Wnt信号途径与心脏发育及病理条件下成体心脏的修复功能

Wnt家族基因高度保守。其编码脂质修饰的糖蛋白能与跨膜受体结合,激活膜内信号途径。当Wnt蛋白缺乏时,APC/Axin/GSK-3β复合体磷酸化细胞质中的β-Catenin,β-Catenin降解;当Wnt蛋白存在时,与跨膜受体Frizzled和共受体LRP-5/6结合,细胞质中的β-Catenin不被降解,转入核内,与TCF/LEF蛋白作用调控下游基因表达。相反,非经典Wnt信号途径不依赖于β-Catenin,非经典Wnt信号途径分为Wnt/Ga2+信号途径和Wnt/JNK信号途径。①Wnt信号途径....     

老年单纯收缩期高血压与颈动脉粥样硬化的关系

目的 探讨老年单纯收缩期高血压患者血压与颈动脉粥硬化的关系.方法 2007年5月～2008年10月在我院就诊的老年高血压患者120例,其中单纯收缩期高血压患者60例,非收缩期高血压患者60例,均予做颈动脉超声检测,比较两组颈动脉粥样硬化发生的情况.结果 老年单纯收缩期高血压患者颈动脉内膜中膜增厚及粥样斑块的发生率与老年非单纯性高血压患者相比更高,差异有统计学意义(P<0.05),提示前者病变更加严重.结论 收缩压是比舒张压更强的致动脉粥样硬化的预测因子.     

Isolated Systolic Hypertension: an Important Cardiovascular Risk Factor

Hypertension is an established risk factor for cardiovascular disease morbidity and mortality. Randomized trials of antihypertensive therapy have demonstrated the benefits of treating diastolic blood pressure, and recently the value of treating isolated systolic blood pressure has also been established. There is an excess risk of cardiovascular disease in subjects with borderline isolated systolic hypertension. In fact, data from men screened for the Multiple Risk Factor Intervention Trial show that the great majority of excess deaths are in those with high-normal systolic blood pressure or with stage 1 hypertension, i.e., systolic blood pressure 130 to 159 mmHg. Similarly, data from the Framingham Heart Study and the Physicians' Health Study emphasize the importance of mild elevations of systolic blood pressure. As age increases the hemodynamic patterns of blood pressure change due to an increase in large artery stiffness, and borderline isolated systolic hypertension becomes the dominant form of hypertension. These facts make the prevention and control of borderline isolated systolic hypertension a key strategic challenge in the effort to prevent excess mortality attributable to blood pressure levels above normal.     

The Impact of White‐Coat Hypertension on Cardiac Mechanics

The authors aimed to investigate right ventricular (RV) and left ventricular (LV) remodeling in patients with white‐coat hypertension (WCH) and sustained arterial hypertension. This cross‐sectional study included 153 untreated patients who underwent 24‐hour ambulatory blood pressure (BP) monitoring and complete two‐dimensional echocardiographic (2DE) examination. Results showed that LV and RV longitudinal mechanics gradually deteriorated from controls to patients with sustained hypertension. Endocardial RV longitudinal strain was lower in WCH and hypertensive patients than in controls. Midmyocardial RV longitudinal strain was decreased in hypertensive patients compared with the other two groups, whereas subepicardial RV longitudinal strain was similar between the observed groups. Twenty‐four–hour systolic BP was associated with 2DE global longitudinal LV and subendocardial RV strain. This study demonstrates that myocardial deformation of both ventricles is significantly impaired in patients with WCH and sustained arterial hypertension, and 24‐hour systolic BP is associated with LV and RV deformation independent of cardiac structure.     

Arterial Stiffness in Treated Hypertensive Patients With White‐Coat Hypertension

Arterial stiffness, assessed through pulse wave velocity (PWV), independently predicts cardiovascular outcomes. In untreated persons, white‐coat hypertension (WCH) has been related to arterial stiffness, but data in treated patients with WCH are scarce. The authors aimed to determine a possible association between WCH and arterial stiffness in this population. Adult treated hypertensive patients underwent home blood pressure monitoring and PWV assessment. Variables associated with PWV in univariable analyses were entered into a multivariable linear regression model. The study included 121 patients, 33.9% men, median age 67.9 (interquartile range 18.4) years, 5.8% with diabetes, and 3.3% with a history of cardiovascular or cerebrovascular disease. In multivariable analysis, WCH in treated hypertensive patients remained a determinant of PWV: β=1.1 (95% confidence interval, 0.1–2.1 [P=.037]; adjusted R² 0.49). In conclusion, WCH is independently associated with arterial stiffness in treated hypertensive patients. Whether this high‐risk association is offset by antihypertensive treatment should be further investigated.     

