原发性高血压合并糖耐量减低患者脉搏波传导速度与内皮功能的变化

目的 探讨原发性高血压(essential hypertension,EH)合并糖耐量减低(impaired glucose tolerance,IGT)患者脉搏波速度(pulse wave velocity,PWV)的变化,并分析其与一氧化氮(nitric oxide,NO)及内皮素(endothelin,ET)的相关性.方法 对正常对照组(A组,n=42)、单纯高血压组(B组,n=40)及高血压合并糖耐量减低组(C组,n=45),分别测定臂踝脉搏波传导速度(baPWV)、血清NO、ET水平.结果 与A组比较,B、C组血NO水平明显下降(P<0.05),baPWV及ET水平明显增高(P<0.05);与B组比较,C组血NO水平明显下降(P<0.05),baPWV及ET水平明显升高(P<0.05).经直线相关分析显示,C组baPWV与血清NO水平呈负相关(P<0.05),与血清ET水平呈正相关(P<0.05),baPWV与年龄、脉压(pulse pressure,PP)及餐后2 h血糖(2-hour postprandial blood glucose,2hPG)也明显相关( P<0.05).结论 原发性高血压患者血管内皮功能明显受损,在高血压基础上糖耐量异常将进一步使血管内皮功能受损和动脉僵硬度增加.     

老年全身炎症反应综合征患者肱动脉血管舒张功能的变化

目的 探讨血管内皮舒张功能在全身炎症反应综合征(SIRS) 老年患者中的变化.方法 选择82 例SIRS 老年患者,分为生存组(n=58) 和死亡组(n=24),同时选择22 例非SIRS 老年患者作为对照,分别检测肿瘤坏死因子(TNF-α)、白细胞介素-1(IL-1)、血浆内皮素-1(ET-1) 和C 反应蛋白(CRP),并采用高分辨血管外超声法检测肱动脉介导的内皮依赖性血管舒张功能(FMD) 和硝酸甘油介导的内皮非依赖性血管舒张功能(NMD).结果 SIRS 组中TNF-α、IL-1、ET-1、CRP 明显升高,差异有统计学意义,在死亡组中,上述指标较生存组高(P<0.01),差异有统计学意义(P<0.05).SIRS 组FMD 较对照组显著降低(2.21±0.18 vs 2.80±0.21,P<0.01),且死亡组中FMD 较生存组降低.SIRS 组NMD 较对照组明显增加(P<0.01),但死亡组中NMD 较生存组下降(P<0.01).TNF-α、IL-1、ET-1、CRP 与内皮依赖性血管舒张功能呈负相关(P<0.01).结论 SIRS 患者血管内皮依赖性舒张功能(FMD) 明显受损,受损程度与病情严重程度相关.     

原发性高血压患者血管内皮功能失调与活性氧的关系及阿托伐他汀治疗的影响

目的观察高血压病患者血管内皮依赖性舒张功能与活性氧的关系及阿托伐他汀治疗的影响.方法将58例高血压病患者随机分为对照组(服用双氢克尿噻和倍他乐克)和实验组(另加用阿托伐他汀),检测两组治疗前后及28例正常人的血清超氧化物歧化酶(superoxidc dismutase,SOD)水平、血管内皮依赖性舒张功能.结果高血压患者血清SOD水平降低,血管内皮依赖性舒张功能受损,两者显著正相关.治疗2个月后,两组血清SOD水平均升高,而实验组SOD升高更显著,且血管内皮依赖性舒张功能改善.结论活性氧是高血压血管内皮功能的主要影响因素,他汀类可通过减少活性氧保护血管内皮功能.     

原发性高血压高迁移率族蛋白1与血管内皮功能的关系

目的 探讨原发性高血压(EH)患者血清高迁移率族蛋白1(HMGB1)与血管内皮功能的关系.方法 连续收集高血压患者30例,正常对照组30例.分别采用酶联免疫吸附法、高效液相色谱法、硝酸还原酶法测定血清HMGB1、血浆非对称性二甲基精氨酸(ADMA)、血清一氧化氮(NO)水平,同时采用高分辨超声检测肱动脉血流介导的内皮依赖性血管舒张功能(FMD).结果 高血压组血清HMGB1、血浆ADMA显著高于对照组(P＜0.01),血清NO、FMD显著低于对照组(P＜0.01).Spearman秩相关分析显示,在所有研究对象中,HMGB1与ADMA呈正相关(r=0.757,P＜0.01),与NO、FMD呈负相关(r=-0.743,P＜0.01;r =-0.707,P ＜0.01).以FMD为应变量进行多元线性逐步回归分析,HMGB1是FMD的独立影响因子之一.结论 血清炎症因子HMGB1可能参与了高血压血管内皮功能损伤过程.     

