冠心病患者脂蛋白(α)与D-二聚体的变化及其相关性研究

目的　观察冠心病 (CHD)患者血清脂蛋白α[Lp(α) ]与血浆D -二聚体 (DD)水平的变化特点 ,并探讨它们之间的关系。方法　对 12 4例CHD患者和 2 6例正常人采用双抗体ELISA法测定Lp(α)浓度和DD水平。结果　CHD患者中 ,急性心肌梗死 (AMI)和不稳定性心绞痛 (UAP)组患者Lp(α)浓度显著高于对照组 (P <0 .0 1) ;陈旧性心肌梗死 (OMI)和稳定性心绞痛 (SAP)组患者Lp(α)浓度亦有一定程度的升高 (P <0 .0 5 )。与对照组相比 ,AMI组患者DD水平显著升高 (P <0 .0 1) ,UAP组患者DD水平亦有所升高 (P <0 .0 5 )。组间比较发现 ,Lp(α)水平在OMI与SAP、UAP与AMI组间差异无显著性 (P >0 .0 5 ) ;DD水平在OMI与SAP组间差异无显著性 (P >0 .0 5 ) ;UAP与AMI组比较有显著差异性 (P <0 .0 5 ) ,后者高于前者 ;UAP、AMI组与SAP、OMI组比较 ,前两组患者DD水平高于后两组 (P <0 .0 5 )。12 4例CHD患者相关分析显示 :Lp(α)与DD水平呈显著正相关 (r=0 .5 79,P <0 .0 0 1)。结论　冠心病患者Lp(α)显著升高且与反映继发性纤溶增强的指标DD有密切相关关系。     

急性冠状动脉综合征患者炎症标记物水平的变化及临床意义

目的 :通过观察C -反应蛋白及纤维蛋白原的水平变化 ,探讨炎症标记物在急性冠状动脉综合征中的关系及临床意义。方法 :急性冠状动脉综合征 (ACS)组 10 2例 ,其中急性心肌梗死 (AMI)亚组 34例 ,不稳定性心绞痛 (UAP)亚组 6 8例 ,选择稳定性心绞痛 (SAP) 4 4例作对照组。分别采用速率散射比浊法及热沉淀比浊法测定血清C -反应蛋白 (CRP)及纤维蛋白原 (FIB)。结果 :ACS组CRP高于SAP组 (19.2 3± 18.2 6mg/Lvs 1.72± 0 .82mg/L ,P <0 .0 5 ) ,AMI亚组明显高于UAP亚组与SAP组(2 6 .34± 2 5 .38mg/Lvs 12 .0 7± 10 .85mg/L、1.72± 0 .82mg/L ,P <0 .0 1) ,UAP亚组高于SAP组 (12 .0 7±10 .85mg/Lvs 1.72± 0 .82mg/L ,P <0 .0 5 )。ACS组FIB高于SAP组 (3.5 3± 1.2 9g/Lvs 2 .2 4± 4 .81g/L ,P<0 .0 5 ) ,AMI亚组明显高于UAP亚组与SAP组 (3.87± 1.5 0g/Lvs 3.4 7± 1.0 8g/L、2 .2 4± 4 .81g/L ,P<0 .0 1) ,UAP亚组高于SAP组 (3.4 7± 1.0 8g/L、2 .2 4± 4 .81g/L ,P <0 .0 5 )。结论 :炎症参与了ACS患者的发病过程 ,血清中炎症因子水平的高低与冠心病病情严重程度有关。ACS患者CRP和FIB水平增高 ,二者均是ACS发生的独立危险因素。     

血浆同型半胱氨酸水平与急性心肌梗死的关系

目的　探讨血浆同型半胱氨酸 (Hcy)水平与急性心肌梗死 (AMI)之间的关系。方法　应用高效液相色谱仪测定血浆Hcy水平 ,对 50例确诊急性心肌梗死患者与 50例正常对照者进行比较分析。结果　AMI组和对照组血浆Hcy水平分别为 (1 6 73± 4 0 1 ) μmol/L和 (1 0 87± 2 95) μmol/L ,两者差异有显著性 (P <0 0 5)。在 37例行冠状动脉造影的AMI患者中 ,多支病变组 (≥ 2支血管病变 )的血浆Hcy水平显著高于单支病变组 [(1 7 2 5± 4 .86) μmol/Lvs (1 2 .2 3±5 1 7) μmol/L ,P <0 0 5]。 结论　高Hcy血症可能是AMI的一种独立危险因素 ,且冠脉病变越严重 ,血浆Hcy水平越高。     

