多囊卵巢综合征中医证型与胰岛素抵抗的研究

目的探讨多囊卵巢综合征（polycystie ovary syndrome,PCOS）的不同中医证型及其内分泌代谢特征,提高中西医结合诊治水平。方法根据中医理论对510例PCOS患者辨证分型,回顾性分析入组患者的糖耐量试验（OGTF）、胰岛素释放试验、体重指数（BMI）等内分泌代谢指标,计算稳态模型胰岛素抵抗指数（HOMA/IR）、空腹胰岛素/空腹血糖（I/G）。结果肾阳虚组192例（37．7％）、脾阳虚组167例（32．8％）、肝郁化热组84例（16．4％）、肾阴虚组67例（13．1％）,肾阳虚、脾阳虚患者较多（P〈0．01）;PCOS患者中44％糖耐量异常,4个证型组糖耐量异常率差异无统计学意义。PCOS患者胰岛素抵抗者占62．7％,脾阳虚组胰岛素抵抗较其他三个证型组高（P〈0．01）。HOMA-IR、I／G诊断胰岛素抵抗的敏感性分别为89．4％、87．5％,差异无统计学意义（P〉0．05）;HOMA-IR、I/G诊断胰岛素抵抗的特异性分别为94％、75％,HOMA-IR的特异性较强（P〈0．01）。结论PCOS以肾阳虚证、脾阳虚证较常见,PCOS患者代谢异常的主要特征为胰岛素抵抗,HOMA-IR诊断胰岛素抵抗的特异性较好。     

分析308例妊娠糖尿病孕妇葡萄糖耐量试验结果

目的：研究妊娠糖尿病（GDM）孕妇口服葡萄糖耐量试验（OGTT）的特点,分析孕妇对GDM的诊断价值。方法：对孕19—38周孕妇口服50g葡萄糖进行筛查,1小时血糖〉7．8mmol／L的孕妇进行OGTT试验。结果：308例GDM孕妇中160例（51．9％）空腹血糖异常,264例（85．7％）1小时血糖异常,222例（71．4％）2小时血糖异常,只有70例（21．7％）3小时血糖异常,其中66例（94．3％）伴有另外1项或者3项血糖异常。结论：口服糖耐量试验中,取消3小时血糖检测,因其对孕妇GDM的诊断影响甚微。     

糖化血红蛋白在妊娠期糖尿病筛查中的临床意义

目的：探讨糖化血红蛋白（ HbA1c）在妊娠期糖尿病（ GDM）筛查中的应用价值。方法：2011年1月～2012年10月,在我院门诊就诊的孕妇245例,其中符合GDM诊断标准的24例为GDM组,其余221例为非GDM组。分别对2组进行空腹血糖（ FBG）、口服葡萄糖耐量试验（ OGTT）及HbA1c进行检测。比较3种检测方法的检测结果,并对检测结果进行评价。结果：GDM组FBG、OGTT及HbAlc均明显高于非GDM组,差异有统计学意义（ P ＜0．05）,在3种项目检测中,HbA1c的灵敏度、特异性和阳性预测值最高,分别为90．0％、80．2％、82．3％,提示HbA1c 在诊断GDM 的3种检查中效果最好。结论：HbA1c水平在GDM患者中明显升高,诊断GDM具有较高的阳性率,早期干预治疗可减少母婴发病率及死亡率。 HbA1c为糖尿病的血糖水平监测提供了新的方法,是临床上筛查、诊断、监测妊娠期糖尿病的简单、可靠的方法。     

脂联素与转化生长因子-β1早期预测妊娠期糖尿病的临床价值

目的：探讨脂联素（APN）与转化生长因子-β1（TGF-β1）水平早期预测妊娠期糖尿病（GDM）发生的临床价值。方法：选取妊娠14～20周的孕妇采空腹静脉血,并随访至妊娠24～28周行75g糖耐量试验（OGTT）。选取其中40例OGTT正常者为对照组,38例GDM孕妇为试验组。比较2组血清脂联素、TGF-β1及血糖、胰岛素水平。结果：GDM组脂联素水平显著低于对照组（P〈0．01）,TGF-β1水平显著高于对照组（P〈0．01）。GDM组脂联素与胰岛素呈负相关,TGF-β1与胰岛素呈正相关。结论：GDM患者血清脂联素与TGF-β1的变化早于血糖的改变,可作为早期预测GDM的因子,有一定的临床价值。     

锦州市区妊娠期糖尿病发生率调查

目的：探讨锦州市区妊娠期糖尿病（GDM）的发生率。方法：于2006～2008年对锦州市内3区孕26～30周的妇女进行口服50g葡萄糖筛查试验。血糖≥7．8mmoVL者做葡萄糖耐量试验。结果：3年共筛查4468例孕妇，其中，筛查阳性424例，占9．49％。阳性者全部接受葡萄糖耐量试验，125例被诊断为GDM，占2．80％。结论：锦州市区近3年GDM发生率为2．02％-3．45％，且呈逐年上升趋势。     

