急性心肌梗死后溶血磷脂酸水平与心肌重塑的关系

目的　研究急性心肌梗死 (AMI)后溶血磷脂酸 (LPA)水平的变化及其与左室重塑的相关关系 ,及LPA在AMI后心肌重塑中的作用。方法　选择AMI患者 86例 ,分别于入院即刻及第 4天测定患者血浆溶血磷脂酸和Ⅲ型前胶原蛋白的水平 ,并于入院即刻和发病第 8～ 10天对患者进行心脏彩色超声的检查 ,测定左室舒张末期直径 (LVDEd)和左室射血分数 (EF) ,并计算心肌梗死占左室面积的百分比。正常对照 4 0例 ,测定其血浆溶血磷脂酸和Ⅲ型前胶原蛋白的水平。根据入院第 4天所测得的LPA水平把患者分为两组 :LPA水平较低组 (LPA <6 0 μmol/L)为A组 ,4 5例 ;LPA水平较高组(LPA≥ 6 0 μmol/L)为B组 ,4 1例 ,比较各组参数的差异性 ,分析它们的相关关系。 结果 (1)AMI后患者血溶血磷脂酸水平较正常对照明显升高 (5 1μmol/L± 1 1μmol/L和 6 4 μmol/L± 1 3μmol/Lvs 2 5μmol/L± 1 1μmol/L ,P =0 0 0 0 1) ;(2 )溶血磷脂酸水平较高组患者与溶血磷脂酸水平较低组患者相比其左室舒张末期直径较大 (5 4 0mm± 3 3mmvs 5 1 1mm± 2 7mm ,P <0 0 5 ) ,心肌梗死面积占左室总面积的百分比较高 (114 %± 6 %vs2 6 %± 12 % ,P <0 0 5 ) ,PCⅢ水平高 (136 μg/L± 10 μg/Lvs113μg/L± 12 μg/L ,P <0     

急性冠脉综合征患者血浆溶血磷脂酸水平观察

目的 观察急性冠脉综合征(ACS)患者土浆中溶血磷脂酸(LPA)水平的变化. 方法将急性冠脉综合征分为急性心肌梗死(AMI)组和不穗定心铰痛(UA)组.其中急性心梗组98例,不稳定心绞痛组92例,测定治疗前及抗血小板活化、抗凝诊疗后1周时血浆溶血磷脂酸值,并设立健康体检者286例作为对照组,测定血浆中溶血磷脂酸值.结果 两组患者血浆LPA水平均高于对照组(2.48±0.5)umol/L.(4.56±0.65)umol/L,(3.63±0.16)umol/L,P值<0.01).结论 作为体内凝血和血栓形成过程早期释放的分析标记物LPA在志性冠脉综合征早期的禹情颓测及指导合理及时应用抗血小板活化,抗凝治疗药物蓐选方面可能有一定的临床应用价值.     

血浆溶血磷脂酸的检测及临床意义

目的　探讨溶血磷脂酸 (LPA)的检测对预防缺血性 (心 )脑卒中发生的预警作用。方法　分别检测对照组 (3 0～ 50岁 )和实验组 (65岁以上老年人 )血浆LPA的浓度 ,并对结果进行临床分析。结果　共检测 60 2例 65～ 84岁的老年人血浆LPA〔(2 .3 4± 1.2 6) μmol/L〕 ,与对照组〔LPA值为 (1.0 7± 0 .80 ) μmol/L〕相比有显著性差异(P <0 .0 1)。实验组中有 14 5例血浆LPA浓度高于参考值上限 ,平均为 (3 .62± 0 .61) μmol/L。 结论　血浆溶血磷脂酸对缺血性 (心 )脑卒中的发生有重要的预警作用     

