N末端B型脑钠肽前体检测在急性心力衰竭患者中的作用

目的对急性心力衰竭患者进行N末端B型脑钠肽前体(NT-proBNP检)测,评价检测结果提示的意义。方法对2010年6月-2012年6月的40例急性心力衰竭患者(观察组)和40例健康者(对照组)的NT-proBNP进行检测并比较检测结果。结果在入院时,观察组患者的NT-proBNP水平明显高于对照组。治疗后进行随访检测:事件组患者的NT-proBNP水平显著高于无事件组患者。结论对急性心力衰竭患者测定其NT-proBNP可以得到有效的早期诊断和预后评估。     

N T-proBNP 在判断 ACS 患者冠状动脉病变程度和短期预后中的价值

目的：通过检测急性冠状动脉综合征（ACS）患者血清 N 端脑钠肽前体（NT-proBNP）的水平变化,观察其对评估ACS 患者冠状动脉病变严重程度和预后的诊断价值。方法选取2013年1月至2014年12月入住南通大学附属医院心内科ACS 患者作为观察对象,其中,不稳定心绞痛患者64例,非 ST 段抬高性心肌梗死患者46例,急性 ST 段抬高性心肌梗死患者22例。将其分为高 NT-proBNP 组（≥474 pg／mL）和低 NT-proBNP 组（＜474 pg ／mL）,心脏超声检测并比较各组患者射血分数;冠状动脉造影术检测两组患者冠状动脉病变情况,血清学检测两组患者心肌肌钙蛋白 I（cTnI）、肌酸激酶同工酶（CK-MB）、C-反应蛋白（CRP）和 NT-proBNP ,计算两组患者平均住院时间和心力衰竭、心源性休克发生率。结果 ACS 患者血清 NT-proBNP 和射血分数呈负相关。高 NT-proBNP 组患者心力衰竭发生率和住院天数明显高于低 NT-proBNP 组;高 NT-proBNP 组在冠状动脉病变支数、冠状动脉狭窄度方面均高于低 NT-proBNP 组;高 NT-proBNP 组 TIMI 血流分级低于低 NT-proBNP 组,差异有统计学意义（P＜0．05）。结论 NT-proBNP 作为判断 ACS 患者冠状动脉病变程度和短期预后的可靠指标值得临床进一步推广。     

心血管病患者血浆N端B型脑钠肽水平变化及临床意义探讨

目的观察心血管疾病患者血浆N端B型脑钠肽水平变化,并就其变化分析临床实际意义。方法选择2011年1月-2013年1月在我院住院治疗的120例心血管疾病患者检测NT-proBNP浓度,另取同时期50例健康人群检测NTproBNP浓度,分析浓度与心功能之间有何联系。结果心血管病组患者血浆NT-proBNP浓度要明显高于健康组,且心功能分级越高,血浆NT-proBNP浓度也就越高。结论心血管病患者的血浆NT-proBNP浓度要显著高于正常健康人群,且血浆NT-proBNP浓度与心功能分级呈正相关,可以将血浆NT-proBNP水平作为评价心功能的一个指标。     

cTnⅠ与NT-proBNP联合检测对急性心肌梗死病情的评估分析

目的分析心肌钙蛋白Ⅰ(cTnⅠ)与氨基末端脑钠肽前体(NT-proBNP)联合检测对急性心肌梗死(AMI)病情的评估。方法选取商丘市第四人民医院2017年1月至2018年6月治疗的80例AMI患者作为观察组,同时选取同期体检健康者75例作为对照组。采集入选者静脉血,检测cTnI、NT-proBNP水平。观察两组NT-proBNP、cTnI水平,并计算各指标单独与联合检查的特异度、敏感度、准确度。结果观察组NT-proBNP、cTnⅠ水平均高于对照组,差异有统计学意义(均P<0.05)。NT-proBNP、cTnⅠ联合检测敏感度、特异度、准确度均高于NT-proBNP、cTnⅠ单项检测,差异有统计学意义(均P<0.05)。结论 cTnⅠ与NT-proBNP联合检测诊断AMI价值较高,有助于评估患者病情,为AMI患者的诊断、治疗提供确切依据。     

心脏瓣膜置换术围术期患者血浆NT-proBNP水平检测及其预后评估

目的探讨血浆N端脑利钠肽前体(N-terminal pro-brain natriuretic peptide in plasma,NT-proBNP)检测在心脏瓣膜置换术围术期的临床应用及对瓣膜手术患者预后的评估价值,为临床心脏瓣膜置换术提供指导。方法随机抽取2011年6月～2019年6月在我院进行心脏瓣膜置换术的240例患者为观察组,检测其围术期的血浆NT-proBNP水平,另选取30名健康志愿者为对照组,检测对照组血浆NT-proBNP水平,探讨血浆NT-proBNP水平与患者心功能之间的联系及对预后的评估价值。结果手术前后,观察组血浆NT-proBNP水平明显高于对照组,差异有统计学意义(P0.05)。且NT-proBNP水平越高,患者的心功能越低,瓣膜置换术后,观察组患者血浆NT-proBNP水平显著高于手术前,后再逐渐降低并显著低于手术前,发生术后不良事件的患者血浆NT-proBNP浓度水平明显高于未发生不良事件的患者,差异有统计学意义(P0.05)。结论心脏瓣膜病患者的血浆NT-proBNP水平较高,且其血浆NT-proBNP水平越高患者心功能越低,检测其浓度值可作为干预心脏瓣膜病的指标,也可作为瓣膜置换术后的评估指标,对瓣膜置换术患者的预后评估有良好的临床应用价值。     

