天津市男性糖尿病危险因素的流行病学研究

对１９９１年天津市糖尿病流行病学调查筛选出的５７例男性非胰岛素依赖型糖尿病（ＮＩＤＤＭ）病例进行了１：１配对病例对照研究。经条件Ｌｏｇｉｓｔｉｃ回归模型分析发现ＮＩＤＤＭ的危险因素是：经济收入高（ＯＲ＝３．０９，９５％ＣＩ＝１．２８～７．４７），既往相关病史（ＯＲ＝７．６５，９５％ＣＩ＝２．３０～２５．４５），糖尿病家族史（ＯＲ＝１３．６６，９５％ＣＩ＝１．８４～１０１．６２），嗜甜食（ＯＲ＝２．３０，９５％ＣＩ＝１．４０～３．８０），肥胖（ＯＲ＝６．８５，９５％ＣＩ＝２．１１～２２．１９）。同时还发现，体育活动（ＯＲ＝０．３８，Ｘ￣２＝９．５５，Ｐ＜０．０１）和蔬菜是其保护性因素。     

原发性肺癌危险因素及其人群归因危险度的研究

目的 探讨的发性肺癌发生有关的因素,为预防肺癌提供科学依据。方法 采用１：２配对病 列－对照研究方法进行研究,应用多因素条件Ｌｏｇｉｓｔｉｃ回归模型分析与肺癌发生有关的因素,并对肺癌危险因素的人群归因危险度（ＰＡＲ）进行估计。结果 筛选出８个与肺癌有关的因素,其中吸烟、离退休、工作场所有毒物质、肺结核病史、常做饭菜、使用煤炭等因素增加肺癌的危险性,其危险度（ＯＲ）分别是：２．３７８,２．３１８,２     

P53蛋白高表达与林县食管癌关系的病例对照研究

目的：探讨Ｐ５３蛋白高表达在食管癌发病中的意义．方法：于１９９５年１０月～１２月在林县进行了病例对照调查，并收集了组织学材料．采用免疫组化ＳＰ法，对病例组（５９例）手术切除的癌组织和对照组（３７例）食管粘膜活检标本的Ｐ５３蛋白表达情况进行了检测．结果：５７．６％（３４／５９）的病例标本和１６．２％（６／３７）的对照标本存在有Ｐ５３蛋白高表达，病例组明显高于对照组（Ｐ＜０．０１）．单因素分析有显著意义的因素为Ｐ５３蛋白高表达、病前２０年食酸菜史、病前１０年食水果史和食管癌家族史，其比值比（ＯＲ）及其９５％可信限（ＣＩ）分别为７．０３（２．３３～２２．２１）、２．９８（１．１０～８．２０）、０．１９（０．０４～０．９０）和２．５１（０．９９～６．４４，Ｐ＜０．０５）．男性、女性Ｐ５３蛋白高表达的ＯＲ（９５％ＣＩ）及合并ＯＲ（９５％ＣＩ）分别为７．３８（１．９６～２９．６４）、８．１７（０．７７～２０３．３６）和７．５８（２．４１～２５．０１），与分层前ＯＲ接近．多因素Ｌｏｇｉｓｔｉｃ回归分析显示Ｐ５３蛋白高表达的ＯＲ（９５％ＣＩ）为５．９１（１．９５～１８．２７）．结论：结果提示Ｐ５３蛋白高表达与食管癌之间存在     

肺癌患者外周血单个核细胞分泌白细胞介素－2受体的研究

采用ＥＬＩＳＡ法对３３例肺癌和２８例健康人外周血单个核细胞（ＰＢＭＣ）分泌可溶性白细胞介素－２受体（ｓＩＬ－２Ｒ）能力的研究显示：肺癌患者ＰＢＭＣ分泌；ＩＬ－２Ｒ能力明显高于健康人（Ｐ＜０．０１）。但鳞癌、腺癌、小细胞未分化癌之间，ＰＢＭＣ分泌ｓＩＬ－２Ｒ能力无差别，三者分别较健康人显著增高（Ｐ＜０．０１）。在肺癌Ⅰ、Ⅱ、Ⅲ、Ⅳ期之间，ＰＢＭＣ分泌ｓＩＬ－２Ｒ能力亦无显著性差异。     

