目的 观察丙泊酚与依托咪酯乳剂在颅脑损伤合并肺部感染患者纤维支气管镜治疗中的镇静效果及安全性.方法 选取河北医科大学第二医院2019年1月-2021年8月收治的重症医学科(ICU)机械通气颅脑损伤合并肺部感染患者84例为研究对象,按照用药方案不同分为丙泊酚组和依托咪酯组,每组各42例.两组均给予纤维支气管镜治疗,丙泊酚组给予丙泊酚乳状注射液1～2 mg·kg-1,人工缓慢静推3～5 min.依托咪酯组给予依托咪酯中/长链脂肪乳注射液0.2～0.4 mgkg-1,缓慢静推.操作中若患者躁动明显或呛咳剧烈影响进境,或气管壁出血,则追加丙泊酚30 mg或依托咪酯6mg.比较两组给药前5min(T0)、给药后-入镜即刻(T1)、入镜后3min(T2)、入镜后10min(T3)、撤镜即刻(T4)、术毕5min(T5)时脑电双频谱指数(BIS)、心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、血氧饱和度(SpO2)、脑氧饱和度(rSO2)差异,比较两组药物平均使用量、追加药物次数、麻醉起效时间、不良反应发生情况及纤维支气管镜操作医生对镇静效果的满意度.结果 T1、T4、T5时两组BIS均低于本组T0时,T2、T3时高于本组T1时(P＜0.05);T0、T2、T4、-15时两组BIS差异无统计学意义(P＞0.05);T1、T3时丙泊酚组BIS低于依托咪酯组(P＜0.05);T1、T2、T3、T4时丙泊酚组HR、MAP低于依托咪酯组(P＜0.05);T0、T5时两组HR、MAP差异无统计学意义(P＞0.05);T0、T1、T2、T3、T4、T5时两组RR、SpO2、rSO2差异无统计学意义(P＞0.05);丙泊酚组药物平均使用量多于依托咪酯组,追加药物次数少于依托咪酯组(P＜0.05);两组麻醉起效时间差异无统计学意义(P＞0.05);依托咪酯组呛咳反应发生率高于丙泊酚组(P＜0.05);两组呼吸抑制发生率、躁动发生率差、纤维支气管镜操作医生对镇静效果满意度差异无统计学意义(P＞0.05).结论 丙泊酚与依托咪酯乳剂在ICU机械通气颅脑损伤合并肺部感染患者行纤维支气管镜治疗中均具有良好镇静效果,其中依托咪酯药物平均使用量较少,对HR、MAP、BIS影响较小,但追加药物频次、呛咳反应发生率较高.

Objective To explore the effect of metoprolol combined with trimetazidine on myocardial remodeling, serum levels of N-terminal pro-brain natriuretic peptid(NT-proBNP) and hypersensitive C-reactive protein(hs-CRP) in patients with chronic heart failure. Methods A total of 100 patients with chronic heart failure admitted to Hebei Chest Hospital from December 2016 to December 2018 were randomly divided into obser-vation group and control group, with 50 cases in each group. The control group took metoprolol and the observation group took metoprolol plus trimetazidine on the basis of routine treatment. Clinical efficacy, serum NT-proBNP and hs-CRP levels, myocardial remodeling, quality of life and adverse reactions were analyzed. Results Total clinical effective rate in observation group was significantly higher than that in control group[92. 0％(46/50) vs 76. 0％(38/50)](χ2 =4. 714, P=0. 030). After treatment, levels of serum NT-proBNP and hs-CRP, left ventricular end-systolic dimension, left ventricular end-diastolic dimension, quality of life score significantly decreased compared with those before treatment; the indexes in observation group were significantly lower than those in control group[(458 ± 80)ng/L vs (873 ± 110)ng/L, (10. 5 ± 2. 9)mg/L vs (14. 4 ± 3. 6)mg/L, (36 ± 4)mm vs (41 ± 4)mm, (49 ± 4)mm vs (56 ± 4)mm, (41 ± 5) vs (49 ± 6)];left ventricular ejection fraction significantly increased after treatment and it was higher in observation group than that in control group [ ( 53 ± 5 )％ vs ( 47 ± 5)％](all P<0. 05). There was no significant difference in the incidence of adverse reactions between groups (χ2 =0.121, P=0.728). Conclusion Metoprolol combined with trimetazidine treating chronic heart failure can effectively reduce serum NT-proBNP and hs-CRP, promote myocardial remodeling and improve quality of life;the adverse reactions are tolerable.

