血清MMP-2、CRP水平对不稳定性心绞痛的诊断及预后判断价值

目的 :探讨血清基质金属蛋白酶 - 2 (MMP- 2 )及 C-反应蛋白 (CRP)定量测定对不稳定性心绞痛 (U A)的诊断及预后判断价值。　方法 :对 46例 UA患者、2 5例稳定性心绞痛 (SA )患者及 2 2例健康志愿者分别进行血清MMP- 2及 CRP酶联免疫测定。　结果 :U A组入院时血清 MMP- 2水平明显高于 SA组及对照组 ,分别为 (4 70 .8±5 1.4) ng/ ml、(32 9.6± 5 4.0 ) ng/ ml及 (2 46 .5± 2 6 .8) ng/ m l(P<0 .0 1)。 UA组入院时血清 CRP水平明显高于 SA组及对照组 ,分别为 (3.6± 0 .4) μg/ m l、(0 .9± 0 .1) μg/ m l及 (0 .7± 0 .1) μg/ m l(P<0 .0 1)。UA组病情稳定后血清MMP- 2及 CRP水平明显降低 ,分别为 (35 0 .4± 41.8) ng/ m l、(0 .9± 0 .3) μg/ ml(P<0 .0 1)。 U A组有 7例发生急性冠状动脉事件 (ACE) ,SA组未发现 ,且 ACE组入院时血清 MMP- 2、CRP水平分别为 (5 0 3.7± 30 .3) ng/ ml、(4 .1± 0 .3) μg/ ml,明显高于 U A组入院时平均 MMP- 2、CRP水平 (P<0 .0 5 )。　结论 :血清 MMP- 2、CRP水平可能对 UA具有一定的诊断及预后判断价值     

不稳定型心绞痛患者血清hs-CRP、cTnI及CK-MB测定的临床意义

目的:探讨不稳定型心绞痛(UA)患者血清hs—CRP、cTnI及CK-MB测定的临床意义。方法:分别用免疫透射比浊法、夹心ELISA法及免疫抑制法测定63例UA患者和40例稳定型心绞痛(SA)患者血清hs-CRP,cTnI及CK-MB含量。结果:UA患者血清hs-CRP含量为(6.34±1.69)mg/L,与SA组(2.21±0.96)mg/L及健康组(1.10±0.64)mg/L相比较有极显著性差异(P<0.01);UA患者血清cTnl含量为(8.60±8.34)μg/L,与SA组(2.47±1.79)μg/L及对照组(1.95±1.94)μg/L相比较有极显著性差异(P<0.01);3组比较,各组患者血清CK-MB含量差异不显著(P>0.05)。结论:UA患者存在微小心肌损伤,炎症反应是UA一个重要发病因素,cTnI是判断微小心肌损伤特异且敏感的指标,hs-CRP在UA发病机制中有重要意义。     

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。     

不稳定心绞痛患者检测血清cTnI的意义

[目的 ]测定不稳定心绞痛 (UA)患者血清中心肌肌钙蛋白I(cTnI)和心肌酶学水平 ,探讨其检测意义。 [方法 ]cTnI与心肌酶 (CK ,CK -MB)分别采用Access微粒子化学发光系统和酶法作为检测手段。 [结果 ]5 0名不稳定心绞痛患者血清cTnI明显高于对照组 (0 .30 6± 0 .393) μg/Lvs(0 .0 2 7± 0 .0 2 1) μg/L (P <0 .0 0 1) ,且与CK -MB有相关性 ,(P <0 .0 0 0 1)。在 5 0名UA患者中有 31人血清cTnI高于正常。其中 14人发生严重心脏事件 (12例发生心肌梗塞 ,2例猝死 ) ,表示不良转归的预测值为 4 5 .2 % ,且随浓度增加严重心脏事件发生率增大 ;在 19人血清cTnI低于正常中 ,无一人发生严重心脏事件 ,表示良好转归的预测值为l0 0 %。 [结论 ]在UA病人中 ,cTnI检测微小心肌损伤的敏感性高于CK及CK -MB。cTnI是诊断心肌损伤高敏感度 ,高特异性的指标 ,对UA的病情变化提供了重要的参考价值。     

