老年人高血压的诊断与治疗进展

老年人高血压有其独特的临床特点，如单纯收缩期高血压较多见、血压波动范围较大、直立性低血压较多见、并发症多且多种疾病并存，以及可能存在假性高血压等。年龄≥60岁；连续3次非同日测量血压，收缩压≥140 mmHg（1 mmHg＝0.133 kPa)和（或）舒张压≥90 mmHg(老年人单纯收缩期高血压指收缩压≥140 mmHg，舒张压＜90 mmHg）；排除假性和继发性高血压者可诊断为老年人高血压。该病的治疗包括非药物治疗和药物治疗。非药物治疗包括减体重、合理膳食、适当体力活动和运动、保持心理平衡、戒烟等。主要降压药物包括利尿药、β-受体阻滞药、钙拮抗药、ACEI、血管紧张肽Ⅱ（AngⅡ）受体阻滞药和α 受体阻滞药六大类。     

肺炎衣原体通过上调酰基辅酶A:胆固醇酰基转移酶1诱导人单核细胞株THP-1源性泡沫细胞形成的实验研究

Objective To investigate the expression changes of acyl-coenzyme A: cholesterol acyhransferase 1 (ACAT1) on Chlamydia pneumoniae (C. pn) induced foam cell formation. Methods Human monocytic cell line (THP-1) was induced into macrophages by 160 nmol/L phorbol myristate acetate (PMA)for 48 h, and were randomly allocated into four groups: negative control group (50 μg/ml LDL for 48 h) ; positive control group (50 μg/ml ox-LDL for48 h) ; C. pn infection group (50 μg/ml LDL plus 1× 105,4×105,5×105and 1×106 IFU C.pn for 48 h or 1×106 IFU C.pn for 0,24,48 and 72h); ACAT inhibitor 58-035 plus C. pn infection group (1, 5, 10 μg/ml ACAT inhibitor 58-035 pretreatment for 1 h,50 μg/ml LDL and 1 × 106 IFU C. pn for 48 h). The mRNA and protein expressions of ACATI were determined by RT-PCR and Western blot, respectively. Lipid droplets in cytoplasm were observed by oil red 0 staining. The contents of intracellular cholesteryl esters were detected by enzyme-fluorescence. Results The mRNA and protein expressions of ACATI were significantly up-regulated in positive control cells compared those in negative control cells and further upregulated by C. pn infection in a time-dependent and concentration-dependent manner (all P ＜ 0.05). There were significantly increases in the accumulation of lipid droplets and the ratio of cholesteryl ester to total cholesterol in positive control cells as compared with negative control cells and these were further aggravated by C. pn (at the concentrations of 5× 105 and 1×106IFU for 48 h) and C. pn infection induced increases in the accumulation of lipid droplets and the ratio of cholesteryl ester to total cholesterol could he significantly attenuated by ACAT inhibitor 58-035 (all P ＜ 0.05). Conclusion Chlamydia pneumoniae induces THP-1-derived foam cell formation by up-regulating the expression of ACATI.     

肺炎衣原体通过上调酰基辅酶A:胆固醇酰基转移酶1诱导人单核细胞株THP-1源性泡沫细胞形成的实验研究

Objective To investigate the expression changes of acyl-coenzyme A: cholesterol acyhransferase 1 (ACAT1) on Chlamydia pneumoniae (C. pn) induced foam cell formation. Methods Human monocytic cell line (THP-1) was induced into macrophages by 160 nmol/L phorbol myristate acetate (PMA)for 48 h, and were randomly allocated into four groups: negative control group (50 μg/ml LDL for 48 h) ; positive control group (50 μg/ml ox-LDL for48 h) ; C. pn infection group (50 μg/ml LDL plus 1× 105,4×105,5×105and 1×106 IFU C.pn for 48 h or 1×106 IFU C.pn for 0,24,48 and 72h); ACAT inhibitor 58-035 plus C. pn infection group (1, 5, 10 μg/ml ACAT inhibitor 58-035 pretreatment for 1 h,50 μg/ml LDL and 1 × 106 IFU C. pn for 48 h). The mRNA and protein expressions of ACATI were determined by RT-PCR and Western blot, respectively. Lipid droplets in cytoplasm were observed by oil red 0 staining. The contents of intracellular cholesteryl esters were detected by enzyme-fluorescence. Results The mRNA and protein expressions of ACATI were significantly up-regulated in positive control cells compared those in negative control cells and further upregulated by C. pn infection in a time-dependent and concentration-dependent manner (all P ＜ 0.05). There were significantly increases in the accumulation of lipid droplets and the ratio of cholesteryl ester to total cholesterol in positive control cells as compared with negative control cells and these were further aggravated by C. pn (at the concentrations of 5× 105 and 1×106IFU for 48 h) and C. pn infection induced increases in the accumulation of lipid droplets and the ratio of cholesteryl ester to total cholesterol could he significantly attenuated by ACAT inhibitor 58-035 (all P ＜ 0.05). Conclusion Chlamydia pneumoniae induces THP-1-derived foam cell formation by up-regulating the expression of ACATI.     

