心衰患者尿酸对血管内皮功能的影响及别嘌呤醇的干预

目的探讨心力衰竭（心衰）患者尿酸（UA）升高对血管内皮功能的影响及别嘌呤醇干预对尿酸升高的慢性心衰内皮依赖性血管舒张功能的影响。方法将30例心衰患者随机分为别嘌呤醇组和对照组，对照组15例，用常规药物治疗2周；别嘌呤醇组15例，在常规药物治疗基础上加用别嘌呤醇。采用高分辨超声技术检测血流介导和硝酸甘油介导的肱动脉舒张功能，并测定治疗前后血浆UA和内皮素（ET-1）。结果（1）用药前，二者比较UA水平及ET-1水平，差异无统计学意义（P〉0．05）；用药后，别嘌呤醇组UA水平及ET-1水平和对照组比较均降低，差异有统计学意义（P〈0．05）。各组用药后UA水平及ET-1水平均明显降低（P〈0．01）。（2）别嘌呤醇组和对照组肱动脉内径基础值无明显差异（P〉0．05），反应性充血引起肱动脉内径变化别嘌呤醇组明显增加（P〈0．01）。含服硝酸甘油后两组肱动脉内径均明显扩张，但两组肱动脉内径变化无明显差异（P〉0．05）。结论心衰患者经药物干预后，UA水平降低，ET-1水平随之下降，尤以别嘌呤醇组降低明显。别嘌呤醇治疗后UA水平明显降低，内皮依赖性血管舒张功能明显改善，别嘌呤醇是慢性心衰的一种便宜而有效的辅助药物。     

腹膜透析液添加尿激酶对腹透患者氧化应激及内皮功能的影响

目的探讨腹膜透析液添加尿激酶对腹透患者血清超氧化物歧化酶（SOD）、丙二醛（MDA）及血浆内皮素（endothelin,ET）、一氧化氮（nitricoxide,NO）的影响。方法将60例慢性肾脏病（CKD4期）患者随机分为治疗组（30例）和对照组（30例）,两组基础治疗相同,治疗组在腹膜透析液中添加尿激酶,治疗4周后观察两组患者SOD、MDA、ET、NO及临床症状的变化。用比色法测定健康对照组、对照组、治疗组血清MDA和SOD水平,用放射免疫法测定测定ET的变化,NO采用硝酸还原法测定。结果与健康对照组比较,对照组、治疗组血清SOD活性降低（P〈0．05）,NO升高（P〈0．05）,MDA含量升高（P〈0．05）,ET水平升高（P〈0．01）。对照组虽能够降低ET水平和NO,但未见SOD、MDA的变化,治疗组能够回升SOD活性,降低MDA含量,与健康对照组及对照组有明显差别（P〈0．05）,与对照组比较,治疗组在降低ET和NO方面疗效更为显著（P〈0．01）。结论腹膜透析液添加尿激酶可通过降低氧化应激反应,改善血管内皮功能,降低ET和NO水平,对CKD患者有治疗作用。     

雌激素替代治疗防止绝经后妇女血管内皮功能障碍效果观察

对 32例绝经者 (观察组 )进行雌激素替代治疗 ,与 2 4例 (对照组 )行经者比较治疗前后血脂、雌二醇 (E2 )、一氧化氮 (NO)和血管内皮功能水平。结果观察组治疗前E2 和NO、肱动脉血流介导舒张反应较对照组下降 ,两组比较 ,差异均有显著性意义 (均P <0 .0 1) ;观察组治疗后E2 和NO较治疗前显著升高 (P <0 .0 1)、肱动脉血流介导舒张反应显著改善 (治疗前后比较 ,均P <0 .0 1)。提示雌激素替代治疗可改善绝经后妇女血管内皮舒张功能 ,防止动脉硬化。     