目的:调查重症急性胰腺炎(SAP)患者生存质量,并分析SAP并发腹腔感染的影响因素.方法:选取我院于2017年1月～2019年12月期间收治的136例SAP患者纳入研究组.另选取同期于我院进行体检的健康者90例纳入对照组.研究组中的患者根据腹腔感染情况分为感染组(n=48)和未感染组(n=88).采用生活质量调查简表(SF-36)对对照组、研究组的生存质量进行评定.SAP并发腹腔感染的影响因素予以单因素及多因素Logistic回归分析.结果:研究组的社金功能、精力、生理职能、情感职能、生理机能、一般健康状况、躯体疼痛、精神健康评分均低于对照组(P＜0.05).单因素分析结果显示:SAP并发腹腔感染与机械通气时间、多器官功能障碍综合征、糖尿病、低氧血症、肠功能障碍时间、肾衰竭、急性生理学和慢性健康状况评分Ⅱ (APACHE Ⅱ)有关(P＜0.05);而与性别、年龄、发病类型、病因、呼吸衰竭无关(P＞0.05).多因素Logistic回归分析结果显示:存在多器官功能障碍综合征、机械通气时间≥10h、肠功能障碍时间≥4d、存在肾衰竭、存在低氧血症、APACHE Ⅱ＞11分均为SAP并发腹腔感染的危险因素(P＜0.05).结论:与健康者相比,SAP患者的生存质量较低,需要院外持续的健康干预.另SAP患者合并腹腔感染与多种因素相关,应引起临床重视并积极采取相关应对措施,以改善患者预后.

目的 观察强化阿托伐他汀联合法舒地尔治疗冠状动脉慢血流现象(coronary slow flow,CSF)患者的临床效果.方法 选择2016年8月至2018年1月在河北医科大学第一医院心内科因胸痛就诊,经冠状动脉造影诊断为CSF的患者72例为研究对象.患者按随机数字表法分为强化他汀组(n=36)和联合用药组(n=36).强化他汀组给予阿托伐他汀40 mg/晚;联合用药组给予阿托伐他汀40 mg/晚,法舒地尔60 mg/d(14 d)静脉注射.6个月后复查冠状动脉造影再次评估冠状动脉血流状态.检测及比较治疗前、后血清三酰甘油(triacylg?lycerol,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)及高敏C-反应蛋白(high-sensitivity C reactive protein,hs-CRP)、肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、白细胞介素-1(interleukin-1,IL-1),一氧化氮(nitric oxide,NO)浓度.结果 治疗6个月后强化他汀组及联合用药组患者各支冠状动脉血流速度均优于治疗前,差异有统计学意义(P<0.05);并且联合用药组各支冠状动脉血流速度改善优于强化他汀组,差异有统计学意义(P<0.05).与治疗前比较,联合用药组治疗后与强化他汀组患者治疗后血清TC、TG、LDL-C、hs-CRP、TNF-α、IL-1浓度均明显降低,而NO浓度明显升高,差异有统计学意义(P<0.05).治疗后,联合用药组患者血清TC、TG、LDL-C浓度与强化他汀组治疗比较,差异无统计学意义(P>0.05),而联合用药组患者血清hs-CRP及TNF-α、IL-1浓度明显低于强化他汀组,NO浓度明显升高,差异有统计学意义(P<0.05).结论 强化阿托伐他汀联合法舒地尔可通过抑制炎症反应、改善内皮功能进而改善CSF,效果优于单独应用强化阿托伐他汀.

