女性致密性骨炎血清骨转换生化标志物水平变化研究

背景 致密性骨炎（OCI）和其他疾病有时难以鉴别，探讨血清骨转换生化标志物可为OCI的鉴别诊断提供依据。 目的 探索女性OCI患者的血清骨转换生化标志物的水平变化及临床意义。 方法 回顾性选取2013年6月至2022年2月在北京积水潭医院门诊及住院诊断为OCI的61例女性患者作为观察组，年龄15~50岁，平均（33.8±6.6）岁，病程2周~15年。选择同期61例女性体检健康者作为对照组，年龄15~48岁，平均（35.6±7.6）岁。比较两组一般临床资料和血清骨转换生化标志物水平，并对血清骨转换生化标志物与病情相关指标进行相关性分析。 结果 观察组血清白蛋白（45.4±2.9）g/L低于对照组（46.5±2.8）g/L（t=2.190，P<0.05）。血清骨转换生化标志物比较结果显示，观察组血清1型胶原羧基末端肽β特殊序列（β-CTX）〔0.28（0.23，0.37）μg/L〕、N-端骨钙素（OC）〔13.1（11.2，16.2）μg/L〕、25-羟维生素D3〔25-（OH）VD3〕〔（14.1±5.1）μg/L〕低于对照组〔0.36（0.29，0.48）μg/L，15.6（13.7，17.3）μg/L，（17.5±6.6）μg/L〕（Z=-2.983、-3.255，t=3.081，P<0.05）。长病程亚组OC水平〔14.6（12.4，18.5）μg/L〕高于短病程亚组〔11.7（10.2，14.0）μg/L〕（Z=-2.407，P<0.05）。多孕亚组β-CTX〔0.25（0.22，0.32）μg/L〕、OC水平〔12.2（10.3，15.0）μg/L〕低于非多孕亚组〔0.33（0.26，0.44）μg/L、13.4（12.0，18.8）μg/L〕（Z=-2.486、-1.897，P<0.05）。相关性分析显示，观察组血清1型前胶原氨基端延长肽（tP1NP）与妊娠次数、生产次数均呈负相关（rs=-0.276、-0.298，P<0.05），OC与体质指数（BMI）、视觉模拟评分法（VAS）评分、妊娠次数均呈负相关（rs=-0.284、-0.374、-0.360，P<0.05），25-（OH）VD3水平与BMI呈正相关（rs=0.275，P<0.05）。 结论 女性OCI患者血清OC、β-CTX水平明显降低，可为鉴别其他疾病提供依据；血清OC水平可以反映OCI患者的严重程度，同时OC水平与患者妊娠次数相关；tP1NP与妊娠次数、生产次数相关。     

试析老年痴呆患者的被窃妄想

目的了解老年痴呆患者被窃妄想的临床特征。方法将83例老年痴呆患者按有无嫉妒妄想分为两组，并就痴呆严重度、类型、伴随症状等进行对照分析。结果被窃妄想在老年痴呆患者中的发生率较高（56．％）；痴呆严重程度轻于无被窃妄想者；被窃妄想在阿尔茨海默病（AD）中的发生率高于血管性痴呆（VD）；有被窃妄想者伴有较多嫉妒妄想（P均〈0．05）。结论被窃妄想可能是老年痴呆较敏感的临床症状之一，尤其对轻度AD的诊断有一定意义。     

正常人在静态和运动状态下"死腔/潮气"估测值和实测值的比较

目的研究正常人静态及运动状态下死腔/潮气(VD/VT)估测值和实测值的关系.方法23名受试者行心肺运动试验,同步实时测定摄氧量和二氧化碳排出量,分别在运动前及运动高峰时抽取动脉血,根据Bohr的公式,得出VD/VT实测值,同时再用呼气末CO2分压(PetCO2)代替PaCO2,计算VD/VT,得出VD/VT估测值.结果根据病史、体检、肺功能和运动前后的心电图判断23名受试者均为正常受试者.静态时的VD/VT估测值和VD/VT实测值分别为0.359±0.109和0.354±O.106,两者无显著性差异(P=0.710),相关分析显示两者高度相关(r=0.911,P＜0.001).运动高峰时的VD/VT估测值和VD/VT实测值分别为0.234±0.070和0.248±0.094,两者无显著性差异(P=0.748),相关分析表明两者显著相关(r=0.783,P＜0.001).与静态时比较,运动时估测和实测VD/VT均明显下降.结论对于正常成人,无论是在静态或最大运动状态下,可用无创方法计算VD/VT代替VD/VT实测值.     

