阻塞性睡眠呼吸暂停综合征合并高血压与红细胞分布宽度的关系

目的：探讨阻塞性睡眠呼吸暂停综合征（OSAS）合并高血压与红细胞分布宽度（RDW）的关系。方法选择2011年1月至2013年8月在中国人民解放军第九四医院呼吸内科门诊及住院的 OSAS 合并高血压患者（OSAS合并高血压组）44例和体检中心体检的原发性高血压患者（高血压组）57例、健康体检者（正常对照组）52例。各组清晨空腹抽取肘静脉血2 mL,用全自动五分类血细胞分析仪检测红细胞（RBC）计数、血红蛋白（Hb）、RDW 及白细胞（WBC）计数,比较各组 RDW 的差异,并进行相关性分析。结果高血压组 RBC 计数、Hb、RDW 和 WBC 计数与正常对照组比较差异均无统计学意义（均 P ＞0．05）;OSAS 合并高血压组 BMI、DBP、RBC 计数、Hb 和 RDW 均明显高于正常对照组、高血压组,SBP 明显高于正常对照组、明显低于高血压组（均 P ＜0．05）;高血压组 SBP、DBP均明显高于正常对照组（均 P ＜0．05）。相关性分析结果显示,OSAS 合并高血压组 RDW 与睡眠呼吸暂停低通气指数（AHI）呈正相关（r＝0．426,P ＜0．05）,与最低氧饱和度呈负相关（r＝－0．509,P ＜0．05）。结论高血压患者RDW 无明显改变,RDW 增高可能是 OSAS 合并高血压患者心脑血管事件的标志物。     

大承气汤联合电针在治疗肝移植术后腹内高压中的应用效果

目的探讨大承气汤联合电针在治疗肝移植术后腹内高压中的应用效果。方法将53例肝移植术后腹内高压（腹内压≥1.330kPa）患者按随机数字表法分为2组：对照组26例采用胃肠减压,静脉营养支持,纠正水、电解质紊乱和酸碱平衡,静脉泵入生长抑素抑制肠液分泌,合理应用抗生素控制感染等常规治疗;治疗组27例在常规治疗基础上采用大承气汤联合电针治疗。治疗1周,比较2组临床效果及腹内压变化情况。结果治疗1周后治疗组有效27例,有效率为100.0%,对照组有效23例,有效率为88.5%,治疗组有效率显著高于对照组（P〈0.05）。治疗组治疗后1-7d腹内压明显低于对照组（P〈0.01）。结论在常规治疗基础上运用大承气汤联合电针治疗肝移植术后腹内高压是一种促进肝移植术后腹胀患者肠蠕动,降低腹内压,减轻腹胀的安全有效方法。     

24小时尿钠排泄与难治性高血压患者血压达标状态的相关性:单中心横断面研究

目的分析24 h尿钠排泄与难治性高血压(resistant hypertension,RH)患者诊室血压及家庭自测血压(home blood pressure monitoring,HBPM)达标状态的关系。方法通过北京协和医院心内科门诊RH数据库,收集2017年10月至2018年3月间在北京协和医院心内科门诊就诊的RH患者临床资料,进行横断面调查。检测患者24 h尿钠,记录患者同期诊室血压、HBPM水平及临床用药情况,以所有患者24 h尿钠水平四分位数为分界点,将研究对象分为低尿钠、低-中尿钠、中-高尿钠及高尿钠4组。采用多因素Logistic回归,分析影响RH血压达标状态的危险因素。结果共202例RH患者入选本研究,男性107例,女性95例,平均年龄(59. 87±16. 30)岁。24 h尿钠平均水平为(198. 92±96. 59) mmol,年轻患者及体质量指数高者尿钠水平更高(P均<0. 001)。随尿钠升高,降压药物的服用种类显著增多(P=0. 001),早晨及上午的HBPM达标率低(P=0. 040,0. 032)。多因素Logistic回归分析显示,24 h尿钠水平与诊室血压(OR=2. 356,95%CI:1. 004～5. 533,P=0. 049),HBPM早晨血压(OR=2. 408,95%CI:1. 026～5. 650,P=0. 030)及HBPM上午血压(OR=2. 299,95%CI:1. 031～5. 129,P=0. 033)达标状态独立相关,而与下午及夜间HBPM血压达标状态无显著相关(P均>0. 05)。结论 24 h尿钠是RH患者诊室血压及HBPM早晨及上午血压达标的独立相关因素,限制钠盐摄入对减少RH患者血压波动、促进血压达标有重要作用。     

