血清胆红素与糖尿病视网膜病变相关性的临床研究

目的研究2型糖尿病患者血清胆红素与糖尿病视网膜病变之间的关系。方法将263例2型糖尿病患者是否合并糖尿病视网膜病变分为合并糖尿病视网膜病变组（DR组）78例和未合并糖尿病视网膜病变组（NDR组）185例,并对两组患者的临床特征进行分析比较,并对糖尿病视网膜病变的危险因素进行多因素logistic回归分析。结果与NDR组相比,DR组患者的糖尿病病程更长（P＜0.01）,胰岛素抵抗更明显（P＜0.05）,而TBil、DBil、间接胆红素水平均显著下降（P＜0.05或0.01）。logistic回归分析显示：病程（OR=1.124）、年龄（OR=1.023）、BMI（OR=1.036）是其独立危险因素,TBil（OR=0.907）、DBil（OR=0.847）是其保护因素。结论DR的发生与血清胆红素水平下降有一定的相关性,血清胆红素可能是DR的一种有益标记物。     

2型糖尿病患者泪液肿瘤坏死因子-α的表达

目的 测定并比较糖尿病患者和正常人泪液中肿瘤坏死因子-α(TNF-α)的含量,并探讨其与糖尿病及糖尿病视网膜病变的关系.方法 正常对照者(NC组)25例、糖尿病无视网膜病变患者(NDR组)15例、糖尿病有视网膜病变患者(DR组)15例,分别用ELISA法检测3组人群泪液中TNF-α的含量.采用SPSS 12.0统计软件,数据比较用t检验,P≤0.05为差异有显著性.结果 泪液中TNF-α的含量:NC组未检测到TNF-α的表达,NDR组为(2.41±1.05)pg/mL,DR组为(4.23±1.92)pg/mL.DR组泪液中TNF-α浓度高于NDR组,且差异有显著性(P＜0 01).结论 2型糖尿痛患者泪液TNF-α水平明显升高.糖屎病视网膜病变患者泪液TNF-α水平进一步升高.提示泪液TNF-α与2型糖尿病及糖尿病视网膜病变的发生有关.     

血清中VEGF TNF-α和CRP水平与2型糖尿病视网膜病变关系的临床研究

目的探讨糖尿病视网膜病变患者血清中血管内皮细胞生长因子（VEGF）、肿瘤坏死因子（TNF-α）及C-反应蛋白（CRP）水平与糖尿病视网膜病变的关系。方法将117例糖尿病患者分为糖尿病视网膜病变组（DR,76例）、非糖尿病视网膜病变组（NDR,41例）,DR组又分为非增生性糖尿病视网膜病变亚组（NPDR,45例）、增生性糖尿病视网膜病变亚组（PDR,31例）。健康对照组40例。采用ELISA法检测血清VEGF、TNF-α及CRP水平,分析对比。结果糖尿病患者血清VEGF、TNF-α及CRP水平与健康对照组比较,有显著性差异（P〈0.01）;DR组血清VEGF、TNF-α及CRP水平显著高于NDR组（P〈0.01）;PDR组血清VEGF、TNF-α及CRP水平显著高于NPDR组（P〈0.01）。结论血清VEGF、TNF-α及CRP可能参与了DR的发生、发展。     

不同分期糖尿病视网膜病变泪液TNF-α的表达

目的 测定并比较2型糖尿病不同分期视网膜病变患者及正常人泪液中肿瘤坏死因子-α(TNF-α)的含量,探讨泪液TNF-α与糖尿病及糖尿病视网膜病变的关系.明确泪液TNF-α与血清TNF-α水平的相关关系.方法 正常对照组(NC组)50例、2型糖尿病无视网膜病变组(NDR组)50例、2型糖尿病单纯性视网膜病变组(DR组)50例,2型糖尿病增生性视网膜病变患者(PDR组)50例,用ELISA法检测四组人群泪液、血清中TNF-α的含量.结果 泪液中TNF-α的含量:NC组为(0.48±0.17)pg/ml,NDR组为(3.84±1.64)pg/ml,DR组为(6.63±2.06)pg/ml,PDR组为(7.76±3.05)pg/ml,两两组间比较均有统计学意义(P ＜0.01或P＜0.05).血清中TNF-α的含量:NC组浓度为(4.78±3.03)pg/ml,NDR组浓度为(13.68±6.66)pg/ml,DR组浓度为(18.92±5.94)pg/ml,PDR组浓度为(21.62±9.92)pg/ml,两两组间比较均有统计学意义(P＜0.01).泪液TNF-α与血清TNF-α水平有相关性(r=0.751,P＜0.05).结论 2型糖尿病患者泪液TNF-α水平明显升高.随着糖尿病视网膜病变程度的加重,泪液TNF-α含量逐渐升高,提示泪液TNF-α水平与糖尿病及不同分期糖尿病视网膜病变的发生有关.泪液TNF-α与血清TNF-α水平之间呈线性正相关关系.     

