代谢综合征患者血浆抵抗素水平与胰岛素抵抗变化的研究

目的：探讨代谢综合征（MS）患者血浆抵抗素（resistin）水平变化及与胰岛素抵抗（IR）的关系。方法：筛选MS患者62例,年龄、性别相匹配的健康成年人58例为对照组。采用酶联免疫吸附法（ELISA）检测血浆resistin水平,用稳态模型胰岛素抵抗指数（HOMA-IR）评估IR程度。结果：对照组与MS组的血浆resistin水平分别为（12.68±5.73）ng/L与（11.75±6.10）ng/L,与对照组比较,MS组的血浆resistin水平差异无显著性（均P〉0.05）;MS组的HOMA-IR指数显著高于对照组的（2.88±1.15）与（1.69±0.88）;在MS组,resistin与体重指数（BMI）、腰围（WC）、空腹血糖（FPG）、2h血糖（2hPG）、空腹胰岛素（FINS）、三酰甘油（TG）、高密度脂蛋白-胆固醇（HDL-C）及HOMA-IR等指标的相关系数r值分别为：0.161、0.125、0.153、-0.088、0.115、0.175、-0.151及-0.126,均P〉0.05。结论：本组MS患者血浆resistin水平变化无显著性,resistin水平与IR无相关性。     

氯化钴干预条件下糖尿病大鼠肾组织HIF-1α的表达及意义

目的研究氯化钴（CoCl2）干预条件下糖尿病（diabetes mellitus,DM）大鼠肾组织缺氧诱导因子1α（hypoxia inducible factor-1α,HIF-1α）的表达及意义。方法按数字随机化原则取8只为正常对照组（CTL组）,16只为模型组,建立糖尿病肾病大鼠模型,并随机均分为糖尿病组（DM组）和CoCl2治疗组（CoCl2组）。检测相关生化指标,免疫组化学检测实验大鼠HIF-1α表达和分布,蛋白免疫印迹法（Western Blotting）检测肾脏组织HIF-1α蛋白表达。结果CTL组肾脏组织无HIF-1α表达,DM组HIF-1α主要分布于肾小管上皮细胞的胞浆和胞核;CoCl2组HIF-1α平均光密度显著高于DM组（P〈0.05）,其HIF-1α蛋白表达水平较DM组显著增加（P〈0.05）。结论缺氧参与糖尿病肾脏疾病（diabetic kidney disease,DKD）早期肾小管间质损伤,化学性低氧模拟剂CoCl2可通过上调HIF-α减轻蛋白尿和肾小管间质损伤,延缓DKD进展。     

血清胎球蛋白A水平与胰岛素抵抗及颈动脉内膜中层厚度在初诊2型糖尿病患者中的相关性分析

旨在探讨初诊2 型糖尿病（nT2DM）患者血清胎球蛋白A（FA）水平与胰岛素抵抗（IR）及颈动脉内膜中层厚度（CIMT）的相关性。方法选取nT2DM 患者100 例作为病例组（T2DM 组）,糖耐量正常（NGT）者100 例作为对照组（NGT 组）,采用酶联免疫吸附实验（ELISA 法）试剂盒检测血清FA 浓度,计算稳态模型胰岛素抵抗指数（HOMA-IR）评估IR,运用彩色超声诊断仪测定CIMT,分析血清FA 浓度与各项临床资料之间的相关性。结果T2DM 组血清FA 水平（368.5±15.6）mg/ml 高于NGT 组血清FA 水平（152.7±7.1）mg/ml,差异有统计学意义（p =0.000）;FA 水平与HOMA-IR（r =0.483,p =0.000）、CIMT（r = 0.509,p = 0.000）、糖化血红蛋白（HbA1c）（r =0.153,p =0.042）、三酰甘油（TG）（r =0.353,p =0.000）、低密度脂蛋白 （LDL-C）（r =0.113,p =0.023）、体重指数（BMI）（r =0.162,p =0.024）、收缩期血压（SBP）（r =0.182,p =0.035）、空腹血糖（FPG）（r = 0.422,p =0.002）及2 h 葡萄糖负荷血糖（2 h OGTT）（r =0.581,p =0.000）呈正相关,与空腹血浆胰岛素（FINS）（r =-0.153,p =0.008）、2 h 葡萄糖负荷血浆胰岛素（PINS）（r =-0.423,p =0.008）、高密度 脂蛋白（HDL-C）（r =-0.183,p =0.011）和HOMA-β细胞胰岛素分泌指数（HOMA-IS）（r =-0.463,p =0.000）呈负相关结论nT2DM 患者血清FA 水平与IR及CIMT之间存在相关性,研究结果表明,血清FA 水平可作为诊断nT2DM 患者大血管病变的独立生物学标志物。     

