绝经后妇女血脂代谢的变化及激素替代治疗的影响

目的：探讨绝经后妇女血脂代谢的变化及激素替代治疗的影响,了解性激素对冠心病发病的影响。方法：选取453例绝经前、围绝经期、绝经后妇女,分别测定其血清中的雌二醇（E2）、孕酮（P）、促卵泡生成素（FSH）、黄体生成素（LH）4项性激素和总胆固醇（TC）、甘油三脂（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDLC）4项血脂指标,并对58例绝经后妇女进行激素替代治疗（HRT）6个月后再重新测定其血清中的脂类。结果：绝经后妇女E2水平较绝经前及围绝经期妇女有明显下降（P〈0．01）,后两者无明显差异（P〉0．05）,绝经后与围绝经期妇女的PSH及LH均较绝经前妇女明显升高（P〈0．01）,绝经后较围绝经期升高更明显,两者比较有显著差异（P〈0．01）;绝经后与绝经前妇女血脂水平相比TC、TG、LDL-C水平明显升高而HDL-C水平明显下降（P〈0．01）,绝经后妇女E2与TC、LDL-C水平呈负相关,与HDL-C水平呈正相关。58例HRT 6个月后,LDL-C明显下降,HDL-C明显上升（P〈0．05）。结论：绝经后妇女血脂异常与体内性激素水平下降有关,HRT对心血管有保护作用。     

子宫切除对内分泌及血脂代谢的影响

目的：了解不同年龄组不同手术方式的女性在子宫切除术后生殖内分泌的变化以及脂代谢的变化。方法：对62例育龄妇女及66例经绝经妇女因良性疾病手术治疗的患者，分别于手术前及手术后2个月测定外周血促卵泡生成素（FSH）、黄体生成素（LH）、雌二醇（E2）、孕酮（P）、睾酮（T）、甘油三酯（TG），胆固醇总量（TC）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、载脂蛋白A1（ApoA1）和载脂蛋白B（ApoB）。结果：育龄妇女手术后性激素FSH、LH、T均有升高（P＜0．01），E2、P下降（P＜0．01），血中TG、LDL,ApoB浓度升高（P＜0．05－P＜0．01），HDL，ApoA1明显下降（P＜0．01）。绝经后妇女手术前后FSH和LH升高，而E2和P降低（P＜0．01）；手术后LDL明显增高，ApoA1下降（P＜0．01）。结论：子宫切除术后雌激素明显下降，血脂明显升高，但不同年龄组妇女性激素变化及血脂代谢不同。     

正常妊娠及妊娠高血压综合征患者血清脂质和载脂蛋白的分析

目的：探讨正常妊娠和妊娠高血压综合征（妊高征）患者血脂和载脂蛋白改变。以及这些改变与妊高征发病的关系。方法：采用酶法和免疫扩散法，对28例妊高征孕妇，31例正常孕妇及24例未孕妇女血脂和载脂蛋白进行了检测。分别测定了甘油三酯（TG），胆固醇（TC），高密度脂蛋白胆固醇（HDL－C），载脂蛋白（apo)AI,B100,CⅡ，CⅢ和E，并计算非HDL－C（nHDLC)和TG/HDL-C秕值，结果：（1）与未孕妇女比较，正常妊娠36－42周妇女血清TG,apoCⅡ及apoCⅢ水平分别升高了3．5倍，2．4倍和2．8倍（P＜0．001），血清TC升高21％（P＜0．01），血清HDL－C未见明显改变，nHDL-C升高33％（P＜0．05），apoA,I,apoB100及apoE分别升高了55％，79％和77％（P＜0．001），TG／DHL－C比值显著增加（P＜0．01），（2）与未孕妇女比较，妊高征组妊娠32－42周妇女血清TG，apoCII及apo CⅢ亦分别升高2＝3倍，4．0倍和2．8倍（P＜0．01），血清TC仅升高27％（P＜0．01），HDL－C升高29％（P＜0．05），nHDL-C升高26％（P＜0．05）；apoAI,apoB100及apoE分别升高52％，90％和67％（P＜0．001），TG／HDL－C比值亦显著增加（P＜0．01），与正常妊娠组比较，妊高征组血脂和载脂蛋白水平平均未见明显差异。（3）不同程度妊高征及正常妊娠对照血脂和载脂蛋白含量的比较显示，妊高征患者各亚组血脂和载脂蛋白的含量不随病情的严重程度而升高。结论：妊娠时胎盘分泌的大量雌性激素是导致正常妊娠及妊高征患者血脂及载脂蛋白显著升高的主要原因，妊娠时血脂及载脂蛋白的升高可能与妊高征的发病无关。     

