慢性阻塞性肺疾病患者脑梗死后血清同型半胱氨酸和叶酸及维生素B12水平研究

目的研究慢性阻塞性肺疾病(COPD)患者脑梗死后血浆同型半胱氨酸、叶酸和维生素B12的水平。方法 100例急性脑梗死患者按是否合并COPD分为COPD组45例和非COPD组55例,另选取同期52例体检健康者作为对照组。检测3组受检者血浆同型半胱氨酸、叶酸和维生素B12水平。结果 COPD组和非COPD组同型半胱氨酸水平高于对照组,COPD组同型半胱氨酸水平高于非COPD组,差异有统计学意义(P<0.05);COPD组叶酸、维生素B12水平低于对照组和非COPD组,差异有统计学意义(P<0.05)。结论 COPD患者存在高同型半胱氨酸,在脑梗死发病中起重要作用,通过补充叶酸、维生素B12可以降低同型半胱氨酸水平,减少COPD患者脑梗死的发生。     

Vitamin B12 and Folic Acid Metabolism in Hookworm-Infected Patients

Studies on the metabolism of B₁₂ and folic acid were performed inpatients with heavy hookworm infection and severe iron deficiency anemia,and in patients with light infection, noninfected patients and normal subjects.

Patients with heavy hookworm infection showed a marked decrease ofthe serum B₁₂ as compared with normal subjects. Eight of 21 cases studiedshowed values of serum B₁₂ below 100 µµg./ml.

Twelve of 13 patients with severe hookworm infection showed impairmentof the pteroylglutamic acid intestinal absorption; however, none of themexhibited megaloblastic proliferation in the bone marrow. They all recoveredwith iron therapy alone. The patients with light infection and the noninfected patients with iron deficiency anemia did not demonstrate significantdifferences from the normal subjects studied.

Submitted on January 19, 1959 Accepted on May 10, 1959     

Cardiovascular Disease Morbidity and Mortality in Patients with Type 1 Diabetes Mellitus

There is an increased risk of cardiovascular disease (CVD) mortality and morbidity in patients with type 1 diabetes mellitus compared with the general population as shown by epidemiologic studies measuring cardiovascular endpoints, as well as by autopsy, angiographic, and coronary calcification studies. Most of the excess CVD risk associated with type 1 diabetes is concentrated in the subset of approximately 35% of patients who develop diabetic nephropathy (after 20 years of diabetes duration), who also typically have dyslipidemias, elevated blood pressure, and hyperglycemia, factors contributing to CVD. For reasons that remain speculative, the relative risks from CVD are higher in women than in men with type 1 diabetes compared with the general population, which effectively eliminates the gender differences in CVD. As in the general population and in patients with type 2 diabetes, education and lifestyle changes, interventions to reduce hyperglycemia, blood pressure, micro-albuminuria, lipid control, and the use of aspirin are important management areas in order to reduce the increased risk of CVD. Whether management with aspirin and statins should be started in type 1 diabetic patients at a younger age or at a lower risk score than in the general population is still under investigation. There is a need for a better understanding of the pathophysiology of vascular complications in type 1 diabetes, more specific risk engines in type 1 diabetes, and accurate estimations of the absolute and relative risk for CVD in order to improve management of CVD in these high-risk patients.     

叶酸及维生素B6对冠心病患者血浆同型半胱氨酸的影响

观察叶酸合用或不同合用维生素Ｂ６对冠心病患者空腹血浆同型半胱氨酸（Ｈｃｙ）的作用差别。５９例血浆同型胱氨酸增高的冠心病患者随机分为３组：１．对照组（２０例）：不同服叶酸等影响血浆同型半胱氨酸的药物;２．叶酸组（２１例）;每天服用５ｍｇ叶酸;３．叶酸合用维生素Ｂ６组（１８例）;每天服用５ｍｇ叶酸及６０ｍｇ维生素Ｂ６。观察或服药１０天后复查血浆同型半胱氨酸水平。服用叶酸５ｍｇ及叶酸５ｍｇ加维生素Ｂ６６     

2型糖尿病和动脉粥样硬化性心血管病的关系

动脉粥样硬化性心血管病是2型糖尿病患者死亡和残疾的主要原因,2型糖尿病患者发生动脉粥样硬化病变的风险显著高于非糖尿病患者。虽然目前关于2型糖尿病与动脉粥样硬化发生和发展之间的关系尚未完全阐明,但大量基础与临床研究已证实二者之间存在密切的内在联系。现有研究提示,2型糖尿病患者发生动脉粥样硬化病变的机制可能涉及高血糖、胰岛素抵抗、血管钙化、氧化应激、内皮功能障碍和炎症反应等。结合近年来最新的研究结果,现总结分析2型糖尿病与动脉粥样硬化性心血管病之间的潜在联系与可能机制。     

