2015年 · 第43卷第06期

In August 2014, I led seven volunteers from the Volunteer Service Corps of Beijing Volunteer Service Federation to Ali, Tibet, which Bi Shumin called 5,000 meters above sea level. Carry out volunteer services in Ali District People's Hospital and Ali Military Division, donate medical equipment, train local doctors, free clinics, ward rounds and consultations. At the same time, I visited a model plateau border defense company named by the Central Military Commission in 2013. Although the volunteers had more or less altitude sickness, tight schedules and a slight feeling of fatigue, everyone was always full of energy and completed the volunteer service task excellently.

In recent years, with the emergence of new hypoglycemic drugs and new diagnosis and treatment technologies in the field of diabetes treatment, great progress has been made in blood glucose management of diabetic patients, and the risk of acute complications and microvascular complications of diabetes has been significantly reduced. However, the morbidity and mortality of cardiovascular diseases are still increasing as the most predominant and common chronic fatal complication of diabetic patients. How to do a good job in the prevention and treatment of cardiovascular diseases and diabetes is always an important issue for doctors and patients. In multiple cardiovascular endpoint studies in patients with major diabetes, strict glycemic control failed to improve patient cardiovascular outcomes^[1,2,3]。 Therefore, the prevention and treatment of cardiovascular diseases in diabetic patients cannot only rely on the improvement and control of blood sugar, but also comprehensive and comprehensive intervention on cardiovascular risk factors including blood sugar. It is a clinical topic that requires the joint participation and cooperation of endocrinology and cardiology. Guidelines for Clinical Diagnosis and Treatment of Abnormal Glucose Metabolism and Atherosclerotic Cardiovascular Disease published in this issue^[4], which provides a practical guidance scheme for this clinical subject.

With the development of translational medicine, the role of biomarkers in cardiovascular diseases has received more and more attention. They are of great application value in early diagnosis, differential diagnosis, treatment response prediction and prognosis judgment of diseases, and are important to achieve precision. An important means of medicine.

Vascular calcification is a common pathological change in atherosclerosis, hypertension, diabetic vascular disease, chronic kidney disease, vascular injury and aging, which significantly increases the occurrence of cardiovascular events^[1]。 Vascular calcification has previously been considered to be a passive, degenerative terminal process of calcium salt deposition in blood vessel wall dominated by imbalance of calcium and phosphorus metabolism. In recent years, studies including our laboratory have found that vascular calcification, similar to bone development, metabolism and cartilage formation, is an active biological process regulated by multiple factors^[2,3]The mechanisms involved are complicated, and there is still a lack of effective interventions in clinical practice. Recent studies have shown that some biologically active small molecules play an important role in the occurrence and development of vascular calcification. In-depth research in this field is expected to provide theoretical basis and intervention target for the prevention and treatment of vascular calcification.

postural tachycardia syndrome (POTS) is a subtype of orthostatic intolerance, which is more common in children, with a prevalence of about 6.8%^[1]。 POTS refers to the symptoms of dizziness or vertigo, chest tightness, headache, palpitations, complexion change, blurred vision, burnout, morning discomfort and syncope under the inducement of sudden standing or standing for a long time. The center rate of the child in the upright test or head-up tilt test (HUT) increased significantly^[2,3]。 The disease seriously affects the learning and life of children, and in severe cases, syncope may occur physical accidental injury. Therefore, the correct diagnosis and treatment of POTS patients is an important issue in the field of pediatric cardiovascular^[4]。 Biomarkers refer to cellular, biochemical, or molecular changes that can be detected from biological media such as blood, urine, tissues, and cells, and are characterized by easy acquisition, stable biochemical properties, and easy detection. In recent years, important progress has been made in the application of biomarkers to guide or assist the diagnosis and treatment of POTS^[4]。 This paper focuses on the research status of biomarkers in the diagnosis and treatment of POTS in children.

natriuretic peptides (NP) family are a kind of polypeptides with natriuretic, diuretic, vasodilating and anti-cell proliferation effects. They are of great significance in maintaining water and salt balance, blood pressure stability, cardiovascular and kidney organ functions. Corin, as a serine protease, plays a key role in NP activation. In recent years, studies have found that Corin and NP family are related to the occurrence and development of cardiovascular diseases such as hypertension, left ventricular hypertrophy, heart failure (HF), etc. This paper reviews the composition, structure and function of Corin-NP system, and expounds its important role in cardiovascular diseases.

