老年冠心病患者血脂与肌酐清除率的相关性研究

目的 探讨老年冠心病患者血脂与肌酐清除率的相关性. 方法 选择784例年龄65岁及以上患者,根据冠状动脉造影结果和肌酐清除率水平进行分组,比较各项血脂水平. 结果肌酐清除率水平随冠状动脉病变的逐渐加重明显下降(F=5.35,P＜0.01).肾功能中重度损伤组(肌酐清除率小于0.83 ml· s-1·1.73 m-2)载脂蛋白A1(ApoA1)水平降低,载脂蛋白B(ApoB)水平升高(F=5.31,F=4.91,均P＜0.01).男性中肾功能中重度损伤组ApoA1水平降低(F=3.52,P＜0.05),ApoB水平升高(F=5.65,P＜0.01),冠心病患者中肾功能中重度损伤组ApoA1水平降低(F=5.79,P＜0.01),ApoB水平升高(F=4.56,P＜0.05),高密度脂蛋白胆固醇水平降低(F=3.39,P＜0.05).多元Logistic回归分析结果表明,肌酐清除率、高密度脂蛋白胆固醇、ApoA1和ApoB是冠心病的影响因素. 结论 血脂异常和肾功能减退均是冠心病发病的危险因素,血脂异常同时引起肾脏损害.对于老年冠心病患者需积极控制血脂,同时关注其他重要脏器功能.     

Alcohol consumption, serum lipids and severity of angiographically determined coronary artery disease

The relation of alcohol consumption to serum lipids and the severity of coronary atherosclerosis was examined in 212 men undergoing coronary angiography. The severity of coronary atherosclerosis was assessed in terms of the presence of greater than or equal to 75% diameter stenosis and the Gensini severity score. Alcohol consumption was divided into 4 categories: none (0 ml alcohol/week), light (1 to 100 ml alcohol/week), moderate (101 to 300 ml alcohol/week) and heavy (greater than or equal to 301 ml alcohol/week). Alcohol consumption was positively related to high-density lipoprotein cholesterol and inversely related to total cholesterol, but was not associated with triglyceride. After adjustment for these serum lipids as well as for cigarette smoking and systemic hypertension, the risk of coronary stenosis was significantly decreased in the moderate drinkers. A decreased risk among moderate drinkers also was noted in terms of Gensini's severity score. These findings suggest that moderate alcohol consumption may protect against severe coronary atherosclerosis.     

饮酒与冠心病

大量的研究表明,饮酒与冠心病之间呈J型曲线关系,少量饮酒可以降低冠心病发病风险。随着研究的深入,发现不仅饮酒的量与冠心病风险相关,饮酒的方式对冠心病的影响也十分重要。饮酒对不同人群的影响以及对冠心病的作用机制也进行了较多的研究,本文将对近期的研究进展作一综述。     

瑞舒伐他汀对老年冠心病患者造影剂肾病的预防作用和对血脂的影响

目的 观察瑞舒伐他汀对老年冠心病患者造影剂肾病（CIN）的预防作用和对血脂的影响。方法 2014年1月~2014年12月确诊的老年冠心病患者114(男67,女47)例,年龄61~83岁,随机分为常规治疗组（n=57）和瑞舒伐他汀组（n=57）。瑞舒伐他汀组在常规治疗的基础上加服瑞舒伐他汀,每晚20 mg,连续8周。两组分别于造影前、造影后24 h、72 h和7 d测定尿素氮（BUN）及血肌酐（SCr）水平并计算内生肌酐清除率（CCr）,同时测定血脂水平。结果 造影前常规治疗组与瑞舒伐他汀组肾功能无显著差异,但瑞舒伐他汀组血脂明显低于常规治疗组（P<0.05,P<0.01）。常规治疗组造影后24 h、72 h BUN和SCr明显高于造影前（P<0.05,P<0.01）,而CCr则明显降低（P<0.01）,血脂无明显变化,这些变化均于7 d后恢复正常。瑞舒伐他汀组造影后仅SCr在24 h、72 h较造影前升高（P<0.05）,BUN和CCr无明显变化。常规治疗组发生CIN 6例（11%）于7 d后恢复,瑞舒伐他汀组无发生CIN病例,与常规治疗组CIN发生率比较有显著差异（P<0.05)。两组造影前后血脂均无显著变化。两组不良反应发生率无统计学差异。结论 瑞舒伐他汀对老年冠心病患者具有降血脂作用和对CIN有显著预防作用。     

