山西地区2型糖尿病患者非酒精性脂肪肝与同型半胱氨酸及亚甲基四氢叶酸还原酶基因多态性的关系

目的探讨血浆同型半胱氨酸（Hcy）水平及亚甲基四氢叶酸还原酶（MTHFR）基因C677T多态性与2型糖尿病（T2DM）患者合并非酒精性脂肪肝的关系。方法对伴和不伴非酒精性脂肪肝的159例T2DM患者行血浆Hcy、叶酸、VitB12、糖化血红蛋白（HbAlc）、血糖水平测定,以PCR-限制性片段长度多态性分析技术检测MTHFR基因C677T多态性,并与52例正常者（对照组）比较。结果单纯糖尿病组（96例）和非酒精性脂肪肝组（63例）高Hcy血症发生率分别为21％（20／96）和49％（31／63）,高于对照组（8％,4／52）,非酒精性脂肪肝组又高于单纯糖尿病组（均P〈0．05）;T2DM患者血浆Hcy水平与MTHFR基因型、HbAlc、血糖水平呈正相关（r值分别为0．248,0．423和0．242,均P〈0．05）;logistic回归分析显示,病程、体重指数、空腹血糖、Hcy均为T2DM非酒精性脂肪肝的独立危险因素。结论高Hcy血症是T2DM非酒精性脂肪肝的危险因素;MTHFR基因型、叶酸、VitB12以及代谢紊乱程度影响血浆Hcy水平。     

糖尿病及其视网膜病变患者对蛋氨酸负荷试验的异常反应

目的　探讨 2型糖尿病 (DM)及其视网膜病变 (DR)患者对蛋氨酸负荷 (PML)试验的反应 ;并探讨PML试验对高同型半胱氨酸血症 (Hhcy)的诊断价值及同型半胱氨酸 (Hcy)致血管损害的可能机制。方法　对 17例DR患者、15例单纯DM患者 (NDC)及 2 8例正常对照 (CON)进行了PML试验 ,荧光偏振免疫分析法测定空腹Hcy (Fhcy)及PML后 4h血浆Hcy浓度 (Phcy) ,测空腹血浆叶酸、维生素B12 ,并以PCR RFLP技术检测亚甲基四氢叶酸还原酶 (MTHFR)C6 6 7T突变 ,测定空腹血糖、餐后血糖、尿素、肌酐、胆固醇、甘油三酯以及HbA1c等生化指标 ,以Griess法测定空腹PML后 4hNO代谢终产物。结果　DM各组体重指数、HbA1c及PBG高于CON组 (P <0 0 5 ) ;DR组和NDC组Fhcy分别为 13 9± 1 4和 11 6± 1 3μmol/L ,高于CON组的 8 8± 1 4 μmol/L。DR组Phcy(37 3μmol/L)、PML前后Hcy差值 (2 4 4 μmol/L)和MTHFRBB基因型 (9/ 17)均高于CON组的 2 2 7μmol/L、15 1μmol/L和 5 /2 8以及NDC组的 2 5 0 μmol/L、14 3μmol/L和 2 / 15。以Fhcy为标准确定的Hhcy发病数为 9例 ,而以PML后的Phcy为标准发病数则为 15例 ;结合两者计算Hhcy发病率 ,DR组高于NDC组 ,两者又高于CON组 (P <0 0 0 1)。餐后NO代谢产物浓度明显高于空腹 ,而且血浆Hcy与     

血浆同型半胱氨酸水平与2型糖尿病周围神经病变关系的探讨

目的:评估空腹血浆总同型半胱氨酸(tHcy)水平与2型糖尿病(DM)周围神经病变的关系,并分析影响DM患者血浆tHcy水平的因素。方法:以103例2型糖尿病患者为DM组,45例健康者为正常对照组,其中DM组分为有周围神经病变组(DPN+组)和无周围神经病变组(DPN-组),用酶转换免疫分析法测定血浆tHcy浓度;并用发光免疫法测定血清叶酸和维生素B12水平。结果:DPN+组的空腹血浆tHcy浓度明显高于DPN-组和正常对照组[(14.20±2.92)μmol/Lvs(9.05±1.78)μmol/L和(8.95±2.27)μmol/L,P<0.01];存在高Hcy血症的DM患者DPN发生率明显高于无高Hcy血症患者(80.65%vs34.72%,P<0.01)。逐步回归分析显示:维生素B12、叶酸(FA)均为DM患者tHcy的决定因素(P<0.01);多元Logistic回归分析显示,空腹tHcy、糖化血红蛋白(HbA1C)、维生素B12均与DPN的发生有关;空腹血浆tHcy、HbA1C、V itB12均为DPN的独立危险因素。结论:空腹高Hcy血症是DPN的危险因素;血清维生素B12、FA水平影响tHcy的浓度。     

