不同剂量阿托伐他汀治疗冠心病的疗效及安全性分析

目的 分析不同剂量阿托伐他汀治疗冠心病的疗效及安全性.方法 选取冠心病患者63例,随机分为对照组(n=30)和观察组(n=33),给予观察组患者阿托伐他汀40mg/d,给予对照组患者阿托伐他汀20 mg/d.对比两组血清高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TCHO)含量、颈动脉粥样硬化斑块情况及不良反应情况.结果 治疗前两组患者HDL-C、LDL-C、TCHO含量及颈动脉粥样硬化斑块厚度等指标比较,差异无统计学意义;治疗后观察组HDL-C(1.71±0.27)mmol/L、LDL-C(0.99±0.45)mmol/L、TCHO(3.14±0.51)mmol/L及颈动脉粥样硬化斑块厚度(1.02±0.18)mm等指标优于对照组HDL-C(0.93±0.18)mmol/L、LDL-C(3.28±1.14)mmol/L、TCHO(5.86±0.84)mmol/L及颈动脉粥样硬化斑块厚度(1.60±0.25)mm,差异具有统计学意义(P<0.05);观察组不良反应发生率6.06%(2/33),对照组不良反应发生率3.33%(1/30),两组比较差异无统计学意义.结论 较高剂量阿托伐他汀治疗冠心病,能显著改善患者血脂水平,缓解心肌缺血状况,疗效显著,具有较高的推广价值.     

低密度脂蛋白、高敏C-反应蛋白、脑钠肽的测定对冠心病的临床意义

目的:探讨血清中低密度脂蛋白(LDL-C)、高敏C-反应蛋白(hs-CRP)、脑钠肽(BNP)浓度与冠心病的关系及临床意义。方法:测定100例经冠状动脉造影(CAG)确诊冠心病(CHD)患者的LDL-C、hs-CRP、BNP水平,并与40例健康体检对照者相比较,分析LDL-C、hs-CRP及BNP的临床意义。结果:心肌梗死(AMI)组[(2.6±0.7)mmol/L]和不稳定型心绞痛(UA)组[(2.6±0.6)mmol/L]LDL-C均高于稳定型心绞痛(SA)组[(2.2±0.7)mmol/L],差异均有统计学意义(P<0.05);AMI组[(2.6±0.7)mmol/L]和UA[(2.6±0.6)mmol/L]组间及对照组[(2.1±0.6)mmol/L]和SA组[(2.6±0.7)mmol/L]间差异均无统计学意义(P>0.05)。CHD组hs-CRP明显高于对照组[(2.1±1.4)mg/L],且AMI组[(13.1±9.4)mg/L]、UA组[(9.2±5.2)mg/L]高于SA组[(5.2±2.1)mg/L],AMI组明显高于UA组,差异均有统计学意义(P<0.05)。AMI组[(457.0±449.3)pg/ml]和UA组[(170.0±99.9)pg/ml]BNP高于对照组[(22.4±19.6)pg/ml]和SA组[(42.8±40.1)pg/ml],AMI组[(457.0±449.3)pg/ml]高于UA组[(170.0±99.9)pg/ml],差异均有统计学意义(P<0.05);对照组[(22.4±19.6)pg/ml]和SA组[(42.8±40.1)pg/ml]间差异无统计学意义(P>0.05)。结论:联合检测LDL-C、hs-CRP和BNP的水平对冠心病的诊断和治疗有一定的参考价值。     

冠心病心绞痛患者血浆白细胞介素-6和单核细胞趋化因子-1变化及其临床意义

目的探讨白细胞介素-6(IL-6)及单核细胞趋化因子-1(MCP-1)在冠心病心绞痛发病机制中的作用。方法选择冠状动脉造影确诊的心绞痛患者70例,包括稳定型心绞痛(SAP)组36例,不稳定型心绞痛(UAP)组34例,另选择30例冠状动脉造影正常者作为对照组。采用酶联免疫吸附法检测血浆IL-6、MCP-1水平。结果 UAP组血浆IL-6、MCP-1水平为(18.12±2.62)pg/L、(25.63±4.76)pg/L,显著高于SAP组的(14.98±2.54)pg/L、(21.78±4.53)pg/L(P<0.01),UAP组、SAP组均高于对照组(11.68±2.51)pg/L、(15.71±4.34)pg/L(P<0.01)。结论血浆IL-6与MCP-1在冠心病患者中显著升高,在反映冠状动脉斑块稳定性及冠状动脉病变的严重程度方面有重要的临床意义。     

