盐酸替罗非班在急性ST段抬高心肌梗死(STEMI)患者急诊PCI术中的应用

目的临床分析盐酸替罗非班在急性ST段抬高心肌梗死(STEMI)患者急诊PCI术中的应用效果。方法选取我院2010年3月至2012年3月收治的64例STEMI患者,按照随机分配的方法,将其分为研究组与对照组,其中研究组34例,对照组30例。对照组给予常规治疗,研究组在常规治疗基础上,实施替罗非班治疗,对比两组治疗前后的心脏不良事件发生率、血管血流变化情况。结果经过治疗后,研究组术后梗死血管TIMI血流3级发生率明显高于对照组,术后心脏不良事件发生率明显低于对照组,两组对比存在显著性差异,具有统计学意义(P<0.05)。结论急性ST段抬高心肌梗死(STEMI)患者急诊PCI术中实施盐酸替罗非班治疗,可有效促进术后梗死血管的血流循环,降低心脏不良事件发生率,且不增加出血并发症的发生,值得临床推广应用。     

25-(OH)D3与相关血液微量元素的相关性研究

目的 测定不同年龄段儿童的血清25-(OH)D3(25-羟维生素D3)的含量,并探究25-(OH)D3与BAKP(骨碱性磷酸酶)及微量元素的相关性.方法 随机选择382例本院儿童保健所门诊正常体检儿童作为研究对象,根据年龄分为0～1岁、1～2岁、2～3岁、3～4岁、4～5岁共5组,采用酶联免疫测试法检测血清25-(OH) D3含量,并测定血清BAKP及Cu、Zn、Fe、Mg等微量元素含量,分析25-(OH) D3与BAKP、微量元素的相关性.结果 各年龄段儿童均明显存在25-(OH) D3缺乏的现象.采用Pearson相关性检验表明,Zn和BAKP、Cu,Fe和BAKP、Cu、Zn,Mg和Cu、Z、Fe之间均存在明显的相关性(P＜0.05);25-(OH) D3与BAKP存在相关性(P＜0.05);而25-(OH) D3与Cu、Zn、Fe、Mg等微量元素之间均无明显相关性(P＞0.05).结论 0～5岁的儿童均不同程度地缺乏25-(OH) D3,尤其是0～2岁的儿童缺乏25-(OH) D3现象严重.相关性分析说明25-(OH) D3与BAKP存在相关性,与Cu、Zn、Fe、Mg等微量元素无相关性,补充Zn和Fe可有助于改善BAKP含量,对改善儿童身体健康具有重要意义.     

肥胖患者血清25-(OH)D的表达与其BMI及腰围的关系

目的 探讨肥胖患者血清25-(OH) D的表达与其BMI及腰围的关系。方法 选取肥胖患者120例纳入肥胖组,同期纳入非肥胖人群100例纳入对照组。采用全自动化学发光免疫分析仪检测25-(OH)D水平,并按25-(OH) D表达情况将肥胖组患者分为正常、下降和缺乏亚组。采用Pearson检验进行血清25-(OH) D表达的相关性分析,采用多元线性回归方程和Logistics回归模型进行回归分析。结果 肥胖组25(OH)D缺乏发生率明显高于非肥胖组(P<0.05),25-(OH)D缺乏组瘦素、神经肽Y、IGF-1、BMI和腰围均显著高于下降组、正常组和非肥胖组(P<0.05);25-(OH) D血清的表达与瘦素、神经肽Y、ICF-1、BMI和腰围呈显著负相关(P<0.05);瘦素、神经肽Y、ICF-1、BMI、腰围是影响25(OH) D表达的独立危险因素(P<0.05);多因素Logistic回归分析结果显示,25-(OH) D、LDL-C、HDL-C、瘦素、神经肽Y和ICF-1为独立危险因素(P<0.05)。结论 25-(OH) D的表达下调与BMI和腰围增...     

