我国中年人群的营养素摄入状况与高血压发病关系的前瞻性研究

目的探讨我国中年人群中营养素摄入状况与高血压发病的关系。方法1983—1984年在北京、广州4组人群中进行心血管病危险因素调查和膳食调查,1993-1994年采用相同的方法对上述人群进行了除膳食调查以外全部项目的复查。本研究对基线有膳食资料、无高血压和其他心血管疾病且参加1993-1994年复查的653人的资料进行分析。结果653人中1983-1984年至1993-1994年共170人发生高血压。将研究对象按经热量校正后的营养素摄入量3分位数分为3组,对多种营养素摄入量与高血压发病关系的分析结果显示：蛋白质摄入量和高血压发病之间存在显著的负关联,钠摄入量与高血压发病之间存在显著的正关联,其他营养素与高血压发病之间的关联大多较弱且不具有统计学意义。结论膳食蛋白质和钠可能是影响我国人群高血压发病的重要的膳食因素,在我国中年人群中增加膳食蛋白质的摄入、同时减少钠的摄入,对于预防高血压可能具有重要的作用。     

A new procedure for Ebstein's anomaly

BACKGROUND: A new procedure for correction of Ebstein's anomaly that restores to near normal the anatomic and physiologic function of the tricuspid valve and the right ventricle is reported. METHODS: Between December 1997 and September 2002, 34 consecutive patients with Ebstein's anomaly underwent this new procedure. There were 13 male and 21 female patients aged 9 months to 48 years (mean, 17 years). Tricuspid incompetence was moderate in 12 patients and severe in 22. Our repair technique is as follows: the displaced posterior leaflet with some chordae tendineae and corresponding papillary muscle are detached from the annulus and ventricular wall, respectively. The leaflet is then reattached to the native posterior annulus with reimplantation of the papillary muscle. The displaced septal leaflet is treated in the same manner. Most of the atrialized portion of the ventricular wall is excised; the tricuspid annulus is plicated. In 8 of the patients the septal leaflet was severely hypoplastic and necessitated creation of a new leaflet using autologous pericardium. RESULTS: All patients survived and recovered uneventfully. Postoperative echocardiography showed that tricuspid incompetence disappeared in 29 patients and was mild in 5. Right ventricular size decreased significantly with complete disappearance of the atrialized segment. Follow-up of patients ranged from 1 to 55 months (mean, 25 months), with 9 patients having more than 3 years of follow-up. They are doing well and their exercise tolerance improved to normal. CONCLUSIONS: This new procedure anatomically corrects Ebstein's anomaly with the satisfactory early and midterm results.     

Long-term prognostic value of exercise <Superscript>99m</Superscript>Tc-MIBI SPET myocardial perfusion imaging in patients after percutaneous coronary intervention

The purpose of this study was to evaluate the long-term prognostic value of exercise technetium-99m methoxyisobutylisonitrile (^99mTc-MIBI) single-photon emission tomography (SPET) imaging in patients after percutaneous coronary intervention (PCI). Three hundred and eighteen consecutive post-PCI patients who underwent exercise and rest ^99mTc-MIBI SPET myocardial perfusion imaging (MPI) were followed up for 38±27 months. Patients with early revascularisation (<3 months after MPI) were excluded. A semiquantitative visual analysis employing a 20-segment and four-point scoring system was used to define the summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS). Death and non-fatal myocardial infarction (MI) were considered as hard events, and late revascularisation procedures (3 months after MPI) as soft events. Fifty-one patients (16.0%) suffered from cardiac events during follow-up, including 1 (0.3%) death, 13 (4.1%) non-fatal MIs, 9 (2.8%) coronary artery bypass grafting procedures and 28 (8.8%) PCIs. According to the SPET results, patients were classified into three groups: patients with normal MPI (SSS=0, n=153), patients with irreversible defects (SDS<3 and SRS>1, n=100) and patients with reversible defects (SDS3, n=65). The annual hard cardiac event rate in patients with reversible defects was 3.9%, which was significantly higher than that in patients with normal MPI (0.2%, ²=7.71; P<0.01). The annual soft cardiac event rate in patients with reversible defects was 10.7%, which was significantly higher than that in patients with irreversible defects (2.5% ²=17.69; P<0.001), and also significantly higher than that in patients with normal MPI (1.5%, ²=33.89; P<0.001). In patients with normal and reversible defects, there was no significant difference in soft and hard cardiac event rates according to whether patients were symptomatic or asymptomatic (P>0.05). However, the annual soft event rate in patients with irreversible defects and symptoms was 5.0%, which was higher than that of 0.6% in asymptomatic patients (²=6.11, P<0.05). Multivariate Cox analysis showed that SSS was the best independent predictor for hard cardiac events (²=12.70; P<0.001) and SDS was the strongest independent predictor for soft cardiac events (²=11.72; P<0.001). Post-PCI patients who have normal exercise ^99mTc-MIBI SPET MPI have a good long-term prognosis, while those with reversible defects are at a higher risk for future cardiac events, without correlation to the chest pain symptoms. However, symptomatic patients with irreversible defects have a higher risk for repeat revascularisation, but not for hard events, compared with asymptomatic patients. Exercise ^99mTc-MIBI SPET MPI has important clinical value for risk stratification and management decision-making in post-PCI patients.     

