阻塞性睡眠呼吸暂停综合征老年患者血管内皮功能变化及其与冠心病的关系

目的　探讨老年阻塞性睡眠呼吸暂停综合征 (OSAS)患者血管内皮功能变化与冠心病的相关性。　方法　选择中、重度OSAS患者 4 7例为OSAS组 ,又分伴冠心病 (18例 )和不伴冠心病(2 9例 )两亚组 ;另选 17例单纯冠心病患者和健康老年人 31例作为对照组。比较各组间血浆一氧化氮 (NO)、内皮素 (ET)和NO/ET的动态变化。　结果　与对照组比较 ,OSAS两组及单纯冠心病组患者NO水平降低 ,ET水平增高 ,NO/ET比值下降 (均为P <0 0 5 ) ,而OSAS伴冠心病者下降更明显。OSAS不伴冠心病者的NO、ET水平及NO/ET比值与单纯冠心病组比较 ,差异无显著性 ,OSAS伴冠心病者的NO和ET水平亦无显著性差异 ,但NO/ET值下降已有统计学意义 (P <0 0 5 )。　结论　OSAS老年患者存在明显血管内皮功能障碍 ,尤以伴冠心病者为甚 ,血管内皮功能损伤可能是OSAS患者并发冠心病的原因之一     

冠心病患者血清血管内皮生长因子水平与冠状动脉病变程度的关系

目的 :探讨冠心病 (CHD)患者血清血管内皮生长因子 (VEGF)水平与冠状动脉病变的关系。方法 :采用酶联免疫吸附法 (ELISA)检测了 12 4例经冠状动脉造影证实有一支以上主要冠状动脉狭窄≥ 5 0 %的CHD患者血清VEGF水平 ,并作相关分析。结果 :CHD组血清VEGF水平明显高于正常对照组〔(2 93.2± 12 6 .3)ng/L∶(12 0 .1± 31.5 )ng/L ,P <0 .0 1〕 ,双支和三支血管病变患者血清VEGF水平高于单支组〔(2 83.4± 85 .0 )ng/L ,(398.1± 10 5 .5 )ng/L∶ (191.7± 2 7.3)ng/L ,P <0 .0 1〕 ,随着血管狭窄程度的加重 ,血清VEGF水平升高越明显 ,两者呈显著正相关 (r =0 .78,P <0 .0 0 1) ,CHD并发高血压和 (或 )糖尿病对血清VEGF水平无显著影响 (P >0 .0 5 )。结论 :CHD患者血清VEGF水平升高 ,其升高程度与冠状动脉病变程度有良好的相关性     

老年代谢综合征患者血浆同型半胱氨酸水平与血管内皮功能的研究

目的探讨老年代谢综合征(MS)患者的血浆同型半胱氨酸(Hcy)水平及血管的内皮功能。方法选择老年MS患者40例(MS组)和健康查体者36例(NC组),检测血浆Hcy水平,同时应用超声检测内皮依赖性血管舒张功能(FMD)及硝酸甘油诱导的非内皮依赖性血管舒张功能(NID)。结果MS组Hcy〔(14.7±5.2)μmol/L〕明显高于NC组〔(10.2±3.1)μmol/L〕(P<0.01),FMD〔(6.7±2.1)%〕及NID〔(9.9±3.8)%〕低于NC组〔分别为(15.4±3.2)%,(15.6±4.1)%;P<0.05,P<0.01〕。FMD与年龄、BMI、TG、SBP、DBP、FBG呈负相关。结论老年MS患者血浆Hcy水平升高,血管内皮功能失调。     

