高血压病患者血浆神经肽Y、神经降压素水平的变化及意义

目的 :观察高血压病患者血浆神经肽 Y（NPY）、神经降压素 （NT）水平的变化 ,探讨其在高血压发病机制中的作用及其与高血压靶器官损害的关系。方法 :用放射免疫分析法检测符合高血压病诊断标准的 80例高血压病患者血浆 NPY,NT浓度 ,同时检查患者心、肾等靶器官功能。结果 :1高血压病患者血浆 NPY水平高于对照组 （P<0 .0 5 ）、而 NT水平明显低于对照组 （P<0 .0 1）。 2高血压病 , , 期患者间血浆 NPY,NT水平差异明显 （P<0 .0 1） ,NPY水平逐渐升高 ,而 NT水平逐渐下降。心功能 , , 级高血压病患者间 NPY,NT水平差异明显 （P<0 .0 1） ,随心功能恶化 ,NPY水平升高 ,而 NT水平降低。伴有室间隔和 （或 ）左室后壁肥厚组血浆 NPY水平高于室间隔和左室后壁正常组 （P<0 .0 1） ,而 NT水平则肥厚组低于正常组 （P<0 .0 1）。肾功能 Ccr≤ 4 9m l/ min组血浆NPY水平高于 Ccr≥ 5 0 m l/ min组 （P<0 .0 1） ,二组间 NT水平无明显差异 （P>0 .0 5 ）。 3高血压病患者血浆 NPY与 NT水平呈负相关 （r=- 0 .4 5 ,P<0 .0 1）。结论 :NPY,NT参与了高血压病的发病过程 ,与高血压病患者心脏、肾脏功能损害程度相关 ,观察血浆 NPY与 NT水平变化有助于判断高血压病患者的病情和预后     

血浆N端B型利钠肽原对前壁与非前壁ST段抬高心肌梗死患者左室收缩功能的预测价值

目的探讨血浆N端B型利钠肽原（NT—proBNP）对急性前壁及非前壁sT段抬高型心肌梗死（STEMI）患者左室射血分数（LVEF）的早期预测价值。方法193例行急诊经皮冠状动脉介入术的STEMI患者,在人院时测量血浆NT—pmBNP水平,并将之以第三四分位数为界分组,分别评价NT—proBNP水平对前壁及非前壁STEMI患者发病6个月后经超声心动图测量的LVEF的预测价值。结果非前壁STEMI患者中NT—proBNP≥310pg／ml组较NT—proBNP〈310pg／ml组的LVEF低[（41±12）％比（54±7）％]（P〈0．05）。多元线性回归分析发现,NT—proBNP≥310pg／ml是非前壁STEMI患者LVEF降低的独立预测因子（β=-6．3,P=0．02）。结论在行急诊经皮冠状动脉介入术的非前壁STEMI患者中,入院NT—proBNP≥310pg／ml是6个月时LVEF降低的独立预测因子。入院时测定血浆NT—proBNP可能有助于对急性非前壁STEMI患者进行早期危险分层。     

心功能不全患者血浆N-末端脑钠肽前体及血清尿酸浓度的相关性

目的：探讨慢性充血性心力衰竭（CHF）患者血浆N-末端脑钠肽前体（NT—proBNP）浓度及血清尿酸（UA）浓度变化及其相关性。方法：65例心功能不全患者,按左室射血分数（LVEF）分两组,即LVEF〉40％组（32例）,LVEF≤40％组（33例）;30例健康体检者作为正常对照组。所有入选者人院后常规检查NT—proBNP,UA,超声心动图测定LVEF。结果：LVEF≤40％组NT—proBNP[1102．3（276．34,1483．3）pg／ml]和UAE478．0（351．5．576．7）μmol／L]水平较LVEF〉40％组[91．5（22．07。165．6）pg／ml;344．7（264．6,424．6）μmol／L]和正常对照组[14．6（5．4,54．1）pg／ml;289．7（214．6,326．3）μmol／L]显著升高．P均〈0．01;LVEF〉40％组NT～proBNP水平显著高于正常对照组（P〈0．01）,UA水平差异无显著性（P〉0．05）;心功能不全患者NT—proBNP与UA呈正相关（r为0．46,P％0．01）;LVEF与NT—proBNP和uA均呈负相关（r=-0．63、-0．42,P均〈0．01）。结论：慢性充血性心力衰竭患者血NT—proBNP浓度和UA浓度升高,且两者呈正相关。测定NT—proBNP和UA浓度有助于判断病情,早期治疗,改善预后。     

