Cardiovascular risk factors in adults with coarctation of the aorta

Background: The aging patient with adult congenital heart disease (ACHD) faces the risk of developing atherosclerotic disease. Patients with coarctation of the aorta (CoA) are especially vulnerable because of an inherent high risk of developing hy‐ pertension. However, data on the prevalence of other cardiovascular risk factors are scarce. Therefore, this study aimed to describe the prevalence of traditional cardio‐ vascular risk factors (diabetes, hypertension, hyperlipidemia, smoking, obesity, and sedentary lifestyle) in adult patients with CoA.
Methods: Patients with CoA who were registered at the ACHD clinic in Gothenburg were asked to participate in a comprehensive cardiovascular risk assessment. This assessment included a glucose tolerance test, cholesterol profile, ambulatory blood pressure measurements, and a lifestyle questionnaire.
Results: A total of 72 patients participated. The median age was 43.5 years and 58.3% were men. Sixty‐six (91.7%) patients had ≥one cardiovascular risk factor and 40.3% had ≥three risk factors. Three (4.2%) patients were newly diagnosed with diabetes or impaired glucose tolerance. More than half of the patients had hyperlipidemia (n = 42, 58.3%) and 35 patients (48.6%) were overweight or obese. Only three (4.2%) patients smoked regularly. Of the 60 patients who underwent 24‐hour ambulatory blood pressure measurement, 33 (55.0%) were hypertensive. Of the 30 patients with known hypertension only 9 (30.0%) had well‐controlled blood pressure on ambula‐ tory blood pressure measurement.
Conclusions: Cardiovascular risk factors among patients with CoA are prevalent. This may indicate a need for more aggressive screening strategies of traditional risk fac‐ tors to minimize the risk of these patients also developing atherosclerotic disease.     

六味能消胶囊联合脂必泰胶囊治疗高脂血症的临床研究

目的探讨六味能消胶囊联合脂必泰胶囊治疗高脂血症的临床效果。方法选取2017年5月—2018年10月东营市东营区人民医院收治的64例高脂血症患者,随机分为对照组和治疗组,每组各32例。对照组口服脂必泰胶囊,1粒/次,2次/d。治疗组在对照组治疗基础上口服六味能消胶囊,1粒/次,3次/d。两组均连续治疗8周。观察两组的临床疗效,比较两组治疗前后血脂指标、血流变学指标、血小板参数及血清学指标的变化情况。结果治疗后,对照组和治疗组的总有效率分别是75.0%、96.9%,两组比较差异具有统计学意义(P0.05)。治疗后,两组总胆固醇(TC)、非-HDL-C、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平均较治疗前显著降低,而高密度脂蛋白胆固醇(HDL-C)显著升高,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,治疗组TC、非-HDL-C、TG、LDL-C水平低于对照组,而HDL-C高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组血浆黏度(PV)、红细胞比容(HCT)、聚集指数(RCAI)、平均血小板体积(MPV)、血小板最大聚集率(MAR)均显著降低,而变形指数(RDI)值均显著升高,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,PV、HCT、RCAI、MPV、MAR值均显著低于对照组,而RDI值高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组血清C反应蛋白(CRP)、内皮素(ET)水平较治疗前均显著降低,而一氧化氮(NO)水平显著增高,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,治疗组CRP、ET水平低于对照组,而NO水平高于对照组,两组比较差异有统计学意义(P0.05)。结论六味能消胶囊联合脂必泰胶囊治疗高脂血症具有较好的临床疗效,综合调脂作用显著,可明显纠正患者体内血流变学异常,改善血小板功能及微炎症状态,保护血管内皮功能,具有一定的临床推广应用价值。     