伊贝沙坦对老年原发性高血压患者血管内皮功能的影响

目的探讨伊贝沙坦和福辛普利对老年原发性高血压患者血管内皮功能的保护作用。方法将62例1个月内未服用过血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂类药物的老年原发性轻、中度高血压患者随机分为福辛普利组和伊贝沙坦组,治疗3个月。用药前、后分别行肱动脉血管内皮依赖性舒张功能(FDD)超声检测,血浆一氧化氮(NO)、内皮素(ET1)和血管性假血友病因子(vWF)水平测定。观察并比较两组、治疗前后FDD、血浆NO、ET1和vWF水平的变化。结果(1)肱动脉超声检测两组用药后FDD较用药前均显著增加,福辛普利组分别为(640±126)%和(507±125)%,伊贝沙坦组分别为(654±137)%和(488±128)%,(P<001),其余各项指标用药前后差异无统计学意义(均为P>005);(2)血浆NO、ET1、vWF水平变化两组用药后NO水平较用药前均显著增加〔(1910±584)μmol/L和(1509±391)μmol/L、(2044±575)μmol/L和(1522±372)μmol/L,P<001〕;ET水平较用药前显著减少〔(2804±783)pmol/L和(2176±756)pmol/L、(2772±823)pmol/L和(2201±653)pmol/L,P<001〕;两组用药前、后vWF水平为(8529±971)%和(7532±791)%、(8629±982)%和(7494±785)%,差异有统计学意义(P<001)。结论伊贝沙坦对老年原发性高血压患者的血管内皮功能有保护作用,且与福辛普利相     

糖尿病大鼠一氧化氮与骨代谢变化的研究

目的　研究糖尿病 (DM )大鼠血清一氧化氮 (NO)与早期骨代谢改变的关系。方法2 0只SD大鼠分为 2组 ,一组以链脲佐菌素诱导建立糖尿病 (STZ DM )大鼠模型 ,另一为正常对照组 ,测定 2组大鼠的空腹血糖 (FBG)、HbA1c、血清胰岛素、全身、股骨和腰椎骨密度 (BMD)、骨代谢相关指标〔血清钙、骨钙素、降钙素、甲状旁腺素 (PTH)、维生素D3 及尿吡啶酚 /肌酐比〕和血清NO水平。结果　STZ DM大鼠与正常对照组相比 ,血清NO水平显著升高〔(5 1.3± 11.9vs 38.1± 12 .0 )μmol/L ,P <0 .0 1〕 ;全身、股骨和腰椎的BMD显著降低〔(0 .15± 0 .0 7vs 0 .2 1± 0 .0 2 ) g/cm2 ,P<0 .0 1;(0 .16± 0 .0 2vs 0 .19± 0 .0 3) g/cm2 ,P <0 .0 5 ;(0 .12± 0 .0 4vs 0 .18± 0 .0 6 ) g/cm2 ,P <0 .0 5〕 ;血清钙浓度显著升高〔(135 .9± 11.3vs 117.2± 6 .5 )mg/L ,P <0 .0 0 1〕 ,骨钙素水平显著升高〔(0 .0 7± 0 .0 4vs 0 .0 5± 0 .0 1) μg/L ,P <0 .0 5〕 ,维生素D3 水平显著降低〔(7.6± 1.9vs 11.6± 4 .1)μg/L ,P <0 .0 5〕 ,尿吡啶酚 /肌酐显著降低〔(4.8± 0 .8vs 75 .8± 6 0 .7)nmol/mmolCr,P <0 .0 1〕 ;而降钙素和PTH水平改变无统计学意义。相关性分析显示 ,血清NO与尿吡啶酚排泄呈负相关 (r= - 0 .74 ,     

溶栓治疗对急性心肌梗死患者血浆内皮素和一氧化氮水平的影响

目的 :探讨溶栓治疗对急性心肌梗死 (AMI)患者内皮素 (ET)和一氧化氮 (NO)水平的影响。方法 :治疗组 32例 ,采用尿激酶 15 0万U于 6 0min内静脉滴注 ,分别测出治疗前及治疗后溶栓再通组 (18例 )和未通组 (14例 )ET和NO水平的动态变化。对照组 2 0例 ,测治疗前ET和NO水平。结果 :①治疗组的ET水平高于对照组 (P <0 .0 5 ) ,NO水平低于对照组 (P <0 .0 5 ) ;②溶栓再通组的ET、NO水平显著增高 ,峰值分别是 196 .2 8± 2 0 .14ng/L和5 6 .82± 13 .6 2 μmol/L ,显著高于溶栓未通组的峰值 (ET 112 .18± 15 .2 2ng/L和NO43.87± 10 .12 μmol/L ,P <0 .0 5 ) ;③再通组ET和NO峰值提前 ,都在溶栓后 2h ,而溶栓未通组ET和NO峰值均为溶栓后 6h。结论 :①ET/NO代谢失衡是构成AMI发生的一个重要机制 ;②溶栓后NO水平升高可拮抗再灌注损伤引起的ET水平增高。     

