慢性心力衰竭患儿血浆肾上腺髓质素、C-型利钠肽及心肌作功指数测定

目的:探讨慢性心力衰竭(CHF)患儿血浆肾上腺髓质素(ADM)、C-型利钠肽(CNP)浓度和心肌作功指数(Tei指数)的变化.方法:42例CHF患儿,心功能Ⅱ级16例、Ⅲ级14例、Ⅳ级12例,原发疾病为扩张性心肌病12例,先天性心脏病19例,心内膜弹力纤维增生症等其他疾病11例.正常对照组11例.用同位素放射免疫分析法测定2组血浆ADM和CNP含量,超声心动图测定Tei指数、左室射血分数(LVEF).结果:CHF患儿治疗前血浆ADM和CNP含量高于正常对照组(P=0.000);治疗后血浆ADM和CNP含量均较治疗前降低(P＜0.05).CHF患儿血浆ADM、CNP含量和Tei指数随心功能级别的升高而升高(P＜0.05).心肌病组、先心病组及其他病组间血浆ADM、CNP含量和Tei指数差异无统计学意义(P均＞0.05).CHF组血浆ADM和CNP水平与Tei指数均呈正相关(r分别为0.87,0.59,P均＜0.001);与LVEF均呈负相关(r分别为-0.69,-0.48,P均＜0.01).结论:ADM有可能成为评估小儿CHF严重程度和预测CHF预后新的生化指标.     

慢性心衰患者血浆C型利钠肽、肾上腺髓质素的变化及意义

目的 测定慢性心衰(CHF)患者血浆C型利钠肽(CNP)、肾上腺髓质素(ADM)水平,以探讨其与心衰严重程度的关系.方法 随机选取115例CHF患者与40例健康者,CHF组按照心功能Ⅱ、Ⅲ、Ⅳ级分为3个亚组,抽取空腹静脉血,采用放射免疫法测量其血浆CNP、ADM的水平.超声心动图测量CHF组左室射血分数(LVEF)值.结果 ①CHF组血浆CNP、ADM的水平(CNP:40.02±21.19 pg/ml;ADM:71.38±29.30 pg/ml)明显高于健康对照组(CNP:14.46±4.54 pg/ml、ADM:21.90±6.58 pg/ml,P＜0.01).②CHF组各亚组的血浆CNP、ADM的水平分别为:心功能Ⅱ级组(CNP:23.59±5.28 pg/ml、ADM:43.34±4.78 pg/ml),心功能Ⅲ级组(CNP:36.56±4.77 pg/ml、ADM:65.78±9.06 pg/ml),心功能Ⅳ级组(CNP:71.41±10.28 pg/ml、ADM:105.04±22.21 pg/ml),任意两组比较均有显著差异性,P＜0.01,③血浆CNP、ADM水平均与LVEF值呈负相关(CNP:r=-0.67,P＜0.01,ADM:r=-0.58,P＜0.05).结论 在CHF患者中,血浆CNP、ADM的水平与心力衰竭严重程度呈正相关,临床上可作为评估CHF严重程度及其预后的指标.     

充血性心力衰竭患者E／Ea与严重程度的相关性

目的探讨充血性心力衰竭(CHF)患者的跨二尖瓣舒张早期血流速度峰值(E)与二尖瓣环舒张早期运动速度峰值(Ea)的比值和CHF严重程度的关系.方法用多普勒组织显像测定54例CHF患者和29例正常人的Ea,用脉冲多普勒测定E,分析CHF患者E/Ea的变化及其与CHF严重程度的关系.结果①CHF患者的E/Ea高于正常组(14.01±4.53 vs 8.41±2.17,P＜0.01).②CHF患者中,心功能Ⅲ～Ⅳ级的E/Ea值高于心功能Ⅱ级的E/Ea值(16.41±5.42 vs12.34±2.88,P＜0.01);其中左室射血分数(LVEF)≥50%的CHF患者,心功能Ⅲ～Ⅳ级的E/Ea值也高于心功能Ⅱ级的E/Ea值(16.27±4.96 vs12.05±3.00,P＜0.01).③脑利钠肽(BNP)≥1 000pg/ml的CHF患者,其E/Ea值高于BNP＜1 000pg/ml的CHF患者(16.63±6.45 vs 13.15±3.00,P＜0.01).④LVEF＜50%与LVEF≥50%的CHF患者比较,E/Ea值差异无统计学意义(15.06±5.09 vs 13.41±4.16,P＞0.05).⑤LVEF＜50%的CHF患者,E/Ea值与LVEF无相关性(r=0.06,P＞0.05).结论CHF患者的E/Ea值升高,其数值能够反映CHF的严重程度.对LVEF正常者,E/Ea升高能提示舒张性心力衰竭的严重程度.     

