目的 分析血清胃饥饿素(Ghrelin)、肥胖抑制素(Obestatin)、同型半胱氨酸(Hcy)水平与老年缺血性脑卒中后并发认知功能障碍的相关性.方法 选取2019年9月至2022年2月邯郸市中心医院收治的120例老年缺血性脑卒中后并发认知功能障碍患者作为观察组,110例老年缺血性脑卒中后无认知功能障碍患者作为对照A组,100例体检健康者作为对照B组.酶联免疫吸附试验测定血清Ghrelin、Obestatin、Hcy水平;使用简易智能精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)对观察组进行评分,根据MMSE评分将观察组分为轻度组(50例)、中度组(30例)、重度组(40例);分析观察组血清Ghrelin、Obestatin、Hcy水平与MMSE、MoCA评分的相关性,老年缺血性脑卒中患者发生认知功能障碍的影响因素,血清Ghre-lin、Obestatin、Hcy水平对老年缺血性脑卒中患者发生认知功能障碍的诊断价值.结果 观察组、对照A组、对照B组血清Ghrelin水平依次升高(P<0.05),Obestatin、Hcy水平依次降低(P<0.05);轻度组、中度组、重度组血清Ghrelin水平、MMSE、MoCA评分依次降低(P<0.05),重度组血清Obestatin、Hcy水平高于轻度组(P<0.05);老年缺血性脑卒中后并发认知功能障碍患者血清Ghrelin水平与MMSE、MoCA评分均呈正相关(P<0.05),血清Obestatin、Hcy水平与MMSE、MoCA评分均呈负相关(P<0.05);血清Ghrelin水平升高为影响老年缺血性脑卒中患者发生认知功能障碍的保护因素,Obestatin、Hcy水平升高为影响老年缺血性脑卒中患者发生认知功能障碍的独立危险因素(P<0.05);血清Ghrelin、Obestatin、Hcy三者联合诊断老年缺血性脑卒中患者发生认知功能障碍的曲线下面积(AUC)为0.904,明显高于血清Ghrelin、Obestatin、Hcy水平单独诊断的AUC(P<0.05).结论 老年缺血性脑卒中后并发认知功能障碍患者血清Ghrelin呈低水平,Obestatin、H cy呈高水平,及时检测三者水平可能对评估患者认知功能障碍发生及病情严重程度具有重要意义.

目的 探究长链非编码RNA母系表达基因3(LncRNA MEG3)、微小RNA-21(miR-21)与冠状动脉钙化的相关性.方法 选取2018年6月至2019年6月在邯郸市中心医院行冠状动脉造影及CT检查确诊为冠状动脉钙化病人189例作为钙化组,另选取同期在该院行冠状动脉造影及CT检查显示无冠状动脉钙化者183例作为未钙化组.采用实时荧光定量PCR(qRT-PCR)法检测血清LncRNA MEG3、miR-21表达水平,采用Pearson法分析病人血清LncRNA MEG3、miR-21水平及与糖化血红蛋白(HbA1c)、高敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)水平相关性,采用logistic回归模型分析冠状动脉钙化发生的影响因素,采用ROC曲线评估血清LncRNA MEG3、miR-21表达水平对冠状动脉钙化的预测价值.结果 与未钙化组相比,钙化组血清miR-21[2.87±0.93比1.02±0.29]、HbA1c[(6.95±1.31)％比(5.41±1.26)％]、hs-CRP[(5.13±1.74)mg/L比(3.02±1.01)mg/L]、TNF-α[(11.72±3.92)ng/L比(9.82±4.13)ng/L]、IL-1β水平[(4.96±0.95)ng/L比(2.32±0.74)ng/L]及冠心病(80.95％比15.85％)、高血压比例(53.97％比22.40％)较高(P<0.05),血清LncRNA MEG3表达水平[0.62±0.17比1.01±0.31]较低(P<0.05).冠状动脉钙化病人血清LncRNA MEG3与miR-21、hs-CRP、TNF-α、IL-1β水平呈负相关,miR-21与hs-CRP、TNF-α、IL-1β水平呈正相关(P<0.05).冠心病、LncRNA MEG3、miR-21水平是影响冠状动脉钙化发生的危险因素(P<0.05).血清LncRNA MEG3、miR-21联合检测预测冠状动脉钙化的曲线下面积为0.88[95％CI:(0.84,0.91)],灵敏度为84.13％,特异度为85.79％.结论 冠状动脉钙化病人血清LncRNA MEG3表达水平明显降低,miR-21表达水平明显升高,二者可能作为生物标志物,共同预示冠状动脉钙化发生.

