高血压病心肌微血管功能损害的研究

目的　探讨高血压病患者是否存在心肌微血管病变以及其与疾病严重程度和心肌肥厚的关系。方法　应用心肌对比超声心动图 ,静注含氟碳气体声振白蛋白微泡造影剂 (全氟显 )后 ,采用间断谐波成像技术测量静息时和注射潘生丁后心肌的A、β和A·β值 ,并计算出A、β比值和冠脉微血管的血流储备 (CMVFR)。 结果　高血压病患者静息时的A、β和A·β值均较对照组增高 (P >0 0 5) ,而注射潘生丁后明显降低 (P <0 0 1 ) ,A、β比值以及CMVFR显著降低(P <0 0 5和 0 0 1 ) ;随着高血压病情的加重 ,A和A·β值增高 ,A比值和CMVFR下降 ,A和A·β值与SBP、DBP显著正相关 (P <0 0 1 )、CMVFR与DBP负相关 (P <0 0 5) ;高血压左室肥厚 (LVH)患者静息状态的A、β和A·β值较无肥厚者增加 ,A、β比值和CMVFR下降 ;A和A·β与LVM和LVMI显著相关 (P <0 0 1 ) ;CMVFR与室间隔厚度负相关(P <0 0 5)。结论　高血压病患者静息时的心肌微循环血流量增加、心肌微血管储备功能和非内皮依赖性的血管扩张能力明显受损、心肌毛细血管密度明显减少 ,并且随着疾病的进展而加重 ;高血压LVH患者较无LVH者的微血管功能受损程度更严重     

高血压病心肌微血管功能损害的研究

目的探讨高血压病患者是否存在心肌微血管病变以及其与疾病严重程度和心肌肥厚的关系.方法应用心肌对比超声心动图,静注含氟碳气体声振白蛋白微泡造影剂(全氟显)后,采用间断谐波成像技术测量静息时和注射潘生丁后心肌的A、β和A*β值,并计算出A、β比值和冠脉微血管的血流储备(CMVFR).结果高血压病患者静息时的A、β和A*β值均较对照组增高(P>0.05),而注射潘生丁后明显降低(P<0.01),A、β比值以及CMVFR显著降低(P<0.05和0.01);随着高血压病情的加重,A和A*β值增高,A比值和CMVFR下降,A和A*β值与SBP、DBP显著正相关(P<0.01)、CMVFR与DBP负相关(\%P\%<0.05);高血压左室肥厚(LVH)患者静息状态的A、β和A*β值较无肥厚者增加,A、β比值和CMVFR下降;A和A*β与LVM和LVMI显著相关(P<0.01);CMVFR与室间隔厚度负相关(P<0.05).结论高血压病患者静息时的心肌微循环血流量增加、心肌微血管储备功能和非内皮依赖性的血管扩张能力明显受损、心肌毛细血管密度明显减少,并且随着疾病的进展而加重;高血压LVH患者较无LVH者的微血管功能受损程度更严重.     

实时心肌声学造影检测高血压心肌微血管功能

目的:通过实时心肌声学造影(MCE),检测有心绞痛症状而冠状动脉造影(CAG)正常的高血压患者心肌微血管功能. 方法:入选有心绞痛症状而CAG正常的患者12例(高血压组),心绞痛症状不典型而CAG正常的非高血压患者8例(对照组),采用声学造影剂声诺维进行实时MCE检查,分别测定静息状态和腺苷负荷后造影剂微泡达到峰值的平台期强度(A),再充盈平均速度(β)及A·β,并测定A比值、β比值和冠状动脉血流储备(CFR)值.结果:高血压组静息时反映局部心肌血容量的A值、反映局部心肌血流量的A·β值与对照组差异无统计学意义(P>0.05),而反应局部心肌血流速度的β值小于对照组(P<0.05),反应心肌血容量储备的A比值、反应心肌血流速度储备的β比值较对照组低(P<0.05),高血压组CFR低于对照组(P<0.01).结论:有心绞痛症状而CAG正常的高血压患者心肌缺血与心肌微血管密度下降、CFR减退有关,实时MCE可定量检测心肌微血管功能.     

