静脉注射蔗糖铁治疗血液透析患者临床观察

目的：观察并比较静脉注射蔗糖铁与口服右旋糖酐铁治疗维持性血液透析（MHD）患者铁缺乏的临床疗效。方法：将30例血透患者分为口服补铁组（对照组）和静脉补铁组（治疗组）。观察1个月，检测两组患者治疗前后血红蛋白、血清铁蛋白、转铁饱和度的变化。结果：蔗糖铁治疗组1个月后患者Hb显著上升，两组间差异非常显著（P〈0．01）。同时蔗糖铁治疗组血清铁蛋白显著升高，转铁蛋白饱和度明显升高；而对照组治疗前后血清铁蛋白无显著性差异：转铁蛋白饱和度上升，蔗糖铁组明显高于口服铁组（P〈0．01）。结论：静脉注射蔗糖铁比口服铁更有效，应用E-PO的尿毒症患者应首选静脉补铁的方法。     

手足口病患儿血清铁蛋白水平变化的临床意义

目的：探讨手足口病患儿血清铁蛋白水平变化的临床意义。方法手足口病患儿106例,其中轻症50例（轻症组）,重症56例（重症组）,健康小儿50例（对照组）。分别于轻症组、重症组小儿治疗前及治疗后,对照组体检当天,采集静脉血,运用化学发光法检测血清铁蛋白水平。结果对照组及轻症组、重症组治疗前血清铁蛋白水平分别为（70．1±15．3）μg／L、（85．4±18．3）μg／L、（212．3±71．4）μg／L,呈对照组＜轻症组＜重症组（ P＜0．05）;治疗前、治疗后轻症组血清铁蛋白水平均明显低于重症组（P＜0．05）;治疗后轻症组、重症组血清铁蛋白水平均明显低于治疗前（P＜0．05）。结论手足口病患儿血清铁蛋白水平明显升高,尤其是重症患儿升高更明显。早期检测手足口病患儿血清铁蛋白水平,有助于早期诊断及鉴别重症患儿。     

贮存铁水平与冠心病的关系

采用放射免疫双抗体法测定了336例不同类型冠心病患者血清铁蛋白（SF）浓度，旨在探讨铁对冠心病发病的影响。结果表明，各类型冠心病SF均显著高于对照组（P＜0．001），急性心肌梗死（OMI）又显著高于其他类型冠心病（P＜0．001），而陈旧性心肌梗死（OMI），心绞痛（AP）与无症状性心肌缺血（SMI）三组间无显著性差异（P＞0．05）。各类型冠心病的SF与血总胆固醇、甘油三酯浓度均呈显著正相关（P＜0．05）。结果提示，机体总铁水平过高是冠心病发病的危险因素，心肌梗死急性期除原基础SF水平升高外，还有继发升高的原因。     

母体血清C反应蛋白诊断早发性新生儿败血症的临床价值

目的：探讨母体血清C反应蛋白在诊断早发性新生儿败血症（EONS）中的作用。方法以该院2010年1月至2013年6月收治的65例早产新生儿（妊娠28～36周）及其母亲为研究对象,新生儿分成败血症组（n＝28）和对照组（n＝37）。免疫比浊法测定产妇分娩72 h内血清C反应蛋白的水平,建立C反应蛋白水平 ROC曲线,将母亲分为C反应蛋白阳性组（≥1．35 mg／dL,n＝25）和C反应蛋白阴性组（＜1．35 mg／dL,n＝40）,比较母体血清C反应蛋白水平与早发性新生儿败血症的关系。结果新生儿败血症组母体血清C反应蛋白水平显著高于对照组[（3．61±2．85）mg／dL vs．（0．82±0．73）mg／dL,P＜0．01]。母体血清C反应蛋白预测新生儿败血症灵敏度和特异度分别为72．0％和83．0％,母体血清C反应蛋白阳性组新生儿败血症发病率明显高于C反应蛋白阴性组（71．4％vs．28．6％,P＜0．01）,其新生儿患败血症的危险系数是母体 C反应蛋白阴性组的10．54倍（P＜0．01）。结论母体血清C反应蛋白升高与早发性新生儿败血症显著相关,母体血清 C反应蛋白可作为早期诊断早发性新生儿败血症的指标。     

初发2型糖尿病患者内脂素与铁代谢关系研究

目的：检测初发2型糖尿病患者血清内脂素及铁代谢相关指标血清铁蛋白、铁调素、可溶性转铁蛋白受体（sTfR）水平,探讨初发2型糖尿病患者血清内脂素与铁代谢之间的相关性。方法初发2型糖尿病患者85例,其中体质量正常者43例（正常体质量糖尿病组,B组）,肥胖者42例（肥胖糖尿病组,D组）;同期选取健康体检者86名,其中体质量正常者（对照组,A组）及肥胖者（单纯性肥胖组,C组）各43例,测定所有受试者血清内脂素和铁蛋白、铁调素、sTfR水平。结果4组研究对象血清内脂素与铁代谢指标铁蛋白、铁调素、sTfR均无明显相关性（r＝0．111,P＞0．05）。结论初发2型糖尿病患者血清内脂素水平与铁代谢指标铁蛋白、铁调素、sTfR之间无相关性。     

