原发性高血压危险因素研究

目的 :分析多种因素与原发性高血压 (EH)的关系 ,从而探讨与EH有关的危险因素。方法 :采用整群抽样的方法 ,共抽取唐山开滦矿业职工 10 4 3例 ,进行相关因素的问卷调查 ,生化指标经全自动生化测定仪测定。用Excel软件建立数据库 ,进行统计分析。结果 :①EH患病率为 18.0 7% ,男性高于女性 ,且随着年龄的增长有增高的趋势。EH的知晓率 35 .71% ,服药率 2 1.98% ,控制率 7.6 9%。②经过单因素分析及分层分析 ,年龄、性别、打鼾、肥胖、高血压家族史、脉压差、心率、血脂异常与EH有关。③通过非条件Logistic回归的筛选 ,与EH有关的因素有年龄、性别、打鼾、肥胖、高血压家族史、心率、三酰甘油 7项指标。结论 :年龄、性别、打鼾、肥胖、高血压家族史、脉压差、心率、血脂异常是EH的危险因素     

脑梗死急性期降压治疗对预后的影响

目的 研究脑梗死急性期降压及在不同时间进行降压治疗对患者近期预后的影响.方法 据发病后是否降压及进行降压的时间,将198例急性脑梗死患者分为6组,观察各组患者神经功能缺损程度及心脑血管事件的再发生率和病死率.结果 在发病后进行降压治疗的患者中其心脑血管事件再发率和病死率明显低于未降压组（P＜0.01） 3d后降压组患者神经功能恢复的程度明显好于未降压组（P＜0.01）.结论 降压治疗可以降低患者心脑血管事件的发生率和病死率3d后进行降压治疗的患者神经功能恢复明显要好.     

门脉高压症患者肝脏储备功能评估的临床研究

目的 :探讨肝硬化门脉高压症患者术前肝脏储备功能的评估方法。方法 :用L ogistic多元回归法分析了 80例门脉高压症断流患者术后出现肝功能不全的相关因素 ,从中筛选与肝功不全关系最密切的危险因子。结果 :排除手术操作本身的影响后 ,术后发生肝功不全影响最大的因素依次为 :肝性脑病 ( ENC)、血浆吲哚氰绿潴留试验 ( ICGR15)及门静脉充血指数 ( PCI)等 ,而术前的血清总胆红素 ( TBIL)、白蛋白 ( A)、A/G比值、总胆汁酸( TBA)、透明质酸 ( HA)、凝血酶原时间 ( PT)、门静脉内径 ( dp)、门静脉流速 ( Vp)及门静脉流量 ( Qp)等因素 ,在多元回归中所占比例不大。结论 :综合分析术前患者临床指标和肝功能实验室检查有助于评价肝硬化患者肝储备功能 ,预测手术风险及术后转归     

颅骨钻孔颅内血肿抽吸术治疗高血压脑出血的临床研究

目的　探讨应用颅骨钻孔颅内血肿抽吸术治疗高血压脑出血。方法　总结分析血量在 30ml以上的高血压脑出血患者 60例经微创手术治疗的情况及预后 ,并设传统开颅手术为对照组进行比较。结果　微创组 60例中 ,总有效率达 83 % ,其中完全恢复生活能力和部分恢复生活能力占 48.3 % ,均明显优于对照组。结论　微创颅内血肿清除术对高血压脑出血患者的治疗效果明显优于传统开颅血肿清除术     

大鼠肝硬化形成过程中胃黏膜微循环内皮素A受体mRNA的表达及其意义

目的观察大鼠肝硬化门静脉高压形成过程中内皮素A受体mRNA在胃黏膜微循环血管上的表达 ,探讨内皮素及其受体对肝硬化门静脉高压大鼠胃黏膜微循环的调节机制。方法应用mRNA原位杂交确定内皮素A受体的部位 ,并进行半定量分析。结果大鼠肝硬化门静脉高压形成过程中门静脉及外周血浆内皮素水平随门静脉压力升高而降低。胃黏膜内皮素A受体mR NA主要在黏膜基底部的微循环前微动脉和后微静脉血管壁表达 ,其中动脉表达明显强于静脉。其表达与门静脉压力呈正相关 (r =0 86 9,P <0 0 5 ) ,与门静脉及外周血内皮素水平呈负相关 (r =-0 797、- 0 74 1,P <0 0 5 )。结论大鼠肝硬化门静脉高压形成过程中外周及门静脉血浆内皮素水平进行性降低 ;胃黏膜微循环内皮素A受体mRNA表达量增加 ,呈现上调趋势 ;内皮素及其受体mR NA表达变化可能与胃黏膜微循环功能障碍有关。     

不良生活方式与高血压病的流行病学调查分析

目的:调查不良生活方式对高血压发病的影响。方法:以国际通用血压测量方法对全区15 384人进行整群随机抽样调查,着重对有、无不良生活方式的两组人群进行高血压患病率调查,及相对危险度(RR)、归因危险度(AR)、人群归因危险度(ARp)、U检验等的检测,以及相关及多元回归分析。结果:食盐量≥12 g/d高血压患病率31.6％,<12 g/d的为 4.4％(P<0.001,RR 7.3,AR 27.3,ARp 57.2％,r=0.8517);BMI>24高血压患病率 23.2％,<24者 6.4％(P<0.001,RR 3.7,AR 16.9,ARp 37.2％,r=0.3215);肥胖患病率 34.7％,无肥胖8.1％(P<0.001,RR 4.3,AR 26.6％,ARp 19.7％,r=0.3529);油腻饮食高血压患病率14.8％,非油腻饮食8.7％(P<0.001,RR1.7,AR 6.1,ARp 13.9％,r=0.3853);吸烟高血压患病率 12.5％,非吸烟 9.2％(P<0.001,RR1.4,AR 3.3,ARp 8.3％,r=0.8403);饮酒患病率 12.7％,非饮酒 9.4％(P<0.001,RR1.35,AR 3.3,ARp6.7％,r=0.4650)。为进一步了解各危险因子与高血压患病率之间的数量关系和对高血压影响作用的大小,对所有对象用年龄(15～80岁)进行了分组,龄差1岁,共66组,多元回归结果为:偏相关系数0.3775～0.0809,建立的统计模型达到极显著水平(P<0.001),复相关系数0.9525。6个回归因子中按对高血压患病率影响(偏相关系数)大小排序:     

