妊娠早中期亚临床甲状腺异常对妊娠及妊娠结局的影响

目的 探讨妊娠早中期亚临床甲状腺异常对妊娠及妊娠结局的影响。方法 采用前瞻性的研究方法。收集2012-06~2013-12解放军第九七医院妇产科随访和分娩的孕妇共985例,其中妊娠早期546例,妊娠中期439例。所有孕妇均进行甲状腺功能筛查。依据甲状腺功能分为亚临床甲状腺功能异常组和正常甲状腺功能且TPOAb阴性组(妊娠期全过程)。亚临床甲状腺功能异常组再分为三个亚组:亚临床甲减组,单纯低T4血症组,TPOAb阳性组。从甲状腺功能正常且TPOAb阴性的孕妇中选择与亚临床甲状腺功能异常组相等例数的孕妇作为正常对照组。通过与正常对照组的比较,探讨妊娠早中期亚临床甲状腺异常对妊娠及妊娠结局的影响。结果 985例孕妇中,亚临床甲状腺功能异常共248例(25.2%),其中亚临床甲减81例(8.2%),单纯低T4血症75例(7.6%),单纯TPOAb阳性92例(9.3%)。亚临床甲减组妊娠期并发症和新生儿并发症的发生率与正常对照组比较差异无统计学意义(P>0.05)。单纯低T4血症组妊娠期并发症的发生率与正常对照组比较差异均无统计学意义(P>0.05),而新生儿体重(t=2.19,P=0.029)、巨大儿的发生率(χ2=5.07,P=0.024)均高于正常对照组。TPOAb阳性组妊娠期蛋白尿(χ2=4.79,P=0.029)、早产(χ2=5.99,P=0.014)、新生儿窒息(P=0.001)的发生率均高于正常对照组。结论 妊娠早中期亚临床甲状腺异常可导致不良妊娠结局的发生,应对孕妇的甲状腺功能进行早期检测,以减少不良妊娠结局的发生。     

甲状腺素片治疗妊娠合并亚临床甲状腺功能减退的研究

目的 了解妊娠期亚临床甲状腺功能减退症的发病率及甲状腺素替代疗法的临床转归.方法 通过分析早孕患者的资料,确诊妊娠合并亚临床甲状腺功能减退症,将患者按照是否接受甲状腺素替代治疗分为治疗组与对照组,治疗组168例,对照组69例,分析2组的妊娠结局.结果 5 455例妊娠女性在研究期间完成妊娠初期甲减筛查,237例妊娠女性被诊断为亚临床甲减,37例被诊断为临床甲减,19例被诊断为低T4血症,对于亚临床甲减孕妇,甲状腺素替代治疗组较对照组先兆流产等不良事件发生率明显低于对照组,P＜0.01.结论 对妊娠妇女早期进行甲状腺素筛查,早发现亚临床甲减孕妇,应用甲状腺素早期干预,可以降低临床不良事件的发生.     

金湾区农村孕妇亚临床甲状腺疾病与不良妊娠结局的研究

目的：了解金湾区农村孕妇亚临床甲状腺疾病的患病率,金湾区农村孕妇亚临床甲状腺疾病与不良妊娠结局的关系。方法采集孕妇周围静脉血3～4 mL装于干燥试管中,留取血清标本,采用化学发光的方法检测孕妇血清中的促甲状腺素（TSH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）水平。结果亚临床甲减8例,患病率为0.23％（初产妇占62.5％,经产妇占37.5％）,亚临床甲亢19例,患病率为5.35％（初产妇31.5％,经产妇68.5％）,不良妊娠的风险增加。大部分病例尚未结束妊娠,有待继续追踪妊娠及分娩过程的并发症。结论重视围产期保健工作,加强孕妇甲状腺功能筛查率,使妊娠期亚临床甲状腺疾病的早发现、早诊断、并加强患者孕期的母婴监护,尽早发现妊娠的并发症并及时治疗,改善妊娠结局,减少不良妊娠的发生率,积极查找发病原因,减低妊娠期亚临床甲状腺疾病的患病率,提高出生人口的素质,促进优生优育。     

