新诊断2型糖尿病患者血脂谱和低密度脂蛋白亚组分特征及与慢性并发症关系

目的　探讨新诊断 2型糖尿病患者血脂谱和低密度脂蛋白 (LDL)亚组分的特征及与慢性并发症的关系。方法　采用横断面研究 ,调查 175例新诊断的 2型糖尿病患者 (糖尿病组 )和 39名无高血压、糖尿病和血脂异常的正常人 (正常对照组 )。分别测定两组的身高、体重、血压、腰围、腰臀比、血糖、血脂 ,并采用 2 %～ 16 %聚丙烯酰胺梯度凝胶电泳 (PAGE)法检测LDL颗粒直径。对糖尿病组患者进行眼底、尿微量白蛋白、尿肌酐和颈动脉、股动脉、髂总动脉内 中膜厚度 (IMT)检查。结果　糖尿病组总胆固醇 (TC)和三酰甘油 (TG)水平均明显高于正常对照组 [TC :(4 .5 9± 0 .80 )mmol/L∶(4 .32± 0 .5 4 )mmol/L ;TG :(1.91± 1.15 )mmol/L∶(0 .89± 0 .2 9)mmol/L ,P值均 <0 .0 5 ];LDL颗粒直径明显小于正常对照组 [(2 6 .5 9± 1.18)nm∶(2 7.4 3± 1.2 4 )nm ,P <0 .0 5 ]。相关和多元逐步回归分析显示 ,TG与LDL颗粒直径成负相关 ,且是LDL颗粒直径的主要影响因素。糖尿病组中 ,伴有大血管病变者的LDL颗粒直径明显小于不伴有大血管病变者。Logistic回归模型分析显示 ,LDL颗粒直径变小是糖尿病患者发生大血管病变的主要危险因素之一。结论　新诊断的 2型糖尿病患者普遍存在血脂紊乱 ,TG升高是LDL颗粒直径变小的主要影     

LDL氧化易感性与体内氧化LDL水平相关性分析

目的 :探讨体内氧化低密度脂蛋白 (Ox LDL)水平与LDL亚组分氧化易感性之间的关系。　方法 :采用序列超速离心分离 2 2例冠心病 (CHD)患者及 2 0例对照组血浆LDL ,体外Cu2 + 介导的LDL氧化分析其氧化易感性的变化 ;ELISA法检测体内Ox LDL水平。　结果 :CHD患者LDL氧化的延滞时间及总氧化值显著升高 ,氧化速率无变化 ;致密LDL氧化的延滞时间及总氧化值亦不同于轻的LDL。CHD患者Ox LDL水平显著升高 (5 39.1± 15 5 .6vs(318.0± 15 9.6 ) μg/L(P <0 .0 1)。Ox LDL水平同致密LDL氧化的延滞时间呈负相关 (r =- 0 .4 8,P <0 .0 5 ) ,同轻的LDL氧化的延滞时间不相关。Ox LDL水平同致密LDL的蛋白质浓度有相关趋势 (r=- 0 .4 2 ,P =0 .0 5 3)。　结论 :高浓度的小而密的B型LDL ,因易于氧化导致体内Ox LDL水平升高 ,促进了动脉粥样硬化 (As)的发生、发展     

氧化低密度脂蛋白与2型糖尿病动脉粥样硬化关系的探讨

目的 :探讨氧化低密度脂蛋白 (OX -LDL)在2型糖尿病 (T2DM )动脉粥样硬化 (AS)发生发展中的作用及其相关性。方法 :对所有研究对象测定胆固醇 (TC)、甘油三酯 (TG)、高密度脂蛋白 (HDL)、低密度脂蛋白 (LDL)等指标 ,采用不连续密度梯度离心及体外LDL氧化修饰法检测T2DM无AS组 (51例 ) ,T2DM有AS组 (27例 )、正常对照组 (30例 )OX -LDL水平。结果 :T2DM有AS组分别与正常对照组、T2DM无AS组比较 ,OX -LDL水平有显著性差别 (P<0.001) ,T2DM无AS组与正常对照组比较OX -LDL水平无显著性差别 (P>0.05) ,T2DM患者OX -LDL与TC、TG、LDL成正相关 ,与HDL成负相关。结论 :DM患者OX -LDL水平可作为早期诊断AS的一个可靠指标 ,DM脂代谢异常是DM发生AS的重要危险因素之一。     

