目的 探讨高原红细胞增多症(HAPC)对藏族原发性高血压(EH)患者心率变异和血压节律的影响.方法 回顾性分析2012年1月至2016年12月青海省人民医院藏族EH合并HAPC患者90例(HAPC+EH组)、单纯HAPC患者84例(HAPC组)和单纯EH患者94例(EH组)的临床资料、24h动态心电和血压监测数据,比较各组昼夜心率变异、昼夜平均血压值与血压节律的差异.结果 HAPC+EH组与HAPC组的24h每5分钟节段平均正常RR间期标准差(SDANN)均较EH组明显升高(均为P<0.05),提示HAPC患者昼夜交感神经兴奋性升高;HAPC+EH组与HAPC组24h和夜间相邻RR间期之差的均方根(rMSSD)这两项指标均较EH组明显降低(均为P<0.05),提示HAPC患者夜间迷走神经活性降低.EH组的24h平均收缩压和平均舒张压均高于HAPC+EH组和HAPC组(均为P<0.05),而HAPC+EH组的夜间收缩压、舒张压下降幅度最小(均为P<0.05)."非杓型"高血压节律发生率在EH组、HAPC组和HAPC+EH组依次升高(38.3％、59.5％和67.8％),两组HAPC患者的"非杓型"高血压节律发生率均明显高于EH组(均为P<0.05).结论 HAPC可能增加藏族EH患者昼夜交感神经兴奋性,同时降低夜间迷走神经兴奋性,使夜间血压下降幅度减小,增加"非杓型"高血压节律的发生率.

Objective:To observe the changes of peripheral platelet (PLT) and eosinophil (EOS) in patients with acute myocardial infarction after cardiac interventional therapy,and to infer the possible effect of them in acute myocardial infarction.Methods:A total of 86 patients with acute myocardial infarction,who were diagnosed and treated in Qinghai People's Hospital during January 2015 to January 2017,were chosen as observation group.At the same time,30 patients with coronary artery disease,without myocardial infarction convinced by coronary angiography,were chosen as control group.Before operation,after operation and three days after operation,the blood samples were taken for blood routine and cardiac troponin T (cTnT) examination.Results:There were no statistical differences in age,gender,weight and history of diabetes mellitus between the two groups (P＞0.05).However,the patients in the observation group had higher proportion in the history of alcohol and tobacco,history of hypertension,cTnT and so on,the differences were statistically significant (P＜0.05).Before operation,the level of PLT in the observation group was significantly higher than that in the control group.After operation,the levels of PLT in the two groups showed gradually downward trend.Three days after operation,the PLT levels were basically the same in the two groups,which had no statistical difference (P＞0.05).Before operation,the level of EOS in the observation group was significantly lower than that in the control group.After operation,the level of EOS showed gradually upward trend.Three days after operation,the EOS levels were basically the same in the two groups,which had no statistical difference (P＞0.05).Conclusion:The history of alcohol and tobacco and the history of hypertension have great influence on the patients with acute myocardial infarction,which has close relationship with the increase of PLT and the decrease of EOS in the course of the disease.

目的:回顾性随访分析陈旧性心肌梗死合并右心室壁运动异常患者最初 5 年内超声心动图检测的心脏重构及左心功能改变特征,以及心脏重构与主要心脏不良事件(MACE)的相关性. 方法:收集 2011-01 月至 2016-12 两次及多次住院治疗的陈旧性心肌梗死患者的超声心动图及一般临床资料,分析陈旧性心肌梗死最初 5 年内超声心动图参数变化特征和 MACE,评估心肌梗死后心功能改变、心室重构、MACE 发生率,以及后二者之间的相互关联.

Objective To retrospective explore ventricular remodeling (VR) and heart function by a ultrasonic cardiogram (UCG) testing,and the correlation between VR and major adverse cardiac events (MACEs) to patients with old myocardial infarction (OMI) and abnormal wall motion in first 5 years.Methods We made an observational retrospective fellow-up study involving a group of 66 patients hospitalized more than 2 times from January 2013 to December 2016.The general clinical data and characteristics of UCG collected to evaluate the heart function,VR and MACEs,as well as association between VR and MACEs.We divided the first 5 years history of OMI into 3 consecutive time segments,named A (≤lyear),B (＞1year,≤3years) and C(＞3years,≤5years),respectively.Results The left atrial dimension (LAd),left ventricular end-diastolic dimension(LVDd),left ventricular ejection fraction(LVEF),and the combined incidence of MACEs of patients were all significantly different among A,B and C segments (P＜0.05).LAd,LVDd and MACEs were gradually increased,while LVEF was decreased from A to C segments.The LVDd and MACEs had a positive correlation in A,B and C segments (r＝0.233,P＝0.032;r＝0.351,P＝0.022;r＝0.421,P＝0.016 respectively).Conclusions The left ventricular remodeling had occurred at different extents,and correlated with prognosis in most patients with OMI and abnormal wall motion in first 5 years,with left ventricular function be decreased,and MACEs risk be increased.

