新诊断2型糖尿病患者颈动脉内膜厚度相关危险因素分析

目的:分析新诊断的2型糖尿病患者颈动脉内膜中层病变及相关危险因素分析。方法:选取参加中国2型糖尿病肿瘤发生风险流行病学调查的普查人群9390人,从中选取符合2型糖尿病诊断标准的新诊断人群,符合条件者共入选1136例,并按照CIMT值进行分组,其中CIMT≥1 mm为增厚组(801例),CIMT1 mm为正常对照组(335例)。比较两组患者的年龄、性别、收缩压、舒张压、脉压差、BMI、腰臀比、糖化血红蛋白、空腹血糖、餐后2 h血糖、高密度脂蛋白、低密度脂蛋白、胆固醇、甘油三酯、血尿酸、尿蛋白、尿蛋白/肌酐(UACR),并对与CIMT相关等危险因素进行进一步评估。结果:CIMT增厚组患者的年龄、腰臀比、BMI、收缩压、舒张压、HbA1c、LDL-C、UA均明显高于CIMT正常组,比较差异有统计学意义(P0.05)。年龄、收缩压、HbAlc、TC与CIMT呈正相关(P0.05),性别与CIMT呈负相关(P0.05),腰臀比、BMI、舒张压、FPG、2 h PG、HDL-C、LDL-C、TC、TG、UACR、UA与CIMT无相关性(P0.05)。结论:年龄、性别、收缩压、HbAlc、TC是新诊断糖尿病患者颈动脉内膜增厚的独立危险因素。     

藏族人群颈动脉内膜中层厚度影响因素的相关研究

目的 探讨高原藏族人群颈动脉内膜中层厚度（CIMT）的超声检测的影响因素。方法 对四川省甘孜州藏族自治州的两个佛学院内的藏族僧侣和周边乡镇藏族非僧侣进行问卷调查、体格检查（身高、体重、腰围、臀围、血压测量等）、CIMT检测及留取空腹血多个相关生化指标检测等,共计1409名参与者。结果 ①按CIMT增厚与正常分组,年龄、舒张压（DBP）、收缩压(SDP)、腰围、臀围、空腹血糖、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高血压患病率、喝茶加盐率、经常摄入蔬菜率、僧侣比例、佛事活动时间均有显著性差异(P＜0.05）。②按藏族僧侣与非僧侣分组比较,舒张压、体重指数（BMI）、腰围、空腹血糖、高密度脂蛋白胆固醇（HDL-C）、佛事活动时间及CIMT均有显著性差异(P＜0.05）。③Logistic回归分析显示,年龄、收缩压、空腹血糖、食肉率、总胆固醇升高是CIMT增加的危险因素;而僧侣、佛事活动时间增加、HDL-C升高是CIMT的保护因素。结论 年龄、收缩压、腰臀比、空腹血糖、总胆固醇升高是藏族人群CIMT增高的危险因素,而僧侣、佛事活动时间增加、HDL-C升高是保护因素。     

2型糖尿病颈动脉内膜中层病变及相关危险因素分析

目的：分析2型糖尿病患者颈动脉内膜中层厚度（CIMT）及其相关危险因素。方法：采用彩色多普勒超声仪测量115例2型糖尿病患者CIMT,并根据CIMT值将全部患者分为A组和B组,其中,A组患者62例,CIMT值≥1．0mm,B组患者53例,CIMT值〈1．0mm。比较两组血糖、血压和血脂等代谢指标,并对与2型糖尿病CIMT增厚的相关危险因素进行评估。结果：A组患者的年龄、糖尿病病程、高血压病程、低密度脂蛋白胆固醇（LDL—C）、体重指数（BMI）明显高于B组,差异均有统计学意义（均P〈0．05）,而两组三酰甘油、总胆固醇、高密度脂蛋白胆固醇、糖化血红蛋白、空腹血糖、餐后2小时血糖水平差异无统计学意义（P〉0．05）。经Logistic回归分析显示,年龄、糖尿病病程、BMI、LDL—C水平是2型糖尿病患者CIMT增厚的独立相关危险因素（OR=1．093、1．088、1．038、1．732,均P〈0．01）。结论：2型糖尿病患者CIMT增厚受多种因素影响。尤其与年龄、肥胖、糖尿病病程和LDL—C水平密切相关。     

