冠心病降脂治疗101例分析

目的了解冠心病患者血脂水平，分析其降脂治疗和达标的情况以及可能影响治疗达标的因素。方法对中南大学湘雅二医院2003年5月至2005年12月已确诊的冠心病患者101例，获取初始血脂水平以及在院期间接受降脂治疗的情况，通过电话、信函结合门诊复查形式进行随访，填答冠心病治疗调查问卷，记录结果并进行分析总结。结果（1）冠心病患者初始血脂异常率为60．6％，住院期间降脂治疗率为80．7％。（2）随访期间降脂治疗率为68．3％，低密度脂蛋白胆固醇（LDL—C）〈2．59mmol／L者占65．3％。（3）达标与否和性别、年龄、学历、社会地位无关（P〉0．05），但与经济收入、吸烟有关（P〈0．05），并受到医疗质量、患者依从性、药效等影响。（4）所有接受降脂治疗的冠心病患者，丙氨酸转氨酶（ALT）与肌酸激酶（CK）值无显著升高，且与初始值比较差异无统计学意义（P〉0.05）。结论冠心病降脂治疗仍存在很大治疗间隙和不少认识误区；达标与否和患者经济水平、生活方式（吸烟等）有关，并受到医疗质量、患者依从性、药效、社会等因素的影响；降脂药物的选择和剂量恰当时，长期治疗是安全的。     

冠状动脉粥样硬化性心脏病235例降脂治疗现状分析

目的了解冠状动脉粥样硬化性心脏病(冠心病)患者目前降脂治疗和达标的情况,并分析可能影响治疗达标的因素。方法选取深圳市第四(福田)医院2010年6月至2012年3月确诊冠心病的患者235例为研究对象。获取初始血脂水平以及在院期间接受降脂治疗的情况,通过电话、信函结合门诊复查形式进行随访,填答冠心病治疗调查问卷,记录结果并进行分析总结。结果 (1)住院期间冠心病患者降脂治疗率为90.2%;(2)随访期间降脂治疗率为68.9%,低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)<1.8 mmol/L和(或)减少≥50%,即降脂达标[2011年欧洲心脏病协会/欧洲动脉硬化协会]患者仅占35.7%;(3)所有接受降脂治疗的冠心病患者,谷丙转氨酶、肌酸激酶与血肌酐浓度无显著升高,且与初始值比较,差异无统计学意义(P<0.05)。结论冠心病降脂治疗仍存在很大治疗间隙和不少认识误区;达标与否受到医疗质量、患者依从性、药效、社会经济等多种因素的影响;降脂药物的选择和剂量恰当时,长期治疗是安全的。     

健康教育对老年冠心病患者血脂、血压、血糖达标状况的影响

目的探讨健康教育对老年冠心病患者血脂、血压、血糖达标状况的影响。方法 2009年7月至2011年12月确诊为冠心病的患者208例,随访用药状况1年,并测定患者血脂、血压、血糖情况,然后分批给冠心病患者做"关于冠心病规范治疗,三高达标"等健康教育讲座,并现场答题,发放《就诊信息提示手册》,随访1年,定期收回手册统计用药情况及检查结果,分析达标情况。结果未做健康教育随访1年,冠心病患者血脂、血压、血糖完全达标率为22.9%,健康教育后随访1年,血脂、血压、血糖完全达标率为32.8%,两者间有统计学差异(P0.05)。结论健康教育可以明显提高老年冠心病患者血脂、血压、血糖达标率。     

肺结核患者治疗依从性及其影响因素调查分析

目的调查分析肺结核患者治疗依从性及其影响因素。方法选取2011年我院收治的肺结核患者256例,通过自制《肺结核患者治疗依从性调查表》了解患者情况。调查内容包括患者基本资料和肺结核治疗情况。结果所有患者中能够遵医嘱、规则治疗者占77.34%(198/256),漏服药者占19.14%(49/256),中断治疗者占3.51%(9/256)。男性患者优依从性率、漏服药率、中断治疗率均高于女性患者(P0.05);≤50岁者优依从性率、漏服药率、中断治疗率均高于50岁者(P0.05);初中及以下文化程度者优依从性率、漏服药率、中断治疗率均高于大专及以上者(P0.05);接受过知识教育者优依从性率高于没有接受过知识教育者,漏服药率、中断治疗率低于没有接受过知识教育者(P0.05)。结论性别、年龄、学历及是否接受过知识教育影响肺结核患者治疗依从性,加强患者防治认知教育、重视医院督导治疗,是提高肺结核患者治疗依从性的重要方法。     