目的:分析Ⅱ型糖尿病合并心脑血管病的临床内科观察与治疗手段.方法:选取2018年7月至2019年7月收治的76例2型糖尿病患者进行分析,根据诊断结果分为观察组和对照组各38例.对照组患者为单纯2型糖尿病患者,观察组2型糖尿病合并心脑血管病患者,对照组患者实施常规降血糖治疗,观察组在对照组的基础上实施心脑血管病的治疗,比较两组患者在治疗后的效果与血糖情况.结果:观察组进行治疗后总有效34例,占比89.4％,对照组总有效37例,占比97.3％,两组数据无明显差异,两组患者治疗前血糖含量数据无明显差异,治疗后血糖含量数据对比无明显差异,在经过治疗后对比治疗前血糖含量都有明显下降,数据具备明显差异,有统计学意义(P＜0.05).结论:临床治疗对2型糖尿病合并心脑血管病患者实施的治疗方案确切,能够有效的帮助患者降低血糖含量,提高患者治疗效果.

目的:探究维生素D(Vit-D)对糖尿病(DM)大鼠模型主动脉中层厚度的影响及其蛋白激酶受体样内质网激酶(PERK)和真核翻译起始因子2α(eIF2α)(PERK/eIF2α)通路的作用机制.方法:选用30只Sprague-Dawley(SD)雄性大鼠,采用随机数表法将其分为对照组、DM组和DM+Vit-D组,每组10只.通过给每只大鼠腹腔注射链脲佐菌素建立大鼠DM模型,DM+Vit-D组大鼠使用活性形式的Vit-D3灌胃(0.1μg·kg-1·d-1).比较各组大鼠的血糖水平、主动脉损伤情况、血清一氧化氮(NO)和内皮素(ET)水平,并采用Western blot检测主动脉组织中PERK/eIF2α通路中的蛋白表达水平.结果:DM模型大鼠的血糖水平均>16.7 mmol·L-1,干预后DM组和DM+Vit-D组的尾静脉空腹血糖(FBG)水平差异无统计学意义.DM组的收缩压和脉搏波传导速度(PWV)显著高于对照组,其差异有统计学意义(t=5.263,t=4.956,P<0.05);DM+Vit-D组的收缩压和PWV显著低于DM组,其差异有统计学意义(t=5.016,t=4.332;P<0.05).DM组大鼠的主动脉中层厚度[(103.24±4.98)μm]显著高于对照组[(90.15±3.24)μm],DM+Vit-D组的主动脉中层厚度[(96.74±4.21)μm]显著低于DM组[(80.25±2.86)μm],差异有统计学意义(t=3.521,t=3.852;P<0.05).DM组的NO水平为(51.49±6.85)μmol·L-1显著降低、ET水平为(110.28±11.39)pg·ml-1显著升高,与对照组比较差异有统计学意义(t=4.585,t=5.677;P<0.05);DM+Vit-D组的NO水平[(61.18±8.21)μmol·L-1]显著升高,ET水平[(101.44±11.32)pg·ml-1]显著降低,与DM组比较差异有统计学意义(t=5.029,t=5.881;P<0.05).DM组大鼠的PERK和eIF2α蛋白水平显著高于对照组,差异有统计学意义(t=3.612,t=4.083;P<0.05);DM+Vit-D组的PERK和eIF2α蛋白水平显著低于DM组,差异有统计学意义(t=3.506,t=3.892;P<0.05).结论:Vit-D可通过抑制DM大鼠的主动脉中PERK/eIF2α通路水平,缓解主动脉损伤和血管内皮功能.

目的:研究黄芪注射液对糖尿病大鼠对比剂肾病防治作用,以期为临床医疗工作者提供一条有效的新的治疗途径.方法:使用SPF级Wistar大鼠,雄性,体重(200±20)g,建造糖尿病模型.实验分为正常对照组(control,C),糖尿病肾病模型组(diabetic nephropathy,DN),糖尿病肾病模型组+对比剂组(contrast medium,CN),糖尿病肾病模型组+对比剂组+黄芪注射液低剂量组(low,L),糖尿病肾病模型组+对比剂组+黄芪注射液中剂量组(middle,M),糖尿病肾病模型组+对比剂组+高剂量组(high,H).每组5只,共30只.测定大鼠肾功能相关指标;观察肾脏组织病理形态.比较6组大鼠各项指标的差异性.结果:与糖尿病肾病模型组比较,在给予对比剂的过程中发现,DN组大鼠肾脏指数(RI)、尿蛋白(UP)、血清尿素氮(sBUN)、尿尿素氮(uBUN)、血肌酐(Scr)显著升高,尿肌酐(uCr)明显下降,提示肾损伤进一步加重;而在给予黄芪注射液后,L、M组除uCr外的数据皆下调.然而,H组UP、sBUN、uBUN数据较CN组虽低,但较L、M组反常性升高.提示黄芪注射液对肾脏起保护作用,可改善肾损害.结论:黄芪注射液对肾脏起保护作用,改善对比剂对肾脏的损伤.

