氯沙坦降压疗效及对尿酸和蛋白尿的影响

目的探讨高血压治疗中氯沙坦对血压、蛋白尿和尿酸的影响.方法观察30例高血压患者服用氯沙坦(50mg/d)治疗8周后血压、尿蛋白、血尿酸及肌酐的变化. 结果氯沙坦治疗8周后,血压明显下降,从161.66±17.52/97.42±6.70mmHg降至137.33±14.81/87.30±8.53mmHg(1mmHg=0.133kPa,P＜0.001);尿酸从457.76±108.77μmol/L降至405.91±90.11μmol/L(P＜0.001);蛋白尿从2210.26±1969.8mg/24h降至1895±2447.97mg/24h(P＜0.001);血肌酐变化不显著(P＞0.05).结论氯沙坦对高血压患者具有良好的降压作用,同时兼有降尿酸、降尿蛋白的作用.     

伊贝沙坦治疗老年人原发性高血压的疗效及对肾功能的影响

目的评估伊贝沙坦对老年高血压患者降压的效果及对肾功能的影响.方法选择36例病人,确诊原发性高血压,开始剂量为150mg/日,若经2周治疗后,舒张压仍超过90mmHg,则剂量加倍,疗程共8周,观察治疗前后血压及肾功能指标并进行比较.结果①8周治疗后血压均明显降低,收缩压从平均(165.5±13.7)mmHg降至(144.6±11.1)mmHg,舒张压从平均(101.3±7.1)mmHg降至(87.1±6.8)mmHg(P＜0.05).②患者尿β2-微球蛋白(β2-MG)从治疗前平均(0.312±0.072)mg/L降至(0.236±0.067)mg/L(P＜0.05);血β2-MG从治疗前平均(2.92±0.53)mg/L降至(2.41±0.48)mg/L;24小时尿蛋白定量从平均(0.32±0.05)g/L降至(0.20±0.02)g/L(P＜0.05);36例病人治疗前后血脂、血糖、肝功能检查无明显变化.结论伊贝沙坦有较好的抗高血压疗效,降压同时减少微量蛋白尿,保护肾功能,对血脂、血糖、尿酸以及肝功能无不良影响.     

血管紧张素Ⅱ受体拮抗剂治疗IgA肾病患者的临床疗效探讨

目的:观察IgA肾病(IgAN)患者予血管紧张素Ⅱ受体拮抗剂氯沙坦治疗后是否能改善选择性蛋白尿指数(SI)以及 SI的变化是否伴随尿蛋白排泄和肾功能的改变.方法:32例肾活检证实为原发性IgAN患者,随机分为两组,各16例.入选标准为蛋白尿≥1 g/d,伴或不伴肾损害.对照组中9例伴高血压,11例伴肾损害.治疗组11例伴高血压,12例伴肾损害.血压控制在收缩压＜150 mmHg(1 mmHg=0.133 kPa),舒张压＜90 mmHg.所有患者给予低盐饮食,对照组高血压给予β受体阻滞剂,肼苯哒嗪,甲基多巴,治疗组予氯沙坦50～100 mg/d,每月查一次血肌酐、总尿蛋白(TUP)、SI、尿蛋白电泳、尿β2微球蛋白、尿溶菌酶、尿NAG酶. 结果:平均治疗(10±3)个月后,对照组血肌酐(μmol/L)从159±70.7上升至203.3±97.1,蛋白尿(g/d)从2.1±1.1上升至2.9±1.8,治疗前后比较均有显著性差异(P<0.05);治疗组血肌酐从(159±44.2)下降到(123.8±53) μmol/L,治疗前后比较有显著性差异(P<0.05),治疗后36%的患者显示蛋白尿降低,蛋白尿从(2.4±1.1)下降到(0.7±0.5) g/d(P<0.001),SI从0.27±0.07下降到0.18±0.07(P<0.001),治疗组蛋白尿明显低于对照组(P<0.001),治疗组尿β2微球蛋白、尿溶菌酶、尿NAG酶均明显低于对照组(P<0.01),治疗组治疗后SI比对照组(0.3±0.11)更有改善(P<0.01),16例中有9例肾损害者与对照组比较显著改善(P<0.05),3例肾功能恢复正常,其他4例患者无治疗反应. 结论:氯沙坦对伴随肾损害和非选择性蛋白尿的IgAN患者可以降低其蛋白尿,改变蛋白尿选择性和改善肾功能.     

