Abstract Background Observational studies have elucidated the associations between dietary factors and hypertension. Nevertheless, the exploration of these relationships using Mendelian randomization remains scarce currently. Methods The Mendelian randomization approach investigated the potential causal relationships between 16 dietary factors and hypertension. To achieve this, we identified genetic variants associated with these dietary factors by utilizing data from European-descent genome-wide association studies with a stringent significance threshold (P < 5 × 10 − 8). Subsequently, we obtained genetic associations with hypertension from the extensive FinnGen Study, encompassing 92,462 cases and 265,626 controls. Our primary analytical method was the inverse variance weighted method, and we also conducted assessments for heterogeneity and pleiotropy to ensure the robustness and reliability of our findings. Results The study revealed significant associations with hypertension risk for various dietary factors. Specifically, higher weekly alcohol consumption (OR: 1.53, 95% CI: 1.19–1.96) and more frequent alcohol intake (OR: 1.20, 95% CI: 1.08–1.33) were positively correlated with an increased risk of hypertension. Likewise, increased poultry intake (OR: 3.25, 95% CI: 1.83–5.78) and beef intake (OR: 1.80, 95% CI: 1.09–2.97) were also linked to a higher risk of hypertension. Conversely, there were protective factors associated with a decreased risk of hypertension. These included consuming salad and raw vegetables, dried fruits, cheese, and cereals. It is important to note that no evidence of pleiotropy was detected, underscoring the robustness of these findings. Conclusions This study uncovered causal relationships between various dietary factors and hypertension risk. Specifically, alcohol consumption in terms of drinks per week and intake frequency, as well as poultry and beef intake, were causally associated with an elevated risk of hypertension. In contrast, consuming salad/raw vegetables, dried fruits, cheese, and cereals demonstrated an inverse causal association with hypertension, suggesting a potential protective effect.

目的 分析动态心电图在冠心病心肌缺血、心律失常诊断中的应用价值.方法 选取2018年4月—2019年5月我院收治的102例冠心病为研究对象,其中行动态心电图检查者52例纳入观察组,50例行常规心电图检查者纳入对照组,比较2组检出结果及诊断价值.结果 观察组心肌缺血总检出率较对照组高,无症状心肌缺血检出率高于对照组(P<0.05,P<0.01);观察组心律失常总检出率高于对照组(P<0.05),且频发、二三联律、成对型房性早搏,二三联律、成对型室性早搏,室上性心动过速,房室传导阻滞,左右束支传导阻滞检出率高于对照组(P<0.05,P<0.01).动态心电图诊断冠心病心肌缺血的敏感度较常规心电图高,诊断冠心病心律失常的敏感度、准确度均较常规心电图高(P<0.05).结论 动态心电图诊断冠心病心肌缺血、心律失常有较高的临床价值,能较好地检出无症状心肌缺血、判断心律失常类型.

目的 探讨利伐沙班用于非瓣膜性心房颤动(NVAF)伴肾功能不全患者的效果与安全性.方法 选择2017年1月～2018年6月于复旦大学附属中山医院青浦分院就诊的非瓣膜性房颤伴肾功能不全患者297例为研究对象,采用随机数字表法分为华法林组(n=148)和利伐沙班组(n=149);华法林组患者给予华法林治疗,利伐沙班组患者给予利伐沙班进行治疗.分析比较两组患者肾功能指标,生存情况,疗效终点事件发生率及安全性终点事件发生率.结果 治疗前,两组患者的血肌酐和肌酐清除率的差异无统计学意义;治疗后,两组的血肌酐均显著高于治疗前,且华法林组的血肌酐高于利伐沙班组;肌酐清除率均低于治疗前,且华法林组的肌酐清除率低于利伐沙班组(均P＜0.05);华法林组的中位总生存期(OS)为20个月,利伐沙班组的中位OS为20个月,利伐沙班组的死亡风险与华法林组无显著差异(HR=0.940,95％CI:0.714～1.237);华法林组和利伐沙班组在主要终点事件发生方面的差异无统计学意义(HR:0.650;95％CI:0.183～2.303;);华法林组和利伐沙班组在主要安全事件发生方面的差异无统计学意义(HR:0.922;CI:0.581～1.464).结论 非瓣膜性房颤伴肾功能不全患者抗凝治疗中,口服利伐沙班比华法林在延缓肾功能进展方面更为有效,但其在预后生存情况,预防脑卒中、全身性栓塞及出血事件发生方面无显著差异.

