醛糖还原酶基因C-106T 多态性与原发性高血压易感性及其种族差异

目的：研究中国汉族人群中醛糖还原(AR)C-106T 基因多态性的分布情况,比较其频率分布是否存在种族差异,并探讨该多态性与原发性高血压易感性的相关性。方法：应用聚合酶链反应- 限制性片段长度多态性(polymerase chain reaction-restriction fragment length polymorphism,PCR-RFLP)的分析方法,在148位原发性高血压病人和137 位正常受试者中,对AR 基因C-106T 多态性进行基因分型。频数分布的比较采用卡方检验,基因型与高血压的关联程度采用95% 置信区间评估。结果：对照人群中AR C-106T 等位的频率为13.9%(95% CI: 11.2%~16.6%), 远低于日本人群(n=712, 18.4%, P=0.0063), 澳大利亚人群(n=240, 37.9%,P<0.0001)和巴西人群(n=62, 34.7%, P<0.0001)。高血压病例和对照人群中AR-C106T 等位基因的频率分别为15.9%(95% CI: 11.6%~20.0%)和11.7%(95% CI: 7.9%~15.5%),两组间基因型分布差异无统计学意义(P=0.147)。结论：醛糖还原酶AR 基因C-106T 多态性的频率分布具有明显的种族差异,该多态性与中国人群原发性高血压的发病风险不相关。     

高血压肥胖者血浆促动脉硬化指数与心血管疾病风险的相关性研究

［摘要］ 目的 探讨中年肥胖者血浆促动脉硬化指数（atherogenic index of plas-ma,AIP）与心血管疾病风险的相关性。 方法 随机选取高血压患者120例,根据内脏脂肪面积分为肥胖组和非肥胖组;根据Framingham风险评分将患者分为高危组、中危组和低危组。比较各组AIP、年龄、腰臀脂肪比、血压、体重指数、血糖和血脂,分析高血压肥胖患者AIP与心血管疾病风险的相关性。 结果 高血压肥胖组AIP、腰臀脂肪比、收缩压、空腹血糖、总胆固醇、三酰甘油明显高于高血压非肥胖组,差异有统计学意义(P＜0.05)。中危组和高危组腰臀脂肪比、收缩压、体重指数、AIP均明显高于低危组,高危组腰臀脂肪比、收缩压、体重指数、AIP均明显高于中危组,差异有统计学意义(P＜0.05)。Spearman秩相关分析结果显示,AIP与心血管因素呈正相关（P＜0.05）。 结论 高血压肥胖者患者均有明显的血脂紊乱和高AIP值以及10年心血管风险,AIP可作为患者心血管疾病风险的重要危险因素。     

血管紧张素原M235T基因多态性与原发性高血压的相关研究

目的:探讨浙江汉族人群中血管紧张素原(AGT)基因M235T变异与原发性高血压的关系.方法:对116例高血压病患者与114名正常血压者进行对照研究.采用聚合酶链式反应(PCR)与限制性片段长度多态性(RFLP)技术检测AGT基因M235T变异.同时测量血压、身高、体重、空腹血糖与血脂.结果:①高血压组收缩压与舒张压水平显著高于对照组(P＜0.01);而两组间年龄、性别、体重指数、血糖与血脂差异无显著性(P＞0.05).②经PCR扩增及Tth 111 I酶切,AGT基因型有三种形式:MM、TT与MT基因型.两组AGT基因型的分布均符合Hardy-Weinberg 平衡.③AGT基因M235T基因型在高血压组与对照组的分布差异有显著性(χ2=6.966,P＜0.05).高血压组TT基因型与T235等位基因的频率高于对照组(TT基因型:0.47 vs 0.33,χ2=5.36,P＜0.05;T235等位基因:0.71 vs 0.60,χ2=6.179,P＜0.05).结论:在浙江汉族人群中,AGT基因M235T变异与原发性高血压的发病显著相关,TT基因型或T235等位基因可能是高血压的一个遗传方面的危险因素.     