依折麦布联合辛伐他汀对极高危人群强化降脂的作用及安全性评价

目的:观察依折麦布联合辛伐他汀对单独应用辛伐他汀未能使总胆固醇(TC)达标的心肌梗死患者或心绞痛合并糖尿病患者血脂的影响,并对其安全性进行评价?方法:经辛伐他汀(40 mg/d)治疗4周后TC未达标(>3.5 mmol/L)的心肌梗死患者或心绞痛合并糖尿病患者47例,在应用辛伐他汀的基础上联合应用依折麦布(10 mg/d)继续治疗4周,观察治疗后的血脂水平及药物对丙氨酸氨基转移酶(ALT)及肌酸激酶(CK)的影响?结果:联用依折麦布前后46例患者的TC分别为(4.01±0.50)mmol/L和(2.97±0.38)mmol/L(P < 0.01),低密度脂蛋白胆固醇(LDL-C)分别为(2.42±0.41) mmol/L和(1.53±0.45)mmol/L(P < 0.01),联用依折麦布前后高密度脂蛋白胆固醇(HDL-C)无显著变化(P=0.605),ALT及CK也无显著变化(P=0.057,P=0.738)?结论:依折麦布联合辛伐他汀可以达到冠心病患者强化降脂的作用,使TC?LDL-C较单独应用辛伐他汀进一步降低,且无肝脏及肌肉损伤?     

急性冠状动脉综合症患者超敏C反应蛋白和血脂检测及临床意义

目的:探讨血清超敏C反应蛋白(hs-CRP)和非高密度脂蛋白胆固醇(NHDL-C)在急性冠状动脉综合症(ACS)的临床价值。方法:用Roche/MODULAR P生化分析仪胶乳增强免疫比浊法检测hs-CRP、酶法检测总胆固醇(TC)、甘油三酯(TG)、直接匀相法检测高密度脂蛋白胆固醇(HDL-C),非高密度脂蛋白胆固醇(NHDL-C)计算法(TC-HDL-C)。结果:ACS组血清hs-CRP为(13.40±7.80)mg/L、TC(4.84±1.02)mmol/L、TG(1.57±0.86)mmol/L、HDL-C(1.06±0.31)mmol/L、NHDL-C(3.58±0.92)mmol/L;健康对照组血清hs-CRP为(0.82±0.74)mg/L、TC(4.68±0.81)mmol/L、TG(1.38±0.77)mmol/L、HDL-C(1.42较,hs-CRP、HDL-C、NHDL-C水平差异均有显著性(P<0.01),TC、TG水平差异均无显著性;ACS组hs-CRP水平分别与HDL-C、NHDL-C水平进行相关分析,均无直线相关性(r=0.125,0.134);健康对照组用同样指标进行相关分析,也均无直线相关性(r=0.106,0.113)。结论:血清hs-CRP、HDL-C、NHDL-C水平与ACS事件发生有关,可作为ACS患者诊断、治疗、预后的观察指标。     

