老年高血压患者静息心率增加对靶器官损害的临床研究

目的探讨老年原发性高血压(EH)患者静息心率(RHR)与靶器官损害的关系。方法入选老年EH患者206例,按RHR水平分为RHR1组<70次/min(56例),RHR2组70次≤RHR<80次/min(84例),RHR3组RHR≥80次(66例)三组。对人选患者做以下检查心电图、超声心动图、颈动脉超声、肌酐清除率以及尿微量白蛋白。结果(1)RHR2组和RHR3组的颈动脉内膜厚度(IMT)、颈动脉内径(CAD)、左心室重量指数(LVMI)以及尿微量白蛋白定量(MAU)均高于RHR1组(P<0.01),而左室射血分数(LVEF)、肌酐清除率小于RHR1组(P<0.01)。(2)RHR与IMT、CAD、LVMI、MAU呈正相关(r分别为0.312、0.289、0.630、0.576,P<0.01),而与LVEF、肌酐清除率呈负相关(r分别为-0.563、-0.510,P<0.01)。(3)非条件Logistic回归分析显示,RHR、收缩压(SBP)、舒张压(DBP)、脉压(PP)对高血压性心脏病、冠心病、心力衰竭、脑血管意外和肾功能损害有不同程度的影响(P<0.05或P<0.01),其中SBP和RHR的作用更大。结论RHR可能是老年EH患者靶器官损害的独立危险因素。     

肾性高血压大鼠血管反应性与细胞钙转运关系的探讨

本文用离体血管条生物测定法观察血管对去甲肾上腺素(NE)及高钾去极化(HiK~ )的收缩反应及~(46)Ca~(2 )示踪测定血管平滑肌细胞钙跨膜内流。实验表明:肾性高血压大鼠主动脉及肠系膜动脉对NE和HiK~ 的收缩反应显著增高。反应性的这一变化与细胞钙内流有明显关系,其中通过血管平滑肌细胞膜电压依赖性钙通道内流的钙增多在血管反应性增高中有重要作用。     

中老年女性静息心率与代谢综合征及其组分间的关联性研究

目的：探讨中老年女性静息心率(RHR)与代谢综合征(MetS)及其相关组分之间的关联性。方法以2010年1月至2014年6月在珠海市人民医院体检科参与体检的862例中老年女性为研究对象,测量其静息心率(RHR)、身高、体重、腰围(WC)、血压、空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL),并将研究对象按照RHR四分位数法分4组：≤70次/min、71~75次/min、76~80次/min、≥81次/min。比较不同RHR组中老年女性MetS及其各组分的患病差异;以≤70次/min组作为对照,采用Logistic回归模型分析其余3组MetS的患病风险。结果 MetS患病率随着RHR的增加呈上升趋势(χ2trend=5.23,Pt rend=0.02),≥81次/min组MetS患病率为48.5%,显著高于≤70次/min (32.4%)、71~75次/min组(37.3%)和76~80次/min组(37.9%),差异均有统计学意义(P<0.05);MetS组分析结果显示：收缩压(Ftrend=12.38,Ptrend=0.002)、FPG (Ftrend=8.56, Pt rend=0.004)和TG (Ftrend=8.53,Ptrend=0.004)随RHR加快而升高,HDL随RHR加快而降低(Ftrend=18.56,Pt rend<0.01),差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,≥81次/min组中老年女性患MetS的风险较≤70次/min组增加了57%(OR=1.57,95%CI=1.08~2.29)。结论 RHR与MetS及其组分间存在相关性,可作为MetS发病的一个预测指标,为诊断和防控MetS患者进展为心脑血管疾病等不良结局提供了新的靶点和研究方向。     

静息心率与高血压

高血压是心脑血管疾病最重要的危险因素。在高血压患者中,静息心率（RHR）增快较为常见,也是交感神经过度激活的标志。本文就RHR与高血压的关系以及高血压患者RHR增快的临床研究进展进行综述,发现RHR增快与高血压发病有密切关系,N时高血压患者RHR增快与靶器官损害相关,是高血压患者发生心血管事件和死亡的独立危险因素,也是心血管病发病和死亡的独立危险因素。在心血管病防治中,心率管理应与血压、血糖、血脂管理并重,成为临床治疗的靶点。心率是高血压病患者的重要预后因素,心率增快伴冠心病的高血压患者应首选β受体阻滞剂,RHR是指导用药的简便有效指标。     

红曲降低肾血管型高血压大鼠血压的生化机制

目的:初探红曲降低肾血管型高血压大鼠(Renovascular Hypertensive Rats,RHR)血压的生化机制.方法:通过试剂盒测定灌胃红曲4周后RHR肺组织ACE活性和主动脉NOS活性,以及灌胃红曲前后血浆ET和CGRP的变化.结果:灌胃4周后.红曲高剂量组和低剂量组肺ACE与阴性对照组相比显著下降(P＜0.01);红曲高和低剂量组血浆ET均比阴性对照组低20个单位(P＜0.01);红曲高剂量组血浆CGRP比灌胃前增高9个单位(P＜0.01),比阴性时照组高7个单位(P＜0.05).结论:红曲的降压途径可能是多方面的:在RHR上可能主要通过抑制肺ACE起到降压作用,同时也能降低血浆ET和升高血浆CGKP.     

