睾酮联合血府逐瘀片对中老年男性代谢综合征患者血管内皮与勃起功能的影响

目的观察睾酮联合血府逐瘀片对中老年男性代谢综合征(MS)患者血管内皮与勃起功能的影响。方法 86例MS伴勃起功能障碍(ED)患者随机分为研究组(45例,采用十一酸睾酮胶丸联合血府逐瘀片治疗)、对照组(41例,单用十一酸睾酮胶丸治疗),6个月后观察两组治疗前后ED病情分级与IIEF-5评分、血清超敏C反应蛋白(hs-CRP)、一氧化氮(NO)、内皮素(ET)-1水平、血液流变学、性激素与主要糖脂代谢指标的变化情况以及治疗对血尿常规、前列腺特异性抗原(PSA)、国际前列腺症状评分(IPSS)、肝肾功能的影响作用。结果治疗后研究组与对照组IIEF-5评分、ED分级、血清NO、总睾酮(TT)、游离睾酮(FT)、睾酮分泌指数(TSI)、性激素结合球蛋白(SHBG)、高密度脂蛋白胆固醇(HDL-C),血液流变学均不同程度的改善、而甘油三酯(TG)、空腹血糖(FBG)、空腹胰岛素(Fins)、ET-1均不同程度降低(P<0.001或P<0.05),研究组疗效显著优于对照组(P<0.001)。结论睾酮联合血府逐瘀片治疗MS合并ED能明显改善患者TT与FT水平、改善血管内皮功能与勃起功能、改善糖脂代谢降低胰岛素抵抗,减轻患者的慢性炎症状态,未见明显的补充睾酮治疗的副作用。     

内源性睾酮对损伤的血管内皮细胞功能和结构的影响

目的　观察内源性睾酮对球囊损伤的血管内皮功能和结构的影响。方法　 2 0只雄性家兔随机等分为去势组和对照组 ,去势组行去势术 (切除双侧睾丸和附睾 ) ,对照组行相应假手术 ;均于术后 2周行右侧髂动脉内皮剥脱术。观察去势 (或相应假手术 )前和脱内皮术后 1周、2周血浆一氧化氮 (NO)、内皮素 1(ET 1)水平的变化。脱内皮术后 2周将动物处死 ,取损伤血管段 ,应用电镜和HE染色观察血管病理形态的变化。结果　两组间同时间点相比 ,血浆NO、ET 1水平变化差异均无显著性 ,但脱内皮术后 2周去势组血浆NO、ET 1水平可恢复至去势前水平 ,去势组比对照组 ,NO为 (12 5±2 2 ) μmol/Lvs (130± 18) μmol/L(P >0 0 5 ) ,ET 1为 (81± 8)ng/Lvs (75± 2 2 )ng/L(P >0 0 5 )。而对照组与实验前水平仍存在统计学差异 ,NO为 (98± 19) μmol/Lvs (14 1± 2 0 ) μmol/L(P <0 0 5 ) ,ET 1为(91± 9)ng/Lvs (71± 12 )ng/L(P <0 0 5 )。电镜下两组血管内膜均几乎完全被新生内皮覆盖 ,再生血管内皮细胞 (VEC)胞体肥大 ,轮廓模糊 ;光镜观察两组损伤血管的内膜面积和内膜 /中膜面积比值差异无显著性。结论　内源性睾酮水平短时低于生理水平时对VEC再生、新生内膜形成无明显影响 ,但有改善损伤的VEC功能的倾向。     

睾酮对血管内皮细胞表达血栓调节蛋白的影响

目的　观察睾酮对内皮细胞表达血栓调节蛋白的作用。方法　用不同浓度的睾酮 (2、6、10、10 0、30 0、4 0 0μg L)处理传代培养内皮细胞株ECV 30 4细胞 2 4h后 ,用四唑盐比色试验检测细胞活力 ;用酶联免疫吸附法检测上层培养液中的可溶性血栓调节蛋白及细胞总血栓调节蛋白的含量。结果　 2、6、10 μg L的睾酮均促进细胞表达血栓调节蛋白 (2 .89± 0 .96vs1.77± 0 .13,3.0 8± 0 .77vs1.77± 0 .13,2 .72± 0 .4 5vs1.77± 0 .13) ,其中以 6 μg L的睾酮作用最大 ,高浓度的睾酮对血栓调节蛋白的表达没有作用 ,不同浓度的睾酮对可溶性血栓调节蛋白的分泌均没有作用。结论　睾酮促进细胞血栓调节蛋白表达增加 ,可增强细胞的抗凝能力。     

