氟伐他汀治疗50例冠心病伴高脂血症的临床疗效分析

目的分析与探讨采用氟伐他汀对冠心病伴高脂血症的治疗效果。方法选取本院2009年8月至2011年8月期间收治的冠心病伴高脂血症患者共50例,对其给予氟伐他汀40mg进行治疗,疗程持续6周,观察患者在治疗前与治疗后的TG、TC、HDL-C、LDL-C以及肝肾功能、血糖值、12导联静息心电图等,观察治疗效果。结果通过6周的治疗后,患者的TC降低有效率为29.0%,TG降低有效率为32.2%,LDL-C降低有效率为30.5%,HDL-C升高有效率为37.0%,治疗前后差异性具有统计学意义。患者合并冠心病的症状在通过6周的治疗后,有明显的好转。结论采用氟伐他汀对冠心病合并高脂血症患者进行治疗疗效良好,不良反应少,值得在临床上进行推广与应用。     

Trends in cardiovascular risk factors in treated and untreated hypertensive and normotensive Finnish subjects, 1982-1987

We compared cardiovascular disease (CVD) risk factors and their changes in drug-treated hypertensive subjects with those of untreated hypertensive and normotensive subjects in the FINMONICA population surveys in 1982 and 1987. The hypertensive subjects had, whether treated or not, a significantly higher mean serum total cholesterol concentration than the normotensive subjects. The mean serum high density lipoprotein (HDL) cholesterol concentration was significantly lower in treated hypertensive subjects than in the untreated ones or in normotensive subjects. From 1982 to 1987 the mean serum total cholesterol decreased 2% (95% confidence interval (CI) -4.8%, +0.9%) and 4.7% (-7.2%, -2.0%) and HDL-cholesterol increased 4.5% (+8.0%, +0.1%) and 9.9% (+13.5%, +6.3%) in treated hypertensive men and women, respectively. On the other hand, the mean body mass index (BMI) of treated hypertensive men increased significantly during the study period, and also the alcohol consumption and the prevalence of smoking tended to increase.     

Myo-inositol treatment increases serum plasmalogens and decreases small dense LDL, particularly in hyperlipidemic subjects with metabolic syndrome

Background and aim: We have previously shown that serum plasmalogen levels positively correlate with HDL, and significantly decrease with aging, and may be related to LDL particle size. The objective of the present study was to investigate the effects of increased serum plasmalogens on lipidosis, particularly the appearance of atherogenic small dense LDL (sdLDL), of subjects with hyperlipidemia and metabolic syndrome (MetS). Methods and results: The effects of increased serum plasmalogen levels, induced by 2 wk of myo-inositol treatment, on several clinical and biochemical parameters were examined in 17 hyperlipidemic subjects including some with MetS. After myo-inositol treatment, significant increases in plasmalogen-related parameters, particularly ChoPlas, and significant decreases in atherogenic cholesterols including sdLDL, were observed. Among the hyperlipidemic subjects treated with myo-inositol, compared to subjects without MetS, subjects with MetS had a significant increase in plasmalogens and a tendency towards reduced sdLDL, high sensitivity C-reactive protein (hsCRP), and blood glucose levels. Correlation analyses between the measured parameters showed that plasmalogens, as well as HDL, function as beneficial factors, and that sdLDL is a very important risk factor that shows positive correlations with many other risk factors. Conclusion: These results suggest that increased plasmalogen biosynthesis and/or serum levels are especially effective in improving MetS among hyperlipidemic subjects with MetS.     

Decline in incidence of epidemic glucose intolerance in Nauruans: implications for the "thrifty genotype"

Trends in the prevalence and incidence of non-insulin-dependent diabetes mellitus and impaired glucose tolerance were studied in Micronesian Nauruans aged 20 years and above, by linking glucose tolerance data collected during population surveys performed in 1975/1976, 1982, and 1987. Based on World Health Organization criteria, the age-standardized prevalence of non-insulin-dependent diabetes mellitus has remained relatively constant (24.0% in 1987), but the prevalence of impaired glucose tolerance has decreased significantly from 21.1% (95% confidence interval (CI) 17.0-25.3) in 1975/1976 to 8.7% (95% CI 7.1-10.3) in 1987. Between the periods 1975/1976-1982 and 1982-1987, the incidence of progression from normal glucose tolerance to either impaired glucose tolerance (incidence rate ratio (IRR) = 0.55, p less than 0.01) or non-insulin-dependent diabetes (IRR = 0.46, p less than 0.05) has decreased dramatically, while progression from impaired glucose tolerance to non-insulin-dependent diabetes has increased (IRR = 1.23). The overall age-standardized incidence of non-insulin-dependent diabetes has declined from 26.2 cases/1,000 person-years in 1975/1976-1982 to 22.5 cases/1,000 person-years in 1982-1987. As there were no changes in the frequency of recognized risk factors, the decline in incidence of glucose intolerance is probably due to the intensity of the epidemic in Nauru, which has already removed a high proportion of the genetically susceptible individuals from the pool with normal glucose tolerance. Coupled with the observations that mortality is higher and fertility lower in diabetic Nauruans across the age range, the observed decline in the incidence and prevalence of non-insulin-dependent diabetes mellitus and impaired glucose tolerance may presage a fall in the population frequency of the diabetic genotype, at least in its more severe form, as might be predicted on the basis of Neel's "thrifty genotype" hypothesis.     

