老年与青壮年上消化道出血病因与临床特点

目的探讨老年人与青壮年人上消化道出血在病因,临床特点方面的不同。方法随机抽取某院2006年1月至2011年1月老年上消化道出血病历50例,青壮年上消化道出血病历50例的临床资料,比较2组的异同。结果老年上消化道出血病因主要是消化性溃疡,但是消化道肿瘤在老年上消化道出血中占有一定的地位。青壮年上消化道出血的病因主要是消化性溃疡,但是食管胃底静脉曲张破裂出血据第二位。结论老年人上消化道出血主要由消化性溃疡引起,其次是肿瘤,与青壮年人群有区别。     

老年心尖肥厚型心肌病冠脉造影特征

目的了解老年心尖肥厚型心肌病(APH)患者冠脉造影及心室造影特征。方法对我科1996～2003年7例老年APH患者冠脉造影资料进行分析。结果所有患者左冠脉普遍增粗,肌桥形成,心室造影见左室“黑桃样”改变,5例合并冠脉狭窄。结论老年APH患者以冠脉普遍增粗、肌桥形成及左室“黑桃样”改变为特征性冠脉造影改变,且合并冠心病概率高。     

老年胰腺癌与糖尿病关系分析

目的分析老年胰腺癌的临床特征，探讨老年胰腺癌与糖尿病之间的关系。方法对2003年1月。2006年12月华东医院老年（≥60岁）胰腺癌病例进行回顾性分析，评价胰腺癌与糖尿病的关系；对胰腺癌合并糖尿病病例分析、评价老年胰腺癌合并糖尿病患者的临床特点及意义。结果1．老年胰腺癌的临床表现以黄疸、消瘦、腹胀和上腹不适为主。2．在胰腺癌组中2年内确诊糖尿病有31例（39．24％），而对照组中有4例（5．0％），两组比较差异有统计学意义。胰腺癌组中糖尿病病史两年以上有11例（13．92％），对照组中有6例（7．5％），两组差异无统计学意义（P〉0.05）。3．老年胰腺癌合并糖尿病患者罹患胰头癌比例高，且CA199阳性率高于非糖尿病患者，两者差异有统计学意义（p〈0．05）。结论糖尿病是胰腺癌的继发性的临床伴发症状，所以老年人一旦出现血糖异常波动，须警惕胰腺癌的可能。     

高海拔地区老年2型糖尿病和非糖尿病患者肺功能的比较

目的比较高海拔地区老年2型糖尿病（T2DM）和非糖尿病者肺功能的变化特点。方法选择高海拔地区老年T2DM患者67例，健康老年体检者50例，应用肺功能测定仪对比分析两组间肺功能各项指标的检查结果。结果老年T2DM组的肺通气功能中用力肺活量（FVC）、第一秒用力呼气容积（FEVl）、用力呼气流速（FEF25-75％）明显低于老年健康组；氦稀释法肺（TLC-He）高于老年健康组。而老年T2DM组肺弥散功能中一口气弥散量（TLCoSB）明显低于老年健康组；弥散率（TLCo／VA）略低于老年健康组，其他肺功能指标均在正常预计值范围内。结论肺功能在高海拔地区老年T2DM和非糖尿病者中有不同的变化。     

High prevalence of hypovitaminosis D and secondary hyperparathyroidism in elders living in nonprofit homes in South Brazil

Objectives Hypovitaminosis D (HD) and secondary hyperparathyroidism (SHP) are common in elders, and many factors could contribute to them. The objectives of this study were to estimate the prevalence of HD, SHP, and its associated factors, in individuals living in nonprofit homes for elders in south Brazil. Design Cross-sectional study. Methods Serum 25-hydroxyvitamin D 25(OH)D, intact parathyroid hormone (PTH), total calcium, phosphorus, alkaline phosphatase, magnesium, creatinine, and albumin levels were measured in late spring, November, 2005. The presence of factors potentially related with HD and SHP—age, sex, weight, height, skin phototype, sun exposure, exercise, smoking, use of ≤5 medications or diuretics or alcohol, and daily calcium ingestion. Results 102 subjects age 77.8 ± 9.0 were included in the study. HD was found in 85.7% and SHP in 53% of the subjects. The estimated daily calcium ingestion was 720 mg. There was no association between serum 25(OH)D levels and any of the risk factors evaluated. Serum 25(OH)D levels were correlated with serum PTH (r = −0.358, P = 0.000), calcium (r = 0.306, P = 0.002), and albumin (r = 0.253, P = 0.011) levels. In univariate analysis, SHP was positively associated with age (P = 0.006), and female sex (0.007); and negatively associated with sunlight exposure (P = 0.020), GFR (P = 0.000), Ln25(OH)D (P = 0.002), and total serum calcium (P = 0.024). After multivariate model adjustment, age [OR 1.09 (CI 1.01–1.18); P = 0.024], Ln25(OH)D [OR 0.92 (CI 0.08–0.74); P = 0.013], GFR [OR 0.96 (CI 0.92–0.99); P = 0.013], and hydrochlorothiazide treatment [OR 7.63 (CI 1.67–34.9); P = 0.008] were independently associated with SHP. Conclusions HD and SHP are highly prevalent in elders living in old-age homes. No associations were established between common risk factors and low serum levels of 25(OH)D levels; however, SHP was independently related with age, 25(OH)D, GFR, and hydrochlorothiazide use.     

