维持性血液透析患者血氨基酸谱及营养状况分析

目的了解维持性血液透析(MHD)病人的血清游离氨基酸谱及营养状况.方法对49例维持性血液透析病人进行饮食评估;测量身高、体重、三头肌皮褶厚度(TSF)、上臂肌围(MAMC)、体质指数(BMI)、血清总蛋白和白蛋白,检测和分析血清游离氨基酸谱.结果患者平均能量摄入为115.03kJ·kg-1·d-1,蛋白质摄入为1.06g·kg-1·d-1;26.5%的病人BMI<18.5,存在营养不良.以MAMC评估,30.61%的病人存在中重度肌蛋白消耗;以TSF评估,69.38%的病人存在中重度体脂消耗.MHD病人的血清总蛋白和白蛋白水平正常,总氨基酸量、EAA/NEAA、Leu、Ile、Phe、Val、Lys、Thr、Ser、Ala和Gln水平显著低于正常人(P<0.05,P<0.01),而Asp、Trp、Arg水平则高于正常人(P<0.01).结论MHD病人存在明显的血清游离氨基酸谱改变,以必需氨基酸水平低下为主,为预防营养不良的进一步发展,应予以合理的营养干预.     

维持性血液透析患者营养状态的分析研究

目的:用营养不良-炎症评估(MIS)方法全面评估维持性血液透析(MHD)患者的营养状况,并找出导致营养不良的主要原因;分析患者营养不良发生的相关危险因素。方法:选取南京市浦口区中心医院101例维持性血液透析患者,根据MIS评分分为轻度营养不良组和中重度营养不良组,观察两组在生化指标及人体测量指标之间的差异。结果:轻度营养不良组与中重度营养不良组年龄、肌酐、铁蛋白、上臂围(MAC)、肱三头肌皮皱厚度(TSF)、上臂中部肌围(MAMC)、体重指数(BMI)、尿素清除率(KT/V)、改良主观综合性评估(MQSGA)等方面,差异均有统计学意义(P0.05)。按照年龄分为老龄组和非老龄组,非老龄组尿素、肌酐、尿酸等方面均高于老龄组(P0.05);老龄组MQSGA、MIS评分等方面均高于非老龄组,差异均有统计学意义(P0.01)。根据C反应蛋白(CRP)水平分为CRP1组和CRP≥1组,结果显示两组人体测量指标及评分方面比较,差异均无统计学意义(P0.05)。MAC、TSF、MAMC、BMI、MQSGA与MIS评分有明显的相关性。结论:本院血液透析中心MHD患者整体营养状态较好。MHD患者血液透析充分,营养不良的主要原因是蛋白质摄入不足。年龄越大,越容易出现营养不良。     

血液透析患者营养状况与逆流行病学现象的探讨

目的 了解维持性血液透析患者(MHD)的营养状况,探讨其存在的逆流行病学现象,为进一步提出针对性营养干预策略提供依据.方法 采用主观综合性营养评估法(SGA)、人体测量、生化指标测定方法综合评估113例维持性血液透析患者的营养状态.结果 根据SGA评分,55.75％(63例)的患者营养状况良好;营养不良患者占44.25％(50例),其中39.82％(45例)为轻-中度营养不良,4.42％(5例)为重度营养不良.营养不良组患者肱三头肌皮褶厚度(TSF)、动静脉瘘对侧上臂周径(MAC)、上臂肌围(MAMC)低于营养良好组,差异有统计学意义(P＜0.01).营养不良组总胆固醇(CH)、三酰甘油(TG)、低密度脂蛋白(LDL)、血清白蛋白(Alb)、前白蛋白(PA)、血肌酐(Scr)、尿素氮(BUN)、钙(Ca)、磷(P)较营养良好组低,其中TG、PA、Scr、BUN差异有统计学意义(P＜0.05,P＜0.01),而高密度脂蛋白(HDL)和甲状旁腺素(PTH)较营养良好组偏高,但差异无统计学意义.结论 MHD患者营养不良发生比例偏高,且MHD患者营养不良是导致其逆流行病学现象的原因之一,建议根据MHD患者具体的病理生理特点来调整治疗标准.     

