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中华老年心脑血管病杂志

中华老年心脑血管病杂志

北大核心

CSTPCD

Chinese Journal of Geriatric Heart Brain and Vessel Diseases
《中华老年心脑血管病杂志》是医药卫生类专业学术期刊。创刊以来始终遵循办刊宗旨，贯彻党和国家的卫生工作及方针政策，结合我国老年人口超过1亿并逐年增加的现状，为促进我国老年医学的发展，吸收借鉴国内外老年心、脑、血管疾病防治研究的最新科技成果，全心全意为老年医疗保健专业服务。《中华老年心脑血管病杂志》是向国内外公开发行的科技期刊（国内统一刊号：CN11-4468/R，国际标准刊号：ISSN 1009-0126，邮发代号：2－379）。现为月刊，大16开本，72页，用铜板纸印刷，图文并茂。是中国科技论文统计源期刊（中国科技核心期刊），中国医药卫生核心期刊。2004年获得全军医学期刊“优秀学术质量奖”。主要报道国内外老年心脏疾病、脑部疾病、血管系统疾病的临床诊断及治疗等相关内容，包括临床研究、基础研究、影像学、遗传学、流行病学、临床生化检验与药物、手术和介入治疗以及有关预防、康复等。主要栏目：专家论坛、述评、临床研究、基础研究、循证医学荟萃、继续教育园地、保健与康复、综述、讲座、病例报告、论著摘要、读者·作者·编者等。读者对象为从事老年临床医疗工作的医护人员、科研人员和医疗保健人员。
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  • 发文量：6952
  • 被引量：5106
  • H指数：2
  • 开始收录时间：1999,1(1)
  • CNKI综合因子：1.158
  • 维普期刊影响因子： 2.32
  • 万方期刊影响因子：2.31
  • 创刊时间：1999
  • 国内刊号/CN：11-4468/R
    国际刊号/ISSN：1009-0126
  • 发行周期：月刊
    邮发代号：2-379
  • 主管单位：中国人民解放军总医院
    主办单位：中国人民解放军总医院
中华老年心脑血管病杂志-联系信息
  • 主编：李小鹰
  • 电话：010-66936463
  • 邮箱：zhlnxnxg@sina.com
  • 地址：北京市复兴路28号
  • 邮编：100853
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  • • 全军医学期刊评比中被评为“优秀学术质量奖”“优秀期刊奖”
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中华老年心脑血管病杂志 >2023年第9期

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  • 摘要：众所周知,EEG在癫痫临床诊断、疗效监测及预后评价方面发挥了重要作用。EEG无创、廉价、可重复和应用广泛的特点,在临床中显示优势。近年来,在癫痫以外领域,如脑血管病、认知功能障碍、一氧化碳中毒脑病、麻醉监测、脑炎等方面的应用研究,也逐渐有新的突破和发展。本文将对EEG癫痫以外的临床应用进展进行综述。
  • 摘要：Objective To study the relationship between hyperuricemia and metabolic syndrome (MS) in elderly males and females.Methods A total of 911subjects (409 males and 502 females) aged ≥60 years,selected during the investigation of risk factors for chronic diseases in Changping District of Beijing,were divided into hyperuricemia group and normal uric acid group.A case control study was performed.Results The incidence of hyperuricemia was 11.30％ in the 911 subjects included in this study with no significant difference found between males and females (11.5％ vs 11.2％,x2 =0.025,P=0.916).The incidence of MS was 60.6％ in these subjects and was significantly lower in males than in females (44.3％ vs 67.2％,x2=82.978,P=0.000).The incidence of hyperuricemia increased with the number of MS components (5.3％ vs 7.9％ vs 9.6％ vs 8.2％ vs 16.2％ vs 17.5％,x2 =15.384,P=0.009).The ratio of female hyperuricemia patients with MS was significantly higher than that of those without hyperuricemia but with MS (85.7％ vs 72.4％,x2 =4.558,P=0.033) with no significant difference found in males.Hyperuricemia was an independent risk factor for MS after adjustment for other factors (OR=2.350,95％CI:1.020-5.416,P=0.045).Conclusion Hyperuricemia is closely related with MS in females.Active intervention of hyperuricemia can thus control the occurrence and progression of MS and reduce the risk of cardiovascular and cerebrovascular events.%目的 探讨不同性别老年人群高尿酸血症(HUA)与代谢综合征(MS)之间的关系.方法 在北京市昌平区进行的有关慢性疾病和危险因素的8084例健康调查者中,选取年龄≥60岁的调查者911例,男性409例,女性502例,男性HUA 47例和血尿酸正常(NUA)362例,女性HUA 56例和NUA 446例,进行病例对照研究.结朵 911例入选者中,HUA发病率为11.30％,男女性HUA发病率比较无显著差异(11.5％ vs 11.2％,x2=0.025,P=0.916);MS发病率为60.6％,男性MS发病率明显低于女性(44.3％ vs 67.2％,x2=82.978,P=0.000).MS组分为0、1、2、3、4和5个时,随MS组分增加HUA患病率明显升高(5.3％ vs 7.9％ vs 9.6％ vs 8.2％ vs 16.2％ vs17.5％,x2=15.384,P=0.009).女性HUA合并MS比例明显高于NUA合并MS比例(85.7％ vs 72.4％,x2=4.558,P=0.033),男性两者无明显差异(P＞0.05).调整混杂因素后,女性HUA是MS的独立危险因素(OR=2.350,95％CI:1.020～5.416,P=0.045).结论 老年女性HUA与MS关系显著,对HUA进行积极干预治疗,有利于控制MS的发生发展,降低心脑血管事件风险.
  • 摘要：目的 探讨云南大理白族老年糖尿病前期及糖尿病的流行现状,并分析相关危险因素.方法 采用多阶段、随机整群抽样方法,于2014年1～12月对1845例包括城镇、农村、城乡结合部居住＞5年的年龄≥60岁的大理白族人群进行横断面调查,男性939例,女性906例.结果 1845例入选者中,糖尿病前期患病率38.45％,男性44.70％,女性33.00％,男性患病率高于女性(P＜0.01);糖尿病患病率17.02％,男性20.48％,女性13.46％,男女性患病率比较无统计学差异(P＞0.05);农村、城镇和城乡结合部居民的糖尿病前期患病率(男性36.34％vs43.09％ vs 51.87％,女性26.41％ vs 32.00％ vs 40.83％)、糖尿病患病率(男性11.50％ vs 20.52％ vs 22.97％,女性为6.01％ vs 14.78％ vs 19.81％)比较,差异有统计学意义(P＜0.05);空腹血糖受损(IFG)、单纯糖耐量受损(IGT)、IFG+ IGT患病率分别为9.95％、51.88％、38.17％,其中男性分别为10.98％、50.23％、38.79％,女性分别为8.54％、54.11％、37.34％.尿酸、高盐饮食、主食摄入量、糖尿病家族史糖尿病和糖尿病前期独立危险因素,牛奶摄入量、HDL-C为糖尿病和糖尿病前期保护因素.结论 云南大理老年白族糖尿病前期及糖尿病流行状况严峻,加强糖尿病教育是防治2型糖尿病发生的重要措施,强调血压、血糖、血脂、尿酸、体质量的综合控制.%Objective To study the epidemiology and risk factors of prediabetes and diabetes in elderly subjects of Dali Bai Autonomous Prefecture.Methods The epidemiology and risk factors of prediabetes and diabetes in 1845 Bai elderly subjects (939 males and 906 females) aged ≥60 years living in urban and rural areas or urban-rual fringe of Dali Bai Autonomous Prefecture were investgated from January 2014 to December 2014 by multistaging and randomized cluster sampling.Results The predvalence of prediabetes was 38.45％ in the 1845 elderly subjects and was significantly higher in males than in females (44.70％ vs 33.00％,P＜0.01).The prevalence of diabetes was 17.02％ in the 1845 elderly subjects with no significant difference found between males and females (20.48％ vs 13.46％,P＞0.05).The prevalence of prediabetes and diabetes was significantly lower in elderly males and females living in urban and rural areas or urban-rual fringe (P＜0.05).UA,high salt diet,food intake volume and family history of diabetes were the independent risk factors for diabetes and prediabetes while milk intake and HDL-C were the protective factors for diabetes and prediabetes.Conclusion The prevalence of diabetes and prediabetes is rather high in elderly subjects of Dali Bai Autonomous prefecture.It is thus important to strengthen diabetes education for the prevention and control of type 2 diabetes,blood pressure,blood glucose,blood lipid,UA and body weight.
