超声诊断老年动脉粥样硬化性肾动脉狭窄的血流参数阈值分析

目的:探讨彩色多普勒超声诊断老年动脉粥样硬化性肾动脉狭窄(ARAS)的血流动力学参数阈值。方法:应用多普勒超声检测259例老年ARAS患者(共462支)的肾动脉和叶间动脉收缩期峰值流速(PSV)、舒张末期流速(EDV)、阻力指数(RI),叶间动脉的加速度(AC)、加速时间(AT),腹主动脉峰值流速,观察肾动脉及肾内叶间动脉血流分布,计算肾动脉与腹主动脉PSV比值(RAR)、肾动脉与叶间动脉PSV比值(RIR),以数字减影血管造影(DSA)检查结果为标准绘制受试者工作特征(ROC)曲线,分析诊断老年ARAS的血流动力学参数阈值,比较上述各参数在不同取值下的敏感性及特异性。结果:诊断≥70%狭窄的老年ARAS患者的最佳PSV、RAR、RIR阈值分别为:248.0cm/s、3.42、10.67,其诊断敏感性和特异性分别为94.4%和81.4%、91.2%和77.8%、93.9%和82.8%。结论:彩色多普勒超声对于老年ARAS患者的筛查诊断、狭窄程度的判断具有重要的临床价值。采用老年ARAS的指标阈值可以提高诊断准确性,对选择治疗方式有指导作用。     

氟伐他汀联合缬沙坦治疗早期糖尿病肾病临床观察

目的 探讨氟伐他汀联合缬沙坦治疗早期糖尿病肾病的临床疗效.方法 65例早期糖尿病肾病患者随机分为两组.两组患者均在严格执行糖尿病饮食、优质低蛋白摄入、常规降糖药物和/或降压药物治疗的基础上,治疗组给缬沙坦80mg/d,口服,同时给氟伐他汀40mg/d,口服;对照组给缬沙坦80mg/d,口服.两组疗程3个月.结果 两组治疗后尿清蛋白排泄率(UAER)明显改善(P<0.05),治疗组与对照组同期比较更明显(P<0.05);治疗组治疗后C-反应蛋白(CRP)明显下降(P<0.05),而对照组下降不明显.结论 氟伐他汀具有降低CRP的抗炎效应,与缬沙坦联用对早期糖尿病肾病进行干预治疗,可有效地降低尿清蛋白排泄率,保护肾功能.     

肾动脉狭窄超声诊断及超声引导介入治疗价值

目的探讨彩色多普勒超声在肾动脉狭窄患者临床诊断及超声引导介入治疗中的价值。方法选择32例肾动脉狭窄患者为观察组,另选择32例健康人为对照组。超声测量两组肾动脉峰值流速(PSV)、肾动脉与腹主动脉峰值流速比值(RAR)、小慢波、收缩早期加速时间检查。结果观察组PSV及RAR均高于对照组(P<0.01);观察组治疗后PSV及RAR均低于治疗前(P<0.01)。结论彩色多普勒超声检查是肾动脉狭窄筛选诊断的重要方法,对超声引导介入治疗的术前方案选择、术中引导和效果评估具有重要的临床价值。     

PTRAS治疗动脉粥样硬化性肾动脉狭窄的临床疗效

目的评价经皮腔内肾动脉支架成形术(PTRAS)治疗动脉粥样硬化性肾动脉狭窄(ARAS)的临床疗效。方法 28例接受PTRAS的ARAS患者根据肾动脉狭窄程度分为A组(肾动脉狭窄50%~75%,n=10)和B组(肾动脉狭窄≥75%,n=18)。统计手术成功率。随访6~18个月,彩色多普勒超声检查PTRAS后肾动脉通畅情况并测量肾动脉主干收缩期峰值流速(PSV),分析两组患者治疗前后血压和肾功能主要指标血清肌酐(SCr)和肾小球滤过率(GFR)的变化。结果 28例PTRAS患者中,治疗成功27例,技术成功率为96.43%。彩色多普勒超声复查显示:术后肾动脉通畅,肾动脉主干PSV显著降低(P<0.05)。A组PTRAS后收缩压显著下降(P<0.05),服用降压药物种类显著减少(P<0.05);B组治疗前后血压测量值和服用降压药物种类比较差异均无统计学意义(P>0.05);A组高血压疗效的获益率显著优于B组(P<0.05)。A组PTRAS后SCr显著降低(P<0.05),GFR分级无明显变化,肾功能获益率100%;B组PTRAS后SCr无明显变化,GFR分级显著下降,肾功能获益率81.25%。结论 PTRAS治疗AR...     

