高血压患者内皮素和一氧化氮与血压节律相关性的研究

目的:探讨高血压患者血浆内皮素(ET)和血清一氧化氮(NO)与血压节律的相关性. 方法:28例高血压患者和17例血压正常人进行动态血压监测和ET,NO测定. 结果:高血压组ET增加,NO下降.28例高血压患者按动态血压监测结果分为勺型和非勺型组,在非勺型组,ET明显增高(53.3±19.1vs37.8±10.0 ng/L),NO明显降低(33.4±12.7 vs 48.4±11.1mg/L);且夜间血压下降与ET负相关(r=-0.52,P＜0.05),NO正相关(r=0.54,P＜0.05). 结论:高血压病患者内皮素和一氧化氮水平可能参与昼夜血压节律的调节.     

药物干预恢复非杓型高血压患者血压昼夜节律对血浆内皮素的影响

目的　探讨通过药物干预使非杓型高血压患者恢复杓型血压昼夜节律后对血浆内皮素 (ET)的影响。方法　 30例 (年龄 6 4 8岁± 11 38岁 ,男 2 2例 ,女 8例 )符合WHO 1999年原发性高血压标准 ,并经动态血压检查定义为非杓型的高血压患者 (非杓型组 )随机分成两组 ,采用自身对照交叉试验法 ,在总剂量及药物种类 (硝苯吡啶缓释片及依那普利 )不变的前提下 ,通过调整用药时间加强夜间降压恢复杓型节律 (a处理 )或按常规的日间降压不恢复 (或保持 )杓型节律 (b处理 )。第一阶段两组分别接受其中一种处理 ,第二阶段分别接受另一种处理。用放免法同步测定每一处理前后的夜间 (2 :0 0 )、日间 (8:0 0 )血浆ET并复查动态血压。同期的健康体检者 45例 (健康对照组 )以及 2 1例同期住院的杓型高血压患者 (杓型组 )作为对照组。比较非杓型组血压昼夜节律恢复后前后ET的水平。结果　与健康对照组比 ,非杓型高血压患者白天及夜间平均血压、ET均显著增高〔分别为 (97 93± 11 6 7)mmHgvs (92 0 0± 7 34)mmHg ;P =0 0 17;(96 96± 12 31)mmHgvs(77 82± 6 35 )mmHg ;(85 2 5± 2 6 97)pg/mLvs (5 9 32± 2 7 6 1)pg/mL ;(78 6 2± 31 17)pg/mLvs(49 89± 2 3 6 4)pg/mL ;P均 <0 .0 1〕。血压恢复杓型后 ,夜间平均     

阻塞性睡眠呼吸暂停综合征老年患者血管内皮功能变化及其与冠心病的关系

目的　探讨老年阻塞性睡眠呼吸暂停综合征 (OSAS)患者血管内皮功能变化与冠心病 (CHD)的内在联系。方法　随机选择 31例无OSAS、无心血管疾病的老年单纯鼾症者为对照组 ,4 5例老年中、重度OSAS患者为OSAS组 ,OSAS组内又分为有CHD(16例 )和无CHD(2 9例 )两个亚组。测定和比较组间的血浆一氧化氮 (NO)、内皮素 (ET)及其比值的动态变化及OSAS组内CHD有无的区别。结果　与对照组相比 ,OSAS组患者的NO水平明显降低〔(2 7.6 9± 9.17)vs(6 1.90± 13.4 7) μmol/L〕 ,ET水平明显增高〔(5 8.0 8± 14 .2 1)vs (34.77± 8.2 3)ng/L〕 ,NO/ET比值明显下降〔(0 .4 7± 0 .18)vs (1.72± 0 .97) ,均P <0 .0 1)〕。CHD的发生率在OSAS组达 35 .6 %。与对照组相比 ,OSAS组中不伴CHD者降低的NO水平 (35 .5 3± 9.39) μmol/L、升高的ET水平 (47.78± 11.13)ng/L和下降的NO/ET比值 (0 .75± 0 .13)已有显著性差异 (P <0 .0 5 ) ;伴有CHD者的NO水平 (2 2 .17± 8.76 )μmol/L、ET水平 (6 9.14± 12 .17)ng/L和NO/ET比值 (0 .32± 0 .14 )较对照组相差更为明显 (P <0 .0 1)。结论　OSAS老年患者存在明显的血管内皮功能障碍 ,尤以CHD者为甚 ,血管内皮功能损伤可能是OSAS患者并发CHD的原因     

