目的 了解上海地区成年体检人群高尿酸血症(hyperuricemia,HUA)患病现状及与体质指数(body mass index,BMI)和其他相关指标的关系.方法 回顾性分析2021年1月1日—11月30日在上海中医药大学附属曙光医院体检的34 546份成人体检资料.记录其年龄、血压、血糖、BMI、空腹血糖、甘油三酯和总胆固醇等资料.比较不同特征男女体检人群HUA患病率差异,使用多因素logistic回归分析探讨不同BMI数及其他相关指标对HUA患病率的影响.结果 34 546例成年体检人群中,检出HUA患者8 120人,检出率为23.50％.男性检出率为31.22％(6 446/20 648),女性检出率为12.04％(1 674/13 898),男性高于女性,差异有统计学意义(x2=586.472,P＜0.001);不同年龄组间HUA患病率不同,男性患病率最高在40岁之前,随年龄增加HUA患病率降低(x2=241.085,P＜0.001),而女性患病率随年龄增加而升高,女性≥70岁患病率最高(x2=207.563,P＜0.001);无论男女人群,高血压组、高血糖组、高甘油三酯组、高总胆固醇组HUA患病率均高于血压正常组、血糖正常组、血脂正常组(均P＜0.001);男、女体检人群HUA患病率均随BMI增加而升高,差异均有统计学意义(x2值分别为563.586、1 155.947,P＜0.001);logistic回归分析显示,偏瘦(OR=0.762,95％CI:0.738～0.786)与肥胖(OR=5.094,95％CI:1.192～21.766)、年龄(50～59 岁:OR=1.292,95％CI:1.056～1.581;60～69 岁:OR=1.473,95％CI:1.150～1.885;≥70 岁:OR=1.779,95％CI:1.183～2.674)、男性(OR=1.996,95％CI:1.076～3.700)、吸烟(OR=1.706,95％CI:1.066～2.730)、高胆固醇(OR=1.114,95％CI:1.010～1.229)均是HUA影响因素(P＜0.05).结论 上海地区成年体检人群HUA检出率总体较高,且HUA患病率随BMI增长而上升,医务人员需重点针对肥胖、男性、吸烟及50岁以上人群制定针对性宣传教育,限制高嘌呤饮食,控制体重等来降低其患病率.

为观察鼻敏康合剂对变应性鼻炎(allergic rhinitis,AR)大鼠鼻黏膜病理及水通道蛋白1(aquaporin 1,AQP1)表达的影响,采用卵清蛋白(ovalbumin,OVA)致敏法建立SD大鼠AR模型,将造模成功的AR大鼠随机分为模型组、西药组、鼻敏康合剂2.53 g/kg组、鼻敏康合剂5.06 g/kg组和鼻敏康合剂10.12 g/kg组,另设空白组.西药组和鼻敏康合剂各剂量组每天灌胃治疗2次,空白组和模型组给予等量生理盐水,连续14d.观察各组大鼠行为学改变;H-E染色法观察鼻黏膜病理、嗜酸性粒细胞(eosinophil,EOS)数量;免疫组化、ELISA、qRT-PCR检测AQP1蛋白及mRNA表达.结果显示,与空白组比较,模型组大鼠行为学积分显著升高(P＜0.05),鼻黏膜组织结构紊乱、重度增生、变性,鼻黏膜EOS数量显著增加(P＜0.05),AQP1蛋白及mRNA表达水平显著上调(P＜0.05).与模型组比较,鼻敏康合剂各剂量组大鼠行为学积分显著降低(P＜0.05),鼻黏膜组织结构相对整齐,EOS数量下降(P＜0.05),AQP1蛋白及mRNA表达水平下调(P＜0.05).该研究提示,鼻敏康合剂可通过下调AQP1表达促进鼻黏膜修复,从而对AR大鼠起到治疗作用.

