C反应蛋白对急性心肌梗死后左室重塑的相关性研究

目的:探讨C反应蛋白(CRP)与急性心肌梗死(AMI)后左室重塑的关系.方法:选54例首次确诊单纯前壁AMI患者分别于0、1、2、3、4、5、6天抽血查CRP计算CRp曲线下面积(CRPAUC),3～4天抽血查脑钠肽(BNP),心肌梗死(MI)后2月做超声心动图检查观察左室舒张末期容积指数(LVEDVi),左室收缩末期容积指数(LVESVi),室壁运动指数(WMSI)和左室射血分数(LVEF),根据CRP峰值分为CRP增高组和CRP正常组.设对照组35例,应用回归分析观察CRP峰值(CRRpeak),CRPAUC,BNP与左室重塑性指标的关系.结果:与对照组比较CRP峰值、BNP以及EDVi、ESVi、WMSi、和EF均有显著性差异,P＜0.05.CRP增高组与CRP正常组比较,除WMSi外BNP、EDVi、ESVi、EF均有显著性差异.单因素相关分析显示,CRPpeak,CRPAUC和BNP与ESVi、EDVi呈正相关(r值分别为0.738,0.573:0.876,0.714;0.624,0.577),而与EF呈负相关(r值分别为-0.625,-0.824,-0.531),尤以CRPAUC为显著.结论:CRP可以对AMI后左室重塑和左室功能不全强有力的预测因子,是影响预后的指标,CRP易于临床检测,可以为MI危险分层提供有价值的依据.     

血清高敏C-反应蛋白与急性心肌梗死后左室重塑的关系

目的探讨血清高敏C-反应蛋白与急性心肌梗死后左室重塑的关系。方法选72例首次确诊单纯前壁急性心肌梗死患者于入院7d内多个时间点抽血查C-反应蛋白以及心肌梗死后3个月做超声心动图检查观察左室收缩末期容积指数，左室舒张末期容积指数和左室射血分数，根据即刻值与峰值分组分析C-反应蛋白浓度与左室重塑的关系。结果C-反应蛋白峰值浓度与EDVi、ESVi、EF无相关性，入院即刻hs—CRP与左室收缩末期容积指数、左室舒张末期容积指数呈正相关（r值分别为0．779，0．852），与LVEF负相关（r=-0．634）。结论入院后即刻C-反应蛋白可以作为AMI后左室重塑和左室功能不全强有力的预测因子，是影响预后的指标，C-反应蛋白易于临床检测，可以为心肌梗死危险分层提供有价值的依据。     

静脉应用重组人脑利钠肽对急性心肌梗死经皮冠状动脉介入治疗后患者心室重塑和左心功能的影响

目的 研究静脉应用重组人脑利钠肽（rhBNP）对急性心肌梗死经皮冠状动脉介入治疗（PCI）术后患者心室重塑和左心功能的影响。方法 选择48例发病12h内的急性前壁心肌梗死PCI术后患者，随机分为rhBNP组25例和常规治疗组23例，分别于发病后1周、4周和24周采用二维超声心动图测定舒张末期容积指数（LVEDVI）、收缩末期容积指数（LVESVI）、左室射血分数（LVEF）、左室质量指数（LVMI），计算梗死区的局部室壁运动指数（RWMI）。结果 两组患者治疗1周时LVEDVI、LVESVI、LVEF、RWMI、LVMI间差异均无显著性意义（P〉0．05）；治疗4、24周时LVEDVI、LVESVI、LVEF以及治疗24周时RWMI、LVMI间差异均有显著性意义（P〈0．05）。结论 PCI术后在常规治疗的基础上应用rhBNP可进一步阻抑急性前壁心肌梗死后心室重塑，改善左心功能。     

