子痫前期患者母胎循环肝细胞生长因子检测及其意义

目的探讨子痫前期母胎循环肝细胞生长因子(HGF)对子痫前期发病的影响。方法采用酶联免疫吸附法测定33例子痫前期孕妇(子痫前期组)和32例正常妊娠孕妇(对照组)外周血、脐静脉血清HGF水平。结果子痫前期组孕妇外周血HGF水平为(142.9±87.64)pg/ml,明显低于对照组的(207.6±110.55)pg/ml(t=2.487,P<0.05);子痫前期组孕妇脐静脉血HGF水平为(13.2±6.28)pg/ml,与正常对照组(16.5±8.22)pg/ml比较差异无统计学意义(t=1.546,P>0.05)。轻度和重度子痫前期孕妇外周血、脐静脉血HGF水平差异均无显著性意义(t=0.382、0.747,均P>0.05)。结论外周血HGF下降可能是子痫前期重要的发病机制之一。     

妊娠期高血压疾病患者血清脂联素、瘦素水平的变化及其临床意义的研究

目的 探讨妊娠期高血压疾病患者血清脂源性细胞因子(脂联素、瘦素)水平的变化及其意义.方法 以53例妊娠期高血压疾病孕妇为研究组(其中轻度子痫前期32例、重度子痫前期21例),20例同期分娩的正常孕妇为对照组.采用ELISA法检测血清脂联素和瘦素水平.同时检测血清三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平.结果 轻度、重度子痫前期患者血清脂联素水平分别为(8.88±4.67)μg/mL及(5.14±2.79)μg/mL,明显低于对照组(11.61±2.90)μg/mL,差异有统计学意义(P＜0.01).而轻度、重度子痫前期患者血清瘦素水平为(21.79±15.19)ng/mL及(27.27±18.38)ng/mL,明显高于对照组(12.35±6.51)ng/mL,差异有统计学意义(P＜0.05,P＜0.01).妊娠期高血压疾病患者血清脂联素与TG、TC、LDL-C和HDL-C均呈显著相关(r值分别为-0.658、-0.624、-0.419和0.461),瘦素水平也与上述指标呈显著相关(r值分别为0.534、0.707、0.418和-0.513).妊娠期高血压疾病患者血清脂联素及瘦素水平呈高度负相关(r =-0.760,P＜0.01).结论 脂联素、瘦素等脂源性细胞因子在妊娠期高血压疾病的发病中可能发挥一定的作用.     

妊娠期高血压疾病中血清可溶性肝X受体α水平的变化

目的检测正常妊娠和妊娠期高血压疾病患者血清中肝X受体α的水平,探究肝X受体α与妊娠期高血压疾病的发病关系及意义。方法采用酶联免疫吸附双抗体夹心法(ELISA)检测44例妊娠期高血压疾病患者(妊娠期高血压15例、轻度子痫前期14例、重度子痫前期15例),16例正常晚期妊娠妇女和22例正常中孕妇女血清中肝X受体α水平。结果妊娠期高血压疾病组血清中肝X受体α浓度为(4.67±2.12)μg/ml,正常晚期妊娠组为(2.79±0.87)μg/ml,两组比较差异有统计学意义(P<0.05)。妊娠期高血压、轻度子痫前期、重度子痫前期患者血清中可溶性肝X受体α水平逐渐升高[分别为(3.57+0.86)μg/ml,(4.48+0.92)μg/ml,(6.05+3.12)μg/ml],各组间差异有统计学意义(P<0.05)。正常中期妊娠组血清中肝X受体α浓度与正常晚期妊娠组比较差异无统计学意义。结论血清肝X受体α水平升高可能与妊娠期高血压疾病的发病及病情发展有关,有可能成为疾病的预测指标。     

血清NGAL及Cys C对子痫前期的诊断价值

目的：探讨检测血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和胱抑素（Cys C）对子痫前期的诊断价值。方法：妊娠期高血压疾病患者160例,其中妊娠期高血压54例,子痫前期轻度52例,子痫前期重度54例,选择同期孕前检查正常孕妇160例为对照组,比较各组孕妇血清NGAL和Cys C水平。结果：160例妊娠期高血压疾病患者血清NGAL及Cys C水平分别为36.24±8.58 μg/L和1.78±2.03 mg/L,高于对照组的21.26±3.78 μg/L和1.05±0.14 mg/L,差异均有统计学意义（P<0.05）。妊娠期高血压疾病各组间比较,血清NGAL及Cys C水平子痫前期重度组>子痫前期轻度组>妊娠高血压组,差异均有统计学意义（P<0.05）。结论：联合检测血清NGAL及Cys C水平有助于子痫前期早期诊断和区分妊高症病情严重程度。     

