胰岛素及生长抑素在高血压病中的作用

本研究采用放射免疫分析方法检测原发性高血压患者血浆胰岛素和生长抑素含量。结果表明：（１）原发性高血压病人血浆胰岛素水平明显增高（Ｐ＜０．０１），而生长抑素含量却明显减少（Ｐ＜０．０１）；（２）原发性高血压伴左室肥厚者，其血浆胰岛素水平显著高于无左室肥厚高血压患者（ｐ＜０．０１），而生长抑素含量却明显低于无左室肥厚高血压患者（Ｐ＜０．０５）；（３）原发性高血压患者其心电图Ｓ一Ｔ段下移。Ｔ波畸变者，血浆胰岛素水平明显高于心电图正常的高血压患者（Ｐ＜０．０５），而生长抑素含量却明显低于心电图正常的高血压病人（Ｐ＜０．０５）。结果提示：在原发性高血压时，体内胰岛素合成与释放增加，参与了血压的调节。胰岛素分泌增加可能与生长抑素分泌减少有关。     

改变在体兔左心室后负荷对其电生理参数的影响

目的：探讨改变在体兔左心室后负荷对室性心律失常发生情况及左心室电生理参数的影响。方法：改变左心室后负荷，观察室性心律失常发生情况，并测定左心室舒张阈值（ＶＤＴ），相对不应期（ＲＲＰ），有效不应期（ＥＲＰ）及其不应期离散和心室纤颤阈（ＶＦＴ）。结果：逐级增加左心室后负荷（ＡＢ级）可使左室空间ＲＲＰ，ＥＲＰ离散增加（Ｂ级，Ｐ＜００５），ＶＦＴ降低（Ｂ级，Ｐ＜００１）；各实验动物均出现室性心律失常（Ｂ级）；而逐级减小左室后负荷（ＣＤ级），心室电生理参数无变化（Ｐ＞００５），各实验动物亦无室性心律失常发生。结论：增加左心室后负荷诱发室性心律失常，与左室空间不应期离散增加有关。     

老年高血压患者血压变异性对左心室肥厚的影响

目的观察血压变异性(BPV)对老年性高血压患者左心室肥厚的影响 .方法老年性高血压患者100例,根据左室重量指数[LVMI]分为两组: 左室肥厚组和非左室肥厚组,进行24小时动态血压监测,以各时段(日间、夜间及24小时)血压的标准差作为血压变异性的量化指标.结果左室肥厚组日间、夜间及24小时收缩压BPV显著高于非左室肥厚组(p<0.01),日间、夜间及24小时收缩压 BPV与LVMI呈正相关,舒张压BPV与LVMI无相关性.结论收缩压B PV与高血压左室肥厚的发生和肥厚程度有关,老年性高血压患者更容易出现左室肥厚,在治疗老年性高血压时,要注意平稳降压.     

老年高血压患者血压变异性对左心室肥厚的影响

目的　观察血压变异性 (BPV)对老年性高血压患者左心室肥厚的影响 .方法　老年性高血压患者 10 0例 ,根据左室重量指数 [LVMI]分为两组 :左室肥厚组和非左室肥厚组 ,进行 2 4小时动态血压监测 ,以各时段 (日间、夜间及 2 4小时 )血压的标准差作为血压变异性的量化指标 .结果　左室肥厚组日间、夜间及 2 4小时收缩压BPV显著高于非左室肥厚组 (p <0 .0 1) ,日间、夜间及 2 4小时收缩压BPV与LVMI呈正相关 ,舒张压BPV与LVMI无相关性 .结论　收缩压BPV与高血压左室肥厚的发生和肥厚程度有关 ,老年性高血压患者更容易出现左室肥厚 ,在治疗老年性高血压时 ,要注意平稳降压     

292例原发性高血压患者动态血压与左室肥厚关系探讨

目的为了观察动态血压监测与高血压左室肥厚的关系。方法对292例高血压患者用动态血压监测,结合心脏彩超观察24h平均收缩压、舒张压、平均脉压及平均夜间收缩压。结果相关分析显示左室肥厚与平均收缩压、平均脉压、平均夜间收缩压显著相关,与平均舒张压无相关。结论高血压患者24h平均收缩压、平均脉压、平均夜间收缩压对左室肥厚有显著影响。     

