偏头痛的诱发因素及其预防

偏头痛是一种常见病,其发生的确切机理仍不十分清楚。已知有许多诱发因素可引起本病急性发作,现将这些诱发因素及偏头痛发作的机理和预防综述于下。一、气候变化不论何地,湿热的天气均可诱发偏头痛发作。如我国南方内陆地区春天促发头痛率居四季之首,为46.3%;北方内陆地区夏季促发头痛率占全年四季的55.3%。因为中国南方内陆春季雾雨连绵,偏于湿暖,北方夏末才出现炎热阴雨天气。云贵地区促发头痛无明显季节性,与该地区“冬无严寒,夏无酷暑”的规律相一致。这是因为湿热的气候容易使人情绪波动、烦躁、食欲减退等,可引起植物     

老年人谵妄的识别与处理

谵妄是老年人中常见的问题,与不良预后有关,对老年人的健康影响较大.通过介绍谵妄的临床相关内容,包括概念、流行病学、诊断,尤其是谵妄的危险、促发因素及其预防和治疗,以引起临床医生的重视.     

45岁以上致死疾病促发因素的调查研究

某些精神或心理因素可以促使疾病的发生,发作或加重,增加死亡率。我们将这些因素定名为促发因素。已经调查出的促发因素分为:情绪激动或精神创伤、压抑心理状态、过劳、酗洒与基他五大类。本文据50例调查,对促发因素增加死亡率的机制加以讨论,提出预防的措施。     

青年急性心肌梗死患者危险因素和促发因素的临床分析

目的:结合新近发现的冠心病危险因素,总结青年人急性心肌梗死(AMI)的临床特点,并探讨其早发心肌梗死的可能机制。方法:回顾性对照分析青年组(≤40岁)和非青年组(≥50岁)AMI患者的危险因素和促发因素的分布及聚集状况,并行冠状动脉造影检查。结果:2组患者危险因素分布存在差异,青年组吸烟及家族史阳性率明显高于非青年组,新的危险因素中,青年组同型半胱氨酸(HCY)明显低于非青年组(P<0.05);青年组危险因素聚集率并不比非青年组高,但其发生AMI前多有明确的促发因素,且促发因素有聚集倾向。结论:青年人早发AMI可能与促发因素聚集有关,多种促发因素同时存在通过心肌缺血叠加效应导致动脉粥样硬化(AS)患者和非AS患者发生AMI。     

高血压危象的诊断和治疗现状

高血压是以体循环动脉血压升高为主的综合征，许多慢性疾病都会导致高血压。各种因素促发血压急剧升高，均可引起靶器官急性损害及其功能障碍，是导致心、脑、肾脏疾病和死亡的主要危险因素。本文主要综述高血压危象诊断和治疗的研究进展。     

椎动脉发育不良与后循环缺血性卒中

椎动脉发育不良是椎动脉的一种常见变异类型.关于椎动脉发育不良与后循环缺血性卒中的关系,目前尚无统一定论.现有的证据提示,椎动脉发育不良可能是后循环缺血性卒中的促发因素,尤其是在并存其他血管危险因素的情况下.文章阐述了椎动脉发育不良的流行病学、椎动脉发育不良患者后循环缺血性卒中的临床表现和影像学特点以及椎动脉发育不良引起后循环缺血性卒中的可能机制.     

肠道细菌易位与消化道疾病

十余年动物和临床研究证明:肠粘膜屏障功能障碍、肠道细菌微生态平衡的破坏及机体免疫功能的损害是导致肠道细菌易位的三个基本要素。然而,哪些疾病及不利因素可引起上述病理变化而促发肠道细菌易位,这是十余年来研究最多的课题。本文就消化道疾病促发肠道细菌易位研究作一概要综述。     

