LP(a)等血脂指标在甲状腺疾病患者中的改变研究

目的 检测甲亢、甲减、结节性甲状腺肿患者血清脂蛋白(a)[LP(a)]等血脂指标,探讨甲状腺激素水平对血脂的影响.方法 用全自动微粒子化学发光免疫分析技术检测FT3、FT4、TSH,以及用日立全自动生化分析仪测总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、极低密度脂蛋白胆固醇(VLDL)、载脂蛋白(ApoB)、载脂蛋白(ApoAl)和LP(a);将38例甲亢、35例甲减、40例结甲患者的LP(a)等血脂指标与40例正常对照做比较.结果 LP(a)在甲亢、甲减、结甲患者中与正常对照比较,P＞0.05,无显著性差异;甲亢患者CHO、LDL、ApoB均比正常对照低,P＜0.01,有显著性意义;甲减患者CHO、LDL、ApoB均比正常对照高,P＜0.05,有差异;结甲患者血脂指标与正常对照比较无意义.结论 本试验发现甲功异常时只影响TC、、LDL、ApoB的浓度,对LP(a)、TG、HDL、VLDL无影响.     

成年人肥胖症血清脂蛋白水平并代谢综合征调查研究

目的　 观察临沂市成年人肥胖症血脂水平及脂蛋白三联征合并代谢综合征之间的关系。方法　 采取多级抽样法抽取 30岁以上的临沂城镇居民 1883人 ,分别检测TCH、TG、HDL C、HDL2 C、HDL3 C、LDL C、VLDL C ;从BMI≥ 2 7者及BMI <2 5者中分别抽取 2 0 3、2 11人检测空腹、餐后1、2h血糖及血清胰岛素 (Ins) ,并对其脂蛋白三联征 (ALP)合并代谢综合征者进行比较。结果　BMI≥ 2 5组的TCH、TG、LDL C、VLDL C显著高于BMI <2 5组 (P <0 .0 5或P <0 .0 1) ;HDL C、HDL2 C、HDL3 C显著低于BMI <2 5组 (P <0 .0 5或P <0 .0 1)。BMI与TCH、TG、LDL C、VLDL C呈显著正相关 ,与HDL C、HDL2 C、HDL3 C无相关 (均P >0 .0 5 )。BMI≥ 2 7组空腹、餐后 1、2h血糖和胰岛素均明显高于对照组 (P <0 .0 5或P <0 .0 1)。ALP合并代谢综合征BMI≥2 7组显著高于对照组 (P <0 .0 1)。结论　 肥胖症血清TCH、TG、LDL C、VLDL C显著增高 ,BMI与TCH、TG、LDL C、VLDL C呈显著正相关 ;ALP合并代谢综合征发生率显著增高。     

糖尿病患者的血脂检测分析

目的对746例糖尿患者，275例糖耐量异常者和427例正常人群的血脂进行检测分析，了解糖尿病和高血脂的相关性。方法酶法测定甘油三酯（TG）、总胆固醇（TCH）；直接法测定高密度脂蛋白胆固醇（HDL—C）、低密度胆固醇（LDL-C）：凝集比浊法测定脂蛋白（a）【LP（a）】；己糖激酶法测定血糖。结果糖尿病组脂蛋白TG、TCH、LDL—C水平显著高于糖耐量异常组和正常对照组（均p〈0．01）；糖耐量异常组TG、TCH、LDL—C水平显著高于正常对照组（均p〈0．01）；各组间HDL-C、Lp（a）差异无显著性。结论糖尿病患者的血脂测定和分析不仅能及时地反映体内脂质代谢状况，还对糖尿病的诊断，疗效监测，病程观察都有重要价值。     

