原发性醛固酮增多症的实验室检验

目的：探讨原发性醛固酮增多症（原醛）的生化特点。方法：分析64例原醛患者的临床特点和手术前后实验室检验结果的变化。结果：64例中,醛固酮瘤（APA）47例（73.4%）,特发性醛固酮增多症（IHA）15例（23.4%）,原发性肾上腺皮质增生（PAH）2例（3.2%）。56例（87.5%）有不同程度的高血压。术前低血钾56例（87.5%）,APA患者严重低血钾发生率高于IHA（P〈0.01）;血浆醛固酮升高55例（85.9%）,血浆低肾素48例（75.0%）;APA和IHA组高醛固酮和低肾素发生率相似（P〉0.05）。5例高血压、血钾、醛固酮正常的APA患者,血醛固酮/肾素活性比值（PAC/PRA）〉30。术后平均随访20.4个月,APA和IHA患者术后血钾恢复正常率无统计学意义（P〉0.05）;高血压治愈和缓解率APA优于IHA（P〈0.05）;手术有效的患者血醛固酮、血醛固酮/肾素活性比值均恢复正常。术前低肾素患者高血压治愈率高于肾素正常者（P〈0.05）。结论：血钾、血浆肾素、醛固酮测定是诊断原发性醛固酮增多症的主要指标,血醛固酮/肾素活性比值有助于原醛的早期诊断。实验室检验对于术后疗效随访和预后评估有重要意义。     

卡托普利试验对原发性醛固酮增多症诊断价值的初步探讨

  目的  评价卡托普利试验（CCT）后各试验指标对原发性醛固酮增多症（简称原醛症）的诊断价值。  方法  回顾性收集2012年6月?2017年10月在四川大学华西医院住院的184例高血压患者的临床资料,使用受试者工作特征（ROC）曲线对CCT后血醛固酮水平/肾素活性（ARR）、血浆醛固酮水平（PAC）、血浆肾素活性（PRA）以及PAC抑制率这4项指标进行评价。  结果  184例高血压患者中原醛症（PA组）125 例,原发性高血压（EH组）59 例,后者又分为正常肾素原发性高血压（NREH组）38 例,低肾素原发性高血压（LREH组）21 例。EH组与PA组CCT后PAC抑制率中位数（P₂₅,P₇₅）分别为0.190（0.083,0.351）与0.125（0.024,0.237）。LREH组CCT前、后PRA低于NREH组（P<0.001）,与PA组比较则差异无统计学意义（P>0.05）。LREH组口服卡托普利后PRA和ARR与PA组有很大重叠,而服药后PAC与PA组重叠范围很小。在原醛症与原发性高血压的鉴别诊断中,CCT后ARR、PAC、PAC抑制率和PRA曲线下面积分别为0.860〔95%置信区间（CI）:0.800～ 0.907〕、0.881（95%CI:0.825～0.924）、0.771（95%CI:0.703～0.831）和0.632（95%CI:0.558 ~ 0.701）,前两者比较差异无统计学意义（Z=0.443,P=0.658）,且均高于后两者（P<0.05）。CCT后PAC与ARR在PA组与EH组中诊断原醛症最佳切点值分别为19.24 ng·dL－1 （敏感性78.4%,特异性88.1%）和32.47 (ng·dL－1)/(ng·mL－1·h－1)（敏感性84.17%,特异性72.41%）。  结论  CCT后ARR和PAC对原醛症诊断价值均较PAC抑制率高,尤以PAC更适合作为原醛症的确诊试验指标。     

