原发性醛固酮增多症心血管事件相关代谢指标研究

目的:探讨原发性醛固酮增多症(PA)患者心血管事件相关代谢指标的特征。方法:收集2008-2012年在我院初诊经手术病理确诊的PA 63例及原发性高血压(EH)58例患者的临床资料,比较两组代谢指标及主要心血管事件发生的差异。结果:(1)除性别构成比(男/女),两组的年龄、体质指数(BMI)、收缩压、舒张压、病程差异无统计学意义(P>0.05)。(2)PA组胰岛素释放试验(IRT)的0、2 h胰岛素低于EH组(P<0.01),两组的糖代谢异常、合并代谢综合征(MS)、糖化血红蛋白和IRT 1、3 h的胰岛素水平差异无统计学意义(P>0.05)。PA组血总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)及血清尿酸(SUA)低于EH组(P<0.01)。(3)PA组主要心血管事件发生率17.5%,EH组为15.5%,差异无统计学意义(P>0.05)。结论:与EH患者相比,PA患者的代谢紊乱、心血管事件发生情况无明显差异,可能与PA的早期筛查、诊断有关。     

清醒脑外伤醛固酮系统变化及护理

目的：探讨清醒脑外伤病伯醛固酮系统变化及对临床护理的指导意义。方法：用放射免疫法检测３０例清醒脑外伤病人受伤２４ｈ内外周血肾素、血管紧张素、醛固酮系统（ＲＡＡＳ）。结果：发现肾素（Ｒｅｎｉｎ）、血管紧张素Ⅰ（ＡＴ－Ⅰ）、血管紧张素Ⅱ（ＡＴ－Ⅱ）、醛固酮（ＡＬＤＷ）值显著下降，通过分级心理护理辅助治疗，在第７天再次检测时虽也呈显著下降，但同第一生比较，降ＡＴ－Ⅱ外，其余均有所上升，趋向于生理平衡。结     

温泉水疗对心血管系统的影响

温泉水疗作为历史悠久的治疗方法,在众多国家的康复保健领域中得到了广泛应用,而人体浸浴在温泉水中,水温、水压、体位等众多因素都对人体的心血管系统产生一定的影响,在获得温泉水疗治疗益处的同时也不乏有急性心脑血管疾病突发带来的猝死病例的发生。随着国内外卫生领域的不断发展及对温泉水疗研究的不断重视,相关领域的学者在这一方面取得了不少的研究进展,文章主要对国内外近年来在温泉水疗对心血管系统影响领域的研究成果进行了初步的汇总和探讨。     

心血管系统念珠菌病的抗真菌治疗

心血管系统的念珠菌病主要为念珠菌心内膜炎,其他尚有念珠菌心包炎、心肌炎、化脓性血栓性静脉炎等.念珠菌心内膜炎发生率低,占感染性心内膜炎的1.2%(33/2 749)[1],念珠菌心包炎等其他感染少见.念珠菌心内膜炎的病死率高,其发生率近年来有上升趋势.治疗措施包括抗真菌治疗以及瓣膜置换或其他外科干预.     

我国心血管系统放射学的回顾与展望

心血管系统从普通放射诊断起步 ,先后开展了Ｘ线平片、心血管造影、ＤＳＡ、ＣＴ(包括螺旋ＣＴ、多层螺旋ＣＴ、电子束ＣＴ)、磁共振等心血管影像学及介入性放射学技术 ,并取得了长足的进步。值此“中国医学影像技术杂志”出版发行 10 0期纪念活动之际 ,将我国心血管系统放射学 (不含磁共振 )的发展作一简要回顾与展望。1　普通Ｘ线(1)透视 :5 0年代至 70年代为普通透视 ,80年代至今为影像增强透视。由于该方法简便经济 ,可以即时从不同角度观察心肺病变的概况等 ,在早期透视作为心血管放射学的主要诊断手段之一 ,对心血管疾病的初步诊断起…     

