硒蛋白S与糖尿病及心脑血管疾病的关系

硒蛋白S(SelS)即Tanis/SEPS1/VIMP是一种跨膜蛋白,在组织中广泛表达,是糖调节蛋白家族中的一员,可保护细胞免受内质网应激损伤,对胰岛β细胞和内皮细胞具有抗氧化保护作用;其作为血清淀粉样蛋白A的受体参与炎性反应,并与血糖、胰岛素抵抗、血脂水平相关.SelS基因多态性与糖尿病和心、脑血管疾病有关,故可能成为防治上述疾病的新靶点.     

脑血管病患者的睡眠异常

脑血管病患者常合并睡眠异常,主要与病变部位、精神心理因素有关.对合并睡眠异常的脑血管病患者应引起重视,积极寻找病因,早期治疗,减少并发症,有利于提高患者的生活质量.文章对脑血管病患者睡眠异常的病因、临床特点、诊断和防治等做了综述.     

Hemorheological disturbances in patients with chronic cerebrovascular diseases

Hemorheological disturbances may occur in more than 40% of patients with ischemic cerebrovascular diseases. In this study the changes of rheological factors--hematocrit, plasma fibrinogen concentration, whole blood and plasma viscosity, red blood cell aggregation and deformability were investigated in 297 patients (173 males, 124 females, mean age 60 +/- 11 years) with transient ischemic attack or chronic phase (> 3 months after onset) ischemic stroke, and in 73 healthy volunteers (35 males, 38 females, mean age 38 +/- 7 years). Hematocrit, plasma and whole blood viscosity were significantly (p < 0.0001) elevated in cerebrovascular patients compared to controls. Plasma fibrinogen concentration (p < 0.001), red blood cell aggregation (p < 0.05) and deformability (p < 0.01) were also impaired in stroke patients. Hemorheological disturbances were dominant in stroke patients with diabetes, hyperlipidemia and smoking habits. Hematocrit, plasma viscosity and red blood cell aggregation showed a significant (p < 0.025-0.001) correlation with the severity of carotid artery stenosis. We could not find any characteristic distribution of rheological parameters among the three subtypes of brain ischemia. Our results show that all of the measured rheological parameters are significantly impaired in chronic ischemic cerebrovascular disorders, especially in diabetic, smoking and alcoholic patients. They correlate with the severity of the carotid artery stenosis, but there is no association with the type of ischemic stroke.     

Chronic cerebrovascular disorders: hemorheological and psychobehavioral aspects

In order to evaluate the existence of a correlation between the hemorheological and the psychobehavioral pattern in chronic cerebrovascular disorder (CCVD) patients, 54 elderly CCVD patients were enrolled in the study. After a thorough clinical and instrumental examination they underwent a hemorheological and psychobehavioral assessment. The results showed a clear correlation between the severity of the psychobehavioral disorder and the hemorheological alterations, particularly with regard to the cellular factors. A hypothesis to explain these findings and future research trends are also discussed.     

Evaluation of hemorheological risk factor profile in plasmacytoma patients

The hemorheological parameters, plasma viscosity, hematocrit, erythrocyte aggregation and deformability of blood samples obtained from plasmacytoma patients are measured by capillary viscometer, microcentrifuge, Myrenne aggregometer, and filtrometer, respectively. These parameters are significantly altered in patients compared to those of normal subjects. The plasma viscosity and erythrocyte aggregation are increased, whereas erythrocyte deformability and hematocrit are decreased. Based on these parameters the hemorheological risk factor profiles are developed and by their overall risk factors, the patients with low and high risk factors are identified.     

