随着人口老龄化到来,衰老相关性疾病已成为困扰各国政府的一个难题.心血管疾病作为代表性疾病,发病率逐年攀升.运动是心血管疾病防治的重要手段.老年人群运动能力及运动量的减低与心血管事件发生存在相关性.肌少症是一种以肌肉含量减少和(或)功能减退为表现的疾病,其与心血管疾病之间关系紧密.本文拟总结近年肌少症与心血管疾病的研究,从疾病的病理生理、相互作用、潜在机制、临床表现及诊断标准、治疗等多层面进行介绍,使上述疾病得到更为深入的理解.

2010年欧洲老年人肌少症工作组(European Working Group on Sarcopenia in Older People,EWGSOP)颁布了肌少症共识,将肌肉减少症(肌少症,Sarcopenia)定义为进行性、广泛性骨骼肌质量减少和力量下降,以及由此引起的机体功能和生活质量降低甚至导致死亡的综合征[1].近10年来肌少症逐渐受到重视,EWGSOP于2018年对共识进行了更新.国际肌少症工作组和亚洲肌少症工作组也先后采用此定义,并发表了肌少症共识报告[2-3].尽管国内研究刚刚起步,缺少相关证据,中华医学会骨质疏松和骨矿盐疾病分会参照国际指南编撰了共识,强调了肌少症对器官功能有影响,引发心脏衰竭和呼吸衰竭,为老年人群致残和致死的主要原因之一[4].但是有关该病的临床特点以及与常见慢性病共病时的监测干预技术尚未达成共识.本文将肌少症相关进展做简要综述,以推动其防治工作的开展.

Objectives: To evaluate the difference of hypertension prevalence between blood pressure(BP) measurement in first day or 3 different days in community population. Methods: 47 955 residences aged 35–75 years old (54.25 ± 15.28y)in Provence of Zhejiang, Henan and Beijing City were included. Blood pressure (BP) was measured for three times with one minute interval and averaged as the final values. Suspected hypertension was defined as systolic BP (SBP)≥140 mm Hg and/or diastolic BP (DBP)≥90 mmHg in the survey, without diagnosed hypertension. Patients with suspected hypertension received BP measurement in other two days within one month. Clinical hypertension was defined that all three BP readings in different days fulfill the above-mentioned standard. Effect on hypertension diagnosis was contrasted between BP measured in First Day or 3 Different Days. Results: There were 7344 diagnosed hypertension patients and 3221 suspected hypertension patients, and hypertension prevalence was 22.03% by BP measurement in first day. Among 3221 patients with suspected hypertension, only 425 (13.19%)were diagnosed as clinical hypertension by BP measurement in 3 different days. Thus, the prevalence of clinical hypertension was 16.20%, 5.83 percentages lower than that by measured in first day. There was significant difference in age, heavy drinking and first-day SBP between hypertension or non-hypertension diagnosed from 3221 suspected hypertension by 3-different-days measurement. Logistic regression analysis showed 65–74yr(OR = 4.470), ≥75yr(OR = 5.358) increased the risk of hypertension diagnosis by 3-different-days measurement, high salt diet(OR = 0.331) decreased the risk. Conclusion: Hypertension prevalence would be overestimated by BP measured in first day, compare with in 3 different days.

