幽门螺杆菌感染对脑梗死患者血清同型半胱氨酸水平的影响

<正>脑梗死是人类最常见的致死和致残原因之一,动脉粥样硬化是脑梗死的主要病理基础,高血压、肥胖、吸烟等传统的动脉粥样硬化危险因素仅能解释部分脑卒中事件,很多心脑血管事件发生在无上述危险因素的情况下。因此,探寻新的危险因素与脑卒中发病的关系已成为目前脑卒中流行病学研究的热点课题。近年研究表明,幽门螺杆菌(Helicobacter pylori,Hp)感染与缺血性心、脑血管疾病的发生关系密切。本研究     

贯彻循证医学原则重视心血管病防治

动脉粥样硬化是可致残、致死的全身性疾病 ,它导致的严重后果包括脑卒中、心肌梗死和间歇跛行 ,它不仅是现今发达国家威胁人类健康与生命的头号杀手 ,也是对包括中国在内的发展中国家的严重威胁。动脉粥样硬化的发生与发展常需要经历一个系列过程。其上游是多重危险因素 (吸烟、高血压、血脂异常、糖尿病、肥胖、代谢综合征等 )的流行 ;稳定性动脉粥样硬化疾病 ,如稳定性心绞痛的病理生理基础是稳定的动脉粥样硬化斑块 ;不稳定性动脉粥样硬化疾病 ,如急性冠状动脉综合征的病理生理基础是不稳定性动脉粥样硬化斑块 ,及在其破裂基础上不同程度…     

血红素氧合酶--CO/胆红素与动脉粥样硬化和冠心病

血红素氧合酶－一氧化碳／胆红素－环－磷酸鸟苷途径作为一个新的细胞信使系统涉及许多生理和病理生理过程，近年研究发现该系统与动脉粥样硬化和冠心病的发生，发展有关。     

高血压对脑血管的影响

高血压是最常见疾病之一，近年来的临床、实验研究表明，长期高血压可使脑血管发生相应的结构和功能变化，了解这些变化的发生和发展的机理及与脑卒中的关系，有助于进一步认识高血压在脑血管疾病中的作用，对预防脑卒中的发生有重要意义。１高血压时脑血管内皮的结构及功...     

联合用药治疗原发性高血压的药理学机制

高血压是导致心、脑血管疾病、肾脏病发生和死亡的最主要的危险因素,是人类最常见的慢性病。我国人群高血压患病率1980年为7.7%、1991年为13.6%、2002年为19.8%,而高血压人群的知晓率、治疗率和控制率分别为30%、25%和60%,心脑血管病的发生和死亡一半以上与高血压有关。因此,控制高血压是防治心脑血管病的关键,降低高血压患者的血压水平,可明显减少脑卒中风险和心血管病风险[1]。     

同型半胱氨酸对脑卒中的影响

<正>脑卒中是导致人类死亡的主要病因之一,预防脑卒中能降低死亡率和发病率,而对已明确的脑卒中危险因素的预防显得至关重要。传统的心脑血管病危险因素如年龄、高血压、脂质失调、糖尿病和吸烟等都与脑卒中的发生及再发有关,但这些并不能完全解释脑卒中事件的所有原因[1]。越来越多的流行病学研究表明同型半胱氨酸(homocysteine,Hcy)是脑卒中的危险因素,Hcy升高与脑卒中再发和全因死亡率风险增     

分子水平观察:社会应激的影响

<正>根据最近对猕猴(rhesusmaeagues)的研究,社会阶层对基因调节有很大影响,尤其在免疫系统。Yenkes National Primate Research Center用此种猕猴做实验。许多生物种系,包括人类都有着社会等级,影响着交配和其他与生存有关的行为。越来越多的证据提示,低层社会的应激亦以多种不同的途经影响着精神和躯体健康,抑制免疫功能,升高心血管问题的危险(如高血压、心脏病和脑卒中)。但在分子层面上,社会应激如何变为生理改变?所知甚少。     

高血压伴心房颤动患者降压药物的选择和抗凝治疗的策略

<正>高血压与心房颤动有着紧密的联系。一方面,高血压是心房颤动常见的共患病,50%的心房颤动患者合并高血压[1-2];另一方面,高血压是心房颤动的常见病因之一。高血压通过血流动力学改变和肾素血管紧张素醛固酮系统(renin-angiotensin-aldosterone system,RAAS)的过度激活引起心房结构重构与电重构,是心房颤动发生和维持的病理生理基础。高血压可增加心房颤动及其相关并发症(包括脑卒中/血栓、大出     

睾酮与男性代谢综合征

男性血清睾酮水平与代谢综合征的发生、发展密切相关.低睾酮水平可能导致腹型肥胖、糖代谢异常、血脂紊乱及高血压,给予睾酮水平低下者睾酮替代治疗(TRT)能明显改善其相关代谢指标.同时,腹型肥胖、糖代谢异常也可通过抑制Leydig细胞功能、增加芳香化酶活性等引起睾酮水平下降.     

