甲亢患者血清Ⅰ型前胶原氨基端前肽、Ⅰ型胶原羧基端肽变化及与甲状腺激素、骨密度的相关性

目的探讨甲状腺功能亢进(甲亢)血清Ⅰ型前胶原氨基端前肽(PⅠNP)、Ⅰ型胶原羧基端肽(β-CTx)变化及与甲状腺激素、骨密度的相关性。方法将2011年1月至2014年3月宜昌市夷陵医院收治的126例甲亢患者作为甲亢组,根据患者近3个月的PⅠNP水平将患者分为3个亚组:控制有效组(PⅠNP<6.5%)47例、控制一般组(6.5%≤PⅠNP<8.0%)36例、控制较差组(PⅠNP≥8.0%)43例。同期选择进行健康体检的非甲亢患者50例作为对照组。检测并比较各组受试者血清碱性磷酸酶(ALP)、血钙、血磷、25-羟基维生素D[25-(OH)D]、甲状旁腺素(PTH)、β-胶原特殊序列(β-Cross Laps)、N端中段骨钙素(N-MID OT)、总Ⅰ型胶原氨基端延长肽(TPⅠNP)水平。结果甲亢组患者血钙、血磷与对照组比较差异无统计学意义(P>0.05),随着PⅠNP水平升高,甲亢患者PTH、25-(OH)D、N-MID Osteocalcin、β-Cross Laps、TPⅠNP呈下降趋势(P<0.05),PⅠNP与PTH、25-(OH)D、N-MID Osteocalcin、β-Cross Laps、TPⅠNP呈负相关(P<0.05)。结论甲亢患者存在骨代谢异常,且源氨基酸控制越差,骨代谢异常越明显,甲亢患者严格控制源氨基酸的同时应注意骨质疏松的预防。     

Graves病患者静脉注射葡萄糖酸钙、EDTA后血浆PTH、降钙素、1_α,25(OH)_2D、钙、磷的动态变化

观察Graves病患者(GD)28例空腹血浆PTH、CT、钙与正常组无明显差异,而1_α,25(OH)_2D较对照组低;GD患者一次静脉注射葡萄糖酸钙及EDTA后血浆PTH、CT、1_α,25(OH)_2D、钙、磷浓度的动态变化,GD患者于CaG组及EDTA组的血钙波动较为显著,而PTH、1_α,25(OH)_2D无明显动态变化,甲状腺C细胞第二相分泌较差。本文提示GD应变情况下血钙的波动更多地受PTH、CT以外甲状腺激素等因素的影响,或甲状腺激素可能提高PTH活性。亦提示患者有维生素丁代谢异常。     

慢性阻塞性肺疾病与骨质疏松症的相关性探讨

目的:探讨慢性阻塞性肺疾病(COPD)与骨质疏松症的相关性及临床意义。方法:选取老年男性COPD患者50例与同龄健康体检者50例,分别测定两组人群的骨密度(BMD)及相关骨代谢指标[血钙(Ca~(2+))、血磷(P)、25(OH)D_3、甲状旁腺激素(PTH)及碱性磷酸酶(ALP)],进行对比及分析。结果:COPD组患者的BMD、血钙(Ca~(2+))、血磷(P)、及25(OH)D_3指标明显低于对照组(P<0.05),PTH高于对照组(P<0.05),而ALP在两组间差异无统计学意义(P>0.05)。结论:COPD患者并发骨质疏松发生率较高,在临床诊疗中应引起高度重视。     

新诊断女性GD患者的25羟维生素D水平

目的探讨新诊断弥漫性毒性甲状腺肿(GD)的女性患者中25羟维生素D[25 (OH) D]水平及其与GD的关系。方法选取个旧地区74例新诊断GD女性患者作为患者组,53例健康体检女性作为健康组。采用liason化学发光法测定2组血清25 (OH) D及甲状腺功能[总三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)、总甲状腺素(TT4)、游离甲状腺素(FT4)、促甲状腺激素(TSH)]、促甲状腺素受体抗体(TRAB)指标水平并进行比较分析,应用多元线性逐步回归分析25 (OH) D水平的影响因素。结果 (1)个旧地区健康对照组及GD组人群血25 (OH) D水平分别为(19.91±6.36) ng/mL和(20.60±9.66) ng/m L,两组间无统计学差异(P>0.05);(2) GD组患者25 (OH) D充足、不足及缺乏比例分别为5.66%、43.40%、50.94%,25 (OH) D充足、不足、缺乏的比例2组间比较无统计学差异(P> 0.05);(3)多因素线性回归分析提示25(OH) D水平与PTH负相关(P<0.001),与TT3水平正相关(P... 更多     

肺心病急性加重期患者1,25-(OH)2D3改变及其原因的研究

目的探讨肺心病急性加重期1,25-(0H)2D3改变及其改变的原因.方法测定了48例患者血1,25-(OH)2D3、25-(OH)D3、甲状旁腺素(PTH)和血钙磷镁(SCa、SP、SMg).结果与对照组相比,病人组l,25-(OH)2D3、25-(OH)D3、PTH、SCa和SMg显著降低(P均＜0.01).25-(OH)D3低于均值组的1,25-(OH)2D3值显著低于25-(OH)D3高于均值组者(P＜0.05);PTH低于均值组的1,25-(OH)2D3值显著低于PTH高于均值组者(P＜0.01).结论肺心病急性加重期时1,25-(OH)2D3显著降低;25-(OH)D3和PTH的降低是1,25-(OH)2D3降低的原因.应予该病患者适量补充药物性维生素D.     