Objectives: To explore the appropriate and applicable techniques for screening and control of refractory hypertension in community level. Methods: Random sampling method was used to recruit 4535 hypertension patients from four project sites managed by Zhejiang Hospital, Beijing Chaoyang Hospital, 301 Hospital and Zhengzhou University. Among them, 97 cases were defined as refractory hypertension patients with application of Three-steps-flow Method and then given individualized intervention and guidance. Results: Among 97 patients with refractory hypertension, 15.5% standardized combination medicine treatment rate, 50.7%compliance rate, 14.4% smoking rate, 18.6% excessive drinking, 78.4% sedentary exercise rate, 37.1% high salt / high calorie diet and 24.7% obesity patients cases. There are 2 cases with thyroid disease history, 48 cases with snoring history and 1 OSAS case. The life style intervention and standardized medication guidance for the patients with refractory hypertension were given. A year later, the results show that the life style of patients with refractory hypertension made remarkable changes. 83.5% and 52.6% of the patients carried out home blood pressure measurement and 24 hour ambulatory blood pressure monitoring during the last one year and medical treatment compliance increased from 50.5% to 88.7%, the average systolic blood pressure and diastolic blood pressure levels were decreased 20.3mmHg and 15.3mmHg and the blood pressure control rate increased from 18.6% to 76.3% Conclusion: With application of the refractory hypertension screening and control technique, blood pressure measurement and hypertension diagnosis could be standardized.With the improvement of physicians’ assessment capacity in terms of refractory hypertension diagnosis and medication,it improves treatment and control rate

Objective To explore the clinical features and prognosis of cardiac myxoma in the elderly patients. Methods A total of 50 elderly inpatients with cardiac myxoma were collected from December 1988 to December 2015 in PLA General Hospital.The clinical data,imaging characteristic and prognosis of patients with cardiac myxoma were analyzed retrospectively.Results The average age for patients was 66.12 ±5.34,and 16(32.0%)patients were fe-male.The mean disease course of cardiac myxoma was(15.8 ±21.7)years and the clinical manifestations include chest distress(20 cases),palpitations(20 cases),dyspnea(8 cases),syncope(8 cases),cerebral embolism(10 cases),limb embolism(4 cases),weakness(14 cases),fever(6 cases),arthralgia(4 cases)and asymptomatic(6 cases).Chest X-ray showed 18 patients(36%)with cardiac hypertrophy.Echocardiography showed the prediction sites of cardiac myxoma were left atrium 44(88%),right atrium 2(4%),left atrioventricular valve 1(2%)and left ventricular 1(2%).The av-erage volume of cardiac myxoma was(26.13 ±31.64)cm3.Patients were followed up for 1 to 26 years,and for an aver-age of 5.4(11.3 ±12.3)years postoperatively.Two patients died(4%),but no recurrence and no progression to malig-nancy was found during the followed up.The correlated risk factors of embolism were syncope and weakness,and the cor-related risk factors of death were joint pain,weakness and large size of cardiac myxoma.Conclusion The clinical symp-toms of cardiac myxoma in the elderly patients were not typica,and the common clinical symptoms were chest distress and palpitations.The cardiac myxoma most frequently involved the left atrium.The recurrence rate and long-term mortali-ty of cardiac myxoma after surgery were low.

Women who smoke have a higher rate of fatal breast cancer than nonsmoking women. An association between smoking and pulmonary metastases from breast cancer has been suggested by epidemiologic studies.To examine the relationship between exposure to cigarette smoke and pulmonary metastasis in a murine model of metastatic mammary cancer.Prospective, randomized study.Animal research laboratory.Female sexually mature BALB/cAnN mice.Mice were randomly divided into experimental and control groups. Experimental animals were exposed to cigarette smoke in specialized exposure chambers, at concentrations chosen to approximate active cigarette smoking. Control animals were exposed to filtered air. One week after the initiation of exposures, mouse mammary tumor cells (tumor cell line 4526) were injected into the tail veins of experimental animals at one of three concentrations (50,000, 100,000, or 150,000 cells per 100 μL). Three weeks later, the mice were killed, and pulmonary metastases were counted and measured.The mean metastatic burden in the lungs was consistently greater for smoke-exposed animals at each concentration of cells injected (at 50,000 cells per 100 μL, 9.8 vs 4.8 μm3, respectively [p < 0.01]; at 100,000 cells per 100 μL, 34.5 vs 17.4 μm3, respectively [p < 0.10]; and at 150,000 cells per 100 μL, 54.0 vs 31.5 μm3, respectively [p < 0.05]). This was largely attributable to a significant increase in the number of metastatic nodules per animal (at 50,000 cells per 100 μL, 8.7 vs 4.8, respectively [p < 0.001]; at 100,000 cells per 100 μL, 24.3 vs 14.0, respectively [p > 0.10]; and at 150,000 cells per 100 μL, 42.0 vs 20.1, respectively [p < 0.02]) rather than to a change in nodule size.Cigarette smoke exposure is associated with an increase in the total pulmonary metastatic burden in this murine model of metastatic mammary cell cancer. This study provides experimental support for an adverse effect of smoking on the metastatic process and suggests a possible mechanism for smokers' increased breast cancer mortality.