心脏磁共振成像检查全面评价心脏功能

目的：应用心脏磁共振检查（MRI）评价心功能,应用心脏MRI心肌灌注延迟显像评价心肌坏死情况,为临床诊断和治疗提供依据。方法：将42例急性心肌梗死患者分为急诊PCI组（22例）和静脉溶栓组（20例）。所有患者于发病后第4周行心脏MRI检查及心肌灌注延迟显像,根据心脏MRI检查计算左室功能参数,根据心肌延迟强化的透壁程度进行视觉评分（VSM）评价心肌梗死范围。结果：急诊PCI组和静脉溶栓组中VSM总分分别与射血分数（EF）、收缩末期容积（EDV）、收缩末期容积指数（EDVI）、舒张末期容积（ESV）、舒张末期容积指数（ESVI）密切相关（P〈0．001）。结论：应用心脏MRI可以全面评价心脏情况。     

培哚普利对急性心肌梗死后左室重构影响的研究

目的观察比较培哚普利与卡托普利对心肌梗死后左室重塑扫心功能的影响。方法将124例首发急性心肌梗死患者分为培哚普利治疗组46例,卡托普利治疗组42例,常规治疗组36例。治疗1周～12个月后,观察三组临床疗效。行二维超声心动图（CUG）检查,分别测定计算并比较左室射血分数（LVEF）、左室收缩末期容积（LESV）、左室舒张末期容积（LEDV）、左室收缩末期容积指数（LESVI）、左室舒张末期容积指数（LEDVI）、室间隔厚度（IVST）、左室后壁厚度（乙VPWT）的变化。结果培哚普利治疗组和卡托普利治疗组CUG各指标均优于常规治疗组（P〈0．01）,治疗12个月后培哚普利组LEDVI、LESVI均显著低于卡托普利组（P〈0．05）,而LVEF显著高于卡托普利组（P〈0．05）。结论血管紧张素转换酶抑制剂（ACED能有效防止心肌梗死后左室重塑的发生。培垛普利与卡托普利比较,疗效更高、安全性更大、耐受性更好。     

超声心动图评价直接PCI与静脉溶栓对老年急性心肌梗死左室结构和功能的影响

目的　应用超声心动图 (ECHO)评价经皮冠状动脉介入技术 (PCI)及静脉溶栓治疗老年急性心肌梗死疗效。方法　 12 8例年龄大于 6 5岁的首发急性心肌梗死患者分为PCI组 (6 9例 )及溶栓组 (5 9例 ) ,均于梗死后第2周和第 4周进行ECHO检查。结果　PCI组左室舒张末期内径 (LVD)、左室舒张末期容积 (LVEDV)和左室收缩末期容积 (LVESV)前后差别无显著性意义 (P >0 0 5 ) ;射血分数 (EF)及左室短轴缩短率 (FS)前后差别有显著性意义 (P <0 0 5 ) ;室壁节段运动指数 (WMSI)降低了 8 70 %。溶栓组LVD、LVEDV、LVESV前后差别有显著性意义 (P <0 0 5 ) ;EF及FS前后差别无显著性意义 (P >0 0 5 ) ;PCI组AMI后第 2周与第 4周WMSI间差别有显著性意义。结论　PCI开通梗塞相关动脉 ,近期内改善左室重构 ,提高左室功能较静脉溶栓疗效显著。适用于溶栓禁忌证或无溶栓禁忌证的高危高龄AMI患者。ECHO是动态观察AMI后心脏结构和功能变化 ,判断预后 ,指导治疗的有效手段     

急性心肌梗塞后左室重建与室性心律失常关系的研究

目的 为评价室性心律失常与心肌梗塞后左室重建等诸因素的关系。方法 本研究对63名急性心肌梗塞（AMI）病人进行二维切面超声心动图（VCG）检查，了解梗塞后左室缩末容积指数（FSVi)和舒末容积指数（EDVi)，左室射血分数（LVEF），通过心电监护和Holter捕捉室性心律失常。结果 发生室性心律失常（OLown3-5级）者12例，占18％；左室容积明显增加，多元逐步回归分析，以复杂室性心律失常为因变量，选入方程的自变量按贡献率大小依次为：ESVi(0.372)、EDVi(0.334)、肌酸磷酸激酶（CK0.295)，溶栓治疗（-0.282)、LVEF（-0.260)和Killip分级（0.244)。结论 AMI后发生复杂室性心律失常与左室容积增加密切相关，可能是AMI发生左室重建死亡率高的直接原因。     

