1 基本情况 患者,男,17岁.1年前体检时发现血压升高,当时血压为 170/120 mm Hg(1 mm Hg=0.133 kPa),偶有头晕、胸闷,无头痛,无气促.夜间无打鼾及呼吸暂停,无阵发性颜面潮红,无心悸,无夜尿增多,无四肢麻木,无恶心、呕吐,未服药,未规律监测血压.为查明高血压病因入住我科.既往史:既往体健.否认特殊个人史.反复仔细询问患者家族史,但均否认家庭成员中有类似疾病患者.

Objective To study the recurrence rate of left ventricular systolic dysfunction of patients with dilated cardiomy-opathy and analysis of its influence factors. Methods 109 cases of patients with DCM whose LVSD was recovered after treatment in our hospital from March 2011 to October 2014 were selected as the research objects, and divided into the re-currence group with 23 cases and non-recurrence group with 86 cases according to whether the recurrence occurred or not, and recurrence was recorded after 18-month follow-up, and the related indicators including first admission and first recov-ery were monitored and recorded. Results Recurrence occurred to 23 cases in all the recovering patients, and the recur-rence rate was 21.10% (23/109), LVEF level obviously decreased and LVEDD level obviously increased at the time of re-currence, all P<0.05, the Logistic regression analysis showed that 4 influence factors of LVSD recurrence of DCM patients were LVEF in the first recovery, increase value of LVEF compared with the baseline, decrease value of LVEDD and LVEDD compared with the baseline. Conclusion The recurrence rate of LVSD in DCM patients is 21% or so, the change degree of LVEF and LVEDD in the first recovery is the main influence factor of LVSD recurrence of DCM patients.

冠心病是当今威胁人类健康的主要疾病之一,动脉粥样硬化是一种脂质代谢紊乱、血凝因素异常、细胞因子、平滑肌细胞增殖和血流动力学改变等多种因素相互作用的结果。近年来,越来越多的研究提示炎症与免疫在动脉粥样硬化的发生、发展中起重要作用。炎症的激活可能是导致斑块不稳定的主要因素。在与冠心病相关的众多炎症介质中,血浆可溶性CD40配体(sCD40L)已成为研究热点。sCD40L通过促进血小板聚集、刺激趋化蛋白表达和释放、增强免疫活性细胞的粘附、诱导金属蛋白酶表达等多种机制促进动脉粥样硬化的演变。