老年高血压患者不同左室构型对心功能和颈动脉结构的影响

目的 观察不同左室构型的老年高血压患者心功能和颈动脉结构的变化. 方法 78例老年高血压患者根据超声左室构型分为四组:正常构型组(n=34)、向心性重构组(n=18)、向心性肥厚组(n=11)和离心性肥厚组(n=15).测定与比较各组24 h动态血压、左室功能、颈动脉内径、血流参数和斑块发生率.结果 向心性肥厚组24 h平均收缩压高于正常构型及向心性重构组(P＜0.01).离心性肥厚组左室射血分数低于正常构型组(P＜0.05),Tei指数高于正常构型组(P＜0.05).向心性肥厚和离心性肥厚组颈总动脉内-中膜厚度(IMT)均高于正常构型组(P＜0.05),且向心性肥厚组颈动脉分叉处IMT高于其他三组(P＜0.01).向心性肥厚组斑块检出率(54.55%)较高,但组间比较无显著差异.结论 在老年高血压人群中,不同左室构型左心功能和颈动脉结构变化不同,离心性肥厚者心功能受损最明显,心室肥厚者颈动脉重构发生率较高.     

高血压患者左室不同构型的特点

目的 :观察高血压患者左室不同构型的临床特点。方法 :对 2 2 8例高血压患者进行超声心动图检查 ,6 0例正常人为对照组。结果 :2 2 8例高血压患者中左室正常构型占 2 1.9% ,向心性重构占 36 .4 % ,向心性肥厚占 32 .9% ,离心性肥厚占 8.8%。高血压组主动脉根部内径和左房内径高于对照组 (P <0 .0 5 ) ,以向心性肥厚和离心性肥厚组更为明显 ;离心性肥厚的CI和SVI高于对照组和向心性重构组 (P <0 .0 5 ) ;向心性重构EF和FS值最高 (P <0 .0 5 ) ,离心性肥厚EF值最低 (P <0 .0 5 ) ;高血压组E/A比值均低于对照组 (P <0 .0 5 ) ,尤其是向心性肥厚和离心性肥厚。总外周血管阻力 (TPR)在向心性重构组最高 (P <0 .0 5 ) ,离心性肥厚组最低 (P <0 .0 5 )。结论 :左室不同几何构型有其各自的特点 ,提示应采取不同的治疗措施。     

高血压左室重构与心律失常(附108例分析)

目的：探讨高血压左室重构与心律失常的关系。方法：用超声心劝图和动态心电图对１０８例高血压患者进行检查,结果：检出左室重构病人３５例,占３２．４％,其中向心性心室重构５例,离心性肥厚１０例,向心性肥厚２０例,房性心律失常,室性心律的占离心性肥厚、向心性肥厚与正常构型,正常对照组相比,Ｐ〈０．０５。结论：高血压时房性心律失常,室性心律失常的发生和高血压时左室构型有关,其中离心性肥厚、向心性肥厚心律失常     

老年高血压患者不同左室构型对心功能和颈动脉结构的影响

目的观察不同左室构型的老年高血压患者心功能和颈动脉结构的变化。方法78例老年高血压患者根据超声左室构型分为四组:正常构型组(n=34)、向心性重构组(n=18)、向心性肥厚组(n=11)和离心性肥厚组(n=15)。测定与比较各组24 h动态血压、左室功能、颈动脉内径、血流参数和斑块发生率。结果向心性肥厚组24 h平均收缩压高于正常构型及向心性重构组(P<0.01)。离心性肥厚组左室射血分数低于正常构型组(P<0.05),Tei指数高于正常构型组(P<0.05)。向心性肥厚和离心性肥厚组颈总动脉内-中膜厚度(IMT)均高于正常构型组(P<0.05),且向心性肥厚组颈动脉分叉处IMT高于其他三组(P<0.01)。向心性肥厚组斑块检出率(54.55%)较高,但组间比较无显著差异。结论在老年高血压人群中,不同左室构型左心功能和颈动脉结构变化不同,离心性肥厚者心功能受损最明显,心室肥厚者颈动脉重构发生率较高。     

组织多普勒联合彩色多普勒超声心动图评价高血压患者左室舒张功能的价值

目的:探讨组织多普勒联合彩色多普勒心动图超声评价高血压患者左室舒张功能的价值。方法:收集原发性高血压患者90例进行研究,根据左心室质量指数(LVMI)以及相对室壁厚度(RWT)进行分为左室正常构型组30例,左室离心性肥厚组30例,左室向心性肥厚组30例。进行常规超声心动图以及彩色多普勒、组织多普勒超声心动图检测左心室舒张功能,比较三组IVS、LVPW、LVEDD、LAD、LVEF、E/A、Em、E/Em。结果:①左室离心性肥厚组、左室向心性肥厚组IVS、LVPW、LAD显著高于左室正常构型组,差异有统计学意义(P<0.05);与离心性肥厚组比较,左室向心性肥厚组IVS、LVPW显著升高,LVEDD显著降低,差异有统计学意义(P<0.05)。左室离心性肥厚组LVEDD显著大于左室正常构型组,差异有统计学意义(P<0.05);左室离心性肥厚组与左室向心性肥厚组LAD比较,差异有统计学意义(P<0.05);左室向心性肥厚组与左室正常构型组LVEDD差异无统计学意义(P>0.05)。②左室离心性肥厚组、左室向心性肥厚组E/A、Em显著低于左室正常构型组,左室离心性肥厚组E/Em显著较左室向心性肥厚组、正常构型组高,差异有统计学意义(P<0.05)。结论:高血压左心肥厚患者可出现向心性肥厚与离心性肥厚,组织多普勒联合彩色多普勒超声检查结果显示离心性左心室肥厚比向心性肥厚患者左心室舒张功能下降更明显。     