纳络酮治疗急性重型颅脑损伤患者血浆内皮素含量变化及其临床意义

目的 探讨纳络酮治疗急性重型颅脑损伤患者血浆内皮素（ET）含量变化及其临床意义，评价纳络酮治疗急性重型颅脑损伤的意义。方法 观察了52例纳洛酮治疗急性重型颅脑损伤患者血浆ET含量在治疗前1d、治疗后3、8d及2周的变化，并且以46例颅脑损伤患者按常规治疗作对照组。结果 颅脑损伤24h内两组患者血浆内皮素较正常人均明显升高（P〈0．05），伤后第3天、第8天两治疗组血浆内皮素较治疗前均明显下降（P〈0．05），但纳络酮治疗组低于常规治疗组（P〈0．05），治疗2周后两组ET水平基本恢复到正常水平。结论 急性重型颅脑损伤患者血浆内皮素含量明显升高，与病情轻重相关，纳络酮治疗较常规治疗能更迅速地降低血浆ET水平。     

犬蛛网膜下腔出血腰大池引流内皮素、一氧化氮变化及其与经颅彩色多美勒超声相关性研究

目的 探讨犬蛛网膜下腔出血（SAH）后脑血管痉挛（CVS）与内皮素（ET）和一氧化氮（NO）的关系、腰大池持续引流后两者变化及与经颅彩色多普勒超声（TCCD）相关性。方法 采用犬SAH模型，测定SAH后腰大池持续引流前后不同时期，血浆和脑脊液中ET和NO含量。观察ET和NO动态变化，同时应用TCCD检查SAH模型不同时期脑动脉血流形态与流速。结果 SAH后引流组血浆和脑脊液中ET含量增加和NO含量下降不明显（P〉0．05），非引流组血浆和脑脊液中ET含量增加和NO含量下降明显（P〈0．01）。TCCD显示：血浆和脑脊液中ET含量变化与大脑中动脉平均流速呈正相关，NO含量变化与大脑中动脉平均流速呈负相关。结论 SAH后脑血管痉挛与ET含量增加和NO含量下降有关，腰大池持续引流有效清除引起脑血管痉挛因子ET，经颅彩色多普勒超声可以根据动脉血的流速和血流形态判断脑血管痉挛的程度及其预后。     

通心络治疗肾病综合征高脂血症

目的观察通心络胶囊治疗肾病综合征（NS）患者高脂血症的临床疗效。方法将NS高脂血症并血粘度异常者57例分为2组,治疗组30例,对照组27例。治疗组给予通心络胶囊每天9粒（0．38克／粒）,分3次口服,辛伐他汀20mg／d,睡前顿服,对照组患者仅服用辛伐他汀20mg／d,睡前顿服,共治疗30d。分别于给药前的3d内和疗程结束后的3d内检测2组患者血总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDDC）、高密度脂蛋白胆固醇（HDDC）和血粘度（全血比粘度、血浆比粘度）。结果2组患者治疗后TC、TG、LDL-C均较治疗前下降,HDL-C均较治疗前升高,全血比粘度、血浆比粘度均较治疗前下降,差异有统计学意义（P〈0．05）;治疗组治疗后TC、TO、LDL-C均较对照组治疗后低,HDLC较对照组治疗后高,全血比粘度、血浆比粘度均较对照组治疗后低,差异有统计学意义（P〈0．05）。结论联用通心络与辛伐他汀能更有效的改善血脂异常和高血粘度。     

舒血宁对糖尿病肾病患者血浆ET、AngⅡ、ADM、NO水平的影响

目的：探讨舒血宁对糖尿病肾病患者血浆内皮素（ET）、血管紧张素Ⅱ（AngⅡ）、肾上腺髓质素（ADM）、一氧化氮（NO）水平的影响。方法：测定60例无肾病糖尿病患者、74例临床糖尿病肾病患者血浆ET、AngⅡ、ADM、NO水平，探讨血浆ET、AngⅡ、ADM、NO水平变化在糖尿病肾病发病中的可能作用。将74例糖尿病肾病患者随机分为两组，常规治疗组和舒血宁治疗组，测定两组治疗前后血浆ET、ADM、AngⅡ、NO水平、尿白蛋白排泄率（UAER）的变化。结果：糖尿病肾病患者较无肾病糖尿病患者血浆ET、AngⅡ、ADM水平明显升高（P〈0．01），血浆NO水平明显降低（P〈0．01）。与对照组比较应用舒血宁治疗可使糖尿病肾病患者血浆ET、AngⅡ、ADM水平明显降低（均P〈0．01），血浆NO水平明显升高（P〈0．01），UAER明显降低（P〈0．01）。结论：血浆ET、AngⅡ、ADM水平升高，NO水平降低在糖尿病肾病的发病中发挥重要作用。舒血宁治疗可纠正糖尿病肾病患者血浆ET、AngⅡ、ADM、NO平衡失调，减少UAER，促进病情恢复。     

