室性心动过速的昼夜规律

通过分析动态心电图室性心动过速(室速)的出现时相,发现室速有明显的昼夜规律,日间多于夜间。但3～5搏的室速与5搏以上的室速昼夜规律不同,前者高峰在11～15时之间,而后者高峰在9～11时。清醒时3～5搏室速多于睡眠时,而5搏以上室速无显著差异。     

老年高血压患者血压昼夜节律与颈动脉粥样硬化的相关性研究

目的探讨老年高血压患者血压昼夜节律与颈动脉粥样硬化的相关性。方法2003￣2004年来我院老年高血压患者共72例(男68例女4例),根据动态血压监测(ABPM)结果分为正常昼夜节律组,即杓型组(n=37,男35例女2例)和异常昼夜节律组,即非杓型组(n=35,男33例女2例)。对所有患者均行颈动脉超声检查,测定右侧颈总动脉(RCCA)、颈内动脉(RICA)内膜中层厚度(IMT)、管腔内径(D),并计算各自的IMT/D值,测定右侧颈动脉分叉处(RBIF)的IMT,观察并记录双侧颈动脉系统斑块的大小、数量。结果(1)两组年龄(Age)、体重指数(BMI)、总胆固醇(TC)、甘油三酯(TG)、全天平均收缩压(24hMSP)、全天平均舒张压(24hMDP)比较均无显著性差异(P>0.05)。(2)两组的RCCA及RICA的IMT、D、IMT/D比较均无显著性差异(P>0.05)。而右颈动脉分叉处IMT,非杓型组明显高于杓型组(P<0.001)。(3)两组总斑块检出率无显著差异,但多发性斑块检出率非杓型组显著高于杓型组(P<0.05)。结论老年高血压患者血压昼夜节律与颈动脉粥样硬化明显相关,异常的血压昼夜节律提示可能存在更严重的靶器官损害。     

COMPARISON OF THE EFFECTS OF AMLODIPINE AND LOSARTAN ON 24-HOUR AMBULATORY BLOOD PRESSURE IN HYPERTENSIVE PATIENTS

Effects of amlodipine (AML), a long-acting calcium antagonist, and losartan (LOS), an angiotensin II receptor antagonist, on 24-hr blood pressure profile were compared in 15 patients with essential hypertension. After 4 weeks of placebo period, the patients were treated with AML or LOS in a random cross-over design for 12–16 weeks each. Either drug was given once daily at 0800 and the doses were titrated so that the office blood pressure was reduced lower than 140/90 mmHg. At the end of each period, 24-hr blood pressure was monitored. Average office blood pressure was lowered from 158 ± 2/ 98 ± 2 mmHg to 134 ± 1/87 ± 1 mmHg by AML and 134 ± 2/88 ± 1 mmHg by LOS. Average 24-hr blood pressure was also reduced from 144 ± 3/ 92 ± 2 mmHg to 131 ± 2/84 ± 2 mmHg by AML and 135 ± 3/85 ± 2 mmHg by LOS. The averaged 24-hr systolic blood pressure was significantly lower in AML than in LOS (p < 0.05). Then, the 24-hr blood pressure was analyzed for four segments; morning (0530–0900 h), daytime (0930–1800 h), evening (1830–2300 h) and night (2330–0500 h). Although the daytime blood pressure was comparable between AML and LOS, systolic blood pressure in the evening and morning hours were lower in AML than in LOS (133 ± 2 vs. 138 ± 3 mmHg, p < 0.01; 129 ± 3 vs. 134 ± 4, p < 0.05). Trough to peak ratio of antihypertensive effect on systolic blood pressure was significantly greater in AML than in LOS (62 ± 5% vs. 55 ± 4%, p < 0.05). Either drug did not cause reflective increase in pulse rate over 24 hours. These results suggest that both AML and LOS are equally effective in lowering daytime blood pressure without eliciting reflex tachycardia, however, the antihypertensive effect of AML lasts longer than that of LOS. Such information seems important to achieve 24-hr blood pressure control using these drugs.     

