BackgroundCurrent evidence on whether occupational sulfur dioxide (SO2) exposure affects the risk of hypertension is still limited, and the research results of the effect of environmental SO2 exposure on risk of hypertension remain inconsistent.ObjectiveTo analyze the association between self-reported occupational exposure to SO2 and the risk of hypertension, and the potential dose-response relationship between the years of exposure to SO2 and the risk of hypertension.MethodsBased on the Jinchang cohort, a nested case-control study design was adopted. A total of 841 newly diagnosed hypertension patients were followed up as the case group, and the control group was selected with 1∶1 individual matching based on non-occupational factors and occupational factors, respectively. The former matching conditions included age ±2 years old, same gender, working age ±2 years, and home address in the same sub-district. The latter was limited to working in the same workshop on the basis of the former conditions. Finally, the former included 717 controls and the latter included 488 controls. A unified questionnaire was used to collect general demographic characteristics, lifestyle habits, history of diabetes, family history of hypertension, and information on occupational exposure to SO2 (self-reported history of occupational exposure to SO2 and years of exposure to SO2). Conditional logistic regression model was used to analyze the association between occupational exposure to SO2 and hypertension, and the dose-response relationship between the years of SO2 exposure and the risk of hypertension.ResultsIn the nested case-control study matching with the non-occupational factors, the OR of hypertension in workers with self-reported occupational exposure to SO2 was 2.39 (95%CI: 1.68-3.39); while when matching with the occupational factors, the OR of hypertension in workers with self-reported occupational exposure to SO2 was 1.48 (95%CI: 1.04-2.12). The results of the dose-response relationship showed that as the SO2 exposure years increased from 1-9 years, 10-19 years, 20-29 years, and 30 years and above, in the nested case-control study matching with non-occupational factors, the ORs of hypertension were 1.85 (95%CI: 0.68-5.08), 1.46 (95%CI: 0.58-3.67), 1.64 (95%CI: 1.00-2.67), and 4.95 (95%CI: 2.63-9.31), respectively; in the nested case-control study matching with occupational factors, the ORs of hypertension were 0.98 (95%CI: 0.40-2.41), 1.84 (95%CI: 0.72-4.70), 1.37 (95%CI: 0.82-2.29), and 2.44 (95%CI: 1.37-4.35), respectively. The two dose-response relationships were positive by χ2 trend test (Ptrend<0.05).ConclusionSelf-reported occupational exposure to SO2 is associated with the risk of hypertension in the study population, and the hypertension risk increases with the increase of SO2 exposure years.

目的:系统评价急性心肌梗死(AMI)病人院前发病的体验及表现.方法:计算机检索PubMed、the Cochrane Library、Web of Science、EMbase、PsycINFO、CINAHL、Scopus、中国生物医学文献数据库、中国知网、万方数据库、维普中文期刊全文数据库,检索关于AMI病人院前发病体验的质性研究,检索年限为建库至2021年3月31日.采用澳大利亚the Joanna Briggs institute(JBI)循证卫生保健中心质性研究质量评价标准对文献进行评价,并采用汇集性整合方法对结果进行整合与分析.结果:共纳入14篇文献,提炼出55个研究结果,归纳形成5个新类别,合成2个整合结果,即AMI病人发病过程中表现出严重的负性情绪和自救障碍.结论:医护人员应高度重视AMI病人院前发病真实体验和切实需求,及时提供有效的心理干预策略、医疗及社会支持,帮助病人树立健康的就医观念,挽救生命及改善预后.

为探索西北地区颗粒物(PM)短期暴露对人群血压(BP)水平的影响,基于金昌队列研究平台,收集甘肃省金昌市2011～2017年颗粒物污染数据及队列人群血压测量数据,在调整相关混杂因素基础上,采用线性混合效应模型分析PM2.5和PM10短期暴露对收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、脉压(PP)和Mid-BP(SBP和DBP的均值)的影响.结果显示,随着PM2.5浓度的增加,人群SBP,MAP,PP和Mid-BP均呈上升趋势,该效应值分别在累积滞后05,03,07和05d最大.随着PM10浓度的增加,5种BP指标也均呈上升趋势,效应最大值均出现在累积滞后07d.PM2.5和PM10对BP产生的影响分别在吸烟和男性人群中更为显著.此外,沙尘天气和气态污染物(SO2和NO2)对PM-BP效应存在一定的修饰作用.因此,在该队列人群中,PM2.5和PM10短期暴露对人群血压具有一定影响,吸烟者和男性人群可能是颗粒物影响血压效应的易感人群.

