Objective: To explore the association between metabolic dysfunction-associated fatty liver disease (MAFLD) and myocardial ischemia in non-obese patients with suspected coronary heart disease (CAD), and to analyze the differences in this association across subgroups stratified by body mass index (BMI) and coronary artery lesion severity. Methods: This retrospective study enrolled non-obese patients (18.5 kg/m²≤BMI<28.0 kg/m²) with suspected CAD who underwent stress/rest radionuclide myocardial perfusion imaging (MPI) at the Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University between January 1, 2022 and December 31, 2024. Patients were divided into myocardial ischemia group and non-ischemia group based on MPI findings. MAFLD diagnosis was determined based on hepatic steatosis detected by low-dose CT integrated with single-photon emission computed tomography/CT (SPECT/CT), combined with established diagnostic criteria (no excessive alcohol consumption plus presence of metabolic dysfunction). Univariate and multivariate logistic regression models were applied to analyze the correlation between MAFLD and myocardial ischemia. Stratified analyses were further performed according to BMI (normal weight: 18.5 kg/m²≤BMI<24.0 kg/m²; overweight: 24.0 kg/m²≤BMI<28.0 kg/m²) and coronary angiography results (obstructive or non-obstructive CAD) to assess the relationship between MAFLD and myocardial ischemia in each subgroup. Results: A total of 271 patients with suspected CAD were enrolled, aged (61.6±10.2) years, with 143 (52.8%) males. There were 135 patients in the myocardial ischemia group and 136 in the non-ischemia group. MAFLD was diagnosed in 88 patients (32.5%). The proportion of patients diagnosed with MAFLD was higher in the myocardial ischemia group than in the non-myocardial ischemia group (61 cases (45.2%) vs. 27 cases (19.9%), P<0.001). Multivariate logistic regression analysis showed that MAFLD was independently associated with myocardial ischemia (OR=3.43, 95%CI 1.85-6.28, P<0.001). Subgroup analysis revealed that MAFLD was associated with myocardial ischemia in both normal weight group (OR=7.62, 95%CI 2.48-23.44, P<0.001) and overweight group (OR=2.60, 95%CI 1.20-5.60, P=0.015), with a stronger association observed in normal-weight individuals. This association also existed in non-obstructive CAD group (OR=6.50, 95%CI 2.23-18.94, P<0.001) and obstructive CAD group (OR=3.05, 95%CI 1.37-6.80, P=0.006). Conclusion: MAFLD acts as an independent risk factor for myocardial ischemia in non-obese patients with suspected CAD, and this association persists across subgroups stratified by BMI (normal weight vs. overweight) and coronary lesion phenotype (obstructive vs. non-obstructive CAD).
Objective: To investigate the effect of Roux-en-Y gastric bypass (RYGB) on salt-sensitive hypertension and its underlying molecular mechanism. Methods: (1) Clinical study: A total of 57 patients who underwent RYGB at Daping Hospital, Army Medical University between December 2010 and May 2025 were enrolled. According to the diagnostic criteria for hypertension, the patients were divided into normotensive group and hypertensive group. Baseline and postoperative clinical data were collected. Daily sodium intake was calculated based on 24-hour urinary sodium excretion, and the correlation between preoperative sodium intake and the reduction of postoperative systolic blood pressure was analyzed. (2) Animal experiment: Forty-eight 6-week-old male Dahl salt-sensitive hypertensive rats were fed an 8% high-salt diet for 8 weeks to establish the salt-sensitive hypertension models. Thirty modeled rats were randomly divided into the RYGB group (n=15) and the sham operation group (n=15). The remaining 18 rats were randomly divided into control group (n=6), liraglutide group (n=6) and liraglutide+EX9-39 group (n=6), which were treated with normal saline, liraglutide (0.2 mg·kg-1·d-1), and