血浆同型半胱氨酸与缺血性脑卒中病因分型及预后的关系研究

目的探讨血浆同型半胱氨酸（Hcy）水平与缺血性脑卒中（ICS）分型及预后的关系。方法用荧光偏振免疫法检测499例初发、97例复发ICS患者及200例健康体检者的血浆Hcy水平,并对ICS患者进行改良TOAST分型及神经功能缺损评估,比较不同组之间Hcy水平差异及Hcy对ICS患者预后的影响。结果 （1）不同类型初发ICS组血浆Hcy水平均显著高于对照组（均P〈0.01）;初发ICS组中不同亚型发病例数依次为AT组〉SAD组〉SUD组〉SOD组〉CE组。（2）动脉粥样硬化血栓形成组不同亚型血浆Hcy水平均显著高于对照组（均P〈0.01）;其中动脉粥样硬化穿支闭塞和混合型为主要发病类型。（3）初发ICS高Hcy血症组好转率显著低于正常Hcy组（P〈0.01）。（4）复发组血浆Hcy水平显著高于初发组（P〈0.01）。结论血浆Hcy水平与ICS的发病、类型及预后和复发有关,高Hcy血症是ICS的独立危险因素。     

天麻钩藤饮联合福辛普利对H型高血压阴虚阳亢证患者的影响

目的：探讨天麻钩藤饮联合福辛普利对H型高血压阴虚阳亢证患者的影响。方法：将120例H型高血压阴虚阳亢证患者随机分为A组60例,服用天麻钩藤饮和福辛普利片;B组60例,服用福辛普利及叶酸片。4周为1疗程。检测治疗前后患者的血压、血清同型半胱氨酸及症状改善情况。结果：经治疗后两组患者血清同型半胱氨酸的浓度无显著性差异。A组降压疗效及症状疗效均优于B组,具有统计学意义。结论：天麻钩藤饮联合福辛普利组降低高同型半胱氨酸血症具有与B组同样的干预作用,但在改善临床症状等方面,疗效优于B组。     

老年原发性高血压HCY与Hs-CRP及LP(a)相关性研究

目的 探讨老年原发性高血压HCY、Hs-CRP、LP(a)之间的相关性.方法 对170例老年原发性高血压分别测定Hs-CRP、HCY、LP(a)水平,分析其相关性.结果 四组Hs-CRP、HCY、LP(a)水平差异有统计学意义(P＜0.05);组间多重比较,正常对照组与高血压各级组比较差异均有统计学意义(P＜0.05);而各级老年高血压组间比较差异也有统计学意义(P＜0.05).结论 血浆HCY、Hs-CRP、LP(a)水平可作为老年原发性高血压发生发展的重要评估指标.     

Nutrition in centenarians

The oldest old are among the fastest growing segment of the population and it is important to understand not only the influence of modifiable lifestyle factors such as diet and nutrition on the achievement of exceptional longevity but also the role, if any, of these factors on maintaining optimal cognitive, mental and physical health into advanced age. This review summarizes studies of dietary intake and patterns of long-lived peoples and presents current knowledge of nutritional status of centenarians as determined with nutritionally relevant biomarkers, providing information on comparative levels of the various biomarkers between centenarians and older adult controls and on the prevalence and predictors of nutritional deficiencies in centenarians. The studies indicate that BMI and nutritional status as indicated by circulating levels of antioxidant vitamins, vitamin B12, folate, homocysteine and 25(OH) vitamin D of centenarians are quite heterogeneous and influenced by region of residency and many of the demographic, dietary and lifestyle factors that influence nutritional status in other older adults. While many of the studies have been small, convenience samples of relatively healthy community-dwelling centenarians, a few have population-based or included participants of varying cognitive functioning. These and future studies examining associations between nutritional status and cognitive, mental and physical function should be instrumental in determining the role of nutrition in promoting longevity and improving the quality of life in these exceptional survivors.     

高同型半胱氨酸血症与短暂性脑缺血发作的相关性

目的探讨高同型半胱氨酸（HHcy）、肿瘤坏死因子（TNF-a）、白细胞介素（IL-6）与短暂性脑缺血发作的相关性。方法纳入90例短暂性脑缺血发作（TIA）患者（其中前循环TIA组45例,后循环TIA组45例）,另纳入45例健康体检者作为对照组。结果 90例短暂性脑缺血患者中76例于发病后第1天血Hcy、TNF-aI、L-6明显高于正常对照组,且Hcy与TNF-aI、L-6呈正相关。结论短暂性脑缺血患者Hcy与健康对照组有明显差异。Hcy水平与TNF-aI、L-6呈正相关。短暂性脑缺血发作组的TNF-aI、L-6与健康对照组有统计学差异。     

