中西医结合治疗原发性高血压颈动脉粥样硬化火热证临床观察

目的 :观察中西医结合治疗原发性高血压颈动脉粥样硬化(CAS)火热证的临床疗效。方法 :选取103例原发性高血压CAS火热证患者,按随机数字表法将其分为两组。对照组51例予常规西医治疗;治疗组52例在对照组基础上以清热泻火、活血通脉为则增加中医治疗。治疗6个月后比较两组中医证候积分、降压效果、斑块变化以及安全性指标。结果:对照组总有效率60.78%,治疗组总有效率88.46%,差异有统计学意义(P<0.05),且治疗组低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)改善均优于对照组(P<0.05)。结论:中西医结合治疗原发性高血压颈动脉粥样硬化能有效降压,明显改善其火热证临床症状,缩减斑块面积。     

芎劳通脉合剂治疗冠心病稳定劳累性心绞痛的临床疗效评价及对颈动脉内中膜厚度的影响

目的通过比较分析加用芎劳通脉合剂治疗与常规二级预防治疗冠心病稳定劳累性心绞痛的临床疗效评价及对颈动脉内中膜厚度的影响,探讨中药制剂对冠心病心绞痛的疗效评价及颈动脉粥样硬化的影响。方法将79例冠心病住院患者随机分为治疗组和对照组,通过对于心绞痛症状计分分级、中医证候、颈动脉内中膜厚度变化的观察,进行疗效对比。结果治疗3月后进行疗效评价,与对照组相比,芎劳通脉合剂治疗组改善症状疗效优于对照组（P〈0．05）;两组均能明显改善患者中医证候,治疗组疗效优于对照组（P〈0．01）;治疗后治疗组颈动脉内中膜厚度减少优于对照组,差异有统计学意义（P〈0．05）。结论组方后的芎劳通脉合剂对扩张冠脉、改善循环、缓解心绞痛症状,改善中医证候,该方剂明显减少颈动脉内中膜的厚度,从而具有抗动脉硬化的功效,值得临床推广。     

畲药化瘀降压益肾方治疗高血压血瘀证早期肾损害的临床研究

目的 观察畲药化瘀降压益肾方治疗高血压血瘀证早期肾损害的临床疗效。方法 选取2017年8月至2019年7月本院高血压血瘀证并伴早期肾损害的患者72例,将病例随机分为治疗组与对照组,每组各36例。对照组服用苯磺酸氨氯地平片降血压,而治疗组在标准治疗基础上加服畲药化瘀降压益肾方,疗程均为12周。观察两组患者在降血压、改善尿微量白蛋白、β2-微球蛋白、ET-1、NO及中医证候积分方面的临床疗效。结果 治疗组降低血压的总有效率为87.0%,对照组为69.4%,治疗组在降低血压方面优于对照组(P0.05);治疗后,治疗组在降低尿微量白蛋白和β2-微球蛋白水平低于对照组(P0.05);治疗组在降低血浆ET-1、升高NO水平方面优于对照组(P0.05)。在改善中医证候方面治疗组总有效率为87.8%,对照组为63.8%,治疗组优于对照组(P0.05)。两组患者不良反应发生率均为5.55%,差异无统计学意义(P0.05)。结论 畲药化瘀降压益肾方治疗高血压血瘀证伴早期肾损害具有显著疗效,能够较好的降低血压、改善中医证候、减少尿微量白蛋白的排出量,不良反应少,安全性好,有临床推广价值。     

