右美托咪定联合远隔缺血预处理对心肌缺血/再灌注损伤的影响

目的 研究右美托咪定联合远隔缺血预处理对心肌缺血/再灌注损伤（MI/RI）的影响以及探讨其对细胞凋亡的影响 方法 选取80例择期体外循环下行心脏瓣膜术病患，随机分成4组(n = 20)；对照组（C组）, 远隔缺血预处理组（R组），右美托咪定组（D组），右美托咪定联合远隔缺血预处理组(DR组)；R组于麻醉诱导后行上肢缺血预处理，D组将盐酸右美托咪定以1 μg/kg负荷剂量泵注10 min后以0.41 μg/ (kg·h)注入至手术结束，DR组联合应用D组和R组两种方法；测主动脉阻断前（T₀）、体外循环结束时（T₁）和结束手术后（T₂）血浆肌钙蛋白I(cTnI)浓度。检测T₀和T₁ 时Bcl-2和Bax蛋白含量及计数心肌细胞凋亡指数（AI）。 结果 T₁和T₂时，与对照组比较，各组血浆cTnI均降低(P<0.05)。与阻断主动脉前相比，体外循环结束后4组心肌组织Bcl-2、Bax蛋白值含量和AI均升高，Bcl-2/Bax下降（P<0.05）；与C组比较，D组、R组和DR组Bcl-2、Bcl-2/Bax均增高，Bax和AI降低（P<0.05）；与R组、D组比较，DR组Bcl-2、Bcl-2/Bax升高，Bax和AI降低（P<0.05）。 结论 右美托咪定与远隔缺血预处理均能减轻MI/RI，二者联合作用优于单独使用，其机制可能与抑制细胞凋亡有关。     

远程缺血预处理对移植肾缺血再灌注损伤的保护作用

移植肾缺血再灌注损伤是一个不可避免的过程,不仅影响移植肾功能早期恢复,还可影响移植肾长期功能和生存率。至今尚缺乏有效措施减少缺血/再灌注引起的损伤。远程缺血预处理可通过机体内源性保护机制提高肾脏对缺血/再灌注损伤的抵抗力,有望成为防治缺血再灌注损伤的新策略。     

Effect of coffee consumption on dyslipidemia: A meta-analysis of randomized controlled trials

Background and aimDyslipidemia is a common metabolic disease worldwide and also an important predisposing factor for cardiovascular diseases (CVDs). Coffee is loved by people all over the world; however, the association between coffee consumption and blood lipids has yielded inconsistent results. So we carried this meta-analysis to explore the effects of coffee consumption on blood lipids.Methods and resultsMedline, PubMed, Web of science, Embase, and Cochrane Library databases were systematically searched until April 2020. Combined weighted mean differences (WMD) with their 95% confidence interval (CI) were calculated using random-effects models, and between-study heterogeneity was assessed by Cochran's Q test and I² statistics. Subgroup analysis and meta-regression analysis were also conducted to explore the potential heterogeneity. A total of 12 RCT studies involving the association between coffee consumption and blood lipid levels were included in the meta-analysis. The pooled results showed that coffee consumption significantly increased total cholesterol (TC) (WMD: 0.21 mmol/L, 95% CI: 0.04; 0.39, P = 0.017), triglyceride (TG) (WMD: 0.12 mmol/L, 95% CI: 0.03; 0.20, P = 0.006) and low-density lipoprotein (LDL-C) (WMD: 0.14 mmol/L, 95% CI: 0.05; 0.24, P = 0.003) while had no significant effect on high-density lipoprotein (HDL-C) (WMD: −0.01 mmol/L, 95% CI: −0.06; 0.04, P = 0.707). Dose–response analysis results revealed significant positive nonlinear associations between coffee consumption and the increase in TC, LDL-C, and TG levels.ConclusionsEvidence from this meta-analysis suggested that coffee consumption may be associated with an elevated risk for dyslipidemia and CVDs. So a reasonable habit of coffee consumption (<3 cups/d) is essential for the prevention of dyslipidemia.     

