精神病患者及其治疗与代谢综合征的关系

近年来,随着非典型抗精神病药物广泛应用于分裂症患者,药物相关的代谢综合征,如肥胖、高血糖症、2型糖尿病、血脂障碍等的报道也越来越多。抗精神病药与代谢综合征的关系引起了国内外众多学者的关注和研究。     

常用非典型抗精神病药物与首发精神分裂症患者代谢综合征的相关性研究

目的:探讨常用非典型抗精神病药物与首发精神分裂症患者代谢综合征的相关性。方法:随访调查单一使用抗精神病药物的首发精神分裂症患者147人,按用药不同,分为非典型抗精神病药物组患者92例,氯丙嗪组55例,测量患者使用抗精神病药物前和使用一年后的BMI、血压、血糖等指标。结果:两组均有病例发生了腹部肥胖、BMI≥24、糖尿病、糖耐量异常、高甘油三脂血症、低HDL血症、高血压、代谢综合征;两组病例在BMI≥24、高血压上有统计学差异(χ2=4.307,P=0.038;χ2=6.857,P=0.009),且氯丙嗪组患者更容易发生BMI≥24、高血压。两组病例在BMI、糖化血红蛋白、舒张压、收缩压方面有统计学差异(t=2.319,P=0.022;t=2.291,P=0.024;t=2.406,P=0.019;t=2.109,P=0.039)。结论:常用非典型抗精神病药物与首发精神分裂症患者代谢综合征的的发生具有相关性。     

长期住院精神分裂症患者中心性肥胖发病率相关因素调查简

目的：了解住院精神分裂症患者肥胖的发生率及其相关因素.方法：对昆明市精神病院住院的精神分裂症患者调查,测定腹围、体重,测定代谢指标,中心性肥胖按照世界糖尿病联盟（IDF）定义,代谢综合征（MS）诊断标准按（IDF） 2005全球统一标准;同时调查与之相关的抗精神病药物的使用情况.结果：女性中心性肥胖代谢综合征患者发生率均高于男性（P＜0.01）;Logistic回归分析中心性肥胖与性别、体质指数有关,不同的抗精神病药物对体重增加、代谢综合征的风险影响有差别.结论：女性服用抗精神病药物治疗后体重增加的风险比男性高,女性患者比男性患者更易发生肥胖和代谢综合征,抗精神病药物引起的体重增加有很高的代谢危险因素.     

长期住院精神分裂症患者中心性肥胖发病率相关因素调查

目的:了解住院精神分裂症患者肥胖的发生率及其相关因素。方法:对昆明市精神病院住院的精神分裂症患者调查,测定腹围、体重,测定代谢指标,中心性肥胖按照世界糖尿病联盟(IDF)定义,代谢综合征(MS)诊断标准按(IDF)2005全球统一标准;同时调查与之相关的抗精神病药物的使用情况。结果:女性中心性肥胖代谢综合征患者发生率均高于男性(P<0.01);Logistic回归分析中心性肥胖与性别、体质指数有关,不同的抗精神病药物对体重增加、代谢综合征的风险影响有差别。结论:女性服用抗精神病药物治疗后体重增加的风险比男性高,女性患者比男性患者更易发生肥胖和代谢综合征,抗精神病药物引起的体重增加有很高的代谢危险因素。     

帕利哌酮缓释片与奥氮平治疗精神分裂症对照研究

新型非典型抗精神病药物与传统抗精神病药物疗效相当,但是药物不良反应较少,更加有利于患者社会功能的恢复,使得医患双方对非典型抗精神病药物接受程度越来越高。     

抗精神病药所致代谢综合征的多因素分析

目的 调查使用抗精神病药所导致代谢综合征(MS)的相关因素.方法 对使用抗精神病药的住院精神障碍患者进行问卷调查和实验室测定,代谢综合征的诊断标准采用2004年中华医学会糖尿病分会代谢综合征标准.结果 调查了符合入组标准的精神障碍患者365例,抗精神病药所致代谢综合征者为96例占26.3%,Logistic回归分析显示影响抗精神病药所致代谢综合征的因素为药物种类、家族史、年龄、运动程度、腹部肥胖,标准回归系数分别为5.7857,4.5728,3.7643,-2.2534,1.5762.结论 使用抗精神病药的患者具有较高的代谢综合征发病风险,可能的危险因素是药物种类、家族史、年龄、腹部肥胖等,在使用抗精神病药的患者中应注意防治代谢综合征.     

非典型抗精神病药物与代谢综合征

非典型抗精神病药物广泛用于精神分裂症及其他精神病性障碍、严重行为障碍等疾病的治疗，治疗期间高危人群可能发生代谢综合征，医生应了解治疗药物的特性和代谢综合征病程的一般规律，在治疗全程密切监测代谢综合征的标志性指标，尽早予以干预。本文通过检索MEDLINE和国内CBM文献，结合临床实践资料对非典型抗精神病药物的临床应用及其与代谢综合征的相关性进行分析和评价。     

非经典抗精神病药对首发精神分裂症患者代谢的影响

近几十年来抗精神病药物广泛应用于临床,明显提高了精神症状的缓解率和精神病患者的出院率,近年来,非典型抗精神病药对精神分裂症患者的疗效可靠、副作用相对较轻微,而被作为抗精神分裂症治疗的一线用药。随着抗精神病药物应用的日趋广泛,由此引发体重增加、代谢综合征（ metabolic syndrome ,MS）等一系列问题越来越受到精神科医生的重视。为了解非典型抗精神病药物对精神分裂症患者体重变化、糖脂代谢异常影响的差别,我们选用本院常用的5种非典型抗精神病药物进行体重、糖代谢、脂代谢影响的比较研究,为临床选择用药提供参考依据。     

氯氮平与代谢综合征的研究进展

代谢综合征是一组心血管疾病的危险因素,包括糖尿病、空腹血糖升高、中心性肥胖、高胆固醇和高血压等。非典型抗精神病药中,氯氮平对体质量、血脂浓度和血糖控制具有不良作用,可导致代谢异常的风险加大。文章通过检索国内外近年文献,明确代谢综合征的概念,综述抗精神病药氯氮平与代谢综合征的关系。     

氯氮平与代谢综合征的研究进展

代谢综合征是一组心血管疾病的危险因素,包括糖尿病、空腹血糖升高、中心性肥胖、高胆固醇和高血压等。非典型抗精神病药中,氯氮平对体质量、血脂浓度和血糖控制具有不良作用,可导致代谢异常的风险加大。文章通过检索国内外近年文献,明确代谢综合征的概念,综述抗精神病药氯氮平与代谢综合征的关系。     

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.