血液透析与腹膜透析患者心脏瓣膜钙化高危因素及对临床预后的影响

目的分析血液透析与腹膜透析患者心脏瓣膜钙化的危险因素以及心脏瓣膜钙化对其临床预后的影响。方法选择2014年1—月广东省江门市中心医院肾内科收治血液透析患者(血透组)67例及腹膜透析患者(腹透组)63例作为研究对象,对比2组患者的各项临床资料,采用Logistic回归模型对影响心脏瓣膜钙化的因素进行分析。结果血透组瓣膜钙化发生率高于腹透组(64.18%vs.46.03%,χ2~=4.327,P=0.038)。2组患者年龄、瓣膜钙化病例、透析时间、收缩压、残余肾功能、血清磷、钙磷乘积、Alb、LDL-C、HDL-C比较,差异有统计学意义(t/χ~2=2.025、4.327、3.652、2.191、4.091、3.205、2.378、2.117、1.990、2.314,P均<0.05)。Logistic回归分析发现,年龄偏大、透析时间较长及残余肾功能低下均是心脏瓣膜钙化的独立危险因素(OR=1.023、1.261、0.436,95%C1分别为1.023~1.359、1.011~1.186、0.221~0.846)。随访调查结果显示,死亡16例,其中心源性死亡12例,非心源性死亡4例。瓣膜钙化对于心源性死亡和非心源性死亡均具有较为明显的预测意义(P<0.05)。结论年龄、透析时间、残余肾功能低下均是导致心脏瓣膜钙化发生的独立危险因素,心脏瓣膜钙化可增加透析患者心血管的病死率。腹膜透析患者的残余肾功能高于血液透析患者,血磷水平和瓣膜钙化发生率低于血液透析患者。     

腹膜透析联合血液透析对慢性肾功能衰竭的疗效观察

目的：探讨血液透析联合腹膜透析与腹膜透析治疗慢性肾功能衰竭患者的临床疗效。方法：选取我院2006年10月~2010年10月收治的慢性肾功能衰竭患者80例,其中32例行腹膜透析联合血液透析治疗（联合组）,48例仅进行腹膜透析（腹透组）,观察两组疗效。结果：两组治疗后肾功能均得到改善,联合组肌酐、尿素氮均低于腹透组,差异均有统计学意义（均P〈0.05）;治疗后联合组血红蛋白及白蛋白水平高于腹透组,甲状旁腺素水平低于腹透组,差异均有统计学意义（均P〈0.05）;联合组治疗中并发症少于腹透组,差异有统计学意义（P〈0.05）。结论：腹膜透析联合血液透析治疗慢性肾功能衰竭,可明显改善肾功能,减少并发症,改善患者生活质量,值得应用。     

维持性血液透析患者心脏瓣膜病变及其相关因素分析

目的：探讨维持性血液透析患者心脏瓣膜病变的情况及其可能相关因素。方法：通过彩色多普勒超声心动图检查观察33例维持性血液透析患者心脏瓣膜病变的类型、程度及相应的血生化指标。结果：33例患者中发现心脏瓣膜钙化18例,心脏瓣膜的钙化主要与血磷、血PTH和透析年限相关。结论：维持性血液透析患者心脏瓣膜病变以钙化为主,且与钙磷代谢紊乱和血液透析年限密切相关。     