体外反搏治疗失血性休克中一氧化氮合酶的变化

目的：探讨反搏治疗失血休克中一氧化氮合酶（ＮＯＳ）的变化。方法：复制狗的失血休克模型，用同位素方法测定反搏前后各组织的ＮＯＳ活性。结果：体外反搏后平均动脉压较反搏前明显上升（Ｐ＜００１）。脑ＮＯＳ测定值假手术对照组明显高于失血休克组Ｐ＜００１）及失血休克克反搏组（Ｐ＜００１），失血休克组则明显低于失血休克反搏组（Ｐ＜００１）；心肌ＮＯＳ活性假手术对照组与失血休克反搏组均明显高于失血休克组（Ｐ＜００５，Ｐ＜００１），但假手术对照组与失血休克反搏组之间无显著差异（Ｐ＞００５）；主动脉ＮＯＳ活性假手术对照组明显高于失血休克组（Ｐ＜００１）及失血休克反搏组（Ｐ＜００５），但失血休克组与失血休克反搏组间无明显差异（Ｐ＞００５）。结论：体外反搏可以增强小血管ＮＯＳ活性，ＮＯＳ活性的恢复则可能在反搏治疗中起重要作用     

男性冠心病患者性激素与脂蛋白（a）关系的初步探讨

目的：探讨男性冠心病患者性激素与血脂的关系。方法：分别用放射免疫法及ＥＬＩＳＡ法测定血清性激素及脂蛋白（ａ）［Ｌｐ（ａ）］水平，用酶法及透射比浊法测定血胆固醇及载脂蛋白浓度。结果：冠心病组血清睾酮（Ｔ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）明显低于正常对照组（Ｐ＜００１），血清雌二醇与睾酮比率、Ｌｐ（ａ）明显高于正常对照组（Ｐ＜００１），而血清雌二醇（Ｅ２）、载脂蛋白及血浆总胆固醇（ＴＣ）两组间无显著差异（Ｐ＞００５）。冠心病组血清Ｔ水平与ＨＤＬ－Ｃ水平呈显著正相关（Ｐ＜００１），与Ｌｐ（ａ）水平呈显著负相关（Ｐ＜００５）；血清Ｅ２水平与Ｌｐ（ａ）水平无相关性。结论：睾酮下降为主的性激素失衡是男性冠心病的致病因子。     

心肌顿抑时红细胞变形性变化机理及其意义初探

目的和方法：本文通过一次性阻断兔冠脉左室支１５ｍｉｎ后再灌注复制在体心肌顿抑（ＭＳ）模型，动态观察心肌缺血前后红细胞变形指数（ｄｅｆｏｒｍａｂｉｌｉｔｙｉｎｄｅｘ，ＤＩ）、红细胞超氧化物歧化酶（ｓｕｐｅｒｏｘｉｄｅｄｉｓｍｕｔａｓｅ，ＳＯＤ）活力、红细胞ＡＴＰ、红细胞丙二醛（ＭＤＡ）含量和心功能参数（左室舒张末压、左室收缩压±ｄｐ／ｄｔｍａｘ）变化。结果：缺血末心功能下降最显著（Ｐ＜００１）；再灌注０５ｈ时ＭＤＡ明显升高，而ＤＩ、ＳＯＤ明显下降（Ｐ＜００１）。随继续再灌注上述指标逐渐恢复。各时点ＡＴＰ无明显变化。再灌注０５ｈ时红细胞ＭＤＡ与ＤＩ、ＳＯＤ均呈显著负相关（Ｐ＜００１），ＤＩ与＋ｄｐ／ｄｔｍａｘ正相关（Ｐ＜００５）。结论：ＭＳ早期红细胞变形性降低与暂时性氧化－抗氧化失衡有关；再灌注早期红细胞变形性降低可能参与ＭＳ早期发生机制     

脑梗死患者的脑电图变化与有关因素——阳性诊断标准研究

目的：探讨脑梗死患者脑电图（ＥＥＧ）改变与有关因素的关系。方法：用ＥＥＧ阳性诊断标准对２３７例脑梗死（ＣＩ）和１４７例腔隙梗死（ＬＩ）患者的脑波进行分析,结果：ＣＩ组在发病４周内ＥＥＧ阳性率显著高于１月后（Ｐ＜００１）,而ＬＩ组则无统计学意义（Ｐ＞００５）。ＣＩ组阳性率（６５％）显著高于ＬＩ组（２１８％,Ｐ＜００１）。ＥＥＧ阳性与病初意识障碍或精神症状有关,然而ＥＥＧ阳性率与病变部位或瘫痪程度有关仅见于ＣＩ组。结论：阳性诊断标准能反映卒中后ＥＥＧ变化特征。     