  • 摘要：Objective To study the curative effect of nicorandil in very old patients with multiple coronary branch lesions and chronic heart failure (CHF).Methods Ninety-six very old patients with multiple coronary branch lesions and CHF admitted to our hospital from January 2012 to July 2016 were randomly divided into experimental group (n=48) and control group (n=48).Patients in experimental group were treated with oral nicorandil (5 mg,3 times a day) while those in control group were treated with isosorbide mononitrate (20 mg,twice a day) in addition to conventional treatment.Their serum B-type natriuretic (BNP) level,LVEF,left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) were measured before and after treatment.The curative effect and adverse reaction were compared between the 2 groups after 6 months of treatment.Results The significant efficacy and total effective rate of nicorandil for angina pectoris and cardiac function were significantly higher in experimental group than in control group after 6 months of treatment (31.3 ％ vs 10.4 ％,83.3 ％ vs 60.4 ％,P＜0.05;31.3％ vs 14.6％,75.0％ vs 54.2％,P＜0.05).The LVEF was significantly higher while the serum BNP level was significantly lower,the LVESD and LVEDD were significantly shorter in experimental group than in control group after 6 months of treatment (P＜0.05).Conclution Nicorandil can effectively reduce the risk of angina pectoris and improve the cardiac function in very old patients with multiple coronary branch lesions and CHF.%目的 研究尼可地尔对高龄冠状动脉多支病变合并慢性心力衰竭患者的治疗效果.方法 选择2012年1月～2016年7月在解放军153中心医院住院的高龄冠状动脉多支病变合并慢性心力衰竭患者96例,随机分为实验组48例和对照组48例.2组在常规治疗基础上,实验组口服尼可地尔5 mg,3次/d,对照组口服单硝酸异山梨酯缓释片20 mg,2次/d,治疗前后均测定B型钠尿肽和超声心动图测定左心室舒张末内径(LVEDD)、左心室收缩末内径(LVESD)、LVEF.观察2组治疗后6个月疗效及不良反应.结果 实验组治疗6个月心绞痛显效和总有效率明显高于对照组(31.3％ vs 10.4％,83.3％ vs 60.4％,P＜0.05).实验组治疗6个月心功能显效和总有效率明显高于对照组(31.3％ vs 14.6％,75.0％ vs 54.2％,P＜0.05).实验组治疗6个月LVEF较治疗前和对照组治疗后明显升高,B型钠尿肽、LVEDD和LVESD较治疗前和对照组治疗后明显减小,差异有统计学意义(P＜0.05).结论 尼可地尔能够明显降低高龄冠状动脉多支病变合并慢性心力衰竭患者的心绞痛发生风险,进一步改善心功能.
  • 摘要：Objective To analyze the relationship between ambulatory blood pressure (ABP) and cognitive function in elderly hypertensive patients with leukoaraiosis (LA).Methods Eighty elderly hypertensive patients with LA underwent 24 h ABP monitoring to record their 24 h SBPV,DBPV,AASI,and APPI.The patients were scored according to the MMSE Scale.Results The 24 h SBPV,DBPV,AASI,and APPI were significantly higher in degrees 1,2,3 of LA than in degree 0 of LA (P＜0.05),in degrees 2,3 of LA than in degree 1 of LA (P＜0.05),and in degree 3 of LA than in degree 2 of LA (P＜0.05).The MMSE Scale score of memory,attention,counting,recall,language and the total score were significantly lower in degrees 2,3 of LA than in degrees 1,2 of LA (P＜0.05).The 24 h SBPV,DBPV,AASI,and APPI were negatively related with the MMSE Scale score (r=-0.8697,P=0.000;r=-0.6709,P=0.002;r=-0.8373,P=0.000;r=-0.5991,P=0.007).Conclusion The severer the LA is,the higher the 24 h SBPV,AASI and APPI are.The 24 h SBPV and AASI can thus be used as the indicators of LA and cognitive function impairement.%目的 比较老老年高血压患者不同程度脑白质疏松(teukoaraiosis,LA)的动态血压参数与认知功能的相关性.方法 对80例老老年高血压患者行24 h动态血压监测,观察24 h收缩压变异性(systolic blood pressure variability,SBPV)、24 h舒张压变异性(diastolic blood pressure variability,DBPV)、动态动脉硬化指数(ambulatory arterial stiffness index,AASI)、动态脉压指数(ambulatory pulse pressure index,APPI)等;并对患者行简易智能状态检查量表(MMSE)评估.结果 与LA 0级比较,1级、2级、3级的24 h SBPV、24 h DBPV、AASI、APPI增大(P＜0.05);与LA 1级比较,2级、3级24 h-SBPV、24 h-DBPV、AASI、APPI增大(P＜0.05);LA 3级的24 h-SBPV、AASI和APPI显著高于2级,差异有统计学意义(P＜0.05).与LA 0级、1级比较,2级、3级的记忆力、注意力和计算力、回忆能力、语言能力和总分显著降低,差异有统计学意义(P＜0.05).24h SBPV(r=-0.8697,P=0.000)、24 h DBPV(r=-0.6709,P=0.002)、AASI(r=-0.8373,P=0.000)、APPI(r=-0.5991,P=0.007)与MMSE呈显著负相关.结论 LA程度越重,24 h SBPV、AASI、APPI越大;24 h SBPV、AASI可能作为LA、认知功能下降的预测指标.
  • 摘要：Objective To study the effect of macrophage phenotype and mesenchymal stem cells (MSC) on polarization of macrophage phenotype damaged due to combined high glucose and inflammation.Methods Primarily cultured peritoneal macrophages from rats were divided into normal group,damaged group (33 mmol/L glucose and 1 μg/ml lipopolysaccharide),treatment group (cocultured high glucose + Inflammation-damaged LPS + MSC transwell),and inhibitor group (MSC+COX-2 inhibitor).Morphology of macrophages was observed under optical microscope,M1 and M2 macrophages were detected by flow cytometry,and serum levels of IL-6,IL-10 and PGE2 were measured by ELISA.Results The ratio of M1 macrophages was significantly lower while that of M2 macrophages was significantly higher in treatment group than in damaged group (8.91％±0.71％ vs 16.19％±0.78％,P＜0.05;51.09％±4.89％ vs 28.10％±12.47％,P＜0.05).The serum level of IL-6 was significantly lower while that of IL-10 was significantly higher in treatment grup than in damaged group (P＜0.05).The ratio of M1 macrophages was significantly higher in inhibitor group than in treatment group (19.94％ ± 2.07％ vs 8.91％ ± 0.71％,P＜0.05).The serum level of IL-6 was significantly higher while that of IL-10 was significantly lower in inhibitor group than in treatment group (P＜0.05).Conclusion MSC can promote the M1 macrophaes damaged due to combined high glucose and inflammation to the polarization of M2 macrophage phenotype and repair the damaged macrophages through the COX-2 pathway.%目的 探讨高糖联合炎症条件下巨噬细胞的袁型变化及脂肪间充质干细胞(MSC)对损伤的巨噬细胞表型极化的影响及其机制.方法 将原代培养的大鼠腹腔巨噬细胞分为正常组、损伤组(33 mmol/L葡萄糖+1μg/ml脂多糖)、治疗组(高糖+脂多糖炎症损伤+ MSC Transwell共培养)、抑制剂组[MSC+环氧化酶2(COX-2)抑制剂].光学显微镜观察巨噬细胞的形态,流式细胞术定量检测巨噬细胞M1及M2表型比例,ELISA细胞因子白细胞介素(IL)-6、IL-10、前列腺素E2的变化.结果 与损伤组比较,治疗组M1型巨噬细胞比例明显降低[(8.91±0.71)％ vs (16.19±0.78)％,P＜0.05],M2型巨噬细胞比例明显升高[(51.09±4.89)％ vs (28.10±12.47)％,P＜0.05],IL-6明显下降,IL-10明显升高;与治疗组比较,抑制剂组M1型巨噬细胞的比例显著升高[(19.94±2.07)％ vs (8.91±0.71)％,P＜0.05],IL-6含量增加,IL-10含量降低,差异有统计学意义(P＜0.05).结论 MSC可c通过COX-2通路促进高糖炎症损伤的M1型巨噬细胞向M2表型极化及修复其损伤.
