老年人T2DM合并下肢动脉粥样硬化疾病不同证型间相关指标分析

目的对老年T2DM合并下肢动脉粥样硬化疾病中医证型与理化指标的相关性展开分析。方法选取100例老年T2DM合并下肢动脉粥样硬化疾病患者作为研究对象。统计T2DM合并下肢动脉粥样硬化疾病的中医证型分布特点及多项生化指标与糖尿病下肢动脉粥样硬化的关系。结果根据中医辨证分为五组,以气阴两虚证型最多,其次血瘀脉络证,再其次为湿热困脾证、阴虚热盛证和阴阳两虚证。血瘀脉络组及气阴两虚组合并高血压及冠心病明显大于其他三组,而且血瘀脉络组气阴两虚组,有显著性差异(χ~2=11.403,P=0.009)。血瘀脉络组空腹血糖、甘油三酯与气阴两虚组比较,有显著性差异(P0.05),余组之间无显著性差异(P0.05);血瘀脉络组、阴阳两虚组糖化血红蛋白、低密度脂蛋白与气阴两虚组比较,有显著性差异(P0.05),余组之间无显著性差异(P0.05);血瘀脉络组、气阴两虚组同型半胱氨酸与阴虚热盛组比较,有显著性差异(P0.05);血瘀脉络组(HOMA-IR)气阴两虚组(HOMA-IR)湿热困脾组、阴虚热盛组、阴阳两虚组(HOMA-IR),气阴两虚组及血瘀脉络组与湿热困脾组、阴虚热盛组、阴阳两虚组比较有显著性差异(P0.05)。HOMA-β(CP)湿热困脾组、阴虚热盛组、阴阳两虚组明显大于气阴两虚组及血瘀脉络组比较有显著性差异(P0.05)。结论老年T2DM合并下肢动脉粥样硬化疾病患者不同中医证型间的理化指标的确存在差异性,为中西医结合防治此病提供一定参考。     

2型糖尿病不同中医证型C肽释放试验特征的临床研究

目的:探讨2型糖尿病不同证型患者在C肽释放试验中的表现特征。方法:151例首发2型糖尿病患者进行中医辨证分型,测定空腹及餐后1小时、2小时、3小时血浆C肽含量,对比不同中医证型间血浆C肽释放水平。结果:空腹C肽释放:湿热困脾证以高分泌型为主,阴虚热盛证、气阴两虚证、血瘀脉络证以正常分泌型为主,阴阳两虚血瘀水停证以低分泌型为主。餐后C肽释放:湿热困脾证、阴虚热盛证以有峰而延迟型为主,气阴两虚证、血瘀脉络证以有峰正常型为主,阴阳两虚血瘀水停证以无峰低平型为主。空腹C肽峰值:湿热困脾证显著高于其它各证(P0.05),阴阳两虚血瘀水停证显著低于其它各证(P0.05),阴虚热盛证、气阴两虚证、血瘀脉络证之间无明显差异。餐后C肽峰值,湿热困脾证、阴虚热盛两证显著高于其它证(P0.05),阴阳两虚血瘀水停证显著低于其它证(P0.05)。结论:中医证型与C肽释放分型存在一定的关系,C肽释放分型可作为T2DM中医证型辨证的微观指标之一。     

2型糖尿病患者血糖、血脂、尿微量白蛋白及免疫指标与中医辨证分型的相关性

目的探讨糖尿病患者血清血糖、血脂、IL-6、IL-8、THF-α和尿微量白蛋白与中医辨证分型的关系。方法血糖、胆固醇、尿微量白蛋白采用OlympusAU400全自动生化分析仪。IL-6、IL-8、THF-α采用放射免疫法测定其水平。结果细胞因子在糖尿病发病中起到一定作用。阴阳两虚组显著高于正常组及阴虚热盛组。阴阳两虚型患者并发症发生率显著高于阴虚热盛组及气阴两虚型。结论阴虚虚热盛组及气阴两虚组IL-6、IL-8、THF-α显著高于健康人对照组,比较无统计学意义。但阴阳两虚型IL-6、IL-8、THF-α显著高于健康人对照组、阴虚热盛组及气阴两虚组;阴阳两虚型患者并发症发生率显著高于阴虚热盛组及气阴两虚型。     