Trypanosomiasis relapse after melarsoprol therapy, Democratic Republic of Congo, 1982-2001

Recently, a high proportion of patients with late-stage Trypanosoma brucei gambiense trypanosomiasis, who had been treated with melarsoprol in some disease-endemic areas, subsequently relapsed. To determine whether the frequency of postmelarsoprol relapses increased over time, we reviewed data from 2,221 trypanosomiasis patients treated with melarsoprol during this period in Nioki, Democratic Republic of Congo, from 1982 to 2001. The frequency of relapses was 5.6%(31/553), 6.8%(35/512), 4.5%(18/398), 11.4%(34/299), and 5.0%(17/343) for those treated from 1982 to 1985, 1986 to 1989, 1990 to 1993, 1994 to 1997, and 1998 to 2001, respectively. The higher frequency of relapses in 1994 to 1997 was associated with an incremental dosage regimen of melarsoprol. In multivariate analysis, after adjustment for treatment regimen, sex, residence, and trypanosomes in cerebrospinal fluid, postmelarsoprol relapses did not increase in Nioki, perhaps because 1) little drug pressure exists; 2) subtherapeutic doses have rarely been administered; 3) little potential exists for the preferential transmission of melarsoprol-resistant strains.     

Alcohol consumption had no beneficial effect on serum lipids in a substantial proportion of patients with primary hyperlipidemia

The cardioprotective effect of moderate alcohol consumption, which is mediated largely by an elevation of high-density lipoprotein (HDL) levels, may be absent in patients with primary disorders of lipid metabolism. In 881 untreated, unrelated patients with primary hyperlipidemia, we estimated the effect of alcohol on fasting serum HDL cholesterol concentration adjusted for age, gender, diet, and smoking with a multiple linear regression model. The number of abstainers, moderate users (1-30 g daily), and heavy alcohol consumers (> or = 30 g daily) was not different between three types of hyperlipidemia. Among hypercholesterolemic (n = 514) and combined hyperlipidemic (n = 227) patients, consumers of alcohol had higher HDL levels compared to abstainers (P(for trend) = 0.0001 and 0.0002, respectively). Heavy drinkers with combined hyperlipidemia had higher triglyceride levels compared to moderate drinkers and abstainers (P(for trend) = 0.008). Alcohol consumption had no effect on the lipid profiles in 140 patients with hypertriglyceridemia. In conclusion, combined hyperlipidemic and hypertriglyceridemic patients may profit from an encouragement to stop consuming alcohol. On the other hand, moderate use of alcohol may delay the development of coronary artery disease in hypercholesterolemic patients by an elevation of HDL levels.     

Breast liver metastases--incidence, diagnosis and outcome.

Breast liver metastases are uncommon and have not been well reported. We studied the clinical outcome of 47 patients who developed liver metastases out of 912 breast cancer patients treated between 1982 and 1987, an incidence of 5.2%. The median disease free interval prior to clinical liver metastases was 20.2 months (range 4-192 months). The most frequent clinical presentations were hepatomegaly (70%) and abdominal pain (34%). The diagnosis was confirmed on ultrasound scan in 72.7% patients. Thirty-one patients (70.5%) received specific treatment with both hormone and chemotherapy but only six showed any evidence of objective response, the majority of whom had metastases only in the liver. The median survival of treated patients was 4 months and absence of jaundice, response to treatment and liver metastases only were associated with significantly better survival. In conclusion breast liver metastases usually present as a manifestation of disseminated disease and have an appalling prognosis. When they occur as an initial site the prognosis is better but very few patients overall respond to conventional treatment.     

Zinc in kidney disease.

