老年原发性高血压患者体位性血压变化与动脉硬化相关性分析

目的探讨老年原发性高血压患者体位性血压水平的变化与动脉硬化的相关性。方法入选2015年1月~2019年2月就诊于我院的年龄≥60岁的原发性高血压患者278例,根据卧立位血压变化结果将入选受试者分为体位性正常血压(ONT)组146例、体位性低血压(OH)组80例、体位性高血压(OHT)组52例。检测各组受试者的肱踝脉搏波传导速度(baPWV)、颈动脉内膜中层厚度(IMT)及斑块形成情况,比较各组间的差异,分析baPWV、颈动脉IMT的相关因素和影响因素。结果与ONT组比较,OH组和OHT组高血压病程和尿酸水平明显升高,差异有统计学意义(P<0.05);OH组和OHT组动脉硬化检出率(80.00%和86.54%vs 59.59%)、baPWV水平[(1880.08±177.25)cm/s和(1870.59±135.06)cm/s vs(1703.21±180.62)cm/s]、颈动脉IMT[(0.98±0.20)mm和(1.06±0.20)mm vs(0.69±0.24)mm]、IMT增厚检出率(28.75%和30.77%vs 13.70%)和颈动脉斑块检出率(12.50%和17.31%vs 6.16%)均较ONT组明显升高,差异有统计学意义(P<0.05)。卧立位收缩压差和卧立位舒张压差与baPWV、颈动脉IMT均呈正相关(P<0.01),且baPWV与颈动脉IMT呈正相关(r=0.372,P<0.01),多元线性回归分析显示,高血压病程、年龄、尿酸、卧立位收缩压差、baPWV是颈动脉IMT的影响因素(P<0.05);卧立位收缩压差、颈动脉IMT、空腹血糖、TG是baPWV的影响因素(P<0.05)。结论老年原发性高血压患者体位性血压变化与动脉硬化密切相关。     

老年原发性高血压患者晨峰现象与靶器官损害

目的 探讨老年原发性高血压晨峰(MBPS)现象对靶器官损害的影响. 方法 老年原发性高血压患者186例,依24 h动态血压分MBPS组(104例)和非MBPS组(82例).所有对象进行心脏和颈动脉超声检查,计算左室质量指数(LVMI)、颈动脉内膜中层厚度(IMT)及斑块的发生率. 结果 MBPS组24 h、白昼以及夜间平均收缩压、脉压均较非MBPS组高(P＜0.05或P＜0.01),MBPS组的LVMI及左右两侧颈动脉IMT均明显高于非MBPS组(P＜0.05或P＜0.01);颈动脉斑块的发生率MBPS组显著高于非MBPS组(P＜0.01). 结论 老年原发性高血压患者具有MBPS现象者有明显的靶器官损害.     

餐后高血糖与高血压病患者颈动脉和冠状动脉粥样硬化相关

目的 探讨原发性高血压患者餐后高血糖对颈动脉和冠状动脉粥样硬化的影响.方法 入选高血压病患者295例,所有患者行75 g葡萄糖耐量试验(OGTT)后分为餐后高血糖组,餐后正常血糖组.超声波检测颈动脉内膜中膜厚度(IMT)和动脉粥样斑块,其中88例合并冠心病患者行冠状动脉造影检查,评价冠状动脉狭窄程度.结果 原发性高血压患者60.7%存在餐后高血糖.餐后高血糖组颈动脉IMT[(1.2±0.3)mm]显著大于餐后正常血糖组[(0.8±0.3)mm](P＜0.01),颈动脉斑块检出率(59.2%)高于餐后正常血糖组(28.4%)(P＜0.01).高血压合并冠心病患者餐后高血糖达63.6%,餐后高血糖组冠状动脉狭窄评分更高(P＜0.01).相关分析餐后血糖水平与颈动脉IMT呈正相关(r=0.478,P＜0.01),餐后血糖与冠脉狭窄程度正相关(r=0.557,P＜0.01).结论 原发性高血压患者餐后高血糖与颈动脉、冠状动脉粥样硬化密切相关.高血压合并餐后高血糖大动脉损伤严重.     