Thiazolidinediones and cardiovascular outcomes in older patients with diabetes

Lorraine L. Lipscombe, MD, MSc; Tara Gomes, MHSc; Linda E. Lévesque, BScPhm, MSc; Janet E. Hux, MD, MSc; David N. Juurlink, BPhm, MD, PhD; David A. Alter, MD, PhD

JAMA. 2007;298(22):2634-2643.

Context  Thiazolidinediones (TZDs), used to treat type 2 diabetes, are associated with an excess risk of congestive heart failure and possibly acute myocardial infarction. However, the association between TZD use and cardiovascular events has not been adequately evaluated on a population level.

Objective  To explore the association between TZD therapy and congestive heart failure, acute myocardial infarction, and mortality compared with treatment with other oral hypoglycemic agents.

Design, Setting, and Patients  Nested case-control analysis of a retrospective cohort study using health care databases in Ontario. We included diabetes patients aged 66 years or older treated with at least 1 oral hypoglycemic agent between 2002 and 2005 (N = 159 026) and followed them up until March 31, 2006.

Main Outcome Measures  The primary outcome consisted of an emergency department visit or hospitalization for congestive heart failure; secondary outcomes were an emergency department visit or hospitalization for acute myocardial infarction and all-cause mortality. The risks of these events were compared between persons treated with TZDs (rosiglitazone and pioglitazone) and other oral hypoglycemic agent combinations, after matching and adjusting for prognostic factors.

Results  During a median follow-up of 3.8 years, 12 491 patients (7.9%) had a hospital visit for congestive heart failure, 12 578 (7.9%) had a visit for acute myocardial infarction, and 30 265 (19%) died. Current treatment with TZD monotherapy was associated with a significantly increased risk of congestive heart failure (78 cases; adjusted rate ratio [RR], 1.60; 95% confidence interval [CI], 1.21-2.10; P < .001), acute myocardial infarction (65 cases; RR, 1.40; 95% CI, 1.05-1.86; P = .02), and death (102 cases; RR, 1.29; 95% CI, 1.02-1.62; P = .03) compared with other oral hypoglycemic agent combination therapies (3478 congestive heart failure cases, 3695 acute myocardial infarction cases, and 5529 deaths). The increased risk of congestive heart failure, acute myocardial infarction, and mortality associated with TZD use appeared limited to rosiglitazone.

Conclusion  In this population-based study of older patients with diabetes, TZD treatment, primarily with rosiglitazone, was associated with an increased risk of congestive heart failure, acute myocardial infarction, and mortality when compared with other combination oral hypoglycemic agent treatments.

     

载脂蛋白B基因多态性与冠心病的关联研究

目的 探讨载脂蛋白B(apolipoprotein B,ApoB)基因-516C/T多态性与冠心病易感性的关系.方法 采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法检测162例冠状动脉粥样硬化性心脏病(简称冠心病)患者(冠心病组)和186名对照者(对照组)的ApoB基因-516C/T基因型和等位基因的分布,并进行对比分析及相关性分析.结果 基因型鉴定结果显示,两组均存在CC型、TT型及CT型基因;冠心病组ApoB基因T等位基因和TT基因型的频率(分别为29.01%、12.96%)均明显高于对照组(19.35%、4.84%),差异均有统计学意义(P<0.05或0.01);回归分析显示,T等位基因携带者较非携带者罹患冠心病的危险性显著增加(P<0.01).此外,对照组中T等位基因携带者血清总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)水平均明显高于非携带者(均P<0.05).结论 ApoB基因-516C/T多态性与冠心病的易感性相关,T等位基因可能是冠心病发病的一个危险的遗传因素.     