不稳定性心绞痛患者血清CRP和TnI含量的测定及临床意义

目的　探讨C -反应蛋白 (CRP)和心肌肌钙蛋白I(TnI)在不稳定性心绞痛 (UA)发病机制中的意义及对预后判断的价值。方法　测定 30例UA患者和 11例稳定性心绞痛 (SA)患者血清CRP和TnI,并与CK -MB相比较 ,同时观察住院期间及随访 1～ 3个月中心脏事件的发生。结果　UA组患者血清CRP含量为 (8.5 6± 2 .0 5 )mg L ,与SA组 (2 .31± 0 .5 9)mg L相比有极显著性差异 (P =0 .0 0 5 ) ;UA组患者血清TnI含量为 (4 .2 5± 1.32 )ng ml,与SA组(0 .2 7± 0 .11)ng ml相比有显著性差异 (P =0 .0 3)。UA组患者血清CRP含量与TnI含量呈一定程度的相关性 (r =0 .5 7,P =0 .0 0 6 )。伴有CRP及TnI升高的UA患者住院期间心绞痛发作次数与正常患者相比明显增多 (P分别为0 .0 0 3和 0 .0 2 ) ,心肌梗死的发生率增高。结论　炎症反应是UA发病的一个重要因素 ;在UA中存在微小心肌损伤 ,TnI是判断微小心肌损伤的敏感指标 ;CRP和TnI可以作为判断UA患者预后的敏感指标     

冠状动脉病变程度与血C反应蛋白及血尿酸的相关研究

目的 :探讨冠状动脉病变程度与血C反应蛋白 (C -reactiveprotein ,CRP)和血尿酸 (Uridacid ,UA)的关系。方法 :测定 186例初诊为“冠心病、不稳定心绞痛”患者的血清CRP和UA水平 ,并根据冠状动脉造影的结果分组 ,观察血清CRP和UA与冠脉病变的关系 ,进行统计学分析。结果 :各组间血CRP水平 :冠脉正常组 (1.5 6± 1.3 2 )mg/mL ;冠脉轻度狭窄组 (2 .45± 1.87)mg/mL ;冠脉中度狭窄组 (3 .0 2± 2 .5 3 )mg/mL ;冠脉重度狭窄组 (4.2 8± 3 .15 )mg/mL ;冠脉完全闭塞组 (5 .3 6± 4.11)mg/mL。冠脉重度狭窄组和冠脉完全闭塞组与冠脉正常组比较。统计学处理差异有显著性意义 (P <0 .0 5 ) ,余组间比较差异无显著性意义 (P >0 .0 5 )。不稳定病变组CRP水平显著高于稳定病变组 (7.83± 4.66)mg/mLvs.(3 .3 8± 2 .2 7)mg/mL ,(P <0 .0 0 1)。各组间血UA值分别为 :冠脉正常组(2 81.7± 5 1.86) μmol/L ;冠脉轻度狭窄组 (3 0 9.2± 5 0 .11) μmol/L ;冠脉中度狭窄组 (3 3 4.6± 49.69) μmol/L ;冠脉重度狭窄组 (3 62 .7± 48.3 2 ) μmol/L ;冠脉完全闭塞组 (3 93 .4± 47.5 5 ) μmol/L。 5组间比较统计学处理差异均有显著性意义 (P <0 .0 5或P <0 .0 1)。不稳定病变组UA水平与稳定病变组相比 (3 42 .7± 5 4     

血浆溶血磷脂酸水平与急性冠脉综合征相关性的临床研究

目的 :探讨急性冠脉综合征 (急性心肌梗塞、不稳定型心绞痛 )患者血浆溶血磷脂酸 (LPA)水平的变化。方法 :入选 12 0例急性冠脉综合征患者 ,根据病情将其分为急性心肌梗死 (AMI)组 6 0例 ,不稳定型心绞痛组 6 0例 [治疗前不稳定型心绞痛 1组 (UA1) ,治疗后不稳定型心绞痛 2组 (UA2 ) ],并入选 6 0例健康者作为正常对照组 ,分别测定血浆溶血磷脂酸 (LPA)。结果 :AMI组和UA1血浆LPA水平均显著高于对照组 (1 8378± 0 6 75 3μmol/L) ,分别是 3 80 17± 1 6 2 89μmol/L、3 0 2 73± 1 2 76 7μmol/L ,P <0 0 5 ,其中异常增高率AMI组占 6 3 3% ,UA1组占 4 5 % ,UA2 组占 13 3% ,正常组 5 % ,不稳定型心绞痛抗凝抗血小板治疗后LPA明显降低 2 0 4 6± 0 84 72 μmol/L。结论 :血浆溶血磷脂酸作为体内凝血和血栓形成过程早期释放的分子标记物在预测急性冠脉综合征的发生发展及指导合理应用抗血小板及抗凝药物方面有重要应用前景。     

