培哚普利对慢性心力衰竭患者血清生长分化因子15水平的影响

目的研究培哚普利对慢性心力衰竭(心衰)患者血清生长分化因子15(GDF-15)水平的影响及与病情的相关性。方法将79例慢性心衰(心衰组)患者随机再分为2组:小剂量组39例,大剂量组40例,疗程6个月。另选择40例仅有心血管病危险因素的患者作为对照组。ELISA法检测2组治疗前后GDF-15、N末端B型钠尿肽前体(NT-proBNP)水平;分析GDF-15与NT-proBNP、纽约心功能分级(NYHA)、超声心动图指标的相关性。结果心衰组GDF-15、NT-proBNP水平明显高于对照组(P<0.01)。NYHAⅠ～Ⅳ级患者GDF-15、NT-proBNP水平随NYHA逐级递增(P<0.01)。GDF-15分别与NT-proBNP(r=0.903,P=0.000)、NYHA(r=0.636,P=0.000)、左心室舒张末内经(r=0.806,P=0.000)呈正相关,与LVEF(r=-0.704,P=0.000)呈负相关。治疗6个月后,小剂量组与大剂量组GDF-15、NT-proBNP水平较治疗前明显降低(P<0.01),大剂量组较小剂量组降低更明显(P<0.01)。结论 GDF-15可作为新的心衰标记物,有助于评估疗效和预后。     

氯吡格雷治疗不稳定型心绞痛的疗效观察

目的 探讨氯吡格雷治疗不稳定型心绞痛的临床效果.方法 选择不稳定型心绞痛患者100例,随机分为观察组与对照组各50例,对照组给予常规治疗,观察组在常规治疗的基础上加用氯吡格雷治疗,观察两组的临床疗效.结果 观察组的总有效率明显高于对照组,两组比较,差异有统计学意义 (χ2=10.25,P＜0.05);观察组治疗后各指标与对照组比较,差异有统计学意义(P＜0.05).两组不良反应情况比较,差异无统计学意义(P＞0.05).结论 氯吡格雷治疗不稳定型心绞痛疗效满意,值得临床推广应用.     

病例分析教学法在心内科临床教学中的改进

为了更好地激发学生的学习积极性，培养学生临床思维能力，在心内科临床教学中改进了病例分析教学法。通过这种方法，学生能更有效地掌握心内科知识，同时提高了综合分析能力，改善了教学效果。     

心绞痛患者CD4^＋CD25^＋Foxp3^＋调节性T细胞检测及意义

目的 探讨不稳定型心绞痛患者外周血CD+4CD+25Foxp3+T细胞的水平及意义.方法 采用流式细胞分析法,检测26例不稳定型心绞痛(观察组)和36例健康对照者(对照组)外周血CD+4CD+25Foxp3+T细胞比例.结果 观察组的CD+4CD+25T细胞与CD+4T细胞比例为(7.18±2.37)%显著低于对照组的(8.81 ±1.50)%(P<0.05);观察组的CD+4CD+25Foxp3+T细胞与CD+4T细胞比例为(1.43±0.55)%也显著低于对照组的(1.75 ±0.58)%(P<0.05).结论 CD+4CD+25Foxp3+调节性T细胞比例降低可能打破了外周免疫耐受,参与了不稳定型心绞痛患者动脉粥样硬化的发生发展.     

国产与进口消融导管治疗室上速的成功率与并发症的对比研究

目的：比较国产温控射频消融导管和进口温控射频消融导管的临床疗效和安全性。方法：通过随机化软件将40例患者随机分入国产射频消融导管组与进口射频消融导管组,每组20例。对两种射频消融导管的推拉阻力、推拉稳定性、柔顺性、可塑性、推拉杆推拉时远段弯曲的可控性、导管推送性能、导管扭转性能7个方面分别进行评分,按满意度5分为最佳,1分为最差,同时记录每一位患者有无并发症。结果：国产温控射频消融导管组和进口温控射频消融导管组成功率相同,各有I例胸痛或迷走反射发生（P〉0．05）,国产温控射频消融导管与进口导管在性能方面相比无差异（P〉0．05）。结论：国产温控射频消融导管在疗效、安全性及性能方面基本达到同类进口导管的水平,适宜在全国各家医院推广使用。     

心肌梗死患者白细胞增多临床意义的探讨

目的 :探讨白细胞计数与急性心肌梗死 (AMI)的关系。方法 :测定 4 3例AMI患者白细胞计数及中性粒细胞数 ,并与 4 3例健康对照组作比较。结果 :AMI组白细胞计数明显高于对照组〔(9 77± 8 4 1 )× 1 0 9/L比 (7 1 8± 5 2 7)× 1 0 9/L ,P <0 0 1〕 ;AMI组的中性粒细胞数也明显高于对照组〔(6 2 4± 2 4 5 )× 1 0 9/L比 (3 81± 1 36 )× 1 0 9/L ,P <0 0 1〕。结论 :白细胞增多与AMI关系密切。动态观察白细胞的变化 ,可能成为AMI患者病情监测及预后判断的辅助指标     

