多囊卵巢综合征患者胰岛素抵抗及瘦素抵抗的研究

目的：探讨多囊卵巢综合征（PCOS）患者体内胰岛素抵抗和瘦素抵抗的情况,进一步研究胰岛素、瘦素、肥胖与PCOS的关系。方法：临床收集30例正常对照者（正常对照组）、30例单纯性肥胖患者（单纯性肥胖组）和41例PCOS患者（PCOS组）的血清标本,分别测定其体质指数（BMI）、瘦素（Leptin）、空腹血糖（FBG）、空腹胰岛素（FINS）、三酰甘油、总胆固醇、高密度脂蛋白和低密度脂蛋白的水平,计算胰岛素抵抗指数（HOMA-IR）。结果：①与正常对照组比较,PCOS组BMI、血清瘦素、FINS、HOMA-IR及低密度脂蛋白水平均显著性升高,高密度脂蛋白水平显著性下降（P〈0.05）;与单纯性肥胖组相比,PCOS组仅FINS水平显著性升高,BMI显著性降低（P〈0.05）。②PCOS组瘦素水平与BMI、FINS、HOMA-IR及三酰甘油水平有关。③正常对照组与PCOS非肥胖组的FINS和HOMA-IR差异无显著性意义（P〉0.05）,而PCOS肥胖组FINS和HOMA-IR均明显高于单纯性肥胖组（P〈0.05）;正常对照组与PCOS非肥胖组、单纯性肥胖组与PCOS肥胖组瘦素水平的差异均无显著性意义（P〉0.05）。结论：多囊卵巢综合征患者胰岛素水平和瘦素水平明显升高,可能存在胰岛素抵抗和瘦素抵抗;PCOS患者瘦素抵抗与胰岛素抵抗之间可能有相互调节的作用;PCOS患者出现胰岛素抵抗不仅是肥胖的后果,还可能与PCOS有直接的关系;PCOS患者瘦素水平的升高可能是肥胖的伴随表现。     

多囊卵巢综合症患者雄激素水平变化与胰岛素抵抗的相关性研究

目的 探讨多囊卵巢综合症(PCOS)患者雄激素水平变化与胰岛素抵抗的相关性.方法 选取诊治的100例PCOS患者(PCOS组)、同期门诊进行健康体检的50例正常育龄妇女(对照组),将PCOS组患者根据体质量指数(BMI)分为非肥胖组(64例)和肥胖组(36例),检测睾酮(T)、空腹血糖(FBG)、空腹胰岛素(FINS),计算胰岛素敏感指数(ISI)、胰岛素抵抗指数(HOMA-IR).结果 PCOS组患者T、FINS、HOMA-IR均高于对照组,ISI低于对照组,组间比较差异有统计学意义(P<0.05);肥胖组患者FINS、HOMA-IR均高于非肥胖组,ISI低于非肥胖组,组间比较差异有统计学意义(P<0.05);Pearson相关分析显示POCS组患者T与HOMA-IR间有正相关性(P<0.05),与ISI间有负相关性(P<0.05).结论 PCOS患者雄激素明显升高,与胰岛素抵抗间有正相关性,共同参与了PCOS的发生及发展.     

多囊卵巢综合征痰湿证血清脂联素水平与胰岛素抵抗关系的研究

目的:探讨多囊卵巢综合征(PCOS)痰湿证患者血清脂联素(APN)水平与胰岛素抵抗(IR)的关系。方法:对51例PCOS痰湿证患者(PCOS痰湿组)、99例PCOS非痰湿证患者(PCOS非痰湿组)及50例健康妇女(对照组),检测空腹血糖(FBG)、空腹胰岛素(FINS)、APN,计算胰岛素抵抗指数(HOMA-IR),同时测量身高、体质量,计算体质量指数(BMI)。结果:FBG在3组之间无显著性差异(P>0.05);FINS、HOMA-IR及BMI在PCOS痰湿组明显高于其他两组(P<0.05);APN在PCOS痰湿组明显低于其他两组(P<0.05);痰湿证PCOS患者APN水平与BMI及HOMA-IR均呈显著负相关关系(P<0.05)。结论:痰湿证PCOS患者血清APN水平降低与BMI、IR密切相关。     

多囊卵巢综合征患者胰岛素抵抗特征及相关因素研究

目的 探讨多囊卵巢综合征(PCOS)患者胰岛素抵抗(IR)特征及其相关因素.方法 对80例PCOS患者(其中肥胖49例,非肥胖31例)的临床特征及内分泌、糖代谢指标[空腹血糖(FPG)、空腹胰岛素(FINS)等]进行回顾性分析.用稳态模型胰岛素抵抗指数(HOMA-IR)、空腹胰岛素敏感指数(ISI)评估胰岛素敏感性.结果 两组患者睾酮(T)、黄体生成素(LH)、卵泡刺激素(FSH)、LH/FSH比较,差异均无统计学意义(P＞0.05).肥胖PCOS组患者的FPG、FINS水平及HOMA-IR、ISI均显著高于非肥胖PCOS组,差异有统计学意义(P＜0.05).肥胖PCOS组和非肥胖PCOS组患者IR发生率分别为86%(42/49)和52%(16/31),差异有统计学意义(P＜0.05).结论 肥胖PCOS患者较非肥胖PCOS患者存在更严重的IR.     