慢性心衰患者血浆心肌营养素-1水平的变化及意义

目的 研究慢性心力衰竭患者血浆心肌营养素-1(CT-1)水平的变化及意义.方法 用双抗体夹心酶标免疫分析法测定血浆CT-1浓度,荧光免疫法测定血浆脑钠肽(BNP)浓度.选择慢性心力衰竭(CHF)患者106例,其中心功能Ⅱ级41例,心功能Ⅲ级36例,心功能Ⅳ级29例,35例健康人为正常对照组.结果 CHF组血浆CT-1、BNP水平明显高于正常对照组[CT-1:(448.5±66.3)pg/mL vs(78.6±13.6)pg/mL,P＜0.01;BNP:(258.9±76.2)pg/mL vs (65.4±32.8)pg/mL,P＜0.01],随着心力衰竭程度的加重二者水平逐渐增高,CHF各组间差异有显著性(P＜0.05或P＜0.01).并且随着血浆CT-1、BNP水平的增高,CHF患者左室射血分数(LVEF)逐渐下降.相关分析中,血浆CT-1水平仅与LVEF呈负相关(r=-0.316,P＜0.01),而BNP水平与年龄、收缩压、舒张压及肌酐呈正相关(r=0.213,P＜0.05;r=0.306,P＜0.01;r=0.264,P＜0.01;r=0.371,P＜0.01),与LVEF呈负相关(r=-0.521,P＜0.01).结论 血浆CT-1浓度可能是反映心衰严重程度的指标,CT-1在反映心衰严重程度方面很可能比BNP更敏感.     

缬沙坦对慢性心力衰竭患者血浆脑钠素水平及左室收缩功能疗效的研究

目的 探讨慢性心力衰竭(CHF)患者在常规治疗基础上加用缬沙坦治疗12周后脑钠素(BNP)水平的变化及心功能的疗效.方法 应用化学发光法测定52例CHF患者治疗前、后和18例对照组血浆BNP浓度:用多普勒超声心动图测定CHF组左室舒张末期内径(LVEDD)及左室射血分数(LVEF).结果 CHF患者血浆BNP水平(456±253)Pg/mL较对照组(28±6)pg/mL明显增高(P＜0.01);不同心功能患者血浆BNP水平差异亦有显著意义,依次为Ⅳ级＞Ⅲ级＞Ⅱ级(P＜0.01),CHF组BNP水平升高与心力衰竭程度呈正相关(r=0.672,P＜0.01).缬沙坦治疗后血浆BNP水平明显下降,与治疗前比较差异有非常显著性(P＜0.01).LVEF有所提高,LVEDD明显缩小与治疗前比较均差异有显著性(P＜0.05).结论 血浆BNP水平可以反映心力衰竭严重程度、作为治疗心力衰竭的一个可靠观察指标.缬沙坦能显著降低脑钠素水平,改善心功能.在心力衰竭的治疗中起着重要作用.     

心力衰竭患者血浆脑钠素及左室射血分数变化分析

目的:观察充血性心力衰竭(CHF)患者血浆脑钠素水平(BNP)及左室射血分数(LVEF)与心功能分级之间的关系,探讨其临床意义.方法:75例CHF患者按NYHA分级分为4个亚组,采用放免法测定各组血浆BNP浓度,用超声心动仪(SONO1000)测定左室射血分数(LVEF).结果:CHF患者血浆BNP浓度显著升高有统计学意义(P＜0.01),且心功能越差升高越明显;血浆BNP浓度与LVEF之间具有良好的负相关(r=-0.59,P＜0.01).结论:CHF患者血浆BNP浓度随心力衰竭严重程度增加而升高,血浆BNP浓度能较好的评价CHF患者的心功能状态.     