目的 探讨2型糖尿病(T2DM)合并桥本甲状腺炎(HT)患者的临床特点.方法 采用回顾性病例对照研究,选取T2DM患者396例,其中合并HT患者142例,收集性别、年龄等一般资料及甲状腺功能、生化指标、胰岛功能等指标.采用倾向值得分匹配法以年龄、糖尿病病程、既往胰岛素使用时间、体质量指数(BMI)进行匹配,以2:1选取单纯T2DM组(222例)和T2DM合并HT组(111例),比较两组临床特征差异,并通过多因素Logistic回归分析评价T2DM患者易患HT的独立危险因素.根据抗体阳性情况进一步将T2DM合并HT组分为甲状腺球蛋白(TG)单抗体阳性组、甲状腺过氧化物酶(TPO)单抗体阳性组及TG和TPO双抗体阳性组,比较甲状腺自身免疫对T2DM患者临床指标的影响.结果 T2DM合并HT组较单纯T2DM组女性患者比例高,BMI、血尿酸水平、餐后2小时C肽低,每日所需胰岛素用量高,差异有统计学意义(P均<0.05).女性是T2DM患者合并HT的主要独立危险因素(OR=4.544,95％CI:2.771～7.452,P<0.01).T2DM合并HT组较单纯T2DM组更易合并糖尿病大血管病变(P<0.05).TG单抗体阳性组和TG、TPO双抗体阳性组较单纯T2DM组更易合并糖尿病大血管病变(P均<0.05).结论 T2DM合并HT患者较单纯T2DM患者BMI、血尿酸水平低,且胰岛功能更差,每日所需胰岛素用量更高,更易合并大血管并发症;女性是T2DM患者合并HT的主要独立危险因素.

目的 分析兰州大学第二医院肾病内科血液透析中心维持性血液透析(maintenance hemodialysis,MHD)患者长期生存期的重大危险事件及影响因素.方法 将2014年7月～2019年7月在兰州大学第二医院肾病内科血液透析中心MHD患者纳入研究.结果 筛选出168例患者,男性占63.10％,女性占36.90％.MHD患者生存期间最常见的重大危险事件为心脑血管事件及血管通路问题(均占17.04％),其次肺部感染(14.38％).心脑血管事件组的患者年龄较高(Z=-2.489,P=0.013),带隧道带涤纶套导管(catheter with cuff,CVC)占比高(x2=5.080,P=0.024),血红蛋白(hemoglobin,Hb)(t=2.465,P=0.015)、尿素氮(blood urea nitrogen,BUN)(t=2.736,P=0.007)、血肌酐(serum creatinine,Scr)(Z=-3.067,P=0.002)、总胆固醇(total cholesterol,TC) (t=2.291,P=0.023)水平低.肺部感染组患者的年龄较高(Z=-2.272,P=0.023),CVC占比高(x2=10.510,P=0.001),Hb (Z=-2.418,P=0.016)、血清白蛋白(serum albumin,ALB) (Z=-2.087,P=0.037)水平低.血管通路事件组的女性患者占比高(x2=11.191,P=0.001),CVC占比高(x2=38.768,P＜0.001),Hb(t=2.551,P=0.012)、BUN(t=2.210,P=0.028)、Scr(Z=-2.408,P=0.016)水平低.重度贫血组女性患者占比高(x2=12.196,P＜0.001),CVC占比高(x2=11.419,P=0.001),Hb(t=5.048,P＜0.001)、Scr(Z=-3.643,P＜0.001)、ALB(Z=-2.324,P=0.020)、血磷(serum phosphate,P)(t=2.821,P=0.005)水平低.多元Logistic回归分析提示:TC(OR=0.685,95％ CI:0.481～0.977,P=0.037)是MHD患者发生心脑血管疾患的独立危险因素.CVC是MHD患者合并肺部感染(OR=2.948,95％ CI:1.248～6.961,P=0.014)及并发血管通路问题(OR=11.164,95％ CI:4.125～30.219,P＜0.001)的独立危险因素.高全段甲状旁腺素(intact parathyroid hormone,iPTH)水平是MHD患者发生重度贫血的危险因素(OR=1.001,95％ CI:1.000～1.002,P=0.013).结论 关注MHD患者的心脑血管及肺部健康问题,建议无特殊情况时MHD患者的通路以动静脉内瘘为主,重视女性患者血管通路的选择及贫血监测.