单纯性肥胖儿童胰岛素抵抗与游离脂肪酸的关系

目的探讨单纯性肥胖儿童血清游离脂肪酸(FFA)与胰岛素抵抗(IR)的相关关系。方法选择50例单纯性肥胖儿童(单纯性肥胖组)和50例正常儿童(对照组),测定各组空腹血清FFA、空腹血糖(FPG)、空腹胰岛素(FINS)和血脂水平,并计算胰岛素抵抗指数(HOMA-IR)值。结果单纯性肥胖组中FFA、HOMA-IR、总胆固醇(TC)和甘油三酯(TG)高于对照组(P<0.05);单纯性肥胖组血清FPG与对照组比较无显著性差异(P>0.05)。在对照组和单纯肥胖组中,血浆FFA与体质量指数(BM I)、FPG、FINS、HOMA-IR、TG和TC呈正相关(P<0.05)。结论单纯性肥胖儿童存在IR,血清FFA与肥胖儿童的BM I、TG、TC及IR密切相关,FFA可能参与了IR的病理生理机制。     

2型糖尿病非糖尿病一级亲属胰岛素抵抗临床研究

目的:观察2型糖尿病(T2DM),非糖尿病一级亲属与无糖尿病家族史的对照之间胰岛素抵抗(IR)程度有无区别,以及IR与体重指数(BMI)、腰臀比、糖代谢、脂代谢等指标间的关系。方法:选取39例T2DM患者、35例T2DM的非糖尿病一级亲属及39例无糖尿病家族史的正常对照,测定其体重指数(BMI)、腰围、臀围及血糖、血脂、空腹胰岛素(FINS),根据公式计算IR指数,HOMA-IR=FINS×FPG/22.5。应用SPSS10.0统计软件分析。结果:①T2DM组甘油三酯(TG)、FINS、HOMA-IR均高于对照组和非糖尿病一级亲属组,P<0.05;一级亲属组胰岛素抵抗程度高于对照组②HOMA-IR与BMI、FBG、TG、FINS、腰围、臀围正相关,P<0.05。③多元线性回归显示,HOMA-IR受FINS水平、FPG、腰围影响。结论:①T2DM和肥胖患者的胰岛素抵抗程度高于正常人。②T2DM的非糖尿病一级亲属的胰岛素抵抗程度较无家族史者更高。③人体内胰岛素抵抗程度与BMI呈负相关。     

PCOS患者AMH水平与肥胖、睾酮水平、胰岛素抵抗的相关性分析

目的比较BMI正常与否多囊卵巢综合征（PCOS）患者抗苗勒管激素（AMH）水平差异,分析AMH水平与患者内分泌及代谢指标的相关性。方法209例PCOS患者按BMI正常与否分为肥胖组（BMI≥25,77例）和正常体重组（BMI＜25,132例）。测定患者血清AMH、卵泡刺激素（FSH）、黄体生成素（LH）、睾酮、空腹血糖和空腹胰岛素、TC、TG和LDL-C水平,计算稳态模型胰岛素抵抗指数（HOMA-IR）,比较两组患者AMH水平差异,并分析AMH水平与各临床指标的相关性。结果肥胖组患者AMH水平低于正常体重组[（8.92±4.70）ng/mlvs（10.99±5.40）ng/ml,P＜0.05],空腹血糖、空腹胰岛素、HORM-IR、TG、LDL-C水平均高于正常体重组（均P＜0.05）,LH、LH/FSH均低于正常体重组（均P＜0.05）。总PCOS组患者AMH水平与患者BMI、空腹胰岛素水平、HOMA-IR呈负相关,与LH、LH/FSH呈正相关,与睾酮不相关。肥胖组患者AMH水平与各临床指标均不相关,正常体重组患者AMH水平与LH/FSH、睾酮水平呈正相关。当控制BMI因素后,总PCOS组患者AMH水平与LH/FSH及睾酮水平呈正相关,与空腹胰岛素水平、HORM-IR不相关。结论肥胖和胰岛素抵抗可能使PCOS患者AMH水平降低;当控制BMI因素后,PCOS患者AMH水平与睾酮水平呈正相关,与胰岛素及HOMA-IR不相关。     

