目的 探讨水化方案对冠状动脉介入术后造影剂肾病的临床疗效.方法 本研究为前瞻性研究,选取新余市人民医院2017年1月至2021年1月应用碘佛醇造影剂行冠状动脉介入150例患者,按照随机数字表法分为水化治疗组和常规治疗组,每组各75例,年龄40～75岁.(1)水化治疗组:在接受冠脉造影及血管介入治疗患者术前6 h静脉给予0.9％氯化钠溶液,滴速为1 ml/(kg·h),直至术后12 h.(2)常规治疗组:冠脉造影患者术后给予0.9％氯化钠溶液500 ml静滴,冠脉造影及冠状动脉介入术患者术后给予0.9％氯化钠溶液1000 ml静滴.观察血肌酐水平、β2微球蛋白水平变化情况、造影剂肾病发生情况.结果 水化治疗组和常规治疗组术前1d血肌酐水平对比,差异无统计学意义(P>0.05);常规治疗组术后2 d、术后1个月血肌酐水平均高于术前1 d(P<0.001);水化治疗组术前1 d、术后2 d、术后1个月血肌酐水平对比,差异无统计学意义(P>0.05);水化治疗组术后2d、术后1个月血肌酐水平低于常规治疗组同时期(P<0.001);水化治疗组和常规治疗组术前1 dβ2微球蛋白水平对比,差异无统计学意义(P>0.05);常规治疗组术后2 d、术后1个月β2微球蛋白水平均高于术前1 d(P<0.05);水化治疗组术前1 d、术后2 d、术后1个月β2微球蛋白水平对比,差异无统计学意义(P>0.05);水化治疗组术后2 d、术后1个月β2微球蛋白水平低于常规治疗组同时期(P<0.001);水化治疗组CIN发生率低于常规治疗组(P<0.001).结论 水化方案能够提升冠状动脉介入术后造影剂肾病的临床预后,能够改善患者的血肌酐水平、β2微球蛋白水平变化情况,降低CIN发生率.

目的 探讨苯溴马隆片联合非布司他在高尿酸血症(HUA)治疗中的应用效果.方法 选择2018年6月-2020年4月于信阳市第四人民医院治疗的82例HUA患者,依随机数字表法分成对照组(41例,非布司他治疗)和观察组(41例,苯溴马隆片联合非布司他治疗).比较两组疗效、肾功能指标[尿微量白蛋白(ALB)、血尿素氮(BUN)、血肌酐(Scr)、胱抑素C(Cys C)]、炎症指标[白介素(IL)-6、IL-1β、超敏C反应蛋白(hs-CRP)、核苷酸结合寡聚化结构域样受体蛋白3(NALP3)]及不良反应.结果 观察组总有效率为95.12％,高于对照组(78.05％),差异有统计学意义(P＜0.05);治疗2个月后,观察组ALB、Cys C、BUN、Scr水平[(10.26±0.75) mg/24 h、(0.82 ±0.36) mg/L、(4.85±0.83) mmol/L、(86.29±9.35) μmol/L]低于对照组[(11.33±0.96)mg/24 h、(1.07 ±0.48) mg/L、(5.49±0.89) mmol/L、(104.31±11.49) μmol/L],差异有统计学意义(P＜0.05);治疗2个月后,观察组IL-6、IL-1β、NALP3、hs-CRP水平[(1.82±0.53) pg/mL、(897.72±40.38) ng/L、(7.43 ±0.62) ng/L、(2.33±0.39) mg/L]低于对照组[(2.47±0.65) pg/mL、(1022.53±48.46) ng/L、(8.75±0.83) ng/L、(3.57 ±0.56) mg/L],差异有统计学意义(P＜0.05);观察组不良反应发生率为9.76％,与对照组4.88％比较,差异无统计学意义(P＞0.05).结论 苯溴马隆片联合非布司他治疗HUA效果较好,可有效改善患者肾功能,减轻炎症反应,且用药安全性较高.

