背景 全科医学专业研究生导师肩负着培养未来全科医学专业人才的重任，全科医学专业研究生导师自身的医患沟通能力对全科医学事业发展至关重要。目的 探讨全科医学专业硕士生导师在门诊接诊过程中的医患沟通能力现状。方法 2022 年 4—6 月，采用整群抽样法，选择来自首都医科大学的全科医学专业硕士生导师 75 例作为测评对象。测评人员作为同行者参与门诊患者就诊全过程，按照医患沟通技能评价量表（SEGUE）对全科医学专业硕士生导师在门诊接诊过程中的医患沟通能力进行测评。将全科医学专业硕士生导师 SEGUE 总得分及各维度得分与前期接受测评的三级医院专家门诊医生和社区卫生服务中心全科医生的测评结果进行比较，分析不同性别、任职方式的全科医学专业硕士生导师 SEGUE 总得分及各维度得分的差异性，比较全科医学专业硕士生导师与美国通科医生的SEGUE 总得分。结果 75 例全科医学专业硕士生导师 SEGUE 总得分为 12~24 分，平均总得分为（17.8±2.6）分；在准备、信息收集、信息给予、理解患者和结束问诊维度上的平均得分分别为（3.9±0.9）、（6.5±1.7）、（3.1±1.1）、（2.6±0.9）、（1.7±0.5）分。全科医学专业硕士生导师、社区卫生服务中心全科医生在 SEGUE 准备和结束问诊维度上的得分高于三级医院专家门诊医生（P<0.05）；就职于一级医院的全科医学专业硕士生导师 SEGUE 总得分及在准备维度上的得分高于就职于二级医院的全科医学专业硕士生导师（P<0.05），就职于一级医院的全科医学专业硕士生导师 SEGUE 总得分及在准备、信息收集维度上的得分高于就职于三级医院的全科医学专业硕士生导师（P<0.05）；全科医学专业硕士生导师 SEGUE 总得分低于美国通科医生（P<0.05）。结论 全科医学专业硕士生导师的临床沟通能力仍有较大提升空间，其临床沟通能力低于美国通科医生。全科医学院（系）的教学管理部门应重视对全科医学专业研究生导师医患沟通能力的培养，并让其通过言传身教提高全科医学专业研究生的人文医学执业技能水平。

目的 探讨高敏C反应蛋白(hs-CRP)/前白蛋白比值对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后无复流的影响.方法 回顾性选取2010 年1 月至2013 年1 月在首都医科大学附属北京安贞医院接受治疗的 902 例 STEMI 患者,根据术中有无无复流现象将患者分为无复流组(184 例)和复流组(718 例).收集患者的临床资料,分析各指标与无复流的相关性.结果 无复流组PCI术前心率、随机血糖、hs-CRP、hs-CRP/前白蛋白比值和中性粒细胞计数以及心功能Killip分级>1 级、术中主动脉内球囊反搏(IABP)、血栓抽吸术比例均高于复流组,PCI术前前白蛋白水平低于、发病到PCI时间短于复流组,差异均有统计学意义(均P<0.05).多因素Logistic回归分析结果显示,糖尿病、心率、随机血糖、hs-CRP/前白蛋白比值(比值比=1.012,95%置信区间:1.004～1.019)、中性粒细胞计数、心功能Killip分级、术中IABP和血栓抽吸术是STEMI患者PCI术后无复流的独立影响因素(均P<0.05).结论 hs-CRP/前白蛋白比值是STEMI患者PCI术后无复流的独立影响因素.

Reactivation of fetal hemoglobin by editing the B-cell lymphoma/leukemia 11A (BCL11A) erythroid enhancer is an effective gene therapy for β-thalassemia. Using the CRISPR/Cas9 system, fetal γ-globin expression can be robustly reactivated to mitigate the clinical course of β-thalassemia. In our study, we found that the transfection efficiencies of CD34+ hematopoietic stem/progenitor cells (HSPCs) were significantly and negatively correlated with the length of plasmids and greatly affected by the linearization of plasmids. Furthermore, the transgene expression of minicircles (MC) without plasmid backbone sequences was better both in vitro and in vivo compared with conventional plasmids. Thus, MC DNA was used to deliver the cassette of Staphylococcus aureus Cas9 (SaCas9) into HSPCs, and a single-guide RNA targeting the erythroid enhancer region of BCL11A was selected. After electroporation with MC DNA, an evident efficiency of gene editing and reactivation of γ-globin expression in erythroblasts derived from unsorted HSPCs was acquired. No significant off-target effects were found by deep sequencing. Furthermore, fragments derived from lentiviral vectors, but not MC DNA, were highly enriched in promoter, exon, intron, distal-intergenic, and cancer-associated genes, indicating that MC DNA provided a relatively safe and efficient vector for delivering transgenes. The developed MC DNA vector provided a potential approach for the delivery of SaCas9 cassette and the reactivation of γ-globin expression for ameliorating syndromes of β-thalassemia.

