原发性高血压患者血清可溶性E选择素水平与胰岛素抵抗的关系

目的:探讨高血压病患者血清可溶性E-选择素(sE-selectin)浓度与胰岛素抵抗、尿酸及血脂的关系。方法:测定186例高血压病患者(男75例,女111例)的空腹血清sE-selectin、血糖、胰岛素、尿酸、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇的浓度,稳态模式评估法计算胰岛素抵抗指数(HOMA-IR)。分析血清sE-selectin浓度与其它各项参数的相关性。结果:以HOMA-IR50%位点,作为判断胰岛素抵抗的切割点,把高血压病患者分为胰岛素抵抗组(IR)与胰岛素敏感组(IS)。男性组血清sE-selectin浓度(50.1±17.8)μg/L显著高于女性组(40.6±16.6)μg/L;男性IR组(51.6±16.8)μg/L与IS组(48.5±18.8)μg/L无显著差异;女性IR组(45.1±18.0)μg/L显著高于IS组(36.0±13.7)μg/L。逐步回归分析显示,男性组HOMA-IR非血清sE-selectin浓度的独立预测因子,但女性组HOMA-IR是血清sE-selectin浓度的独立预测因子;尿酸和血脂均非血清sE-selectin浓度的独立预测因子。结论:女性原发性高血压患者血清sE-selectin浓度与胰岛素抵抗直接相关,男性则无直接相关;尿酸及血脂与血清sE-selectin浓度均无直接相关。     

Fas在妊娠过程中表达变化的研究

目的探讨Fas在正常妊娠过程及妊娠期高血压疾病(HDCP)中的表达变化及意义。方法分别选取正常妊娠早期和晚期及HDCP胎盘绒毛组织。采用免疫组织化学方法检测Fas表达,并用高清晰彩色病理图像分析系统对其表达进行分析。结果Fas在妊娠早期胎盘组织中极少表达,妊娠晚期胎盘组织中表达增高。HDCP胎盘组织中Fas表达明显升高,与前两组比较差异有极显著性(P<0.01)。结论孕早期滋养细胞表面Fas表达在母胎免疫耐受中发挥重要作用,孕晚期Fas表达增加可能是引起HDCP的原因之一。     

Gestörte alpha2-Adrenozeptorfunktion bei Hämodialysepatienten mit renaler Anämie — eine mögliche Ursache der Blutdrucksteigerung unter rekombinantem humanem Erythropoietin?

Summary Nine patients on maintenance hemodialysis and transfusion-demanding renal anemia (group A) were treated with rHuEPO 120 IU/kg i.v. three times per week. Hemoglobin-content was raised from 7.2±0.9 to 10.4±0.8 g/dl. In all patients blood pressure rose, three patients developed arterial hypertension. Mean diastoloic blood pressure was 66±12 and 78±16 mmHg (p<0.001) before and after rHuEPO. Rise in blood pressure was accompanied by a significant fall in plasma-noradrenaline-levels (from 498±100 to 383±75 pg/ml;p<0.05) and alpha₂-adrenoceptor-density (from 574±76 to 384±49;p<0.05). Compared to nine patients on maintenance hemodialysis and hematocrit over 30% (group B), patients with severe renal anemia (group A before treatment) had higher densities of alpha₂-adrenoceptors (574±76 vs. 218±32;p<0.001) despite higher plasma-noradrenaline-levels (498±100 vs. 399±63; n.s.). We suppose a anemia-related disturbance of alpha₂-receptor-function with the result of abolished receptor down-regulation and impaired vascular reagibility to vasoconstricting stimuli. With the correction of anemia receptor-function improves, receptor down-regulation as well as vascular reagibility is re-established resulting in augmented vascular resistance and higher blood pressure.