Alcohol consumption and coronary calcification in a general population

BACKGROUND: A U- or J-shaped association exists between alcohol consumption and coronary heart disease. One of the proposed mechanisms for this association involves atherogenesis, but there are no data on the association between alcohol consumption and coronary atherosclerosis in asymptomatic subjects. Coronary calcification, a measure of coronary atherosclerosis, allows for the study of the association. METHODS: This cross-sectional study was performed using data from the population-based Rotterdam Coronary Calcification Study. Data on alcohol consumption were available for 1795 individuals without coronary heart disease. Mean +/- SD age of the participants was 71 +/- 5.7 years. Coronary calcification was detected on electron beam computed tomographic scans and quantified as a calcium score by the Agatston method. Extensive coronary calcification was defined as a calcium score above 400. RESULTS: In this population, 15.8% of individuals consumed no alcohol; 46.5% consumed 1 alcoholic drink or less per day; 16.9% consumed 1 to 2 drinks per day; and 20.9% consumed more than 2 drinks per day. A U-shaped association was found between alcohol consumption and coronary calcification. Compared with nondrinkers, the odds ratio of extensive coronary calcification was 0.60 (95% confidence interval [CI], 0.44-0.82) for those who consumed 1 drink or less daily; 0.51 (95% CI, 0.35-0.76) for those who consumed 1 to 2 drinks daily; and 0.90 (95% CI, 0.62-1.29) for those who consumed more than 2 drinks. The association remained after multivariate adjustment. CONCLUSIONS: The consumption of 2 alcoholic drinks or fewer per day was inversely associated with extensive coronary calcification. The risk of extensive coronary calcification was 50% lower in individuals who consumed 1 to 2 alcoholic drinks per day than in nondrinkers.     

Alcohol consumption and its relationship to smoking, weight, blood pressure, and blood lipids. The Albany Study

Between 1953 and 1955, a still-ongoing prospective cardiovascular study enrolled 1,910 employed men. Men who drank more alcohol had higher levels of cigarette use, blood pressure, and high-density-lipoprotein cholesterol concentrations. After 18 years of follow-up, the survivors consumed twice as much alcohol, on the average, as they had at entry, weighed slightly more, and had substantially higher blood pressures. Formerly heavy drinkers who had quit, however, lost weight and had less than average blood pressure increases. There was no significant association between changes in smoking habits and changes in drinking habits.     

Alcohol consumption and coronary artery calcium in middle-aged Japanese men

Epidemiologic studies have investigated the relation between alcohol intake and coronary calcification, with controversial results. Furthermore, the influence of heavy drinking has not been well elucidated. In the present study, a random sample of community-based Japanese men aged 40 to 49 years without a history of cardiovascular disease (n=245) were examined for coronary artery calcium (CAC) determined by electron-beam computed tomography and drinking status. There was a J-shaped association between alcohol intake and CAC. There was an increase of CAC in heavy drinkers (>or=46 g/day), and participants who were drinking>or=69 g/day showed a significant increase in CAC compared with never drinkers after adjusting for other cardiovascular risk factors.     

Alcohol consumption among HIV-infected patients

This prospective, cohort study analyzed the prevalence of alcoholism and patterns of alcohol intake over time in a cohort of HIV-infected patients, predominantly homosexual/bisexual men. One hundred eleven HIV-positive subjects were recruited from a comprehensive HIV clinic associated with a large Midwestern university hospital. Each participant completed the Michigan Alcoholism Screening Test (MAST) survey and a standardized quantity—frequency questionnaire on alcohol intake at enrollment. The quantity—frequency scale was repeated every six months for a total of 30 months. Forty-five of the 111 subjects (41%) met the criteria for alcoholism, as defined by a MAST score 5 or higher. There was a significant decrease in alcohol consumption over time, from 6.4 drinks/week in the initial time period to 3.9 drinks/week by the final time period (p<0.001). Presented in part at the Midwestern Society of General Internal Medicine meeting, September 1993, Chicago, Illinois. Supported in part through contract number N01-HR-76035 from the National Heart, Lung and Blood Institute.     

Alcohol consumption, coronary calcium, and coronary heart disease events.

