血浆心钠素变化与慢性肾病中医辨证分型

应用放免法对68例慢性肾病患者和32例正常人进行血浆心钠素(ANF)含量的检测.结果表明慢性肾病患者血浆ANF含量明显高于对照组;慢性肾病不同中医证型ANF含量依次为脾肾阳虚型>肺肾气虚型>气阴两虚型>肝肾阴虚型.     

美托洛尔对原发性高血压患者部分血管活性肽的干预影响

目的探讨原发性高血压(EH)患者血清血管紧张素Ⅰ(AⅠ)、血管紧张素Ⅱ(AⅡ)、心钠素(ANF)和醛固酮(ALD)水平,经美托洛尔干预治疗的变化及其临床意义.方法放射免疫法测定62例EH组和48例非高血压组血清AⅠ、AⅡ、ANF和ALD水平,并进行比较研究.测定美托洛尔干预治疗前后上述血管活性肽变化.结果EH血清AⅠ和ALD显著高于对照组(均P《0.05),AⅡ和ANF无显著差异(均P《0.05).Ⅰ、Ⅱ、Ⅲ期EH组间四者血清水平的方差检验无显著差异(均P《0.05),23例合并心脑血管并发症组与39例无心脑血管并发症组间四者也无显著差异(均P《0.05).AⅠ与AⅡ,ALD与AⅡ间呈显著正相关(r=0.513,P《0.01;r=0.362,P《0.05),AⅠ、AⅡ、ALD均与平均动脉压呈显著正相关(r=0.443,0.469,0.513;均P《0.05).EH患者经美托洛尔干预治疗后血清AⅠ、AⅡ、ANF、ALD显著性下降(均P《0.01或P《0.05).结论EH患者血清AⅠ和ALD显著升高,经美托洛尔干预治疗后,血清AⅠ、AⅡ、ANF、ALD显著性下降.     

血压正常的2型糖尿病患者血压昼夜节律、血浆醛固酮、肾素及心钠素水平研究

目的 研究不伴高血压的新诊断2型糖尿病患者血压昼夜节律及肾素、血管紧张素、醛固酮(ADS)、心钠素水平.方法 选取我院住院的2型糖尿病伴高血压患者(2DMH组)72例,我院住院或门诊新诊断2型糖尿病不伴高血压患者(2DM组)68例,体检中心健康体检者(C组)54例.对所有入选者进行24h动态血压监测,观察昼夜血压的正常节律是否存在,记录24 h平均收缩压(24 hSBP)和舒张压(24 hDBP),日间平均收缩压(dSBP)和舒张压(dDBP),夜间平均收缩压(nSBP)和舒张压(nDBP),计算△MBP.并检测三组研究对象血浆肾素、血管紧张素、血浆醛固酮、心钠素水平. 结果 2DM组血压昼夜节律消失者显著高于C组(47/68 vs 9/54,P＜0.05),其中以24hDBP、dDBP及nDBP显著升高(P＜0.05).2DM组PRA、AngⅡ、ADS均显著高于C组(P＜0.05).2DMH组PRA、AngⅡ、ADS显著高于2DM组(P＜0.05).2DMH组及2DM组ANP显著低于C组(P＜0.05). 结论 新诊断的不伴有高血压的2型糖尿病患者已有血压昼夜节律的紊乱且血清PRA、AngⅡ、ADS已开始升高.     

The integrated concentration of plasma renin activity and aldosterone in essential hypertension

Measurement of the integrated concentration is most suited for the study of blood components that fluctuate rapidly. The integrated concentration of plasma aldosterone (IC-ALDO) and plasma renin activity (IC-PRA) were measured in 24 patients with essential hypertension and in 10 normal adult subjects, using a non-thrombogenic 24-hour constant blood withdrawal system. The integrated concentration of plasma aldosterone in the control subjects was 7.7 +/- 1.8 ng/100 ml (mean +/- 1 SD). Eight hypertensive patients had IC-ALDOs that were more than 3 standard deviations above the mean. Although the mean IC-PRA of the hypertensive patients was lower than the mean of controls (0.6 +/- 0.6 and 0.9 +/- 0.6, respectively), the difference was not significant. However, high integrated concentration of plasma aldosterone was mostly associated with low integrated concentration of plasma renin activity. Consequently, the ratio of IC-ALDO to IC-PRA in the hypertensive patients was significantly higher (p less than 0.001). In six hypertensive patients the ratio was more than 4 standard deviations above the mean for the normal control subjects (12.2 +/- 7.6). Individuals with inappropriately high integrated concentrations of plasma aldosterone can therefore be identified by the simultaneous determination of IC-ALDO and IC-PRA.     

