糖尿病对充血性心力衰竭患者心率变异性的影响

目的 :观察糖尿病是否会加重充血性心力衰竭 (CHF)患者的自主神经功能异常。方法 :对 35例糖尿病合并CHF和 4 5例非糖尿病CHF患者行 2 4h动态心电图检查 ,采用 2 4h时域和频域心率变异性方法来评价自主神经功能。结果 :两组有重要预后价值的HRV指标 (SDNN ,SDANN5及TP功率 )无差别。反映迷走神经活性的HRV指标 (pNN5 0 ,RMSSD及HF功率 )在两组有类似程度的降低。糖尿病组的LF明显低于非糖尿病组[(3.6 1± 0 .18)vs (4.0 9± 0 .2 1)In ms2 ,P =0 .0 4 ]。合并糖尿病组患者的LF/HF也明显低于非糖尿病组 [(2 .2± 0 .2 )vs (1.4± 0 .2 ) ,P =0 .0 0 1]。结论 :在CHF患者 ,合并的糖尿病不影响具有预后价值的HRV指标。此外 ,在CHF交感神经刺激增加的情况下 ,糖尿病不进一步降低迷走神经活性 ,但降低交感神经活性。     

妊高征患者母血、脐血白细胞介素—6与肿瘤坏死因子的研究

目的探讨白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)与妊高征发病机理的关系.方法采用放射免疫法检测重度妊高征患者30例(妊高征组)母血、脐血中IL-6与TNF-α的含量.并以同期正常妊娠妇女30例作对照(正常妊娠组).结果妊高征组母血中IL-6含量为(163.30±64.82)ng/L,TNF-α含量为(1.52±0.31)ng/L,均较正常妊娠组显著增高(P<0.01,P<0.01).妊高征组脐血中IL-6含量为(135.20±84.16)ng/L,TNF-α含量为(1.31±0.16)ng/L,也均较正常妊娠组明显升高(P<0.01;P<0.01).结论IL-6与TNF-α参与了妊高征的血管内皮损伤过程,两种细胞因子的升高与妊高征的发生密切相关.     

糖尿病患者心率变异及QT离散度改变的研究

目的探讨心律变异(HRV)及QT离散度对糖尿病病情预测的价值.方法糖尿病组50例,健康对照组60例,检测空腹血糖、血脂、QTd及心率变异的各种指标(SDNN、RMSSD、PNN50、LF/HF).结果糖尿病组空腹血糖高于对照组.糖尿病组SDNN、RMSSD时间短于对照组(t=4.23,t=3.19, P<0.01).PNN50低于对照组(t=5.06,P<0.01).LF/HF大于对照组(t=5.50,P<0.01).糖尿病组QTd值大于对照组(t=8.02,P<0.01).结论糖尿病患者HRV及QTd有显著性改变,提示有自主神经功能损害,可作为糖尿病合并冠心病患者心脏猝死高危因素的指标.     

急性病毒性心肌炎与心脏自主神经张力的关系

目的通过分析急性病毒性心肌炎患者心率异性(he art rate variability,HRV)的改变,探讨急性病毒性心肌炎与心脏自主神经张力的关系. 方法应用24 h动态心电图检测60例急性病毒性心肌炎患者和36例正常人的HRV时域指标,并根据是否有心律失常将急性病毒性心肌炎患者分为心律失常组和非心律失常组,与正常对照组进行HRV的分析比较.结果心律失常组、非心律失常组和对照组SDNN分别为(89.81±17.7 3) ms、(117±22.47) ms、(130.50±28.33) ms.心律失常组与非心律失常组和对照组比较 HRV明显降低(P<0.001),非心律失常组与对照组比较HRV降低(P<0.05).结论急性病毒性心肌炎患者自主神经功能受损,主要表现在迷走神经张力降低,有心律失常者损害更明显,HRV降低的程度与病情严重程度呈正相关.     

