应激对室性心律失常患者血液流变学的影响

对２０例功能性室性心律失常患者和２０例与之在人口学特征方面相匹配的健康人进行了生活事件的评定和血液流变学指标的测定。结果发现：病例组高切变率血液粘度［ηｂ（Ｈ）］、血浆粘度［ηＰ］、红细胞压积（ＨＣＴ）和红细胞聚集性（ＲＣＡ）与对照组相比差异有显著性（Ｐ＜０．００１）；生活事件紧张总值与上述血液流变学指标呈正性显著相关（Ｐ＜０．００１）。提示应激性生活事件影响血液流变学特性，为应激与室性心律失常关系的研究提供了依据。     

78例妊娠高血压综合征患者血液流变性观察

目的 :观察妊高征患者血液流变学指标的变化。方法 :用北京普利生LBY N6A自清洗旋转式粘度计测定正常孕妇 32例 (对照组 )和妊高征患者 78例 (轻度组 33例、中度组 2 0例、重度组 2 5例 )的全血粘度、血浆粘度、HCT、ESR、血沉方程K值、红细胞聚集指数、红细胞变形指数等血液流变学指标。结果 :与对照组比较 ,轻度组只有红细胞聚集指数升高 (P <0 .0 5 ) ;中度组的HCT、ESR、血沉方程K值、全血低切粘度、红细胞聚集指数均明显升高 (P <0 .0 5～ 0 .0 1 ) ,红细胞变形指数明显下降 (P <0 .0 5 ) ;重度组的HCT、ESR、血沉方程K值、红细胞聚集指数及全血粘度 (低切、中切、高切 )均明显升高(P <0 .0 5～ 0 .0 1 ) ,红细胞变形指数明显下降 (P <0 .0 1 )。结论 :各期妊高征患者血液流变学指标有不同程度的改变 ,重度妊高征改变最显著。因而对妊高征的病情监测和指导治疗有一定的临床价值     

不同性别糖尿病患者血液流变学指标分析

目的 :观察糖尿病患者不同性别之间的血液流变学指标变化的差异。方法 :测定糖尿病患者和健康对照人群的血液流变学指标 ,运用统计学方法对相关指标进行两组间统计学分析。结果 :男性糖尿病患者全血粘度、红细胞压积、红细胞刚性指数极显著高于正常对照组 (P <0 .0 1) ;红细胞聚集指数显著高于对照组 (P <0 .0 5 )。而女性糖尿病患者的血液粘度只有在切变率 3 0s- 1 时高于正常对照 (P <0 .0 5 ) ,其余指标均没有显著性差异。结论 :血液流变学指标与男性糖尿病患者有关 ,而与女性糖尿病患者关系不明显     

肝病患者血液流变学的研究

目的　探讨多种肝病患者血液流变学的改变及其不同时期内机体微循环的变化。方法　检测 82例慢性肝病患者血液流变学指标、肝功能、乙型肝炎 (乙肝 )病毒 (HBV)DNA、输血传播病毒(TTV)DNA ,并做出相关分析。结果　乙型肝炎组与正常对照组比较 :全血低切粘度、红细胞聚集指数均有明显升高 (P <0 0 5 ) ,乙肝HBVDNA与血液流变学指标间差异无显著意义 (P >0 0 5 ) ;肝硬化组与正常对照组比较 :失代偿期组红细胞压积、全血高切粘度、全血低切粘度明显降低 (P <0 0 5 ) ;代偿期组全血低切粘度、血浆粘度、红细胞聚集指数明显升高 (P <0 0 5 ) ;TTV阳性组与正常对照组 :全血高切粘度、全血低切粘度明显升高 (P <0 0 5 )。结论　乙肝患者体内有微循环障碍 ,肝硬化患者代偿期机体内呈高凝状态 ,失代偿期呈低凝状态。TTV阳性患者体内有微循环障碍 ,TTV对机体有一定的致病作用。血液流变学应作为肝病患者检查的指标。血液流变学与HBVDNA是肝病检查中相对独立的指标。     

慢性阻塞性肺疾病急性加重期血液流变性观察

目的 :观察慢性阻塞性肺疾病 (COPD)急性加重期患者血液流变学特性。方法 :检测6 0例急性加重期、4 5例稳定期患者及 12 0例健康体检者的全血粘度、血浆粘度、血沉、红细胞压积和纤维蛋白原等血液流变学指标。结果 :COPD急性加重期患者与COPD稳定期患者和健康体检者血液流变测定值有显著性差异 (P <0 .0 5 ) ,除血浆粘度外其余项目测定值均有统计学意义 (P <0 .0 5 )。结论 :COPD急性加重期病人血液流变性有明显改变 ,可为病情评估、疗效评价和预后判断提供帮助     

