慢性肾衰竭非透析患者血浆内皮素-Ⅰ和一氧化氮水平的变化及其意义

目的探讨内皮素-Ⅰ/一氧化氮在慢性肾衰竭非透析患者中的变化。方法通过对60例慢性肾衰竭非透析患者和20例健康志愿者测定内皮素-Ⅰ、一氧化氯、NOS。结果慢性肾衰竭非透析患者血浆内皮素一I、血清一氧化氮水平升高,血清NOS水平降低,内皮素-Ⅰ、一氧化氮与Ccr呈负相关,NOS与Ccr无相关性。结论慢性肾衰竭非透析治疗患者存在内皮素/一氧化氮的失衡,两者参与慢性肾衰竭的进展。     

81例慢性肾脏病左心室结构及功能情况变化的临床分析

目的：研究中晚期慢性肾脏疾病心脏结构、功能变化特征。方法：选择81例慢性肾脏病3-5期患者及30例正常对照,检查心脏超声,测量左心室舒张末内径（LVDd）,左心室收缩末期内径（LVDs）,室间隔舒张末厚度（IVS）,左心室后壁舒张末厚度（PWTH）,左心室射血分数（EF）,舒张早期和舒张晚期二尖瓣口最大血流速度之比（E/A）,用公式计算左心室心肌质量指数（LVMI）、相对室壁厚度（RWT）。结果：81例CKD患者与正常对照组及CKD3-5期组间进行比较,得出以下结果：①81例患者超声心动图结果显示,38．27％存在LVDd增大（49．33±6．78）mm,71．61％存在IVS增厚（12．57±2．58）mm,49．38％存在PWTH增厚（11．91±2．33）mm,30．51％存在EF下降（0．58±0．29）％,41．76％存在E／A下降（0．74±2．99）,有93．90％出现左心室肥大（LVH）（LV—MI 187．06±73．85g／m^2）,其中向心性肥厚占62．20％,离心性肥厚占23．17％：8．54％已出现向心性重构;只有6．10％结构完全正常。②41．76％左心室舒张功能障碍。结论：慢性肾脏病患者心血管疾病的发生率很高,主要表现为左心室肥大,且以向心性肥厚为主。     

四氢生物蝶呤对左心室舒张功能作用的研究进展

四氢生物蝶呤缺乏可导致一氧化氮合酶脱偶联、氧自由基生成增多。在氧化应激过程中,氧自由基产生增强并且其防御机制发生改变,通过促进心肌细胞凋亡、心肌肥厚和纤维化,使心肌重构、内皮功能障碍、炎症及血管重构,最终导致心脏舒张功能发生损害。氧化应激可降低四氢生物蝶呤的生物利用度,给予外源性的四氢生物蝶呤对心室舒张功能障碍有明显的治疗作用。该文就四氢生物蝶呤在左心室舒张功能障碍中的作用予以综述。     

斑点追踪成像评价高血压患者左心室重构对舒张功能的影响

目的探讨二维斑点追踪成像技术评估高血压患者左心室重构对其心脏舒张功能的影响。方法选取原发性高血压患者90例,其中正常构型患者30例、向心性重构患者30例、向心性肥厚患者30例,另选取身高、体重与年龄相匹配的健康对照组30例。应用二维斑点追踪成像技术在左心室短轴心尖水平测量心尖部峰值旋转角度及其达峰时间,并左心室短轴心底水平测量心底部峰值旋转角度及其达峰时间,从而计算出左心室峰值扭转角度。结果正常构型组左心室峰值扭转角度较向心性重构组和向心性肥厚组增大（P〈0．05）,而向心性肥厚组左心室峰值扭转角度较正常构型组和向心性重构组减小（P〈0．05）。结论正常构型患者左心室扭转运动明显增强,向心性肥厚患者左心室扭转运动减小。随着左心室舒张功能的减低,左心室扭转运动逐渐减低。二雏斑点追踪成像为高血压患者左心室重构对舒张功能的影响提供了一个量化的指标。     

内皮素在慢性肾功能衰竭左心室重构中的预测作用

目的:探讨血清内皮素-1在预测慢性肾功能衰竭患者心脏并发症中的作用。方法:用ELISA法测定患者血清内皮素-1活性,并行心脏超声检查,测定反映肾功能衰竭患者心脏并发症的相关指标,左心室心肌重量指数、室间隔厚度、左心室舒张末期直径。结果:非透析慢性肾功能衰竭患者血清内皮素-1活性与左心室心肌重量指数、室间隔厚度、左心室舒张末期直径呈显著相关性(P<0.001)。结论:血清内皮素-1活性与慢性肾功能衰竭心脏并发症密切相关,是一项有用的预测指标。     

