雌激素对冠心病患者血脂代谢和凝血系统的影响

目的观察雌激素对冠心病患者血脂代谢和凝血系统的影响.方法绝经女性冠心病组32例,对照组30例,在行冠状动脉造影确诊后,检查血中雌激素2(E2)、甘油三酯(TG)、总胆固醇(TC)、纤维蛋白原(Fg)、凝血因子Ⅷ(Ⅷ因子)、血管性血友病因子抗原(VWFAg)、Ⅷ因子促凝血活性(ⅧC)的数值并进行比较,根据冠脉造影中危险分数与射血分数进行相关分析.结果冠心病组E2水平与非冠心病对照组比较呈明显的降低现象,冠心病组与非冠心病对照组的比值为37.9764.92,P<0.01,冠心病TC、TG、Fg及VWFAg较非冠心病对照组的水平呈明显的升高现象(P<0.05).同时,危险分数与射血分数也呈显著负相关(r=-0.367 4,P<0.05).结论绝经后的女性随着雌激素水平的降低,血脂谱向着易患冠心病的方向改变.雌激素对凝血功能的调节可能是对心血管起保护作用的机理之一.危险分数是评价冠心病患者血管病变严重程度的良好指标.     

老年冠心病患者脂代谢与凝血功能关系的临床分析

目的 探讨血脂和凝血功能在老年冠心病患者发病中的作用及两者的关系.方法 本文对220例冠心病患者和70例无冠状动脉病变对照者的血浆测定血浆脂蛋白a [LP(a)]、血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、凝血酶-抗凝血酶Ⅲ复合物(TAT)、D-二聚体(D-D)、血浆纤维蛋白原(Fg)水平,根据冠状动脉造影结果将冠心病组分为单支和多支病变组,观察其与各指标之间的关系.结果 老年冠心病组血脂水平和血浆Fg、TAT、D-D明显高于对照组,HDL-C低于对照组,且随着冠状动脉病变支数的增加,指标均明显升高(P＜0.05).Fg、LDL-C、LP(a)与冠状动脉病变程度密切相关(OR分别为1.17、1.10、和1.04、P＜0.05).结论 Fg、LDL-C和LP(a)是冠心病发病的独立危险因子;血浆Fg、TAT和D-D浓度的监测对体内高凝状态和冠心病的预防具有重要意义.     

雌激素对绝经后女性冠心病患者血脂及血管内皮功能的影响

目的:研究雌激素对绝经后女性冠心病患者血脂及血管内皮功能的影响,探讨绝经后女性冠心病患者血脂及血管内皮功能的相关性。方法:将60例绝经后女性冠心病患者随机分为治疗组和对照组各30例,治疗组在常规治疗的基础上服用尼尔雌醇2 mg,2周1次,对照组仅采用常规治疗,均连续服用6个月。于治疗前及治疗后检测血清总胆固醇(TC)、血清三酰甘油(TG)水平,低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)以及血浆内皮素(ET-1)和一氧化氮(NO)水平,并观察疗效。结果:①与治疗前相比,治疗组TC、TG、LDL-C、ET-1水平均明显下降,HDL-C、NO水平明显上升;②与对照组治疗后相比,治疗组TC、TG、ET-1水平均明显下降,HDL-C、NO水平明显上升,差异均有统计学意义(P<0.05);③Pearson相关分析显示,ET-1与TC、TG及LDL-C之间呈正相关,与HDL-C呈负相关;NO与TC、TG及LDL-C之间呈负相关,与HDL-C呈正相关,差异均有统计学意义(P<0.05)。结论:血脂紊乱及血管内皮功能异常可能参与了绝经后女性冠心病的发生和发展,二者具有相关性;雌激素对绝经后冠心病患者的血脂有明显改善,并具有保护血管内皮功能的作用,有利于冠心病的防治。     

