阿尔茨海默病和轻度认知损伤诊断的逐步Fisher判别模型

目的 建立正确率较高的阿尔茨海默病和轻度认知损伤的诊断模型.方法 通过对391例包括正常人、阿尔茨海默病患者以及轻度认知损伤患者的33项临床指标的研究,运用逐步Fisher判别进行诊断模拟,选出正确率最高的判别函数.结果 筛选出6项指标建立了阿尔茨海默病以及轻度认知损伤诊断模型.经过100次随机抽样诊断模拟,对于正常人、轻度认知损伤以及阿尔茨海默病患者诊断的平均正确率达到75.50％,最高正确率达到80.63％.结论 逐步Fisher判别诊断模型能提高阿尔茨海默病以及轻度认知损伤的诊断正确率,为科研和临床诊断提供了一种新途径.     

轻度认知功能障碍患者预后情况的评估预测模型

目的 通过数学方法建立轻度认知功能障碍患者24个月预后的判别评估模型.方法 通过对152例轻度认知功能障碍患者的27项临床指标的分析,分别运用贝叶斯判别分析、决策树、BP神经网络、模糊C均值聚类及K均值聚类进行评估预测,选择准确率较高的判别模型.结果 通过差异性检验,根据P＜0.01共筛选出6项指标,建立5种评估预测模型,经过100次随机抽样诊断模拟,得到贝叶斯判别分析在轻度认知功能障碍患者预后评估的平均正确率达74.86％,最高正确率达到84.21％.结论 本研究建立的数学模型能提高轻度认知功能障碍患者24个月预后的评估准确率.     

Bayes判别分析对输卵管妊娠早期诊断价值的探讨

目的 探讨利用Bayes判别分析进行输卵管妊娠早期诊断方法的价值。方法 以经手术和病理诊断为未破裂的输卵管妊娠的病例620例为病例组研究对象,同期收治早期宫内妊娠流产者890例为对照组研究对象,对有关临床、生物化学与形态学指标进行分析,利用Bayes判别分析的方法进行指标筛选、建立诊断模型,进行输卵管妊娠的早期诊断。结果 采用Bayes判别分析法建立诊断模型,经交互验证考核判别函数对输卵管妊娠的判别正确率达99．68％,对先兆流产的判别正确率达80．00％,对异常宫内妊娠的判别正确率达93．18％,总正确率达91．9％。经自身验证考核对输卵管妊娠的判别正确率达99．68％,对先兆流产判别正确率达80．00％,对异常宫内妊娠的判别正确率达95．45％,总正确率达92．6％。结论 通过临床、生物化学和形态学指标建立模型对输卵管妊娠早期诊断效果较好。     

兔血液凝血功能诊断的逐步判别与分析

目的 测定兔胸部不同程度撞击伤后凝血指标的变化,并对传统的活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)和纤维蛋白原(FIB)含量等指标进行筛选.方法 用相关分析做数据预处理剔除指标,再用逐步判别分析(stepwise diseriminant analysis,SDA)选人指标,并用多元线性判别分析诊断,最后随机抽样比较剔除指标前后的诊断效果.结果 用逐步判别分析法选人4项指标,判别正确率达87.60%;剔除指标FIB后,判别正确率达96.12%;1 000次抽样诊断检验,4项指标和3项指标的平均诊断正确率分别为83.07%和85.16%.结论 逐步判别分析可有效判别兔血液出、凝血功能状况,剔除指标FIB后诊断正确率略有提高.     

多类判别分析在肺心病酸碱失衡临床诊断中的应用研究

本文将165例慢性肺心病酸碱失衡患者的各项检测结果用IBM-PC/AT型微型计算机进行资料处理。对各变量用单因素方差分析进行6组间显著性检验后,将13个变量引入多类判别模型,经逐步筛选进行多类判别分析得出一组判别函数Y值(Y_1,Y_2…Y_6)。同时对本研究所建立的判别函数进行判别效果检验,结果表明原临床诊断与计算机诊断符合率为80.39％。木文试图用多类判别分析方法得出判别酸碱失衡类型的数学模型,以期应用于今后的临床分型。     

肺癌标志物的多元分析模型及其在肺癌临床诊治中的应用

目的:研究17种肺癌标志物在肺癌临床诊治中的应用价值.方法:对肺癌患者、肺部良性疾病患者及健康对照人群各40例,测定血清中17种肺癌标志物的水平并用多元逐步回归方法进行筛选,在综合分析17种肺癌标志物间的相互作用后,淘汰价值较小的标志物,最后用判别分析的方法建立相应的判别函数式.结果:第一次共筛选出NSE、CYFRA21-1,SIL-2R、CEA、SF、CA125、SA、SOD等8个指标,用判别函数进行判断其诊断准确性为75.83%,进一步筛选,又剔出SIL-2R,SF,CA125,SA等4个影响较小的因素后其诊断准确性达到98.3%.结论:用y=0.1259(NSE)+0.3737(CYFRA21-1)+0.18492(CEA)+0.12993(SOD)判别函数作为肺癌的辅助诊断方法及治疗后的疗效观察指标有较高的临床应用价值.     

