先天性心脏病合并肺动脉高压患儿血清尿酸、C - 反应蛋白与NT - proBNP的检测及临床意义

目的 探讨先天性心脏病合并肺动脉高压患儿血清尿酸（SUA）、C - 反应蛋白（CRP）与氨基末端B型脑钠肽前体(NT - proBNP)的检测及临床意义。方法 通过回顾性分析220例先天性心脏病相关性肺动脉高压患儿的临床病历资料,分析患儿SUA、CRP、NT - proBNP水平与肺动脉高压相关性。结果 心脏病合并肺动脉高压患儿SUA水平随着肺动脉高压程度有逐渐升高的趋势,分别为（0.31±0.04）mmol/L、（0.40±0.08）mmol/L、（0.49±0.08）mmol/L,差异有统计学意义（P＜0.05）。CRP随着肺动脉高压程度呈逐渐升高的趋势,分别为（0.59±0.63）mg/L、（1.66±0.28）mg/L、（3.4±0.41）mg/L,差异有统计学意义（P＜0.05）。NT - proBNP随着肺动脉高压轻中重度不同,分别为（104.6±15.7）pg/ml、（327.4±20.6）pg/ml、（565.3±45.9）pg/ml,呈逐渐升高的趋势,差异有统计学意义（P＜0.05）。经相关性分析,尿酸、C - 反应蛋白、NT - proBNP与肺动脉舒张压、肺动脉收缩压及肺动脉平均压呈正相关。结论 SUA、CRP、NT - proBNP水平与肺动脉压力呈正相关,可间接反映先天性心脏病相关性肺动脉高压患儿的病情严重程度。     

高血压与尿酸血脂及肌酐水平相关性探讨

目的观察高血压患者血尿酸、肌酐及血脂水平的改变与关系及其临床意义。方法以2010年上海市松江区泗泾地区已确诊为高血压并在社区随访跟踪的1 328例患者和6 241例同期健康体检者为研究对象,用奥林巴斯400型全自动生化分析仪测定甘油三酯（TG）、胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、血肌酐（Cr）、血糖（GLU）、血尿酸（UA）的水平。结果高血压组血UA显著高于对照组（P〈0.01）,TG、TC、动脉硬化指数（AIP）、脉压差（DP）均显著高于对照组（P均〈0.01）,HDL-C显著低于对照组（P〈0.01）;高血压各亚组中Cr、GLU、UA、DP组间比较差异有统计学意义（P〈0.01）;相关分析显示,高血压组血UA与Cr呈正相关（r=0.478,P〈0.01）,与HDL-C呈负相关（r=-0.142,P〈0.01）;不同年龄段男女性别间UA水平（男性F=2.824,P〈0.05;女性F=6.249,P〈0.01）及高尿酸血症分布（男性χ2=11.204,P〈0.05;女性χ2=10.891,P〈0.05）;总体差异有统计学意义,随着年龄的增加,尿酸值和高尿酸血症的检出率不断升高;高尿酸患者中Cr和Cr升高率均明显高于非高尿酸者（P〈0.01）。结论①血尿酸升高是高血压病的危险因素之一;血尿酸升高与脂质代谢异常有关。②高血压患者Cr值与尿酸关系密切,尿酸是高血压患者肾损害的早期表现。③高血压病与血尿酸、血脂水平明显相关,且分别是独立的危险因素。     

老年心力衰竭感染患者血钠、B型钠尿肽、尿酸的水平与心功能的相关性研究

目的探讨血钠(Na)、B型钠尿肽(BNP)、尿酸(UA)在老年心力衰竭感染中的表达及与心功能的关系,以降低老年心力衰竭的感染率。方法选取2010年1月-2014年1月50例老年心力衰竭感染患者为感染组,同期选择50例老年心力衰竭无感染患者为疾病非感染组,选择50名健康人群为对照组;检测受试者血Na、BNP、UA水平,采用SPSS 17.0软件进行分析。结果感染组患者血BNP、UA水平高于非感染组和对照组,差异有统计学意义(P<0.01);非感染组患者血Na水平明显低于对照组,差异有统计学意义(P<0.01);感染组患者血BNP、UA水平高于非感染组,差异有统计学意义(P<0.01);感染组患者血NA水平明显低于非感染组,差异有统计学意义(P<0.01)。结论血BNP、UA在老年心力衰竭感染中呈高表达,而血Na在老年心力衰竭感染中呈下降趋势,血Na、BNP、UA与老年心力衰竭感染病情及进展密切相关。     