The Profile of the Serum Levels of Inflammatory Cytokines TNF-a, IL-6, IL-10 and Captopril Intervention in Reno-hypertensive Rats

Objectives To observe the profile of the serum levels of inflammatory cytokines interleukin-6（IL-6）, tumor necrosis factor（TNF-α）and interleukin-10 （IL-10） and evaluate the effects of angiotensin- converting enzyme inhibitor-Captopril on them in renohypertensive rats. Methods Using reformed two-kidney-one-clip （2K 1C） method, renal hypertensive rats （RHR） were obtained by ligating abdominal aorta. 30 Wistar rats were randomized into three groups： sham-operation group （A）, model control group （ B ） and captopril group （C）. All rats were killed after being given the trial drugs 5 weeks, ELISA assays were used to detect the levels of IL-6 and IL-10, the levels of TNF-alpha were measured with radioimmunoassays. Results ①compared with group A, the left ventricular hypertrophy was aggravated in group B significantly, the ratio of left ventricle and body weight（LV/BW） was 0.00318 ±0.00030 （B）and 0.00256 ±0.00040 （A） respectively（P 〈 0.001 ）, the levels of IL-6 and TNF-α increased significantly （P 〈 0.001 and P 〈 0.002 respectively）, whereas the levels of IL-10 were not changed between the two groups （P 〉 0.05）; ② compared with group B, the LV/BW was 0.00266 ± 0.00018 （C） and 0.00318±0.00030 （B） respectively（P 〈 0.001）, the levels of IL-6 and TNF-α decreased significantly （ P 〈 0.01）, whereas the levels of IL-10 were not changed between the two groups （P 〉 0.05） ; Condusions Angiotensin converting enzyme inhibitor-captopril can lower the serum levels of proinflammatory cytokines IL-6 and TNF-α effectively, but can not increase the levels of anti-inflammatory cytokine feature IL-10, it suggests that captopril may have to prevent or slow development hypertensive complications by means of levels of pro-inflammatory cytokines a of lowering the but not by increasing anti-inflammatory cytokine IL-10.     

肾血管性高血压大鼠脑梗塞后脑微血管形态计量学动态观察

本研究选用双肾双夹肾动脉狭窄术复制成的肾血管性高血压大鼠（ＲＨＲ）５４只；同龄正常血压鼠（ＳＤＲ）５４只，各分为大脑中动脉闭塞（ＭＣＡｏ）前、后不同时间的９个实验和对照组，各组均即时从心腔等压灌注中华墨汁，取脑顶叶梗塞灶边缘区，行冠状、矢状、水平三方向取材，制片，在显微镜下作微血管形态计量学测定．结果显示ＲＨＲ顶叶脑皮质毛细血管直径、单位体积毛细血管长度、表面积、通过２００μｍ的毛细血管支数均较ＳＤＲ减少，表明高血压可致脑微血管稀疏；同时观察到局部脑梗塞后上述反映毛细血管网三维构筑的参数变化远较对照鼠明显，缺血后脑损伤更严重。说明毛细血管损伤程度与梗塞灶的大小直接相关，因此应加强高血压的防治，以保护脑微血管立体构筑。     

滋水降火饮镇静、降血压药效研究

探讨滋水降火饮对高血压大鼠的防治作用 ,观察滋水降火饮镇静安神作用和以两肾一夹高血压大鼠 (2K1C RHR)的降压、逆转左心肥厚和减轻靶器官损害作用。滋水降水饮能明显延长戊巴比妥钠小鼠的睡眠时间 ,增加睡眠只数 ,抑制小鼠的自发活动 ;预防性治疗可延缓 2K1C RHR血压的升高 ;经 8周治疗 ,2K1C RHR的血压有不同程度的降低 ,左心肥厚有一定程度逆转。     

Protective Role of Resting Heart Rate on All-Cause and Cardiovascular Disease Mortality

ObjectiveTo study the protective role of lower resting heart rate (RHR) in cardiovascular disease (CVD) and all-cause mortality.Patients and MethodsPatients (n=53,322) who received a baseline medical examination between January 1, 1974, and December 31, 2002, were recruited from the Cooper Clinic, Dallas, Texas. They completed a medical questionnaire and underwent clinical evaluation. Patients with CVD or cancer or who had less than 1 year of mortality follow-up were excluded from the study. Relative risks and 95% CIs for all-cause and CVD mortality across RHR categories were estimated using Cox proportional hazards models.ResultsHighest cardiorespiratory fitness with lower mortality was found in individuals with an RHR of less than 60 beats/min. Similarly, patients with a higher RHR (≥80 beats/min) were at greater risk for CVD and all-cause mortality compared with an RHR of less than 60 beats/min. This analysis was followed by stratification of the data by hypertension, where hypertensive individuals with high RHRs (≥80 beats/min) were found to be at greater risk for CVD and all-cause mortality compared with those with hypertension and lower RHRs (<60 beats/min). In addition, unfit individuals with high RHRs had the greatest risk of CVD and all-cause mortality. The unfit with low RHR group had a similar risk for CVD and all-cause mortality as the fit with high RHR group.ConclusionLower cardiorespiratory fitness levels and higher RHRs are linked to greater CVD and all-cause mortality.     

冠心舒通胶囊对冠心病心房颤动患者心电图及症状改善的影响

目的了解冠心舒通胶囊对冠心病心房纤颤患者静息心室率、心肌缺血及心悸等症状的影响。方法 108例确诊为冠心病心房纤颤接受冠心舒通胶囊足疗程治疗的患者为治疗组,另选择冠心病心房纤颤未接受冠心舒通胶囊治疗的患者104例为对照组,均配合给予冠心病规范治疗。治疗前后对比观察心悸、胸闷症状、静息心室率（RHR）、心电图的变化。结果治疗前后冠心病心房纤颤冠心舒通胶囊治疗组症状、心电图心室率、ST段、T波,与对照组相比,差异有显著性意义（P〈0.05）。结论冠心舒通胶囊辅助治疗可改善冠心病心房纤颤患者症状,降低冠心病心房纤颤患者心室率,心肌缺血得到改善,有助于冠心病的治疗。