瘦素与高血压

瘦素是与肥胖密切相关的内分泌激素。但目前认为对瘦素的研究已超越肥胖的范畴。许多研究表明。瘦素不仅与能量代谢有关，而且可能参与了高血压发生发展的病理生理过程。     

Testosterone and cardiovascular risk

Cardiovascular (CV) disease is one of the most common causes of death in the western populations and, nowadays, its incidence is increasing even in the developing countries; although CV disease affects both sexes, it is more frequent in males in whom it shortens the average life expectancy. In this regard, this difference has been wrongly attributed for many years to the negative effects of testosterone (T); however, nowadays, a large amount of evidence suggests that this hormone may have protective effects on the CV system and that, indeed, the low levels of T could be associated with an increased CV risk and with an augmentation of morbidity and mortality in males. Such an aspect gains great relevance in light of the consideration that T decrease, besides occurring as a consequence of rare pathological conditions, can often take place with natural aging, causing a state of “male menopause”, also called late-onset hypogonadism. In this review, we aimed to summarize the present state of the art concerning the association between T deficit and CV disease by analyzing the protective role of T on CV system and the relationship of this hormonal lack with metabolic syndrome, CV morbidity and mortality, and with the CV complications, such as ischemic heart disease, heart failure and stroke, that frequently occur in T deficiency.     

Cardiovascular and Cerebrovascular Safety of Testosterone Replacement Therapy Among Aging Men with Low Testosterone Levels: A Cohort Study

PurposeWe assessed the risk of ischemic stroke, transient ischemic attack, and myocardial infarction associated with testosterone replacement therapy (TRT) among aging men with low testosterone levels.MethodsUsing the UK Clinical Practice Research Datalink, we formed a cohort of men aged 45 years or older with low testosterone levels and no evidence of hypogonadotropic or testicular disease, between 1995 and 2017. Hazard ratios (HRs) and 95% confidence intervals (CIs) of a composite of ischemic stroke/transient ischemic attack and myocardial infarction were estimated using time-dependent Cox proportional hazards models, comparing current use of TRT with nonuse.ResultsThe cohort included 15,401 men. During 71,541 person-years of follow-up, 850 patients experienced an ischemic stroke/transient ischemic attack/myocardial infarction (crude incidence rate 1.19 [95% confidence interval (CI), 1.11-1.27] per 100 persons per year). Compared with nonuse, current use of TRT was associated with an increased risk of the composite outcome (HR 1.21; 95% CI, 1.00-1.46). This risk was highest in the first 6 months to 2 years of continuous TRT use (HR 1.35; 95% CI, 1.01-1.79), as well as among men aged 45-59 years (HR 1.44; 95% CI, 1.07-1.92).ConclusionsTRT may increase the risk of cardiovascular events in aging men with low testosterone levels, particularly in the first 2 years of use. In the absence of identifiable causes of hypogonadism, TRT should be initiated with caution among aging men with low testosterone levels.     

中国11省市队列人群危险因素与不同类型心血管病发病危险的比较

目的描述在中国35—64岁人群中,不同类型心血管病（包括急性冠心病事件、急性缺血性脑卒中和出血性脑卒中事件）发病的特点。比较传统心血管病危险因素与冠心病和脑卒中（急性缺血性脑卒中和出血性脑卒中事件）发病危险的关系。方法以中国多省市前瞻性队列研究的数据为基础,该队列由1992年建立的11省市35～64岁27249人和1996年到1999年又加入的3129人所组成,共30378人。本研究基线危险因素水平和1992--2003年期间发生的心血管病（包括冠心病和脑卒中）事件的关系进行分析。结果（1）急性冠心病事件、急性缺血性脑卒中事件和急性出血性脑卒中事件的累积人年发病率分别为114／100000、209／100000和73／100000。（2）随访期间发生心血管病的亚组人群基线时有84％～89％的人伴有1个或1个以上的心血管病危险因素,高于无心血管病的亚组人群（64．7％,P〈0．01）。（3）危险因素对不同类型心血管病发病的影响及作用强度有所差别：对冠心病发病危险的影响因素根据强度依次为高血压、吸烟、高胆固醇血症和低高密度脂蛋白胆固醇血症;对缺血性脑卒中发病危险的影响因素依次为高血压、糖尿病、低高密度脂蛋白胆固醇血症、吸烟和肥胖;对出血性脑卒中发病危险的独立影响因素只有高血压。结论在心血管病的主要危险因素中,不同的危险因素对不同类型的心血管病发病危险的作用存在差别。我国人群不同危险因素的变化趋势将影响不同类型心血管。     