检测C-反应蛋白在冠心病病变程度及预后价值的探讨

目的 :探讨C -反应蛋白 (CRP)与冠心病 (CHD)病变程度及预后之间的关系。方法 :测定经临床确诊的CHD患者 1 38例的血清CRP浓度 ,并与非冠心病患者 5 9例的血清CRP浓度相比较。结果 :急性心肌梗死 (AMI)、不稳定型心绞痛 (UA)、稳定型心绞痛 (SA)及对照组其CRP血清浓度分别为 1 3.2 6± 1 .6 7mg/L、1 1 .2 3± 1 .0 8mg/L、8.1 7± 2 .0 1mg/L、4 .6 2± 1 .6 8mg/L、其中CHD单支变、双支病变及三支病变者其CRP浓度依次增高 ,分别为 8.5 4± 2 .0 3mg/L、1 0 .2 8± 1 .95mg/L、1 2 .1 9± 2 .37mg/L ,显示随着CRP浓度增高病变程度加重、发生急性冠状动脉事件也增高。结论 :检测血清CRP浓度对了解冠心病病变程度及预后有重要价值 ,可作为监测CHD的一个指标     

同型半胱氨酸与冠状动脉病变关系的初步探讨

目的　探讨血浆同型半胱氨酸 (Hcy)水平与冠状动脉病变支数的关系 ,以及其与急性心肌梗死 (AMI)、不稳定性心绞痛 (UA)之间的关系。方法　采用全自动酶化学发光法对 82例行选择性冠状动脉造影术的患者进行血浆Hcy测定。根据冠状动脉造影结果分组 :正常对照组 2 5例 (包括 3例临床诊断为AMI的患者 ) ,单支血管病变组 2 3例 ,双支血管病变组 18例 ,3支血管病变组 16例 ;根据临床诊断分组 :AMI组 36例、UA组 2 4例 (两组冠状动脉病变支数无差异 )和非冠心病组 2 2例。结果　① 3支病变组的Hcy为 (2 5 .14± 11.78) μmol/L ,2支病变组为 (19.6 2± 7.0 4) μmol/L ,单支病变组为 (18.43± 7.16 ) μmol/L ,3组均显著高于正常对照组的 (14.0 6± 2 .5 4) μmol/L(P值均 <0 .0 1)。②AMI组的Hcy为(2 0 .0 7± 7.72 ) μmol/L ,UA组为 (2 0 .6 2± 10 .6 3) μmol/L ,均显著高于非冠心病组的 (14.2 3± 2 .6 3) μmol/L(P值均 <0 .0 1) ;UA组的Hcy略高于AMI组 ,但差异无显著性 (P =0 .41)。 结论　血浆Hcy升高是冠心病的危险因素。其增高不仅与冠状动脉病变支数呈正相关 ,而且与冠状动脉病变的活动显著相关 ,进一步提示增高的血浆Hcy与冠心病心肌缺血事件的发生密切相关。     

茶色素对早期糖尿病肾病患者血浆GMP-140和血浆内皮素的影响

目的 :探讨茶色素对早期糖尿病肾病患者血浆GMP - 14 0和血浆内皮素 (ET)的影响及临床意义。方法 :6 8例早期糖尿病肾病患者随机分成对照组 (n =34)和治疗组 (n =34)两组 ,对照组采用糖尿病 (DM )常规治疗 ,治疗组在常规治疗基础上加用茶色素治疗 ,每天 3次 ,每次 0 .2 4 g口服。两组疗程均为 8周。另选取 30名正常人为健康人组。采用放射免疫法和酶联免疫吸附法分别测定健康人组、对照组与治疗组治疗前后血浆ET、2 4h尿白蛋白排泄率 (UAER)和血浆GMP - 14 0。结果 :糖尿病肾病 (DN)患者血浆ET、血浆GMP - 14 0水平显著高于健康人 (均P <0 .0 1) ,治疗组治疗后血浆ET、血浆GMP - 14 0、UAER水平分别为 70 .6± 19.7ng/L、6 8.9± 19.7μg/L、6 9.5 2± 4 0 .2 7μg/min ,较治疗前的 10 3.2± 2 6 .3ng/L、10 1.2± 39.5 μg/L、10 9.31±72 .15 μg/min明显降低 (均P <0 .0 1) ,对照组治疗后血浆ET、血浆GMP - 14 0、UAER水平分别为 98.4±2 4 .2ng/L、89.2± 35 .9μg/L、95 .35± 4 9.92 μg/min ,较治疗前的 10 1.8± 2 5 .9ng/L、98.9± 37.1μg/L、10 8.2 3±6 9.72 μg/min无明显变化 (均P >0 .0 5 ) ,治疗组治疗 8周后血浆ET、血浆GMP - 14 0、UAER较对照组显著下降 (P <0 .0 1,P <0 .0 5 ,P <0     

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…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…