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中华内科杂志

中华内科杂志

北大核心

CSCD

CSTPCD

Chinese Journal of Internal Medicine
1953年创刊，中华医学会主办。本刊为我国内科领域高级学术期刊。重点报道内科领域领先的科研成果和诊疗经验，以及对内科临床有指导作用，且与内科临床密切结合的基础理论研究。以广大内科医师为主要读者对象。本刊被众多国内外知名数据库收录，为国内核心类期刊。多次获得国家级奖励。辟有专论、内科论坛、论著、短篇论著、病例报告、讲座、综述、会议纪要、继续教育园地、标准与讨论、临床病理（例）讨论等栏目。
  • 发文量：7873
  • 被引量：6618
  • H指数：3
  • 开始收录时间：1989,28(1)
  • CNKI综合因子：1.82
  • 维普期刊影响因子： 2.92
  • 万方期刊影响因子：2.53
  • 创刊时间：1953
  • 国内刊号/CN：11-2138/R
    国际刊号/ISSN：0578-1426
  • 发行周期：月刊
    邮发代号：2-58
  • 主管单位：中国科学技术协会
    主办单位：中华医学会
中华内科杂志-联系信息
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  • 电话：010-51322201 51322206
  • 邮箱：cjim@cmaph.org
  • 地址：北京市西城区东河沿街69号
  • 邮编：100052
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  • 摘要：Objective To explore the association between Doppler echocardiography parameters and pulmonary capillary wedge pressure (PCWP) obtained by right heart catheterization (RHC) in patients with pulmonary hypertension (PH).Methods RHC and a simultaneous echocardiography were performed in 86 PH patients.The correlation between the echocardiographic parameters and PCWP was analyzed.Results The early diastolic velocity(E) of mitral valve blood flow was significantly correlated with PCWP ( γ =0.36,P ＜0.01 ).Tissue Doppler imaging measured the diastolic velocity of mitral annulus on the lateral(E'L)and the septal (E'S) wall.Then the average E'M was calculated.The ratio of E to E'L,E'S and E'M showed a strong correlation with PCWP ( γ =0.62,0.34 and 0.47 respectively,P ＜ 0.01 ).E/E'L ＜ 6 accurately predicted 100％ PCWP≤ 15 mm Hg (1 mm Hg =0.133 kPa),and E/E'L ＞ 15 could predict PCWP ＞ 15 nun Hg with specificity of 98.5％.Conclusion There are positive correlation between E/E' and PCWP obtained by RHC in PH patients.%目的 探讨肺高压患者中超声心动图参数与右心导管(RHC)测定肺毛细血管楔压(PCWP)之间的关系.方法 对86例肺高压患者同时进行RHC和超声心动图检查,将多普勒指标与PCWP进行相关性分析.结果 二尖瓣跨瓣血流速度舒张早期峰值(E)与PCWP有显著相关(γ=0.36,P＜0.01).组织多普勒测定二尖瓣环侧壁(L)和间隔(S)的运动速度舒张早期峰值(分别为E'L、E'S),并计算二者的平均值(E'M)；二尖瓣E分别与E'L、E'S和E'M的比值(即E/E'L、E/E'S和E/E'M)均与PCWP有显著相关性(r分别为0.62、0.34和0.47,P＜0.01),由二尖瓣环侧壁获取的E/E'L ＜6能够100％地预测PCWP≤15 mm Hg(1 mm Hg=0.133 kPa),E/E'L＞ 15预测PCWP＞15 mm Hg的特异性为98.5％.结论 在肺高压患者中,超声心动图获取的二尖瓣E峰和二尖瓣环运动速度(E ')比值E/E’与RHC测量的PCWP有良好的相关性.