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Abkürzungen rHuEPO rekombinantes humanes Erythropoietin - teMAP mittlerer arterieller Blutdruck - RR Blutdrucknach RIVA-ROCCI - RBF regionaler Blutfluß - RPR regionaler peripherer Widerstand     

Predicting Home and Work Blood Pressure Measurements from Resting Baselines and Laboratory Reactivity in Black and White Americans

The relationship between blood pressure in the laboratory (both at rest and in response to laboratory tasks) and ambulatory blood pressure at home and at work was evaluated. One hundred nineteen normotensive and unmedicated mild-moderate hypertensive black and white females and males participated in laboratory blood pressure monitoring at rest and during four challenging tasks (structured interview, video game, bicycle exercise, and cold pressor test) as well as ambulatory blood pressure monitoring while at home and at work. Baseline blood pressure taken while subjects were at rest was the strongest predictor of ambulatory systolic blood pressure (r = .64) and diastolic blood pressure (r = .77) at work. Among reactivity tasks the strongest predictors of ambulatory blood pressure in the total population were the structured interview and the video game (both psychological tasks) followed by the cold pressor test. Racial comparisons, however, determined that the cold pressor test predicted diastolic blood pressure significantly better for blacks (r = .73) than for whites (r = .40), suggesting a possible difference in blood pressure regulation.     

原发性开角型青光眼与高血压的关系

目的 探讨原发性开角型青光眼与高血压病的关系．方法 随机选择确诊原发性开角型青光眼50例，高血压病50例，观察眼压、血压、视乳头C／D比，视野，归纳总结．结果 50例原发性开角型青光眼中，血压高者25例(50％)．50例高血压病中，眼压高者38例(76％)，视野损害40例(80％)，光敏度下降35例(70％)，中心暗点25例(50％)，周边视野缩小17例(34％)，生理盲点扩大17例(34％)．结论 原发性开角型青光眼与高血压病有极大关联．     

Plasma lipids and lipoproteins and essential hypertension

In recent years there have been many studies demonstrating a correlation between increased arterial blood pressure and altered lipid profiles, and there has been an especially positive correlation between high cholesterol levels and blood pressure. There are differences between the various reports that are important. In our study the lipid distribution in 105 hypertensive patients with mild or moderate arterial hypertension according to WHO criteria without clinically or ultrasonographically apparent atherosclerosis was compared to the lipid distribution in 65 age-matched healthy persons. On the epidemiological level a significant, positive association was found between LDL serum levels (P 0.001), Apo B serum levels (P 0.001), serum triglyceride levels (P 0.05) and VLDL serum levels (P 0.01) and arterial hypertension. However, in contrast to recent reports, no significant difference was found between total serum cholesterol levels in normotensives and hypertensives, and there was no difference in HDL serum levels. No evidence could be found for a significant increase in lipoprotein (a) serum levels in hypertensives.Abbreviations LDL low density lipoprotein - VLDL very low density lipoprotein - HDL high density lipoprotein - Apo B 100 apolipoprotein B 100 - Apo A I apolipoprotein A I Correspondence to: H. Vetter     

Blutdruck,relatives Körpergewicht,Alkoholkonsum und Elektrolytausscheidung in der BRD und der DDR: Die Intersalt-Studie

Summary The relationships between body mass index (BMI) and age, alcohol consumption, 24-hr urinary electrolyte excretion, and BP were studied in 588 subjects from three German centers participating inIntersalt, a highly standardized, previously reported protocol. Men and women aged 20–59 were sampled in Bernried, FRG; Cottbus, GDR; and Heidelberg, FRG. The subjects from the three centers did not differ in BMI, level of education, physical activity, cigarette- or alcohol-consumption patterns, or urinary Cl excretion. Mean Na excretion was 167, 147, and 172 mmol/24 hr in Bernried, Cottbus, and Heidelberg, while mean K excretion was 72, 55, and 73 mmol/24 hr, respectively. The excretion of these electrolytes was significantly lower in Cottbus than in Bernried or Heidelberg. BMI increased progressively in men with age; in women BMI plateaued until the 5th decade, after which it increased to equal that of men. In individual centers, the excretion of electrolytes was correlated with BML Sodium and chloride excretion were highly correlated. The data from each individual center were fitted to a multiple regression model. Age, BMI, sex, and alcohol consumption entered the model.

