2型糖尿病中内皮细胞损伤及血小板功能状态的改变

目的:观察2型糖尿病患者内皮细胞损伤及血小板功能状态的变化及临床意义. 方法:利用双抗体夹心( ELISA)法测定血浆血管性血友病因子抗原(vWF:Ag)水平;采用玻珠柱法测定血小板黏附率(PAdT). 结果:vWF:Ag(160.8±35.6)%、PAdT(89.5±7.8)%水平显著高于无血管病变组,差异有显著意义(P<0.05～0.01). 结论:2型糖尿病患者均存在血管内皮损伤,并由此引起血小板功能状态的改变;血浆vWF:Ag及PAdT水平在一定程度上可反映2型糖尿病患者血管病变的情况.     

突发性聋患者血浆vWF、GMP-140水平的变化

目的通过测定突发性聋患者血浆凝血因子Ⅷ相关抗原(vWF)和血小板颗粒膜蛋白(GMP-140)水平变化,进一步探讨血管病变与突发性聋的关系。方法采用酶联免疫双抗体夹心法(ELISA)分别检测20例青年组(年龄≤60岁)突发性聋患者和20例老年组突发性聋患者血浆中vWF和GMP-140含量,并用相同的方法测定20例健康对照组上述指标。结果①突发性聋患者的血浆中vWF和GMP-140含量均较对照组明显增高,差异显著(P<0.01)。②老年组患者的血浆vWF和GMP-140含量较青年组患者明显升高,有显著性差异(P<0.05、P<0.01)。结论①突发性聋患者体内存在血管内皮细胞受损和血小板高度活化状态,并可能参与了突发性聋的发病过程。②老年患者比青年患者存在着更严重和(或)广泛的血管内皮细胞受损,以及更强烈的血小板激活反应。认为血管病变是突发性聋的重要病因之一。     

血小板α-颗粒膜蛋白测定与糖尿病微血管病变关系的研究

目的:研究血小板功能与Ⅱ型糖尿病微血管病变两者间的关系,方法:用放射免疫分析法测定的46例Ⅱ型糖尿病患者(有微血管病变20例,无微血管病变26例)和10例健康对照者的血浆CNP-14O浓度和外周血小板计数结果:Ⅱ型糖尿病患者血浆CMP-140浓度较对照组明显增高(P<0.05)有微血管病变组较无微血管病变组明显增高(P<0.001) 糖尿病组与对照组血小板计数无差异(P>0.05)GMP-140水平变化与空腹血糖、血浆胆固醇、年龄无相关性,与病程呈正相关,(r=0.407,P<0.01)。结沦:GMP-140水平变化与糖尿病微血管病变有密切关系     

阵发性睡眠性血红蛋白尿症血栓前状态部分指标的检测

目的:了解PNH患者凝血、纤溶及血小板功能变化,从而对PNH患者有关的血栓前状态进行评估。方法:vWF:Ag、GMP-140采用酶联免疫法;t-PA:A、PAI:A采用发色底物法;PAgT采用TYXN-91凝血仪,ADP为诱导剂。结果:PNH组 vWF:Ag、GMP-140、t-PA:A与PAgT均明显高于对照组(P<0.01,P<0.05),PAI:A无显著性变化(P>0.05)。结论:PNH患者存在血管内皮细胞损伤与血小板活化,从而有利于血栓形成。     

vWF、TM、GMP-140变化与糖尿病肾病的关系研究

目的观察血浆von Willebrand因子(von Willebrand factor,vWF)、血栓调节蛋白(thrombomodulin,TM)、血小板α-颗粒膜蛋白(Platelet alpha-granule membrane glycoprotein-140,GMP-140)在糖尿病肾病(diabetic nephropathy,DN)各期的水平,探讨其在DN发生、发展中的作用。方法检测30例正常人和90例2型DM患者血浆vWF、TM、GMP-140的水平,并进行统计学分析。结果①DM各组血浆vWF高于正常对照组(P<0.01)。②TM、GMP-140在正常白蛋白尿组出现有统计学意义的升高(P均<0.05)。结论①DM患者存在不同程度血管内皮损伤和血小板活化。②TM、GMP-140是早期诊断DN较敏感的指标,并能反映DN的发生和发展,与尿白蛋白排泄(Urinary AlbuminExcretion,UAE)联合检测有助于早期诊断DN。     