益气祛风通络法治疗高血压颈动脉粥样硬化的临床疗效观察

目的：观察益气祛风通络法治疗高血压颈动脉粥样硬化患者的临床疗效。方法：选择符合纳入标准病例共90例,采取随机、对照、双盲法,分为对照组、蛭龙活血试验组1（简称试验组1）和联合治疗试验组2（简称试验组2）,每组30例。治疗方案：对照组,辛伐他汀片＋安慰剂A＋基础治疗;试验组1,蛭龙活血通瘀胶囊＋安慰剂B＋基础治疗;试验组2,基础治疗＋辛伐他汀片＋蛭龙活血通瘀胶囊。观察颈动脉内中膜厚度（IMT）和中医证候疗效、治疗前后中医临床症状积分。结果：①试验组2中医证候疗效总有效率为96.7%;试验组1总有效率80.0%;对照组总有效率76.7%。试验组2与试验组1、对照组比较,差异有统计学意义（P＜0.05）。试验组1虽然总疗效率优于对照组,但差异无统计学意义（P〉0.05）;②三组患者的颈动脉内中膜厚度、斑块总积分均较治疗前减少（P＜0.05）,其中试验组2各指标的降低与对照组、试验组1比较有差异统计学意义（P＜0.05）。③2个试验组治疗后心烦、眩晕、头痛、神疲乏力、气短、舌脉象等均有明显改善,差异有统计学意义（P＜0.05）,且试验组2上述主要中医临床症状的改善更加明显;对照组仅头痛、心烦易怒、眩晕项有所改善（P＜0.05）。结论：益气祛风通络法能显著改善高血压颈动脉粥样硬化患者中医临床症状,降低颈动脉内中膜厚度和斑块总积分,与辛伐他汀合用临床疗效更加显著。     

补肾活血汤治疗老年高血压病肾虚血瘀证的临床研究

目的观察补肾活血汤治疗老年高血压病肾虚血瘀型患者的临床疗效。方法将132例老年高血压病肾虚血瘀型患者随机分为对照组与治疗组,每组66例。对照组给予苯磺酸氨氯地平治疗,治疗组在对照组基础上给予补肾活血汤治疗,4周为1个疗程,观察两组治疗前后血压、临床症状、血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)及血清内皮素(ET)、一氧化氮(NO)的变化。结果治疗组降压疗效总有效率为92.42%,对照组为81.82%;治疗组临床症状总有效率为96.97%,对照组为77.27%;治疗后治疗组TG、TC、LDL-C、ET、NO显著改善;两组比较差异有统计学意义(P0.05,P0.01)。结论补肾活血汤治疗老年高血压病肾虚血瘀证具有较好的疗效。     

通脉活血汤合复方卡托普利治疗原发性高血压56例

目的：探讨通脉活血汤治疗原发性高血压的临床疗效。方法：将95例原发性高血压患者随机分为治疗组56例和对照组39例,皆用复方卡托普利片,治疗组在此基础上加上通脉活血汤,对比两组血压、症状、心肌缺血、左室舒张功能、血脂、血糖的变化及安全性。结果：降压总有效率治疗组89.29%,对照组66.67%,两组疗效比较有显著性差异（P〈0.05）;治疗组在改善症状、左室舒张功能及心肌缺血状况及纠正血脂、血糖代谢紊乱方面亦有较好疗效（P〈0.01）,且无明显的不良反应。结论：通脉活血汤联合复方卡托普利治疗原发性高血压有较好的疗效。     

中西医结合治疗原发性高血压60例临床观察

目的观察中西医结合治疗原发性高血压的临床疗效。方法将120例原发性高血压患者随机单盲分成2组,对照组30例给予常规西药治疗,治疗组30例在对照组治疗基础上予中医辩证施治,2组均治疗4周后观察治疗前后中医症状积分、中医证侯疗效、降压综合疗效评定。结果治疗组降压总有效率96.7%,对照组总有效率85.0%,2组比较,差异有显著性意义(P<0.05)。2组治疗后中医症状积分均较治疗前下降,但治疗组下降幅度明显高于对照组（P＜0.05）。治疗组中医证候总有效率为98.3%,优于对照组83.3%（P＜0.05）。结论原发性高血压采用中西医结合治疗能提高降压总有效率,改善症状、体征。     

