高血压病患者左室几何构型与胰岛素抵抗关系的研究

目的　探讨高血压病 (EH)患者胰岛素抵抗 (IR)对左室几何构型的影响。方法　依照左室质量指数 (LVMI)和相对室壁厚度 (RWT)将 118例EH患者分为左室正常构型组 (5 8例 )、向心性重构组 (2 2例 )、向心性肥厚组 (14例 )、离心性肥厚组 (2 4例 )。并行口服葡萄糖耐量试验和同步胰岛素释放试验 ,计算胰岛素敏感性指数 (ISI)、血糖曲线下面积 (AG)、胰岛素曲线下面积 (AI)、空腹血浆胰岛素 /空腹血糖 (FSI/FSG)比值、AI/AG比值。设对照组 86例。应用单元和多元回归分析观察RWT、LVMI与各胰岛素敏感性指标的关系。结果　与对照组比较 ,EH各左室构型组除FSG外 ,FSI、ISI、AG、AI、FSI/FSG、AI/AG差异均有显著性 (P <0 0 5～P <0 0 1) ,但各构型组间差异无显著性 (P >0 0 5 )。单因素相关分析显示EH组RWT与FSI、AG、AI、收缩压呈正相关 (r值分别为 0 193,0 196 ,0 2 36 ,0 183,P均 <0 0 5 ) ,与ISI呈负相关 (r值为 - 0 2 5 1,P <0 0 1) ,LVMI与体重指数、收缩压、舒张压呈正相关 (r值分别为 0 2 4 2 ,0 2 14 ,0 184 ,P <0 0 5～P <0 0 1) ,而与各胰岛素敏感性指标不相关 (P >0 0 5 )。逐步回归分析显示RWT与ISI呈独立相关 (R2 =0 0 6 3,P =0 0 0 6 )。结论　HIS及IR存在于EH患者各种左室几何     

高血压病患者左室肥厚及构型改变与胰岛素抵抗的关系

目的:探讨高血压病(EH)患者胰岛素抵抗(IR)对左心室肥厚(LVH)和几何构型的影响。方法:检测124 例EH病人的左室重量指数(LVMI),相对室壁厚度(RWT),空腹血清葡萄糖(FSG)、空腹血胰岛素(FSI)浓度, 并计算胰岛素敏感性指数(ISI)。依照LVMI及RWT的数值124例EH病人被分为左室正常构型(51例),向心性构型(30例),向心性肥厚型(22例),离心性肥厚型(21例)。结果:RWT与年龄、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、平均心率呈正相关(r=0.16-0.22,P<0.05),与ISI呈负相关(r=-0.24),LVMI与SBP、DBP呈正相关(r=0.16-0.20,P<0.05),与ISI不相关。向心性重构组和向心性肥厚组年龄、RWT、HR、BMI大于正常构型组(P<0.05-<0.01),而ISI小于正常构型组(P<0.01)。结论:胰岛素敏感性降低与EH患者左心室肥厚无关,与RWT增加密切相关;ISI可能是EH患者发生左室向心性构型的重要影响因素之一。     

胰岛素抵抗与原发性高血压左室肥厚关系的研究

目的　探讨胰岛素抵抗 (IR)对原发性高血压 (EH)患者左室肥厚的影响。方法　检测 93例 EH病人的左室心肌重量指数 (LVMI)、相对室壁厚度 (RWT)、空腹血糖 (FSG)、空腹血胰岛素 (FSI) ,并计算胰岛素抵抗指数 (IRI)。设对照组 48例。结果　 IRI在对照组与 EH各组比较差异呈显著性 (P<0 .0 1 ) ,但在 EH各组间差异无显著性 (P>0 .0 5)。 IRI在 EH各组间与 RWT呈正相关 (P<0 .0 1 ) ,与 LVMI不相关 (P>0 .0 5)。结论　 IR存在于 EH患者中 ,与 RWT的增加有密切的关系 ,高胰岛素血症是 EH患者发生左室肥厚的重要因素。     

代谢综合征对高血压患者左室肥厚的影响

目的探讨代谢综合征（MS）对高血压患者左室肥厚（LVH）的影响。方法选择321例原发性高血压病人，其中单纯高血压187例，男性86例，女性101例，年龄（61．0&#177;11．3）岁；高血压合并MS（参照美国成人胆固醇教育计划NCEP-ATPⅢ2001提出的MS的诊断标准）134例，男性55例，女性79例，年龄（61．0&#177;9．7）岁。测定所有患者超声心动图的各种参数，计算左室质量指数（LVMI）和相对室壁厚度（RWT）。入选患者排除糖尿病、继发性高血压、缺血型心肌病、脑血管疾病、肝肾功能不全、心力衰竭（NYHAⅡ、Ⅲ）。结果1）高血压合并MS组病人左室舒张末期内径（LVEDd）、室间隔舒张末期厚度（IVSD）、左室后壁舒张末期厚度（LVPWd）、LVMI均明显高于单纯高血压组，P均〈0．01。2）高血压合并MS组左室结构正常（NG）的比例明显低于单纯高血压组（11．9％VS26．7％，P〈0．05），而向心性肥厚（CCH）的比例明显高于单纯高血压组（20．2％VS8．6％，P〈0．05）。两组向心性重构（CCR）和离心性肥厚（ECH）的比例无差异（P〉0．05）。3）高血压合并MS组病人LVH的比率明显高于单纯高血压组（26．1％VS11．2％，P〈0．01）。4）多因素回归分析只有SBP和腹围与LVMI相关，腹围与LVMI呈显著正相关（r=0．692，P〈0．01）。结论MS对高血压LVH有显著的影响。除血压外，腹围是LVH的一个独立预测因子。对LVH的干预，不仅要纠正血流动力学异常，拮抗神经体液的激活，还应对MS各因素积极干预，控制体质量，以有效的逆转LVH。     

