BackgroundPrevious findings have indicated that elevated low-density lipoprotein cholesterol (LDL-C) and remnant cholesterol (RC) are associated with hypertension. We aim to explore whether higher RC levels may be associated with hypertension beyond LDL-C in the general US adult population.MethodsThis study included 10,842 adults from the National Health and Nutrition Examination Survey (NHANES) 1999–2018. Weighted multivariable logistic regression models were used to estimate the odds ratios (ORs) of hypertension for LDL-C and RC. We also performed analyses examining the association between hypertension and LDL-C vs. RC concordant/discordant groups.ResultsA total of 4,963 (41.54%, weighted) individuals had hypertension. The weighted median levels were LDL-C: 118mg/dL, RC: 20mg/dL. At lower LDL-C clinical cut-point, the proportion of discordantly high RC dramatically increased. After multivariable adjustment, log RC was associated with higher prevalence of hypertension [OR 2.54, 95% confidence interval (CI) 2.17–2.99]. Participants with the highest tertile of RC were more likely to have hypertension (OR 2.18; 95% CI 1.89-2.52) compared with those with the lowest tertile of RC. This association remained marked after including body mass index (BMI), LDL-C, high-density lipoprotein cholesterol (HDL-C) or triglycerides. The association between LDL-C and hypertension was absent after adjusting for BMI, RC or triglycerides. Compared with low LDL-C/low RC group, the discordant low LDL-C/high RC group was associated with hypertension (OR 2.04; 95% CI 1.72-2.42), whereas the high LDL-C/low RC group was not, regardless of BMI, HDL-C or triglycerides. Similar results were observed when examining discordance among different clinical cut-points, except for the cut-point of LDL-C 70 mg/dL and RC 13 mg/dL. To better understand the association, we performed an additional analysis, which showed that among participants with apolipoprotein B < median (92mg/dL), those with discordant RC ≥ median (20mg/dL) had significantly higher odds of having hypertension (OR 1.73; 95% CI 1.38-2.17).ConclusionRC was associated with hypertension beyond LDL-C in the general US adult population. This association went beyond increased triglycerides levels, and lipoproteins other than apoB may be involved.

Objective To compare and explore Chinese medicine（CM） prescription regularity in stable coronary artery disease（SCAD） patients who encountered recurrent cardiovascular events using real world data.Methods Clinical and follow-up data from 3 646 SCAD patients in 10 Grade-A tertiary hospitals across the country was collected. The patients were assigned to case group（recurrent cardiovascular events,346 cases） and control group（without recurrent cardiovascular events,3 300 cases） according to the recurrent cardiovascular events. Totally 200 cases were included in paired-control group after the cases and the controls paired based on risk factors. Frequency statistics and association rules were adopted to analyze the regularity of CM prescription in both groups. Results The percent of Qi deficiency and Yang deficiency is higher in case group,the percent of Qi stagnation,blood stasis and turbid phlegm is higher in paired-control group（P＜0.05,P＜0.01）. A total of 206 prescriptions in case group and 161prescriptions in paired-control group,consisting of 225 herbs were analyzed. The most frequently used herbs in the case group were Aurantii Fructus,Atractylodes Macrocephala Koidz,Poria Cocos（Schw.） Wolf,Angelicae Sinensis Radix,and Persicae Semen. The most frequently associated herbs in the case group were Angelicae Sinensis Radix,Chuanxiong Rhizoma,Persicae Semen,and Aurantii Fructus. The most frequently used herbs in the paired-control group were Hedysarum Multijugum Maxim,Radix Salviae,Arum Ternatum Thunb,Glycyrrhiza uralensis Fisch,and Radix Bupleuri. The most frequently associated herbs in the paired-control group were Hedysarum Multijugum Maxim,Panax Notoginseng,Radix Salviae,Trichosanthes Kirilowii Maxim,and Gastrodia Elata. Conclusions In real word practices,CM therapeutic rule of promoting blood flow and regulating Qi was more commonly applied in patients with recurrent cardiovascular events,while CM therapeutic rule of invigorating Qi and harmonizing blood,combined with promoting blood flow and dissipating phlegm was more commonly applied in patients without recurrent cardiovascular events.

病毒性心肌炎是小儿较为常见的一种疾病,由于儿童机体发育未成熟,易患病且易产生危重症,应及时诊治.目前,现代医学目前仍缺乏特效药物,中医药治疗可获得良好的临床疗效.本研究从"虚"与"毒"两个方面探讨小儿病毒性心肌炎的病机与辨治,以期为中医临床诊治提供参考.

目的:对炙甘草汤加减治疗心律失常的系统评价/Meta分析进行方法学质量和证据等级再评价.方法:计算机检索中英文数据库,搜集炙甘草汤加减治疗心律失常的系统评价/Meta分析,检索时限为建库至2021年12月31日.由2名研究员独立筛选和提取资料,基于PRISMA声明、AMSTAR2量表和GRADE分级方法对纳入研究的报告质量、方法学质量及证据质量进行评价.结果:共纳入7篇系统评价/Meta分析.PRIMSA声明评价显示,纳入研究得分为13.5～21.0分,5篇文献质量中等,2篇文献质量低.报告质量缺陷主要表现在方案与注册、研究选择、证据总结强度方面;AMSTAR2量表显示,7篇文章质量等级均为极低级,存在问题最多的有4个条目;GRADE证据显示,22个证据包括14个极低级证据,7个低级证据,仅有1个中等证据.导致降级的主要因素为局限性和发表偏倚.结论:炙甘草汤加减治疗心律的失常系统评价/Meta分析提供的方法学质量和证据等级总体偏低,建议进一步开展高质量临床试验,规范系统评价报告程序.