PCOS患者PAF-AH活性及其与糖脂代谢相关性的研究

目的 探讨多囊卵巢综合征(PCOS)患者血小板活化因子乙酰水解酶(PAF-AH)活性及其与糖脂代谢的关系.方法 按照鹿特丹标准筛选PCOS患者87例,同时选取年龄匹配的健康妇女83名作为对照.① 用化学发光法检测血清雌二醇(E2)、总睾酮(TT)、黄体生成素(LH)、促卵泡激素(FSH)、空腹胰岛素(FINS);② 用酶法试剂盒测定空腹血糖(FGLU)、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);③ 用[3H-acelty] PAF示踪三氯醋酸沉淀法检测血浆PAF-AH活性.结果 ① PCOS组体重指数(BMI)、腰臀比(WHR)、F-G评分、血清TT水平、LH/FSH比值高于对照组(P<0.01).② PCOS组血清FINS、胰岛素抵抗指数(HOMA-IR)、TG、TC、LDL-C、非高密度脂蛋白胆固醇(non-HDL-C)和致动脉粥样硬化指数(AI)高于对照组(P<0.01),而HDL-C水平低于对照组(P<0.01).但血浆PAF-AH活性两组间差异无统计学意义(P>0.05).③ 非肥胖PCOS患者(BMI＜25 kg/m2)FINS、HOMA-IR、LDL-C、non-HDL-C、AI高于非肥胖对照妇女(P<0.05).肥胖PCOS患者(BMI≥25 kg/m2)除了更严重的上述代谢异常外,FGLU、TG、TC、BMI、WHR、收缩压(SBP)、舒张压(DBP)也明显升高(P<0.05),HDL-C水平明显降低(P<0.05).然而非肥胖对照、非肥胖PCOS与肥胖PCOS三亚组间血浆PAF-AH活性差异无统计学意义(P>0.05).④ Person相关分析表明:PCOS组血浆PAF-AH活性分别与non-HDL-C、LDL-C、AI、TG、TG、WHR呈正相关,与HDL-C呈负相关(P<0.05).多重线性回归表明:non-HDL-C与SBP是PCOS组血浆PAF-AH活性有意义的预测因子(P<0.05).结论 PCOS组血浆PAF-AH活性与对照组比较无明显改变,血脂特别是胆固醇与血浆PAF-AH活性相关联.肥胖PCOS患者比非肥胖PCOS患者表现出更严重的脂代谢异常与胰岛素抵抗.     

多囊卵巢综合征患者胰岛素抵抗的临床分析

目的探讨多囊卵巢综合征(PCOS)患者胰岛素抵抗(IR)和非胰岛素抵抗(NIR)的临床特征,为PCOS的合理治疗提供依据。方法 92例PCOS患者按稳态模式胰岛素抵抗指数(HOMA-IR)分为胰岛素抵抗组(n=60)和非胰岛素抵抗组(n=32)。测定记录两组患者年龄、体重指数(BMI)、腰围、臀围、腰臀比(WHR)、Ferriman-Gallwey(F-G)评分、痤疮分级;检测两组患者血清内分泌激素、口服糖耐量试验(OGTT)及胰岛素释放实验(IRT);用磁颗粒酶免法检测血清黄体生成素(LH)、促卵泡生成素(FSH)、雌激素(E2)、孕激素(P)、泌乳素(PRL)、睾酮(T);用葡萄糖氧化酶法测空腹血糖和餐后60,120,180 min血糖的含量;用放射免疫方法测定空腹胰岛素和餐后60,120,180 min胰岛素的含量。用SPSS 17.0软件对结果进行统计分析。结果 IR组患者肥胖、腰围、臀围、WHR及BMI均高于NIR组(P<0.05),IR组OGTT各时点血糖值及曲线面积(GAUC)、IRT各时点胰岛素值、胰岛素曲线下面积(IAUC)、HOMA-IR均明显高于NIR组(均P<0.01),而胰岛素敏感性指数(ISI)则明显低于NIR组(P<0.01),IR组的LH/FSH值低于NIR组,而E2高于NIR组。结论 IR可促进PCOS患者肥胖,尤其腹型肥胖的发生,并与PCOS糖代谢紊乱密切相关,早期干预对预防PCOS患者远期并发症具有重要意义。     

原发性高血压与胰岛素抵抗关系的临床研究

目的 :探讨高血压病与胰岛素抵抗之间的关系。方法 :对高血压病患者 67例 ,正常血压者 (对照组 ) 3 1例的空腹血糖 (FBG)、胰岛素 (FINS)以及相关实验室资料进行对比。结果 :高血压组和对照组的年龄、空腹血糖、胆固醇(TC)比较差异无显著性 (P >0 0 5 ) ,甘油三酯 (TG)和体重指数 (BMI)两组比较差异显著 (P <0 0 5 )。空腹胰岛素和胰岛素抵抗 (HOMA IR)两组比较差异极显著 (P <0 0 1)。两组分析显示 :体重指数正常的高血压患者其胰岛素抵抗和对照组比较差异有显著性 (P <0 0 5 )。结论 :原发性高血压病人存在胰岛素抵抗 ,合并脂质代谢紊乱、肥胖等因素时 ,胰岛素抵抗更明显     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.