非洛地平与培哚普利对高血压病患者肾功能的影响

目的探讨非洛地平和培哚普利治疗对高血压病患者肾功能的影响。方法高血压病患者60例随机分为两组,非洛地平组与培哚普利组各30例,疗程24周,治疗前后观察肾功能指标变化。结果两组治疗后均能显著降低血压(P＜0.01)及尿蛋白的排泄量,两组24小时尿白蛋白分别从104.2±34.5mg/24h、103.2±41.8mg/24h降至69.8±28.4mg/24h、66.8±28.3mg/24h,P均＜0.01;24小时尿蛋白量从0.26±0.059g/L、0.26±0.061g/L降至0.18±0.032g/L、0.18±0.042g/L,P均＜0.01。两组之间无显著性差异(P＞0.05)。结论非洛地平、培哚普利长期治疗均能显著降低血压,可减少蛋白尿,保护肾功能。     

2型糖尿病患者血尿酸水平与尿白蛋白/肌酐的关系

目的 研究2型糖尿病患者血尿酸水平与尿白蛋白/肌酐的关系.方法 该院住院540例(男265例,女275例)2型糖尿病者,年龄(60.6±11.5)岁,没有用过利尿剂、降尿酸药物或饮酒史,检测血尿酸及尿白蛋白与肌酐比.根据尿白蛋白与肌酐比值分为正常(＜30.0mg/g)、微量白蛋白(30.0～299.9mg/g)、大量蛋白尿组(＞300.0 mg/g).采用单因素分析血尿酸与尿白蛋白排泄率的相关性;多元回归分析该组2型糖尿病患者血尿酸水平与收缩压、舒张压、尿白蛋白与肌酐比、糖化血红蛋白A1c、血脂的关系.结果 在糖尿病正常蛋白尿组、微量蛋白尿组及大量蛋白尿组对应的血尿酸水平分别为(242±60)μmol/L,(345±84)μmol/L,和(416±108)μmol/L,有统计学差异(P＜0.05);在男性组,异常蛋白尿发生率在低尿酸水平组(＜295μmol/L)及高尿酸水平组(＞295μmol/L)分别为35.9%,63.1%(P＜0.01)在女性组分别为33.5%,66.4%(P＜0.01).在男性组,血尿酸水平与TG、In(ACR)相关,与HDL-C负相关;而在女性组及总体人群血尿酸水平除上述相关关系外,还与CCr呈负相关(P＜0.05).在调整了CCr及年龄、BMI、高血压病史、吸烟、SBP、DBP、HbA1c、TG、TC、HDL-C和LDL-C等混杂因素后In(ACR)的标化系数为0.214(P＜0.05),血尿酸水平每增加1mg/dl则异常蛋白尿的相对危险度为1.256(P＜0.05).结论 该研究提示血尿酸水平与2型糖尿病患者尿白蛋白/肌酐相关.     

增大剂量的贝那普利治疗慢性肾脏病轻中度蛋白尿

目的观察增大剂量的贝那普利对于慢性肾脏病患者轻中度蛋白尿(1~3.5g/24h)的有效性和安全性。方法采用前瞻性、自身对照试验,为期24周。48例纳入研究对象的患者中,贝那普利的剂量每8周在原有基础上增加1倍。治疗过程中检测血常规、尿常规、24h尿蛋白定量、Scr、血电解质和肝功能,并记录血压及不良反应情况。结果患者24h蛋白尿定量试验前为2.32±0.96g,8周、16周、24周时均有明显下(P<0.01)。16例(33.3%)完全缓解,18例(37.5%)部分缓解。试验前血压基线水平为(138.4±4.6/88.6±3.9)mmHg;8周时降至(130.6±7.2/80.3±6.8)mmHg(P<0.01);16周血压为(120.3±6.8/73.4±8.5)mmHg(P<0.01);24周时血压为(112.9±9.8/65.2±8.6)mmHg。结论贝那普利可显著减少慢性肾脏病患者的蛋白尿,并呈剂量依赖性。使用20mg/d的贝那普利是较为安全的、当剂量≥40mg/d时,应注意低血压的发生。     

