高血压病患者心肌声学密度与血压昼夜节律变异的关系

目的:探讨高血压病患者心肌声学密度(AD)和血压昼夜节律变异的关系.方法:将原发性高血压患者65例,根据动态血压分为杓型组30例及非杓型组35例,选取健康体检者30例作为对照组,用AD技术测量室间隔及左室后壁的平均背向散射积分(AⅡ)及背向散射积分心动周期变化幅度(PPI).结果:非杓型组24 h平均收缩压与舒张压、夜间平均收缩压与舒张压明显高于杓型组(P＜0.05,P＜0.01).非杓型组室间隔、左室后壁的AⅡ高于杓型组及对照组(P＜0.01).非杓型组室间隔、左室后壁的PPI测值低于杓型组及对照组(P＜0.01).结论:血压昼夜节律异常与高血压患者心肌病变有密切的关系.AD技术可作为评价高血压患者心肌损害及其病变程度的重要参考指标.     

背向散射积分技术评价原发性高血压心肌损害的临床应用研究

目的应用背向散射积分技术评价原发性高血压患者心肌损害程度。方法原发性高血压患者67例,分为两组,NLVH组（高血压非心肌肥厚组）30例：左室心肌重量指数（LVM I）〈125 g/m^2（男）,〈120 g/m^2（女）;LVH组（高血压心肌肥厚组）37例：LVM I≥125 g/m^2（男）,≥120 g/m^2（女）。选择门诊体检正常成人28例为对照组。用二维、M型超声检测对照组和高血压组的室间隔、左室后壁舒张末期厚度、左室心肌重量（LVM）及LVM I;再用背向散射积分技术检测上述3组室间隔、左室后壁的背向散射积分参数即平均背向散射积分（AⅡ）、标化背向散射积分值（AⅡ%,室间隔与左心腔的AⅡ的比值）及背向散射积分心动周期变化幅度（PPI）。结果LVH组室间隔、左室后壁的AⅡ、AⅡ%分别高于NLVH组及对照组（P〈0.05）。LVH组室间隔、左室后壁的PPI测值分别低于NLVH组及对照组（P〈0.05）。结论背向散射积分技术可作为评价原发性高血压患者心肌损害及其程度的重要参考指标。     

2型糖尿病患者心肌超声背向散射参数研究

目的探讨心肌背向散积分（IBS）技术在评价2型糖尿病患者心肌病变中的临床价值。方法对50例2型糖尿病患者、42例健康人应用IBS技术测定室间隔（IVS）和左室后壁（LVPW）心肌的心动周期时间、平均背向散射积分（AII）、背向散射积分标化值（IBS％）、背向散射积分周期性变异幅度（CVIB），并行常规超声心动图检查，计算左室心肌重量。结果①与对照组相比，糖尿病组室间隔和左室后壁中部的IBS％明显增高[（3．8±1．4）VS（2．7±0．9）和（3．63±1．34）vs（2．58±1．07），P〈0．01]，CVIB明显减低[（8．9±2．2）vs（10．3±1．7）和（10．4±2．7）VS（13．2±5．3），P〈0．05]，且室间隔IBS％与Ep／Ap呈负相关（r=-0．48，P〈0．01），CVIB与Ep／Ap呈正相关（r=0．64，P〈0．01）；②糖尿病组左室心肌重量增加。结论心肌背向散射积分参数能早期反映2型糖尿病患者心肌的组织病理改变。     