彩色多普勒超声评价老年肾动脉粥样硬化性狭窄及肾动脉血流动力的价值

目的 探讨彩色多普勒超声评价老年肾动脉粥样硬化性狭窄对肾动脉血流动力学的影响.方法 老年动脉粥样硬化性疾病患者65例(共观察130条肾动脉),应用彩色多普勒超声观察肾动脉行走、内径、管壁回声、管腔内及血流充盈情况,并记录肾动脉峰值流速(PSA)、肾动脉的峰值流速与腹主动脉峰值流速比值(RAR)、肾动脉峰值流速与叶间动脉峰值流速比值(RIR)、叶间动脉加速时间(AT).结果 65例130条肾动脉中,肾动脉狭窄＜50%者90条占69.2%,狭窄50%～69%者24条占18.4%,狭窄≥70%者16条占12.3%.随着狭窄程度加重,PSA、RAR、RIR、AT加大(P＜0.05).结论 彩色多普勒超声对老年动脉粥样硬化性疾病引起的肾动脉狭窄初筛、早期诊断及评估介入性治疗效果、术后随访具有较高的临床价值.     

“慢小波”形态恢复正常对肾动脉狭窄支架置入术后的疗效评价

目的:通过"慢小波"形态恢复正常对肾动脉狭窄支架置入术后的分析,评价其疗效。方法:采用超声多普勒技术诊断肾动脉起始段狭窄≥70%;肾内叶间动脉出现"慢小波"的患者103例(120支狭窄的肾动脉)作为研究对象,经肾动脉造影检查证实并行经皮血管内球囊成形支架置入术,于术后1周内行超声多普勒复查。观察术前及术后1周内肾动脉起始段收缩期峰值流速(PSV);肾动脉狭窄处与腹主动脉峰值流速比(RAR);肾内叶间动脉的收缩期峰值流速(PSV)、舒张期流速(EDV)、阻力指数(RI)、加速时间(AT)、加速度(AC)。结果:肾动脉起始段PSV由术前的(380.30±192.40)cm/s降为(116.20±47.60)cm/s(P<0.01);RAR由(3.87±0.71)降为(1.38±0.35)(P<0.01)。叶间动脉PSV和EDV由术前的(16.30±7.30)cm/s、(7.60±2.30)cm/s升为(25.90±7.40)cm/s、(9.10±2.70)cm/s(P<0.01);RI由(0.54±0.06)升为(0.68±0.07)(P<0.01);AT由术前的(0.10±0.03)s降为(0.05±0.02)s(P<0.01);AC由术前的(195.02±59.20)cm/s2升高为(392.01±63.30)cm/s2(P<0.01)。结论:肾动脉起始段支架术后,除了支架内流速减低外,肾内叶间动脉"慢小波"形态恢复正常也可以有效地评价肾动脉支架置入治疗术后疗效。     

氟伐他汀对急性冠脉综合征炎症反应的影响

目的:探讨氟伐他汀对急性冠状动脉综合征(Acute Coronary Syndrome ACS)患者冠脉病变炎症的影响.方法:采用随机对照方法将200例血脂正常的ACS患者分为氟伐他汀治疗组100例和非氟伐他汀治疗组100例.另选健康对照组82例,测定治疗前、治疗后8周血浆C反应蛋白(CRP)及白介素-1(IL-1)水平的变化.结果:①急性冠脉综合征患者血浆CRP、IL-1水平明显高于健康人.②氟伐他汀治疗组治疗8周后血浆CRP、IL-1水平明显下降,与治疗前比较,差异有显著性意义(P<0.01).非氟伐他汀组两项指标治疗前后无明显变化(P>0.05).结论:氟伐他汀可阻滞ACS患者冠脉病变的炎症反应.     

