老年高血压伴脑梗死24h动态血压的临床分析

目的探讨老年高血压脑梗死24h动态血压的临床分析方法将2012年10）~--2013年10月我院收治的老年高血压病人分为高血压并发症梗死患者和非并发脑梗死病人两个组别,并分别对两组病人的动态血压进行测量,比较两组病人的脉压和血压。结果两组患者的动态血压相比差异具有统计学意义（P〈0．05）。结论脑梗死病人的ABPP增加非常的明显,对老年高血压病人的脉压进行监测,可以更好的对老年高血压病人的疾病的状态以及预后进行更加准确的判断。     

Comparisons of spot vs 24-h urine samples for estimating population salt intake: Validation study in two independent samples of adults in Britain and Italy

ObjectivesTo assess the reliability and reproducibility of estimations of group mean 24-h urinary sodium (Na) excretion through timed spot urines compared to 24 h urinary Na output in two independent cross-sectional population samples including men and women and different ethnic groups.Methods and ResultsStudy 1 was carried out in Britain and included 915 untreated 40–59 yrs male and female participants (297 white, 326 of black African origin and 292 South Asian). Study 2 was carried out in Italy and included 148 white men (mean age 58.3 yrs). All participants provided both a 24-h urine collection and a timed urine sample as part of population surveys. Na, creatinine (Cr) and volume (V) were measured in all samples. Age, body mass index (BMI) and blood pressure (BP) were also measured. We compared the daily Na excretion through 24-h urine (gold standard) with its estimate from timed urine samples with two methods: Tanaka's predictions and Arithmetic extrapolations, and assessed them with correlation coefficients, Bland–Altman plot, prediction of quintile position and Receiver Operating Characteristic (ROC) Areas Under the Curve (AUC) for a cut-off of <100 mmol of Na/day. In Study 1 (discovery study) with the Tanaka method there were poor correlations between predicted and measured 24-h Na excretions in different ethnic groups and genders (r_Spearman from 0.055 [R² = 0.003] in black women to 0.330 [R² = 0.11] in white women). The Bland–Altman plots indicated consistent bias with overestimate for low and underestimate for high intakes. ROC AUCs varied from 0.521 to 0.652 with good sensitivity (95–100%) but very poor specificity (0–9%). With the Arithmetic extrapolations correlations varied from 0.116 [R² = 0.01] to 0.367 [R² = 0.13]. Bias was detected with both Bland–Altman plots and through quintile analyses (underestimate at low levels and overestimate at high levels). Finally, ROC AUCs varied from 0.514 to 0.640 with moderate sensitivity (64–70%) but low specificity (20–53%). In Study 2 (validation study) results were consistent with the discovery phase in white men.ConclusionBased on these results, 24-h urinary collection for the measurement of Na excretion remains the preferred tool for assessing salt intake when compared with reported methods based on timed spot urine samples.     

肥厚型心肌病磁共振钆剂延迟增强与心电图 QTe/RR的关系

摘要：目的 探讨肥厚型心肌病（HCM）磁共振钆剂延迟增强与动态心电图QTe/RR斜率的关系。方法 将本院 2016 年 1 月—2017 年 6 月接诊的 96 例 HCM 患者,根据心脏磁共振扫描（CMR）是否出现钆剂延迟增强（LGE）分为 LGE阳性组和LGE阴性组。采用评分法评估LGE阳性组患者LGE透壁程度。所有受试者行24 h动态心电图检查, 计算心率（HR）、QT间期及QTe/RR斜率。分析LGE阳性组总LGE评分与QTe/RR斜率之间的相关性,分析LGE透壁 程度和QTe/RR斜率与患者预后的关系。结果 CMR结果显示LGE阳性51例（53.13%）,LGE阴性45例（46.87%）; LGE阳性组与LGE阴性组左心室射血分数（LVEF：0.412±0.092 vs. 0.508±0.083）、左心室舒张末期容积［LVEDV（mL）： 173.91±43.68 vs.148.52±31.77］及左心室舒张末期后壁厚度［LVPWD（mm）：13.26±2.81 vs. 12.15±2.37］比较差异有统 计学意义（t分别为5.301、3.219、2.077,均P＜0.05）;LGE阳性组QT间期（ms：439.67±25.82 vs. 411.53±31.66）、QTe/RR 斜率（0.20±0.05 vs. 0.16±0.03）均高于 LGE 阴性组（t 分别为 4.794、4.674,均 P＜0.05）;LGE 阳性组总 LGE 评分为 （26.37±7.52）分,与QTe/RR斜率呈正相关（r=0.742,P＜0.001）;LGE阳性组室性心律失常、心源性猝死等不良反应发 生率高于LGE阴性组（17.65% vs. 4.44%,c2=4.107,P＜0.05）;总LGE评分、QTe/RR斜率与患者室性心律失常、心源性 猝死有关（P＜0.05）。结论 HCM患者LGE程度与QTe/RR斜率显著相关,综合评估两项指标可能更有助于HCM预 后判断     