癫痫持续状态的抢救

癫痫持续状态或称癫痫状态 (statusepilepticus)。系统频繁而持久的癫痫发作所形成的一种固定的癫痫状态而言。包括癫痫连续多次发作 ,发作间期意识不清或一次发作持续在 30min以上者。病因及促发因素癫痫持续状态可由原发性及继发性的原因引起。但多为继发性者 ,包括颅脑外伤、颅内感染、脑血管病、颅内肿瘤、代谢性脑病、药物中毒、变性及脱髓鞘性疾病等原因。原发性者多系迁延 10年以上的难治性癫痫。凡首发症状即表现为癫痫持续状态者 ,应首先考虑为脑肿瘤 ,特别是额叶肿瘤。促发因素中最常见者为突然停药、换药、减药或漏服药物。其次…     

偏头痛的药物防治进展

偏头痛是神经系统常见的病症,发病机理十分复杂,至今没有明确的论断。最新认为,可能是由遗传特性与内外因素相互作用引起的,遗传特性包括神经血管不稳定和血小板异常。前者表现为头痛前驱期脑血流减少,头痛期增加;后者在头痛前驱期聚集增强,头痛期聚集降低,各种促发因素在此背景上起作用。其中,神经和体液相互作用所产生的某些生化媒介物,在发病上也     

特殊诱因促发急性心肌梗死6例分析

急性心肌梗死(AMD）是由于心肌发生急性缺血、冠状动脉供血突然中断或心肌需氧与供血之间失去平衡的结果。发生机理可有多种因素构成，在一些病例中某些因素起主要作用，1／3～2／3 AMI患者有促发因素，现将临床遇到特殊诱因促发6例AMI报告如下，供同道参考。     

Association of marital status with cardiovascular outcome in patients with breast cancer

BackgroundThe influences of marital status on cardiovascular death risk in patients with breast cancer remained unclear. This study aimed to evaluate the associations of different marital status with cardiovascular death risk in patients with breast cancer.MethodsA total of 182,666 female breast cancer patients were enrolled in this study from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2014, and was divided into two groups: married (N=107,043) and unmarried (N=75,623). A 1:1 propensity score matching (PSM) was applied to reduce inter-group bias between the two groups. Competing-risks model was used to assess the associations between different marital status and cardiovascular death risk in patients with breast cancer.ResultsAfter PSM, marital status was an independent predictor for cardiovascular death in patients with breast cancer. Unmarried condition was associated with increased cardiovascular death risk than married condition among breast cancer patients [unadjusted model: hazard ratio (HR) =2.012, 95% confidence interval (CI): 1.835–2.208, P<0.001; Model 1: HR =1.958, 95% CI: 1.785–2.148, P<0.001; Model 2: HR =1.954, 95% CI: 1.781–2.144, P<0.001; Model 3: HR =1.920, 95% CI: 1.748–2.107, P<0.001]. With the exception of separated condition (adjusted HR =0.886, 95% CI: 0.474–1.658, P=0.705), further unmarried subgroups analysis showed that the other three unmarried status were associated with increased cardiovascular death risk as follows: single (adjusted HR =1.623, 95% CI: 1.421–1.853, P<0.001), divorced (adjusted HR =1.394, 95% CI: 1.209–1.608, P<0.001), and widowed (adjusted HR =2.460, 95% CI: 2.227–2.717, P<0.001). In particularly, widowed condition showed the highest cardiovascular death risk in all 4 unmarried subgroups.ConclusionsUnmarried condition (e.g., single, divorced and widowed) was associated with elevated cardiovascular death risk compared with their married counterparts in patients with breast cancer, suggesting that more attention and humanistic care should be paid to unmarried breast cancer patients (especially the widowed patients) in the management of female breast cancer patients.     

