病毒性心肌炎患儿室性早搏负荷量与心率变异性的关系

目的探讨病毒性心肌炎患儿室性早搏负荷量与心率变异性(HRV)的关系。方法选取2017年3月至2018年10月郑州大学第一附属医院收治的140例病毒性心肌炎合并室性早搏患儿,纳入观察组。选取同期于该院体检的46名健康儿童纳入对照组。根据室性早搏负荷量将观察组患儿分为低负荷组(77例)、中负荷组(40例)与高负荷组(23例)。比较观察组和对照组HRV相关指标,包括全部正常窦性RR间期标准差(SDNN)、每5 min的正常窦性RR间期的标准差(SDANN)、全部相邻RR间期差值的均方根(RMSSD)、相邻RR间期差值大于50 ms的百分数(PNN50)、低频功率(LF)、高频功率(HF)和LF/HF。比较不同负荷组HRV相关指标的差异。分析病毒性心肌炎患儿室性早搏负荷量与HRV的相关性。结果观察组患儿SDNN、SDANN、RMSSD、PNN50、HF、LF、LF/HF值均低于对照组,差异有统计学意义(均P<0.05)。中负荷组SDNN、SDANN、PNN50、LF值均低于低负荷组,差异有统计学意义(均P<0.05)。高负荷组SDNN、SDANN、RMSSD、PNN50、HF、LF、LF/HF值均低于低负荷组,差异有统计学意义(均P<0.05)。高负荷组SDANN、PNN50值均低于中负荷组,差异有统计学意义(均P<0.05)。病毒性心肌炎患儿室性早搏负荷量与SDNN、SDANN、RMSSD、PNN50、HF、LF、LF/HF均呈负相关(均P<0.05)。结论病毒性心肌炎合并室性早搏患儿的自主神经系统调节受损,自主神经系统调节受损程度随室性早搏负荷量的增加而加重。     

海洛因依赖者心率变异性研究

目的 探讨海洛因依赖者心率变异性(HRV)的特点.方法 测定海洛因依赖者HRV的时域、频域指标,并与正常对照组进行比较.结果 海洛因依赖者较正常对照者心率(HR)、低频功率(LF)和低频功率与高频功率(HF)之比(LF/HF)显著增高,24 h R-R间期标准差(SDNN)、24h每5minR-R间期平均值的标准差(SDANN)、HF显著降低,24h相邻R-R间期差值的均方根(RMSSD)降低,差异均有统计学意义(均P<0.05).海洛因依赖者前后两次HRV检测结果差异无统计学意义(P>0.05).初吸者较正常对照者SDNN、SDANN、HF显著降低,极度低频率(VLF)降低;复吸者较正常对照者SDNN、SDANN、HF显著降低,RMSSD降低;复吸者较初吸者LF和VLF升高.高吸组较正常对照组SDNN、SDANN、HF显著降低,LF/HF显著升高;高吸组较低吸组LF/HF升高;低吸组较正常对照组SDNN、SDANN显著降低,低吸组较正常对照组LF/HF显著升高,LF升高,上述指标差异均有统计学意义(P<0.05或<0.01).结论 海洛因依赖者HRV降低并且指标具有可重复性,迷走神经张力降低,交感神经张力增高,尤其高吸者和复吸者其HRV改变更明显.HRV测定可以更真实地及早发现海洛因依赖者中的高危人群,便于及时处置,也能为HRV更广泛地应用于临床提供依据.     

300例高龄冠心病患者心率变异性分析

目的探讨高龄(≥70岁)冠心病患者心率变异性(HRV)的变化。方法对高龄冠心病组(300例)与正常对照组(198例)的电信号进行研究,观察比较时域指标:连续24 h内正常RR间期的标准差(SDNN)、全程记录中每5分钟正常RR间期平均值的标准差(SDANN)、相邻正常RR间期差值的均方根(RMSSD)、相邻RR间期差值>50 ms百分比(PNN50);频域指标:总功率(TP)、低频功率(LF)、高频功率(HF)。结果冠心病组HRV的SDNN、SDANN、RMSSD、PNN50、HF显著低于正常对照组(P<0.01),TP、LF比较差异无统计学意义(P>0.05)。结论高龄冠心病患者存在自主神经功能紊乱,迷走神经活性降低,交感神经活动相对增强。     