血清胱抑素C和同型半胱氨酸水平与早期糖尿病肾病的关系

目的：探讨血清胱抑素C (Cys C)及同型半胱氨酸(Hcy)水平与早期糖尿病肾病的关系。方法选择我院肾脏风湿科2015年1月至2016年2月期间收治的121例2型糖尿病患者,将尿白蛋白排泄率(UAER)<30 mg/24 h者62例纳入单纯DM组,UAER在30~300 mg/24 h者59例纳入早期DN组,并选择50例健康体检者纳入对照组。检测并比较三组受检者的血肌酐(Scr)、尿素氮(BUN)、Cys C和Hcy水平。结果单纯DM组与对照组比较,UAER、血清Cys C、Hcy、Scr及BUN差异均无统计学意义(P>0.05);早期DN组UAER及血清Cys C、Hcy水平分别为(189.68±35.64) mg/24 h、(1.76±0.55) mg/L、(19.15±4.32)μmol/L,均明显高于单纯DM组的(14.58±4.68) mg/24 h、(0.57±0.32) mg/L、(13.62±3.52)μmol/L,差异均有统计学意义(P<0.05);早期DN组患者血清Cys C及Hcy阳性率分别为47.45%、50.85%,明显高于单纯DM组的19.35%、24.19%,差异均有统计学意义(P<0.05);Peason相关分析结果显示,血清Cys C、Hcy水平与UAER均呈正相关性(r=0.636、0.568,P<0.05)。结论2型糖尿病患者定期检测血清Hcy、Cys C对早期识别及诊断糖尿病肾病具有重要意义。     

糖尿病患者血浆同型半胱氨酸的测定与评价

目的:探讨血浆同型半胱氨酸(Hcy)水平与2型糖尿病(T2DM)慢性并发症之间的关系。方法:应用酶联免疫法测定78例T2DM患者(无并发症组28例,慢性并发症组50例)血浆Hcy水平,同时测定血浆叶酸、VitB12浓度及血糖(FBG)、糖化血红蛋白(HbA1C)的水平,并与30例正常人对照。结果:T2DM患者血浆Hcy水平高于正常对照组(P<0.05),以有慢性并发症     

B族维生素水平与2型糖尿病患者肾病进展的关系

目的 探讨B族维生素在2型糖尿病（diabetes mellitus,type 2,T2DM）患者血浆中的水平差异并分析其与糖尿病肾病（diabetic nephropathy, DN）进展的关联性。方法 选取2017年1月—2017年8月同济大学附属同济医院诊断为T2DM的住院患者209例,根据肾小球滤过率（glomerular filtration rate, GFR）和尿微量白蛋白的排泄率（urinary albumin excretion rates, UAER）将209例患者分为糖尿病无肾病组（n=99）、糖尿病轻度肾病组（n=70）和糖尿病中重度肾病组（n=40）。比较3组患者的维生素B1（VitB1）、维生素B2（VitB2）、维生素B6（VitB6）、叶酸（VitB9）、维生素B12（VitB12）及其他临床生化指标的含量,并进行相关性分析。结果 3组T2DM患者的白蛋白（albumin, ALB）、VitB6、VitB9、VitB12水平随肾脏病变程度的加重而降低,差异有统计学意义（P＜0.05）,同型半胱氨酸（homocysteine, Hcy）水平随肾脏病变程度的加重而升高,差异有统计学意义（P＜0.05）;3组T2DM患者的ALB水平与VitB9、VitB12水平均呈正相关关系（r=0.198,P＜0.05;r=0.205,P＜0.05）,Hcy水平与VitB9、VitB12水平呈负相关关系（r=-0.414,P＜0.001;r=-0.276,P＜0.05）;VitB2水平与腰臀比（waist-to-hip ratio, WHR）水平呈正相关关系（r=0.150,P＜0.05）。结论 Hcy、VitB9及VitB12水平与T2DM患者的肾病进展密切相关,监测糖尿病患者的Hcy、VitB9及VitB12的含量有助于临床预测、判断DN的进展。     