目的 探讨老年2型糖尿病(T2DM)胰岛素强化治疗效果的影响因素.方法 采用前瞻性随机试验方法,选取信阳市第四人民医院内分泌科2018年6月-2019年6月收治的94例老年T2DM患者作为研究对象,所有患者均给予胰岛素强化治疗,根据患者血糖控制情况将其分为一般组和良好组.统计94例患者一般资料,经Logistic回归分析找出老年T2DM胰岛素强化治疗效果的影响因素.结果 94例老年T2DM经胰岛素强化治疗后,有67例血糖控制良好,占71.28％;有27例血糖控制一般,占29.72％;良好组患者运动干预、治疗方式、治疗依从性、治疗前C肽水平与一般组患者对比,差异有统计学意义(P＜0.05);经Logistic回归分析,提示运动干预、胰岛素泵、治疗依从性良好、治疗前C肽高表达均为老年T2DM胰岛素强化治疗效果的保护因素.结论 老年T2DM胰岛素强化治疗效果受多种因素影响,其中运动干预、胰岛素泵、治疗依从性良好、治疗前C肽高表达等为其保护因素,可有效增强治疗效果.

目的:探讨米力农与洋地黄毒苷片治疗慢性心力衰竭的疗效及对心功能的影响.方法:收集2015年1月—2018年8月收治的慢性心力衰竭患者82例,按照不同用药方案分为观察组35例和对照组47例.对照组给予对症治疗和洋地黄毒苷片,每日0.125 mg/次或0.25 mg/次,共2周.观察组在对照组基础上每日静脉泵注含米力农0.3 mg/kg的氯化钠液50 ml,共2周.观察两组患者的疗效和治疗前后Lee氏计分、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)和心脏指数(CI)变化情况.结果:观察组总有效率为94.29％(33/35),优于对照组的76.60％(36/47,P<0.05).观察组治疗后Lee氏计分和LVEDD均低于对照组,LVEF和CI均高于对照组(P<0.05).结论:米力农联合洋地黄毒苷片治疗慢性心力衰竭疗效显著,可明显改善患者心功能,可作为优选治疗方案.

目的:研究CYP2C19基因多态性检测在冠心病氯吡格雷治疗中的应用价值.方法:选取2016年4月-2017年12月本院收治的冠心病患者120例,按照随机数字表法分为治疗组(n=60)与对照组(n=60).对照组采用传统治疗方式,治疗组采用CYP2C19基因导向的治疗方式.对比两组不良心血管事件发生率、血小板抑制率.结果:治疗12个月后,强代谢者血小板抑制率高于中代谢者、慢代谢者、对照组,差异均有统计学意义(P<0.05);治疗组心源性死亡、脑血管意外、大出血及支架内血栓形成发生率均低于对照组,差异均有统计学意义(P<0.05).结论:CYP2C19基因多态性检测在冠心病氯吡格雷治疗中,可有效及早发现PCI术后氯吡格雷抵抗,降低氯吡格雷反应性,抑制血小板凝聚,降低支架内血栓形成等不良心血管事件发生率.

目的 探讨冠心病患者血脂水平检测及载脂蛋白E(ApoE)基因多态性分析的临床意义.方法 选取本院2016年10月～2018年3月收治的90例冠心病患者作为实验组,另选取同期住院的90例非冠心病患者作为对照组.采用生物化学的方法分别对经冠状动脉造影确诊的90例实验组患者和90例对照组患者进行空腹血脂水平检测,采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)分析方法对ApoE基因进行多态性分析.结果 实验组的总胆固醇、三酰甘油、低密度脂蛋白胆同醇(LDL-C)、载脂蛋白B及脂蛋白a水平均高于对照组(P＜0.05),载脂蛋白A1水平低于对照组(P＜0.05).实验组ApoE等位基因ε2基因型频率明显低于对照组(P＜0.05).结论 ApoE基因多态性特征会明显影响人群中个体的血浆脂质水平,增加人群中个体发生冠心病的危险,为有效预防冠心病提供有力依据.