卒中患者高血压危险因素及并发症3059例20年回顾性分析

目的分析卒中患者的高血压危险因素、并发症及病死率，为防治卒中提供参考依据。方法对3059例住院卒中患者进行回顾性分析，统计患者的一般情况、高血压、并发症及病死率，并进行x^2检验。结果3059例卒中患者血压升高者1970例，以轻度居多。在脑出血中，重度高血压有增高趋势，其中接受过降压治疗者897例，坚持治疗者244例；并发症主要为生化代谢异常、肺部感染、消化道出血和肾功能不全等；病死率以脑出血患者最高，脑梗死最低，均有随年代下降趋势，而蛛网膜下腔出血的病死率无明显下降。结论预防卒中必须坚持降压治疗，及时纠正生化代谢异常和防治肺部感染，是减少卒中并发症的重点。     

老年慢性心房颤动患者发生血栓栓塞性中风的危险因素

目的　探讨老年慢性心房颤动患者发生血栓栓塞性中风的危险因素。方法　对 42 0例 (>6 0岁 )资料完整的慢性心房颤动患者进行统计分析 ,其中发生血栓栓塞性中风 83例 (19.8% ) ;死亡 71例 (16 .9% )。结果　 (1)单变量分析老年慢性心房颤动患者发生血栓栓塞性中风最有意义的危险因素 :高血压、糖尿病、心肌梗死、心力衰竭、左室射血分数降低、胆固醇及甘油三酯增高、高密度脂蛋白降低 (P<0 .0 5 ) 。年龄、性别对血栓栓塞性中风无明显影响 (P >0 .0 5 ) ,胆固醇、甘油三酯与血栓栓塞性中风有明显关系 (P <0 .0 1)。 (2 )Cox回归显示 :高血压、胆固醇水平增高是老年慢性心房颤动患者发生血栓栓塞性中风的独立危险因素。结论　老年慢性心房颤动患者发生血栓栓塞性中风危险因素众多 ;有效控制血压、积极降脂治疗是预防血栓栓塞性中风的关键。     

The associations of age,lifestyle factors and chronic disease with testosterone in men: the Tromsø Study

OBJECTIVE: To study whether lifestyle factors and/or chronic disease are associated with the age-related decline of total and free testosterone in men, or if these factors might be associated with the variation of total and free testosterone but not with their age-related decline. DESIGN: A population-based, cross-sectional study was used. METHODS: Total testosterone and sex hormone binding globulin (SHBG) levels were analyzed and free testosterone levels were calculated in 1563 men participating in the Troms? study in 1994/1995. Anthropometric characteristics were also measured and two standardized questionnaires completed, including lifestyle factors and medical history. The data were analyzed with multiple linear regression analysis of covariance, and logistic regression. RESULTS: Total and free testosterone were inversely associated (P=0.001 and P<0.001), while SHBG was positively associated (P<0.001) with age. Body mass index (BMI) was inversely associated with total (P<0.001) and free (P=0.016) testosterone and SHBG (P<0.001). Both total and free testosterone were positively associated with tobacco consumption (P<0.001 and P=0.004) and total testosterone was positively associated with coffee consumption (P<0.001). SHBG was positively associated with smoking (P=0.004) and coffee consumption (P<0.001). Men who reported having had a stroke or having a cancer diagnosis had lower levels of total testosterone (P<0.001 and P<0.01) and free testosterone (P<0.01). CONCLUSIONS: BMI and smoking are independent contributors to the variation of total and free testosterone and SHBG levels, and coffee consumption to the variation of total testosterone and SHBG. Thus, lifestyle factors can have a direct effect on circulating levels of free endogenous sex hormones and to total levels due to the effect on SHBG levels.     

