尿微量白蛋白/ 尿肌酐比值预测体外循环心脏 手术后急性肾损伤及预后的价值分析

目的 探讨尿微量白蛋白/ 尿肌酐比值（uACR）预测体外循环心脏手术后发生急性肾损伤 （AKI）及短期治疗结局的临床价值。方法 选取2018 年2 月—2019 年5 月在上海市第一人民医院治疗的心 脏停跳条件下全身麻醉行体外循环心脏手术的82 例患者。根据术后7 d 内是否发生AKI,分为AKI 组30 例 和非AKI 组52 例。比较两组患者入重症监护病房（ICU）当日uACR、血清肌酐（Scr）、急性生理学与慢 性健康状况评估Ⅱ（APACHE Ⅱ）评分和估算的肾小球滤过率（eGFR）。受试者工作特征（ROC）曲线确 定uACR 预测AKI、重症AKI 及术后28 d 死亡的效能。多因素Cox 回归模型分析体外循环心脏手术患者 发生AKI 的危险因素。结果 AKI 组入ICU 时APACHE Ⅱ评分、Scr 及uACR 高于非AKI 组（P <0.05）, 而eGFR 值低于非AKI 组（P <0.05）。经多因素Cox 回归分析,年龄[Rl ^ R=1.078（95% CI ：1.002,1.315）]、 高血压[Rl ^ R=2.184（95% CI ：1.294,5.165）]、糖尿病[Rl ^ R=1.297（95% CI ：1.046,1.485）]、体外循环时 间[Rl ^ R=3.882（95% CI ：2.127,5.089）]、主动脉阻断时间[Rl ^ R=1.406（95% CI ：1.079,2.178）] 及入ICU 时uACR[Rl ^ R=1.914（95% CI ：1.453,3.162）] 是体外循环心脏手术患者术后发生AKI 的独立危险因素 （P <0.05）。经ROC 曲线分析,入ICU 时uACR 预测AKI、重症AKI、术后28 d 内死亡的ROC 曲线下的 面积分别为0.784（95% CI ：0.691,0.835）、0.550（95% CI ：0.507,0.615）及0.716（95% CI ：0.680,0.782）。 结论 uACR 在一定程度上可以反映肾脏早期损伤程度,有望成为体外循环心脏手术后发生AKI 的早期预警 和预后判断指标。     

脓毒症相关急性肾损伤患者血清NGAL、CysC水平变化及诊断价值研究

目的探讨并发急性肾损伤（AKI）的脓毒症患者血清中性粒细胞明胶酶相关载脂蛋白（NGAL）、半胱氨酸蛋白酶抑制剂C（CysC）水平的变化及其临床诊断效能。方法选取ICU收治的脓毒症患者156例,根据是否发生AKI分为AKI组（71例）与无AKI组（85例）。采用ELISA法检测患者血清NGAL、CysC水平,分析NGAL、CysC水平与临床指标的相关性,采用ROC曲线评估诊断效能。结果AKI组患者血清NGAL水平高于无AKI组[（91.63±33.14）ng/mlvs（59.26±22.32）ng/ml,P＜0.001],血清CysC水平也高于非AKI组[（1.50±0.60）滋g/dlvs(0.94±0.44)滋g/dl,P＜0.001]。AKI组患者血清NGAL水平与年龄（r=0.258,P=0.003）、血清肌酐（r=0.439,P＜0.001）、APACHEⅡ评分（r=0.516,P=0.001）、CysC（r=0.406,P＜0.001）、AKI分期（r=0.639,P＜0.001）均呈正相关,与估算的肾小球滤过率（eGFR）（r=-0.392,P＜0.001）呈负相关;血清CysC水平与年龄（r=0.360,P=0.002）、血清肌酐（r=0.491,P＜0.001）、APACHEⅡ评分（r=0.311,P=0.008）、AKI分期（r=0.387,P=0.001）均呈正相关,与eGFR（r=-0.456,P＜0.001）呈负相关。NGAL诊断脓毒症相关AKI的AUC为0.784（95%CI：0.711～0.857,P＜0.001）,CsyC诊断脓毒症相关AKI的AUC为0.776（95%CI：0.703～0.850,P＜0.001）,NGAL联合CsyC诊断的AUC为0.830（95%CI：0.764～0.896,P＜0.001）。结论血清NGAL、CysC水平在并发AKI的脓毒症患者中明显升高,且两项指标诊断脓毒症相关AKI的价值均较高。     