脂质代谢紊乱与颈动脉粥样硬化

按颈动脉超声检查结果将85例病员分成班块组(CP)与无斑块组(NCP),比较两组血脂值。并作颈动脉斑块指数(PLI)与血脂值之间相关分析。结果显示CP组的甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL)及脂蛋白(a)[LP(a)]值均高于NCP组,而高密度脂蛋白胆固醇(HDL)值低于NCP组。其中两组间TG、HDL有显著性差异,LP(a)有非常显著性差异,PLI与TG、LP(a)呈显著正相关,与HDL呈显著负相关。提示LP(a)、TG升高,HDL降低与颈动脉粥样硬化(CAS)发生及发展有关。LP(a)、TG、HDL水平可预告CAS的发生及程度,维持正常水平的血脂对防治CAS乃至冠状动脉粥样硬化十分重要。     

绝经前后女性原发性高血压患者脂蛋白及血脂水平变化的研究

目的　研究绝经前后女性原发性高血压患者脂蛋白 (a)及血脂变化的特点 ,探讨其对女性冠心病发病情况的影响。方法　女性原发性高血压患者 118例 ,绝经前 6 0例 ,绝经后 5 8例 ,测定脂蛋白 [LP(a) ]、总胆固醇(TC)、甘油三酯 (TG) ,低密度脂蛋白胆固醇 (LDL -C)和高密度脂蛋白胆固醇 (HDL -C)。对比绝经前后LP(a)及血脂水平的变化 ,并与健康体检女性 118例作对照。结果　高血压组LP(a) ,TC ,TG ,LDL -C均显著高于对照组 ,而HDL -C则明显低于对照组 ,绝经后患者LP(a) ,TC ,TG ,LDL -C明显高于绝经前患者 ,而HDL -C则前者低于后者。结论　女性绝经后原发性高血压患者LP(a) ,TC ,LDL -C ,TG均明显高于绝经前患者 ,提示血脂水平的变化是绝经后冠心病发病率明显上升的重要危险因素     

单纯性肥胖与合并2型糖尿病患者血脂水平的变化

目的 :研究单纯性肥胖、肥胖合并2型糖尿病患者血浆脂蛋白(a)[Lp(a)]等血脂水平的差异及变化规律。方法:检测和比较单纯性肥胖者、肥胖合并2型糖尿病者及健康对照共160例血脂指标。测定项目包括Lp(a)、载脂蛋白A(apoA -Ⅰ )、载脂蛋白B(apoB)、甘油三脂 (TG)、胆固醇 (TC)、高密度脂蛋白 (HDL -C)、低密度脂蛋白(LDL -C)和极低密度脂蛋白 (VLDL -C)。结果:单纯性肥胖组和肥胖合并2型糖尿病组的血浆Lp(a)、TC、TG、LDL -C、VLDL -C、apoB均比健康对照组高 ,差别有统计学意义(P<0.01) ,而HDL -C、HDL -C2、apoA的水平低于健康对照 ,差别也有显著性(P<0.01) ;HDL -C3 无统计学意义 (P>0.05)。结论:单纯性肥胖者和肥胖合并2型糖尿病的血脂代谢异常 ,提示患动脉粥样硬化和冠心病等心血管疾病危险性增大     

高血压和冠心病患者血脂及载脂蛋白检测结果分析

目的探讨高血压、冠心病(CHD)患者脂代谢的变化规律.方法对本院30例正常人群、53例高血压及67例CHD患者的血脂、载脂蛋白用HITACHI 7060全自动生化分析仪检测并进行对比分析.结果与正常对照组相比较,高血压病患者TC、TG、ApoB100均显著性升高(P＜0.01),LDL、Lp(a)升高显著(P＜0.05);CHD患者TC、TG、LDL、ApoB100、Lp(a)均显著性升高(P＜0.01),ApoA1、HDL呈显著性降低(P＜0.05).高血压病组与CHD组相比较,CHD患者TG、Lp(a)升高及HDL降低在两组间的差异有显著性(P＜0.05),而ApoA1显著性降低(P＜0.01).结论通过监测血脂、载脂蛋白水平,对于高血压病、CDH的早期诊治或预防具有重要的临床价值.     

