急性冠脉综合征患者经皮冠状动脉介入治疗前强化他汀类治疗对术后高敏C-反应蛋白、肿瘤坏死因子-α、P-选择素水平的影响

目的 观察急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)前给予阿托伐他汀强化治疗,术后血样高敏C-反应蛋白(hs-CRP)、肿瘤坏死因子(TNF)-α、P-选择素水平的变化,探讨其临床意义.方法 选择择期行PCI的住院患者78例,按随机数字表法分为两组:标准治疗组39例(阿托伐他汀20mg/d),强化治疗组39例(于术前12、2 h分别给予阿托伐他汀40、20mg).检测两组患者术前1 d,术后6、12 h hs-CRP、TNF-α、P-选择素水平,并进行比较.结果 标准治疗组28例、强化治疗组29例成功置入支架.两组术前1 d hs-CRP、TNF-α、P-选择素水平比较差异无统计学意义(P＞0.05),术后6、12 h均较术前显著升高(P＜0.05),标准治疗组术后12 h较术后6 h仍明显增高[hs-CRP:(10.29±0.77)mg/L比(6.34±1.23)mg/L;TNF-α:(58.15±5.19)ng/L比(36.12±3.89)ng/L;P-选择素:(49.58±4.92)μg/L比(31.47±3.71)μg/L](P＜0.05),强化治疗组术后12 h与术后6 h相比虽仍有升高,但差异无统计学意义[hs-CRP:(6.83±1.46)mg/L比(5.95±1.17)mg/L;TNF-α:(42.18±7.79)ng/L比(34.07±8.79)ng/L;P-选择素:(33.57±4.63)μg/I比(29.78±5.61)μg/L](P＞0.05).标准治疗组术后6、12 h hs-CRP、TNF-α、P-选择素水平较强化治疗组增高,但差异无统计学意义(P＞0.05).结论 ACS患者PCI前短期给予阿托伐他汀强化治疗,可有效降低患者hs-CRP、TNF-α、P-选择素水平,有助于PCI后机体促炎和抗炎失衡状态的恢复.

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Objective To observe the changes of postoperative blood high sensitive C-reactive protein (hs-CRP), tumor necrosis factor(TNF)-o, P-selectin levels in patients with acute coronary syndrome (ACS) who had an atorvastatin intensive treatment before operation, and investigate its clinical significance.Methods Seventy-eight cases of ACS patients who intended to undergo percutaneous coronary intervention were divided into two groups by random digits table:39 patients comprising the standard treatment group (given atorvaatatin 20 mg/d, conventional treatment), 39 patients comprising the enhanced group (given atorvastatin 40 mg, 20 mg separately at preoperative 12 h, 2 h on the basis of conventional treatment).Among them, 28 cases of the standard treatment group and 29 cases of the enhanced group finally underwent the test. The hs-CRP,TNF-α ,P-selectin levels at preoperative 1 day,postoperative 6 h,postoperative 12 h were detected and then the changes of three factors were analyzed. Results There was no significant difference in hs-CRP,TNF- α, P-selectin between the two groups at preoperative 1 day. The values of the two groups markedly increased at postoperative 6 h, 12 h and the difference was statistically significant (P ＜0.05). The values of the standard treatment group were markedly higher at postoperative 12 h than those at postoperative 6 h,and the difference was statistically significant [hs-CRP: (10.29 ± 0.77) mg/L vs. (6.34 ±1.23) mg/L;TNF-α: (58.15±5.19) ng/L vs. (36.12 ± 3.89) ng/L;P-selectin: (49.58 ±4.92) μg/L vs.(31.47 ± 3.71) μ g/L] (P ＜ 0.05). However, the values of the enhanced group were higher at postoperative 12 h than those at postoperative 6 h but the difference was no statistically significant [hs-CRP: (6.83 ± 1.46)mg/L vs. (5.95 ± 1.17) mg/L; TNF- o: (42.18 ± 7.79) ng/L vs. (34.07 ± 8.79) ng/L; P-selectin: (33.57 ±4.63) μ g/L vs. (29.78 ± 5.61) μ g/L] (P ＞ 0.05). Three factors in standard treatment group were elevating significantly at postoperative 6 h, 12 h compared with those in the enhanced group, but the difference was no statistically significant (P ＞ 0.05). Conclusion Short-term intensive therapy of atorvastatin in ACS patients who intend to do PCI, can reduce the hs-CRP, TNF-α, P-selectin levels effectively.     

急性心肌梗死患者窦性心率震荡现象的临床价值分析

目的 探讨急性心肌梗死患者窦性心率震荡的临床价值.方法 选取86例急性心肌梗死患者(心肌梗死组)和60例有室性期前收缩的健康体检者(非心肌梗死组)进行24 h动态心电图监测,比较两组室性期前收缩后的震荡初始(TO)和震荡斜率(TS).结果 心肌梗死组T0高于非心肌梗死组(P＜0.01);TS低于非心肌梗死组(P＜0.01).死亡组TO高于非死亡组(P＜0.05),TS低于非死亡组(P＜0.05).心肌梗死组中TO异常50例(58.1%),TS异常58例(67.4%),非心肌梗死组分别为10例(16.7%)和6例(10.0%),两组比较差异均有统计学意义(P＜0.05).T0和TS均异常的52例中死亡24例(46.2%),TO或TS异常的28例中死亡7例(25.0%),TO和TS均正常的6例中死亡1例(16.7%),三种情况病死率比较差异有统计学意义(P＜0.01).结论 急性心肌梗死患者窦性心率震荡现象减弱或消失时病死率增高,及时监测分析心肌梗死患者TO和TS对预测猝死高危患者及危险分层有重要临床价值.

