2016年 · 第55卷第04期

Atherothrombosis is a systemic pathophysiological process affecting the heart, cerebrovascular and peripheral arteries, which can lead to coronary artery disease, ischemic cerebrovascular disease, transient ischemic attack and peripheral artery disease. As a classic antiplatelet drug, aspirin plays an important role in the prevention and treatment of cardiovascular diseases. It can be said that it is the cornerstone of antithrombotic treatment of atherosclerotic cardiovascular disease (ASCVD). The benefit of aspirin in the secondary prevention of cardiovascular diseases has been affirmed, but its application in the primary prevention of cardiovascular diseases is still controversial. There is still a lack of prospective large-scale clinical studies in China to evaluate the efficacy and safety of aspirin in the primary prevention. The survey results of "Current Situation of Primary Prevention of Aspirin in Outpatient Hypertensive Patients in China", which was cooperatively completed by 46 hospitals in 22 provinces and cities across the country published in this journal, show that among hypertensive patients without cardiovascular diseases, the primary prevention application rate of aspirin is 29.2%; Among them, the aspirin application rate of patients with high risk of cardiovascular diseases was 32.2%; The use rate of aspirin in low and medium risk patients was 22.4%. Among all the primary prevention applications of aspirin, the proportion of low-and moderate-risk people who are not suitable for use accounted for 23.3%. It shows that in the current primary prevention application of aspirin, the application of high-risk patients is insufficient and the application of low-and medium-risk patients is not suitable. To this end, we invited two professors, Sun Yihong and Hu Dayi, to write a monograph "Challenges and Confusions of Aspirin for Primary Prevention of Cardiovascular Diseases in China", pointing out that the primary problem faced by aspirin use in China is how to correctly assess the risk of cardiovascular events in primary prevention populations and find high-risk populations; It is suggested that the applicable population of aspirin should be selected according to the benefit and risk ratio in clinical practice, and the principle that the benefit is greater than the risk should be grasped.

Aspirin is the oldest antiplatelet drug. As early as the 4th century BC, Hippocrates described willow bark and leaves as relieving headaches and antipyretic. In 1828, German pharmacology professor Johann Buchner extracted salicin. In 1899, German chemist Felix Hoffmann isolated acetylsalicylic acid, but at that time it was mainly used as an antipyretic and analgesic. In 1971, biochemist Bergström et al. discovered the anti-platelet action mechanism of aspirin. As a classic antiplatelet drug, aspirin plays an important role in the prevention and treatment of cardiovascular diseases; But like all antithrombotic drugs, aspirin prevents blood clots and is accompanied by adverse reactions, especially an increased risk of bleeding. The important principle of aspirin use is to balance the benefits and risks, and ensure the maximum benefits of antithrombotic therapy.

Elevated plasma cholesterol, especially LDL-C levels, are pathogenic risk factors for atherosclerotic cardiovascular disease (ASCVD). Numerous studies have confirmed that reducing LDL-C plays a key role in the prevention of atherosclerotic cardiovascular events^[1,2]。 Statins are currently the most powerful, safe and best tolerated drugs in reducing LDL-C among clinical lipid-lowering drugs. A series of large-scale randomized controlled studies in the past 30 years have shown that statin treatment will significantly reduce LDL-C levels, which can greatly reduce the recurrence and initial events of ASCVD. Several important randomized controlled clinical studies released in recent years have not only further demonstrated the preventive effect of long-term intensive reduction of LDL-C on ASCVD^[3,4,5]"Cholesterol Hypothesis" to "Cholesterol Principle"^[6]That is, under the existing alternative treatment methods, as long as cholesterol is lowered within a certain range, there can be cardiovascular benefits. Statins are currently the most commonly used, effective and safe cholesterol-lowering drugs in clinical practice. Conventional dose statin therapy is the basis of lipid-lowering therapy for primary prevention of ASCVD in clinical practice.

