吡格列酮治疗早期糖尿病肾病33例

目的探讨吡格列酮治疗2型糖尿病合并糖尿病肾病（DN）的疗效及其抗炎机制。方法选择2006年2月至2007年12月我院门诊及住院的63例早期DN患者,随机分为治疗组和对照组。对照组给予常规治疗,治疗组每日加服吡格列酮30mg。比较两组治疗前及治疗后3、6、9个月的尿白蛋白排泄率（UAER）、血肌酐（Scr）和C-反应蛋白（CRP）等指标。结果治疗组UAER和Scr下降比对照组明显（P〈0．05,P〈0．01）,起效更快（早3个月）;治疗组CRP明显下降（P〈0．05,P〈0．01）,而对照组CRP下降不明显（P〉0．05）。结论吡格列酮不仅可以改善代谢紊乱,还可以降低CRP的抗炎效应而减轻微量白蛋白尿和改善肾功能。     

辛伐他汀联合川芎素干预早期糖尿病肾病疗效观察

目的探讨辛伐他汀联合川芎素干预早期糖尿病肾病的临床疗效。方法43例早期糖尿病肾病患者随机分为两组。两组患者均在严格执行糖尿病饮食、减少蛋白质摄人、常规降糖药物和（或）降压药物治疗的基础上，治疗组给予辛伐他汀20mg／d，口服，同时给口服川芎素200mg／d；对照组给辛伐他汀20mg／d，口服。两组疗程3个月。结果两组治疗后血肌酐（Scr）、血尿素氮（BUN）、尿清蛋白排泄率（UAER）均有改善（P〈0．05），治疗组治疗后与对照组同期比较更明显（P〈0．05）；治疗组治疗后C-反应蛋白（CRP）明显下降（P〈0．05），而对照组下降不明显（P〉0．05）。结论辛伐他汀具有降低CRP的抗炎效应，与川芎素联用对早期DN进行干预治疗，可有效地减少蛋白质，改善肾功能。     

氟伐他汀对早期糖尿病肾病的疗效观察

目的探讨氟伐他汀治疗糖尿病肾病的疗效及其作用机制。方法将早期患者60例随机分为氟伐他汀（治疗组）和安慰剂（对照组）,各30例。对照组给予糖尿病饮食,控制血糖等常规治疗;治疗组每晚加服氟伐他汀40mg。3个月后,比较两组治疗前及治疗后的尿清蛋白排出率（UAER）、血肌酐（Scr）和C反应蛋白（CRP）等指标。结果治疗组UAER、Scr和CPR下降较治疗前明显降低（P〈0．01）,与对照组比较UAER、CPR下降更明显。而对照组3者下降较治疗前不明显（P〉0．05）。结论氟伐他汀因降低CPR的抗感染效应而减轻微量清蛋白尿和改善肾功能,该作用不依赖其降血脂效应。     

辛伐他汀联合氯沙坦治疗血脂正常的早期糖尿病肾病临床分析

目的进一步探讨辛伐他汀和氯沙坦对糖尿病肾病患者肾脏保护作用的可能机制。方法将54例血浆密度脂蛋白（LDL—C）水平正常的早期DN患者随机分为两组,两组患者均接受糖尿病饮食、运动、降糖等综合治疗,限制蛋白质摄入为0．8g／（kg·d）,待有效控制血糖1周后,治疗组给予氯沙坦50mg／d,晨起空腹顿服,辛伐他汀20mg／d,睡前服药。对照组给予氯沙坦50mg／d,晨起空腹顿服。12周后观察空腹血糖（FBG）、糖化血红蛋白（HbAlc）、收缩压（SBP）、舒张压（DBP）、低密度脂蛋白（LDL—C）、血清尿素氮（Scr）、尿白蛋白排泄率（UAE）、尿白蛋白含量（CRP）变化。结果对照组治疗后Scr、UAE均有改善（P〈0．05）,CRP下降不明显（P〉0．05）;治疗组治疗后Scr、UAE、CRP改善更明显（P〈0．01）,与对照组治疗后同期比较,Scr、UAE、CRP差异均有统计学意义（P〈0．05）;治疗后两组血压均有所下降,治疗组和对照组治疗前后差异均有统计学意义（P〈0．05）。结论辛伐他汀的肾保护机制部分与抗炎作用有关,不论是否有高脂血症,都应尽早联合使用他汀类降脂药物及ARB对早期DN进行干预治疗,可有效地抑制糖尿病患者的微血管炎症性损害,减少蛋白尿,延缓肾损害的进展。     