2型糖尿病患者血清缺氧诱导因子-1α与颈动脉粥样斑块的相关性

目的 观察2型糖尿病(T2DM)患者血清缺氧诱导因子-1α(HIF-1α)的变化,探讨其与动脉粥样硬化性大血管病变的关系.方法 选择32例T2DM合并颈动脉斑块患者(T2DM+ CP组),24例单纯T2DM患者(T2DM组),24名健康体检者(正常对照组),采用酶联免疫吸附法(ELISA法)测定血清HIF-1α浓度.结果 T2DM+ CP组和T2DM组HIF-1α水平均显著高于正常对照组(均P＜0.01),T2DM+ CP组HIF-1α水平明显高于T2DM组(P＜0.05).血清HIF-1α水平与空腹血糖、糖化血红蛋白C(HbA1c)、胰岛素抵抗指数(HOMA-IR)成明显正相关(均P＜0.05).多元线性逐步回归分析表明,HbA1c是血清HIF-1 α水平的独立影响因素.结论 T2DM患者体内高水平的血清HIF-1α与血糖、胰岛素抵抗有关,在大血管并发症的发生发展过程中起着重要的作用.     

血清铁蛋白与2 型糖尿病周围神经病变的 相关性分析

目的 探讨血清铁蛋白（SF）与2 型糖尿病（T2DM）周围神经病变（DPN）的相关性。方法 选取 2016 年1 月-2016 年12 月该院T2DM 患者150 例,将其分为糖尿病无周围神经病变组（T2DM 组）66 例,糖 尿病周围神经病变组（DPN 组）84 例,同时选择健康体检者30 例作为对照组（NC 组）。测定各组血清SF 与空 腹血糖（FPG）、餐后2 h 血糖（2 hPG）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、三酰甘油（TG）、高密 度脂蛋白（HDL）、低高密度脂蛋白（LDL）、同型半胱胺酸（Hcy）及空腹胰岛素（FINS）;评价胰岛素抵抗指数 （HOMA-IR）、胰岛β 细胞分泌指数（HOMA-IS）,并分析血清SF 与相关指标的关系。结果 ① 3 组舒张压（DBP）、 FPG、2 hPG、HbA1c、TC、TG、LDL、FINS 及Hcy 比较,差异有统计学意义（P <0.05）;DPN 组与T2DM 组FPG、2 hPG、HbA1c、TG、FINS 及Hcy 均呈逐渐增高趋势（P <0.05）。3 组HOMA-IR、HOMAIS 比较,差异有统计学意义（P <0.05）;3 组HOMA-IR 逐渐增高,而HOMA-IS 逐渐降低。② 3 组血清SF 水平比较,差异有统计学意义（P <0.05）;DPN 组血清SF 水平>T2DM 组>NC 组。③血清SF 与HbA1c、 HOMA-IR 及Hcy 呈正相关（rs =26.600、14.055 及9.513,P =0.000、0.000 及0.043）,与HOMA-IS 呈负相关（rs = -0.895,P =0.004）。④多元线性回归分析显示,SF、Hcy、2 hPG、TG、FINS、HOMA-IR 及HOMA-IS 是 DPN 的危险因素（P <0.05）。结论 血清SF 水平的升高与血糖、血脂代谢紊乱、胰岛素抵抗及氧化应激有关, 其共同参与DPN 的发生、发展。     

焦虑抑郁情绪障碍对2型糖尿病患者胰岛素敏感性的影响

目的观察焦虑抑郁情绪对2型糖尿病（T2DM）患者的胰岛素敏感性。方法对本院2010年5月-2011年7月98例糖尿病患者行汉密尔顿焦虑抑郁量表评分,并其分为焦虑抑郁合并T2DM组（试验组）和T2DM组（对照组）,分别检测其空腹血糖、空腹胰岛素,计算胰岛素抵抗指数（HOMA-IR）、胰岛素敏感指数（HOMA-IS）和胰岛分泌指数（HOMA-β）。结果试验组HOMA-IR、HOMA-β高于对照组,HOMA-IS低于对照组,差异均有统计学意义（P〈0.01）。结论焦虑抑郁情绪障碍可导致T2DM患者的胰岛素敏感性下降。     

