胆固醇水平对慢性心力衰竭患者预后的影响

目的:探讨总胆固醇(TC)水平对于慢性心力衰竭(CHF)患者预后的影响。方法:入选1995年至2010年805例CHF患者,按TC水平为4个亚组:TC≤160 mg/dl、TC161～200 mg/dl、TC201～239 mg/dl及≥240 mg/dl组,探讨血脂水平、其他实验室指标及超声心动图指标与预后的相关性。终点事件为全因死亡、心源性死亡。结果:平均随访(3.11±3.32)年,共发生199例终点事件,其中全因死亡占78.4%,心源性死亡占15.6%。亚组间生存率差异有统计学意义(P=0.036),TC降低提示生存率降低。多因素回归分析表明,TC水平是CHF终点事件的独立危险因素(OR=0.75,95%CI:0.62～0.89,P=0.002)。结论:TC水平是CHF死亡的独立危险因素。     

The effects of dietary cholesterol upon the hypercholesterolemia of pregnancy

The hypercholesterolemia which accompanies the normal human pregnancy is not known to be influenced by diet or other factors. The present experiment in fourteen pregnant women was designed to document this phenomenon under controlled metabolic conditions and to study the effect of dietary cholesterol upon this usual increase in serum cholesterol. The subjects included twelve normal subjects, one juvenile diabetic, and one type II familial hypercholesterolemic subject. They were fed controlled, nutritionally adequate diets which were equivalent except for the cholesterol content, which was cholesterol-free or 600–1000 mg from egg yolk daily. Calories were adjusted to permit weight gain of 1.4 kg per mo. The cholesterol-free diet lowered the mean serum cholesterol level in the 12 normal pregnant women from 234-187 mg/dl, a 20% decrease (?47 ± 37 S.D.) (p < 0.005). The addition of cholesterol to the diet invariably elevated the mean serum cholesterol concentrations to 223 mg/dl, a 19% increase (+36 ± 12) (p < 0.001). The mean serum triglyceride levels increased steadily throughout pregnancy regardless of diet, up to 198 ± 43 (S.D.) mg/dl at term. Both serum cholesterol and triglyceride concentrations decreased strikingly 1 wk after parturition. These serum cholesterol and triglyceride responses occurred similarly in the familial hypercholesterolemic and the diabetic women. The increased serum cholesterol levels during the high cholesterol diets occurred largely in the low density lipoprotein (LDL) fraction. Despite the inevitable alterations of cholesterol and lipooprotein homeostasis which occur in pregnancy, the results of this study indicated that the usual hypercholesterolemia of pregnancy in women eating the general American diet was greatly ameliorated by a very low cholesterol, nutritionally adequate diet.     

胆固醇与胆结石的关系

目的:探讨胆固醇与胆结石的关系.方法:对某高校3 905名教职员工进行健康检查,采用彩超进行肝胆检查,全自动生化分析仪进行血总胆固醇测定,分析他们二者的关系.结果:3905名教职员工健康检查发现胆结石189例,其中胆固醇增高(>5.17 mmol/L)68例(35.98%),胆固醇正常偏高(4.67-5.16mmol/L)40例(21.16%),胆固醇正常(<5.17mmol/L)81例(42.86%),胆固醇正常偏高和增高与胆固醇正常相比,其胆结石发病率明显增高(均P<0.01).结论:胆结石与高胆固醇增高有一定关系,在胆结石保守治疗时,应注意降低胆固醇.     

Usefulness of parental serum total cholesterol levels in identifying children with hypercholesterolemia.

It was hypothesized that healthy children with high cholesterol levels may have parents who exceed acceptable cholesterol levels established by the National Cholesterol Education Program. One hundred sixty families (320 parents, 263 children aged 3 to 10 years) were evaluated for total cholesterol and other risk factors. Before the study, almost half of the parents had not had serum total cholesterol measured. The odds ratio for a child having a total cholesterol greater than or equal to 5.17 mmol/liter (200 mg/dl) was 13.6:1 (confidence interval 5.7 to 32.5) for a child with at least 1 parent having cholesterol greater than or equal to 6.20 mmol/liter (240 mg/dl) versus a child whose parents had low total cholesterol. Testing only children who had at least 1 parent with a total cholesterol greater than or equal to 5.17 mmol/liter (200 mg/dl) had a sensitivity of 98% for detecting children's total cholesterol greater than or equal to 5.17 mmol/liter. It is concluded that parental total cholesterol is useful in identifying children with high total cholesterol levels. Pediatricians may identify a large number of parents with hypercholesterolemia not previously recognized.     

Prognostic significance of self-measurements of blood pressure

BACKGROUND: Self-measurements of blood pressure may offer some advantage in diagnostic and therapeutic evaluation and in management of patients. However, the most important limitation of self-measurement is that there are limited data available about the prognostic value of this information. RESULTS: Authors of several previous reports demonstrated that self-measurement reflects target-organ damage better than does casual measurement of blood pressure. So far, investigators in Tecumseh and Ohasama studies have provided pilot data on prognostic value of self-measurements. Investigators in Ohasama study demonstrated that self-measurements predict cardiovascular morbidity and mortality and all-cause mortality better than do casual measurements of blood pressure. Investigators in Tecumseh study demonstrated that self-measurement can predict future development of sustained hypertension and of diastolic dysfunction. These preliminary results suggest that self-measurements have strong predictive power for endpoints and surrogate measures of cardiovascular target-organ damage. CONCLUSION: The final answer on the prognostic significance of self-measurement has not been given. Prognostic studies designed to compare casual measurement of blood pressure, self-measurement, and ambulatory blood pressure monitoring are needed.     

