尿酸与心血管事件

半个世纪以前 ,人们已经发现高尿酸血症与心血管疾病之间存在着一定的联系。自从 195 1年Gertler等[1] 首次提出尿酸与冠心病之间可能存在复杂的相互作用以来 ,许多流行病学和临床研究结果证实了血尿酸增高与心血管疾病相关联[2 4] ,高尿酸血症与心血管事件之间的关系受到人们的高度关注。尿酸是人体内嘌呤类化合物代谢的最终产物 ,从肾脏排出体外。血尿酸升高与嘌呤的过量合成和肾脏对尿酸的排出减少有关。流行病学和临床研究结果显示 ,肥胖、高血压、高甘油三酯血症、过量酒精摄入是高尿酸血症发病的危险因素 ,其患病率在不同种族和地区…     

重视高血压患者高尿酸血症的筛查与管理

正1 高尿酸血症与高血压及心血管病风险尿酸是体内嘌呤代谢的产物。当血尿酸升高超过血尿酸盐溶解度上限时,就会以结晶的形式析出。这一水平,即为定义高尿酸血症的界值。临床通常以血清尿酸水平男性≥7 mg/dL(420 μmol/L)、女性≥6 mg/dL(360 μmol/L)作为高尿酸血症的切点[1]。高尿酸血症与高血压的发生、发展有一定关系。早先的研究发现,47%的高血压人群存在高尿酸血症[2]。     

老年高尿酸血症与心血管疾病

早在20多年前,就有研究探讨尿酸是否是心血管事件的独立危险因素,但至今尚无一致性结论.因而,高尿酸血症在心血管疾病中的真正作用还不十分清楚[1～3].由于心血管疾病牵涉到许多危险因素,而这些危险因素又和高尿酸血症密切相关,这就给确定或者排除高尿酸血症的独立作用带来很大困难.     

高尿酸血症与冠心病

正自Gertlerl等~([1])于上世纪五十年代初提出尿酸与冠状动脉粥样硬化性疾病相关以来,大量流行病学和临床研究对该观点进行了论证。60多年过去了,高尿酸血症和心血管疾病之间的关系仍存在争议。一方面尿酸被认为是一种抗氧化剂,另一方面高尿酸血症又常与代谢综合征、高血压、冠心病等密切相关。心血管疾病患者血尿酸升高是反映机体对抗氧化应激的一种代偿性机制,还是在心血管疾病发病机制中有直接作用,仍不清楚。尽管近年来有     

高尿酸血症与心血管事件的关系

尿酸(UA)是体内嘌呤代谢的终产物,当体内UA生成增多和(或)排泄减少时则出现循环血UA含量增高.近年来, 高UA血症作为心血管疾病的一个危险因素正日益受到人们的重视[1,2].越来越多的证据表明高UA血症是冠心病的独立危险因素[3].高尿酸血症与许多传统的心血管危险因素包括老年、男性、高血压、糖尿病、高三酰甘油血症、肥胖、胰岛素抵抗等相关联,通过相互作用或独立参与心血管疾病的发生、发展及转归[4,6]. 对高尿酸血症进行早期干预,可能是预防和治疗与其相关的心血管疾病的一条新途径.     

血清尿酸水平与冠心病的相关性分析

<正>近年来,临床研究与流行病学调查的大量证据表明,高尿酸血症与心血管疾病密切相关[1]。血清尿酸水平的升高作为冠心病的又一个危险因素已受到医学界越来越多的重视。本文检测了132例患者的血     

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近年研究表明,合并高尿酸血症的高血压患者发生心血管事件的危险性增加。文章介绍了高尿酸血症与高血压、心血管疾病相互关系的流行病学依据,重点阐述高血压并发高尿酸血症患者降尿酸药物的选择及高血压药物对尿酸排泄的影响。     

社区居民高血压与高尿酸血症患病情况调查分析

<正>高血压是导致心血管疾病以及全因死亡率高的首要原因[1]。大量流行病学研究提示,高尿酸血症是高血压、冠心病、心力衰竭的独立危险因素,并与心血管疾病的发生发展有着密切关系[2]。我们为了解社区高血压病患病与高尿酸血症患病情况,以进一步指导心血管疾病的社区防治,进行了调查研究,现报告结果如下。1对象和方法1.1调查对象采取随机抽样的方法,于从上海市长征镇新长征花苑居委的35岁及以上户籍人员名单中随机抽     

