胱抑素C、超敏C反应蛋白和B型利钠肽对慢性心力衰竭患者近期预后的分析

目的观察胱抑素C(cystatin C,CysC)、超敏C反应蛋白及血清B型利钠肽(brain natriuretic peptide,BNP)在慢性心力衰竭(chronic heart failure,CHF)患者早期疗效评价中的应用价值。方法选取2018年1月至2018年12月本院收治的260例CHF患者作为CHF组,根据美国纽约心脏病学会(NYHA)分级标准分为Ⅱ级组(n=99)、Ⅲ级组(n=75)与Ⅳ级组(n=86);同时,选取同期55名正常体检者作为对照组,比较各组血清BNP、CysC、Hs-CRP水平及左室射血分数、左室舒张末期内径。出院3个月随访记录主要心脏不良事件发生情况。结果Ⅲ级组和Ⅳ级组血清尿素氮、肌酐、尿酸、BNP、CysC水平及LVEDD均高于对照组,LVEF低于对照组,差异有统计学意义(P<0.05);Ⅳ组血清尿素氮、肌酐、尿酸、BNP、CysC水平及LVEDD均明显高于Ⅱ级组和Ⅲ级组,且LVEF低于Ⅱ级组和Ⅲ级组(P<0.05)。心功能等级越高,血清BNP、CysC、LVEDD水平越高,LVEF越低,比较差异有统计学意义(P<0.05)。Pearson相关性分析显示,BNP水平与尿素氮、肌酐、尿酸、胱抑素C及左室射血分数呈正相关(P<0.05);BNP水平与LVEDD呈负相关(P<0.05)。发生心脏不良事件(major adverse cardiac events,MACE)组血清BNP、CysC、Hs-CRP水平高于未发生心脏不良事件组(P<0.05)。结论血清BNP、CysC、Hs-CRP水平及左室射血分数与慢性心力衰竭的严重程度密切相关,且会增加近期不良预后风险。     

陈旧心肌梗死患者胱抑素C水平及预后相关性研究

目的探讨陈旧心肌梗死(old myocardial infarction,OMI)患者血清胱抑素C(cystatinC,CysC)水平的变化及其与心功能的关系,分析因心血管事件发生再人院患者治疗前后心功能变化及血清CysC水平的相关性,同时明确血清CysC水平变化与肾小球滤过率(GFR)是否有相关性.方法测定81例陈旧心肌梗死患者血清CysC浓度等指标,以患者24 h内首次血清CysC值作为基线,≥1.50 mg/L为CysC显著增高组,＜1.50 mg/L为CysC正常或轻微增高组.心功能按纽约心脏协会(NYHA)分级,NYHAⅠ级46例,NYHAⅡ级14例,NYHAⅢ级10例,NYHAⅣ级11例,对照组为体检健康者30例.结果OMI患者血清CysC水平与对照组比较均增加,差异有统计学意义(P＜0.05).血清CysC与心功能严重程度呈正相关.血清CysC显著增高组的患者心血管事件和再住院率都明显增加.治疗后血清CysC水平与治疗前比较均下降,差异有统计学意义(P＜0.05).血清CysC与GFR呈负相关.结论OMI患者血清CysC水平明显升高,随着血清CysC升高,心衰程度加重,心血管事件及再住院率增加.血清CysC的水平反映心衰患者早期肾脏功能的受损.     

BNP、血清胱抑素C和血清前白蛋白对重症心衰的临床诊断价值分析

目的分析BNP、血清胱抑素C(CysC)和血清前白蛋白(PA)在重症心衰中的表达及意义,为重症心衰严重程度的准确评估提供更多的生化指标。方法选择2018年03月至2019年08月我院收治的130例重症心衰患者为观察组,并按照NYHA分级法将其分为心功能Ⅲ级(60例)、Ⅳ级(70例);同时选取同期住院的30例心功能正常或心功能Ⅰ～Ⅱ级患者作为对照组,分别收集160例患者BNP、血清CysC、血清PA的检测结果,比较两组患者BNP、血清CysC、血清PA水平。结果观察组患者BNP、血清CysC明显高于对照组,血清PA明显低于观察组,差别具有统计学意义(P0.05);其中,观察组心功能Ⅳ级患者BNP、血清CysC明显高于心功能Ⅲ级患者,血清PA明显低于心功能Ⅲ级患者,差异具有统计学意义(P0.05)。结论重症心衰患者BNP、血清CysC升高,血清PA降低;BNP、血清CysC随着重度心衰程度的加重而升高,血清PA随加重而降低。因此,血清CysC、血清PA可与BNP监测相结合有助于更准确地判断重症心衰的严重程度,为重症心衰的临床决策提供实验室依据,具有较高的临床诊断价值。     

心力衰竭患者BNP的临床价值

目的:探讨心力衰竭患者血浆脑钠肽(BNP)的变化及临床意义。方法:测定心力衰竭患者80例及对照组23例空腹血清BNP、左室舒张末内径(LVEDD)、左室射血分数(LVEF)等指标。结果:心力衰竭患者血浆BNP水平显著高于对照组(P<0.01)。心力衰竭组BNP水平随心功能NYHA(美国纽约心脏病学会)分级的加重而增高。心衰患者BNP水平与LVEF呈负相关(r=-0.87,P<0.01),与LVEDD呈正相关(r=0.79,P<0.01)。结论:血浆BNP水平能较好地反映心功能状况,对心衰患者的诊断、病情和预后判断具有重要临床意义。     