目的 筛选、比较卵巢过度刺激综合征大鼠模型(OHSS)的建立方法,为OHSS机制研究及治疗药物的开发提供良好的动物模型.方法 将60只3～5周龄的Wistar和SD大鼠随机分组后注射不同剂量的孕马血清(PMSG)和人绒毛膜促性腺激素(hCG)进行OHSS模型的建立,并通过大体病理学检查、脏器指数测量、血液孕激素、雌激素及VEGF浓度测定等方法对所建立模型进行综合评价.结果 3周龄SD大鼠出现了明显的卵巢增大,血管通透性增加,血清VEGF水平上升等OHSS典型改变,更适用于进行OHSS大鼠模型的建立.结论 比较并筛选得到了可靠造模方法,为后续的OHSS发病机制研究及治疗药物开发提供了良好的动物模型.

目的 探讨中成药津力达颗粒对骨骼肌线粒体生物发生和胰岛素敏感性的影响.方法 随机将雄性SD大鼠分为正常饲养组12只、高脂饲养组24只,6周后每组选取6只行高胰岛素-正葡萄糖钳夹试验,鉴定造模成功后,分别测定体重、胰岛素抵抗指数(HOMA-IR)、腹腔注射葡萄糖耐量实验(IPGTT)、葡萄糖输注率(GIR)等.余造模成功高脂喂养的18只大鼠进一步分为模型组、吡格列酮干预组、津力达颗粒干预组,继续喂养8周,分别测定体重、血脂、IPGTT、GIR等,并检测骨骼肌组织中Toll样受体2(TLR2)蛋白,以及线粒体生物发生指标过氧化物酶体增殖物激活受体γ共激活因子α(PGC1α)、线粒体融合蛋白2(MFN2)、核呼吸因子1(NRF-1)和胰岛素信号通路磷脂酰肌醇3激酶(PI3K)、磷酸化蛋白激酶B(P-AKT)、葡萄糖转运蛋白4(GLUT4)等蛋白的表达水平.结果 ①喂养6周后:与正常组相比,模型组体重、HOMA-IR均显著升高,IPGTT各时点血糖显著升高,GIR明显下降,差异均有统计学意义(P＜0.05).②喂养14周后:与模型组相比,吡格列酮干预组和津力达颗粒干预组大鼠体重及血脂水平明显下降,IPGTT各时点血糖显著下降,GIR显著升高,差异均有统计学意义(P＜0.05).③喂养14周后:与模型组相比,津力达颗粒干预组和吡格列酮干预组上调了线粒体生物发生指标PGC1α、MFN2、NRF-1以及胰岛素信号通路PI3K、P-AKT、GLUT4等蛋白表达水平,并且下调了骨骼肌组织中TLR2蛋白的表达,差异有统计学意义(P＜0.05).结论 津力达颗粒与吡格列酮类似,可能通过促进骨骼肌线粒体生物发生而改善胰岛素敏感性.

Objective To investigate the influence of alprostadil on renal function,oxidative stress,and immune function in early diabetic nephropathy patients.Methods Eighty-six cases of early diabetic nephropathy patients in our hospital during April 2013 to January 2016 were chosen as research subjects,all patients were divided into observation (n =43) and control (n =43) groups according to random data form.Patients in observation group received alprostadil combined with pioglitazone treatment and those in control group received pioglitazone treatment only,both lasted for one month.Before treatment,one month after treatment,renal function indices were detected;serum oxidative stress indices were detected by automatic biochemical analyzer;T lymphocyte subsets in peripheral blood were measured by flow cytometry.Results Before treatment,there were no significant differences in renal function,oxidative stress,immune function between two groups (P ＞ 0.05).One month after treatment,peripheral blood renal function indices such as blood urea nitrogen (BUN),estimated glomerular filtration rate (eGFR),and cystatin C (CysC) levels were lower in observation group than in control group,the level of serum albumin (Alb) was higher in observation group than in control group,the difference was statistically significant (P ＜ 0.05);semm oxidation indices malondialdehyde (MDA),and advanced oxidation protein products (AOPP) were lower in observation group than in control group,human antioxidant indices such as superoxide dismutase (SOD),and total antioxidant capacity (T-AOC) were higher in observation group than in control group,the difference was statistically significant (P ＜ 0.05);peripheral blood CD3 +,CD4 + T lymphocytes and the ratio of CD4 +/CD8 + were higher in observation group than in control group,CD8 +T lymphocyte level was lower in observation group than in control group,the difference was statistically significant (P ＜ 0.05).Conclusions Alprostadil can optimize the renal function and immune function in early diabetic nephropathy patients,reduce the degree of oxidative stress.