脓毒症合并AKI患者血清miR-494表达及其临床意义

目的 探讨脓毒症合并急性肾损伤（AKI）患者血清miR-494表达与肾功能、外周血辅助性T细胞17(Th17)细胞的相关性,分析影响脓毒症合并AKI患者预后的因素。方法 选择2018年1月-2020年3月贵州盘江投资控股（集团）有限公司总医院收治的85例脓毒症合并AKI患者（AKI组）,122例脓毒症未合并AKI患者（NAKI组）,另选择132名健康志愿者为对照组。检测血清miR-494、血清尿素氮（BUN）、血肌酐（Scr）、肾小球滤过率（e GFR）水平和外周血Th17细胞占比,分析其相关性。使用logistic回归分析影响脓毒症合并AKI患者预后的危险因素。结果 AKI组血清miR-494、BUN、Scr水平、外周血Th17细胞占比高于NAKI组和对照组,eGFR低于NAKI组和对照组,差异均有统计学意义（P均<0.01）。AKI组患者血清miR-494表达水平与BUN、Scr、外周血Th17细胞占比成正相关（r=0.689、0.641、0.652,P均<0.01）,与eGFR成负相关（r=-0.633,P<0.001）。AKI患者死亡23例,存活62例。AKI...     

IGFBP7在早期预测脓毒症急性肾损伤中作用的研究

探讨胰岛素样生长因子结合蛋白7(IGFBP7)在早期预测脓毒症急性肾损伤(AKI)中的作用。选取入住本院ICU的患者97例分为脓毒症组和脓毒症AKI组,分析两组患者间尿IGFBP7水平的差异及各组不同时间点尿IGFBP7的差异,评估其在早期预测脓毒症AKI中的作用。结果显示脓毒症AKI组入住ICU当天尿IGFBP7水平高于脓毒症组(P＜0.05)。随AKI各期进展血清肌酐(SCr)、尿素氮(BUN)、胱抑素C(CysC)和尿IGFBP7水平逐渐升高(P＜0.05)。尿IGFBP7曲线下的面积为0.81(95％CI:0.73-0.89),优于SCr和CysC。尿IGFBP7可以作为临床诊断脓毒症AKI的敏感性指标。     

早期生理盐水复苏后脓毒症患者血清氯水平 与急性肾损伤的关系

目的 探索脓毒症患者经生理盐水复苏72 h 后血清氯离子水平与急性肾损伤（AKI）的关系。 方法 选取2015 年1 月—2019 年5 月山西医科大学第一医院重症监护室收治并用生理盐水早期复苏的200 例 脓毒症或脓毒症休克患者,按照72 h 后的血清氯,分为高氯血症组（≥ 110 mmol/L）和非高氯血症组 （<110 mmol/L）,观察其初始血清氯离子浓度及肌酐、72 h 后最高血清氯离子浓度及肌酐、基础肌酐清除率 （Ccr）、初始急性生理功能和慢性健康状况评估Ⅱ（APACHE Ⅱ）评分、机械通气、肾替代治疗等指标,并 计算72 h 后血清氯离子变化值。结果 两组患者年龄、性别、机械通气、肾替代治疗、Ccr、APACHE Ⅱ 评分、72 h 后最高血清氯离子浓度及72 h 后血清氯离子浓度变化值比较,差异有统计学意义（P <0.05）。高 氯血症组AKI 发病率较非高氯血症组高（P <0.05）。单因素Logistic 回归分析显示,72 h 后最高血清氯离子 浓度与AKI 有关（P <0.05）。72 h 后血清氯离子浓度变化值≥ 1.5 mmol/L 和72 h 后血清氯离子浓度变化 值≥ 5.5 mmol/L 与AKI 也有关（P <0.05）。多因素Logistic 回归分析显示,APACHE Ⅱ评分[Ol ^ R=2.451 （95% CI：1.961,2.880）,P =0.000]、72 h 后最高血清氯离子浓度[Ol ^ R=2.023（95% CI：1.991,3.211）,P =0.010] 和72h 后血清氯离子浓度变化值[Ol ^ R=3.211（95% CI ：2.347,3.630）,P =0.006] 是AKI 发病的危险因素。 结论 脓毒症患者经生理盐水复苏72 h 后血清高氯离子与AKI 独立相关,且72 h 后血清氯离子浓度变化值、 APACHE Ⅱ评分也与AKI 有关。     