Objective To analyze the etiological changes in the elderly hospitalized patients with heart failure (HF) and investigate the strategies to prevent and treat HF. Methods A retrospective study was performed on 6 288 patients (4001 males and 2287 females) with a primary diagnosis of validated HF who were consecutively admitted to our hospital during the years of 1993 to 2010. The patients were divided into groups A, B and C with 6 years as interval. The etiological features and 30-day in-hospital mortality were compared in different genders and ages from the above 3 groups. Results During the period of 18 years, the number of the inpatients was increased year by year, with the proportion of women increased and men decreased, and the percentage of age 60 to 69 years old declined and over 80 years old risen. Of the 6288 patients, the proportion of accompanied hypertension and diabetes was increased, but that with coronary artery diseases, prior myocardial infarction and cor pulmonale decreased. There was no significant change in the proportions of acute myocardial infarction, rheumatic heart disease, congenital heart disease, anemia and hyperthyroid heart disease. In the inducing factors, the rate of pneumonia and atrial fibrillation was increased, but the rate of ventricular tachycardia and ventricular fibrillation reduced. The ratio of double, triple or more etiological factors was increased with aging, but there was no significant difference over the 3 different periods. The 30-day in-hospital mortality was decreased gradually, especially in males (P<0.01). Conclusion During the 18 years, the proportions of patients with hypertension and diabetes as etiological factors are increased significantly, but those of coronary artery disease and cor pulmonale are decreased obviously, and those of pneumonia and atrial fibrillation risen in the elderly patients with heart failure at first hospitalization. There is a significant decline in the 30-day in-hospital mortality among the cohort. The reasons of these findings are worth of further study.

Background Many reports have claimed associations between diagonal earlobe crease (DELC) and coronary artery disease (CAD), but data in Chinese populations are limited. Methods This cohort study investigated 449 consecutive Chinese, 250 cases with CAD and 199 without CAD, who were certified by coronary artery angiography in our center. Characteristic differences and the relation of DELC to CAD were assessed by Chi-square and t tests. The multivariate regression was performed to adjust for confounders and ROCs mode were used to detect its predicting performance for CAD. Results The prevalence of DELC was 46.2% in those without CAD and 75.2% in those with CAD (P < .001). Subjects with DELC had more stenostic vessels and higher prevalence of both any and significant coronary artery stenosis than those without DELC (P < .001). The sensitivity, specificity and positive and negative predictive values for DELC to diagnose CAD in the whole population were 0.752, 0.538, 0.671 and 0.633. The higher sensitivity and positive predictive values (ppv) were found in male, the lowest sensitivity and the highest ppv in the <45 years old group, and the lowest specificity and ppv in the >75 years old group. After adjusting for other variables including age, gender and traditional risk factors, DELC remained a positive predictor for CAD (OR, 3.408; 95% CI 2.235-5.196; P < 0.001), but not for hypertension, diabetes mellitus, hypercholesterolemia and hypertriglyceridemia. ROC analysis showed the area under the curve was 0.645 (95% CI 0.593-0.697, p < 0.001). Conclusions The study showed a significant association between DELC and CAD independent of established risk factors in Chinese.

