二维斑点追踪成像技术评价高血压患者左室收缩功能的价值

目的:探讨超声二维斑点追踪成像技术(2D-STI)评价原发性高血压患者左室收缩功能异常的价值。方法:原发性高血压患者56例,根据左室心肌质量指数(LVMI)(男性LVMI134g/m~2、女性LVMI110g/m~2者为左心室肥厚)分为非左心室肥厚组(36例)和左心室肥厚组(20例);另选择健康志愿者作为健康对照组(54例)。对各组心尖长轴基底段、中间段、心尖段和左心室短轴二尖瓣、乳头肌、心尖水平的心内膜下、外膜下进行斑点追踪成像分析,获取其纵向应变(LS)峰值,径向应变(RS)峰值和圆周应变(CS)峰值,计算其平均值作为整体应变值并进行组间比较。结果:与健康对照组比较,左室肥厚组长轴、短轴各段平均LS、RS、CS峰值显著降低(P均0.01),非左室肥厚组长轴、短轴各段平均LS峰值显著降低(P均0.05)。结论:超声二维斑点追踪成像技术能够早期评价原发性高血压患者左室收缩功能异常。     

超声斑点追踪技术在评价心肌梗死患者左室径向收缩功能中的应用

目的探讨超声斑点追踪技术（STI）诊断节段性室壁运动异常及评价左室收缩功能的临床应用价值。方法对30例心肌梗死患者（心梗组）和30例查体健康者（对照组）应用超声心动图仪获得高频帧二维图像,使用二维应变软件检测左室短轴三个水平（二尖瓣、乳头肌、心尖）各节段心肌的峰值径向应变（SR）及应变率（SRs）。结果心梗组梗死节段峰值SR和SRs在乳头肌水平各节段心肌均显著低于对照组（P均〈0.01）,而二尖瓣水平、心尖水平只有前间隔、前壁、侧壁、后间隔不同程度低于对照组（P〈0.05）,三个水平节段心肌与对照组比较均有显著性差异（P〈0.01）,SRs、SR均与LVEF明显相关（r分别=0.608、0.375,P分别〈0.01、0.05）。结论 STI能准确评价节段性室壁运动异常,可作为临床评价心肌梗死患者左室收缩功能的一种更科学、更客观的方法。     

二维斑点追踪技术对缩窄性心包炎患者左心室功能改变的定量评价

目的采用二维斑点追踪技术对缩窄性心包炎患者左心室功能改变状况进行定量评价。方法 40例缩窄性心包炎患者经临床检测确诊后,行心包剥脱术并常规超声检查,采集患者左室长轴观、二腔、四腔心观和心尖水平、乳头肌、二尖瓣环水平左室短轴观的二维图像,检测各切面最大径向、纵向、圆周以及总体应变,术后1个月后对上述指标重复检测。结果治疗后超声心动图检测结果显示,患者左右心房内径减小,左室内径增加,左心室射血分数提高,舒张早期二尖瓣口速度提升(P0.05);二维斑点追踪技术对手术后患者心尖二腔、四腔切面总体纵向应变进行测量,数据显著提升(P0.05);心尖左室长轴总体纵向应变治疗后在一定程度上增加,但数据比较无统计学意义(P0.05);二尖瓣环、乳头肌以及心尖水平短轴前面总圆周应变测量数据出现显著增加(P0.05);在进行手术后,患者二尖瓣环、心尖水平左室短轴观总体径向应变增加(P0.05),乳头肌水平短轴观总体径向应变略微增加,但差异无统计学意义(P0.05)。结论缩窄性心包炎患者在行心包剥脱术后,机体左室纵向应变、径向应变和圆周应变均存在不同程度改善,能有效恢复患者心脏房室结构,对心功能恢复起到推动作用;同时采用二维斑点追踪技术可以对缩窄性心包炎患者术后恢复效果有效评价,值得推广。     

