餐后血脂抑制甲状腺功能减退症患者的内皮依赖性血管舒张功能

目的探讨临床甲状腺功能减退症（简称甲减）和亚临床甲减患者餐后血脂与血管内皮功能的关系。方法选择10名正常女性受试者为对照组,20名甲减患者分成两组：临床甲减组与亚临床甲减组（每组各10例）。采用高分辨血管外超声法检测肱动脉血流介导的内皮依赖性血管舒张功能和硝酸甘油（GNT）介导的内皮非依赖性血管舒张功能。结果餐后血脂引起甲减患者血管内皮功能异常与三酰甘油和自由基水平密切相关。脂肪餐负荷试验中,甲减患者及正常对照组在餐后4 h时,内皮依赖性血管舒张功能降低（P〈0.05）,对照组和亚临床甲减组患者在8 h时内皮依赖性血管舒张功能恢复到基线水平,亚临床甲减组患者在6 h时内皮依赖性血管舒张功能低于基线水平（P〈0.05）。然而,临床甲减组患者在进食脂负荷餐后6 h时内皮依赖性血管舒张功能继续下降（P〈0.01）,在8 h时开始升高,但仍低于基线水平（P〈0.05）。Spearman’s分析显示甲减组（P〈0.01）和对照组患者（P〈0.05）进食脂负荷餐后内皮依赖性血管舒张功能与三酰甘油﹑硫代巴比土酸反应物质（TBARS）水平呈负相关,而三酰甘油水平与TBARS水平呈正相关。结论进食脂负荷餐后,甲减患者和正常对照组的内皮依赖性血管舒张功能降低,且与血清三酰甘油和氧自由基水平密切相关。     

脂联素改善肥胖大鼠离体主动脉内皮依赖性血管舒张功能的实验研究

目的 研究脂联素对食物诱导的肥胖大鼠内皮依赖性血管舒张功能的影响.方法 将10只SD雄性大鼠分为2组,正常对照组予普通饲料喂养;高脂饲料组予高脂饲料喂养.6周后处死动物,将3 mm长的主动脉环置于培养皿中,分别以脂联素及脂联素加内皮一氧化氮合成酶特异性抑制剂(L-NAME)孵育离体血管环,并与空白对照比较,在器官浴槽中观察离体胸主动脉环对乙酰胆碱或硝普钠的舒张反应.结果 高脂饲料喂养的大鼠内皮依赖性舒张功能明显受损,其最大舒张程度仅为对照组的29%.脂联素组内皮依赖性血管舒张功能较高脂饲料组增加102%,脂联素加L-NAME组内皮依赖性血管舒张功能接近丧失.结论 脂联素对肥胖动物受损的血管内皮细胞具有确切的直接保护作用.     

阿托伐他汀钙对急性心肌梗死患者血管内皮细胞功能的影响

目的　观察心肌梗死急性期降脂治疗对内皮依赖性血管舒张功能的作用。方法　采用超声法检测 2 0例急性心肌梗死 (AMI)和 2 0例健康成年人肱动脉内皮依赖性舒张功能、内皮非依赖性舒张功能。 2 0例AMI患者在常规治疗 (血管紧张素转换酶抑制剂、β受体阻滞剂和阿司匹林等 )的基础上口服阿托伐他汀钙 10mg d ,8周后复测肱动脉内皮依赖性舒张功能、内皮非依赖性舒张功能和血脂全套。结果　AMI患者肱动脉内皮依赖性舒张功能 (2 .5 3± 1.18) %较对照组 (8.6 9± 3.31) %明显降低 (P<0 .0 0 1) ,AMI组的肱动脉内皮非依赖性舒张功能 (17.2 1± 5 .36 ) %也较对照组 (2 5 .18± 9.34) %明显降低 (P <0 .0 1)。AMI患者服用 10mg d阿托伐他汀钙治疗 8周后 ,肱动脉内皮依赖性舒张功能 (6 .32±2 .86 ) %较治疗前 (2 .5 3± 1.18) %有显著改善 (P <0 .0 1)。肱动脉内皮非依赖性舒张功能与治疗前比较差异无显著性 (17.0 4 %± 5 .2 7%vs 17.2 1%± 5 .36 % ,P >0 .0 5 )。治疗后TC、LDL C和TG水平明显降低 (P <0 .0 5 )。结论　AMI患者肱动脉内皮依赖性血管舒张功能明显减退 ,短期口服阿托伐他汀钙 (10mg d)降脂治疗对受损的血管内皮功能有改善作用     