Objective To discuss the application of modified Nikaidoh in Taussig-Bing anomaly with pulmonary stenosis.Methods The modified Nikaidoh procedure was employed to exchange and transplant the aortic and pulmonary roots and rebuild the left and right ventricular outflow tracts.The changes in structure of heart tissues,the post-operative recovery and growth and development of the patients were observed.Results After the modified Nikaidoh procedure,the relationship between the ventricle and artery was recovered to be normal,without the serious progressive aortic valve insufficiency,and medium or above pulmonic valve regurgitation,and left and right ventricular outflow tract obstruction.5 cases survived after the operation and 1 case died of serious heart failure and multiple organ dysfunction syndrome.According to the follow-up of 4 months to 7 years,the growth and development of patients were improved,with the significant increase in the oxygen saturation and the disappearance of cyanosis.Conclusion The application of modified Nikaidoh in Taussig-Bing anomaly with pulmonary stenosis can achieve the anatomical radical cure and obtain the good surgical effect.

Objective To investigate the effect of different right ventricular pacing sites on anxiety and depression in patients with atrioventricular block after implantation of permanent cardiac pacemaker,so as to emphasize the importance of psychological status in such patients with physical diseases.Methods The participants enrolled in this study were 78 cases with high degree or complete atrioventricular block,who were admitted in Department of Cardiology of the First Hospital of Hebei Medical University,and treated by implantation of DDD/DDDR pacemakers from December 2012 to December 2014.They were divided into right ventricular apex(RVA) group(n=38) and right ventricular outflow tract septum(RVOTs) group(n=40) by random number table method.Baseline characteristics of them were collected.QRS duration before surgery and at the 4th week after surgery,Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS) scores before surgery,at the 1st and the 4th weeks after surgery were recorded.Results QRS duration in RVA group was longer than that in RVOTs group at the 4th week after surgery(P<0.05).QRS durations at the 4th week after surgery of both groups were longer than those before surgery(P<0.05).Pacing sties and implantation duration of the artificial cardiac pacemaker did not exert interaction effect on the SAS and SDS scores(P>0.05).Implantation duration of the artificial cardiac pacemaker had significant major effect on SAS and SDS scores in both groups(P<0.05),while pacing sites did not(P>0.05).The SAS and SDS scores at the 4th week after surgery were lower than those before surgery and at the 1st week after surgery in both groups(P<0.05).Conclusion RVA pacing and RVOTs pacing both can reduce the symptoms of anxiety and depression,and there is no difference between them.