The influence of neonatal thymectomy on the blood serum level of total lipids, NEFA, triglycerides, total cholesterol and beta-lipoproteins in rats

The time course of changes in the blood serum content of total lipids (TL), nonesterified fatty acids (NEFA), triglycerides (TG), total cholesterol (TC) and beta-lipoproteins (beta-LP), caused by neonatal thymectomy (NTE), was investigated in neonatally thymectomized and in sham-operated rats aged 15, 30, 45 days, 2, 3 and 5 months. TL were significantly increased on days 15, 30, 45 and 60 after operation; their level in 3- and 5-month-old rats was already normal. In control rats, NEFA level increased with age; their level in NTE rats was significantly higher on days 15, 30, 45 and 60 after thymectomy. Similar changes were registered in TG level. The effect of NTE was most pronounced in TC whose level was significantly higher in thymectomized rats than in control rats till the 150th day after operation. Serum concentration of beta-LP in NTE rats exceeded several times that of sham-operated rats in all age groups. The role of the thymus in the control of lipid metabolism in rats is discussed.     

Prognostic significance of ambulatory blood pressure.

Measurements of ambulatory blood pressure as an adjunct to casual/clinic blood pressure measurements are currently widely used for the diagnosis and treatment of hypertension. There have been many recent reports on the clinical significance of ambulatory blood pressure. The relationship between ambulatory blood pressure level and target-organ damage uniformly demonstrated on a cross-sectional basis that average ambulatory blood pressure is correlated to target-organ damage. The main limitation of cross-sectional studies, however, is the difficulty of drawing inferences about causality from them. We have been monitoring the prognosis of the Ohasama population and reported that ambulatory blood pressure is superior to casual blood pressure for the prediction of mortality. We also observed that the daytime ambulatory blood pressure is a better predictor for cardiovascular mortality in the general population than is the night-time ambulatory blood pressure. It is widely recognized that casual/clinic blood pressure is less representative of the true blood pressure level than is average ambulatory blood pressure. One reason that clinic blood pressure is a poor predictor of prognosis is that clinic blood pressure includes several biases, including the white-coat effect. For determining white-coat hypertension, measurement of blood pressure in a non-medical setting such as ambulatory blood pressure monitoring is indispensable. We examined the prognostic significance for mortality of white-coat hypertension and reversed white-coat hypertension (clinic blood pressure 相似文献   

Prognostic significance of between-arm blood pressure differences

Blood pressure (BP) recordings often differ between arms, but the extent to which these differences are reproducible and whether the differences have prognostic importance is unknown. We enrolled 421 consecutive patients from a medicine and a renal clinic at a veterans' hospital. Three BP recordings were obtained in each arm using an oscillometric device in a sequential manner and repeated in 1 week. Patients were followed for all-cause mortality 相似文献   

Effects of exercise, dietary cholesterol, and dietary fat on blood lipids

Exercise, a low fat diet, or a diet low in saturated fat content can each lower plasma total cholesterol and low-density lipoprotein (LDL) cholesterol. We investigated whether these factors together could prevent the lipid-raising effects of dietary cholesterol. Ten healthy, athletic, normolipidemic male volunteers were studied. Two diets of 4 weeks duration each were compared in a randomized, blind crossover design. Diets were identical except for cholesterol content: one contained 600 mg/d; the other 200 mg/d. Both diets contained 15% of calories as protein, 55% as carbohydrate, 30% as fat, and the polyunsaturated fat to saturated fat ratio was 1.5. Exercise level and body weight were kept constant in each subject. As compared with plasma values obtained following the 200-mg/d cholesterol diet, mean values following the 600-mg/d cholesterol diet significantly increased for LDL cholesterol and apolipoprotein B by 10% and 13%, respectively. Mean plasma triglycerides, high-density lipoprotein 2 and 3, and apolipoprotein A-1 levels did not change significantly. Individual responses, however, were highly variable. Three subjects increased LDL cholesterol by more than 25%; 2 subjects increased LDL cholesterol by 10% to 25%; and 5 subjects had 5% or less change in LDL cholesterol. A dietary cholesterol increase can significantly elevate plasma LDL cholesterol and apolipoprotein B in certain normolipidemic, healthy men even when they are exercising regularly and consuming a moderately fat restricted, low saturated fat diet. Dietary cholesterol restriction may therefore be justifiable even when other life-style and dietary measures to minimize blood cholesterol are undertaken.     

118例高胆固醇血症患者调脂治疗达标情况分析

目的 调查高胆固醇血症患药物治疗达标率。方法 对现行调脂治疗持续时间≥2个月的118例高胆固醇血症患进行血脂检查,并根据1997年我国制定的《血脂异常防治建议》确定血脂是否达标。结果 总胆固醇（TC）和低密度脂蛋白胆固醇（LDL－C）总达标率分别为23．7％、38．1％,他汀类药物LDL－C总达标率高于海鱼油和绞股兰每日20mg辛伐他汀LDL－C达标率高于每日20mg氟伐他汀。结论 现行调脂治疗达标率较低,可能与选择药物的种类和药物剂量有关。