氧化应激状态与阻塞性睡眠呼吸暂停低通气综合征的关系

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与患者体内氧化应激状态的相关性。方法选择我院OSAHS患者共40例,与正常对照组40例进行多导睡眠仪监测（PSG）,采集各组受试者当天睡前及次日晨起空腹静脉血,检测血清中抑制羟自由基（OH·）能力、抗超氧阴离子自由基（Oj_）能力及谷胱甘肽（GSH）含量。结果OSAHS组GSH含量、血清抑制OH·能力、抗0f能力均比对照组低,差异具有统计学意义（P〈0．05）;OS．AHS组GSH含量、血清抑制OH·能力、抗0f能力晨起比睡前降低,差异具有统计学意义（P〈0．05）;OSAHS组晨起血清抑制OH·能力、抗OZ能力、GSH水平与AHI呈负相关,与睡眠呼吸障碍事件时最低SaO：呈正相关。结论OSAHS与氧化应激状态存在着密切联系,OSAHS患者有持续氧化应激存在,睡眠过程可加重氧化应激状态。     

瘦素、胰岛素抵抗与阻塞性睡眠呼吸暂停低通气综合征关系的研究

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea and hypopnea syndrome,OSAHS)患者血清瘦素水平与胰岛素抵抗的关系,以及2者与睡眠呼吸监测各指标的相关性.方法 选择未接受任何治疗的OSAHS患者69例,健康体检者20例为对照组,记录睡眠呼吸监测各项指标,计算体块指数(BMI),同步检测空腹血糖(FBG)、空腹血清瘦素及空腹胰岛素水平,以HOMA-IR评价胰岛素抵抗.(1)据AHI分为正常对照组(10例),轻度OSAHS组(19例),中度OSAHS组(26例),重度OSAHS组(24例);(2)据BMI及AHI分为A组(正常对照10例),B组(单纯肥胖10例),C组(非肥胖OSAHS27例),D组(肥胖OSAHS 42例).分别比较各组间空腹血清瘦素水平、空腹血糖、空腹胰岛素、HOMA-IR的差异; (3)分析OSAHS患者血清瘦素水平与HOMA-IR的相关性,以及2者与空腹血糖、空腹胰岛素、睡眠呼吸监测各项指标的相关性.结果 (1)空腹血清瘦素水平、空腹胰岛素水平、HOMA-IR:重度OSAHS组高于轻中度OSAHS组及正常对照组(P＜0.01),B、C、D3组高于A组(P＜0.05),D组高于B、C组(P＜0.05); (2)空腹血糖:重度OSAHS组高于轻度OSAHS组及正常对照组(P＜0.05),B、C、D3组高于A组(P＜0.05),D组高于B、C组(P＜0.05); (3)轻中度OSAHS组间及B、C组间以上指标差异不明显(P＞0.05); (4) OSAHS患者血清瘦素水平与HOMA-IR呈正相关;血清瘦素水平、HOMA-IR与空腹血糖水平、空腹胰岛素、AHI、BMI、ESS呈正相关,与平均血氧饱和度及最低血氧饱和度呈负相关.结论 OSAHS患者血清瘦素及胰岛素抵抗增高,与睡眠呼吸紊乱及低氧存在相关性,胰岛素抵抗与血清瘦素水平的增高有关,OSAHS病情严重度可影响瘦素分泌及胰岛素抵抗.     

妊娠合并阻塞性睡眠呼吸暂停低通气综合征患者内脂素和巨噬细胞移动抑制因子的检测意义

探讨妊娠合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与血清内脂素和巨噬细胞移动抑制因子（MIF）的相关性及其意义。选择妊娠合并OSAHS患者102例（分成轻度、中度和重度）和正常妊娠组36例,采用ELISA检测血清内脂素和MIF含量。OSAHS合并高血压组睡眠呼吸暂停低通气指数（AHI）、平均动脉压（MAP）、内脂素和MIF含量明显高于单纯OSAHS组（均P〈0．01）,单纯OSAHS组明显高于正常妊娠组（均P〈0．01）;同时重度OSAHS患者的内脂素和MIF含量明显高于中度OSAHS,中度明显高于轻度患者,差异有统计学意义（均P〈0．01）。妊娠合并OSAHS患者病情与内脂素、MIF水平密切相关。     