培哚普利对原发性高血压患者循环一氧化氮/内皮素平衡的影响

目的 :探讨血压与循环一氧化氮 ( NO) /内皮素 ( ET)的关系及培哚普利对其影响。方法 :应用 Griess、放免法观察培哚普利治疗前、后 30例原发性高血压 ( EH)患者循环 NO/ ET的变化 ,并与 2 5例健康者对照。结果 :NO与 ET比值 ( NO/ ET) :EH组治疗前较对照组明显减低 ( P <0 .0 1) ,而治疗后则较治疗前有明显升高 ( P <0 .0 5 )。平均血压 ( MBP) :EH组治疗前明显高于对照组 ( P <0 .0 1) ,而治疗后则较治疗前明显下降 ( P <0 .0 1)。各组 MBP与 NO/ ET呈显著负相关(对照组 r =- 0 .5 81、 P <0 .0 1,EH组治疗前 r =- 0 .35、 P <0 .0 5 ,治疗后 r =- 0 .5 0 5、 P <0 .0 1)。结论 :EH患者循环 NO/ ET失衡 ,与血压呈负相关 ,可能参与高血压维持与发展。培哚普利改善 NO/ ET失衡 ,与血压下降平行 ,可能是培哚普利降压机制的另一重要方面。     

高血压患者颅底血流速度改变与内皮素、一氧化氮关系的探讨

目的　研究血管内皮细胞合成分泌的血管活性物质内皮素 (ET)、一氧化氮 (NO)与高血压患者脑血流改变的关系。方法　测定 5 4例高血压患者与 2 0例非高血压患者血浆ET及NO水平 ,同时测定经颅多普勒血流。结果　①高血压组的颅底动脉收缩期峰值流速 (VS)及脉动指数(PI)明显高于对照组 (P <0 .0 5 ) ;②高血压病人血浆NO与颅底动脉血流速度呈负相关 (P <0 .0 2 ) ,ET与颅底动脉血流速度呈正相关 (P <0 .0 1) ;③高血压组血浆NO水平明显低于对照组 (P <0 .0 5 ) ,ET水平高于对照组 (P <0 .0 5 ) ,中重度高血压组NO水平低于轻度高血压组 (P <0 .0 5 ) ,ET水平高于轻度高血压组 (P <0 .0 5 )。结论　血浆ET和NO水平在一定程度上反映了高血压及其血管内皮损伤的程度     

高血压病患者血浆C型利钠利尿肽变化的及临床意义

许多研究证实高血压病患者血浆某些血管活性物质浓度发生了变化 ,并且其浓度变化与高血压病的程度相关 [1]。本研究采用放射免疫方法测定高血压病患者血浆 C型利钠利尿肽 ( CNP)、一氧化氮( NO)、降钙素基因相关肽 ( c GRP)、血管紧张素 ( Ang )、内皮素 ( ET) ,旨在探讨 CNP在高血压病发生发展中的作用。1　资料与方法1 .1　一般资料　选择 2 0 0 0年 5月～ 1 2月住院的 2 6例原发性高血压病患者为观察组。男 2 1例 ,女 5例 ;年龄 44～ 80岁 ,平均 ( 5 8.3± 5 .4)岁 ,体重指数( 2 5 .1± 3.2 ) kg/m2 ,血压 ( 1 64± 1 8) /( 94± …     

