尿白蛋白排泄率与代谢综合征相关组分的关系

目的研究尿白蛋白排避率（UAER）与代谢综合征相关组分的关系。方法2型糖尿病（T2DM）患者258例,按照UAER分为正常白蛋白尿组（NAU）（〈30ms／24h）、微量白蛋白尿组（MAU）（30-299ms／24h）和临床白蛋白尿组（CAU）（≥300ms／24h）,比较三组的体质量指数（BMI）、血压、血生化指标、24h尿尿酸（UUA）、胰岛素分泌指数（HOMA—IS）、胰岛素抵抗指数（HOMA—IR）和胰岛素敏感指数（ISI）,并行Pearson相关分析和多元逐步回归分析。结果与NAU组比较,MAu组收缩压（SBP）、BMI、血尿酸（UA）、UUA、in（HOMA—IR）和In（HOMA—IS）升高,In（ISI）降低（P〈0．05）;而CAU组SBP、舒张压（DBP）、BMI、甘油三酯（TG）、极低密度脂蛋白（VLDL）、UA、UUA和1n（HOMA—IR）升高,In（ISI）降低（P〈0．05）;CAU组较MAu组TG升高（P〈0．05）。UAER与SBP、TG、VLDL、UA呈正相关（P〈0．01）。多元逐步回归显示TG、SBP、UA是UAER的主要影响因素。结论,12DM患者TG、SBP、uA是UAER的主要影响因素,提示对这些危险因素的控制有助于预防和控制糖尿病肾病。     

肥胖者C-反应蛋白与胰岛素抵抗的相关性研究

目的观察肥胖者血浆超敏C-反应蛋白（hs—CRP）表达,探讨炎症因子在肥胖和胰岛素抵抗发生中的作用。方法测定15例肥胖者和17例非肥胖者hs—CRP,测定体质量指数（BMI）、腰臀比（WHR）、空腹血糖（FBG）、空腹胰岛素（FINS）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）和收缩压（SBP）、舒张压（DBP）、胰岛素抵抗指数（HOMA—IR）。结果肥胖者的BMI、WHR、TG、FINS、HOMA—IR、hs—CRP表达量均显著高于非肥胖对照组（P〈0．05）,hs—CRP与BMI、WHR、FINS、HOMA—IR、TG、DBP呈正相关（r=0．646～0．950,P〈0．01）。结论肥胖者hs—CRP表达量增加,与肥胖者的胰岛素抵抗、血脂异常关系密切。     

尿微量白蛋白与冠心病的关系

目的：探讨尿微量白蛋白与冠心痛的关系。方法：选择体重指数无统计学差别的正常对照组及冠心病组[其中包括：急性心肌梗死组（AMI），不稳定心绞痛组（UAP）和稳定心绞痛组（SAP）]，分别测定其尿微量白蛋白（MAU）、尿白蛋白排泄率（UAER）、甘油三脂（TG）、高密度脂蛋白（HDL）及空腹血糖（FBG）等指标。结果：与对照组比较，SAP组和UAP组UAER差别有显著性（P〈0．05）；与SAP组比较，UAP组差别无显著性（P〉0．05），AMI组UAER差别有显著性（P〈0．05）；与UAP组比较，AMI组UAER差别有显著性（P〈0．05）。结论：尿微量白蛋白可以作为判断心血管事件发生及严重程度的指标之一。     

2型糖尿病患者伴微量白蛋白尿的相关因素分析

目的：探讨2型糖尿病患者的微量蛋白尿和相关指标的相关性。方法：将30例2型糖尿病患者按蛋白尿分成正常蛋白尿组（16例）和微量蛋白尿组（14例）。测定收缩压（SBP）、舒张压（DBP）、身高、体重、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、空腹血糖（FPG）和空腹胰岛素（FINS）。计算体重指数（BMI）和胰岛素抵抗指数（HOMA—IR）。结果：2型糖尿病的患者,随着微量白蛋白尿的出现,其血压、血脂、FINS、HbA1c、HOMA—IR均相应地有所升高。结论：与尿白蛋白正常的2型糖尿病患者相比,伴有微量白蛋白尿的2型糖尿病患者病程更长,收缩压以及血脂水平更高,胰岛素抵抗更为严重。     