尼尔雌醇与米索前列醇在绝经后妇女取环中的运用

目的探讨尼尔雌醇与米索前列醇在绝经后妇女取环中的应用效果。方法将140例绝经后妇女分为观察组与对照组，每组70例。观察组干取环前应用尼尔雌醇与米索前列醇，对照组不用任何药物。观察两组宫颈软化程度、术中综合反应程度及取环效果。结果观察组宫颈软化程度，取环效果均较对照组显著提高（P〈0．01），术中综合反应程度低于对照组（P〈0．01或0．05）。结论尼尔雌醇与米索前列醇用于绝经后妇女取环，可明显改善取环效果。     

补肾中药对围绝经期及绝经后期妇女性激素与血脂改变的影响

目的探讨补肾中药降低围绝经期及绝经后期妇女血脂水平的疗效以及对性激素水平的影响。方法采用随机对照单盲的临床研究方法，通过8周临床观察，运用SPSS11．0及PEMS2．0进行治疗前后血脂及性激素水平的分析。结果中药治疗组中医证候疗效明显优于西药组（P＜0．01），西药对照组降低血脂疗效高于中药组（P＜0．01），补肾中药具有降低TC、TG、LDL．C的作用（P＜0．01），升高HDL．C的作用不明显（P＞0．05），对性激素水平无明显改善（P＞0．05）。结论 补肾中药治疗更年期妇女高脂血症疗效确切，尤其是辨证分型属肝肾阴虚型患者，能降低高脂血症患者TC、TG、LDL-C，对围绝经期妇女性激素水平的影响尚需进一步证实。     

冠心病妇女绝经后雌激素替代治疗对趋化因子受体CXCR2的影响

目的：探讨经雌激素替代治疗后的绝经后冠心病妇女外周血单核细胞趋化因子受体CXCR2的变化。方法：选22例已绝经的冠心病妇女为观察组,20例绝经后健康妇女作为对照组,两组受试又随机分为干预组和安慰剂组,干预组口服结合型雌二醇（倍美力）,每日0．625mg,连续3个月,安慰剂组口服安慰剂（维生素C）,观察对象均分别于用药前及用药3个月末抽血测血清雌二醇（E2）水平,外周血单核细胞趋化因子受体CXCR2蛋白表达水平。结果：（1）治疗前冠心病组血清E2,CXCR2蛋白水平显低于正常对照组（P＜0．01）;（2）经过雌激素干预治疗3个月后,绝经后妇女血清E2水平均显上升（P＜0．01）,外周血单核细胞趋化因子受体CXCR2水平均显下降（P＜0．01）,且冠心病组较对照组变化更明显;（3）血清E2水平与CXCR2水平变化呈显负相关（r=-0.46).结论：雌激素替代治疗后的绝经后妇女外周血单核细胞趋化因子受体CXCR2下调,且有冠心病变化更明显,提示与雌激素的心脏保护作用有关。     

