老年人高血压与肾功能相关研究

目的探讨老年人血压与肌酐清除率(CCr)间的相关关系。方法对459例老年(≥60岁)体检者及1490例中轻年体检者测定血压、肾功能、血脂等指标,通过Cockcroft-Gault方程估算CCr及Logistic回归分析影响肾功能损害的因素。结果老年组高血压发生率(45.8%)、肾功能损害发生率(80.2%)明显高于中青年组(19.7%和37.4%,P=0.000)。老年组CCr〔(75.5±22.8)ml.min-1.(1.73m2)-1〕明显低于中轻年组〔(101.7±24.6)ml.min-1.(1.73m2)-1,P=0.000〕。肾功能损害1期、2期、3期之间收缩压、舒张压及脉压无统计学差异。结论老年人高血压、肾功能损害的发生率明显高于中青年人。老年人肾功能损害程度与体重指数、年龄、血尿酸显著相关,血压并非是影响CCr的因素。     

冠状动脉介入术患者对比剂肾病的相关危险因素分析

目的:研究冠状动脉造影(CAG)和经皮冠状动脉介入治疗(PCI)患者对比剂肾病(CIN)的发病率及危险因素。方法:选择2010年10月至2011年4月南京军区南京总医院接受CAG和PCI的患者672例,以术后48h血清肌酐(SCr)较术前升高25%或升高44.2μmol/L(0.5mg/dl)作为CIN的诊断标准,分析CIN的发病率及危险因素。结果:672例患者中,年龄≥65岁者292例(43.5%),冠心病588例(87.5%),高血压461例(68.6%),糖尿病144例(21.4%),术前SCr≥110μmol/L者30例(4.5%),贫血42例(6.3%),服用血管紧张素转换酶抑制剂344例(51.2%),利尿剂95例(14.1%),二甲双胍39例(5.8%),对比剂用量≥200ml者237例(35.3%)。672患者中55例(8.2%)发生CIN,发生CIN者与非CIN者在年龄≥65岁、冠心病、对比剂用量≥200ml及利尿剂等方面有明显差异(P<0.05)。Logistic多因素回归分析显示,年龄≥65岁、对比剂用量≥200mL是CIN的独立危险因素。结论:在CAG和PCI患者的CIN发病率较高,年龄≥65岁和对比剂用量≥200mL是其独立危险因素。     

老年人慢性肾功能衰竭的诊治

随着社会人口老龄化，老年人慢性肾功能衰竭（CRF）已成为常见的疾病。国外对一组8641例、历时8年的调查表明，CRF发病率为1．2％，其中，年龄≥65岁者占1．7％；〈65岁者仅为0．8％。1990年在美国血液透析患者中，65岁以上者占38．5％，而在当年新增加的血液透析患者中，42％为65岁以上的患者。老年人CRF的病因与非老年人有所不同，目前认为继发于高血压、糖尿病、动脉粥样硬化等的肾脏病变是危害老年肾功能的主要疾病，梗阻性肾病也占有较大的比例。     

尿白蛋白与肌酐比值联合血肌酐对老年高血压患者早期肾小球滤过率下降的诊断价值

目的分析尿白蛋白与肌酐的比值(UACR)联合血肌酐(SCr)对老年高血压患者早期肾小球滤过率(GFR)下降的诊断价值。方法选取2017年3月至2018年12月于第四军医大学西京医院收治的老年高血压患者260例作为高血压组,根据血压水平将其分为高血压1级组、高血压2级组和高血压3级组,根据GFR将其分为肾功能正常组和肾功能受损组。另选取100例于第四军医大学西京医院体检的健康老年人作为对照组。比较高血压组和对照组、各个亚组的收缩压、舒张压、SCr、UACR、GFR水平,采用受试者操作特征曲线(ROC)分析UACR联合SCr对老年高血压患者早期GFR下降的诊断价值。结果高血压组患者的收缩压、舒张压、SCr、UACR均明显高于对照组,GFR明显低于对照组(P0.05),高血压3级组患者的收缩压、舒张压、SCr、UACR均明显高于高血压2级组和高血压1级组,GFR明显低于高血压2级组和高血压1级组(P0.05),高血压2级组的收缩压、舒张压、SCr、UACR均明显高于高血压1级组,GFR明显低于高血压1级组(P0.05),肾功能受损组的收缩压、舒张压、SCr、UACR均明显高于肾功能正常组,GFR明显低于肾功能正常组(P0.05),SCr联合UACR检测有较高的诊断价值,曲线下面积为0.949,敏感度为85.15%,特异性为94.25%。结论 SCr联合UACR对老年高血压患者早期GFR下降有较高的诊断价值。     