糖耐量低减患者尿白蛋白排泄率与肿瘤坏死因子及一氧化氮水平的关系

目的：探讨老年患糖耐量低减（IGT）时尿白蛋白排泄率（UAER）与肿瘤坏死因子－α（TNF－α）及一氧化氮（NO）水平之间的关系。方法：IGT微量白蛋白尿组和正常白蛋白尿组各30例,分别测定TNF－α和NO含量。结果：IGT微量蛋白组TNF－α和NO含量较正常白蛋白尿组显升高（P＜0．05）。结论TNF－α和NO共同参与IGT微量白蛋白尿的发生。     

老年2型糖尿病合并非酒精性脂肪肝相关危险因素分析

目的：分析老年2型糖尿病合并非酒精性脂肪肝的相关危险因素。方法：选择485例老年2型糖尿病患者,其中单纯糖尿病患者列为对照组,2型糖尿病合并非酒精性脂肪肝患者列为观察组,对两组患者进行相关危险因素进行检测或相关问卷调查,采用统计学方法分析2型糖尿病合并非酒精性脂肪肝的危险因素。结果：①病程≥10年、饮酒、BMI＞24．0kg／m2、HOMA－IR＞1糖尿病患者,非酒精性脂肪肝患病率明显高于病程＜10年、不饮酒、BMI≤24．0kg／m2、HOMA－IR≤1的糖尿病患者,比较差异有统计学意义（病程χ2＝0．973,饮酒χ2＝0．799,BMIχ2＝0．784,HOMA－IRχ2＝1．184,P＜0．05）;②观察组HOMA－IR、TG、HDL－c、LDL－c水平高于对照组,比较差异有统计学意义（ HOMA－IR t＝9．445, TG t＝9．832,HDL－c t＝10．314,LDL－c t＝9．876,P＜0．05）;③病程、饮酒、BMI、HOMA－IR、TG是2型糖尿病合并非酒精性脂肪肝危险因素（病程OR＝0．973,饮酒OR＝0．799,BMI OR＝0．784,HOMA－IR OR＝1．184,TG OR＝0．763,P＜0．05）。结论：影响老年2型糖尿病合并非酒精性脂肪肝因素较多,病程、饮酒、BMI、HOMA－IR、TG为独立危险因素。     

2型糖尿病患者心血管危险因素集簇现象

目的　探讨影响 2型糖尿病患者心血管危险因素集簇现象的因素。方法　分析了 6 4 1例 2型糖尿病住院患者和 5 9例健康体检者体重参数、血压、血脂、血糖、外周白细胞计数 (WBC)水平 ,采用稳态模式 (HOMA)评价胰岛素抵抗 ,并根据HOMA IR中位数 (3.2 2 98)和WBC中位数 (5 .9× 10 9/L) ,将 2型糖尿病患者分为升高组和正常组。根据心血管危险因素数量、性别、危险因素成分 ,进行分析。结果　合并 1种危险因素组 (M 1)、2种危险因素组 (M2 )、3种危险因素组 (M3)和 3种以上危险因素组 (M 4 )的体重指数 (BMI)、收缩压 (SBP)、舒张压 (DBP)、空腹血糖 (FBG)、甘油三酯 (TG)和HOMA IR水平高于无危险因素组 (M0 ) (P <0 .0 5 )。随着危险因素数量增多 ,BMI、SBP、DBP、TG、HOMA IR和胆固醇 (TC)呈升高趋势 ,高密度脂蛋白 胆固醇 (HDL C)呈降低趋势 ,各种大血管病变的患病率明显上升。合并高血压或WBC升高的 2型糖尿病患者冠心病患病率明显高于正常组 (P <0 .0 5 )。累加Logistic回归分析显示 ,SBP、BMI、FBG、HDL C、TC、TG、空腹胰岛素 (FINS)、低密度脂蛋白 胆固醇 (LDL C)、尿白蛋白排泄率 (UAER)和HOMA IR是影响男性 2型糖尿病患者心血管危险因素集簇主要的危险因素 ,SBP、BMI、TG、HDL C和UAER是影响女     