血脂水平与冠心病并发慢性心力衰竭患者预后的关系

目的探讨血脂水平与冠心病并发慢性心力衰竭患者预后的关系。方法选择冠心病并发慢性心力衰竭患者441例,按血脂水平分为低水平组、较低水平组、较高水平组和高水平组。按随访期间使用他汀类药物情况分为他汀组247例和非他汀组194例,按随访期是否死亡分为生存组(n=435)和死亡组(n=6)。比较低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)、甘油三酯(TG)各水平组的死亡率,血脂水平与患者预后的关系采用多因素COX回归分析。结果他汀组和非他汀组HDL-C、TC、TG、LDL-C各水平组的死亡率差异无统计学意义(P>0.05)。死亡组年龄、吸烟、肾功能衰竭、贫血、心房颤动比例显著高于生存组(P<0.05),左室射血分数(LVEF)及血管紧张素转换酶抑制剂(ACEI)的使用率显著低于生存组(P<0.05),两组TG、TC、HDL-C、LDL-C水平差异无统计学意义(P>0.05)。多因素Cox回归分析显示年龄、低水平HDL-C、较低水平HDL-C是影响冠心病并发慢性心力衰竭患者预后的危险因素(P<0.05),而LVEF和ACEI是预后的保护因素。结论提高HDL-C水平可能改善冠心病心力衰竭患者的预后,TC、TG、LDL-C水平对冠心病心力衰竭患者预后无明显影响。     

氢氯噻嗪、卡托普利联合辛伐他汀治疗老年高血压合并高脂血症的疗效

目的探讨氢氯噻嗪、卡托普利联合辛伐他汀治疗老年高血压合并高脂血症的临床效果。方法选择102例老年高血压合并高脂血症患者,根据治疗方法不同平均分为两组,对照组给予氢氯噻嗪联合卡托普利治疗,研究组给予氢氯噻嗪、卡托普利联合辛伐他汀治疗。随访12个月,观察血压、血脂改善情况及不良心脑血管事件发生情况。结果两组患者治疗期间收缩压和舒张压水平均稳定下降,组间对比无显著性差异(P>0.05)。治疗后,研究组患者血脂水平较治疗前明显改善(P<0.05),而对照组患者血脂水平无明显改善(P>0.05)。随访12个月,研究组不良心脑血管事件发生率(9.8%)显著低于对照组(25.5%)(P<0.05)。结论对老年高血压合并高脂血症患者给予降压调脂治疗,能明显改善血压和血脂水平,降低远期不良心脑血管事件发生率,值得临床推广。     

80岁以上冠心病高危患者强化降脂的疗效和安全性

目的用辛伐他汀对80岁以上冠心病高危患者进行强化降脂治疗,观察其疗效和安全性。方法 80岁以上确诊冠心病高危患者50例,予辛伐他汀40 mg每晚8时服用。治疗前检测血脂、肝肾功能及肌酸激酶等。治疗4及24 w后重复检查上述指标,比较治疗前后血脂水平的变化率、达标率及不良反应。结果辛伐他汀40mg/d能有效降低总胆固醇(TC)、低密度脂蛋白(LDL)、三酰甘油(TG)水平,与治疗前相比,差异有显著性(P0.01);治疗24 w TC、LDL、TG分别下降18.71%、24.22%、16.13%。高危患者LDL2.6mmol/L为达标,25例患者17例达标,达标率68%,极高危患者LDL1.81mmol/L为达标,25例患者8例达标,达标率32%。治疗中有1例出现肝酶升高,2例出现乏力伴肌酶升高而中止治疗。结论对于80岁以上冠心病高危患者,辛伐他汀能显著降低TC、TG、LDL水平,提高达标率,具有良好的安全性。     

