原发性高血压病人血清瘦素水平与胰岛素抵抗的相关性研究

目的 探讨高血压病人血清瘦素水平与胰岛素抵抗的关系。方法 分别选择男性女性合并肥胖或非肥胖的高血压病人和正常血压者。测定收缩压（SBP）、舒张压（DBP）、身高、体重、腰围、臀围、血清瘦素水平、空腹血糖和胰岛素水平并计算体重指数（BMI）、腰臀比（WHR）、胰岛素敏感指数（ISI）。分析高血压病人血清瘦素水平与胰岛素敏感指数的关系。结果 无论男女血清瘦素水平在同一体质水平（肥胖或非肥胖）高血压组高于正常血压组,同一血压水平（高血压或正常血压）肥胖组高于非肥胖组,ISI则成相反趋势的变化。除男性高血压病肥胖组与非肥胖组ISI差异无显著性,其余上述各组比较差异均有显著性。男性病人血清瘦素水平与ISI存在相关性,女性病人二者未见相关性。结论高血压病人存在高瘦素血症和胰岛素抵抗,男性病人血清瘦索水平与ISI高度相关。     

糖耐量受损人群血浆C-反应蛋白和纤维蛋白原变化及其意义

目的了解糖耐量受损(IGT)状态下炎症因子的变化及其意义.方法检测48例正常糖代谢人群(NGT)和49例IGT人群血浆中C-反应蛋白(CRP)和纤维蛋白原(Fg)水平,并测量其身高、体重、腰围、臀围、血压,测定血脂(TG、TC、LDL-C、HDL-C)和胰岛素水平,计算HOMA-IR、体重指数(BMI)和腰臀比值(WHR).结果① IGT组CRP和Fg水平明显高于NGT组;②线性相关分析显示,在IGT人群中,CRP和Fg与HOMA-IR、空腹胰岛素水平、BMI、WHR、舒张压、收缩压、TG和LDL-C呈正相关,与HDL-C呈负相关;③ IGT组BMI、脂代谢异常发生率、高血压发生率和HOMA-IR显著高于NGT组. 结论炎症因子水平在IGT状态下已开始升高,且与胰岛素抵抗、高血压、肥胖、脂代谢紊乱等多种大血管病变危险因素密切相关.     

肥胖大鼠血糖、血脂、瘦素和下丘脑瘦素水平的变化

目的 建立营养性肥胖鼠的动物模型,观察营养性肥胖鼠中糖、脂代谢异常和胰岛素抵抗及瘦素抵抗的情况。方法 （1）高脂饮食诱导建立肥胖大鼠模型;（2）采用放射免疫法测定其血清胰岛素．瘦素和下丘脑组织的瘦素水平。结果 （1）肥胖和超重大鼠血糖、血脂、血清瘦素水平程度显著升高;（2）肥胖组和超重组大鼠下丘脑组织的瘦素含量低于正常组;（3）大鼠的体重、TG、HOMA—IR与血清瘦素水平呈显著正相关,而与下丘脑瘦素水平呈负相关。结论 肥胖鼠体内存在糖、脂代谢异常和胰岛素抵抗,同时还存在瘦素抵抗。这些代谢紊乱对肥胖的发生具有重要意义。     

复发性流产患者体质指数、胰岛素水平与糖代谢状态的特征研究

目的 分析复发性流产患者临床与生化指标及其分布特征,同时探讨复发性流产(RSA)与肥胖、胰岛素抵抗(IR)以及糖代谢异常的关系.方法 选择876例复发性流产妇女作为病例组(RSA组),另外选取同时期因男方因素行辅助生殖技术助孕的妇女1397例作为对照组,回顾性分析其临床资料,比较两组的体质指数(BMI)、空腹胰岛素(FINS)、空腹血糖(FPG)水平.同时将BMI水平分为4个区间,比较不同区间下两组胰岛素和血糖的分布特征.再筛选出差异有统计学意义的变量进行Logistic回归分析.结果 RSA组空腹血糖、空腹胰岛素、HOMA-IR水平明显高于对照组,差异有统计学意义(P＜0.01);RSA组空腹血糖受损(IFG)、IR检出率高于对照组,差异有统计学意义(P＜0.05).RSA组BMI及糖代谢均异常的检出率高于对照组,差异有统计学意义(P＜0.05).RSA组在超重和肥胖患者中糖代谢异常检出率高于对照组,差异有统计学意义(P＜0.05);RSA组在正常体质量患者中IR检出率高于对照组,差异有统计学意义(P＜0.01).多因素分析显示,IR是RSA发生的危险因素.结论 复发性流产与IR、糖代谢异常有关,超重或肥胖的复发性流产患者更易发生糖代谢紊乱,应重视正常体质量复发性流产妇女的内分泌代谢状态.     

