原发性高血压左心室肥厚患者AGT(M235T)、ACE(I/D)基因协同效应探讨

目的　探讨血管紧张素原(AGT)(M235T)、血管紧张素转换酶(ACE)(I/D)对原发性高血压(EH)患 者发生左心室肥厚(EH LVH)的基因协同效应。方法　对中国四川籍汉族人群中109例EH患者,采用聚合酶 链反应(PCR)以及PCR限制性片段长度多态性(RFLP)方法检测ACE(I/D)、AGT(M235T)基因多态性;利用超 声心动图检测左心室质量(LVM)并计算左心室质量指数(LVEI)。结果　ACE(I/D)基因多态性D等位基因频 率在EH LVH组中明显增高(χ2=4.69,P=0.030),男性EH患者中,ACE(I/D)基因型构成比与LVH有关联(χ2 =9.55,P=0.008),协同存在AGT TT时,ACE(I/D)基因多态性与EH LVH有关(χ2=6.22,P=0.044),且D等 位基因在EH LVH明显增高(χ2=6.91,P=0.009),该类EH患者发生LVH的相对危险度增高(OR:2.50,95% CI:1.25～5.00)。结论　ACE(I/D)基因多态性D等位基因可能是LVH的独立危险因子,ACE基因多态性与 AGT基因多态性之间的协同效应表明,同时携带AGT TT型时,具有ACE(I/D)基因多态性D等位基因的EH患 者更易发生LVH。     

原发性高血压左心室肥厚患者AGT(M235T)、ACE(I/D)基因协同效应探讨

目的探讨血管紧张素原(AGT)(M235T)、血管紧张素转换酶(ACE)(I／D)对原发性高血压(EH)患者发生左心室肥厚(EH—LVH)的基因协同效应。方法对中国四川籍汉族人群中109例EH患者,采用聚合酶链反应(PCR)以及PCR限制性片段长度多态性(RFLP)方法检测ACE(I／D)、AGT(M235T)基因多态性;利用超声心动图检测左心室质量(LVM)并计算左心室质量指数(LVEI)。结果ACE(I／D)基因多态性D等位基因频率在EH—LVH组中明显增高(x^2=4．69,P=0．030),男性EH患者中,ACE(I／D)基因型构成比与LVH有关联(x^2=9．55,P=0．008),协同存在AGT-TY时,ACE(I／D)基因多态性与EH-LVH有关(x^2=6．22,P=0．044),且D等位基因在EH-LVH明显增高(x^2=6．91,P=0．009),该类EH患者发生LVH的相对危险度增高(OR：2．50,95％CI：1．25—5．00)。结论ACE(I／D)基因多态性D等位基因可能是LVH的独立危险因子,ACE基因多态性与AGT基因多态性之间的协同效应表明,同时携带AGT—TT型时,具有ACE(I／D)基因多态性D等位基因的EH患者更易发生LVH。     

中国土家族人群血管紧张素原和血管紧张素转化酶基因多态性与冠心病的关系

目的研究血管紧张素原(AGT)基因M235T分子变异和血管紧张素转化酶(ACE)基因I/D多态性与冠状动脉粥样硬化的关系。方法采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术检测冠心病(CHD)组137例和健康对照组125例AGT基因多态性,采用聚合酶链反应技术检测CHD组和健康对照组ACE基因I/D多态性。结果 CHD组AGT-TT基因型频率为75.91%,显著高于健康对照组43.20%(P<0.01);ACE-DD基因型频率为35.77%,显著高于健康对照组15.20%(P<0.01)。结论在中国土家族人群中,AGT基因TT基因型和ACE基因DD基因型是CHD发病既相互独立又具有协同作用的危险因子。     

肾素-血管紧张素系统基因多态与子痫前期的相关性

目的：探讨肾素-血管紧张素系统基因中血管紧张素原（ACT）基因M235T多态、血管紧张素Ⅰ转换酶（ACE）基因插入，缺失（I／D）多态和血管紧张素Ⅱ-1型受体（AT。R）基因A1166C多态与子痫前期的关系。方法：应用聚合酶链反应（vca）、限制性酶切及电泳分型等方法对45例子痫前期患者（子痫前期组）和45例非高血压妊娠妇女（对照组）的AGT基因M235T多态、ACE基因Ⅰ/D多态、AT1R基因A1166C多态性进行分析。结果：（1）AGTM235T多态的TT基因频率两组比较差异有显著性。（2）ACE基因DD、ID、Ⅱ型在两组中分布无明显差异。（3）AT1R基因A1166CAA、AC、CC型在两组中分布无明显差异。（4）子痫前期组具备TT基因型者，其合并DD基因型的95％口为1．473—31．919，合并1166C等位基因C的95％CI为1．316～18．991。结论：AGT变异基因235T与子痛前期发生有关，T等位基因可能是子痫前期的易感基因。ACE基因DD型与子痫前期的相关性限于携带有M235T等位基因的患者。携带有AT1R基因C等位基因和AGT基因TT型的妇女子痫前期发病危险升高。     

