糖原合酶激酶-3β与心肌疾病的研究进展

正糖原合酶激酶3β(GSK-3β)是一种丝氨酸/苏氨酸蛋白激酶,调节多种细胞功能,包括代谢、转录、翻译、细胞生长和凋亡~([1]),GSK-3β在心肌细胞的生长与凋亡中也扮演着重要角色,参与调控心肌细胞肥大~([2,3])、心力衰竭(HF)~([4,5])、缺血再灌注损伤(I/R)~([6-8])、心肌纤维化~([9,10]),本文就其与心脏疾病的发生、发展进行总结。1 GSK-3家族概述GSK-3是一种丝氨酸/苏氨酸蛋白激酶,广泛表达于多     

远隔缺血适应心脏保护作用的神经机制

<正>急性ST段抬高型心肌梗死(STEMI)是冠状动脉粥样硬化性心脏病(冠心病)患者的主要死亡原因~([1]),早期再灌注治疗包括溶栓和直接经皮冠状动脉介入治疗(PCI)是其最为有效的治疗手段。然而,再灌注治疗过程中无法避免的缺血再灌注损伤(IRI)所致的心肌细胞坏死或凋亡,在最终心肌梗死面积中所占比例达50%~([2]),严重影响STEMI患者的近期和远期预后。一直以来,探索减轻缺血再灌注损伤的心肌保护措施成为冠心病防治领域的研究热点。近年来,一系列基础和临床研究证实远隔缺血适应(RIC)对STEMI患者是一种有效的心脏保护策略,可改善患者心脏功能和临床预后~([3,4])。RIC通过对远隔组织或器官(如肢体)循     

经皮冠状动脉介入术后应用复方丹参滴丸辅助治疗急性心肌梗死的疗效观察

<正>在发生急性心肌梗死(acute myocardial infarction,AMI)时,心肌因缺血及缺血再灌注损伤会引起氧化应激反应,心肌细胞钙通道异常开放也会加重心肌损伤~([1])。患者常因心力衰竭而死亡。经皮冠状动脉介入术(percutaneous coronary intervention,PCI)术后复流可能加重AMI心肌血流再通后再灌注损伤,并诱发心力衰竭的发生~([2])。故及时复流、增强患者心功能并降低PCI术后缺血再灌注损伤是     

D-二聚体检测在主动脉夹层中的应用

<正>众多研究指出D-二聚体检测可用于主动脉夹层(AD)的早期诊断。D-二聚体是交联纤维蛋白降解产物~([1]),在正常人的血浆中含量很低,其质量浓度的升高反应活化的血栓形成及纤维蛋白的溶解活动~([2])。D-二聚体检测早期应用于静脉血栓栓塞症(VTE)相关疾病的低危患者的排除诊断~([2,3]),目前在非静脉血栓栓塞症中的应用得到显著提高~([3]),尤其在AD的应用已写入指南~([2-5])。本文就D-二聚体检测在AD中的     

老年男性慢性阻塞性肺疾病患者骨密度及骨代谢生化指标临床分析

<正>慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是严重危害人类健康的最常见的慢性呼吸道疾病,已成为世界公共卫生问题~([1-2])。据世界卫生组织(WHO)预计,到2020年COPD将跃升为世界第三大致死原因~([3-4])。资料显示,我国40岁及以上人群中COPD患病率高达8.2%~([1,5])。慢性阻塞性肺疾病全球倡议(GOLD)中指出,     

氧化应激在COPD骨骼肌功能障碍中的研究进展

<正>慢性阻塞性肺疾病(COPD)是我国第三位死亡原因的疾病,患病人数达到1亿,与高血压、糖尿病共为三大最常见的慢性疾病~([1])。骨骼肌功能障碍作为COPD最为常见的并发症,可严重影响呼吸肌和外周肌肉的功能,导致患者活动受限,疾病恶化,是COPD发病率和死亡率的独立预测指标~([2])。COPD骨骼肌功能障碍的发生与氧化应激、蛋白合成/分解失衡、细胞凋亡、线粒体损伤等机制有关~([3～5]),其中氧化应激可以导致骨骼肌细胞凋亡增多、蛋白分解加速、肌肉收缩力下降~([6,7]),从而在COPD骨骼肌功能障碍中发挥重要作用~([8])。     