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Objective To explore the clinical utility of the sinus rhythm turbulence in the patients with acute myocardial infarction (AMI). Methods All day the dynamic electrocardiogram was monitored in 36 patients with AMI (AMI group) and 60 healthy subjects with ventricular premature beat (VPB) (control group),the TO value and TS value after VPB was compared between two groups. Results The TO value after VPB in AMI group was higher than that in control group (P＜0.01), the TS value after VPB in AMI group was lower than that in control group (P ＜ 0.01). The TO value in the non-survivors with AMI was higher than that in the survivors,while their TS value was lower with a significant difference (P＜ 0.01). The irregular positive rate of the TO value and the TS value in the patients with AMI was 58.1%(50/86) and 67.4%(58/86), while that of the healthysubjects was 16.7%(10/60) and 10.0%(6/60) with a significant difference (P ＜ 0.05). The research from the follow-up visit of the selected patients in 2 years showed that death rate of the patients with both irregular TO and TS was 46.2% (24/52), the death rate with either irregular TO or TS was 25.0%(7/28), the death rate with both regular TO and TS was 16.7%(1/6), and the difference of the three phenomenon was significant (P ＜ 0.01). Conclusion As long as the sinus rhythm turbulence of the patients with AMI disappears or declines,the death rate increases, and to monitor and analyze their TO and TS in time is helpful for us to avoid the sudden death of the patients and to discover the levels of their risks.     

血液灌注对维持性血液透析患者微炎性反应状态的影响

目的 探讨血液灌注(HP)对维持性血液透析(MHD)患者微炎性反应状态的影响.方法 50例行MHD治疗的慢性肾衰竭患者(MHD组),按随机数字表法分为两组:HP联合血液透析(HD)组(HP+HD组,25例)和单纯HD组(HD组,25例),并设对照组(25例).检测治疗前及治疗24周后血清高敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平.结果 与对照组比较,MHD组血清hs-CRP[(6.72±263)mg/L 比(1.35±0.92)mg/L]、IL-6[(348.83±64.41)ng/L比(54.49±2247)ng/L]、TNF-α[(7.52±317)ng/L比(2 53±0.88)ng/L]水平明显增高(P＜0.05).治疗前HP+HD组与HD组血清hs-CRP、IL-6、TNF-α水平比较差异无统计学意义(P>0.05).治疗后,与HD组比较,HP+HD组血清hs-CRP[(4.78±2.49)mg/L比(6.89±2.69)mg/L]、lL-6[(260.54±56.72)ng/L比(357.14±56.37)ng/L]、TNF-α[(5.36±241) ng/L比(7.49±2.87)ng/L]水平明显下降(P＜0.05).结论 HP可改善MHD患者微炎性反应状态.

Abstract：

Objective To observe the effect of hemoperfusion on micro-inflammation in patients with maintenance hemodialysis (MHD).Methods Fifty MHD patients (MHD group) and 25 healthy volunteers (control group) were involved in this study.The MHD patients were divided into two groups by random digits table:hemoperfusion combined with hemodialysis group (HP + HD group,25 cases) and hemodialyais group (HD group,25 cases).The plasma levels of micro-inflammatory cytokines including high-sensitive C-reactive protein (hs-CRP),interleukin-6 (IL-6) and tumor necrosis faetor-α (TNF-α ) were measured before and after treatment.Results The plasma levels of hs-CRP,IL-6 and TNF-α in MHD group were significantly higher than those in control group [(6.72 ± 2.63) mg/L vs.(1.35 ± 0.92) mg/L,(348.83 ± 64.41) ng/L vs.(54.49 ±22.47) ng/L,(7.52 ± 3.17) ng/L vs.(2.53 ±0.88) ng/L](P＜0.05).There was no significant difference in the plasma levels of hs-CRP,IL-6,TNF-α before treatment between HD group and HP+HD group (P＞0.05),Compared with those in HD group,the plasma levels of hs-CRP,IL-6 and TNF-α after treatment in HP+HD group were significantly decreased [(4.78 ±2.49) mg/L vs.(6.89 ±2.69) mg/L,(260.54 ±56.72) ng/L vs.(357.14 ±56.37) ng/L,(5.36 ±2.41) ng/L vs.(7.49 ±2.87) ng/L] (P <0.05).Conclusion Hemoperfusion improves micro-inflammation in patients with MHD.     

大剂量阿托伐他汀对急性冠状动脉综合征患者经皮冠状动脉介入治疗围手术期心肌保护作用

目的 观察大剂量阿托伐他汀对急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)围手术期的心肌保护作用.方法 120例择期行PCI的ACS患者,按随机数字表法分为两组,每组60例,A组术前3d口服阿托伐他汀80mg/d,B组术前3d口服阿托伐他汀20mg/d.两组患者均于术前、术后6 h、术后12 h测定肌钙蛋白Ⅰ(cTnI)、肌酸激酶同工酶MB(CK-MB)、超敏C反应蛋白(hs-CRP)、白细胞介素(IL)-6.于术前、术后3d测定总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C),并进行比较.结果 两组术后6 h及术后12 h cTnI、CK-MB、hs-CRP、IL-6水平均明显高于术前,差异有统计学意义(P<0.05).术后6 h A组cTnI、CK-MB水平明显低于B组[(0.35±0.18)μg/L比(0.48±0.16)μg/L,(3.78±0.45)μg/L比(4.56±0.55)μg/L],术后12 h A组hs-CRP、IL-6水平明显低于B组[(4.53±0.98)mg/L比(7.03±0.88)mg/L,(30.6±11.2)ng/L比(43.8±12.1)ng/L],差异均有统计学意义(P<0.05).两组患者术前、术后TC、TG、LDL-C、HDL-C水平比较差异无统计学意义(P>0.05).结论 择期行PCI患者术前3d口服阿托伐他汀80 mg/d,其心肌保护作用优于口服阿托伐他汀20 mg/d,可在临床应用.

