目的 探讨不同时间服用长效降压药物氨氯地平对高龄老年高血压患者血压昼夜节律及变异性的影响.方法 连续入选2014年9月至2016年9月于河北省沧州市中心医院心内科门诊就诊的高血压患者123例,对入选患者的启动第一次24 h血压动态监测,将其中非杓型血压患者纳入夜间服用氨氯地平组,其余患者纳入晨起服用氨氯地平组,2周后再次进行动态血压监测,并对两组患者的动态血压监测参数及血压变异性进行比较.结果 与晨起服药相比,夜间服用依氨氯地平能有效改善高龄老年患者血压的非杓型血压节律(P<0.05).夜间服用氨氯地平可降低部分动态血压参数(P<0.05).与晨起服用降压药物相比,夜间服用长效降压药物降低血压的变异性(P<0.05).结论对于高龄老年高血压患者,夜间服用氨氯地平可有效控制全天血压水平,纠正非杓型血压节律,同时还可降低血压的变异性.

目的 探讨高龄高血压患者血压昼夜节律及血管舒张功能与服药时间的关系.方法 将144例≥80岁非杓型高血压患者均分为晨起服药组和夜间服药组,分别于每日8:00和20:00服用苯磺酸左旋氨氯地平2.5 mg,连续服用24周;记录2组患者治疗前后的动态血压指标[24 h平均收缩压(24hSBP)、24 h平均舒张压(24hDBP)、白昼平均收缩压(dSBP)、夜间平均收缩压(nSBP)、白昼平均舒张压(dDBP)、夜间平均舒张压(nD-BP)];分析2组患者治疗后血压的昼夜节律变化,观察治疗前后2组患者的血清一氧化氮(NO)、内皮素(ET)、同型半胱氨酸(Hcy)水平及肱动脉血流介导的血管舒张功能(FMD).结果 2组患者治疗后24hSBP、24hDBP、dSBP、nSBP、dDBP、nDBP均低于治疗前(P<0.05),夜间服药组治疗后nSBP、nDBP低于晨起服药组(P<0.05),杓型血压所占比例高于晨起服药组(P<0.05);治疗后,2组患者血清ET、Hcy水平低于治疗前(P<0.05),NO水平及FMD高于治疗前(P<0.05),夜间服药组治疗后血清ET水平低于晨起服药组(P<0.05),NO水平及FMD高于晨起服药组(P<0.05).结论 高龄非杓型高血压患者夜间服用苯磺酸左旋氨氯地平降压效果优于晨起服药,能纠正非杓型血压节律,其机制可能与增加血管内皮NO合成和释放、上调FMD值及降低ET水平有关.

Diabetic cardiomyopathy (DCM) is a common cardiovascular disease. A declined miR-20a-5p was observed in hearts of diabetic mice, while its effect on DCM remains unknown. Herein, we established streptozotocin-induced DCM rat model and high glucose-stimulated H9C2 model of DCM. Then they were treated with adenovirus expressing miR-20a-5p to explore the function of miR-20a-5p. Insulin tolerance test and intraperitoneal glucose tolerance test assay revealed that miR-20a-5p reduced blood glucose level. Besides, miR-20a-5p improved cardiac dysfunction reflected by reduced heart weight/body weight and left ventricular diastolic pressure, and increased left ventricular systolic pressure and ±LV dp/dt max. MiR-20a-5p prevented cardiomyocyte apoptosis, along with the upregulated c-caspase-3, bax and downregulated bcl-2. Moreover, miR-20a-5p alleviated cardiac hypertrophy as the parameters of atrial natriuretic peptide, B-type natriuretic peptide and MyHC-β decreased. Also, miR-20a-5p attenuated the cardiac fibrosis demonstrated by decreased transforming growth factor-β1, collagen I levels and the inflammatory response manifested by reduced interleukin-6, tumour necrosis factor-α and IL-1β production. Furthermore, miR-20a-5p prevented Jun NH2-terminal kinase (JNK) phosphorylation and nuclear factor-κB (NF-κB) p65nuclear translocation. Similarly, the effects of miR-20a-5p on DCM were confirmed in our in vitro experiments. Additionally, ROCK2 is a possible target gene of miR-20a-5p. ROCK2 overexpression reversed the protective effect of miR-20a-5p on DCM. Overall, miR-20a-5p may effectively ameliorate DCM through improving cardiac metabolism, and subsequently inhibiting inflammation, apoptosis, hypertrophy, fibrosis and JNK/NF-κB pathway via modulating ROCK2.