中心性肥胖患者血压、血脂、血糖及颈动脉粥样硬化程度的检测

目的 观察中心性肥胖患者血压、血脂、血糖及颈动脉粥样硬化程度的变化.方法 测量409例中心性肥胖患者(观察组)的血压、血脂、血糖,采用彩色多普勒超声检查其颈动脉内膜中层厚度(IMT)和斑块形成情况,并与412例健康受检者(对照组)进行比较.结果 观察组205例(50.12％)高胆固醇、141例(34.47％)高甘油三脂、103例(25.48％)高血糖、212例(51.83％)高血压,对照组分别为176例(42.72％)、62例(15.05％)、30例(7.28％)、74例(17.96％).观察组高胆固醇、高甘油三酯、高血糖、高血压发生率均明显高于对照组(P均＜0.05).观察组颈动脉IMT为(1.18 ±0.28)mm,对照组为(0.89±0.18)mm.观察组颈动脉IMT明显高于对照组(P＜0.05).观察组285例(69.68％)检出颈动脉斑块,对照组83例(20.15％).观察组颈动脉斑块检出率明显高于对照组(P＜0.01).结论 中心性肥胖患者高血压、高血脂、高血糖发生率和动脉粥样硬化程度均高于健康对照者.     

动脉硬化早期检测临床研究

目的 研究评价动脉硬化的指标臂踝脉搏波传导速度（baPWV）和踝臂血压指数（ABI）与心血管疾病发生及其危险因素间的关系,探讨其作为冠心病,颈动脉粥样硬化斑块等心血管疾病预测指标的临床价值以及硝酸甘油对ABI和baPWV的影响.方法 以本院门诊和住院患者1000例为研究对象,男性713例,女性287例,年龄（69.51±15.18）岁,采用VP-1000全自动动脉硬化测定仪检测患者双侧baPWV和ABI.其中150例疑为冠心病者行冠状动脉造影检查,154例行颈动脉超声多普勒检测颈动脉粥样硬化斑块情况.结果 ①baPWV与高血压直接相关（OR =6.528,95％CI=3.137 ～12.763,P＜0.05）,与吸烟（OR=6.446,95％CI=2.411～17.235）、高脂血症（OR =4.694,95％CI=2.200～10.014）、性别（男性）（OR =3.100,95％CI=1.106～8.687）和冠心病（OR=1.795,95％0=1.020～3.894）密切相关（P＜0.05）.随着心血管疾病危险因素聚集,动脉硬化的发生率明显增加.②baPWV在评估冠心病中的价值：冠状动脉造影阳性组与冠脉造影阴性组比较,baPWV＞ 1700 cm/s,敏感性83.33％、准确性84.00％,Kappa值0.61.③颈动脉粥样硬化斑块与baPWV的关系：颈动脉粥样硬化斑块与年龄、baPWV、吸烟史、脉压相关（P＜0.05）;随着baPWV的升高,颈动脉粥样硬化斑块的OR值增加.④含服硝酸甘油对baPWV与ABI的影响：服药后所有受试对象的baPWV值均减小（P＜0.01）,baPWV变化与用药前的收缩压和年龄呈正相关.服药后所有受试对象的ABI值均减小（P＜0.01）,ABI的变化与用药前心率呈负相关,与用药后的心率呈正相关.结论 ①baPWV值可能是冠心病、颈动脉粥样硬化斑块发生的独立预测因子.②硝酸甘油可改善ABI和baPWV测量值,其临床意义有待进一步探讨.     

高血压患者血清瘦素水平与肾素-血管紧张素-醛固酮系统相关性分析

目的 分析高血压患者瘦素与肾素-血管紧张素-醛固酮系统(RAAS)的相关性及病理生理机制.方法 高血压组70例,对照组66例,采用放射免疫方法测定瘦素、血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)和醛固酮(ALD)浓度.结果 高血压组瘦素、PRA和AngⅡ高于对照组(P＜0.05).影响瘦素的因素是性别、体重指数(BMI)、收缩压(SBP)和PRA(P＜0.01).高血压组瘦素与PRA、AngⅡ、ALD、SBP正相关(P＜0.01).将高血压组分为高肾素组和非高肾素组,高肾素组瘦素高于正常肾素组(P＜0.01).结论 高血压患者存在瘦素抵抗,瘦素通过激活RAAS导致血压增高,主要表现为SBP升高.     