中医体质类型与高血压的相关性研究

目的：研究中医体质类型与原发性高血压的相关性,为体质与疾病相关理论提供流行病学调查依据。方法：汇集我国9省市（江苏、安徽、甘肃、青海、福建、北京、吉林、江西、河南）横断面中医体质调查数据7782例。中医体质调查采用标准化的中医体质量表实施,体质类型（平和质、气虚质、阳虚质、阴虚质、痰湿质、湿热质、血瘀质、气郁质、特禀质）的判定应用判别分析法。采用多元逐步logistic回归分析筛选原发性高血压有意义的主要体质影响因素。结果：控制性别、年龄、婚姻状况、职业、文化程度因素后,多元逐步logistic回归分析模型入选了3个中医体质因素,按影响程度的大小依次为痰湿质、阴虚质和气虚质,其比值比（odds ratio,OR）和959／6可信区间（confidence interval,CI）分别为2．00[1．58,2．553、1．66[1．33,2．083和1．37[1．13,1．66]。以性别分层分析,男性高血压的主要体质影响因素是痰湿质、阴虚质,其0R值和95％C1分别为1．61[1．22,2．14]、1．60[1．17,2．19];女性高血压的主要体质影响因素是痰湿质、阴虚质和气虚质,其OR值和95％C1分别为2．80[1．79,4．39]、1．55[1．13,2．14]和1．39[1．05,1．84],痰湿质对女性高血压的影响更显著。结论：痰湿质、阴虚质和气虚质是原发性高血压的主要体质影响因素,男性和女性高血压的中医体质影响因素不同。     

经皮穿刺球囊二尖瓣成形术前后血浆心钠素、肾素-血管紧张素-醛固酮水平的变化

目的　观察风心病二尖瓣狭窄 (MS)患者经皮穿刺球囊二尖瓣成形术 (PBMV)前后血浆心钠素 (ANF)、肾素 (PRA) -血管紧张素 (AT) -醛固酮 (Ald)系统 (RAAS)以及血液动力学的变化。方法　采用放射免疫分析法 (RIA)测定正常组与MS组PBMV前后血浆ANF和RAAS的水平 ;二尖瓣口面积 (MVA)、平均跨瓣压差 (PGmean)的测定用超声心动图 (UCG) ;平均左房压 (LAP)的测定用心导管法。结果　MS组PBMV术前ANF、PGmean均明显高于正常组 (P <0 .0 0 1) ,MVA低于正常组(P <0 .0 0 1) ,PRA、AT -Ⅱ、Ald与正常组比较无统计学差异 (P >0 .0 5 ) ;PBMV术后ANF、PGmean、LAP均明显降低 (P <0 0 0 1) ,MVA明显扩大 (P <0 .0 0 1) ,PRA、AT -Ⅱ、Ald与术前比较无显著差异 (P >0 .0 5 ) ;ANF水平与PGmean ,LAP成正相关关系 ,(相关系数r分别为 0 .40 ,0 .41,P <0 .0 5 )与MVA呈负相关关系 (r为 - 0 .39,P <0 .0 5 ) ;RAAS水平与ANF水平、血液动力学参数无相关关系。结论　ANF水平变化与血液动力学改善明显相关 ,与RAAS水平无相关关系 ,说明人体内ANF与RAAS的相互联系和相互影响较为复杂 ,可能与心功能不全、血液动力学的异常等因素有关     

高血压病患者的血浆肾素活性与脑钠肽水平及预后的关系

目的：观察具有不同血浆肾素活性的高血压病患者中血清脑钠肽（BNP）水平的差异,并随访12个月内的临床转归情况。方法将845例新发高血压病患者作为研究对象,对同一危险分层的患者根据血浆肾素差异按5分位法分取高肾素组和低肾素组,比较两组血清BNP水平的差异,并随访12个月内心脑血管事件的发生情况。结果低、中危高血压患者中血清肾素水平差异对血浆BNP水平和临床事件的影响甚微;高危患者中肾素活性的差异仅对BNP的影响具有显著性;极高危患者的高肾素组,其血浆BNP浓度和心脑血管事件（心肌梗死、不稳定型心绞痛、心源性猝死、心力衰竭、恶性心律失常、脑卒中）明显高于低肾素组。结论伴高肾素活性的极高危高血压病患者中血浆BNP水平升高,可能参与了高血压的靶器官损害,导致患者更容易发生心脑血管事件。     

