吡格列酮与二甲双胍联合炔雌醇环丙孕酮片对多囊卵巢综合征患者血清性激素水平及妊娠率的影响

目的 分析吡格列酮与二甲双胍联合炔雌醇环丙孕酮片对多囊卵巢综合征(PCOS)患者血清性激素水平及妊娠率的影响.方法 选取2018年1月至2019年8月本院收治的86例PCOS患者,依据随机数字表法分为对照组和实验组,每组43例.对照组采用二甲双胍、炔雌醇环丙孕酮片联合治疗,实验组采用吡格列酮与二甲双胍联合炔雌醇环丙孕酮片治疗,比较两组临床疗效、随访6个月妊娠率以及治疗前后血清性激素[睾酮(T)、黄体生成素(LH)、卵泡刺激素(FSH)]水平、氧化应激反应指标[丙二醛(MDA)、超氧化物歧化酶(SOD)]水平.结果 实验组治疗总有效率为95.35％,高于对照组的79.07％(P<0.05);治疗后,实验组FSH、LH、T均低于对照组(P<0.05);治疗后,实验组SOD高于对照组,MDA低于对照组(P<0.05);随访6个月,实验组妊娠率为90.48％,高于对照组的71.43％,差异具有统计学意义(P<0.05).结论 吡格列酮与二甲双胍联合炔雌醇环丙孕酮片治疗PCOS效果显著,可有效改善患者血清性激素水平,缓解胰岛素抵抗,减轻氧化应激反应,提高妊娠率.     

单药或联合用药对多囊卵巢综合征促排卵效果的对照研究

目的 针对多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者的胰岛素抵抗、高雄激素血症,用胰岛素增敏剂二甲双胍及盐酸吡格列酮联合避孕药炔雌醇环丙孕酮片对治疗效果进行评估,观察单独及联合用药对促排卵的疗效.方法 回顾性分析171例具有胰岛素抵抗的PCOS患者,随机分为对照组和实验组,对照组34例,使用炔雌醇环丙孕酮片治疗.实验组分为4组:A组35例,二甲双胍治疗;B组33例,炔雌醇环丙孕酮片联合二甲双胍治疗;C组36例,盐酸吡格列酮联合炔雌醇环丙孕酮片治疗;D组33例,二甲双胍、盐酸吡格列酮联合炔雌醇环丙孕酮片治疗.各组患者均治疗3个月,然后观察各组患者治疗前后体重指数(body mass index,BMI)、腰围、性激素、糖脂代谢指标及排卵情况.结果 各实验组较对照组胰岛素抵抗、高雄激素血症有明显改善,各组排卵率比较上升趋势,差异无统计学意义(P＞0.05).对照组恢复排卵率61.76%(21/34);实验组:A组恢复排卵率62.86%(22/35),B组为75.76%(25/33),C组为72.22%(26/36),D组为84.85%(28/33).结论 二甲双胍、盐酸吡格列酮、炔雌醇环丙孕酮片对于PCOS伴胰岛素抵抗患者均有排卵作用,3种药交叉及序贯联合应用,对胰岛素抵抗的PCOS患者促排卵治疗具有协同作用,可有效提高排卵率,是安全有效恢复排卵的方法.     

炔雌醇环丙孕酮联合吡格列酮治疗PCOS伴2型糖尿病不孕患者的效果

目的研究炔雌醇环丙孕酮联合吡格列醇治疗PCOS(多囊卵巢综合征)伴2型糖尿病不孕患者的效果。方法选取我院妇产科2016年2月至2017年8月收治的150例PCOS伴2型糖尿病患者为对象,根据治疗方法分组,对照组患者给予炔雌醇环丙孕酮+二甲双胍治疗,观察组患者给予炔雌醇环丙孕酮+吡格列酮治疗,对比两组患者的治疗效果指标。结果治疗3个月经周期后,观察组患者空腹胰岛素均低于对照组患者,P0.05;观察组患者治疗后的T和LH均低于对照组,P0.05;治疗3个月经周期,观察组的卵巢过度刺激综合征发生率1.30%与对照组的卵巢过度刺激综合征发生率4.11%对比差异不明显,P 0.05;随访1年:观察组妊娠率31.17%高于对照组的妊娠率16.44%,P0.05;观察组排卵率87.01%高于对照组的排卵率73.97%,P0.05。结论炔雌醇环丙孕酮联合吡格列醇治疗PCOS伴2型糖尿病疗效确切,改善糖代谢和性激素分泌状况,值得推广。     