Newly diagnosed type 2 diabetes and risk of dementia: A population-based 7-year follow-up study in Taiwan

BackgroundDiabetes is associated with an increased risk of developing dementia. However, data on the patients with newly diagnosed type 2 diabetes are limited.ObjectiveTo investigate the relationship between newly diagnosed type 2 diabetes and the risk of developing dementia, ischemic stroke and intracranial hemorrhage after disease diagnosis and the interrelationship between dementia and the stroke events.MethodData were collected from the National Health Insurance Research Database of Taiwan. The study cohort included 3717 patients newly diagnosed with type 2 diabetes and 37,170 age- and sex-matched comparison patients from the same period. All patients were tracked for 7 years following their index visit in 2000–2001.ResultAfter adjusting for potential confounders, dementia risk was approximately 63% higher (hazard ratio [HR], 1.63; 95% CI, 1.33–1.99) among newly diagnosed type 2 diabetic patients than among comparison subjects. Newly diagnosed type 2 diabetes also increased the risk of developing ischemic stroke but not intracranial hemorrhage. About 43.6% of diabetic patients who developed dementia also had ischemic stroke during the follow-up period, higher than the rate 29.6% in the comparison group.ConclusionThis study shows that newly diagnosed type 2 diabetes is associated with a 63% higher future risk of dementia during the 7-year follow-up period. The high dementia and ischemic stroke overlap rate in the diabetic study group suggests vascular events play an important role in the pathogenesis of developing dementia.     

Prothrombin mutant,factor V Leiden,and thermolabile variant of methylenetetrahidrofolate reductase among patients with sickle cell disease in Brazil

The prevalence of the prothrombin gene variant (allele 20.210 A), factor V Leiden mutation, and homozygosity for transition 677C→T in the methylenetetrahydrofolate reductase (MTHFR) gene was determined among patients with sickle cell disease (SCD). The group included 73 patients with median age of 32.3 years with a diagnosis of sickle cell anemia in 53 patients, hemoglobinopathy SC in 16 patients, and four with S/β⁰ thalassemia. Vascular complications such as ischemic stroke or deep vein thrombosis were diagnosed in nine patients. Heterozygosity for the prothrombin gene variant or factor V Leiden mutation was identified in four patients. However, only one patient, who developed ischemic stroke, was identified as a carrier of factor V Leiden mutation. None of the patients presented homozygosity for the thermolabile variant of the MTHFR. These data suggest a low clinical impact of inherited hypercoagulability risk factors in developing thrombosis, occlusive stroke, or mortality data among patients with SCD in Brazil. Am. J. Hematol. 59:46–50, 1998. © 1998 Wiley-Liss, Inc.     

Cardiovascular Risks of Exogenous Testosterone Use Among Men: A Systematic Review and Meta-Analysis

Purpose

We sought to evaluate whether exogenous testosterone therapy is associated with increased risk of serious cardiovascular events as compared with other treatments or placebo.

The many faces of testosterone

Testosterone is more than a “male sex hormone”. It is an important contributor to the robust metabolic functioning of multiple bodily systems. The abuse of anabolic steroids by athletes over the years has been one of the major detractors from the investigation and treatment of clinical states that could be caused by or related to male hypogonadism. The unwarranted fear that testosterone therapy would induce prostate cancer has also deterred physicians form pursuing more aggressively the possibility of hypogonadism in symptomatic male patients. In addition to these two mythologies, many physicians believe that testosterone is bad for the male heart. The classical anabolic agents, 17-alkylated steroids, are, indeed, potentially harmful to the liver, to insulin action to lipid metabolism. These substances, however, are not testosterone, which has none of these adverse effects. The current evidence, in fact, strongly suggests that testosterone may be cardioprotective. There is virtually no evidence to implicate testosterone as a cause of prostate cancer. It may exacerbate an existing prostate cancer, although the evidence is flimsy, but it does not likely cause the cancer in the first place. Testosterone has stimulatory effects on bones, muscles, erythropoietin, libido, mood and cognition centres in the brain, penile erection. It is reduced in metabolic syndrome and diabetes and therapy with testosterone in these conditions may provide amelioration by lowering LDL cholesterol, blood sugar, glycated hemoglobin and insulin resistance. The best measure is bio-available testosterone which is the fraction of testosterone not bound to sex hormone binding globulin. Several forms of testosterone administration are available making compliance much less of an issue with testosterone replacement therapy.