冠心病介入治疗前行实时心肌声学造影评价缺血或存活心肌的实用价值

目的:探讨冠状动脉支架置入术前行实时心肌声学造影(RTMCE)评价存活心肌的临床应用价值。方法:对20例择期行经皮冠状动脉支架置入术的冠心病患者(病例组)和7例冠状动脉造影未见异常患者(对照组)分别于支架置入术前后行RTMCE检查及双嘧达莫负荷后RTMCE检查,分析心肌血流再灌注的时间-密度曲线形态及相应的心肌显像峰值强度(A)、曲线上升平均斜率(β)和局部心肌血流量(A·β),评估用药前后各指标的比值变化。结果:静息状态灌注正常的病变节段,负荷前A、β及A·β与正常心肌无显著差异,负荷后A、β及A·β储备值明显低于正常心肌,缺血心肌支架置入术后心肌灌注明显改善。静息状态灌注异常的病变节段,负荷前A、β及A·β明显低于正常心肌,负荷后A、β及A·β储备值明显低于正常心肌,缺血心肌治疗后心肌灌注较治疗前有改善,但仍明显低于正常心肌。结论:冠心病患者冠状动脉支架置入术前行RTMCE检查有助于筛选合适的病例进行血运重建,避免给患者造成不必要的损伤。     

心肌声学造影定量心肌血流判断存活心肌的实验研究

目的　评价经静脉心肌声学造影 (MCE)判断存活心肌的可行性。方法　建立急性心肌梗死犬模型 ,经外周静脉持续滴注微泡造影剂 ,通过计算A·β值测定心肌相对血流量。以放射性微球法测定的心肌血流量 (MBF)为标准 ,了解A·β值测定MBF的准确性。通过A·β值估测心肌存活与否 ,病理检查验证其可靠性。结果　放射性微球法所测的正常区、缺血区、坏死区的MBF分别为 ( 1 5± 0 3)、( 0 7± 0 3)、( 0 3± 0 2 )ml·min-1·g-1;MCE测得的A·β值分别为 5 2 46± 15 0 9、2 4 36±3 89、3 74± 3 80 ;正常区、缺血区、坏死区的MBF和A·β值“标化”后分别为 1 0± 0 0、0 44± 0 17、0 17± 0 11和 1 0± 0 0、0 48± 0 0 9、0 0 7± 0 0 8,二者的相关性良好 (r=0 81,P =0 0 0 1)。MCE对坏死心肌的判定结果与病理结果吻合。结论　心肌声学造影可用于活体状态下评价存活心肌 ,“标化”后的A·β值 <0 2 3提示心肌坏死。     

原发性高血压患者肺静脉血流超声特征

目的 :测量原发性高血压 ( EH)患者肺静脉血流 ( PVF)特征 ,以重新评估左室舒张功能的变化。方法 :使用 HP- 5 5 0 0型彩色多普勒超声诊断仪 ,对 95例 EH患者 ( EH组 ) ,19例正常人 (对照组 )的右上 PVF和二尖瓣血流的频谱进行对照研究。结果 :EH组的心房收缩期逆向 PVF A波速率显著高于对照组〔( 3 7.3 8± 5 .69)cm/ s∶ ( 2 6.16± 3 .12 ) cm/ s,P <0 .0 0 1〕。在 E/ A比值和左室心肌重量指数正常的 EH组 ,A波速率也显著高于对照组〔( 3 8.77± 4 .4 4 ) cm / s,P <0 .0 0 1〕。结论 :测定 EH患者 PVF的 A波速率更能敏感评估左心室舒张功能     

急性心肌梗死再灌注治疗后早期ST段变化预测心肌微血管功能

目的 :评价急性心肌梗死直接经皮冠状动脉腔内成形术 (PTCA)和支架置入术后ST段变化与心肌微血管灌注之间的关系 ,探讨ST段变化预测心肌微血管功能的可行性。方法 :测量PTCA和支架置入术前及术后 1、5、10、2 0、3 0min及 12h内相关导联ST段抬高指数 (∑STI)。术后 12h内行静脉心肌声学造影 (MCE)。根据心肌灌注将 2 4例患者分为无再流者 8例 (MCE积分为 3分或 2分 ) ,再流者 16例(MCE积分为 1分 )。MCE图像用MCE图像分析软件进行定量分析。结果 :心肌梗死相关动脉成功重建后 ,16例患者危险区有再流 ,8例出现无再流现象 ;再流者 16例患者中 ,14例∑STI下降≥ 5 0 % ,而在无再流者 8例中只有 1例 (P =0 0 0 0 1) ;无再流者 7例在术后 10min内∑STI进一步抬高≥3 0 % ,而再流者仅有 2例 (P =0 0 0 3 )。∑STI变化预测心肌微血管灌注敏感性、特异性及准确性均为 87 5 % ,阳性预测值为 93 3 % ,阴性预测值为 77 8%。术后 2 0min的∑STI与标化A·β值存在显著的负相关 (γ =-0 881,P =0 0 0 0 1)。结论 :急性心肌梗死成功再灌注治疗后不同的ST段变化与心肌微血管灌注有关 ;急性心肌梗死再灌注治疗后早期ST段变化可预测心肌微血管功能。     