广州地区健康成年人血液流变学指标参考值的调查分析

目的 :探讨广州地区健康成年人血液流变学指标参考值范围。方法 :测定 5 0 3例成年人血液流变学指标 ,并按性别和年龄分组统计分析。结果 :男性和女性全血粘度 (mPa·s)低切、中切、高切参考值范围分别为 10 .5 5± 1.41、6.2 8± 0 .65和 5 .2 0± 0 .5 3 ,8.96± 1.3 2、5 .47± 0 .5 7和 4.5 0± 0 .5 0 ;血浆粘度 (mPa·s)分别为 1.3 6± 0 .12和 1.3 8± 0 .11;红细胞比积 ( % )分别为 44 .3 8± 3 .0 2和 3 9.60± 2 .99。男女除血浆粘度值外 ,其他各项血液流变学指标均有显著性差异 (P <0 .0 1) ,同性别不同年龄组间无显著差异 (P >0 .0 5 )。与北京地区血液流变学各参考值比较 ,男性除全血高切粘度外其它四项均有显著性差异 (P <0 .0 1) ,女性五项指标除红细胞压积外均有显著性差异(P <0 .0 1)。结论 :地区间血液流变学指标参考值存在差异 ,有必要确定本地区健康成年人参考值范围 ,为临床提供准确依据     

心脏跳动中房室缺修补术体外循环的血液流变性变化

目的 :探讨心脏跳动中心内直视术体外循环对血液流变性的影响。方法 :随机选择 2 0例年龄≥ 8岁的心脏跳动中房室缺修补术患者 ,体外循环采用无血预充技术 ,在转机前、转机复温开始、停机后 1h分别采血作血液流变学测定分析。结果 :转流期间血浆粘度、红细胞压积、各切变率下的全血粘度和全血还原粘度、血沉方程K值及红细胞聚集指数均下降 (P <0 .0 5 ) ;停机后 1h ,全血粘度、红细胞压积和红细胞聚集指数仍较低 (P <0 .0 5 )。结论 :心脏跳动中心内直视术体外循环期间 ,血液流变学的状态发生明显变化 ,此变化有利于微循环灌注。     

中药冠心康对实验性家兔动脉粥样硬化模型血液流变性的影响

目的 :研究中药冠心康对血液流变性的影响 ,为探索益气通阳化痰中药冠心康在防治高粘血症中的作用机制提供理论依据。方法 :采用食饵性家兔高脂血症及动脉粥样硬化模型 ,分四组 (空白对照组、模型对照组、活血化瘀法对照组、益气通阳化痰法治疗组 )进行对比研究。实验开始时及第 12周分别测定下述指标 :( 1)血小板粘附性和血小板聚集性 ;( 2 )血液流变学主要指标 :全血粘度、血浆粘度、红细胞压积、血沉、红细胞聚集指数、红细胞变形指数。结果 :( 1)高脂组血小板粘附性和聚集性明显高于其它三组 (P <0 .0 5 ) ,化痰组与活血组之间无显著差异 (P >0 .0 5 )。 ( 2 )化痰组与活血组都具有降低血粘度的作用 (P <0 .0 5 ) ,化痰组在降低全血粘度和红细胞聚集指数方面优于活血组 (P <0 .0 5 )。结论 :中药冠心康能有效地防治高脂血症 ,在某些方面优于活血化瘀中药。     

伤科接骨片对激素性股骨头缺血性坏死血液流变性的实验研究

目的 :探讨伤科接骨片对激素性股骨头缺血性坏死血液流变性的影响。方法 :45只健康成年三黄鸡随机分为三组 :对照组、模型组和伤科接骨片组 ,模型组和伤科接骨片组采用胸肌注射地塞米松磷酸钠建立激素性股骨头缺血性坏死模型。对照组同一时间经胸肌注射等量生理盐水。 12周后取材 ,测定血液流变学指标和股骨头内PO2值。结果 :模型组股骨头内PO2值明显下降 ,全血粘度、血浆粘度、红细胞聚集指数明显升高 ,而红细胞变形指数明显下降 ,与对照组比较有显著性差异 (P <0 .0 5或P <0 .0 1) ,应用伤科接骨片后各项指标明显改善 ,与模型组比较有显著性差异 (P <0 .0 5或P <0 .0 1)。结论 :伤科接骨片能够改善股骨头微循环和血液流变特性 ,对激素诱导的股骨头缺血性坏死有较好的防治作用。     

