儿童代谢综合征患者血清炎症因子和脂联素的浓度水平及临床意义

目的探讨儿童代谢综合征（metabolicsyndrome,MS）儿童血清炎症因子和脂联素的水平及临床意义。方法对100例正常儿童、120例单纯肥胖儿童和86例代谢综合征儿童常规体检,ELISA方法测定血清中超敏C反应蛋白（hs—CRP）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF—α）和脂联素水平。结果MS儿童hs—CRP、IL-6和TNF-α炎症因子水平高于单纯肥胖和正常儿童,差异具有显著统计学意义（P〈0．05）。而代谢综合征儿童脂联素浓度低于单纯肥胖和正常儿童（P〈0．05）。炎症因子hs—CRP、IL-6与体重指数BMI呈正相关,而与脂联素呈负相关。结论血清炎症因子和脂联素水平可作为判断MS病情及进展的有效指标。     

GLP-1类似物Exenatide对大鼠糖尿病肾病的保护作用及部分抗炎机制研究

目的 GLP-1类似物Exenatide对糖尿病大鼠肾脏功能、肾脏病理的影响,并探讨其对炎症反应的作用及部分机制。方法建立糖尿病大鼠动物模型,应用GLP-1类似物Exenatide治疗给药后,观察其对糖尿病大鼠尿量、尿蛋白、血肌酐水平等肾脏功能以及IL-1、IL-6、TNF-α等肾脏炎性细胞因子的影响。结果 Exenatide可明显降低异常升高的尿量、尿蛋白及血肌酐水平,改善肾脏病理变化;降低异常升高的IL-1、IL-6、TNF-α水平,抑制ERK的活化。结论 Exenatide对大鼠糖尿病肾病的保护作用可能与其抑制ERK的活化,抑制炎症反应相关。     

不同血液净化方式对糖尿病肾病患者脂肪因子、炎症因子的影响

目的:探讨不同血液净化方式对糖尿病肾病维持性血透(MHD)患者脂肪因子、炎症因子的影响。方法:将81例进行MHD的糖尿病肾病患者随机分为3组,分别为常规血液透析(HD)组27例,血液透析并血液灌流(HD+HP)组27例,联机血液透析滤过组(OL-HDF)27例。检测治疗前后各组脂肪因子中脂联素和抵抗素水平及炎症因子中白细胞介素-6(IL-6)和肿瘤坏死因子(TNF-α)水平,比较治疗前、后不同血液净化组之间脂肪因子和炎症因子的变化情况。结果:HD组治疗前、后血清中脂肪因子和炎症因子的水平比较,差异无统计学意义(P>0.05);HD+HP组与OL-HDF组治疗后脂联素水平均较治疗前明显升高,抵抗素、IL-6及TNF-α水平降低,OL-HDF组抵抗素、IL-6及TNF-α水平较HD+HP组降低更明显,差异具有统计学意义(P<0.05);结论:HD+HP治疗和OL-HDF治疗,对糖尿病肾病患者血清中脂肪因子和炎症因子水平都有较好的调节作用,HDF治疗对抵抗素、IL-6及TNF-α的清除效果更好。     

升清与健脾理气药物抗高脂饮食诱导肥胖大鼠的作用及对脂联素和炎症因子的影响

目的 观察升清和健脾理气药物对饮食诱导肥胖(DIO)大鼠肥胖程度及对脂联素和炎症因子的影响.方法 Wistar大鼠120只,10只作为空白对照组,给予基础饲料,其余110只给予高脂高营养饲料17周,按照体重,得到DIO大鼠40只和肥胖抵抗(DIO-R)大鼠10只,将DIO大鼠又分为DIO模型组、西布曲明组、健脾理气组和升清组,每组10只,分别以生理盐水(2 mL/d)、西布曲明1.6 mg/(kg·d)、健脾理气药物3.2 g/(kg·d)、升清药物3.2 g/(kg·d)灌胃,空白对照组与DIO-R组予生理盐水(2 mL/d)灌胃.灌胃期间空白对照组予基础饲料,余5组继续高脂饲料.灌胃16周后,测量体重、身长,取腹腔内全部脂肪,测量肥胖程度及脂肪含量.取血测定胰岛素抵抗指数(IRI)、血糖、甘油三酯、胆固醇、肿瘤坏死因子(TNF-α)、脂联素.取脂肪匀浆测定TNF-α、脂联素.结果 DIO模型组比正常大鼠体重、体重指数、脂肪系数、胆固醇、IRI明显升高(P＜0.05,P＜0.01);血清和脂肪中脂联素均下降(P＜0.05),TNF-α均升高(P ＜0.05,P＜0.01).与DIO模型组比较,DIO-R组体重、体重指数、脂肪系数、IRI均降低(P ＜0.05,P＜0.01);血清和脂肪中脂联素升高(P＜0.01),TNF-α降低(P ＜0.05,P＜0.01).健脾理气药物可降低脂肪匀浆中TNF-α水平(P＜0.05);升清药物可以升高血清及脂肪匀浆中脂联素水平,降低TNF-α(P＜0.05,P＜0.01).结论 升清药物能抑制高脂饲料诱导的肥胖和胰岛素抵抗,其机制与促进脂联素分泌,降低TNF-α水平有关.“脾不升清”可能是肥胖的病机关键之一.     

