腹膜透析患者血清脂联素与胰岛素抵抗的关系

目的探讨持续不卧床腹膜透析(CAPD)患者血清脂联素与胰岛素抵抗的关系。方法选择80例CAPD患者,采用ELISA法测定血清脂联素,放射免疫分析法检测超敏C反应蛋白(hs-CRP)、血浆胰岛素水平,采用酶法测定空腹血糖、血尿酸、三酰甘油水平。分析血清脂联素水平与稳态模型胰岛素抵抗指数(HOMA-IR)、hs-CRP、BMI、三酰甘油、尿酸等的关系。结果三酰甘油、HOMA-IR、hs-CRP与血清脂联素水平有密切相关性(P<0.01或P<0.05)。HOMA-IR与BMI(r=0.58,P<0.01)、三酰甘油(r=0.31,P<0.01)、尿酸(r=0.26,P<0.05)、hs-CRP(r=0.31,P<0.01)呈正相关关系,而与脂联素(r=-0.49,P<0.01)呈负相关关系。脂联素、尿酸、hs-CRP是腹膜透析患者HO-MA-IR主要决定因素。结论腹膜透析患者血清脂联素水平与三酰甘油、hs-CRP和胰岛素抵抗密切相关,血清脂联素较高的患者HOMA-IR低,提示腹膜透析患者血清脂联素可能具有心血管保护作用。     

肝硬化门静脉高压术后脂联素变化的临床意义

目的探讨断流术对肝硬化门静脉高压症患者脂联素和糖代谢的影响。方法检测肝硬化门静脉高压症术后的空腹血糖、餐后2h血糖（2hPG）、空腹血清胰岛素（FINS）和血清脂联素。结果糖代谢异常组患者术前空腹血糖、2hPG和FINS水平显著高于糖代谢正常组（P〈0．05）,血清脂联素显著低于糖代谢正常组（P〈0．05）。该组患者术后空腹血糖、2hPG和FINS水平显著下降（P〈0．05）,血清脂联素显著上升（P〈0．05）。结论断流术可能通过增加肝硬化门静脉高压症患者的脂联素水平而促进肝细胞糖代谢过程。     

2型糖尿病患者血清脂联素、超敏C-反应蛋白与胰岛素敏感性相关性分析

[目的]探讨2型糖尿病（T2DM）患者血清脂联素、超敏C-反应蛋白（hs-CRP）与胰岛素敏感性相关性。[方法]测定2型糖尿病组、T2DM合并肥胖组、单纯性肥胖组及正常对照组空腹血糖（FPG）、空腹胰岛素（FINS）、脂联素及超敏C反应蛋白（hs-CRP）,计算胰岛素抵抗指数（HOMA-IR）及胰岛素敏感指数（ISI）;前3组给予罗格列酮8周治疗后,重复测定,并对前后数据进行统计学比较。[结果]2型糖尿病及肥胖较正常对照组FINS、hs-CRP、HOMA-IR升高,脂联素、ISI降低;给予罗格列酮8周后,FINS、hs-CRP、HO-MA-IR明显下降,脂联素、ISI明显升高,差异有统计学意义;hs-CRP与FPG、FINS、HOMA-IR呈正相关,与脂联素、ISI呈负相关。[结论]血清标志物hs-CRP、脂联素的检测,对2型糖尿病早期诊断、治疗、预后、胰岛素抵抗及生理机制的研究具有重要意义。     

2型糖尿病患者血清瘦素、脂联素与胰岛素抵抗相关性研究

目的探讨2型糖尿病（T2DM）血清瘦素、脂联素与胰岛素抵抗的相关性。方法选取2型糖尿病患者138例,正常对照组80例,检测体重、身高、空腹血糖（FPG）、空腹胰岛素（FINS）、胆固醇（TC）、甘油三脂（TG）、低密度脂蛋白（LDL-C）、高密度脂蛋白（HDL-C）以及血清瘦素、脂联素。结果 （1）血清脂联素水平与FPG、BMI、HOMA-IR呈负相关。瘦素与BMI、FPG及HOMA-IR呈正相关。（2）多元线性逐步回归分析显示：FPG、FINS、BMI、脂联素、瘦素是影响2型糖尿病胰岛素抵抗的主要危险因素。结论瘦素、脂联素与2型糖尿病胰岛素抵抗密切相关,它们可能直接参与2型糖尿病胰岛素抵抗的发生。     

