脑外伤后低钠血症患者急性期临床经过及近期预后观察

目的 观察脑外伤后低钠血症患者急性期临床经过及近期预后表现.方法 连续选择近期住院的脑外伤患者133例,检测住院期间血、尿钠值,并观察急性期临床经过和预后表现.低钠血症诊断标准为住院期间血钠≤125mmol/L和尿钠测定≥80mmol/24h.结果 133例脑外伤中确诊低钠血症患者47例(35.34%),血钠正常患者86例(对照组).低钠血症组的平均意识障碍时间、CT阳性发现例数、平均血肿量、中线移位例数和平均住院天数均明显高于对照组,而入院时GCS评分和出院时ADL评分却明显低于后者(P均＜0.05～0.01).结论 低钠血症可明显影响脑外伤患者急性期临床经过及近期预后.     

低钠血症对慢性心力衰竭患者近期临床预后的影响

目的分析低钠血症对心力衰竭患者临床预后的影响。方法回顾性分析2006年2月至2012年8月期间在解放军324医院诊疗的322例心衰患者,按照血清钠的浓度分为低钠血症组与正常血钠组,均为161例,比较分析两组患者的相关临床资料情况。结果低钠血症组BNP水平、住院天数、住院死亡率、再住院率分别较正常血钠组同一心功能患者明显升高(P<0.05);在低钠血症组,血钠浓度随着心功能的降低而降低(P<0.05),随着血钠浓度的降低而BNP水平升高(P<0.05),住院天数及住院死亡率随着心功能的降低而升高(P<0.05)。结论心衰合并低钠血症患者具有心功能差、住院死亡率和再住院率高以及住院时间长的特点。     

脑外伤后低钠血症患者急性期临床经过及近期预后观察

目的观察脑外伤后低钠血症患者急性期临床经过及近期预后表现。方法连续选择近期住院的脑外伤患者133例,检测住院期间血、尿钠值,并观察急性期临床经过和预后表现。低钠血症诊断标准为住院期间血钠≤125mmol/L和尿钠测定≥80mmol/24h。结果133例脑外伤中确诊低钠血症患者47例（35.34%）,血钠正常患者86例（对照组）。低钠血症组的平均意识障碍时间、CT阳性发现例数、平均血肿量、中线移位例数和平均住院天数均明显高于对照组,而入院时GCS评分和出院时ADL评分却明显低于后者（P均〈0.05～0.01）。结论低钠血症可明显影响脑外伤患者急性期临床经过及近期预后。     

2型糖尿病合并低钠血症及低钙血症的机制探讨

目的 探讨2型糖尿病合并低钠、低钙血症的发病机制.方法 选取2004年3-6月在我院住院的2型糖尿病患者,从中筛选出年龄、性别、血压相匹配的30例低钠血症者和50例血钠正常者.测定低钠血症组和血钠正常组患者的血钠、钾、钙、磷、促肾上腺皮质激素(ACTH)、24 h尿游离皮质醇(UFC)、甲状旁腺激素(PTH)和血清25(OH)D3和1,25(OH)2D3水平.然后,低钠血症组患者给予补充小剂量泼尼松(5 mg/d)替代治疗后,比较治疗前后患者的血钠、钙和血清25(OH)D3、1,25(OH)2D3水平变化.结果 与血钠正常组比较,低钠血症组糖尿病患者血钠、钙及血清1,25(OH)2D3水平显著降低,血钾显著升高,差异有统计学意义(P＜0.05);而血、尿皮质醇仅有升高趋势,但差异无统计学意义(P＞0.05).低钠血症组患者补充泼尼松治疗后,血钠、钙及血清1,25(OH)2D3水平显著高于治疗前,差异有统计学意义(P＜0.05).结论 糖尿病合并低钠血症者可能存在肾上腺皮质功能相对不足,降低了1,25(OH)2D3的合成,导致低钙血症.适当补充小剂量糖皮质激素可能上调了肾脏近曲小管1α羟化酶活性,促进1,25(OH)2D3的形成,从而改善低钠和低钙血症.     

