拜心通与依那普利对高血压左心室肥厚患者QT间期离散度的影响

将５３例伴有左心室肥厚的高血压病患随机分为依那普利治疗组和拜心通治疗组，对比２组１２周后与治疗前ＱＴ间离散度的变化，并对该５３例患治疗前后的左心室质量指数与ＱＴｄ进行直线相关分析。结果：治疗前依那普组和拜心通组ＱＴｄ分别为（７１±２０．４）ｍｓ和（７３±２２）ｍｓ，治疗后仍那普利组和拜心通组ＱＴｄ分别为（７１±２０．４）ｍｓ和（７３±２２）ｍｓ，治疗后依那普利组为（４７±１６）ｍｓ，拜心通组为     

拜心通对高血压左心室肥厚患者血浆P物质及左心室质量指数的影响

为了探讨拜心通对高血压左心室肥厚（ＬＶＨ）患者的左心室质量指数（ＬＶＭＩ）及血浆Ｐ物质（ＳＰ）的影响，选择了２６例高血压伴ＬＶＨ患者每ｄ口服拜心通３０ｍｇ，治疗１２周。结果：治疗后ＬＶＭＩ平均降低２９．０３ｇ·ｍ－２，下降幅度为２０．６４％；治疗前后ＬＶＭＩ差异有显著性（Ｐ＜０．００１）；血浆ＳＰ浓度治疗前后无显著性差异（Ｐ＞０．０５）。结果提示：拜心通能够逆转ＬＶＨ，对血浆ＳＰ浓度无明显影响。     

拜心通对高血压左心室肥厚及肾素-血管紧张素-醛固酮系统的影响

对比控释型钙拮抗剂（ＣａＡ）拜心通（ＡｄａｌａｔＧＩＴＳ）治疗前与治疗１２周及２４周，对高血压左心室肥厚（ＬＶＨ）患者的左心室质量指数（ＬＶＭＩ）、血浆肾素活性（ＰＲＡ）和血管紧张素Ⅱ（ＡＮＧⅡ）、醛固酮（ＡＬＤ）的血浆浓度的影响。结果：治疗１２周末时，ＬＶＭＩ由（１４０．６５±１４．６５）ｇ·ｍ－２降至（１１１．６２±１０．４９）ｇ·ｍ－２（Ｐ＜０．００１）。之后ＬＶＭＩ下降趋缓，２４周治疗结束时为（１０５．７９±１２．１３）ｇ·ｍ－２，较１２周末差异无显著性（Ｐ＞０．０５）；治疗１２周时ＰＲＡ和血浆ＡＮＧⅡ、ＡＬＤ浓度均有上升趋势，但均无显著性差异（Ｐ均＞０．０５），２４周末时，上述各指标变化不确定，亦无显著性差异（Ｐ均＞０．０５）。提示：控释型ＣａＡ对高血压合并ＬＶＨ者的交感神经系统无明显激活作用，且可显著减轻ＬＶＨ。     

拜心通对高血压左心室肥厚患者血浆P物质及左心室质量指数的影响

为了探讨拜心通对高血压左心室肥厚患者的左心室质量指数及血浆Ｐ物质的影响，选择了２６例高血压伴ＨＶＨ患者每ｄ口服拜心通３０ｍｇ，治疗１２周。结果，治疗后ＬＶＭＩ平均降低了２９．０３ｇ．ｍ＾－２，下降幅度为２０．６４％；治疗前后ＬＶＭＩ差异有显著性；血浆ＳＰ浓度治疗前后无显著性差异。结果揭示：拜心通能够逆转ＬＶＨ，对血浆ＳＰ浓度无明显影响。     

