丹红注射液对冠脉介入术后病人血小板活化状态的影响

目的 现察志性冠脉综合征(ACS)患者介入治疗术后血小板活化指标CD62P、CD63的改变,评价丹红注射液对冠脉介入术后病人血小板活化状态的影响.方法 42例ACS志者随机分为丹红治疗组(21例)和常规治疗组(21例),2组病例在冠脉介入术前和术后次日采用流式细胞仪检测血小板活化指标CD62P、CD63.丹红治疗姐介入治疗术后即静脉滴注射液14d后复查上述指标,井进行治疗前后比较和2组间比较.结果 经丹红注射液治疗后,CD62P,CD63较治疗前明显下降(P<0.01);丹红注射液治疗组CD62P、CD63较常规治疗组明王下降(P<0.05).结论 丹红注射液具有抑制血小板活化的作用,在预防和治疗血栓性疾病中有一定的临床价值.     

通心络胶囊对急性冠脉综合征患者血小板活化功能的影响

目的探讨通心络胶囊对急性冠脉综合征(ACS)患者血浆CD62P和CD63的影响及临床疗效。方法71例ACS患者随机分为通心络组和对照组,2组同时服用阿司匹林等药物,通心络组给予通心络胶囊,每次3粒,每天3次,治疗8周。治疗前后采用流式细胞仪检测血浆CD62P和CD63水平,并观察心绞痛发作次数变化。同时选择20例门诊健康体检者为健康人组。结果治疗前通心络组、对照组血浆CD62P和CD63水平明显高于健康人组(P<0.01);治疗后通心络组心绞痛发作次数较对照组明显减少,同时血浆CD62P和CD63水平较对照组显著下降(P<0.05),但通心络组及对照组血浆CD62P和CD63水平仍高于健康人组(分别为P<0.05和P<0.01)。结论通心络胶囊可以明显抑制血小板活化功能的异常,并具有良好的抗心绞痛疗效。ACS患者早期加用通心络胶囊是安全有效的,值得提倡。     

丹参多酚酸盐对ACS患者血小板活化功能的影响及作用机制

目的探讨丹参多酚酸盐对急性冠脉综合征(ACS)患者血小板活化功能的影响及作用机制。方法选取123例ACS患者分为观察组(60例)和对照组(63例),均实施常规基础治疗,观察组另给予丹参多酚酸盐辅助治疗,对照组给予等量生理盐水安慰剂。对比两组临床疗效。结果观察组总有效率(88.33%)和对照组(68.25%)差异有统计学意义(P0.05);治疗前观察组CD63、CD62p和GP IIb/IIIa和对照组比较差异无统计学意义(P0.05),治疗后观察组降低程度和对照组差异有统计学意义(P0.05);观察组不良心血管事件发生率(3.33%)和对照组(4.76%)差异无统计学意义(P0.05)。结论丹参多酚酸盐可以显著改善ACS患者血小板活化功能,推测可能和CD63、CD62p和GP IIb/IIIa蛋白水平有关。     

抗血小板治疗对急性冠脉综合征患者血小板活化标志物表达的影响

目的:研究急性冠脉综合征(ACS)患者外周血血小板活化标志物(CD62P及PAC-1)的表达,探讨血小板活化在急性冠脉综合征发生过程中的作用及抗血小板治疗对其的影响.方法:采用流式细胞仪技术测定85例ACS患者外周血CD62P及PAC-1,并与30例正常对照组比较.85例ACS患者中单用阿司匹林组(41例)与联用阿司匹林及氯吡格雷组(44例)比较.结果:ACS患者的CD62P及PAC-1表达水平显著高于正常对照组(P＜0.01);ACS患者单用阿司匹林或联用氯吡格雷治疗前后的CD62P及PAC-1表达水平有显著差异(P＜0.01);单用阿司匹林组与联用阿司匹林及氯吡格雷组比较也有统计学差异(P＜0.01).结论:外周血血小板活化标志物(CD62P及PAC-1)可以作为ACS患者血小板被激活的指标而检测,抗血小板治疗能抑制CD62P及PAC-1的表达,联用阿司匹林及氯吡格雷可以更好地抑制血小板激活,减少血小板聚集.     