目的 探讨金昌市热浪对高血压疾病住院人数的影响及潜在混杂因素.方法 收集2011-2016年金昌市3所综合医院每日高血压住院信息及同期气象资料和大气污染物资料.描述分析纳入研究的气象因素与高血压住院人数,分别采用单向回顾性1∶6病例交叉研究、双向对称1∶6病例交叉研究和按时间分层的病例交叉研究方法,在控制星期几效应、相关气象因素和环境污染物等混杂因素后,建立热浪与高血压住院人数的COX回归模型.根据效应值选择滞后效应最大的滞后天数,进行年龄、性别的分层分析,根据热浪持续类型分析热浪对高血压住院人数的影响.结果 研究期间共纳入5次热浪事件.热浪期间,高血压住院人数随温度变化而变化.3种病例交叉研究方法结果显示,热浪对高血压住院人数的变化具有影响,且存在一定的滞后效应.其中,单向回顾性1∶6病例交叉研究结果中效应值最大,热浪在单滞后2d和累积滞后3d对高血压住院人数影响的OR分别为2.707、4.796.分层分析发现,热浪对男性、女性高血压住院人数均具有影响,且对男性的影响更大(OR=5.900).65岁以下年龄组人群对热浪较为敏感(OR=6.266).热浪持续时间越长,高血压住院人数增加风险越大.结论 热浪对金昌市居民高血压疾病住院人数的增加具有影响.

嗜酸细胞增多综合征(hypereosinophilic syndrome,HES)是一组嗜酸性粒细胞持续增多,并伴有组织损伤的异质性疾病[1].据世界卫生组织统计,其发病率约为0.036/10万,死亡率约为9.3％[2].HES的病因复杂,临床表现多样,症状轻者可无任何异常,重者可累及全身多个系统,如皮肤、肺部、胃肠道、心脏、神经系统、血液系统等.当与2型糖尿病合并发生,诊断与治疗都更复杂.

工业化的迅猛发展使人体暴露于重金属的机会越来越多,长期低水平的暴露对生物体健康和环境的影响都是不容忽视的.镍是多器官多系统损伤性毒物,目前已报道了许多镍对生态系统中各个生物体的损伤及可能的机制,并将镍列为环境内分泌干扰物之一,而内分泌系统在维持内环境平衡,调节机体生长发育和物质代谢方面发挥重要作用,镍中毒对内分泌腺体损伤的研究却鲜见报道,因此本文对有毒重金属镍对机体内分泌腺体甲状腺和胰腺的损伤及可能机制的研究进展进行综述.

目的 构建人促甲状腺激素受体(TSHR)A亚基的原核表达载体pET 102/D-TOPO/TSHRA,在大肠杆菌中表达并分析其免疫活性.方法 采用逆转录—聚合酶链式反应扩增TSHRA基因编码序列,定向连接到载体pET102/D-TOPO中,经聚合酶链式反应、酶切、测序鉴定后转化大肠杆菌BL21 StarTM (DE3);异丙基硫代-β-D-半乳糖苷诱导表达TSHR A亚基融合蛋白,超声裂解细菌,SDS聚丙烯酰胺凝胶电泳、Western blotting鉴定,在变性、复性、镍柱纯化后,目的蛋白与Graves患者血清结合鉴定其免疫活性.结果 成功构建pET102/D-TOPO/TSHRA亚基表达载体,优化融合蛋白表达条件,SDS聚丙烯酰胺凝胶电泳鉴定重组质粒可表达47 kD大小的特异性蛋白,Western blotting鉴定其被His抗体、鼠源性抗人促甲状腺激素受体多克隆抗体识别,复性后融合蛋白与Graves患者混合血清呈强阳性结合,正常人血清未有任何形式的结合.结论 成功构建人促甲状腺激素受体A亚基原核表达载体,并在大肠杆菌中表达了其亚基融合蛋白,该蛋白与Graves患者血清呈强阳性特异性结合.

