摘要:目的:研究高血壓病患者脂蛋白脂肪酶(liportein lipase, LPL)S447X基因多態性與認知功能之間的關系。方法: 對2008年1月至2008年11月在四川大學華西醫院醫院門診就診的原發性高血壓患者190例,收集一般資料,采用國際通用的簡易智力狀況量表測驗認知功能,計算認知評分,用聚合酶鏈反應限制性片段長度多態性(PCRRFLP)技術測定LPL S447X基因多態性。同時測定膽固醇、甘油三酯、空腹血糖、空腹胰島素及餐后2h血糖、餐后2h胰島素水平。結果: 高血壓病患者認知功能正常組和認知功能障礙組組間LPLS447X基因的基因型和基因頻率差異均無統計學意義(Pgt;0.05), SS和SX頻率分別為92.6%、7.4%,S和X等位基因頻率分別為96.3%和3.7%。結論: LPLS447X 基因多態性可能與高血壓認知功能障礙無明顯相關性。Abstract: Objective:To study the relationship between liportein lipase(LPL) S447X polymorphism and cognitive function in patients with primary hypertension. Methods:One hundred and ninety hypertensive patients from January 2008 to November 2008 in West China Hospital of Si Chuan University. We collected the general data and applied the Mini Mental State Examination to test the cognitive function and computed score. PCRRELP method was used to analyze the LPL S447X gene polymorphism. Total cholesterol、triglyeride、fasting plasma glucose and postprandial blood sugar、fasting insulin and postprandial plasma insulin were collected. Results:In primary hypertensive patients, both of the genotype frequency and the allele frequency of the LPL S447X polymorphism were not different between the cognitive normal group and the cognitive impaired group (Pgt;0.05). SS genotype was present in 0926 of the population, SX genotype was present in 0.074 of the population. allele frequencies were 0.963 for S allele and 0.037 for X allele. Conclusion:This results suggest S447X polymorphism in LPL with primary hypertension may not be associated with cognitive impairment. And age and postprandial plasma insulin level are the risk factors of hypertensive cognitive impairment.
ObjectiveTo investigate the relationship of 24-hour ambulatory pulse pressure (24hPP) with left ventricular mass index (LVMI) in elderly essential hypertension patients. MethodsThe data of 110 elderly patients with essential hypertension from January to December 2012 were collected in the study. All patients received 24-hour ambulatory blood pressure monitoring and echoeardiographic examination 24hPP and LVMI were calculated according to the results of 24-hour ambulatory blood pressure monitoring and echocardiographic measurements. The patients were divided into group A [24hPP<60 mm Hg (1 mm Hg=0.133 kPa), n=70] and group B (24hPP≥60 mm Hg, n=40). ResultsThe 24-hour systolic blood pressure and 24hPP for patients in group B were significantly higher than those in group A (P<0.001). Compared with group A patients, the interventricular septal thickness, left ventricular posterior wall thickness, left ventricular mass and left ventricular mass index were significantly higher in group B (P<0.05). Pearson correlation analysis showed that 24hPP had a positive correlation with LVMI in the elderly essential hypertension patients (r=0.33, P<0.001). Multiple stepwise regression analysis showed that 24hPP was the main factor for the increase of LVMI in elderly essential hypertension patients (β=0.90, P<0.001). ConclusionThe 24hPP is positively correlated with LVMI in elderly essential hypertension patients. The 24hPP is an important risk factor for left ventricular structural damage in elderly essential hypertensive patients.
ObjectiveTo explore the method and feasibility of establishing patent ductus arteriosus (PDA) model in Bama miniature pig by using autologous jugular vein, and to provide a large animal model for the development of PDA occluder and the study of pulmonary hypertension associated with congenital heart disease. MethodsFive male Bama miniature pigs weighing about 45 kg were selected to gain the PDA model of the autogenous jugular vein, which was fixed by glutaraldehyde and anastomosed between the ascending aorta and the main pulmonary artery. The patency of PDA was confirmed by echocardiography and angiocardiography immediately and one week after the operation. Two animals were selected to undergo transcatheter closure of PDA via femoral vein 1 week after the operation, and the rest were euthanized to obtain PDA and lung tissue for pathological examination. ResultsThe PDA model was successfully established in all five animals with a success rate of 100.0%. Immediately and 1 week after the operation, echocardiography and angiography showed that PDA blood flow was unobstructed, and hematoxylin-eosin staining showed that PDA endothelialization was good. One week after the operation, two animals were successfully treated with transcatheter femoral vein occlusion. The pathological examination of lung tissue showed thickening of the intima and muscular layer of pulmonary arterioles, thickening of pulmonary interstitium and infiltration of neutrophils. ConclusionIt is safe and feasible to establish a large animal model of PDA by using autogenous jugular vein anastomosis between the ascending aorta and the main pulmonary artery. The model can be used for the development of PDA interventional occlusive devices and the pathophysiological study of congenital heart disease-related pulmonary hypertension.