Ang-2/Tie、VEGF与2型糖尿病视网膜病变关系的研究

目的探讨血清促血管生成素1（Ang-1）和促血管生成素2（Ang-2）及其受体Tie-2与血清血管内皮生长因子（VEGF）在糖尿病视网膜病变发病中的作用。方法选择137例2型糖尿病患者,其中无糖尿病视网膜病变组（NDR组）47例,糖尿病视网膜病变组（DR）90例,糖尿病视网膜病变组又分为非增殖性糖尿病视网膜病变组（NPDR）49例和增殖性糖尿病视网膜病变组（PDR）41例。采用ELISA法测定所有受试者血清中促血管生成素1,促血管生成素2,Tie-2受体和血管内皮生长因子的浓度水平并进行统计学比较分析。结果促血管生成素1在非增殖性糖尿病视网膜病变（NPDR）组高于无糖尿病视网膜病变组（NDR组）（P〈0.05）;促血管生成素2在3组间差异有统计学意义,在增殖性糖尿病视网膜病变组明显高于非增殖性糖尿病视网膜病变组和无糖尿病视网膜病变组组（P〈0.05）,非增殖性糖尿病视网膜病变组又高于增殖性糖尿病视网膜病变组（P〈0.05）;血清中血管内皮生长因子浓度在3组中逐渐升高（P〈0.05）。相关分析表明在视网膜病变中促血管生成素2和血管内皮生长因子及Tie-2受体呈正相关,差异有统计学意义（P〈0.05）。结论促血管生成素1和促血管生成素2及其受体Tie-2组成的信号传导系统与血管内皮生长因子共同参与了糖尿病视网膜病变的发生、发展,其水平异常与病情的严重程度密切相关。     

糖尿病视网膜病变患者血清同型半胱氨酸与氧化应激反应的变化

目的 观察糖尿病视网膜病变(DR)患者血清同型半胱氨酸与氧化应激反应的变化,探讨糖尿病视网膜病变患者血清同型半胱氨酸水平与氧化应激反应的相关性.方法 测定50例健康对照者,50例无DR 2型糖尿病患者(NDR组)、50例合并非增殖型DR 2型糖尿病患者(NPDR组)及50例合并增殖型DR 2型糖尿病患者(PDR组)血清同型半胱氨酸(Hcy)及丙二醛(MDA)、超氧化物歧化酶(SOD)、还原型谷胱甘肽(GSH)水平.结果 所有糖尿病患者Hcy、MDA含量均明显高于正常对照组(P＜0.01);NPDR组及PDR组均较NDR组明显升高,血清SOD、GSH含量所有糖尿病患者低于正常对照组(P＜0.01);NPDR组及PDR组均较NDR组低(P＜0.01);同时PDR组又低于NPDR组(P＜0.01);血清Hcy与MDA水平呈正相关(r=0.84,P＜0.05),与SOD、GSH含量均呈负相关(r=-0.77,-0.68,P＜0.05).结论 糖尿病视网膜病变患者血清同型半胱氨酸水平升高,氧化应激反应增强,氧化应激与血清同型半胱氨酸水平升高有关,血清同型半胱氨酸水平升高,氧化应激在糖尿病视网膜病变发生发展中发挥重要作用.     

糖尿病视网膜病变患者血管内皮生长因子的测定及其意义

目的探讨血管内皮生长因子（VEGF）与2型糖尿病患者视网膜病变（DR）之间的关系。方法将52例2型糖尿病患者分为31例糖尿病视网膜病变组（DR组）和21例糖尿病视网膜无病变组（NDR组）,又将DR组分为背景型糖尿病患者视网膜病变组（BDR组）19例和增值型糖尿病患者视网膜病变组（PDR组）12例。分别检测各组VEGF值并与36例正常对照组进行比较。结果正常对照组、糖尿病组、NDR组、BDR组及PDR组VEGF含量（pg/ml）分别为108.4±27.2、185.2±32.6、162.3±28.7、220.3±44.6和201.9±31.7。糖尿病组和正常对照组相比,差异有高度统计学意义（均P〈0.01）;BDR、PDR与NDR组相比,差异均有统计学意义（均P〈0.05）,PDR与BDR相比,差异亦有统计学意义（P〈0.05）。结论 VEGF可作为了解糖尿病视网膜病变程度的参考指标。     

