血浆脑钠素与老年性左心室舒张功能不全的相关性探讨

目的探讨老年舒张性心力衰竭(DHF)患者血浆脑钠素(BNP)水平的改变及其与心功能的关系。方法应用床旁快速免疫荧光测定法(Biosite Diagnostics)检测31例DHF患者及23例健康对照者血浆BNP水平,并与心脏超声指标进行相关性分析。结果DHF患者血浆BNP水平明显高于健康对照组(617.54±235.65pg/mL vs 77.86±10.30pg/mL,P<0.01),抗心衰治疗后下降(617.54±235.65pg/mL vs 217.43±78.56pg/mL,P<0.05);BNP水平随E/A降低而增高;多因素相关分析显示BNP水平与E/A(r=-0.52,P<0.01)、LVEF(r=-0.28,P<0.05)呈负相关,与LVMI(r=0.44,P<0.01)呈正相关。结论老年DHF患者血浆BNP水平增高,DHF严重程度与BNP水平有关。     

阻塞性睡眠呼吸暂停低通气综合征患者血清C反应蛋白和白细胞介素水平的变化及意义

目的观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)血清C反应蛋白(CRP)和白细胞介素(6IL-6)水平的变化及其意义。方法选择诊治的32例OSAHS患者,采用ELISA法检测血清CRP和IL-6的水平,并与30例对照组进行比较分析。结果 OSAHS组患者血清CRP和IL-6的水平明显高于对照组,两组比较差异有统计学意义(P<0.05);且CRP和IL-6与呼吸暂停低通气指数(AHI)呈正相关(r=0.768,P<0.01);与脉搏血氧饱和度呈负相关(r=-0.816,P<0.01)。结论 CRP和IL-6与OSAHS密切相关,对于阐明睡眠相关因子在OSAHS发病机制中的作用及其变化规律有着重要意义。     

原发性高血压患者血浆肾上腺髓质素水平观察

用特异性放免法测定了33例原发性高血压(EH)患者血浆肾上腺髓质素(AM)的水平,结果示EH患者血浆AM含量(128.8±10.54pg/ml)明显高于对照组(46.63±3.55pg/ml)(P<0.001),但低于肾实质性高血压组(176.8±19.43pg/ml)(P<0.05);随着EH分期的增重,AM水平升高越显著;并与平均动脉压(MAP)呈正相关(r=0.849,P<0.001);肾功能异常者亦明显升高P相似文献   

充血性心力衰竭患者血浆心钠素,血管紧张素Ⅱ和醛固酮的含量测定

用放射免疫分析方法对68例充血性心力衰竭(CHF)患者和32例正常人的血浆心钠素(ANP)、血管紧张素Ⅱ(AⅡ)和醛固酮(ALD)的含量进行了检测。结果 ANP,AⅡ和 ALD 的含量分别为3683.52±579.14pg/ml,181.73±70.85pg/ml,203.25±83.95pg/ml,显著高于对照组水平(分别为2080.14±412.74pg/ml,84.73±26.11pg/ml,180.30±47.30pg/ml)(P<0.01,0.01,0.05),并且 ANP 与 ALD 呈显著正相关(r=0.53,P<0.01);AⅡ与 ALD、ANP呈显著负相关(r=-0.46,-0.48,P<0.01)。文中对 CHF 的体液调控机理及ANP,AⅡ和 ALD 含量变化的意义进行了讨论。     

类风湿关节炎患者血清白介素-33、白介素-35表达及其临床意义

目的:初步探讨白介素-33(IL-33)、白介素-35(IL-35)在类风湿关节炎(RA)发病中的意义。方法:酶联免疫吸附法(ELISA)检测50例RA患者(其中RA活动组25例,RA缓解组25例)、25名健康对照组血清IL-33、IL-35水平,并与临床资料进行相关性分析。结果:RA活动组患者血清IL-33水平(332.02±31.43)pg/ml显著高于RA缓解组(227.56±48.02)pg/ml及健康对照组(77.03±20.68)pg/ml,差异有统计学意义(P<0.05),RA缓解组与健康对照组差异有统计学意义(P<0.05);RA活动组血清IL-35水平(236.14±32.20)ng/L显著低于RA缓解组(353.21±24.61)ng/L及健康对照组(349.60±28.45)ng/L,差异有统计学意义(P<0.05),RA缓解组与健康对照组差异无统计学意义(P>0.05)。RA患者血清IL-33与IL-35水平之间呈显著负相关(r=-0.473,P<0.05);血清IL-33水平与关节肿胀数、关节压痛数、血沉(ESR)、C反应蛋白(CRP)、DAS28评分、抗CCP抗体呈正相关(P<0.05);血清IL-35水平与关节肿胀数、关节压痛数、ESR、CRP、DAS28评分、类风湿因子(RF)、抗CCP抗体呈负相关(P<0.05)。结论:RA活动组患者血清IL-33水平升高、IL-35水平减低,二者可能参与了RA发生发展,并可作为RA病情活动的预测指标。     

