颈动脉和下肢动脉超声检查对新诊断2型糖尿病患者动脉粥样硬化的检出率及与心脑血管事件的关系

目的：探究分析颈动脉和下肢动脉超声对新诊断2型糖尿病患者动脉粥样硬化的检出率及与心脑血管事件的关系。方法选择236例新诊断2型糖尿病患者进行研究,对所有患者均进行颈动脉和下肢动脉超声检查,根据检查结果比较分析超声同时检查颈动脉与下肢动脉对动脉粥样硬化病变的检出结果,并对所有患者进行随访,对患者心脑血管事件进行统计。结果所有新诊断2型糖尿病患者的动脉粥样硬化确诊例数为男69例（62.73%）,女82例（65.08%）,差异无统计学意义。对分组检测患者比较,联合诊断组患者男性、女性和总检出率分别为69例（62.73%）,女82例（65.08%）和151（63.98%）,显著高于单纯颈动脉超声检查患者的检出率,差异有统计学意义（P<0.05）。对所有患者心脑血管事件进行随访比较发现,颈动脉和下肢动脉均发生硬化的糖尿病患者的心脑血管事件总发生率达到20.00%,显著高于单纯颈动脉硬化患者,差异有统计学意义（P<0.05）。结论单纯通过劲动脉超声检查患者的动脉粥样硬化,检出率明显较低,联合下肢动脉超声可以显著提高动脉粥样硬化的检出率,且联合检查有利于判断新诊断2型糖尿病患者是否发生心脑血管事件,临床建议广泛使用。     

糖尿病患者颈动脉硬化的高频诊断

随着人民生活水平的提高，因代谢障碍而并发的2型糖尿病患者逐渐增多。外周血管尤其是动脉血管的粥样硬化是糖尿病的常见并发症。糖尿病的发生和发展对于血管粥样硬化的发生发展有着重要的影响。有关动脉粥样硬化的影像学观察、血流动力学改变等方面的研究报道很多，但是2型糖尿病患者颈动脉粥样硬化的发生率与普通健康人群粥样硬化发生率间存在着怎样的差异，各型斑块的发生率在两组人群中又有怎样的差别，此类问题的研究报道尚少。笔者应用高频超声针对40例健康人和38例临床确诊的2型糖尿病患者的颈动脉内膜-中膜厚度、斑块形成以及狭窄等进行了观察比较，着重探讨糖尿病患者与健康人群间颈动脉粥样硬化发生的差异，进而探讨2型糖尿病与颈动脉粥样硬化发生和发展间的关系，评价超声检查在其早期诊断中的意义。     

2型糖尿病患者颈动脉及下肢动脉血流相关分析

目的:探讨彩色多普勒超声对2型糖尿病患者颈动脉及下肢动脉血管病变的诊断作用与意义.方法:应用彩色多普勒超声对69例2型糖尿病患者进行颈动脉及双侧下肢动脉常规检查,并设同期相应年龄的体检者60例作为对照组.通过观察其颈动脉及下肢动脉管壁、管腔、内-中膜厚度及斑块大小、血流情况,对两组患者进行回顾性分析.结果:69例2型糖尿病组患者颈动脉及下肢近端血管动脉粥样硬化斑块检出率高于60例对照组.结论:糖尿病患者动脉粥样硬化斑块检出率高.彩色多普勒超声联合检测颈动脉及下肢动脉,可以直观地观察大血管管壁及管腔病变,对于预测疾病的高危人群,具有重要的临床价值.而且它对糖尿病患者尽早了解下肢远端血管供血情况至关重要,可作为了解2型糖尿病患者大血管病变的首选检查方法之一.     