Abnormalities of Zn metabolism are well documented in patients with chronic renal disease, especially those with nephrotic disease and uremia. The causes of Zn deficiency in kidney disease are not clear. Decreased dietary Zn intake and intestinal absorption, increased endogenous Zn secretion, and increased urinary Zn excretion (as in the nephrotic syndrome and in renal transplant recipients) all may contribute to altered Zn metabolism. Zn depletion may account for decreased taste, sexual and gonadal dysfunction, hyperprolactinemia, glucose intolerance, hyperlipidemia, growth retardation in children, neuropathy, anemia, abnormalities of neutrophil and lymphocyte function, and delayed wound healing. The benefit of pharmacologic doses of Zn, in the treatment of such manifestations, requires further evaluation under controlled conditions. Before use of Zn routinely for therapeutic purposes in uremic subjects, the cause(s) of abnormal Zn metabolism should be identified.     

Zinc in kidney disease

Abnormalities of Zn metabolism are well documented in patients with chronic renal disease, especially those with nephrotic disease and uremia. The causes of Zn deficiency in kidney disease are not clear. Decreased dietary Zn intake and intestinal absorption, increased endogenous Zn secretion, and increased urinary Zn excretion (as in the nephrotic syndrome and in renal transplant recipients) all may contribute to altered Zn metabolism. Zn depletion may account for decreased taste, sexual and gonadal dysfunction, hyperprolactinemia, glucose intolerance, hyperlipidemia, growth retardation in children, neuropathy, anemia, abnormalities of neutrophil and lymphocyte function, and delayed wound healing. The benefit of pharmacologic doses of Zn, in the treatment of such manifestations, requires further evaluation under controlled conditions. Before use of Zn routinely for therapeutic purposes in uremic subjects, the cause(s) of abnormal Zn metabolism should be identified.     

Community cholesterol screening: medical follow-up in subjects identified with high plasma cholesterol levels

Population screening or plasma cholesterol is an effective method of detecting hypercholesterolemia; however, follow-up and treatment are essential components of such a program. After a city-wide screening in 1987 of more than 19,872 persons, using a mailed survey with a response rate of 48%, we evaluated subsequent actions of 3,078 individuals with high plasma cholesterol levels. Slightly more than half the population was aware of high blood cholesterol levels prior to the time of screening and apparently used the program for follow-up. Overall, after the screening, 65% consulted a physician within 5 months of screening and blood cholesterol levels were remeasured in 80% of the sample. Procrastination and expense were cited as the primary reasons for failing to consult a physician. If screening is to be effectively utilized as a means of reducing the prevalence of high plasma cholesterol levels, diligent follow-up must be made of all individuals identified to be at increased risk on the basis of their initial values.     

瑞舒伐他汀钙治疗老年冠心病合并高脂血症的疗效分析

目的 探讨使用瑞舒伐他汀钙治疗老年冠心病合并高脂血症的疗效.方法 将我院2010年10月～2011年10月冠心病合并高脂血症的患者94例随机分为2组,对照组患者47例给予阿托伐他汀钙治疗,实验组患者给予瑞舒伐他汀钙治疗,比较2组患者治疗2个月后的疗效.结果 经统计学分析,实验组患者血清总胆固醇、甘油三酯及低密度脂蛋白低于对照组患者,P＜0.05,差异有统计学意义;实验组患者高密度脂蛋白高于对照组患者,P＜0.05.结论 使用瑞舒伐他汀钙治疗老年冠心病合并高脂血症具有较好的效果,可以提高疗效、降低血脂,具有较高的临床意义.     

Study of yearly changes in intractable disease patients receiving financial aid for treatment]

Yearly changes of intractable disease patients receiving financial aid for treatment were observed for 24 intractable disease patients from 1983 to 1987. The results obtained were as follows. 1. The number of intractable disease patients receiving financial aid for treatment increased from 1983 to 1987 for 23 of the diseases. Only the number of SMON patients did not increase. 2. Medical care expenditures for these patients also increased since 1983. Greater increases for in-patients than for out-patients were seen for Huntington's chorea and Behcet's disease, while larger increases were seen for out-patients with Parkinson's disease, Scleroderma.dermatomyositis.primary multiple myositis, Buerger's disease, and others. 3. The proportion of national health insurance holders among intractable disease patients was 42.1% as compared with 34.7% among total national patients. The proportion was especially higher for Huntington's chorea (64.6%), Parkinson's disease (64.1%) and SMON (59.4%) patients.     