liraglutide combined with EX9-39 (75 μg·kg-1·d-1), respectively. Rat blood pressure was measured via non-invasive tail-cuff method and invasive radiotelemetry method, and isolated vascular function was detected. HE, PAS and Masson staining were used to evaluate mesenteric vascular remodeling, glomerular matrix distribution and renal fibrosis degree, respectively. Enzyme-linked immunosorbent assay was adopted to detect serum levels of glucagon-like peptide-1 (GLP-1) and angiotensin Ⅱ (AngⅡ). Western blot was performed to determine the protein expression of tumor necrosis factor-α, interleukin-6, GLP-1 receptor (GLP-1R), angiotensin-converting enzyme (ACE) 1, ACE2, angiotensin Ⅱ type 1 receptor (AGTR1), phosphorylated Na⁺/H⁺ exchanger 3 (NHE3) and total NHE3 in renal cortex. (3) Cell experiments: Rat renal epithelial NRK-52E cells were used. Four experimental groups were set up: high-salt group (treated with 160 mmol/L NaCl for 24 h), high-salt+liraglutide group (100 nmol/L liraglutide), high-salt+liraglutide+EX9-39 group(100 nmol/L liraglutide+150 nmol/L EX9-39), and control group (equal volume of drug vehicle). Western blotting was performed to detect the expression of ACE1, AGTR1, phosphorylated NHE3 and total NHE3. Results: (1) Clinical study: The enrolled patients had an age of (43.91±10.19) years, including 33 males (58%). There were 24 patients in the normotensive group and 33 in the hypertensive group. Compared with the baseline levels, both systolic blood pressure ((133.26±16.48) mmHg vs. (118.23±15.40) mmHg, 1 mmHg=0.133 kPa) and diastolic blood pressure ((83.16±12.44) mmHg vs. (74.54±8.80) mmHg) were decreased after RYGB (both P<0.05). The median daily preoperative sodium intake of all participants was 10.45 (8.19, 15.58) g/d. A positive correlation was observed between preoperative sodium intake and the reduction in postoperative systolic blood pressure (R=0.326, P=0.013). (2) Animal experiment: At the 8th week after surgery, the tail-cuff systolic blood pressure ((125.33±12.16) mmHg vs. (182.00±11.61) mmHg), 24-hour mean systolic blood pressure ((125.81±12.89) mmHg vs. (182.11±10.21) mmHg) and 24-hour mean diastolic blood pressure ((97.36±6.59) mmHg vs. (144.85±16.58) mmHg) in the RYGB group were lower than those in the sham group (all P<0.05). Compared with the sham group, the RYGB group presented a lower ratio of vascular wall thickness to outer vessel diameter, higher vasodilation of mesenteric arteries, and less glomerular collagen deposition. Meanwhile, the levels of serum creatinine, blood urea nitrogen and urinary protein, as well as the expression of tumor necrosis factor-α and interleukin-6 in renal cortex were also lower in RYGB group than sham group (all P<0.05). In addition, compared with sham group, the serum GLP-1 level, renal cortical GLP-1 receptor expression and NHE3 phosphorylation level were higher in the RYGB group, while serum AngⅡ and the expression of ACE1 and AGTR1 in renal cortex were lower (all P<0.05). Drug intervention results showed that tail-cuff systolic blood pressure was lower in the liraglutide group than in the control group ((167.00±9.98) mmHg vs. (182.00±6.26) mmHg, P<0.05). No significant difference in tail-cuff systolic blood pressure was found between the liraglutide+EX9-39 group and the control group (P>0.05). (3) Cell experiments: High-salt treatment upregulated the expression of ACE1 and AGTR1 and inhibited NHE3 phosphorylation in NRK-52E cells. Liraglutide reversed the above abnormalities, whereas EX9-39 antagonized the regulatory effects of liraglutide. Statistically significant differences were observed in the expression levels of the above proteins among all groups (all P<0.05). Conclusion: RYGB can effectively ameliorate salt-sensitive hypertension. The underlying mechanism is associated with GLP-1-mediated inhibition of renin-angiotensin system activity and promotion of NHE3 phosphorylation.