慢性肾脏病患者血清suPAR水平与颈动脉内膜中层厚度的相关性研究

目的：探讨慢性肾脏病（chronic kidney disease，CKD）患者血清可溶性尿激酶型纤溶酶原激活物受体（suPAR）水平与颈动脉内膜中层厚度（carotid intima-media thickness，CIMT）的相关性。方法：回顾性纳入2017年1月1日至2018年6月1日共155例CKD患者作为CKD组，另选45例健康体检者作为对照组，评估两组患者临床特征参数及生化指标的差异，分析CKD患者suPAR水平与生化指标相关性，并评估CKD患者CIMT增厚的发生率及其影响因素，利用受试者操作特征（receiver operating characteristic，ROC）曲线探讨suPAR水平预测CKD患者CIMT增厚的临床效能。结果：与对照组比较，CKD患者体质量指数（BMI）、低密度脂蛋白胆固醇（LDL-c）、总胆固醇（TC）、甘油三酯（TG）、收缩压、舒张压、糖化血红蛋白、超敏C-反应蛋白（hs-CRP）、尿酸、CIMT和suPAR均高于对照组，而eGFR低于对照组（P＜0.05）；Pearson相关分析显示，CKD患者suPAR水平与LDL-c、TC、TG、收缩压、hs-CRP、尿酸和CIMT水平均呈正相关性，与eGFR呈负相关性（P＜0.05）。CIMT超过0.8 mm的患者共69例，发生率为44.52%（69/155），单因素分析表明，LDL-c、收缩压、hs-CRP、尿酸、eGFR、suPAR水平在CIMT增厚组和正常组间差异均有统计学意义（P＜0.05）。Logistic 回归分析显示，suPAR升高是导致CKD患者CIMT增厚的危险因素，而eGFR升高是其保护因素(P＜0.05)。ROC曲线结果发现，suPAR（AUC：0.841）预测CKD患者CIMT增厚的临床效能较好，当截断值为8.9 μg·L-1时，敏感度和特异度分别为87.4%和90.7%。结论：CKD患者血清suPAR水平升高，可作为反映病情严重程度及预测患者CIMT增厚的一个临床指标。     

2型糖尿病患者颈动脉内中膜厚度与低度白蛋白尿的相关性

目的: 探讨2型糖尿病（type 2 diabetes mellitus,T2DM）患者颈动脉内中膜厚度（carotid intima madia thickness,CIMT）与低度白蛋白尿的相关性。方法: 选择T2DM患者460例,检测CIMT和尿白蛋白/肌酐比值（urinary albumin to creatinine ratio,UACR）。根据UACR四分位切点将全部患者分为4组,分别为0＜Q1＜7.06 mg/g（n=112）,7.06≤Q2＜8.91 mg/g（n=118）,8.91≤Q3＜12.10 mg/g（n=115）,12.10≤Q4＜30.0 mg/g（n=115）。收集4组患者的一般资料,采用Logistic回归分析CIMT和UACR的相关性。结果： Q1-Q4组CIMT增厚的发生率分别为30.36%、38.14%、45.22%、53.91%,且CIMT与UACR呈正相关（r=0.300,P<0.01）。Logistic回归分析显示UACR与CIMT增厚发生率相关(OR：1.166,95%CI：1.080～1.259,P<0.01)。 结论： 随着UACR升高,CIMT增加。UACR是T2DM患者CIMT增厚的危险因素。     

血浆同型半胱氨酸与帕金森病相关性研究

目的 通过检测帕金森病（PD）患者及健康人群血浆同型半胱氨酸（Hcy）的浓度并进行对比,探讨高同型半胱氨酸与帕金森病的风险相关性.方法 收集60例帕金森患者及15例健康人群血清进行同型半胱氨酸浓度检测并进行对比分析,其中帕金森病患者随机分为A组（常规治疗＋叶酸及维生素B12治疗组）及B组（常规治疗组）进行治疗,各30例,C组为健康人群,A、B两组患者治疗前后采用帕金森病症状评分量表（UPDRS）评分并进行分析.结果 帕金森病患者（A组与B组）Hcy水平高于C组（健康人群）,差异具有统计学意义（P＜0.05）,治疗后A组血清Hcy水平低于B组,差异有统计学意义（P＜0.05）;A组和B组UPDRS评分均有改善（均P＜0.05）,A组优于B组（P＜0.05）.结论 帕金森病患者血浆Hcy水平较健康人群增高,叶酸、VitB 12辅助治疗可能对帕金森病治疗具有临床意义.     

糖耐量减低的绝经后女性和肽素水平与冠状动脉粥样硬化病变的相关性

目的：观察糖耐量减低的绝经后女性血浆和肽素（copeptin）水平与冠状动脉粥样硬化病变的相关性。方法：将80例新发糖耐量减低（空腹血糖＜7.0 mmol/L,7.8 mmol/L≤早餐后2 h血糖＜11.0 mmol/L）的绝经后女性（年龄56~59岁）依据基线copeptin水平分成A组（＜5 pmol/L）、B组（＞20 pmol/L）,每组各收集40例。分析两组间基线时和6个月后冠状动脉（CTA）狭窄程度积分的差异。结果：①基线时,A组与B组之间的copeptin水平差异有统计学意义（P＜0.05）,而在体重、空腹全血血糖、早餐后2 h血糖、空腹血清甘油三酯、血清总胆固醇、血清低密度脂蛋白胆固醇、平均动脉压、血清肌酐水平、年龄等指标上差异无统计学意义。②经治疗性生活方式调整及口服阿司匹林（100 mg/d）、瑞舒伐他汀（10 mg/d）6个月后,在copeptin水平、冠脉CTA的狭窄程度积分、空腹全血血糖、早餐后2 h血糖指标上,B组明显高于A组,差异有统计学意义（P＜0.05）,且B组有糖尿病、冠心病的发病,A组没有。结论：在糖耐量减低、绝经后女性的冠心病危险因素的基础上,高血浆copeptin水平会进一步促进冠状动脉粥样硬化病变发生和恶化。     