ObjectiveTo study the concepts and pathophysiology of intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS). MethodsRelevant information was gathered from previous original articals,and by checking the latest issues of appropriate journals. Meantime computerised MEDLINE search from 1998 to August 2001 was conducted using the Medical Subject Heading and textwords “abdominal”, “compartment syndromes”, “intraabdominal” and “hypertention” and “pressure”.Then the literature in the recent two years about the advances of IAH and ACS were reviewed. Especially the concepts, pathophysiology and clinical application of IAH and ACS were mainly summarized.ResultsAkin to compartment syndrome, the pathophysiological effects of increased intraabdominal pressure developed well before any clinical evidence of compartment syndrome. These changes included ①reduction of gastrointestinal blood flow，②increase of respiratory airway pressure whereas decrease of pulmonary compliance，③decline in cardiac output but rise in peripheral vascular pressure，④oliguria even anuria，⑤increase of intracranial pressure，⑥decrease of hepatic blood flow，⑦decrease of abdominal wall compliance.ACS can be defined as dysfunction of various organs caused by a progressive unphysiologic increase of the intraabdominal pressure. Clinically the syndrome is characterised by inadequate ventilation, tensely distended abdomen and oliguria or anuria.Early decompression by simple laparotomy and delayed closure is the treatment of choice. ConclusionThe concepts of IAH and ACS have been increasingly accepted. They mainly affects the respiratory,cardiovascular and renal systems; secondarily affect gastrointestinal, central nervous systems,liver and abdominal wall. The reduction of cardiac output and pulmonary compliance are probably promoting factors inducing organ dysfunction.
【Abstract】 Objective To improve the knowledge of idiopathic pulmonary arterial hypertension ( IPAH) to elevate the levels of early diagnosis and treatment. Methods The clinical data of 39 IPAH patients admitted in Beijing Anzhen Hospital from October 1997 to June 2010 were reviewed. Results Of the 39 IPAH patients, 14 cases were male and 25 cases were female, with an average age of ( 29. 7 ±16. 4)years old. Main clinical manifestations were exertional dyspnea/breathlessness ( 90. 9% ) , chest tightness( 72. 7%) , chest pain ( 30. 7% ) , cough ( 41. 0% ) , fatigue ( 48. 7% ) , syncope ( 35. 9% ) , cyanosis( 28. 2% ) , edema of lower extremity ( 43. 6%) , etc. As revealed through echocardiography, 39 cases had a mean systolic pulmonary arterial pressure ( SPAP) of ( 88. 8 ±24. 2) mmHg, with right ventricle enlargementin 37 cases and normal in 2 cases. Pulmonary angiography showed central pulmonary arterial dilatation with pruning of the peripheral blood vessels in 36 cases and normal in 3 cases. Right heart catheterization and acute vasodilator testing was performed with iloprost in 15 patients, systolic pulmonary arterial pressure was( 77. 6 ±27. 8 ) mm Hg, and positive rate was 20. 0% . 24 cases were misdiagnosed at admission, and misdiagnosis rate was 61. 5% . The average time of misdiagnosis was ( 26. 0 ±24. 5) months. 20 cases were treated with general medical therapy and 1 case was managed with lung transplantation before April 2008.Then 13 cases were given pulmonary arterial hypertension-targeted therapies, including sidenafil, iloprost or bosentan. Two patients died in hospital with a mortality rate of 5. 1% . Conclusions IPAH is uncommon and often occurs in young and middle-aged women. The symptoms are nonspecific and easily misdiagnosed.Echocardiography and pulmonary angiography are helpful in diagnosis. Right heart catheterization and acute vasodilator testing should be carried out if available. The patients should be early treated with pulmonary arterial hypertension-targeted therapies. Lung transplantation may be an option for end-stage cases.
ObjectiveTo explore the nursing intervention effect on pre-hypertension. MethodsA total of 240 prehypertension patients in our community from July 2012 to January 2013 were randomly divided into observation group and control group with 120 patients in each group. No intervention was carried out for the control group. Blood pressure profile was established for the observation group and health education, exercise intervention, diet and body weight intervention measures were also given to the patients in this group. The improvement of life behavior and blood pressure control, and the awareness of hypertension health knowledge were compared between the two groups. ResultsAwareness of the disease knowledge, risk factors, complications, prevention and treatment in the observation group was significantly better than those in the control group (P<0.05). After intervention, the improvement scores of diet control, exercise increase, smoking quitting and alcohol drinking control in the observation group were significantly higher than those in the control group (P<0.05). The systolic blood pressure, diastolic blood pressure and body mass index after intervention in the observation group were significantly lower than those in the control group (P<0.05). ConclusionCommunity nursing intervention can increase the health knowledge in pre-hypertensive patients, help patients establish a good way of life and control blood pressure effectively, and reduce the incidence of hypertension.