糖尿病患者血管紧张素转换酶与凝血变化的相关分析

目的观察2型糖尿病患者血清血管紧张素转换酶与凝血部分指标的变化及临床意义。方法利用双抗体夹心ELISA法检测76例2型糖尿病患者及45例健康对照者血浆血管性假性血友病因子抗原(VWF:Ag)、凝血酶调节蛋白(TM)、血小板选择素(P-Selection)水平;同时用免疫比浊法测血清血管紧张素转换酶(SACE)的水平。结果糖尿病组SACE(105.7±14.8)U/L,血浆VWF:Ag(159.2±20.1)%,TM(34.6±10.2)μg/L,P-Selection(21.5±4.6)μg/L水平均显著高于健康对照组,差异有显著意义;有血管病变的患者SACE(118.3±15.9)U/L,血浆VWF:Ag(172.5±30.3)%,TM(39.8±15.4)μg/L,P-Selection(24.6±7.3)μg/L水平均显著高于无血管病变组,差异有显著意义。结论2型糖尿病患者存在SACE高水平及一定程度的血管内皮损伤,并由此引起血小板活化和血液的高凝状态;血清SACE、血浆VWF:Ag、TM、P-Selection水平在一定程度上可能反映2型糖尿病患者血管病变的情况。     

血浆vWF:Ag、Fib及PLG活性水平与糖尿病微量白蛋白尿症的关系

目的 评价血浆vWF:Ag、Fib及PLG活性水平与糖尿病微量白蛋白尿症的关系.方法 血浆vWF:Ag采用ELISA测定,Fib采用凝血酶法测定,PLG活性通过发色底物法检测,UAER采用化学发光免疫法测定.结果 与正常对照组比较,糖尿病无并发症组血浆vWF:Ag、Fib水平及PLG活性均升高,差异有显著性(P<0.05);而糖尿病微量白蛋白尿症组血浆vWF:Ag、F1b水平及PLG活性升高更显著(P<0.01);同时,糖尿病微量白蛋白尿症患者血浆vWF:Ag、Fib、PLG活性水平与UAER显著相关(P<0.05).结论 糖尿病微量白蛋白尿症的发生与血管内皮损伤及凝血、纤溶异常相关.     

培哚普利改善高血压病患者血浆GMP-140与vWF水平的临床观察

目的:观察原发性高血压(EH)患者血浆GMP-140及vWF水平,探讨EH及其危险因素的防治措施。方法:收集EH患者75例,按血压高低分为3组,每组25例。另选15例健康者作为对照组。观察所有受试者血浆GMP-140及vWF水平。给予EH患者培哚普利片4mg,qd,口服2周后,若收缩压(SBP)>140mmHg或舒张压(DBP)>90mmHg,则增加剂量至4mg,bid。观察他们降压治疗前和治疗4周后两项指标的改变。结果:EH患者血浆GMP-140及vWF水平显著增高,且与EH级别密切相关。培哚普利降压治疗后,EH患者血压降至正常,血浆GMP-140及vWF也明显下降。相关分析表明,DBP分别与GMP-140及vWF显著正相关,GMP-140及vWF之间显著正相关。结论:EH患者存在血小板活性增强和内皮功能受损,且血管内皮损伤越重,血小板聚集功能越强。培哚普利可有效降压,并可显著抑制血小板活性和恢复血管内皮功能。     

PTCA术前、后血小板膜表面GMP-140测定及临床意义

利用抗人活化血小板α-颗粒膜蛋白(GMP-140)特异的单克隆抗体(SZ-51),采用放免法研究了42例经皮冠状动脉血管成形术患者术前、术后静脉血中血小板活化状态,发现术后患者GMP-140分子数明显高于术前(P<0.01),同时测vWF:Ag水平,术后也明显高于术前(P<0.01)。另外对其中20位患者随访发现有4位患者术后6个月内因持续剧烈胸病而再次入院,其血小板GMP-140水平在术后6个月内持续维持较高水平。表明PTCA术后病人存在血小板高活性状态,术后6个月内患者心血管事件的发生可能与血小板持续高水平有关。     

冠状动脉粥样硬化病变与血浆vWF及GMP-140水平的关系

目的:通过测定不同冠状动脉粥样硬化病变患者血浆血管性血友病因子(vWF)及α-颗粒膜蛋白(GMP-140)水平,探讨其临床意义.方法:70例接受选择性冠状动脉造影的患者(1)根据冠脉硬化病变形态分为S组(光滑斑块组);C组(复杂病变斑块组).(2)复杂病变组患者根据病变支数分为Ⅰ组(单支病变组);Ⅱ组(双支病变组);Ⅲ组(三支病变组).所有患者于冠脉造影前采血测定血浆vWF、GMP-140水平.结果:(1)C组血浆vWF、GMP-140水平显著高于S组.(2)Ⅲ组血浆vWF、GMP-140水平显著高于Ⅰ、Ⅱ组,Ⅱ组血浆vWF水平显著高于Ⅰ组.结论:1.冠脉造影表现为复杂形态病变者属于高危不稳定性病变.2.血浆vWF、GMP-140水平可作为判断冠状动脉粥样硬化病变的程度、范围及是否存在不稳定病变的间接指标.     

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.