妊娠期糖调节受损与妊娠结局的关系

目的　探讨妊娠期糖调节受损,即妊娠期糖尿病(GDM)及妊娠糖耐量异常(GIGT)与妊娠结局的关系。方法　2 4 2 1例孕妇行5 0 g葡萄糖筛查,对342例异常者行75g葡萄糖耐量试验(OGTT) ,确诊糖耐量异常者(GIGT组) 12 4例,妊娠期糖尿病者(GDM组) 5 9例并与对照组15 0例分别比较妊娠结局。结果　糖尿病家族史、体重指数、年龄与孕妇GIGT ,GDM的发生有关联,两组患者妊娠高血压综合征、羊水过多、巨大儿、新生儿病率的发生率明显高于对照组(P <0 .0 5 ) ,且两组对妊娠结局的影响无明显差异。结论　GDM与GIGT均能对妊娠造成不同程度的危害,应引起重视。     

多囊卵巢综合征患者胰岛B细胞功能评估及糖代谢状态调查

目的：探讨多囊卵巢综合征（ PCOS）患者胰岛 B 细胞功能改变对糖代谢异常的影响。方法分析90例PCOS患者与90例正常对照组的临床资料,分析PCOS患者胰岛B细胞功能损害与糖代谢异常的关系。结果与正常对照组相比,PCOS患者具有较低的早相处置指数（ DI30）。总处置指数（ DI120）及糖负荷后30 min胰岛素净增值与葡萄糖净增值的比值水平,差异均有统计学意义（P均＜0．05）;PCOS患者胰岛素曲线下面积与葡萄糖曲线下面积的比值高于正常对照组,差异有统计学意义（P＜0．05）。两组基础处置指数（DI0）、HOMA稳态模型B细胞功能（HOMA-B）差异无统计学意义（P＞0．05）。 PCOS组糖尿病占16．7％（15／90）,糖尿病前期占31．1％（28／90）,其中空腹血糖调节受损（IFG）组4．4％（4／90）,糖耐量降低（IGT）占22．2％（20／90）,IFG及IGT合并存在占4．4％（4／90）,均显著高于正常对照组（P＜0．05）。结论 PCOS患者的胰岛B细胞功能较正常对照组明显减退,糖代谢异常发生率明显增高,其中胰岛B细胞损害以早相胰岛素分泌功能受损为主,可能与PCOS患者糖代谢异常发病率升高有关。     

妊娠期糖尿病32例的检验分析

目的：对年龄大于30岁、身高低于1．59米、肥胖、高血压、孕期中反复尿糖阳性、胎儿较大、羊水过多的孕妇进行血糖筛查试验，阳性者或可疑者再进行糖耐量试验（OGTT），以便尽早检测出妊娠期糖尿病（GDM）。方法：己糖激酶法检测500例孕妇血糖，全部病例均经过葡萄糖耐量试验确诊。结果：GDM患者和正常妊娠妇女相比较空腹血糖均降低，其结果无显著性差别（P〉0．05），而餐后血糖达到高峰的时间不一样，而且2小时也不能降至正常水平，其结果差别有统计学意义（P〈0．01）。结论：检出的32例GDM空腹血糖降低，餐后血糖高而且恢复正常水平也缓慢。     

经阴道超声对多囊卵巢综合征的诊断价值

目的：探讨彩色多普勒超声对多囊卵巢综合征（PCOS）的诊断价值。方法：对43例PCOS患者（PCOS组）和25例月经周期规则有止常排卵者（对照组）进行经阴道二维及彩色多普勒超声检查，观测其卵巢体积（OV）、卵泡数目（FN）、卵巢间质内血流形态特征及其血流动力学指标，并进行对比分析。结果：PCOS组的卵巢体积、卵泡数目大于对照组，差异有统计学意义（P〈0．001）；收缩期峰值流速（PSV）高于对照组，差异有统计学意义（P〈0．01），而阻力指数（RI）、搏动指数（PI）低于对照组，差异有统计学意义（P〈0．001）。PCOS组卵巢间质内血管显示清晰、数量丰富（100％），其中91．9％的卵巢可见1支纵向贯穿卵巢间质的较粗血管，而对照组卵巢间质内血流呈散在点状。结论：经阴道二维及彩色多普勒超声对多囊卵巢综合征有较高的诊断价值。     

多囊卵巢综合征患者的糖耐量和胰岛素测定

目的探讨多囊卵巢综合征患者（PCOS）糖代谢和胰岛素分泌的特征。方法49例PCOS患者和21例对照组按体重指数（BMI）分为3组：对照组、PCOSI组（BMI〈25kg／m^2）、PCOSⅡ组（BMI≥25kg／m^2）。比较3组的糖耐量及胰岛素水平。结果与对照组比较,PCOS Ⅰ组空腹及口服葡萄糖后各组血糖差异均无统计学意义（P〉0．05）;胰岛素除空腹差异无统计学意义外（P〉0．05）,其余各组胰岛素释放量均有统计学意义（P〈0．05）。PCOSⅡ组口服葡萄糖后1h、2h血糖明显升高（P〈0．05）;胰岛素各组释放量差异均有统计学意义（P〈0．05）。与PCOSI组比较,PCOSⅡ组口服葡萄糖后1h、2h胰岛素释放量也有统计学意义（P〈0．05）。结论PCOS患者胰岛素释放量明显增加,肥胖可加重患者的胰岛素释放,导致PCOS患者高胰岛素血症进一步发展,且更易出现糖代谢异常,增加糖尿病发生的危险性。     

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.