西拉普利与美托洛尔对高血压前臂动脉功能影响的临床研究

目的：比较西拉普利与美托洛尔长期治疗原发性高血压患者肱动脉功能的影响。方法：脉冲多普勒法。结果：两组原发性高血压患者分别接受西拉普利或美托洛尔治疗6个月后血压均明显下降,但西拉普利组的肱动脉管径、血流速度、血流量和扩张性增加,血流阻力减少;而美托洛尔治疗组的肱动脉管径、血流速度、血流量和扩张性有所下降或无明显改变。结论：西拉普利可以部分改善高血压者前臂动脉功能。     

西拉普利与美托洛尔对高血压前臂动脉功能影响的临床研究

目的比较西拉普利与美托洛尔长期治疗对原发性高血压患者肱动脉功能的影响。 方法脉冲多普勒法。 结果两组原发性高血压患者分别接受西拉普利或美托洛尔治疗6个月后血压均明显下降,但西拉普利组的肱动脉管径、血流速度、血流量和扩张性增加,血流阻力减少;而美托洛尔治疗组的肱动脉管径、血流速度、血流量和扩张性有所下降或无明显改变。 结论西拉普利可以部分改善高血压患者前臂动脉功能     

西拉普利改善高血压动脉功能的临床研究

研究原发性高血压患者上臂动脉功能与血液动力学改变及西拉普利对其逆转效应。方法脉冲多普勒法。结果与血压正常者（ＮＴ）相比，高血压患者（ＨＴ）的前臂阻力（Ｒ）和肱动脉内径（Ｄｄ）增加，平均血流速度（Ｖｍ）减慢，扩张性（ＤＩＳ）和顺应性（ＣＯＭ）减小，但血流量（Ｑ）无差异；在反应性充血状态下，两组的Ｄｄ、Ｖｍ、Ｑ增加，Ｒ减小，但这种变化在ＮＴ更为明显。西拉普利治疗１２周后，ＨＴ的Ｄｄ、Ｖｍ、Ｑ、ＤＩＳ、ＣＯＭ增加，Ｒ减小，但仍与ＮＴ有差异。结论高血压患者早期已有动脉损害，西拉普利可部分逆转这种改变。     

300例高血压前期者脉搏波传导速度与颈动脉硬化改变及相关性

目的 探讨高血压前期人群大动脉顺应性和颈动脉硬化的情况及相关性.方法 分层随机抽取高血压前期、高血压、正常血压各300例作为研究对象.采用动脉硬化诊断装置VP-1000测定肱踝脉搏波传导速度和踝臂指数,多普勒彩色超声观察颈总动脉内膜-中膜厚度以及斑块形成情况,比较三组间差异.比较各血压组合并颈动脉斑块时脉搏波传导速度的变化情况,分析颈动脉内膜-中膜厚度与脉搏波传导速度的相关性.结果 (1)随着血压从正常向高血压转变,肱踝脉搏波传导速度呈上升趋势,高血压前期组(1 390±171 cm/s)较正常血压组(1 293±151 cm/s)升高但低于高血压组(1 652±291 cm/s,P<0.01);踝臂指数高血压前期组(1.115±0.060)与正常血压组(1.114±0.061)相比差异无统计学意义(P>0.05),但在高血压组明显升高(1.132±0.067,P<0.01).(2)颈动脉内膜-中膜厚度增厚率及斑块发生率在高血压前期组与正常血压组相比差异均无统计学意义,但在高血压组显著升高(P<0.01);颈总动脉内膜-中膜厚度在高血压前期组(0.73±0.10mm)与正常血压组(0.72±0.12 mm)相比差异无统计学意义(P>0.05),但在高血压组显著增厚(0.78±0.16 mm,P<0.01).(3)有或无合并颈动脉斑块时,高血压前期组脉搏波传导速度均较正常血压组升高(P<0.01),但低于高血压组(P<0.01);各血压组合并颈动脉斑块时脉搏波传导速度较无颈动脉斑块时均升高(P<0.01).肱踝脉搏波传导速度与颈总动脉内膜-中膜厚度呈正相关(r=0.271,P<0.01),校正血压因素后相关性仍存在(r=0.156,P<0.01).结论 高血压前期肱踝脉搏波传导速度显著升高.提示存在早期动脉硬度改变.肱踝脉搏波传导速度与颈动脉内膜-中膜厚度呈正相关,肱踝脉搏波传导速度可作为评估高血压前期动脉硬度有效且简便易行的指标.     