缺氧诱导因子1-α及血管内皮生长因子与2型糖尿病微血管并发症的关系

目的探讨2型糖尿病（T2DM）微血管并发症患者血清血管内皮生长因子（VEGF）和缺氧诱导因子-1α（HIF-1α）水平的变化及其意义。方法对T2DM组108例和健康体检者30人进行研究,根据尿白蛋白排泄率将糖尿病患者分为正常白蛋白尿组（40例）、微量白蛋白尿组（36例）和临床白蛋白尿组（32例）。测定各组血清VEGF、HIF-1α、胆固醇、三酰甘油、肌酐、空腹血糖和胰岛素等,并进行比较。结果 T2DM患者正常白蛋白尿组、微量白蛋白尿组、临床白蛋白尿组的VEGF水平分别为（382.66±50.83）、（452.37±61.35）、（582.29±52.76）ng/L,HIF-1α分别为（78.33±21.02）、（98.46±32.55）、（120.17±31.46）pg/L,均显著高于对照组的（301.18±51.26）ng/L和（52.17±17.38）pg/L（P〈0.01）;VEGF和HIF-1α水平均随尿白蛋白排泄率的增加而增加。结论 T2DM患者体内高水平的血清VEGF和HIF-1α可能在微血管并发症的发生发展过程中有重要作用。     

不同病程的2 型糖尿病患者血清胆红素、 25（OH）D3 水平与胰岛素抵抗的相关性分析

目的 探讨不同病程的2 型糖尿病（T2DM）患者血清胆红素、25（OH）D3 水平与胰岛素 抵抗（IR）的相关性。方法 选取2016 年5 月—2018 年8 月于秦皇岛市第一医院内分泌科就诊的171 例 T2DM 患者作为研究对象。根据糖尿病病程分为T2DM-1 组、T2DM-2 组及T2DM-3 组，分别测定 TBIL、IBIL、DBIL、25（OH）D3 等指标水平。采用Pearson 相关性分析上述各指标与稳态胰岛素评价指数 （HOMA-IR）的相关性，并采用多元线性回归分析IR 的危险因素。结果 T2DM-3 组病程、SBP、DBP、 LDL、FPG、2hPG、HbA1c、HOMA-IR 及CRP 较T2DM-1 组和T2DM-2 组高（P <0.05），FINS、TBIL、 DBIL、IBIL 及25（OH）D3 较T2DM-1 组和T2DM-2 组低（P <0.05）。Pearson 相关性分析显示，HOMAIR 与BMI、CRP 呈正相关（r =0.199 和0.178，P <0.05），与25（OH）D3、DBIL 呈负相关（r =-0.373 和 -0.346，P <0.05）。多元线性回归分析显示，25（OH）D3、DBIL 是影响HOMA-IR 的独立因素（P <0.05）。 结论 病程5 ～ 10 年的T2DM 患者存在IR、血脂及血压紊乱，患心血管疾病风险增加，DBIL、维生素 D 水平下降，CRP 升高，机体慢性低度炎症水平升高，且25（OH）D3、DBIL 是影响该类患者IR 的独立 因素。     

世居藏族人群血清缺氧诱导因子-1α与动脉血氧分压的关系及临床意义

目的探讨缺氧诱导因子-1α（HIF-1α）在世居藏族及移居汉族人群血清中的水平，分析其与动脉血氧分压（PaO2）的关系和临床意义。方法选取符合标准的世居藏族（藏族组）及移居汉族（汉族组）自愿者各40名，检测其血清中HIF-1α水平，测定PaO2。结果藏族组与汉族组血清HIF-1α、PaO2水平比较，差异无统计学意义（P〉0．05）。汉族组血清HIF-1α水平与PaO2之间呈负相关（r=-0．475，P〈0．05）。藏族组血清HIF-1α水平与PaO2无直线相关性（r=-0．270，P〉0．05）。结论藏族与汉族人在低氧到一定程度时，血清中HIF-1α水平都升高，水平是相同的，但是与Paoz关系不同。     

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.