低钠血症对慢性心力衰竭患者预后的影响

目的:探讨低钠血症与慢性心力衰竭再住院率、病死率的关系。方法:将慢性心力衰竭患者根据血钠水平分为低钠血症组与正常血钠组,监测两组之间的BNP水平和LVEF值,并观察两组患者6个月内的再住院率。结果:低钠血症组再住院率高于正常血钠组,低钠血症组患者BNP水平较正常血钠组同一组别水平高,正常血钠组与低血钠组心功能Ⅱ、Ⅲ、Ⅳ级BNP的比较差异显著(P<0.05),血浆BNP与血钠成显著负相关(r=-0.25,P<0.05)。结论:低钠血症可能促进慢性心衰患者血浆BNP分泌增加,神经内分泌及肾素水平激活更明显,是心衰不良预后的标志。     

低钠血症398例临床特征分析

目的：分析低钠血症的病因、转归及特点,为本地低钠血症的临床流行病学研究提供初步资料。方法收集2012年6月-2013年12月于大连医科大学附属第一医院住院的低钠血症患者临床资料,按照血清钠离子（Na＋）浓度分为轻度低钠血症组（130≤Na＋＜135 mmol/L）,中度低钠血症组（120≤Na＋＜130 mmol/L）以及重度低钠血症组（ Na＋＜120 mmol/L）,分析病因、各组转归、合并症情况及血钠水平的影响因素等。结果398例低钠血症在住院患者中的发病率0．03％,根据基础疾病进行分析,其中以肺部疾病103例（占25．88％）,中枢神经系统疾病74例（占18．59％）,恶性肿瘤56例（占14．07％）,消化系统疾病53例（占13．32％）居多。重度组死亡率高于轻、中度组（ P＜0．05）。年龄、肾小球滤过率与血Na＋呈负相关;血Cl-、血渗透压与血Na＋呈正相关,差异有显著性意义（ P＜0．05）。结论低钠血症是住院患者常见的并发症,主要原因是肺部疾病、中枢神经系统疾病、恶性肿瘤;随着年龄增长、肾小球滤过率升高时容易合并低钠血症。早期识别、正确处理能降低低钠血症的发生率和病死率。     

钠代谢紊乱对重型颅脑损伤患者病情及预后评价临床应用研究

目的:研究血钠紊乱程度在重型颅脑损伤患者病情及预后评估的临床应用价值.方法:149例重型颅脑损伤根据血钠水平分为低钠血症组47例,血钠正常组64例,高钠血症组38例,比较三组重型颅脑损伤患者格拉斯歌昏迷评分以及预后情况.结果:血钠正常组、低钠血症组、高钠血症组三组入院GCS评分依次降低,平均APACHEⅡ评分依次升高;高钠血症组死亡率为25.8％,高于血钠正常组、低钠血症组,差异有统计学意义(P＜0.05),血钠正常组死亡率与低钠血症组无统计学差异(P＞0.05);低钠血症组、血钠正常组钠离子浓度与GCS评分及平均APACHEⅡ评分均无相关性(P＞0.05),高钠血症组钠离子浓度与GCS评分呈负相关(r=-0.65,P＜0.05),与平均APACHEⅡ评分均呈正相关(r=0.59,P＜0.05).结论:高钠血症在重型颅脑损伤患者中较为凶险,具有较高的死亡率,钠离子的增高程度与疾病严重程度相关,可作为重型颅脑损伤患者并发高钠血症预后的评估指标.     