89例中老年高脂血症患者膳食调查与分析

目的 通过调查分析中老年高脂血症患者膳食摄入情况及膳食结构，为今后营养健康教育提供依据。方法 2004年采用记录法记录89例中老年高脂血症患者3d的膳食摄入情况。结果 本次调查的中老年高脂血症患者能量摄入基本合理，膳食结构尚需调整。碳水化合物摄入量提供热能比例偏低（为52．60％），而脂肪和蛋白质提供热能比例偏高（脂肪32．33％，蛋白质15．07％）。钙、维生素A、膳食纤维摄入量相当不足。结论 应加强高脂血症患者的营养健康教育普及宣教工作，指导高脂血症患者更合理的膳食摄入。     

Assessment of angina pectoris after myocardial infarction: comparison of "Rose Questionnaire" with physician judgment in the Beta-Blocker Heart Attack Trial

The London School of Hygiene Cardiovascular Questionnaire (Rose Questionnaire) was compared with physician opinion in assessment of angina pectoris in the Beta-Blocker Heart Attack Trial, a long-term (June 1978-October 1981), multicenter study of 3,837 post-myocardial infarction patients, half of whom were treated with propranolol and half with placebo. At baseline, about three times as many patients were thought to have angina by the physician as were diagnosed by the Questionnaire (36.1% vs. 11.5%). Over the average 25-month follow-up period, angina was identified by the physician 50% more often than by the Questionnaire (60.3% vs. 38.6%). The results for each treatment group (propranolol or placebo) were very similar to these overall results. Associations between diagnosis of angina and other patient characteristics were similar for the two measures at baseline. Although the physician diagnosis of angina identified more patients who suffered a subsequent fatal or nonfatal event than did the Questionnaire, it also diagnosed more angina patients who did not have an event. Thus, each of the measures of angina predicted total mortality and coronary heart disease mortality to similar extents (comparable relative risks), even after adjustment for covariates. Neither measure was significantly predictive of recurrent nonfatal myocardial infarction. One measure is not clearly superior to the other in this population. Other factors, such as cost and type of personnel available to conduct the study, may determine which measure is preferred.     

Risk factors for Clostridium difficile toxin-associated diarrhea

The hospital-wide attack rate for Clostridium difficile-associated diarrhea at our tertiary-care university hospital was 0.02 per 100 patient discharges (0.02%) in 1982, but 0.41% and 1.47% in 1986 and 1987, respectively, with a peak incidence of 2.25% in the fourth quarter of 1987. Hospital antibiotic usage patterns showed concurrent increased use of third-generation cephalosporins, and intravenous vancomycin and metronidazole. Thirty-seven cases selected for study were older than 37 control patients, more likely to have an underlying malignancy and less likely hospitalized on the obstetrics/gynecology service. Their mean duration of hospitalization prior to diagnosis was 21 days, versus a mean total length of stay of eight days for controls. All cases received antibiotics, compared to 24 of the controls. Cases were given more antibiotics for longer periods, and more often received clindamycin, third-generation cephalosporins, aminoglycosides and vancomycin. Gender, race, duration of hospitalization, prior surgery and antiulcer therapy were not significant by logistic regression analysis. Epidemiologic variables with significantly different adjusted odds ratios (95% confidence intervals) were age greater than 65 years (14.1, 1.4-141), intensive care unit residence (39.2, 2.2-713), gastrointestinal procedure (23.2, 2.1-255) and more than ten antibiotic days (summation of days of each antibiotic administered) (16.1, 2.2-117). Control measures included encouraging earlier isolation and treatment of suspected cases and formulary restriction of clindamycin, with use of metronidazole for therapy of anaerobic infections. By the second half of 1988, the attack rate had dropped progressively to 0.74%.     

Technology in ambulatory medical care: Cost increasing or cost saving?

Health insurers fear that increased use of medical technology in ambulatory care results in increased billings per physician. This view may overlook certain subtle links between available, appropriated technology in ambulatory practice and the propensity to hospitalize a marginal patient. In this paper, the impacts of technology on four components of total per physician treatment cost were analyzed statistically using 1976-1978 percentage changes for a sample of more than 700 Swiss physicians: number of cases treated, per case billings for ambulatory care, rate of hospitalization and cost of a hospital stay relative to ambulatory care. On net, a 10% reduction in use of laboratory work and X-ray procedures was estimated to result in about 2 and 0.4% savings, respectively. A similar reduction of direct drug sales to patients would increase total cost by 0.3%. From the vantage point of society, even the modest savings indicated probably disappear as soon as the full social cost of a hospital stay is taken into account.     