目的 探究血浆N末端脑钠肽前体(NT-proBNP)水平对接受他汀类药物治疗急性心肌梗死(AMI)患者预后的评估价值.方法 选取2018年11月至2019年11月我院收治的60例AMI患者(AMI组)和同期健康体检志愿者60名(对照组)为对象,依据AMI组预后不同分为主要不良心血管事件(MACE)发生组、无MACE组,比较AMI组、对照组一般资料、血浆NT-proBNP水平,观察治疗前后AMI组血浆NT-proBNP水平、血脂指标,比较不同预后AMI患者血浆NT-proBNP水平,分析血浆NT-proBNP水平与血脂指标的相关性,ROC曲线分析血浆NT-proBNP水平对AMI患者预后的预测价值.结果 AMI组血浆NT-proBNP水平明显高于对照组(P<0.05);AMI组患者治疗后血浆NT-proBNP水平、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDLC)水平明显降低,而高密度脂蛋白胆固醇(HDLC)明显升高,差异有统计学意义(P<0.05);AMI患者血浆NT-proBNP水平与血清TC、LDLC呈明显正相关(P<0.05).随访发现共有12例发生MACE,48例未发生MACE,MACE发生组入院即刻血浆NT-proBNP水平较无MACE组明显高(P<0.05);血浆NT-proBNP水平预测接受他汀类药物治疗AMI患者预后的ROC曲线下面积为0.929,敏感度高,最佳临界值为510.539 pg/mL.结论 血浆NT-proBNP水平在接受他汀类药物治疗AMI患者预后中的预测价值高且敏感度高,或可作为接受他汀类药物治疗AMI患者预后评估的有效标志物.

IntroductionThe aim of this study is to explore serum norepinephrine (NE) concentration and β3-adrenoceptor (β3AR) protein expression at different times during myocardial ischemia/reperfusion (I/R) in rats and to examine the role of β3AR in I/R.Material and methodsA total of 28 Sprague-Dawley (SD) rats were randomly divided into one sham group and six I/R groups (6 h, 12 h, 18 h, 24 h, 72 h, and 120 h). The rats in the I/R groups were subjected to ischemia for 45 min. After reperfusion, the serum NE concentration and the β3AR protein expression in the myocardial tissue of the left ventricular injury region were detected. Another 18 SD rats were randomly divided into a sham group, I/R groups, and an I/R + BRL37344 group. The myocardial infarct size (MIS) and the expression of apoptotic and anti-apoptotic proteins in the left ventricular myocardium of each group were measured.ResultsCompared with the sham group, the serum NE concentration of rats in the I/R groups was significantly higher at 6 h (p < 0.001); the expression of myocardial β3AR protein started at 12 h. The serum NE concentration and myocardial β3AR protein expression were both highest at 72 h but remained high in the 120-hour group. Compared with the sham group, the expression levels of the pro-apoptotic proteins Bax and cleaved caspase-3 after I/R were significantly higher (p < 0.01, p < 0.001, respectively), and the expression of anti-apoptotic protein Bcl-2 was significantly lower (p < 0.01). Compared with I/R groups, the expression levels of Bax and cleaved caspase-3 in the I/R + BRL37344 group were significantly lower (p < 0.05, p < 0.01, respectively), and that of Bcl-2 was up-regulated (p < 0.05); MIS was significantly decreased (p < 0.001).ConclusionsWith the prolongation of myocardial I/R in rats, serum NE concentration and β3AR protein expression showed a significant increasing trend and reached a peak at 72 h. Specific β3AR agonist BRL37344 can reduce myocardial I/R injury in vivo in rats, alleviate apoptosis, reduce infarct size, and improve cardiac function.

目的 探讨同型半胱氨酸(Hcy)、脑钠肽(BNP)对阵发性心房颤动(简称房颤)患者复律的影响.方法 回顾性分析2017年1月—2019年12月在复旦大学附属中山医院青浦分院心内科治疗的150例阵发性房颤(房颤持续时间≤48 h)患者的临床资料.依据复律成功与否分为复律成功组、复律失败组,选取同期无房颤病史的窦性心律患者50例为对照组.比较3组间年龄、性别、病史、ACEI或ARB服药情况、实验室检查结果,以及超声心动图各项指标的差异.采用多因素logistic回归分析复律成功的影响因素.结果 3组患者的年龄,性别构成,合并高血压、糖尿病、基础心脏病患者比例的差异均无统计学意义(P值均＞0.05).与对照组相比,复律成功组Hcy、BNP水平较高,心室率较快,左心房内径(LAD)较大,差异均有统计学意义(P值均＜0.05).与复律成功组相比,复律失败组患者Hcy、BNP水平较高,LAD较大,差异均有统计学意义(P值均＜0.05),复律成功组与复律失败组间心室率的差异无统计学意义(P＞0.05).多因素logistic回归分析显示,LAD(OR=1.312,95％CI为1.171～1.985)、Hcy(OR=1.975,95％CI为 1.217～3.862)、BNP(OR=1.348,95％CI 为 1.261～1.715)与房颤复律相关(P 值均＜0.01).结论 LAD增大、Hcy、BNP水平升高是影响阵发性房颤患者复律的危险因素.