Circular RNAs have pivotal roles in cardiovascular disease. The injury of cardiac myocytes is associated with occurrence of cardiovascular disease. Circular RNA hsa_circ_0010729 (circ_0010729) is associated with cardiac myocytes injury. However, the mechanism of circ_0010729 in cardiac myocytes injury remains largely unclear. In our study, cardiac myocytes were treated by oxygen-glucose deprivation (OGD). The abundances of circ_0010729, microRNA-338-3p (miR-338-3p), and calmodulin 2 (CALM2) were detected by quantitative reverse transcription polymerase chain reaction or Western blot. OGD-induced damage in AC16 cells was assessed by cell viability, apoptosis, and autophagy using Cell Counting Kit-8, flow cytometry, and Western blot analyses. The target relationship of miR-338-3p and circ_0010729 or CALM2 was explored by starBase and dual-luciferase reporter analysis. Our results showed that the circ_0010729 level was enhanced in OGD-treated AC16 cells and murine primary cardiac myocytes. circ_0010729 silence weakened OGD-induced viability inhibition and promotion of apoptosis and autophagy in AC16 cells and murine primary cardiac myocytes. miR-338-3p was sponged by circ_0010729 and miR-338-3p knockdown alleviated the effect of circ_0010729 silence on OGD-induced damage. miR-338-3p directly targeted CALM2 to inhibit OGD-induced damage in AC16 cells. circ_0010729 could regulate CALM2 expression by sponging miR-338-3p. Collectively, circ_0010729 interference mitigated OGD-induced damage in cardiac myocytes through increasing cell viability and inhibiting apoptosis and autophagy by regulating miR-338-3p/CALM2 axis. This study indicated circ_0010729 might act as a target for treatment of cardiovascular disease.

This study aimed to analyze the correlation between the level of brain natriuretic peptide (BNP) and the condition and prognosis of chronic heart failure (CHF). For this purpose, between January 2017 and July 2020, we recruited a total of 120 CHF patients who were treated in Cangzhou Central Hospital into this study, consisting of 40 patients in NYHA II, 40 in NYHA III and 40 in NYHA IV, and simultaneously, 40 subjects with normal heart function were enrolled into the control group. General data were collected from the patients and subjects, and laboratory tests regarding the BNP level, LVEDD and LVEF were carried out. Correlation between plasma level of BNP and the evaluation of condition and prognosis of CHF was also analyzed. For further evaluation, the expression of BNP gene expression was considered in the femoral blood of participants by the Real-time PCR technique. The results showed that comparison over the clinical data of subjects among these groups showed no significant difference (P > 0.05). In the research group, the averages of LVEDD and BNP in plasma were (58.53±3.75) mm and (5089.86±22.39) pg/mL, significantly higher than those in the control group, while the LVEF was (45.66±3.42) %, which was lower than that in the control group (all P < 0.05). For the subgroup comparison, as the NYHA class augmented, patients also had a significant increase in the mortality rate and the difference among subgroups had statistical significance (P < 0.05). Furthermore, with 442 pg/mL as a critical point for BNP, patients in the research group were further divided into the BNP>442 pg/mL group and BNP ≤442pg/mL group, and the statistical analysis revealed that in the BNP>442 pg/mL group, the incidence rate of cardiovascular events, re-hospitalization rate and mortality rate were 53.53%, 14.14% and 7.07%, which were all significantly higher than those in the BNP ≤ 442 pg/mL group (all P < 0.05). Also, BMP gene expression was increased in NYHA II, NYHA III, and NYHA IV groups compared to the control group. However, this increase was statistically significant in the NYHA III group (P <0.05) and in the NYHA IV group (P <0.01) compared to the control group. In conclusion, the level of BNP in plasma can reflect the condition of CHF and is critical to the clinical diagnosis, treatment and prognosis evaluation and evaluation of the BNP gene confirmed the result. Thus, it is worth being promoted in clinical practice.

