降脂治疗对老年原发性高血压患者胰岛素抵抗的影响

目的：探讨老年原发性高血压伴高胆固醇血症者行降脂治疗对其胰岛素抵抗（IR）的影响。方法：73例老年原发性高血压伴高胆固醇血症者随机分为治疗组（37例）及对照组（36例）,在行低脂饮食及抗高血压治疗同时观察治疗组用辛伐他丁（5～10mg/d）前及4个月后的血脂、高腹血糖、胰岛素和肝、肾功能的变化。结果：治疗组降脂治疗后血胆固醇下降12．7％,甘油三酯下降9．5％,低密度脂蛋大醇下降11．9％,高密度脂蛋白胆固醇上升了9．0％,胰岛素敏感指数（ISI）显著提高（P＜0．05）;而对照组血脂水平虽有下降,但无显著性意义,ISI亦无明显变化。结论：老年原发性高血压伴高胆固醇血症者用辛伐他丁治疗不仅可降脂,同时可显著改善基胰岛素抵抗。     

阿托伐他汀对原发性高血压患者血压及内源性纤溶活性的影响

目的　通过对阿托伐他汀调脂同时对原发性高血压 (EH)患者血压及内源性纤溶活性影响的观察 ,探讨其非调脂作用。方法　观察 4 2例 1级原发性高血压患者 ,口服阿托伐他汀 10mg ,2 /d ,8周 ,分别对患者治疗前及治疗后进行血压、血清总胆固醇 (TC)、甘油三酯 (TG)、低密度脂蛋白胆固醇 (LDL -C)、高密度脂蛋白胆固醇 (HDL -C)、分泌组织性纤溶酶原激活因子 (t-PA)和纤溶酶原激活抑制因子 (PAI - 1)检测。结果　与正常对照组比较 ,EH组治疗 8周后收缩压均有显著降低 (P <0 .0 5 ) ,t-PA活性明显升高 (P <0 .0 1) ,PAI - 1活性明显降低 (P <0 .0 5 ) ,EH并血脂紊乱 (EHA)组治疗后TC、TG、LDL -C较治疗前均显著降低 (P <0 .0 1) ,HDL -C明显升高 (P <0 .0 5 )。结论　阿托伐他汀在有效调脂同时可发挥其非调脂作用 ,能降低EH患者血压及改善内源性纤溶活性     

早期应用阿托伐他汀对不稳定型心绞痛冠状动脉血流储备的影响

目的 :研究早期应用阿托伐他汀治疗不稳定型心绞痛 (UAP)伴高胆固醇血症患者冠状动脉 (冠脉 )血流储备 (CFR)的影响。方法 :将 40例UAP伴高胆固醇血症患者随机均分为治疗组和对照组 ,用经胸彩色多普勒冠脉血流显像技术检测CFR ,比较治疗前后血脂及CFR的变化。结果 :阿托伐他汀治疗 3个月后血清总胆固醇(TC)、低密度脂蛋白胆固醇 (LDL C)、三酰甘油 (TG)均明显降低 (P <0 .0 1 ) ,CFR由治疗前 1 .92± 0 .41升至 2 .97±0 .62 ( P<0 .0 1 )。对照组治疗前后血脂及CFR变化差异无统计学意义 ;TC及LDL C与CFR呈负相关 ( r=-0 .44及 -0 .47,P <0 .0 5 )。结论 :阿托伐他汀调脂治疗可以改善UAP患者的冠脉微循环 ,提高CFR。     

阿托伐他汀对老年原发性高血压患者血管内皮功能的影响

目的探讨阿托伐他汀对老年原发性高血压患者血管内皮功能的影响.方法观察40例老年原发性高血压患者(治疗组)经阿托伐他汀每日1次10 mg治疗8周后,血脂、血浆内皮素(ET)水平的变化,并用超声检测肱动脉血管内皮依赖性舒张功能(EDD)的变化.选择15例健康老年人(对照组)做为对照.结果治疗组血浆ET水平明显高于对照组,血管内皮依赖性舒张功能受损,治疗后ET血浆水平明显下降(P＜0.01),EDD明显改善(P＜0.01),且ET和EDD改善与LDL-C下降程度无相关性.结论阿托伐他汀可以改善老年原发性高血压患者血管内皮的功能,且独立于降脂作用之外.     

