高血压患者各节段动脉弹性功能的相关性及影响因素分析

目的:探讨脉搏波传导速度(PWV)包括肱踝脉搏波传导速度(baPWV)、颈股脉搏波传导速度(cfPWV)、颈肱脉搏波传导速度(cbPWV)及股踝脉搏波传导速度(faPWV)、大动脉弹性指数(C1)、小动脉弹性指数(C2)、踝臂指数(ABI)的相关性及影响因素.方法:入选对象140例,其中单纯高血压患者102例(高血压组),血压正常者38例(正常血压组),采用BP-203RPE Ⅱ(VP-1000)动脉硬化测定仪测定2组各个节段PWV及ABI,采用CVProfilor DO-2020动脉功能测定仪测定C1、C2.分析动脉弹性的其他指标与cfPWV的相关性.结果:①高血压组各个动脉节段PWV及ABI显著高于正常血压组(P＜0.01),而C1、C2显著低于正常血压组(P＜0.05).②各个动脉节段PWV与cfPWV均呈显著正相关(P＜0.01),但cbPWV及baPWV与cfPWV相关性最强(r值分别为0.792和0.703,P<0.01),C1、C2与cfPWV显著负相关(P＜0.01);ABI与cfPWV呈正相关(P＜0.05).③年龄和血压是脉弹性功能各指标的共同影响因素.年龄每增加10岁,cfPWV、baPWV、cbPWV、faPWV升高的危险性增加180.3%、347.4%、131.3%、69.0%,C1、C2下降的危险性增加116.0%、219.6%;SBP每升高10 mmHg(1 mmHg=0.133 kPa),cfPWV、baPWV、faPWV升高的危险性增加141.3%、218.8%、50.9%,C1、C2下降的危险性增加169.3%、67.9%;DBP每升高5 mmHg,cbPWV升高的危险性增加124.6%,ABI升高的危险性增加37.8%.结论:baPWV是一个简单、敏感的便于临床测量PWV的方法;年龄及SBP、DBP是中心动脉及外周动脉弹性功能的主要影响因素.     

老年缺血性心脑血管疾病患者PWV及ABI的差异比较

目的探讨老年冠心病(CAD)与缺血性脑血管疾病(ICD)患者脉搏波传导速度(PWV)和踝臂指数(ABI)是否具有差异。方法回顾性分析缺血性心脑血管疾病患者和正常对照427例,应用全自动动脉硬化测定仪测定臂踝PWV(Brachial-Ankle PWV,baPWV)和ABI及相关参数。结果 CAD患者仅年龄明显高于对照组(P0.05),而四肢收缩压(SBP)、平均动脉压(MAP)、舒张压(DBP)、左、右两侧的baPWV和ABI与对照组无统计学差异(P0.05);ICD患者年龄、四肢SBP、MAP、除左下肢外DBP和左、右两侧的baPWV数据高于对照组(P0.05),而ABI无统计学差异(P0.05)。ICD组年龄、四肢SBP、MAP、DBP和左、右两侧的baPWV较CAD患者更高(P0.05),而ABI无明显统计学差异(P0.05)。结论 baPWV测量可以定量地反映老年人血管损伤,老年缺血性心、脑血管疾病患者在baPWV数值上存在显著差异,临床治疗可能需要差异化。     

