普伐他汀对冠心病患者血脂、血浆 Chemerin 水平、超敏C 反应蛋白、血清脂联素的影响

目的 探讨普伐他汀对冠心病患者血脂、血浆脂肪因子趋化素（Chemerin）水平、超敏C反应蛋白（hs—CRP）、血清脂联素的影响。方法 收集2010年1月～2013年12月湖北省荣军医院老年病科收治的118例冠心病患者,并将其随机分为常规治疗组和普伐他汀组,观察治疗前后血浆Chemerin水平、hs—CRP、血清脂联素的变化,分析Chemerin、脂联素、hs—CRP与血脂浓度之间的相关性。结果 疗程结束后,普伐他汀组血浆Chemerin、hs—CRP、总胆固醇（TC）、三酰甘油（TG）及低密度脂蛋白胆固醇（LDL—C）水平均较常规治疗组显著降低（P〈0．01）,血清脂联素及高密度脂蛋白胆固醇（HDL—C）水平均较常规治疗组显著升高（P〈0．01）。血浆Chemerin与TG呈正相关（r=0．48,P〈0．01）;hs—CRP与HDL—C呈负相关（r=-0．21,P〈0．01）;血清脂联素与HDL—C呈正相关（r=0．56,P〈0．01）,与Chemerin、hs—CRP均呈负相关（r=-0．43、-0．36。P〈0．01）。结论 普伐他汀可以显著降低冠心病患者血脂水平,而且能提高血清脂联素水平以降低hs—CRP浓度及血浆Chemerin水平。     

原发性高血压患者血浆脂联素水平与胰岛素抵抗及高敏C反应蛋白的关系

目的：检测原发性高血压（EHP）患者血浆脂联素水平,探讨其与胰岛素抵抗及高敏C反应蛋白（hs—CRP）的关系。方法：选取原发性高血压患者（EHP组）102例及血压正常者（NT组）80例,测定空腹血浆脂联素浓度、血清胰岛素水平及hs—CRP,稳态模型法（HOMA）计算胰岛素抵抗指数（HOMA—IR）。结果：①EHP组的脂联素水平[（6．82±3．41）mg／L]明显低于NT组【（9．51±2．42）mg／L],差异有高度统计学意义（P〈0．01）。②EHP组的hs—CRP水平[9．42±2．30）me／L]明显高于NT组[（4．68±1．73）mg／L],差异有高度统计学意义（P〈0．01）。③HOMA—IR随血压水平升高而升高,2级及3级EHP组与NT组比较差异有统计学意义（P〈0．05）。④相关分析显示脂联素与收缩压（SBP）、舒张压（DBP）、体重指数（BMI）、腰围（we）、HOMA—IR、hs—CRP之间存在负相关。脂联素、BMI、hs—CRP、HOMA—IR为影响血压的独立因素。结论：①原发性高血压患者血浆脂联素水平较血压正常者明显降低,且其hs—CRP升高,存在胰岛素抵抗。②血压与脂联素、BMI、hs—CRP、HOMA—IR之间存在独立的相关性。     

空腹血糖正常的冠心病患者糖代谢状况与血PAI-1，hsCRP，HbA1c及冠脉病变的关系

目的：调查空腹血糖正常的冠心病患者糖代谢状况,探讨冠心病合并糖耐量减低患者血浆纤溶酶原激活物抑制物1（PAI-1）、高敏C反应蛋白（hs—CRP）、糖化血红蛋白（HbA1c）水平与冠脉病变的关系。方法：对冠脉造影确诊的226例冠心病患者行口服葡萄糖耐量试验,据结果分成糖耐量正常（NGT）组,糖耐量减低（IGT）组和2型糖尿病（T2DM）组,分析糖代谢状况,测定三组的血PAI-1,hs—CRP,HbA1c水平和冠脉病变积分。结果：共发现糖代谢异常者120例（53．1％）;血PAI-1,hs—CRP,HbA1c水平和冠脉病变积分在IGT和T2DM组比NGT组明显升高（P〈0．05）;相关分析显示,冠心病合并IGT组血PAI-1,hs—CRP,HbA1c水平和冠状动脉病变积分呈正相关,相关系数分别为,r=0．6082（P〈0．01）、0．4443（P〈0．05）、0．6327（P〈0．01）。结论：空腹血糖正常的冠心病患者糖代谢异常发生率高;冠心病合并IGT者冠脉病变严重,多支冠脉病变发生率高,病变呈弥漫性狭窄;血浆PAI—1,hs—CRP,HbA1c水平和冠状动脉病变严重程度有关。     

