紫癜性肾炎患儿血清可溶性细胞间黏附分子-Ⅰ及血管内皮生长因子的临床意义

目的:探讨可溶性血管细胞黏附分子(sVCAM-1)与血管内皮生长因子(VEGF)在儿童紫癜性肾炎(HSPN)的变化及临床意义。方法:采用酶联免疫吸附法(ELASA)检测HSPN组59例,过敏性紫癜组55例,并选取HSPN患儿处于急性期35例,恢复期41例及68例健康对照儿童血清sVCAM-1、VEGF水平。结果:儿童紫癜性肾炎组血清sVCAM-1、VEGF水平较正常对照组均明显升高(P<0.001)。肾炎组血清sVCAM-1水平较单纯过敏性紫癜组明显升高(P<0.01),肾炎组较单纯过敏性紫癜组血清VEGF水平升高,但差异无显著意义(P>0.05)。儿童HSPN急性组血清sVCAM-1、VEGF水平明显高于恢复期和正常对照组(P<0.001)。恢复期组与正常对照组比较,sVCAM-1水平差异无统计学意义(P>0.05),而VEGF水平差异有显著性意义(P<0.01)。HSPN急性期血清sVCAM-1水平与VEGF水平呈显著正相关(P<0.01)。结论:sVCAM-1、VEGF参与了儿童紫癜性肾炎的发病过程,且反映其病情进展变化程度。     

过敏性紫癜患儿血浆血栓调节蛋白、血管性假血友病因子的变化及临床意义

目的 通过检测过敏性紫癜(HSP)患儿血浆血栓调节蛋白(TM)、血管性假血友病因子(vWF)的水平变化,探讨它们在过敏性紫癜发病机制中的作用及与紫癜性肾炎的关系. 方法随机选择笔者所在医院儿内科住院的患儿38例,应用酶联免疫吸附试验检测过敏性紫癜患儿急性期(38例)、缓解期(30例)及健康对照儿童(20例). 结果过敏性紫癜患儿急性期TM、vWF水平明显高于对照组(P均<0.01),也高于缓解组(P均<0.05),伴肾受累组vWF高于非肾受累组(P<0.05),而TM在两组之间无显著性差异(P>0.05),TM、vWF浓度之间呈正相关. 结论TM、vWF参与了过敏性紫癜疾病的病理生理过程,动态测定对过敏性紫癜尤其是紫癜性肾炎临床诊断、病情评估及指导治疗有一定帮助.     

过敏性紫癜患者一氧化氮及肿瘤坏死因子的检测及临床意义

目的 :探讨过敏性紫癜 (HSP)患儿一氧化氮 (NO)及肿瘤坏死因子 (TNF)的变化及其临床意义。方法 :采用改良的 Griess法、酶联免疫吸附试验 (ELISA)双抗体夹心法检测 32例 HSP患儿及 2 8例正常健康儿血浆中 NO及 TNF活性水平。结果 :HSP急性期血浆 NO及 TNF水平较正常对照组均明显升高 (P均 <0 .0 1 ) ,恢复期则接近正常 (P均 >0 .0 5)。急性期紫癜性肾炎 (HSPN)患儿血浆 NO及 TNF含量较同期单纯 HSP患儿血浆 NO及 TNF含量有所升高 ,但均达到显著差异。急性期 HSP患儿血浆 NO与 TNF呈显著正相关 (r=0 .835,P<0 .0 1 )。结论 :NO及 TNF均参与了 HSP发生发展过程     

