急性心肌梗塞后左室重构变化的研究

应用二维多普勒超声心动图对６８例急性心肌梗塞（ＡＭＩ）患者的左室重构（ＬＶＲ）变化进行了观察。结果显示，心肌梗塞后ＬＶＲ早期（３～６周）左室舒张末内径（ＬＶＤｄ）、左室舒张末容积（ＥＤＶ）、左室收缩末容积（ＥＳＶ）、左室收缩期最大室壁应力（Ｅｄｂ）、左室收缩末期室壁应力（Ｅｓｂ）、平均室壁应力（ｍｅａｎｂ）、二尖瓣舒张晚期血流速度峰值（ＰＶＡ）、左房张力（ＬＡＴ）、左房射血力（ＬＡＦ）及峰值充盈速度（ＰＦＲ）显著增大（Ｐ＜０．０１－０．００１），射血分数（ＥＦ）、心输出量（ＣＯ）、左室收缩期圆周指数（ＬＶＳＣＩ）、平均周边纤维缩短速率（ＭＶＣＦ）、二尖瓣舒张早期血流速度峰值（ＰＶＥ）及ＰＶＡ／ＰＶＥ显著降低（Ｐ＜０．０１－０．００１）。ＬＶＲ晚期（６－１２个月），ＥＤＶ、ＥＳＶ增加，ＥＦ、ＣＯ及ＬＶＳＣＩ降低（Ｐ＜０．００１）；与ＬＶＲ早期比较，ＰＶＥ、ＰＶＡ及ＬＡＦ无显著性差异（Ｐ＞０．０５）。提示ＡＭＩ后ＬＶＲ的主要病因是梗塞区膨展、左室扩张、容量负荷及室壁应力增加，从而导致心肌梗塞并发症；ＥＳＶ、ＥＤＶ及ＥＦ可作为了解远期ＡＭＩ患者预后的最佳指标。     

高血压左室肥厚的不同构型

高血压544例（男性336）和无高血压的配对组204例（男性106），应用心脏超声法对左室构型进行研究，依据相对室壁厚度、左室质量指数的分布、前室间隔及其基底部肥厚程度。6种左室构型检出率分别为:正常左室构型，男女分别占52％，42%；离心性肥厚占16％，25％，性别差异显著（P＜0.001）；向心性重构，男女各占10%，9％；向心性肥厚7％，8％；非对称性室间隔肥厚及前室间隔基底部肥厚型，分别占7%，9％。研究表明左室构型与年龄、性别、病程及收缩压有一定关系，但左室肥厚类型的形成可能取决于心脏内在因素，向心性肥厚与离心性肥厚之间不一定有依从关系。     

超声观察高血压左室理构的临床意义

应用心脏超声按Ｇａｕａｕ法对８２例高血压患者的左室重构进行观察。结果显示，正常构形３６例，向心性重构６例，向心性肥厚１１例和偏心性肥最２９例。     

高血压病左室结构功能变化及血浆内皮素的相关性

目的：探讨高血压病患者左室结构,功能变化与血浆内皮素（ＥＴ）的关系。方法：原发性高血压不伴左室肥厚（ＬＶＨ）组（ＥＨ）３５例,伴ＬＶＨ组（ＥＨ＋ＬＶＨ）２８例,正常对照组３０例,放射免疫法测定血浆ＥＴ水平,超声心动图检测心脏结构与功能,计算机左室重量指数（ＬＶＭＩ）,平均室壁厚度（ＭＷＴ）,相对室壁厚度（ＲＷＴ）。结果：ＥＨ组及ＥＨ＋ＬＶＨ组血浆ＥＴ高于正常对照组（Ｐ〈０．０１）,ＥＨ＋ＬＶＨ组ＥＴ高于ＥＨ组（Ｐ〈０．０１）。ＥＴ与ＬＶＭＩ,ＭＷＴ室间隔厚度,左室后壁厚度呈正相关（ｒ分别为０．４２４,０．３１６,０．２６８和０．３１７,均Ｐ〈０．０１）,ＥＴ与Ｅ／Ａ呈负相关（ｒ＝－０．３０４,Ｐ〈０．０１）。结论：ＥＴ与高血压和ＬＶＨ相关。     