急性有机磷农药中毒合并中间综合征危险因素分析

目的本研究通过对２ ２ ６例急性有机磷农药中毒病人的临床特征进行分析; 探讨有机磷中毒合并中 间综合征（ Ｉ ＭＳ ） 的危险因素; 为临床诊治急性有机磷农药中毒并中间综合征提供依据。方法收集我院急诊科 ２ ０ ０ ６ － ０ １～ ２ ０ １ １ － １ ２急性有机磷农药中毒病人２ ２ ６例; 按其是否并发Ｉ ＭＳ分为Ｉ ＭＳ组２ ６例; 非Ｉ ＭＳ组２ ０ ０例。单 因素分析中 α ＜ ０ ． ０ ５的变量确定为自变量; 以 Ｉ ＭＳ为因变量; 作前向 Ｗａ ｌ ｄ概率似然比统计法多元 Ｌ ｏ ｇ ｉ ｓ ｔ ｉ ｃ 回归; 由此确定 Ｉ ＭＳ的独立危险因素和相对危险度（ Ｒ Ｒ ） 及９ ５ ％可信区间（ ９ ５ ％Ｃ Ｉ ） 。结果毒物种类、 中毒途径、 中毒 程度、 Ａ Ｐ Ａ Ｃ Ｈ Ｅ Ⅱ、 中毒后有无肌颤、 抬头困难、 血白细胞计数、 Ｐ ａ Ｏ ２ 、Ｐ ａ Ｃ Ｏ ２ Ｉ ＭＳ组与非 Ｉ ＭＳ组有差异; 差异具有 统计学意义（ Ｐ ＜ ０ ． ０ ５ ） 。抬头困难、 Ｐ ａ Ｏ ２降低、 Ｐ ａ Ｃ Ｏ ２增高、 Ａ Ｐ Ａ Ｃ Ｈ Ｅ Ⅱ评分经过 Ｌ ｏ ｇ ｉ ｓ ｔ ｉ ｃ 回归分析是急性有机磷 农药中毒并发中间综合征的独立危险因素。结论抬头困难、 Ｐ ａ Ｏ ２降低、 Ｐ ａ Ｃ Ｏ ２增高、 Ａ Ｐ Ａ Ｃ Ｈ Ｅ Ⅱ评分是急性有 机磷农药中毒并发中间综合征的独立危险因素。     

肺癌患者外周血单个核细胞分泌白细胞介素—2受体的研究

采用ＥＬＩＳＡ法对３３例肺癌和２８例健康人外周血单个核细胞（ＰＢＭＣ）分泌可溶性白细胞介素－２受体（ｓＩＬ－２Ｒ）能力的研究显示：肺癌患者ＰＢＭＣ分泌ｓＩＬ－２Ｒ能力明显高于健康人（Ｐ〈０．０１）。但鳞癌、腺癌、小细胞未分化癌之间，ＰＢＭＣ分泌ＳＩＬ－２Ｒ能力无差别，三者分别较显著增高（Ｐ〈０．０１）。在肺癌Ⅰ、Ⅱ、Ⅲ、Ⅳ期之间，ＰＢＭＣ分泌ＳＩＬ－２Ｒ能力亦显显著性差异。     

