目的探讨老年颈动脉粥样硬化伴高同型半胱氨酸（homocysteine,Hcy）血症患者在叶酸（folic acid,FA）、维生素B12（vitamin b12,VitB12）治疗前后血清低氧诱导因子-1α（hypoxia inducible factor-1,HIF-1α）,P-选择素(（P-selection,CD62p）和超敏C反应蛋白（hsCRP）表达变化。方法选择2016年1月～2017年3月湖北医药学院附属东风医院收治的老年颈动脉粥样硬化伴高Hcy血症患者140例,以随机表法分为观察组（70例）和对照组（70例）,两组在相同常规治疗基础上,只对观察组给予口服叶酸5mg/天和VitB12 500μg/天进行干预治疗。在入院治疗4周后检测患者血清Hcy,叶酸,VitB12浓度和血清HIF-1α,CD62p,hsCRP表达水平;并应用超声仪测量其两组患者颈动脉斑块在治疗前后的积分状况。结果治疗后观察组血清Hcy,HIF-1α,CD62p,hsCRP水平和动脉粥样硬化斑块积分均低于对照组,两组间的差异均有统计学意义（t=7.847,7.847,23.96,20.104,均P＜0.05）;患者血清HIF-1α,CD62p和hsCRP表达水平与颈动脉粥样硬化相关性为r=0.683,0.588,0.501,P＜0.05,HIF-1α与hs-CRP表达水平相关性为r=0.606,P＜0.05,CD62p与hsCRP表达水平相关性为r=0.615,P＜0.05,均呈正相关;患者血清HIF-1α与CD62p的表达水平无相关性（r=0.112,P＞0.05）。结论叶酸和VitB12联合治疗可降低血清Hcy,HIF-1α,CD62p和hsCRP的表达水平,对相关患者进行叶酸,VitB12,Hcy,HIF-1α,CD62p和hsCRP等项目检测,对预防治疗和评估老年颈动脉粥样硬化程度具有重要的临床价值。

Objective To investigate the changes of Troponin Ⅰ(cTnⅠ),high sensitivity C reactive protein(hs-CRP) and N-terminal pro brain natriuretic peptide type B(NT-ProBNP) in elderly patients with chronic heart failure and its prognostic value.Methods 76 elderly patients with chronic heart failure in our hospital from January 2015 to February 2016 were selected as the observation group,and according to the heart function classification program recommended by New York Heart Association (NY-HA),they were divided into 10 cases of grade Ⅰ,25 cases of grade Ⅱ,26 cases of grade Ⅱ,15 cases of grade Ⅳ.50 healthy elderly patients in our hospital were selected as the control group.The levels of cTnI,hs-CRP and NT-ProBNP were detected and compared between the two groups.The patients in the observation group were followed-up for 1 year after discharge,and the incidence of cardiovascular events were observed.Results The levels of cTnI,hs-CRP and NT-ProBNP in the observation group were higher than those in the control group;the levels of cTnI,hs-CRP and NT-ProBNP in patients in grade Ⅰ,grade Ⅱ,grade Ⅲ and grade Ⅳ gradually increased;19 patients had cardiovascular events,55 patients had no cardiovascular events,and another 2 cases were lost.The levels of cTnI,hs-CRP and NT-ProBNP in the cardiovascular event group were higher than that in the non cardiovascular event group,and the differences above were statistically significant (P ＜ 0.05).Conclusion CT-hI,hs-CRP and NT-ProBNP can better reflect the cardiac function in elderly patients with chronic heart failure,and have important reference value for the evaluation of the disease and prognosis.

目的 探讨血清神经元特异性烯醇化酶(NSE)水平对非痴呆性血管性认知障碍(VCIND)患者进展至血管性痴呆(VaD)的预测价值.方法 前瞻性、连续性队列研究,纳入湖北医药学院附属东风医院于2014年6月14日～2015年10月1日期间初次收治、尚处于VCIND阶段的患者为观察队列,对其进行为期一年的随访以确认预后转归,确诊VaD后,采用修订版简易精神状态检查量表(MMSE-R)评定痴呆程度.分析进展至VaD与未进展至的VaD患者各项临床资料差异性;按基线NSE水平对其进行四分位数分组,使用Logistic回归分析不同NSE水平对于进展至VaD的预测价值;以随访时MMSE-R量表为因变量,以NSE等其他临床指标为自变量,基于多元线性回归分析基线NSE水平对进展至VaD的影响.结果 (1)观察队列中所有患者均至少进行为期一年的随访,最终纳入66患者的临床资料,16例患者于随访期内进展至VaD(实验组)、50例患者于随访期未见病情进展(对照组).实验组患者的年龄、BMI、吸烟史所占比、TC、NSE均显著高于对照组,其差异均有统计学意义(P＜ 0.05);C-Peptide显著低于对照组,差异具有统计学意义(P＜0.05).(2)依照基线NSE水平行四分位分组,单因素Logistic 回归分析显示,最高四分位分组进展至VaD的风险是最低四分位分组的1.43倍;通过多因素Logistic回归分析校正其他危险因素后,最高四分位分组进展至VCIND的风险依然为最低四分位分组的1.21倍.(3)多元线性回归显示,基线NSE水平与随访时MMSE-R评分存在显著相关性,依据多元线性回归方程,以一年为随访周期,NSE含量每升高1ng/mL,VaD患者的MMSE-R评分降低0.368分.结论 VCIND患者的NSE水平增加是其进展至VaD的独立危险因素,其水平与病情程度存在显著相关性.

