冠心病患者院内启动调脂治疗的临床研究

目的:探讨冠心病(CHD)患者院内启动调脂治疗对服药依从性和临床预后的影响.方法:398倒住院CHD患者,采用回顾性资料分析和门诊及电话随访方法.结果:CHD患者出院前服用调脂药物占75.9%,应接受调脂治疗的患者平均随访17个月后,院内启动调脂治疗组服用调脂药物比例明显高于院内未启动调脂治疗组(P<0.01),出院后至少进行一次血脂复查者比例院内启动调脂治疗组同样高于未启动调脂治疗组(P<0.05),LDL-C达标率两组间没有显著性差别,两组间心血管事件发生率未见统计学差异(P均>0.05).结论:院内启动调脂治疗可改善患者依从性,提高服药率.     

冠心病合并结直肠癌对血脂水平的影响及调脂治疗探讨

目的:分析研究冠心病伴有结直肠癌对血脂水平造成的影响,以及对其采取调脂治疗的临床治疗效果。方法:抽取2011年4月-2013年8月在我院收治的患有冠心病伴有结直肠癌的病人40例(实验组),同时抽取血脂检查TC全部都在5.70mmol/L或者在5.70mmol/L以上的冠心病病人40例(对照组),对两组病人均采取调脂治疗。结果:实验组TC以及LDL-C明显低于对照组,其差异具有统计学意义(P0.05),实验组Lp(a)明显高于对照组,其差异具有统计学意义(P0.05)。调脂治疗六个月以后,实验组的LDL-C和HDL-C水平持续下降,TC以及Lp(a)没有明显变化,其差异不具有统计学意义(P0.05)。结论:结直肠癌病人的Lp(a)水平增高也许和结直肠癌抗肿瘤效应有密切关系,伴有冠心病的结直肠癌病人血脂谱变化在这种疾病病人当中采取调脂治疗的安全有效性提出更高的要求。     

强化调脂对动脉粥样硬化斑块的影响

目的:探讨强化调脂对动脉粥样硬化斑块的影响。方法:对96例经颈部血管彩色超声多普勒检查确诊为颈动脉粥样硬化斑块形成的患者为研究对象。随机分为强化调脂组和调脂组。调脂组患者进行为期8周的治疗性生活方式改变(TLC)及辛伐他汀口服;强化调脂组患者进行为期8周改进的治疗性生活方式改变(改进TLC)及辛伐他汀、维生素C口服。治疗前后采用高分辨率彩色超声多普勒观察患者颈动脉结构及血流情况,并测定颈动脉内膜-中层厚度(IMT)及血流频谱、血脂等项目,与治疗前作对照分析。结果:两组病例经治疗8周后,调脂组患者颈动脉彩超结果(颈动脉IMT、颈动脉血流的Vmax、RI、PI)与治疗前比较,差异无显著性(P>0.05),血脂检测结果 TC、TG、LDL-C均有下降(t=2.21、2.56、3.34,P<0.01),HDL-C无显著性差异(t=1.42,P>0.05)。强化调脂组患者颈动脉彩超结果(颈动脉IMT)变薄,有显著性差异(t=3.30,P<0.05),而该组颈动脉血流的Vmax、RI、PI与治疗前比较,差异无显著性(P>0.05);另外,强化调脂组患者的TC、TG、LDL-C有显著性下降(t=4.38、3.51、5.23,P<0.01),HDL-C无显著性差异(t=1.19,P>0.05)。结论:强化调脂是治疗动脉粥样硬化安全可靠的一种方案。     

