目的:对高血压药物临床试验文献的伦理问题进行调研,以了解我国杂志是否提高了报告临床试验伦理道德的情况.方法:在维普中文科技期刊数据库中检索2003年、2008年和2013年高血压患者口服降压药物临床研究文献,分析文献中是否有通过伦理委员会批准、是否患者签署知情同意书的描述,比较各阶段高血压口服降压药物临床试验文献的伦理状况.结果:共收集到相关文献2003年292篇、2008年603篇、2013年1 046篇,随机对照临床试验的各有76篇(26.03％)、364篇(60.36％)、828篇(79.15％)(p =0.000),其中描述通过伦理委员会审查的文献分别为为2(2.63％),4(1.10％),以及57 (6.88％),(P=0.000),描述患者签署知情同意书的分别为7(9.21％),29(7.67％),和144(17.39％) (P =0.000).结论:与2003、2008年相比,2013年我国降压药物临床试验文献对伦理的报告有明显改善,但与国外文献相比仍有差距,我国药物临床试验文献的伦理管理仍亟需加强.

Background Alteration in the protein composition of high-density lipoprotein (HDL) has been proposed as a mechanism for the development of coronary heart disease (CHD). In HDL, an increase in serum amyloid A protein (SAA) accompanying the decrease in apolipoprotein A-I (apoA-I) has been found during the acute inflammation period. However, whether this phenomenon persists in CHD patients, a disease related to inflammation, is unknown. The purpose of the present study was to explore the relationship between SAA and apoA-I in HDL isolated from CHD patients. Methods Overall, 98 patients with confirmed stable CHD and 90 control subjects matched for age and gender were enrolled in this case-control study. Potassium bromide (KBr) density gradient ultracentrifugation was used to isolate HDL from plasma. The levels of SAA and apoA-I in the HDL samples were detected by enzyme-linked immunosorbent assay kits. Pearson's correlation and general linear models were used in the analysis. Results Compared with controls, patients with CHD had a significant decrease in the amount of apoA-I ((14.21±8.44) μg/ml vs. (10.95±5.95) μg/ml, P =0.003) in HDL and a significant increase in the amount of log SAA (1.21±0.46 vs. 1.51±0.55, P <0.00001). Differences were independent of age, body mass index (BMI), HDL cholesterol (HDL-C), and other factors. An independently and statistically significant positive correlation between log SAA and apoA-I in HDL was observed only in the CHD group (β =2.0, P =0.026). In the general linear model, changes in log(SAA), age, age2, gender, BMI and HDL-C could explain a statistically significant 43% of the variance in apoA-I. Conclusions This study provides direct evidence for the first time that there was an independent positive correlation between log SAA and apoA-I in the HDL of CHD patients, indicating the alteration of protein composition in HDL. However, the question of whether this alteration in HDL is associated with impairment of HDL functions requires further research.

<正>难治性血脂异常是指用一般常规治疗方法或常规药物剂量较难见效的血脂异常。结合具体病例,我们探讨一下几种难治性血脂异常的治疗经验。1重度的混合型血脂异常及联合用药病例:患者,男,61岁,阵发性胸痛1年,持续1小时。平时在上坡及快走时诱发,休息3~5分钟后好转,心电图(ECG)正常,平板运动试验阳性(+)。1小时前,患者胸痛持续1小时不缓解。吸烟史30年。冠心病家族史。无出血倾向史。入院

Objective To study heart rate variability(HRV) of health young man.Method Record and analyze heart rate and HRV in 24 hour Holter recording in 205 health young men.Results The standard deviation of all RR intervals(SDNN),the square root of the mean squared differences of successive of RR intervals(rMSSD),the percentage of of successive of RR intervals > 50ms(PNN50) were 184.8±42.7(80~297) ms,30.2±18.8(7.3~89) ms,19.0±10.4(1~51),low frequency(LF),high frequency(HF) and LF/HF in daytime were 719.0±504.0(74~2575) ms2,289.8±306.3(25~1772) and 3.2±1.6(0.4~7.91),while those in night were 650.6±480.9(20~2468) ms2,971.8±870.0(24~5489) and 1.1±1.2(0.1~8.3).There were significant difference between day and night.Conclusion The present study can provided some useful information about HRV in health young man.

代谢综合征(MS)与急性冠状动脉综合征(ACS)均是一系列心血管危险因素的聚集及其事件链上的心血管疾病。各种心血管危险因素(如腹型肥胖、胰岛素抵抗、血脂异常和高血压)的聚集导致MS,而MS各危险因素相互协同共同引起或者加速动脉粥样硬化的进程,并增加斑块的不稳定性,是ACS极其重要的危险因素。ACS合并MS者比不合并MS者临床预后更差。以治疗性生活方式改变为基础并配合药物治疗来防治MS,进而预防ACS;ACS患者应使MS各指标全面达标,以减少或防止心血管事件。