吸烟对氨氯地平降压疗效及肱踝脉搏波传导速度的影响

目的探讨吸烟对氨氯地平降压疗效及肱踝脉搏波传导速度的影响。方法随机选择80例轻中度高血压男性患者,按其是否吸烟分为吸烟组和不吸烟组,均给予氨氯地平5 mg/d降压治疗,12周后,分析两组患者的降压疗效及肱踝脉搏波传导速度的改善程度。结果吸烟组和不吸烟组降压有效率分别为55.0%和57.5%,两组差异无显著性。吸烟组治疗前肱踝脉搏波传导速度明显高于不吸烟组(P<0.05),治疗后吸烟组肱踝脉搏波传导速度较治疗前无明显变化,而不吸烟组较治疗前明显下降(P<0.05)。结论吸烟对钙拮抗剂氨氯地平的降压疗效无影响,但吸烟增加高血压患者动脉硬度,并降低氨氯地平对动脉硬度的改善。     

长期应用氯吡格雷对冠心病患者血管内皮功能的影响

目的探讨长期应用氯吡格雷对冠心病患者血管内皮功能的保护作用。方法将166例经冠状动脉造影确诊为冠心病的患者(均予裸支架植入治疗)随机分为试验组和对照组,治疗的前6个月两组均应用氯吡格雷和阿司匹林6个月,6个月后对照组只应用阿司匹林,试验组继续应用氯吡格雷和阿司匹林6个月(其他冠心病基础用药一致)。分别于治疗6个月、12个月采用肱动脉超声和上臂反应性充血试验的方法观察并比较两组肱动脉舒张期内径、平均血流速度、血流量、动脉扩张性、血流阻力和肱动脉中膜厚度等反映患者血管内皮功能的指标。结果试验组肱动脉管径、血流速度、血流量和扩张性增加,血流阻力和肱动脉内膜中膜厚度降低;其应用12个月比6个月效果更明显。治疗12个月后试验组比对照组血管内皮功能指标改善更明显(P<0.05)。在反应性充血状态下,试验组肱动脉管径、血流速度、血流量增加,血流阻力降低;而对照组血流速度、血流量、血流阻力、肱动脉管径等指标治疗12个月与治疗6个月差异无统计学意义(P>0.05)。结论长期应用氯吡格雷对冠心病患者血管内皮功能可能有保护作用。     

高血压患者血压节律与动脉弹性的研究

目的比较高血压患者与正常人血压节律的变化及血压节律对动脉弹性的影响.方法采用美国Pulse MetricInc公司生产的无创血流动力学测定仪(型号Dynapulse5000A)分别对84例高血压患者及32例正常人进行24小时血压监测并同期测定动脉弹性参数系统血管顺应性、系统血管阻力、肱动脉扩张性、肱动脉阻力.结果高血压患者血压节律异常者高于正常对照组,高血压组非杓型血压比例占69%,而正常对照组仅6.2%.高血压患者的动脉弹性功能异常高于正常对照组,高血压组系统血管顺应性及肱动脉扩张性均较正常对照组减退,而系统血管阻力及肱动脉阻力均较正常对照组增加;而血压节律异常患者动脉弹性功能异常更为明显.结论高血压患者有更高的血压节律异常,血压节律异常的患者动脉弹性的减退更明显.     

