冠心病室性心律失常与LVEF及QTd的相关性研究

目的探讨冠心病室性心律失常与左室射血分数(LVEF)及QT离散度(QTd)的相关性。方法测量和分析62例冠心病伴室性心律失常患者(实验组)和58例正常人(对照组)的LVEF值及心电图最大QT间期(QTmax),最小QT间期(QTmin)。结果实验组的LVEF值和QTd分别为:(41.36±6.85)ms和(64.98±16.86)ms;对照组的LVEF值和QTd分别为:(57.68±4.16)ms和(34.05±13.23)ms。实验组与对照组之间比较差异有显著性,P<0.01。结论冠心病室性心律失常与LVEF及QTd密切相关,LVEF值和QTd可作为预测冠心病伴室性心律失常的可靠指标。     

甲亢左室肥大患者室性心律失常与QT离散度的关系及临床意义

目的:探讨甲亢左室肥大患者室性心律失常与QT离散度的关系及临床意义.方法:回顾性对206例甲亢患者QT离散度(QTd)进行分析.结果:左室肥大组、左室正常组QTd分别为61.36±22.08 ms和40.18±9.68 ms(P＜0.01),室性心律失常(VA)检出率为35.92%;VA、复杂VA及室速(VT)患者的QTd显著高于无VA者(P均＜0.01);LVA者QTd显著高于无LVA者(P＜0.01);并检出LVH又QTd＞60 ms者VA、复杂VA及VT检出率均显著高于LVH,但QTd＜60 ms者(均P＜0.01).结论:QTd对预测甲亢LVH者发生VA可能具有一定的参考价值.     

急性心肌梗塞后QT离散度的演变及其与室性心律失常的关系

目的　研究急性心肌梗塞 (AMI)后QT离散度 (QTd)的演变及其对快速室性心律失常的预测价值。方法　测量 34例AMI后患者不同时期和伴室性心律失常时的QTd ,并与健康对照组 (90名 )相比。结果　AMI后患者的QTd在急性期 (72± 18ms)明显大于亚急性期 (5 8± 17ms,P <0 .0 1) ,亚急性期大于陈旧期 (49± 2 1ms,P <0 .0 1) ,均明显大于对照组 (36± 10ms,P <0 .0 1)。陈旧期内心功能Ⅰ级、Ⅱ级者的QTd(36± 14ms,41± 15ms)与对照组无明显差异 (P >0 .0 5 ) ,Ⅲ～Ⅳ级者的QTd(6 6± 2 0ms)明显延长 (P <0 .0 1)。 9例AMI伴室速 /室颤 (VT/VF)者的QTd(91± 18ms)显著长于急性期不伴VT/VF者 (70± 14ms,P <0 .0 1)。结论　AMI后 0～ 3天QTd显著延长 ,随梗塞愈合渐趋正常 ,QTd显著延长是预示危重室性心律失常的不良之兆     

三种心电信息对急性心肌梗塞患者恶性室性心律失常事件发生的预测价值

目的 :探讨心室晚电位 (VLP)、QT离散度 (QTd)、校正QT离散度 (QTcd)对急性心肌梗塞 (AMI)患者恶性室性心律失常事件发生的预测价值。方法 :测定 6 4例AMI患者和 30例健康人的VLP、QTd、QTcd ,并对AMI患者随访 1年。结果 :AMI组VLP阳性率 (4 2 2 % )较对照组 (6 7% )明显增高 (P <0 0 1) ,QTd、QTcd分别为 74 2± 18 4ms和 81 3± 2 2 6ms较对照组 (2 8 4± 10 6ms和 34 8± 15 3ms)明显延长 (P <0 0 1)。 6 4例AMI患者随访 1年发生恶性室性心律失常事件 18例 ,其中VLP阳性率、QTd、QTcd分别为 88 9%、86 5± 2 7 4ms、93 6± 34 8ms和非事件组(2 3 9%、6 2 7± 2 4 3ms、6 9 4± 2 5 2ms)比较 ,差异有显著性 (P <0 0 1)。在预测AMI患者恶性室性心律失常事件发生的敏感性 ,特异性和有效性QTd分别为 6 6 5 %、85 4%、78% ,QTcd分别为 72 4%、71 3 %、71% ,VLP分别为42 6 %、92 8%、6 8%。结论 :VLP(+ )和QTd、QTcd明显延长与AMI患者发生恶性室性心律失常事件密切相关 ,并可作为AMI患者预后和恶性室性心律失常事件发生可靠的 ,非侵入性预测指标。其中以QTcd敏感性最高 ,VLP(+ )最具特异性。     