  • 摘要：目的 评价机械取栓治疗在大脑中动脉M2段和大脑前动脉闭塞的疗效.方法 回顾性纳入接受机械取栓治疗的大脑中动脉M2段和大脑前动脉闭塞患者1 5例,其中大脑中动脉M2段11例,大脑前动脉4例.观察取栓治疗后患者血管再通情况、颅内出血、脑卒中再发以及病死率发生情况.随访观察90 d,比较取栓前与取栓后90 d的美国国立卫生院卒中评分(NIHSS)及改良的Rankin量表评分(mRS).结果 15例患者均血管满意再通,均为脑梗死溶栓分级2b/3级以上.2例患者有症状性颅内出血,90 d时NIHSS评分中位数明显低于术前[4.0(0.0,18.0)分vs 13.0(10.0,28.0)分,P＜0.01].其中1例住院期间并发肺栓塞死亡.90 d随访时,mRS 0～2分8例(53.3％).结论 对于大脑中动脉M2段和大脑前动脉闭塞的急性缺血性脑卒中患者,支架取栓治疗可能是安全而且有效的.
  • 摘要：Objective To study the relationship of serum uric acid (UA) level with metabolic syndrome (MS) and chronic kidney disease (CKD) in elderly residents of Beijing communities.Methods A total of 1419 elderly subjects from 3 Beijing communities who underwent physical examination were included in this study.Their waist circumference,blood pressure,and serum levels of blood glucose,TC,TG,HDL-C,LDL-C,UA,urea nitrogen and creatinine were measured and their glomerular filtration rate (eGFR) was assayed.Relationship of serum UA level with MS and CKD was analyzed.Results The age was older,the SBP and DBP,the prevalence of smoking and the serum low HDL-C level were higher while the prevalence of obesity,the serum levels of TG and high LDL-C,the incidence of hyperuricemia and MS were lower in males than in females (P＜0.01).No significant difference was found in the prevalence of CKD between men and women (P=0.283).The serum UA level was positively related with the serum urea nitrogen and creatinine level (rmale=0.148,rfemale =0.247,P＜0.01;rmale =0.495,rfemale =0.514,P＜0.01) and was negatively related with eGFR in both males and females (rmale =-0.358,rfemale =-0.416,P＜0.01).Logistic regression analysis showed that age and hyperglycemia were the independent risk factors for CKD in both males and females.Conclusion Hyperuricemia is an important risk factor for CKD.However,MS is not related with CKD.%目的 横断面调查北京社区老年居民血清尿酸水平与代谢综合征(metabolic syndrome,MS)和慢性肾病(chronic kidney disease,CKD)的关系.方法 北京3个大型社区老年健康体检者1419例,采集腰围、血压、空腹血糖、TC、TG、HDL-C、LDL-C、尿酸、尿素、肌酐等指标,并根据公式估算肾小球滤过率(eGFR),分析不同性别血清尿酸与MS和CKD的关系.结果 男性年龄、收缩压、舒张压、吸烟、低HDL-C血症显著高于女性,而肥胖、高TG血症、高LDL-C血症、高尿酸血症、MS患病率显著低于女性,差异有统计学意义(P＜0.01).不同性别CKD患病率无明显差异(P=0.283).男性和女性尿酸与尿素、肌酐呈正相关(r男=0.148,r女=0.247,P＜0.01;r男=0.495,r女 =0.514,P＜0.01),与eGFR呈负相关(r男=-0.358,r女=-0.416,P＜0.01).logistic回归分析显示,年龄和高尿酸血症是不同性别CKD患病的独立危险因素.结论 高尿酸血症是CKD的重要危险因素,但MS与CKD无明确关系.
  • 摘要：目的 探讨大理白族湾桥社区老年人群血尿酸水平与代谢综合征(MS)各组分之间的关系.方法 选择2014年度大理白族自治州湾桥白族社区资料完整的老年MS患者1564例,根据诊断分为高尿酸血症组318例,尿酸正常组1246例,进行体格检查及生化指标检测,计算体质量指数(BMI)和肾小球滤过率(GFR),采用logistic回归分析血尿酸与MS及其组分的关系.结果 1564例研究对象中,MS 412例(26.3％),男性236例(27.6％),女性176例(24.8％).高尿酸血症组男性、BMI、腰围、TG、LDL-C、尿酸、收缩压、舒张压、C反应蛋白、空腹血糖、肌酐、尿微量白蛋白、MS比例明显高于尿酸正常组,HDL-C及GFR水平明显低于尿酸正常组,差异有统计学意义(P＜0.01).logistic回归分析显示,尿酸与BMI、腰围、空腹血糖、TG、收缩压、男性、C反应蛋白呈正相关(P＜0.05,P＜0.01).随着尿酸水平的升高,发生MS的危险性呈现增大的趋势(P＜0.01),用高尿酸血症替代MS除必要条件以外的其他指标,与原标准诊断结果具有较好的一致性(P＜0.01).结论 大理白族地区人群中高尿酸血症检出率高,且尿酸水平与MS各组分关系密切,可能成为MS筛查及风险预测的有效指标.%Objective To study the association between serum level of uric acid (UA) and components of metabolic syndrome (MS) in Wanqiao Community of Dali Bai Autonomous Prefecture.Methods A total of 1564 elderly patients from Wanqiao Community of Dali Bai Autonomous Prefecture were divided into hyperuricemia group (n=318) and normal UA group (n=1246).They underwent physical examination and biochemical test for the measurement of their BMI and GFR.Association between serum level of UA and components of MS was analyzed by logistic regression analysis.Results Of the 1564 elderly patients included in this study,412 (26.3％) were diagnosed with MS with males accounted for 27.6％ and females accounted for 24.8％.The number of males,the BMI and WC,the serum levels of TG,LDL-L,UA,CRP,FPG,SCr,MAU,the SBP and DBP,the incidence of MS were significantly higher while the serum HDL-C level and GFR were significantly lower in hyperuricemia group than in normal UA group (P＜0.01).Logistic regression analysis showed that the serum UA level was positively related with BMI,WC,FPG,TG,SBP,male and CRP (P＜0.05,P＜0.01).The risk of MS incressed with the elevating serum UA level (P＜0.01).Conclusion The prevalence of hyperuricemia is high in Bai population of Dali.Serum UA level is closely related with MS,which may become an effective biomarker for screening and predicting MS.
