动脉粥样硬化性心血管病炎症的临床评价和治疗

血管内皮细胞功能紊乱和炎症在动脉粥样硬化及其相关疾病的进展中起重要作用,C反应蛋白、高灵敏C反应蛋白、细胞黏附因子、白细胞介素和斑块温度及斑块pH变化参与动脉粥样硬化炎症过程。现对这些炎症标志物在动脉粥样硬化炎症中的临床评价及其药物干预研究进展做一复习。     

Disturbances of lipid metabolism in children with chronic renal failure

This review discusses the pathogenesis, clinical significance and current therapy of hyperlipoproteinaemia (HLP) in children with chronic renal failure. Uraemic dyslipidaemia, characterized by hypertriglyceridaemia and low high-density lipoprotein-cholesterol levels, is present in the majority patients with chronic renal failure. In addition, serum levels of total cholesterol, very lowdensity lipoprotein-cholesterol, low-density lipoproteincholesterol and apolipoprotein B are frequently elevated. The pathophysiological mechanisms causing these disturbances are complex and mainly involve a diminished catabolism of triglyceride-rich lipoproteins. For unknown reasons and independent of other lipoproteins, serum levels of the highly atherogenic and thrombogenic lipoprotein(a) are also often elevated. HLP is an important factor in cardiovascular morbidity and mortality. In addition, dyslipidaemia may enhance progression of renal disease in patients with residual renal function. Therefore, treatment of HLP seems indicated in overtly hyperlipidaemic patients, but until there is more experience with lipid-lowering drugs in children, no safe recommendations for pharmacological treatment of HLP can be given. Dietary modifications can be recommended only to a limited extent.     

四环素对动脉光切作用的影响

为观察光敏剂与动脉组织的结合情况及其对光切的作用，动脉标本经四环素溶液浸泡后分别做冰冻切片及用三倍频Ｎｄ∶ＹＡＧ激光（波长３５３ｎｍ，输出功率２．０Ｗ，脉宽２００ｎｓ，脉冲频率５．８ｋＨｚ，每点照射５秒）消融后做石蜡连续切片。结果表明：四环素可以与动脉粥样硬化组织特异结合，并能增强光切，减轻激光对所消融动脉组织的热损伤。     

冠心病与肿瘤坏死因子、白细胞介素-6浓度关系的研究

采用放射免疫法及酶联免疫吸附法检测35例冠心病患者（其中20例冠状动脉狭窄，15例心肌梗死）及20例健康者血清肿瘤坏死因子（TNF）、白细胞介素-6（IL－6）的浓度及血脂水平。结果显示：①冠心病组较对照组TNF浓度高（P＜0.01），而以心肌梗死组更为明显（P＜0.001）；②冠心病组TNF浓度与胆固醇、低密度脂蛋白-胆固醇、载脂蛋白B100呈正相关，而与高密度脂蛋白-胆固醇、载脂蛋白地呈负相关。③冠状动脉狭窄组与对照组比较IL－6浓度光显著性差异（P＞0．05），但心肌梗死组IL－6浓度显著增高（P＜0．001）。提示：TNF、IL－6与冠心病的发生发展有关，IL－6参与了急性心肌梗死的缺血损伤；内皮细胞受损，TNF、IL－6作用，脂质代谢的异常是冠心病发生的重要环节。     

Percutaneous transluminal angioplasty of atherosclerotic basilar artery stenosis

Symptomatic intracranial involvement of vertebral and basilar arteries by atherosclerosis is not accessible to surgical treatment. We report a case of major basilar artery stricture responsible for haemodynamic strokes treated successfully by percutaneous dilatation.     

Selective use of coronary calcification measurements in an expanded intermediate risk group

Risk assessment is an imperative initial step in the clinical management of cardiovascular risk factors. On the basis of the estimation of the 10-year absolute risk of manifesting coronary heart disease (myocardial infarction or coronary heart disease death), risk categories are conventionally divided into low, intermediate, and high. The most widely used quantitative risk assessment algorithm, the Framingham risk score for hard events, is based on traditional risk factors, but it does not fully account for all available cardiovascular risk factors. Current national guidelines defining coronary heart disease risk categories based on the Framingham risk score may inaccurately assign persons with a high burden of subclinical coronary atherosclerosis to a low-risk group (<10% risk), failing to predict the true risk of a cardiovascular event. Coronary artery calcification as a measure of subclinical atherosclerosis has already established itself as a useful adjunct for refining the broad intermediate risk category of adults, leading to more decisive management strategies. In a point-counterpoint format this article argues for the improved accuracy of coronary calcium scoring in predicting the risk of future cardiac events in persons with a low Framingham risk score (including women and different ethnic groups). To better incorporate recent scientific findings into cardiovascular assessment and to refine stratification in those with a low Framingham risk score, we therefore propose a timely algorithm supporting coronary calcium screening in a selected group of low-risk persons.     

Functional Imaging of Atherosclerosis to Advance Vascular Biology

Preliminary events leading to the rupture of atherosclerotic plaques or aneurysmal wall expansion undoubtedly are linked to altered and increased metabolism of cells in the vascular wall. To allow in vivo identification of this local activity, imaging techniques such as positron emission tomography (PET) and contrast ultrasonography may be used. However, the use of complementary multimodal imaging methods, such as computed tomography (CT), magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), etc., can inform about other processes, including vascular wall calcification, haemosiderin deposits, apoptosis and accumulation of activated platelets in the arterial wall. Such techniques may be used as an adjunct in following the evolution of the disease, as well as having crucial roles as molecular and cellular probes of arterial disease. Therefore, functional imaging techniques may be able to help us take more reliable decisions on the need for medical or surgical treatment of arterial disease.     

肾病患者血清载脂蛋白A_1、B、高密度脂蛋白胆固醇水平的测定价值

目的　为探讨肾病患者继发动脉粥样硬化性心血管合并症的危险因素。方法　用免疫比浊法和直接测定法测定 2 7例无合并症的肾病患者和 36例健康人的血清载脂蛋白 (apo)A1、B、高密度脂蛋白胆固醇 (HDL -c)水平。结果　对照组的apoA1、apoB、apoA1/apoB ,HDL -c水平分别为 1.4 8± 0 .2 8g/L、0 .93± 0 .2 0 g/L、1.37±0 .34、1.4 8± 0 .30mmol/L ;患者分别为 1.2 1± 0 .31g/L、1.34± 0 .2 2g/L、0 .78± 0 .4 0、0 .98± 0 .36mmol/L ,两组间的结果差异均具有显著性意义 (P <0 .0 5 )。结论　肾病患者在出现动脉粥样硬化性心血管合并症之前 ,体内已经具备了诱发合并症的生化基础 ,故临床上应早期采取针对性预防措施。     

The mechanism of intimal thickening in arteriosclerosis

The limitations of current theories of the mechanism of intimal thickening in arteriosclerosis are briefly reviewed. The suggestion is advanced that this change is due to intimal oedema, arising from failure of the lymphatic system of the surrounding tissue to remove adequately, protein-containing fluid filtering outwards through the vascular endothelium. It is postulated that such local environmental influences account for the variability in the degree of arterial degeneration seen in different arteries, and in different portions of the same artery.