Abstract:退行性心脏瓣膜病(degenerated heart valvular disease,DHVD)是一种随龄而增加的以瓣膜内大量钙质沉积为特征的老年人常见的心脏瓣膜病变.随着人类寿命的延长,此病在老年人中的发生率日益增加.钙盐结晶沉积在心脏瓣膜上,引起心脏血管的形态及功能变化,导致心脏血流动力学紊乱,诱发严重心血管系统并发症,是老年心血管疾病致死的重要原因之一.……

Abstract:Objective To discuss the clinical characteristics of the elderly patients with calcific valvular heart disease (CVHD). Methods The clinical data of 230 CVHD patients aged over 60 years were enrolled. The diagnosis was confirmed by echocardiography. The patients’ data were retrospectively analyzed,including clinical manifestation,the results of echocardiography and other adjunctive examinations. Results CVHD was usually complicated by hypertension,coronary artery disease,and diabetes mellitus. In which,aortic valve was most frequently involved,followed by mitral valve. The calcified regions were more frequently seen in non coronary cusp than in right or left coronary cusp. The incidence of valvular regurgitation was higher than that of valvular stenosis. The incidence of mitral calcification was significantly higher in female than in male. The common cardiac function impairments were left ventricular diastolic dysfunction (82.3%),left atrial enlargement (37.1%) and left ventricular enlargement (18.5%). The common arrhythmia included premature beat (41.7%),atrial fibrillation (20.4%) and atrioventricular block (16.1%). Chest X-ray test revealed aortic arch calcification in 77.5% of cases. Biochemical test displayed dyslipidemia in 62.6% of patients. Conclusion CVHD has certain specific clinical manifestations and laboratory examination findings. The aortic arch calcification is helpful for its diagnosis. But,echocardiography is mandatory to reach a definite diagnosis of CVHD.

Abstract:Objective To investigate the effects of long-term oral administration of warfarin on cardiac valvular calcification. Methods Thirty-four patients who received oral administration of warfarin for over one year,and 18 disease condition-matched controls were selected. Echocardiography was performed to detect the valvular calcification. Some calcium metablic factors 〔calcium,phosphate,parathyroid hormone (PTH),alkaline phosphatase (AKP)〕,inflammation indicators 〔including high-sensitive C reactive protein (HsCRP),low density lipid cholesterol (LDL-C)〕,and calcification related matrix proteins 〔matrix Gla protein (MGP),osteopontin (OPN),Fetuin-A〕 were analyzed. The incidence of osteoporosis was recorded. Results The incidence of valvular calcification was 14.7% in warfarin group,and 11.1% in control group,with no significant difference between two groups. Serum MGP concentration was significantly lower in warfarin group 〔(3.7±1.9) nmol/L〕 than in control group 〔(11.0±4.3) nmol/L〕. OPN concentration was significantly higher in warfarin group 〔(154±56 ) μg/L〕 than in control group 〔(86±35) μg/L〕. Fetuin-A level was not different between the two groups. AKP level was significantly higher in warfarin group 〔(79±10) U/L〕 than in control group 〔(65±8) U/L〕. There was no difference in serum calcium,phosphate,PTH between the two groups. The patients suffering from osteoporosis accounted for 52.9% in warfarin group,higher than that in control group (38.9%). Conclusion Long-term oral administration of warfarin does not add the risk of valvular calcification,but increases the incidence of osteoporosis,which is not obviously associated with arterial inflammation,but might be associated with changes of MGP level.

