超声心动图Tei指数评价慢性肾功能衰竭患者左心功能的临床价值

目的：探讨超声心动图Tei指数评价慢性肾功能衰竭(以下简称慢性肾衰)患者左心功能的临床价值。方法：对慢性肾衰患者88例和对照组50例测定射血分数(ejection fraction,EF)、E/A,并计算Tei指数。结果：慢性肾衰患者(观察组)EF、E/A与健康者(对照组)比较差异无统计学意义(P>0.05),而Tei指数较对照组明显延长(P＜0.05)。结论：Tei指数能早期检出慢性肾衰患者左心功能异常,优于EF、E/A等传统指标。     

Tei指数评价卡维地洛治疗慢性心衰疗效

目的探讨卡维地洛对慢性心力衰竭的疗效,并用Tei指数进行评价。方法67例慢性心力衰竭患者随机分为治疗组(n=32)和对照组(n=35),两组均应用ACEI、利尿药和洋地黄制剂基础抗心衰治疗:治疗组加用卡维地洛(15±3.6 mg/天);对照组加用安慰剂。分别于治疗前及治疗后3月、6月后测定LVEF、SI、CI、E/A、LVDD、Tei指数。结果①卡维地洛治疗3个月后,Tei、SV、CI、E/A显著改善P<0.05,对照组以上指标无显著差异P>0.05;治疗6个月后治疗组和对照组LVEF、LVDD、SV、CI、E/A、Tei均显著改善P<0.01;②6个月后治疗组LVEF、SI、CI、E/A、LVDD、Tei指数均较对照组有显著差异P<0.05。结论卡维地洛治疗可显著改善心衰病人心功能,Tei指数与常规超声测量的心功能指标均能很好反映心功能变化,且Tei指数较LVEF、LVDD更敏感。关键词:卡维地洛;慢性心衰;Tei指数     

超声心动图评价老年慢性心力衰竭伴肺动脉高压的左心功能

目的:探讨应用彩色超声心动图Tei指数评价研究伴肺动脉高压(PAH)的老年慢性心力衰竭(心衰)患者的左心功能.方法:收集2008年1月至2009年10月因冠心病、高血压或原发性扩张型心肌病引起慢性充血性心衰的住院或门诊老年患者62例.将患者分为两组,研究组(心衰伴肺高压)34例和对照组(心衰不伴肺高压)28例.超声心动图测量左室射血分数(LVEF)、左室E/A比值及计算Tei指数.结果:两组间Tei指数、LVEF均有显著性差异,E/A比值组间比较无明显差异.方差分析可见,对照组的Tei指数、LVEF水平分别与伴有肺高压组的均有明显差异,且Tei指数差异尤为明显;且肺高压越严重者Tei指数越大.结论:肺动脉高压对老年心衰患者的左心功能损害产生影响;其左心功能损害的严重程度与患肺高压严重程度相关;超声心动图Tei指数在评价老年慢性心衰患者左心整体功能方面有重要临床意义.     

多普勒超声心动图评估易栓症对中晚孕胎儿心功能的影响

目的 探讨多普勒超声心动图评估易栓症对中晚孕胎儿心功能的影响。方法 以60例易栓症孕妇为对象,以同期60例正常妊娠孕妇为对照组。两组均接受超声心动图检查,分析胎儿心功能。结果 观察组二尖瓣环内径(MVA)、三尖瓣环内径(TVA)、肺动脉瓣环内径(PVA)、主动脉瓣环内径(AVA)高于对照组(P<0.05)。观察组左室壁厚度(LVWT)、室间隔收缩/舒张末期厚度(IVSs/IVSd)水平高于对照组(P<0.05)。观察组左室短轴缩短率(LVFs)、左室射血分数(LVEF)、心室Tei指数高于对照组,二尖瓣E峰/A峰值速度(E/AMV)、三尖瓣E峰/A峰值速度(E/ATV)E/ATV)低于对照组(P<0.05)。观察组D二聚体(D-D)水平高于对照组,抗凝血酶(AT)低于对照组(P<0.05)。Peason相关性分析显示D-D与LVFs、LVEF、心室Tei指数正相关,与E/AMV、E/ATV负相关(P<0.05);AT与LVFs、LVEF、心室Tei指数负相关,与E/AMV、E/ATV正相关(P<0.05)。结论 利用超声心动图可早期发现易栓症中晚期胎...     

