Sex Hormones Affect Aging Process by Influencing Lipid Profiles, Cellular Immunological Function and Lipid Peroxides and Oxidation System

Objectives To investigate the correlation between sex hormones(SH) and aging. Methods Through epidemiological investigation in our country, the levels of SH were measured by radioimmunoassy; lipid profile, glucose and apolipoprotein by automatic biochemic analytical instrument; T cell subsets by flow cytometer; and MDA, SOD were evaluated by the thiobarbituric acid (TBA) test and the nitrite method modified by Oyanagui respectively using spectrophotometry. Results In men, the serum levels of follicle stimulating hormone ( FSH)、luteinizing hormone(LH) increased significantly with aging, but serum prolactin(PRL) and progesterone(P) levels remained unchanged in all life; Both testosterone (T) and free testosterone (FT) all decreased greatly with aging, but 17β - estradiol( 17β - E_2) was reverse ; E_2 was negatively correlated with T and E_2/T increased with aging. The level of serum total cholesterol (TC) increased with aging, but triglycerides (TG) remain unchanged; compared with young group, high - density lipoprotein cholesterol ( HDL - C) ; HDL - C/TC of other groups decreased significantly, but low - density lipoprotein cholesterol ( LDL - C ) changed inversely; HDL- C/LDL- C reduced slightly with aging and showed no difference between groups. Apolipoprotein A1 (apoA1) and apoB all enhanced greatly with aging; meanwhile the ratio of apoA1/apoB decreased. The concentration of serum glucose (GLU) was unchanged in all life. To compare with those in the young group, CD3 + , CD4 + in other groups reduced greatly, CD4 + remained unchanged. Meanwhile, CD8 + increased significantly with aging. Compared with the young group, serum malondialdehyde(MDA) value of the old ones increased obviously, but the activity of superoxide dismutase(SOD) was reverse. By partial correlation analysis (controlling BMI, FSH, LH and PRL), TC、 LDL-C、apoA1、apoB、CD8 + 、MDA of men all presented a positive correlation with E_2/T respectively, their correlation coefficients (γ) were 0. 262、0. 136、 0. 532、0. 379、0. 394、0. 234 (P < 0. 001 ) ; HDL - C、 HDL- C/TC、HDL- C/LDL- C、CD3 + 、CD4 +/CD8 + 、SOD showed a negatively correlation with E_2/T respectively, γequaled - 0.563、- 0.332、- 0.654、- 0.1530、-0.4140、-0.236(P<0.001). In women, the serum concentrations of FSH、LH increased significantly after menopause; PRL increased little with aging; compared with young group, E_2 and P in postmenopausal groups reduced obviously, E_2/P revealed significant reduce with aging. T enhanced significantly after menopause, but nor did FT. E_2, P and the ratio of E_2/P were negatively correlated with age respectively by bivariate correlation analysis, and a positive relation between T and age. After 70 years old, the level of TC increased obviously, and so did that of TG after menopause; HDL decreased with aging, but LDL increased after 70, with the result that the ratios of HDL- C/TC and HDL- C/LDL- C all reduced with aging; apoA1 decreased gently after 70, but apoB increased signifi- cantly after menopause; correspondingly, the ratio of apoA1/apoB declined obviously. The concentration of GLU increased with aging. CD3 + and CD4 + didn't change until 60, but reduced after 60. Compared with the young groups, CD8 + remained unchanged, CD4 +/CD8 + reduced greatly with aging, CD4 + and CD8 + presented a negatively correlation with age respectively. The value of MDA in serum of women increased notably after 70 years old, but SOD activity already decreased significantly from 60. By partial correlation analysis (controlling BMI, FSH, LH and PRL), HDL-C、CD4 +、CD4 +/CD8 + showed a certain correlation with E_2/P respectively; γ were 0. 245、 0.157、0. 154 ( P <0.05 ) ; TG、 LDL、 apoB、 apoA1/ apoB、SOD presented a negatively correlation with E_2/P respectively, γ were 0. 452、 0. 236、 0.321、 0. 135、 0.156、0.154、0.426 ( P < 0.05 ). Conclusions The Disequilibrium of SH had correlations with lipid profile, cellular immunological function and lipid peroxides and oxidation system; these suggested SH took an important role in the process of aging.