高血压病人Q-Td对左室肥大的诊断价值

目的通过观察４８例高血压病人心电图ＱＴ离散度，了解高血压病合并ＬＶＨ时ＱＴ离散度的变化。方法４８例高血压病人，按超声心动图检查结果分为左心室肥厚（ＬＶＨ）组与非ＬＶＨ组，测量比较两组校正ＱＴ离散度，并试以校正ＱＴ离散度≥５０ｍｓ作为ＬＶＨ诊断指标，考察其特异性和敏感性。结果ＬＶＨ组校正ＱＴｄ较非ＬＶＨ组增大（Ｐ＜０．０００１）。以校正ＱＴｄ≥５０ｍｓ作为ＬＶＨ诊断高血压并发ＬＶＨ的特异性达８０％，敏感性为８７％。结论高血压并ＬＶＨ，心电图ＱＴｄ增大，以校正ＱＴｄ≥５０ｍｓ作为ＬＶＨ诊断指标是实用可靠的。     

高血压左心室肥厚相关因素的探讨

目的　分析２０１ 例高血压者临床和超声心动图资料,旨在探讨左心室肥厚（ＬＶＨ） 的相关因素。方法　应用超声心动图测量ＩＶＳＴ、ＰＷＴ、ＬＶＤ、ＬＡＤ、Ａ峰、Ｅ峰、Ｅ／Ａ 比值,以左心室重量指数（ＬＶＭＩ） 作为诊断ＬＶＨ 的指标。结果　ＬＶＨ 检出率２０．９ ％ ,男女性之间无显著性差异,如仅凭ＩＶＳＴ 和ＰＷＴ≥１１ｍ ｍ 作为诊断ＬＶＨ 的标准,其阳性率９２ ．９％ ,假阴性率７ ．１％ ,假阳性率３２．１ ％ ;ＬＶＨ类型以对称性肥厚为主占９２ ．９％ 。ＬＶＨ组的年龄、高血压病程与ＮＬＶＨ 组有显著性差异（ Ｐ＜０ ．０１） ;ＬＶＨ 组ＬＡ扩大占５７ ．１％ ,Ｅ／Ａ缩小占１００ ％ ,与ＮＬＶＨ 组相比有显著性差异（Ｐ＜０ ．０１）;ＮＬＶＨ 组其ＩＶＳＴ、ＰＷＴ 及ＬＶＭＩ与正常组相比有显著性差异（ Ｐ＜ ０．０１） 。结论　以ＬＶＭＩ作为诊断ＬＶＨ 的标准较为准确、可靠,年龄、高血压病程是影响ＬＶＨ的一个重要因素,ＬＶＨ 伴ＬＡ 扩大和左室舒张功能下降,可出现在ＬＶＨ 之前,ＮＬＶＨ者较正常人其左心室重量增加。     

急性心肌梗塞心电图QT离散度的分析

对１００例急性心肌梗塞（ＡＭＩ）急性期心电图及其中６０例的恢复期心电图ＱＴ离散度（ＱＴｄ）进行测定,结果分别为ＱＴｄ：５０４０±２０２５ｍｓ和２４８３±１２６９ｍｓ,ＱＴｃｄ：５７．４８±２５１４ｍｓ和２７３１±１３８４ｍｓ,ＡＭＩ急性期的心电图ＱＴｄ和ＱＴｃｄ均值均显著高于恢复期;按心电图心梗导联数目多少把１００例ＡＭＩ分为：１～,４～,８～等三组,其早期心电图ＱＴｄ值分别为：４４７４±１７０４ｍｓ、５３０８±２１３８ｍｓ、５８００±２１０１ｍｓ,三组间无显著差别（Ｆ＝２７３８３,Ｐ＞００５）;根据心电图心梗定位把１００例ＡＭＩ分为：前壁梗塞、后壁梗塞、复合壁梗塞等三组,其早期心电图ＱＴｄ值分别为：５２５０±２２３４ｍｓ、４５３１±１６６５ｍｓ５４１７±１７３０ｍｓ,三组间无显著差别（Ｆ＝１５３５５,Ｐ＞００５）。结果提示：心电图ＱＴ离散度在急性心肌梗塞早期显著增大,心肌梗塞部位和范围不是ＡＭＩ早期心电图ＱＴ离散度改变的主要影响因素,ＡＭＩ早期心电图ＱＴ离散度增大反映了心室肌复极不均匀,在ＡＭＩ急性期监测ＱＴ离散度的动态变化有重要临床意义。     