远端缺血预处理对择期行介入治疗的缺血性心脏病患者心肌损伤及预后的影响

目的探讨远端缺血预处理对择期行PCI患者的心肌保护作用及远期预后影响。方法选择择期行PCI的缺血性心脏病患者122例,采用随机对照表法分为观察组和对照组,各61例。2组均常规药物治疗,观察组在PCI术前1 h予远端缺血预处理30 min。观察2组患者术后16 h高敏肌钙蛋白Ⅰ(hs-cTnⅠ) 0. 12、 0. 16、 0. 20、 0.24、 0. 28、 0. 36和 0. 48μg/L所占比例及4a型心肌梗死发生率,随访6和12个月时再发心绞痛、再发心肌梗死和死亡等主要不良心血管事件发生情况。结果观察组不同hs-cTnⅠ水平比例均明显低于对照组( 0. 12μg/L,54. 1%vs 78. 7%,P=0. 004; 0. 16μg/L,49. 2%vs 68. 9%,P=0. 039),观察组4a型心肌梗死发生率显著低于对照组(41. 0%vs 59. 0%,P=0. 046)。术后6个月随访时,观察组较对照组再发心绞痛和再发心肌梗死发生率虽有下降,但差异无统计学意义(9. 8%vs 21. 3%,χ~2=3. 055,P=0. 080; 0 vs 3. 3%,χ~2=2. 033,P=0. 154),术后12个月随访时,观察组较对照组再发心绞痛和再发心肌梗死发生率明显下降(13. 1%vs 32. 8%,χ~2=6. 675,P=0. 010;1. 6%vs 11. 5%,χ~2=4. 816,P=0. 028)。2组随访期间均无死亡患者。结论远端缺血预处理可显著降低择期行PCI患者术后hs-cTnⅠ水平,保护心肌,降低4a型心肌梗死发生率,并改善患者预后。     

远程缺血预适应对心肌保护作用的研究综述

对于急性冠脉综合征患者经皮冠状动脉介入成为其最有效的治疗方式,为预防其产生的缺血再灌注损伤,远程缺血预适应是目前最有前景的治疗方式。该方案能够有效地缩减心肌梗死面积,减轻心肌细胞水肿,缓解炎症反应,降低血清心肌坏死物以及恶性心律失常的发生率。目前的研究表明,其保护作用与体液机制、神经机制以及二者的相互作用有关。最新的观点认为囊泡机制也参与其中。相关的临床研究也证明了其心脏保护作用。因此完善远程缺血预适应的具体机制以及寻找最优化的治疗方式可能对急性冠脉综合征患者的治疗以及预后带来新的希望。     

Effect of soy isoflavones on blood pressure: a meta-analysis of randomized controlled trials

Background and aimThe effect of soy isoflavones on blood pressure is controversial. The objective of this study was to evaluate the effect of dietary soy isoflavones on blood pressure.Methods and ResultsTrials were searched in PubMed, the Cochrane Library, Embase and references cited in related reviews and studies. A total of eleven trials were reviewed. Meta-analysis results showed a mean decrease of 2.5 mm Hg (95% CIs, ? 5.35 to 0.34 mm Hg; P = 0.08) for systolic blood pressure and 1.5 mm Hg (95% CIs, ? 3.09 to 0.17 mm Hg; P = 0.08) for diastolic blood pressure in the soy isoflavones-treated group compared to placebo. Meta-regression and subgroup analyses indicated that blood pressure status was a significant predictor of heterogeneity for the effect of soy isoflavones on blood pressure. Subgroup analysis of hypertensive subjects revealed that a greater blood pressure reduction was identified in the soy isoflavone-treated group compared to placebo (5 trials; SBP: ? 5.94, 95% CIs [? 10.55, ? 1.34] mm Hg, P = 0.01; DBP: ? 3.35, 95% CIs [- 6.52, ? 0.19] mm Hg, P = 0.04). In contrast, treatment with soy isoflavones did not lead to a significant reduction in blood pressure in normotensive subjects (6 trials; SBP: 0.29, 95% CIs [- 2.39, 2.97] mm Hg, P = 0.83; DBP: ? 0.43, 95% CIs [- 1.66, 0.81] mm Hg, P = 0.50).ConclusionSoy isoflavones had an effect of lowering blood pressure in hypertensive subjects, but not in normotensive subjects. Larger trials need to be carried out to confirm the present findings.     