脂蛋白相关磷脂酶A2、糖化血红蛋白水平与糖尿病患者冠脉病变程度的相关性分析

目的 探讨脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)、糖化血红蛋白(HbA1c)水平与糖尿病患者冠脉病变程度的相关性.方法 选取2017年7月至12月在陆军军医大学(第三军医大学)第二附属医院心血管内科住院患者241例;按冠脉狭窄程度及糖尿病病史分为冠心病组(42例)、糖尿病组(34例)、糖尿病合并冠心病组(127例)、正常对照组(38例).按左心室射血分素(LVEF)结果分为LVEF＜ 50％组(91例)和LVEF≥50％(150例).检测循环Lp-PLA2和HbA1c水平并进行统计学分析.结果 糖尿病合并冠心病组Lp-PLA2水平显著高于糖尿病组和正常对照组(P ＜0.05);HbA1c在糖尿病合并冠心病组显著高于冠心病组和正常对照组(P＜0.05).多元线性回归分析Lp-PLA2、HbA1c与冠脉狭窄程度(Gensini积分)正相关(r值:0.189、0.138,P＜0.05).多因素Logistic回归分析Lp-PLA2、HbA1c为冠脉狭窄程度的独立危险因素(OR值:1.012、0.097、P＜0.05).LVEF＜ 50％组Lp-PLA2水平显著高于LVEF≥50％组(P ＜0.05);HbA1c水平两组间比较差异无统计学意义(P＞0.05).结论 糖尿病合并冠心病患者循环Lp-PLA2和HbA1c水平明显升高且与冠状动脉狭窄程度呈正相关,二者联合检测对预测糖尿病患者冠脉病变程度有较好的临床价值.     

糖尿病大鼠心脏结构和功能改变的研究

目的 观察糖尿病大鼠不同病程中心脏结构和功能的改变,并探讨两者之间的关系.方法 45只雄性SD大鼠随机分组,其中腹腔注射链脲佐菌素(STZ,55 mg/kg)诱导糖尿病模型,病程4周(A1组)、8周(A2组)和12周(A3组),各10只;注射柠檬酸盐液冲服的大鼠为对照组,4周(B1组)、8周(B2组)和12周(B3组)各5只.用心脏实时三维超声诊断仪评估大鼠的心功能,Masson染色观察大鼠心脏纤维化程度并计算心肌胶原容积分数.结果 A1组左室质量指数、心肌胶原容积分数及心功能指标与B1组相比,差异无统计学意义(P＞0.05).A2和A3组左室质量指数、左室收缩内径和心肌胶原容积分数均较同期对照组显著增高(P＜0.05).与B2组比较,A2组左室短轴缩短率和左室射血分数稍下降,但差异无统计学意义(P＞0.05);A3组左室短轴缩短率和左心室射血分数均低于同期对照组(P＜0.05).相关分析显示,心肌胶原容积分数与左室质量指数呈显著正相关(r=0.915,P＜0.05),与左室短轴缩短率及左室射血分数呈负相关(r1=-0.903,P＜0.01;r2=-0.872,P＜0.05).结论 STZ诱导的糖尿病大鼠在病程的早期即可出现心脏结构和功能的改变,随着病程的延长,心脏病变加重.     

2型糖尿病患者抑郁情绪对血糖控制的影响

目的 探讨2型糖尿病(T2DM)患者抑郁情绪对血糖控制的影响.方法 应用Zung抑郁自评量表(SDS)评估抑郁情况,276例T2DM患者分为SDS≥53分(A组)、SDS＜53分(B组).比较两组糖化血红蛋白(HbA1c)、空腹血糖(FPG)及胰岛素抵抗指数(HOMA-IR)等,分析T2DM患者血糖控制的影响因素.结果 T2DM患者SDS标准分与HbA1c呈正相关(r=0.26,P＜0.05).多元回归分析显示T2DM患者SDS标准分与HbA1c仍相关(β=0.30,t=5.1,P＜0.05).A组HbA1c水平高于B组(t=3.685,P＜0.05);当校正性别、年龄、受教育程度等因素后,A组HbA1c仍高于B组(F=47.8,P＜0.05).结论 抑郁情绪不利于T2DM患者血糖控制.     