心血管病的危险因素——血尿酸增高

1　高尿酸血症与心血管疾病的关系高尿酸血症常合并有肥胖、肾疾患、动脉粥样硬化高血压和早发冠心病。但高尿酸血症与心血管疾病的关系 ,多年以来一直存在争议。Fessel等 [1 ]经 1 0年随访研究 ,发现高尿酸血症患者发生冠心病或高血压者 ,其危险性增加 1 0倍。原发性高血压患者较正常血压者发生痛风的危险性增加 3倍。 Framingham研究 [2 ] 每两年作一次体检及血脂、血尿酸等测定的患者 ,在第 4次时男性平均血尿酸水平为 5 mg/dl (2 97μmol/l) ,第 1 3次时为 5 .7mg/dl(3 3 9μmol/l) ;女性分别为 3 .9mg/dl (2 3 2 μmol/l)和4.7mg/dl(2…     

血清尿酸与高尿酸血症相关疾病

尿酸是人体嘌呤碱基分解代谢终产物,经肾脏排泄。体内尿酸生成超过肾脏排泄时血清尿酸会显著升高,造成高尿酸血症。高尿酸血症与痛风、心血管疾病、肿瘤裂解综合征及肾脏疾病的引发或加剧密切相关。本文对血清尿酸的临床意义进行综述。     

Application of Six-minute Walk Test in Heart Transplantation Patients

Objectives To analyze the six-minute walk test （6MWT） and gas exchange of 5 heart transplantation patients and to approach the variation tendency of exercise tolerance, oxygen uptake （ VO2 ） and heart rate chronotropic response. Methods 5 cases of heart transplantation patients （ age 25 - 52 years） were undertaken 6MWT 6 - 30 months after operation, synchronizing gas exchanging parameters were measured by wireless portable remote sensing K4B^2 gas analyzer, 51 normal controls were compared. Results The six-minute walk distance （6MWD） of 5 patients were （592.6 ± 26.7 ） m （558 - 625 ） m, the ascending tendency during exercise was slower, the maximum heart rates were 80% ± 6% of age-predicting maximal heart rate, lower than normal control （86%） ; the end point VO2/kg were （21.8 ± 1.4 ） mL/min · kg （ 19. 94 - 23.60） mL/min · kg. Conclusions The 6WMD and VO2 of 5 patients reached normal range, but the heart rate chronotropic response and VO2 ascending tendency were slower than those of normal controls.     

Peroxisome Proliferator-activated Receptor-γ2 Pro12Ala and C-689T Polymorphisms and Haplotypes Affect the Profiles of Coronary Heart Disease in Diabetic Chinese People

Objectives Peroxisome proliferator-activated receptor-γ2（PPARγ2） variant Pro12Ala was demonstrated with risk of coronary heart disease （CHD） and type 2 diabetes mellitus （T2DM）. Another variant C-689T in the promoter was reported with lower receptor activity but lack of reports on association between C-689T and CHD or T2DM. Methods A total of 351 subjects without CHD and T2DM （controls） and 125 patients with CHD and T2DM （cases） were enrolled in our case-control study. Polymerase chain reaction-restricted fragments length polymorphism （PCR-RFLP） was used to detect Pro12Ala and C-689T polymorphisms. And effects on CHD merged with T2DM of the two polymorphisms were analyzed in individual and haplotype analyses. Results In the study, Pro12Pro, Pro12Ala and Ala12Ala genotype frequencies were 92.9%, 6.8% and 0.3% in controls; 92.8%, 7.2% and 0.0% in cases respectively whilst CC, CT and TT genotype frequencies were 93.4%, 6.3% and 0.3% in controls; 92.8%, 7.2% and 0.0% in cases respectively. Pro12Ala and C-689T polymorphisms were in strong linkage disequilibrium （D＇=0.81, P=0.000） and the observed haplotype frequency of Pro-C, Pro-T, Ala-C and Ala-T was 0.957, 0.006, 0.008 and 0.028 respectively. No significant associations were detected between the two polymorphisms and CHD merged with T2DM in either individual or haplotype analyses. In subjects with obesity [body mass index （BMI）≥25 kg/m^2], we found that both Pro12Ala and C-689T polymorphisms were associated with BMI. In haplotype analyses, we found that Pro12Ala and C-689T haplotypes had associations with systolic blood pressure in total population, with BMI, waist circle and total cholesterol（TC） in obesity subgroup and with fasting blood glucose and TC in males. Conclusions PPARγ2 Pro12Ala and C-689T polymorphisms and haplotypes affect the profiles of CHD merged with T2DM in Chinese Han people.     

