目的:旨在探讨血管病变检测系统在高血压病患者外周血管结构和功能评价中的价值,并了解坎地沙坦干预的效果。方法:运用血管病变检测系统对31例正常人和43例高血压病患者外周血管功能进行测定,并将43例高血压病患者随机分为常规治疗组和坎地沙坦组,观察治疗前后两组外周血管功能指标[四肢血压SBP、DBP、PP、MAP、肱踝脉搏波传导速度（BaPWV）及踝臂指数（AB I）)和心脏射血分数（EF）改变的情况]结果:常规治疗组和坎地沙坦组四肢血压均明显高于正常对照组,治疗后两组血压均显著下降,坎地沙坦组下降更为突出。两组BaPWV均高于正常对照组[分别为（1759.67±274.21）cm/s比（1438.32±325.43）cm/s,P＜0.05;（1764.38±352.24）cm/s比（1438.32±325.43）cm/s,P＜0.05];两组治疗后均较治疗前明显下降[治疗后分别为（1634.53±272.26）cm/s,（1524.62±3012.30）cm/s,P均＜0.05]。两组AB I和EF均较正常对照组下降,治疗后均明显升高,坎地沙坦升高更显著。结论:血管病变检测系统对于高血压病患者外周血管结构和功能评价很有价值。高血压病患者外周血管功能早期明显异常,常规抗高血压治疗和坎地沙坦治疗均能明显改善高血压病患者外周血管功能,坎地沙坦治疗效果更优。

Objective:To investigate the effects of Brain natriuretic peptide(BNP) on myocyte apoptosis and the expression of apoptosis-associated genes in rat hearts with acute myocardial ischemia and reperfusion(IR).Methods:Models were BNPde by a ligation or release of left coronary artery in rats.The rats were randomly divided into 3 groups.(1) Sham-operated group: sham surgery,infusion of normal saline,observe the same amount of time;(2) Ischemia-reperfusion group(IR group): ischemic 45 minutes,reperfusion 1 hour,infusion of normal saline;(3)Brain natriuretic peptide in the treatment group(BNP group): 45 minutes ischemia,reperfusion 1 hour,infusion of BNP.Myocyte apoptosis and the protein expression of bax and bcl-2 genes were detected by digoxin random labeling and immunohistochemistry.Results: The apoptotic index and the positive expression index of bax and bcl-2 genes were significantly increased in IR group(P0.01).BNP significantly inhibit the myocyte apoptosis and the expression of bax gene but no effect on the bcl-2 gene expression.Conclusions: The myocyte apoptosis and the expression of bax and bcl-2 are significantly increased in rat hearts with IR.BNP is valuable in the treatment of IR because of its inhibition to bax gene expression.

1 病史摘要 患者,女性,64岁.因"反复胸闷7年,加重3天"门诊入院.既往有高脂血症史,否认高血压及糖尿病史.否认嗜烟酒史,已绝经10余年.查体:神清,血压110/70 mm Hg,体温36.5度,呼吸18次/分.心界无扩大,心率85次/分,律齐,各瓣膜区未闻及杂音.两肺呼吸音粗,未闻及明显干湿啰音.双下肢无水肿.辅助检查:心电图示窦律、非特异性ST-T改变;血脂示甘油三酯2.93 mmol/L、胆固醇7.9 mmol/L;心超示静息状态下未见明显异常;行冠脉造影提示右冠未见明显狭窄,左前降支近中端第一对角支开口处70%狭窄,内附有血栓,致血流明显变缓.左回旋支可见散在斑块,可见40%～50%狭窄,未做特殊处理.但术后当天发现右腹股沟穿刺处一小血肿约2.0 cm×2.0 cm,已予沙袋加压包扎6小时.术后4天患者诉右大腿根部胀痛伴行走时不适,血肿范围扩大,周围皮肤青紫,听诊可闻及杂音,足背动脉搏动良好.术后诊断:1、冠心病,不稳定性心绞痛,心功能Ⅱ级; 2、高脂血症;3、股动脉假性动脉瘤,予加强抗栓抗缺血治疗(拜阿司匹林+氯吡格雷+法安明,异舒吉),同时行B超检查.

目的:旨在探讨血管病变检测系统在慢性心力衰竭 (CHF) 患者外周血管结构和功能评价 中的价值,并了解厄贝沙坦干预的效果.方法:运用血管病变检测系统对35例正常人和47例CHF患者外周血管功能进行测定,并将47例CHF患者随机分为常规治疗组和厄贝沙坦组,观察治疗前后两组外周血管功能指标[四肢血压SBP、DBP、PP、MAP、肱踝脉搏波传导速度(BaPWV)及踝臂指数(ABI)]和心脏射血分数(EF)改变的情况.结果:常规治疗组和厄贝沙坦组四肢血压均明显高于正常对照组,治疗后两组血压均显著下降,厄贝沙坦组下降更为突出.两组BaPWV均高于正常对照组[分别为(1731.63±263.20)cm/s比(1426.35±312.47)cm/s,P＜0.05;(1716.50±320.40)cm/s比(1426.35±312.47)em/s,P＜0.05];两组治疗后均较治疗前明显下降[治疗后分别为(1610.42±278.26)cm/s,(1482.70±306.21)cm/s,P均＜0.05].两组ABI和EF均较正常对照组下降,治疗后均明显升高,厄贝沙坦升高更显著.结论:血管病变检测系统对于CHF患者外周血管结构和功能评价很有价值.CHF患者外周血管功能早期明显异常,常规抗心衰治疗和厄贝沙坦治疗均能明显改善CHF患者外周血管功能.厄贝沙坦治疗效果更优.

患者,男性,69岁.因胸闷、气促1周伴反复晕厥2次入院.住院期间有晕厥发作1次,有高血压、高脂血症、陈旧性心肌梗死史,15年前行横结肠肿瘤手术,5年前行胸腺瘤切除术,无烟、酒嗜好.