老年高血压病患者脉压与靶器官损害的相关性研究

目的探讨老年高血压病患者脉压与靶器官损害的相关性。方法将206例老年高血压病患者根据脉压水平分为PP〈50mmHg组,50～60mmHg组,61—70mmHg组,PP〉70mmHg组。观察各组脉压与心、脑、肾靶器官损害的相关性。结果各组性别、吸烟、血糖、血脂和高血压病程差异无统计学意义（P〉0．05）,单因素Logistic回归分析：校正年龄、收缩压（SBP）、舒张压（DBP）、脉压进入回归方程,多因素逐步Logistic回归分析,脉压与靶器官损害有显著相关性（P〈0．01）。结论高血压痛患者脉压与靶器官损害密切相关,脉压增大,靶器官损害增多。     

动态脉压与老年高血压合并脑梗死及颈动脉硬化的关系

目的研究老年高血压患者动态脉压（PP）与脑梗死及颈动脉粥样硬化的关系,为临床有针对性的干预PP、预防高血压并发症提供理论基础。方法对老年高血压及老年高血压合并脑梗死的动态PP进行比较,同时对老年高血压颈动脉内膜中层厚度（IMT）增厚组与正常组的动态PP进行比较。结果1）与单纯高血压组比较,高血压合并脑梗死组的24h动态脉压（24hAPP）、白昼脉压（dPP）、夜间脉压（nPP）水平显著增大,24h平均收缩压（24hASBP）、夜间平均收缩压（nSBP）水平显著升高,24h平均舒张压（24hADBP）、白昼平均舒张压（dDBP）、夜间平均舒张压（nDBP）水平显著下降,而两组间dSBP比较无统计学意义;2）老年高血压患者IMT增厚组的24hAPP、dPP和nPP水平均显著增高于IMT正常组;3）与动态PP〈60mmHg者比较,动态PP≥60mmHg的高血压患者脑梗死发生率显著升高;4）与动态PP〈60mmHg者比较,动态PP≥60mmHg的单纯高血压患者的IMT显著增厚。结论动态PP增大是老年高血压患者颈动脉粥样硬化及未来发生脑梗死的重要危险因素。     

老年高血压患者的脉压与肾损害关系的临床观察

目的探讨老年高血压患者中脉压与肾损害的关系。方法老年高血压患者78例，按脉压（PP）水平分为〈50mmHg、50—59mmHg、60—69mmHg及≥70mmHg4组，分析PP与尿素氮、血肌酐（Scr）、内生肌酐清除率（Ccr）及24h尿蛋白定量的关系。结果随着PP的增大，Ccr明显降低，Scr及24h尿蛋白定量明显增加，不同脉压组间差异有统计学意义（p〈0．05和〈0．01）。结论老年高血压病患者脉压增大，可促进肾脏损害，提示在老年高血压病患者中脉压也是预测肾脏损害有价值的指标，控制脉压可以减轻老年高血压病患者肾脏损害。     

老年原发性高血压患者脉压与靶器官损害关系的探讨

目的通过对老年原发性高血压患者临床资料分析,探讨老年原发性高血压患者脉压与靶器官损害的关系。方法将102例老年原发性高血压患者分为脉压〉60mmHg组和脉压〈60mmHg组,两组患者均做心电图、超声心动图、头颅CT、血肌酐及尿清蛋白定量测定。结果脉压〉60mmHg组冠心病、左心室肥厚、脑梗死发生率、血肌酐浓度、24h尿清蛋白定量均高于脉压〈60mmHg组,两组比较差异有统计学意义。结论老年原发性高血压患者靶器官损害与增大的脉压有关。     

老年高血压脉压与颈动脉斑块、胆红素的关系

目的探讨老年高血压病患者动态脉压与颈动脉粥样硬化斑块、血清胆红素的关系。方法将120例老年原发性高血压病患者按照脉压的不同,分为3组：PP1组（脉压〈51mmHg,1mmHg=0．133kPa）,PP2组（脉压51—65mmHg）,PP3组（脉压〉65mmHg）,分别测定颈动脉粥样硬化斑块程度、血清胆红素水平。结果随着脉压增高,颈动脉粥样硬化斑块程度越严重,PP3〉PP2〉PP1（P〈0．05）;血清胆红素水平越低,PP3〈PP2〈PP1（P〈0．05）。结论颈动脉粥样硬化、血清胆红素水平与脉压高低密切相关,适当提高血清胆红素水平可能防止动脉粥样硬化进展,降低脉压,减轻高血压靶器官损害。     

24小时平均脉压与冠心病的临床研究

目的：探讨高血压患者24h平均脉压（24hPP）与冠状动脉狭窄的关系。方法：338例高血压（EH）患者均行动态血压（ABP）监测、冠状动脉造影及冠状动脉狭窄积分。根据24hPP水平分为〈60mmHg组和≥60mmHg组。根据冠脉造影结果分为冠脉狭窄组和非冠脉狭窄组，比较2组的冠脉狭窄积分及狭窄率。结果：PP≥60mmHg组的冠脉狭窄记分、冠脉狭窄率高于PP〈60mmHg组。结论：PP增大是冠心病的独立危险因素，使冠状动脉的狭窄率、狭窄程度、累及的血管支数增加。     