单核细胞趋化蛋白1肿瘤坏死因子α与冠状动脉斑块易损性的相关性研究

目的 探究单核细胞趋化蛋白-1 (MCP-1)和肿瘤坏死因子α(TNF-α)与冠状动脉斑块易损性的相关性及其对于冠心病不稳定性斑块的诊断价值.方法 选取2010年8月至2016年8月河南省人民医院收治的经冠状动脉造影(CAG)检查确诊的98例冠心病患者为研究对象,根据冠状动脉内超声显像(IVUS)的结果分为不稳定性斑块组(53例)和稳定性斑块组(45例).选择该院同期健康体检者50例为对照组.比较3组患者血浆MCP-1、TNF-α水平,分析其与冠心病传统危险因素的相关性,采用受试者工作特征(ROC)曲线分析MCP-1、TNF-α对于冠心病不稳定性斑块的诊断价值.结果 不稳定性斑块组血浆MCP-1和TNF-α水平显著高于稳定性斑块组(P＜0.05),且不稳定性斑块组及稳定性斑块组上述指标水平均显著高于对照组(P＜0.05);MCP-1水平与年龄、尿酸、体质量指数(BMI)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、TNF-α、肌酸激酶同工酶(CK-MB)呈正相关(r=0.203、0.169、0.189、0.187、0.258、0.437、0.696),TNF-α水平与尿酸、BMI、TC、LDL-C、CK-MB呈正相关(r=0.133、0.153、0.362、0.586、0.411),与高密度脂蛋白胆固醇(HDL-C)呈负相关(r=-0.351);MCP-1、TNF-α单项检测冠心病不稳定性斑块的灵敏度分别为0.833、0.893,但联合检测的灵敏度更高,可达0.909.结论 血清MCP-1、TNF-α对于冠状动脉斑块易损性具有一定的诊断价值,有望成为新的判断冠心病斑块性质的指标.     

阿托伐他汀联合二甲双胍对急性冠脉综合征患者TF的影响

目的:研究阿托伐他汀联合二甲双胍对急性冠脉综合征(acute coronary syndrome,ACS)患者血清组织因子(tissue factor,TF)的影响?方法:首先取10名ACS患者空腹静脉血进行人单核细胞分离?培养,分别予以终浓度为0?0.1?1.0?10.0 μmol/L阿托伐他汀,0?0.1?1.0?10.0 μmol/L二甲双胍,以及联合应用1.0 μmol/L阿托伐他汀和1.0 μmol/L二甲双胍进行干预,用酶联免疫吸附试验检测培养细胞膜TF水平?其次选取48名ACS患者根据服用药物情况分为未用药物干预组,阿托伐他汀组,二甲双胍联合阿托伐他汀组,检测外周血中TF含量,同时检测患者空腹血脂?血糖?胰岛素?C肽?C反应蛋白等相关指标?结果:阿托伐他汀组在各浓度(0,0.1,1.0,10.0 μmol/L)时TF测定值分别为(5.62±1.09)pg/ml?(4.35±0.75)pg/ml?(3.70.±0.91)pg/ml?(2.68±0.67)pg/ml,二甲双胍组在各浓度(0?0.1?1.0?10.0 μmol/L)时为(5.62±1.09)pg/ml?(5.12±0.88)pg/ml?(3.97±0.46)pg/ml?(3.02±0.88)pg/ml,阿托伐他汀联合二甲双胍组在0及各1.0 μmol/L干预时TF所测浓度为(5.62±1.09)pg/ml?(1.98±0.86)pg/ml?在48名ACS患者外周中,阿托伐他汀组?联合使用二者组与未用药物干预组TF分别为(88.25±21.55)pg/ml?(57.63±23.75)pg/ml?(216.28±95.42)pg/ml,3组之间差异有统计学意义(P < 0.05),同时血糖及血脂等相关指标也有统计学差异(P < 0.05)?结论:阿托他汀或二甲双胍均可降低ACS外周血单核细胞合成TF的表达,并呈现浓度依赖性,在ACS患者中阿托伐他汀联合二甲双胍可改善血脂异常,提高胰岛素敏感性,协同降低ACS患者血循环中TF表达?     