普伐他丁治疗高胆固醇血症的临床观察

观察国产普伐他丁对原发性高胆固醇血症患者（n=61）的调脂疗效，结果表明普伐他丁治疗8周可使血清总胆固醇（TC）水平及低密度脂蛋白胆固醇（LDLc）分别下降24％和32％。降TC总有效率为85.2％，轻度降低甘油三酯，但对高密度脂蛋白胆固醇（HDLc)影响不明显。国产普伐他丁调脂疗效与日本产普伐他丁相似。     

高血压伴高甘油三酯血症调脂和降压治疗效果观察

目的观察调脂治疗和联合降压对高血压的影响。方法将97例伴高甘油三酯血症的高血压患者,分为联合调脂治疗组和联合降压组,调脂治疗8周,观察治疗前后血压及血脂变化。结果治疗后两组患者血压水平平均显著下降,两组间无显著差异。用非诺贝特治疗的调脂治疗组甘油三酯治疗前后下降有显著差异。结论调脂治疗对血压有重要影响,合并甘油三酯血症的经一联降压药不能控制高血压患者,优先选择调脂治疗。     

阿托伐他汀对动脉粥样硬化及血脂的临床价值探讨

目的　探讨阿托伐他汀对动脉粥样硬化及血脂的临床影响。方法　选择 82名高胆固醇血症患者口服阿托伐他汀片 2 0mg ,每日一次 ,疗程 12个月。治疗前及治疗后 3个月、6个月、12个月分别检查血脂、血内皮素 (ET)及颈动脉内膜中层厚度 (CIMT) ,同时观察不良反应发生的情况。结果　阿托伐他汀治疗 3个月、6个月、12个月后TC、TG及LDL_C下降 (P <0 0 1) ,HDL_C上升 ( 3个月P <0 0 5 ,6个月P <0 0 1) ,阿托伐他汀治疗 12个月后血内皮素下降 (P <0 0 5 ) ,CIMT下降 (P <0 0 5 )。结论　根据临床观察 ,用阿托伐他汀治疗能有效降低血中TC、TG及LDL_C的浓度 ,提高血中HDL_C浓度 ,改善内皮细胞的功能 ,延缓及降低颈动脉硬化进程     

部队干休所老年冠心病患者二级预防情况调查

目的调查北京地区部队干休所老年冠心病患者二级预防情况。方法采用横断面调查方式,入选干休所老年冠心病患者249例。采集患者合并高血压、高脂血症及降压、调脂、抗血小板用药情况。采用电子血压计检测患者血压水平,采用酶法测定血清总胆固醇(TC)、三酰甘油(TG)以及低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)。分析患者血压、血脂达标及用药情况。结果 249例老年冠心病患者平均年龄(84.4±3.33)岁。89.2%的患者合并高血压,97.7%的患者血压达标,其中94.6%的患者服用了降压药物。93.4%的患者TC达标,边缘升高5.6%;94.0%的患者LDL-C达标,边缘升高4.8%,高LDL-C血症患者1.2%;76.7%的患者TG达标,边缘升高13.7%,高TG血症患者9.6%;38.5%的患者HDL-C正常,低HDL-C血症患者23.7%,高HDL-C血症患者37.8%。4.0%的患者表现为单项血脂指标异常;24.3%的患者表现为两项血脂指标异常;89.6%的患者服用了调脂药物。85.5%的患者服用了抗血小板药物,其中73.2%的患者服用阿司匹林,19.2%的患者服用波利维。结论部队干休所老年冠心病患者合并高血压的比例高,患者药物依从性好,血压达标率高;血脂指标控制较好,高胆固醇血症发生率低;抗血小板药物使用率较高。     

