H型高血压患者发生射血分数保留心力衰竭的危险因素分析

目的探讨H型高血压患者发生射血分数保留心力衰竭(HFpEF)的相关危险因素,为预防HFpEF发生提供参考依据。方法回顾性分析2015年1月至2019年1月于秦皇岛市第一医院心血管内科门诊就诊及住院治疗的200例H型高血压发生HFpEF患者的临床资料,作为研究组,选取同期80例H型高血压合并射血分数正常非心衰患者记为对照组。比较两组患者基本临床信息的差异情况,并采用Logistic逐步回归分析H型高血压患者发生HFpEF的危险因素。结果两组性别构成比、年龄、吸烟史、高血压分级以及合并肥胖症、糖尿病、冠状动脉粥样硬化性心脏病(冠心病)、慢性阻塞性肺疾病(COPD)、心房纤颤(房颤)、睡眠呼吸暂停综合征(SAHS)率比较,差异均有统计学意义(P<0.05),组间左室射血分数(LVEF)、左室舒张末期内径(LVDd)、左室舒张期末室间隔厚度(IVST)、左房容积(LAV)和N末端脑钠肽前体(NT-proBNP)水平比较差异也有统计学意义(P<0.01)。多因素Logistic回归分析显示,女性、高龄、吸烟、高血压Ⅲ级、肥胖症、糖尿病、冠心病、COPD均是H型高血压患者发生HFpEF的危险因素。结论高龄、女性、高血压分级较高及合并肥胖症、糖尿病、冠心病、COPD疾病等因素会增加H型高血压患者发生HFpEF的风险,应结合患者上述因素的具备情况采取相应预防治疗等干预措施,努力降低HFpEF发生风险。     

高龄女性射血分数保留的心力衰竭患者相关危险因素分析

目的 探究高龄女性射血分数保留的心力衰竭(HFpEF)患者的临床特点及其影响因素。方法 连续入选2017年1月至2020年12月就诊于北京中医药大学东直门医院心血管科年龄≥80岁的女性心力衰竭患者292例,根据LVEF分为射血分数减低的心力衰竭(HFrEF)组87例HFpEF组205例。比较2组临床资料,采用多因素logistic回归分析。结果 HFpEF组心房颤动比例、血钾和LVEF明显高于HFrEF组,高脂血症、心肌梗死病史、冠心病血运重建比例及心率明显低于HFrEF组(P<0.05,P<0.01)。多因素logistic回归分析显示,心率(95%CI:1.008～1.056,P=0.009)、心肌梗死病史(95%CI:2.718～9.950,P=0.000)、冠心病血运重建(95%CI:1.042～3.648,P=0.037)、高脂血症(95%CI:1.615～6.068,P=0.001)是心力衰竭发作的独立危险因素。结论心肌梗死病史、高脂血症、冠心病血运重建术、心率是高龄女性心力衰竭的危险因素。     

体质量指数联合血浆脑钠肽与中重度慢性心力衰竭老年患者预后的关系

目的 旨在筛选中重度心力衰竭老年患者预后不良的独立危险因素。方法 共纳入中重度慢性心力衰竭老年患者病例149例,其中1年内全因死亡的患者63例,生存患者86例。收集患者临床资料,包括患者年龄、性别、体质量指数(BMI)、高血压病史、糖尿病病史、冠心病病史、扩张型心肌病、纽约心脏协会(NYHA)心功能分级、左室舒张末期内径、左室射血分数、脑钠肽(BNP)、血红蛋白、尿肌酐及抗心力衰竭药物使用情况。采用单因素和多因素Logistic回归分析筛选中重度慢性心力衰竭老年患者死亡的危险因素。结果 存活组BMI降低的患者比例、NYHA心功能分级Ⅳ级患者比例、BNP水平低于死亡组且有统计学意义(P<0.05);存活组NYHA心功能分级Ⅱ级患者比例、左室舒张末内径、左室射血分数、血红蛋白水平高于死亡组且有统计学意义(P<0.05)。单因素Logistic回归分析表明,BMI(<18.5 kg/m²)、NYHA心功能分级、BNP是中重度慢性心力衰竭患者死亡的危险因素。左室舒张末内径和左室射血分数是中重度慢性心力衰竭患者死亡的保护因素。多因素Logisitic回归分...     