维持性血液透析患者采用不同血液净化方式心脏瓣膜钙化高危因素分析

目的观察维持性血液透析患者采用不同血液净化方式心脏瓣膜钙化患病情况及高危因素分析。方法收集在泰兴市人民医院血液净化中心维持血液透析患者54例,分为血液透析(HD)组18例、血液滤过(HDF)组18例、血液灌流串联血液透析(HP+HD)组18例。观察各组患者治疗前后血钙、血磷、甲状旁腺激素(PTH)指标变化及心脏瓣膜钙化程度,分析血钙、血磷、钙磷乘积、PTH与心脏瓣膜钙化的关系。结果 (1)治疗12个月后54例患者中有23例(42.59%)出现不同程度的心脏瓣膜钙化,3组患者心脏瓣膜钙化发生率分别为HD组55.56%,HDF组44.44%,HP+HD组27.78%,差异有统计学意义(P<0.05)。(2)治疗12个月后,Ⅰ度钙化组血磷、钙磷乘积及PTH水平明显高于无钙化组(P<0.05),Ⅱ、Ⅲ度钙化组血钙、血磷、钙磷乘积、PTH水平高于无钙化组和Ⅰ度钙化组(P<0.05),Ⅲ度钙化组血磷、钙磷乘积及PTH水平明显高于Ⅱ度钙化组(P<0.05)。(3)HD组治疗前后血钙、血磷、PTH比较差异无统计学意义(P>0.05)。HDF组、HP+HD组治疗后血钙较治疗前升高,血磷及PTH下降,差异有统计学意义(P<0.05)。治疗后3组患者血钙比较差异无统计学意义(P>0.05)。治疗后HDF组和HP+HD组的血磷、PTH水平明显低于HD组(P<0.05);HP+HD组的血磷及PTH水平与HDF组比较明显降低,差异有统计学意义(P<0.05)。结论高磷血症、高PTH等是心脏瓣膜钙化的高危因素,应用HDF、HP+HD透析方式能较好地清除血磷、PTH等,以HP+HD透析方式尤佳,可降低心脏瓣膜钙化率。     

尿毒症患者钙磷代谢紊乱与心脏瓣膜钙化的相关性分析

目的：研究和探讨尿素症患者钙磷代谢紊乱与心脏瓣膜钙化的相关性其临床意义。方法：选取2013年1月～2014年6月于我院进行治疗的120例尿毒症患者为观察组,对患者的血磷值、血钙值进行检测,同时应用彩色B超检测心脏瓣膜钙化情况,并根据心脏彩超检查有无心脏瓣膜钙化分为心脏瓣膜钙化组和无心脏瓣膜钙化组,比较2组实验室检查结果,分析尿毒症患者钙磷代谢紊乱与心脏瓣膜钙化两者的相关性。结果：120例患者当中,78％的尿毒症患者都存在血管钙化的现象,并且其平均血磷值为2．00mmol／L,已经明显高于推荐目标的上限值。出现心脏瓣膜钙化情况的为64人,达到53％,心脏瓣膜钙化组患者的年龄大于无心脏瓣膜钙化组,透析时间长于无心脏瓣膜钙化组,血钙、血磷水平均显著高于无心脏瓣膜钙化组。结论：尿毒症患者心脏瓣膜钙化程度与血钙、血磷代谢异常呈正相关关系,可以从这方面治疗心脏瓣膜钙化病症;另外年龄越大、透析时间越长的患者更应该注意饮食控制和持续的药物调节。     

难治性继发性甲状旁腺功能亢进患者腹主动脉钙化与心脏瓣膜钙化相关性研究

目的 总结难治性继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)患者腹主动脉钙化与心脏瓣膜钙化情况,分析其相关性.方法 选择50例难治性SHPT患者,分别行腹部侧位X线和心脏彩超检测腹主动脉钙化和心脏瓣膜钙化情况,并分析其相关性.结果 心脏瓣膜钙化分级越高者,腹主动脉钙化积分(abdominal aorta calcification score,AACS)相应越高.二尖瓣和主动脉瓣均钙化组AACS较单纯二尖瓣或主动脉瓣钙化组高,无钙化组AACS相对最低.AACS≤5分组与AACS＞5分组二尖瓣钙化和主动脉瓣钙化情况差异有统计学意义(P值分别为0.007、0.001).结论 难治性SHPT患者腹主动脉钙化及心脏瓣膜钙化发生率高,且腹主动脉钙化与心脏瓣膜钙化有明显相关.     

