高血压病左室结构功能变化与血浆内皮素的相关性

目的 :探讨高血压病患者左室结构 ,功能变化与血浆内皮素 （ET）的关系。方法 :原发性高血压不伴左室肥厚（L VH）组 （EH） 35例 ,伴 L VH组 （EH+ L VH） 2 8例 ,正常对照组 30例。放射免疫法测定血浆 ET水平 ,超声心动图检测心脏结构与功能。计算左室重量指数 （L VMI） ,平均室壁厚度 （MWT） ,相对室壁厚度 （RWT）。结果 :EH组及 EH+ L VH组血浆 ET高于正常对照组 （P<0 .0 1） ,EH + L VH组 ET高于 EH组 （P<0 .0 1） ,ET与 L VMI,MWT室间隔厚度 ,左室后壁厚度呈正相关 （r分别为 0 .42 4,0 .316 ,0 .2 6 8和 0 .317,均 P<0 .0 1） ,ET与 E/ A呈负相关 （r=-0 .30 4,P<0 .0 1）。结论 :ET与高血压和 L VH相关。     

高血压病患者血浆神经肽Y、神经降压素水平的变化及意义

目的 :观察高血压病患者血浆神经肽 Y（NPY）、神经降压素 （NT）水平的变化 ,探讨其在高血压发病机制中的作用及其与高血压靶器官损害的关系。方法 :用放射免疫分析法检测符合高血压病诊断标准的 80例高血压病患者血浆 NPY,NT浓度 ,同时检查患者心、肾等靶器官功能。结果 :1高血压病患者血浆 NPY水平高于对照组 （P<0 .0 5 ）、而 NT水平明显低于对照组 （P<0 .0 1）。 2高血压病 , , 期患者间血浆 NPY,NT水平差异明显 （P<0 .0 1） ,NPY水平逐渐升高 ,而 NT水平逐渐下降。心功能 , , 级高血压病患者间 NPY,NT水平差异明显 （P<0 .0 1） ,随心功能恶化 ,NPY水平升高 ,而 NT水平降低。伴有室间隔和 （或 ）左室后壁肥厚组血浆 NPY水平高于室间隔和左室后壁正常组 （P<0 .0 1） ,而 NT水平则肥厚组低于正常组 （P<0 .0 1）。肾功能 Ccr≤ 4 9m l/ min组血浆NPY水平高于 Ccr≥ 5 0 m l/ min组 （P<0 .0 1） ,二组间 NT水平无明显差异 （P>0 .0 5 ）。 3高血压病患者血浆 NPY与 NT水平呈负相关 （r=- 0 .4 5 ,P<0 .0 1）。结论 :NPY,NT参与了高血压病的发病过程 ,与高血压病患者心脏、肾脏功能损害程度相关 ,观察血浆 NPY与 NT水平变化有助于判断高血压病患者的病情和预后     

硝苯啶对老年高血压病患者左室肥厚减退作用的长期观察

24例老年高血压病 期患者 ,服用硝苯啶 4年以上。服药前经超声心动图检查 ,证实有左室肥厚。服药 2年后 ,收缩压、舒张压、左室重量 (L VM)与左室重量指数 (L VMI)都有显著的降低 ,左室收缩与舒张功能有所改善。服药 4年后 ,收缩压与舒张压继续有所下降 ,但 L VM与 L VMI有所回升 ,与治疗前相比 ,则无显著差异。表明经硝苯啶 4年治疗 ,左室肥厚程度保持原有水平 ,左室收缩与舒张功能获得改善     

替米沙坦改善原发性高血压病患者心肌肥厚及早期肾功能失调

目的:评估替米沙坦在高血压病靶器官损害中的保护作用。方法:轻中度原发性高血压病左室肥厚患者60例服用替米沙坦40～80mg/d,共26周,服药前后行超声心动图,观察舒张末期室间隔厚度（IVST）,舒张末期左心室后壁厚度（LVPWT）及A/E比值的变化;并计算左室心肌质量指数（LVMI）的改变;同时放射免疫分析法测量血β2微球蛋白（β2MG）、尿β2MG含量。结果:替米沙坦能有效降低血压,降压有效率为72%,治疗后LVMI降低（146±12vs123±10）（P<0.01）,A/E值改善（P<0.05）,血、尿β2MG水平降低。结论:替米沙坦在降低血压同时能够有效地保护心肾功能。     

