老年血液流变学改变及与中医血瘀证的关系

生物流变学创始人Copley AL教授对于血液流变学的研究领域曾做过精辟论述。他认为血液流变学是研究血液在血管流动和变形的一门学科。它从宏观、细胞及分子不同水平研究有关的流变现象。Copley把血管和血液作为一个整体，并称之为“血管一血液器官”。因此，血液流变学改变，应考察这些方面的变化。     

老年高血压左室肥厚与舒张功能的关系

目的探讨老年高血压病患者左室肥厚（ＬＶＨ）与舒张功能的关系。方法６０例老年高血压病患者经二维超声检查分为ＬＶＨ组及无ＬＶＨ组，并设对照组（无高血压者）。用脉冲式多普勒分别测定二尖瓣舒张早期血流充盈峰值（ＰＶＥ）、舒张晚期充盈峰值（ＰＶＡ）及ＰＶＡ／ＰＶＥ以评价左室舒张功能。全部数据用ｘ±ｓ表示，组间差异用ｔ检验，指标间相关关系用直线相关求出并进行相关系数显著性检验。Ｐ＜０．０５为判断差异有显著性的标准。结果老年高血压病患者左室心肌重量指数（ＬＶＭＩ）增加、左房增大、左室舒张功能受损。且ＬＶＭＩ增加与左室舒张功能受损有关。结论老年高血压病患者左室舒张功能受损先于收缩功能受损。而且，左室舒张功能受损并非ＬＶＨ所致，但ＬＶＨ可加重左室舒张功能受损。左房（ＬＡ）增大是左室舒张功能受损的代偿结果。     

高血压左室肥厚的研究进展

左室肥厚（LVH）是高血压最常见的亚临床靶器官损害之一,是高血压患者心血管不良预后的重要标志,及早发现并逆转LVH有重要的临床意义。该文介绍高血压LVH的流行病学、机制,以及与心血管疾病关系的相关研究。     

老年男性高血压患者血液流变学变化的研究

为了解老年男性高血压患者血液黏度改变及其特点 ,我们对老年男性高血压患者进行血液黏度检测 ,与健康老年男性血液流变学进行比较。1　资料与方法1.1　 对象　高血压诊断按有关标准〔1〕,男 6 8例 ,年龄 6 0～ 84岁 (平均 6 5 .1± 9.18岁 ) ;对照为我院健康体检者 ,血压正常 ,经心电图、胸片检查未见异常且无其他病史者 ,男 15 80例 ,年龄 2 2～ 88岁 (平均 5 1.86± 14 .10岁 )。1.2 　 方法　所用的仪器为北京中勤世帝公司生产的 R80血液黏度仪。取空腹静脉血 ,肝素抗凝 ,恒温 37℃分别测量全血黏度 ,血浆黏度和红细胞刚性指数和红细胞…     

老年高血压病左室肥厚与QT离散度

国外一些研究报道QT离散度与左心室肥大有关,且随左心室重量增加而增大。本文旨在探讨老年高血压病左室肥厚及左心室重量改变与QTd改变关系。1　资料和方法1.1　对象　病例选择我院2 0 0 1年7月～2 0 0 2年10月收治的原发性高血压患者4 8例,符合WHO/ FSH(1999)高血压治疗指南的诊断标准〔1〕。根据年龄分为老年组2 6例,男19例,女7例,年龄6 0～75岁;老年前期组2 2例,男16例,女6例,年龄4 5～5 9岁;对照组为健康老年人6例,男4例,女2例,年龄6 0～78岁。1.2 　方法　QT间期分析采用美国PI公司生产十二导联动态心电图仪同步描记2 4 h心电图,…     

川芎微乳对气虚血瘀型大鼠血液流变学的影响

目的 观察川芎微乳对气虚血瘀型大鼠血液流变学指标的影响.方法 用冠脉结扎加饥饿、疲劳的方法制造大鼠气虚血瘀模型.灌胃给药2周后处死大鼠,检测血液流变学指标.结果 川芎微乳各剂量组全血黏度、全血还原黏度、红细胞流变性均低于模型组(P<0.05或P<0.01),且呈剂量依赖性.结论 川芎微乳能明显改善气虚血瘀型大鼠的血液流变学指标.     