溶栓治疗对急性心肌梗死患者血浆内皮素和一氧化氮水平的影响

目的 :探讨溶栓治疗对急性心肌梗死 (AMI)患者内皮素 (ET)和一氧化氮 (NO)水平的影响。方法 :治疗组 32例 ,采用尿激酶 15 0万U于 6 0min内静脉滴注 ,分别测出治疗前及治疗后溶栓再通组 (18例 )和未通组 (14例 )ET和NO水平的动态变化。对照组 2 0例 ,测治疗前ET和NO水平。结果 :①治疗组的ET水平高于对照组 (P <0 .0 5 ) ,NO水平低于对照组 (P <0 .0 5 ) ;②溶栓再通组的ET、NO水平显著增高 ,峰值分别是 196 .2 8± 2 0 .14ng/L和5 6 .82± 13 .6 2 μmol/L ,显著高于溶栓未通组的峰值 (ET 112 .18± 15 .2 2ng/L和NO43.87± 10 .12 μmol/L ,P <0 .0 5 ) ;③再通组ET和NO峰值提前 ,都在溶栓后 2h ,而溶栓未通组ET和NO峰值均为溶栓后 6h。结论 :①ET/NO代谢失衡是构成AMI发生的一个重要机制 ;②溶栓后NO水平升高可拮抗再灌注损伤引起的ET水平增高。     

一氧化氮对内皮素促心肌细胞肥大及肌球蛋白基因表达的影响

目的 :探讨一氧化氮 (NO )对内皮素 (ET)促大鼠培养心肌细胞肥大及肌球蛋白重链 (MHC)基因表达的影响。方法 :对 12 0只大鼠采用心肌细胞培养及斑点杂交的方法 ,同时测定心肌细胞直径、数目及 3H-亮氨酸(3H- L eu)掺入率。结果 :NO组、ET组心肌细胞数目与对照组比较 ,均无明显差异 (P >0 .0 5 ) ,ET组细胞直径较对照组增加 (34 .5± 5 .5 ) % (P <0 .0 1) ,NO组较对照组增加 (6 .2± 2 .5 ) % (P >0 .0 5 ) ;NO明显抑制 ET促 3H-L eu掺入率的增加 (P <0 .0 1) ,NO组与对照组相比 ,β- MHC m RNA表达明显增加 ,α- MHC m RNA表达明显减少 (P <0 .0 1) ,NO显著逆转 ET的上述作用。结论 :NO有抑制 ET促心肌细胞肥大的作用 ,并可逆转 ET致MHC同工蛋白的病理性转换     

原发性高血压患者血一氧化氮及内皮素水平的研究

目的 研究原发性高血压患者血一氧化氮（NO）及内皮素（ET）水平的变化与高血压轻重程度、血压节律异常的相关性及其临床意义.方法 高血压组232例,对照组130例.高血压组内分为低危、中危、高危组分别89、78、65例;按血压节律性分为杓型与非杓型组分别109、123例.所有受试者进行NO、ET检测和动态血压分析.结果 高血压组与正常对照组比较血NO降低而ET升高,二者比值下降更明显,在两组间如上三组数据差异均有统计学意义.原发性高血压各组随高血压危险度上升,NO降低,ET升高,二者比值下降的幅度有加大趋势.原发性高血压患者随着正常血压节律性的丧失,NO降低,ET升高,二者比值下降的幅度有加大趋势.结论 血NO上升、ET下降及二者比值的相应明显变化不仅与原发性高血压的发病有关,也与高血压的危险程度和血压正常节律的存在与否具有明显的相关性.     