腹膜透析患者钙磷代谢状况73例临床分析

目的探讨腹膜透析患者的钙磷代谢状况。方法收集存活腹膜透析患者73例,化验血钙、血磷、血甲状旁腺素（PTH）及血25羟维生素D总量指标;根据不同的PTH水平分成低PTH组（〈100 pg/ml）、正常PTH组（100~300pg/ml）、高PTH（〉300pg/ml）,比较其血钙、血磷及血25羟维生素D水平。结果 3组PTH、血钙、血磷及25羟维生素D差异均有统计学意义（均P〈0.05）;高PTH组与低PTH组、高PTH组与正常PTH组血钙及血磷差异均有统计学意义（均P〈0.05）;低PTH组与正常PTH组、低PTH组与高PTH组血25羟维生素D水平差异有统计学意义（P〈0.05）。结论在维持性腹膜透析患者中,高PTH患者比例较高,同时伴低血钙、高血磷;而且普遍存在活性维生素D不足,低PTH患者尤为明显。     

新疆喀什维吾尔族人群血清25羟维生素D及血钙与血压的相关性

目的探讨维吾尔族受检人群的血清25羟维生素D[25(OH)D]及血钙水平与血压的关系。方法采用分层随机抽样的方法于2012年12月-2013年1月在新疆喀什地区纳入维吾尔族受检者共232例,其中原发性高血压患者132例(高血压组),正常对照者100例(正常对照组)。检测其血压、血清25-羟维生素D和血钙、磷相关指标,分析血清25(OH)D及血钙水平对血压的影响。结果维吾尔族原发性高血压患者血清25(OH)D、血钙水平低于维吾尔族正常对照组,体质指数高于维吾尔族正常对照组,差异有统计学意义;维生素D缺乏组患者收缩压高于维生素D不足组;血钙低于维生素D不足组,差异均有统计学意义;血清25(OH)D每下降6ng/mL,收缩压升高的危险性增加0.68;体质指数每增加5kg/m2,血压升高的危险性增加1.78;血钙每增加0.2mmol/L,舒张压≥90mmHg的危险性降低0.42。结论新疆维吾尔族受检人群普遍存在维生素D缺乏,高血压患者维生素D水平更低;维吾尔族血清25(OH)D水平、体质指数对血压有一定的影响,血钙水平对舒张压有一定的影响。     

慢性肾脏病5期患者血清铁调素水平与钙磷代谢的相关性

目的 探讨慢性肾脏病(CKD)5期患者血清铁调素水平及与钙磷代谢的关系.方法 检测56例CKD 5期患者(CKD组)及20例健康人(对照组)血清铁调素水平,以及CKD组患者的25-羟维生素D、甲状旁腺素(PTH)、血磷、血钙、血清碱性磷酸酶(ALP)、血清铁、铁蛋白、总铁结合力(TIBC)水平,分析CKD 5期患者铁调素水平及与其他指标的相关性.结果 CKD组血清铁调素水平为(22.69±18.54)mg/L,明显高于对照组的(13.56±8.02) mg/L(P ＜0.05).血清铁调素水平与铁蛋白、转铁蛋白饱和度、血磷、ALP及PTH水平呈正相关(P＜0.05),与TIBC呈负相关(P＜0.05),与血清铁、血钙、25-羟维生素D水平之间无明显相关性(P＞0.05).多元线性回归分析显示,血磷、PTH、铁蛋白水平是CKD 5期患者血清铁调素水平的独立影响因素(P＜0.05).结论 CKD 5期患者的钙磷代谢异常和高铁调素水平密切相关.     

维生素D2注射液对老年女性维生素D缺乏患者血清甲状旁腺激素的影响

目的探讨维生素D2注射液对老年女性维生素D缺乏患者血清甲状旁腺激素（PTH）的影响。方法选取2018年12月在浙江省人民医院住院的老年女性维生素D缺乏患者44例,采用随机数字表法分为试验组和对照组各22例。试验组患者在坚持晒太阳的基础上,给予维生素D2注射液60万U肌肉注射,1次/月,直至血清25-羟基维生素D[25（OH）D]≥75nmol/L后停用;而对照组仅坚持晒太阳,连续观察12个月。所有患者每月检测血清25（OH）D、PTH、血钙、血磷、血糖、肌酐、ALT水平,并进行统计分析。结果试验组患者血清25（OH）D水平≥75nmol/L用时（11.6±3.1）个月。试验组患者治疗后血清25（OH）D水平明显高于对照组,血清PTH水平明显低于对照组,差异均有统计学意义（均P＜0.01）,但两组患者血钙、血磷、血糖、肌酐和ALT水平比较差异均无统计学意义（均P＞0.05）。结论维生素D2注射液可有效降低老年女性维生素D缺乏患者的血清PTH水平。     

PTH依赖性与非PTH依赖性高钙血症生化特点比较

目的对比分析PTH依赖性与非PTH依赖性高钙血症的生化特点。方法回顾性分析60例高钙血症住院患者的临床资料,依据甲状旁腺素(PTH)水平分为对照组(PTH依赖性)37例与观察组(非PTH依赖性)23例,观察比较两组患者血钙、血磷、碱性磷酸酶(ALP)等指标及血钙校正前后的浓度差,并进行统计学分析。结果观察组校正血钙、血磷水平高于对照组,差异有统计学意义(P<0.05),血白蛋白水平低于对照组,差异有统计学意义(P<0.05)。两组患者碱性磷酸酶(ALP)水平比较,差异无统计学意义(P>0.05)。对照组血钙水平与校正血钙比较,差异无统计学意义(P>0.05)。观察组校正血钙水平高于血钙水平,差异有统计学意义(P<0.05)。结论非PTH依赖性高钙血症校正血钙、血磷水平高于PTH依赖性高钙血症,临床上应对非PTH依赖性高钙血症进行血钙校正以指导诊治。     

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.