Influence of continuous blood purification on inflammation and target organ damage in patients with severe acute pancreatitis complicated by MODS

Objective:To study the influence of continuous blood purification on inflammation and target organ damage in patients with severe acute pancreatitis accompanied by MODS.Methods: A total of 78 patients with severe acute pancreatitis complicated by MODS who were treated in our hospital between June 2012 and March 2016 were selected and divided into control group (n=39) and observation group (n=39) according to random number table. Control group were treated with routine treatment, observation group were treated with conventional treatment plus continuous blood purification, and serum inflammatory factors, liver function indexes and renal function indexes were compared between two groups of patients before and after treatment.Results: Before treatment, differences in serum levels of inflammatory factors, liver function indexes and renal function indexes were not statistically significant between two groups of patients. After treatment, serum inflammatory factors IL-6, IL-8, MCP-1 and HMGB1 levels of observation group were lower than those of control group, liver function indexes ALT, AST, TBIL and ALP levels of observation group were lower than those of control group, and renal function indexes Scr and BUN levels of observation group were lower than those of control group.Conclusion: Continuous blood purification can reduce the systemic inflammatory response as well as liver and kidney injury in patients with severe acute pancreatitis complicated by MODS.

Correlation between shock index and inflammation, oxidative stress as well as target organ damage in patients with sepsis

Objective:To study the correlation between shock index and inflammation, oxidative stress as well as target organ damage in patients with sepsis.Methods: A total of 70 patients with sepsis treated in our hospital between March 2013 and May 2016 were collected and divided into no shock group (SI<0.5) (n=11), general shock group (0.5 SI 2) (n=42) and severe shock group (SI>2.0) (n=17) according to the shock index (SI). Immediately after admission, serum levels of inflammatory factors, oxidative stress indexes and liver function indexes were detected.Results:Serum interleukin-1β (IL-1β), interleukin-8 (IL-8), tumor necrosis factor (TNF-α), advanced oxidation protein products (AOPPs), total bilirubin (TB),γ-glutamyl transpeptidase (GGT) and alanine aminotransferase (ALT) levels of severe shock group and general shock group were higher than those of no shock group while anti-inflammatory factors interleukin-10 (IL-10), interleukin-13 (IL-13), soluble tumor necrosis factor receptorⅠ(sTNF-RI), glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) and catalase (CAT) levels were lower than those of no shock group;serum IL-1β, IL-8, TNF-α, AOPPs, TB, GGT and ALT levels of severe shock group were higher than those of general shock group while IL-10, IL-13, sTNF-RI, CAT, GSH-Px and SOD levels were lower than those of general shock group.Conclusion:The higher the shock index in patients with sepsis, the more severe the inflammation, oxidative stress and target organ damage, and the two are positively correlated.

Effect of continuous blood purification on inflammatory response, immune response and target organ damage in patients with sepsis

Objective: To study the effect of continuous blood purification on inflammatory response, immune response and target organ damage in patients with sepsis. Methods: A total of 78 patients with sepsis who were treated in the hospital between January 2015 and December 2016 were collected and divided into control group and observation group according to the random number table method, 39 cases in each group. Control group received conventional therapy for sepsis, and observation group received continuous blood purification on the basis of conventional therapy. The differences in inflammatory response, immune response and target organ damage were compared between the two groups before and after treatment. Results: Before treatment, difference in serum inflammatory factor contents, peripheral blood Th17/Treg cellular immunity levels and serum myocardial injury marker contents were not statistically significant between the two groups. After treatment, serum IL-2, IL-6, PCT, CRP, NT-prBNP, CK, CK-MB, TnT and TnI contents as well as peripheral bloodTh17 and Treg cell levels and Th17/Treg proportion of both groups of patients were lower than those before treatment, and serum IL-2, IL-6, PCT, CRP, NT-prBNP, CK, CK-MB, TnT and TnI contents as well as peripheral blood Th17 and Treg cell levels and Th17/Treg proportion of observation group were lower than those of control group. Conclusion: Continuous blood purification can effectively reduce systemic inflammatory response, inhibit immune response, and reduce myocardial injury in patients with sepsis.