尿中性粒细胞明胶酶相关脂质运载蛋白、肝型脂肪酸结合蛋白对成人泌尿系统疾病致急性肾损伤诊断价值及检测临床意义

目的:探讨尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肝型脂肪酸结合蛋白(L-FABP)对成人泌尿系统疾病致急性肾损伤(AKI)的诊断价值及检测临床意义。方法:选取115例泌尿系统疾病患者为研究对象。根据是否发生AKI分为AKI组48例、非AKI组67例。比较AKI组和非AKI组患者一般资料，测定血清肌酐(Scr)、尿素氮(BUN)、白蛋白(Alb)、血红蛋白(Hb)及尿NGAL、L-FABP水平。采用Logistic回归模型分析泌尿系统疾病患者发生AKI的危险因素，Spearman相关分析AKI组尿NGAL、L-FABP与Scr的相关性，ROC曲线评估尿NGAL和L-FABP水平对AKI的诊断价值。结果:AKI组APACHEⅡ评分、尿L-FABP、NGLA及血清Scr、BUN水平高于非AKI组，eGFR水平低于非AKI组(均P<0.05)。Logistic多因素回归分析显示eGFR和血清Scr、BUN及尿NGAL、L-FABP水平均为泌尿系统疾病患者发生AKI的独立危险因素(均P<0.05)。尿NGAL、L-FABP水平与Scr呈正相关(r=0.609、0.817,均...     

脓毒症休克患者血清Kal、VE-Cad的变化及与预后的关系

目的 探讨脓毒症休克患者血清人源性激肽释放酶结合蛋白（Kal）、血管内皮钙黏蛋白（VE-cad）的变化及与预后的关系。方法 前瞻性选取2016年3月—2018年3月杭州市丁桥医院重症医学科收治的脓毒症休克患者252例,根据纳入和排除标准排除74例,最终纳入研究的脓毒症休克患者为178例。根据患者28 d预后分为存活组120例和死亡组58例。比较两组患者的临床指标及入住重症监护病房（ICU）第1天、第3天、第5天血清Kal和VE-cad水平变化,记录患者急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分和序贯性器官功能衰竭评估（SOFA）评分。采用Pearson相关分析血清Kal、VE-cad与APACHEⅡ评分和SOFA评分的相关性。采用受试者工作特征（ROC）曲线评估血清Kal、VE-cad单独及联合检测对脓毒症休克患者预后的价值。采用二元Logistic回归分析脓毒症休克死亡的影响因素。结果 死亡组的氧合指数和血清白蛋白（ALB）水平低于存活组（P <0.05）,机械通气时间、ICU住院时间长于存活组（P <0.05）,血清C反应蛋白（CRP）、降钙素原（PCT）水平、血管外肺水指数（EVLWI）、APACHEⅡ评分和SOFA评分高于存活组（P <0.05）。两组入住ICU第1天、第3天、第5天血清Kal、VE-cad水平比较,不同时间点的血清Kal、VE-cad有差异（P <0.05）,两组血清Kal、VE-cad有差异（P <0.05）,两组血清Kal、VE-cad变化趋势有差异（P <0.05）。血清Kal水平与APACHEⅡ评分和SOFA评分呈负相关（r =-0.397和-0.466,P <0.05）;血清VE-cad与APACHEⅡ评分和SOFA评分呈正相关（r =0.173和0.192,P <0.05）。入院24 h内血清Kal、VE-cad及两者联合检测的曲线下面积（AUC）分别为0.687（95% CI：0.604,0.770）、0.859（95% CI：0.805,0.912）、0.890（95% CI：0.845,0.936）,血清Kal检测预测脓毒症休克患者死亡的敏感性为81.0%（95% CI：0.772,0.854）,特异性为50.0%（95% CI：0.474,0.531）;VE-cad检测预测脓毒症休克患者死亡的敏感性为69.0%（95% CI：0.649,0.726）,特异性为86.7%（95% CI：0.822,0.914）;血清Kal和VE-cad联合检测预测脓毒症休克患者死亡的敏感性为82.2%（95% CI：0.781,0.868）,特异性为89.6%（95% CI：0.852,0.954）。CRP［R=1.221（95% CI：1.022,1.459）］、PCT［R=1.195（95% CI：1.035,1.380）］、VE-cad［R=1.373（95% CI：1.055,1.787）］、EVLWI［R=1.846（95% CI：1.178,2.893）］是脓毒症休克患者死亡的危险因素（P <0.05）,Kal［R=0.428（95% CI：0.190,0.966）］是脓毒症休克患者死亡的保护因素（P <0.05）。结论 CRP、PCT、Kal、VE-cad、EVLWI是脓毒症休克患者死亡的影响因素,脓毒症休克患者血清VE-cad水平升高,Kal水平降低,两者的联合检测对评估脓毒症休克患者的预后有一定临床价值。     

