类风湿患者DD和AT-Ⅲ检测的临床意义

目的 检测类风湿关节炎(RA)患者血浆D-二聚体(DD)及抗凝血酶Ⅲ(AT-Ⅲ)表达水平,探讨其在RA中的临床意义.方法 选择RA患者36例为RA组,正常对照组30例,测定其血浆DD、AT-Ⅲ及血浆C反应蛋白(CRP)水平.结果 RA组患者血浆DD水平为(289.36±71.75) μg/L,显著高于正常对照组的(132.25±38.63)μg/L;血浆AT-Ⅲ水平为(56.2±12.70)％,明显低于对照组的(92.40±3.80)％,差异均有统计学意义(P＜0.05).相关性分析显示,RA组患者血浆DD、AT-Ⅲ水平与DAS28评分具有相关性(r=0.32,P＜0.01;r=-0.72,P＜0.01).RA组患者经治疗病情缓解后(DAS28＜2.6)血浆DD水平为(141.38±32.75) μg/L,显著低于治疗前的(289.36±71.75)μg/L,差异有统计学意义(P＜0.01),与正常对照组比较差异无统计学意义(P＞0.05);RA组患者经治疗病情缓解后血浆AT-Ⅲ水平为(96.20±4.20)％,显著高于治疗前的(56.2±12.7)％,差异有统计学意义(P＜0.01),与正常对照组比较差异无统计学意义(P＞0.05).结论 血浆DD及AT-Ⅲ水平与RA患者的病情活动有关,可反映心血管病变危险性,对RA患者的病情判断及预后估计有重要的评判价值.     

血清同型半胱氨酸、纤维蛋白原与急性缺血性脑卒中预后的相关性研究

目的：探讨血清同型半胱氨酸(Hcy)、纤维蛋白原(Fib)与急性缺血性脑卒中(AIS)预后的关系。方法选择2014年1月至2015年6月期间我院收治的150例急性缺血性脑卒中患者作为研究对象,选择同期50例健康体检者作为对照组。根据临床神经功能缺损程度评分(CNDS)将AIS患者分为轻度缺损组(n=36)、中度缺损组(n=84)及重度缺损组(n=30),并根据患者不同预后将其分为预后良好组(n=61)与预后不佳组(n=89);比较不同研究对象间血清Hcy、Fib水平。结果观察组患者血清Hcy、Fib水平分别为(19.64±5.49)μmol/L、(4.35±1.42) g/L,均明显高于对照组的(8.63±3.61)μmol/L、(2.79±0.62) g/L,差异均有统计学意义(P<0.05);血清Hcy、Fib水平在轻度缺损组为(15.14±2.19)μmol/L和(4.06±0.22) g/L、中度缺损组为(18.79±2.46)μmol/L和（4.25±0.33）g/L,重度缺损组为（24.13±2.71)μmol/L和(5.46±0.29) g/L,三组患者的Hcy、Fib水平均依次升高,差异均有统计学意义(P<0.05);预后不佳组患者血清Hcy、Fib水平分别为(21.68±7.63)μmol/L和（4.98±1.24）g/L,明显高于预后良好组的(17.24±6.19)μmol/L和(4.21±1.38) g/L,差异均有统计学意义(P<0.05)。结论血清Hcy、Fib水平与急性缺血性脑卒中患者病情严重程度及预后密切相关,临床可通过检测血清Hcy、Fib水平对患者疾病严重程度及预后进行评估。     

不同剂量硫酸氯吡格雷治疗缺血性脑卒中患者的临床研究

目的 探究不同剂量硫酸氯吡格雷治疗缺血性脑卒中患者对临床疗效、不良事件及预后的影响.方法 选取2015年12月至2016年12月新乡医学院第三附属医院收治的114例缺血性脑卒中患者临床资料进行分析,依据治疗方案不同,分成对照组(57例)与研究组(57例),对照组行低剂量硫酸氯吡格雷治疗,研究组行高剂量硫酸氯吡格雷治疗,比较两组血流动力学指标变化、不良反应情况、神经功能与日常生活能力评分.结果 研究组治疗后血流动力学指标中,血浆黏度(1.49±0.24)mPa/s、全血低切黏度(11.05±3.16)mPa/s、全血高切黏度(4.83±0.88)mPa/s、纤维蛋白原(3.42±0.42)g/L均优于时照组(P＜0.05);研究组与对照组不良反应总发生率分别为15.78％、10.52％,二者差异无统计学意义(P＞0.05);两组治疗前神经功能缺损评分(NIHSS评分)、日常生活能力评分(ADL评分)差异均无统计学意义(P＞0.05),治疗后研究组NIHSS评分(11.05±5.51)分、ADL评分(79.25±3.17)分均优于对照组(P＜0.05).结论 高剂量硫酸氯吡格雷(每次75 mg,1次/日)用于缺血性脑卒中治疗可有效提升疗效,预后良好.     