老年人超重、血尿酸升高与肾功能损害相关分析

目的 探讨老年人超重、血压、血尿酸(UA)间相互关系及上述因素对肾功能的影响.方法 对454例老年(≥60岁)体检者测血压、肾功能、血脂等,通过MDRD计算肾小球滤过率(GFR),经F检验、t检验及Logistic回归分析影响肾功能损害的因素.结果 1、超重的老年人肾功能损害及代谢综合征(Ms)发生率为70.5%、21.3%,明显高于体重正常的老年人(x2=14.862及44.616,P均=0.000).2、超重老年者GFR(81.7±19.2)ml·min-1·(1.73 m2)-1显著低于体重正常者(90.4±20.2)ml·min-1·(1.73 m2)-1(t=4.568,P=0.000).3、肥胖合并高血压者GFR明显低于体重正常无高血压者.4、UA>416 μmol/L组GFR显著低于、血压显著高于UA<360 μmol/L组.结论 老年人超重与血压、UA、GFR关系密切,超重、UA升高者肾功能易受损,血压对GFR影响不大.     

河北涞源县贫困人口高血压患病现况及影响因素分析

目的探讨河北涞源县贫困人口高血压的患病现况和该地区高血压发病的主要危险因素。方法研究对象均来自河北省保定市银坊镇下属21个行政村在册的贫困人口,随机抽取150人(男/女:59/91)参与调查。排除认知功能异常不能配合完成问卷调查及生化检查缺项的居民,共141人(男/女:54/87)纳入研究,年龄44~92岁。研究对象均完成完整的问卷调查、体格检查及血生化检查。按照高血压与非高血压分为两组,年龄、体重指数、性别与是否吸烟等进行亚组分析。结果高血压患病率为48.2%。体重、BMI、TC、LDL-C、吸烟者占比高血压组明显高于非高血压组,差异有统计学意义(P<0.05)。<65岁贫困居民高血压患病率(77.5%)明显高于≥65岁老年人(36.6%,OR=5.96,95%CI:2.56-13.88,P<0.001)。BMI≥28 kg/m^2组高血压患病率为65.5%,显著高于BMI<24kg/m^2组,(OR=2.43,95%CI:1.04-5.73,P<0.05)。男性吸烟组高血压患病率为50%,非吸烟组25%,两者比较差异无统计学意义(P>0.05)。Logistic回归分析男性、年龄≥65岁、不吸烟为高血压患病的保护因素。结论该地区贫困人口高血压患病率为48.2%,体重、BMI、总胆固醇、低密度脂蛋白、吸烟率高血压组明显高于非高血压组。BMI≥28 kg/m^2是高血压患病的危险因素,男性、≥65岁、非吸烟是高血压患病的保护因素。     

慢性心力衰竭患者血红蛋白水平与心肾功能的相关性

目的:探讨慢性心力衰竭(CHF)患者血红蛋白(Hb)水平与其心功能、肾功能的关系。方法:150例CHF男性患者按照心功能分为三组:NYHA II级组44例、III级组49例,IV级组57例,并随机抽选30例健康体检患者为健康对照组,分析各组心功能指标[左室舒张末期内径(LVEDd),左室射血分数(LVEF),N末端脑利钠肽前体(NT-proBNP)],肾功能指标[血清肌酐(SCr),肾小球率过滤(GFR)],血液学指标[Hb,红细胞(RBC),血红细胞比容(HCT)];根据CHF患者贫血情况分为贫血组(61例)和非贫血组(89例),并对两组上述指标进行比较。结果:CHF各组贫血发生率均明显高于健康对照组,且随着心衰等级的增加而明显升高(P<0.05);与健康对照组比较,CHF各组心功能各项指标(LVEDd,LVEF,NT-proBNP),肾功能指标(SCr,GFR),血液学指标(Hb,RBC,HCT)均有明显恶化,且随着心衰等级增加而明显加重(P均<0.05);与CHF非贫血组比较,CHF贫血组SCr[(89.78±44.79)mmol/L比(78.79±45.02)mmol/L]、GFR[(86.13±25.42)ml.min-1(1.73m)-1比(67.99±32.12)ml.min-1(1.73m)-1]、LVEF[(55.79±11.34)%比(45.65±12.03)%]水平明显降低,LVEDd[(49.89±8.93)mm比(56.45±11.23)mm]明显增大,NT-proBNP[(945.27±1249.76)pg/ml比(3884.23±2790.42)pg/ml]水平明显升高(P<0.05);线性相关分析显示Hb与LVEDd、NT-proBNP呈负相关(r=-0.346,-0.547,P均<0.05),与LVEF、GFR呈正相关(r=0.453,0.338;P均<0.05)。结论:慢性心力衰竭患者血红蛋白下降会显著降低心、肾功能。     