1临床资料 患者男,50岁.因"持续胸痛2h"于2016年2月27日在复旦大学附属中山医院青浦分院就诊.患者为心前区持续性压榨性疼痛2h不缓解,入院2周前开始出现鼻痒、喷嚏等鼻炎样症状,症状不重,未治疗.患者既往有吸烟史20余年(20支/日),否认高血压病、糖尿病病史.入院查体:血压133/88 mmHg(1 mmHg=0.133 kPa),神志清楚,颈软;双肺呼吸音清晰,未闻及干湿性啰音;心界不大,心率65次/分,心律齐,各瓣膜听诊区未及病理性杂音;腹平软,肝脾肋下未及,双下肢不肿.

目的 探讨N端脑钠肽前体(NT-proBNP)水平对普罗帕酮转复阵发性心房颤动病人疗效的影响.方法 选取2013年1月-2013年12月成功转复窦性心律的阵发性心房颤动(心房颤动持续时间＜24 h)住院病人50例,所有病人复律前完成心脏彩超检查,测定复律前后的NT-proBNP水平,采用普罗帕酮复律,出院后每周随访心电图,每个月行动态心电图检查,随访6个月,依据心房颤动是否复发分为非复发组(38例)和复发组(12例).结果 两组病人年龄、心房颤动持续时间、左房内径和心室率比较,差异无统计学意义(P＞0.05).复律前复发组病人NT-proBNP水平高于非复发组(P＜0.05);复律后两组病人NT-proBNP水平均降低,但复发组仍然高于非复发组(p＜0.05).复发组复律前后NT-proBNP水平均明显高于未复发组(P＜0.05).结论 NT-proBNP水平与阵发性心房颤动的复发相关.

AIM To study the relationship between serum asymmetric dimethylarginine (ADMA) levels and severity of coronary heart disease.METHODS A total of 45 patients with coronary heart disease were enrolled and divided into two groups:angina pectoris (Including stable angina and unstable angina,n =23) group,acute myocardial infarction (n =22) group.Clinical history was recorded,myocardial enzyme,TG,TC,LDL-C,HDL-C,hs-CRP and serum ADMA levels were measured.Coronary artery lesions were assessed by a Syntax scoring system.The correlation between serum ADMA levels and Syntax score,TG,TC,LDL-C,HDL-C,hs-CRP was analysed.RESULTS Serum ADMA level [(60 ±24) μg/L]in the AMI group was significantly higher (P ＜0.05) than that in the angina pectoris group [(31 ±21)μg/L] (P ＜0.05).The levels of LDL-C and hs-CRP were positively correlated with serum ADMA levels in all patients.Serum ADMA levels and Syntax score of coronary stenosis were positively correlated in all patients.CONCLUSION Plasma ADMA levels are a relative factor of severity of coronary heart disease.

Asymmetry dimethylarginine (ADMA)is an endogenous competitive antagonist of nitric oxide synthase(NOS),which competitively inhibit NOS,to reduce nitric oxide content and lead to vascular endothelial dysfunction.ADMA is a risk factor for endothelial dysfunction and closely associated with coronary heart disease(CAD) and its major risk factors.Therefore,ADMA is expected to be a new predictor for CAD.

目的 观察盐酸曲美他嗪片(万爽力)治疗心绞痛患者的疗效及对白介素6(IL-6)与脑钠肽(BNP)水平的影响.方法 选择2013年1月-2014年1月上海复旦大学附属中山医院青浦分院心内科进行治疗的心绞痛患者140例,按照患者入院顺序随机分为观察组和对照组各70例.对照组常规抗心绞痛治疗,观察组在此基础上加用盐酸曲美他嗪治疗.观察2组患者的治疗效果、心绞痛发作次数和持续时间、运动试验结果,检测治疗前后IL-6、BNP变化并记录不良反应情况.结果 观察组总有效率为97.2％,明显高于对照组的85.7％(x2=5.833,P＜0.05);2组治疗后心绞痛发作次数和持续时间均有明显减少,且观察组均低于对照组(P＜0.01);运动持续时间、ST段下降1 mm时间均有所增加,且观察组均高于对照组(P＜0.01);2组治疗后IL-6、BNP均有所下降,且观察组明显低于对照组(P ＜0.05或P＜0.01).结论 万爽力可有效治疗心绞痛,改善患者IL-6、BNP水平,且安全性高,耐受性好,值得推广使用.