过敏性紫癜急性期血浆白细胞介素-15水平的变化及意义

目的 探讨过敏性紫癜(HSP)患儿急性期血浆白细胞介素-15(IL-15)水平的变化及其意义.方法 以25例健康儿童为正常对照组,对61例HSP患儿急性期和缓解期血浆IL-15水平进行检测,并对不同临床类型间急性期血浆IL-15水平进行比较.血浆IL-15水平用双抗体夹心ELISA法检测.结果 ①HSP组急性期血浆IL-15水平为(17.5±10.2)ng/L,显著高于HSP组缓解期[(5.7±4.3)ng/L]和正常对照组[(4.2±3.5)ng/L],差异有极显著性意义(P＜0.01),而HSP缓解期与正常对照组间差异无显著性意义(P＞0.05);②急性期有、无肾损害者血浆IL-15水平分别为(29.1±16.5)ng/L和(10.5±7.4)ng/L,均极显著高于正常对照组(P均＜0.01);急性期有肾损害组血浆IL-15水平极显著高于无肾损害组(P＜0.01).结论 IL-15在HSP的发病机制特别是紫癜性肾炎的发生过程中起重要作用.     

血小板反应蛋白-1和血小板活化因子在川崎病中的变化及意义

目的: 探讨川崎病患儿血浆血小板反应蛋白 1(thrombospondin 1,TSP 1)、血小板活化因子(platelet activating factor,PAF)的变化及意义。方法: 收集川崎病患儿53例,按心脏超声检查显示的冠状动脉内径,分成冠状动脉损伤(CAL)组32例和非冠状动脉损伤(NCAL)组21例,均于急性期及恢复期采用ELISA法检测血浆TSP 1、PAF含量。另以20例健康儿童作为对照组。结果： 川崎病组患儿急性期血浆TSP 1浓度明显高于恢复期和对照组(P均＜0.05),而恢复期与对照组间差异无统计学意义(P＞0.05)。血浆PAF含量在川崎病组急性期、恢复期均显著高于对照组(P均＜0.05);急性期CAL组PAF含量显著高于NCAL组(P＜0.05)。 结论： 川畸病患儿血浆TSP 1和PAF含量与急性期炎症反应相关,PAF可作为预测冠状动脉早期损伤的实验室指标。     

血小板活化因子在川崎病中的变化及临床意义

目的 探讨川崎病患儿血浆血小板活化因子(PAF)的变化及其临床意义.方法 收集川崎病患儿40例(其中冠状动脉损伤组16例,无冠状动脉损伤组24例),按病程分为急性期和恢复期;20例健康儿童为对照组.测定其血浆PAF的含量.结果 川崎病组患儿急性期与恢复期PAF含量均高于对照组(P<0.05);急性期PAF含量高于恢复期(P<0.05).急性期冠状动脉损伤组PAF含量明显高于非冠状动脉损伤组(P<0.05).川崎病组患儿急性期PAF含量与冠脉扩张呈正相关.结论 血浆PAF可能参与了川崎病的病理生理过程,且可能与冠状动脉的损伤有一定的关系.     

HPS病儿急性期血浆IL-13和IL-15水平变化及意义

目的 探讨过敏性紫癜(HSP)病儿急性期血浆白细胞介素13(IL-13)和白细胞介素15(IL-15)水平的变化及其在HSP发病机制中的意义.方法 应用双抗体夹心ELISA法,对61例HSP病儿急性期血浆IL-13和IL-15水平进行检测,对不同临床类型HSP间血浆IL-13和IL-15水平进行比较,并以25例健康儿童作为正常对照组.结果 HSP病儿急性期血浆IL-13水平显著高于正常对照组(t′=5.49,P＜0.01).有、无肾损害组血浆IL-13水平皆高于正常对照组,差异有显著性(F=53.92,q=13.87、3.40,P＜0.01、0.05);有肾损害组显著高于无肾损害组(q＝11.86,P＜0.01).HSP病儿急性期血浆IL-15水平亦显著高于正常对照组(t′=8.98,P＜0.01);有、无肾损害组血浆IL-15水平均显著高于正常对照组,差异有显著性(F=40.45,q=12.18、3.46,P＜0.01);有肾损害组显著高于无肾损害组(q=9.95,P＜0.01).结论 HSP病儿急性期血浆IL-13和IL-15水平显著升高在HSP发病机制中有重要作用,而且与紫癜性肾炎的发生、发展关系密切.     