Serum aldolase isozyme levels in patients with cerebrovascular diseases

A subunit specific radioimmunoassay was developed for the quantification of human aldolase A, B, and C. The method used was a double antibody radioimmunoassay using radioiodinated purified aldolase A, B, or C subunits as the ligand, specific chicken antibodies to aldolase isozymes and rabbit antibodies to chicken IgG. The Iodogen method was used for iodination of the purified isozyme subunits in this study. Human brain tissue contained similar concentrations of aldolase A and aldolase C, and a smaller amount of aldolase B, which was the main isozyme of liver tissue. Levels of serum aldolase A were greater than 203 ng/ml, the upper limit of normal, in six of 24 patients with cerebral infarction and in 11 of 31 patients with cerebral hemorrhage. Nine of 24 patients with cerebral infarction and 16 of 31 patients with cerebral hemorrhage had serum aldolase C levels greater than 4.1 ng/ml, the upper limit in normal sera. These data suggest that serum aldolase C may be a more specific and sensitive marker of cerebrovascular diseases than aldolase A. We also demonstrated that serial measurement of serum aldolase C in patients with cerebrovascular diseases might be useful in estimating prognosis, since serially increasing serum aldolase C levels during the course of these diseases were correlated with a high mortality rate.     

经桡动脉数字减影血管造影术在老年脑血管病患者中的临床应用

目的在老年脑血管病患者中评估经桡动脉穿刺数字减影血管造影术的可行性及安全性。方法选择行全脑血管造影术的脑血管病患者200例,按血管入路随机分为桡动脉组100例和股动脉组100例,对比分析2组穿刺成功率、选择性造影成功率、曝光时间、并发症发生率。结果桡动脉组穿刺成功率及并发症发生率明显低于股动脉组(93.0%vs 100.0%,4.0%vs 10.0%,P<0.05),曝光时间明显长于股动脉组[(10.26±2.23)min vs(4.57±1.07)min,P<0.01],2组造影成功率比较,差异无统计学意义(P>0.05)。结论经桡动脉穿刺行数字减影血管造影术可以在老年脑血管病患者中开展,但是其操作难度及时间增大。     

老年心房颤动患者合并脑血管病危险因素研究

目的研究老年心房颤动(房颤)患者合并脑血管病的危险因素。方法选择房颤患者16 885例,根据年龄分为老年组7254例(年龄≥65岁),对照组9631例(年龄<65岁),对比分析老年房颤患者合并脑血管病的危险因素。结果房颤患者合并脑血管病的总患病率为9.4%。老年组脑血管病患病率明显高于对照组(14.4%vs5.6%,P<0.01),老年组合并脑血管病危险因素中,男性比例明显低于对照组,高血压、糖尿病、高同型半胱氨酸血症、冠心病比例明显高于对照组(P<0.05,P<0.01)。logistic回归分析,年龄、高血压、糖尿病、高脂血症、高同型半胱氨酸血症为房颤合并脑血管病的独立危险因素(P<0.01)。结论老年心房颤动患者合并脑血管病患病率明显高于非老年心房颤动患者,年龄、高血压、糖尿病、高脂血症、高同型半胱氨酸血症是心房颤动合并脑血管病的独立危险因素。     

Evaluation of nutritional state in hospitalized patients with cerebrovascular stroke

The cerebrovascular stroke is serious disease with the high mortality and resulting in invalidity. The result of its treatment is not yet encouraging. The stress situation which is characteristic for the acute stage of disease leads to catabolic status. This condition can be worsen if nutritional parameters are not properly monitored and the nutrition is not sufficient. We examined 30 patients admitted to our medical ward with the diagnosis of ischemic cerebrovascular stroke. We have not applied any nutritional intervention. We measured some anthropometric, biochemical and imunological parameters of nutrition at the time of admission to ward and after 14 days of hospitalization. Our results showed that nutritional status has worsen during this period according to the significant deterioration of the followed anthropometric and biochemical parameters. Malnutrition has the detrimental impact on rehabilitation and mobilization of the patients and extends time of hospitalization. Nutritional status should be monitored and corrected since the start of disease, preferably in intensive care unit.     