Background: Left ventricular thrombus (LVT) is reported to be a common complication in acute myocardial infarction (AMI) patients. And it has the potential to cause systemic embolism. This retrospective study was to present the current situation of LVT in clinical practice, as well as to evaluate the clinical characteristics and the risk factors of LVT after AMI. Methods: LVT cases (n = 96) were identified from 13,732 AMI (non-ST elevation myocardial infarction was excluded) patients in Fuwai Hospital's electronic medical records system from January 2003 to January 2013. The controls (n = 192) were gender- and age-matched AMI patients without LVT during this period. A conditional logistic regression (fitted by the Cox model) was performed to identify the independent risk factors. Results: The incidence of LVT after AMI was 0.7%. Univariate analysis indicated that the anterior myocardial infarction (especially extensive anterior myocardial infarction), lower left ventricular ejection fraction (LVEF), LVEF ⩽40%, severe regional wall motion abnormalities (RWMA), pericardial effusion, and left ventricular aneurysm were all related to LVT after AMI. The independent risk factors obtained from the conditional logistic regression analysis were lower LVEF (odds ratio (OR) = 0.891, 95% confidence interval (CI): 0.828–0.960), extensive anterior myocardial infarction (OR = 6.403, 95% CI: 1.769–23.169), severe RWMA (OR = 7.348, 95% CI: 1.323–40.819), and left ventricular aneurysm (OR = 6.955, 95% CI: 1.673–28.921). Conclusions: This study indicated that lower LVEF, extensive anterior myocardial infarction, severe RWMA, and left ventricular aneurysm were independent risk factors of LVT after AMI. It also suggested that further efforts are needed for the LVT diagnosis after AMI in clinical practice.

目的:分析急性心肌梗死早期左心室血栓及导致体循环动脉栓塞病例,总结特点,指导临床实践.方法:回顾检索2007年至2009年住院治疗所有急性心肌梗死病案,分析左心室血栓及体循环动脉栓塞的相关特征.结果5900例急性心肌梗死患者中,发现左心室血栓50例,血栓形成率为0.8％,其中有3例发生体循环动脉栓塞,栓塞率6％,急性脑栓塞是最常见的栓塞并发症.结论:左心室血栓多发生于急性ST段抬高性前壁心肌梗死,低的左室射血分数、室壁瘤形成与心室血栓形成相关;心源性栓塞中大脑动脉栓塞风险相对较高.

目的：研究急性心肌梗死（AMI）患者并发左心室血栓（LVT）形成的临床特征及危险因素。

PurposeThe aim of this study was to assess the efficacy and safety of ivabradine (Iva) noninferiority to atenolol (Aten) in Chinese patients with chronic stable angina pectoris.MethodsIn this double-blind, double-dummy trial, patients with symptomatic angina pectoris and positive exercise tolerance test were randomized into the Iva [5 or 7.5mg bis in die (BID)] or Aten group (12.5 or 25mg BID) according to computer-generated random numbers for 12weeks.ResultsOne hundred and sixty-eight patients were randomized to the Iva group and 166 to the Aten group. In a full analysis set, increases in the total exercise duration (TED) were 54.3120.1seconds with Iva 5mg and 58.8 +/- 114.7seconds with Aten 12.5mg at the fourth week, and at the 12th week, TED improved by 84.1 +/- 130.5seconds with Iva and 77.8 +/- 126.6seconds with Aten (95%CI: -21.4-34.1seconds, p=0.0011 for noninferiority). The analysis of per protocol set yielded similar results (95%CI: -31.4-33.0seconds, p=0.0131 for noninferiority). Heart rate was reduced in both groups at rest and during peak exercise. There were small, nonsignificant differences in the number of adverse events between the two groups (66 in Iva and 73 in Aten, p>0.05). Nine patients (5.42%) were reported to develop phosphenes/luminous phenomena and blurred vision in the Iva group (p=0.0035).ConclusionsIva is effective in reducing heart rates and improving exercise capacity and noninferior to Aten in Chinese patients with chronic stable angina pectoris. Iva is well tolerated and safe. Copyright (c) 2014 John Wiley & Sons, Ltd.