厄贝沙坦联合氨氯地平对青年肥胖高血压患者血清瘦素水平及胰岛素敏感性的影响

目的：观察厄贝沙坦联合氨氯地平治疗对青年肥胖高血压患者血清瘦素水平及胰岛素敏感性的影响。方法：入选104例青年肥胖原发性高血压患者,应用厄贝沙坦150mg/d联合氨氯地平5mg/d（联合组,n=104例）治疗24周;另选取同期健康体检体重正常者为正常对照组（对照组,n=100）,测定对照组及联合组治疗前后的体质量指数（BMI）、腰臀比值（WHR）、血压、血清瘦素水平、空腹血糖和空腹胰岛素,采用稳态模型评价胰岛素抵抗指数（HOMA-IR）。结果：治疗前联合组的血压、血清瘦素水平和HOMA-IR与对照组有明显的差异（P〈0.05）。治疗24周后,联合组的血压、血清瘦素水平和HOMA-IR明显下降（P〈0.05）。结论：厄贝沙坦联合氨氯地平可有效控制青年肥胖高血压患者的血压,且能改善与肥胖相关的代谢紊乱。     

肥胖高血压患者血清瘦素与血压的关系探讨

目的:探讨肥胖高血压患者血清瘦素(Leptin)水平与血压、糖脂代谢及体脂的关系。方法:选择肥胖高血压患者(A组)48例,单纯肥胖患者(B组)48例,均男、女各半,测量身高、体重、体重指数(BMI)、腰臀比(WHR)、血压、空腹血糖(FBS)、血清胰岛素(INS)、胰岛素敏感指数(ISI)及瘦素水平。结果:A组患者INS、FBS、TG及Leptin显著高于B组(P<0.01),HDL则相反;两组TC、LDL无显著差异(P>0.05)。单因素相关分析发现,血清Leptin水平在男女之间存在显著性差异(P<0.01)。结论:血清Leptin与BMI、WHR、SBP、DBP、FBS、INS、ISI显著相关,在肥胖高血压患者的发生发展中具有重要的作用。     

多囊卵巢综合征患者血清瘦素水平的变化及临床意义

目的研究多囊卵巢综合征（PCOS）患者血清瘦素水平变化及其临床意义。方法初次诊断为PCOS的170例患者根据体质量指数（BMI）分为正常体质量组（P1组,n=69）、超重组（P2组,n=44）和肥胖组（P3组,n=57）。酶联免疫吸附法检测血清瘦素水平,分析BMI、腰臀比及血糖、胰岛素和血脂水平以及胰岛素抵抗指数（HOMA—IR）和胰岛B细胞分泌功能指数（HOMA—IS）与血清瘦素水平的相关性。以年龄和体质量指数（BMI）相匹配的143名健康志愿者作为正常对照,且同样分为正常体质量组（C1组,n=102）、超重组（c2组,n=20）和肥胖组（C3组,n=21）。结果血清瘦素水平检测和分析结果显示,P1组与C1组比较差异无统计学意义;但P2组〉C2组,P3组〉C3组,差异均有统计学意义（P〈0．01）。Spearman相关分析显示,PCOS患者血清瘦素水平与BMI、腰臀比以及血清三酰甘油、高密度脂蛋白胆固醇、空腹及餐后2h血胰岛素、空腹及餐后2h血糖、HOMA—IR、HOMA—IS相关;进一步的多元逐步回归分析结果表明,PCOS患者血清瘦素水平与BMI和HOMA—IR独立相关。结论PCOS的发生和发展可能与血清瘦素水平升高导致糖脂代谢异常有关。     

瘦素和代谢综合征的研究现状

瘦素是由脂肪细胞分泌的一种多肽激素,能与其受体结合发挥抑制食欲,减少能量摄入,增加能量消耗等多种生物学效应。代谢综合征是包括胰岛素抵抗、高胰岛素血症、糖耐量异常、中心性肥胖、高血压和脂代谢紊乱的一组临床综合征,它是发生心脑血管疾病的危险因素。多数研究表明,瘦素与胰岛素抵抗关系密切,高瘦素血症是代谢综合征的组成部分;血清瘦素水平与肥胖呈显著正相关;瘦素能够控制体质量,纠正糖、脂代谢紊乱,增加胰岛素敏感性;瘦素对高血压及心血管疾病的影响,研究结果目前尚存争议。     

高血压合并糖尿病患者的血清瘦素、脂联素检测分析

目的:探讨高血压合并糖尿病患者血压、血糖水平与血清瘦素浓度、脂联素浓度的相关性。方法:分别应用放射免疫分析和ELISA法,对55例高血压合并糖尿病患者及38例单纯高血压患者进行血清瘦素和脂联素测定,同时测定血压、血糖、胰岛素抵抗指数、体质量指数(腰围/身高比值),并与30例健康者做比较,分析素数、脂联素与高血压、高血糖、肥胖及胰岛素抵抗的关系。结果:高血压合并糖尿病组患者的血清脂联素水平低于单纯高血压组,且两组血清脂联素水平均明显低于正常人组;高血压合并糖尿病组与单纯高血压组患者血清瘦素水平差异无统计学意义(P>0.05),两组血清瘦素水平均明显高于正常人组。结论:血清脂联素浓度与血压水平及血糖水平呈负相关,血清瘦素水平与血压水平呈正相关,与血糖升高无关联,但与肥胖有关,血清脂联素对于胰岛素抵抗的影响程度明显大于血清瘦素。     

高血压患者基础糖代谢测定的临床意义

本文的目的是探讨高血压病的基础糖代谢紊乱,在76例高血压病组(肥胖43例、非肥胖33例)和52例正常对照组测定空腹血糖、胰岛素、C肽、果糖胺、糖化血化蛋白,结果如下:1.高血压病组的五项指标均高于正常对照组;2.在高血压病组肥胖与非肥胖组病人之间空腹糖代谢无差异;3.高血压病组65％为高胰岛素血症;4.胰岛素释放指数高于正常,而胰岛素敏感指数低于正常;5.经多因素分析,收缩压和舒张压与空腹胰岛素呈正相关;该研究表明,1)高血压病组存在着胰岛素抵抗和基础糖代谢紊乱;2)高血压病高胰岛素血症与胰腺胰岛素的分泌增加相关,且可能是高血压的致病因素之一。     

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.