单心动周期全容积成像评价心肌梗死患者左心室收缩功能收缩同步性

［摘要］目的　探讨应用单心动周期实时四维超声心动图（single beat real—time four dimensional echocardiography．sRT-4DE）评价心肌梗死患者左室整体节段舒缩功能及室壁运动同步性,左室收缩缩功能对左心室室壁运动同步性的影响．方法　研究对象分为2组:心肌梗死组40例,其中陈旧性前壁心肌梗死15例;正常组30例,均行实时四维超声心动图检查,通过左室分析软件获得整体及节段容积一时间曲线及左室整体及节段收缩功能参数、左室收缩同步性参数．结果　心肌梗死组左室收缩未期容积（ESV）、左室舒张末期容积（EDV）显著大于正常组（P＜0.01）．左室射血分数（LVEF）显著小于正常组（P＜0.01）;心肌梗死组左室16节段收缩同步性参数显著大于正常组（P＜0.01）,其中SDI与LVEF的相关系数r＝-0.521,P＜0.01．与正常组相比,心肌梗死组16个节段的Dispes16、ESSI增大（P＜0.05）．结论　sRT-4DE能够准确评价心肌梗死患者左室收缩同步性及收缩功能,左室整体及节段收缩减退可影响左室室壁运动的同步性．     

黄芪注射液对老年急性心肌梗死早期患者左室重塑及心功能的影响

目的：观察黄芪注射液对老年急性心肌梗死（AMI）早期患者左室重塑和心功能的影响。方法：92例急性心肌梗死患者随机分为黄芪治疗组（治疗组，46例）和常规治疗组（对照组，46例），于治疗1周及4周后行超声心动图检查，测定左室舒张末容积指数、左室收缩末容积指数、左室前部内膜弧长和左室后部内膜弧长，同时治疗4周后行核素心血池心室造影，判断左室民缩与舒张功能。结果：治疗4周后，治疗组左室舒张末容积指数、左室收缩末容积指数和左室前部内膜弧长无明显提高，两组比较差异显著（P＜0．05）；治疗组左室射血分数、左室峰射血率及左室峰充盈率明显提高，左室峰充盈率时间缩短，与对照组比较差异显著（P＜0．05）。结论：黄芪注射液是阻抑老年AMI左室重塑、改善心脏功能的有效药物之一。     

氟伐他汀对心肌梗死后心衰大鼠内皮素-1表达的影响

目的探讨羟甲基戊二酰辅酶A（HMG-CoA）还原酶抑制剂氟伐他汀对急性心肌梗死后心衰大鼠内皮素-1（ET-1）表达变化的影响。方法雌性SD大鼠急性心肌梗死（AMI）术后6h随机分为心力衰竭对照组和氟伐他汀组,另设假手术组。直接灌胃给药8周后行高频多普勒超声、血流动力学、心脏重塑指标、左室非梗死区心肌ET-1mRNA表达的测定。结果与假手术组比较,心力衰竭对照组左室舒张末期内径（LVEDD）、左室舒张末期容积（LVEDV）、E峰、E峰减速度、E／A、左室舒张末压（LVEDP）、左右心室心肌肥厚指数、非梗死区胶原容积分数（CVF）和ET-1mRNA表达均显著增加（均P〈0．01）,左室短轴缩短率（FS）和射血分数（EF）均显著降低（均P〈0．01）。与心力衰竭对照组比较,氟伐他汀组的LVEDD、LVEDV、E峰、E峰减速度、E／A、LVEDP和左、右心室心肌肥厚指数、CVF和ET-1mRNA表达均显著降低（均P〈0．01）,FS和EF显著升高（均P〈0．01）。结论ET-1参与了心肌梗死后的心肌纤维化和心衰进展,氟伐他汀抑制心肌梗死后心肌纤维化和心衰进展的作用机制至少部分与其下调ET-1表达有关。     

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.