冠心病患者胰岛素抵抗与内皮素、血管性假性血友病因子的关系

对52例冠心病患者和16例对照组行空腹血糖（FSG）、空腹胰岛素（FSI）、内皮素（ET）、血管性假性血友病因子（vWF）测定及冠脉造影检查,并计算胰岛素敏感指数（ISI）。与对照组比较,冠心病组FSI、ET、vWF明显升高,ISI明显下降（P均〈0．01）;冠心病组血浆ET、vWF与ISI呈显著负相关（P〈0．01）;ISI与冠脉狭窄程度呈显著负相关（P〈0．01）,ET、vWF与冠脉狭窄程度呈显著正相关（P〈0．01）。提示冠心病患者存在胰岛素抵抗,并与冠脉内皮功能受损程度密切相关。     

相对室壁厚度对原发性高血压患者左室功能的预测作用

目的采用超声指标评价原发性高血压患者不同左室几何构型的左室功能,探讨相对室壁厚度（RWT）与左室收缩功能和舒张功能的关系。方法利用超声心动图观察24名健康成年人和120例原发性高血压患者,根据RWT和左室重量指数（LVMI）将高血压患者分为四种左室几何构型组,分别以室壁中层缩短率（mFs）及E/A比值来评价左室收缩及舒张功能。应用单因素方差分析比较不同组间各参数的差异,应用多元回归分析分别筛选与mFs及E/A比值独立相关的参数。结果与正常对照组比较、左室正常构型组比较,向心性重构组和向心性肥厚组mFs明显降低（P〈0.01）;在多元回归分析中,RWT分别与mFs和E/A比值独立相关（r2=0.67,P〈0.01;r2=0.27,P〈0.01）。结论原发性高血压患者向心性重构组和向心性肥厚组左室收缩功能和舒张功能受损明显。RWT对原发性高血压患者左室收缩功能和舒张功能具有预测作用。     

原发性高血压左室重构与血压、胰岛素抵抗的关系

60例原发性高血压（EH）患者监测血压,测定空腹血糖和胰岛素,同时应用超声心动仪测定心脏结构。结果向心性重构组和向心性肥厚组胰岛素敏感指数明显小于正常构型组,向心性肥厚组和离心性肥厚组收缩压显著高于正常构型组;与正常构型组比较,向心性重构组舒张末期左室内径（LVDd）明显缩小,离心性肥厚组LVDd明显增大;向心性重构组、向心性肥厚组和离心性肥厚组室间隔厚度（IVST）、左室后壁厚度（LVPWd）显著厚于正常构型组,差异均有统计学意义（P〈0．05）。认为血压和胰岛素抵抗对高血压患者左室重构存在重要影响。     

运动高血压患者左室重构的超声心动图研究

目的研究静息血压控制者运动负荷下血压变化,并观察患者的心脏左室心肌重构,探讨其高血压反应的意义。方法采用无创血压监测仪监测200例受试者心电图踏车负荷试验时的运动血压相关指标,采用超声心动图测量入组患者的左心室几何形态参数,根据相对室壁厚度（RWT）和左心室重量指数（LVMI）明确左室心肌重构的程度,并以最强负荷时收缩压I〉200mmHg和或舒张压≥95mmHg分为运动血压正常组（A组）和运动高血压组（B组）,比较两组间的差异。结果两组在静息血压控制方面无明显差异（P〉0．05）,但左房内径（LAd）、舒张期室间隔厚度（IVST）、左室舒张期内径（LVDd）、左室后壁厚度（LV网仃）及LVMI比较,差异有统计学意义（P〈0．05）。结论运动高血压与心脏损害可能存在关系。临床上应关注运动血压异常反应者。     

超声心动图评价高龄高血压患者左心室收缩与舒张功能

该文探讨超声心动图各指标评估高龄老年高血压患者左心室不同构型的收缩与舒张功能的临床价值。方法：将高龄老年原发性高血压患者153例，按Ganau法分为4组：正常构型组（47例），左心室质量指数（LVMI）男〈134g／m^2，女性〈110g／m^2，相对室壁厚度（RWT）〈0．45；向心性重构型组（35例），LVMI正常型构组，     

曲美他嗪对高血压病伴射血分数正常的心力衰竭患者心脏重构及心功能的影响

目的探讨曲美他嗪（TMZ）对高血压病伴射血分数正常的心力衰竭（HFNEF）患者心脏重构及心功能的影响。方法将107例高血压伴HFNEF患者随机分为两组,对照组给予常规治疗,TMZ组在常规治疗基础上给予TMZ20mg口服,3次／d。两组分别于治疗前及治疗6个月后检测心脏超声指标,测定血脂、hsCRP、脑钠肽（BNP）,并计算胰岛素抵抗指数（HOMA．IR）。结果治疗后两组的左室质量指数（LVMI）、左房舒张末期内径（LAEDD）、hsCRP、HOMA-IR、BNP明显降低,LVEF、VE／VA明显升高（P均〈0．05）。与对照组相比,TMZ组6个月后hsCRP、HOMA—IR、BNP、LAEDD明显降低,LVEF、VE／VA升高明显（P〈0．05）;而LVMI两组间比较差异不明显,但TMZ组有下降趋势（P=0．054）。结论TMZ通过改善心肌能量代谢、抗炎、改善胰岛素抵抗等机制,可抑制HFNEF患者左房重构,并具有改善左室重构的趋势。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.