血清抗AT1—受体自身抗体在难治性高血压患者中的病理作用及临床干预研究

目的：本文探讨了抗AT1－受体的自身抗体在难治性高血压中的存在及临床干预措施和效果。方法与结果：根据美国JNC－Ⅵ的诊断标准,收集了58例礁治性高血压病人,96例非难治性高血压病人及40例正常血压对照者;性别及年龄因素匹配。人工合成AT1－受体胸外第二环肽片段作为抗原,以ELISA法检测入选病人及对照组血清中的抗AT1－受体抗体,在上述3组病例中,抗体的阳性率分别为43％,10.4％及7.5%,在难治性高血压组抗体阳性率具有显著性差异（P＜0.05）。对抗体阳性的难治性高血压病人,随机分为血管紧张素－Ⅱ拮抗剂治疗组及ACE抑制剂治疗组,进行了为期6个月的临床随访,观察了两组病人在血压降低值、抗体变化及高血压并发症方面的差异,共得到有效病例数48例,发现血管紧张素-Ⅱ拮抗剂组和血压降低值优于ACE抑制剂组,且血压控制稳定。结论：抗AT1－受体自身抗体可能是导致部分高血压病人血压控制困难的原因之一,其机制可能AT1-受体自身抗体对AT1－体的激动活性有关,使用血管紧张素－Ⅱ拮抗剂氯沙坦可有效地阻断AT1-受体的各种激动途径,对抗AT1－受体自身抗体阳性的难治性高血压病人具有更大的使用价值。     

高血压患者血清AT1受体及α1受体的自身抗体检测

目的:建立抗血管紧张素Ⅱ1型受体(AT1)抗体及αl肾上腺素受体抗体的检测方法,并评价其与不同类型高血压的关系。方法:以合成的AT1受体及αl受体细胞外第二环功能表位肽段为抗原,采用间接ELISA法检测150例健康者、92例轻中度原发性高血压患者以及85例原发性高血压合并肾损害患者的血清中AT1受体和αl受体及其抗体。结果:正常对照组、轻中度原发性高血压组、原发性高血压合并肾损害组血清中检测出AT1受体及α1受体的自身抗体分别为9.33%和7.33%、10.87%和9.78%、30.59%和24.71%。高血压合并肾损害组与对照组、轻中度原发性高血压组比较,差异有显著性(P<0.01)。结论:AT1受体及αl受体的自身抗体可能参与了不同类型的高血压恶性阶段的发生和发展。     

血清抗AT_1-受体自身抗体在难治性高血压患者中的病理作用及临床干预研究

目的 :本文探讨了抗AT1 -受体的自身抗体在难治性高血压中的存在及临床干预措施和效果。方法与结果 :根据美国JNC -Ⅵ的诊断标准 ,收集了 58例难治性高血压病人 ,96例非难治性高血压病人及 40例正常血压对照者 ;性别及年龄因素匹配。人工合成AT1 -受体胞外第二环肽片段作为抗原 ,以ELISA法检测入选病人及对照组血清中的抗AT1 -受体抗体 ,在上述 3组病例中 ,抗体的阳性率分别为 43 % ,1 0 4%及 7 5 % ,在难治性高血压组抗体阳性率具有显著性差异 (P <0 0 5)。对抗体阳性的难治性高血压病人 ,随机分为血管紧张素 -Ⅱ拮抗剂治疗组及ACE抑制剂治疗组 ,进行了为期 6个月的临床随访 ,观察了两组病人在血压降低值、抗体变化及高血压并发症方面的差异 ,共得到有效病例数 48例 ,发现血管紧张素 -Ⅱ拮抗剂组的血压降低值优于ACE抑制剂组 ,且血压控制稳定。结论 :抗AT1 -受体自身抗体可能是导致部分高血压病人血压控制困难的原因之一 ,其机制可能与抗AT1 -受体自身抗体对AT1 -受体的激动活性有关 ,使用血管紧张素 -Ⅱ拮抗剂氯沙坦可有效地阻断AT1 -受体的各种激动途径 ,对抗AT1 -受体自身抗体阳性的难治性高血压病人具有更大的使用价值     

