慢性肺原性心脏病患者血浆C型利尿利钠因子的变化

目的:探讨慢性肺原性心脏病(肺心病)患者血浆C型利尿利钠因子(CNP)的变化及与动脉血氧分压pao2、肺动脉压的关系。方法:采用放射免疫分析法,检测30例肺心病患者急性加重期及缓解期血浆CNP的水平;经彩色多普勒测定右室射血前期时间(RVPEP)与肺动脉血流加速时间(AT)之比,以反映肺动脉压高低,并行动脉血气分析。对照组为20例健康体检者。结果:肺心病患者急性加重期和缓解期血浆CNP水平((73.38±33.29) n/L,(43.18±9.68) ng/L)明显高于对照组((16.89±9.16) ng/L)(P均<0.001),急性加重期高于缓解期(P<0.001);肺心病组急性加重期pao2((50.82±15.23)mmHg)明显低于缓解期((77.57±10.08)mmHg)(P<0.001),而急性加重期RVPEP/AT水平(1.64±0.36)高于缓解期(1.26±O.26)(P<0.001);肺心病组急性加重期和缓解期血浆CNP水平与pao2均呈显著负相关(r=-O.57,P<0.01;r=-0.79,P<0.001),而与RVPEP/AT均呈正相关(r=0.45,P<0.05;r=0.44,P<0.05)。结论:检测肺心病患者血浆CNP水平,可作为判断病情的一项指标。     

慢性肺源性心脏病患者血清胰岛素样生长因子1测定

目的:测定慢性肺源性心脏病(肺心病)患者血清胰岛素样生长因子 1(IGF -1)的水平。方法:用免疫放射分析法测定 30例肺心病患者急性加重期和缓解期血清IGF- 1水平,并与动脉血氧分压(paO2 )及右室射血前期时间(RVPEP)与肺动脉血流加速时间 (AT)比值 (RVPEP/AT)进行相关分析。另选 30例健康人为正常对照组。结果:肺心病组急性加重期和缓解期血清IGF- 1水平( (337. 84±102. 22)μg/L, ( 284. 37±99. 77)μg/L)均高于正常对照组( (231. 59±88. 89)μg/L, P<0. 01),急性加重期又高于缓解期(P<0. 01)。肺心病组急性加重期和缓解期血清IGF- 1水平均与paO2呈负相关(r=-0. 633,P<0. 001;r=-0. 828,P<0. 001 ),与RVPEP/AT呈正相关 (r=0. 653,P<0. 001;r=0. 470,P<0. 000 1)。结论:IGF 1可能参与并促进了慢性肺心病的发生发展过程。     

脑钠素、内皮素测定在慢性肺心病患者中临床应用价值的探讨

目的测定慢性肺心病患者血浆脑钠素(BNP)、内皮素1(ET-1)水平及探讨其临床应用价值。方法用放射免疫法测定健康人及慢性肺心病患者(30例)不同时期血浆BNP及ET-1水平。结果慢性肺心病患者急性加重期及缓解期BNP分别为64±14ng/ml及52±8ng/ml,ET-1分别为67±18ng/ml及48±12ng/ml,较健康对照组明显升高(P<0.001),直线相关分析表明,肺心病急性发作期组血浆BNP和ET-1水平与PaO2呈负相关(r=-0.68,-0.82,P均<0.01),与PaCO2、RVPEP/AT呈正相关(r=0.67,0.58,P<0.01)。缓解期血浆BNP水平与PaO2、PaCO2无相关性(P>0.05),肺心病患者血浆BNP与ET-1之间无显著相关性。结论血浆BNP、ET-1均参与肺心病的发生及发展过程,但在肺心病情况下,两者之间无显著相关性。     

慢性肺原性心脏病患者血浆精氨酸加压素、心钠素及肺动脉压测定

目的:观察慢性肺原性心脏病患者急性加重期和缓解期血浆精氨酸加压素(AVP)及心钠素(ANP)的变化及其与肺动脉压的关系.方法:慢性肺心病患者(肺心病组)33例,分别于急性发作期和缓解期应用放射免疫法测定血浆AVP和ANP水平,同时选择30例健康志愿者为对照.肺心病患者经彩色多普勒测定右室射血前期时间/加速时间(RVPEP/AT)以估测肺动脉压.结果:①正常对照组、肺心病组缓解期与急性加重期AVP((4.62±4.14)ns/L,(53.98±26.18)ng/L,(138.28±57.18)ng/L)与ANP((67.00±63.88)ng/L,(298.50±141.06)ns/L,(627.89±177.77)ng/L)呈升高趋势,3组间比较,差异有统计学意义(F分别为92.85,127.40,P均<0.05).肺心病组缓解期RVPEP/AT低于急性加重期((1.24±0.26)vs(1.63±0.36),t=8.86,P<0.05).②肺心病急性加重期和缓解期AVP、ANP与RVPEP/AT以及AVP与ANP均有相关性,P均<0.05.结论:AVP、ANP均可能参与肺动脉压的调节,检测血浆AVP或ANP水平可用于评估肺心病的严重程度和预后.     

