目的 探讨miR-18a、miR-19a在老年冠心病(CHD)并发脑梗死(CI)患者血清中的表达及意义.方法 选择2017年11月-2020年4月在浙江省临海市第二人民医院收治的老年冠心病并发脑梗死的109例(CHD并发CI组),选择同期老年单纯冠心病患者113例(CHD组).纳入影响老年冠心病并发心肌梗死的10个因素,包括性别、年龄、吸烟史、高血压史、高血脂史和糖尿病史,以及MMP-9、D-D、miR-18a、miR-19a指标进行单因素及多因素Logistic回归分析,探讨血清miR-18a、miR-19a在老年冠心病并发脑梗死患者中的表达意义.结果 miR-19a是老年冠心病并发脑梗死的独立危险因素(P<0.05),此外,危险因素还有高血脂病史和MMP-9、D-D,而miR-18a为保护因素(P<0.05).结论 确定高血脂史,动态检测miR-18a、miR-19a、MMP-9、D-D水平,有利于防治冠心病并发的脑梗死.

Objective To investigate the effect of irbesartan combined with resuvastatin on early diabetic nephropathy( DN) complicated with cardiovascular disease,and its influence on SDF -1/CXCR4 expression. Methods From January 2016 to December 2017,130 early DN patients complicated with cardiovascular disease in the Second People＇s Hospital of Linhai were selected as study objects,and according to the digital table,they were randomly divided into three groups: irbesartan group(control group 1,n＝43),resuvastatin group(control group 2,n＝43) and irbesartan combined with resuvastatin group (observation group,n＝44).The clinical efficacy,blood pres-sure,blood lipids and SDF -1/CXCR4 expression were compared among the three groups.Results After treatment,the total effective rate in the observation group was 93.18%(41/44 ),which in the control group 1 was 69.77%(30/43),which in the control group 2 was 74.42%(32/43),there was statistically significant difference among the three groups(χ2＝12.341,10.106,all P＜0.05).After treatment,the levels of SBP and DBP in the observation group had statistically significant differences compared with those in the control group 1 and control group 2( F＝23.087,20.249,all P＜0.05).After treatment,there were statistically significant differences in TC,TG,HDL-C and LDL-C between the observation group and control group 1,control group 2(F＝18.408,15.623,14.852,9.845,all P＜0.05).After treatment,the level of SDF -1 in the observation group was significantly higher than that before treatment,and which was also significantly higher than that in the control group 1 and control group 2(F＝21.085,P＜0.05).After treatment,the positive rate of CXCR4 in the observation group was significantly higher than that before treatment,and compared with that in the control group 1 and control group 2,the difference was statistically significant(F＝23.641,P＜0.05).Conclusion Irbesartan combined with resuvastatin in the treatment of early DN patients with cardiovascular disease has significant clinical efficacy,can effectively improve blood pressure and blood lipid levels,significantly improve the level of SDF -1 and CXCR4 positive rate.

目的探讨缬沙坦对高血压病患者APN、hs-CRP、TNF-α的调节作用。方法将80例1-2级原发性高血压患者随机分为治疗组和对照组各40例,治疗组予以缬沙坦80mg,1日1次,若4周后血压仍不达标(>140/90mmHg),则缬沙坦1日160mg,对照组患者予以硝苯地平缓释片10mg,1日2次,若4周后血压仍不达标,则硝苯地平缓释片20mg,1日2次,两组均8周为一疗程。结果两组所有患者均在8周内实现血压达标,两组血压达标率及达标时血压情况基本一致(P>0.05)。治疗前,两组APN、hs-CRP和TNF-α含量基本一致(均P>0.05)。治疗一个疗程后,治疗组APN有所升高(P<0.05),而对照组APN变化不明显(P>0.05);两组hs-CRP和TNF-α含量均有所下降(均P<0.05),但治疗组降低比对照组更明显(均P<0.05)。结论缬沙坦对高血压病患者外周血中APN、hs-CRP、TNF-α的含量有一定的调节作用,可能有利于改善高血压患者的预后。

目的:探讨IL-18、NO、ET检测对冠心病(CHD)患者冠脉狭窄程度的临床价值.方法:检测冠状动脉不同狭窄程度CHD患者外周血IL-18、NO、ET的含量.结果:重度狭窄组IL-18、ET含量高于中度狭窄组(P<0.05),NO含量低于中度狭窄组(P<0.05);中度狭窄组IL-18、ET含量高于轻度狭窄组(P<0.05),NO含量低于轻度狭窄组(P<0.05);轻度狭窄组IL-18、ET含量高于正常对照组(P<0.05),NO含量低于正常对照组(P<0.05).结论:临床可通过检测CHD患者血浆中IL-18、NO、ET的含量,作为评价冠脉狭窄程度严重程度的指标.