超声联合hs-CRP检测在ACS诊断中的意义

目的:观察颈动脉超声检查联合血清高敏C反应蛋白(hs-CRP)检测在急性冠脉综合征(ACS)的诊断中的作用.方法:选取本院确诊为稳定性心绞痛(SAP组)40例,ACS(ACS组)70例,对上述入选患者行体表颈动脉超声、冠状动脉造影,并检测各组血清hs-CRP水平,分析颈动脉超声检查结果及患者血清hs-CRP水平与ACS的关联性,并设同期来院体检正常者30例(对照组)进行对比观察.结果:ACS组CIMT、颈动脉斑块发生率及血清hs-CRP水平均明显高于SAP组及对照组,差异有统计学意义(P＜0.05);SAP组与对照组CIMT、颈动脉斑块发生率及血清hs-CRP水平比较,差异无统计学差异(P＞0.05);hs-CRP≥4 mg/L组ACS发生率、CIMT、斑块发生率明显高于hs-CRP＜4 mg/L组,差异具有统计学意义(P＜0.05);1、2、3支冠脉病变患者颈总动脉的内膜-中膜厚度(CIMT)、颈动脉斑块发生率及血清hs-CRP水平均明显高于无冠脉病变患者,差异有统计学意义(P＜0.05).结论:ACS患者血清hs-CRP水平与颈动脉斑块发生率正相关,提示颈动脉超声联合hs-CRP检测可对ACS的诊断及预测预后有积极意义.     

不同剂量辛伐他汀对急性冠脉综合征患者颈动脉粥样硬化疗效观察

目的:观察急性冠脉综合征(ACS)病人使用两种剂量辛伐他汀(40mg/日,20mg/日),观察对血浆超敏C反应蛋白(hs-CRP)及颈动脉粥样硬化的影响.方法:对90例ACS病人随机分两组,治疗组45例,每晚服用40mg辛伐他汀;对照组45例,每晚服用20mg辛伐他汀.随访12个月,观察血浆hs-CRP、彩色多普勒技术测定颈动脉内-中膜厚度(IMT)及颈动脉斑块变化.结果:治疗组和对照组治疗12个月,均能显著降低hs-CRP(P＜0.01),但治疗组与对照组比较差异有显著性(P＜0.05);且治疗组能降低双侧IMT和斑块积分(P＜0.01).结论:ACS应用40mg/日辛伐他汀治疗,明显抑制hs-CRP,有利于动脉粥样硬化斑块的稳定性,减少心脏事件发生.     

脑梗死患者血清Hcy、hs-CRP水平与IMT的相关性研究

目的探讨脑梗死患者血清同型半胱氨酸(Hcy)、超敏C-反应蛋白(hs-CRP)水平与颈动脉中层厚度(IMT)的相关性。方法对90例脑梗死患者(脑梗死组)、50例健康体检者(对照组)进行血清Hcy、hs-CRP水平和IMT检测,并对检测结果进行组间比较。比较两组颈动脉硬化程度和斑块性质。并比较不同IMT脑梗死患者血清Hcy、hs-CRP水平。结果脑梗死组血清Hcy、hs-CRP和IMT分别为(20.61±5.84)μmol/L、(8.16±1.84)mg/L和(1.56±0.34)mm,均高于对照组(12.42±3.67)μmol/L、(1.52±0.67)mg/L和(0.67±0.28)mm(P0.01)。脑梗死组IMT增厚率和斑块形成率分别为26.67%和60.00%,均高于对照组12.00%和34.00%(P0.05,P0.01)。脑梗死组硬斑发生率为9.26%,低于对照组的64.71%;软斑发生率为61.11%,高于对照组的11.76%,差异均有统计学意义(P0.01)。脑梗死患者血清Hcy、hs-CRP水平随着动脉硬化程度的加重呈增高趋势(P0.01),血清Hcy、hs-CRP水平与IMT呈正相关(P0.05)。结论脑梗死患者血清Hcy、hs-CRP水平升高,二者与IMT呈正相关,可能共同促进了动脉粥样硬化和脑梗死的发生和发展。     

合并2型糖尿病的高血压患者颈动脉粥样硬化改变及阿托伐他汀干预研究

目的 探讨合并2型糖尿病的高血压患者颈动脉粥样硬化程度、与高敏C-反应蛋白(hs-CRP)的关系及阿托伐他汀的干预作用.方法 62例合并2型糖尿病的高血压患者(A组)和42例单纯性高血压患者(B组)入院后常规降压、降糖、抗血小板治疗,A组加用阿托伐他汀10 mg,每晚1次.分别于入院后及6个月时测定血浆hs-CRP、脂蛋白(a)[LP(a)]、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA 1c),高频超声检测颈动脉,记录颈动脉内膜中层厚度(IMT)、颈动脉斑块积分、斑块发生率.结果 入院时A组hs-CRP明显高于B组,分别为(8.78±1.59)mg/L和(6.34±1.43)mg/L,P＜0.01,IMT、颈动脉斑块积分、斑块发生率A组也明显高于B组;阿托伐他汀治疗后hs-CRP、IMT、颈动脉斑块积分、斑块发生率分别由(8.78±1.59)mg//L、(1.24±0.13)mm、82.3%、(6.23±0.57)mm下降为(6.19±1.30)mg/L、(0.98±0.19)mm、69.5%、(5.07±0.42)m,P＜0.01.相关分析表明hs-CRP、LP(a)与IMT、颈动脉斑块积分、斑块发生率成正相关;hsCRP与HbA1c、TG、LDL-c呈正相关(P＜0.005～0.01);结论 合并2型糖尿病的高血压患者颈动脉粥样硬化程度较重;阿托伐他汀治疗可改善颈动脉粥样硬化程度及炎症反应程度,具有稳定斑块作用;③hs-CRP有致动脉硬化作用.     

