糖耐量减低老年患者hs-CRP、HCY水平与动脉硬化的关系

目的:探讨糖耐量减低(IGT)老年患者超敏C-反应蛋白(hs-CRP)、同型半胱氨酸(HCY)水平与动脉硬化(AS)的关系。方法:选取64例老年IGT患者,进行多普勒超声诊断仪检测颈动脉内膜中层厚度(IMT)及斑块形成情况,并与28例正常对照组相比较,测定hs-CRP、HCY水平。结果:与正常对照组相比,单纯IGT组hs-CRP、HCY有所升高,差异有统计学意义(P<0.05);IGT合并AS组hs-CRP、HCY显著升高,差异有统计学意义(P<0.01);与单纯IGT组相比,IGT合并AS组hs-CRP、HCY有所升高,差异有统计学意义(P<0.05)。结论:老年糖尿病前期的糖耐量减低增加了动脉硬化的风险,hs-CRP、HCY水平可预测IGT患者发生了大血管病变。     

阿卡波糖对糖耐量减低患者干预治疗的效果观察

目的:探讨阿卡波糖用于糖耐量减低(IGT)患者的干预效果.方法:45例IGT患者随机分为阿卡波糖治疗组(24例)和对照组(21例),对照组患者进行糖尿病健康教育并根据个体情况制定饮食及运动方案,治疗组患者在对照组治疗方案的基础上给予阿卡波糖.比较对照组与治疗组治疗前和治疗18个月后的空腹血糖(FPG)、餐后2h血糖(2hPG)、体重指数(BMI)、总胆固醇(TC)、甘油三酯(TG)以及两组患者血糖的转归情况.结果:治疗组治疗后的FPG、2hPG、BMI、TC和TG均明显低于治疗前,差异具有统计学意义(P ＜0.01,P＜0.05).治疗组IGT发展为2型糖尿病的发生率虽然低于对照组,但差异无统计学意义(P＞0.05);治疗组IGT转为血糖正常的百分率明显高于对照组,差异具有统计学意义(P＜0.05).结论:阿卡波糖用于干预糖耐量减低的效果可靠.     

糖耐量减低者血清抵抗素水平的变化及二甲双胍对其水平的影响

目的探讨糖耐量减低(IGT)患者血清抵抗素(Res)水平的变化及二甲双胍干预对糖耐量减低患者Res水平的影响。方法分别测定156例糖耐量减低患者(IGT组)和150例糖耐量正常者(CG组)的空腹Res水平,并进行组间比较,二甲双胍干预IGT组3个月后,进行干预前后自身比较,分析二甲双胍对Res的影响。结果 IGT组Res水平显著高于CG组(P<0.05);IGT组经二甲双胍干预后,Res水平较干预前有所下降(P<0.05)。结论 IGT患者Res水平高于CG者,二甲双胍治疗可以降低IGT者的Res水平,改善胰岛素抵抗。     

系统健康教育对糖耐量减低者转归的影响

目的:探讨系统健康教育对糖耐量减低(IGT)者转归的影响;方法:采用单盲对照法,将就诊于门诊及在社区开展糖尿病健康教育筛查出的86例IGT者分为系统接受健康教育(健康教育组)和未能系统接受健康教育(对照组)。检测每组入组时以及随访2年时空腹血糖、口服葡萄糖耐量试验2 h 血糖、糖化血红蛋白等指标;统计糖耐量正常转化率和糖尿病转化率,并进行自身前后比较和组间比较。结果:干预随访2年后健康教育组空腹血糖和口服葡萄糖耐量试验 2 h 血糖指标均明显低于对照组(P<0.01)。健康教育组糖耐量正常转化率显著高于对照组(P<0.01),而糖尿病转化率低于对照组(P<0.05)。结论:健康教育可以增加IGT者糖耐量正常转化率,降低糖尿病转化率。     

依那普利联合二甲双胍治疗高血压伴糖耐量减低患者的疗效观察

目的:观察依那普利联合二甲双胍治疗原发性高血压(EH)伴糖耐量减低(IGT)患者糖代谢、胰岛素敏感性、脂代谢、体重指数和血压的影响。方法:64例EH伴IGT患者分组进行依那普利降压治疗(对照组)和依那普利降压加二甲双胍治疗(治疗组),均治疗24周,比较两组患者治疗前后糖代谢、胰岛素敏感性、脂代谢、体重指数和血压的变化。结果:治疗组患者IGT、胰岛素敏感性明显改善,与对照组比较,差异有统计学意义(P<0.05):血脂水平、体重指数较对照组也有所下降,但两组比较差异无统计学意义(P>0.05);两组服药后收缩压及舒张压均下降,但治疗组收缩压降压幅度较对照组大,比较差异有统计学意义(P<0.05)。结论:依那普利与二甲双胍联合治疗能较好地用于EH伴IGT患者的干预治疗,有利于提高降压疗效。     