目的 探讨在不同时间段服用依那普利叶酸片对80岁以上高血压患者血压昼夜节律及同型半胱氨酸水平(Hcy)的影响.方法 入选2015年6月至2017年6月于沧州市中心医院心血管内科门诊就诊的102例非杓型高血压患者,随机分为晨起服药组和夜间服药组,分别于每日8:00和20:00服用依那普利叶酸片,在治疗前和治疗2周后进行动态血压监测,比较服药前后血压昼夜节律的变化以及对血浆Hcy水平的影响.结果 与晨起服药相比,夜间服用依那普利叶酸片具有同样良好的降压效果(P>0.05).与晨起服药相比,夜间服用依那普利叶酸片能有效改善高龄老年患者血压的非杓型血压节律,杓型血压所占的比例分别为53.6％、17.3％(P<0.05).治疗后,晨起服药组与夜间服药组的Hcy水平(16.31±1.74μmol/L vs.17.13±2.31μmol/L)比较,无显著统计学差异(P>0.05).结论 对于高龄老年H型高血压患者,夜间服用依那普利叶酸片同样可以有效控制血压,降低Hcy水平,纠正非杓型血压节律.

目的 观察硝苯地平控释片在清晨、夜晚服用对老年高血压患者的疗效及对血管内皮功能的影响.方法 选取2016年1月至2018年1月在沧州市中心医院就诊的120例高血压患者作为研究对象,按随机数字表法分为清晨组(n=60)和夜间组(n=60).清晨组予以清晨服用硝苯地平控释片,夜间组予以夜间服用硝苯地平控释片.观察并比较两组患者的临床疗效、动态血压结果、昼夜节律变化、血管内皮功能、心脏结构与功能、不良反应发生情况.结果 夜间组患者临床总有效率为96.67％,高于清晨组的86.67％,差异有统计学意义(P<0.05).治疗后,夜间组的24 h动态血压的平均收缩压(systolic blood pressure,SBP)和舒张压(diastolic blood pressure,DBP),白天平均SBP和DBP,夜间平均SBP和DBP均低于清晨组,差异具有统计学意义(P<0.05);且夜间组患者杓型血压比例为70.00％,高于清晨组患者的51.67％,差异具有统计学意义(P<0.05).治疗后,两组患者左心室射血分数(left ventricular ejection fraction,LVEF)比较,差异无统计学意义(P>0.05).治疗后,两组患者的室间隔舒张末期厚度(interventricular septum end-diastolic thickness,IVST)均较治疗前减小,且夜间组患者的IVST显著小于清晨组,差异有统计学意义(P<0.05).治疗后,两组患者的内皮依赖性舒张功能(flow-mediated vasodilation,FMD)和一氧化氮(nitric oxide,NO)浓度均较治疗前升高,且夜间组患者的FMD和NO浓度均高于清晨组,差异有统计学意义(P<0.05).两组均未出现严重不良反应以及不良事件.结论 相较于清晨服药,老年高血压患者夜间服用硝苯地平控释片能够有更好地降压效果,具有很好的临床应用价值.

[目的]探讨左西孟旦联合重组人脑利钠肽(rhBNP)治疗急性心肌梗死(AMI)合并心功能不全患者临床疗效及对患者炎症因子水平的影响.[方法]回顾性分析2017年12月至2018年12月本院收治的116例AMI合并心功能不全患者的临床资料,根据治疗方法的不同将其分为观察组(左西孟旦+rhBNP)和对照组(左西孟旦),每组各58例.比较两组治疗前后左心室射血分数(LVEF)、心率(HR)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)水平,两组血清白细胞介素(IL-10、IL-6、IL-17)、超敏C反应蛋白(hs-CRP)水平及临床治疗效果.[结果]治疗前两组LVEF、HR、LVESD、LVEDD比较,差异无统计学意义(P＞0.05);治疗后观察组LVEF高于对照组,HR、LVESD、LVEDD低于对照组,差异有统计学意义(P＜0.05).治疗前两组血清IL-10、IL-6、IL-17、hs-CRP水平比较,差异无统计学意义(P＞0.05);治疗后观察组血清IL-10水平高于对照组,IL-6、IL-17、hs-CRP水平低于对照组,差异有统计学意义(P＜0.05).观察组治疗有效率为94.8％(55/58)显著高于对照组的79.3％ (46/58),差异有统计学意义(x 2=4.335,P＜0.05).[结论]应用左西孟旦联合rhBNP治疗AMI合并心功能不全患者,临床疗效较佳,可改善损伤的心肌细胞,调节血清IL-10等炎症因子水平,改善患者心功能,值得临床推广应用.

