血清脂联素及CRP／APN比值的变化在腹部创伤患者病情监测中的意义

目的：探讨血清脂联素（ APN）及C反应蛋白（ CRP）与APN比值（ CRP／APN比值）的变化在腹部创伤患者病情监测中的意义。方法将本科室收治的80例腹部外伤患者依据AIS－ISS评分分为轻伤组及重伤组,将来本院体检的正常成年人30例作为对照组。分别于入院后即刻及第1 d、2 d、4 d、7 d共5个时间点,采用放射免疫法检测患者APN、CRP水平及CRP／APN比值,并同步进行全身炎症反应综合征（ SIRS）评分,对所得结果进行统计学分析及相关性分析。结果与对照组相比,轻伤组和重伤组患者的APN水平均明显降低（ P＜0.05）,重伤组APN水平明显低于轻伤组（ P＜0.05）;血清CRP与CRP／APN比值与SIRS评分呈正相关,相关系数分别为0.81（P＜0.05）和0.91（P＜0.05）,而APN水平与SIRS评分呈负相关（r＝－0.88,P＜0.05）。结论APN与CRP／APN比值可以作为评估腹部伤情严重程度的客观指标,有助于准确及时地评估病情。     

血清脂联素和C-反应蛋白监测在评估腹部创伤患者病情严重程度中的意义

目的:探讨血清脂联素(APN)和C-反应蛋白(CRP)监测在评估腹部创伤患者病情严重程度中的意义。方法:114例腹部创伤患者根据BIS-ISS评分分为轻伤组(n=65)和重伤组(n=49),分别于患者入院后24 h(T_1)、48 h(T_2)、72 h(T_3)和7 d(T_4)检测患者血清中APN和CRP水平,并计算CRP/APN值,评估患者SIRS评分。结果:轻伤组和重伤组患者T_(1~4)时APN较T_0时降低,而CRP和SIRS评分均较T_0时升高,T_(2~4)时CRP/APN值均较T_0时升高(P<0.05);轻伤组和重伤组患者T_(0~4)时APN均低于对照组,而CRP/APN值均高于对照组,T_(1~4)时CRP高于对照组,差异均有统计学意义(P<0.05);轻伤组患者T_(1~4)时APN均高于重伤组,而SIRS评分均低于重伤组,T_(2~4)时CRP和CRP/APN值均低于重伤组,差异均有统计学意义(P<0.05);腹部创伤患者血清APN水平与SIRS评分呈负相关(r=0.764,P<0.05),而CRP水平和CRP/APN值与SIRS评分均呈正相关(r=0.692和0.914,均P<0.05);ROC曲线分析显示,APN预测SIRS的曲线下面积0.648,灵敏度73.5%,特异度81.6%,CRP分别为0.567、69.2%和77.3%,CRP/APN值分别为0.879、88.3%和92.3%。结论:腹部创伤患者血清APN和CRP水平及其比值均发生变化,可作为客观评估患者全身炎症反应程度及病情严重程度的指标。     

急性脑梗死患者血清脂联素与神经功能缺损程度的相关性

目的 研究血清脂联素(APN)水平与急性脑梗死患者神经功能缺损程度的相关性.方法 测定55例急性脑梗死患者及51例健康对照者的APN、同型半胱氨酸(Hcy)、C反应蛋白(CRP),并分析治疗前、治疗3个月后APN水平与脑梗死患者神经功能缺损程度的相关性.结果 脑梗死组与对照组治疗前、治疗3个月后APN比较差异有统计学意义(P<0.05);Hcy治疗前后两组比较差异无统计学意义(P>0.05);CRP治疗前后两组比较差异无统计学意义(P>0.05).APN降低、Hcy和CRP升高均是脑梗死的危险因素.治疗前APN与神经功能缺损程度呈负相关(r=-0.69,P<0.01),治疗3个月后APN与神经功能缺损程度也呈负相关(r=-0.71,P<0.01).结论 APN水平与急性脑梗死神经功能缺损程度可能具有相关性.     