The DIAB-HYCAR study

Summary Microalbuminuria and proteinuria are strong independent predictors for increased cardiovascular mortality in non-insulin-dependent diabetic (NIDDM) patients. In such patients, angiotensin converting enzyme (ACE) inhibition improves the evolution of diabetic nephropathy; however, no data are currently available on the effects of such intervention on cardiovascular morbidity and mortality. The aim of the Diab-Hycar study is to test the hypothesis that ACE inhibition with a low daily dose of 1.25 mg ramipril, which has no significant effect on blood pressure, may reduce cardiovascular morbidity and/or mortality in normotensive or hypertensive NIDDM patients with persistent albuminuria. Selected and followed by general practitioners, 4000 patients will receive their usual oral antidiabetic treatment and if necessary antihypertensive treatment (ACE inhibitors excluded). In addition in a randomized, double-blind trial they will be given either a placebo or 1.25 mg ramipril daily. The follow-up is currently scheduled to last 3 years. The efficacy of ACE-inhibition will be assessed by the following major end-points: cardiovascular death, sudden death, myocardial infarction, stroke, renal replacement therapy. The Diab-Hycar study started on 3 February 1995. By 1 September 1995, 11 000 urine samples were tested. The prevalence of persistent albuminuria was 23 %, 964 patients were initially included in the study, with 619 eligible patients included soon after. Different strategies have been developed to record cardiovascular events correctly and to minimize the number of patients lost to follow-up. [Diabetologia (1996) 39: 1662–1667]     

Difficulties in maintaining potassium homeostasis in patients with heart failure

Potassium (K) concentration plays a significant role in cell metabolism and membrane excitability. The imbalance of serum potassium is important because it can lead to life-threatening events. Potassium balance may be lost both through the neurohormonal mechanisms involved in cardiovascular diseases and through the drugs used in the treatment of this illness. Avoiding both hypo- and hyperkalemia is beneficial in several cardiovascular diseases, especially heart failure. Electrolyte abnormalities are frequently seen complications in subjects with heart failure. Malignant ventricular arrhythmias and sudden cardiac death are particularly feared complications in K+ instability.     

Cause of Death in Older Men After the Diagnosis of Prostate Cancer

OBJECTIVES: To compare survival and cause of death in men aged 65 and older diagnosed with prostate cancer and with survival and cause of death in a noncancer control population.
DESIGN: Retrospective cohort from a population-based tumor registry linked to Medicare claims data.
SETTING: Eleven regions of the Surveillance, Epidemiology and End Results (SEER) Tumor Registry.
PARTICIPANTS: Men aged 65 to 84 (N=208,601) diagnosed with prostate cancer from 1988 through 2002 formed the basis for different analytical cohorts.
MEASUREMENTS: Survival as a function of stage and tumor grade (low, Gleason grade<7; moderate, grade=7; and high, grade=8–10) was compared with survival in men without any cancer using Cox proportional hazards regression. Cause of death according to stage and tumor grade were compared using chi-square statistics.
RESULTS: Men with early-stage prostate cancer and with low- to moderate-grade tumors (59.1% of the entire sample) experienced a survival not substantially worse than men without prostate cancer. In those men, cardiovascular disease and other cancers were the leading causes of death.
CONCLUSION: The excellent survival of older men with early-stage, low- to moderate-grade prostate cancer, along with the patterns of causes of death, implies that this population would be well served by an ongoing focus on screening and prevention of cardiovascular disease and other cancers.     

估算的脉搏波传导速度对心血管事件和全因死亡的影响

目的:观察估算的脉搏波传导速度(ePWV)对心血管事件和全因死亡的影响.方法:以参加2006～2007年度健康体检的101510例职工作为研究对象,从中选取从2010年起进行臂踝脉搏波传导速度(baPWV)检测且基线资料完整的43235例研究对象设为拟合人群,采用多元线性回归模型,以baPWV为因变量,以年龄、年龄的平...     

Is left ventricular diastolic function an independent marker of prognosis after acute myocardial infarction?

