿病维持性血液透析患者作为观察组,根据颈动脉硬化厚度情况将其分为CA-IMT增厚组(n=69)和CA-IMT正常组(n=21),另选取...     

佩尼聚醚砜空心纤维透析器对维持性血液透析患者的有效性和安全性分析

目的 观察佩尼聚醚砜空心纤维透析器(PES14HF)对维持性血液透析患者的有效性和安全性.方法 36例血液透析患者分别使用PES14HF和日本尼普洛株式会社生产的聚醚砜空心纤维透析器(PES-150DS)进行透析,每次3.5 h以上.以透析前后血肌酐、尿素氮和β2-微球蛋白等指标的清除及下降率进行疗效评估,以透析前后外周血血红蛋白(Hb)、白蛋白(Alb)等指标的变化进行安全性评估.结果 ES14HF组治疗前后血肌酐分别为(990.2±191.2)、(333.8±89.5)μmol/L,血尿素氮分别为(24.7±4.1)、(7.0±1.9)mmol/L,β2微球蛋白分别为(22.9±1.7)、(13.6±3.3)mmol/L,治疗前后差异均有统计学意义(P均＜0.01).PES-150DS组治疗前后血肌酐分别为(1059.5±179.4)、(395.5±86.1)μmol/L,血尿素氮分别为(25.3±4.8)、(8.1±2.8)mmol/L,β2微球蛋白分别为(22.3±2.9)、(18.0±3.0)mmol/L,治疗前后差异均有统计学意义(P均＜0.01);但2组间治疗前后血肌酐、尿素氮、β2微球蛋白比较,差异均无统计学意义(P均＞0.05).2组透析后血β2微球蛋白均下降,但PES14HF组溶质下降率更明显(P=0.017).结论 佩尼聚醚砜空心纤维透析器PES14HF在维持性血液透析患者中的应用安全、有效.     

不同血红蛋白输血指征对中老年肿瘤手术患者的影响

目的探讨应用不同输血指征管理对中老年消化道肿瘤手术患者的影响。方法选择ASAⅠ—Ⅱ级、年龄45—72岁消化道恶性肿瘤患者80名,随机数字法均分为Ⅰ组:输血指征为Hb 100 g/L;Ⅱ组:输血指征为Hb80 g/L。患者入手术室后常规使用静脉复合气管内吸入麻醉,分别于麻醉前、肿瘤切除后、术毕、术后24 h和出院时测定血常规、血乳酸含量、动脉血气,并记录术中总输血、输液量、输血并发症。结果1)血常规:在肿瘤切除后至手术后24 h,Hb 80 g/L组(Ⅱ组)患者Hb[(89±4.6)g/L]明显低于Hb 100 g/L组[Ⅰ组,(109±5.1)g/L],但在出院时,Ⅰ、Ⅱ组Hb分别为(127±8.3)g/L和(128±6.0)g/L(P>0.05);2)血乳酸浓度:肿瘤切除后2组患者分别从术前的(1.03±0.10)、(1.00±0.08)mmol/L升高为(1.90±0.15)和(1.85±0.19)mmol/L,并持续至出院(P<0.05)。3)动脉血气和血流动力学:2组患者在麻醉前、术后24 h和出院时,动脉氧分压(PaO2):Ⅰ组分别为(82.4±3.8)、(82.3±4.2)、(81.9±3.0)mmHg,Ⅱ组分别为(82.6±3.9)、(80.7±3.3)、(81.8±3.3)mmHg;动脉CO2分压(PaCO2):Ⅰ组分别为(41.0±1.5)、(41.4±2.0)、(41.7±1.5),Ⅱ组分别为(41.3±1.8)、(41.7±1.5)、(41.5±1.6)mmHg;血液pH:Ⅰ组分别为7.41±0.02、7.41±0.01、7.41±0.02,Ⅱ组分别为7.41±0.02、7.42±0.02、7.41±0.02;4)输血和相关并发症等:观察过程中患者无一例死亡。Ⅱ组患者输入浓缩红细胞的比例(22.5%)和输血量[(0.40±0.77)U/例]均显著低于Ⅰ组(分别为47.5%和(0.93±1.00)U/例,P<0.01),但2组患者输液量、输血并发症发生率、术后切口感染率(1/40vs1/40)、延迟愈合率(1/40vs1/40)和住院时间[(11.7±1.0)dvs(11.7±1.0)d]差异无统计学意义(P>0.05)。结论无脏器功能异常合并症的中老年消化道肿瘤患者,术中将输血指征从Hb 100 g/L降至80 g/L进行管理,能满足机体代谢的需要,显著降低浓缩红细胞输入比例和输入量,同时不增加术后切口感染率及延迟愈合率,不延长患者住院时间,对节约用血有重要意义。