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高血压是心血管疾病的独立危险因素。单纯舒张期高血压(IDH),是指在标准状态下测量的收缩压<140 mmHg,同时舒张压≥90 mmHg。高血压分为三种亚型:单纯收缩期高血压(ISH)、单纯舒张期高血压(IDH)、收缩期合并舒张期高血压(SDH)。单纯舒张期高血压是一种发生率相对较低的高血压类型。然而近年来一些大型临床研究发现IDH与ISH、SDH一样已经成为心血管事件发生的独立危险因素。因此IDH越来越受到重视,了解掌握IDH的特点及治疗措施已经成为降压治疗及预防心血管疾病的重要组成部分。     

我国临床医学发展现状与展望(七)——我国消化病学的发展现状(下)

六、胃肠运动功能当前国际上对胃肠运动功能的研究已取得重大进展,检测方法已获认可,通过大量动物实验,已开始应用于临床。食管、胃、肠等腔内压力曲线、各     

血清脂蛋白(a)、胆红素水平与冠状动脉病变程度关系研究

目的 检测冠心病(CHD)患者的血清脂蛋白(a)和胆红素水平,并探讨其与CHD的关系.方法 对196例疑诊冠心病而接受冠状动脉造影的患者检测血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白(a)[Lp(a)]、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL).根据冠状动脉狭窄情况分为非冠心病组(冠状动脉狭窄小于50%,52例)、单支病变组(仅有一支冠状动脉分支狭窄大于或等于50%,53例)和多支病变组(有一支以上冠状动脉分支狭窄大于或等于50%,91例).分析影响冠状动脉病变的相关因素及冠状动脉病变程度与血脂、胆红素的关系.结果 各组间LDL-C、Lp(a)水平依次呈递增趋势,差异有统计学意义(P＜0.05)各组间间接胆红素水平呈依次递减趋势,多支病变组与非冠心病组、单支病变组差异有统计学意义(P＜0.05).单因素logistic回归结果表明血清脂蛋白(a)、间接胆红素均为影响冠状动脉病变的因素(回归系数分别2.125、-1.557,P＜0.01).进一步多因素logistic回归分析表明脂蛋白(a)对冠状动脉病变的影响要弱于低密度脂蛋白胆固醇、甘油三酯(0R值分别为1.238、5.031、3.996,95%CI分别为1.069-6.322、2.457-12.356、2.785-14.764).结论 血清Lp(a)水平升高、IBIL水平降低是CHD发病及病变程度的危险因素. Abstract： Objective To investigate the association of Lipoprotein (a) and bilirubin with coronary heart disease(CHD). Methods One hundred and ninty -six patients undergone coronary angiography and completed clinical examination of TC, TG, HDL - C, LDL - C, Lp ( a), TBIL, DBIL, IBIL were divided into the without coronary diseases group ( coronary artery stenosis ＜50% ,52 cases) ,the single vessel disease group(with only one vessel stenosis ≥50% ,53 cases) and the multi -vessel disease group (with more than one vessel stenosis ≥50% ,91 cases)according to the coronary angiographic results. The correlative factors of coronary lesion and the relationship between Lipid,bilirubin and the severity of coronary lesion were analyzed. Results Higher levels of LDL - C and Lp(a) were found in the single vessel disease group and in the multi -vessel disease group compared with the without coronary disease group, significant difference was found in the LDL- C and Lp(a) level among the 3 groups(P＜0.05). The levels of IBIL were lower in the single vessel disease group and in the multi -vessel disease group compared with the without coronary disease group,significant difference was found in indirect bilirubin level in the multi -vessel disease group compared with in the without coronary disease group and in the single vessel disease group(P＜0.05). Single factor logistic regression showed that Lp (a) and indirect bilirubin are both correlation factors with coronary lession (r =2. 125 and - 1. 557, P ＜0.01 respectively). Advanced multi - factor logistic regression showed weaker correlation of Lp (a) with coronary lesion compared with LDL - C and TG (OR = 1. 238,5.031 and 3.996,95% CI1.069 - 6.322,2.457 - 12.356,2.785 - 14.764 respectively). Conclusions High level of Lp(a) and Low level of IBIL in human significantly influence the severity of coronary heart disease(CHD).     