目的 观察慢性心力衰竭(CHF)患者血清甲状腺激素水平和B型利钠肽(BNP)浓度变化特点及三者间的相关性.方法 选取符合标准的CHF患者102例,心功能正常(NYHA分级I级)的患者27例作为对照组,采用化学发光免疫法测定甲状腺素水平(T3、rT3, T4、FT4.)及促甲状腺素(TSH);采用放射免疫法测定BNP.结果(1)CHF组血清T3,FT3水平较低,与对照组比较,差异有显著性.(2)CHF组内比较:随心功能不全程度加重,T3,FT3水平依次降低,差异有显著性;(3)CHF组T4,FT4水平低于对照组,TSH水平高于对照组,但差异无统计学意义(P>0.05)(4)CHF组与对照组比较:BNP水平升高,差异有显著性(P<.0.01).(5)CHF组内比较:随心功能不全程度加重,BNP水平依次升高,差异有显著性(P<0.01).结论 心力衰竭患者心功能,与甲状腺激素,B型利钠肽变化相关,可作为CHF患者病情严重程度的客观指标,对心力衰竭的诊断、病情和预后判断均有临床价值.

目的 研究不同类型的心房颤动患者经导管消融术治疗的临床疗效及安全性.方法 连续选择2009年1月至2012年1月复旦大学附属中山医院青浦分院收治,诊断为心房颤动且行经导管射频消融术治疗的患者共86例,其中阵发性心房颤动组48例,非阵发性心房颤动组(包括持续性心房颤动和永久性心房颤动)38例.比较两组单次消融的成功率及并发症情况的差异.结果 阵发性心房颤动组的单次消融成功率明显高于非阵发性心房颤动组,差异有统计学意义[89.6％(43/48)vs.57.9％(28/38),P＜0.05];阵发性心房颤动组并发症发生率低于非阵发性心房颤动组,差异有统计学意义[4.2％(2/48) vs.18.4％(7/38),x2=22.596,P=0.000].结论 经导管射频消融术是治疗阵发性心房颤动的有效手段,其单次消融有效率及安全性均优于非阵发性心房颤动.

目的：探讨CD36基因多态性与冠心病（ CAD）患者临床特征之间的关系。方法选择CAD患者120例，采用变性高效液相色谱（ DHPLC）技术分析包含内含子片段的外显子4和5的CD36基因扩增产物，分析CD36基因多态性与CAD患者临床特征的相关性。结果 CD36基因有两种多态性变异，即IVS3-6 T/C（rs3173798）和IVS4-10 G/A（rs3211892）。 IVS3-6 T/C多态性的C等位基因与糖尿病病史、高敏C反应蛋白升高、血清脂蛋白α浓度降低以及早发心肌梗死有关（P均＜0．05）。 IVS4-10 G/A多态性的A等位基因与晚发心肌梗死和白细胞数量增加有关（P均＜0．05）。结论 CD36基因多态性与CAD患者的临床特征存在一定的相关，不同CD36基因型CAD患者的发病机制、临床特征可能不尽相同。

Objective To investigate the clinical results of non-invasive ventilator in the treatment of acute left heart failure. Methods 70 cases with acute left heart failure admitted in our hospital from March 2012 to February 2014 were randomly divided into the control group and the treatment group with 35 cases in each by the contrast method. The control group received the con-ventional drug therapy, and cardiotonic, diuretic, vasorelant and other treatment, and the treatment group received non-invasive ventilator (BiPAP) treatment based on the cardiotonic, diuretic, vasorelant and other treatment. And the clinical effects were com-pared between the two groups. Results Using non-invasive ventilator in the treatment of acute left heart failure has significant ad-vantages. The total efficiency of the treatment group was significantly higher than that of the control group, there was statistically significant difference between the two groups by clinical comparison, P<0.05. Conclusion Non-invasive ventilator has definite effi-cacy in the treatment of acute left heart failure, which is worthy of clinical application and promotion.

目的:分析中西医结合治疗慢性肺源性心脏病的临床疗效。方法:收集慢性肺源性心脏病患者92例,随机分为观察组和对照组,每组各46例,对照组予以西药治疗,观察组则在西药基础治疗的基础上予以静脉滴注10ml丹参川芎嗪注射液+250ml 5%的葡萄糖注射液。结果:观察组的治疗有效率为93.5%,显著高于对照组的74.9%,P<0.05。结论:中西医结合治疗慢性肺源性心脏病疗效显著,较单纯的西医治疗疗效更佳,无明副作用,值得应用。

目的观察异丙肾上腺素治疗严重房室传导阻滞(高度、Ⅲ°房室传导阻滞)合并尖端扭转型室速(Tdp)的疗效。方法取住院严重房室传导阻滞合并尖端扭转型室速(Tdp)患者41例,予静脉滴注滴注异丙肾上腺素,同时纠正合并电解质紊乱情况,观察患者心电图变化及临床病情进展。结果所有患者用药后数小时病情均得到有效控制,且副作用少。结论在严重房室传导阻滞合并Tdp的紧急情况下,静脉滴注异丙肾上腺素疗效显著,可做首选。