阿托伐他汀联合贝那普利治疗老年糖尿病肾病的临床疗效研究

目的:研究阿托伐他汀联合贝那普利治疗老年糖尿病肾病的临床疗效。方法:选取老年糖尿病肾病患者100例,随机分为对照组和观察组,其中对照组50例在常规治疗基础上,应用贝那普利;观察组在常规治疗基础上,应用阿托伐他汀联合贝那普利,均治疗3周。观察两组治疗前后临床症状的变化,并检测血尿素氮(BUN)、血肌酐(Cr)、治疗前后尿蛋白排泄率(UAER),血清糖化血红蛋白(Hb Alc),C反应蛋白(CRP),微量白蛋白(MALB),β微球蛋白(β2MG),平均动脉压(MAP)。结果:治疗后,两组患者BUN、Cr、CRP、MAP、UAER、MALB、β2MG水平均有明显降低,差异有统计学意义(P<0.05),观察组BUN、Cr、UAER水平明显低于对照组,差异有统计学意义(P<0.05)。结论:阿托伐他汀联合贝那普利治疗糖尿病肾病疗效好,可以明显降低BUN、Cr、Hb Alc、CRP、MAP、UAER、MALB、β2MG水平,保护肾功,具有一定的临床应用价值。     

阿托伐他汀对糖尿病肾病患者炎症状态的影响

目的:观察阿托伐他汀对糖尿病肾病患者血清C反应蛋白(CRP)、单核细胞趋化蛋白-1(MCP-1)及尿白蛋白排泄率(UAER)的影响。方法:糖尿病肾病患者108例,随机均分为一般治疗组和阿托伐他汀治疗组。其中一般治疗组仅给予一般性治疗(包括控制血糖、血压等),阿托伐他汀治疗组给予一般治疗加阿托伐他汀40 mg/d,共观察12周。另取20名健康体检者作为对照组。所有研究对象分别于治疗前及治疗4周、8周、12周后各采静脉血1次,测定血清CRP、MCP-1和代谢指标空腹血糖、血脂(总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯),并采集24 h尿检测UAER。结果:阿托伐他汀治疗组血浆CRP、MCP-1及UAER水平在治疗前与一般治疗组患者差异均无统计学意义(P>0.05),在治疗后均明显低于一般治疗组(P<0.01),且随着治疗时间的延长,阿托伐他汀治疗组血浆CRP、MCP-1及UAER水平均有明显降低(P<0.01);血浆CRP、MCP-1与UAER均呈正相关关系(P<0.01)。结论:阿托伐他汀可能通过抑制炎症反应而保护糖尿病肾病患者的肾脏功能。     

氟伐他汀对早期糖尿病肾病的疗效观察

目的探讨氟伐他汀治疗糖尿病肾病的疗效及其作用机制。方法将早期患者60例随机分为氟伐他汀（治疗组）和安慰剂（对照组）,各30例。对照组给予糖尿病饮食,控制血糖等常规治疗;治疗组每晚加服氟伐他汀40mg。3个月后,比较两组治疗前及治疗后的尿清蛋白排出率（UAER）、血肌酐（Scr）和C反应蛋白（CRP）等指标。结果治疗组UAER、Scr和CPR下降较治疗前明显降低（P〈0．01）,与对照组比较UAER、CPR下降更明显。而对照组3者下降较治疗前不明显（P〉0．05）。结论氟伐他汀因降低CPR的抗感染效应而减轻微量清蛋白尿和改善肾功能,该作用不依赖其降血脂效应。     

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.