Association of Isolated Systolic,Isolated Diastolic,and Systolic‐Diastolic Masked Hypertension With Carotid Artery Intima‐Media Thickness

Masked hypertension (MH) is associated with advanced target organ damage. However, patients with MH constitute a group of individuals with heterogeneous characteristics concerning their ambulatory blood pressure (BP) status. The aim of this study was to evaluate the association of isolated systolic MH, isolated diastolic MH, and systolic/diastolic MH with carotid artery intima‐media thickness (CIMT). A total of 101 patients with MH underwent carotid artery ultrasonographic measurements. The patients were divided into three groups according to office and daytime BP values: isolated systolic MH, isolated diastolic MH, and systolic/diastolic MH. Patients with isolated systolic (n=36) (0.771 mm) and systolic/diastolic MH (n=37) (0.775 mm) had significantly (P<.05) higher CIMT values than those with isolated diastolic MH (n=28) (0.664 mm), even after adjustment for baseline characteristics and risk factors. Patients with isolated systolic and systolic/diastolic MH presented significantly higher CIMT values compared with patients with isolated diastolic MH.     

Subclinical Organ Damage in White‐Coat Hypertension: The Possible Role of Cystatin C

The authors investigated the relationship of white‐coat hypertension (WCH) with subclinical organ damage and potential relevant mechanisms. A total of 386 untreated patients were enrolled and divided into 204 patients with WCH and 183 with normotension. Flow‐mediated dilation (FMD), pulse wave velocity (PWV), intima‐media thickness, left ventricular mass index (LVMI), and cystatin C levels were measured. All tests were two‐sided, and a P value <.05 was considered statistically significant. The WCH group exhibited higher LVMI and PWV values, decreased E/A ratio and FMD values, and increased prevalence for left ventricular hypertrophy compared with controls (P<.001 for all). Cystatin C was significantly higher in the WCH group compared with controls (P=.035) and was positively associated with LVMI (P<.05 for both). The presence of WCH is associated with more pronounced subclinical organ damage compared with normotension. Cystatin C may play a significant role and therefore warrants further investigation.     

心血管危险因素对颈动脉粥样硬化的影响及超声评价的意义

越来越多的研究表明心血管危险因素导致了颈动脉内膜中层厚度(IMT)增厚;超声检测到的颈动脉粥样硬化与冠脉造影所示的冠状动脉粥样硬化严重程度明显相关。目前颈动脉IMT可作为反映动脉粥样硬化的指标。由于颈动脉超声检查无创、准确、简便、重复性好,可用于对新发现的或已确定的危险因素进行综合评价,也可用于通过临床对高危因素干预后,动态观察动脉粥样硬化的进展及消退,还对冠心病高危人群发生心血管事件的预测具有重要意义。     

Carotid Disease Is a Risk Factor for Stroke in Coronary Bypass Operations

A bstract The purpose of this study was to investigate the risk of perioperative major cere-brovascular events (MCVEs) in patients undergoing coronary artery bypass grafting (CABG) and to develop preventive therapy. After excluding the patients with marked ascending aortic atheromas and those with combined intracardiac procedures such as valve replacement and aneurysmectomy, 722 consecutive patients who had carotid artery duplex scanning (CADS) and CABG were studied. The results of the study showed the correlation of advanced age, smoking, previous major cerebrovascular event (MCVE), and severe coronary artery disease with high grade carotid artery stenosis of 80–99% (p < 0.05). A total of 13 patients had perioperative MCVE and an analysis of risk factors showed that the MCVE correlated with carotid stenosis of > 60% and reduced cardiac output requiring inotropic support (p < 0.01). Prophylactic carotid endarterectomy (CEA) in patients with 80% to 99% carotid stenosis notably decreased the incidence of MCVE (p < 0.01). and the use of the "pump off" technique instead of standard cardiopulmonary bypass decreased MCVE (p = 0.0561. On the basis of these data, prophylactic carotid endarterectomy is effective in averting perioperative MCVE in subjects with carotid stenosis of 80% to 99%. and for those with 6096 to 7996 carotid stenosis, the pump off technique decreases MCVE.     