谷胱甘肽硫转移酶及活性氧与阻塞性睡眠呼吸暂停低通气综合征的相关性研究

目的 通过检测阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清谷胱甘肽硫转移酶(GSH-ST)活力、活性氧(ROS)水平的变化,探讨OSAHS患者体内氧化应激状态和抗氧化酶的变化及其临床意义.方法 选择OSAHS患者(OSAHS组)及健康人(对照组)各30例,两组受检者的性别、年龄和体质指数间有均衡性.所有受检者在夜间入睡前及晨醒后抽取静脉血,用比色法测定各组GSH-ST活力及抑制羟自由基(OH·)能力、抗超氧阴离子自由基(O-2)能力.结果 OSAHS组睡前血清抑制OH·能力、抗O-2能力较对照组降低,OSAHS组这2个指标晨起比睡前降低,差异均有统计学意义(P＜0.01);OSAHS组血清GSH-ST活力较对照组增高(P＜0.01),OSAHS组血清GSH-ST活力晨起与睡前无明显变化(P＞0.05);OSAHS组睡眠呼吸暂停低通气指数(AHI)与晨起血清抑制OH·能力、抗O-2能力均呈负相关,与血清GSH-ST活力均呈正相关;OSAHS组血清GSH-ST活力与晨起抑制OH·能力、抗O-2能力呈负相关.结论 OSAHS患者有持续的氧化应激存在,并与OSAHS严重程度相关;OSAHS患者GSH-ST活力增高,且与OSAHS严重程度及氧化应激的程度有相关性.     

VEGF及HIF—1α在阻塞性睡眠呼吸暂停低通气综合征合并冠心病患者中的表达

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并冠心病患者血中血管内皮生长因子（VEGF）及缺氧诱导因子-1α（HIF-1α）的表达。方法根据多导睡眠呼吸监测将90例OSAHS患者分为单纯OSAHS组（A组）50例和OSAHS合并冠心病组（B组）40例;同时选择健康体检者60例作为对照组（C组）。比较3组外周血VEGF和HIF-1α水平。结果B组患者VEGF和HIF-1α水平均高于A组,A组患者VEGF和HIF-1α水平均高于C组（均P〈0．05）。OSAHS患者血浆VEGF和HIF-1α水平与睡眠呼吸紊乱指数、血氧饱和度〈90％时间、晨起收缩压及舒张压呈不同程度正相关,与最低血氧饱和度呈负相关。OSAHS患者血浆VEGF与HIF-1α水平呈正相关性。结论HIF-1α主要通过调节VEGF水平来参与OSAHS发病,并可能是OSAHS诱发冠心病的重要机制。     

阻塞性睡眠呼吸暂停低通气综合征与血压动态变化的研究

目的探讨不同程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血压动态变化规律。方法采用多导睡眠监测系统(PSG)对105例轻度、中度、重度OSAHS患者、28例正常对照者和21例无OSAHS的高血压病患者进行夜间7小时睡眠监测,同时测量睡前、睡时1AM和醒后血压及最低血氧饱和度,并对上述各指标进行统计学分析。结果OSAHS组血压水平均明显高于正常对照组,且OSAHS患者血压随病情加重逐渐升高(P<0.01),最低血氧饱和度随着病情加重逐渐降低(P<0.01)。中、重度OSAHS组睡时及醒后血压明显高于睡前水平(P<0.01)。结论OSAHS患者血压昼夜节律多消失,呈“非杓型”改变,随病情加重,睡时及晨间血压较白天高。故应早期、合理、有效治疗。     

急性胰腺炎早期IL-6的动态变化及其临床意义

目的:探讨急性胰腺炎早期IL-6变化及与疾病严重程度相关性。方法:选取2008年2月-2013年2月本院住院的101例AP患者,根据病情程度将其分为轻症组43例,中重症组31例,重症组27例,同时选取30例健康查体者作为对照组。应用双抗体夹心免疫发光法测定患者第1、3、7、10天血清中IL-6含量,比较三组患者之间IL-6含量变化。结果:在组间比较中,轻症患者d1、d3及d7血清IL-6含量明显高于对照组,差异均有统计学意义(P0.05),d10血清IL-6含量虽比对照组高,但差异无统计学意义(P0.05);中重症及重症患者d1、d3、d7及d10血清IL-6含量明显高于对照组,中重症患者四次测量IL-6含量水平明显高于轻症患者,重症患者四次测量IL-6含量水平明显高于中重型及轻型,比较差异均有统计学意义(P0.05)。在组内比较中,轻症组及中重症组患者组内d1、d3、d7及d10血清IL-6含量比较差异均有统计学意义(P0.05);重症患者d1与d3、d7与d10差异有统计学意义(P0.05),而d3及d7差异无统计学意义(P0.05)。结论:血清IL-6含量动态变化可以作为胰腺炎病情发展的监控指标。     