脑梗死患者AGT、ACE和MTHFR基因多态性的研究

[目的]探讨血管l紧张素原(AGT)、血管紧张素转换酶(ACE)和亚甲基四氢叶酸还原酶(MTHFR)基因多态性与脑梗死的相关性.[方法]应用基因芯片技术联合检测中国南方的114例脑梗死患者和76例正常对照者AGT基因M235T、ACE基因I/D和MTHFR基因C667T多态性位点.[结果]脑梗死组的AGT基因TT型和T等位基因、ACE基因DD型和D等位基因频率均显著高于对照组(χ2=6.370,P=0.012;χ2=5.627,P=0.018;χ2=4.216,P=0.040;χ2=11.916,P=0.001);MTHFR基因TT型和T等位基因在脑梗死组和对照组间无差异(χ2=1.037,P=0.287;χ2=0.779,P=0.377).[结论]AGT和ACE基因多态性可能是中国南方汉族人群脑梗死的遗传危险因素,而MTHFR基因多态性可能与脑梗死无相关性.     

血管紧张素原基因M235T多态性与结直肠癌易感性关系的研究

目的探讨血管紧张素原(AGT)基因 M235T多态性与中国人群结直肠癌易感性的关系.方法采用聚合酶链反应-限制性片段长度多态性方法检测结直肠癌组151例患者和健康对照组202例AGT基因M235T多态性.结果结直肠癌组与对照组AGT M235T基因型和等位基因分布差异无统计学意义(P>0.05).根据临床病理特征进行分层分析,发现携带TT基因型个体患低分化结直肠癌的风险比携带 MT/MM基因型高2.50倍(P=0.008,OR=2.50;95%CI,1.26-4.97);未发现AGT M235T多态性与结直肠癌临床分期和转移状态之间存在明显相关性(P>0.05).结论 AGT M235T多态性与中国人群结直肠癌的分化程度等临床病理特征密切相关.     

血管紧张素系统相关基因多态性与妊娠期高血压疾病的相关性研究

目的探讨胎儿血管紧张素原(AGT)基因T174M、血管紧张素转换酶(ACE)基因插入/缺失(I/D)、血管紧张素Ⅱ-1型受体(AT1R)基因A1166C多态性与妊娠期高血压疾病(HDCP)的相关性。方法采用聚合酶链反应-限制性片段长度多态(PCR-RFLP)技术分别检测67例妊娠期高血压疾病孕妇(HDCP组,其中妊娠期高血压组12例和子痫前期组55例)与70例正常孕妇(对照组)的胎盘的T174M、A1166C突变位点和ACEI/D多态性的基因型。结果(1)HDCP组、妊娠期高血压组和子痫前期组分别和对照组比较,AGT基因型频率和等位基因频率差异均无统计学意义(P均>0.05)。(2)相对于AA基因型,HDCP组和子痫前期组AT1RAC基因型人群的OR值分别为3.241和3.667,子痫前期组C等位基因相对A等位基因的OR值为3.400。(3)相对于Ⅱ基因型,HDCP组和子痫前期组ACEDD基因型人群的OR值分别为2.899和3.429;D等位基因相对于I等位基因的OR值分别为1.76和1.90。(4)2组ACE和AT1R联合基因分析:相对于Ⅱ-AA联合基因型,同时携带AC-DD和AC-DI联合基因型OR值为7.5。结论胎儿AGT基因T174M多态性可能与HDCP的发生无关联;胎儿AT1R基因A1166C和ACEI/D多态性均与HDCP的发生可能有关,胎儿ACE基因缺失及AT1R基因A1166C多态性可能共同对HDCP的发生发展起作用。     