原发性高血压患者血管紧张素Ⅱ、内皮素-1水平与颈动脉病变的关系

目的 探讨原发性高血压患者外周血中血管紧张素Ⅱ(AngⅡ)、内皮素-1(ET-1水平变化与颈动脉病变的关系。方法 选取青海省湟中县第一人民医院2018年1月30日至2019年4月30日收治的150例原发性高血压患者,检测外周血中AngⅡ、ET-1水平。根据患者颈动脉内膜厚度将观察组分为3个亚组,分别为颈动脉内膜正常组(45例)、颈动脉内膜增厚组(65例)、颈动脉斑块组(40例)。分析观察组各亚组AngⅡ、ET-1水平,并观察颈动脉斑块的影响因素。结果 颈动脉斑块组AngⅡ、ET-1水平高于颈动脉内膜正常组和颈动脉内膜增厚组,差异有统计学意义(P 0.05),颈动脉内膜增厚组AngⅡ、ET-1水平高于颈动脉内膜正常组,差异有统计学意义(P 0.05)。原发性高血压合并颈动脉斑块患者吸烟比例、高血脂比例、入院收缩压、胆固醇、AngⅡ、ET-1、高血压病程高于原发性高血压未合并颈动脉斑块患者(t/χ2=5.322、8.495、4.812、5.127、20.585、13.495、4.671,P 0.05)。多因素回归分析显示,高血脂、高血压病程、AngⅡ、ET-1是原发性高血压颈动脉斑块的独立影响因素[OR(95%CI)=1.536(1.045～3.125)、1.362(1.123～4.562)、1.856(1.223～5.721)、1.236(1.167～5.369),P 0.05]。结论 原发性高血压患者外周血ET-1和AngⅡ水平与颈动脉病变程度有关,ET-1和AngⅡ水平对预测原发性高血压合并颈动脉斑块有一定的意义。     

年龄相关性血管硬度与血压的关系研究

目的探讨年龄相关性血管硬度与血压的关系。方法选取2014年6月—2015年6月在天津市西青医院进行健康体检者504例,根据年龄分为青年组(≤44岁,n=82)、中年组(45~59岁,n=230例)、老年组(60~79岁,n=135例)和高龄组(≥80岁,n=57)。比较各组受试者血压及血管硬度,并分析血管硬度与血压的关系。结果青年组高血压检出率为20.73%(17/82),中年组为32.61%(75/230),老年组为42.22%(57/135),高龄组为43.86%(25/57)。高龄组、老年组和中年组受试者收缩压和脉压高于青年组,高龄组和老年组受试者收缩压和脉压高于中年组(P0.05);但老年组和高龄组受试者收缩压和脉压比较,差异无统计学意义(P0.05);各组受试者舒张压比较,差异无统计学意义(P0.05)。高龄组、老年组和中年组受试者左侧踝臂脉搏波传导速度(ba PWV)和右侧baPWV均高于青年组,高龄组和老年组受试者左侧baPWV和右侧baPWV均高于中年组,高龄组受试者左侧baPWV和右侧baPWV均高于老年组(P0.01);高龄组、老年组和中年组受试者左侧踝臂指数(ABI)和右侧ABI均高于青年组,高龄组受试者左侧ABI高于中年组、老年组(P0.01)。Pearson相关性分析结果显示,年龄与左侧baPWV和右侧baPWV均呈正相关(r值分别为0.531、0.556,P0.01);而年龄与左侧ABI和右侧ABI均无直线相关性(r值分别为0.137、0.004,P0.05)。Mantel-Haenszel卡方检验结果显示,右侧baPWV与高血压分级无关(χ~2=1 229.67,P=0.355),左侧ba PWV与高血压分级亦无关(χ~2=1 239.35,P=0.277);右侧ABI(χ~2=419.81)和左侧ABI(χ~2=351.59)均与高血压分级有关(P0.001)。结论随着年龄增长,血管硬度增加、收缩压升高,且血管硬度与血压有关。     

