非离子型造影剂对正常肾功能和肾功能不全患者肾功能的影响分析

目的探讨和分析非离子造影剂对正常肾功能和肾功能不全患者肾功能的影响。方法回顾性分析具有完整临床资料的2008年10月至2010年10月来我院使用造影剂检查和介入手术治疗的住院患者100例,其中正常肾功能患者50例,肾功能不全患者50例。两组比较采用非离子型造影剂进行冠脉造影,其中又按使用等渗造影剂与低渗造影剂分为二个治疗组．同时对其中进行单纯造影与造影后直接行PCI术的患者根据造影剂用量的不同,分为≤100mL组和〉100mL组,观察和比较对两组患者等渗造影剂与低渗造影剂以及不同剂量的造影剂对肾功能的影响。结果肾功能正常组患者在造影前和造影后血肌酐、血尿素氮、肌酐清除率以及尿B：微球蛋白的水平无显著性差异（P〉0．05）,≤100mL组和〉100mL组的血肌酐、血尿素氮、肌酐清除率以及尿p：微球蛋白的水平无显著性差异,（P〉0．05）;而肾功能不全组患者在造影前和造影后血肌酐和尿B：微球蛋白水平具有显著性差异,（P〈0．05）,≤l00mL组的血肌酐、血尿素氮、肌酐清除率以及尿B。微球蛋白的水平显著低于〉100mL组,差异具有显著性,P〈0．05。血尿素氮和肌酐清除率水平无显著性差异（P〉0．05）。肾功能不全组患者发生造影剂肾病患者有3例,发生率为6％;等渗组对肾功能的影响明显小于低渗组,组间比较差异具有统计学意义（P〈0．05）结论非离子型造影剂可对慢性肾功能不全患者的肾功能产生较大影响,并且低渗造影剂对于肾功能不全的患者的影响大于等渗造影剂,肾功能不全的患者应慎用非离子型造影剂。     

碘造影剂对老年患者肾功能不良影响的预防措施

目的：探讨碘造影剂对老年患者肾功能不良影响的预防措施。方法：60例经确认具有造影检查适应证的老年患者，在造影前进行造影荆相关性肾病（Contrast-Associated Nephropath，CAN）危险因素筛查，并根据患者所具有的可变危险因素分别予以控制血糖、血压、心力衰竭等对症治疗方行造影检查，同时加强对具有不可变危险因素者进行临床不良反应的监测，观察患者应用造影剂前后肾功能的变化及有否发生CAN。结果：60例老年患者造影后24h、72h尿NAG与造影前相比差异有显著性（P〈0．05），造影7d与造影前相比差异无显著性（P〈0．05）。而BUN、Cr，各时段之间比较无显著性差异（P〉0．05）。全部患者均无发生CAN。结论：严格掌握造影检查适应证，重视筛查与发生有关的危险因素，并在使用造影剂之前纠正其可变的不利因素，控制碘造影剂的使用剂量，可避免对老年患者造成严重不良反应或发生CAN。     

他汀类药物预防冠脉介入术后造影剂肾病的研究

目的：探讨他汀类药物在预防冠脉介入术后（PCI）造影剂相关肾病（CIN）的作用。方法：将住院行冠状动脉介入治疗的冠心病患者138例随机分为他汀组和非他汀组。两组在水化治疗基础上,他汀组在应用造影剂前、后24h,每日1次口服阿托伐他汀80mg。然后分别测定并比较两组患者造影后24、72h的血清尿素氮（BUN）、血清肌酐（Scr）、内生肌酐清除率（Ccr）以及造影剂肾病的发生率。造影剂均使用非离子型低渗造影剂碘海醇,记录使用量。结果：他汀组BUN及Scr增加值和增加百分比明显低于非他汀组（P〈0．05）,Ccr下降值和下降比率以及CIN的发生率（5．80％VS15．94％）亦明显低于非他汀组（P〈0．05）。结论：应用阿托伐他汀对于冠脉介入治疗患者造影剂肾病的发生具有一定的预防保护作用。     