老年高血压病人合并射血分数保留的心力衰竭的临床特征及相关危险因素分析

目的 探讨老年高血压合并射血分数保留的心力衰竭(HFpEF)的临床特点及其相关危险因素。方法 纳入569例老年高血压住院病人,根据是否合并HFpEF分为HFpEF组和对照组,比较2组间临床特点的差异;采用多元Logistic回归分析老年高血压病人发生HFpEF的影响因素。结果 HFpEF组年龄、女性比例、超重、2型糖尿病患病率、血清B型尿钠肽、尿素氮、肌酐水平显著高于对照组(P<0.05)。HFpEF组舒张期室间隔厚度、舒张期左心室内径、舒张期左心室后壁厚度、左心房内径、左心室质量指数均显著高于对照组(P<0.01)。Logistic回归分析显示,老年高血压合并HFpEF的相关危险因素包括女性、超重、2型糖尿病及左心室质量指数。结论 女性、超重、2型糖尿病、左心室质量指数是老年高血压病人合并HFpEF的相关危险因素。     

红细胞压积对射血分数保留型及射血分数中间型心衰患者易损期的影响

目的 探讨红细胞压积（hematocrit，HCT）对射血分数保留型及射血分数中间型心力衰竭（Heart Failure with preserved Ejection Fraction and Heart Failure with mid-range Ejection Fraction ,HFpEF and HFmrEF）患者易损期的影响。方法 选取2017年5月1日至2018年5月31日于我院确诊为射血分数保留及射血分数中间型（EF≥40%）且根据纽约心脏病协会心功能分级为Ⅱ级及以上的心力衰竭患者行前瞻性队列研究，共纳入心力衰竭患者160例。选取同一时间住院的180例非心力衰竭患者作为对照。通过单因素Logistic相关分析确定HCT、年龄、糖尿病、左心室射血分数、血红蛋白、脑钠肽、白蛋白、肌酐、尿酸是患者发生心力衰竭的危险因素。通过单因素COX回归分析研究HCT对HFpEF和HFmrEF患者易损期的影响。结果 （结果中有HR、95%CI、P，还要添加哪些数据？） 随访3个月，与高HCT组相比，低HCT组心力衰竭患者终点事件发生率更高（HR=0.488，95%CI 0.258~0.926，P=0.028），具有统计学意义。Kaplan-Meier生存曲线显示低HCT组不良心血管事件发生率更高，生存率低（P=0.025），尤其是心力衰竭加重再入院（P=0.006）。结论 低HCT可能是HFpEF and HFmrEF患者易损期不良预后的危险因素。     

老年慢性心力衰竭住院患者的临床特点和预后分析

目的分析射血分数减低心力衰竭(HFrEF),射血分数中位心力衰竭(HFmrEF)和射血分数保留心力衰竭(HFpEF)的老年住院患者临床特点和预后。方法收集老年慢性心力衰竭住院患者1355例,中位随访18个月,根据LVEF分为HFrEF组339例、HFmrEF组375例和HFpEF组641例,分析3组临床特点,用Cox风险比例模型分析影响预后因素。结果与HFpEF组比较,HFrEF组年龄更低[(70.0±7.5)岁vs(74.7±7.8)岁],扩张型心肌病和心肌梗死比例更高(20.4%vs 0.3%,54.9%vs 12.6%),高血压和心房颤动比例更低(59.0%vs 86.6%,22.7%vs 83.5%,P0.05)。HFmrEF组男性、吸烟和心房颤动比例与HFrEF组相似(P0.05)。HFrEF组主要心血管事件发生率高于HFmrEF组和HFpEF组(45.1%vs 26.7%和26.4%,P=0.000),HFmrEF组发生率与HFpEF组相似(P0.05)。年龄、男性、肾功能不全以及左心房内径为HFrEF组不良预后的影响因素,尿酸是HFmrEF组不良预后的影响因素,年龄、冠心病、谷草转氨酶、肌酐、左心室舒张末期内径以及纽约心功能分级Ⅲ/Ⅳ级为HFpEF不良预后的影响因素。结论 3种类型心力衰竭呈现不同的临床表现、病因和预后。     