Influence of renal ischaemia‐reperfusion injury on renal neutrophil gelatinase‐associated lipocalin receptor (24p3R) in rats

The neutrophil gelatinase‐associated lipocalin (NGAL) receptor (24p3R) is expressed in distal nephron and contributes to the endocytosis of NGAL in urine. This study was undertaken to evaluate an influence of renal ischaemia‐reperfusion injury on 24p3R. Unilateral renal pedicle was clamped for 0, 10, 20, 30, or 45 minutes in male Wistar rats. Urine was collected for 24 hours after reperfusion, and ischaemic kidney and blood sample were obtained. Apparent histological injury in the ischaemic kidney was detected in the 30 and 45 minutes‐treated groups. Urinary NGAL excretion elevated in rats with renal ischaemia for more than 20 minutes, while serum creatinine increased in rats for more than 30 minutes of ischaemia. Renal protein expression of NGAL did not significantly change. Renal mRNA expressions of megalin and cubilin, which are expressed at renal proximal tubules and uptake NGAL, decreased in animals with renal ischaemia for more than 20 minutes. Renal protein expression of 24p3R, which is expressed at renal distal tubules and uptake NGAL, decreased in rats with renal ischaemia for 45 min. This study showed for the first time that renal 24p3R decreased in response to renal ischaemia. As relatively longer renal ischaemia (45 minutes) decreased renal 24p3R protein and increased urinary NGAL excretion, the down‐regulation of 24p3R protein might contribute to the elevated urinary excretion of NGAL in rats with unilateral ischaemia‐reperfusion injury.     

24h平均脉压差与冠心病心律失常的相关性分析

目的 探讨冠心病(CHD)合并高血压(HBP)患者24h平均脉压与冠状动脉病变程度及心律失常的关系.方法 选择经冠脉造影、动态血压与心电同步监测等相关检查诊断为CHD合并HBP患者154例,依据24h平均脉压(PP)将其分为A、B两组,A组PP＜50mmHg、B组PP≥50mmHg,对比两组冠状动脉病变程度、心律失常发生情况.结果 B组患者三支病变发生率及病变血管支数显著高于A组,p＜0.01;B组患者双支病变发生率、冠脉狭窄积分、冠脉狭窄程度均高于A组,p＜0.05;B组患者ST-T改变、心律失常的发生率均明显高于A组,p＜0.05.结论 采用24h动态血压和心电同步监测CHD合并HBP患者,发现脉压变大与冠状动脉病变程度、心律失常及心肌缺血呈正相关,表明PP是一项较为可靠且简便易行的客观评估CHD预后重要指标之一.     

术后24h开始经口进食对直肠癌患者术后恢复的影响

为探讨术后24h开始经口进食对直肠癌患者术后恢复的影响,选择2013年12月至2014年2月于我科择期行直肠癌根治术的60例患者进行研究,随机分为观察组和对照组,各30例,观察组术后接受快速康复治疗（术后24h开始进食）,对照组术后接受传统治疗（肠功能恢复后开始进食）。对比两组患者术后住院时间、首次排气时间和首次排便时间。结果显示,观察组患者术后住院时间、首次排气时间、首次排便时间均明显短于对照组,P〈0．05。结果表明,直肠癌患者术后24h开始经口进食安全、可行,术后肠道功能恢复快,住院时间短。     

真核表达载体pEGFP-N1-kin17的构建及其在Zmpste24-/-小鼠胚胎成纤维细胞内的表达

目的：构建人kin17基因真核表达载体pEGFP-N1-kin17,将载体转染至野生型及Zmpste24基因缺失的小鼠胚胎成纤维上皮细胞,荧光显微镜观察kin17蛋白表达情况。方法用高保真DNA 聚合酶,从pCMV-kin17载体中扩增获取人kin17 cDNA编码序列,将其克隆至pEGFP-N1载体中,经酶切、连接、转化后,挑取阳性克隆进行菌液进行PCR、菌液质粒双酶切及测序鉴定;将成功构建的GFP-kin17表达载体转染Zmpste24-/- MEFs,荧光显微镜观察kin17蛋白的核定位情况。结果 pEGFP-N1-kin17转化细菌克隆测序结果完全正确;将载体转入MEFs后,可以通过荧光显微镜观察到kin17蛋白的表达。结论成功构建GFP融合的kin17真核表达载体,该载体为kin17蛋白的研究提供工具。本实验中载体pEGFP-N1-kin17在野生型和Zmpste24-/- MEFs中均成功表达。