早期慢性肾脏病合并冠心病强化他汀治疗的研究

目的探讨强化洛伐他汀治疗对早期慢性肾脏病（CKDI-Ⅱ）合并冠心病患者肾功能的影响。方法选择2007年1月-2009年1月西丽人民医院就诊早期慢性肾脏病合并冠心病患者62例并随机分为治疗组和对照组。对照组给予常规治疗及洛伐他汀20mg／d,强化治疗组在上述治疗的基础上将洛伐他汀加至40ms／d。每3个月比较两组患者血压、血总胆固醇（TC）、低密度脂蛋白（LDL—C）、高密度脂蛋白（HDL—C）、甘油三酯（TG）、尿蛋白定量（Upr）、血肌酐（Scr）、c反应蛋白（CRP）、肝功能等指标。结果两组治疗后较治疗前Tc、TG、LDL-C均明显下降,治疗前后差异有统计学意义（P〈0．05,P〈0．01）,但组间无显著差异,HDL．C略上升,但差异无统计学意义（P〉0．5）。两组治疗后Upr和Ser均明显下降（P〈0．05）,强化治疗组Upr和Scr下降比对照组明显（P〈0．05,P〈0．01）。结论强化洛伐他汀在治疗慢性肾脏病合并冠心病中应用安全,能够更好地保护肾功能。     

辛伐他汀联合缬沙坦治疗早期糖尿病肾病的疗效分析

目的研究辛伐他汀、缬沙坦联用或单用对糖尿病肾病的肾保护作用。方法选用早期糖尿病肾病（UAER20-200μg／min）103例，随机分为3组。缬沙坦组35例，联合用药组36例，对照组32例，比较3组治疗前及治疗后3个月、6个月的尿蛋白排泄率（UAER）、血脂、血肌酐（Scr）和C-反应蛋白（CRP）、内生肌酐清除率（CCr）、血压等指标。结果治疗后，缬沙坦组、联合用药组UAER均降低。联合用药组UAER降低幅度大于缬沙坦组（P〈0．05）；缬沙坦组、联合用药组Ccr均增加，联合用药组Ccr增加幅度大于对照组（P〈0．01）；联合用药组血TC、LDL-C均有降低（P〈0．01），且下降趋势与治疗时间呈正比；联合用药组CRP明显下降（P〈0．05），且下降趋势与治疗时间呈正比。结论采用缬沙坦和辛伐他汀联合治疗糖尿病肾病具有改善肾功能、延缓病情进展的作用。     

贝那普利联合阿托伐他汀治疗早期糖尿病肾病疗效观察

目的观察贝那普利联合阿托伐他汀（立普妥）治疗早期糖尿病肾病（DN）的临床疗效。方法80例符合2型糖尿病诊断标准和糖尿病肾病分期诊断标准的早期DN患者,按就诊序号平行分为观察组和对照组,各40例。两组均给予糖尿病常规治疗,对照组同时给予盐酸贝那普利（洛汀新）10mg,1天1次,口服;观察组在给予盐酸贝那普利的基础上加服阿托伐他汀20mg,1天1次;两组均连续治疗12周。观察两组治疗前后尿蛋白排泄率（UAER）、尿白蛋白、尿素氮（BUN）、肌酐（cr）,计算尿白蛋白／肌酐比值（ACR）,血清糖化血红蛋白（HbAlc）,C反应蛋白（CRP）,计算平均动脉压（MAP）,观察记录两组不良反应发生率。结果治疗后两组的UAER、ACR、CRP、MAP均明显改善（P〈0．05,P〈0．01）,治疗后治疗组UAER、ACR显著低于对照组（P〈0．05）。结论盐酸贝那普利（洛汀新）联合阿托伐他汀治疗早期DN疗效明显、确切,患者依从性好,不良反应少,对胰岛素增敏效应无明显影响。     

