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Abstract:心血管并发症是慢性肾衰竭患者的主要并发症之一,在终末期肾功能衰竭接受肾脏替代治疗的患者中,它也是头号致死病因[1].在血液透析(he-modialysis,HD)治疗前,不少慢性肾衰竭患者已存在心血管病变及高血压、糖尿病等相关危险因素,还有其他危险因素,如炎症、氧化应激、以及慢性肾衰竭相关贫血及电解质紊乱等,这些因素的综合作用加速了血管病变的进程,与更多的心室肥厚、心肌纤维化、瓣膜病变、心律失常和猝死相关[2,3].基于慢性肾衰竭患者的特殊性,超声心动图技术在无创性心脏结构和功能的评价中已成为目前最重要的诊断工具.……

Abstract:ObjectiveTo explore the relationship between the methylation of p16 gene and human longevity.MethodsThe methylation specific polymerase chain reaction was used to analyze the methylation status of p16 gene in 156 long-lived healthy Zhuang ethnic group people (aged 90-105 years,mean 93.2 years,long-lived group,LG) and 142 healthy controls (aged 20-72 years,mean 34.8 years,control group,CG) from Bama area. The difference in p16 gene methylation between the two groups was analyzed to study the role of p16 gene methylation in human longevity. ResultsThe methylation of p16 gene was more frequent in CG than in LG. ConclusionThe methylation of p16 gene is less frequent in long-lived Zhuang ethnic group elderly people in Bama area.

Abstract:ObjectiveTo evaluate the impact of successful revascularization for chronic total occlusion (CTO) by percutaneous coronary intervention ( PCI) on heart function of heart dysfunction patients. MethodsBetween June 1993 and December 2007,the clinical data of 472 consecutive patients with heart dysfunction undergoing PCI for CTO in the General Hospital of Shenyang Military Command were analyzed.The mean age was (59.4 ±11.5) years. The patients were divided into CTO success group (n=421) and CTO failure group (n=51) respectively according to the results of CTO revascularization by PCI. Six months after CTO revascularization by PCI,the patients underwent cardiac ultrasound examination to compare the heart function between the two groups. ResultsCardiac ultrasound examination was successfully performed in 391 patients (92.9%) in CTO success group and 46 patients ( 90.2%) in CTO failure group at a mean of (6.2±1.7) months after PCI procedures. In CTO success group,left ventricular ejection fraction (LVEF) was significantly increased after PCI procedures 〔(50±6)% vs (44±3)%,P<0.05〕,and left ventricular end-diastolic volume index (LVEDVI) was significantly declined 〔(78±14)ml/m2 vs (85±14)ml/m2,P<0.05〕. But the LVEF and LVEDVI showed no significent change in CTO failure group 〔(42±4)% vs (44±4)%,(87±14)ml/m2 vs (6±15)ml/m2 respectively,P>0.05〕. In addition,compared with CTO failure group,most patients in CTO success group improved in NYHA stage (P<0.05). ConclusionSuccessful CTO revascularization leads to the improvement of left ventricular function in heart dysfunction patients.

Abstract:ObjectiveTo evaluate the clinical risk factors of heart failure following an abdominal operation in elderly patients. MethodsA total of 762 patients (≥65 years) who underwent an abdominal operation were divided into heart failure group (n=32) and control group (n=730). Their clinical data were analyzed retrospectively to evaluate the risk factors of heart failure. ResultsNineteen patients (59.3%) sufferred from heart failure at 1-3 days after abdominal operation. Compared with control group,in heart failure group,there were more patients of advanced age(53.1% vs 25.2%),more patients with history of coronary heart disease (62.5% vs 38.6%) and heart failure (25.0% vs 4.0%),more patients following emergency operation(41.4% vs 15.8%),more patients with preoperative ST segment depression (≥0.05mV)(34.4% vs 18.2%),more patients with WBC>10×109/L at 1-3 days after operation(31.3% vs 16.0%),and more patients with infusion fluid ≥2 500ml/d(21.9% vs 7.1%,P<0.05). A multivariable logistic regression analysis showed that the history of heart failure(OR=9.52),emergency operation (OR=15.723) and advanced age (OR=2.933) were independent risk factors of heart failure in elderly patients who underwent an abdominal operation. ConclusionAdvanced age,history of coronary heart disease and heart failure,emergency operation,preoperative ST segment depression,WBC>10×109/L at 1-3 days postoperatively and infusion fluid ≥2 500ml/d are more common in patients with heart failure than patients without heart failure following an abdominal operation. The history of heart failure,emergency operation and advanced age are independent risk factors of heart failure in elderly patients who underwent an abdominal operation.