VDR基因敲除鼠一氧化氮合酶和内皮素-1基因的表达

目的探讨维生素D受体(VDR)基因敲除鼠血压变化以及与血压水平密切相关的内皮型一氧化氮合酶、内皮素-1基因在主动脉的表达情况,了解维生素D、维生素D受体与血压的联系及可能机制。方法小鼠血压采用动脉血管插管法直接测定,主动脉内皮型一氧化氮合酶、内皮素-1基因表达采用实时定量聚合酶链式反应检测。结果内皮型一氧化氮合酶、内皮素-1基因均能在野生型正常鼠及维生素D受体基因敲除鼠主动脉表达。与野生型正常鼠比较,纯合子维生素D受体基因敲除鼠收缩压、舒张压明显升高,主动脉内皮型一氧化氮合酶基因表达明显下调,内皮素-1基因表达明显上调(P均<0.05),杂合子维生素D受体基因敲除鼠收缩压、舒张压及主动脉内皮型一氧化氮合酶、内皮素-1基因表达则无明显改变(P均>0.05)。相关性研究发现主动脉内皮型一氧化氮合酶基因表达水平与收缩压、舒张压水平呈负相关,与收缩压、舒张压水平呈正相关(P均<0.05)。结论纯合子维生素D受体基因敲除鼠存在与血压密切相关的主动脉内皮型一氧化氮合酶、内皮素-1基因表达水平明显异常。     

eNOS在高血压病以及左室肥厚的研究

原发性高血压和左心室肥厚是由多种环境因素、生活方式和遗传因素共同作用所引起的一种多基因遗传病。近年来研究表明,内皮型一氧化氮合酶可能参与原发性高血压及左心室肥厚发生发展。本文就一氧化氮、一氧化氮合酶的生理作用,一氧化氮合酶G894T位点突变的机制及其与原发性高血压及左心室肥厚的关系作一综述。     

核素造影评价生长激素缺乏症者左心室功能

为了评价生长激素缺乏症患者左心室功能，用平衡法核素心室造影测定了３５例儿童期生长激素缺乏症患者左心室收缩与舒张功能。结果：４０％患者左心室整体的收缩功能低下，８１％为左心室局部收缩功能受损，舒张功能低下的阳性率为４５．７％。结论：局部收缩功能异常早于舒张功能异常，而舒张功能异常则又早于整体收缩功能异常。     

高血压心室重构及其干预策略

高血压左心室重构是心脏事件重要的独立危险因素,其发生机制复杂,包括结构重构和功能重构。主要表现为心脏在慢性超负荷的压力、容量作用下发生的病理改变致使左室肥厚组织胶原结构发生改变,导致心肌顺应性降低,舒张功能受到损害;作用于肾素-血管紧张素系统的药物及肾上腺素受体阻滞剂、醛固酮拮抗剂、他汀类药物、内皮素受体拮抗剂、胰激肽原酶、钙通道阻滞剂等药物通过不同途径和机制延缓和(或)逆转左心室重构。     

慢性肾功能衰竭非透析患者心脏结构功能变化的研究

目的：了解慢性肾功能衰竭(CRF)非透析患者心脏结构、功能变化特征，并探讨高血压、贫血、血清白蛋白、血脂与心脏结构功能改变之间的关系。方法：回顾性分析103例未进入血液透析或刚开始进入血液透析的尿毒症患者，其多普勒超声心动图结果及其同期血压、血红蛋白、血清白蛋白、血脂，了解其规律及之间的关系。结果：1．103例患者超声UCG结构显示，有75．7％出现LVH，其中向心性肥厚占41．7％，离心性肥厚占34．0％：17．5％已出现向心性重构；只有6．8％结构完全正常。2．19．4％左心室收缩功能障碍。3．血红蛋白、收缩压、血清白蛋白、LDL在有LVH和无LVH组存在明显差异，而年龄、高血压时间、舒张压、TG、TCH和HDL之间无显著性差异。血红蛋白与左室心肌质量指数(LVMI)呈负相关，而血压、年龄、血清白蛋白、血脂与LVMI无显著的相关性。结论：CRF患者未进入透析前心血管疾病的发生率已经很高，主要表现为LVH，且以向心性肥厚为主。心脏结构功能变化可能与高血压、贫血、营养不良等因素有关。     

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.     

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.