QT延长与高血压合并心房颤动导管射频消融术后复发的相关性分析

目的 探讨高血压合并阵发性心房颤动患者的QTc是否与心房颤动导管射频消融术后复发相关.方法 回顾性分析201 1年1月至2012年12月在北京安贞医院第1次行导管射频消融术的高血压合并阵发性心房颤动心功能正常患者242例,将纳入患者按疾病复发情况分为复发组（98例）和未复发组（144例）,收集术前心电图和其他临床资料,术后定期随访.结果 随访（17±9）个月,98例患者（40.0％）心房颤动导管消融术后复发.与未复发组相比,复发组QTc明显延长[（429±26） ms比（419 ±23） ms]（P=0.004）.复发组的左心房前后径较未复发组明显增大[（41±6）mm比（38±5）mm]（P=0.003）.QTc与心率存在明显的相关性（r=0.162,P=0.011）.长QTc组（n=53）的导管消融术后心房颤动复发率明显较正常QTc组（n=165）和短QTC组（n=24）高（P =0.001、P=0.069）;左心房直径＜38.3 mm组与左心房直径≥38.3 mm组消融术后心房颤动复发率比较,左心房增大与导管消融术后复发相关（P=0.017）.多因素Cox回归分析表明QTc和左心房前后径是心房颤动复发的独立危险因素（QTc：风险比=2.361,95％置信区间：1.353 ～4.121,P=0.003;左心房前后径：风险比=1.795,95％置信区间：1.041 ～3.094,P=0.035）.长QT患者心房颤动复发的风险比为2.361（95％置信区间：1.353 ～4.121,P=0.003）.与左心房前后径单独预测术后复发相比,左心房前后径和QTc联合能更好地预测心房颤动导管消融术后复发.结论 QT延长是高血压合并心房颤动导管消融复发的独立危险因素.     

ACEI与长效CCB对高血压脑卒中二级预防的效果分析

目的：探讨ACEI与长效CCB对高血压合并脑卒中二级预防的效果。方法回顾性分析2009年6月~2014年6月社区健康档案中高血压合并脑卒中存活跃2个月的患者863例,以ACEI为降压基础治疗的408例,长效CCB为降压基础治疗的455例,主要观察脑卒中的复发、脑卒中死亡、心肌梗死发生及死亡、总死亡等,观察时间6~70个月,平均39个月。结果两组患者血压下降幅度比较差异无统计学意义（P>0.05）;两组危险因素干预情况比较差异无统计学意义（P>0.05）;ACEI组联合利尿剂的患者多于CCB组,差异有统计学意义（P<0.05）;两组≥2种联合用药率相比,差异无统计学意义（P>0.05）;ACEI组与CCB组所有脑卒中复发分别为111例（27.2%）、107例（23.5%）,差异有统计学意义（P<0.05）;两组其他心血管事件发生率比较,差异无统计学意义（P>0.05）。结论降压药对高血压合并脑卒中二级预防的效果与脑卒中一级预防相同,长效CCB优于ACEI。     

缬沙坦对维持性血液透析患者保护作用的研究进展

尿毒症严重危害人类身体健康,血液透析是维持尿毒症患者长期生存的一种方式。缬沙坦（Valsartan）为血管紧张素II受体1型（angiotensin II type 1 receptor,AT1R）的特异性拮抗剂,具有控制维持性血液透析患者的血压、改善患者心功能、保护残余肾功能以及改善微炎症状态等作用,在临床上广泛应用于维持性血液透析患者。本文就缬沙坦对维持性血液透析患者的保护作用作一综述。     

Effects of Xin-Ji-Er-Kang formula on 2K1C-induced hypertension and cardiovascular remodeling in rats

Ethnopharmacological relevance

Xin-Ji-Er-Kang (XJEK), a Chinese herbal formula, is effective against hypertension induced coronary heart disease, viral myocarditis and toxic myocarditis. In this study, the effect of XJEK on cardiovascular system was investigated. To test the hypothesis that Xin-Ji-Er-Kang (XJEK) has an anti-hypertensive effect mediated through attenuation of cardiac remodeling, and amelioration of vascular endothelial dysfunction and oxidative stress.

