静脉盐负荷对高血压盐敏感者肾脏PGI2及TXA2的影响及盐敏感性高血压的胰岛素抵抗

OBJECTIVE: To investigate insulin resistance and the effects of intravenous acute saline load on renal production of prostaglandin I(2) (PGI(2)) and thromboxane A(2) (TXA(2)) in salt-sensitive hypertensive patients. METHODS: The 24-hour excretion of urinary 6-keto-prostaglandin F (PGF) 1alpha and thromboxane B(2) were measured before and after intravenous acute saline load in 53 hypertensive patients whose salt sensitivity had been determined. Oral glucose tolerance test and insulin release test were performed in all the subjects. RESULTS: after intravenous acute saline load, the 24-hour excretions of urinary 6-keto PGF 1alpha were significantly lower in salt-sensitive (SS) hypertensive patients than that in non-salt-sensitive (NSS) ones (316+/-57 pg/min vs 371+/-68 pg/min, P<0.01), and the decrease from baseline was much greater in SS group than that in NSS group (197+/-99 pg/min vs 136+/-101 pg/min, P<0.01). Both 24 hour urinary excretion of TXA(2) and the increase in urinary excretion of TXA(2) were significantly greater in SS hypertensive patients than those in NSS ones after salt loading (394+/-32 pg/min vs 359+/-44 pg/min, P<0.01, and 80+/-47 pg/min vs 47+/-45 pg/min, P<0.01, respectively). The plasma glucose and insulin concentrations in every time point were much higher in SS hypertensive subjects than that in NSS ones, and the former group had lower insulin sensitivity index than the latter (0.013+/-0.003 vs 0.018+/-0.004, P<0.01) CONCLUSION: Saline load produces significantly different effects on renal production of PGI(2) and TXA(2) in SS and NSS hypertensive patients, and these changes may be related to the pathophysiology of SS hypertensive patients after acute salt loading. Insulin resistance is greater in SS hypertensive patients than in NSS ones.     

高龄高血压患者的盐敏感性及血管重构相关性分析

目的 对高龄高血压患者进行盐敏感性与血管重构的相关性分析.方法 选取2010年3月到2012年3月期间在我院住院治疗的180例高龄高血压患者作为研究对象.首先对患者进行盐敏感性知识的问卷调查,高血压患者通过急性盐水负荷试验来检测高血压患者的盐敏感性,患者口服二甲双胍,在试验前均不服用降压药,进行血管重构程度检测.结果 94.4%的患者不知道盐敏感性高血压,97.2%不知道盐敏感性高血压的预防方法,36.1%的患者接受限制高盐饮食;115例是盐敏感性高血压患者,65例为非盐敏感性高血压患者;治疗后盐敏感性患者与非盐敏感性患者血压及血糖值比较差异有统计学意义（P＜0.05）;高血压患者的动脉弹性参数Ep为（117.97±28.70）kPa.结论 高龄高血压患者的盐敏感性与血糖的调节有关,通过调节盐敏感性,改变血管的构造,从而有益于血压的稳定维持.     

Effects of antihypertensives on arterial responses associated with obstructive sleep apneas

