缬沙坦对慢性心力衰竭患者血浆脑钠素水平及左室收缩功能疗效的研究

目的 探讨慢性心力衰竭(CHF)患者在常规治疗基础上加用缬沙坦治疗12周后脑钠素(BNP)水平的变化及心功能的疗效.方法 应用化学发光法测定52例CHF患者治疗前、后和18例对照组血浆BNP浓度:用多普勒超声心动图测定CHF组左室舒张末期内径(LVEDD)及左室射血分数(LVEF).结果 CHF患者血浆BNP水平(456±253)Pg/mL较对照组(28±6)pg/mL明显增高(P＜0.01);不同心功能患者血浆BNP水平差异亦有显著意义,依次为Ⅳ级＞Ⅲ级＞Ⅱ级(P＜0.01),CHF组BNP水平升高与心力衰竭程度呈正相关(r=0.672,P＜0.01).缬沙坦治疗后血浆BNP水平明显下降,与治疗前比较差异有非常显著性(P＜0.01).LVEF有所提高,LVEDD明显缩小与治疗前比较均差异有显著性(P＜0.05).结论 血浆BNP水平可以反映心力衰竭严重程度、作为治疗心力衰竭的一个可靠观察指标.缬沙坦能显著降低脑钠素水平,改善心功能.在心力衰竭的治疗中起着重要作用.     

慢性心力衰竭患者应用辛伐他汀对心功能及血浆C-反应蛋白和B型脑利钠肽的影响

目的 探讨辛伐他汀对慢性心力衰竭(CHF)患者心功能及血浆C-反应蛋白(CRP)和B型脑利钠肽(BNP)的影响.方法 92例CHF患者随机分为治疗组和对照组,均给予抗心力衰竭常规治疗,治疗组在常规治疗基础上加用辛伐他汀,疗程12周.治疗前后用彩色多普勒测定心功能指标左室射血分数(LVEF)、左室收缩末容积指数(LVESVI)、左室舒张末容积指数(LVEDVI)、左室舒张早期和晚期充盈速度比值(E/A),测定血浆CRP和BNP水平.结果 两组患者治疗12周后心功能比较,差异有统计学意义(P＜0.05);两组治疗后心功能指标LVEF、LVESVI、LVEDVI、E/A水平比较,差异均有统计学意义(P＜0.01);两组治疗后CRP、BNP水平比较,差异均有统计学意义(P＜0.01).结论 CHF患者在常规治疗同时加用辛伐他汀治疗,可明显降低血浆CRP及BNP水平,同时降低LVESVI、LVEDVI,增加LVEF,改善心功能.     

慢性心力衰竭患者治疗前后心钠素、脑钠素浓度变化

目的 观察慢性心力衰竭患者心钠素、脑钠素浓度改变及卡维地洛对其影响.方法 慢性心力衰竭患者50例(观察组)和正常健康人20例(对照组).采用放射免疫法测定治疗前后血浆ANP、BNP浓度;彩色超声心动图测定左心室射血分数、左心室舒张末期内径等.结果 观察组血浆ANP、BNP浓度均高于对照组(P均＜0.01);临床慢性心力衰竭程度越重,血浆ANP、BNP浓度越高(P均＜0.01);卡维地洛治疗者与常规治疗者治疗满2w后均有血浆ANP、BNP浓度下降,卡维地洛治疗者血浆ANP、BNP浓度下降更明显(P＜0.05);而满3个月时卡维地洛治疗者左心室射血分数、左心室舒张末期内径均比常规治疗者明显改善(P均＜0.05).结论 ANP、BNP浓度可以反映心功能状态;卡维地洛可以降低ANP、BNP浓度及改善心脏重构及心功能.     

卡维地洛对慢性收缩性心力衰竭患者心功能及血浆脑钠肽的影响

目的:观察卡维地洛对慢性收缩性心力衰竭(CHF)患者心功能、血浆脑钠肽(BNP)的影响。方法:慢性收缩性心力衰竭患者54例,随机分为常规治疗组和卡维地洛组各27例。常规治疗组使用血管紧张素转化酶抑制剂或血管紧张素拮抗剂、利尿药、硝酸酯类药和洋地黄类药,卡维地洛组在常规治疗基础上加用卡维地洛,疗程16周。观察心功能改善并测定治疗前后左心室射血分数(LVEF)、左心室舒张末期内径(LVEDd)和血浆BNP水平。结果:两组心功能均得到显著改善,血浆BNP水平明显下降,卡维地洛组更明显(P<0.05)。卡维地洛组LVEF和LVEDd虽较常规治疗组有所增加和下降,但差异无显著性。结论:在常规治疗心衰基础上加用卡维地洛能更有效地改善心功能和降低血浆BNP水平。     

卡维地洛治疗充血性心力衰竭的临床观察

目的观察卡维地洛治疗充血性心力衰竭(CHF)的疗效。方法随机将CHF患者58例分为A组:常规抗心衰药物治疗;B组:在常规治疗基础上加卡维地洛,疗程3个月。结果B组总有效率93.3%,明显高于A组(P<0.05)。结论卡维地洛治疗CHF可改善心功能,延缓心室重构,提高生存质量。     

益气温阳活血利水法治疗慢性心力衰竭心室重塑及心功能的临床研究

目的 探讨益气温阳与活血利水法治疗慢性心力衰竭(CHF)心室重塑及心功能的临床疗效.方法 将100例CHF患者随机分为治疗组和对照组,各50例.治疗组在西药综合治疗的基础上服用益气温阳、活血利水的纯中药制剂,对照组采用西药综合治疗.观察两组患者治疗前后心室重塑及心功能变化.结果 治疗组总有效率为94%,明显优于对照组的72%(P＜0.05).治疗组左室舒张末期内径(LVEDD) 明显缩小(P＜0.01)、舒张末室间隔厚度(IVS) 明显下降(P＜0.05)、左室射血分数(LVEF)显著提高(P＜0.01 ),效果优于对照组.结论 益气温阳、活血利水药能明显改善CHF心室重塑及心功能.     