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Objective To observe the perioperative myocardial protection of high-dose atorvastatin to acute coronary syndrome(ACS) patients during percutaneous coronary artery interventional therapy(PCI).Methods One hundred and twenty patients with ACS undergoing elective PCI were divided into group A and group B with different oral dose of atorvastatin ( 80 mg/d and 20 mg/d ) for 3 days before operation by random digits table. Troponin I (cTnI), creatine kinase isozyme MB (CK-MB), high sensitive C-reactive protein (hs-CRP), interleukin (IL)-6 levels were measured before operation, 6 hours, 12 hours after operation and total cholesterol (TC), triglyeride (TG), low desity lipeprotein cholesterol (LDL-C), high density lipeprotein cholesterol (HDL-C) levels were measured before operation and 3 days after operation.Results cTnI,CK-MB,hs-CRP and IL-6 levels in the two groups were increased significandy 6 hours and 12 hours after operation (P <0.05). Six hours after operation, cTnI and CK-MB levels in group A were significantly lower than those in group B [(0.35±0. 18 ) μg/L vs. (0.48±0. 16 ) μg/L, ( 3.78±0.45 )μg/Lvs. (4.56±0.55 )μg/L] (P < 0.05 ). Twelve hours after operation , hs-CRP and IL-6 levels in group A were significantly lower than those in group B [(4.53±0.98 ) mg/L vs. (7.03±0.88 ) mg/L, ( 30.6±11.2) ng/L vs.(43.8±12.1) ng/L] (P <0.05). TC, TG, LDL-C, HDL-C levels in the two groups did not change significantly before and after operation (P >0.05). Conclusions Myocardial protective effects of ACS patients treated with atorvastatin 80 mg/d for 3 days are better than those treated with oral atorvastatin 20 mg/d. High-dose atorvastatin can produce more beneficial effects.     

急性一氧化碳中毒后迟发性脑病患者血清和脑脊液中5-羟色胺和多巴胺的水平

目的 探讨急性一氧化碳中毒后迟发性脑病(DEACMP)患者血清和脑脊液(CSF)中5-羟色胺(5-HT)、多巴胺(DA)水平的变化及其临床意义.方法 用高效液相色谱法动态检测42例DEACMP患者血清和CSF中5-HT、DA水平,用日常生活能力量表(ADL)、常识记忆注意测验(IMCT)、长谷川痴呆量表(HDS)动态检查DEACMP患者的病情变化,并与38例其他脑病患者和38例非脑病患者进行比较.结果 DEACMP组治疗前血清中5-HT水平[(662.61±178.50)nmol/L]、DA水平[(155.74±60.32)nmol/L]明显低于非脑病组[分别为(914.08±198.04)、(225.70±48.53)nmol/L],差异均有统计学意义(P＜0.01),治疗前血清中DA水平也明显低于其他脑病组[(243.57±66.94)nmol/L],差异亦有统计学意义(P＜0.01),而治疗前血清中5-HT水平与其他脑病组[(729.54±299.87)nmol/L]比较,差异无统计学意义(P＞0.05);DEACMP组治疗后血清中5-HT水平[(714.08±170.47)nmol/L]、DA水平[(192.18±33.07)nmol/L]与治疗前比较均有不同程度升高,但仅有DA水平治疗前后变化的差异有统计学意义(P＜0.05).DEACMP组治疗前CSF中5-HT水平、DA水平明显低于非脑病组及其他脑病组,差异均有统计学意义(P＜0.05);治疗后CSF中5-HT水平[(232.44±54.28)nmol/L]恢复正常,与治疗前比较,差异有统计学意义(P＜0.01),而治疗后CSF中DA水平虽略有升高,但与治疗前比较,差异无统计学意义(P＞0.05).DEACMP组治疗前ADL评分(50.64±7.29)、HDS评分(8.55±8.08)、IMCT评分(4.95±7.30)与治疗后(分别为35.57±16.14、16.45±10.30、15.64±10.90)比较,差异均有统计学意义(P＜0.01).DEACMP组治疗前后血清中DA水平变化和HDS评分变化之间呈明显负相关(t=0.376,P＜0.05).结论 DEACMP患者血清和CSF中5-HT、DA水平动态变化与病情变化基本一致,动态检测5-HT、DA水平变化可作为DEACMP病情变化和治疗效果的生物学指标.

