阿托伐他汀钙对急性心肌梗死患者血管内皮细胞功能的影响

目的　观察心肌梗死急性期降脂治疗对内皮依赖性血管舒张功能的作用。方法　采用超声法检测 2 0例急性心肌梗死 (AMI)和 2 0例健康成年人肱动脉内皮依赖性舒张功能、内皮非依赖性舒张功能。 2 0例AMI患者在常规治疗 (血管紧张素转换酶抑制剂、β受体阻滞剂和阿司匹林等 )的基础上口服阿托伐他汀钙 10mg d ,8周后复测肱动脉内皮依赖性舒张功能、内皮非依赖性舒张功能和血脂全套。结果　AMI患者肱动脉内皮依赖性舒张功能 (2 .5 3± 1.18) %较对照组 (8.6 9± 3.31) %明显降低 (P<0 .0 0 1) ,AMI组的肱动脉内皮非依赖性舒张功能 (17.2 1± 5 .36 ) %也较对照组 (2 5 .18± 9.34) %明显降低 (P <0 .0 1)。AMI患者服用 10mg d阿托伐他汀钙治疗 8周后 ,肱动脉内皮依赖性舒张功能 (6 .32±2 .86 ) %较治疗前 (2 .5 3± 1.18) %有显著改善 (P <0 .0 1)。肱动脉内皮非依赖性舒张功能与治疗前比较差异无显著性 (17.0 4 %± 5 .2 7%vs 17.2 1%± 5 .36 % ,P >0 .0 5 )。治疗后TC、LDL C和TG水平明显降低 (P <0 .0 5 )。结论　AMI患者肱动脉内皮依赖性血管舒张功能明显减退 ,短期口服阿托伐他汀钙 (10mg d)降脂治疗对受损的血管内皮功能有改善作用     

辛伐他汀对Ⅱ型糖尿病患者血管内皮功能的影响

目的 :研究辛伐他汀对Ⅱ型糖尿病 (DM )患者血管内皮功能的影响。方法 :6 0例Ⅱ型DM患者 ,根据血脂情况分成血脂异常组 (32例 )和血脂正常组 (2 8例 ) ,予辛伐他汀 2 0mg ,每晚 1次 ,连续 8周 ,测定治疗前后血脂及用高分辨血管外彩色多普勒测定肱动脉内皮依赖性舒张功能。结果 :血脂异常组治疗前后比较血脂和肱动脉内皮依赖性舒张功能均有显著性改善 (P <0 .0 1或 0 .0 5 ) ;血脂正常组治疗前后比较血脂无显著性变化(P >0 .0 5 ) ,肱动脉内皮依赖性舒张功能显著改善 (P <0 .0 5 )。血脂异常组肱动脉内皮依赖性舒张功能与低密度胆固醇、总胆固醇呈显著负相关 (r=- 0 .5 73,- 0 .2 93,P <0 .0 1或 0 .0 5 ) ;血脂正常组肱动脉内皮依赖性舒张功能与血脂各项指标均无明显相关性 (P >0 .0 5 ) ;两组肱动脉内皮依赖性舒张功能的改善程度与血脂基础值和血脂下降值均无明显相关性 (P >0 .0 5 )。结论 :辛伐他汀通过调脂和调脂外作用 ,显著改善Ⅱ型DM患者血管内皮功能 ,可延缓慢性血管并发症的发生与发展。     

缬沙坦对高血压合并糖尿病患者血压及血管内皮功能的影响

目的:研究缬沙坦对原发性高血压合并2型糖尿病患者血压及血管内皮依赖性舒张功能的影响。方法:23例高血压合并2型糖尿病患者服用缬沙坦片80-160mg/d,测定治疗前及治疗后3、6个月体重指数(BMI)、总胆固醇(TC)、甘油三酯(TG)、空腹血糖(FBG)、餐后2h血糖(2h-PBG)、收缩压(SBP)、舒张压(DBP)及右肱动脉内径基础值(D0)和反应性充血、含服硝酸甘油后右肱动脉内径的变化率(△D1、△D2),并对治疗前后各指标的变化进行了比较。结果:(1)治疗后3、6个月与治疗前相比,BMI、TC、TG、FBG、2h-PBG均无明显变化(P均>0.05)。(2)治疗后3、6个月SBP、DBP均较治疗前明显降低(P均<0.01),而治疗后6个月与3个月相比,血压降低更为明显(P<0.05)。(3)治疗后3、6个月反应性充血后右肱动脉内径变化率均较治疗前明显改善(P均<0.05),但治疗后6个月较3个月无进一步改善。结论:缬沙坦治疗原发性高血压合并2型糖尿病在降压同时可有效改善血管内皮依赖性舒张功能,且降压效果呈现时间依赖性。     

氟伐他汀对老年高血压病患者内皮依赖性血管舒张功能影响的研究

目的　研究氟伐他汀对老年高血压病患者内皮依赖性血管舒张功能的影响。方法　用高分辨超声技术 ,对老年高血压病患者 1、 2、 3级各 17例 (分 3组 )氟伐他汀治疗前后和 15例正常血压老年患者 (对照组 )肱动脉的内皮依赖性及内皮非依赖性血管舒张功能进行检测。结果　高血压各组内皮依赖性血管舒张功能与对照组间差异有显著性意义 (P<0 0 0 1) ;但高血压组间无显著性差异 ;高血压各组内皮非依赖性血管舒张功能与对照组比较无显著性差异 ;5 1例高血压病患者服用氟伐他汀 2 0～ 4 0mg d ,5个月后内皮依赖性血管舒张功能与治疗前相比差异有显著性意义。多元逐步回归分析显示 ,内皮依赖性血管舒张功能与收缩压 (SBP)明显相关 (R2 =0 35 9,df=6 5 ,P <0 0 0 1)。结论　高血压本身是内皮功能受损的独立危险因素 ,经氟伐他汀干预后受损的内皮依赖性血管舒张功能明显改善     