冠心病患者他汀类药物干预后LDL-C、TC变化与血小板CD62P表达的相关性研究

目的研究冠心病患者采用他汀类药物干预后LDL-C、TC变化与血小板CD62P表达的相关性。方法将61例冠脉支架术后患者分为口服辛伐他汀组(20 mg/d)和瑞舒伐他汀组(10 mg/d),疗程均为1个月。治疗前后采用流式细胞术检测血小板CD62P表达的变化,同时检测血脂的变化,Person法分析治疗前后TC、LDL-C的变化与血小板CD62P表达变化的相关性。结果辛伐他汀组患者血小板CD62P表达率由治疗前的(19.37±14.78)%降至(4.91±5.48)%,TC和LDL-C水平由治疗前的(4.96±1.20)mmol/L和(3.58±1.81)mmol/L分别降至(4.18±0.49)mmol/L和(2.51±0.61)mmol/L,治疗前后比较差异有统计学意义(P<0.01)。瑞舒伐他汀组患者血小板CD62P表达率由治疗前的(13.79±11.28)%降至(3.72±4.56)%,TC和LDL-C水平由治疗前的(4.88±1.37)mmol/L和(3.30±1.06)mmol/L分别降至(3.81±1.00)mmol/L和(2.20±0.64)mmol/L,治疗前后比较差异有统计学意义(P<0.01)。但治疗前后两组间比较差异无统计学意义(P>0.05)。Person线性相关分析结果显示,两组患者治疗前后TC、LDL-C的降低值与血小板CD62P的降低值之间无相关性(P>0.05)。结论他汀类药物能改善冠脉支架术后患者血小板CD62P表达,可能是该药减少心血管事件发生的机制之一。     

急性冠脉综合征患者CD61、CD62p的表达和血浆vWF含量的变化及药物干预作用

目的：探讨急性冠脉综合征（ACS）血小板颗粒膜糖蛋白(CD62p)及血小板脂膜蛋白(CD61)与血浆假性血友病因子（vWF）的关系及奥扎格雷的干预作用。方法：应用流式细胞术(FCM)和酶联免疫吸附试验（ELISA）测定36例ACS患者硝酸酯+奥扎格雷钠治疗前后静脉血CD62p、CD61和血浆vWF的表达水平,对两者在ACS时的变化进行对比分析。同时设20例健康体检者做对照组。结果：ACS患者CD62p是［（89.60±6.98）%］,表达明显高于正常组［（40.88±7.56）%］（P<0.05）,药物干预治疗后下降至（66.11±8.72）%,治疗前后比较差异亦具有显著性（P<0.05）,其水平变化与vWF、心绞痛和缺血ST-T改善一致;CD61表达量为（91.38±6.97）%,与正常组比较差异无显著性（P>0.05）,药物干预治疗前后比较,差异无显著差性（P>0.05）。结论：CD62p是血小板活化的敏感指标,且与vWF和临床症状有很好的相关性。     

胰岛素强化治疗对急性冠脉综合征合并糖尿病患者PCI术后血小板功能的影响

目的:探讨胰岛素强化治疗对急性冠脉综合征(ACS)合并糖尿病患者行PCI术后血小板功能的影响。方法:选择PCI术后2月服用维持剂量双联抗血小板药物达到稳态的ACS合并糖尿病患者85例,随机分为胰岛素组43例(A组)和口服降糖药组42例(B组),另设ACS非糖尿病患者40例(C组)为对照,分别比较PCI术前、术后2月、4月血小板功能指标CD62P、CD63、MPAR。结果:A、B组患者临床特征基线比较,差异无统计学意义(P>0.05),与C组比较FPG、HbA1C、血小板功能指标差异有统计学意义(P<0.05);PCI术后2月A、B组FPG、HbA1C、血小板功能指标仍高于C组,差异有统计学意义(P<0.05);术后4月A组FPG、HbA1C、血小板功能指标低于B组,差异有统计学意义(P<0.05),A组和C组比较血小板功能指标差异无统计学意义(P>0.05)。CD62P、CD63、MPAR互为正相关(P<0.05)。结论:胰岛素强化治疗对PCI术后在服用双联抗血小板药物期间血小板功能的抑制有协同作用,对于血糖控制不佳的ACS合并糖尿病患者,在PCI术后使用胰岛素强化方案获益更大。     