低剂量吲哒帕胺缓释片治疗原发性高血压的30小时动态血压评价

目的评价吲哒帕胺1.5 mg新型缓释片(SR I .D)的长效降压疗效及安全性.方法 24例轻中度原发性高血压患者,服SR I .D 1.5 mg前和8周后分别进行连续30小时的动态血压监测,并测定血钾及血尿酸,观察药物的安全性.结果服药后诊所血压总有效率54.2%.SBP/DBP由治疗前的(142.4±11.9/97.2±5.0)mmHg降至治疗后的(132.5±8.4/88.0±6.0)mmHg,心率无明显改变.前24小时ABPM血压由(130.3±9.1/86.3±6.3)mmHg降至(123.4±10.3/81.4±7.3)mmHg,延长段6小时ABPM血压由(136.9±9.7/90.7±6.0)mmHg降至(128.0±8.6/85.7±7.9)mmHg,两者均有显著意义.SBP和DBP的T/P比值分别为0.75和0.73.治疗后血钾由(4.6±0.56)mmol/L下降至(4.1±0.36)mmol/L(P<0.01),最低值为3.5 mmol/L(2例).血尿酸值由服药前的(333.8±73.0)mol/L变为(367.9±88.3)μmol/L,异常的例数由3例上升至7例,但尚无统计学差异.结论吲哒帕胺1.5 mg缓释片每日1次给药降压平稳而达30小时以上,不良反应少.     

氯沙坦钾与福辛普利治疗老年高血压和高尿酸血症的疗效比较

目的:观察比较氯沙坦(Los)和福辛普利(Mon)治疗老年高血压和高尿酸血症的临床疗效和安全性.方法:老年轻中度高血压伴高尿酸血症65例,随机分为2组,其中氯沙坦钾组33例,剂量50mg/d;福辛普利组32例,剂量10mg/d,均早晨口服一次,持续8周.治疗第2、4、6、8周末测诊室血压、心率(HR),并记录症状、体征;第4、8周末各测血生化一次(包括血尿酸).结果:第8周末降压总有效率Los组73%,Mon组75%.组间比较差异无显著性(P＞0.05);第8周末降压幅度Los组SBP/DBP下降15.46/11.88mmHg,Mon组下降15.94/13.28mmHg.第2、4、6、8周末血压下降值组间比较差异无显著性(P＞0.05),降血尿酸第8周末Los(0.56±0.03)mmol/L降至(0.43±0.07)mmol/L,有效率70%;Mon组(0.56±0.03)mmol/L降至(0.53±0.03)mmol/L,有效率21%.两组间第4、8周血尿酸差值比较P＜0.01,有显著性差异;咳嗽发生率Los组1例为3%,Mon组4例为12%,有显著性差异.结论:氯沙坦钾治疗老年高血压合并高尿酸血症疗效确切安全.     

脉搏波传导速度在健康体检中的应用价值及其危险因素分析

目的:探讨沈阳地区臂踝脉搏波传导速度(baPWV)在健康体检中的应用价值及其危险因素。方法:选择在沈阳军区总医院健康管理中心接受定期健康体检符合入选条件的人员1610例,测定其双侧baPWV及其他相关指标,使用Logistic回归分析评估baPWV与年龄、人体质量指数(BMI)、动脉血压及血生化指标的关系。结果:1610例受检者中,男性baPWV值明显高于女性[(1397.93±239.08)cm/s比(1361.03±244.72)cm/s,P=0.003]。同时,无论男性还是女性,baPWV均随年龄增加而增长。与baPWV正常组(1400cm/s)比较,baPWV升高组(≥1400cm/s)年龄[(45.57±8.95)岁比(57.07±10.50)岁]明显较大,BMI[(25.25±6.82)kg/m2比(26.14±3.44)kg/m2]、空腹血糖[FBG,(4.88±1.73)mmol/L比(5.43±2.02)mmol/L]、低密度脂蛋白-胆固醇[LDL-C,(2.67±0.82)mmol/L比(2.84±0.77)mmol/L]、总胆固醇[TC,(4.88±0.99)mmol/L比(5.13±0.98)mmol/L]、甘油三酯[TG,(1.73±1.65)mmol/L比(2.15±1.91)mmol/L]、收缩压[SBP,(116.72±12.04)mmHg比(136.87±16.21)mmHg]、舒张压[DBP,(76.99±9.01)mmHg比(86.34±10.84)mmHg]及脉压[PP,(39.72±8.32)mmHg比(50.53±14.17)mmHg]显著升高(P均0.01)。多变量Logistic回归显示,年龄、FBG、TG、SBP、DBP、PP水平是baPWV升高的独立危险因素(OR=1.549~5.943,P0.05或0.01)。结论:沈阳地区健康体检人群的baPWV与心血管危险因素密切相关,在心血管疾病风险筛查中具有较好的应用价值。     