Abstract：

Objective To explore the changes and the clinical significance of 5-hydroxytryptamine (5-HT), dopamine (DA) levels in serum and cerebrospinal fluid (CSF) of patients with delayed encephalopathy(DEACMP)after acute carbon monoxide poisoning. Methods The dynamic detection of 5-HT and DA levels in serum and CSF from 42 patients with DEACMP was performed with high performance liquid chromatography (HPLC). The condition changes of patients with DEACMP were analyzed with three types of scales: the activity of daily living scale (ADL), information memory concentration test (IMCT) and Hasegawa's dementia scale(HDS); these changes were compared with those from 38 other encephalopathy patients and 38 nonencephalopathy patients, respectively. Results Before treatment, the serum 5-HT and DA levels [(662.61 ± 178.50) and (155.74± 60.32) nmol/L, respectively] of DEACMP group were both significantly lower than those[(914.08±198.04) and (225.70±48.53) nmol/L] of nonencephalopathy group (P＜0.05); the serum DA level of DEACMP group was also significantly lower than that [(243.57±66.94) nmol/L] of other encephalopathy group (P＜0.05); the serum 5-HT level of DEACMP group was not significantly different from that [(729.54±299.87 ) nmol/L] of other encephalopathy group (P＞0.05). After treatment, the serum 5-HT and DA levels[(714.08±170.47) and (192.18±33.07 nmol/L, respectively)] of DEACMP group elevated to various extent, but only serum DA level was significantly higher than that before treatment (P＜0.05). Before treatment,the CSF 5-HT and DA levels of DEACMP group were significantly lower than those of nonencephalopathy group and those of other encephalopathy group (P＜0.05). After treatment, the CSF 5-HT level (232.44±54.28 nmol/L) was similar to normal level and significantly higher than that before treatment (P＜0.05); the CSF DA level[(56.83±12.85) nmol/L] of DEACMP group increased only slightly (P＞0.05). In DEACMP group, ADL score (50.64±7.23), HDS score (8.55±8.08) and IMCT score (4.95±7.30) before treatment were significantly different from those (8.5 ± 8.08, 4.95 ±7.30 and 15.64 ± 10.90) after treatment (P＜0.01). In DEACMP group, there was a negative correlation between DA level changes and HDS score changes, when the DA levels and HDS scores before treatment were compared with those after treatment (P＜0.05). Conclusion The dynamic changes of 5-HT and DA levels in serum and CSF of patients with DEACMP consisted basically with the patient's condition change. The dynanically detected 5-HT and DA levels can be used as the biological indicators to reflect the condition change and treatment effects of DEACMP patients.     

蔗糖铁注射液治疗老年缺铁性贫血疗效观察

目的 观察蔗糖铁注射液治疗老年缺铁性贫血(IDA)的疗效和不良反应.方法 选择32例老年IDA患者,按随机数字表法分为静脉组(17例)和口服组(15例),观察两种方法对改善贫血的疗效和不良反应.结果 治疗后静脉组及口服组血红蛋白(Hb)均较治疗前升高,分别为(100.18±8.71)g/L和(85.80±6.92)g/L,两组比较差异有统计学意义(P＜0.01);治疗后血清铁亦有上升,两组分别为(23.84±5.34.)μmol/L和(14.63±3.29)μmol/L,与治疗前比较差异有统计学意义(P＜0.01).静脉组无明显不良反应发生,口服组有6例(40%)发生胃肠道反应.结论 静脉用蔗糖铁可作为老年IDA患者补铁方式,疗效优于口服铁剂,且不良反应发生率低.

Abstract：

Objective To observe the effect and adverse reactions of iron sucrose injection in treating old patients with iron deficiency anemia(IDA). Methods Thirty-two old patients with IDA were divided into injection group(17 patients)and oral group(15 patients)by random digits table. The effects of improvement on IDA and their adverse reactions were observed. Results After treatment, hemoglobin(Hb)in the injection group and oral group was(100.18±8.71)g/L and(85.80 ± 6.92)g/L(P＜0.01), and serum iron was(23.84±5.34)μmol/L and(14.63±3.29)μmol/L(P＜0.01).There were no obvious adverse reactions in injection group, whereas there were 6 cases(40%)with gastric and colon adverse reaction in oral group. Conclusions The treatment of intravenous injection of iron sucrose can be effectively used to cure old patients with IDA. It has better effect and has lower rate of adverse reaction.     

阻塞型睡眠呼吸暂停低通气综合征患者抑郁情绪和高敏C反应蛋白的变化

目的 探讨阻塞型睡眠呼吸暂停低通气综合征(OSAHS)患者抑郁情绪和高敏C反应蛋白(hs-CRP)的改变及相关关系.方法 选择OSAHS患者54例(OSAHS组)和健康对照者30例(对照组),使用抑郁自评量表(SDS)和采用速率散射比浊法分别评估受试者的抑郁情绪状态和测定其血清hs-CRP水平.结果 OSAHS组患者SDS评分和hs-CRP水平分别为(48.8±12.7)分、(3.3±0.7)mg/L,均高于对照组的(36.3±6.3)分、(1.4±0.4)mg/L(P＜0.01).SDS评分和hs-CRP水平与睡眠呼吸暂停低通气指数(AHI)呈正相关(r=0.636、0.628,P<0.01);与平均血氧饱和度(MSa02)(r=-0.509、-0.614,P<001)、最低血氧饱和度(LSaO-2)(r=-0.607、-0.512,P<0.01)呈负相关;SDS评分与hs-CRP水平呈正相关(r=0.536,p<0.01).SDS评分与AHI、hs-CRP和LSaO2呈直线回归关系(F=33.31,P:0,002).结论 OSAHS患者存在抑郁情绪障碍和hs-CRP水平增高,且与OSAHS病情程度相关;血清hs-CRP水平增高是OSAHS抑郁障碍高发的原因之一.

