脑钠肽与冠状动脉病变程度的相关性

目的探讨脑钠肽(BNP)与冠状动脉病变程度的相关性。方法检测280例冠心病患者(冠心病组)和75例非冠心病患者(非冠心病组)的BNP浓度,冠脉病变程度由病变冠脉支数和Gensini积分表示,分析BNP水平与冠状动脉病变程度的关系。结果冠心病组BNP浓度高于非冠心病组(=0.023);随着冠脉病变支数的增加,BNP浓度逐渐上升(=0.882,=0.031),同时随着冠脉病变Gensini积分的上升,BNP浓度也逐渐增加(=0.79,=0.027)。结论 BNP浓度与冠脉病变有一定的相关性,随着BNP的上升,患者冠脉病变支数增加,冠脉Gensini积分也增高。BNP浓度可作为冠脉病变程度评价的参考指标之一。     

趋化因子CXCLl6与冠心病病变程度及胰岛素抵抗的关系

摘要：目的探讨冠心病患者趋化因子CXCChemokineLigand16（CXCLl6）水平与胰岛素抵抗（IR）及冠脉病变程度之间的关系。方法选择经冠状动脉造影证实的冠心病患者稳定型心绞痛（SAP）20例,急性冠脉综合征（ACS）24例。另有冠状动脉造影正常的20例作为对照组。平均年龄（62．61±10．37）岁。测定空腹血糖、空腹胰岛素、血脂、超敏C反应蛋白（hs—CRP）及血浆CXCLl6水平（采用酶联免疫吸附法）等生化指标。同时,根据稳态模式评估法计算胰岛素抵抗指数（iai）,采用Gensini积分系统评估冠脉病变程度。观察各组之间CXCLl6水平与冠脉病变程度及1R1关系。结果冠心病患者血浆CXCLl6、hs—CRP水平、IRI和Gensini积分均高于对照组（P〈O．05）;冠心病患者中,ACS组hs—CRP、IRI和Gensini积分高于SAP组（P〈O．05）;SAP患者Gensini积分与CXCLl6,IRI与hs—CRP均呈正相关（r分别为0．476,0．591,P均〈0．05）。结论血浆CXCLl6水平和IRI均为冠心病的预测指标,它们对冠脉病变狭窄程度有一定的辅助预测作用。     

冠心病患者N-末端脑钠肽前体水平与冠脉病变程度的关系

目的观察不同程度冠脉病变患者的血浆NT-proBNP水平的变化,探讨血浆NT-proBNP水平与冠状动脉病变严重程度的关系。方法选择2015年1月至2015年12月期间因冠心病在我院就诊且行冠脉造影患者153例,根据冠状动脉造影结果将患者分为三组:冠脉单支病变组49例(单支组)、冠脉双支病变组83例(双支组)、冠脉多支病变组21例(多支组)。另选同期入院非冠心病患者20例为对照组。测定各组患者血浆NT-proBNP水平和左室射血分数,并用Gensini积分法评价冠状动脉病变的严重程度。结果血浆NT-proBNP水平对照组明显低于各冠脉病变组(P0.01),且NT-proBNP水平随着冠状动脉病变支数的增加而增高,各组间有显著性差异。血浆NT-proBNP水平与冠状动脉病变血管支数及冠脉造影Gensini积分呈显著正相关,与LVEF呈负相关。结论血浆NT-proBNP水平可以反映冠脉病变严重程度。患者血浆NT-proBNP水平有助于对冠心病患者进行危险分层,识别高风险人群,并指导判断预后。     

冠心病患者血浆纤维蛋白原、血栓前体蛋白水平与冠状动脉病变程度的相关性

目的测定冠心病患者血浆Fg及TpP水平,结合冠状动脉造影所示冠脉病变支数和狭窄程度(Gensini积分),分析血浆Fg、TpP水平与冠脉病变程度相关性.方法选取昆明医科大学第一附属医院心内科冠心病患者,随机分为4组:急性心肌梗死组、不稳定型心绞痛组、稳定型心绞痛组及正常对照组,酶联免疫吸附法检测患者血浆Fg、TpP水平,冠脉造影记录所示病变血管支数及狭窄程度(Gensini积分),统计分析血浆Fg、TpP水平与冠脉病变程度的相关性.结果冠心病患者血浆Fg、TpP水平明显高于正常对照组(P＜0.05),Fg水平随病变血管支数增多而升高,而TpP水平随病变血管支数增加无明显升高,Gensini积分随病变血管支数增加而增加;血浆Fg水平与冠脉病变支数呈正相关,TpP与冠脉病变支数无相关性,血浆Fg、TpP水平与冠脉病变狭窄程度呈正相关(P＜0.05).结论冠心病患者血浆Fg、TpP水平明显升高,其水平高低与CHD严重程度密切相关.血浆Fg水平与冠脉病变支数和狭窄程度正相关,血浆TpP水平与冠脉病变支数无相关性,与冠脉病变狭窄程度正相关.     

