老年高血压患者血脂异常与胰岛素抵抗的关系

目的 探讨老年高血压急血脂／裁脂蛋白异常与胰岛素抵抗的关系。方法 检测38例老年高血压患和24例正常对照血清胰岛素(INS)、血浆总胆固醇(TC)、甘油三酯(TG)、载脂蛋白A1(ApoA1)、载脂蛋白B100(ApoB100)、高密度脂蛋白胆固醇(HDL—C)水平，并计算胰岛素敏感性指数(ISI)。结果 与正常对照组(n=24)比较，高血压病组(n＝38)血清TC、TG、ApoB100、INS显增加(P＜0．05)，HDL—C、ApoA1、INS显降低(P＜0．05)，表明高血压患存在胰岛素抵抗(IR)，空腹胰岛素水平分别与TG、低密度脂蛋白胆固醇和ApoB呈正相关(P＜0．05)，与HDL—C、ApoA呈负相关(P＜0．05)，正常对照组上述指标间则无相关(P＞0．05)。结论 高血压病患血脂、载脂蛋白异常与胰岛素抵抗密切相关，提示高血压病患IR可能是影响脂代谢的重要因素之一。     

血清胆汁酸及载脂蛋白APO－A－I APOB与肝硬化Child分级关系的探讨

目的：探讨血清胆汁酸（TBA）及血清载脂蛋白APO－A－I，APOB与肝硬化Child分级之间的关系。方法：采用空腹静脉血清，对80例肝硬化组，56例肝病组及80例非肝病组住院病人检测TBA，载脂蛋白APO－A－I，APOB含量。结果肝硬化组及肝病组血清TBA含量明显高于非肝病组（P＜0．05）。且随肝硬化Child分级的增加而递增，Child B,C级TBA含量明显高于A级（P＜0．01）；肝硬化组血清载脂蛋白APO－A－I，APOB含量明显低于肝病组及非肝病组（P＜0．05）。随肝硬化Child分级增加而逐渐降低。Child B,C级载脂蛋白APO－A－I，APOB含量明显低于A组（P＜0．01）。结论：血清TBA，载脂蛋白APO－A－I，APOB水平是一项反映慢性肝损害的敏感指标，对肝硬化的诊断，分级有重要意义。     

高血压对老年冠心病患者左室重构和冠脉病变的影响

目的：探讨高血压对老年冠心病患者左室重构和冠状动脉（冠脉）病变的影响。方法：将130例冠心病患者（其中91例合并高血压病）冠脉造影和超声心动图资料进行对比分析，据年龄、有无高血压分为4组：A组为非老年（＜60岁）无高血压病29例；B组为非老年合并高血压病33例；C组为老年（≥60岁）无高血压病10例；D组为老年合并高血压病58例，观察年龄、高血压病、左室重构指标、冠脉狭窄程度间的关系。结果：①D组的左室重量指数（LVMI）高于A组（P＜0．05）；②B组的相对室壁厚度比（RWT）等左室重构指标高于A组（P＜0．05）；③D组冠脉狭窄分级、多支病变发生率高于B组（P＜0．05）；④C组与D组间LVMI、冠脉狭窄程度等无差别（P＞0．05）。结论：①老年、高血压病并存的冠心病患者左室重构明显，冠脉狭窄重、范围广；②在非老年冠心病患者中，左室重构与高血压有关；③在老年冠心病患者，高血压似乎未加重左室重构和冠脉狭窄程度。     