高血压合并胃食管返流患者一氧化氮内皮素含量对血压的影响

目的：观察合并胃食管返流（GER）的高血压病患者血浆一氧化氮（NO），内皮素（ET）改变对血压趋势的影响。方法：高血压病人经临床症状及胃镜检查诊断合并有GER的32例患者为观察组，不合并GER的32例为对照组。两组均检测凌晨1时及上午6时血浆NO，ET值，同时观察24小时动态血压变化。结果：合并GER的高血压患者凌晨1时（GER高峰时）NO浓度降低，ET浓度增高，血压呈非勺型，无GER的高血压患者血压仍呈勺型。结论：GER可以影响血浆NO，ET水平进而影响高血压患者24小时血压趋势。     

采集网和采集勺采集轮胎内埃及伊蚊幼虫效率的比较

本文比较了在不同类型轮胎中固定在韧性塑料框架上的采集网和标准幼虫采集勺对埃及伊蚊幼虫的采集效率，当已知数量的蚊幼虫引入到轮胎内，采集网法采集的蚊幼虫数比采集勺法多２～６．８倍。轮胎内的底泥可显著降低两方法的采集率，水面高度与轮胎体积均影响采集率的高低。与采集勺比较，采集网法采集率波动小，采集幼虫敏感性高，与已知幼虫数相关性好。因此，作者认为采集网法在采集轮胎内幼虫方面较采集勺法为优。     

Comparison of the left atrial appendage flow velocities between patients with dipper versus nondipper hypertension

Objective: In this study, left atrial appendage (LAA) flow velocities of dipper and nondipper hypertensive patients were compared with normal subjects. Methods: Twenty‐three patients with nondipper hypertension (NDH), 25 patients with dipper hypertension (DH), and 25 control subjects with comparable age, gender, and body mass indices were enrolled in the study. A detailed history, physical examination, and routine laboratory tests were obtained on all participants. Standard transthoracic echocardiographic examinations were performed on each subject. In addition, LAAs of all patients were visualized using transesophageal echocardiography. LAA filling and ejection velocities were measured using pulsed‐wave Doppler with the sample volume placed in proximal third of the LAA. The mean LAA ejection velocity in patients with NDH (47.7 + 13.0 cm/sec) was found to be significantly lower relative to the DH (66.3 + 12.9 cm/sec) and the control group (81.7 + 8.0 cm/sec) (P < 0.001). The mean LAA filling velocity in patients with NDH (41.7 + 14.7 cm/sec) was also significantly lower relative to those observed in the DH 58.8 + 9.2 cm/sec) and the control group (67.2 + 7.9 cm/sec) (P<0.001). Conclusion: In NDH patients, LAA filling and ejection flow rates are decreased relative to DH patients and the control group. For patients with NDH detected using ambulatory blood pressure monitoring, more aggressive treatment approach should be considered. Maintenance of LAA function may prevent potential complications secondary to left atrial appendage dysfunction. (Echocardiography 2012;29:391‐396)     

高龄高血压患者反杓型血压与白蛋白尿的相关性

目的探讨高龄高血压患者白蛋白尿与血压节律异常的关系。方法选取2012年6月至2013年6月在北京友谊医院住院的70例高龄高血压患者,收集临床资料、尿白蛋白排泄率以及动态血压监测结果。根据尿检结果将其分为白蛋白尿组（n=32）和非白蛋白尿组（n=38）。比较两组之间的白昼平均收缩压（dSBP）和舒张压（dDBP）、夜间平均收缩压（nSBP）和舒张压（nDBP）,以及夜间收缩压和舒张压下降率、血压变异曲线。结果白蛋白尿组与非白蛋白尿组问比较,年龄、性别、糖尿病发生率、超敏C反应蛋白、左室射血分数等方面均无明显差异（P〉0．05）。与非白蛋白尿组比较,白蛋白尿组患者估测肾小球滤过率（eGFR）明显下降（P〈0．05）。动态血压监测结果显示两组患者dSBP和dDBP均在正常范围,且无明显差异（P〉0．05）,但白蛋白尿组nSBP明显升高（P〈0．01）。两组患者非杓型血压节律的发生率无显著差异,白蛋白尿组患者的反杓型曲线比例更高（P〈0．01）。结论夜间收缩压升高,即反杓型血压节律,与高龄高血压患者白蛋白尿和eGFR下降高度相关。     

