厄贝沙坦治疗前后原发性高血压患者血浆内皮素-1的变化

目的　观察厄贝沙坦治疗前后原发性高血压 (EH)患者血浆内皮素 - 1(ET - 1)水平的变化 ,探讨ET - 1在EH发展中所起的作用。方法　 88例高血压患者作为EH组 ,服用厄贝沙坦治疗 4周 (剂量 15 0～ 30 0mgd-1) ,4 8例健康人作为对照组。测量两组血压和血浆ET - 1水平 ,检测厄贝沙坦治疗后EH组血压和血浆ET - 1的变化。结果　3例患者因不良反应退出研究。EH组与对照组血浆ET - 1水平分别为 90 .2 4± 2 9.2 3ng/L、5 8.31± 11.4 2ng/L ,前者较后者显著增高 (P <0 .0 5 ) ,且高血压III级ET - 1水平显著高于高血压II级 (P <0 .0 5 ) ,高血压II级ET - 1水平显著高于高血压I级 (P <0 .0 5 )。厄贝沙坦组治疗后ET - 1水平为 6 8.98± 8.2 0ng/L ,较治疗前显著降低 (P <0 .0 1)。厄贝沙坦组治疗前SBP和DBP分别为 16 8.34± 12 .92、112 .33± 8.0 4mmHg ,治疗后分别为 12 8.32± 18.4 3、82 .76± 4 .2 2mmHg ,均较治疗前明显降低 (P <0 .0 5 )。结论　EH患者血压与ET - 1水平正相关 ,厄贝沙坦在有效降压的同时 ,血浆ET - 1水平亦降低。     

电刺激小脑对脑梗塞患者血浆内皮素的影响

目的　探讨电刺激小脑治疗对急性脑梗塞患者血浆内皮素水平的影响。方法　将6 0例急性脑梗塞患者 ,随机分为电刺激小脑治疗组 (30例 )和常规治疗对照组 (30例 ) ,分别观察其疗效和治疗前后血浆内皮素 (ET)含量的变化 ,并与 30名健康人的血浆ET水平进行比较。结果　脑梗塞患者的血浆内皮素水平 (6 1.76± 34 .6 0 )ng/L ,明显高于健康人 (44 .48± 6 .41)ng/L ,P <0 .0 1。电刺激小脑治疗组治疗前与对照组血浆内皮素水平差异无显著性 (P >0 .0 5 ) ;治疗后患者血浆内皮素水平 (39.12± 2 1.39)ng/L ,较对照组 (6 1.5 0± 12 .6 4)ng/L明显降低 (P <0 .0 1) ,与健康人比较差异无显著性 (P >0 .0 5 )。对照组治疗前后差异无显著性 (P >0 .0 5 )。结论　电刺激小脑治疗对急性脑梗塞患者有明显疗效 ,利于患者的早期肢体功能恢复 ,血浆ET水平的降低是其治疗机制之一。     

尿毒症和肾移植患者血清透明质酸的变化

目的　测定血浆中透明质酸 (HA)与尿毒症和肾移植患者病情变化的关系。方法　采用竞争性酶联免疫吸附试验测定尿毒症组 (A组 )、肾移植组 (B组 )、正常对照组 (C组 )血浆HA水平 ,同时测定血清肌酐 (SCr)。结果　血清HA水平A组 ( 414 2 5± 2 0 8 6 5ng/ml)高于B组 [( 6 9 5 7±46 2 8)ng/ml]和C组 [( 6 0 85± 2 5 5 5 )ng/ml](P <0 0 5 ) ;B组和C组比较差异无显著意义 (P >0 0 5 ) ,与血肌酐呈正相关 (r=0 87)。同时A组患者血肌酐透析前后比较差异有显著意义 [分别是透前 ( 810 48± 2 14 72 ) μmol/L透后 ( 2 2 5 2 8± 16 6 32 ) μmol/L ,(P <0 0 5 ) ];而血浆HA透析前后无变化[分别是透前 ( 414 2 5± 15 7 83)ng/ml]透后 ( 40 2 34± 12 5 6 7)ng/ml,(P >0 0 5 ) ]。结论　血HA可作为评估尿毒症和肾移植患者病情变化的一个指标。     