第四心音在诊断缺血性心脏病合并左心舒张功能不全时的意义

测定５８７例缺血性心脏病患者心音图上的第四心音（Ｓ＿４），发现Ｓ＿４的检出率为７７．１７％。心肌梗塞、心绞痛和缺血性心肌病患者中Ｓ＿４／Ｓ＿１比值≥２５％，音频≥１００Ｈｚ者居多。以有无Ｓ＿４分组观察，两组左室收缩功能无显著差异（Ｐ＞０．０５）。而左室舒张功能指标有非常显著的差异。Ｓ＿４（＋）组左室快充期充盈分数（ＲＦＦ），二尖瓣舒张早期关闭斜率（ＡＶＥＦ）分别下降８．６５％和９．０１％；左室慢充期充盈分数（ＳＦＦ，ＡＦＦ）、二尖好血流Ａ峰及Ａ／Ｅ比值相应升高，（Ｐ＜０．０５～０．００１）。表明：异常Ｓ＿４与左室舒张末期容量负荷过重及左房向左室排血发生障碍有密切相关性。     

高血压合并阵发性房颤患者心脏超声临床特点

目的:观察分析高血压合并阵发性房颤患者的心脏超声特点,为临床准确诊断提供依据。方法:选取2019年08月至2020年08月我院收治的51例高血压合并阵发性房颤患者作为研究组,同时选取51例单纯高血压患者作为常规组,所有患者均接受心脏超声诊断确定有无二尖瓣返流;同时观察心脏收缩期右房上下径、左房前后径、室间隔厚度、舒张期左心室末期内径、左室射血分数、早期二尖瓣血流速度/心房收缩时二尖瓣充盈峰速(Early mitral valve velocity/Mitral valve filling peak velocity during atrial contraction,E/A)。结果:研究组与常规组血压、腰围、BMI指数、血脂、血糖以及血尿素氮无差异(p>0.05);研究组二尖瓣返流病例数多于常规组(P<0.05);研究组E/A、室间隔厚度、收缩期左房前后径均高于常规组(P<0.05),而收缩期右房上下径、舒张期左心室末期内径、左室射血分数无差异(P>0.05)。通过Logistic分析发现,二尖瓣反流、室间隔厚度、收缩期左房前后径与阵发性房颤相关(P<0.05)。结论:高血压合并阵发性房颤的心脏超声特点包括:室间隔厚度增加、左心房扩大、二尖瓣返流等,与单纯高血压差异显著。     

ACE/DD基因型和MYH7突变与原发性高血压左室肥厚的关系

 目的 探讨ACE/DD基因型与MYH7突变联合作用和高血压左室肥厚（LVH）的关系。方法 对102例高血压LVH患者与101例高血压非LVH患者以及100例正常对照进行病例-对照研究。超声心动图测量和计算左室重量指数（LVMI）。用聚合酶链反应（PCR）、限制性片段长度多态性（RFLP）检测ACE/ID多态性,双脱氧末端测序方法检测MYH7基因突变。结果 高血压LVH组ACE基因DD基因型频率显著高于高血压非LVH组和正常对照组（P<0.01）;MYH7基因未发现突变。结论 ACE基因多态性与高血压LVH形成有关,DD基因型易发生左心室肥厚。MYH7基因突变与高血压LVH无明显关系,ACE基因DD基因型与MYH7基因间不存在联合作用。     

高血压病患者左室肥厚及其相关因素分析

目的:观测高血压病(EH)患者的主动脉根部内径(AOD)、脉压(PP)及其他相关因素,结合文献分析其与左室肥厚间的关系,以指导临床治疗和预测血管意外发生的危险性。方法:对58例EH患者,应用超声心动图测量并计算其左室后壁厚度(LVPWT)、室间隔厚度(TVST)、AOD,用血压仪测量并计算其血压各参数值;根据测算结果将本组58例分为左室肥厚组和无左室肥厚组,并将相关数据进行组间统计学比较。结果:两组间比较,年龄、病程、脉压(PP)、收缩压(SBP)及AOD值有显著性差异(P<0.01),而舒张压(DBP)和平均动脉压(MAP)值无明显差异(P>0.05)。结论:PP增大及AOD增宽与左室肥厚呈正相关;PP在高血压左室肥厚中起重要作用,早期发现有利于心脑血管疾病的防治。     

Assessment of myocardial metaiodobenzylguanidine uptake and its relation to left ventricular systolic and diastolic functional parameters in dilated cardiomyopathy.

