从循征医学看老年心血管病药物治疗进展(下)

三、老年冠状动脉粥样硬化性心脏病(冠心病)的药物治疗 1.他汀类药物:对这类药物的药理研究发现它除了良好的降胆固醇、甘油三酯的作用外,还具有重要的非调脂作用,如抑制炎症、稳定斑块,改善内皮功能,抗血小板聚集、改善血流状态,抑制平滑肌细胞增殖等作用.因而他汀类药物在临床得到广泛的应用.甚至有人认为它所带来的贡献可以与20世纪40年代青霉素所带来的贡献相媲美.因此,他汀类药物成为目前研究的热点和重点.     

防治缺血性心血管病，必须积极进行“调脂”治疗（下）

四、血脂异常的药物治疗1.血脂异常的诊断:血脂异常一般是指血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三脂(TG)超过正常及/或高密度脂蛋白胆固醇(HDL-C)水平低下。研究发现,在东方人群中,血清总胆     

易损斑块的生物学标志物及治疗进展

随着他汀类药物以及药物洗脱支架的临床应用,冠状动脉粥样硬化性心脏病的发病率和致死率明显下降。然而,每年死于急性心血管事件的大部分人没有前驱症状,且现有的诊断技术难以在心血管事件前发1现受害者。近年的研究发现,导致急性心血管事件的主要原因是动脉粥样硬化（AS）斑块破裂和血栓形成,后者取决于AS斑块的不稳定性,即易损性（vulnerability）。     

他汀类药物独立于降脂作用以外的多效性评价

近10多年来,应用他汀类药物预防冠心病的一级、二级试验取得了举世瞩目的成就,肯定了其调脂治疗的益处;同时,他汀类药物调脂以外的作用也备受关注.从临床研究到基础研究,越来越多的证据显示他汀类药物治疗的多效性.这种多效性包括：抑制平滑肌细胞增殖,促进新生血管形成,改善内皮功能,抑制血小板聚集,抑制炎症反应,稳定斑快,降低胰岛素抵抗和骨质吸收.     

高血压病非药物治疗的新尝试

流行病学调查显示,高血压已成为导致过早死亡的首要原因[1],而血压值与心血管疾病的风险之间有着直接的线性关系,控制不佳的高血压可导致冠状动脉粥样硬化性心脏病、心力衰竭、卒中和慢性肾脏疾病等发生风险增加。近年来,已有数种针对高血压治疗的创新医疗器械和装置处于开发和试验阶段,     

他汀类药物的多效性——非调脂治疗作用及临床研究进展

他汀类药物在治疗高胆固醇血症、心脑血管病方面发挥了重要作用,近年来他汀类药物的非调脂作用,即他汀类药物的多效性逐渐受到关注,逐渐增加的临床试验结果显示他汀类药物在心力衰竭、高血压、肾脏保护、延缓退行性瓣膜病进展、抗心律失常、影响凝血系统及促进干细胞分化等方面有重要作用,合理应用可充分发挥他汀类药物疗效,对心血管疾病的治疗可能有重要意义.目前正在进行的有关临床试验研究将逐步阐明他汀类药物多效性机理.     

从循征医学看老年心血管病药物治疗进展(上)

20 世纪心血管疾病研究的成就是举世瞩目的,其突出的表现是随机对照试验(ran domize (controlled trials,RCT)作为一种方法和标准被医学界广泛接受.与此同时,荟萃分析(meta analysis)作为对大量RCT的概括和总结也日益得到认可.     

Outpatient treatment of patients with cardiovascular diseases

In Germany, cardiovascular disturbances belong to the diseases most frequently treated in the offices of general practitioners and internal specialists. With comprehensive monitoring and the taking of adequate therapeutic measures, the average mortality age of the majority of the 18 million patients suffering from circulatory diseases lies at 79.4 years. In the age group of over 70 years, 70 to 80% of the patients receive treatment against cardiovascular disturbances, most of them against hypertension. One of the most important goals of monitoring and intervention in the outpatient sector is the treatment of hypertension, especially in connection with measures taken against disturbances in lipometabolism in order to prevent secondary diseases. The success of treatment is shown by the decreasing age standardized rate of cardiac infarctions, especially among men, and the decreasing mortality rate of patients below 65. The increasing treatment in the outpatient sector is accompanied by additional interventions, especially by bypass surgery in the hospital sector. The concerted actions in both the outpatient and the inpatient sector result in a higher service provision to come to a higher quality of life in the patients and to prevent early death.     

循证医学在内科系统疾病诊治中的应用

随着医学模式从经验医学向现代医学转变,单纯依靠临床医生或同道既往对同种疾病治疗的成功经验为依据,或者单纯依靠病理生理学机制进行医疗决策或新药开发是不够的。例如,从疾病的病理生理进程来看,心肌梗死患者发生室性心律失常是猝死的重要危险因素。因此,我们有充足理由对此类患者常规使用抗心律失常药物。但随后的随机对照试验证明,I类抗心律失常药虽然能抑制室性心律失常,却增加病人的病死率;短效钙拮抗剂虽然能有效降低高血压患者的血压水平,却增加心梗和死亡风险。因此,医务人员必须将个人的临床专业知识和临床经验与现有的最佳临床研究结果和患者的选择相结合,为患者制定最佳的医疗决策,这就是循证医学的核心思想。     

脂蛋白(a)与心血管疾病的关系

脂蛋白(a)[Lp(a)]结构类似于低密度脂蛋白(LDL),高水平Lp(a)是一种公认的心血管疾病危险因子。体内存在氧化型Lp(a)更易于促进动脉粥样硬化的发生发展。Lp(a)中的载脂蛋白(a)[apo(a)]存在异质性,研究显示其危险性可能是由于apo(a)等位基因水平差异引起的,而且apo(a)的多态性影响到Lp(a)水平的临床测定,如何降低apo(a)对结果的影响还需要更多深入研究。目前针对高Lp(a)水平的人群尚无统一的治疗标准,但降脂治疗有益于预防心脑血管疾病的发生。     

Gene transfer with ultrasound and microbubbles (optison) as a potential treatment for cardiovascular diseases

Cardiovascular diseases are the leading causes of mortality and morbidity in developed countries. Most conventional therapy is inefficient and tends to treat the symptoms rather than the underlying causes of the disorder. Gene therapy based on ultrasound with microbubbles offers a novel approach for the prevention and treatment of cardiovascular diseases. The major development of gene transfer has importantly contributed to intense investigation of the potential of gene therapy in cardiovascular medicine. The amazing advances in molecular biology have provided a dramatic improvement of the technology that is necessary to transfer target genes into somatic cells. Gene transfer methods have been surprisingly improved. In fact, some of them (retroviral vectors, adenoviral vectors or liposome based vectors, etc) have been used in clinical trials already. However, some severe side effects were reported in clinical gene therapy using such viral vector, so people wish for safe and efficient clinical gene therapy. Transfection with ultrasound and microbubbles has been reported as a new powerful tool in a new class for gene therapy.     

促红细胞生成素治疗心血管疾病的研究进展

慢性心功能不全患者普遍存在贫血。促红细胞生成素(EPO)不仅改善贫血,同时改善心功能不全患者的左心室功能,提高生活质量。EPO的非促红细胞生成作用包括抑制细胞凋亡,促进细胞增殖和血管生成。这些作用可能是其能治疗卒中、心肌缺血/再灌注损伤等心血管疾病的治疗学基础。