Abstract:ObjectiveTo evaluate the effects of tirofiban on no-reflow phenomenon in patients with acute myocardial infarction (AMI) receiving emergency percutaneous coronary intervention (PCI). MethodsFrom January 2006 to December 2008,104 AMI patients were divided into tirofiban treatment and control groups (n=48 and 56,respectively) according to whether tirofiban was applied during emergency PCI. The patients’ basic clinical characteristics,angiographic results,and PCI efficiency were compared between two groups. Thrombolysis in Myocardial Infarction study (TIMI) grading and TIMI frame count (TFC) were performed in all culprit vessels after emergency PCI. ResultsThere was no significant difference between two groups in basic clinical characteristics and preoperative angiogram. Compared with control group,better TIMI 3 blood flow (91.7 % vs 76.8 %,P = 0.0408),less no-reflow rate (4.2% vs 16.1 %,P=0.0491),less distal embolization rate (8.3 % vs.23.2 %,P =0.0408) and better TFC (20.2±2.8 vs 31.2±4.4,P=0.0225) were achieved in tirofiban treatment group. No severe bleeding complication occurred in any patients. Major adverse cardiac events were significantly higher in control group than in tirofiban treatment group (12.5% vs 8.9%,P=0.011). ConclusionTirofiban used during emergency PCI in patients with AMI can effectively prevent no-reflow phenomenon.

Abstract:ObjectiveTo analyze the incidence and risk factors of abdominal aortic aneurysm (AAA) in elderly individuals with coronary heart disease (CHD). MethodsEighty-six CHD patients (CHD group) and 60 patients without CHD (control group) (both>65 years) were selected. All subjects underwent conventional echocardiographic examination to investigate the incidence of AAA. The risk factors of AAA in CHD patients were analyzed. ResultsAAA incidence in CHD group was significantly higher than that in control group (15.1% vs 3.3%; P<0.05). A logistic regression analysis showed that smoking (OR=4.79;P<0.01) and carotid artery stenosis (OR=3.29; P<0.05) were closely related to incidence of AAA,while diabetes was correlated negatively to incidence of AAA (OR=0.15; P<0.05). ConclusionElderly CHD patients have high incidence of AAA. CHD and AAA have some similar risk factors in elderly individuals.

Abstract:ObjectiveTo analyze the clinical characteristics of multiple organ dysfunction syndrome in the elderly(MODSE). MethodsTotally 200 cases of MODS were retrospectively analyzed. They were divided into elderly group (n=94) and control group (n=106). The precipitating factor,the first impaired organ,the incidence rate and mortality rate of MODS were compared between the two groups.ResultsExcept the originally impaired organ,there were differences in the precipitating factor,the first impaired organ,the incidence rate and the mortality rate of MODS. ConclusionThere are some features which may differentiate MODSE from MODS. The prognosis of MODSE is worse.

Abstract:ObjectiveTo investigate the correlation between myocardial perfusion and coronary endothelial injury in angina patients. MethodsCoronary stenosis was identified in 30 patients with angina pectoris. Coronary heart disease was excluded in 18 control patients. Blood samples were collected during coronary angiography. The concentrations of nitric oxide (NO),endothelin (ET) and the number of circulating endothelial cells (CEC) in coronary sinus blood were measured to mirror the coronary endothelial injury and dysfunction. Myocardial contrast echocardiography (MCE) was then performed. The images were estimated visually with score on the segmental myocardial perfusion situation. The contrast peak intensity,time to peak intensity (TP) and area under the curve (AUC) of MCE were then analyzed quantitatively by time-intensity curve obtained by equipment attached software. ResultsIn angina patients,especially in unstable angina patients,NO concentration in coronary sinus blood was lower,while ET concentration and CEC number were markedly higher than those in control group(P<0.05). The contrast peak intensity,TP,AUC of MCE showed markedly difference between unstable angina and stable angina patients. ET and CEC had negative correlation with MCE,and NO showed positive correlation with MCE. ConclusionMCE is closely associated with coronary endothelial injury. The combinaton of the two may describe the lesion of coronary artery and evaluate the prognosis of patients with coronary heart disease more satisfactorily.