老年冠心病心衰患者血浆白细胞介素—6和一氧化氮浓度的变化

目的观察老年冠心病心衰患者血浆白细胞介素-6(Interleukin-6，IL-6)及一氧化氮(NitricOxide,NO)浓度的变化。方法选择48例老年冠心病心衰患者和30例健康老年人，测定其血浆IL-6、NO浓度。结果心衰组血浆IL-6浓度(19.81±15.9)pg／ml明显高于对照组(7.02±2.36)pg／ml,P＜0.001)，NO浓度(73.39±35.49)μmol／L明显高于对照组(42.82±17.24)μmol／L，P＜0.001。心衰组血浆IL-6和NO浓度与左室射血分数(LVEF)呈负相关(r分别为-0.6和-0.37，均P＜0.01)，血浆NO浓度与IL-6浓度呈正相关(r=0.06，P＜0.001)。结论老年冠心病心衰血浆IL-6、NO浓度明显升高，二者随心衰加重而升高。IL-6和NO在心衰的发生发展中可能起重要作用。     

老年高血压患者炎症因子变化与颈动脉粥样硬化的相关性

目的探讨老年高血压患者颈动脉粥样硬化与炎症因子的关系。方法选取老年原发性高血压患者48例,健康体检者30例,应用彩色多普勒超声检测颈动脉内膜中层厚度(intima-media thickness,IMT),以颈动脉超声IMT≥0.9 mm作为颈动脉内膜增厚或动脉粥样斑块指标。测定C反应蛋白(CRP)、IL-6、TNF-α及血脂、血糖、血压等。结果老年高血压组收缩压、舒张压、TC、LDL-C及颈动脉斑块发生率明显高于对照(P<0.01)。老年高血压组CRP、IL-6、TNF-α、颈动脉IMT值均明显高于对照组(P<0.01)。在老年高血压患者,颈动脉IMT与CRP(r=0.422;P<0.01)、IL-6(r=0.313;P<0.01)、TNF-α(r=0.296;P<0.01)进行直线相关分析,结果显示IMT与炎症因子呈正相关。结论老年高血压患者颈动脉粥样硬化的形成除与血压增高、血脂异常有关外,炎症因子是其发病的主要因素。     

冠心病心绞痛患者血浆白细胞介素-6和单核细胞趋化因子-1变化及其临床意义

目的探讨白细胞介素-6(IL-6)及单核细胞趋化因子-1(MCP-1)在冠心病心绞痛发病机制中的作用。方法选择冠状动脉造影确诊的心绞痛患者70例,包括稳定型心绞痛(SAP)组36例,不稳定型心绞痛(UAP)组34例,另选择30例冠状动脉造影正常者作为对照组。采用酶联免疫吸附法检测血浆IL-6、MCP-1水平。结果 UAP组血浆IL-6、MCP-1水平为(18.12±2.62)pg/L、(25.63±4.76)pg/L,显著高于SAP组的(14.98±2.54)pg/L、(21.78±4.53)pg/L(P<0.01),UAP组、SAP组均高于对照组(11.68±2.51)pg/L、(15.71±4.34)pg/L(P<0.01)。结论血浆IL-6与MCP-1在冠心病患者中显著升高,在反映冠状动脉斑块稳定性及冠状动脉病变的严重程度方面有重要的临床意义。     

白介素-6和转化生长因子-β1在膝骨关节炎发病中的作用

目的探讨白介素(IL)-6和转化生长因子(TGF)-αβ1在膝骨关节炎(OA)发病中的作用及其关系,并寻求可以反映OA严重程度的指标.方法OA组患者40例,其中轻度14例,中度16例,重度10例;对照组5例.关节液中IL-6与TGF-β1浓度测定采用酶联免疫吸附试验法(ELISA).统计采用K-W非参数检验及相关分析.结果对照组IL-6和TGF-β1浓度分别为(23.00±9.41)pg/ml和(152.00±103.77)pg/ml,OA组分别为(228.33±373.06)pg/ml和(708.50±476.97)pg/ml,两组差异有显著性(P＜0.05).滑液中IL-6浓度与OA严重程度呈负相关(r=-0.497,P＜0.01),而TGF-β1与OA严重程度不相关,但滑液中TGF-β1与IL-6浓度呈正相关(r=0.377,P=0.017).结论IL-6和TGF-β1在膝骨关节炎的发病中有重要的病理作用;滑液中IL-6的浓度与OA严重程度呈负相关,其可能是一种对软骨具有保护性的细胞因子.OA关节滑液中IL-6和TGF-β1浓度呈正相关,IL-6可能部分参与TGF-β对软骨的双重作用.     

经鼻持续气道正压通气治疗对OSAHS患者胰岛素抵抗的影响

目的探讨经鼻持续气道正压通气(nCPAP)对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者胰岛素抵抗(IR)的治疗价值。方法接受多导睡眠监测的中重度OSAHS患者115例,其中65例接受综合干预治疗6个月为对照组,50例在综合干预治疗的同时接受nCPAP治疗为实验组。在治疗前后分别测定体重指数(BMI)、呼吸暂停低通气指数(AHI)、最低血氧饱和度(miniSpO2)、空腹血糖值和空腹胰岛素值,并计算其胰岛素敏感指数(ISI)。结果治疗前实验组ISI为-4.75±0.44,对照组为-4.78±0.37,两者差异无显著性意义(t=0.021,P>0.05);治疗后实验组(-4.19±028)较对照组(-4.52±0.47)明显升高(t=4.408,P<0.001)。两组ISI与BMI均呈负相关(分别为r=-0.451,P<0.01;r=-0.422,P<0.01),ISI与AHI均呈负相关(分别为r=-0.866,P<0.001;r=-0.829,P<0.001),ISI与miniSpO2均呈正相关(分别为r=0.771,P<0.001;r=0.809;P<0.001)。结论nCPAP能明显改善OSAHS患者的IR。MBI、AHI和miniSpO2可能是nCPAP治疗OSAHS患者IR的有效预测指标。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.