糖耐量正常的冠心病患者胰岛素抵抗与冠脉病变程度的关系

目的观察正常糖耐量的冠心病患者中冠脉病变与胰岛素抵抗的关系。方法回顾性分析本院行冠脉造影的129例冠心病患者的临床资料,根据Gensini积分评估冠脉病变的严重程度,采用HOMA-IR来评估机体的胰岛素抵抗,最后探讨两者的关系。结果单因素相关分析表明胰岛素抵抗组的冠脉病变程度明显高于胰岛素敏感组,且随着胰岛素抵抗的加重,冠脉病变程度和支数随之加重;多因素相关分析表明,胰岛素抵抗与Gensini积分、冠脉有无病变显著相关。结论在糖耐量正常的冠心病患者中,血糖、糖化血红蛋白可能不是冠脉病变的危险因素,而胰岛素抵抗可能是冠脉病变发生发展最强的危险因素,在冠心病的防治时有必要对正常糖耐量患者的胰岛素抵抗进行有效的干预。     

糖化血红蛋白A1c与冠心病的相关性研究

目的：研究糖化血红蛋白A1c（HbA1c）水平与冠心病及其严重程度的关系及意义。方法：对疑诊为冠状动脉粥样硬化性心脏病（冠心病）而做选择性冠状动脉造影的140例患者进行HbA1c测定,采用冠脉狭窄程度积分（Gensini法）和冠脉病变支数分组,评价HbA1c水平与冠心病、冠脉狭窄程度积分及冠脉狭窄支数的相关性。结果：冠心病组患者A1c水平较对照组明显升高（P（0.01）,在冠心病组中,HbA1c水平随着冠脉病变支数和Gensini积分的增加而升高。直线相关分析表明：Gensini积分与A1c水平呈正相关（r=0.528,P（0.01）。结果：HbA1c水平与冠脉病变程度呈正相关,HbA1c水平升高是冠心病的危险因素。     

脉压指数、血浆脂联素与冠心病的相关性

目的探讨脉压指数（PPI）、血浆脂联素（APN）水平与冠心病严重程度的相关性。方法随机收集选择我院行冠状动脉造影患者共146例,冠状动脉病变的严重程度分别用冠脉病变的血管支数、冠脉狭窄程度和冠脉病变积分表示。行24h动态血压监测,计算PPI以及测量身高、体重计算体重指数（BMI）。采用ELISA试剂盒检测血浆APN水平,同时检测患者生化指标,如空腹血糖（FPG）、TC、TG、LDL-C、HDL-C等。结果冠脉病变程度随年龄而逐渐加重,冠脉狭窄积分多支病变组〉两支病变组〉单支病变组〉冠脉正常组;PPI冠脉病变组〉冠脉正常组,多支病变组〉两支病变组〉单支病变组（P〈0.05）;血浆APN水平多支病变组〈两支病变组〈冠脉正常组,多支病变组〈两支病变组〈单支病变组（P〈0.05）;直线相关分析结果表明年龄、BMI、PPI、FPG与冠心病的发生呈显著正相关,血浆APN与冠心病的发生呈显著负相关,血浆APN水平与年龄、PPI呈负相关;多因素Logistic回归分析结果显示：PPI、APN、年龄是冠状动脉病变程度的危险因素。结论脉压指数、血浆脂联素与冠状动脉病变的严重程度密切相关,血浆APN与PPI呈负相关,两者联合检测对冠心病的严重程度及危险性评估和预后有一定的价值。     

胰岛素抵抗与冠状动脉病变的相关性研究

[目的]探讨胰岛素抵抗与冠状动脉病变的关系。[方法]236例胸痛患者按冠状动脉造影的结果分成对照组(80例)及冠心病组(156例),冠心病组根据冠状动脉病变支数又分3个亚组:1支病变组,49例;2支病变组,69例;3支病变组,38例。冠脉造影前测定空腹胰岛素(FINS)和空腹血糖(FBG)、血脂等生化指标,并计算出胰岛素敏感指数ISI=LN[1/(FBG×FINS)]。[结果]①冠心病组患者与对照组比较,存在高胰岛素血症(P<0.01)和胰岛素敏感性降低(P<0.01);②随冠状动脉病变支数的增加,FINS和ISI明显增高,二支病变组、三支病变组FINS和ISI显著高于一支病变组(P<0.05)。[结论]胰岛素抵抗与冠心病发生率成正比;胰岛素抵抗与冠状动脉病变的广泛程度有密切的关系。     

冠心病患者冠状动脉病变与胰岛素抵抗的相关性研究

目的探讨冠心病患者冠脉病变与胰岛素抵抗(IR)的关系。方法68例经冠状动脉造影(CAG)证实至少有1支血管病变≥50％的患者为研究对象,所有患者均行口服葡萄糖耐量试验(OGTT)及血脂、胰岛素测定。以胰岛素敏感性指数作为评价胰岛素抵抗程度指标,对冠状动脉病变程度、冠心病危险因素行相关分析。结果胰岛素抵抗与体重指数、空腹血糖、空腹胰岛素、血脂、高血压病史均有明显相关性,而且胰岛素抵抗程度与冠脉病变程度呈正相关。结论胰岛素抵抗是促进冠状动脉粥样硬化形成及发生心血管疾病的危险因素。     

胰岛素抵抗对冠心病患者冠状动脉病变严重程度的影响

【目的】探讨胰岛素抵抗作为冠心病的危险因素与冠脉病变严重程度的关系。【方法】采用回顾性研究,收集358例住院并行冠脉造影确诊冠心病的患者病例,根据稳态模型胰岛素抵抗指数（HOMA—IR）分为胰岛素抵抗（IR）组和胰岛素敏感（IS）组,分析胰岛素抵抗对冠状动脉病变严重程度的影响。【结果】IR组重度狭窄病变、复杂病变、弥漫性病变、C型病变发生率高（P〈0．05）。IR组Gemini积分、病变血管支数、病变数高于IS组（P〈0．05）。经Spearman相关分析表明HOMA—IR与Gemini积分呈正相关。经多元线性回归分析表明：HDL—C为冠状动脉病变的保护因素,收缩压、LDL—C、HOMA—IR为冠状动脉病变的危险因素。【结论】HOMA—IR可以预测或提示冠状动脉病变严重程度,IR患者冠状动脉病变严重,弥漫病变、复杂病变、重度狭窄病变发生率高。     

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.