Association of blood pressure variability with target organ damage in older patients with essential hypertension

Background:Although multiple measures of blood pressure variability(BPV)have been proposed,whether they are better than mean blood pressure in predicting target organs is unclear.We aimed to determine the relationship between short term BPV and target organ injury.Methods:This study was a retrospective study,and 635 inpatients in the Department of Cardiology from 2015 to 2020 were selected.We divided participants into four groups on the basis of the quartiles of BPV.One-way analysis of variance was used to compare the differences between the groups,and linear regression was used to analyze the relationship between BPV and target organ damage.Results:The average age of 635 patients was 74.36±6.50 years old.Among them,354 of 627 patients had diminished renal function(56.5%),221of 604 patients had associated left ventricular hypertrophy(36.6%),and 227 of 231 patients had carotid plaque formation(98.3%).The baseline data indicated significant differences in fasting glucose,total cholesterol,low-density lipoprotein,creatinine,glomerular filtration rate,sex,calcium channel blocker use,and the rate of diminished renal function.Multiple linear regression analysis showed that BPV was negatively correlated with renal injury(creatinine:r=0.306,p<0.01;estimated glomerular filtration rate:r=0.058,p<0.01),and BPV is positively correlated with cardiac injury(r=0.083,p<0.01).Elevated BPV was not found to be associated with vascularinjury.Conclusion:Renal function decreases with increasing BPV and left ventricular mass increases with increasing BPV.

口服敌草快和百草枯中毒患者靶器官损害情况分析

目的 分析敌草快和百草枯中毒患者的靶器官损害特点,为进一步提高临床救治水平提供科学依据。方法 回顾性收集88例单纯经口服敌草快中毒患者(敌草快组)和80例百草枯中毒患者(百草枯组)的临床资料,包括年龄、性别、中毒剂量、中毒到入院时间、中毒催吐导泻情况、中毒到洗胃时间、临床表现、中毒到第一次血液灌流时间、血液灌流次数、住院天数、肝肾功能[丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、肌酐(Cr)]、凝血功能[凝血酶原时间(PT)]、白细胞计数(WBC)、肺损伤指标[氧合指数(PO2/FiO2)]、心肌损伤指标[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)]、血乳酸(Lac)、pH值及最终预后等指标。比较敌草快组和百草枯组患者的临床资料差异及不同中毒剂量死亡率与存活率及总体存活率;比较敌草快组和百草枯组死亡患者靶器官功能受损情况;比较死亡患者与存活患者敌草快和和百草枯的中毒剂量。结果 敌草快组年龄最大73岁,最小15岁;百草枯组年龄最大59岁,最小14岁;敌草快组男性34例(38.64%),女性54例(61.36%);百草枯组男37例(46.25%),女43例(53.75%);两组中毒后均以咽喉部疼痛、恶心、呕吐、上腹疼痛为主要临床表现,少部分中毒剂量少的患者可没有任何症状;百草枯组中毒剂量>50 ml的患者出现胸闷气促症状,敌草快组中毒剂量>50 ml的患者出现意识烦躁、嗜睡、谵妄甚至抽搐、昏迷等症状。两组性别、平均年龄、平均中毒剂量、平均中毒到入院时间、中毒催吐导泻率、平均中毒到洗胃时间、平均中毒到第一次血液灌流时间、平均血液灌流次数比较无明显差异(P>0.05);敌草快组的平均住院天数(4.86±1.81)d明显短于百草枯组的(7.85±1.13)d(P<0.05)。中毒剂量21~50 ml和51~100 ml时,敌草快组存活率均高于百草枯组(P<0.05);敌草快组总体存活率78.41%明显高于百草枯组的37.50%(P<0.05)。入院后第3天,敌草快组死亡患者ALT(109.26±63.88)U/L、TBIL(40.29±10.39)μmol/L、PT(12.24±1.56)s、Lac(1.54±1.09)mmol/L及WBC(13.24±3.43)×109/L均低于百草枯组死亡患者的(327.12±127.86)U/L、(68.38±48.55)μmol/L、(17.39±2.73)s、(4.53±1.54)mmol/L、(23.32±4.56)×109/L,Cr(308.44±156.87)μmol/L、PO2/FiO2(207.32±76.10)mm Hg(1 mm Hg=0.133 kPa)、CK(456.56±101.39)U/L、CK-MB(63.29±21.39)U/L、cTnI(11.56±1.31)ng/ml均高于百草枯组死亡患者的(201.93±87.01)μmol/L、(153.25±64.25)mm Hg、(50.29±21.39)U/L、(47.21±12.22)U/L、(4.29±4.21)ng/ml(P<0.05)。死亡患者敌草快和百草枯中毒剂量均明显高于存活患者(P<0.05);死亡患者敌草快中毒剂量大于百草枯(P<0.05);存活患者敌草快和百草枯中毒剂量无明显差异(P>0.05)。结论 敌草快和百草枯中毒患者的年龄以40岁以下中青年女性多见,所有口服中毒患者均出现咽痛、恶心、呕吐等消化道症状;敌草快口服中毒剂量大者会出现意识改变,包括烦躁、嗜睡、抽搐、昏迷等,而百草枯中毒剂量大者会出现胸闷气促等症状;服用同等剂量除草剂,敌草快存活率高于百草枯;敌草快以肾、心肌及神经系统损伤最为显著,且与患者预后密切相关;百草枯中毒以肺、肝和肾脏损伤为主;敌草快中毒患者总体死亡率低于百草枯中毒死亡率。