民航飞行人员同型半胱氨酸与高血压病的关系及其与血脂的相关性

目的 分析同型半胱氨酸（homocysteine，Hcy）与原发性高血压（高血压病）的关系及其Hcy与血脂的相关性。 方法 28例健康体检者为对照组，38例高血压病患者为高血压病组，高血压病组又分为调脂组20例和未调脂组18例。分别测定各组受试对象血浆Hcy及血脂指标。 结果 与对照组比较，高血压组Hcy水平显著升高（P<0.01）；与未调脂组比较，调脂组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B(ApoB)显著降低（P <0.01），但Hcy水平下降不显著；Pearson相关性分析显示:调脂组Hcy与三项血脂指标TC、LDL-C、ApoB均无相关性。 结论 高Hcy血症（HHcy）是民航飞行员高血压患者的危险因素；Hcy与TC、LDL-C水平无相关性，调脂治疗并不能够改善血浆Hcy水平。     

瑞舒伐他汀与辛伐他汀治疗老年冠心病伴高胆固醇血症患者的效果

目的评价瑞舒伐他汀与辛伐他汀治疗老年冠心病伴高胆固醇血症患者的临床效果。方法总结90例老年冠心病伴高胆固醇血症患者的临床资料,将其均分两组,对照组45例采用辛伐他汀治疗,观察组45例则选择采用瑞舒伐他汀治疗,对比不同用药疗效。结果治疗后两组LDL-C、TC水平均有下降,且观察组下降优于对照组(P0.05),而两组患者治疗前后的HDL-C、TG水平则无明显差异,不良反应对比无差异(P0.05)。结论相较于辛伐他汀,瑞舒伐他汀用药治疗老年冠心病伴高胆固醇血症改善血脂水平效果显著,且安全可靠。     

肌氨肽苷对冠心病患者血管内皮功能的影响及其与血小板功能的关系

目的　评价肌氨肽苷注射液对冠心病患者血管内皮功能及血小板功能的影响及二者之间的相互关系。方法　将 14 6例冠心病患者分为肌氨酞苷治疗组与常规治疗组 ,各组又分别分为急性心肌梗死 (AMI)、陈旧性心肌梗死 (OMI)、不稳定型心绞痛 (UA)及稳定型心绞痛 (SA) 4个亚组。对照组 2 0例。分别测定各组治疗前后的血浆内皮素 (ET)、一氧化氮 (NO)及血小板最大聚集率 (PAGTmax)、血栓素B2 (TXB2 )的变化。结果　 1.治疗前 ,各AMI组与UA组的血浆ET、PAGTmax及TXB2 较对照组显著增高 ,NO与对照组比较显著降低 ;OMI及SA组各参数均无显著性差异。 2 .肌氨肽苷治疗后AMI组与UA组的血浆ET、PAGTmax及TXB2 较治疗前显著降低 ,NO呈显著性增高(P <0 .0 5 ,P <0 .0 1) ,与对照组比较差异无显著性 (P >0 .0 5 ) ;ET下降值分别与PAGTmax、TXB2 的变化呈显著性正相关关系。而常规治疗组治疗后各值与治疗前比较虽有变化 ,但均无显著性差异。结论　肌氨肽苷注射液可通过降低血浆ET水平和增加NO浓度来改善血管内皮功能及进一步发挥抑制血小板聚集及血栓形成的作用     