冠状动脉扩张是一类以冠状动脉管径异常扩张为特征的罕见病，其病因多样，发病机制尚未完全阐明，治疗手段有限，且预后不良。近年来国内外对该疾病的机制研究多聚焦于免疫炎症和细胞外基质降解两方面，但对不同病因所致冠状动脉扩张的发病机制的异同仍不清楚。为了加强对该疾病的认知、更好地指导临床诊疗，该文基于冠状动脉扩张的病因，对其发病机制予以总结和探讨。
Objective: To investigate the safety and efficacy of the Laager left atrial appendage occlusion system in stroke prevention in patients with atrial fibrillation. Methods: This was a prospective, multicenter, non-randomized, single-arm cohort study with prespecified performance goal. Patients with nonvalvular atrial fibrillation were enrolled at 12 centers nationwide from November 2017 to April 2019. All enrolled patients had CHA2DS2-VASc scores of ≥2 for males and ≥3 for females, and were not suitable for long-term warfarin anticoagulation therapy. All patients underwent left atrial appendage occlusion with the Laager occlusion system and were followed up. The primary efficacy endpoint was the rate of successful left atrial appendage occlusion, defined as a residual shunt ≤3 mm on transesophageal echocardiography at 12 months postoperatively. The primary safety endpoint was the incidence of ischemic stroke. Results: A total of 212 patients with nonvalvular atrial fibrillation were enrolled, with an age of (65.9±8.5) years, including 86 females (40.6%). Immediate procedural success was achieved in 210 patients (99.1%), and residual shunt >3 mm was observed in 2 patients post-procedure. At 12 months postoperatively, 187 patients completed transesophageal echocardiography (including 2 patients with residual shunt >3 mm post-procedure), and the success rate of left atrial appendage occlusion was 96.8% (181/187). The incidence of ischemic stroke was 0.5% (1/212). Conclusion: The Laager left atrial appendage occlusion system demonstrates favorable safety and efficacy for stroke prevention in patients with nonvalvular atrial fibrillation.
Objective: To investigate the prognostic value of single-photon emission computed tomography (SPECT) myocardial perfusion imaging parameters in patients with ischemic heart disease of different sexes. Methods: This retrospective cohort study consecutively enrolled patients diagnosed with ischemic heart disease who underwent rest gated SPECT myocardial perfusion imaging at the First Hospital of Shanxi Medical University between 2016 and 2021. Patients were followed up and categorized into good and poor prognosis groups within each sex based on the occurrence of major adverse cardiovascular events. Propensity score matching was used to balance clinical covariates between prognostic groups within each sex, and differences in SPECT myocardial perfusion imaging parameters were compared between groups. Multivariate Cox regression analysis was performed to identify prognostic factors for patients of different sexes. Results: A total of 1 475 patients completed follow-up (follow-up time: 3.05 (1.71,4.97) years), with an age of (60.5±12.7) years, including 1 058 males (71.7%). After propensity score matching, 866 males (433 in the good prognosis group and 433 in the poor prognosis group) and 302 females (151 in the good prognosis group and 151 in the poor prognosis group) were included. No statistically significant differences were observed in baseline clinical characteristics between prognostic groups within each sex (all P>0.05). Among male patients, the poor prognosis group exhibited higher total perfusion deficit, lower eccentricity index, left ventricular ejection fraction, and peak filling rate compared to the good prognosis group. Among female patients, the poor prognosis group demonstrated a lower peak filling rate than the good prognosis group (all P<0.05). Multivariate Cox regression analysis revealed that increased total perfusion deficit (HR=1.01, 95%CI: 1.00-1.02) and decreased eccentricity index (HR=0.14, 95%CI: 0.02-0.93) were independent risk factors in male patients, whereas decreased peak filling rate (HR=0.67, 95%CI: 0.50-0.91) was an independent risk factor in female patients (all P<0.05). Conclusions: Sex-specific differences exist in the prognostic value of SPECT myocardial perfusion imaging parameters for ischemic heart disease. Increased total perfusion deficit and decreased eccentricity index are independent risk factors in male patients, while decreased peak filling rate is an independent risk factor in female patients.
Objective: To evaluate the predictive value of the admission creatinine-to-albumin ratio (CAR) for 30-day all-cause mortality and in-hospital adverse events in patients with type B aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR). Methods: This retrospective cohort study analyzed clinical data from 968 consecutive TBAD patients undergoing TEVAR at Guangdong Provincial People's Hospital from January 2010 to January 2024. Admission serum creatinine and albumin levels within 24 hours were used to calculate CAR. The optimal cut-off value of CAR was identified via maximally selected rank statistics for predicting 30-day all-cause mortality. Patients were stratified into high-CAR (≥the cut-off value of CAR) and low-CAR (0.05). For new-onset dialysis, the effect of CAR was significantly stronger in complicated TBAD than in uncomplicated TBAD (interaction P=0.02). Results held after excluding patients with Ⅳ-Ⅴ time renal disease or cirrhosis. Conclusions: Admission CAR≥3.00 independently predicts 30-day mortality and in-hospital adverse events in TBAD patients following TEVAR, with a non-linear dose-response relationship. Among all endpoints, CAR demonstrates the strongest predictive value for postoperative severe renal deterioration (new-onset dialysis), an effect that appears amplified in complicated TBAD.