辛伐他汀对高血压合并动脉粥样硬化患者内皮功能的影响

目的 探讨辛伐他汀对高血压合并动脉粥样硬化患者内皮功能的影响.方法 选择吴川市人民医院心内科于2016年1~6月期间收治的高血压合并动脉粥样硬化患者92例为研究对象,根据随机数字表法随机分为观察组(n=46)与对照组(n=46),对照组予氨氯地平降压治疗,观察组联合应用辛伐他汀治疗,疗程3个月.比较治疗前后两组患者的颈动脉内膜中层厚度(IMT)、斑块积分、血管内皮依赖性舒张功能(FMD)及血清一氧化氮(NO)水平.结果 治疗后,对照组患者的颈动脉IMT、斑块积分、FMD及血清NO与治疗前比较差异均无统计学意义(P>0.05);治疗后,观察组患者的颈动脉IMT及斑块积分分别为(1.10±0.15)mm、(3.92±1.23)分,均较治疗前的(1.33±0.27)mm、(5.91±2.02)分明显降低,且低于对照组,FMD及血清NO分别为(10.41±3.45)%、(73.62±20.93)μmol/L,均较治疗前的(7.36±2.21)%、(42.13±11.43)μmol/L明显增高,且高于对照组,上述各项指标比较差异均有统计学意义(P<0.05).结论 辛伐他汀可有效改善高血压合并动脉粥样硬化患者的内皮功能,稳定并逆转动脉粥样硬化斑块.     

二甲双胍对低密度脂蛋白诱导的大鼠血管内皮功能紊乱的改善作用

目的 研究二甲双胍是否对低密度脂蛋白损伤的大鼠血管内皮功能具有保护作用并探讨其机制.方法 一次性从大鼠舌下静脉注射天然低密度脂蛋白(n-LDL)4mg/kg诱发血管内皮细胞损伤,随后测定血管舒张功能及血脂,血清一氧化氮(NO)、丙二醛(MDA)和SOD活性.结果 单次静脉注射n-LDL能降低大鼠胸主动脉乙酰胆碱诱导的内皮依赖性舒张反应,而对硝普钠诱导的非内皮依赖性舒张反应无影响;血清NO水平及SOD活性显著降低.MDA浓度明显增高而血脂水平无明显变化.二甲双胍预处理能改善n-LDL诱导的内皮舒张功能障碍,增加血清NO水平,减少MDA生成,不改变血脂含量.结论 二甲双胍对体内LDL损伤的血管内皮功能具有保护作用.其机制可能与二甲双胍保护内皮依赖性舒张因子和抗氧化作用有关.     

血管内皮舒张功能与原发性高血压危险性分层的关系

目的采用高频超声技术检测原发性高血压(EH)病人血管内皮依赖性舒张功能(EDD)和血管内皮非依赖性舒张功能(EIDD),探讨血管内皮舒张功能与原发性高血压危险性分层的关系。方法将80例EH病人分为低危组、中危组、高危组、极高危组,并选20例正常人作为对照。利用高频超声检测EH病人和正常对照组在静息状态下、加压充血后和服用硝酸甘油后的肱动脉内径和血流量的变化,并计算充血后肱动脉内径变化率(FMD)和服用硝酸甘油后肱动脉内径变化率(GNT-MD),以FMD、GNT-MD代表EDD和EIDD。结果高血压各组FMD均低于对照组(F=7.35,q=3.21～4.43,P<0.05);高危组与极高危组FMD低于低危组和中危组(q=3.02～4.03,P<0.05)。极高危组和高危组GNT-MD与对照组、低危组及中危组比较差异有显著性(F=6.18,q=3.02～4.43,P<0.05)。结论EDD和EIDD可反映高血压的危险性,可作为高血压危险性分层的评价指标之一。超声是检测血管内皮舒张功能的简便、无创、可靠的方法。     