高血压病左室肥厚及舒张功能不全患者血浆NT-proBNP的变化

目的：观察高血压病左室肥厚及舒张性心功能不全患者血浆N末端脑利钠肽前体（NT-proBNP）含量变化。方法：利用酶联免疫法,对经多普勒超声心动图检查证实的68例高血压病伴左室肥厚及舒张功能不全患者及66例高血压病无左室肥厚患者的血浆NT—proBNP浓度进行测定。结果：高血压病伴左室肥厚及舒张功能不全患者组的血浆NT—proBNP浓度明显高于高血压非左室肥厚组[（308．35±74．04）pg／ml：（211．50±73．58）pg／ml,P〈0．01]。NT—proBNP与左室质量指数（LVMI）呈正相关（r=0．863,P〈0．001）,与E／A呈负相关（r=-0．758,P〈0．001）。结论：高血压病伴左室肥厚及舒张功能不全患者的血浆NT—proBNP浓度明显升高,且与应用超声心动图技术评价的高血压伴左室肥厚及舒张功能不全有较好的相关性。     

心血管病患者血浆NPY,NT水平变化与心功能的关系

本文作者旨在观察心血管疾病患者血浆神经肽 Y(NPY)、神经降压素 (NT)水平的变化与心功能损害的关系 ,探讨二者在心血管病心功能损害过程中的作用。1　方法　选择 13 6例心血管疾病患者 ,包括高血压病患者80例 ,冠心病、心绞痛或陈旧性心肌梗死患者 5 6例。按纽约心功能学会心功能分级对患者进行心功能分级。用放射免疫分析法检测患者血浆 NPY,NT浓度。选择 2 8例健康者作为对照组。2　结果　 1心血管病患者血浆 NPY水平 (15 9.7± 5 6.3pg/ ml)高于对照组 (12 0 .8± 5 1.9pg/ ml,P<0 .0 5 )、而 NT水平 (69.5± 2 9.6pg/ ml)低于对…     

单核细胞趋化蛋白-1在系统性硬化症患者中的表达

目的 探讨单核细胞趋化蛋白-1（MCP-1）在系统性硬化症（SSc）的相关性。方法 采用酶联免疫吸附试验（ELISA）方法检测27例SSc患者血浆MCP-1水平，并与21名年龄和性别相匹配的健康志愿者血浆中浓度对照，同时采用反转录聚合酶链反应（RT-PCR）和免疫组织化学染色方法检测MCP-1mRNA和蛋白质在5例SSc患者和3名健康志愿者皮肤成纤维细胞中的表达。结果 血浆MCP-1水平SSc组为（787±393）pg／ml，明显高于健康志愿者组的（426±266）pg/ml（P〈0．05）。对SSc组的进一步分析显示，11例弥漫型SSc患者血浆MCP-1水平为（896±347）pg／ml，高于16例局限型SSc患者的（714±332）pg/ml（P〈0．05）；18例并发有肺间质纤维化的SSc患者血浆MCP-1水平（844±327）pg／ml，也高于9例无肺间质纤维化的SSc患者的（676±314）pg／ml（P〈0．05）。RT-PCR和免疫组织化学染色的结果显示，5例分离于SSc病变皮肤、在体外培养的成纤维细胞有MCP-1的mRNA和蛋白质分子表达，而3名取自健康志愿者皮肤的成纤维细胞则无表达。结论 SSc患者血浆MCP-1水平显著升高，而且与皮肤受累程度和肺间质纤维化有一定的关系。RT-PCR和免疫组织化学染色结果表明，SSc患者病变皮肤组织表达MCP-1增高，提示MCP-1在SSc的病程中起重要作用。     

