Individual and joint effects of borderline ankle-brachial index and high plasma total homocysteine on all-cause death in hypertensive adults

BACKGROUNDThe cardiovascular hazards of total homocysteine (tHcy) are long known. In addition, despite the acknowledgment on the importance of low ankle-brachial index (ABI) (< 0.9), borderline ABI (0.91-0.99) was once commonly overlooked. This study aims to explore the independent and joint effect of tHcy level and borderline ABI on all-cause death in hypertensive population.METHODSThis study included 10,538 participants from China H-type Hypertension Registry Study. ABI was described into two groups: normal ABI (1.00-1.40) and borderline ABI. tHcy level was also divided into two groups: < 15.02 and ≥ 15.02 μmo/L. Four groups were analyzed, using COX proportional hazard regression model, separately and pairwise to observe the independent and joint effect on all-cause death.RESULTSA total of 126 (1.2%) deaths were observed in the 1.7 years follow-up time. Borderline ABI has a higher predicted risk of death than normal ABI (HR = 1.87, 95%CI: 1.17-3.00) after adjusting for potential covariates. Compare with tHcy level < 15.02 μmo/L (low tHcy), those with tHcy ≥ 15.02 μmo/L (high tHcy) had higher risk to event outcome (HR = 1.99, 95% CI: 1.30-3.05). According to the cumulative hazard curve, group with borderline ABI and high tHcy level has significantly higher altitude and larger increasing rate over follow-up period compare to other groups. Among those with borderline ABI, participants with high tHcy had higher death risk than those with low tHcy, nevertheless, no significant different between borderline and normal ABI among those with low tHcy levels.CONCLUSIONSBorderline ABI and tHcy level both have independent predictive value on all-cause death. The combined group of borderline ABI and high tHcy has highest risk factor of outcomes, which suggested the mutual additive value of borderline ABI and tHcy. More attention should be given to the importance of borderline ABI in hypertensive population, especially with elevated tHcy level.

Homocysteine (Hcy) is a sulfur-containing, non-proteinogenic amino acid synthesized through the transmethylation of amino acid methionine from one-carbon metabolism. Elevated plasma total homocysteine (tHcy) level is associated with endothelial dysfunction, increased blood coagulation, and metabolic disturbance, promoting cardiovascular diseases, stroke, and coronary artery disease.^[1,2] Notably, patients with high Hcy levels and concomitant hypertension were suggested to be at particularly higher risk.^[3] Moreover, increasing studies have explored a positive association between advanced Hcy level with all-cause mortality. According to a recent dose-response meta-analysis, for each 5-μmol/L increment of tHcy levels, the risk for all-cause mortality increased by 33.6%.^[4]The ankle-brachial index (ABI) is an effective, well-established measure that is commonly used in the diagnosis of peripheral artery disease (PAD),^[5] meanwhile was well studied as an important indicator of atherosclerosis and CVD events.^[6] Although ankle-brachial index (ABI) ≤ 0.90 has been recognized as the threshold value for abnormal/low ABI, which was proven to increase the risk of all-cause mortality,^[7] a study from the American Heart Association has suggested ABI between 0.91 and 1.00 should be considered as “borderline area” in terms of cardiovascular risks,^[8] considering of prior probability and sensitivity of ABI calculation. Emerging studies have aimed to explore the predictive value of borderline ABI,^[9-11] however, controversy remains because of limited and inconsistent data. The current study aimed to explore the individual and joint effect of borderline ABI and tHcy on all-cause mortality among hypertensive adults. Although ABI level ≤ 0.90 has been and is going to remain significant in clinical practice, we believe broader concern should be placed on borderline ABI, especially for its value in risk differentiation and identification. To the best of our knowledge, there are no similar previous studies.     

牙乳头细胞基本特征及其研究进展

牙乳头细胞来源于外胚间充质,具有多向分化潜能,是体内唯一分化为成牙本质细胞的前体细胞。该细胞在牙发育和牙体牙髓损伤修复过程中起重要作用。牙乳头细胞相关的组织工程化研究是近年来的热点。下面就牙乳头细胞的形态及其功能特征、三维细胞培养、组织工程化牙研究进展等方面的研究作一综述。     

从玄府气液理论探讨偏头痛的病机及治疗

偏头痛是一种常见的神经-血管功能障碍性疾病。玄府是遍布机体各处的一种至微至小的组织结构,其主要功能包括流通气液、渗灌气血和运转神机。脑玄府开阖不利是头痛各种证候形成的共同基础,气郁玄府、浊停玄府、血瘀玄府或玄府气血不足,是头痛重要的发病机制。治以开通玄府法,以畅达人体阻滞之气、血、津、液,用药多选用祛风、理气、活血、化痰、通络之品。     

灾害护理知信行量表的编制及信效度检验

目的:编制灾害护理知信行量表,并对其进行信效度检验。方法:根据知信行理论模型编制灾害护理知信行量表。随机抽取500名护生实施问卷调查并进行因子分析及信效度评估,3周后,随机抽取200名护生检验重测信度。结果:灾害护理知信行量表包括知识、态度及行为3个维度,共30个条目,总量表及各维度Cronbach′sα系数分别为0.96,0.92,0.95,0.96;分半信度为0.82,总量表及各维度重测信度分别为0.90,0.82,0.83,0.85。量表总内容效度指数为0.93,各条目内容效度指数为0.85～1.00。结论:灾害护理知信行量表具有良好的信效度,可作为评估护生灾害护理知信行水平的工具,可作为灾害护理教育的形成性评价指标。     