Mycobacteria that cause human disease mainly include the Mycobacterium tuberculosis complex (Mycobacterium tuberculosiscomplex, MTB), Mycobacterium leprae (M.leprae) and Mycobacterium leprae diffuse (M.lepromatosis) and non-tuberculous mycobacteria (Nontuberculous mycobacteria, NTM) Class 3. According to the growth rate of NTM, the Berger Handbook of Systems Bacteriology classifies it into fast-growing types (e.g., M. abscessus, M. chelonae, M. fortuitous, etc.) and slow-growing types (e.g., M. avium-M. intracellularis complex (Mycobacterium avium complexMAC), Mycobacterium kansasii, Mycobacterium ulcerans, etc.). With the increasing number of HIV/AIDS patients, opportunistic infections mainly based on MAC reported in European and American countries have attracted much attention. As a result, for a long time, clinical cognition of NTM infection is mostly limited to immunodeficient patients, covering MAC-based drug combinations. The following is intended to review and compare the authoritative literature on the diagnosis and treatment of NTM infection at home and abroad, so as to better reference and use by clinicians.

Esophageal cancer is a common malignant tumor and one of the serious diseases that endanger human life and health^[1]。 The Taihang Mountain area at the junction of Henan, Hebei and Shanxi provinces, especially Linzhou in Henan and Changzhi in Shanxi, is one of the regions with the highest incidence and mortality of esophageal cancer in the world. Folic acid is one of the indispensable essential nutrients for human beings. When folic acid intake is insufficient, the risk of esophageal cancer increases^[2]。 In this study, the plasma folate levels of five groups of esophageal squamous cell carcinoma patients in Linzhou, Henan, control population in Linzhou, Shanxi, control population in Changzhi, Shanxi and Linzhou immigrants living in Changzhi (hereinafter referred to as Linzhou immigrants) were detected by ELISA, and the relationship between folate levels and the occurrence of esophageal squamous cell carcinoma was investigated.

Acute pancreatitis (AP) is an acute inflammatory disease caused by abnormal activation of pancreatic enzymes and self-digestion of pancreas and its surrounding tissues. Among them, severe acute pancreatitis (SAP) is often accompanied by serious complications, and the mortality rate can be as high as 20%^[1]。 At present, the pathogenesis of AP is not clear. B7 family members are key costimulatory molecules that provide the second signal of T cell activation, and play an important role in the regulation of immune inflammatory response. B7-H1, B7-H2 and B7-H3 as new members of B7 family have become the research hotspots^[2]。 At present, the research on B7 family members mainly focuses on tumor immunity and some inflammatory responses, but there are few literature reports in AP^[3,4,5]。 This study is a prospective clinical study. By collecting blood samples from patients with AP at different time points and different severity, the serum soluble B7-H1 (SB7-H1), SB7-H2 and SB7-H3 levels were detected, and the relationship between them and the progression and severity of AP was discussed, so as to provide new ideas for the evaluation and treatment of AP.

Patients with systemic lupus erythematosus (SLE) are prone to various opportunistic infections due to the long-term treatment with immunosuppressants, but Penicillium marneffei (PSM) is rare. One case is reported and the literature is reviewed, and its clinical characteristics and treatment experience are summarized, so as to improve clinicians' understanding of it.

Corynebacterium jielii (Corynebacterium jeikeium) is a kind of Gram-positive aerobic bacteria parasitic on the surface of human skin, belonging to the normal bacterial flora of human body, and generally does not cause disease; However, in cases such as immunodeficiency, it can cause extremely serious clinical diseases such as sepsis or infectious endocarditis. If not treated or not treated in time, it can lead to death. The following reports a case of a patient with infective endocarditis caused by Corynebacterium jersey.

July 2015Am Heart JA single-center clinical study headed by Professor Chen Yundai of the People's Liberation Army General Hospital, "Effect of liraglutide on cardiac function in patients with acute ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention in emergency department" (Chen WR, Hu SY, Chen YD, et al. Effects of liraglutide on left ventricular function in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am Heart J, 2015, 170:845-854.). This study was a prospective, randomized, double-blind, placebo-controlled study to observe the effect of liraglutide, a glucagon-like peptide 1 (GLP-1) receptor agonist, on cardiac function in patients with acute myocardial infarction.