11,12-环氧二十碳三烯酸对未成熟兔离体心脏停搏及再灌注性心律失常的影响

目的　观察 11,12 环氧二十碳三烯酸 (11,12 EET)对冷停搏未成熟兔离体心脏停搏效果及再灌注性心律失常的影响 ,探讨其作用机制。　方法　将 16只未成熟兔随机配对 ,分成对照组(离体心脏灌注St.Thomas Ⅱ停搏液 ,15ml/kg)和实验组 (离体心脏灌注含 70nmol/L11,12 EET的St .Thomas Ⅱ停搏液 ,15ml/kg)。利用非循环式Langendorff灌注装置 ,测定 (1)心脏灌注停搏液后的电机械活动停止时间和再灌注后电机械活动恢复时间 ;(2 )心脏停搏 2h(15℃ )后再灌注 1h(3 7℃ )过程中的心率、冠状动脉流量变化、心律失常活动及评分 ;(3 )心脏再灌注 1h后的心肌含水量、心肌钙离子含量。　结果　实验组与对照组的电活动停止时间 [(9 3± 0 9)s与 (13 6± 1 9)s ,P <0 0 1]、机械活动停止时间 [(4 5± 1 7)s与 (7 3± 2 1)s,P <0 0 5]、心肌钙离子含量 [(3 2 2± 0 3 3 ) μmol/克干重心肌 (gdw)与 (3 97± 0 2 6) μmol/gdw ,P <0 0 1]、心律失常发生及评分 [(2 0 3± 0 83 )与 (3 88± 1 2 5)分 ,P <0 0 1]、心肌含水量 [(84± 4)与 (90± 5) % ,P <0 0 1]比较 ,实验组均低于对照组。各时点冠状动脉流量显著增高。两组之间的电机械活动恢复时间、心率变化差异无显著性 (P >0 0 5)。　结论　传统的St     

Awareness,treatment and control of hypertension in patients attending hospital clinics in China

OBJECTIVES: To determine awareness, treatment and control of hypertension in patients attending hospital clinics in China. DESIGN: A cross-sectional survey. PATIENTS AND SETTING: Patients over the age of 35 years, who were attending outpatient clinics in 18 hospitals of eight major cities of Northern and Southern China, were interviewed face-to-face between June and July 1999. METHODS: Trained fieldworkers completed questionnaires regarding demographics, hypertension knowledge and awareness, treatment history and quality of life issues. Qualified physicians performed blood pressure assessment. RESULTS: A total of 9703 volunteers enrolled, of which 4510 (46.5%) were hypertensives. Among hypertensives, 23% were unaware of their high blood pressure. Although 89% of those aware reported receiving therapy, only 56% of them were taking medication regularly, and 33% were thus controlled. Although 69% of all hypertensives measuring at examination reported taking antihypertensive therapy, only 44% of them were actually taking medication regularly. Furthermore, 73% of hypertensives believed hypertension was not a serious problem, and required no regular medication. CONCLUSIONS: The results showed that a substantial number of outpatients have a hypertensive range of blood pressure. Although most of these patients are already being treated with drug regimen, the patient's misconceptions and lack of knowledge about the disease appear to be the major cause of treatment failure. The low rate of high blood pressure control for both sexes calls for further improvements.     