高血压病患者血浆中脑利钠肽水平与不同左室构型的相关性

目的: 分析心脏功能代偿期的高血压患者不同心脏构型之间的血浆中脑利钠肽(BNP)水平差异,探讨左室重构可能的机制. 方法: 心脏收缩功能正常的高血压患者166例,血压正常对照组87例,应用彩色多普勒超声诊断仪,按Ganau分类法,将高血压组患者的左心室重构分为正常型、向心性重构型、向心性肥厚型、离心性肥厚型4种构型. 对比血浆BNP水平. 结果: 总体上高血压组BNP水平高于对照组,按心脏重构分组后,以向心性肥厚组BNP水平升高最显著(P<0.01),向心性构型组和离心性肥厚组次之(P<0.01, P<0.05),而正常构型组虽高于对照组,但差别不具有显著差异. 结论: 尽管高血压患者尚未出现心功能失代偿,但BNP水平有升高;在不同左心室构型之间,BNP水平不同,提示BNP可能参与了高血压左心室的重构.     

高血压不同左室构型与心脏功能的关系

目的　比较高血压病人不同左室构型与心功能的关系。　方法　采用二维、M型和多普勒超声心动图方法测定 15 0例高血压患者 (正常左室构型、向心性肥厚及离心性肥厚患者各 5 0例 )的心脏收缩功能指数 FS及EF、舒张功能指数 E、A、DT、E/ A等。结果　正常左室构型组、向心性肥厚组及离心性肥厚组左室舒张功能均减退。向心性肥厚组左室收缩功能增强 ,而离心性肥厚组左室收缩功能明显下降。　结论　不同的左室构型的心功能变化不同     

高血压左心室重构的超声心动图特征

目的:观察高血压患者心脏形态、结构,认识左心室重构、类型及特点.方法:对240例高血压患者和60例正常人进行超声心动图检查,按照Ganau的方法判断左心室重构及构型分型,进行统计分析.结果:高血压组中左室正常构型者22.50%,向心性重构者36.25%,向心性肥厚者32.50%,离心性肥厚者8.75%.离心性肥厚者的心指数和每搏指数高于对照组和向心性重构者;射血分数和左室短轴缩短率向心性重构者增高,离心性肥厚患者值低;高血压组E/A比值降低,尤其是向心性肥厚明显.结论:高血压患者发生左心室重构,有不同几何构型和特点.     

高血压左室重构与动态血压关系的临床观察

为探讨高血压病左室重构与动态血压的关系 ,对 43 1例门诊初诊高血压病患者均进行动态血压检查。依据左室构型将高血压病患者分为 4组 :分别为正常左室构型组、向心性重构组、向心性肥厚组、离心性肥厚组。对 4组的动态血压各项指标进行方差分析。结果表明收缩压各项指标各组间均有统计学差异。舒张压指标中仅夜间舒张压向心性肥厚与离心性肥厚组较正常构型和向心性重构组为高 ,其余舒张压指标无统计学差异。提示 :收缩压指标是高血压左室构型改变的重要危险因素。     

高血压左室重构对心功能及血流动力学影响的研究

目的:研究高血压左室重构对心功能及血流动力学的影响.方法:采用彩色超声心动图对260例原发性高血压与70例正常对照组进行心脏结构和心功能的测定,并依据测定值:左心室重量指数(LVMI)和左室相对室壁厚度(RWT)将高血压病人分为四种构型组:正常构型、向心性重构、向心性肥厚、离心性肥厚.结果:正常构型组:血压(BP)、总外周阻力(TPR)轻度升高,收缩功能正常、舒张功能轻微受损.心脏结构轻度改变.向心性重构组:LVMI在正常范围,但明显高于对照组,RWT超过正常范围,TPR明显高于其它构型组,左室壁厚度开始增厚并高于对照组,左室舒张末径(LVEDD)小于对照组.心肌收缩功能尚正常、舒张功能轻度受损.向心性肥厚组:左室舒张末期室间隔厚度(IVSTD)左室舒张末期后壁厚度(LVWPTD)最厚,E/A和IVRT明显减小和延长,舒张功能明显受损,收缩功能处于亚临床状态.离心性肥厚组:LVMI、LVEDD最大,左心室射血分数(EF)、短轴缩短率(FS)、左室中层短轴缩短率(mFs)最低,左室收缩功能明显下降,舒张功能明显受损.结论:不同左室构型的高血压心功能及血流动力学改变不同,治疗、预后也不同.     

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.