老年慢性肺心病患者血浆肾上腺髓质素和脑钠素水平变化的意义

目的　测定老年慢性肺心病患者血浆肾上腺髓质素 (ADM )和脑钠素 (BNP)的水平并探讨其临床意义。　方法　用放射免疫分析法测定 39例急性加重期和 30例缓解期老年肺心病患者的血浆ADM和BNP水平 ,并与动脉血氧分压 (PaO2 )、内皮素 1(ET 1)及右室射血前期时间与肺动脉血流加速时间的比值 (RVPEP/AT)进行相关分析。 2 7例健康老年人为健康对照组。　结果　老年肺心病组急性加重期和缓解期血浆ADM和BNP水平〔分别为 (2 7 31± 6 2 7)ng/L、(17 2 2± 4 15 )ng/L和 (6 6 2 1± 12 79)ng/L、(5 2 74± 8 85 )ng/L〕均高于健康对照组〔分别为 (11 18± 3 95 )ng/L、(34 5 2± 3 34)ng/L〕 ,急性加重期均高于缓解期 (均为P <0 0 0 1)。老年肺心病组急性加重期和缓解期血浆ADM均与PaO2 呈负相关 ,与ET 1及RVPEP/AT呈正相关。老年肺心病组急性加重期血浆BNP与PaO2 呈负相关 ,与ET 1及RVPEP/AT呈正相关 ,缓解期血浆BNP与ET 1及RVPEP/AT呈正相关 ,与PaO2 无显著相关。　结论　ADM和BNP可能参与了老年人肺心病的病理生理过程并在其中具有代偿作用。     

高血压患者内皮素和一氧化氮与血压节律相关性的研究

目的 :探讨高血压患者血浆内皮素 (ET)和血清一氧化氮(NO)与血压节律的相关性。方法 :2 8例高血压患者和 1 7例血压正常人进行动态血压监测和 ET,NO测定。结果 :高血压组 ET增加 ,NO下降。2 8例高血压患者按动态血压监测结果分为勺型和非勺型组 ,在非勺型组 ,ET明显增高(5 3.3± 1 9.1 vs37.8± 1 0 .0 ng/ L) ,NO明显降低 (33.4± 1 2 .7vs 48.4± 1 1 .1 mg/ L ) ;且夜间血压下降与 ET负相关 (r=- 0 .5 2 ,P<0 .0 5 ) ,NO正相关 (r=0 .5 4,P<0 .0 5 )。结论 :高血压病患者内皮素和一氧化氮水平可能参与昼夜血压节律的调节     

老年阻塞性睡眠呼吸暂停综合征并存脑卒中患者氧化应激指标观察及发病机制探讨

目的 观察老年阻塞性睡眠呼吸暂停综合征(OSAS)合并脑卒中患者血浆中血管内皮生长因子、一氧化氮、内皮素等指标的变化情况并初步探讨其发病机制.方法 经手握式脉搏血氧监测仪监测后,将患者分为OSAS并存脑卒中患者32例;单纯OSAS患者36例;单纯脑卒中患者31例;无脑卒中和OSAS患者33例为对照组.检测血浆中血管内皮生长因子(VEGF)、内皮素(ET)和一氧化氮(NO)浓度.结果 (1)血浆VEGF浓度从高到低分别为:OSAS并存脑卒中患者(195.3±56.7)ng/L、单纯OSAS患者(162.3±48.7)ng/L、单纯脑卒中患者(156.4±51.8)ng/L及正常对照组(114.1±54.Z)ng/L,差异有统计学意义(F=21.02,P<0.05);(2)血浆NO浓度从低到高分别为:OSAS并存脑卒中患者(62.3±4.9)mmol/L、单纯脑卒中患者(64.7±5.1)mmol/L、单纯OSAS患者(66.2±4.2)mmol/L及正常对照组(77.5±6.8)mmol/L,差异有统计学意义(F=17.35,P<0.05);(3)血浆ET浓度从高到低分别为:OSAS并存脑卒中患者(59.8±9.6)ng/L、单纯脑卒中患者(56.5±4.3)ng/L,单纯OSAS患者(54.7±7.9)ng/L、及正常对照组(37.2±8.5)ng/L,差异有统计学意义(F=4.27.P<0.05).结论 (1)OSAS患者血浆VEGF、ET浓度升高,血浆NO水平下降;(2)并存脑卒中的OSAS患者比无脑卒中的单纯OSAS患者血浆VEGF、ET浓度升高更显著,血浆NO水平下降更明显.提示:OSAS老年脑卒中患者存在明显血管内皮功能障碍,伴脑卒中者为甚,血管内皮功能损伤可能是OSAS患者并发脑卒中的原因之一.     