糖尿病肾病（ DN）是糖尿病（ DM）常见的慢性微血管并发症之一，也是引起终末期肾病及导致DM患者死亡的主要原因。 DN发病机制复杂，目前尚未完全阐明，大量研究证实，多种细胞因子激活是DN病变的关键诱因，如胰岛素样生长因子（IGF）及其结合蛋白（IGFBP）就与DN的发生发展关系密切。其中，IGF?2及其主要结合蛋白之一IGFBP?2与DN相关性的研究比较少且国内外结论不一，我们通过复习相关文献，就IGF?2及IGFBP?2与DN相关性的研究进展做一综述。

Objective:In order to explore carbamylated erythropoietin(CEPO)'s effect in chronic heart failure(CHF)area,besides many studies have already shown CEPO has clearly cardioprotective effect in other areas.Levels of serum Matrix Metalloproteinase-2(MMP-2),Tissue Inhibitor of Metalloproteinase-1(TIMP-1) and Volume Fraction of Collagen(CVF) were assessed to reflect whether CEPO has cardioprotective effect in rats with CHF and its possible mechanisms.Method:10 of 80 Wistar rats have been randomly selected as control group,other 70 rats were injected with isoprenaline intraperitonealy to establish CHF models.After nine weeks,when CHF models were established successfully,CHF rats were divided into two groups,CHF group(n=18) and CEPO group(n=18).CEPO group were injected intraperitonealy CEPO 50 μg/kg,twice a week,while CHF and control group were received the same volume of normal saline at the same time.After four weeks,hemodynamic parameter,Left Ventricular Mass Index(LVMI),the level of serum MMP-2,TIMP-1 and CVF were evaluated respectively.Result:Compared with control group,Left Ventricular Systolic Pressure(LVSP),maximal rate of rise/decline of left ventricular pressure(±dp/dtmax)(P0.01 for each) were significantly decreased,on the other hand,Left ventricular diastolic pressure(LVDP) and Left Ventricular End Diastolic Pressure(LVEDP) were significantly increased(P0.01),the level of serum MMP-2,LVMI and CVF were increased too,but TIMP-1 was decreased(P0.01) in CHF group;Secondly,compared with CHF group,CEPO group have higher LVSP,±dp/dtmax and level of serum TIMP-1(P0.01),lower LVDP,LVEDP,level of serum MMP-2,LVMI and CVF(P0.01).Conclusion:CEPO could reverse myocardial remodeling,improve cardiac function in rats with CHF through regulate the expression of MMP-2,TIMP 1 and degredate the volume of collagen.

Objective To explore the effect of carbamylated erythropoietin on left ventricular remodeling in rats with chronic heart failure(CHF).Methods 10 of 90 healthy male wistar rats were randomly assigned to control group,the rest received intraperitoneal injections of isoproterenol to establish a model of CHF.After 5 weeks,the survived rats were randomly divided into CHF group and CEPO group.CEPO group was administered intraperitoneal injections of CEPO of 50 μg/kg twice a week for 4 weeks;CHF group and the control group received equivalent saline.After the completion of CEPO injection,hemodynamic,level of BNP,and the ratio of left ventricular weight to body weight(LVW/BW) were measured.Results As compared with the control group,left ventricular end systolic pressure(LVSP),maximal rate of rise/decline of left ventricular pressure(±dp/dtmax) were significantly decreased in CHF group(P<0.05),whereas left ventricular end diastolic pressure(LVEDP),level of BNP and the ratio of left ventricular weight to body weight(LVW/BW) were significantly higher(P<0.05).As compared with CHF group,LVSP and ± dp/dtmax were significantly increased(P<0.05),while LVEDP,level of BNP,and LVW/BW were significantly decreased(P<0.05) in CEPO group.Conclusions CEPO can improve cardiac function in rats with CHF by reducing BNP level and alleviating cardiac remodeling.

Objective To observe the value of carbamylated erythropoietin(CEPO) on rats with chronic heart failure(CHF) and its possible mechanism.Methods Ninty Wistar rats were randomly divided into intervention,CHF and control group.Both intervention group and CHF group were established models of CHF by intraperitoneal injection of isoproterenol.The intervention group were received CEPO.After 4 weeks,rats were observed changes in hemodynamics,inducible nitric oxide synthase(iNOS) and superoxide dismutase(SOD).Results Compared with control group,left ventricular systolic pressure(LVSP) and maximal rate of rise/decline of left ventricular pressure(±dp/dtmax) were lower(P0.05),whereas left ventricular end-diastolic pressure(LVEDP) and heart rate(HR) were higher(P0.05),the level of iNOS increased(P0.05),the level of SOD decreased(P0.05) in both CHF group and intervention group.Compared with CHF group,intervention group had higher LVSP,±dp/dtmax and SOD levels(P0.05),lower LVEDP,HR and iNOS levels(P0.05).Conclusion CEPO has the role of against CHF by inhibiting the excessive release of nitric oxide and scavenging oxygen free radicals.

