湖南省1023例急性心肌梗塞的回顾分析

湖南省20所综合医院1983－1993年的急性心肌梗塞（AMI）住院患者1023例，男女之比为2．68：1，平均年龄61．9±9．9岁，女性发病年龄约比男性大5岁。既往罹患高血压病与冠心病者分别占43．3％与37．7％。以胸痛为首发症状者占86．1％。前壁与下壁梗塞者分别占49．9％与32．2％。死亡155例（15．2％），男女死亡率分别为13．7％与19．7％。主要死因心脏骤停（34．8％）、心衰（36．1％）与休克（23．2％）。     

男性早发冠心病患者临床和冠脉病变特点

总结87例年龄≤45岁的男性早发冠心病患者（甲组）的临床和冠状动脉造影特点，并与同期146例年龄≥60岁的男性老年冠心病患者（乙组）作比较。结果显示：甲组患者的吸烟史和家族史明显高于乙组（74．7％比44．5％）及（32．2％比9．5％）。甲组患者以急性心肌梗塞发病者多见。冠脉造影显示：甲组患者以单支病变多见，甲组中急性心肌梗塞患者冠脉正常者占一定比例。     

海南省1986～1996年486例急性心肌梗死的临床分析

目的通过了解海南省急性心肌梗死（AMI）发病情况、临床特点和预后，进一步为防治AMI提供更多的依据。方法对海南9间医院1986～1996年期间AMI住院患者486例，以统一标准表格采集资料，输入计算机进行统计分析。结果AMI病例有逐年增加趋势；男女之比为4．4：1，平均年龄为（61．7±11．8）岁，女性发病年龄比男性大9岁。以胸痛为首发症状者占84．6％；前壁与下壁梗死者分别占52．2％和29．4％；病死率为12．1％，主要死因有心源性休克（39．0％）、心脏骤停（33．9％）、心衰（22．0％）。影响急性期预后的因素包括年龄、泵功能、严重心律失常、梗死部位及伴发糖尿病等。结论加强CCU的建立，及时防治心律失常、泵衰竭等并发症，可进一步降低AMI病死率。     

海宁市423例临界高血压4年随防分析

对海宁市城镇9个居民区临界高血压进行4年（1990～1993）随访，除部分失访和服降压药物者外计有423例（男性227例，女性196例，平均39．2岁），青壮年占总数77.8％；血压恢复正常为21，7％，仍在临界高血压范围之内为49．4％．转为确诊高血压24．5％。年龄初测血压水平、心率和体重指数是进展为确诊高血压的重要发病因素。     

北京部分城区老年人群高血压现况调查

目的分析2002～2003年北京部分城区60～74岁老年人群高血压患病率及有关特点。方法以北京大学和首钢地区60～74岁1157例心血管病危险因素横断面调查结果为研究样本，对老年人高血压的患病率、高血压的类型、高血压患者合并其他心血管病危险因素等情况进行分析。结果（1）该地区60～74岁人群高血压患病率、治疗率和控制率分别为60．5％、60．9％和23．4％；（2）随着年龄增长，男女两性高血压患病率呈持续增加趋势（P〈0．05）；与60～64岁组相比，70～74岁组男性高血压患病率增加了30．3％，女性高血压患病率增加了32.1％；（3）老年人单纯收缩期高血压患病率为25.0％，占老年高血压患者的42.3％；（4）老年高血压患者合并至少一个其他心血管病危险因素的比例为85．9％。结论高血压是北京部分城区60～74岁老年人群常见的心血管疾病，单纯收缩期高血压为老年高血压患者的常见类型，老年高血压患者绝大多数合并有其他心血管病危险因素。     