冠心病患者皮肤胆固醇与血清胆固醇的相关性研究

目的:在冠心病患者随访中应用皮肤胆固醇无创检测系统检测皮肤胆固醇水平,探讨皮肤胆固醇在冠心病慢病管理中的应用价值。方法:本研究为短期、非干预性、前瞻性研究,入选2020年5月—2020年11月在中国科学技术大学附属第一医院住院治疗的急性冠状动脉综合征患者102例,所有患者均采用瑞舒伐他汀10 mg/d作为起始降脂方案,在入院次日、第2周、第4周、第8周、第12周空腹测定血脂及皮肤胆固醇,并根据随访4周时低密度脂蛋白胆固醇(LDL-C)是否达标分为降脂达标组以及降脂未达标组。结果:线性相关分析显示,皮肤胆固醇降幅与LDL-C降幅呈正相关(r=0.528,P0.001)。在同一随访节点,降脂达标组皮肤胆固醇降幅中位数较未达标组高(P0.05)。降脂达标组皮肤胆固醇降幅随时间延长逐渐上升,LDL-C降幅总体呈上升趋势;降脂未达标组皮肤胆固醇降幅、LDL-C降幅随时间延长上升不明显。结论:急性冠状动脉综合征患者皮肤胆固醇降幅与血清LDL-C降幅呈正相关,提示皮肤胆固醇在急性冠状动脉综合征慢性期管理中的潜在应用能力。     

低密度脂蛋白与冠状动脉狭窄程度的相关性研究

目的:探讨血脂基础水平尤其是LDL-C与冠状动脉狭窄程度相关性,明确动脉粥硬化患者血脂基础水平,为冠心病的降脂治疗提供证据依据。方法:收集2011年1月至2014年12月就诊于首都医科大学附属北京安贞医院,行冠状动脉造影且12周内无他汀等降脂类药物用药史的患者434例,根据造影结果分为病例组(有冠状动脉狭窄,n=285),对照组(无冠状动脉狭窄,n=149)。对比分析两组人口学基本资料、血脂各项基础水平、血压、血糖水平及其与冠状动脉狭窄程度的相关性。结果:与对照组比较,病例组患者年龄较大,男性所占比例及吸烟史患者所占比例较高,糖尿病患者所占比例较高,病例组患者的空腹血糖(GLU)及糖化血红蛋白水平(HAB1AC)均显著高于对照组,病例组患者的TC、LDL-C、non-HDL-C及HCRP水平显著高于对照组,HDL-C显著低于对照组(P0.05)。两组间,体质量指数(BMI)、心率、高血压患者所占比例及TG水平,差异无统计学意义(P0.05)。Logistic回归分析,经校正体质量指数(BMI)、心率、TC、HDL-C、TG、non-HDL-C及HAB1AC等因素之后,年龄、吸烟、LDLC、HCRP及GLU是冠状动脉狭窄的相关危险因素(P0.05)。经相关性分析得出LDL-C、GLU及HAB1AC与冠状动脉狭窄程度呈正相关(P0.05)。经分层比较,不同LDL-C分层冠状动脉狭窄程度,差异无统计学意义(P0.05)。结论:研究表明中国冠心病患者血脂基础水平并不是很高,冠心病的危险因素除了血脂水平,还有吸烟史、糖尿病、年龄及炎症因子CRP等。LDL-C虽与冠状动脉狭窄程度呈正相关,但并非LDL-C越低冠状动脉狭窄程度越小。因此,强化降脂治疗可能并不适合中国冠心病人群,具体的降脂治疗方案应根据不同患者的血脂基础水平进行个体化治疗。     

冠心病患者经皮冠状动脉介入治疗术后药物治疗现状及其与长期预后的关系

目的调查冠心病患者经皮冠状动脉介入治疗(PCI)术后应用药物及其与长期预后的关系.方法对584例冠心病患者PCI术后应用的主要药物及吸烟状况进行调查,并对主要心脏不良事件进行随访.结果平均随访时间(18.66±12.16)个月,术后99.0%的患者应用阿司匹林,应用时间平均(10.3±8.2)个月,99.8%使用氯吡格雷,应用时间平均(7.8±5.O)个月;随访期间5.14%患者完全停止抗血小板治疗.在出院时,血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂、β受体阻滞剂、他汀类药物、钙通道拮抗剂及硝酸酯的应用率分别为42.0%、63.7%、83.0%、19.9%及46.4%,随访期间降低到36.1%、57.O%、66.8%、17.6%及36.6%.术前吸烟为53.77%,随访期间为17.80%.停止抗血小板治疗、术后吸烟增加非致死性心肌梗死(10.0%对1.1%,P＜0.01;4.81%对0.83%,P＜0.01)及主要不良心脏时间(20.0%对6.9%,P＜0.01;11.54%对6.67%,P＜0.05).结论冠心病患者在PCI术后对药物的依从性良好,但术后停止抗血小板治疗及继续吸烟者预后差.     

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.     

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.     

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.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

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.