原发性高血压、2型糖尿病患者心肌收缩力受损差别及影响因素探讨

目的探讨原发性高血压(EH)、2型糖尿病(T2DM)、EH合并T2DM(EH+T2DM)患者心肌收缩力受损害的差别及部分影响因素。方法采用超声心动图(UCG)评价24例健康者、49例EH、20例T2DM和21例EH+T2DM患者的左心室壁内缩短分数(MFS)及应力相关MFS(S-cMFS),并同时检测糖化血红蛋白A1c(HbA1c)、血糖(GL)、24h尿总蛋白(TuA)、微量蛋白(MuA)、肾功能和血脂。结果与正常组比较,EH、T2DM和EH+T2DM组MFS和S-cMFS明显减少,T2DM和EH+T2DM组更为明显;单变量相关分析显示HbA1c、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)与MFS和S-cMFS呈显著相关,MuA与MFS呈显著负相关;多变量相关分析提示仅MuA和HbA1c与MFS显著相关,HbA1c与S-cMFS显著相关。结论EH、T2DM和EH+T2DM患者心肌收缩力明显损害,尤以EH+T2DM患者更显著,HbA1c和MuA是损害心肌收缩力的重要因素,TC、TG、LDL也可能具有不良影响。     

老年冠心病合并高血压及2型糖尿病患者核素心肌显像与血清学指标研究

目的 应用99m锝-甲氧基异丁基异腈(99mTc-MIBI)单光子发射计算机断层(SPECT)心肌灌注显像对比分析老年冠心病患者(CHD)与CHD合并2型糖尿病(T2DM)和/或原发性高血压(EH)患者心肌缺血、心功能差异,并比较各组间血清学指标差异.方法 对237例老年CHD患者行门控SPECT核素心肌灌注显像,按病情分为4组:单纯CHD组、合并T2DM组、合并EH组、合并T2DM及EH组.分别统计4组总负荷评分(SSS)、总静息评分(SRS)、和总差值(SDS)、左室射血分数(LVEF)及血清学各项指标,并对4组数据进行对比分析.结果 合并T2DM组、合并EH组、合并T2DM及EH组核素心肌灌注显像SSS、SDS及D-二聚体(D-D)、血管性假血友病因子(vWF)、超敏C-反应蛋白(hs-CRP)均高于单纯CHD组(P＜0.05),而LVEF明显小于单纯CHD组(P＜0.05);合并T2DM及EH组SSS、SDS及D-D、vWF、hs-CRP均高于单纯合并T2DM组或合并EH组,左室射血分数(LVEF)则明显降低(P＜0.05);合并T2DM组、合并EH组两组间无明显差异(P=0.34);4组间血脂无明显差异.多因素分析显示D-D、vWF、hs-CRP水平与SSS、SDS呈正相关.结论 核素心肌灌注显像可有效评价冠脉心肌血供情况;CHD合并T2DM或EH患者心肌缺血显著,心功能较差;合并T2DM及EH患者心肌缺血最严重,而且心功能最差;D-D、vWF、hs-CRP水平可反映心肌缺血程度.     

2型糖尿病合并无症状冠心病的危险因素分析

目的探讨T2DM合并无症状冠心病(CAD)的危险因素。方法选取328例既往无CAD病史,亦无胸闷、胸痛等CAD相关症状的T2DM患者为研究对象,根据冠状动脉CTA检查结果分为单纯T2DM组(T2DM)和合并无症状CAD组(ACAD)。结果 ACAD组年龄、糖尿病病程、吸烟、高血压病、入院前服用降压药及他汀类药物比例高于T2DM组(P0.05或P0.01)。Logistic回归分析显示,年龄、糖尿病病程增加、有高血压病及吸烟为T2DM合并ACAD的独立危险因素。结论T2DM合并ACAD的危险因素是年龄、糖尿病病程、高血压病和吸烟。     

血清去磷酸化未羧化基质gla蛋白水平与2型糖尿病合并冠状动脉粥样硬化性心脏病的相关性研究

目的探讨血清去磷酸化未羧化基质gla蛋白(dp-ucMGP)水平与T2DM合并冠状动脉粥样硬化性心脏病(CAD)的相关性。方法选取2018年1月至2019年12月于赣南医学院第一附属医院内分泌科或心内科住院治疗的T2DM患者526例,按照是否合并CAD分为合并CAD组(CAD)240例及单纯T2DM组(T2DM)286例,收集两组一般临床资料,ELISA法检测血清dp-uc MGP水平,检测相关代谢指标及骨代谢指标。结果 CAD组血清dp-ucMGP高于T2DM组[(538±227)vs(350±193)pmol/L,P=0.005]。多元线性逐步回归分析结果显示,年龄、DM病程、SBP、骨钙素(OC)是血清dp-ucMGP的影响因素。二元Logistic回归分析结果显示,dp-uc MGP、DM病程、SBP、LDL-C是T2DM合并CAD的危险因素。结论血清dp-ucMGP与T2DM患者年龄、DM病程、SBP、OC密切相关,dp-ucMGP可能参与T2DM合并CAD的发生发展。     