离子通道水平上内皮素缩血管机制的研究进展

９０年代以来，用膜片钳、荧光探针等先进手段，在细胞膜和镶嵌着通道蛋白的人工脂膜上，观察了跨膜的内向离子流和外向离子流。已证明Ｌ型、Ｔ型、Ｎ型电压依赖性钙通道，ＢＫ型钙依赖性钾通道，以及一种钙依赖性非选择性阳离子通道参与内皮素对血管的调控机制。     

糖代谢与睾酮关系的研究进展

<正>众所周知,睾酮对人体生长发育有着至关重要的作用。持续降低的睾酮水平是男性性腺功能减退的标志。研究表明,糖代谢紊乱与性腺功能障碍之间互为因果,关系密切。一方面,糖尿病病人的性腺功能减退发病率很高,其中有48.0%的早发性T2DM男性病人并发性腺功能减退,26.7%的晚发性T2DM男性病人并发性腺功能减退^[1]。另一方面,性腺功能减退也是糖尿病的常见合并症,正常生理水平的睾酮能够发挥维持胰岛素敏感性的作用。胰岛素抵抗是糖尿病发病的关键环节,     

血管损伤修复与炎症反应的研究进展

血管损伤后,内皮细胞、平滑肌细胞以及炎症细胞可以产生多种细胞因子、趋化因子、细胞黏附分子和蛋白水解酶,引起白细胞黏附、血小板的激活和血栓形成,血管平滑肌细胞的增生、迁移和凋亡以及细胞外基质的增生和重构。炎症在血管损伤后内膜增生以及血管成形术和支架置入术后血管再狭窄中起重要作用。本综述主要介绍各种炎症介质在血管损伤修复中的重要作用的新进展。     

血管紧张素原及其与血压关系的研究进展

血管紧张素系统血压最重要的调节系统之一，它由一系列激素及相应的酶组成，通过对血容量和外周阻力的控制调节人体血压和水、电解质平衡。近年来，随着分子生物学技术的发展和对该系统研究的深入，血管紧张素原（ＡＧＴ）越来越受广泛的关注，被认为可能是该系统功能和调...     

血管激素睾酮与心血管疾病

<正>几十年来,睾酮已被医学界认为在前列腺癌和心血管疾病的发展中发挥作用,然而其潜在的心血管治疗作用却普遍被忽视。大量有关前列腺癌患者在抗雄性激素疗法(ADT)中获益,男性运动员因滥用类固醇药物突发心脏性猝死的临床报道,使得睾酮激素被整个医学界误解[1]。最新研究为睾酮平反,雄性激素非但不会增加心血管疾病的     

睾酮对维生素D3和尼古丁诱导的主动脉血管钙化的影响

目的建立SD大鼠血管钙化模型,并观察睾酮在主动脉血管钙化中的作用。方法将10周龄SD雄性大鼠分为:对照组、钙化组、钙化+低剂量睾酮组和钙化+高剂量睾酮组,每组8只。除对照组外,其余三组采用维生素D3(300 k U/kg一次肌肉注射)和尼古丁(25 mg/kg溶于花生油中早、晚各灌胃1次)诱导大鼠血管钙化模型;低剂量睾酮组注射1 mg/kg外源性睾酮(隔日注射1次),高剂量睾酮组注射2 mg/kg睾酮(隔日注射1次),持续8周后处死。采用ELISA法测定大鼠血清睾酮和骨形态发生蛋白4(BMP-4)含量,采用试剂盒检测血管组织钙离子及碱性磷酸酶(ALP)含量,蛋白免疫印迹分析(Western blot)检测主动脉血管组织BMP-4、骨桥蛋白(OPN)的蛋白表达水平,Von Kossa染色法观察血管钙化情况。结果 (1)成功制备了大鼠血管钙化模型:Von Kossa染色可见钙化组大鼠血管中膜大量黑色颗粒样钙盐沉积,而对照组血管结构完好,未见黑色钙盐沉积物。(2)睾酮对血管钙化的影响:睾酮组钙含量、ALP、BMP-4、OPN水平显著低于钙化组(P0.01),且高剂量睾酮组低于低剂量睾酮组,对照组水平最低; Von Kossa染色可见钙化组血管中膜出现大量黑色颗粒样钙盐沉积,而低剂量睾酮组和高剂量睾酮组均见少量钙盐沉积,对照组无钙盐沉积。结论外源性睾酮能一定程度上减轻维生素D3和尼古丁诱导的大鼠血管钙化。     