This study was performed to determine if alcohol intake was associated with reduced coronary risk in a high-risk asymptomatic population, and whether this effect was independent of coronary risk factors and coronary calcium. In 1,196 asymptomatic subjects with coronary risk factors, we assessed alcohol consumption history, performed risk factor measurements, and quantified coronary calcium with electron beam computed tomography. These subjects were then followed for a mean of 41 months, and coronary events (myocardial infarction or coronary death) were noted. Significant inverse predictors of coronary events included alcohol use and serum high-density lipoprotein cholesterol level. Direct predictors of events were history of systemic hypertension, smoking, diabetes mellitus, serum cholesterol, and coronary calcium score. Subjects with coronary calcium were 3.1 times more likely to suffer a coronary event than those without calcium (95% confidence interval [CI] limits 1.3 to 7.2). Subjects who drank alcohol had a relative risk of 0.3 (95% CI limits 0.2 to 0.6) for developing coronary events. After controlling for age, gender, and other risk factors with logistic regression, these differences in relative risk persisted (relative risk 0.58; 95% CI limits 0.41 to 0.82). Alcohol consumption is a significant inverse predictor of coronary events, comparable in magnitude to standard risk factors and to radiographically measured coronary calcium. This effect is independent of coronary risk factors and coronary calcium.     

老年急性脑梗塞患者血脂及血液流变学变化分析

目的研究老年急性脑梗塞患者血脂及血液流变学变化特点，并分析二者的相关性。方法７６例老年急性脑梗塞患者，测定全血粘度（ＢＶ）、血浆粘度（ＰＶ）、血小板聚集率（ＰＡｇｔ）、凝血酶时间（ＴＴ）、凝血酶原时间（ＰＴ）、白陶土部分凝血活酶时间（ＫＰＴＴ）、总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）、脂蛋白（ａ）［ＬＰ（ａ）］、载脂蛋白（Ａｐｏ）Ａ１、Ｂ、Ｅ。结果ＴＣ、ＴＧ、ＨＤＬ、ＬＤＬ、ＬＰ（ａ）、ＡｐｏＡ、ＡｐｏＢ各项在急性脑梗塞组与对照组之间比较均有显著性差异，ＢＶ、ＰＶ、ＰＡｇｔ均较对照组明显升高。ＢＶ及ＰＡｇｔ分别与ＴＣ、ＴＧ、ＬＤＬ呈显著正相关，与ＨＤＬ呈显著负相关。结论血脂异常、高凝与高粘度血症构成了老年脑梗塞发病的重要环节，血脂的变化与血液流变学及凝血的改变密切相关     

老年人血脂异常的管理

<正>动脉粥样硬化性心血管疾病(ASCVD)是危害人类健康,导致人们生活质量下降,甚至死亡的主要疾病。以TC或LDL-C升高为主要特点的血脂异常是ASCVD及其不良预后事件的重要独立危险因素。近年来,国人血脂平均水平有较明显升高,血脂异常的患病率大幅度增加,随之带来ASCVD的患     

Moderate beer consumption and the blood coagulation in patients with coronary artery disease

Objectives. To evaluate the influence of a short period of moderate beer consumption on the status of the thrombolitic activity in patients with coronary artery disease (CAD).
Subjects and design. From 28 patients with two- or three-vessel CAD 22 were randomly assigned to an experimental group (EG) and six to control group (CG). Before and after completion of the study every one of the 28 patients was examined and a wide range of laboratory tests was performed.
Setting. A University Hospital in Israel.
Intervention. Of the EG, 22 patients consumed 330 mL of beer day⁻¹ (20 g of alcohol) for the 30-day period in addition to the usual antiatherosclerotic diet. Patients of the CG did not consume alcohol beverages.
Main outcome measures. Fibrinogen, prothrombin time (PT), coagulant activity of Factor VII (F VIIc) and Factor VII antigen (F VIIag), and plasminogen activator inhibitor (PAI) levels were studied.
Results. After the investigation a statistically significant decrease was found in F VIIc ( P < 0.01) and F VIIag ( P < 0.001) and to a lesser extent a decrease in the value of PAI. Fibrinogen and PT remained unchanged in the EG also.
Conclusions. Even a short period of moderate beer consumption results in a decrease in thrombogenic activity. The only sensitive tests were F VIIc and F VIIag. The decrease in thrombogenic activity may be the main cause of decreased mortality in patients with CAD who consume moderate quantities of alcoholic beverages.     