孕早期甲状腺功能筛查对妊娠合并亚临床甲状腺功能减退的应用价值研究

目的：观察妊娠妇女孕早期甲状腺功能异常的发病率,探讨孕早期进行甲状腺功能筛查的意义．方法随机选择来丽江市人民医院产科门诊做产检的孕妇630例,在常规产检的同时做甲功5项筛查．对检测结果统计分析,对甲减、亚临床甲状腺功能减退（亚甲减）的61例孕妇追踪其治疗情况及不良妊娠结局,探讨甲减、亚甲减与不良妊娠结局的相关性．结果630例孕妇中,检出甲亢8例,患病率1.3%,甲减、亚甲减61例,发病率9.7%,其中甲减5例,患病率0.8%,亚甲减56例,患病率8.9%．甲减组TSH、FT4与正常对照组相比差异有统计学意义（P〈0.01）,亚甲减组TSH、FT4、TT4与正常对照组相比差异有统计学意义（P〈0.05）．61例甲减、亚甲减组中有39人接受左甲状腺素治疗,22人未接受治疗．接受治疗组不良妊娠结局发生率显著低于未接受治疗组（P〈0.05）．结论孕早期6-20周孕妇进行甲功检测,对及时发现妊娠期甲状腺功能异常有重要意义,应作为孕妇常规产检项目．     

妊娠早、中期甲状腺功能异常对妊娠结局和新生儿的影响

目的 探讨妊娠早、中期甲状腺功能异常对妊娠结局和新生儿的影响.方法 选取铜川市妇幼保健医院2014年4月至2016年4月住院部收治的180例甲状腺功能筛查诊断为亚临床甲减孕妇作为观察组,60例甲状腺功能筛查正常孕妇作为对照组.比较两组孕妇的妊娠结局及新生儿状况.结果 观察组孕妇的流产率(7.8%)、产后出血(12.2%)、早产(10.6%)、妊娠期高血压(10.6%)、妊娠期糖尿病发生率(11.7%)均明显高于对照组(0、1.7%、1.7%、1.7%、0),差异均有统计学意义(P<0.05);观察组孕妇的胎儿窘迫和胎儿生长受限发生率分别为12.2%、10.6%,明显高于对照组的3.3%、1.7%,差异均有统计学意义(P<0.05).结论 妊娠早、中期合并亚临床甲减可导致多种不良妊娠结局,对胎儿生长发育也有不良影响.     

孕早期甲状腺功能筛查对预防妊娠合并亚临床甲减及妊娠结局影响的研究

目的探究妊娠合并亚临床甲减孕妇进行孕早期甲状腺功能筛查的效果和妊娠结局。方法选取2017年8月至2018年8月该院进行产检的早孕产妇168例,对所有患者进行甲状腺功能筛查,以亚临床甲减是否遵医嘱治疗将其分为对照组和实验组,对照组为为遵医嘱治疗患者,实验组为遵医嘱治疗患者,对比两组患者的妊娠时间、并发症及妊娠结局。结果 168例孕妇中检查出甲减4例,所占比例为2.4%;亚临床甲减36例,所占比例为21.42%;甲亢5例,所占比例2.97%。亚临床甲减孕妇的促甲状腺激素(TSH)显著高于正常孕妇(P0.05);亚临床甲减孕妇的甲状腺激素(T4)、游离三碘甲状腺原氨酸(FT4)水平显著降低正常孕妇(00.05)。实验组孕妇总并发症发生率显著低于对照组(P0.05);实验组早产、胎儿生长受限显著少于对照组(P0.05);实验组妊娠时间显著长于对照组(P0.05)。结论妊娠合并亚临床甲减患者进行孕早期甲状腺功能筛查能够有效的评估甲状腺功能状态,同时在孕早期筛查患有亚临床甲减的孕妇,能够及时对其进行治疗,减少患者孕期的并发症,改善妊娠结局。     

妊娠期甲状腺功能减退的筛查与替代治疗

目的：：探讨妊娠期甲状腺功能筛查的必要性及妊娠期临床甲减与亚临床甲减左旋甲状腺素（L-T4）治疗的安全性与有效性。方法：对1872例妊娠期妇女进行促甲状腺释放激素（TSH）、游离甲状腺激素（FT4）、甲状腺过氧化物酶抗体（TPOAb）水平测定,回顾性分析87例妊娠合并亚临床甲减患者的妊娠结局,并与100例甲状腺功能正常孕妇做对照。结果：妊娠合并临床甲减检出率0.64%,亚临床甲减检出率7.85%,TPOAb 阳性检出率8.44%。亚临床甲减占甲状腺功能减退症的89.10%。在接受 L-T4治疗的临床甲减与亚临床甲减孕妇中,无1例不良妊娠结局发生。结论：在孕早期进行甲状腺功能筛查,及时诊断甲状腺功能减退症并给予替代治疗,可避免妊娠不良结局的发生。     