黄连素对2型糖尿病大鼠CRP、IL-6、TNF-α、脂联素的影响

目的：观察黄连素对2型糖尿病大鼠血糖、CRP、IL-6、TNF-α、脂联素的影响。方法：70只成年雄性健康SD大鼠,随机分为正常对照组和实验组。实验组给予高糖高脂饲料8周后,按40mg/kg1次性腹腔注射链脲佐菌素（STZ）造2型糖尿病大鼠模型。1周后,将成模大鼠随机分成4组,即黄连素高剂量组、黄连素低剂量组、优降糖组、模型组。给药组灌胃给药4周,正常对照组、模型组同时灌服等容量生理盐水。4周后处死,心脏取血对空腹血糖（ FPG）、IL-6、CRP、TNF-α、脂联素进行检测。结果：经黄连素治疗后,大鼠CRP、IL-6、TNF-α水平明显降低、脂联素水平明显升高,与对照组相比差异有显著性（ P＜0．05）。结论：黄连素治疗2型糖尿病大鼠的机制与其影响血清炎症因子水平有关。     

四联疗法治疗难治性肾病综合征及对患者血清IL-6、TNF-α的影响

目的研究激素、环磷酰胺、低分子量肝素、血管紧张素Ⅱ受体拮抗剂四联疗法治疗难治性肾病综合征的疗效及对患者血清白细胞介素-6(IL-6)、肿瘤坏死因子-α (TNF-α)的影响.方法应用酶联免疫吸附法检测难治性肾病综合征患者经四联药物治疗前后血清IL-6、TNF-α水平的变化,并监测患者24 h尿蛋白、血浆白蛋白、血脂的变化.结果 难治性肾病综合征患者治疗前血清IL-6、TNF-α水平显著高于正常对照组(P＜0.05).经四联药物治疗后血清IL-6、TNF-α水平较治疗前明显下降(P＜0.05).与治疗前相比,治疗后24 h尿蛋白水平显著下降(P＜0.05),血浆白蛋白水平显著升高(P＜0.05),血脂水平显著下降(P＜0.05).难治性肾病综合征组治疗后与正常组比较,TNF-α、24 h尿蛋白水平、血浆白蛋白水平仍有差异(P＜0.05),IL-6、血脂无显著性差异(P＞0.05).结论在难治性肾病综合征患者体内存在TNF-α、IL-6的异常,四联疗法对其有明显的抑制作用,能有效降低24 h尿蛋白,提高血浆白蛋白含量,降低血脂,缓解难治性肾病综合征的病情.     