Abstract：

Objective To study the changes of serum high-sensitivity C-reactive protein (ha-CRP) and depression in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS),and investigate the relationship between them.Methods Thirty healthy volunteers (control group) and 54 OSAHS patients (OSAHS group) were recruited for the study.The level of serum hs-CRP was determined by scatter rate nephelometry,and the state of depression was assessed by self-rating depression scale (SDS).Results The level of serum hs-CRP and SDS score were higher in OSAHS group than those in control group [(48.8 ± 12.7) scores vs.(36.3 ± 6.3) scores,(3.3 ±0.7) mg/L vs.(1.4 ± 0.4) mg/L](P＜0.01).SDS score and the level of serum hs-CRPwere positively correlated to apnea-hypopnea index(AHI) (r = 0.636,0.628 ;P<0.01) and negatively related to the MSaO2 (r =-0.509,-0.614;P <0.01) and LSaO2 (r =-0.607,-0.512;P <0.01).The level of serum hs-CRP was positive correlation to SDS score (r = 0.536,P<0.01).SDS score was related to the AHI,the level of serum hs-CRP and LSaO2 in multiple linear regression(F= 33.31,P = 0.002).Conclusion Depression is correlated to AHI and the level of serum hs-CRP in patients with OSAHS.     

原发性高血压不同类型与窦性心率震荡关系

目的 探讨不同类型原发性高血压患者窦性心率震荡(HRT)的特点,评估窦性HRT指标对原发性高血压患者心脏自主神经功能损害的价值.方法 107例原发性高血压患者(高血压组)和46例健康体检者(健康对照组)均接受24 h动态心电图(Holter)检查,根据血压昼夜节律特点将高血压组分为杓型高血压组38例、非杓型高血压组53例及反杓型高血压组16例,分别比较各组HRT和心率变异性(HRV)各项指标,并分析震荡初始(TO)、震荡斜率(TS)与24 h平均收缩压、舒张压等指标之间的关系.结果 高血压组TO、TS、窦性RR间期标准差(SDNN)与健康对照组比较,差异均有统计学意义(P＜0.05).非杓型高血压组及反杓型高血压组TO明显高于健康对照组(P＜0.05),TS则明显低于健康对照组(P＜0.05);而杓型高血压组TO、TS与健康对照组比较差异均无统计学意义(P＞0.05).同时非杓型高血压组和反杓型高血压组的TO明显高于杓型高血压组,TS则明显低于杓型高血压组,差异均有统计学意义(P＜0.05).相关性分析显示,TO与平均心率和年龄呈正相关(Spearman等级相关系数=0.265,P=0.004;Spearman等级相关系数=0.217,P=0.018),与SDNN和左室射血分数(LVEF)呈负相关(Spearman等级相关系数=-0.287,P=0.002;Spearman等级相关系数=-0.179,P=0.049).TS与平均心率和年龄呈负相关(r=-0.335,P=0.015;r=-0.238,P=0.009),而与SDNN和LVEF呈正相关(r=0.540,P=0.001;r=0.432,P=0.001).结论 在原发性高血压患者中,血压昼夜节律异常者窦性HRT减弱或消失,提示窦性HRT在评估原发性高血压患者心脏自主神经功能损害方面有一定价值.

Abstract：

Objective To explore sinus heart rate turbulence (HRT) in patients with different subtypes of essential hypertension (EH), and analyze the relationship between HRT and autonomic nervous system function damage in these patients. Methods The study consisted of 107 patients with EH (EH group) and 46 controls (control group). Based on 24 hours dynamic electrocardiogram, all patients were divided into dipper,non-dipper,and anti-dipper blood pressure group. The indexes about HRT and heart rate variability (HRV) among these groups were calculated and compared,and the relationship between turbulence onset (TO),turbulence slope (TS) and 24 hours mean systolic blood pressure,diastolic blood pressure was analyzed. Results There were significant differences in TO,TS,SDNN between EH group and control group(P ＜ 0.05 ). TO in non-dipper and anti-dipper blood pressure group was significantly higher than that in control group( P ＜ 0.05 ), and TS was lower than that in control group(P ＜ 0.05 ). There was no significant difference in TO,TS between dipper blood pressure group and control group (P ＞ 0.05). TO in non-dipper and anti-dipper blood pressure group was significantly higher than that in dipper blood pressure group, but TS was lower than that in dipper blood pressure group (P ＜0.05). Correlation analysis showed that TO had positive relationship with average heart rate and age (rs = 0.265, P = 0.004;rs = 0.217, P = 0.018 ), but had negative correlation with SDNN and left ventricular ejection fraction (LVEF) (rx = -0.287,P = 0.002;rx =-0. 179, P = 0.049). Whereas, TS had negative correlation with average heart rate and age (r = -0.335, P =0.015 ;r = -0.238,P= 0.009), but had positive relationship with SDNN and LVEF(r = 0.540,P = 0.001 ;r =0.432,P = 0.001 ). Conclusions HRT of EH patients becomes significantly low. It suggests that the autonomic nerve function in EH patients be injured seriously.     