可溶性E-选择素对冠心病心绞痛的诊断意义

目的 :探讨可溶性E 选择素 (sE selectin)在冠心病 (CHD)中的临床意义及其对心脏缺血性胸痛与非心脏缺血性胸痛的鉴别诊断价值。方法 :用ELISA法检测了 72例经冠状动脉造影 (CAG)诊断的胸痛患者血清sE selectin水平 ,并以 18例健康体检者作为对照。结果 :CAG阳性组sE selectin水平〔(6 8.4± 17.8) μg/L〕较CAG阴性组〔(5 4 .6± 19.6 ) μg/L〕及对照组〔(5 2 .8± 17.4 ) μg/L〕均明显增高 (P <0 .0 5 ) ,尤以急性心肌梗死患者增高更为显著〔(74 .3± 18.6 ) μg/L〕。以≥ 6 0 μg/L为低限 ,其诊断CHD的敏感性为 74 % ,特异性为 83%。 结论 :CHD患者血清sE selectin水平增高 ,并反映病情严重程度 ,可作为可疑胸痛患者的辅助鉴别诊断手段     

青少年高血压的研究进展

随着人们生活和行为方式的改变,高血压发病明显呈年轻化趋势。在青少年时期识别高血压病高危人群有助于早期进行有效干预和治疗,降低未来高血压的发生率及其严重性。现试从青少年高血压的诊断、发病因素、特点、治疗策略等方面的研究进展作一综述。     

Morbidity in cardiovascular diseases in immigrants in Sweden

INTRODUCTION: Although immigration to Sweden has increased in the last few decades, the incidence rates of cardiovascular disease and coronary heart disease in immigrants are unknown. The aim of the present study is to estimate whether place of birth affects the incidence rates of cardiovascular disease and coronary heart disease. MATERIAL AND METHODS: The study was designed as a follow-up study on morbidity in cardiovascular disease and coronary heart disease between 1 January 1997 and 31 December 1998, including three and a half million persons with age range 35-64 years, of whom 550 000 were born abroad, from the database MigMed consisting of the whole Swedish population. Incidence rates and relative risks were estimated by indirect standardization and a proportional hazard model. RESULTS: The age-adjusted risk of coronary heart disease was higher in most foreign-born groups than in Swedes. For example, in nine of 12 male groups, the relative risks varied between 1.1 and 2.2, and in seven of 12 female groups, the relative risks varied between 1.4 and 2.5. When also adjusting for level of education and employment status, the risks were still high, but on a lower level. CONCLUSIONS: Foreign-born people possess an over-risk of cardiovascular or coronary heart disease(CVD/CHD) compared with Swedish-born persons, also when level of education and employment status are taken into account.     

C·肉毒杀鼠素(冻干剂)应用研究

目的为研究C·肉毒杀鼠索对杀灭达乌尔黄鼠(简称黄鼠)的大面积应用情况和对家畜、家禽的毒害作用,进行了C·肉毒杀鼠素的应用研究.方法大面积投毒采用ES-2药饵撒播机[1],间隔约80m进行条投.羊、鸡采用直接灌胃.结果大面积应用的灭鼠率为83.72%.对羊、鸡最高剂量分别为500万MLD、150万MLD,均未出现中毒现象.结论 C·肉毒杀鼠素是较为理想的草原大面积杀灭黄鼠的理想、首选药物.     