超声心动图检查对慢性肾功能衰竭患者左心结构与功能的诊断价值探讨

目的:探讨超声心动图评价慢性肾功能衰竭肾病3期(CKD3)及肾病4期(CKD4)心脏结构和左心功能的临床价值。方法:对慢性肾功能衰竭CKD3~4期患者38例和对照组30例应用超声心动图常规检测左室舒张末期内径(LVEDd),室间隔、左室后壁厚度(IVs、LVPW)、左室射血分数(LVEF%)(Simpson双平面法)、E/A;测量二尖瓣口相邻两个频谱相距的时间(a)及左室射血时间(b),根据公式Tei=(a—b)/b计算Tei指数。结果:慢性功能衰竭(CRF)氮质血症组IVS较对照组增厚(P<0.05),LVPW、LVEDd、EF、E/A均与对照组无显著性差异(P>0.05),肾病组左心Tei指数较对照组明显延长(P<0.05)。结论:CKD3~4期患者心腔结构、功能发生改变,超声心动图评价心脏结构敏感性及特异性等方面均具有优势,Tei指数可以早期检出其心脏功能异常。     

急性心肌梗死患者行PCI治疗后血浆NT-proBNP与Tei指数的变化及其与心功能分级的关系

目的 研究急性心肌梗死患者行PCI介入治疗后,不同心功能状态患者的NT-proBNP,Tei指数的变化,及其与心功能分级的关系.方法 选取在我科治疗的70例急性心肌梗死患者作为研究对象,比较介入治疗后不同心功能分级的患者Tei指数及血浆NT-proBNP的差异,并分析其相关性.结果 不同心功能分级患者的Tei指数、NT-ProBNP以及LVEF差异均有统计学意义(P＜0.05),提示Tei指数与NT-ProBNP随心功能分级增加而升高;LVEF则随心功能分级增加而降低.线性相关性分析发现,Tei指数与NT-proBNP呈正相关(P＜0.05);Tei指数、NT-proBNP均与LVEF呈负相关(P＜0.05).结论 Tei指数与NT-proBNP可较为敏感的反映PCI治疗急性心肌梗死后心功能的恢复情况,两者联合应用更为客观和准确.     

Tei指数评价吸烟人群中糖尿病患者左心功能

目的:探讨用Tei指数评价吸烟人群中糖尿病患者左心功能的临床价值。方法:将120例2型糖尿病患者按是否吸烟分为糖尿病吸烟组和糖尿病组,每组各60例。将120例健康体检者按是否吸烟分为单纯吸烟组和对照组,每组各60例。各组研究对象均行超声心动图检查,获取左室射血分数(LVEF)、左室短轴缩短率(LVFS)值、二尖瓣瓣尖处舒张期E波峰速度(E)、A波峰速度(A)、计算E/A比值。Tei软件测量二尖瓣血流频谱A峰至下一E峰间距(a),主动脉血流频谱射血间期(b),a-b/b即为左室Tei指数,并进行比较。结果:糖尿病吸烟组、糖尿病组、单纯吸烟组研究对象间LVEF、LVFS无显著差异(P>0.05)、左心室Tei指数均明显高于对照组(P<0.05);糖尿病吸烟组患者的左室E、E/A低于对照组(P<0.05);糖尿病吸烟组患者的左心Tei指数较糖尿病组及单纯吸烟组明显增高(P<0.05)。结论:Tei指数较LVEF、LVFS、E/A更准确、全面地估测左心室收缩与舒张功能,吸烟可加重糖尿病患者左心室整体功能的损害。     

