高敏C-反应蛋白与2型糖尿病肾病

目的： 前瞻性探讨2型糖尿病（DM）患者高敏C-反应蛋白（hs-CRP）与糖尿病肾病（DN）及其发生风险的关系。 方法：应用ELISA法测定55例正常对照组、66例不伴DN和68例伴DN的2型糖尿病患者的hs-CRP水平,比较3组间的差异;对58例入组时无DN的2型糖尿病患者进行降糖、降压等措施综合干预,追踪观察5年,观察干预前后尿白蛋白排泄率（UAE）、hs-CRP及肾功能的动态变化。 结果：入组时,2型糖尿病组的血清hs-CRP水平高于正常对照组（P＜0.05);在年龄,BMI,糖尿病病程,平均动脉压,空腹血糖,糖化血红蛋白及血肌酐都匹配的条件下,入组时DN组的hs-CRP水平高于无DN的DM 组和正常对照组（P<0.05）;28例在随访终点发生DN的DM患者与30例在随访终点未发生DN患者比较,前者入组时和随访结束时的血清hs-CRP水平高于后者（P＜0.05);经降糖、降压等综合治疗5年后,终点时未发生DN的DM1组血清hs-CRP水平低于入组时（P＜0.05),而发生了DN的DM2组终点的血清hs-CRP水平虽较入组时略低,但差异无统计学意义（P＞0.05）。 结论：高敏C-反应蛋白水平在DM组和DN组逐渐增高,表明其可能是2型DM和DN发生的危险因素;终点发生DN的DM患者有高水平的hs-CRP基线值,在一定程度上能够预测2型糖尿病患者发生DN的风险。     

CRP与2型糖尿病视网膜病变的关系

目的 探讨血清C-反应蛋白(CRP)与2型糖尿病视网膜病变的关系.方法 将132例2型糖尿病根据眼底结果分糖尿病组、单纯型DR组、增殖型DR组测定血清CRP水平,并与糖脂代谢指标作相关分析.结果 CRP水平糖尿病组与糖尿病DR有显著差异(P＜0.05),且随病程延长而升高,CRP水平与血糖、HbA1c、BMI、TC、TG、LDL-C呈正相关(P＜0.05).结论 提示CRP可能与2型糖尿病应网膜病变的发生、发展有一定相关性.     

血清IL-10及IL-18与糖尿病性视网膜病变的相关性

目的探讨2型糖尿病病人血清白细胞介素-10(IL-10)、白细胞介素-18(IL-18)与糖尿病性视网膜病变(DR)的相关性。方法检测40例单纯2型糖尿病病人(DM组)及40例伴有DR的2型糖尿病病人(DM+DR组)血清IL-10和IL-18水平,以无2型糖尿病及DR的40例正常人作为正常对照组。结果 DM组、DM+DR组IL-18明显高于正常对照组,DM+DR组IL-18高于DM组,差异均有显著性(F=6.34,P<0.05)。DM+DR组、DM组IL-10低于正常对照组,差异有显著性(F=6.45,P<0.05);DM+DR组、DM组IL-10比较,差异无显著性(P>0.05)。结论 DR的发生与血清IL-18水平的变化有一定关系。     

血清高敏C反应蛋白与2型糖尿病大血管病变的相关性研究

目的 探讨血清高敏C反应蛋白与2型糖尿病大血管病变的关系.方法 选取2型糖尿病患者62例,其中2型糖尿病并发大血管病变组(A组)32例,无大血管病变组(B组)30例,另选30例健康者为对照组(C组).分别测定三组患者血清高敏C反应蛋白水平.结果 2型糖尿病组高敏C反应蛋白水平与健康对照组比较明显升高(P＜0.05);并发大血管病变患者高敏C反应蛋白水平高于非大血管病变患者(P＜0.05).结论 血清高敏C反应蛋白水平的检测对预测2型糖尿病患者发生大血管病变的发生有重要的临床意义.     