氯沙坦对糖尿病心肌病患者脑钠肽和C反应蛋白的影响研究

目的 探讨氯沙坦对糖尿病心肌病患者血浆脑钠肽(BNP)及C反应蛋白(CRP)水平的影响.方法 60例糖尿病患者按照是否合并糖尿病心肌病分为糖尿病对照组(30例)和糖尿病心肌病组(30例),并测定血浆BNP及CRP水平;继将糖尿病心肌病组按照随机数字表法分为常规治疗组(15例)及氯沙坦治疗组(15例),采取相应治疗,12周后检测其心功能及血浆BNP、CRP水平的变化.结果 糖尿病心肌病组患者的BNP、CRP水平分别为(331.27±65.64)ng/L、(26.10±10.13)mg/L,明显高于糖尿病对照组的(76.09±39.14)ng/L、(7.03±2.71)mg/L(P＜0.01);氯沙坦治疗组治疗后的BNP及CRP水平明显低于常规治疗组(P＜0.05),左室射血分数明显高于常规治疗组(P＜0.05),左室舒张末期内径明显低于常规治疗组(P＜0.05).结论 BNP与CRP水平升高能作为临床反映糖尿病心肌病变严重程度的血清学指标,而氯沙坦能降低其水平,并改善心功能,对糖尿病心肌病具有较好的疗效.

Abstract：

Objective To explore the effects oflosartan on brain natriuretic peptide(BNP)and C-reactive protein(CLRP)in diabetic cardiomyopathy patients. Methods Sixty diabetics were divided into diabetic control group(30 cases)and diabetic cardiomyopathy group(30 cases), and the levels of BNP and CRP in plasma were determined. Then, diabetic cardiomyopathy group were divided into conventional treatment group(15 cases)and losartan treatment group(15 cases)by random digits table to take corresponding treatment for 12 weeks. The changes of cardiac function, the levels of BNP and CRP in plasma were detected and compared. Results The levels of BNP and CRP in diabetic cardiomyopathy group [(331.27 ±65.64)ng/L,(26.10±10.13)mg/L]were significantly higher than those in diabetic control group[(76.09±39.14)ng/L,(7.03±2.71)mg/L](P＜0.01). After treatment 12 weeks, the levels of BNP and CRP were significantly lower, left ventricular ejection fraction was significantly higher and left ventricular end-diastolic diameter was significantly lower in losartan treatment group than those in conventional treatment group(P＜0.05).Conclusions The increasing levels of BNP and CRP can reflect clinical severity of diabetic cardiomyopathy.Losartan can decrease the levels of BNP and CRP, and improve heart function, and it has better effective on diabetic cardiomyopathy.     

谷胱甘肽对2型糖尿病周围神经病变患者血清氧化应激指标及感觉神经传导速度的影响

目的 观察2型糖尿病周围神经病变患者血清氧化应激相关指标的变化,探讨抗氧化剂--谷胱甘肽(GSH)对2型糖尿病周围神经病变患者的神经保护作用.方法 检测54例2型糖尿病周围神经病变患者(研究组)与30例健康体检者(对照组)血清中丙二醛(MDA)含量与超氧化物歧化酶(SOD)活性;将54例2型糖尿病周围神经病变患者按随机数字表法分为GSH组和CON组,每组27例.GSH组予GSH 1.8 g/d,CON组予B族维生素治疗,均治疗14 d.分别检测两组治疗前后MDA含量、SOD活性、双侧胫后感觉神经传导速度(SCV).结果 研究组MDA含量(7.23 ±2.31) μmol/L和SOD活性(59.72±13.58) kU/L,对照组MDA含量(4.87 ±1.17)μmol/L和SOD活性(76.19 ± 7.55)kU/L,研究组MDA含量高于对照组,SOD活性低于对照组,两组比较差异有统计学意义(P＜0.01);GSH组和CON组治疗后MDA含量下降,SOD活性升高,治疗前后比较差异有统计学意义(P＜0.05),但两组治疗后比较差异无统计学意义(P＞0.05).CON组治疗后SCV虽有上升但与治疗前比较差异无统计学意义(P＞0.05),而GSH组治疗后SCV显著增加(P＜0.05),两组治疗后比较差异有统计学意义(P＜0.05).结论 2型糖尿病周围神经病变患者体内存在氧化应激反应,GSH抗氧化治疗可以改善受损神经,较传统的营养神经治疗有较好的神经保护作用.

Abstract：

Objective To observe the change of oxidalive stress indexes in the patients with diabetic perineuropathy (DPN), and investigate the protection role of glutathione (GSH) on neuroprotective effect. Methods The levels of superoxide dismutase (SOD) and malondialdehyde (MDA) and sensory nerve conduction velocity (SCV) were detected in 54 cases with DPN (DPN group) and 30 cases of health examination (control group). Fifty-four cases with DPN were divided into GSH group (given basic treatment and GSH 1.8 g/d) and CON group(given basic treatment and B vitamin) with 27 cases each by random-digits table. After treatment of 2 weeks, the levels of SOD, MDA and SCV were compared. Results The levels of MDA in DPN group were significantly higher than those in control group, while the activity of SOD was significantly lower than that in control group [(7.23 ±2.31) μmol/L vs. (4.87 ± 1.17) μmol/L, (59.72 ± 13.58) kU/L vs. (76.19 ± 7.55 ) kU/L](P＜ 0.01). After treatment, the level of MDA was decreased and the activity of SOD was increased in GSH group and CON group (P ＜0.05),but there was no significant difference between the two groups(P＞ 0.05). After treatment, the level of SCV was significantly increased in GSH group,while there was no significant difference in CON group (P ＞0.05). Conclusions Oxidative stress exists in DPN patients. The antioxidant treatment with GSH can improve impaired nerve and has a better effect of nerve protection than classical nerve nutrition therapy.     