目的:探讨对慢性心力衰竭患者采用院外管理模式加以干预后对其预后情况产生的影响.方法:选择我院2016年01月～2017年12月收治的122例慢性心力衰竭患者作为实验对象;采用数字奇偶法分组;研究出院后管理模式期间,对照组(61例):未对患者给予出院管理;观察组(61例):选择院外管理模式给予出院管理;最终就两组慢性心力衰竭患者生活质量评分、再住院率以及死亡率展开对比.结果:同对照组慢性心力衰竭患者生活质量评分对比,观察组获得明显下降(P<0.05);同对照组慢性心力衰竭患者再住院率(31.15％)以及死亡率(24.59％)对比,观察组(8.20％)、(6.56％)获得明显下降(P<0.05).结论:对于慢性心力衰竭患者选择院外管理模式展开出院管理,于患者生活质量提高、再住院率以及死亡率降低方面获得明显效果,从而对于慢性心力衰竭患者病情好转以及预后改善做出充分保证.

目的:评价延伸护理对高血压患者服药依从性的影响.方法:选取2015年1月－2015年12月在我院心内科病房或门诊确诊的原发性高血压患者102例;其中男59例,女43例,按随机原则分为两组,对照组50例,观察组52例,对照组给予传统的出院指导,观察组采用延续性护理干预.比较两组患者在出院时、出院后1个月、3个月、6个月、12个月5个时间点的服药依从性,血压达标率与并发症.结果:观察组患者的服药依从性明显高于对照组(P<0.05),患者的血压达标率高于对照组(P<0.05),并发症明显低于对照组,差异具有统计学意义.结论:延续性护理干预,提高了服药依从性,提高了血压达标率,减少了并发症,值得推广.

目的 探讨不同服药时间对80岁以上高血压患者血压昼夜节律及晨峰现象的影响.方法 对入选的2014年6月～2015年6月于我院心内科门诊就诊的80岁以上高血压患者进行动态血压监测,将非杓型血压患者的长效降压药物服用时间由晨起调整为夜间,2周后再次进行动态血压监测,并比较调整前后血压昼夜节律的变化以及对血压晨峰的影响.结果 与晨起服药比较,夜间服用长效降压药物对血压的昼夜节律并无显著影响,同时具有同样良好的降压效果(P＞0.05).与晨起服药比较,睡前服用长效降压药物能有效改善高龄老年患者血压的晨峰现象(P＜0.05),血压晨峰控制率为83％.结论 对于高龄老年高血压患者,夜间服用降压长效降压药物同样可以有效地控制血压水平,虽然未能纠正非杓型血压节律,但可以有效控制血压的晨峰现象.

目的:研究健康教育在高血压患者护理中的作用.方法:选取2017年3月至2017年9月期间,我院心血管内科收治的160例高血压患者.根据患者入院时间的先后顺序,将患者分为两组,2017年3月至2017年5月期间收治的高血压患者80人为对照组,实施一般高血压护理常规.2017年6月至2017年9月期间收治的高血压患者80人为观察组,在对照组的基础上增加健康教育.两组患者在年龄、性别、疾病种类、疾病程度等方面无差异,具有可比性.结果:观察组在护理差错、住院费用、住院天数、并发症的发生率明显降低,满意度明显提高.结论:健康教育有利于高血压患者的康复.因健康教育简单、易实施,因此值得推广.

Objective To investigate the effect of ticagrelor and clopidogrel on peri-operative high sense C reactive protein(hs-CRP) and short-term efficacy and safety in patients with acute coronary syndrome(ACS) undergoing percutaneous coronary intervention(PCI).Methods Totally 379 patients with ACS undergoing PCI were randomized into ticagrilor group(n=189) and clopidogrel group(n=190).Ticagrilor group(180 mg loading dose,90 mg maintanining dose,twice daily)and clopidogrel group(600 mg loading dose,75 mg maintanining dose,once daily).Hs-CRP and cTnI were detected in 24 hours before and after PCI procedure.All patients were followed up for three months,and adverse events were observed.Results There were no significant difference in the baseline data between two groups.The ratio of hs-CRP elevation after PCI in ticagrelor group was lower compared with that in clopidogrel group(33.3% vs 63.6%,P<0.01).There was no significant difference in peri-operative myocardial infarction between two groups(15.3% vs 16.3%,P=0.796).In the postoperative one month follow-up, the patients in ticagrelor group showed significantly lower MACCE rate compared with that in clopidogrel group(P=0.033).There was no significant difference in bleeding events between two groups(P>0.05).Conclusion In patients with ACS undergoing PCI, ticagrelor significantly reduces the elevation of hs-CRP during PCI procedure as compared with clopidogrel,which suggests ticagrelor significantly inhibits the inflammation in PCI procedure.