探讨胃动素、神经降压素和一氧化氮合酶与Oddi括约肌运动功能障碍的关系

目的 探讨胃动素（MTL）、神经降压素（NT）及一氧化氮合酶（NOS）对胆囊切除后Oddi括约肌（SO）运动功能的影响。 方法 在动物实验中，豚鼠造模组（胆囊切除）和对照组（开关术）术后12周行SO压力测定（SOM），计算受试者工作特征（ROC）曲线下面积值（AUC）及界限值，从造模组中筛选出符合条件的豚鼠，作为SO运动功能障碍（SOD）模型组。采用放射免疫法检测SOD模型组和对照组血浆MTL、NT的含量及采用积分光密度值方法检测SO组织中MTL、NT及NOS蛋白表达量。在临床研究中，比较SOD组（SO压力＞40 mmHg）和对照组患者血浆MTL、NT含量。 结果 根据ROC曲线计算AUC为0.75，豚鼠SO压力≥29.8 mmHg（界限值）为SOD模型组。SOD模型组（n=10）血浆MTL［（193.16±29.2） pg／mL］和NT含量［（104.57±19.52） pg／mL］均分别高于对照组（n=11） 血浆MTL［（154.24±27.69）pg／mL］和血浆NT含量［（79.65±11.24）pg／mL］（P＜0.01）； SO中MTL（3 556.71±455.80）和NT蛋白表达量（6 321.74±203.54）高于对照组MTL（3 075.92±350.06）和NT蛋白表达量（5 843.57±344.00），而NOS蛋白表达量（2 954.21±173.54）低于对照组（3 314.91±246.67）（P＜0.05）。临床研究SOD组（n=15）血浆MTL［（350.98±24.31）pg／mL］和NT含量［（102.39±19.56）pg／mL］分别高于对照组（n=15）MTL［（319.56±23.54）pg／mL］和NT含量［（80.45±12.35）pg／mL］（P＜0.05）。 结论 血浆MTL和NT含量以及SO中MTL、NT和NOS蛋白表达量与SOD发生有关。检测血浆MTL和NT可能对胆囊切除术后SOD有辅助诊断作用。     

肌钙蛋白T与N端B型尿钠肽前体对急性肺栓塞患者危险分层的意义

目的探讨联合检测生化标记物肌钙蛋白T（cTnT）和N端B型尿钠肽前体（NT—proBNP）水平对急性肺栓塞（APE）患者进行危险分层及预后判断的临床意义。方法根据血浆cTnT和NT—proBNP水平将59例APE患者分为3组：1组（14例）,cTnT〈0．1ng／ml,NT—proBNP〈100pg／ml;2组（28例）,cTnT≥0．1ng／ml或NT—proBNP≥100pg／ml;3组（17例）,cTnT≥0．1ng／ml且NT-proBNP≥100pg／ml,分析cTnT和（或）NT—proBNP升高对APE患者危险分层与临床预后的关系。结果三组间动脉血PaO2、P（A—a）O2比较差异有统计学意义（P〈0．01）。进行两两比较,1、3组动脉血PaO2、P（A—a）O2分别与其他各组相比差异有统计学意义（P〈0．01）。1组、2组、3组预后不良者分别为0（0％）、7例（25．0％）、9例（52．9％）,差异有统计学意义（P〈0．01）。59例APE患者中临床不良事件发生组与无临床不良事件组比较,PaO2、cTnT、NT—proBNP水平差异均有统计学意义（P〈0．01）。结论联合检测cTnT和NT—proBNP在APE患者早期危险分层、指导临床决策及预后判断中具有重要价值。     

血浆NT-proBNP水平检测对心力衰竭的诊断价值

40例充血性心力衰竭患者（实验组）按NHYA分级标准分成三个亚级（Ⅱ级、Ⅲ级、Ⅳ级），并选择30例非充血性心力衰竭患者为对照组，采用电化学发光和双抗体夹心免疫分析法检测各研究对象的N-端B型钠尿肽原（NT．proBNP）水平。结果实验组、对照组血液中NT—proBNP水平分别为（2248．1&#177;1363．9）、（69．5&#177;51．2）pg／ml，实验组明显高于对照组（P〈0．01）。实验组治疗前后NT—proBNP分别为（2248．1&#177;1363．9）、（976．9&#177;692．2）pg/ml，差异有显著统计学意义（P〈0．01）。实验组心功能分级Ⅱ、Ⅲ、Ⅳ级NT-proBNP分别为（855．3&#177;249．3）、（1748．6&#177;1121．2）、（3354．8&#177;898．4）pg／ml，各级间水平比较差异有统计学意义（P均〈0．05）。认为血浆NT—proBNP水平可作为充血性心力衰竭诊断及判断疗效的重要生化指标。     