  • 摘要：目的 回顾性分析北京地区冠心病合并心房颤动(atrial fibrillation,AF)患者行PCI术后出院心率状况,探讨此类患者在北京部分医院的心率控制现状,观察患者出院后心率状况,统计其随访期间发生的主要不良心血管事件(MACE)及全因病死率.方法 选取北京12所三级甲等医院2010年1月1日～2014年12月31日入院的冠心病合并心房颤动并行PCI的患者共2471例.收集患者病历资料,记录其住院期间临床、检验、检查等相关指标.电话随访所有入选患者,填写随访记录表.记录随访对象发生MACE、目前血压、心率、合并用药、随访期间手术等情况,随访时间(3.5±1.5)年.结果 此类患者心率控制达标率较低,MACE发生率为26.9％.发生MACE患者心率快于未发生者,72.3％患者用β受体阻滞剂控制心率,控制达标率仅4.3％;与服用胺碘酮和β受体阻滞剂比较,服用洋地黄类药物患者MACE发生率显著升高(45.9％ vs 15.3％、25.9％,P＜0.05).结论 北京地区冠心病合并AF患者行PCI术后的心率控制欠佳,需进一步加强该类患者的心率管理.%Objective To study the control of heart rate of coronary heart disease (CHD) patients with atrial fibrillation (AF) after placing stents in some hospitals of Beijing by observing their major adverse cardiovascular events (MACE) and all-cause mortality during the follow-up.Methods A total of 2471 CHD patients with AF who underwent PCI in 12 class A hospitals in Beijing from 2010-01-01 to 2014-12-31 were included in this study.Their medical records,clinical examination findings and laboratory testing parameters were recorded.The patients were followed up for 3.5 ±-1.5 years,during which the incidence of MACE,blood pressure,heart rate,used drugs,surgical procedure were recorded.Results The heart rate was poorly controlled and the incidence of MACE was 26.9％ in CHD patients with AF after placing stent.The heart rate was faster in CHD patients with AF who occurred MACE than in those who did not occur MACE.The heart rate was treated with β-receptor blockers in 72.3％ of the CHD patients with AF with a control rate of 4.3 ％.Theincidence of MACE was significantly higher in CHD patients with AF who received digitalis treatment than in those who received amiodarone and β-receptor blocker treatment (45.9％ vs 15.3％ and 25.9％,P＜0.05).Conclusion The control of heart rate was poor in CHD patients with AF in Beijing after PCI,and should thus be further strengthened.
  • 摘要：Objective To study the effect of Zhuyu Tongmai Capsule on vascular endothelial cytokines in ischemic stroke (IS) patients.Methods One hundred and twenty IS patients were randomly divided into control group (n=60) and treatment group (n=60).Patients in control group were treated with oral aspirin (0.25 mg,3 times a day) plus conventional vasodilators and neurotropic drugs and those in treatment group were treated with Zhuyu Tongmai Capsule plus aspirin,conventional vasodilators and neurotropie drugs for 1 month.Serum levels of TXB2,6-KetoPGF1α,NO,and active oxygen were measured in two groups.Results The serum levels of TXB2 and active oxygen were significantly lower while those of 6-Keto-PGF1α and NO were significantly higher in two groups after treatment than before treatment (P＜0.05).The serum levels of TXB2 and active oxygen were significantly lower while those of 6-Keto-PGF1α and NO were significantly higher in treatment group than in control group after treatment (P＜0.05).The serum levels of TC,LDL-C,TG,and hs-CRP were significantly lower while those of HDL-C were significantly higher in both groups after treatment (P＜0.05).Conclusion Zhuyu Tongmai Capsule can effectively downregulate the serum levels of TXB2 and active oxygen and upregulate those of 6-Keto-PGF1α,NO,blood lipid,and hs-CRP in IS patients.%目的 观察逐瘀通脉胶囊对脑梗死患者血清血管内皮细胞因子的影响.方法 选择脑梗死患者120例,随机分为对照组60例和治疗组60例.对照组常规对症药物治疗基础上,加阿司匹林口服0.25 mg,3次/d,连续治疗1个月.治疗组在对照组治疗的基础上,口服逐瘀通脉胶囊0.4g,3次/d,连续治疗1个月.观察2组血清血管内皮细胞相关因子血栓素B2(TXB2)、6-酮-前列腺素F1α(6-Keto-PGF1α)、NO、活性氧水平变化.结果 治疗组和对照组治疗后血清TXB2、活性氧水平明显低于治疗前,6-Keto-PGF1α、NO水平明显高于治疗前(P＜0.05).与对照组比较,治疗组治疗后血清TXB2、活性氧水平明显降低[(76.95±23.97)ng/L vs(93.54±30.71)ng/L,(329.58±49.77)mmol/Lvs (374.12±52.01)mmol/L,P＜0.05],6-Keto-PGF1α、NO水平明显升高[(113.84±36.11)ng/Lvs (92.94±33.75)ng/L,(97.44±20.71)mmol/L vs(81.74±23.67)mmol/L,P＜0.05].治疗组和对照组治疗后TC、LDL-C、TG、高敏C反应蛋白明显降低,HDL-C水平明显升高,且治疗组疗效明显优于对照组(P＜0.05).结论 逐瘀通脉胶囊可有效的降低TXB2、活性氧水平,提高6-Keto-PGF1α、NO水平,调节血脂、高敏C反应蛋白.
  • 摘要：目的 研究富马酸二甲酯(dimethylfumarate,DMF)通过调节核转录因子-E2相关因子2(Nrf2)对β淀粉样蛋白(A8)诱导的氧化应激的防御作用和作用机制.方法 将大鼠星形胶质细胞分为Aβ组、DMF组、Nrf2组和Nrf2+DMF组.采用RT-PCR检测各组细胞Nrf2、醌氧化还原酶1(Nqo1)、血红素氧化酶1(HO-1)和Kelch样环氧氯丙烷相关蛋白1(Keap1) mRNA表达水平,采用Western blot检测组蛋白去乙酰酶(HDAC)表达水平.结果 Nrf2组较Aβ组、Nrf2+ DMF组较DMF组Nrf2、Nqo1和HO-1 mRNA表达显著降低(P＜0.05).DMF组较Aβ组Nrf2、Nqo1和HO-1 mRNA表达显著升高,Keap1 mRNA表达显著降低(P＜0.05).Nrf2+ DMF组较Nrf2组Keap1 mRNA表达显著降低(P＜0.05).DMF组较Aβ组HDAC表达显著降低(6.41±0.43 vs9.01±1.54,P＜0.05),Nrf2+ DMF组较Nrf2组HDAC表达显著降低(6.72±0.30 vs8.76±0.74,P＜0.05).结论 DMF可能通过抑制HDAC表达,提高Nrf2水平,从而减弱Aβ诱导的大鼠星形胶质细胞的氧化应激反应.%Objective To study the effect of dimethyl fumarate (DMF) on Aβ-induced oxidative stress by regulating NF-E2-related factor 2 (Nrf2) expression and its mechanism.Methods Rat astrocytes were divided into Aβ group,DMF group,Nrf2 group and Nrf2 +DMF group.Expressions of Nrf2,Nqo1,Ho-1,Keap1 mRNA and HDAC were detected by RT-PCR and Western blot respectively.Results The expression levels of Nrf2,Nqo1 and HO-1 mRNA were significantly lower in Nrf2 group and Nrf2+DMF group than in Aβ group and DMF group (P＜0.05) and were significantly higher in DMF group than in Aβ group (P＜0.05) while the expression level of Keap1 mRNA was significantly lower in DMF group and Nrf2+DMF group than in Aβ group and Nrf2 group (P＜0.05).The expression level of HDAC was significantly lower in DMF group and Nrf2+DMF group than in Aβ group and Nrf2 group (6.41±0.43 vs 9.01±1.54,P＜0.05;6.72±0.30 vs 8.76± 0.74,P＜0.05).Conclusion DMF increases the Nrf2 expression by inhibiting the HDAC expression,thus reducing Aβ-induced oxidative stress in rat astrocytes.