氨氯地平抗家兔动脉粥样硬化的作用机制

目的　探讨氨氯地平抗动脉粥样硬化的作用机制。方法　建立兔动脉粥样硬化模型 ,分为实验 1、2、3组、实验对照组 (AS组 )、空白对照组 ,检测各组不同时期血清中一氧化氮 (NO)、血浆中内皮素 (ET)水平。结果　血清中NO平均值 ,实验 1、2、3组、AS、空白对照组分别为 :4 .71± 0 .35 ,4 .6 2± 0 .4 8,3.71± 0 .5 6 ,2 .12± 0 .34,6 .72± 0 .37mmol/l。实验组与实验对照组比较 ,NO值明显升高 ,差异显著 (P <0 .0 1)。血浆中ET平均值 ,上述各组分别为 :30 2 .11±4 6 .2 1,2 84 .32± 37.2 5 ,35 7.79± 34.18,1835 .83± 2 6 .6 5 ,10 7.2 4± 2 4 .8Pg/ml。实验组与实验对照组比较 ,ET值明显降低 ,差异显著 (P <0 .0 1)。结论 :　氨氯地平抗动脉粥样硬化的作用机制可能与升高血清中NO、降低血浆中ET有关。     

康复干预对轻中度老年高血压患者动态血压和血浆内皮素的影响

目的 :探讨康复干预对老年轻、中度高血压患者动态血压及血浆内皮素的影响。方法 :38例老年高血压患者使用无创伤性动态血压监测仪进行动态血压监测 ,并采空腹静脉血检测血浆内皮素 (ET 1)。非药物康复治疗 8周后再次行ABPM及ET 1测定。结果 :38例患者中 ,血压昼夜节律呈非杓型 16例 (4 0 % )。 38例患者平均血浆ET 1水平轻微升高 ,按血压昼夜节律情况分为杓型组和非杓型组后发现 ,ET 1水平在非杓型组明显升高 (P <0 .0 5 )。康复干预治疗 8周后 ,动态血压及非杓型组平均ET 1水平明显下降 (P <0 .0 5 )。结论 :综合康复干预可作为轻、中度老年高血压病的初始治疗 ,康复干预后能明显降低轻、中度老年高血压患者动态血压和非杓型组血浆ET 1水平。     

低能量氦-氖激光血管内照射对急性脑梗死患者血浆内皮素的影响

目的　探讨低能量氦 氖激光血管内照射 (ILIB)对急性脑梗死患者血浆内皮素 (ET)的影响。方法　 85例急性脑梗死患者随机分为ILIB治疗组与常规治疗组 ,采用放免法分别测定 2组患者治疗前及治疗后的血浆ET水平 ,将同时来院查体的健康老年人 3 9例作为正常对照组 ,并用同种方法测定血浆ET水平。结果　ILIB治疗组 48例 ,治愈 11例 ,显效 2 6例 ,有效 8例 ,无效 3例 ,总有效率 93 .75%。常规治疗组 3 7例 ,治愈 4例 ,显效 14例 ,有效 12例 ,无效 7例 ,总有效率 81.0 8%。 2组比较 ,差异有显著性 (P <0 .0 5)。急性脑梗死患者血浆ET水平明显高于正常对照组 (P <0 .0 1) ,治疗 10d后 ,ILIB组血浆ET水平下降明显 ,由(69 .0 1± 10 .3 1)ng/ml降至 (52 .3 2± 8.43 )ng/ml(P <0 .0 1) ,并趋于正常 (P >0 .0 5) ,常规治疗组由 (67.43±11.42 ) pg/ml降至 (59.93± 10 .56) pg/ml ,但仍明显高于正常对照组 (P <0 .0 5)。治疗 2 0d后 ,2组ET水平均下降 ,ILIB治疗组降至 (50 .0 9± 7.2 4) pg/ml,常规治疗组降至 (51.3 6± 8.2 1) pg/ml ,并均趋于正常 (P >0 .0 5)。结论　ILIB能降低急性脑梗死患者血浆ET的水平 ,对急性脑梗死有较好的治疗作用     

辛伐他汀对一氧化氮缺乏性高血压大鼠早期肾功能的影响

目的 :观察羟甲基戊二酰辅酶A(HMG CoA)还原酶抑制剂辛伐他汀 (Simvastatin)对一氧化氮缺乏性高血压大鼠肾功能的保护作用 ,并探讨其机制。方法 :通过给予一氧化氮合酶抑制剂L NAME制造一氧化氮缺乏性高血压大鼠模型 ,2 4只WKY大鼠随机分为正常对照组 (C组 )、高血压组 (L组 )、辛伐他汀组 (L +S组 )。收集 2 4h尿液测定尿 β2 微球蛋白 (β2 M)、尿蛋白 ,第 8周宰杀收集标本 ,检测血和肾组织中一氧化氮 (NO)、内皮素 (ET 1 )、血管紧张素Ⅱ (AngⅡ )水平。结果 :给予L NAME2周即见血压升高 ,第 8周时显著升高 ,达 (1 76 .5± 3.5 )mmHg。与C组比较 ,L组第 7天和第 8周时尿蛋白及 β2 M形成两个高峰 ,尿蛋白分别为 (4 0 .5± 1 0 .4 6 )mg Lvs 1 5 .2 8± 2 .1 6mg L和 (8.4± 5 .6 2 )g Lvs(1 3.6 5± 3.36 )mg L(P <0 .0 0 1 ) ,尿 β2 M分别为 (0 .5 8± 0 .1 1 )mg Lvs(0 .2 9± 0 .0 6 )mg L和 (0 .6 4± 0 .0 4 )mg Lvs(0 .34± 0 .0 6 )mg L(P <0 .0 1 )。 8周时肾脏局部NO、ET 1及AngⅡ水平均有显著差异 (P <0 .0 5 )。辛伐他汀在不影响血压和血脂条件下 ,减少尿蛋白和尿β2 M排出 ,以第 7天至 2周时最明显 (P <0 .0 5 ) ;使大鼠肾脏局部 ,特别是肾皮质NO水平增高 ,ET 1及AngⅡ水平降低。     