  • 摘要：Objective To investigate the value of percutaneous balloon dilation and percutaneous transhepatic cholangial drainage (PTCD) catheter maintenance in the treatment of benign biliary strictures.Methods The clinical data of 21 patients with benign biliary strictures at Peking Union Medical College Hospital from June 2005 to June 2011 were retrospectively studied,in which 12 patients in severe stricture (stenosis ＞ 70％ ) were treated with percutaneous balloon dilation and PTCD catheter placed across the stricture,while another 9 patients in median stricture( stenosis ＜ 70％ ) were only treated with PTCD catheter maintenance.Results Of the 12 patients underwent balloon dilation and 6-12 months ( median:9 months)of PTCD catheter placement,11 patients had the catheter successfully removed.In the follow-up of 6-24months ( median:10 months),patency of bile duct was preserved in 9 of 11 patients,and recurrent stenosis was seen in 2 patients.A severe complication with biliary artery branch rupture and massive hemobilia was seen in 1 patient during balloon dilation.Of the 9 patients only treated with 1-12 months (median:6months) of PTCD catheter placement,7 patients had the catheter successfully removed.In the follow-up of 5-18 months (median:8 months),patency of bile duct was preserved in 5 of 7 patients,and recurrent stenosis was seen in 2 patients.No severe complication occurred.Conclusions When endoscopy therapy is failed or the patient can't undergo endoscopy therapy,the percutaneous balloon dilation and PTCD catheter maintenance method is an effective alternative therapeutic approach in the treatment of benign biliary strictures.The moderate benign biliary stricture may be effectively treated only by the PTCD catheter maintenance method.%目的 探讨经皮穿刺球囊扩张及留置经皮经肝胆管引流(PTCD)管支撑治疗良性胆管狭窄的价值.方法 回顾性分析北京协和医院2005年6月至2011年6月的21例内镜治疗困难的良性胆管狭窄患者的临床资料.其中12例重度胆管狭窄(狭窄＞70％)患者进行了经皮穿刺球囊扩张并在狭窄部留置PTCD管支撑治疗,9例中度胆管狭窄(狭窄＜70％)患者进行了经皮穿刺单纯在狭窄部留置PTCD管支撑治疗.结果 12例球囊扩张治疗患者,留置PTCD管支撑治疗6～12个月(中位时间9个月),11例成功拔除引流管；随访6～24个月(中位时间10个月),有9例胆管保持通畅,2例发生胆管再狭窄；1例发生严重并发症,在球囊扩张治疗时胆管动脉分支破裂出血.9例中度胆管狭窄患者单纯留置PTCD管支撑治疗1～12个月(中位时间6个月),7例成功拔管；随访5～18个月(中位时间8个月),2例发生胆管再狭窄；无严重并发症发生.结论 对于不能进行内镜治疗或者内镜治疗失败的良性胆管狭窄患者,经皮穿刺球囊扩张及留置PTCD管支撑治疗是一种有效的替代治疗方法.单纯留置PTCD管支撑治疗有可能对中度良性胆管狭窄有一定的疗效.
  • 摘要：Objective To investigate the relationship between regular exercise habit and peak oxygen uptake (VO2 peak ) early after acute ST-elevation myocardial infarction (STEM I).Methods A total of 239 patients who underwent cardiopulmonary exercise testing (CPET) early after STEMI in a single exercise laboratory were enrolled.Influencing factors to VO2peak were analyzed retrospectively.Results There were 53.6％ patients reported to have regular exercise habits before STEMI.No significant difference between patients with and without exercise habit in VO2peak early after STEMI (P =0.317) were found by t test.Mter adjusted by risk factors including demographic features,clinical characteristics and cardiovascular,etc,regular exercise habit was an independent factor for VO2peak (β =1.703,P =0.015 ).Following age-stratification,the significant difference was found between patients with and without exercise habits in VO2peak only in patients aged between 40-49 years old ( P =0.004 ).Conclusions The relationship between regular exercise habit and VO2peak early after STEMI suggests that exercise tolerance of patients with exercise habit will be better than sedentary patients even after STEMI,in particular to patients aged between 40-49 years old.%目的 评价急性ST段抬高心肌梗死(STEMI)患者发病前规律运动与发病后早期峰值摄氧量( VO2peak)的关系.方法 研究入选初次发生急性STEMI并行心肺运动试验的患者239例,回顾性分析患者发病后早期VO2peak的影响因素.结果 128例(53.6％) STEMI患者在发病前有规律运动习惯,经独立样本t检验,规律运动与无规律运动组患者发病后早期VO2peak差异无统计学意义(P=0.317).经性别、年龄及临床特征等多因素校正,既往规律运动是STEMI后早期VO2 peak的独立影响因素(β=1.703,P =0.015).按年龄分层,结果显示仅40～49岁年龄层患者VO2 peak在规律运动和无规律运动两组间差异有统计学意义[(25.0±3.3)ml·kg-1·min-1比(21.3±5.1 )ml·kg-1·min-1,P=0.004].结论 规律运动者即使发生STEMI,运动耐量仍优于不运动者,且这种相关性在相对年轻(40 ～49岁)的患者中最为突出.
  • 摘要：Objective To study the relationship between the genetic polymorphisms of carboxylesterase 1 gene (CESI) and the susceptibility to antituberculosis drug-induced hepatotoxicity (ATBDIH).Methods Genetic polymorphisms of CES1 in 473 tuberculosis patients with or without hepatotoxicity (200∶ 273) after antituberculosis chemotherapy were analyzed by PCR-MassArray.Results In4 tags of CES1 single nucleotide polymorphism (SNP),the frequency of the rs1968753 allele had statistical difference between the hepatotoxicity group and the no-hepatotoxicity group ( P =0.0236 ).The characteristics of anti-hepatotoxicity had been shown relationship with rs8192950 ( P =0.044,OR =0.649,95％ CI =0.426-0.989,AC/AA ) and rs1968753 ( P =0.048,OR =0.556,95％ CI =0.311-0.995,GG/AA).The diplotypes with ‘ CGC' haplotype exhibited significant protection against hepatotoxicity at one copy (P=0.048,OR=0.654,95％CI=0.430-0.996).Conclusions The genetic polymorphisms of CESI might have significant association with ATBDIH.SNP rs8192950 AC genotype and rs1968753 GG genotype might be the candidates for risk prediction of ATBDIH.%目的 研究羧酸酯酶(CES)基因1多态性及其与抗结核药物肝毒性易感性之间的关系.方法 应用PCR-时间飞行质谱技术(PCR-MassArray)分析473例抗结核治疗后发生肝损害(200例)和未发生肝损害(273例)结核病患者的CES1基因多态性,并通过统计学分析CES1各单核苷酸多态性(SNP)位点基因型与抗结核药物所致肝毒性之间的关系.结果 在筛选出的4个CES1标签SNP位点中,rs1968753的等位基因频率在肝损害和无肝损害组间存在分布差异(P=0.0236).SNP1rs8192950(P=0.044,OR=0.649,95％CI=0.426～0.989,AC/AA)和SNP2 rs1968753(P=0.048,OR =0.556,95％CI =0.311 ～0.995,GG/AA)与抗肝毒特性有显著关联.由‘CGC’参与构成的双单体型,在1份拷贝时表现出显著的肝毒保护性(P =0.048,OR=0.654,95％ CI=0.430～0.996).结论 CES1基因多态性可能与抗结核药物性肝损害密切相关,SNP rs8192950的AC基因型和rs1968753的GG基因型可能成为抗结核药物肝毒性风险预测的候选突变.