目的 调查北京部分社区卫生服务中心老年糖尿病患者处方中多重用药(≥5种/d)发生率,分析多重用药可能原因及降糖药物使用合理性.方法 收集2019年12月1—12日在首都医科大学附属北京安贞医院4家医联体社区卫生服务中心就诊的60岁及以上老年患者的处方共1200例,录入处方信息进行描述性分析.结果 1200例处方中309例为糖尿病患者处方.91例(29.4％)患者存在多重用药,合并疾病种类多、降糖药物使用种类多是影响多重用药的可能原因.降糖药物中单药治疗占57.9％(179/309),单药治疗中二甲双胍使用率最高[30.7％(55/179)].新型降糖药物钠-葡萄糖共转运蛋白2抑制剂、胰高血糖素样肽1激动剂、二肽基肽酶4抑制剂在4家社区卫生服务中心较少应用.不同种类降糖药物之间的联合未见不合理应用情况.结论 首都医科大学附属北京安贞医院4家医联体卫生服务中心老年糖尿病患者多重用药比例较高,糖尿病合并多种其他疾病和使用降糖药物种类多是可能的影响因素.糖尿病治疗以传统降糖药物为主,药物应用合理,但是具有心、肾器官保护作用的新型降糖药物应用较少.

Gremlin1 belongs to the superfamily members of transforming growth factor (TGF)-β1, playing a profibrotic role in chronic kidney diseases (CKD) and the transition from the late stage of acute kidney injury (AKI) to CKD, but the effect it plays in the early stage of AKI is unclear. This study aimed to investigate the role of Gremlin1on apoptosis in renal tubular epithelial cells under ischemia–reperfusion (I/R) induction. We detected Gremlin1 and TGF-β1 expression in the kidneys of mice undergoing renal ischemia–reperfusion injury bilaterally. We induced apoptosis through depletion and reperfusion of oxygen and serum in human kidney tubular epithelial cells (HKCs), mimicking I/R injury in vivo, and detected the role and pathways of Gremlin1 and TGF-β1on HKCs injury. Mice undergoing bilateral I/R surgery presented AKI with a significant increase in serum creatinine, obvious renal tubular injuries, and increased macrophage cell and T-cell infiltration in interstitial areas. Gremlin1 expression was significantly increased along with TGF-β1 in the kidneys of AKI mice compared to sham mice. Exogenous Gremlin1 inhibited I/R-induced caspase3 expression in HKCs, which was blocked by a VEGFR2 kinase inhibitor III (SU5416). TGF-β1 also inhibited I/R-induced cell apoptosis in HKCs but had no synergic effect with Gremlin1. The TGF-β1’s inhibitory effect could be blocked by the TGF-β1 type I receptor (activin receptor-like kinase 5, and ALK5)-specific inhibitor SB431542. Gremlin1 and TGF- β1 protect kidney tubular epithelial cells from ischemia–reperfusion-induced apoptosis through VEGFR2 and Smad2 signaling pathways.

β-Thalassemia is an autosomal recessive genetic disease caused by defects in the production of adult hemoglobin (HbA, α2β2), which leads to an imbalance between α- and non-α-globin chains. Reactivation of γ-globin expression is an effective strategy to treat β-thalassemia patients. Previously, it was demonstrated that hemoglobin subunit beta pseudogene 1 (HBBP1) is associated with elevated fetal hemoglobin (HbF, α2γ2) in β-thalassemia patients. However, the mechanism underlying HBBP1-mediated HbF production is unknown. In this study, using bioinformatics analysis, we found that HBBP1 is involved in γ-globin production, and then preliminarily confirmed this finding in K562 cells. When HBBP1 was overexpressed, γ-globin expression was increased at the transcript and protein levels in HUDEP-2 cells. Next, we found that ETS transcription factor ELK1 (ELK1) binds to the HBBP1 proximal promoter and significantly promotes its activity. Moreover, the synthesis of γ-globin was enhanced when ELK1 was overexpressed in HUDEP-2 cells. Surprisingly, ELK1 also directly bound to and activated the γ-globin proximal promoter. Furthermore, we found that HBBP1 and ELK1 can interact with each other in HUDEP-2 cells. Collectively, these findings suggest that HBBP1 can induce γ-globin by enhancing ELK1 expression, providing some clues for γ-globin reactivation in β-thalassemia.