沂蒙山区冠心病患者与血浆甘油三酯代谢异常及其它脂类水平的相关研究

目的探讨冠心病（CHD）患者与血浆甘油三酯代谢异常及其它脂类水平的关系。方法对100例确诊为冠心病患者及100例健康人测定空腹血浆甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白-胆固醇（HDL－C）、低密度脂蛋白-胆固醇（LDL－C）、APOA－Ⅰ、APOB100、脂蛋白a[LP（a）]、血糖及胰岛素浓度。同时将年龄、性别、体重指数（BMI）、空腹血浆TG、TC、LDL-C、APOB100、LP（a）、血糖、胰岛素等因素考虑在内，对CDH发病进行多元逐步logistic回归分析。结果CHD组与对照组相比：空腹血浆TG、TC、LDL－C、APOB100、LP（a）、血糖、胰岛素浓度显著升高（P＜0.01），HDL－C浓度显著降低（P＜0.01）；APOB100、HDL－C及TG水平与CHD的发病独立相关。结论提示空腹血浆TG代谢异常与CHD独立显著相关，是独立危险因素之一。     

通脉降脂软胶囊对大鼠高血脂症模型血脂的影响

目的通脉降脂软胶囊对大鼠高血脂症模型血脂的影响。方法通过高脂饮食建立大鼠高血脂模型,设空白组、模型组、通脉降脂软胶囊低剂量组(低剂量组)、通脉降脂软胶囊中剂量组(中剂量组)、通脉降脂软胶囊高剂量组(高剂量组)、血脂康对照组,测定血清TC、TG、HDL、LDL、脂蛋白(LPα)、ALT及AST。结果空白组与模型组比较TG、LDL及血清脂蛋白(LPα)明显升高(P<0.05),各试验组与模型组TG比较明显降低(P<0.01),高剂量组TC与模型组的比较亦明显降低(P<0.05),高剂量组和血脂康对照组与模型组的LDL比较明显降低(P<0.01),各试验组对HDL作用不明显,各试验组和血脂康对照组对血清脂蛋白(LPα)无明显影响,各试验组与空白对照组的ALT、AST比较差异无统计学意义。结论通脉降脂软胶囊量具有降低高血脂大鼠血脂的作用,对肝功能没有显著影响。     

股动脉和正中静脉血脂和脂蛋白谱的观察

目的血管粥样硬化好发于动脉,通常不发生于静脉,其机制尚未完全阐明。除外血管结构、血氧浓度、血流动力学的差异,血液某种生化成分,如血脂的质和量的变化有可能参与动脉粥样硬化的形成机制。本研究观察股动脉和正中静脉血脂和脂蛋白谱的变化,初步了解血脂因素是否参与血管粥样硬化。方法患者10例,男7例,女3例,年龄(60．0±10．7)岁,其中冠心病8例,心肌病1例(少1例)。取非抗凝的股动脉和正中静脉血标本。常规方法检测血脂和载脂蛋白,包括TG、TC、LDL-C、HDL-C、Apo(A、B、E)及LP(a)。改良梯度凝胶电泳(GGE)法检测血清脂蛋白,包括VLDL、IDL、Lp(a)、LDL、HDL亚类,以及白蛋白携带的游离脂肪酸。配对资料的t检验进行统计分析。结果常规方法未检出股动脉和正中静脉血脂和载脂蛋白水平存在显著差异。改良GGE法检测发现,正中静脉血清VLDL含量显著．低于股动脉中的含量(t=4．507,P<0．001),差值为血脂总体的(0．75±0．52)％,其他脂蛋白及其亚类含量的差异无统计学意义。结论患者股动脉和正中静脉血脂和脂蛋白含量的变化很小,改良GGE法因其高效、敏感度高,能够检出其中的差异。正中静脉血VLDL含量降低的原因,可能与外周血管网内脂蛋白脂酶对其中富含的TG的酯解作用有关。静脉血VLDL含量降低是否与其少发粥样硬化有关,尚需进一步研究。     

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.