慢性肺心病患者血浆心钠素浓度变化及其临床意义

应用放免法测定了37例正常人、68例慢性肺心病患者血浆心钠素(ANP)浓度。慢性肺心病心功能代偿期血浆ANP浓度与正常人无差异(P>0.05),而心功能失代偿期则明显低于正常人和心功能代偿期(P值均<0.01)。心功能Ⅳ级时血浆ANP降低最明显,而Ⅲ级又明显低于Ⅱ级。心功能不全纠正后血浆ANP明显上升,但心功能不全未纠正者临终前最低。表明慢性肺心病时血浆ANP浓度的动态变化可作为估计病情、观察疗效和判断预后的一个指标。     

不同心功能状态下心房纤颤患者的血浆心钠素水平

采用放射免疫法测定32例心房纤颤病人和正常人血浆心钠素(ANP)。发现心房纤颤患者的ANP明显低于对照组(P<005);血浆ANP与心功能分级呈负相关(r=-0.570,P<0.05),与心房纤颤病程无关(r=-0.173,P>0.05);不同年龄和病因之间ANP差别无显著性(P>0.05)。提示心房纤颤患者血浆ANP含量取决于心功能状态。     

老年人心血管、脑疾病心钠素测定的临床意义

本文着重介绍了采用作者建立的一种灵敏的放射免疫方法,测定老年心血管、脑疾病中血浆ANP含量。晚期肺心病老年患者,血浆ANP含量明显低于早期PHD者(P<0.05)。伴有左心室肥厚的高血压老年患者血浆ANP浓度明显高于左心室正常的高血压患者(P<0.01)。高血压脑卒中后血压仍高和血压正常的老年患者,血浆ANP分别为861.1±108.4和536.8±50.1pg/ml。总之,测定老年人血浆ANP的浓度,对于探讨老年人心血管、脑血管疾病的发病机理和病情严重程度有重要意义。     

老年冠心病心功能不全患者血浆白细胞介素-6浓度的变化

目的 :观察老年冠心病心功能不全患者血浆白细胞介素 6 (interleukin - 6 ,IL - 6 )浓度的变化。方法 :选择老年冠心病心功能不全患者 48例、心功能正常者 15例及健康老年人 30例 ,采用酶联免疫吸附法测定其血浆IL - 6浓度。结果 :冠心病心功能不全组血浆IL - 6浓度较冠心病心功能正常组及健康对照组明显增高 (均P <0 .0 5 ) ,而冠心病心功能正常组与健康对照组之间无明显差异 (P >0 .0 5 ) ;血浆IL - 6浓度与左室射血分数呈负相关 (r =- 0 .6 0 ,P <0 .0 1) ;因心功能不全恶化再入院患者血浆IL - 6浓度高于未再入院患者 (P <0 .0 1)。结论 :IL - 6具有判断病情、评价预后的价值     

倍他乐克缓释片对心肌梗死后左心功能不全的影响

目的探讨倍他乐克缓释片对心肌梗死后左心功能不全的影响。方法 68例心肌梗死后左心功能不全患者随机分为倍他乐克组和对照组。两组均予以常规内科治疗,倍他乐克组加用倍他乐克缓释片,连用12个月。结果治疗12个月后,两组血浆AngⅡ、ALD及血浆BNP浓度均明显改善(P<0.05或P<0.01),且倍他乐克组改善幅度大于对照组(P<0.05);同时倍他乐克组治疗总有效率明显优于对照组(χ2=4.19,P<0.05)。两组治疗期间药物不良反应发生率比较无统计学差异(χ2=1.44,P>0.05),未发生严重的药物不良反应。结论倍他乐克缓释片治疗心肌梗死后左心功能不全能有效改善患者左心功能,疗效显著,安全性较好。     

口服避孕药对动脉血压与血浆心钠素水平的影响

观察25例口服避孕药妇女的血压和血浆 ANP 变化,其中血压正常者血浆ANP 无明显变化(P>0.05),血压增高者血浆 ANP 明显增高(P<0.01)。服药者血浆ANP 水平与血压呈高度正相关(P<0.01),与服药时间无关(P>0.05)。提示口服避孕药可能是通过血压增高使血浆 ANP 水平增加,而其引起的血压增高是高 ANP 型的。     