Objective To evaluate the impact of hydrochloride ivabradine on the heart rate and QTc interval after single and multiple doses in healthy Chinese volunteers.Methods Thirty-six volunteers were randomized into three groups:ivabadine 5 mg group (n =12,group 1)、10 mg group (n =12,group 2) and 20 mg group (n =12,group3).Each volunteer received single dose of ivabradine on day 1 and day 8,and was given ivabradine twice daily from day 3 to day 7.Results Resting heart rate was reduced from (62.67±5.68)bpm to (59.75±6.52) bpm in group1,(67.00±7.11) bpm to (62.75±8.35) bpm in group2,(59.75±6.52)bpm to (56.50±3.92)bpm in group3 at 2 hours after single dose administration and back to baseline after 6 hours.After 5 days continuous medication,the maximum heart rate (21.27±4.32) bpm,(26.74±5.21) bpm and (55.51±6.38)bpm in 3 groups respectively,the minimum heart rate was lowered (3.60±0.78) bpm,(3.25±0.52) bpm and (3.78 ± 0.43) bpm,the average heart rate was lowered (12.31 ± 1.43) bpm,(12.34± 1.29) bpm and (20.32±2.78)bpm,the total heart rate was reduced (9838.46±900.42)bpm,(11345.27+1213.54)bpm and (25461.46±2746.78)bpm.The QTc interval was decreased and demonstrated time-and dose-dependent.Phosphene-like mild transient visual symptoms were the most frequently reported adverse events.Conclusion Ivabradine at the doses of 5 mg to 20 mg bid was well tolerated and could decrease resting heart rate and QTc interval in healthy Chinese volunteers.

Objective To study interaction effects between body mass index(BMI)and genetic polymorphisms of L-type calcium channelα1Cgene(CACNA1C)on predicting the efficacy of amlodipine in the treatment of hypertension. Methods A pharmacogenetic analysis was performed on 181Chinese individuals with essential hypertension who were treated with a low dose amlodipine based antihypertensive drugs. SNPs rs1051375,rs2238032, rs2239050,rs2239128 in CACNA1Cgene were genotyped using PCR and direct sequencing method. Multiple linear regression was used to association analysis between BMI(genotypes)and efficacy of amlodipine. Multivariate analysis of variance and ordinal logistic regression was used to interaction effects analysis between BMI and genotypes on efficacy of amlodipine. Results After adjustment of the influence of confounding factors including basic blood pressure,age,gender,uric acid,triglyeride and drug,both BMI and genotypes of rs2238032G/T in CACNA1C were associated with systolic BP reduction after treatments(B=-0.612,P=0.044;B=11.818,P=0.037,respectively),and rs2238032 G/T also was related to diastolic BP reduction(B=12.450,P=0.001). Multivariate analysis of variance showed a significant interaction effect between BMI and genotypes of rs2238032 G/T on efficacy of amlodipine(P0.05). The carriers of the TT genotype with a normal BMI had a better treatment response to amlodipine contrasted to the carriers of other genotypes with abnormal BMI. And ordinal Logistic regression showed a similar trend in interaction effect between BMI and rs2238032 G/T genotype GT on efficacy of amlodipine(B=0.212,P=0.066). Conclusion BMI and SNP rs2238032 in CACNA1Cgene may have a interaction effect on efficacy of amlodipine in the treatment of essential hypertension.

Objective To determine whether mean platelet volume(MPV) and platelet count(PLT) were associated with left ventricular thrombus(LVT) after acute myocardial infarction(AMI). Methods The 207 consecutive patients with AMI were included: 69 LVT cases and 138 no LVT age matched controls.Blood samples were collected for MPV and PLT measurements on admission and at the 6-8th day after admission. Results MPV did not differ between patients with LVT and controls [(10.3±1.0)fl vs.(10.3±0.8)fl,P=0.854] on admission,but MPV was significantly higher in LVT cases compared with controls [(11.1±1.7)fl vs.(10.7±0.7)fl,P=0.029] at the 6-8th day after admission.Neither PLT on admission nor at the 6-8th day after admission showed a difference between LVT cases and controls.There is a linear relationship between MPV and PLT at the 6-8 th day after admission in all patients. Conclusions MPV has a close association with the formation of LVT after AMI.

Objective To study association between genetic polymorphisms of L-type calcium channel alpha subunit 1C gene(CACNA1C) and efficacy of amlodipine in the treatment of hypertension.Methods A pharmacogenetic analysis was performed on 181 Chinese individuals with essential hypertension who were treated with amlodipine based antihypertensive drugs.Seven SNPs(rs1051375,rs2238032,rs7311382,rs2239050,rs2239127,rs2239128,rs2239129) in CACNA1C were chosen for genotypic analysis using direct sequencing method.Multiple linear regression was used to association analysis between genetic polymorphisms and efficacy of amlodipine.Results After adjustments of the influence of confounding factors on blood pressure,the comparison of 4th week′s △SBP and △DBP over genotypes of these single nucleotide polymorphisms showed that rs2238032G/T had a more significant association with BP reduction after treatments(△SBP:P=0.02;△DBP:P=0.01).Both SBP and DBP were significantly decreased in patients with TT+GT carrier in rs2238032 G/T when compared with patients with GG carrier.And rs2239050C/G,rs7311382C/T,rs2239127C/T,rs2239128C/T,rs2239129C/T,rs1051375A/G showed a significant difference in BP reduction over genotypes respectively.Conclusion SNPs rs2238032 in CACNA1C are associated with efficacy of amodipine in the treatment of essential hypertension.