2型糖尿病并发脑梗死患者与颈动脉粥样硬化的临床研究

目的探讨2型糖尿病并发脑梗死患者与颈动脉粥样硬化的关系。方法对130例行头颅CT或头颅MRI证实的脑梗死患者均进行颈动脉颅外段彩色超声多普勒检查并测定血脂。分甲组（2型糖尿病并发脑梗死组）和乙组（非2型糖尿病并发脑梗死组）。甲组60例，乙组70例。观察2型糖尿病并发脑梗死患者颈动脉粥样硬化的发生率及血脂异常与颈动脉粥样硬化的关系，两组进行比较。结果甲组60例中58例（96．7％）发生不同程度的颈动脉粥样硬化，乙组70例中50例（71．4％）发生不同程度的颈动脉粥样硬化，两组间有显著性差异（P〈0．05）；两组发生高胆固醇血症、高甘油三酯血症无显著性差异（P〉0．01），但发生高低密度脂蛋白血症甲组和乙组有显著性差异（P〈0．05），甲组中83．3％的患者LDL升高，乙组中67．1％的患者LDL升高；高低密度脂蛋白血症患者当中颈动脉粥样硬化发生率很高，甲组LDL升高患者当中92．0％不同程度地发生颈动脉粥样硬化，乙组LDL升高患者当中85．1％不同程度地发生颈动脉粥样硬化。结论颈动脉粥样硬化是2型糖尿病并发脑梗死的重要危险因素，2型糖尿病患者低密度脂蛋白升高可能是发生颈动脉粥样硬化的危险因素，因此严格监测及控制血糖同时定期检查血脂及颈动脉血管超声，在出现临床症状之前及时给予干预，对2型糖尿病患者脑梗死的一级预防和二级预防具有非常重要的意义，值得引起广大临床医师的重视。     

彩色多普勒超声在脑梗死患者颈动脉粥样硬化诊断中的应用

目的:探讨彩色多普勒超声对脑梗死患者颈动脉粥样硬化的诊断价值。方法:对123例脑梗死患者及90名正常人的颈动脉内中膜厚度及斑块形成进行对比分析。结果:脑梗死患者颈动脉粥样硬化斑块形成检出率63.4%,单纯内膜增厚检出率21.9%;55岁以上组颈动脉斑块检出率明显高于55岁以下组（P<0.05）。正常人颈动脉粥样硬化斑块形成检出率6.7%;单纯内膜增厚检出率11.1%;脑梗死组颈动脉粥样硬化斑块形成检出率高于对照组（P<0.01）;脑梗死患者患有高血压病的颈动脉粥样硬化斑块检出率72.6%,患糖尿病的颈动脉粥样硬化斑块检出率60.0%,同时患有高血压及糖尿病颈动脉粥样硬化斑块检出率84.4%,明显高于无高血压及糖尿病患者（P<0.01）。结论:彩色多普勒超声检查可早期发现脑梗死患者是否有颈动脉粥样硬化,以55岁以前为关键期,是一种无创、有价值的实用方法。     

彩色多普勒对高血压颈动脉粥样硬化的诊断

目的探讨彩色多普勒对高血压动脉粥样硬化的诊断.方法选取45例高血压动脉粥样硬化病例,行彩色多普勒超声检查,分析其检出率和诊断标准.结果45例高血压颈动脉粥样硬化患者经彩色多普勒检查,发现颈动脉粥样硬化斑块者40例,检出率为%.结论彩色多普勒对高血压颈动脉粥样硬化具有极高的检出率,值得临床推广应用.     

高频彩色多普勒超声诊断糖尿病合并高血压患者颈动脉粥样硬化病变的价值

目的探讨高频彩色多普勒超声诊断2型糖尿病(DM)合并高血压(EH)患者颈动脉粥样硬化的价值。方法选取2009年1月～2011年8月我院收治的2型糖尿病患者200例,分为两组,92例单纯2型糖尿病患者为DM组和108例2型糖尿病合并高血压患者为DM+EH组;另选100例健康体检者作为对照组。采用高频彩色多普勒超声检测颈动脉内-中膜厚度(IMT)和硬化斑块,对颈动脉粥样硬化病变和狭窄的发生率进行对比分析。结果①DM+EH组及DM组颈动脉IMT均高于对照组,DM+EH组颈动脉IMT均高于DM组,差异均有高度统计学意义(均P<0.01)。②DM+EH组、DM组颈动脉斑块检出率均明显高于对照组,差异均有高度统计学意义(均P<00.1);DM+EH组患者的颈动脉斑块检出率高于DM组,差异有统计学意义(P<0.05);颈动脉粥样硬化斑块主要出现在颈动脉分叉处及颈内动脉。③DM+EH组患者颈动脉狭窄的总检出率高于DM组,差异有统计学意义(P<0.05);狭窄≥50%的检出率DM+EH组及DM组比较,差异无统计学意义(P>0.05)。结论 2型糖尿病合并高血压患者颈动脉粥样硬化的发病率明显增高,高频彩色多普勒超声诊断颈动脉粥样硬化为临床的早期防治提供了可靠的参考依据。     

