慢性心衰患者CA125与N-末端脑钠素原及心功能相关性研究

目的:探讨慢性心衰患者血清肿瘤抗原糖类抗原125(CA125)与N-末端脑钠素原(WT--ProBNP)及心功能相关性。方法:选择慢性心衰患者108例,根据NYHA心功能分级标准进行分级,分别检测CA19-9、CA125、NT-ProBNP、E/E’及左心射血分数(LVEF)并检测LVEF及E/E’。结果:III级患者CA125、NT-ProBNP较II级患者均出现显著性升高(P<0.05),IV级患者较II、III级患者均出现显著性升高(P<0.05)。III级患者LVEF、E/E’较II级患者均出现显著性差异(P<0.05),IV级患者LVEF较II级患者均出现显著性升高(P<0.05),E/E'较II、III级患者均出现显著性升高(P<0.05)。CA125与NT-ProBNP、E/E'显著正相关(P<0.05),与LVEF显著负相关(P<0.05)。结论:CA125与心功能相关指标密切相关,对其水平检测有助于明确慢性心衰的进展。     

跨理论模型对慢性心衰患者康复训练的临床效果分析

目的 探讨跨理论模型对慢性心衰患者康复训练的临床效果.方法 选择慢性心衰患者112例,心功能Ⅱ级57例,心功能Ⅲ级55例,采用跨理论模型对慢性心衰患者康复训练后分别检测心功能、METS、6min步行实验及生活质量评分及血管内皮功能.结果 Ⅱ级及Ⅲ级患者治疗后较治疗前LVEF均出现升高(P＜0.05),E/E'较治疗前均出现下降(P＜0.05).Ⅱ级及Ⅲ级患者治疗后较治疗前METS、6 min步行实验均出现升高(P＜0.05),生活质量评分较治疗前均出现下降(P＜0.05).Ⅱ级及Ⅲ级患者治疗后较治疗前AngⅡ、ET、vWF均出现下降(P＜0.05).结论 采用跨理论模型对慢性心衰患者康复训练可显著改善改善患者心功能及血管内皮功能,并提高运动耐量和生活质量.     

TGF-β1、CTGF对慢性心衰心肌纤维化进展的临床意义

目的 探讨TGF-β 1、结缔组织生长因子(connectivetissue growthfactor,CTGF)对慢性心衰心肌纤维化进展的临床意义.方法 选择慢性心衰患者108例,根据NYHA心功能分级标准进行分级后分别检测TGF-β 1、CTGF、ALD、PI NP、PⅢNP.结果 Ⅲ级患者TGF-β1、CTGF、ALD水平较Ⅱ级患者均出现显著升高,差异有统计学意义(P＜0.05),Ⅳ级患者较Ⅱ、Ⅲ级患者TGF-β1、CTGF均出现显著性升高,差异有统计学意义(P＜0.05),ALD较Ⅲ级患者出现显著升高,差异有统计学意义(P＜0.05).Ⅲ级患者PI NP、PⅢNP及PI NP/PⅢNP较Ⅱ级患者均出现显著性变化,差异有统计学意义(P＜0.05),Ⅳ级患者PI NP、PⅢNP及PI NP/PⅢNP较较Ⅱ、Ⅲ级患者均出现显著升高,差异有统计学意义(P＜0.05).TGF-p1与PI NP、PI NP/PⅢNP正相关(P＜0.05),CTGF与PI NP、PⅢNP、PI NP/PⅢNP正相关(P＜0.05).结论 TGF-β1、CTGF与心肌纤维化指标密切相关,对其水平检测有助于明确慢性心衰的进展.     

心肌重构水平监测在慢性心衰患者病情评估中的临床意义

目的：探讨MMP-9、TIMP-1检测对评估慢性心衰发生及发展的意义．方法观察组为慢性心衰患者127例,对照组选自社区健康人群40例研究对象,分别检测血MMP-9、TIMP-1并进行超声心动图检查明确LVEF及E/E＇．结果观察组患者MMP-9显著高于对照组（＜0.01）, TIMP-1较对照组有显著性下降（＜0.05）,MMP-9/TIMP-1较对照组存在显著性升高（＜0.05）．观察组LVEF、E/E＇较对照组差异具有显著统计学意义（＜0.05）．观察组心功能III级MMP-9、MMP-9/TIMP-1较心功能II级者出现显著性升高（＜0.05）, TIMP-1较心功能 II级者出现极显著性下降（＜0.05）．LVEF、E/E＇较心功能 II级者有显著性升高（＜0.05）．心功能IV级患者MMP-9、TIMP-1、MMP-9/TIMP-1均较心功能II、III级患者显著差异（＜0.05）, LVEF、E/E＇较心功能 II 级者有显著性升高（＜0.05）,但较 III 级患者并无显著性差异（＞0.05）． MMP-9＋TIMP-1＋MMP-9/TIMP-1较MMP-9、TIMP-1、MMP-9/TIMP-1单一指标具有更高的灵敏度及特异度,而LVEF＋E/E＇联合诊断价值较IL-18＋NT-ProBNP为差．结论 MMP-9、TIMP-1及其比值测定有助于慢性心衰早期发现与诊断,并有助于判断病情进展．     