Objective:To investigate the incidence of acute kidney injury (AKI) following cardiac surgery and related risk factors in 4 878 patients.Methods:The information from patients who underwent cardiac surgery through March 2015 to October 2015 was collected retrospectively from the electronic database of Beijing Anzhen Hospital. A total of 4 878 patients were divided into AKI group and non-AKI group according to whether AKI occurred within 7 days after cardiac surgery. The incidence of AKI was calculated, and the AKI incidence in different types of cardiac surgeries were compared. Clinical data such as baseline clinical information, operation information, comorbidity, hospital stay time, life ability score in discharge from the hospital, and so on, were compared between AKI group and the non-AKI group using univariate analysis. Risk factors for AKI following cardiac surgery were analyzed using the binary multivariate logistic regression.Results:A total of 933 patients suffered from AKI (19.1%) following cardiac surgery. The time of stay in the hospital was longer in AKI group than that in the non-AKI group [(14.4±8.9) vs (13.7±7.7) d, P<0.05)]. The incidence of AKI in different types of cardiac surgeries varied significantly ( P<0.001). The logistic regression analysis showed that male, diabetes, hypertension, the elevated basic serum creatinine, cardiac dysfunction (NYHA grade≥Ⅲ), cardiopulmonary bypass, a combination of operations≥3, the rethoracotomy exploration and hemostasia, and using an invasive ventilator for over 96 hours were the independent risk factors for the AKI following cardiac surgery (all P<0.05), and the odds ratio (95% confidence interval) were 1.81(1.46-2.24), 1.29(1.03-1.62), 5.85(4.73-7.22), 1.81(1.36-2.40), 4.49(3.60-5.60), 1.84(1.49-2.27), 23.24(18.25-29.59), 2.34(1.45-3.77) and 1.94(1.09-3.43) respectively. Conclusions:The incidence of AKI after cardiac surgery in Beijing Anzhen Hospital is 19.1%. AKI following cardiac surgery prolongs the time of stay in the hospital. Independent risk factors for AKI following cardiac surgery are multiple, and one of the most critical factors is a combination of operations≥3.

目的 研究术前糖化血清白蛋白(GA)水平对冠状动脉旁路移植术(CABG)患者术后急性肾损伤(AKI)发生风险的影响.方法 回顾性分析2015年3-10月入住首都医科大学附属北京安贞医院心脏外科2 644例行CABG患者的病历资料.根据患者术后7d内是否发生AKI分为AKI组及非AKI组.采用单因素及多因素Logistic回归分析CABG患者术后发生AKI的危险因素.结果 行CABG的2 644例患者中548例术后发生AKI,总AKI发生率为20.7％.多因素Logistic回归分析结果显示,GA≥21％、术前血肌酐增高、合并高血压、纽约心脏病协会心功能分级≥Ⅲ级、体外循环、联合多项手术为CABG手术后发生AKI的独立危险因素(比值比=1.778、1.748、11.713、14.252、2.359、750.660,95％置信区间:1.171～2.701、1.035～2.952、7.823～ 17.536、9.654 ～21.040、1.620～3.436、342.546～1 645.006,均P＜0.05),而女性是保护性因素(比值比=0.544,95％置信区间:0.386～0.768,P=0.001).结论 本研究收集的资料中CABG患者术后AKI发生率为20.7％,术前GA≥21％是术后AKI发生的独立危险因素.

目的 研究糖尿病患者冠状动脉旁路移植术(CABG)前糖化血清白蛋白(GA)水平对术后急性肾损伤(AKI)及康复的影响.方法 回顾性分析2015年3～10月于北京安贞医院心外科行CABG的糖尿病患者病历资料.Logistic回归分析CABG后AKI的危险因素,比较不同GA水平患者住院时间及出院时的生活能力评分.结果 646 例患者中 135 例(20.9％)发生 CABG 后 AKI.GA≥21％、年龄≥65岁、高血压、NYHA心功能分级≥Ⅲ级、体外循环、联合手术≥3项为CABG后AKI的独立危险因素.GA<21％及GA<17％组住院时间较GA≥21％及GA≥17％组缩短(P<0.01),出院时的生活能力评分提高(P<0.05).结论 糖尿病患者CABG后AKI发生率20.9％.GA<21％可减少CABG后AKI风险,有利于早期康复.