普伐他汀联合罗格列酮治疗早期糖尿病肾病的疗效观察

目的观察普伐他汀联合罗格列酮治疗早期糖尿病肾病的临床疗效。方法糖尿病肾病患者88例，随机均分为普伐他汀治疗组、联合治疗组。其中普伐他汀治疗组给予普伐他汀40mg／d，联合组在普伐他汀治疗基础上加用罗格列酮4mg／d，治疗时间6个月。所有研究对象分别于治疗前及治疗后各采静脉血1次，测定血清胰岛素抵抗指数和三酰甘油、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇，治疗前、后测尿白蛋白排泄率。结果两组高密度脂蛋白胆固醇治疗后均升高（P〈0．05），其余各项指标在治疗后均明显低于治疗前（P〈0．05），联合治疗组各项指标较普伐他汀治疗组变化更为显著（P〈0．05）。结论普伐他汀能抑制早期糖尿病肾病的发展，联合罗格列酮作用更为显著。     

益气活血汤对冠心病心绞痛气虚血瘀患者血脂和血管内皮功能的影响

目的探讨益气活血汤对冠心病心绞痛气虚血瘀患者血脂以及血管内皮功能的影响。方法将笔者所在门诊部2009年1月～2011年1月收治的冠心病心绞痛气虚血瘀患者90例随机分为对照组与治疗组,每组45例,对照组给予硝酸酯类、钙离子拮抗剂、β-受体阻断剂等常规治疗,治疗组在常规治疗基础上给予益气活血汤治疗,两组均连续治疗4周。观察治疗前后两组甘油三酯、总胆固醇、低密度脂蛋白-胆固醇、高密度脂蛋白-胆固醇以及一氧化氮的变化。结果两组治疗后,TG、TC、LDL-C均明显低于治疗前（P〈0.05）,HDL-C高于治疗前（P〈0.05）;治疗组治疗后的TG、TC、LDL-C明显低于对照组,HDL-C和NO明显高于对照组,两组上述指标比较差异均有统计学意义（P〈0.05）。结论益气活血汤能明显降低冠心病心绞痛气虚血瘀患者血清TG、TC、LDL-C,升高HDL-C;并且能明显升高NO水平,对血管内皮功能具有保护作用,值得在临床中推广应用。     

硬膜外阻滞对妊娠高血压综合征患者血浆一氧化氮和内皮素含量的影响

目的 研究硬膜外阻滞前后妊高征患者血浆中一氧化氮（NO）和内皮素（ET）的变化。方法 选择20例择期剖宫产患者,正常妊娠组（NLP组）10例,妊高征组（PIH组）中度妊高征患者10例,分别于硬膜外阻滞前及阻滞完善后抽取母体静脉血,测定血浆一氧化氮和内皮素的浓度。结果 阻滞前PIH组血浆NO浓度明显低于NLP组（P＜0．01）,ET含量显著高于NLP组（P＜0．01）;阻滞后两组血浆NO水平均显著升高（P＜0．05）,ET水平明显降低（P＜0．05）。结论 血浆中NO含量降低和ET浓度增高是妊高征发病的一个重要环节,硬膜外阻滞可使妊高征患者血浆NO水平和ET浓度降低,是一种有效和安全的麻醉方法。     