In the past 20 years, the prevalence of diabetes in China has increased significantly. In the early 1980s, the prevalence of diabetes in China was only 1%. The results of the National Diabetes Epidemiological Survey from 2008 to 2010 showed that the prevalence of diabetes in the population over 20 years old reached 9.7%^[1]11.6% were over 18 years old^[2]The vast majority of them are type 2 diabetes. The final outcome of type 2 diabetes Atherosclerotic vascular disease (ASVD), including cardiovascular, cerebrovascular, and peripheral arterial lesions, is the leading cause of death in diabetic patients^[3]。 ASVD can occur at some stage of diabetes, or even before the onset of diabetes or prediabetes. Type 2 diabetes is not a simple disease of abnormal glucose metabolism. In addition to β cell dysfunction and insulin resistance, type 2 diabetes often coexists with other cardiovascular risk factors including hypertension, dyslipidemia, overweight and obesity. Systemic arterial vasculopathy and the occurrence of events are the outcome of most patients with type 2 diabetes. Type 2 diabetes increases the risk of cardiovascular and cerebrovascular diseases by 2 to 4 times, regardless of men and women^[4]。 The incidence and mortality of stroke in diabetic patients in China are higher than the world average. Stroke is the most common clinical outcome of ASVD in adult diabetic patients in China, and it is also the main cause of death and disability, followed by coronary atherosclerotic cardiovascular disease (CVD)^[5]。

chronic constipation (CC) is one of the most common digestive tract disorders, which is characterized by reduced frequency of bowel movements, dry and hard stool, and/or difficulty in defecation, with symptoms lasting for at least 6 months^[1]。 The overall prevalence of CC in China is about 8.2%, and the prevalence of the elderly over 60 years old is as high as 18.1%^[2]Most of them are functional constipation (FC). The main pathophysiological mechanisms of FC include delayed colonic transit and defecation disorders. The diagnostic criteria of functional gastrointestinal disease Rome III refer to FC caused by anorectal dysfunction as functional defecatory disorder (FDD), which includes two subtypes: incongruous defecation and insufficient rectal propulsion^[3]。

renin-angiotensin system (RAS) is an important regulator for maintaining human physiological homeostasis and plays an important role in the development of cardiovascular diseases. This system has recently discovered active substances such as angiotensin III, angiotensin- (1-9) and alamandine. Among them, the most well-known member, angiotensin Ⅱ (Ang Ⅱ), has the effects of constricting blood vessels, causing myocardial hypertrophy, myocardial fibrosis and atherosclerosis. Its enzymatic hydrolysis product Angiotensin- (1-7) [Ang- (1-7)] has attracted widespread attention because it is opposite to Ang Ⅱ. It was found that Ang- (1-7) produces cardiovascular protection through the specific receptors of Mas-related G protein-coupled receptors (Mrgprs)^[1,2]。 The mechanism of Ang- (1-7) antagonizing atherosclerosis can be summarized as inhibiting oxidized low density lipoprotein (ox-LDL), protecting vascular endothelial cell function, and inhibiting the proliferation of foam cells and vascular smooth muscle cells. The progress of the role of Ang- (1-7) in atherosclerosis is reviewed.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multi-systemic damage. Lupus nephritis (LN) is one of the most common and serious complications of SLE and an important cause of SLE death^[1]。 However, although the current effective drugs for the treatment of LN, such as glucocorticoids and immunosuppressants, can partially control the disease, there are still some patients whose disease cannot be completely relieved, and serious adverse reactions can occur. Therefore, it is necessary to seek new drugs that are more effective, more targeted and less toxic and side effects for the treatment of LN. In recent years, there have been more and more reports on the treatment of LN by biological agents, and good clinical efficacy has been achieved. Compared with traditional therapeutic drugs, new biologics have a faster onset of action and can target the pathogenesis of LN. The main mechanism of action is to regulate the activation of B lymphocytes and T lymphocytes, the interaction between T lymphocytes and B lymphocytes and the production of related cytokines. The research progress of biological agents in the treatment of LN is summarized as follows.

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