高龄老年高血压的临床研究进展

随着社会老龄化进程的加快,80岁以上高龄老人的绝对数量以及占总人口的比例均在增加,如何提高高龄老年高血压的防治水平备受关注。现试从高龄老年高血压的临床特点、治疗策略等方面的临床研究进展作一综述。     

中国老年性耳聋的研究与干预进展

老年性耳聋已成为影响我国老年人生活质量的最主要的慢性病之一。助听器是目前帮助听力损失的老年人克服交流障碍的主要手段。在我国,数字助听器已逐渐取代模拟助听器并且体现出了更好的效果。但是老年听力损失患者中使用助听器的比例仍然很小。人工耳蜗植入也已被应用在老年患者中。我国针对老年人的听力康复服务还有较长的路要走。     

糖尿病大鼠心室肌细胞钾通道的改变

目的研究糖尿病大鼠心室肌细胞钾通道的改变及增加葡萄糖代谢对其的作用。方法取体重150～200g的雄性SpragueDawley大鼠,腹腔注射链脲菌素(STZ)建立糖尿病模型,采用酶解法获得单个心室肌细胞,应用膜片钳全细胞记录技术记录钾电流。结果糖尿病大鼠心室肌细胞瞬间外向性钾流(Ito)密度较对照组显著降低[ 60mV时,分别为(15.90±1.19)pA/pF(n=25)和(28.55±0.97)pA/pF(n=12),P<0.001];分别用100nmol/L胰岛素及1.5mmol/L二氯乙酸在体外预处理心室肌细胞4～5h和3～4h使Ito密度恢复至对照组水平[ 60mV时,分别为(29.40±0.38)pA/pF(n=20)和(27.35±0.97)pA/pF(n=12)]。结论糖尿病大鼠心室肌细胞钾通道功能发生改变,增加葡萄糖代谢可逆转这一改变,提示葡萄糖代谢与Ito功能间存在一定关系。     

Sex Differences in Ethanol-induced Dopamine Release in Nucleus Accumbens and in Ethanol Consumption in Rats

In vivo microdialysis was used to examine changes in nucleus accumbens and striatal dopamine, dihydrophenylacetic acid (DO-PAC), and homovanillic acid (HVA) following acute administration of ethanol (0.0, 0.25, 0.5, 1.0, or 2.0 g/kg) in male and female Long-Evans rats. Following dialysis, rats were trained to bar-press for oral ethanol reinforcement. In nucleus accumbens, females showed significant increases in extracellular dopamine following 0.25 or 0.5 g/ kg ethanol, but did not show significant increases over baseline at the higher doses. Males showed slight increases in dopamine at the lower doses and decreased dopamine at 2.0 g/kg. In striatum, both sexes showed increased dopamine at the lower doses and decreased dopamine at 2.0 g/kg. There were slight increases in nucleus accumbens DOPAC and HVA at some doses in both sexes, but no changes in striatal metabolite levels. In addition to showing increased responsiveness to ethanol-induced mesolimbic dopamine stimulation, females consumed more ethanol than males during behavioral testing. The pattern of both greater ethanol-induced nucleus accumbens dopamine release and greater ethanol consumption in females supports the hypothesis that ethanol reward is mediated, at least in part, by the mesolimbic dopamine system.     

Epstein-Barr virus in malignancies in renal transplant recipients in Japan

A role for Epstein-Barr virus (EBV) in the development of malignancies including lymphomas, and carcinoma of the stomach, nasopharynx, thymus and salivary gland is suggested. It is indicated that EBV evokes polyclonal-B-cell-proliferative diseases in immunocompromised hosts, such as transplant patients, which results in monoclonal malignant lymphomas. The suppression of immune functions in these patients is thought to lead to incomplete elimination of the cells expressing EBV latent infection genes. To examine the etiological role of EBV in the development of malignancies following renal transplant in Japan, 42 malignancies in 1744 cases of renal transplant were studied for the presence and type of EBV. The polymerase chain reaction revealed that 5 malignancies were positive for EBV, all type A: 2 of 2 cases of non-Hodgkin's lymphoma (NHL), 2 of 8 cases of gastric adenocarcinoma of the common type, and 1 of 2 cases of gastric plasmacytoma. In situ hybridization revealed positive signals in the nucleus of tumor cells in 2 cases of NHL and 1 of plasmacytoma. Positive signals were found in the small lymphoid cells but not in the tumor cells in 2 cases of gastric carcinoma. On the basis of these findings, a role for EBV in the development of malignancies in renal transplant patients is unlikely except for lymphoid neoplasias.Abbreviations PCB polymerase chain reaction - EBV Epstein-Barr virus - NHL non-Hodgkin's lymphoma