老年脑白质疏松合并高血压对患者认知功能的影响

目的探讨老年脑白质疏松(LA)合并高血压对患者认知功能的影响。方法选取2014年1月~2015年1月期间于我院神经内科门诊就诊或病房收治的42例老年LA合并高血压患者为研究对象,归为老年LA伴高血压组,并选择同期40例无脑白质病变的单纯老年高血压患者归为老年高血压组,以及来我院体检的30例健康老年人作为老年健康对照组。以蒙特利尔认知评估量表(Mo CA)评估3组的认知功能。结果老年LA伴高血压组的视空间与执行功能、命名、注意力、抽象及延迟回忆的评分及总分均显著低于老年健康对照组,差异均有统计学意义(P0.05)。且视空间与执行功能、抽象的评分及总分均显著低于老年高血压组,差异有统计学意义(P0.05)。老年LA伴高血压组的认知功能损害发生率显著高于老年高血压组及对照组,差异均有统计学意义(P0.05)。结论与老年高血压和健康老人相比,老年LA合并高血压患者的认知功能明显减退,认知功能障碍率明显升高,故需要对这些老年患者定期检测认知功能,对认知功能障碍进行早期干预。     

Fatal outcome of posterior reversible encephalopathy syndrome (PRES) in a lupus nephropathy patient: A case report

Posterior reversible encephalopathy syndrome is a rare underestimated condition, that generally complicates a rise in blood pressure in an acute setting. This entity has been increasingly identified in patients with systemic lupus erythematosus disease. PRES is challenging to diagnose seeing as it presents with nonspecific neurological symptoms, such as head-aches, confusion, seizures, visual changes or a coma, and can mimic neuropsychiatric lupus. Imaging plays a necessary role in confirming this diagnosis, as it is characterized by vasogenic edema of the posterior white matter, in which the distribution is bilateral and symmetrical. Although this syndrome is rare, early diagnosis allows a prompt treatment and therefore a favorable outcome. We present a case report of PRES in a 14-year-old female previously diagnosed with lupus nephropathy, who presented to the emergency department with seizures and uncontrolled hypertension, that was unfortunately not reversible is this patient.     

Association of left ventricular diastolic function with coronary artery calcium score: A Project Baseline Health Study

BackgroundCoronary artery calcium (CAC) and left ventricular diastolic dysfunction (LVDD) are strong predictors of cardiovascular events and share common risk factors. However, their independent association remains unclear.MethodsIn the Project Baseline Health Study (PBHS), 2082 participants underwent cardiac-gated, non-contrast chest computed tomography (CT) and echocardiography. The association between left ventricular (LV) diastolic function and CAC was assessed using multidimensional network and multivariable-adjusted regression analyses. Multivariable analysis was conducted on continuous LV diastolic parameters and categorical classification of LVDD and adjusted for traditional cardiometabolic risk factors. LVDD was defined using reference limits from a low-risk reference group without established cardiovascular disease, cardiovascular risk factors or evidence of CAC, (n ?= ?560). We also classified LVDD using the American Society of Echocardiography recommendations.ResultsThe mean age of the participants was 51 ?± ?17 years with 56.6% female and 62.6% non-Hispanic White. Overall, 38.1% had hypertension; 13.7% had diabetes; and 39.9% had CAC >0. An intertwined network was observed between diastolic parameters, CAC score, age, LV mass index, and pulse pressure. In the multivariable-adjusted analysis, e’, E/e’, and LV mass index were independently associated with CAC after adjustment for traditional risk factors. For both e’ and E/e’, the effect size and statistical significance were higher across increasing CAC tertiles. Other independent correlates of e’ and E/e’ included age, female sex, Black race, height, weight, pulse pressure, hemoglobin A1C, and HDL cholesterol. The independent association with CAC was confirmed using categorical analysis of LVDD, which occurred in 554 participants (26.6%) using population-derived thresholds.ConclusionIn the PBHS study, the subclinical coronary atherosclerotic disease burden detected using CAC scoring was independently associated with diastolic function.Clinicaltrials.gov identifierNCT03154346.     

