目的：探讨尿毒症维持性血透(MHD)患者营养不良、炎症与脂质代谢紊乱三者间的相关关系，以及对心血管并发症的预测。方法:测51例尿毒症维持性血透患者血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白(Apo)A1、ApoB、脂蛋白（a）LP(a)、白蛋白(ALB)、C反应蛋白(CRP)、血清铁蛋白（SF），与30例正常人进行对照研究。结果：MHD患者TG、LDL、ApoB、LP(a)、CRP、SF显著增高,HDL、ApoA1、ALB显著降低(P＜0.05)；随着透析时间的延长，各项检测指标变化进一步加重；且心血管事件发生者血清CRP和LP(a)明显增高，ALB明显降低，血脂紊乱更显著。相关性分析：ALB与HDL、ApoA1正相关，与CRP、LP(a)、TC、TG、ApoB负相关；CRP与LP(a)、TC、TG、ApoB、LDL、SF正相关，与HDL、ApoA1负相关，P均＜0.05。结论：MHD患者存在明显的脂质代谢紊乱、炎症和营养不良，三者的相互促进和影响可能是心血管事件发生的危险因素。
Abstract: The amniotic fluidderived stem cells (AFSC) possess considerable advantageous characteristics including high proliferation potential, easy availability, low immunogenicity and oncogenicity，and accordance with medical ethnics. Moreover, they do not require the sacrifice of human embryos for their isolation and the cells can differentiate into all three kinds of germs. Accordingly，they initiate a new and very promising field in stem cell research and they will be a potential source of stem cells for therapies related to regeneration medicine of cardiovascular diseases. The research about the AFSC utilization in cardiovascular diseases is just started. Though there were some exciting breakthroughs, there still remain many challenges. In the article，we will discuss AFSC characteristics, influence of amniotic fluid harvesting time on stem cells, isolation and purification, emphasizing mainly on the potential of AFSC differentiation into cardiovascular cells, current situation and problems in this field.
Objective To observe and analysis the features of images of fundus fluorescein angriography (FFA) in low-perfused retinopathy caused by cephalo-cervical peripheral vascular stenosis or occlusion. Methods The results of FFA of 27 patients diagnosed with carotid artery stenosis or occlusion by digital subtraction angiography (DSA) and examination of Doppler and vascular-pulsation were retrospectively analyzed. Result All of the patients had a delayed arm-retinal circulation duration from 20.0 to 81.08 seconds with the mean of 32.1 seconds; a delayed retinal arteriovenous filling duration from 6 to 64.0 seconds with the mean of 24.2 seconds. Delayed arm-retinal circulation duration and retinal a rteriovenous filling duration in 10 cases (37.0%); microangioma, vascular wall staining, nonperfused capillary area in 11 (40.7%); and anterior ischemic syndrome in 6 (22.2%) were found. In the 6 patients with anterior ischemic syndrome, 4 cases had narrow retinal artery, segmental changes of blood stream, vascular atresia, and abnormal arterio-venous anastomosis, and 2 cases had bold vascular loops. Conclusions The main manifestations of FFA in patients with low-perfused retinopathy are malperfusion and retinal ischemia, whose degrees relate to the extend of carotid artery stenosis or atresia, and the process of the disease.Serious retinal ischemia may combined with anterior ischemic syndrome. (Chin J Ocul Fundus Dis，2004，20：84-86)
Objective To systematically evaluate anti-platelet effect of clopidogrel influenced by CYP2C192,3 polymorphism in patients with cardiovascular diseases, in order to provide references for its safe medication. Methods Literature was retrieved in electronic databases covering EMbase, PubMed, The Cochrane Library, CBM and CNKI from establishment dates to November, 2011. Observational studies and clinical trials were included, cross-checked, assessed and pooled for meta-analysis. meta-analysis was performed using the software RevMan 5.1. Results A total of 13 articles including 14 trials (n=36 855) were included. The results of meta-analysis showed that: a) there was no significant difference in the incidences of cardiovascular events between CYP2C192,3 carriers and CYP2C191 carriers; b) the risk of stent thrombosis in CYP2C192,3 carriers was significantly higher than that in CYP2C191 carriers (Plt;0.000 1), and the relative risk of CYP2C192,3 carriers increased 92% within one month (Plt;0.000 1); c) as for bleeding events, there were no significant differences between CYP2C192,3 carriers and CYP2C191 carriers. Conclusion Compared with CYP2C191 carriers, CYP2C192,3 carriers have a higher risk of stent thrombosis in clopidogrel-treated patients, but there are few differences in cardiovascular and bleeding events between the two carriers. Therefore, CYP2C192,3 carriers with cardiovascular diseases and ready to receive PCT are suggested to pay more attention to stent thrombosis when using clopidogrel. We propose that patients with cardiovascular diseases and ready to receive PCT should have CYP2C19 tests to determine the use of antiplatelet drug (clopidogrel) to avoid thrombus.