目的 分析社区老年高脂血症患者降脂药物处方情况,促进老年患者降脂药物合理应用.方法 收集北京安贞医院医联体4家社区卫生服务中心2019年12月1～12日门诊就诊的老年患者处方各300张,分析不同社区不同种类降脂药物应用情况、降脂药物使用情况、联合用药情况.结果 4家社区卫生服务中心1200份处方中258份为包含降脂药物的处方,其中大屯社区、金盏社区、潞城社区、甘棠社区中含降脂的药物处方分别有112例、66例、27例、53例.4家社区中应用最多的降脂药物均为他汀类,其次为胆固醇吸收抑制剂,其余种类的降脂药应用较少.降脂药物的联合应用处方共13例,两种他汀药物联合应用3例,联合应用种类共有5种,其中他汀类与胆固醇吸收抑制剂(依折麦布)的联合应用最多.不合理的降脂药物与非降脂药物联合用药情况中有1例辛伐他汀与红霉素联合应用,5例辛伐他汀与氨氯地平联合应用.结论 4家社区卫生服务中心老年患者降脂药物总体应用合理,存在少数潜在不良反应风险的联合用药处方,临床需注意监测和随访.

发表论文是科研工作的重要一环,但医学研究生普遍感觉论文写作困难.本文对多年审稿中发现的一些有代表性的问题进行总结分析,论述实施真实而有意义的研究、获得并提供真实可靠数据、认真撰写及反复修改的重要性及方法,以帮助医学研究生提高中文论文的写作能力.

Objective To establish the mouse model of acute kidney injury(AKI) on the basis of chronic kidney disease through a two-step lateral lumbar surgery method.Methods Male C57BL/6 mice with age of 8-12 weeks old were used in this study.Three mice were normal control.Sixteen mice had unilateral ureteral obstruction(UUO) with left lateral lumbar incision;8 mice had bilateral renal ischemia (40 min) reperfusion (24 h) (I/R) at 48 h and 96 h after UUO,as UUO 3 d +I/R group and UUO 5 d +I/R group.Serum creatinine was tested by picric acid method.Left renal tissue was separated for hematoxylin eosin(HE) and Masson staining,acute renal tubular injury assessment and fibrous tissue semi-quantitative analysis.Results Serum creatinine level [(197 ±47),(186 ±26) μmol/L vs (54 ± 10) μmol/L] and acute renal tubular injury score in UUO 3 d + I/R group and UUO 5 d + I/R group were significantly higher than those in normal control group (P ＜ 0.05).HE staining showed massive inflammatory cell infiltration,tubular dilatation,cast formation,brush border disappearance,tubular epithelial cell vacuolar degeneration and necrosis in renal interstitium,with thin renal cortex,shrinked tubules,flat epithelial cells and broaden interstitial space.Masson staining showed that fiber matrix increased in renal interstitium of mice in UUO 3 d + I/R group and UUO 5 d + I/R group.Conclusion UUO plus renal ischemia reperfusion is an effective method to establish mouse chronic kidney disease and AKI model.

