咪哒普利降压疗效和不良反应比较研究

目的 对照比较咪哒普利、贝那普利、坎地沙坦、硝苯地平缓释剂治疗1～3级高血压病的疗效和安全性.方法 对入选283例1～3级高血压病患者,随机分为4组：（A组）咪哒普利组（咪哒普利5～10mg,1次/d,n＝88）;对照组分别为（B组）贝那普利组（10～20mg,1次/d,n＝70）、（C组）坎地沙坦组（4～8mg,1次/d,n＝58）和（D组）硝苯地平缓释剂组（10～30mg,1次/d,n＝67）,治疗4周,观察用药前、后坐位血压,记录不良反应.结果 （1）4组的总有效率分别为咪哒普利组84.1%、贝那普利组70.0%、坎地沙坦组81.0%、硝苯地平缓释剂组80.9%,4组之间差异无统计学意义（P＞0.05）.4组血压前后均显著下降（P＜0.01）,其中咪哒普利组和硝苯地平缓释剂组降压效果分别与贝那普利组比较均存在差异,有统计学意义（P＜0.05）.（2）4组不良反应发生率分别为咪哒普利组7.9%、贝那普利组15.7%、坎地沙坦组15.3%、硝苯地平缓释剂组26.9%,而咪哒普利咳嗽发生率仅为6.8%.结论 咪哒普利降压效果肯定,耐受性较好,特别是咳嗽不良反应明显降低.     

小剂量氨氯地平联合贝那普利治疗轻、中度高血压的临床研究

目的 观察小剂量氨氯地平联合贝那普利治疗轻、中度高血压的疗效及安全性.方法 将98例轻、中度高血压患者随机分为两组,研究组(50例)给予贝那普利(洛汀新,北京诺华制药有限公司)10 mg+苯磺酸氨氯地平(络活喜,辉瑞制药)2.5 mg,1次/d;对照组(48例)给予贝那普利10mg,1次/d.治疗4周后降压疗效判定为无效者,将剂量加倍,在8周观察期内不联用其它降压药.比较两组血压、生化指标、不良反应.结果 治疗4周后,研究组收缩压(132.3±12.2) mm Hg显著低于对照组(137.1±10.8) mm Hg,研究组舒张压(86.12±9.3) mm Hg显著低于对照组(91.4±10.7) mm Hg,有效率显著高于对照组(75.0% vs 54.1%,P ＜0.01);治疗8周后,研究组收缩压显著低于对照组(P＜0.05),研究组舒张压显著低于对照组(P＜0.05),有效率显著则高于对照组(P＜0.01);两组均无严重不良反应,无因不良反应停药者.结论 小剂量氨氯地平联合贝那普利治疗轻、中度高血压,疗效优于单用贝那普利,不良反应未见增加.     

苯磺酸氨氯地平联合贝那普利治疗高血压110例疗效观察

目的探讨苯磺酸氨氯地平联合贝那普利治疗高血压的临床疗效及不良反应。方法 220例高血压患者随机分为治疗组110例,采用苯磺酸氨氯地平联合贝那普利治疗,对照组110例仅采用贝那普利治疗,观察比较两组的临床疗效。结果于治疗4周后观察两组的临床疗效,治疗组有效率为97.3%（107/110）,明显高于对照组,差异有显著性（P〈0.05）。两组治疗前收缩压和舒张压比较,P〉0.05,差异无统计学意义;治疗4周后,两组收缩压和舒张压比较,P〈0.05,差异有统计学意义。且组间比较,P〈0.05,差异有统计学意义。结论苯磺酸氨氯地平联合贝那普利治疗高血压疗效满意,值得各医院推广应用。     

氨氯地平联合贝那普利治疗高血压合并冠心病的临床效果观察

目的:观察氨氯地平片联合贝那普利片治疗高血压合并冠心病的临床疗效。方法:收集76例高血压合并冠心病患者,按照入院先后顺序分为观察组(38例)与对照组(38例)。观察组患者口服氨氯地平联合贝那普利,对照组患者单独服用氨氯地平治疗,疗程12个月,统计分析两组临床疗效及血压的变化。结果:观察组与对照组的临床疗效分别为94.74%、73.68%,两组比较差异有统计学意义(P<0.05);治疗后观察组患者收缩压为(126.4±6.3)mm Hg,舒张压(76.5±4.2)mm Hg,对照组患者收缩压为(139.1±8.8)mm Hg,舒张压(86.0±5.6)mm Hg,两组比较差异有统计学意义(P<0.05)。结论:氨氯地平联合贝那普利可以明显控制高血压合并冠心病患者的临床血压,临床疗效显著,不良反应少,是确切的治疗高血压合并冠心病的方法。     

苯磺酸氨氯地平联合单硝酸异山梨酯缓释片治疗冠心病50例疗效分析

目的探讨苯磺酸氨氯地平联合单硝酸异山梨酯缓释片治疗冠心病的临床效果。方法选择该院2010年10月—2014年10月该院收治的50例冠心病患者为研究对象,随机分为对照组和观察组。对照组给予单硝酸异山梨酯缓释片治疗,观察组在对照组的基础上加用苯磺酸氨氯地平治疗。比较两组治疗效果、血压改善情况及血液流变学指标改善情况。结果观察组治疗总有效率93.3%,显著高于对照组的70%。观察组治疗后收缩压、舒张压（123.2±6.4）mm Hg、（68.5±5.4）mm Hg显著低于对照组（138.2±6.4）mm Hg、（75.8±5.3）mm Hg。两组不良反应发生率经统计学分析,差异无统计学意义（P〉0.05）。结论苯磺酸氨氯地平联合单硝酸异山梨酯缓释片治疗冠心病临床效果显著,不良反应少,值得临床推广应用。     

