冠心病生物标志物的研究进展

动脉粥样硬化是一种慢性血管壁炎症性疾病,导致血管损伤或斑块的形成,其特征是炎性细胞浸润。冠状动脉粥样硬化性心脏病(冠心病)是由冠状动脉粥样硬化致心肌缺血缺氧或坏死而引起的心脏病。目前有很多研究证实,冠心病与炎性因子和免疫有关,而与炎症和免疫有关的因子很多。目前有一些新的生物指标如:组织蛋白酶K、脂蛋白相关磷脂酶A2、缺血修饰白蛋白和肽素等。这些因子对冠心病的预后和危险分层等起着重要的作用。     

血清炎症因子对冠心病相关致病机制的研究进展

冠心病全称冠状动脉粥样硬化性心脏病,指的是人体冠状动脉出现结构或功能性的病变,导致心肌缺血缺氧性坏死,诱发心脏病;冠心病属于严重危害人体健康的内科疾病,其中冠状动脉粥样硬化是最主要的病理学基础。近年来,研究结果显示,冠状动脉粥样硬化不单纯只是脂质沉积,同时也属于炎症病变反应。炎症反应在冠状动脉粥样硬化的发生、发展过程中起到至关重要的作用。研究发现,血清炎症因子主要由人体免疫细胞因子生成、具有内源性多肽特性,可参与介导大多免疫反应,与冠心病的关系密切。本文对人体血清炎症因子与冠心病的相关指标机制进行综述。     

超敏C反应蛋白与冠状动脉粥样硬化性心脏病的关系

冠状动脉粥样硬化性心脏病(冠心病)是冠状动脉粥样硬化使管腔狭窄或阻塞,导致心肌缺血、缺氧而引起的心脏病,分为无症状性心肌缺血、心绞痛、心肌梗死、缺血性心肌病和猝死,临床上以心绞痛和心肌梗死更为常见;冠心病已成为世界上最常见的死亡原因之一。现代医学认识到,冠状动脉粥样硬化本质上是慢性炎症增殖性疾病,C反应蛋白(CRP)作为慢性炎症标志物与心血管疾病的关系已得到实验证实,     

冠心病与胸痹的相关性的探讨

冠心病又称冠状动脉粥样硬化性心脏病,是指冠状动脉粥样硬化使血管腔狭窄或阻塞,或（和）因冠状动脉功能性改变（痉挛）导致心肌缺血缺氧或坏死而引起的心脏病,统称冠状动脉性心脏病,简称冠心病。冠状动脉造影是目前诊断冠心病的金标准。而冠心病在传统中医的认识中,多归属于胸痹、真心痛等范畴。本文通过对114例中医诊断为胸痹的患者进行冠状动脉造影,诊断结果与其中医病证诊断结果分析,以讨论冠心病与传统中医认识中的胸痹的相关性。     

冠心病炎症反应与痰瘀蕴毒理论相关性探讨

冠状动脉粥样硬化心脏病简称冠心病,系指由于冠状动脉硬化和（或）功能性冠状动脉病变（痉挛）使血管腔狭窄或阻塞发生冠状循环障碍,引起心肌氧供需之间不平衡而导致心肌缺血缺氧的一种心脏病。当前社会,冠心病已成为危害中老年人健康的常见病、多发病，在心血管疾病中死亡率最高。现代医学认为，其发病机制主要与炎症、脂质代谢紊乱及内皮细胞损伤等反应有关。     

维吾尔族人群血尿酸水平与冠心病的关系

冠状动脉粥样硬化性心脏病(CHD),是指冠状动脉粥样硬化使血管腔狭窄或堵塞,或冠状动脉功能性改变导致心肌缺血或(和)坏死而引起的心脏病,简称冠心病.近十年其发病人数在我国呈逐年上升趋势.近年有关血尿酸与冠心病之间关系的研究备受学者关注,研究发现,血尿酸水平升高是冠心病的独立危险因素[1],且血尿酸水平与种族有关[2].     

冠心病早期诊断策略

冠心病又称冠状动脉粥样硬化性心脏病,是指冠状动脉粥样硬化导致管腔狭窄或堵塞从而引起心肌缺血或梗死的心脏病,因此又称为冠状动脉性心脏病或缺血性心脏病。冠心病在临床上分为慢性稳定性冠心病和急性冠状动脉综合征（ACS）。慢性稳定性冠心病的病理生理机制主要是由于冠状动脉发生严重粥样硬化性狭窄导致心肌缺血,临床表现为一定运动量下诱发心绞痛;而ACS则是由于冠状动脉发生急性狭窄或闭塞所致的临床综合征,     

超敏C反应蛋白与冠心病的相关性研究进展

超敏C反应蛋白(hs-CRP)是冠状动脉粥样硬化性心脏病(冠心病)发生和演变过程中的关键因素,在各种类型的冠心病患者中,血清hs-CRP浓度均升高。hs-CRP在冠状动脉粥样硬化的发病机制中发挥着十分重要的作用。冠状动脉粥样硬化实质上是一个慢性炎症的发生、发展过程,而hs-CRP是由白细胞介素6刺激肝脏产生的急性时相反应蛋白,也是导致心血管疾病的直接致病因素,是与动脉粥样硬化发生和演变有关的促炎因子,并可以预测未来心血管事件的发生,从而为冠心病的监测、临床诊断、治疗及预后提供重要的参考价值。     

冠状动脉粥样硬化性心脏病的药物治疗

冠状动脉粥样硬化性心脏病指冠状动脉粥样硬化使血管腔狭窄或阻塞,和（或）因冠状动脉功能性改变（痉挛）导致心肌缺血缺氧或坏死而引起的心脏病,统称冠状动脉性心脏病,简称冠心病。1发病机制：对本病发病机制,曾有多种学说从不同角度来阐述,包括脂质浸润学说、血栓形成学说、平滑肌细胞克隆学说等。近年多数学者支持“内皮损伤反应学说”,认为本病各种主要危险因素最终都损伤动脉内膜,而粥样硬化病变的形成是动脉对内膜损伤作出的炎症一纤维增生性反应的结果。     

在中老年冠心病中有关滋补的运用

冠状动脉粥样硬化性心脏病是指冠状动脉粥样硬化使血管腔阻塞,导致心肌缺血而引起的心脏病,它和冠状动脉功能性改变一起统称为冠状动脉性心脏病,简称为冠心病.冠心病是一种中老年性疾病,患者以四十岁以上的中老年人为多见.临床上以胸骨后或心前区痉挛、胸闷和呼吸不畅为其主要症状,久之可导致心肌的梗死和坏死,出现危象或发生猝死.冠心病的发生与年老肾衰,脾气不足、膏粱烟酒、七情忧伤、寒邪侵袭,导致本虚标实,内闭外脱等病因有关.     

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.