老年高血压病患者血浆神经肽Y、神经降压素水平变化与心肾功能损害的相关分析

目的观察老年高血压病患者血浆神经肽Y（NPY）、神经降压素（NT）水平变化与心肾功能损害的关系。方法选择符合高血压病诊断标准的解放军总医院第一附属医院住院的老年患者57（男性36，女性21）例，年龄60～88（71．3±6．8）岁，选择23（男16，女7）例老年健康查体者或健康志愿者作为对照组，年龄60～76（65．5±6．6）岁。用彩色超声心动图检查患者心脏结构和功能。测定内生肌酐清除率（Ccr）评价患者肾功能。用放射免疫分析法检测血浆NPY、NT浓度。结果（1）老年高血压病患者血浆NPY水平（159±56）pg／ml高于老年对照组（123±54）pg／ml（t=-2．585，P〈0．05），而NT水平（66±31）pg／ml明显低于对照组（101±19）pg／ml（t=2．617，P〈0．01）。（2）将老年高血压病患者按左室射血分数（LVEF）分为3组（1组：LVEF≥55％，2组：LVEF=41％～54％，3组：LVEF≤40％）。3组间NPY、NT浓度均差异明显（F=12．36，P〈0．01，F=4．92，P〈0．05），随心功能恶化，NPY水平升高，而NT水平降低。伴有左室肥厚[室间隔≥11mm和（或）左室后壁≥11mm为左室肥厚]组血浆NPY水平（177±52）pg／ml高于室间隔和左室后壁正常组（135±47）pg／ml（t=-2．84，P〈0．01），而NT水平则肥厚组（56±25）pg／ml低于正常组（94±31）pg／ml（t=4．74，P〈0．01）。（3）将患者按其肾功能，Ccr≥50ml／min和Ccr≤49ml／min分为两组，Ccr≤49ml／min组血浆NPY水平（187±53）pg／ml高于Ccr≥50ml／min组（148±55）pg／ml（t=-1．978，P〈0．05）。NT水平二组分别为（61±29）pg／ml和（69±33）pg／ml，比较未显示出明显差异（t=0．991，P〉0．05）。结论老年高血压病患者血浆NPY、NT水平变化与患者心肾功能损害程度相关，观察血浆NPY、NT水平变化有助于判断老年高血压病患者的病情和预后。     

高血压病患者淋巴细胞肾上腺素能β2受体密度与心脏不同几何构型的关系

目的 :研究高血压病患者外周血淋巴细胞 β2 受体密度与心脏不同几何构型之间的关系。方法 :采用放射性配基结合分析法 ,测定不同心脏构型高血压病患者 91例外周血淋巴细胞的 β2 受体密度 ,并与正常人 31例对照。结果 :与对照组比较 ,向心性重构 （CCR）及向心性肥厚 （CCH）组 β2 受体密度显著增加 ,离心性肥厚 （ECH）组 β2 受体密度显著减少 ,而正常几何构型 （NG）组无明显变化。结论 :高血压病患者外周血淋巴细胞 β2 受体密度与其心脏的几何构型有关。     

脉压变异性与高血压靶器官损害的相关性分析

目的探讨脉压变异性与高血压靶器官损害的关系。方法搜集近5年住我院未曾治疗的高血压病患者192例(男101例,女91例),以脉压变异性(PPV)<10mmHg、10≤PPV<15mmHg、PPV≥15mmHg分为3个组。分析各组的PPV与尿素氮(BUN)、血清肌酐(Cr)、血清尿素(UA)、内生肌酐清除率(Ccr)、左室质量指数(LVMI)、室间隔厚度(IVSd)、后壁厚度(PWd)、主动脉起始段内径(AoD)、冠状动脉左前降支(LAD)、左室舒张期内径(LVDd)、左室射血分数(LVEF)、左室短轴缩短率(FS)及心脑并发症发生率的相关性。结果①PPV与年龄、BUN、Cr、UA、收缩压(SBP)、舒张压(DBP)、脉压(PP)、LVMI呈正相关(P均<0.05),而与Ccr、FS、LVEF呈负相关(P均<0.05)。②左室肥厚、心功能不全、心电图异常及脑并发症的发生率与患者年龄、SBP、DBP、PP、PPV有关(P均<0.05),差异有统计学意义。结论高血压病患者PPV增大,可促进心脏、脑及肾脏等靶器官损害。提示高血压病患者中PPV也是预测心脏、脑及肾脏损害有价值的指标。控制PPV可以减轻高血压病患者靶器官的损害。     