探讨血清视黄醇结合蛋白4与冠心病的相关性

目的 观察冠心病患者血清视黄醇结合蛋白4(RBP4)水平,并探讨RBP4与冠心病的关系.方法 64例冠心病患者分为急性心肌梗死(AMI)组10例,不稳定型心绞痛(UAP)组42例,稳定型心绞痛(SAP)组12例,另选择21例冠状动脉造影结果正常者为对照组.采用酶联免疫吸附法(ELISA)测定血清RBP4水平.结果 血清RBP4在AMI和UAP组中高于SAP组和对照组,差异有统计学意义(P＜0.05),在SAP组与对照组之间差异无统计学意义(P＞0.05);血清RBP4在单支、双支、三支病变组中均高于对照组(P＜0.05),但在单支、双支与三支病变组之间差异均无统计学意义(P＞0.05).结论 RBP4可作为预测斑块稳定性的标志物,为冠心病危险分层及采取积极干预措施提供依据,但不能反映冠状动脉狭窄程度及范围. Abstract： Objective To investigate the serum retinol - binding protein 4 ( RBP 4 ) of coronary heart disease (CHD)patients and evaluate whether plasma macrophage migration inhibitory factor were associated with CHD. Methods Sixty -four patients with CHD were divided into the acute myocardial infarction (AMI) group ( n = 10), the unstable angina pectoris (UAP) group ( n = 42) and the stable angina pectoris(SAP) ( n = 12),21 normal subjests without CHD diagnosed by CAG served as the control group. The serum level of RBP4 measured by enzyme linked immune sorbent assay (ELISA). Results The serum level of RBP4 were higher in AMI and UAP group thai in SAP group and control group ( P ＜ 0. 05 ). The mean level of RBP4 in SAP group was not differently significantly, compared with that in control ( P ＞ 0. 05 ) ;The mean level of in single, double and three vessel lesion group were higher than that in control group (P ＜0. 05 ),but the serum levels of RBP4 among single, double and three were not significant different ( P ＞ 0. 05).Conclusions RBP4 may act as one of vulnerable plaques,we can take active to stabilize vulnerable plaques and decrease the occurrence of cardiac events,but may not reflect the severity of artery stenosis.     

压力困扰量表的编制

目的:编制能够可靠有效测量应激反应的类别和强度的压力困扰量表。方法:依据心理应激理论和相关测量工具编写项目库,对466名受试者的初测数据进行项目分析和探索性因素分析,确定量表的项目和维度。对另外466名受试者施测正式量表和校标量表,检验量表的信度和效度。结果:压力困扰量表由59个项目组成,包括抑郁、敌对、躯体化和焦虑4个维度;各维度及量表总的α系数分别为0.95、0.87、0.88、0.83、0.97。压力困扰量表和中国大学生心理应激量表、压力自评量尺的相关系数分别为0.26、0.35(P0.01)。结论:本研究编制的压力困扰量表具有令人满意的心理测量学特征,可以用于有关的研究和临床实践中。     

Buri父母权威问卷的中文修订

目的:对Buri1991年编制的父母权威问卷(Parental Authority Questionnaire,PAQ)进行中文修订和信效度检验。方法:研究用翻译的PAQ,先后测量了726名大学生,55名大学生在一个月后进行了重测。部分被试填写了父母养育方式量表,作为效标效度检验。结果:中文修订的PAQ由三个因素组成。母亲版(PAQ-M)各维度内部一致性系数为0.655～0.869,重测信度为0.621～0.822。父亲版(PAQ-F)各维度的内部一致性系数为0.653～0.862,重测信度为0.600～0.755。验证性因素分析的结果证实了PAQ中文版的三因素模型,相关分析的结果表明问卷有较好的效标效度。结论:修订后的中文版PAQ的信效度达到心理测量学的标准,可以满足国内有关研究的需要。     