原发性高血压与心脏β2、α1及AT1受体自身抗体的关系

目的探讨抗G-蛋白偶联型β2、α1及AT1受体的自身抗体在原发性高血压病程中的分布情况。方法应用酶联免疫吸附测定(ELISA)技术,以细胞外第二环表位肽段的合成肽作为抗原,检测50例高血压心脏病、40例单纯高血压和40例正常人血清中抗G-蛋白偶联家族中β2、α1和AT1受体的自身抗体。结果高血压心脏病患者血清中抗G-蛋白偶联型β2、α1和AT1受体自身抗体的阳性率明显高于单纯高血压和正常组(P<0.05);高血压心脏病自身抗体阳性的平均几何滴度与单纯性高血压比较无明显差异(P>0.05),但两组阳性抗体的平均几何滴度均明显高于正常组。高血压心脏病抗β2受体自身抗体阳性患者中,81.0%同时具有α1受体的自身抗体,76.2%同时具有AT1受体的自身抗体,52.4%存在上述3种受体的自身抗体。结论抗G-蛋白偶联型β2、α1及AT1受体的自身抗体参与原发性高血压的病理生理过程,可能与心肌和血管重构有关。     

抗AT1和α1受体自身抗体与高血压病合并肾损害的关系

目的: 探讨抗血管紧张素Ⅱ受体1型(AT1-受体)和α1-肾上腺素受体(α1-受体)自身抗体是否与高血压病合并肾损害有关. 方法:以合成的AT1和α1受体多肽片段为抗原,应用酶联免疫吸附测定(ELISA)技术,检测61例高血压病合并肾损害患者和60例高血压病无肾损害患者及40例正常人,血清中抗G-蛋白偶联型AT1受体(165～191),和α1受体(192～218)自身抗体. 用放射免疫法,测定血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)和醛固酮(ALD)浓度,用荧光分析法测定儿茶芬胺:肾上腺素(E)和去甲肾上腺素(NE). 结果:高血压病合并肾损害组抗AT1和α1受体抗体阳性率分别为59.0%和54.1%,明显高于高血压组的13.3%和10.0%及正常对照组10.0%和7.5%(P<0.01). 神经内分泌激素指标(PRA,AngⅡ,ALD,E,NE),高血压病合并肾损害组,明显高于高血压组及正常对照组. 结论: 抗G-蛋白偶联型AT1和α1受体自身抗体可能与高血压病合并肾损害发病有关,同时伴有神经内分泌激活.     

慢性肾小球肾炎患者血清抗α1受体和血管紧张素Ⅱ1受体自身抗体与肾损害程度的分析

目的探讨慢性肾小球肾炎（chronic glomerulonephritis,CGN）患者血清中抗血管紧张素Ⅱ1受体自身抗体（AT1受体抗体）和抗α1肾上腺受体自身抗体（α1受体抗体）产生的阳性率与血清肌酐水平的关系。方法以合成的AT1和α1受体多肽片段为抗原,应用酶联免疫吸附测定（ELISA）技术,检测111例慢性。肾小球肾炎患者（CGN）,61例高血压无肾损害患者,40例正常人血清中抗AT1和α1受体自身抗体。结果①CGN抗AT1和α1受体自身抗体阳性率分别为68．5％（76／111）和56．8％（63／111）明显高于单纯高血压组的34：4％（21／61）、27．9X（17／61）和正常对照组（分别为10．0％和12．5％）（P〈0．05,P〈0．01）;②CGN患者亚组比较,早期肾衰期抗AT1和α1受体自身抗体的检出阳性率最高,与晚期肾衰和尿毒症期比较具有显著性统计学意义（P〈0．01）;③血清肌酐水平比较分析（血清肌酐高于正常但〈450μmol／L组）抗AT1和抗α1受体自身抗体的检出阳性率,明显高于血清肌酐水平450～707μmol／L组和〉707μmol／L组,比较具有统计学意义（P〈0．01）。结论CGN发病与血清抗AT1和α1受体自身抗体产生有关,血清抗AT1和α1受体自身抗体与血清肌酐水平有关,免疫学机制可能参与CGN发病。     

抗α1和AT1受体自身抗体对2型糖尿病合并难治性高血压的影响

目的 观察哌唑嗪联合缬沙坦治疗抗α1和AT1受体自身抗体阳性的糖尿病肾病合并难治性高血压的作用.方法 以合成的α1和AT1受体多肽片段为抗原,应用ELISA技术,检测277例人血清抗α1和AT1受体自身抗体,其中糖尿病肾病合并难治性高血压120例(A组),糖尿病肾病合并非难治性高血压111例(B组),正常对照组46例(C组),A组中抗α1和AT1受体自身均阳性者71例(A1组),抗α1和AT1受体自身均阴性者49例(A2组),A1、A2两组均给予缬沙坦、哌唑嗪、尼群地平、双氯噻嗪、阿司匹林,分别观察它们的降压疗效.结果 A组α1和AT1受体阳性率(55.8%、59.2%)与B组(27.9%、35.1%)、C组(7.5%、10.0%)比较具有统计学差异(P<0.01),哌唑嗪联合缬沙坦治疗后A1组降压疗效明显优于A2组(P<0.05),A1组临床疗效评定总有效率明显优于A2组(P<0.05).结论 糖尿病肾病合并难治性高血压患者,通过抗α1和AT1受体自身抗体检测,有针对性的选择降压药物哌唑嗪和缬沙坦,不但降压疗效好,而且安全.     