氯沙坦减轻幼龄肾损伤大鼠蛋白尿的作用

目的　观察血管紧张素Ⅱ受体 1拮抗剂氯沙坦减轻幼龄肾损伤大鼠蛋白尿的作用。方法　对SD幼龄大鼠 (1个月龄 ,体重 10 0 g左右 )行单侧肾切除加阿霉素注射建立动物模型 ,术后治疗组即给予氯沙坦 5mg/kg·d-1灌胃 ,共12周 ,观察大鼠蛋白尿的变化。结果　于治疗的第 9、12周 ,尿蛋白 (mg/d)氯沙坦组与同期模型组相比分别为 :2 4 2±2 12vs 17 4 8± 9 77、4 6 3± 4 15vs 15 18± 4 71(P值均<0 0 1)。结论　在单侧肾切除后 1周注射阿霉素的幼龄肾损伤大鼠动物模型中 ,氯沙坦显示了较好的降尿蛋白作用     

氯沙坦对老年原发性高血压患者血尿酸水平的影响

目的观察氯沙坦对老年原发性高血压患者血尿酸水平的影响.方法老年原发性高血压患者60例,随机分为二组观察组30例口服氯沙坦 50mg/d,对照组30例口服安氯地平5mg/d,均连续服药12周.结果观察组服氯沙坦治疗前、后血尿酸水平分别为(446.3±6.2)mmol/L和(410.5±7.1)mmol/L,服药后血尿酸水平较服药前明显下降(P<0.01);对照组服安氯地平治疗前、后血尿酸分别为(440.5±5.5) mmol/L和(436.8±6.8) mmol/L,无明显变化(P>0.05);观察组服氯沙坦治疗前、后血压水平分别为(164/110±7/8) mmHg 和(132/84±7/6) mmHg ,对照组服安氯地平治疗前、后血压水平分别为(167/112 ±10/7) mmHg和(128/80±5/7) mmHg,二组患者服药后血压水平较服药前均明显下降(P<0.01);二组患者服药后血压水平无明显差异性(P>0.05).结论氯沙坦能降低老年原发性高血压患者血尿酸水平.     

厄贝沙坦联合氨氯地平治疗早期糖尿病肾病合并高血压38例效果观察

目的：探究厄贝沙坦联合氨氯地平治疗早期糖尿病肾病合并高血压的效果。方法：选择早期糖尿病肾病合并高血压患者114例,随机分为3组,每组38例。在常规降糖药物治疗的基础上,A组加用厄贝沙坦,B组加用氨氯地平,C组加用厄贝沙坦和氨氯地平,治疗10周,分别于治疗前后检测3组患者的血压和尿液相关指标。结果：C组总有效率92.11%,高于A组的73.68%和B组的78.95%,差异有统计学意义（P＜0.05）。治疗后C组收缩压125.47±8.93mmHg,低于A组133.54±9.76mmHg、B组135.19±9.58mmHg,差异均有统计学意义（P＜0.05）。治疗后C组舒张压77.58±9.26mmHg,低于A组85.47±10.12mmHg、B组87.25±9.37mmHg,差异均有统计学意义（P＜0.05）。治疗后C组24h尿白蛋白47.27±17.36 mg/24h,低于A组81.85±16.45 mg/24h、B组63.57±16.68 mg/24h,治疗后C组24h尿蛋白定量0.10±0.03 g/L,低于A组0.25±0.02 g/L、B组0.19±0.03 g/L,治疗后C组0.05±0.02 mg/L,低于A组0.10±0.02 mg/L、B组0.09±0.01 mg/L,差异均有统计学意义（P＜0.05）。结论：两者联合用药后可显著降低患者血压,减少尿蛋白排泄,对肾脏起到一定的保护作用,值得临床推广。     

缬沙坦的降压效果及对血尿酸、尿蛋白的影响

目的探讨缬沙坦对高血压患者的降压效果及降尿酸、减轻蛋白尿的作用.方法 93例高血压合并高尿酸血症患者随机分为缬沙坦组(n=47)和氨氯地平组(n＝46).缬沙坦组给于缬沙坦(代文)80 mg/d,氨氯地平组给予氨氯地平(络活喜)5 mg/d治疗,同时观察两组血压、血尿酸、24 h尿白蛋白排泄率的变化.2周后血压控制无效者予加倍剂量服用,用药4、8、12周继续观察上述指标.结果①缬沙坦降压平稳有效,与氨氯地平组比较无显著差异(P＞0.05);加倍剂量服用降压效果更显著.②缬沙坦组血尿酸下降,24 h尿尿酸排泄增加,24 h尿蛋白排出减少,与氨氯地平组比较有显著差异(P＜0.05).结论缬沙坦能同时降压和降尿酸,减少尿蛋白,有很好的肾脏保护作用.     

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.     

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.