高血压家族史儿童血压水平的研究

目的：了解有高血压家族史儿童的血压水平。方法：对167例有高血压家族史的儿童测量血压,以175例无高血压家族史的健康儿童作为对照。结果：与对照组比较,有家族史的儿童收缩压和舒张压明显增高,高血压检出率明显增高（2．57％：15．13％,P〈0．01）。有早发高血压家族史的儿童与非早发家族史儿童比较,收缩压和舒张压更高,高血压检出率更高（21．54％：12．94％,P〈0．01）。结论：有高血压家族史儿童血压水平较无高血压家族史儿童高,以有早发高血压家族史儿童更明显,提示成年后发生高血压的危险性显著升高。     

冠心病家族史儿童血浆脂类水平的研究

目的：探讨有冠心病（CHD）家族史儿童的血脂,脂蛋白,载脂蛋白（Ano)水平,方法：对83例有CHD家族史的儿童检测血浆总胆固醇（TC）,甘油三酯（TG）,低密度脂蛋白－胆固醇（LDL－C）,高密度脂蛋白－胆固醇（HDL－C）,ApoA I,ApoB100,ApoE及脂蛋白（a)[Lp (a)]浓度,以无CHD家族史的健康儿童作为对照。结果：与对照组比较,有CHD家族史的儿童血TG,TC,LDL－C,Apo B100,Lp(a)的浓度明显增高,HDL－C,Apo AI,ApoE水平降低（P均＜0．01）;但男,女血脂水平差异不显（P＞0．05）,有早发CHD家族史的儿童与无早发CHD家族史儿童及对照组比较,血TG,TC,LDL－C,Apo B100,Lp(a）浓度增高;HDL－C,ApoE,ApoA I 水平下降（P均＜0．01）,以本研究指标检测结果判别其父母是否有CHD,具有较高的阳性率,有早发CHD家族史阳性率更高。结论：结果提示有CHD家族史儿童血脂水平可预测成年后发生CHD的危险性。     

有冠心病家族史儿童载脂蛋白E基因多态性的研究

目的：探讨有冠心病（CHD）家族史儿童载脂蛋白（apo)E基因多态性的分布及其对血脂、脂蛋白、apo的影响。方法：采用改良的聚合酶链式反应－限制性片段长度多态性方法,分析83例有CHD家族史的儿童和282例无CHD家族史的儿童apoE基因型。结果：与无CHD家族史的儿童比较,有CHD家族史儿童apoε4等位基因频率较高（分别为6．0％、15．7％,P＜0．01）。早发CHD家族史的儿童ε4等位基因频率较非早发及无CHD家族史儿童为高,三组之间的ε4等位基因频率差异有性（分别为18．3％、14．8％、6．0％,P＜0．05。apoE基因多态性对有CHD家族史儿童的血脂水平有影响,ε2、ε3、ε4等位基因携带有的血总胆固醇（TC）、低密度脂蛋白－胆固醇（LDL－C）、脂蛋白（a)、apoB100、apoE浓度有差异（P＜0．05）;与ε3等位基因携带比较,ε4具有较高的血TC、LDL－C、apoB100水平和较低的apoAⅠ、apoE水平;ε2等位基因携带的血TC、LDL－C和脂蛋白（a)水平较低（P＜0．05）。结论有CHD家族史儿童apoE基因多态性其他儿童不同,并对血浆脂蛋白代谢产生明显影响。     

冠心病与非冠心病患者运动试验血压变化的研究

目的：研究运动实验中冠心病（CHD）与非冠心病（NCHD）血压（BP）变化特点，方法：将130例患分成正常，CHD，高血压，高血压伴CHD4组，观察各组在实验过程中收缩压（SBP），SBP变异指数，舒张压（DBP），DBP变异指数的变化特点。结果：运动SBP多升高，SBP，SBP变异指数在CHD与NCHD之间无差异。运动中DBP多下降，正常组的DBP较CHD组的下降更明显（P＜0．01）。结论：运动实验中CHD的DBP较运动前下降程度比正常人少。     

音乐疗法对老年高血压病患者康复的作用

目的：探讨音乐疗法对老年高血压,冠心病患的效果,方法：在不使用降压药,扩冠药和抗凝药的情况下,对9例高血压,冠心病的高龄患采取音乐疗法,每天1小时,30小时为一疗程,并就治疗前,后的症状,血压水平,心电图进行比较,结果：音乐治疗后,收缩压下降显（P＜0．05）,舒张压下降非常显（P＜01）,收缩压平均下降20．25mmHg;舒张压平均下降11．03mmHg;心率平均减慢8次／分（P＜0．01）,T波升高（P＜0．01）,临床症状改善明显,结论：音乐疗法有助老年高血压和冠心病患的康复。     

