直接支架植入术对冠脉循环白细胞及血小板功能的影响

目的探讨直接支架植入术对冠脉循环白细胞及血小板功能的影响。方法46例行PCI术的单支病变患者,随机选择进行直接支架植入及预扩张后植入支架各23例,分别于术前,术后10min,术后6h取冠状窦血待测,流式细胞术检测中性粒细胞表面CD11b/CD18表达,放免法检测血浆血小板GMP-140及TXB2浓度。结果两组术后10min中性粒细胞表面CD11b/CD18表达及血浆血小板GMP-140及TXB2浓度均较术前有明显升高(P<0.05)。术后6h两组中性粒细胞表面CD11b/CD18表达均较术前有明显升高(P<0.01),预扩张组更为明显(P<0.05),血浆血小板GMP-140及TXB2浓度与术前比较差异无显著性。结论直接支架术对白细胞激活较预扩张后植入支架弱,提示直接支架术对血管内皮损伤较轻。     

后扩张球囊在心脏冠状动脉内支架术中的应用效果研究

目的探讨后扩张球囊在心脏冠状动脉内支架术的应用效果。方法选取于我院行心脏冠状动脉内支架术的患者84例为研究对象,其中42例患者术后行高压球囊后扩张为观察组,其余42例为对照组。术后查看支架情况,测量患者的最小管腔面积(MSA),并对比两组患者治疗后的支架膨胀程度和支架内是否血栓。结果两组患者治疗前的膨胀程度差异不大。治疗后,行球囊后扩张术的观察组患者的膨胀程度远高于对照组,差异有统计学意义(P<0.05)。另外,观察组的血栓发生率为4.76%,远低于对照组的21.43%,差异有统计学意义(P<0.05)。结论后扩张球囊用于心脏冠状动脉内支架术后,可以增大支架的膨胀程度,减少支架内再狭窄,对提高患者的预后效果意义重大。     

择时冠状动脉内支架治疗不稳定型心绞痛临床效果观察

目的：观察早期冠状动脉内支架植入术与延迟支架植入术治疗不稳定型心绞痛的临床效果。方法选择我院收治的80例不稳定型心绞痛患者为研究对象,随机分为对照组和观察组各40例。对照组入院后7~10 d行支架术,观察组入院后48 h内行支架术。比较两组患者的手术成功率、再狭窄发生率及治疗前后冠状静脉窦NO水平变化情况。结果观察组手术成功率(92.5%)明显高于对照组(75.0%),随访再狭窄发生率(2.5%)明显低于对照组(20.0%),观察组术后即刻及术后6 h的NO水平分别为(54.2±12.3)μmol/L和(70.5±13.5)μmol/L,均明显低于对照组的(84.6±13.1)μmol/L和(93.6±12.8)μmol/L,以上各项指标比较差异均有统计学意义(P<0.05)。结论选择早期冠状动脉内支架植入术治疗不稳定型心绞痛成功率高,再狭窄发生率低,治疗后冠状静脉窦NO水平下降显著,值得临床推广应用。     

多个药物支架植入安全性和可行性的临床研究

目的 评估多药物支架植入术的近期疗效及安全性.方法 对我院从2004年6月到2005年12月共34例多个药物支架(≥3枚)植入术进行回顾性分析,对照组为单个支架植入组(n=64)和两支架植入组(n=53),随访术后6月冠状动脉内急性及亚急性血栓形成的发生率、再狭窄和心血管事件的发生率.结果 151例患者PCI治疗均成功.介入治疗1个月随访结果显示,多支架组、两支架组及单支架组均没有发生冠状动脉内血栓形成(P＞0.05),介入治疗6个月随访结果显示,再狭窄及心血管事件发生率均无统计学差异(P＞0.05).结论 多个药物支架植入治疗,并不增加近期血栓形成和心血管事件的发生率.     

血管内支架成形术治疗颈动脉狭窄后血小板活化功能变化的观察

目的研究颈动脉狭窄支架植入治疗对患者活化血小板的影响。方法选择临床表现和神经影像学检查符合北美症状性颈动脉内膜剥脱试验（NASCET）纳入标准的患者34例,脑血管造影明确诊断后行颈动脉自膨胀支架植入治疗,术前、术后口服阿斯匹林及氯吡格雷抗栓治疗,并在术前及术后检测患者血小板活化程度,定期随访。结果颈动脉狭窄支架植入治疗后2周内患者CD62P和CD63水平较术前明显增高（均P〈001）,3个月后复查下降至术前水平,两者之间相比较无统计学差异（均P〉0．05）。与无狭窄组相比,再狭窄组CD62P和CD63水平升高更明显（均P〈0.05）,CD63升高持续时间更长。结论支架植入治疗后急性期存在血小板过度活化状态,且有一定的再狭窄率,这可能是急性期血栓形成及血管内再狭窄的因素之一,应予强化抗血小板治疗。     