健脑安治疗血管性痴呆肾虚痰浊证的单盲对照研究

目的 评价健脑安治疗血管性痴呆肾虚痰浊证的临床疗效,论证补肾降浊法是否为治疗血管性痴呆的一种有效疗法。方法 6周随机单盲对照临床试验。40例轻中度VD病人,治疗组25例,对照组15例。治疗组给予口服复方中药制剂健脑安片,1片／次,3次／d。对照组给予口服都可喜片,40mg/次,2次／d。结果 健脑安能显改善血管性痴呆肾虚痰浊证,并且其改善肾虚痰浊证的疗效显优于都可喜（P＜0.05)。结论 健脑安对血管性痴呆患肾虚痰浊证的疗效显优于都可喜。补肾降浊法为治疗血管性痴呆的有效治法,具有指导临床治疗痴呆用药和进一步临床研究的价值。     

EFFECTS OF COMBINATION OF ACUPUNCTURE AND MOXIBUSTION WITH CHINESE DRUGS ON LIPIDS PEROXIDE AND ANTIOXIDASE IN PATIENTS OF VASCULAR DEMENTIA

Withincreaseofincidenceofcerebrovascu-lardiseases,thepatientsofVDincreasedaybyday.Inrecentyearsithasbeenindicatedthatacupuncture,moxibustionandChinesedrugshavedefinitetherapeuticeffectsforVDL1].Inordertoprobeintothetherapeuticmechanism,inthepresentexperim…     

防治痴呆新药的构效关系研究

阿尔茨海默病、帕金森病和血管性痴呆是严重危害老年人生命健康的多发病。目前临床应用的防治痴呆药物的作用机制主要涉及改善胆碱能神经递质、激动多巴胺(DA)受体、阻滞N-甲基-D门冬氨酸(NMDA)受体和改善脑血管功能等。综述了近年来报道的防治痴呆新药的构效关系研究进展。     

针药结合对VD大鼠脑内Ach及AchE活性的影响

目的:观察电针与中药复方脑康胶囊结合对VD大鼠脑内Ach含量及AchE活性的影响.方法:雄性大鼠60只,随机抽取10只,作为正常对照组;余下50只经4-血管阻断法造成VD动物模型后,随机抽取40只分成模型组、针药结合组、电针组、中药组.经4周分别治疗后处死取脑,检测其脑内Ach含量及AchE活性并进行比较.结果:针药结合组与模型组比较,Ach含量明显升高(P＜0.01),AchE活性明显降低(P＜0.01);与电针组和中药组相比,Ach含量升高(P＜0.05),AchE活性降低(P＜0.05).结论:针药结合能明显改善VD大鼠胆碱能系统的功能,调节脑内Ach生理代谢,从而达到治疗VD的目的,其作用较单纯电针和中药治疗明显.     

Novedades en arritmias y estimulación cardiaca en 2013

This report discusses a selection of the most relevant articles on cardiac arrhythmias and pacing published in 2013. The first section discusses arrhythmias, classified as regular paroxysmal supraventricular tachyarrhythmias, atrial fibrillation, and ventricular arrhythmias, together with their treatment by means of an implantable cardioverter defibrillator. The next section reviews cardiac pacing, subdivided into resynchronization therapy, remote monitoring of implantable devices, and pacemakers. The final section discusses syncope.     

A Reappraisal of Exercise Electrocardiographic Indexes of the Severity of Ischemic Heart Disease: Angiographic and Scintigraphic Correlates

Objectives. We explored how the exercise electrocardiographic (ECG) indexes generally presumed to signify severe ischemic heart disease (IHD) correlate with coronary angiographic and scintigraphic myocardial perfusion findings.