长期维持性血液透析患者营养状况与死亡率的关系

目的探讨维持性血液透析(MHD)患者的营养状况及其与死亡率的关系。方法对56例MHD患者进行营养综合评估(SGA)、人体测量及生化指标的测量。观察指标包括身高、体重、肱三头肌皮皱厚度(TSF)、上臂肌围(AMc)、血清总蛋白(TP)、白蛋白(Alb)、前白蛋白(PA)、转铁蛋白(TF)、血红蛋白(HgB)、计算Kt/V值评估透析充分性等,计算实际体重占理想体重百分比(IBw%)并作营养评价,分析其与死亡率的关系。结果①营良好组、轻中度营养不良组及重度营养不良组患者间ALB、PA、TF、AMC、HgB、Kt/V值,差异有统计学意义(P<0.05);营养良好组与轻中度营养不良组TSF、IBM差异无统计学意义,其中营养良好者48.2%、轻中度营养不良者42.9%、重度营养不良者8.9%。②营养良好者死亡率11.1%、营养不良死亡率31%,其中轻中度营养不良组死亡率20.8%、重度营养不良组死亡率80%,死亡率明显高于营养状况较好者。结论维持性血液透析患者51.8%存在不同程度的营养不良,且死亡率明显高于营养状况较好者。     

维持性血液透析患者营养状况的临床评估与护理对策

目的 评估113例维持性血液透析(HD)患者的营养状况,针对不同患者的营养状况制定个体化的饮食方案.方法 通过人体学测量,生化指标的测定及透析状况分析等,综合评估113例维持性血液透析患者的营养状况.结果 113例患者,营养良好组与营养不良组比较,上臂肌围(MAMC)、前白蛋白(PA)及透析前肌酐(Pre-Cr)显著升高(P＜0.05).各项营养指标异常的比例为理想体重百分比(IBW％) 15.4％,体重指数(BMI)19.5％,肱三头肌皮褶厚度(TSF)90.3％,上臂肌围(MAMC)36.3％,白蛋白(ALB)40.7％,前白蛋白(PA) 35.4％,血红蛋白(Hb)92％.所有患者尿素减少率(URR)为0.663±0.080,尿素清除指数(Kt/V)为1.392±0.231.结论 1)血清前白蛋白、上臂肌围及透析前血清肌酐水平对评估血液透析患者的营养状况可靠敏感,临床实用性强.2)及时、准确的进行营养状况评估,采用综合措施进行防治,对改善维持性血液透析患者的预后有重要意义.     

血液透析患者营养状况调查分析

目的:对血液透析患者营养状况进行调查,分析营养不良的影响因素,为制订合理的干预措施,改善患者生活质量提供依据。方法:对我院诊治的62例进行维持性血液透析半年以上患者临床资料进行回顾性分析,采用改良定量主观营养评估(MQSGA)及实验室生化检查来评估患者营养状态,对可能影响状态的因素进行分析。结果:62例患者中共有32例发生营养不良,发生率为51.6%。32例营养不良患者中,轻中度23例(71.9%),重度7例(21.9%),极重度2例(6.2%)。蛋白质摄入不足、老年、透析不充分及腹膜炎症状态与患者发生营养不良有关。两组患者血肌酐、白蛋白、肱三头肌皮褶厚度(TSF)及上臂肌围(MAMC)差别具有统计学意义(P<0.05)。结论:维持性血液透析患者营养不良发生率高,蛋白质摄入不足、老年、透析不充分及炎症状态与患者发生营养不良有关。临床工作中应采取有效合理的干预方法加强营养,改善患者生活质量。     

长期双极反渗水透析对维持性血透患者营养状态的影响

目的:通过维持性血透(MHD)从单极反渗水透析改为双极反渗水透析,探讨双极反渗水透析对MHD营养状况的影响。方法:33例单极反渗水透析至少1年MHD患者,改为双极反渗水透析后,进行为期72个月随访,监测水质指标,比较12月和72月血清白蛋白(ALB)、人体测量、主观营养评分(SGA)等指标。结果:所有患者改为双极反渗水透析12月后,透后体重、BMI、体脂、TSF、MAMC均有增高趋势,但差异无统计学意义,白蛋白水平(p<0.05)和主观营养评分(p<0.05)得到显著改善。延长观察到双极反渗水透析72个月,透后体重和BMI又呈降低趋势,但未达到统计学差异,体脂含量减少(p<0.05),TSF减少(p<0.05),MAMC没有变化(p>0.05),白蛋白水平明显升高(p<0.05),SGA评分改善(p<0.05);双极反渗水透析72月与12月比较,白蛋白水平无变化(p>0.05),MAMC没有变化(p>0.05),SGA降低(p<0.05),TSF减少(p<0.05)、体脂含量减少(p<0.05)。结论:双极反渗水改进了透析液水质,可改善MHD营养状态。     