阿托伐他汀对自发性高血压大鼠血压和心肌血管紧张素Ⅱ1型和2型受体表达的影响

目的　观察阿托伐他汀对自发性高血压大鼠血压和心肌血管紧张素Ⅱ受体 1和血管紧张素Ⅱ受体 2的调节作用。方法　采用免疫组织化学染色法检测心肌血管紧张素Ⅱ受体 1和血管紧张素Ⅱ受体 2蛋白表达 ,原位杂交法测定心肌血管紧张素Ⅱ受体 1和血管紧张素Ⅱ受体 2mRNA表达水平。于给药前和给药后每两周测量大鼠尾动脉收缩压 ,并测定血清总胆固醇、甘油三酯、高密度脂蛋白胆固醇及低密度脂蛋白胆固醇水平。结果　实验前自发性高血压大鼠各组收缩压均显著高于Wistar kyoto大鼠组 (P <0 .0 1)。给药后第 4周和第 6周 ,5 0mg阿托伐他汀组收缩压明显下降 (P <0 .0 1) ,总胆固醇、甘油三酯及低密度脂蛋白胆固醇水平明显降低 (P <0 .0 5 ,P <0 .0 1) ;自发性高血压大鼠对照组心肌血管紧张素Ⅱ受体 1和血管紧张素Ⅱ受体 2蛋白阳性表达及其mRNA表达均明显高于Wistar kyoto大鼠组 (P <0 .0 1) ,6周后 ,5 0mg阿托伐他汀组血管紧张素Ⅱ受体 1蛋白和其mRNA表达明显降低 (P <0 .0 1) ,而血管紧张素Ⅱ受体 2蛋白和其mRNA表达明显高于自发性高血压大鼠对照组 (P <0 .0 1)。结论　阿托伐他汀能降低自发性高血压大鼠的血压 ,并对心肌血管紧张素Ⅱ受体有双重调节作用 ,即使血管紧张素Ⅱ受体 1下调、血管紧张素Ⅱ受体 2上调     

高脂血症患者LDL氧化易感性及调脂药物干预的影响

目的观察高脂血症对LDL氧化易感性的影响以及调脂药物干预后的改变.方法应用短程密度梯度超速离心分离血浆LDL,对11例高甘油三酯血症患者口服微粒化非诺贝特200 mg/d、10例高胆固醇血症患者口服普伐他汀10 mg/d治疗4周前后和6例正常人的LDL在体外以CuCl2诱导氧化,测定LDL开始氧化的迟滞期和氧化速率.结果 (1)LDL氧化的迟滞期,在高甘油三酯血症患者和高胆固醇血症患者均较正常组明显缩短(43.8±11.6,40.8±10.7 vs 70.5±14.6 min, P均<0.01).(2)LDL的氧化速率,在高甘油三酯血症患者和高胆固醇血症患者均较正常组明显增快(0.036±0.004,0.031±0.011 vs 0.020±0.011 O.D./min,P均<0.05).(3)高甘油三酯血症患者给微粒化非诺贝特治疗后LDL氧化的迟滞期显著延长(62.4±5.0 min,P<0.01),氧化速率明显减慢(0.031±0.003 O.D./min,P<0.05).(4)高胆固醇血症患者于普伐他汀治疗后LDL氧化的迟滞期明显延长(58.8±6.1 min,P<0.05),氧化速率无显著性变化(0.025±0.009 O.D./min,P>0.05).结论高甘油三酯血症患者和高胆固醇血症患者LDL氧化易感性增高,微粒化非诺贝特和普伐他汀能够降低高甘油三酯血症患者及高胆固醇血症患者LDL的氧化易感性.     