氟伐他汀对早期糖尿病肾病患者尿微量白蛋白排泄率的影响

目的：观察氟伐他汀对早期糖尿病肾病（DN）患者尿微量白蛋白排泄率（UAER）、C-反应蛋白（CRP）和血肌酐（Scr）的影响。方法：将我院2011年2月～2012年10月收治的80例DN患者随机分为对照组和观察组,每组40例,两组患者均给予控制血糖和血压的常规治疗方案,观察组患者在此基础上另行氟伐他汀治疗。两组患者疗程均为9个月,分别于治疗前和治疗后3、6和9个月检测两组患者UAER、CRP和Scr。结果：治疗3个月后,与治疗前比较,观察组UAER和CRP明显降低,差异有统计学意义（P〈0.05）;观察组UAER和CRP与对照组同期比较明显降低,差异具有统计学意义（P〈0.05）。治疗6个月后,与治疗前比较,对照组UAER和观察组UAER、CRP、Scr明显降低,差异具有统计学意义（P〈0.05）;观察组UAER和CRP与对照组同期比较明显降低,差异具有统计学意义（P〈0.05）。治疗9个月后,与治疗前比较,对照组和观察组UAER、CRP、Scr均明显降低,差异有统计学意义（P〈0.05）;观察组UAER、CRP、Scr与对照组同期比较明显降低（P〈0.05）。直线相关分析结果显示,DN患者UAER、CRP和Scr之间呈正相关（P〈0.05）。结论：氟伐他汀治疗早期DN患者,UAER、CRP和Scr降低更明显,起效更快,值得临床推广使用。     

辛伐他汀对急性冠脉综合征患者血浆C-反应蛋白水平的影响

目的研究辛伐他汀对急性冠脉综合征（ACS）患者血浆C-反应蛋白（CRP）的影响。方法60例ACS患者随机分为常规治疗组和辛伐他汀治疗组,疗程2周,常规治疗组服安慰剂,辛伐他汀治疗组每晚服辛伐他汀20mg,分别测定治疗前后血浆CRP水平,同时测定25例健康人血浆CRP水平。结果ACS患者血浆CRP水平高于健康人血浆CRP水平（P〈0．05）;辛伐他汀治疗组治疗后血浆CRP水平低于治疗前水平（P〈0．05）;常规治疗组治疗前后血浆CRP水平差异无统计学意义（P〉0．05）：结论炎症在ACS的发病中起了重要的作用,辛伐他汀具有独立于调脂的抗炎作用,而其抗炎作用对防治ACS患者早期动脉粥样硬化及稳定斑块起着重要的作用。     

糖肾复元汤治疗糖尿病肾病临床研究

目的：观察糖肾复元汤治疗糖尿病肾病（DN）的疗效。方法：将120例DN患者分为治疗组85例，对照组35例。两组均常规应用洛汀新10mg／d，根据病情使用胰岛素或格列喹酮（糖适平）、二甲双胍控制血糖。治疗组在此基础上加用糖肾复元汤口服。疗程为8周。观察治疗前后空腹血糖（FPG），餐后2h血糖（PG），血尿素氮（BUN）、肌酐（Scr），24h尿蛋白定量（Uprot），尿微量白蛋白排泄率（UAER）的变化。结果：治疗组总有效率显著优于对照组（P〈0．01）：同时能明显减少Uprot，Scr，BUN，UAER水平，两组比较P〈0．05或P〈0．01。结论：糖肾复元汤治疗DN疗效显著．中西医结合治疗DN优于单用西药治疗。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.