Objective To analyze whether the combination of alprostadil and high-dose atorvastatin can relieve acute kidney injury caused by contrast agent in DN patients treated with PCI.Methods The author took 196 DN patients treated with PCI as the study subjects.The patients were randomly divided into control group,high-dose atorvastatin group,alprostadil group and combination therapy group(n =49).All patients were treated with regular treatments,including anti-platelet,anti-coagulation,anti-hyperlipidemia,Blood pressure control,blood sugar control,coronary dilatation and so on.The patients in the four groups were all treated with the same hydration therapy from pre-12h to the post-12h of the operation. The alprostadil group and the ecombination therapy group were given intravenous injection of 20μg alprostadil at 30 min before operation,12,36 and 60h after operation.The control group and high-dose atorvastatin group were treated with the same dose of placebo at the corresponding time point(0.9％ Sodium chloride injection 2ml).The patients in high-dose atorvastatin group and combined therapy group daily plus atorvastatin 20mg (total to 40mg/d) 3 days before operation.The author observed the changing situations of CysC,Scr,β2-MG and hs-CRP before and 48h,72h after operation respectively.The author compared the morbidity of CIN of these four groups.Results There was no significant significance in level differences of CysC,Scr,β2-MG and hs-CRP between the four groups before PCI(P ＞0.05).The levels of CysC,β2-MG and hs-CRP of patients in alprostadil group and high-dose atorvastatin group and combination therapy group at 48h and 72h after operation were all lower than those in the control group(P ＜ 0.05).The levels of Scr of patients in alprostadil group and high-dose atorvastatin group and combination therapy group at 72h after operation was all lower than those in the control group(P ＜ 0.05).The level of Scr of patients in combination therapy group was lowest(P ＜ 0.05).The morbidity of contrast-induced nephropathy was 36.7％ in the combination group,which was significantly lower than the other three groups (P ＜ 0.05).Conclusion Intravenous injection of alprostadil combined with high-dose atorvastatin can relieve acute kidney injury caused by contrast agent and reduce the morbidity of CIN.

Objective To investigate the impact of alprostadil injection on renal function of coronary heart disease patients complicated with diabetic nephropathy undergoing PCI. Methods From January 2014 to June 2015,a total of 107 coronary heart disease patients complicated with diabetic nephropathy were selected in the Department of Cardiology,the Second Hospital of Hebei Medical University,and they were divided into control group( n = 53) and experiment group( n = 54) according to therapeutic methods. Patients of the two groups received conventional PCI and standard hydration treatment, meanwhile patients of control group were given intravenous injection of 0. 9% sodium chloride injection(2 ml)before 12 hours of PCI,intravenous injection of 0. 9% sodium chloride injection(2 ml per time,1 time per day) after PCI for 6 days,while patients of experiment group were given intravenous injection of alprostadil injection ( 20 μg) before 12 hours of PCI, intravenous injection of alprostadil injection(20 μg per time,1 time per day)after PCI for 6 days. eGFR and CysC before PCI, after 24 hours,48 hours and 72 hours of PCI,UAER and ACR before PCI and after one week of PCI were compared between the&nbsp;two groups. Results There was interaction between time and method in eGFR and CysC(P ﹤ 0. 05);the main effects of time and method were significant in eGFR and CysC(P ﹤ 0. 05);after 24 hours,48 hours and 72 hours of PCI,eGFR of experiment group was statistically significantly higher than that of control group,respectively,while CysC of experiment group was statistically significantly lower than that of control group,respectively( P ﹤ 0. 05). No statistically significant differences of UAER or ACR was found between the two groups before PCI(P ﹥ 0. 05). After 1 week of PCI,UAER and ACR of experiment group were statistically significantly lower than those of control group(P ﹤ 0. 05);meanwhile UAER and ACR of experiment group were statistically significantly lower than those before PCI(P ﹤ 0. 05),while UAER and ACR of control group were not statistically significantly different compared with those before PCI ( P ﹥ 0. 05 ). Conclusion Alprostadil injection can effectively inhibit the increase of CysC of postoperative coronary heart disease patients complicated with diabetic nephropathy treated by PCI,improve the eGFR and reduce the urine trace albumin levels,has certain protective effect on renal function.