Objective To investigate the change and clinical significance of serum hepcidin,serum ferritin (SF),transferrin re-ceptor (sTfR)and serum iron (SI)in patients in type 2 diabetes(T2DM).Methods 130 patients with T2DM were divided into 2 groups according to the 24 hour urine microalbumin (mAlb)quantitative:group A for trace microalbumin group 45 ca-ses (mAlb30~300 mg/24 h),group B for normal albuminuria group of 85 cases,an alternate period of 45 cases of healthy physical examination for group C (control group).Results Serum hepcidin and SF of group A (42.27±32.12 ng/ml,211.6 ±107.2 ng/ml)were significantly higher than those in group B (26.12 ± 18.36 ng/ml,179.1 ± 109.7 ng/ml)and the healthy control group (P <0.05),hepcidin and SF of group B was significantly higher than that of the control group (9.47 ±1.65 ng/ml,84.41±47.10 ng/ml,P <0.01),SI and transferrin receptor(sTfR)has no statistical significance between the three groups (P >0.05).Correlation analysis showed that patients with type 2 diabetes hepcidin was positively related with SF (P <0.05),hepcidin and sTfR,SI had no significant correlation.Conclusion These results indicated that there existed serum hepcidin and SF increased iron overload and iron metabolism disorder in type 2 diabetes.Therefore,detection of serum iron and SF can be used as a predictor of diabetes early renal damage.

目的：明确血浆脂蛋白相关磷脂酶A2含量（ LP－PLA2）与慢性心力衰竭（ CHF）患者预后的关联性。方法测定126例CHF患者入院时的血浆LP－PLA2水平，出院后常规随访12个月，依据随访期内出现心血管事件（ CE）与否，将CHF患者分为CE组与非CE组，分析2组临床资料及血清LP－PLA2对于CHF的检测价值。结果包括LP－PLA2在内，CE组与非CE组之间有9项组间资料差异有统计学意义。多因素Logistic回归分析显示LP－PLA2水平升高、NT－proBNP水平升高、LVEF降低、LVDD增加、BMI升高是CHF患者12个月内发生CE的独立危险因素。使用ROC曲线判定LP－PLA2预测CHF患者12个月内发生CE的概率，LP－PLA2水平5．12 ng／mL时预测价值最高，灵敏度为76．07％、特异性为67．89％。 Kaplan－Meier生存曲线提示LP－PLA2水平≥5．12 ng／mL时，CHF患者CE发生率增高。结论血浆LP－PLA2水平升高是CHF患者12个月内CE发生的独立危险因素，LP－PLA2水平可对CHF患者的预后转归进行有效预测。

Objective To investigate the clinical significance of N-terminal pro-B-type natriuretic peptide(NT-proBNP) detection in evaluation of acute type A aortic dissection (AAAD) prognosis .Methods Medical records of patients with confirmed diagnosis of AAAD were retrospectively analyzed .64 patients were enrolled in accordance with the inclusion and exclusion criteria ,and were di-vided into survival group(n=56) and death group(n=8) according to prognosis .Multivariate Logistic regression analysis was em-ployed to screen the independent risk factors which would affected the prognosis .Receiver operator characteristic ,ROC) curve was used to evaluate the predictive value of NT-proBNP for AAAD prognosis .Results Differences of history of smoking ,incidence sea-son ,disturbance of consciousness ,misdiagnosis ,low density lipid-cholesterol(LDL-C) ,fasting C-peptide(FCP) ,hypersensitive C-re-active protein(hs-CRP) ,cardiac troponin I(cTnI) ,NT-proBNP ,mean arterial pressure(MAP) and prothrombin time(PT) of pa-tients between the survival group and the death group showed statistical significance (P<0 .05) .Multivariate Logistic regression a-nalysis demonstrated that smoking history ,disturbance of consciousness ,high LDL-C ,high cTnI ,high NT-proBNP and low MAP were independent risk factors for patients with poor prognosis .ROC area under the curve(AUC) of NT-proBNP prediction for peri-operative mortality risk of patients with AAAD was 0 .697(P< 0 .05 ,95% CI:0 .643~0 .733) ,and its specificity and sensitivity were 75 .85% and 70 .07% ,respectively .When NT-proBNP was 909 .69 pg/mL ,its predictive value for AAAD was the best .Set the critical value as the threshold ,the patients above were divided into the threshold above group and the threshold below group . The survival rate of patients in the threshold below group [98 .18% (54/55)] was significantly higher than that in the threshold a-bove group[22 .22% (2/9)](χ2 = 7 .211 ,P< 0 .05) .Conclusion NT-proBNP level is closely related to the prognosis of patients with AAAD and NT-proBNP detection may be conducive to predicting high risk of AAAD .

Objective:To study clinical value of detections of glycosylated hemoglobin(HbA1c),high sensitive C reactive protein(hsCRP),urine microalbumin(UMA) and urine β2-microglobulin(β2-MG) in patients with type 2 diabetes mellitus(T2DM).Methods:A total of 224 T2DM patients were enrolled as T2DM group and 197 healthy subjects were regard as healthy control group.Levels of HbA1c,hsCRP,UMA and β2-MG were measured,and compared in two groups.Results:Compared with healthy control group,there were significant increase in levels of HbA1c [(5.24±0.75)% vs.(8.72±0.92)%],hsCRP [(1.13±0.89) mg/ L vs.(6.21±1.31) mg/ L],UMA [(14.9±9.24) mg/ L vs.(72.5±15.6) mg/ L] and urine β2-MG [(0.18±0.05) mg/ L vs.(1.24±0.28) mg/ L] in T2DM group,P0.05 or 0.01;Pearson correlation analysis indicated that HbA1c was positively correlated with incidence rates of DM complications(r=0.415,P0.05).Conclusion:Detections of glycosylated hemoglobin,high sensitive C reactive protein and urine trace protein are important for the diagnosis of type 2 diabetes mellitus.