高压氧综合治疗对脑挫裂伤患者免疫功能的影响

目的:研究高压氧治疗脑挫裂伤前后患者免疫功能的变化.方法:免疫速率散射比浊法检测114例脑挫裂伤患者治疗前后血浆中C3、C4、IgG、IgA、IgM的变化,采用GCS评分标准判断疗效.结果:GCS评分,高压氧治疗组为12.95±1.96分,对照组为9.67±2.82分,差异有统计学意义(P＜0.01).补体水平,高压氧组治疗前C3、C4分别为0.97±0.28g/L与0.31±0.27g/L;治疗后C3、C4分别为1.20±0.23g/L与0.43±0.27g/L,差异统计学意义(P＜0.01),对照组无统计学意义(P＞0.05).免疫球蛋白水平,高压氧治疗前后IgG、IgA、IgM差值分别为1.72±1.02g/L、0.22±0.26g/L、0.04±0.36g/L,差异有统计学意义(P＜0.01).结论:高压氧治疗脑挫裂伤能明显增强机体的免疫机能.     

急性缺血性脑卒中患者超早期基质金属蛋白酶表达水平与临床预后的关系

目的：探讨急性缺血性脑卒中患者超早期基质金属蛋白酶（MMPs）表达水平与临床预后的关系。方法选取2014年12月至2015年12月我院收治的急性缺血性脑卒中患者90例,随访患者90 d,应用改良Ranking量表(mRS)评价患者的预后,mRS评分0~1分纳入预后良好组(50例),mRS评分2~6分纳入预后不良组(40例),比较两组患者入院时基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)和基质金属蛋白酶-13(MMP-13)水平,分析MMP-2、MMP-9及MMP-13与mRS评分的相关性。结果预后良好组和预后不良组患者的MMP-2和MMP-13水平分别为(241.29±10.42)μg/L、(79.29±3.45)μg/L和(243.45±9.58)μg/L、(83.42±5.08)μg/L,差异均无统计学意义(P>0.05);预后不良组患者的MMP-9水平为(153.42±20.98)μg/L,明显高于预后良好组的(79.24±8.52)μg/L,差异具有统计学意义(P<0.05);Pearson相关性分析显示：MMP-9与mRS评分呈正相关关系(r=0.856,P=0.002),MMP-2、MMP-13与mRS评分无相关关系(r=0.483、0.503,P=0.086、0.082)。结论 MMP-9对急性缺血性脑卒中预后具有预测作用,MMP-2和MMP-13水平与急性缺血性脑卒中预后无关。     

糖尿病性心肌病血浆类胰蛋白酶与血糖相关性的分析

目的 观察肥大细胞特异性分泌的类胰蛋白酶在糖尿病性心肌病(DCM)患者中的表达及其与空腹血糖的关系.方法 选取2012年8月至2013年3月在第二军医大学长征医院心内科就诊的DCM患者26例(DCM组)、缺血性心肌病(ICM)患者32例(ICM组)、健康志愿者20例(健康对照组).收集各组受试者的一般临床资料并检测其空腹血糖等生化指标.采用酶联免疫吸附法检测各组受试者的血浆类胰蛋白酶水平,分析类胰蛋白酶水平与空腹血糖的相关性.结果 3组受试者的一般临床资料和空腹血糖差异均无统计学意义.DCM组和ICM组患者的血浆类胰蛋白酶水平高于对照组[(7.19±0.62) μg/L、(6.81±0.94) μg/L vs (2.37±0.56) μg/L,P＜0.01];DCM组患者的血浆类胰蛋白酶水平高于ICM组,但差异无统计学意义.Pearson相关性分析结果显示,血浆类胰蛋白酶水平与空腹血糖呈正相关(r=0.637,P＜0.01).结论 DCM患者体内的血浆类胰蛋白酶水平升高,且与空腹血糖呈正相关.     

急性脑梗死早期患者血清氧化低密度脂蛋白水平与梗死体积的相关性研究

目的 检测急性脑梗死早期患者血清氧化低密度脂蛋白(ox-LDL)水平,探讨其与梗死体积的相关性,为疾病预后及病情严重程度的评估提供依据.方法 80例急性脑梗死患者根据CT显示的梗死灶体积分为小、中、大梗死组,并于发病48 h采用酶联免疫吸附试验测定患者血清ox-LDL水平,比较不同梗死体积患者血清ox-LDL水平差异及ox-LDL水平与梗死体积间的相关性.结果 不同体积脑梗死患者的血清ox-LDL水平分别为(514.9±65.4)、(655.4±53.6)、(699.1±102.2)μg/L,3组比较差异有统计学意义(F=40.6,P＜0.05),小梗死组血清ox-LDL水平较大、中梗死组明显降低(P＜0.05),中梗死组血清ox-LDL水平亦显著低于大梗死组(P＜0.05).脑梗死患者的血清ox-LDL水平与梗死体积呈正相关(r=0.648,P＜0.01).结论 急性脑梗死早期患者血清ox-LDL水平升高,且ox-LDL水平与梗死体积呈正相关,ox-LDL水平越高,梗死体积越大,其病情程度越严重.     