偶测血压正常的Ⅱ型糖尿病患者动态血压监测的临床意义

监测36例偶测血压正常的Ⅱ型糖尿病患者的24小时动态血压,38例健康对照组比较,并将糖尿病组分为糖尿病心血管自主神经病变组（16例）及非糖尿病心血管自主神经病组（20例）。结果：与对照组相比,Ⅱ型糖尿病患者的平均24小时、白昼、夜间收缩压明显增高（P＜0．01）,平均24小时、夜间舒张压明显增高（P＜0．05,P＜0．01）,而平均白昼舒张压无明显变化（P＞0．05）;收缩压及舒张压的夜间血压下降百分率均明显降低（P＜0．01,P＜0．05）：糖尿病的心血管自主神经病变组与非心血管自主神经病组相比,夜间收缩压下降百分率明显降低（P＜0．01）,而夜间舒张压下降百分率无明显变化（P＞0．05）。 结论：在Ⅱ型糖尿病患者中,动态血压的监测较偶测血压更易发现夜间血压异常：患者的血压昼夜节律改变是否合并糖尿病自主神经病变有密切关系。     

肾实质性高血压与原发性高血压昼夜节律对比分析

目的：比较肾实质性高血压与轻,中度原发性高血压的昼夜血压节律之差异,方法：实验组（A组）对象为经临床和实验室检查确诊的肾实质性高血压病人,共23例,对照组（B组）为同期随机抽取的我科23例轻,中度原发性高血压病人,两组均作动态血压检测（ABPM）,ABPM前1周均停服降压药物。结果：A,B两组24小时收缩压,舒张压,白天收缩压,舒张压无显性差异（P＞0．05）,夜间收缩压,舒张压则有高度显性差异（P＜0．01）,夜间血压下降率A组收缩压,舒张压均＜10％,B组则＞10％,两组间亦有高度显性差异（P＜0．01）。结论：肾实质性高血压夜间收缩压,舒张压下降较少,昼夜节律改变减弱,治疗时应重视恢复昼夜节律。     

肾实质性高血压24小时动态血压分析

目的：分析肾实质性高血压24小时动态血压变化。方法：实验组（A组）对象为经临床和实验室检查确诊的肾实质性高血压病人，共52例；对照组（B组）为同期随机抽取的我院52例轻、中度原发性高血压病人。两组均作动态血压检测（ABPM）。结果：A、B两组之间24小时收缩压、舒张压，白天收缩压、舒张压无显著性差异（P〉0．05），夜间收缩压、舒张压则有高度显著性差异（P〈0．01），夜间血压下降率A组收缩压、舒张压均〈10％，B组则〉10％，两组间亦有高度显著性差异（P〈0．01）。结论：肾实质性高血压夜间收缩压、舒张压下降较少，昼夜节律减弱。     

老年2型糖尿病患者颈动脉粥样硬化的观察

目的：探讨老年2型糖尿病患颈动脉硬化以及粥样斑块与各种危险因子的关系。方法：用彩色多普勒超声观察68例老年2型糖尿病患双侧颈动脉内中膜厚度（IMT）。结果：内膜增厚组及斑块形成组空腹胰岛素水平、24h尿白蛋白定量明显增加（P＜0．05，P＜0．01），并且随着内膜增厚程度的加重，这种增加越明显，而胰岛素敏感指数明显降低（P＜0．05）。空腹、餐后2h血糖、糖化血红蛋白及餐后2h胰岛素、血脂各项指标在各组间变化不明显。内膜增厚组及斑块形成组年龄，有高血压、冠心病、脑血管病史的百分比，高血压病程，收缩压，舒张压值均有明显增高（P＜0．05，P＜0．01）。吸烟人数百分比、糖尿病病程无明显差异。结论：老年糖尿病患IMT增厚心脑血管疾病的发病率增高，这与他们存在高胰岛素血症、低胰岛素敏感性以及有较高的尿白蛋白水平有关，IMT可作为早期观察糖尿病大血管并发症的一种方法。     