Abstract:Objective To compare the effect of coronary revascularization between titanium nitric-oxide biological availability stent (Titan2-BAS) and sirolimus-eluting stent (SES) in elderly patients. Methods One hundred and twenty-five patients with coronary artery diseases were enrolled,including 75 males and 50 females. The patients were categorized into Titan2-BAS group (group A,n=79) and SES group (n=46). All the stents were implanted through transulnar or transradial approach. Patients in group A received aspirin and clopidogrel for 1 to 3 months,while patients in group B received the same medications for at least 12 months. The success rate of stent implantation,incidence of in-stent thrombosis in early period and incidence of major adverse cardiac events(MACE)during follow-up visit,including death,acute myocardial infarction,and criminal artery reestablishment were observed in both groups. Results (1) The lesion was averagely (25±3.6) mm long and (3.1±0.3) mm internal diameter in group A,and (24±4.2) mm long and (3.1±0.4) mm internal diameter in group B,with no significant difference between the two groups. (2) In group A,146 Titan2-BAS were implanted in 129 narrowed lesions,and 1 stent implantation failed. In group B,82 SES were implanted in 72 lesions. The success rate of stent implantation were 99.3% in group A and 100% in group B,with no significant difference between the two groups. (3) All subjects survived,and were followed up for 1-17 months (average 5.8 months). One patient presented in-stent thrombosis on the second day after stent implantation in group B,whereas no thrombosis developed in group A. One patient was submitted to revascularization in the third month after stent implantation in group A,while no revascularization was performed in group B. In general,there was no difference between group A and B in the incidence of MACE(1.3% vs 2.2%). Conclusion Concerning coronary revascularization,the short and long-term efficacy of Titan2-BAS is similar to that of SES in elderly patients with coronary artery disease. Titan2-BAS adds no extra risk of MACE.?更多

Abstract:Objective To study the pathogenesis and prevention of subacute thrombosis (SAT) in coronary stents after percutaneous coronary intervention. Methods We reviewed 529 patients who underwent percutaneous coronary intervention (PCI) from January 2004 to August 2007. Among them,5 patients represented SAT associated with coronary stents. The clinical data and angiography results and anti-thrombus treatment of these 5 patients were analyzed. Results (1) The incidence of SAT was 0.94% (5/529),and it mostly presented at 2-5 d after PCI. Three patients had definite stent thrombosis,and coronary angiography showed no stent restenosis after active treatment for 6 months. Two patients had probable stent thrombosis. Two patients died,one in hospital and one after discharge,both due to absence of timely intervention therapy. (2) Among 5 SAT cases,3 patients represented ST-elevation myocardial infarction,1 represented acute left heart failure and cardiogenic shock,1 represented unstable angina. Four patients represented SAT associated with use of drug-eluting stent,and 1 represented SAT associated with use of bare stents. Conclusion SAT may be related to intraoperative stent malposition,acute myocardial infarction,diabetes and C-type diseases. Timely intervention therapy can reduce the hazard for SAT.

Abstract:Objective To investigate the prevalence of chronic diseases and accompanied anxiety-depression disorders in elderly inhabitants in communities in Beijing. Methods A total of 2235 Beijing Dongsi community-dewelling subjects were randomly selected (age ≥50 years).The prevalence of common community-onset diseases were investigated,such as hypertension,heart disease,diabetes,and osteoarthrosis,etc. The level of anxiety-depression disorder was evaluated using Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS). Results The most common chronic diseases in Dongsi community were essntial hypertension,heart diseases,diabetes,and osteoarthrosis. Compared with the subjects suffering no chronic diseases,the ones with chronic diseases had a significantly higher prevalence of anxiety-depression disorder. The prevalence of anxiety-depression disorder rose significantly with the increased number of chronic diseases. Conclusion The elderly community-dewellings who already suffer from chronic diseases are more likely to have anxiety-depression disorder. There may be a mutual relationship between chronic diseases and anxiety-depression disorder.?更多

Abstract:Objective To investigate the changes of serum cytokines in chronic heart failure (CHF) patients who received cardiac resynchronization therapy for 1 and 3 months and its relationship with left ventricular ejection fraction (LVEF).Methods Thirty CHF patients with New York Heart Association (NYHA) classⅢor Ⅳwere selected. Fifteen patients received biventricular pacing therapy (CRT group) and the other 15 patients received optimal medical therapy (control group). The LVEF and serum levels of TNF-α and IL-6 were determined before treatment,at 1,3 months after treatment respectively.Results The serum TNF-α and IL-6 concentrations were decreased significantly after 3 months of CRT treatment,and LVEF was improved remarkably after 1 and 3 months of CRT treatment. The serum cytokines (TNF-α and IL-6) level had a significant negative correlation with LVEF. Conclusion After 3 months of CRT treatment,the heart function is improved,and serum cytokines(TNF-α,IL-6) concentrations are decreased. It indicates that serum level of TNF-α and IL-6 may have predictive value for the heart function of patients with CHF.