Objective To investigate the influence of earlier renal fibrosis on ischemia and reperfusion induced acute kidney injury. Methods Male C57BL/6 mice at eight to twelve weeks old age were divided into 4 groups randomly: (1)Sham (n=3); (2)Unilateral ureter obstruction (UUO, n=6):UUO for 3 days (UUO3d, n=3) and UUO for 5 days (UUO5d, n=3);(3)Ischemia and reperfusion (IR, n=7): bilateral kidney ischemia for 40 minutes followed by 24 hours of reperfusion; (4)UUO for 3 days plus IR (UUO3d+IR, n=6): bilateral kidney ischemia after UUO 2 days for 40 minutes followed by 24 hours of reperfusion, and the real time for UUO was 3 days. Pathologic analysis for acute or chronic injury was performed on paraffin embedded kidney sections with hematoxylin and eosin (HE) or Masson staining. Apoptosis was detected by immunohistochemistry(IHC) and Western blotting with anti-caspase-3 antibody, and proliferation was observed by IHC with anti-ki67 antibody. Results On kidney sections with HE or Masson staining, it showed that the chronic kidney lesions and fibrosis got more severe as time of UUO prolonged from 3 days to 5 days; the area of matrix deposition increased in UUO5d and UUO3d mice significantly compared to Sham mice (P<0.05) and was smaller in UUO3d mice compared with UUO5d mice obviously (P<0.05). Acute kidney injury could be observed in UUO3d+IR mice, such as massive inflammatory cells infiltration, tubules dilation, brush border disappearance, tubular epithelial cells vacuolar degeneration, necrosis, casting formation, coexisting with chronic lesions: thinner cortex, broadened interstitial space, and increased blue stained matrix. Acute kidney injury score in UUO3d+IR mice was higher than that in IR mice significantly (P<0.05), and serum creatinine level increased significantly in UUO3d+IR mice compared to Sham mice (P<0.05). Caspase-3 expression increased and ki67 positive tubular cells decreased in UUO3d+IR mice than those in IR mice obviously (P<0.05). Conclusion Earlier renal fibrosis aggravates acute kidney injury induced by ischemia reperfusion in mice through increasing apoptosis and decreasing proliferation of tubular epithelial cells.

Objectives To investigate regulation of microRNA (miR)-200 family (a, b, c, 141, and 429) in chronic pancreatitis (CP). This was accomplished by examining miR-200 family levels in a mouse model in vivo and their regulation in pancreatic cells in vitro. Methods Chronic pancreatitis was induced by cerulein for 4 weeks (50 μg/kg, 5 hourly intraperitoneal injections/day, and 3 days/week). Control mice received normal saline. The pancreata were harvested for fibrosis assessment by Sirius red staining and for miRNA, collagen, and fibronectin levels by quantitative PCR. In vitro, human primary pancreatic stellate cells and human primary pancreatic fibroblast (hPFBs), and rat pancreatic epithelial AR42J cells were treated with vehicle, transforming growth factor (TGF)-β (1 ng/mL), or BMP2 (50 ng/mL) for 24 hours and then harvested for miRNA analysis. Results In CP, miR-200s were decreased by 56% to 70% and inversely correlated with pancreatic fibrosis, miR-21, and miR-31 (P < 0.05). In vitro, TGF-β inhibited miR-200b in AR42J cells by 62%, whereas BMP2 increased miR-200b in all 3 cell types in a range of 1.5- to 3.4-fold and inhibited miR-21 in hPFBs by 21% (P < 0.05). Conclusions Both in vivo and in vitro studies suggest an antifibrogenic function of miR-200s in CP. The TGF-β and BMP2 may function through inverse regulation of miR-200b levels.

Objective To investigate the use status of anti-hypertensive drugs in outpatients.Methods A retrospective study was conducted in Beijing Anzhen Hospital,Capital Medical Univemity from May to December 2015.Totally 187 047 medical prescriptions of constant anti-hypertensive regimens in 14 768 hypertensive outpatients with Beijing medical insurance and more than 1 time of visiting were included.The prescriptions of anti-hypertensive drugs were analyzed among departments of general medical practice,cardiology,hypertension and other subjects;the application status of dual-drug regimens which were recommended in guidelines was analyzed.Results In 187 047 prescriptions,singh-dmg regimen accounted for 92 423 (49.4％),and drug combination accounted for 94 624 (50.6％).Drug combination rate in hypertension department was significantly higher than that in general medical practice,cardiology and other departments [69.6％ (34 117/48 985) vs 45.8％ (20 582/44 961),45.1％ (23 703/52 612),40.1％ (16 222/40 489)] (P ＜0.05).Compound preparation use rate in hypertension department was significantly higher than that in general medical practice,cardiology and other departments[49.2％ (16 785/34 117) vs 42.0％ (8 647/20 582),39.5％ (9 361/23 703),31.6％(5 132/16 222)] (P＜0.05).Use rate of dual-drug recommended in guidelines in hypertension department was significantly higher than that in general medical practice,cardiology and other departments[80.5％ (10 211/12 689) vs 76.7％(7 700/10 037),76.8％ (9 366/12 199),75.6％ (7 103/9 398)] (P ＜0.05),and the regimen of calcium channel blockers + angiotensin receptor antagonists was the most widely used.Conclusions Drug combination is the predominant therapeutic regimen for hypertensive patients.Outpatient use status of anti-hypertensive agents in department of hypertension is acceptable in accordance with guidelines.

