年龄与代谢综合征的关系及防治对策

目的 了解中老年人群年龄与多种代谢异常的聚集状况,为心脑血管疾病的一级预防提供依据.方法 对744例中老年人按不同年龄分为5组,分析代谢综合征各项指标的变化规律及特点.结果 年龄与肥胖呈明显负相关(P＜0.001),与高血糖、高血压及冠心病、脑卒中呈明显正相关(P＜0.05,或P＜ 0.001);40～60岁组代谢综合征的患病率基本一致(约为30%),70岁以后明显增加,到80岁时可高达51%( P＜0.05,或P＜0.01).代谢综合征与冠心病和脑卒中的患病率均明显相关(P＜0.05),随着临床指标个数的增加,冠心病的患病率增加了6.8%,脑卒中的患病率增加了7.44%.结论 中年人群超重或肥胖的患病率明显高于老年组,应引起足够重视;随着年龄增长,代谢异常数目增多,尤其是≥3项指标的人数明显增加;代谢综合征作为心血管危险因素直接导致冠心病、脑卒中患病率增加.因此,针对中老年人群代谢综合征的特点,制定相应的干预措施十分重要.     

老年髋部骨折围手术期并发症危险因素评估

目的研究老年髋部骨折围手术期并发症相关危险因素。方法对2008年1月～2012年8月于我院因髋部骨折行手术治疗的571例老年患者临床资料进行回顾性研究,男性187例,女性384例;平均年龄73.75岁。37.8%患者合并高血压病,18.3%合并糖尿病,12.3%合并冠心病。收集并分析可能导致围手术期并发症相关危险因素,运用二分类Logistic多重逐步回归分析法;采用SPSS13.0进行统计分析,P<0.05有统计学意义。结果围手术期并发症110例,占总数的19.26%。通过统计学分析,年龄(OR=0.6,95%CI 0.4～0.9)、术前合并高血压(OR=1.6,95%CI 1.2～2.1)、术前合糖尿病(OR=0.3,95%CI0.1～0.6)、心功能不全(OR=1.8,95%CI 1.1～2.9)、美国麻醉师协会(ASA)分级≥3级(OR=2.2,95%CI1.2～4.3)、WBC计数升高(OR=1.8,95%CI 1.0～3.0)、低钾(OR=2.7,95%CI 1.3～5.5)、低白蛋白(OR=1.6,95%CI 1.0～2.5)、全身麻醉(OR=1.6,95%CI 1.1-2.3)、手术时间(OR=1.9,95%CI 1.2-3.1)为老年髋部骨折围手术期内并发症危险因素(P<0.05)。结论明确术前及术中危险因素,在预防和减少围手术期并发症过程中具有重要的作用。     

军队离退休干部高血压现状调查分析

目的分析2004—2005年驻湛部队60~81岁离退休老年干部高血压患病率及有关特点。方法以290例60~81岁心血管病危险因素调查结果为研究样本,对老年人高血压的患病率、高血压的类型、高血压患者合并其他心血管危险因素等情况进行分析。结果(1)该人群60~81岁高血压的患病率、治疗率、控制率分别为61.4%,62.8%,23.1%;(2)随着年龄增长,男女高血压患病率呈持续增加趋势(P<0.05);(3)老年人单纯收缩期高血压患病率为27.9%,占老年高血压的45.5%;(4)老年高血压合并至少一个其他心血管危险因素的比例为86.7%。结论高血压是部队老年离退休干部的常见心血管疾病,单纯收缩期高血压是老年高血压的常见类型,老年高血压患者绝大多数合并有其他心血管危险因素。     

