高血压合并血脂紊乱和脂肪肝的依那普利和血脂康治疗

目的 研究依那普利联合血脂康对高血压合并血脂紊乱和脂肪肝治疗作用。方法 116例患者在改善不良生活习惯同时,应用依那普利调整血压,必要时加钙拮抗剂,小剂量氢氯噻嗪,在调脂及脂肪肝应用血脂康0．6bid8周为一疗程,连用3个疗程。测定治疗前后血压、BMI、血脂、肝功能及动态肝B型超声监测。结果 经应用血脂康,依那普利治疗后：1．血压降到正常水平103例;2、BMI明显下降,血脂显著下降,与治疗前比较P＜0．01;3．肝功能显著改善P＜0．01;4、经动态B超观察治疗后各项指标较治疗前有显著改善P＜0．01。结论 依那普利并血脂康能有效治疗高血压合并血脂紊乱并逆转脂肪肝。     

二甲双胍治疗2型糖尿病并非酒精性脂肪肝的疗效观察

采用病例自身对照研究,选择36例2型糖尿病合并(DF患者),用二甲双胍850mg bid口服,疗程为半年.治疗前后查ALT、AST及肝脏B超等,用稳态模式胰岛素指数(HOMA-IR)评价胰岛素抵抗.结果治疗后FBG、2hPBG、HbA1C、TG、BMI、FINS、HOMA-IR较前明显下降(P<0.01),肝功能指标ALT、AST有所好转(P<0.01),复查肝脏B超脂肪肝消失率为25%.结论二甲双胍不仅可以降低血糖,而且可以改善胰岛素的敏感性,对2型糖尿病合并非酒精性脂肪肝也有一定的疗效.     

长期应用依那普利对高血压病患者左心室结构及QT离散度的影响

目的研究依那普利长期应用对高血压合并左室肥厚(LVH)的左室结构及QT间期离散度(QTd)的影响.方法观察32名原发性高血压患者每天口服依那普利5～10mg,平均18个月后,血压左室结构及QTd改变.结果用药后收缩压(SBP)和舒张压(DBP)显著降低(P<0.01),心率(HR)无明显改变(P>0.05).左室重量指数(LVMI)、室间隔厚度(lVST)及左室后壁厚度(PWT)明显减少(P<0.05).QTd显著降低(P<0.01).结论依那普利长期应用具有良好的降压效果,同时还可逆转LVH降低QTd,改善预后.     

血清瘦素与原发性高血压和体脂及血脂的关系研究

目的探讨血清瘦素浓度与原发性高血压患者血压水平及靶器官损害、性别、肥胖和脂质代谢的关系.方法用放射免疫法检测68例原发性高血压患者和40例健康自愿者的血清瘦素浓度,同时检测甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)和体重指数(BMI)等指标,分析血清瘦素浓度与不同血压水平和靶器官受累程度不同的原发性高血压以及性别、BMI、血脂的关系.结果高血压组血清瘦素显著高于对照组(P<0.05),且3级高血压血清瘦素显著高于2级高血压(P<0.05),2级高血压血清瘦素显著高于1级高血压(P<0.05),血清瘦素与SBP、DBP均呈直线正相关(P<0.01,P<0.05);血清瘦素浓度与高血压靶器官损害病程度无关;女性瘦素显著高于男性(P<0.01);肥胖者血清瘦素显著高于非肥胖者(P<0.05);血清瘦素与TG呈直线正相关(P<0.05),而与TC、 HDL-C 和HDL-C无关.结论血清瘦素与血压水平相关,与高血压靶器官受损无相关性,与性别和TG有关,与BMI和TG呈正相关.     

不同年龄组的高血压左室肥厚及依那普利干预试验

目的探讨依那普利逆转左室肥厚(LVH)的作用及其年龄的关系。方法90例高血压LVH病人按年龄被分为青年、中年、老年3组,予以依那普利治疗,设定治疗目标血压。于治疗前及后6个月分别作超声心动图检查,测量左室重量指数(LVMI),E、A波峰速等指标。结果依那普利能显著降低不同年龄组的LVMI(P<0.05～P<0.001),并改善左室舒张功能(P<0.05～P<0.01);青、中年组较老年组更为明显(P<0.05～P<0.01)。结论随着年龄的增长依那普利逆转左室肥厚的效果逐渐降低。     

氯沙坦治疗高血压的疗效及对心率变异性影响的研究

目的　观察氯沙坦的降压作用及其对心率变异性(HRV)的影响。方法　32例轻、中度原发性高血压患者口服氯沙坦50mg/日～100mg／日,共6周,治疗前后分别测定其血压及心率变异性。结果　治疗第4周出现血压下降,以收缩压（SBP）下降为著（P<0.01）;第6周SBP、舒张压（DBP）均明显下降（P<0.01）。治疗前反映交感神经活性的时域指标SDNN、SDANN、SDNNI低于正常对照组（P<0.05）,其降低程度与病程有关;反映副交感神经的时域指标rMSSD、PNN50与对照组无差异。治疗后SDNN、SDANN值升高（P<0.05）SDNNI值升高更著（P<0.01）;而rMSSD、PNN50值虽升高,但无统计意义。结论　1.氯沙坦具有明确的降压作用;2.氯沙坦治疗可改善高血压患者的心率变异性。     