辛伐他汀治疗老年冠心病的疗效及安全性研究

目的 观察老年冠心病（CHD）患者中,辛伐他汀不同剂量调脂的有效性和安全性.方法 选择确诊为CHD的老年患者124例,随机分为观察组63例和对照组61例,观察组患者给予辛伐他汀40mg,对照组给予辛伐他汀20mg,均为每晚服药1次.分别于用药前、用药后第6、12、24周空腹采静脉血清,以酶法测定总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、三酰甘油（TG）、肌酶以及肝、肾功能等.结果 用药第6周两组患者的TC和LDL-C均比用药前明显下降,且一直保持到用药24周末（P＜0.05）.第6、12、24周的TC、LDL-C水平在观察组比对照组明显降低（P＜0.05）.观察组患者24周TC达标率（82.8%比64.9%,P＜0.05）和LDL-C达标率（83.0%比64.9%,P＜0.05）明显高于对照组.两组患者谷丙转氨酶（ALT）升高、肌酶升高等副作用的发生率未见明显差异.结论 40mg辛伐他汀能够安全而且更有效地降低 TC和LDL-C水平,使更多的CHD患者的血清胆固醇达到理想标准水平,老年患者亦可耐受此剂量.     

辛伐他汀消退颈动脉粥样硬化斑块的临床研究

目的 采用颈动脉超声定量评价他汀类药物辛伐他汀服药前及服药6月、12月后颈动脉内中膜厚度(IMT)及斑块面积的改变，并同时观察相应生化指标的变化情况，评价辛伐他汀稳定与消退斑块的作用。方法 应用HP SONOS 5500型彩色超声多普勒仪，检查有不同程度颈动脉粥样硬化斑块形成的患者68例，其中治疗组46例，对照组22例：对有斑块的颈动脉部位，于斑块最大面积时冻结图像，沿斑块边缘测定其面积，同时测定颈动脉分叉处IMT。所有患者于服药前及服药6月、12月后检查相应生化指标。治疗组惠者给予每日辛伐他汀20mg口服，共12月。服药期间所出现的不适嘱及时告知。结果 所有治疗组患者12月服药期间均无不适主诉，46例惠者两侧颈动脉共有79个斑块，服药半年消失25个斑块，消失率达32％；服药12月后消失31个斑块，消失率达39％；未消失的斑块均有不同程度的缩小。用药6月及12月后IMT有明显减低；用药后6月与12月总胆固醇、低密度脂蛋白均明显降低，服药前、6月、12月尿素、肌酐、肌酸激酶等生化指标无明显差异，丙氨酸氨基转移酶明显减低。结论 颈动脉超声定量评价辛伐他汀服药6月及12月IMT及斑块面积改变的结果表明，坚持服用他汀类药物，可以达到稳定与消退斑块的作用。     

Health behaviors and their determinants in multiethnic, active Israeli seniors

To assess factors that affect the adoption of healthy lifestyles among a variety of active Israeli seniors, a survey was conducted in 2002 at the Peiluyada, a physical activity-oriented health fair for seniors held annually in Israel from 1995 to 2002. A multi-language, self-administered questionnaire, assessing predisposing factors, barriers and health-protective behaviors, was fielded to potential participants. Response rate at the event was 51%. Hebrew and Arabic speakers generally characterized their health as good to very good, while Russian speakers' health was rated only poor to fair. Over 80% engaged in regular physical activity, were satisfied with their diet, and conformed to international nutritional recommendations. Vaccination coverage against influenza (81%) and pneumocccocus (58%) was highest among Arabic speakers, and lowest among Russian speakers (33.5% and 12%, respectively). Higher age (> or =75 years) was significantly associated with receiving a vaccination against influenza. Major barriers to exercise included low motivation and poor physical health or disability. Health-related dietary restrictions were the leading nutritional barrier. Prominent barriers to vaccination included concerns about vaccine effectiveness (39%) and side effects (29%). Leading cues to action were a recommendation from one's doctor (67%) and from a healthcare worker (51%).     

强化降脂治疗对老年不稳定性心绞痛病人的临床效果

目的 :评价强化降脂治疗对老年不稳定性心绞痛 (UAP)病人预后的影响 ,探讨降脂药物的作用机制。方法 :确诊为老年UAP病人 79例 ,随机分为常规药物治疗组 (常规组 ,n =3 9)和常规药物加立普妥 (lipitor)组 (立普妥组 ,n =40 ) ,立普妥初始剂量 10mg/d ,根据低密度脂蛋白胆固醇达标情况 ( <2 6mmol/L)增量 ,最大剂量 40mg/d。以 12导联ST段压低数值总和 (∑ST)和 1周内心绞痛发作次数作为心肌缺血指标 ,空腹取静脉血测定血糖、甘油三酯、低密度脂蛋白胆固醇、血浆一氧化氮、纤溶酶原激活物抑制物、C 反应蛋白、心肌酶谱、肝肾功能及血、尿常规。 6个月后复测上述指标 ,同时观察半年内心脑血管事件。两组病人年龄、性别、血压、心率、吸烟、空腹血糖及危险分层比例无明显差异。结果 :6个月后共纳入病人 76例 (常规组 ,n =3 8;立普妥组 ,n =3 8)。用药前后比较 :两组病人用药后心绞痛发作次数及∑ST均较用药前明显下降 ,立普妥组下降更明显 ,均有显著性差异 (P <0 0 5及P <0 0 1) ;立普妥组治疗后较治疗前甘油三酯及低密度脂蛋白胆固醇明显下降 ,有显著性差异 (P <0 0 5及P <0 0 1) ,一氧化氮明显增加 ,有极显著性差异 (P <0 0 1) ;C 反应蛋白及纤溶酶原激活物抑制物明显降低 ,有显著性差异 (P <0 0     

The Brazilian Back Complaints in the Elders (Brazilian BACE) study: characteristics of Brazilian older adults with a new episode of low back pain

Objective

Low back pain (LBP) is little explored in the aging population especially when considering age-relevant and culturally dependent outcomes. We aimed to describe socio-demographic and clinical characteristics of Brazilian older people with a new episode of LBP presenting to primary care.