Background Many patients with obstructive sleep apnea syndrome (OSAS) have complicated with hypertension and may be prescribed with antihypertension medications to control their blood pressure. But whether antihypertension medications can also decrease arterial stiffness or control the blood pressure increasing following obstructive events is not well described. This study aimed to investigate whether antihypertensive medications can ameliorate the changes in arterial stiffness and blood pressure associated with OSA. Methods Sixty-one OSAS patients ［13 women, 48 men, mean age (53.4±12.3) years］, 26 normotensive patients (N), 7 hypertensive patients on no antihypertension medications (H), and 28 hypertensive patients on various combination antihypertension therapy (HM), were prospectively diagnosed with standard nocturnal polysomnography. Beat-to-beat blood pressure was continuously recorded from the radial artery by applanation tonometry during baseline sleep. As a measure of arterial stiffness, arterial augmentation index (AAI) was calculated as the ratio of augmented systolic blood pressure (SBP) to pulse pressure and expressed as a percentage for the following conditions: awakening, the first 10 (“early apnea”) and last 10 (“late apnea”) cardiac cycles of obstructive events (apnea or hypopnea), and the first 15 cardiac cycles following event termination (“post apnea”) for all events with nadir O2 saturation ≤89%.Results Systolic blood pressure (SBP) post-apnea ［(142.74±13.06) mmHg (N), (137.06±26.56) mmHg (H), (136.94±14.1) mmHg (HM)］ was significantly increased from awakening ［(135.76±14.76) mmHg (N), (135.58±23.17) mmHg (H), (129.77±14.00) mmHg (HM)］, early apnea ［(130.53±12.65) mmHg (N), (124.47±24.97) mmHg (H), (126.04±13.12) mmHg (HM)］, and late apnea ［(129.8±12.68) mmHg(N), (124.78±25.15) mmHg (H), (124.48±13.82) mmHg (HM)］ respectively (P&lt;0.001, repeated measures ANOVA). AAI was significantly increased for the N group (P&lt;0.001) from awakening to late apnea ［(10.45±2.62)% vs (14.43±3.21)%］ and from early apnea to late apnea ［(10.61±2.34)% vs (14.43±3.21)%］, and also for H group (P&lt;0.05) from awakening to late apnea ［(11.23±3.87)% vs (16.32±8.02)%］ and from early apnea to late apnea ［(11.75±3.79)% vs (16.32±8.02)%］. Meanwhile, no significant differences in AAI among awakening, early apnea, late apnea, and post-apnea conditions were found in HM group. Conclusions The current data demonstrate that systemic blood pressure increases significantly during the post-apneic phase of OSAS, compared with that during awakening and intra-apnea phases even with the use of combined antihypertensive therapy which could normalize BP during awakening in the hypertensive patients. However, increases in arterial stiffness during obstructive events could be ameliorated by combined antihypertension medications.     

食盐中添加钾、钙与限盐对血压偏高青少年及其家庭成员血压的随机、单盲、对照试验

目的观察在原有膳食钠摄入条件下,增加钾和钙摄入量可否起到与减少钠摄入量相同的降压作用.方法在经过8年血压随访的汉中市心血管病防治区4623名青少年中,对其中330名血压偏高者共300个家庭采用随机、单盲、对照的方法分为(1)补钾、补钙组110名,和其共同生活的家庭成员进行为期2年的对照试验,钾和钙的添加量约为每日10mmol,与食盐混合提供给每个家庭;(2)限盐组110名,通过以家庭为单位进行高血压卫生健康教育,使每日钠摄入量在原有基础上逐渐减少50～100mmol,家用食盐按需要提供;(3)对照组110名,也免费提供家用食盐.随访每半年进行1次,内容包括3天饮食的回顾性调查,夜12小时尿钠、钾排泄量,高血压卫生知识问卷考试,血压、身高及体重的测量等.随访人员均经过血压测量的培训和考试,并进行过多次高血压流行病学调查.盐敏感性判定用静脉盐水负荷法,尿钠、钾测定用火焰光度法.结果两年期血压偏高者的平均随访率为87.4%,家庭总成员的随访率为81.8%;经两年期试验,补钾补钙组血压较基线分别下降了5.9/2.8mmHg.随访发现,补钾和钙半年后血压即呈现降低,1年后最显著;限盐组3天饮食回顾性调查日摄钠量2年后较基线平均减少了54mmol,血压平均下降5.8/2.8mmHg,而对照组则上升了1.3/2.3mmHg;补钾补钙组,2年末随访血压盐敏感者(n=37)下降了9.9/5.5mmHg,明显高于盐不敏感者(n=64),后者仅下降了3.6/1.1mmHg,P＜0.01;限盐组中,盐不敏感者的血压较盐敏感者下降显著,较基线分别下降7.9/3.2mmHg和2.2/2.5mmHg.结论在食盐中适量添加钾和钙盐和减少盐的摄入量一样均有助于降低或延缓血压偏高青少年血压的进一步升高,从而达到预防高血压的目的,特别是盐敏感者.     