醛固酮与肺纤维化

肺间质纤维化是一组以肺间质弥漫性渗出、浸润和纤维化为主要病变的疾病，其发病机制尚不完全明确。目前认为转化生长因子β(TGF-β)过表达、氧化／抗氧化失衡、Th1／Th2细胞因子平衡失调、凝血纤溶障碍等多种因素与其发病有关。近年来醛固酮在心肌、肾纤维化发病机制中的作用逐渐引起重视，但在肺纤维化中的作用研究较少。现就近几年醛固酮与肺纤维化的研究进展做一综述。     

血液透析回血速度对患者心血管系统的影响

目的探讨血液透析回血速度对患者心血管系统的影响。方法采用不同回血速度对36例维持性血透患者进行165例次血液透析治疗，观察患者心率、血压及自觉症状情况。结果150ml／min回血速度对患者心血管系统有一定影响（P〈0．001），100—120ml／min回血速度较为安全。结论维持性血液透析患者心血管并发症较多，正确适当的回血速度对减少并发症的发生，提高透析质量至关重要。     

心血管系统引起运动疲劳的假说与讨论

目的：运动疲劳是运动训练过程的一个重要的问题，但对于运动疲劳产生的原因以及其中的相关机制的研究仍存在许多争议，并且存在许多假说。为此，探讨心血管系统与运动疲劳的关系。 资料来源：应用计算机检索www．Ovid．com数据库和http：／／www．ncbi．nlm．nih．gov网站，1996-01—2005-11期间的相关文章，检索词为：“cardiovascular，fatigue，exercise，prolong”，限定文章语言种类为英文。 资料选择：在检索316篇文献中，选择长时间运动与心血管系统，长时间运动疲劳与心血管系统，代谢物的堆积与心血管系统等文献124篇。 资料提炼：在124篇文献中，删除31篇重复文献；对93篇文献进行分类整理，其中18篇文献作为参考文献。 资料综合：①心血管系统引起的运动疲劳假说：主要内容是运动过程中，心脏提供的血流量，已满足不了工作肌肉对氧和营养物质及运走过多代谢产物的需求。②这一学说。受到相关的实验支持：心输出量和氧利用率持续增加可导致肌肉的工作能力提高。③心输出量：高水平的耐力运动的左室舒张末期内径及舒张末期室间隔的厚度显著大于无训练者（P〈0．05）。④红细胞含量及血容量：长期的运动训练可以诱导红细胞的含量及血容量增加。⑤肌肉组织内血流量的阻力：机体的血流动力学的变化，被认为是引起运动疲劳的重要因素。⑥运动时氧利用率及代谢产物的堆积可能影响运动能力，并且与运动疲劳相关。 结论：①引起运动疲劳是多种生物学因素共同作用的结果。②运动时，心血管系统的对工作肌肉供氧能力及运走相关的代谢产物能力可能是引起运动疲劳的一个因素，但目前对其中的一些变化的确切机制并不清楚。     

心肌梗死后重构与肾素血管紧张素醛固酮系统

随着人民生活水平的提高 ,心肌梗死的发生率越来越高 ,由于心肌梗死后早期普遍发生心室重构 ,很多患者进展为心力衰竭 ,有很高的心血管事件发生率。随着对心室重构研究的深入 ,人们发现肾素血管紧张素醛固酮系统 (RAS)是重构的罪魁祸首 ,笔者就心肌梗死后重构与RAS系统的关系做一综述。1　什么是重构重构是心脏对损伤的基本反应 ,心室重构是指心肌损伤后由基因组表达改变引起的分子、细胞和间质的改变 ,分子改变表现为白介素、基质金属蛋白酶和生长因子等的表达增加 ,细胞的改变包括心肌细胞的肥大、调亡和纤维母细胞的增殖等 ,间质的改…     