绞股蓝总苷颗粒改善高脂血症C57BL/6J小鼠脂代谢的研究

为评价绞股蓝总苷颗粒以及其与他汀联用的降血脂作用，采用高脂饲料诱导构建高脂血症C57BL/6J小鼠模型。随机分为空白组、模型组、阳性药组(Lip，10 mg/kg)、绞股蓝总苷颗粒低、中、高剂量组(L、M、H，90，120，180 mg/kg)，联合组(Lip+H，180 mg/kg+10 mg/kg)。连续给药4周后检测血脂成分、血清ALT、AST及载脂蛋白B(Apo B)含量，H&E染色观察小鼠肝脏病理变化，利用RT-PCR法和Western blot法测定三磷酸腺苷结合盒转运体A1(ABCA1)、肝X受体(LXRα)、胆固醇7α-羟化酶(CYP7A1)和B族Ι型清道夫受体(SR-BΙ)等肝脏胆固醇代谢关键因子蛋白、基因表达水平。结果显示绞股蓝总苷颗粒能显著降低小鼠体重、腹部脂肪质量及血清总胆固醇(TC)、AST水平，并修复受损小鼠肝细胞；联合组能显著降低小鼠TC水平，效果优于绞股蓝总苷颗粒高剂量组和阳性药单用组。此外，绞股蓝总苷颗粒能显著升高ABCA1的蛋白水平，同时上调ABCA1、CYP7A1和SR-BΙ的基因表达。实验结果表明，绞股蓝总苷颗粒能够显著降低血脂，且与阿托伐他汀联用后降脂效果提高，并可降低血清转氨酶，初步探索其降脂机制可能是通过参与胆固醇逆转运调节TC含量。     

急性心肌梗死热毒证候病因探讨回顾性分析

目的:探讨急性心肌梗死热毒证患者的危险因素,对其证候病因进行分析。方法:回顾性筛选收集广州中医药大学第一附属医院确诊为急性心肌梗死患者的临床资料,进行中医证候分布调查,并将其分为热毒证组及非热毒证组,分析两组的一般资料以及住院病情预后,并采用Logistic回归分析热毒证病因的危险因素。结果:研究纳入322例患者中热毒证组占42.20%(136例),非热毒证组占57.8%(186例)。热毒证组平均血管病变数、左室舒张末、左室射血分数明显差于非热毒组(P0.05),住院期间心血管死亡例数两组未见明显差异。单因素分析热毒证分布为吸烟、辛辣厚味饮食、糖尿病、高脂血症多重心血管危险因素聚集人群(P0.05),Logistic回归分析发现吸烟、低密度脂蛋白、甘油三酯3个因子是预测热毒证候病因的独立要素,比值比(OR)分别为1.755,1.637,1.483。结论:急性心肌梗死热毒证形成病因与吸烟、血脂代谢紊乱相关,住院期间预后与非热毒证未见差异,但心室重构程度重于非热毒证组。     

1例三高病史患者同种异体肝移植手术配合报道

报道1例三高病史患者同种异体肝移植患者的病例资料,归纳总结术中配合要点及护理关注点。特殊患者术前全面评估、术中细致配合是保障肝移植手术成功的保障。     

Paroxysmal Severe Mitral Regurgitation

ObjectiveTo investigate the clinical presentation, pathophysiology, and treatment for "paroxysmal severe mitral regurgitation" (MR), which is an underappreciated cause of heart failure with preserved left ventricular ejection fraction.MethodsWe retrospectively reviewed cases of transient severe MR that were evaluated at Mayo Clinic in Rochester, Minnesota, between January 1, 2006, and December 31, 2019. Paroxysmal severe MR was defined as the appearance of transient severe MR in patients with mild MR at rest, normal left ventricle (LV) size, left ventricular ejection fraction greater than 40%, and absence of obstructive coronary artery disease.ResultsWe identified 6 patients (5 women) with a median age of 68 years. There were 3 distinct mechanisms of paroxysmal severe MR, which we labeled types 1, 2, and 3. Type 1 MR was caused by LV dyssynchrony from a rate-dependent left bundle branch block, which led to apical leaflet tenting and incomplete coaptation. Type 2 MR occurred from mitral annular dilatation during maneuvers that increased left-sided volume. Type 3 MR was caused by coronary artery vasospasm with apical leaflet tenting. Treatments varied depending on the underlying cause and included cardiac resynchronization therapy for type 1, surgical valve replacement for type 2, and medical therapy for type 3.ConclusionParoxysmal severe MR is a rare cause of heart failure in patients with preserved LV function. We have identified 3 distinct mechanisms that can lead to this dynamic process, with treatments varying based on the underlying cause.     

