儿茶酚胺代谢产物检测对嗜铬细胞瘤诊断价值的比较

目的比较24h尿3-甲氧基-4-羟基苦杏仁酸（VMA）,5h尿VMA／Cr,血、尿3甲氧基去甲肾上腺素（NMN）和3甲氧基肾上腺素（MN）在嗜铬细胞瘤诊断中的准确性。方法对45例嗜铬细胞瘤患者、111例肾上腺皮质腺瘤患者、145例原发性高血压患者和39例健康体检者的24h尿VMA,5h尿VMA／Cr,血、尿NMN和MN的检测结果进行比较。结果24h尿VMA检测的敏感性仅为73．3％,低于血NMN＋MN的95．6％（P〈0．05）、尿NMN＋MN的97．8％（P〈0．05）和血、尿NMN＋MN联合检测的100％（P〈0．01）。5h尿VMA／Cr检测的特异性为84．1％,低于24h尿VMA的92．2％、血NMN＋MN的93．6％、尿NMN＋MN的93．9％和血、尿NMN＋MN的联合检测99．7％（P均〈0．01）：24h尿VMA、5h尿VM～Cr、血NMN＋MN和尿NMN＋MN的ROC曲线下面积分别为0．884、0．923、0．972和0．985。结论血、尿NMN＋MN检测的敏感性和特异性高,是临床诊断嗜铬细胞瘤较为理想的检测方法。如果两者联合检测将进一步提高诊断的准确性。     

41例嗜铬细胞瘤的诊治分析

目的提高嗜铬细胞瘤(PCM)的诊治水平。方法41例手术治疗的住院患者。对患者一般资料、病理、临床表现、血清生物化学及肿块病理性质等进行分析。结果有阵发性高血压者30例(73.2%),24h尿VMA浓度显著升高(126.40±39.00)μmol/24h。肿瘤大小(4.52±2.68)cm×(4.38±2.55)cm,髓质嗜铬细胞瘤占85.4%,核磁共振检出率95.1%,术后1周血压恢复正常者为30.7%。结论阵发性高血压和尿VMA浓度升高是诊断PCM最重要指标,核磁共振检查可提高疾病的诊断率。手术治疗是降低血压确实有效的治疗措施。     

高效液相色谱测定尿中香草扁桃酸含量

目的 :建立测定尿中的香草扁桃酸 (VMA)含量的高效液相色谱法。方法 :以Nova PakC18柱为分析柱 ,流速是 0 9ml·min-1,流动相为 40mmol·L-1NaH2 PO4 液 (内含Na2 EDTA和辛基磺酸钠各为 5 0mg·L-1,pH3.0 ) ,采用电化学检测器和利用内标法测定了 30例正常人 2 4h尿中的VMA含量。结果 :当VMA浓度为 5～ 2 0 0 μmol·L-1时呈良好的线性关系。VMA的平均回收率为 99 1% ,平均批内变异系数为 5 8% ,平均批间变异系数为 7 7% ,最低检出量是 5 3 2μg。标本量为 10 0 μl时的最低检出浓度为 0 2 8μmol·L-1;正常人 2 4h尿中VMA含量为 (18 13± 6 17) μmol。结论 :该方法能准确测定尿中VMA含量 ,适合临床常规应用。     

检测血、尿胱抑素C对判断尿蛋白来源的临床探讨

[目的]探讨检测血、尿中胱抑素C(Cystatin C)浓度对判断尿中蛋白质源自肾小球还是肾小管的临床意义。[方法]受检对象分为三组:单独肾小球受损组、肾小管受损组、正常体检组。分别检测三组血、尿中的Cystatin C浓度、24h尿蛋白含量,经统计学处理,观察三组血、尿中的Cystatin C浓度与24h尿蛋白含量的相关性。[结果]肾小球滤过率正常组的尿蛋白含量为2 814.0±3 450.0mg/24h,血清Cystatin C含量为0.57±0.23mg/L,相关系数(r)为-0.201;肾小球滤过率下降组的尿蛋白含量为2 055.4±4 134.0mg/24h,Cystatin C含量为2.60±1.52mg/L,r为-0.375。肾小管正常组的尿蛋白浓度为1795.0±2 100.1mg/24h,尿Cystatin C浓度为0.00±0.00mg/L,r为-0.110。肾小管受损组的尿蛋白浓度为1 980.1±2128.4mg/24h,尿Cystatin C浓度为4.30±2.00mg/L,r为-0.150。[结论]血、尿中的Cystatin C浓度均与尿蛋白含量无相关性,而Cystatin C是肾小球滤过率的内源性标志物,正常肾小管又可以几乎百分之百重吸收,这有利于临床医生用血、尿中Cystatin C的浓度来判断尿蛋白的来源。     

任意尿香草扁桃酸和高香草酸的肌酐比值测定诊断神经母细胞瘤

目的：探讨任意尿香草扁桃酸／肌肝（VMA／Cr)和高香草酸／肌杆（HVA／Cr）测定对神经母细胞瘤的诊断价值。方法：50例1－5岁正常儿童和11例2－5岁神经母细胞瘤患儿的任意尿标本，用高效液相色谱法测定VMA、HVA浓度，Beckmann自动生化分析仪测定肌酐（Cr)浓度，计算VMA／Cr、HVA／Cr。结果：1－5岁儿童的99％的正常值范围为VMA／Cr＜14．9mmol/mol，HVA／Cr＜23．8mmol/mol。11例神经母细胞瘤患儿中有10例VMA／Cr和HVA／Cr均超过正常值范围，诊断符合率90．9％。结论：任意尿VMA／Cr和HVA／Cr测定采样方便，诊断符合率高，可取代24h尿VMA、HVA总量测定法用于神经母细胞瘤术前诊断和术后随访。     