高血压患者心脏重构与早期肾功能损害及脂联素的相关性探讨

目的 探讨老年高血压(EH)患者心脏重构与早期肾功能损害及脂联素的相关性.方法 老年高血压病患者221例、老年正常对照组116名均采静脉血测定血尿素氮(BUN)、血肌酐(Cr)及脂联素(APN),留24 h尿测定尿微量白蛋白,并计算内生肌酐清除率(Ccr).所有患者行心脏超声检测,测量舒张期末左室内径(LV)、舒张期末左室后壁厚度(LVPW)、舒张期末室间隔厚度(IVS),计算左室重量指数(LVMI).结果 EH早期肾功能损害组的IVS、LVPW、LVM、LVMI和脂联素均显著高于肾功能正常组(P<0.05).在30 mL/min≤Ccr<60 mL/min组与Ccr≥90 mL/min组比较,LVPW、LVM、LVMI和脂联素显著增大(P<0.05),而LV和IVS无统计学意义(P>0.05);3组间两两比较,各指标无统计学差异(P>0.05).EH的左室重构组中尿白蛋白的排泄率显著高于无左室重构组(P<0.05),Ccr显著低于无左室重构组(P<0.05),而BUN、Cr无统计学意义(P>0.05).结论 高血压早期肾功能损害对心血管重构有显著影响;肾功能是脂联素的显著调节因素,而低脂联素血症是心血管疾病的预测因素.     

糖尿病早期肾损害对左室重塑的影响

目的：探讨糖尿病早期肾功能损害对左室重塑的影响。方法：124例糖尿病患者根据尿微量白蛋白水平分别分为肾功能正常组（n=68）和早期肾功能损害组（n=56），比较左室结构的变化和左室肥厚的发生率。结果：早期肾功能损害组的左室后壁厚度（LVPWT）、左室质量（LVM）和左室质量指数（LVMI）较肾功能正常组明显增加，其数值分别为（9．0±1．2）mm：（8．3±1．0）mm、（159±2）g：（11±5）g和（43±2）：（30±1），P均〈0．05。早期肾功损害组左室肥厚（LVH）的发生率为21．9％，显著高于肾功能正常组的（2．3％），P〈0．05。结论：糖尿病早期肾功能损害对左室重构有显著影响，对糖尿病患者积极预防早期肾功能损害能减少左室重构的发生。     

老年高血压病患者血尿酸水平及其他心血管相关因素

目的 观察老年高血压病患者血尿酸,血脂,胰岛素抵抗指数和内生肌酐清除率等相关因素,探讨血尿酸在老年高血压病患者中的临床意义。方法 老年高血压病组78例（A组）,中青年高血压病组57例（B组）,老年健康对照组41例（C组）。测量体质量指数（BMI）,腰围（WC）,腰臀比（WHR）,检测血尿酸（SUA）,总胆固醇（TC）,三酰甘油（TG）,高密度脂蛋白胆固醇（HDL-C）,低密度脂蛋白胆固醇（LDL-C）,空腹血糖(FBG),空腹胰岛素水平（FIn）,计算胰岛素抵抗指数（HOMA-IR）,血肌酐(Scr),计算内生肌酐清除率（Ccr）。结果 高尿酸血症发生率分别为A组:23%,B组:28%,C组:2%。A组与C组比较,A组BMI、WHR、SUA、TG、TC、SBP、DBP、FIn、HOMA-IR均明显升高,A组Ccr、HDL-C低于C组,具有统计学意义（P<0.05）; A组与B组比较,A组WHR、FIn、HOMA-IR、Ccr、DBP低于B组,具有统计学意义（P<0.05）。结论 高血压病患者高尿酸血症发生率明显升高,血尿酸可作为高血压病患者临床评估的重要指标之一。     

Glucose and insulin concentration in amniotic fluid and in maternal blood in early and in late pregnancy

Glucose concentration in the amniotic fluid decreases towards the end of gestation, whereas the insulin concentration increases. The ratio between fetal (amniotic fluid) glucose to maternal glucose is reduced by about 50% at the end of pregnancy, whereas the ratio of C peptide is increased four times. The higher glucose concentration in amniotic fluid in early pregnancy could be explained by a lower fetal metabolic rate in the early stage of development and a low insulin activity of the fetus.     