Evaluation of cerebrovascular events in patients with rheumatoid arthritis]

OBJECTIVE: We evaluated cerebrovascular events (cerebral infarction or cerebral bleeding) in patients with rheumatoid arthritis (RA). METHODS: Prognosis and the causes of death among 1100 RA patients from 1995 to 1999, were analyzed. 34 RA patients were complicated by cerebrovascular events. About them, hemoglobin, platelet, C-reactive protein, rheumatoid factor, total cholesterol, triglyceride, duration of disease, functional class, and dose of steroids per day were measured. RESULT: Among 1100 patients with RA, 90 died at the age of 70.2. Of these patients, 24 (26.7%) died of cerebrovascular events, 19 (21.1%) of heart failure, 16 (17.8%) of infectious diseases, 10 (11.1%) of malignant tumors, and 9 (10%) of renal failure. When RA patients who died of cerebrovascular events were compared with those who died of other causes, the dose of steroid was significantly lower and the age was higher in RA patients who died of cerebrovascular events. However, there were no significant differences in total cholesterol and triglyceride levels between the two groups. Although the major cause of death in RA patients was reported to be complication by cardiovascular diseases, infectious diseases, or renal failure, the frequency of deaths was higher in elderly RA patients complicated by cerebrovascular events. When the frequency of complication by cerebrovascular events was investigated in all RA patients including those who survived, 24 died and 10 survived. The frequency of complication by cerebral infarction was higher than that of complication by cerebral bleeding in RA patients who died of cerebral events. CONCLUSION: RA patients can live longer with improvements in care and treatment, the number of elderly RA patients who may died of complication by cerebrovascular events may gradually increase.     

老年人主动脉弓及颈内动脉粥样硬化斑块与脑血管病的相关性研究

目的探讨老年人升主动脉、主动脉弓及颈内动脉粥样硬化斑块与脑血管病的关系。方法选择25倒死于脑血管病的患者作为脑卒中组,15例死于非心脑血管病的患者为对照组,两组取升主动脉、主动脉弓和颈内动脉处相关组织,镜下观察动脉粥样硬化斑块的病理性质。结果脑卒中组患者升主动脉斑块有12例,颈内动脉斑块有12例,以扁平斑、硬斑和软斑为主;主动脉弓和颈内动脉入口处斑块有18例,其中溃疡斑和出血性斑块多见;对照组患者上述位置斑块各有5例.以散在硬斑为主,有少量软斑。结论老年人主动脉弓及颈内动脉入口处的溃疡斑、出血性斑块破裂可导致血栓形成,是引发脑血管病的危险因素。     

甲状腺疾病与脑血管病

甲状腺疾病与脑血管病的关系日益受到关注。研究显示,甲状腺疾病与缺血性脑血管病、烟雾病、脑静脉窦血栓形成、动脉夹层分离等多种脑血管病有关。文章对甲状腺疾病与脑血管病相关性的研究进展进行了综述。     

Immunological functions and clinical course of elderly patients with cerebrovascular diseases]

In the elderly, cerebrovascular diseases (CVD) are often complicated by severe infections such as pneumonia. This study aimed to examine the possible relationship at various timepoints of observation between immunological functions and the clinical course and to correlate the changes of immunological functions with CVD lesion side. The study was based on 25 right-handed patients (14 male and 11 female, mean age; male 69.0 years and female 74.9 years) with acute, focal neurological deficits of CVD (5 cerebral bleeding, 20 cerebral infarction; 11 right cerebral lesioned subjects, 14 left cerebral lesioned subjects). All patients were evaluated in terms of lymphocyte counts, T, B cell counts, T cell subsets, lymphocyte transformation and natural killer activity in peripheral blood as indices of immunological functions at various timepoints during the clinical course. Some of these immunological functions decreased within two months (acute stage) after onset of CVD, and some cases with decreased immunological functions developed complications of severe infection such as pneumonia. Patients who had both decreased immunological function and severe infection were 1 out of cases with 7 right cerebral lesions and 6 out of with 9 left cerebral lesions. This study suggests that the decreased immunological function in CVD subjects may be correlated with the site of the CVD lesion. In all left cerebral lesioned subjects, a reduction of immunological functions and a susceptibility to severe infection were not observed in the acute stage of CVD, however, some left cerebral lesion cases may be more closely related than in right cerebral lesion cases. The mechanism remains to be clarified.(ABSTRACT TRUNCATED AT 250 WORDS)     