  • 摘要：目的 观察每4周1次皮下注射持续性促红细胞生成素受体激活剂(C.E.R.A.)维持慢性肾脏病(CKD)透析贫血患者Hb水平的疗效和安全性.方法 采用开放、随机、对照、多中心临床试验方法.选择血液透析或腹膜透析且已接受促红细胞生成素(EPO)治疗的CKD贫血成年患者,在6周的预治疗期接受EPO-β3每周1～3次皮下注射,维持Hb于100～120 g/L.其后符合入选标准的患者以2∶1比例随机接受C.E.R.A.每4周1次皮下注射(C.E.R.A.组,187例)或EPO-β每周1～3次皮下注射(EPO组,94例)持续治疗28周(包括20周剂量滴定期和8周疗效评估期).C.E.R.A.的起始剂量根据首次给药前1周内使用的EPO-β剂量换算而定.主要研究终点为疗效评估期Hb值相对基线水平的变化.结果 共253例患者完成了28周的治疗.C.E.R.A.组在疗效评估期Hb值相对基线的变化为+2.57 g/L,EPO组为+1.23 g/L,两组差异为1.34 g/L(95％CI-1.11 ～3.78 g/L),其95％ CI的下限大于预设的非劣效性界值-7.5 g/L(P＜0.0001),故认为C.E.R.A.每4周1次皮下注射对CKD透析贫血患者维持Hb水平的疗效非劣于EPO-β.C.E.R.A.组和EPO组平均Hb值维持于目标值的患者比例相当(69.0％比68.9％).C.E.R A.组和EPO组不良事件的总发生率相似(41.7％比46.2％),安全性结果与研究人群的基础疾病有关.结论 在已接受EPO治疗的CKD透析贫血患者中,换用C.E.R.A.每4周1次皮下注射可有效维持Hb水平,且非劣效于EPO-β治疗.CKD透析贫血患者对于皮下注射C.E.R.A.总体上耐受良好.%Objective To evaluate the efficacy and safety of continuous erythropoietin receptor activator (C.E.R.A.) once every 4 weeks by subcutaneous administration on hemoglobin (Hb)maintenance in dialytic patients with chronic renal anemia who had been treated with stable dose of erythropoietin (EPO).Methods This was an open,randomized,controlled,multi-center trial.All the hemodialysis or peritoneal dialytic patients in EPO maintenance treatment received subcutaneous EPO-β during the 6-week pre-treatment period to maintain Hb level between 100 g/L and 120 g/L.Eligible patients were randomized (2∶1 ) to accept either C.E.R.A.once every 4 weeks by subcutaneous administration ( C.E.R.A.group,n =187 ) or subcutaneous EPO-β 1-3 times weekly ( EPO group,n =94) for 28 weeks (including 20-week dose titration period and 8-week efficacy evaluation period ). The starting dose of C.E.R.A.was converted according to the dose of EPO-β administered in the week preceding the first study drug administration.The primary outcome was the change of Hb level between the baseline and that in the efficacy evaluation period.Results Totally 253 patients completed the whole 28-week treatment.The change of baseline-adjusted mean Hb was +2.57 g/L for C.E.R.A.group and + 1.23 g/L for EPO group,resulting in a treatment difference of 1.34 g/L (95％ CI - 1.11-3.78 g/L).Since the lower limit of 95％ CI was greater than the pre-defined non-inferiority margin -7.5 g/L( P ＜ 0.0001 ),C.E.R.A.once every 4 weeks by subcutaneous administration was clinically non-inferior to EPO regarding the maintenance of stable Hb level.The proportion of patients maintaining Hb level within the range of 100-120 g/L through efficacy evaluation period was similar between the two groups ( 69.0％ for C.E.R.A.group vs 68.9％ for EPO group,P ＞0.05 ).The overall incidence of adverse events was similar between the C.E.R.A.(41.7％)and EPO (46.2％ ) groups ( P ＞ 0.05 ).The safety findings were in accordance with the patients' primary diseases rather than the administration.Conclusions Conversion from EPO to C.E.R.A.once every 4 weeks by subcutaneous injection could maintain the Hb in target level in dialytic patients with renal anemia,and it was non-inferior to EPO.In general,subcutaneous administration of C.E.R.A.is well tolerated in dialytic patients with chronic renal anemia.