The circadian rhythm of blood pressure and the effect of sa lt intake in salt-sensitive subjects

Objective To investigate the effect of salt intake on the circadian rhythm of blood pressure and the characteristics of ambulatory blood pressure (ABP) in salt-sensitive (SS) subjects. Methods Twenty-three normotensive subjects and forty-three patients with essential hypertension were included in this study.Salt sensitivity was determined with a chronic dietary salt loading test and an acute venous saline loading test, respectively.24-hour ABP measurements were performed twice in normotensive subjects when they were on a high salt diet and when they had a low salt diet.Blood and urine samples were collected for measurement of plasma norepinephrine concentration (PNE), plasma renin activity (PRA), angiotensin Ⅱ, aldosterone, erythrocyte sodium content and urinary sodium excretion.24-hour ABP readings were also obtained in patients with essential hypertension when antihypertensive drugs were discontinued for at least 2 weeks. Results High salt intake attenuated the circadian rhythm of blood pressure in SS normotensive subjects, and the nocturnal decline in blood pressure was smaller in SS patients with essential hypertension than in salt-resistant (SR) patients.The level of PNE was higher and the suppression of PRA was smaller in SS subjects than in SR subjects when they had a high salt diet, and the urinary sodium excretion decreased and the erythrocyte sodium content increased significantly in SS subjects on high salt intake. Conclusions High salt intake caused an abnormal circadian rhythm of blood pressure in SS subjects.The blunted nocturnal decline in blood pressure may be a characteristics of SS patients with essential hypertension.     

盐敏感性高血压患者胰岛素抵抗性及其与炎症因子的关系

目的探讨盐敏感性高血压患者胰岛素抵抗状况及其与炎症因子的关系。方法对190例高血压患者采用急性盐水负荷试验,确定盐敏感性高血压125例,非盐敏感性高血压65例,分别进行糖耐量试验及胰岛素同步释放试验,对炎症因子指标HsCRP,IL-6进行检测。结果与盐不敏感性高血压患者相比,盐敏感性高血压患者空腹血糖水平与血胰岛素水平显著增高,胰岛素敏感指数降低;高糖负荷后血糖水平与血胰岛素水平显著增高,胰岛素敏感指数显著降低;盐敏感性高血压患者炎症因子HsCRP,IL-6水平较非盐敏感性高血压患者明显升高,差异有统计学意义。结论盐敏感性高血压患者存在更严重的胰岛素抵抗,且其非特异性炎症因子水平高于盐不敏感者。     

连续无创血压(CNAP)与传统无创血压(NIAP)在剖宫产脊椎麻醉后血压监测中的比较

目的 研究与传统无创血压（non-invasive arterial pressure,NIAP）监测相比,剖宫产脊椎麻醉（简称脊麻）时连续无创血压（continuous non-invasive arterial pressure,CNAP）监测是否有利于维持产妇血流动力学稳定。方法 选择ASA Ⅰ~Ⅱ级,择期在脊麻下行剖宫产手术的产妇40例,采用随机数字表法将产妇分为2组,CNAP组（CS组）和NIAP组（N组）。血压的管理采用相同的方案,N组根据NIAP测定的血压数据,CS组根据CNAP测得的数据。我们比较了CNAP与NIAP监测的准确性和精确性,使用Bland-Altman散点图对获得的数据进行统计学分析。并记录两组产妇脊麻后低血压出现时间、低血压的发生率和血流动力学稳定的时间。结果 根据2 270对数据,CNAP与NIAP在SBP、DBP和MAP平均偏倚（NIAP-CNAP）和标准差分别为（-4±14）mmHg、（-9±14）mmHg和（-6±13）mmHg。脊麻后两组严重低血压发生率CS组明显低于N组（11.1% vs.28.9%,P=0.035）,CS组血流动力学的稳定时间明显长于N组（93.5% vs.83.7%,P=0.01）。结论 与NIAP监测相比,剖宫产脊麻时CNAP监测有利于维持产妇血流动力学的稳定。     

