检测血清肌钙蛋白诊断急性病毒性心肌炎

目的比较血清心肌肌钙蛋白与血清CK-MB水平诊断心肌炎性损伤的敏感性和特异性.方法建立急性病毒性心肌炎小鼠模型,测定小鼠血清心肌肌钙蛋白I(cTnI)、心肌肌钙蛋白T(cTnI)及肌酸激酶MB同工酶(CK-MB)水平;同时观察42例临床拟诊急性病毒性心肌炎患者血清肌钙蛋白及血清CK-MB水平.结果 28只病鼠中19例(67.85%)cTnI升高,17例(60.71%)cTnI升高,6例(21.42%)CK-MB升高;42例患者中26例(61.9%)cTnI升高,16例(38.1%)cTnT升高,2例(4.76%)CK-MB升高.结论测定血清肌钙蛋白水平探查心肌炎性损伤远较血清CK-MB敏感.     

血清心肌肌钙蛋白I与肌酸激酶同工酶-MB在小儿病毒性心肌炎诊断中的应用

目的探讨血清心肌肌钙蛋白I（cTnI）及肌酸激酶同工酶-MB（CK—MB）对小儿病毒性心肌炎患者的诊断价值。方法采用增强免疫比浊法及酶速率法测定59例病毒性心肌炎患儿、41例非心肌炎患儿和45例健康体检小儿的血清cTnI及CK—MB阳性率。结果3组间血清cTnI比较和CK—MB比较,差异均有显著性（Х^2=72．21,P〈0．05;Х^2=35．24,P〈0．05）;病毒性心肌炎组CK—MB阳性率较cTnI阳性率低（Х^2=4．32,P〈0．05）;非心肌炎组cTnI阳性率低于CK-MB阳性率（Х^2=21．09,P〈0．05）;对照组血清cTnI和CK—MB阳性率均为0。血清CK—MB阳性率随病程延长下降,病程在1周内血清cTnI阳性率高于血清CK—MB阳性率（Х^2=4．50,P〈0．05）。结论测定cTnI对于诊断小儿病毒性心肌炎有较高的敏感性和特异性,可作为小儿病毒性心肌炎早期诊断的可靠指标。     

血清肌钙蛋白Ⅰ对病毒性心肌炎的诊断及其预后评估的应用价值

目的 探讨血清肌钙蛋白I对病毒性心肌炎及其预后的诊断价值。方法测定体检正常者及病毒性心肌炎患者心肌肌钙蛋白Ⅰ(cTnⅠ)，并做分析；连续测定病毒性心肌炎患者CK、CK—MB和cTnⅠ，并做比较；根据临床症状缓解率、彩色超声所示心功能异常、心律失常好转率、CK—MB、演变为扩张性心肌病等临床资料，分析cTnI与病毒性心肌炎及其预后的关系。结果cTnⅠ的阳性预测率为97．5％，特异性为90．6％；经过治疗118例cTnⅠ高于参考值范围的患者中有36例持续升高，通过临床资料分析，在临床症状缓解率，彩色超声所示心功能异常、心律失常好转率，CK—MB，演变为扩张性心肌病等方面均与cTnⅠ降至正常者有显著性差异。结论 血清心肌肌钙蛋白I对病毒性心肌炎的诊断明显优于CK及CK—MB，并对其预后具有良好的诊断价值。     

肌钙蛋白I对溶栓治疗急性心肌梗死的检测意义

目的：探讨心肌肌钙蛋白I（cTnI）对溶栓治疗急性心肌梗死（AMI）时的检测意义。方法：观察比较42例急性心肌梗死（AMI）患者和30例对照组的cTnI和心肌酶谱的测定。结果：AMI患者的阳性率分别：cTnI87．5％、CK56．3％、CK—MB62．5％。结论：AMI患者胸痛后6h之内血清cTnI的敏感性最高，对早期诊断及时溶栓治疗ANI有重大临床价值。     

经皮冠状动脉腔内成形术前后心肌肌钙蛋白I的变化及与远期心脏事件的关系

目的：评价经皮冠状动脉腔内成形术（PTCA）对心肌的可能影响，以探讨PTCA术后心肌损伤的相关因素及对远期心脏事件的影响。方法：对173例行PTCA术的冠状动脉硬化性心脏病（CAD）患者分别测定其术前，术后血清心肌肌钙蛋白I（cTnI)及肌酸激酶同工酶（CK－MB），随访患者的远期心脏事件。结果：42例患者术前cTnI正常，术后升高，84例术前术后均正常，47例术前术后均升高，1例患者CK－BM术前术后均升高，10例患者CK－MB术后增高，血清cTnI升高与球囊扩张总时间，压力，次数，支架植入数，造影剂量用及术中胸痛发生有关（P＜0．05），随访62例出院患者，在平均21个月的随访时间中，共有26例患者发生心脏事件34件，各组间远期心脏事件比较差异无显著性（P＞0．05），结论：cTnI监测PTCA术患者心肌损伤比CK－MB敏感，特异性高，PTCA术造成的心肌损伤与手术操作的强度有关，其不足以影响PTCA的疗效。     