应用多普勒组织成像技术评价原发性高血压左室舒张功能及其相关因素

目的:应用多普勒组织成像技术(DTI)探讨原发性高血压(EH)左室舒张功能的特点,同时检测血中心钠素(ANP)、脑钠素(BNP)的变化,分析两者与左室舒张功能的关系。方法:对照组20例,EH患者(EH组)61例,均行常规超声及DTI检查,EH患者根据左室质量指数(LVMI)分为左室心肌肥厚(LVH)亚组和无 LVH(NLVH )亚组。DTI测量二尖瓣侧环心肌舒张早期峰值运动速度(e)、晚期峰值运动速度(a)及其比值(e/a),测量二尖瓣瓣尖水平舒张早期的最大流速(E0)、舒张晚期的最大流速(A)及 E0 与A流速的比值E0/A。入选病例均测定血浆ANP、BNP浓度。结果:与对照组相比,EH患者E0/A、e/a减小,LVH亚组减小更明显;与对照组相比,EH血浆 ANP、BNP浓度升高, LVH升高更明显; E0/A、e/a比值与 ANP 呈负相关( r = - 0.56和 r = -0.60, 均P<0.01),与BNP呈负相关( r=-0.62和 r=-0.65,均 P<0.01)。结论:血浆 ANP、BNP与应用DTI技术评价的EH左室舒张功能均有较好相关性。     

糖尿病患者左室超声背向散射改变的初步观察

目的　了解 2型糖尿病 (T2 DM)心肌背向散射 (IBS)变化的特点及其临床意义。　方法正常对照组 5 0例 ,T2 DM组 5 0例 ,病程≤ 5年 ,糖化血红蛋白 (Hb A1c) (9.6 9± 1.78) % ,应用HP5 5 0 0型超声诊断仪 ,在胸骨旁左室乳头肌短轴切面分别测量左心室前间壁、前壁、侧壁、后壁、下壁和后间隔心肌组织的 IBS,并将其与心包 IBS的比值作为心肌 IBS的校正值 (IB% ) ;舒张末期与收缩末期的差值即 CVIB,并将其与心包 IBS的比值作为心肌 CVIB的校正值 (CVIB% )。同时测定左室等容舒张期时间 (IVRT) ,二尖瓣血流图 E峰与 A峰的比值 (E/ A )。　结果　 T2 DM组心脏左室各室壁心肌背向散射参数与正常对照组比较 IB%增大 ,CVIB减低 ,差异非常显著 (P <0 .0 0 1) ,两组IVRT、E/ A均在正常范围 (P>0 .0 5 )。　结论　 T2 DM患者左室 IBS有明显的变化且呈弥漫性改变 ,左室 IBS的变化出现在舒张功能异常 (糖尿病心肌病亚临床期 )之前 ,背向散射技术可早期发现糖尿病心肌微结构的病变     

定量组织速度成像评价高血压左室心功能的研究

目的:探讨定量组织速度成像(QTVI)在评价原发性高血压(EH)患者局域心肌舒缩功能的临床应用价值。方法:比较EH左室肥厚(LVH)与无左室肥厚(NLVH)患者不同心肌节段的收缩期峰值速度(Vs)、舒张早期峰值速度(Ve)和舒张晚期峰值速度(Va)。结果:LVH及 NLVH组 Vs、Ve值均显著小于正常对照组;LVH组与NLVH组的部分心肌节段Vs、Ve值比较差异有统计学意义(P<0.05)。结论:QTVI能敏感地反映EH不同病期的病理改变,可以作为高血压病程的一个重要参考指标。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。