Abstract:Objective To investigate the clinical characteristics of complete left bundle branch block (CLBBB) patients complicated by coronary heart disease (CHD). Methods The data of 733 hospitilized patients (from January 2002 to January 2008) with CCLBBB were retrospectively analyzed. The difference in clinical characteristics between CCLBBB patients complicated with and without CHD were compared. The independent predictors for CHD in CCLBBB patients were determined by regression analysis. Results The CLBBB patients complicated by hypertension,CHD and dilated cardiomyopathy accounted for 49.4%,44.1% and 26.5%,respectively. About 58% of CLBBB patients were complicated with cardiac dilation or myocardial dysfunction,and 19.9% with other arrhythmia. The results of logistic analysis showed that sex (P<0.001,B=1.991,95%CI:1.375-2.882),age ≥65 years(P<0.001,B=2.793,95%CI:1.948-4.005),hypertension(P=0.022,B=1.522,95%CI:1.062-1.640),diabetes mellitus (P<0.001,B=2.459,95%CI:1.540~3.926),hyperlipemia(P=0.803,B=1.057,95%CI:0.682-2.180)were positively related to CHD; dilated cardiomyopathy (P<0.001,B=0.072,95%CI:0.045-0.127),rheumatic valvular disease (P=0.027,B=0.253,95%CI:0.075-0.853),and atrial fibrillation or atrial flutter (P=0.024,B=0.564,95%CI:0.343-0.927) and other atrio-ventricular block(P<0.001,B=0.418,95%CI:0.263-0.665) were negatively related to CHD. Conclusion CLBBB patients,≥65 years,male sex,with hypertension or diabetes mellitus,are more susceptibly to suffer from CHD. While dilated cardiomyopathy,atrial fibrillation or atrial flutter,other atrio-ventricular block,cardiac dilation or myocardial dysfunction are more common in CLBBB patients without CHD.

Abstract:Objective To investigate the myocardial protection effect of short-term high dose statin pretreatment during percutaneous coronany intervention (PCI) in elderly patients with non-ST-segment-elevation acute coronary syndrome (NSTEACS). Methods Ninety-two elderly NSTEACS patients admitted for PCI were randomized into high dose atorvastatin group (atorvastatin 40 mg/d,n=47) and control group (atorvastatin 10 mg/d,n=45). A 3 to 5-day pretreatment with atorvaststin was given to the subjects. The two groups were identical in other medication treatment. Before PCI,all subjects received oral administration of clopidogrel 300mg as a dose again.Levels of creatine kinase (CK),CK-MB and cTnI level were measured at baseline,8 and 24 h after the procedure. Major adverse cardiac events (MACE,including death,myocardial infarction and revascularization) at 30-day follow-up visit were analyzed. Results The levels of CK and CK-MB at 24 h were significantly lower in high dose atorvastatin group than in control group〔(3.2±0.5) vs (4.1±0.4) g/L,(0.31±0.09) vs (0.38±0.12) g/L,P<0.05〕,while they were not significantly different at 8 h between two groups. The proportion of patients with cTnI level above normal up-limit value and that with CK,CK-MB level above 3-fold normal up-limit at 24-hour was significantly lower in high dose atorvastatin group than in control group ( 8.5% vs 26.7%,6.4% vs 15.6%,6.4% vs 17.8%,P<0.05). MACE incidence at 30-day follow-up visit was lower in high dose atorvastatin group (12.8%) than in control group (17.8%),but with no significant difference. Conclusion High dose atorvastatin pretreatment provides myocardial protection during PCI in elderly patients with NSTEACS.?更多