Depression and anxiety are associated with abnormal nocturnal blood pressure fall in hypertensive patients

Background: Previous studies have shown that depression and anxiety were independent risk factors for hypertension. Non-dipper hypertension is associated with higher cardiovascular mortality. The aim of this study was to evaluate the anxiety and depression scores in patients with dipper and non-dipper hypertension. Methods: The study sample consisted of 153 hypertensive patients. All patients underwent 24-h blood pressure monitoring. Patients were classified into two groups according to their dipper or non-dipper hypertension status. We evaluated results of the Hospital Anxiety and Depression Scale between groups. Results: Seventy-eight patients (38 male, mean age: 51.6?±?12.5 years) had dipper hypertension while 75 patients (27 male, mean age: 55.4?±?14.1 years) had non-dipper hypertension (p?=?0.141, 0.072, respectively). Clinical characteristics were similar for both groups. Patients with non-dipper hypertension had significantly higher depression and anxiety scores compared to patients with dipper hypertension. Dipper and non-dipper status significantly correlated with anxiety (p: 0.025, r: 0.181) and depression score (p: 0.001, r: 0.255). In univariate analysis, smoking, alcohol usage, presence of diabetes, hyperlipidemia, anxiety score >8 and depression score >7 were predictors of dipper versus non-dipper status. In multivariate logistic regression analyses only depression score >7 was independent predictor of dipper versus non-dipper status (odds ratio: 2.74, confidence intervals: 1.41–5.37). A depression score of 7 or higher predicted non-dipper status with a sensitivity of 62.7% and specificity of 62.8%. Conclusion: Non-dipper patients have significantly higher anxiety and depression scores compared to dipper patients. Evaluation of anxiety and depression in patients with hypertension might help to detect non-dipper group and hence guide for better management.     

非杓型血压的临床特点及相关因素分析

目的:研究非杓型血压的临床特点和相关因素,以提高非杓型血压的知晓率和治疗率。方法:选择原发性高血压或其他心脏疾病并发原发性高血压,并排除严重并发疾病的患者。收集临床资料,并行血生化、心电图、心超等辅助检查。所有患者进行24小时动态血压监测,将夜间平均血压与白天比较,无下降者,为反杓型血压组,下降超过10%,为杓型血压组,下降不超过10%,为非杓型血压组,并分析其临床特点。结果:共55例入选,所有患者均为高血压Ⅱ级或Ⅲ级,杓型血压者19例(35%),非杓型者22例(40%),反杓型者14例(25%),广义非杓型血压共36例(占65%)。不同血压节律组间比较,年龄、冠心病史、脑卒中史、血浆尿素氮及夜间收缩压、舒张压差异有显著性。Logistic回归提示冠心病史、脑卒中史、血浆尿素氮增高为血压昼夜节律异常的影响因素。结论:住院高血压病患者中非杓型血压的发生率较高,冠心病、脑卒中、血浆尿素氮增高的患者是非杓型血压的相关因素。     

阿托伐他汀联合贝那普利、氨氯地平对非杓型高血压患者降压疗效观察

【】目的：观察阿托伐他汀联合贝那普利、氨氯地平对非杓型高血压患者昼夜血压变化的影响。方法：将60例非杓型高血压患者随机分为单纯降压组和调脂联合降压组,治疗3个月后对治疗前后降压疗效及昼夜血压变化进行比较并作出评价。结果：治疗3个月后,调脂联合降压组及单纯降压组血压水平均较前下降,调脂联合降压组对降低患者夜间血压较单纯降压组明显,差异性比较有统计学意义(P<0.05)。结论：阿托伐他汀联合贝那普利、氨氯地平能有效降低高血压,在有效降压的同时,可减少昼夜血压波动,改善昼夜节律消失现象。     

Reproducibility study of nocturnal blood pressure dipping in patients with high cardiovascular risk

