心肌损伤标志物在急性冠脉综合征危险分层中的意义研究

目的 探讨血浆同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)、心脏型脂肪酸结合蛋白(H-FABP)及缺血修饰清蛋白(IMA)水平在急性冠脉综合征(ACS)危险分层中的临床应用,为临床对ACS患者病情的危险程度进行准确评估和及时治疗提供客观依据.方法 选取2012年4-11月在我院心血管内科住院的ACS患者82例为病例组,并按全球急性冠状动脉事件注册(GRACE)危险评分软件对其进行危险分层,分为低、中、高危组;另选取同期我院体检健康者89例为对照组.检测对比各组Hcy、hs-CRP、H-FABP及IMA水平.结果 4组受试者Hcy、hs-CRP水平、H-FABP及IMA间差异均有统计学意义(P＜0.05),Hcy水平比较:低危组、中危组及高危组间差异无统计学意义(P＞0.05),但均高于对照组(P＜0.05);hs-CRP水平比较:中危组、高危组高于对照组(P＜0.05),低危组与对照组间差异无统计学意义(P＞0.05);H-FABP水平比较:高危组高于中危组,高危组和中危组均高于低危组(P＜0.05);IMA水平比较:高危组高于中危组,高危组和中危组均高于低危组(P＜0.05).结论 Hcy水平未随ACS患者疾病危险程度的加重而增加;血浆hs-CRP、H-FABP、IMA水平均可提示ACS患者疾病的危险程度,其水平随疾病危险程度的增加而增高,对ACS患者低危与中、高危的危险分层有较高的临床价值.     

心肌损伤标志物在急性冠脉综合征危险分层中的意义研究

目的探讨血浆同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)、心脏型脂肪酸结合蛋白(H-FABP)及缺血修饰清蛋白(IMA)水平在急性冠脉综合征(ACS)危险分层中的临床应用,为临床对ACS患者病情的危险程度进行准确评估和及时治疗提供客观依据。方法选取2012年4—11月在我院心血管内科住院的ACS患者82例为病例组,并按全球急性冠状动脉事件注册(GRACE)危险评分软件对其进行危险分层,分为低、中、高危组;另选取同期我院体检健康者89例为对照组。检测对比各组Hcy、hs-CRP、H-FABP及IMA水平。结果 4组受试者Hcy、hs-CRP水平、H-FABP及IMA间差异均有统计学意义(P<0.05),Hcy水平比较:低危组、中危组及高危组间差异无统计学意义(P>0.05),但均高于对照组(P<0.05);hs-CRP水平比较:中危组、高危组高于对照组(P<0.05),低危组与对照组间差异无统计学意义(P>0.05);H-FABP水平比较:高危组高于中危组,高危组和中危组均高于低危组(P<0.05);IMA水平比较:高危组高于中危组,高危组和中危组均高于低危组(P<0.05)。结论 Hcy水平未随ACS患者疾病危险程度的加重而增加;血浆hs-CRP、H-FABP、IMA水平均可提示ACS患者疾病的危险程度,其水平随疾病危险程度的增加而增高,对ACS患者低危与中、高危的危险分层有较高的临床价值。     

老年急性冠脉综合征患者心肌损伤标志物水平与疾病危险程度的相关性

目的:探讨老年急性冠脉综合征(ACS)患者血清超敏C反应蛋白(hs-CRP)、生长分化因子(GDF-15)、心型脂肪酸结合蛋白(H-FABP)及缺血修饰白蛋白(IMA)水平变化及其与ACS危险分层的相关性.方法:将68例老年ACS患者作为疾病组,采用GRACE评分法进行危险分层,根据评分结果将疾病组患者分为低危组(23例)、中危组(25例)及高危组(20例);另选同期体检健康者60例作为对照组.比较各组间血清hs-CRP、GDF-15、H-FABP及IMA水平差异及相关性.结果:与对照组比,疾病组患者血清hs-CRP、GDF-15、H-FABP及IMA水平均明显较高.不同危险分层组间:中、高危组患者血清hs-CRP水平均明显高于低危组,而中、高危组间比较,hs-CRP水平无明显差异;血清GDF-15、H-FABP及IMA水平变化趋势均为低危组<中危组<高危组.老年ACS患者血清GDF-15、H-FABP及IMA水平均与hs-CRP水平呈正相关.结论:血清中心肌损伤指标GDF-15、H-FABP及IMA水平均与老年ACS患者疾病危险程度呈正相关,对老年ACS的危险分层具有较高的参考价值.     