长期大量摄入高盐、高脂及高碳水化合物等营养素是诱发高血压、肥胖及糖脂代谢紊乱的主要危险因素，也是心血管疾病（CVD）的重要致病因素，而上述物质均需经胃肠道进入机体。胃肠道作为人体最大的内分泌与免疫器官，近年研究证实其可通过肠-脑轴、肠-心轴、肝-心轴等途径参与CVD的发生发展。因此，胃肠道不仅是营养物质吸收的关键器官，其功能紊乱（如菌群失调、屏障受损等）还可导致营养物过度吸收、有害物质进入血液循环，进而引发炎症与代谢紊乱，成为CVD的重要始动器官。该文聚焦胃肠道与CVD的关联，剖析味觉、肠道功能、肝脏代谢等在高血压、动脉粥样硬化及心力衰竭中的作用机制，并探讨味觉调控、菌群改变、药物干预及代谢手术等防治措施，旨在为CVD的综合防控提供新策略。
Objective: To develop and validate a risk scoring system for post-percutaneous coronary intervention (PCI) gastrointestinal bleeding in East Asian patients with acute coronary syndrome (ACS) based on the Fine-Gray model. Methods: This post-hoc analysis was performed on the BleeMACS international multicenter registry study. Patients with ACS undergoing PCI from 15 hospitals across 10 countries between November 2003 and June 2014 were enrolled and stratified into the East Asian group (China and Japan) and the non-East Asian group (other countries). The Fine-Gray model was used to screen predictors and construct an integer-based risk scoring system, with LASSO competing-risk regression for sensitivity analysis. The primary endpoint was gastrointestinal bleeding within 1 year after discharge, with death treated as a competing risk event. Bootstrap resampling was applied for internal validation. Calibration performance was assessed using calibration slope, intercept, and expected-to-observed (E/O) risk ratio. Risk stratification was performed using the Aalen-Johansen cumulative incidence function curve and Gray's test. The temporal distribution of bleeding events was analyzed, and subgroup analyses were conducted according to sex, diabetes mellitus, chronic kidney disease, and dual antiplatelet therapy (DAPT) status. Results: A total of 15 401 ACS patients were enrolled, with an age of (63.6±12.7) years and 3 592 females (23.32%). There were 2 332 patients in the East Asian group and 13 069 in the non-East Asian group. The final model incorporated seven predictors: admission hemoglobin (subdistribution hazard ratio (SHR)=0.82, 95%CI 0.74-0.90), age (SHR=1.02, 95%CI 1.01-1.04), hypertension (SHR=1.57, 95%CI 1.10-2.25), history of heart failure (SHR=1.97, 95%CI 1.08-3.57), peptic ulcer (SHR=3.25, 95%CI 1.41-7.52), proton-pump inhibitor use (SHR=1.54, 95%CI 1.12-2.12), and bleeding history (SHR=1.65, 95%CI 0.98-2.78). The bootstrap-corrected C-index was 0.693 (95%CI 0.652-0.738), with a calibration slope of 0.969 and an E/O ratio of 0.99, indicating favorable overall calibration performance. Risk stratification showed that the bleeding risk in the high-risk group was 3.93 times that in the low-risk group in the overall cohort. For the East Asian group, Gray's test P=0.116, with no significant difference among risk strata. The trend of bleeding risk was consistent with that of the overall cohort, and the ratio of cumulative bleeding risk between the high-and low-risk subgroups was 2.72 in the East Asian group. During the 1-year follow-up, 160 cases of post-PCI gastrointestinal bleeding occurred. The cumulative incidence was higher in East Asian patients than in non-East Asian patients (34 cases (1.46%) vs. 126 cases (0.96%)), with a higher proportion of late bleeding events (181-365 days) (14 cases (41.2%) vs. 41 cases (32.5%)). Subgroup analyses demonstrated stable risk stratification and good calibration performance across clinical subgroups. Conclusions: The gastrointestinal bleeding risk scoring system established in this study exhibits acceptable discrimination and excellent calibration, with stable performance in East Asian populations and various clinical subgroups. East Asian ACS patients have a higher incidence of post-PCI gastrointestinal bleeding with persistent late risk, indicating the need for prolonged monitoring and individualized antithrombotic therapy strategies.