Novel Biomarkers for Predicting Cardiovascular Disease in Patients With Diabetes

It is generally acknowledged that patients with diabetes comprise a high-risk population for the development of cardiovascular disease. However, it is perhaps less well recognized that there actually exists considerable heterogeneity in vascular risk within this patient population, with a sizable subset of individuals seemingly at low risk for major cardiovascular events despite the presence of diabetes. Because traditional clinical risk calculators have shown wide variability in their performance in the setting of diabetes, there exists a need for additional risk predictors in this patient population. In this context, there has been considerable interest in the potential utility of circulating biomarkers as clinical tools that might facilitate risk stratification and thereby guide therapeutic and preventative decision-making. Coupled with the current era of dedicated cardiovascular outcome trials in type 2 diabetes, this interest has spawned a growing literature of recent studies that evaluated potential biomarkers. To date, these studies have identified N-terminal pro-B-type natriuretic peptide, high-sensitivity cardiac troponins, and growth differentiation factor-15 as cardiovascular biomarkers of particular potential in patients with diabetes. Furthermore, recognizing the potential benefit of collective consideration of different biomarkers reflecting distinct pathophysiologic processes that might contribute to the development of cardiovascular disease, there is emerging emphasis on the evaluation of combinations of biomarkers for optimal risk prediction. Although not currently ready for clinical practice, this rapidly-growing topic of biomarker research might ultimately facilitate the goal of individualized risk stratification and thereby enable truly personalized management of diabetes.     

Folic Acid Therapy and Cardiovascular Disease in ESRD or Advanced Chronic Kidney Disease: A Meta-Analysis

Summary

Background and objectives

The efficacy of folic acid therapy to lower homocysteine (Hcy) levels in an effort to reduce cardiovascular disease (CVD) risk in patients with ESRD or advanced chronic kidney disease (ACKD; creatinine clearance, <30 ml/min) remains inconclusive. We conducted a meta-analysis of relevant randomized trials to further examine this issue.

Design, setting, participants, & measurements

This meta-analysis included 3886 patients with ESRD/ACKD from seven qualified randomized trials using folic acid therapy and with CVD reported as one of the end points.

Results

When pooling the seven trials, folic acid therapy reduced the risk of CVD by 15% (RR, 0.85; 95% CI, 0.76 to 0.96; P = 0.009). A greater beneficial effect was observed among those trials with a treatment duration >24 months (RR, 0.84; 95% CI, 0.72 to 0.98; P = 0.02), a decrease in Hcy level >20% (RR, 0.83; 95% CI, 0.73 to 0.95; P = 0.007), and no or partial folic acid fortification (RR, 0.80; 95% CI, 0.65 to 0.99; P = 0.04). The beneficial effect also was seen when Hcy levels decreased >20%, even in the presence of folic acid fortification (RR, 0.85; 95% CI, 0.73 to 0.99; P = 0.04). In the corresponding comparison groups, the estimated RRs were attenuated and insignificant.

Conclusions

Folic acid therapy can reduce CVD risk in patients with ESRD/ACKD by 15%. A greater beneficial effect was observed among those trials with no or partial folic acid fortification or a decrease in Hcy level >20% regardless of folic acid fortification.     

二甲双胍对2型糖尿病患者血浆同型半胱氨酸水平的影响

目的探讨二甲双胍对2型糖尿病患者血浆总同型半胱氨酸水平的影响。方法采用高效液相荧光检测的方法测定30例健康对照者3、0例2型糖尿病患者及服二甲双胍(0.75~1.00 g/天)治疗3个月后的糖尿病患者血浆总同型半胱氨酸的水平。结果2型糖尿病患者血浆总同型半胱氨酸水平(14.1±5.7μmol/L)高于对照组(9.5±3.4μmol/L,P<0.01),并且总同型半胱氨酸水平与年龄、体质指数、空腹血糖和空腹胰岛素明显正相关(P<0.05),与胰岛素敏感指数呈负相关。二甲双胍治疗3个月后,血浆总同型半胱氨酸水平(11.6±4.7μmol/L)比治疗前降低(P<0.05)。结论2型糖尿病患者血浆总同型半胱氨酸水平增高,二甲双胍治疗后可降低血浆总同型半胱氨酸水平。     