目的 分析血清成纤维细胞生长因子(FGF)-23、转化生长因子(TGF)-β1和可溶性生长刺激表达基因2(sST-2)诊断高血压病人发生肾损害的临床价值.方法 选取2018年1月—2020年1月我院收治的原发性高血压病人204例,作为高血压组.根据高血压分级标准,204例病人中1级61例,2级67例和3级76例.根据肾小球滤过率将病人分为肾功能正常组(107例)、轻度肾功能不全组(42例)和中重度肾功能不全组(55例).同时选取同期在我院行健康体检者45名作为对照组.观察高血压组和对照组血清FGF-23、TGF-β1、sST-2和胱抑素C(CysC)水平变化;分析血清FGF-23、TGF-β1、sST-2和CysC水平与高血压分级和肾功能的关系;血清FGF-23、TGF-β1、sST-2和CysC水平预测高血压肾功能损害的诊断效能.结果 高血压组血清FGF-23、TGF-β1、sST-2和CysC水平高于对照组(P<0.01).高血压病人血清FGF-23、TGF-β1、sST-2和CysC水平随着高血压分级和肾功能不全损害严重程度增加而升高(P<0.01).血清FGF-23、TGF-β1和sST-2诊断高血压病人发生肾功能损害的效能优于CysC,联合检测灵敏度为88.7％,特异度为94.4％,受试者工作特征曲线下面积为0.968,优于FGF-23、TGF-β1和sST-2单一指标.高血压肾功能损害病人血清FGF-23水平与TGF-β1(r=0.687,P<0.01)和sST-2(r=0.726,P<0.01)呈正相关,血清TGF-β1与sST-2水平呈正相关(r=0.816,P<0.01).结论 血清FGF-23、TGF-β1和sST-2水平与高血压严重程度和肾损害有关,三者联合检测有助于高血压病人发生肾功能损害的早期诊断.

糖尿病肾病是一种严重的糖尿病并发症[1],患者一旦出现典型症状便表示病情已处于不可逆状态,常规治疗仅能延缓患者的肾功能恶化速度,患者仍会不可避免的病情恶化,从而导致尿毒症的出现,威胁患者生命[2].因此,尽早确诊对于糖尿病患者的治疗有着重要的意义.相关研究指出,糖尿病肾病患者的肾功能指标检验对于患者的诊断和治疗有着重要的价值[3].本研究抽取2019—2020年在我院经病理诊断确诊为糖尿病肾病的40例患者进行临床研究,对肾功能指标检验在糖尿病肾病中的价值进行验证分析,现报告如下.

高血压呈现年轻化趋势,中青年高血压病人常无典型头晕、头痛临床表现,血压表现为高血压1级、2级低、中危型,或以单纯舒张压升高为主,未引起临床足够重视,从而使中青年高血压病人整体知晓率、治疗率及控制率偏低,导致心血管意外事件发生及长期心血管疾病风险增加.笔者跟随孟伟教授学习,现总结孟伟教授治疗中青年高血压证经验,孟伟教授认为中青年高血压多属湿热证,不同于传统"肝阳上亢证"的认识,结合现代人的不良生活方式分析中青年高血压湿热证成因,提出从湿热论治中青年高血压的辨证思路,临床应用每获良效.

从针刺蝶腭神经节治疗鼻炎的过程中发现对于耳鸣亦起到治疗作用.本文从蝶腭神经节与听觉中枢的解剖关系来寻找针刺蝶额神经节治疗特发性耳鸣的机制.通过解剖学及文献报道,初步认为耳鸣中枢化机制及听觉中枢可塑性是针刺蝶腭神经节治疗特发性耳鸣的理论依据.同时从理论和临床两方面着手进一步探讨针刺蝶腭神经节治疗特发性耳呜的中枢化机制,为进一步拓展针刺蝶腭神经节技术的应用及实验研究夯实基础.

目的 探讨开音散结汤联合针刺治疗血瘀痰凝型慢喉喑的疗效.方法 选取门诊血瘀痰凝型慢喉喑患者30例.口服自拟方开音散结汤联合针刺外治,2周为1疗程,共治疗3个疗程.结果 开音散结汤联合针刺治疗血瘀痰凝型慢喉喑疗效良好,VHI评分及MPT均较治疗前明显改善(P<0.01),其差异具有显著统计学意义.结论 开音散结汤联合针刺外治能够使嗓音障碍得到不同程度改善,VHI评分显著降低,MPT明显延长,证实中药内服联合针刺外治是值得临床深入探讨治疗血瘀痰凝型慢喉喑的一种综合方法.

老年性失眠是指特发于老年期的原发性失眠,中医药治疗老年性失眠有其特有的优势.根据老年人的生理病理特点,认为本病的发生与肾密切相关,病机总为肾精气阴阳亏虚、脏腑功能失调;治疗应谨守病机,审因论治,可采用交通心肾,滋阴补肾,温肾安神等治法,临床应用六味地黄丸、二仙汤、地黄饮子等补肾中药疗效突出.相关研究表明补肾中药可通过调节 γ-氨基丁酸含量以及对抗下丘脑-垂体-肾上腺轴亢进以发挥作用.