代谢性疾病（糖尿病、肥胖）及高血压是心脏功能障碍、心肌重构和主要不良心血管事件的重要危险因素。心脏磁共振（CMR）可非侵入性评估心脏的结构、功能及组织学特征，在心肌纤维化、微循环障碍等病理改变的定量分析中具有独特价值。通过电影成像、应变分析、延迟强化成像及mapping等技术，CMR不仅能早期发现亚临床心肌损伤，还可动态监测代谢性心血管疾病心肌重构的进展，为风险分层、预后评估提供依据。该文拟系统阐述代谢性心血管疾病心脏重构机制及CMR多模态成像技术在该领域的临床应用进展，以期为临床实践提供有益的参考。
心房颤动（房颤）是临床常见的心律失常，其病理机制涉及电重构与代谢调节网络的复杂相互作用。值得注意的是，房颤可引发显著的心肌代谢重编程，这种代谢稳态失衡不仅加速心房结构重构，更是维持颤动波持续传导的关键病理基础。该文系统阐述了房颤中心肌能量代谢障碍、脂质代谢失调、氨基酸代谢紊乱等核心代谢表型特征，以及线粒体功能障碍与氧化应激级联反应在其中的调控作用，并分别介绍不同类型的心脏细胞在房颤中的代谢重编程，从代谢维度揭示房颤的重要分子机制，以期为其精准防治提供新的视角和干预靶点。
冠状动脉钙化是冠状动脉粥样硬化的高度特异性影像学标志，同时是冠心病预后不良的重要危险因素。表观遗传修饰在心血管疾病的发生发展中发挥重要的作用，主要通过DNA甲基化、组蛋白修饰以及非编码RNA调控等机制改变心血管稳态。该文从表观遗传学角度出发，结合不同表观修饰所介导的DNA甲基化、组蛋白修饰和非编码RNA等对冠状动脉钙化发病机制的影响进行综述，以期为冠状动脉钙化早期干预与精准防治提供理论依据与参考。
主动脉扩张性疾病是一类高致死性血管疾病，主要包括主动脉夹层、主动脉瘤与假性动脉瘤，是急性主动脉综合征的重要病因。其发生发展涉及血管平滑肌细胞表型转换与死亡、血管壁炎症反应、细胞外基质降解及遗传易感、高血压、吸烟等危险因素的共同作用。近年来，多组学、单细胞测序和分子影像等技术推动了该领域基础研究进展，并促进了生物标志物筛选、风险分层、靶向干预等转化研究。然而，现有研究仍存在标志物缺乏标准化验证、靶向药物临床证据不足、动物模型与人类疾病差异明显等问题。未来需进一步整合多组学、影像学、生物工程和人工智能等技术，推动主动脉扩张性疾病的早期识别、精准分层和个体化干预。该文系统述评了主动脉扩张性疾病的机制研究、临床转化进展、主要瓶颈及未来发展方向。
腹主动脉瘤是一种常见的真性动脉瘤。近年来，腹主动脉瘤的发病率和死亡率明显增加，目前治疗方法主要为预防性手术。大量研究显示腹主动脉瘤患者体内铁水平明显升高，铁代谢异常在腹主动脉瘤的发生和发展过程中发挥重要作用。该文主要对铁代谢及其在腹主动脉瘤发病机制中的作用进行综述，以期为腹主动脉瘤的预防和治疗提供新的视角。
心血管疾病（CVD）是全球范围内死亡的主要原因之一。成熟心肌细胞再生能力丧失是制约CVD临床疗效的关键障碍，心肌细胞发生损伤坏死后，心脏难以通过内源性增殖实现组织修复。HIPPO信号通路可调控心肌细胞增殖、肥大与死亡进程，在心肌损伤修复中发挥重要作用，有望改善心肌梗死后心脏泵血功能、减少恶性心律失常、延缓心力衰竭进展。该文综述HIPPO信号通路参与CVD发生发展的调控机制，为靶向干预该信号通路实现CVD的预防与治疗提供依据。
Objective: To investigate the correlation between dynamic changes of C-reactive protein (CRP) during hospitalization and adverse outcomes in patients with acute uncomplicated Stanford type B aortic intramural hematoma (IMH). Methods: This was a single-center retrospective cohort study that consecutively enrolled patients diagnosed with acute uncomplicated Stanford type B IMH at the General Hospital of Northern Theater Command from January 2020 to November 2025. Based on the median value of the difference between the last and first CRP measurements during hospitalization (defined as ΔCRP), patients were divided into a low-change group (ΔCRP<-0.65 mg/L) and a high-change group (ΔCRP≥-0.65 mg/L). The primary endpoint was aortic-related adverse events (ARAE) within 12 months, defined as a composite of aortic-related death, progression to penetrating aortic ulcer (PAU) or aortic dissection, and rapid progression of IMH (marked hematoma thickening, progressive aortic dilation, signs of rupture, or uncontrollable clinical symptoms). Kaplan-Meier method was used to plot survival curves. Cox proportional hazards regression models were used to analyze the association between ΔCRP and ARAE, and subgroup analyses were performed stratified by sex (male, female), age (≥60 years,<60 years), body mass index (≥24 kg/m²,<24 kg/m²), smoking (yes, no), drinking (yes, no), hypertension (yes, no), and ulcer-like projection (yes, no). Results: A total of 212 patients were enrolled, aged (64.3±9.1) years, and 66.0% (140/212) were male. The low-change and high-change groups each included 106 patients. The initial CRP level was significantly higher in the low-change group than in the high-change group (14.6 (5.2, 59.2) mg/L vs. 2.6 (1.8, 16.7) mg/L, P<0.001). Follow-up at 12 months was completed in 164 patients (77.4%), among whom 68 cases (41.5%) experienced ARAE. At the 12-month follow-up, the incidence of ARAE was significantly higher in the high-change group than in the low-change group (48.8% (42/86) vs. 33.3% (26/78), P=0.044), and the Kaplan-Meier survival analysis yielded consistent results (Plog-rank=0.022). Multivariable Cox proportional hazards regression analysis showed that ΔCRP was an independent associated factor