丹红注射液防治冠脉支架术后再狭窄的临床观察

目的探讨丹红注射液对冠心病患者冠脉支架植入术后再狭窄(in.stent restenosis,ISR)的影响。方法 78例实施经皮冠状动脉介入(percutaneous comnary inte nrernjon,PCI)治疗的冠心病患者,随机分为丹红治疗组(n=32)和对照组(n=46),对照组常规采用肠溶阿司匹林片和氯比格雷片口服,治疗组在此基础上静脉滴注丹红注射液,术后6个月常规行冠状动脉造影(cAG),比较两组支架植入术后再狭窄率的差别。结果 CAG示:治疗组冠脉支架术后再狭窄率明显低于对照组,两组相比差异有统计学意义(P<0.01),无论是普通支架亚组还是药物涂层支架亚组(DES)均有相似的结果(P均<0.01)。两组均无严重不良反应发生。结论丹红可明显降低冠脉支架术后再狭窄率,安全性良好。     

心脉通1号对冠状动脉内支架植入后再狭窄作用的研究

目的用中药心脉通1号（瓜蒌通脉丸）对冠状动脉内支架血栓、支架内再狭窄（RS）的作用进行研究。方法将100例冠心病支架置入成功的患者,随机分为支架术常规用药组（对照组）50例,心脉通1号联合组（治疗组）50例,应用全血流式细胞术检测血小板膜糖蛋白中活化的GPⅡb/Ⅲa（PAC—1）、P-选择素（CD62P）以及用荧光散射比浊法测血浆纤维蛋白原（Fg）,采用免疫透射浊度法测血浆高敏C反应蛋白（hs-CRP）的变化。观察比较支架术后冠脉事件发生情况及中医证候的变化。结果两组术前PAC—1、CD62P、Fg及CRP水平,差异无显著性（P〉0.05）,两组术后与术前比较,以上指标均有明显上升,差异有显著性（P〈0.01）,术后30d两组以上指标较本组术后均有明显下降,差异有显著性（P〈0.01）,术后30d时中药组CRP下降较常规组明显,差异有显著性（P〈0.05）。结论心脉通1号联合治疗在降低支架内再狭窄的发生方面优于阿司匹林和氯吡格雷,可能心脉通1号具有抑制血小板活化、抑制炎症反应的作用。     

阿司匹林联合欣维宁预防PCI术后亚急性血栓形成研究

目的观察阿司匹林、氯吡格雷、肝素联合国产血小板GPⅡb/Ⅲa受体拮抗剂预防冠状动脉支架术后亚急性血栓形成的效果。方法自2006年8月～2007年2月以46例冠心病心绞痛患者,共置入50枚支架作为普通治疗组,此外以20例ACS患者,共置入支架25枚作为实验组,比较效果。结果普通治疗组46例患者中有1例在术后3d发生心绞痛,冠脉造影示前降支支架远端有新鲜血栓,给予国产血小板受体拮抗剂盐酸替罗非班治疗,先以10!g/kg的剂量大于3min静脉注射治疗,5min后造影血栓消失。实验组随诊3月未见亚急性血栓形成。结论阿司匹林、氯吡格雷、肝素、国产血小板GPⅡb/Ⅲa受体拮抗剂联合疗法对预防冠状动脉支架术后(尤其是高危患者)亚急性血栓形成安全有效。     

强化抗血小板干预对老年冠心病患者血小板聚集率及血栓事件的影响

目的支架术后双抗血小板治疗1年与2年对老年冠心病患者血小板聚集率及血栓事件的影响。方法选取我院2012年3月至2013年3月300例老年冠心病患者为研究对象,随机分为A组与B组,每组150例。所有患者均随访2年,随访成功率为100%。A组给予支架术后双抗血小板治疗1年,B组给予支架术后双抗血小板治疗2年,其中A组根据植入支架不同分为A_1组(Excel国产支架)与A_2组(XinCEV均衡进口支架),每组75例。其中B组根据植入支架不同分为B_1(Excel国产支架)与B_2组(XinCEV均衡进口支架)。比较A、B组主要心血管(MACE)事件发生率,血小板聚集率及心源性猝死、心梗、靶血管再次PCI及出血事件。比较A1组与B1组MACE事件及A_2组与B_2组MACE事件。结果 A、B组治疗前,随访1、2年后,血小板聚集率比较无统计学意义(P0.05)。A组MACE事件发生率18.00%高于B组8.67%(P0.05);A、B组出血发生率比较无统计学意义(P0.05)。A_1组MACE事件发生率24.00%高于B1组9.33%(P0.05)。A_2组与B_2组MACE事件发生率比较无统计学意义(P0.05)。结论支架术后双抗血小板治疗2年与双抗血小板治疗1年比较,发生出血事件没有增多,可进一步有效降低MACE事件发生率,亚组分析中不同支架双抗血小板治疗1年与2年组比较有差异,本研究中进口支架XinCEV双抗血小板治疗1年与2年组比较无差异,提示此组支架抗栓1年治疗时间已经足够,而国产支架Excel需要更长疗程的双抗血小板治疗。     

丹参片对冠状动脉药物支架术后患者远期预后的临床研究

[目的]观察丹参片对冠状动脉药物支架术后患者远期预后的影响。[方法]80例冠脉动脉药物支架术后1年的患者随机分为对照组与治疗组,治疗组在服用规范西药治疗基础上加服丹参片6个月,随访两组的临床终点事件。[结果]术后再梗率、PCI术、CABG术、心源性疾病住院率、术后脑中风中,两组间（P〉0.05）无统计学意义。然心功能衰竭发生率、心功能分级、心绞痛分级、自觉疗效（P〈0.05）有统计学意义,其中心绞痛分级（P〈0.01）有显著统计学意义。[结论]丹参片对冠状动脉药物支架术后患者有远期疗效。     

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.