下壁心肌梗死后左室功能变化临床观察

急性心肌梗死后左心室重构和心功能变化是近年来研究热点,但对临床较常见的下壁心肌梗死研究不多。本文对60例下壁心肌梗死患者分两组(急性与陈旧性)应用彩色多普勒二维超声心动图检查结果进行对照分析,并对其变化规律作初步探讨。 资料与方法 一、研究对象:1996年～1999年住入我院的下壁心肌梗死患者60例,均符合世界卫生组织关于缺血性心脏病的诊断标准,同时除外2次或2次以上     

老年高血压病患者血浆内皮素与左室重量和功能关系的研究

目的探讨老年高血压病患者(EH)血浆内皮素(ET)与左室重量和功能的关系。方法采用放射免疫分析法和多昔勒超声心动图技术检测86例EH患者和57例健康对照者血浆ET的浓度及室间隔(IVST)、左室后壁厚度(PWT)、左室心肌重量指数(LVMI)以及左室流入道E峰和A峰比值(E/A)、E峰加速面积(EAA)。结果EH组ET、IVST、PWT、LVMI显著高于对照组(P值均＜0．01),E/A、EAA显著低于对照组(P＜0．01);EH组ET与IVST、LPWT、LVMI之间均存在着显著正相关(P值均＜0．01),ET与E/A、EAA之间均存在着显著负相关(P值均＜0．01)。结论ET可能是引起EH患者左室肥厚及舒张功能不全的原因之一。     

Oxaceprol is as Effective as Diclofenac in the Therapy of Osteoarthritis of the Knee and Hip

In this multicentre (five centres in Germany), randomised, double-blind, comparative study, 150 patients with painful degenerative joint disease according to EULAR criteria received either oxaceprol (200 mg three times daily) or diclofenac (25 mg three times daily) for 20 days. Joint function, the primary variable, assessed according to Lequesne’s indices, improved equally in both treatment groups to a clinically relevant degree. Joint mobility improved by approximately 60% in both groups. By the end of therapy in both groups, the period of pain-free walking time had more than doubled and subjectively evaluated pain perception (VAS) was reduced by almost 50% without any significant differences between the treatments. The incidence of adverse drug reactions was similar in both groups but oxaceprol induced milder symptoms. Oxaceprol is as effective and better tolerated than diclofenac in the treatment of osteoarthritis. Received: 13 November 1997 / Accepted: 19 June 1998     

Advances in the immunopathophysiology of the idiopathic inflammatory myopathies: Not as simple as suspected

In the past three decades, not much has changed in the pathophysiologic concepts of dermatomyositis and polymyositis. However, in the past couple of years, many changes have occurred reflecting the extremely complex nature of the immune response in general. New pathophysiologic models are needed, but at present, none of them encompasses all the recent findings. The changing concepts of dermatomyositis and polymyositis offer new opportunities for unraveling these diseases and developing better strategies for prevention and treatment. This article discusses the most important developments and their methodologic short-comings.     

Vascular risk factors correlate to the extent as well as the severity of coronary atherosclerosis