Precursors of essential hypertension: body weight, alcohol and salt use, and parental history of hypertension

Body mass index, alcohol and salt consumption, and parental history of hypertension were examined as possible predictors of the development of essential hypertension in 1,031 persons, ages 30-49 years at entry, with documented normotension followed by documented hypertension after a mean interval of 6 years. In a comparison with 1,031 matched persistently normotensive persons initial body mass index and percentage increase in body mass index were each predictive of hypertension. Consumption of three or more alcoholic drinks a day at baseline was also predictive, more so if this level of intake persisted than if it diminished. Heavy salt intake as crudely estimated at baseline by one question was also associated with the development of hypertension. Parental history of hypertension was also predictive, more so for hypertension in the mother than for hypertension in the father, and the association was apparent only in female subjects. These characteristics at baseline showed independent associations with subsequent hypertension in multivariate analysis. When follow-up data were included in the multivariate analysis, alcohol consumption at the hypertensive examination was much more strongly related than at the baseline examination, suggesting a short-term effect, and heavy salt consumption was no longer predictive, possibly because of a marked loss of subjects due to missing follow-up data. This large study confirms longitudinally the importance of obesity, weight gain during adulthood, alcohol, family history, and, to some extent, salt as predictive and possibly causal factors for essential hypertension.     

糖尿病肾病血尿酸与血脂及肌酐清除率的关系

目的 通过检测2型糖尿病(T2DM)患者血尿酸(SUA)、血脂、血肌酐(SCr)等水平,探讨高尿酸血症与相关影响因素及糖尿病肾病发生、发展的关系.方法 根据尿微量白蛋白(mAlb)/肌酐(Cr)水平将102例T2DM患者分为三个亚组:正常白蛋白尿组30例(尿mAlb/Cr＜30μg/mg)、微量白蛋白尿组41例(30μg/mg≤尿mAlb/Cr＜300μg/mg)及临床白蛋白尿组31例(尿mAlb/Cr≥300μg/ms),测定SUA、SCr、糖化血红蛋白(HbA1c)、空腹胰岛索(FINS)、三酰甘油(TG)等指标,计算肌酐清除率(CCr),并与40例对照者(对照组)比较.结果 临床白蛋白尿组SUA水平为(369.3±181.2)μmol/L,显著高于对照组、正常白蛋白尿组、微量白蛋白尿组的(248.6±109.4)、(228.7±104.8)、(296.5±121.4)μmol/L(P＜0.01或＜0.05),且SUA随mAlb/Cr的增加而增加.SUA与SCr、TG呈正相关r=0.369、0.525,P＜0.01),与CCr呈负相关r=-0.389,P＜0.01);多元线性逐步回归分析显示TG与SUA呈正相关(P＜0.05),CCr与SUA呈负相关(P＜0.05),SCr与SUA无相关性.结论 TG和CCr是SUA的独立相关因素,CCr与SUA相关性较SCr更好,高尿酸血症可能参与了T2DM患者糖尿病肾病的发生、发展过程,应尽早干预治疗.     

血清同型半胱氨酸、胆红素、尿酸水平检测在冠状动脉病变患者中的意义

目的 探讨血清同型半胱氨酸、胆红素、尿酸水平检测在冠状动脉病变患者中的意义.方法 2010年1月～2011年12月,分别检测600例冠心病(CHD)患者[其中稳定性心绞痛(SAP) 132例,不稳定心绞痛(UAP) 171例,急性非Q波心肌梗死(NQMI) 153例和急性Q波心肌梗死(QMI) 144例]和300健康对照者血清同型半胱氨酸、胆红素、尿酸水平.结果 CHD组血清同型半胱氨酸、总胆红素和尿酸水平明显高于对照组(P＜0.05).UAP组血清同型半胱氨酸、总胆红素和尿酸水平明显高于SAP组(P＜ 0.05); QMI组和NQMI组血清同型半胱氨酸、总胆红素和尿酸水平明显高于UAP组和SAP组(P＜0.05),而QMI组和NQMI组血清同型半胱氨酸、总胆红素和尿酸水平比较,差异无统计学意义(P＞0.05).结论 血清同型半胱氨酸、总胆红素和尿酸水平检测对于诊断CHD,判断CHD患者的病情具有重要意义,及早改善其在血中的浓度,有助于延缓动脉粥样硬化的发展.     