创伤性骨折患者血浆D-二聚体水平表达及其临床意义

目的 分析创伤性骨折患者血浆D-二聚体(D-dimer,D-D)水平表达及其临床意义,旨在为评判创伤性骨折患者病情程度及预后效果提供理论依据.方法 选取本院2018年12月至2019年12月收治的78例创伤性骨折患者作为研究对象,按照创伤程度分为轻伤组(n=30)、重伤组(n=26)与危重伤组(n=22),另选取同期于本院行健康体检者40名作为对照组.比较4组血浆D-D水平,分析其与骨折创伤程度相关性.结果 对照组D-D水平为(185.23±63.25)μg/L,轻伤组D-D水平为(304.52±83.71)μg/L,重伤组D-D水平为(483.76±123.74)μg/L,危重伤组D-D水平为(532.75±136.82)μg/L;危重伤组D-D水平最高,依次为重伤组、轻伤组,对照组水平最低,差异有统计学意义(F=79.842,P<0.001).经一般线性双变量Person相关性分析检验得知,D-D水平与创伤性骨折患者创伤程度呈正相关(r=0.826,P=0.000).结论 创伤性骨折患者血浆D-D水平与创伤严重程度呈正相关,血浆D-D水平对评判创伤性骨折患者病情的严重程度和预后具有重要意义,对预估患者病情及预后效果具有较高临床价值.     

血浆脂联素和B型钠尿肽水平在慢性充血性心衰患者心功能评价中的应用价值

目的:探讨血浆脂联素(APN)和B型钠尿肽(BNP)水平检测在慢性充血性心力衰竭(CHF)患者心功能评价中的临床应用价值,为其临床研究提供可参考依据.方法:共纳入120例诊断为CHF患者作为病例组,同时从门诊随机抽取35例无心脏疾病史的人群作为对照组.病例组患者于治疗前、治疗后3周,对照组于纳入本研究当日抽取空腹肘正中静脉血,采用双抗体夹心ELISA法检测APN和BNP水平,分析其与CHF患者心功能等级的关系.结果:与对照组相比,心功能Ⅱ～Ⅳ级患者血浆APN、BNP水平均明显比较高,差异比较有统计学意义(P＜0.05);对NYHA不同等级间血浆APN、BNP水平分析发现,随着心功能等级的增高,其血浆APN、BNP水平逐渐上升,差异比较亦有统计学意义(P＜0.05).与治疗前相比,治疗后所有患者血浆APN、BNP水平均有明显下降,两者相比差异有统计学意义(P＜0.05).进一步行相关性分析显示,血浆APN、BNP水平随着CHF患者NYHA等级的升高而上升,相关系数r分别为0.986、0.977(P＜0.01),呈明显正相关.结论:APN和BNP水平检测在CHF患者心功能评价中有重要的临床应用价值,其可以随着心功能严重程度的增加而增加,因此APN和BNP水平的检测可以更好了解患者病情的发展及转归.     

脂联素等与慢性阻塞性肺病相关肺动脉高压的相关性研究

目的观察慢性阻塞性肺病（COPD）合并肺动脉高压（PH）和COPD非PH患者血浆脂联素（APN）、血清肿瘤坏死因子α（TNF-α）和C反应蛋白（CRP）的水平,探讨炎症反应在COPD相关PH发病机制中的意义。方法将60例COPD急性加重期患者,根据超声心动图拟诊PH的标准为肺动脉收缩压（PASP）≥40 mmHg,分为COPD合并PH组和COPD非PH组各30例,2组均给予吸氧、抗感染、止咳化痰、平喘等常规对症治疗[平均住院日（13.10±3.20）d,（13.27±4.36）d]。选择同期健康体检者22例。应用酶联免疫吸附法（ELISA）测定血浆APN和血清TNF-α水平,免疫比浊法测定血清CRP,比较3组间血浆APN、血清TNF-α和CRP水平,且观察COPD非PH组和COPD合并PH组治疗前后上述指标的变化,并将血APN、TNF-α和CRP水平与PASP进行相关性分析。结果 COPD非PH组和COPD合并PH组血浆APN、血清TNF-α和CRP水平均较对照组明显升高,差异有统计学意义（P〈0.05）;且COPD合并PH组明显高于COPD非PH组（P〈0.05）。与治疗前比较,COPD非PH组与PH组治疗后的PASP、血浆APN、血清TNF-α和CRP水平均明显降低（P〈0.05）。PH组治疗后血浆APN、血清TNF-α和CRP水平明显高于COPD非PH组,差异有统计学意义（P〈0.05）。COPD合并PH组治疗前后血浆APN、血清TNF-α和CRP水平分别与PASP呈正相关（r分别为0.744、0.614、0.482、0.627、0.538、0.493,P〈0.05）。结论血浆APN、血清TNF-α和CRP水平的升高与COPD相关PH患者的PASP的升高相关,说明APN、TNF-α和CRP可能参与COPD相关PH的形成过程。     