阿托伐他汀10mg与辛伐他汀20mg对2型糖尿病合并血脂异常的藏族患者降脂疗效及炎性指标比较

目的 评价阿托伐他汀10 mg和辛伐他汀20 mg对2型糖尿病合并血脂异常的藏族患者降脂疗效和对血清高敏C反应蛋白( hs-CRP)的影响。方法 选择2型糖尿病合并血脂异常的藏族患者70例,按随机数字表法分为阿托伐他汀10 mg组和辛伐他汀20mg组,每组35例。治疗前和治疗后4周分别测定总胆固醇(TC)、低密度脂蛋白胆固醇( LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)、载脂蛋白B(ApoB)、白细胞(WBC)计数、空腹血糖(FBG)和hs-CRP水平,并观察两组的不良反应。结果 治疗后4周,两组TC、LDL-C、ApoB均较治疗前显著下降(P＜0.01)。阿托伐他汀10 mg组治疗后4周TG水平较治疗前显著降低[(1.39±0.63) mmol/L比(1.95±1.62) mmol/L,P＜0.05],而辛伐他汀20 mg组治疗后4周TG水平有下降趋势但差异无统计学意义[(1.72±0.32)nnol/L比(1.93±0.83) mmol/L,P＞0.05]。两组治疗后hs-CRP水平均较治疗前显著降低,阿托伐他汀10mg组hs-CRP水平降低幅度大于辛伐他汀20mg组（40.51％比35.34％）,差异有统计学意义(P＜ 0.05)。逐步回归分析表明,hs-CRP水平的降低独立于降脂效果,仅与他汀种类相关（标准化回归系数=-0.384,P=0.022）。结论 辛伐他汀20 mg对于血清TC和LDL-C水平的降低作用与阿托伐他汀10 mg相当,两种他汀类药物均可降低藏族2型糖尿病患者hs-CRP水平,阿托伐他汀疗效略优于辛伐他汀。     

阿托伐他汀对早期糖尿病肾病患者血清胱抑素C及尿微量蛋白的影响

目的 探讨阿托伐他汀对早期糖尿病肾病(DN)患者血清胱抑素C及尿微量蛋白的影响.方法 68例早期DN患者按照随机数字表法分为对照组和观察组,每组34例,对照组予常规治疗,观察组在常规治疗基础上予阿托伐他汀治疗,比较两组治疗前后血脂、血清胱抑素C、尿白蛋白排泄率(UAER)、尿微量蛋白[微量白蛋白(MAU)、α1微球蛋白(α1-MG)、β2微球蛋白(β 2-MG)]的变化.结果 观察组治疗后总胆固醇(TC)、三酰甘油(TG)、血清胱抑素C、UAER、MAU、α1-MG、β2-MG较治疗前均显著下降[(4.32±1.26) mmol/L比(5.65±1.38) mmol/L,( 1.67±0.64) mmol/L比(2.53±0.96) mmol/L,( 1.29±0.38) mg/L比(1.74±0.51)mg/L,(61.09±18.45)μg/min比(86.42±21.34)μg/min,(5.73±4.81) mg/L比(23.16±9.73) mg/L,( 1.41±1.21) mg/L比(4.76±1.24) mg/L,(1.21±0.13) mg/L比(2.58±0.26) mg/L](P＜0.01或＜0.05);对照组治疗后TC、TG、血清胱抑素C较治疗前有所下降,但差异无统计学意义(P＞0.05),而UAER、MAU、α1-MG、β2-MG与治疗前比较差异有统计学意义(P＜0.01或＜0.05),但下降程度不及观察组(P＜ 0.05或＜0.01).结论 阿托伐他汀可显著降低早期DN患者血清胱抑素C及尿微量蛋白水平,起到肾脏保护作用.     

慢性心力衰竭患者心率震荡现象的临床意义

目的 探讨慢性心力衰竭(CHF)患者窦性心率震荡(HBT)的临床意义.方法 30例CHF患者(CHF组)及28例非器质性心脏病患者(对照组)行24 h动态心电图检查.根据NYHA心功能分级,将CHF组分为轻度CHF组(Ⅰ～Ⅱ级)16例及重度CHF组(Ⅲ～Ⅳ级)14例;CHF组中缺血性心脏病18例及非缺血性心脏病12例.分析比较各组HRT的初始值(TO)及震荡斜率(TS)两项指标.结果 CHF组TO值[(0.43±0.83)%]较对照组[(-1.49±1.00)%]明显增高(P＜0.05),CHF组TS值[(2.67±0.66)ms/RRI]较对照组[(8.52±2.09)ms/RRI]明显降低(P＜0.05).重度CHF组TO值[(0.79±0.67)%]较轻度CHF组[(0.12±0.86)%]明显增高(P=0.026),重度CHF组TS值[(2.88±0.79)ms/RRI]较轻度CHF组[(2.40±0.35)ms/RRI]明显增高(P=0.045).缺血性心脏病与非缺血性心脏病患者TO及TS值比较差异无统计学意义(P＞0.05).CHF组中TO及TS值同时异常(TO≥0,TS≤2.5 ms/RRI)占53.3%(16/30),而TO或TS值仅1项异常占40.0%(12/30),CHF组HRT检测异常率为93.3%(28/30).结论 CHF患者HRT现象明显减弱,HRT可作为CHF严重程度的有效观测指标,对CHF患者预后的预测起指导作用.     