男性高血压患者动态血压节律异常与良性前列腺增生的相关性研究

目的:探讨男性高血压患者血压节律异常与良性前列腺增生间的相关性.方法:对198例(45~92岁)高血压合并良性前列性增生的患者进行24 h动态血压监测,根据夜间血压下降率分为杓型组(100例)和非杓型组(98例),比较两组患者低密度脂蛋白、糖化血红蛋白、踝臂指数、收缩压、舒张压、前列腺抗原及前列腺体积.结果:非杓型组和杓型组昼间收缩压[(130.2±9.4) mmHg vs(128.6±7.5) mmHg,(1 mmHg=0.133 kPa)]、昼间舒张压[(76.0±6.1) mmHg vs(75.8±5.5) mmHg]无明显差异,但夜间收缩压[(134.8±9.7) mmHg vs (115.6±3.0) mmHg]及夜间舒张压[(78.8±6.5) mmHg vs(67.5±2.7) mmHg]有显著性差异(P＜0.05),非杓型组和杓型组患者前列腺体积有显著性差异[(44.8±11.6) ml vs(35.4±9.9) ml,P＜0.05].结论:血压患者血压节律异常与前列腺增生程度可能存在相关性.     

正常血压中年人群的盐敏感状况及盐敏感检测方法

目的 调查血压正常的中年人群的盐敏感状况,比较慢性盐负荷试验与冷加压试验两种方法在盐敏感性检出上的一致性。 方法 对68例血压正常的中年人进行冷加压试验和慢性盐负荷试验,根据慢性盐负荷试验结果将该人群分为盐敏感(SS)组和盐不敏感(NSS)组,比较SS组和NSS组的一般资料及血压增幅值差异。采用配对四格表资料的χ2 检验比较慢性盐负荷试验和冷加压试验两种方法检测盐敏感性的差异。 结果 慢性盐负荷试验结果发现,SS组为22例(32.4%),NSS组为46例(67.6%)。与NSS组相比,SS组的年龄偏大、高血压家族史比例偏高(P<0.05),静息时心率、收缩压、舒张压均偏高(P<0.01)。与NSS组比较,SS组在冷加压试验后舒张压、收缩压、平均动脉压增幅均升高(P<0.05,P<0.01)。慢性盐负荷试验和冷加压试验两种方法检测盐敏感性的结果差异无统计学意义(χ2=0.363,P＞0.05)。结论 血压正常的中年人群中盐敏感性检出率为32.4%,冷加压试验或可代替慢性盐负荷试验检测人群的盐敏感性。     

高血压患者动态血压参数与颈动脉内-中膜厚度关系的研究

目的研究高血压病患者动态血压参数与颈动脉内-中膜厚度(CA-IMT)的关系。方法采用无创动态血压仪对127例高血压病患者进行24 h动态血压监测,同时应用高分辨率彩色多普勒超声显像仪测量患者颈动脉内-中膜厚度,据颈动脉内-中膜厚度分两组:CA-IMT≥0.9 mm为增厚组(n=53),CA-IMT<0.9 mm为正常组(n=74)。结果①CA-IMT增厚组与CA-IMT正常组的临床指标比较无统计学意义;②CA-IMT增厚组与CA-IMT正常组的动态血压参数比较:24 h平均收缩压(145.7±9.2)mmHg和(127.5±9.6)mmHg,24 h平均舒张压(83.5±5.1)mmHg和(76.7±5.6)mmHg,24 h脉压(62.3±10.1)mmHg和(47.8±9.5)mmHg;白天平均收缩压(148.6±6.3 mmHg)和(134.8±8.2)mmHg,白天平均舒张压(86.7±4.8)mmHg和(80.1±5.7)mmHg,白天脉压(63.5±10.9)mmHg和(51.4±9.1)mmHg;夜间平均收缩压(139.2±12.4)mmHg和(121.6±8.6)mmHg,夜间平均舒张压(79.3±9.0)mmHg和(70.3±5.2)mmHg,夜间脉压(60.1±11.7)mmHg和(50.4±7.1)mmHg,两者差异均有统计学意义(P<0.01)。CA-IMT增厚组与CA-IMT正常组其动态血压呈非勺型节律为54.7%比35.1%,其差异有显著性意义(P<0.05)。结论高血压病动态血压参数异常者颈动脉IMT增厚的发生率高,对靶器官损害有预测价值。     