Objective To analyze clinical characteristics of perimenopausal patients with coronary heart disease(CHD) with different syndromes of blood stasis.Methods Totally 150 perimenopausal patients with CHD with different degree blood stasis syndrome from December 2014 to October 2016 in Beijing Anzhen Hospital,Capital Medical University were divided into mild group,moderate group and severe group,with 50 cases in each group.Basic clinical data,biochemical indicators and echocardiographic parameters were analyzed.Resuits The proportion of single vessel lesion and left main coronary artery + triple vessel lesions had significant differences among severe group,moderate group and mild group [12.0％ (6/50) vs 22.0％ (11/50),34.0％ (17/50);24.0％ (12/50) vs 12.0％ (6/50),4.0％ (2/50)] (P ＜0.05).Levels of fasting blood glucose,total cholesterol,low density lipoprotein cholesterol (LDL-C),homocysteine (Hcy),C-reactive protein and uric acid in severe group were significantly higher than those in mild group [(7.5 ± 2.1) mmol/L vs (6.3 ± 1.6) mmol/L,(5.0-± 1.2) mmol/L vs (4.2 ±0.9) mmol/L,(3.4 ±0.8) mmol/L vs (2.7 ±0.8)mmol/L,(16.2 ±9.5) μmol/L vs (10.2 ± 2.8) μmol/L,2.38 (1.25,6.05) mg/L vs 1.25 (0.36,2.68) mg/L,(377 ± 113) μmol/L vs (299 ± 74) μmol/L];levels of total cholesterol,LDL-C,Hcy and uric acid in severe group were significantly higher than those in moderate group [(4.6 ± 1.2) mmol/L,(3.1 ± 0.9) mmol/L,(12.4 ± 5.4) μmol/L,(336 ± 75) μmol/L];the level of high density lipoprotein cholesterol(HDL-C) in severe group was significantly lower than that in mild group and moderate group [(0.79 ± 0.15) mmol/L vs (1.00 ± 0.26),(0.89 ± 0.26) mmol/L] (P ＜ 0.05);HDL-C in moderate group was lower,LDL-C and uric acid were higher than those in mild group (P ＜ 0.05).Left atrial diameter,left ventricular end-diastolic diameter,interventricular septal thickness,left ventricular posterior wall thickness and left ventricular ejection fraction had significant differences among severe group,moderate group and mild group[(42±7)mmvs (39±7),(36±5)mm;(50±5)mmvs (48±6),(47 ±5)mm;(10.1 ± 1.5)mmvs (9.5±1.2),(8.7±1.1)mm;(9.2±1.0)mmvs (8.9±1.4),(8.1±1.1)mm;(59±8)％ vs (63 ± 8) ％,(65 ± 6) ％] (P ＜ 0.05).Conclusion The severity of coronary artery disease and glucose and lipid metabolism disorder increase with the severity of blood stasis syndrome in perimenopausal women.

Objective To analyze risk factors of liver injury after intravenous administration of amiodarone.Methods Clinical data of 1 919 patients with intravenous administration of amiodarone were analyzed retrospectively;the patients were treated in 5 hospitals in Beijing from June 10,2011 to May 10,2012.According to the occurrence of liver injury after drug administration,patients were divided into liver injury group(185 cases)and normal liver function group(1 734 cases).Gender,age,body mass index,cardiac function,history of alcohol drinking,history of liver diseases,solvent of amiodarone,the loading dose,the total dose during the first 24 h of administration,type of arrhythmia,glomerular filtration rate and drug-related adverse reactions were analyzed.Results In 1 919 patients,370 cases(19.3％) had corrected QT interval(QTc interval) prolongation;185 cases (9.6％) had liver function injury;42 cases(2.2％) had severe hypotension;30 cases(1.6％) had bradyarrhythmia and 14 cases had phlebitis (0.7％).Multivariate logistic regression analysis showed that male was an independent risk factor of liver injury after amiodarone administration (odds ratio =1.805,95％ confidence interval:1.152-2.829,P =0.010);using 5％ glucose solution as the solvent of amiodarone was a protective factor(odds ratio =0.594,95％ confidence interval:0.393-0.898,P =0.013).Conclusions Liver injury and QTc interval prolongation are main adverse effects of intravenous administration of amiodarone.Male is an independent risk factor and using 5％ glucose solution as solvent is a protective factor of amiodarone-induced liver injury.