An increased incidence of gallstones after gastrectomy has been reported, but with varying risk factors.To delineate the incidence of and risk factors for gallstone formation after gastrectomy.We retrospectively analyzed patients with Stages 0, I, and II adenocarcinoma of the stomach who had undergone curative gastrectomy with routine lymph node dissection between August 1996 and November 2010. We reviewed the clinical factors, radiographic presentation of the gallstones, and follow-up records.We included 215 patients (124 men and 91 women), with a median age of 53 years (range, 16–89 years). Gallstones were observed in 46 patients (21.4%) during follow-up periods of 6 months–14.5 years. Gallstones were diagnosed at a median of 2.3 years after gastrectomy. The cumulative incidence of gallstones at 5 years and 10 years was 18% and 20%, respectively. Total gastrectomy, Billroth II reconstruction (vs. Billroth I), age ≥ 60 years, and diabetes mellitus (multivariate odds ratios of 3.8, 3.3, 2.7, and 2.6, respectively) were the risk factors for gallstone formation. Complicated cholelithiasis was identified in seven patients (15.2% of patients with gallstones and 3.3% of all patients) and was more prevalent in patients who had undergone total gastrectomy (5 of 14; 35.7%) than in those who had undergone subtotal gastrectomy (2 of 32; 6.2%; p = 0.02).The incidence of gallstone formation was 21.4%. Total gastrectomy, Billroth II reconstruction, age ≥ 60 years, and diabetes mellitus were risk factors for gallstone formation. Total gastrectomy is also a risk factor for complicated gallstone.

目的 探讨急性心肌梗死(AMI)患者发生重症多器官功能衰竭(MOF)的相关危险因素,为临床早期识别高危患者提供依据.方法 对解放军总医院近18年中收治的6674例[18～101岁,平均(62.94±13.63岁)]AMI患者进行回顾性分析,根据是否发生重症MOF分为两组,应用多因素logistic回归分析MOF与患者的年龄、性别、合并症、并发症等的相关性.结果 83(1.24％)例发生了MOF.MOF组住院死亡率明显高于非MOF组(49.40％ vs 8.13％,P＜0.001).年龄(65～74岁,OR=2.76,95％ CI:1.26～6.03,P=0.011;≥75岁,OR=4.85,95％ CI:2.96～7.94,P＜0.001)、肺部感染(OR=4.27,95％ CI:2.68～6.82,P＜0.001)、心源性休克(OR=2.24,95％ CI:1.08～4.63,P=0.030)、慢性肾功能不全(OR=2.09,95％ CI:1.09～4.01,P=0.027)是AMI后发生MOF的独立危险因素.受试者工作特征曲线(ROC)下面积为0.83(95％ CI:0.75～0.89,P＜0.001),提示模型有较高的判别MOF患者的能力.结论 MOF在AMI患者中较少见,但严重危害患者预后.积极防治合并症和并发症可有效预防MOF的发生.

OBJECTIVES:Percutaneous coronary intervention( PCI) for ST-elevation myocardial infarction (STEMI) has been widely accepted for patient who come within 12 hours, but for those who come to the hospital late (12 hours to 28 days) the long-term data and possible predictors are limited regarding 'hard' endpoints in 'real world'.METHODS:The registry data of all 5523 consecutive patients admitted due to an incident STEMI (12 hours to 28 days) in our center were analyzed. Patients were divided into 3 age groups (age<65; age = 65-74; age ≥75) and two therapeutic groups including conservative and PCI group. The primary endpoints included 30-day mortality and 1-year mortality.RESULTS:The clinical characteristics include female gender; history of diabetes mellitus, previous myocardial infarction, cerebral vascular disease, chronic renal failure, atrial fibrillation, hypertension, anemia, gastric bleeding; presentation of ventricular tachycardia/ventricular fibrillation, pneumonia, heart failure, multiple organ failure and cardiogenic shock. The ratio of all the above factors increased with the age getting older (all p<0.05), while that of the PCI decreased significantly with ageing (53.9%, 36.3% and 21.7%). Except hypertension, all the other factors were less seen in the PCI group than in the conservative group (p<0.01). Pooled estimates, based on type of therapy and age groups, PCI resulted in significantly lower 30-day and 1-year mortality. Cox analysis showed the positive predictors for 30 days and 1 year mortality were heart failure, cerebral vascular disease, chronic renal failure, ventricular tachycardia/ventricular fibrillation, age, female, gastric intestinal bleeding, cardiogenic shock, multiple organ failure, while PCI was a negative predictor. ROCs analysis showed AUCs were always higher for PCI group.CONCLUSIONS:The elderly have more comorbidities and higher rates of mortality, mandating thorough evaluation before acceptance for PCI. PCI between 12 hours to 28 days in all ages of patients including the elderly with STEMI is significantly more effective than conservative therapy.