原发性高血压不同类型与窦性心率震荡关系

目的 探讨不同类型原发性高血压患者窦性心率震荡(HRT)的特点,评估窦性HRT指标对原发性高血压患者心脏自主神经功能损害的价值.方法 107例原发性高血压患者(高血压组)和46例健康体检者(健康对照组)均接受24 h动态心电图(Holter)检查,根据血压昼夜节律特点将高血压组分为杓型高血压组38例、非杓型高血压组53例及反杓型高血压组16例,分别比较各组HRT和心率变异性(HRV)各项指标,并分析震荡初始(TO)、震荡斜率(TS)与24 h平均收缩压、舒张压等指标之间的关系.结果 高血压组TO、TS、窦性RR间期标准差(SDNN)与健康对照组比较,差异均有统计学意义(P＜0.05).非杓型高血压组及反杓型高血压组TO明显高于健康对照组(P＜0.05),TS则明显低于健康对照组(P＜0.05);而杓型高血压组TO、TS与健康对照组比较差异均无统计学意义(P＞0.05).同时非杓型高血压组和反杓型高血压组的TO明显高于杓型高血压组,TS则明显低于杓型高血压组,差异均有统计学意义(P＜0.05).相关性分析显示,TO与平均心率和年龄呈正相关(Spearman等级相关系数=0.265,P=0.004;Spearman等级相关系数=0.217,P=0.018),与SDNN和左室射血分数(LVEF)呈负相关(Spearman等级相关系数=-0.287,P=0.002;Spearman等级相关系数=-0.179,P=0.049).TS与平均心率和年龄呈负相关(r=-0.335,P=0.015;r=-0.238,P=0.009),而与SDNN和LVEF呈正相关(r=0.540,P=0.001;r=0.432,P=0.001).结论 在原发性高血压患者中,血压昼夜节律异常者窦性HRT减弱或消失,提示窦性HRT在评估原发性高血压患者心脏自主神经功能损害方面有一定价值.

Abstract：

Objective To explore sinus heart rate turbulence (HRT) in patients with different subtypes of essential hypertension (EH), and analyze the relationship between HRT and autonomic nervous system function damage in these patients. Methods The study consisted of 107 patients with EH (EH group) and 46 controls (control group). Based on 24 hours dynamic electrocardiogram, all patients were divided into dipper,non-dipper,and anti-dipper blood pressure group. The indexes about HRT and heart rate variability (HRV) among these groups were calculated and compared,and the relationship between turbulence onset (TO),turbulence slope (TS) and 24 hours mean systolic blood pressure,diastolic blood pressure was analyzed. Results There were significant differences in TO,TS,SDNN between EH group and control group(P ＜ 0.05 ). TO in non-dipper and anti-dipper blood pressure group was significantly higher than that in control group( P ＜ 0.05 ), and TS was lower than that in control group(P ＜ 0.05 ). There was no significant difference in TO,TS between dipper blood pressure group and control group (P ＞ 0.05). TO in non-dipper and anti-dipper blood pressure group was significantly higher than that in dipper blood pressure group, but TS was lower than that in dipper blood pressure group (P ＜0.05). Correlation analysis showed that TO had positive relationship with average heart rate and age (rs = 0.265, P = 0.004;rs = 0.217, P = 0.018 ), but had negative correlation with SDNN and left ventricular ejection fraction (LVEF) (rx = -0.287,P = 0.002;rx =-0. 179, P = 0.049). Whereas, TS had negative correlation with average heart rate and age (r = -0.335, P =0.015 ;r = -0.238,P= 0.009), but had positive relationship with SDNN and LVEF(r = 0.540,P = 0.001 ;r =0.432,P = 0.001 ). Conclusions HRT of EH patients becomes significantly low. It suggests that the autonomic nerve function in EH patients be injured seriously.     