住院心力衰竭患者入院时低钠血症对预后的影响

目的调查在景德镇市第三人民医院心衰病房住院的心力衰竭患者入院时低钠血症对预后的影响。方法将2014年1月~2016年1月于景德镇市第三人民医院心衰病房住院的成人(首次入院年龄≥18岁)症状性心衰(纽约心脏病协会NYHA心功能Ⅱ~Ⅳ)患者80例作为实验对象,以血清钠浓度135 mmol/L定义为低钠血症,其中低钠组37例,非低钠组43例,调查我国心衰住院患者入院时低钠血症的患者,分析入院低钠血症与心衰住院患者院内死亡及出院随访1年内全因死亡和心衰死亡的关系。结果 80例住院心力衰竭患者中,低钠组患者入院时收缩压、左心室射血分数均较低,其血管肾素活性及醛固酮浓度较高;低钠组患者住院天数明显长于非低钠组,其病死率也显著高于非低钠组(P0.05);经分析得出:入院时伴随的低钠血症影响心力衰竭患者住院天数及病死率(P0.05),血钠与住院天数之间呈负相关关系(P0.05)。经Logistic回归分析,在校正患者入院收缩压水平、NYHA分级、肌酐后,低钠血症仍旧是全因死亡与心衰死亡的独立预测因素。结论心力衰竭患者中发生低钠血症的几率较高,低钠血症会降低患者的心功能,延长其住院天数,增加患者住院病死率。对此应积极预防低钠血症以缩短心力衰竭患者住院时间及改善患者预后。     

小细胞肺癌合并低钠血症病人临床特征及与化疗疗效的关系

目的：探讨小细胞肺癌(SCLC)合并低钠血症病人的临床特征及与化疗疗效的关系,为改善SCLC合并低钠血症病人的预后提供理论依据。方法：选取SCLC病人106例,其中合并低钠血症者38例,血钠正常者68例。所有病人均采用依托泊苷联合铂类方案连续化疗2周期。分析低钠血症组与血钠正常组一般临床资料,按RECIST 1.1标准评价近期疗效,按NCICTCAE 3.0标准评价不良反应。低钠血症组依据化疗后血钠是否纠正分为血钠纠正组与血钠未纠正组,分析其与临床疗效的关系。根据化疗疗效将病人分为疾病控制组和疾病进展组,比较2组化疗前后胃泌素释放肽前体(ProGRP)和神经元特异烯醇化酶(NSE)水平,并分析血清钠水平与ProGRP、NSE水平的相关性。结果：SCLC合并低钠血症的发生率为15.83%(38/240)。SCLC合并低钠血症组与血钠正常组临床分期、骨转移、胸腔积液、NSE水平、ProGRP水平差异均有统计学意义(P<0.05)。低钠血症组病人客观缓解率(ORR)、疾病控制率(DCR)均低于血钠正常组(P<0.05)。与血钠正常组比较,低钠血症组病人更容易出现胃肠道反应(P&l...     

老年顽固性心力衰竭伴低钠血症的临床研究

目的探讨老年顽固性心力衰竭伴低钠血症的临床特点及治疗策略。方法回顾性分析2011年1月至2011年12月北京市和平里医院收治的74例60岁以上心功能Ⅲ^Ⅳ级心力衰竭患者的临床资料,其中合并低钠血症者59例,根据血钠水平分为血清钠正常组(135Ⅳ级心力衰竭患者的临床资料,其中合并低钠血症者59例,根据血钠水平分为血清钠正常组(135¹45 mmol/L)、轻度低钠血症组(130145 mmol/L)、轻度低钠血症组(130¹34 mmol/L)、中重度低钠血症组(中度120134 mmol/L)、中重度低钠血症组(中度120¹29 mmol/L、重度<120 mmol/L)三组。比较分析三组患者的临床特点及规范抗心力衰竭治疗+3%氯化钠静脉治疗的临床疗效。结果入院时合并低钠血症患者治疗后血钠水平显著升高,与治疗前比较差异有统计学意义(P<0.05);但三组患者平均住院日比较差异无统计学意义(P>0.05);中重度低钠血症组病死率较血清钠正常组高,差异有统计学意义(P<0.05);多因素回归分析显示:心功能分级为Ⅳ级和较长时间的血钠水平低与心力衰竭患者的病死率有密切联系。结论适度补充氯化钠可及时纠正老年顽固性心力衰竭合并的低钠血症,改善其预后。     

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.