垂体腺瘤患者胰岛素抵抗和皮质醇水平的相关性研究

目的 探讨垂体腺瘤(PA)患者胰岛素抵抗(IR)、血清皮质醇水平及昼夜分泌节律情况.方法 选取2016年10月至2017年4月该院收治的67例PA患者(垂体性Cushing综合征23例,生长激素腺瘤15例,泌乳素瘤16例,无功能性腺瘤13例)作为观察组,选取该院同期体检的49例健康体检者作为对照组.分别测定两组对象的空腹血糖(FPG)、空腹胰岛素(FINS)、血清皮质醇等生化指标,计算IR指数(HOMA-IR),并分析患者IR与血清皮质醇的相关性.结果 观察组皮质醇昼夜分泌节律紊乱的发生率为58.21％;皮质醇分泌节律异常的PA组患者空腹血清皮质醇水平明显高于相应的皮质醇分泌节律正常的PA组和对照组;垂体性Cushing综合征和生长激素腺瘤组的FINS水平和HOMA-IR均高于对照组,相关性分析显示,垂体性Cushing综合征和生长激素腺瘤患者的HOMA-IR与空腹血清皮质醇、FINS水平呈正相关(P＜0.05).结论 垂体性Cushing综合征和生长激素腺瘤存在IR的发生,这可能与血清皮质醇升高密切相关.     

代谢综合征患者血清和尿皮质醇水平与心血管危险因素的关系

目的 初步探讨代谢综合征患者血清和尿皮质醇水平与心血管危险因素的关系。方法对78例代谢综合征患者进行回顾性研究。结果晨8：00时血清皮质醇水平与BMI、腰围、臀围、腰臀比、收缩压、舒张压、空腹和OCTT2h血糖、空腹和OGTT2h胰岛素、胰岛素抵抗稳态模型评估（HOMA-IR）、空腹血清胆固醇、HDL-C、LDL-C、TG、Apo-A1、Apo-B、血清尿酸和尿白蛋白排泄率均不相关,而24h尿游离皮质醇水平则与BMI、腰围、臀围、收缩压、空腹胰岛素、HOMA-IR和TG呈正相关。结论代谢综合征患者24h尿游离皮质醇水平与心血管危险因素相关。     

散发性阿尔茨海默病患者胰岛素抵抗与血脂皮质醇的临床研究

目的探讨散发性阿尔茨海默病（SAD）患者胰岛素抵抗、血清胰岛素、胆固醇、甘油三酯与皮质醇的变化。方法对34例SAD患者和32例正常对照组血清胰岛素、空腹血糖、胆固醇（TC）、甘油三酯（TG）与皮质醇进行测定,计算胰岛素敏感指数,并进行组间对比研究。其中SAD组根据痴呆临床评定量表（CDR）得分进一步分轻度、中度、重度痴呆组进行比较。结果血清胰岛素、皮质醇浓度和胰岛素敏感指数各组间相比无显著性差异（P〉0．05）。轻度痴呆患者TC、TG显著高于中度和重度痴呆组（P〈0．05）,中度痴呆组TG和重度痴呆组TC显著低于正常对照组（P〈0．05）。结论部分散发性AD患者的外周胰岛素抵抗可能无显著性改变,随痴呆程度的加重,血清胆固醇、甘油三酯有降低趋势,提示中重度SAD痴呆患者特别需要加强营养支持。     

2型糖尿病患者血清皮质醇浓度的变化

目的　了解 2型糖尿病患者血清皮质醇分泌的变化及其对胰岛素敏感性的影响。方法　用RIA法测定 6 0例新发 2型糖尿病患者 (肥胖及非肥胖者各 30例 )晨 8时、下午 4时以及口服糖耐量试验期间血清皮质醇浓度的变化 ,同时作血清葡萄糖浓度及胰岛素浓度测定。 40例健康者为正常对照组。结果　①肥胖的 2型糖尿病患者晨 8时及下午 4时血清皮质醇浓度均高于同BMI的正常对照组 (P <0 0 5 )。②肥胖的 2型糖尿病组口服糖耐量试验期间血清皮质醇浓度不下降并有轻度升高 ,而非肥胖组及对照组服糖后血清皮质醇浓度则明显下降。③糖尿病患者血清皮质醇浓度与胰岛素敏感指数呈负相关 (r =- 0 34 ,P <0 0 1)。结论　肥胖的 2型糖尿病存在一定程度的肾上腺皮质分泌功能的异常。     

颅脑手术患者血糖和血清激素水平变化的观察

对４２例颅脑手术患者术前及术后３ｄ内血糖和血清胰岛素、促生长素、皮质醇、Ｔ４及Ｔ３含量作了检测。结果表明：颅脑手术患者术后血糖和血清胰岛素，促生长素及皮质醇含量均有明显增高，而血清Ｔ４和Ｔ３含量改变不大，认为血糖含量可以作为估价颅脑手术引起脑损伤严重程度和患者意识障碍的客观指标，同时颅脑手术后血清胰岛素、促生长素和皮质醇水平的改变对机体糖代谢发生紊乱起重要作用。     