血清载脂蛋白CⅢ、残余脂蛋白胆固醇水平与冠状动脉粥样硬化性心脏病合并2型糖尿病的关系

目的探讨冠状动脉粥样硬化性心脏病(冠心病,CAD)合并2型糖尿病(T2DM)患者血清载脂蛋白CⅢ(apoCⅢ)、残余脂蛋白胆固醇(RLP-C)的水平变化。方法入选2017年1月至2018年5月山西医科大学第二医院心血管内科住院患者816例,分为冠心病合并糖尿病组(T2DM+CAD组,n=192)、冠心病不合并糖尿病组(CAD组,n=198)、糖尿病不合并冠心病组(T2DM组,n=200)、非冠心病非糖尿病组(对照组,n=226)。采用析因设计方差分析比较CAD和T2DM交互作用对血清apoCⅢ水平的影响;Bootstrap法检验RLP-C对apoCⅢ和Gensini评分之间的中介效应;Logistic回归分析apoCⅢ对T2DM、CAD、T2DM+CAD发病的影响。结果与对照组相比,CAD、T2DM、CAD+T2DM组血清apoCⅢ、RLP-C水平较高。析因设计方差分析显示,CAD和T2DM在血清apoCⅢ、RLP-C水平升高方面存在交互作用。相关性分析结果显示,CAD和CAD+T2DM组血清apoCⅢ、RLP-C水平与Gensini评分呈正相关。Bootstrap法检验结果显示,RLP-C在apoCⅢ和Gensini评分之间发挥部分中介作用。多因素Logistic回归分析显示,apoCⅢ是CAD+T2DM组发病的独立危险因素[OR=1.890,95%CI(1.424～2.508),均P0.05]。结论 CAD和T2DM在apoCⅢ、RLP-C升高方面有交互作用,RLP-C在apoCⅢ和Gensini评分之间发挥部分中介作用,apoCⅢ是CAD合并T2DM的独立危险因素。     

老年2型糖尿病颈动脉内中膜厚度与冠心病的相关性分析

目的探讨老年2型糖尿病(T2DM)患者颈动脉内-中膜厚度(IMT)与冠心病(CAD)之间的关系。方法随机选取133例T2DM患者,根据冠状动脉造影检查结果分为CAD组(伴CAD,35例)和非CAD组(不伴CAD者,98例),检测两组患者的IMT及颈动脉斑块情况,绘制ROC曲线,评估其诊断T2DM伴CAD的价值。结果 CAD组患者的IMT较非CAD组明显增厚,斑块分级显著高于非CAD组(P0.05);Logistic多因素回归分析显示ICA-IMT、CCA-IMT及斑块分级是T2DM伴CAD的独立危险因素(P0.05);通过ROC曲线分析显示,以颈内动脉起始处-内中膜厚度(ICA-IMT)≥0.9 mm、双侧颈总动脉-内中膜厚度(CCA-IMT)≥1.3 mm以及斑块分级≥2中任意2项作为阳性,诊断CAD的特异度为84.25%,灵敏度为95.33%。结论 ICA-IMT、CCA-IMT及颈动脉斑块分级是T2DM合并CAD的独立危险因素,检测IMT及对颈动脉斑块进行分级可作为预测T2DM合并CAD安全、有效、无创性指标。     

原发性高血压伴2型糖尿病患者的心率变异分析

目的探讨原发性高血压(EH)与原发性高血压伴2型糖尿病(EH+T2DM)患者自主神经功能变化和二者之间的心率变异。方法选取我院心内科住院的EH病人42例为EH组:30例EH+T2DM病人为EH+T2DM组;40例健康人为对照组。作24小时动态心电图记录,进行HRV分析。结果EH组、EH+T2DM组及对照组之间HRV有明显变化,(P<0.05);EH组较对照组HRV值明显改变(P<0.05);而EH+T2DM组较EH组之HRV值显著降低,(P<0.05)。结论EH组较对照组自由神经功能损害明显,EH+T2DM患者较单纯EH者自主神经功能损害更明显。     