高血压病患者血浆内皮素与降钙素基因相关肽变化的临床意义

目的　探讨内皮素 (ET)及降钙素基因相关肽 (CGRP)在高血压病患者中的作用。方法　用放射免疫法测定 5 8例高血压患者血浆ET及CGRP的浓度 ,与 2 0名健康体检者进行对照。结果　Ⅰ、Ⅱ、Ⅲ期高血压病患者和健康者的血浆ET浓度分别为 (5 3.9± 15 .6 )、(89.1± 2 8.3)、(12 3.5± 2 5 .4)、(4 6 .3± 11.2 )ng/L ,Ⅰ、Ⅱ、Ⅲ期高血压病患者和健康者的血浆CGRP浓度分别为 (4 9.3± 2 1.3)、(34 .6± 19.1)、(2 0 .7± 8.7)、(5 5 .8±2 6 .7)ng/L ,Ⅱ、Ⅲ期高血压病患者ET浓度明显高于健康对照组 (P <0 .0 1)且随高血压病病情进展而逐渐显著升高 ,而Ⅱ、Ⅲ期高血压患者CGRP浓度则明显低于健康对照组 (P <0 .0 5 ) ,随高血压病进展逐渐显著降低。结论　ET和CGRP与高血压病的发生和变化有着密切联系。     

急性缺血性脑血管病循环血小板生成素和血管活性肽类的动态变化

目的　研究急性缺血性脑血管病早期循环血小板生成素 (TPO)、内皮素 (ET)和降钙素基因相关肽 (CGRP)水平的动态改变及与血小板PL计数的关系。方法　采用放射免疫法及血常规检查检测 13例患者治疗前、治疗 4h、第 2天及第 3天的循环血液TPO、ET、CGRP及PL。治疗分别采用尿激酶溶栓和 /或常规治疗。结果　①患者血液TPO、ET、CGRP水平均较正常明显升高 ,差异显著。其中TPO、ET升高持续至来诊后第 3天TPO分别为 (12 4 70± 12 6 2 )ng/L、(12 1 5 6± 13 31)ng/L、(12 5 6 5± 16 98)ng/L、(117 0 0± 7 0 5 )ng/L对比 (90 0 0± 5 0 0 )ng/L ,P <0 0 1;②比较不同类型缺血性脑血管病或 /和不同治疗方法各时间点的血液TPO、ET、CGRP水平无显著差异 ;③TPO、ET、CGRP、PL之间均无相关性 ;而患者年龄与CGRP呈显著性负相关 (r=- 0 4 5 5 ,P =0 0 0 2 )。结论　急性缺血性脑血管病早期血清TPO升高 ,其升高受到血小板以外的因素调节 ;溶栓治疗对TPO水平无影响。血浆CGRP水平随年龄增长而降低可能是老年人易发生脑血管痉挛的原因之一     

内皮素与急性有机磷农药中毒后多器官功能障碍综合征的相关性研究

目的　探讨内皮素 (ET)与急性有机磷农药中毒 (AOPP)后多器官功能障碍综合征 (MODS)的关系及临床价值。方法　应用放射免疫法检测 38例AOPP后MODS患者与 30名健康人血浆ET水平 ,分析AOPP后MODS患者血浆ET水平与APACHEⅡ、全血胆碱酯酶 (AChE)活力、心肌肌钙蛋白I (cTnI)、血清酶学、血生化等指标的关系。结果　AOPP后MODS患者血浆内皮素水平较正常对照组明显升高 (P <0 0 1) ,死亡组与非死亡组血浆ET水平明显高于正常对照组 (P <0 0 1) ,而死亡组血浆ET明显高于非死亡组 (P <0 0 1)。血浆ET与与APACHEⅡ评分、 (cTnI)、肌酸激酶同工酶 (CK -MB)、乳酸脱氢酶 (LDH)、丙氨酸氨基转移酶 (ALT)、天门冬氨酸氨基转移酶 (AST)、血尿素氮 (BUN)、血肌酐 (Scr)呈正相关 (P<0 0 1或 0 0 5 ) ,与AChE呈显著负相关 (P <0 0 1)。结论　ET参与了AOPP后MODS的发病过程 ,且与APACHEⅡ评分呈正相关关系 ,血浆ET可作为AOPP后MODS患者多器官功能损害程度的评估、指导治疗、观察病情变化与预后判断的临床指标之一 ,使用ET拮抗剂或抑制剂对防治MODS的发生发展有重要的临床意义。     

