纤维蛋白原与2型糖尿病下肢血管病变相关性分析

目的:探讨纤维蛋白原(FIB)与2型糖尿病(T2DM)下肢血管病变的相关性。方法:将T2DM202例根据踝肱比(ABI)分成两组:ABI≤0.9为外周动脉疾病(PAD)组,ABI>0.9为对照组,对两组患者年龄、性别、血压、病程、纤维蛋白原(FIB)、肌酐(Cr)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、胆固醇(TC)、低密度脂蛋白(LDL-C)及高密度脂蛋白(HDL-C)等多重动脉粥样硬化危险因素进行多变量分析。结果:Logistic回归分析表明T2DM并发PAD组血浆FIB水平升高,与年龄、血压、LDL-C均是T2DM并发PAD的危险因素。FIB等影响因素的多元逐步回归分析结果显示,FIB与T2DM病程、PAD、LDL-C具有相关性。结论:T2DM患者并发PAD时血浆FIB水平升高,因此应重视对FIB的干预。     

踝肱指数用于诊断糖尿病下肢外周血管病变的临床意义

目的 探讨踝肱指数(ABI)用于诊断糖尿病下肢外周血管病变(PAD)的临床价值. 方法 采用英国产ES-1000SPM血管多谱勒诊断仪对98名2型糖尿病患者进行ABI测定,以ABI＜0.9为异常,分成PAD组和非PAD组,比较两组病人的年龄、病程、血糖、血脂、肾功能、HbA1C. 结果 检出糖尿病下肢血管病变38例(38.8%),其中无临床症状者15例.和非PAD组比较,PAD组患者年龄大,病程长,餐后2 h血糖、TG、LDL-C、HbA1C均明显升高,有显著性差异(P＜0.05). 结论 踝肱指数可用于早期诊断糖尿病下肢血管病变,且无创、价廉、简单,患者易接受.高龄、病程长、高血糖、高TG、LDL-C是引起下肢血管病变的危险因素.     

糖尿病患者下肢动脉病变危险因素分析

目的 通过踝肱指数(ABI)检查,探讨糖尿病患者下肢外周动脉病变(PAD)的患病率,并分析影响ABI的危险因素.方法 对长寿区人民医院2007年6月至2008年12月住院糖尿病患者112例,使用多普勒血管超声仪检测ABI,同时检测血脂、HbA1C等;通过回归分析探讨影响ABI的危险因素.结果 112例糖尿病患者中,ABI降低组(ABI<0.9)13例(11.6%);ABI升高组(ABI≥1.3)6例(5.3%);ABI正常组(0.9≤ ABI< 1.3)91例(83.1%).与ABI正常者相比,ABI降低组患者年龄更大,病程更长,收缩压、TC、LDL-C更高;多因素Logistic逐步回归分析显示,年龄是导致ABI降低的独立危险因素,而病程和LDL-C是导致ABI升高的危险因素.结论 通过ABI检测发现,大约11.6%的糖尿病患者存在PAD;合并糖尿病PAD的患者血压、血脂代谢紊乱更为明显.因此,对门诊和住院糖尿病患者,应常规进行ABI检测以早期发现糖尿病PAD;严格控制血压、血脂对于预防糖尿病PAD至关重要.     

踝肱收缩压在诊断早期糖尿病下肢血管病变的临床研究

目的探究踝肱收缩压在诊断早期糖尿病下肢血管病变的临床研究价值。方法利用多普勒彩色血流探测器对本院2013年8月至2014年8月112例2型糖尿病患者进行ABI测定,将ABI0.9作为异常条件分为PAD(病变组)和非PAD(正常组)两个对照实验小组,观察并比较两组患者的年龄、病程、身体质量指数、空腹血糖、餐后2h血糖、糖化血红蛋白、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、胆固醇、肌酐。结果两组CHOL、Cr水平对比无明显差异,P0.05;其余指标均有明显差异,P0.05。结论利用ABI指数对于诊断早期糖尿病下肢血管病变能起到帮助,高龄、长病程、高TG、高血糖、LDL-C等是影响下肢血管病变的高危因素。     

踝臂指数与下肢动脉彩超对糖尿病下肢血管病变的诊断价值

目的探讨踝臂指数(ABI)、下肢动脉彩超在糖尿病下肢血管病变(PAD)中的诊断价值。方法 148例2型糖尿病患者进行ABI、下肢动脉彩超检查,根据四格表法分析ABI及下肢动脉彩超诊断PAD及PAD狭窄或闭塞的检出率,分别计算ABI检测PAD及PAD狭窄或闭塞的敏感度、特异度、阳性似然比、阴性似然比、阳性预测值及阴性预测值。结果下肢动脉彩超对糖尿病下肢血管病变检出率高于ABI(P0.05)。PAD早期ABI敏感性低,特异性高。PAD动脉狭窄或闭塞时,ABI敏感性明显升高,特异性仍较高。结论 ABI是一种简单、实用及无创的评价下肢动脉狭窄或闭塞的方法,但也有其局限性,超声检查仍是2型糖尿病患者PAD早期诊断的重要手段。     

皮肤晚期糖基化终末产物与2型糖尿病合并下肢动脉病变的相关性

目的 分析2型糖尿病伴下肢动脉病变患者皮肤晚期糖基化终末产物（AGEs）水平变化及其临床意义.方法 111 例2 型糖尿病患者,依据 ABI（ankle-brachial index,踝肱指数）不同将其分为DM1组（0.9≤ABI≤1.3,n=46）、PAD1组（0.5≤ABI〈0.9,n=51）、PAD2组（ABI〈0.5,n=14）,正常对照组35例,为同期体检健康人群.分别测定皮肤AGEs、糖化血红蛋白、ABI等指标.结果 与正常对照组相比,糖尿病患者皮肤AGEs水平明显升高（P〈0.05）;与DM1组相比,PAD组皮肤AGEs水平明显增高（P〈0.05）,且PAD2组皮肤AGEs水平明显高于PAD1组.结论 2 型糖尿病患者皮肤AGEs水平升高并可能参与了糖尿病下肢血管病变的发生,可以作为反映糖尿病下肢血管病变程度的指标之一.     

