伊贝沙坦治疗轻中度原发性高血压临床观察

目的　观察伊贝沙坦治疗轻、中度原发性高血压的疗效及安全性。方法　采用自身对照开放试验 ,选取 6 3例轻、中度原发性高血压患者 ,服用伊贝沙坦 15 0mg d ,如 4周无效加至 30 0mg d ,观察 8周。每 2周随访血压、心率 ,观察服药前后超声心动图各项指标及实验室检查的变化 ,并记录不良反应。结果　经 8周治疗后 ,伊贝沙坦降压总有效率达 95 % ,血压较治疗前有明显下降 (P <0 .0 5 ) ,超声心动图二尖瓣舒张早期血流峰值 (E)、二尖瓣舒张晚期血流峰值 (A)及E A比值均有显著差异 (P<0 .0 5 ) ;整个治疗期间无明显不良反应发生。结论　伊贝沙坦是一个安全、有效的降压药物 ,同时能改善心室舒张功能。     

厄贝沙坦治疗轻中度原发性高血压的临床研究

目的：探讨厄贝沙坦治疗轻、中度原发性高血压的临床效应和安全性。方法：119例轻中度原发性高血压随机单盲分为两组，厄贝沙坦（治疗）组：60例，150－300mg/d口服，6周后未达显效，加双氢氯噻嗪（HCTZ）12.5mg/d疗程半年。氯沙坦（对照）组：59例，50－100mg/d口服，6周后未达显效，加服HCTZ12.5mg/d，疗程半年。治疗前后均进行偶测血压、动态血压（ABPM）、肝肾功能、生化、血浆肾素活性（PRA）、血管紧张素Ⅱ（AngⅡ)、醛固酮（Aldo)、内皮素（ET）等检查，并观察心脑事件发生情况及药物不良反应。结果：治疗组总有效率81．7％（49／60例），降压幅度24．6／14．5mmμg，谷／峰（T／P）比值：收缩压（SBP）0．81。舒张压（DBP）0．76，6周后未达显效，加服HCTZ2周，达显效27．0％（10／36例）；对照组总有效率80．7％（47／59例）、降压幅度24．2／14．1mmμg，T／P比值SBP0．79、DBP0．75，6周后未达显效，加服HCTZ2周达显效24．3％（9／37例），两组降压疗效均相似（P均＞0．05）。两组治疗后PRA、AngⅡ均较治前升高（P＜0．05－0．01）Aldo,ET均较治疗前降低（P＜0．05），但4项指标组间比较无显差异（P＞0．05），半年随访，两组心脑事件发生率相似，不良反应轻微。结论：厄贝沙坦是一种降压效果可靠，作用持久，稳定、安全、耐受性好，服药方便（1次／日），可作为治疗轻、中度原发性高血压的新型AngⅡ、Ⅰ型受体拮抗剂（AT1RT）药物之一，值得推广应用。     

动态血压监测厄贝沙坦治疗高血压的临床疗效

目的 研究厄贝沙坦治疗原发性轻中度高血压的临床疗效及安全性。方法 入选40例原发性轻中度高血压患者，随机分为两组，分别给予厄贝沙坦或贝那普利治疗4wk，每2wk随访一次，并于服药前后进行24h动态血压监测（ABPM）。结果 厄贝沙坦降压总有效率达85．0％，ABPM结果提示其对夜间收缩压和舒张压均有显著性降低（P〈0．05），同时不影响血压昼夜节律及心率，无明显不良反应发生。结论 厄贝沙坦降压疗效显著且平稳，安全性好。     

氯沙坦与培哚普利治疗老年轻、中度高血压病的疗效研究

目的：比较氯沙坦和培哚普利治疗老年轻、中度高血压的临床疗效与不良反应。方法：88例老年轻、中度高血压患，随机分为氯沙坦组（A组n=42)口服氯沙坦50－100mg，每日一次，培朵普利组（B组n=46)；口服培哚普利4－8mg，每日一次，持续12周，分别观察两组治疗前后偶测血压、24小时动态血压、血脂、血尿酸变化，记录不良反应。结果：①两组治疗前后的降压有效率和降压幅度比较无显性差异（有效率P＞0．05，收缩压下降幅度P＞0．05，舒张压下降幅度P＞0．05）；②氯沙坦和培哚普利能同样降低老年高血压病人各时点及24小时、日间、夜间的平均SBP、DBP、和血压负荷。③两降低的谷／峰比满意，氯沙坦降压的SBP和DBP T／P比分别为68．3％和79．7％，培哚普利分别为68．4％和79．8％；④氯沙坦组治疗后血尿酸明显下降（P＜0．01），而培哚普利组治疗前后血脂与血尿酸值比较无显性差异（P＞0．05）；⑤培哚普利组咳嗽发生率为6．5％，氯沙坦组无一例出现咳嗽反应。结论：氯沙坦和培哚普利治疗老年轻、中度高血压具有同样的降压效果，氯沙坦的主要优点是咳嗽发生率低，能明显降低血尿酸。     

