FGF-23与基质Gla蛋白在维持性血液透析患者中的表达及意义

目的 观察维持性血液透析患者血清成纤维细胞生长因子23((FGF-23)、基质Gla蛋白(MGP)的表达及其钙磷代谢的关系.方法 采集4O例血液透析患者及40名健康对照者的静脉血,离心取血清,采用ELISA 法分别测定其FGF-23、MGP的表达状况,同时检测其1,25-二羟维生素D[1,25-(OH)2VitD]、血清肌酐(Scr)、钙(Ca)、磷(P)水平状况.结果 FGF-23、MGP在血透组患者中表达明显高于健康对照组人群(P<0.01),而血透组患者血清1,25-(OH)2VitD水平明显低于健康对照组(P<0.01).Pearson相关性分析结果显示血清FGF-23与MGP、血清肌酐、磷、透析时间呈正相关(P<0.01),与1,25-(OH)2VitD负相关(P<0.01).结论 维持性血液透析患者FGF-23、MGP水平明显升高,1,25-(OH)2VitD明显降低.FGF-23水平与MGP、血清肌酐、磷、透析时间、1,25-(OH)2VitD等多种因素有关.     

血液灌流联合血液透析对维持性血液透析患者钙磷代谢的影响

目的 观察血液灌流(HP)联合血液透析(HD)对行维持性血液透析(MHD)患者钙磷代谢的影响及可能的作用机制.方法 测定21例行MHD的患者(研究组)HP联合MHD治疗前、后的血清1,25-二羟维生素D3[1,25-(OH)2D3]、成纤维细胞生长因子23(FGF-23)、全段甲状旁腺激素(iPTH)、血清肌酐(SCr)、血钙、血磷及生化指标.透析治疗方案为每2周行5次HD,每2周行1次HP联合HD,24周为1个疗程.以年龄、性别匹配的20名健康者作为对照组.结果 研究组治疗前的血清FGF-23、iPTH、尿素氮(BUN)、SCr、血磷均显著高于对照组(P值均＜0.05),血钙和1,25-(OH)2D3均显著低于对照组(P值分别＜0.05、0.01).研究组进行1次及6次HP联合HD治疗后,血清BUN、SCr较治疗前显著下降(P值均＜0.01),其他指标的差异均无统计学意义(P值均＞0.05).研究组患者进行12次HP联合HD治疗后,血清BUN、SCr、血磷、iPTH、FGF-23较治疗前显著下降(P值均＜0.01),1,25-(OH)2D3较治疗前显著升高(P＜0.01),其他指标的差异均无统计学意义(P值均＞0.05).经过12次联合治疗后,研究组的皮肤瘙痒和骨痛的视觉模拟评分均较治疗前显著降低(P值均＜0.05).结论 HP联合HD治疗可以改善行MHD患者的钙磷代谢及维生素D代谢,可能与HP对FGF-23的吸附、改善维生索D缺乏的状态有关.     

终末期肾病病人血清FGF-23与心血管钙化的关系

目的探讨终末期肾病(ESRD)病人血清成纤维细胞生长因子23(FGF-23)水平与心血管钙化的关系。方法 ESRD病人60例,应用彩色多普勒超声心动图、侧位腹部X线平片对心脏和腹主动脉钙化进行定性检测,酶联免疫吸附法检测FGF-23,实验室常规方法测定血清肌酐(Scr)、钙(Ca)、磷(P)、碱性磷酸酶(ALP)、总胆固醇(TC)、三酰甘油(TG)、血红蛋白(HB),电化学发光法测定全段甲状旁腺激素(iPTH)。以40例健康查体者为对照组。结果 ESRD病人血清FGF-23水平较对照组显著升高,差异有显著性(t=7.50,P<0.01)。ESRD病人血清FGF-23水平与Scr、P、iPTH、ALP呈正相关(r=0.411～0.675,P<0.01),与Ca、TC、TG、HB无相关性(r=-0.113～-0.012,P>0.05)。心血管钙化组血清FGF-23水平显著高于非钙化组(t=5.40,P<0.01)。结论 ESRD病人血清FGF-23水平升高与心血管钙化的发生发展密切相关。     