高血压合并2型糖尿病患者动脉弹性与氧化应激和血管内皮功能的相关性

目的 研究高血压合并糖尿病患者肱-踝脉搏波传导速度与血清中丙二醛、超氧化物歧化酶和一氧化氮的相关性,探讨氧化应激、血管内皮功能变化在动脉硬化过程中的作用.方法 研究对象168例分为正常对照组(n=40)、原发性高血压组(n=70)和高血压合并2型糖尿病组(n=58),各组分别用比色法检测血清丙二醛、超氧化物歧化酶和一氧化氮含量,应用动脉硬化自动检测仪测定肱-踝脉搏波传导速度.结果 与对照组比较,原发性高血压组和高血压合并2型糖尿病组中丙二醛水平和肱.踝脉搏波传导速度明显增高(P<0.01),超氧化物歧化酶和一氧化氮水平明显降低(P<0.01);与原发性高血压组比较,高血压合并2型糖尿病组丙二醛水平和肱-踝脉搏波传导速度明显增高(P<0.05),超氧化物歧化酶和一氧化氮水平降低(P<0.05).相关分析显示肱-踝脉搏波传导速度与年龄、收缩压、舒张压、胆固醇、空腹血糖、高敏C反应蛋白和丙二醛呈正相关(相关系数r分别为0.418、0.672、0.469、0.179、0.392、0.277和0.571,均P<0.05),与超氧化物歧化酶和一氧化氮呈负相关(r分别为-0.438和-0.571,均P<0.05).多元逐步回归分析显示收缩压、丙二醛、空腹血糖和年龄是肱-踝脉搏波传导速度的独立危险因素.结论 高血压合并糖尿病患者动脉弹性明显减弱,且与体内氧化应激增强和血管内皮功能损伤有关,提示氧化应激和血管内皮功能在动脉硬化过程中起重要作用.     

原发性高血压合并2型糖尿病患者肾素前体表达水平及与血管损伤的相关性

目的　探讨原发性高血压合并2型糖尿病患者肾素前体表达水平及与血管损伤的相关性。方法　入选原发性高血压患者78　例，原发性高血压合并2型糖尿病患者41例。采集病史，并进行血压、颈-股动脉脉搏波传导速度的测量及生物化学指标的检查，应用酶联免疫吸附法测定患者血浆肾素前体浓度，应用SPSS　19.0统计软件进行分析，应用t检验比较两组间各指标均数是否具有统计学差异，采用Pearson相关分析肾素前体与颈-股动脉脉搏波传导速度及各指标的相关性，运用多元线性回归分析脉搏波传导速度的独立相关因素。结果　两组间年龄、体质指数、舒张压、脉压、肌酐、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇的差异无统计学意义（P>0.05）。原发性高血压合并2型糖尿病组收缩压、空腹血糖、甘油三酯均高于原发性高血压组，差异有统计学意义（P<0.05）。原发性高血压合并2型糖尿病组肾素前体与原发性高血压组相比差异无统计学意义（P>0.05），原发性高血压合并2型糖尿病组颈-股动脉脉搏波传导速度值高于原发性高血压组，差异具有统计学意义（P<0.05）。对颈-股动脉脉搏波传导速度的相关因素进行分析显示，年龄、收缩压、脉压与颈-股动脉脉搏波传导速度相关（P<0.05），多元线性回归分析显示颈-股动脉脉搏波传导速度与年龄、收缩压独立相关（P<0.05）。结论　（1）原发性高血压合并2型糖尿病患者血浆肾素前体水平与原发性高血压患者无差异。（2）原发性高血压合并2型糖尿病时血管损伤加重，但与肾素前体间未见明确相关性。     

原发性高血压患者血压分级及危险因素分层与脉搏波速度关系的研究

目的探讨原发性高血压患者血压分级以及危险因素分层与动脉脉搏波速度(PWV)的关系。方法应用动脉脉搏波速度(PWV)自动测量系统测定入选的560例原发性高血压患者的肱动脉-踝动脉baPWV值,并对患者进行危险因素分层,比较不同血压水平及危险程度患者的脉搏波速度。结果1级与2级高血压患者的baPWV差异无统计学意义[(1540±150)cm/s比(1630±160)cm/s,P=0.298];伴有一种以上心血管危险因素者的baPWV显著高于单纯高血压患者[(1645±138)cm/s比(1584±160)cm/s,P=0.001)]。结论存在一种或一种以上心血管危险因素的高血压患者,PWV值明显高于无危险因素的高血压患者,心血管危险因素对脉搏波速度的影响可能较大。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。