不同诊断切点高同型半胱氨酸血症患者临床特征分析

目的观察老年人群中不同诊断切点(≥10μmol/L;≥15μmol/L;≥20μmol/L)高同型半胱氨酸血症(hyperhomocystinemia,HHcy)患病率及其临床特征。方法选取5976例65岁以上老年人为研究对象,按不同诊断切点分为四组,分析不同同型半胱氨酸(homocysteine,Hcy)水平与肾功能、高血压等的关系。结果 (1) HHcy≥10、15、20μmol/L患病率分别为84. 96%、41. 62%、18. 66%。(2) Hcy影响因素中,年龄、肌酐、尿酸不受诊断切点的影响。(3)单因素回归分析显示,血清Hcy水平升高与高尿酸血症、肾功能不全、高血压显著相关,但进一步校正血尿酸、肌酐后,与高血压关系均不再相关(P0. 05)。结论 HHcy患病率受诊断切点影响明显,肾功能是影响血浆Hcy水平的主要因素,血浆Hcy水平升高与高血压无独立相关性。     

老年肾功能损害与冠心病关系的研究

目的研究老年人肾功能损害与冠心病患病的关系。方法选择年龄>65岁老年患者1264例,根据慢性肾脏病分期及估算肾小球滤过率(eGFR)分为5组:≥90 ml/(min·173 m~2)为对照组508例、60～89 ml/(min·173m~2)组(A组)403例、30～59 ml/(min·173 m~2)组(B组)221例、1 5～29 ml/(min·1 73 m~2)组(C组)104例和<15ml/(min·1 73 m~2)组(D组)28例。采用logistic回归分析肾功能与冠心病之间的关系。结果与对照组比较,C组和D组患者冠心病患病率明显升高,差异有统计学意义(P<0.05,P<0.01);且男性较女性冠心病患病率明显升高,差异有统计学意义(P<0.05,P<0.01)。logistic回归分析显示,调整影响冠心病危险因素后,冠心病风险仍随eGFR的降低而增加(P=0.00)。结论年龄>65岁老年患者肾功能损害是其患冠心病的一个独立危险因素。     

老年高血压患者动态血压与肾功能损害

目的:探讨老年高血压患者动态血压与慢性肾功能损害的关系。方法:对已服降压药物控制血压的老年高血压患者测定24h动态血压,以血清肌酐(SCr)代入简化MDRD公式估算肾小球滤过率(GFR),以GFR60mL·min-1·1.73m-2设为肾功能不全组(男性40例,女性5例),与GFR≥60mL·min-1·1.73m-2、年龄、性别匹配的45例比较。结果:1.2组患者年龄相近,(77.0±6.1)岁vs(76.9±5.5)岁,P0.05;SCr、GFR差异有统计学意义。2.90例中非勺型血压71例占78.9%,2组比较差异无统计学意义,38/45vs33/45,χ2=1.668,P0.05。3.肾功能不全组平均舒张压(DBP)、日间舒张压(dDBP)、最高舒张压(DBPmax)、舒张压波动幅度(△DBP=最高舒张压-最低舒张压)明显低于对照组,平均脉压(PP)及夜间脉压(nPP)明显高于对照组,均P0.05。Logistic多元回归分析显示,△DBP降低与nPP增加为肾功能不全的独立危险因素,OR值分别为0.941(95%CI0.894～0.991)和1.043(95%CI1.006～1.081)。4.GFR与DBPmax、△DBP正相关,与PP、nPP、nSBP负相关,在控制年龄因素后相关性依然具有统计学意义,均P0.05;△DBP与DBPmax显著正相关,r=0.820,P0.01,而与最低舒张压(DBPmin)无相关性。结论:合并有肾功能不全的老年高血压患者较对照人群明显有增加的PP和降低的DBP水平。其nPP的增加和△DBP的降低与肾功能损害有关。降压治疗的老年患者,PP(尤其nPP)的增加和△DBP的降低可能对GFR下降存在不利影响。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.