调理脾胃中药对血液透析患者营养状况的改善作用

[目的]探讨调理脾胃中药对血液透析患者营养不良症的改善作用。[方法]将61例血液透析(简称血透)并营养不 良症患者随机分为中药治疗组(简称治疗组)31例和单纯血透治疗组(简称对照组)30倒,两组在对症治疗、血透相关因 素一致条件下维持血液透析,治疗组结合辨证服用调理脾胃中药(脾胃虚弱为主者选用六君子汤加减;湿浊中阻为主者选 用黄连温胆汤加减)。系统观察两组患者营养不良症的主要症状、体征、肱三头肌皮褶厚度(TSF)、上臂中段肌肉周径 (MAMC)、血清总蛋白(TP)、血清白蛋白(Alb)、转铁蛋白(TRF)、血红蛋白(Hb)、蛋白分解率(nPCR)、改良主观综合 性营养评估(SGA)评分等方面的变化。[结果]治疗组比对照组体征症状改善明显(P<0.01),干体重增加(P<0.05), TSF和MAMC增加(P<0.05),血清TP、Alb、TRF、Hb含量明显提高(P<0.01),nPCR提高(P<0.05),SGA评分显著 下降(P<0.01)。[结论]调理脾胃法对改善维持血透营养不良症患者的症状体征及脂肪、蛋白质储存的不足,提高患者 血清TP、Alb、TSF含量和nPCR等多项营养生化指标有较好的疗效。     

维持性血液透析患者血清钠水平与营养状态的相关性研究

目的 研究维持型血液透析(MHD)患者血清钠水平与营养状态的相关性.方法 选取2014年9月至2016年9月在平顶山市中医院接受MHD的终末期肾病患者68例,依据血清钠水平分为低钠组(28例)与正常组(40例),比较两组患者的上臂围(MAC)、上臂肌围(MAMC)、肱三头肌皮褶厚度(TSF)、握力(HGS)、营养状况、体质量及实验室指标水平.结果 低钠组透析间期体质量获得量占干体质量的百分数(IDWG％)、改良定量整体主观评估(MQSGA)评分均高于正常组,MAMC、HGS及血清白蛋白(ALB)则低于正常组,差异有统计学意义(P<0.05).透析前血清钠水平与MAMC、HGS和ALB水平呈正相关(r=0.689、0.591、0.612,P<0.05),与MQSGA评分呈负相关(r=-0.516,P<0.05).控制年龄、性别和糖尿病等混杂因素后,血清钠水平仅与MQS-GA评分呈负相关(r=-0.406,P<0.05).结论 MHD患者透析前血清钠水平降低,可能与蛋白质能量消耗较大、透析间期体质量增加及营养状态较差相关.     

维持性血液透析患者hs-CRP水平与营养不良、贫血的关系研究

目的：探讨维持性血液透析（MHD）患者血清超敏C-反应蛋白（hs-CRP）水平与营养不良及贫血的关系。方法：71例2010年8月-9月在我院行血液透析治疗的MHD患者,根据睁CRP水平分为微炎症组（≥3mg／L）和非微炎症组（〈3mg／L）。透析前空腹采血检测患者血常规、血生化指标及hs-CRP,透析后采血检测BUN、测量人体学指标。结果：①7l例MHD患者发生微炎症30例（42．25％）;微炎症者营养不良（SGA2-3）发生率为93．33％（28／30）,明显高于非微炎症者（P〈0．01）;微炎症组患者血红蛋白、ALB、PA、TSF、MAMC、MAC、GS均显著低于非炎症组（P〈0．01,P〈0．05）。②相关分析结果：hS-CRP与HB、ALB、PA、TSF、MAMC、MAC显著负相关（P〈0．01,P〈O．05）;控制年龄、性别、身高、体重后的偏相关分析结果显示,hs-CRP与HB、ALB、MAMC、MAC显著负相关（P〈0．01,P〈0．05）。结论：MHD微炎症患者营养状况差、贫血较严重,hS-CRP水平可反映MHD患者营养不良及贫血程度;降低微炎症反应,有望改善预后。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.