Objective To observe serum amyloid A(SAA) changes in plasma and HDL respectively in patients with coronary heart disease(CHD),and explore the relationship between SAA and atherosclerosis. Methods Plasma and HDL SAA in CHD group(65 cases) and control group(62 cases) was analyzed with the SAA enzyme-linked immunosorbent assay.Meanwhile,other cardiovascular risk factors,blood lipid levels,as well as hs-CRP of the two groups were compared.Results The history of hypertension,smoking,hs-CRP level and family CHD history were significantly higher in the CHD group(P<0.05) than in control group.SAA in both plasma and HDL was significantly higher in the CHD group(15.93±12.04) mg/L vs(10.92±11.04) mg/L, (115.22±70.61) mg/L vs(35.92±25.42) mg/L(P<0.001).Logistic regression analysis showed that the QR values(95%CI) of lghs-CRP and IgSAA were 3.449(1.207-9.854) and 5.909(1.531-22.801) respectively.Conclusion Both plasma and HDL SAA levels were significantly higher in CHD group,and may be an important risk factor for CHD.

他汀类药物是在甲羟戊酸途径的早期阶段抑制羟甲基戊二酸单酰辅酶A(HMG-CoA)还原酶,从而抑制胆固醇的合成和该途径的其他一些产物的生成,如辅酶Q10、血红素A和异戊烯类蛋白质等.而这些产物在细胞生物学和人类生理学中产生了重要的作用.因此,抑制了这些产物既与他汀类药物的降脂作用有关,也很有可能与他汀类药物的不良反应相关.

1 血脂异常的现状 血脂异常是血液脂质代谢异常的简称,主要包括:血清低密度脂蛋白胆固醇(LDL-C)水平过高和(或)总胆固醇(TC)水平过高;血清甘油三酯(TG)水平过高;血清高密度脂蛋白胆固醇(HDL-C)水平过低.

Objective: To analyze the distribution and drug sensitivity of bacteria of infective endocarditis (IE),so as to help to rationally use antibiotics. Methods:The blood/neoplasm culture and drug sensitivity tests from 91 hospitalized patients with IE were studied retrospectively in Fuwai Hospital.Results:Among 67 IE patients with blood culture, 20cases(29.9%) were positive. The main bacteria were streptococcus and staphylococcus. Drug sensitivity analysis indicated that streptococcus were sensitive to penicillin, while staphylococci were resistant to penicillin, oxacillin and amoxicillin,and sensitive to levofloxacin, cotrimoxazole, erythromycin, ciprofloxacin and vancomycin. Among 44 IE patients with vegetation culture, 4 cases(9.1%) were positive. Conclusions:Streptococcus and staphylococcus are still the dominant bacteria of IE. In order to choose antibiotics correctly, blood culture and drug sensitivity test or other experimental measures to reveal bacteria are necessary.

目前世界各个国家高血压的治疗现状仍不容乐观,高血压的知晓率、治疗率和达标率仍然很低,如何提高"三率"水平是我国高血压防治的主要任务.造成我国高血压"达标率低"的一个重要原因就是高血压用药配伍不合理,使患者未得到有效的治疗.

Objective To study the in-hospital mortality rate of recombinant human tissue-type plasrninogen activator(rt-PA) and urokinase(UK) from 2005 to 2009.Methods We retrospectively analyzed the type of thrombolytic agents and cause of death in ST elevated acute myocardial infarctiong patients(n=57) and pulmonary thromboembolism patients(n=60).Results In the 117cases,ten patients died in hospital due to cardiac shock(n=6)、cardiac rupture(n=3) and ventricular fibrillation(n=1).No case died of bleeding complication.Seven of ten deaths suffered acute myocardial infarction.The other 3 deathes due to cardiac shock suffered pulmonary thromboembolism.About 84%(98 cases) patients used rt-PA,of whom seven patients died.In the patients using UK(n=19),3 cases died.Conclusion The in-hospital mortality rate of the patients using thrombolytic therapy was mainly associated with underlying diseases.The scientific and standardized thrombolytic therapy is safe.

<正> 冠状动脉粥样硬化性心脏病(coronary atheroscleroticheart disease)指冠状动脉粥样硬化使血管腔狭窄或阻塞,或(和)在此基础上合并冠状动脉功能性改变(痉挛)、血栓形成,导致心肌缺血缺氧或坏死而引起的心脏病。目前,冠心病的现代治疗在治疗性生活方式改善的基础上,主要有3个方面:(1)药物治疗;(2)PCI;(3)冠状动脉旁路移植术(CABG)。近年来,PCI和CABG的技术日臻完善并取得了较好的疗效。但药物治疗仍是冠心病治疗的基础,即使成功介入和

调脂药就是调节血脂代谢的药物,包括使血清总胆固醇、低密度脂蛋白胆固醇、甘油三酯等降低,和使血清高密度脂蛋白上升.大多数血脂异常患者需长期服用调脂药物.合理应用调脂药,应该兼顾安全、有效两方面.

原发性高血压以血压升高为主要临床表现,是多种心、脑血管和肾脏疾病的重要病因和危险因素,并最终可导致这些器官的功能衰竭.值得强调的是,目前高血压防治指南更新很快,不断完善.然而指南与临床之间存在较大缺口,合理用药是补缺的关键。