妊娠特异性甲状腺功能参数在评价妊娠期甲状腺功能中的作用

目的：探讨妊娠特异性甲状腺功能参数对妊娠期甲状腺功能评价的作用。方法收集妊娠中期孕妇1200例,采集其血清标本并测定血清TT4、TSH、FT4以及TPOAb水平,以妊娠特异性与非妊娠人群的甲状腺功能指标参考范围进行亚临床甲状腺功能异常的筛查。结果妊娠特异性甲状腺功能参数筛查妊娠中期妇女的甲减与低甲状腺素发生率分别为5.92%、1.50%,显著高于非妊娠人群参考范围的1.42%、0.08%,差异具有统计学意义（P<0.05）;以非妊娠人群参考范围作为诊断标准,其对亚临床甲减与低甲状腺素血症筛查的漏诊率分别为4.50%、1.42%。结论应用妊娠特异性甲状腺功能参数进行妊娠期甲状腺功能异常的筛查可显著降低漏诊率,值得推广应用。     

妊娠期甲状腺功能及抗体筛查对妊娠结局的影响

目的探讨甲状腺功能及抗体筛查对孕妇妊娠结局的影响。方法 2012-10/2013-10月对750例孕妇行产前甲状腺功能筛查,另选取750名非妊娠妇女为对照组,分别采用免疫吸附法测定两组甲状腺过氧化酶抗体（thyroid peroxidase antibody,TPOAb）、促甲状腺素（thyrotropin,TSH）、总甲状腺素（total thyroxine,TT4）、血清游离甲状腺素（serum free thyroxine,FT4）、游离三碘甲腺原氨酸（free triiodothyronine,FT3）以及总三碘甲腺原氨酸（total triiodothyronine,TT3）水平。结果 750例孕妇中共发现甲状腺功能亢进（甲亢）78例（10.40%）,甲状腺功能减退（甲减）62例（8.27%）,TPOAb阳性25例（3.33%）,而对照组中甲亢12例（1.60%）、甲减8例（1.07%）,TPOAb阳性78例（10.40%）,两组甲亢、甲减及TPOAb阳性率具有统计学差异（P〈0.05）。与正常妊娠组相比,甲减组患者早产、妊娠高血压、孕期贫血、孕期低体重、胎儿窘迫、孕期糖代谢异常发生率显著升高（P〈0.05）,而甲亢组患者子痫前期、孕期心脏病、流产、早产、胎儿窘迫、新生儿生长受限发生率显著升高,差异有统计学意义（P〈0.05）。结论与正常妇女相比,妊娠妇女甲状腺功能异常发生率较高,应引起孕妇及医生的重视。妊娠期甲状腺功能异常患者不良妊娠结局发生率较高,因此临床工作者应重视妊娠期甲状腺功能筛查,做到早筛查,早诊治,以改善患者妊娠结局。     

妊娠期亚临床甲状腺功能减低与妊娠结局分析

目的探讨妊娠期亚临床甲状腺功能减低对妊娠结局和产科并发症的影响。方法用化学发光法检测血清游离甲状腺素（吼）、促甲状腺激素（TSH）、甲状腺过氧化物酶抗体（TPOAb）浓度,对达到亚临床甲减诊断标准者,按TPOAb阴性或阳性结果进行分组研究,随访妊娠结局。结果筛查1279名孕妇,临床甲减（13例）发生率为1．02％,亚临床甲减（57例）发生率为4．46％。亚临床甲减发生流产、早产、胎儿生长受限（FGR）、妊娠高血压疾病、妊娠期糖尿病、贫血及胎盘早剥等产科并发症风险增加,不良妊娠结局发生率达40．35％（25／57）,正常对照组为18％。结论妊娠期亚临床甲状腺功能减退与妊娠不良结局及并发症有相关性。对孕妇人群进行甲状腺功能筛查,及时、适当的治疗可将妊娠风险降低。     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.