开博通、硝苯啶对原发性高血压患者血浆内皮素、肾素─血管紧张素─醛固酮系统的影响

本文对２４例原发性高血压（ＥＨ）患者随机分为应用升博通组及硝苯啶组，各１２例，均进行１４ｄ治疗，探讨这两种药物对血浆内皮素（ＦＴ）、肾素（ＰＲＡ）、皿管紧张素Ⅱ（ＡＴⅡ）及醛固酮（ＡＬＤ）系统、血压和心率的影响。结果表明：ＥＨ患者治疗前血浆ＦＴ、ＰＲＡ、ＡＴⅡ及ＡＬＤ浓度与正常对照组相比差异有显著性意义（Ｐ＜Ｏ．０１和Ｐ＜０．０５）．开博通组治疗后，血浆ＡＴⅡ、ＡＬＤ、血压及心率平均值与治疗前相比差异有显著性意义（Ｐ＜０．０１和Ｐ＜０．０５），ＦＴ和ＰＲＡ差异无显著意义（Ｐ＞０．０５）；硝苯啶组治疗后血浆ＥＴ、血压平均值与治疗前相比差异有极显著性意义（Ｐ＜０．０１）、ＡＴⅡ、ＡＬＤ虽有下降但差异无显著性意义（Ｐ＞０．０５），心率平均值增加（Ｐ＜０．０１）。以上两种药物从不同作用机制影响血管活性物质的皿浆浓度来降低血压，提示将此两种药物联合使用，呵更有效地发挥降压效果。     

Plasma atrial natriuretic factor concentrations in essential and renovascular hypertension

Plasma atrial natriuretic factor concentrations were measured in 44 patients with mild untreated essential hypertension and 48 normotensive controls. Mean venous plasma atrial natriuretic factor concentrations were 13.2 (SEM 1.5) and 13.0 (1.3) ng/l in the hypertensive patients and controls, respectively. Plasma atrial natriuretic factor concentrations were significantly correlated with age in both groups. Plasma atrial natriuretic factor concentrations were also measured during renal vein catheterisation in a group of 15 hypertensive patients; of these, eight had renovascular hypertension, and in all eight cases plasma atrial natriuretic factor concentrations were increased in the aorta and inferior vena cava. It is concluded that mild essential hypertension is not associated with increased plasma atrial natriuretic factor concentrations, whereas an age related increase in concentrations occurs in hypertensive and normotensive people.     

血浆脑利钠肽水平与高血压病患者房颤的发生相关性研究

目的 探讨在心脏收缩功能正常情况下,高血压病患者房颤的发生与血浆脑利钠肽（BNP）水平的相关性。方法 146例心脏收缩功能正常的高血压病患者以发生房颤情况分为窦律、阵发性房颤和永久性房颤三组,进行血浆BNP水平、左房室大小的横断面调查。结果 三组间年龄、血压水平、心脏超声检测左室射血分数、左室大小等能数差异无统计学意义（P〉0．05）;永久房颤组的左房内径大于实窦律组（P〈0．05）,血浆BNP水平高于窦律组（P〈0．01）,而阵发性房颤组血浆BNP虽高于窦律组,但差异无统计学意义（P〉0．05）。结论 心脏收缩功能正常的高血压病患者合并永久性房颤后,BNP水平明显升高,且与左房增大有关。BNP水平是否可为高血压病患者房颤的发生进行危险分层,及与房颤的相互影响机制有待进一步研究。     

高血压患者左房内径改变与动态血压关系的研究

【目的】探讨高血压病左房内径改变与脉压的关系及其影响因素。【方法】入选106例轻中度高血压病患者,监测其24h血压,行超声多谱勒检查并测定左房内径LAD,以LAD1≥3.5cm;LAD2<3.5cm分为年龄匹配的两组,观察组间的脉压、诊所血压、24h平均收缩、舒张压、血压负荷、夜间血压下降率变化及LAD各参数间的相关关系。【结果】左房内径增大组与正常组比较,体重指数存在显著性差异(P<0.01),除脉压(P>0.05)外,动态血压(ABPM)各参数间存在统计学差异(P<0.05)。线性回归分析显示,LAD与LVM、IVST、PWT、CO、EDV、dSBP、24hSBP、cSBP及BMI明显正相关。以标化的左房内径LADI为阴变量,各期脉压、血压及左室结构指标为自变量行多元回归分析,最终进入回归方程的是体重指数、诊室收缩压以及左室舒张末内径,其回归方程为LADI=8.9-0.2BMI-0.2LVD 2.1SBP,R2=59.2%(F:37.8,P<0.001)。【结论】原发性高血压患者左房内径增大更取决于血压水平及血压负荷,与脉压水平关系不明显,高血压肥胖者更易发生左房内径改变。     