Objective To investigate the expression and meaning of LKB1 and survivin in non - small cell lung cancer(NSCLC). Meth-ods 60 samples of NSCLC patients were retrospectively selected into the present study. All these patients came from the pathology department of our hospital from March. 2014 to March. 2015,as the contrast group. At the same time,we selected the normal lung tissue beside the cancer area as blank group. RT - PCR was used to test the expression of the LKB1 gene and survivin gene. The relationship between the two genes and age, pathology type,clinical stage,size of the tumor were analyzed. Results In the contrast group,the expression of LKB1 gene was lower than the blank group( P < 0. 05),the survivin gene was higher than the blank group( P < 0. 05). The reducing expression of LKB1 had no relationship with the age,pathology type,degree of differentiation,size of the tumor( P > 0. 05),but positive relationship with the clinical stage( R = 0. 67,P < 0. 05). The rising expression of Survivin gene had no relationship with the age,size of the tumor,clinical stag,but positive relationship with the degree of differentiation( R = 0. 71,P < 0. 05). The expression of survivinis in the large cell lung cancer was higher than the squamous cancer and glandular cancer( P < 0. 05),but there was no obvious difference between those in squamous cancer and glandular cancer. Conclu-sion The low expression of LKB1 and the high expression of Survivin may relate to the tumorigenesis and the metastasis of tumor. LKB1 has the advantage of diagnosing the clinical stage of lung cancer. Survivin gene is more sensitive in distinguishing the pathology type of tumor and the dif-ferentiation degree. The two genes may become new tumor makers of lung cancer.

目的 探讨心肌梗死患者自体外周血干细胞(autologous peripheral blood stem cell,APBSC)动员、采集的效率,以及自体外周血干细胞移植(autologous peripheral blood stem cell transplantation,APBSCT)治疗心肌梗死的安全性和可行性.方法 46例心肌梗死患者在常规药物治疗基础上,冠状动脉旁路移植术(coronary artery bypass grafting,CABG)前5d,根据患者体质量,给予重组人粒细胞集落刺激因子(recombinant human granulocyte colony stimulating factor,rhG-CSF)450 μg/d(≤65 kg)或600 μg/d(＞65 kg)皮下注射,进行APBSC动员及扩增.CABG前24 h进行APBSC采集.46例患者均在非体外循环下行CABG,在完成血管桥吻合后,经桥血管及心外膜下注入采集的APBSC.在APBSC动员、采集前后检测外周血和采集产品中单个核细胞(mononuclear cells, MNC)及CD34+细胞数量.检测APBSC采集前后血压、心率、呼吸、白细胞(white blood cell,WBC)、红细胞(red blood cell,RBC)、血红蛋白(hemoglobin,Hb)、血细胞比容(hematocrit,Hct)、血小板(platelet,Plt)和血清Ca2+的变化.观察APBSC动员、采集、移植过程中有无不良反应.结果 APBSC动员后外周血中WBC、MNC、CD34+细胞数量较动员前显著升高(P＜0.01).APBSC采集后外周血中MNC、CD34+细胞数量较采集前显著升高(P＜0.01),APBSC采集前后血压、心率、呼吸、WBC、RBC、Hb、Hct及血清Ca2+变化差异无统计学意义(P＞0.05),Plt计数采集后较采集前明显降低(P＜0.01).APBSC动员、采集、移植过程中发生不良反应20例,其中APBSC动员过程中的不良反应占17.4％(8/46),APBSC采集过程中的不良反应占10.9％(5/46),APBSC移植过程中的不良反应占15.2％(7/46).结论 心肌梗死患者APBSC经过动员、采集后可获得较高的MNC和CD34+细胞产量;APBSCH治疗心肌梗死安全可行.

目的:通过单光子发射型电子计算机断层显像术(SPECT)评价自体外周血干细胞移植(APBSCT)治疗心肌梗死的临床疗效.方法:自2012年1月～2015年2月就诊于河北省胸科医院心肌梗死患者76例,根据是否行APBSCT分为移植组46例、对照组30例.入选患者常规药物治疗,移植组冠状动脉旁路移植术(CABG)前5天,进行自体外周血干细胞(APBSC)的动员及扩增,CABG前1天进行APBSC采集.入选患者采取非体外循环下CABG,移植组经心外膜下及冠状动脉桥血管注入采集的APBSC.两组均在术前及术后6个月运用SPECT评价心肌灌注情况;运用超声心动图评价左心室形态、室壁节段运动指数(WMSI)及心功能指标.结果:术后6个月时两组与术前相比心肌灌注缺损面积减小,左心室舒张末期内径(LVDd)较术前明显减小,左心室射血分数(LVEF)较术前明显增高,WMSI较术前明显降低,差异有统计学意义(P＜0.05).移植组术后指标更优于对照组,差异有统计学意义(P＜0.05).结论:CABG同期APBSCT治疗心肌梗死能改善心肌血流灌注,SPECT对APBSCT治疗心肌梗死有较高的临床价值.