月经史与胎儿宫内生长迟缓的流行病学研究

①目的了解母亲月经史与胎儿宫内生长迟缓（ＩＵＧＲ）的关系。②方法以Ｆｏｘｐｒｏ建立青岛市区１９９２年新生儿数据库，采用ＳＰＳＳ－Ｗｉｎｄｏｗ６．０软件对５２９１例婴儿的性别，产次，母亲年龄、身高、初次就诊时的体重、舒张压、孕周、产前就诊次数、自然流产次数、月经初潮年龄、月经周期、文化程度、职业等因素与ＩＵＧＲ的关系进行单因素和多因素Ｌｏｇｉｓｔｉｃ回归分析。③结果在瘦型母亲中（ＢＭＩ＜２１），月经初潮年龄＞１４岁组相对于初潮年龄＜１４岁组发生ＩＵＧＲ的相对危险度（ＲＲｓ）为１．６３（９５％ＣＩ１．１６～２．２９），月经周期为２９～３０ｄ组和≥３１ｄ组相对于≤２８ｄ组发生ＩＵＧＲ的ＲＲｓ分别为１．７５（９５％ＣＩ０．９６～３．２０）和２．９２（９５％ＣＩ１．４２～６．０３）。在正常体型的母亲中（ＢＭＩ＝２１～２４），只有月经周期≥３１ｄ的母亲与ＩＵＧＲ有关（ＲＲｓ＝２．１７，９５％ＣＩ１．１８～４．０８），而胖型母亲则与ＩＵＧＲ无关。④结论母亲月经初潮年龄、月经周期对ＩＵＧＲ具有独立影响，但这种影响受到母亲体型的修正。     

尿激酶型纤维酶原激活系统与肺癌转移的关系

目的 研究尿激酶型纤溶酶原激活物ＵＰＡ及其特异受体ＵＰＡＲ和抑制物ＰＡＩ－１,ＰＡＩ－２与肺非小细胞癌（ＮＳＣＬＣ）转移的关系。方法 用免疫组化ＬＳＡＢ法检测ＵＰＡ,ＵＰＡＲ,ＰＡＩ－１和ＰＡＩ－２在６６例肺ＮＳＣＬＣ中蛋白水平表达。结果肺腺癌,鳞癌有淋巴结转移组ＵＰＡ,ＰＡＩ－１阳性率及表达强度均比无移组高,Ｐ值均〈０．０５。肺大细胞癌有淋巴结转移组ＵＰＡ,ＵＰＡＲ阳性率无比转移组高,Ｐ＝０．     

吸烟,酒精,胆石病和糖尿病作为胰腺癌的危险因素的研究

对１７０例胰腺癌和１７０例对照组非肿瘤疾病进行对比。计算其相对危险度（ＲＲ）评价糖尿病，胆石病，吸烟和饮酒作为胰腺危险因素的意义。结果显示吸烟者胰腺癌危险度明显增加（ＲＲ１．９，９５％ＣＩ１．２～３．９），并随吸烟年发和吸烟量增加而增加，饮酒无相关性；胆石病（ＲＲ３．４．９５％ＣＩ１．６～９．７）和糖尿病（ＲＲ３．２７，９５％ＣＩ２．６１～４．０５）胰腺癌的危险度均有增加，但糖尿病仅出现在胰腺癌发     

冠心病病人淋巴细胞CR1表达及血清sIL—2R水平的变化

目的探讨冠心病病人外周血淋巴细胞补体Ⅰ型受体（ＣＲ１）表达及血清可溶性白细胞介素－２受体（ｓＩＬ－２Ｒ）浓度的变化。②方法采用淋巴细胞花环试验和酶联免疫吸附法（ＥＬＩＳＡ）,检测了７２例冠心病病人和６３例健康人淋巴细胞ＣＲ１花环率（Ｌ－ＣＲ１Ｒ）及血清ｓＩＬ－２Ｒ浓度变化。③结果冠心病病人Ｌ－ＣＲ１Ｒ明显降低,ｓＩＬ－２Ｒ浓度明显增高,与对照组比较差异有极显著性（ｔ＝６．４１４,７．８０６,Ｐ＜０．００１）。冠心病病人Ｌ－ＣＲ１Ｒ与ｓＩＬ－２Ｒ呈负相关（ｒ＝－０．８１５,Ｐ＜０．００１）。不稳定心绞痛（ＵＡ）、急性心肌梗死（ＡＭＩ）和陈旧性心肌梗死（ＯＭＩ）病人Ｌ－ＣＲ１Ｒ和ｓＩＬ－２Ｒ比较,差异亦具有极显著性（Ｆ＝７．８６０,１１．５７９,ｑ＝６．６２７～１０．５５０,Ｐ＜０．００１）,且以ＡＭＩ病人的变化最明显。④结论外周血淋巴细胞ＣＲ１表达和血清ｓＩＬ－２Ｒ浓度异常与冠心病病情变化有密切关系。     

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.