低分子肝素联合卡托普利治疗肾病综合症21例疗效观察

自 1997年 1月 2 0 0 2年 1月 ,我们应用低分子肝素联合卡托普利治疗肾病综合症 2 1例 ,取得满意的疗效。现报告如下 :1　临床资料1.1　一般资料 :本组 4 0例患者中 ,男 2 6例 ,女 14例 ,年龄 14～ 6 1岁 ,平均年龄 31岁。临床表现 :明显浮肿 ,尿蛋白 (+++)～ (++++) ,血清总蛋白 5 1.3± 3.2g/L ,白蛋白为 19.2± 2 .6g/L ,胆固醇 6 .5 1± 0 .31mmol/L ,甘油三脂 3.4 1± 0 .2 3mmol/L。将 4 0例患者随机分为①治疗组 2 1例 ,②对照组 19例。两组在年龄、性别、病因、临床表现等方面无显著差异性。1.2　治疗方法 :两组均给予泼尼松 (1mg…     

高浓度病毒唑雾化吸入治疗婴幼儿毛细支气管炎疗效观察

目的 :了解高浓度病毒唑雾化吸入治疗毛细支气管炎是否较常规浓度病毒唑雾化吸入治疗毛细支气管炎更有效。方法 :将 84例毛细支气管炎患儿分成治疗组和对照组 ,治疗组用 5 0mg/mL病毒唑雾化治疗 ,每次约 0 5h ,对照组用 10mg/mL病毒唑雾化吸入。结果 :治疗组平均喘憋缓解时间为 (3 0 1± 1 2 3)d ,住院天数 (6 5 0± 1 2 6 )d ;对照组平均喘憋消失时间为 (4 .4 8± 1.4 1)d ,病程为 (9.0 1± 1.33)d。结论 :高浓度病毒唑雾化吸入较常规剂量病毒唑雾化吸入治疗毛细支气管炎可明显缩短喘憋时间和病程     

甲泼尼龙与特布他林联用在COPD治疗中的作用

目的 :观察静脉注射甲泼尼龙与短效β2 受体激动剂特布他林雾化吸入联用对慢性阻塞性肺疾病 (COPD)急性加重期的治疗作用。方法 :49例 COPD急性加重期患者随机分为治疗组 (2 5例 ) ,给予静脉注射甲泼尼龙 80 mg/次 ,3次 /d,连续 3d后改用布地奈德干粉剂 (DPI) 1 2 0 0 μg/ d吸入 ,对照组 (2 4例 )给予布地奈德 (DPI) 1 2 0 0 μg/ d吸入 ,两组均联用特布他林雾化溶液 ,每次 5mg,2次 / d。每日测 FEV1 、PEF,连续观察 5d。结果 :治疗组 FEV1 值从治疗前 (0 .69±0 .1 8) L上升到 (1 .0 6± 0 .32 ) L(P<0 .0 1 ) ,PEF值从 (1 .46± 0 .54) L/ s上升到 (2 .88± 0 .47) L/ s(P<0 .0 1 ) ,FEV1 值及 FEV1 增加量 >2 0 0 ml的病例数均高于对照组。结论 :静脉注射甲泼尼龙与短效 β2 受体激动剂雾化吸入联用对COPD急性加重期的肺功能的改善作用优于吸入皮质激素     

茶色素对早期糖尿病肾病患者血浆GMP-140和血浆内皮素的影响

目的 :探讨茶色素对早期糖尿病肾病患者血浆GMP - 14 0和血浆内皮素 (ET)的影响及临床意义。方法 :6 8例早期糖尿病肾病患者随机分成对照组 (n =34)和治疗组 (n =34)两组 ,对照组采用糖尿病 (DM )常规治疗 ,治疗组在常规治疗基础上加用茶色素治疗 ,每天 3次 ,每次 0 .2 4 g口服。两组疗程均为 8周。另选取 30名正常人为健康人组。采用放射免疫法和酶联免疫吸附法分别测定健康人组、对照组与治疗组治疗前后血浆ET、2 4h尿白蛋白排泄率 (UAER)和血浆GMP - 14 0。结果 :糖尿病肾病 (DN)患者血浆ET、血浆GMP - 14 0水平显著高于健康人 (均P <0 .0 1) ,治疗组治疗后血浆ET、血浆GMP - 14 0、UAER水平分别为 70 .6± 19.7ng/L、6 8.9± 19.7μg/L、6 9.5 2± 4 0 .2 7μg/min ,较治疗前的 10 3.2± 2 6 .3ng/L、10 1.2± 39.5 μg/L、10 9.31±72 .15 μg/min明显降低 (均P <0 .0 1) ,对照组治疗后血浆ET、血浆GMP - 14 0、UAER水平分别为 98.4±2 4 .2ng/L、89.2± 35 .9μg/L、95 .35± 4 9.92 μg/min ,较治疗前的 10 1.8± 2 5 .9ng/L、98.9± 37.1μg/L、10 8.2 3±6 9.72 μg/min无明显变化 (均P >0 .0 5 ) ,治疗组治疗 8周后血浆ET、血浆GMP - 14 0、UAER较对照组显著下降 (P <0 .0 1,P <0 .0 5 ,P <0     