Abstract:ObjectiveTo analyze the roles of adenosine stress myocardial perfusion tomographic imaging(ASMPTI) in diagnosis of coronary artery diseases (CAD) and its significance for evaluating the sites,numbers,and stenosis of involved vessels. MethodsASMPTI was performed in 116 elderly patients suspicious for CAD. Adenosine was infused intravenously within 6min 〔140μg/(kg·min)〕. At 3 min after adenosine infusion,740 MBq of 99mTc-methoxy-isobatyl-isonitrile (MIBI) was injected intravenously. Single photon emission computed tomography myocardial perfusin imaging was obtained 1.5h after adenosine infusion. If the findings were abnormal,rest myocardial perfusion imaging would be performed next day. Coronary angiography (CAG) was performed in all patients within 1 week after myocardial imaging. ResultsAmong 116 cases,coronary artery stenosis was demonstrated by CAG in 73 patients,including 22 patients with single vessel lesions,32 with double vessel lesions and 19 with triple vessel lesions. The sensitivity,specificity and accuracy of ASMPTI for CAD were 87.7%,72.1% and 65.5%,respectively. The sensitivity for diagnosing single,double and triple vessel lesions was 59.1%,84.4% and 89.5% respectively (P<0.05). The sensitivity for diagnosing 50%-75% diameter stenosis was 57.1%,and that for diameter stenosis ≥75% was 89.4%,with significant difference between the two groups(P<0.05). The positive rate of ASMPTI was high for left anterior desending coronary artery involved coronary stenosis,either for single,double,or triple vessel lesions. As for 17 cases undergoing introvascular ultrasound,7 cases had plaque area >50% or lumen area <4mm2,and had off-center or unstable plaque. They received percutaneous coronary intervention. The ASMPTI was all positive in these 7 cases. ConclusionThe sensitivity of ASMPTI is related to coronary artery stenosis degree and numbers of involved vessels. The sensitivity for serious stenosis and double or triple vessel lesions is high,while that for mild or moderate stenosis and single vessel lesions is low. The positive concordance rate of ASMPTI for left anterior descending coronary artery is higher than that for left circumflex coronary artery and right coronary artery. It also has some values in predicting the borderline lesions.

Abstract:ObjectiveTo estimate the safety and feasibility of permanent pacemaker implantation in patients over 80 years old. MethodsTotally 125 patients aged over 80 years (very old group) who underwent permanent pacemaker implantation in General Hospital of Shenyang Military Command from January 1997 to December 2007 were selected. Another 570 elderly patients aged 65 to 79 years (elderly group),who received similar procedures during the corresponding period,served as controls. The clinical data,success rate of the procedures,and perioperative complications incidence rate were compared between the two groups. ResultsThe concomitance of multiple heart diseases (except the indications of pacemaker implantation) and the combinations of non-heart diseases were more frequent in very old group than in elderly group. The success rate of the procedures was 100% in both two groups. In very old group,single-chamber pacemaker was used in 69 patients,dual-chamber pacemaker in 50 patients,three-chamber pacemaker in 4 patients,and dual-chamber pacemaker combined with ICD in 2 patients. The patients in very old group had poor tolerance to the procedures and high perioperative complications incidence rate. The manipulation-associated perioperative complications incidence rate was not significantly different between the two groups. All complications were alleviated following effective treatment. All patients survived till being discharged from hospital. ConclusionIt is possible to avoid and decrease perioperative complications by considering the clinical features of heart diseases and improving perioperative management in over 80 years old patients,therefore it is safe and feasible to perform pacemaker implantation in patients over 80 years.

Abstract:目的探讨高血压并ST段抬高急性心肌梗死(AMI)后心电图特征性改变,评估室性电风暴与临床预后的关系。方法对有高血压并ST段抬高AMI室性电风暴(室速或室颤)患者367例(电风暴组)及无高血压室性电风暴AMI患者120例(无电风暴组)进行心电图检查和持续心电监护,分析心电图特征与临床高危特点。结果室性电风暴组患者心电图可见心房终末电位异常、∑ST段抬高振幅增高、ST段抬高导联数增多、QTc间期延长、对应导联ST段振幅下移发生率高,梗死部位以前壁或复合前壁、左前降支合并回旋支或(和)右冠脉完全闭塞多支病变为主,与无室性电风暴组比较,差异有显著性(P<0.05),临床并发泵衰竭、AMI扩展、住院病死率、室性电风暴AMI发病后<6h内发生率明显增多(P<0.01)。结论高血压并ST段抬高AMI室性电风暴患者,心电图多项指标异常对临床预后险恶有预测作用。