无痛性消化性溃疡89例

目的提高对无痛性消化性溃疡（PU）的认识和诊断水平．方法回顾性分析89例无痛性PU的临床资料，列举和分析了临床症状、特点，及内镜下分型．结果我科1988／1996经内镜检查证实972例PU患者中，有89例为无痛性PU，占9．15％．89例中，食管溃疡3例（3／89，3．4％），十二指肠溃疡54例（54／89，60．6％），胃溃疡26例（26／89，29．2％），复合性溃疡6例（6／89，6．8％）．溃疡形态为有苔者65例，无苔者24例，线状溃疡3例，浅溃疡21例．发病年龄为16岁～81岁．60岁以上者36例（40．4％）．发病时间1mo以内者53例．常见的临床表现为上腹部不适，食欲减退，恶心、呕吐，上消化道出血．本组无痛性PU特点：①老年人多见；②病史短者较多见；③临床误诊多．本组误诊率达84．3％（75／89）．故对于缺乏典型症状的患者，尤其是老年患者，不能仅满足于一般临床诊断，应进行内镜检查以提高确诊率．结论了解无痛性PU的临床特点，对提高本病的诊断意识和水平，减少误诊是重要的．     

慢性肾功能衰竭的基本构成: 单中心956例临床研究

目的探讨慢性肾功能衰竭（CRF）住院患者病因的基本构成,为临床诊治提供数据。方法调查我院。肾内科2009年1月至2010年12月住院患者中全部慢性肾功能衰竭患者。结果慢性肾功能衰竭患者共956例,占同期住院总人数的44．4％。其中男性527例,女性429例;城市（各级市和市属区）患者670例,乡村（县城、乡、镇、村）患者286例;CKD2期90例,CKD3期228例,CKD4期160例,CKD5期478例。慢性肾功能衰竭的年龄构成为16-89岁,平均（53．8±17．5）岁,其中青年（≤35岁）185例,中年（36-59岁）366例,老年（≥60岁）405例,首次诊断的患者691例,占72．3％,其中需要透析治疗357例,占37．3％。慢性肾功能衰竭病因构成：慢性肾炎占23．8％,糖尿病肾病占16．7％,高血压肾损害占8．2％,多囊。肾占2．5％,狼疮性肾炎占1．4％,病因不详者占32．2％。结论本组数据中,慢性肾功能衰竭来自城市患者多于乡村,中、老年人多于青年人,病因主要为慢性肾炎、糖尿病、高血压、多囊肾等。无法判断病因患者较多,首次诊断即为慢性肾功能衰竭的患者也较多。     

有家族史与无家族史高血压患者发病特点及危险因素的调查分析

该文分析了有家族史和无家族史高血压患者的发病特点及危险因素的异同。方法：对心血管内科门诊就诊的15岁以上原发性高血压患者913例，进行发病特点及心血管危险因素调查，根据有无家族史分为2组，家族史阳性者522例（A组），年龄（53．0±13．8）岁；家族史阴性者391例（B组），年龄（51．6±14．0）岁。数据采用SPSS11．5软件包，以多元logistic回归分析高血压的主要危险因素；用t检验和x^2检验对2组发病年龄、血压分级及高血压危险因素的差异进行统计学分析。     

胃及十二指肠球部溃疡的内镜调查报告

目的利用内镜资料调查胃溃疡（GU）和十二指肠球部溃疡（DU）的某些临床流行病学特点．方法收集5a的内镜资料，统计GU，DU的检出率及发病季节，性别及年龄分布等特点及幽门螺杆菌的检出情况．结果5405例受检病例中共检出DU1236例，GU197例，检出率分别为22．9％和3．6％．DU检出率以1月～3月份及12月份最高（27．7％～32．0％，平均30．2％），6月～8月份最低（16．1％～16．8％，平均17．2％，与1月～3月份及12月份平均检出率比较，P＜0．01）．GU的检出率无明显季节差异（P＞0．05）．DU，GU的男女之比分别为5．43：1和3．40：1，男女性检出率分别为26．8％和12．7％（P＜0．01），3．9％和3．0％（P＞0．05）．40岁以上者GU检出率为6．5％（其中60岁以上者为9．1％），40岁以下者为2．6％（与40岁以上者比较，P＜0．01），而DU的检出率无明显年龄差异．214例溃疡患者胃粘膜尿素酶试验阳性率为76．6％，其中DU为77．6％，GU为72．5％．结论DU的发病与季节气候有关，冬春季较夏秋季更易发病；GU发病与季节无关．DU和GU均以男性多发，其检出率男性明显高于女性．GU多见于40岁以上患者，而且年龄愈大检出率愈高；DU的检出率无年龄差异．     