阿西莫司联合小剂量阿托伐他汀治疗肾移植术后混合型高脂血症的疗效与安全性

目的  评价阿西莫司联合小剂量阿托伐他汀治疗肾移植术后混合型高脂血症的疗效及安全性。方法  56例肾移植术后合并混合型高脂血症的患者, 随机分为联合小剂量组[28例, 阿西莫司(250 mg, 每日2次)+阿托伐他汀(10 mg, 每日1次)]和正常剂量组[28例, 阿托伐他汀(20~40 mg, 每日1次)]。比较治疗前及治疗后1、2、3个月血清中总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、血清肌酐(Scr)、血尿素氮(BUN)、尿酸(UA)、肌酸激酶(CK)等指标, 并记录药物不良反应。结果  与治疗前比较, 正常剂量组与联合小剂量组在治疗后TC、TG、LDL-C均下降, HDL-C轻度升高, 差异均有统计学意义(均为P < 0.01)。与正常剂量组比较, 联合小剂量组的TG、LDL-C均较低, HDL-C较高, 差异均有统计学意义(均为P < 0.01)。在治疗前和治疗后各时间点, 正常剂量组与联合小剂量组的ALT、AST、Scr、BUN、UA、CK比较, 差异均无统计学意义(均为P>0.05)。正常剂量组和联合小剂量组的消化系统、神经系统、骨骼肌肉系统、皮肤血管的不良反应发生率比较差异均有统计学意义(均为P < 0.05)。结论  阿西莫司联合小剂量阿托伐他汀能安全有效地治疗肾移植术后混合型高脂血症。     

Combined hyperlipidemia in a single subject with tetraplegia: ineffective risk reduction after atorvastatin monotherapy

BACKGROUND/OBJECTIVE: Effects of atorvastatin (Lipitor) drug monotherapy (10 mg daily) on fasting blood lipid profiles and cardiovascular disease (CVD) risks were examined for a single subject with C5-C6 tetraplegia. Routine fasting lipid profiles were analyzed by standard biochemistry techniques for total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol (HDL-C). Lipid profiles were analyzed on 3 occasions before drug therapy was initiated and 3 months after therapy commenced. The TC:HDL and LDL:HDL ratios were computed for all sampling times and used to assess pretreatment and post-treatment CVD risk. RESULTS: Fasting TC, TG, and LDL-C were all significantly reduced by therapy. The pretreatment HDL-C of 35 mg/dL was lowered to 21 mg/dL. As a result, the TC:HDL risk ratio was only marginally reduced from 6.6 to 6.4, whereas the LDL:HDL risk ratio remained unchanged by treatment. CONCLUSIONS: In this man with tetraplegia, atorvastatin drug monotherapy rapidly lowered TC, TG, LDL-C, and HDL-C. However, the TC:HDL ratio, considered the best predictor of CVD risk, was unchanged.     

脂肪乳剂建立大鼠高脂血症模型的研究

目的 用两种不同浓度脂肪乳剂按灌胃法建立大鼠高脂血症模型,并对其血脂水平进行评价,为建立合适的高脂血症动物模型提供依据.方法 将30只150～180 g健康雄性SD大鼠随机分为正常对照组、低浓度脂肪乳剂组及高浓度脂肪乳剂组,每组10只.分别饲以基础饲料、低浓度配方脂肪乳剂(20％猪油、6％胆固醇、0.2％丙基硫氧嘧啶、2％胆酸钠及10％吐温-80)及高浓度配方脂肪乳剂(30％猪油、10％胆固醇、1％丙基硫氧嘧啶、5％胆酸钠及20％吐温-80).2周后处死大鼠,测定血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)水平.结果 高浓度脂肪乳剂组血清TC、TG、HDL-C及LDL-C水平与正常对照组及低浓度脂肪乳剂组比较均升高(P＜0.05),低浓度脂肪乳剂组血清TC、TG及HDL-C水平与正常对照组比较差异无统计学意义(P＞0.05).结论 高浓度脂肪乳剂可以成功建立SD大鼠高脂血症模型,低浓度脂肪乳剂不适合用于建立SD大鼠高脂血症模型.     