肾素-血管紧张素系统基因多态性与冠状动脉血栓疾病

为了观察中国人群中肾素-血管紧张素系统基因多态性的分布特征，并分析这些基因多态性与冠状动脉血栓(CATD)疾病的相关性以及该基因多态性间的相互作用，采用直接聚合酶链式反应(PCR)和PCR-限制性片段长度多态性(PCR—RFLP)方法对192例冠状动脉血栓疾病患者和110例对照组个体进行血管紧张素转换酶(ACE)、血管紧张素原(AGT)和血管紧张素II I型受体(AT1R)基因的基因多态性进行检测。结果表明：①在中国人群中，ACE基因各基因型分布分别为DD12．2％、ID43．9％和II43．9％；AGT基因各基因型分布为MM8．2％，MT36．7％和TT55．1％；AT1R基因各基因型分布分别为AA91．8％和AC8．2％。②冠状动脉血栓疾病组与对照组相比，上述3种基因多态性的分布均无明显差异。③同时携带AT1R—AC和AGT—TT基因型的个体，与AT1R—AA和AGT—TT基因型个体相比，罹患CATD的相对危险度达到3．517(95％C10．988—12．527)；与AC基因型和非TT基因型个体相比，罹患CATD的危险性可增加至15．000(95％CI 1．940—115．963)；在AT1R—AC基因型个体，等位基因D在CATD组和对照组的分布亦存在有明显的差异(P=0．017)。结论：我国人群ACE基因I／D多态性、AGT基因M235T多态性和ATlR基因A1166C多态性各基因型和等位基因的分布明显不同于西方人群；上述3种基因多态性不是我国人群冠状动脉血栓疾病或心肌梗塞的独立的危险因素。但AT1R基因AC基因型与AGT基因TT基因型、AT1R基因AC基因型和ACE基因等位基因D在罹患冠状动脉血栓疾病的危险性上有显著的协同作用。     

云南汉族健康人群6个原发性高血压候选基因多态性分布

目的 探讨RAS、血管内皮和钠肽系统中血管紧张素原(AGT),血管紧张素转化酶(ACE),内皮型-氧化氮合酶(eNOS),内皮素-2(ET-2),心钠素(ANP)和钠肽受体C(NPRC)等6个高血压候选基因多态性在云南汉族健康人群中的分布,为进一步研究它们在原发性高血压等心血管疾病发生中的作用提供当地信息.方法 用基因芯片检测技术,对97例健康者进行AGT M235T (MM,MT,TT);ACE I/D(II,ID,DD);eNOS Glu298Asp(EE,ED,DD);ET-2 A985G( AA,AG,GG);ANPT2238C(TT,TC,CC)和NPRC A-55C(AA,AC,CC)等位点基因多态性检测.结果 云南汉族97例健康人群中:①AGT M235T位点的MM,MT,TT基因型频率分别是0.052,0.381,0.567;M和T的等位基因频率分别是0.242,0.758.②ACE I/D突变的II,ID,DD基因型频率分别为0.340,0.598,0.062;I和D等位基因频率分别是0.680,0.320.③eNOS Glu298Asp位点的EE,ED,DD基因型频率分别是0.845,0.144,0.011;E和D等位基因频率分别是0.918,0.082.④ET-2 A985G位点的AA,AG,GG基因型频率分别是0.020,0.258,0.722;A和G等位基因频率分别是0.149,0.851.⑤ANPT2238C位点的TT,TC基因型频率分别是0.959,0.041,未检出CC基因型;T和C等位基因频率分别是0.979,0.021.⑥NPRC A-55C的AC,CC基因型频率分别是0.763,0.237,未检出AA基因型;A和C等位基因频率分别是0.381,0.619.结论 云南汉族健康人群AGT M235T,ACE I/D,eNOS Glu298Asp(E298D),ET-2 A985G,ANP T2238C和NPRC A-55C等6个位点基因多态性有地区特征.     

血管紧张素原基因多态性与血管性认知障碍关系的研究

目的 探讨血管紧张素原(AGT)基因G-6A和M235T多态性与血管性认知障碍(VCI)的关系.方法 采用随机对照研究,聚合酶链反应(PCR)方法检测VCI组(67例)、正常对照组(71例)AGT基因G-6A和M235T多态性.结果 VCI组AGT基因M235TT等位基因频率0.73,TT基因型频率0.52,与对照组(0.68,0.45)比较差异无统计学意义(P0.05),TT基因型对VCI的比数比为0.544(95%CI为0.208～1.424,P0.05).VCI组AGT基因G-6 A等位基因频率0.69,AA基因型频率0.48,与对照组(0.63,0.39)比较差异无统计学意义(P0.05),AA基因型对VCI的比数比为0.602(95%CI为0.252～1.738.P0.05).结论 脑梗死伴血管性认知障碍患者与AGT基因G-6A和M235T多态性无关,AGT基因这两个位点多态性未参与发病.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.