难治性高敌血压合并糖耐减低AT1受体自身抗体阳性患者降压疗效临床观察

目的 观察血管紧张素Ⅱ(AngⅡ)AT1受体拮抗剂对AT1受体自身抗体阳性的难治性高血压合并糖耐量减低(IGT)患者降压疗效.方法 应用ELISA技术检测237例人血清抗AT1受体自身抗体,其中难治性高血压病合并IGT患者91例(为A组),非难治性高血压病伴IGT患者106例(为B组),健康对照组40例(为C组).A组中AT1受体自身抗体阳性者39例为A1治疗组,阴性者52例为A2对照组,两组均给予口服:尼群地平10mg/tid;氢氯噻嗪12.5mg/d;肠溶阿斯匹林100mg/d;缬沙坦160mg/d;卡托普利25mg/tid.正常对照组40例.结果 ①难治性高血压合并IGTAT1受体自身抗体阳性率为57.1%(52/197),明显高于非难治性高血压伴IGT的15.1%和正常对照组的12.5%,比较具有统计学意义.②难治性高血压合并糖耐量减A1组降压疗效明显优于A2组,两组比较具有显著性统计学意义(P<0.05).③临床降压效果评定,A1组总有效率为84.6%, 明显高于A2组51.9%,两组比较具有极显著性意义(P<0.01).结论 对难治性高血压合并糖耐量减低,通过抗 AT1受体自身抗体检测,有针对性选择降压药物缬沙坦且降压安全有效.     

抗α1和AT1受体自身抗体对2型糖尿病合并难治性高血压的影响

目的观察哌唑嗪联合缬沙坦治疗抗α1和AT1受体自身抗体阳性的糖尿病肾病合并难治性高血压的作用。方法以合成的α1和AT1受体多肽片段为抗原,应用ELISA技术,检测277例人血清抗α1和AT1受体自身抗体,其中糖尿病。肾病合并难治性高血压120例（A组）,糖尿病肾病合并非难治性高血压111例（B组）,正常对照组46例（C组）,A组中抗α1和AT1受体自身均阳性者71例（A1组）,抗α1和AT1受体自身均阴性者49例（A2组）,A1、A2两组均给予缬沙坦、哌唑嗪、尼群地平、双氯噻嗪、阿司匹林,分别观察它们的降压疗效。结果A组α1和AT1受体阳性率（55．8％、59．2％）与B组（27．9％、35．1％）、C组（7．5％、10．0％）比较具有统计学差异（P〈0．01）,哌唑嗪联合缬沙坦治疗后A1组降压疗效明显优于A2组（P〈0．05）,A1组临床疗效评定总有效率明显优于A2组（P〈0．05）。结论糖尿病肾病合并难治性高血压患者,通过抗α1和AT1受体自身抗体检测,有针对性的选择降压药物哌唑嗪和缬沙坦,不但降压疗效好,而且安全。     

抗血管紧张素Ⅱ1受体和α1肾上腺素受体抗体与高血压患者心脏重构的观察

目的观察原发性高血压患者血清抗血管紧张素Ⅱ1受体（抗AT1受体）和α1肾上腺素受体自身抗体（抗α1受体抗体）对高血压患者心脏重构的影响。方法采用酶联免疫吸附法（ELISA）对553例原发性高血压患者进行血清抗α1受体和抗AT1受体抗体检测并记录所有患者的超声心动图检查结果。比较不同滴度组血清抗体对心脏重构的影响。结果553例高血压病患者血清抗α1-受体和抗AT1受体抗体阳性率分别为32．3％（179／553）,42．3％（234／553）。抗劬受体抗体1：40（滴度）阳性组左心房扩大比率明显高于阴性组（P=0．021）;≥1：80阳性组左心室扩大比率明显高于阴性组（P=0．006）。抗AT1受体抗体1：40阳性组右心房扩大比率明显高于阴性组（P=0．011）;≥1：80阳性组左心室扩大比率明显高于阴性组（P=0．004）。双抗阳性组左心室和右心房扩大比率明显高于双抗阴性组（P分别为0．006和0．044）。结论抗α1-受体和AT1受体抗体与高血压痛患者心脏扩大有关,可能是导致高血压病患者心脏重构的重要因素之一,且两种抗体可能有相互促进作用。     

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.