Materials and methods

Hypertension was induced in Wistar rats by 2 kidney 1 clip (2K1C) treatment. The hypertensive rats were then randomly assigned into four groups and treated as follows: group 1 (Sham-operated [Sh-Op] group received only drinking water), group 2 (induced hypertensive model+no treatment), and group 3 (induced hypertensive+a single daily oral dose of 24 g kg⁻¹ XJEK treatment) and group 4 (induced hypertensive+a single oral dose of 15 mg kg⁻¹ Fosinopril treatment). The rats in all the defined groups were respectively treated for a period of 4 weeks. Cardiovascular parameter such as systolic blood pressure (SBP) was measured weekly by using tail-cuff apparatus; left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP) and the rate of the rise in left ventricular pressure (±dp/dt max) were measured by using a PowerLab 8/30 apparatus (AD Instruments, Australia) at the end of the 8th week; heart weight/body weight (HW/BW) was determined as an index of myocardial hypertrophy (MH). Hematoxylin and eosin (H&E) and Van Gieson (VG) stain were used to assess the cardio-histological changes. Colorimetric analysis was used to assay serum superoxide dismutase (SOD) activity, malondialdehyde (MDA), nitric oxide (NO), and hydroxyproline (Hyp) contents in cardiac tissue. Angiotensin II (Ang II) content in serum was assessed by radioimmunoassay; tetrahydrobiopterin (BH₄) content in cardiac tissue, BNP and endothelial NOS (eNOS) in serum were determined by using ELISA, and the protein expressions of c-Jun NH2-terminal kinase (JNK), P-JNK, p38, P-p38, and NADPH oxidases-2 (Nox-2) were measured by western blot.

Results

XJEK therapy could impair the heart systolic and diastolic function, potently improve the heart weight index, inhibit the elevation of HW/BW ratio, and markedly ameliorate hemodynamic indices and vascular remodeling index. It has blunted the decrease of SOD, NO and the increase in MDA and Ang II serum contents, myocardial cross-section area (CSA), collagen volume fraction (CVF) and perivascular circumferential collagen area (PVCA) compared to the hypertensive model group. It also reduced the serum content of Hyp while increased BH4 levels in cardiac tissue. In addition, the expressions of Nox-2, P-JNK and P-p38MAPK were all suppressed compared to the hypertensive model group. Moreover, treatment with XJEK improved endothelial dysfunction (ED) manifested by promoting eNOS activities and enhancing the NO activity in serum.

Conclusion

The results of the present study show that XJEK attenuates 2K1C-induced hypertension in rats, which confirms our hypothesis that XJEK has an anti-hypertensive and cardiovascular remodeling effect via attenuation of cardiac remodeling and improvement of endothelial dysfunction and oxidative stress.     

高血压老年病人合并高尿酸血症或痛风的临床研究

目的：调查分析高血压合并高尿酸血症（HU）或痛风的老年病人经护理健康教育后对HU和痛风知识的认知及对治疗遵从性的改善情况。方法：选择高血压合并HU或痛风的老年患者112例,给予护理健康教育干预,调查其干预前后对HU和痛风疾病的认知情况及对治疗的遵从情况,以及综合治疗前后血压和血尿酸。结果：112例患者在干预前对该疾病的认知和对治疗的遵从性普遍较低,通过健康教育后,患者对该病知识的知晓率普遍提高,对治疗的遵从性也明显提高。本组患者治疗前后血压分别为170±18／100±14mmHg,131±12／79±11mmHg,治疗后显著低于治疗前（P〈0．01）;治疗前后血尿酸分别为548±86μmol／L,294±53μmol／L,治疗后显著低于治疗前（P〈0．01）。结论：通过护理健康教育干预后,患者对HU和痛风的认知程度和对治疗的遵从性普遍提高,表明护理干预在高血压合并HU或痛风的治疗中有重要作用。     

护理干预对28例高血压病患者服药依从性的影响探讨

目的：研究护理干预在高血压病人服药依从性中的作用及治疗效果。方法：将2008年10月～2009年10月收治的56例高血压病患者分为对照组（28例）给予药物治疗和常规护理方法,护理干预组（28例）除常规护理方法外,由专人负责实施全程护理干预。结果：护理干预组实施护理干预措施后,两组患者的降压效果和患者的服药依相比较,在统计学差异有显著性（P〈0．05）。结论：在临床护理工作中采取相应的护理干预,加强高血压患者的管理,可增强高血压患者的服药依从性,对有效控制高血压有明显效果。     

The in vivo effects of Tulbhagia violacea on blood pressure in a salt-sensitive rat model

Aim of the study

The in vivo effects of Tulbhagia violacea on systemic arterial blood pressure and on the renin-angiotensin system in a Dahl salt-sensitive rat model were investigated.