Objective To evaluate the efficacy of n-3 PUFAs (fish oil) for prevention of cardiovascular events. Methods Randomized controlled trials (RCTs) were searched from the following electronic databases: PubMed, EMbase, The Cochrane Library (Issue 1, 2009), CBM, and CNKI. Quality assessment and data extraction were conducted by two reviewers independently. Disagreement was resolved through discussion. All data were analyzed by using Review Manager 4.2 software. Results Five studies involving 37 689 participants met the inclusion criteria. Meta-analysis results showed that: 1) Compared with placebo, the incidence rates of the cardiovascular death (RR=0.91, 95% CI 0.84 to 0.98), cardiovascular events (RR=0.95, 95%CI 0.91 to 0.98), angina (RR=0.79, 95%CI 0.64 to 0.96), and myocardial infarction (RR=0.79, 95%CI 0.65 to 0.96) could be reduced by n-3 PUFAs (fish oil). 2) There were no significant differences in death from any cause, the hospitalization rates of cardiovascular disease, sudden death, and heart failure (RR=0.95, 95%CI 0.90 to 1.00; RR=0.97, 95%CI 0.93 to 1.02; RR=0.90, 95%CI 0.79 to 1.01; RR=0.98, 95%CI 0.91 to 1.06). 3) Compared with placebo, the incidence rates of the arrhythmia and stroke could be increased, but there were no significant differences (RR=1.14, 95%CI: 0.80 to 1.62; RR=1.12, 95%CI 0.97 to 1.30). Conclusion Compared with placebo, n-3 PUFAs (fish oil) has good effects on reducing the incidence rates of total cardiovascular events, cardiovascular death, myocardial infarction, and angina pectoris, and it has the same efficacy in death from all cause, sudden death, heart failure, and the hospitalization rates of cardiovascular disease. There are no significant differences in the increased rates of arrhythmia and stroke.
Objective To evaluate the rationality of drug treatment for cardiovascular diseases in aged people and the effects of evidence-based practice. Methods Descriptive study was conducted to compare the therapies for the patients suffering from cardiovascular diseases before and after evidence-based practice by investigating drug use during 1998-1999 (211 cases) and 2002-2003 (211 cases). Results Among antihypertensive drugs, the ACEIs and diuretics played a more important role than before. CCBs and ACEIs were still the most frequently used drugs, and drug combination was more common, comparing to that before evidence-based practice. Lipid lowering drugs and ACEIs were used more common in coronary heart disease. Quality of life of patients was more emphasized and combination use of anti-anxiety drugs was adopted. When treating heart failure, β-receptor blockers, aldadinc and ACEIs were more frequently used. Conclusions After evidence-based practice, drug use is much more based on evidence instead of experience and textbook. As a result, the rate of reaching ideal blood pressure is higher than before. The rate of rational drug use before and after evidence-based practice has increased from 42% to 78%, respectively.
目的 阻塞性睡眠呼吸暂停低通气综合征（OSAHS）可引起心血管疾病发生增高，是高血压病及冠心病等的独立危险因素。打鼾是OSAHs的主要临床症状。本研究的主要目的是了解成都地区自然人群打鼾发生情况及其与心血管疾病危险因素的关系。 方法 2007年在成都市成华区采用随机抽样方法对男、女性共711人进行了心血管疾病危险因素调查[年龄45～80岁，平均（3.28 ± 6.25）岁，男性患者占所有患者的57.8%]，主要包括问卷调查、体格检查及血液学检查等，其中打鼾调查主要包括打鼾时间、次数及憋醒情况。将与打鼾相关的3个指标综合考虑后，计算出打鼾的严重程度，并分析了其与心血管疾病危险因素的关系。 结果 男性人群中打鼾率较女性高（62.0%、51.0%，P=0.003），且重度及极重度打鼾率也较女性高。随着打鼾的严重程度增加，体质量指数、血肌酐及尿酸等心血管疾病危险因素逐渐升高（趋势P均＜0.05），而高密度脂蛋白胆固醇逐渐降低（P=0.001）。另外，随着打鼾的严重程度增加，高血压患病率及收缩压也逐渐升高，但无统计学意义（趋势P=0.063，0.08）。 结论 成都地区中老年城镇人群的打鼾率较高，且男性高于女性。另外，随着打鼾的严重程度增加，心血管疾病危险因素也逐渐升高。这提示我们在临床工作中，对于打鼾的患者需要加强心血管疾病危险因素的筛查及干预，以期减少它的发生发展。