尿液N-末端-前B型钠尿肽在慢性心衰中的诊断价值

目的:探讨尿液N末端-前B型钠尿肽(NT-proBNP)在慢性心衰中的诊断价值。方法:收集2013年10月—2015年3月期间来我院就诊的86例慢性心力衰竭患者作为观察对象,同时收集来80例健康体检者作为对照组。分别检测其血液及尿液NT-proBNP水平,并将两组结果进行比较分析。结果:慢性心力衰竭患者组的尿液及血液NT-proBNP水平均明显高于健康对照组,差异有统计学意义(P<0.01);且慢性心衰患者尿液及血液NT-proBNP水平随着心功能NYHA分级的增高而升高。尿液与血液NT-proBNP水平呈正相关。结论:尿液NT-proBNP及血液NT-proBNP水平在慢性心力衰竭诊断中具有相似的价值。检测尿液NT-proBNP水平对慢性心力衰竭患者的诊断、治疗、病情评估及预后判断有重要的意义。     

心衰患者肺毛细血管楔嵌压和NT-proBNP的相关性分析

目的评价心衰患者血清N末端脑型尿钠肽(NT-proBNP)定量检测与肺毛细血管楔嵌压间的相关性。方法选择我院2005年6月至2006年4月心内科住院的心衰患者90例并按床边漂浮导管测定肺毛细血管楔嵌压(PCWP),采用电化学发光检测仪Elecsys2010定量检测不同PCWP(水平)组心衰患者血清NT-proBNP血清浓度和心脏彩超测定左室舒张末期内径,左室射血分数(LVEF)。结果当PCWP<18mmHg时NT-proBNP平均水平451pg/ml,当18mmHg≤PCWP≤30mmHg时,NT-proBNP平均水平4258pg/ml,当PCWP>30mmHg时NT-proBNP平均水平11845pg/ml,各组间其差异有显著性(P<0.05)。结论血清NT-proBNP定量检测对于诊断心衰有定性和定量意义,心衰患者血清NT-proBNP水平明显增高,且与PCWP水平有正相关性,随PCWP升高血清NT-proBNP值也增加。     

NT-proBNP检测联合GRACE评分对ACS患者预后的预测价值

目的：探讨NT-proBNP检测联合GRACE评分对ACS患者预后的预测价值。方法选取2011年6月—2014年3月来该院就诊的300例ACS患者,行NT-proBNP检测、GRACE评分。按不良心血管事件的发生将患者分为事件组与非事件组,回顾性分析两组患者 NT-proBNP、GRACE等数据。结果事件组NT-proBNP值仍高于非事件组（P＜0.05）,事件组GRACE评分高于非事件组（P<0.05）;GRACE评分及NT-proBNP水平对于预测ACS患者预后的能力均为中等,且二者对NSTE-ACS患者出院后6个月后发生MACE事件的预测能力无统计学差异。而对GRACE联合NT-proBNP进行ROC曲线分析,曲线下面积为0.852(P<0.001),表明二者联合可以增加对NSTE-ACS患者预后判断的能力。结论 NT-proBNP检测联合GRACE评分对ACS患者预后的预测可以更为准确评估ACS患者早期风险,有着独特的临床价值,也可以辅助临床医生对患者进行更科学的治疗。     

NT-proBNP联合血清HCY检测在心力衰竭患者治疗及预后评估中的应用效果

目的观察氨基末端B型脑钠肽前体(NT-proBNP)联合血清同型半胱氨酸(HCY)检测在心力衰竭患者治疗及预后评估中的应用效果。方法将云南新昆华医院2017年1月至2018年1月接收的心力衰竭患者50例纳入至研究组,将同期健康体检者50例纳入至对照组中,对比治疗前后NT-proBNP、左室射血分数(LVEF)和HCY水平;随访1年,对HCY水平及NT-proBNP进行检测,并将心源性不良事件记录下来。结果在HCY水平及NT-proBNP水平方面,研究组相比于对照组更高(P0.05);在LVEF、方面,HCY水平及NT-proBNP水平治疗研究组改善明显。结论联合HCY与NT-proBNP检测有助于避免患者诱发心源性不良事件,预测效果明显。     

血N末端脑钠肽在心源性和肺源性呼吸困难鉴别中的临床应用

目的:检测患者血清N-末端脑钠肽(NT-proBNP)水平,探讨NT-proBNP其在心源性和肺源性呼吸困难临床鉴别中的应用。方法:选择我院2015年7月至2015年12月住院患者,其中心源性呼吸困难患者43例;肺源性呼吸困难患者45例;正常对照组40例。检测血清NT-proBNP在各组的水平变化。结果:心源性呼吸困难组血NT-proBNP水平,与肺源性呼吸困难组和正常组对照组NT-proBNP水平比较差异均有显著性意义(P0.01)。结论:血清中NT-proBNP含量的测定,在临床上对心源性呼吸困难和肺源性呼吸困难的早期诊断和鉴别具有较大的应用价值。     

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.