缺氧诱导因子在妊娠高血压疾病胎盘中的表达

目的　研究缺氧诱导因子-1α在妊娠期高血压疾病患者胎盘组织中的表达,及其在妊娠期高血压 疾病发病机制的作用。方法　采用免疫组化法检测55例妊娠期高血压疾病患者(高血压组)及正常10例孕妇(正 常组)的胎盘组织中缺氧诱导因子-1α蛋白的表达。其中高血压组包括妊娠期高血压15例,轻度子痫前期15例, 重度子痫前期15例,子痫患者10例。结果　子痫患者胎盘缺氧诱导因子-1α阳性表达率为80.6%,光密度值为 219.60±26.70;重度子痫前期阳性表达率为79.3%,光密度值218.13±32.82;轻度子痫前期阳性表达率为 69.4%,光密度值186.47±26.75;妊娠期高血压阳性表达率为33.4%,光密度值125.29±26.90;正常孕妇阳性表 达率为24.5%,光密度值120.50±10.76;高血压组中子痫和子痫前期患者缺氧诱导因子-1α表达水平明显高于 妊娠期高血压患者和正常孕妇(P<0.05)。结论　①妊娠期高血压疾病患者胎盘组织中缺氧诱导因子-1α表达 明显高于正常孕妇(P<0.05);②缺氧诱导因子-1α随着妊娠期高血压疾病的加重表达逐渐增强,并在发病机制 中起重要作用。     

妊娠期高血压疾病孕妇血清尿酸、肌酐、尿素氮水平对围产儿预后的影响

目的:分析妊娠期高血压疾病孕妇血清尿酸、肌酐、尿素氮水平变化,并探讨不同血清尿酸水平对围产儿预后的影响。方法:选择2017年8月-2019年5月于本院分娩的妊娠期高血压疾病孕妇168例为研究组,抽选同期来本院体检的健康孕妇100例设为参照组。比较两组血清尿酸、肌酐、尿素氮水平,同时观察不同血清尿酸水平对围产儿结局的影响。结果:研究组的血清尿酸、肌酐、尿素氮水平均高于参照组,差异均有统计学意义(P0.05)。妊娠期高血压组、子痫前期组、重度子痫前期组。三组血清尿酸、肌酐、尿素氮水平比较,差异均有统计学意义(P0.05);重度子痫前期组血清尿酸、肌酐、尿素氮水平均高于妊娠期高血压组及子痫前期组,子痫前期组血清尿酸、肌酐、尿素氮水平均高于妊娠期高血压组,差异均有统计学意义(P0.05)。尿酸值297.5～400.0 μmol/L的孕妇胎儿呼吸窘迫、胎儿生长受限、新生儿窒息的发生率均高于尿酸值297.5 μmol/L孕妇;尿酸值400.0 μmol/L孕妇胎儿呼吸窘迫、胎儿生长受限、新生儿窒息、新生儿死亡的发生率均高于尿酸值297.5 μmol/L孕妇;尿酸值400.0 μmol/L孕妇新生儿死亡的发生率高于尿酸值297.5～400.0 μmol/L孕妇,差异均有统计学意义(P0.05)。结论:妊娠期高血压疾病孕妇血清尿酸、肌酐、尿素氮水平均高于正常孕妇,且相应指标水平会随病情加重而升高,孕妇血清尿酸越高,围产儿不良结局的发生率就越高,临床或可将其作为围产儿预后的观测指标。     

妊娠期高血压疾病患者血清IL-1β、IL-10、TNF-α及MPO水平测定及其意义

目的 探讨炎症因子水平在妊娠期高血压疾病发病中的意义.方法 采用ELISA法测定90例妊娠期高血压疾病患者(妊娠期高血压、子痫前期、子痫患者各30例)及30例健康孕妇(对照组)血清白细胞介素(IL)-1β、IL-10、肿瘤坏死因子α(TNF-α)及髓过氧化物酶(MPO)水平并加以比较.结果 (1)与对照组比较,妊娠期高血压组、子痫前期组及子痫组患者血清IL-1β、TNF-α及MPO水平均升高(P均<0.05),且在3组间有逐渐增高趋势,以子痫组患者IL-1β、TNF-α及MPO水平最高.(2)与对照组比较,妊娠高血压组、子痫前期组及子痫组患者血清IL-10水平均降低,其中子痫前期组及子痫组IL-10水平差异有统计学意义(P均<0.01),而妊娠高血压组差异无统计学意义(P>0.05).结论 妊娠期高血压疾病患者血清炎症因子水平的改变可能与妊娠期高血压疾病严重程度有关,IL-1β、IL-10、TNF-α及MPO可以作为评估妊娠期高血压疾病严重程度的预测指标.     

