阿仑膦酸钠联合钙剂治疗妇女绝经后骨质疏松症的效果观察

目的 探讨阿仑膦酸钠联合钙剂治疗绝经后骨质疏松症的效果.方法 60例绝经后骨质疏松症患者分成治疗组及对照组,治疗组(31例)予口服阿仑膦酸钠胶囊联合钙尔奇-D片治疗,对照组(29例)予口服钙尔奇-D片,连续用药6个月;分别于治疗前后对患者的腰背疼痛进行评价,分别测定腰椎、股骨颈及Wards三角区骨密度(BMD),血钙、血磷、血清骨钙素(BGP)、血清骨原性碱性磷酸酶(BAP)和尿Ⅰ型胶原羟基端交联肽(NTx).结果 治疗后,与对照组比较,治疗组腰背疼痛明显缓解,腰椎L2～4、股骨颈及Wards三角区部位BMD均有不通程度的上升,BAP、BGP和尿NTx有所下降,差异均有统计学意义(均P＜0.05).结论 阿仑膦酸钠联合钙剂对可以有效增加绝经后骨质疏松症妇女的BMD,缓解骨痛,降低骨转化,且耐受性好.     

龟鹿二仙膏联合阿仑膦酸钠片治疗绝经妇女骨质疏松症的临床研究

目的观察龟鹿二仙膏联合阿仑膦酸钠片治疗绝经妇女骨质疏松症的临床疗效,并探讨其作用机制。方法选取76例绝经妇女骨质疏松症患者,随机分为对照组和观察组,每组40例。对照组采用阿仑膦酸钠片口服治疗,观察组在对照组治疗基础上予以龟鹿二仙膏口服治疗。比较2组治疗前后腰椎及股骨近端BMD、血清IGF-1和TNF-α水平变化及临床疗效。结果治疗前,2组患者腰椎及股骨近端BMD、血清IGF-1和TNF-α水平比较,差异无统计学意义(P0.05);治疗后,2组患者腰椎及股骨近端BMD均较治疗前明显升高,且观察组改善程度显著优于对照组(P0.05);治疗后,2组患者血清IGF-1均较治疗前明显升高,TNF-α均较治疗前明显降低,且观察组改善程度显著优于对照组(P0.05);治疗后,观察组临床治疗总有效率为92.11%,显著高于对照组的68.42%(P0.05)。结论应用龟鹿二仙膏联合阿仑膦酸钠片治疗绝经妇女骨质疏松症可显著升高腰椎及股骨近端BMD,改善血清IGF-1及TNF-α水平,提高临床疗效,值得推广应用。     

阿仑膦酸钠肠溶片预防和治疗绝经后妇女骨质疏松症的疗效及安全性分析

目的 评价阿仑膦酸钠肠溶片治疗绝经后妇女骨质疏松症的临床疗效及安全性.方法 选择我院收治的绝经后骨质疏松症妇女84例,随机分为3组,每组28例,A组给予阿仑膦酸钠肠溶片10 mg/d,B组给予阿仑膦酸钠片10 mg/d,C组给予阿仑膦酸钠肠溶片70 mg/周.3组患者在此基础上加服钙尔奇D600,疗程均为6个月.观察3组患者治疗前后骨密度、血骨钙素(BGP)、C端交联多肽(CTX)水平及新骨折发生情况,同时观察不良反应.结果 3组患者疗效(骨密度改善情况)间差异无统计学意义(P＝0.43);治疗后3组患者的BGP、CTX水平间差异均无统计学意义(P＞0.05);3组患者消化系统不良反应发生率间差异无统计学意义(P＞0.05).治疗期间3组均无新骨折发生,无严重不良事件发生.结论 阿仑膦酸钠肠溶片治疗绝经后妇女骨质疏松症临床疗效与阿仑膦酸钠片无差异,消化系统不良反应发生率间亦无差异.     