血浆脂联素水平与冠状动脉粥样硬化的相关性研究

目的:探讨脂联素水平与冠状动脉粥样硬化病变程度的相关性。方法:根据冠状动脉造影结果将临床诊断为急性冠脉综合征的283例患者进行分组,应用放射免疫法检测血浆脂联素水平,同时监测血压、血糖、血浆胰岛素、血脂、高敏C反应蛋白(hs-CRP)等相关指标。结果:①冠心病患者血浆脂联素水平明显低于正常对照组(P<0.01);②脂联素水平与冠脉粥样硬化程度、HDL-C、空腹血糖、胰岛素抵抗指数、hs-CRP显著相关(P<0.05);③随着受累冠状动脉数量的增加2型糖尿病发病率明显升高(P<0.01)。结论:低血浆脂联素水平是冠状动脉粥样硬化发生发展的独立危险因素。     

血清OPG、hs-CRP与冠心病的相关性

目的探讨冠心病（CHD）患者血清骨保护素（OPG）、超敏C反应蛋白（hs—CRP）水平及冠状动脉病变程度的关系。方法选取人住我院心内科的患者,按疾病严重程度分为急性冠脉综合征（ACS）组（n=30例）、稳定型心绞痛（SA）组（n-30例）及对照组（CO）组（n=10例）,检测并比较3组患者血清OPG、hs—CRP表达水平的差异。结果ACS组患者血清OPG及hs-CRP水平明显高于SA组及CO组,SA组血清OPG及hs—CRP水平高于CO组（P〈n01或P〈O．05）。血清OPG、hs—CRP含量均随冠脉病变数目的增加而增高,且血清OPG水平与hs—CRP水平呈正相关（P〈0．01）。结论冠心病患者血清OPG、hs—CRP水平与冠状动脉病变程度有关,提示OPG系统可能通过干预血管炎症反应而参与了冠状动脉粥样硬化病变进程。     

脂联素和hs-CRP在冠心病患者病情评估中的临床价值

目的研究脂联素和hs—CRP在冠心病患者病情评估中的临床价值。方法根据症状体征将冠心病患者分为稳定型心绞痛组（SAP组）、不稳定型心绞痛组（UAP组）和急性心肌梗死组（AMI组）,选择正常健康人为对照（CON组）,比较四组研究对象血清脂联素、hs—CRP和Gensini积分的差异,分析脂联素、hs—CRP与Gensini积分相关性。结果SAP组、UAP组和AMI组冠心病患者脂联素显著低于CON组（P〈0．01）,hs—CRP和Gensini积分显著高于CON组（P〈0．01）。SAP组、UAP组和AMI组脂联素依次降低,hs—CRP和Gensini积分依次升高,差异均具有统计学意义（P〈0．01）。SAP组、UAP组和AMI组冠心病患者脂联素与Gensini积分呈负相关（P〈0．05）,hs—CRP与Gensini积分呈正相关（P〈0．05）。结论脂联素和hs—CRP在冠心病患者病情评估中具有重要意义．脂联素水平越低、hs—CRP水平越高,表明冠心病病情越重。     

同型半胱氨酸和超敏C反应蛋白在冠状动脉硬化患者中的临床意义

目的探讨检测同型半胱氨酸（Hcy）及超敏C反应蛋白（hs—CRP）在冠状动脉粥样硬化患者中的临床意义。方法采用透射免疫比浊法,分别检测106例冠状动脉粥样硬化组（CAS）和100名冠状动脉正常组（CAN）的Hcy和hs—CRP水平。结果冠状动脉粥样硬化患者的Hcy和hs-CRP含量显著高于冠状动脉正常人（P〈0．01）。高Hcy和hs—CRP与高血脂、高血压、糖尿病、吸烟等动脉粥样硬化危险因素相比,相对危险度的OR值分别为5．75、4．33、3．43、2．40、2．38、2．29。结论Hcy和hs—CRP是冠状动脉粥样硬化性心脏病的独立危险因素;高Hcy和高hs．CRP血症与高血压、高血脂、糖尿病、吸烟等动脉粥样硬化危险因素相比,危险性更高。     