葛根素对早期糖尿病肾病的治疗作用

目的 :探讨葛根素对早期糖尿病肾病的治疗作用。方法 :将 72例早期糖尿病肾病患者随机分为对照组 33例和治疗组 39例 ,对照组采用常规治疗 ,治疗组在常规治疗基础上加用葛根素注射液 ,然后比较两组治疗前后的尿微量白蛋白的值。结果 :对照组治疗前后尿微量白蛋白分别为 (95 .1± 61 .4) μg/min和(92 .3± 64 .9) μg/min ,差异无显著性 (P >0 .0 5) ;治疗组治疗前后尿微量白蛋白为 (1 0 0 .5± 51 .5) μg/min和(52 .5± 33 .0 ) μg/min ,差异有显著性 (P <0 .0 1 )。 结论 :葛根素具有降低早期糖尿病肾病的尿微量白蛋白的作用。     

肾病患者血清载脂蛋白A_1、B、高密度脂蛋白胆固醇水平的测定价值

目的　为探讨肾病患者继发动脉粥样硬化性心血管合并症的危险因素。方法　用免疫比浊法和直接测定法测定 2 7例无合并症的肾病患者和 36例健康人的血清载脂蛋白 (apo)A1、B、高密度脂蛋白胆固醇 (HDL -c)水平。结果　对照组的apoA1、apoB、apoA1/apoB ,HDL -c水平分别为 1.4 8± 0 .2 8g/L、0 .93± 0 .2 0 g/L、1.37±0 .34、1.4 8± 0 .30mmol/L ;患者分别为 1.2 1± 0 .31g/L、1.34± 0 .2 2g/L、0 .78± 0 .4 0、0 .98± 0 .36mmol/L ,两组间的结果差异均具有显著性意义 (P <0 .0 5 )。结论　肾病患者在出现动脉粥样硬化性心血管合并症之前 ,体内已经具备了诱发合并症的生化基础 ,故临床上应早期采取针对性预防措施。     

肝硬化难治性腹水的超滤浓缩回输治疗

目的　研究腹水超滤浓缩回输治疗难治性腹水的疗效。方法　利用FCN 0 1型腹水超滤浓缩回输机及DY 10 6 0一次性腹水浓缩器对 2 2例难治性腹水患者在抽取腹水浓缩后进行静脉回输。结果　显示症状改善 ,腹水明显消退 [治疗前后腹围为 (89± 8)cm、(78± 6 )cm ,P <0 .0 5 ];血浆白蛋白升高 [治疗前后为 (2 5 .2± 7.2 ) g/L、(36 .3± 6 .7)g/L ,P <0 .0 5 ];每 2 4h尿量显著增加 [治疗前后为 (6 4 0± 4 0 )ml、(12 0 0± 6 0 )ml/,P <0 .0 1];血尿素氮和肌酐则下降 [治疗前后分别为 (9.3± 3.8)mmol/L、(5 .8± 3.0 )mmol/L和 (14 9.2± 2 6 .3) μmol/L、(89.5± 17.2 )μmol/L ,P <0 .0 5 ];腹水中蛋白质明显上升 [治疗前后为 (5 .2 3± 1.2 )g/L、(2 2 .14± 1.5 ) g/L ,P <0 .0 1]。 结论　超滤浓缩回输是临床上治疗难治性腹水的一种实用且有效的方法     