长期雌激素替代治疗对血压及心肌IR和IRS-1表达的影响

目的：研究长期雌激素替代治疗对血压及心肌组织胰岛素受体（IR）和胰岛素受体底物-1（IRS-1）表达水平的影响。方法：将50只雌性SD大鼠随机分成3组，构建假手术、去势（去卵巢）和雌激素替代3组动物模型。手术前后,用尾套法测定大鼠的尾动脉收缩压，RT-PCR方法检测大鼠心肌IR和IRS-1的表达。结果：去势组血压［（118.75±2.77） mmHg］明显高于假手术组 ［（103.86±1.84）mmHg，P＜0.05］和替代组［（107.83±3.24）mmHg，P＜0.05］ 。去势组大鼠心肌IRS-1的相对表达量（1.2588±0.1045）显著低于假手术组（2.2089±0.0988, P＜0.05）和替代组(1.9100±0.1230，P＜0.05）。然而，替代组与假手术组间血压和IRS-1的表达无明显差异（P＞0.05）。假手术、去卵巢和替代组间心肌IR的表达差异无统计学意义（P＞0.05）。结论：长期雌激素替代治疗可降低血压、增加心肌细胞IRS-1的表达，从而一定程度上保护心血管。但血清雌激素水平对心肌细胞IR的表达影响不明显。     

中国人直立性高血压的年龄和性别差异—单中心研究

目的：探讨单中心中国人直立性高血压(orthostatic hypertension,OHT)的年龄和性别差异。方法：选择2000年1月至2012年8月在中南大学湘雅二医院晕厥专科门诊就诊或住院的不明原因头晕、晕厥等患者2 994例进行直立倾斜试验(head-up tilt test,HUTT)检查,年龄2.00~78.00(19.07±14.78)岁,男1 406例,女1 588例。符合OHT者745例,分为成人组(≥18岁,247例)和儿童组(<18岁,498例),分析OHT出现率、OHT类型及HUTT后3 min血压增加量的年龄与性别差异。结果：1)OHT出现率为24.88%(745/2 994),男女比较差异未见统计学意义(25.75% vs 24.12%,χ2=1.058,P>0.05);成人组较儿童组出现率高(27.05% vs 23.83%,χ2=4.125,P<0.05);745例OHT患者中52例(6.98%)表现为直立后收缩压、舒张压均升高(sOHT合并dOHT),16例(2.15%)为单纯直立性高收缩压(sOHT),677例(90.87%)为单纯直立性高舒张压(dOHT)。成人组单纯sOHT出现率、sOHT合并dOHT出现率均明显高于儿童组(分别为1.11% vs 0.29%,χ2=7.965,P<0.01;2.88% vs 1.24%,χ2=9.849,P<0.01);成人组单纯dOHT出现率与儿童组比较差异未见统计学意义(23.56% vs 22.20%,χ2=0.668,P>0.05);sOHT合并dOHT与单纯dOHT在不同性别组中出现率差异未见统计学意义(男：1.71% vs 1.76%,χ2=0.014,P>0.05;女：23.68% vs 21.66%,χ2=1.742,P>0.05);但儿童中dOHT出现率男性高于女性(24.53% vs 19.74%,χ2=6.933,P<0.05)。2)与儿童组比较,成人组sOHT合并dOHT收缩压增加量[(25.62±4.96) mmHg vs (23.54±5.83) mmHg,t=1.385,P>0.05]、dOHT舒张压增加量[(13.46±3.49) mmHg vs (13.23±3.22) mmHg, t=0.840,P>0.05]差异均无统计学意义。与儿童组比较,成人组sOHT收缩压增加量[(25.44±4.96) mmHg vs (23.68±5.35 ) mmHg,t=1.411,P>0.05]及dOHT舒张压增加量[(14.09±4.28) mmHg vs (13.05±3.82) mmHg,t=1.887,P>0.05]差异均未见统计学意义。结论：OHT出现率成人高于儿童,以dOHT多见,儿童以男性多见。在sOHT合并dOHT与单纯dOHT中,直立后3 min血压增加量成人与儿童未见差异。     