中青年维持性血透与腹透患者血清iFGF23水平及影响因素分析

目的:探讨中青年维持性血透(MHD)与维持性腹透(MPD)患者血清全段成纤维细胞生长因子23(iFGF23)水平,并探讨其影响因素。方法:将行透析治疗的84例中青年尿毒症患者分为MHD组及MPD组,比较两组患者血清iFGF23及相应临床参数,并对可能影响iFGF23的因素进行相关性分析。结果:MHD组iFGF23水平较MPD组显著升高(P<0.05);单因素相关性分析显示:iFGF23与血磷、钙、钙磷乘积、全段甲状旁腺激素(iPTH)、N末端B型钠尿肽原(NTproBNP)、透析龄及尿素氮(BUN)显著正相关(P<0.05),与Kt/V、尿量及二氧化碳结合力显著负相关(P<0.05);多因素相关性分析显示:经多因素校正后,iFGF23与iPTH独立正相关(P<0.05)。结论:中青年MHD患者血清iFGF23水平显著高于MPD患者,提示腹透比血透更利于FGF23的清除;FGF23水平受体内矿物质代谢、透析龄、透析充分性、尿量及NT-proBNP等多因素的影响,其中iPTH是影响FGF23水平的独立因素。     

血液透析与血液灌流联合治疗对长期血液透析患者微炎性因子及钙磷代谢的影响

目的探讨血液透析与血液灌流联合治疗对长期血液透析患者微炎性因子及钙磷代谢的影响。方法选择2009年1月至2011年12月在长沙市第一医院收治的维持性血液透析患者98例,按随机数字表法分为对照组和观察组,各49例。对照组采用血液透析治疗,观察组采用血液透析与血液灌流联合治疗。观察两组治疗前、治疗6个月时血清CRP、Hb、Alb、TC、TG、BUN、Scr以及血钙、血磷、1,25-(OH)2D3、FGF-23、iPTH改善情况。结果治疗6个月时观察组患者CRP、Hb、Alb、TC、TG水平较本组治疗前及对照组治疗后明显改善,差异有统计学意义(P<0.05);两组治疗前后血清BUN、Scr水平变化的差异无统计学意义(P>0.05);观察组患者血磷、血清FGF-23、iPTH均较治疗前下降,差异具有统计学意义(P<0.05),血清1,25-(OH)2D3较治疗前升高,差异有统计学意义(P<0.01)。结论定期采用血液透析与血液灌流联合治疗长期血液透析患者,有助于改善机体微炎症状态,维持钙磷代谢平衡,进一步提高患者的生活质量和存活率,值得临床推广应用。     

碳酸镧与碳酸钙对高磷血症血液透析患者成纤维细胞生长因子-23影响的比较

目的 比较碳酸镧和碳酸钙对血液透析高磷血症患者血清成纤维细胞生长因子-23(FGF-23)水平的影响.方法 56例慢性肾衰竭维持性血液透析患者,血清磷＞1.78 mmol/L、血清钙＜2.38 mmol/L、白蛋白＞30 g/L,限制饮食中磷摄入量约为1 000mg/d.患者随机分为碳酸镧组和碳酸钙组,分别接受碳酸镧或碳酸钙治疗16周.每2周常规检测血清钙、血清磷水平.在治疗第0、8和16周检测血清FGF-23及全段甲状旁腺素(iPTH)水平.结果 碳酸镧和碳酸钙能降低血磷水平.两组血清校正钙离子和iPTH水平无明显变化.与碳酸钙相比,碳酸镧能有效降低FGF-23,并且血清磷与血清FGF-23水平的改变呈正相关.结论 在血液透析患者中应用碳酸镧可以有效降低血清磷及血清FGF-23,而应用碳酸钙并不能减少血清FGF-23.     

腹膜透析患者血清骨硬化蛋白水平 及其影响因素分析

目的 观察腹膜透析（PD）患者血清骨硬化蛋白水平变化,分析其相关的临床因素。方法 选 取2016 年1 月—2017 年1 月就诊于石河子大学第一附属医院及石河子人民医院肾内科行PD（透析时间> 3 个月）的患者78 例作为实验组,同时选取石河子大学第一附属医院及石河子人民医院健康体检者78 例作 为对照组,所有入组对象均接受腹部平片检查,根据腹主动脉钙化评分（AACS）将PD 患者分成轻度钙化 组、中度钙化组及重度钙化组,收集相关生化指标,同时采用酶联免疫吸附实验检测血清成纤维细胞生长因 子-23（FGF-23）、25- 羟维生素D[25（OH）D] 及骨硬化蛋白水平。结果 ①实验组血清骨硬化蛋白、 FGF-23 水平均较对照组升高,25（OH）D 水平较对照组降低（P <0.05）;②随着钙化水平的逐渐加重,骨硬 化蛋白、FGF-23、全段甲状旁腺激素（iPTH）、血磷、血肌酐（CREA）、尿酸、SBP、DBP 等指标均升高（P <0.05）, 血清25（OH）D、血钙、肾小球滤过率（eGFR）均降低（P <0.05）;③ Pearson 相关分析显示：血清骨硬化 蛋白与年龄、血磷、iPTH、FGF-23、AACS、SBP 及CREA 均呈正相关（P <0.05）,与25（OH）D、血钙及 eGFR 均呈负相关（P <0.05）;④ Logistic 回归显示：AACS、eGFR、FGF-23、iPTH、血磷及25（OH）D 是骨硬化蛋白的独立危险因素（P <0.05）。结论 PD 患者血清骨硬化蛋白水平升高,其与AACS、eGFR、 FGF-23、iPTH、血磷及25（OH）D 明显相关。     