联合应用杏灵分散片和调脂药治疗血脂异常的临床疗效观察

目的 :观察联合应用杏灵分散片和调脂药治疗血脂异常的临床疗效及预后。方法 :对60例血脂异常患者的临床资料进行回顾性分析,将其分为观察组和对照组。为对照组患者单用调脂药进行治疗,为观察组患者联合应用调脂药和杏灵分散片进行治疗,并对比分析其进行治疗后的血脂达标率。结果 :观察组患者的血脂达标率为92.8%,对照组患者的血脂达标率为65.6%,二者相比差异显著(P<0.05),有统计学意义。在为两组患者进行治疗后3个月复查其血脂水平的结果显示,观察组患者的血脂达标率为89%,对照组患者的血脂达标率为45%,二者相比差异显著(P<0.05),有统计学意义。结论:将杏灵分散片与他汀类药物、贝特类药物等调脂药联合起来治疗血脂异常可使患者的血脂更快达标,减少其肝脏受到的损害,改善其预后,此法值得在临床上推广应用。     

调脂积冲剂治疗非酒精性脂肪性肝病临床研究

目的:观察自拟方调脂积冲剂治疗非酒精性脂肪性肝病的临床疗效。方法:非酒精性脂肪性肝病患者70例,随机分为治疗组35例,予调脂积冲剂(每包含生药4.14g),1次1包,1天2次,口服,连续治疗3个月。对照组35例,予荷丹片(0.73g/片),1次2片,1天3次,口服,连续治疗3个月。观察两组治疗前后肝功能、血脂、B超情况。结果:两组治疗后肝功能ALT、AST、GGT均较治疗前改善(P0.01),组间比较差异无统计学意义(P0.05)。两组治疗后TG、TC与治疗前比较,差异有统计学意义(P0.05),组间比较差异无统计学意义(P0.05)。但治疗组中医症状积分改善优于对照组(P0.05)。B超肝脏影像学正常率治疗组优于对照组(P0.05)。结论:调脂积冲剂对非酒精性脂肪性肝病患者有较好疗效。     

整合疗法治疗高脂血症的疗效观察

目的:观察肝病治疗仪运用脉冲电磁场,以中药离子导入治疗为核心,辅以耳穴贴压、有氧运动、饮食疗法为整合方案,加强对高脂血症的治疗效果,并探讨其作用机理.方法:采用随机设计,将112例符合标准的患者分为A、B组,每组56例.在肝病治疗仪统一治疗前提下,观察两组疗程前后血脂值变化,并进行统计学分析.结果:两组降低TC、TG、LDL-C有显著疗效(P<0.05),HDL-C升高.两组疗效对比:A组在治疗后调脂作用明显优于B组(P<0.05).结论:整合效应(肝病治疗仪、耳穴贴压、有氧运动、营养平衡)为一体,治疗高脂血症有明显的调脂效果.时防治心脑动脉硬化有一定的使用价值,临床值得推广应用.     

阿托伐他汀对高脂血症患者血浆C反应蛋白的影响

目的观察阿托伐他汀对70例高脂血症患者血浆C反应蛋白(CRP)的影响。方法70例高脂血症患者随机分为2组,2组同时饮食控制和改变生活方式,对照组未用任何调脂药物,治疗组口服阿托伐他汀10mg/次,1次/d,1个月后观察血脂及CRP的变化。结果治疗组1个月后总胆固醇和低密度脂蛋白较治疗前有明显降低(P<0.05),高密度脂蛋白与甘油三酯前后差异无统计学意义(P>0.05),各项血脂参数前后均无明显差异(P>0.05),血浆CRP前后有明显差异(P<0.05);对照组差异无统计学意义(P>0.05)。治疗后2组CRP差异有统计学意义(P<0.05),且治疗组血浆CRP浓度的降低与血浆总胆固醇、低密度脂蛋白浓度的降低无明显相关性(P>0.05),但与血浆高密度脂蛋白的升高呈显著负相关(r=-0.22,P<0.01)。结论阿托伐他汀可短期内安全有效地降低血浆CRP水平,且独立于降血脂作用,可有效减少CHD事件发生,改善预后。     