Objective To explore the influence factors of abnormal blood pressure fluctuation in elderly patients with hypertension.Methods A total of 1 768 hypertensive patients aged 60 years or older admitted to Dongzhimen Hospital,Beijing University of Chinese Medicine between March 2016 to March 2017 were enrolled.Patients without abnormal blood pressure fluctuation were assigned to control group(n =1 553) and patients with abnormal blood pressure fluctuation were observation group(n =215).Comorbidities and risk factors of abnormal blood pressure fluctuation were analyzed.Results Logistic regression indicated that cerebral hemorrhage (odds ratio =29.37,P =0.01),cerebral infarction(odds ratio =21.35,P =0.01),lacunar infarction(odds ratio =17.44,P =0.01),cervical spondylosis(odds ratio =12.89,P =0.01),neurotic headache(odds ratio =9.32,P =0.03),emotional stress(odds ratio =11.83,P =0.01) and angina attack(odds ratio =6.41,P ＜ 0.01) were influence factors of abnormal blood pressure fluctuation.Conclusion Ischemic stroke,cervical spondylosis and hemorrhagic stroke are associated with abnormal blood pressure fluctuation in the elderly.

临床中,慢性心力衰竭病人存在不同程度的认知功能障碍,以轻微认知功能障碍为特征,临床评价较困难.若不进行有效干预,后期可发展为阿尔茨海默病或血管性痴呆,因此,早期发现并进行有效防治具有重要临床意义.现回顾慢性心力衰竭认知功能病人的流行病学资料,对慢性心力衰竭病人认知功能损害特征进行描述,主要表现为执行功能受损,同时比较不同评价量表在心力衰竭病人认知障碍中的应用特点.

Objective To investigate the effects of homocysteine(Hcy),high-sensitive C-reactive protein (hs-CRP),D-dimer(DD)and endothelial Expression of Endothelial Nitric Oxide Synthase(eNOS)in serum of patients with coronary atherosclerotic heart disease.Methods 100 cases with coronary heart disease treated by coronary angiography in our hospital were selected as the observation group from October 2015 to February 2017.At the same time,50 cases of healthy subjects were selected as the control group.The serum of patients with atherosclerosis was collected,and the contents of Hcy,hs-CRP,D-D and eNOS were measured. Results Compared with the control group,the levels of Hcy,hs-CRP and D-D in the blood of the observation group significantly increased,but the content of eNOS decreased significantly(P<0.05).Hcy,hs-CRP and D-D increased gradually with the severity of the disease,and the content of eNOS decreased gradually.The difference was statistically significant(P<0.05).The detection rate of high homocysteine,hs-CRP,D-Dimer and eNOS in patients was significantly higher than that in each index.Conclusion Hcy,hs-CRP,D-D and eNOS were abnormal in the serum of patients with atherosclerosis.And Hcy,hs-CRP,D-D and eNOS combined detection and real-time monitoring for the diagnosis of coronary atherosclerotic heart disease patients has important clinical significance.

目的:观察益气固本调免方对IgA肾病患者血转化生长因子β1(TGF-β1)的影响.方法:将85例IgA肾病(CKD1-4期)患者随机分为2组,观察组43例给予益气固本调免方治疗,对照组42例给予科素亚治疗,疗程4个月.观察2组治疗前后临床疗效,24小时尿蛋白定量,尿红细胞数,血TGF-β1水平,平均动脉压及肾小球滤过率.结果:总有效率观察组为74.4％,对照组为42.9％,2组比较差异有统计学意义(P＜0.05).对照组24小时尿蛋白定量降低(P＜0.05),观察组尿红细胞数和24小时尿蛋白定量显著降低(P＜0.05),组间比较差异有统计学意义(P＜ 0.05).血TGF-β1水平观察组显著降低,组内比较差异有统计学意义(P＜0.05),对照组有降低趋势,但治疗前后比较差异无统计学意义(P＞0.05);血TGF-β1水平的改善显著优于对照组(P＜0.05).平均动脉压及肾小球滤过率,治疗前后2组间比较,差异无统计学意义(P＞ 0.05).血TGF-β1水平变化与尿红细胞数(r=0.834 2,P＜ 0.01)、24小时尿蛋白定量(r=0.568 2,P＜0.05)观察组呈正相关.结论:益气固本调免方能有效减少IgA肾病患者的血尿和蛋白尿,其机制可能与血TGF-β1水平的变化相关.