2型糖尿病一级亲属脂联素等与胰岛素抵抗的相关研究

测定糖耐量正常T2DM患者一级亲属35例，及对照组42例的脂联素、抵抗素、TNF-α。结果1．一级亲属组脂联素水平低于正常对照组（12．29&#177;3．64mg／L vs 14．66&#177;3．43mg／L，P〈0．05），而抵抗素、TNF-α水平显著高于正常组（分别是19．02&#177;6．85Pg／ml vs 15．68&#177;6．24pg／ml，P〈0．05；14．12&#177;2．87pg／ml vs 10．43&#177;2．58pg／ml，P〈0．05）；2．一级亲属组IR指数与脂联素呈负相关（r=-0．53，P〈0．05），与抵抗素、TNF-α呈正相关（分别为r=0．62，P〈0．05；r=0．48，P〈0．05）。结论脂联素、抵抗素、TNF-α可能与T2DM患者一级亲属的IR相关。     

阿苯达唑联合黄芪对华支睾吸虫感染大鼠肝功能异常的疗效观察

Objective To observe the levels of alanine aminotransferase(ALT), total bilirubin(TBIL), hyaluronic acid (HA), procollagen type Ⅲ aminoterminal peptide (P Ⅲ NP) and larninin (LN) in the sera of rats infected with Clonorchis sinensis (C. sinensis) after treatment of albendazole combined with milkvetch root. Methods Thirty-two healthy adult Wistar rats were randomly divided into four groups with 8 in each based on body mass: control group, non-treatment group, Albendazole group(ALB group) and albendazole combined with milkvetch root group(ALB+MR group). The rats in non-treatmen, ALB and ALB+MR groups were infected orally with metacercariae of C. sinensis 50 per rat. The rats in control group were mock-infected with saline. The rats in ALB group were treated to each rat with 50 mg/kg alhendazole for 5 days, and ALB+MR groups were given to same treat with albendazole, meanwhile each rat injected with 800 mg/kg milkvetch root intraperitoneally for 30 days. All rats were killed after infestation 14 weeks and their sera samples were collected to detect ALT, TBIL, HA, PⅢNP, LN. Results There were statistically significant differences in the levels of ALT and LN in the sera of rats between groups(F=31.40,11.82, P<0.01). Compared with control[ (47.88±4.88)U/L, (51.20±4.12)μg/L], the levels of ALT and LN in rats in non-treatment group [(85.50±9.65)U/L, (64.20±4.18) μg/L] and ALB group [(65.29± 7.78) U/L, (58.23±2.55) μg/L] were significantly increased (P<0.05). Compared with non-treatment group, the levels of ALT and LN in rats in ALB group and ALB+MR groups[(50.25±9.29)U/L, (53.68±5.63)μg/L] were significantly decreased(P<0.05), and they decreased more obviously in ALB+MR group (P<0.05). There were statistically significant differences in the levels of TBIL, PⅢNP and HA in the sera of rats between groups (χ2=15.309,21.418,19.759, P<0.01). Compared with control[(0.700±0.350)μmol/L, (26.085±4.075)μg/L, (81.935±42.550)μg/L], the levels of TBIL, PⅢNP and HA in rats in non-treatment group(2.400 μmol/L, 46.220 μg/L,310.885 μg/L) and ALT group(1.200 μmol/L,36.540 μg/L, 178.010 μg/L) were significantly increased(P<0.05). Compared with non-treatment group, the level of TBIL in ALT+MR group(0.750 μmol/L), the levels of pⅢNP and HA in ALT and ALT+MR group(30.470,100.240 μg/L) were significantly decreased(P< 0.05). The levels of TBIL, PⅢNP and HA decreased more obviously in ALB+MR group(P<0.05). Conclusions The liver function in rats infected with C. sinensis is abnormal. The liver function and fibrosis are improved after treatment with albendazole or albendazole combined with milkvetch root. The treatment of albendazole combined with milkvetch root is more effective.     

