妊娠期肝病101例临床研究

目的了解妊娠期肝病的病因、临床类型的分布特征，对围产儿及产后结局的影响。方法回顾性分析1999年6月至2006年6月我院收治的101例妊娠早中期肝病的孕产妇的病历资料，对妊娠合并病毒性肝炙的病因构成及临床类型构成、妊娠期特有肝病类型构成和妊娠期肝病对围生儿及产后结局的影响进行统计分析。结果妊娠期肝病患者中，妊娠合并病毒性肝炎（VHP）55例（占54．46％），妊娠期肝内胆汁淤积症（ICP）26例（占27．72％），妊娠剧吐肝损6例（占5．94％），不明原因肝损12例（占11．88％），结论妊娠期肝病以VHP、ICP常见，VHP以乙肝居多，均可增加妊娠及分娩时母婴的危险性。     

妊娠期肝病

妊娠期出现肝功能损害或黄疸时，统称为妊娠期肝病，对孕妇及围产儿有很大威胁，属高危妊娠之一。妊娠期肝病按其与妊娠的关系主要分为两大类：妊娠期合并症（如病毒性肝炎、药物性黄疸，胆囊炎胆石症。阿米巴肝浓肿、良性肝肿瘤，溶血性黄疸，肝硬化）和妊娠期特有的肝病（如妊娠肝内胆汁淤积症、妊娠急性脂肪肝，妊娠剧吐致肝损害，妊高征致肝损害）。Schiff报道妊娠期黄疸（JP）发生率为0.067％，孕早期主要见于病毒性肝炎，妊娠后期主要见于妊娠期肝内胆汁淤积症，两者共占妊娠期黄疸的62.1～97.7％。     

32例妊娠期肝内胆汁郁积症孕妇围产儿死亡分析

作者对１９８９年至１９９３年５年间本院３２例妊娠期肝内胆汁郁积症（ＩＣＰ）孕妇的围产儿死亡情况进行回顾性分析。发现该类孕妇围产儿死亡占住院ＩＣＰ孕妇的４３‰，高于同期正常孕妇，属高危妊娠，孕３５周以后发现肝功能异常者占７５．０％；７８．１％的围产儿死亡发生在孕３５周以后。对孕妇应定期查肝功能，加强胎儿宫内缺氧监护。适用分娩是防治本病的主要原则，围产儿死亡原因尚不明了，胎儿畸形、宫内生产迟缓及脐带因     

41例子痫的临床分析

目的为了探讨降低子痫发生率的方法，减少并发症的发生，降低孕产妇及围产儿的死亡率。方法对我院1978年1月-2007年12月间收治的41例子痫患者的临床资料进行回顾性的分析。结果孕产妇死亡1例，病死率2．4％，围产儿死亡7例，病死率为16．3％。结论加强孕期保健，及时诊断规范治疗妊娠期高血压疾病，适时终止妊娠，注意产后护理，可以有效的降低子痫的发生率，降低孕产妇及围产儿的死亡率。     

妊娠期肝内胆汁淤积症的诊断和治疗新进展

妊娠期肝内胆汁淤积症(ICP)是妊娠特有的并发症。该症可引起产后出血率增加，但其更大的危害是围产儿结局不良。据文献报道，围产儿病死率可达63‰～133‰，胎儿宫内缺氧10．2％～33．3％，早产10％～40％，羊水粪染27％～54％，是目前公认的对胎儿极具威胁的高危妊娠。有报道不明原因的围产儿死亡，有半数是由ICP所致。     

妊娠期高血压疾病并发弥漫性血管内凝血的相关性分析

目的：探讨妊娠期高血压疾病与DIC的相关性,如何降低孕产妇及围产儿的死亡率。方法：对24年内19例患者的临床资料进行回顾性分析。结果：19例中子痫、重度子痫前期为14例。诱发因素为胎盘早剥10例,产后出血8例,羊水栓塞1例,孕产妇死亡率为21．05％,其中前12年为25％,后12年为14．29％,围产儿死亡率为36．84％,其中前12年为41．67％,后12年为28．57％。结论：妊娠期高血压疾病病情越严重发生DIC的比例越高,早诊断,早治疗可降低孕产妇及围产儿死亡率。     

32例妊娠期肝内胆汁郁积症孕妇围产儿死亡分析

作者对１９８９年至１９９３年５年间本院３２例妊娠期肝内胆汁郁积症（ＩＣＰ）孕妇的围产儿死亡情况进行回顾性分析。发现该类孕妇围产儿死亡占住院ＩＣＰ孕妇的４３‰，高于同期正常孕妇（１１‰，Ｐ＜０．０１），属高危妊娠。孕３５周以后发现肝功能异常者占７５．０％；７８．１％的围产儿死亡发生在孕３５周以后。对孕妇应定期查肝功能；加强胎儿宫内缺氧监护。适时分娩是防治本病的主要原则。围产儿死亡原因尚不明了，胎儿畸形、宫内生长迟缓及脐带因素不是主要死亡原因。     

常州市区2000年至2004年45 727例围产儿死亡监测结果分析

目的：为了解围产儿死亡发生情况，寻找影响围产儿死亡的相关因素，采取相应对策。方法：对常州市区2000年至2004年围产儿死亡监测资料进行回顾性分析。结果：常州市区5年围产儿病死率为12．18‰，有逐年下降的趋势。围产儿死亡主要原因为畸形、原因不明、脐带因素、胎盘因素、窒息。围产儿死亡与性别关系不明显，早产儿死亡占围产儿死亡的构成比为62．38％，低出生体重占围产儿死亡的构成比为63．38％，分娩方式以顺产为主，占总的分娩方式的62．12％。结论：加强孕前优生优育宣传及孕期保键，降低出生缺陷的发生是降低围产儿死亡的有力措施。     

265例妊娠期肝内胆汁淤积症分度诊治

目的 探讨妊娠期肝内胆汁淤积症（ICP）分度诊断与治疗的临床意义。方法 将我院自2000年10月至2006年10月在我院产前检查并诊断ICP的265例患者，根据ICP分为轻度与重度ICP。观察其妊娠结局与分度诊断前后围产儿死亡率。结果 （1）重度组和轻度组ICP患者终止妊娠的平均孕周分别（35．6±1．7）周和（37．6±2．0）周，两组比较，差异有显著性意义（P〈0．05）。（2）重度组ICP患者羊水粪染、新生儿窒息、新生儿转入重症监护室、剖宫产的发生率分别39．02％、12．20％、30．49％、97．56％，明显高于轻度组的9．30％、4．37％、9．29％、51．91％。（3）分度诊疗前后围产儿死亡率分别为6．08％、0．75％，两者相比，差异有显著性（P〈0．05）。结论 ICP分度诊疗有助于改善围产儿预后，降低死亡率。     

妊娠期肝内胆汁淤积症诊断和治疗的新进展

妊娠期肝内胆汁淤积症（ICP）是妊娠特有的并发症。该症可引起产后出血率增加，但其更大的危害是围产儿结局不良。据文献报道，围产儿病死率可达63‰—133‰，胎儿宫内缺氧10.2％—33．3％，早产10％—40%，羊水粪污27％-54％，是目前公认的对胎儿极具威胁的高危妊娠。据报道不明原因的围产儿死亡，有半数是由ICP所致。     

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.     

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.     

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.