急性心肌梗塞患者血浆内皮素-1浓度的动态变化

对急性心肌梗塞（AMI）患者按是否并发梗塞后心绞痛、梗塞延展和心力衰竭分为24倒无并发症组和11例有并发症组，采用放射免疫方法检测不同时间血浆内皮素－1（ET－1）浓度。结果显示：与正常对照组（1．60±0．43pg／ml）比较，无并发症组和有并发症组AMI患者血浆ET－1浓度在入院即刻已经升高（2．70±0．46pg／ml和2．98±0．50pg／ml，均P＜0．01），无并发症组到发病后第3天降低到正常（1．82±37pg／ml．P＞0．05）．而有并发症组一直持续到观察终点第7天仍然比较高（3．60±0．41pg／ml，P＜0.01）。提示：AMI患者血浆ET－1浓度持续升高反映了心肌持续缺血或心功能减退。     

肥胖2型糖尿病患者血清Apelin水平的变化及其意义

目的探讨肥胖2型糖尿病患者血清Apelin水平的变化及其意义。方法糖尿病和肥胖患者的空腹血糖和胰岛素水平,计算胰岛素抵抗指数（HOMA-IR）;用酶联免疫吸附法测定患者血清Apelin含量。结果肥胖糖尿病患者32例,正常体重糖尿病31例,单纯肥胖患者34例,正常对照组30例,分别测定血清Apelin比正常对照组明显升高（P〈0．01）。肥胖糖尿病组血清Apelin水平为（426．3±35．0）pg／ml明显高于正常体重糖尿病组的（376．4±40．8）pg／ml和单纯肥胖组（392．2±31．1）pg／ml,差异有统计学意义（P〈0．01）。结论肥胖和胰岛素抵抗相伴时引起血清Apelin升高,高血糖和肥胖并存加重胰岛素抵抗,导致肥胖糖尿病组Apelin进一步升高。     

多发性硬化患者血清及脑脊液中IL-18的水平及意义

目的：检测多发性硬化（multiple sclerosis，MS）患者血清及脑脊液中IL-18的水平，探讨它在MS发病中的作用。方法：收集53例MS患者，根据患者病情变化，把MS患者分为急性发病组及病情缓解组。利用ELISA方法检测两组患者血清及脑脊液中IL-18的水平，并同时测定MS患者血清C反应蛋白（CRP）水平。结果：MS急性发病组血清IL-18浓度（156．09±48．77）pg／ml均高于MS缓解组（127．11±36．36）pg／ml与正常对照组（115．58±45．49），P〈0．05；而MS缓解组与正常对照组血清IL-18的水平没有明显变化（P〉0．05）。MS急性发病组脑脊液中IL-18浓度（187．79±44．06）pg／ml高于MS缓解组（133．70±39．33）pg／ml，P〈0．05，也高于MS急性发病组血清中IL-18的水平（156．09±48．77）pg／ml，P〈0．05；而MS缓解组血清及脑脊液中水平无明显变化（P〉0．05）。MS急性发病组血清CRP（39．46±13．57）μg／ml水平高于MS缓解组（8．2±4．4）μg／ml，P〈0．05；并且，MS急性发病组血清IL-18的水平与CRP呈成正相关关系（r=0．48，P〈0．05）。结论：IL-18可能参与MS发病，并与MS病情活动有关。     

不同亚型哮喘患儿的IL-5、IL-17水平变化

目的探讨白细胞介素-5（IL-5）、IL-17在不同亚型中重度儿童哮喘发病中的作用。方法以酶联免疫吸附法（ELISA）检测45例不同亚型中重度哮喘患儿及20例正常儿童外周血单个核细胞（PBMC）在CD3单克隆抗体（0．2mg／L）及CD28单克隆抗体（1mg/L）刺激下分泌的IL-5、IL-17水平,了解IL-5、IL—17与儿童哮喘病情及气道炎症的关系。结果嗜酸细胞型哮喘（EA）组患儿PBMC表达IL－5水平（79．75±13．49）pg／ml显著高于非嗜酸细胞型哮喘（NEA）组（69．73±9．17）pg／ml及正常对照组（51．30±14．33）pg／ml（P〈0．01）,NEA组患儿PBMC表达IL-17水平（5684．1±884．74）pg／ml显著高于EA组（4938．1±465．58）pg／ml及正常对照组（2685．0±1081．03）pg／ml（P〈0．01）,慢性持续组IL-5、IL-17水平显著高于临床缓解组（P均〈0．05）。结论中重度哮喘患儿外周血单个核细胞IL-5、IL－17表达水平升高,并与临床分期相关,IL-5在EA中的作用较NEA更为突出,IL-17在NEA中的作用较EA更为突出。     

