盐酸阿罗洛尔治疗慢性肾功能不全合并高血压的多中心研究

目的多中心、前瞻性观察αβ受体阻断剂盐酸阿罗洛尔(Arotinolol)对慢性肾功能不全合并肾性高血压患者的降压疗效和安全性.方法在上海市七家综合性医院肾脏科门诊的慢性肾功能不全(血清肌酐值Scr＞1.5～5 mg/dL)合并高血压病人90例,给予盐酸阿罗洛尔治疗12周,分别观察患者服药前后血压、心率和肝肾功能等生化指标变化及其不良反应.结果90例中有85例完成12周的临床试验.与试验前比较,用药第4周起,患者的收缩压和舒张压均有显著性下降(P＜0.01),降压总有效率达81.18%.服药4周后患者心率显著减慢,但平均心率＞60次/min;个别病例出现可逆性心悸、胸闷,但其肾功能、血脂、血常规、血糖、肝功能和EKG等均未见显著性变化.结论12周的多中心临床研究表明,盐酸阿罗洛尔是治疗慢性肾功能不全合并高血压的有效药物之一,且安全性良好.     

盐酸阿罗洛尔临床应用研究概述

盐酸阿罗洛尔是具有β受体阻滞和适度α受体阻滞作用的降压药,降压效果明显,被广泛地应用于高血压、慢性肾功能不全合并高血压、心绞痛、原发性震颤等疾病的治疗。本文主要针对阿罗洛尔近几年的临床应用做简要综述。     

盐酸阿罗洛尔片治疗老年原发性高血压的临床疗效观察

目的观察αβ受体阻滞剂盐酸阿罗洛尔片（以下简称＂阿罗洛尔片＂）对老年原发性高血压的临床疗效和不良反应。方法采用自身对照的实验方法,选择老年原发性高血压患者64例,口服阿罗洛尔片治疗8周。对治疗前后各项相关指标进行对照检测。结果收缩压、舒张压、心率及心肌耗氧量及血脂与治疗前比较均有显著下降（P〈0.01）,降压效果显效率62%,总有效率85%,未发现对轻度高血压与中、重度高血压的降压效果有不同。不良反应少,各项生化指标稳定（P〉0.05）。结论盐酸阿罗洛尔片治疗老年性高血压疗效确切,耐受性好。     

阿罗洛尔治疗维持性血液透析合并高血压疗效观察

目的观察分析阿罗洛尔治疗维持性血液透析合并高血压的临床效果。方法选取2012年1-8月收治的MHD合并高血压患者19例,采用治疗前后自身对照,疗程为4周,可根据入选患者具体情况适当变更,观察治疗1、2、3和4周后患者的用药情况、疗效及治疗前后血压、心率的比较。结果治疗前后血压和心率的比较得出疗效的总有效率为87．5％,差异有统计学意义（P〈0．05）。结论阿罗洛尔能够有效的控制MHD合并的高血压,而有良好的降压效果。     

阿罗洛尔治疗原发性高血压的临床研究

目的　观察小剂量阿罗洛尔治疗原发性高血压的疗效,并与美托洛尔比较。方法　采用随机对照方法,将原发性高血压患者91例,随机分为阿罗洛尔治疗组4 4例和美托洛尔治疗组4 7例,其中阿罗洛尔组用阿罗洛尔5mg ,12服,每日二次,治疗4周前后自身血压比较,分析两种药物降压效果,并进行两组间疗效比较。观察组部分病例进行动态血压监测,比较分析疗效。结果　阿罗洛尔治疗组平均坐位血压由治疗前的2 1.6 8/ 13.85±1.6 1/ 0 .79kPa下降到18.5 6 / 11.8±1.5 2 / 0 .5 9kPa ,(P <0 .0 1)。心率从80 .3±8.7次/min下降到71.3±6 .1次/min(P <0 .0 1)。两组间治疗有效率比较无显著差异P >0 .0 5 ,动态血压监测提示两组均可平稳控制2 4h血压,保持昼夜节律。结论　小剂量阿罗洛尔能降低轻、中度原发性高血压患者的血压,疗效显著,且较少发生副作用。     

盐酸阿罗洛尔治疗特发性震颤临床疗效观察

目的:观察盐酸阿罗洛尔治疗特发性震颤的临床疗效及安全性。方法:采用随机对照试验方法,100例特发性震颤患者分为盐酸阿罗洛尔治疗组50例和普萘洛尔对照组50例,进行4周临床观察。治疗前、后分别进行震颤评分,并观察不良反应和血压、心率变化。结果:盐酸阿罗洛尔组与普萘洛尔组治疗前后自身对照差异均有显著意义(P<0.001),盐酸阿罗洛尔组疗效优于普萘洛尔组(P<0.001)。比较治疗前后血压和心率变化,盐酸阿罗洛尔组差异均无显著意义(P>0.05),而普萘洛尔组治疗后水平低于治疗前(P<0.05)。盐酸阿罗洛尔组不良反应轻微。结论:盐酸阿罗洛尔是一种安全有效的治疗特发性震颤的药物。     