慢性肾脏病非透析患者微炎症状态分析

目的 探讨慢性肾脏病(CKD)非透析患者微炎症状态标志物与肾功能及临床传统心血管病危险因素的关系.方法 选择CKD非透析患者100例,依据美国NKF-K/DOQI的肾功能分期标准,将患者分为CKD1期、CKD2期、CKD3期、CKD4期、CKD5期,每组20例.同期25例本院的健康体检者作为健康对照组.分别测定血清超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、脂蛋白a(LPa)水平(均采用酶联免疫吸附法)及相关临床指标,比较不同CKD分期中血清hs-CRP、IL-6、LP(a)水平,并探讨炎症因子与肾功能及临床传统心血管病危险因素之间的关系.结果 ①CKD组患者的血清hs-CRP(3.54±2.57)mg·L-1高于健康对照组(1.85±1.36)mg·L-1、IL-6(2.10±1.29)pg·mL-1高于对照组(1.53±0.93)pg·mL-1、LP(a)(326.34±124.39)mg·L-1高于对照组(152.32±63.46)mg·L-1,差异均有统计学意义(P＜0.05).②与CKD 1、2、3期患者比较,CKD 5期患者血清IL-6含量显著升高(P＜0.05),CKD4、5期患者血清hs-CRP含量也显著升高(P＜0.05);与CKD1、2期患者比较,CKD5期患者血清LP(a)含量显著升高(P＜0.05).③相关分析显示,CKD患者血清hs-CRP与血肌酐呈正相关性(r=0.502,P＜0.01);LP(a)水平与血肌酐呈正相关性(r=0.274,P＜0.05).结论 CKD患者微炎症状态标志物hs-CRP、IL-6、LP(a)本身可能作为损伤因子,参与肾功能恶化,并可能与心血管病变的发生有关.微炎症因子在CKD患者中有早期预测心血管疾病(CVD)的重要作用,有望用于CKD患者并发心血管疾病的早期诊断、危险分层.     

血清hs-CRP、Hcy水平变化与高血压危险分层的相关性及临床意义

目的探究血清高敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)水平变化与高血压危险分层的相关性及临床意义。方法选取2016年3月至2017年12月河南省职工医院收治的高血压患者126例作为研究对象,危险分层:中危20例,高危36例,极高危70例;均以胶体金法测定血清hs-CRP水平,免疫比浊法测定血清Hcy水平。比较不同危险分层患者hs-CRP、Hcy水平,分析血清hs-CRP、Hcy水平变化与高血压危险分层的相关性。结果不同危险分层患者血清hs-CRP、Hcy水平比较,差异有统计学意义(P<0.05);其中中危患者血清hs-CRP、Hcy水平低于高危患者,高危患者血清hs-CRP、Hcy水平低于极高危患者,差异有统计学意义(P<0.05)。血清hs-CRP、Hcy水平变化与高血压危险分层呈正相关(P<0.05)。结论血清hs-CRP、Hcy水平变化与高血压危险分层呈正相关,及时测定血清hs-CRP、Hcy水平有助于判断高血压患者危险程度,对高血压诊断、防治具有重要临床指导意义。     

急性冠脉综合征患者血清卵泡抑素样蛋白1与病变严重程度的关系

目的:探讨急性冠脉综合征(ACS)患者血清卵泡抑素样蛋白1(FSTL-1)水平变化的意义。方法:ACS患者205例,依据ACC/AHA指南进行危险分层,分为低危组59例,中危组69例,高危组77例。选取同期非缺血性胸痛患者50例作对照。采用ELISA法测定血清FSTL-1水平,采用Gensini评分系统评测冠脉病变严重程度,同时测定血脂、肌钙蛋白T(cTnT)和N末端B型利钠肽原(NT-proBNP)等指标。结果:高危组、中危组、低危组及对照组4组间血清FSTL-1水平差异有统计学意义(F=311.588,P<0.001),从高危组、中危组到低危组血清FSTL-1水平逐渐降低(P<0.05),但均高于对照组(P<0.05)。高危组和中危组ACS患者血清FSTL-1水平与Gensini评分、血清NT-proBNP水平呈线性正相关(r=0.756、0.465和0.699、0.395,P均<0.01)。结论:血清FSTL-1水平有可能成为评估早期ACS病变严重程度的生物标志物。     

胎盘生长因子与非ST段抬高ACS危险分层间关系的研究

目的：观察非ST段抬高急性冠状动脉综合征（ACS）患者的血清胎盘生长因子（PIGF）的浓度变化,以探讨PIGF水平在非ST段抬高ACS临床治疗中的意义。方法：冠状动脉造影患者40例,分为中危、高危两组（低危0例）,其中高危组25例,中危组15例,对比分析非sT段抬高ACS不同危险分层PIGF的变化。结果：高危组PIGF浓度43．16±12．93ng／L,显著高于中危组的31．73±7．09ng／L（P〈0．05）。结论：PIGF可用于非ST段抬高ACS的危险分层,在非ST段抬高ACS临床治疗策略制定中有一定的参考价值。     