炔雌醇环丙孕酮分别联合二甲双胍、吡格列酮治疗多囊卵巢综合征的疗效、安全性对比及对患者HDL-C水平的影响

目的探讨炔雌醇环丙孕酮分别联合二甲双胍、吡格列酮治疗多囊卵巢综合征临床疗效。方法抽取多囊卵巢综合征患者102例,对常规组给予炔雌醇环丙孕酮+二甲双胍,对实验组给予炔雌醇环丙孕酮+吡格列酮,对比两组的治疗效果。结果两组患者的自发排卵率、妊娠率、不良反应发生率均无明显差异,P0.05;治疗后两组患者的HDL-C水平均明显高于同组治疗前,且实验组高于常规组,P0.05。结论对多囊卵巢综合征患者采取炔雌醇环丙孕酮分别联合二甲双胍、吡格列酮治疗的疗效相当。     

对比二甲双胍、吡格列酮分别联合炔雌醇环丙孕酮治疗多囊卵巢综合征的疗效与安全性

目的:对二甲双胍、吡格列酮分别联合炔雌醇环丙孕酮治疗多囊卵巢综合征药物使用结果进行分析,对其治疗效果和安全性进行比较。方法:选取多囊卵巢综合症患者76例为试验研究对象,并且随机将选中患者分为参照组与研究组各38例,对参照组患者使用二甲双胍结合炔雌醇环丙孕酮的治疗方法,对研究组使用吡格列酮结合炔雌醇环丙孕酮的治疗方法,对两组患者的临床实际治疗效果进行比较分析。结果:两组试验组患者的病情均得以好转,具体表现在BMI、HDL-C、T、LH、FINS都得到一定程度的改善,在两组实验结果比较中,参照组的BMI水平十分明显的低于研究组,因此数据差异具有统计学意义(P0.05),而在研究组中HDL-C的水平改善治疗效果相对于参照组有明显的优化效果,数据差异具有统计学意义(P0.05),对于两组患者T、LH、FINS的水平比较,各指标没有明显的差异,所以没有统计学意义(P0.05)。结论:对二甲双胍、吡格列酮分别联合炔雌醇环丙孕酮治疗多囊卵巢综合征得治疗效果中,二甲双胍结合炔雌醇环丙孕酮使用可以明显降低患者BMI水平;吡格列酮结合炔雌醇环丙孕酮使用可以使HDL-C水平得以改善,治疗效果更佳。所以,在实际临床治疗中,应该针对不同患者的不同病症酌情结合不同的药物进行临床治疗。     

炔雌醇环丙孕酮片与二甲双胍联合治疗肥胖型多囊卵巢综合征的效果探讨

目的 探讨炔雌醇环丙孕酮片与二甲双胍联合治疗肥胖型多囊卵巢综合征的效果.方法 选取我院2015年5月—2016年1月诊治的肥胖型多囊卵巢综合征患者62例,随机分为2组,对照组(n=31)单纯应用炔雌醇环丙孕酮片治疗,治疗组(n=31)采取炔雌醇环丙孕酮片与二甲双胍联合治疗,对比2组临床疗效.结果 治疗组胰岛素抵抗指数高于对照组(P<0.05),而FINS、FPG水平低于对照组(P<0.05).结论炔雌醇环丙孕酮片与二甲双胍联合治疗肥胖型多囊卵巢综合征的效果肯定,值得借鉴.     