高血压患者动脉脉搏波传导速度与超敏C反应蛋白相关性

目的研究动脉脉搏波传导速度(PWV)与超敏C反应蛋白(hs_CRP)的相关性。方法选取210位高血压患者,将入选患者分为原发性高血压组(EH组,n=77),高血压合并糖耐量异常组(EH+IGT组,n=60)及高血压合并糖尿病组(EH+T2DM组,n=73),比较各组间PWV、hs_CRP的相关性。结果 EH+T2DM组的PWV较EH及EH+IGT组增高;EH+T2DM组的hs_CRP较EH增高,差异有统计学意义(P0.05),但与EH+IGT组比较无统计学意义(P0.05)。通过简单线性分析得出,PWV与年龄、hs_CRP呈正相关,进一步多元线性回归分析,结果表明年龄、hs_CRP与PWV呈独立相关。结论 hs_CRP是高血压患者PWV的独立危险因素,炎症可能参与动脉硬化的发生发展。     

脂蛋白(a)、淀粉样蛋白A及胱抑素C水平在糖尿病合并高血压患者并发糖尿病周围神经病变中的临床意义

目的 探讨脂蛋白(a)、淀粉样蛋白A(SAA)及胱抑素C水平在糖尿病合并高血压患者并发糖尿病周围神经病变(DPN)中的临床意义。方法入选2014年1月-2018年1月内分泌科就诊的200例2型糖尿病合并高血压(T2DM+EH)患者,根据是否合并DPN分为T2DM+EH组120例,DPN+EH组80例;同期收治单纯2型糖尿病(T2DM)患者100例为T2DM组。比较3组对象的基本资料、血清脂蛋白(a)、SAA及胱抑素C水平,并进行Spearman相关和多元Logistic回归分析。结果DPN+EH组与T2DM+EH组的糖尿病病程、体质量指数(BMI)、血压、总胆固醇、三酰甘油、低密度脂蛋白胆固醇(LDL-C)、空腹血糖、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、血肌酐高于T2DM组(均P0.05);DPN+EH组与T2DM+EH组相比,病程、收缩压、平均动脉压(MAP)、空腹血糖、2hPG、HbA1c、血肌酐更高(均P0.05)。DPN+EH组与T2DM+EH组运动神经传导速度(MCV:正中神经、腓总神经)、感觉神经传导速度(SCV:正中神经、腓肠神经)低于T2DM组(均P0.05);DPN+EH组MCV(正中神经、腓总神经)、SCV(正中神经、腓肠神经)又低于T2DM+EH组(均P0.05)。DPN+EH组与T2DM+EH组的血清脂蛋白(a)、SAA、胱抑素C水平高于T2DM组(均P0.05);DPN+EH组血清脂蛋白(a)、SAA、胱抑素C水平又高于T2DM+EH组(均P0.05)。Pearson相关性分析显示,病程、MAP、HbA1c、脂蛋白(a)、SAA及胱抑素C与DPN+EH患者腓总神经MCV、腓肠神经SCV呈负相关(均P0.05)。Logistic回归分析显示,病程、HbA1c、MAP、脂蛋白(a)、SAA及胱抑素C是DPN+EH发病的影响因素。结论脂蛋白(a)、SAA及胱抑素C是糖尿病合并高血压患者发生DPN的影响因素。     

对氧磷酯酶-1与老年人2型糖尿病合并高血压的研究

目的探讨血清对氧磷酯酶-1(PON-1)活性与老年人2型糖尿病(DM)合并高血压(EH)的关系。方法设健康对照组、单纯2型DM组和2型DM合并EH组,分别测定PON-1、NO水平。结果老年单纯2型DM组PON-1活性为(94.81±28.50)kU/L,比健康对照组显著降低犤(132.93±19.45)kU/L,P<0.01犦,老年2型DM合并EH组PON-1活性(66.02±14.60)kU/L,比老年单纯2型DM组显著降低(P<0.01)。NO水平在老年2型DM合并EH组比健康对照组和老年单纯2型DM组显著降低(P<0.01)。PON-1活性与NO水平呈高度正相关(r=0.63,P<0.001),Logistic回归分析表明PON-1活性是2型DM合并EH的高度危险因素(P<0.01)。结论PON-1活性在2型DM显著下降,且在2型DM合并EH患者下降更显著。PON-1活性与NO呈正相关。PON-1活性降低是2型DM合并EH的高度危险因素。     

Beta blocker overdose with propranolol and with atenolol

During a one-month period, two cases of beta-adrenergic blocker overdose were treated by the emergency staff at our hospital. One case of propranolol intoxication demonstrated profound cardiovascular collapse and generalized tonic-clonic seizures. The condition failed to respond to high-dose intravenous pressor agents, but did improve significantly with IV glucagon infusion. The second overdose involved atenolol. Although the blood levels reported were very high, the patient showed no cardiovascular compromise and required only inhaled bronchodilators for an exacerbation of her asthma.     