原发性高血压患者血压昼夜节律与细胞因子的相关性研究

目的观察昼夜血压呈杓型、非杓型分布的高血压病患者血浆中细胞因子的变化,探讨细胞因子与血压昼夜节律的相关性。方法经动态血压监测将84例高血压病患者分为杓型组35例,非杓型组49例,采用双抗体夹心ELISA法分别测定血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、γ-干扰素(IFN-γ),可溶性白细胞介素-2受体(sIL-2R)水平。结果非杓型组与杓型组比较,IL-6、TNF-α、sIL-2R明显升高(P<0.001;P<0.001;P<0.001),IFN-γ明显降低(P<0.01);夜间血压下降与IL-6、TNF-α、sIL-2R负相关[收缩压(SBP)与IL-6:r=-0.347,P<0.01;SBP与TNF-α:r=-0.427,P<0.005;SBP与sIL-2r:r=-0.309,P<0.01;舒张压(DBP)与IL-6:r=-0.292,P<0.05;DBP与TNF-α:r=-0.462,P<0.005;DBP与sIL-2R:r=-0.278,P<0.05];夜间血压下降与IFN-γ正相关(SBP与IFN-γ:r=0.263,P<0.05;DBP与IFN-γ:r=0.241,P<0.05)。多元线性回归分析,IL-6、TNF-α、sIL-2R与夜间血压下降直线相关(SBP:F=6.742,P<0.005;DBP:F=6.138,P<0.005)。结论血压昼夜节律异常的高血压病患者存在细胞因子水平升高,细胞因子可能参与血压昼夜节律的调节。     

老年高血压肾素水平与靶器官损害的相关分析

目的分析老年高血压的血浆肾素水平特点及与靶器官损害的关系。方法采用回顾性研究方法,对老年高血压的血浆肾素水平及靶器官损害进行分析。结果1、老年组在PRA(激发)上要低于非老年组(P<0.05)。2、老年高血压高肾素组在左室肥厚上的比例要明显高于低肾素组(P<0.05)。结论老年高血压的肾素水平要低于非老年组;老年高血压患者的高肾素组在左室肥厚上的比例要明显高于低肾素组。     

EFFECTS OF ALCOHOL CONSUMPTION AND RESTRICTION ON HOME BLOOD PRESSURE IN HYPERTENSIVE PATIENTS: SERIAL CHANGES IN THE MORNING AND EVENING RECORDS

To study the time course of alcohol effects on blood pressure (BP), we examined morning and late evening home BP for 4 weeks in a regular alcohol consumption period and for 4 weeks in a alcohol restriction period in 30 Japanese men with essential hypertension (52 ± 2 years, m ± SE) in a randomized crossover study. Mean daily intake of alcohol were 66.5 ± 4.7 and 10.2 ± 1.9 ml, respectively. At the end of the regular alcohol period, morning BP had increased by 4.4 ± 1.1/2.9 ± 0.8 mmHg but evening BP had decreased by 7.4 ± 1.9/5.7 ± 1.7 mmHg. The depressor effect of alcohol on the evening BP was evident from day 1 to week 4, while the pressor effect on the morning BP was significant from week 2 regardless of the order of the two periods. These results confirm the biphasic effect of alcohol on BP, and suggest that the status of alcohol intake may markedly influence the morning–evening BP difference.     

高血压病患者心电图缺血样发作与室性心律失常

本文报告１０３例无冠心病临床表现的高血压患者ＳＴ段压低与室性心律失常及心脏昼夜节律变化的关系。结果表明，在高血压病患者Ｈｏｌｔｅｒ监测示心电图ＳＴ段压低呈缺血样改变者占３０．１％。通过有无ＳＴ段压低改变两组比较，发现有ＳＴ段压低组室性心律失常发生率比较高，并且ＳＴ段压低和室性心律失常的存在似与心脏昼夜节律变化有关。     

吲达帕胺、卡托普利对高血压病患者尿白蛋白的影响

观察了４０例高血压病患者服吲达帕胺（ｉｎｄａｐａｍｉｄｅ）或卡托普利（ｃａｐｔｏｐｒｉｌ）８周前后尿液中白蛋白、血清肌酐及血尿素氮的变化。结果：两组降压效果相似，尿白蛋白均显著减少（Ｐ＜０．０１）；血清肌酐、白尿素氮无明显变化。结果表明，吲达帕胺、卡托普利均能减少尿白蛋白的排泄，对肾脏有保护作用。     

