Comparison of Anticoagulant Effects on Vein Grafts between Human TFPI Gene Transfection and Aspirin Oral Administration

To develop a more efficient antithrombotic way after coronary artery bypass grafting(CABG),the anticoagulant effects were compared of human tissue factor pathway inhibitor(TFPI) gene transfection and aspirin oral administration(traditional method) on vein grafts.An eukaryotic expression plasmid pCMV-(Kozak) TFPI was prepared.Animal model of carotid artery bypass graft-ing was constructed.In operation,endothelial cells of vein grafts in TFPI group and empty plasmid control group were transfected with pCMV-(Kozak) TFPI and empty plasmid pCMV respectively,while no transfection was conducted in aspirin control group.After operation,aspirin(2 mg·kg-1·d-1) was administered(i.g.) in aspirin control group.Three days later,grafts(n=10) were harvested for RT-PCR,Western blotting and immunohistochemical analyses of exogenous gene expression and for pathological,scanning electron microscopic observation of thrombus.Thirty days later,the patency rates of remnant grafts(n=10) were recorded by vessel Doppler ultrasonography.Human TFPI gene products were detected in gene transferred vein grafts.Three days later,thrombi were found in 7 animals of aspirin control group and in 8 animals of empty plasmid control group,but in only 1 of TFPI group(P<0.01).Thirty days later,5 grafts were occluded in empty plasmid control group,but none of grafts was occluded in the other groups(P<0.05).The endothelial surfaces of grafts in both of the control groups were covered with aggregated erythrocytes and platelets,and it were not seen in TFPI group.It was suggested that the anticoagulant effects on vein grafts of human TFPI gene trans-fection are better than those of aspirin.     

不同糖代谢人群血尿酸、血脂及胰岛素抵抗相关性研究

Objective To study the levels of senlm uric acid(UA)in normal glucose(NC),impaired glucose regulation(IGR)and type 2 diabetes mellitus(T2DM),and investigate its relationship with insulin resistance and dyslipidemia.Method The levels of blood glucose,lipids,fasting insulin(HNS)and serum UA were measured in patients of 45 T2DM(T2DM group),20 IGR(IGR group)and 29 NC(NC group).Status of insulin resistance and insulin secretion function was evaluated by HOMA-IR and ISI.Results The levels of triglyceride(TG)and UA in T2DM group and IGR group were significantly higher than those in NC group[(3.34±8.77),(1.85±0.67),(1.26±0.38)mmoi/L and(316.71±96.20),(403.62±76.80),(325.45±94.43)mmol/L](P<0.01).HDL-C levels in T2DM group were significantly lower than those in IGR and NC group[(1.05±0.30),(1.07±0.21),(1.12±0.20)mmol/L](P<0.01).NO significant difference of FINS levels was found in the three groups.HOMA-IR level in T2DM and IGR group was higher than that in NC group(3.84,3.77,2.34)(P<0.01).ISI in T2DM and IGR group was lower than that in NC group(-4.52±0.79,-4.44±0.19,-4.03±0.58)(P<0.01).Correlation analysis indicated that the level of UA was positively related with BMI.TG and negatively related with HDL-C.Conclusion Increased UA in IGR indicates that hyperurieacidemia developes before DM.     

Graves氏病患者血清甲状腺刺激免疫球蛋白的测定及其在临床上的意义

弥漫性甲状腺肿伴甲状腺功能亢进(Graves氏病,以下简称弥漫性甲亢)是甲状腺功能亢进症中最常见的类型,其发病机理与机体免疫功能障碍有密切关系。国外不少资料表明,在多数弥漫性甲亢患者血中存在一种异常的甲状腺刺激物——甲状腺刺激免疫球蛋白(Thyroid stimulating immunoglobulin,TSI)。但国内报告很少。本文对55例弥漫性甲亢患者和15例正常人进行了血清TSI测定,探讨它在本病发病中的作用;并对TSI测定的临床意义,作初步的分析。     

超声诊断膀胱肿瘤活动性出血1例

正患者男,54岁,1个月前无明显诱因出现前程无痛性血尿,尿液呈鲜红或暗红色,偶有血凝块,无发热、尿频、尿急、腰背部疼痛等不适。外院对症治疗无明显好转遂来我院就诊。体格检查:双肾区未见明显隆起,无压痛及叩击痛,双侧输尿管及膀胱走行区均未见明显深压痛,外生殖器正常,血常规及肝肾功能等实验室检查指标均正常,前列腺特异性抗原阴性。超声检查:膀胱充盈良好,壁稍毛糙,膀胱右侧壁见一大小约1.6 cm×0.6 cm稍高团块状回声,与膀胱壁关系紧密,不随体位改变而移动,扫查过程中于团块状回声上缘见持续性流出物(图1A),考虑为活动性出血所致;CDFI于团块状回声内未探及明显血流信号,其上缘持续性流出物显示为低速彩色多普勒信号     

