苯那普利联合维生素E对糖尿病肾病的防治作用

目的探讨肾素-血管紧张转换酶抑制剂苯那普利联合维生素E对糖尿病肾病的治疗作用.方法将糖尿病肾病患者随机分成苯那普利 维生素E治疗组32例,苯那普利5～10 mg/d 维生素E600 ng/d治疗60d,并设对照组28例,治疗前后测定24h尿蛋白、肾小球滤过率、血糖及血脂.结果治疗组肾小球高滤过状态得以改善(P＜0.001),尿蛋白排泄量明显减少(P＜0.001),而对照组肾功能指标无明显变化(P＞0.05),两组血糖、糖化血红蛋白、血脂在治疗前后无明显变化(P＞0.05).结论苯那普利联合维生素E对糖尿病肾病有保护及治疗作用.     

苯那普利治疗老年高血压病疗效观察

目的　观察苯那普利对老年高血压病的治疗效果 ,以及对心率、肾功能、血糖、血脂和电解质的影响。方法　 62例患者随机分成苯那普利治疗组 (治疗组 )和氨氯地平治疗组 (对照组 ) ,分别给予苯那普利和氨氯地平治疗 4周 ,测定治疗前后的血压、心率、肾功能、血糖、血脂和电解质 ,并进行比较。结果　经自身前后对照 ,两药均有显著降压效果 (P <0 .0 1) ,对心率、血糖、血脂和电解质无明显影响 (P >0 .0 5 ) ,但治疗组肾功能显著改善 (P <0 .0 5 )。结论　苯那普利降压效果显著 ,对肾功能有保护作用 ,尤其适用于老年高血压病患者     

川芎嗪注射液加苯那普利治疗糖尿病肾病疗效观察

目的 :观察川芎嗪注射液加苯那普利治疗糖尿病肾病的疗效。观察其甘油三酯、胆固醇、尿蛋白、血压 ,肾功能的变化。方法 :将 4 8例糖尿病肾病病人分为三组 ,每组 16例 ,A组给予川芎嗪注射液 ,苯那普利。B组用川芎嗪注射液。C组 :苯那普利。观察治疗二个月前后血压 ,2 4小时尿蛋白 ,甘油三酯 (TG) ,胆固醇 (TC) ,血肌酐 (Scr)和血尿素氮 (BUN)的变化。结果 :川芎嗪 (B组 )可减低血胆固醇 ,甘油三酯 ,有轻度降血压作用。苯那普利 (C组 )可减少蛋白尿、血压 ,改善肾功能。联合用药 (A组 )能明显减低胆固醇、甘油三酯、降血压、蛋白尿 ,降低SCr、BUN水平 (P <0 0 5orP <0 0 1)。结论 :川芎嗪注射液和苯那普利能降低血压 ,减少尿蛋白排出 ,降低血脂 ,改善肾功能 ,防止和缓糖尿病肾病的发展。     

厄贝沙坦与苯那普利治疗轻中度原发性高血压的疗效比较

目的 :比较厄贝沙坦与苯那普利治疗轻中度原发性高血压 (EH)的临床疗效。方法 :将 90例轻中度 EH患者分为厄贝沙坦组 (n=4 5 )和苯那普利组 (n=4 5 ) ,前者给予厄贝沙坦 1 5 0 mg口服 ,qd;后者给予苯那普利 1 0 mg口服 ,qd,疗程 1 2周。治疗前后测偶测血压、动态血压 ,观察不良反应。结果 :厄贝沙坦组总有效率为 77.8% ,降压幅度为 2 2 .6 / 1 4 .4 m m Hg,T/ P比值 :SBP0 .81、DBP0 .80 ;苯那普利组总有效率为 80 % ,降压幅度为 2 2 .9/ 1 4 .6 m m Hg,T/ P比值 :SBP0 .82 ,DBP0 .81。各项指标两组间比较无显著性差异 (P>0 .0 5 )。厄贝沙坦组干咳发生率 (2 .2 % )与苯那普利组 (2 2 .2 % )比较有显著性差异 (P<0 .0 5 )。结论 :厄贝沙坦治疗轻中度 EH有效 ,降压效果与苯那普利相似 ,但耐受性优于苯那普利     

氯沙坦联合苯那普利治疗糖尿病肾病的临床疗效

目的:观察氯沙坦联合苯那普利对早期糖尿病肾病(DN)的临床疗效。方法:将60例2型糖尿病肾病患者随机分为两组,分别使用氯沙坦、苯那普利两药联用为治疗组(n=30),单用苯那普利为观察组(n=30),疗程16周。观察两组治疗前后各组患者的平均动脉压(MAP)、尿白蛋白排泄率(UAER)、内生肌酐清除率(Ccr)、尿素氮(BUN)、空腹血糖(FBG)、糖化血红蛋白(HbA1C)、血脂等变化。结果:治疗组与观察组对早期DN,均有明显降低血压、UAER和BUN的作用,各组在治疗前后具有明显差异(P<0.01或P<0.05);但治疗组效果更好,尤其降低UAER作用有明显差异(P<0.01);各组FBG、CH、TG治疗前及治疗后各组间比较无统计学意义(P>0.05)。结论:氯沙坦联合苯那普利治疗早期糖尿病肾病疗效确切。     