高血压合并T2DM患者大血管病变的影响因素分析

目的 探讨高血压合并2型糖尿病(T2DM)患者大血管病变的影响因素。方法 回顾性分析南昌市第三医院2018年1月～2019年12月收治的200例高血压合并T2DM患者临床病历资料,根据是否发生大血管病变分为大血管病变组(MA组)和无大血管病变组(非MA组)。收集两组临床病历资料,找出高血压合并T2DM患者发生大血管病变的影响因素,并进行多因素分析。结果 单因素分析显示,T2DM病程、吸烟、收缩压(SBP)、空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)可能是高血压合并T2DM患者发生大血管病变的影响因素(P0.05);经多因素Logistic回归分析,T2DM病程、吸烟、SBP、FPG、2 hPG、Hb Alc、TG、LDL-C可使高血压合并T2DM患者发生大血管病变的危险增加2.915(1.575～5.393)倍、3.013(1.501～6.048)倍、1.862(1.024～3.387)倍、4.354(2.108～8.992)倍、1.984(1.073～3.668)倍、2.048(1.123～3.734)倍、1.965(1.068～3.618)倍、1.926(1.057～3.509)倍。结论 T2DM病程、吸烟、SBP、FPG、2 hPG、HbAlc、TG、LDL-C是高血压合并T2DM患者发生大血管病变的独立危险因素,故积极控制患者血压、血糖、改善饮食、加强戒烟管理对预防高血压合并T2DM患者发生大血管病变具有重要意义。     

早发冠心病患者甲烯四氢叶酸还原酶基因的C677T多态性研究

目的探讨同型半胱氨酸代谢过程的关键酶之一——甲烯四氢叶酸还原酶（ＭＴＨＦＲ）基因Ｃ６７７Ｔ多态性与早发冠心病发病的关系。方法采用限制性内切酶片段长度多态性方法检测患者的ＭＴＨＦＲ基因Ｃ６７７Ｔ位碱基突变。结果６７例患者中Ｔ纯合基因型占３４．３％（２３／６７）、杂合基因型占４３．３％（２９／６７）,Ｃ纯合基因型占２２．４％（１５／６７）;Ｔ等位基因频率为５５．９％（７５／１３４）,Ｃ等位基因频率为４４．１％（５９／１３４）;与正常对照组比较,差异均有显著性意义（Ｐ＜０．０５）。结论ＭＴＨＦＲ基因Ｃ６７７Ｔ点突变可能是中国人早发冠心病发病的危险因素之一。     

微量清蛋白尿与原发性高血压患者心血管事件的相关性研究

目的探讨原发性高血压患者微量清蛋白尿（MAU）的出现与心血管事件的相关性。方法入选2010年1月至2010年12月收治的高血压患者122例,调查患者的相关危险因素包括性别、年龄、平均动脉压、病程、糖尿病、吸烟、体质量指数（BM I）、低密度脂蛋白（LDL-C）水平,以及合并心血管事件（心力衰竭、急性冠脉综合征、脑卒中）,以免疫比浊法测定患者24 h尿微量清蛋白,再按尿微量清蛋白检测结果进行分组：正常清蛋白尿组（〈30.0 mg/24 h）和微量清蛋白尿组（30.0~300 mg/24 h）,比较两组危险因素及心血管事件。结果两组危险因素无明显差别,而微量清蛋白尿组心血管事件（急性冠脉综合征、心力衰竭、脑卒中）的发病率显著高于正常清蛋白尿组（P〈0.05）。对心血管事件危险因素的多因素分析提示MAU是独立的危险因素。结论微量清蛋白尿是高血压患者心血管事件独立的预测因子和危险因素。     

高血压患者不良生活习惯与心血管疾病死亡和全因死亡风险关系的研究

目的 探讨吸烟对饮酒高血压患者心血管疾病死亡(CVDM)和全因死亡(ACM)风险的影响,分析吸烟量和饮酒量同时升高对饮酒高血压患者死亡和全因死亡风险是否存在协同作用.方法 选取2004年1~12月我院老年病科诊治的饮酒高血压患者1000例.收集所有患者的人口统计学信息、吸烟信息及个人疾病史等资料,随访记录患者的CVDM和ACM.采用COX比例风险模型分析吸烟指标对饮酒高血压患者CVDM和ACM风险的影响.结果 在CVDM风险和ACM发生风险方面:每日吸烟量>10支高于1~10支,累计吸烟量≥20包/年高于0.1~19包/年,吸烟年限>35年高于1~35年,开始吸烟年龄<20岁高于>20岁,差异均具有统计学意义(P<0.05);当每日饮酒量>200 ml/d,累计饮酒量≥20(盅/年),饮酒年限>35年或饮酒开始年龄≤20岁患者的CVDM风险分别为RR=2.352、2.693、2.254、2.336;ACM风险分别为RR=3.092、2.346、1.936、2.018.结论 吸烟可增加饮酒高血压患者CVDM和ACM风险,风险的大小与吸烟量和吸烟年限呈剂量反应关系;饮酒量和吸烟量同时升高可进一步增加此风险.     

Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial

Context  The worldwide explosive increase in type 2 diabetes mellitus and its cardiovascular morbidity are becoming major health concerns. Objective  To evaluate the effect of decreasing postprandial hyperglycemia with acarbose, an -glucosidase inhibitor, on the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance (IGT). Design, Setting, and Participants  International, multicenter double-blind, placebo-controlled, randomized trial, undertaken in hospitals in Canada, Germany, Austria, Norway, Denmark, Sweden, Finland, Israel, and Spain from July 1998 through August 2001. A total of 1429 patients with IGT were randomized with 61 patients (4%) excluded because they did not have IGT or had no postrandomization data, leaving 1368 patients for a modified intent-to-treat analysis. Both men (49%) and women (51%) participated with a mean (SD) age of 54.5 (7.9) years and body mass index of 30.9 (4.2). These patients were followed up for a mean (SD) of 3.3 (1.2) years. Intervention  Patients with IGT were randomized to receive either placebo (n = 715) or 100 mg of acarbose 3 times a day (n = 714). Main Outcome Measures  The development of major cardiovascular events (coronary heart disease, cardiovascular death, congestive heart failure, cerebrovascular event, and peripheral vascular disease) and hypertension (=" BORDER="0">140/90 mm Hg). Results  Three hundred forty-one patients (24%) discontinued their participation prematurely, 211 in the acarbose-treated group and 130 in the placebo group; these patients were also followed up for outcome parameters. Decreasing postprandial hyperglycemia with acarbose was associated with a 49% relative risk reduction in the development of cardiovascular events (hazard ratio [HR], 0.51; 95% confidence interval [CI]; 0.28-0.95; P = .03) and a 2.5% absolute risk reduction. Among cardiovascular events, the major reduction was in the risk of myocardial infarction (HR, 0.09; 95% CI, 0.01-0.72; P = .02). Acarbose was also associated with a 34% relative risk reduction in the incidence of new cases of hypertension (HR, 0.66; 95% CI, 0.49-0.89; P = .006) and a 5.3% absolute risk reduction. Even after adjusting for major risk factors, the reduction in the risk of cardiovascular events (HR, 0.47; 95% CI, 0.24-0.90; P = .02) and hypertension (HR, 0.62; 95% CI, 0.45-0.86; P = .004) associated with acarbose treatment was still statistically significant. Conclusion  This study suggests that treating IGT patients with acarbose is associated with a significant reduction in the risk of cardiovascular disease and hypertension.      

老年心血管疾病的外科治疗

目的：总结老年心血管疾病的外科治疗特点。方法：回顾分析1994年1月至2004年9月间，在我科手术的60岁以上老年心血管疾病患者138例，对其病变特征、手术方式、体外循环管理及围手术期处理进行讨论。结果：术后出现并发症23例（16．7％），死亡7例（5．1％），其中3例死于严重术后低心排血量，4例术后死于多器官功能衰竭综合征。随访109例（78．9％），术后心功能和生活质量明显改善。结论：高龄是心血管外科治疗的高危因素之一，但并非手术禁忌，严格掌握手术适应证、选择适当手术方式、加强术中心肌保护和围手术期处理是提高手术治疗效果的关键。     

The association of cardiovascular disease with impaired health-related quality of life among patients with type 2 diabetes mellitus

INTRODUCTION

The aim of this study was to evaluate the health-related quality of life (HRQoL) of Malaysian patients with type 2 diabetes mellitus (T2DM) who have cardiovascular disease (CVD), as well as identify the determinants of HRQoL among this cohort of patients.