The purpose of this study was to assess the relation between myocardial metaiodobenzylguanidine (MIBG) uptake and left ventricular systolic and diastolic functional parameters, both of which are known as predictors of prognosis in patients with dilated cardiomyopathy. Echocardiography and iodine-123-MIBG myocardial scintigraphy were performed in 35 patients of dilated cardiomyopathy with normal sinus rhythm. Mean myocardial MIBG uptake in the patient group at early and delayed images were significantly lower than those in normal control subjects (10.6 +/- 1.1, 9.8 +/- 1.2 vs 12.4 +/- 1.0, 12.1 +/- 1.0, p < 0.01). There were, however, no significant differences of mean MIBG uptake in the lung and mediastinum between the two groups (p > 0.05). There were no significant correlations between myocardial MIBG uptake, expressed as the ratio of heart/mediastinum MIBG activity at delayed image, and left ventricular systolic and diastolic functional parameters [left ventricular ejection fraction, left ventricular end-diastolic dimension, peak velocity of early diastolic filling (E velocity), deceleration time of E wave, cardiac output, left ventricular end-diastolic pressure]. In conclusion, the myocardial uptake of MIBG is decreased in patients with dilated cardiomyopathy assessed by iodine-123-MIBG myocardial scintigraphy. There were, however, no significant correlations between myocardial MIBG uptake and left ventricular systolic and diastolic functional parameters derived from echocardiography.     

缬沙坦治疗高血压病并逆转左心室肥厚改善心功能的临床研究

目的评估缬沙坦治疗高血压病的降压效果、安全性与逆转高血压心肌肥厚和改善心功能的疗效。方法以氨氯地平为对照药物，在老年性轻、中度高血压患者中进行随机、平行对照的临床研究。结果缬沙坦组患者治疗4周总有效率为60．8％（45／74），降压幅度15．6／10．9mmHg；治疗24周后总有效率为78．4％（54／74）．降压幅度21．1／17．9mmHg。缬沙坦组治疗24周后在逆转高血压心肌肥厚中取得满意的疗效，能显著逆转左室肥厚（LVH），左室后壁厚度（PWT），室间隔厚度（IVST），降低左室重量指数（LVMI），且缬沙坦组能有效地改善心功能．经治疗后患者的心脏每分输出量（CO）、左室射血分数（LVEF）、舒张早期与舒张晚期峰值流速的比值（E／A）、E峰减速度（Ede）均不同程度得到改善；缬沙坦组患者血尿酸、C-反应蛋白较治疗前明显下降，不良反应率为8．1％．主要是面红、头昏及心悸。心率、血生化、肝肾功能无明显变化。结论缬沙坦降压疗效好，且能逆转左心室肥厚，改善心功能，不良反应少，可作为治疗老年性轻、中度高血压伴左心室肥厚的一线药物。     

依那普利和倍他乐克对长期血透病人左心肥大的影响

目的和方法：比较依那普利和倍他乐克对血透病人左心功能及心肌重量的影响。血两 被分为３组,比较１２个月后血压、左心功能及左心肥大的改变。结果：组１（依那普利）和组２（倍他乐克）在治疗后血压有同等程度不下降,而心脏检查示：治疗后,组１舒张末期左这人径９ＬＶＥＤＤ）、左室心肌重量（ＬＶＭ）、左 室心肌重量指数（ＬＶＭＩ）、室间隔厚度（ＩＶＳ）、左室后壁厚度（ＬＶＰＷＤ）、和二尖瓣舒张晚期最大充盈速度（Ａ     

Left ventricular hypertrophy in patient on dialysis

Left ventricular hypertrophy (LVH) is a significant factor for higher mortality caused by cardiovascular diseases, which are the main cause of death (45%) in hemodialysis patients. In this study we analyzed the link between hypertension nad anemia, which are the main risk factors for the occurrence of LVH. The study included 40 patients (20 M and 20 F, age 20-80 years) who were treated with chronic dialysis. Using the method of transthoracic echocardiography, in M-mode, 38 patients underwent measurement of the thickness of intraventricular septum and posterior wall of the left ventricle at the end of diastole. LVH was expressed through the left ventricle mass index (LVMI) > 131 g/m2 for male and > 100 g/m2 for female. The efficiency of dialysis was calculated with the standard formula (Kt/V1,2). The patients on erythropoietin therapy received medium maintenance dose of 4000 units per week. Blood pressure and hemoglobin data were included in the calculations. A statistically higher rate of hypertension was found in males (M 17/20, F 10/20, p = 0.04), and of myocardial hypertrophy in females (M 7/20, F 17/20, p = 0.004). Overall patient data analysis showed LMVI to be statistically significantly higher (p = 0.0004) in hypertensive patients, and so were the values of systolic and diastolic pressure (p = 0.0006) in spite of applied medication. Hemoglobin was significantly higher (p = 0.04) in LVH patients. A significant positive correlation was found between LVMI and arterial pressure (p = 0.006), and negative between LVMI and hemoglobin concentration (p = 0.03). There was no statistically significant correlation between LVMI and age, interdialytic fluid intake and Kt/V. These results indicate that among patients on chronic dialysis treatment, LVH is more frequent in those with hypertension. The higher hemoglobin concentration found in patients with LVH was probably due to the relatively small number of patients. It is necessary to reduce the effect of risk factors for LVH by using better therapeutic options, thus to decrease the mortality in dialysis patients.     