替格瑞洛在老年急性ST段抬高型心肌梗死(STEMI)患者行急诊PCI中的疗效及安全性

目的:探讨老年急性ST段抬高型心肌梗死(STEMI)患者行PCI使用替格瑞洛的临床效果,分析用药安全性.方法:选取2014年1月～2016年1月于我院就诊的STEMI行急诊PCI的患者共40例,以随机抽签法分为对照组和观察组各20例,对照组给予氯吡格雷治疗,观察组给予替格瑞洛治疗,比较造影诊断结果及临床疗效.结果:观察组LVEF水平显著高于对照组(P<0.05),血小板计数显著高于对照组(P<0.05).结论:STEMI患者行急诊PCI采用替格瑞洛治疗的临床疗效更加显著,预后质量好,不良事件发生率低,具有推广意义.     

SLE患者血25(OH)D水平的变化及其临床意义

目的观察SLE患者血清25(OH)D水平变化,并探讨SLE患者补充维生素D的意义。方法对2011年9月1日至2011年11月30日上海市中医院风湿免疫科20例SLE住院患者进行血25(OH)D水平测定。结果发现2例患者25(OH)D在正常值范围,18例患者低于正常值,其均值明显低于正常值。结论本组SLE患者25(OH)D水平明显降低,需要维生素D的补充。     

替格瑞洛在急性ST段抬高型心肌梗死(STEMI)患者急诊PCI围手术期内的临床疗效

目的:分析研讨替格瑞洛在急性ST段抬高型心肌梗死(STEMI)患者急诊PCI围手术期内的临床疗效.方法:采用随机抽签方式,从我院2013年4月~2016年1月收治的接受急诊PCI治疗的STEMI患者中,抽取106例纳入研讨范围,再次按照随机抽签方式分为两组,即53例对照组、53例研究组,研究组术前接受替格瑞洛和阿司匹林药物,对照组术前接受氯吡格雷和阿司匹林药物,把两组临床状况纳入对比讨论.结果:研究组MACE总发生率7.55%比对照组的18.87%明显要低,组间数据差异有统计学意义(P<0.05).研究组并发症总发生率5.67%比对照组的26.41%明显要低,组间数据差异有统计学意义(P<0.05).结论:临床可在STEM患者接受急诊PCI手术治疗前给予替格瑞洛药物,此方式可控制血小板指数,术后预后良好,降低并发症发生可能性,推广应用价值高.     

STEMI患者急诊经皮冠状动脉介入术后ST段回落不良的影响因素分析

目的 探讨急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入术后ST段回落不良的临床特点及相关影响因素。方法 回顾性分析石河子大学医学院第一附属医院2019年1月至2021年6月确诊为STEMI患者并于12 h内行直接经皮冠状动脉介入治疗术（pPCI）患者的临床资料。根据pPCI术后1 h内心电图ST段回落的不同程度,将患者分为ST段回落不良组（ST段回落率≤50%）和ST段回落良好组（ST段回落率>50%）。比较两组STEMI患者的临床基本资料及手术相关情况,应用二元logistic回归模型分析STEMI患者pPCI术后ST段回落不良的影响因素。结果 STEMI患者pPCI术后1 h内出现ST段回落不良的发生率为43.31%。ST段回落不良组患者的年龄、入院首次氨基末端B型脑钠肽前体（NT-proBNP）、入院首次心肌肌钙蛋白Ⅰ（cTnⅠ）、单核细胞计数、单核细胞计数与高密度脂蛋白胆固醇比值（MHR）均高于ST段回落良好组,而左心室射血分数（LVEF）水平明显低于ST段回落良好组（P <0.05）。急性心肌梗死症状出现到球囊扩张时间（SOTBT）<3 h...     