原发性高血压患者血管内皮功能失调与活性氧的关系及阿托伐他汀治疗的影响

目的观察高血压病患者血管内皮依赖性舒张功能与活性氧的关系及阿托伐他汀治疗的影响.方法将58例高血压病患者随机分为对照组(服用双氢克尿噻和倍他乐克)和实验组(另加用阿托伐他汀),检测两组治疗前后及28例正常人的血清超氧化物歧化酶(superoxidc dismutase,SOD)水平、血管内皮依赖性舒张功能.结果高血压患者血清SOD水平降低,血管内皮依赖性舒张功能受损,两者显著正相关.治疗2个月后,两组血清SOD水平均升高,而实验组SOD升高更显著,且血管内皮依赖性舒张功能改善.结论活性氧是高血压血管内皮功能的主要影响因素,他汀类可通过减少活性氧保护血管内皮功能.     

Interaction of hypertension and diabetes on impairment of endothelial function

目的　评价血管平滑肌功能 (硝酸甘油引起的血管舒张 )不全与内皮功能不全的联系并探讨糖尿病与高血压对内皮功能的损害是否具有协同作用。方法　用高分辨率超声波仪测定肱动脉对硝酸甘油 (NTG)的扩张反应及血流介导的内皮依赖性血管舒张(EDD)。结果　平滑肌功能受损与受损的EDD呈正相关 (r =0 54,P <0 0 0 1)。单纯糖尿病或高血压仅EDD较对照组降低 ( 5 74 %± 3 32 % ;4 14%± 2 93%对 9 4 5%± 3 88% ,P分别 <0 0 5及 0 0 1) ,糖尿病合并高血压组不仅EDD受损 ( 2 78%± 2 0 8% ,P <0 0 0 1) ,平滑肌功能也受损 ( 14 11%± 4 63对 2 3 53%± 6 77% ,P <0 0 0 1)。结论　导致血管内皮功能不全的病理过程可能也同样损害血管平滑肌功能。 2型糖尿病与高血压相互作用加重血管舒张功能不全。     

实验性高胆固醇血症兔离体主动脉功能变化的研究

目的探讨高胆固醇血症对血管功能的影响。方法20只新西兰雄性兔随机分为2组正常饮食组(normal cholesterol,NC)10只及高胆固醇饮食组(hypercholesterol,HC)10只。4周后取出每只兔的降主动脉,5mm宽动脉环放置于含有25mlKreb液的组织－器官水浴系统中。分别测量游离血管对乙酰胆碱（10-10～10-5mol/L)的舒张反应及对去甲肾上腺素（10-10～10-5mol/L）的收缩反应。结果2组兔血胆固醇有显著差异,其中NC组（30.1±11.2）mg/dl,HC组（987.3±110.0)mg/dl(P<0.01);HC组血管对乙酰胆碱舒张反应与NC组比较明显减弱,HC组最大为（58.50±6.17）％,NC组最大为(103.2±6.9)％(P<0.01）;HC组血管对去甲肾上腺素反应增强,最大收缩力HC组为(4.15±0.56)g,NC组为(2.9±0.3)g(P<0.05）。2组动脉病理学检查无动脉硬化的改变。结论高胆固醇血症降低血管内皮依赖性舒张反应,增加血管对去甲肾上腺素的收缩反应。高胆固醇血症时血管内皮功能改变早于动脉粥样硬化的结构改变。     