急性冠脉综合征患者血浆溶血磷脂酸水平与冠状动脉病变的相关性

目的探讨急性冠脉综合征(ACS)患者血浆溶血磷脂酸(LPA)水平与冠状动脉病变程度的关系及临床意义。方法 60例ACS患者[包括急性心梗(AMI)30例和不稳定型心绞痛(UAP)30例]作为研究组,另选30例健康体检者作为对照组;所有人均取外周静脉血检测血浆LPA。冠状动脉病变进行Gensini评分,分析ACS患者LPA水平与Gensini评分的关系。结果 ACS(包括AMI和UAP)组与对照组比较,LPA水平明显增高,差异有统计学意义(P<0.01)。AMI组与UAP组Gensini评分的差异具有统计学意义(P<0.01)。相关性检验显示:ACS患者血浆LPA水平与Gensini评分成正相关(r=0.828,P<0.01)。结论 ACS患者血浆溶血磷脂酸水平与冠状动脉病变程度密切相关。     

溶血磷脂酸在冠心病患者中的表达及其与冠状动脉病变的关系

目的 观察溶血磷脂酸(LPA)在冠心病患者中的表达及其与冠状动脉病变的关系,并探讨LPA与炎症和脂质过氧化反应的关系.方法 将按照美国心脏病学会/美国心脏协会冠心病处理指南的诊断标准并经冠状动脉造影确诊的85例患者纳入研究,分为3组,急性心肌梗死(AMI)组31例,不稳定型心绞痛(UA)组30例,稳定型心绞痛(SA)组24例;选择冠状动脉造影正常的20例非冠心病患者作为对照组.入选者均测定其LPA、C-反应蛋白(CRP)及低密度脂蛋白胆固醇(LDL-C)水平,并进行冠状动脉造影,按照Jenkins评分系统进行评分.比较各组LPA的表达情况,并对LPA与Jenkins评分、CRP、LDL-C进行Spearman直线相关分析.结果 4组患者LPA的表达水平比较,差异有统计学意义(P<0.01).AMI 组LPA的表达水平[(4.85±0.36)μmol/L明显高于UA组(3.67±0.84)μmol/L]、SA组[(2.61±0.73)μmol/L]和对照组[(1.75±0.49)μmol/L],UA组LPA表达水平明显高于SA组和对照组,SA组表达水平明显高于对照组.冠心病患者LPA的表达水平与Jenkins评分(r=0.901)、CRP水平(r=0.755)和LDL-C水平(r=0.549)均呈正相关,差异有统计学意义(P<0.01).结论 随着冠心病病情加重,LPA的表达水平升高,LPA的表达水平可反映冠状动脉病变的严重程度,LPA与炎症和脂质过氧化反应有关.     

同型半胱氨酸与冠状动脉病变关系的初步探讨

目的　探讨血浆同型半胱氨酸 (Hcy)水平与冠状动脉病变支数的关系 ,以及其与急性心肌梗死 (AMI)、不稳定性心绞痛 (UA)之间的关系。方法　采用全自动酶化学发光法对 82例行选择性冠状动脉造影术的患者进行血浆Hcy测定。根据冠状动脉造影结果分组 :正常对照组 2 5例 (包括 3例临床诊断为AMI的患者 ) ,单支血管病变组 2 3例 ,双支血管病变组 18例 ,3支血管病变组 16例 ;根据临床诊断分组 :AMI组 36例、UA组 2 4例 (两组冠状动脉病变支数无差异 )和非冠心病组 2 2例。结果　① 3支病变组的Hcy为 (2 5 .14± 11.78) μmol/L ,2支病变组为 (19.6 2± 7.0 4) μmol/L ,单支病变组为 (18.43± 7.16 ) μmol/L ,3组均显著高于正常对照组的 (14.0 6± 2 .5 4) μmol/L(P值均 <0 .0 1)。②AMI组的Hcy为(2 0 .0 7± 7.72 ) μmol/L ,UA组为 (2 0 .6 2± 10 .6 3) μmol/L ,均显著高于非冠心病组的 (14.2 3± 2 .6 3) μmol/L(P值均 <0 .0 1) ;UA组的Hcy略高于AMI组 ,但差异无显著性 (P =0 .41)。 结论　血浆Hcy升高是冠心病的危险因素。其增高不仅与冠状动脉病变支数呈正相关 ,而且与冠状动脉病变的活动显著相关 ,进一步提示增高的血浆Hcy与冠心病心肌缺血事件的发生密切相关。     