心肌缺血预适应对急性心肌梗死影响的观察

目的:探讨心肌缺血预适应对急性心肌梗死(AMI)临床表现及其预后的影响。方法:根据AMI前有无心绞痛发作分为预缺血组和无预缺血组,分组观察AMI患者血清肌酸磷酸激酶(CPK)峰值,住院期间并发症(心衰、心源性休克、严重心律失常),以及住院期间心性病死率。结果:预缺血组血清CPK峰值明显低于无预缺血组(P<0.05),住院期间心源性休克及严重心律失常发生率明显低于无预缺血组(P<0.05)。结论:心肌缺血预适应可减轻心肌坏死程度,缩小梗死面积,并减少AMI并发症的产生。     

心脏和肾脏短暂缺血对心肌保护作用的比较研究

目的　明确心脏和肾脏短暂缺血预处理对心肌缺血 再灌注 (MIR)所致心肌坏死和细胞凋亡的影响。方法　在家兔MIR模型上 ,36只动物随机分为单纯MIR组、心肌短暂缺血预处理 (MIP)组和肾脏短暂缺血预处理 (RIP)组。实验过程中 ,记录血流动力学、心外膜电图 ;应用三苯硝基四氮唑红测定心肌梗死范围 ;采用末端标记和流式细胞方法检测心肌细胞凋亡等。结果　 (1)血流动力学和心外膜电图 :三组动物的血流动力学指标在MIR过程中逐渐下降 ;心外膜电图ST段在缺血期明显抬高 ,再灌注过程中恢复正常。 (2 )心肌梗死范围 :MIR组的心肌梗死范围 (坏死区占缺血区的重量百分比 )为 (5 3 83± 2 0 4 ) % ,MIP组和RIP组的心肌梗死范围分别为 (2 9 6 7± 2 16 ) %和 (33 0 0±3 4 6 ) %。与MIR组相比 ,MIP组和RIP组的心肌梗死范围明显减小 (P <0 0 1)。 (3)心肌细胞凋亡 :末端标记显示 ,MIR组、MIP组和RIP组中缺血区的心肌细胞凋亡率分别为 (10 98± 0 92 ) %、(5 93±0 81%和 (5 5 8± 0 5 0 ) % ,MIP组和RIP组缺血区中的细胞凋亡率较MIR组明显降低 (P <0 0 1)。结论　MIP和RIP均能减少MIR所致的心肌梗死范围和细胞凋亡 ,MIP和RIP对心脏的保护效应无明显差别。     

Antibiotics for the secondary prevention of ischemic heart disease: a meta-analysis of randomized controlled trials

BACKGROUND: Infections have been suspected in the pathogenesis of ischemic heart disease (IHD) for more than 100 years. Chlamydia pneumoniae has been identified in atherosclerotic specimens, and in some studies antibody titers to C pneumoniae have been related to the risk of myocardial infarction. The numerous clinical trials that have studied the use of antibiotics in the secondary prevention of IHD have had conflicting results. METHODS: This study is a meta-analysis of the published randomized controlled trials on the secondary prevention of IHD with antibiotics. Studies included in the analysis were limited to those studies that used antibiotics effective against C pneumoniae, enrolled patients with known IHD, and examined clinical outcomes related to IHD. Inclusion in the analysis was limited to well-designed randomized controlled trials that met inclusion criteria established by an expert panel. RESULTS: Nine published studies, with a total of 11 015 participants, were identified that met the criteria for this meta-analysis. Four of the studies reported a benefit from antibiotics, whereas 5 found no effect. A funnel plot of the published studies did not suggest the existence of other unpublished data. The combined effect found no benefit from antibiotics in the prevention of cardiovascular events in subjects with known IHD (relative risk, 0.94 [95% confidence interval, 0.86-1.03]) or mortality (relative risk, 0.94 [95% confidence interval, 0.79-1.12]). CONCLUSION: In patients with known IHD, macrolide antibiotics for C pneumoniae did not result in a statistically significant reduction in recurrent cardiac events or mortality over 3 months to 3 years.     

Effect of platelet-rich plasma on meniscus repair surgery: A meta-analysis of randomized controlled trials