ERK1/2途径介导苯那普利对糖尿病肾病大鼠保护作用的实验研究

目的观察苯那普利对糖尿病大鼠肾组织AngⅡ水平、磷酸化ERK1 2 (P4 2 4 4MAPK)表达及肾脏病理变化的影响 ,探讨苯那普利对糖尿病大鼠肾脏保护作用的机制。方法健康、雄性Wistar大鼠 18只 ,随机分为正常对照组 (A组 ,n =6 )、实验组 (n =12 )。实验组大鼠用链脲佐菌素 (STZ ,6 0mg kg )腹腔注射制成糖尿病模型后 ,再随机分为糖尿病组 (B组 ,n =6 ) ,以及糖尿病苯那普利 (6mg·kg 1 ·d 1 )治疗组 (C组 ,n =6 )。于实验组大鼠确定糖尿病模型成功后 8周末时 ,称体重 ,留取 2 4小时尿 ,采下腔静脉血 ,取双侧肾脏 ,称肾重 ,留取肾脏标本。测血糖、肌酐清除率 (Ccr)、肾肥大指数 (肾重 体重 )的变化。肾组织做常规病理检查 ,放免法测定血浆及肾脏组织的AngⅡ含量 ,Western blot法分析肾脏磷酸化ERK1 2的表达。结果①苯那普利对糖尿病大鼠的血糖无影响。②糖尿病大鼠于 8周末即已出现明显的糖尿病肾病表现 :Ccr(2 .4 3± 0 .2 5 )明显高于正常大鼠 (0 .77± 0 .0 9) ,肾脏肥大指数 (10 .38± 0 .73)明显高于正常大鼠 (6 .5 6± 0 .4 3)。③苯那普利治疗糖尿病大鼠有明显的肾脏保护作用 :苯那普利治疗 8周末其Ccr(1.6 4± 0 .13)较糖尿病组 (2 .4 3± 0 .2 5 )有明显下降 ,第 8周末肾脏肥大指数有所增加     

左旋氨氯地平联合苯那普利对22例2型糖尿病肾病伴高血压患者血压及肾功能的影响

目的　探讨左旋氨氯地平、苯那普利联合应用对 2型糖尿病肾病伴高血压患者血压及肾功能的影响。方法　 6 9例 2型糖尿病伴高血压及蛋白尿患者随机分为 3组 :左旋氨氯地平组2 4例 ,苯那普利组 2 3例 ,联合治疗组 2 2例 ;3组分别给予左旋氨氯地平 2 .5 mg、苯那普利 10 m g及苯那普利 10 m g和左旋氨氯地平 2 .5 m g,每日 1次 ,疗程 12周。观察治疗前后血压和肾功能变化。结果　两药单独治疗及两药联合应用均可明显降低糖尿病肾病高血压 (P<0 .0 1) ,减少 2 4 h尿白蛋白排出 (P<0 .0 5 ) ,联合治疗降血压和降低尿蛋白的幅度优于单独治疗 (P<0 .0 1)。结论　左旋氨氯地平和苯那普利治疗糖尿病肾病高血压均有较好的降压作用 ,且能减少 2 4 h尿蛋白的排泄 ,两药联合治疗可起到协同作用。     

缬沙坦和苯那普利治疗原发性高血压的临床观察

目的　探讨缬沙坦和苯那普利单用、联合治疗原发性高血压的临床效果。方法　对 30例单用缬沙坦 (A组 )和 2 5例单用苯那普利 (B组 )及 30例联合治疗病人 (C组 )比较 ,观察其治疗前后血压的变化、肝功能、血脂和不良反应。结果　 3组治疗 2周后血压较治疗前都有所下降 ,联合治疗组 2～ 4周下降明显 ,P<0 .0 5。3组治疗前后肝功能、血脂无明显变化 ,缬沙坦组无明显不良反应。结论　缬沙坦和苯那普利联合治疗原发性高血压较单独使用更能有效的控制血压     

高血压病患者血清Ⅲ型前胶原和血管紧张素Ⅱ水平 及苯那普利的干预作用

目的　探讨高血压病患者血清Ⅲ型前胶原 (PC Ⅲ )和血管紧张素Ⅱ (AngⅡ )含量的变化以及苯那普利对其影响。方法　用放免法检测 2 0例健康人 (对照组 )及 46例高血压病患者 (高血压病组 )PC Ⅲ和AngⅡ水平 ;观察高血压病组经苯那普利治疗前后上述指标变化并与对照组进行对比。结果　高血压病组较对照组PC Ⅲ和AngⅡ水平明显升高 (P <0 .0 5 ,P <0 .0 1) ,高血压病组用苯那普利治疗后PC Ⅲ和AngⅡ水平显著下降 (P <0 .0 5 )。结论　高血压病患者心肌胶原合成活跃 ,苯那普利可降低血清PC Ⅲ和AngⅡ水平 ,改善心肌胶原代谢异常     

苯那普利联合小剂量氢氯噻嗪治疗高血压40例观察

目的　观察苯那普利联合小剂量氢氯噻嗪治疗原发性轻中度高血压的疗效。方法　原发性高血压 75例分为 ,对照组 (n =35)服苯那普利 ,心功能Ⅲ级者予西地兰速尿 ,地高辛。合并冠心病者予鲁南欣康 ;治疗组 (n=40 )在对照组基础上加氢氯噻嗪 ,疗程均 6周 ,观察其对血压、心功能、KFG、代谢、电解质的影响。结果　两组的血压均明显下降 ,有效有显著差异 (P <0 .0 5) ;心功能改善率有显著差异 (P <0 .0 5) ,ST -T改善无显著差异 (P >0 .0 5) ,对代谢 ,电解质无影响。结论　两药联合治疗原发性轻中度高血压 ,方便、有效、安全、适合作一线的联合用药方案。     

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.     

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.     

Notes for contributors to Journal of Nanjing Medical University

Journal of Nanjing Medical University (English Edition) JNMU, sponsored by Nanjing Medical University, was established in 1987. It is a bimonthly comprehensive English medical journal published locally and abroad.Since 2007, Journal of Nanjing Medical University (English Edition )was granted Elsevier the full publishing and distribution rights worldwide for the Electronic Edition, excluding the People's Republic of China.