多囊卵巢综合征患者空腹皮质醇浓度测定及其相关因素分析

目的:测定多囊卵巢综合征(PCOS)患者空腹血浆皮质醇浓度,并分析其相关影响因素.方法:84例PCOS患者分为超重或肥胖组(34例)和正常体重组(50例),对照组为年龄匹配的健康妇女(20例).测定空腹皮质醇、葡萄糖、胰岛素水平及胰岛素敏感性(葡萄糖钳夹技术评价).结果:与正常体重PCOS组和正常对照组相比,超重或肥胖PCOS患者的空腹血浆皮质醇水平下降(P＜0.05).对所有PCOS患者的空腹皮质醇进行多元回归分析提示,PCOS患者空腹皮质醇与体重指数、胰岛素敏感性、空腹胰岛素呈负相关.结论:超重或肥胖PCOS患者空腹皮质醇水平降低.PCOS患者空腹皮质醇水平不仅与体重有关,还与胰岛素敏感性和空腹胰岛素水平有关.     

妊娠糖尿病母亲新生儿及健康巨大儿血糖、胰岛素和皮质醇水平的变化

目的 探讨妊娠糖尿病母亲新生儿及健康巨大儿微量血糖、血清胰岛素、皮质醇水平的改变。方法 采用微量法、电化学发光法分别检测31例妊娠糖尿病母亲新生儿(GDM组)、33例同期出生的健康足月巨大儿(巨大儿组)和35例同期出生的健康足月新生儿(对照组)微量血糖及血清胰岛素、皮质醇的含量,并进行统计学分析。结果 与对照组相比,GDM组、巨大儿组微量血糖明显降低,血清胰岛素、皮质醇水平均明显升高(P均＜0.05);与巨大儿组相比,GDM组中巨大儿微量血糖明显降低,血清胰岛素水平明显升高(P均＜0.05),血清皮质醇水平虽升高,但差异无统计学意义(P＞0.05)。结论 妊娠糖尿病母亲新生儿、健康巨大儿均存在微量血糖、胰岛素、皮质醇的异常,因此加强对孕妇孕前及孕期的健康指导有利于减少妊娠糖尿病及巨大儿的发生。     

妊娠糖尿病母亲新生儿及健康巨大儿血糖等水平的转化

目的:对妊娠糖尿病新生儿以及健康孕妇巨大儿出生后的微量血糖、血清胰岛素和皮质醇进行检测和研究。方法:选择我院收治的40例妊娠糖尿病母亲新生儿,作为GDM组;同期出生的40例健康足月巨大儿作为巨大组;同期出生的40例健康足月新生儿,作为对照组。结果:GDM组和巨大儿组的微量血糖与对照组相比明显降低,而血清胰岛素和皮质醇明显升高,两组之间的差异具有统计学意义,P<0.05;巨大儿组的微量血糖与对照组相比明显降低,而血清胰岛素和皮质醇明显升高,两组之间的差异具有统计学意义,P<0.05。结论:妊娠糖尿病母亲新生儿以及健康巨大儿的血糖、胰岛素和皮质醇水平都会发生异常。     

颅脑外伤患者胰岛素抵抗程度与脑损伤、应激反应的相关性研究

目的:研究颅脑外伤患者胰岛素抵抗程度与脑损伤、应激反应的相关性。方法:选择在我院诊断为急性颅脑损伤的78例患者作为的TBI组,同期体检的90例健康志愿者作为对照组。采集外周血后检测葡萄糖、胰岛素、神经损伤标志分子、应激激素及氧化应激反应产物,计算胰岛素抵抗指数(HOMA-IR)。结果:TBI组的HOMA-IR指数显著高于对照组;TBI组血清中NSE、UCH-L1、S100β、MBP、胰高血糖素、生长激素、皮质醇、MDA、8-OHdG的含量显著高于对照组;高HOMA-IR患者的血清NSE、UCH-L1、S100β、MBP、胰高血糖素、生长激素、皮质醇、MDA、8-OHdG的含量显著高于低HOMA-IR患者。结论:颅脑外伤患者的胰岛素抵抗程度显著加剧且与脑损伤程度、应激反应程度密切相关。     

原发性肝癌患者血清皮质醇含量变化及中药干预对其影响

目的研究原发性肝癌患者血清皮质醇水平变化的影响因素及中药治疗的机制。方法按纳入标准和排除标准选取原发性肝癌患者79例和健康人66例,采用放射免疫法检测血清皮质醇水平,采用多元回归分析的方法观察原发性肝癌患者血清皮质醇水平的影响因素;经过中医综合治疗（华蟾素、艾迪或消癌平治疗）14 d后,观察13例原发性肝癌患者血清皮质醇水平的变化。结果原发性肝癌患者血清皮质醇水平较健康人明显降低（P〈0.05）,其水平与外周血钾水平具有显著相关性。中药治疗后,原发性肝癌患者外周血皮质醇水平显著升高（P〈0.01）。结论①原发性肝癌患者外周血皮质醇水平较健康人明显降低。②中医综合治疗可以提高原发性肝癌患者皮质醇水平,提示中药对血清皮质醇的影响可能是其作用机制之一。     

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.