老年人多囊肾尿毒症透析期间心脏损害的超声心动图研究

多囊肾属先天性发育异常，早期无症状，40岁后开始出现临床症状，发展致晚期出现高血压和肾功能损害，终因尿毒症而死亡‘’‘。病人后期依赖透析而生存，常出现各种并发症。心血管系统并发症是导致死亡的重要原因。1996年以来，我们选择20例，年龄50岁以上由多囊肾所致尿毒症患者，于透析期间以超声心动图对心脏损害进行系统的观察，并与正常对照组比较分析，报告如下：1对象与方法1．1对象20例患者为1996年至现在来院进行血液透析的多囊肾所致的尿毒症患者，男12例，女8例。年龄．54～70岁。透析时间3～24月，设正常对照组20例，男女各10…     

Clinical characteristics and risk factors for kidney failure in patients with autosomal dominant polycystic kidney disease: A retrospective study

Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary and progressive renal disease. By the age of 65 years, 45% to 70% of patients with ADPKD reach end-stage renal disease (ESRD). Although there are various treatments for this condition, no standard therapy exists to delay the progression of ADPKD. Hence, understanding the factors that affect disease progression may be helpful for the treatment of ADPKD. The medical records of 288 patients with ADPKD at Keimyung University Dongsan Medical Center between January 1989 and August 2018 were analyzed retrospectively. Furthermore, we inspected the risk factors involved in the progression of ADPKD and the kidney survival rates of patients using the Cox proportional hazards model and Kaplan–Meier survival analysis. The mean age at the time of diagnosis was 43.1 ± 14.1 years, and there were 146 males (50.7%). In total, 197 patients (68.4%) had hypertension and 11 patients (3.8%) had cerebral aneurysm. Stroke occurred in 35 patients (12.1%), including 11 cases of cerebral hemorrhage and 24 cases of cerebral infarction. Twenty-eight patients (9.7%) died during the follow-up period (117.1 ± 102.1 months). Infection (42.9%) was the most common cause of mortality, followed by sudden cardiac death (25.0%). Overall, 132 patients (45.8%) progressed to ESRD and 104 patients (36.1%) required renal replacement therapy (RRT). The mean duration from diagnosis to RRT was 110.8 ± 93.9 months. Age at diagnosis after 30 years (odd’s ratio [OR], 2.737; 95% confidence interval [CI], 1.320–5.675; P = .007), baseline serum creatinine levels (OR, 1.326; 95% CI, 1.259–1.396; P < .001), and cyst infection (OR, 2.065; 95% CI, 1.242–3.433; P = .005) were the independent risk factors for kidney failure in multivariable analysis. To delay the advance of ADPKD to ESRD, early diagnosis and close observation for the onset of cyst infection are crucial.     

Treatment of hypertension in chronic renal insufficiency

Hypertension is the most common complication of chronic renal insufficiency (CRI) and it accelerates the rate of progression of most forms of CRI. Several large clinical trials have clearly demonstrated the efficacy of antihypertensive treatment for prevention of progression of renal failure. Angiotensin-converting enzyme (ACE) inhibitors may have therapeutic advantages. However, large scale trials include a variety of chronic renal diseases, and the origins of renal diseases are quite diverse. Moreover, the differences in sex, age, race have not been considered. Based on these trials, it was concluded that blood pressure control is the most effective means for the prevention of deterioration of renal dysfunction. Consistent with this view, our recent preliminary data provide evidence that aggressive blood pressure control using self-reported blood pressure values measured by a home blood pressure device is promising to arrest the progression of renal failure in Japanese patients with CRI.     