胱抑素C对急性前壁心肌梗死患者发生心功能不全的预测价值

目的探讨血清胱抑素C(CysC)水平对急性前壁心梗患者发生心功能不全的预测价值。方法急性前壁心梗患者87例,按住院期间有无心功能不全症状分为两组:发生心功能不全组(n=54)和未发生心功能不全组(n=33)。再按左室射血分数(LVEF)值分为两组:LVEF值大于50%的病例组(n=48)和LVEF值小于50%的病例组(n=39)。所有病例入院第2天清晨检测血清胱抑素C水平。结果与未发生心功能不全组比较,发生心功能不全组的患者血清CysC水平明显升高(P<0.01);与LVEF≥50%病例组患者对比,LVEF<50%病例组患者的血清CysC水平明显升高(P<0.01)。结论血清胱抑素C升高对急性前壁心梗患者发生心功能不全有预测价值,有利于判断患者的预后。     

陈旧性心肌梗死合并室内传导阻滞B-型脑钠肽水平变化及对心功能的影响

目的探讨陈旧性心肌梗死合并室内传导阻滞BNP水平变化及对心功能的影响。方法连续入选2013年1～11月我院收治的陈旧性心肌梗死患者255例,根据心电图QRS波时限分为室内传导阻滞组57例,非室内传导阻滞组198例。住院24 h内测定BNP水平,两周测定患者左室舒张末内径（LVEDD）、左室射血分数（LVEF）。结果两组患者在年龄、性别、高血压、糖尿病、NYHA分级等方面比较差异均无统计学意义（P〉0.05）。与非室内传导阻滞组比较,室内传导阻滞组BNP水平升高,LVEDD增大,LVEF降低,其差异均有统计学意义（P〈0.05）。结论陈旧性心肌梗死合并室内传导阻滞BNP过度分泌参与了左室重构,并影响左心功能。     

慢性心力衰竭患者血胱抑素浓度变化及临床意义

目的探讨慢性心力衰竭（CHF）患者血清胱抑素C（CysC）浓度变化及其临床意义。方法将77例CHF患者按NYHA心功能分级标准,分为心功能Ⅰ～Ⅳ级,采用颗粒增强免疫比浊法测定CysC的浓度,并测定血脑利钠肽（BNP）及左室射血分数（LVEF）。另择63例心功能正常者作为对照组。结果CHF患者血CysC浓度明显高于对照组僻〈0．01）,心功能Ⅲ、Ⅳ级的血清浓度高于Ⅰ～Ⅱ级（P〈0．05）;不同病因心力衰竭组相互比较,血CysC浓度差异无统计学意义;血CysC与年龄成正相关,与LVEF、BNP水平呈弱相关。结论CysC可能是心力衰竭恶化的标志物之一,是评估CHF风险的简便有效指标。     

左卡尼汀治疗老年急性冠脉综合征前后血清心衰标志物的水平变化分析

目的 探讨左卡尼汀治疗老年急性冠脉综合征(ACS)前后血清心衰标志物的水平变化.方法 选取2018年10月至2019年10月本院收治的188例ACS老年患者,根据治疗方法的不同分为对照组和观察组,每组94例.对照组采用常规治疗,观察组在常规治疗基础上加用左卡尼汀治疗.比较两组患者血清心衰标志物水平、心功能参数、不良反应发生情况.结果 治疗后,观察组患者胱抑素C(CysC)、脑钠尿肽(BNP)、N末端脑钠尿肽前体(NT-proBNP)、左室收缩末期容积(LVESD)、左室舒张末期容积(LVEDD)水平均低于对照组,左室射血分数(LVEF)、心排血量(CO)水平和二尖瓣舒张早期与晚期血流峰值比值(E/A)均高于对照组,差异均有统计学意义(P<0.05);两组患者不良反应发生率比较差异无统计学意义.结论 左卡尼汀治疗ACS老年患者可有效改善血清心衰标志物水平与心功能,且不增加不良反应,值得临床推广应用.     

慢性心力衰竭患者血浆BNP水平与心功能分级之间的相关性

目的:探讨慢性心力衰竭患者血浆BNP水平与心功能分级之间的相关性.方法:131例慢性心力衰竭患者,按纽约心脏协会NYHA分级标准分为4组,用电化学发光法测定血浆BNP浓度.血浆BNP水平与心脏多普勒超声指标的左室射血分数(LVEF)、左室短轴缩短率(LVFS)、左室舒张末内径(LVEDD)相关关系.结果:不同NYHA心功能分级患者的血浆BNP水平不同,随心功能级别增加而显著增高(P<0.05).血浆BNP水平与左室射血分数(LVEF)呈负相关(r=-0.56,P<0.05),与左室短轴缩短率(LVFS)呈负相关(r=-0.57,P<0.05),与左室舒张末期内径(LVEDD)呈正相关(r=-0.56,P<0.05).结论:血浆BNP值可作为较可靠的早期预测心功能不全的指标.     

血浆B型利钠肽与血清胱抑素检测在慢性收缩性心功能不全的临床意义

目的 分析对慢性收缩性心功能不全患者检测血浆B型利钠肽(BNP)与血清胱抑素水平的临床意义.方法 100例慢性收缩性心功能不全患者根据NYHA分级标准分为3组,健康查体者20例作为对照组.用免疫荧光法检测血清胱抑素、血浆BNP浓度,心脏彩超检测左心室射血分数等指标.结果慢性收缩性心功能不全患者血清胱抑素C、血浆BNP浓度显著高于对照组,且随着心力衰竭的加重而显著增加(P均＜0.01).结论 联合检测血清胱抑素C、血浆BNP能够预测慢性收缩性心功能不全患者发生心肾综合征(cardiorenal syndrome,CRS)的可能性.     

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.