炔雌醇环丙孕酮结合二甲双胍及综合治疗对PCOS患者糖脂代谢及内分泌功能的影响

目的 探讨炔雌醇环丙孕酮结合二甲双胍及综合治疗对多囊卵巢综合征患者糖脂代谢及内分泌功能的影响.方法 回顾性分析2017年6月至2019年9月本院收治的168例PCOS患者的临床资料,根据治疗方式不同分为对照组和观察组,每组84例.对照组采用综合治疗结合炔雌醇环丙孕酮治疗,观察组采用综合治疗+炔雌醇环丙孕酮结合二甲双胍治疗.比较两组治疗前后糖脂代谢水平及内分泌功能.结果 治疗前,两组总胆固醇(TC)、甘油三酯(TG)、空腹血糖(FBG)、空腹胰岛素(FINS)指标比较差异无统计学意义;治疗后,观察组TC、TG、FBG、FINS水平均低于对照组,差异有统计学意义(P<0.05);治疗前,两组雌二醇(E2)、促黄体生成素(LH)、卵泡雌激素(FSH)、睾酮(T)水平比较差异无统计学意义;治疗后,观察组E2、T、LH、FSH水平均低于对照组,差异有统计学意义(P<0.05).结论 PCOS患者采用炔雌醇环丙孕酮结合二甲双胍及综合治疗效果确切,可有效调节患者糖脂代谢水平,改善内分泌功能,利于病情转归.     

多囊卵巢综合征合并胰岛素抵抗患者应用两种不同胰岛素增敏剂对糖代谢的影响

目的探究多囊卵巢综合征(PCOS)合并胰岛素抵抗患者应用两种不同胰岛素增敏剂对糖代谢的影响。方法选取2019年1月至2020年1月本院收治的PCOS合并胰岛素抵抗患者90例作为研究对象,按照随机数字表法分为二甲双胍组(n=45)和吡格列酮组(n=45)。二甲双胍组采用盐酸二甲双胍片治疗,吡格列酮组采用吡格列酮二甲双胍片治疗,比较两组治疗前后BMI、HOMA-IR、FINS和FBG等糖代谢水平,FSH、LH、E₂、T和LH/FSH等内分泌代谢水平。结果治疗前,两组BMI、HOMA-IR、FINS和FBG比较差异无统计学意义;治疗后,两组BMI均明显低于治疗前,吡格列酮组HOMA-IR和FINS均明显低于治疗前,差异均有统计学意义(P<0.05),二甲双胍组HOMA-IR、FINS和FBG与治疗前比较差异均无统计学意义;治疗后,吡格列酮组HOMA-IR和FINS明显低于二甲双胍组,差异有统计学意义(P<0.05),两组BMI和FBG比较差异无统计学意义。治疗前,两组FSH、LH、E₂、T和LH/FSH比较差异无统计学意义;治疗后,二甲...     

炔雌醇环丙孕酮联合二甲双胍治疗肥胖型多囊卵巢综合征的疗效分析

目的分析炔雌醇环丙孕酮与二甲双胍联合治疗肥胖型多囊卵巢综合征患者的临床效果。方法选取中山市博爱医院妇科2013年3月至2014年3月收治的80例肥胖型多囊卵巢综合征患者,按随机抽样法分为对照组和观察组,各40例。对照组单纯给予炔雌醇环丙孕酮片进行治疗,观察组采用炔雌醇环丙孕酮片联合二甲双胍治疗。结果治疗前两组BIM、FIN、IR、T、FSH、LH、E2均无差异(P>0.05);治疗后观察组除BIM外,FIN、IR、T、FSH、LH、E2均低于对照组(P<0.05)。结论炔雌醇环丙孕酮片联合二甲双胍对肥胖型多囊卵巢综合征效果显著,可有效调节卵巢激素的分泌,值得临床应用及推广。     

炔雌醇醋酸环丙孕酮联合二甲双胍治疗肥胖型多囊卵巢综合征患者的临床疗效

目的研究炔雌醇醋酸环丙孕酮联合二甲双胍治疗肥胖型多囊卵巢综合征患者的临床疗效。方法随机抽取于我院治疗的肥胖型多囊卵巢综合征患者74例定为研究对象,并随机将其分为两组(对照组与研究组),各37例。单纯使用炔雌醇醋酸环丙孕酮对对照组进行治疗,联合使用炔雌醇醋酸环丙孕酮与二甲双胍对研究组进行治疗,观察两组患者的临床疗效。结果对照组BMI、FBG、FIN指数均明显高于研究组,且P0.05,差异存在统计学意义。结论炔雌醇醋酸环丙孕酮联合二甲双胍治疗肥胖型多囊卵巢综合征患者的临床疗效更为显著,值得推广。     

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.