维生素D与高血压病及高血压危险分层相关性研究

目的 通过对25-羟基维生素D（25-0H-vitD）测定,研究维生素D在健康人群与高血压病患者的浓度变化,以及维生素D（按高血压心血管危险分层标准）不同组别高血压患者的浓度变化,为维生素D缺乏对高血压发病率及对高血压危险分层、预后提供依据.方法 收集健康体检者作为对照组（55例）,内科门诊及住院部高血压患者作为实验组（139例）,实验组分为低危（30例）、中危（30例）、高危（36例）、极高危组（43例）4组;分别将对照组与实验组,实验组低、中、高、极高危组分别进行比较.结果 对照组、实验组25-OH-D浓度分别为（29.1±5.58）、（22.58±6.0）,实验组低危、中危、高危组、很高危组25-OH-D浓度分别为（24.98±6.53）、（24.14±5.14）、（21.49±5.78）、（20.73±5.8）.对照组与实验组有统计学差异（P〈0.01）,低危组与中危组,中危组与高危组、高危组与很高危组的差异无统计学意义（P〉0.05）,低危组与高危组及很高危组有统计学意义（P〉0.01,P＜0.05）,中危组与很高危组有统计学意义（P＜0.05）,25-OH-D与收缩压、舒张压存在负相关（r=-0.696、r=-0.544,P＜0.01）.结论 原发性高血压病患者血清vitD浓度下降,尤其是伴有高危因素的患者血清维生素D水平降低更明显.     

超敏C反应蛋白在妇科疾病诊断中的应用

目的 为探讨盆腔包块患者血清中超敏C反应蛋白(hs-CRP)含量变化.方法 采用免疫比浊法,检测35例慢性盆腔炎,30例子宫肌瘤,31例卵巢囊肿患者血清中hs-CRP含量的变化和随机选择40例健康人群做对照组进行对比性分析.结果 慢性盆腔炎组血清中hs-CRP含量(10.20±3.30)mg·L-1,明显高于对照组(1.31±O.95)mg·L-1(P<0.01);子宫肌瘤组(2.16±1.02)mg·L-1、卵巢囊肿组(2.26±0.63)mg·L-1与健康对照组比较,差异无统计学意义(P>0.05);慢性盆腔炎组血清中hs-CRP含量分别为子宫肌瘤组、卵巢囊肿组的4.72、4.51倍,其含量也有统计学意义(P<0.05).结论 在妇科盆腔包块诊断中,炎性反应性疾病多伴有hs-CRP升高,而良性肿瘤患者hs-CRP含量正常.hs-CRP可作为临床鉴别炎性疾病与良性肿瘤依据之一.     

不同危险分层非ST段抬高急性冠脉综合征患者胱抑素-C和超敏C反应蛋白水平分析简

目的 通过检测胱抑素-C（Cys-C）和超敏C反应蛋白（hs-CRP）在不同危险分层的非ST段抬高急性冠脉综合征（NSTEACS）患者的浓度,旨在探讨Cys-C和hs-CRP与不同危险分层的NSTEACS的关系.方法 选取2010年3月～2012年6月鹤山市人民医院住院患者90例,并选取同期住院排除冠心病的患者30例作为正常对照组,其中NSTEACS低危患者30例,中危患者30例,高危患者30例.对90例临床NSTEACS不同危险分层患者和30例正常者依次进行全面的临床特征分析.所有病例于入院即刻、1周抽血测定hs-CRP和Cys-C浓度.结果 hs-CRP入院即刻、1周后水平均随着NSTEACS危险分层级别的增高,其值随之增高.高危组明显高于中、低危组及正常对照组,差异有统计学意义（均P＜ 0.05）.Cys-C入院即刻水平在高危组中最低,与正常对照组相比,差异有统计学意义.1周后高危组水平上升,明显高于正常对照组,差异有统计学意义（均P＜ 0.05）.hs-CRP和Cys-C在入院即刻浓度随着NSTEACS患者危险分层提高,二者呈明显负相关（r=-0.439,P＜0.05）.1周后二者水平值呈正相关（r=0.349,P＜0.05）.结论 联合检测Cys-C和hs-CRP的水平可以判断不同危险分层NSTEACS的严重程度,对NSTEACS的诊治及其预后评价均有重要的参考价值.     

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.     

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.     

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.