儿童肥胖与代谢综合征及胰岛素抵抗的相关性研究

目的探讨儿童肥胖与代谢综合征以及胰岛素抵抗的相关性。方法选取肥胖儿童57例和正常体重儿童53例分别作为观察组和对照组．使其在性别和年龄方面具有可比性。测量两组儿童的体重、身高,计算BMI,测量儿童血压及腰围：行糖耐量试验,测定空腹血糖及餐后2h血糖;测定TC（胆固醇）、TG（甘油三酯）、HDL—c（高密度脂蛋白）、LDL—c（低密度脂蛋白）;计算两组儿童胰岛素抵抗指数。结果观察组儿童BMI、WC、FPG、2hPG、SBP、DBP、TG、LDL—c、FINS以及HOMA—IR均明显高于对照组,HDL—c水平明显低于对照组,两组比较差异具有统计学意义（P〈0．05）。儿童BMI、腰围、SBP、DBP、GLU、TG、LDL—c以及FINS与HOMA—IR呈正相关,HDL—c与HOMA—IR呈负相关（P〈0．05）。结论相比正常体重儿童,肥胖儿童更容易伴随代谢异常,也更容易存在心血管疾病的相关危险因素,应加强对儿童肥胖危害的宣传,提高人们的认识程度,从而采取健康的生活方式,预防代谢综合征和胰岛素抵抗的发生。     

2型糖尿病患者肾上腺激素水平及行为类型关系探讨

目的 探讨2型糖尿病的发生与肾上腺激素水平及行为类型的关系。方法60例2型糖尿病患者和60例健康自愿者进行A型行为问卷测试,均检测空腹血糖（FPG）、空腹胰岛素（FINS）、去甲肾上腺素（NE）、肾上腺素（E）、餐后2h血糖（2hPPG）及24h尿游离皮质醇（UFC）水平,测身高、体重、计算体重指数（BMI）、胰岛素抵抗指数（HOMA—IR）。结果2型糖尿病组A型行为评分、NE、E、UFC、BMI、HOMA—IR明显高于正常对照组（P〈0．05或P〈0．01）,病例组A型行为评分值与NE、E、UFC、FPG,2hPPG呈正相关关系。以HOMA—IR为因变量的回归分析显示,UFC、BMI是进入回归方程的因素。结论A型行为是促发2型糖尿病的重要因素,其机制与肾上腺激素水平变化有关。     

2型糖尿病合并非酒精性脂肪肝的相关因素及其它与胰岛素抵抗的关系

目的分析2型糖尿病合并非酒精性脂肪性肝病（NAFLD）的相关因素并研究其与胰岛素抵抗之间的关系,并探讨诱发NAFLD的相关危险因素。方法选取2型糖尿病患者180例,其中合并NAFLD者90例,未合并NAFLD者90例,回顾患者的一般临床资料、实验室检测结果,比较两组患者的一般临床资料、检测结果及胰岛素抵抗指数。结果NAFLD组在WHR、BMI、ALT、TG等指标上显著高于非NAFLD组（P〈0．05）,在HDL—C则相反;NAFLD组患者的HOMA—1R、HOMA—B显著高于较非NAFLD组（P〈0．05）;BMI、wHR、HOMA—IR、TG是NAFLD发生的独立危险因素（P〈0．05）。结论BMI、WHR、HOMA—IR、TG升高能提高2型糖尿病合并NAFLD的发病几率。     

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.