同型半胱氨酸与缺血性心肌病和扩张性心肌病的关系探讨

目的：探讨同型半胱氨酸（Hcy）水平变化与缺血性心肌病和扩张性心肌病的关系及意义。方法：选取我院冠心病患者198例,其中缺血性心肌病患者80例（A组）,扩张性心肌病患者53例（B组）,普通冠心病患者65例（对照组）,入选者均行冠状动脉造影。比较三组的一般临床资料。采用酶联免疫法测定并比较三组血清同型半胱氨酸水平,测定相关生化指标。采用彩色多普勒超声诊断仪测定三组左房内径,左室舒末内径及左室射血分数。结果：B组与对照组相比,同型半胱氨酸水平无明显差异,A组同型半胱氨酸水平明显高于对照组（P〈0.05）,A组同型半胱氨酸水平与B组相比显著增高（P〈0.05）,A组年龄高于B组及正常对照组（P〈0.05）。三组一般临床资料,如糖尿病、血脂、高血压、吸烟饮酒、叶酸、维生素B12水平等方面比较,差异无统计学意义。与对照组相比,A组与B组的左房内径、左室舒末内径明显增大（P〈0.05）,左室射血分数明显降低（P〈0.05）。结论：检测同型半胱氨酸水平在临床上可对鉴别缺血性心肌病和扩张性心肌病提供帮助。     

透析前慢性肾脏病患者的微炎症状态与心血管风险

目的了解GFR（15—59）mL／（min·1．73m^2）的CKD患者微炎症状态的发生率。方法观察CKDⅢ-Ⅳ期患者36例,与29例健康对照者以及32例ESRD患者比较,分析其炎症指标血白介素-6（IL-6）、肿瘤坏死因子Ⅱ（TNF-α）、同型半胱氨酸（Hcy）、超敏C反应蛋白（hscRP）。结果CKDⅢ-Ⅳ期的患者与ESRD患者的IL-6、TNF-α、Hcy、hsCRP均较正常人群偏高（P〈0．05）。结论在CKDⅢ-Ⅳ期患者中已经普遍存在微炎症状态。     

血压患者体内同型半胱氨酸水平与颈动脉内膜中层厚度的关系

目的观察原发性高血压患者血清同型半胱氨酸与颈动脉内膜中层厚度（IMT）的关系。方法门诊收集原发性高血压患者60例,分为H型高血压组和正常高血压组。循环酶法测定血清同型半胱氨酸水平,采用高分辨彩色多谱勒超声仪测量颈总动脉从内膜内表面到中膜外表面的厚度以及颈动脉斑块等指标。结果H型高血压组颈动脉内膜中层厚度明显高于正常高血压组（P〈0．05）;但斑块检出率两组未发现明显差异;血清总同型半胱氨酸水平与颈动脉斑块发生率呈正相关（r=0．77,P〈0．05）。结论H型高血压患者颈动脉内膜中层厚度明显增加,且与血清同型半胱氨酸水平呈正相关。     

Methylenetetrahydrofolate reductase polymorphism determines the plasma homocysteine-lowering effect of large-dose folic acid supplementation in patients with cardiovascular disease

OBJECTIVE: The polymorphism of the gene encoding methylenetetrahydrofolate reductase (MTHFR) and folic acid nutritional status play important roles in atherosclerosis. The present study investigated the total homocysteine-lowering effect of folic acid in response to the MTHFR genotype in patients who have cardiovascular disease. METHODS: Twenty-three patients who had cardiovascular disease (ages 44 to 88 y) were supplemented with 5 mg of folic acid/d for 8 wk. Blood samples were collected before and after supplementation for the measurement of folic acid. The presence of the 677C-->T mutation was assessed by polymerase chain reaction followed by restriction enzyme analysis. RESULTS: After the 8 wk of folic acid supplementation, plasma total homocysteine decreased 40% in patients who had the TT genotype, 23% in those who had the CT genotype, 10% in those who had the CC genotype, and 27% in carriers of the T allele. The plasma total homocysteine-lowering effect of folic acid was significant only in patients who had the CT genotype and in carriers of the T allele. CONCLUSIONS: The MTHFR polymorphism may be involved in the total homocysteine-lowering effect of folic acid in patients who have cardiovascular disease.     

丹红注射液对合并代谢综合征的非ST段抬高型急性心肌梗死患者血清CD137、高敏C反应蛋白和高半胱氨酸水平的影响

目的：探讨丹红注射液对合并代谢综合征的非ST段抬高型急性心肌梗死患者血清CD137、高敏C反应蛋白（hs-CRP）和高半胱氨酸水平（Hcy）的影响。方法纳入合并代谢综合征的非ST抬高型心肌梗死患者126例,按随机数字表法随机分为常规治疗组和丹红治疗组,每组63例。常规治疗组患者给予常规治疗,丹红治疗组在常规治疗组基础上给予丹红注射液静脉滴注,20 ml/次。检测患者入院时和治疗后10 d时血清CD137、hs-CRP和Hcy水平。采用Gensini评分法评价冠状动脉疾病严重程度。结果两组治疗后,血清CD137、hs-CRP、Hcy均较同组治疗前明显降低（常规治疗组t值分别为12.393、17.408、9.458,丹红治疗组t值分别为16.110、17.573和13.481,P均＜0.01）,丹红治疗组较常规治疗组下降更显著（t值分别为2.815、3.224和3.157,P均＜0.01）。126例患者术前CD137、hs-CRP与冠状动脉狭窄程度积分（Gensini积分）呈显著正相关（r分别为0.720和0.562,P均＜0.01）。结论合并代谢综合征的非ST段抬高型急性心肌梗死患者血清CD137、hs-CRP水平与冠状动脉疾病程度相关,静脉滴注丹红可能通过降低CD137、hs-CRP对冠状动脉疾病有一定的保护作用。