高血压病左心室肥厚QTd检测

目的 探讨高血压病患者左室肥厚和舒张功能受损时的ＱＴ离散度（ＱＴｄ）变化。方法 ７４例高血压病患者，用多导联同步心电图测量并计算出ＱＴｄ，超声心动图测量Ｅ／Ａ比值和等容舒张时间（ＩＲＴｍｓ），计算左室重量（ＬＶＭ）和左室重量指数（ＬＶＭＩ），作相关分析。结果 左室肥厚（ＬＶＨ）组４６例的ＱＴｄ显著高于非ＬＶＨ组，Ｐ〈０．００１。ＬＶＨ组均有不同程度的Ｅ峰下降、Ａ峰增大、Ｅ／Ａ比值减少及ＩＲＴ延长。     

高血压病患者左心房内径、左心室重量指数与心脏功能关系探讨

对１４２例高血压病（ＥＨ）患者按左心房内径（ＬＡＤ）、左心室重量指数（ＬＶＭＩ）分组研究其与心机械图检测排血前时间与左室排血时间的比值（Ｐ／Ｌ）、心导纳向量环心房收缩相与心室射血相比值（Ｖ／Ｔ－Ⅱ）的关系。结果ＬＡＤ≥３５ｍｍ组左室舒张功能明显异常，与ＬＡＤ正常组比较Ｖ／Ｔ－Ⅱ值差异有高度显著性（Ｐ＜０．０１）；ＬＶＭＩ增高组与ＬＶ－ＭＩ正常组比较Ｐ／Ｌ、Ｖ／Ｔ－Ⅱ差异有高度显著性（Ｐ＜０．０１）；ＥＨ＿ＬＡＤ扩大发生率较ＬＶＭＩ增加发生率为高（Ｐ＜０．０１）；ＬＡＤ扩大者增高比ＬＡＤ不大者明显（Ｐ＜０．０１）。提示：应重视ＥＨ的ＬＡＤ扩大，ＬＶＭＩ增高患者，且宜早期改善心脏舒张功能，逆转心脏结构异常。     

心力衰竭患者心肌β受体系统调控在左心室重塑中的作用

目的研究心力衰竭患者心肌β受体系统调控在左心室重塑中的作用。方法对２０例ＮＹＨＡⅡ～Ⅲ级开胸换瓣患者，用３Ｈ－ｄｉｈｙｄｒｏａｌｐｎｅｎｏｌｏｌ（３Ｈ－ＤＨＡ）放射配基，结合分析法测定β受体密度最大结合量（Ｂｍａｘ），用放射免疫法测定淋巴细胞内环核苷酸（ｃＡＭＰ）水平，并以心脏超声仪测定和计算左心室重量指数（ＬＶＭＩ）。结果心衰患者心肌Ｂｍａｘ和ｃＡＭＰ均与ＬＶＭＩ显著负相关（ｒ＝－０．７７，Ｐ＜０．０１和ｒ＝－０．４６，Ｐ＜０．０５）。Ⅲ级心功能患者心肌和血淋巴细胞Ｂｍａｘ（６３±１２ｆｍｏｌ／ｍｇｐｒｏ和５１４±１１５ｆｍｏｌ／１０７ｃｅｌ）显著低于Ⅱ级患者（９４±２０ｆｍｏｌ／ｍｇｐｒｏ和７０２±１３８ｆｍｏｌ／１０７ｃｅｌ）；ＬＶＭＩ增高组心肌和血淋巴细胞Ｂｍａｘ（６２±１２ｆｍｏｌ／ｍｇｐｒｏ和５１６±１２２ｆｍｏｌ／１０７ｃｅｌ）显著低于ＬＶＭＩ正常组（９２±２１ｆｍｏｌ／ｍｇｐｒｏ和６８２±１４６ｆｍｏｌ／１０７ｃｅｌ）。结论Ｂｍａｘ能反映心室重塑和心功能受损的程度；心肌细胞的信息传导改变早于左心室重塑的改变。     

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.