Objective To investigate the effects of bisoprolol on chromaffin granule protein A (CgA) in heart failure patients with preserved left ventricular ejection fraction (HFpEF), and to explore the role of CgA in HFpEF patients and the treatment effect of bisoprolol.Methods 66 chronic heart failure patients were randomly divided into treatment group and control group (33 patients in each group). Treatment group was given bisoprolol and standardized treatment, the control group was only given standardized treatment. CgA level and change of echocardiography were measured two weeks after treatment in two groups.Results There is no difference as to CgA level, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), E peak, A peak, E/A and left ventricular isovolumic relaxation time (IVRT) between two groups before treatment (P>0.05). After treatment, all the indexes above in treatment group were improved better than control group (P<0.05). The total effective rate in treatment group was higher than control group (87.87%vs. 63.63%,P<0.05).Conclusion The effect of bisoprolol on HFpEF patients is remarkable. CgA is useful for condition judgment and prognosis of HFpEF patients.

目的:观察国产草酸艾司西酞普兰对缺血性慢性心力衰竭合并抑郁症状患者内皮功能及心血管事件的影响,进一步评价草酸艾司西酞普兰的临床疗效,并探讨其机制.方法:将100例确诊为慢性缺血性心力衰竭合并抑郁症状患者随机分为对照组(n=48)和治疗组(n=52),两组患者均给予慢性缺血性心力衰竭常规治疗和心理干预,治疗组患者每早加服国产草酸艾司西酞普兰10 mg,两组患者于治疗前及治疗8周末进行汉密尔顿抑郁量表(HAMD)评分,测定肱动脉血流介导的内皮依赖性血管舒张功能(FMD),并记录心绞痛、心力衰竭、急性心肌梗死和恶性心律失常的发生情况.结果:治疗8周后,治疗组与对照组的HAMD评分分别为(7.61±3.32)和(20.27±3.06)分,有统计学显著差异(P＜0.05);治疗组与对照组的肱动脉血流介导的FMD分别为(4.40±0.52)％和(4.66±0.56)％,有统计学显著差异(P＜0.01).治疗组心绞痛发作、急性心肌梗死、急性心力衰竭及恶性心律失常发生率分别为7.69％,0％,3.85％和1.92％,对照组分别为16.67％,4.17％,6.25％和4.17％.两组的心血管事件有统计学差异意义(P＜0.05).结论:草酸艾司西酞普兰可以明显改善慢性缺血性心力衰竭合并抑郁症状患者的抑郁状态,改善患者的血管内皮功能,进一步降低心血管事件,且药物安全.

Nonalcoholic fatty liver disease ( NAFLD ) is a clinical syndrome characterized by hepatic steatosis and fat deposition,without history of excessive drinking.The incidence of NAFLD is on the rise sig-nificantly both in China and abroad.Insulin resistance is a common reason of many kinds of metabolic disea-ses,such as type 2 diabetes mellitus,obesity,hypertension,dyslipidemia,and many metabolic diseases are associated with NAFLD.And a number of studies have confirmed that insulin resistance and NAFLD are correlated significantly, NAFLD can affect insulin signaling pathway directly or indirectly.Searching for the related factors of insulin resistance induced by NAFLD to explore the molecular mechanism of its occurrence , development and treatment, may be the future research direction.