原发性高血压24小时动态血压分析

目的：分析原发性高血压24小时动态血压变化。方法：应用美国产动态血压监测仪观察40例原发性高血压24小时动态血压并与96例血压正常进行比较。结果：单纯高血压患白天,夜间,平均收缩压,平均舒张压及24小时血压负荷值均比血压正常组高（P＜0．01）,高血压靶器官损害各组收缩压和舒张压又比单纯高压患高（P＜0．01）,结论：24小时动态血压与高血压靶器官损害有关,血压越高,靶器官损害越多,多脏器损害血压最高,脑,肾损害血压次之。     

The management of the family at high risk for coronary heart disease

The family at risk has at least one member who has (1) hyperlipidemia; (2) low HDL2-cholesterol; (3) essential hypertension; (4) a family history of premature CHD; or (5) actively smokes. The predictive value of CHD risk factors in adults is well documented and quantified. Familial aggregation, genetic studies, and tracking of blood pressure provide evidence that children born to families with a high prevalence of hypertension or who as adolescents track in the upper part of the blood pressure distribution are themselves at risk for hypertension. Similarly, familial aggregation, tracking, and autopsy studies provide evidence for the relationship of serum lipids to the subsequent development of coronary atherosclerosis. Smoking by parents adversely affects the hearts and lungs of children. In addition, the child with a parent who smokes is more likely to become an active smoker. Preventive strategies are now available to the pediatrician to reduce the risk of premature CHD.     

Screening of family members of patients with premature coronary heart disease; results from the EUROASPIRE II family survey.

AIMS: To determine whether the Joint European Societies' recommendations that first degree blood relatives of patients with premature coronary heart disease (CHD) should be screened for coronary risk factors is being followed and, if so, how effectively these relatives are being managed. METHODS AND RESULTS: Using a postal questionnaire, 3322 relatives (siblings and children >/=18 years of age) of 1289 index patients in the EUROASPIRE II survey who had suffered from premature CHD (men under 55 years and women under 65 years) were asked whether screening for coronary risk factors had occurred and, if so, how they were being managed in terms of lifestyle advice and drug therapies. Overall, screening for coronary risk factors because of CHD in the family was only performed in 11.1% of siblings and 5.6% of children. However, prevalences of different cardiac risk factors were high both in relatives and offspring and a clear familial clustering could be documented. Less than 50% of siblings and 25% of children were given some general lifestyle advice regarding cardiac risk factors. Moreover, active interventions such as starting antihypertensive or lipid lowering drugs were rarely carried out, particularly in children of patients with premature CHD. CONCLUSIONS: European physicians rarely screen family members of patients with premature CHD for cardiac risk factors. General lifestyle style advice or active treatment for these risk factors are also rarely given. However, since these family members have a high prevalence and familial clustering of cardiac risk factors, they form an ideal target population for primary prevention of CHD in high-risk patients.     

早发与晚发冠心病患者临床及冠状动脉病变特点的性别差异分析

目的:探讨早发与晚发冠心病患者临床及冠状动脉(冠脉)病变特点的性别差异.方法:收集2016年1月—2017年2月于我院心内科经冠脉造影(CAG)检查明确冠心病诊断的692例患者一般和临床资料,根据NECP-ATP Ⅲ规定将所纳入患者分为早发冠心病组(男性110例、女性83例)与晚发冠心病组(男性298例、女性201例)...     

Clinical significance of inter-arm pressure difference and ankle-brachial pressure index in patients with suspected coronary artery disease

BACKGROUND: Although measuring blood pressure at the bilateral brachia is common in medical practice, its clinical significance in patients with suspected coronary artery disease (CAD) has not been fully clarified. METHODS: To define the significance of inter-arm systolic blood pressure difference in patients with suspected CAD, and to assess the relationship between inter-arm pressure difference and CAD, simultaneous brachial and ankle blood pressure measurements and stress myocardial single-photon emission computed tomography (SPECT) were performed in 386 consecutive patients with suspected CAD, excluding those with previous myocardial infarction or coronary revascularization. RESULTS: Subclavian artery stenosis, defined as > or = 15 mmHg inter-arm systolic blood pressure difference, was found in 27 patients (7%). Age (65 +/- 12 vs 65 +/- 11 years), male sex (21/27 vs 244/359), prevalence of hypertension(63% vs 56%), hypercholesterolemia (63% vs 62%), diabetes mellitus(33% vs 38%), cigarette smoking (44% vs 41%) and family history of CAD (15% vs 12%) were similar between patients with subclavian artery stenosis and those without. The incidence of decreased ankle-brachial pressure index (ABI) was higher (37% vs 12%, p = 0.001), and percentage ischemic myocardium as assessed by SPECT was greater (9.0 +/- 8.5% vs 5.6 +/- 6.6%, p < 0.05) in patients with subclavian artery stenosis than in those without. Furthermore, significant correlations were observed between inter-arm pressure difference and percentage ischemic myocardium (r = 0.13; p = 0.01), and ABI (r = -0.26, p < 0.0001). Among 386 patients, 283 underwent coronary angiography, and 63% of those who had inter-arm blood pressure difference had CAD. Furthermore, 83% of those CAD patients had multi-vessel CAD, which is regarded as a high-risk subset for subsequent cardiac events. CONCLUSIONS: Inter-arm pressure difference is often found in patients with suspected CAD, and is associated with significant CAD and peripheral artery disease. Thus, inter-arm pressure difference may be regarded as a simple marker for coronary and peripheral artery diseases.     