心电向量图诊断高血压早期心脏靶器官损害的临床应用及影响因素

目的探讨心电向量图(vectorcardiogram,VCG)对高血压心脏电活动异常的诊断价值,并分析早期心脏靶器官损害的影响因素。方法选取昆明市中医医院心血管病科2022年1月至2023年2月的高血压病住院患者80例,经超声心动图(ultrasound cardiogram,UCG)排外心脏结构异常。比较心电图(electrocardiogram,ECG)与VCG对异常心室除极与复极指标的检出情况。按心电向量检查结果将80例病例分为正常组(n=40)与异常组(n=40),比较2组早期心脏损害的相关影响因素指标,将差异有统计学意义的因素做二元Logistic回归分析,筛选出早期心脏损害的独立影响因素。结果VCG检出异常心室复极指标较ECG有优势(P<0.05),二者对异常除极指标的检出差异无统计学意义(P>0.05)。正常组与异常组比较,在年龄、规律服药、家族史、糖尿病、24 h平均收缩压(24 h average systolic blood pressure,24 h SBP)、白昼平均收缩压(daytime average systolic blood pressure,DSBP)、夜间平均收缩压(night average systolic blood pressure,NSBP)、血压负荷值、清晨血压、脉压差等指标上,差异有统计学意义(P<0.05)。二元Logistic回归分析显示,年龄[OR(95%CI)=0.891,0.998]、夜间平均收缩压[OR(95%CI)=1.018,2.10]、家族史[OR(95%CI)=0.029,0.499]、糖尿病[OR(95%CI)=0.042,0.916]是高血压早期心脏损害的独立影响因素。结论VCG为高血压早期心脏靶器官损害的有效检测手段。