氨氯地平抗兔动脉粥样硬化的实验研究

目的　观察氨氯地平的抗动脉粥样硬化 (AS)效应并探讨其机制。方法　将 32只大耳白兔随机分为 :对照组、模型组、硝苯地平治疗组、氨氯地平治疗组 ,每组 8只兔分别给予普通饲料、高脂饲料、高脂饲料 +硝苯地平、高脂饲料 +氨氯地平喂养 6 0d ,试验前、中、后测定血浆和红细胞的脂质、脂质过氧化物、红细胞膜流动性 (M Flu)、血浆内皮素 (ET)、全血血小板活化因子 (PAF)以及血小板聚集率 (PAR)水平 ,实验后取心脏、主动脉、肝脏作组织生化和病理学检查。结果　氨氯地平与硝苯地平作用类似 ,可降低血中ET、PAF水平 ,升高高密度脂蛋白胆固醇 (HDL C)水平 ,减少肝脏、主动脉以及红细胞膜胆固醇含量 ,抑制血液和组织的脂质过氧化损伤 ,保护血管内皮细胞和红细胞的功能 ,调整血管平滑肌细胞的表型并抑制其增殖 ,降低血小板聚集活性。结论　氨氯地平和硝苯地平具有显著的抗动脉粥样硬化作用。     

Effects of synvinolin on platelet aggregation and thromboxane B2 synthesis in type IIa hypercholesterolemic patients

An increased susceptibility of platelets to aggregation induced by various agents and a higher production of active arachidonate metabolism have been described in type IIa hypercholesterolemia. This study was designed to evaluate whether changes in platelet function could be observed in hypercholesterolemic patients after synvinolin therapy. Administration of synvinolin to 12 type IIa hypercholesterolemic patients for 24 weeks had a lipid lowering effect and resulted in a marked reduction of platelet aggregation and thromboxane formation induced by collagen and arachidonate. Maximum response was achieved at 4-8 weeks and lipid lowering effects at 2 weeks. This finding indicates that platelet changes cannot be explained by a direct effect of synvinolin on platelets, and the antiplatelet response may therefore depend on platelet membrane lipid composition changes, particularly in the platelet cholesterol content of platelet membranes, following substantial reductions of total plasma cholesterol and LDL-cholesterol.     

Effects of simvastatin on lipid levels and platelet activation in elderly patients with hypercholesterolemia

Background and Objective To investigate the effects of simvastatin on lipid lowering therapy and platelet activation in elderly patients with hypercholesterolemia. Methods Fasting serum lipids, CD63, CD41a, serum glucose, hepatic and renal function, routine urine analysis (UA) were measured in 50 healthy subjects, and in 50 elderly patients with hypercholesterolemia before and after 4 weeks treatment with simvastatin (20mg daily for 4 weeks). Results 1. After simvastatin treatment for 4 weeks, the fasting serum level of lipids in elderly patients with hypercholesterolemia was significantly lower than before treatment (P<0.01). 2. CD63 and CD41a were decreased after treatment compared with before, respectively (1.36 0.34) vs (4.26 1.06), (P<0.01) and (123.54 19.73) vs (253.78 16.75), (P<0.01). 3. Changes in serum lipid level tended to be positively correlated with the declines in CD63 and CD41a, but there was no statistical significance (P>0.05). Conclusions The results suggested that lipid lowering therapy with simvastatin inhibit platelet activity.(J Geriatr Cardiol 2007;4:215-217.)     

