心先安治疗老年顽固性心力衰竭临床疗效评价

目的 :心先安治疗顽固性心力衰竭的有效性和安全性。方法 :75例顽固性心力衰竭患者随机分为 :心先安治疗组 (A组 ) (38例 )和对照组 (B组 ) (37例 ) ,均予采用标准抗心衰治疗 (依那普利、速尿、地高辛 )。A组联用心先安 90～ 180 mg/ d,观察治疗前和治疗后的临床指标变化 ,评价其临床有效性和安全性。结果 :与 B组比较 ,A组用药后 ,无创心排量指标和临床心功能分级显著改善 ,总有效率达 89.4 % ,与 B组比较有显著性差异 (P<0 .0 5 )。结论 :心先安临床用药安全、疗效确切、无明显的毒副作用 ,是治疗顽固性心力衰竭的有效药物     

美托洛尔治疗不伴心力衰竭的扩张型心肌病的疗效观察

目的探讨美托洛尔治疗不伴有心力衰竭的扩张型心肌病的临床疗效。方法将湖南省桃源县红十字会医院收治的94例早期扩张型心肌病患者随机分为观察组和对照组,各47例。均给予吸氧、抗凝、抗血小板聚集、强心、利尿,扩血管及降低心脏负荷等常规治疗和对症处理。观察组患者在此基础上加用美托洛尔口服治疗。所有患者均接受6个月的治疗,测定患者治疗前后左房内径(LA)、左室舒张末期内径(LVEDD)和左室射血分数(LVEF),并评估两组患者接受治疗后的生活质量。结果两组患者接受治疗后心率、左房内径、左室舒张末期内径和左室射血分数均显著优于治疗前,差异有统计学意义(P<0.05),且观察组显著优于对照组,差异有统计学意义(P<0.05);所有患者接受治疗6个月后,观察组患者生活质量总分显著高于对照组患者(P<0.01)。结论美托洛尔治疗不伴有心力衰竭的扩张型心肌病患者可显著改善各项心功能指标,延缓疾病发展,提高患者生活质量,值得临床推广。     

Effects of ozone and fine particulate matter (PM2.5) on rat system inflammation and cardiac function

In order to understand the toxic mechanisms of cardiovascular system injuries induced by ambient PM_2.5 and/or ozone, a subacute toxicological animal experiment was designed with exposure twice a week for 3 continuous weeks. Wistar rats were randomly categorized into 8 groups (n = 6): 1 control group, 3 groups exposed to fine particulate matters (PM_2.5) alone at 3 doses (0.2, 0.8, or 3.2 mg/rat), 1 group to ozone (0.81 ppm) alone and 3 groups to ozone plus PM_2.5 at 3 doses (0.2, 0.8, or 3.2 mg/rat). Heart rate (HR) and electrocardiogram (ECG) was monitored at approximately 24-h both after the 3rd exposure and the last (6th) exposure, and systolic blood pressure (SBP) was monitored at approximately 24-h after the 6th exposure. Biomarkers of systemic inflammation and injuries (CRP, IL-6, LDH, CK), heart oxidative stress (MDA, SOD) and endothelial function (ET-1, VEGF) were analyzed after the 6th exposure. Additionally, myocardial ultrastructural alterations were observed under transmission electron microscopy (TEM) for histopathological analyses. Results showed that PM_2.5 alone exposure could trigger the significant increase of CRP, MDA, CK, ET-1 and SBP and decrease of heart rate variability (HRV), a marker of cardiac autonomic nervous system (ANS) function. Ozone alone exposure in rats did not show significant alterations in any indicators. Ozone plus PM_2.5 exposure, however, induced CRP, IL-6, CK, LDH and MDA increase, SOD and HRV decrease significantly in a dose–response way. Meanwhile, abnormal ECG types were monitored in rats exposed to PM_2.5 with and without ozone and obvious myocardial ultrastructural changes were observed by TEM. In conclusion, PM_2.5 alone exposure could cause inflammation, endothelial function and ANS injuries, and ozone potentiated these effects induced by PM_2.5.     