Objective To investigate the cardioprotective effects of carbamylated erythropoietin(CEPO) in rats with chronic heart failure(CHF) and its possible mechanism.Methods Ten rats were randomly selected from 90 male Wistar rats as control group,and the rest of the Wistar rats were treated by intraperitoneal injection of isoproterenol(ISO) to establish animal models of CHF.After being fed for 5 weeks,the rats were redivided into CEPO group and CHF group.The CEPO group underwent intraperitoneal injection of CEPO(50μg/kg) twice a week for 4 weeks.The CHF group and control group received equivalent amount of saline at the same time.After 4 weeks of CEPO therapy,the hemodynamics,tumor necrosis-alpha(TNF-α) level and interlerkin-6(IL-6) level in serum,and cardiomyocyte apoptosis rate were measured.Results Compared with the control group,the left ventricular systolic pressure(LVSP) and maximum rate of rise/decline of left ventricular pressure(dp/dtmax) decreased significantly in the CHF group(P<0.05),but the left ventricular end-diastolic pressure(LVEDP) and heart rate(HR) increased significantly(P<0.05).Compared with the CHF group,the LVSP and dp/dtmax increased significantly in the CEPO group(P<0.05),but the LVEDP and HR decreased significantly(P<0.05).Compared with the control group,the TNF-α level and IL-6 level in serum and cardiomyocyte apoptosis rate increased significantly in the CHF group(TNF-α: 4.01±0.20 vs 8.09±0.09 pg/ml,IL-6: 20.93±1.20 vs 30.26±0.94 pg/ml,cardiomyocyte apoptosis rate: 3.80±0.57% vs 22.35±0.60%)(P<0.05).Compared with the CHF group,the TNF-α level and IL-6 level in serum and cardiomyocyte apoptosis rate decreased significantly in the CEPO group(TNF-α: 8.09±0.09 pg/ml vs 6.40±0.14 pg/ml,IL-6: 30.26±0.94 pg/ml vs 25.66±0.74 pg/ml,cardiomyocyte apoptosis rate: 22.35±0.60% vs 13.67±0.36%)(P<0.05).Conclusion CEPO can improve cardiac function in rats with CHF,possibly due to its effects of reducing local inflammation reaction and inhibiting the apoptosis of cardiomyocytes.

促红细胞生成素(EPO)能直接促进红细胞生成,可用于预防和治疗多种原因引起的贫血.EPO广泛分布于人体各个系统,除促造血作用外,还具有抗炎、抗凋亡、促进新生血管生成等多种作用,并可通过这些作用发挥广泛的组织保护效能.然而,长期大剂量应用EPO必然增加高血压、血栓形成等风险.氨甲酰化促红细胞生成素(carbamylated erythropoietin,CEPO)作为EPO衍生物的代表,不仅药代动力学特征与EPO相似,且可通过抗炎、抗凋亡、促进新生血管生成等多种作用减轻心、脑、肾等器官的缺血-再灌注损伤,但其无促红细胞生成活性,不会增加高血压及血栓形成风险.因此,CEPO的应用前景比EPO更为广阔.该文将EPO及CEPO的心脏保护作用作一综述.

AIM:To investigate the effect of extracellular signal-regulated kinase 1/2(ERK1/2)signaling pathway on carbamylated erythropoietin-induced cardioprotection against ischemia-reperfusion(I/R)injury.METHODS:Forty rabbits were randomly allocated to control group,I/R group,I/R+CEPO group,I/R+ PD98059 group,I/R+CEPO+PD98059 group.We compared the difference of infarct size using observations of ST↑,NST↑%,NQ% in the 12-lead ECG.The paraffin slices were subjected to terminal deoxy-nucleotidyl transferase-mediated dUTP nick-end labeling(TUNEL)staining for detection of cardiac myocyte apoptotic rate.RESULTS:There was no diference between I/R+PD98059 group and I/R group on ST↑,NST↑%,NQ% and cardiac myocyte apoptotic rate(P>0.05);I/R+CEPO+PD98059 group was higher than I/R+CEPO group on ST↑,NST↑%,NQ% and cardiac myocyte apoptotic rate(P<0.05);I/R+CEPO group and IR+PD98059+CEPO group were lower than I/R group on ST↑,NST↑%,NQ% and cardiac myocyte apoptotic rate(P<0.05).CONCLUSION:Acute cardioprotective effect of CEPO was mediated by activation of ERK1/2 signaling pathway.ERK1/2 signaling pathway wasn't significantly actived in the absence of CEPO.