  • 摘要：冠状动脉分叉病变约占冠心病介入治疗领域的20%,是常见的临床问题,同时也是冠状动脉介入治疗领域最具挑战性的病变之一[1]。冠状动脉分叉病变的治疗操作难度大,手术成功率低,并发症发生率高,远期效果差[2]。冠状动脉分叉病变的介入治疗策略和术式选择仍存在较多争议。药物涂层球囊（DCB）是一种新的介入治疗器械,其以球囊为抗细胞增殖药物载体。
  • 摘要：Objective To study the value of DWI,3D-TOF MRA and 3D-ASL in diagnosis of transient ischemic attack (TIA).Methods Fifty-three TIA patients served as a patient group and 30 age-matched healthy volunteers served as a control group in this study.They underwent T1WI,T2WI,T2-FLAIR,DWI,MRA and 3D-ASL.The findings in T1WI,T2WI,T2-FLAIR,DWI,MRA and 3D-ASL were statistically analyzed.Results DWI showed no high signals in the 83 subjects included in this study.The accuracy of MRA,ASL and their combination in diagnosis of TIA was 63.4％,71.1％ and 88.0％ respectively,with a sensitivity of 49.1％,58.5％ and 83.0％ respectively,and a specificity of 90.0％,93.3％ and 96.7％ respectively.The accuracy,sensitivity and specificity of combined 3D-TOF MRA and 3D-ASL were higher than those of either 3D-TOF MRA or 3D-ASL (P＜0.05).Of the 53 patients,24.5％ were positive for both 3D-TOF MRA and 3D-ASL,24.5％ were positive for 3D-TOF MRA and negative for 3D-ASL,34.0％ were negative for MRA and positive for 3D-ASL,17.0％ were negative for both 3D-TOF MRA and 3D-ASL.Conclusion 3D-ASL,3D-TOF MRA and DWI have their advantages and disadvantages,and can show the different characteristics of brain.Their combination can improve the diagnosis of TIA,follow the trail of changing condition,and can thus be used in diagnosis of TIA.%目的 探讨磁共振弥散加权成像(DWI)、三维时间飞跃法血管成像(3D-TOF MRA)和三维动脉自旋标记(3D-ASL)灌注成像在短暂性脑缺血发作(TIA)中的诊断价值.方法 选择临床诊断为TIA的患者53例为病例组,同期另选30例年龄匹配的健康志愿者作为对照组,入选者均行MRI常规扫描(T1 WI、T2 WI、T2 FLAIR)、DWI、3D-TOF MRA和3D-ASL扫描.根据扫描结果进行统计分析.结果 83例入选者DWI序列均未见高信号显示,3D-TOF MRA、3D-ASL及两者联合诊断TIA准确性分别为63.4％、71.1％、88.0％;敏感性分别为49.1％、58.5％、83.0％;特异性分别为90.0％、93.3％、96.7％.3D-TOF MRA与3D-ASL联合检查准确率、敏感性及特异性均明显高于两者单独检查(P＜0.05).病例组中,3D-TOF MRA阳性+ASL阳性的患者13例(24.5％);3D-TOF MRA阳性+3D-ASL阴性患者13例(24.5％);MRA阴性+ASL阳性的患者18例(34.0％);3D-TOFMRA阴性+3D-ASL阴性的患者9例(17.0％).结论 3D-ASL、3D-TOF MRA和DWI检查方法各具优缺点,可从不同方面反映脑的特征,将三者联合应用可更好确诊TIA,追踪病情改变,应该作为TIA诊断的常规扫描序列.
  • 摘要：目的 探讨小凹蛋白1(caveolin-1)对氧化型低密度脂蛋白(oxLDL)诱导RAW 264.7细胞衰老的影响及可能机制.方法 不同浓度oxLDL(0、20、40、80和120 μg/ml)诱导RAW 264.7细胞衰老,依次为A、B、C、D和E组,检测细胞中caveolin-1的变化.通过RNA干扰(siRNA)的方式下调细胞caveolin-1表达,分为oxLDL组、质粒对照组、siRNA组和无血清对照组,观察oxLDL(60 μg/ml)诱导的RAW 264.7细胞衰老的影响,同时Western blot检测p47phox在膜蛋白中的表达,细胞上清液中丙二醛含量、超氧化物歧化酶(SOD)活性.结果 C、D和E组较A组细胞衰老阳性率增加(P＜0.05),同时caveolin-1表达增加,与p47phox表达增加一致,与oxLDL组比较,siRNA组细胞衰老活性率减少(P＜0.05),细胞膜p47phox表达下降,细胞上清液丙二醛含量明显下降[(7.12±1.26)nmol/ml vs (11.97±1.78) nmol/ml,P＜0.05],SOD活性明显增加[(79.98±3.94)U/ml vs (50.03±6.57) U/ml,P＜0.05].结论 caveolin-1可能通过氧化应激影响oxLDL诱导巨噬细胞的衰老过程,从而影响衰老相关性动脉粥样硬化过程.%Objective To study the effect of caveolin-1 on oxLDL-induced aging of RAW 264.7 macrophages and its mechanism.Methods The aging of RAW 264.7 macrophages was induced with oxLDL (at the concertrations of 20 μg/ml,40 μg/ml,80 μg/ml and 120 μg/ml).Cavevolin-1 protein in RAW 264.7 macrophages was assayed.Expression of cavevolin-1 was detected by interfering RNA.Effect of caveolin-1 on oxLDL (60 μg/ml)-induced aging of RAW 264.7 macrophages was observed.Exprcssion level of p47phox in membrane protein,MDA level in supernatant of RAW 264.7 macrophages,and activity of SOD were measured.Results The aging of RAW 264.7 macrophages and the expression level of caveolin-1 protein in RAW 264.7 macrophages and that of p47phox in membrane protein increased with the increasing oxLDL concentration.The number of aging RAW 264.7 macrophages was less and the expression level of p47phox in membrane protein and the MDA level in supernatant of RAW 264.7 macrophages were lower (7.12± 1.26nmol/mlvs 11.97±1.78 nmol/ml,P＜0.05) while the activity of SOD was higher (79.98±3.94 U/ml vs 50.03 ±6.57 U/ml,P＜0.05) after the expression of caveolin-1 was interfered with RNA than before the expression of caveolin-1 was interfered with RNA.Conclusion Caveolin-1 affects oxLDL-induced aging of RAW 264.7 macrophages by regulating oxidative stress and aging-related atherosclerosis.
  • 摘要：Objective To study the protective effect of bone marrow mononuclear cells (BMMNC) transplantation in rats following ischemic stroke and its mechanism.Methods Ninety-six SD rats were randomly divided into sham operation group,model group,COX-2 inhibitor group and BMMNC group.Tissue samples were taken at 24 and 72 h and on day 7 after a model of middle cerebral artery occlusion (MCAO) was established by Longa occlusion.The neurological function of rats was scored according to the Zea Longa method.The ischemic stroke size was measured with TTC staining,and expressions of COX-2 and IL-1β were detected by Western blot and immunohistochemical staining.Results The ischemic stroke size was significantly smaller while the expression levels of COX-2 and IL-1β were significantly lower in BMMNC group than in model group at 24 and 72 h and on day 7 after the model was established (0.133±0.032 vs 0.342±0.042,0.141±0.035 vs 0.362±0.062,0.150±0.032 vs 0.330±0.050,P＜0.05;0.213±0.045 vs 0.272±0.055,0.231±0.087 vs 0.331±0.105,0.134±0.030 vs 0.163±0.053,P＜0.05).No significant difference was found in ischemic stroke size and expression levels of COX-2 and IL-1β between BMMNC group and model group (P＞0.05).Conclusion BMMNC transplantation can significantly improve the neurological function of rats following ischemic stroke by inhibiting the immune inflammatory reaction and downregulating the expression levels of COX-2 and IL-1β.%目的 研究骨髓单个核细胞(BMMNC)移植对大鼠脑梗死后损伤的保护作用以及相关机制.方法 雄性SD大鼠96只随机分为假手术组、模型组、环氧化酶2(COX-2)抑制剂组(NS398 20 mg/kg)和BMMNC组(1×107个BMMNC),每组24只.采用改良线栓法制备大脑中动脉永久闭塞模型,分别于模型成功后24、72 h和7d取材观察,每个时间点8只.采用Zea-Longa法进行神经功能评分;TTC染色法测脑梗死体积;免疫组织化学染色和Western blot技术检测COX-2、白细胞介素1β(IL-1β)表达.结果 BMMNC组24、72 h和7d时脑梗死体积明显低于模型组(P＜0.05);COX-2蛋白表达[(0.133±0.032) vs (0.342±0.042)、(0.141±0.035) vs (0.362±0.062)、(0.150±0.032) vs (0.330±0.050),P＜0.05]和IL-1β蛋白表达[(0.213±0.045)vs(0.272±0.055)、(0.231±0.087) vs (0.331±0.105)、(0.134±0.030) vs (0.163±0.053),P＜0.05]水平明显低于模型组,BMMNC组与COX-2抑制剂组上述指标无显著差异(P＞0.05).结论 BMMNC移植可通过抑制脑内免疫炎性反应,显著改善脑梗死大鼠的神经功能,可能与下调COX-2、IL-1β表达有关.