替米沙坦对高血压病脉压和CRP、TNF-α、IL-6的影响

 【目的】 检测高血压病患者血浆hs-CRP?TNF-α?IL-6水平,探讨其与脉压的关系?观察其受替米沙坦/HCT和比索洛尔的影响,分析两类药物抗炎和降低脉压作用的差异?【方法】 90例高血压病患者和15例健康对照者,检测血浆hs-CRP?TNF-α?IL-6水平;高血压病患者随机分为两组,分别应用替米沙坦/HCT(80 mg/12.5 mg,qd )和比索洛尔(5 mg,qd)治疗6周,观察两亚组患者血压?脉压及血浆hs-CRP?TNF-α?IL-6水平的变化?【结果】 和健康对照组比较,高血压病患者血浆炎症因子水平升高[hs-CRP(mg/L)3.4±3.1 vs 1.2±1.6,TNF-α(pg/L)4.5 ± 3.1 vs 1.1 ± 1.3,IL-6(pg/L)187 ± 43 vs 36 ± 11,均P < 0.05];高血压病患者分组治疗6周后,替米沙坦/HCT组患者血浆炎症因子水平明显下降,而比索洛尔组无明显变化[降低值hs-CRP(mg/L)1.83 ± 1.67 vs 0.10 ± 1.50,TNF-α(pg/L)2.4 ± 1.9 vs 0.2 ± 1.2,IL-6(pg/L)48 ± 13 vs 12 ± 8,均P < 0.05],替米沙坦组脉压的下降较比索洛尔组明显[PP(mmHg)8.5 ± 7.6 vs 2.1 ± 8.9,P < 0.05)]?【结论】 高血压病患者血浆hs-CRP?TNF-α?IL-6水平升高?可能与脉压有关,替米沙坦/HCT较比索洛尔更明显降低脉压和炎症因子水平?     

脑梗死与血脂、血尿酸水平的相关分析

目的:探讨脑梗死与血脂、血尿酸水平(UA)的关系。方法:选择我院住院诊断新发脑梗死患者662例,经颅多普勒超声检查及颈动脉超声检查,其中180例提示有颅内或颅外动脉狭窄(狭窄组),其余482例为非狭窄患者(非狭窄组),另选择80例年龄和性别与狭窄组、非狭窄组相匹配的体格检查健康者为对照组。采用全自动生化分析仪测定三组患者血脂、血尿酸水平。结果:血管狭窄组患者血浆总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)及血尿酸分别为(4.7±0.7)mmol/L、(1.7±0.8)mmol/L、(3.7±0.8)mmol/L和(420.1±98.2)μmol/L;非狭窄组患者为(4.2±1.0)mmol/L、(1.6±0.5)mmol/L、(3.4±0.6)mmol/L和(398.6±78.1)μmol/L;对照组为(3.5±0.9)mmol/L、(1.4±0.7)mmol/L、(2.8±0.9)mmol/L和(310.5±60.6)μmol/L。狭窄组、非狭窄组与对照组比较,差异均有显著性(P<0.01);狭窄组与非狭窄组血浆TC、TG、LDL-C、尿酸水平比较,差异亦有显著性(P<0.01);血尿酸与TC、TG、LDL-C无显著相关性(P>0.05)。结论:血浆TC、TG、LDL-C、血尿酸水平增高,是脑梗死患者独立危险因素,且与血管狭窄相关。     

2型糖尿病患者血脂八项检测及其意义探讨

目的:探讨2型糖尿病患者发生动脉硬化性心血管合并症的危险因素。方法:对223例尚无心血管合并症的2型糖尿病患者,进行血清总胆固醇(TC)、甘油三脂(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A1(ApoA1)、载脂蛋白B(ApoB)、脂蛋白LP(a)检测;并与102位健康人进行对照分析。结果:对照组TC、TG、HDL-C、LDL-C、ApoA1、ApoB、ApoA1/ApoB和LP(a)分别为:(4.55±0.72)mmol/L、(1.03±0.43)mmol/L、(1.48±0.29)mmol/L、(2.98±0.68)mmol/L、(1.28±0.17)g/L、(0.78±0.15)g/L、(1.84±0.26)g/L和(0.12±0.08)g/L;患者组TC、TG、HDL-C、LDL-C、ApoA1、ApoB、ApoA1/ApoB和LP(a)分别为:(4.62±0.87)mmol/L、(2.08±0.66)mmol/L、(1.02±0.44)mmol/L、(3.53±0.81)mmol/L、(1.02±0.24)g/L、(0.98±0.26)g/L、(1.09±0.29)和(0.28±0.11)g/L。两组比较:除TC外,其余各项结果差异均有显著性意义(P<0.01或P<0.05)。结论:2型糖尿病患者在出现动脉硬化性心血管合并症之前,体内已具备了诱发合并症的生化基础,故治疗糖尿病的同时,应及早采取针对性措施预防动脉硬化性心管合并症的发生。     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.