长时间左心辅助对犬体内血管紧张素Ⅱ及心钠素的影响

目的：监测左心辅助期间犬体内血管紧张素Ⅱ及心钠素水平的变化。方法：采用自身配体对设计的犬8条，进行左心辅助9h，用放免分析方法测定在辅助前（对照组），辅助后3，6，9h的血管紧张素Ⅱ和心钠素水平的变化。结果：血浆中的血管紧张素Ⅱ在辅助3h虽较辅助前增高，但差异无统计学意义，在辅助后6h明显升高（P＜0．05），在辅助后9h呈下降趋势 相比差异无显著性（P＞0．05）；血浆中心钠素水平在辅助后较辅助前明显下降（P＜0．05，0．01，0．01）。结论：左心辅助期间血管紧张素Ⅱ有短暂增加，心钠素持续降低。     

鹿角方治疗充血性心衰竭疗效观察

目的：进一步观察鹿角方治疗充血性心衰竭（CHF）的临床疗效及其作用机制。方法：将充血性心衰竭患60例随机分为鹿角方组40例、地高辛组20例,观察临床疗效、肾虚症状积分、NYHA心功能分级、Lee心衰评分、心率（HR）、心肌耗氧量（MOC）、心胸比例、超声心动图（射血分数（EF）、心输出量（CO）、舒张期室间隔厚度（IVST）,舒张期左室后壁厚度（PWT)、左室质量指数（LVMI）、放射免疫法测定血浆心钠素（ANF）、血管紧张素Ⅱ（Ang Ⅱ）等指标。结果：鹿角方组临床总有效率为90．0％,与地高辛组（90．0％）无显性差异（P＞0．05）。鹿角方组肾虚症状总积分显下降（P＜0．01）,而地高辛组疗后未见显改变（P＞0．05）。鹿角方组、地高辛组NYHA心功能分级均显改善（P＜0．01）。鹿角方组、地高辛组Lee心衰评分均显改善（P＜0．01）。鹿角方组、地高辛组HR、MOC均显下降（P＜0．01）。鹿角方组、地高辛组心胸比例均显改善（P＜0．01）。鹿角方组EF、CO、IVST、LVMI均显改善（P＜0．01）;地高辛组EF、CO显改善（P＜0．01）,而IVST、PWT、LVMI未见显下降（P＞0．05）。鹿角方组血浆ANF和AngⅡ水平均显下降（P＜0．01）;地高辛组仅血浆ANF水平显下降（P＜0．01）,而血浆AngⅡ水平上升无显性差异（P＞0．05）。结论：鹿角方既能增强心肌收缩功能,又能逆转左室肥厚,确有治疗CHF的临床疗效;该作用可能与改善循环内分泌（AngⅡ、ANF）紊乱有关。     

婴幼儿肺炎患者血浆内皮素、血管紧张素水平变化及意义

目的 探讨婴幼儿肺炎血浆内皮素（ET）和血管紧张素Ⅰ、Ⅱ（AngⅠ、AngⅡ)水平变化及其临床意义。方法 用放射免疫分析法检测轻型肺炎组患者（45例）,肺炎心衰组患者（9例）和对照组（15名）的血浆ET、AngⅠ,AngⅡ水平。结果 轻型肺炎组及肺炎心衰组血浆ET、AngⅠ,AngⅡ水平明显高于对照组（u=15.25,14.86,14.96,35.38,33.26,33.38,均P＜0．05或0．01）,肺炎心衰组明显高于轻型肺炎型（u=20.13,18.40,18.42均P＜0．05）。直线相关分析结果表明轻型肺炎组及肺炎心衰组ET与AngⅠ,AngⅡ,AngⅠ,AngⅡ均呈正相关（均P＜0．05或0．01）。结论 ET和血管紧张素相互作用共同参与了肺炎与肺炎心衰的发生和发展,其升高幅度与病情严重程度相平行。     

无创呼吸机在急性左心衰竭中的应用

目的评价双水平正压无创通气（BiPAP）救治急性左心衰竭的临床疗效。方法84例急性左心衰竭患者随机分为治疗组与对照组,治疗组在常规抗心衰治疗基础上联用BiPAP呼吸机面罩正压通气治疗,42例对照组为常规抗心衰治疗,观察治疗前、治疗后1h、6h的动脉血PaO2、SaO2、PaCO2,心率、呼吸、血压、24h后心功能改善情况。结果两组患者治疗前各指项比较差异无统计学意义（P〈0．05）。治疗组治疗后1h、6h的PaO2、SaO2、PaCO2,心率、呼吸、血压均较对照组明显改善（P〈0．05）,24h心功能改善,有效率治疗组较对照组明显增高（95．24％ vs 71．43％,P〈0．05）。结论无创双水平正压通气对急性左心衰的治疗有一定效果。     

120例心衰患者血浆BNP测定与心脏超声心功能检测对比

目的：探讨心衰患者不同程度心功能血浆 BNP水平差别。方法：选取心衰患者120例及同期健康体检者38例分别作为观察组和对照组。2组人群均抽取空腹肘静脉血测定BNP水平;观察组患者同时通过心脏超声检查,测定器LVEF 及LVEDD水平。结果：观察组患者BNP水平明显高于对照组,且心功能越差,BNP水平越高。组间差异有统计学意义（ P＜0．05）。不同水平LVEF和LVEDD的心衰患者BNP水平差异明显,LVEF水平越低,BNP水平越高;LVEDD越高,BNP水平越高。组间比较有统计学意义（ P＜0．05）。经过治疗,随着LVEF和LVEDD水平好转,患者BNP水平有明显下降,与治疗前相比差异有统计学意义（P＜0．05）。结论：心衰患者血浆BNP水平较健康人群明显升高,而且BNP水平与心脏超声检查对心功能的判定相一致,因此血浆BNP水平可以较好的反映心衰患者的心功能,作为临床评价心衰患者心功能的辅助指标。     