Increased lipoprotein X causes hyperlipidemia during intravenous administration of 10% fat emulsion in man

To clarify the mechanisms of hyperlipidemia during intravenous Intralipid 10%, lipoprotein profiles including lipoprotein X were studied in 13 patients receiving 2.0 g of fat per kilogram per day by Intralipid 10% over a period of 8 weeks. All patients were fed exclusively by total parenteral nutrition providing 1.1 g of amino acid and 30 kcal/kg per day. Intravenous administration of Intralipid 10% caused a marked increase of low-density lipoprotein (LDL), phospholipid, and cholesterol, especially free cholesterol, whereas triglyceride, very-low-density lipoprotein, and high-density lipoprotein remained within the normal range. Lipid composition of LDL approximated that of lipoprotein X progressively with the intravenous Intralipid 10%. Quantification of lipoprotein X revealed that its increase was proportionate with that of LDL and total lipid. From these findings, hyperlipidemia during intravenous Intralipid 10% is induced almost exclusively by the increased lipoprotein X.     

Methods and results of in-vitro fertilisation in the Netherlands in the years 1983-1994

OBJECTIVE: To describe methods and results of in-vitro fertilisation (IVF) treatment during the first 12 years after the introduction of IVF treatment in the Netherlands. Design. Retrospective cohort study. METHOD: A nationwide study was conducted among women who had had their first IVF cycle stimulated with gonadotrophins in 12 IVF centres in the Netherlands in the period 1 January 1983 to 31 December 1994 (n = 8, 184). RESULTS: The subfertility diagnosis related to tubal factors decreased from 70% in 1987 to 25% in 1994. The subfertility diagnosis related to a male factor increased from 8.7% in 1987 to 35.5% in 1994. The mean age at first IVF treatment remained roughly constant. During the introduction of GnRH agonists there was an increase in gonadotrophin dosages, the number of retrieved oocytes, the number of high responders and/or women who experienced an ovarian hyperstimulation syndrome (OHSS). The percentage of deliveries with at least one baby born alive after the first IVF cycle increased from 6% in 1984 to 18% in 1994. The number of live births per 100 transferred embryos increased from 2.5 in 1985 to 12 in 1994. Furthermore, the mean numbers of embryos transferred after the first IVF cycle decreased from 3.2 in 1987 to 2.2 in 1994. The overall success rate - defined as the proportion of women who had at least one child born alive after one or more IVF cycles - for women who had their first IVF treatment between 1983 and 1994 was 37.1%. The percentage of triplets or quadruplets decreased from 8.7 in 1989 to 1.2 in 1994. The percentage of twin deliveries remained about 25. CONCLUSION: The introduction of GnRH agonists and the higher dosages of gonadotrophins led to a higher oocyte harvest. During the first years of IVF treatment there was an increase in the success rate after the first treatment cycle. The overall success rate remained constant after 1991. The risk of developing an OHSS increased whereas the rate of twin deliveries remained constant.     

Skin diseases in family medicine: prevalence and health care use

PURPOSE Ongoing care for patients with skin diseases can be optimized by understanding the incidence and population prevalence of various skin diseases and the patient-related factors related to the use of primary, specialty, and alternative health care for these conditions. We examined the recent prevalence of skin diseases in a defined population of family medicine patients, self-reported disease-related quality of life, extent and duration of skin disease, and the use of health care by patients with skin diseases.METHODS We undertook a morbidity registry-based epidemiological study to determine the prevalence of various skin diseases, using a patient questionnaire to inquire about health care use, within a network of family practices in the Netherlands with a practice population of approximately 12,000 citizens.RESULTS Skin diseases accounted for 12.4% of all diseases seen by the participating family physicians. Of the 857 questionnaires sent to patients registered with a skin disease, 583 (68.0%) were returned, and 501 were suitable for analysis. In the previous year, 83.4% of the patients had contacted their family physician for their skin disease, 17.0% had contacted a medical specialist, and 5.2% had consulted an alternative health care practitioner. Overall, 65.1% contacted only their family physician. Patients who reported more severe disease and lower quality of life made more use of all forms of health care.CONCLUSION This practice population-based study found that skin diseases account for 12.4% of diseases seen by family physicians, and that some skin problems may be seen more frequently. Although patients with more extensive skin diseases also obtain care from dermatologists, most patients have their skin diseases treated mainly by their family physician. Overall, patients with more severe disease and a lower quality of life seek more treatment.