应用斑点追踪成像技术评价心力衰竭患者左室短轴二维应变

目的:应用斑点追踪成像技术（STI）测量正常人及慢性心力衰竭患者(HF)左室短轴各节段二维应变,探讨STI技术评价HF患者左室功能的临床价值。方法: 采集HF患者及对照组左室短轴(二尖瓣、乳头肌、心尖水平)二维高帧频图像,测量各节段的收缩期径向应变（Rs）、环向应变（Cs）。结果: 对照组Rs在同一水平各节段间差异无统计学意义,乳头肌水平显著高于心尖水平,Cs在同一水平各节段间差异有统计学意义（P<0.05）。HF组各短轴水平整体Rs、Cs及各节段的Rs、Cs均显著低于对照组（P<0.01）。结论: HF患者左室各短轴水平及各节段收缩期径向及环向应变均明显低于正常人,提示其左室短轴收缩功能明显受损。     

二维斑点追踪显像对冠心病患者经皮冠状动脉介入术前后左室心肌功能的定量评价

目的探讨二维超声斑点追踪显像技术(2DSTI)识别冠心病的早期缺血心肌及评价经皮冠状动脉介入(PCI)术后治疗效果的临床应用价值。方法 60例非心肌梗死患者根据冠状动脉造影(CAG)中左前降支(LAD)狭窄程度分为正常组,轻度狭窄组(75%)。分别于PCI术前1周内和术后3个月获取左室短轴观二尖瓣环水平、乳头肌水平、心尖水平及心尖四腔观、二腔观,左室长轴观的高帧频二维超声心动图,应用斑点追踪显像(STI)软件,检测其相关供血心肌节段的收缩期纵向、径向、圆周峰值应变以及左室基底部、心尖部旋转角度和左室整体扭转角度。结果 PCI治疗前:正常组应变-时间曲线轮廓整齐,波峰值较大,重度狭窄组应变曲线形态紊乱,多数节段波峰低平。重度狭窄组大多数节段、中度狭窄组部分节段收缩期纵向峰值应变明显低于正常组(P<0.05),重度狭窄组部分节段明显低于轻度狭窄组(P<0.05)。各冠脉狭窄组绝大部分供血心肌节段径向收缩期峰值应变及圆周收缩期峰值应变与正常对照组相比,差异无统计学意义(P>0.05)。重度狭窄组收缩期在二尖瓣环及心尖水平最大旋转角度及整体扭转角度与正常对照组比较均明显降低,差别有统计学意义(P<0.05),与轻度狭窄组比较,在心尖水平最大旋转角度及整体扭转角度差别有统计学意义(P<0.05),与中度狭窄组比较,仅整体扭转角度差别有统计学意义(P<0.05);中度狭窄组心尖水平最大旋转角度及左室收缩期整体扭转角度与正常组比较明显降低,差别有统计学意义(PP<0.05)。各组左室短轴收缩期峰值径向应变、圆周应变无明显改善(P>0.05)。中重度狭窄组左室收缩期心尖部最大旋转角度及整体扭转角度均较术前明显升高,差别具有统计学差异(P<0.05)。结论 (1)应用2DSTI可定量评价左室心肌的局部功能和整体功能;(2)应用2DSTI能够识别     

二维应变成像评价酒精性心肌病右心室纵向功能的价值

目的：应用二维应变成像（2DSI）技术评价酒精性心肌病（ACM）右心室纵向功能的临床应用价值。方法：酒精性心肌病患者32例,正常对照组35例。对两组行常规超声参数及2DSI参数测定,收缩期参数包括：右心室游离壁基底段、中间段和心尖段收缩期的位移峰值（D）、收缩期应变峰值（S）、收缩期应变率峰值（SRs）;舒张期参数包括：舒张早期应变率峰值（SRe）、舒张晚期应变率峰值（SRa）。结果：常规超声参数比较,ACM组右心室前后径（RVEDd）与对照组比较明显增加（P〈0．05）,两组间右室射血分数（RVEF）无统计学差异。2DSI参数比较,ACM组D、S、SRs、SRe和SRa等参数与对照组比较均显著减低（P〈0．05,P〈0．01）。结论：2DSI可作为有效评价酒精性心肌病右心室纵向功能的一种无创性的新方法。     

斑点追踪成像技术评价原发性高血压患者左室心肌分层应变的研究

目的:探讨采用斑点追踪成像( STI)技术测定左室心内膜层和心外膜层心肌收缩期峰值应变评价原发性高血压(EH)左室不同构型患者左室收缩功能的价值.方法:入选EH患者56例(EH组),其中非左室肥厚30例(A亚组),左室肥厚26例(B亚组);健康志愿者53例(对照组).应用STI技术获取所有对象左室长轴及短轴各切面的心内、外膜层心肌收缩期纵向、径向峰值应变及左室心内、外膜层心肌的整体纵向和径向峰值应变值.结果:B亚组患者左室心内、外膜层心肌收缩期纵向峰值应变显著低于对照组(心内膜层:P＜0.01;心外膜层:P＜0.05),EH组二尖瓣水平短轴径向峰值应变显著高于对照组(P＜0.05).结论:EH患者径向应变的增高代偿了纵向应变的减低,STI可评价EH不同构型患者左室整体和局部收缩功能从而为早期发现心肌病变提供了无创性的新方法.     