6分钟步行试验在慢性心力衰竭患者中的应用进展

<正>对慢性心力衰竭(chronic heart failure,CHF)患者心功能的评估,除要考虑心功能分级、左心室射血分数的变化外,一般还应有运动耐量的指标。作为评估运动耐量的金标准,心肺运动测试(cardiopulmonary exercise testing,CPET)因设备复杂、需要专业人员参与及要求患者达到最大运动量,其在临床上的应用受到了限制。而6分钟步行试验(6 minute walk test,6MWT)简便易行、运动强度接近人体日常活动,临床上易被患者接受,对评估患者运动耐量具有一定的作用。近年来,6MWT的应用领域已逐渐扩展到预测患者预后及评价心力衰竭治疗效果。最近,国外有研究者试图将6MWT     

Cardioprotective effects of trimetazidine on patients with dilated cardiomyopathy and left bundle branch block

Background The effects of trimetazidine on patients with dilated cardiomyopathy(DCM) and left bundle branch block(LBBB) are not clear. Methods Sixty consecutive patients with DCM, LBBB and heart dysfunction(35% ≤ LVEF ≤ 45%) were randomly allocated to heart failure therapy plus trimetazidine group(20 mg three times a day; 30 patients) or heart failure therapy alone group(30 patients). During follow-up of 6months, QRS morphology, plasma NT-proBNP, 6-minute walk test(6MWT) and echocardiographic indexes were measured. Results At the 6th month, a significant functional improvement was noted in patients receiving trimetazidine added to heart failure treatment. In patients from the trimetazidine group, an increase of left ventricular ejection fraction(LVEF) was noted(from 38 ± 5.5% to 47 ± 7.1%, P = 0.020). The increase of LVEF in the trimetazidine group was associated with a more significant reduction of the left ventricular endsystolic diameter(LVESD) compared with the control group at 6-month follow-up. The NT-pro BNP levels decreased significantly in the trimetazidine group(3.11 ± 0.47 at baseline and 2.77 ± 0.45 at 6-month followup, P 0.01) and the 6MWT increased significantly in the trimetazidine group(325 ± 44 m at baseline and419 ± 56 m at 6-month follow-up, P 0.01). The differences in NT-pro BNP levels(2.77 ± 0.45 vs 2.96 ±0.46, P = 0.036) and 6MWT(419 ± 56 m vs 366 ± 54 m, P = 0.032) between the two groups were significant at 6-month follow-up. Conclusions Trimetazidine can improve LV function caused by DCM and LBBB. The positive effects of trimetazidine on LV function are especially evident in patients with optimization of drug therapy for heart failure, which strongly suggests an additive effect of these therapy modalities.     

Changes of Plasma Levels of Brain With Chronic Heart Failure before Natriuretic Peptide in Patients and after Carvedilol Treatment

Objectives To investigate the changes of plasma brain natriuretic peptide （BNP） concentrations in patients with chronic heart failure （CHF） before and after carvedilol treatment. Methods Plasma BNP concentrations of patients with CHF （n = 56） before and after carvedilol treatment and of normal controls （n = 60） were measured with specific radioimmunoassay. Left ventricular ejection fraction of patients with CHF before and after carvedilol was measured with 99mTc gated cardiac blood pool scintigraphy. Results The results showed that plasma BNP concentrations of patients with CHF were significantly higher than that of normal controls [ （222. 65 ± 78.52） ng·L^-1 vs. （38.82 ± 15.31 ） ng·L^-1 , P 〈 0. 01 1. Plasma BNP concentrations had a significant negative correlation with left ventricular ejection fractions （r=-0. 68 ,P 〈 0. 01 ）. After three months treatment of carvedilol, plasma BNP concentrations fell to （79. 65 ±69.52 ）ng·L^-1 （P 〈 0. 01 ）, left ventricular ejection fractions increase from 34. 41% ± 4. 54% to 46. 51% ± 5.38 % （P 〈 0. 01 ）. Conclusions These results indicate that plasma BNP concentrations are increased in patients with CHF, and markedly increased according to the severity of heart failure classified by NYHA classification. Carvedilol can markedly decrease plasma BNP concentrations and improve left ventricular function in patients with CHD.     

Comparison of Ventricular Electrophysiological Effects of Amiodarone in Canine Models With Congestive Heart Failure and Normal Dogs