二甲双胍对糖耐量受损合并代谢综合征患者血清视黄醇结合蛋白4和炎性因子的影响

目的 观察二甲双胍对糖耐量受损(IGT)合并代谢综合征(MS)患者临床血生化指标及血清视黄醇结合蛋白4(RBP-4)、高敏C反应蛋白(hs-CRP)和肿瘤坏死因子α(TNF-α)的影响。方法 将60例新诊断IGT合并MS患者按随机数字表法分为二甲双胍组和生活干预组,每组30例,比较两组治疗前和治疗16周后体质指数(BMI)、糖化血红蛋白(HbA1c)、HOMA模型胰岛素抵抗指数(HOMA-IR)、血脂、血清RBP-4、hs-CRP、TNF-α水平的变化。结果 治疗后二甲双胍组较生活干预组HbA1c、HOMA-IR、RBP-4、hs-CRP和TNF-α明显下降[(5.09±0.26)％比(5.69±0.49)％,2.95±0.63比3.49±0.78,( 18.69±6.50) mg/L比(26.20±6.97) mg/L,( 2.37±0.53) mg/L比（2.99±0.57)mg/L,(9.49±2.37)μg/L比(14.33±2.62)μg/L],差异有统计学意义(P＜0.01)。多元线性回归分析显示,RBP-4变化与BMI、HOMA-IR、hs-CRP、TNF-α有线性回归关系(β=0.284、0.506、0.274、0.230,P＜0.01),其中HOMA-IR对RBP-4的影响最大。结论 二甲双胍可明显改善IGT合并MS患者的胰岛素抵抗,显著降低RBP-4、hs-CRP和TNF-α的水平,具有明显的抗炎作用。     

s同剂量阿托伐他汀对急性冠脉综合征（ACS）患者血脂、血清炎症因子水平的影响

目的观察不同剂量阿托伐他汀对急性冠脉综合征（ACS）患者血脂水平、血清炎症因子水平的影响。方法192例ACS患者随机分为A、B、C三组,A组：给予阿托伐他汀10mg／d,B、C组：给予阿托伐他汀20／40mg／a,检测治疗前及治疗2周、4周后患者TC、u）L—C、sCD40L、血清hs—CRP、MMP～9水平。结果用药4周治疗后,40mg治疗组血清TC、LDL—C水平均较用药前明显降低（P〈0．001）;三组治疗2周后血清hs—CRP、sCIMOL、MMP～9与治疗前比较明显降低,4周后进一步降低,40nag治疗组降低最显著。结论阿托伐他汀能降低ACS患者血脂水平、血清炎症因子水平,大剂量应用时作用更明显。     

强化调脂对急性冠状动脉综合征患者促炎和抗炎失衡的影响

目的 观察强化调脂对急性冠状动脉综合征(ACS)患者促炎和抗炎失衡的影响,探讨阿托伐他汀抗炎和稳定斑块的机制.方法 检测82例ACS患者、17例稳定型心绞痛(SAP)患者和22例对照者的高敏C反应蛋白(hs-CRP)和IL-10水平.将41例应用阿托伐他汀调脂治疗的ACS患者随机分为标准治疗组(阿托伐他汀10 mg/d)及强化治疗组(阿托伐他汀40 mg/d),观察治疗前和治疗1个月后血脂、hs-CRP及IL-10水平的变化.结果 ACS患者hs-CRP水平[(11.10±14.30)mg/L]明显高于SAP患者[(2.47±2.72)mg/L]和对照者[(2,34±4.22)mg/L],P均<0.05;ACS患者IL-10水平[(3.94±1.91)ng/L]明显低于SAP患者[(6.31±4.26)ng/L]和对照者[(7.76±2.82)ng/L],P均<0.05.强化治疗组与标准治疗组患者治疗后hs-CRP水平明显降低(P<0.05),IL-10水平明显升高(P<0.05),且强化治疗作用更强(P<0.05).结论 ACS患者hs-CRP水平明显升高,但IL-10水平明显降低,提示机体斑块不稳定与促炎和抗炎失衡有关.阿托伐他汀强化治疗能明显降低hs-CRP水平,升高IL-10水平,提示其稳定斑块的作用可能与改善促炎和抗炎失衡有关.     

阿卡波糖对糖耐量减低患者血管内皮功能的保护

目的 观察阿卡波糖对糖耐量减低患者血管内皮功能的影响.方法 根据口服葡萄糖耐量试验选择56例糖耐量减低(IGT)患者,按系统抽样法随机分为对照组27例和治疗组29例.对照组口服安慰剂,治疗组口服阿卡波糖25～50 mg,3次/d,连续12周.测定两组治疗前后体质指数、血脂、空腹血糖(FPG)、空腹胰岛素、糖化血红蛋白(HbA1c)、高敏C反应蛋白(hs-CRP)、血管性血友病因子(vWF)、餐后2h血糖和餐后2h胰岛素及肱动脉内皮依赖性舒张功能(EDD).结果 与治疗前比较,治疗组患者治疗后体质指数、餐后2h血糖、餐后2h胰岛素、HbA1c、hs-CRP、vWF明显降低[(24.69±2.62) kg/m2比(22.02±2.59) kg/m2; (9.26±1.02) mmol/L比(7.43±0.95) mmol/L;(42.17±9.98) U/L比(34.76±9.86) U/L; (6.03±0.67)％比(5.37±0.56)％;(5.45±1.93) mg/L比(4.52±1.55) mg/L;( 187.22±26.57)％比(165.13±23.86)％] (P＜ 0.05或＜0.01),EDD明显增大[(6.08±1.22)％比(7.94±1.25)％](P＜0.01).对照组治疗前后各指标比较差异无统计学意义(P＞0.05).结论 阿卡波糖可以降低IGT患者餐后血糖,并减轻机体胰岛素抵抗,减少炎性因子,改善血管内皮功能,延缓糖尿病的发生及动脉粥样硬化的发展.