Impact of fluvastatin on hyperlipidemia after renal transplantation

BACKGROUND: Renal transplant recipients are at increased risk of atherosclerotic vascular disease with hyperlipidemia. Many recipients have preexisting cardiovascular disease at the time of transplantation, and immunosuppressive therapy may aggravate existing risk factors or promote development of new risk factors, notably hyperlipidemia and hypertension. Fluvastatin is one of the statins, an HMG-CoA reductase inhibitor, which has been shown to be effective in lowering cholesterol levels. We treated hyperlipidemia after renal transplantation with Fluvastatin for more than 6 months.We attempted to clarify the efficacy of fluvastatin on hyperlipidemia in renal transplant recipients. MATERIALS: Forty-five renal transplant recipients with hyperlipidemia were enrolled in this study. The mean age was 44.2 years, with 23 men and 22 women. Thirty-seven transplantations were from a living related donors and eight from cadaveric donors. Thirty-three recipients were ABO-compatible, seven recipients had minor mismatches, and five recipients were ABO-incompatible. The dose of fluvastatin was 20 mg per day. Levels of total cholesterol (TC), triglyceride (TG), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), serum creatinine (s-Cr), ALT, ALP, uric acid (UA), hematocrit (Ht), CPK, and blood pressure were examined in all recipients before treatment as well as 1, 3, and 6 months after Fluvastatin administration. RESULTS: The mean levels of TC and TG were significantly reduced from 256, to 224 and 215 mg/dL, and from 188 to 170 and 147 mg/dL at 1 and 6 months after treatment, respectively. The mean levels of HDL-C were 72 mg/dL before treatment, 81 mg/dL at 1 month, and 80 mg/dL at 6 months after treatment. The mean levels of LDL-C were 153 mg/dL before treatment, 145 mg/dL at 1 month, and 145 mg/dL at 6 months after treatment. Fluvastatin significantly produced a reduction rate in TC of 16%, TG of 22%, and LDL-C of 5% after 6 months of treatment, respectively. The mean levels of HDL-C of were increased 10% after 6 months of treatment. The serum creatinine and CPK were not significantly different. There were no clinically significant differences in other factors. No significant adverse effects were observed. CONCLUSIONS: Fluvastatin seemed to be safe and highly effective to control TC, TG, LDL-C, and HDL-C in renal transplant recipients.     

Ezetimibe effectively lowers LDL-cholesterol in cardiac allograft recipients on stable statin therapy

We investigated tolerability and efficacy of ezetimibe treatment (10 mg/d) in 25 heart allograft recipients already on stable statin therapy. Total cholesterol (TC), low-density cholesterol (LDL-C), high-density cholesterol (HDL-C), triglycerides (TG), immunosuppressant drug levels, laboratory and clinical parameters were assessed before, four months and one yr after initiation of ezetimibe treatment. Mean equivalent statin dose was 53.5 +/- 12.3 mg of pravastatin, remaining unchanged throughout the study period. Ezetimibe was generally well tolerated, only two patients (8%) discontinued ezetimibe due to stomach pain or headache. Mean TC decreased from 231.8 +/- 6.4 mg/dL before therapy to 202.2 +/- 8.8 mg/dL after four months and 192.9 +/- 7.0 mg/dL after one yr (p < 0.001). Mean LDL-C decreased from 143.1 +/- 5.4 mg/dL to 121.4 +/- 7.9 mg/dL (month 4; p < 0.05) and 107.1 +/- 5.6 mg/dL (one yr; p < 0.001). TG decreased from 182 +/- 14.3 mg/dL to 173.3 +/- 17.5 mg/dL after one yr (p < 0.05), whereas HDL-C was unchanged. Initial LDL-C and cardiac diagnosis before transplantation were identified as predictors of absolute LDL-C reduction. Immunosuppressant drug doses and blood concentrations were unchanged as well as other laboratory and clinical parameters. Ezetimibe appears safe and effective for further reduction of TC and LDL-C in heart allograft recipients already on stable statin therapy. Extent of pre-treatment LDL-C and cardiac disorder prior to transplantation appear to correlate with the efficacy of ezetimibe therapy.     