儿童过敏性紫癜血浆一氧化氮与内皮素-1变化的意义

目的：探讨内源性一氧化氮（NO）和内皮素-1（ET-1）在儿童过敏性紫癜（HSP）发病中的作用。 方法：对48例HSP患儿［紫癜性肾炎（HSPN）组21例,非肾脏受累（NHSPN）组27例］ 急性期、恢复期血浆NO、ET-1水平进行测定。 结果：HSP患儿急性期血浆NO、ET-1水平均明显高于恢复期及对照组（P<0.01）,尤以HSPN组升高更显著,与NHSPN组比较差异有显著性(P<0.05);急性期血压升高组NO/ET-1比值较血压正常组低（P<0.05）;恢复期非肾脏受累组NO、ET-1水平虽仍较对照组高,但差异无显著性（P>0.05）;HSPN组恢复期NO、ET-1水平虽较急性期下降,但仍明显高于对照组（P<0.05）,且NO/ET-1比值小于急性期;HSPN组和NHSPN组急性期和恢复期NO与ET-1呈明显正相关（HSPN组急性期r=0.7843,P<0.01,恢复期r=0.4920,P<0.01;NHSPN组急性期r=0.6831,P<0.01,恢复期r=0.6317,P<0.01）。 结论：NO、ET-1的水平可作为临床判定HSP患儿病情轻重、并发症的发生及预后的重要指标。     

过敏性紫癜患儿血浆中血栓调节蛋白水平的测定及意义

目的探讨过敏性紫癜（HSP）患儿血浆血栓蛋白（TM）水平的变化及意义。方法采用ELASA法测定42例确诊为HSP的惠儿急性期、恢复期及不同临床表现者（合并肾损害组与无肾损害组）的血浆TM水平。并与40例健康对照儿童进行比较。结果HSP患儿血浆TM水平在急性期为（7．49±1．95）μg／L、恢复期为（3．99±1．16）μg/L,均明显高于正常对照组（2．86±0．59）μg/L;急性期又明显高于恢复期。差异均有统计学意义（g值分别为15．38、18．63、4．50,P〈0．01）。急性期紫癜性肾炎患儿血浆TM水平较未合并肾脏损害的过敏性紫癜患儿升高更明显[（9．15±2．14）μg/L VS（6．65±1．19）μg/L]（t=4．077,P〈0．05）。结论血浆TM水平在HSP患儿急性期、尤其有肾脏损害时明显升高;血浆TM可能参与HSP血管内皮细胞受损的病理过程;动态检测血浆TM水平有助于观察病情、判断预后及指导治疗。     

儿童过敏性紫癜补体活性研究

目的探讨过敏性紫癜患儿在急性期和恢复期血清补体C3、C4活性。方法选取2009年10月～2011年11月我院接诊治疗的过敏性紫癜患儿97例为研究对象．按其临床表现分为皮肤型组、腹型组、肾型组、关节型组和混合型组;按照其病情进展分为急性期和恢复期,分别测定患儿的血清补体C3、C4水平。同时,与32例健康儿童组成的对照组同期测定的补体水平做对比分析。检测方法为应用美国Beckman—coulter公司的Array360型散射免疫比浊仪,采用免疫散射速率比浊法进行检测。结果过敏性紫癜患儿在急性期和恢复期血清补体C3、C4水平在不同临床分型组问差异无统计学意义（P〉0．05）;急性期、恢复期与对照组相比,血清补体C4水平差异无统计学意义（P〉0．05）;与对照组相比,急性期皿清补体C3水平降低（P〈0．05）,恢复期C3水平相对急性期升高,但仍较对照组低（P〈0．05）。结论不同临床分型过敏性紫癜患儿其血清补体水平无明显差异;而相对于健康患儿其急性期补体C3水平降低,恢复期相对同升,而血清补体C4水平无变化。     

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.