Abstract:ObjectiveTo compare the short-term efficiency and safety of high (600mg) versus low (300mg) loading doses of clopidogrel in patients with acute ST-segment elevation myocardial infarction (STEMI) before percutaneous coronary intervention (PCI). MethodsFrom August 2006 to Feburary 2008,a total of 131 patients with acute STEMI were randomly divided into two groups. Except age,there was no significant difference in baseline data between the two groups (P>0.05). Two hours before PCI,the patients respectively received 600mg (group A,n=65) and 300mg (group B,n=66) loading dose of clopidogrel administration,followed by the maintenance dose of 75mg/d. After 30-day follow-up,the incidence of major clinical cardiovascular events including death,recurrent myocardial infarction,urgent target vessel revascularization,angina pectoris,stroke,readmission,ST segment resolution two hours after the procedure,cardiac troponin I(cTnI) peak,hemorrhagic events,and adverse reactions were compared between the two groups. ResultsThe baseline data before PCI were not different between the two groups. The incidence of 30-day major clinical cardiovascular events (7.7% vs 19.7%,P<0.05),ST segment resolution two hours after the procedure (70.8% vs 45.5%,P<0.05),and cTnI peak after the procedure 〔(16±3)μg/L vs (22±5)μg/L,P<0.01〕 had significant difference between the two groups. The 30-day hemorrhagic events (9.2% vs 7.6%,P>0.05) and adverse reactions (12.3% vs 10.6%,P>0.05) had no significant difference between the two groups. ConclusionCompared with routine loading dose (300mg),high loading dose (600mg) clopidogrel pre-treatment can significantly improve the short term outcome of the patients with acute STEMI undergoing PCI,and the safety was identical.

Abstract:ObjectiveTo investigate the correlation between the levels of high-sensitivity C-reactive protein (hsCRP) and the stability of carotid atherosclerotic plaques and the gender-associated differences in elderly hypertensive patients. MethodsA total of 172 hypertensive patients aged over 70 years underwent ultrasound examination to measure intima media thickness (IMT). Carotid atherosclerotic plaques were identified with IMT >1.3mm. Serum hsCRP and serum lipids,creatinine and uric acid were tested. Then the patients were divided into three groups according to result of B-mode ultrasound examination:non-plaque group,stable plaque group and unstable plaque group. ResultsSerum hsCRP was significantly higher in plaque group(n=131) than in non-plaque group 〔n=41,(3.2±2.5) vs(2.0±1.8)mg/L,P=0.005〕. Logistic regression analysis showed that the serum hsCRP was the only risk factor of carotid atherosclerosis plaque (RR=1.299,95%CI=1.052-1.604,P=0.015). Further analysis showed that the serum hsCRP was significantly higher in unstable plaque group 〔(4.2±2.5)mg/L〕 than in stable plaque group 〔(2.5±2.2)mg/L,P<0.001〕 or non-plaque group (P<0.001),but there was no difference between the latter two groups (P=0.278). Serum hsCRP was higher in both female and male elderly patients with unstable carotid atherosclerosis plaques than in patients with stable plaques or without plaques. ConclusionSerum hsCRP is associated with the stability of carotid atherosclerotic plaques in elderly hypertensive patients. Serum hsCRP is higher in patients with unstable carotid atherosclerosis plaques than in patients with stable plaques or without plaques. This correlation exists in both female and male elderly hypertensive patients,with no gender-associated difference.?更多

Abstract:ObjectiveTo analyze the clinical characteristics of chronic obstructive pulmonary diseases (COPD) patients with acute exacerbation and liver function impairment and the influence of the liver-protective therapy on the prognosis of the patients. MethodsAll selected patients received basic therapy,and were divided into 3 groups. In group A,56 COPD patients with liver function impairment received liver-protective therapy. In group B,42 COPD patients with liver function impairment received no liver-protective therapy. In group C,68 COPD patients without liver function impairment received no liver-protective therapy. The clinical symptoms,the laboratory test results,hospitalization duration,hospitalization cost,and the clinical outcome were compared among three groups. ResultsCompared with group C,the patients in group A and B displayed a worse clinical outcome,more severe clinical symptoms,higher hospitalization cost,and longer hospitalization duration. The hospitalization cost was higher in group A than in group B 〔(9 534±326) vs (7 864±265) RMB yuan)〕,while hospitalization duration 〔(25±6) vs (25±6)d〕,recovery of liver function,mortality (17.3% vs 16.8%) had no significant difference between group A and B. ConclusionLiver function impairment in COPD patient with acute exacerbation extends hospitalization duration,increases hospitalization cost,and raises the patients’ mortality. However,liver-protective therapy exerts no effect on the prognosis of the patients.