阻塞性睡眠呼吸暂停患者心脑血管血栓性疾病高危因素的观察

目的　观察阻塞性睡眠呼吸暂停综合征 (OSAS)患者血管内血栓形成的高危因素。方法　选择 2 4例中或重度OSAS患者 (实验组 )以及 19例正常成人 (对照组 ) ,分别于晨起 6时及午后 4时检测红细胞压积 (Hct)、血小板聚集率 (PAG)、血液粘滞度 (WBV)、凝血酶原时间 (PT) ,部分凝血活酶时间 (APTT)、血浆纤维蛋白原 (Fng)及内皮素。结果　OSAS组 6∶0 0AM .与 4∶0 0PM比 ,Hct、WBV、血浆Fng及PAG均明显增高 (P均〈0 .0 5 ) ,PT及APTT缩短 (P均〈0 .0 5 )。对照组各项指标 6∶0 0AM .与 4∶0 0PM比无明显差异 (P >0 .0 5 )。实验组与对照组 6∶0 0AM .比 ,Hct、WBV、PAG、血浆Fng及内皮素水平均明显升高 (P〈0 .0 5 ) ,而PT及APTT明显缩短 (P〈0 .0 5 )。实验组与对照组在 4∶0 0PM时比 ,Hct、PAG及内皮素水平亦明显升高 (P〈0 .0 5 ) ,PT及APTT显著延长 (P〈0 .0 5 )。结论　OSAS存在显著的血栓栓塞高危因素 ,且清晨较午后更为明显。     

厄贝沙坦对老年高血压患者内皮素及心钠素的影响

目的:探讨厄贝沙坦对老年高血压患者血浆内皮素(ET)及心钠素(ANP)的影响。方法:随机开放选择,采用放射免疫法测定37例老年高血压患者服用厄贝沙坦前、后ET及ANP水平的变化。结果:与对照组比较,高血压组患者ET、ANP水平明显升高(P<0.01),厄贝沙坦治疗后ET、ANP水平显著降低(P<0.01)。结论:高血压患者血浆ET、及ANP水平明显升高,厄贝沙坦对老年高血压患者不但有较好的降压作用,还能够降低ET及ANP水平,可能有较好的血管内皮保护功能。     

Nitric oxide-dependent inhibition of platelet aggregation in elderly patients with hypercholesterolemia

Hypercholesterolemia reduces production of nitric oxide (NO), a potent inhibitor of platelet aggregation, in endothelial cells. Recently platelet has been found to have NO synthase. Hypercholesterolemia may influence platelet NO production. We investigated NO-dependent inhibition of platelet aggregation in elderly hypercholesterolemic patients with total cholesterol (Tchol) of 240 mg/dl or more (n = 21). In elderly controls with Tchol less than 240 mg/dl (n = 61), L-arginine (5-50 mM) inhibited ADP-induced platelet aggregation in a dose-dependent manner (42.4% inhibition at 50 mM). However, L-arginine did not inhibit platelet aggregation in elderly hypercholesterolemic patients. L-arginine increased cyclic GMP production in elderly controls, but not in hypercholesterolemic patients (p < 0.02). Hypercholesterolemic patients showed increased platelet aggregation compared with elderly controls(p = 0.018). L-nitro-arginine methyl ester 12.5-50 uM increased platelet aggregation in both groups. Superoxide dismutase improved L-arginine inhibition of platelet aggregation in elderly hypercholesterolemic patients (p = 0.02). LDL cholesterol of 160 mg/dl or more was an independent predictor for loss of L-arginine inhibition of platelet aggregation (relative risk 3.9, p = 0.0098). This result suggests that hypercholesterolemia causes decreased NO-dependent inhibition of platelet aggregation due to reduced NO utilization. NO-dependent platelet aggregation may be a powerful tool for detection of vascular injury.     

Effect of combination therapy of benidipine hydrochloride and candesartan cilexetil on serum lipid metabolism and blood pressure in elderly hypertensive patients with type 2 diabetes mellitus