静脉用蔗糖铁注射液治疗血液透析患者肾性贫血的临床研究

目的评价蔗糖铁注射液治疗维持性血液透析（血透）患者铁缺乏的有效性与安全性。方法159例维持性血透患者随机分为静脉组与口服组,分别采用静脉注射蔗糖铁及口服硫酸亚铁进行补铁治疗,总疗程50d。检测治疗前后血清铁指标、红细胞相关指标及生化指标,并对不良反应进行监测。结果①治疗50d时,静脉组Hb及Hct显著升高,分别上升（23．8±17．2）％和（27．8±20．2）％,幅度明显高于口服组[（10．9±14．5）％和（15．2±20．9）％],P〈0．001。②治疗50d后两组血清铁蛋白（sv）与转铁蛋白饱和度（TSAT）均较治疗前显著升高,且静脉组升高幅度[SF（310．0±389．0）％,TSAT（88．2±96．3）％]明显高于口服组SF（150．3±433．8）％,TSAT（33．8±55．6）％],P〈0．001。③治疗50d后静脉组血清白蛋白及血清钾较治疗前升高,白蛋白由（36．9±5．2）g/L升至（39．3±5．9）g／L,血清钾由（4．8±0．8）mmol／L升至（5．1±0．9）mmol／L,P〈0．01。两组治疗前后血WBC及其它生化指标均相近。④静脉组4例有不良反应,1例出现药物相关皮疹,停药后消失;1例轻微心悸;2例轻度胃肠道反应。口服组15例出现明显胃肠道症状,2例出现轻微药物性皮疹。静脉组总不良反应发生率（4／70,5．7％）明显低于口服组（17／66,25．8％）,P〈0．005。结论静脉注射蔗糖铁可有效纠正维持性血透患者的铁缺乏,提高铁利用率及rHuEPO的治疗效果,且不良反应发发生率低、安全性良好。     

定期无偿献血对献血者血清铁和铁蛋白的影响

目的：研究献血对血清铁含量的影响。方法收集76例无偿献血人员为献血组,83例健康人员（非献血人员）为对照组,采集空腹静脉血,进行血常规、血清铁和铁蛋白检查。结果献血组血清铁、红细胞和红细胞压积均在正常范围,血清铁蛋白和血红蛋白除1例外也在正常范围。献血组男性血清铁蛋白为（116．52±67．16）ng／mL,对照组男性为（186．39±103．15） ng／mL,两组比较差异有统计学意义（P ＜0．05）;献血组女性血清铁蛋白为（66．2±47．62）ng／mL,对照组女性为（101．1±73．89） ng／mL,两组比较差异有统计学意义（P ＜0．05）。献血组血清铁与对照组比较差异无统计学意义（P ＞0．05）。结论献血组血清铁蛋白降低,但是并没有造成贫血。因此,献血可以减少体内的铁贮存量。     

血清可溶性转铁蛋白受体及转铁蛋白在儿童缺铁性贫血合并感染中的诊断价值

目的探讨血清可溶性转铁蛋白受体（sTfR）、转铁蛋白（Tf）在儿童缺铁性贫血合并急性感染（iron deficiency with acute infection，IDAI）中的变化和诊断价值。方法采用速率散射免疫比浊法，测定IDAI组、单纯缺铁性贫血（IDA）组、IDAI组治疗后及健康对照组的血清sTfR、Tf、铁蛋白（SF）水平。常规铁染色观察骨髓储存铁。结果IDAI组和IDA组患儿sTfR、Tf均显著高于对照组（P〈0．01），两组间无显著差异（P〉0．05），IDAI组治疗后血红蛋白（Hb）上升至100g／L以上，但与对照组还有差距时（P〈0．05），sTfR、Tf值降至对照组水平（P〉0．05）。结论sTfR、Tf对诊断缺铁性贫血特异强，测定结果不受感染因素干扰，是临床判断贫血合并感染儿童是否缺铁和监测疗效的可靠指标，临床应用价值优于SF和骨髓储存铁。     

转铁蛋白受体指数在2型糖尿病中的意义探讨

目的 通过检测2型糖尿病（T2DM）转铁蛋白受体指数的变化，探讨T2DM铁贮存状况并为诊断铁贮存提供一个新指标。方法 T2DM患者30名，对照组30名。免疫透射比浊法测可溶性转铁蛋白受体（sT双）水平，电化学发光法测血清铁蛋白（SF）浓度。结果 与对照组比较，T2DM组转铁蛋白受体指数（sTfR／lgSF比值）降低，SF值升高，差异有显著性（P〈0.01）；sTfR．水平降低，两组间差异无显著性（P〉0．05）。对照组SF与ST双呈负相关（r=-0．288，P=0．03），T2DM组无此相关性。结论 转铁蛋白受体指数在T2DM组明显降低，说明T2DM患者存在由铁过载引起的铁代谢紊乱：转铁蛋白受体指数可全面地反映铁贮存情况。     

HCG及PLF水平与胎儿发育迟缓的相关研究

目的探讨孕妇血浆绒毛膜促性腺激素（HCG）及胎盘异铁蛋白（PLF）水平与胎儿宫内发育迟缓（IUGR）发生、发展的关系。方法对晚孕早期（孕24—34周）最初正常的1802例孕妇，根据随访妊娠结局分为IUGR组（64例），用化学发光法进行血浆绒毛膜促性腺激素和胎盘异铁蛋白的水平测定，并与正常组（50例）对比分析。结果IUGR组p—HCG为（50．63±8．86）μg／L校正常组（18．76±3．69）μg/L明显升高；而PLF（242．76±43．69）mg／L低于正常组（716．95±82．63）mg／L，差异有统计学意义（P〈0．01）；绒毛膜促性腺激素与胎盘异铁蛋白水平呈负相关（r=-0．563，P〈0．01）。结论晚孕早期绒毛膜促性腺激素水平升高和胎盘异铁蛋白水平的降低与胎儿宫内发育迟缓的发生有密切关系。     

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.