老年高血压左室肥厚患者的室性心律失常与心肌缺血

目的　了解老年原发性高血压左室肥厚患者的室性心律失常、心肌缺血的特点及两者的关系。方法　 90例老年 (≥ 6 0岁 )高血压患者经超声心动图测定左室质量指数 (LVMI) ,分为左室肥厚 (A组 )和非左室肥厚 (B组 )。经2 4h动态心电图测定 2 4h室性早搏总数 (VPCs)、Lown’s分级、ST段压低程度、持续时间及 2 4h发作次数。结果　A组室性心律失常的发生率明显增加 (P <0 .0 5 ) ,室性早搏 :75 %比 5 4% ,Lown’s 3～ 4级 :2 6 %比 4%。A组发作性ST段压低的发生率高 ,缺血持续时间长 (5 0 %比 15 % ,P <0 .0 5 )。所有缺血发作均为无症状性。室性心律失常与心肌缺血的昼夜节律变化基本相同。结论　无冠心病临床证据的老年原发性高血压左室肥厚患者的室性心律失常及心肌缺血的发生率增加 ,两者的昼夜节律变化基本相同     

非酒精性脂肪肝血瘀证患者血液流变学变化

[目的]观察非酒精性脂肪肝并符合血瘀证诊断患者的血液流变学变化,探讨血液流变学对其诊断的实用价值,为临床使用中医活血化瘀法提供理论依据.[方法]选择非酒精性脂肪肝血瘀证者42例,采用LIANG-100血液黏度计及TILSEAGCH100比色计测定其血液流变学指标的变化,并与37例健康成人进行对照.[结果]非酒精性脂肪肝血瘀证患者全血黏度(高切300 1/s、中切115 1/s、低切1 1/s)、红细胞聚集性、血浆黏度和纤维蛋白原等指标均有明显改变,与对照组比较差异有统计学意义(P＜0.0 5).[结论]非酒精性脂肪肝并血瘀证患者适合使用活血化瘀疗法,血液流变学指标可作为一种观察临床疗效的定量指标.     

老年高血压左室肥厚患者左室重构和冠脉病变探析

目的探讨老年高血压左心室肥厚患者左心室以及冠状动脉病变。方法选择曾在海安县人民医院进行治疗的120例老年高血压患者,在这120例患者中,有60例伴有左心室肥厚,将其作为观察组,另外60例患者未伴左心室肥厚,将其作为对照组,对两组患者均行心脏超声检查以及冠状动脉检查,并且对两组患者的检查结果进行比较分析。结果在完成检查之后,比较两组患者左心室扩张、冠状动脉高度狭窄与冠状动脉完全闭塞以及左心室体积增大所出现的患者人数,观察组中患者例数明显高于对照组患者,两组患者之间存在显著差异。结论对于老年高血压患者,若其伴左心室肥厚,则患者左心室重构率以及冠状动脉病变率均比较高,在临床上应加强注意。     