Tamsulosin is a new kind of α1A receptor specific antagonist,and its curative effect on benign prostatic hyperplasia( BPH) is definite with fewer adverse reactions and good compliance in patients,it is especially suitable for BPH patients above 70 years old and unable to endure operations. Here is to make a review of the curative effects of single or combined tamsulosin therapy for BPH complicated by various diseases,and the adverse reactions,in order to provide basis for the development of polycentric and large-scale evidence-based medicine in future and promote the application of tamsulosin in clinical.

利尿药是治疗心力衰竭的基本用药,是缓解心力衰竭症状最快的药物,也是唯一解除心力衰竭水钠潴留的药物.而呋塞米是利尿药中应用最多的药物,既往该药多用于口服和静脉注射,近年来用该药静脉点滴治疗心力衰竭虽取得了一定疗效,但是还有许多问题,诸如适应证的选择、每天应用总量、滴速、疗程等尚未解决.本文围绕呋塞米静脉点滴治疗心力衰竭基础和临床研究进展进行讨论,期望能对上述问题做出解答,对呋塞米正确应用提供一些帮助.

This Article retrieved literatures about the relationship between the time of administration antihypertensive drugs and the circadian rhythm of blood pressure, evaluated the effect of administration antihypertensive at bedtime, provided recommendation of how to take antihypertensive. Firstly, most patient should to take antihypertensive in the morning. Secondly, about 20 percent of patient show abnormal circadian rhythm of blood pressure, that is mean non-dipper hypertension through ambulatory blood pressure monitoring, should adjust the medication administration from morning to night or morning and night. Thirdly, antihypertensive which are chosen to administrate at bedtime should be long time acting. Administration hypertensive at bedtime will help restore the normal circadian rhythm of blood pressure, alleviate the morning surge, and reduce even reverse the damage to target organs.

Objective To understand the disease patterns about male patients of different ages.Methods In accordance with the principes of the international classification and encoding of disease,main diagnosis of patients in hospital was collected and summarized.Results(1)The 96 cases of 60～69 age were admitted into Gerontology Department in 2012,the 129 cases of 70～79 age were admitted into Gerontology Department too.(2)The inpatients number and age composition were increased gradually from 60～(51 case,22.67%),70～(59 case,26.22%)to 75～(70 case,31.11%)age groups.(3)The circulatory,respiratory,tumor,nervous and digestive system disease were the top five disease of inpatients in two groups with the disease composition in 2012.The arrange of respiratory system disease and tumor were different with different ages.Conclusion(1)The circulatory system disease composition was decrease with age(63.54% and 57.36% respectively),the prevention and treatment measures must be strengthened.(2)The disease composition of respiratory system disease was increased with ages(8.33% and 11.63% respectively).(3)The disease composition of tumor was decreased with ages(17.71% and 10.08% respectively).(4)The disease composition of nervous and digestive system disease was increased with ages(4.17%,2.08% and 8.53%,6.98% respectively).(5)It should lay stress on preventing and treating measures of circulatory system disease in the future medical practices.

<正>自1997年Missov等采用高敏感性酶联免疫化学发光检测法,首次报道了心力衰竭(心衰)患者血清肌钙蛋白Ⅰ(cTnⅠ)含量增高后,十年来许多学者陆续从不同的方面对慢性心力衰竭与cTnⅠ的关系进行了研究,得出一些相同或是相反的结论。笔者现将慢性心力衰竭与cTnⅠ的研究进展

OBJECTIVE: To observe the curative effect of shuxuetong injection for senile cerebral infarction.METHODS: A total of 72 patients with senile cerebral infarction were enrolled: on the basis of the basis treatment,36(trial group) were randomly assigned to receive shuxuetong injection 6 mL infused in 0.9% NS 250 mL by i.v drip q.d for 14 days,36(control group) to receive injection 20 mL infused in 0.9% NS 250 mL by i.v drip q.d for 14 days.RESULTS: The total effective rates were 91.7% and 77.8% respectively(P0.05),showing significant differences as compared with before medication(P0.05).CONCLUSION: Shuxuetong injection is safe and reliable in treating senile cerebral infarction.

笔者用路路通注射液治疗急性期脑梗死患者60例,疗效显著,现报道如下.