  • 摘要：Objective To explore the effects of proton pump inhibitors (PPIs) therapy on esophageal acid exposure of patients with gastroesophageal reflux disease(GERD),and the correlation of anxiety and depression with recurrence of acid-related symptoms after discontinuation of PPIs.Methods From February 2010 to June 2011,28 patients with GERD diagnosed by ambulatory 24 h esophageal pH monitoring admitted to Beijing Jishuitan Hospital were treated with esomeprazole 20 mg 2 times/d for 8 weeks (male 16,female 12).Symptoms after drug discontinuation were monitored.Ambulatory 24 h esophageal pH monitoring was performed on patients,whose symptom recurred within 8 weeks after treatment.BMI,Self-rating Anxiety Scale(SAS),and Self-rating Depression Scale (SDS) were detected.Results Among the 28 patients with GERD,15 (53.6％) recurred symptoms after withdraw of PPIs.Compared with the asymptomatic group after withdraw of PPIs,the pretreatment duration of pH 4 (supine),24 h total acid reflux time,number of time periods with acid reflux ＞5 minutes,the maximal acid reflux time and 24 h total number of acid reflux in the symptomatic recurrence group were statistically significantly increased ( 11.7％vs 4.5％,138.8 minutes vs 62.1 minutes,6.0 vs 2.0,27.0 minutes vs 12.4 minutes,74.0 times vs43.0times,respectively,all P values ＜ 0.05 ).There were no significant differences in BMI,SAS and SDS between the two groups.Conclusions The basic level of esophageal acid exposure of patients with GERD before PPIs therapy may influence the esophageal acid exposure after PPIs therapy and then may affect the recurrence of symptoms.Although anxiety and depression is common in patients with GERD,it is not found that the recurrence of acid-related symptoms after the discontinuation of PPIs therapy is related to the anxiety and depression.%目的 探讨质子泵抑制剂( PPIs)治疗对胃食管反流病(GERD)患者食管酸暴露的影响及焦虑抑郁情绪与GERD患者PPI停药后酸相关症状再发的相关性.方法 2010年2月至2011年6月北京积水潭医院经24h食管pH动态监测确诊的GERD患者28例(男16例,女12例),给予口服埃索美拉唑20 mg 2次/d,治疗8周.监测停药后症状,对停药后8周内有症状复发者,复查24h食管pH动态监测.同时测定患者的BMI、焦虑自评量表(SAS)积分、抑郁自评量表(SDS)积分.结果 28例GERD患者中,停药后症状复发者15例(53.6％).PPI停药后症状复发者较无症状复发者治疗前的pH ＜4时间百分比(卧位)、24h酸反流总时间、24h酸反流＞5 min时间段数、最长酸反流时间、24h总反流次数均明显更高(分别为11.7％比4.5％,138.8 min比62.1 min,6.0比2.0,27.0 min比12.4 min,74.0次比43.0次,P值均＜0.05).各组GERD患者BMI、SAS积分、SDS积分比较,差异无统计学意义.结论 GERD患者接受PPI治疗前基础食管酸暴露水平可能对PPI治疗后食管酸暴露产生影响,从而影响症状的再发.虽然焦虑抑郁在GERD患者中普遍存在,但未发现焦虑抑郁情绪与GERD患者PPI治疗停药后酸相关症状的再发相关.
  • 摘要：Objective To investigate the expression of TET2 and DLK1 mRNA in bone marrow CD3+ T cells of patients with myelodysplastic syndrome (MDS) and their clinical significance and to explore the potential mechanism of abnormal cell-mediated immunity.Methods CD3+ T cells were sorted by magnetic activated cell-sorting system.The expressions of TET2 and DLK1 mRNA in bone marrow CD3+ T cells from 26 MDS patients and 16 healthy controls were detected by fluorescence quantitative PCR.Results The expression of TET2 mRNA in CD3+ T cells was down-regulated in the MDS patients by (0.16 ±0.15) fold compared with the controls ( P ＜ 0.05 ).The expression of TET2 mRNA in CD3+ T cells of MDS patients was positively correlated with serum complement C3 ( r =0.404,P ＜ 0.05 ).The expression of DLK1 mRNA in CD3+ T cells was up-regulated in the MDS patients by (1.61 ±0.88) folds compared with the controls (P＜0.05).Grouped by the chromosomes,the patients with chromosome abnormalities presented significantly higher DLK1 mRNA level than those with normal chromosomes [ ( 1.45 ± 0.44 ) folds,P ＜0.05 ].The expression of DLK1 mRNA in CD3+ T cells of MDS patients was positively correlated with the proportion of bone marrow blasts ( r =0.343,P ＜ 0.05 ).Conclusions The mRNA expression of TET2 in CD3+ T cells of MDS patients was decreased while the mRNA expression of DLK1 was increased,which might decline the immune surveillance function.The findings would be useful for exploring the mechanism of immune tolerance.%目的 探讨骨髓增生异常综合征(MDS)患者骨髓CD3+T细胞TET2及DLK1基因的表达水平及其临床意义,为进一步阐明MDS细胞免疫异常的机制提供依据.方法 应用免疫磁珠分选骨髓CD3+T细胞,应用实时荧光定量PCR(qPCR)检测26例MDS患者和16例正常对照骨髓CD3+T细胞中TET2和DLK1 mRNA的表达水平,分析它们与临床特征之间的相关性.结果 MDS患者骨髓CD3+ T细胞中TET2 mRNA表达是正常对照组的(0.16±0.15)倍(P＜0.01)；TET2mRNA表达水平与血清补体C3呈显著正相关(r =0.404,P＜0.05)；MDS患者骨髓CD3+T细胞中DLK1 mRNA表达是正常对照组的(1.61±0.88)倍(P＜0.05)；依据染色体分组,染色体异常组DLK1表达水平是染色体正常对照组的(1.45±0.44)倍(P＜0.05)；DLK1 mRNA表达水平与骨髓原始细胞比例呈显著正相关(r =0.343,P＜0.05).结论 MDS患者骨髓CD3+T细胞中TET2 mRNA表达降低,DLK1 mRNA表达增高,提示CD3+T细胞有质的异常,这可能是导致机体免疫监视功能下降的机制之一.