α1 抗胰蛋白酶与脓毒症患者发生急性 肾损伤的关系及其预测价值

目的 探讨α1 抗胰蛋白酶（α1-AT）与脓毒症患者急性肾损伤（AKI）发生的关系及其预测 价值。方法 选取2017 年9 月—2019 年10 月在宁波大学医学院附属医院重症医学科住院的脓毒症患者90 例。 28 例AKI 患者作为AKI 组,其余62 例患者未合并AKI 作为非AKI 组。连续监测患者7 d 血清和尿α1- AT,并绘制受试者工作特征（ROC）曲线分析AKI 确诊前48 和24 h 及当日对脓毒症患者发生AKI 的预 警或诊断价值。结果 ①与非AKI 患者入组当日数据比较,AKI 组患者AKI 确诊前48 和24 h 及确诊当 日血清α1-AT 含量降低（P <0.05）,而尿α1-AT 含量升高（P <0.05）。②经ROC 曲线分析,AKI 确诊 前48 和24 h 尿α1-AT 对AKI 的预警效能高于血清α1-AT（P <0.05）。③多因素非条件一般Logistic 回 归分析结果显示,尿α1-AT 是AKI 发生的独立影响因素[Ol ^ R=1.813（95% CI ：1.230,2.974）,P =0.001]。 结论 脓毒症合并AKI 患者血清α1-AT 含量升高,而尿α1-AT 含量降低,对AKI 发生具有早期预警和诊 断效能,且尿α1-AT 是AKI 发生的独立影响因素。     