【Abstract】ObjectiveTo inquire the therapeutic effect of retroperitoneal splenic autotransplantation combined with lower esophageal transection in the treatment of hepatic cirrhosis induced portal hypertension with randomized comparasion.MethodsThe hepatic cirrhosis induced portal hypertension patients with Child A or B grade of liver function were randomly divided into splenic autotransplantation group and splenectomy group.In the splenic autotransplantation group, retroperitoneal transplantation of pedicled autosplenic tissue combined with modified lower esophageal transection was performed,while in the splenectomy group, splenectomy combined with modified lower esophageal transection was conducted.The general conduction, splenic scanning, liver function, serum tuftsin and IgM levels in patients were observed 2 to 6 months after operation, and compared with those before operation. ResultsOne patient died in the splenectomy group on the 6th postoperative day, rebleeding occurred in one case of the splenic autotransplantation group. The levels of tuftsin and IgM in splenic autotransplantation group were higher than those of splenectomy group after operation, with significant difference (P＜0.01). The liver function between two groups showed no difference (Pgt;0.05).ConclusionSpleen autografts could maintain the basic immune function of spleen and survive for a long time.
【Abstract】ObjectiveTo evaluate the role of MRA, IPVG and DUS in the hemodynamics studies of portal hypertension. MethodsThirtyeight patients with portal hypertension were examined with Philips Gyroscan 1.0 Tesla MR imaging system. 3DDCE MRA and 2DPC MR were used for study of portal venous anatomy and its hemodynamics. The results were compared with those obtained from IPVG and DUS. Results3DDCE MRA could clearly display the anatomical imaging of portal venous system and its imaging quality was better than that of IPVG. The data of hemodynamics from 2DPC MR including diameter, blood velocity and blood flow were closely correlated to those from DUS. ConclusionAs a noninvasive technique, MRA can display the anatomy of portal venous system and measure its hemodynamics exactly. It should be applied as the first choice in hemodynamics evaluation for portal hypertension.
Objective To explore the causes and treatment of rebleeding after operation on portal hypertension patients. Methods The clinical data of 41 rebleeding cases underwent the operational between January 2000 and December 2009 in Peking Union Medical College Hospital were retrospectively analyzed. Results All 13 cases who got rebleeding after shunt operation received lienectomy, but for those who got rebleeding after lienectomy, 23 patients received Phemister or modified Phemister or expanded lienectomy and 5 patients received shunt operation. Surgical related complications occurred in 7 cases (17.1%) at 2 weeks after operation, including abdominal bleeding (3 cases), gastrointestinal bleeding (2 cases), and intractable ascites (2 cases). After the follow-up of 3-60 months (mean 39 months), all patients were still alive. During the follow-up, 3 cases of recurrent esophageal varices were observed and one of them got rebleeding.Conclusion The majority of rebleeding after lienectomy tend to be ascribed to the wrong operations chose, while bad operation skill often contribute to the rebleeding after shunt operation, suggesting ideal therapeutic effect for rebleeding can benefit from appropriate operation choose.
Objective To explore current results after staged operations in patients with functional single ventricle anomalies and pulmonary hypertension. Methods We retrospectively analyzed the clinical data of 129 patients with functional single ventricle anomalies and pulmonary hypertension undergoing pulmonary artery banding in our hospital between April 2008 and December 2015. There were 81 males and 48 females. There were 71 patients with double outlet of right ventricle, 17 patients with tricuspid atresia, 7 patients with transposition of great arteries, 33 patients with uni-ventricular heart, and one patient with complete atrio-ventricular septal defect. The surgical results, transition to Glenn procedure and subsequent transition to Fontan procedure were analyzed. Results The 129 patients underwent 159 operations of pulmonary artery banding totally. Hospital mortality was 4.7% (6/129). Nine patients were lost to follow-up. Eighty-seven (67.4%) patients underwent the second-stage Glenn procedure, and 43 patients(33.3%) underwent third-stage Fontan procedure. Two patients died after Glenn and 3 patients died after Fontan separately. There were 32 patients who accompanied with coarctation, interruption of aortic arch, heterotaxy, total anomalous pulmonary venous connection or atrio-ventricular valve regurgitation. Fifteen (46.9%) patients succeeded in transition to Glenn, and 6 (18.8%) patients succeeded in transition to Fontan. Fourteen patients developed obstruction of left ventricular outlet tract or bulbo-ventricular foramen. Conclusion Early pulmonary artery banding is an acceptable strategy for patients with single ventricle anomalies and pulmonary hypertension. Outcomes and results of subsequent Glenn and Fontan procedures are generally good. Accompanied complex anomalies are risk factors for lower ratio of transition to Glenn and Fontan procedure.