北京市石景山区32 372例体检人群血脂异常流行病学调查研究

目的了解体检人群血脂异常的发生现状,并分析发生血脂异常的影响因素。方法选择2013年7月至2016年10月在中国中医科学院眼科医院进行健康体检的北京市石景山区的32 372例体检者为研究对象;采用问卷调查研究方式收集受试者的基线资料、体检指标及血脂指标;应用Logistic回归对影响机体血脂异常的危险因素进行研究。结果 32 372例体检人群血清胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)的平均水平分别为(5.31±1.32)mmol/L、(1.72±1.09)mmol/L、(1.40±0.61)mmol/L、(2.82±0.79)mmol/L。血脂异常的总发生率为44.79%(14 500/32 372),男性的发生率为51.06%(8 943/17 514),女性的为37.40%(5 557/14 858),不同性别间血脂异常发生率比较,差异有统计学意义(P<0.05)。单因素分析显示,血脂异常的发生与年龄、吸烟史、酗酒史、体质量指数(BMI)、喜欢吃油腻食品、喝茶史、向心性肥胖及高血压存在直接关系(P<0.05)。多因素Logistic回归分析显示,高龄[比值比(OR)=1.803,P=0.013]、有吸烟史(OR=1.995,P=0.017)、BMI≥24 kg/m~2(OR=3.894,P=0.001)、喜欢吃油腻食品(OR=3.023,P=0.003)、高血压(OR=2.281,P=0.013)、男性(OR=1.434,P=0.019)为血脂异常的危险因素。将BMI作为预测血脂异常的参考,其预测阈值点为BMI=24.40 kg/m~2。结论北京市石景山区体检人群血脂异常的发生率较高,高龄、吸烟、肥胖、喜欢吃油腻食品、男性及高血压可增加血脂异常的发生率。     

轻度肾功能减退是心血管疾病的独立危险因素

现已证实,终末期肾脏病(end-stage renal disease,ESRD)是心血管疾病(cardiovascular disease,CVD)的高危因素,ESRD病人CVD的发生率较同龄一般人群高5～8倍。然而近年发现,轻度肾功能减退患者[血肌酐轻度增高或肾小球滤过率(GFR)降低]CVD的危险也明显增高。探索这部分患者CVD危险性增加的机制及其防治措施更有助于改善慢性肾脏病患者的预后,因此已成为肾脏病学界近年的前沿研究领域。     

某营区中青年人群心血管疾病危险因素调查分析

目的：调查分析某营区中青年人群心血管疾病（CVD）危险因素变化情况。方法：选择某营区35～44岁人群中,1998年与2008年两次CVD危险因素调查资料完整者1116例,按照WHO-MONICA方案CVD危险因素调查方法进行调查。以1998年调查结果作为基线数据,连续监测10年,与2008年该人群血压、血糖、血脂、血尿酸、体重指数（BMI）等指标,以及高血压病、糖尿病、高尿酸血症、脂肪肝等的发生率进行比较。结果：（1）2008年CVD主要危险因素水平均显著高于1998年（P〈0.05）。其中升高幅度最大的为血尿酸（UA）水平,10年间升高了51.9%;其次为三酰甘油（TG）水平,升高了43.2%。（2）男性和女性CVD主要危险因素水平10年间均有所升高,但男性多种危险因素水平显著高于女性（P〈0.05）。（3）2008年CVD主要危险因素发生率均显著高于1998年（P〈0.05）,其中高尿酸血症发生率升高的幅度最大,升高了1.4倍;其次为糖尿病,升高了1.2倍。具有1种或以上危险因素者所占比例由1998年的21.4%上升到2008年的32.1%。结论：某营区35～44岁人群10年间CVD主要危险因素水平及发生率均呈上升趋势,CVD主要危险因素个体聚集倾向显著增高。     