QT离散度与肥厚型心肌病左室重量和室性心律失常关系的研究

目的 :分析QT离散度 (QTd)和肥厚型心肌病患者左室肥厚程度和室性心律失常的关系。方法 :原发性肥厚型心肌病 2 5例 ,正常对照组 2 4例。应用二维超声心动图测量计算左室重量 (LVM ) ,记录 2 4小时动态心电图和同步 1 2导联心电图各导联间的QT间期计算QTd、QTcd ,比较QTd、QTcd与左室重量和室性心律失常的关系。结果 :①肥厚型心肌病组LVM、QTd、QTcd明显大于正常对照组 (分别为 30 5 .2± 94.1 g与 1 50 .6± 32 .8g ;80 .2± 1 6 .5ms与 35 .6± 7.6ms ;86 .4±1 7.5ms与 40 .7± 9.1ms,P均 <0 .0 1 ) ;②严重室性心律失常患者LVM、QTd、QTcd明显高于无严重室性心律失常患者 (分别为 375 .4± 91 .6g与 2 72 .2± 77.3g ;93 .8± 1 5 .8ms与 73 .8± 1 2 .8ms,P均 <0 .0 1 ,98.1± 1 7.7ms与 80 .8± 1 4 .9ms,P <0 .0 5) ;③肥厚型心肌病患者LVM与QTd、QTcd显著相关 ,r分别为 0 .72 4 7和 0 .6450。结论 :肥厚的心肌细胞排列紊乱是导致QTd、QTcd增大的主要原因 ,可作为反映心肌复极弥散程度的指标 ,QTd、QTcd的增加可预测严重室性心律失常的发生     

恶性室性心律失常与QTd的关系分析

目的比较健康人(50例)与严重室性心律失常者(56例)的QT离散度变化差异.方法采用随机、单盲的方法测定两组对象的QTd.结果恶性室性心律失常组的QTd、QTcd、(70.8±17.2ms、16.4±6.2ms)均明显较健康对照组(52.4±15.3ms、9.8±4.3ms)延长,两组P值均《0.01.结论QTd的测量简单易行有效,可实用于基层医院对严重室性心律失常及猝死的估计.     

QT离散度与恶性室性心律失常的关系简析

目的 :探讨 QT离散度 (QTd)与恶性室性心律失常的关系。方法 :测量 89例患者同步 12导联心电图。结果 :在恶性室性心律失常组 (42例 ) QTd为 (92± 31) ms,非恶性室性心律失常组 (47例 )为 (6 2± 19) ms,两组比较差异有极显著性 (P<0 .0 1) ,随 QTd增大 ,恶性室性心律失常发生显著增加 (高 )。结论 :QTd是恶性室性心律失常监测的重要指标。     

冠心病Q-T离散度与室性心律失常的关系

目的　预测冠心病发生恶性室性心律失常的Q -T离散度 (Q -Td)。方法　观察 16 4例冠心病与Q -Td的关系。结果　Q -Td在恶性室性心律失常组分别为 (99.4 7±2 0 .13)ms;潜在恶性室性心律失常组为 (6 7.39± 14 .2 1)ms;无室性心律失常组为 (4 8.75± 2 9.93)ms。三组间差异非常显著P <0 .0 1=;Q -Td≥ 10 0ms者全部发生恶性室性心律失常。结论　Q -Td值越大 ,室性心律失常的发生率越高     

索他洛尔对急性心肌梗塞患者QT离散度的影响及室性心律失常的干预研究

目的:探讨索他洛尔对急性心肌梗死(AMI)患者QTc、QTd、影响及室性心律失常的干预作用。方法:60例AMI患者随机分为治疗组(30例)及对照组(30例),测量入院时QTc、QTd,治疗组给予索他洛尔(80—160mg/d)干预后观察第一天、第二天、第三天、第四天、第七天、第十天QTc,QTd的变化及室性心律失常发生率,并与对照组比较。结果:AMI患者入院时治疗组与对照组的QTc、QTd无显著性差异(417.4±14.3ms vs 413.2±14.6ms P>0.05,66.2±11.6ms vs 67.4±14.3ms P>0.05);给予索他洛尔(80—160mg/d)干预后治疗组于2天时较对照组QTc显著延长、QTd明显缩短(437.8±17.7ms vs 429.6±16.4ms P<0.05;68.9±11.7ms vs 78.1±21.1ms P<0.05),并于7天时治疗组与对照组QTd差异最显著(48.2±14.7ms vs 59.1±13ms P<0.01);两组60例AMI患者中有18例发生室性心律失常,发生室性心律失常组QTd明显高于未发生室性心律失常组(92.2±19.2ms vs 65.2±19.4P<0.01);索他洛尔干预2周内治疗组室性心律失常发生率明显低于对照组(16.6％ vs 43.3％P<0.05)。结论:AMI后QTd显著延长与室性心律失常的发生密切相关,AMI后早期使用索他洛尔可使QTd显著降低,改变其自然演变过程,并明确降低AMI后早期恶性室性心律失常的发生率;表明了索他洛尔能够有效的缩小缺血后心肌复极化的高散度,有利于AMI患者心肌电活动的一致和稳定,从而降低AMI猝死率,改善预后。     

老年高血压病左室肥厚与Q-T离散度及心室晚电位关系的探讨

目的为探讨老年高血压病左室肥厚(LVH)与Q-T离散度(QTd)、心室晚电位(VLP)及室性心律失常(VA)的关系.方法测定90例老年高血压病患者的LVH、QTd、VLP.结果高血压病伴LVH时QTd为58.04±17.13ms,VLP阳性率为30.30%;无LVH者QTd为47.02±16.09ms,VLP阳性率为7.00%,两者比较差异显著(P＜0.01).结论高血压病伴LVH时QTd大于60ms,VLP阳性与VA发生密切相关,且VLP阳性者QTd多在70ms以上,提示在老年高血压病伴LVH时如检测到异常长QTd、VLP阳性则对预测恶性心律失常可能有一定的临床意义.     

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.