目的 探讨血栓抽吸在急性ST段抬高型心肌梗死(STEMI)患者急诊介入治疗的效果.方法 选取2015年7月～2017年6月本院接诊的86例行急诊介入治疗的STEMI患者,按照数字抽签法随机分为观察组和对照组,各43例.对照组行单纯经皮冠状动脉介入术(PCI)治疗,观察组在PCI术中接受血栓抽吸治疗,比较两组治疗效果.结果 观察组治疗后TIMI血流分级3级以及心电图ST段回落幅度≥50％所占比例均高于对照组,差异有统计学意义(P<0.05).观察组患者治疗后CK-MB、肌钙蛋白峰值水平均低于对照组,差异有统计学意义(P<0.05).两组患者治疗后1周LVEF及LVEDD水平对比差异无统计学意义,观察组患者治疗后3个月LVEF水平高于对照组,LVEDD水平低于对照组,差异有统计学意义(P<0.05).观察组心脏不良事件总发生率显著低于对照组,差异有统计学意义(x2=7.242,P<0.05).结论 血栓抽吸能够提高急性ST段抬高型心肌梗死患者急诊介入治疗的效果,可有效改善患者心肌功能,降低术后心脏不良事件发生率,临床应用价值较高.

目的 探讨主动脉球囊反搏术(IABP)在高危急性心肌梗死治疗中的应用效果.方法 按照随机数字表法将40例高危急性心肌梗死患者均分为观察组和对照组各20例.对照组行急诊介入治疗,观察组行急诊介入治疗+IABP辅助治疗.对比2组患者收缩压、舒张压、心率、尿量及并发症发生情况.结果 观察组收缩压、舒张压、尿量均高于对照组,心率低于对照组,差异有统计学意义(P<0.05);观察组患者病死率低于对照组,差异有统计学意义(P<0.05).结论 IABP应用在高危急性心肌梗死治疗中能有效地稳定血流动力学,降低介入治疗的病死率,而且并发症少,临床应用价值高.

选取我院2015年1月～2016年2月期间收治的70例老年T2DM患者为,随机将其分为对照组35例.给予甘精胰岛素治疗,观察组35例在加以磷酸西格列汀治疗.结果观察组HOMA-IR、HOMA-β及空腹C肽水平优于对照组,(P＜0.05);治疗后两组HbA1c 、FBG及2hPG水平均显著下降,观察组优于对照组(P＜0.05);不良反应发生率低于对照组,(P＜0.05).结论老年T2DM患者给予磷酸西格列汀联合甘精胰岛素治疗可有效改善胰岛功能,控制血糖水平.

学科建设是医院发展与改革的“永恒”主题,学科建设水平的高低是医院整体实力的重要标志.面对建设区域中心医院的新形势,为切实推进学科建设,积极创建省医学领先学科、省市共建学科及市领先学科,不断提升医疗技术水平和核心竞争力,我院提出了加强学科建设的战略方针.现将我院近几年在学科创新管理研究方面的情况报告如下.

目的：探讨前列地尔联合血栓通治疗糖尿病下肢血管病变的临床效果。方法将2014年6月至2015年6月信阳市第四人民医院收治的84例糖尿病下肢血管病变患者随机分成对照组和观察组，各42例。给予所有患者糖尿病常规治疗，对照组在此基础上给予前列地尔治疗，观察组在对照组基础上加用血栓通治疗，测定两组治疗前后无痛行走距离、最大行走距离、下肢疼痛积分以及踝肱指数（ABI）。结果治疗前，两组无痛行走距离、最大行走距离、ABI 及下肢疼痛积分差异无统计学意义（P ＞0.05）；治疗后，观察组无痛行走距离、最大行走距离、ABI 及下肢疼痛积分均优于对照组，差异具有统计学意义（P ＜0.05）。结论前列地尔联合血栓通治疗糖尿病下肢血管性病变的临床效果肯定，能够显著改善症状，减轻患肢疼痛，延长行走距离，值得推广应用。

