2型糖尿病患者血脂、脂蛋白及载脂蛋白水平的变化分析

目的 探讨血脂、脂蛋白及载脂蛋白在2型糖尿病患者中的变化及意义.方法 检测124例2型糖尿病患者和60例健康对照者血清中胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇酯(HDL-C)、低密度脂蛋白胆固醇酯(LDL-C)、载脂蛋白A,(ApoA1)、载脂蛋白B(ApoB)和脂蛋白a[LP(a)]的水平变化.结果 糖尿病组的TC、TG、LDL-C和Lp(a)水平明显高于对照组,而HDL-C和ApoA1/ApoB水平明显低于对照组,差异有显著性.有血管病变组的TC、TG、LDL-C和Lp(a)水平明显高于无血管病变组,而HDL-C和ApoA1/ApoB水平明显低于无血管病变组,两组比较差异有显著性.结论 糖尿病患者体内存在着血脂、脂蛋白及载脂蛋白水平的变化,并在糖尿病发生血管病变中发挥着重要作用.     

老年冠心病患者超敏C反应蛋白与血脂联合检测结果分析

目的 探讨老年冠心病患者超敏C反应蛋白和血脂检测分析的临床意义.方法 测定180例老年冠心病患者和150例老年正常对照组血清超敏C反应蛋白(HS-CRP)、总胆固醇(TC),甘油三脂(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、脂蛋白(a)[Lp(a)]水平并进行统计学分析.结果 180例老年冠心病患者和150例正常对照组HS-CRP、TC、TG、LDL-C、ApoB、Lp(a)均显著高于正常组(P＜0.01),HDL-C、ApoA1低于正常组(P＜0.01).结论 HS-CRP是心血管疾病的独立危险因素,冠心病患者HS-CRP与血脂代谢异常有相关性;其与血脂联合检测对老年冠心病的诊断和治疗有重要意义.     

妊娠期妇女血脂水平的调查分析

目的 探讨正常妊娠妇女的血脂及载脂蛋白水平的变化及临床意义.方法 对100例正常妊娠妇女和100例正常育龄未孕妇女的血清总胆固醇(TotalCholesterol,TC)、甘油三酯(Triglyceride,TG)、低密度脂蛋白-胆固醇(10w Density Li-poprotein Cholesterol,LDL-C)、高密度脂蛋白-胆固醇(High Density Lipoprotein Cholesterol,HDL-C)、血清载脂蛋白A1(Apolipoprotein A I,ApoA1)、载脂蛋白B(Apolipoprotein B,ApoB)进行检测.结果 两组各项指标比较,正常妊娠组TC、TG、LDL-C及ApoB水平明显高于对照组(P均<0.01),而其HDL-C和ApoA1水平则明显低于对照组(P均<0.01).结论 正常妊娠妇女血清多项脂类呈现出规律性变化,孕妇处于生理性高血脂状态,是妊娠过程中一种正常的生理性适应变化,应重视妊娠妇女血脂的监测.     

2型糖尿病患者大血管病变与脂蛋白(a)的关系

目的 了解2型糖尿病(type 2 diabetes mellitus ,T2DM)患者大血管病变与脂蛋白(a)[lipoprotein (a),Lp(a)]的关系.方法 对238例T2DM患者采用彩色多普勒仪检查两侧颈总动脉平均内膜厚度(intima-media thickness,IMT),分为内膜正常组、内膜增厚组、斑块形成组,并测定血压、体质量指数(body mass index ,BMI)、空腹血糖(fasting plasma glucose ,FPG)、Lp(a)、三酰甘油(triglyceride ,TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol ,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol LDL-C)、载脂蛋白A(apolipoprotin A ,ApoA)、载脂蛋白B(apolipoprotin B,ApoB).分析Lp(a)与其他血脂成分的关系、IMT与Lp(a)和其他成分的相关性.结果 性别、FPG、BMI在正常IMT组、内膜增厚组、斑块形成组3组之间的差异无统计学意义(P＞0.05),TC、LDL-C、TG、HDL-C、ApoA、ApoB和Lp(a)在3组中两两比较差异均有统计学意义(P＜0.05);Lp(a)与HDL-C、ApoA、ApoB有明显相关性;年龄、LDL-C、Lp(a)与IMT厚度高度相关(P＜0.01).结论 Lp(a)水平与HDL-C、ApoA、ApoB有较好的相关性,Lp(a)增高是动脉粥样硬化性疾病的独立危险因素.     

急性冠脉综合征血脂特点与脂蛋白a的相关性

目的研究急性冠脉综合征(ACS)患者的血脂特点及脂蛋白a(Lp(a))的相关性。方法对85例ACS患者的总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A-I(ApoA)、载脂蛋白B(ApoB)、Lp(a)的含量进行测定,并与40例稳定性心绞痛(SA)患者比较,分析Lp(a)与血脂因素的相关性。结果ACS组TC、TG、LDL-C明显升高,血清Lp(a)浓度高于SA组(P0.001)。ACS组血清Lp(a)水平与血脂各指标无明显相关性(P0.10)。结论急性冠脉综合征存在血脂代谢紊乱,但Lp(a)含量与血脂因素没有相关性。     