不同分期糖尿病视网膜病变泪液IL-6的表达

目的 测定并比较2型糖尿病不同分期视网膜病变患者及正常人泪液中白细胞介素-6( inter-leukin-6,IL-6)的含量,探讨泪液白细胞介素-6与糖尿病及糖尿病视网膜病变的关系.明确泪液IL-6与血清IL-6水平的相关关系.方法 正常对照者(normal control group,NC组)30例、2型糖尿病无视网膜病变患者(NDR组)30例、2型糖尿病单纯性视网膜病变患者(DR组)30例,2型糖尿病增生性视网膜病变患者(PDR 组)30例,4组年龄、性别比例相匹配.用ELISA法检测4组人群泪液、血清中IL-6的含量.实验资料采用SPSS 12.0统计软件分析,数据比较用单因素方差分析,并对泪液、血清IL-6进行相关分析.结果 泪液中IL-6的含量:NC组浓度为(3.12±1.07 )pg/mL,NDR组浓度为(10.23±3.16)pg/mL,DR组浓度为(16.42±5.71)pg/mL,PDR组浓度为(25.13±4.96 )pg/mL.组间两两比较均差异有统计学意义(P＜0.01或P＜0.05).血清中IL-6的含量:NC组浓度为(88.86±16.71)pg/mL,NDR组浓度为(126.43±20.93)pg/mL,DR组浓度为(240.42±39.21 )pg/mL,PDR组浓度为(269.50±30.20 )pg/mL.组间两两比较差异均有统计学意义(P＜0.01).泪液IL-6与血清IL-6水平有相关性(r=0.758,P ＜0.05).结论 糖尿病患者泪液IL-6含量增高;随着糖尿病视网膜病变程度的加重,泪液IL-6含量逐渐升高,提示泪液IL-6水平与糖尿病及不同分期糖尿病视网膜病变的发生有关.泪液IL-6与血清IL-6水平之间呈直线正相关关系.     

糖尿病视网膜病变患者血中VEGF及IGF-1的定量测定与分析

目的 检测糖尿病视网膜病变（DR）患者外周血中的VEGF和IGF-1水平,并探讨其临床意义。方法 选取30例健康者作为对照组,2型糖尿病患者120例为试验组;试验组再分为无糖尿病视网膜病变（NDR）组30例,单纯型糖尿病视网膜病变（BDR）组33例,单纯型糖尿病视网膜病变合并黄斑水肿（macular edema ME）组22例,增生型糖尿病视网膜病变（PDR）组35例。用ELISA法检测血浆VEGF和IGF-1水平。结果2型糖尿病患者外周血中VEGF及IGF-1水平明显高于正常者,差异有统计学意义（P〈0.01）。而在2型糖尿病患者中,单纯型DR组血清VEGF及IGF-1水平明显高于无DR组,差异有统计学意义（P〈0.05）;单纯型并黄斑水肿组及增生型组血清VEGF水平明显高于单纯型DR组,差异有统计学意义（P〈0.01）,而血清IGF-1水平明显高于单纯型DR组,差异有统计学意义（P〈0.05）;而单纯型并黄斑水肿组和增生型组血清VEGF及IGF-1水平差异无统计学意义（P〉0.05）。结论 2型糖尿病患者血清中VEGF及IGF-1水平随着DR的发生、黄斑水肿以及DR的加重而逐渐升高,对其进行监测有利于糖尿病视网膜病变的早期诊断和治疗。     

2型糖尿病患者血尿酸、尿微量白蛋白水平与视网膜病变的相关性研究

目的 探讨2型糖尿病患者尿白蛋白排泄率（UAER）及血尿酸（UA）水平与糖尿病视网膜病变（DR）的关系.方法 443例2型糖尿病患者按照眼底结果分为无DR组（NDR）、非增殖期DR组（NPDR）及增殖期DR组（PDR）,观察各组临床生化指标并分析DR病变的危险因素.结果 本研究人群中DR的患病率为40.41％（179/443）,NPDR的患病率为34.76％（154/443）,PDR的患病率为5.64％（25/443）.NPDR组及PDR组患者糖尿病病程、糖化血红蛋白（HbA1c）高于NDR组（P＜0.05）.PDR组收缩压（SBP）、总胆固醇（TC）及低密度脂蛋白（LDL）高于NDR组（P＜0.05）,血肌酐（Cr）、UA、UAER高于NDR及NPDR组（P＜0.05）,肾小球滤过率（GFR）明显低于NDR及NPDR组（P＜ 0.05）.随着UAER的增加,DR发生率明显增加（P＜0.05）.高尿酸血症组患者DR发生率明显增加（P＜0.05）.Logistic回归分析显示糖尿病病程、HbA1c、UAER、UA、eGFR为影响DR的独立危险因素.结论 UAER及UA与DR发生密切相关,对其进行联合筛查有助于早期检出DR.     

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.