红芪抗放化疗所致靶器官损伤作用机制及其“构-效-量”关系

目的探讨红芪抗放化疗所致靶器官损伤的“成分-靶点-通路”可能性药效机制,并基于其潜在机制验证主要活性成分的“量-效”关系。方法以TCMSP、Uniprot、Swiss Target Prediction、GeneCards、Cytoscape、Omicshare等平台进行网络药理学分析;以Autodock、Pymol和Ligplot等进行分子对接;以红芪水提取物进行动物实验验证;以HPLC法对8种主要成分进行含量测定。结果确定了红芪抗放化疗所致靶器官损伤的4种活性成分、8个关键靶点、4条重点通路;分子对接显示,芒柄花素和槲皮素同时与HSP90AA1、柚皮素与MAPK3、熊果酸与TP53具有较好的结合活性;动物实验表明,胃肠因子MTL、VIP明显升高,肝肾因子Cr、BUN、AST、ALT明显降低,IL^(-1)0升高,TNF-α明显降低;含量测定结果表明,芒柄花苷含量最高(2.8848μg·g^(-1))。结论探讨了红芪抗放化疗所致靶器官损伤保护作用的“构-效”关系,并对其活性成分的“量-效”关系进行验证。

基于血清学指标构建H型高血压患者MACE发生风险预测模型

目的探讨H型高血压患者不良心血管事件(MACE)发生的危险因素,并构建H型高血压患者MACE发生风险预测模型。方法选取2019年1月至2022年11月该院收治的375例H型高血压患者作为研究对象,根据是否发生MACE分为MACE组(41例)和非MACE组(334例)。收集两组临床资料,采用多因素Logistic回归分析H型高血压患者发生MACE的危险因素。构建H型高血压患者MACE发生风险的列线图预测模型,以C-index量化模型预测性能,并绘制校准曲线评价列线图预测模型的校准度及鉴别效度,绘制决策曲线分析列线图预测模型的临床净受益。结果MACE组高血压病程、同型半胱氨酸(Hcy)、尿酸(UA)、Toll样受体(TLR4)水平及靶器官损害数目>2个的患者比例、高血压分级为3级的患者比例、入院当日收缩压(SBP)、入院当日舒张压(DBP)、夜间平均SBP、夜间平均DBP均高于非MACE组,高分子量脂联素(HMW-ADP)水平低于非MACE组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,夜间平均SBP、Hcy、TLR4水平升高及HMW-ADP水平降低均是H型高血压患者发生MACE的危险因素(P<0.05)。列线图预测模型预测H型高血压患者MACE发生风险的C-index为0.821(95%CI:0.712~0.896)。决策曲线分析结果显示,当列线图预测模型预测值为0.75~0.80时,可提供附加临床获益。结论基于Hcy、TLR4、HMW-ADP、夜间平均SBP构建H型高血压患者MACE发生风险的列线图预测模型具有良好预测效果,适合在临床工作中推广应用。

原发性高血压患者TyG指数与血压变异性及亚临床靶器官损伤的相关性

目的:探讨原发性高血压(EH)患者甘油三酯葡萄糖(TyG)指数与血压变异性(BPV)及亚临床靶器官损伤(STOD)的相关性。方法:选取226例EH患者为研究对象,患者均佩戴动态血压监测仪,收集24 h实时血压,同时行亚临床靶器官相关检查,根据检查结果,将发生STOD归为STOD组(n=107);未发生STOD者归为NSTOD组(n=119)。采用单因素或多因素Logistic回归分析影响EH患者发生STOD的因素;Pearson相关性分析TyG指数与BPV的相关性。结果:单因素分析显示,病程、甘油三酯(TG)、空腹血糖(FBG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1C)、TyG指数、尿微量白蛋白与肌酐比值(ACR)、左心室质量指数(LVMI)、臂-踝脉搏波速度(baPWV)、24 h舒张压(SBP)标准差(24 hSSD)、日间SBP标准差(dSSD)、夜间SBP标准差(nSSD)、24 h SBP变异系数(24 hSCV)、日间SBP变异系数(dSCV)、SBP加权标准差(SBPWSD)、SBP实际变异均值(SBPARV)水平、夜间血压下降率均是影响EH发生STOD的相关因素(P<0.05);回归分析显示,TyG指数、24 hSSD、dSSD均是影响EH患者STOD发生的危险因素(P<0.05);相关性分析显示,TyG指数与BPV中24 hSSD、dSSD均呈正相关关系(P<0.05)。结论:TyG指数、BPV中24 hSSD、dSSD均是影响EH患者发生STOD的危险因素,临床上可早期监测,以早期诊断和治疗。