Hypertension in Pregnancy Is a Risk Factor for Microalbuminuria Later in Life

The authors aimed to compare renal function by estimated glomerular filtration rate and albuminuria in 3 groups of women: nulliparous women, women with a history of normotensive pregnancies, and women with a history of at least one hypertensive pregnancy. Women who participated in the second Family Blood Pressure Program Study visit (2000–2004) and had serum creatinine and urine albumin measurements (n=3015) were categorized as having had no pregnancy lasting >6 months (n=341), having had only normotensive pregnancies (n=2199), or having had at least 1 pregnancy with hypertension (n=475) based on a standardized questionnaire. Women who reported having had at least one pregnancy with hypertension were significantly more likely to be hypertensive (75.6% vs 59.4%, P<.001), diabetic (34.2% vs 27.3%, P≤.001), and have higher body mass index (32.8 vs 30.5, P<.001) than those who reported normotensive pregnancies. There was a significantly greater risk of microalbuminuria (urine albumin‐creatinine ratio >25 mg/g) in those who reported at least one pregnancy with hypertension (odds ratio, 1.37; confidence interval, 1.02–1.85; P=.04) than in those with normotensive pregnancies, after adjusting for risk factors for chronic kidney and cardiovascular disease. Hypertension in pregnancy is associated with an increased risk of future microalbuminuria.     

老年高血压患者颈动脉粥样硬化病变及相关因素

目的探讨老年高血压患者的颈动脉粥样硬化病变程度及其与血脂、血尿酸、C-反应蛋白的关系。方法应用彩色多普勒超声检测22例正常老年人(对照组)、47例老年高血压患者(A组)、43例老年高血压合并冠心病患者(B组)的颈动脉内中膜厚度(IMT)、粥样硬化斑块、血流参数[收缩期峰值流速(Vmax)、阻力指数(RI)];同时检测血脂、血尿酸(UA)及C反应蛋白(CRP)。结果A组与对照组比较,平均IMT、最大IMT及CRP增高(均为P<0.001),斑块发生率、Vmax、RI、胆固醇(TC)、低密度脂蛋白(LDL-C)、UA增高(均为P<0.05);B组与A组比较,平均IMT、最大IMT、RI及CRP增加更为明显(均为P<0.001),斑块发生率、Vmax、TC、甘油三酯(TG)、LDL-C、UA也有相应变化(均为P<0.05)。结论老年颈动脉粥样硬化病变与许多危险因素有关,防治应采取综合措施。     

老年高血压患者颈动脉粥样硬化病变及相关因素

目的探讨老年高血压患者的颈动脉粥样硬化病变程度及其与血脂、血尿酸、C-反应蛋白的关系.方法应用彩色多普勒超声检测22例正常老年人(对照组)、47例老年高血压患者(A组)、43例老年高血压合并冠心病患者(B组)的颈动脉内-中膜厚度(IMT)、粥样硬化斑块、血流参数[收缩期峰值流速(Vmax)、阻力指数(RI)];同时检测血脂、血尿酸(UA)及C反应蛋白(CRP).结果A组与对照组比较,平均IMT、最大IMT及CRP增高(均为P<0.001),斑块发生率、VmaxRI、胆固醇(TC)、低密度脂蛋白(LDL-C)、UA增高(均为P<0.05);B组与A组比较,平均IMT、最大IMT、RI及CRP增加更为明显(均为P<0.001),斑块发生率、Vmax、TC、甘油三酯(TG)、LDL-C、UA也有相应变化(均为P<0.05).结论老年颈动脉粥样硬化病变与许多危险因素有关,防治应采取综合措施.     

低舒张压的收缩期高血压中医证型与颈动脉粥样硬化的相关性研究

目的探讨低舒张压的收缩期高血压患者中医证型与颈动脉粥样硬化之间的相关性。方法将132例低舒张压的收缩期高血压(SBP>140 mmHg,DBP<70 mmHg)患者辨证分型,分为血瘀证、痰浊证、气虚证、阴虚证、阳虚证。所有患者均行颈动脉超声检查。常规检查颈动脉血管内-中膜厚度及粥样斑块并进行评分。结果血瘀证和痰浊证组颈动脉病变程度显著高于其他证型(P<0.05)。结论血瘀证及痰浊证是低舒张压收缩期高血压的多发证型;低舒张压收缩期高血压可作为心脑血管病预后提示之一。血瘀证和痰浊证是低舒张压收缩期高血压的危险证型。     

Is Hypertension a Major Independent Risk Factor for Retinopathy in Type 1 Diabetes?

Hypertension is an established risk factor for retinopathy. Whether it is an independent risk factor or acts only by association with nephropathy is not known. Therefore, we studied 273 Type 1 diabetic patients. They were divided into four groups. Group 1 (n = 55) were normotensive and normoalbuminuric, group 2 (n = 51) had hypertension but were normoalbuminuric, group 3 (n = 33) had nephropathy but were normotensive, and group 4 (n = 134) had nephropathy and hypertension. Hypertensive patients with normoalbuminuria (blood pressure 146 +/- 19 (+/-SD)/87 +/- 12 mmHg) had the same prevalence of retinopathy as normoalbuminuric normotensive patients (123 +/- 12/75 +/- 5 mmHg). Hypertensive nephropathic patients (blood pressure 147 +/- 18/87 +/- 8 mmHg) had more retinopathy than hypertensive normoalbuminuric patients despite similar blood pressure (normal retina/advanced retinopathy: 3%/73% vs 46%/17%, p less than 0.001). Nephropathic normotensive patients had worse retinal changes than hypertensive normoalbuminuric patients (19%/49%, p less than 0.001) but fewer than the nephropathic hypertensive patients p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of Olmesartan‐Based Treatment on Masked,White‐Coat,Poorly Controlled,and Well‐Controlled Hypertension: HONEST Study