Toll‐Like Receptors in the Progression of Autosomal Dominant Polycystic Kidney Disease

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary cause of chronic kidney disease. The intriguing role of innate immune system and inflammation become a target for potential therapeutic approach to slow progression. When toll‐like receptors (TLRs) signaling and their receptors activate, they start a cascade of intracellular signaling that induces the production of the inflammatory cytokines and chemokines. Thus, we aim to investigate the association of TLRs between progression of ADPKD. Ninety ADPKD patients and ninety matched controls were enrolled this prospective study and were followed during 3 years. TLR‐2 and TLR‐4 gene polymorphisms and expressions were measured. Hypertension was diagnosed with ambulatory blood pressure monitoring. Rapid progression was defined as sustained decline in estimated glomerular filtration rate (eGFR) of more than 5 mL/min per 1.73 m² per year. TLR‐4Asp299Gly polymorphisms were significantly different between patient and control group (P < 0.05). Also, TLR‐2 and TLR‐4 gene expressions were significantly different between the ADPKD patients and the control subjects (P < 0.05). The expression levels of both TLR‐2 and TLR‐4 were found to be higher in the rapid progression groups comparing the slow progression group (P < 0.05). TLR‐2 gene expression, hypertension and uric acid were found to be independent risk factors in identifying rapid progression in ADPKD patients. TLR‐2 and TLR‐4 gene expressions are associated with rapid progression in ADPKD patients. TLRs may play a role in the progression of ADPKD.     

Heart rate response to graded exercise correlates with aerobic and ventilatory capacity in patients with heart failure

BACKGROUND: Autonomic dysfunction and reduced exercise tolerance are typical features of patients with congestive heart failure (CHF). Baro-chemoreflex balance and organ response may have a common role in conditioning exercise tolerance, ventilation, and chronotropic competence in patients with CHF. HYPOTHESIS: We tested the hypothesis that there is a relationship between functional capacity and chronotropic competence to exercise in CHF. METHODS: In all, 48 stable outpatients with CHF (age 65 +/- 10 years, 41 men, NYHA class 2.1 +/- 0, ejection fraction 31 +/- 7%, peak VO2 16 +/- 4 ml/kg/min) performed cardiopulmonary exercise testing (CPX). Heart rate (HR) response to exercise was assessed by the chronotropic index (CRI). The CRI was calculated by the following formula: CRI = peak HR - rest HR/220 - age - rest HR x 100 (normal value > 80%). The relationship of CRI to peak oxygen consumption (VO2) and ventilation/carbon dioxide production (VE/VCO2) ratio was examined. A group of 33 healthy controls underwent CPX as well. RESULTS: The CRI correlated directly with peak VO2 (r = 0.638, p < 0.001) and inversely with VE/VCO2 (r = -0.492, p < 0.001) in patients with CHF. A CRI < 78% identified patients with CHF and a peak VO2 < 20 ml/kg/min, area under the receiver operating curve (AUROC): 0.76, 95% confidence interval (CI) 0.60-0.92. A CRI < 74% predicted exercise hyperventilation in CHF (AUROC: 0.71 for VE/VCO2 > 30, 95% CI 0.53-0.88). The CRI was not significantly related either to peak VO2 or to VE/VCO2 in the control group. CONCLUSIONS: In patients with mild to moderate CHF, CRI correlates with functional capacity. This relationship adds new data on pathophysiologic grounds and supports the routine incorporation of CRI into CPX interpretation.     

Percutaneous injection therapy for hepatocellular carcinoma in patients with chronic renal insufficiency

OBJECTIVES: Percutaneous injection therapy using acetic acid or pure ethanol is effective for hepatocellular carcinoma (HCC). However, its efficacy in HCC patients with coexisting chronic renal insufficiency (CRI), defined as a serum creatinine level of 1.5 mg/dl or above, is not known. This study compared the survival in HCC patients with and without CRI undergoing percutaneous injection therapy. METHODS: A total of 172 patients (129 male; age 67 +/- 10 years) during a 4-year period were included. Thirty-five of these patients had CRI (creatinine level 2.7 +/- 1.8 mg/dl) before treatment Fourteen patient- and tumour-related parameters were included for survival analysis. RESULTS: The mean follow-up period was 24 +/- 9 (range 4-40) months. Seven (20%) and 39 (28%) patients in the groups with and without CRI, respectively, died. There was no significant survival difference in patients with and without CRI. The cause of death was related to renal failure in two (29%) patients in the former group and one (3%) patient in the latter group. For the patients with CRI, the presence of ascites and a serum creatinine level of 2.3 mg/dl or above were poor prognostic factors in the univariate analysis; the latter was the only independent factor predicting a poor survival by the Cox multivariate proportional model. CONCLUSIONS: CRI does not affect overall survival in HCC patients undergoing percutaneous injection therapy. However, a serum creatinine level of 2.3 mg/dl or above is an independent poor prognostic predictor among patients with existing CRI.     