妊娠期高血压疾病患者凝血和抗凝因子的变化及意义

目的:探讨妊高征患者凝血和抗凝因子的变化及意义。方法:采用STA-R自动血凝仪分别检测80例妊娠期高血压疾病患者(妊高征组)、25例正常孕妇(对照组)的凝血因子Ⅷ:C、Ⅸ:C、AT(抗凝血酶):C及VWF(血小板表面受体)抗原含量。结果:妊高征组凝血因子Ⅷ:C、Ⅸ:C及VWF:Ag均明显高于对照组(P<0.05或P<0.01);妊高征组AT:C明显低于对照组(P<0.05或P<0.01)。结论:检测凝血因子Ⅷ:C、Ⅸ:C、AT:C及VWF:Ag对诊治妊高征有一定的临床意义。     

老年冠心病患者脂代谢与凝血功能关系的临床分析

目的探讨血脂和凝血功能在老年冠心病患者发病中的作用及两者的关系。方法本文对220例冠心病患者和70例无冠状动脉病变对照者的血浆测定血浆脂蛋白a[LP(a)]、血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、凝血酶—抗凝血酶Ⅲ复合物(TAT)、D-二聚体(D-D)、血浆纤维蛋白原(Fg)水平,根据冠状动脉造影结果将冠心病组分为单支和多支病变组,观察其与各指标之间的关系。结果老年冠心病组血脂水平和血浆Fg、TAT、D-D明显高于对照组,HDL-C低于对照组,且随着冠状动脉病变支数的增加,指标均明显升高(P<0.05)。FgLDL-C、LP(a)与冠状动脉病变程度密切相关(OR分别为1.17、1.10、和1.04、P<0.05)。结论Fg、LDL-C和LP(a)是冠心病发病的独立危险因子;血浆Fg、TAT和D-D浓度的监测对体内高凝状态和冠心病的预防具有重要意义。     

纤维蛋白原与冠心病关系的研究

目的探讨血浆纤维蛋白原 (Fg)与冠心病 (CHD)的关系 ,分析血浆 Fg的影响因素。方法对 81例确诊的冠心病患者和 83例正常对照测量了身高、体重、血压、血浆 Fg浓度、血清总胆固醇 (TC)、高密度脂蛋白胆固醇 (HDL - C)和甘油三酯 (TG) ,询问了吸烟和饮酒情况。比较 CHD患者和正常人的血浆 Fg浓度 ,应用多元回归分析血浆 Fg的影响因素 ,应用 Logistic回归分析 CHD的危险因素。结果 CHD患者和正常人的血浆 Fg水平分别为 (4.3± 1 .1 )和 (3.6± 1 .3) g/ L,CHD患者的血浆 Fg浓度明显高于正常人 (P<0 .0 1 )。血浆 Fg水平与年龄、吸烟、体质指数、TC和 TG正相关 ,与饮酒和HDL- C呈负相关 ,吸烟是血浆 Fg升高的最主要的因素 (P=0 .0 0 2 )。 Logistic回归分析结果显示 ,TG(β=1 .86,P=0 .0 0 8,OR=4.31 ,95% CI 1 .78～ 1 1 .2 3)和 Fg(β=1 .73,P=0 .0 2 ,OR=3.88,95% CI 1 .75～ 8.70 )是 CHD的危险因素 ,HDL- C(β=- 1 .89,P=0 .0 0 5,OR=0 .2 3,95% CI0 .0 7～ 0 .89)是 CHD的保护因素。结论吸烟是血浆 Fg升高的最主要的因素 ,血浆 Fg升高是 CHD的独立危险因素     

介入治疗对原发性肝癌凝血及纤溶功能影响的临床研究

[目的]探讨原发性肝癌介入治疗前后凝血及纤溶功能的变化. [方法]选取2007年1月～2009年1月来本院就诊并进行介入治疗的92例原发性肝癌患者作为观察组,正常对照组60例,对比分析两组各项指标一采用ELISA法检测P-选择素、尿激酶型纤溶酶原激活物(uPA)、血管性血友病因子(vWF),采用发色底物法检测纤溶酶原激活物抑制物(PAI),采用光散射比浊法检测凝血酶时间(TT)、活化的部分凝血活酶时间(AFTT)、血浆凝血酶原时间(PT)、凝血因子Ⅶ(FⅦ)、Ⅷ(FⅧ)、X(FX)及纤维蛋白原含量(Fg). [结果]观察组介入治疗后,与治疗前相比,PT、APTT、Ps、VWF和uPA都低于治疗前(P＜0.05);FⅦ、FⅧ高于治疗前(P＜0.05).与对照组相比,PT、AFTT、TT、Ps、VWF和uPA都高于对照组(P＜0.05);Fg、FⅦ、FⅧ和FX都低于对照组(P＜0.05). [结论]介入治疗能够减轻原发性肝癌患者的凝血和纤溶功能亢进,但不能恢复正常.     