积极降压对脑小血管病防治策略的影响

2017年,美国心脏病学会和美国心脏协会提出将高血压诊断标准降为130/80 mm Hg (1 mm Hg=0. 133 kPa),这与其他指南有所不同。降压治疗的核心目标在于靶器官的保护,近年来降压治疗与脑小血管病预防的相关问题日益受到临床重视。目前研究结果表明,降压治疗对腔隙性卒中患者的二级预防以及白质病变进展的预防可能有一定积极意义,但确切的降压目标值并未确定。血压与临床结局可能呈现J型关系,血压过低或过高可能均有害,而取得最大获益的降压目标有待进一步探索。     

MSCT血管成像技术在门静脉高压症中的临床应用价值

目的探讨多层螺旋CT（MSCT）血管成像技术（MSCT angiography,MSCTA）在门静脉高压症（portal hy-pertension,PHT）诊断及临床治疗中的价值。方法对50例PHT患者者行MSCTA,观察患者门静脉系统的解剖学类型、门静脉主干及其分支侧支循环显示情况;观察食管胃底静脉曲张的形态、位置及血供类型。结果 50例门静脉高压症患者门静脉及侧支循环显影包括：食管下段静脉曲张94.0%,胃底静脉曲张90.0%,胃左静脉曲张90.0%,食管旁静脉曲张72.0%,胃短、胃后静脉曲张32.0%,脾/胃-肾静脉分流28.0%,副脐静脉、腹壁静脉曲张26.0%,腹膜后-椎旁静脉曲张22.0%。对21例患者施行手术,手术与影像学诊断完全符合。MSCTA检出胃静脉曲张（gastric varices,GV）阳性49例所见的病状与胃镜下所见病状对比一致性较好。结论 MSCTA能为PHT患者判断病变程度、预测其并发症及选择治疗方案提供可靠的依据。     

671例高血压住院患者用药状况分析

目的：分析2009年成医附院高血压住院患者降压达标时的用药状况及临床意义。方法：对住院的671例高血压患者在血压达标时所用降压药的情况进行分析。结果：671例患者中联合用药者521例,占用药例数的77.65%,其中两药合用者262例,占用药例数的39.05%,以CCB＋ARB（89例）最常见;三药合用者201例,占用药...     

Inappropriately elevated endothelin‐1 plays a role in the pathogenesis of intradialytic hypertension

The aim of this study is to investigate the effects of endogenous vasoactive substances on the occurrence of intradialytic hypertension (IDH) in patients during maintenance hemodialysis. Thirty‐four maintenance hemodialysis patients were enrolled in this trial, and 17 of them were diagnosed with IDH (defined as an increase in blood pressure of at least 10 mmHg during or immediately after a hemodialysis session), while 17 age‐matched and sex‐matched controls without IDH were selected for a retrospective comparison. We collected patients' blood samples before and after a dialysis session and measured the plasma levels of N‐terminal fragment brain natriuretic peptide, renin, angiotensin‐II, aldosterone (ALD), angiotensin‐converting enzyme (ACE), endothelin‐1 (ET‐1), nitric oxide (NO), norepinephrine (NOR), and adrenomedullin. The post‐dialysis serum ET‐1 concentrations were significantly higher (4.09 ± 2.06 vs. 2.75 ± 1.34 pg/mL, P < 0.05), while the post‐dialysis ratio of NO to ET‐1 was lower (17.79 ± 5.65 vs. 24.78 ± 12.04, P < 0.05) in IDH patients compared with the control group. Post‐dialysis ALD and NOR values were significantly lower (P < 0.01) and ACE levels were significantly higher (P < 0.01) than the pre‐dialysis concentrations only in the control and not in the IDH group. All other measured factors did not differ significantly between the groups and between pre‐dialysis and post‐dialysis determinations. Compared with blood angiotensin‐II, ALD, ACE, NOR, adrenomedullin, N‐terminal fragment brain natriuretic peptide, and NO status, inappropriately elevated ET‐1 plasma concentrations may play a predominant role in the pathogenesis of IDH.     