影响老年创伤患者心肺复苏成功的危险因素分析

目的研究影响急诊老年创伤患者心肺复苏成功的危险因素。方法回顾性分析2010年~2013年急诊行心肺复苏的120例老年创伤患者,男性74例,女性46例;年龄62~82岁,平均(73.42±6.25)岁。其中32例复苏成功,成功率26.67%。对120例患者的临床资料进行Pearson单因素分析和多因素Logistic回归分析。结果 Pearson单因素分析显示,患者的年龄(χ~2=19.342)、第一目击者急救(χ~2=8.661)、心肺复苏开始时间(χ~2=61.204)、复苏时患者心律(χ~2=13.208)、肾上腺素用量(χ~2=19.171)及基础疾病(χ~2=30.727)等因素与老年创伤患者心肺复苏成功有关(P均0.05)。Logistic回归分析显示,患者的年龄≥70岁[OR=1.627(95%CI:1.43~2.24)]、无第一目击者急救[OR=1.587(95%CI:1.36~2.04)]、心肺复苏开始时间5min[OR=1.513(95%CI:1.15~1.98)]、复苏时患者心律非室颤[OR=1.487(95%CI:1.07~1.84)]、肾上腺素用量5mg[OR=1.822(95%CI:1.52~2.31)]及有基础疾病[OR=1.423(95%CI:1.02~1.78)]为影响老年创伤患者心肺复苏成功的危险因素,P均0.05。患者格拉斯哥昏迷评分(GCS)和神经功能缺损评分(NFI)在3个月后均较治疗7d时有明显改善,差异均有统计学意义(P0.05)。结论影响急诊老年患者心肺复苏成功的危险因素包括患者的年龄、第一目击者急救、心肺复苏开始时间、复苏时患者心律、肾上腺素用量及基础疾病等。     

老年男性吸烟指数与缺血性卒中发生的剂量-效应关系

卒中是中国人群致死、致残的第一大疾病,其中缺血性卒中约占75%左右。既往研究表明,吸烟是缺血性卒中（IS）的常见致病因素[1]。然而,吸烟的危害虽已得到人们的广泛认识,但中国男性缺血性卒中患者的吸烟尚未得到良好控制。我国是世界上最大的烟草生产、消费国,吸烟人群众多。吸烟作为可干预的重要危险因素,     

综合危险因素预测稳定型心绞痛患者冠状动脉病变

目的分析肾功能损害等危险因素对稳定性心绞痛患者冠状动脉(冠脉)病变程度的相关性,并建立评估冠脉病变的数学模型。方法1024例行冠脉造影患者分为病变组(625例)和对照组(399例),评估肾功能损害等冠心病的临床危险因素,以Logistic回归结合ROC曲线分析其与冠脉病变的相关性,并建立评估冠脉病变的回归模型。结果回归分析显示尿蛋白:肌酐比值>7.25μg/mg(OR=3.6;95%CI2.6～4.9;P<0.001),超敏C反应蛋白(hsCRP)>20mmol/L(OR=3.2;95%CI2.3～4.4;P<0.01),GFR<60ml/min·1.73m2(OR=2.3;95%CI1.4～3.8;P<0.01),左室射血分数(LVEF)<50%(OR=2.3;95%CI1.4～3.6;P<0.01),低密度脂蛋白>2.6mmol/L(OR=2.1;95%CI1.6～2.9;P<0.01),吸烟史(OR=2.0;95%CI1.4～2.8;P<0.01),男性(OR=1.8;95%CI1.2～2.6;P=0.002),糖尿病(OR=1.6;95%CI1.1～2.4;P<0.05)及高血压(OR=1.5;95%CI1.1～2.1;P<0.01)为冠脉病变相关的独立因素。建立评估冠脉病变回归模型:P/(1-P)=EXP(-2.453 1.270×尿蛋白:肌酐比值>7.25μg/mg 1.158×hsCRP>20mmol/L 0.819×GFR<60ml/min·1.73m2 0.813×LVEF<50% 0.761×低密度脂蛋白>2.6mmol/L 0.676×吸烟史 0.594×男性 0.459×糖尿病 0.425×高血压)。ROC曲线下面积0.811,切点为0.977,灵敏度49.0%,特异度92.7%。结论肾功能损害等危险因素与冠脉病变显著相关。Logistic回归模型对无创评估冠脉病变有一定的临床实用价值。     

