高血压治疗中的血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂

一线降压药物可分为A、B、C、D。4类。其中A类药物包括血管紧张素转换酶（ACE）抑制剂和血管紧张素受体拮抗剂（ARBs）;B类药物为B肾上腺素能受体拮抗剂（又称β受体阻滞剂）,对于无并发症的原发性高血压,此类药物已不常作为降压药物单独使用。     

急性心肌梗塞与血管紧张素转化酶活性关系的临床研究

以马尿酸定量法测定符合ＷＨＯ规定的诊断标准的急性心肌梗塞（ＡＭＩ）患者７８例和正常对照组３４例的血清血管紧张素转化酶（ＡＣＥ）活性。结果：（１）ＡＭＩ患者的血清ＡＣＥ活性显著高于对照组（Ｐ〈０．００１）,（２）ＡＭＩ亚急性期或恢复期的ＡＣＥ活性均显著低于ＡＭＩ急性期者（Ｐ〈０．０５,Ｐ〈０．０１）,恢复期ＡＭＩ患者的ＡＣＥ活性则显著低于亚急性期者（Ｐ〈０．０５）;（３）ＡＭＩ患者并发心衰或并发休克     

β受体阻滞剂在心肌梗死应用中的评价

β受体阻滞剂在高血压、心律失常及心力衰竭中的应用均取得了世人瞩目的成就。对于它在治疗心肌梗死的疗效、安全性及合理使用等方面的问题 ,也正在进行广泛而深入的研究。现将有关资料综述如下。1　冠心病的新观点及流行病学经过大量实验研究和临床循证 ,现在把冠心病 (ＣＨＤ     

心肌梗死患者血管紧张素转换酶基因型分析

目的 研究心肌梗死与血管紧张素转移酶（ＡＣＥ）基因多态性的关系。方法 应用ＰＣＲ技术扩增病人外周血ＡＣＥ基因第１６内含子目的片段，琼脂糖凝胶电泳确认等位基因，计算各组基因型频率。结果 病例组和对照组ＡＣＥ基因多态性分布频率，ＤＤ型分别为４１．４％和２２．０％、ＩＤ型分别为３１．０％和４１．５％、Ⅱ分别为２７．６％和３６．６％，病例组ＤＤ型高于对照组，ｘ＾２＝４．２１，Ｐ〈０．０５。结论 ＡＣＥ基因     

血管紧张素1转换酶基因多态性与支架后再狭窄的相关性研究

目的;研究血管紧张素1转换酶（ACE）基因多态性与冠心病（CHD）患者行冠状动脉内支架后再狭窄（ISR）的相关性。方法：选择了1997－2000年间128例行冠状动脉内支架术的东北汉族患者,对其进行了追踪随访。在3个月－2年后再行冠状动脉造影术,根据支架内狭窄程度进行分组,并利用聚合酶链反应（PCR）分析方法进行ACE基因分型,再结合临床生化指标和二次冠状动脉造影术的结果,探讨两者间的关系。结果：43例ISR患者DD,ID,II的频率为0．651,0．163,0．186,85例支架术后未狭窄患者DD,ID,II的频率为0．412,0．282,0．305,DD型的支架患者比II,ID型的患者,有较高的再狭窄发生率（P＜0．025）,D等位基因频率（73．26％）,明显地高于I等位基因频率（26．74％,P＜0．01）,结论：ACE基因多态性与ISR有相关性,D等位基因可能是ISR发生的危险因素之一。     

Pacing after acute myocardial infarction

Experience of endocardial pacing in eighty-two patients with atrioventricular block after myocardial infarction is described. A unipolar pacing wire was passed into an antecubital fossa vein and passed into the right atrium and wedged into the apex of the right ventricle under radiological control using an image intensifier. All patients were attached to an external demand unit set at 60/min which will pace if there is asystole longer than 1 sec. The disadvantages of pacing are discussed.     

血管紧张素转化酶基因多态性与心肌梗死的相关研究

目的：了解血管紧张素转化酶（ａｎｇｉｏｔｅｎｓｉｎ ｃｏｎｖｅｒｔｉｎｇ ｅｎｚｙｍｅ, ＡＣＥ） 基因的插入／缺失（ｉｎｓｅｒｔｉｏｎ／ｄｅｌｅｔｉｏｎ,Ｉ／Ｄ）多态性在中国人群中与心肌梗死（ 简称心梗）是否相关。方法：选择了１５０ 例住院心梗病人为实验组,１５０ 例住院的非心血管病患者作对照, 抽取外周静脉血提取ＤＮＡ,同时所有研究对象记录其病史、体检等临床资料及吸烟、饮酒等流行病学资料,应用ＰＣＲ 进行ＡＣＥ 的基因型分析。结果：Ｉ等位基因和Ｄ 等位基因频率在心梗组分别为０ ．５８ 和０ ．４２ ,在对照组为０ ．６５ 和０．３５。基因型频率的分布符合ＨａｒｄｙＷｅｉｎｂｅｒｇ 平衡。在全体研究的样本中,未发现ＩＤ或ＤＤ 基因型与心梗相关;但在年龄小于或等于６０ 岁的个体中,ＤＤ 基因型与心梗显著相关（ＯＲ＝ ２ ．３３ ,９５％ ＣＩ：１．２０４ ．５７）。并且这一相关性在年龄６０ 岁及以下且肥胖的个体中进一步增强。结论：在研究的样本中,未发现ＡＣＥ基因型与心梗相关;但在年龄６０ 岁及以下的个体中,ＤＤ基因型与心梗显著相关,且这种相关在合并肥胖的个体中进一步加强。     