Objectives This study compared the effects of amiodarone on ventricular electrophysiological properties in normal dogs and CHF dogs. Methods Dogs （n=44） were randomized into four groups： Group 1 （n=10） was the control. Group 2 （n=10） was given amiodarone orally 300 mg·d^-1 for 4 to 5 weeks. Group 3 （n=12） was the congestive heart failure （CHF） models induced by right ventricular rapid pacing （240 pulses·min^-1 for 4 to 5 weeks）. Group 4 （n=12） was the CHF models given amiodarone orally 300 mg·d^-1 for 4 to 5 weeks. The ventricular electrophysiological variables were evaluated by standard electric stimulation and monophasic action potential （MAP） recording. Results Amiodarone prolonged sinus cycle length （SCL）, intra-ventricular conduction time （IVCT）, MAP duration （MAPD90）, ventricular effective period （VERP）, ventricular activation time （VAT） and ventricular recovery time （VRT） without significant effects on the ratio of VERP to MAPD90 （VERP/MAPD90）, ventricular fibrillation threshold （VFT）, the dispersion of VRT （VRT-D）, and ventricular late repolarization duration （VLRD） in normal dogs. However, amiodarone did not further prolong the prolonged SCL, MAPD90, VERP, VAT and VRT, but further prolonged IVCT in CHF dogs. Amiodarone normalized the abnormal ventricular electrophysiological properties in CHF dogs as manifested by increasing the decreased VERP/MAPD90 and VFT, shortening the prolonged VLRD, and decreasing the increased VRT-D. Amiodarone did not worsen the hemodynamic parameters in normal and CHF dogs. Conclusions Amiodarone had different effects on ventricular electrophysiological properties in normal and CHF dogs. The favorable effects of amiodarone in normalizing some abnormal cardiac electrophysiological properties in CHF models may have potential value on the prevention and treatment of ventricular arrhythmias and sudden cardiac death in CHF.     

吸烟致冠状动脉粥样硬化性心脏病机制研究进展

吸烟是促进心血管疾病发生、发展的重要危险因素。在全球,烟草相关疾病每年约引起500万人死亡,其中超过1／3死于心血管疾病。冠状动脉粥样硬化性心脏病（简称冠心病）是与吸烟关系最为密切的心血管疾病之一,吸烟者冠心病发生率可增加2～3倍[2]。研究吸烟与冠心病的关系及致病机制有助于禁烟、戒烟及对心血管疾病的防治。     

Vacuum sealing drainage technique in the treatment of poor healing wounds after heart valve surgery： experience in cardiac nursing

Background Poor wound healing or postoperative infection after open-heart surgery is most commonly seen. If not treated in time or the infection progresses, it can lead to sternal infection, even mediastinal and pericardial infection, causing a higher mortality rate. Vacuum sealing drainage(VSD) is a new technology to promote wound healing. We studied the use of VSD technique in poor wound healing after heart valve surgery to see if it could achieve good therapeutic efficacy. Methods From 2013 October to 2014 October in Guangdong General Hospital, 86 cases of the application of vacuum sealing drainage technique in the treatment of cardiac nonunion after valve replacement in patients with nursing observation. The treatment time, death rate and infection rate, etc were compared. Results Wound healing time of 86 patients receiving vacuum sealing drainage was 14.6 ± 3.6 days, and no patient died. Two patients came back to hospital for repair due to dehiscence of the incision after discharge. Conclusion Nursing observation and drainage management were the key of VSD. VSD technique is worthy to be popularized clinically.     

The Treatment of Ostial Coronary Arteriopathy Secondary to Thoracic Irradiation With Off-pump Coronary Artery Bypass Grafting： A Case Report and Review of Literatures

Objectives We report a case in which a patient who suffered from angina secondary to mediastinal irradiation and have been treated by off-pump coronary artery bypass （OPCAB） in our hospital since 3 years ago. A 34-year-old man presented with angina for 8 years after receiving radiation therapy for Hodgkin＇s lymphoma. We retrospectively reviewed all the cases of OPCAB in our hospital and followed-up data for up to 3 years post-operatively. Mediastinal irradiation is probably the cause of significant ostial stenosis of left main coronary and right coronary artery. OPCAB grafting was performed on this patient 3 years ago. His angina disappeared after operation, and he recovered well during follow-up. Conclusions Patients with malignancies who have received mediastinal irradiation should be carefully followed up and routinely screened for the premature development of coronary artery disease. OPCAB may be an appropriate treatment for coronary artery disease caused by mediastinal irradiation.     

颈动脉高分辨磁共振成像预测冠心病的价值

目前心血管疾病（cardiovascular disease,CVD）在美国已成为死亡的主要原因[1],其发病率在国内也逐年升高并呈年轻化趋势,且死亡率已超过肿瘤,成为严重危害人民健康的第一杀手,其中最常见的病种为冠心病.研究发现,急性心血管事件的元凶超过2/3发生于非显著狭窄性病变,由斑块破裂造成[2],因此血管壁病变而不是血管腔病变才是各种心脑血管病发生和发展的基础[3].对于动脉轻度狭窄的患者,仅了解血管的狭窄程度己不能全面反映病变的严重程度,对动脉粥样硬化斑块成分分析及稳定性的判断逐渐受到人们的重视.