Objective To observe the efficacy and safety of ticagrelor treated on patients with low clopidogrel response.Methods A total of 1 73 of 493 patients undergoing percutaneous coronary intervention(PCI)with acute coronary syndrome(ACS)were selected as low colpidogrel response identified by thrombelastography and enrolled in this study.Patients with low clopidogrel response were randomized into clopidogrel treated group (n = 87 )and ticagrelor treated group(n =86).Patients responding to clopidogrel were still treated with clopidogrel(75 mg daily) and patients with low clopidogrel response received ticagrelor treatment(90 mg twice daily).Platelet aggregation rate was compared between two groups after treatment for 3 days,7 days and 30 days.All patients were followed 12 months for major adverse cardiovascular events(MACCE)and bleeding events.Results Patients in ticagrelor treated group showed significantly lower platelet aggregation rate compared with patients in clopidogrel treated group after 3 days,7 days,and 30 days (P <0.05).Patients in ticagrelor treated group showed significantly lower MACCE rate compared with patients in clopidogrel treated group in the postoperative 12 months'follow-up(P <0.05).There were no significant difference in bleeding events(P >0.05 ).Conclusion Ticagrelor therapy can achieve ideal antiplatelet effects for patients with low clopidogrel response.For the patients with low clopidogrel response receiving PCI, ticagrelor can be an effecive and safe choice for antiplatelet therary.

自发性脊髓硬膜外血肿(spontaneous spinal epidural hematoma,SSEH)是一种罕见疾病,Holtas等[1]统计每年发病率约为0.1/100,000.这种疾病无明确外伤史并出现脊髓压迫症状,多以急性背部疼痛起病,进展迅速,导致脊髓、神经根受压甚至截瘫[2、3].确诊该病以体格检查及MRI为标准,但我科收治的1例SSEH患者,因发病当日行心脏冠脉造影支架置入术(爱克塞尔支架),无法行胸椎MRI检查,我们通过CT薄层增强扫描定位病灶并手术治疗,术后患者截瘫恢复,现报告如下.

Objective: To explore the treatment effect and clinical significance on patients with coronary slow flow(CSF). Methods:80 cases of patients with CSF, the Self-Rating Anxiety Scale(SAS) and Self-Rating Depression Scale(SDS) score is positive, were randomly divided into observation group and control group, 40 cases were observed in the conventional treatment group care psychological care given on the basis of the control group were given routine treatment and care. Discharge line SAS and SDS again measured and analyzed statistically.Results:Through the psychological care, observation group with the anxiety and depression symptoms have improved significantly(P<0.05). Conclusions: Effective psychological care can improve the CSF patients with the anxiety and depression symptoms, and promote patients recovery.

Objective: To investigate the effect of intensive atorvastatin therapy on acute ST-segment elevation myocardial infarction(STEMI) before emergency percutaneous coronary intervention(PCI). Methods:102 patients with STEMI suffered within 6 hours took emergency PCI treatment came from Cangzhou Center Hospital(62 males and 40 females). According to atorvastatin dose took before PCI, this 102 patients were divided into two groups:the contral group (A group,20mg,n=52) and the intensive group (B group,80mg,n=50). The levels of serum placental growth factor(PlGF) and high-sensitivity C-reactive protein (hs-CRP) were detected at a moment before PCI treatment, 12h,24h and 72h after PCI. We recorded the preoperative and postoperative 1h ECG,and calculated single-lead STR. We described TMPG classiifcation of patients in accordance with the results of the image of Coronary angiography after PCI. Results:(1) The proportion of single-lead STR≥50% and TMPG2/3 in B group was higher than A group(P<0.05). (2)In two groups ,PlGF and hs-CRP levels were higher after PCI than before PCI, which were higher in 24 hours after PCI than 12 hours after PCI, and 72 hours was lower than 24 hours(P<0.05). (3)Compared with Agroup, PlGF and hs-CRP levels had no difference in B group before PCI and after PCI 12h(P>0.05).But they were lower after PCI 24h and 72h in B group(P<0.05).Conclusions:The intensive atorvastatin therapy could reduce the levels of PlGF and hs-CRP, inhibit inlfammatory response better,and improve myocardial reperfusion better on acute STEMI patients before emergency PCI.

<正>研究发现,冠心病患者常合并焦虑、抑郁情绪障碍,抑郁被认为是冠心病的独立危险因素[1]。心率变异性(heart rate variability,HRV)是指窦性心律在一定时间内周期性改变的现象,是反映交感与副交感神经张力及其平衡的重要指标。抑郁患者常会