格言·幽默

今年上半年，某研究小组报告说，与传统的心肌梗死后经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）相比，将凝血块从闭塞的冠状动脉中抽吸出来更有助于改善心脏病患者心肌的早期灌注。最近，该研究小组拥有了1年后的研究结果，即接受抽吸技术治疗的患者心源性死亡和全因死亡的危险均低于传统治疗组。     

Fish consumption and incidence of heart failure: a meta-analysis of prospective cohort studies

Background  The association between fish consumption and heart failure (HF) incidence is inconsistent.

Methods  We performed a systematic search of Pubmed and Embase (from 1953 to June 2012) using key words related to fish and HF. Studies with at least three categories of fish consumption reporting both relative risk (RR) and corresponding 95% confidence interval (CI) for HF incidence were included. The pooled RR and 95%CI were calculated using a fixed or random-effects model. The generalized least squares regression model was used to quantify the dose-response relationship between fish consumption and HF incidence.

Results  Five prospective cohort studies including 4750 HF events of 170 231 participants with an average of 9.7-year follow-up were selected and identified. Compared with those who never ate fish, individuals with higher fish consumption had a lower HF incidence. The pooled RRs for HF incidence was 0.99 (95%CI, 0.91 to 1.08) for fish consumption 1 to 3 times per month, 0.91 (95%CI, 0.84 to 0.99) for once a week, 0.87 (95%CI, 0.81 to 0.95) for 2 to 4 times per week, and 0.86 (95%CI, 0.84 to 0.99) for 5 or more times per week. An increment of 20 g of daily fish intake was related to a 6% lower risk of HF (RR: 0.94, 95% CI, 0.90 to 0.97; P for trend = 0.001).

Conclusions  This meta-analysis suggests that there is a dose-dependent inverse relationship between fish consumption and HF incidence. Fish intake once or more times a week could reduce HF incidence.

     

Clinical and psychological impact of prophylactic implantable cardioverter-defibrillators in a community heart failure population

Aims  

ICD implantation for primary prevention of sudden cardiac death in patients with left ventricular systolic dysfunction (ejection fraction ≤35%) has increased since the publication of the SCD-HEFT and MADIT-II data. The aim of this study is to examine the effectiveness and safety of prophylactic ICD use in a community heart failure population and to assess the impact on patient’s quality of life.     

Predictors of new-onset kidney disease in a community-based population

Context  Kidney disease is associated with an increased risk for the development of cardiovascular disease and end-stage renal disease; however, risk factors for kidney disease have not been well studied. Objective  To identify predictors of the development of new-onset kidney disease. Design, Setting, and Participants  A community-based, longitudinal cohort study of 2585 participants who attended both a baseline examination in 1978-1982 and a follow-up examination in 1998-2001, and who were free of kidney disease at baseline. Main Outcome Measures  Kidney disease was assessed by the Modification of Diet in Renal Disease Study equation and defined by a glomerular filtration rate (GFR) in the fifth or lower percentile (59.25 mL/min per 1.73 m² in women, 64.25 mL/min per 1.73 m² in men). Stepwise logistic regression was used to determine the impact of risk factors on the occurrence of new-onset kidney disease. Baseline and long-term, 12-year, averaged risk factor models were explored. Results  At baseline, there were 1223 men and 1362 women, with a mean age of 43 years, who were free of preexisting kidney disease. After a mean follow-up of 18.5 years, 244 participants (9.4%) had developed kidney disease. In multivariable models, baseline age (odds ratio [OR], 2.36 per 10-year increment; 95% confidence interval [CI], 2.00-2.78), GFR (<90 mL/min per 1.73 m²: OR, 3.01; 95% CI, 1.98-4.58; 90-119 mL/min per 1.73 m²: OR, 1.84; 95% CI, 1.16-2.93), body mass index (OR, 1.23 per 1 SD; 95% CI, 1.08-1.41), diabetes (OR, 2.60; 95% CI, 1.44-4.70), and smoking (OR, 1.42; 95% CI, 1.06-1.91) were related to the development of kidney disease. In addition to baseline age and GFR, the long-term, averaged risk factors that were predictive of kidney disease included hypertension (OR, 1.57; 95% CI, 1.17-2.12), high-density lipoprotein cholesterol level (OR, 0.80 per 1 SD; 95% CI, 0.69-0.92), and diabetes (OR, 2.38; 95% CI, 1.45-3.92). Compared with a normal GFR (=" BORDER="0">120 mL/min per 1.73 m²), a mildly reduced GFR (<90 mL/min per 1.73 m²) predicted a 3-fold odds of progression to kidney disease (OR, 2.95; 95% CI, 1.94-4.49). Conclusions  Established cardiovascular disease risk factors are associated with the development of new-onset kidney disease. Patients with a mildly reduced GFR should be monitored for progression to kidney disease.      