2型糖尿病下肢血管病变与可溶性P选择素及C反应蛋白的相关性研究

目的观察单纯2型糖尿病(type 2 diabetes mellitus,T2DM)和T2DM并下肢血管病变患者可溶性P选择素(P-selectin,Ps)及C反应蛋白(C-reaction protein,CRP)的变化,探讨Ps、CRP与踝臂指数(ankle artery-brachial pressureratio,ABI)的相关性及其在T2DM下肢血管病变(peripheral arterial disease,PAD)发生、发展中的作用。方法 167例T2DM患者,按ABI测定结果分为下肢血管正常组(NPAD组)和病变组(PAD组),75例同期健康体检者作为对照组。比较各组一般情况、生化指标,测定Ps、CRP。结果①与NPAD组、对照组相比,PAD组Ps、CRP、HbA1c显著升高(P<0.05)。②PAD组、NPAD组Ps与ABI呈明显负相关(r=-0.554,P<0.01;r=-0.359,P<0.05)。PAD组、NPAD组CRP与ABI呈负相关(r=-0.435,P<0.01;r=-0.342,P<0.05)。PAD组Ps、CRP与病程、餐后2 h血糖、胰岛素抵抗指数呈正相关(P<0.05);血浆CRP、Ps之间呈正相关(r=0.977,P<0.01)。CRP、Ps与血脂、年龄、空腹C肽无显著相关性(P>0.05)。结论血浆高Ps、CRP水平是2型糖尿病PAD的重要危险因素,与PAD严重程度密切相关;测定血浆Ps、CRP将有助于预测T2DM并下肢血管病变的发生及其预后的严重性评价。     

同型半胱氨酸及纤维蛋白原与2型糖尿病下肢血管病变关系的研究

目的:分析研究同型半胱氨酸及纤维蛋白原与2型糖尿病下肢血管病变之间的相关性。方法:选择2型糖尿病患者103例,根据患者下肢血管病变分为1号研究组(血)和2号研究组(非),选择正常健康对象50例,对比三组对象的同型半胱氨酸及纤维蛋白原监测指标,并分析相关性。结果:与2号研究组和对照组相比,血管病变组的两项监测指标差异均有统计学意义(P<0.05),两项监测指标水平均呈现异常升高现象。同型半胱氨酸和纤维蛋白原均是造成2型糖尿病患者下肢血管病变的独立危险因素(P<0.05)。结论:血浆同型半胱氨酸、纤维蛋白原水平异常升高是造成2型糖尿病患者下肢血管病变并发症出现的独立危险因素,临床需加强研究。     

踝臂指数评估2型糖尿病下肢外周动脉病变的临床价值

目的 评价踝臂指数(ABI)在糖尿病下肢外周动脉病变(PAD)诊断中的价值及相关因素分析.方法 检测284例2型糖尿病(172DM)患者ABI,ABI≤0.9为PAD组,ABI>0.9为非PAD组.对部分ABI<0.9者进行下肢动脉彩色多普勒超声检查以明确血管病变程度.比较两组一般情况及血生化间的差异,分析ABI与血糖、血脂、血肌酐、糖化血红蛋白(HbAlc)、体重指数、血压的关系.结果 检出PAD 96例(33.8%),其中68例行下肢动脉彩色多普勒超声检查证实均有不同程度动脉硬化和狭窄.PAD组空腹血糖(FBG)、餐后2h血糖(2hBG)、HbAlc、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、收缩压均高于非PAD组.结论 ABI是诊断糖尿病PAD的一种无创可靠的方法,T2DM患者常规进行ABI检测可以及早发现PAD.ABI与FBG、2hBG、HbAlc、TG、LDL-C、收缩斥相关,均是PAD的危险因素.     

红细胞分布宽度与2型糖尿病下肢血管病变的相关性研究

目的探讨红细胞分布宽度与糖尿病患者下肢血管病变的相关性。方法选取2019年2月至2019年6月于我院内分泌科就诊的110例2型糖尿病患者,采用多普勒血流探测仪检测患者ABI,根据ABI值分为下肢血管病变组(ABI≤0.9)、正常组(0.9ABI≤1.3),比较两组患者年龄、性别、病程、收缩压、舒张压、体重指数(BMI)、C肽(C-P)、TC、TG、HDL、糖化血红蛋白(HbA1c)、红细胞分布宽度。结果两组比较,下肢血管病变组年龄、病程、LDL-C、红细胞分布宽度较正常组偏高,差异有统计学意义(P0.05),而性别、TC、TG、HDL、糖化血红蛋白差异无统计学意义。结论红细胞分布宽度与2型糖尿病患者下肢血管病变密切相关,且这种相关性与年龄、病程相联系。     

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.