血清同型半胱氨酸水平、亚甲基四氢叶酸还原酶基因多态性与糖尿病肾病相关性研究

目的:探讨血清同型半胱氨酸水平、亚甲基四氢叶酸还原酶(MTHFR)基因的分布情况与2型糖尿病肾病(DN)的关系。方法:利用聚合酶链反应和限制性片断长度多态性(PCR鄄RELP)方法检测了47名健康对照组和40名2型糖尿病肾病患者MTHFR基因的677碱基多态性突变C→T情况,同时测定其血清同型半胱氨酸(Hcy)水平和叶酸水平,并加以对照分析。结果:2型糖尿病肾病患者MTHFR基因突变型C677T基因的频率明显高于对照组,差异极显著(P<0.05),且Hcy水平明显高。在叶酸浓度≤6.92nmol/L时,DN组TT型发生频率及T等位基因频率明显高于对照组(P<0.05);但当叶酸浓度>6.92nmol/L时,DN组TT型发生频率及T等位基因频率与对照组无差异(P>0.05)。结论:MTHFR基因C677T位碱基突变导致血浆同型半胱氨酸水平升高是糖尿病肾病发病的重要危险因素。     

尿微量清蛋白检测在糖尿病肾病的早期诊断中的应用价值

目的:探讨尿微量清蛋白(mAlb)检测在糖尿病肾病的早期诊断中的应用价值。方法:选择我院2008年1月～2012年1月确诊的100例糖尿病患者,包括60例糖尿病肾病患者(DN组)和40例糖尿病早期患者(早期DM组),另选30例体检健康者为对照组。采集所有研究对象的静脉血以及尿液,检测血糖、血肌酐、尿素氮及尿微量清蛋白。结果:对照组空腹血糖(FBG)为(5.12±0.45)mmol/L,尿素氮(BUN)、血肌酐(Scr)、mAlb定量异常均为0例,mAlb为(8.5±1.2)mg/L;早期DM组FBG为(7.65±1.32)mmol/L、BUN、Scr、mAlb定量异常分别为9(30.0%)、8(20.0%)、33(82.%)例,mAlb为(25.3±9.8)mg/L,DN组FBG为(8.56±2.54)mg/L、BUN、Scr、mAlb定量异常分别为50(83.3%)、55(91.7%)、60(100.0%)例,mAlb为(55.1±22.5)mg/L。早期DM组及DN组与对照组比较,差异有统计学意义(P<0.05);DN组BUN、Scr、mAlb定量异常率及mAlb与早期DM组比较,差异有统计学意义(P<0.05);早期DM组及DN组中,mAlb定量异常率显著高于BUN、Scr异常率,差异有统计学意义(P<0.05)。结论:mAlb有助于糖尿病肾病的早期诊断。     

老年2型糖尿病合并脑梗死患者血清同型半胱氨酸水平分析

目的 探讨老年2型糖尿病合并脑梗死患者血清同型半胱氨酸(Hcy)水平的异常变化,同时了解血清同型半胱氨酸(Hcy)与叶酸、维生素B12(VitB12)的关系.方法 对47例老年2型糖尿病合并脑梗死患者、44例老年2型糖尿病无合并脑梗死患者、43例健康老年人(对照组)进行血清Hcy与叶酸、VitB12分析.结果 老年2型糖尿病合并脑梗死组的血清Hcy水平明显高于老年2型糖尿病无合并脑梗死组和对照组,叶酸、VitB12低于其他两组.结论 老年2型糖尿病患者除严格控制血糖外,有必要检测血清Hcy与叶酸、VitB12,及时给予补充叶酸和VitB12,以早期预防或延缓大血管并发症的出现,从而降低脑梗死的患病率和病死率.     

高同型半胱氨酸血症与深静脉血栓形成

目的研究亚甲基四氢叶酸还原酶(MTHFR)C677T位点基因多态性及血清叶酸、维生素B12(VitB12)与血浆同型半胱氨酸(Hcy)水平和深静脉血栓形成DVT的关系。方法采用聚合酶链反应-限制性片段长度多态性法(PCR-RFLP)检测111例对照者和69例DVT患者的MTHFRC677T基因型,放射免疫法(RIA)测定血清叶酸和VitB12浓度,荧光偏振免疫法(FPIA)测定血浆Hcy水平。结果DVT组与对照组MTHFRC677T的TT基因型频率和T等位基因频率均无显著性差异;DVT组的血浆Hcy水平为(13.03±8.74)μmol/L,明显高于对照组的(10.14±4.30)μmol/L(P<0.05),两组叶酸和VitB12的差异均无显著性;高同型半胱氨酸血症增加了DVT患病的危险性(OR=2.53,95%CI1.08～5.92)。低叶酸水平和TT基因型共同作用增加DVT危险性(OR=3.1295%CI1.17～8.38)。结论高同型半胱氨酸血症是汉族人DVT发病的独立危险因素;血清叶酸水平、MTHFRC677T位点基因多态性均不是DVT的独立危险因素,但两者间存在的交互作用可共同影响血浆Hcy水平。     

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.