多西环素对大鼠急性心肌梗死后转化生长因子-β1表达及心肌细胞凋亡的影响

目的：探讨多西环素对大鼠急性心肌梗死(MI)后转化生长因子-β1(TGF-β1)表达及心肌细胞凋亡的影响。方法将30只成年Wistar大鼠随机分为假手术组、MI组及多西环素组。通过结扎冠状动脉左前降支建立大鼠MI模型。采用ELISA检测血清心肌肌钙蛋白I(c-TnI)水平,Western blot检测心肌组织TGF-β1及caspase-3蛋白表达,末端标记法(TUNEL)检测心肌细胞凋亡。结果与假手术组比较,MI组及多西环素组c-TnI水平升高,TGF-β1及caspase-3蛋白表达水平升高,心肌细胞凋亡指数明显增加,差异有统计学意义(P<0.05)。多西环素可降低c-TnI水平,下调心肌组织TGF-β1及caspase-3蛋白表达,抑制心肌细胞凋亡,差异有统计学意义(P<0.05)。结论 MI后TGF-β1表达明显上调,心肌细胞凋亡增加,是心室重塑发生的重要机制。多西环素可通过下调TGF-β1表达,抑制心肌细胞凋亡,进而延缓心室重塑进程。     

扩张型心肌病患者CD4~+CD25~+Foxp3~+ T细胞的检测及意义

目的:探讨扩张型心肌病(DCM)患者外周血CD4+CD25+Foxp3+T细胞的水平及意义。方法:采用流式细胞术检测DCM患者30例及健康对照组20例外周血CD4+CD25+T细胞和CD4+CD25+Foxp3+T细胞的比例。结果:DCM患者外周血CD4+CD25+T细胞占CD4+T细胞的比例为(8.53±1.64)%,显著低于健康对照组的(11.4±2.17)%,P0.01;DCM患者CD4+CD25+Foxp3+T细胞占CD4+T细胞比例为(0.99±0.54)%,显著低于健康对照组的(1.55±0.55)%,P0.01;且DCM患者心功能越差,CD4+CD25+Foxp3+T细胞占CD4+T细胞的比例越低。结论:DCM患者调节性T细胞比例的减少,可能打破了自身免疫耐受,发生了针对心肌抗原的自身免疫反应,参与了DCM的发病。     

广西武鸣县人群高血压现况调查及危险因素分析

高血压是一种常见病、多发病，是许多心脑血管疾病的基础病及重要的危险因素，常见于老年人。为了解广西武鸣县华侨投资区人群高血压患病率及其相关影响因素，为高血压防治提供参考依据，笔者于2004年10月对该投资区进行现场调查。     

Experimental Study of Nicotine on Angiogenesis and Restenosis

Objectives To investigate the effects of nicotine on angiogenesis and restenosis in a rabbit model of critical limb ischemia and balloon catheter denuding injury iliac artery. Methods Forty male New Zealand White rabbits were randomly divided into control, low-,middle-, and high-dose (0.005,0.05 or 5μg/kg, respectively) nicotine groups.Balloon catheter denuding injury iliac artery and ligation of a femoral artery were performed in all animals fed with a high-cholesterol diet (HCD)beginning 2 weeks before operation. Nicotine was administered daily by intramuscular injection in the ischemic hindlimb for 3 weeks. Control rabbits received an equal volume of phosphate-buffered saline alone.Collateral vessels of the ischemic hindlimb were observed by angiography of abdominal aorta, and the density of intramuscular microvessels in ischemic hindlimb was examined by immunohistochemistry. The levels of blood lipids and the indexes of hepatic or renal functions were also determined before HCD and after nicotine treatment. Results One rabbit in control, two in low-, one in middle- and two in high-dose group died during the experiment. The remaining 34 rabbits were included in the study. Two or five weeks after HCD, the levels of blood lipids were significantly increased in all groups, but there was no significant difference on the levels between control and nicotine-treated groups three weeks after nicotine treatment; The indexes of hepatic or renal functions were no significant changes three weeks after nicotine treatment; There were no significant differences on collateral vessels shown by angiography in all four groups; The density of intramuscular microvessels in three nicotine-treated groups was significantly higher than that in control group; But the intimal area in all three nicotine-treated groups was also larger than that in control group.Conclusions The present study shows that intramuscular administration of nicotine for three weeks could not increase arteriogenesis in ischemic hindlimb of rabbits, but is capable of significantly promoting intramuscular angiogenesis in ischemic hindlimb.Nicotine can also accelerate intimal thickening of balloon catheter denuding injury lilac artery, so it may contribute to the development of restenosis.