馒头餐试验和胰升糖素C肽刺激试验评价胰岛B细胞功能的比较

目的 探讨馒头餐试验是否可代替胰升糖素Ｃ肽刺激试验以评价胰岛Ｂ细胞功能。方法 １１２例糖尿病人连续２天分别进行馒头餐试验和胰升糖素Ｃ肽刺激试验。结果 馒头餐后１,２,３小时血Ｃ肽与胰升糖素试验６分种Ｃ肽水平呈明显正相关。结论对进行胰升糖素Ｃ肽刺激试验有禁忌证的病人,可用馒头餐试验来了解胰岛Ｂ细胞储备功能。     

卧位型心绞痛容量负荷试验

目的探讨卧位型心绞痛发生机制．为临床治疗提供理论依据。方法选择卧位型心绞痛20例,混合型心绞痛12例,劳力型心绞痛10例．采用Swan-Ganz导管检查及容量负荷试验．结合无创检查中心脏X线片、超声心动图、心脏放射性核素检查指标,判断心功能状态．并给予相应治疗。结果①卧位型心绞痛者容量负荷前后平均肺动脉压、肺楔嵌压(PWP)均较其他类型心绞痛者高(P<0．01),负荷后卧位型心绞痛者平均肺动脉压、PWP升高,心脏指数下降,与其他组比较有显著性差异(P<0．05)。②6例容量负荷前PWP正常的卧位型心绞痛者,负荷后PWP明显升高≥18mmHg。③与有创检查中PWP相比．无创检查中心脏表面积、左室舒张末径明显增大,射血分数值显著下降,是判定收缩功能障碍的良好指标,而心脏表面指数、左室舒张末径、射血分数值正常而E／A<1,高峰充盈率降低且肺淤血征阳性亦存在舒张功能障碍。结论卧位型心绞痛的发生与心功能不全密切相关,以舒张功能障碍者多见。     

The utility of combined cardiopulmonary exercise stress testing in the evaluation of pediatric patients with chest pain

Introduction: A cardiac cause is an extremely rare etiology of pediatric chest pain. Despite its low sensitivity/specificity, exercise stress testing (EST) is widely used to determine the prognosis in patients with suspected/established coronary disease. We aimed to look at the utility of a combined cardiopulmonary EST in the evaluation of pediatric patients with chest pain.
Methods: After institutional review board approval, a retrospective chart review was performed of all pediatric patients who were referred for an EST for chest pain from January 2014 to 2017. Patients with incomplete records, severe congenital heart disease, and a prior EST were excluded.
Results: A total of 389 patients met the inclusion criteria. Echocardiogram (ECHO) was performed on 333 (85.6%) patients and 43 (11%) previously unknown structural cardiac anomalies were identified. A total of 76 (19.5%) patients had an abnormal EST with the 3 most common causes being related to the respiratory system. Only four patients had both an abnormal exercise stress test and an incidental structural anomaly on ECHO but none of them had their symptoms recreated during the EST.
Conclusion: Only 1% of patients previously undiagnosed with heart disease had an abnormal stress test and an incidental anomaly on ECHO. These ECHO anomalies were unlikely to be the cause of chest pain. Furthermore, since the majority of abnormal stress tests were secondary to a pulmonary cause, a complete cardiopulmonary EST may be an effective screening tool for certain patients presenting with chest pain. Our study emphasizes the need for performing a complete cardiopulmonary EST instead of an isolated cardiac stress test to maximize diagnostic efficiency and yield.     

6年间气道高反应性对重度吸烟者慢性阻塞性肺疾病发病的影响

目的探讨气道高反应性对重度吸烟者慢性阻塞性肺疾病（COPD）发病的影响。方法1996年，对456名慢性呼吸症状和重度心脑血管病的重度吸烟者（FVC≥15包／年）进行调查，询问吸烟史，测量气道反应性、第一秒用力呼气量（FEV1）、用力肺活量（FVC）。2002年对其中259人再次进行呼吸功能测量，以及COPD发病情况。结果调整年龄、性别、身高、吸烟包／年、吸烟种类（无过滤嘴、有过滤嘴、混吸）、戒烟和基线FEV1后，气道高反应性（AHR，PC20 FEV1〈8mg／ml）加快了FEV1（β=19．2ml／yr，P=0．003），FVC（β=20．6ml／yr，P=0．012）和FEV1／FVC（β=0．4％／yr，P=0．008）的1996-2002年间的下降速度。对基线无COPD者进行亚组分析发现，气道高反应性者6年后COPD发病危险显著增加，调整调整年龄、性别、身高、吸烟影年、吸烟种类（无过滤嘴、有过滤嘴、混吸）、戒烟和基线FEV1后，OR值为5．6（95％可信区间：1．1-28．2）。结论气道高反应性在吸烟引起的COPD发病过程中起着重要作用，气道反应性测定有助于吸烟易感者的早期发现。     