Left Ventricular Hypertrophy and Hypertension

The level of left ventricular (LV) mass as measured by echocardiography or other techniques in hypertensive patients reflects the integrated effects of the level of arterial pressure, the concomitant volume load imposed on the heart, and of alterations in arterial waveform morphology as well as of body size and non-hemodynamic variables. The LV may respond to these stimuli by concentric or eccentric hypertrophy or by the recently-described pattern of concentric remodeling, in which LV mass is normal but relative wall thickness is increased. The are strong parallelisms between increases in cardiac and systemic arterial wall thicknesses, and patients with discrete atheromas detectable by carotid ultrasound have elevated LV masses. Patients with eccentric and concentric LV hypertrophy have two to four-fold increases in the incidence of cardiovascular morbid events compared to hypertensive patients with normal LV geometry, and the change in LV mass during treatment has been associated with the risk of subsequent morbidity in initial studies. In contrast to the strong predictive power of LV geometric assessment, use of indirect measures of target organ status in the WHO systm for classification of the severity of hypertension does not improve on the prediction of prognosis that can be obtained by consideration of the level of arterial pressure. Current evidence suggests that evaluation of LV geometry may contribute to improved clinical decision-making in situations where more precise stratification of risk would clarify whether or not to institute treatment, or whether it should be with drugs or non-pharmacologic measures.     

694例高血压患者糖代谢障碍与左室肥厚的关系

６９４例高血压患者糖代谢障碍（ＧＩ）（包括糖尿病及葡萄糖耐受不良）的检出率及其对左室肥厚（ＬＶＨ）的影响，患者与正常人检出率分别为１４．４％及３．１％。男、女高血压之总检出率无统计学差异（１４．５％：１５．５％）。但高血压病人伴ＧＩ者ＬＶＨ检出率明显高于无ＧＩ的高血压（２４．２％：１７．３％）。研究提示ＧＩ常与高血压并存，伴ＧＩ之高血压不论中老年均有更高之ＬＶＨ检出率。     

单纯收缩期高血压患者左心室肥厚与室性心律失常的关系

目的探讨单纯收缩期高血压的病人左室肥厚与心律失常的关系。方法采用２４ｈ动态心电图和彩色多普勒超声观察患者左室肥厚及心律失常的发生情况，并观察单纯收缩期高血压与舒张期高血压左室结构改变。结果左室肥厚组室性心律失常发生率明显高于非左室肥厚组（Ｐ＞０．０１），单纯收缩期高血压组左室肥厚高于舒张期高血压组。结论左室肥厚可使室性心律失常发生率增加，收缩压增高较舒张压增高更易导致左室肥厚。     

老老年高血压患者左室肥厚与血压变异性相关研究

目的：探讨老老年高血压患者左室肥厚（LVH）与血压变异性（BPV）的关系。为老老年高血压患者临床诊疗提供更多临床依据,改善心脑血管预后,提高生活质量。方法选取中国中医科学院广安门医院2012年5月-2013年6月心内科住院老老年原发性高血压患者77例,男性34例,女性43例,年龄≥80岁;根据患者左室质量指数（LVMI）将患者分成左室肥厚组与非左室肥厚组,比较两组患者的动态血压参数,血压变异性及生化指标情况。结果夜间舒张压LVH 组34例（9.74±4.33）〉非LVH 组43例（6.87±3.05）,差异有统计学意义（P〈0.01）,其他血压参数差异无统计学意义。相关性分析显示：差异有统计学意义（r=0.294, P〈0.05）。结论老老年高血压患者左室肥厚与夜间舒张压、HDL C有关,故应重视老老年高血压患者夜间舒张压波动性,及高密度脂蛋白情况,以改善并预防左心室肥厚。     

Relation of Endothelium, Thrombogenesis, and Hemorheology in Systemic Hypertension to Ethnicity and Left Ventricular Hypertrophy

