妊高征患者血清α1-抗胰蛋白酶变化的研究

目的观察妊娠高血压综合征(简称妊高征)患者血清α1-抗胰蛋白酶(α1-AT)的变化,探讨其临床意义.方法分别测定妊高征患者(妊高征组)、正常妊娠孕妇(正常妊娠组)和未孕妇(未孕组)血清α1-AT、纤维蛋白原(FIB)、全血粘度(WBV)、血浆粘度(PV)和红细胞压积(Hct).结果妊娠期妇女血清α1-AT水平随孕周的增加而降低,而FIB的水平则随孕周增加而增加.重度妊高征孕妇与正常妊娠组孕妇α1-AT比较差别有显著性意义(P＜0.05),妊高征患者血清α1-AT水平与全血粘度高切比(HsWBV),全血粘度低切比(LsWBV)及Hct呈显著负相关,与PV无相关性.结论血清α1-AT水平可作为妊高征患者病情变化的一项辅助指标;妊高征与血液粘度关系密切,予抗凝治疗是治疗妊高征高粘血症的一个重要措施.     

正常妊娠和妊高征血浆ANP与ET水平及其相互关系的研究

探讨ANP与ET在正常妊娠和妊高征中血浆水平变化规律及相互关系。采用RIA正常孕阳20例,正常妊娠早孕20例,晚孕20例,产后20例,脐血16例以及妊高征孕妇30例,产后20例,脐血16例血浆ANP与ET浓度。结果：（1）血浆ANP水平变化规律：正常妊娠是脐血组＞正常晚孕组＞产后组＞早孕组＞非孕组,后四组之间无显性差异（P＞0．05）,但与脐血组之间有非常显性差异（P＜0．01）;妊高征是脐血组＞孕妇组＞产后组,但无统计学差异（P＞0．05）。（2）血浆ET水平变化规律：正常妊娠是脐血组＞正常晚孕组＞早孕组＞非孕组＞产后组,后四组之间无显性差异（P>0．05）,但与脐血组之间有显性差异（P＜0．05）。妊高征脐血组＞孕妇组＞产后组,但无统计学差异（P＞0．05）。（3）正常妊娠与妊高征血浆ANP和ET水平比较均是：妊高征孕妇组,产后组＞正常晚孕组,产后组（P＜0．01）,脐血组之间变化不明显（P＞0．05）。（4）在正常妊娠和妊高征中,血浆ANP水平与尿蛋白呈负相关(r=-0.33,P<0.05);血浆ET水平与收缩压呈正相关（r=0.20,P<0.05);血浆ANP与ET之间呈正样关（r=0.96,P<0.01).结论：血浆ANP与ET在正常妊娠过程及妊高发病中起着重要作用,并且两之间相互作用,相互影响。     

围产医学新进展

围产医学是一门新兴学科,其发展迅速,现从以下三个方面介绍这个领域的新进展.一、妊高征的研究(一)不同程度妊高征患者内皮素(ET)的变化:正常妊娠妇女血浆ET水平高于正常非妊娠妇女,而妊高征患者血浆ET水平高于正常妊娠晚期妇女,并随妊高征病情加重而增高.妊高征患者产后ET恢复至正常非妊娠水平.妊高征的病理生理变化与子宫胎盘缺血、缺氧、免疫因素、血液高凝状态等因素有关.这些因素引起血管内皮细胞损害,ET释放增加,导致血管收缩,血压升高.如能减少ET的产生,降低其作用,将会对妊高征的防治开辟新途径.     

内皮素/一氧化氮系统失调在妊高征发病中的作用

目的 :观察妊高征患者血浆一氧化氮 (NO)和内皮素 (ET)含量的变化并探讨其在妊高征发病中的意义。方法 :应用镉柱比色法和放射免疫法分别对 43例妊高征患者 (妊高征组 )、36例正常妊娠妇女 (对照组 )和 19例正常非孕妇 (正常组 )血浆中NO代谢产物亚硝酸盐 /硝酸盐 (NO-2 /NO-3 )及ET - 1含量进行了检测。结果 :正常妊娠妇女血浆中NO-2 /NO-3 含量 (34.2 9± 10 .15 ) μmol/L明显高于非孕正常组妇女 (11.98± 3 .99)μmol/L ,并随孕周的增加而增加 ,孕中期达高峰 (39.45± 9.16 ) μmol/L ,到孕晚期有所下降 (31.42± 7.86 5 )μmol/L。血浆中ET的含量有所上升 ,但与非孕正常组妇女相比则没有显著差异 (P >0 .0 5 ) ;与正常晚期妊娠对照组相比 ,轻、中度妊高征妇女血浆中NO-2 /NO-3 含量虽有所上升 ,但没有明显差异 (P >0 .0 5 ) ,而重度妊高征妇女则有明显上升 (P <0 .0 5 )。妊高征妇女血浆ET含量 (96 .0 5± 13 .5 7)ng/L与正常晚期妊娠妇女(36 .48± 6 .17ng/L)相比有极显著的上升 (P <0 .0 1) ,并且与妊高征的严重程度成正比 (r =0 .5 2 ,P <0 .0 1) ,ET/NO比值 (2 .47)明显大于正常晚期妊娠对照组妇女 (1.13,P <0 .0 5 )。结论 :妊高征患者内皮细胞损伤导致ET/NO系统平衡失调可能在妊高征的发病机     