“特发性”左心室功能不全成年患者心肌中病毒基因组或多病毒感染的发生率高

Background For a long time, enteroviruses have been considered to be the most common cause of acute viral myocarditis(MC), with possible transition from MC to dilated cardiomyopathy(DCM). Recent investigations have shown, however, that other viruses are also frequently encountered in MC patients, suggesting that persistence of various virus species may play a pathogenic role in the transition from MC to DCM. The purpose of this study was to screen endomyocardial biopsies(EMBs) from patients with “ idiopathic” DCM for the presence of viral genomes by using polymerase chain reaction(PCR) to assess the frequency of cardiac viral infections that may be involved in the pathogenesis of the disease. Methods and Results EMBs were obtained for PCR analysis from 245 consecutive patients(median left ventricular ejection fraction, 35.0% ; range, 9% to 59% ). PCR and reverse transcription- PCR were performed to detect the genomic sequences of enterovirus(EV), adenovirus(ADV), human cytomegalovirus(HCMV), herpes simplex virus, Epstein- Barr virus(EBV), human herpesvirus 6(HHV- 6), parvovirus B19(PVB19), and influenza A and B viruses. Myocardial inflammation was assessed by histological and immunohistological analyses. Viral genomes could be amplified from EMBs of 165(67.4% ) of the 245 DCM patients: EV=23(9.4% ), ADV=4(1.6% ), PVB19=126(51.4% ), HHV- 6=53(21.6% ), EBV=5(2.0% ), HCMV=2(0.8% ), including n=45 cases(27.3% ) with multiple infections. Active or borderline myocarditis according to the Dallas classification did not exist in any case. Lymphocyte and macrophage infiltrates were not significantly different in virus- positive versus virus- negative patients. Conclusions Viral genomes were frequently detected in EMB of patients with systolic left ventricular dysfunction. Our data suggest that myocardial persistence of various viruses, often presenting as multiple infections, may play a role in the pathogenesis of DCM far more frequently than suspected so far.

孤立性左室舒张功能障碍患者心脏细小病毒B19感染率较高

Background The etiology of left ventricular(LV) isolated diastolic dysfunction often remains unclear. In the present study, we report a strong association between parvovirus B19(PVB19) genomes and isolated LV diastolic dysfunction. Methods and Results In 70 patients(mean± SD age, 43± 11 years) admitted with exertional dyspnea and/or reduced exercise tolerance despite preserved LV systolic contractility(ejection fraction=68% ), isolated diastolic dysfunction was clinically suspected. Patients with classic risk factors for diastolic dysfunction such as hypertension, coronary heart disease, diabetes mellitus, or pulmonary disease had been excluded. Diastolic function was assessed by echocardiography and LV and RV catheterization. Endomyocardial biopsies(EMBs) were analyzed for the presence of storage or infiltrative diseases or myocarditis, including molecular screening for cardiotropic virus genomes. In a substudy of 24 patients who reported atypical angina, coronary endothelial function was additionally investigated with a coronary Doppler flow- wire technique. In 37 of 70 patients(53% ), isolated diastolic dysfunction was confirmed as the cause of their clinical symptoms. No evidence for cardiac storage or infiltrative diseases was found in these cases, but in 35 of 37 of these patients(95% ), cardiotropic virus genomes were detected in EMBs(P< 0.001). PVB19 was the most frequent pathogen in 31 of 37 patients(84% ). In a subgroup of 10 patients with diastolic dysfunction and coexisting endothelial dysfunction, all 10(100% ) were PVB19 positive. Conclusions PVB19 genomes were predominant in patients with unexplained, isolated diastolic dysfunction. A strong association with the incidence of endothelial dysfunction was obvious, consistent with the hypothesis that PVB19- induced endothelial dysfunction may be a possible pathomechanism underlying diastolic dysfunction.

急性冠状动脉综合征的正常血管造影结果-血管造影前风险分层、血管造影结果和随访观察

Background: Coronary angiographies performed during acute coronary syndrome show different coronary morphologies-vessel occlusions, thrombi and various types of stenoses. In a few cases of acute coronary syndrome, angiography reveals normal coronary arteries. It is the purpose of this study to analyze this specific subset of patients who presented with an acute coronary syndrome but had a normal coronary angiogram with respect to the preangiographic diagnostics, risk stratification and clinical follow-up. Methods and results: A total of 897 coronary angiographies were performed as an emergency procedure in our institution. The majority of patients(n=821) presented with coronary artery disease and the majority was treated by mechanical revascularization(86.3%). In 76 patients(8.5%), no coronary artery stenosis was documented. However, according to the preangiographic risk stratification, coronary artery disease was expected in these patients. Observations documented angiographically included coronary spasms(6.6%) and muscle bridges(5.3%). During a mean follow-up of 11.2±6.4 months, one patient developed an acute myocardial infarction requiring coronary intervention. All other patients were free of any cardiac event. Conclusions: In summary, we have to consider that coronary angiography may not always detect the cause of myocardial ischemia in every patient. There is a small group of patients with normal coronary angiograms during acute coronary syndrome. Additional diagnostic procedures like intravascular ultrasound(IVUS) or the assessment of intracoronary physiological parameters may increase the diagnostic value of angiography.