Hypertension, hormones, and aging

The most rapidly growing segment of the United States population is the geriatric group, especially those above 75 years of age. Hypertension, diabetes mellitus, and dyslipidemia increase with advancing years in Westernized, industrialized societies such as the United States. These disorders contribute significantly to strokes and myocardial infarctions and associated morbidity and mortality in our elderly population. The increase in these chronic disease processes with aging is related, in part, to increasing obesity, reductions in physical activity, and medications that predispose to these conditions (ie, nonsteroidal inflammatory agents and hypertension). Hypertension in the elderly is characterized by high peripheral vascular resistance/reduced cardiac output, impaired baroflex sensitivity, relatively greater systolic pressures, increased blood pressure variability, and a propensity to salt sensitivity. Type 2 diabetes in the elderly is related to alterations in body composition (ie, increased central adiposity and decreased lean body mass) and to reduced physical activity. There is an increasing body of evidence that aggressive treatment of hypertension and dyslipidemia in the elderly results in comparable, if not greater, reductions in cardiovascular morbidity and mortality in the elderly as in younger counterparts.     

Night Shift Work,Genetic Risk,and Hypertension

ObjectiveTo perform a prospective cohort study to investigate whether night shift work is associated with incident hypertension and whether this association is modified by genetic susceptibility to hypertension because evidence on the association between night shift work and hypertension is insufficient.MethodsA total of 232,665 participants of UK Biobank who were recruited from 2006 to 2010 and observed to January 31, 2018, were included in this study. A Cox proportional hazards model with covariate adjustment was performed to assess the association between night shift work exposure and hypertension risk. We constructed a polygenic risk score (PRS) for genetic susceptibility to hypertension, which was used to explore whether genetic susceptibility to hypertension modified the effect of night shift work. The robustness of the results was assessed by sensitivity analysis.ResultsNight shift workers had a higher hypertension risk than day shift workers, which increased with increasing frequency of night shift work (P_trend<.001). The association was attenuated but still remained statistically significant in the fully adjusted model. We explored the joint effect of night shift work and genetic susceptibility on hypertension. Permanent night shift workers with higher hypertension PRSs had higher risk of hypertension than day workers with low PRSs.ConclusionNight shift work exposure was associated with increased hypertension risk, which was modified by the genetic risk for hypertension, indicating that there is a joint effect of night shift work and genetic risk on hypertension.     

Hypertension, perceived clinician empathy, and patient self-disclosure

The purpose of this study was to compare groups of outpatient hypertensive and diabetic patients to a control group (no known chronic illnesses) on their perceptions of clinician empathy and the importance and difficulty of disclosing information about themselves to health care providers. It was hypothesized that hypertensives would differ from the other groups in perceiving less clinician empathy and in attributing less importance, but greater difficulty, to self-disclosing. The sample was 54 hypertensives, 47 diabetics, and 115 nonchronically ill patients. Each subject completed the Empathy scale of the Barrett-Lennard Relationship Inventory and a patient self-disclosure questionnaire. The empathy hypothesis was supported but the self-disclosure hypotheses were not. Hypertensive patients differed from other patients in perceiving the least clinician empathy and in attributing the greatest importance to discussing their responses to health care.     

Hypertension, plasma lipids and antihypertensive drugs

Treatment of hypertension is quite effective in preventing cerebrovascular disease. Morbidity and mortality from coronary heart disease, the major complications of high blood pressure are not, however, generally affected when mild to moderate hypertension is treated with antihypertensive drugs. This is probably owing to the multifactorial nature of atherosclerosis, the main cause of coronary heart disease. For example, dyslipidemias and other risk factors are very common among hypertensive patients. Prevention of coronary heart disease among hypertensive subjects is possible only by intervening in the many contributory risks. Non-pharmacological hypolipidemic treatments such as adequate nutrition and exercise are positive steps in the treatment of all hypertensive patients. The role of various antihypertensive agents should also be carefully considered. The associations between hypertension, several metabolic abnormalities, development of organ complications and various antihypertensive drugs should be explored in detail.