妊高征患者及其新生儿染色体不稳定性的研究

目的　比较妊高征 (PIH)孕妇外周血及其新生儿脐血SCE频率 ,以探讨PIH母婴DNA损伤情况并提高其监测水平。方法　采用紫外光照射 ,SCE分化染色法对 2 1例PIH病人和 15例正常孕妇 (对照组 )外周血及其所分娩新生儿脐血进行SCE测定。结果　PIH组外周血和脐血SCE频率分别为 6.11± 1.2 9,5.98± 1.38;对照组外周血和脐血SCE频率分别为 3.4 5± 0 .71,3.16± 0 .57。两组比较有极显著性差异 (P <0 .0 0 1)。结论　PIH孕妇及新生儿皆有遗传物质DNA的损伤 ,SCE频率可作为一项诊断、监测PIH的重要指标     

代谢综合征患者的自主神经功能紊乱

目的探讨代谢综合征患者是否存在自主神经功能紊乱。方法82例代谢综合征患者和36例健康人用心率变异性(HRV)分析作短时时域和频域检测。结果代谢综合征组的平均心率显著大于健康对照组(81.5±9.7次/分,72.3±8.6次/分,P<0.01),SDNN显著小于健康对照组(98.1±8.6 ms2,138.9±11.5ms2,P<0.01),LF与健康对照组无显著性差异(434.8±415.9 ms2,417.6±404.8 ms2,P>0.05),LF显著小于健康对照组(181.2±126.5 ms2,278.4±198.7 ms2,P<0.05),LF/HF比值显著大于健康对照组(2.4±1.3,1.5±0.9,P<0.01)。结论代谢综合征患者存在自主神经功能紊乱,主要是迷走神经活性显著降低,使自主神经功能指数LF/HF比值显著增大。     

阵发性心房颤动发作前后心率变异性频阈指标分析

目的:观察心房颤动(atrial fibrillation,AF)发作前后心率变异性(heart rate variability,HRV)频阈指标的变化以探讨自主神经系统的张力变化在AF发作中的作用?方法: 2005年1月~2007年12月在南京医科大学第一附属医院就诊的阵发性AF患者共17例满足分析条件,行24 h动态心电图检查,对动态心电图资料进行离线分析,分别选取AF发作前5 min和发作后1 h的5 min时段进行HRV的频阈指标分析?结果:共有27阵AF满足分析条件?总体上AF发作前后频阈指标无显著性变化?将AF发作时间分成日间组15阵和夜间组12阵,统计表明两组之间并无显著性差别?但是AF发作前后的HRV频阈指标变化可分为2种类型:第1种A型为LF以及LF/HF增加,而HF下降(LF12.3±9.6 vs 22.4±14.1,P=0.0002;LF/HF0.9±0.5 vs 2.5±2.0,P=0.004;HF15.9±13.9 vs 12.1±11.7,P=0.003);第2种B型为LF及LF/HF下降,而HF增加(LF29.5±26.7 vs 7.4±6.1,P=0.04;LF/HF4.4±3.1 vs 0.6±0.5,P=0.02;HF6.5±1.5 vs 16.3±9.3,P=0.02)?这种神经张力改变的类型有一定的发作时段特异性,即A型更多发生于夜间,而B型更多发生于日间,但是未达统计学差异(P=0.07)?结论:AF发作前后均伴随HRV频阈指标的变化,这种变化可分为两种类型,可能分别代表了交感和迷走两神经系统张力的变化?并且这种变化显示出一定的时间特异性趋势?     

Impact of right upper pulmonary vein isolation on atrial vagal innervation and vulnerability to atrial fibrillation

Background Based on the hypothesis that pulmonary vein isolation could result in the damage of the epicardial fat pads, this study aimed to investigated the impact of right upper pulmonary vein (RUPV) isolation on vagal innervation to atria. Methods Bilateral cervical sympathovagal trunks were decentralized in 6 dogs. Metoprolol was given to block sympathetic effects. Multipolar catheters were placed into the right atrium (RA) and coronary sinus (CS). RUPV isolation was performed via transseptal procedure. Atrial effective refractory period (ERP), vulnerability window (VW) of atrial fibrillation (AF), and sinus rhythm cycle length (SCL) were measured at RA and distal coronary sinus (CSd) at baseline and vagal stimulation before and after RUPV isolation. Serial sections of underlying tissues before and after ablation were stained with haematoxylin and eosin.Results SCL decreased significantly during vagal stimulation before RUPV isolation (197±21 vs 13±32 beats per minute,P&lt;0.001), but remained unchanged after RUPV isolation (162±29 vs 140±39 beats per minute, P&gt;0.05). ERP increased significantly before RUPV isolation compared with that during vagal stimulation [(85.00±24.29) ms vs (21.67±9.83) ms at RA, P&lt;0.001; (90.00±15.49) ms vs (33.33±25.03) ms at CSd P&lt;0.005], but ERP at baseline hardly changed after RUPV isolation compared with that during vagal stimulation [(103.33±22.50) vs (95.00±16.43) ms at RA, P = 0.09; (98.33±24.83) vs (75.00±29.50) ms at CSd, P=0.009]. The ERP shortening during vagal stimulation after RUPV isolation decreased significantly [(63.33±22.51) ms vs (8.33±9.83) ms at RA, P&lt;0.005; (56.67±20.66) ms vs (23.33±13.66) ms at CSd, P&lt;0.05]. AF was rarely induced at baseline before and after RUPV isolation (VW close to 0), while VW of AF to vagal stimulation significantly decreased after RUPV isolation [(40.00±10.95) vs 0 ms at RA, P&lt;0.001; (45.00±32.09) vs (15.00±23.45) ms at CS, P &lt;0.05]. The architecture of individual ganglia was significantly altered after ablation.Conclusions The less ERP shortening to vagal stimulation and altered architecture of individual ganglia after right upper pulmonary vein isolation indicate that isolation may result in damage of the epicardial fat pads, thereby attenuating the vagal innervation to atria. The decreased vulnerability window of atrial fibrillation indicates that vagal denervation may contribute to its suppression.     