PDGF与肝素对动脉SMCI,Ⅲ型前胶原mRNA表达及胶原蛋白合成？…

目的 研究,探讨血小板源生长因子（ｐｌａｔｅｌｅｔｄｅｒｉｖｅｄｇｒｏｗｔｈｆａｃｔｏｒ,ＰＤＧＦ）和肝素对人主动脉平滑肌细胞（ｈｕｍａｎａｏｒｔａａｍｏｏｔｈｍｕｓｃｌｅ,ｃｅｌｌ,ｈＡＳＭＣ）增殖,胶原蛋白的合成,分泌以及Ｉ,Ⅲ型前胶原ｍＲＮＡ表达和转移生长因子β（ｔｒａｎｓｆｏｒｍｉｎｇｇｒｏｗｔｈｆａｃｔｏｒβ－ＴＧＦ－β）ｍＲＮＡ表达的调节作用,方法＾３Ｈ－ＴｄＲ,＾３Ｈ－脯氨酸掺入及Ｎ     

经冠状动脉内移植骨髓间充质干细胞在体示踪及体内再分布的实验研究

目的探讨利用心脏磁共振成像（MRI）对经冠状动脉内注射的超顺磁性氧化铁颗粒（SPIO）标记的骨髓间充质干细胞（bone marrow mesenchymal stem cells，BMMScs）进行在体示踪的可行性，观察移植细胞在体内的再分布情况。方法从猪的髂骨处抽取骨髓，分离、培养BMMSCs。用SPIO和CM—DiI（Cell Tracker^TM C-7001，Molecular Probe）对细胞进行双重标记。通过导管将标记的细胞注射到冠状动脉左前降支内，分别在细胞移植后当天、移植后1周、3周通过MRI检查对移植细胞进行在体示踪；并分别取不同器官的组织标本进行组织病理学检查。结果冠状动脉内注射的SPIO标记的BMMSCs可在心脏MRI上显影，表现为散在分布的点状信号缺失或低密度影像，并可持续3周。病理检查发现移植细胞较为均匀的分布在移植冠状动脉相关的心肌组织内，在移植后1周可见细胞进入冠状静脉系统内。移植细胞在体内能分布至肺、脾和肾，而在肝组织中很少见。结论用MRI技术可对经冠状动脉内注射的SPIO标记的BMMSCs进行在体示踪；移植细胞在体内有向非靶器官再分布的情况，相关器官组织形态学未见明显的改变。     

微囊化重组CHO细胞移植促进大鼠心肌梗死后血管新生的实验研究

目的在大鼠心肌梗死部位植入微囊化重组中华仓鼠卵巢（chinese hamster ovary，CHO）细胞，观察其分泌的血管内皮细胞生长因子（VEGF）是否可以促进心肌梗死部位的血管新生，改善心功能。方法通过质粒转染的方法构建可以分泌VEGF的重组CHO细胞系，用微囊包裹，观察微囊内细胞的生长及分泌情况。制备大鼠心肌梗死模型，随机将48只8周龄SD雄性大鼠分成微囊化细胞移植组（MC—CHO组）、单纯细胞移植组（CHO组）、空微囊移植组（MC组）和无血清培养基移植组（对照组），每组12只。移植3周后检测心功能改善情况，病理切片观察微囊结构及囊内细胞存活情况，注射部位微血管计数比较促血管新生效果。结果体外检测可见重组CHO细胞在微囊生长迅速，第8d时培养上清中VEGF达3852pg／ml；移植3周后MC—CHO组左心室大小和心功能明显好于其它3组，差异有统计学意义（P〈0．05）；局部微血管密度MC—CHO组较CHO组、MC组和对照组明显增加（22．3±3．1vs．15．6±2．8，11．4±2．5和13．2±2．7个／每高倍视野，P〈0．05）；组织学检查可见微囊结构完整，内有存活且具有分泌功能的CHO细胞。结论微囊化重组CHO细胞移植可促进大鼠心肌梗死后血管新生，改善心功能。     

学龄前儿童瓣膜成形术

目的 探讨学龄前儿童瓣膜疾患行瓣膜成形术的疗效。方法 总结１９９０年１月－１９９８年４月收治的学龄前儿童瓣膜疾患２８３例，男１３０例，女１５３例，年龄２个月－６岁，平均３．０５岁，其中≤１岁２２例（７．７７％）。≤３岁１７０例（６０．０７％）。体重３．１－２１．０ｋｇ，平均１１．８４ｋｇ，≤１０ｋｇ１０６例（３７．４６％）。主要瓣膜疾患包括：单纯瓣膜疾病９例（３．１８％），其中二尖瓣关闭不全（ＭＩ