应用RNA阵列技术检测自发性高血压大鼠不同组织NOSⅢ基因表达

目的:探讨自发性高血压大鼠(SHR)不同组织一氧化氮合酶Ⅲ(NOS Ⅲ)基因表达改变及其在高血压形成中的作用.方法:提取2、4、6、8、10、12不同周龄雄性SHR和正常血压大鼠(WKY)心室肌、血管平滑肌、肝脏和肾脏组织的总RNA,利用高通量RNA阵列技术(RNA array)检测SHR和对照组WKY不同组织NOS Ⅲ mRNA表达的改变.结果:与同周龄WKY相比较,SHR在6、8、10、12周龄血压出现显著性升高[(158.50±7.69 vs 108.67±5.89,174.33±4.46 vs 128.50±4.97,198.00±13.45 vs 142.00±3.58,216.67±8.91 vs 141.17±4.92) mmHg,P均<0.01],10、12周龄心室肌重量/体重比出现显著增加[(4.08±0.17 vs 3.59±0.11,4.05±0.18 vs 3.40±0.19)mg/g,P均<0.01],心肌中NOS Ⅲ基因表达在6、8、10、12周龄出现显著性升高,(1.12±0.18 vs 0.90±0.15,1.46±0.34 vs 1.06±0.18,1.66±0.31 vs 1.21±0.30,1.98±0.40 vs 1.31±0.38,P＜0.05),肾脏组织NOS Ⅲ基因表达在4、6、8、10、12周龄出现显著性升高(1.10±0.21 vs 0.81±0.11,1.28±0.18 vs 0.95±0.13,1.31±0.23 vs 0.99±0.23,1.70±0.30 vs 1.08±0.25,1.83±0.33 vs 1.15±0.20,P＜0.05).肝脏组织中NOS Ⅲ基因表达无显著性差异(P均>0.05),血管平滑肌中未见上述基因的明显表达.结论:NOS Ⅲ mRNA表达的继发性增加是高血压发生和发展过程中重要的分子生物学机制.     

高盐饮食对Dahl大鼠肾脏SGK1基因表达的影响

目的：通过观察高盐负荷后Dahl盐敏感大鼠肾脏血清和糖皮质激素调节蛋白激酶1（SGK1）基因的表达,探索其在盐敏感性高血压形成中的作用。方法对Dahl盐敏感大鼠和对照组SS-13BN大鼠分别给予正常盐[0.3%氯化钠（NaCl）]和高盐（8%NaCl）饮食3周干预,测定血压,采用Real-time PCR检测肾脏SGK1基因信使核糖核酸（mRNA）。结果 SS高盐饮食组大鼠及SS-13BN高盐组大鼠血压均比其低盐饮食组高;与13BN组相比,SS高盐组血压较低盐组升高幅度更为显著;Dahl盐敏感大鼠高盐组肾脏SGK1的表达较低盐组显著增加,同时也显著高于高盐组SS-13BN大鼠。结论高盐引起Dahl盐敏感大鼠肾脏SGK1的表达异常增加可能是盐敏感性高血压形成的重要原因。     

老年IgA肾病的临床病理特征和预后分析

目的:探讨老年IgA肾病(IgA nephropathy,IgAN)临床病理特征和预后.方法:选择肾活检确诊的年龄≥60岁的IgA肾病患者70例,与同期肾活检确诊的年龄<60岁的IgA肾病患者82例进行临床、病理及预后对比分析比较.结果:老年组与非老年组相比,收缩压[(142.0±20.4)mmHg vs (124.2±16.9)mmnHg,1 mmHg=0.133 kPa]、舒张压[(83.1 4±11.8)mmUg vs(78.9 4±12.3)millHg]、肾穿时血肌酐水平[(172.7-1±125.8)μmol/L vs(94.4 4±42.5)μmol/L]、血胆固醇[(5.7 4±1.6)mmoL/ vs (5.1±1.6)mmol/L]、24 h尿蛋白定量[(3.4±2.9)g/d vs(1.8 4±2.O)g/d]、高血压的发生率(57.1%vs32.5%)、慢性肾疾病(chronic kidney disease,CKD)分期3～5期的比例(64.O%伪14.6%)差异均有统计学意义(P<0.05).两组的病程、肉眼血尿的发生率、血甘油三酯、血WgA水平差异无统计学意义(P>o.05).病理资料上,老年组肾病理以慢性化病变为主,与非老年组相比,肾小球硬化[(19.7 4±20.1)%vs(13.4 4±17.8)%]、肾小管萎缩(>1分,34.2%vs25.6%)、间质纤维化(>1分,34.2%vs 18.2%)、肾小动脉硬化(>2分,20.O%vs 8.5%)的比例差异均有统计学意义(P<0.05).而系膜细胞增生、新月体比例、间质炎症细胞浸润在两组间差异无统计学意义(P>0.05).平均随访(34.6 4±33.3)个月,老年组3年和5年累计肾生存率显著低于非老年组(74.6%1.78 100%,62.2%vs92.9%,P=0.002).结论:老年组IgA肾病患者在确诊时高血压、肾功能不全、高脂 血症的发生率较高,肾脏病理改变以慢性病变为主,肾小动脉病变明显,这可能是导致老年IgA肾病患者预后差的原因.     