PAX2在肾小管上皮细胞转分化中的作用

目的 揭示核转录因子（PAX2）在肾小管上皮细胞转分化过程中的可能作用。方法 38例病例组肾组织按间质病变程度分为轻、中、重3组,其中轻度病变15例,中度病变11例,重度病变12例;对照组为5例外伤后肾切除组织。采用免疫组化法评定肾组织PAX2的表达率和肾小管上皮细胞转分化率。对肾间质病变轻、中、重3组组内肾小管上皮细胞转分化率、PAX2表达率作方差分析,对PAX2表达量与肾小管上皮细胞转分化率作相关分析。结果 正常对照组肾小管上皮细胞只表达角蛋白（CK）,不表达平滑肌肌动蛋白（α-SMA）及PAX2。病例组肾间质病变轻、中、重3组肾小管上皮细胞均不同程度表达α-SMA及PAX2;不同肾间质病变组,肾小管上皮细胞转分化率及PAX2表达量差异均有统计学意义。相关分析表明,PAX2表达量和肾小管上皮细胞转分化率呈正相关（r=0．886,P〈0．05）。结论 PAX2回归表达可能导致肾小管上皮细胞转分化。     

ECHO病毒性脑炎30例临床分析

ECHO病毒为肠道病毒,主要通过粪-口途径传播,其4、6、19、11、16、30型流行株常侵犯中枢神经系统,引起病毒性脑炎流行。我科于2005年5～7月共收治30例ECHO6型病毒性脑炎,现报道如下。     

奎硫平治疗强迫症的辅助作用

目的：探讨奎硫平辅助治疗强迫症的临床疗效和安全性。方法：对48例强迫症患者,在服用原抗抑郁药的基础上随机分为奎硫平组和安慰剂组,分别给予合用奎硫平和安慰剂。疗程12周。采用Yale-Brown强迫症量表（Y-BOCS）和治疗中出现的症状量表（TESS）评定疗效和不良反应。结果：奎硫平组Y-BOCS评分治疗后有显著下降,安慰剂组则无差异;治疗后Y-BOCS评分以奎硫平组显著较低。两组TESS评分相仿。结论：抗抑郁药合用奎硫平治疗强迫症有一定辅助作用。     

16层螺旋CT在心房颤动射频消融术前的应用测量

目的研究心房颤动导管射频消融肺静脉电隔离术前左心房、肺静脉和食管16层螺旋CT成像技术及临床意义。资料与方法40例心房颤动患者在术前1-3天行多层螺旋CT（MSCT）检查,采用容积再现（VR）、多平面重组（MPR）及最大密度投影（MIP）等方法重组并测量各肺静脉口直径、左心房至肺静脉第一分支的距离、食管与左心房后壁接触的范围、食管壁厚度、左心房后壁厚度以及左心房与食管间的脂肪垫厚度。结果共显示肺静脉165支,右上肺静脉口前后径和上下径分别为（16.3±3.1）mm和（19.0±2.6）mm;右下肺静脉分别为（16.4±3.6）mm和（18.0±3.5）mm;左上肺静脉分别为（14.4±3.0）mm和（18.4±3.6）mm;左下肺静脉分别为（12.6±2.8）mm和（17.0±2.8）mm。食管与左心房后壁接触的平均长度为（56±12）mm,在双上、下肺静脉水平与左心房后壁接触的食管平均宽度分别为（10±5）mm和（14±5）mm。60%的食管位于左心房后壁中线偏左,大致与左上、下肺静脉口平行;40%的食管沿左上肺静脉向右下肺静脉斜行走行。左心房后壁和食管前壁的平均厚度分别为（2.2±0.8）mm和（3.5±1.6）mm。95%的左心房与食管间可见脂肪垫,其平均厚度为（0.8±0.2）mm。结论应用MSCT造影增强扫描可清楚显示各肺静脉口直径、分支特征、走行以及有无发育畸形,同时还能评价食管与左心房的关系,为心房颤动导管射频消融术的顺利实施提供重要解剖依据。     

MR扩散加权像在急性病毒性肝炎中的初步应用

目的探讨MR扩散加权像在急性病毒性肝炎患者中对肝功能评价的价值。方法健康志愿者20例作为对照组,急性病毒性肝炎（AVH）患者56例（其中肝功能正常组26例,肝功能异常组30例）作为研究组。分别测量各例的表观扩散系数（ADC）并与转氨酶对比分析。结果在扩散敏感系数（b值）取200、400、600 s/mm2时肝功能正常组及异常组的ADC值均高于对照组,差异有统计学意义。肝功能异常组的ADC值与转氨酶呈正相关。结论在急性病毒性肝炎患者中,DWI是一种具有潜力无创的评价肝功能的重要手段,有待于进一步的探索和提高。     

综合干预后血脂达标率调查

目的探讨综合干预措施对老年人血脂异常状况改善的价值。方法采用国际标准化心血管流行病学调查方法,对辖区内离退休老干部进行心血管危险因素调查;对该人群进行健康教育,并对每一个体进行危险评估、个体化用药指导,并跟踪随访。结果(1)本研究人群是多重危险因素高度聚集的心血管疾病群体,冠心病及等危症者占69.81%;(2)经过3年的综合干预,他汀类药物的服用率由14.48%上升到22.32%;高TC血症治疗达标率由27.00%上升至63.78%;高LDL-C控制率由19.79%上升到63.65%;TC与LDL-C的达标率都有显著增高(P<0.01);TG的达标率无显著变化。结论健康教育和根据危险分层确定个体化治疗方案相结合的综合干预,能够明显提高高胆固醇血症老年患者的血脂达标率。