斑点追踪显像对冠心病经皮冠状动脉介入治疗后的疗效评价简

目的 探讨二维超声斑点追踪显像技术（two-dimensional speckle tracking imaging,2DSTI）评价冠状动脉粥样硬化性心脏病（冠心病）患者经皮冠状动脉介入（percutaneous coronary intervention,pCI）治疗后效果的临床应用价值.方法 经冠状动脉造影（coronary angiography,CAG）证实左前降支狭窄＞75％的40例非心肌梗死患者,分别于PCI治疗前1周内和治疗后3个月获取左心室短轴观二尖瓣环水平、乳头肌水平、心尖水平及心尖四腔观、二腔观,左心室长轴观的高帧频二维超声心动图,应用斑点追踪显像（speckle tracking imaging,STI）软件,检测其相关供血心肌节段的收缩期纵向、径向、圆周峰值应变以及左心室基底部、心尖部旋转角度和左心室整体扭转角度.结果 PCI治疗前应变-时间曲线形态紊乱,多数节段波峰低平.在PCI治疗后3个月,缺血心肌节段的轮廓趋向规则,波峰明显升高.左心室大部分节段纵向收缩期峰值应变较术前明显增加,差异有统计学意义（P＜0.05）.各组左心室短轴收缩期峰值径向应变、圆周应变无明显改善,差异无统计学意义（P＞0.05）.左心室收缩期心尖部最大旋转角度及整体扭转角度均较术前明显升高,差异有统计学意义（P＜0.05）.结论 应用2DSTI可定量评价左心室心肌的局部和整体功能,为冠心病患者PCI治疗后疗效的观察提供一种经济、简便、无创的检查方法.     

应用超声斑点追踪技术早期诊断心肌缺血的初步研究

目的探讨斑点追踪技术早期诊断心肌缺血的临床应用价值。方法选取29例正常人和29例冠心病患者（单支病变14例,双支病变8例,三支病变7例）,采集每位受检者三个左室长轴观的动态二维图像,应用自动功能成像软件测量左室长轴方向18节段的收缩应变和三个左室长轴观总应变及平均总应变,同时用三平面法测量左室射血分数（LVEF）。对两组间各参数值进行比较,并分析三平面法LVEF与GLS-Avg的相关性。结果正常对照组各室壁纵向应变自基底段向心尖段逐渐增加,各室壁间差异无统计学意义,冠心病组部分室壁应变从基底段到心尖段逐渐递增的规律性变化消失,部分缺血节段应变绝对值明显低于正常对照组相应节段（P〈0.05）,冠心病组GLS-A2C、GLS-LAX、GLS-A4C及GLS-Avg绝对值均低于正常对照组,差异均有统计学意义（P〈0.05）;单支、双支、三支病变组GLS-Avg变化规律为：三支病变组〈双支病变组〈单支病变组,三平面法LVEF与GLS-Avg的相关系数为r=0.92。结论斑点追踪技术可以定量评价左室局部及整体应变,从而早期发现心肌缺血;斑点追踪技术和三平面法测量的左室整体收缩功能相关性良好。     