螺内酯对心肌梗死大鼠血流动力学及血清TGF-β1的影响

目的 研究螺内酯对大鼠心肌梗死后血清转化生长因子-β1(TGF-β1)的影响.方法 结扎SD大鼠冠状动脉前降支,建立心肌梗死模型,将术后存活24 h大鼠随机分为两组:螺内酯(MIS)组给予螺内酯20 mg/(kg·d)溶于2 ml生理盐水灌胃,连续4周;心肌梗死(MI)对照组给予等体积的生理盐水,穿针但不结扎前降支的作为假手术组,给予等体积的生理盐水,4周末行血流动力学测定,同时断尾取血测血清TGF-β1含量.结果 与假手术组相比,4周末AMI组血清TGF-β1含量显著升高(P＜0.01),左室舒张末压(LVEDP)显著增加(P＜0.01),左室内压最大收缩速率(+dp/dtmax)显著下降(P＜0.01).与AMI组相比,4周末螺内酯组血清TGF-β1含量显著下降(P＜0.01),LVEDP显著下降(P＜0.01),而+dp/dtmax显著增加(P＜0.01).结论 螺内酯可能通过抑制TGF-β1产生而改善心功能,抑制心肌纤维化. Abstract： Objective To observe the effects of aldactone on blood serum TGF - β1 in acute myocardial infarction rats. Methods Rats surviving 24 h after AMI induced by left anterior descending branch ligation were randomized to aldactone and control group compared with sham - operated group. The aldactone group was given aldactone 20 mg/( kg · d) , the MI control group and sham -operated group were given an equal volume of saline, continued for 4 weeks. At the end of 4th week,the hemodynamics change was detected, then tails to take blood and measure the serum TGF - β1.Results Compared with the sham - operated rats,the serum TGF - β1 level and the LVEDP of the AMI rats were significantly elevated at the end of the 4th week ( P ＜0.01 ) , while the + dp/dtmax were significantly reduced ( P ＜0.01 ) compared with the AMI control group, the serum TGF - β1 level and the LVEDP of the aldactone group rats decrease significantly at the end of the 4th week (P ＜ 0.01 ) ,while the + dp/dtmax were significantly elevated ( P ＜ 0.01 ). The difference had statistical significance. Conclusions Aldactone may improve the cardiac fibrosis and inhibit myocardial fibrosis by inhibiting the production of the TGF - β1.     

原发性高血压患者胰岛素抵抗与血管紧张素Ⅱ的相关性

目的 探讨原发性高血压(EH)患者胰岛素抵抗与血管紧张素Ⅱ(AngⅡ)、左室重构的相关性.方法 收集120例EH患者,根据HOMA-IR公式计算的胰岛素抵抗指数将其分为两组:胰岛素抵抗组(IR)、非胰岛素抵抗组(N-IR),测量并比较两组间电解质、血脂、血肌酐清除率、AngⅡ、左室射血分数、左室质量指数(LVMI)水平.结果 LVMI、AngⅡ水平IR组均明显高于N-IR组(P＜0.05).结论 EH患者胰岛素抵抗与血AngⅡ水平有关,并可能与左室重构有关. Abstract： Objective To investigate the relationship between insulin resistance and angiotensin Ⅱ , the left ventricular remodeling in patients with essential hypertension(EH). Methods According to the insulin resistance index, 120 cases of EH were divided into two groups: insulin resistance group (IR), non- insulin resistant group (N-IR). And the electrolyte, blood lipids, creatinine clearance rate, Ang Ⅱ , left ventricular ejection fraction and left ventricular mass index (LVMI) were measured and the results were compared between the two groups. Results LVMI and Ang Ⅱ levels of IR group were significantly higher than those of N - IR group ( P ＜ 0.05). Conclusions Insulin resistance is related with the levels of Ang Ⅱ , and may be related with left ventricular remodeling.