血清25-羟维生素D与孕中期GDM患者糖脂代谢的关系研究

目的:探讨孕中期妊娠糖尿病(GDM)孕妇血清25-羟维生素D[25-(OH)D]水平与糖脂代谢指标的关系。方法:选择2016年1月～2018年1月某院建卡体检的220例孕中期GDM孕妇为GDM组,以同期240例健康孕妇为健康组,检测两组孕妇血25-(OH)D、空腹血糖(FBG)、餐后2h血糖(2hPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)水平,分析不同25-(OH)D水平患者各糖脂代谢指标差异。结果:GDM组FBG、FINS、2hPG、HbAlc、HOMA-IR及TG水平均明显高于健康组,而血清25-(OH)D水平则显著低于健康组(P0.05);两组血TC、HDL-C及LDL-C水平比较,差异无显著性(P0.05);随着25-(OH)D缺乏程度的加剧,GDM孕妇血FBG、FINS、2hPG、HbAlc、HOMA-IR及TG水平显著升高(P0.05),血TC、HDL-C及LDL-C水平则无明显变化(P0.05)。GDM孕妇血25-(OH)D水平与FBG、FINS、2hPG、HbAlc、HOMA-IR、TG呈明显负相关(P0.05),与血TC、HDL-C、LDL-C无显著相关性(P0.05)。结论:GDM孕妇血25-(OH)D水平显著降低,25-(OH)D水平与糖脂代谢情况存在密切联系。     

Quantitation of serum 25(OH)D2 and 25(OH)D3 concentrations by liquid chromatography tandem mass spectrometry in patients with diabetes mellitus

Vitamin D has been considered to regulate calcium and phosphorus homeostasis and to preserve skeletal integrity. Serum 25-hydroxyvitamin D (25(OH)D) is the best indicator of vitamin D levels. The association of serum 25(OH)D deficiency with increased risk of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) is controversial. We investigated serum 25(OH)D₂ and 25(OH)D₃ levels in diabetes patients by using liquid chromatography tandem mass spectrometry (LC-MS/MS). Serum 25(OH)D2 and 25(OH)D3 levels were measured with liquid chromatography tandem mass spectrometry in electrospray ionization positive mode. Chromatograms were separated using an ACE5 C18 column on a gradient of methanol. The total 25(OH)D levels were calculated as the sum of 25(OH)D3 and 25(OH)D2 levels. A total of 56 patients with T1DM and 41 patients with T2DM were enrolled in this study. There were 42 and 28 non-diabetic, age-matched volunteers who participated as the T1DM controls and the T2DM controls, respectively. The total 25(OH)D levels were lowest in the 21–40 age group. The levels of both 25(OH)D3 and the total 25(OH)D were significantly higher in the T1DM and T2DM groups than in the controls (p < 0.01 in T1DM and p < 0.05 in T2DM group, respectively). The 25(OH)D2 levels were only significantly higher in T1DM patients than in the controls. The percentages of vitamin D deficiency (total 25(OH)D less than 20 ng/mL) in the T1DM, T2DM, the T1DM controls and the T2DM controls were 7.1%, 0%, 14.3% and 3.6%, respectively. The percentages of vitamin D insufficiency (total 25(OH)D less than 30 ng/mL) in the T1DM, T2DM, the T1DM controls and the T2DM controls were 26.8%, 7.3%, 54.8% and 17.9%, respectively. The percentages of vitamin D deficiency and insufficiency were significantly lower in the T1DM patients than in the T1DM controls (p < 0.01). In the present study, both type 1 and type 2 diabetes patients had higher serum 25(OH)D levels and lower percentages of vitamin D deficiency/insufficiency.     

25-羟维生素D与儿童1型糖尿病及酮症酸中毒的相关性研究

目的 探讨血清25-羟维生素D[25-(OH)D]水平与儿童1型糖尿病及酮症酸中毒(DKA)的相关性。方法 选取2006年1 月—2009年12月在本院治疗的152例患儿,其中52例为首次发病的1型糖尿病患儿,其余100例按糖尿病标准排除糖尿病。对52例1型糖尿病患儿的临床和实验室资料进行研究,分析血清25-(OH)D水平与儿童1型糖尿病及酮症酸中毒的关系。结果 1型糖尿病儿童血清25-(OH)D 的平均水平为(63.67±28.41)nmol·L^-1,显著低于非糖尿病儿童(P<0.05),差异有统计学意义。DKA患儿的血清25-(OH)D 的平均水平为(58.63±27.79)nmol·L^-1,显著低于非DKA患儿(P<0.05),差异有统计学意义。结论 血清 25-(OH)D的水平较低可能会增加儿童1型糖尿病以及发生酮症酸中毒的风险。     