3种透析方式对于维持性血液透析患者难治性高血压的疗效观察

目的观察血液透析、血液透析并滤过和血液透析＋血液透析并滤过3种血液净化治疗方法对维持性血液透析患者难治性高血压的临床疗效。方法将60例维持性血液透析患者随机分为3组,即血液透析组、血液透析并滤过组和血液透析＋血液透析并滤过组各20例。血液透析组每周行血液透析治疗3次;血液透析并滤过组每周行血液透析并滤过治疗3次;血液透析＋血液透析并滤过组每周行血液透析治疗2次,血液透析并滤过治疗1次。观察治疗4周和8周后血压的变化。结果血液透析组治疗4周和8周后和治疗前相比,患者血压差异无统计学意义（P〉0．05）;血液透析并滤过组和血液透析＋血液透析并滤过组中,治疗4周后两组血压都较本组治疗前明显下降（P〈0．05）;但两组间比较,差异均无统计学意义（P〉0．05）;治疗8周与治疗4周时相比,两组患者血压均基本保持稳定,没有明显进一步下降,差异无统计学意义（P〉0．05）。结论血液透析＋血液透析并滤过及血液透析并滤过两种血液净化方式均可以有效改善血液透析患者难治性高血压,而且血液透析＋血液透析并滤过比血液透析并滤过方式更为经济。     

完全腹腔镜脾切除断流术治疗肝硬化门静脉高压症

目的 探讨完全腹腔镜下巨脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症的可行性、有效性和安全性.方法 对26例患者行巨脾切除联合贲门周围血管离断术,其中16例行完全腹腔镜下二级脾蒂离断法脾切除联合贲门周围血管离断术,10例行传统开腹手术.比较两组的手术时间、术中出血量、术后并发症发生率、术后外周血血小板数值及术后住院时间等.结果 腹腔镜组成功完成手术12例,中转开腹4例.腹腔镜组与开腹组平均手术时间分别为(315±77) min和(291±31)min,两组相比差异无统计学意义,t=0.892,P=0.384;术中平均出血量分别为(409±216) ml和(980±402) ml,两组相比差异有统计学意义,t=4.105,P＜0.01;术后并发症发生率分别为17％和30％,两组相比差异无统计学意义,x2=0.064,P=0.525;术后平均住院时间分别为(10±3)d和(17±8)d,两组相比差异有统计学意义,t=2.539,P＜0.01.结论 完全腹腔镜下巨脾切除联合贲门周围血管离断术安全、可行、有效,具有出血少、痛苦小、术后住院时间短的优点,是一种值得推广的微创手术.     

贲门周围血管断流术治疗肝硬化门静脉高压症

目的 评估贲门周围血管离断术治疗肝硬化门静脉高压症合并食管胃底曲张静脉破裂出血的效果.方法 回顾性分析1996年1月至2007年10月间收治的85例肝硬化门静脉高压患者接受贲门周围血管离断术的资料.结果 本组随访率为78％.全组患者术后1、3和5年生存率分别为95％、88％和82％,肝功能Child A级与Child B级患者术后生存时间之间相比差异有统计学意义(P＜0.05),1、3和5年出血率分别为6％、16％和28％,肝性脑病发生率为7％.贲门周围血管离断术后7d时患者丙氨酸转氨酶、天门冬氨酸转氨酶和血清白蛋白已恢复至术前状态.结论 贲门周围血管离断术是治疗门静脉高压症食管胃底曲张静脉破裂出血的可靠手段,肝功能储备是影响患者术后长期生存的关键因素.     

肺动脉高压形成中的血管重构分子生物学机制研究进展

肺动脉高压（PAH）是以肺动脉压和肺血管阻力升高为特征的临床血流动力学症候群,可导致右心衰竭和死亡。血管重构是PAH最显著的组织病理学特征,其形成受多方面因素的调控。内质网应激、钙紊乱和线粒体功能紊乱通过调节细胞内钙稳态和细胞代谢调控血管细胞的增殖凋亡能力;表观遗传学现象（如DNA损伤和微小RNA表达异常）参与调控血管细胞的异常增殖;血管细胞表型转化（包括内皮细胞间质转化和平滑肌细胞表型转换）是引起血管细胞异常增殖的重要原因。血管重构由多种细胞和分子通路共同作用产生,针对多靶点来改善PAH中发生的异常血管重构,进而延缓甚至逆转PAH的进程,有望成为PAH治疗上新的突破口。     

《2018年欧洲高血压管理指南》解读

随着心血管病的防治理念逐渐由被动防治转向主动预防,高血压作为心血管病的首要危险因素,也越来越受到重视,近年来有关降压治疗带来心血管病获益的临床循证医学证据不断积累,2018年欧洲心脏病学会年会上发布的《2018年欧洲高血压管理指南》,较《2013年欧洲高血压管理指南》在高血压的管控方面有较大更新,既沿用了以往的一些理念,又更新了许多新的内容,新版高血压管理指南在高血压诊断、血压测量、高血压的风险分层、降压治疗的启动时机、降压治疗的目标值变化、高血压的治疗、难治性高血压与继发性高血压的处理等方面均进行了全面而详细的阐述,其在高血压防控方面加大了力度,尤其在高血压的启动治疗时机、启动治疗的血压阈值、治疗药物的起始联合用药及对单片固定复方制剂的优先推荐以及高血压患者的血压监测及综合管理的治疗理念方面,值得临床借鉴与学习。