2型糖尿病证病结合动物模型的研究

目的探讨2型糖尿病证病结合动物模型的造模方法及成模标准，建立2型糖尿病病证结合动物模型。方法应用STZ造成大鼠糖尿病（FBG≥16.7mmol/L）后应用中药造成中医阴阳两虚；阴虚热盛；气阴两虚；血瘀气滞证候模型。结果（1）造模后出现饮水增多、尿量增多、生长迟缓、身体消瘦、拉尾排便、排尿等糖尿病大鼠共同特征。阴阳两虚组大鼠还出现大便干燥、舌红等征象；阴虚热盛组大鼠出现大便干燥、舌红等征象；气阴两虚组大鼠出现精神萎糜、倦怠懒动、舌胖大，少津；血瘀气滞组大鼠还出现背毛减少、臀部毛色枯黄、性情暴烈、易激惹、捕捉时叫声频繁、抵抗力大、攻击行为频繁、大便质稀色深、舌质暗等血瘀气滞气滞的症状。（2）实验室指标有不同程度改变。结论应用传统的糖尿病造模方法与糖尿病病证特点和中药四气五味药性理论相结合，研制2型糖尿病病证结合动物模型具有可行性。     

2型糖尿病患者血同型半胱氨酸水平与中医证型间的相关性研究

目的:探讨2型糖尿病(T2DM)患者血同型半胱氨酸(Hcy)水平与中医证型的关系。方法:将202例T2DM患者辨证分为阴虚热盛型、气阴两虚型和阴阳两虚型3组,测定各组患者血总Hcy(tHcy)水平,并对中医证型与tHcy水平间的关系进行统计学分析。结果:202例T2DM患者中有73.76%合并高Hcy血症,其中阴阳两虚组血tHcy水平最高,气阴两虚组次之,阴虚热盛组最低,差异有统计学意义(P0.05)。结论:T2DM患者的血Hcy水平与中医证型之间存在一定的相关性。     

糖尿病微血管病变中医辨证分型与ACE基因多态性相关性研究

目的探讨中医证型与ACE基因多态性分布间的相关性。方法选择糖尿病微血管病变患者186例,中医辨证分为阴虚热盛型、气阴两虚型及阴阳两虚型,并采用PCR方法检测血管紧张素Ⅰ转化酶(ACE)基因多态性。结果ACE基因型及等位基因频率在阴虚热盛型与气阴两虚型间无显著性差异(P>0.05),而在阴虚热盛型与阴阳两虚型以及气阴两虚型与阴阳两虚型间均有显著性差异(P<0.05)。结论中医证型与ACE基因多态性有关联。ACE基因多态性可作为糖尿病微血管病变中医辨证分型的客观化指标依据。     

2型糖尿病(消渴病)微观辨证的临床研究

目的　为糖尿病的临床辨证、治疗用药提供客观依据和帮助。方法　观察 2型糖尿病 (消渴病 ,diabetesmellitus)不同证型患者各 30例 ,正常对照组 30例 ,检测血清一氧化氮 (NO)、血浆α -颗粒膜蛋白 (GMP 14 0 )、血浆D -二聚体 (D D)、血清白细胞介素 - 6 (IL 6 )这些微观指标的变化 ,探讨其与中医辨证分型的关系。结果　①血清NO值在各组中的变化是阴虚热盛组 >正常对照组>气阴两虚组 >气滞血瘀组 ,每两组间具有显著性差异 (P <0 0 5 ) ,其中气滞血瘀组与其它 3组具有非常显著性差异 (P <0 0 1)。②糖尿病各组患者血浆GMP 14 0、D D值均较正常对照组有非常显著性增高 (P <0 0 1) ,在糖尿病组各证型中 ,呈阴虚热盛组 <气阴两虚组 <气滞血瘀组变化趋势 ,且血浆GMP 14 0和D D的变化呈正相关 (r=0 6 6 )。③血清IL 6在糖尿病组较正常对照组升高 ,其变化呈阴虚热盛组 <气阴两虚组 <气滞血瘀组趋势 ,每两组间具有非常显著性差异 (P <0 0 1)。结论　糖尿病发病以正气不足为内在依据。随着病程的进展 ,脾肾亏虚及血瘀加重是必然趋势。治疗应重视补脾肾和活血化瘀     

