This study aimed to probe the effects of low-dose irbesartan and hydrochlorothiazide in combination with levamlodipine at different times on the circadian rhythm of blood pressure, matrix metalloproteinases (MMPs), and tissue inhibitors of metalloproteinases (TIMPs) levels in patients with non-dipper hypertension (NDH). In this prospective randomized controlled trial, 124 patients with NDH who visited our hospital between August 2018 and July 2021 were enrolled and divided into morning (62 patients) and night (62 patients) medication groups according to the random number table method. All patients received low-dose irbesartan and hydrochlorothiazide combined with levamlodipine, with the morning medication group taking the medication between 7:00 and 10:00 and the night medication group taking the medication between 19:00 and 22:00 for 24 weeks. The effect of antihypertensive medication in both groups was measured, and changes in ambulatory blood pressure, blood pressure circadian rhythm, left ventricular structure, vascular endothelial function, MMPs, and TIMPs levels were observed before treatment initiation and after 24 weeks of treatment in both groups. The percentage of the dipper type was higher in the night medication group than in the morning medication group, while the percentage of the non-dipper type was lower in the morning medication group (p < .05). Low-dose irbesartan and hydrochlorothiazide combined with levamlodipine at different times can effectively treat NDH, but bedtime dosing is more beneficial in reducing nocturnal blood pressure, reversing NDH, improving the circadian rhythm of blood pressure, left ventricular structure, regulating vascular endothelial function, increasing MMPs levels, and reducing TIMP levels.

目的 探讨老年高血压患者肠道菌群变化及其与血清炎症指标的相关性.方法 100例65岁以上老年高血压患者作为观察组,同期接受体检的100例老年健康者作为对照组.分别开展粪便涂片、肠道菌群培养、呼气氢浓度检测、14 C-尿素呼气试验评价肠道菌群变化特征,并测量血清C反应蛋白(CRP)、白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α水平,采用Pearson相关分析肠道菌群失调与血清炎症指标的相关性.结果 观察组中,Ⅰ度菌群失调49例,Ⅱ度菌群失调16例;而对照组中Ⅰ度菌群失调8例,无Ⅱ度菌群失调.观察组大肠杆菌、肠球菌的菌落数显著高于对照组(P<0.01),而双歧杆菌、乳酸杆菌的菌落数及B/E值显著低于对照组(P<0.05).观察组的小肠细胞生长状态(SIBO)阳性和Hp阳性例数显著多于对照组(P<0.05,P<0.01).观察组受试者的平均血清CRP、IL-6、TNF-α值明显高于对照组(P<0.05,P<0.001).双歧杆菌、乳酸杆菌水平与CRP、IL-6、TNF-α呈负相关,大肠杆菌、肠球菌水平与CRP、IL-6、TNF-α呈正相关(P<0.01,P<0.001).结论 老年高血压患者存在肠道菌群紊乱和血清炎症指标升高,且肠道菌群变化与血清炎症指标有显著相关性.

<正>我院2005年1月至2006年12月共行胆囊切除、胆总管探查术45例,术后并发急性胰腺炎3例,现报道如下:1病例资料例1女,45岁,因胆囊炎、胆囊结石病史1年,行胆囊切

目的 通过分析小儿阑尾炎临床误诊的主要原因,以期降低小儿阑尾炎误诊率.方法 对被误诊的23例小儿阑尾炎原因进行回顾性分析.结果 本组病例中误诊率为19.83%,误诊病例的种类较多.结论 小儿阑尾炎误诊原因复杂,主要误诊的原因为对不典型病例认识不足、病史采集不详细、盲目相信辅助检查、小儿查体不合作和片面强调典型体征.

我院1999年1月～2000年12月共行胆囊切除、胆总管探查术45例,术后并发急性胰腺炎3例,将其诊治情况报道如下.