脂联素与非酒精性脂肪性肝病肝纤维化及胰岛素抵抗的关系

目的研究脂联素水平与非酒精性脂肪性肝病（NAFLD）患者肝纤维化指标及胰岛素抵抗指数（HO-MA-IR）的关系。方法采用ELISA法检测NAFLD患者和正常对照组的脂联素水平及肝纤维化指标Ⅲ型前胶原（PCⅢ）、透明质酸（HA）、Ⅳ型胶原（CⅣ）、层黏蛋白（LN）水平，采用稳态模式胰岛素抵抗指数（HOMA-IR）评估胰岛素抵抗。结果NAFLD组脂联素水平显著低于对照组，HOMA-IR及肝纤维化指标显著高于对照组（P〈0．05）。IR与PCⅢ、PCⅣ、HA和LN呈显著正相关（P〈0．05），脂联素水平与腰臀围比（WHR）、体重指数（BMI）、空腹血糖（FBG）、甘油三酯（TG）、空腹胰岛素（FINS）、HOMA-IR、PCⅢ、PCⅣ、HA和LN呈显著负相关（P〈0．01或〈0．05）。结论NAFLD患者血清脂联素水平降低，脂联素的表达在NAFLD患者肝纤维化与胰岛素抵抗进程中可能起重要作用。     

2型糖尿病患者血清抵抗素、瘦素、脂联素水平与微血管病变的关系

目的 探讨2型糖尿病患者血清抵抗素、瘦素、脂联素水平与微血管病变的关系.方法 选择河北北方学院附属第一医院2型糖尿病患者(T2DM) 120例,根据是否伴微血管病变,分为无微血管病变组(NON-MAP) 60例和微血管病变组(MAP)60例,另选取健康体检人群(NC)60例,采取酶联免疫吸附试验(ELISA)测定各组空腹抵抗素、瘦素、脂联素水平,并测定各组的空腹血糖、胰岛素和血脂水平,用胰岛素抵抗指数(HOMA-IR)评价胰岛素抵抗.结果 MVP组及NON-MVP组患者血清抵抗素、瘦素、游离脂肪酸(FFA)及超敏C反应蛋白(hs-CRP)水平均显著高于NC组,而脂联素明显低于NC组,差异有统计学意义(P＜0.05);相关分析表明T2DM患者血清抵抗素、瘦素水平与hs-CRP、淳离脂肪酸(FFA)、HOMA-IR、三酰甘油(TG)呈正相关(P＜0.05),与高密度脂蛋白胆固醇(HDL-C)呈负相关(P＜0.05);脂联素水平与hs-CRP、FFA、HOMA-IR、TG呈负相关,与HDL-C呈正相关(P＜0.05);血清抵抗素、瘦素水平呈明显正相关,而二者与脂联素均呈明显负相关;以血清抵抗素、瘦素、脂联素为因变量,进行多元线性逐步回归分析显示,对三者影响最大的是HOMA-IR和腰臀比(WHR).结论 T2DM患者血清抵抗素、瘦素水平升高、脂联素水平降低,提示血清抵抗素、瘦素、脂联素水平与T2DM的发病及其微血管病变的发生相关.     

2型糖尿病患者脂联素与胰岛素抵抗相关性研究

目的：探讨2型糖尿病脂联素与胰岛素抵抗的相关性。方法：选取2型糖尿病患者138例,分为非肥胖组68例,肥胖组70例。正常对照组：共80例,其中正常非肥胖者40例,正常肥胖者40例。采用酶免法（ELISA）测定血清脂联素,并分析其与胰岛素抵抗的相关性。结果：2型糖尿病组空腹血糖（FPG）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）高于对照组,脂联素水平低于对照组。肥胖组BMI、空腹胰岛素、HOMA-IR、脂联素水平低于非肥胖组。结论：FPG、FINS、BMI、脂联素是影响2型糖尿病胰岛素抵抗的主要危险因素。     