Effect of intravenous adenosine infusion on myocardial perfusion and function. Hemodynamic/angiographic and scintigraphic study.

BACKGROUND. Myocardial perfusion imaging during adenosine-induced hyperemia with dipyridamole or adenosine is an accepted method to diagnose coronary artery disease (CAD) and risk assessment. The mechanism of perfusion abnormality may be caused by disparate flow responses or coronary steal. This study examined the relation between 201Tl perfusion pattern and hemodynamic/angiographic changes during intravenous adenosine infusion. METHODS AND RESULTS. Patients with suspected CAD underwent sequential hemodynamic, coronary arteriographic, and left ventriculographic studies simultaneously with 201Tl imaging during adenosine infusion (140 micrograms.kg-1.min-1 for 6 minutes). There were 33 patients with CAD and 12 patients without CAD. The 201Tl images (using single-photon emission computed tomography) were abnormal in 31 patients with CAD (sensitivity, 94%) and normal in the patients without CAD (specificity, 100%). In patients with and without CAD, there were significant increases in heart rate and cardiac output (p less than 0.0001) and decreases in systemic vascular resistance and blood pressure (p less than 0.0001). There was a 77 +/- 38% increase in pulmonary capillary wedge pressure in normal subjects and a 125 +/- 83% increase in patients with CAD (p = 0.02). ST segment depression was observed in 11 patients with CAD (33%). In CAD patients, there was no change in percent diameter or area stenosis measured quantitatively during adenosine infusion. In 15 patients, contrast left ventriculography was repeated during adenosine infusion. In these patients, 201Tl perfusion defects were seen in 31 of 75 segments (41%) whereas only six of 75 segments (8%) developed regional wall motion abnormality (p less than 0.001); the remaining segments showed either no change or improved function. The left ventricular ejection fraction did not change significantly (73% versus 75%). CONCLUSIONS. There is a disparity between the effects of adenosine on left ventricular perfusion and function; most patients with CAD have perfusion defects whereas the global and regional systolic function remains unchanged or improves. Diastolic left ventricular dysfunction is a probable mechanism of the increase in pulmonary capillary wedge pressure.     

Cardiovascular risk factors in first-degree relatives of patients with premature coronary artery disease

OBJECTIVE: The objective of this study was to evaluate the prevalence of coronary risk factors among Iranian first-degree relatives of patients with premature coronary artery disease (PCAD) and compare them with the general population. METHODS AND RESULTS: The study comprised 144 siblings and offspring (aged 25-64 years) of patients with angiographically documented PCAD (< 55 years in men and < 65 years in women). Body mass index, blood pressure and smoking were investigated. Fasting venous blood was analysed for lipids and fasting plasma glucose. The means of measured values and prevalence of risk factors were compared with the results obtained from the Tehran University Population Laboratory Study. Two or more atherosclerosis risk factors were found in 76% of men and 50.3% of women. Prevalence of smoking, obesity, hypertension and diabetes was 24.3%, 30%, 29.9% and 6.9%, respectively. Total cholesterol and LDL-C levels were higher than desirable in 36.8% and 15.3% of our subjects, respectively, 14.6% had lower HDL-C values and 31.9% presented hypertriglyceridaemia. Overall, 60.4% of cases revealed at least one of the lipid abnormalities. Compared with the Tehran University Population Laboratory Study men showed a higher prevalence of high LDL and triglyceride (TG) levels and obesity. High LDL-C and smoking were found to be more prevalent among women with a family history of premature CAD. CONCLUSIONS: The prevalence of coronary risk factors among first-degree relatives of patients with premature CAD is high, especially in men. Risk factor identification and modification should be considered in individuals with a positive family history of premature CAD.     