Osteoporosis in celiac disease and in endocrine and reproductive disorders

As the increase in lifespan brings to light diseases that were previously not clinically detectable, osteoporosis has become an issue of worldwide significance. The disease is marked by a loss of bone mass; the bones become less dense, fragile and more prone to fracturing. Because it is regulated by endocrine and environmental factors, osteoporosis presents a multifactorial etiopathogenesis, with the genetic component accounting for 70% of an individual variation in bone mass density （BMD）, the principal determinant, with age, of fracture risk. Pathological conditions such as celiac disease （CD） exacerbate the process of bone loss, so that the occurrence of osteoporosis in celiac subjects is of particular note： indeed, the screening of osteoporosis patients for this disease is advisable, since it may be the only sign of undiagnosed CD. An increase in interleukin IL-1β, of the IL-1 system, in the relatives of celiac patients confirms the genetic predisposition to osteoporosis and its presence is evidence of an association between the two conditions. The direct effect on the bones of CD is secondary to poor absorption of calcium and vitamin D. In women osteoporosis is indirectly associated with early menopause and amenorrhea, and it may follow prolonged breast-feeding and frequent pregnancies, while in men it is associated with hypogonadism and GH deficit. These endocrine and non-endocrine factors exert their effects on bones by modulating the RANK/RANK-L/OPG system. An appropriate lifestyle from adolescence onwards, together with early diagnosis of and treatment for CD and primaryand secondary endocrine pathologies are important for the prevention of damage to the bones.     

Anti-malarial efficacy of pyronaridine and artesunate in combination in vitro and in vivo

Pyronaridine is a Mannich base anti-malarial with demonstrated efficacy against drug resistant Plasmodium falciparum, P. vivax, P. ovale and P. malariae. However, resistance to pyronaridine can develop quickly when it is used alone but can be considerably delayed when it is administered with artesunate in rodent malaria models. The aim of this study was to evaluate the efficacy of pyronaridine in combination with artesunate against P. falciparum in vitro and in rodent malaria models in vivo to support its clinical application. Pyronaridine showed consistently high levels of in vitro activity against a panel of six P. falciparum drug-sensitive and resistant strains (Geometric Mean IC50=2.24 nM, 95% CI=1.20-3.27). In vitro interactions between pyronaridine and artesunate showed a slight antagonistic trend, but in vivo compared to pyronaridine and artesunate administered alone, the 3:1 ratio of the combination, reduced the ED90 of artesunate by approximately 15.6-fold in a pyronaridine-resistant P. berghei line and by approximately 200-fold in an artesunate-resistant line of P. berghei. Complete cure rates were achieved with doses of the combination above or equal to 8 mg/kg per day against P. chabaudi AS. These results indicate that the combination had an enhanced effect over monotherapy and lower daily doses of artesunate could be used to obtain a curative effect. The data suggest that the combination of pyronaridine and artesunate should have potential in areas of multi-drug resistant malaria.     

Differentiation pathways in carcinogenesis and in chemo- and radioresistance

Cancer stem cells (CSCs) share many features with embryonic stem cells (ESCs) such as the ability for self-renewal and differentiation. Signaling pathways that are involved in these processes are also involved in chemo- and radioresistance (e.g. Wnt, Notch and Hedgehog pathways). This review is focused on the influence of three important differentiation pathways on carcinogenesis and on chemo- and radioresistance in ESCs and CSCs.     

Telemedicine and Advances in Urban and Rural Healthcare Delivery in Africa

Telecardiology holds great promise for Africa, from tele-echocardiography and tele-ECG s, to home monitoring and text messaging for medication adherence monitoring. The burden of disease is great and there is an extreme shortage of health professionals. Telemedicine can provide access to scarce specialist care, improve the quality of care in rural areas and reduce the need for rural patients to travel to seek medical attention. International cross border service can alleviate the shortage of doctors. But telecardiology, and telemedicine uptake in general, has been poor in Africa. Legal and ethical issues around local and cross border telemedicine have not been resolved. The literature was reviewed and obstacles to telemedicine in Africa and current telemedicine activities in Africa, are described. There are few sustained telemedicine services in Africa with the exception of tele-education. There is an expectation that mobile phones will facilitate a range of telemedicine activities in Africa. Africa needs telemedicine.