畲医活血消积方对H型高血压左室肥厚的临床疗效及内质网应激的影响

  目的  观察畲医活血消积方对H型高血压左室肥厚血瘀证患者的临床疗效及内质网应激相关性标志物的影响,并探讨其作用机制。  方法  选择2018年4月—2019年5月就诊于丽水市中医院的H型高血压左室肥厚血瘀证患者80例,按照随机数字表法分为对照组和观察组,各40例。对照组采用西药治疗,观察组采用西药加畲医活血消积方治疗。比较2组患者降压疗效、中医证候积分、血压、同型半胱氨酸(Hcy)、左室肥厚指标及内质网应激相关性标志物的差异,同时记录不良反应。  结果  观察组降压总有效率为90.0%,高于对照组的72.5%(χ2=4.021,P=0.045)。治疗后, 观察组的中医证候积分、血压、Hcy、左室舒张末期内径和左心室质量指数均低于对照组(均P＜0.05);观察组的血清葡萄糖调节蛋白78[(6.25±1.83)ng/mL]、蛋白激酶R样内质网激酶[(15.74±1.75)ng/mL]、C/EBP同源蛋白[(8.52±0.65)ng/mL]低于对照组[(7.35±1.07)ng/mL、(16.85±1.82)ng/mL、(9.45±0.58)ng/mL,t=3.282、2.780、6.751,均P＜0.05]。2组均未见不良反应。  结论  畲医活血消积方治疗H型高血压左室肥厚血瘀证患者临床疗效显著,可能与该方有效调控内质网应激有关。      

坎地沙坦酯联合左旋氨氯地平对高血压患者血清hs-CRP及颈动脉内中膜厚度的影响

目的探讨坎地沙坦酯联合左旋氨氯地平对高血压患者血清hs-CRP及颈动脉内中膜厚度的影响。方法选择2012年1月—2014年6月本院收治的高血压患者80例作为研究对象,按照随机数表法分为对照组和治疗组两组,每组各40例。对照组采取氢氯噻嗪加左旋氨氯地平治疗,治疗组采取坎地沙坦酯联合左旋氨氯地平治疗。比较两组临床降压疗效,观察两组治疗前后血压、血清超敏C-反应蛋白(hs-CRP)、血脂、颈动脉内中膜厚度(IMT)水平及不良反应发生情况。结果治疗组患者临床降压总有效率显著高于对照组,差异有统计学意义(P<0.05)。治疗后,治疗组患者的血压、hs-CRP、血脂及IMT水平明显低于对照组,差异均有统计学意义(P<0.05)。两组均未出现严重不良反应(P>0.05)。结论坎地沙坦酯与左旋氨氯地平联用临床降压疗效较好,可提高血压控制效果,调节血脂水平,改善颈动脉内中膜厚度(IMT)水平,临床安全性较高。     

丹黄通脉胶囊联合西药治疗颈动脉粥样硬化患者的疗效观察

目的 观察丹黄通脉胶囊联合西药治疗颈动脉粥样硬化患者的临床疗效。方法 选取2019年1月—2020年5月期间陕西中医药大学第二附属医院收治的100名颈动脉粥样硬化患者,按随机数字表法将患者分为对照组和治疗组,每组各50例。对照组采用常规西医治疗,治疗组采用丹黄通脉胶囊联合常规西医治疗。治疗6个月后,观察比较两组患者临床总疗效,治疗前后中医症状(眩晕,头痛,颜面潮红,肢体麻木)积分、颈动脉内中膜厚度和颈动脉斑块面积、血脂指标[总胆固醇(Total cholesterol, TC)、甘油三酯(Triglyceride, TG)、高密度脂蛋白(High-density lipoprotein, HDL)、低密度脂蛋白(Low density lipoprotein, LDL)]、终点事件发生率及不良反应发生率。结果 治疗后治疗组总有效率87.50%(42/48)明显高于对照组71.43%(35/49),差异有统计学意义(P<0.05)。治疗后两组患者中医症状(眩晕,头痛,颜面潮红,肢体麻木)评分均较治疗前明显降低,差异有统计学意义(P<0.05);且治疗组中医症状评分均较对照组明...     

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.     

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.     

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.