The effects of combination therapy of angiotensin II receptor blockers (ARBs) and a calcium antagonist, benidipine hydrochloride, on glucose and lipid metabolism and pulse pressure were studied in elderly hypertensive patients with type 2 diabetes mellitus. Twenty-five hypertensive diabetic patients aged 65 years or older, who had been receiving candesartan cilexetil, were administered benidipine hydrochloride (4 mg/day) and followed for 4 months. After 4 months, systolic and diastolic blood pressure decreased significantly from 154/91 mmHg to 139/78 mmHg (p<0.01 versus before benidipine hydrochloride administration). Body mass index (BMI) and glycosylated hemoglobin (HbA1c) were apparently reduced but the changes were not statistically significant. The serum lipid profile showed no significant changes in serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). Serum lipoprotein lipase mass levels (preheparin LPL mass) increased significantly from 51 to 59 ng/dl (p<0.01 versus before benidipine hydrochloride administration), and the LDL/HDL motility ratio calculated from PAG disc electrophoresis decreased significantly (p<0.05 versus before benidipine hydrochloride administration). When patients were divided into a systolic hypertension group (systolic blood pressure > or =140 mmHg and diastolic blood pressure <90 mmHg) and non-systolic hypertension group (others), preheparin LPL mass was significantly lower in the systolic hypertension group, and the decrease in pulse pressure and increase in preheparin LPL mass were significantly greater in the systolic hypertension group. Stepwise regression analysis showed that low preheparin LPL mass at baseline was associated with a decrease in pulse pressure. Add-on benidipine hydrochloride therapy in elderly hypertensive patients with type 2 diabetes mellitus significantly decreases the LDL/HDL motility ratio and pulse pressure, and significantly increases preheparin LPL mass, in addition to improving blood pressure control. These findings suggest that combination therapy with benidipine hydrochloride and candesartan cilexetil may contribute to the suppression of arteriosclerosis and may be useful for elderly hypertensive patients with diabetes mellitus.     

雌-孕激素替代治疗对绝经后妇女血脂和脂蛋白代谢的长期作用

目的　观察雌 孕激素替代治疗 (HRT)对绝经后妇女血脂和脂蛋白代谢的长期作用。方法　 193例健康绝经后妇女分为A组 (高胆固醇血症组 ) 6 3例、B组 (无高胆固醇血症组 ) 6 0例和C组 (对照组 ) 70例 ,A、B组均给予倍美力 (天然结合型雌激素 ) 0 .6 2 5mg d +安宫黄体酮 2mg d治疗 ,连续 3年监测血清性激素、血脂及脂蛋白水平。结果A组总胆固醇 (TC) ,低密度脂蛋白胆固醇 (LDL C)水平分别下降 12 .1% (P <0 .0 1)、15 .7% (P <0 .0 1) ,B组LDL C下降 4 .5 % (P <0 .0 5 ) ,A、B组高密度脂蛋白胆固醇 (HDL C)水平均明显升高 ,分别为 15 .1% (P <0 .0 1)、2 5 .8% (P <0 .0 1) ,均在第 3个月就出现明显改变 ,并在服药期间可保持疗效 ,对照组则变化不明显。B组TC有下降趋势 ,各组甘油三酯 (TG)均有增高趋势 ,但差异均无显著性意义。A、B组血清 17 β雌二醇 (17 βE2 )和孕酮于第 3个月显著升高 ,血清卵泡刺激素、黄体生成素水平则于第 6个月明显下降 ,并在服药期间可保持疗效 ,而对照组变化不明显。结论　绝经后妇女HRT能改善血清TC、TG、LDL水平 ,并在服药期间可保持疗效 ,对具有高胆固醇血症者效果更佳     

氟伐他汀治疗冠心病的可能机制探讨

目的 观察氟伐他汀的降脂效果并探讨其治疗冠心病的可能机制。方法 对30例合并高胆固醇血症的冠心病患者给予氟伐他汀40mg/每晚治疗,分别于服药前4周、服药后0、6、12周取血测定一氧化氮(NO)、6-酮-前列腺素Flα(6-K-PGFlα)、C-反应蛋白(CRP)及总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)水平。结果 服药12周末血TC、LDL-C和HDL-C变化分别为:-20.9%、-25.6%和+8.3%;血中NO和6-K-PGFlα较治疗前明显升高(P<0.05),CRP明显降低(P<0.05)。结论 氟伐他汀在调节血脂的同时,尚有保护血管内皮、抑制炎症反应和减少血小板聚集作用。