儿童原发性肺动脉高压较成人有不同遗传背景

染色体2q33的骨形态遗传蛋白受体Ⅱ(BMPR2)基因突变可导致家族性原发性肺动脉高压(PPH),并在26%的成年突发性疾病患者中发生。其他疾病相关性基因局限在染色体2q31(PPH2)和12q13(ALK1)。

外观健康的癌症生存者的运动能力

Aims: To evaluate cardiopulmonary exercise tolerance in a large cohort of appa rently healthy paediatric cancer survivors in order to determine their participa tion in sporting activities. Methods: A total of 84 young (< 21 years) asy- mptomatic childhood cancer survivors, who had been exposed to anthracyclines ( mean dose 212 mg/m2) and/or chest irradiation (median dose 2000 cGy), with norma l left ventricular systolic function at rest (fractional shortening > 29%), and 79 healthy controls were studied. Exercise testing was performed on a treadmill ergometer. Gas exchange analysis and derived variables were measured on a breat h-by-breath basis. Pulmonary functional evaluation was performed before exerci se. Echocardiographic evaluation at rest was performed within one month before t he exercise test. Results: There were no differences in exercise responses betwe en patients and controls. In boys < 13 years, mean VO2 max was slightly but sign ificantly lower than in controls. This finding was thought to be a result of dec reased physical fitness as all the other exercise parameters were similar to those in the controls. Conclusions: Results show that apparently healthy survivors of paediatric cancer can take part in dynamic sporting activities if they exhibi t a normal response to cardiopulmonary exercise testing, while those that exhibi t a reduced VO2 max should be re-evaluated after an aerobic training programme, and should undergo tailored dynamic physical activity if the VO2 max does not n ormalise.

心电图对于区分透壁心肌梗死和非透壁心肌梗死的可靠性:一项与磁共振成像金标准的对照试验

Cardiovascular magnetic resonance(CMR) using contrast enhancement allows exact determination of the site and transmural extent of myocardial infarction(MI). We evaluated whether 12-lead electrocardiography can differentiate transmural from non-transmural MI or determine the site of MI by comparing the findings with those of contrast-enhanced CMR. A total of 27 patients(59.5±12.9 years) with a history of MI(6.4±2.9 months) underwent CMR(Magnetom, Siemens,Erlangen, Germany). Cine images were acquired in the horizontal and vertical long axes and short axis by TrueFISP. Contrast-enhanced CMR images were acquired in the same axes by segmented FLASH 15 min after administration of gadolinium-DTPA(0.15 mmol/kg). This showed the MI to be transmural in 11 patients and nontransmural in 16. An electrocardiogram(ECG) was recorded in all patients before CMR. T-wave alterations, descending ST depression, pathological Q-waves and absent R waves were more frequent in non-transmural MI than transmural MI, as defined by contrast-enhanced CMR (p≥0.618). However, none of the differences were statistically significant. R-wave reduction, q waves and horizontal ST-depression were more frequent in transmural than in non-transmural MI(p≥0.157). Again, the differences were not significant. The sensitivity of the ECG for MI localization was highest in inferior infarctions(85.71%), the specificity was highest in anterior infarctions (100%), the best positive predictive value(80%) was achieved for anterolateral infarctions, and the best negative predictive value for lateral infarctions(95.83%). Transmural and non-transmural MI cannot be differentiated by ECG. The ECG is most accurate in detecting anterolateral MI.

INTRAVASCULAR ULTRASOUND IMAGING OF ANGIOGRAPHICALLY "SILENT" LEFT MAIN CORONARY ARTERY ATHEROSCLEROSIS

Patients with left main coronary artery (LMCA) atherosclerosis have a poor prognosis compared with lesions in the other coronaries. Because of the methodological problems. LMCA atherosclerotic lesions are not frequently detected by coronary angiography. The purpose of the study was to reveal the existence of LMCA disease in patients with normal coronary arteries by using intravascular ultrasound imaging. Ninety-seven patients with angiographically normal coronary arteries were examined with a 3.5 F or 4.8 F. 20 MHz intravascular ultrasound catheter. The vessel, lumen and plaque areas were determined and percent area and diameter stenosis were calculated. Plaque formation with or without calcific deposits identified by ultrasound accoustic shadowing were regarded as signs of atherosclerosis.

Acupuncture Effects on Heart Failure: How to Create Objective Study Designs

According to a modem understanding of acupuncture mechanisms, acupuncture may elicit vegetative reflexes, presumably influencing the systemwide vegetative dysregulation associated with the heart failure syndrome, a feature of which is low performance in the 6 min walk test. The author performed a preliminary prospective, randomized, single-blinded clinical trial （n=21） in a cross-over design comparing acupuncture treatment, which was either compatible with individual Chinese diagnosis according to the Heidelberg Model of TCM （i-ACU） or a standardized treatment on acupoints with no specific relation to TCM diagnosis （u-ACU）. The repeated measures analysis revealed a significant effect for i-ACU vs. u-ACU （F =7.2, df=1.37, P=-0.011）. The study revealed first evidence that acupuncture may prolong 6 min walk distance as a key parameter of heart failure.