普伐他汀降脂治疗对冠心病血管内皮舒张功能的影响

目的 :研究普伐他汀对冠心病高胆固醇血症患者血管内皮依赖性舒张功能的影响。方法 :采用高分辨超声技术 ,对 70例冠心病高胆固醇血症患者普伐他汀降脂前后和 70例正常对照者的血管内皮依赖性舒张功能进行检测。结果 :高胆固醇血症组肱动脉血流介导性舒张较正常对照组明显减弱 ((3.5± 2 .8) %和 (14 .5± 3.4 ) % ,P<0 .0 0 1) ,而 2组对硝酸甘油的反应差异无统计学意义 ((2 0 .5± 7.2 ) %和 (2 2 .9± 4 .3) % ,P >0 .0 5 )。 70例冠心病高胆固醇血症患者服用普伐他汀 10mg治疗 (3.8± 0 .8)个月后 ,血浆总胆固醇从 (6 .31± 0 .70 )mmol/L降至 (5 .0 6±0 .6 3)mmol/L ,同时肱动脉内皮依赖性舒张较治疗前明显改善 ((10 .0± 3.2 ) %和 (3.5± 2 .8) % ,P <0 .0 0 1) ,而治疗前后肱动脉对硝酸甘油的反应无明显改变。结论 :冠心病高胆固醇血症患者存在血管内皮依赖性舒张功能障碍 ;经普伐他汀降胆固醇治疗后 ,受损的血管内皮依赖性舒张功能得到明显改善     

超声测定肱动脉管径变化率对原发性高血压患者外周血管内皮功能障碍的评价

目的:探讨高频超声检测原发性高血压患者肱动脉血管内皮依赖性舒张功能的临床应用及意义。方法:选取45例原发性高血压病患者与20例正常人,采用高频超声研究受检者的肱动脉反应性充血后内径变化率来评价血管内皮依赖性舒张功能。结果:与正常组相比,原发性高血压组肱动脉反应性充血后内径变化率显著减小(P<0.01)。结论:应用高频超声能够准确、简便、有效地评价动脉血管内皮依赖性舒张功能。     

伊贝沙坦对原发性高血压患者血管内皮功能的影响

目的 研究国产新型血管紧张素Ⅱ受体拮抗剂伊贝沙坦对原发性高血压患者血管内皮功能的影响。方法 应用2-D多普勒超声心动图观察30例原发性高血压患者口服伊贝沙坦(每日150-300mg)治疗16周前后内皮依赖性舒血管功能的变化。结果 肱动脉加压前后(流量介导的血管舒张，反映内皮依赖性舒血管功能)的血管内径变化百分比在治疗后明显增加；而含服硝酸甘油前后(硝酸甘油介导的血管舒张，反映非内皮依赖性舒血管功能)肱动脉内径变化百分比在治疗后无明显变化。结论 伊贝沙坦可以改善内皮依赖性舒血管功能。     

洛伐他汀对冠心病合并2型糖尿病患者血管内皮功能的影响

目的 :研究洛伐他汀对冠心病合并 2型糖尿病患者血管内皮功能的影响。方法 :分别检测 32例冠心病合并 2型糖尿病患者给予洛伐他汀治疗前后血糖、血脂 ,用高分辨血管外彩色多普勒测定肱动脉内皮依赖性舒张功能。结果 :治疗前后比较血脂和肱动脉内皮依赖性舒张功能均有显著性改善 (P<0 .0 1 ) ,肱动脉内皮依赖性舒张功能改善的程度与患者血 TC和 L DL降低的程度呈负相关关系 (P<0 .0 5 )。结论 :洛伐他汀保护内皮功能 ,对治疗冠心病合并糖尿病患者有一定的应用价值     

辛伐他汀对不稳定型心绞痛患者血管内皮功能的影响

目的 :观察辛伐他汀对不稳定型心绞痛患者血管内皮功能的影响。方法 :60例不稳定型心绞痛患者 ,随机分为两组 ,一组为辛伐他汀组 1 0mg/d ,一组为对照组 ,两组各 30例 ,治疗 8W后 ,采用超声多普勒于治疗前后对其进行血管内皮功能的测定。结果 :治疗组血清TC、TG、LDL -C显著降低 ,肱动脉内皮依赖性舒张功能较治疗前明显改善 (P <0 .0 1 ) ,治疗前后肱动脉对硝酸甘油的反应无显著性变化。结论 :辛伐他汀治疗可显著改善不稳定型心绞痛患者血管内皮依赖性舒张功能。     

伊贝沙坦对高血压病患者内皮功能及胰岛素抵抗的影响

目的:探讨伊贝沙坦对高血压病患者内皮功能及胰岛素抵抗的影响。方法:48例原发性高血压患者口服伊贝沙坦1 2周,治疗前、后采静脉血测定空腹及餐后2 h血糖、胰岛素、C肽,并计算各自胰岛素敏感指数,同时用高分辨率血管外超声法检测肱动脉内皮依赖性血管舒张功能。结果:伊贝沙坦治疗1 2周后患者的收缩压和舒张压均降低;空腹、餐后胰岛素及C肽水平较前降低;空腹、餐后胰岛素敏感指数均较前显著升高;肱动脉内径的基础值及血流介导的内皮依赖性舒张功能明显改善。结论:伊贝沙坦能有效降压和改善胰岛素抵抗及肱动脉内皮依赖性舒张功能     

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.