老年舒张性心力衰竭的临床特点分析

目的：分析老年舒张性心力衰竭（DHF）发病的临床特点。方法对2012年3月至2013年12月我科收治的57例临床诊断为舒张性心力衰竭患者临床资料进行回顾性分析,通过生化检查、B型脑钠肽（BNP）水平测定、超声心动图、心电图、全胸片等检查,对DHF患者的BNP水平、心超特点以及基础疾病进行分析。结果 DHF患者的BNP水平明显增高,平均值为594．7 pg/mL（正常值＜100 pg/mL）,心脏超声特点为左心房明显增大占84．2％,平均值为44．6 mm,肺动脉压升高占71．9％,平均值48．5 mmHg,室间隔肥厚的患者占19．3％,平均值10．4 mm,左室后壁增厚占8．7％,平均值9．7 mm,LVEF大致正常;心电图检查房颤占56．1％,所患基础疾病：心房颤动、高血压病、冠心病、糖尿病分别占56．1％、66．7％、47．3％和21．1％。结论心房颤动、高血压病、冠心病、糖尿病等疾病可能是发生DHF的主要病因,心超检查和BNP水平监测、心电图检查是诊断DHF的重要手段。     

重庆市化龙桥社区高血压知晓状况与危险因素分析

目的研究高血压病社区知晓状况、患病特征和危险因素.方法采用问卷调查与体格检查相结合的方法,系统抽样调查社区内15岁以上居民4 913人.结果该社区HT患病率8.55%(95%可信区间:5.88%～11.22%),比"知晓患病率"(6.29%,95%可信区间:3.58%～9.00%)增高36%,年龄越小,增高幅度越大.55～74岁两年龄组女性居民HT患病率显著高于男性(P＜0.05),相对危险度RR分别为1.7(95%可信区间:1.10～2.64)和1.8(95%可信区间:1.31～2.61);在非HT居民中,除55～74岁的血压无性别差异外,其余年龄组男性的血压均显著高于女性(P＜0.001).Logistic分析表明HT家族史、高层居住、糖尿病伴中心性肥胖和老年化是社区主要危险因素,女性患病危险性高于男性,患者饮食费用高、健康满意度低、就诊次数多、冠心病危险性高;不知已患病的患者还表现出清淡饮食少和体育锻炼少.结论高血压病患者受生理、心理和社会等因素影响,其知晓状况在青壮年中最差,高血压病的治疗应包括对社区因素的综合控制,防治应从青壮年开始做起.     

慢性心力衰竭长期生存列线图预测模型的构建

目的 建立一个慢性心力衰竭长期生存率列线图预测模型。方法 纳入山东省千佛山医院共235例慢性心力衰竭患者临床数据,采用LASSO回归、多因素COX回归分析后得出影响慢性心力衰竭长期生存率的独立预测因子,构建列线图模型。采用一致性指数(C-index)、校准曲线和时间依赖性受试者工作特征曲线评估列线图模型的预测能力。结果 LASSO回归筛共选出7个与慢性心力衰竭长期生存率相关的独立预测因子,分别为年龄、左室舒张末期内径、二尖瓣反流、三尖瓣反流、红细胞分布宽度、血尿酸、血尿素氮,并构建了列线图预测模型、进行模型的内部验证。训练集、验证集C-index分别为0.782、0.791,1年、5年、10年生存率的曲线下面积分别为0.813、0.843、0.876,校准曲线表现出良好的一致性。结论 通过本次研究,建立了一个能够相对准确预测慢性心力衰竭长期生存率的列线图模型,对临床医生判断慢性心力衰竭患者预后有一定的指导意义。     

未确诊糖尿病心衰患者的9年生存率研究

目的：研究未诊断糖尿病心力衰竭（Heart failure,HF）患者的9年生存率。方法：本院心内科住院的首次出院诊断为急性HF的所有患者进行了一项回顾性队列观察研究。结果：100例中共有65例患者死亡,其中48例患者死于心血管疾病。Kaplan-Meier生存曲线说明临床糖尿病患者和无症状糖尿病患者全因死亡和心血管疾病死亡的风险较高。无症状糖尿病患者和临床糖尿病患者的全因死亡风险类似,比无糖尿病患者的全因死亡率明显更高。结论：HF患者入院时更应重视诊断血糖异常。     