健康体检人群糖尿病发病风险的评估方法

目的建立适合健康体检个体糖尿病发病风险的评估方法。方法结合国内外的研究结果分析近年糖尿病发病率资料及发病风险因素,得出我国成年人糖尿病发病的主要风险因素,将目标人群随机分为两组队列,队列1用于危险因素评分方法的建立,采用非条件logistic回归分析筛选糖尿病的危险因素,根据危险因素的回归系数确定不同变量的积分值,以累计积分值的大小判断个体患病的危险性,并以队列2的资料验证该方法进行人群筛检的价值。结果研究结果表明男性与女性分别当积分值为65．0与65．5时,约登指数最大,故将65．0与65．5作为判别不同性别发生糖尿病风险的阈值,其筛检的灵敏度分别为90．6％与83．3％,特异度分别为89．4％与97．7％,阳性预测值分别为58．8％与80．0％,阴性预测值为98．3％与98．2％。曲线下面积分别为0．955与0．899,危险因素评分法用于筛查糖尿病,差异有统计学意义（P=0．000）。结论该方法简易经济,可操作性强,有望成为健康体检机构筛查人群糖尿病发病的高危人群的实用、有效的方法。     

超声造影剂肝渡越时间对肝良恶性病变诊断的临床意义

目的探讨超声造影剂肝渡越时间(hepatic transit time,HTT)对肝良恶性病灶鉴别诊断的临床意义。方法良性病灶组包括22例局灶性脂肪肝和50例血管瘤;恶性病灶组包括26例原发性肝癌,16例转移性肝癌。经肘静脉弹丸注射超声造影剂声诺维,计算超声造影剂HTT。结果良性病灶HTT值波动范围大,其HTT范围6~17 s,平均(10.5±2.3)s。恶性病灶HTT均不大于10 s,HTT范围3~10 s,平均(6.0±1.9)s。以HTT<10 s作为恶性的诊断标准,其敏感性为95.0%,特异性为50.0%,阳性预测值为52.6%,阴性预测值为94.7%。结论超声造影剂HTT在肝良恶性病变中的价值主要在于对恶性病灶的排除诊断,不适合进行病灶恶性的确切诊断。     

高频超声结合增强型能量多普勒成像评价Ⅱ型糖尿病患者指尖微血管变化的应用研究

目的寻找Ⅱ型糖尿病患者并发末梢微血管病变的早期证据，为临床提供有效的观察方法和指标。方法应用高频超声结合增强型能量多普勒显像（e-Flow）观察30例Ⅱ型糖尿病患者右手中指末节指腹和甲床内微血管床的分布特征、走行和数量，并计算指腹动脉和甲床动脉的收缩期峰值速度（PSV）、舒张期峰值速度（EDV）以及血管阻力（RI）参数。观察结果与32例年龄、性别相匹配的健康成人对照。结果①正常人中指末节指腹的血管供应丰富，e-Flow清晰显示手指的两支掌侧固有动脉及发出的分支，呈网状分布于整个指腹。血管形态勾勒清晰，走行正常，可追踪全程；甲床内微血管呈纵行分布，末梢可见横行吻合支，血管网清晰，血供丰富。②糖尿病患者中指的末节指腹血管网显示欠丰富，仅可显示一或两支固有动脉分支或仅见零星点条状血流，血管走行迂曲断续，与正常人差异有统计学意义（P〈0．05）；甲床内微血管，尤其是远端血管显示不良，仅见零星点条状血流，与正常人差异有统计学意义（P〈0．05）；糖尿病合并症者的指端微血管异常较单纯糖尿病患者为甚。③与正常人比较，糖尿病患者的指腹动脉、甲床动脉PSV、EDV测值稍减低（P〈0．05～0．09），RI相应升高（P〈0．05）。结论E-Flow结合传统彩色多普勒血流成像技术可敏感、准确地反映糖尿病患者的指端微血管分布减少，血管阻力增高，为临床早期诊断糖尿病微血管病变和评价治疗效果提供了新手段。     