肿瘤坏死因子α在慢性心力衰竭中的临床意义

目的 :探讨TNF -α在慢性心力衰竭中的临床意义。材料和方法 :应用放免法检测 6 9例CHF病人 (NY HAⅡ～Ⅳ级 )和 2 2例正常人血浆TNF -α ,以M型超声测定LVEF、FS。结果 :CHF病人血浆TNF -α明显升高 (19.6 1± 8.2 8pmol/Lvs 12 .0 3± 4 .83pmol/LP <0 .0 1) ,且升高程度与心功能严重程度相一致 (Ⅳ级2 6 .6 1± 7.75 pmol/L ;Ⅲ级 19.30± 8.31pmol/L ;Ⅱ级 15 .2 8± 5 .0 6 pmol/L ;ⅣvsⅢ及ⅢvsⅡP均 <0 .0 5 )。TNF -α与LVEF、FS呈负相关 (r=- 0 .3876 ,P <0 .0 2 5和r =- 0 .4 183,P <0 .0 1)。结论 :血浆TNF -α水平在CHF病人中增高 ,与心功能分级相一致 ,并与心脏收缩功能呈负相关     

原发性慢性肾小球肾炎患者血浆肾上腺髓质素、内皮素-1的变化及临床意义

目的:探讨肾上腺髓质素(ADM),内皮素-1(ET-1)与原发性肾小球肾炎肾功能损害的关系及其内在联系.方法:正常对照组15例,原发性慢性肾小球肾炎38例,根据内生肌酐清除率(Ccr)将患者分为4组.采用放射免疫法检测各组血浆ADM,ET-1,同时检测血管紧张素Ⅱ与醛固酮.结果:与正常对照组相比,Ⅰ、Ⅱ、Ⅲ、Ⅳ组血浆ADM显著升高(P＜0.01),血浆ADM与血清肌酐(Scr)、24 h尿蛋白量呈正相关(r=0.885 2,P＜0.001;r=0.457 6,P＜0.05),与平均动脉压(MAP)、血浆血管紧张素(AngⅡ)和醛固酮(ALD)呈负相关(r=-0.386 7,P＜0.01,r=-0.581 3,P＜0.001,r=-0.395 6,P＜0.01).血浆ET-1与Scr、MAP、AngⅡ和ALD均呈正相关(r=0.766 0,P＜0.001,r=0.305 7,P＜0.05,r=0.284 6,P＜0.05,r=0.623 5,P＜0.001).血浆ADM与血浆ET-1呈正相关(r=0.608 6,P＜0.001).结论:血浆ADM的升高可能是代偿ET-1升压和促进肾脏纤维化的结果,对肾脏有一定的保护作用;ADM在肾脏疾病的治疗中可能具有重要的前景.     

充血性心力衰竭患者血浆瘦素水平的变化及其临床意义

目的探讨充血性心力衰竭(CHF)患者血浆瘦素(Leptin)水平的变化及其临床意义.方法应用ELISA法测定45例男性CHF患者(CHF组)和30例男性健康查体者(对照组)血浆Leptin水平,同时分别测量体重指数(BMI)、腰围/臀围比(WHR)及血压等,采用改良Simpson法测定CHF组患者左室射血分数(LVEF).比较CHF组与对照组及CHF组不同病因亚组血浆Leptin水平变化,并将NYHA心功能分级与Leptin水平进行相关分析.结果CHF组患者血浆Leptin水平明显高于对照组(P＜0.001),且随NYHA心功能分级的增高,血浆Leptin水平呈升高趋势,两者显著相关(rs=0.875,P＜0.001);CHF组不同病因亚组血浆Leptin水平无显著性差异(P＞0.05).结论CHF患者血浆Leptin水平升高,并与心衰的严重程度相关;CHF患者高Leptin血症可能参与了CHF分解代谢等病理生理过程.     

先天性心脏病肺动脉高压病人血浆肾上腺髓质素含量测定及其与一氧化氮的关系

①目的探讨先天性心脏病肺动脉高压病人血浆肾上腺髓质素(ADM)的含量变化及其与一氧化氮(NO)的关系.②方法根据肺动脉压水平将40例病人分为肺动脉高压组和对照组,用放射免疫分析法测定血浆ADM含量;单一试剂比色法测定血浆NO含量.③结果肺动脉高压组肺动脉和肺静脉血浆ADM含量均明显高于对照组(t=3.814,3.194,P＜0.01,0.05),肺动脉血浆NO浓度亦明显高于对照组(t=3.044,P＜0.01);全部病人肺静脉血浆ADM含量明显低于肺动脉(t=7.440,P＜0.001);肺动脉高压组肺动脉中ADM和NO血浆含量与肺动脉收缩压均呈正相关(r=0.50,0.49,P＜0.01),在肺静脉中ADM含量与肺动脉收缩压亦呈正相关(r=0.54,P＜0.01),肺动脉高压组血浆NO与ADM的含量呈正相关(r=0.35,P＜0.05).④结论先天性心脏病肺动脉高压发生发展过程中ADM升高,NO可能介导ADM的扩血管作用.     

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.