论阻塞性睡眠呼吸暂停低通气综合征与脑血管疾病的关系

睡眠呼吸暂停低通气综合征（SAHS）及脑血管意外均为多发病。在SAHS患者中脑卒中更为常见，脑血管意外后呼吸暂停的发生率增加，二者关系密切。目前较为明确的是中枢性睡眠呼吸暂停（CSA）的发生肯定与脑血管意外有关，但阻塞性睡眠呼吸暂停（OSA）与脑血管意外究竟孰因孰果尚难定论，加之二者有许多共同的易患因素，答案就变得更为复杂。胡洁等^[1]的研究观察了椎基底动脉缺血患者经支架植入治疗前后阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者呼吸暂停低通气指数（AHI）的变化情况，对回答这一问题可以提供有益的启示。     

代谢综合征患者脉压与心脑血管疾病的相关性

目的：探讨脉压（PP）、脉压指数（PPI）与代谢综合征（MS）患者心脑血管疾病的相关性。方法：选择近5年我院门诊和住院MS患者204例（男138例．女66例）,按PPI≤0．40、0．41～0．50、0．51～0．60、〉0．60分为4组,按PP≤40mmHg、41～60mmHg、61～80mmHg、〉80mmHg（1mmHg=0．133kPa）分为4组．分析各组间PP、PPI与心脑血管疾病发生率的相关性。结果：①不同组的PP、PPI在吸烟、饮酒、体重指数（BMI）、血糖、腹围、舒张压（DBP）、甘油三脂（TG）、高密度脂蛋白-胆固醇（HDL-C）、及低密度脂蛋白-胆固醇（LDL—C）方面无显著差别（P〉0．05）,在年龄、收缩压（SBP）方面差异有显著性（P〈0．05～〈0．01）;不同组的PP及PPI的左室肥厚、冠心病、心功能不全、脑卒中发生率有显著性差异（P均〈0．05）;左室肥厚、冠心病、心功能不全、脑卒中的发生率与患者年龄、收缩压、脉压、脉压指数有显著相关性[EXP（B）=1．614～3．340,P均〈0．05]。结论：MS患者心脑血管疾病与年龄、SBP、PP、PPI等因素有关,与PPI的关系更为密切。     

急性脑血管病合并脑心综合征92例分析

目的探讨脑心综合征的临床特点及发病机制。方法回顾分析92例急性脑血管病(ACVD)并发脑心综合征的临床资料。结果ACVD患者脑心综合征的发生率为63.01%,大部分脑心综合征患者在ACVD两天内发病,多数于两周内随病情改善而好转;心脏损害的表现主要为心电图的复极异常、心律失常以及心肌酶谱不同程度的升高。出血性卒中、近中线结构的损害及意识障碍的患者并发脑心综合征发生率更高。结论其发生机制可能与脑特定部位受损导致对心脏神经支配紊乱,神经、体液调节障碍,血管病变及血流动力学变化等有关。应对ACVD加强心脏监护,积极诊治脑心综合征。     

他汀类药物预防缺血性脑血管病的研究进展

他汀类药物（以下简称他汀类）因具有降脂作用，早在20世纪80年代就被应用于临床。它是3-羟基-3-甲基戊二酸单酰辅酶A（HMG—CoA）还原酶的抑制剂，主要通过竞争性抑制HMG—CoA还原酶而减少甲羟戊酸和其他甲羟戊酸通路的中间产物生成。以往用于临床的主要目的是降低血脂，尤其是降低胆固醇。迄今为止，很多基础研究和临床试验证实，他汀类在心血管病事件一级和二级预防中有显著作用。其中，大样本多中心随机对照试验4S试验和胆固醇与复发性血管事件研究（CARE）试验证实，他汀类对心血管疾病有预防作用的同时，对卒中也有积极的预防作用。     

非对称性二甲基精氨酸与糖尿病脑血管病变

一氧化氮(nitric oxide,NO)是已知最重要的内源性血管舒张因子.内皮型一氧化氮合酶(nitric oxide and enzyme,NOS)的竞争性抑制剂非对称性二甲基精氨酸(asymmetric dimethylarginine,ADMA)可抑制NO的合成,使NO/NOS通路发生障碍,NO合成减少.近年来的研究表明,ADMA与糖尿病脑血管病变的发生和发展有关,为进一步明确该病的发生机制提供了新的见解.