High-protein diets in hyperlipidemia: effect of wheat gluten on serum lipids, uric acid, and renal function.

BACKGROUND: The metabolic effects of diets high in vegetable protein have not been assessed despite much recent interest in the effect of soy proteins in reducing serum cholesterol. OBJECTIVE: We assessed the metabolic effects of diets high in vegetable protein (specifically, wheat gluten) on serum lipids, uric acid concentrations, and renal function. DESIGN: Twenty hyperlipidemic men and women consumed isoenergetic test (high-protein) and control metabolic diets for 1 mo in a randomized crossover design. In the high-protein diet, 11% of the total dietary energy from starch in the control bread was replaced by vegetable protein (wheat gluten), resulting in 27% of total energy from protein compared with 16% in the control diet. In other respects, the 2 diets were identical. RESULTS: Compared with the control, the high-protein diet resulted in lower serum concentrations of triacylglycerol (by 19.2 +/- 5.6%; P = 0.003), uric acid (by 12.7 +/- 2.0%; P < 0.001), and creatinine (by 2.5 +/- 1.1%; P = 0.035) and higher serum concentrations of urea (by 42.2 +/- 5.8%; P < 0.001) and a higher 24-h urinary urea output (by 99.2 +/- 17.2%; P < 0.001). No significant differences were detected in total or HDL cholesterol or in the renal clearance of creatinine. LDL oxidation, assessed as the ratio of conjugated dienes to LDL cholesterol in the LDL fraction, was lower with the high-protein diet (by 10.6 +/- 3.6%; P = 0.009). CONCLUSIONS: High intakes of vegetable protein from gluten may have beneficial effects on cardiovascular disease risk by reducing oxidized LDL, serum triacylglycerol, and uric acid. Further studies are required to assess the longer-term effects on renal function.     

血清胆红素与尿酸在冠心病诊断中的应用价值

目的 探讨血清胆红素与尿酸(UA)检验对临床诊断冠心病的应用价值.方法 选取2018年4月-2020年5月在茌平区人民医院接受治疗的54例冠心病患者作为研究组,以同时期进行健康体检的54例体检者作为对照组,比较两组的血清胆红素和UA水平.研究组给予冠状动脉造影,依照评分标准对患者的病变情况进行评估.结果 研究组DBiL...     

The clinical utility of serum uric acid measurements in pre-eclampsia and transient hypertension in pregnancy

BACKGROUND: Our purpose was to evaluate the clinical utility of serum uric acid measurements in the hypertension diseases of pregnancy. METHODS: We identified 286 women and categorized them into three diagnostic groups according to definitions of hypertensive diseases in pregnancy published by the National Working Group on Hypertension in Pregnancy: pre-eclampsia (94), transient hypertension (102) and normal (90). We compared the median uric acid concentration for each group and calculated the sensitivities and the specificities in diagnosing pre-eclampsia. The results were analyzed by the Mann-Whitney test. RESULTS: Median serum uric acid values in the pre-eclamptic group, in the transient hypertension group and in the control group were 375 (262-536) mumol/L, 309 (214-387) mumol/L, 259 (143-339) mumol/L, respectively. Compared with normal, the median serum uric acid levels in women with pre-eclampsia or transient hypertension were significantly elevated. Differences in median serum uric acid concentrations between women with preeclampsia and with transient hypertension were statistically significant too. The prevalence of IUGR in the pre-eclamptic group and transient hypertension group was 65.9% and 29.4%, respectively. Sensitivity for serum uric acid levels of 339 mumol/L was 77.3% in the pre-eclamptic group and 32.3% in the transient hypertension group; the difference was statistically significant. Specificity was exactly the same in both groups (92%). CONCLUSIONS: Our data, in accordance with international literature, confirm the clinical utility of serum uric acid as a marker of pre-eclampsia, but not of transient hypertension. Furthermore its high predictive value makes it possible to select a group of pre-eclamptic women with high risk for intrauterine growth retardation.     

