抑郁症治疗前后血清神经生长因子的变化及其影响因素研究

目的研究抗抑郁治疗前后抑郁症患者血清神经生长因子(NGF)的变化及NGF与生活事件、防御方式的关系。方法所有抑郁症患者给予盐酸帕罗西汀治疗6周,采用酶联免疫吸附法(ELISA)检测31例抑郁症患者(研究组)治疗前和治疗6周末及25例正常对照(对照组)血清NGF的含量。对31例抑郁症患者进行生活事件量表(LES)、防御方式问卷(DSQ)和汉密尔顿抑郁量表(HAMD)的评定。结果治疗前,研究组血清NGF水平显著高于对照组(P<0.01),研究组抗抑郁治疗6周末血清NGF水平显著低于治疗前(P<0.01)。结论 NGF参与了郁症患者神经损伤的修复过程,帕罗西汀可调节NGF水平。     

电针合并帕罗西汀对抑郁症患者生存质量的影响

目的 探讨电针联合帕罗西汀治疗抑郁症的临床疗效、副作用及对患者生存质量的改善效果.方法 62例抑郁症患者随机分为两组,分别为口服帕罗西汀合并电针治疗(治疗组)与单用帕罗西汀治疗(对照组),疗程均为6周,10周后随访,于治疗前后采用汉密尔顿抑郁量表(HAMD量表)和Asberg抗抑郁药物副作用量表(SERS量表)及世界卫生组织生存质量测定量表简表(WHOQOL-BREF)评定.结果 两组患者疗效比较差异有统计学意义(P＜0.01);治疗组从治疗1周末起,对照组从治疗2周末起HAMD量表评分较治疗前开始有显著性下降,与治疗前比较差异均有统计学意义(P＜0.01);治疗组WHOQOL-BREF心理、环境领域评分与对照组比较差异有统计学意义(P＜0.05);治疗组治疗2周末、治疗4周末SERS量表分值与对照组同期比较差异有统计学意义(P＜0.05).结论 电针联合帕罗西汀治疗抑郁症比单纯用抗抑郁药临床疗效佳,且起效迅速,副作用少,在改善患者生存质量上更有优势.     

帕罗西汀合并利培酮治疗难治性抑郁症的疗效分析

目的:探讨小剂量利培酮与帕罗西汀治疗难治性抑郁症的辅助效果.方法:将98例难治性抑郁症患者随机分为2组:①帕罗西汀合并利培酮组(以下简称合并利培酮组):在帕罗西汀(20 mg/d)治疗的同时合并应用利培酮(0.5～2.0mg/d).②帕罗西汀组:单用帕罗西汀(20mg/d)治疗.两组持续治疗观察期均为4周.于入组前、入组后第1,2,4周末分别应用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)及副反应量表进行评定.结果:①治疗第2,4周末,两组间HAMD、HAMA总分及减分率的差异有统计学意义(P＜0.05或P＜0.01).②合并利培酮组的总有效率为66％,痊愈和显效率占52％.帕罗西汀组的总有效率为27％,痊愈和显效率占19％.两组间的差异有统计学意义(P＜0.05).结论帕罗西汀合并小剂量利培酮治疗难治性抑郁症的疗效优于单用帕罗西汀,在临床治疗中可选用.     

帕罗西汀合并认知行为疗法治疗伴焦虑症状抑郁症的对照研究

目的 评价帕罗西汀合并认知行为疗法对伴焦虑症状抑郁症的治疗效果.方法 符合CCDM-3抑郁症的诊断标准,并且汉密尔顿焦虑量表(HAMA)评分＞14分的门诊及住院患者58例,随机分为两组:治疗组给予帕罗西汀合并认知行为治疗,对照组只给予帕罗西汀治疗,为期6周,于治疗前及治疗后第1、2、4、6周末用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定疗效.结果 在治疗第1、2、4、6周末治疗组疗效优于对照组,尤其对焦虑症状疗效更好,具有极显著性差异(P＜0.01).结论 帕罗西汀合并认知行为疗法治疗伴焦虑症状的抑郁症效果优于单用帕罗西汀.     

曲唑酮联合帕罗西汀治疗抑郁症的对照研究

目的 探讨曲唑酮联合帕罗西汀治疗抑郁症的疗效.方法 将80名入组病例随机分为研究组与对照组各40例.研究组为曲唑酮联用帕罗西汀,对照组仅用帕罗西汀,2周末视病情可酌情帕罗西汀加量至40 mg/d,采用HAMD评定疗效,SERS量表评定副反应,观察6周.结果 2周末、4周末、6周末两组组内HAMD评分较治疗前差异均有显著性意义(P均＜0.01);4周末、6周末HAMD评分两组间比较差异有统计学意义(P＜0.05).两组显效率经统计学分析差异有显著性意义(χ2=4.71,P＜0.05),两组组间4周末SERS评分比较差异有显著性意义(P＜0.01),6周末SERS评分两组比较差异仍有显著性意义(P＜0.05).两组不良反应发生率比较差异也有显著性意义(χ2=4.44,P＜0.05).结论 曲唑酮联合帕罗西汀治疗抑郁症缓解程度高,不良反应较少且轻.     