Objective:To study the influence of Biminkang Mixture on lung function, inflammatory factor and immune function in patients with allergic rhinitis combined with asthma. Methods:Niney-four patients with allergic rhinitis combined with asthma were divided into the control group (47 cases) and observation group (47 cases) in October 2015 to March 2017 in our hospital, according to random number table method. The control group was given conventional Western medicine treatment and the observation group was given Biminkang Mixture on the basis of the control group. After 3 months, the clinical efficacy was observed. The lung function indexes including max volume value (MVV), vital capacity (VC) and forced expiratory volume in one second (FEV1) were checked by pulmonary function instrument and the levels of TNF-α, IL-6 and IL-8 were detected by ELISA, and the immune cells inlcuding CD3+, CD4+and CD8+were detected by flow cytometry instrument. Results:After 3 months treatment, the total effective rate (91. 49％) in observation group was significantly higher than the control group' s 76. 60％ (P＜0. 05). The lung function indexes including MVV, VC and FEV1 in observation group were significantly higher than that of control group (P＜ 0. 05). The levels of TNF-α, IL-6 and IL-8 in observation group were significantly lower than those of the control group (P＜ 0. 05). The CD3+and CD4+in observation group were significantly higher than those of the control group, and the CD8+was significantly lower than that of the control group (P＜ 0. 05). Conclusion:Biminkang Mixture in treatment of patients with allergic rhinitis combined with asthma can improve the clinical curative effect, lung function and immune function and reduce inflammation. It was worthy of clinical popularization and application.

目的 观察鼻敏康合剂对变应性鼻炎(AR)大鼠鼻黏膜病理和血清分泌型黏蛋白5AC(MUC5AC)、黏蛋白5B(MUC5B)水平的影响.方法 将60只SD大鼠随机分为空白组、模型组、西药组和中药低、中、高剂量组各10只,除空白组外均建立AR模型,造模后西药组给予地氯雷他定灌胃,中药低、中、高剂量组分别给予2.53、5.06、10.12 g生药/mL鼻敏康合剂灌胃,空白组和模型组给予等量生理盐水灌胃.连续灌胃2周后,HE染色法观察大鼠鼻黏膜病理变化,ELISA法检测血清MUC5AC、MUC5B.结果 与空白组比较,模型组鼻黏膜有不同程度的变性、坏死,以嗜酸性粒细胞为主的炎细胞浸润明显,部分区域可见坏死、脱落;与模型组比较,中药中、高剂量组及西药组鼻黏膜以嗜酸性粒细胞为主的炎细胞浸润程度减轻,中药低剂量组鼻黏膜炎症程度改善不明显.血清MUC5AC、MUC5B水平由高到低依次为模型组、西药组、中药低剂量组、中药高剂量组、中药中剂量组、空白组,除西药组与中药低剂量组差异无统计学意义外,其他各组两两比较差异均具有统计学意义(P均<0.01).结论 鼻敏康合剂可有效缓解AR大鼠鼻黏膜炎细胞浸润,降低血清MUC5AC、MUC5B水平,从而减轻AR发作时的高分泌状态.

目的 探讨CA19-9、Cyfra21-1与2型糖尿病(T2DM)患者血清皮质醇水平的相关性.方法 选取T2DM患者121例作为观察组及同期健康体检者59例作为对照组,检测和比较两组空腹血清皮质醇及CA19-9、Cyfra21-1水平,并对其进行相关性分析.结果 观察组患者血清皮质醇、肿瘤标志物CA19-9、Cyfra21-1浓度显著高于对照组(P<0.05),且血清皮质醇与Cyfra21-1呈正相关变化(r=0.131,P<0.05).结论 T2DM患者血清皮质醇的升高一定程度上提示肿瘤患病的风险增加,临床诊治中应进一步筛查T2DM患者血清CA19-9、Cyfra21-1水平.

尽管部分高血压患者不痛不痒,无明显不适症状,但高血压对身体器官的损害却在持续进行中.一旦引起心、脑、肾及视网膜等器官的损害,其损伤是不可逆的. 认识高血压的危害 高血压损害相应的靶器官,是通过联系媒介即血管而形成的.举例而言,血管似自来水管,长时间水压过高,一则容易使自来水管老化,相当于血管的动脉粥样硬化;二则可能会导致水管破裂,相当于血管破裂出血.较高的压力使血管硬化,弹力减弱,管腔狭窄,血流减少,出现供血不足的表现;血管受损亦招致"修补小能手"血小板和"织网巧匠"凝血因子蜂拥而至,最后缠绕管腔阻塞血管,造成闭塞,形成脑栓塞(脑卒中)、心肌梗死(猝死)等.硬化的血管在较高压力下容易破裂出血,产生脑出血(脑卒中)、视网膜出血(失明).