Abstract:Objective To investigate the association between metabolic syndrome (MS) and cardio-cerebral vascular diseases in the elderly Beijing residents and its sex-and age-dependent variances. Methods A cohort of 1827 elderly Beijing residents were selected. The physical examination,including height,body weight,blood pressure,several serum metabolic indices,was performed. Metabolic syndrome was diagnosed with China criteria. Demographic data and prevalence of cardio-cerebral vascular diseases in the subjects were investigated. Results The mean age of the subjects was (71±7) years. Among 1827 subjects,there were 372 MS cases,accounting for 20.4%,with higher proportion of women than men. The prevalence of MS remarkably decreased with aging. The prevalence of hypertension was 63.2%,impaired fasting glycaemia 23.5%,overweight and obesity 34.2%,hypertriglyceride 29.8%,and low HDL-C 3.7% respectively,and all were higher in women than in men. Prevalence of diabetes mellitus was 13.7%,and there was no sex-related difference for it. Systolic blood pressure and HDL-C levels increased with aging; while diastolic blood pressure,body mass index,fasting glycaemia and triglyceride levels decreased with aging. The prevalence of coronary heart disease and stroke were higher in the elderly with MS than in those without MS. But,the difference was only seen in the elderly <80 years rather than≥80 years. The prevalence of coronary heart disease in elderly men with MS and prevalence of stroke in elderly women with MS were higher than that in the elderly without MS. Conclusion The prevalence of MS is high in the elderly. Those with MS have a high prevalence of cardio-cerebral vascular diseases,and there exists the sex-and age-related difference.

Abstract:Objective To investigate the relationship between the plasma macrophage migration inhibitory factor (MIF) concentration and coronary arteriosclerosis lesions in patients with coronary heart diseases (CHD). Methods Totally 142 patients were divided into CHD group and control group according to the result of the coronary angiography (CAG). CHD group was further divided into stable angina pectoris (SAP) group and acute coronary syndrome (ACS) group according to the clinical diagnosis; and divided into one-vessel,two-vessel,three-vessel group according to the extent of coronary lesion. The plasma MIF concentration was measured by ELISA. Results The plasma MIF concentration was significantly higher in CHD group than in control group〔(14.97±4.11) vs (9.07±1.28) μg/L〕,and in ACS group than in SAP group〔(16.66±3.56) vs (11.01±2.12) μg/L〕. The plasma MIF concentration increased gradually with the increase of extent of coronary lesions. Conclusions The increase of plasma MIF concentration is significantly associated with development of coronary arteriosclerosis. MIF can be a reliable predictive index for coronary arteriosclerosis progression. MIF has a high association with unstable plaques in coronary arteriosclerosis.

Abstract:Objective To observe the clinical effects of intensive insulin therapy in elderly patients with sepsis. Methods A total of 114 patients (>60 years) with sepsis were randomly divided into two groups,intensive insulin therapy group (n=59) and routine insulin therapy group (n=55). The blood glucose was controlled within 4.4-8.3 mmol/L in intensive insulin group,and 10.0-11.1 mmol/L in routine insulin therapy group. Other therapies were identical in two groups. The serum C-reactive protein (CRP) level,duration for antibiotic usage,hospital-acquired infection rate,amount of vasopressors used,incidence of acute renal failure requiring blood purification,28-day survival rate were recorded. Results In intensive insulin therapy group,the serum CRP level,duration for antibiotic usage,hospital-acquired infection rate,amount of vasopressors used,and incidence of acute renal failure requiring blood purification were significantly reduced,and 28-day survival rate was significantly elevated,compared with routine insulin therapy group. Conclusion For elderly patients with sepsis,early intensive insulin therapy can control blood glucose more effectively and timely,and can improve the clinical therapeutic effects.

Abstract:Objective To investigate the relationship between ambulatory blood pressure (ABP) and renal dysfunction in patients aged ≥70 years with cardiovascular diseases(CVD). Methods Eighty-four patients aged 70-87 years with CVD were included. The glomerular filtration rate (GFR) was estimated with the simplified Modification of Diet in Renal Disease study (MDRD) equation,and GER <60 ml/(min·1.73 m2) was considered as renal dysfunction. The patients were divided into renal dysfunction group (n=44) and control group with normal renal function (n=40). The 24-hour ABP parameters were compared between two groups. Results There were more patients with coronary artery disease,diabetes,heart failure or mean systolic blood pressure(SBP) >130 mmHg in renal dysfunction group than in control group. There was no significant difference in numbers of hypertension cases and non-dipper blood pressure cases. The mean pulse pressure (PP) was significantly higher,while maximal diastolic blood pressure (DBPmax) and wave amplitude of DBP (ΔDBP) were lower in renal dysfunction group than in control group. Mean SBP,PP,nocturnal SBP (nSBP) and nSBP load were positively correlated with the patients age. Serum creatinine(SCr) was positively correlated with PP,nSBP and minimum SBP (SBPmin),and negatively correlated with DBPmax and ΔDBP. GFR changed correspondingly. The correlation of SCr with PP and nSBP remained significant after age-matching. Conclusion The increase in PP and nSBP and the decline in DBPmax and ΔDBP are correlated with renal dysfunction in aged patients with CVD. Patients with renal dysfunction are more vulnerable to suffer from coronary artery disease,diabetes,and heart failure. They also displayed more remarkable changes of ABP.