醛固酮实验室检测及其标准化

醛固酮是原发性醛固酮增多症的重要筛查、诊断指标。目前国内外醛固酮实验室检测方法分为2大类:免疫法与质谱法。免疫法包括放射免疫分析法(RIA)与化学发光免疫分析法(CLIA),是当前醛固酮临床检测的主要方法,局限于抗体特异性,免疫法易受交叉反应干扰。质谱法具有高灵敏、高特异的特点,被视为小分子激素类检测"金标准",但前期成本高昂、技术人才要求高,目前醛固酮临床常规质谱检测仍处于初期阶段。免疫法检测醛固酮时不同检测系统间检测结果存在差异,且免疫法与质谱法检测醛固酮结果可比性不佳,准确测定醛固酮并推动醛固酮结果一致可比,是实验室辅助筛查、诊断原发性醛固酮增多症时急需解决的问题,解决该问题有赖于醛固酮测定标准化。目前醛固酮参考溯源体系不完整,缺乏同位素稀释液相色谱串联质谱法(ID-LC/MS/MS)参考测量程序、参考物质与完善的质量保证项目。灵敏、准确的ID-LC/MS/MS能有效降低或避免交叉反应干扰,基于此技术建立参考方法,研制参考物质,完善醛固酮参考溯源体系,有望为临床醛固酮检测提供溯源参考,推进临床醛固酮测定标准化。     

长托宁或东莨菪碱用于颈丛麻醉时对心血管不良反应的影响

目的观察对比长托宁和东莨菪碱作为术前用药分别用于颈丛麻醉时对心血管不良反应的影响。方法 60例颈丛麻醉患者随机分为氯化钠溶液组（A组,n=20）、东莨菪碱组（B组,n=20）、长托宁组（C组,n=20）,麻醉前15 min A组静脉注射氯化钠溶液1 ml,B组静脉注射东莨菪碱0.3 mg（1 ml）,C组静脉注射长托宁0.5mg（1 ml）。以0.447%甲磺酸罗哌卡因＋1%利多卡因混合液行双侧颈浅丛和一侧颈深丛神经阻滞,连续监测并记录麻醉前15 min及麻醉后5、10、15、20 min时心率（HR）、收缩压（SBP）、舒张压（DBP）变化。结果 A组麻醉后各时间点HR、SBP、DBP与麻醉前15 min比较差异有统计学意义（P〈0.05）;B组麻醉后大部分时间点HR、SBP、DBP与C组比较差异有统计学意义（P〈0.05）;A、B两组麻醉后各时间点HR较麻醉前15 min均有差异（P〈0.05）。C组麻醉后各时间点HR与麻醉前15 min比较差异无统计学意义（P〉0.05）,与A组比较麻醉后各时间点HR、SBP、DBP与麻醉前15 min比较差异有统计学意义（P〈0.01）。结论长托宁能够有效地预防颈丛麻醉导致的心血管不良反应,较东莨菪碱更适合于作为颈丛麻醉的术前用药。     

Impact of Arterial Stiffness on Adverse Cardiovascular Outcomes and Mortality in Peritoneal Dialysis Patients

♦ Background: Cardiovascular (CV) disease is a major cause of morbidity and mortality in patients with end-stage renal disease. In recent years, arterial stiffness has taken on great importance in the pathophysiology of CV diseases. The independent predictive value of arterial stiffness for CV events and for all-cause and CV mortality has been demonstrated in the general population and in hemodialysis patients. Our aim in this study was to determine the relationship of arterial stiffness with mortality and fatal and nonfatal CV events in peritoneal dialysis (PD) patients.♦ Methods: In this prospective observational cohort study with 2 years of follow-up, we studied a cohort of 156 PD patients with a mean follow-up of 19.2 ± 6.4 months. At baseline, echocardiography and standard clinical and biochemical analyses were performed in all patients and in 28 healthy subjects. Aortic stiffness index beta (ASIβ, a surrogate marker of arterial stiffness) was calculated as follows: ♦ Results: During the follow-up period, 25 of the patients (16.0%) died, and 10 of those deaths had CV causes. Nonfatal CV events occurred in 15 patients. The median ASIβ was greater in PD patients than in control subjects (4.2 vs. 3.5; interquartile range: 3.2 – 5.5 vs. 2.5 – 4.8; p = 0.028]. In the fully adjusted multivariate Cox regression analysis (co-variates: age, sex, albumin, hemoglobin, diabetes mellitus, comorbid CV disease, left ventricular mass index, residual glomerular filtration rate, dialysate-to-plasma ratio of creatinine, Kt/V urea, left ventricular ejection fraction, duration of dialysis, smoking), ASIβ independently predicted fatal and nonfatal CV events (hazard ratio: 1.239; 95% confidence interval: 1.103 to 1.392), but not all-cause mortality.♦ Conclusions: Our results provide the first direct evidence that arterial stiffness is an independent risk predictor of adverse CV outcome in PD patients.     