Colitis associated with biological agents

In the past, there has been considerable focus on a host of drugs and chemicals that may produce colonic toxicity. Now, a variety of new biological monoclonal antibody agents, usually administered by infusion, have appeared in the clinical realm over the last decade or so to treat different chronic inflammatory or malignant disorders.For some of these agents, adverse effects have been documented, including apparently new forms of immune-mediated inflammatory bowel disease. In some, only limited symptoms have been recorded, but in others, severe colitis with serious complications, such as bowel perforation has been recorded. In others, adverse effects may have a direct vascular or ischemic basis, while other intestinal effects may be related to a superimposed infection. Some new onset cases of ulcerative colitis or Crohn's disease may also be attributed to the same agents used to treat these diseases, or be responsible for disease exacerbation. Dramatic and well documented side effects have been observed with ipilimumab, a humanized monoclonal antibody developed to reduce and overcome cytotoxic T-lymphocyte antigen 4, a key negative feedback regulator of the T-cell anti-tumor response. This agent has frequently been used in the treatment of different malignancies, notably, malignant melanoma. Side effects with this agent occur in up to 40% and these are believed to be largely immune-mediated. One of these is a form of enterocolitis that may be severe, and occasionally, fatal. Other agents include rituximab (an anti-CD20 monoclonal antibody), bevacizumab (a monoclonal antibody against the vascular endothelial growth factor) and anti-tumor necrosis factor agents, including infliximab, adalimumab and etanercept.     

Water intoxication with seizures

Presented is the case of a normal two-month-old girl who developed seizures secondary to water intoxication. The infant had been fed 20 to 30 oz of water daily for three days, while her usual formula was withheld because of vomiting and diarrhea. On the day of admission, the infant exhibited signs of water intoxication in the form of lethargy, vomiting, and seizures. Hyponatremia, hypothermia, and hyperglycemia were noted on admission, and are common features of the syndrome. The patient responded well to fluid restriction and salt replacement. Previous reports have attributed water intoxication to feeding mismanagement, vigorous hydration, dilute formulas, and swimming lessons.     

Weber-Christian disease with ileocolonic involvement successfully treated with infliximab

Weber-Christian disease(WCD) is an inflammatory disease whose main histological feature is lobular panniculitis of adipose tissue. The location of panniculitis determines the clinical presentation,being the subcutaneous adipose tissue the most frequent one,followed by liver,spleen,bone marrow and mesenteric adipose tissue.Systemic corticosteroids are first line treatment,but other options should be considered if systemic symptoms are observed or in case of refractory clinical situation.We report herein a case with WCD showing orbital,mesenteric and ileocolonic involvement,which required surgical treatment and also developed postoperative recurrence.Symptoms were resolved by administration of thalidomide and,afterwards,infliximab.To our knowledge,this is the first report of Weber-Christian disease with luminal ileocolonic involvement,treated with infliximab.     

Anticoagulation with Bivalirudin during Deep Hypothermic Circulatory Arrest in a Patient with Heparin-Induced Thrombocytopenia

Heparin-induced thrombocytopenia is a well-recognized complication of anticoagulation with heparin. We present the case of a patient with recent heparin-induced thrombocytopenia who subsequently needed surgery on an emergency basis for acute type A aortic dissection. This article reports the successful use of bivalirudin, a direct thrombin inhibitor, as an alternative to heparin throughout cardiopulmonary bypass and deep hypothermic circulatory arrest. We contend that bivalirudin is a safe alternative to heparin when performing surgery for aortic dissection and should be considered as an option for use in patients who present with heparin-induced thrombocytopenia.     