OBJECTIVE:To explore risk factors for cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) patients arising from comorbidities so as to identify high risk patients earlier.METHODS:A retrospective study was conducted on 5523 patients who were hospitalized with AMI in PLA General Hospital from January 1993 to December 2009. The patients were divided into two groups based on presence or absence of CS. Logistic regression analysis was used from comorbidities to evaluate the independent risk factors for CS.RESULTS:Among 5523 hospitalized AMI patients, 197 (3.57%) developed CS. The 30-day in hospital mortality rate of CS group was significantly higher than that of non-CS group [55.33% (109/197) vs. 7.49% (399/5326), P<0.001]. On the basis of logistic regression analysis, advanced age [odds ratio (OR)=1.03, 95% confidence interval (95%CI) 1.02 - 1.05, P<0.001], previous attack of myocardial infarction (OR=1.57, 95%CI 1.13 - 2.19, P=0.007), history of stroke (OR=1.98, 95%CI 1.20 - 3.27, P=0.008), chronic renal failure (OR=1.76, 95%CI 1.23 - 2.51, P=0.002) and pneumonia (OR=1.72, 95%CI 1.17 - 2.52, P=0.006) were independent risk factors for CS. Using receiver operator characteristic curve (ROC curve) analysis, the model was shown a good quality to judge the outcome of CS patients as the area under curve equals 0.81 (95%CI 0.75 - 0.85, P<0.001).CONCLUSIONS:Advanced age and comorbidities including previous myocardial infarction, previous stroke, chronic renal failure and pneumonia were independent risk factors for CS.

Insulin-like growth factor 1 (IGF-1) is a molecule with strong proliferative effects, and statins have been reported to exhibit antitumor effects based on clinical and experimental studies. However, their effects on cardiac myxoma (CM) cells and the underlying signaling mechanism(s) are largely unknown. Therefore, we investigated whether the protein/lipid phosphatases and tensin homolog deleted on chromosome ten (PTEN) and pleckstrin homology domain leucine-rich repeat phosphatase 1 and 2 (PHLPP1 and 2) are involved in the proliferative effect of IGF-1 on CM cells and the pharmacological impact of atorvastatin. The activity of PTEN and PHLPPs was determined using specific substrate diC16PIP3 and pNPP. We found that IGF-1 enhanced CM cell proliferation and inhibited both PTEN and PHLPP2 activity in a concentration- and time-dependent manner. Atorvastatin acted counter to IGF-1 and reversed the above effects mediated by IGF-1. Both IGF-1 and atorvastatin did not affect the activity of PHLPP1 and the protein expression of the three phosphatases. The results suggest that IGF-1 may exert its proliferative effects by negatively regulating the PTEN/PHLPP2 signaling pathway in CM cells, and atorvastatin may be a potential drug for the treatment of CM by enhancing the activity of PTEN and PHLPP2.