国产帕罗西汀联合奥氮平治疗难治性抑郁症的对照研究

目的 观察国产帕罗西汀联合奥氮平治疗难治性抑郁症的疗效和不良反应.方法 采用门诊顺序将60例难治性抑郁症患者随机平均分为研究组(国产帕罗西汀联合国产奥氮平)和对照组(国产帕罗西汀加安慰剂),在治疗前、治疗后4、8、12周末分别用汉密尔顿抑郁量表(HAMD)和不良反应量表(TESS)评定疗效和不良反应.结果 治疗4周后研究组HAMD总分及各因子分比治疗前明显降低,且治疗因子分显著低于对照组(P<0.01).不良反应两组差异无统计学意义(P>0.05).结论 国产帕罗西汀联合奥氮平治疗难治性抑郁症疗效确切,值得临床推广应用.     

肠易激综合征伴抑郁症状临床分析

目的探讨肠易激综合征(IBS)伴抑郁症状患者,抗抑郁能否改善IBS相关症状.症状程度与抑郁症状相关性.方法将临床诊断为IBS伴抑郁症状患者随机分成治疗组(得舒特 诺为 帕罗西汀)和对照组(得舒特 诺为)其中治疗组、对照组各30例,疗程4～6周.治疗期间记录症状改善情况及Zung氏量表评分.结果治疗组2周末、4周末总有效率分别为86.6%、93.3%与对照组比较2组差异有显著性(P＜0.01)但治疗组2周末与4周末比较差异无显著性(P＞0.05),治疗组2周末、4周末Zung氏量表评分与治疗前比较差异有显著性(P＜0.01).结论IBS伴抑郁症状患者抗抑郁治疗有效.     

帕罗西汀联合尼莫地平治疗血管性抑郁症的疗效观察

目的:观察帕罗西汀联合尼莫地平治疗血管性抑郁症的临床疗效。方法:选择2010年8月至2012年12月在我院门诊及住院120例血管性抑郁症患者随机分为2组,每组60例。治疗组给以帕罗西汀联合尼莫地平加常规治疗,对照组给以帕罗西汀加常规治疗,疗程8周。治疗前和治疗后采用汉密顿抑郁量表(HAMD)和神经功能缺损评分评定疗效。结果:治疗组抗抑郁疗效和神经功能改善情况均优于对照组,二者比较差异均有统计学意义(P<0.01)。结论:采用帕罗西汀联合尼莫地平治疗血管性抑郁症的临床疗效明显,优于单纯抗抑郁治疗,不良反应少,安全性高。     

帕罗西丁对抑郁伴睡眠障碍患者血清BDNF、NGF及NT-4水平变化研究

目的?探讨帕罗西汀治疗抑郁症伴睡眠障碍患者多导睡眠图及脑源性神经营养因子变化。方法?选取2017 年3 月～2018 年5 月在绍兴市第七人民医院进行治疗的60 例抑郁症伴睡眠障碍患者,考察患者治疗前和治疗后的汉密尔顿抑郁量表评分（HAMD）和匹兹堡睡眠质量指数（PSQI）评分,ELISA 法测定患者治疗前后血清BDNF、NGF、NT-4 表达水平。结果?治疗后抑郁伴睡眠障碍患者HAMD 评分显著低于治疗前,差异有统计学意义（P＜0.05）;治疗后PSQI 评分显著低于治疗前,差异有统计学意义（P＜0.05）;治疗后BDNF 表达水平显著高于治疗前,差异具有统计学意义（P＜0.05）;治疗后NGF 表达水平显著高于治疗前,差异具有统计学意义（P＜0.05）;治疗后NT-4 表达水平显著高于治疗前,差异具有统计学意义（P＜0.05）。结论 抑郁症与睡眠障碍存在双向作用关系,经过抗抑郁联合催眠剂治疗后,患者的HAMD、PSQI 评分显著降低,BDNF、NGF、NT-4 表达水平显著升高,睡眠质量显著改善。     

帕罗西汀与氟西汀治疗抑郁症的对照研究

目的观察国产盐酸帕罗西汀片治疗抑郁症的效果和不良反应。方法将60例抑郁症患者随机分为两组,治疗组用国产盐酸帕罗西汀治疗,对照组用氟西汀治疗,疗程8周。用临床疗效总评量表(CGI)及Hamilton抑郁量表(HAMD)评定疗效,用副反应量表(TESS)评定不良反应。结果两组近期疗效和不良反应差异无显著性(P均>0.05)。治疗组第1周末HAMD评分与治疗前比较差异有高度显著性(P<0.01),而对照组差异无显著性(P>0.05)。结论国产盐酸帕罗西汀治疗抑郁症的近期效果和不良反应与氟西汀相仿,但起效时间快。     

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.