脓毒症AKI生物学标志物在CRRT中的临床价值

目的 探讨胱抑素C （cystatin C,Cys C）、中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinase-associated lipocalin,NGAL）、尿白细胞介素18（interleukin-18,IL-l8）在脓毒症急性肾损伤（acute kidney injury,AKI）患者早期预测选择连续性肾脏替代治疗（continuous renal replacement therapy,CRRT）及治疗置换模式不同比较中的临床价值评估。方法 选择2012年7月~2016年4月收治的脓毒症且并发AKI的患者,确诊后24h内收集患者血清Cys C、尿NGAL和尿液IL-18标本,用ELISA法分别检测血清Cys C、尿NGAL和尿液IL-18标本水平,同时收集血肌酐（Scr）、尿素氮（BUN）、血白细胞等临床指标。根据患者在之后住院期间是否需要接受CRRT,分为脓毒症CRRT组和脓毒症非CRRT组,对两组进行对比分析,同时脓毒症CRRT组治疗前后在动脉端采取血液标本及尿液标本检测;通过ROC曲线下面积评价血清Cys C、尿NGAL和尿液IL-18浓度在评价脓毒症AKI患者需CRRT的早期预测价值,对CRRT治疗中患者进行单纯随机抽样分组分为2L/h及4L/h置换剂量组,同时和不同时间点的血清Cys C、尿NGAL和尿液IL-18浓度进行单因素方差分析。结果 总共收集71例脓毒症AKI患者,男性占63.3%,患者年龄21~86岁,平均年龄63.9±14.8岁。36例患者最后接受CRRT治疗,确诊AKI后的24h内,2组患者Scr、BUN、血白细胞等临床指标比较,差异无统计学意义（P>0.05）;但脓毒症CRRT组尿血清Cys C、尿NGAL和尿液IL-18浓度水平明显高于脓毒症非CRRT组（P<0.05）。血清Cys C、尿NGAL和尿液IL-18浓度在预测脓毒症AKI患者需CRRT治疗的ROC曲线下面积分别是血清Cys C对于脓毒血症AKI患者需进行CRRT治疗的预测价值的AUC值为0.905（95% CI：0.831~0.979,P=0.000）,尿NGAL、尿IL-18预测价值的AUC值分别为0.926（95% CI：0.862~0.991,P=0.000）和0.897（95% CI：0.827~0.967,P=0.000）。在CRRT治疗过程中,置换液流量为分别设定2L/h及4L/h置换剂量行分组透析治疗,2L/h组透析患者数为17例,4L/h组透析患者数为19例。经过12、24h治疗后,血清Cys C、尿NGAL和尿液IL-18在各组内逐渐下降（P<0.05）,4L/h组血清Cys C、尿NGAL和尿液IL-18在第24h均明显低于2L/h组（P<0.05）。结论 血清Cys C、尿NGAL和尿液IL-18在脓毒症AKI患者选择CRRT治疗时机中有一定的参考价值,其中尿NGAL具有更好的早期预测价值,其次为血清Cys C和尿IL-18。此外,在CRRT治疗过程中,置换液流量为4L/h透析治疗比2L/h组透析患者在持续24h治疗后,可能有更好的治疗效果。     

血清胱抑素C联合尿白介素18对脓毒症并发急性肾损伤的早期预测价值

目的 探讨血清胱抑素-C（sCys-C）和尿白介素18（uIL-18）水平检测对严重脓毒症并发急性肾损伤（AKI）的预测价值。方法 选择2012年12月-2014年10月在重庆市肿瘤研究所重症医学科住院的严重脓毒症患者,将并发AKI的18例患者归为AKI组,在未发生AKI的患者中选取年龄、性别、原发病种及危重程度等因素与AKI组匹配的20例为非AKI组。分别留取入选患者诊断脓毒症后0、6、10、24、48、72 h的血标本及尿标本,测定各时间点血肌酐(Scr)、sCys-C及uIL-18水平,采用受试者工作特征曲线（ROC曲线）及曲线下面积（AUC）评价sCys和uIL-8单用或联用时对脓毒症患者并发AKI的早期预测价值。结果 AKI组患者sCys-C和uIL-18分别在诊断脓毒症后24、10 h达到峰值水平,其峰值水平与非AKI组比较,差异均有统计学意义（P＜0.05）。Pearson相关分析显示,sCys-C与Scr呈正相关（r=0.966,P＜0.001）,uIL-18与Scr呈正相关（r=0.873,P＜0.001）。以sCys-C为2.00 mg/L为诊断截点时,其预测脓毒症患者并发AKI的灵敏度和特异度分别为75.2%和77.9%,AUC为0.765〔95%CI（0.646,0.982）,P＜0.05〕;以uIL-18为265 ng/L为诊断截点时,灵敏度为82.7%,特异度为75.0%,AUC为0.785〔95%CI(0.680,1.013),P＜0.05〕;sCys-C联合uIL-18预测脓毒症患者并发AKI的AUC为0.940〔95%CI(0.829,0.997),P＜0.01〕。结论 脓毒症并发AKI患者sCys-C及uIL-18水平明显升高,这两项指标诊断脓毒症并发AKI的时间点早于Scr;联合应用sCys-C及uIL-18能更早、更准确预测AKI的发生,优于单一指标诊断。     

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.