老年性高血压患者的脉压与靶器官损害的关系

目的:探讨老年高血压病患者脉压PP与靶器官损害的关系。方法:入选229例老年性高血压患者按PP值大小分为PP1组56例:PP50~60mmHg,PP2组61例:PP61~70mmHg,PP3组63例:PP71~80mmHg,PP4组49例:PP≥81mmHg,四组。分别比较个组间所测量数椐的均数值。对入选患者测血压、超声心动图、测定尿微量白蛋白排泄量(MAU)、计算内生肌酐清除率(CC r)。结果:随着PP值的增大,EF%,E/A,LVED的参数逐渐下降,而LVM I、LVPW D参数逐渐增加,再不同的PP组中CC r随着PP值增加而逐渐下降,MAU则随着PP值的增大而增多。结论:血压与靶器官损害的关系,不仅与血压水平有关,而且与PP值有关。     

探讨原发性高血压患者脉压与微量白蛋白尿和动脉粥样硬化的关系

目的：探讨原发性高血压（EH）患者脉压（PP）与早期肾损害指标微量白蛋白尿（MAU）和动脉粥样硬化的早期征象颈动脉内膜中层厚度（C-IMT）之间的关系。方法：116名EH患者根据PP水平分为3组,对3组的MAU、C-IMT;斑块发生率、血清超敏C反应蛋白（hs-CRP）、血尿素氮（BUN）、肌酐（Cr）、尿酸（UA）、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）、甘油三酯（TG）、血糖（FBG）、体重指数（BMl）等进行分析和比较。结果：1.PP≥60mmHg组的原发性高血压患者MAU水平及C-IMT明显高于PP〈40mmHg组和40mmHg≤PP〈60mmHg组的原发性高血压患者（P〈0.05）。2.即≥60mmHg组的原发性高血压患者患者颈动脉斑块发生率明显高于PP〈40mmHg组和40mmHg≤PP〈60mmHg组的原发性高血压患者（P〈0.05）。3.C-IMT与MAU水平呈正相关（P〈0.05）。结论：原发性高血压患者脉压与尿微量白蛋白水平及颈动脉内膜中层厚度密切相关,尿微量白蛋白也是亚临床期动脉粥样硬化的早期标志。     

老年高血压患者动态脉压指数与靶器官损害的关系

目的探讨老年高血压患者动态脉压指数与靶器官损害的关系。方法选择60岁以上原发性高血压患者146例,按动态脉压指数水平分为3组：脉压指数≤0.40组（44例）,脉压指数0.41～0.50组（56例）,脉压指数≥0.51组（46例）。3组患者均化验血清肌酐,行动态血压、超声心动图、颈动脉超声、颅脑CT和（或）MRI检查;计算内生肌酐清除率（Ccr）、24h平均收缩压（24hMSBP）、24h平均舒张压（24hMDBP）、24h平均脉压（24hMPP）、脉压指数、左室重量指数（LVMI）、左室射血分数（LVEF）、左室舒张早期充盈峰值流速（E峰）及舒张晚期左房收缩期充盈峰值流速（A峰）比值（E/A）、颈动脉内膜-中层厚度（IMT）。结果3组患者左室肥厚、脑损害、肾功能损害及颈动脉斑块的患病率间差异均有统计学意义（P〈0.05）,脉压指数0.41～0.50组及脉压指数≥0.51组以上指标患病率与脉压指数≤0.40组比较,差异均有统计学意义（P〈0.05）,脉压指数≥0.51组以上指标患病率与脉压指数0.41～0.50组比较,差异均有统计学意义（P〈0.05）。脉压指数≥0.51组LVEF〈50%患病率与其他两组比较,差异均有统计学意义（P〈0.05）,E/A〈1的患病率与脉压指数≤0.40组比较,差异有统计学意义（P〈0.05,）。Spearman相关分析显示,动态脉压指数与心脑肾及颈动脉损害有相关性（均P〈0.05）。结论老年高血压患者动态脉压指数增大与靶器官结构和功能的损害程度密切相关;动态脉压指数可以作为老年高血压患者靶器官损害的预测因子。     

代谢综合征患者餐后状态血压及脉压变化与靶器官损害的关系

目的 探讨代谢综合征患者餐后状态血压和脉压变化及其与心血管及肾脏病变的关系。方法 233例住院患者，分为高血压病（EH）组、2型糖尿病（DM）组和代谢综合征（MS）组，检测24h动态血压、颈动脉粥样宽块发生率（CAPR）、颈动脉内膜厚度（IMT）、左室重量指数（LVMI）、左室舒张早期充盈峰值流速（EPFV）与心房收缩期充盈峰值流速（APFV）比值（E／A值）和内生肌酐清除率（CcR）及24h尿微量白蛋白排泄量（MA）。结果 （1）进餐前后SBP和PP差值≥10mmHg（1mmHg=0．133kPa）的高血压痛患者，其CAPR、IMT、LVMI、MA明显高于差值〈10mmHg者（P〈0．01），E／A和CcR明显低于差值〈10mmHg者（P〈0．01）。（2）进餐前后PP差值≥10mmHg代谢综合征患者，其CAPR、IMT、LVMI和MA均明显高于差值〈10mmHg者（P〈0．01），而其E／A和CcR明显低于差值〈10mmHg者（P〈0．01）；进餐前后SBP差值≥10mmHg、DBP差值≥5mmHg者，其MA显著高于差值〈10mmHg和〈5mmHg者（P〈0．05）。（3）进餐前后SBP差值≥10mmHg、DBP差值≥5mmHg的糖尿病患者，其MA明显高于差值〈10mmHg和〈5mmHg者（P〈0．01）。（4）与靶器官损害相关分析显示：早餐后1h血压变化与心脏、颈动脉及肾脏病变呈显著相关。结论 餐后血压和脉压是预测代谢综合征患者心脏、血管及肾脏损害的有价值指标。     

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.