甲亢患者治疗前后血浆因子Ⅷ的变化

32例甲状腺功能亢进症(甲亢)患者血浆因子Ⅷ促凝活性(Ⅷ:C),Von Willebrand因子相关抗原(VWF:Ag)极显著高于正常组,经他巴唑治疗后,他们均恢复正常,治疗前后自身比较差异极显著。T_3、T_4、~(125)I—T_3RuR,FT_4I与他们显著相关。逐步回归表明FT_4I对Ⅷ:C影响显著,T_3.T_4对VWF:Ag影响显著,并对其机制进行了探讨。     

女性绝经后性激素与急性冠脉综合征的关系

目的探讨女性绝经后性激素及其比例关系与急性冠脉综合征之间的关系。方法研究对象为行冠脉造影确诊的女性冠心病患者66例,分为急性冠脉综合征(ACS)组50例,稳定型心绞痛(SAP)组16例,27例疑诊冠心病行冠脉造影检查排除冠心病者为对照组。测定三组血清雌二醇(E2)、睾酮(T)、孕酮(P)水平,同时测定空腹血糖、血脂、载脂蛋白等指标。结果(1)SAP组低密度脂蛋白胆固醇(LDL-C)显著高于对照组。(2)ACS组LDL-C、甘油三酯(TG)、T与TE2均显著高于对照组,而E2、载脂蛋白A(ApoA)则低于对照组。(3)多因素分析结果显示女性绝经后ACS与ApoA及LDL-C有显著相关性,线形相关分析表明TE2与胆固醇(TC)、LDL-C、载脂蛋白B(ApoB)呈正相关,与高密度脂蛋白胆固醇(HDL-C)、ApoA呈负相关。结论女性绝经后性激素水平及其比例关系,不能作为ACS的独立危险因素,女性绝经后性激素比例失衡与体内血脂异常等危险因素存在密切相关性,导致ACS病理生理改变的发生。     

女性绝经后冠心病患者血浆雌二醇水平与冠心病影响因素分析

目的探讨女性绝经后冠心病患者血浆雌二醇(E_2)水平与冠心病影响因素的相关性。方法选取118例绝经后女性,根据患者冠状动脉造影检查结果,将82例确诊冠心病患者分为A组,36例非冠心病患者分为B组。比较两组患者的左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室舒张末压(LVEDP)、E_2、NT-pro BNP、血浆同型半胱氨酸(Hcy)、叶酸(FA)、维生素B_(12)及血脂检测结果;比较A组中不同冠状动脉病变数目、冠状动脉评分患者的LVEF、LVEDD、LVEDP、E_2及NT-pro BNP检测结果。结果 A组LVEF显著低于B组,而LVEDD、NT-pro BNP显著高于B组(P0.05)。A组患者VB12、FA及HDL低于B组,而Hcy、TG及TC高于B组(P0.05)。随着冠状动脉病变数目的增加,绝经后冠心病患者LVEF、E_2水平显著下降,而LVEDD、LVEDP及NT-pro BNP水平显著上升(P0.05)。随着冠状动脉评分的增加,绝经后冠心病患者LVEF、E_2水平显著下降,而LVEDD、LVEDP及NT-pro BNP水平显著上升。E_2水平与HDL-C、维生素B_(12)及FA之间呈正性关系(P0.05),与NT-pro BNP、LDL-C、Hcy、TC及TG之间呈负相关(P0.05)。结论绝经后女性体内E_2水平明显降低,E_2可能通过影响体内糖脂代谢、炎症反应,进而参与女性绝经后冠心病的发生和发展。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.