原发f生高血压合并早发冠心病患者心率震荡分析

目的探讨原发性高血压合并早发冠心病患者心率震荡（HRT）的特点及其与单纯高血压病、单纯冠心病患者HRT的差异。方法将124例住院患者根据冠脉造影结果、实验室检查、心脏超声检查、血压等分为正常对照组、高血压组、冠心病组和高血压合并冠心病组（合并组）,4组均行24h动态心电图检查,分析单次室性期前收缩后HRT的初始值（TurbulenceOnset,TO）和斜率（TurbulenceSlope,Ts）。结果对各组患者一般情况的比较分析表明,合并组与高血压组相比,早发冠心病家族史、空腹血糖水平、甘油三酯水平存在显著差异。高血压组、冠心病组、合并组的TO、TS值与正常对照组比较均有显著统计学差异（P〈0．01～0．05）;高血压组的TO、TS值与冠心病组和合并组比较亦有显著统计学差异（P〈0．01）。结论高血压、冠心病及高血压合并冠心病患者HRT指标明显异常,其中高血压合并冠心病患者HRT指标受损最严重。     

早发冠心病患者冠状动脉病变特点及危险因素分析

目的 探讨早发冠心病患者冠状动脉病变特点及危险因素.方法 入选我院2012年6月至2014年4月经冠状动脉造影诊断为冠心病的患者279例,根据男性年龄≤55岁、女性年龄≤65岁分为早发冠心病组和非早发冠心病组.统计患者入院基本临床资料.所有患者均检测空腹血糖（FPG）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）.根据冠状动脉狭窄直径≥50％累及左前降支（LAD）、左回旋支（LCX）、右冠状动脉（RCA）或左主干（LM）分为单支、双支（累及左主干为双支病变）及三支病变组.根据Gensini积分标准对每位患者冠状动脉病变进行评分.结果 早发冠心病组男性比例、吸烟比例、存在早发冠心病家族史的比例、TG水平显著高于非早发冠心病组（P＜0.05）.与非早发冠心病组相比,早发冠心病组患者以单支病变为主,二者在受累冠状动脉部位上并无差别.非早发冠心病组患者平均冠状动脉病变支数、平均Gensini积分高于早发冠心病组（1.97±0.82比1.66±0.93,P=0.003;8.72±6.21比48.65±8.90,P=0.000）.多因素Logistic回归分析显示,男性（95％CI：2.342～10.420,P=0.000）、吸烟（95％CI：9.468～31.220,P=0.000）、早发冠心病家族史（95％CI：8.120～23.480,P=0.001）、TG（95％CI：1.224～5.465,P=0.001）是早发冠心病患者独立危险因素.结论 早发冠心病患者冠状动脉病变特点是以单支病变为主.男性、吸烟、早发冠心病家族史、TG是早发冠心病患者的独立危险因素.积极戒烟、降低TG能够降低早发冠心病的发病率.     

How to improve screening in first-degree relatives of patients with premature coronary heart disease.

BACKGROUND: Guidelines on the prevention of cardiovascular disease recommend screening in close relatives of patients with premature coronary heart disease (CHD). This family history puts them at increased risk for CHD, independent of other major risk factors, but screening for CHD risk factors in these relatives is not widely practiced in Europe. This demonstration project examined how to improve screening of close relatives of patients with premature CHD in daily practice. METHODS: A controlled study design was used. Four hospitals were compared in a pre-test as to the actual screening of relatives of patients with premature CHD. Then they were arranged in pairs and randomly assigned to the Usual care (U) or Intervention group (I). An information and health education program--involving patients, relatives and family doctors--was developed in I to improve screening by the family doctor. RESULTS: The pre-test confirmed that screening of relatives of patients with premature CHD is poorly practiced in the four regions; no significant differences between I and U were observed. The screening of relatives during the study period reached 63.9% in I compared to 25.4% in U. This difference between I and U was present in siblings and offspring. The cardiovascular risk profile of the relatives of I was not optimal and needed improvement. CONCLUSION: Screening of first-degree relatives of patients with premature CHD can be significantly improved through a health education program. This is the first and necessary step to improve the management of risk factors in these people, who are at increased risk for CHD.