透析前后血管紧张素Ⅱ的变化与高血压关系

本文采用放射免疫法测定血液透析前后病人血浆血管紧张素II（ANGII），分析其变化及其与高血压的关系。结果显示，尿毒症患者血浆ANGII为59．8±6．80pg／ml，显著高于正常对照组的39.25±21.16pg／ml（P＜0．01）。在透析后高血压组透析后尿毒症患者血浆ANGII急剧上升，与透析     

先天性心脏病伴肺动脉高压患者血清一氧化氮及血浆内皮素水平的变化研究

目的探讨一氧化氮（NO）和血浆内皮素1（ET－1）在先天性心脏病（COHD）合并肺动脉高压中的作用及其临床意义。方法75例左向右分流型COHD患儿分为三组：其中无肺动脉高压组25例;轻度肺动脉高压组25例和中重度肺动脉高压组25例,正常对照组25例。采用放射免疫法和硝酸盐还原酶法测定血液中NO和ET－1含量,计算NO／ET—1比值。结果CHD组血浆ET－1水平（46．18±2．541pg／ml）高于对照组（25．75±3．87pg／ml）,P〈0．005;血清NO浓度（23．82±6．46μg／ml）低于对照组（37．27±2．47μg／ml）,P〈0．001;NO／ET—1的比值（0．68±0．39）明显低于对照组（1．18±2．80）,P〈0．001。CHD伴中重度肺动脉高压组的NO浓度低于轻度肺动脉高压组和无肺动脉高压组（P〈0．001）,肺动脉压力的程度和NO／ET—1的浓度呈负相关（r=-0．813,P〈0．001）。结论COHD患者血浆ET—1浓度的升高和NO浓度的降低及NO／ET-1比值降低,在肺动脉高压形成和发展中起到了重要的作用。     

川崎病患儿血清IL-3、IL-6、TPO水平变化研究

目的研究川崎病（KD）患儿血清白细胞介素-3（IL-3）、白细胞介素-6（IL-6）、促血小板生成素（TPO）水平变化，探讨其与冠脉损害（CAL）的关系。方法采用双抗体夹心酶联免疫吸附实验（ELISA），分别测定正常对照组与KD患儿急性期、治疗后恢复期血清IL-3、IL-6、TPO水平。结果①KD患儿急性期IL-3水平为248．93±126．00pg／ml，与治疗后恢复期的148．20±45．26pg／ml相比，P〈0．001；与正常对照组的115．62±43．72pg／ml相比，P〈0．05。②急性期IL-6水平为230．20±118．52pg／ml，与治疗后恢复期的98．47±25．12pg／ml相比，P〈0．001，与正常对照组68．33±22．63pg／ml相比，P〈0．01。⑧急性期TPO水平为337．5±117．77pg／ml，与治疗后恢复期120．03±46．69pg／ml相比，P〈0．001，与正常对照组的109．12±53．89Pg／ml相比，P〈0．01。④35例KD患儿中7例伴发CAL，28例无冠脉损害（NCAL）。CAL组IL-3水平为276．51±119．20pg／ml，与NCAL组的213．58±108．75pg／ml相比P〉0．05；CAL组IL-6水平为262．67±119．20pg／ml，与NCAL组的202．32±93．36pg／ml相比P〉0．05；CAL组TPO水平为406．85±138．78pg／ml，与NCAL组的287．62±123．63pg／ml相比，P〈0．05。结论IL-3、IL-6、TPO在KD急性期水平增高，恢复期水平下降。提示：KD急性期炎性因子水平增加。KD患儿伴CAL组的TPO水平明显增高，提示TPO的水平增高可能与冠脉损害有关，可做为KD患儿伴CAL的预测指标。     