for ARAE (HR=1.54, 95%CI 1.25-1.90, P<0.001). Subgroup analyses demonstrated that in subgroups of age≥60 years, body mass index≥24 kg/m², with smoking history, and with hypertension, the high-change group was significantly associated with an increased risk of ARAE (all P<0.05). Conclusions: A non-significant decrease or an increase in CRP during hospitalization is an independent associated factor for ARAE in patients with acute uncomplicated Stanford type B IMH. Dynamic CRP monitoring facilitates early identification of high-risk patients and provides a simple and effective tool for clinical risk stratification.
Objective: To investigate the effect of continuous positive airway pressure (CPAP) therapy on blood pressure and vascular endothelial function in patients with hypertension and moderate-to-severe obstructive sleep apnea (OSA). Methods: This was a retrospective study. Patients diagnosed with hypertension and moderate-to-severe OSA in the Department of Hypertension, Tianjin Kanghui Hospital, from October 2023 to December 2024 were enrolled. Patients were divided into the observation group (received standard CPAP therapy ≥4 hours per night and ≥5 nights per week) and the control group (did not receive CPAP therapy). Both groups received standard antihypertensive medication and were observed continuously for 24 weeks. Vascular endothelial function was assessed by flow-mediated dilation (FMD) of the brachial artery, and blood pressure fluctuations were evaluated by ambulatory blood pressure monitoring. Spearman rank correlation analysis was used to evaluate the correlation between changes in endothelial function and changes in blood pressure parameters. Antihypertensive medication load was assessed using the defined daily dose of antihypertensive drugs. Results: A total of 109 patients with hypertension and moderate-to-severe OSA were enrolled, with an age of (47.13±11.21) years, including 15 females (14%). There were 54 patients in the observation group and 55 in the control group. After 24 weeks of treatment, FMD was higher in the observation group than in the control group ((7.15±1.15)% vs. (4.08±1.46)%, P0.001). Ambulatory blood pressure monitoring showed that the mean 24-hour systolic blood pressure ((120.96±5.27) mmHg vs. (124.71±3.15) mmHg) and mean 24-hour diastolic blood pressure ((77.36±6.99) mmHg vs. (81.60±3.67) mmHg) were lower in the observation group than in the control group (both P0.05). Specifically, the mean daytime systolic blood pressure ((123.86±5.83) mmHg vs. (126.73±4.65) mmHg), mean daytime diastolic blood pressure ((80.12±7.16) mmHg vs. (82.75±4.61) mmHg), mean nighttime systolic blood pressure ((116.40±5.37) mmHg vs. (123.12±5.99) mmHg), and mean nighttime diastolic blood pressure ((72.57±7.54) mmHg vs. (80.29±5.67) mmHg) were all lower in the observation group than control group (all P0.05). The nighttime systolic blood pressure dipping ratio ((5.88±2.73)% vs. (3.13±4.45)%) and nighttime diastolic blood pressure dipping ratio ((9.37±5.65)% vs. (2.89±5.92)%) were higher in the observation group than the control group (both P0.05). In addition, the defined daily dose of antihypertensive drugs was lower in the observation group than in the control group ((1.60±0.86) vs. (2.26±0.87), P0.001]. Spearman rank correlation analysis showed that changes in FMD were negatively correlated with the reduction in mean nighttime diastolic blood pressure only in the observation group (r=-0.441, P=0.001). Conclusion: CPAP therapy is associated with improved vascular endothelial function, reduced blood pressure and reversal of non-dipper blood pressure rhythm in hypertensive patients with moderate to severe OSA.