收缩压,舒张压,脉压在糖尿病并高血压病人肾脏损害中的意义

目的研究2型糖尿病及高血压病患者脉压(PP)与尿微量白蛋白(UmAlb)的关系,为早期防治肾脏损害提供临床依据.方法对271例患者1, 2型糖尿病患者(DM)87例、高血压病患者(EH)85例和2型糖尿病合并高血压病患者(DM+EH)99例进行血压检测和UmAlb测定.结果 DM组UmAlb与收缩压(SBP)和舒张压(DBP)相关性不显著(P>0.05);而与PP显著正相关(P<0.05).EH组UmAlb与SBP和PP呈显著正相关(P<0.05),而与DBP相关性则不显著(P>0.05);EH+DM组UmAlb与SBP、DBP、PP均呈显著正相关(P<0.01及0.05).UmAlb与PP相关的显著性在EH+DM组中最大,r=0.282,P=0.002,三组患者中反映肾功能的其他指标则与SBP、DBP和PP无相关性.结论在上述3种病人中只有PP总是与早期肾损害相关.因此,为防止DM和EH患者肾脏损害加重,降低PP甚为重要.     

抵抗素、超敏C反应蛋白及血脂水平与2型糖尿病并发心血管病变的相关性研究

目的观察血清抵抗素、超敏C反应蛋白(hs-CRP)及血脂在2型糖尿病(T2DM)并发心血管病变患者中水平的变化及其相关关系。方法选择单纯T2DM组50例,T2DM合并心血管病变组50例,分别测定血清抵抗素、hs-CRP及血脂等指标,以5 0名健康人作正常对照。结果 T2 DM合并心血管病变组血清抵抗素和hs-CRP水平分别为(1 6.9 9±7.1 3)ng/mL、(4.9 7±2.88)mg/L,高于单纯T2DM组的(12.98±6.15)ng/mL、(3.61±1.49)mg/L,且均明显高于对照组的(9.32±4.46)ng/mL及(1.34±0.95)mg/L,3组两两比较差异有统计学意义(P<0.01)。T2DM组血脂水平除高密度脂蛋白胆固醇降低外,其余均比对照组明显升高(P<0.01),而T2DM组之间比较无统计学意义(P>0.05)。T2DM合并心血管病变组血清抵抗素水平与hs-CRP呈正相关(r=0.304,P<0.05),而与血脂水平无相关性(P>0.05)。结论血清抵抗素及hs-CRP可能作为炎症因子参与T2DM并发心血管病变发病机制,动态检测及时干预,可能有助于控制血管并发症的发生、发展。     

Postprandial Lipoproteins and Cardiovascular Disease Risk in Diabetes Mellitus

Diabetes mellitus is associated with increased risk for atherosclerotic cardiovascular disease (CVD). Recent prospective studies in healthy individuals suggest that the postprandial triglyceride (TG) level is a better independent predictor for assessing future CVD events than fasting TG levels. In contrast, results have been more controversial among diabetic patients, as some studies report a positive association between postprandial TG and CVD. This raises the issue of to what extent postprandial TG levels may be of predictive value in the diabetic population. One possibility impacting on the predictive power of postprandial TG in identifying CVD risk may be the presence of other risk factors, including alterations in lipid and lipoprotein metabolism, which could make it more difficult to identify the impact of postprandial lipemia on cardiovascular risk. The findings provide a challenge to develop a better approach to assess the impact of postprandial lipemia on CVD risk under diabetic conditions.     

对原发性高血压伴缺血性脑卒中患者血浆同型半胱氨酸水平的临床观察

目的 :探讨叶酸、维生素B6、腺苷辅酶维生素B12 对原发性高血压伴缺血性脑卒中患者血浆同型半胱氨酸 (Hcy)水平的影响。方法 :血浆Hcy水平增高的缺血性脑卒中住院患者 70例分为干预组 (n =3 5 )和对照组 (n =3 5 )。干预组口服叶酸10mg/d ,维生素B610mg/d ,腺苷辅酶维生素B12 5 0 0 μg/d 4周。对照组未服用上述药物。入院时及 4周后采用高压液相色谱法 (HPLC)测定血浆Hcy含量。结果 :干预组在实施叶酸、维生素B6、腺苷辅酶维生素B12 干预 4周后 ,血浆Hcy水平下降 ,与对照组相比有显著性差异 (P <0 0 5 )。两组患者 4周前后血浆Hcy水平的变化差值具有极显著性差异 (P <0 0 0 1)。结论 :口服叶酸、维生素B6、腺苷辅酶维生素B12 可使原发性高血压伴缺血性脑卒中患者血浆Hcy水平下降