冲击剂量阿法D_3治疗血透继发甲状旁腺功能亢进的疗效观察

目的观察冲击剂量阿法D3对血液透析患者继发甲状旁腺功能亢进(SHPT)的疗效。方法将31例血透继发甲状旁腺功能亢进的患者随机分为两组,对照组16例,口服阿法D30.25μg/d,观察组15例,口服阿法D32μg/次,每周2次,两组疗程均为12周,比较治疗前后的甲状旁腺激素(PTH)、血钙、血磷、碱性磷酸酶(AKP)变化。结果治疗12周后,观察组与对照组比较,PTH明显下降(P<0.01),血钙显著上升(P<0.01)。结论常规和冲击剂量的阿法D3口服治疗均能有效的降低PTH,升高血钙,对血磷、肝、肾功能无明显影响,但冲击疗法优于常规疗法。     

小剂量1,25(OH)2D3口服冲击治疗30例尿毒症继发性甲状旁腺功能亢进

[目的]对30例尿毒症继发性甲状旁腺功能亢进(SHPT)患使用小剂量1，25(OH)2D3(罗钙全)口服冲击治疗，与常规治疗疗效比较．[方法]60例尿毒症血透患，随机分为常规治疗(n=30)，口服罗钙全0．25μg／d，冲击治疗组(n=30)，口服罗钙全2μg／／次，每周2次，8周后改为0．25μg／d维持用．[结果]冲击治疗组血甲状旁腺素(PTH)、碱性磷酸酶(AKP)、血磷较常规治疗组下降明显、血钙上升，症状改善，无高血钙发生．[结论]应用小剂量1.25(OH)3D3口服冲击治疗SHPT，是一种经济合理、安全有效的方法．     

盖三淳治疗慢性肾功能不全继发甲状旁腺功能亢进的临床观察

为对比口服大剂量(2μg，每周2次)和常规剂量(每天O．25μg)盖三淳[1，25(OH)2D3]对慢性肾功能不全(CRI)继发甲状旁腺功能亢进患者(SHPT)的治疗效果。将30例CRI患者随机分为两组，常规剂量治疗组(C组)15例每天口服盖三淳0．25μg，冲击治疗组(T组)15例口服盖三淳每周2次，每次2／μg。两组均限磷饮食、常规补钙0．75g／d，观察时间为3个月。观察前及治疗后每月查血清全段甲状旁腺激素(iPTH)，每2周查血钙(Ca^2 )、血磷(Pˉ)及血清肌酐(Scr)水平。取两组治疗第1、3月检查值进行比较。结果，T组iPTH在治疗后第一月较治疗前就有明显下降(P＜0．01)，但C组在治疗3个月时才有明显降低(P＜0．01)，T组在治疗第1个月及3个月后与C组比较降低更明显，有显著差异(P＜0．05)。观察血钙水平变化，C组虽有所上升，但与治疗前相比差异不明显，T组在治疗第1个月及第3个月后有显著性上升。两组血磷水平治疗后均有所下降，但无显著差异。两组Scr在治疗前后无显著差异。提示1，25(OH)2D3冲击疗法较常规剂量疗法对SHPT缓解更显著，但治疗前应注意检测iPTH。     

罗钙全在慢性肾衰非透析患者中的应用效果观察

目的 :观察 1 2 5 (OH) 2 D3 治疗合并继发性甲状旁腺功能亢进 (Secondaryhyperarathyroidism ,SHPT)的慢性肾功能衰竭(Chronicrenalfailure ,CRF)非透析患者的临床疗效及安全性。方法 :4 3例合并SHPT的CRF非透析患者随机分为两组 ,对照组以碳酸钙 1gTid口服 +限磷饮食 ,治疗组在对照组治疗方案基础上加 1 2 5 (OH) 2 D3 0 2 5 μgQd ,共观察 3个月 ,治疗前后均观察临床症状 ,测全段甲状旁腺素 (iPTH)、碱性磷酸酶 (AKP)、血钙 (Ca)、血磷 (P)、血肌酐 (Cr)、血尿素氮 (BuN) ,同时观察 1 2 5(OH) 2 D3 的副作用。结果 :治疗 3个月后治疗组血钙明显升高 (P <0 0 5 ) ,血磷、AKP、iPTH明显下降 (P <0 0 5 ) ,对照组上述指标无显著变化 ,治疗组总有效率显著大于对照组 (P <0 0 5 ) ,且仅少数出现较严重高钙、高磷血症。结论 :1 2 5 (OH) 2 D3 治疗合并SHPT的CRF非透析患者疗效显著 ,无严重副作用 ,使用安全 ,值得推广     