高龄老年高血压人群血尿酸浓度与脑梗死的相关性研究

目的 探讨高龄老年高血压患者血尿酸(UA)水平与脑梗死的关系.方法 选取2009年在我院老年科住院的年龄≥80岁的高血压和脑梗死患者572例,根据所患疾病分为高血压组(Ⅰ组387例)和高血压合并脑梗死组(Ⅱ组185例),测定UA、血清肌酐(Cr)、高密度脂蛋白胆固醇(HDL-C)、血糖等生化指标,分析UA水平与高血压合并脑梗死的相关性.结果 Ⅰ组UA为(312.49±55.31)μmol/L、Cr为(86.48±18.38)μmol/L、HDL-C为(1.29±0.37)mmol/L;Ⅱ组UA为(397.76±63.64)μmol/L、Cr为(100.52±19.99)μmol/L、HDL-C为(1.11±0.33)mmol/L.两组比较分别为P=0.001、P=-0.001、P=0.024.Logistic回归分析显示,脑梗死患病率与UA(OR 1.727,95%CI 1.258～3.903)和HDL-C(OR 0.794,95%CI 0.663～0.975)明显相关.结论 UA增高是高血压合并脑梗死的一个重要危险因素.     

高龄老年高血压人群血尿酸浓度与脑梗死的相关性研究

目的探讨高龄老年高血压患者血尿酸(UA)水平与脑梗死的关系。方法选取2009年在我院老年科住院的年龄≥80岁的高血压和脑梗死患者572例,根据所患疾病分为高血压组(Ⅰ组387例)和高血压合并脑梗死组(Ⅱ组185例),测定UA、血清肌酐(Cr)、高密度脂蛋白胆固醇(HDL-C)、血糖等生化指标,分析UA水平与高血压合并脑梗死的相关性。结果Ⅰ组UA为(312.49±55.31)μmol/L、Cr为(86.48±18.38)μmol/L、HDL-C为(1.29±0.37)mmol/L;Ⅱ组UA为(397.76±63.64)μmol/L、Cr为(100.52±19.99)μmol/L、HDL-C为(1.11±0.33)mmol/L。两组比较分别为P=0.001、P=0.001、P=0.024。Logistic回归分析显示,脑梗死患病率与UA(OR1.727,95%CI1.258~3.903)和HDL-C(OR0.794,95%CI0.663~0.975)明显相关。结论 UA增高是高血压合并脑梗死的一个重要危险因素。     

中青年原发性高血压患者静息心率与代谢综合征的关系

目的 探讨中青年原发性高血压患者静息心率(RHR)与代谢综合征之间的关系.方法 选择2012年1月至2013年5月门诊及住院中青年原发性高血压患者340例,按照RHR分为RHR1组(52例):RHR＜ 70次/min;RHR2组(168例):RHR 70～85次/min; RHR3组(120例):RHR＞ 85次/min.各组患者均行血压、空腹血糖、糖负荷后2h血糖、三酰甘油、高密度脂蛋白胆固醇、腰围测定,并进行比较.结果 三组空腹血糖、糖负荷后2h血糖、三酰甘油、腰围、收缩压、舒张压随RHR升高而升高,高密度脂蛋白胆固醇随RHR增高而下降[空腹血糖:(4.96±0.65),(5.66±0.77),(6.85±0.73) mmol/L;糖负荷后2h血糖:(6.85±0.51),(7.94 ± 0.66),(8.97±0.59) mmol/L;三酰甘油:(1.69±0.43),(2.58±0.75),(3.52±0.90) mmol/L;腰围:(78.3±6.5),(88.6±7.3),(95.8±9.2)cm;收缩压:(143.2±5.6),(156.7±6.1),(164.3±7.4)mmHg,1 mmHg =0.133 kPa;舒张压:(85.4±5.2),(93.6±4.7),(101.2±3.5) mmHg;高密度脂蛋白胆固醇:(1.08±0.64),(0.95±0.59),(0.78±0.33) mmol/L],各组间比较差异均有统计学意义(P＜0.05).相关性分析显示:RHR与空腹血糖、糖负荷后2h血糖、三酰甘油、腰围呈正相关(r值分别为0.52,0.45,0.50,0.36,P＜0.05),与高密度脂蛋白胆固醇呈负相关(r值为-0.39,P＜0.05).结论 RHR与中青年原发性高血压患者代谢紊乱密切相关,降压同时应注重心率控制.     

