P波离散度及P波最大时限对阵发性心房颤动预测的价值

目的 分析P波离散度(Pd)及P波最大时限(Pmax)与阵发性心房颤动(PAF)的关系,探讨Pd及Pmax对PAF的预测价值. 方法 选择50例PAF患者为观察组,同期住院的非房性心律失常患者50例为对照组.测量两组的Pmax和Pd,以Pd≥40 ms、Pmax≥110 ms为标准进行组间对比分析. 结果观察组的Pmax、Pd值明显高于对照组,两组比较差异有统计学意义(P＜0.05).为预测PAF,以Pmax≥110 ms为标准,其敏感度为86%,特异度为82%,阳性预测值为83%;以Pd≥40 ms为标准,其敏感度为82%,特异度为88%,阳性预测值为87%;两者联合的敏感度为80%,特异度为92%,阳性预测值为91%. 结论 Pd和Pmax是预测PAF的两个无创而简便可靠的指标.     

参松养心胶囊对高血压并阵发性心房颤动患者P波离散度的影响

目的研究参松养心胶囊对原发性高血压(EH)并阵发性房颤(PAF)的疗效及P波最大时限(Pmax)和P波离散度(Pd)的影响。方法治疗组38例EH并PAF患者采用参松养心胶囊1.6g口服,每日3次,连续服药4周,观察临床疗效及心电图Pmax、Pd的变化,并与对照组40例无房颤(AF)的EH患者比较。结果治疗组治疗前Pmax及Pd分别为(124±13)ms、(49±12)ms,均较对照组(110±8)ms、(31±9)ms明显延长(P均<0.01);服药4周后治疗组PAF发作减少,有效率76.3%,Pmax及Pd[(115±12)ms、(35±12)ms]较治疗前[(124±13)ms、(49±12)ms]明显缩短(P均<0.05),与对照组治疗后比较差异无统计学意义(P>0.05)。结论EH并PAF者较无AF的EH患者Pmax、Pd延长,参松养心胶囊治疗4周即可缩短Pmax及Pd,并可能减少PAF的发作。     

P波离散度对高血压伴发阵发性心房颤动的预测价值

目的:探讨P波离散度(Pd)对高血压患者阵发性心房颤动(房颤)的预测价值。方法:将88例高血压患者分为高血压伴阵发性房颤(Ⅰ组)40例,无阵发性房颤的高血压患者(Ⅱ组)48例,同步记录窦性心律时12导联心电图。分别测量12导联P波时限计算P波离散度(Pd)[Pd=最大P波时限(Pmax)-最小P波时限(Pm in)];超声心动图测量左心房内径(LAD)和左室射血分数(LVEF)。结果:Ⅰ组Pd显著高于Ⅱ组[(51.2±10.6)ms比(37.8±6.9)ms,P<0.001];Ⅰ组Pmax显著高于Ⅱ组[(125.3±12.9)ms比(112.8±12.2)ms,P<0.001];Ⅰ组LAD高于Ⅱ组[(40.6±3.0)mm比(39.1±2.3)mm,P<0.05];两组Pm in、LVEF无统计学意义(P>0.05)。单因素回归分析显示,Pmax、Pd、LAD均是阵发性房颤的预测因子。多元逐步回归分析表明,仅Pd是阵发性房颤的独立预测因子。结论:Pd是高血压患者发生阵发性房颤的独立预测因子。     

原发性高血压伴阵发性房颤P波离散度的变化及意义

目的　探讨原发性高血压患者的P波离散度 (Pd)变化及临床意义。方法　测量 5 3例高血压患者伴阵发性房颤 (PAF组 )及 5 8例高血压无阵发性房颤患者 (对照组 )窦性心律时的 12导联ECG ,分别测定最大P波时限 (Pmax)及最小P波时限 (Pmin)并计算其P波离散度 (Pd) ,心脏超声测量左房内径 (LAD)和左室射血分数 (LVEF)。结果　PAF组的Pd及Pmax分别为 (4 7 77± 7 99)ms和 (12 3 74± 11 2 9)ms,较对照组〔分别为 (36 83± 7 2 8)ms和(116 10± 11 12 )ms〕明显延长 (P <0 0 1) :最小P波间期PAF组为 (76 34± 10 78)ms,较对照组 (79 2 8± 10 39)ms缩短 ,但无显著性差异 (P >0 0 5 )。结论　原发性高血压伴阵发性房颤患者Pd及Pmax延长 ,Pd可用于预测高血压患者房颤发作。     