不同剂量碘普罗胺对老年患者肾功能的影响

目的：了解不同剂量的低渗性非离子型造影剂碘普罗胺（Iopromide）对老年病人肾功能的影响。方法：31例无肾病史、术前肾功能正常的患者依据接受造影剂的剂量不同分为两组。通过在术后第1天、5天测定血清尿素氮（BUN）、血清肌酐（Scr）及肌酐清除率（Ccr），观察使用非离子型造影剂碘普罗胺后患者的肾功能变化。结果：造影前及后1d，5d，两组病人间BUN，Scr和Ccr水平差异性均无显著（P〉0．05）。术后1d时，两组病人均出现Scr轻度升高、Ccr轻度降低，5d时，则恢复到造影前水平。全部病例均无急性肾功能衰竭发生。结论：一次294ml以内剂量的非离子型造影剂碘普罗胺对老年病人是相对安全的，应用后Scr，Ccr的轻度改变，在5d内恢复至造影前水平，且在一定剂量范围内与造影剂剂量间无显著相关性。     

碳酸氢钠静脉输注对造影剂肾病预防作用的研究

目的观察慢性肾脏病患者在围造影期随机应用生理盐水和碳酸氢钠两种不同干预方法后造影剂肾病的发生率,验证并比较两种预防方法的有效性。方法将拟行冠状动脉造影并伴有肾功能损害的患者,随机分为碳酸氢钠组和生理盐水组。两组分别从造影前6h开始给予1．5％碳酸氢钠注射液或0．9％氯化钠注射液,按2ml／（kg·h）速度静脉输注,最大速度≤150ml／h。造影中至造影结束后6h,以80ml／h速度继续静脉输注。造影剂均使用碘海醇,记录使用剂量。分别测定造影前和造影后24h、72h的血清肌酐、尿素氮,比较两组患者造影剂肾病的发生率。结果105例患者年龄43～88岁,平均（70．51士7．69）岁。两组患者在性别、年龄、BMI、合并糖尿病病史和高血压病史、eGFR、血脂和血糖水平、碘海醇用量上均无显著性差异。血清肌酐水平在造影前碳酸氢钠组高于生理盐水组[（110．5±27．4）μmol／LVS（102．5±13．3）μmol／L,P=0．043]。两组患者共发生造影剂肾病8例（7．62％）,其中碳酸氢钠组1例（1.82％）,生理盐水组7例（14％）,两组造影剂肾病的发生率具有显著性差异（P=0．026）。结论与0．9％氯化钠注射液比较,围造影期应用1．5％碳酸氢钠静脉滴注能进一步降低已有肾功能损害患者造影剂肾病的发生,有效地保护肾脏功能。     

大剂量静脉补液对造影剂肾损害的保护作用观察

目的：了解大剂量静脉补液对血管造影患者肾功能的保护作用。方法：随机观察了48例应用泛影葡胺进行静脉肾盂造影和肾血管造影的患者，其中19例在造影前后均给予大剂量静脉补液，另外29例为对照。于造影前及造影后第1、6天分别监测血肌酐（Scr)、内生肌酐清除率（Ccr)、血渗透压、尿渗透压、24h尿蛋白定量、尿常规。结果：在应用大剂量补液治疗的一组中，各观察指标造影前、后比较差异无显著性（P＞0．05），仅尿常规指标有加重者2例，均于造影后第6天恢复造影前水平。对照组于造影后第1天尿蛋白定量增加，Scr上升（P＜0．05），Ccr下降（P＜0．05），第6天复查基本恢复造影前水平，但有1例未能恢复。结论：大剂量静脉补液不但安全、易行，且可大大减少造影剂所造成的肾损害。     