体脂肪率在代谢综合征诊断中的应用

目的：探讨不同性别个体体脂肪率（BF%）与代谢综合征（MS）之间的关系,阐明BF%是不同性别体检者MS的判定因素之一。方法：选择健康体检者904人,其中男性554人,女性350人。检测其BF%、体质量指数（BMI）、腰臀比（WHR）、收缩压（SBP）、舒张压(DBP)、空腹血糖（FBG）和血脂（BL）等指标,分析不同性别体检者各代谢指标差异;采用Spearman相关分析方法分析不同性别体检者各代谢指标与BF%的相关性;采用Logistic回归分析方法分析不同性别体检者BF%与MS的发病风险;采用受试者工作特征（ROC）曲线分析不同性别体检者BF%判定MS的可靠性和适宜切点。结果：男性体检者SBP、DBP、FPG、BMI和WHR水平高于女性(P<0.05)。男性体检者BF%低于女性(P<0.05);男性和女性BF%分别与SBP(r=0.27,r=0.41)、DBD(r=0.27,r=0.34)、FBG(r=0.18,r=0.37)、总胆固醇（TC）(r=0.19,r=0.31)、甘油三酯（TG）(r=0.42,r=0.47)和低密度脂蛋白-胆固醇(LDL-C)(r=0.17,r=0.33)水平均呈显著正相关关系,与高密度脂蛋-胆固醇（HDL-C）水平呈显著负相关关系（r=－0.28,r=－0.30）。在调整MS相关因素后,BF%仍为MS的独立危险因素（OR=1.090,95%CI 1.044~1.137）,男性BF%异常升高发生MS的风险是BF%正常者的1.086倍（95%CI ：1.030~1.144）,女性BF%异常升高发生MS的风险是BF%正常者的1.107倍（95%CI 1.02
7~1.192）。男性BF%诊断MS的ROC曲线下面积为0.710 （95%CI 0.665~0.754）,BF%在29.050%为最佳切点值;女性BF%诊断MS的ROC曲线下面积为0.811（95%CI：0.749~0.873）,BF%在38.550%为最佳切点值。结论：不同性别个体的BF%是MS的危险因素,对MS的发生具有预测价值。     

不同糖代谢人群血尿酸、血脂及胰岛素抵抗相关性研究

目的探讨2型糖尿病（T2DM）、糖调节受损（IGR）和血糖正常（NC）状态下血尿酸（UA）水平与胰岛素抵抗及血脂异常的相关性。方法94例门诊行空腹胰岛素检测的患者按照糖代谢状态分成T2DM组（45例）、IGR组（20例）、NC组（29例）,比较三组血UA和血脂、胰岛素抵抗指数（HOMA.IR）的变化情况。结果在校正年龄、体重指数（BMI）后,T2DM、IGR组的三酰甘油（TG）、血UA水平与NC组相比差异有统计学意义[分别为（3.34±8.77）、（1.85±0.67）、（1.26±0.38）mmol／L和（316.71±96.20）、（403.62±76.80）、（325.45±94.43）mmol／L]（P〈0.01）,T2DM组较NC、IGR组高密度脂蛋白胆固醇（HDL-C）水平明显降低[分别为（1.05±0.30）、（1.12±0.20）、（1.07±0.21）mmol／L]（P〈0.01）;HOMA-IR在T2DM、IGR组与NC组比较差异有统计学意义（中位数分别为3.84、3.77、2.34）（P〈0.01）;胰岛素敏感指数在T2DM、IGR组明显低于NC组（分别为-4.52±0.79、-4.44±0.19、-4.03±0.58）（P〈0.01）。相关分析显示血UA水平与BMI、TG呈显著正相关,与HDL-C呈显著负相关。结论高UA血症和脂质代谢紊乱一样,均是T2DM常见的代谢异常;早在IGR期即已出现包括高UA血症在内的多种代谢紊乱,应该给予早期干预。     

不同糖代谢人群血尿酸、血脂及胰岛素抵抗相关性研究

Objective To study the levels of senlm uric acid(UA)in normal glucose(NC),impaired glucose regulation(IGR)and type 2 diabetes mellitus(T2DM),and investigate its relationship with insulin resistance and dyslipidemia.Method The levels of blood glucose,lipids,fasting insulin(HNS)and serum UA were measured in patients of 45 T2DM(T2DM group),20 IGR(IGR group)and 29 NC(NC group).Status of insulin resistance and insulin secretion function was evaluated by HOMA-IR and ISI.Results The levels of triglyceride(TG)and UA in T2DM group and IGR group were significantly higher than those in NC group[(3.34±8.77),(1.85±0.67),(1.26±0.38)mmoi/L and(316.71±96.20),(403.62±76.80),(325.45±94.43)mmol/L](P<0.01).HDL-C levels in T2DM group were significantly lower than those in IGR and NC group[(1.05±0.30),(1.07±0.21),(1.12±0.20)mmol/L](P<0.01).NO significant difference of FINS levels was found in the three groups.HOMA-IR level in T2DM and IGR group was higher than that in NC group(3.84,3.77,2.34)(P<0.01).ISI in T2DM and IGR group was lower than that in NC group(-4.52±0.79,-4.44±0.19,-4.03±0.58)(P<0.01).Correlation analysis indicated that the level of UA was positively related with BMI.TG and negatively related with HDL-C.Conclusion Increased UA in IGR indicates that hyperurieacidemia developes before DM.