1 病例资料 患者女,65岁,2019年6 月29 日因"呼吸困难、胸闷间作半年余"就诊我院心内科门诊.患者神清,精神可,阵发性呼吸困难、胸闷,与活动、情绪无关,持续10 ～20min可自行缓解,发作时意识清晰,否认胸背部疼痛、汗出、恶心、心慌、头晕、黑矇及晕厥,3个月前于外院行冠状动脉造影,未见明显狭窄(未见报告).当日收入我院.高血压病20 余年,血压最高达200/100mmHg(1mmHg =0. 133kPa),现规律口服苯磺酸氨氯地平片5mg qd,血压控制在125/85mmHg左右.否认其他病史.查体:体温:36. 3℃,血压:111/75mmHg (1mmHg=0. 133 kPa),心率:76 次/min,呼吸:16 次/min.阳性体征:束臂加压试验( Trousseau )、面神经叩击征( Ch-vostek) ( +).遂追问病史,得知患者1998、2011 年因"甲状腺肿瘤"分别切除甲状腺右叶、左叶,术后规律口服左甲状腺素钠片50μg bid.近5年来无明显诱因双手搐搦间作,持续5～10min缓解.2018年4月26日查血钙1. 35mmol/L,予补充钙剂、活性维生素D症状好转,未规律服用钙剂及活性维生素D制剂,未监测血钙水平.实验室检查:钾3. 40mmol/L,钠 139. 4mmol/L,氯 96. 9mmol/L,钙 1. 35mmol/L,磷2. 27mmol/L.肌酸激酶(CK)505. 8U/L,乳酸脱氢酶(LDH) 422. 1U/L,α-羟丁酸脱氢酶(α-HBDH) 257. 3U/L,肌酸激酶同工酶(CK-MB)17. 6U/L.肌钙蛋白 T(TnT) <40ng/L.B型利钠肽(BNP)121pg/ml.甲状旁腺激素(PTH)3. 0pg/ml.25-羟基维生素D327. 1ng/ml.血气分析:氧分压:66mmHg、酸碱度:7. 47.24h尿钙、白蛋白、肝肾功能、甲状腺功能、风湿四项、血镁浓度均正常.心电图示:窦性心律, V1 ～V6 导联T波倒置,无ST-T的动态演变,QTc:498ms.甲状腺彩色多普勒示:可见甲状腺残余右叶大小约2. 7cm × 1. 1cm × 0. 7cm,回声尚均匀,未探及明显结节.心脏超声示:房室内径正常,室间隔轻厚,室壁运动及收缩期增厚率正常,左室射血分数60％.胸CT、颅脑CT未见明显异常.

目的 应用斑点追踪显像技术(STI)评价养阴舒心方对射血分数保留心力衰竭(HFpEF)患者左室收缩功能及收缩同步性的影响.方法 选取2018年1月-2019年2月于天津中医药大学第一附属医院心血管科门诊首诊为HFpEF患者60例,另选取健康人群30名为健康组.采用随机数字表法将HFpEF患者分为治疗组(31例)和对照组(29例),对照组采用西医常规治疗,治疗组在西医常规治疗基础上联合养阴舒心方汤剂治疗,共治疗14天.患者治疗前后分别行STI评估左室收缩功能、同步性及中医症状积分.结果 与健康组比较,对照组和治疗组左室整体长轴应变绝对值(|GLS|)下降(P＜0.05),运动达峰时间标准差(Ts-SD) 16、Ts-SD12、Ts-SD6延长(P＜0.05).与本组治疗前比较,治疗组患者治疗后|GLS|升高(P＜0.01),Ts-SD16和Ts-SD6缩短(P＜0.05),中医症状积分降低(P＜0.01);对照组Ts-SD6缩短(P＜0.05).与对照组同期比较,治疗组治疗后|GLS|升高,中医症状积分下降(P＜0.01).结论 养阴舒心方联合西医常规治疗可改善HFpEF患者的左室收缩功能;GLS可较左室射血分数更早评估HFpEF患者的左室收缩功能.

射血分数中间值心力衰竭是区别于射血分数保留的心力衰竭和射血分数降低的心力衰竭的新亚组,其在人口学、病因学、合并症、生物标志物、超声心动图及预后方面均具有介于射血分数保留的心力衰竭和射血分数降低的心力衰竭之间的独特临床特征,而在治疗方面,射血分数中间值心力衰竭患者似乎受益于能够改善射血分数降低的心力衰竭预后的药物治疗,但其获益情况有待进一步证实.现从临床特点、治疗和预后方面对射血分数中间值心力衰竭的研究进展做一综述.

本文通过分析“肺主皮毛”理论的实质,结合烫伤的现代病理机制和中医学病因病机,探讨用该理论指导烫伤的辨证论治.认为“肺主皮毛”理论对指导烫伤的辨证论治十分重要,从肺论治烫伤,在病机上要注重火毒内陷、火毒伤津、气血两虚、阴竭阳脱等变化;在治疗上以清解肺热、凉血通络、补益肺气、滋阴润肺、回阳救逆为法.