骨化三醇和阿法骨化醇治疗血液透析患者继发性甲状旁腺功能亢进的疗效分析

目的:观察骨化三醇和阿法骨化三醇治疗血液透析患者继发性甲状旁腺功能亢进(SHPT)的疗效。方法:将68例维持性血液透析SHPT患者随机均分为A组和B组,A组给予骨化三醇冲击疗法治疗,B组给予阿法骨化醇常规剂量口服治疗,比较治疗前及治疗后4、8周的全段甲状旁腺激素(iPTH)、血钙和磷的变化。结果:两组患者治疗前与治疗后第4、8周iPTH均有显著下降,差异有统计学意义(P<0.05);A组较B组下降更明显,效果优于B组,差异有统计学意义(P<0.05);治疗过程中两组患者血钙、血磷同治疗前相比有所上升但差异无统计学意义(P>0.05)。结论:在维持性血液透析SHPT患者中使用骨化三醇间断服药方式和常规剂量阿法骨化醇,能使治疗过程中血磷浓度、钙磷乘积维持稳定,有效控制iPTH的升高,对血钙影响较小。与阿法骨化醇治疗相比,骨化三醇在改善iPTH治疗效果更优。     

司维拉姆治疗维持性血液透析合并继发性甲状旁腺功能亢进患者的疗效

目的探讨司维拉姆治疗维持性血液透析(MHD)患者继发性甲状旁腺功能亢进(SHPT)的疗效。方法选择2016年6月至2017年6月在安徽医科大学附属六安医院血液透析中心规律透析超过3个月且合并SHPT的76例患者为研究对象,按随机数字表法将患者分为观察组及对照组各38例,在常规血液透析、健康教育的基础上,观察组予口服司维拉姆,每次800 mg,1天3次;对照组予口服碳酸钙,每次500 mg,1天3次,6个月为一个疗程,观察并比较两组患者治疗前、治疗3个月及治疗6个月的血钙、磷及全段甲状旁腺激素(i PTH)水平的变化。结果治疗前,两组血钙、磷、i PTH比较,差异均无统计学意义(P> 0. 05)。与治疗前比较,治疗3、6个月后,两组血磷及i PTH均下降,差异有统计学意义(P <0. 05);观察组血钙升高,差异无统计学意义(P> 0. 05),对照组血钙明显升高,差异有统计学意义(P <0. 05)。治疗后,观察组血钙水平低于对照组,差异有统计学意义(P <0. 05);两组血磷及i PTH水平比较,差异均无统计学意义(P> 0. 05)。结论司维拉姆治疗MHD患者合并SHPT,临床疗效满意,且无高钙血症副作用。     

甲状旁腺切除术治疗尿毒症继发性甲状旁腺功能亢进症52例临床观察

目的观察甲状旁腺切除术治疗尿毒症继发性甲状旁腺功能亢进症(SHPT)的临床疗效和术后并发症。方法回顾性分析2016年10月至2018年3月在安徽医科大学附属安庆医院接受甲状旁腺切除术的52例SHPT患者的临床资料,观察术前及术后不同时期(1 d、3 d、7 d、1个月、3个月)血钙、血磷、全段甲状旁腺激素(i PTH)、碱性磷酸酶(ALP)的变化,以及临床症状的缓解和术后并发症、复发情况。结果 52例患者均顺利完成手术。围手术期无死亡病例。随访期未发现复发病例。术后3例患者持续性甲状旁腺功能亢进。49例患者术后血钙、血磷、i PTH、ALP均显著下降,与术前比较差异有统计学意义(P <0. 05)。术后所有患者骨痛、皮肤瘙痒、失眠、肌无力等症状均得到不同程度的缓解。术后1例患者发生甲状旁腺功能减退,39例患者发生低钙血症,经积极口服及静脉补充钙剂后均未出现明显的临床症状。结论甲状旁腺切除术治疗尿毒症SHPT安全、有效,能迅速降低SHPT患者高水平的i PTH,改善钙磷代谢紊乱,同时临床症状明显缓解。     