高血压病P波离散度相关因素与房颤的研究

目的　探讨P波离散度 (pd)能否预测高血压病患者伴发的阵发性心房颤动的发生。 方法　观察 41例有阵发性心房颤动病史的高血压病患者 (Ⅰ组 )的最大P波时限 (Pmax)、最小P波时限 (Pmin)、Pd、左房内径 (LAD)和左室射血分数 (LVEF) ,并与无阵发性心房颤动病史的 42例高血压病患者 (Ⅱ组 )比较。结果　Pmax:Ⅰ组非常显著高于Ⅱ组 [(1 2 5± 1 4 )ms比 (1 1 2± 1 2 )ms,P <0 .0 0 1 ] ;Pd:Ⅰ组非常显著高于Ⅱ组 [(51± 1 2 )ms比 (36± 8)ms,P <0 .0 0 1 ]。Pmin、LAD两组差别无统计学意义。单因素回归分析显示 :Pmax、Pd、LVEF均是阵发性心房颤动的预测因子。多因素回归分析显示仅Pd是阵发性心房颤动的独立预测因子。结论　Pmax、LVEF和Pd均可能预测高血压病患者伴发的阵发性心房颤动的发生 ,多因素回归分析显示Pd是阵发性心房颤动的独立预测因子     

P波离散度与急性心肌梗塞并发阵发性房颤的临床研究

目的 :探讨急性心肌梗塞并发阵发性房颤 (PAF)与体表心电图P波最大时限 (Pmax)、P波离散度 (Pd)的关系。方法 :观察 2 9例急性心肌梗塞并发阵发性房颤患者 (观察组 )的Pmax和Pd ,并与 2 7例急性心肌梗塞无阵发性房颤患者 (对照组 )比较。结果 :①Pmax、Pd :观察组显著大于对照组 (Pmax :12 5 0 1±7 6 8ms比 10 8 92± 6 32ms ,P <0 0 1;Pd :4 7 2 1± 9 90ms比 30 0 1± 6 95ms ,P <0 0 1)。②Pmax >110ms和Pd >4 0ms预测PAF的敏感性、特异性、阳性预测准确性分别为 86 4 %、82 1%、91 6 %和 88 8%、85 6 %、92 1% ;当Pmax >110ms且Pd >4 0ms预测PAF的敏感性、特异性、阳性预测准确性分别为78 1%、88 2 %、94 0 %。结论 :Pmax延长和Pd增加可能是预测急性心肌梗塞并发PAF的一项指标。     

P波离散度和最大时限对阵发性心房颤动发作的预测价值

目的探讨P波离散度(Pd)和P波最大时限(Pmax)对阵发性心房颤动(PAF)发作的预测价值。方法用12导联同步心电图记录方法,测定150例PAF患者非AF发作时的Pd和Pmax,并与对照组进行比较,分析上述指标对PAF发作的敏感性、特异性和阳性预测值。结果PAF组的Pd和Pmax分别为(47±8)ms和(126±12)ms,明显大于对照组(27±9)ms和(105±10)ms(P<0.01);以Pd≥40ms及Pmax≥110ms作为阳性标准两者预测PAF的敏感性为87.3%、84.0%,特异性85.5%、72.7%,阳性预测值94.2%、89.4%。两者联合应用的敏感性、特异性和阳性预测值分别是78.7%、90.9%和95.9%。结论Pd和Pmax值可用作预测PAF的心电图指标,两者联合应用可提高预测的特异性和阳性预测值。     