妊娠期糖尿病患者血糖、血脂、血浆脂蛋白及载脂蛋白水平测定

目的:探讨妊娠期糖尿病孕妇血糖控制水平与其血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、极低密度脂蛋白胆固醇(VLDL-C)、载脂蛋白A1、B(ApoA1、ApoB)水平变化的关系。方法:选择妊娠期糖尿病(GDM)孕妇30例,其中19例为血糖良好控制组,11例为血糖控制不良组,对照组正常孕妇30例(正常妊娠组)。3组分别于孕32~36周抽取静脉血,测定空腹静脉血清TC、TG、HDL-C、LDL-C、VLDL-C、ApoA1及ApoB。结果:血糖良好控制组与对照组相比,各测定值差异均无统计学意义(P>0.05);而血糖控制不良组与对照组相比,除TC外,各测定值均与对照组差异有统计学意义,TG、LDL-C、VLDL-C、ApoB均较对照组明显升高(P<0.05),而HDL-C、ApoA1测定值较对照组显著降低(P<0.05)。结论:GDM患者,血糖控制在满意范围内,其血脂,血浆脂蛋白及载脂蛋白不会发生严重紊乱,对母体的健康不会产生严重的不利影响;反之,其血脂、血浆脂蛋白及载脂蛋白代谢将发生严重紊乱。     

A2型妊娠期糖尿病与血脂代谢水平相关性分析

目的观察妊娠期糖尿病（GDM）孕妇与正常孕妇血脂的差异,探讨妊娠中晚期血脂与A2型GDM的相关性。方法对GDM孕妇根据是否使用胰岛素控制血糖的分为观察组A1（53例）、观察组A2（43例）,正常孕妇49例为对照组。比较对照组、观察组A1及观察组A2孕妇妊娠中晚期总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、脂蛋白a、载脂蛋白A1（ApoA1）和载脂蛋白B（ApoB）的水平,并分析血脂与A2型GDM的相关性。结果观察组A2孕中期的TG、HDL-C、Apo A1、脂蛋白a及孕晚期的TC、TG、HDL-C、Apo A1与对照组比较差异有统计学意义（P < 0.05~P < 0.01）,观察组A1孕中期的HDL-C、Apo A1、脂蛋白a及孕晚期的ApoA1、HDL-C与观察组A2比较差异有统计学意义（P < 0.01）。logistic回归分析,孕中期ApoA1、孕晚期TC及孕晚期HDL-C与A2型GDM密切相关,ROC曲线分析在三者联合预测孕期发生A2型GDM的中,曲线下面积为0.869,95%CI为0.795~0.943,具有较高预测可信度（P < 0.05）。结论孕中期ApoA1、孕晚期TC及孕晚期HDL-C与孕期A2型GDM的发生发展相关。     

甲状腺功能减退症患者治疗后的血脂水平变化

目的：探讨甲状腺功能减退症患者甲状腺激素治疗后的血脂变化。方法：52例患者给予甲状腺片口服治疗，每日20～80mg，治疗前及甲状腺功能恢复正常后分别检测总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆圉辟(HDL-C)、栽脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、脂蛋白(a)[Lp(a)]，低密度脂蛋白(LDL-C)经公式换算得出数值。结果：TC、LDL-C、ApoB、Lp(a)经治疗后显著降低，分别降低30％、42％、40％、47％，TG、HDL-C、ApoA1变化不大。结论：甲状腺功能减退症患者经甲状腺片治疗后使血浆TC、LDL-C、AooB、Lp(a)显著下降。     

血脂异常与脑血管疾病相关性临床探讨

目的探讨脑梗死与脑出血患者血脂与血清脂蛋白异常的相关性。方法对78例脑梗死、69例脑出血患者及70例正常对照血清甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白A（ApoA）、载脂蛋白B（ApoB）、脂蛋白Lp（a）和ApoAI/ApoB检测结果进行统计分析。结果脑梗死组TG、TC、HDL-C、LDL-C、ApoAI/ApoB与正常对照组比较差异有统计学意义（P〈0.05）;脑出血组与正常对照组比较差异无统计学意义（P〉0.05）。结论脑梗死与脑出血血脂代谢异常有显著差异。     

孕妇脂代谢水平与巨大儿发生的相关性研究

目的:探讨孕妇脂代谢水平与巨大儿发生的关系。方法:测定2244例非妊娠合并糖尿病孕妇妊娠晚期血清中空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白AⅠ(ApoAⅠ)及载脂蛋白B(ApoB)水平,详细记录孕妇年龄、孕次、孕前体重、身高、分娩孕周、实验室数据及新生儿性别、体重,根据新生儿出生体重分为巨大儿组及正常体重儿组进行比较。结果:(1)巨大儿组孕妇的TG、ApoB水平显著高于正常体重儿组(P<0.001),而HDL-C、ApoAⅠ水平显著低于正常体重儿组(P<0.05),两组孕妇间TC、LDL-C水平差异无统计学意义(P>0.05);(2)高血脂组孕妇巨大儿的发生比例高于正常血脂组(P=0.011);(3)新生儿出生体重与孕妇血TG水平显著正相关(r=0.315,P<0.001)。结论:孕期注意监测孕妇血脂变化,合理饮食比例,控制血脂,对于预防巨大儿的发生具有临床意义。     

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.