多重动脉粥样硬化患者踝臂指数与全因、心因性死亡的相关性研究

目的探讨踝臂指数作为冠心病独立危险因素的地位和作用。通过随访,评估不同ABI水平对于具有多重动脉粥样硬化危险因素的住院患者长期预后的意义、目前所需采取的措施。方法多中心随机抽取符合条件的3 732例住院患者,分为≤0.4,0.4相似文献   

低踝臂指数与动脉硬化高危男性病死率关系的队列研究

目的研究具有多重动脉硬化危险的男性的踝臂指数（ABI）与全因和心血管疾病（CVD）病死率的关系。方法多中心连续人选内科住院病人中具有多个动脉硬化危险因素的男性病人1941例,年龄36～96岁,进行基线特征调查并平均随访13个月,观察其终点事件的发生率。结果外周动脉疾病（PAD）组的全因病死率（15．4％vs 7．7％）和CVD病死率（5．1％vs 1．8％）均高于正常组,且差异有统计学意义。在重度PAD组、轻度至中度PAD组、临界组和正常对照组中的全因病死率（分别为17．6％,15．2％,10．1％和7．3％）和CVD病死率（分别为14．7％,4．4％,2．9％和1．6％）差异有显著统计学意义（P〈0．001）。经Cox回归分析后,轻至中度PAD组（0．4〈ABI≤0．9）全因死亡的RR为1．585（95％CI：1．126～2．230）。重度PAD组（ABI≤0．4）CVD死亡的RR为4．443（95％CI：1．811～10．902）,轻至中度PAD组CVD死亡的RR为1．859（95％CI：1．091～3．166）。PAD组的全因死亡和CVD死亡生存明显低于正常组。结论ABI是全因死亡和CVD死亡的独立危险因素,ABI越低CVD病死率可能越高。     

血清LDL-C水平与老年射血分数降低性心衰患者预后的关系

目的研究血清低密度脂蛋白胆固醇(LDL-C)水平对老年住院射血分数降低性心力衰竭(HFr EF)患者长期预后的影响。方法本研究为单中心回顾性研究。选取2007年8月至2012年2月于郑州大学人民医院住院治疗的不同病因的340例老年HFr EF患者,依据血清LDL-C水平分为3组:低水平LDL-C组(LDL-C≤2.266 7 mmol/L),中等水平LDL-C组(LDL-C≤2.873 3 mmol/L),高水平LDL-C组(LDL-C>2.873 3 mmol/L),分析各组全因死亡率差异,采用多因素Cox比例风险回归模型分析不同水平LDL-C对全因死亡率的影响。结果 340例患者中共116例发生全因死亡。其中高水平LDL-C组全因死亡率为23.89%,低于中等水平LDL-C组36.09%及低水平LDL-C组43.36%(P<0.05)。Kaplan-Meier生存曲线显示高水平LDL-C组全因死亡低于其余2组(Log Rank=12.595,P=0.002)。根据多因素Cox比例风险模型,低水平LDL-C组患者全因死亡率是高水平LDL-C组患者的2.135倍(95%CI:1.311~3.477,P=0.002)。结论高水平的LDL-C与老年住院HFr EF患者长期全因死亡率降低有关。     

踝臂指数与老年冠心病患者发生心血管事件的相关性

目的:探讨踩臂指数与老年冠心病患者发生心血管事件的相关性。方法:483例(年龄≥60岁)经冠脉造影诊断的冠心病患者,分为PAD组(ABI≤0.9,n=144)和非PAD组(ABI>0.9,n=339),随访1年。结果:PAD组共发生心血管事件(心血管死亡、非致死性心肌梗死、不稳定心绞痛住院、冠状动脉血运重建)49例(34.0%),高于PAD组的59例(17.4%);(P=0.001)。预测心血管事件的独立危险因素为:ABI(OR=2.45),糖尿病(OR=2.01),年龄(OR=1.74),陈旧心肌梗死(OR=1.65)。结论:ABI是预测老年冠心病患者发生心血管事件的独立危险因素。     

Banach评分对急诊科急性冠脉综合征患者预后的预测价值

目的 探讨Banach评分对急诊科就诊急性冠脉综合征(ACS)患者预后的预测价值.方法 收集年龄≥18岁确诊的ACS患者共229例.记录患者临床资料,完成Banach评分的计算,并对纳入的病例进行7 d、30 d和6个月的随访,对全因死亡率进行相关性分析.结果 收集了229例ACS患者,平均年龄为(69.1±12.9)岁,男163例(71.2%).ACS病例中,ST段抬高型心肌梗死者122例(53.3%),非ST段抬高ACS者107例[46.7%,非ST段抬高型心肌梗死者42例(18.3%),不稳定型心绞痛者65例(28.4%)].年龄、糖尿病史、高脂血症史、就诊时心率、血压、肌钙蛋白T的水平存活组与死亡组比较差异有统计学意义(P<0.05).对病例进行6个月的随访,7 d全因死亡率为7.9%(18例),30 d全因死亡累计10%(23例),6个月全因死亡累计10.5%(24例).应用Banach评分预测ACS患者7 d、30 d和6个月全因死亡率的曲线下面积分别是:0.791(95% CI为0.733~0.842)、0.791(95% CI为0.733~0.842)、0.802(95% CI为0.745~0.852).结论 Banach评分对急诊科ACS患者死亡率的预测效能敏感,能较好地预测ACS患者的短期和中期预后.     