男性睾酮与血脂代谢相关性及其机制

近年来,与血脂代谢异常相关的疾病,如动脉粥样硬化、冠心病等发病率逐渐升高.目前研究表明,男性睾酮水平与血脂代谢的发生、发展密切相关.男性在中年以后,随着年龄的增长,血清睾酮水平逐渐下降,而其血脂代谢异常的发生率相应增加.因此,低睾酮水平与血脂代谢异常发生率的升高可能存在相关性.但睾酮对血脂代谢的影响及机制尚不十分清楚,仍存在较大争议.     

Relationships of vascular function with measures of ambulatory blood pressure variation

Background

Characteristics of short-term blood pressure (BP) variation may influence cardiovascular disease risk via effects on vascular function.

Objective

In a cross-sectional study of a group of treated hypertensive and untreated largely normotensive subjects we investigated the relationships of measures of short-term BP variation with brachial artery vasodilator function.

Methods

A total of 163 treated hypertensive (n = 91) and untreated largely normotensive (n = 72) men and women were recruited from the general population. Measures of systolic and diastolic BP variation were calculated from 24 h ambulatory BP assessments and included: (i) rate of measurement-to-measurement BP variation (SBP-var and DBP-var); and (ii) day-to-night BP dip (SBP-dip and DBP dip). Endothelium-dependent vasodilation was assessed as flow-mediated dilation (FMD) and endothelium-independent vasodilation was assessed in response to glyceryl trinitrate (GTN). Relationships were explored using univariate and multivariate linear regression.

Results

The relationships of brachial artery vasodilator function with BP variation were not significantly different between treated hypertensive and untreated subjects, therefore these groups were combined for analysis. In univariate analysis, higher SBP-var (P < 0.001) and lower DBP-dip (P = 0.004) were associated with lower FMD; and higher SBP-var (P = 0.002) and lower SBP-dip (P = 0.003) and DBP-dip (P = 0.001) were associated with lower GTN-mediated dilation. In multivariate analysis, lower SBP-dip (P = 0.007) and DBP-dip (P = 0.03) were independently associated with lower GTN response.

Conclusions

Our results indicate that a lower day-to-night BP dip is independently associated with impaired smooth muscle cell function. Although rate of BP variation was associated with measures of endothelial and smooth muscle cell function, relationships were attenuated after accounting for age and BP.     

Association of metabolic syndrome with testosterone and inflammation in men

ObjectiveThere is limited data on the assessment of relationship between sex hormones, metabolic syndrome (MS) and inflammation. Therefore, our objective was to examine the relationship between metabolic syndrome, testosterone and inflammation.Patients and methodsIt was a cross-sectional study which included 309 subjects in the age range of 30–70 years. Blood was analyzed for plasma glucose, serum lipids, total testosterone (TT) and high-sensitivity C-reactive protein (hs-CRP).ResultsThere were 153 patients with metabolic syndrome and 156 without MS according to modified NCEP guidelines. Age, BMI, obesity, dyslipidaemia, smoking (OR = 2.35, CI = 1.35–4.09), LDL-Ch, low TT (OR = 0.76, CI = 0.38–1.52) and elevated hs-CRP (OR = 1.56, CI = 0.87–2.80) were significant independent predictors of MS (all P < 0.05).ConclusionsThe low testosterone and high hs-CRP levels are independent predictors of metabolic syndrome.     