慢性肺源性心脏病患者血清基质金属蛋白酶-1测定

目的:探讨慢性肺源性心脏病(简称肺心病)患者血清基质金属蛋白酶-1(MMP-1)的水平及其与低氧性肺动脉高压(HPH)的关系.方法:采用酶联免疫吸附法(ELISA)测定30例肺心病患者急性加重期和缓解期血清MMP-1水平,同步测定动脉血氧分压(pO2)及右心室射血前期时间(RVPEP)与肺动脉血流加速时间(AT)的比值(RVPEP/AT)并进行相关性分析.选择30例健康人为对照组.结果:肺心病组患者急性加重期和缓解期血清MMP-1水平均高于正常对照组(P均＜0.001),且急性加重期高于缓解期(P＜0.001).肺心病组急性加重期pO2低于缓解期(P＜0.001),急性加重期RVPEP/AT高于缓解期(P＜0.001).肺心病急性加重期和缓解期血清MMP-1水平均与pO2呈负相关(r=-0.81,r=-0.73,P均＜0.001),与RVPEP/AT呈正相关(r=0.78,r=0.72,P均＜0.001).结论:肺心病患者血清MMP-1水平升高可能参与了HPH的病理生理过程.     

血清碱性成纤维细胞生长因子与慢性肺心病关系的临床研究

目的 探讨碱性成纤维细胞生长园子（bFGF）与慢性肺心病低氧性肺动脉高压（HPH）的关系。方法 本实验通过测定28例慢性肺心病患者急性加重期和缓解期血清bFGF水平，并应用超声Doppler技术测定右室射血前期时间（RVPEP）与肺动脉血流加速时间（AT）的比值（RVPEP／AT），同时测定动脉氧分压（PaO2），并加以统计分析。结果 慢性肺心痛组急性加重期和缓解期血清bFGF水平[（68±15）、（55±14）pg／ml]均高于正常对照组[（40±13）pg／ml，]，差异有统计学意义（P〈0．01，）；急性加重期又高于缓解期，差异亦有统计学意义（P〈0．01）。两组患者bFGF水平与PaO2呈负相关，与RVPEP／AT呈正相关。结论 bFGF参与了慢性肺心痛HPH的形成过程。     

血浆B型钠尿肽对肺心病的预后评估价值研究

目的 探讨血浆B型钠尿肽(BNP)对肺心病的预后评估价值,为临床治疗工作提供重要依据.方法 回顾分析80例肺心病患者临床资料,并挑选同期接受体检的35例健康者为对照组,使用快速免疫荧光法对两组患者血浆BNP水平展开分析,比较肺心病患者治疗后血浆B型钠尿肽水平.结果 肺心病组不同等级心功能不全患者与健康者(42.19±6.81)ng/L血浆B型钠尿肽水平存在显著性差异,肺心病患者血浆BNP水平随心功能不全等级依次递增,且预后良好(52.54±6.43)ng/L的肺心病患血浆BNP水平明显低于预后不良者(81.56±7.80)ng/L,差异具有统计学意义(P<0.05).结论 肺心病患者血浆BNP水平明显升高,其上升程度与疾病严重程度密切相关,检测血浆B型钠尿肽水平对早期诊断、治疗肺心病产生重要影响.     