汉族男性吸烟对血清胰岛素和瘦素水平及脂质代谢的影响

目的 探讨男性吸烟对血清胰岛素（INS）、瘦素（LP）水平及脂质代谢的影响。方法 将78例汉族男性按吸烟（A组）、曾经吸烟（B组）和不吸烟（C组）分为3组,每组各26例。各组间年龄、体重指数（BMI）、腰臀围比值（WHR）、平均动脉压（MBP）、体力活动强度等方面具可比性。测定其空腹血清胰岛素（FINS）、LP、空腹血糖（FPG）、血脂（Tch,TG,LDL－C,HDL－C）浓度等指标。并以FPG与FINS乘积倒数的自然对数作为胰岛素敏感性指数（ISI）来评估胰岛素抵抗（IR）的程度。结果 （1）A组和B组的FPG、FINS、LP水平显著高于C组;而ISI则显著低于C组;（2）B组的FINS、LP水平显著低于A组（P＜0．05）;（3）A组和B组的Tch,TG,LDl-C显著高于C组（均P＜0．05）;B组和C组的HDL－C显著高于A组（P＜0．05）;（4）FPG、FINS、LP、Tch、TG、LDL－C值与吸烟量呈显著性正相关（P＜0．01－0．001）,ISI与吸烟量呈显著性负相关（P＜0．005）。结论 长期吸烟可引起FINS、LP敏感性下降,导致胰岛素抵抗（IR）及瘦素抵抗（LR）,并引起脂质代谢紊乱,戒烟后有利于INS、LP敏感性恢复,从而减轻IR和LR。并部分改善脂质代谢紊乱。     

老年糖尿病患者餐后脂代谢紊乱与胰岛素敏感性的相关性研究

目的探讨老年糖尿病患者餐后脂代谢紊乱与胰岛素敏感性的相关性。方法测定老年糖尿病患者胰岛素敏感指数（IAI）和胰岛素抵抗指数（IR）等两项指标作为评价胰岛素敏感性指标，并与空腹及餐后2，4，6，8h时段的总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白A1（APOA1）及载脂蛋白B（APOB）水平进行相关分析，探讨它们之间的关系。结果除餐后2h胰岛素水平外，老年糖尿病组空腹及餐后4，6，8h时段胰岛素水平明显高于对照组（P〈0．05或〈0．01）；老年糖尿病组IR显著高于对照组（P=0．016）。老年糖尿病组及对照组IAI与IR呈显著负相关（r=0．812，-0．985），且老年糖尿病组IAI与空腹、餐后4、6及8h的TG呈显著负相关（r=-0．433，-0．429，-0．518，-0．451），而IR与体重指数（BMI）、腰臀比值（WHR）、餐后4h及餐后6h的TG呈显著正相关（t=0．659，0．554，0．455，0．498）。多元逐步回归分析，老年糖尿病组，去除年龄、BMI及WHR因素，以IAI、IR为应变量，空腹及餐后2、4、6和8h等5个时点的血脂各项指标为自变量，其回归方程为：IAI=-0．609TG（6h）-0．385（P=0．031），IR=0．807TG（6h）＋0.584（P=0．008）。结论老年糖尿病患者具有明显空腹及餐后高胰岛素血症及明显的胰岛素抵抗；老年糖尿病患者空腹及餐后6h的TG水平与IAI和IR显著相关，提示胰岛素抵抗是老年糖尿病患者餐后血脂异常的发病机制之一。     

柴芪汤对代谢综合征大鼠糖脂代谢及胰岛素抵抗的影响

目的：观察不同剂量柴芪汤对代谢综合征模型大鼠糖脂代谢及胰岛素抵抗（ IR）的影响。方法56只大鼠分为正常组16只,模型组16只,柴芪汤低、中、高剂量组各8只。采用高脂高糖高盐饲料持续喂养方式复制大鼠代谢综合征模型。柴芪汤各组从第9周开始分别灌胃给予不同剂量：低剂量组为1．90 g／（kg· d）,中剂量组5．71 g／（kg· d）,高剂量组17．13 g／（kg· d）。实验第8周末,模型组与正常组随机选取8只大鼠采血,实验第12周末,各组大鼠均行腹主动脉采血。用生化法检测血脂（ TG、TC、HDL-C、LDL-C）、空腹血糖（ FBG）,放免法检测空腹胰岛素（ FINS）,公式计算胰岛素抵抗指数（ IRI）。结果治疗4周后,与模型组比较,柴芪汤低剂量组FINS、TG明显下降（P＜0．05）,HDL-C明显升高（P＜0．05）;高、中剂量组FINS、TG、TC、IRI明显下降（P＜0.05）, HDL-C明显升高（P＜0．05）。结论柴芪汤可改善代谢综合征大鼠糖脂代谢,并能减轻IR,以中、高剂量效果明显。     