Objective:To explore the relationship between Serum Sialic Acid,High-Sensitivity C-Reactive Protein and prehypertension.Methods:160 residents who received physical examination in our hospital from October 2012 to September 2014 were divided into three groups,normal group,prehypertension group and hypertension group.The blood pressure,height,weight,levels of Serum SA,hs-CRP,total cholesterol(TC),low density lipoprotein(LDL),high-density lipoprotein(HDL),triacylglycerol(TG) and fasting blood-glucose(FPG)were measured and detected.Multiple Linear Regression was conducted to analyze the influence of SA and hs-CRP to the systolic blood pressure (SBP)and diastolic blood pressure (DBP).Results:The levels ofDBP,SBP,BMI,SA,hs-CRP,TC,LDL,HDL and FBG among these three groups had statistical differences (P＜0.05).As the blood pressure rose,so did the levels ofBMI,SA and hs-CRP,while HDL decreased.As to the level of TC and LDL,hypertension group were all higher than normal group,while it has no statistical differences between prehypertension group and hypertension group.The result of Multiple Linear Regression showed positive relationship between BMI,SA,hs-CRP,FBG and SBP,so was BMI,SA,hs-CRP,LDL and DBP.Conclusion:The levels of serum SA,hs-CRP showed a positive relationship with blood pressure independently which could be the assessment criteria of prehypertension.

β受体功能亢进症以心慌、心率增快等为主症,西医目前尚无统一的诊断及治疗标准,而中医,将此类病症归属于“心悸”范畴,心悸的证型多种,其中痰热内扰证多见.临床上黄连温胆汤治疗心悸之痰热内扰证效果显著.

目的 探究H型高血压患者和普通高血压患者中不同基因型的血管紧张素转化酶的活性差异以及其对血脂水平的影响.方法 实验采用了聚合酶链式反应的方法,分别鉴定68例H型高血压患者和64例普通型高血压患者血管紧张素转化酶的基因型,并且对不同基因型的血管紧张素转化酶的活性和对应的血脂水平进行了检测.结果 利用SPSS19.0对数据进行分析,H型高血压和普通高血压患者的不同基因型的血管紧张素转化酶活性的差异均具有统计学意义(P＜0.01),但血管紧张素水平的差异无统计学意义.血管紧张素转化酶基因多态性对血脂水平影响的研究表明,H型高血压组中缺失型纯合子(DD型)与插入型杂合子(ID型)和插入型纯合子(Ⅱ型)相比较,DD型血脂水平明显偏高,其中胆固醇(TC)(P＜0.01),高密度脂蛋白(HDLD),低密度脂蛋白(LDLC)和载脂B的水平的差异均具有统计学意义(P＜0.05).普通高血压组仅HDLC,LDLC和载脂B的差异具有统计学意义(P＜0.05).结论 在H型高血压和普通型高血压患者中,血管紧张素转化酶的基因多态性与血管紧张素转化酶的活性及血脂含量有关.H型高血压患者的DD型的血管紧张素转化酶的活性最高,并且血脂水平偏高,其中胆固醇含量增高最为明显,更加容易患高血脂症.

目的 探讨血清乙型肝炎病毒(hepatitis B virus,HBV) DNA检验中低于检测下限(500 u/mL)实测值的临床价值.方法 180例6个月内首次血清HBV DNA＞0～500 u/mL慢性乙型肝炎患者,采用实时荧光定量PCR法检测其血清HBV DNA水平,3个月1次,共1 a;56例监测期间血清HBV DNA最高拷贝为0 u/mL为减少组,57例HBVDNA＞0～103 u/mL为维持组,36例HBV DNA＞103～104 u/mL为升高1组,31例HBV DNA＞104 u/mL为升高2组;观察各组首次HBV DNA检测载量值,并比较随访期间血清乙型肝炎e抗原(hepatitis B virus e antigen,HBeAg)和谷丙转氨酶(glutamic-pyruvic transaminase,GPT)的变化.结果 血清HBV DNA升高1组和升高2组首次血清HBVDNA载量(2.32±0.27、2.37±0.24)高于减少组(1.92±0.24)和维持组(2.12±0.29),减少组HBV DNA载量低于维持组,差异均有统计学意义(P＜0.05);随访1 a中,HBV DNA升高1组、升高2组血清GPT升高至正常参考值2倍以上比率(25.00％、38.71％)高于维持组(7.02％),差异有统计学意义(P＜0.01),各组HBeAg阳性率比较差异均无统计学意义(P＞0.05).结论 持续病毒抑制的慢性乙型肝炎患者,血清HBV DNA升高旱于其他血清学指标,血清HBVDNA低于检测下限实测值越接近检测下限(500 u/mL),1 a内疾病复发及肝损伤可能性越大.