收缩性心力衰竭患者Tei指数与内皮素-1联合检测的临床意义

目的探讨收缩性心力衰竭(SHF)患者Tei指数和血浆内皮素-1(ET-1)水平检测的临床意义。方法 108例SHF患者按入院时NYHA心功能分级分为:Ⅱ级(35例,B组)、Ⅲ级(36例,C组)、Ⅳ级(37例,D组),另选择50例健康体检者为对照组(A组),分别测定各组患者Tei指数、左室射血分数(LVEF)、二尖瓣口舒张早期血流频谱峰值与舒张晚期血流频谱峰值比值(E/A)及血浆ET-1水平。结果 SHF各组Tei指数、血浆ET-1水平均显著高于A组,LVEF及E/A比值均低于A组,差异有统计学意义(P<0.05),随心力衰竭程度的加重,Tei指数、ET-1水平显著增高,LVEF显著降低,而各组间E/A比值无显著性差异(P>0.05)。心力衰竭患者Tei指数与ET-1水平呈显著正相关(r=0.59,P<0.05);结论SHF患者Tei指数与ET-1水平有较好的相关性,二者的联合检测可估测患者的病情、评价疗效和判断SHF患者的预后。     

妊娠期妇女血清NT-proBNP水平变化在伴发心功能损害中的监测价值

目的探究妊娠期妇女血清NT-pro BNP水平在伴发心功能损害中的监测价值。方法选取2013年6月~2015年11月我院收治的82例妊娠合并心脏病患者作为观察组,另选取在我院同期进行检查的正常妊娠者80例作为对照组,采用电化学免疫发光法检测两组研究对象血清NT-pro BNP水平,彩色多普勒超声心动仪检测二尖瓣血流舒张早期以及晚期充盈峰(E峰及A峰)、E/A、左室射血分数(LVEF)及左室舒张末径(LVEDD)。结果观察组NT-pro BNP以及心功能相关指标LVEDD均明显高于对照组(P0.05)。随着心功能分级增加,NT-pro BNP、LVEDD、A值逐渐增加(P0.05),LVEF、E、E/A值逐渐降低(P0.05)。NT-pro BNP与心功能分级、LVEDD呈正相关(r=0.672,P=0.017;r=0.297,P=0.056);NT-pro BNP与LVEF、E/A呈负相关(r=0.324,P=0.045;r=0.472,P=0.061)。结论妊娠期心功能损害者NT-pro BNP水平明显升高,与心功能指标LVEF、E/A呈负相关,与心功能分级呈正相关,对临床监测心功能状况以及治疗、预后具有参考价值。     

Tei指数联合动脉导管肺动脉端内径预测动脉导管未闭患儿心功能价值分析

目的 应用Tei指数联合动脉导管肺动脉端内径(PDADpa)评估动脉导管未闭(PDA)患儿心功能。方法 选取2018年4月至2019年5月在安徽省儿童医院行介入治疗的PDA患儿50例,术前根据改良ROSS评分,分为心功能正常组(32例)与心功能不全组(18例),比较两组Tei指数、PDADpa、血浆B型钠尿肽(BNP)、左心室舒张末期内径(LVDD)、左心室射血分数(LVEF),对可能影响心功能的因素进行二分类logistic回归分析,并绘制ROC曲线分析Tei指数、PDADpa及2者联合预测PDA患儿心功能的价值。结果 心功能不全组PDADpa、BNP、LVDD均高于心功能正常组,Tei指数低于心功能正常组,差异均具有统计学意义(P<0.05),两组LVEF差异无统计学意义(P>0.05);Tei指数、PDADpa是PDA患儿心功能不全的危险因素(P<0.05);Tei指数联合PDADpa预测PDA患儿心功能不全的ROC曲线下面积为0.934,灵敏度为88.89%,特异度为89.66%。结论 Tei指数联合PDADpa可作为预测PDA患儿心功能不全的早期重要指标。     

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.