Objective: To explore the association between cumulative blood pressure load from childhood to midlife and the risk of arteriosclerosis in midlife. Methods: This study was based on the Hanzhong Children's Hypertension Cohort in Shaanxi Province. Using 36-year longitudinal follow-up data of 4 623 children and adolescents aged 6-18 years enrolled at baseline in 1987, the study period spanned from 1989 to 2023 with 7 follow-up assessments. A total of 1 845 participants were ultimately included in the analysis. Subjects were divided into the arteriosclerosis group and the non-arteriosclerosis group based on whether arteriosclerosis was detected at the final follow-up. Cumulative blood pressure load, including cumulative systolic blood pressure, diastolic blood pressure, and mean arterial pressure loads, was defined as the ratio of the area under the curve of blood pressure exceeding the standard threshold to the total area under the curve. Using the no-load group (cumulative blood pressure load=0) as the reference, participants were further divided into low-, medium-, and high-load groups based on tertiles. Multivariate logistic regression models were used to analyze the association between cumulative blood pressure load and arteriosclerosis. Restricted cubic spline models were applied to fit the dose-response relationship. Stratified analyses were performed by sex, age, smoking status, alcohol consumption, body mass index, and medication history. Results: The enrolled participants aged 49.00 (46.00, 51.00) years, with 1 016 males (55.1%). There were 506 cases (27.4%) in the arteriosclerosis group and 1 339 cases (72.6%) in the non-arteriosclerosis group. Compared with the non-arteriosclerosis group, the arteriosclerosis group had a higher proportion of males (328 (64.8%) vs. 688 (51.4%)), and higher levels of body mass index (25.72 (23.70, 27.78) kg/m2vs. 24.12 (22.26, 26.13) kg/m2), systolic blood pressure (138.17 (127.67, 150.00) mmHg vs. 121.33 (112.33, 132.00) mmHg, 1 mmHg=0.133 kPa), diastolic blood pressure (91.33 (83.67, 99.00) mmHg vs. 80.33 (73.67, 88.00) mmHg), and mean arterial pressure (107.34 (98.44, 115.89) mmHg vs. 94.00 (86.56, 102.11) mmHg) at the final follow-up (all P0.05). Multivariate logistic regression analysis, using the no-load group as the reference, showed that the risk of arteriosclerosis increased sequentially across the low-(OR=1.44, 95%CI: 0.99-2.11), medium-(OR=1.72, 95%CI: 1.15-2.57), and high-load groups of cumulative systolic blood pressure load. The association was stronger for cumulative diastolic blood pressure load (low-load: OR=2.98, 95%CI: 1.82-4.87; medium-load: OR=4.96, 95%CI: 3.05-8.06; high-load: OR=15.39, 95%CI: 9.34-25.37). Cumulative mean arterial pressure load showed a similar increasing trend (low-load: OR=2.31, 95%CI: 1.54-3.47; medium-load: OR=3.90, 95%CI: 2.63-5.80; high-load: OR=12.55, 95%CI: 8.28-19.02). Restricted cubic spline analysis revealed a non-linear positive correlation between all three cumulative blood pressure loads and the risk of midlife arteriosclerosis (all P0.05). Stratified analysis indicated that these associations were consistent across subgroups defined by sex, age, smoking status, alcohol consumption, body mass index, and medication use, with no interaction effects (all Pfor interaction0.05). Conclusion: Cumulative blood pressure load from childhood to midlife is a risk factor for midlife arteriosclerosis, with a clear dose-response relationship. The association is most pronounced for cumulative diastolic blood pressure load.