水化联合腺苷受体抑制剂对造影剂肾病的预防作用

目的探讨介入检查和治疗过程中水化联合腺苷受体抑制剂对造影剂肾病的预防作用。方法选择我院2010年10月-2013年10月于导管室行冠状动脉造影（CAG）和／或经皮冠状动脉介入治疗（PCI）患者共258例,随机分为水化联合腺苷受体抑制剂研究组和水化治疗对照组,其中研究组102例,对照组156例。术前查血清肌酐水平,并依据Cockcroft—Gault公式计算血清肌酐清除率;术后检测所有患者第二天、第三天血清肌酐水平,计算血清肌酐清除率。结果研究组与对照组在应用造影剂前后血清肌酐水平、血清肌酐清除率的变化程度不同,与研究组相比,对照组血清肌酐水平升高的程度、血清肌酐清除率下降的程度更明显（P〈0．05）。研究组造影剂肾病的发生率为4．9％,对照组造影剂肾病的发生率为11．5％,差异有统计学意义（P〈0．05）。结论本研究通过比较研究组和对照组术前和术后血清肌酐水平、血清肌酐清除率的变化,二组造影剂肾病的发生率等资料,表明在充分水化的基础上联合腺苷受体抑制剂能够降低造影剂肾病的发生率,对造影剂肾病的发生有一定的预防保护作用。     

胱抑素C在评价2型糖尿病患者肾功能中的应用价值

[目的]探究血清胱抑素C（Cysc）在评价2型糖尿病（T2DM）患者肾功能中的应用价值。[方法]选取T2DM患者95例,依据尿蛋白分为无蛋白尿组（A组）40例,微量白蛋白尿组（B组）34例,临床蛋白尿组（C组）21例,使用免疫比浊法测定患者的空腹血肌酐（SCr）与血清CysC水平并计算肌酐清除率（CCr）。[结果]B、C组患者血清SCr、CysC水平均高于A组,CCr水平低于A组（P〈0．05）,CCr随蛋白尿程度加重而下降。B、c组患者血清SCr、CysC水平与CCr呈负相关（P〈0．01）,且B组患者中,CysC与CCr的相关性更强（P〈0．01）。[结论]血清CysC可以作为评价糖尿病肾病患者肾功能的指标,尤其适用于早期糖尿病肾病患者。     

非离子型与离子型造影剂不良反应的对比研究及预防

目的探讨非离子型与离子型造影剂的不良反应，为有效预防造影剂不良反应提供科学依据。方法选取介入中心1258例接受非离子型造影剂的患者为实验组，746例接受离子型造影剂的患者为对照组，观察不良反应发生率，并分别在造影前后检测患者肾功能，数据用Z检验和t检验。结果实验纽不良反应发生率为2．3％，对照组为4．6％，高于非离子型造影剂组（P〈0．05）。两组患者造影前BUN、SCr无明显差异（P〉0．05）；造影后2d实验组患者的BUN、SCr低于对照组（P〈0．05），CrCl高于对照组（P〈0．05）；造影后7d两组患者的BUN、SCr、CrCl均无明显差异（P〉0．05）。结论非离子型造影剂不良反应发生率低于离子型造影剂，且对肾脏损伤较小，可以广泛应用于临床，并为控制其不良反应及肾毒性采取了有效措施。     

肾康保护腹膜透析患者残余肾功能的临床研究

目的探讨肾康注射液对尿毒症腹膜透析患者残余肾功能的保护作用。方法选择尿毒症腹膜透析患者40例,随机分为对照组20例和治疗组20例,2组均进行持续不卧床腹膜透析（CAPD）。治疗组分别于第1、4月开始予肾康注射液60ml,静脉滴注1次／d,连续14d,分别于治疗前后测定患者的肌酐清除率（GFR）作为残余肾功能（RRF）评价疗效。结果治疗组治疗前后肌酐清除率无明显下降（P〉0．05）,而对照组治疗前后肌酐清除率下降明显（P〈0．05）,对照组与治疗组治疗后相比肾脏肌酐清除率明显下降（P〈0．05）。结论。肾康注射液对尿毒症腹膜透析患者的残余肾功能有保护作用。     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.