  • 摘要：目的 评价帕尼培南-倍他米隆治疗中重度肺部感染的临床有效性与安全性.方法 开放性、前瞻性、多中心临床研究.对621例中重度肺部感染患者[社区获得性肺炎(CAP) 345例,医院获得性肺炎(HAP) 230例,呼吸机相关性肺炎(VAP) 46例]静脉滴注帕尼培南-倍他米隆500 mg,1次/6h,7～14d一个疗程,评估治疗结束时的临床疗效和细菌学疗效,记录观察期间出现的不良反应.结果 帕尼培南-倍他米隆治疗中重度肺部感染的临床有效率为84.4％,其中CAP、HAP、VAP的临床有效率分别为91.9％、76.1％、69.6％,中度、重度肺部感染的临床有效率分别为87.5％和82.8％.细菌分离阳性率为54.8％,细菌学清除率为80.9％；对铜绿假单胞菌、肺炎克雷伯杆菌、大肠埃希菌、鲍曼不动杆菌的清除率分别为74.7％、95.6％、89.5％和50.9％.与药物相关的不良反应12例,发生率为1.8％,均为轻度,未予处理,停药后恢复正常.结论 帕尼培南-倍他米隆治疗中重度肺部感染的疗效佳且不良反应发生率低.%Objective To evaluate the clinical efficacy and safety of intravenous panipenembetamipron in the treatment of moderate to severe pulmonary infection.Methods An open,perspective,multicenter clinical trial was conducted.Among the enrolled 665 patients,621 patients with moderate to severe pulmonary infection were treated with intravenous panipenem-betamipron at a dose of 500 mg every 6 hours per day for 7-14 days.Among them,the community acquired pneumonia (CAP),hospital acquired pneumonia (HAP) and ventilator associated pneumonia (VAP) patients were 55.6％ ( 345/621 ),37.0％ (230/621)and 7.4％ (46/621),respectively.All the adverse events were recorded.Results The overall effective rate of panipenem-betamipron was 84.4％ with CAP of 91.9％,HAP of 76.1％ and VAP of 69.6％.The effective rates in the patients with moderate and severe pulmonary infection were 87.5％ and 82.8％,respectively. Bacterial separation rate was 54.8％ and bacterial eradication rate was 80.9％.Bacterial eradication rates to pseudomonas aeruginosa,pneumobacillus,Escherichia coli.and acinetobacter baumannii were 74.7％,95.6％,89.5％ and 50.9％,respectivdy.The adverse events rate was 1.8％ (12/665).Conclusion Intravenous panipenem-betamipron is effective in treating moderate to severe pulmonary infection with low adverse events rate.