腰段脊神经阻滞对妊高征患者血浆雌激素水平的影响

目的探讨脊神经阻滞是否通过调节孕妇的内分泌水平而发挥其作用.方法测定重度妊高征患者(PIH组)20例,随机分为蛛网膜下腔阻滞组(SB)和硬膜外腔阻滞(EB)组,各10例.正常未孕妇女(NNP组)12例,正常晚期妊娠妇女(NLP组)18例.3组经腰段脊神经阻滞前、后血浆雌激素水平的变化.雌激素的测定采用放免分析法进行测定.数据用SPSS软件进行t检验.结果NLP组雌激素水平为(71.66±19.22)pg/ml、PIH组(211.12±47.61)pg/ml较NNP组(374.16±122.61)pg/ml明显降低(P＜0.01),PIH组较NLP组明显降低(P＜0.05),PIH组SB(237±67.23)pg/ml,EB(288.5±61.26)pg/ml)后均较阻滞前升高(P＜0.05),且EB较SB升高明显(P＜0.05).结论妊高征病人较正常妊娠晚期妇女体内雌激素水平降低,而脊神经阻滞可以提高妊高征病人体内雌激素水平.硬膜外阻滞较蛛网膜下腔阻滞使妊高征病人体内雌激素水平升高更明显.     

血管紧张素转换酶抑制剂和β-受体阻断剂对冠心病患者心率变异性的影响

目的 :观察血管紧张素转换酶抑制剂和 β 受体阻断剂用药前后冠心病患者心率变异性 (HRV)的变化 ,以探讨血管紧张素转换酶抑制剂和β 受体阻断剂对冠心病人HRV的影响及机理。方法 :将 93例冠心病人根据用药情况分为 3组 ,C1组 :服用消心痛 +阿司匹林 ;C2组 :服用消心痛 +阿司匹林 +卡托普利 ;C3组 ;服用消心痛 +阿司匹林 +倍他乐克 (或阿替洛尔 )。观察用药前后全天HRV变化。结果 :C1组用药前后R -R连续差异平方根 (rMSSD)、高频能谱 (HF ,ms2 )、低频能谱 (LFms2 )和LF/HF差异无显著意义 (P >0 0 5 )。C2组用药前后比较 ,rMSSD为 2 5 3 7± 11 87和 3 6 68± 12 2 3 ,HF为 170 78± 10 8 80和 196 3 4± 10 8 77,LF/HF为2 0 9± 1 3 7和 1 75± 1 0 6,rMSSD、HF试验后比试验前明显升高 ,差异有极显著意义 (P <0 0 1) ;LF/HF降低 ,差异有显著意义 (P <0 0 5 )。C3组用药前后rMSSD为 2 8 97± 11 71和 3 3 2 9± 10 77,HF为 15 5 3 1± 10 1 2 5和 2 14 42± 12 0 77,LF为 3 0 2 79± 2 11 2 4和 3 3 5 40± 2 0 8 82 ,LF/HF为 2 5 1± 1 62和 1 83± 1 2 2。rMSSD、HF在试验后比试验前明显升高 ,差异有极显著意义 (P <0 0 1) ;LF升高 ,差异有显著意义 (P <0 0 5 ) ;LF/HF明显降低 ,差     

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.