     

Family History of Hypertension and Cardiovascular Responses to Orthostatic Stress

Cardiovascular effects of orthostatic stress (sitting to standing) were assessed in 60 healthy young male subjects according lo family history of hypertension (half with a positive and half with a negative family history' of hypertension). Systolic (SBP) and diastolic blood pressure (DBF) were recorded on each successive heart heal using a non-invasive blood pressure tracking system. Heart rate (HR) and respiration rate (RR) were also recorded. During the postural change, characteristic phasic changes were shown with an initial fall and subsequent recover of SBP and DBF and a mirror image response in MR and RR. Phasic analysis of the pre-standing sit, peak/trough, and recovery stand values indicated group differences in the initial as well as the later phases of orthostatic response. In the initial phase, subjects with a positive family history of hypertension showed an earlier trough in systolic and pulse pressure and an earlier peak in heart rate response immediately on standing up. The level of the pulse pressure trough was also higher in these subjects. In the later standing phase, these subjects showed higher levels of pulse pressure. The results were interpreted in terms of increased sympathetic nervous system activity during the initial phase and structural and neurocirculatory abnormalities in the later phase of orthostatic regulation in individuals with a positive family history of hypertension.     

不同年龄高血压大鼠心肌中MKP-1的表达及对心肌肥厚的影响

目的：研究不同年龄的自发性高血压大鼠（SHR）和Wistar Kyoto大鼠（WKY）心室肌组织中丝裂原活化蛋白激酶（MAPK）及其磷酸酶（MKP-1）的表达以及与心肌肥厚的关系。方法： 用左心室重量与体重的比值作为心肌肥大指数并以此指标反映心肌肥厚；分别用Western blotting方法和RT-PCR法半定量测定心室肌组织中磷酸化细胞外信号调节激酶（p-ERK）的蛋白表达和MKP-1 mRNA的含量。结果： （1）SHR的血压自8周龄起明显高于WKY（P<0.01），心肌肥大指数明显大于WKY（P<0.05），ERK和MKP-1的表达均比WKY高（P<0.05）；（2）SHR的血压随年龄增长而升高（P<0.05），至14周趋于稳定，心肌肥大指数则在24周时出现激增（P<0.01）；（3）p-ERK随年龄增长呈递增趋势，而MKP-1呈递减趋势，且与心肌肥大指数和ERK的表达呈负相关（P<0.01）。结论： MKP-1在高血压大鼠随年龄和血压增加的心肌肥厚过程中起重要作用，其表达逐渐下降可能是导致ERK激活增加，进而引起心肌细胞肥大的重要原因。     

胎盘生长因子在妊娠期高血压疾病胎盘组织中的定位及定量分析

目的探讨胎盘生长因子(placental growth factor,PLGF)在妊娠期高血压疾病胎盘中定位及定量表达。方法选择妊娠期高血压疾病患者46例,其中子痫前期重度23例,子痫1例;慢性高血压并发子痫前期1例,选择同期正常妊娠妇女20例作为对照组。采用免疫组织化学染色法和免疫印迹(Western blot)方法检测两组患者胎盘PLC蛋白定位及定量表达。结果 (1)免疫组织化学染色发现PLGF蛋白在妊娠期高血压疾病组及正常妊娠组胎盘中分布范围基本一致, 主要分布在绒毛合体滋养细胞和间质细胞的胞浆,部分血管合体膜上也有PLGF阳性染色。(2)Western blot方法检测妊娠期高血压疾病组子痫前期轻、重度胎盘绒毛PLGF蛋白表达低于正常妊娠组(0.3±0.4 vs 0．6±0．4、0．2±0．5 vs 0．6± 0．4),差异有统计学意义(P<0．01);妊娠期高血压患者胎盘中PLGF蛋白的表迭为0．5±0．6,与对照组比较,差异无显著性(P>0．05)。结论胎盘PLGF蛋白表达异常在妊娠期高血压疾病发病中可能具有重要的作用。