四种超声心动图技术评价正常人心肌生物力学参数及其与心功能相关关系

目的: 比较直接二维测量法(D2D)、解剖M型(AMM)、组织速度成像技术(TVI)及二维斑点追踪技术(STI)评价正常人心肌生物力学参数及其与心功能相关关系的方法,比较他们在临床运用过程优点及存在问题。方法: 分别应用D2D、AMM、TVI及STI测量并比较40例正常人收缩、舒张期心肌在长轴方向、短轴和圆周方向的心脏生物力学参数。结果: D2D显示:正常人收缩期纵向应变(LS)及应变率(LSR):下壁>后间隔>前间隔>后壁>前壁>侧壁（P>005）;收缩期LS、LSR与左室射血分数（LVEF）相关系数(r)分别为-0523及-0550。AMM显示:正常人收缩末期径向应变(RS)及径向应变率(RSR)游离壁大于间隔:收缩期RS、RSR与左LVEF(r)分别为0533及0495。TVI显示:收缩期LS:心尖段<基底段、中间段(P<005);舒张早期LS中间段>基底段>心尖段;舒张晚期LS心尖段<基底段、中间段(P<005);收缩期LS、LSR与LVEF(r)分别为-0562及-0550。STI显示:收缩期LS从基底段到心尖段逐步递增;左室扭转运动表现为心底部顺时针旋转和心尖部逆时针旋转,心脏整体表现为心动周期内逆时针方向为主的扭转运动。心肌收缩期平均LS及LSR与左室收缩功能参数间r的绝对值均超过055。结论: D2D通过直接测量左室长轴方向心肌长度的变化,间接计算LS与LSR;AMM克服了M型超声测量的角度限制,比较适合体位不合作的患者;TVI适合评价长轴方向室壁运动特征;STI对二维图像的超声斑点回声进行逐帧追踪,可以更准确测量局部室壁V、S等参数,定量评价局部心肌的收缩和舒张功能,测量参数与传统超声测量LVEF相关性较好,但设备要求较高。     

慢性肾衰竭患者同型半胱氨酸血症与动脉粥样硬化的关系

目的　研究慢性肾功能衰竭 (CRF)患者血浆同型半胱氨酸 (Hcy)水平与动脉粥样硬化及动脉舒张功能障碍的关系。方法　选择CRF患者 197例和健康对照 5 3例 ,采用荧光偏振免疫分析法测定血浆总同型半胱氨酸 (tHcy)水平 ,用高分辨超声技术检测颈总动脉内膜 中层厚度 (IMT)、粥样硬化斑块以及反应性充血后和含服硝酸甘油后肱动脉内径的变化率。结果　CRF患者高同型半胱氨酸血症发生率为 84 4 % ,其血浆tHcy水平 [(2 3 5 6± 11 91) μmol/L]明显高于正常对照组 [(7 97±2 6 5 ) μmol/L](P <0 0 1)。CRF患者平均IMT值和颈动脉粥样斑块检出率均明显高于年龄匹配的正常对照组 ,肱动脉反应性充血后内径增加率 (Dh)为 (4 0 5± 3 81) % ,含服硝酸甘油后内径增加率 (Dn)为 (4 94± 4 2 8) % ,均分别明显低于正常对照组Dh的 (8 81± 6 15 ) %和Dn 的 (11 72± 7 6 4 ) % (P <0 0 1)。按动脉粥样硬化严重程度分级 ,病变越重者血浆tHcy水平越高。多因素逐步回归分析显示 ,影响颈总动脉IMT的因素按影响程度依次为血浆tHcy、透析时间和年龄 (RR =0 4 84 ,P <0 0 0 1) ;影响Dh 的因素为血浆tHcy水平、年龄、透析时间和血清总胆固醇水平 (RR =0 2 6 3,P <0 0 0 1) ;影响Dn 的因素为年龄和血浆tHcy水平 (RR =0 2     

慢性肾衰竭合并冠心病患者血浆氧化型低密度脂蛋白水平变化及临床意义

目的 探讨慢性肾衰竭(CRF)合并冠心病患者血浆氧化型低密度脂蛋白(ox-LDL)水平变化及临床意义.方法 用ELISA方法测定299例住院病人和111例健康自愿者血浆ox-LDL水平,同时测定血浆TC、TG、HDL-C、LDL-C、Scr与ALB指标.结果 血浆ox-LDL水平:CRF合并冠心病组[n=148,(430.88±190.56) μg/dl]明显高于非合并冠心病组[n=72,(139.13±50.15) μg/dl](P<0.05);CRF合并不稳定性心绞痛组[n=66,(545.58±202.89) μg/dl]明显高于合并稳定性心绞痛组[n=82,(255.75±112.3) μg/dl](P<0.05).CRF组[n=220,(372.18±153.68) μg/dl]明显高于正常对照组[n=111,(34.90±17.65) μg/dl]与慢性肾炎组[n=79,(40.64±20.20) μg/dl](P<0.05);但慢性肾炎组与正常对照组无显著性差异(P>0.05).结论 CRF患者血浆ox-LDL水平显著高于正常人及慢性肾炎患者,并发冠心病的患者其血浆ox-LDL水平升高更为明显,其中合并不稳定性心绞痛患者血浆ox-LDL水平尤其高.因此,CRF患者血浆ox-LDL浓度的高低可间接提示动脉粥样硬化的存在及严重程度.     