外周动脉疾病患者血浆血红素加氧酶-1、氧化型低密度脂蛋白与颈动脉内膜中层厚度的相关性研究

目的:探讨外周动脉疾病患者血浆血红素加氧酶-1(HO-1)与动脉硬化的关系.方法:ELISA法分别测定外周动脉疾病患者77例、对照组33例血浆HO-1及氧化型低密度脂蛋白(ox-LDL)的水平,超声测定颈动脉内膜中层厚度,分析3项指标之间的相关性.结果:外周动脉疾病患者血浆HO-1水平的自然对数(LnHO-1)(3.68±0.10)μg/L较对照组(5.18±0.12)μg/L显著降低(P＜0.001),ox-LDL水平的平方根(Sqrt ox-LDL)显著高于对照组[(3.20±0.17)μg/L VS(1.55±0.24)μg/L,(P＜0.001)].血浆Ln HO-1与Sqrt ox-LDL呈负相关(r=-0.509,P＜0.001),与颈动脉内膜中层厚度呈负相关(r=-0.178,P＜0.05);Sqrt ox-LDL与颈动脉内膜中层厚度呈正相关(r=0.336,P＜0.001).偏相关分析校正年龄、吸烟年支数、血糖、血脂指标后,Ln HO-1与Sqrt ox-LDL仍呈负相关(r=-0.257,P＜0.05),与颈动脉内膜中层厚度无相关性(r=-0.038,P＞0.05);血浆Ln HO-1与颈动脉内膜中层厚度呈正相关(r=0.157,P＜0.05).结论:血浆HO-1水平与外周动脉疾病的发生、发展密切相关,可能具有重要的抗氧化应激作用.     

急性一氧化碳中毒后迟发性脑病患者血清胰岛素样生长因子-1水平及其临床意义研究

目的 研究急性一氧化碳中毒后迟发性脑病(DEACMP)患者血清胰岛素样生长因子-1(IGF-1)水平的动态变化及其临床意义.方法 选择2007年11月-2008年6月在我院住院的33例DEACMP患者,采用酶联免疫吸附法动态测定血清IGF-1水平,用日常生活能力量表(ADL)、长谷川痴呆量表(HDS)、常识-记忆-注意测验(IMCT)动态评估DEACMP患者的病情变化,并与32例急性一氧化碳中毒(ACMP)后未发生DEACMP的患者(ACMP组)和32例健康体检者(正常对照组)的以上指标进行比较.结果 (1)DEACMP组急性期血清IGF-1水平[(136.10± 51.51)μg/L]低于正常对照组[(192.91±145.97)μg/L,P＜0.05],DEACMP组急性期与ACMP组[(156.51± 93.13)μg/L]比较,ACMP组与正常对照组比较,差异均无统计学意义(P＞0.05).DEACMP组恢复期血清IGF-1水平[(187.69±92.46)μg/L]较急性期升高,差异有统计学意义(P＜0.05).(2)DEACMP组急性期ADL、HDS和IMCT评分与恢复期比较,差异均有统计学意义(P＜0.05).(3)DEACMP组中IGF-1水平与ADL评分呈负相关(r=-0.377,P=0.03).结论 IGF-1在DEACMP脑损伤中可能起着重要保护作用,血清IGF-1水平可能作为临床转归、疗效判定的指标之一.     

血浆D-二聚体动态变化对急性脑梗死患者预后的影响

目的 探讨脑梗死病人血浆D-二聚体的动态变化及对预后的影响. 方法 采用散射比浊法检测67例脑梗死病人急性期和恢复期的血浆D-二聚体水平,以50名健康自愿者为对照.根据恢复期血浆D-二聚体水平与急性期相比下降是否超过一个急性期标准差(脑梗死组患者急性期血浆D-二聚体的标准差,本实验为0.325)将病人分为下降组和稳定组,分别对其预后进行观察和比较. 结果 脑梗死病人急性期的血浆D-二聚体水平与对照组比较明显升高,差别有统计学意义(P＜0.01).脑梗死病人恢复期血浆D-二聚体水平比急性期时下降者预后良好,稳定者预后不良(P＜0.01). 结论 脑梗死病人急性期和恢复期血浆D-二聚体水平的变化可较直接地反映机体的凝血、继发性纤溶状态和病情的变化,对诊断和预后判断有一定的指导意义.     

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.