几种老年性疾病患者血液流变性及血脂变化

目的 :探讨脑梗死、高血压、冠心病、糖尿病等几种老年性疾病的血脂和血液流变学指标的变化。方法 :分别检测患者全血粘度 (ηb)、血浆粘度 (ηP)、红细胞压积 (HCT)、红细胞聚集指数 (EAI)、红细胞刚性指数 (TK)以及纤维蛋白原 (Fib)、胆固醇 (T ch)、甘油三脂 (TG)等指标 ,并与正常人对比分析。结果 :几种老年性疾病患者的血液流变学和血脂指标明显异常 ,与对照组比较差异有显著性 (P <0 .0 5～0 .0 1)。结论 :老年性疾病患者血液流变特性和血脂的异常改变 ,是引起体内血液瘀滞 ,导致微循环障碍和血栓形成的危险因素之一。检测这些指标 ,对老年性疾病诊断、治疗和预后判断具有重要意义。     

Stress and course of disease in multiple sclerosis

In this prospective study, 96 healthy controls and 101 multiple sclerosis patients were followed up for as many as 6 years, and self-reported stressful events and health status were assessed. The authors evaluated (a) whether patients reported more stressful life events than healthy controls and (b) the bidirectional relationship between stress and functional deterioration among patients. Healthy controls reported more life events than patients, Odds ratio (OR) = 1.13, p < .0001; and this relationship was attributable to healthy controls' reporting more neutral/positive events than patients. A bidirectional relationship was confirmed between stress and illness: there was an increased risk of disease progression when rate of reported stressful events was higher, OR = 1.13, p < .0003, and an increased risk of reported stressful events when rate of disease progression was higher, OR = 2.13, p < .0001. There were no differences in reported stress by level of baseline disability. The authors concluded that multiple sclerosis patients demonstrate a vicious cycle between stress and disease progression.     

甲亢患者病前应激性生活事件研究

目的：探讨甲亢患者病前经历的应激性生活事件的特点及与疾病的联系。方法：采用事件量表（ＬＥＳ）对８２例初发的甲亢患者进行测定,并与正常对照比较。结果：甲亢患者病前经历有影响的负性生活事件频数及总生活事件频数、负性生活紧张值及总生活事件紧张值显著高于对照组（Ｐ〈０．０５）,男性患者正性生活事件紧张值显著高于女性患者。结论：提示患病前经历较多负性生活事件的应激可能与发病有一定联系。     

Stress and Course of Disease in Multiple Sclerosis

Abstract

In this prospective study, 96 healthy controls and 101 multiple sclerosis patients were followed up for as many as 6 years, and self-reported stressful events and health status were assessed. The authors evaluated (a) whether patients reported more stressful life events than healthy controls and (b) the bidirectional relationship between stress and functional deterioration among patients. Healthy controls reported more life events than patients, Odds ratio (OR) = 1.13, p < .0001; and this relationship was attributable to healthy controls' reporting more neutral/positive events than patients. A bidirectional relationship was confirmed between stress and illness: there was an increased risk of disease progression when rate of reported stressful events was higher, OR = 1.13, p < .0003, and an increased risk of reported stressful events when rate of disease progression was higher, OR = 2.13, p < .0001. There were no differences in reported stress by level of baseline disability. The authors concluded that multiple sclerosis patients demonstrate a vicious cycle between stress and disease progression.     

应激,行为类型与急性心肌梗塞后的生理生化改变

对８０例ＡＭＩ患者进行发病前２小时应激事件回顾性调查、性格类型调查、血小板聚集测定及Ｈｏｌｔｅｒ检查，结果显示ＡＭＩ患者Ａ型性格者占８５％，诱发ＡＭＩ患者的应激事件主要为情绪激动。Ａ型行为组血小板聚集及值恶性室性心律失常的检出方面均高于Ｂ型行为组，提示Ａ型行为类型的ＡＭＩ者的心理应激可增加血小板聚集，增加心室易损性并具有一定的危险性。     

溶栓治疗后急性心肌梗死患者心率变异性的变化

目的观察急性心梗患者(AMI)溶栓后心率变异性(HRV)变化。方法41例患者被分为两组溶栓再通组21例;常规治疗组20例。观察两组患者病后心率变异性的改变。结果溶栓再通组病人在各时间点的HRV均高于常规治疗组(P<0.05);组内比较,3月、6月时的HRV均高于2周时(P<0.05)。2周时再通者室性心律失常低于常规治疗组(P<0.05)。结论溶栓后冠脉再通可改善心脏自主神经系统功能,减少室性心律失常。     