不同胎龄新生儿血清25-羟维生素D水平与糖代谢的相关性分析

目的:探讨不同胎龄新生儿血清25-羟维生素D(25-(OH)-D_3)水平与糖代谢的相关性。方法:选取131例新生儿作为研究对象,根据胎龄的长短将全部新生儿共分成四组:A组:胎龄≤32周;B组:32周胎龄37周;C组:37周≤胎龄≤39周和D组:胎龄39周。采用酶联免疫吸附法检测血清25(OH)-D_3浓度,应用微量血糖仪检测空腹血糖(FPG),采用酶联免疫吸附法检测空腹血清胰岛素(FINS),采用免疫比浊法测糖化血红蛋白(HbA1c)。计算胰岛素抵抗(IR)指数。比较四组新生儿的25-(OH)-D_3水平和各糖代谢指标的变化,并分析25-(OH)-D_3水平与糖代谢指标的相关性。结果:A组新生儿的25-(OH)-D3水平均显著低于B组、C组和D组(P0.05),B组、C组和D组间的25-(OH)-D_3水平无显著性差异(P0.05)。A组新生儿的FPG、FINS和IR各水平均显著高于B组、C组和D组(P0.05),四组间HbA1c水平无显著性差异(P0.05)。相关性分析结果显示,A组和B组的25-(OH)D值与其FPG、和IR值呈显著负相关关系(r=-0.596,-0.582,P0.01),与其FINS值呈显著正相关关系(r=0.639,P0.01),C组和D组的25-(OH)D值与其FPG、HbAlc、FINS和IR各指标均无显著相关性(P0.01)。结论:胎龄≤32周的新生儿的25-(OH)-D_3水平显著降低,且早产儿(胎龄37周)25-(OH)-D_3水平的与糖代谢指标密切相关。     

Action of 24R, 25 dihydroxyvitamin D3 (24,25 (OH)2D3) on bone in vivo

The administration of 24R,25(OH)2D3 for 2 years led to an increase in bone volume in the rat. Radiographs showed the striking increase in the density of the bones from animals treated with large amounts of 24R,25(OH)2D3. Total bone minerals measured by direct single photon absorptiometry showed a dose-dependent increase of up to approximately 150% that of controls in both the femur and coccyx of the treated animals. Histological observation revealed a thickened cortex with narrowed medullary area, and Villanueva's bone stain indicated the increase of mineralized bone. The result clearly demonstrates that 24,25(OH)2D3, if massive doses are given, has the biological action of increasing bone volume without disturbing the development of bone sizes.     

Disposition and metabolism of F6-1alpha,25(OH)2 vitamin D3 and 1alpha,25(OH)2 vitamin D3 in the parathyroid glands of rats dosed with tritium-labeled compounds.