冠心病和高血压病患者血浆心钠素的变化

本文检测了正常人9例、冠心病26例、高血压病23例血浆心钠素。冠心病患者中,陈旧性心肌梗塞患者血浆心钠素显著低于正常人和急性心肌梗塞及心绞痛者;左心腔增大、心房纤颤及心力衰竭时血浆心钠素明显降低。高血压病Ⅰ期血浆心钠素高于正常,Ⅱ期与正常组无显著差异,Ⅲ期及左室增大者显著降低。提示:应激状态下心钠素增高,显著增高时可能是心房梗塞的征象;血浆心钠素可作为高血压病分期的一个指标,在一定程度上反应心脏状态。     

原发性高血压患者血清部分血管活性肽的测定及其临床意义

目的 :探讨原发性高血压 (EH)患者血清血管紧张素I(AI)、血管紧张素II(AII)、心钠素(ANF)和醛固酮 (ALD)水平的变化及其临床意义。方法 :应用放射免疫法测定了 70例原发性高血压(EH)患者血清血管紧张素I(AI)、血管紧张素II(AII)、心钠素 (ANF)和醛固酮 (ALD)水平 ,并与 30例非高血压患者进行对照研究。结果 :原发性高血压患者血清AI(2 .2 30± 0 .30 4ug/L)和ALD(142 .98± 14.0 5ng/L)显著高于对照组 (1.2 4 5± 0 .16 6ug/L ,5 4 .2 0± 4 .336ng/L) (t=2 .0 5 96 ,P <0 .0 5 ;t=4 .0 70 3,P <0 .0 1) ,但AII(42 .976± 3.4 5 7ng/Lvs 4 0 .4 97± 3.5 72ng/L)和ANF(0 .4 16 4± 0 .0 2 6 9ug/Lvs 0 .395 7± 0 .0 311ug/L)无显著差异 (P均 >0 .0 5 )。EH患者中 ,I、II、III期组间四者血清水平的方差检验无显著差异(P均 >0 .0 5 ) ,2 9例合并心脑血管并发症者与 4 1例无心脑血管并发症者组间四者也无明显差异 (p均>0 .0 5 ) ;AI与AII、ALD与AII间呈显著正相关 (r=0 .5 13,p <0 .0 1;r=0 .2 70 ,P <0 .0 5 ) ,但AI与ANF、AI与ALD、AII与ANF、ANF与ALD间无显著差异 (r =0 .0 31,r=0 .0 39,r =0 .0 4 4 ,r=0 .115 ;P均 >0 .0 5 ) ;AI、AII、ALD均与平均动脉压呈正相关 (r=0 .4 172 ,0 .4 4 18,0 .5 12 4     

Relation between arterial pressure, dietary sodium intake, and renin system in essential hypertension

Forty-one patients with mild essential hypertension, 36 patients with severe hypertension, and 28 normotensive subjects were studied on a high sodium intake of 350 mmol/day for five days and low sodium intake of 10 mmol/day for five days. The fall in mean arterial pressure on changing from the high-sodium to the low-sodium diet was 0.7 +/- 1.7 mm Hg in normotensive subjects, 8 +/- 1.4 mm Hg in patients with mild hypertension, and 14.5 +/- 1.4 mm Hg in patients with severe hypertension. The fall in blood pressure was not correlated with age. Highly significant correlations were obtained for all subjects between the ratio of the fall in mean arterial pressure to the fall in urinary sodium excretion on changing from a high- to a low-sodium diet and (a) the level of supine blood pressure on normal diet, (b) the rise in plasma renin activity, and (c) the rise in plasma aldosterone. In patients with essential hypertension the blood pressure is sensitive to alterations in sodium intake. This may be partly due to some change either produced by or associated directly with the hypertension. A decreased responsiveness of the renin-angiotensin-aldosterone system shown in the patients with essential hypertension could partly account for the results.     

Relation between endoscopy, radionucleotide scintigraphy and traditional Chinese medicine in 39 patients with reflux esophagitis

Histological biopsy and radionucleotide scintigraphy (RNS) were carried out in 39 patients with symptoms and esophagoscopy evidence of gastroesophageal reflux disease. The detective rates were 74% and 79% respectively. The mechanism were discussed. There was no correlation between histological changes, RNS and clinical TCM types based on the theory of TCM.     

Effects of atrial natriuretic factor on patients with renovascular hypertension.

Previous studies have shown the effects of atrial natriuretic factor (ANF) on rats with renovascular hypertension (RVH). In the present study low dose alpha-hANF (0.025 microgram/kg/min) was administered intravenously for 60 minutes to seven RVH patients. Results demonstrated an inhibition of renin-angiotensin-aldosterone system (RAAS), reduction of plasma catecholamine and arginine vasopressin(AVP), diuresis and natriuresis, increase of hematocrit and creatinine clearance, and slight decrease of blood pressure. These results showed that most factors involved in the establishment and maintenance of RVH are affected by ANF infusion.