老年男性血清脂肪因子Irisin、Asprosin水平与骨质疏松性髋部骨折的相关性

目的 探讨血清脂肪因子鸢尾素(Irisin)、白脂素(Asprosin)水平与老年男性骨质疏松性髋部骨折的关系。方法 选取2020年6月—2022年6月收治106例老年男性骨质疏松症作为病例组,另选取同期体检的80名老年男性健康人群作为对照组。根据纳入骨质疏松症患者是否发生髋部骨折再分为髋部骨折组(n=44)和无骨折组(n=62)。采用酶联免疫吸附试验检测所有受试者血清Irisin、Asprosin水平,骨密度仪测量骨质疏松症患者股骨大粗隆、健侧股骨颈、第1～4腰椎骨密度,采用受试者工作特征(ROC)曲线评估血清Irisin、Asprosin水平对老年男性骨质疏松性髋部骨折的预测价值,采用多因素Logistic回归分析探讨老年男性骨质疏松性髋部骨折的影响因素。结果 病例组血清Irisin、Asprosin水平高于对照组(P<0.01)。髋部骨折组血清Irisin、Asprosin水平高于无骨折组(P<0.01)。血清Irisin、Asprosin联合预测老年男性骨质疏松症患者发生髋部骨折的曲线下面积为0.907(95%CI:0.862,0.952)。股骨颈骨密度≤0.77 ...     

心血管疾病患者高密度脂蛋白心脏保护功能的改变

高密度脂蛋白胆固醇（high density lipoprotein cholesterol,HDL-C）水平是心血管疾病风险的独立预测因素,与心血管事件发生风险呈负相关。但是单纯增加HDL-C的浓度并不能减少心血管疾病的发生率,过高浓度的HDL-C可能促进心血管疾病发生,所以HDL-C与心血管疾病发生和进展是否有因果关系仍不明确。在某些疾病内环境下,组成HDL的蛋白或脂类和参与HDL代谢的酶等成分发生改变,这些因素将导致HDL心血管保护功能下降。所以,在研究HDL与心血管疾病关系时,评估它的功能和质量,可能比评估它的数量更重要。     

3D printing of the aortic annulus based on cardiovascular computed tomography: Preliminary experience in pre-procedural planning for aortic valve sizing

Backgroundto determine reliability and reproducibility of measurements of aortic annulus in 3D models printed from cardiovascular computed tomography (CCT) images.MethodsRetrospective study on the records of 20 patients who underwent aortic valve replacement (AVR) with pre-surgery annulus assessment by CCT and intra-operative sizing by Hegar dilators (IOS). 3D models were fabricated by fused deposition modelling of thermoplastic polyurethane filaments. For each patient, two 3D models were independently segmented, modelled and printed by two blinded “manufacturers”: a radiologist and a radiology technician. Two blinded cardiac surgeons performed the annulus diameter measurements by Hegar dilators on the two sets of models. Matched data from different measurements were analyzed with Wilcoxon test, Bland-Altmann plot and within-subject ANOVA.ResultsNo significant differences were found among the measurements made by each cardiac surgeon on the same 3D model (p = 0.48) or on the 3D models printed by different manufacturers (p = 0.25); also, no intraobserver variability (p = 0.46). The annulus diameter measured on 3D models showed good agreement with the reference CCT measurement (p = 0.68) and IOH sizing (p = 0.11). Time and cost per model were: model creation ∼10–15 min; printing time ∼60 min; post-processing ∼5min; material cost ∼1€. Conclusion3D printing of aortic annulus can offer reliable, not expensive patient-specific information to be used in the pre-operative planning of AVR or transcatheter aortic valve implantation (TAVI).     

