高血压合并心脑血管疾病患者的血压处理

2013年6月在欧洲高血压学会（ESH）年会上,ESH与欧洲心脏病学会（ESC）共同发布了《2013ESH／ESC动脉高血压管理指南》。下面结合新的ESC高血压指南及《2010年中国高血压防治指南》的建议,简单介绍高血压合并几种常见心脑血管病（脑卒中、冠心病、心力衰竭）的血压控制目标和药物选择。     

2007年ESH/ESC高血压治疗指南明确提出:联合治疗是/高血压初始治疗的很好策略——新版ESH/ESC指南中高血压治疗的关键点

2007版欧洲高血压学会(ESH)/欧洲心脏学会(ESC)高血压治疗指南已于2007年6月15日至19日在意大利米兰召开的第17届ESH年会上公布.该指南在2003版ESH/ESC高血压治疗指南基础上进行了更新.新版指南强调:患者获益与血压降低程度密切相关,多项证据支持降低血压对高血压患者有保护作用.     

ESH/ESC指南及其与JNC-7的区别评价

欧洲已成为全球高血压流行最严重的地区,35岁以上人群血压的平均水平(136/83 mmHg)和高血压患病率(44.2%)明显高于北美,而社会经济状况和医疗条件又不同于发展中国家.因此,按照第四版或1999年WHO/ISH高血压治疗指南中关于各个地区或国家按照实际情况制定治疗指南的建议,在WHO/ISH认可下,欧洲高血压学会(ESH)和心脏病学会(ESC)的学术团体以临床试验和研究获得的证据为基础,以教育和提供较全面平衡的信息知识为目的,起草并在2003年6月《Journal of Hypertension》第21卷发表了首次欧洲高血压治疗指南,即ESH/ESC指南.     

2007ESH／ESC高血压指南要点解读——循证、务实、灵活、平衡

2007年6月19日,2007版欧洲高血压学会(ESH)/欧洲心脏学会(ESC)高血压指南在第17届ESH年会上公布。本指南在2003版欧洲指南基础上,充分融入了近年来新揭晓的重要临床试验证据,对高血压的诊断与治疗做出了的建议。新指南再次重申了"降压是硬道理,患者获益主要来自于血压下降"的核心理念,进一步强调了改善生活方式对高血压防治的重要意义,同时对高血压的诊断与治疗建议作出了更新与完善。本指南虽然由欧洲学术团体颁布,但由于制定过程中充分参照了全球范围内涉及各个种族(包括中国)的临床试验新证据,因此具有广     

欧洲高血压指南更新

新近,欧洲高血压协会（ESH）对2007版高血压指南进行了更新并正式颁布。新指南以上一版指南为基础,充分参照近两年来新揭晓的临床试验证据,对高血压的诊断与治疗建议做出了更新与完善。在新版指南中,有以下10个方面值得关注。     

三大高血压指南精要对比解读

本文对2009版欧洲高血压协会/欧洲心脏病学会(ESH/ESC)高血压指南再评价、2010版中国高血压防治指南和2011版英国国家健康与临床医疗研究所(NICE)指南中的要点进行了对比解读,强调总体心血管风险评估以及个体化设定降压目标的重要性,指出五大类降压药均可作为高血压的起始和维持用药,强调我国的临床实践应以我国现行的高血压防治指南为准。     

2007年ESC／ESH高血压的新视点（一）

自2003年欧洲高血压指南发布后,国际上完成了一系列有价值的大规模随机对照临床试验,为高血压的治疗提供了许多新证据。2007年6月欧洲心脏病学会（ESC）-欧洲高血压学会（ESH）联合颁布了《欧洲高血压指南》,该指南在保留2003年指南框架的基础上,充分体现了高血压防治的战略前移,更加重视事件预防,强调高血压不是孤立性疾病,需要总体评估和预防。     

解读2007版《欧洲高血压治疗指南》

2007年6月15日欧洲高血压学会（ESH）在米兰召开的17届年会上与欧洲心脏病学学会（ESC）联合公布了新的《欧洲高血压治疗指南》（以下简称新版指南）。此次修订后指南的最大特点是为临床医生提供了详实的证据。提出了参考性建议而非强制规定。     

生命网与欧洲高血压指南的实施

2003年6月,由欧洲高血压协会(ESH)和欧洲心脏协会(ESC)组建的高血压治疗指南起草委员更新和公布了"欧洲心脏病协会动脉高血压治疗指南".新指南制定的目的是把目前所能收集到的最好的、最全面的信息提供给与高血压治疗有关的各级医务人员.基于这个目的,新指南不仅保留了1999年WHO/ISH的一些内容,而且综合、客观分析了近来的一些大规模随机对照试验和荟萃分析,并结合欧洲的实际情况,提出了新的观点和认识.     

2005年高血压领域中的热点问题

在过去的2005年里，中国高血压防治指南（全文）正式发表；发表重要的临床试验有ALLHAT亚组（欧洲高血压年会，ESH）、VALUE亚组（ESH）、ELSA亚组（ESH）、CAMELOT亚组（美国心血管病年会，AHA）、FEVER（ESH）、ASCOT-BPLA（欧洲心血管病年会，ESC）、ASCOT-UA亚组（AHA）和ACTION亚组（ESH）等。提出的热点问题有高血压新定义、高血压指南“解读”、降压与冠心病和联合用药方案等。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.