当归对正常及肝硬化犬门脉血液动力学的影响

研究当归对正常（ｎ＝６）和慢性胆管结扎肝硬化犬（ｎ＝８）的全身和门脉血液动力学的影响。结果表明，给正常及肝硬化犬静滴当归注射液（８０ｍｇ／ｋｇ／ｍｉｎ），可以明显降低正常犬ＭＡＰ（１９．４５：１７．３４ｋＰａ，Ｐ＜０．０２），对ＨＲ和ＩＶＣＰ没有影响，但肝硬化犬ＭＡＰ、ＨＲ和ＩＶＣＰ均没有明显变化。相反，应用当归注射液后肝硬化犬ＷＨＶＰ（２．４２±０．８０：１．７９±０．７６ｋＰａ，Ｐ＜００１）、ＨＶＰＧ（１．６９±０．７０：１．０６±０．６８ｋＰａ，Ｐ＜００１）、Ｐｐｖ（２．５０±０．７９：１．８１±０．７４ｋＰａ，Ｐ＜０．００１）和Ｒｐｖ（０．８９±０．４８：０．５８±０．４０ｋＰａ·Ｓ／Ｌ，Ｐ＜００１）显著下降，但Ｑｐｖ、ＱＨＡ和ＱＴＬ治疗前后基本保持稳定。研究证明，当归注射液是一种治疗门脉高压的安全有效药物。     

大鼠急性坏死性胰腺炎合并肾损害及前列环素的保护作用

制作大鼠急性坏死性胰腺炎（ＡＮＰ）模型，观察肾组织学、肾功能的变化及前列环素（ＰＧＩ２）的影响。结果发现，ＡＮＰ模型制作后４８小时，肾组织出现严重的损害，肾功能明显下降，肾静脉血６－酮－ｐＧＦ１α／ＴＸＢ２比值、肾血流量及肾组织灌流量均明显下降。给予外源性ｐＧＩ２能明显增加６－酮－ｐＧＦ１α／ＶＴＸＢ２比值，增加肾血流量及肾组织灌流量，减轻肾组织学改变，改善肾功能。     

EFFECTS OF GENDER AND AGE ON THE CARDIAC BARORECEPTOR REFLEX IN HYPERTENSION

The present study examined whether alterations in the cardiac baroreceptor reflex in hypertension may be a function of constitutional differences associated with gender and age. These hypotheses were tested using a cross-sectional design that compared 20 normotensive and 21 hypertensive men and women of varying age for differences in baroreceptor reflex sensitivity and response latency for heart rate, obtained using a modified bolus phenylephrine (Oxford) method.

Relative to their respective normotensive controls, baroreceptor reflex sensitivity was reduced in hypertensive men, but not in hypertensive women. Among normotensive subjects, men had greater baroreceptor reflex sensitivity than women. Independent from the effects associated with differences in blood pressure, age was not a significant predictor of reduction in baroreceptor reflex sensitivity. However, a combination of high blood pressure and older age was associated with a significant increase in baroreceptor reflex response time. In summary, gender and aging interacted with hypertension to alter two different aspects of the baroreceptor reflex. These results provide a preliminary indication that a decline in arterial baroreflex sensitivity may be more specific to hypertension in men than in women. Prolongation in baroreflex response latency in older hypertensive subjects also suggested that aging and hypertension may have a synergistic effect on cardiac parasympathetic function.     

高钾饮食对两肾—夹型高血压大鼠血压、肾小球和肾、脾小动脉的影响

用两肾一夹型高血压Wistar大鼠模型观察了高钾饮食对血压、肾小球、肾小管和肾、脾细动脉及小动脉的影响。与普通饮食喂养的高血压大鼠相比,高钾饮食组大鼠血压升高的幅度明显降低(P<0.01),肾小球纤维化和蛋白管型显著减少(P<0.05),高钾组动脉血压的变化与肾细动脉相对内径呈中度负相关(r=-0.575)。提示高钾饮食能抑制两肾一夹型高血压大鼠的血压升高,对肾小球及小脉动有一定的保护作用。