新生儿吸入性肺炎合并心肌损害相关检测指标分析

目的 分析不同检测指标对新生儿吸入性肺炎并心肌损害病情监测的临床意义.方法 选择新生儿吸入性肺炎并心肌损害患儿69例,采用ROSS心功能分级标准分为无心衰组、轻度心衰组、中度心衰组、重度心衰组.分别检查4组患儿的N-末端脑纳素原（NT-ProBNP）、酸激酶同工酶（CK-MB）、肌钙蛋白（cTnI）、高敏C反应蛋白（hs-CRP）及左心射血分数（LVEF）、早期血流速度与舒张早期心肌运动速度比值（E/E）.结果 轻度心衰组LVEF、E/E＇、NT-ProBNP较无心衰组升高（P＜0.05）.中度心衰组患儿CK-MB、NT-ProBNP、E/E较无心衰组、轻度心衰组差异有统计学意义（P＜0.05）.重度心衰组患儿cTnI、CK-MB、E/E＇较无心衰组、轻度心衰组差异有统计学意义（P＜0.05）,NT-ProBNP较其他3组差异有统计学意义（P＜0.05）.结论 新生儿吸入性肺炎患儿NT-ProBNP水平可有效反映心功能变化,对于判断心衰进展具有重要意义.     

增强型体外反搏治疗慢性心衰的临床疗效观察

目的探讨增强型体外反搏治疗慢性心衰的临床疗效.方法选择慢性心衰患者106例,随机分为对照组及观察组,分别有53例.对照组采用常规治疗,观察组在此基础上加用增强型体外反搏治疗,分别检测血EDF、CTGF、Np、Hcy及超声心动图.结果对照组及观察组患者EDF、CTGF水平治疗后较治疗前均出现显著性降低(P＜0.05),观察组患者治疗后EDF、CTGF较对照组患者均出现显著性下降(P＜0.05).观察组患者Np、Hcy水平治疗后较治疗前均出现显著性降低(P＜0.05),对照组患者Hcy水平治疗后较治疗前均出现显著性降低(P＜0.05),观察组患者治疗后Np、Hcy较对照组患者均出现显著性下降(P＜0.05).对照组及观察组患者LVEF、E/Et水平治疗后较治疗前均出现显著性差异(P＜0.05),观察组患者治疗后E/E较对照组患者均出现显著性下降(P＜0.05).结论增强体外反搏治疗慢性心衰,可通过改善EDF、CTGF、Np、Hcy水平起到改善心功能状态的作用.     

IGF-2及IGFBP-2与脑神经胶质瘤侵袭能力的相关性分析

目的 探讨IGF-2及IGFBP-2与反映脑神经胶质瘤侵袭能力的MMP-2、TIMP-2相关性.方法 选择到咸阳市中心医院神经外科就诊的86例胶质细胞瘤患者,Ⅰ级30例,Ⅱ级患者25例,Ⅲ级患者20例,Ⅳ级患者11例,对各级患者血清IGF-2、IGFBP-2、MMP-2、TIMP-2进行检测.结果 Ⅱ级患者IGF-2、IGFBP-2较Ⅰ级出现升高,差异有统计学意义(P＜0.05),Ⅲ级患者IGF-2、IGFBP-2较Ⅰ级、Ⅱ级均出现升高,差异有统计学意义(P＜0.05),Ⅳ级患者IGF-2、IGFBP-2较Ⅰ级、Ⅱ级、Ⅲ级均出现升高,差异有统计学意义(P＜0.05).Ⅱ级患者MMP-2/TIMP-2较Ⅰ级呈升高,差异有统计学意义(P＜0.05),Ⅲ级患者MMP-2及TIMP-2较Ⅰ级均差异有统计学意义(P＜0.05),MMP-2/TIMP-2较Ⅰ级、Ⅱ级患者均出现升高,差异有统计学意义(P＜0.05),Ⅳ级患者MMP-2及TIMP-2及MMP-2/TIMP-2较Ⅰ级、Ⅱ级、Ⅲ级均,差异有统计学意义(P＜0.05).IGF-2与TIMP-2、MMP-2/TIMP-2相关 (P＜0.05),IGFBP-2与TIMP-2、MMP-2/TIMP-2相关(P＜0.05).结论 随着神经胶质瘤分级的进展,IGF-2及IGFBP-2水平与脑神经胶质瘤侵袭能力密切相关,是反映神经胶质瘤侵袭能力的重要因子.     