肺癌标志物的多元分析模型及其在肺癌临床诊治中的应用

目的：研究17种肺癌标志物在肺癌临床诊治中的应用价值。方法：对肺癌患者、肺部良性疾病患者及健康对照人群各40例，测定血清中17种肺癌标志物的水平并用多元逐步回归方法进行筛选，在综合分析17种肺癌标志物间的相互作用后，淘汰价值较小的标志物，最后用判别分析的方法建立相应的判别函数式。结果：第一次共筛选出NSE，CYFRA21-1，SIL-2R、CEA、SF、CAl25、SA、SOD等8个指标，用判别函数进行判断其诊断准确性为75．83％，进一步筛选，又剔出SIL-2R，SF，CAl25，SA等4个影响较小的因素后其诊断准确性达到98．3％。结论：用y=0．1259(NSE) 0．3737(CYFRA21-1) 0．18492(CEA) 0．12993(SOD)判别函数作为肺癌的辅助诊断方法及治疗后的疗效观察指标有较高的临床应用价值．     

组合临床常用非创伤性检查方法探索建立肝硬化早期诊断的数学模型

目的联合运用血清肝纤维化标志物透明质酸HA、血白球蛋白比例A／G测定与B超检查等临床常用的几种非创伤性检查方法，寻找与病理诊断结论相符或具有病理诊断价值的检查方法组合，初步探索建立在对慢性肝病患者的肝硬化诊断价值方面与肝组织病理活检具有等价效应的判别函数数学模型。方法以进行过病理检查的慢性乙肝患者为研究对象进行病例对照研究，应用统计学方法对临床资料进行分析，筛选与病理诊断肝硬化密切相关的因素变量，以这些变量为基础进行统计学判别分析，建立可用来判断慢性肝病患者发生肝硬化的判别函数的数学模型。结果以肝活检病理组织检查作为诊断肝硬化的病例对照标准，通过多变量分析显示，在本研究所涉及的与肝硬化病理诊断有关的几种因素中，血HA异常升高达250ng／ml以上，白／球蛋白比例倒置小于1，B超诊断肝硬化等三个因素与病理诊断肝硬化关系最为密切；判别分析显示，以此三因素进行判别分析所建立的判别函数可正确判断慢性肝病患者中肝硬化的发生，对病理诊断肝硬化的判别结果与本资料原分类的判对符合率达91．1％。结论结合HA异常升高、白球蛋白比例倒置、B超诊断肝硬化等变量所建立的判别函数对慢性乙肝患者进行综合判断，诊断肝硬化的价值可与病理组织诊断相比，是用非创伤性检查方法诊断肝硬化的可行性选择。     

应用Bayes准则下的逐步判别进行缺血性中风的先兆报告

运用Bayes准则下的逐步判别分析方法及电子计算机技术对缺血性中风的先兆报告因子进行了筛选,建立起较为“精炼”的判别函数式,回代总符合率达88.78％。     

血清多肿瘤标志物判别方程建立及其对胃癌诊断与分类的意义

目的 探讨多肿瘤标志物联合检测系统在胃癌诊断中的意义,建立联合诊断胃癌的判别诊断函数,以提高多肿瘤标志物诊断胃癌的准确率.方法 对170例胃癌患者、112例胃部良性疾病患者及1 203名正常体检者的12种常见肿瘤标志物检测结果及临床资料进行回顾性研究,分析比较单项指标及联合指标的阳性率,通过Fisher二分类判别分析建立判别诊断方程.结果 用C-12芯片检测胃癌的灵敏度是50.00%,显著高于胃良性病变患者(34.82%)和健康体检者(10.59%) (P<0.05),有诊断意义的指标是CA19-9、CEA、CA125、CA242和HGH(P<0.05),前面3项指标联合检测的敏感度为44.12%,正确率为59.22%.建立胃癌诊断判别方程及分类诊断方程,胃癌诊断符合率为80.10%.结论 用C-12多肿瘤标志物蛋白质芯片检测胃癌可提高诊断的灵敏度,优于单项肿瘤标志物;诊断判别函数可明显提高胃癌诊断的正确率,具有一定的临床参考价值.     

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.     

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.