低频电刺激治疗脑卒中后吞咽障碍的疗效观察

正随着我国人口老龄化趋势的加快,脑卒中的发生率也逐渐上升。脑细胞缺血缺氧5 min后即可发生不可逆性损伤~([1-2])。脑卒中病人吞咽障碍的发生率为30%～50%,误吸发生率为40%～70%~([3]),急性卒中后约76%的病人可并发一过性或持续性吞咽功能障碍~([4])。由于病人多数是老年人,即使是局灶性损害,也可以引起严重的吞咽障碍~([5])。尽管部分病人的吞咽障碍是一过性的~([6]),但容易导致不     

慢性阻塞性肺疾病的成因及其治疗的困惑与希望

<正>慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)的特征是一种常见的以持续呼吸系统症状和气流受限,呈慢性和进行性发展,通常与有毒颗粒物或有害气体的显著暴露引起的气道和/或肺泡异常相关~([1-3])。呼吸系统症状包括呼吸困难、咳嗽和/或咳痰最为常见,其发生率和死亡风险均很高~([4])。据世界卫生组织(World Health Organiztion,WHO)估计,全世界约有3.28亿COPD患者~([5]),40岁以上的人群患病     

慢性阻塞性肺疾病与认知功能障碍相关性的研究进展

<正>慢性阻塞性肺疾病(COPD)是一种常见的肺部慢性炎症性疾病,以不完全可逆的气流受限为特征,目前普遍认为COPD是多系统疾病,临床中发现COPD患者随着病程的进展逐渐出现不同程度的认知障碍。据统计目前有近4 000万人患有痴呆,并且预计在将来的20年内这个数据将翻倍。所有类型的痴呆如阿尔茨海默病、血管性痴呆、混合性痴呆等都有前驱期。轻度认知障碍被认为是痴呆前驱期表现~([1]),并且每年有5%～10%的轻度认知障碍发展为痴呆~([2])。研究证实~([3])     

外泌体在脑梗死诊疗中的研究进展

正脑梗死是缺血、缺氧以致神经血管单元中各组分受到损害,如神经元坏死和凋亡、血-脑屏障通透性改变、胶质细胞及血管内皮细胞损伤等,各组分之间的相对平衡被打乱,引起的一系列级联损伤反应~([1]),占所有脑血管疾病76%~([2])。目前有效治疗方法为采用组织型纤溶酶原激活剂溶栓及血管内血栓清除术,但是由于其时间窗仅为数小时~([3-4]),临床上     

Post-surgical and obstructive gastroparesis

Post-surgical gastroparesis (PSG) is recognized as a consequence of vagal nerve injury following upper abdominal surgery. It has been well documented following vagotomy for peptic ulcer surgery. With the increasing role of surgical treatment in the management of GERD and morbid obesity, PSG is now being diagnosed after fundoplication and bariatric surgery. PSG has also been reported after heart and lung transplantation, possibly due to opportunistic viral infection or motor-inhibitory effects of the immunosuppressive drugs, in addition to vagal nerve injury. Initial postoperative management of PSG should be conservative as many symptoms following abdominal surgery resolve with time. This occurs possibly because the enteric nervous system is able to adapt to the loss of vagal input or vagal reinnervation occurs. Persistent symptoms are difficult to manage and require a multidisciplinary team approach. Gastric electrical stimulation has shown promise in small series.     

应当关注慢性阻塞性肺疾病和阻塞性睡眠呼吸暂停的共存问题

目前对于COPD和阻塞性睡眠呼吸暂停(OSA)的病因、发病机制、临床表现、合并症、鉴别诊断、治疗和预后均已有较深入的了解,但对于2种疾病共存即重叠综合征的发病机制、临床表现、危害和治疗则知之不多或不够重视.     