Differential impact of aging and gender on lipid and lipoprotein profiles in a cohort of healthy Chinese Singaporeans

Aim： To evaluate the impact of age and gender on lipid and lipoprotein profiles and the burden of dyslipidemia in a cohort of healthy Chinese Singaporean. Methods： A total of 1 775 healthy Chinese, 536 men and 1 239 women aged between 30 and 70 years old were involved in the present study. Results： Gender differences in all lipid and lipoprotein levels were clearly evident. Singaporean Chinese men have significantly higher levels of total cholesterol （TC）, triglyceride （TG）, low density lipoprotein-cholesterol （LDL-C） and total cholesterol/high density lipoprotein-cholesterol （TC/HDL-C）, and lower levels of HDL-C than women. Although lipid and lipoprotein levels in men did not change in the different age groups, those in women, especially TC, LDL-C and TC/HDL-C, were significantly higher in older women （〉 50 years old） than corresponding levels in younger women （30-46 years old）. Furthermore, TG was significantly correlated with lipids and lipoproteins differently in men and women. If 100 mg/dL of LDL-C were to be adopted as the therapeutic cut-off level, then the burden of care will be huge as approximately 90% of both Chinese men and women have LDL-C greater than 100 mg/dL. Condusion： In light of the findings of the present study, we suggest that preventive measures to promote the reduction in risk of coronary heart disease （CHD） must address the high proportion of men and women with high LDL-C, and that these measures should take into account both the gender and age factors. For men, reduction of high cholesterol must start early in life, whereas for women, steps must be taken earlier to mitigate the anticipated sharp increase in risk, especially after menopause.     

血脂及血管内皮功能异常在糖尿病肾脏病发病中的意义

目的 研究血脂及血管内皮功能异常在糖尿病肾脏病发病学中的意义。方法选择2008年1月至2008年12月在我院住院的糖尿病。肾脏病患者40例,为糖尿病肾脏病组（D组）,同时选择同期40名健康者,为对照组（N组）。采用PAP酶法测定2组血清总胆固醇（TC）、三酰甘油（TG）,直接法测定血清高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDLC）,免疫比浊法测定脂蛋白（a）[Lp（a）],采用放射免疫分析法测定血浆内皮素1（ET-1）,硝酸还原法测定一氧化氮（NO）。结果与N组相比,D组TC、TG、LDL-C、Lp（a）、ET-1升高（P＜0．05）,HDL-C、NO降低（P〈0．05）。结论血脂紊乱和血管内皮功能异常在糖尿病肾脏病发病中起重要作用。     

Combined treatment with low-dose pravastatin and fish oil in post-renal transplantation dislipidemia

BACKGROUND: The most common cause of post-transplant dyslipidemia is the use of corticosteroids and cyclosporin-A (CyA). The HMG-CoA reductase inhibitors have emerged as the agents of first choice in the treatment of post-transplant hyperlipidemia in combination with low fat diet. The objective of this study was to evaluate the efficacy of combined treatment with low-dose pravastatin and fish oil in post-renal transplantation dislipidemia. PATIENTS AND METHODS: Twenty-four renal transplant patients, 15 men and 9 women aged from 30 to 60 years with stable renal function were included in this study. All patients were transplanted from living related donors and were given a stable triple immunosuppressive therapy, with methylprednisolone, azathioprine and CyA. All patients were also given a standard diet containing 1 g/kg BW protein, reducing the daily fat to less than 30%, and maintaining at least a 1:1 ratio of saturated to polyunsaturated (or monounsaturated) fats. A dosage of 20 mg pravastatin (pravachol) and 1 g of fish oil (prolipid) were added to the diet after dinner, according to our protocol. Blood samples were taken after each study period for total cholesterol, LDL-cholesterol, triglycerides, Apo A(1), Apo B, Lp(a), creatinine, CPK and fibrinogen determination. RESULTS: At the end of the therapeutic protocol with pravastatin a significant reduction (p < 0.02) of total and LDL-cholesterol was observed, but no significant change in triglycerides, HDL, Lp(a), Apo A(1), Apo B and fibrinogen was shown. At the end of the therapeutic protocol with pravastatin and fish oil supplement significant changes were seen in TC (p < 0.02), TG (p < 0.03), LDL-C (p < 0.03), Apo A(1) (p < 0.04) and Apo B (p < 0.05) concentrations. There were no significant changes in HDL-C and Lp(a) concentrations. Renal function and cyclosporine levels were not changed during and after the study. CPK was increased only in one case. CONCLUSIONS: It is suggested that if the response to the diet is inadequate, the use of combined treatment with low-dose pravastatin and fish oil is a more effective strategy than the pravastatin treatment alone for changing the lipid profile after renal transplantation.     