心肌肌钙蛋白I和肌钙蛋白T检测在病毒性心肌炎诊断中的应用

目的探讨肌钙蛋白I（cTnI）和肌钙蛋白T（cTnT）在病毒性心肌炎（VMC）的诊断及病情观察方面的价值。方法对78例病毒性心肌炎患者进行入院后1、2、3周及2个月cTnT和心肌酶谱的动态监测;cTnT、cTnI与心电图（ECG）、及病程关系的研究。结果急性病毒性心肌炎患者在各检测期内血清cTnT的阳性率（73．8％）和cTnI的阳性率（66．7％）显著高于心肌酶谱各项目（P〈0．05）：肌酸激酶（CK）47．44％、肌酸激酶同工酶（CKMB）51．28％、门冬氨酸氨基转移酶（AST）42．31％、乳酸脱氢酶（LDH）42．31％、d羟丁酸脱氢酶（d—HBDH）44．87％。cTnT和cTnI阳性组EcG正常率5．26％,9．62％）明显低于阴性组（71.43％,57．69％）（P〈0．05）。结论在病毒性心肌炎的诊断中cTnT和cTnI可取代传统的心肌酶谱测定作为判断急性心肌炎的指标;同时cTnT和cTnI在病毒性心肌炎病情进展的观察中也具有重要意义。     

心肌损伤标记物在急性心肌梗死早期诊断中的临床意义

目的：探讨新的生化标记物对急性心肌梗多E（AMI）早期诊断价值。方法：动态监测198例AMI患者血清心肌肌钙蛋白I、T（cTnI、cTnT）及肌酸磷酸激酶（CK）及同工酶（CK—MB）的变化，对比分析它们对AMI的早期诊断和预后的判断价值。结果：AMI起病6小时之内，以cTnI诊断敏感性最高（90．20％），CK—MB次之（52．94％）．CK最低（27．45％）；cTnI和cTnT升高程度及持续时间与预后呈正相关。结论：早期确诊或排除AMI以cTnI和CK-MB组合更为可取；判断溶栓是否再通，cTnI和CK—MB更为准确可靠；这些心肌损伤标记物升高显著并呈持续升高者，则提示预后不佳。     

血清心肌肌钙蛋白I与肌酸激酶同工酶检测在小儿病毒性心肌炎临床诊断中的应用价值

目的：探讨血清心肌肌钙蛋白I（cTnI）与肌酸激酶同工酶（CK—MB）检测在小儿病毒性心肌炎临床诊断中的应用价值。方法：选取本院收治的病毒性心肌炎患儿72例作为心肌炎组,同期收治的上呼吸道感染及肺炎患儿65例作为非心肌炎组,同期进行健康体检的健康儿童56例作为健康对照组。分别对三组受检儿童血清cTnI和CK—MB的阳性异常比率,以及心肌炎组患儿治疗前后cTnl和CK-MB水平的变化情况进行比较和分析。结果：与心肌炎组患儿相比,非心肌炎组患儿血清cTnI阳性异常率及血清CK-MB阳性异常率均明显降低,差异具有统计学意义P〈0．05）。与心肌炎组患儿治疗前相比,治疗后cTnI和CK—MB水平均明显下降,差异具有统计学意义（P〈0．05）。结论：cTnI检测对于小儿病毒性心肌炎患儿具有较高的特异性,可作为临床诊断的重要指标。     

血清肌钙蛋白I在急性有机磷农药中毒心肌损伤诊断中的价值

目的：探讨测定血清肌钙蛋白I（ cTnI）对急性有机磷农药中毒（ AOPP）患者心肌损伤诊断的价值及临床意义。方法AOPP患者98例,分别于中毒第1 d、第2 d、第3 d、第5 d、第7 d,测定血清cTnI、肌酸激酶（ CK）、肌酸激酶同工酶（ CK－MB）、乳酸脱氢酶（ LDH）的值,观察峰值出现规律。按中毒的严重程度将其分为轻度中毒组、中度中毒组、重度中毒组。选取在本院体检的25例健康者作为对照组。将各组中毒患者各指标检查结果与对照组进行比较。结果 AOPP患者血清cTnI在中毒第2 d达高峰,第7 d仍显著高于对照组（ P＜0.01）,CK、CK－MB、LDH于中毒后第3 d达高峰;不同程度中毒患者血清cTnI 和心肌酶谱值随着病情的严重增加而增高,但cTnI增幅比CK、CK－MB、LDH更大。结论 AOPP越严重,血清cTnI值升高越明显,血清cTnI测定有助于对AOPP心肌损害的早期诊断,在抢救AOPP患者时,有必要对患者血清cTnI和心肌酶谱值进行动态观察,尤其是血清cTnI 的变化,其对AOPP心肌损伤的诊断比心肌酶谱有更高敏感性,更有价值。     

急性病毒性心肌炎患儿心肌肌钙蛋白T快速测定的临床意义

目的：对临床诊断的50例急性病毒性心肌炎患儿在急性发病期进行全血心肌肌钙蛋白T（cTnT）测定,并同时与心肌酶谱检测对照,分析研究其发生机理和临床意义。方法：通过双抗夹心法检测全血cTnT。同时在日立7060生化分析仪上速率法测定乳酸脱氢酶（LDH、肌酸磷酸激酶（CK）及其同工酶（CK—MB）。结果：治疗前l周患儿cTnT明显高于正常对照组（P〈0．01）;初次测定50例患儿中2l例（42％）全血cTnT明显升高,ll例（22％）血浆CK-MB明显升高,9例（17％）血浆cTnT和cK-MB均升高,cTnT阳性率高于CK—MB（卡方=9．179,P〈0．01）。结论：快速测定全血cTnT对急性病毒性心肌炎惠儿的早期诊断具有一定临床价值,同时对判断预后有一定意义。     

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.     

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.