Diagnostic and therapeutic approach to coexistent chronic obstructive pulmonary disease and obstructive sleep apnea

The high prevalence of both obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) in Western societies is well documented. However, OSA frequently remains unrecognized and untreated among patients with COPD. Patients with both conditions have a greater risk for fatal and nonfatal cardiovascular events compared with patients with COPD or OSA alone. Efficacious treatment with continuous positive airway pressure reduces the risk of cardiovascular complications in patients with OSA. The aim of the present review is to discuss the diagnostic approach to patients with both conditions and to delineate the benefits of timely recognition and treatment of OSA in patients with COPD.     

Hypertension and obstructive sleep apnea

Obstructive sleep apnea is a common disorder that is often unrecognized and underappreciated. Emerging evidence suggests that there is a causal link between obstructive sleep apnea and hypertension. This relationship appears to be independent of other comorbidities that have been previously linked to hypertension, such as obesity. The majority of studies support the contention that alleviation of sleep disordered breathing has a clinically significant beneficial impact on decreasing both nighttime and daytime blood pressure. A pathophysiologic basis for patients with sleep apnea having an increased risk for hypertension is not fully elucidated. However, there is consistent evidence that autonomic mechanisms are implicated. Sympathetic activation along with humoral responses to repetitive episodes of hypoxemia and apnea over the longer term may cause vasoconstriction, endothelial dysfunction, and possibly hypertension. Patients with sleep apnea are often obese and may be predisposed to weight gain. Hence, obesity may further contribute to hypertension in this patient population.     

Myxedema and obstructive sleep apnea

Three cases of hypersomnolence, snoring and documented sleep apnea are reported. All three patients were profoundly myxedematous, both clinically and biochemically. Polygraphic studies during sleep documented the presence of repetitive episodes of obstructive sleep apnea in all three patients. These were accompanied by arterial oxygen desaturation. After becoming euthyroid following the administration of the l-thyroxine all patients underwent a repeat evaluation in the sleep laboratory. These studies revealed nearly complete resolution of obstructive sleep apnea in all patients. In addition, several sleep parameters showed marked improvement. These data strongly suggest that the presence of profound daytime sleepiness in hypothyroid patients could be indicative of a potentially lethal complication of myxedema, obstructive sleep apnea.     

Erythropoietin and obstructive sleep apnea

OBJECTIVE: We tested the hypothesis that repetitive severe hypoxemia resulting from obstructive sleep apnea would increase serum erythropoietin, and that this increase would be attenuated by effective treatment of obstructive sleep apnea. METHODS: We studied healthy untreated patients with obstructive sleep apnea (18 severe and 10 very mild) before and after acute treatment with continuous positive airway pressure, and 12 healthy control subjects free of obstructive sleep apnea. RESULTS: Baseline erythropoietin levels before sleep were similar in the obstructive sleep apnea and control groups. However, erythropoietin levels increased (by 20%, P =.037) in patients with severe obstructive sleep apnea after 3.5 hours untreated (lowest O2, 77% +/- 3%), and decreased after 4 hours of continuous positive airway pressure treatment (P =.001). Erythropoietin responses in patients with severe obstructive sleep apnea were different (F = 4.0, P =.03) from controls, in whom erythropoietin levels remained stable throughout the night (P =.94). Erythropoietin responses were similar in very mild obstructive sleep apnea and controls (P =.58). CONCLUSIONS: Our results indicate that untreated severe obstructive sleep apnea results in increased erythropoietin, which decreases after continuous positive airway pressure treatment. Increased erythropoietin may be a potential reversible mechanism to explain the association between obstructive sleep apnea and cardiovascular disease.     

阻塞性睡眠呼吸暂停综合征与慢性阻塞性肺疾病的相关分析

目的观察阻塞性睡眠呼吸暂停综合征（OSAS）与慢性阻塞性肺疾病（COPD）是否具有相关性。对50例OSAS患者依是否伴发COPD分为单纯OSAS组和重叠综合征组,分别对其肺功能和睡眠呼吸多导分析资料进性分析。50例中30例为重叠综合征,其夜间与睡眠有关的低氧血症较单纯OSAS患者更为明显。