2型糖尿病患者血尿酸水平与心脑血管病关系探讨

目的探讨血尿酸水平对2型糖尿病患者心脑血管并发症的影响。方法对我院2005年3月至2007年9月2型糖尿病住院患者临床资料进行回顾性分析。结果A组（低血尿酸）血胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）均明显低于B组（高血尿酸）（P〈0．05），高密度脂蛋白胆固醇（HDL-C）明显高于B组，A组血浆比黏度和纤维蛋白原较B组明显降低（P〈0．05）；高血压、冠心病和脑卒中发生率均明显低于B组（P〈0．05）。纤维蛋白原、血浆比黏度、TC、TG、LDL-C、高血压、冠心病和脑卒中与2型糖尿病患者血尿酸水平明显，呈正相关（P〈0．05或〈0．01），HDL-C水平和2型糖尿病患者血尿酸水平呈负相关（P〈0．01）。结论血尿酸水平是影响2型糖尿病患者心脑血管并发症的独立危险因素。     

血脂、血尿酸检测与冠心病的临床应用

[目的]探讨血脂、血尿酸检测与冠心病的发病关系。[方法]比较吉林大学第二医院心血管内科住院并确诊为冠心病的患者500例和正常对照组300例的血脂、血尿酸检测水平。[结果]冠心病组血清胆固醇、甘油三酯、尿酸水平非常显著的高于正常对照组（P〈0．01）,血清甘油三酯与血尿酸呈正相关。[结论]血脂、血尿酸检测水平升高是冠心病的危险因素。     

老年冠心病患者血清胆红素水平的变化

目的：探讨老年人群血清胆红素水平与冠状动咏病变程度的关系。方法：对163例经选择性冠状动脉造影（CAG）明确诊断为冠心病的患者（冠心病组）和 105例经CAG证实无冠状动脉狭窄的患者f对照组）测定血清总胆红素（Bill—T）、直接胆红素（Bili—D）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL—C），并计算间接胆红素（Bili-I）水平。结果：冠心病组血清Bili- T、Bili—I水平及HDL—C明显低于对照组（P〈0．05或P〈0．01），而LDL．C水平在冠心病组明显高于对照组（P〈0．01），但冠脉狭窄范围和程度与胆红素水平无明显关联（P〉0．05）。急性冠脉综合征时胆红素水平显著升高（P〈0．05）。结论：血清胆红素水平降低可能在冠心病发病中具有一定的作用。[著者文摘]     

血清同型半胱氨酸及血脂水平与冠心病的相关性分析

[目的]探讨血清同型半胱氨酸（HCY）和血脂水平的变化与冠心病（CHD）的关系。[方法]经冠状动脉造影确诊的冠心病患者103例和对照组100例,检测两组血清HCY及血脂等生化指标。[结果]冠心病组血清HCY及血脂水平与对照组相比差异有统计学意义（P〈0．05）;相关分析显示血清HCY与TG呈正相关（P〈0．05）。多元Logistic回归分析显示冠心病的发病与高密度脂蛋白胆固醇（HDL—C）呈负相关,与总胆固醇（TC）和总胆固醇／高密度脂蛋白胆固醇比值（TC／HDL—C）呈正相关。[结论]高水平HCY和血脂水平对冠心病的早期诊断和治疗具有重要意义。     

冠心病与糖尿病患者血清甲状腺激素水平的变化

[目的]探讨冠心病、糖尿病与血清甲状腺激素水平的变化的关系及其临床意义。[方法]用化学发光免疫分析法测定临床确诊的32例糖尿病患者，59例冠心病患者，36例正常健康人血清中的甲状腺激素水平。[结果]血清TT3水平在两组病例中均显著低于正常对照组（P〈0．05），冠心病心衰组T13水平显著低于非心衰组（P〈0．05），糖尿病治疗前T13水平显著低于治疗后（P〈0．05），TT4、TSH水平在3组中变化不大（P〉O．05）。[结论]冠心病、糖尿病患者与甲状腺激素密切相关，血清中TT3水平的动态观察可作为判断病情变化和预后评估的指标之一。     

