2008年 · 第121卷第16期

Hypertension is a prevalent disorder and accounts for a large proportion of cardiovascular morbidity and mortality worldweide.1 In china,hypertension appears to be a big burden of public health issues。

Abstract：Background The baseline characteristics of patients in a multinational trial are possibly related to cardiovascular outcome.This study compared the baseline Characteristics of patients recruited in China with those recruited in other countries.Methods A total of 508 Chinese hypertensive men and 728 women over the age of 80 years who entered the Hypertension in the Very Elderly Trial(HYVET)were compared with those in 860 men and 1 348 women who entered the trial in other countries.Results The Chinese subjects were slightly younger,had less previous hypertension but more previous strokes than the subjects from other countries.The Chinese subjects smoked more than those from other countries,but drank less alcoho1.They had less previous episodes of myocardial infarction and were,on average,lighter and shorter.The Chinese had lower mean concentrations of blood urea,uric acid and creatinine as well as higher concentrations of high density lipoprotein(HDL)cholesterol.The concentration of total cholesterol was,on average,lower in the Chinese subjects as was blood glucose.The levels of serum sodium and potassium,blood hematocrit and hemoglobin were all,on average,lower in the Chinese subjects.Conclusions Calorie restriction,compared with the rest of the world,may have resulted in lower stature and weight, and recent increases in calorie intake have not changed the metabolic profile of the very elderly hype~ensive patients in China.Some of these biochemical differences may reflect different dietary lifestyle in the Chinese。

Abstract：Background Recently,it has been proposed that the autoantibodies against various cardiovascular receptors play a role in the pathogenesis of primary hypertension.In this study,we aimed to identify whether or not there are autoantibodies against cardiovascular L-type Ca2+ channels in patients with primary hypertension.Methods A peptide corresponding to the sequence 2-16 of the alc-subunit of L-type Ca2+ channel was used as an antigen to screen the autoantibodies from 90 patients with primary hypertension and 45 healthy controls by an enzyme-linked immunosorbent assay(ELISA).The clinical data of 90 hypertensive patients were compared between patients with and without these autoantibodies.Results Serum from 3(6.7%)of the 45 healthy controls,33(36.7%)of 90 hypertensives showed positive responses in ELISA(P<0.01).The prevalence of such autoantibodies in two subgroups of hypertensives with coronary heart disease(9/21,57.1 4%,P<0.05)and left ventricular diastolic dysfunction(28/63,44.4%,P<0.05)was higher than in those without the corresponding complications.And the patients with such autoantibodies had lower E/A than patients without such autoantibodies(O.803±0.191 vs 1.004=L+0.322,P=0.002).Conclusion There are autoantibodies against vascular L-type Ca2+ channels in patients with primary hypertension。

Abstract：Background As a kind of sirolimus-eluting stent(SES)made in China,Firebird SES is more effective than bare metal stent(BMS)and not inferior to Cypher SES for short coronary lesions in terms of reduction of restenosis and revascularization.However,Firebird SES does not show any benefits in patients with a very long coronary lesion(VLCL).The present study was undertaken to evaluate the safety and efficacy of Firebird SES for VLCL by comparison of Cypher SES and BMS.Methods In this prospective,nonrandomized and comparative study,eligible patients with de novo coronary lesion(≥30 mm)between January 2005 and June 2006 were allocated into Firebird SES group,Cypher SES group or BMS group.They were subjected to an angiographic follow-up of 6 months and a clinical follow-up of 12 months.The primary endpoints constitute the in-stent and in-segment restenosis rates at 6 months.The secondary endpoint was defined as a major adverse cardiovascular event(MACE)that was a 12-month combined endpoint of all-cause deaths,reinfarction or in-stent thrombosis.and target-lesion revascula rizatjon.The 12-month in-stent thrombosis was also evaluated to address the safety of Firebird SES implantation exceptionally.Results A total of 468 patients were assessed for eligibility.Of 11 3 patients who were finally included according to the prior inclusion and exclusion criteria,39(41 lesions)were treated with Firebird SES,37(39 lesions)with Cypher SES,and 37(37 lesions)with BMS.There were no significant differences in the baseline characteristics between the three groups;but there were longer lesions,more frequent use of overlapping stent in the Firebird SES group and the Cypher SES group.Angiographic follow-up showed that the rates of binary stenosis were similar between the Firebird SES group and the Cypher SES group(in-segment:14.6%vs 12.8%,relative risk(risk1.14.14p=0.81:in-stent:9.8%vs 10.3%, RR0.95,p=0.94),and significantly lower than those in the BMS group(in-segment:vs 36.1%,RR0.41 or 0.36,P=0.04 or 0.03,respectively;in-stent:vs 30.6%,RR0.32 0r 0.34,p=0.03 or 0.04,respectively).The total MACE rate up to 12 months was also similar in both SES groupss(7.7%vs 5.4%,P=1.000),and significantly Iower than that in the BMS group (27.0%,p=0.034 or 0.024,respectively).The in-stent thrombosis rate in the follow.up period was 2.6%in the Firebird SES group,not higher in the Cypher SES and BMS groups(2.7% and 2.7%,respectively,p=1.000).Conclusions In the treatment of VLCL,Firebird SES would be safer and more effective than BMS.Firebird SES may be not inferior to Cypher SES in terms of restenosis and MACE。