依那普利和氯沙坦对自发性高血压大鼠肾皮质环核苷酸水平的影响

目的观察肾脏环磷酸腺苷(cAMP)、环磷酸鸟苷(cGMP)和一氧化氮(NO)水平与高血压的关系,以及依那普利和氯沙坦降压治疗对自发性高血压大鼠(SHR)肾皮质cAMP、cGMP和NO水平的影响.方法 14周龄雄性SHR分三组(n=6)依那普利组15 mg*kg-1*d-1灌胃;氯沙坦组37.5 mg*kg-1*d-1灌胃;SHR对照组以等量蒸馏水灌胃.Wistar-kyoto(WKY)对照组亦以等量蒸馏水灌胃.采用放射免疫法及Griess法检测肾皮质cAMP、cGMP、血管紧张素Ⅱ(AngⅡ)和NO代谢产物亚硝酸盐(NO3-)水平.结果 SHR对照组肾皮质Ang Ⅱ含量较WKY组显著升高(P<0.01);与SHR对照组相比,依那普利组Ang Ⅱ含量显著降低(P<0.01),氯沙坦组Ang Ⅱ含量增加(P<0.05).与WKY相比,SHR对照组cAMP水平低于WKY组(P<0.01),依那普利组cAMP水平明显高于SHR对照组(P<0.05),氯沙坦组cAMP较SHR对照组有升高趋势,但无显著性差异(P>0.05);SHR对照组肾皮质NO3-、cGMP含量较WKY组显著减少(P<0.01);依那普利治疗组NO3-、cGMP含量较SHR对照组显著增加(P<0.01),氯沙坦组与SHR对照组相比,NO3-、cGMP含量增加(分别为P<0.01,P<0.05),各组NO3-水平与cGMP水平呈正相关(r=0.8689,P<0.01).结论 SHR肾皮质cAMP、cGMP 显著低于WKY,依那普利和氯沙坦均可升高SHR的cGMP水平,依那普利还可改善SHR肾cAMP代谢.     

老年脂肪肝合并高血压患者的综合护理体会

目的探讨老年脂肪肝合并高血压患者的综合护理措施。方法选择我院2011年1月~2015年1月收治的老年脂肪肝合并高血压患者54例作为研究对象,均予以有效的对症治疗,同时配合综合护理方法干预,包括基础护理、心理护理、饮食护理及运动指导等,并观察护理效果。结果本组患者经治疗及护理后,临床症状均消失,肝功能全部正常,血压、血脂水平均显著下降,患者满意度达100.0%。结论综合护理干预可提高老年脂肪肝合并高血压患者的疗效,改善患者的生活质量,故值得临床推广与应用。     

复方益肝灵联合血脂康治疗脂肪肝120例

[目的]研究复方益肝灵联合血脂康治疗脂肪肝的疗效.[方法]120例脂肪肝患者口服复方益肝灵,4粒/次,3次/d,同时配合血脂康胶囊,2粒/次,2次/d,1个月为1个疗程,根据病情,一般服1～2个疗程.[结果]治疗前后经χ2检验,肝功能、血脂及肝脏B超变化差异均有统计学意义(P＜0.05、＜0.01).[结论]复方益肝灵联合血脂康治疗脂肪肝的疗效确切,且无不良反应.     

培哚普利对高血压合并心房颤动患者再次脑卒中的干预

目的观察长效血管紧张素转换酶抑制剂(ACEI)培哚普利对高血压合并心房颤动(AF)患者再次脑卒中的干预作用.方法选取高血压合并AF、且在3年内发作脑卒中的患者35例,随机分为对照组与治疗组.对照组继续原来的降压治疗方案,治疗组在此基础上再加用培哚普利2～4(mg/d).观察血压、脉压、动态血压变化以及再次脑卒中的发生率和死亡率.结果降压治疗5年后,两组患者血压均显著下降,(P<0.001).但治疗组血压波动幅度、脉压均明显降低(P小于0.005～0.001),而对照组无明显变化(P>0.05).治疗组与对照组再次脑卒中发生率分别为33.33%(5/15)和70%(14/20),(P<0.001),RR为0.48;脑卒中死亡率分别为13.33%(2/15)和45%(9/20),(P<0.01),RR为0.30.结论长效ACEI培哚普利可使血压平稳下降,使高血压合并AF患者再次脑卒中的发生率和死亡率均明显下降.     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.