临夏地区各民族血脂水平调查

[目的]分析多民族聚集地区比较特殊的生活、起居、饮食习惯的影响下人群的甘油三脂（TG）、胆固醇（CHOL）和高密度脂蛋白胆固醇（HDL—C）3种血脂水平与全国其它人群有无差别，提供本地区不同民族的3种血脂水平的参考范围，以指导卫生部门和临床医生预防和治疗与高血脂有关的高血压、冠心病等心脑血管疾病。[方法]对临夏州医院2005～2006来做健康体检的不同民族、不同性别，年龄在18～60岁的近300例体检者分别测定了甘油三脂（TG）、胆固醇（CHOL）和高密度脂蛋白胆固醇（HDL—C）。[结果]①临夏地区汉族与回族和东乡族之间：甘油三脂（TG）差别有显著性（P〈0．01）；高密度脂蛋白胆固醇（HDL—C）差异有显著性（P〈0．05）；总胆固醇（CHOL）水平差异无显著性，（P〉0．05）；②回族与东乡族之间：甘油三脂（TG）、高密度脂蛋白胆固醇（HDL—C），胆固醇（CHOL）水平差异无显著性，（P〉0．05），③本地区各民族男女之间甘油三脂（TG）、胆固醇（CHOL）和高密度脂蛋白胆固醇（HDL—C），有显著差别（P〈0．05），④临夏各民族血脂水平与《全国临床检验操作规程》《诊断学》[23提供的普通人群的血脂水平有显著差异性（P〈0．05）。[结论]不同的饮食、生活习惯是导致人群血脂水平不同的主要因素这一。临夏地区应建立本地区的血脂参考范围。     

血清同型半胱氨酸，高敏C-反应蛋白与冠心病的关系

[目的]探讨血清同型半胱氨酸（Hcy）：高敏C-反应蛋白（hs—CRP）水平与冠心病（CHD）的关系。[方法]选自2010年而2月-2010年12月我院心血管内科住院病人46例并与55例正常对照进行分析。[结果]冠心病组与正常对照组比较血清Hcy及h—CRP水平差异显著（P〈0．01）,胆固醇（CHO）,脂蛋白（a）（Lpa）及纤维蛋白原（Fbg）水平差异显著（P〈0．05）。[结论]高血清Hcy是冠心病独立危险因素,监测血清Hcy,血脂及h—CRP水平对冠心病的诊断治疗有重要意义。     

同型半胱氨酸检测与心血管疾病的关系

[目的]研究血清同型半胱氨酸（HCY）水平与心血管疾病的关系。[方法]应用荧光生物化学法测定心脑血管疾病患者和健康体检者空腹血清HCY水平。[结果]心血管疾病患者血清HCY水平明显高于对照组（P〈0．05），冠心病（心血管疾病组）各型之间的血清HCY有差异（P〈0．05），即血清HCY随冠心病的加重而加重。[结论]HCY是心血管疾病的重要危险因素，其水平随着冠心病程度加重而增加。     

冠心病患者血清尿酸和胆红素测定结果分析

[目的]探讨血清尿酸（UA）、胆红素（BIL）与冠心病（CHD）的关系。[方法]选择206例冠心病患者（冠心病组），其他疾病组203例、104例健康体检者（对照组），测定血清尿酸和胆红素浓度并做结果分析。[结果]冠心病组血尿酸水平显著高于对照组（P〈0．01），总胆红素显著低于对照组（P〈0．01），差异有统计学意义。[结论]高水平UA、低血清BIL水平可能是CHD的危险因素之一，通过血清UA、BIL的综合测定，可间接评估患者冠状动脉病变的严重程度。     

慢性高尿酸血症肾病患者高凝状态的研究

[目的]探讨慢性高尿酸血症。肾病患者的高凝状态及临床意义。[方法]高尿酸血症肾病患者组89例,单纯血尿酸增高组50例,对照组50例,采用SYSMEX CA7000型血液凝固仪测定凝血酶原时间（PT）、活化部分凝血活酶时间（APTY）、纤维蛋白原（FIB）、凝血酶时间（TT）、血管性血友病因子（vWF）、抗凝血酶活性（AT：A）、蛋白C活性（PC：A）、D-二聚体（D—Dimer）。[结果]高尿酸血症肾病患者组D—Dimer、vWF水平显著高于对照组（P〈0．01）,AT和PC活性显著低于对照组（P〈0．01）。单纯血尿酸增高组的vWF显著高于对照组（P〈0．01）,但显著低于高尿酸血症肾病患者组（P〈0．01）,其他各项指标与对照组比较,均无显著性差异（P〉0．05）。高尿酸血症肾病患者D—Dimer、vWF、AT：A、PC：A水平与外周血尿酸水平显著相关（P〈0．01）,单纯血尿酸增高组D—Dimer、vWF、AT：A、PC：A水平与外周血尿酸水平不相关（P〉0．05）。[结论]慢性高尿酸血症肾病患者抗凝血、内皮系统出现异常改变,且其水平变化与尿酸水平密切相关。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.