针刺治疗原发性高血压病作用机制的研究进展

随着针刺降压优势的逐渐显现,针刺降压机制成为研究热点。本文检索并梳理近10年来针刺治疗原发性高血压(essential hypertension,EH)的相关文献研究,总结针刺治疗EH的机制包括通过改善炎症反应、氧化应激,调控基因表达、生物因子分泌等影响以神经—内分泌—免疫三大系统为中心的多个系统,提高对靶器官的保护,降低血压。具体来说,针刺可通过调节中枢神经系统来直接影响血压,尤其是作用于下丘脑、延髓等区域;通过干预肾素—血管紧张素—醛固酮系统调控激素和酶的活性,进而影响血管收缩,改善血管内皮功能;在通过免疫系统发挥作用同时,针刺还能提高心血管的控制能力,减轻肾小球动脉硬化及间质纤维化,抑制神经细胞凋亡,从而综合降低血压。目前对于针刺降压机制研究成果颇丰,但仍存在些许不足之处,笔者认为今后研究需深入挖掘三大系统之间相关联的靶基因、靶蛋白,对针刺联合药物治疗靶器官损害相关研究量化其参数、明确药量等,以期为指导临床治疗提供更可信的实验数据和科学依据。

Association factors of target organ damage： analysis of 17 682 elderly hypertensive patients in China

Background Hypertensive target organ damage （TOD） is the main reason for mortality or disability in elderly hypertensive patients. The studies on TOD of hypertension in Asia, especially in Chinese elderly hypertensive patients, are very limited. The aim of this study was to evaluate the prevalence and correlative factors of TOD in older Chinese hypertensive inpatients. Methods This is a retrospective survey and data were collected from the computerized medical files of hypertensive inpatients from January of 1993 to December of 2008. The analysis was done on 17 682 inpatients, aged 60 years or older, with a diagnosis of essential hypertension （EH）. The evidence of hypertensive TOD and associated factors with TOD were collected. Results The prevalence of any hypertensive target organ involvement among these subjects was high. In multivariable Logistic regressions adjusted for potentially confounding factors, older age, male gender, diabetes, EH grade 3, systolic blood pressure （SBP）, and low-density lipoprotein cholesterol （LDL-C）, were independently associated with coronary artery disease. Age, duration of EH, EH grade 3, SBP, pulse pressure （PP）, and homocysteine （Hcy） were independently associated with cerebrovascular disease. Age, diabetes, duration of EH, EH grade 3, SBP, PP and estimated glomerular filtration rate （eGFR） were independently associated with chronic kidney disease. Male gender, EH grade 3 and SBP were independently associated with aortic dissection. Conclusions The prevalence of hypertensive TOD is high in older Chinese hypertensive inpatients. Various cardiovascular risk factors are associated with hypertensive TOD. The level of SBP and severe hypertension （grade 3 hypertension） are common independent risk factors of TOD.

Relationships of Inflammatory Factors and Risk Factors with Different Target Organ Damage in Essential Hypertension Patients