急性心肌梗死患者凝血酶抗凝血酶复合物水平的研究

目的　观察急性心肌梗死 (AMI)发作期间凝血酶抗凝血酶复合物 (TAT)的变化。方法　 54例临床确诊的AMI患者和 2 3例不稳定型心绞痛 (UAP)患者及 2 0例健康中老年人作对照组作为研究对象 ,采用ELISA法测定血浆中的TAT含量。结果　与对照组比较 ,AMI患者和UAP患者血浆中的TAT的含量均显著增加 (分别为 17.79± 11.88ng/mlvs 7.68± 6.41ng/ml,P <0 .0 5;9.88± 5.47ng/mlvs 7.68± 6.41ng/ml ,P <0 .0 5) ;并且AMI组和UAP组相比TAT含量存在显著差异 ,P <0 .0 5。结论　AMI发作期间血液呈高凝状态 ;TAT是反映体内高凝状态的敏感指标     

梗死前心绞痛对急性心肌梗死溶栓治疗再通速率的影响

目的　探讨梗死前心绞痛 (缺血预处理 )对急性心肌梗死 (AMI)溶栓治疗后冠脉血管再通率、再通速率、梗死面积及心室功能的影响。方法　将 90例AMI住院患者分为心绞痛组与非心绞痛组 ,均一次性给予尿激酶 15 0～ 2 0 0万U溶栓。连续监测特异性血清心肌酶 ,计算血管再通时间 ,按Wagner方法计算早期及最后 (1周后 )心肌梗死面积 ,超声心动图测定左室射血分数 (EF)。结果　 (1)心绞痛组AMI后血清心肌酶峰值明显低于非心绞痛组〔(12 44 5± 14 7 4)IU·L- 1 vs .(162 4 3± 199 7)IU·L- 1 ,P <0 0 5〕 ;(2 )心绞痛组心肌梗死面积 (QRS积分 )明显小于非心绞痛组〔(4 .0± 1 5 )分vs .(5 1±2 0 )分 ,P <0 0 5〕 ;(3 )心绞痛组尿激酶溶栓血管再通率及再通速率高于非心绞痛组〔82 9%vs .60 .5 % ,P <0 0 5 ;(67.4±13 .6)minvs .(95 4± 16 5 )min ,P <0 0 5〕 ;(4 )心绞痛组AMI后EF恢复优于非心绞痛组〔(5 6.2± 9.5 ) %vs .(4 5 .7± 6 7) % ,P <0 0 5〕 ,且心脏主要并发症及住院病死率明显降低 (P <0 0 5 )。结论　梗死前心绞痛对缺血心肌起明显的保护作用 ,对提高急性心肌梗死溶栓后血管再通率、再通速率有益     

冠心病患者血浆血栓前体蛋白及D-二聚体的检测

目的 :了解血栓前体蛋白 (TpP)及D 二聚体 (D Dimer)的检测在冠心病中的临床应用价值。方法 :6 5例冠心病患者分为急性心肌梗死 (acutemyocardialinfarction ,AMI) 2 2例 ,不稳定型心绞痛 (unstableanginapectoris,UAP) 2 7例和稳定型心绞痛 (stableanginapectoris,SAP) 16例三组 ,采用酶联免疫吸附法 (ELISA)检测各组血浆中的TpP及D Dimer含量。结果 :TpP :AMI组为 (9 4± 3 3)mg/L ,UAP组为 (3 4± 1 9)mg/L ,SAP组为 (2 8± 1 5 )mg/L。AMI组明显高于UAP组 (P <0 0 1) ,UAP组高于SAP组 (P >0 0 5 ) ;D Dimer:AMI为 (1 2 7± 0 5 4 )mg/L ,UAP组为 (0 94± 0 4 1)mg/L ,SAP组为 (0 4 3± 0 2 5 )mg/L ,AMI组高于UAP组 ,UAP组高于SAP组 ,差别均有显著意义 (P <0 0 1)。结论 :TpP和D Dimer的联合检测对急性心肌梗死具有早期诊断和鉴别诊断价值。     