利多卡因试验对肝硬化病人肝贮备功能及其预后的评价

目的 应用利多卡因代谢产物（ＭＥＧＸ）浓度评价肝硬化病人肝贮备功能及其预后。方法 依纳入排除标准自１９９５年１２月至１９９６年１２月共有６８例住院病人进入本研究。病例入选时记录病人的一般资料、Ｃｈｉｌｄ－Ｐｕｇｈ分类及分级并进行利多卡因试验。ＭＥＧＸ浓度采用ＴＤｘ分析仪测定，方法为荧光偏振免疫测定。全部病例进入随访，平均随访１０个月以上。应用方差分析比较肝硬化病人不同Ｃｈｉｌｄ－Ｐｕｇｈ分级状态时     

Evaluation of dexterity in insulin-treated patients with type 1 and type 2 diabetes mellitus

Background

Daily routine for insulin-treated patients with diabetes mellitus requires correct performance of self-monitoring of blood glucose and insulin injections several times a day. Dexterity skills may play an important role in the performance efficacy of these procedures.

Methods

We collected data of insulin-treated (>10 years) patients with different age ranges [healthy controls, 14 female/11 male, age (mean ± standard deviation) 55 ± 7 years; type 1 diabetes mellitus (T1DM) patients, 12/13, 45 ± 9 years, disease duration 23.9 ± 6.5 years; T2DM patients, 8/17, 64 ± 6 years, 16.2 ± 6.9 years; T2DM patients (>70 years of age), 9/16, 75 ± 4 years, 19.7 ± 7.0 years]. After assessment of neuropathy (temperature, pain, and vibration perception), the patients participated in two dexterity test batteries [Jebsen–Taylor hand-function test (JHFT) and motoric performance series (MPS)].

Results

Patients with type 2 diabetes showed disturbed vibration perception as compared to the other groups. The dexterity results were influenced by age to a large extent. Older T2DM patients performed worst in the majority of the subtests (e.g., JHFT, writing nondominant hand: control, 40.8 ± 11.7 s; T1DM, 46.3 ± 50.9 s, not significant versus control; old T2DM, 68.1 ± 29.5 s, p < .05; young T2DM, 52.5 ± 26.2 s, p < .05). Patients with type 1 diabetes showed similar JHFT and MPS results than the 10-year-older control subjects and performed outside of the age-dependent normal reference range.

Conclusions

Manual skills and dexterity differed between the groups, and age-corrected reduced skills were common in both T1DM and T2DM patients in this study. Our findings underline the importance of considering dexterity and manual skills when designing medical devices for patients with diabetes mellitus.     

改良型阿托品试验的探讨

目的:探讨阿托品试验改良法对窦房结功能的诊断价值.方法:取2008年6月至2009年9月在我院行阿托品试验的患者,均经其他检查(动态心电图或心电图)诊断为窦性心动过缓,共220例.分为常规组和改良组,行阿托品试验.结果:常规组阳性33例,占30.5%,改良组阳性16例,占15.7%.结论:常规阿托品试验法存在一定的假阳...     

二丙酸倍氯米松干粉剂治疗晚发老年哮喘的临床观察

目的 观察吸入类固醇二丙酸倍氯米松（ＤＢＰ）干粉剂对晚发老年哮喘（ＬＯＡ）的疗效。方法 将２２例ＬＯＡ患者与２３例非老年２哮喘患者进行对比研究,观察吸入β２受体激动剂沙丁胺醇干粉剂后１秒钟用力呼气容积（ＦＥＶ１）的变化以及吸入ＤＢＰ干粉剂后ＦＥＶ１及其占预计值百分比（ＦＥＶ１％）、早晚最大呼气流速（ＰＥＦＲ）及其日内变异率等变化。结果 两组患者在吸入沙丁胺醇干粉剂后ＦＥＶ１均明显增高（Ｐ〈０．０１