+GZ应激下心血管调节肽的变化

简要综述了近几十年来国内外有关心血管调节肽在＋ＧＺ应激下变化的文献，重点回顾了不同的＋ＧＺ作用方式，着／不着抗荷服和不同飞行条件心血管调节肽含量的变化等问题；并简要讨论了＋ＧＺ下的血液动力学改变，心理应激及其他因素对心血管调节肽可能产生的影响；指出了研究＋ＧＺ应激下心血管调节肽的变化在进行飞行员心血管调节功能评定中的意义。     

Dobutamine stress magnetic resonance imaging

Cardiovascular magnetic resonance imaging (CMR) provides superior imaging of cardiac structure and function that makes it a useful tool in the diagnosis of cardiovascular disease. The heart's response to stress has long been used as a diagnostic aid for identifying a cardiovascular etiology for patient symptoms or for cardiovascular risk stratification. Historically, this has been done with stress nuclear scintigraphy or echocardiography techniques. A distinct advantage of CMR over these modalities is greater image quality resulting in better test characteristics; this review summarizes the techniques and principles involved in dobutamine stress MRI. Electronic Publication     

D-二聚体、纤溶酶原激活物抑制物在急性肾衰竭患者血液净化中的临床意义

目的探讨急性肾衰竭(ARF)时D-二聚体(D-D)、纤溶酶原激活物抑制物(PAI)在不同的血液净化方法中的动态变化及临床意义。方法对我院2007年1月—2010年3月急诊住院58例ARF患者血液净化前、净化后4 h及38例健康人进行血浆中D-D含量及PAI水平测定。ARF患者血液净化方法随机采用血液透析(HD)(31例)、血液透析滤过(HDF)(27例)。结果 ARF患者D-D含量及PAI水平较对照组明显升高[D-D(0.83±0.04)与(0.48±0.03)mg/L,P=0.000 2;PAI(14.95±0.73)与(8.03±0.30)103kat/L,P<0.0001;]HD治疗4 h后D-D含量和PAI活性较治疗前升高[D-D(0.89±0.05)与(1.48±0.37)mg/L,P=0.018;PAI(14.89±1.78)与(22.10±3.56)103kat/L,P=0.025],而HDF治疗后D-D含量和PAI无明显变化[D-D(0.91±0.06)与(1.12±0.09)mg/L,P=0.65;PAI(15.81±1.98)与(16.10±2.56)103kat/L,P=0.86]。结论 ARF患者D-D、PAI水平升高,存在凝血-纤溶系统的紊乱,HD可以加重这种改变,而采用HDF治疗可避免对患者凝血机能的影响,在急性肾衰竭治疗中有一定临床价值。     

20例心脏大血管创伤后晚期后遗症的诊断与治疗

目的：报告心脏大血管创伤后晚期后遗症的诊断和治疗。方法：收集我科１９５４年６月～１９９５年４月治疗２０例心脏大血管损伤后遗症，其中穿入性损伤９例，闭合性损伤６例和医源性损伤５例。病变有瓣膜损伤８例，心脏异物５例，假性动脉瘤和动静脉瘘４例，右心室动脉瘤加心室间隔缺损（ＶＳＤ）、晚期心脏压塞和右下肺弹头、术后缩窄性心包炎各１例。施行手术早期取出心脏异物和心包腔引流４例。择期手术１５例，其中施行瓣膜替换术６例，瓣膜成形术２例，假性动脉瘤和动静脉瘘缝补术３例，心室间隔缺损加右心室室壁瘤缝补术、心腔内异物、血心包和缩窄性心包炎各１例。结果：１９例经手术治疗痊愈出院，１例因动脉导管结扎后假性动脉瘤，控制感染时突然瘤体破裂出血死亡。结论：早期诊断、早期或择期手术可取得良好效果。     

高压氧辅助治疗对卒中后抑郁患者血清5-HT、NE及神经功能的影响

目的：观察高压氧（HBO）辅助治疗对卒中后抑郁（PSD）患者血清5-羟色胺（5-HT）、去甲肾上腺素（NE）及神经功能的影响。方法70例PSD患者根据数字表法随机分为2组,对照组（n=35例）采用常规措施治疗,观察组（n=35例）待确定活动性出血已稳定或已趋于稳定后,在对照组治疗基础上加用HBO治疗。两组疗程均为30d,比较两组患者治疗前后血清5-HT、NE表达水平及汉密尔顿抑郁量表（HAMD）、中国脑卒中量表（CSS）,改良Barthel指数（MBI）评分变化。结果两组患者治疗后血清5-HT、NE表达水平均明显升高（P<0.05）,且观察组升高较对照组更为显著（P<0.05）;两组患者治疗后HAMD、CSS评分明显降低（P<0.05）,而MBI评分明显升高（P<0.05）,且观察组降低或升高较对照组更为显著（P<0.05）。结论 HBO辅助治疗可明显升高PSD患者血清5-HT、NE表达水平,改善抑郁状态和神经功能。     