  • 摘要：Objective To evaluate the effect of pitavastatin on blood glucose in patients with hypercholesterolemia,and to investigate the efficacy of pitavastatin in diabetic patients combined with hypercholesterolemia.Method This study was a 12-week,multi-center,open-label,without parallel-group comparison,phase Ⅳ clinical trail.Results Contrasting to baseline,the prevalences at week 4 and 12 post-treatment of abnormal fasting plasma glucose (FPG) and glycosylated hemoglobin Alc (HbA1c)( FPG:14.2％ vs 14.1％ and 11.0％ ; HbA1c:14.3％ vs 15.1％ and 16.1％ ) in the safety set subjects without diabetes mellitus (DM),as well as in those with DM but not taking glucose-lowering drugs (FPG:7/7 vs 4/7 and 5/7; HbAlc:5/5 vs 4/4 and 5/5) had no significant changes (all P vaules ＞0.05).Contrasting to baseline,the levels of TC [ (6.51±0.94) mmol/L vs (5.12 ±0.93) mmol/L and (4.54 ±1.00) mmol/L],LDL-C [(4.11 ±0.79)mmol/L vs (3.02 ±0.81) mmol/L and (2.51 ±0.70)mmol/L] and TG [2.10(1.53,2.54) mmol/L vs 1.62(1.26,2.00) mmol/L and 1.35(1.10,1.86)mmol/L]at week 4 and 12 post-treatment in the per protocol set 55 subjects with DM were significantly reduced (all P values ＜ 0.05 ) ; 33.3％ of subjects at high risk and 10.0％ of subjects at very high risk had achieved a TC target value; 55.6％ of subjects at high risk and 40.0％ of subjects at very high risk had achieved a LDL-C target value.Conclusion Pitavastatin has a safe effect on blood glucose and it could be used to treat diabetic patients combined with hypercholesterolemia in China.%目的 评价匹伐他汀对高胆固醇血症患者血糖的效应及其治疗糖尿病高胆固醇血症的疗效.方法 以多中心、非盲、不设平行对照的方式开展为期12周的Ⅳ期临床试验.结果 用药期间,与基线比较治疗4周和12周,空腹血糖(FPG)、糖化血红蛋白(HbA1c)异常率在安全集非糖尿病受试对象(FPG:14.2％比14.1％和11.0％；HbAlc:14.3％比15.1％和16.1％)、未服用降糖药物的糖尿病受试对象(FPG:7/7比4/7和5/7;HbA1c:5/5比4/4和5/5)差异均无统计学意义(P值均＞0.05).与基线相比,治疗4周和12周时符合方案集55例糖尿病高胆固醇血症患者的血清TC[(6.51±0.94) mmol/L比(5.12±0.93) mmol/L和(4.54±1.00) mmol/L]、LDL-C[ (4.11±0.79)mmol/L比(3.02±0.81) mmol/L和(2.51±0.70) mmol/L]、TG [2.10(1.53,2.54) mmol/L比1.62(1.26,2.00) mmol/L和1.35(1.10,1.86) mmol/L]水平明显下降(P值均＜0.05)；33.3％高危患者和10.0％极高危患者的TC值达到治疗目标值；55.6％高危患者和40.0％极高危患者的LDL-C值达标.结论 匹伐他汀对患者血糖无明显影响,可用于我国糖尿病高胆固醇血症患者的长期治疗.
  • 摘要：目的 分析多省市人群1992-2007年空腹TG水平变化与累积糖尿病发病风险的关系.方法 以1992年6省市35～64岁参加了心血管病危险因素调查者为基线数据,2007年进行了危险因素再调查；去除1992年已有糖尿病和2次调查资料不完整者,用于本研究共5408例.根据TG水平分为3组:1组TG＜ 1.70 mmol/L,2组TG 1.70～2.25 mmol/L,3组TG≥2.26 mmol/L.结果 与1992年相比,2007年该人群TG水平增加了0.40 mmol/L；高TG血症患病率从23.4％上升至39.0％.队列人群15年糖尿病累积发病率12.8％；按基线TG水平分3组,15年累积糖尿病发病率分别为10.5％、16.2％和26.6％.以基线TG 1组为对照,在调整了多个危险因素后,2组和3组糖尿病发病风险RR分别为1.44(95％CI 1.12～1.83)和2.40(95％ CI 1.90 ～3.03).两时点(1992年和2007年)检测TG均以1组为对照,多因素分析显示,2次检测TG 3组累计糖尿病发病风险均增加了2.39倍(RR3.39,95％CI2.49～4.61).结论 多省市队列人群基线高TG水平是糖尿病发病风险独立影响因素；两时点TG的变化对糖尿病发病风险预测能提供更多的信息.%Objective To explore the 15-years change in fasting TG level and the accumulative incidence of type 2 diabetes mellitus (T2DM) from 1992 to 2007,and to assess the association between the change in TG level and the accumulative onset risk of T2DM.Methods A total of 11 387 subjects aged 35-64 years were recruited from 6 provinces in China in the baseline survey in 1992,and were followed-up for cardiovascular disease till 2007.In 2007,9184 subjects were successfully followed-up and 5966 subjects entered into the second examination.Totally 5408 participants,who were free of diabetes at baseline and had complete information for both check ups,were included in this analysis.Fasting TG levels were categorized into three groups:＜ 1.70 mmol/L,1.70-2.25 mmol/L and ≥2.26 mmol/L.The association between 15-years change in TG level and the accumulative onset risk of T2DM was assessed by logistic regression analysis.Results In 1992,the mean level of TG was 1.49 mmol/L in male and 1.26 mmol/L in female.During the 15 years,TG levels increased by 0.25 mmol/L and 0.53 mmol/L in male and female,respectively.The prevalence of elevated TG ( ＜ 1.70 mmol/L) increased from 23.4％ in 1992 to 39.0％ in 2007.The 15-year accumulative incidence of diabetes was 13.9％ in male and 11.8％ in female.The incidence rates were 10.5％,16.2％ and 26.6％ for TG levels of ＜ 1.70 mmol/L,1.70-2.25 mmol/L and ≥2.26 mmol/L,respectively.Multivariate logistic regression analysis showed that the baseline TG level was significantly associated with the onset risk of diabetes after adjustment for other cardiovascular risk factors.At any given baseline TG level,the onset risk of diabetes increased with the TG levels in the second examination in 2007.After adjusting other risk factors,participants with the highest categories of both baseline and follow-up TG levels had 2.1 folds higher accumulative onset risk of diabetes ( RR =3.39,95％CI 2.49-4.61 ) than those with the lowest categories of both baseline and follow-up TG levels.Conclusion Baseline TG level is independently associated with diabetes onset risk,and the change of TG level in a 15-year interval predicts the onset risk of diabetes beyond the baseline TG level.