老年男性急性冠脉综合征患者游离睾酮水平与妊娠相关蛋白A及细胞间黏附因子1的关系

目的 观察老年男性急性冠脉综合征( ACS)患者体内游离睪酮水平(FT)与炎症因子妊娠相关蛋白A(PAPP-A)、细胞间黏附因子-1 (ICAM-1)的相关性.方法 采用酶联免疫法检测88例老年男性体内FT与 PAPP-A、ICAM-1,其中ACS患者46例,同年龄健康对照42例.采用多因素逐步回 归方法分析FT与 PAPP-A、ICAM-1的相关性.结果 老年男性ACS患者体内FT低于对照组(P＜0.01),而PAPP-A、ICAM-1分别高于对照组(P＜0.01),FT水平与 PAPP-A、ICAM-1负相关.结论 老年男性ACS患者体内FT与炎症因子PAPP-A、ICAM-1负相关.     

血压变异性与靶器官损害研究进展

目前普遍认为高血压患者平时平均血压与靶器官损害密切相关,同时平均血压也是高血压诊治的重要依据,并且当前的主要临床指南也支持降低平均血压可以减少靶器官损害这一观点。但随着动态血压监测技术的发展,人们对血压波动的研究逐步深入,越来越多的临床研究显示血压变异性是靶器官损害的有效预测因素,且独立于平均压之外。     

内皮功能障碍与脑小血管病

脑小血管病(cerebral small vessel disease,CSVD)是指脑穿支小动脉、毛细血管和小静脉的各种病变导致的临床、认知和病理表现的综合征.CSVD不仅是卒中的主要原因,而且也可导致认知损害和痴呆.大量研究证实,内皮功能障碍在CSVD的发病机制中起着重要作用.文章就内皮功能障碍与CSVD的关系进行了综述,以期对CSVD的病因、发病机制和临床防治提供新的思路.     

MicroRNA及其与心律失常关系的研究进展

MicroRNA(miRNA)是一类调节基因,是内源性非编码、长度为18~22个核苷酸的小分子RNA,在转录后水平调节基因表达发挥重要的生物学作用。近期研究表明,miRNA表达水平的变化与心律失常密切相关,诸如miR-1、miR-133、miR-328、miR-208、miR-21及miR-15等可通过细胞膜离子通道的功能和异常表达引发心律失常,干预和调控miRNA的表达水平,有望为心律失常的诊疗提供一个新靶点。     

老年高血压降压治疗的研究进展

高血压是老年人心脑血管疾病的危险因素,既往高血压防治重点集中在年轻人,对老年人缺乏相关研究,严格降压能否减少心血管疾病和死亡尚存争议,由于高龄相关因素和并发症问题,老年高血压降压治疗仍然存在挑战。本文结合近年老年高血压相关临床试验,对老年高血压的流行病学、临床特点、降压目标值及治疗做一综述,为老年高血压临床治疗提供一定帮助。     

福州城镇男性阻塞性睡眠呼吸暂停低通气综合征患者睾酮水平研究

目的 研究福州城镇男性阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的血清睾酮水平及经鼻持续气道正压通气(nCPAP)治疗对OSAHS患者血清睾酮水平的影响.方法 182例入选者经多导睡眠监测,按年龄分25～45岁、46～65岁两层,再按睡眠呼吸紊乱严重程度进行分组:分别为正常对照组(20例、21例)、单纯性鼾症组(14例、13例)、轻度OSAHS组(21例、17例)、中度OSAHS组(19例、19例)、重度OSAHS组(18例、20例).在多导睡眠监测次晨抽取外周静脉血用电化学发光法测定血清睾酮.对比正常对照组、单纯性鼾症组、OSAHS组间睾酮水平的差异,分析睾酮水平与睡眠呼吸紊乱指数(AHI)、体质量指数(BMI)之间的相关性.开展nCPAP干预实验,对接受/未接受nCPAP治疗的中重度OSANS患者随访3个月,复查多导睡眠监测及血清睾酮指标.结果 ①正常对照组与单纯性鼾症组2组间血清睾酮差异无统计学意义(P值均＞0.05).OSAHS组血清睾酮较正常对照组及单纯性鼾症组低.②睾酮与AHI、BMI、年龄均呈负相关(r=-0.589,P＜0.01;r=-0.225;P＜0.05;r=-0.454,P＜0.01),睾酮与最低SaO2呈正相关(r=0.459,P＜0.01).③中重度OSAHS患者中,接受nCPAP治疗者随访3个月后,血清睾酮水平升高(P＜0.01).未接受nCPAP治疗者随访3个月后,血清睾酮水平无明显变化(P＞0.05).结论 ①OSAHS患者血清睾酮水平低,血清睾酮水平与AHI、BMI呈负相关.②OSAHS患者血清睾酮水平随年龄增加而降低.③nCPAP治疗可改善OSAHS患者血清睾酮水平.