阿伦膦酸钠对绝经后妇女骨折的预防作用

目的观察阿伦膦酸钠（福善美）对绝经后妇女骨质疏松症骨折的预防作用。方法绝经后骨质疏松妇女105例,随机分为2组：治疗组53例,对照组52例。2组均应用碳酸钙（钙尔奇D）600mg口服,每晚一次,α-D3骨化醇0．25μg口服,每日2次。治疗组加福善美70mg,每周1次口服。各组用药后每年检测腰椎及髂部骨密度（bonemineraldensity,BMD）、骨钙素（boneglaprotein,BGP）、Ⅰ型胶原氨基末端（cross-linked N-telopeptideoftype collagen,NTx）及随访骨折事件发生率。结果福善美治疗组治疗3年,全身BMD均有不同程度提高。腰椎BMD上升16．7％,股骨颈BMD值上升24．2％,与治疗前相比有统计学意义（P〈0．05）。对照组骨密度稍下降,但无统计学意义（P〉0．05）,两组相比有统计学意义（P〈0．01）;治疗组仅发生2例骨折事件,对照组发生7例骨折事件,两组相比有统计学意义（P〈0．01）;两纽治疗均无明显不良反应。结论福善美治疗绝经后妇女骨质疏松症疗效肯定,对骨折有显著预防作用．长期治疗无明显不良反应。     

阿仑膦酸钠防治绝经后骨质疏松的疗效

目的观察国产阿仑膦酸钠防治绝经后骨质疏松症的疗效。方法56例50～74岁骨量减少或骨质疏松的绝经后妇女随机分为两组(每组28人),每日给予阿仑膦酸钠10mg/d或安慰剂,两组均加服碳酸钙片和维生素D,治疗6个月。试验前后用双能X线吸收法检测腰椎和髋部的骨矿密度(bonemineraldensity,BMD),同时检测骨转换的生化指标。结果与治疗前相比,治疗组腰椎BMD平均增加5%(P<0.01),对照组各部位的BMD均下降(P<0.05);治疗组骨吸收指标和骨形成指标均降低,其中NTx下降最明显,近75.7%(P<0.001),而对照组却无显著性变化。结论国产阿仑膦酸钠能降低绝经后妇女的骨转换,增加骨量。     

左归丸联合阿仑膦酸钠片治疗绝经后骨质疏松症的临床研究

目的探讨左归丸联合阿仑膦酸钠片治疗绝经后骨质疏松症的临床疗效及作用机制。方法选取2016年8月—2018年10月本院妇科收治的绝经后骨质疏松症患者102例,按照随机数字表法分为观察组和对照组,每组51例。对照组患者予以阿仑膦酸钠片口服治疗,观察组患者在对照组治疗基础上予以左归丸口服。比较2组患者治疗前后腰椎及股骨近端骨密度(BMD)水平变化,比较2组患者治疗前后血清抗酒石酸酸性磷酸酶-5b(TRACP-5b)及组织蛋白酶K(CTSK)水平变化,比较2组患者临床疗效。结果治疗后,2组患者腰椎及股骨近端BMD水平均较治疗前明显升高,且观察组显著高于对照组(P0.05);2组患者血清TRACP-5b及CTSK水平均较治疗前明显下降,且观察组显著低于对照组(P0.05);观察组患者临床治疗总有效率为92.16%,显著高于对照组的70.59%(P0.05)。结论应用左归丸联合阿仑膦酸钠片治疗绝经后骨质疏松症患者可显著升高腰椎及股骨近端BMD水平,提高临床疗效,其治疗机制可能与降低血清TRACP-5b及CTSK水平有关。     

甲状旁腺素、降钙素和阿仑膦酸钠治疗绝经后妇女骨质疏松症的疗效比较

目的：比较甲状旁腺素、鲑降钙素、阿仑膦酸钠对绝经后妇女骨质疏松症的疗效.方法：对110位确诊患有骨质疏松症的绝经后妇女进行随机分组,分别接受甲状旁腺素20 μg/d皮下注射（36例）或鲑降钙素200 IU/d鼻内给药（36例）或阿仑膦酸钠70 mg/周口服（38例）,共24周.测定主要指标为从基线到终点腰椎骨密度（BMD）变化量;次要指标为从基线到终点全髋BMD变化量及血清骨钙素含量的变化.对结果进行分析比较.结果：共100例患者完成治疗,10例患者中途退出研究.甲状旁腺素组（n=36）在增加患有骨质疏松症的绝经后中国妇女腰椎BMD及血清骨钙素含量方面明显优于降钙素组（n=31）及阿仑膦酸钠组（n=33）,在改变全髋BMD方面与降钙素组及阿仑膦酸钠组无明显差别.结论：与降钙素及阿仑膦酸钠相比,甲状旁腺素在促进患有骨质疏松症的绝经后妇女的骨形成方面的效果更佳.     