The effect of hormone replacement therapy on diastolic left ventricular function in hypertensive and normotensive postmenopausal women

Objectives: To evaluate the effect of hormone replacement therapy (HRT) on left ventricular diastolic function in a group of hypertensive and normotensive postmenopausal women. Methods: Left ventricular diastolic function at rest was evaluated by M-mode, two-dimensional and Doppler echocardiography in 19 postmenopausal women with normal blood pressure and 11 postmenopausal women with mild hypertension, before treatment and during 12 months of HRT. Transdermal estradiol was used in women with a surgical menopause and a sequential regimen of transdermal estradiol and peroral medroxyprogesterone acetate in women with a spontaneous menopause. The parameters assessed were: body mass index, heart rate, ejection fraction of the left ventricle (EF), septal (SW) and posterior wall (PW) dimensions, left ventricular end-systolic (LVsd) and end-diastolic (LVdd) dimensions and volumes (ESV, EDV), total diastolic time (DT), duration of the early (Ei) and of the late (Ai) filling phase, peak velocity of the early (E) and late mitral flow (A), A/E velocity ratio and systolic and diastolic blood pressure. Quantitative data were analyzed using unpaired t-test, MANOVA and multiple regression analysis where appropriate. Results: Hypertensive postmenopausal women had significantly higher SW (P<0.05), PW (P<0.05), A/E (P<0.05) and A (P<0.001) than normotensive postmenopausal women, before therapy. After 12 months of HRT a significant decrease in SW, PW, LVsd, ESV and increase in EF, DT, Ei and E was observed in both hypertensive and normotensive postmenopausal women. Heart rate slowed and systolic pressure decreased significantly only in normotensive postmenopausal women on HRT. Conclusion: HRT of 12 months' duration does not deteriorate left ventricular diastolic function of both hypertensive and normotensive postmenopausal women. Improvement in some parameters of diastolic function could be partially explained by the decrease in heart rate and systolic pressure, induced by therapy.     

血压负荷,血压昼夜节律及心率变异性与左室肥厚的关系

目的：观察高血压左心室肥厚患者血压负荷，血压昼节律和心率变异性及其相关性。方法：选择伴有左室肥厚的高血压患者31例（I组），不伴左心室肥厚的高血压患者33例（Ⅱ组），选择年龄与患者可比的健康人30例作为对照组（Ⅲ组），进行动态血压与动态心电图同步监测，分析24小时血压负荷，血压昼夜节律及24小时心率变异性时域指标。结果：（1）血压负荷，血压昼节律：I、Ⅱ组24小时血压负荷，日间血压及夜间血压显著高于Ⅲ组，I组与Ⅱ组间血压负荷有显著差异；I与Ⅱ组非构型血压显著高于Ⅲ组，I与Ⅱ组二者间的非构型高血压出现率有显著差异。（2）心率变异性：I、Ⅱ组心率变异性各参数显著低于Ⅲ组，I与Ⅱ组间心率变异性也有显著差异。（3）四个指标的相关性：I组HRV与24小时血压负荷，非构型出现率及左室肥厚呈负相关。结论：高血压左室肥厚患者昼夜节律消失，血压负荷增加，心率变异性降低。副交感神经调节功能减弱可能与上述变化有关。高血压治疗中应注意改变心率变异性，恢复血压昼夜节律，减少血压负荷。     

QT dispersion in adult hypertensives

Increased QT dispersion is associated with sudden cardiac death in congestive cardiac failure, hypertrophic cardiomyopathy and following myocardial infarction. Patients with hypertension--in particular, those with left ventricular hypertrophy (LVH)--are also at greater risk of sudden cardiac death. We examined whether QT dispersion, which is easily obtained from a routine ECG, correlates with LVH. One-hundred untreated patients with systemic hypertension and 78 normotensives had QT dispersion measured manually from a surface 12-lead electrocardiogram and two-dimensional echocardiography performed to measure interventricular septal thickness, posterior wall thickness and left ventricular internal diameter. Office blood pressure was also recorded. Multivariate analysis demonstrated significant relationships between QT dispersion and office systolic blood pressure, and left ventricular mass index. Manual measurement of QT dispersion might be a simple, noninvasive screening procedure to identify those hypertensives at greatest risk of sudden cardiac death in a third-world country.