血浆IL-17水平与颈动脉内中膜厚度的相关性研究

目的探讨原发性高血压并颈动脉硬化患者血浆中白细胞介素-17（IL-17）水平与颈动脉内中膜厚度（IMT）的相互关系。方法选取原发性高血压患者220例,行颈动脉彩超检查,根据颈动脉内中膜厚度分组,原发性高血压并颈动脉斑块组（斑块组）96例,原发性高血压并颈动脉增厚组（增厚组）61例,原发性高血压并颈动脉正常组（正常组）63例,对照组61例。采集所有研究对象的血浆,采用酶联免疫吸附法（ELISA）测定其血浆中IL-17浓度,比较血浆IL-17水平与IMT的相关性。结果（1）血浆IL-17水平在斑块组为（401．850±111．137）pg／ml、增厚组为（272．018±82．373）pg／ml、正常组为（195．864±64．001）pg／ml和对照组为（25．509±7．721）pg／ml,血浆IL-17水平依次降低,差异具有显著统计学意义（均P=0.000,P〈0．001）;（2）相关分析显示血浆IL-17水平与IMT呈正直线相关（r=0．732,P〈0．001）。结论原发性高血压并颈动脉硬化患者血浆IL-17与颈动脉内中膜厚度呈正相关。     

儿童哮喘外周血内皮素和肿瘤坏死因子的水平变化及其临床意义

探讨哮喘患儿急性发作期,缓解期外周血ET、TNF－a水平变化,并分析其相关性。本实验选择47例哮喘患儿,32名正常儿童作为对照组,分别在哮喘急性发作期和缓解期采静脉血,用放射免疫法检测ET、TNF-a水平。结果发现发作期哮喘息儿血浆ET明显高于正常儿童（分别为91．26±21．606,54．42±18．602ng／L,P＜0．0005）,缓解期降至正常水平（64．50±20．159ng／L,P＞0．05）重症组高于轻中症组建（分别为108．27±19.50879．32±20．61ng／L,P＜0．005）,发作期哮喘息儿血清TNF-a水平亦明显高于正常儿童（分别为1．877±0．39,1．176±0．39ng／L,P＜0．005）缓解期降至正常水平（1．183±0335ng／L,P＞0．05）重症组高于轻中症组（分别为2.18±0．441．65±035ng／L,P＜0．0005）ET和TNF-a水平呈显著正相关。提示ET和TNF-a在哮喘发病机制中有其重要作用．对哮喘的病情判断及预后有一定指导意义。     

沙利度胺联合化疗治疗白血病临床疗效研究

目的探讨研究沙利度胺联合化疗治疗急性白血病的临床疗效以及对血管内皮生长因子（VEGF）、血管内皮生长因子受体（VEGFR）、碱性成纤维细胞生长因子（bFGF）、骨髓微血管密度（MVD）的影响。方法将符合标准的45例急性白血病患者分成观察组（24例）和对照组（21例），每组均进行常规化疗，观察组同时口服沙利度胺100mg／d。取患者血浆，使用ELISA法测定治疗前后2组患者VEGF、VEGFR、bFGF以及MVD水平以及不良反应的发生情况，比较两种治疗方法的疗效。结果治疗后观察组患者VEGF、VEGFR与MVD分别为（212．8±36．2）pg／ml、（1765．4±338．1）pg／ml、（8．31±1．55）n／HP，与对照组的（289．0±31．7）pg,／ml、（1359．9±392．8）pg／ml、（14．21±2．74）n／HP相比差异有统计学意义（P〈0．05）。2组患者的bFGF分别为（2．10±0．19）pg／ml与（2．12±0．29）pg／ml，差异无统计学意义（P〉0．05）。观察组消化道反应与神经系统症状发生率显著性高于对照组（P〈0．05）。结论沙利度胺通过抑制患者体内VEGF的表达与减少MVD而达到治疗急性白血病的目的，值得临床推广并进一步深入研究。     

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.