Objective Explore the hydroxyl benzene sulfonic acid calcium combined a cobalt ammonium in clinical ef-fect in the treatment of diabetic neurogenic lesions. Methods Collect our hospital October 2014 to March 2016 during the month of 140 patients having symmetrical distal diabetic neuropathy clinical data of patients were randomly divided into treatment and control groups,, the treatment group (n = 70) with hydroxyl benzene sulfonic acid calcium in combi-nation with a cobalt ammonium treatment; The control group (n = 70), a cobalt ammonium treatment alone. Treatment cycle for 12 weeks, and then observe two groups of patients in general symptom scores before and after the treatment (TSS) and nerve dysfunction score (NDS) to compare the clinical efficacy of change. Results After 12 weeks of treat-ment, patients treated with TSS score (7.7 ± 2.1) points, NDS score (7.6 ± 2.2) points, significantly better than the con-trol group (P<0.05), each group patients are resistant to treatment, and good security. Change in the TTS indicators for the "pain", the most obvious difference has the remarkable significance (P< 0.01). Conclusion Hydroxy benzene sul-fonic acid calcium in combination with a cobalt ammonium treatment of diabetic peripheral neuropathy effect is obvi-ous, is an effective way to treat diabetes neurologic lesions.

目的：分析冠脉内超声（intravascular ultrasound， IVUS）与血流储备分数（fractional flow reserve，FFR）检查在冠脉临界病变介入治疗中的应用价值。方法将63例冠状动脉造影为临界病变患者随机分为强化他汀药物治疗组、血运重建组和对照组，比较不良心血管事件的发生情况。结果血运重建组再发心绞痛1例；强化他汀药物治疗组中，出现急性心肌梗死1例，再发心绞痛2例；对照组中再发心绞痛2例。3组主要的不良心血管事件的发生率均较低。结论 FFR可作为冠状动脉临界病变是否需要经皮冠状动脉介入治疗（PCI）治疗的重要临床依据，FFR>0.75，IVUS检查能够提示不稳定斑块，单纯药物治疗是安全的。

目的 观察尤瑞克林对兔心肌缺血再灌注损伤的保护作用,并探讨其作用机制.方法 新西兰大白兔48只,随机均分成假手术组(Sham组)、缺血再灌注组(I/R组)、尤瑞克林治疗组(Y组).术中观察心电图变化,测定各组不同时间点血清中肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、内皮素-1(ET-1)和一氧化氮(NO)的含量；再灌注结束后I/R组、Y组各取8只兔心肌组织,进行相应染色后通过光学显微镜观察形态学变化,电境观察超微结构变化.结果 与I/R组相比,Y组的CK-MB、cTrI、IL-6、TNF-α、ET-1水平明显降低(P均＜0.05),NO生成增加(P均＜0.05)；心肌组织形态学及超微结构损伤明显减轻.结论 尤瑞克林对兔缺血再灌注损伤心肌具有明显保护作用,并能明显减轻心肌细胞和组织的损伤,其作用机制可能与其抗炎、保护血管内皮功能有关.

Objective To investigate the efficacy of "hypertension club" in the prevention and treatment of hypertension.Methods A total of 131 patients with hypertension were given systematic management and education through establishing "hypertension Club".Carotid-femoral pulse wave velocity(CF-PWV),medication compliance,blood pressure control rate,bad lifestyle and patient satisfaction with medical staff were compared before and 6 months after joining "hypertension club".Results CF-PWV value and bad lifestyle significantly decreased but medication compliance,blood pressure control rate and patient satisfaction with medical staff significantly increased 6 months after joining "hypertension club"(P<0.01).Conclusion "Hypertension club" is effective for the prevention and treatment of hypertension.

Objective To evaluate the clinical efficacy of combined treatment with sildenafil and fluvastatin in patients with pulmonary arterial hypertension(PAH).Methods Thirty patients with PAH were treated with sildenafil 25 mg tid alone(sildenafil group,n=15) or in combination with fluvastatin 40 mg qn(combination group,n=15).Right heart catheterization,6-minute-walk test(6MWT) and arterial partial pressure of oxygen(PaO2) measurement were performed to evaluate the curative effect before and 16 weeks after treatment.In addition,levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood urea nitrogen(UREA),creatinine(CREA) and creatine kinase(CK) were detected.Results Mean pulmonary artery pressure(mPAP) significantly decreased and 6MWT and PaO2 obviously increased(P0.05) after treatment in both groups.Moreover,the decrease in mPAP and increase in 6MWT and PaO2 in combination group were more obvious than those in sildenafil group(P0.05).However,no significant changes in ALT,AST,UREA,CREA and CK were found after treatment in both groups(P0.05).Conclusion Sildenafil combined with fluvastatin is an effective and economical treatment for PAH.