Abstract：Background The prevalence of metabolic syndrome(MetS)in hypertensive population in Chinese countryside is unknown.Firstly this study compared the prevalence of MetS according to National Cholesterol Education Program (NCEP) ATPlll,revised NCEP and International Diabetes Federation(IDF)definitions.Secondly,it investigated the association between MetS,coronary heart disease(CHD)and stroke in patients with hypertension. Methods In this CROSS sectional study,the cluster sampling method was used.Three MetS definitions were applied to 1418 normal subjects and 5348 hypertensive patients aged 40-75 years in rural areas in China.The agreement between different MetS definitions was estimated by K statistics.Logistic regression analyses determined the association between MetS defined by the three MetS definitions and CHD and stroke.Results In subjects without hypertension,the prevalence of Mets was 4.1%bv NCEP definition.8.3%revised NCEP definition and 7.8%IDF definition.In hypertensive individuals,the prevalence was 1 4.0%,32.9%,and 27.4%in men:35.6%,53.1%,and 50.2%in women by the same definitions,respectively.In hypertensive individuals,the agreement was 94.4%in men and 97.0%in women between revised NCEP and IDF definitions.The IDF defined MetS was more strongly associated with CHD than the NCEP or revised NCEP defined MetS(adjusted odds ratio:1.92 compared with 1.85 and 1.69 in men:1.64 compared with 1.48 and 1.60 in women).Conclusions In the patients with hypertension,the revised NCEP and IDF definitions identified more individuals than NCEP definition and their agreement is very high.The IDF defined MetS is more strongly associated with CHD than the NCEP or revised NCEP defined MetS,but weakly or not associated with stroke。

Abstract：Background Acute renal failure following coronary artery bypass grafting(CABG)surgery is associated with high morbidity and mortality.Approximately half of all patients who develop acute kidney injury(AKI)subsequently develop acute renal failure(ARF).The purpose of the study was to compare early transient changes in renal function within the first post-operative week following CABG in patients that were either off-pump or on-pump.Methods Eight hundred and forty-nine consecutive patients with isolated CABG in a single institution between January 1990 and August 2006 were retrospectively analyzed.including 51 8 off-pump and 331 on-pump patients.A multivariate Logistic regression model was constructed to identify risk factors for the development of AKI.Results sixty-one off-pump patients and 63 on-pump patients developed AKI.Risk factors for the development of post-operative AKI included an ejection fraction≥50%or≤30%,a pulse pressure>60 mmHg,peripheral vascular disease,diabetes,emergent procedure,triple-vessel disease,body mass index,peri-operative and post-operative.intra.aortic balloon pumping,NYHA class III and IV,and cardiopulmonary bypass.An ejection fraction Z50%and peri-operative and post-operative intra-aortic balloon pumping were protective(OR<1).Peak serum creatinine for post-operative Akl was noted 12 hours and 24 hours in the off-pump and on-pump patients,respectively.Serum creatinine kinetics revealed rapid recovery in the 24th to 48th hour(off-pump)and the 48th to 72nd hour(on-pump).Conclusion Renal protection strategies are indicated from general anesthesia induction until 48 and 72 houm post-operatively in off-pump and on-pump patients,respectively。