血浆溶血磷脂酸水平与急性冠脉综合征相关性的临床研究

目的 :探讨急性冠脉综合征 (急性心肌梗塞、不稳定型心绞痛 )患者血浆溶血磷脂酸 (LPA)水平的变化。方法 :入选 12 0例急性冠脉综合征患者 ,根据病情将其分为急性心肌梗死 (AMI)组 6 0例 ,不稳定型心绞痛组 6 0例 [治疗前不稳定型心绞痛 1组 (UA1) ,治疗后不稳定型心绞痛 2组 (UA2 ) ],并入选 6 0例健康者作为正常对照组 ,分别测定血浆溶血磷脂酸 (LPA)。结果 :AMI组和UA1血浆LPA水平均显著高于对照组 (1 8378± 0 6 75 3μmol/L) ,分别是 3 80 17± 1 6 2 89μmol/L、3 0 2 73± 1 2 76 7μmol/L ,P <0 0 5 ,其中异常增高率AMI组占 6 3 3% ,UA1组占 4 5 % ,UA2 组占 13 3% ,正常组 5 % ,不稳定型心绞痛抗凝抗血小板治疗后LPA明显降低 2 0 4 6± 0 84 72 μmol/L。结论 :血浆溶血磷脂酸作为体内凝血和血栓形成过程早期释放的分子标记物在预测急性冠脉综合征的发生发展及指导合理应用抗血小板及抗凝药物方面有重要应用前景。     

急性白血病患者血浆DD、VWF含量检测及其临床意义

为了探讨急性白血病(AL)患者血浆DD、VWF水平变化的意义,采用ELISA双抗体夹心法对60例AL患者和30名正常对照者血浆DD、VWF水平进行了检测。结果显示,初、复发AL患者血浆DD(0.2055±0.0980mg/L,0.5401±0.7365mg/L)、VWF(213.42±69.59％,227.01±93.24％)水平明显高于缓解组(0.1180±0.0334mg/L,127.84±71.45％)(P<0.01)和正常对照组(0.1030±0.0291mg/L,147.85±36.26％)(P<0.01);未缓解组血浆DD水平(0.1918±0.0249mg/L)明显高于缓解组和正常对照组(P<0.01),而VWF水平(117.55±27.88%)则与缓解组和正常对照组无明显差异(P>0.O5);初诊AL患者血浆DD、VWF水平之间明显正相关(r=0.557,P相似文献   

2型糖尿病患者血浆NO、vWF和DD水平的变化及临床意义

目的　探讨 2型糖尿病患者血浆一氧化氮 (NO)、血管性假血友病因子 (vWF)及D 二聚体 (DD)的变化 ,了解它们在糖尿病血管病变中的变化及临床意义。方法　采用硝酸还原酶法和酶联免疫吸附双抗体夹心法 ,测定4 0例 2型糖尿病患者和 2 3名正常人血浆NO、vWF和DD水平。结果　糖尿病 (无并发症 )患者血浆NO水平( 4 7.6 4± 18.38μmol/L)明显低于正常人 ( 75 .4 9± 15 .6 6 μmol/L ,P <0 .0 1) ,vWF水平 [( 4 9.4 6± 7.93) % ]明显高于正常人 [( 2 3.6 9± 3.6 3) % ,P <0 .0 1],DD水平 ( 1.0 3± 0 .0 9mg/L)明显高于正常人 ( 0 .2 5± 0 .36mg/L ) ;糖尿病并发肾病患者血浆vWF水平 [( 10 9.4 6± 12 .93) % ]明显高于糖尿病无并发症者 [( 4 9.4 6± 7.93) % ,P <0 .0 1]。结论　血浆NO、vWF及DD水平反映 2型糖尿病患者血管结构和功能的改变 ,在糖尿病的临床进展和并发症的发生中起重要作用。血浆vWF水平有可能是 2型糖尿病肾病发生的早期预测指标。     

血浆超敏C反应蛋白与急性冠脉综合征患者冠脉疾病程度分析

目的 探讨急性冠脉综合征(ACS)患者冠脉病变程度与血浆超敏C反应蛋白(hs-CRP)指标之间的关系.方法 方便选择该院自2014年5月—2016年5月间收治的急性冠脉综合征患者84例进行研究,对比急性心肌梗死患者(AMI)45例、不稳定性心绞痛(UAP)患者39例血液中hs-CRP水平的差异,分析不同病情程度hs-CRP的相关性.结果 ACS患者中UAP组患者的Hs-CRP指标为(5.01±1.84)mg/L,Gensini评分为(36.42±23.80)分;而AMI组患者两项指标依次为(6.36±2.40)mg/L,(43.48±25.33),组间数据对比差异有统计学意义(P<0.05).结论 急性冠脉综合征冠脉病变严重程度与血浆超敏C反应蛋白存在相关性,能够准确反映心肌受损情况,为疾病诊断治疗提供指导.     

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.