伊贝沙坦对原发性高血压左室肥厚逆转作用及降压疗效观察

目的 :观察伊贝沙坦对高血压左室肥厚逆转及降压疗效安全性。方法 :随机选择 6 0例轻 ,中度原发性高血压同时伴左室肥厚患者 ,分两组进行治疗。治疗组 :口服伊贝沙坦 15 0mg ,每日 1次。对照组 :口服苯那普利 10mg,每日 1次。两组治疗 8周后进行评估 ,应用超声心动图进行对照。结果 :与治疗前相比 ,治疗组降压总有效率为83 3% ,对照组为 86 77%。两组心脏结构均有显著改善 (P <0 0 5 )。与对照组相比 ,差异无显著性意义 (P >0 0 5 )。结论 :伊贝沙坦对高血压左室肥厚逆转及降压作用与苯那普利同样有效 ,可作为高血压治疗的一线药物。     

厄贝沙坦治疗老年人轻中度高血压对左室舒张功能的影响

目的 观察厄贝沙坦治疗老年人轻、中度原发性高血压的降压疗效及对左室舒张功能的影响.方法 采用自身对照开放试验,选取34例老年人轻、中度原发性高血压患者,每天晨起顿服厄贝沙坦150mg/d,疗程12W.每2W随访一次,观察血压变化及不良反应和治疗前后超声心动图各项指标变化.结果 经过12W治疗后,厄贝沙坦降压总有效率为88.23%,血压较治疗前有明显下降(P＜0.01),超声心动图检测二尖瓣舒张早期血流速度E峰值较前升高,二尖瓣舒张晚期血流速度A峰值较前降低,E/A比值提高,与治疗前相比均有显著性差异(P均＜0.05).结论 厄贝沙坦对于老年人轻、中度原发性高血压降压疗效确切,而且可明显改善左心室舒张功能,不良反应轻微.     

西拉普利对高血压病左心室肥厚及QT离散度的影响

目的：观察西拉普利降压疗效的同时，探讨其逆转左室心肥厚（LVH）及对QT离散度（QTd）的影响。方法：观察组选择符合WHO分期诊断标准共首次诊治的轻、中度（I、II期）高血压病患共39例，给予西拉普利5mg/d治疗，治疗1周后，血压未降至正常范围剂量加倍，达到理想 的降压效果后，改维持量2.5-5mg/d以巩固治疗。观察时间为12个月。对照组36例为健康体检。结果：观察组QTd、校正QT离散度（QTcd）和导联校正后的QTcd(QTcd,lead-adjust)显大于正常对照组（P＜0．05）；高血压伴LVHQTd,QTcd和QTcd,lead-adjust显大于不伴LVH(P＜0．05）。结论：原发性高血压无论伴LVH与否，QTd和QTcd均显增加。QTcd与左心室质量分数（LVMI）呈正相关，西拉普利在有效降压的同时，还可逆转LVH并导致QTcd减小。     

乌拉地尔与酚妥拉明治疗高血压急症的降压疗效比较

目的：比较乌拉地尔与酚妥拉明对高血压急症的治疗效果。方法：高血压急症患者60例，随机分为两组后用乌拉地尔12．5mg静脉注射再予15－30mg/h静脉滴注维持和酚妥拉明3．5－4mg/h静脉滴注分别治疗，结果乌拉地尔组于用药后5min内即已出现明显的降压效果（P＜0．05）。此后的降压效果相对平稳；30min后心率已有所减慢，60 min及120min时已明显减慢（P＜0．05，P＜0．01）；与酚妥拉明比较，其降压效果及减慢心率差异有显著性（P＜0．05）。结论：乌拉地尔用于治疗高血压急症时有较好的降压作用且起效迅速，还可以减慢心率，疗效较酚妥拉明为优。     

乌拉地尔和硝普钠治疗高血压急性症中的降压疗效对比观察

目的：探讨乌拉地尔和硝普钠对高血压急症的治疗效果。方法：高血压急症患者63例，随机分两组后分别用乌拉地尔12.5mg静脉注射再予（15-30)mg/h静滴维持和硝普钠（5－15）mg/h静滴分别治疗，分别于用药前及用药后（5、10、20、30、60、120)min测定收缩压、舒张压及心率的变化；结果：两组均于用药后5分钟内即已出现明显的降压效果（P＜0．05），治疗后血压明显降低（P＜0．01），两组间的降压效果无统计学差异（P＞0．05），但乌拉地尔组30min后心率已有所减慢（P＜0．05），60min及120min时已有明显减慢（P＜0．01）；而硝钠组心率增快（P＜0．05）。两组间的心率变，有显著性差异（P＜0．05）；结论：乌拉地尔有与硝普钠相同的降压效果，但可以减慢心率。     

伊贝沙坦治疗慢性充血性心力衰竭的观察

目的：观察伊贝沙坦治疗慢性充血性心力衰竭的疗效。方法：58例慢性充血性心力衰竭患者随机分为常规治疗组28例和伊贝沙坦组30例，常规治疗组予控制原发病，去除心力衰竭诱因以及强心，利尿和血管扩张剂治疗，伊贝沙坦组在常规治疗的基础上口服伊贝沙坦150mg,1次／d，4周后观察治疗前后心功能，心率（HR）、血压（BP）、心胸心纺的变化及不良反应。结果：与常规治疗组比较，心功能明显改善（P＜0．05），心率和血压显著降低（P＜0．05），心胸比率显著缩小（P＜0．05）；未见明显不良反应。结论：在常规治疗的基础上加用伊贝沙坦治疗充血性心力衰竭的疗效好，不良反应少。     

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.