静脉注射心钠素对充血性心力衰竭患者的临床及血流动力学影响

本文报告2例充血性心力衰竭患者经静脉注射心钠素后在临床及血流动力学方面的影响。结果显示心钠素可明显降低充血性心力衰竭患者的肺毛嵌压,并能增加心输出量及尿钠排泄量,对血压、心率无明显影响,无副作用。提示心钠素为治疗充血性心力衰竭开辟了一条新途径。     

外源性肽类物质对豚鼠交感神经肽Y和去甲肾上腺素释放的影响

以经Langendorff技术改良制作、保持交感神经完整分布的豚鼠心脏作实验模型,电刺激豚鼠心脏左交感神经节,观察神经递质NA和NPY的释放情况。与S_1比较,S_2测值变化为:给予外源性NPY使NA释放减少;ANP呈剂量依赖性抑制NA释放,同时减少NPY释放;A Ⅲ使高钠状态下的豚鼠明显增加NPY和NA的释放;CGRP不影响双递质的释放。提示具有心血管效应的各种外源性肽类,都可能通过它们对应的受体,对电刺激交感神经节时的双递质释放产生不同的影响。     

γ－氨基丁酸及神经肽Y对豚鼠血流动力学的影响

γ－氨基丁酸（ＧＡＢＡ）１０ｍｇ／ｋｇ静脉注射使豚鼠的收缩压（ＳＡＰ）、舒张压（ＤＡＰ）迅速下降，与给药前比较，差异有显著意义（Ｐ＜０．０５和＜０．０１），而左室压最大变化速度（±ｄｐ／ｄｔ＿（ｍａｘ））和左室舒末压（ＬＶＥＤＰ）也有所下降，但无显著差异．神经肽Ｙ（ＮＰＹ）０．２μｇ／ｋｇ静脉注射，可使以上心功能指标迅速上升（Ｐ＜０．０１），但持续时间较短，１０ｍｉｎ即恢复正常，预先给予ＧＡＢＡ３０ｍｉｎ后，再注射ＮＰＹ，其正性作用未见减弱，提示外周ＧＡＢＡ对ＮＰＹ无直接拮抗作用．     

生长激素对老年人心血管系统的影响

生长激素(growth hormone，GH)主要作用是促进合成代谢和机体生长，维持肌肉的基质和长度并有对抗胰岛素作用。通、常，成人GH不足和衰老开始时都有明显的去脂肪体重减少，脂肪增加，骨密度下降，皮肤变薄，免疫功能下降，学习记忆功能减弱的表现。近年来研究发现生长激素在心血管生理方面具有重要作用。生长激素缺乏者其心肌萎缩，心功能受损，易发生心力衰竭。恢     

瘦素对大鼠血压及血清一氧化氮浓度的影响

目的　静脉注射瘦素 (leptin)于Wistar大鼠 ,观察其对血压、心率及血清一氧化氮的影响。 方法　 2 4只大鼠随机分为 4组 ,分别静脉注射 3种剂量的leptin (10 ,10 0 ,10 0 0 μg/kg)或生理盐水 (saline) ,测定用药前及用药后 90min血压 (BP)、心率 (HR)及血清一氧化氮 (NO)浓度的变化。结果　瘦素组NO浓度用药后比用药前分别升高了 (2 1 83± 1 2 5 ) % ,(34 92± 2 0 7) % ,(86 88± 2 0 0 ) % (均P <0 0 1) ,与对照组比较 ,差异均有统计学意义 (P <0 0 5或 0 0 1) ,剂量效应曲线呈线性 (r =0 935 ,P <0 0 1)。 4组BP、HR未发生明显变化 (均P >0 0 5 )。结论　静脉注射leptin能促进Wistar大鼠NO的释放 ,不能改变BP和HR。