心率变异性与心力衰竭患者房性心律失常的相关性研究

目的探讨心率变异性(HRV)与心力衰竭(HF)患者房性心律失常的关系。方法选取2013年10月至2016年9月舞钢公司总医院收治的84例HF患者作为观察组,并根据是否合并房性心律失常分为观察A组(合并心律失常,n=41)与观察B组(未合并心律失常,n=43),另选取同期处于心功能代偿期41例心血管疾病患者作为对照组。均于入院后进行24 h动态心电图监测,对比各组HRV相关指标水平变化情况,包括全部窦性心搏RR间期的标准差(SDNN)、相邻RR间期差值的均方根(RMSSD)、相邻NN之差>50 ms的个数占总窦性心搏个数的百分比(PNN50)、RR间期平均值标准差(SDANN)、高频功率(HF)、低频功率(LF)水平。结果观察A组、观察B组SDNN、RMSSD、PNN50、SDANN等HRV相关指标均低于对照组,差异有统计学意义(P<0.05),且观察A组各HRV相关指标低于观察B组,差异有统计学意义(P<0.05)。结论 HF合并心律失常患者HRV通常低于未合并心律失常者,提示HRV与HF心律失常的发生密切相关。     

扩张型心肌病患者心率变异时域指标变化与心血管事件发生的相关性

目的 :探讨扩张型心肌病患者HRV变化与心血管事件发生的相关性。方法 :采用 2 4h动态心电图对 99例扩张型心肌病患者进行心率变异 (HRV)分析 ,回顾性分析本院 1997年 8月至 2 0 0 2年 8月进行动态心电图检查的 99例扩张型心肌病患者之病历资料 ,分析全部患者 2 4h动态心电图检查结果 ,记录HRV的时域分析指标 :正常RR间期的标准差 (SDNN) ;5min平均RR间期的标准差 (SDANN) ;相邻RR间期相差≥ 5 0ms占总窦性心搏的百分数 (PNN5 0 )。结果 :DCM的HRV时域分析指标SDNN、SDANN、PNN5 0显著低于对照组P <0 .0 5。以HRV的时域指标SDNN低于 6 0ms、PNN5 0低于 4 .0和心功能指标LVEF <30 %为联合预测心血管事件发生的敏感性为 78% ,特异性为 71% ,阳性预测值为 70 %。结论 :扩张型心肌病患者HRV减低增加了心血管事件的发生率 ,对预测心血管事件的发生有一定的临床价值。     

参松养心胶囊对急性心肌梗死患者心率变异性的影响

目的探讨参松养心胶囊对急性心肌梗死患者心率变异性(HRV)的影响。方法将107例AMI治疗患者随机分为两组:参松养心胶囊加常规AMI治疗组(治疗组)58例,常规AMI对照组49例。治疗前进行HRV测定,两组间比较各指标均无显著性差异(P均>0.05),治疗1个疗程(28 d)后再次进行HRV测定。结果①治疗组:治疗后,正常R-R间期标准差(SDNN)2、4 h去Holter 5 min平均正常RR间期标准差(SDANN)2、4 h去Holter 5 min平均正常RR间期标准差的平均数(SDNNIDX)2、4 h去Holter正常相邻RR间期之差>50 ms的心搏数所占百分比(PNN50)、低频成分(LF)、高频成分(HF)、总功率谱(TP)较治疗前均显著升高(P均<0.01),LF/HF显著降低(P<0.01);②对照组:治疗后,SDANN、PNN50、LF、HF、TP较治疗前均显著升高(P均<0.05),LF/HF显著降低(P<0.05);③治疗后参松养心胶囊组与对照组比较SDANN、RMSSD、PNN50、LF、MF、HF、TP均显著升高(P均<0.05),LF/HF显著降低(P<0.05)。结论①常规AMI治疗(静脉溶栓、硝酸酯类及抗凝治疗),提高AMI患者的HRV;②参松养心胶囊加常规AMI治疗,对改善AMI患者HRV更显著,且能改善自主神经平衡性,改善预后。     

难治性心绞痛的心率变异性表达及其预后研究

目的 分析难治性心绞痛（refractory angina pectoris,RFA）患者心率变异性（heart rate variability,HRV）变化特点,探讨HRV对患者预后的预测价值。方法 选取难治性心绞痛患者60例,并以同期非难治性心绞痛患者60例作为对照组,分析两组间HRV指标,包括全部窦性心搏RR间期标准差（SDNN）、24h每5minRR间期均值标准差（SDANN）、相邻RR间期差值的均方根（rMSSD）、相邻RR间期差值>50ms的心搏数占全部心搏数的百分比（PNN50）、极低频功率（very low frequency power,VLF）、低频功率（low frequency power,LF）和高频功率（high frequency power,HF）、低频与高频功率比值（LF/HF）,通过二元Logistic回归分析校正难治性心绞痛的危险因素。记录两组患者出院后1年内主要不良心血管事件（major adverse cardiac events, MACE）发生情况,根据是否发生MACE将难治性心绞痛组分为MACE和非MACE两个亚组,分析并比较两亚...     