酶联免疫吸附法测定尿中性肽链内切酶及其临床意义

目的:建立尿中性肽链内切酶(NEP)检测的酶联免疫吸附(ELISA)法,探讨该检测的临床意义。 方法:将研究组分为对照组(n=100) 、单纯肾小球疾病组(n=31)、急性肾小管损伤组(n=44)、慢性肾小管损伤组(n=48)、马兜铃酸肾病组(n=13)、慢性肾功能衰竭(CRF)组(n=13)。收集各组患者晨尿,用ELISA法测得尿NEP的浓度,并用相应尿肌酐值予以标化。同时检测各组患者的尿微量蛋白。 结果:急性肾小管损伤组尿NEP明显高于正常对照组(P=0.0001), 慢性肾小管损伤组、马兜铃酸肾病组、CRF组尿NEP均明显低于正常对照组(P均< 0.01),而单纯肾小球疾病组尿NEP与正常对照组无差异(P =0.3027)。急性组尿NEP与尿NAG呈正相关,与其他几种尿微量蛋白间无相关性。在其他几组内,尿NEP与肌酐清除率(Ccr)呈正相关,与尿微量蛋白呈负相关。在肾小球疾病组内尿NEP与尿微量蛋白无明显相关性。 结论:本研究首次建立了尿NEP检测的ELISA法,并用于临床研究。对尿NEP的检测,提供了一种快速、非损伤性测量手段,籍此帮助诊断近端肾小管损伤及判断病程。     

Gastric parietal, chief, and G-cell densities in chronic renal failure

We calculated morphometrically the amount of antral gastrin-producing (G) cells and body parietal and chief cells in gastric biopsy specimens from 30 undialysed patients with chronic renal failure (CRF) and from sex- and age-matched controls. The CRF patients had raised fasting serum gastrin levels, whereas these were normal in the controls (mean, 290 +/- 283 (+/- SD) ng/l (n = 27) versus 33 +/- 36 (n = 30)). Serum gastrin values of the patients and controls correlated positively with G-cell density (r = 0.501, n = 36, p = 0.002), as did the maximal acid output of the CRF patients with parietal cell density (r = 0.617, n = 14, p = 0.019). In CRF patients the densities of G, parietal, and chief cells were higher than those in the controls (G cells, 351 +/- 151 (+/- SD) cells/mm2, n = 21 versus 211 +/- 90, n = 16, p = 0.002; parietal cells, 299 +/- 94, n = 15 versus 224 +/- 72, n = 14, p = 0.025; chief cells, 886 +/- 346, n = 15 versus 743 +/- 182, n = 14, p = 0.181). The results agree with previous findings indicating that hyposecretion of gastric acid in CRF does not derive from decreased capacity for acid secretion but rather from the inhibition of acid output. Increased parietal cell density in CRF patients gives cause to suspect that the maximum acid output might even in raised, possibly depending on the permanent hypergastrinaemic state with its trophic influence on the gastric body mucosa.     

Evaluation of alveolar permeability and lung ventilation in patients with chronic renal failure using Tc-99m DTPA radioaerosol inhalation lung scintigraphy

Lung ventilation (LV) and alveolar permeability (AP) were measured in 24 male chronic renal failure (CRF) patients on regular hemodialysis (HD). LV and AP were determined by Tc-99m DTPA aerosol inhalation lung scintigraphy using commercial lung radioaerosol delivery units. The equilibrium LV images were visually interpreted by two independent and experienced nuclear medicine physicians. The degree of AP damage to the total right lung was presented as the clearance rate (k value; %/min) of the time-activity curve from dynamic total right lung images. The results showed 10/24 (42%) cases with inhomogeneous distribution and 8/24 (33%) cases with hypoventilation on equilibrium LV images. In comparison with 10 male normal controls, the k value of the CRF patient group was larger (1.14 ± 0.36%/min vs 0.75 ± 0.14%/min, p value <0.05). In addition, there was no significant correlation for k value and albumin level (r ² = 0.008) or for k value and HD duration (r ² = 0.228). In conclusion, CRF can predispose patients to LV change and AP damage. However, the degree of AP damage is not related to serum albumin level or HD duration. Offprint requests to: Chia-Hung Kao     