  • 摘要：目的 研究老年体位性低血压与心肌梗死(MI)的关系.方法 对广州军区离退休干部中＞65岁的1081例无MI的老年患者进行立卧位血压及心率的测量,将患者分为收缩压体位性低血压(OH-S)/舒张性体位性低血压(OH-D)两部分,统计其发生率；对上述人群进行跟踪随访,以新发MI作为终点事件,分别观察OH-S/OH-D与新发MI的关系.结果 人群总的体位性低血压发生率为24.5％( OH-S 19.3％,OH-D 17.2％),高龄老年组体位性低血压、OH-S明显高于老年组(26.1％比20.1％,P=0.045;21.0％比14.6％,P=0.018)；OH-D的发生率在两组之间差异无统计学意义；随访315 d后,体位性低血压患者中的MI发生率明显高于非体位性低血压患者；OH-S和OH-D患者的MI发生率分别高于非OH-S和非OH-D患者.进一步校正年龄、卧位血压、肌酐、既往心脑血管病史后,体位性低血压(HR 15.635,95％ CI3.299 ～74.091,P=0.001)、OH-S(HR8.760,95％ CI 2.487～30.851,P=0.001)、OH-D(HR 3.889,95％ CI 1.097～13.790,P=0.035)与MI的发生仍具有相关性,OH-S与OH-D相比有更大的相关性.结论 收缩压及舒张压体位性低血压增加MI的发生风险.%Objective To investigate the association between the systolic/diastolic orthostatic hypotension (OH-S/OH-D) and myoeardial infarction (MI) in the elderly.Methods Health screening physical examination were carried in 1081 subjects without MI aged over 65 years in Guangzhou Military region.The orthostatic blood pressure and heart rate were measured in supine position after resting for more than 5 minutes and at 0 and 2 minutes after standing.All the cases were divided into systolic or diastolic group on the basis of definition of orthostatic hypotension and followed up by telephone or inpatient medical records with mean period of 315.8 days.The primary endpoint was MI occurrence.Results The prevalence of OH in this cohort was 24.5％ ( OH-S/OH-D:19.3％/17.2％ ).Significant differences in the occurrence of OH and OH-S were found in the elderly and the very elderly subjects( ≥80 years) (26.1％ vs 20.1％,P=0.045; 21.0％ vs 14.6％,P =0.018),while no difference was found in OH-D.The prevalence of MI in the OH positive subjects was significantly higher than that in the OH negative subjects,as well as in OH-S or OH-D group.After adjustment of age,supine blood pressure,creatinine and cerebrovascular history by logistic regression,the association was observed between MI and OH ( HR 15.635,95 ％ CI 3.299-74.091,P=0.001),OH-S(HR 8.760,95％CI2.487-30.851,P=0.001)and OH-D(HR 3.889,95％ CI 1.097-13.790,P =0.035 ).Conclusion OH-S and OH-D hypotension are robust predictors for MI in the elderly.
  • 摘要：Objective To explore the role of T cell-mediated immunity in the pathogenesis of venous thromboembolism ( VTE ) by analyzing the differential expression of T cell immune-related gene mRNAs peripheral blood mononuclear cells (PBMCs) between VTE patients and controls with GeneChip Human Genome. Methods Human eDNA microarray analysis was employed in PBMCs from 20 VTE patients and 20 hypertensive controls,and random variant model (RVM) corrected t-test was used for statistical analysis of differential gene expression.Results Six mRNA stripes including CD247,CD3D,CD3G,Granzyme A (GzmA),Granzyme B (GzmB) and Zeta-chain-associated protein kinase 70 (ZAP70)were found to be associated with T cell-mediated immunity.Significant down-regulation of these six mRNAs was found in the VTE group compared with the controls ( 15.3050 ± 0.6346 vs 15.8053 ± 0.5567,13.7878 ±0.7731 vs 14.3820 ±0.4857,13.3299 ± 0.9104 vs 14.1246 ± 0.6011,14.8893 ± 0.8675 vs 15.5305 ±0.4624,15.9113 ±0.8123 vs 16.4553 ±0.5055,14.3652 ±0.7717 vs 14.3652 ±0.7717;all P values ＜ 0.05 ).Conclusions T cells' function including antigen recognition,signal transduction and cytotoxicity was impaired in VTE patients.T cell-mediated immunity dysfunction probably plays an important role in the pathogenesis of VTE.%目的 探讨静脉血栓栓塞症(VTE)患者T细胞免疫功能在VTE发病中的作用.方法 采用全人类基因表达谱芯片分别检测VTE组(20例)和对照组(20例)受试者外周血单个核细胞(PBMC)T细胞免疫功能相关基因mRNA表达.结果 VTE组患者PBMC CDu7 mRNA( 15.3050±0.6346)、CD3D mRNA( 13.7878±0.7731)、CD3G mRNA( 13.3299±0.9104)、GzmA mRNA( 14.8893±0.8675)、GzmB mRNA( 15.9113±0.8123)、ZAP-70 mRNA(14.3652±0.7717)表达水平较对照组( 15.8053±0.5567、14.3820±0.4857、14.1246±0.6011、15.5305±0.4624、16.4553±0.5055、14.9229±0.4133)下调,差异均有统计学意义(P值均＜0.05).结论 VTE患者存在T细胞免疫功能紊乱,T细胞的识别抗原、传导信号功能及杀伤性病毒微生物功能下降.T细胞免疫功能紊乱有可能在VTE的发生发展中起重要作用.