营养不良、微炎症状态对腹膜透析患者心血管钙化的影响

目的 分析维持性腹膜透析患者营养不良、微炎症状态与心血管钙化的相关性, 并探讨心血管钙化的相关危险因素.方法 选择2016年1月至2017年12月昆明医科大学第二附属医院行持续性非卧床腹膜透析 (CAPD) 患者81例, 完善该81例患者相关实验室检查、人体测量, 行超声心动图评估其心脏瓣膜钙化 (CVC) 、腹部侧位片了解其腹主动脉钙化 (AAC) 情况, 采用改良定量主观整体评估表 (MQSGA) ) 评估患者营养状况, 根据评分分为营养正常 (<10分) 、轻中度营养不良 (1120分) 、重度营养不良 (2135分) 组.结果 营养正常组24例 (29.6%) , 轻中度营养不良组41例 (50.6%) , 重度营养不良组16例 (19.8%) , 瓣膜钙化发生率为45.7%, 腹主动脉钙化发生率为24.7%, 心血管钙化发生率为55.6%.营养不良、微炎症状态在有无瓣膜钙化2组间差异有统计意义意义 (P<0.05) , 年龄 (P=0.006) 、透析龄 (P=0.048) 、前白蛋白 (P=0.015) 、磷 (P=0.007) 、钙磷乘积 (P=0.013) 、hs-CRP (P=0.004) 在瓣膜钙化组和非瓣膜钙化组之间差异有统计学意义.结论腹膜透析患者普遍存在营养不良、微炎症状态, 营养不良、微炎症状态越重心血管钙化发生率越高, 高龄、长透析龄、低前白蛋白、高磷、高钙磷乘积、hs-CRP升高是心脏瓣膜钙化的独立危险因素.     

腹膜透析患者钙磷代谢与颈动脉钙化相关性临床研究

目的观察钙磷代谢紊乱与颈动脉钙化的关系,探讨持续性非卧床腹膜透析（CAPD）患者颈动脉钙化的危险因素及防治。方法将68例CAPD患者根据透析剂量及颈动脉钙化程度分组,观察颈动脉钙化与血钙、血磷等各生化指标的关系。采用彩色多普勒超声诊断仪观察腹透患者颈动脉钙化程度。结果 68例CAPD患者中不同程度颈动脉钙化者51例（75.0%）,随着透析时间的延长,腹膜透析患者颈动脉钙化程度增加（P〈0.01）;钙化组血磷、钙磷乘积、C反应蛋白较无钙化组显著增高,而血浆白蛋白较无钙化组显著降低（P〈0.05或P〈0.01）。结论腹膜透析患者中存在不同程度颈动脉钙化,其钙化程度与营养状态、透析时间相关,患者高磷血症、钙磷乘积升高、炎症状态、低白蛋白水平是颈动脉钙化的重要危险因素。     

血液透析患者钙镁比值与心脏瓣膜钙化的关系

目的 研究维持性血液透析（Maintenance Hemodialysis MHD）患者心脏瓣膜钙化（Cardiac Valve Calcification,CVC）的影响因素。 方法 研究对象为我院血液透析中心行维持性血液透析治疗的159例患者,收集患者的一般资料和实验室结果,经胸超声心动图（Transthoracic Echocardiogram,TEE）测定心脏瓣膜钙化情况,分析MHD患者CVC钙化的影响因素。结果 钙化组和无钙化组间年龄、透析龄、高血压病史、血小板计数、血肌酐、血磷、血镁、钙镁比值、白蛋白水平有统计学意义（P＜ 0.05）。二元Logistic回归分析显示,高龄、长透析龄、高磷和高钙镁比值是CVC的危险因素。 结论 高钙镁比值是CVC的独立危险因素,可增加MHD患者CVC的发生。     

心脏术后并发急性肾功能衰竭行腹膜透析的护理

目的了解心脏术后并发急性肾功能衰竭行腹膜透析的护理监测及应对措施。方法2005年1月～2010年12月期间我院行心脏手术872例,其中12例并发急性肾功能衰竭,7例术后行腹膜透析治疗,通过尿量的观察、血电解质的监测、容量负荷的计算以及肾功能的检测,及时把握腹透时机并积极处理并发症。结果7例患者中2例因严重低心排出量而死亡。余5例均在腹透支持下安全渡过急性肾功能衰竭少尿期后逐步恢复肾功能。结论心脏术后并发急性肾功能衰竭患者及时腹透治疗并精心护理能及时有效地纠正水电解质和酸碱平衡失调,顺利渡过术后急性肾功能不全期,提高生存率。     

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.