耳穴贴压联合生活方式干预对非酒精性脂肪肝的疗效

目的观察耳穴贴压联合饮食治疗、有氧运动等生活方式干预对非酒精性脂肪肝的疗效及影响。方法将96例非酒精性脂肪肝患者随机分为观察组(耳穴贴压联合生活方式干预组)、对照组(生活方式干预组)。治疗4个月后,对血脂(TC、TG、HDL-C)、肝功能(ALT、AST、GGT)、体质指数(BMI)、腰围、B超等指标进行检测与评价。结果两组患者在血脂(TC、TG)、肝功能(ALT、AST、GGT)、BMI、腰围、B超指标均有明显降低,HDL-C有明显升高;两组患者观察期前后组内数据对比均差异有统计学意义(P<0.05或P<0.01),观察组与对照组观察期结束后对比差异有显著性(P<0.05)。结论耳穴贴压联合饮食治疗、有氧运动等生活方式干预对治疗非酒精性脂肪肝疗效显著。     

卷烟厂中老年女性职工骨密度与生活方式关联的调查分析

【摘要】 目的 调查卷烟厂中老年女性人群骨密度（BMD）与生活方式的关系,为制订特殊职业人群简便易行、易于接受的预防骨质疏松性骨折的方法提供科学依据。方法 问卷调查参加健康体检的许昌市卷烟厂45岁~65岁的女性职工,并采用双能X线测定腰椎骨密度,分析许昌市卷烟厂中老年女性职工工龄、体重指数、运动及牛奶摄入等对骨密度的影响。同时,将所有调查对象分别分为：运动组Ⅰ［运动频率高于4次/周,运动时间大于1小时/次（小于2小时）,已坚持半年以上者］和运动组Ⅱ（运动频率高于4次/周,运动时间大于2小时/次,已坚持半年以上者）;喝牛奶组Ⅰ［饮用牛奶次数大于5次/周,每次饮用量大于或等于250ml（小于500ml）,已坚持半年以上者］和喝牛奶组Ⅱ（饮用牛奶次数大于5次/周,每次饮用量大于或等于500ml,已坚持半年以上者）。结果 随着工龄增长,骨密度呈逐渐下降趋势,体重指数与骨密度呈正相关。运动组腰椎骨密度高于无运动组,差异有统计学意义(P＜0.05)。运动组Ⅰ与运动组Ⅱ腰椎骨密度比较,差异无统计学意义(P＞0.05)。喝牛奶组腰椎骨密度高于对照组,差异有统计学意义(P＞0.05)。喝牛奶组Ⅰ与喝牛奶组Ⅱ腰椎骨密度比较,差异无统计学意义(P＞0.05)。结论 保持较高体重指数高、体育运动（每次运动1小时左右）、长期饮用牛奶或酸奶（每次大于250ml）是降低特殊职业人群骨质疏松发生的有效方法,亦是适易于群众接受、简便易行的健康生活方式。     

有氧运动对高脂膳食金黄地鼠糖脂代谢及肝脏过氧化物酶增殖体受体的影响

目的探讨有氧运动对高脂膳食金黄地鼠糖脂代谢及过氧化物酶增殖体受体(PPARs)的影响。方法将健康雄性清洁级金黄地鼠20只随机分为对照组和运动组,每组10只。2组金黄地鼠均给予质量分数10%高脂膳食。运动组金黄地鼠做跑台运动10周,对照组未做跑台运动。10周后检测金黄地鼠生物化学指标及肝脏组织中PPARs的基因表达。结果有氧运动10周后,2组金黄地鼠血清三酰甘油、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇比较差异无统计学意义(P>0.05);运动组金黄地鼠空腹血糖、胰岛素水平明显低于对照组,差异有统计学意义(P<0.05,P<0.01);有氧运动可以金黄地鼠提高肝脏总胆固醇、肝脂酶、脂蛋白脂酶(LPL)水平(P<0.05);2组金黄地鼠血清、肝脏、肌肉及肾周脂肪中游离脂肪酸比较差异无统计学意义(P>0.05);有氧运动升高金黄地鼠肝脏PPARs不明显(P>0.05)。结论有氧运动对高脂膳食金黄地鼠肝脏PPARs影响不明显,但可以调节糖脂代谢,降低血糖及胰岛素水平,改善胰岛素抵抗。     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.