Trends of incidence and mortality rates of stroke from 1983 to 2000 in Hanzhong rural population

Objective: To explore the trends of incidence and mortality rates of stroke in Hanzhong rural population. Methods: Acting as the WHO MONICA project. Results: The incidence rate of stroke was 152. 9/100 000. There was decline trend in male(P <0. 05). The mortality rate of stroke was 115.9/100 000. There was no significant decline trend during 18-year period (P < 0. 05). The incidence and mortality rates of stroke of male were higher than those of female(P<0. 05). The incidence and mortality rates were all increased with age(P <0. 01 ). Conclusion: It must stick to the long- term prevention measures to decrease incidence rate, and improve the condition of medical treatment to reduce the mortality rate in rural population.     

Can we alter survival in patients with congestive heart failure?

OBJECTIVE--To assess the efficacy of pharmacologic therapy in improving survival in patients with congestive heart failure (CHF) in the context of recent investigational studies having mortality as an end point. DATA SOURCES--Data were obtained from English-language articles that reported both randomized and retrospective studies assessing the efficacy of pharmacologic therapy in the treatment of patients with CHF. The review included articles indexed under the terms congestive heart failure and drug therapy in the National Library of Medicine's MEDLINE database. STUDY SELECTION--Studies selected for detailed review were those having mortality as a primary or secondary end point. DATA EXTRACTION--Guidelines for assessing data quality and validity included study size, double-blind and randomized design, the number of end points, the sensitivity and specificity of objective measurements, and the validity of the statistical analysis. DATA SYNTHESIS--Review of the existing literature demonstrates that pharmacologic agents that improve resting hemodynamics or exercise duration in patients with CHF may not necessarily prolong survival. However, recent studies demonstrate that angiotensin-converting enzyme inhibitors prolong survival in patients with symptomatic CHF, while at the same time improving exercise capacity and left ventricular performance. Although less well tolerated, the combination of hydralazine hydrochloride and isosorbide dinitrate therapy also improves survival, but to a lesser degree. New agents show promise, but definitive assessment requires the results of large, randomized and double-blind studies having mortality as an end point. CONCLUSIONS--Mortality is an important end point in assessing the efficacy of drugs for the treatment of CHF.     

An overview of survival studies in patients with heart failure.

Heart failure is associated with poor prognosis, but recent large-scale investigations have generated valuable and practical information to help improve clinical management and patient survival. This review presents an overview of the findings of recent heart failure survival studies and how these may affect therapeutic strategy for patients with this condition.     

双腔起搏器术后患者心力衰竭发生率及危险因素

目的:探讨双腔心脏起搏器植入术后患者的心力衰竭发生率及相关危险因素。方法:入选2014年1月～2017年1月共247例植入双腔心脏起搏器的患者,其中215例完成随访,统计随访期间心力衰竭的发生率,对相关因素进行多因素Logistic回归分析。结果:215例患者中随访期间出现心力衰竭者42例,发生率19.5%。多因素Logistic逐步回归分析显示,植入时射血分数低、心室起搏比例高是起搏器术后发生心力衰竭的危险因素(OR=4.89、3.21,均P<0.05)。结论:植入双腔永久起搏器患者术后发生心力衰竭比例为19.5%,危险因素包括植入时射血分数低和心室起搏比例高,需加强此类患者起搏器术后的治疗及监测。     

Periostin基因多态性与汉族人群心力衰竭发病的初步研究

目的:研究Periostin基因多态性与汉族人群心力衰竭发病的关系?方法:采用聚合酶链反应-限制性片段长度多态法(PCR-RFLP)检测Periostin基因启动子区功能性位点(SNP C-33G)基因型?病例组选自心内科住院的心衰患者464例,对照组选自同期在医院健康体检或住院的正常人群640例?基因型及其他危险因素与心衰关系采用Logistic回归分析?结果:经过年龄?性别?血压?血糖?吸烟?高脂血症等多因素Logistic回归校正,Periostin 基因rs3829365位点的CG or GG基因型是心力衰竭的一个独立危险因素;在吸烟的心衰患者中,Periostin C-33G的CG or GG基因型可能起到保护作用?结论:Periostin基因rs3829365位点可能有助于心衰易感性和严重性的判断?     