2型糖尿病患者伴慢性肾脏病和外周动脉疾病对全因死亡和心血管疾病死亡的影响

目的 评价2型糖尿病（type 2 diabetes mellitus, T2DM）患者伴慢性肾脏病(chronic kidney disease, CKD)和外周动脉疾病(peripheral arterial disease, PAD)对全因和心血管疾病（cardiovascular disease, CVD）死亡的影响。方法 2004年7月—2005年1月,收集北京和上海地区8所医院的T2DM患者1559例。根据是否患有CKD或PAD,将研究对象分为不同的CKD/PAD组,对其进行5年的随访研究。使用生存分析比较各组的生存率,使用COX比例风险模型比较各组的全因和CVD死亡相对危险度（relative risk, RR）。结果 经过5年随访,共获得1343例T2DM患者的完整随访资料。随访期间,共发生全因死亡370例（27.55%）,其中CVD死亡185例（13.78%）。与非PAD非CKD组相比较,CKD合并PAD组的全因和CVD死亡率最高,其RR值分别为3.12（95%CI: 2.30~4.24）和3.47（95%CI: 2.29~5.24）。结论 T2DM患者同时伴CKD和PAD具有较高的全因和CVD死亡风险。     

踝臂指数对心血管高危患者全因及心血管死亡率的预测作用

目的 评估心血管高危患者踝臂指数(ABI)与1年全因及心血管死亡率的相关性.方法 选择3179例心血管高危患者,检测静息状态下ABI,以ABI＜ 0.9为低ABI.将患者分为4组:冠状动脉粥样硬化性心脏病(CHD)组、缺血性脑卒中(IS)组、糖尿病(DM)组、极高危(VHR)组.随访1～1.5年,评价ABI与1年全因及心血管死亡率的相关性.结果 低ABI发生率为28.2％.低ABI者的全因死亡率及心血管死亡率(14.2％,6.6％)高于ABI正常者(6.5％,2.5％)(P＜0.01).各组低ABI者全因死亡率及心血管死亡率均高于ABI正常者(P＜0.01).DM患者全因死亡及心血管死亡风险均高于其余3组.结论 ABI是死亡率强有力的独立预测因子,其中低ABI患者的1年全因死亡及心血管死亡风险大幅度增加.     

六分钟步行试验对慢性心力衰竭患者的预后评价

目的:评价六分钟步行试验(六MWD)对心衰病人预测价值。方法:共入选202例慢性心衰病人,被分为≤200m、201~300m、301~400m和>400m4组,平均随访2年。结果:6min步行距离越短的心衰病人,其全因死亡率(P=0.029)和心因性死亡率越高(P=0.015);全因住院率(P=0.029)和心因性再住院率(P=0.034)增加。6min步行距离在≤200m和>200m的心衰病人之间全因死亡(P=0.006)和心因性死亡(P=0.001)也有明显差别,但在>200m的各组心衰病人之间全因死亡和心因性死亡无明显差别。在多因素回归分析中NYHAⅢ/Ⅳ的心衰病人有明显的死亡危险(P=0.001)。心衰病人(≤200m)的全因死亡(95%CI=1.64)和心因性死亡(95%CI=2.38)也有明显高的校正危险比;结论:6min步行距离≤200m的心衰病人有很高的死亡风险,修改现行6MWD的标准方案可为病人提供更多的预测信息。     

中性粒细胞/淋巴细胞比值对下肢动脉硬化闭塞症患者预后预测作用的meta分析

目的：系统评价中性粒淋巴细胞比率(NLR)与下肢动脉粥样硬化患者预后的关系。方法：检索PubMed、Scopus、Web of science、中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库,检索时间截止至2021/12/31。收集第一作者、发表年份、国家、研究类型、样本量、性别、年龄、吸烟、合并疾病、NLR均数、NLR截断值、结局指标、随访时间；运用纽卡斯尔-沃太华量表(NOS)对纳入文献进行质量评估；使用Stata 16.0软件采用随机效应模型计算PAD患者高、低NLR组间不同结局的效应量。结果：共纳入17篇文献(n=4554),NOS评分均≥6分。Meta分析结果显示,高NLR与全因死亡、截肢和介入后再狭窄的关系密切,合并后效应量分别为HR=1.93(95%CI:1.21~3.10),HR=1.92(95%CI:1.43~2.59),OR=1.76(95%CI:1.1~2.75)。进一步的亚组分析结果提示,高NLR对1年内PAD患者全因死亡和截肢的发生具有预测价值,合并后HR分别为3.37(95%CI:2.32~4.90),2.64(95%CI：2.10~3.31),而对介入后再狭窄的预测作用不确切[OR=1.68,95%CI(0.75,3.75)]。结论：高NLR与全因死亡、截肢、介入后再狭窄的关系密切,可作为PAD患者1年内发生截肢和全因死亡的预测指标。     

糖尿病患者下肢动脉病变危险因素分析

目的 通过踝肱指数(ABI)检查,探讨糖尿病患者下肢外周动脉病变(PAD)的患病率,并分析影响ABI的危险因素.方法 对长寿区人民医院2007年6月至2008年12月住院糖尿病患者112例,使用多普勒血管超声仪检测ABI,同时检测血脂、HbA1C等;通过回归分析探讨影响ABI的危险因素.结果 112例糖尿病患者中,ABI降低组(ABI<0.9)13例(11.6%);ABI升高组(ABI≥1.3)6例(5.3%);ABI正常组(0.9≤ ABI< 1.3)91例(83.1%).与ABI正常者相比,ABI降低组患者年龄更大,病程更长,收缩压、TC、LDL-C更高;多因素Logistic逐步回归分析显示,年龄是导致ABI降低的独立危险因素,而病程和LDL-C是导致ABI升高的危险因素.结论 通过ABI检测发现,大约11.6%的糖尿病患者存在PAD;合并糖尿病PAD的患者血压、血脂代谢紊乱更为明显.因此,对门诊和住院糖尿病患者,应常规进行ABI检测以早期发现糖尿病PAD;严格控制血压、血脂对于预防糖尿病PAD至关重要.     

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.     

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.