西地那非治疗顽固性高血压患者疗效观察

目的 观察枸橼酸西地那非对顽固性高血压患者的临床疗效.方法 选取2013年1月至2016年10月海南医学院附属第二医院顽固性高血压住院患者52例为观察对象,采用随机、单盲、安慰剂对照的方法分为西地那非组和安慰剂组各26例,所有患者治疗8周,通过治疗前、后24 h动态血压变化评价西地那非对于顽固性高血压的疗效.结果 经过8周治疗,西地那非组患者24 h平均动脉压的降幅明显优于安慰剂组[收缩压(SBP)(-8.8±1.4)mmHg vs(1.3±1.2)mmHg;舒张压(DBP)(-5.3±3.3)mmHg vs(1.8±1.1)mmHg;平均动脉压(MBP)(-7.9±3.6)mmHg vs(0.8±0.9)mmHg],血压降幅在白昼更加明显[SBP(-6.0±4.7)mmHg vs(4.4±1.5)mmHg;DBP(-4.6±4.1)mmHg vs(0.92±2.2)mmHg;MBP(-4.8±3.9)mmHg vs(3.5±1.4)mmHg],差异均有统计学意义(P<0.05).夜间血压两组患者差异无统计学意义(P>0.05).结论 西地那非可用于顽固性高血压患者的治疗.     

高血压患者动态血压变异性与心室重构的关系研究

目的探讨高血压患者动态血压变异性与心室重构的关系。方法选取2011年4月至2013年4月武汉市第八医院治疗的高血压患者140例为高血压组,体检正常者140例为血压正常组。分别于7:00²2:00(日间)每15分钟自动测量一次血压,22:0022:00(日间)每15分钟自动测量一次血压,22:00⁷:00(夜间)每30分钟自动测量一次血压,比较两组24 h平均收缩压、24 h平均舒张压、24 h血压变异性、舒张期左心室后壁厚度(LVPWT)、舒张期室间隔厚度(IVST)、左心室舒张末期内径(LVIDd)、左心室质量指数(LVMI)。结果高血压组的24 h平均收缩压、24 h平均舒张压、收缩压标准差、舒张压标准差、LVPWT、IVST、LVIDd和LVMI均显著高于血压正常组[(131.8±14.8)mm Hg vs(124.2±15.8)mm Hg、(80.6±9.2)mm Hg vs(75.3±9.6)mm Hg、(12.3±3.1)mm Hg vs(10.2±3.2)mm Hg、(8.9±2.5)mm Hg vs(7.8±2.5)mm Hg、(10.7±3.2)mm vs(9.6±2.9)mm、(11.9±1.9)mm vs(9.2±1.9)mm、(53.1±7.4)mm vs(49.5±8.2)mm、(45.2±5.2)g/m2vs(42.1±6.4)g/m2(P<0.05)]。结论相比于正常人,高血压患者的动态血压变异性更为显著,其心室重构更加明显。     