糖耐量减低患者内皮依赖性舒张功能和血浆一氧化氮及内皮素的变换

目的观察糖耐量减低(IGT)对血管内皮功能的影响.方法选择32例糖耐量减低患者,测定血一氧化氮、内皮素的水平,并应用高分辨力超声测量右肱动脉在静息时(基础内径)、反应性充血(流量介导血管舒张)和舌下含服硝酸甘油时(含服硝酸甘油介导血管舒张)舒张末期内径.取34例查体健康者作为对照组.结果糖耐量减低组血一氧化氮水平明显低于对照组(P＜0.001),内皮素水平显著高于对照组(P＜0.001),肱动脉流量介导血管舒张程度较对照组明显降低(P＜0.001),而两组间硝酸甘油介导血管舒张程度和基础内径与对照组相比差异无显著性(P＞0.05).结论 IGT患者内皮依赖性舒张功能及NO水平显著降低,ET水平显著升高,提示糖耐量减低患者存在着明显的血管内皮依赖性舒张功能障碍及内皮功能受损.     

男性糖耐量减低患者性激素受体测定的意义

目的:探讨糖耐量减低(IGT)患者雌激素受体(ER)和雄激素受体(AR)的改变及意义。方法:选择男性IGT患者30例,年龄35-65岁,均经OGTT确诊,选择30例健康者和30例糖尿病(DM)患者作对照。白细胞ER、AR检测采用放射配体结合法。结果:性激素水平三组间无明显差异,白细胞ER水平IGT组和DM组均明显低于健康对照组(P<0.01),IGT组和DM组     

糖耐量减低患者C反应蛋白水平与病情的关系

目的：检测糖耐量减低（IGT）患者C反应蛋白（CRP）水平变化,探讨其与病情的关系。方法：葡萄糖耐量试验筛查出IGT患者86例和糖耐量正常的体检健康者55例,测定2组血浆C反应蛋白水平。结果：糖耐量减低组血浆C反应蛋白升高,与糖耐量正常组比较,差异有统计学意义（P〈0．01）。结论：在糖耐量减低阶段已存在血管内皮功能紊乱及轻度炎症病变。     

二甲双胍干预糖耐量减低

目的探讨二甲双胍干预对糖耐量减低（IGT）患者的疗效。方法按照1999年WHO与国际糖尿病联盟（IDF）糖尿病专家委员会对IGT的诊断标准将86例诊断为IGT的患者双盲随机分为治疗组和对照组，治疗组进行二甲双胍和生活方式干预，对照组单纯生活方式干预。结果治疗组在治疗前后体重、血压、血脂、空腹血糖、OGTT2h试验表明差异有显著性，与对照组的差异也有显著性。结论二甲双胍干预糖耐量减低有助于恢复糖耐量异常，降低糖尿病的发病危险性。     

老年原发性高血压患者踝肱指数脉压指数与认知功能的关系

目的:探讨老年原发性高血压患者踝肱指数、脉压指数与认知功能的关系。方法:通过对610例老年原发性高血压患者进行踝肱指数(ankle-brachial index,ABI)检测,分为ABI减低组(观察组)(ABI≤0.9,n=220)和ABI正常组(1.3>ABI>0.9,n=390)(对照组)。两组均以《简明智能状态检查表》(mini-mental state examination,MMSE)进行认知功能检测,比较两组间MMSE评分的差异并分析两组脉压指数(pulse pressure index,PPI)差异。结果:ABI减低组MMSE评分明显低于ABI正常组(23.4±1.8比28.1±1.4,P<0.05)。其中两组计算力、即时记忆力、延迟回忆力评分差异有统计学意义(P<0.05),定向力、语言表达能力差异无统计学意义(P>0.05);观察组PPI明显高于对照组(P<0.05)。结论:老年原发性高血压患者ABI降低、PPI升高是引起认知功能障碍的重要因素,筛查ABI及PPI对早期发现认知功能障碍并进行干预具有重要临床意义。     

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.