睡眠呼吸暂停相关性高血压颈动脉硬化的危险因素

目的 调查睡眠呼吸暂停相关性高血压中颈动脉粥样硬化及不稳定斑块的患病率及影响因素.方法 603例诊断为睡眠呼吸暂停相关性高血压入选病例组,根据睡眠呼吸紊乱指数(AHI)进一步分为轻(AHI 5～15)、中(AHI 15～30)、重(AHI≥30)3组,AHI＜5者为对照组.根据颈动脉超声判断斑块性质.结果 4组间性别不匹配;颈动脉粥样硬化在中、重度组高于对照组(P＜0.01),不稳定斑块在组间无差异;对该人群颈动脉粥样硬化可能的危险因素进行因子分析,共提取6个公因子,以各因子得分为因变量进入逐步logistic回归,提示阻塞性睡眠呼吸暂停、血脂( TC、LDL-C)为颈动脉粥样硬化的危险因素,OR分别为1.36(95％ CI 1.15～1.59)、1.31 (95％ CI1.12～1.54),血脂为不稳定斑块的危险因素,OR为1.30(95％ CI 1.06～ 1.58).结论 睡眠呼吸暂停相关性高血压中颈动脉粥样硬化可能与阻塞性睡眠呼吸暂停独立相关,而不稳定斑块形成则主要与脂代谢紊乱有关.     

多重危险因素干预与老年颈动脉粥样硬化斑块关系的研究

目的 探讨多重危险因素干预与老年人颈动脉粥样硬化和斑块的关系,评估强化他汀降脂治疗重要性、安全性、有效性及达标剂量. 方法 入组181例经彩色颈动脉超声检查确诊为颈总动脉内中膜(IMT)增厚和颈动脉粥样硬化斑块伴有多重危险因素患者.数字抽签随机分为2组给予综合控制血脂、血压、血糖等,常规治疗组阿托伐他汀10 mg,强化治疗组阿托伐他汀20 mg,治疗24个月. 结果 两组患者干预后的血压、血脂、血糖、微量白蛋白尿(MAU)及超高敏C反应蛋白(hs-CRP)较治疗前均有改善(P％0.05或P＜0.01);强化治疗组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)及hs-CRP差值分别为(0.9±0.6) mmol/L,(1.3±0.7)mmol/L、(3.9±3.0) mg/L,常规治疗组分别为(0.3±0.3) mmol/L、(1.0±0.6) mmol/L、(2.9±1.9) mg/L,差异有统计学意义(均P＜0.01).强化治疗组颈动脉IMT、颈动脉斑块的性质改善(P＜0.01);斑块个数两组均减少,强化治疗组的变化趋势更显著(P＜0.01);强化治疗组颈动脉双侧斑块面积均改善(P＜0.05). 结论 多重危险因素综合干预治疗,可稳定、延缓颈动脉粥样硬化及斑块,老年人常规剂量他汀治疗可使LDLC达到目标值.     

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.     

Communicating with patients with inflammatory bowel disease

Ulcerative colitis and Crohn's disease, the two main forms of inflammatory bowel disease (IBD), are chronic illnesses that affect hundreds of thousands of Americans. Patients with IBD suffer chronically from diarrhea, abdominal pain, gastrointestinal bleeding, malabsorption, and weight loss requiring continuous medical and surgical attention. Despite recent advances in therapy, IBD follows a course of exacerbations and remissions with approximately 25-50% of patients relapsing annually. Hence, these diseases are readily encountered in primary care and gastroenterology clinics. Though medical and surgical treatment options have improved significantly, little has been written about the psychosocial aspects of IBD. Currently, there is a paucity of data concerning effective communication methods enabling physicians to develop stronger rapport with patients suffering from IBD, the care of whom requires a multidisciplinary approach involving primary care physicians, gastroenterologists, and colorectal surgeons. Because IBD has a high morbidity, it is worthwhile to further investigate those social factors that will improve patients' quality of life. In this paper, we summarize some of the common problems that emerge when taking care of patients with IBD and provide initial guidelines based on the world literature regarding the management and education of patients with IBD. Both primary care physicians and specialists (gastroenterologists, colorectal surgeons) need to be aware of the questions and concerns of IBD patients and to be capable of dispensing the information in a clear and concise manner. Using the case scenario format, we review the most common aspects of communication for health care professionals taking care of IBD patients and suggest ways to establish and maintain long-term doctor-patient relationships. The two most significant interventions that dramatically improve quality of life and patient-physician relationships are proper patient education and appropriate treatment of concurrent depression and anxiety. We hope that our review will form a framework by which different members of the medical team learn their roles in the complex management decisions affecting IBD patients.