BACKGROUND: Because most acute coronary events result from thrombosis at sites of minor plaque, the extent of non-obstructive coronary artery disease (CAD), rather than simply the number of severe stenoses, might be clinically relevant. OBJECTIVE: To examine the relationship between vascular risk factors and a novel extent score for CAD that measures the percentage of the coronary tree involved with atheromatous plaque, as judged by coronary angiography. METHODS: We assessed the extent and severity of CAD and the presence of vascular risk factors of 429 consecutive eligible patients (296 men, aged 61 +/- 11 years) who presented for elective coronary angiography. Detailed analyses of lipid levels were performed for 126 subjects. RESULTS: The mean extent score was 54 (range 0-100). The presence of diabetes (P < 0.001), current or former smoking (P < 0.005) and a history of hypertension (P < 0.001) were all strongly associated with the CAD extent score, as was severity of disease. For the 283 patients with one or no severe stenosis, diabetes was associated with a greater extent score (57 versus 41%, P < 0.005), as was smoking (49 versus 34%, P < 0.005). For the 126 patients with detailed data on lipid levels, extent of coronary artery disease was independently correlated to age (P < 0.005), male sex (P < 0.05), presence of diabetes (P < 0.05), hypertension (P < 0.05), level of lipoprotein (a) (P < 0.005) and low-density:high-density lipoprotein ratio (P < 0.01) in multivariable analysis. CONCLUSIONS: Extent of CAD, as well as its severity, is significantly associated with traditional vascular risk factors. Because most acute coronary events occur at sites of minor plaque, this might explain the mechanism whereby risk factors confer adverse prognostic significance.     

Motility of Lyme disease spirochetes in fluids as viscous as the extracellular matrix

When properties of extracellular fluids that might regulate the ability of the Lyme disease spirochete to locomote were investigated, the rate of progression correlated with viscoelasticity. Such spirochetes flexed and rotated but did not progress in relatively nonviscous fluids and migrated increasingly rapidly as the viscous characteristics of the medium increased. The viscoelastic properties of various kinds of hyaluronic acid resembled those of a methylcellulose standard. The maximum velocity that spirochetes achieved in such solutions related directly to viscoelasticity rather than to chemical composition. Spirochetes remained motile during 3 h of observation despite 100-fold dilution of the standard nutrient medium. The immobility of Lyme disease spirochetes in media less viscous in character than fixed tissue suggests dissemination via the intercellular ground substance of skin.     

Orlistat is as beneficial as metformin in the treatment of polycystic ovarian syndrome

The objective of this study was to evaluate and compare the effect of treatment with orlistat vs. metformin on the hormonal and biochemical features of patients with polycystic ovarian syndrome (PCOS). Twenty-one Caucasian women with PCOS [mean (+/-SEM) age 27 +/- 0.9 yr and body mass index 36.7 +/- 3.3 kg/m(2)] participated in this prospective, randomized, open-labeled study. All subjects had an 8-wk run-in period of dietary modification and then randomized to receive either metformin (500 mg three times daily) or orlistat (120 mg three times daily) for 3 months. Weight, blood pressure, and fasting blood samples were taken at screening, randomization, and on completion. Insulin resistance (IR) was calculated using the homeostasis model of assessment (HOMA)-IR method [HOMA-IR = (insulin x glucose)/22.5]. The results are expressed as mean +/- SEM. When compared with baseline, treatment with both orlistat [93.5 +/- 11.5 ng/dl (3.24 +/- 0.4 nmol/liter) vs. 114.5 +/- 11.5 ng/dl (3.97 +/- 0.4 nmol/liter), P = 0.039] and metformin [97.2 +/- 11.5 ng/dl (3.37 +/- 0.4 nmol/liter) vs. 120.0 +/- 8.7 ng/dl (4.16 +/- 0.3 nmol/liter), P = 0.048] produced a significant reduction in total testosterone. Treatment with orlistat produced a 4.69% reduction in weight (99.0 +/- 6.0 vs. 94.6 +/- 6.1 kg, P = 0.002), and this reduction was more significant than the reduction produced by metformin (4.69 vs. 1.02%, P = 0.006). There was no significant reduction seen after either treatment group for fasting insulin, HOMA-IR, SHBG, or any of the lipid parameters studied. In this study, orlistat produced a significant reduction in weight and total testosterone. The reduction in total testosterone was similar to that seen after treatment with metformin. Therefore, orlistat may prove to be a useful adjunct in the treatment of PCOS.