Abstract：Background Rotation of the left ventricular(LV)apex to the base,or LV torsion,is related to myocardial contractility and structure and has recently been recognized as a sensitive indicator of cardiac performance,but it has been difficult to measure.The recent development of 2-dimensional(2D)speckle tracking imaging(STI)may provide a powerful means of assessing LV torsion.This study was conducted to evaluate the global and regional LV twist in patients with anterior wall myocardial infarction(AMI)disease before and after revascularization by STI.Methods 2D STI was performed in 35 AMI patients before and one month after revascularization,as well as in 32 normal controls.Left ventricular global and regional rotations were obtained at basal and apical short-axis levels;LV torsion was defined as apical rotation relative to the base.The time sequences were normalized to the percentage of systolic and diastolic duration.Results Before revascularization,LV peak regional and global torsion in patients with Aml were significantly reduced as the result of reduced apical and basal rotation relative to those of normal control group(all P<0.001):most significantly in the anterior and anterior-septal regions(P<0.001);one month after revascularization,there were significant changes in peak rotation at either the base or apex relative to pre-revascularization values(all P<0.001).Similarly,peak regional and global LV torsion were increased significantly(all P<0.001).Global torsion inversely correlated with EDV(r=0.605,P=0.028)and ESV(r=-0.638,P=-0.019):and positively correlated with LVEF(r=0.630,P=0.021).tlght relations were also found between torsion and.LV longitudinal and short axis function.Conclusions Systolic torsion was decreased in AMI patients.Revascularization therapy can improve the LV function of the AMI patients.STI has a potential to quantify left ventricular global and segment torsion in patients with AMI,and may make the assessment more available in clinical and research cardiology。

Abstract：Background Although the role of fibrinogen as a predictor of acute myocardial infarction(MI)has been well-established,the association of genetic polymorphisms in the fibrinogen gene with MI is still controversial.This study was conducted to elucidate the association between the genetic polymorphisms of the fibrinogen β-chain(FGB)gene and MI in Chinese Han population.Methods The occurrence of 3 common polymorphisms(i.e.-455G/A,R448K and 8558C/G)in a case-control study including 508 patients with MI and 503 healthy controls was investigated. Results Analyses of single polymorphisms showed that individuals carrying the rare alleles for the 3 polymorphisms were significantly associated with a decreased risk of MI.Logistic regression analysis indicated that R448K remained independently associated with MI after adjustment for environmental risk factors(adjusted odds ratio(OR)=0.71 for KK/RK versus RR.P=0.023).The three polymorphisms were found to be in strong linkage disequilibrium.Haplotype analyses showed that the A-K-G haplotype(-455A,448K,8558G)was associated with a protective effect against MI.Compared with the common haplotype G-R-C,the adjusted OR for A-K-G was 0.68(95% CI,0.51-0.90;P=0.006). Conclusion These data indicate that individuals carrying the FGB 448K allele may be protective against having MI in this population。