In 1990, sudoh et al. isolated an active polypeptide from pig brain for the first time, namely C-type natriuretic peptide (CNP), which became the third member of the natriuretic peptide family. Other members include A-type natriuretic peptide (ANP), B-type natriuretic pepetide (BNP), D-type natriuretic peptide (DNP), and the like. Among them, ANP and BNP, also known as cardiac natriuretic peptides, are mainly derived from cardiomyocytes, and play physiological functions such as relaxing blood vessels, inhibiting renin angiotensin aldosterone system, increasing urinary sodium excretion and reducing blood volume. Similarly, CNP, as a cardiovascular active peptide, can relax arteries and veins, inhibit the migration, proliferation and extracellular matrix formation of vascular smooth muscle cells (VSMC) and cardiomyocytes, reduce the formation of atherosclerotic plaques, regulate cardiovascular function and humoral homeostasis, thus playing a protective role in the occurrence and development of cardiovascular diseases such as heart failure (heart failure), hypertension, myocardial hypertrophy and atherosclerosis.

Due to the change of lifestyle and the aging of the population, the number of patients with abnormal glucose metabolism and atherosclerotic cardiovascular disease (ASCVD) in China has increased significantly. Diabetes mellitus is a metabolic disease, but the main damage manifests as vascular lesions. Epidemiological studies have shown that diabetes is one of the main independent risk factors for cardiovascular disease (CVD). Abnormal glucose metabolism can significantly increase the risk of cardiovascular events in both patients who have already developed CVD and their high-risk groups. On the other hand, compared with non-diabetic patients, diabetic patients have a worse prognosis after developing CVD with obvious clinical symptoms. The risk of ASCVD has increased as early as pre-diabetes, and interventions at this time can reduce diabetes and cardiovascular events and reduce medical costs. Therefore, ASCVD risk assessment, screening and intervention should be carried out as early as possible in patients with abnormal glucose metabolism; On the contrary, the risk of abnormal glucose metabolism in patients with ASCVD is extremely high, and early detection of abnormal glucose metabolism is also very important.

A 14-year-old female was admitted to the hospital on 2 October 2014 due to "dyspnea after strenuous exercise for 3 months". Physical examination showed no obvious abnormalities. Electrocardiogram showed sinus arrhythmia. Echocardiogram showed that the aortic valve was a four-leaf structure, arranged in a "cross" character, the size of the leaflets was basically the same, and the echo was not abnormal (Figure 1)； Aortic valve flow rate 1.46 m/s; Minor regurgitation of the aortic valve; The left atrial diameter was 26 mm and the left ventricular end-diastolic diameter was 47 mm; Left ventricular ejection fraction 60%.

atrial remodeling is a new concept proposed in recent years, which has been neglected in the past, and has been paid more and more attention in recent years. Any lesions that can cause atrial enlargement or deformation and interstitial fibrosis, such as tachyarrhythmia, hypertrophic cardiomyopathy, hypertension, sleep apnea syndrome, pericardial lipothesis and valvular heart disease, can cause atrial remodeling. Atrial remodeling is associated with adverse cardiovascular events such as atrial fibrillation and heart failure, which in turn aggravates atrial remodeling and forms a vicious circle^[1,2]。 Timely control of etiology, early atrial remodeling is often reversible, so early diagnosis and intervention are of important clinical significance.

autophagy is a self-protection mechanism of cells, which plays an important role in intracellular homeostasis and cell survival^[1]。 Studies have shown that autophagy is closely related to the occurrence and development of many cardiovascular diseases^[2]。 The occurrence of autophagy is a complex dynamic process, and its activation and biological function are regulated by a variety of autophagy associated genes (Atg) and signaling pathways. microRNA (miRNA) is a kind of endogenous non-coding RNA molecule composed of 22-25 nucleotides. It causes the degradation of target mRNA or represses the translation of target mRNA by complementary pairing with different degrees of base with target gene, and regulates the gene at the post-transcriptional level. In recent years, it has been found that miRNA participates in the regulation of autophagy process by regulating the expression of autophagy-related genes, and plays an important role in the development of organisms and the occurrence of cardiovascular diseases.