自2020年国家标准化心脏康复中心建设项目落地广西壮族自治区以来，自治区区域化心脏康复体系逐步构建完善。该文系统梳理广西心脏康复体系建设现状与运营特点。该体系以国家标准化心脏康复中心建设标准为指导，构建“核心-支撑-延伸”三级康复诊疗网络，形成心血管内科/心胸外科主导、康复医学科主导、特色临床学科主导、独立康复治疗科运营的四类协同康复模式。截至2024年12月，全区14个地市已有60余家医疗机构开展心脏康复服务，其中8家通过国家级标准认证；依托康复专科医联体实现44家医疗机构资源联动，年康复服务量超2万人次。当前广西心脏康复体系仍存在专业人才供给不足、机构技术水平不均衡、医患康复认知薄弱、区域医疗资源配置失衡等现实问题。作为少数民族聚居地区，广西的建设实践为区域立体化心脏康复体系建设提供了参考经验，未来需持续优化资源配置、加强人才培养，进一步提升心脏康复服务能力，适配群众多层次健康保障需求。
Objective: To investigate the factors associated with recurrent in-stent restenosis (ISR) after drug-eluting stent (DES) implantation and to establish a screening model. Methods: This cross-sectional study enrolled patients who underwent DES implantation and subsequent coronary angiography at the Second Hospital of Dalian Medical University from January 2020 to July 2023, with confirmed ISR. Patients were divided into an ISR group (first episode) and a recurrent ISR (R-ISR) group (≥2 episodes at the same lesion). Clinical data, laboratory parameters, echocardiographic findings, and coronary angiography results were collected. Correlation analysis and multivariate logistic regression were performed to identify independent factors associated with R-ISR. A logistic regression model was constructed using stepwise regression, and its screening value was assessed by the area under the receiver operating characteristic curve (AUC). Results: A total of 292 patients with DES restenosis were included, aged (66.5±9.5) years, with 73.6% male. There were 202 in the ISR group and 90 in the R-ISR group. Correlation analysis showed that R-ISR was associated with lactate dehydrogenase (LDH) (rpb=-0.159, P=0.007), number of stents (rpb=0.256, P0.001), neutrophil-to-lymphocyte ratio (NLR) (rpb=0.350, P0.001), and interleukin-1β (rpb=0.324, P0.001). Multivariate logistic regression identified number of stents (OR=1.271, 95%CI 1.094-1.477, P=0.002), LDH (OR=0.989, 95%CI 0.982-0.996, P=0.002), NLR (OR=1.370, 95%CI 1.131-1.660, P=0.001), and interleukin-1β (OR=1.190, 95%CI 1.019-1.388, P=0.028) as independent factors for R-ISR. The combined model of these four indicators yielded an AUC of 0.742 (95%CI 0.641-0.843). Conclusions: LDH, number of stents, NLR, and IL-1β are independent related factors for R-ISR. The model based on these four variables demonstrates good predictive value for screening R-ISR, providing a reference for early identification and intervention in high-risk patients.
线粒体相关内质网膜（MAMs）是线粒体与内质网通过物理接触形成的特殊功能结构域，介导两大细胞器间的物质转运与信息交流，在空间分布与生物学功能上均实现高度偶联。脓毒症心肌病是脓毒症进程中出现的可逆性心肌功能损伤。现有研究表明MAMs可通过调控钙信号传导、自噬、线粒体动力学、内质网应激及炎症等关键通路，参与脓毒症心肌病的发生与发展。该文就MAMs的结构特征、生物学功能及其在脓毒症心肌病中的作用机制作一综述，以期为该病的防治提供潜在新靶点。