Reduced baroreflex effectiveness index in hypertensive patients with chronic renal failure

BACKGROUND: Impaired arterial baroreflex function has been associated with an increased risk of ventricular arrhythmia and sudden death. This has also been suggested for patients with chronic renal failure (CRF) who are at high risk for cardiovascular morbidity. The aim of this study was to investigate the arterial baroreflex function in CRF patients with emphasis on analyzing the time during which the arterial baroreflex is active, the baroreflex effectiveness index (BEI). METHODS: Beat-to-beat blood pressure (measured with Portapres) and electrocardiography were continuously registered during 30 min rest in 216 hypertensive CRF patients on hemodialysis (n=95), continuous ambulatory peritoneal dialysis (n=59), or conservative treatment (n=59). The spontaneous sequence method was used to calculate BRS and BEI. Age-matched healthy subjects (n=43) were examined for comparison. RESULTS: The BRS was reduced by 51% and the BEI by 49% in CRF patients compared with healthy subjects (P<.001 for both). In addition, CRF patients with diabetes showed further reductions compared with patients without diabetes (15% reduction of BRS and 44% of BEI, P<.01 for both). The treatment modality for renal failure had no effect on BRS or BEI. In a multivariate linear regression analysis, age, body mass index, and systolic blood pressure were independent predictors of BRS, whereas age and diabetes were independent predictors of BEI in patients with CRF. CONCLUSIONS: We conclude that BEI, which is markedly reduced in hypertensive patients with CRF, may convey information on arterial baroreflex function that is complementary to BRS.     

Immunoreactive corticotropin-releasing factor is present in human maternal plasma during the third trimester of pregnancy

Immunoreactive (IR) corticotropin-releasing factor (CRF)-like activity was detectable in the majority of plasma samples obtained from women in the third trimester of pregnancy (68.7 +/- 23.6 pg/ml (14.4 +/- 4.9 fmol/ml); mean +/- SE, n = 15), but not in plasma (less than 10 pg/ml) from first (n = 9) or second (n = 11) trimester of pregnancy, 1 day post partum (n = 7), non-pregnant women (n = 10), or in plasma obtained from patients with Cushing's disease (n = 2) or Nelson's syndrome (n = 1), or in basal (n = 6) or ether-stressed (n = 6) rat plasma. Gel filtration of third trimester pooled plasma revealed that the majority of such material eluted with Kav of rat CRF (1-41). The IR CRF (1-41)-sized material eluted with the identical retention time as rat CRF in a reverse phase high performance liquid chromatography (HPLC) system. The detection of IR CRF exclusively in third trimester maternal plasma, together with our previous demonstration that material physicochemically indistinguishable from it is present in human term placental extracts, suggests that the placenta may be the source of plasma IR CRF.     

Chronic renal failure in diabetic patients increases lipid risk factors for atherosclerosis

Diabetic patients are at high risk of cardiovascular disease and the risk is amplified in the presence of nephropathy, which may be partially attributed to modifications in lipoproteins. Moreover, lipoprotein profile may be affected by incipient nephropathy, glomerulopathy, and mild or severe renal failure. The aim of our study was to evaluate whether chronic renal failure (CRF) changes lipoprotein profile and apo A-I urinary excretion in diabetic subjects with glomerulopathy in comparison with non-diabetic subjects with glomerulopathy and CRF. Diabetic (n=25) and non-diabetic (n=10) patients with glomerulopathy and CRF showed significantly higher LDL-cholesterol, non-HDL-cholesterol and HDL-triglyceride levels than diabetic individuals without CRF (n=10). Arylesterase and paraoxonase activities did not show any difference between groups. Apo A-I could not be detected in urine samples from diabetic patients without CRF. All diabetic subjects with glomerulopathy and CRF who presented proteinuria above 6.5 g/24 h showed detectable urinary apo A-I (range=13.1-61.0 mg/24 h). Similarly, all non-diabetic patients with glomerulopathy and CRF who had proteinuria above 8.0 g/24 h also evidenced detectable apo A-I in urine (range=25.6-557.3 mg/24 h). Urinary apo A-I showed positive and significant correlations with urea (r=0.73, p<0.05) and proteinuria (r=0.97, p<0.0001), and a negative correlation with albumin plasma levels (r=-0.68, p<0.05). In conclusion, the presence of CRF in diabetic patients was associated with a more atherogenic lipoprotein profile.     