射血分数保留的心力衰竭生物标志物的研究进展

射血分数保留的心力衰竭(HFpEF)是收缩功能正常(左心室射血分数50%)而舒张功能障碍的心力衰竭,该文介绍HFpEF的生物标志物在诊断、危险分层和预后评估中的研究进展。     

不同类型老年心力衰竭患者QRS波时限及心率变异性与心功能相关性

目的 探讨不同类型老年心力衰竭患者QRS波时限及心率变异性(HRV)与心功能相关性。方法 选取老年心力衰竭患者106例，男66例，女40例，根据左心室射血分数(LVEF)分为射血分数降低心力衰竭(HFrEF)组34例、射血分数中间值心力衰竭(HFmrEF)组33例、射血分数保留心力衰竭(HFpEF)组39例；完善脑钠肽(BNP)、心电图、动态心电图等相关检查。结果 HFrEF组QRS波时限长于HFmrEF组和HFpEF组，差异有统计学意义(P<0.01);HFmrEF组和HFpEF组无统计学差异(P>0.05);HFrEF组左室收缩末期内径(LVESD)明显大于HFmrEF组和HFpEF组(P<0.001),HFmrEF组明显大于HFpEF组(P<0.001);HFrEF组左室舒张末期内径(LVEDD)明显大于HFmrEF组和HFpEF组(P<0.001),HFmrEF组明显大于HFpEF组(P<0.001);3组间HRV时域指标无统计学差异(P>0.05)。相关性分析显示，老年心力衰竭患者QRS波时限与LVEF呈显著负相关性(r=-0.432...     

射血分数保留的心力衰竭的心肌纤维化及炎性相关标志物

心力衰竭(心衰)指心脏结构或功能性疾病所引起的心室收缩和(或)舒张功能障碍.2016年欧洲心脏病学会提出,根据左心室射血分数将心衰细分为射血分数降低的心力衰竭(HFrEF)、射血分数保留的心力衰竭(HFpEF)和射血分数中间值的心力衰竭(HFmrEF)[1].HFpEF患者年龄较大,多伴随糖尿病、心房颤动、高血压、慢性...     

血浆NT-proBNP水平对冠心病无症状心脏舒张功能减退的评估

目的评估血浆NT-proBNP水平对于射血分数正常的冠心病患者出现无症状舒张功能减退的预测价值。方法筛选2009年6月至12月期间于北京大学第一医院心内科住院的确诊心肌梗死或经冠状动脉造影证实的冠心病患者,排除左室射血分数减低者（LVEF〈50%）及有心力衰竭症状者,入选253例患者,结合常规超声心动图及组织多普勒结果将患者分为心室舒张功能正常组（115例）及心室舒张功能减退组（138例）。对比两组血浆NT-proBNP水平并分析其对心室功能减退的预测价值。结果心室舒张功能减退组NT-proBNP水平高于心室舒张功能正常组（中位数175.4ng/L,范围8.64～5970ng/L比中位数84.7ng/L,范围5.69～3250ng/L,P〈0.01）,经logistic回归分析,NT-proBNP水平是心室舒张功能减退的独立预测因子（对数转换后,OR=2.78,95%CI1.43～5.40,P〈0.01）,应用NT-proBNP水平诊断心室舒张功能减退的ROC曲线下面积为0.67（95%CI0.60～0.73,P〈0.01）,以NT-proBNP〉119.15ng/L作为截点时敏感性为64%,特异性为62%。结论血浆NT-proBNP水平升高是射血分数正常的冠心病患者出现无症状心室舒张功能减退的独立预测指标。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.