阿卡波糖联合二甲双胍对动脉粥样硬化危险因素的影响

目的　评价对动脉粥样硬化危险因素的影响。方法　肥胖患者 33例 ,均诊为初发型高血压病、冠心病或脑梗死。对其分别予以常规治疗的同时 ,加服阿卡波糖和二甲双胍 ,治疗期间未服用其他影响血糖和血脂的药物。坚持治疗 30例 ,检测其治疗前后血糖、胰岛素、糖化血红蛋白及血脂水平。结果　 8周后餐后 2h血糖由(11.82± 2 .72 )mmol/L降到 (7.74± 1.19)mmol/L ,糖化血红蛋白由 (8.2 7± 2 .5 8) %降到 (6 .36± 1.32 ) % ;空腹胰岛素由 (2 7.93± 9.32 )U/L降到 (15 .4 5± 3.5 6 )U/L ;餐后 2h胰岛素由 (172 .2 4± 5 2 .95 )U/L降到 (10 1.80± 38.83)U/L ,血清胆固醇由 (6 .5 2± 1.82 )mmol/L降到 (5 .0 2± 1.6 4 )mmol/L ,血清甘油三酯由 (3.12± 1.2 0 )mmol/L降到(2 .19± 0 .81)mmol/L ,低密度脂蛋白由 (4.2 8± 0 .4 0 )mmol/L降到 (2 .95± 0 .5 1)mmol/L ,脂蛋白 (a)由 (0 .39±0 .12 )g/L降到 (0 .2 8± 0 .2 0 )g/L ,均有显著差异 (P <0 .0 5 )。结论　阿卡波糖联合二甲双胍对多种致动脉粥样硬化的危险因素有明显改善作用     

低分子肝素在肾病综合征中的应用

目的 :探讨低分子肝素吉哌啉对肾病综合征的治疗作用 ;方法 :3 9例原发性肾病综合征按治疗方法分为两组 :A组为观察组 ,共 2 0例 ,B组为对照组 ,共 1 9例 ,两组患者均给予钙离子拮抗剂 ,强的松 1mg/ (kg·d)顿服 ,视病情用 6周～ 8周 ,环磷酰胺 2 0 0mg隔日一次静脉注射 ,视病情用量 6g～ 8g。A组加用低分子肝素吉哌啉 50 0 0u +生理盐水40ml静脉注射 2 0天～ 2 5天为一疗程 ;结果 :治疗后 2 4小时尿蛋白定量A组较B组显著减少 (0 .82 g± 0 .64 gVS 1 .99g± 0 .85g,P <0 .0 1 ) ,治疗后血浆白蛋白定量A组较B组有明显回升 (3 1 .8g/L± 5.77g/LVS 2 7.3 6g/L± 7.55g/L ,P <0 .0 5) ,说明A组疗效优于B组 ;结论 :低分子肝素吉哌啉在治疗肾病综合征中的抗凝作用减轻了肾小球基膜阴离子电荷的损伤 ,最终可减少尿蛋白的排出 ,增强治疗肾病综合征的疗效。     

麦考酚酸酯治疗IgA肾病的随访对照观察

目的　对比研究麦考酚酸酯 (MMF)对IgA肾病的临床疗效、安全性和耐受性。方法　选择病理诊断IgA肾病IV～V级 (Lee分级 ) ,蛋白尿 >2 0g/d ,血肌酐 <35 5 μmol/L的患者共 6 2例 ,分为MMF组和对照组。MMF组初始剂量给MMF1 0g/d(体重 <5 0kg)或 1 5g/d(体重 >5 0kg) ,治疗 6个月后减量至 0 75～ 1 0g/d ,12个月后可减至 0 5～ 0 75g/d ;对照组给予醋酸泼尼松片 0 8mg·kg-1·d-1,规律减量。分别于治疗前及治疗后 3、6、12、18、2 4个月测定尿蛋白定量、尿N 乙酰氨基 β 葡萄糖苷酶酶 (NAG酶 )、内生肌酐清除率、血浆尿素氮、肌酐、白蛋白、甘油三酯、胆固醇及肝功能等多项临床指标。对MMF组 5例重复肾活检患者治疗前后的肾脏病理改变进行半定量分析。结果　 (1)治疗3个月时 ,MMF组尿蛋白定量 (1 9g/2 4h± 1 6g/2 4h)较治疗前 (3 2g/2 4h± 1 7g/2 4h)明显减少 (P<0 0 1) ,白蛋白 (41g/L± 6g/L)较治疗前 (37g/L± 7g/L)明显升高 (P <0 0 1) ;但对照组尿蛋白定量(2 3g/2 4h± 1 9g/2 4h)、白蛋白 (30g/L± 7g/L)与治疗前 (2 9g/2 4h± 1 4g/2 4h、37 1g/L± 5 8g/L)比较差异无显著意义 (P >0 0 5 )。治疗 6、12及 18个月时 ,两组尿蛋白定量均较治疗前明显降低 (P<0 0 1) ,白蛋白均明显升高 (     

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.     

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.     

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.