Combined Hyperlipidemia In A Single Subject With Tetraplegia: Ineffective Risk Reduction After Atorvastatin Monotherapy

Abstract

Background/Objective: Effects of atorvastatin (Lipitor) drug monotherapy (1 0 mg daily) on fasting blood Iipid profiles and cardiovascular disease (CVD) risks were examined for a single subject with C5-C6 tetraplegia. Routine fasting Iipid profiles were analyzed by standard biochemistry techniques for total cholesterol (TC) , triglycerides (TG) , low-density lipoprotein-cholesterol (LDL-C) , and high-density lipoprotein-cholesterol (HDL-C). Lipid profiles were analyzed on 3 occasions before drug therapy was initiated and 3 months after therapy commenced. The TC:HDL and LDL:HDL ratios were computed for all sampling times and used to assess pretreatment and post-treatment CVD risk.

Results: Fasting TC, TG, and LDL-C were all significantly reduced by therapy. The pretreatment HDL-C of 3 5 mg/ dl was lowered to 21 mg/ dl. As a result, the TC:HDL risk ratiowas only marginally reduced from 6 .6 to 6.4, whereas the LDL:HDL risk ratio remained unchanged by treatment.

Conclusions: In this man with tetraplegia, atorvastatin drug monotherapy rapidly lowered TC, TG, LDL-C, and HDL-C. However, the TC: HDL ratio, considered the best predictor of CVD risk, was unchanged.     

双侧睾丸切除后动脉粥样硬化相关生化指标的变化

目的探讨男性去势手术对动脉粥样硬化相关生化指标的影响.方法对接受双侧睾丸切除手术的30例前列腺癌患者,于术前、术后1周及术后1、4、8个月分别测定血清雄激素、前列腺特异抗原及与动脉粥样硬化有关的血脂、血糖、胰岛素和纤溶酶原激活物抑制剂-1、纤维蛋白肽A等生化指标,并进行分析.结果去势术后1周,血睾酮、游离睾酮、前列腺特异抗原较术前显著降低.术后1个月甘油三酯[(1.8±0.6)mmol/L,t=-2.21,P＜0.05]、空腹胰岛素及血糖、餐后2h胰岛素及血糖开始较术前明显增高,差异有显著意义;而胰岛素敏感指数显著降低(-4.4±0.4,t=3.72,P＜0.01),差异有非常显著意义.术后4个月,总胆固醇[(6.6±1.0)mmol/L,t=3.09]、低密度脂蛋白胆固醇[(4.1±0.9)mmol/L,t=3.57]、纤溶酶原激活物抑制剂-1[(27.02±5.98)μg/L,t=2.33]、纤维蛋白肽A[(3.4±1.7)nmol/L,t=3.27]开始较术前明显增加;均P＜0.05,差异有显著意义.脱氢表雄酮、性激素结合蛋白、高密度脂蛋白胆固醇、载脂蛋白α1及载脂蛋白β、纤维蛋白原手术前后无明显改变.睾酮、游离睾酮与甘油三酯、总胆固醇、低密度脂蛋白胆固醇、纤溶酶原激活物抑制剂-1、纤维蛋白肽A、空腹胰岛素及血糖、餐后2h胰岛素及血糖水平分别呈直线负相关,睾酮、游离睾酮与胰岛素敏感指数呈直线正相关.结论雄激素水平降低对男性发生动脉粥样硬化的危险因素产生影响,从而可能增加动脉粥样硬化的发生率.