老年阻塞性睡眠呼吸暂停低通气综合征患者血浆脂类的研究

目的　探讨老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的血脂变化情况。方法　选取32例6 0岁以上OSAHS患者(OSAHS组)和30例健康体检者为对照组。两组均经睡眠监测,对呼吸紊乱指数、夜间最低血氧饱和度及血脂中总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白进行比较,且上述指标之间及其与体重指数之间行相关性分析。结果　OSAHS组患者血中甘油三酯、总胆固醇/高密度脂蛋白比值明显升高(P <0 .0 0 1)。结论　血脂异常是OSAHS的并发症,为OSAHS诱发心脑血管病的重要环节。     

Alcohol consumption and blood pressure in the 1982 Maryland Hypertension Survey

This study examines the relationship between alcohol consumption and blood pressure in the 1982 Maryland Hypertension Survey, a crossectional population-based household survey of blood pressure control in adults residing in Maryland. In individuals less than 50 years old, a J shaped dose-response association was found with abstainers and heavy alcohol consumers having significantly higher blood pressures than moderate alcohol consumers (1 to 2 beverages per day). In individuals 50 years and older, alcohol was associated with higher blood pressures only at the highest levels of intake (greater than 2 beverages per day). The prevalence of hypertension was similarly affected in each age group. This association between alcohol consumption and blood pressure was independent of several variables that are associated with increased blood pressure such as age, sex, race, smoking, education, Quetelet index, social participation, and physical activity. The population attributable risk for hypertension due to heavy alcohol consumption is 5 to 7% in those greater than 50 years old and 6 to 8% in those less than 50 years old. These data suggest that alcohol consumption is a potentially important risk factor for elevations in blood pressure and hypertension.     

冠心病患者血脂异常与冠状动脉病变的相关性分析

目的探讨冠心病患者冠状动脉病变范围及狭窄程度与血脂的关系。方法 9847例疑诊冠心病并行诊断性冠状动脉造影的住院患者中,确诊冠心病6419例(65.2%),排除3428例(34.8%),以冠状动脉造影阳性(主要血管直径狭窄≥50%)作为诊断冠心病的标准。冠状动脉造影病变程度采用Gensini积分评价。术前进行甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)检查,对比分析冠心病组冠状动脉狭窄程度及范围与血脂的关系。结果对6419例冠心病患者进行统计学分析显示TC、LDL-C随着冠状动脉病变支数及病变程度(冠状动脉病变Gensini积分)的增加而升高,并与之成明显的负相关(P<0.001);而高密度脂蛋白则随着病变支数和病变程度(冠状动脉病变Gensini积分)的增加而降低,呈明显的负相关(P<0.001),进一步多元线性回归分析显示HDL-C(β=-0.075,OR值-5.580,95%CI:-7.541～-3.618,P<0.001)与冠状动脉病变程度成独立正相关,低密度脂蛋白(β=0.067,OR值2.712,95%CI:0.943～4.481,P=0.003)与冠状动脉病变程度成独立正相关,而与TG(β=0.002,OR值0.067,95%CI:-0.689～0.822,P=0.863)、TC(β=0.034,OR值1.080,95%CI:-0.392～2.553,P=0.150)无独立相关性。结论 TG、TC、LDL-C可以作为冠心病的危险因素,而HDL-C与冠状动脉病变程度成独立负相关,LDL-C与冠状动脉病变程度成独立正相关。虽然TG和TC在本研究中未体现出与冠状动脉病变程度存在独立相关性,但因本研究为横断面研究,研究结果存在一定的局限性,应结合临床具体分析。所以积极控制血脂对防止冠心病有积极意义。     

Apolipoproteins: valuable indicators of atherogenicity in patients with coronary disease and normal blood lipids

The lipid, lipoprotein and apolipoprotein B, A-I and A-II fractions in 20 young patients, (mean age 34.4 years) with myocardial infarction were compared with the results of a control group of 20 healthy men (mean age 35.8 years). The apolipoproteins B and A-I distinguished the myocardial infarction from the control patients. The patient group (who had slightly lower total and HDL cholesterol levels) had significantly higher apo B and lower A-I fractions than the controls. There was no significant difference in apo A-II fractions between the two groups. The measurement of the apo B and A-I fractions would appear to improve the lipid diagnosis by distinguishing the patients predisposed to atherosclerosis due to disorders of fat metabolism who may not be detected by less detailed lipid studies.