伊伐布雷定对急性失代偿性收缩性心力衰竭患者24小时心率、24小时心率变异性的影响

目的 探讨伊伐布雷定(IVB)对急性失代偿性收缩性心力衰竭(ADSHF)患者24小时心率(24 h HR)、24小时心率变异性(24 h HRV)的影响.方法 选择2015年7月至2016年7月在该院住院的ADSHF患者60例,分为试验组(30例)及对照组(30例).两组均予以常规的急性心力衰竭的治疗,试验组加用口服IVB治疗.在入院时和IVB治疗7d后,两组均予以24h动态心电图监测,测定两组的24 h HR、24 h HRV时域指标[所有正常RR间期标准差(SDNN)、5 min平均RR间期的标准差(SDANN)、与相邻正常RR间期之间的差的平方的值的平方根(RMSSN)、连续正常RR间期超过50毫秒的百分比(PNN50)]和频域指标[低频(LF)、高频(HF)、LF/HF],并比较两组的差异.结果 治疗后,试验组的24 h HR较治疗前明显下降(P＜0.05),但对照组只有轻微下降(P＞0.05);试验组24 h HRV时域指标(SDNN、SDANN、RMSSN、PNN50)和频域指标(LF、HF)均较入院时明显上升(P＜0.05),对照组只有轻微上升(P＞0.05);试验组和对照组的LF/HF比值变化幅度有明显差异(-0.57vs.0.15,P＜0.05).结论 IVB可以明显且持续地减少ADSHF患者的24 h HR,增加24 h HRV,改善自主神经平衡.     

2型糖尿病患者同型半胱氨酸水平与心率变异的相关性

[目的]探讨2型糖尿病患者同型半胱氨酸(Hcy)水平与心率变异(HRV)之间的关系.[方法]采用酶联免疫吸附实验,对112例糖尿病患者测定Hcy水平,根据Hcy水平分为正常组、轻度升高组、中度升高组3组.对3组患者分别采用24 h动态心率变异性(HRV)频谱分析技术测定HRV,并与Hcy作相关分析.[结果](1)轻度升高组与中度升高组的正常RR间期的标准差(SDNN)、5 min平均心率的标准差(SDANN)、爱丁堡指数(PNN50)、相邻R-R间期之差的均方根值(RMMSD)均低于正常组(P＜ 0.05～0.01),并且随着Hcy水平的升高,轻度与中度升高组中HRV时域指标有进一步下降.(2) Hcy升高组中高频(HF)显著低于Hcy正常组(P＜0.01),Hcy升高组中低频(LF)较Hcy正常组明显减低(P＜ 0.01),交感-迷走神经平衡指标(LF/HF)在Hcy升高组较正常组升高(P＜0.05).(3)2型糖尿病Hcy升高者HRV指数较正常组有所下降,Hcy与HRV呈负相关.[结论]2型糖尿病合并高Hcy血症患者心率变异中的时域分析和频域分析的各项指标参数均减低,并出现自主神经的损害,心脏自主神经活动的昼夜节律改变丧失.Hcy是自主神经病变的危险相关因素,对早期发现自主神经病变有益.     

化疗对淋巴瘤患者心电活动的影响及危险因素分析

目的 分析化疗对淋巴瘤患者心率变异性(HRV)时域指标及心脏电生理活动的影响。方法 选取2020年9月至2021年12月在该院确诊为初治淋巴瘤并接受化疗的76例患者作为淋巴瘤组,另选取年龄、性别匹配的76例健康者作为对照组。观察化疗前后两组HRV时域指标,包括正常窦性RR间期的总体标准差(SDNN)、每5分钟窦性RR间期均值标准差(SDANN)、正常连续窦性RR间期差值均方根(rMSSD)、相邻RR间期差值>50 ms百分比(pNN50),淋巴瘤组化疗前后心肌缺血、房室传导阻滞、窦性心动过缓、快速性心律失常等心血管不良事件发生情况并进行比较分析。观察淋巴瘤患者化疗前后性别、体重指数、24 h平均心率、淋巴瘤疾病分期、危险度分层、国际预后指数(IPI)、美国东部肿瘤合作组表现状态(ECOG-PS)评分及Ki67增殖指数等指标,采用单因素及多因素logistic回归模型分析HRV降低的影响因素。结果 化疗前淋巴瘤组SDNN、SDANN、pNN50均明显低于对照组(P<0.05),化疗后淋巴瘤组SDNN、SDANN、rMSSD、pNN50均较化疗前明显降低(P<0.05);...     

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.