化学修饰低密度脂蛋白与颈动脉粥样硬化相关性的研究

目的观察各类型化学修饰低密度脂蛋白(LDL)与颈动脉粥样硬化(AS)的关系。方法使用复式超声确诊颈AS病人78例,其中伴有糖尿病者30例,不伴糖尿病者48例。氧化修饰低密度脂蛋白(Ox-LDL)测定采用化学法。糖化修饰低密度脂蛋白(Gly-LDL)测定采用微柱亲和层析法。糖氧化修饰低密度脂蛋白(Gly-ox-LDL)测定采用微柱亲和层析加荧光分光光度法。结果血浆Ox-LDL、Gly-LDL和Gly-ox-LDL含量在伴有糖尿病组分别为(1.49±0.48)nmol/ml、(8.66±2.42)%和(0.118±0.083)nmol/ml;在不伴糖尿病组分别为(1.43±0.45)nmol/ml、(6.38±3.03)%和(0.088±0.034)nmol/ml。两病例亚组各修饰型LDL含量与对照组间差异有显著性意义(P均<0.05)。伴有糖尿病组Gly-LDL和Gly-ox-LDL含量与不伴糖尿病组间差异均有显著性意义(P<0.05)。结论化学修饰LDL在颈AS形成中起重要作用,其中Ox-LDL起的作用最重要。     

槲皮素对2型糖尿病患者外周血单个核细胞DNA损伤体外修复的观察

目的观察2型糖尿病(DM)患者氧化/抗氧化状态、外周血单个核细胞(PBMCs)DNA损伤情况及槲皮素的体外修复作用。方法采用单细胞凝胶电泳技术检测39例2型DM合并血管并发症、29例2型DM无并发症患者PBMCsDNA损伤情况(用彗星率表示),与26例健康对照比较。检测受试者血浆总抗氧化能力(TAC)、丙二醛(MDA)及巯基(SH)含量。观察槲皮素对2型DM患者PBMCsDNA损伤的体外修复作用。结果2型DM无并发症组PBMCs彗星率及血浆MDA含量明显高于健康对照组(P均<0.01),血浆SH含量、TAC明显低于健康对照组(P均<0.01);2型DM血管并发症组彗星率及MDA含量高于无并发症组(分别为P<0.01和P<0.05),TAC低于无并发症组(P<0.05)。2型DM无并发症组及血管并发症组患者彗星率与MDA含量呈正相关(r分别为0.446和0.504,P<0.05和P<0.01),与TAC呈负相关(r分别为-0.418和-0.399;P均<0.05)。体外修复显示:10μmol/L槲皮素作用4h显著降低了2型DM患者PBMCs彗星率(P均<0.01)。结论2型DM患者体内存在氧化/抗氧化失衡、DNA氧化损伤,血管并发症组重于无并发症组。氧化应激可能参与了2型DM患者血管并发症的发生发展。     

冠心病患者OX-LDL、Lp(a)及脂质、载脂蛋白的临床分析

目的　观察冠心病 (CHD)患者血浆氧化修饰低密度脂蛋白 (OX LDL)、脂蛋白 (a)〔Lp(a)〕的水平在动脉粥样硬化(AS)的发生发展中所起的作用。方法　采用酶联免疫吸附实验 (ELISA)及双抗体夹心法测定血浆OX LDL和Lp(a)的水平。结果　CHD患者血浆OX LDL、Lp(a)的水平明显高于对照组 (P <0 .0 1) ,且水平的高低与CHD的严重程度呈正相关。结论　OX LDL、Lp(a)与AS的发生发展有密切联系 ,是血脂诊断中特异性强、灵敏度高的检测指标 ,动态检测其变化对CHD的辅助诊断具有一定的价值 ,同时也为CHD患者的抗氧化治疗提供了依据     