The authors examined the effects of olmesartan‐based treatment on clinic systolic blood pressure (CSBP) and morning home systolic blood pressure (HSBP) in 21,340 patients with masked hypertension (MH), white‐coat hypertension (WCH), poorly controlled hypertension (PCH), and well‐controlled hypertension (CH) using data from the Home Blood Pressure Measurement With Olmesartan Naive Patients to Establish Standard Target Blood Pressure (HONEST) study. MH, WCH, PCH, and CH were defined using CSBP 140 mm Hg and MHSBP 135 mm Hg as cutoff values at baseline. At 16 weeks, the MH, WCH, PCH, and CH groups had changes in CSBP by ?1.0, ?15.2, ?23.1, and 1.8 mm Hg, and changes in morning HSBP by ?12.5, 1.0, ?20.3, and 2.0 mm Hg, respectively. In conclusion, in “real‐world” clinical practice, olmesartan‐based treatment decreased high morning HBP or CBP without excessive decreases in normal morning HBP or CBP according to patients' BP status.     

氨氯地平对老年收缩期高血压患者大动脉内皮功能和粥样硬化的影响

目的　评价氨氯地平对老年收缩期高血压 (EISH)患者大动脉内皮功能和粥样硬化的影响。方法　选择老年收缩期高血压患者 2 5例 ,应用高分辨超声技术检测EISH患者氨氯地平治疗 12周前后的肱动脉内皮依赖性舒张功能(FMD) ,颈动脉平均内中膜厚度 (MIMT)及颈动脉斑块的Crouse积分 ,并观察治疗前后收缩压和脉压的变化。结果 　EISH患者治疗 12周后收缩压、脉压和MIMT比治疗前明显下降 (P <0 .0 5或 <0 .0 1) ,FMD明显改善 (P <0 .0 1)。结论　氨氯地平除能有效降低EISH患者的血压外 ,还能改善大动脉内皮功能     

80岁以上老年人单纯收缩期高血压与颈动脉硬度

目的:研究80岁以上高龄老年人单纯性收缩期高血压(ISH)与颈动脉僵硬度的关系。方法:采用高分辨率超声仪对80岁以上高龄老年人单纯收缩期高血压患者25例(单纯收缩期高血压组)、收缩期/舒张期均高的高血压患者24例(收缩期/舒张期高血压组)及正常血压者20例(正常对照组)进行检测,测量其颈动脉收缩期和舒张期内径,并计算颈动脉紧张度、扩张性和僵硬度,而后对3组之间进行差异显著性比较及相关因素分析。结果:颈动脉紧张度在单纯收缩期高血压组低于收缩期/舒张期高血压组(P0.05),与正常对照组比较差异无统计学意义(P0.05)。颈动脉扩张性在单纯收缩期高血压组和收缩期/舒张期高血压组明显低于正常对照组(P0.01);颈动脉僵硬度在单纯收缩期高血压组明显高于正常对照组和收缩期/舒张期高血压组(P0.01);差异均有统计学意义。结论:80岁以上高龄老年人单纯性收缩期高血压患者颈动脉僵硬度增加,颈动脉扩张性降低,临床上应重点关注对单纯性收缩期高血压患者的检查和治疗。     

Mental Arithmetic Is a Useful Diagnostic Evaluation in White Coat Hypertension

It remains unclear whether patients with white coat hypertension are more susceptible to mental stress than are those with essential hypertension. To compare the pressor responses to mental arithmetic between the two types of hypertension, 21 untreated female outpatients, aged 42 to 64 (mean 55) years, with hypertension, were studied. After 2 weeks of self-monitoring blood pressure, 11 patients were diagnosed as having white coat hypertension and the remaining 10 patients were diagnosed as having essential hypertension. The systolic and diastolic blood pressure responses to mental arithmetic testing were significantly greater in the patients with white coat hypertension (+38 ± 18/+24 ± 13 mm Hg) than in those with essential hypertension (+21 ± 8/+13 ± 6 mm Hg). These differences also were statistically significant in controlling for the effects of age and baseline blood pressures. These data suggest that mental arithmetic testing may be a useful tool for the diagnosis of white coat hypertension.