Objective:To determine the occurrence of amiodarone-induced side effects,and analyze risk factors for amiodarone-induced QTc interval (QT interval corrected by heart rate) prolongation.Methods:Clinical data of 534 in-patients with intravenous amiodarone administration in our hospital from June 10,2011 through May 10,2012 were analyzed retrospectively.According to whether or not the QTc interval prolonged after intravenous amiodarone administration,patients were divided into QTc interval prolongation group(L-QTc) and QTc interval non-prolongation group (N-QTc),then demographic characteristics,medical history,operation,acute kidney injury following cardiac surgery,bonus dose,total dose of amiodarone during the first 24 hours,and types of arrhythmia were compared between two groups,using chi-square or t-student test first and multivariable logistic regression analysis finally.Results:After cases with incomplete ECG records before or after amiodarone administration were picked out,total 243 cases were analyzed.It revealed that 62 patients (25.5％) occurred QTc interval prolongation,18 (5.62％) patients had liver injury,5 patients (2.1％) appeared severe decreased blood pressure,and 2 (0.8％) patients got phlebitis,but nobody had allergic response,bradyarrhythmia or atrioventricular block.Multivariable logistic regression analysis showed that acute kidney injury following cardiac surgery were an independent risk factor for QTc prolongation.Conclusion:Intravenous amiodarone used to be administrated in patients after cardiac surgery in our hospital.Intravenous amiodarone administration induced higher occurrence of QTc interval prolongation.Acute kidney injury following cardiac surgery is an independent risk factor for QTc prolongation.

Objective To analyze the risk factors of premature coronary heart disease in female of different ages.Methods Totally 364 female with premature coronary heart disease from March 2014 to March 2015 were enrolled and divided into young groups (35-45 years old),perimenopausal group (46-55 years old) and postmenopausal group (56-65 years old).The risk factors,including hypertension history,diabetes history,family history of coronary heart disease,cholesterol,low density lipoprotein cholesterol (LDL-C),fasting blood glucose,hemoglobin A1c (HbA1C) were analyzed.Results Three hundred and sixty patients were finally enrolled,including 23 cases in young group,81 cases in perimenopausal group and 256 cases in postmenopausal group.The proportions of hypertension history,diabetes history,increased fasting blood glucose and increased HbA1C were significantly higher,the proportions of family history of coronary heart disease was significantly lower in perimenopausal group and postmenopausal group than those in young group [69.1％ (56/81),69.5％ (178/256) vs 39.1％ (9/23);32.1％ (26/81),41.8％ (107/256)vs 13.0％ (3/23);46.9％ (38/81),59.0％ (151/256) vs21.7％ (5/23);40.7％ (33/81),48.8％ (125/256) vs 17.4％ (4/23);27.2％ (22/81),12.5％ (32/256) vs 52.2％ (12/23)],in addition,the proportion of family history of coronary heart disease in postmenopausal group was significantly lower than that in perimenopausal group (P ＜ 0.05);the proportions of hypercholesteremia and low density lipoproteinemia in postmenopausal group were significantly higher than that in young group [92.6％ (237/256) vs 82.6％ (19/23),78.1％ (200/256) vs 60.9％ (14/23)] (P ＜0.05).The other risk factors were not significantly different among groups (all P ＞ 0.05).The proportions of non vessel lesion,single vessel lesion were significantly lower [7.8％ (6/77),1.7％ (4/239) vs 19.0％ (4/21);24.7％ (19/77),24.3％ (58/239) vs 47.6％ (10/21)],the proportions of ≥ 3 vessels lesion,left circumflex and right coronary artery lesion were significantly higher in perimenopausal group and postmenopausal group than those in young group [39.0％ (30/77),42.7％ (102/239) vs 14.3％ (3/21);53.2％ (41/77),59.0％(141/239) vs 14.3％ (3/21);62.3％ (48/77),70.3％ (168/239) vs 38.1％ (8/21)] (all P ＜ 0.05);the proportions of left main coronary artery and left anterior descending lesions were not significantly different among groups (P ＞ 0.05).In addition,the patients were also complicated with other risk factors,such as oral contraceptives,abnormal thyroid function and ischemic infarction,etc.Conclusion In female with premature coronary heart disease,along with the age,the risk factors such as hypertension,diabetes and hyperlipemia are increased,and the severity of coronary artery disease is also increased,while the proportion of family history of coronary heart disease is significantly reduced;some rare risk factors are also found at different stage.