过敏性紫癜病儿血浆血管内皮生长因子水平的变化

①目的　探讨过敏性紫癜 (HSP)病儿血浆血管内皮生长因子 (VEGF)的水平变化及其在HSP发病中的作用。②方法　采用双抗体夹心ELISA法检测 38例HSP病儿及 16例正常儿童的血浆VEGF水平。③结果HSP病儿急性期血浆VEGF水平明显高于缓解期及正常对照组 ,差异有显著性 (t =3.5 2 9、4 .183,P <0 .0 1)。急性期有、无肾损害组血浆VEGF水平分别为 (2 30 .71± 74 .93)ng/L、(192 .70± 139.83)ng/L ,二者比较差异无显著意义 (t=0 .814 ,P >0 .0 5 ) ;急性期有、无胃肠道症状组血浆VEGF水平分别为 (2 80 .0 6± 16 1.4 9)ng/L、(15 2 .88±4 6 .4 3)ng/L ,二者比较差异有显著性 (t=2 .79,P <0 .0 5 )。④结论　HSP病儿急性期血浆VEGF水平明显升高 ,提示VEGF参与了HSP血管炎症反应过程 ,在HSP发病机制中有重要意义。VEGF可能与HSP胃肠道损害有较为密切的关系。     

急性脑梗死患者血浆尿激酶型纤溶酶原激活物及其受体的表达

目的　检测急性脑梗死患者血浆中尿激酶型纤溶酶原激活物 (uPA)及其受体 (uPAR)的含量变化 ,并探讨其在脑梗死发生发展过程中的作用。方法　应用ELISA双抗体夹心法分别测定89例急性脑梗死患者、30例其他疾病对照组和 30名健康对照组血浆中uPA和uPAR含量 ,并按病情分轻、中、重 3组进行比较。结果　脑梗死患者急性期血浆uPA和uPAR含量分别为 ( 16 6 4± 384 )ng/L及 ( 1375± 30 3)ng/L ,其他疾病对照组为 ( 10 33± 12 3)ng/L及 ( 978± 12 0 )ng/L ,正常对照组为 ( 10 0 5±12 9)ng/L及 ( 90 5± 15 9)ng/L。脑梗死组与后两组比较P <0 0 5或P <0 0 1。脑梗死患者恢复期uPA含量为 ( 1186± 385 )ng/L ,与两对照组比较P >0 0 5 ,uPAR含量为 ( 115 9± 2 6 1)ng/L ,明显高于两对照组 (均P <0 0 1)。重度患者急性期血浆uPA和uPAR含量分别为 ( 1939± 2 5 7)ng/L及 ( 15 11± 379)ng/L ,中度患者分别为 ( 15 94± 2 0 5 )ng/L及 ( 12 97± 15 1)ng/L ,轻度患者分别为 ( 135 9± 176 )ng/L及 ( 12 2 7± 98)ng/L ,重度患者组与后两组比较P <0 0 1;恢复期uPA和uPAR含量分别为 ( 115 3± 170 )ng/L及( 1186± 15 8)ng/L ,轻度患者分别为 ( 10 4 2± 187)ng/L及 ( 10 5 4± 10 9)ng/L ,两者比较P <0 0 5和     

肝硬化患者血浆血管紧张素Ⅱ浓度与肾功能关系

目的　探讨肝硬化患者血浆中血管紧张素Ⅱ (ATⅡ )水平与腹水、肾功能状态的关系。方法　 39例肝硬化患者作为研究对象 ,应用放射性核素肾图评价肾功能状态 ,同步测定血浆中ATⅡ、内生肌酐清除率(Ccr)、血钠以及 2 4h尿钠排泄水平。结果　肝硬化患者血浆ATⅡ水平为 (2 90 .31± 4 7.4 5 )pg/ml,明显高于正常参考值 (34.30～ 90 .70 pg/ml,P <0 .0 5 ) ,合并腹水者的血浆ATⅡ水平为 (386 .2 3± 76 .4 2 ) pg/ml,明显高于无腹水患者的 (112 .86± 2 2 .5 4 ) pg/ml(P <0 .0 5 ) ;ChildC级患者的ATⅡ水平明显高于ChildA及B级患者 (P<0 .0 5 ) ;2 4h尿钠排泄量与血浆ATⅡ水平成负相关 (r =- 0 .5 2 ,P <0 .0 5 ) ,但与腹水、肾有效血浆流量不相关 ;血钠水平与血浆ATⅡ水平成负相关 (r =- 0 .6 7,P <0 .0 1) ,血钠水平下降者的血浆ATⅡ水平为 (5 4 6 .2 3± 131.5 9)pg/ml,明显高于血钠正常者的 (12 0 .74± 17.15 )pg/ml(P <0 .0 1) ,但与肾有效血浆流量无关 ;血浆ATⅡ水平与Ccr及肾功能不相关。结论　在肝硬化疾病的不同阶段 ,血浆ATⅡ水平存在差异。血浆ATⅡ可能参与肝硬化腹水形成 ,其机制与水钠潴留有关 ,并有导致稀释性低钠血症的倾向 ,但与肾有效血浆流量无关     

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.