阿托伐他汀对急性冠脉综合征患者脂联素和超敏C反应蛋白的影响

目的探讨阿托伐他汀干预对急性冠脉综合征（ACS）患者血清脂联素（APN）和超敏C反应蛋白（hs—CRP）的影响。方法采用酶联免疫吸附法（ELISA法）测定85例ACS患者和40例健康对照组的血清脂联素和hs-CRP水平;将ACS患者随机分为阿托伐他汀治疗组45例,在常规治疗基础上每晚口服阿托伐他汀40mg／d,ACS对照组40例仅常规治疗。于治疗前后分别测定血清脂联素和hs-CRP水平,并进行比较和相关分析。结果与健康对照组比,ACS患者血清脂联素水平显著降低,而血清hs-CRP水平显著升高,差异有统计学意义（P〈0．01）。治疗后8周与治疗前比较,阿托伐他汀治疗组和ACS对照组的血清脂联素水平均显著升高,hs-CRP水平均显著下降;与ACS对照组比较,阿托伐他汀治疗组治疗后血清脂联素水平更高,而血清hs—CRP水平更低,差异有统计学意义（P〈0．01）。ACS患者的血清脂联素与h8-CRP呈负相关（r=-0．348,P=0．013）。结论ACS患者血清脂联素下降和hs—CRP升高在粥样斑块的炎症反应起重要作用。阿托伐他汀等他汀类药物可通过降低血清hs—CRP及升高脂联素等促炎性细胞因子的水平,减轻ACS患者粥样斑块内的炎症。     

趋化因子CXCLl6与冠心病病变程度及胰岛素抵抗的关系

摘要：目的探讨冠心病患者趋化因子CXCChemokineLigand16（CXCLl6）水平与胰岛素抵抗（IR）及冠脉病变程度之间的关系。方法选择经冠状动脉造影证实的冠心病患者稳定型心绞痛（SAP）20例,急性冠脉综合征（ACS）24例。另有冠状动脉造影正常的20例作为对照组。平均年龄（62．61±10．37）岁。测定空腹血糖、空腹胰岛素、血脂、超敏C反应蛋白（hs—CRP）及血浆CXCLl6水平（采用酶联免疫吸附法）等生化指标。同时,根据稳态模式评估法计算胰岛素抵抗指数（iai）,采用Gensini积分系统评估冠脉病变程度。观察各组之间CXCLl6水平与冠脉病变程度及1R1关系。结果冠心病患者血浆CXCLl6、hs—CRP水平、IRI和Gensini积分均高于对照组（P〈O．05）;冠心病患者中,ACS组hs—CRP、IRI和Gensini积分高于SAP组（P〈O．05）;SAP患者Gensini积分与CXCLl6,IRI与hs—CRP均呈正相关（r分别为0．476,0．591,P均〈0．05）。结论血浆CXCLl6水平和IRI均为冠心病的预测指标,它们对冠脉病变狭窄程度有一定的辅助预测作用。     

2型糖尿病大血管病变与脂联素及超敏C-反应蛋白的关系

目的探讨2型糖尿病（T2DM）和2型糖尿病合并大血管病变患者血浆脂联素及超敏C-反应蛋白（hs—CRP）的变化和意义。方法选择86例2006年5月至12月在本院门诊及住院的T2DM患者及30例门诊健康体检查。正常对照组30例（A组）,单纯T2DM组44例（B组）,T2DM合并大血管病变组42例（C组）。用酶联免疫吸附试验（ELISA）法检测血浆脂联素,采用免疫透射比浊清测定超敏C-反应蛋白,采用Acuson128110彩色超声诊断仪测量各组受试者的颈动脉最大内膜-中膜厚度。结果正常对照组血浆脂联素高于单纯T2DM组,单纯T2DM组高于合并大血管病变组,组间比较差异有统计学意义（P〈0．01）,hs—CRP水平则相反,差异也有统计学意义（P〈0．01）。血清hs—CRP水平与颈动脉最大IMT（r=0．864,P〈0．05）。脂联素与hs—CRP呈强负相关。结论脂联素和Hs CRP与糖尿病大血管病变的发生、发展相关,可作为预测大血管病变的参考指标。     

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.