Abstract：

Objective To explore the testosterone levels in Fuzhou urban male patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and impact of nasal continuous positive airway pressure (nCPAP) treatment. Methods Following polysomnographic examination, 182 sbjucts were assigned to 25-45years and 46-65years two groups. Each group consist of:control group(20,21 case), simple snores(14,13case), mild OSAHS(21,17case) ,moderate OSAHS(19,19 case),and severe OSAHS (18,20case). The serum level of testosterone was measured after sleep at the polysomnographic examination night. Of 76 patients with moderate or severe OSAHS, 29 patients who underwent nCPAP therapy were set as "nCPAP group" ,47 patients who did not undergo nCPAP therapy were set as "control group". 10 patients were excluded from further follow-up. The assessment protocol was then repeated after 3 months follow-up. Results ①There were no statistically significant differences of the serum level of testosterone between simple snores and control group. The serum level of testosterone was significantly lower in OSAHS patient. ② Liner regression analysis showed the serum level of testosterone was negatively correlated with AHI, BMI, year( r = -0.589, P ＜0. 01; r = -0.225, P ＜0.05; r = - 0.454, P＜0. 01), testosterone was correlated with SaO2 ( r =0.459, P ＜0.01). ③After 3 months nCPAP therapy in OSAHS patients, the serum level of testosterone was significantly increased ( P ＜ 0.01). While there were no similar changes in OSAHS patients without nCPAP therapy( P >0. 05). Conclusions ①OSAHS patients have lower level of testosterone. The serum level of testosterone was negatively correlated with AHI,BMI. ②As the age older,the serum level of testosterone lower in OSAHS patients. ③The serum level of testosterone could be improved by nCPAP therapy in OSAHS patients.     

Food anthocyanins decrease concentrations of TNF-α in older adults with mild cognitive impairment: A randomized,controlled, double blind clinical trial

Background & aimsVascular function, blood pressure and inflammation are involved in the pathogenesis of major chronic diseases, including both cardiovascular disease (CVD) and mild cognitive impairment (MCI). This study investigated the effects of food anthocyanins on microvascular function, 24-h ambulatory blood pressure (ABP) and inflammatory biomarkers in older adults with MCI.Methods and resultsThirty-one participants with MCI [19 female, 12 male, mean age 75.3 (SD 6.9) years and body mass index 26.1 (SD 3.3) kg/m²], participated in a randomized, controlled, double-blind clinical trial (Australian New Zealand Clinical Trials Registry: ACTRN12618001184268). Participants consumed 250 mL fruit juice daily for 8 weeks, allocated into three groups: a) high dose anthocyanins (201 mg); b) low dose anthocyanins (47 mg); c) control. Microvascular function (Laser Speckle Contrast Imaging combined with a post-occlusive reactive hyperaemia test), 24h ABP and serum inflammatory biomarkers were assessed before and after the nutritional intervention.ResultsParticipants in the high anthocyanins group had a reduction in serum tumor necrosis factor alpha (TNF-α) (P = 0.002) compared to controls and the low anthocyanins group (all P's > 0.05). Serum IL-6, IL-1β, c-reactive protein, and parameters of microvascular function and 24h ABP were not altered by any treatment.ConclusionA daily high dose of fruit-based anthocyanins for 8 weeks reduced concentrations of TNF-α in older adults with MCI. Anthocyanins did not alter other inflammatory biomarkers, microvascular function or blood pressure parameters. Further studies with a larger sample size and longer period of follow-up are required to elucidate whether this change in the immune response will alter CVD risk and progression of cognitive decline.