Background： Atherosclerosis （AS） is an inflammatory disease. Inflammation was considered to play a role in the whole process of AS. This study aimed to analyze the relationships of inflammatory factors and risk factors with different target organ damages （TOD） in essential hypertension （EH） patients and to explore its clinical significance. Methods： A total of 294 EH patients were selected and divided into four groups according to their conditions of TOD. Forty-eight healthy subjects were selected as control. The clinical biochemical parameters, serum amyloid A, serum tryptase, and lipoprotein-associated phospholipase A2 （Lp-PLA2） in each group were detected, and the related risk factors were also statistically analyzed. Results： Fihrinogen （Fbg） was the most significant independent risk factor in acute coronary syndrome （ACS） group （odds ratio [OR]： 22.242, 95% confidence interval [CI]： 6.458-76.609, P 〈 0.001） with the largest absolute value of the standardized partial regression coefficient B＇ （b＇： 1.079）. Lp-PLA2 was the most significant independent risk factor in stroke group （OR： 13.699, 95% CI： 5.236-35.837, P 〈 0.001） with b＂ 0.708. Uric acid （UA） was the most significant independent risk factor in renal damage group （OR： 15.307, 95% CI：4.022 58.250, P〈0.001）with b＇= 1.026. Conclusions： Fbg, Lp-PLA2, and UA are the strongest independent risk factors toward the occurrence of ACS, ischemic stroke, and renal damage in EH patients, thus exhibiting the greatest impacts on the occurrence ofACS, ischemic stroke, and renal damage in EH patients, respectively.

利司那肽联合贝那普利对代谢综合征患者血糖血压、肠道微生态、靶器官损害的影响

目的探讨利司那肽联合贝那普利治疗对代谢综合征患者血糖血压、肠道微生态、靶器官损害的影响。方法选取2020年6月—2022年5月126例代谢综合征,根据治疗方法的不同均分为贝那普利组、利司那肽组和联合组,分别予贝那普利、利司那肽、贝那普利联合利司那肽治疗。统计3组治疗前后血糖、血压、肠道微生态指标、靶器官损害及不良反应发生情况。结果治疗6个月后,空腹血糖、餐后2 h血糖、糖化血红蛋白联合组<利司那肽组<贝那普利组,舒张压、收缩压联合组<贝那普利组<利司那肽组(P<0.05);治疗6个月后,乳酸杆菌、双歧杆菌、酵母菌联合组高于利司那肽组、贝那普利组,肠杆菌联合组低于利司那肽组、贝那普利组(P<0.05);治疗6个月后,联合组靶器官损害总发生率低于利司那肽组、贝那普利组(P<0.05);利司那肽组、贝那普利组肠道微生态指标、靶器官损害总发生率比较差异无统计学意义(P>0.05);3组不良反应总发生率比较差异无统计学意义(P>0.05)。结论利司那肽联合贝那普利治疗有利于调节代谢综合征患者肠道微生态,降低血压、血糖,减少靶器官损害发生,且安全可靠。

高血压患者夜间血压对心脏和血管功能的影响

目的 探讨高血压患者夜间血压对以左心室整体纵向应变(global longitudinal strain,GLS)为代表的亚临床左心室收缩功能障碍和动脉硬化的影响。方法 在一项基于社区的队列研究中,回顾性收集了199例原发性高血压(高血压)患者的GLS、动态血压监测(ABPM)数据和颈-股动脉脉搏波传导速度(pulse wave velocity,PWV)。采用多元线性回归分析和Logistic回归分析评价夜间血压与心脏、血管靶器官损害的关系。结果 199例高血压患者(平均年龄62岁)包括56.3%的女性,24.1%的吸烟者。与血压正常组患者相比,单纯性夜间高血压组患者的PWV、PWV/GLS增加,GLS降低,差异均有统计学意义(P<0.05)。与血压正常组患者比较,持续性昼夜高血压组患者的PWV、PWV/GLS升高,差异均有统计学意义(P<0.05)。多因素线性回归分析结果显示,夜间血压与GLS相关,独立于24 h血压、白天血压或诊室血压。夜间收缩压与GLS呈负相关,夜间舒张压与GLS呈正相关。校正24 h血压后,夜间血压与PWV、PWV/GLS无显著相关性。多因素Logistic回归分析结果显示,夜间收缩压与异常GLS独立相关。校正24 h收缩压后,夜间收缩压与PWV没有独立相关。结论 夜间收缩压与GLS减低独立相关,与PWV、PWV/GLS不是独立相关。对于夜间高血压患者更应该关注亚临床收缩功能障碍。