BACKGROUND: In addition to clinical risk markers, indices of left ventricular (LV) systolic function are valuable prognostic markers after acute myocardial infarction (MI). Previous studies have also suggested that LV diastolic function may contribute with prognostic information. The present study assessed whether this assumption applies to a large population of patients with acute MI who underwent thrombolytic therapy. METHODS AND RESULTS: 520 out of 608 patients participating in the ATTenuation by Adenosine of Cardiac Complications (ATTACC) study, with an ST-elevation acute MI underwent two-dimensional and Doppler echocardiographic examination at 4 (range 2-10) days after admission. During the follow-up period of 31 (S.D. +/- 11) months, cardiovascular death occurred in 57 (11%) patients, nonfatal acute MI occurred in 77 (15%), and 124 (24%) patients suffered a combined cardiovascular end-point (either nonfatal acute MI or cardiovascular death). Univariate regression analysis showed that all indices of LV systolic function predicted cardiovascular death and combined cardiovascular end-points. Regarding LV diastolic function only a restrictive filling pattern predicted cardiovascular death. In a multistep multivariate regression analysis in which the variables were introduced in a hierarchic order age, history of systemic hypertension, wall motion score index (WMSi), and history of previous MI and diabetes mellitus were independent predictors of cardiovascular death. A history of systemic hypertension or congestive heart failure were independent predictors of nonfatal acute MI, while a history of systemic hypertension, wall motion score index and diabetes mellitus independently predicted combined cardiovascular end-points. CONCLUSIONS: The results of this study confirmed that clinical risk indicators and LV systolic function were the most important independent predictors of cardiovascular death and combined cardiovascular end-points. LV diastolic function assessed by Doppler-echocardiography did not provide additional prognostic information.     

离休干部172例在院死亡疾病谱分析

目的：探讨在长海医院住院去世的上海军队离休干部的死亡原因及其变化趋势。方法选取1985年3月至2013年1月上海军队干休所死亡离休干部172例及其死亡登记表,分析死因顺位及死因构成比。结果1985年1月～2013年1月,该队列人群前5位死因构成比分别为：肿瘤（41.9%）,神经系统疾病（16.9%）,循环系统疾病（15.7%）,呼吸系统疾病（10.5%）和内分泌、营养与代谢疾病（7.6%）。前5位死亡病种分类构成比分别为：肿瘤（42.4%）,冠心病（12.8%）,慢性阻塞性肺疾病（8.7%）,脑梗死（8.1%）和2型糖尿病（7.6%）。肿瘤死亡顺位及构成比前8位分别为：肺癌（35.6%）,胰腺癌（9.6%）,直肠癌和胃癌（均为8.2%）,前列腺癌和肝癌（均为5.5%）,淋巴瘤和多发性骨髓瘤（均为4.1%）。结论肿瘤是老年患者最主要的致死原因,心脑血管疾病也是老年患者住院死亡的主要原因之一,应加强肿瘤与心脑血管疾病的防治工作。     

Cardiovascular mortality in liver and kidney transplant recipients: A retrospective analysis from a single institution

Previous studies have demonstrated cardiovascular causes to be among the leading causes of death after liver (LT) and kidney transplantation (KT). Although both recipient populations have unique pre-transplant cardiovascular burdens, they share similarities in post-transplant exposure to cardiovascular risk factors. The aim of this study was to compare cardiovascular mortality after LT and KT.We analyzed causes of death in 370 consecutive LT and 207 KT recipients from in-hospital records at a single tertiary transplant center. Cardiovascular causes of death were defined as cardiac arrest, heart failure, pulmonary embolism, or myocardial infarction.After a median follow-up of 36.5 months, infection was the most common cause of death in both cohorts, followed by cardiovascular causes in KT recipients and graft-related causes in LT recipients in whom cardiovascular causes were the third most common. Cumulative incidence curves for cardiovascular mortality computed with death from other causes as the competing risk were not significantly different (P = .36). While 1-year cumulative cardiovascular mortality was similar (1.6% after LT and 1.5% after KT), the estimated 4-year probability was higher post-KT (3.8% vs. 1.6%). Significant pre-transplant risk factors for overall mortality after KT in multivariable analysis were age at transplantation, left ventricular ejection fraction <50%, and diastolic dysfunction grade 2 or greater, while significant risk factors for cardiovascular mortality were peripheral artery disease and left ventricular ejection fraction <50%. In the LT group no variables remained significant in a multivariable model for either overall or cardiovascular mortality.The present study found no significant overall difference in cardiovascular mortality after LT and KT. While LT and KT recipients may have similar early cardiovascular mortality, long-term risk is potentially lower after LT. Differing characteristics of cardiovascular death between these two patient populations should be further investigated.     