急性脑梗死患者C反应蛋白水平与病情严重程度的关系

目的：探讨急性脑梗死患者血清C反应蛋白（CRP）水平与急性脑梗死病情严重程度的关系。方法：测定64例急性脑梗死患者和30名健康人的血清CRP的含量,分析CRP与急性脑梗死患者病情和危险因素的相关性。结果：急性脑梗死组血清CRP水平明显高于正常对照组（P〈0.01）,急性脑梗死患者不同临床分型组间血清CRP水平比较,重型组明显高于中型、轻型组,差异均有显著性（P〈0.05）,急性脑梗死患者血清CRP含量与病情的严重程度呈正相关。结论：血清CRP水平增高与急脑梗死的发生和严重程度有密切关系,是脑梗死发病的一个危险因素。     

慢性心力衰竭患儿脂联素水平及与BNP水平相关性研究

目的 探讨慢性心力衰竭患儿血浆脂联素(APN)水平,并与B型脑钠肽(BNP)、C反应蛋白(CRP)、心功能分级进行相关性分析.方法 连续入选2013年1月—2015年1月我院确诊为慢性心力衰竭的住院患儿40例,同时选取健康对照45例作为对照组.采用ELISA法测定血浆中APN、BNP、CRP水平,采用快速免疫分析仪进行肌钙蛋白I测定.结果 与对照组相比,CHF组APN、BNP、CRP、 肌钙蛋白水平明显升高,CHF组LVEF值明显降低,差异有统计学意义(P<0.05),随着NYHA分级的增高,血浆APN、BNP、CRP水平逐渐升高(P均<0.01).Spearman等级相关分析结果 显示:血浆APN、BNP、CRP水平高低与心功能分级呈正相关(P<0.01).Pearson相关分析结果 显示:血浆APN水平与BNP水平呈正相关(P<0.01).结论 慢性心力衰竭患儿血浆APN、BNP及CRP水平明显升高,并且与心功能分级呈正相关,血浆APN与BNP呈正相关.APN检测为心力衰竭的诊断及病情的评估提供了一个新的思路.     

老年社区获得性肺炎中D二聚体、C反应蛋白、血沉检测的临床意义

目的探讨血浆D二聚体(D-D)、C反应蛋白(CRP)和血沉(ESR)水平与老年社区获得性肺炎(CAP)严重程度的关系。方法收集130例老年CAP患者的临床资料,按不同的病情严重程度评分标准对患者进行分组,分别测定患者血浆D-D、CRP、ESR水平,分析其在不同分组间的差异。结果不同肺炎严重度指数(PSI)分级间、不同CURB-65分组间D-D、CRP水平比较差异均有统计学意义(P0.05),重症肺炎组D-D、CRP水平均显著高于非重症肺炎组(P0.01)。ESR水平在以上不同分组间比较差异均无统计学意义(P 0.05)。血浆D-D与CRP水平显著相关(r=0.368,P0.01)。结论血浆CRP、D-D与CAP的严重程度有一定的相关性。     

脂联素及高敏C反应蛋白与急性脑梗死预后的相关性研究

目的 探讨急性脑梗死患者血浆脂联素(adiponectin,APN)及高敏C反应蛋白(high-sensitive C-reactive protein,Hs-CRP)水平变化与预后的相关性。方法 147例急性脑梗死患者采用头颅MRI的DWI计算梗死容积,进一步分为大、中、小梗死组,分别在治疗前、治疗第7天、第14天测定APN与Hs-CRP,同时进行临床神经功能损害程度评价,对结果进行分析。结果 随着梗死容积增大,APN降低,Hs-CRP升高,经过治疗逐渐恢复。随着梗死容积增大,NIHSS逐步升高,BI逐渐下降,治疗后NIHSS明显下降而BI明显升高。随着梗死容积增大,APN降低而Hs-CRP升高,同时NIHSS升高而BI降低。APN与NIHSS呈负相关,APN与BI呈正相关,Hs-CRP与NIHSS呈正相关,Hs-CRP与BI呈负相关。结论 血浆APN、Hs-CRP水平与脑梗死病情的严重程度密切相关,定期检查APN、Hs-CRP对评估脑梗死的预后很有价值。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.