阿仑膦酸盐、唑来膦酸治疗原发性骨质疏松症的临床对比研究

目的:探讨阿仑膦酸盐、唑来膦酸治疗原发性骨质疏松症的临床效果。方法:选取2018年1-12月在本院接受治疗的原发性骨质疏松症患者100例,采用随机数字表法将患者分为阿仑膦酸盐组和唑来膦酸组,每组50例。阿仑膦酸盐组予以口服阿仑膦酸钠片治疗,唑来膦酸组予以静脉滴注唑来膦酸注射液治疗。比较两组患者治疗前后腰椎和股骨颈骨密度(BMD)、疼痛程度以及生化指标,并比较两组患者治疗期间的不良反应和新发骨折发生情况。结果:治疗6个月后,唑来膦酸组患者腰椎BMD、股骨颈BMD均高于阿仑膦酸盐组,差异均有统计学意义(P0.05),且唑来膦酸组患者VAS评分低于阿仑膦酸盐组,差异有统计学意义(P0.05)。治疗12个月后,唑来膦酸组患者腰椎BMD、股骨颈BMD均高于阿仑膦酸盐组,差异均有统计学意义(P0.05)。治疗6个月后,唑来膦酸组的碱性磷酸酶(ALP)为(59.14±4.53)U/L,低于阿仑膦酸盐组的(64.61±4.82)U/L,差异有统计学意义(P0.05)。阿仑膦酸盐组患者新发骨折发生率为18.0%,高于唑来膦酸组的4.0%,差异有统计学意义(P0.05)。结论:唑来膦酸治疗原发性骨质疏松症效果较阿仑膦酸盐显著,可有效提高患者骨密度,减轻患者疼痛程度。     

阿仑膦酸钠联合骨化三醇治疗绝经后妇女骨质疏松症的疗效观察

目的探讨阿仑膦酸钠联合骨化三醇治疗绝经后妇女骨质疏松症的临床疗效。方法将32例绝经后妇女骨质疏松症患者随机分为A及B组,各16例。A组口服阿仑膦酸钠片和骨化三醇片,B组仅服骨化三醇片。观察两组治疗前及治疗6个月后疼痛改善、腰椎及股骨颈的骨密度（BMD）、血钙和血磷等生化指标的变化。结果 A组治疗后疼痛评分较治疗前明显改善（〈0.05）,B组无明显变化（〉0.05）。两组治疗后BMD均有明显上升,但A组明显大于B组（〈0.01）。两组治疗前后血钙及血磷均在正常范围。结论阿仑膦酸钠联合骨化三醇治疗绝经后妇女骨质疏松症疗效确切,明显优于单用骨化三醇,值得推广应用。     

利塞膦酸钠胶囊治疗绝经后骨质疏松症

目的:观察利塞膦酸钠胶囊治疗绝经后骨质疏松症的有效性及安全性. 方法:采用随机、双盲、安慰剂平行对照方法,入选患者随机分入试验组和对照组,试验组晨起口服利塞膦酸钠胶囊,对照组口服安慰剂,2组均在晚间口服维生素D3/碳酸钙(凯思立D片),疗程为12个月.治疗前、治疗6个月、12个月时,测量腰椎和髋部骨密度、摄胸腰椎侧位X线片,并观察心电图、血常规、尿常规、肝肾功能等安全性指标. 结果:共入组42例,在治疗6个月和12个月时,试验组腰椎骨密度的变化与对照组比较均有统计学意义,但2组髋部骨密度之间的变化无统计学意义.观察期间所有患者均无脆性骨折发生,安全性观察指标无异常变化. 结论:利塞膦酸钠胶囊治疗绝经后骨质疏松症是安全有效的,用药6个月内即能明显增加患者腰椎骨密度.     

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.