厄贝沙坦对非杓型高血压患者昼夜节律的干预作用及血醛固酮水平的影响

目的:观察厄贝沙坦治疗非杓型高血压患者降压效果及其杓型血压昼夜节律恢复情况,并观察治疗后血浆醛固酮水平的影响。方法:对杓型和非杓型两组原发性高血压患者分别给予150-300 mg/d,观察降压效果及对血压昼夜节律的影响,并监测用药前后血浆醛固酮水平的变化。结果:所有高血压患者应用厄贝沙坦治疗前后收缩压及舒张压均有不同程度的下降,非杓型组夜间收缩压及舒张压的下降值与杓型相比有统计学差异,出现了明显的昼夜节律,血浆醛固酮水平出现了明显差异。结论:厄贝沙坦对非杓型高血压患者有良好的降压作用,并能恢复非杓型高血压患者的昼夜节律,向杓型血压变化。     

Aldosterone receptor antagonism and heart failure: insights from an outpatient clinic

Objective:  In randomized clinical trials, aldosterone antagonists have been shown to reduce mortality and morbidity in heart failure (HF). The aim of the present study was to examine the risk-benefit profile of aldosterone antagonists in routine clinical practice.
Methods:  A retrospective analysis, extending over a 1-year period, of the clinical, instrumental and laboratory data of 264 HF outpatients was performed. All patients were on a β-blocker and an ACE-inhibitor (or angiotensin-II receptor-blocker) and 151 were taking an aldosterone antagonist.
Results:  At baseline, subjects treated with aldosterone antagonists had a higher NYHA class, a larger left-ventricular end-diastolic volume, a worse ejection fraction and a higher systolic pulmonary arterial pressure (sPAP). During follow-up, a greater reduction in sPAP and a tendency towards improved systolic and diastolic function were observed in subjects treated with aldosterone antagonists. Moreover, clinical and laboratory parameters did not deteriorate in patients taking aldosterone antagonists. Mortality rates were similar in the two groups (8·6% vs. 8·8%, P  = NS).
Conclusions:  The use of aldosterone antagonists in HF is associated with an improvement in cardiac function and is well tolerated. In the present study, patients administered these agents had a comparable clinical outcome to that of the control group, despite important differences in baseline risk.     

A Decrease in Serum Aldosterone Level is Associated with Maintenance of Sinus Rhythm after Successful Cardioversion of Atrial Fibrillation

Background: The activation of the renin–angiotensin–aldosterone system has been implicated in the progression of atrial structural remodeling during atrial fibrillation (AF). However, consequences of the changes of aldosterone in AF have not been evaluated. Objectives: This study's aim was to evaluate changes of serum aldosterone concentration after successful cardioversion of persistent AF and to determine the prognostic value of these changes. Methods: The prospective, single center study included 45 consecutive patients with nonvalvular persistent AF and preserved left ventricular systolic function, referred for cardioversion. None of the patients were taking aldosterone antagonists. Blood samples for aldosterone measurement were collected twice: 24 hours before and 24 hours after cardioversion. Results: Forty‐three patients were successfully converted to sinus rhythm. On the 30th day following cardioversion, 24 patients maintained sinus rhythm (group A), 19 patients relapsed to AF (group B). Serum aldosterone concentration before cardioversion did not differ significantly between both groups (175.6 ± 112.82 pg/mL vs 125.8 ± 51.2 pg/mL; P = 0.25). However, in group A serum aldosterone level decreased significantly within 24 hours after cardioversion, from 175.6 ± 112.8 pg/mL to 101.4 ± 44.2 pg/mL (P = 0.0034). In group B, the aldosterone level before and after cardioversion did not differ significantly (125.8 ± 51.2 pg/mL vs 118.2 ± 59.6 pg/mL; P = 0.68). Logistic regression analysis revealed that a decrease in plasma aldosterone concentration after direct current cardioversion more than 13.2 pg/mL predicted sinus rhythm maintenance in a 30‐day follow‐up, with 87% sensitivity and 64% specificity. Conclusions: There is a positive correlation between the fall in aldosterone concentration 24 hours after cardioversion and maintenance of sinus rhythm during 30 days of observation. (PACE 2010; 561–565)     