盐酸阿罗洛尔联合松龄血脉康胶囊治疗清晨高血压的临床疗效观察

目的探讨盐酸阿罗洛尔(阿尔马尔)联合松龄血脉康胶囊在针对原发性清晨高血压临床治疗的降压效果及心率的变化。方法选取高血压病(Ⅰ、Ⅱ级)患者160例为研究观察对象,将患者随机分成对照组及观察组,每组各80例。对照组患者的治疗方案为服用盐酸阿罗洛尔,观察组患者的治疗方案为服用同等剂量盐酸阿罗洛尔的基础上再加服松龄血脉康胶囊,两组疗程均为8周。入选前后观察实验对象24小时的动态血压变化,比较两组患者治疗前后清晨血压、心率变化情况和临床症状改善情况等。结果两组患者治疗后清晨血压、心率均比治疗前降低,观察组效果更明显,差异有统计学意义(P<0.05)。结论盐酸阿罗洛尔联合松龄血脉康胶囊对清晨高血压的治疗效果显著,具有降低患者心率,可明显改善临床症状并且无明显不良反应,值得临床推广。     

盐酸阿罗洛尔治疗中青年高血压合并舒张性心力衰竭的疗效观察

目的观察盐酸阿罗洛尔对中青年高血压合并舒张性心力衰竭患者的降压及改善舒张功能的临床效果。方法选取中青年高血压合并舒张性心力衰竭患者61例,随机分为治疗组31例和对照组30例,在常规治疗基础上,治疗组给予盐酸阿罗洛尔片10~15 mg/次,每日2次,对照组给予酒石酸美托洛尔片25~50 mg/次,每日2次,观察2组治疗前、治疗12周后血压、心率、左心室舒张功能指标及6 min步行距离。结果治疗12周后,治疗组血压控制明显优于对照组(P<0.05);治疗组较对照组左心室舒张末期内径、左心房内径降低(P<0.05);E/A及EF值均明显升高(P<0.05);治疗组6 min步行距离较对照组延长(P<0.05)。结论盐酸阿罗洛尔对中青年高血压合并舒张性心力衰竭患者具有良好的逆转左心室重塑、改善舒张功能和降压的综合效果。     

阿罗洛尔联合非洛地平在老年慢性肾功能不全并高血压治疗的应用效果

目的:分析阿罗洛尔联合非洛地平在老年慢性肾功能不全并高血压治疗的应用效果。方法:选取收治的60例老年慢性肾功能不全并高血压患者临床资料,根据所治疗时的方案分为两组,对照组20例行阿罗洛尔治疗,研究组40例在其基础上行非洛地平治疗,对资料进行对比和分析。结果:两组治疗后血压水平均较治疗前有所改善,且研究组改善效果优于对照组;研究组BUN、UA与ALT指标均优于对照组,且研究组总有效率97.50%高于对照组50.00%,差异有统计学意义(P<0.05)。结论:阿罗洛尔联合非洛地平在老年慢性肾功能不全并高血压治疗的应用效果显著。     

氯沙坦治疗慢性肾功能不全伴高血压20例观察

目的　评价氯沙坦在治疗慢性肾功能不全伴高血压时对肾脏的保护作用。方法　 40例慢性肾功能不全伴高血压患者 ,2 0例接受氯沙坦 (Los)治疗 ,2 0例接受苯那普利 (Ben)治疗 ,对照观察 4周。治疗前后测血压、肾功能、内生肌酐清除率、2 4h尿蛋白定量。结果　Los与Ben组的降压有效率分别为 95 %、90 % ,但差异无显著性(P >0 .0 5 )。两组治疗前后血清肌酐、尿素氮及内生肌酐清除率均无明显变化。氯沙坦可降低血尿酸水平 ,与治疗前对照有显著差异 (P <0 .0 1) ;苯那普利不影响血清尿酸。两组治疗后 2 4h尿蛋白均较治疗前减少 (P <0 .0 5 )。氯沙坦不良反应轻微。结论　氯沙坦对高血压患者慢性肾功能代偿与失代偿期有效 ,且副作用小 ,与利尿剂合用其降压效果可增强 ;氯沙坦有肾脏保护作用。     

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.