Abstract:ObjectiveTo analyze the clinical characteristics of the severe sepsis in the elderly. MethodsThe clinical data of elderly severe sepsis patients admitted to General Hospital of Chinese Armed Police Forces between June 2005 and January 2009 were analyzed retrospectively. ResultsOf 645 elderly ≥65 yeras old severe sepsis patients,the total hospital mortality rate was 61.1%,and the intensive care unit (ICU) mortality rate was 41.4%. The length of total hospital stay was 21 days (median). The length of ICU stay was 20 days (median). The acute physiology and chronic health evaluation (APACHE) score Ⅱ ranged from 8 to 58 (median 26). The incidence of septic shock was 40.2%,and its mortality was 70.7%. Cultures were performed for bacteria on 935 samples,and the overall positive culture rate was 30%. The APACHE Ⅱ,length of ICU stay and length of hospital stay increased significantly in the hospital-acquired infection group compared with the community-acquired infection group. The organ dysfunction incidence rates were 77.9% in lungs,44.3% in blood,53.2% in brain,31.5% in heart,48.1% in gastrointestinal tract,20.5% in kidneys and 14.6% in liver. The mortality rate in group with organ dysfunction was significantly higher than that in group with normal organ function. The mortality rate of sepsis in the elderly increased obviously with the increase in the number of the dysfunctional organs. ConclusionThe severe sepsis in the elderly has a high mortality rate. It is frequently complicated with hospital-acquired infections and multiple organ dysfunctions. Comprehensive treatment is recommended for these patients to protect against organ dysfunctions.

Abstract:ObjectiveTo explore a quick and efficient surgical technique for establishing heterotopic abdominal heart transplantation model in rats. MethodsHeterotopic abdominal heart transplantation of rats was performed by using Ono’s method with modification. When donor heart stopped beating completely,the superior vena cava,inferior vena cava and pulmonary vein were ligated respectively with a 1/0 silk through aorta and pulmonary artery. After raising the silk and cutting all blood vessels,the donor heart was harvested. There were 20 donors and 20 recipients in experimental group (Wistar to SD rats) and control group (Wistar to Wistar rats) respectively. Over 72 hour-survival of the animal after operation was considered a successful operation. On day 4,the transplanted hearts were observed histopathologically. ResultsThe success rate of the operation was 90%. The donor heart harvesting time was(3.2±0.6)min. Acute rejection was observed in experiment group,and not in control group. ConclusionIn this technique,the donor heart harvesting time is reduced significantly compared with the current widely used Ono’s method. Wistar to SD rat heterotopic heart transplantation can establish the experimental animal model of immune rejection.

Abstract:ObjectiveTo demonstrate the roles of androgen in the heart injury of high-salt fed male rats,and to explore the interventional effect of angiotensin Ⅱ receptor type 1(AT1R) antagonist. MethodsForty Wistar rats were randomly assigned to sham-operation (Sham) group,castration (Cas) group,testosterone (Tes) supplement group,and candesartan (Cand) intervention group,with 10 in each group. All animals fed high-salt diet (8% NaCl) for 8 weeks. Animals in Sham group received sham operation,while those in Cas,Tes and Cand groups received surgical castration. Intramuscular injection of testosterone 4mg/(kg·2week) was performed in Tes and Cand groups,and intragastric administration of candesartan 3mg/(kg·d) in Cand group. The blood pressure of tail artery was measured at baseline,4 and 8 weeks after experiment respectively. At 8 weeks after experiment,the left ventricular weight (LVW),and left ventricle/body mass index (LVI) were determined; pathological changes in myocardium were observed; and serum testosterone concentration was measured by RIA. ResultsAfter 8 weeks of high-salt diet feeding,compared with the basic level,the blood pressure increased significantly in Sham and Tes groups (P<0.01); compared with Sham group,it decreased significantly in Cand or Cas group (P<0.01). LVW and LVI in Cand or Cas group decreased significantly compared with Sham group(P<0.01). Compared with Sham group,the morphological features of myocardium in Can or Cas group remained and intact and clear. ConclusionAndrogen plays a role in high-salt-induced left ventricular hypertrophy and blood pressure elevation. AT1R antagonist can exert some interventional effects.?更多

Abstract:1 病历摘要 　　患者男性,60岁,农民,主因"乏力4个月,浮肿2个月,消瘦1个月",于2006年7月6日入住我院肾内科.患者于4个月前无诱因出现乏力,2个月前间断出现双下肢可凹性浮肿,于南昌医学院查尿常规:蛋白+、潜血+,血肌酐138.2μmol/L,血红蛋白(HGB)102g/L.……