早期静脉应用β受体阻滞剂对急性心肌梗死患者预后影响的Meta分析

目的系统评价再灌注时心肌梗死后早期静脉应用β受体阻滞剂对患者预后的影响。方法检索Pubmed、Embase、Cochrane图书馆、中国知网、万方数据知识服务平台、维普期刊资源整合服务平台、中国生物医学文献数据库,收集比较再灌注背景下心肌梗死后早期静脉使用β受体阻滞剂(试验组)不使用或者使用安慰剂(对照组)对患者预后影响的研究。主要观察指标为短期及长期的全因病死率及恶性心律失常、心肌再梗死、心源性休克等发生率。采用Revman5.2软件对提取的数据进行荟萃分析。结果纳入8项临床研究,共48 367例患者。Meta分析显示,试验组与对照组相比,心肌梗死患者恶性室性心律失常发生率下降(OR=0.83,95%CI 0.75~0.93,P=0.000 9);心源性休克、心力衰竭发生率增加(OR=1.29,95%CI1.18~1.41,P<0.01),2组心肌梗死患者全因病死率、再梗死、缺血等不良事件发生率差异无统计学意义(OR=0.98,95%CI 0.92~1.05,P=0.63;OR=0.95,95%CI0.88~1.03,P=0.21)。结论在心肌梗死早期静脉给予β受体阻滞剂可以降低梗死后恶性室性心律失常发生率,但同时也有增加心源性休克、心力衰竭发生的风险,在改善病死率方面没有明显获益。     

血管紧张素转换酶抑制剂在儿科临床中的应用

目的 对血管紧张素转换药抑制剂(ACEI)在儿科的临床应用作一综述。方法 对ACEI在临床中应用的有关最近成果加以分析整理。结果 展现ACEI治疗充血性心力衰竭、小儿高血压、肺动脉高压、肾脏疾病、儿童血管迷走性晕厥等治疗方面的最新成果。结论 根据上述不同疾病，选择ACEI中不同类型的药物讲行治疗．可提高疾病治疗效果。     

血管紧张素转化酶检测对肺癌诊断的临床意义

目的 :探讨血管紧张素转化酶检测对肺癌的辅助诊断的价值。方法 :采用紫外速率法对60例肺癌患者和30例肺良性疾病患者血清血管紧张素转化酶进行检测。结果 :各组肺癌患者血管紧张素转化酶水平显著低于肺良性疾病组和正常对照组 (P<0.01) ,其阳性检出率分别为腺癌84.6 % ,鳞癌76.0 % ,未分化癌77.8 % ,对整体肺癌的敏感性为78.3% ,特异性为70%。结论 :血管紧张素转化酶检测对肺癌的临床诊断具有较高的价值     

Left ventricular thrombi after acute myocardial infarction

Two-dimensional echocardiography was utilized in a prospective study to find the incidence, characteristics and natural history of left ventricular thrombus in 50 consecutive patients with acute myocardial infarction. The overall incidence of thrombosis was 14%; 19% in anterior and 5% in inferior infarction. The thrombus was detected at the apex in 4, along the ventricular septum in 2 and at both these sites in one patient. It was observed 3-10 days after the infarction. Thrombus at the ventricular septum, seen in this study, has not been reported previously in acute myocardial infarction. Development of apical and septal thrombi was significantly associated with akinesis of these sites. Only 2 patients with protruding thrombi had systemic embolism. We conclude that the apex as well as the septum are common sites for thrombosis in patients with severe wall motion abnormalities following acute anterior infarction. Careful observation of these sites during echocardiography may reveal thrombi prone for embolization.     

Follow-up care after acute myocardial infarction.

OBJECTIVE: To examine the medical care received by patients following discharge from hospital after acute myocardial infarction (AMI). SETTING AND DESIGN: Community-based cross-sectional survey. PATIENTS: 2836 consecutive patients aged 25-64 years living in the Perth Statistical Division who were admitted to hospital with AMI during 1984-1988. After one reminder the response rate was 71%. RESULTS: Half of all respondents were in full-time employment at the time of their AMI. At follow-up this had fallen to a third. Over 80% of patients visited a cardiologist after AMI, with half remaining under consultant care to the time of survey. However, one in five patients reported no follow-up care at the time of survey. Seventy-three per cent of patients reported undergoing at least one exercise stress test after AMI, with 61% undergoing angiography, 16% angioplasty and 24% coronary bypass surgery. Large proportions of the patients accurately reported being prescribed beta-blockers and antiplatelet agents. The pattern of prescribing at discharge corresponded closely with the use of cardioactive agents at the time of survey and with drugs reported to have been taken continuously since discharge to the time of survey. CONCLUSIONS: These data suggest that follow-up care after AMI is both comprehensive and widespread. Such care may have contributed significantly to the overall decline in mortality from ischaemic heart disease.