26,26,26,27,27,27-Hexafluoro-1alpha,25(OH)2 vitamin D3, a hexafluorinated analog of 1alpha,25(OH)2 vitamin D3, has been reported to be several times more potent than the parent compound with respect to some vitamin D actions. The reason for enhanced biological activity in the bones, kidneys, and small intestine appears to be related to F6-1alpha,25(OH)2 vitamin D3 metabolism to ST-232 (26,26,26,27,27,27-hexafluoro-1alpha,23S,25-trihydroxyvitamin D3), a bioactive 23S-hydroxylated form that is resistant to further metabolism. We compared the disposition and metabolism of [1beta-3H]F6-1alpha,25(OH)2 vitamin D3 and [1beta-3H]1alpha,25(OH)2 vitamin D3 in parathyroid glands of rats intravenously administered with labeled compounds at a dose of 10 microg/kg. In the [1beta-3H]F6-1alpha,25(OH)2 vitamin D3-dosed group, radioactivity was highly detected in the kidneys, parathyroid glands, and the small intestine. The radioactivity in the parathyroid glands remained high until 48 h postdosing, with values of 2.5, 8.4, and 14.6 times higher at 6, 24, and 48 h postdosing than after dosing with [1beta-3H] 1alpha,25(OH)2 vitamin D3. In the group given [1beta-3H]F6-1alpha,25(OH)2 vitamin D3, the unchanged compound was mainly detected with a small amount of ST-232 at 6 h postdosing. At the 24- and 48-h time points, over half of the radioactivity was observed as ST-232, and additionally, ST-233, the 23-oxo form, accounted for a small amount at the 48-h time point. The present study demonstrated local retention of [1beta-3H]F6-1alpha,25(OH)2 vitamin D3 and the bioactive metabolite ST-232 in parathyroid glands after intravenous administration. The findings may indicate one of the reasons for the higher potency of F6-1alpha,25(OH)2 vitamin D3 than 1alpha,25(OH)2 vitamin D3 in parathyroid.     

Comparison of the relative effects of 1,24-dihydroxyvitamin D(2) [1, 24-(OH)(2)D(2)], 1,24-dihydroxyvitamin D(3) [1,24-(OH)(2)D(3)], and 1,25-dihydroxyvitamin D(3) [1,25-(OH)(2)D(3)] on selected vitamin D-regulated events in the rat

The present experiments were conducted to compare the relative hypercalciuric and hypercalcemic activities of 1,24-dihydroxyvitamin D(2) [1,24-(OH)(2)D(2)], 1,24-dihydroxyvitamin D(3) [1, 24-(OH)(2)D(3)], and 1,25-dihydroxyvitamin D(3) [1,25-(OH)(2)D(3)] in 7-week-old rats. The rats were dosed orally with each sterol for 7 days at a rate of 1 ng/g body weight/day. We also monitored the effect of the three compounds on the induction of mRNA for CaATPase and for 25-hydroxyvitamin D-24-hydroxylase in the kidney and intestine, on plasma vitamin D metabolite levels, and on the capacity to evoke modification in the vitamin D receptor/retinoic acid X receptor (VDR/RXR) heterodimer conformation. Plasma calcium was elevated in the rats treated with 1,24-(OH)(2)D(3) and 1, 25-(OH)(2)D(3), but not in the 1,24-(OH)(2)D(2)-dosed rats. Urinary calcium was elevated significantly (relative to controls) in all groups. The order of hypercalciuric activity was 1,25-(OH)(2)D(3) >/= 1,24-(OH)(2)D(3) >/= 1,24-(OH)(2)D(2) > control. Duodenal plasma membrane calcium ATPase (PMCA) mRNA was elevated to a similar extent in all groups relative to controls. Duodenal 24-hydroxylase mRNA was elevated in all groups relative to controls; however, the elevations were significantly higher in the 1,24-(OH)(2)D(3) and 1, 25-(OH)(2)D(3) groups compared with the 1,24-(OH)(2)D(2) group. Kidney 24-hydroxylase also was elevated significantly in the 1, 24-(OH)(2)D(3)- and 1,25-(OH)(2)D(3)-treated rats but not in the 1, 24-(OH)(2)D(2)-treated rats. Recombinant human vitamin D receptor (hVDR) extracts were incubated with saturating concentrations of 1, 24-(OH)(2)D(2), 1,24-(OH)(2)D(3), and 1,25-(OH)(2)D(3) and subsequently analyzed by electrophoretic mobility shift assay (EMSA). Overall binding was comparable for all metabolites; however, the 1, 24-(OH)(2)D(2) complex exhibited distinctly altered mobility relative to 1,24-(OH)(2)D(3) and 1,25-(OH)(2)D(3), suggestive of an effect on hVDR/hRXR conformation. These data suggest that 1, 24-(OH)(2)D(2) is not as potent as either of the vitamin D(3) sterols at affecting hypercalcemia or hypercalciuria in young growing rats; however, 1,24-(OH)(2)D(2) can evoke other biological responses similar to the vitamin D(3) sterols. These different responses may be related to the alterations in conformation state of the hVDR/hRXR heterodimer.     