高血压阳性家族史健康子代血管内皮功能和血清一氧化氮水平分析

目的分析有高血压阳性家族史但血压正常的健康子代,其内皮依赖性血管舒张功能和血清NO水平。方法入选有高血压阳性家族史,但本人血压正常的子代个体48例(男26例,女22例)作为家族史阳性组,取45例血压正常同时无高血压家族史的健康人作为对照组(男24例,女21例),按标准方法测定血压,计算体重指数〔体重指数(BMI)=体重(kg)/身高(m)2〕,抽取空腹静脉血查血糖、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、尿酸、肌酐以及血清NO,用无创超声法测定两组血流介导的血管扩张(FMD)和硝酸甘油介导的血管扩张(NMD)。结果与对照组比较,家族史阳性组收缩压和血尿酸水平较高(P<0.05);同时家族史阳性组FMD和血清NO水平均较正常对照组低(P<0.05),而两组间NMD差异无统计学意义。结论有高血压阳性家族史的子代健康个体,即使血压在正常范围时,也已经发生血管内皮依赖性舒张功能降低,血清NO水平下降,对这类人群应早期和严格防治。     

原发性高血压患者血清Fractalkine 水平与血管内皮功能损伤的相关性研究

目的 研究原发性高血压患者Fractalkine（FKN）与血管内皮功能的相关性。方法 纳入50 例原发性高血压患者作为高血压组,50 例健康体检者为对照组。使用酶联免疫吸附法（ELISA）测定血清FKN水平,使用高效液相色谱法测定血浆非对称性二甲基精氨酸（ADMA）水平,硝酸还原酶法测定血清一氧化氮NO 水平。使用高分辨超声检测肱动脉血流介导的内皮依赖性血管舒张功能（FMD）及非内皮依赖性舒张功能（NMD）。38 例原发性高血压患者（剔除12 例）接受3 个月的规范降压治疗。比较治疗前后收缩压、FKN、ADMA、NO、FMD 的变化水平,进一步分析FKN 治疗前后变化量绝对值与收缩压、ADMA、NO、FMD 变化量绝对值的相关性。结果 与对照组比较,高血压组的血清FKN、血浆ADMA 水平升高（P <0.05）,FMD、血清NO 水平降低（P <0.05）。FKN 与ADMA、收缩压、舒张压呈正相关（r =0.785、0.730 和0.785,均P =0.000）,与NO、FMD 呈负相关（r =-0.800 和-0.783,均P =0.000）。经过3 个月的降压治疗,发现收缩压、舒张压、FKN、ADMA 比治疗前降低,NO、FMD 比治疗前升高。其中FKN 治疗变化绝对值（△ FKN）与△收缩压、△舒张压、△ FMD、△ ADMA、△ NO 呈正相关（r =0.720、0.405、0.707、0.687和0.726,P =0.000、0.012、0.001、0.032 和0.001）。结论 原发性高血压患者血清FKN 水平的升高与血管内皮功能的损伤可能有关。降压治疗可改善原发性高血压患者的内皮功能,降低血清中的FKN 水平。     

原发性高血压患者血管内皮依赖性舒张功能障碍与血栓前状态的相关性研究

目的　探讨原发性高血压患者血管内皮功能损伤、血栓前状态及两者间的关系。方法　对原发性高血压Ⅰ级 (n =2 0 )、Ⅱ级 (n =2 0 )患者及正常人 (n =2 0 )采用高分辨率超声技术检测血流介导的肱动脉舒张功能(FMD) ,并分别测定血清一氧化氮 (NO)水平和血浆血栓素B2 (TXB2 )和 6 -酮 -前列腺素 1a(6 -K -PGF1a)水平 ,并进行相互比较。结果　与正常对照组比较 ,原发性高血压Ⅰ级、Ⅱ级患者血浆TXB2 的水平明显升高 ,差别有统计学意义 (P <0 .0 5 ) ,FMD、NO、6 -K -PGF1a水平明显下降 ,差别有统计学意义 (P <0 .0 5 ) ;与原发性高血压Ⅰ级组比较 ,原发性高血压Ⅱ级组TXB2 的水平明显升高 ,差别有统计学意义 (P <0 .0 5 ) ,FMD、NO、6 -K -PGF1a水平明显下降 ,差别有统计学意义 (P <0 .0 5 ) ;经直线相关分析显示 :血清NO、FMD与血浆 6 -K -PGF1a呈正相关 (P <0 .0 5 ) ,血清NO、FMD与血浆TXB2 呈负相关 (P <0 .0 5 )。结论　原发性高血压患者血管内皮明显受损 ,存在血栓前状态 ,可能是血栓性疾病如急性心梗、脑卒中发生的机制 ,将有助于对高血压患者心血管事件的预测。     

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.