Objective To study the protective effect of fasudil on myocardial ischemia-reperfusion injury(MIRI) in rabbits and its mechanism of action.Methods Thirty-six New Zealand rabbits were randomly divided into three groups:sham operation group(Sham group),ischemia-reperfusion group(I/R group) and fasudil treatment group(F group),with 12 rabbits in each group.The model of acute MIRI was established.Intraoperative electrocardiogram changes were observed and levels of serum creatine kinase MB(CK-MB),troponin Ⅰ(cTnⅠ),tumor necrosis factor-α(TNF-α)and nitric oxide(NO) were detected at different time points.At the end of reperfusion,the morphological changes in myocardial tissue were observed under an optical microscope and the ultrastructural changes were observed with an electron microscope.Results Compared with I/R group,CK-MB,cTnⅠ and TNF-α levels and structural damage significantly decreased and NO levels obviously increased in F group(P<0.05).Conclusion Fasudil exerts a protective effect on MIRI and reduces myocardial cell and tissue damage through a mechanism involving anti-inflammation and vascular protection.

Objective To study the clinical significance of serum deoxyribonuclease Ⅰ(DNaseI) activity in patients with acute myocardial infarction(AMI).Methods The serum DNase Ⅰ activity and the levels of creatine kinase-MB(CK-MB) and cardiac troponin-T(cTn-T) were determined in coronary heart disease patients who had acute chest pain within 12 hours(except systemic lupus erythematosus) and 42 healthy subjects or patients without evidence of myocardial ischemia(control group).These patients with coronary heart disease were divided into three groups:AMI group(n=48),unstable angina pectoris group(n=43) and stable angina pectoris group(n=43).Results Serum DNaseⅠ activity in patients with AMI began to increase within 3 hours after symptom onset and reached a peak,then it began to decline within 12 hours and returned to baseline within 24 hours.Serum CK-MB and cTn-T levels began to increase 3-6 hours after symptom onset.Serum DNase Ⅰ activity in unstable angina pectoris group,stable angina pectoris group and control group was maintained in the normal range,and was significantly different from that in AMI group(P<0.05).Conclusion Serum DNaseⅠ activity is a more specific and sensitive index than CK-MB and cTn-T levels for diagnosis of AMI.

Objective To investigate the effect of Ghrelin on human umbilical vein endothelial cells(HUVECs) apoptosis induced by angiotensin Ⅱ(AngⅡ) in vitro.Methods HUVECs cultured in vitro were randomly divided into 6 groups:control group,Ghrelin group,AngⅡ group,AngⅡ+Ghrelin(10-8mol/L)group,AngⅡ+Ghrelin(10-7 mol/L)group and AngⅡ+Ghrelin(10-6mol/L) group,with 6 multiple pores in each group.After 18 h culture,the HUVECs viability was analyzed by using MTT and the ratio of cell apoptosis was detected by flow cytometry.Results AngⅡ obviously decreased HUVECs survival rate and increased apoptosis ratio,compared with the control group(all P0.01).Ghrelin significantly inhibited the decrease of cell survival and increase of apoptosis ratio induced by AngⅡin a concentration-dependent manner.However,Ghrelin alone did not influence HUVECs apoptosis.Conclusion Ghrelin can protect HUVECs from AngⅡ-induced apoptosis.

Objective To investigate the changes of arterial stiffness by measuring pulse wave velocity(PWV) in prehypertensive people.Methods The carotid-femoral PWV(CF-PWV) were measured in 622 prehypertensive people using Complior SP automatic arteriosclerosis measurement system,and were compared with normotensive group (n=512) and hypertension grade 1 group(n=445).Results The CF-PWV of prehypertensive group was significantly higher than normotensive group and lower than hypertension grade 1 group.The difference between every two groups were significant (all P0.01).Conclusions Arterial stiffness increases in prehypertensive people with arterial elasticity already decreased,which is better than that of hypertensive people.