Sleep disordered breathing in chronic obstructive pulmonary disease

We prospectively studied sleep disordered breathing in 50 consecutive patients (39 males) with chronic obstructive pulmonary disease (COPD) with chronic respiratory failure (CRF) (n=33) and without CRF (n=17) by performing polysomnography. Patients with CRF had a lower mean nocturnal oxygen saturation (SaO2 %) (88.6+/-6.7 vs. 96.3+/-0.8; p=0.0001) and a lower minimal nocturnal SaO2 (73.6+/-12.0 vs. 84.3+/-7.3; p=0.002) compared to those without CRF, suggesting that patients with CRF tend to have more severe drops in nocturnal SaO2. Patients with CRF also had a lower FEV1 (% predicted) (p=0.01) and PEFR (% predicted) (p=0.031) compared to those without CRF suggesting an indirect relation to the oxygen saturation. Other pulmonary functions were comparable between both the groups. Among patients with and without CRF, the total sleep time (minutes); the rapid eye movement (REM) stage (% of total sleep time); the non-rapid eye movement (NREM) stage (% of total sleep time) were comparable (p=NS). Only three of the 50 patients with COPD had a significant (>5) apnea-hypopnea index (AHI) (total no. of apneas + total no. of hypopneas/ total sleep time [(hours) = AHI] and these three patients had a mean BMI = 27.7 which was higher than the mean BMI of the whole group (21.1). The AHI was comparable in patients with and without respiratory failure. Multiple regression analysis revealed a positive correlation between AHI and the neck circumference (r=0.41; p=0.005) and BMI (r=0.31; p=NS). There was a small but statistically insignificant negative correlation between AHI and neck length (r= -0.28; p=NS). We conclude that, BMI per se contributes to the AHI and nocturnal desaturation in patients with COPD.     

Impact of gender on the incidence and outcome of contrast-induced nephropathy after percutaneous coronary intervention

BACKGROUND: Contrast-induced nephropathy (CIN) is a recognized complication after percutaneous interventions (PCI). We sought to determine the impact of gender on incidence and clinical outcome of CIN. METHODS AND RESULTS: Of a total 8,628 patients who underwent PCI, there were 1,431 (16.5%) who developed CIN (defined as > 25% rise in creatinine after PCI). Patients were followed clinically for one year. CIN was present in 23.6% of female versus 17.4% of male patients (p < 0.0001). Multivariate analysis showed that female gender (OR = 1.4, 95% CI = 1.25 1.60; p < 0.0001), pre-PCI chronic renal failure (CRF) (OR= 1.8, 95% CI = 1.53 2.10, p < 0.0001), diabetes mellitus (OR = 1.5, 95% CI = 1.34 1.70; p < 0.0001), age (OR = 1.01, 95% CI = 1.01 1.02, p < 0.0001), and hypertension (OR = 1.2, 95% CI = 1.06 1.36, p = 0.0035) were independent predictors of CIN. Clinical outcomes after CIN were examined in patients with or without CRF. Among patients without CRF who developed CIN, females (n = 465) had higher rates of one-year mortality, and MACE comparing to males (n = 710) without CRF (14% vs. 10% mortality, 36% vs. 30% MACE; p = 0.05 and 0.06, respectively). In patients with CRF who developed CIN, we found no significant gender differences in one-year clinical events (37% vs. 36% mortality, 42% vs. 45% MACE; p = 0.8 and 0.6, respectively). By multivariate analysis only baseline CRF, diabetes, age, functional NYHA IV class were identified as independent predictors of one-year mortality in patients with CIN after PCI. CONCLUSIONS: Female gender is an independent predictor of CIN development after PCI and a marker of worse 1-year mortality after CIN in patients without baseline CRF. After CIN is developed, pre-PCI CRF, diabetes mellitus, age, severe heart failure (not gender) are independent predictors of one-year mortality.