妊娠合并OSAHS孕妇血清ENA-78和MIF水平分析

目的：分析妊娠合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)孕妇血清趋化因子(ENA-78)和巨噬细胞移动抑制因子(MIF)的水平。方法：82例妊娠合并OSAHS孕妇为观察组,其中50例为单纯OSAHS患者、32例为OSAHS合并高血压患者;选择同期40例正常妊娠孕妇作为对照组。采用标准的多导睡眠呼吸监测系统监测所有孕妇,根据呼吸暂停时的低通气指数(AHI)将妊娠合并OSAHS孕妇分为三组,轻度29例、中度27例、重度26例。采用ELISA法检测所有孕妇血清ENA-78和MIF的水平。结果：OSAHS合并高血压孕妇、单纯OSAHS孕妇血清MIF、ENA-78水平明显高于对照组孕妇,OSAHS合并高血压孕妇血清MIF、ENA-78水平明显高于单纯OSAHS孕妇(P＜0.01);重度OSAHS孕妇血清MIF、ENA-78水平明显高于中度和轻度OSAHS孕妇,中度OSAHS孕妇血清MIF、ENA-78水平明显高于轻度OSAHS孕妇(P＜0.01)。结论：血清ENA-78和MIF水平能反映妊娠合并OSAHS病情的严重程度。     

睡眠呼吸暂停相关高血压的研究

目的 探讨OSAHS相关性高血压病患者的血压的变化情况。方法 32例OSAHS患者均合并高血压病，同时选取正常对照组30例。两组均经多导睡眠图(PSG)监测，并同时测量了睡前及晨起肘部肱动脉血压，对OSAHS患者的睡前血压、晨起血压及经CPAP治疗8周后的相应指标做出比较。结果 (1)OSAHS组与对照组AHI、夜间最低SaO2的比较，两者差异均有显著性(P＜0．001)；(2)OS-AHS组晨起血压较睡前血压显著性升高(P＜0．001)；(3)晨起血压OSAHS组较对照组显著性升高，(P＜0．001)；(4)经CPAP治疗后，AHI显著性下降(P＜0．001)；夜间最低SaO2显著性升高(P＜0．001)；睡前及晨起血压显著性降低(P＜0．001)；(5)AHI与夜间最低SaO2呈负相关(P＜0．05)；AHI与晨起血压不相关(P＞0．05)；(6)夜间最低SaO2与晨起舒张压呈负相关(P＜0．05)，回归分析显示BP=137．046～0．415 SaO2(回归系数P＜0．001)；(7)体重指数与晨起舒张压呈正相关(P＜0．05)；与夜间最低SaO2呈负相关(P＜0．05)；与AHI呈正相关(P＜0．001)。结论 (1)在OSAHS患者，随AHI加大，夜间最低SaO2降低；(2)夜间SaO2下降，是导致晨起舒张压升高的重要因素；(3)CPAP治疗对于纠正OSAHS患者高血压有重要意义。     

UPPP手术对阻塞性睡眠呼吸暂停低通气综合征患者血清hs-CRP的影响

目的探讨悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrom,OSAHS)患者血清超敏C-反应蛋白(high sensitive C-creative protein,hs-CRP)的影响。方法选择20例OSAHS患者,先后进行UPPP手术,术前均被抽取晨起血清,检测hs-CRP。术后3个月再次测量血清hs-CRP,同时设立两对照组进行对照研究。结果OSAHS患者术前的血清hs-CRP水平明显高于两个对照组(P<0.05),术后3个月明显降低。结论hs-CRP可以作为预测此类患者发生心血管疾病的指标,而UPPP手术可以降低OSAHS患者血清hs-CRP水平,从而减少OSAHS患者心血管疾病的发病率。     

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.     

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.     

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.