妊高征及正常孕妇产后内皮素变化

1993年2月～1994年2月对30例妊高征患者及15例正常孕晚期孕妇采用放射免疫直接测定法测定其产前及产后24、48,72 h血浆内皮素(Endothelin,ET)。结果:轻、中度妊高征组与正常孕妇相比无差异(P>0.05),而重度组与前两者相比有显著性差异(P<0.05)。正常孕妇组产后24、48及72 h血浆ET差异不明显;而妊高征组,尤其是重度组产后48及72h与产前相比较有显著性差异(P<0.01)。结果表明ET参与了妊高征病理生理变化,并在妊高征的发生发展中具有重要作用。     

妊娠高血压综合征患者血浆神经肽Y水平变化的相关性研究

据<中华妇产科杂志>2001年4月36卷第4期报道 为探讨妊娠高血压综合征(妊高征)患者血浆神经肽Y(NPY)水平的变化及其与妊高征发病的关系,湖南医科大学附属第二医院妇产科晋丽平等,采用放射免疫分析法测定了30例妊高征患者(妊高征组)产前及产后、23例正常妊娠妇女(正常妊娠组)和20例正常育龄未孕妇女(正常非孕组)血浆NPY水平.     

妊娠高血压综合征患者血浆内皮素、神经肽及瘦素含量的变化及其临床意义

目的:观察正常非妊娠妇女、正常妊娠及妊娠高血压综合征(妊高征)患者血浆内皮素、神经肽Y及瘦素含量变化并探讨其在妊高征发病过程中的作用。方法:运用放射免疫法检测非孕妇女(正常组,23例)、正常妊娠妇女(妊娠组,60例)及妊高征患者(妊高征组,66例)血浆内皮素、神经肽Y及瘦素的含量。结果:妊高征组血浆内皮素的水平明显高于正常妊娠组,差异显著(P<0.01)。而妊高征组神经肽Y的水平较高于正常妊娠组明显高于正常组,差异显著(P<0.01)。瘦素的水平在妊高征组明显高于正常妊娠组和正常组,差异显著(P<0.05)。结论:妊高征患者血浆内皮素、神经肽Y及瘦素含量上升,提示神经体液因素在妊高征的发病过程中发挥了一定的作用且瘦素与妊娠高血压综合征有密切关系。是引起妊高征病理生理变化的重要因素。     

晚期正常妊娠及妊高征患者血浆NO及内皮素变化的临床意义

用亚硝酸盐法及放射免疫分析法对３２例正常晚期妊娠妇女，２８例妊高征患者及２０例育龄非孕妇女的血浆一氧化氮和内皮素进行测定。结果；１．正常晚期妊娠妇女血浆ＮＯ含量明显高于育龄非孕女女，但血浆ＥＴ水平两者差异无显著性。２．妊高征患者血浆ＮＯ含量明显低于正常晚期妊娠妇女和育龄非孕女女，而血浆ＥＴ水平无高于正常晚期妊娠妇女和育龄非孕妇女；妊高征组血浆ＮＯ含量降低与ＥＴ的增高综合评分呈负相关。     

新生儿脐血浆内皮素与妊高征的关系

目的 :探讨新生儿脐血浆内皮素 (ET)水平与妊高征严重程度的关系。方法 :应用放射免疫法分别对 31例妊高征孕妇的新生儿 ,10例正常妊娠妇女的新生儿脐血浆ET水平测定。结果 :妊高征孕妇的新生儿脐血浆ET水平明显高于正常孕妇的新生儿 (P <0 .0 5 ) ,但在妊高征Ⅲ度之间无明显差异 (P >0 .0 5 )。结论 :妊高征引起的ET升高是导致胎儿宫内窘迫的重要原因之一。无论妊高征的严重程度如何都会引起新生儿血浆ET水平的升高     

内皮素在先兆早产发病中的作用

探讨ET在先兆早产发病过程中的作用。用放射免疫法测定 30例先兆早产妇女和 2 8例同孕周正常妊娠妇女 ,30例足月孕临产后潜伏期妇女 ,2 5例正常非孕期妇女外周血浆中内皮素 - 1(ET - 1)含量。妊娠妇女血浆ET - 1显著高于正常非孕组 ,先兆早产组、潜伏期组显著高于正常孕周组 ,先兆早产组与潜伏期组无显著差异。提示 :ET - 1可能在分娩发动中起着重要的作用 ,先兆早产可能与孕妇血浆ET - 1水平增高有关。     

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.