痰湿壅塞证高血压病患者血管内皮依赖性舒张功能的超声研究

目的:应用高分辨超声观察痰湿壅塞证高血压病患者血管内皮依赖性舒张功能(FMD),探讨化湿利水泄浊合剂对EH患者FMD的保护作用以及对血浆内皮素(ET)的影响。方法:将50例痰湿壅塞证高血压病患者随机分为治疗组(25例)和对照组(25)例,分别采用化湿利水泄浊合剂和西拉普利治疗,治疗前后分别用高分辨率超声检测各组患者的肱动脉内皮依赖性舒张功能,同时用放射免疫法测定ET含量。结果:高血压病患者存在FMD失调,用化湿利水泄浊合剂治疗后患者的FMD明显改善;ET水平降低(P<0.05)。结论:化湿利水泄浊合剂可降低EH患者血浆内皮素水平,对EH患者血管内皮依赖性舒张功能有保护作用。     

辛伐他汀对冠心病患者血管内皮功能的影响

目的探讨冠心病患者血管内皮依赖性舒张功能及血清NO浓度的变化及辛伐他汀干预对其的影响。方法用高分辩超声技术检测各组对象的肱动脉内皮依赖性舒张功能,并测定血清NO浓度,药物干预8周后复测上述指标。结果与正常对照组比较,冠心病患者肱动脉内皮依赖性舒张功能明显减退(P<0.01),血清NO浓度降低(P<0.01)。辛伐他汀可改善血管内皮依赖性舒张功能([8.12±4.26)%vs(2.64±1.35)%,P<0.01],升高血清NO浓度([68.35±18.34)μmol/Lvs(48.64±15.97)μmol/L,P<0.01],并且血管内皮依赖性舒张功能的改善与血清NO浓度的增加正相关(r=0.827,P<0.01)。结论冠心病患者肱动脉内皮依赖性血管舒张功能明显减退,血清NO浓度降低。辛伐他汀通过增加血清NO浓度改善冠心病患者的血管内皮功能,该作用可能是他汀类调脂药防治冠心病的机制之一。     

原发性高血压患者血管内皮依赖舒张功能变化与细胞浆内游离钙代谢的关系

该研究旨在探讨原发性高血压 (EH)患者血管内皮依赖舒张功能变化与细胞浆内游离钙代谢的关系。材料和方法 :EH和正常对照 (Control)各 2 0例。用高分辨超声测定肱动脉内皮依赖性血流介导血管舒张 (FMD)和舌下含服硝酸甘油后非内皮依赖性舒张。用FURA - 2荧光探针法测量细胞内钙。结果 :两组性别、年龄和血脂水平无统计学差异 ,EH和Control组FMD(% )分别为 2 18± 4 6和 9 12± 4 8(P <0 0 5 ) ;EH组和Control组细胞胞浆内游离钙 (nmol/L)分别为 111 6 0± 2 2 71和 81 6 7± 2 1 31(P <0 0 5 ) ;FMD(% )与细胞胞浆内游离钙浓度呈负相关关系 (γ =- 0 5 2 ,P <0 0 5 ) ,两组舌下含服硝酸甘油后血管舒张无统计学差异。结论 :EH患者血管内皮依赖舒张功能下降可能与NO活性下降后对血管平滑肌细胞内钙升高抑制作用下降 ,导致血管平滑肌细胞内钙升高有关。细胞钙代谢可以作为血管内皮功能变化的一个重要参考指标。     

氟伐他汀对不稳定型心绞痛患者血管内皮功能的影响

目的:探讨氟伐他汀对不稳定型心绞痛(UA)患者血管内皮依赖性血管舒张功能(FMD)的影响。方法36例UA患者随机分为氟伐他汀组与对照组,治疗8周前后,采静脉血用酶法测定胆固醇和甘油三酯;采用高分辨血管外超声法检测治疗前后肱动脉FMD和非内皮依赖性舒张功能(NMD)。结果:氟伐他汀治疗8周后肱动脉FMD(12.3%±1.4%)较治疗前(5.1%±1.2%)及对照组(5.4%±1.9%)均显著改善(P<0.05),而肱动脉NMD差异无显著性意义(P>0.05)。结论:氟伐他汀具有改善UA患者血管FMD的作用。     

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…