天津市城市人群2型糖尿病中医诊断治疗情况

探讨天津市城市地区2型糖尿病中医辨证分型与治疗情况。 方法：回顾性调查2003-2007年天津市城市地区多中心不同等级中医医院2型糖尿病住院患者中医辨证分型情况,初步分析2型糖尿病患者的各中医证型构成比。 结果：天津市城市地区人群2型糖尿病患者证型分布比例由高到低依次为气阴两虚、痰湿内阻、阴虚热盛、阴阳两虚和血瘀气滞型。气阴两虚、阴阳两虚以及痰湿内阻型2型糖尿病患者主要集中在60岁以上人群,阴虚热盛型以50-59岁患者居多,而血瘀气滞型糖尿病患者在40-49岁分布比例较高。气阴两虚型患者当归使用频次最高,阴虚热盛型患者陈皮使用频次最高,阴阳两虚型患者白芍使用频次最高,痰湿内阻型患者甘草使用频次最高,血瘀气滞型患者杏仁使用频次最高。 结论：天津市城市地区2型糖尿病主要以气阴两虚、痰湿内阻和阴虚热盛型为主,主要集中在50岁及以上的中老年人群中。中药治疗原则以补气养血、燥湿化痰为主,当归、陈皮、白芍、甘草（生甘草、炙甘草）和杏仁是使用频次较高的5味中草药。     

慢性肾衰的中医证型与血浆内皮素、血清一氧化氮的关系

目的：研究慢性肾衰的不同中医证型与血浆内皮素（ET）、血清一氧化氮（NO）的关系。方法：150例慢性肾衰患者按照《中药新药临床研究指导原则》分为脾肾气虚型、气阴两虚型、脾肾阳虚型、阴阳两虚型及肝肾阴虚型组，并以30例健康体检者为对照组。测定并比较血浆ET与血清NO含量。结果：各组慢性肾衰患者血浆ET差异均有统计学意义（P〈0．01）。中医各证型血浆ET含量依次为对照组〈脾肾气虚组〈气阴两虚组〈肝肾阴虚组〈脾肾阳虚组〈阴阳两虚组。中医各证型血清NO含量依次为脾肾阳虚组〉阴阳两虚组〉肝肾阴虚组〉气阴两虚组〉脾肾气虚组〉对照组。在各病例组中ET和NO呈显著正相关（P〈0．01）。结论：慢性肾衰患者血浆ET、血清NO含量的变化可作为判断肾衰严重程度的客观指标。     

147例2型糖尿病患者中医辨证分型及临床指标相关性分析

目的探讨2型糖尿病中医辨证分型特点,分析各临床常规指标与证型的关系,为2型糖尿病中医辨证提供客观依据。方法收集147例合格2型糖尿病病例,按阴虚热盛、湿热困脾、气阴两虚、阴阳两虚辨证分型,同时配以30例同期健康体检者做对照。分析不同证型与年龄、病程、体质指数(BMI)、胰岛素敏感指数(ISI)、糖代谢、脂代谢等的关系。结果气阴两虚最多见;阴阳两虚型女性比例大于男性;年龄与病程变化趋势相同:阴虚热盛型<湿热困脾型<气阴两虚型<阴阳两虚型。各证型的BMI、空腹血糖(FPG)、餐后2 h血糖(2 h PBG)、糖基化血红蛋白(HbA1c)、ISI、高密度脂蛋白(HDL)、载脂蛋白AⅠ(ApoAⅠ)、甘油三酯(TG)、载脂蛋白B(ApoB)与对照组比较差异均有统计学意义(P<0.05);其中气阴两虚、阴阳两虚型HDL、ApoAⅠ与阴虚热盛、湿热困脾型比较差异有统计学意义(P<0.05);气阴两虚型的低密度脂蛋白(LDL)与对照组、阴阳两虚型差异有统计学意义(P<0.05)。结论 2型糖尿病辨证分型以气阴两虚型最多,证型变化有从阴虚热盛、湿热困脾、气阴两虚到阴阳两虚的趋势;2型糖尿病中医辨证分型与多项临床常规检查指标间存在相关性,对中医辨证客观化具有参考价值。     

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.