  • 摘要：Objective To investigate whether human serum albumin (ALB) can improve long-term cognitive function in SAH rats.Methods Eighty adult male SD rats weighing 270-320 g were randomly divided into sham operation group and normal saline,low ALB dose (0.63 g/kg) and high ALB dose (1.25 g/kg) treatment groups (20 in each group).Endovascular perforation model was used to induce SAH.Working and spatial memory of SAH rats were evaluated by novel object recognition (NOR) and Morris water maze (MWM) respectively.Spine density and synapserelated proteins levels were measured by immunoblotting with Golgi staining.Results The shortterm and long-term working memory were significantly better in both low and high ALB dose treatment groups (P=0.001).Compared with normal saline treatment group,the latency and swimming distance were significantly shorter (P=0.015,P=0.019;P=0.015,P=0.017),while the frequency to cross quadrant was significantly higher (P=0.018,P=0.027) in low and high ALB dose treatment groups.The spine density was significantly higher in hippocampal area in low dose treatment group (P=0.025),while both cortical and hippocampal spine densities were significantly higher in high dose group than in saline group (P=0.026,P=0.016).The expression levels of synapse-related proteins were significantly higher in both low and high ALB dose treatment groups.Conclusion ALB can significantly improve cognitive functions in SAH rats by upregulating spine density and synapse-related proteins levels.%目的 探讨静脉即刻给予人血白蛋白(ALB)是否对蛛网膜下腔出血(SAH)远期认知功能预后具有改善作用.方法 选取270～320 g成年SD 2月龄雄性大鼠80只,随机分为假手术组、生理盐水组、低剂量组(ALB 0.63g/kg)和高剂量组(ALB 1.25 g/kg),每组20只.采用血管刺破方法建立大鼠SAH模型.在建模后29d开始进行认知功能评估,采用新事物认知实验进行短时和长时工作记忆能力测试;Morris水迷宫实验进行空间记忆能力评价;高尔基染色和蛋白印迹实验检测树突棘密度及突触相关蛋白表达.结果 低、高剂量组大鼠短时和长时工作记忆能力都较生理盐水组大鼠明显提高(P=0.001).与生理盐水组比较,低、高剂量组大鼠第3天潜伏期(P=0.015,P=0.019)和第4、5天游泳距离(P=0.015,P=0.017)明显缩短,穿越原平台位置次数显著提高(P=0.018,P=0.027).与生理盐水组比较,低剂量组显著提高海马区树突刺密度(P=0.025);高剂量组显著提高皮质及海马区树突棘密度(P=0.026,P=0.016);低、高剂量组大鼠突触相关蛋白表达水平明显提高(P＜0.05).结论 ALB可能通过提高SAH大鼠树突棘密度和突触相关蛋白含量,促进认知功能恢复.
  • 摘要：慢性心力衰竭是大多数心血管病的最终阶段,是世界范围发病率和死亡率最主要的病因之一。据估计,目前全世界超过2300万人患有慢性心力衰竭,随着老龄化社会的到来,其发病率将会在未来10年继续增长。近几十年新的医学观念和手段已经使多种心脏疾病的预后获得改观,但慢性心力衰竭死亡率（5年死亡率近50%）依然高居不下。心脏移植是目前晚期心力衰竭患者最为有效的治疗手段,但供者不足、术后免疫抑制以及花费巨大严重阻碍其发展和推广。
  • 摘要：微颗粒是细胞在活化、凋亡过程中形成的微小囊泡。微颗粒广泛存在于血液、组织和细胞中,与机体多种病理生理过程有关（如心血管疾病、糖尿病、炎性反应、肿瘤等）。关于微小RNA（microRNA,miRNA）的研究已经成为生命科学领域研究的热点,越来越多的研究表明,miRNA与人类多种疾病密切相关。
  • 摘要：自1970年起由Merzenich和Wall等发表的一系列研究表明,大脑在一生中都存在适应和重构的能力,从单个神经元到神经环路都可以发生改变。重构的机制非常复杂,根据不同的时程各不相同,包括了突触效能的改变,轴索的增生和修剪,甚至在一些已有神经环路中产生新的神经元。结构磁共振和功能磁共振成像（fMRI）证实了脑卒中后的修复以及新技能的形成都与大脑的重构有关。
  • 摘要：心脑血管疾病和肿瘤是老年人的常见疾病,同时是人类的头号和二号杀手。近年来,肿瘤治疗取得了许多进步,恶性肿瘤患者生存时间明显延长。但有研究发现,肿瘤治疗相关心力衰竭的死亡风险是原发性心肌病的3.5倍,肿瘤患者死于心血管事件的风险甚至超过肿瘤复发的风险,成为肿瘤患者生存面临的又一严峻挑战。与肿瘤治疗相关的心血管毒副作用的防治,应引起我们的高度重视。
  • 摘要：Objective To study whether clinical characteristics,therapies and in-hospital events of elderly patients with acute coronary syndrome (ACS) changed over time.Methods This study enrolled 944 ACS patients aged ≥ 60 years hospitalized in Department of Cardiology,Peking University First Hospital,including 628 patients aged 60-74,316 patients aged 75-89,of them,162 patients in 2000,293 patients in 2007,489 patients in 2014,respectively.Temporal trends of clinical features,guideline-recommended therapies and in-hospital events were analyzed.Results From 2000 to 2014,patients were older,percentage of comorbidities such as hypertension,diabetes and hyperlipedemia increased (for hypertension,increased from 66.0％ to 75.5％,for DM,from 21.6％ to 43.1％,for hyperlipedemia,from 12.3％ to 44.0％).The proportion of patients who underwent previous CAG and PCI increased (for CAG,from 18.5％ to 40.9％,for PCI,from 8.0％ to 33.3％).Patients with symptomatic heart failure and infection at admission decreased.AMI patients took up a lesser proportion in 2007 and 2014,compared with those in 2000.UA patients increased markedly in 2014.Use of guideline-recommended drugs increased.PCI use increased from 34.6％ in 2000 to 70.6％ in 2014 (P＜0.01).Meanwhile,in-hospital mortality decreased from 11.1％ in 2000 to 1.6％ in 2014,and in-hospital MACCE from 21.6％ to 8.4％ (P＜0.01).Conclusion Clinical characteristics changed,use of guideline-recommended drugs and PCI increased over time,and in-hospital outcomes improved in elderly patients with ACS.%目的 探讨老年急性冠状动脉综合征(ACS)的临床特征和治疗及院内事件是否随时间发生变化.方法 入选2000年、2007年和2014年北京大学第一医院心内科住院治疗的老年ACS患者(年龄≥60岁)944例,其中60～74岁628例,75～89岁316例.2000年162例,2007年293例,2014年489例.分析入选患者的临床特征、指南推荐下治疗和院内事件随时间变化趋势.结果 2000年、2007年和2014年患者的年龄呈增长趋势,高血压从66.0％增至75.5％、糖尿病从21.6％增至43.1％、高脂血症从12.3％增至44.0％,既往冠状动脉造影从18.5％增至40.9％,既往PCI从8.0％增至33.3％,同时,入院时发生症状性心力衰竭和合并感染比例下降(P＜0.05,P＜0.01).心肌梗死比例下降,不稳定性心绞痛比例增高(P＜0.05,P＜0.01).指南推荐下院内药物治疗呈增加趋势,PCI从2000年的34.6％增至2014年的70.6％ (P＜0.01).院内病死率从2000年的11.1％降至2014年的1.6％,院内主要不良心脑血管事件从2000年的21.6％降至2014年的8.4％(P＜0.01).结论 老年ACS临床特征随时间发生变化,指南推荐下院内药物治疗和PCI比例呈增加趋势,院内预后得到改善.