Although the arterial tree is exposed to increased pressure in hypertensive patients, paradoxically, the complications of hypertension (heart attacks, stroke) are mainly thrombotic rather than hemorrhagic. Patients with left ventricular (LV) hypertrophy are at high risk of the complications of hypertension. We performed a cross-sectional study of 178 patients attending a hypertension clinic in a city center teaching hospital, and measured plasma levels of the soluble adhesion molecule P-selectin (associated with platelet activity/function and atherosclerosis), the von Willebrand factor (vWf; a marker of endothelial dysfunction), fibrin D-dimer (an index of thrombogenesis), plasminogen activator inhibitor (PAI, an index of fibrinolysis), lipoprotein(a) (Lp(a), associated with thrombogenesis and atherogenesis) and hemorheological indexes (fibrinogen, hematocrit, plasma viscosity, hemoglobin) in patients with essential hypertension, in whom the LV mass and LV mass index were determined using echocardiography. The 178 patients (86 men, mean age 54 ± 15 years) were compared with 47 normotensive healthy controls (aged 56 ± 20 years). Hypertensive patients had higher P-selectin, PAI, vWf, fibrin D-dimer, Lp(a), plasma fibrinogen, and plasma viscosity when compared with controls. Black hypertensive patients had higher Lp(a) levels and LV septal and posterior wall thickness on echocardiography, but lower plasma PAI levels. Patients with LV hypertrophy (defined as a LV mass index>134 g/m² in men or>110 g/m² in women) had higher plasma fibrinogen compared with those without LV hypertrophy. Systolic blood pressures were significantly correlated to age, plasma viscosity, plasma fibrinogen, and vWf. Diastolic blood pressures were significantly correlated with age and plasma fibrinogen. Fibrinogen levels were correlated with LV mass, LV mass index, left atrial size, plasma viscosity, and vWf. Fibrin D-dimer levels were significantly correlated with vWf and fibrinogen levels. Thus, hypertensive patients have high plasma fibrinogen levels, thrombogenesis, and impaired fibrinolysis (as indicated by high D-dimer and PAI levels, respectively), platelet activation (raised soluble P-selectin), and endothelial dysfunction (high vWF). The high plasma fibrinogen levels were related to blood pressures, LV mass index (and LV hypertrophy), and left atrial size. These abnormalities in hemorheologic factors and markers of thrombogenesis and endothelial function may act synergistically to increase the risk of thrombogenesis and atherosclerosis in hypertensive patients.     

Hypertension Images: Electrocardiographic Left Ventricular Hypertrophy

The electrocardiogram is an inexpensive adjunct for assessing target organ damage in hypertensive patients. The gender-specific Cornell voltage criteria (men: R_aVL+ S_V3 >35 mm; women: R_aVL+ S_V3 >25 mm) have better overall accuracy than the often-used Soko low-Lyon or Romhilt-Estes criteria. One of the earliest electrocardiographic findings of hypertensive heart disease is a duration of the negative phase of the P wave in chest lead V₁ of >0.04 seconds, a manifestation of left atrial enlargement or abnormality. There is no other cardiovascular risk factor more potent than left ventricular hypertrophy with a "strain pattern." Despite limitations in determining hypertensive heart disease, the electrocardiogram provides other information that is useful in the management of patients with hypertension.     

高血压左室肥厚诊断的探讨

随机选择104例高血压患者（血压≥160／95mmHg）进行心电图（ECG）和超声心动图（UCG）检查。结果UCG左心室肥厚（LVH）检出率为76％，ECGLVH检出率为24％，ECGLVH患者的左心室重量指数（LVMI）显著增大，伴左心宝功能不全者的LVMI也明显增大，多元相关分析示LVMI与舒张末期左心室内径、室间隔厚度、左室后壁厚度呈显著正相关（P＜0．001）。     

伴左室肥厚高血压病患者发生室性心律失常临床意义的探讨

对１２９例高血压病患者进行２４小时动态心电图监测，分析室性心律失常的发生。结果表明：伴左室肥厚高血压组（ｎ＝４８）复杂室性心律失常（按Ｌｏｗｎ分级≥ＩＩＩ级）的发生率显著高于无左室肥厚的高血压组（ｎ＝８１），７０．８％ＶＳ１３．６％，Ｐ＜０．００５；复杂室性心律失常昼夜变化以晨６时至正午１２时发生率较高。提示高血压病左室肥厚存在复杂室性心律失常易发性及致心律失常源的基础。积极逆转左室肥厚、改善心肌缺血及抗室性心律失常的治疗是有意义的。