非甾体类抗炎剂致上消化道溃疡的临床特点

[目的]研究非甾体类抗炎剂（NSAIDs）相关胃、十二指肠溃疡的临床特点。[方法]统计2001年1月～2006年1月消化病专家门诊及住院患者的临床资料。根据胃镜检查前1周内有无服用NSAIDs史，将138例患者分为A（服NSAIDs，41例）、B（未服NSAIDs，97例）组，对2组患者的临床症状、胃镜、活检结果进行比较。[结果]饱胀、烧心、恶心、腹痛4项主症中前3项A组均高于B组，但腹痛B组高于A组（P〈0．05）。A组中胃溃疡（GID占80．5％（多发性为24．4％），十二指肠球部溃疡（DID为19．5％（多发性4．9％）；B组分别为48．5％（12．4％）、51．5％（11．3％）。活动性溃疡A组占63．4％，溃疡灶〈10mm占80．5％；B组分别为42．3％、62．9％，2组间比较P〈0．01。幽门螺杆菌检出率A组63．4％，B组81．3％，B组明显高于A组（P〈0．05）。[结论]提高临床医师对NSAIDs相关溃疡临床特点的认识，加强对必须服用NSAIDs者的防治及医学指导，尽量减少其不良反应。     

3种类型布-加综合征的临床特点分析

[目的]探讨3种类型布-加综合征的临床特征.[方法]回顾性分析3种类型共57例布-加综合征患者的临床资料,对其临床表现、实验室生化检查结果及影像学结果等进行比较.[结果]57例中男38例,女19例,发病率男女之比为2∶1.3种类型中以下腔静脉型最多26例(45.6％)、肝静脉型14例(24.6％)、混合型17例(29....     

Effect of early correction of anemia with erythropoietin on left ventricular mass in predialysis patients: a multi-center trial

Objective To assess the effects of early correction of anemia with recombinant human erythropoietin (rHuEPO) on the development and progression of left ventricular hypertrophy (LVH) in patients with mild-to-moderate chronic renal insufficiency (CRI) who are not on hemodialysis. Methods A total of 158 patients with serum creatinine from 147μmol/L to 400μmol/L were enrolled in this prospective, multicenter study. Eighty-six patients with hemoglobin (Hb)<110g/L received rHuEPO treatment with a target Hb of > 110g/L (Group A). Forty patients with comparable Hb concentration ( <110g/L) but did not receive rHuEPO (Group B) and 32 patients with Hb≥110g/L and without rHuEPO treatment (Group C) were served as controls. Left ventricular mass index (LVMI) was evaluated by echocardiography at baseline and every 3 months for 2 years. Results There was no difference in age, gender, etiology of renal failure, blood pressure and cardiovascular risk factors among the 3 groups. At baseline, the prevalence of LVH was 72.1 % in group A, 72.5% in group B and 59.4% in group C. LVMI was inversely correlated with Hb levels (r=0.70, P<0.01). During the 2-year period, the mean LVMI decreased from 142.6±25.7g/m2 to 132.4±18.5 g/m2 in group A, while increased significantly in both group B and group C. The mean Hb concentration increased from 93.8±14.6g/L to 111.2±10.3g/L(P<0.05) in group A, but tended to decrease in group B and group C. There was no significant change of the mean blood pressure, number of anti-hypertensive drugs and serum creatinine concentrations in all 3 groups. However, patients' serum creatinine doubled more often in group B and group C than in group A. Conclusions LVH was common in predialysis CRI patients and was associated with the severity of anemia. Early intervention with rHuEPO may reverse LVH in these patients.     