脑钠肽在老年慢性心力衰竭诊断及预后评估中的应用价值

目的观察血浆脑钠肽(BNP)水平与老年慢性心力衰竭(CHF)患者心功能分级的关系,探讨BNP在老年CHF早期诊断及预后评估中的临床应用价值。方法选择老年CHF患者183例(CHF组)和健康老年人62例(对照组),比较不同心功能分级老年CHF患者血浆BNP和心肌肌钙蛋白I(cTnI)水平,并分析老年CHF患者血浆BNP水平与左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD)的关系。结果 CHF组心功能Ⅰ级患者血浆BNP水平与对照组比较差异无统计学意义(P>0.05),CHF组心功能Ⅱ、Ⅲ、Ⅳ级患者血浆BNP水平显著高于对照组(P<0.05),心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者血浆BNP水平两两比较差异均有统计学意义(P<0.05)。CHF组心功能Ⅰ、Ⅱ级患者cTnI水平与对照组比较差异均无统计学意义(P>0.05),CHF组心功能Ⅲ、Ⅳ级患者cTnI水平显著高于对照组(P<0.05),CHF组心功能Ⅲ、Ⅳ级患者cTnI水平显著高于心功能Ⅰ、Ⅱ级患者(P<0.05),CHF组心功能Ⅳ级患者cTnI水平显著高于心功能Ⅲ级患者(P<0.05),CHF组心功能Ⅰ、Ⅱ级患者cTnI水平比较差异无统计学意义(P>0.05)。CHF患者血浆BNP和cTnI水平与心功能分级均呈显著正相关(P<0.05)。血浆BNP水平与LVEDD呈显著正相关(P<0.05),而与LVEF呈显著负相关(P<0.05)。结论 BNP在老年CHF的诊断及预后评估中有重要的临床价值。     

慢性心功能不全患者血浆内源性洋地黄样因子浓度的临床观察

本文采用地高辛放射免疫测定法检测42例慢性心功能不全患者和31例正常人血浆EDLF浓度,结果显示:慢性心功能不全组血浆EDLF浓度明显高于正常组,而各级心功能不全组之间血浆EDLF浓度无明显差别;右心功能不全组血浆EDLF高于左心功能不全;心功能不全患者血浆EDLF浓度与血清K~+呈明显负相关(r=-0.37,n=35,P<0.025),而与血清Na~+无明显相关。内源性洋地黄样因子Endogenous digitalis-like factor,EDLF)是体内具有洋地黄样作用的生物活性.物质,能抑制钠-钾ATP酶活性,竞争性抑制~3H哇巴因与受体结合,可与地高辛抗体发生交叉免疫反应,有强心、缩血管和利尿作用。为探讨EDLF与心功能不全的关系,我们对42例慢性心功能不全患者和31例正常人采用地高辛放射免疫测定法进行血浆EDLF浓度检测,以分析其意义。     

慢性心力衰竭患者治疗前后心钠素、脑钠素浓度变化

目的 观察慢性心力衰竭患者心钠素、脑钠素浓度改变及卡维地洛对其影响.方法 慢性心力衰竭患者50例(观察组)和正常健康人20例(对照组).采用放射免疫法测定治疗前后血浆ANP、BNP浓度;彩色超声心动图测定左心室射血分数、左心室舒张末期内径等.结果 观察组血浆ANP、BNP浓度均高于对照组(P均＜0.01);临床慢性心力衰竭程度越重,血浆ANP、BNP浓度越高(P均＜0.01);卡维地洛治疗者与常规治疗者治疗满2w后均有血浆ANP、BNP浓度下降,卡维地洛治疗者血浆ANP、BNP浓度下降更明显(P＜0.05);而满3个月时卡维地洛治疗者左心室射血分数、左心室舒张末期内径均比常规治疗者明显改善(P均＜0.05).结论 ANP、BNP浓度可以反映心功能状态;卡维地洛可以降低ANP、BNP浓度及改善心脏重构及心功能.     

心力衰竭时ANP和RAAS的变化与左心功能的关系及卡托普利对其的影响

40例充血性心力衰竭患者,治疗前血浆ANP(心钠素)及RAAS(肾素—血管紧张素—醛固酮系统)水平明显升高,且ANP增高的程度与左心功能呈线性负相关,与心力衰竭的程度呈线性正相关。治疗前ANP浓度与RAAS有明显线性关系,卡托普利及常规治疗后,心功能改善血浆ANP浓度明显下降,说明心力衰竭时血浆ANP浓度可间接反映左心功能水平,并可作为判断治疗效果的间接指标。心力衰竭时ANP浓度升高但不发挥明显利尿利钠作用,其原因可能为其作用被同时增高的RAAS抑制有关。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.