活血益气补肾方对老年髋关节置换术后血液流变学参数及eNOS活性的影响

目的:观察活血益气补肾方对老年髋关节置换术后血液流变学参数及内皮型一氧化氮合酶(endothelial nitric oxide synthase,e NOS)活性的影响。方法:将符合标准的60例行髋关节置换术患者随机分为3组,每组20例。中医治疗组服用活血益气补肾方,肝素治疗组皮下注射依诺肝素,对照组服用阿司匹林肠溶片,检测3组术前、术后第1、10天血液e NOS、一氧化氮(nitric oxide,NO)及血液流变学的变化。结果:中医治疗组患者术后1 d血液e NOS、NO含量、全血黏度(whole blood viscosity,WBV)、血浆黏度(plasma viscosity,PV)、红细胞比积(hematocrit,HCT)、红细胞聚集系数(erythrocyte aggregation index,EAI)、刚性指数(index of rigidity,IR)、红细胞变形指数(erythrocyte deformation index,EDI)和红细胞电泳时间(erythrocyte electrophoresis time,EET)与其余2组比较,差异无统计学意义(P0.05),术后10 d中医治疗组和对照组比较,血液e NOS和NO浓度明显高于对照组,血液流变学指标明显改善;中医治疗组和肝素治疗组比较,上述指标差异不显著(P0.05)。结论:活血益气补肾方能有效提高老年髋关节置换术后血液e NOS和NO浓度,改善血液流变状态。     

原发性肺癌患者的血液流变学研究

观察了原发性肺癌患者血液流变学的变化,采用血液比粘度计检测正常组(42例),肺癌组(58例),慢性阻塞性肺病(COPD)组(76例)患者的血沉降率、血球压积、全血比粘度、血浆比粘度及全血还原比粘度。结果:1 COPD组血球压积、低及中切变率时全血比粘度较正常组、肺癌组显著升高(P<0.05).2 肺癌组血沉降率较正常组、COPD组显著升高(P<0.05).3 肺癌组的血球压积、低及中切变率时的全血比粘度较正常组无显著性差异(P>0.05).4 3组高切变率时全血比粘度、全血还原比粘度与血浆比粘度无显著性差异(P>0.05).5正常组与COPD组血沉降率无显著性差异(P>0.05)。结论:肺癌患者血沉降率增高提示其红细胞聚集力增强,而其血粘度无明显改变,可能与红细胞压积无明显改变有关。COPD患者血球压积、血粘度明显增高,可能与长期缺氧有关。     

血液流变学变化与排斥反应

本文对30例肾移植患者及2例胰腺移植病人进行了血液流变学若干参数测定。结果显示:急慢性肾排斥反应期的血浆粘度、全血还原粘度、纤维蛋白原定量等较肾功能稳定期升高,且有显著性差异;急性胰腺排斥反应时,也有血液流变学参数异常增高,并随排斥反应转归不同而变化各异。认为血液流变学异常与排斥反应密切有关,血液流变性质改变是导致移植物功能丧失的重要因素之一。     

Stressful life events, depression and demoralization as risk factors for acute coronary heart disease

BACKGROUND: While the effect of psychological stress and depression on the course of heart disease is commonly recognized, the relationship between recent life events, major depression, depressive symptomatology and the onset of acute coronary heart disease (CHD) has been less considered. The aim of this study was to investigate the presence of stressful life events, major and minor depression, recurrent depression and demoralization in the year preceding the occurrence of a first acute myocardial infarction (AMI) and/or a first episode of instable angina and to compare stressful life events, also related with mood disorders, in patients and healthy controls. METHODS: 97 consecutive patients with a first episode of CHD (91 with AMI and 6 with instable angina) and 97 healthy subjects matched for sociodemographic variables were included. All patients were interviewed with Paykel's Interview for Recent Life Events, a semistructured interview for determining the psychiatric diagnosis of mood disorders (DSM-IV), a semistructured interview for demoralization (DCPR). Patients were assessed while on remission from the acute phase. The time period considered was the year preceding the first episode of CHD and the year before the interview for controls. RESULTS: Patients with acute CHD reported significantly more life events than control subjects (p < 0.001). All categories of events (except entrance events) were significantly more frequent. 30% of patients were identified as suffering from a major depressive disorder; 9% of patients were suffering from minor depression, 20% from demoralization. Even though there was an overlap between major depression and demoralization (12%), 17% of patients with major depression were not classified as demoralized and 7% of patients with demoralization did not satisfy the criteria for major depression. Independently of mood disorders, patients had a higher (p < 0.001) mean number of life events than controls. With regard to life events, the same significant difference (p < 0.001) compared to controls applied to patients with and without mood disorders. CONCLUSIONS: Our findings emphasize, by means of reliable methodology, the relationship between life events and AMI. These data, together with those regarding traditional cardiac risk factors, may have clinical and prognostic implications to be verified in longitudinal studies.