Objective To observe the effect of bisoprolol in heart failure patients with preserved left ventricular ejection fraction.Methods 52 heart failure patients with preserved left ventricular ejection fraction from September to February in 2014 were selected as subjects. According to the random number table, subjects were divided into observation group and control group, each group had 26 subjects. Each group received routine treatment, observation group was given bisoprolol, control group only received routine drug treatment. Subjects were followed up for 3 months after 14 days’ treatment. Blood pressure, heart rate, neuroendocrine factors, left ventricular fractional shortening (FS), cardiac output (CO), the changes of left ventricular function and clinical curative effect were compared between two groups, before and after treatment.Results There were no significant differences in gender, age and NYHA function between two groups (P>0.05). Heart rates of observation group were significantly lower than control group (P<0.05). After treatment, systolic blood pressure, diastolic blood pressure, thromboxane B2, tumor necrosis factor-α, brain natriuretic peptide was statistically significant between two groups (P<0.05). FS and CO in two groups were different before and after treatment (P<0.05), especially for observation group (P<0.05).Conclusion Compared with conventional drug therapy, bisoprolol is more effective in heart failure patients with preserved left ventricular ejection fraction.

Objective To study the clinical efficacy of autologous peripheral blood stem cell transplantation for the treatment myocardial infarction,in the same period of coronary artery bypass grafting (CABG).Methods From January 2012 to January 2015,76 patients with myocardial infarction were selected.Patients were divided into transplantation group (n =46) and control group (n =30) on the basis of whether being treated by autologous peripheral blood stem cell transplantation.After myocardial infarction patients were taken to the hospital with the therapy of conventional drug,5 days before CABG,transplantation group was given the autologous peripheral blood stem cell mobilization and expansion,24 hours before CABG,taking autologous peripheral blood stem cell collection.76 patients took CABG with non-cardiopulmonary by pass,transplantation group was given autologous peripheral blood stem cell via transplantation vessels and subepicardial,while the control group was not given the injection of autologous peripheral blood stem cell.The LV morphology,wall motion score index (WMSI) and index of cardiac function before and after the operation in both groups were evaluated by echocardiography.Results Six months after CABG,there was a significant decrease in Left ventricular end-diastolic diameter and wall motion score index,Left ventricular ejection fraction was increased.The indexes of cardiac function in the transplantation group were better than the control group.Conclusion Autologous peripheral blood stem cell transplantation for the treatment myocardial infarction can improve the heart function,and has obvious recent clinical curative effect in the same period of CABG.

Objective To explore the effects of bisoprolol adding to the conventional therapy on neuroendocrine hormones in patients with heart failure with preserved left ventricular ejection fraction ( HFPEF ) .Methods Fifty-one patients with HFPEF were randomly assigned into two groups: control group ( n =25 ) and trial group ( n =26 ).The control group was treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonist and aldosterone receptor antagonists, diuretics and other drugs combination therapy.The trial group was the control group plus bisoprolol 5 -10 mg · d-1 .Each group was two weeks.The levels of brain natriuretic peptide ( BNP ) , atrial natriuretic peptide ( ANP ) , leptin, chromogranin A ( CGA ) , interleukin -6 ( IL-6 ) , thromboxane B2 ( TXB2 ) , tumor necrosis factor -α( TNF-α) , endothelin ( ET ) , hypersensitive C-reactive protein ( hs-CRP) were observed fourteen days before and after the treatments, and the incidence rate of adverse drug reactions.Results The total efficiency of the trial group was 88.46%significantly higher than 60.00%in the control group(P<0.05).The levels of plasma BNP, ANP, leptin, CGA, ET, hs-CRP were significantly decreased in the trial group ( P<0.05 ) after treatment.The levels of plasma BNP, ANP, Leptin, CGA, hs-CRP were significantly decreased in the control group ( P<0.05) after treatment.The levels of BNP, leptin, CGA, ET, hs-CRP lower in trial group than in the control group ( P<0.05 ).The incidence rate of adverse drug reactions were not statistical difference between the two groups ( P>0.05).Conclusion Bisoprolol adding to the convertional therapy can significantly improve the heart function of patients with HFPEF and can lead to more decrease of BNP, leptin, CGA, ET, hs -CRP than the conventional therapy.