Ficolin-3、TRF及hs-CRP联合检测在2型糖尿病早期诊断中的价值

目的 检测2型糖尿病(T2DM)患者,T2DM的期人群及健康人群血清中纤维凝胶蛋白-3 (Ficol-in-3)、转铁蛋白(TRF)、超敏C反应蛋白(hs-CRP)水平,来探讨血清中Ficolin-3、TRF及hs-CRP水平与T2DM的关系.方法 选择大连医科大学附属第一医院T2DM患者33例,T2DM前期组41(包括29例糖耐量减低者和12例空腹血糖受损者)及健康对照组30例,比较各组间Ficolin-3、TRF及hs-CRP的水平,分析3者与T2DM间的关系.结果 (1)血清Ficolin-3水平:在T2DM前期组(26.1±10.5) μg/mL及T2DM组(28.1±8.5)μg/mL均高于正常对照组(20.8±11.7 μg/mL,P＜0.05),T2DM前期组与T2DM组无显著性差异(P＞0.05);(2)血清TRF水平:T2DM前期组(261.3±51.1) mg/dL明显高于正常对照组(236.5±31.9 mg/dL,P＜0.05),T2DM组(242.0±57.7) mg/dL与正常对照组、T2DM组与T2DM前期组均无显著性差异(P＞0.05);(3)血清hs-CRP水平:T2DM组(3.12±3.47) mg/L明显高于正常对照组(1.19± 1.41) mg/L和T2DM前期组(1.70±1.97mg/L,P＜ 0.05),T2DM前期组与正常对照组无显著性差异(P＞0.05).结论 血清Ficolin-3、TRF和hs-CRP的水平可以有助于2型糖尿病的早期诊断,对T2DM的早期预防及病情发展有一定的预测价值.     

2型糖尿病合并视网膜病变老年患者血清脂联素及同型半胱氨酸的水平分析

目的 探讨2型糖尿病合并视网膜病变老年患者的血清脂联素(APN)和同型半胱氨酸(Hcy)水平及其相关性.方法 从该院2012年1月至2014年12月住院治疗的2型糖尿病患者中筛选68例合并视网膜病变老年患者(T2DM+ DR组),调查其一般资料,检测常规生化指标并采用酶联免疫吸附法测定血清总APN、高分子量APN及Hcy水平,同时采用Pearson相关分析法评价三者间的相关性.选取同期65例老年2型糖尿病患者(T2DM组)和70例老年健康体检者(NC组)作对照.结果 T2DM、T2DM+DR组的腰臀比、空腹血糖、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白、空腹血胰岛素及胰岛素抵抗指数水平均高于NC组,高密度脂蛋白胆回醇水平低于NC组;T2DM+ DR组的病程和体质量指数均高于T2DM组,差异均有统计学意义(P＜0.05);T2DM、T2DM+DR组的总APN和高分子量APN水平均低于NC组,总APN与高分子量APN的比值(H/T)亦低于NC组(P＜0.05),但Hcy水平高于NC组(P＜0.05);且T2DM+ DR组的总APN、高分子量APN水平均低于T2DM组,Hcy水平高于T2DM组,差异均有统计学意义(P＜0.05);T2DM+DR组血清总APN(r=-0654)、高分子量APN(r=-0.562)水平均与Hcy水平呈负相关(P＜0.05).结论 2型糖尿病合并视网膜病变老年患者的血清APN水平降低、Hcy水平升高,可能与2型糖尿病的视网膜病变进展有关.     

糖尿病视网膜病变患者血清同型半胱氨酸与氧化应激反应的变化

目的 观察糖尿病视网膜病变(DR)患者血清同型半胱氨酸与氧化应激反应的变化,探讨糖尿病视网膜病变患者血清同型半胱氨酸水平与氧化应激反应的相关性.方法 测定50例健康对照者,50例无DR 2型糖尿病患者(NDR组)、50例合并非增殖型DR 2型糖尿病患者(NPDR组)及50例合并增殖型DR 2型糖尿病患者(PDR组)血清同型半胱氨酸(Hcy)及丙二醛(MDA)、超氧化物歧化酶(SOD)、还原型谷胱甘肽(GSH)水平.结果 所有糖尿病患者Hcy、MDA含量均明显高于正常对照组(P＜0.01);NPDR组及PDR组均较NDR组明显升高,血清SOD、GSH含量所有糖尿病患者低于正常对照组(P＜0.01);NPDR组及PDR组均较NDR组低(P＜0.01);同时PDR组又低于NPDR组(P＜0.01);血清Hcy与MDA水平呈正相关(r=0.84,P＜0.05),与SOD、GSH含量均呈负相关(r=-0.77,-0.68,P＜0.05).结论 糖尿病视网膜病变患者血清同型半胱氨酸水平升高,氧化应激反应增强,氧化应激与血清同型半胱氨酸水平升高有关,血清同型半胱氨酸水平升高,氧化应激在糖尿病视网膜病变发生发展中发挥重要作用.     