2型糖尿病合并高血压患者血清网膜素、脂联素及内脂素水平变化

目的探讨2型糖尿病(T2DM)合并高血压患者血清网膜素、脂联素及内脂素水平的变化。方法 102例T2DM患者,根据是否合并高血压分为T2DM合并高血压组(n=50)和T2DM无高血压组(n=52)。检测2组患者的空腹血糖(FBG)、糖化血红蛋白(Hb A1c)、空腹胰岛素(FINS)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平;并检测糖耐量试验(OGTT)2 h后的血糖(2h BG)、胰岛素(2h INS)水平及空腹和OGTT 2 h后网膜素、脂联素、内脂素水平。结果 2组患者血脂、FBG、FINS、2h BG、2h INS水平及胰岛素抵抗指数(HOMA-IR)比较,差异无统计学意义(P>0.05)。2组患者空腹网膜素、脂联素及内脂素水平与OGTT后2 h比较,差异无统计学意义(P>0.05)。T2DM合并高血压组患者空腹及OGTT后2 h网膜素和脂联素水平低于T2DM无高血压组(P<0.05),内脂素水平高于T2DM无高血压组(P<0.05)。血清内脂素水平与HOMA-IR和FINS呈正相关(P<0.05);血清网膜素和脂联素水平与HOMA-IR和FINS呈负相关(P<0.05)。结论 T2DM合并高血压患者血清网膜素、脂联素及内脂素水平明显改变,且与胰岛素抵抗有一定的相关性。     

非酒精性脂肪肝患者血清脂联素水平及其相关因素研究

目的：讨论非酒精性脂肪肝患者血清脂肪素水平及其相关因素。方法：检测正常人、单纯脂肪肝、脂肪肝合并糖耐量低减（IGT）和脂肪肝合并2型糖尿病（DM）四组人群空腹状态下的血糖、血胰岛素、血脂、脂联素和肝、肾功能、75g糖耐量试验后的血糖、血胰岛素,并计算腰臀比（WHR）、体重指数（BMI）、胰岛素抵抗指数（HOMA-IR）。结果：与对照组相比,另三组血清脂联素均显著降低（P〈0．05）;单纯非酒精性脂肪肝（F）组和非酒精性脂肪肝合并mT（FI）组均显著高于非酒精性脂肪肝合并2型糖尿病（FD）组（P〈0．05）,脂联素与BMI、WHR、TG、FBG、FINS、ALT、HOMA-IR呈显著负相关。结论：非酒精性脂肪肝（NAFLD）患者血清脂联素下降,随着血糖升高逐步降低,血清脂联素与胰岛素抵抗指数星负相关。     

原发性高血压患者血清脂联素水平分析

目的:探讨原发性高血压患者血清脂联素水平及其与血脂、血糖、胰岛素、超敏C反应蛋白(hs-CRP)抵抗之间的关系。方法:选取原发性高血压患者(EH组)65例及健康对照者40例,用酶联免疫吸附法检测各组空腹血清脂联素浓度,同时测定各组的血压、体重指数(BMI)、腰围(WC)、血脂、空腹血糖、空腹胰岛素(FINS)、hs-CRP等指标,采用稳态模型法计算胰岛素抵抗指数(IRI),分析血清脂联素与各指标间的相关性。结果:原发性高血压组血清脂联素水平明显下降[(10.30±0.93)ug/ml VS(12.83±1.66)ug/ml),P<0.01〗;hs-CRP水平明显高于对照组[(2.68±0.78)mg/L VS(1.69±0.04)mg/L,P<0.01];IRI值高于对照组[(1.53±0.62)VS(1.27±0.29),P<0.01]。Pearson相关性分析显示,EH组血清脂联素与收缩压(SBP,r=-0.30)、BMI(r=-0.50)、WC(r=-0.54)、TG(r=-0.32)、FINS(r=-0.29)、IRI(r=-0.33)、hs-CRP(r=-0.32)之间呈负相关(P<0.05~0.01),与HDL-C(r=0.31,P<0.05)呈正相关;多元逐步回归分析显示:在对照组,BMI和FINS是影响脂联素水平的独立因素;在高血压组,收缩压、WC、HDL-C、hs-CRP是影响脂联素水平的独立因素。结论:原发性高血压患者血清脂联素水平下降并与血脂、胰岛素抵抗和hs-CRP具有一定的相关性。     

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.