老年人上消化道出血104例临床分析

分析104例60岁以上的老年人上消化道出血的病因,依次为急性胃粘膜病变,上消化道肿瘤,消化性溃疡及门脉高压。手术治疗效果优于内科保守治疗,而保守治疗又以甲氰咪胍效果较好。     

Value of Doppler ultrasound for the diagnosis of renal artery stenosis in children

To evaluate the reliability of Doppler ultrasonography (US) in identifying children with renal artery stenosis (RAS) among those with hypertension, we compared Doppler US results in 22 hypertensive children (mean age 8.9±4.3 years), with (13 cases) and without RAS at angiography, and in 33 normotensive children (mean age 8.8±4.7 years). We observed 2 false-negatives and 2 false-positives with Doppler US. Of the 2 false-negative diagnoses, 1 had RAS on an accessory renal artery located behind a normal upper polar artery and the other was observed in a patient with bilateral multiple stenosis of the very distal segments of renal arteries. The 2 false-positive diagnoses were due to sinuous left renal artery and to technical reasons, respectively. In another patient, Doppler US showed a tight RAS, while arteriography was normal. RAS was subsequently confirmed by a second arteriography. Peak systolic velocity values of Doppler US were significantly higher in patients with proven angiographic RAS (3.44±0.66 m/s) than in hypertensive patients with normal renal arteries at angiography (0.99±0.35 m/s, P <0.0001) and normotensive healthy children (1.04±0.23 m/s, P <0.0001). With the use of multiple views, and the experience acquired with practice, false-negatives or false-positives due to the geometry of the renal artery can be avoided. Nevertheless, very distal stenosis can be missed by Doppler US. Received October 30, 1995; received in revised form April 16, 1996; accepted May 14, 1996     

Effect of dexfenfluramine treatment on body weight,blood pressure and noradrenergic activity in obese hypertensive patients

Summary The effect of dexfenfluramine (dF) on body weight, blood pressure and noradrenergic activity were studied in 30 obese hypertensive patients randomly divided into two groups and treated for 3 months either with dF (30 mg daily; 16 subjects) or placebo (Pl; 14 subjects). 11 patients from the dF group and 9 patients given Pl completed the entire experimental protocol, including monthly visits for metabolic and hormonal measurements, as well as a bicycle exercise test with arterial catheterisation for haemodynamic and catecholamine measurements performed before and after 3 months of treatment.A progressive significant decrease in body weight, averaging 6.0 kg after 3 months was observed in the dF-treated group, whereas loss of weight in the placebo group (1.4 kg) was not significant. While blood pressure and noradrenergic activity, assessed as changes in the plasma levels and urinary excretion of norepinephrine, remained unaffected in the Pl group, a significant drop in the supine systolic and diastolic blood pressures, as well as in the resting venous norepinephrine level and in urinary norepinephrine excretion was found after the first month of dF administration. In addition, the exercise-induced rise in systolic and diastolic blood pressure, as well as in arterial plasma norepinephrine and epinephrine concentrations, was significantly reduced after 3 months of dF administration; there were no such changes in the Pl-treated group.The results of the present study indicate that, in addition to the weight-reducing effect of dexfenfluramine, its hypotensive effect may be mediated by a decrease in noradrenergic activity.     

Comparison of FK-506 and cyclosporine regimens in pediatric renal transplantation

Clinical aspects of FK-506 or cyclosporine immunosuppression regimens were evaluated in 48 consecutive pediatric renal transplant recipients. Tapering and discontinuation of prednisone was employed only in children receiving FK-506 who experienced minor or no rejection episodes during the 1st posttransplant month. At 1 year follow-up, 17 of 22 (77%) of all children with functioning allografts were receiving no prednisone (n=13) or a mean dosage of 0.07 mg/kg per day (n=4). During the 1st month, acute cellular rejection was more common in the FK-506 group (0.58 vs. 0.21 rejections per patient,P<0.05) but allograft survival (92%) and renal function at 1 year posttransplant were identical in both groups. Compared with the cyclosporine regimen, FK-506 immunosuppression may be associated with a higher incidence of cytomegalovirus or reversible Epstein-Barr virus-induced lymphoproliferative disease. However, the FK-506 group had less hirsutism and gingival hypertrophy and required fewer antihypertensive medications independent of steroid use. Height standard deviation scores and weight-for-height index improved only in preadolescents receiving FK-506 but no prednisone (P<0.02 andP<0.05, respectively), but did not differ between children on FK-506 plus prednisone and those in the cyclosporine group. We conclude that the major advantages of FK-506 over cyclosporine immunosuppression are a reduced severity of hypertension and an improved cosmetic appearance which may improve long-term medical compliance. When used as monotherapy, FK-506 also shows promise in relieving the growth retardation associated with cyclosporine regimens that include prednisone.