Abstract：Background The Lecompte(REV)procedure is used to correct abnormal ventriculoarterial connedions in patients with congenial heart diseases;it avoids the need for an extracardiac conduit for pulmonary outflow tract reconstruction.The present study aimed to investigate effectiveness and criteria of the REV procedure in children with abnormal ventriculoarteriaI connections. Methods Thirty-eight children(mean age,(2.2+1.7)years;mean weight,(11.5±3.8)kg)with abnormal ventrieuloarterial connections who had an REV procedure in our hospital from January 1998 to May 2006 were studied.Only 10 patients had the usual anteroposterior relationship of the two great arteries.The infundibular septum between the two semilunar valves was aggressively resected to enlarge it and construct a straighter left ventricular outflow tract and a wide tunnel between the ventricular septal defect(VSD)and the aorta.Eighteen cases had the original REV procedure;20 had a modified REV procedure.Results All patients are alive;none developed severe complications.The postoperative right ventricular(RV)to left ventricular(LV)pressure ratio was 0.20-0.45.Five patients had RV dysfunction;2 patients had a pressure gradient in the RV ventricular outlet of 30.0-34.5 mmHg;3 cases had a 37.5-47.3 mmHg pressure difference in the RPA.All patients had an RV pressure less than half the systemic pressure.These gradients'magnitudes in all patients were consistent with the post-operative RV to LV pressure ratio(P<0.05).During the follow-up(mean,(4.2±0.6)yeam),2 patients had an RPA pressure gradient of 24.0-29.3 mmHg which abated to less than 10 mmHg after two years. Conclusions The REV procedure provides satisfactory short-to medium-term results.It may be superior to the Rastelli procedure for treating ventriculoarterial connection abnormalities;it allows early,complete anatomic repair and reduces the need for late re-opemtion,since no extracardiac conduit is needed.Longer follow-up is needed to determine Iong-term outcomes。

Abstract：Background Spontaneous direct carotid-cavernous fistula(CCF)is relatively rare and few reports have been found in the literature.The aim of this paper was to report the clinical characteristics,imaging findings and curative effect of endovascular treatment for patients with spontaneous direct CCF.Methods We retrospectively analyzed the clinical data of nine patients with spontaneous direct CCF admitted between May 2003 and November 2007 and the outcomes of endovascular treatment.Sudden neuro-ophthalmological symptoms were the most common clinical presentation at diagnosis(n=8).No patients had a history of head trauma.Cerebral digital subtraction angiography(DSA)was performed on all cases under local anesthesia and seven cases received endovaSCUIar treatment.Results In eight patients,internal carotid angiograms recorded during the early arterial phase revealed aneurysms located in the cavernous sinuses,and in one patient,a dilated internal carotid artery(ICA)was seen.Among the nine cases,seven received endovascular treatment via a transarterial approach and complete occlusion of the fistula was obtained with no technique-related complications,one died suddenly before treatment and one gave up treatment.A detachable balloon was used as the embolic material in two cases.a detachable balloon and detachable coil as the embolic material in two cases,balloon-assisted coil embolization in two cases and covered stents were successfully placed in the parent vessel to exclude the aneurysm and fistula from circulation in one case.During a follow-up period of 3-48 months,all treated patients remained asymptomatic except for one patient who suffered from ipsilateral decreased vision.Conclusions Most spontaneous direct CCF may be caused by a ruptured intracavernous aneurysm with direct shunting into the cavernous sinus.Endovascular treatment seems to be a safe and effective method for treating spontaneous direct CCF。

Abstract：Background Recent studies indicate that Sl 00P expression may be a biomarker that can predict the success of cancer chemotherapy. Whether it is relevant to chemOtherapeutics in ovarian cancer is unknown.In this study,we investigated the association of S1OOP expression with paclitaxel sensitivity in ovarian cancer cell lines.Methods We measured S1 OOP expression and paclitaxel resistance profiles in parent SKOV3 and OVCAH3 cell lines.Then,the two cell lines were transiently transfected with SlOOP siRNA.We also constructed an OVCAR3 cell clone that stably overexpressed SIOOP The effect of S100P expression level on the survival of cells exposed to paclitaxel was measured using the MTT assav.S1OOP expression was evaluated by semi-quantitative RT.PCR and Western blotting.Significance of differences was calculated using independent samples t-test and one way analysis of variance(ANOVA).Results Lower S1 00P expression was associated with a survival advantage in OVCAR3 cells exposed to paclitaxel;the survival advantage in SKOV3 cells was smaller P<O.05).The survival advantage associated with decreased S1 OOP expression was even greater for SKOV3 and OVCAR3 cells that had been transfected with S1 00P siRNA before being exposed to paciitaxel(P<0.05).Consistent with this,the OVCAR3 cell clone that was transfected to overexpress S1 00P was more sensitive to paclitaxelf P<0.05).Conclusions Low S1 00P expression contributes to drug resistance to paclitaxel in ovarian cancer cell lines.S100P expression thus might be a marker that can predict the effectiveness of paclitaxel based chemotherapy.Such a marker could be helpful in improving individual medication regimens for ovarian cancer patients。