从玄府理论论治肝纤维化

肝纤维化基本病机为玄府郁闭、肝脾失养、络脉瘀阻.外感湿毒及情志内伤阻滞气机,使肝失调达,气机郁闭,疏泄失常,久则酿生火、热、毒邪,阻滞玄府.饮食内伤、外感湿毒或他邪及脾,导致脾失健运,运化失司,湿聚而不散,痰湿内生,导致气血津液失调,一则气血津液生成不足,则玄府失于濡养而致闭塞;二则湿邪困阻,气血津液运行不畅,湿郁蕴热...     

Impact of mercury exposure on blood pressure and cardiac autonomic activity among Cree adults (James Bay, Quebec, Canada)

Aboriginal populations from Quebec (Canada) are exposed to higher mercury levels than southern regions since these populations consume high quantities of fish. Epidemiological evidence suggests a detrimental impact of mercury on cardiovascular risk factors such as heart rate variability (HRV) and blood pressure (BP). The objective of this study was to assess the impact of mercury exposure on BP, resting heart rate (HR) and HRV among Cree adults. Data were collected among 791 adults ≥18 years old living in seven communities of the James Bay. Blood mercury and hair levels were used as biomarkers of recent and long-term exposure. BP was measured through a standardised protocol while HRV was derived from a 2-h Holter monitoring assessment. The relationship between mercury and the outcomes was studied using ANOVA and ANCOVA analysis. Geometric mean of blood mercury and hair mercury concentration was 17.0 nmol/L (95%CI: 6.1–44.0) and 2.36 nmol/g (95%CI: 2.09–2.65); respectively. After adjusting for confounders, blood mercury was associated with HRV parameters such as LF (β=0.21, P=0.0002), HF (β=0.15, P=0.004) and LF/HF (β=0.06, P=0.003). Similar associations were observed with hair mercury. In contrast, no significant association was observed between blood mercury or hair mercury and BP after adjusting for confounders. In conclusion, mercury exposure seems to affect HRV among Cree adults even after considering fish nutrients (n-3 fatty acids and selenium) and other contaminants (lead and polychlorinated biphenyls) that are also present in the traditional diet of this population.     

The cardiorenal syndrome in heart failure

The frequently occurring condition of renal failure in heart failure (HF) has been termed the cardiorenal syndrome. However, the importance of renal insufficiency in HF has only been embraced in the last decade, and therefore, the pathophysiology of cardiorenal failure is still poorly understood. The main driving force of renal failure in HF is probably hemodynamic derangement, with both reduced renal perfusion and increased venous pressure as the most important driving forces. Different cardiorenal connectors may modulate this relationship. Furthermore, renal failure is not only limited to reduced filtration but also includes glomerular hypertension and tubulointerstitial hypoxia, leading to loss of glomerular integrity and tubular damage. Recognition of these key pathophysiologic pathways in the concept of the cardiorenal syndrome is needed to value the interrelationship and incremental contribution of different risk markers and possible new treatments to improve renal function and outcome in this complex and bidirectional interplay between the heart and the kidney.     

A high-fat diet and the threonine-encoding allele (Thr54) polymorphism of fatty acid-binding protein 2 reduce plasma triglyceride-rich lipoproteins

The threonine-encoding allele (Thr54) of the fatty acid-binding protein 2 (FABP2) DNA polymorphism is associated with increased triglyceride (TG)-rich lipoproteins (TRL). We hypothesized that the TRL response to diets of varied fat content is affected by the FABP2 A54T polymorphism, specifically that a high-fat diet would reduce TRL and that the Thr54 allele would have an enhanced response. Sixteen healthy, postmenopausal women completed a crossover dietary intervention that included three 8-week, isoenergetic diet treatments. The treatments consisted of high fat (40% of energy as fat), low fat (20% of energy), and low fat + n-3 fatty acids (20% of energy plus 3% as n-3 fatty acids). Eight subjects were homozygous for the wild type (Ala54/Ala54) of the FABP2 polymorphism, whereas 8 subjects had at least 1 Thr54 allele (7, Ala54/Thr54; 1, Thr54/Thr54). High-fat diet showed significantly reduced plasma TGs, chylomicron TG, and very low-density lipoprotein TG from baseline in all participants. Although carriers of the Thr54 allele of the FABP2 polymorphism had significantly reduced TRL, there is no evidence of an interaction, which does not support our hypothesis. The alanine-encoding allele did not influence the dietary effects on the plasma lipids.