It has been shown that in most people there is a physiological reduction in blood pressure during nighttime sleep, it falling by approximately 10% compared to daytime values (dippers). On the other hand, in some people, there is no nighttime reduction (non‐dippers). Various studies have found an association between being a non‐dipper and a higher risk of cardiovascular disease, but few have assessed whether the nocturnal pattern is maintained over time. From the database of the TAHPS study, data were available on 225 patients, each of whom underwent 24‐hour ambulatory blood pressure monitoring (ABPM) on four occasions over a period of 5 months. We studied the reproducibility of the nocturnal BP dipping pattern with mixed linear analysis and also calculated the concordance in the classification of patients as dippers or non‐dippers. The intraclass correlation coefficients between the different ABPM recordings were 0.482 and 0.467 for systolic and diastolic blood pressure, respectively. Two‐thirds (67%) and 70% of the patients classified, respectively, as dippers or non‐dippers based on systolic and diastolic blood pressure readings in the first ABPM recording were found to have the same classification based on the subsequent recordings. We conclude that the reproducibility of nocturnal dipping patterns and concordance of dipper vs non‐dipper status in individual patients is modest and therefore that we should be cautious about recommending treatments or interventions based on these patterns.     

Hypertensive response to exercise in dipper and non-dipper normotensive diabetics

Non-dipper blood pressure (NDP) as an indicator of autonomic dysfunction could be associated with hypertensive response to exercise (HRE) in diabetic patients. HRE was determined as a predictor of development of unborn hypertension. We aimed to investigate if any correlation among NDP and HRE in normotensive type 2 diabetic patients. A total of 59 consecutive type 2 diabetic patients without history of hypertension and with normal blood pressure (BP) on ambulatory blood pressure monitoring (ABPM) were enrolled to the study. We divided the study population in to two groups depending on their BP on ABPM as dipper (group 1) or non-dipper (group 2). There were 22 patients (mean age 49.5?±?7 and 10 male) in group 1 and 37 patients (mean age 53.1?±?10 and 14 male) in group 2. Daytime diastolic and mean BP of dippers and night time systolic and mean BP of non-dippers were significantly higher. HRE was not significantly different between groups (59% vs. 62%, p?=?0.820). Hemodynamic parameters during the exercise test were similar. At multivariate linear regression analysis, resting office systolic blood pressure (SBP) (r?=?0.611, p?r?=?0.266, p?=?0.002) and age (r?=?0.321, p?=?0.010) were independently correlated with peak exercises SBP. Logistic regression analyses identified the resting office SBP (OR 1.191, 95% CI 1.080–1.313; p?p?=?0.012) were independent predictors of HRE. This study revealed that HRE is not related with non-dipper BP in diabetic patients. This study could inspire to further studies to explore the main reasons of HRE in diabetes mellitus.     

Serum Urotensin II Levels in Patients with Non-Dipper Hypertension

Hypertension terms “dipper” and “non-dipper” are propounded by the change that occurs during ambulatory blood pressure (BP) monitoring. The purpose of this study is to present whether the serum urotensin II levels are different in patients with dipper and non-dipper hypertension and to put forward the effects causing this difference, if there are any. Patients recently diagnosed with hypertension were included in the study. With ambulatory BP monitoring, 81 patients with high BP were divided into two groups, dipper (n = 40) and non-dipper (n = 41). Serum urotensin II levels were analyzed by ELISA method. Serum urotensin II levels were higher in patients with non-dipper hypertension than in patients with dipper hypertension (204 [106–533] vs. 140 [96–309], P = .004). There was a positive correlation between total systolic BP and serum urotensin II levels (r = 0.408 and P = .009), but the relation in the non-dipper hypertension group was not significant (r = 0.194 and P = .2). In conclusion, serum urotensin II levels were higher in non-dipper HT patients than dipper HT patients. This higher urotensin II level might be responsible for poor prognoses.