维持性血液透析患者左心室肥大与FGF-23及钙磷代谢的相关性研究

目的:探讨维持性血液透析(MHD)患者左心室肥大(LVH)与血清成纤维细胞生长因子23(FGF-23)、血钙、血磷、全段甲状旁腺激素(iPTH)等临床指标的相关性。方法:按照研究需要随机选取弋矶山医院血液净化中心80例病情相对稳定的MHD患者,所有患者血清FGF-23水平采用酶联免疫吸附ELISA法测定,其他需测定指标有血清钙、磷、iPTH等,所有入选患者检查超声心动图,依据Devereux公式计算左心室质量指数(LVMI)后根据LVH的诊断标准将研究对象分为2组,即LVH组59例和N-LVH组21例。结果:单因素分析显示,LVH组在透析龄、磷、钙磷乘积、胆固醇、收缩压、舒张压、LVMI、FGF-23和iPTH上均高于N-LVH组(P<0.05),而LVH组在高密度脂蛋白和血红蛋白上均低于N-LVH组(P<0.05);LVMI与透析龄(r=0.840)、磷(r=0.900)、FGF-23(r=0.953)和收缩压(r=0.687)均呈正相关(P<0.05);多因素分析显示,FGF-23、透析龄、收缩压和磷指标的升高是影响LVMI升高的重要因素。结论:MHD患者LVH与血清FGF-23、血磷等升高密切相关。     

血清1，25-（OH）2VitD3与钙磷水平在COPD中的临床意义

目的：观察慢性阻塞性肺疾病（COPD）患者血清1,25-（OH）2VitD3与钙磷水平变化及其与肺功能、体重指数（BMI）的相关性,探讨其与病情严重程度及预后的关系。方法：随机选取COPD患者、健康对照者各30例,分别测定COPD急性加重期、稳定期及对照组的血清1,25-（OH）2VitD3与钙磷水平,并测定肺功能（FEV1、FEV1／FVC）及BMI等指标。结果：COPD患者急性加重期、稳定期血清1,25-（OH）2VitD3及钙磷水平较对照组明显降低,其中各组血清1,25-（OH）2VitD3、钙水平差别有统计学意义（P〈0．01）,而血清磷水平于急性加重期和稳定期、急性加重期和对照组比较差别有统计学意义（P〈0．01）;急性加重期和对照组中,血清1,25-（OH）2VitD3水平与BMI、肺功能指标成正相关,血清钙水平与BMI成正相关。结论：COPD患者不论急性加重期还是稳定期血清1,25-（OH）2VitD3与钙磷水平均较对照组明显降低,并和病情严重程度相关,影响预后,对临床治疗有一定指导意义。     

不同透析方式对终末期肾病患者钙磷代谢的影响

目的:探讨终末期肾病患者血钙、血磷、全段甲状旁腺激素(PTH)达标情况及不同透析方式对钙磷代谢的影响。方法:回顾性分析收治的101例终末期肾病患者的临床资料,根据透析方式的不同,将其分为血透组、腹透组及非透析组,三组分别为43例、14例、44例,比较三组患者血钙、血磷及PTH水平及达标情况。结果:①血透组血钙、血磷、PTH达标率分别为:69.77%、30.23%、53.49%;腹透组血钙、血磷、PTH达标率分别为:50.00%、35.71%、57.14%;非透析组血钙、血磷、PTH达标率分别为:54.55%、2.27%、75.00%。三组在血钙、PTH达标率方面比较,差异无统计学意义(P>0.05),腹透组血磷达标率最高,差异有统计学意义(P<0.05)。②三组患者在血钙、血磷、PTH、白蛋白、25羟维生素D测定(25-OH-VD)、血红蛋白水平比较,差异有统计学意义(P<0.05),血透组血磷水平低于腹透组及非透析组,血红蛋白、血白蛋白、25-OH-VD水平高于腹透组及非透析组。结论:终末期肾病患者血钙、血磷及PTH水平达标率较低,尤其血磷水平达标率最低,腹透患者血磷达标高于血透患者。     

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.