声学密度技术定量评价兔缺氧肺动脉高压后左室心肌损伤

目的:探讨声学密度定量(AD)技术评价缺氧肺动脉高压(PH)后左室心肌损害的应用价值.方法:在建立缺氧肺动脉高压兔模型的基础上,应用AD技术对PH组和正常对照组兔左室相应部位心肌密度值进行测定.结果:缺氧PH组背向散射强度标准差(SDI)及背向散射强度周期性变化幅度(CVIB)与正常组比较无显著差异;但左心室前壁和后壁心动周期背向散射强度平均值(AII)明显升高(P<0.05),室间隔中部CVIB明显减低(P<0.05)和AII明显升高(P<0.05).PH组左室心肌不同部位AII值与左室舒张末压(LVDEP)成正相关(r=0.620 6～0.631 1,P<0.01).结论:AD技术对判定缺氧PH后左室心肌损伤改变较为客观、简便,有较高的应用价值.     

超声新技术对早期糖尿病心脏病变左室收缩功能异常病理基础的评价

目的探讨多普勒组织技术(DTI)及背向散射积分技术(IBS)在检测早期糖尿病心脏病变左室收缩功能异常病理基础方面的临床价值。方法 36例糖尿病患者及25例健康人,应用DTI分别测量左室6个壁收缩期峰值速度(Sa),应用IBS分别测量室间隔及左室后壁的校正背向散射积分(IBS%)及其周期变异幅度(CVIB)。并计算有统计学差异的IBS与DTI参数之间的相关关系。结果与对照组比较,糖尿病组左室壁平均Sa显著减低(P<0.05),下壁及前间隔Sa均显著低于对照组(P<0.01);糖尿病组室间隔IBS%显著增高(P<0.05),左室后壁CVIB显著减低(P<0.01)。间隔的IBS%与前间隔Sa及左室壁平均Sa呈显著负相关(分别为r=-0.524,P<0.01;r=-0.506,P<0.01),与下壁Sa呈显著负相关(r=-0.383,P<0.05);左室后壁CVIB与下壁Sa及左室壁平均Sa皆呈显著正相关(分别为r=0.469,P<0.01;r=0.415,P<0.01)。结论 DTI及IBS技术能够无创检测出早期糖尿病心脏病变左室收缩功能异常病理基础。     

正常人左室心肌声学密度相关因素的研究

目的 本文通过对正常人左室声学密度相关因数的研究,探讨左室结构、功能对左室声学密度的影响.方法 正常人31例,利用二维心脏超声测量左室结构参数,并计算相对室壁厚度(RWT)和心肌重量指数(LVMI);并用超声背向散射技术测量左室室间隔心肌声学密度的变化,分析左室结构、功能变化与背向散射变化的内在联系.结果 正常人胸骨旁长轴室间隔(IVSL)的标化平均声学密度(IB%)与RWT及E峰速度时间积分与A峰速度时间积分比(VTIE/VTIA)相关(r=0.52,P<0.05).结论 正常心肌背向散射与左室构型及心功能有关.     

应变率显像及背向散射积分技术综合评价2型糖尿病患者心肌的收缩功能

目的探讨应变率显像（SRI）及背向散射积分技术（IBS）在综合评价2型糖尿病患者心肌收缩功能中的价值。方法采用Philips公司生产的SONOS 7500彩色超声诊断仪,应用组织多普勒技术及IBS技术对30例健康组（对照组）及30例2型糖尿病患者（DM组）分别进行左室局部心肌的应变、应变率曲线定量分析及测定心肌背向散射积分参数。测量心脏左室整体收缩功能指标,即左室射血分数（EF）、短轴缩短率（FS）、每搏输出量（SV）,室壁增厚率（△T％）。结果与正常对照组比较,DM组左室各节段心肌收缩期应变（S）、应变率（SR）均明显降低（P〈0.01）,MD组室间隔及左室后壁心肌的背向散射积分标化值（IBS％）显著增大（P〈0．01）,背向散射积分心动周期变异幅度（CVIB）及变异率（CVIB％）减小（P〈0．01）。两组间心脏左室整体收缩功能差异无统计学意义。结论与常规心脏超声检查比较,SRI及IBS技术能较早地发现2-DM患者心肌局部收缩功能的改变,可以为临床及时提供重要的影像学信息。     

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.