不同年龄健康女性血清性激素和抗酒石酸酸性磷酸酶的变化

目的：研究女性血清性激素和抗酒石酸酸性磷酸酶（TRACP）水平随年龄的变化，为骨质疏松症的基础与临床研究提供参数。方法：测定236例23－59岁绝经前（按年龄分为3组，每组间隔10年）和91例48－71岁绝经后健康女性志愿者血清黄体生成素（LH）、卵泡刺激素（FSH）、雌二醇（E2）、孕酮（P）水平及TRACP活性。结果：绝经前各年龄组比较，仅FSH水平在绝经前第3组妇女中明显升高（P＜0．05）；绝经后与绝经前组比较，FSH，LH和TRACP明显升高（P＜0．01），而雌二醇和孕酮明显降低（P＜0．01），且与TRACP呈显著负相关（r分别为－0．41和－0．37，P＜0．01）。结论：女性绝经后，雌孕激素缺乏，导致FSH，LH升高，同时骨吸收加快，血清TRACP活性增加。     

绝经妇女骨丢失率及骨吸收指标的变化

目的：了解南京市区妇女骨丢失率及骨吸收指标与绝经时间的关系，为早期防治骨质疏松提供依据。方法：随机测定576例妇女骨吸收指标尿吡啶酚（Pyr)浓度，其中233例同时测量腰椎2－4、左髋部胫骨密度，按中青年、围绝经期，绝经早期，绝经晚期分4组。结果：（1）腰椎2－4、股骨颈骨密度年下降率：围绝经期与绝经前相似为0．6％、0．5％；绝经早期为2．3％、0．9％，绝经期晚期为1．0％、1．6％。（2）围绝经期、绝经早期及绝经晚期与中青年尿Pyr/Cr（肌酐）比较均升高，差异有显著性（P＜0．01），后3组间比较差异无显著性（P＞0．05）。各组骨质疏松伴发率分别为0、2．2％、22．8％、67．6％。（3）围绝经期及其后妇女中，骨量正常，骨量减少及骨质疏松3组间尿Pyr/Cr比较差异无显著性（P＞0．05）。结论：（1）围绝经期及其后妇有吸收指标处于稳定的高水平。（2）围绝经期丢失率与绝经前相当；绝经早期妇女以松质骨为主的腰椎骨量丢失最快，以后下降处于稳定状态；随年龄增长，股骨颈骨量年丢失率逐渐增加。（3）骨密度与骨吸收指标之间无相关关系。     

绝经后性激素变化在胰岛素抵抗发病中的作用

目的：探讨绝经后妇女性激素变化在胰岛抵抗发病中的作用。方法：A组：26例绝经后糖耐量减低（IGT）妇女；B组：21例绝经后糖耐量正常（NGT）妇女；C组：17例正常月经期妇女。分别测定空复血糖、胰岛素及餐后2h血糖及胰岛素，计算胰岛素敏感性指数（IAI）。测定雌二醇（E2）、促卵泡刺激素（FSH），促黄体生成素（LH）、睾酮（T）。结果：绝经后IGT妇女E2水平和IAI明显低于另两组（P值分别＜0．01），T水平明显高于另两组（P值分别＜0．05），而葡萄糖和胰岛素水平明显升高，线性相关分析显示，E2水平与IAI呈显著正相关，T水平与IAI呈显著负相关，结论：绝经后低雌激素及高雄激素的共同作用是导致胰岛素抵抗的原因之一。     

利维爱治疗前后绝经女性骨密度的动态观察

为探讨利维爱治疗绝经后妇女骨质疏松症骨密度的变化规律，将76例绝经后妇女随机为分利维爱组和钙剂组，连续用药6个月，采用QDR2000型双能X线骨密度测定仪，进行腰椎及股骨上端骨密度测定。结果显示：利用爱组（45例）治疗6个月后，髋部三角区（ward‘s)骨密度明显升高与治疗前及对照组比较差异有显著性（P＜0．05）；对照组治疗前后骨密度无明显变化（P＞0．05）。提示利维爱可有效防止绝经后妇女髋部骨量丢失。     

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.