充血性心力衰竭病人甲状腺素水平的变化

目的　为探讨充血性心力衰竭 (CHF)患者甲状腺素水平及其与预后的关系。方法　观测了 2 5例CHF患者 (治疗组 )治疗前后及同期 3 0例健康体检者 (对照组 )血浆甲状腺激素水平的变化。结果　治疗组T3水平明显低于对照组 ,且治疗组T3水平随心功能的恶化而降低 ,随治疗好转而回升 ,而T4 则明显波动。结论　CHF患者心功能与T3浓度有密切关系 ,还可降低外周血管阻力 ,减轻心脏后负荷     

心先安对心功能不全的疗效观察

目的：观察大剂量,短疗程心先安（ＭｃＡＭＰ）治疗慢性心功能不全（ＣＨＦ）疗效。方法：应用大剂量ＭｃＡＭＰ治疗５２例ＣＨＦ患者,前后应用无创心功能检测进行对比分析。结果：用药后心脏除左室收缩功能、心泵功能改善,血管外周阻力（ＴＰＲ）降低外（Ｐ〈０．００１）,左室舒张末压降低,心舒张功能亦好转（Ｐ〈０．０５）,临床心功能改善,总 率６７．３１％。结论：大剂量心先安是治疗ＣＨＦ的有效药物之一。     

The safety and tolerability of beta blockers in heart failure with reduced ejection fraction: is the current underutilization of this evidence-based therapy justified?

Introduction: Beta blockers are one of the cornerstones for treatment of Heart Failure with Reduced Ejection fraction (HFRef), yet their use is often limited by adverse effects, either perceived or real. We performed a review of available data using PubMed.gov utilizing beta blocker, heart failure, reduced ejection fraction and safety as key words.

Areas covered: Several well designed, large scale randomized clinical trials including CIBS-II (bisoprolol), MERIT-HF (metoprolol succinate), and Copernicus (carvedilol) among others, have been conducted in patients with HFRef and demonstrated an improvement in cardiac mortality and morbidity. Despite the preponderance of data supporting the use of beta blockers for patients HFRef, these medications remain underutilized and/or are often prescribed at lower than recommended dosages. Some of the reluctance to embrace beta blockade may be attributed to concern on the part of both the patient and prescriber about the non-cardiac adverse effects of this class of drugs. We have reviewed several recent reviews and meta-analyses of trials of beta blocker in heart failure which have conclusively demonstrated their tolerability in the populations studied.

Expert opinion: In the final section of this paper we provide our opinions regarding initiating and optimizing beta blocker therapy for patients with HFRef.     

芪苈强心胶囊对慢性心力衰竭患者生存质量的影响

目的 观察芪苈强心胶囊对慢性心力衰竭(CHF)患者生存质量的影响及临床疗效.方法 选择CHF患者60例,随机分为治疗组与对照组,各30例,2组均给予常规抗心力衰竭治疗,治疗组在抗心力衰竭常规治疗的基础上加用芪苈强心胶囊口服治疗,4粒/次,3 次/d,共治疗12周,对照组仅进行常规抗心力衰竭治疗.采用简明健康调查问卷(SF-36)及明尼苏达生活质量问卷(MLFQ)评价2组治疗前后生活质量变化,对比2组治疗前后Lee心力衰竭积分变化及治疗效果.结果 治疗组在生理职能、生理功能、躯体疼痛、心理健康、社会功能及总体健康各纬度计分显著高于对照组(P＜0.05);2组治疗后SF-36总分较治疗前显著上升,MLFQ总评分及Lee心力衰竭积分较治疗前显著降低(P＜0.05);治疗组总有效率96.7％,对照组73.3％(P＜0.05).结论 芪苈强心胶囊可有效缓解CHF患者心衰症状,延缓心衰进程,改善患者生存质量.     

Thyroid Status and Death Risk in US Veterans With Chronic Kidney Disease

Objective

Given that patients with non–dialysis-dependent chronic kidney disease (NDD-CKD) have a disproportionately higher prevalence of hypothyroidism compared with their non-CKD counterparts, we sought to determine the association between thyroid status, defined by serum thyrotropin (TSH) levels, and mortality among a national cohort of patients with NDD-CKD.

Predialysis Kidney Function and Its Rate of Decline Predict Mortality and Hospitalizations After Starting Dialysis

Objective

To determine whether kidney function level and its rate of decline in the immediate predialysis period among veterans transitioning to end-stage renal disease (ESRD) predict postdialysis mortality and hospitalization.

心衰患者窦性心率震荡检测及多因素影响分析

目的　观察心力衰竭患者窦性心率震荡 (HRT)现象的特征并探讨其临床意义。方法　 2 0 0 4 - 0 1～ 0 4哈尔滨医科大学第一临床医学院门诊 30例心衰患者及 30名健康对照者均接受 2 4hHolter检查 ,分别计算HRT的初始值 (TO)、HRT的斜率 (TS) ,并进行TO、TS与年龄、左室射血分数 (LVEF)、左室舒张末期内径 (LVED)、室早数目、室早前心率、联律间期、代偿间期的相关分析及不同起源室早TO、TS的组间比较。结果　心衰者与健康者HRT间存在明显差别 :心衰者TO明显高于对照者 (0 5 7± 4 71%与 - 1 5 6± 2 6 0 % ,P <0 0 2 5 ) ;心衰者TS明显低于对照者 (3 17± 2 0 3%与 9 6 4± 6 4 7,P <0 0 0 1)。TO、TS与年龄、LVEF、LVED、室早数目相关 ,与室早前心率、联律间期、代偿间期不相关 ,起源不同室早的TO、TS间无明显差异。结论　慢性心衰患者中窦性心率震荡现象明显减弱 ,由于TO、TS与LVEF、LVED相关 ,可凭借TO、TS对心衰患者进行危险分层 ,但它对预后的预测价值有待于大样本长期随访来证实。