Abstract：Background Hypertension is common,especially in individuals aged 40 years and over,and it affects about half of the population aged 60 years and over.This study aimed to determine the frequency and risk factors of hypertension among individuals aged 50 years and over,and to examine its effect on the health related quality of life(HRQOL).Methods This population-based cross-sectional study was conducted in two settlements in a region of western Turkey between March 1 and April 30,2007.A questionnaire concerning life habits associated with hypertension,medical histories,and demographic characteristics was filled in by a face to face interview.The SF·36 scale was used to assess HRQOL Body mass index(BMI)was calculated by measuring the weight and length of the body. Results of 1599 individuals living in the region,1193 participated in the survey(48.3%men and 51.7%women).The overall prevalence rate of hypertension was 59.5%(n=710),being 58.O%in men and 60.9% in women(P>0.05).The variables that most positively influenced hypertension(P≤0.05,for each one)were older age(especially the age group of those aged 60 and over),single,no health insurance,consumption of animal fat in meals,and family history of hypertension.The HRQOL of the patients with hypertension was lower than that of those without hypertension(P≤0.05). The HRQOL was better in hypertensive patients whose blood pressure was under control,whereas it was worse in those with at least one chronic disorder accompanying hypertension(P≤0.05,for each one).Conclusions Great emphasis should be placed on the need for a public health program for the detection,prevention, and control of hypertension,including other risk factors,as well as for the modification of foods and life habits,specifically in individuals who are most likely to be at risk of hypertension。

Abstract：Objective The alm of this review is to objectively access the trial evidence on the role of omega-3.red yeast rice and garlic in preventing clinical cardiovascular events.Given the large number of clinical trials favoring statin use in cardiovascular disease,it is important to see if evidence is available for these supplements and whether they could replace statin therapy.Data source A PubMed search was conducted using the keywords 'trial,omega-3,red yeast rice,xuezhikang,garlic, cholesterol,cardiovascular,outcomes';the resulting trials were reviewed together with the references quoted in the papers obtained.Study selection The studies selected are prospective,randomized,placebo-controlled studies with predefined clinical cardiovascular end-points recruiting at least 2000 patients,with a follow-up over 2 years.Results Modest dose omeqa-3 fatty acld has been shown in GiSSl-P(11324 patients,follow-up 3.5 years)to produce a reduction in sudden death of 45%,and in cardiac death of 35%,acting probably via an anti-arrhythmic effect.In JELILS (18645 patients,follow-up 4.6 years),high dose omega-3 given to Japanese patients on a high fish diet and already on statin treatment produced fu rther benefit with a 19%reduction of nonfatal cardiovascular outcomes;fatal cardiac events are not affected.CCSPS(4870 patients,follow-up 4 years),a secondary prevention trial using xuezhikang,a commercial red yeast rice preparation.produced a 46%reduction in nonfatal myocardial infarction and coronary death.There has been no trial to show that garlic reduces clinical cardiovascular outcomes.A rigorous trial with constant assessment of chemicals in the study material in 192 patients found that over a 6-month follow-up.raw garlic and 2 commercial preparations do not significantly affect lipid levels.Conclusions Omega-3 in modest doses reduces cardiac deaths,and in high doses reduces nonfatal cardiovascular events.Red yeast rice reduces adverse cardiac events to a similar degree as the statins.It is unlikely that garlic is useful in preventing cardiovascular disease。

Inflammation plays an important role in the pathogenesis of atherosclerosis,and low-grade chronic systenuc inflammation iS thought to be related to adverse cardiovascular outcomes.In the past decade, epidemiological studies have repeatedly shown an association between coronary heart disease and periodontal disease。

Myxoid adrenocorticfal adenomas are extremely rare with only 24 cases reported.1-12 The first case was reported by Tang et al1 in 1979 which was diagnosed as a myxoid adrenocortical carcinoma. Nearly all the reports were of single case except Browen et al3 who described a group of 14 cases. We report here an additional case of myxoid adrenocortical adenoma with an immunohistochemical study of the tumor and discuss the diagnosis with reference to the current literature。