  • 摘要：目的 调查广州市65岁以上离退休老年高血压患者家庭血压监测的相关知识及行为情况.方法 选取2016年3～5月在我院参加离退休干部体检和社区健康体检的高血压患者765例,其中家庭测血压354例(测量组),家庭未测血压411例(未测组).进行横断面调查,包括基线资料(性别、年龄、生命体征、既往疾病史、检验结果等)和家庭血压测量频率、测量时间、血压达标情况等.结果 765例高血压患者中,每天测血压224例(29.3％),每天多次测血压32例(4.2％),无固定时间测血压98例(12.8％).晨起测血压205例(26.8％),睡前测血压12例(1.6％),晨起+睡前测血压17例(2.2％),有症状时测血压120例(15.7％).测量组降压目标知晓率和达标率明显高于未测组(33.9％％ vs 22.4％,P=0.000;53.7％ vs 44.0％,P=0.008),收缩压明显低于未测组[(137.46±18.23)mm Hg vs (140.78±18.36)mm Hg,P=0.008].结论 调查人群中家庭血压监测率不高,且家庭血压相关知识认知不足,医护人员在健康教育中应着重加强家庭血压相关知识指导及培训,以提高血压达标率.%Objective To investigate the home blood pressure monitoring-related knowledge and behaviors in elderly hypertensive patients aged≥65 years in Guangzhou.Methods Seven hundred and sixty-five elderly hypertensive patients who underwent physical examination in our hospital from March 2016 to May 2016 were divided into home blood pressure moitoring group (n=354) and non home blood pressure monitoring group (n =411).Their baseline data (gender,age,vital signs,past medical history and laboratory test parameters),frequency and time of home blood pressure monitoring,rate of normalized blood pressure were recorded.Results The blood pressure was monitored once a day in 224 (29.3％),several times a day in 32 (4.2％),at unregular times in 98 (12.8％),at morning in 205 (26.8％),before going to bed in 12 (1.6％),at morning and before going to bed in 17 (2.2％),at presence of symptoms in 120 (15.7％) out of the 765 hypertensive patients.The awareness rate of blood pressure decreasing target and the achieved rate of normal blood pressure were significantly higher while the SBP was significantly lower in home blood pressure moitoring group than in non home blood pressure monitoring group (33.9％ vs 22.4％,53.7％ vs 44.0％,P=0.000;137.46±18.23 mm Hg vs 140.78±18.36 mm Hg,P=0.008).Conclusion The rate of home blood pressure monitoring is not high and the home blood pressure monitoring-related knowledge is poor in elderly hypertensive patients.Training of home blood pressure monitoring-related knowledge should thus be strengthened in health education of elderly hypertensive patients in order to improve their blood pressure.
  • 摘要：目的 探讨老年中重度热烧伤患者并发急性脑梗死的危险因素.方法 入院72 h内确诊的老年中重度热烧伤合并急性脑梗死患者42例作为观察组,头颅CT或MRI检查未出现脑梗死患者47例作为对照组,采用单因素分析和二元logistic回归分析相关危险因素.结果 与对照组比较,观察组中性粒细胞、红细胞比容、血小板计数、纤维蛋白原、血栓素A2、肌酐、降钙素原、C反应蛋白、TNF-α及白细胞介素6显著升高,入院时收缩压显著降低,差异有统计学意义(P＜0.01).二元logistic回归分析显示,入院时收缩压(OR=1.106,95％CI:1.007～1.501,P=0.007)、纤维蛋白原(OR=3.316,95％ CI:1.251～8.792,P=0.016)、血栓素A2(OR=1.077,95％CI:1.003～1.156,P=0.041)、TNF-α(OR=2.901,95％CI:1.109～2.799,P=0.013)、白细胞介素6(OR=1.502,95％CI:1.581～2.031,P=0.021).结论 入院时收缩压、纤维蛋白原、血栓素A2、TNF-α、白细胞介素6是老年中重度热烧伤合并急性脑梗死的独立危险因素.%Objective To study the risk factors in elderly moderate-severe thermal burn patients with acute ischemic stroke (AIS).Methods Forty-two elderly moderate-severe thermal burn patients with AIS served as an observation group and 47 elderly moderate-severe thermal burn patients without AIS served as a control group in this study.Risk factors in thermal burn patients with AIS were analyzed by univariate and multivariate logistic regression analysis respectively.Results The number of neutrophils and platelets,hematocrit,serum levels of fibrinogen,thromboxane A2,creatinine,procalcitonin,C-reactive protein,TNF-α and interleukin-6 (IL-6) were significantly higher while the systolic blood pressure (SBP) on admission was significantly lower in observation group than in control group (P＜0.01).Logistic regression analysis showed that SBP on admission,serum levels of fibrinogen,thromboxane A2,TNF-α and IL-6 were the independent risk factors in elderly moderate-severe thermal burn patients with AIS (OR =1.106,95％CI:1.007-1.501,P=0.007;OR=3.316,95 ％ CI:1.251-8.792,P=0.016;OR=1.077,95％CI:1.003-1.156,P=0.041;OR=2.901,95％CI:1.109-2.799,P=0.013;OR=1.502,95％CI:1.581-2.031,P=0.021).Conclusion SBP on admission,serum levels of fibrinogen,thromboxane A2,TNF-α and IL-6 are the independent risk factors in elderly moderate-severe thermal burn patients with AIS.
  • 摘要：目的 探讨脑梗死患者脑微出血(cerebral microbleeds,CMB)与血清同型半胱氨酸的相关性,进而寻找复发脑梗死的危险因素及生物标记.方法 回顾性分析脑梗死患者540例,其中首发脑梗死患者188例(首发脑梗死组),复发脑梗死患者352例(复发脑梗死组).依据影像学资料分为CMB患者146例(CMB组),非CMB患者394例(非CMB组).比较人口统计学资料、血管危险因素以及血清学指标与CMB、复发脑梗死的相关性,并对脑梗死进行不同年龄区分析.结果 CMB组高血压、收缩压、同型半胱氨酸明显高于非CMB组,TC明显低于非CMB组,差异有统计学意义(P＜0.05,P＜0.01).与复发脑梗死组比较,首发脑梗死组年龄明显降低,吸烟、收缩压、舒张压、糖化血红蛋白、TC、LDL明显升高,差异有统计学意义(P＜0.05,P＜0.01).多因素分析显示,高血压、同型半胱氨酸为CMB的独立危险因素(OR=1.852,95％CI:1.134～3.026,P=0.014;OR=1.012,95％CI:1.001～1.023,P=0.037).TC为CMB的保护因素(OR=0.827,95％CI:0.732～0.935,P=0.002).年龄45～65岁患者差异最大,且更易出现首发脑梗死.结论 CMB可通过控制血压和血清同型半胱氨酸水平、调整TC等治疗达到预防的作用;同时可降低复发脑梗死,特别是控制高血压和糖尿病.%Objective To study the relationship between cerebral microbleeds (CMB) and serum homocysteine level in ischemic stroke (IS) patients in order to find the risk factors and biomarkers for recurrent IS.Methods Five hundred and forty IS patients were divided into first-ever IS group (n=188) and recurrent IS group (n=352) or into CMB group (n=146) and CMB-free group (n=394) according to their imaging data.Relationship of demographic data,vascular risk factors and serological parameters with CMB and recurrent IS was analyzed.The age to develop IS was also analyzed.Results The incidence of hypertension,SBP and serum homocysteine level were significantly higher while the serum TC level was significantly lower in CMB group than in CMB-free group (P＜0.05,P＜0.01).The age was significantly younger while the prevalence of smoking,SBP,DBP,serum levels of HbAIc,TC and LDL were significantly higher in first-ever IS group than in recurrent IS group (P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that hypertension and serum homocysteine level were the independent risk factors for CMB while TC was the protective factor for CMB (OR =1.852,95％ CI:1.134-3.026,P =0.014;OR=1.012,95％ CI:1.001-1.023,P=0.037;OR=0.827,95％CI:0.732-0.935,P=0.002).First-ever IS was easy to occur in 45-65 years old patients.Conclusion CMB can prevent IS by regulating hypertension and serum levels of homocysteine and TC,and reduce the incidence of recurrent IS,especially that of hypertension and diabetes mellitus.