缬沙坦与贝那普利治疗慢性心力衰竭疗效比较

目的比较缬沙坦与贝那普利治疗慢性心力衰竭（简称慢性心衰）的疗效和安全性。方法74例慢性心衰患者随机分为缬沙坦组（38例,口服缬沙坦80～320mg/d）和贝那普利组（36例,口服贝那普利5～20mg/d）,疗程3个月。比较2组心功能改善情况和不良反应。结果缬沙坦组总有效率为91.8%（34/37）、贝那普利组总有效率为89.6%（26/29）,2组治疗后心率、血压、LVD、心胸比均有改善,但组间比较差异无统计学意义。治疗中,缬沙坦组1例因不能耐受退出试验,贝那普利组则有7例退出试验,2组比较差异有统计学意义（P〈0.05）。结论缬沙坦与贝那普利治疗慢性心衰疗效相似,但缬沙坦的不良反应少,患者依从性优于贝那普利。     

氨氯地平联合贝那普利治疗高血压糖尿病的疗效分析

目的 分析研究氨氯地平联合贝那普利治疗高血压糖尿病的疗效.方法 选择重度高血压伴有糖尿病的患者156例.将所有患者随机场分为试验组和对照组,每组78例.患者在停服降压药15 d后,试验组患者采用氨氯地平联合贝那普利用药,每天口服1次贝那普利,1次10 mg,每天口服1次氨氯地平,每次5 mg;对照组患者采用贝那普利单一给药.治疗1个疗程后,每天服用4 mg贝那普利,每天1次.连续8周每天早上给药.观察患者不良反应发生情况及对高血压的降压效果.结果 试验组治疗前收缩压、舒张压分别为(174.0±5.3)mmHg(、109.2±7.1)mmHg,治疗后收缩压、舒张压为(121.3±4.8)mmHg(、79.1±4.9)mmHg;对照组治疗前收缩压、舒张压分别为(174.9±5.6)mmHg(、106.9±5.8)mmHg,治疗后收缩压、舒张压为(140.1±4.2) mmHg、(94.2±5.6)mmHg;疗后,试验组患者与对照组患者的血压均有明显下降,试验组与对照组间比较血压下降差异也很明显.试验组与对照组治疗前后及2组之间的比较差异均有统计学意义(均P<0.05);试验组降压总有效率为94.9%,对照组降压总有效率为76.9%.2组有效率差异有统计学意义(χ2=6.182,P=0.041),试验组不良反应发生率为7.7%,对照组不良反应发生率为15.4%.实验组明显低于对照组(χ2=8.563,P=0.035).结论 氨氯地平联合贝那普利用药与单一用药相比,前者能够有效降低中重度高血压伴糖尿病患者血压并且不良反应较后者少.     

硝苯地平缓释剂、咪哒普利、坎地沙坦、贝那普利治疗1～3级高血压病的疗效和安全性比较

目的比较硝苯地平缓释剂、咪哒普利、坎地沙坦、贝那普利治疗1～3级高血压病的疗效和安全性。方法选择该院收治的240例1～3级高血压病病人,随机分为4组：每组各60例,分别给予硝苯地平缓释剂、咪哒普利、坎地沙坦、贝那普利4种药物治疗,疗程均为1个月,观察4组病人治疗效果及不良反应。结果硝苯地平组与咪哒普利组总有效率分别为86.67%、85.0%,明显高于坎地沙坦组、贝那普利组,组间比较,差异有统计学意义（P〈0.05）。咪哒普利组不良反应率为6.67,明显低于其它3组,差异有统计学意义（P〈0.05）。结论 4种药物均可有效控制血压,硝苯地平组与咪哒普利控制血压的效果好于坎地沙坦与贝那普利同时,咪哒普利具有更高的安全性,病人耐受性较好,可作为降压的首选。     

奥美沙坦酯与贝那普利治疗110例高龄高血压患者的疗效比较

目的：分析血管紧张素Ⅱ受体拈抗剂（ARB）奥美沙坦酯治疗原发性商血压的临床疗效及安全性，为临床台理用药提供参考依据。方法：将本院确诊的110例原发性高血压病例随机分为奥美沙坦酯治疗组与贝那普利对照组各55例，分别给予奥美沙坦酯片20mg／d和贝那普利片10mg／d口服，总疗程均为8周。结果：服药8周后治疗组总有效率为94．5％，对照纽总有效率89．1％，两组疗效比较差异无统计学意义（P〉0．05）；治疗组：F咳等副作用发生率为7．2％，对照组干咳等副作用发生率为20％，两组比较差异有统计学意义（P〈0．05）。结论：奥美沙坦酯治疗组与贝那普利治疗高龄高血压疗效都较好，但奥美沙坦酯副作用更低，患者依从性好。     

贝那普利加小剂量氢氯噻嗪治疗高血压病的临床疗效

[目的]评价贝那普利加小剂量氢氯噻嗪治疗轻、中度高血压病的临床疗效。[方法]选取高血压病患者120例,治疗组63例予以贝那普利10mg加氢氯噻嗪25rag;对照组57例,仅用贝那普利治疗。[结果]治疗组总有效率96.9％,对照组总有效率85.9％,治疗组疗效优于对照组（P〈0.05）。[结论]贝那普利加小剂量氢氯噻嗪治疗高血压病的临床疗效较好。     

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.