BACKGROUNDS: Myxomas are the most prevalent primary cardiac neoplasms. However, the molecular mechanisms of tumourigenesis and the potential inhibiting ability of statins are largely unknown. OBJECTIVE: To investigate whether the phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signalling pathway is involved in the biological actions of cardiac myxoma (CM) cells and the pharmacological impact of atorvastatin. METHODS: CM cells were cultured, and their proliferating and secreting abilities were determined after pretreatment with or without interleukin (IL)-6 and atorvastatin. Western blotting was used to detect the protein expression of Akt and phosphorylated Akt. RESULTS: IL-6 increased CM cell proliferation by a factor of 3.2 and IL-6 production by a factor of 20.3 compared with the control group, which were attenuated by both PI3K inhibitors wortmanin and atorvastatin. Akt phosphorylation was enhanced by IL-6 and inhibited by wortmanin and atorvastatin. Atorvastatin reversed IL-6-induced Akt phosphorylation in a concentration-dependent manner. DISCUSSION AND CONCLUSION: The results suggest that PI3K/Akt signalling pathways play an important biological role in CM cells when stimulated with IL-6. Atorvastatin may inhibit CM cells by regulating the activation of Akt.

BACKGROUND:The association between index finger to ring finger length ratio (2D:4D) and cardiac disorders has been reported, however it has not been discussed in terms of coronary artery disease (CAD). We investigated whether 2D:4D could be used as a marker for predisposition to CAD as assessed by coronary angiography in Chinese men and women. METHODS:This study included 1764 persons divided into 4 groups, 441 cases with CAD and 441 persons without CAD as control in each sex of the same age. Finger lengths were measured twice for both hands using electronic calipers. Student t test was used to detect the difference of 2D:4D among groups. The receiver operator characteristic curves (ROCs) were used to detect the diagnostic effect of 2D:4D for CAD. RESULTS:There were no significant differences in age among the four groups. A significant difference of 2D:4D ratios between right and left hand were observed only in men in both control and CAD groups. On the right hand in the control group and on both hands in the CAD group, the 2D:4D ratios were higher in women than in men (all, P < 0.001). In men with CAD, mean 2D:4D was higher than mean 2D:4D in control men (right hand 0.962±0.042:0.927±0.038; left hand 0.950±0.044:0.934±0.048; both hands, P < 0.001), but this was not observed in women. No relationship was found between 2D:4D and age (all, P >0.05). The area under the curve of right hand 2D:4D in male was 0.72 (95% CI 0.683-0.753, p<0.001), while it was 0.602 (95% CI 0.565-0.639, p<0.001) in left hand. CONCLUSIONS:The present study showed an association between high 2D:4D ratio and CAD in both hands in men. There were no significant differences in mean 2D:4D between women with CAD and controls.

Background and aim: Myxoma is the most common type of primary cardiac neoplasm, but the clinical characteristics and long term outcome are less known in the elderly in China. Methods: We analyzed medical records of 112 consecutive patients who underwent operative resection of cardiac myxoma between December 1988 and December 2010 in our hospital. Their data were retrospectively analyzed and the difference between two age groups (< 60 years, n = 87 and ≥ 60 years, n = 25) was compared. Results: The mean age of 112 patients was 48.8 ± 12.5 (range 13 ~ 75) years, and 66 patients (58.9 %) were female. The interval from onset of symptoms to diagnosis was 12 months and the most common presenting symptoms were chest distress (66 patients 58.9 %), followed by palpitations (55 patients, 49.1 %) and dyspnea (47 patients, 42.0 %). Mitral valve diastolic murmur was heard in 67 (59.1 %) patients. The tumor was located in the left atrium in 96 (85.8 %) patients. There were no in-hospital death. During follow-up ranged between one and twenty-one (7.3 ± 5.3) years, there was no malignancy. Myxoma recurred in 3 (2.7 %) patients and deaths occurred in 5 (4.5 %) patients. The 5 and 15 years survival was 97.8 % and 89.5 %, respectively. To compare with the younger patients, the elderly have higher ratios of concomitant hypertension, fewer complaints of dyspnea and chest distress (p < 0.05). Conclusion: The elderly have lower complaints of dyspnea and chest distress, surgical treatment is associated with low long-term mortality and recurrence rate even in the elder patients.