老年高血压病患者血脂及其脂蛋白亚组分胆固醇含量的检测分析

目的观察老年高血压病患者血脂的变化。方法分别检测老年高血压病患者、中年高血压病患者及正常老年人的血脂及脂蛋白亚组分胆固醇含量,比较三者之间的差异。结果老年高血压病组的LDL-c、TC／HDL－c均明显高于中年高血压病组及老年正常对照组（P＜0.05或0.01）,HDL－c明显低于中年高血压病组及正常对照组（P＜0．05或0．01）．TG明显高于老年正常对照组（P＜0.01）,而TC无明显差异。结论老年高血压患者存在着明显的脂质代谢异常。     

运动对胰岛素抵抗大鼠脂代谢紊乱干预效应的研究

目的探讨运动对高脂膳食诱导IR大鼠脂代谢紊乱的干预效应。方法特殊高脂膳食喂养4周，建立IR．动物模型。游泳运动前后以钳夹技术观察IR．大鼠胰岛素敏感性及大鼠血浆、红细胞内脂代谢相关指标变化。结果运动后IR大鼠葡萄糖输注率（GIR．）显著高于非运动IR．大鼠（P〈0．05），正常大鼠运动前后GIR水平无明显变化；坚持4周游泳运动后A组大鼠血浆TG、TC及FFA水平明显降低（P分别〈0．05，〈0．05及〈0．01），HDL—C及LDL与运动前比较有增高及降低趋势，但两者比较无统计学意义；坚持4周游泳运动后A组大鼠红细胞内TC／PL以及磷脂分级SM／PC分子比值运动前后差异无显著性。结论运动改善IR大鼠胰岛素敏感性及脂代谢紊乱。     

氯沙坦对高血压左室肥厚的影响

目的 探讨氯沙坦对高血压左室肥厚（LVH）的逆转向左室收缩和舒张功能的影响。方法 68例高血压LVH患者给予口服氯沙坦（50－100）mg/d、部分病例加用氢氯噻嗪12．5－25mg/d）共20周。观测治疗前后心率（HR）、坐位收缩压（SBp)、舒张压（DBp)、超声心动图左室内径（LAD）、舒张末期室内间隔厚度（IVST）、左室后壁厚度（PWT）、左室舒张末期内径（LVDd)及左室短轴缩短率（LVFS）、左室射血分数（LVEF）、二尖瓣舒张早期和舒张晚期血流峰速度比（E／A）及左室重量指数（LVMI）的变化。结果 氯沙坦治疗20周后，患者SBp,DBp明显下降（P＜0．0001）；IVST、PWT、LAD、LVMI明显减小（P＜0．001）；LVDd有增大趋势，但差异不明显（P＞0．05）；心率及LVEF、LVFS无明显变化（P＞0．05），而E／A明显上升（P＜0．01）。结论（1）氯沙坦可以显著降低高血压LVH患者的血压、逆转LVH；（2）氯沙坦可以明显改善左室舒张功能，但对心率及左室收缩功能无明显影响；（3）氯沙坦副作用小、耐受性好。     

妊娠高血压疾病与胰岛素抵抗及脂代谢异常的关系

目的研究妊娠高血压疾病（PIH）与胰岛素抵抗（IR）及脂代谢异常的关系。方法以38例妊高症患者为研究对象,并以同期正常孕妇32例为对照组。检测两组空腹血糖（FBG）、胰岛素（FINS）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、载脂蛋白A-1（apoA-1）、载脂蛋白B（apoB）的含量,用HOMA指数做胰岛素抵抗指标：HOMA=空腹血糖×空腹胰岛素/22.5。结果妊娠期高血压疾病组与正常妊娠组相比,其HOMA指数,TG,LDL,apoB显著升高。HDL,apoA-1显著降低。HOMA指数与脂代谢各指标间具有显著相关性。结论妊娠高血压疾病患者存在胰岛素抵抗与脂代谢异常,并且两者具有相关性。     

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.