  • 摘要：目的 利用经颅彩色多普勒超声(TCCD)监测急性脑卒中患者脑中线移位的程度,并对不同程度脑中线移位患者预后进行分析评估.方法 选取2015年10月～2016年1月入住我院神经内科,应用TCCD监测脑中线移位患者58例,其中经头颅CT或MRI证实有脑中线移位的大面积脑梗死患者25例(脑梗死组)和脑出血患者33例(脑出血组),并进行统计学分析.结果 脑梗死组和脑出血组头颅CT/MRI与TCCD监测的脑中线移位值比较,差异无统计学意义[(3.32±2.43)mm vs (3.28±2.31)mm,P=0.986;(3.64±2.03)mmvs(3.43±1.90)mm,P=0.630].TCCD检测脑中线移位值与年龄、性别、血管危险因素及临床病情不相关(P＞0.05).TCCD检测脑中线移位的ROC曲线下面积0.961±0.008,特定界值1.75,敏感性100％％,特异性85.5％,准确性70.0％.结论 TCCD监测脑中线结构及移位有优势,为临床工作提供更方便(床旁)、可靠、无创的技术手段,为患者提供更经济的检查方法.%Objective To monitor the brain midline shift in acute ischemic stroke (AIS) patients by transcranial color coded duplex (TCCD) ultrasonography.Methods Fifty-eight patients with brain midline shift admitted to our hospital from October 2015 to January 2016 for TCCD ultrasonography were included in this study.Of these patients,25 with CT-or MRI-conformed massive ischemic stroke served as an ischemic stroke group and 33 with CT-or MRI-conformed cerebral hemorrhage served as a cerebral hemorrhage group.Their brain midline shift was statistically analyzed.Results No significant difference was found in brain midline shift monitored by CT/MRI and TCCD ultrasonography between the two groups (3.32±2.43 mm vs 3.28±2.31 mm,3.64± 2.03 mm vs 3.43± 1.90 mm,P＞0.05).TCCD ultrasonography showed that brain midline shift was not related with age,gender,vascular risk factors and clinical condition (P＞0.05),and showed that the area under the ROC curve for brain midline shift was 0.961±0.008,with a specific value of 1.75,a sensitivity of 100％,a specificity of 85.5％,and an accuracy of 70.0％.Conclusion TCCD ultrasonography has its advantages in monitoring brain midline structure and shift,and provides a more convenient,reliable,and noninvasive technique for clinians and a more economic examination method for patients.
  • 摘要：目的 观察有氧运动对大鼠急性心肌梗死后心脏功能的改善性研究.方法 实验大鼠24只,随机分为假手术组,梗死模型组、有氧运动组,每组8只.各组大鼠10周后进行血流动力学指标检测,左心室压力最大上升速率(+dp/dtmax)和左心室压力最大下降速率(-dp/dtmax),左心室收缩压(LVSP)、左心室舒张末压(LVEDP).血管紧张素Ⅱ(AngⅡ)、白细胞介素6(IL 6)、基质金属蛋白酶(MMP)-2、MMP 9、Ⅰ型胶原蛋白、Ⅲ型胶原蛋白mRNA表达.结果 与假手术组比较,梗死模型组和有氧运动组大鼠LVEDP、AngⅡ、IL-6明显升高,LVSP、+dp/dtmax、-dp/dtmax明显降低(P＜0.05,P＜0.01).与梗死模型组比较,有氧运动组大鼠+dp/dtmax、-dp/dtmax明显升高,LVEDP、AngⅡ、IL-6明显降低[(20.5±3.5)mm Hg vs (25.8±4.0)mm Hg,P＜0.05,1 mm Hg=0.133 kPa;(1176.7±140.9)ng/L vs (1436.7±230.2) ng/L,P＜0.05;(123.0±28.7)ng/L vs (161.8±14.3) ng/L,P＜0.01].与假手术组比较,梗死模型组MMP-2、MMP-9、Ⅰ型胶原蛋白、Ⅲ型胶原蛋白mRNA表达明显增加(P＜0.01).与梗死模型组比较,有氧运动组MMP-2、MMP-9、Ⅰ型胶原蛋白、Ⅲ型胶原蛋白mRNA表达明显降低(P＜0.01).结论 有氧运动可以通过抑制血中AngⅡ、IL-6水平的增加以及抑制MMP-2、MMP-9、Ⅰ型胶原蛋白、Ⅲ型胶原蛋白mRNA表达改善心肌梗死大鼠的心脏功能.%Objective To study the effect of aerobic exercise on heart function of rats following acute myocardial infarction (AMI).Methods Twenty-four AMI SD rats were randomly divided into sham operation group,AMI model group and aerobic exercise group (8 in each group).After ten weeks,hemodynamic parameters,left ventricular+ dp/dt left ventricular-dp/dt LVSP,LVEDP,and expression levels of Ang Ⅱ,IL-6,MMP-2,MMP-9,collagen 1 and collagen 3 mRNA were measured.Results The LVEDP and serum levels of Ang Ⅱ and IL-6 were significantly higher while the LVSP,+dp/dt and-dp/dt were significanty lower in AMI model group than in sham operation group (P＜0.05,＜0.01).The +dp/dtmax and-dp/dtmax were significanty higher while the LVEDP and serum levels of Ang Ⅱ and IL-6 were significanty lower in aerobic exercise group than in AMI model group.The expression levels of MMP 2,MMP-9,collagen 1 and collagen 3 mRNA were significantly higher in AMI model group than in sham operation group and were significantly lower in aerobic exercise group than in AMI model group (P＜0.01).Conclusion Aerobic exercise improves the heart function of rats following AMI by downregulating the expression levels of Ang Ⅱ,IL-6,MMP-2,MMP-9,collagen 1 and collagen 3 mRNA.
  • 摘要：1临床资料 患者男性,65岁,活动时心前区疼痛2年,加重1h入院,1h内反复出现心绞痛,持续数分钟缓解,伴有大汗。入院查血压120/80mm Hg（1mm Hg=0.133kPa）,双肺呼吸音低,未闻及干湿啰音,心率80/min,律齐,听诊区未闻及杂音。肌酸激酶同工酶84,心电图示ST段压低,初步诊断急性冠状动脉综合征,急诊行PCI。
  • 摘要：心外膜脂肪组织（epicardial adipose tissue,EAT）是位于心肌与脏层心包之间的脂肪组织,其解剖位置与心肌、冠状动脉紧密相连,可释放多种促炎因子。研究显示,EAT与多种心血管及代谢性疾病相关。近年来,EAT超声学评估方法受到广泛采纳,被用于心血管及代谢性疾病的临床研究。
  • 摘要：急性缺血性脑卒中具有发病率高、致残率高、病死率高、复发率高、合并症多及治愈率低等特点,给患者家庭及社会带来沉重的负担。各国的急性缺血性脑卒中诊治指南反复指出,重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗仍然是急性缺血性脑卒中最有效的治疗方式。

    中华老年心脑血管病杂志的期刊信息

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    • 热门主题：中国人民解放军总医院
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