Unscrambling the research: Eggs, serum cholesterol and coronary heart disease

The role of dietary cholesterol in raising plasma cholesterol levels has been debated over the past 25 years. Consequently, eggs, as a food high in dietary cholesterol, have been targeted as a food to limit when advising patients on a diet to lower serum cholesterol levels. The aim of the present review was to evaluate the literature to address the effects of dietary cholesterol from eggs on serum cholesterol levels and risk of coronary heart disease. An increase in dietary cholesterol from eggs by 100 mg daily, equivalent to half a medium egg or three to four eggs a week, results in an increase of approximately 0.05 mmol/L in LDL cholesterol. Adding 100 mg of cholesterol per day (equivalent to three to four eggs a week) to a high saturated fat diet caused an increase in LDL cholesterol of 0.061 ± 0.006 mmol/L, whereas adding the same quantity of cholesterol to a low saturated fat diet caused an increase in LDL cholesterol of only 0.036 ± 0.004 mmol/L (P = 0.03). Despite the small increase in LDL‐cholesterol levels with increasing egg intake, most epidemiological studies have shown little or no association between egg intake and risk of coronary heart disease. However, the impact of dietary cholesterol for people with type 2 diabetes has been poorly studied. In conclusion, in a healthy Western population, there is insufficient evidence to excessively restrict egg intake as part of a healthy diet. Eggs should be considered in a similar way as other protein‐rich foods and selected as part of a varied diet that is low in saturated fat and contains a variety of cardio‐protective foods such as fish, wholegrains, fruits, vegetables, legumes and nuts.     

Injectable contraceptive, DMPA, serum HDL cholesterol and heart infarct

In 23 women who had used the injectable contraceptive depot medroxyprogesterone acetate (DMPA) for at least 1 year, the mean serum high-density lipoprotein cholesterol (HDL-C) level was distinctly lower than in 23 women carrying an IUD. The high serum DMPA levels during the 1st few weeks after a subsequent DMPA injection, and the low levels 12 weeks after the injection were found to be associated with the same (low) serum HDL-C level. For this reason, a fall in the serum HDL-C level in DMPA users is probably not a direct effect of the DMPA, but rather an indirect effect of the diminished production of endogenous estrogens in the ovaries of DMPA users. Though the investigation does not justify definite conclusions, it appears advisable not to prescribe DMPA to women with an increased risk of atherosclerosis and myocardial infarction. (author's)     

血尿酸和超敏C-反应蛋白与长寿家系的关系

目的 分析血尿酸、超敏C-反应蛋白与长寿家系的关系。 方法 选取5个长寿县的90岁及以上长寿老人,并匹配选取其他年龄段的非长寿老人进行横断面调查,817名老人均接受问卷收集基本信息,空腹静脉血测定血尿酸、超敏C-反应蛋白。结果 在整个调查人群中,长寿家系血尿酸水平显著高于非长寿家系（t=2.146, P=0.016）。非长寿老人中,长寿家系高尿酸血症、高超敏C-反应蛋白患病率与非长寿家系比较差异有统计学意义（〖XC五号.EPS;P〗=11.163、5.253,P=0.001、0.022）。多因素logistic回归分析结果显示,在非长寿老人中,长寿家系患高尿酸血症的风险更高（OR=1.670,95%CI:1.054-2.646）,患高超敏C-反应蛋白的风险更低（OR=0.417,95%CI:0.193-0.899）。在长寿老人中,长寿家系和非长寿家系患高尿酸血症和高超敏C-反应蛋白的风险无差别（P=0.101、0.435）。结论 一定范围的高血尿酸和低超敏C-反应蛋白可能是长寿的有益因素,并可能是长寿遗传的特征指标。