老年心血管疾病患者血糖 尿酸 血脂变化及其与临床相关性分析

目的 探讨老年心血管疾病患者血糖、尿酸、血脂的变化及其与临床的相关性.方法 选取2013年8月至2014年5月确诊的心血管疾病人群,其中冠心病组100例、高血压组100例为疾病组,另选同年龄段的体检人员（排除炎症及心血管疾患）63例为对照组.比较三组人群的血糖（GLU）、血尿酸（URIC）及血脂水平.结果 疾病组除男性冠心病患者URIC水平较对照组明显增高,差异有统计学意义（P＜0.05）外,其他各项结果并无增高.冠心病组男性TC及LDDC水平较高血压组水平低,差异有统计学意义（P＜0.01）;冠心病组女性的TC、HDL-C及LPa水平较高血压组低,差异有统计学意义（P＜0.05）;疾病组TC、LDL-C、HDL-C水平与对照组比较,差异有统计学意义（P＜0.05或0.01）;疾病组TG/TC、LPa/TC的比值较对照组明显增高,差异有统计学意义（P＜0.05）.结论 血糖、尿酸、血脂水平及性别差异与老年心血管疾病存在明显相关性,在诊断和筛查心脑血管疾病、改善预后等方面具有重要的临床意义.     

乙肝合并NAFLD患者肝功能及病毒复制与脂代谢水平相关性分析

目的 研究乙肝合并NAFLD患者肝功能及病毒复制与脂代谢水平相关性.方法 选择乙型肝炎患者138例,分为有患者分为慢性乙型肝炎组（A组）及慢性乙型肝炎合并NAFLD组（B组）,分别有65例、73例,同时选择50名健康人群作为对照组（C组）.分别检测肝功能肝功能、HBV-DNA及血清脂肪因子水平.结果 A组较C组ALT及AST差异有统计学意义（P＜0.05）,B组较A组及C组ALT及AST差异有统计学意义（P＜0.05）.A组较C组Chemerin、内脂素、瘦素水平差异有统计学意义（P＜0.05）,B组较A组及C组Chemerin、内脂素、瘦素水平均差异有统计学意义（P＜0.05）.Chemerin及瘦素与ALT、AST呈正相关（P＜0.05）,内脂素与AST呈正相关（P＜0.05）.结论 乙肝合并NAFLD患者肝功能与脂代谢紊乱具有较好的相关性,两者共同参与了NAFLD的形成.     

高血压患者颈动脉内中膜厚度与脂联素的关系

目的：探讨高血压患者颈动脉内中膜厚度（ IMT）与血浆脂联素水平（ APN）的变化及其关系。方法收集原发性高血压患者80例,按IMT分别为高血压内膜正常组、高血压内膜增厚组,另收集门诊体检正常者40例为对照组。检测3组的血糖（ FBG）、血浆总胆固醇（ TC）、三酰甘油（ TG）、高密度脂蛋白胆固醇（ HDL－C）、低密度脂蛋白胆固醇（ LDL－C）;采用酶联免疫吸附法测定血浆APN水平。应用彩色多普勒超声仪测定颈动脉IMT。结果组间比较,高血压内膜正常组与内膜增厚组血浆LDL－C、TC水平均高于对照组,差异有统计学意义（ P＜0.05）,LDL－C、TC水平在高血压内膜正常组与内膜增厚组间的比较差异无统计学意义（P＞0.05）;FBG、TG、HDL－C在3组间差异无统计学意义（ P＞0.05）。高血压内膜增厚组APN低于高血压内膜正常组[（2.36±0.27） vs （3.28±0.25） mmol／L,P＜0.01）]及对照组[（2.36±0.27）vs（4.25±0.22） mmol／L,P＜0.01）];高血压内膜正常组低于对照组（ P＜0.05）。相关分析显示高血压患者IMT与APN （ r＝－0.232, P＝0.028）呈负相关;与LDL－C （ r＝0.207, P＝0.036）呈正相关;与HDL－C、TC、TG、FBG无相关性。结论高血压患者血浆APN水平降低, IMT与APN水平呈负相关, IMT增厚与低APN血症可能都与高血压的发展有关。     

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.