低剂量吲哒帕胺缓释片治疗原发性高血压的30小时动态血压评价

目的　评价吲哒帕胺 1 5mg新型缓释片 (SRI .D)的长效降压疗效及安全性。方法　 2 4例轻中度原发性高血压患者 ,服SRI .D 1 5mg前和 8周后分别进行连续 3 0小时的动态血压监测 ,并测定血钾及血尿酸 ,观察药物的安全性。结果　服药后诊所血压总有效率 54 2 %。SBP/DBP由治疗前的 (14 2 4± 11 9/ 97 2± 5 0 )mmHg降至治疗后的(13 2 5± 8 4/ 88 0± 6 0 )mmHg ,心率无明显改变。前 2 4小时ABPM血压由 (13 0 3± 9 1/ 86 3± 6 3 )mmHg降至 (12 3 4±10 3 / 81 4± 7 3 )mmHg ,延长段 6小时ABPM血压由 (13 6 9± 9 7/ 90 7± 6 0 )mmHg降至 (12 8 0± 8 6/ 85 7± 7 9)mmHg ,两者均有显著意义。SBP和DBP的T/P比值分别为 0 75和 0 73。治疗后血钾由 (4 6± 0 56)mmol/L下降至 (4 1±0 3 6)mmol/L(P <0 0 1) ,最低值为 3 5mmol/L(2例 )。血尿酸值由服药前的 (3 3 3 8± 73 0 )mol/L变为 (3 67 9± 88 3 )μmol/L ,异常的例数由 3例上升至 7例 ,但尚无统计学差异。 结论　吲哒帕胺 1 5mg缓释片每日 1次给药降压平稳而达 3 0小时以上 ,不良反应少     

动态血压监测评价国产坎地沙坦酯对高血压的疗效及安全性

目的 :观察国产坎地沙坦酯对原发性高血压 (EH)患者治疗的有效性、安全性及耐受性。方法 :EH患者 37例 ,整个研究过程包括 2周停药观察期和 8周治疗期。口服坎地沙坦酯 8mg ,qd ,在治疗 1、2、4、6和 8周末各随访 1次。服药 4周后若患者坐位舒张压 (DBP)≥ 90mmHg(1mmHg =0 .133kPa)则增加剂量至 16mg。在治疗开始时以及治疗期的第 8周进行 2 4h动态血压监测。结果 :①服药后 2 4h和白昼、夜间收缩压 (SBP)和DBP较服药前明显下降 ,分别为 (7.5 4± 12 .2 9) / (5 .19± 8.2 8) ,(6 .99± 14 .0 5 ) / (4 .6 2± 9.5 0 ) ,(8.4 8± 13.4 0 /(6 .0 2± 9.5 0 )mmHg ,均 P <0 .0 1。② 2 4h动态血压监测示服药后 2 4h各时点DBP和SBP均较服药前下降 ,大部分时点P <0 .0 5。③DBP、SBP的谷峰比率分别为 0 .70、0 .6 4。④平滑指数 (SI) :SBP、DBPSI分别为 3.99、3.10。⑤轻微不良反应发生率为 8.1% (3/ 37例 )。结论 :患者每日一次口服国产坎地沙坦酯 8～ 16mg治疗EH能持续 2 4h安全、平稳降压     

