6分钟步行运动训练对射血分数正常的心力衰竭患者运动耐力及左室舒张功能的影响

目的 探讨6 min步行运动训练对射血分数正常心力衰竭患者运动耐力及左室舒张功能的影响.方法 采用随机数字表法将90例射血分数正常心力衰竭患者分为训练组及对照组,每组45例患者.2组患者均给予常规药物治疗(包括利尿剂、血管紧张素转换酶抑制剂或血管紧张素受体阻断剂、CC钙离子阻断剂及控制高血压、房颤、糖尿病、冠心病等药物),治疗组在上述治疗基础上辅以6 min步行运动训练.2组患者治疗时间均为6个月.于治疗前、后分别检测2组患者血浆脑钠肽前体N末段(NT-proBNP)水平,采用彩超测定心脏左房容积指数(LAVI),同时观察2组患者治疗前、后6 min步行距离变化情况.结果 2组患者分别经6个月治疗后,发现训练组NT-proBNP浓度[心功能Ⅱ级患者运动后为(331.9±107.3) pg/ml,心功能Ⅲ级患者运动后为(442.7±124.1)pg/ml]、6 min步行距离[心功能Ⅱ级患者为(493.0 ±56.8)m,心功能Ⅲ级患者为(385.0 ±48.7)m],对照组NT-proBNP浓度[心功能Ⅱ级患者运动后为(398.2±111.7) pg/ml,心功能Ⅲ级患者运动后为(534.1±124.9) pg/ml]、6 min步行距离[心功能Ⅱ级患者为(369.0±48.9)m,心功能Ⅲ级患者为(306.0±40.4)m],均较治疗前显著改善(P＜0.05),并且训练组6 min步行运动距离、LAVI[心功能Ⅱ级患者为(25.1±8.1)ml/m2,心功能Ⅲ级患者为(28.5±9.0) ml/m2]及NT-proBNP表达均显著优于对照组水平(均P ＜0.05).结论 6 min步行运动训练能显著改善射血分数正常心衰患者的运动耐力及左室舒张功能,有益于延缓病情进展及提高生活质量.     

Diabetes and Myocardial Fibrosis: A Systematic Review and Meta-Analysis

ObjectivesThis systematic review and meta-analysis investigated the association of diabetes and glycemic control with myocardial fibrosis (MF).BackgroundMF is associated with an increased risk of heart failure, coronary artery disease, arrhythmias, and death. Diabetes may influence the development of MF, but evidence is inconsistent.MethodsThe authors searched EMBASE, Medline Ovid, Cochrane CENTRAL, Web of Science, and Google Scholar for observational and interventional studies investigating the association of diabetes, glycemic control, and antidiabetic medication with MF assessed by histology and cardiac magnetic resonance (ie, extracellular volume fraction [ECV%] and T₁ time).ResultsA total of 32 studies (88% exclusively on type 2 diabetes) involving 5,053 participants were included in the systematic review. Meta-analyses showed that diabetes was associated with a higher degree of MF assessed by histological collagen volume fraction (n = 6 studies; mean difference: 5.80; 95% CI: 2.00-9.59) and ECV% (13 studies; mean difference: 2.09; 95% CI: 0.92-3.27), but not by native or postcontrast T₁ time. Higher glycosylated hemoglobin levels were associated with higher degrees of MF.ConclusionsDiabetes is associated with higher degree of MF assessed by histology and ECV% but not by T₁ time. In patients with diabetes, worse glycemic control was associated with higher MF degrees. These findings mostly apply to type 2 diabetes and warrant further investigation into whether these associations are causal and which medications could attenuate MF in patients with diabetes.     

Prevalence and predictors associated with severe pulmonary hypertension in COPD

Background

Pulmonary hypertension (PH) is one of the most common complications of COPD (chronic obstructive pulmonary disease), but its severe form is uncommon. Various factors play an important role in the occurrence and severity of pulmonary hypertension in patients.

Utility of flow cytometric reticulocyte quantification as a predictor of engraftment in autologous bone marrow transplantation

Flow cytometric reticulocyte quantification with thiazole orange (TO) was used to study erythropoiesis in 20 patients following autologous bone marrow transplantation for the treatment of acute myelogenous leukemia. Flow cytometric reticulocyte analysis provided not only the reticulocyte percentage and absolute reticulocyte count but a quantitative reticulocyte maturity index (RMI) proportional to the amount of RNA in the reticulocytes. The RMI values, but not the reticulocyte percentage or absolute counts, correlated temporally with the rise in the absolute neutrophil counts in the posttransplantation period. In the majority of patients (12/20), the RMI value was the earliest indicator of bone marrow engraftment. The findings of this study demonstrate an important clinical utility of TO reticulocyte analysis by flow cytometry and indicate the diagnostic importance of the RMI measurement in the evaluation of erythropoietic activity in bone marrow transplant patients.