The Clinical Significance of Serum High-sensitivity C-reactive Protein in Diabetic Patients with Atherosclerotic Cerebral Infarction

目的 探讨2型糖尿病合并动脉粥样硬化性脑梗死患者血清高敏C反应蛋白(hs-CRP)的变化情况及其临床意义.方法 采用免疫荧光干式定量法测定试验组26例糖尿病合并动脉粥样硬化性脑梗死患者及对照组83例非糖尿病性动脉粥样硬化性脑梗死患者血清hs-CRP浓度.应用体外诊断试剂盒测定血脂、血糖指标,颈动脉彩色多普勒超声仪检查颈动脉粥样硬化斑块的大小及超声特点,同时测定患者颈动脉内膜中层厚度(IMT)变化.结果 糖尿病合并动脉粥样硬化性脑梗死组hs-CRP水平明显高于非糖尿病性动脉粥样硬化性脑梗死组,差异有统计学意义(P＜0.05);试验组颈动脉内膜中层厚度增厚及2级以上斑块发生的例数多于对照组,差异有统计学意义(P＜0.05).结论 血清hs-CRP对糖尿病合并动脉粥样硬化患者脑梗死的发生发展和预后有重要的预测价值.     

血清胰岛素样生长因子及其结合蛋白水平与2型糖尿病视网膜病变的关系

目的 探讨血清胰岛素样生长因子及其结合蛋白水平与2型糖尿病患者糖尿病视网膜病变(diabetic retinopathy,DR)的关系.方法 用免疫放射分析法测定28例合并DR、68例无DR的2型糖尿病患者以及156例正常对照者的空腹血清IGF-Ⅰ,Ⅱ,IGFBP-1,3水平.结果 ①与正常对照人相比,2型糖尿病患者无论有否DR,血清IGF-Ⅰ(ng/ml)降低[256.1±163.99(对照组),184.73±110.97(DR组),163.12±11.97(NDR组),P＜0.05],糖尿病合并与不合并DR两组间差异无显著性;②与正常对照相比,糖尿病患者不伴DR者IGF-Ⅱ(ng/ml)水平较低(863.82±268.27 vs 703.31±295.12,P＜0.05),正常对照组与糖尿病合并DR组之间,糖尿病两组间差异无显著性;③糖尿病无论是否合并DR血IGFBP-1水平(ng/ml)都显著高于正常对照组(均P＜0.05),糖尿病二组间差异无显著性(54.06±30.85,75.81±58.91,68.17±36.54);④IGFBP-3水平三组间差异无显著性.结论 糖尿病患者血浆IGF-Ⅰ,Ⅱ,IGFBP-1,3水平与DR的关系不明确,尚需进一步研究.     

视黄醇结合蛋白4与糖尿病视网膜病变的相关性研究

目的 探讨2 型糖尿病（T2DM）患者的视黄醇结合蛋白4（RBP4）水平与糖尿病视网膜病变（DR）的关系。方法 应 用酶联免疫吸附法测定31 例无DR 的糖尿病患者（NDR 组）、33例非增殖性DR 患者（NPDR 组）、34 例增殖性DR 患者（PDR组）和36例无糖尿病的健康体检者（对照组）的血清RBP4 水平,比较4组RBP4水平,并分析其与BMI、超敏C反应蛋白（hs-CRP）、TG 等的关系。结果 NDR 组、NPDR 组和PDR组患者血清RBP4 水平分别为（18.76±5.17）、（25.33±4.68）、（31.57±5.98）mg/L,与对照组[（11.65±4.32）mg/L]比较,差异有统计学意义（P＜0.05 或0.01）;NPDR 组、PDR组患者血清RBP4水平高于NDR 组,差异有统计学意义（P＜0.05 或0.01）。相关分析显示血清RBP4 水平与BMI、hs-CRP、TG 及HOMA-IR 呈显著正相关（r= 0.714、0.837、0.796、0.801,均P＜0.05）,多元逐步回归分析显示hs-CRP 和HOMA-IR 显著影响RBP4 水平（P＜0.05）。结论 血清RBP4 在糖尿病患者中显著升高,其水平变化与DR 的发生、发展密切相关。     

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.