氯沙坦的降压疗效及其对血压谷/峰比值的影响

目的:以动态血压观察氯沙坦片对原发性高血压病患者的疗效及其对血压谷峰比值的影响。方法:60例原发性高血压病患者被随机均分为氯沙坦片组和苯那普利片组(各30例),分别给予氯沙坦片50～100mg和苯那普利片10～20mg,晨服,1次/日,疗程16周。结果:治疗后两组病人的血压均有明显下降,氯沙坦片组,收缩压(SBP)由治疗前的168.2±16.3 mmHg降至138.3±17.2mmHg,舒张压(DBP)由治疗前的99.8±8.1mmHg降至治疗后的85.3±6.4mmHg,SBP、DBP谷/峰比值分别为0.73和0.68;苯那普利组;SBP由治疗前的169.4±16.7mmHg降至139.3±16mmHg,DBP由治疗前的98.7±9.2mmHg降至治疗后的84.6±6.3mmHg,SBP、DBP谷/峰比值分别为0.67、0.63,与治疗前比较,P均<0.01,但组间比较差异不显著(P>0.05)。氯沙坦组无明显副作用,苯那普利组有6例出现咳嗽,2例咳嗽较剧烈,退出观察。结论:氯沙坦片能安全、有效、平稳地降低高血压病人的血压,其疗效与苯那普利疗效相似,但副作用明显少于后者,是高血压治疗的理想用药。     

氯沙坦对高血压病人24小时血压的影响

目的观察氯沙坦对高血压病人24小时血压的影响,探讨其临床意义。 方法20例Ⅰ-Ⅱ级高血压病人,入院后停药2周,服氯沙坦50mg,qd,疗程12周,1个月后血压若未降至140/90mmHg以下,可加大剂量到100mg,qd,治疗前后复查24小时动态血压。以二次给药间距终末时血压下降数除以给药间距中最大血压下降数值作为药物降压的谷/峰比(T∶P),以夜间血压均值与白昼血压均值比较时下降10%或大于10mmHg者为夜间血压下降或"杓型者",反之为夜间血压不下降者或"非杓型者"。 结果　发现(1)氯沙坦能明显降低高血压病人的24小时平均血压(mmHg)(SBP134±14比113±8,DBP89±12比71±5,P<0.01);有效率为85.0%.(2)氯沙坦降压的SBP和DBPTP比率分别为78.6%(48%～93.9%)和76.2%(46.4%～89.6%).SBP,DBP和MBP的平滑曲线指数分别是1.23±0.32,1.36±0.41和1.32±0.38.(3)对夜间血压高于正常值(120/80mmHg)的高血压患者,氯沙坦明显降低夜间血压(mmHg)(SBP142.6±8.8降至116.3±11.4,DBP89.2±9.6降至74.3±6.8,P<0.01),对夜间血压已属正常者,氯沙坦无进一步降压作用(SBP120.3±3.7比116.3±6.8;DBP78.2±6.1比74.3±7.2,P>0.05).(3)24小时SBP,DBP下降幅度与治疗前SBP,DBP明显相关,r分别为0.803和0.797,P<0.01. 结论　氯沙坦是一种安全有效的降压药,其主要优点是24小时平稳降压,谷峰比满意,夜间无过度降压的危险,晨间血压上升受到明显抑制,基础血压越高,降压效果越好。     

饮用水由硬水变为软水致高血压疗效下降

1064例高血压病人，909例饮用硬水，155例饮用软水。硬水系北戴河枣园地下水，硬度45.21，含Ca~（2 ）7.70mmol／LMg~(2 )8.55mol／L。入院第15天平均血压下降值，SBP20.25±4.35mmHg，DBP14.96±2.92mmHg。降压显效率62.82%，总有效率88.34%。软水系洋河、青龙河混合水，硬度6.76，含Ca~(2 )1.51mmol／L.Mg~(2 )0.92mmol／L。入院第15天平均血压下降值，SBP8.35±2.03mmHg,DBP6.92±1.35mmHg。降压显效率17.42％，总有效率52.90％。两组差异非常显著（P＜0.001）。北戴河枣园水因富含Ca~(2 )、Mg~(2 )具有明显的降压作用。     

Pancreatic invasion is a prognostic indicator after radical resection for carcinoma of the ampulla of Vater