自发性高血压大鼠的年龄及盐饮食对血压的影响

目的观察年龄和高盐摄入对自发性高血压大鼠（SHR）血压的影响。方法以不同年龄的雄性自发性高血压大鼠（SHR）为高血压动物模型,各年龄组随机分为低盐（0．5％NaCL）组和高盐饮食（4％NaCL）组,通过5周的低盐和高盐干预后,应用鼠尾血压计技术观察1O周龄、20周龄、50周龄5个周龄组SHB尾动脉收缩压,并比较各年龄组低盐和高盐SHR收缩压的变化。结果①随着SHR的年龄增加,血压也逐渐升高。20周龄sHR组血压明显高于1O周龄SHB组（167．1±8．9mmHgVS．151．0±25．6mmHg,P〈0．05）,而且50周龄较20周齿拿-sHR血压也呈升高的趋势（179．0±12．9mrnHgVS．167．1±8．9mrnHg,P〈0．05）。②与低盐组相比,高盐组血压均有不同程度的升高。1O周龄高盐组与低盐组相比,血压呈升高的趋势（147．6±12．2mmHgvs174．1±28．0,P〈0．05）;在20周龄高盐组与低盐组sHR相比,血压也呈升高的趋势（169．1±11．1V8189．2±11．1,P〈0．05）;50周龄高盐组与低盐组相比,血压有着显著的升高（175．2±9．6mmHgvs207．9±18．8mmHg,P〈0．05）。结论发现随着年龄的增长,SHR血压呈逐渐升高趋势;高盐饮食可致不同年龄的SHR血压升高,而且血压的盐敏感性随着年龄的增长而增加。     

All-trans retinoic acid in pulmonary vascular structural remodeling in rats with pulmonary hypertension induced by monocrotaline

Objective To determine whether all-trans retinoic acid (atRA) exerts an inhibitory effect on rats with pulmonary hypertension induced by monocrotaline.Methods All rats were given a single subcutaneous injection of either monocrotaline (60 mg/kg) or saline.Monocrotaline-injected rats received either atRA (30 mg· kg(-1)·day(-1)) or saline through oral-gastro intubation.On Days 7 , 14, 21, and 28 respectively after monocrotaline injection, cardiovascular cath eters were inserted to examine the mean pulmonary artery pressure of rats in eac h group.Meanwhile, the matrix metalloproteinase-1 (MMP-1) mRNA expression an d hydroxyproline content in the main pulmonary artery were determined by RT-PCR and chromometry, respectively.Results The mean pulmonary artery pressure of rats in the model group increased signific antly on day 21 and reached a peak on Day 28 compared with the control group (25 .7±4.3 mm Hg vs 15.1±1.5 mm Hg and 38.5±6.4 mm Hg vs 16.4±2.0 mm Hg, P&lt;0.01).MMP-1 mRNA overexpression was present on Day 14 (0.72 ±0.15 vs 0.39±0.08, P&lt;0.01) and was rapidly down-regulated on Day 21 and 28 compared with Day 14, but was still higher than that in the control.The hydroxyoroline content of the main pulmonary artery dropped significantly on Da y 14 (4.01±1.13 μg/mg vs 5.10±0.91 μg/mg, P&lt;0.05) and increased s ignificantly on Days 21 and 28 compared with the control.atRA inhibited the MM P-1 mRNA overexpression from Day 14 to Day 28 and reduced the hydroxyproline co ntent (5.59±0.70 μg/mg vs 7.96±1.13 μg/mg and 7.77±0.96 μg/mg vs 9.93±1.27 μg/mg, P&lt;0.01) and the mean pulmonary artery pressure compa red with the model group (19.6±3.2 mm Hg vs 25.7±4.3 mm Hg and 26.3± 4.6 mm Hg vs 38.5±6.4 mm Hg, P&lt;0.01).Conclusion atRA inhibits MMP-1 overexpression and the accumulation of collagen, which migh t elicit favorable geometric remodeling in rat pulmonary hypertension induced by monocrotaline.     

E选择素在正常高值血压患者的变化

目的探讨正常高值血压患者血浆E选择素水平变化。方法采用酶联免疫双抗体夹心法测定正常对照组（n=30）及正常高值血压组（n=60）血浆E选择素水平。结果正常高值血压组与正常对照组在性别、年龄、胆固醇、甘油三脂、空腹血糖、心率经值间比较无统计学差异（P〉0.05）;正常高值血压组与正常对照组在收缩压[（127.32±9.52）mmHg vs（116.25±8.81）mmHg]、舒张压[（77.24±8.13）mmHg vs（72.63±6.65）mmHg]均存在差异性（P〈0.05）;正常高值血压组较正常对照组存在高血浆水平E选择素[（49.32±6.91）ng/nl vs（33.12±7.82）ng/nl,P〈0.05]。结论正常高值血压患者存在高血浆水平E选择素提示血管内皮功能激活、受损。