METHODS

This study was an analytical cross-sectional study involving 313 patients aged 30–78 years (150 men, 163 women; mean age 55.7 ± 9.2 years) who were diagnosed with T2DM (mean duration of T2DM 10.1 ± 8.1 years) at two tertiary Malaysian government hospitals. The patients’ sociodemographic, lifestyle, clinical and laboratory data were collected prospectively from medical records and via face-to-face interviews. HRQoL was assessed using the 15D instrument – a generic, 15-dimensional and standardised measure of HRQoL that can be used as both a profile and a single index score measure.

RESULTS

T2DM patients with CVD were found to have significantly lower 15D HRQoL scores than their non-CVD counterparts (p < 0.001). The HRQoL of T2DM patients with CVD was significantly lower than those without CVD (p < 0.05) in all of the 15 dimensions of the 15D instrument. Multinomial logistic regression analysis using backward stepwise method revealed a significant association between CVD and impaired HRQoL (odds ratio [OR] 11.746, 95% confidence interval [CI] 4.898–28.167). Age (OR 1.095, 95% CI 1.054–1.137), duration of T2DM (OR 1.085, 95% CI 1.032–1.140), ethnicity (OR 0.411, 95% CI 0.187–0.903), body mass index (OR 1.074, 95% CI 1.006–1.148), and physical activity level (OR 3.506, 95% CI 1.415–8.689) were also significant predictors of HRQoL.

CONCLUSION

In T2DM patients, the presence of CVD was significantly associated with a lower HRQoL. Therefore, the importance of tertiary prevention to minimise the potential deterioration of the HRQoL of T2DM patients with CVD should be highly emphasised.     

Reduction of iron stores and cardiovascular outcomes in patients with peripheral arterial disease: a randomized controlled trial

Context  Accumulation of iron in excess of physiologic requirements has been implicated in risk of cardiovascular disease because of increased iron-catalyzed free radical–mediated oxidative stress. Objective  To test the hypothesis that reducing body iron stores through phlebotomy will influence clinical outcomes in a cohort of patients with symptomatic peripheral arterial disease (PAD). Design, Setting, and Patients  Multicenter, randomized, controlled, single-blinded clinical trial based on the Iron (Fe) and Atherosclerosis Study (FeAST) (VA Cooperative Study #410) and conducted between May 1, 1999, and April 30, 2005, within the Department of Veterans Affairs Cooperative Studies Program and enrolling 1277 patients with symptomatic but stable PAD. Those with conditions likely to cause acute-phase increase of the ferritin level or with a diagnosis of visceral malignancy within the preceding 5 years were excluded. Analysis was by intent-to-treat. Intervention  Patients were assigned to a control group (n = 641) or to a group undergoing reduction of iron stores by phlebotomy with removal of defined volumes of blood at 6-month intervals (avoiding iron deficiency) (n = 636), stratified by hospital, age, and baseline smoking status, diagnosis of diabetes mellitus, ratio of high-density to low-density lipoprotein cholesterol level, and ferritin level. Main Outcome Measures  The primary end point was all-cause mortality; the secondary end point was death plus nonfatal myocardial infarction and stroke. Results  There were no significant differences between treatment groups for the primary or secondary study end points. All-cause deaths occurred in 148 patients (23%) in the control group and in 125 (20%) in the iron-reduction group (hazard ratio (HR), 0.85; 95% confidence interval (CI), 0.67-1.08; P = .17). Death plus nonfatal myocardial infarction and stroke occurred in 205 patients (32%) in the control group and in 180 (28%) in the iron-reduction group (HR, 0.88; 95% CI, 0.72-1.07; P = .20). Conclusion  Reduction of body iron stores in patients with symptomatic PAD did not significantly decrease all-cause mortality or death plus nonfatal myocardial infarction and stroke. Trial Registration  clinicaltrials.gov Identifier: NCT00032357