不同剂量替罗非班联合替格瑞洛对糖尿病STEMI患者急诊PCI的疗效观察

目的 探讨双联抗血小板（阿司匹林加替格瑞洛,DAPT）联合不同剂量的替罗非班对糖尿病合并急性心肌梗死（ST-segment elevation myocardial infarction,STEMI）急诊经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）的近期疗效和安全性。方法 接受急诊PCI的糖尿病合并STEMI患者158例,随机分为DAPT组（A组）53例,DAPT加常规剂量替罗非班组（B组）52例,DAPT加1/2剂量替罗非班组（C组）53例;PCI时B、C组冠状动脉内注射盐酸替罗非班（10 μg·kg^-1）,PCI后B组以0.15 μg·kg^-1·min^-1、C组以0.075 μg·kg^-1·min^-1持续静脉泵入24 h;统计分析3组的临床资料、冠状动脉病变特征、住院时间和并发症的发生率。结果 与A组比较,PCI术后B组和C组TIMI 3级血流和TMPG 3级心肌灌注明显升高（P<0.05）;住院期间再梗死、梗死后心绞痛、严重心律失常、Killip Ⅲ级以上心功能的发生率显著降低（P<0.05）。B组严重出血、中度出血的发生率显著高于A组和C组患者（P<0.05）,B组和C组轻度出血的发生率显著高于A组（P<0.05）。结论 糖尿病合并STEMI急诊PCI时1/2剂量的替罗非班加DAPT能够有效改善TIMI血流和TMPG心肌组织水平灌注,降低梗死后心绞痛、再梗死、严重心律失常、心力衰竭等严重并发症的发生,减少严重出血的并发症。     

大疱性类天疱疮患者血清25-羟基维生素D水平的临床分析

目的检测大疱性类天疱疮(Bullous pemphigoid,BP)患者血清25-(OH)D水平,探讨其临床意义。方法 2018年3月至2019年5月我院皮肤科收治的50例BP患者纳入观察组,选取同时期入院的年龄和性别相匹配的48例带状疱疹患者作为对照组。检测两组血清25-(OH)D水平,并测定肝功能,血常规,血清钙、磷、镁及碱性磷酸酶。记录观察组患者的BP面积指数评分(Bullous pemphigoid disease area index,BPDAI)及神经系统合并症。比较两组检验结果,分析观察组患者性别、年龄及神经系统合并症对血清25-(OH)D水平的影响,对观察组患者血清25-(OH)D水平与BPDAI评分及其他化验指标的相关性进行分析。结果观察组患者血清25-(OH)D水平、血清钙、白蛋白低于对照组(P<0.05),嗜酸性粒细胞计数高于对照组(P<0.05),两组碱性磷酸酶水平比较差异无统计学意义(P>0.05)。观察组男性、女性患者血清25-(OH)D水平比较差异无统计学意义(P>0.05);年龄<80岁的患者与≥80岁的患者血清25-(OH)D水平比较差异无统计学意义(P>0.05);伴神经系统合并症的患者血清25-(OH)D水平明显低于无神经系统合并症的患者(P<0.05)。观察组患者BPDAI为35～125分,平均(74.0±24.9)分。Pearson相关分析提示,BP患者血清25-(OH)D水平和BPDAI呈负相关(r=-0.49,P<0.01),与血清白蛋白水平呈正相关(r=0.32,P<0.05)。BP患者血清25-(OH)D水平与血清钙、碱性磷酸酶、嗜酸粒细胞计数无相关性。结论 BP患者血清25-(OH)D水平降低,尤其伴有神经系统合并症的患者血清25-(OH)D水平下降可能更多见。25-(OH)D水平可能与BP病情严重程度呈负相关,可能与血清白蛋白水平呈正相关。