Sixty-three patients who had undergone pancreatoduodenectomy for carcinoma of the ampulla of Vater were analyzed with respect to tumor extent and prognosis. The postoperative mortality rate was 3% and overall survival rates 3 and 5 years after surgery were 55% and 46%, respectively. pTNM stage did not reflect prognosis after resection in patients at stages 2 and 3, while pancreatic invasion and regional lymph node metastasis clearly reflected prognosis after resection. Of the 26 patients who had no pancreatic invasion, regional lymph node metastasis was seen in only 19%, whereas of the 37 patients with pancreatic invasion, 62% exhibited lymph node metastasis. These factors were significantly correlated (P<0.001). Pancreatic invasion appeared to be an indirect indicator of regional lymph node metastasis. We conclude that, to improve prognosis for patients with pancreatic invasion, extended resection including extended lymphadenectomy, is a preferable additional procedure.     

Japanese guidelines for adult asthma 2017

Adult bronchial asthma is characterized by chronic airway inflammation, and presents clinically with variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma induces airway remodeling, leading to intractable asthma. The number of patients with asthma has increased; however, the number of patients who die of asthma has decreased (1.2 per 100,000 patients in 2015). The goal of asthma treatment is to enable patients with asthma to attain normal pulmonary function and lead a normal life, without any symptoms. A good relationship between physicians and patients is indispensable for appropriate treatment. Long-term management by therapeutic agents and elimination of the causes and risk factors of asthma are fundamental to its treatment. Four steps in pharmacotherapy differentiate between mild and intensive treatments; each step includes an appropriate daily dose of an inhaled corticosteroid, varying from low to high levels. Long-acting β₂-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonist are recommended as add-on drugs, while anti-immunoglobulin E antibody and oral steroids are considered for the most severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β₂-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by choosing treatment steps for asthma in accordance with the severity of exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-induced asthma, and pregnancy are also important issues that need to be considered in asthma therapy.     

Japanese guidelines for adult asthma 2020

Bronchial asthma is characterized by chronic airway inflammation, which manifests clinically as variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma may induce airway remodeling and become intractable. The prevalence of asthma has increased; however, the number of patients who die from it has decreased (1.3 per 100,000 patients in 2018). The goal of asthma treatment is to control symptoms and prevent future risks. A good partnership between physicians and patients is indispensable for effective treatment. Long-term management with therapeutic agents and the elimination of the triggers and risk factors of asthma are fundamental to its treatment. Asthma is managed by four steps of pharmacotherapy, ranging from mild to intensive treatments, depending on the severity of disease; each step includes an appropriate daily dose of an inhaled corticosteroid, which may vary from low to high. Long-acting β₂-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonists are recommended as add-on drugs, while anti-immunoglobulin E antibodies and other biologics, and oral steroids are reserved for very severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β₂-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by selecting treatment steps for asthma based on the severity of the exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-exacerbated respiratory disease, and pregnancy are also important conditions to be considered in asthma therapy.     

Regenerative therapies in electrophysiology and pacing

The prevention and treatment of cardiac arrhythmias conferring major morbidity and mortality is far from optimal, and relies heavily on devices and drugs for the partial successes that have been seen. The greatest success has been in the use of electronic pacemakers to drive the hearts of patients having high degree heart block. Recent years have seen the beginnings of attempts to use novel approaches available through gene and cell therapies to treat both brady- and tachyarrhythmias. By far the most successful approaches to date have been seen in the development of biological pacemakers. However, the far more difficult problems posed by atrial fibrillation and ventricular tachycardia are now being addressed. In the following pages we review the approaches now in progress as well as the specific methodologic demands that must be met if these therapies are to be successful.     