P波离散度预测阵发性心房纤颤及评估胺碘酮治疗作用的价值

目的探讨体表心电图P波离散度(Pd)和最大P波时限(Pmax)与阵发性心房纤颤(Paf)的关系及评估胺碘酮对其治疗效果。方法观察测量40例PAf患者Pmax、Pd,并与40例无器质性心脏病,无心房纤颤病史者作对比分析。PAf患者给予胺碘酮治疗,观察有效者和无效者服药前后Pmax、Pd的变化,亦作对比分析。结果PAf患者Pmax、Pd与对照组有显著性差异(P<0.01),Pd≥40ms,预测Af的敏感度80%,特异度87.5%阳性预测准确度达85%,Pmax≥110ms预测Af敏感度85%特异度70%阳性预测准确度80%,而当Pmax≥110ms+Pd≥40ms时预测Af的敏感度、特异度及阳性预测准确度分别为72.5%、92.5%和90%。PAf患者给予胺碘酮治疗后,胺碘酮治疗有效率65%,有效组治疗前后Pmax、Pd有显著性差异(P<0.01),无效组治疗前后Pmax、Pd无显著性差异(P>0.05)。结论体表心电图Pd及Pmax可以用来预测PAf的发生与评价药物疗效。     

体表心电图 Pmax Pd对阵发性房颤的预测价值

目的探讨体表电生理指标对阵发性房颤患者的预测价值.方法对54例特发性房颤(Ⅰ组),51例器质性心脏病伴阵发性房颤(Ⅱ组),50例正常人(Ⅲa组)和55例不伴房颤的器质性心脏病(Ⅲb组)用分规测量12导联心电图的同一心动周期的P波时限.得到P波时限的最大值(Pmax)和最小值(Pmin), P波离散度(Pd).M型超声心动图测量左房内径(LAD)和射血分数(LVEF).结果 Pmax在Ⅰ、Ⅱ组间P<0.025,Ⅰ、Ⅲa组间P<0.01,Ⅱ、Ⅲb组间P>0.05; Pd在Ⅰ、Ⅱ组间P<0.05,Ⅰ、Ⅲa组间P<0.05, Ⅱ、Ⅲb组间P>0.05;而Pmin在各组间无差异;LAD和LVEF在Ⅰ、Ⅱ组间P<0.01,Ⅱ、Ⅲb组间和Ⅰ、Ⅲa组间无显著性差异.以Pmax≥115ms和/或Pd≥45ms为阳性标准,其对特发性房颤的敏感性72.58%,特异性94.36%,准确性88.64%.结论 Pd和Pmax对预测阵发性房颤是2个有用的电生理指标,但不能将器质性心脏病伴阵发性房颤者从器质性心脏病者中区分出来,左房扩大和LVEF的降低是导致器质性心脏病合并阵发性房颤的主要影响因素.     

体表心电图指标对阵发性房颤患者的预测价值

目的探讨体表电生理指标对阵发性房颤患者的预测价值.方法对48例特发性房颤(Ⅰ组),85例器质性心脏病伴阵发性房颤(Ⅱ组),50例正常人(Ⅲa组)和80例不伴房颤的器质性心脏病(Ⅲb组)用分规测量12导联心电图的同一心动周期的P波时限.得到P波时限的最大值(Pmax)和最小值(Pmin),P波离散度(Pd).M型超声心动图测量左房内径(LAD)和射血分数(LVEF).结果 Pmax在Ⅰ、Ⅱ组间P<0.025,Ⅰ、Ⅲa组间P<0.01,Ⅱ、Ⅲb组间P>0.05; Pd在Ⅰ、Ⅱ组间P<0.05,Ⅰ、Ⅲa组间P<0.05,Ⅱ、Ⅲb组间P>0.05;而Pmin在各组间无差异;LAD和LVEF在Ⅰ、Ⅱ组间P<0.01,Ⅱ、Ⅲb组间和Ⅰ、Ⅲa组间无显著性差异.以Pmax≥115ms和/或Pd≥45ms为阳性标准,对特发性房颤的敏感性72.58%,特异性94.36%,准确性88.64%.结论 Pd和Pmax对预测阵发性房颤是两个有用的电生理指标,但不能将器质性心脏病伴阵发性房颤者从器质性心脏病者中区分出来,左房扩大和LVEF的降低是导致器质性心脏病合并阵发性房颤的主要影响因素.     

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.