Impact of chronic renal insufficiency on clinical outcomes in patients undergoing saphenous vein graft intervention with drug‐eluting stents: A multicenter Southern Californian Registry

Objectives : To evaluate the clinical outcomes in patients with chronic renal insufficiency (CRI) who undergo saphenous vein graft (SVG) intervention with drug‐eluting stents (DES). Background : Patients with CRI have higher rates of major adverse cardiac events (MACE) after percutaneous revascularization. SVG intervention is associated with increased rates of MACE compared with percutaneous revascularization of native arteries. However, the impact of CRI on SVG intervention with DES has not been well delineated. Methods : Consecutive patients who underwent SVG intervention with DES at five medical centers from April 2003 to December 2007 were included in this analysis. Results : A total of 172 patients, 39 patients with CRI and a serum creatinine ≥1.5 mg dL^?1, and 133 patients without CRI, underwent SVG intervention with DES. Patients with CRI were more often older, diabetic, and had a longer mean total stent length. At 1 year, patients with CRI had a higher MACE rate (35.9% vs. 15.8%, hazard ratio [HR] 2.48, 95% confidence interval [CI] 1.26–4.88, log rank P = 0.009), mainly driven by higher mortality (20.5% vs. 9.8%, HR 3.41, 95% CI 1.10–10.58, log rank P = 0.024). There was a trend toward higher rates of target vessel revascularization in the CRI group (21.8% vs. 10.3%, HR 2.42, 95% CI 0.94–6.24, log rank P = 0.059). Stent thrombosis rates were not different between patients with and without CRI (2.6% vs. 2.3%, P = 0.8). Multivariable analysis revealed that CRI was the only significant predictor of 1‐year MACE (HR 2.2, 95% CI 1.1–4.3; P = 0.03). Conclusions : Patients with CRI who underwent SVG intervention with DES had higher risks of MACE and death compared with patients with preserved renal function. Further treatment strategies are needed in this high‐risk group who undergo SVG intervention with DES. © 2010 Wiley‐Liss, Inc.     

Hypertension in autosomal dominant polycystic kidney disease: observational study in 207 patients with a mean follow-up of 107 months.

INTRODUCTION AND OBJECTIVES: Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common hereditary diseases in adults. ADPKD is a frequent cause of 4 secondary hypertension and, conversely, hypertension is a common manifestation of ADPKD and, more importantly, one of the few that are treatable. Given the autosomal dominant nature of the disease and the fact that it is easy to diagnose with a renal scan, ADPKD patients can be diagnosed early at a pre-symptomatic stage, and hypertension can be detected and treated. The main purpose of this article is to report our experience in the long-term follow-up of patients with ADPKD, with particular emphasis on hypertension. METHODS: A retrospective analysis was made of 532 patients observed in our outpatient clinic due to renal cysts over the last 17 years, of whom 383 were diagnosed with ADPKD according to Ravine's criteria. Patients were followed-up as outpatients on a yearly basis, or more frequently if necessary. Data on demography and clinical findings were analyzed with particular emphasis on blood pressure control, number and type of antihypertensive drugs, and left ventricular mass index (LVMI). RESULTS: At the beginning of follow-up 56% of the patients, including 30.7% of the young adults aged 20 to 34 years, were hypertensive. Focusing on 207 patients observed in 2006, with a mean follow-up of 107 +/- 66 months, a significant decrease in systolic and diastolic blood pressure was observed between the first and last observations. Of a subgroup of 115 patients who were normotensive at the initial observation, 50% became hypertensive by the age of 40. During follow-up, only eleven had a cardiovascular event such as angina, myocardial infarction, stroke or peripheral artery disease (rate 0.006 events/patient-year). LVMI correlated with age, renal function and systolic and diastolic blood pressure, but only age was an independent risk factor for increased left ventricular mass. CONCLUSION: Hypertension is a common complication in ADPKD patients. Early diagnosis and follow-up at a pre-symptomatic stage of the disease are important since this enables early initiation of antihypertensive therapy, which could reduce the rate of cardiovascular events in this population.