子痫前期患者胎盘瘦素对血清瘦素水平及缺氧对胎盘瘦素合成的影响

目的: 探讨妊娠期高血压疾病子痫前期患者胎盘与血清瘦素水平的关系及缺氧对胎盘绒毛合成瘦素的影响. 方法: 应用RIA法测定孕妇肘前静脉及胎盘附着部位子宫静脉血血清瘦素水平,其中妊娠期高血压疾病子痫前期患者(研究组)15例,正常妊娠妇女(对照组)20例;并在缺氧(20 mL/LO2)及常氧(210 mL/LO2)环境下培养8例正常足月胎盘绒毛,通过RIA法检测胎盘绒毛培养液中瘦素的含量.结果: 研究组外周血瘦素水平为23.29±12.87 μg/L,对照组为13.87±5.57 μg/L,两组比较差异有统计学意义(P<0.05);研究组子宫静脉血瘦素水平为16.44±8.62 μg/L,对照组为11.21±4.20 μg/L,两组比较有统计学意义(P<0.05).研究组和对照组外周血瘦素水平均高于子宫静脉血(P<0.05).在缺氧条件下胎盘绒毛培养上清中瘦素的含量高于常氧条件下(P<0.05).结论: 妊娠期高血压疾病患者胎盘及血清中瘦素的水平升高,可能与妊娠期高血压疾病发病有关,而且胎盘缺氧可能是胎盘瘦素合成增加的重要因素之一.胎盘只是正常妊娠孕妇及妊娠期高血压疾病患者血中瘦素增加的来源之一.     

妊娠期高血压疾病患者血清尾加压素Ⅱ水平的变化研究

目的了解妊娠期高血压疾病患者血清尾加压素Ⅱ(UrotensinⅡ,UⅡ)水平及平均动脉压(mean ar-terial pressure,MAP)水平,探讨血清UⅡ在妊娠期高血压疾病发病中的作用。方法选择96例妊娠期高血压疾病患者,其中妊娠期高血压组30例、子痫前期轻度组28例、子痫前期重度组38例;40例正常晚孕妇女为正常妊娠组,采用放射免疫法检测4组孕妇外周血中血清UⅡ水平,同时测定MAP。结果(1)子痫前期轻、重度组与正常妊娠组孕妇血清UⅡ水平间差异有显著性意义(P<0.05),子痫前期轻度组与重度组血清UⅡ水平间差异有显著性意义(P<0.05),妊娠期高血压组与正常妊娠组血清UⅡ水平间差异无显著性意义(P>0.05)。(2)妊娠期高血压疾病各组与正常妊娠组MAP水平间差异有显著性意义(P<0.01)。(3)4组患者血清UⅡ水平与MAP均呈正相关(P<0.001)。结论妊娠期高血压疾病子痫前期患者血清UⅡ水平明显高于正常妊娠妇女,UⅡ可能参与了妊娠期高血压疾病的发生、发展过程。     

血管内皮生长因子及可溶性受体-1水平变化对子痫前期发病的预测探讨

目的:探讨孕妇血浆中血管内皮生长因子(VEGF)及可溶性受体-1(sFlt-1)水平变化对子痫前期发病的早期预测价值。方法:采用酶联免疫吸附试验(ELISA)对200例初始血压正常的孕妇自孕16周开始检测血清VEGF及sFlt-1水平,共测定3次。结果:(1)200例孕妇中发展为子痫前期18例,其余182例孕妇妊娠结局正常;(2)在孕16~20、22~28、30~36周子痫前期组孕妇血清VEGF、sFlt-1水平分别为(29.30±4.25)ng/L、(6.68±1.65)μg/L;(26.98±3.81)ng/L、(15.18±3.99)μg/L;(26.77±4.32)ng/L、(20.23±5.67)μg/L。正常妊娠组VEGF、sFlt-1水平分别为(33.18±2.01)ng/L、(6.72±0.76)μg/L;(30.97±3.24)ng/L、(6.78±1.03)μg/L;(30.62±1.65)ng/L、(6.87±1.03)μg/L。两组比较孕16~20周差异无统计学意义(P>0.05),而孕22~28周、孕30~36周差异有统计学意义(P<0.01)。(3)sFlt-1水平作为预测子痫前期发生的指标,采用ROC曲线求得sFlt-1预测界限值为9.26μg/L。其预测敏感度81.82%,特异度99.13%,阳性预测值94.74%,阴性预测值96.61%。结论:血清sFlt-1水平可以作为子痫前期发病的早期预测指标。     

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.