Curing Cats with Feline Infectious Peritonitis with an Oral Multi-Component Drug Containing GS-441524

Feline infectious peritonitis (FIP) caused by feline coronavirus (FCoV) is a common dis-ease in cats, fatal if untreated, and no effective treatment is currently legally available. The aim of this study was to evaluate efficacy and toxicity of the multi-component drug Xraphconn^® in vitro and as oral treatment in cats with spontaneous FIP by examining survival rate, development of clinical and laboratory parameters, viral loads, anti-FCoV antibodies, and adverse effects. Mass spectrometry and nuclear magnetic resonance identified GS-441524 as an active component of Xraphconn^®. Eighteen cats with FIP were prospectively followed up while being treated orally for 84 days. Values of key parameters on each examination day were compared to values before treatment initiation using linear mixed-effect models. Xraphconn^® displayed high virucidal activity in cell culture. All cats recovered with dramatic improvement of clinical and laboratory parameters and massive reduction in viral loads within the first few days of treatment without serious adverse effects. Oral treatment with Xraphconn^® containing GS-441524 was highly effective for FIP without causing serious adverse effects. This drug is an excellent option for the oral treatment of FIP and should be trialed as potential effective treatment option for other severe coronavirus-associated diseases across species.     

Serum metabolome profiles characterized by patients with hepatocellular carcinoma associated with hepatitis B and C

AIM: To clarify the characteristics of metabolite profiles in virus-related hepatocellular carcinoma(HCC) patients using serum metabolome analysis. METHODS: The serum levels of low-molecular-weight metabolites in 68 patients with HCC were quantified using capillary electrophoresis chromatography and mass spectrometry. Thirty and 38 of the patients suffered from hepatitis B virus-related HCC(HCC-B) and hepatitis C virus-related HCC(HCC-C), respectively.RESULTS: The main metabolites characteristic of HCC were those associated with glutathione metabolism, notably 13 γ-glutamyl peptides, which are by-products of glutathione induction. Two major profiles, i.e., concentration patterns, of metabolites were identified in HCC patients, and these were classified into two groups: an HCC-B group and an HCC-C group including some of the HCC-B cases. The receiver operating characteristic curve for the multiple logistic regressionmodel discriminating HCC-B from HCC-C incorporating the concentrations of glutamic acid, methionine and γ-glutamyl-glycine-glycine showed a highly significant area under the curve value of 0.94(95%CI: 0.89-1.0, P 0.0001).CONCLUSION: The serum levels of γ-glutamyl peptides, as well as their concentration patterns, contribute to the development of potential biomarkers for virus-related HCC. The difference in metabolite profiles between HCC-B and HCC-C may reflect the respective metabolic reactions that underlie the different pathogeneses of these two types of HCC.     

Management of a child with acute thyroxine ingestion

We report a case of thyroxine overdose in a child. Despite extremely high thyroxine (T4RIA) levels on admission, the patient's only symptoms were mild hypertension and tachycardia. Both symptoms responded to propranolol, with a drop in pulse rate and a decrease in blood pressure to normal levels. After four days of cardiac monitoring, the patient was released and received propranolol for five additional days as an outpatient.     

Role of chemoprophylaxis with either NSAIDs or statins in patients with Barrett’s esophagus简

The incidence of esophageal adenocarcinoma, a poor prognosis neoplasia, has risen dramatically in recent decades. Barrett’s esophagus represents the best-known risk factor for esophageal adenocarcinoma development. Non-steroidal anti-inflammatory drugs through cyclooxygenase-2 inhibition and prostaglandin metabolism regulation could control cell proliferation, increase cell apoptosis and regulate the expression of growth and angiogenic factors. Statins can achieve equivalent effects through prenylation and subsequently control of cellular signaling cascades. At present, epidemiological studies are small and underpowered. Their data could not justify either medication as a chemo-preventive agent. Population based studies have shown a 43% reduction of the odds of developing an esophageal adenocarcinoma, leaving out or stating a 25% reduction in patients consuming non-aspirin nonsteroidal anti-inflammatory drugs and a 50% reduction in those patients consuming aspirin. They have also stated a 19% reduction of esophageal cancer incidence when statins have been used. Observational studies have shown that non-steroidal anti-inflammatory drugs could reduce the adenocarcinoma incidence in patients with Barrett’s esophagus by 41%, while statins could reduce the risk by 43%. The cancer preventive effect has been enhanced in those patients taking a combination of non-steroidal anti-inflammatory drugs and statins (a 74% decrease). Observational data are equivocal concerning the efficacy of non-steroidal anti-inflammatory drug subclasses. Non-steroidal anti-inflammatory drugs clearly have substantial potential for toxicity, while statins are rather safe drugs. In conclusion, both non-steroidal anti-inflammatory drugs and statins are promising chemopreventive agents and deserve further exploration with interventional studies. In the meanwhile, their use is justified only in patients with cardiovascular disease.