无创正压通气治疗应用于重度急性左心衰合并 II 型呼吸衰竭抢救的疗效观察

目的：探讨无创正压通气治疗应用于重度急性左心衰合并 II 型呼吸衰竭抢救的临床疗效。方法：收集2014年1月至2015年5月期间我院重度急性左心衰合并 II 型呼吸衰竭患者84例,根据随机数字法,将其分为对照组（持续正压通气）和观察组（无创正压通气）,每组各42例。比较治疗前后两组血压（SBP、DBP）、心率（HR）、呼吸频率,K ＋、Na ＋、血气分析（PaO2、PaCO2）及心功能指标（左室射血分数（LVEF）、每搏输出量（SV）、心肌作功指数（TEI））变化情况。结果：与对照组相比,观察组治疗后 SBP、DBP、HR、呼吸频率均明显降低,P ＜0．05;与对照组相比,观察组治疗后 K ＋、Na ＋水平均显著降低,PaO2明显增高,PaCO2显著降低,P ＜0．05;与对照组相比,观察组治疗后 LVEF、SV 均明显增高,TEI 显著降低,P ＜0．05。结论：无创正压通气治疗能够明显改善重度急性左心衰合并 II 型呼吸衰竭患者的缺氧症状及心功能,值得临床推广。     

阻断肾素—血管紧张素系统对糖尿病大鼠肾脏的保护作用

目的：探讨不同水平阻断肾素－血管紧张素系统对糖尿病（DM）大鼠肾脏保护作用及其机制。方法：SD大鼠随机分成正常对照组（NC组）、DM对照组（DM组）、ACEI（雷米普利）组和AT1RA（芦沙坦）组。观察平均颈动脉压（MAP）、体重、肾重、尿白蛋白（UAlb）、血AngⅡ、ET-1、NO及肾脏病理学。结果ACEI组和AT1RA组与DM组相比，体重明显增加，肾重明显降低（P＜0．01），UAlb明显降低（P＜0．01），MAP明显降低（P＜0．01）。治疗组的电镜下肾脏改变均较同期DM组病变轻。ACEI能使血浆AngⅡ降低，在第4、8周时甚至低于DM组，而AT1RA使血浆AngⅡ明显增高。两组血ET－1在第4、8周时均明显降低（P＜0．01，并能抑制血NO的早期升高及后期下降（P＜0．01）。结论：ACEI和AT1RA可能通过在不同水平阻断AngⅡ的作用而显降低血ET－1水平，部分延缓NO的下降，介导了DM时肾脏的保护作用。     

依那普利对急性心肌梗死患者左心功能及重塑过程的影响

目的：评价依那普利对急性心肌梗死（AMI）患左心功能及左心室重塑的影响。方法：对40例初次前壁心肌梗死的患，发病12小时内开始应用依那普利治疗，分别与急性心肌梗死急性期及恢复期进行二维超声心动图（2DE）检查。结果：恢复期依那普利组左心射血分数（LVEF）明显改善（P＜0．05），LVDd,PWd相应缩小（P＜0．05）。结论：不伴有明显血流动力学障碍的AMI患，早期应用依那普利可减轻左心室扩张，改善患左心功能。     

小儿肺炎心衰患者血浆降钙素基因相关肽和血管紧张素Ⅱ的含量变化及意义

目的 探讨降钙素基因相关肽（CGRP）和血管紧张素Ⅱ（ATⅡ）在婴幼儿肺炎心衰中的作用。方法 采用放射免疫法检测各组（肺炎并心衰组、肺炎组和对照组）血浆CGRP和ATⅡ水平,同时测定肺炎心衰时动脉血氧分压（PaO2)。结果 ①肺炎心衰患儿血浆CGRP水平低于对照组和普通肺炎组（P＜0．01）;肺炎心衰组ATⅡ高于对照组和肺炎组（P＜0．01）,且肺炎组亦高于对照组（P＜0．01）。②肺炎心衰患儿心 衰纠正后CGRP和ATⅡ趋于正常。③肺炎心衰患儿血浆CGRP与PaO2成正比（P＜0．05）,ATⅡ与PaO2成反比（P＜0．05）。结论 CGRP和ATⅡ在婴幼儿肺炎心衰发病中起重要作用。     

辛伐他汀对慢性心力衰竭患者心功能及肿瘤坏死因子-α的影响

目的：观察辛伐他汀对慢性心衰患者心功能及肿瘤坏死因子-α（TNF-α）的影响。方法：88例慢性心衰患者（NYHA分级Ⅱ～Ⅲ级）随机分成两组，治疗组（46例）和对照组（42例）。对照组给予常规强心、利尿、扩血管治疗，治疗组在此基础上加用辛伐他汀10mg／d。治疗前后检查心脏超声，评估心功能，测定TNF—α水平。结果：心功能：治疗组与对照组相比有明显改善（P〈0．01），左室射血分数有明显提高（P〈0．05）；TNF—α水平：治疗后治疗组TNF—α水平明显降低（P〈0．05），对照组前后比较无改变。结论：辛伐他汀能降低血浆细胞因子TNF—α水平，改善心脏功能。     

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.