高血压患者中原发性醛固酮增多症的检出率及特点

目的：分析探讨高血压患者中原发性醛固酮增多症的检出率及特征。方法：选取122例高血压患者作为研究对象,对本组患者实施醛固酮增多症检测以及其他指标的检测,从而有效的排除其他继发性高血压患者。将该122例患者分为醛固酮增多症组和原发性高血压组;2组患者均实施卧、立位试验,血钾及肾上腺薄层CT检测,同时一部分患者实施午夜地塞米松抑制试验、促肾上腺皮质激素及性激素测定,对患者主要观察的指标有血醛固酮、醛固酮与肾素活性比值以及肾素活性等。结果：2组患者中共有24例患者被确诊为原发性醛固酮增多症,所占比例为19．67％,此外并未发现无功能腺瘤;2组患者在一般资料上无显著性差异,但原发性醛固酮增多症组在卧、立位血醛固酮及醛固酮与肾素活性比值均发生显著升高,而血肾素活性出现明显下降,差异显著性（P＜0．05）,在血钾水平上则无较大差异（P＞0．05）。结论：在同一时期住院的高血压患者中原发性醛固酮症有着较高的检出率,这其中以醛固酮腺瘤和单侧肾上腺增生的比值较为接近。     

原发性醛固酮增多症的诊断分析

目的：探讨原发性醛固酮增多症的诊断。方法回顾性分析我院从2012年8月到2015年10月手术病理确诊的42例原发性醛固醇增多症患者的临床资料。统计患者血浆醛固酮(PAC)与肾素比值(ARR)及血浆醛固酮指标用于临床诊断的检出率及诊断符合率,阳性率等。结果女性原发性醛固醇增多症患者其血钾水平低于男性,差异具统计学意义(P＜0.05)。当ARR高于30时,原发性醛固酮增多症的检出率高于ARR＞30且PAC＞415pmol/L,差异具统计学意义(P＜0.05)。结论通过监测疑似PA患者值的变化,当ARR高于30时,原发性醛固酮增多症的检出率为83.33%,高于其他临床指标检出率,值得临床广泛推广应用。     

原发性醛固酮增多症中低血钾对糖代谢的影响

目的 探讨低血钾在原发性醛固酮增多症[包括肾上腺醛固酮分泌腺瘤（APA）、特发性醛固酮增多症（IHA）]患者糖、胰岛素代谢中的作用。方法根据有无低血钾将178例原发性醛固酮增多症患者（APA 103例、IHA 75例）分为低血钾组和正常血钾组,2组均行3h口服葡萄糖耐量试验和卧立位醛固酮试验,观察血糖、胰岛素变化与血钾之间的关系。结果低血钾组血钾曲线下面积、胰岛素曲线下面积、空腹胰岛素水平均低于正常血钾组（P〈0．05,P〈0．01）;低血钾组血糖曲线下面积、卧位醛固酮水平均高于正常血钾组（P〈0．05）;低血钾组糖耐量异常者为75．3％,正常血钾组为48．5％,两组比较差异具有显著性（P〈0．01）。APA和IHA中代谢综合征的患病率分别为38．8％、57．3％,两者比较差异具有显著性（P〈0．05）。结论低血钾是导致原发性醛固酮增多症患者中胰岛素分泌下降的可能原因之一;应警惕原发性醛固酮增多症患者合并代谢综合征的情况,并及时纠正其可能存在的代谢紊乱。     

原发性醛固酮增多症高血压患者的临床特点分析

目的探讨分析原发性醛固酮增多症致高血压患者的临床特点。方法选取2013年12月-2014年12月我院收治的原发性醛固酮增多症高血压患者45例作为观察组,另选取同期就诊的原发性高血压患者50例作为对照组。通过相应临床检查及实验室检查结果分析原发性醛固酮增多症高血压患者的临床特点及其与原发性高血压的差异性。结果两组患者血钾、血钠指标比较无显著差异,观察组患者收缩压与舒张压略高于对照组,但无显著差异(P0.05);观察组卧位与站立位下肾素活性(PRA)、血醛固酮(PAC)以及醛固酮-肾素比值(ARR)水平与对照组比较差异有显著统计学意义(P0.05)。结论原发性醛固酮增多症高血压患者与原发性高血压临床表现类似,但在PRA、PAC、ARR水平等比较上存在显著差异,可作为原发性醛固酮增多症高血压临床特征及初步诊断依据。     