Materials and methods

Animals were treated for 14 days intraperitoneally as follows: Tulbhagia violacea (Tvl) (50 mg/kg b.w.), captopril (Cap) (10 mg/kg b.w.) or DMSO (Con). Baseline blood pressures were recorded prior to the commencement of the study and biweekly during the experimental period. Urine volume and sodium concentration were measured during the experimental period. On day 15, animals were anaesthetized (sodium thiopentane, 50 mg/kg, i.p.), blood samples for aldosterone levels were taken and the kidneys removed for determining AT1a mRNA expression.

Results

Cap and Tvl groups showed significantly reduced AT1a mRNA expressions by 3.11- and 5.03-fold, respectively, when compared to the Con group (p < 0.05). When compared to baseline blood pressures (day 0); Cap and Tvl showed reductions in systolic blood pressure (SBP) of 7.76 ± 0.41% and 9.12 ± 0.31%, respectively (mean% decrease from day 0 to day 14). In contrast, in the Con group the systolic blood pressure increased from day 0 to day 14 by 4.66 ± 0.56%. Blood pressure changes in all treated groups differed from Con significantly. Systolic blood pressure decreased with the decrease in AT1a mRNA expressions in these groups. When comparing day 0 to day 14, urine output increased in the Cap and Tvl groups. In the Con group, urinary volume was reduced by day 14 as compared to day 0. Urinary sodium excretion was increased in the treated groups by day 14.

Conclusion

It can be concluded that Tulbhagia violacea reduces systemic arterial blood pressure in the Dahl rat by decreasing renal AT1 receptor gene expression and hence modulating sodium and water homeostasis.     

Polycystic ovary syndrome (PCOS)

Polycystic ovaries syndrome (PCOS) is one of the most common female hormonal disorders. Its multiple components--reproductive, metabolic, neoplasic and cardiovascular--have a major impact on the public health. Androgen excess and resistance to insulin, probably from genetic origin, are responsible for most of the clinical symptomatology. Resistance to insulin seems to be accompanied by a greater risk of glucose intolerance, type 2 diabetes, lipidic anomalies and can involve the development of cardiovascular diseases. In addition, sleep apnea syndrome is more progressively described in PCOS. Infertility, menses disorders and hirsutism often push these patients to consult their physician. A better understanding of the physiopathological mechanisms led to the emergence of new therapeutic options increasing the sensitivity to insulin. Besides the pregnancy wishes, cares aim to attenuate the marks of the hyper-androgenism (hormonal treatment and cosmetic) and to correct cardiovascular, respiratory and gynaecological risk factors. In case of infertility by anovulation, cares must be performed by trained experts to minimize the risk of ovarian hyper-stimulation syndrome and multiple pregnancies. A gradation from loose weight to clomiphene citrate ovulation induction, ovarian drilling, low dose gonadotropin, in vitro fertilisation, or in vitro maturation of oocytes should bring back good reproduction potential.     

高血压与正常血压病人脑动脉硬化和腔隙性脑梗死的影像比较分析

目的：探讨高血压与正常血压病人脑动脉发生粥样硬化狭窄和腔隙性脑梗死的磁共振影像差别。方法：使用0．3T永磁开放式磁共振成像系统,对2000例缺血性脑病的患者进行脑的T2 WI、T1 WI、FIR DE序列横断面和脑MRA检查。结果：高血压与正常血压病人脑动脉发生粥样硬化狭窄的程度和腔隙性脑梗死的数量有明显差别。结论：高血压病人脑动脉粥样硬化的程度比正常血压病人的程度较轻,而腔隙性脑梗死的程度较重。     

老年收缩期高血压的临床意义

本文报告300例老年高血压病并发症的多因素逐步回归分析。通过计算机运算,建立脑卒中组、心力衰竭组及冠心病组的三个最优回归方程。结果显示收缩期高血压与并发症密切相关,是一个危险因素,与舒张期高血压比较具有更重要的临床意义。