他汀类药物对冠脉综合征患者血清hs-CRP与颈动脉IMT的影响

目的：探讨他汀类药物对冠脉综合征患者血清超敏C反应蛋白(hs-CRP)和颈动脉内膜中层厚度（IMT）的影响。方法选取2012年6月至2015年1月期间我院心血管内科确诊治疗的冠脉综合征患者150例,依据随机分配原则分为常规组和他汀组,每组75例,常规组患者给予抗血小板、抗凝、溶栓、抗缺血、抗心力衰竭及心律失常等常规治疗和10 mg阿托伐他汀口服治疗,他汀组患者在基础治疗上给予20 mg阿托伐他汀口服治疗,两组均持续治疗1个月,采用酶联免疫吸附法(ELISA)检测血清hs-CRP水平,随访1年,统计分析所有患者治疗前后颈动脉IMT、斑块大小、厚度、数量和治疗前、治疗后3个月、6个月、12个月的血清hs-CRP水平及左心射血分数(LVEF)、不良心脏事件发生情况。结果治疗前,常规组和他汀组患者颈动脉IMT [(1.74±0.46) mm vs (1.71±0.44 mm]、斑块大小[(23.58±5.84) mm2 vs (24.02±5.91) mm2]、厚度[(2.82±0.82) mm vs (2.76±0.79) mm]、数量[(5.48±0.64)个vs (5.39±0.61)个]和血清hs-CRP [(27.46±7.31) mg/L vs (28.06±7.41) mg/L]水平基本相同,差异均无统计学意义(P>0.05);治疗后,他汀组患者颈动脉IMT [(1.21±0.34) mm vs (1.52±0.38) mm]、斑块大小[(14.57±4.72) mm2 vs (19.51±5.41) mm2]、厚度[(1.53±0.52) mm vs (1.89±0.61) mm]、数量[(2.94±0.33)个vs (3.52±0.38)个]和3个月[(18.32±7.02) mg/L vs (24.23±7.11) mg/L]、6个月[(12.36±6.13) mg/L vs (18.43±7.05) mg/L]、12个月[(7.63±3.21) mg/L vs (11.36±5.03) mg/L]的血清hs-CRP水平明显低于常规组,差异均有统计学意义(P<0.05);他汀组患者治疗后LVEF水平为(57.96±8.11%)%,明显高于常规组的(52.13±7.84)%,不良心脏事件发生率为4.00%,明显低于常规组的13.33%,差异有统计学意义(P<0.05)。结论较大剂量他汀类药物可有效缓解冠脉综合征患者的颈部血管斑块及机体炎症状态,改善患者左心室功能,且可有效减少不良心脏事件的发生,值得临床推广应用。     

老年原发性高血压患者动态脉压与高敏C反应蛋白以及颈动脉粥样硬化的关系

目的 探讨老年原发性高血压(EH)患者动态脉压(PP)与血清高敏C-反应蛋白(hs-CRP)以及颈动脉内膜中层厚度(IMT)的关系.方法 选择老年EH患者190例,对入选者行动态血压监测,测定血清hs-CRP浓度,并行颈动脉血管超声检查.按动态脉压水平分为三组:PP 1组[PP≤45 mm Hg(1 mm Hg=0.133 kPa)];PP 2组(45 mm Hg＜PP＜65 mm Hg);PP 3组(PP≥65 mm Hg).据斑块的分级标准分为:0级、Ⅰ级、Ⅱ级、Ⅲ级共四组.结果 高脉压组的hs-CRP和IMT水平均高于低脉压组(P＜0.05).随着脉压增大,斑块检出率、Ⅱ级及以上斑块发生率均明显升高(P＜0.05).斑块高级别组hs-CRP和IMT显著高于斑块低级别组(P＜0.05或P＜0.01),并且IMT与PP及hs-CRP呈显著正相关,相关系数分别为0.673和0.622(P均＜0.01).进一步行多因素Logistic回归分析显示PP、SBP及hs-CRP与IMT增厚呈正相关.结论 动态脉压及高敏C-反应蛋白水平与老年EH患者颈动脉粥样硬化的发病密切相关,其机制可能与炎症反应有关.     