46例腺瘤型原发性醛固酮增多症的临床分析

目的探讨腺瘤型原发性醛固酮增多症的临床特点。方法回顾性分析46例经手术病理证实的腺瘤型原发性醛固酮增多症患者的临床资料。结果所有患者均伴有高血压,以高血压为首发症状者43例（93．48％）,其中1、2、3级高血压分别为2．17％、17．39％、80．44％;伴肌无力、乏力或肢端麻木者23．52％。平均血钾浓度为（3．37±0．38）mmol／L,其中低钾血症者26例（56．52％）;低血浆肾素活性者37例（80．43％）,血浆醛固酮水平增高者38例（82．62％）;肾上腺CT扫描对腺瘤型原发性醛固酮增多症的诊断阳性率为93．48％。结论腺瘤型原发性醛固酮增多症主要表现为重度高血压伴低肾素活性及高醛固酮血症,低钾血症的发生率少于60％;肾上腺CT扫描对腺瘤型原发性醛固酮增多症的诊断有重要价值。     

静脉盐水负荷试验在原发性醛固酮增多症诊断中的应用

目的 探讨静脉盐水负荷试验在原发性醛固酮增多症(原醛症)诊断中的应用价值.方法 2004～2006年临床确诊原醛症患者65例,其中醛固酮瘤27例,特发性醛固酮增多症(特醛症)26例,原发性肾上腺增生11例,醛固酮癌1例.所有患者检测血电解质,血、尿醛固酮及立位血浆肾素活性等生化指标,同时行静脉盐水负荷试验.以19例原发性高血压患者作为对照组.结果 与对照组比较,原醛症组患者的血、尿醛固酮明显升高,而血钾及立位血浆肾素活性则低;原醛症组和对照组静脉盐水负荷后血醛固酮不能抑制者分别为95.4%(62/65)和21.1%(4/19);该试验对原醛症诊断的敏感性和特异性分别为95.4%和93.9%.65例原醛症患者中,醛固酮瘤和原发性肾上腺增生患者的血钾较特醛症患者低,而血、尿醛固酮则高;醛固酮瘤、特醛症、原发性肾上腺增生及醛固酮癌患者的静脉盐水负荷后血醛固酮的抑制率分别为16.1%、28.9%、15.4%和5.2%.结论 原发性肾上腺增生患者生化指标改变与醛固酮瘤患者类似,均较特醛症患者更为明显.静脉盐水负荷试验是一项安全且可靠的原醛症确诊方法,其敏感性和特异性均较高.     

立卧位试验在原发性醛固酮增多症分型中的应用价值

原发性醛固酮增多症是由于肾上腺皮质肿瘤或增生致醛固酮分泌增多，引起潴钠排钾、体液容量扩张而抑制了肾素-血管紧张素-醛固酮（RAS）系统。临床上以高血压、低血钾为主要特点，最常见的分型包括有肾上腺醛固酮瘤（APA）和特发性醛固酮增多症（IHA）。APA患者手术能够治愈，而IHA患者往往手术疗效不佳，多考虑药物治疗，因此进行术前分型诊断具有重要的临床价值。本文对外科手术后病理明确诊断的原发性醛固酮增多症患者进行立卧位试验回顾分析，     

原发性醛固酮增多症30例临床分析

原发性醛固酮增多症 (原醛症 )主要包括醛固酮瘤(APA)和特发性醛固酮增多症 (IHA)。患者由于肾上腺皮质球状带肿瘤或增生 ,醛固酮分泌增多 ,导致水钠潴留、体液容量扩张而抑制了肾素 -血管紧张素 ,引起高血压、低血钾、代谢性碱中毒为主要临床表现的综合征。我院近年收治 30例该类患者 ,现将其临床特点综合分析如下。1　临床资料1.1　一般资料　男性 16例 ,女性 14例 ,年龄 35～ 6 6岁 ,平均为 (49± 6 .2 )岁。临床根据高血浆醛固酮、低血钾、高血压、低血浆肾素定性诊断 3例 ,经手术证实 2 7例 ,其中 APA 17例 ,IHA10例。病程最长 2 …     

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.