高血压伴原因未明低钾血症患者临床资料及血清中炎症因子分析

目的:探讨高血压伴原因未明低钾血症患者在低钾状态下高血压过程中炎症因子的变化情况。方法:依据纳排标准,选取242例高血压伴原因未明低钾血症患者(观察组)及257例原发性高血压合并血钾正常(4.0~4.5 mmol/L)的患者(对照组)。对比分析两组患者临床资料及靶器官损害情况,应用ELISA法检测并对比两组患者(各16例)血清炎症因子(促炎因子:IL-1β、TNF-α、IL-6、IL-8;抗炎因子:TGF-β1、IL-10)的表达情况。结果:与对照组相比,观察组患者年龄更低[(50.01±13.92)岁vs(46.34±12.22)岁,P=0.002],BMI更高[(22.99±2.71)kg/m^(2)vs(26.16±3.32)kg/m^(2),P<0.001],尿微量白蛋白更高[3.01(0,10.80)mg/L vs 8.8(1.24,28.42)mg/L,P<0.001],外周动脉及靶器官损害更重(P<0.05);低钾状态下,外周血中炎症因子如IL-1β、IL-6、IL-8、TGF-β1、TNF-α表达增加(P<0.05),IL-10表达低于对照组(P<0.001)。结论:低钾状态可能诱导机体炎症因子分泌增加,炎症反应更明显,促进高血压伴原因未明低钾血症患者外周动脉硬化及靶器官损害的发生。

胸痛患者三种不同诊断标准的运动性高血压患病率和影响因素分析及其对靶器官损害的影响

目的:通过分析胸痛患者进行平板运动试验的血压数据,探讨运动性高血压在该人群中的患病率和可能的影响因素及其对靶器官损害的影响。方法:连续回顾性收集2021年6月至2022年6月在阜外华中心血管病医院行平板运动试验检查的胸痛患者的临床资料。根据国际上运动性高血压三种常见的诊断标准[美国心脏协会(AHA)标准、Dlin标准和弗雷明汉心脏研究(FHS)标准],比较运动性高血压的患病率及在不同亚组中的分布情况,并比较不同诊断标准下运动性高血压人群左心室肥厚的患病率。结果:共纳入1 254例患者,平均年龄(51.0±10.0)岁,其中女性477例(38.0%)。AHA标准、Dlin标准和FHS标准运动性高血压的患病率分别为29.2%、29.8%和11.6%。进一步分析发现,在体重指数(BMI)≥28.0 kg/m^(2)及有高血压病史的人群中三种诊断标准下的运动性高血压患病率均显著升高。多因素Logistic回归分析显示,BMI≥28.0kg/m^(2)和高血压病史与三种不同诊断标准诊断的运动性高血压都有显著的相关性(P均<0.05)。AHA标准、Dlin标准和FHS标准下运动性高血压和非运动性高血压人群的左心室肥厚患病率分别为11.5%vs. 8.0%(P=0.050)、10.7%vs.8.3%(P=0.175)和15.2%vs. 8.2%(P=0.006)。多因素Logistic回归分析显示,FHS标准下的运动性高血压不是左心室肥厚的独立影响因素(P=0.988)。结论:BMI≥28.0 kg/m^(2)和(或)有高血压病史的胸痛患者更容易发生运动性高血压,更需要警惕运动性高血压带来的危害。在评估对左心室肥厚等靶器官损害的影响时,推荐应用FHS标准诊断运动性高血压。

中医药干预NF-κB信号通路防治高血压靶器官损伤的实验研究进展

高血压是多种心血管疾病的重要危险因素之一,长期持续血压升高可导致心、脑、肾、血管等靶器官的损伤,且其患病率及致残率呈不断攀升趋势。高血压靶器官损伤过程与免疫炎症失调相关,而核因子κB(nuclear factor-κB,NF-κB)是介导炎症反应的枢纽。NF-κB信号通路是中医药防治高血压靶器官损伤的重要靶点之一。对近5年来国内外中药单体及其有效成分、复方制剂、针灸作用于NF-κB信号通路而防治高血压所致心、脑、肾及血管等靶器官损伤的实验研究进行综述,旨在为中医药防治高血压靶器官损伤提供新的理论依据与思路。