A long-term surviving patient with cancer of papilla of Vater after local resection

We report successful local resection for cancer of papilla of Vater in an 86-year-old woman. She was referred to our hospital because of right hypochondralgia. Abdominal ultrasonography and computed tomography showed marked dilatation of the common bile duct (CBD). Endoscopic retrograde cholangiography disclosed a small shadow defect in the terminal of the dilated CBD. Biopsy of the papilla revealed well-to-moderately differentiated adenocarcinoma. Considering her extreme old age and keeping in mind her quality of life after the operation, and the finding that the tumor was localized within the papilla and highly differentiated, we performed local resection. In addition, the intrapancreatic portion of the CBD and part of the main pancreatic duct (MPD) were further resected to secure a negative margin, confirmed by frozen section. The MPD was reapproximated to the duodenal mucosa and a choledocho-duodenostomy was performed for CBD reconstruction. Histopathological examination showed the tumor was papillary adenocarcinoma, 10 × 15 mm in size; there was no invasion beyond the sphincter of Oddi, it had partly infiltrated the CBD, but had not invaded to the pancreas or duodenum. The patient's postoperative course was not eventful and she has had good quality of life for the past 6 years since the operation, without any evidence of recurrence. Although radical pancreaticoduodenectomy is now the standard procedure in patients with malignant tumor of the papilla of Vater, local resection is a reasonable alternative for high-risk patients with highly differentiated, apparently localized carcinomas.     

贮存式自体输血开展对优化妇科手术用血结构的影响

目的:总结本院2011-2013年贮存式自体输血开展前后,妇科手术用血异体少白细胞红细胞和自身贮血的应用情况。方法:对本院妇科手术台次,异体少白细胞红细胞及贮存式自体血液的使用人数、量及比例分别进行统计。结果:最近3年妇科手术台次逐年上升,异体少白细胞红细胞用量从463.5U下降至320.5U,自体输血量上升至161U。异体输血比例由手术人次的33.61%下降至19.80%,自体输血比例由0上升至22.61%。人均异体少白细胞红细胞使用量由0.783U下降至0.450U,人均自体全血用量由0上升至0.226U。结论:贮存式自体输血开展,使妇科手术用血结构得到优化,其对临床节约用血的影响,得到了规模性,量化体现。     

改水、服硒、食用蓬灰防治大骨节病的效果观察

本实验应用改水、服硒、食用蓬灰等措施在大骨节病区对3～13岁儿童进行现场防治实验。用现患率、健康儿童新发率、X线痊愈率作为其判定指标。 通过四年的实验观察,现患率由1980年的46.40％下降到1984年的20.30％,有非常显著的差异。36名健康儿童连续四年观察未有新发病人,而对照组出现新发病例,取得了较好的防治效果。本文还对防治措施的作用进行了分析讨论。     

Recent results: biomarkers of aging

This communication reviews recent papers attempting to identify Biomarkers of Aging (BoA). A BoA is a biological parameter that will predict functional capability at some later age. Few, if any, BoA have been found and this review describes the recent search for BoA. Among others that have been put forward are IL6 and other markers of inflammation, allostatic load, and corticosterone, which have been described primarily in humans. Work in model systems as well as theoretical work are also reviewed.     

Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation

This paper considers the argument for obesity as a chronic relapsing disease process. Obesity is viewed from an epidemiological model, with an agent affecting the host and producing disease. Food is the primary agent, particularly foods that are high in energy density such as fat, or in sugar‐sweetened beverages. An abundance of food, low physical activity and several other environmental factors interact with the genetic susceptibility of the host to produce positive energy balance. The majority of this excess energy is stored as fat in enlarged, and often more numerous fat cells, but some lipid may infiltrate other organs such as the liver (ectopic fat). The enlarged fat cells and ectopic fat produce and secrete a variety of metabolic, hormonal and inflammatory products that produce damage in organs such as the arteries, heart, liver, muscle and pancreas. The magnitude of the obesity and its adverse effects in individuals may relate to the virulence or toxicity of the environment and its interaction with the host. Thus, obesity fits the epidemiological model of a disease process except that the toxic or pathological agent is food rather than a microbe. Reversing obesity will prevent most of its detrimental effects.