Abstract:Objective To determine the influence of recombinant human relaxin (rhRLX) on collagen gene expression in cardiac fibroblasts (CFs) under high glucose (HG) conditions. Methods CFs were isolated from Sprague-Dawley rats and cultured primarily. The mRNA levels of type Ⅰ,type Ⅲ collagen and RLX in CFs after 3 passages under normal glucose (NG,5.6 mmol/L) and high glucose (HG,25 mmol/L) conditions were assessed by RT-PCR. rhRLX (100 μg/L) was cocultured with CFs under NG and HG conditions for 72 h respectively,then the mRNA levels of type Ⅰand type Ⅲ collagen were detected. Results HG increased the expression of type Ⅰ and type Ⅲ collagen,which was inhibited by rhRLX. The RLX mRNA expression was stronger in HG group than in NG group. Conclusion rhRLX inhibits the HG-enhanced overexpression of typeⅠand type Ⅲ collagen.?更多

Abstract:Objective To study the influence of experimental acute pulmonary thromboembolism (PTE) on hepatocyte growth factor (HGF) levels in plasma and tissue of rabbit,and to explore the diagnostic value of HGF in PTE. Methods Thirty-two rabbits were randomly used for detection of HGF in plasma (n=16) and tissues (n=16). For each detection,the rabbits were further divided into control group and PTE model group,with 8 in each. The PTE model was established by intravenous injection of autologous blood clots,and the control group was injected with isometric normal saline. The HGF (0,1,3,6,12,24,48,72 h) level in plasma was detected by ELISA. The rabbits were sacrificed at 12 h,and the expression of HGF in tissue of lung,liver,and right side of the heart was detected by immunohistochemistry. Results The plasma HGF level was significantly higher in PTE group than in control group. It began to elevate at 1h after PTE,and reached its peak at 12 h,significantly higher than that in control group〔(1.74±0.49) vs (0.26±0.23) μg/L,P<0.001〕. Then,it began to reduce gradually at 72 h. However,it remained at low level in control group through the whole experimental duration (P<0.5 μg/L). In tissue of lung and right side of the heart,the expression of HGF was significantly higher in PTE group than in control group,while in liver tissue,it was not significantly different between PTE group and control group. The HGF expression in lung tissue was significantly elevated compared with right side of the heart and liver tissues. Conclusion HGF can be used for the adjunctive diagnosis of PTE.?更多

Abstract:1病历摘要患者张某,男性,60岁,农民。主因淋巴结肿大、肾衰竭9d,于2009年3月13日转入中日友好医院肾内科。患者于2004年10月因左颌下淋巴结肿大,曾在当地区人民医院行淋巴结活检,病理结果不详。2007年8月因外伤住院,住院期间曾检查血常规、尿常规、肾功能,未告知异常。9d前,因右侧颌下淋巴结肿大,再次在当地区人民医院行穿刺活检时发现肾衰竭,无发热、皮疹、消瘦等,血肌酐为469.3μmol/L,血红蛋白121g/L,B超示双肾体积增大(左肾14.6cm×6.0cm×5.6cm,右肾13.2cm×5.8cm×5.8cm),诊断为急性肾衰竭,转入肾内科。

Abstract:噻唑烷二酮类(thiazolidinediones,TZDs)药物包括罗格列酮(rosiglitazone,RSG)、比格列酮(pio-glitazone,PIO)、曲格列酮(troglitazone,TRO),TRO上市后因为严重的肝脏毒性已退出市场.它们属于胰岛素增敏剂,通过增加脂肪、骨骼肌、肝脏组织的胰岛素敏感性降低胰岛素抵抗,改善2型糖尿病患者的血糖和血脂异常[1～3].……

Abstract: