妊娠期糖尿病患者脐血瘦素/母血瘦素水平及新生儿出生体重的关系

目的 探讨妊娠期糖尿病(gestational diabetes mellitus,GDM )患者母血瘦素、脐血瘦素水平及其与新生儿体重的关系.方法 采用酶联免疫法测定40例GDM患者(GDM组)与40例正常孕妇(对照组)血清、脐静脉血清瘦素、胰岛素水平,同时测身高、体重计算体重指数,记录新生儿出生体重.结果 GDM组患者母血瘦素及胰岛素水平均高于对照组(P<0.01,P<0.05);并且GDM组母血瘦素与其胰岛素呈正相关(r=0.57,P<0.01).GDM 患者和对照组母血瘦素水平明显高于脐血瘦素,但两者无相关关系;GDM组患者脐血瘦素、胰岛素水平明显高于对照组(P<0.01,P<0.05);GDM组脐血瘦素与胰岛素水平、新生儿出生体重呈正相关(r＝0.39,P<0.05;r＝0.49,P<0.01).本研究未发现孕妇血瘦素与新生儿出生体重有相关关系.结论 妊娠期糖尿病母儿同时存在高瘦素血症和高胰岛素血症,高瘦素状态与其发病有重要关系.     

妊娠期糖尿病母婴血清瘦素和胰岛素水平的关系

目的探讨妊娠期糖尿病(GDM)母婴瘦素水平与胰岛素的关系。方法采用放射免疫法测定GDM孕妇33例,正常孕妇30例的血清及新生儿脐血瘦素水平及胰岛素,分析瘦素及胰岛素水平关系。结果GDM组母血胰岛素、母血瘦素、脐血胰岛素、脐血瘦素水平均高于对照组(P<0.05);GDM组母血瘦素与母血胰岛素呈正相关(r=0.452;P=0.023),脐血瘦素与胰岛素水平呈正相关(r=0.387,P=0.031)。结论妊娠期糖尿病母儿同时存在高瘦素血症和高胰岛素血症,妊娠期糖尿病胎儿高胰岛素血症可以导致胎儿体内瘦素的增加。     

子痫前期病人瘦素、胰岛素水平测定及其与胎儿生长发育的关系

目的 了解子痫前期病人及其新生儿瘦素、胰岛素水平,探讨瘦素、胰岛素在子痫前期发病中的意义及其与胎儿宫内生长发育的关系.方法 采用放射免疫分析法,对30例子痫前期病人(其中轻度、重度各15例)及30例正常孕妇的血清瘦素、胰岛素水平进行测定,同时测定其新生儿脐血瘦素、胰岛素水平.结果 子痫前期病人及新生儿脐血血清瘦素及胰岛素水平明显高于对照组(F=9.048～67.360,q=2.595～16.061,P＜0.05、0.01);重度子痫前期病人血清瘦素与胰岛素水平呈正相关(r=0.661,P＜0.01);重度子痫前期病人新生儿体质量明显低于正常对照组,差异有统计学意义(F=23.705,q=2.434～5.998,P＜0.01);各组新生儿瘦素水平与体质量呈正相关(r=0.423～0.757,P＜0.05、0.01).结论 子痫前期病人血清瘦素及胰岛素水平有随病情加重逐渐增高的趋势,两者共同参与子痫前期的发病.脐血瘦素水平可以反映胎儿宫内发育情况.     

2型糖尿病大鼠Ghrelin表达及与胃排空关系

目的 探讨2型糖尿病大鼠血清及胃组织Ghrelin表达变化与胃排空的关系.方法 将大鼠随机分为糖尿病组、单纯肥胖组和对照组,通过高糖高脂饮食结合小剂量链脲佐菌素(STZ)的方法建立2型糖尿病大鼠动物模型.饲养8周后糖尿病组注射STZ后,检测并计算各组大鼠体质量、空腹血糖、胰岛素、胰岛素抵抗指数、胃排空、血清Ghrelin及胃组织Ghrelin mRNA表达.结果 糖尿病组和单纯肥胖组大鼠饲养8周后,体质量和胰岛素水平较对照组明显升高(F=63.90、16.72,q=12.76～14.51,P<0.01),血糖与对照组比较差异无显著性(P>0.05).注射STZ后,糖尿病组大鼠血糖水平升高,与对照组比较差异有显著性(F=129.00,q=20.50,P<0.05),而胰岛素水平与对照组差异无显著性(P>0.05).糖尿病组和单纯肥胖组大鼠液体胃排空低于对照组(F=123.00,q=19.49、18.52,P<0.05),血清Ghrelin、胃组织Ghrelin mRNA表达均明显下降(F=35.01、34.69,q=8.73～11.16,P<0.05).结论 2型糖尿病大鼠血清Ghrelin水平、胃组织Ghrelin mRNA表达的下降可能与糖尿病胃排空障碍有关.     

血清钙与妊娠糖尿病胰岛素抵抗相关性的研究

目的:探讨血清钙水平与妊娠糖尿病(GDM)患者胰岛素抵抗的相关性。方法:选取100例GDM患者作为观察组,选取100例健康孕妇作为对照组,对所有研究对象的血清钙水平、糖化血红蛋白(HbA1c)水平、胰岛素抵抗指数(HOMA-IR)进行观察和比较。结果:观察组患者的HOMA-IR均高于对照组,随着HbA1c水平的上升,患者的HOMA-IR出现了显著上升,当HbA1c水平>10%时,患者的血清钙水平出现了显著下降,差异均有统计学意义(q=3.205~3.747,P<0.05);多元线性回归分析结果显示,GDM患者的HOMA-IR与血清钙水平(标化回归系数=-0.513,P<0.05)呈负相关关系,与HbA1c水平呈正相关关系(标化回归系数=0.322,P<0.05)。结论:随着GDM病情的进展,患者表现为血清钙水平的下降和胰岛素抵抗程度的上升,两者具有良好的相关性,血清钙水平可作为反映GDM患者胰岛素抵抗程度的辅助指标。     

胎儿生长受限与瘦素、胰岛素样生长因了-Ⅰ水平的相关性

目的研究胎儿生长受限(FGR)与瘦素、胰岛素样生长因子-Ⅰ(IGF-Ⅰ)的关系,探讨脐血瘦素、IGF-Ⅰ的临床检测价值.方法采用放射免疫法检测40例正常孕妇(对照组)和24例FGR孕妇(FGR组)的血清与脐血(脐A和脐V)中瘦素和IGF-Ⅰ水平,并对其结果进行相关性分析.结果(1)FGR组血清瘦素及IGF-Ⅰ水平与对照组比较,差异无显著性(P＞0.05);(2)FGR组脐血瘦素和IGF-Ⅰ水平均明显低于对照组(P＜0.01,P＜0.05).(3)两组孕妇血清瘦素和IGF-Ⅰ水平与脐血瘦素和IGF-Ⅰ水平无相关性(r=0.129,r=-0.059,均P＞0.05);脐血瘦素水平与新生儿出生体重呈正相关关系(r=0.600,P<0.05),与胎盘重量亦呈正相关关系(r=0.44,P<0.05);脐血IGF-Ⅰ水平与新生儿出生体重呈正相关关系(r=0.469,P<0.05),与胎盘重量无相关关系(r=0.30,P>0.05).(4)脐A瘦素和IGF-Ⅰ水平与相应脐V瘦素和IGF-Ⅰ水平差异无显著性(P>0.05).(5)脐血瘦素与IGF-Ⅰ水平无相关关系(r=0.397,P>0.05).结论脐血瘦素和IGF-Ⅰ水平与胎儿生长发育状态密切相关;脐血瘦素或IGF-Ⅰ水平降低可能是FGR发生的原因之一;瘦素调控胎儿生长发育没有IGF-Ⅰ的直接参与;脐A与脐V血瘦素及IGF-Ⅰ水平均可作为评价胎儿生长发育的临床指标.     

血清脂肪细胞因子与妊娠期糖尿病关系的研究

探讨妊娠期糖尿病(gestational diabetes mellitus, GDM)孕妇血清脂肪细胞因子即脂连素、TNF α、瘦素与妊娠 期糖尿病发生发展的关系。方法：测定50例GDM孕妇和36例正常孕妇（NGT）血清脂连素、瘦素与TNF α浓度及相关参数浓度。采用放射免疫法 测定脂连素、瘦素及C肽浓度，ELISA法检测血清TNF α浓度，电化学发光法检测胰岛素浓度，采用低压液相色谱分析法和葡萄糖氧化酶法分别 检测糖化血红蛋白和血糖。结果: ① GDM孕妇血清TNF α［（4.6±1.5）pg/ml］水平明显高于NGT［（3.3±1.6）pg/ml］，且GDM组TNF α 与胰岛素、血糖、C肽、HbA1c浓度呈正相关关系；② GDM孕妇血清脂连素浓度［（10.3±2.4）μg/ml］明显低于NGT孕妇［（15.6±3.2） μg/ml］, GDM组脂连素浓度与胰岛素、血糖、C肽、HbA1c浓度呈负相关关系；③GDM孕妇血清瘦素水平［（15.3±3.8）ng/ml］ 明显高于NGT ［（ 10.3±2.1）ng/ml］，GDM组血清瘦素浓度与胰岛素、血糖、C肽、HbA1c浓度呈正相关关系。结论：血清脂肪细胞因子直接或间接地参与 妊娠期糖尿病发生发展，是代谢综合征的重要预测因子。     