Background:Studies have shown that platelet-rich plasma (PRP) can enhance the effect of meniscus repair, but some studies have suggested different views on the role of PRP. Therefore, a meta-analysis was conducted to determine whether PRP can enhance the effect of meniscus repair with respect to pain reduction and improved functionality and cure rate in patients with meniscus injury.Methods:PubMed, EMBASE, Cochrane Library Databases, clinicaltrials.gov, and the CNKI Database were searched from their inception till December 1, 2020. The RCTs reporting the outcomes of the Pain Visual Analog Scale (VAS), Lysholm score, healing rate, and adverse events were included. The risk of bias was assessed using Cochrane collaborative tools. The simulated results were expressed with effect size and 95% confidence interval, and sensitivity and subgroup analysis were performed.Results:The meta-analysis included 8 RCTs and 431 participants. Compared with the control group, use of PRP during meniscus surgery significantly improved the VAS (SMD: –0.40, P = .002, 95%CI: –0.66 to –0.15) and Lysholm score (MD: 3.06, P < .0001, 95%CI: 1.70–4.42) of meniscus injury, but the PRP showed no benefit in improving the healing rate of meniscus repair (RR: 1.22, P = .06, 95%CI: 0.99–1.51). No serious adverse events were reported in any study.Conclusions:PRP is safe and effective in improving the effect of meniscus repair as augment. High quality RCTs with long follow-up and definitive results are needed in the future to confirm the use and efficacy of PRP in meniscus tears.     

Effect of telehealth interventions on major cardiovascular outcomes: a meta-analysis of randomized controlled trials

Background Telehealth interventions (THI) were associated with lower levels of cardiovascular risk factors in adults, whereas the effect of THI on cardiovascular disease (CVD) still remains controversial. A meta-analysis was conducted to summarize the evidence from randomized controlled trials (RCT) which investigated potential impact of THI on the incidence of CVD in patients with or without prior CVD. Methods PubMed, EmBase, and the Cochrane Library were searched to identify RCTs to fit our analysis through December 2016. Relative risk (RR) with its 95% confidence interval (CI) was used to measure the effect of THI using a random-effect model. Sensitivity analysis, subgroup analysis, heterogeneity tests, and tests for publication bias were also conducted. Results Eight RCTs were included and with a total of 1635 individuals. The summarized results indicated that participants who received THI showed a significant reduction of the CVD incidence as compared with usual care (RR: 0.59; 95% CI: 0.47–0.74; P < 0.001). Furthermore, the effect of THI was greater in patients with history of CVD (RR: 0.55; 95% CI: 0.44–0.70; P < 0.001) than in patients without history of CVD (RR: 0.99; 95% CI: 0.51–1.94; P = 0.977). Sensitivity analysis suggested that the intervention effect persisted and the conclusion was not changed. Subgroup analysis indicated mean age, study quality might play an important role on the risk of CVD. Conclusions The findings of this study indicated THI could reduce the recurrence of CVD. Further large-scale trials are needed to verify the effect of THI on CVD in healthy individuals.     

Effect of resistance training on resting blood pressure: a meta-analysis of randomized controlled trials

OBJECTIVE: To assess the influence of resistance training on resting blood pressure in healthy sedentary adults. METHODS: A comprehensive literature search with the MEDLINE computerized database was conducted and reference lists of published articles and reviews on the topic were checked. Inclusion criteria were as follows: the study involved a randomized, controlled trial; resistance training was the sole intervention; participants were sedentary normotensive and/or hypertensive adults with no other concomitant disease; the article was published in a peer-reviewed journal up to December 2003. We identified nine randomized controlled trials, involving 12 study groups and 341 participants. A standard protocol was used to extract information on sample size, participant characteristics, study design, training method and duration, and study outcomes. Pooled blood pressure estimates were obtained, weighted by either the number of participants in the training group or the inverse of the variance for blood pressure change. RESULTS: The weighted net changes of blood pressure, after adjustment for control observations, averaged -3.2 [95% confidence limits (CL) -7.1 to +0.7]/-3.5 (95% CL -6.1 to -0.9) mmHg when weighted for the number of trained participants, and -6.0 (95% CL -10.4 to -1.6)/ -4.7 (95% CL -8.1 to -1.4) mmHg, when weighted by the reciprocal of the variance for the blood pressure change. CONCLUSIONS: Our results suggest that moderate intensity resistance training is not contraindicated and could become part of the non-pharmacological intervention strategy to prevent and combat high blood pressure. However, additional studies are needed, especially in the hypertensive population.     

远程缺血预适应心肌保护机制的临床进展

急性心肌梗死的发病与缺血/再灌注引起的组织损伤有关.远程缺血预适应通过减轻心肌缺血再灌注损伤达到心肌保护作用.远程缺血预适应的心肌保护机制尚未完全清楚,大量实验研究证实存在体液假说和神经假说,并且两者之间具有协同作用.本文对近几年来远程缺血预适应心肌保护机制及临床进展作一综述.