氨氯地平联合阿托伐他汀对高血压合并高血脂症患者的疗效

目的:探究氨氯地平联合阿托伐他汀在治疗高血压合并高血脂症中的临床疗效.方法:门诊治疗的高血压合并高血脂症患者200例,随机均分为观察组和对照组,观察组患者采用氨氯地平联合阿托伐他汀治疗,对照组患者采用氨氯地平进行治疗;观察两组患者治疗前后血压变化,比较治疗效果;同时比较两组患者治疗前后的低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)及胆固醇(TC),丙氨酸氨基转移酶(ALT)、血肌酐、血钾(K+)及血尿酸水平.结果:治疗后,观察组总有效率优于对照组,不良反应明显低于对照组(P＜0.05),收缩压和舒张压较治疗前明显下降,观察组改善更明显(P＜0.05);观察组患者LDL-C、TG及TC水平较治疗前下降,而HDL-C升高,这些血脂成分改变优于对照组(P＜0.05);观察组治疗后,血肌酐和血尿酸水平下降明显(P＜0.05),与无变化的对照组间比较,差异有统计学意义(P＜0.05).结论:氨氯地平联合阿托伐他汀对高血压合并高血脂症患者的治疗效果优于单独使用氨氯地平.     

不同剂量瑞舒伐他汀治疗老年冠心病合并高脂血症的临床研究

目的探讨不同剂量瑞舒伐他汀治疗老年冠心病合并高脂血症的临床疗效。方法选取2011年7月—2013年12月来都江堰市中医医院就诊的老年冠心病合并高脂血症患者240例,随机分为辛伐他汀组,瑞舒伐他汀大、中、小剂量组,每组60例。辛伐他汀组患者晚餐后口服辛伐他汀片,20 mg/次,1次/d。瑞舒伐他汀大、中、小剂量组患者分别口服瑞舒伐他汀钙片20、10、5 mg/次,1次/d。两组均连续治疗6个月。观察各组的临床疗效,同时比较4组治疗前后总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、颈动脉斑块的面积、颈内膜–中膜的厚度。结果治疗后,辛伐他汀组和瑞舒伐他汀大、中、小剂量组总有效率分别为63.33%、91.67%、76.67%、68.33%,大、中、小剂量组患者的总有效率明显高于辛伐他汀组;大剂量组的总有效率明显高于中、小剂量组,差异有统计学意义(P0.05)。治疗后,4组患者TG、TC、LDL、颈动脉斑块面积和颈内膜–中膜厚度均显著降低,HDL显著升高,同组治疗前后差异有统计学意义(P0.05);且大、中剂量组的改善程度优于辛伐他汀组,大剂量组的改善程度优于中、小剂量组,差异有统计学意义(P0.05)。结论瑞舒伐他汀治疗老年冠心病合并高脂血症患者具有较好的疗效,可有效改善患者的血脂水平,尤其是大剂量组疗效更佳。     

温针灸联合耳针治疗女性脾肾阳虚型肥胖并发高脂血症临床观察

目的:比较温针灸联合耳针埋压与单纯温针灸治疗脾肾阳虚型肥胖并发高脂血症女性患者的临床疗效差异.方法:收集130例患者随机分成观察组和对照组,每组65例.对照组针刺穴取脾俞、中脘、肾俞、中极、关元、命门、太白、丰隆等,并于脾俞、中脘、肾俞、中极行温针灸,隔日治疗1次,连续治疗3个月.观察组在对照组治疗的基础上加用耳穴揿针埋压,穴取脾、肾、膀胱、三焦、内分泌、内生殖器等.观察两组治疗前后肥胖指标(体质量(W)、肥胖度(A)、体质指数(BMI)、体脂百分率(F％)),血脂指标(血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C))及临床疗效.结果:两组患者治疗后W、A、BMI、F％肥胖指标,TC、TG、LDL-C血脂水平,均较治疗前明显下降(均P＜0.01),HDL-C较治疗前明显上升(均P＜0.01);治疗后观察组TC、HDL-C的改善优于对照组(均P＜0.01),在改善各项肥胖指标方面,两组比较差异无统计学意义(均P＞0.05).观察组综合总有效率为95.4％(62/65),优于对照组的84.6％(55/65,P＜0.001).结论:温针灸联合耳针埋压及单纯温针灸对肥胖并发高脂血症患者异常的脂质代谢均有良性调整作用,且温针灸联合耳针疗法在减肥作用和改善TC和HDL-C水平方面优于单纯温针灸疗法.