急性脑梗死患者尿8-异前列腺素F2α排出量的变化

目的探讨急性脑梗死患者尿8-异前列腺素F2α排出量的变化,明确其体内氧化自由基产生情况。方法选取20例脑梗死患者作为试验组,根据发病时间分别测定发病24h内和发病第14d时尿8-异前列腺素F2α的浓度。并根据标准选取19例体检者作为对照组。结果(1)脑梗死患者发病24h内和发病第14d时尿8-异前列腺素F2α的浓度与正常对照组间差别有显著性意义(P<0.01);(2)脑梗死患者发病第14d时与发病24h内尿8-异前列腺素F2α浓度间差别有显著性意义(P<0.01)。结论急性脑梗死患者体内脂质过氧化有显著增加,常规治疗第14d时体内氧化应激反应仍在加重。     

窒息新生儿尿β2—微球蛋白的变化及其意义

测定106例足月新生儿出生24h内与出生后6～10天中尿β_2-微球蛋白(β_2-MG)的浓度,结果提示宫内窘迫组,轻、重窒息组患儿尿β_2-MG均显著增加。3组新生儿出生后6～10天日β_2-MG较出生后24h内尿β_2-MG明显下降,表明尿β_2-MG浓度与窒息程度密切相关。而血肌酐浓度不能灵敏反映窒息程度。     

血管紧张素-(1-7)对胰岛素分泌细胞株NIT-1增殖的影响

[目的]探讨血管紧张素[Ang-(1-7)]对小鼠胰岛素分泌细胞株NIT-1细胞增殖的影响.[方法]NIT-1细胞按以下分组分别处理24 h,采用CCK-8比色法检测细胞增殖.(1)11.1、25.0、30.0、35.0和40.0 mmol/L葡萄糖液,35.0 mmol/L甘露醇分别处理24 h;(2)0、10-7、10-6、10-5和10-4 mol/L Ang-(1-7)分别处理24 h;(3)高糖(HG,35.0 mmol/L)、HG+Ang-(1-7)(10-5 mol/L)、HG+Ang-(1-7)+Mas受体拮抗剂(A-779,10-5 mol/L)和HG+A-779组.[结果](1)较11.1 mmol/L组,葡萄糖浓度为35.0和40.0 mmol/L时,NIT-1细胞的增殖明显减低(1.02±0.07 vs 1.21±0.10;0.90±0.05 vs 1.21±0.10,P＜0.05).(2)在11.1 mmol/L葡萄糖培养条件下,10-7～10-4mol/L之间的Ang-(1-7)不影响NIT-1细胞的增殖.(3)与HG组相比,HG+Ang-(1-7)组细胞的增殖率明显增加(1.44±0.24 vs 1.14±0.07,P＜0.05),加入A-779共同孵育可逆转Ang-(1-7)的促增殖效应(1.20±0.02 vs 1.44±0.24,P＜0.05).[结论]Ang-(1-7)通过Mas受体拮抗高糖对NIT-1细胞增殖的抑制作用.     

饮食对甲磺酸雷沙吉兰人体药代动力学的影响

采用开放、随机、自身对照交叉试验设计,考察高脂餐对雷沙吉兰在健康中国人体内的药代动力学影响。12名健康受试者分别于空腹或高脂餐后,单次口服甲磺酸雷沙吉兰片1 mg,0～8 h间隔采集血样,0～24 h间隔采集尿样,采用LC-MS/MS法测定雷沙吉兰的血药与尿药浓度,DAS 2.1计算药代动力学参数。雷沙吉兰在0.006 4～12.8 ng/mL范围内线性关系良好。测得空腹和高脂餐后口服甲磺酸雷沙吉兰片1 mg,雷沙吉兰的cmax分别为(3.93±1.55)和(1.58±0.75)ng/mL,tmax分别为(0.5±0.2)和(0.9±0.8)h,t1/2分别为(1.08±0.78)和(1.51±0.63)h,AUC0-8 h分别为(2.81±0.92)和(2.43±0.77)ng.h/mL,24 h内以雷沙吉兰形式经尿液分别排泄(0.20±0.12)%和(0.20±0.09)%。结果表明建立的LC-MS/MS法准确可靠,高脂饮食对雷沙吉兰的吸收速率有显著影响,但对吸收程度、尿排泄率无显著影响。     

高效液相色谱法测定SHR尿液中犬尿喹啉酸含量的变化

目的 建立高效液相色谱荧光法测定尿液中犬尿喹啉酸(KYNA)含量的方法,观察不同周龄自发性高血压大鼠(SHR)及其正常对照大鼠(WKY)的尿KYNA含量变化.方法 高效液相色谱荧光法采用的色谱柱为ODS色谱柱,流动相为10mmol/L醋酸钠缓冲液(pH4.5)和乙腈(体积95:5),激发波344 nm,发射波398nm.选择4周龄WKY大鼠和SHR各4只、16周龄WKY大鼠和SHR各6只检测24h尿液中的KYNA含量,并进行统计学分析.KYNA浓度检测的线性范围0.220～33.000nmol/mL(R2=0.999 1),回收率为(90.37±8.47)%,日内差异为4.70%～9.40%,日间差异为5.20%～7.50%.4周龄WKY组24h尿KYNA含量为(41.251±22.663)μg/24h尿,SHR组为(35.387±10.814)μg/24h尿,两组问无统计学差异(P＜0.05);16周龄SHR尿KYNA含量为(39.511±15.985)μg/24h尿,较WKY组(90.690±42.189)μg/24h尿明显降低(P＜0.05).结论 高效液相色谱荧光方法具有灵敏、稳定、特异性高等特点,可用于临床检测尿KYNA.成年SHR尿KYNA含量较WKY大鼠减少,提示可能与高血压的发生发展有关.     

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.