Background. In exercise testing, it is generally assumed that the early onset of ST segment depression and its occurrence at a low rate–pressure product (ischemic threshold); the amount of maximal ST segment depression; and a horizontal or downsloping ST segment and its prolonged recovery after exercise signify more severe IHD. However, the relation of these indexes to coronary angiographic and exercise myocardial perfusion findings in patients with IHD is unclear.

Methods. We prospectively carried out a symptom-limited 12-lead Bruce protocol thallium-201 single-photon emission computed tomographic (SPECT) exercise test in 66 consecutive subjects with stable angina, ≥70% stenosis of at least one coronary artery, normal rest ECG and left ventricular wall motion and a prior positive exercise ECG. The above ECG indexes, vessel disease (VD), a VD score and the quantitative thallium-SPECT measures of the extent, maximal deficit and redistribution gradient of the perfusion abnormality were characterized.

Results. Maximal ST segment depression could not differentiate the number of diseased vessels; was not related to VD score, maximal thallium deficit or redistribution gradient; but was related to the extent of perfusion abnormality (r = 0.29, 95% confidence interval [CI] 0.08 to 0.52, p = 0.02). Time of onset of ST segment depression correlated inversely only with VD (r = −0.22, 95% CI −0.44 to −0.05, p < 0.05), whereas the ischemic threshold had low inverse correlation only with VD score (r = −0.25, 95% CI −0.47 to −0.01, p < 0.05) and the redistribution gradient (r = −0.33, 95% CI −0.53 to −0.10, p < 0.01). A horizontal or downsloping compared with an upsloping ST segment did not demonstrate more severe angiographic and scintigraphic disease. Recovery time did not correlate with angiographic and scintigraphic findings, and correlations between angiographic and scintigraphic findings were also low or absent.

Conclusions. In this homogeneous study group, the exercise ECG indexes did not necessarily signify more severe IHD by angiographic and scintigraphic criteria. Lack of concordance between the exercise ECG, angiography and myocardial scintigraphy suggests that these diagnostic modalities examine different facets of myocardial ischemia, underscoring the need for caution in the interpretation of their results.

(J Am Coll Cardiol 1997;29:1497–504)     

The lowest VE/VCO2 ratio best identifies chronic thromboembolic pulmonary hypertension

Introduction

The natural history of acute pulmonary embolism (PE) under treatment is about a gradual resolution of the thrombi, and uncommonly, the development of chronic thromboembolic pulmonary hypertension (CTEPH). We hypothesized that ventilatory efficiency parameters during cardiopulmonary exercise testing (CPET) may be able to monitor the process and predict CTEPH.

Methods

15 patients rehabilitated from acute PE (total resolution of thrombi), 44 patients with chronic PE (with residual thrombi), 66 patients with CTEPH, and 36 sedentary healthy controls performed incremental CPET.

Results

The lowest VE/VCO₂ was higher in CTEPH patients than that in chronic PE and rehabilitated patients (43.4 L/min vs 29.9 L/min vs 27.1 L/min, p < 0.005). The VE/VCO₂ slope (48.4 L/min/L/min vs 29.9 L/min/L/min vs 28.0 L/min/L/min, p < 0.005) and oxygen uptake efficiency plateau (OUEP) (37.1 L/min vs 27.0 L/min vs 25.2 L/min, p < 0.005) had the similar changes. In logistic regression analysis, the lowest VE/VCO₂ ≥ 34.35 L/min was the best predictor of CTEPH (OR 159.0, 95% CI 36.0-702.3, p < 0.001). The lowest VE/VCO₂ was higher in chronic PE patients compared with the controls (29.9 L/min vs 26.5 L/min, p < 0.05), but there was no difference between the rehabilitated patients and the controls. In multiple linear regression analysis, the percentage of vascular obstruction by ventilation-perfusion lung scanning (PVO) was the most significant independent predictor for indices of ventilatory efficiency in chronic PE and rehabilitated patients.

Conclusions

CTEPH is associated with weakened ventilatory efficiency. The lowest VE/VCO2 ratio has the best capability to predict CTEPH. Ventilatory inefficiency improves along with recovery of acute PE.