微量白蛋白尿对心血管疾病死亡及全因死亡风险的预测价值

目的 对2181名中老年人在现况调查基础上进行为期4年的随访,以期对微量白蛋白尿预测心血管疾病死亡及全因死亡风险方面提供流行病学证据.方法 选取2004年6月北京中老年人群流行病学调查资料作为研究对象,记录该人群中截至2008年5月的4年期间因各种原因死亡的受检者资料.将基线人群按照尿白蛋白/肌酐（ACR）分为正常白蛋白尿组（NAU组）、微量白蛋白尿组（MIAU组）和大量白蛋白尿组（MAAU组）,比较死亡组与生存组基线时临床特征及代谢指标,在随访研究中引入Cox回归模型,调整年龄、糖尿病史、高血压史及血脂紊乱等潜在危险因素,研究不同ACR水平与心血管疾病死亡及全因死亡的关系,计算归因危险度百分比.计量资料用均数±标准差或中位数（四分位数间距）表示,组间比较用独立样本的t检验或方差分析,组间率的比较用X2检验.结果 4年期间共有77例死亡,全因死亡率为8.7/1000人年,其中心血管疾病死亡和恶性肿瘤死亡占总死亡人数的74%.与生存组相比,死亡组合并MIAU、MAAU及糖尿病的比例显著高于生存组（分别为18.2%vs 8.7%,9.1%vs 1.6%,50.6%vs 25.8%,P＜0.01）.NAU、MIAU和MAAU人群全因死亡率分别为6.8‰、20.6‰和58.8‰.在NAU人群中,恶性肿瘤是该人群的首要死亡原因,其次是心血管疾病.而在MIAU人群和MAAU人群中,心血管疾病为该人群的首要死亡原因.校正年龄、血糖、高血压、血脂异常等因素后,与NAU组相比,MIAU组的心血管疾病死亡风险增加了1.72倍,全因死亡风险增加1.01倍,MAAU组心血管疾病死亡风险增加了3.87倍,全因死亡风险增加2.76倍.以NAU组为对照,经Cox回归调整年龄、血糖、血压、血脂紊乱后,分析不同尿白蛋白排泄率（UAER）组心血管疾病死亡及全因死亡人群归因危险度百分比,18.32%的心血管疾病死亡及11.96%的全因死亡见于ACR≥30 mg/g.结论恶性肿瘤是NAU人群的首要死亡原因,其次是心血管疾病.在MIAU人群和MAAU人群中,心血管疾病为首要死亡原因.与NAU组相比,MIAU组与MAAU组的心血管疾病死亡风险及全因死亡风险显著增加.     

急性冠状动脉综合征患者基线C反应蛋白和低密度脂蛋白水平对其急性期预后的意义

目的分析基线高敏C反应蛋白（hs—CRP）和低密度脂蛋白胆固醇（LDL—C）水平与不同急性冠状动脉综合征（ACS）急性期预后的相关性及意义。方法连续入选172例ACS患者,入院24h内测定患者基线状态的hs—CRP和LDL—C水平,对所有患者随访30d,记录任何原因死亡、心血管事件（事件）发生次数和时间。按出现死亡、事件和无事件对患者进行分组,分析和比较三组患者基线hs—CRP、LDL～C和hs—CRP／LDL—C。应用Logistic回归分析包括年龄,治疗前、后血肌酐（Cr）水平等共19项危险因素对死亡率和事件发生率的影响。结果单因素分析显示,三组ACS患者基线LDL—C水平差异无统计学意义,死亡患者的LDL—C有更低的倾向。死亡患者的hs—CRP是无“事件”患者的13．0倍,是单纯有“事件”患者的5．5倍,差异有统计学意义。结论基线hs—CRP是ACS患者急性期死亡和心血管事件的非独立危险因素,基线LDL—C与急性预后不相关。hs—CRP可作为急性期治疗的靶目标。