糖化低密度脂蛋白与糖尿病合并颈动脉粥样硬化的关系

目的　观察糖化低密度脂蛋白 (Gly -LDL)与糖尿病合并颈动脉粥样硬化 (CAS)的关系。方法通过询问病史、血糖测定和颈动脉复式超声检查确诊 2型糖尿病 (2型DM)合并CAS病人 32例。对照组 30例。采用氨基苯硼酸琼脂糖凝胶亲合层析法测定血浆Gly -LDL含量。结果　 2型DM合并CAS组Gly -LDL水平为(8 89± 2 5 0 ) %。对照组Gly -LDL水平为 (4 0 5± 1 0 8) %。 2型DM合并CAS组Gly -LDL水平显著高于对照组(P <0 0 0 1) ,且氧化修饰低密度脂蛋白 (Ox -LDL)与Gly -LDL含量呈正相关 (P <0 0 0 1) ,颈动脉狭窄率与Gly-LDL含量呈正相关 (P <0 0 0 1)。结论　Gly -LDL水平与 2型DM病人动脉粥样硬化 (AS)形成有密切关系。糖化促进氧化是 2型DM病人发生AS的重要发病机制之一。Gly -LDL水平可反映CAS的程度 ,与AS的发展有关     

2型糖尿病患者血清脂蛋白氧化易感性及高密度脂蛋白抗氧化能力分析

目的 :探讨 2型糖尿病患者血清脂蛋白氧化易感性以及高密度脂蛋白抗低密度脂蛋白氧化能力的变化。　方法 :采用密度梯度超速离心分离 5 3例 2型糖尿病患者血清脂蛋白组分 (VL DL、L DL 和 HDL) ,用 A2 34 nm光吸收鉴定脂蛋白氧化易感性 ,硫代巴比妥酸值 (TBARS )分析脂蛋白脂质过氧化程度 ,同时检测 HDL对 L DL氧化的抑制能力 ,并与正常人 (44例 )进行比较。　结果 :2型糖尿病患者 VL DL 、L DL 氧化延滞时间明显缩短 (VL DL:80 .7± 5 .8vs 2 4.3± 4.85 ;L DL :6 0 .0± 4.0 vs 1 7.4± 3.0 1 ,P<0 .0 0 1 ) ,HDL组分对 L DL氧化的抑制能力明显降低 (P<0 .0 1 )。　结论 :2型糖尿病患者 VL DL、L DL 组分氧化易感性提高以及 HDL 抗氧化能力的下降 ,是 2型糖尿病动脉粥样硬化发生率高的原因之一     

高密度脂蛋白的氧化修饰的特征及对低密度脂蛋白氧化的影响

研究高密度脂蛋白（HDL）氧化修饰后对其结构及对低密度脂蛋白（LDL）氧化的影响。在体外用Cu2+氧化人血浆HDL，观察其蛋白和脂质部分的变化，并测定在HDL存在条件下LDL氧化的硫代巴比妥酸值（TBARS）。结果：氧化HDL（OX－HDL）的TBARS值升高，色氨酸残基（Trp）的特征荧光吸收（λ286，335nm）强度降低且λmax（发射）从335nm升至341nm，紫外吸收（λ234nm）增高，琼脂糖凝胶电泳迁移增快。LDL氧化后的TBARS值为13．40±0．42。在HDL或Ox－HDL（50μg和100μg）共存条件下，LDL氧化的TBARS值分别为6．24±0．71，1．43±0．04和12.75±0.47，12.58±0．23。结论：HDL氧化修饰后其脂质和蛋白部分均经历显著变化，HDL氧化导致其抑制LDL氧化能力的丧失。     

银杏叶提取物对Ⅱ型糖尿病患者血浆氧化修饰低密度脂蛋白的影响

目的 :观察银杏叶提取物 ( GBE)对 型糖尿病 ( DM)患者血浆氧化修饰低密度脂蛋白 ( Ox-L DL)水平的影响。方法 :选择 型 DM及正常对照组各 30例。DM组口服银杏叶治疗 ,用药前后测定 Ox- L DL、丙二醛 ( MDA)、过氧化物歧化酶 ( SOD)、空腹血糖 ( FBS)、空腹血胰岛素 ( INS)、糖化血红蛋白 ( Hb Alc)和血脂 ( CH、TG)。结果 : 型 DM血浆 Ox- LDL、MDA水平明显高于对照组 ,而 SOD活力低于对照组。 型 DM组血浆 Ox- L DL、MDA在用药 4周后较前有明显下降 ( P<0 .0 1) ,同时影响血脂水平 ( P<0 .0 5) ;SOD活力和糖代谢指标在用药前后差异不显著。结论 :Ox-L DL在 型 DM的动脉粥样硬化过程中可能发挥重要作用 ;GBE具有良好抗氧化效果 ,对防治DM的血管病变有积极的意义。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.