Image quality dependence on in-plane positions and directions for MDCT images

Objective

The present study was performed to examine the dependence of image quality on in-plane position and direction in computed tomography (CT) imaging using the modulation transfer function (MTF), noise power spectrum (NPS) and analysis of signal-to-noise ratio (SNR). For detailed analysis of SNR, the low-contrast detectability was compared using simulated small low-contrast objects.

Materials and methods

Three models of multidetector-row CT (MDCT) were employed. The measurement positions for MTF were set to the isocentre and several peripheral areas, and NPS and SNR were calculated for the isocentre and 128 mm off-centre. To evaluate directional dependence, the one-dimensional physical properties were measured separately in the radial and azimuthal directions. Seven radiological technologists also performed a perceptual detection study at the different in-plane positions using computer-simulated low-contrast images.

Results

The results of MTF and SNR differed between the isocentre and the peripheral area. The MTF values also tended to decrease with distance from the isocentre, and the SNR values in the low frequency range for the peripheral area were superior to those for the isocentre. In the detection study, the low-contrast detectability in the peripheral area was 13-40% higher than the value in the isocentre.

Conclusion

The results of the present study indicated that clinical CT images have remarkable non-uniformity of image quality. Therefore, the detailed analysis performed in this study will provide useful information for the development of advanced image processing applications, such as computer-aided diagnosis (CAD) and de-noising of CT images.     

Anterior interosseous nerve lession and distal myoclonus revealing a parsonage turner syndrome associated with hashimoto thyroiditys

Parsonage-Turner Syndrome (PTS), also known as brachial neuritis or neuralgic amyotrophy, is a rare disorder affecting 2 to 3 individuals per 100,000 each year. Abrupt onset shoulder pain, followed by motor weakness, paresthesia and hypoesthesia, is usually reported, lasting several months with variable recovery. The etiology of the disease may be idiopathic or triggered by an underlying autoimmune disease in genetically susceptible individuals. Our report addresses a unique case of Parsonage-Turner Syndrome in a patient suffering from concurrent Hashimoto Thyroiditis. A previously healthy A 22 year-old female was referred to the Department of Neurology after complaints of sudden-onset motor weakness in her left upper limb. On physical examination, the patient could not make an “Ok sign” with her thumb and distal phalanx or form a complete fist, revealing weakness within the anterior interosseous branch of the median nerve. Further testing with electromyography demonstrated muscular atrophy within the arm''s anterior compartment, forearm, and triceps brachii of the posterior compartment. Additional imaging and physical examination were unremarkable, confirming our diagnosis of PTS. Furthermore, lab reports revealed elevated levels of anti-thyroglobulin and anti-thyroid peroxidase antibodies and our patient was concurrently diagnosed with Hashimoto''s thyroiditis.This case aims to highlight the rare co-occurrence of Hashimoto''s thyroiditis with Parsonage-Turner Syndrome in an otherwise healthy patient. A 2014 study published by Nugent et al. had also shed light on brachial neuritis in a patient suffering from autoimmune connective tissue disease, and through this case study, we hope to add to the growing literature regarding the correlation between PTS and autoimmune diseases. Symptoms of PTS can easily be misdiagnosed given its similarity to other peripheral neuropathies, and careful assessment and thorough understanding of the disease is required to successfully distinguish it from other neurological pathologies.     

Validity of apparent diffusion coefficient (ADC) value in diagnosis and follow-up of multiple sclerosis patients in different clinical subtypes

Background

Multiple sclerosis (MS) is a chronic disease with a wide range of pathologic changes that modify the apparent diffusion coefficient (ADC) value.