流式细胞术检测冠心病患者血小板表面糖蛋白的变化

目的 观察冠心病患者及其亚组的血小板膜P选择素(CD62P)和糖蛋白Ⅱb/Ⅲa(PAC-1)的变化及其意义.方法 采用流式细胞仪三色荧光标记技术来测定急性冠脉综合征、慢性心肌缺血综合征患者及22名健康对照组的血小板表面糖蛋白(CD62p/PAC-1)的表达率,并比较其变化.结果 病例组的血小板表面糖蛋白表达率显著高于对照组,其中急性冠脉综合征患者的PAC-1:(15.54±6.43)%,CD62p:(9.83±6.06)%,与对照组相比(P＜0.001),慢性心肌缺血综合征PAC-1:(5.38±2.62)%,CD62p:(11.00±6.37%),较对照组也有显著升高(P＜0.001).急性冠脉综合征组的PAC-1水平显著高于慢性心肌缺血综合征CIS组P＜0.001.结论 冠心病患者处于血小板高度活化状态,其中急性冠脉综合征患者血小板处于活化的早期阶段,而慢性心肌缺血综合征患者血小板处于慢性激活状态,CD62P和PAC-1是血小板功能检测非常敏感的指标.     

不稳定型心绞痛患者血小板活化状态的临床研究

目的考察不稳定心绞痛(UAP)患者体内血小板活化状态,探讨冠脉病变严重程度与血小板活化程度的关系。方法UAP组55例,稳定心绞痛(SAP)组32例,均服用阿斯匹林75mg/d,对照组40例。采用流式细胞术测定活化血小板的膜蛋白CD63、CD62P、TsP的表达率。观察行冠脉造影术42例UAP患者,比较单支病变组、双支病变组和3支病变组血小板膜蛋白表达率的差异。结果UAP组中3种膜蛋白的表达率均显著高于SAP组和对照组,男女之间无显著性差异,双支组和3支组显著高于单支组。结论UAP患者存在高度的血小板活化状态,随冠脉病变严重程度增加而增加,小剂量阿斯匹林治疗的UAP患者仍有较高的血小板活化状态。     

噻氯匹定对急性冠脉综合征患者血小板活化状态的干预研究

目的了解噻氯匹定对急性冠脉综合征患者血小板活化的干预状况.方法对85例临床疑似急性冠脉综合征患者服用噻氯匹定250mg,2次/d及阿斯匹林100mg,1次/d,疗程3 d,并在服药前后测定血小板表面颗粒膜糖蛋白(CD62P)和溶酶体膜糖蛋白(CD63)的表达程度.结果85例患者服用噻氯匹定后行冠状动脉造影示冠状动脉造影阳性45例,其血小板膜CD62P 16.11%±5.32%较服药前18.32%±6.12%差别无显著性意义(t=1.563,P＞0.05);CD63表达阳性率26.43%±8.99%较服药前30.45%±8.21%差别也无显著性意义(t=1.581,P＞0.05).冠状动脉造影阴性者为40例,其血小板膜CD62P 3.25%±1.13%较服药前3.85%±1.01%差别无显著性意义(t=1.131,P＞0.05);CD63表达阳性率5.33%±1.32%较服药前6.01%±1.58%差别也无显著性意义(t=1.281,P＞0.05).结论为了进一步抑制急性冠脉综合征患者血小板活化状态,短期仅服用噻氯匹定片250mg,2次/d加阿斯匹林100mg,1次/d,3d,疗程可能偏短.     

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.