颈动脉粥样斑块及内中膜厚度与冠心病的相关性分析

目的 探讨颈动脉粥样斑块及内中膜厚度(IMT)与冠心病(CHD)发生的关系.方法 对145例疑诊CHD先后作颈动脉超声检查测量IMT和观察粥样斑块及冠状动脉造影.结果 非CHD 44例,CHD 101例,IMT为(0.75±0.10)mm和(0.99±0.29)mm;颈部斑块发生率25%(11/44)和77.22%(78/101).两组比较差异有统计学意义(P<0.005).硬斑块组发生CHD最高96.55%,软斑块组次之83.33%,无斑块组最低41.07%,各组间比较差异均有统计学意义(P<0.005).以IMT≥0.85mm或出现斑块来预测CHD,敏感性77.22%,特异性81.81%,阳性预测值83.72%.结论 颈动脉粥样斑块及内中膜厚度增加与CHD密切相关,采用颈动脉超声检查可预测CHD发生.     

PAS三联疗法对急性脑梗死患者血清MMP-7、MMP-8水平的影响及颈动脉易损斑块的干预作用

目的:探讨普罗布考、阿司匹林、他汀类药物(PAS)三联疗法对急性脑梗死患者血清超敏C-反应蛋白(hs-CRP)、基质金属蛋白酶-7(MMP-7)及基质金属蛋白酶-8(MMP-8)水平的影响,观察其对颈动脉易损斑块的干预作用.方法:135例急性脑梗死患者根据颈动脉超声检查结果分为颈动脉稳定斑块组(n=45)和颈动脉易损斑块组(n=90).将稳定斑块组作为对照组,易损斑块组根据治疗方法按随机数字法分为AS组45例(阿司匹林100mg/d,阿托伐他汀20 mg/d,口服)和PAS组45例(阿司匹林100 mg/d,阿托伐他汀20 mg/d,普罗布考0.25/次,2次/d,口服).比较治疗前和治疗4周血清hs-CRP、MMP-7和MMP-8水平;观察治疗前及治疗后12月颈动脉内-中膜厚度(IMT值)、斑块面积及斑块回声变化.结果:治疗前,易损斑块组中两亚组(AS组和PAS组)血清hs-CRP、MMP-7和MMP-8水平均高于稳定斑块组(对照组),差异有显著性(P均＜0.01);两组(AS组和PAS组)间血清hs-CRP、MMP-7和MMP-8水平差异无显著性(均P＞0.05).治疗后4周,PAS组中血清hs-CRP、MMP-7和MMP-8水平均低于AS组,其下降幅度均大于AS组,差异具有显著性(P均＜0.01);治疗12月后,两组IMT值和斑块面积较治疗前减少,且PAS组两项指标低于AS组,差异具有显著性(P均＜0.01);PAS组低回声斑块回声增强例数多于AS组(P＜0.01).结论:PAS三联疗法能迅速降低脑梗死患者血清炎性因子水平,具有更强的抗炎作用,可逆转和稳定斑块.     

传统心血管危险因素结合炎性标志物及颈动脉斑块对冠心病预测的价值

目的 探讨颈动脉内中膜厚度(IMT)、斑块指数及血清高敏C-反应蛋白(hs-CRP)浓度等指标与冠脉病变程度的关系,从而对冠心病的早期预防提供新的途径.方法 对1 506例患者进行冠脉造影,颈动脉彩超及血清hs-CRP检查.根据造影结果分为对照组(814例),单支病变组(341例),双支病变组(131例)和三支病变组(220例),检测IMT、hs-CRP及计算斑块指数.结果 对照组IMT、斑块指数及hs-CRP与冠心病组差异均有统计学意义.单支病变组IMT及斑块指数与双支病变组及三支病变组差异有统计学意义,而双支病变组及三支病变组组间差异无统计学意义.hs-CRP在冠心病组间差异无统计学意义.结论 通过彩超检测颈动脉IMT和斑块指数及测定血清hs-CRP浓度对冠心病的早期诊断,治疗及观察其疗效有重要的临床价值.     

替勃龙治疗对绝经期妇女颈动脉内中膜厚度和动脉粥样硬化斑块面积的影响

目的 观察替勃龙治疗对绝经期妇女颈动脉内中膜厚度及动脉粥样硬化斑块面积的影响.方法 100例绝经后妇女被分为绝经期治疗组50例,每天口服替勃龙(利维爱)2.5 mg;50例未进行激素治疗的作为对照组.采用无创性高分辨超声分别检测颈动脉内中膜厚度(IMT)及动脉粥样硬化斑块面积.结果 治疗组颈总动脉的IMT下降了27.1%,从治疗前的(0.73±0.18)mm(95%CI 0.68～0.78mm),下降到治疗后的(0.57±0.21)mm(95%C1 0.51～0.63mm)(P＜0.01);颈动脉粥样硬化斑块面积明显减少(P＜0.05).结论 替勃龙治疗后胆固醇、LDL降低,IMT变薄,动脉粥样硬化斑块面积减少,认为有降低动脉硬化的作用.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

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.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.