Profiling B-type natriuretic peptide in a stable heart failure population: a valuable adjunct to care

Aim  

To examine the prognostic importance of absolute values and change in values of BNP in patients with stable heart failure (HF).     

影响慢性心力衰竭存活的重要的预测因子分析

目的：探讨多种预测因子对慢性心力衰竭患者预后的影响。方法：对我院心内科2007年1月～2009年8月280例资料完整的心力衰竭住院病例进行分析,对治疗前和治疗后的心率、血压、12导联心电图、心脏彩超、实验室检查、NYHA状态及治疗、转归进行分析。结果：低钠血症的程度、NYHA状态恶化、心律失常、肾功能不全、慢性低血压、血细胞比容降低及LVEF降低均影响患者的预后。结论：联合低钠血症的程度,NYHA状态恶化、心律失常、肾功能不全、慢性低血压、血细胞比容降低及LVEF降低这些预后因子有助于预测慢性心力衰竭患者的预后及再住院与高危状况的发生。     

多发性硬化症社区人群中未被认识的抑郁症状

背景与目的：多发性硬化症（MS）与抑郁之间的相关性已被阐明，但是，MS患者抑郁的患病率可能变化较大。本研究旨在对1个社区MS人群先前未被认识的抑郁症状的点患病率进行评估，并验证与其他疾病特征间的关系。患者与方法：在爱尔兰的两个郡进行一项流行病学研究，在研究过程中确诊的376例临床确诊或疑似MS（Poser标准）患者，其中的211例患者同意参与本项研究。对患者进行检查，并评定患者的Kurtzke残疾状态扩展量表评分和MS功能复合评分，同时对受试者进行贝克抑郁量表Ⅱ和MS影响量表评定。结果：共有60例（28％）患者存在中重度抑郁症状，211例患者中仅有35例有抑郁病史，后者通过在纳入本项研究前的任何时间确诊为抑郁或服用过抗抑郁药物而定义，在其余的176例患者中，41例（23．3％）经贝克抑郁量表Ⅱ评定为中重度抑郁症状。上述41例具有明确抑郁症状的患者和135例较少受累患者间唯一的显著临床差异是前者的病程较短。结论：本项研究中1／4的MS患者表现出未被认识并因此未接受治疗的抑郁症状，单用残疾程度并不能很好地提示是否会伴有抑郁症状。     

Characteristics, treatment and short-term survival of patients with heart failure in a cardiology private practice in Jamaica

BACKGROUND: Randomized clinical trials have demonstrated improvement in mortality with angiotensin converting enzyme inhibitors (ACEIs), beta blockers and aldosterone antagonists. The use of these lifesaving treatments remain inadequate. AIM: To determine the clinical features, aetiology, treatment and short-term survival of heart failure in a cardiology private practice in Jamaica. METHODS: This is a retrospective analysis of the medical records of 1055 consecutive patients presenting to a consultant cardiologist private practice between January 2002 and March 2003. Data were extracted from the records of the first 100 patients with heart failure. RESULTS: Most were over 65 years of age, female, never smoked cigarettes, overweight/obese and hypertensive (82%). The most commonly prescribed medications at one month were ACEIs (91%), beta blockers (88%) and loop diuretics (55%). The main aetiologies were hypertension (54%) and ischaemic heart disease (IHD) (26%). Ninety-one per cent were in sinus rhythm and 6% in atrial fibrillation. Forty-nine per cent had echocardiograms, of these 39% had ejection fractions (EF) > 40% and 27% had EF < or = 20%. The survival at one year was 81%. CONCLUSION: Hypertension was the major aetiology of heart failure followed by IHD. Medical treatment closely approached the recommended standards of major heart failure guidelines with high ACEI and beta blocker use comparable to recent heart failure trials. Short-term survival was very high.     

BREV的有效性：173例学习障碍儿童BREV与对照系列的比较

背景:BREV系列(认知功能快速评估系统)是用于快速评估年龄在4～9岁儿童神经心理的一项工具。目的:在标准化(700例自然儿童)及与对照系列比较的验证(202例癫痫患儿)后,本研究旨在173例学习障碍儿童中,进一步验证BREV的有效性。研究人群和方法:研究方案包括BREV的管理、精确的神经心理学检查和对患者口头书面语言的评估。采用统计分析,比较BREV和其他对照评估方法的结果,并对比BREV指示的建议和最终诊断,规定BREV系列的诊断敏感性和诊断特异性。结果:BREV试验和对照试验间的所有比较均具有显著性。在语言方面,172例中有168例儿童B…