超声与数字减影血管造影对颈动脉粥样硬化病变诊断的应用比较

目的 比较血管超声与数字减影血管造影(DSA)检查对颈动脉粥样硬化病变的诊断价值.方法 对96例缺血性脑血管病患者进行颈部动脉超声及DSA检查,以及对诊断颈部血管狭窄的敏感性和特异性,以及对硬化斑块检出率的差异.结果 超声与DSA在诊断颈动脉狭窄上有较高程度的一致性,尤其是对重度狭窄及闭塞动脉的诊断(经Kappa检验,...     

新诊断的酮症倾向2型糖尿病患者临床特征及其影响颈动脉粥样硬化的危险因素分析

目的:探讨新诊断的酮症倾向2型糖尿病患者临床特征及其影响颈动脉粥样硬化的危险因素。方法:新诊断的2型糖尿病患者201例,根据有无自发酮症或酮症酸中毒分为酮症倾向2型糖尿病组(78例)以及非酮症倾向2型糖尿病组(123例)。测量身高、体重、血压;检测血尿酮体、血气分析、谷氨酸脱羧酶抗体(GAD-Ab)、糖脂代谢指标以及胰岛功能;颈动脉B超测定颈动脉粥样硬化斑块。结果:①新诊断的2型糖尿病患者中,以自发酮症或酮症酸中毒起病的占38.8%,其发病年龄平均为44岁,入院时糖化血红蛋白平均为11.91%,其中男性患者占71.8%,超重/肥胖患者占57.7%,高血压患者占24.4%,高甘油三酯血症患者占55.1%。②与非酮症倾向T2DM患者比较,酮症倾向T2DM患者发病年龄较小、糖化血红蛋白水平较高、馒头餐试验空腹及餐后2h胰岛素水平较低,HOMA-β值也较低,差异具有统计学意义(P<0.05)。③酮症倾向T2DM患者颈动脉粥样硬化的检出率为55.7%,非酮症倾向T2DM患者颈动脉粥样硬化的检出率为62.4%,两组间无统计学差异(P>0.05)。④与无颈动脉粥样硬化的患者相比,合并颈动脉粥样硬化的酮症倾向T2DM患者的年龄较大,收缩压、低密度脂蛋白水平较高,差异有统计学意义(P<0.05);而2组间的血糖水平无明显差异(P>0.05)。结论:在新诊断的酮症倾向2型糖尿病患者中,一半以上的患者存在有颈动脉粥样硬化,进一步分析发现在糖代谢紊乱的基础上,高收缩压及高低密度脂蛋白水平能够促进颈动脉粥样硬化的发生发展。     

2型糖尿病患者颈动脉和下肢动脉粥样硬化斑块超声检查及影响因素分析

目的 通过分析超声联合检查2型糖尿病患者颈动脉、下肢动脉粥样硬化斑块程度,明确糖尿病患者大血管并发症的情况,以便指导治疗.方法 对103例2型糖尿病住院患者超声检查颈动脉和下肢动脉斑块情况,分析其特点及其相关因素.结果 糖尿病患者颈动脉斑块、下肢动脉斑块及均有斑块者比例约为3:2:6,并且严重程度与病程、年龄相关(P＜0.05),不同病程糖尿病患者血糖、血脂水平及高血压患病率间差异均无统计学意义(P＞0.05).结论 对2型糖尿病患者监测血管超声,对血脂、血糖早期进行干预并长期监测使达标,可以延缓大血管病进展,减少患者脑梗死、冠心病和糖尿病足等大血管病的发病率.     

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.