经皮穿刺脊椎成形术中聚甲基丙烯酸甲酯对心血管系统的影响

目的:评估经皮穿刺脊椎成形术(PVP)中注射聚甲基丙烯酸甲酯(PMMA)对患者心血管系统的影响。方法:对48例实施PVP患者分别于术前、PMMA注射过程中、注射后监测平均动脉压(MAP)、心率、脉搏及脉搏氧饱和度(SpO2),并应用多元回归模型分析心血管系统变化及与并发症的关联性。结果:MAP在PMMA注射中、注射后5 min、10 min分别为94.0 mmHg、97.3 mmHg和97.5 mmHg,与注射前(92.2 mmHg)比较差异无统计学意义(P=0.19,0.23,0.24);心率在注射中、注射后5 min、10 min平均分别为80.5/min、80.4/min和80.0/min,与注射前(80.5/min)比较差异无统计学意义(P=0.71,0.92,0.65);SpO2在注射中、注射后5 min、10 min分别为98.0%、98.0%和97.4%,与注射前(98.0%)比较差异无统计学意义(P=0.80,0.89);SpO2的4个最低值出现在注射后10 min,与注射前比较,差异具有统计学意义(P=0.007),但SpO2平均值与注射前比较差异无统计学意义(P>0.05)。PVP中PMMA的注射与机体心血管变化无显著性关联。结论:PVP中注射PMMA安全,对心血管无明显影响。     

PBL与LBL相结合的教学法在心血管系统解剖教学中的运用

目的探讨LBL教学法、PBL教学法、PBL与LBL相结合的教学法等三种教学法在心血管系统解剖教学中运用的教学效果。方法将南通大学临床医学专业本科2009级9个班随机分成LBL教学法、PBL教学法和PBL与LBL相结合教学法3组,每组各3个班共90人。采用问卷调查及考试测评的方法评估3种不同教学方法的教学效果。结果 LBL组学生的客观题测试成绩较好,而病例分析题成绩较差。PBL组学生的客观题测试成绩较差,而病例分析题成绩较好。PBL与LBL相结合组学生在客观题和病例分析题成绩两方面都较好。问卷调查结果显示,PBL教学法、PBL与LBL相结合的教学法都能提高学生的沟通能力、学习积极性、综合分析能力和语言表达能力等。结论 PBL与LBL相结合的教学法不仅增强了学生对课本内容的记忆,而且使学生能将所学知识灵活运用到临床病例分析中,学生的综合素质也得到一定的提高。     

Aldosterone in primary hypertension relationship to plasma renin activity and urinary electrolytes and a comparison with normotensive subjects

Plasma aldosterone (PA) and urinary aldosterone (Aldo-U) concentrations were studied in 123 patients with primary (essential) hypertension during basal (1 h supine rest), upright and frusemide (80 mg orally) stimulated conditions, and were related to urinary sodium and potassium excretions, supine and sitting blood pressure (BP) and the relationship to plasma renin activity (PRA). As controls, 120 normotensive subjects, matched for age and sex, were investigated identically during strictly defined out-patient conditions. No differences regarding the different mean PA levels, urinary electrolyte excretion or the urinary sodium: potassium ratio were observed between the hypertensive and the normotensive populations. However, the hypertensive subjects had significantly higher mean Aldo-U excretions than the controls. Correlations between PA and the corresponding PRA were consistently significant in the normotensive control group but weak to non-existent in the hypertensive subjects. No relationships at all could be found between the different PRA and Aldo-U values in the hypertensive population but significant correlations were noted in the control group. These findings point to a disturbed function of the renin-angiotensin-aldosterone (RAA) system even in primary hypertension.