Correlation Between Uric Acid and Hemoglobin in Elderly Patients With Parkinson′s Disease

目的 探讨老年帕金森病(PD)患者血尿酸水平与性别、年龄、病情分级、血红蛋白之间的关系.方法 分别采用尿酸氧化酶传感器检测法、氰化高铁血红蛋白比色法测定100例老年PD患者和100例健康对照者血清尿酸浓度、血红蛋白浓度,比较两组的差异.结果 PD组血清尿酸浓度低于健康对照组(P＜0.05);PD组血红蛋白浓度与健康对照组比较,差异无统计学意义(P＞0.05);PD不同分期组血清尿酸浓度均低于健康对照组(P＜0.05),PD Ⅰ级尿酸浓度＞Ⅱ级＞Ⅲ级＞Ⅳ级＞Ⅴ级;PD组不同年龄段组间血清尿酸浓度差异均无统计学意义(P＞0.05);男性组与女性组尿酸、血红蛋白浓度差异均无统计学意义(P＞0.05).PD组血尿酸与血红蛋白无相关性(P＞0.05).结论 老年帕金森病患者血清尿酸水平降低,但其尿酸水平与性别、年龄无关联,血红蛋白浓度与尿酸无相关性.     

慢性心力衰竭患者血尿酸和血清胆红素异常的临床意义

目的 探讨慢性心力衰竭（CHF）患者血尿酸（UA）和血清胆红素异常的变化及其临床意义。方法选择72例CHF患者为研究组,按心功能分级分为2组：心功能Ⅲ-Ⅳ级组41例;心功能Ⅱ级组31例。另外选取30例心功能正常者作为对照组。所有病例入院当天或第2天测定其血尿酸和血清胆红素水平,其中心功能Ⅲ-Ⅳ级患者治疗1周后复查血尿酸和血清胆红素。结果与心功能正常对照组及心功能Ⅱ级患者比较,心功能Ⅲ-Ⅳ级患者血尿酸及血清胆红素水平明显升高（P〈0．01）;治疗一周,心衰有效纠正后,复查血尿酸和血清胆红素水平明显下降（P〈0．01）。心功能Ⅱ级患者血尿酸和血清胆红素水平与对照组比较差异无统计学意义。结论对慢性心衰患者观测血尿酸和血清胆红素水平有助于判断心衰严重程度及其治疗效果。     

血尿酸对判断慢性心衰治疗效果的意义

目的 观察慢性心衰急性失代偿期患者血尿酸水平与心功能的关系.方法 (1)检测58例心功能Ⅲ～Ⅳ级(NYHA分级)患者血尿酸浓度,与60例急性心衰患者血尿酸浓度进行比较.(2)对不同病因(分别为冠心病、扩张性心肌病、高血压心脏病、风湿性心脏病组)的心功能Ⅲ～Ⅳ级患者的血尿酸浓度进行比较.(3)对58例慢性心力衰竭患者急性失代偿期治疗前后血尿酸程度进行比较.结果 (1)急性心功能不全组(对照组)血尿酸浓度(176±22) μmol/L,心功能Ⅲ～Ⅳ级组(观察组)血尿酸浓度(485±62) μmol/l,对照组与观察组间比较差异有统计学意义(P＜0.05).(2)心功能Ⅲ～Ⅳ级不同病因组间血尿酸浓度差异无统计学意义(P＞0.05).(3)对照组治疗前血尿酸浓度(176±22) μmol/L,治疗后(168±35) μmol/L,差异无统计学意义(P＞0.05),观察组治疗前后分别为(485±62) μmol/L、(299±47) μmol/L,治疗前后差异有统计学意义(P＜0.05).(4)心衰患者血尿酸水平变化与性别无关.结论 慢性心衰急性失代偿期血尿酸浓度高,心功能改善后血尿酸浓度明显下降,动态检测血尿酸浓度这一生化指标对判断慢性心衰的治疗效果是有意义的.     

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.