中药防治高血压靶器官损害相关信号通路的研究进展

高血压是一种常见的心血管疾病,当前我国高血压的患病率及病死率持续上升,且其并发症的致残致死率居高不下。血压持续升高可导致心、脑、肾、血管等多个靶器官损害。本文就中药防治高血压靶器官损害相关信号通路的研究进展作一综述,归纳出RhoA/ROCK、肾素-血管紧张素-醛固酮系统、内皮素-1/一氧化氮、转化生长因子β1/Smads、磷脂酰肌醇3激酶/蛋白激酶B、Toll样受体4/核转录因子κB相关6条信号通路,以期为临床诊疗高血压及其靶器官损害的进一步研究提供理论证据。

MTHFR C677T基因多态性与H型高血压及其靶器官损害的相关研究进展

H型高血压患者占原发性高血压的75%,同型半胱氨酸(Hcy)作为一种含巯基的毒性氨基酸,在H型高血压人群中,高Hcy与高血压协同对心脑肾等靶器官造成损害,严重危害患者的生命健康和生活质量,故关注H型高血压的病因,对其进行提前预防和治疗至关重要。既往对H型高血压病因的研究更多关注于吸烟、高龄、饮食等环境因素。近年来,随着科研技术水平的提高,亚甲基四氢叶酸还原酶(methylenetetrahydrofolate reductase,MTHFR)基因尤其是C677T位点成为人们研究的热点。MTHFR作为Hcy代谢的关键酶,其基因突变与H型高血压的发病及靶器官的损害有着密不可分的关系。但由于基因的分布具有地区与种族的差异性,故其同一疾病在不同地区与种族的相关性研究结果可能不一致。现将MTHFR C677T基因多态性与H型高血压及其靶器官损害的相关性研究进展进行综述。

原发性高血压患者心脏靶器官损害的心电图特点

目的探讨原发性高血压患者心脏靶器官损害的心电图改变特点,定性定量分析不同血压水平下各指标改变的意义。方法回顾性分析2021年10月至2022年11月在郑州大学第二附属医院门诊、住院及体检确诊为原发性高血压,且均行常规心电图、动态血压检查的159例患者的临床资料。依据动态血压检查结果,按照全天收缩压/舒张压均值水平分为A、B、C 3个亚组,采用方差分析和χ2检验比较不同组间心电图改变,总结原发性高血压患者心脏靶器官损害的心电图特点。结果原发性高血压患者心电图异常率高(93.1%),主要表现为心房波/心室波异常(73.0%)、ST-T改变(55.3%)、心律失常(20.8%)。原发性高血压患者心电图异常有性别差异,男性多表现心房波/心室波异常,而女性多表现ST-T改变。原发性高血压患者不同血压水平亚组之间,心房波/心室波异常差异有统计学意义(P<0.05),而年龄、ST-T改变、心律失常差异无统计学意义(P>0.05)。原发性高血压患者不同血压水平亚组之间,心房波/心室波异常、ST-T改变、心律失常各指标定性分析中差异无统计学意义(P>0.05),表现为P波时限≥120 ms,Macrua指数>1.6,ST段水平型压低,T波低平、倒置发生率占比大。原发性高血压患者不同血压水平亚组之间,心房波/心室波异常、ST-T改变、心律失常各指标定量分析中,ST段水平型压低和T波倒置程度随血压水平升高而加重,差异有统计学意义(P<0.05)。结论原发性高血压患者靶器官损害心脏电学异常发生率高,应用心电图检查可定性、定量分析不同血压水平对心脏靶器官损害的程度。