卡维地洛和美托洛尔对慢性心力衰竭的疗效及血浆脑钠肽、细胞因子影响的对比研究

目的 对比观察卡维地洛和美托洛尔对充血性心力衰竭(CHF)患者的疗效及血浆脑钠肽、细胞因子浓度的影响.方法 60例CHF患者,随机分为卡维地洛组和美托洛尔组,20例健康体检者为正常对照组.研究组在常规治疗基础上加用卡维地洛或美托洛尔治疗12周.用酶联免疫法测定血浆脑钠肽(BNP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平.结果 治疗12周后卡维地洛组和美托洛尔组NYHA分级以及LVEF、LVEDd、LVESd均有显著改善(P<0.05);卡维地洛组与美托洛尔组相比改善更显著(P<0.05).CHF患者BNP、TNF-α和IL-6浓度均显著高于对照组(P<0.05);治疗后卡维地洛组与美托洛尔组浓度均较治疗前显著降低(P<0.05);两组比较,卡维地洛组BNP、TNF-α和IL-6浓度显著低于美托洛尔组(P<0.05).结论 卡维地洛与美托洛尔均能显著改善CHF患者的心功能,降低异常升高的BNP、TNF-α和IL-6,卡维地洛改善心功能、逆转心室重塑的作用优于美托洛尔.     

卡维地洛治疗高血压并慢性心力衰竭的疗效观察

目的:观察卡维地洛对高血压并慢性心力衰竭(CHF)患者的心功能影响及临床疗效.方法:选择高血压并高心病或冠心病82例,心功能Ⅱ～Ⅳ级的患者,随机分为两组,常规组(40例),给与控制血压、利尿、转换酶抑制剂(ACEI)、洋地黄治疗.卡维地洛组(42例),在常规治疗基础上加用卡维地洛(20mg Bid×180天).结果:卡维地洛组临床显效率(57.1%),总有效率(92.8%),较常规组显著提高(P＜0.05).卡维地洛组与常规组治疗前后,心率、血压、左室舒张末期直径、左室收缩末期直径、左室射血分数、心输出量、E/A、等容舒张期时间均有显著改善(卡维地洛组P＜0.01,常规组P＜0.05),且卡维地洛组上述指标改善更明显(P＜0.01或P＜0.05).结论:卡维地洛显著改善高血压并慢性心力衰竭患者的心功能,是一种安全有效的治疗方法.     

卡维地洛治疗慢性充血性心力衰竭患者的临床疗效

目的:探讨卡维地洛对慢性充血性心力衰竭(CHF)患者的症状、心功能、心室重构和细胞因子的影响。方法:随机选择CHF患者72例随机分为心力衰竭常规治疗组(n=34)和卡维地洛治疗组(n=38),后者在常规抗心力衰竭治疗基础上加用卡维地洛,剂量平均为12.5～37.5mg/次,2次/d,患者经治疗随访达6～12个月,观察两组治疗前和治疗后6个月、12个月,对患者症状、心室重构及心功能的影响,分别测定左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)和6min步行距离。测定健康对照组(n=35)和两组心衰患者治疗前和治疗6个月血浆肿瘤坏死因子(TNF-α)、B形脑钠尿肽(BNT)和白细胞介素-6(IL-6)的浓度。结果:CHF患者在强心、利尿和血管紧张素转换酶抑制剂治疗基础上,用卡维地洛治疗6、12个月后,能显著改善慢性心力衰竭患者的运动耐量、心功能和心室重构,LVEDD、LVESD、LVEF和6min步行距离的改善均优于常规治疗组(P<0.01,P<0.05)。心衰患者3种细胞因子血浆浓度均高于对照组(P<0.001),卡维地洛治疗后细胞因子的下降明显优于常规抗心力衰竭治疗(P<0.01)。结论:卡维地洛可明显改善CHF患者心功能,提高运动耐量,抑制左室重构,降低细胞因子TNF、BNT和IL-6的浓度。     

卡维地洛联合缬沙坦治疗慢性心力衰竭的临床效果及安全性

目的：研究慢性心力衰竭（CHF）应用卡维地洛与缬沙坦联合治疗的临床疗效及安全性。方法：收集2015年1月至2016年1月期间,该院收治的CHF患者82例,随机分为观察组与对照组,每组41例。两组均予以常规对症治疗,对照组加用缬沙坦治疗,观察组在对照组的基础上加用卡维地洛治疗。结果：观察组总有效率为97.56％,显著高于对照组,治疗后观察组的LVEF显著高于对照组（P＜0.05）,LVESE及LVEDD显著低于对照组（P＜0.05）;两组不良反应比较差异无统计学意义（P＞0.05）。结论：卡维地洛与缬沙坦联合治疗CHF能够改善患者的心功能,提高临床疗效,且副反应少,值得临床推广应用。     

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.