子痫前期病人瘦素、胰岛素水平测定及其与胎儿生长发育的关系

目的了解子痫前期病人及其新生儿瘦素、胰岛素水平,探讨瘦素、胰岛素在子痫前期发病中的意义及其与胎儿宫内生长发育的关系。方法采用放射免疫分析法,对30例子痫前期病人（其中轻度、重度各15例）及30例正常孕妇的血清瘦素、胰岛素水平进行测定,同时测定其新生儿脐血瘦素、胰岛素水平。结果子痫前期病人及新生儿脐血血清瘦素及胰岛素水平明显高于对照组（F=9.048-67.360,q=2.595-16.061,P〈0.05、0.01）;重度子痫前期病人血清瘦素与胰岛素水平呈正相关（r=0.661,P〈0.01）;重度子痫前期病人新生儿体质量明显低于正常对照组,差异有统计学意义（F=23.705,q=2.434-5.998,P〈0.01）;各组新生儿瘦素水平与体质量呈正相关（r=0.423-0.757,P〈0.05、0.01）。结论子痫前期病人血清瘦素及胰岛素水平有随病情加重逐渐增高的趋势,两者共同参与子痫前期的发病。脐血瘦素水平可以反映胎儿宫内发育情况。     

妊娠期糖尿病孕妇血清TNF-α水平与胰岛素抵抗的关系

目的探讨妊娠期糖尿病(GDM)孕妇血清肿瘤坏死因子-α(TNF-α)水平与胰岛素抵抗的关系。方法选择GDM孕妇39例(GDM组)、同期正常妊娠孕妇38例(正常妊娠组),采用酶联免疫吸附试验测定空腹血清TNF-α水平;同时测定2组孕妇空腹血糖、胰岛素、糖化血红蛋白(HbA1c)水平,并且根据公式计算2组孕妇的胰岛素敏感指数(ISI)。结果(1)GDM组空腹血清TNF-α、血糖、胰岛素、ISI、HbA1c水平分别为(5.3±0.9)ng/L、(6.1±0.7)mmol/L、(13.1±3.2)mU/L、-4.3±0.4、(5.7±0.4)%,正常妊娠组孕分别为(4.4±0.7)ng/L、(4.8±0.6)mmol/L、(9.1±2.6)mU/L、-3.8±0.4、(5.4±0.5)%,2组比较差异有统计学意义(P<0.01或P<0.05);(2)GDM组孕妇空腹血清TNF-α水平与ISI呈负相关(r=-0.388,P<0.01),与空腹血糖、HbA1c呈正相关(r=0.524,P<0.01;r=0.426,P<0.01),与胰岛素无相关性。正常妊娠组孕妇TNF-α水平与ISI呈负相关(r=-0.336,P<0.05),但相关性显著小于GDM组,与胰岛素、血糖及HbA1c无相关性。结论GDM组孕妇空腹血清TNF-α水平明显升高,且与ISI呈显著负相关,提示TNF-α参与了GDM孕妇的胰岛素抵抗。     

IGF-Ⅰ及胰岛素与妊娠期糖尿病的关系

目的研究胰岛素样生长因子-Ⅰ(IGF-Ⅰ)、胰岛素与妊娠期糖尿病(GDM)的相关性。方法以30例GDM为GDM组,30名正常孕妇为对照组。两组孕妇于妊娠第31±1周,采用放射免疫法测母体血清胰岛素,酶联免疫吸附法测母体血清IGF_Ⅰ和足月分娩时的脐血清IGF_Ⅰ。结果GDM组与对照组相比,母血IGF_Ⅰ差异无统计学意义(P>0.05),LnIRI、脐血IGF_Ⅰ、新生儿体重均有显著性差异(P<0.01)。GDM组的母血IGF_Ⅰ和LnIRI成正相关(r=0.424,P<0.05),脐血IGF_Ⅰ和新生儿体重成正相关(r=0.434,P<0.05)。结论GDM存在严重的胰岛素抵抗(IR)。母血IGF_Ⅰ与GDM的IR存在相关性,脐血IGF_Ⅰ参与了GDM巨大儿的病理生理过程。IGF_Ⅰ可能是通过IR这条途径,使生长激素_胰岛素_胰岛素样生长因子轴失常,导致GDM的形成。     

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.