脂联素配合微创清除术在冠心病患者中的诊疗意义及其与炎症因子相关性分析

目的比较冠心病及正常对照组血液中脂联素及炎症因子的水平差异,分析脂联素与炎症因子的相关性,评估脂联素配合微创清除术在冠心病患者中的诊疗意义。方法选择2011年7月至2013年7月在该院接受治疗的80例冠心病患者(观察组),另选取70例健康体检者作为正常对照组,分析两组脂联素及炎症因子的差异及其相关性。并对30例行微创清除手术(介入)和10例行开胸手术治疗的患者进行脂联素与预后的分析。结果观察组与对照组在性别比例、年龄、体质指数(BMI)和空腹血糖上比较,差异均无统计学意义(P0.05),而观察组总胆固醇和甘油三酯高于对照组(P0.05)。观察组炎症指标(hs-CRP、TNF-α和IL-6)均明显高于正常对照组(P0.05),而脂联素低于对照组(P0.05),观察组脂联素水平与CRP(r=-0.412,P0.01)、TNF-α(r=-0.382,P0.01)和IL-6(r=-0.321,P0.01)均呈负相关关系。微创清除介入术患者的住院时间和费用均小于开胸手术组,且微创术后脂联素水平与住院时间(r=-0.335,P=0.023)和住院费用(r=-0.415,P=0.018)均呈负相关关系。结论冠心病患者的脂质、炎症因子水平明显升高,而脂联素水平却下降,并且脂联素与炎症因子呈明显的负相关关系。微创术后脂联素水平与住院时间和住院费用负相关。     

炎性因子TNF-α IL-6脂联素与2型糖尿病相关性的研究

目的：分析2型糖尿病人血液中炎性因子白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）及脂联素与正常健康个体的差异,探讨TNF-α、IL-6、脂联素与2型糖尿病的相关性。方法：检测并分析30例2型糖尿病人与11例健康个体血液中TNF-α、IL-6及脂联素的水平。结果：2型糖尿病人血中TNF-α和IL-6的水平明显高于健康个体,脂联素水平则明显低于健康个体,此种变化在肥胖患者或空腹血糖〉11.1mmoL/L的糖尿病人身上更加明显。结论：2型糖尿病人血液中TNF-α和IL-6水平增加,脂联素的水平降低,且与2型糖尿病人的肥胖程度、空腹血糖水平存在相关性。     

肥胖／糖尿病过程中大鼠脂肪细胞因子水平变化的比较

目的：探讨在肥胖、糖尿病过程中大鼠脂肪细胞因子水平的变化情况。方法：Wistar雄性大鼠,随机分为3组,每组12只：普通饮食组（正常对照）、高脂饮食组（肥胖）、高脂饮食＋链脲佐菌素组（糖尿病组）。在饲养过程中分别选取第0、3、6、9、12、14周等6个时间点,每个时间点各组随机选取6只大鼠,眼底静脉采血,EDTA抗凝,酶联免疫（ELSA）法检测血清中各因子水平。结果：随着大鼠体重及血糖水平的增加,以第9周为节点,与正常对照组大鼠相比肥胖组及糖尿病组大鼠,血清中FFA、TNF-α、IL-6、PAI-1、HMGB-1等因子水平明显增高,而血清脂联素水平则明显下降,糖尿病组下降尤为明显,组间差异有统计学意义（P〈0．05）。差异最早（第6周）出现的为FFA水平,且早于血糖水平的变化。结论：在肥胖／糖尿病发生、发展过中,FFA水平的增高可能是始动因素,伴随着脂联素水平的降低,导致大鼠脂肪细胞各种炎症因子水平的升高,继而引发系统性炎症,最终导致IR及T2DM的发生。     

咖啡及其成分胡芦巴碱对2型糖尿病大鼠的抗糖尿病作用

目的:探究咖啡及其主要成分胡芦巴碱对2型糖尿病大鼠的胰岛素敏感性、脂代谢、炎症反应以及脂联素水平等的影响。方法:以高脂高糖饲料喂养联合腹腔注射小剂量链脉佐菌素建立2型糖尿病大鼠模型,所有大鼠随机分成四组:正常对照组、模型组、咖啡组和胡芦巴碱组。测定空腹血糖(FBG)、胰岛素(FINS)、胰岛素敏感指数(ISI)、总胆固醇(TC)、甘油三醋(TG)、高密度脂蛋白胆固醇(HDL)、肿瘤坏死因子α(TNF-α)、白介素-6(IL-6)和脂联素(APN)等水平的变化。结果:咖啡和胡芦巴碱均可降低2型糖尿病大鼠的血糖和胰岛素水平,并显著提高胰岛素敏感性(P0.05);胡芦巴碱可使TC和TG水平显著下降(P0.05),HDL水平显著升高(P0.05),而咖啡只能使TC水平降低(P0.05);咖啡组IL-6水平显著下降(P0.05),APN水平显著升高(P0.05),而胡芦巴碱还能显著降低TNF-α水平。结论:咖啡和胡芦巴碱均可有效提高胰岛素敏感性,改善脂代谢紊乱,减轻炎症反应以及促进APN分泌。     

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.