甲状旁腺切除对血液透析患者冠状动脉钙化和心血管事件的影响

目的:观察甲状旁腺切除术(parathyroidectomy,PTX)对尿毒症并继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者冠状动脉钙化和心血管事件的影响。方法:将74例临床诊断SHPT明确的尿毒症患者,按照是否同意接受手术的意愿分为手术组和常规治疗组。手术组切除甲状旁腺,常规治疗组按KDOQI指南进行骨化三醇冲击治疗。结果:手术组1年后血清Ca、P、钙磷乘积(Ca×P)、i PTH、冠状动脉钙化积分均明显下降(P<0.05),同常规治疗组比较,差异有统计学意义(P<0.01)。常规治疗组1年后虽然甲状旁腺激素也明显下降,但冠状动脉钙化积分进展性升高,差异有统计学意义(P<0.05)。随访期间,手术组同常规治疗组心血管事件发生率比较,差异有统计学意义(P<0.05)。logistic回归分析显示冠状动脉钙化与血钙、磷、钙磷乘积显著相关,差异有统计学意义(P<0.01),而血磷、冠脉钙化是血液透析患者心血管事件发生的重要危险因素,差异有统计学意义(P<0.01)。结论:甲状旁腺切除术能改善SHPT患者冠状动脉钙化,降低心血管事件发生率。     

尿毒症继发性甲状旁腺功能亢进症术后复发再手术治疗的效果

目的 探讨尿毒症继发性甲状旁腺功能亢进症(SHPT)术后复发再手术治疗的手术方式及效果.方法 对14例尿毒症SHPT术后复发患者的临床资料进行回顾性分析,对比患者在手术前后症状、血清全段甲状旁腺激素(iPTH)、血钙血磷等变化,总结其手术效果及手术并发症等临床资料.结果 14例患者分别行颈部复发甲状旁腺全切除术或颈部复发甲状旁腺切除加移植物切除术或移植物切除术.所有切除的甲状旁腺和移植物组织病理检查均显示为结节性增生.术后患者骨痛及皮肤瘙瘁症状全部缓解,贫血状况好转,仅1例患者出现一过性声嘶,均无呛咳、窒息、吞咽困难等.术后12例出现低钙血症,经静脉及口服补钙均获有效控制,1年后基本停用钙剂,2例仅移植物复发者术后未出现低钙血症.与术前比较,术后血iPTH、血钙、血磷及钙磷乘积水平均显著降低(P＜0.05,P＜0.01).结论 尿毒症SHPT术后复发再手术治疗应以切除全部残留甲状旁腺组织为目的,以避免再次复发.     

血液灌流联合活性维生素D冲击治疗继发性甲状旁腺功能亢进的临床观察

[目的]观察血液灌流(HP)联合活性维生素D冲击疗法对维持性血液透析患者继发性甲状旁腺功能亢进(SHPT)的疗效。[方法]对17例SHPT在常规血液透析基础上采用HA型树脂血液灌流联合活性维生素D冲击疗法,前后自身对照,观察治疗前后血清全段反应性甲状旁腺激素(iPTH)、血钙、血磷、血红蛋白及临床症状等变化情况。[结果]治疗后患者iPTH显著下降(P0.01),血钙上升,血磷下降,血色素上升,临床症状好转。[结论]血液灌流(HP)联合活性维生素D冲击疗法对治疗继发性甲状旁腺功能亢进疗效满意。     

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.