高敏C反应蛋白、心肌肌钙蛋白I对急性冠脉综合征的诊断价值

目的 :探讨急性冠脉综合征 (ACS)的早期诊断方法。方法 :6 8例冠心病 (CHD)患者分成 3组 ,其中急性心肌梗死 (AMI)组 2 1例 ,不稳定型心绞痛 (UA)组 2 7例 ,稳定型心绞痛 (SA)组 2 0例 ,采用胶乳凝集反应法定量测定高敏 C反应蛋白 (Hs-CRP) ,采用固相层析免疫法定性测定肌钙蛋白 I(c Tn I)。结果 :AMI组与 UA组的 Hs-CRP含量及 c Tn I阳性率均明显高于 SA组 ,差异均有显著性 (P<0 .0 5 ) ;AMI组与 UA组比较差异有显著性 (P<0 .0 5 )。结论 :Hs-CRP和 c Tn I的增高与急性冠脉综合征密切相关。     

脑梗死与脑出血患者血浆溶血磷脂酸含量的比较

目的 :探讨脑梗死与脑出血患者血浆溶血磷脂酸 (lysophosphatidicacid ,LPA)含量的变化规律 ,为临床诊断和治疗脑梗死提供依据。方法 :选择确诊的脑血栓形成、脑出血患者于发病 3天内、发病 2周时、发病 4周时取静脉血测定LPA含量 ,动态观察其变化过程。LPA检测采用有机溶剂提取 ,分离LPA ,用定磷法测定。结果 :脑血栓形成患者发病 3天内血浆LPA含量显著高于脑出血组及健康对照组 ,分别为 1 0 .6 3μmol/L± 3.6 7μmol/L ,2 .6 7μmol/L± 1 .4 0 μmol/L ,2 .0 4 μmol/L± 1 .0 1 μmol/L ;脑血栓形成组LPA的增高可持续 2周 (发病 2周时含量为5 .31 μmol/L± 1 .94 μmol/L) ,发病第 4周时降至正常水平 (2 .0 9μmol/L± 1 .0 1 μmol/L) ,总体规律为发病时明显增高 ,而后呈逐渐下降趋势。脑出血组发病 2周时含量 2 .5 4 μmol/L± .91 μmol/L、发病四周时含量 2 .2 8μmol/L±1 .0 4 μmol/L,与出血发病 3天内含量及对照组比较无显著性差异。结论 :LPA可以作为鉴别脑梗死与脑出血的一个指标 ,用来指导脑梗死的治疗     

低分子肝素联合葛根素治疗不稳定型心绞痛92例临床观察

不稳定型心绞痛(UA)属急性冠脉综合征类型之一。是介于稳定型心绞痛(SA)和急性心肌梗死(AMI)之中间状态,易发展为AMI,危及患者生命。我们在常规治疗基础上,应用低分子肝素(商品名速避凝)联合注射用葛根素(商品名:布瑞宁)治疗UA 92例,探讨其对冠心病不稳定型心绞痛的治疗作用,报告如下。1　资料与方法1.1　一般资料　选择2 0 0 1年1月至2 0 0 3年12月入院患者184例,其诊断均符合1979年WHO制定的UA诊断标准。随机分为速避凝联合布瑞宁治疗组和常规治疗组各92例。治疗组:男6 2例,女30例;年龄4 0岁～78岁,平均年龄(6 1±7)岁,其中初发劳…     

血浆同型半胱氨酸水平与急性心肌梗死的关系

目的　探讨血浆同型半胱氨酸 (Hcy)水平与急性心肌梗死 (AMI)之间的关系。方法　应用高效液相色谱仪测定血浆Hcy水平 ,对 50例确诊急性心肌梗死患者与 50例正常对照者进行比较分析。结果　AMI组和对照组血浆Hcy水平分别为 (1 6 73± 4 0 1 ) μmol/L和 (1 0 87± 2 95) μmol/L ,两者差异有显著性 (P <0 0 5)。在 37例行冠状动脉造影的AMI患者中 ,多支病变组 (≥ 2支血管病变 )的血浆Hcy水平显著高于单支病变组 [(1 7 2 5± 4 .86) μmol/Lvs (1 2 .2 3±5 1 7) μmol/L ,P <0 0 5]。 结论　高Hcy血症可能是AMI的一种独立危险因素 ,且冠脉病变越严重 ,血浆Hcy水平越高。     

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.