H型亚微米梁的混频特性测量

本文简述了H型亚微米梁的工艺实现过程,从实验上详细研究H型梁的两种混频方式:向下混频和向上混频.考察的H型梁长度分别为8μm、10μm、12μm和15μm,小激励下谐振频率分别为13.30 MHz、8.77 MHz、6.12 MHz和3.65 MHz.通过在梁上施加两路不同频率的静电激励信号,调整两信号频率差值及和值在梁的本振频率附近变化,经过梁的自适应过程实现信号混频,最后由多普勒测振仪检测梁的混频特性.实验结果表明梁在向下混频时的振幅随两路信号频率的平移而改变,出现所谓的窗口效应;对于这两种混频方式,混频分量越接近梁的本征频率,梁的振幅越大,反之梁振幅下降越多;在输入信号功率均设置为14 dBm时,对比向上混频,向下混频使得梁的振幅更大,诸如12μm长的梁向下混频时梁振幅为4.082 nm,而向上混频时混频处振幅仅为1.826 nm.     

Melatonin May Curtail the Metabolic Syndrome: Studies on Initial and Fully Established Fructose-Induced Metabolic Syndrome in Rats

To examine the effect of melatonin given to rats simultaneously with fructose on initial and fully developed metabolic syndrome, male Wistar rats had free access to chow and 5% or 10% fructose drinking solution for 8 weeks. As compared to controls, systolic blood pressure augmented significantly under both treatments whereas excessive body weight was seen in rats receiving the 10% fructose only. Rats drinking 5% fructose showed a greater tolerance to a glucose load while rats having access to a 10% fructose drinking solution exhibited the expected impaired glucose tolerance found in the metabolic syndrome. Circulating triglyceride and low density lipoproteins-cholesterol (LDL-c) concentration augmented significantly in rats showing a fully developed metabolic syndrome only, while high blood cholesterol levels were found at both stages examined. Melatonin (25 μg/mL drinking solution) counteracted the changes in body weight and systolic blood pressure found in rats administered with fructose. Melatonin decreased the abnormal hyperglycemia seen after a glucose load in 10% fructose-treated rats but it did not modify the greater tolerance to glucose observed in animals drinking 5% fructose. Melatonin also counteracted the changes in plasma LDL-c, triglyceride and cholesterol levels and decreased plasma uric acid levels. The results underline a possible therapeutical role of melatonin in the metabolic syndrome, both at initial and established phases.     

四氯化碳复合、梯段用药法制备大鼠门脉高压模型的研究

目的探讨构建一种稳定、可靠的门脉高压大鼠模型的制备方法,并研究该模型肝脏病理结构以及血流动力学的改变。方法雄性SD大鼠95只,体重150～170g,按编号法随机分为模型组和对照组。模型组:按0.4mL/100g剂量予以背部皮下注射50%CCl4橄榄油溶液,每周2次,持续4周。第5周开始改为以0.5mL/100g标准注射,每周2次,持续4周。对照组:仅注射橄榄油,频度及剂量同模型组。结果对照组10只大鼠全部存活。模型组85只大鼠,死亡24只,死亡率28%。存活61只大鼠,肝脏均可观察到纤维组织不同程度地增生,肝小叶结构破坏,假小叶形成,模型成功率100%。模型组门静脉压力和门静脉内径比对照组明显增加(P<0.05);血清TB、ALT及AST较正常对照组均明显升高(P<0.05),而ALB则明显降低(P<0.05)。结论该方法所构建的动物模型其组织学改变与人类肝硬变相似,门静脉压力显著增高,是研究门脉高压症的理想模型。