  • 摘要：目的 探讨尿苷二磷酸葡萄糖醛酸转移酶1A(UGT1A)、核因子E2相关因子2(Nrf2)及Kelch样环氧氯丙烷相关蛋白-1(Keapl)表达与结肠肿瘤发生发展的关系.方法 应用免疫组化法检测正常结肠(24份)、结肠腺瘤(30份)、结肠癌(77份)组织标本中UGT1A、Nrf2及Keap1的蛋白表达情况,分析其与结肠肿瘤患者临床病理特征的联系.结果 UGT1A在正常结肠黏膜、结肠腺瘤、结肠腺癌组织中的阳性表达率分别为83.3％ (20/24)、80.0％( 24/30)和53.2％ (41/77),腺癌组织中UGTIA阳性表达率明显低于前两者(P值均＜0.05).而Nrf2在结肠腺瘤[70.0％ (21/30)]及腺癌组织[87.0％ (67/77)]中的阳性表达率明显高于正常结肠黏膜组织[41.7％ (10/24)],且腺癌中的阳性率亦高于腺瘤组织,P值均为0.000.Keap1的阳性表达率在结肠腺癌组织中为61.0％ (47/77),高于正常结肠黏膜组织中的54.2％(13/24)(P =0.040),而低于结肠腺瘤组织中的70.0％ (21/30)(P=0.002).UGT1A及Nrf2的表达与结肠癌各临床病理特征参数无明显关联性,而Keap1的阳性表达率在结肠癌各分化程度[中高分化与低分化分别为70.0％ (35/50)、44.4％ (12/27)]及浸润程度分层间[T1 ～T2及T3～T4分期分别为78.8％ (26/33) 、47.7％ (21/44)]的差异均有统计学意义(P值均＜0.05).结论 UGTIA表达下调及Nrf2/Keap1信号系统的表达异常可能与结肠肿瘤的发生相关.%Objective To investigate the role of UDP-glucuronosyltransferase 1A (UGT1A),nuclear factor erythroid-2-related factor 2 (Nrf2) and kelch-like ECH-associated protein 1 ( Keapl ) in the tumorigenesis of colonic carcinoma.Methods The expressions of UGT1 A,Nrf2 and Keapl were detected in normal colonic mucosa(24 cases),adenoma tissue (30 cases) and adenocarcinoma tissue (77 cases) by immunohistochemistry,and the relationship between their expressions and the clinical pathological characteristics was analyzed.Results The positive rates of UGT1 A in normal colonic mucosa,adenoma and adenocarcinoma tissue were 83.3％ ( 20/24),80.0％ ( 24/30 ) and 53.2％ ( 41/77 ),respectively.The positive rate of UGT1A in adenocarcinoma was lower than those in colonic mucosa and adenoma ( all P ＜0.05 ).On the contrary,the positive rates of Nrf2 in adenoma [70.0％ (21/30) ] and adenocarcinoma tissue [ 87.0％ (67/77) ] were higher than that in normal colonic tissue [ 41.7％ (10/24),all P =0.000 ].The positive rates of Keapl in normal colonic mucosa,adenoma and adenocarcinoma tissue were 54.2％ ( 13/24),70.0％ (21/30) and 61.0％ (47/77),respectively ( normal colonic tissue vs adenocarcinoma tissue,P =0.040 ; adenoma vs adenocarcinoma,P =0.002 ).There was no correlation between the expression of UGT1 A,Nrf2 and the clinicopathologic features of colon carcinoma,while the differences of Keapl positive rates in the various degrees of tumor differentiation [ moderately-well differentiated vs poorly differentiated:70.0％ (35/50) vs 44.4％ (12/27) ] and invasion [T1-T2 vs T3-T4:78.8％ (26/33) vs 47.7％ (21/44) ]were statistically significant (all P ＜ 0.05 ).Conclusion The decreased expression of UGT1A and the dysregulation of Nrf2/Keapl system may play a role in colonic tumorigenesis.
  • 摘要：Objective To investigate the changes of plasma ghrelin,growth hormone (GH) and growth hormone releasing hormone (GHRH) and gastric ghrelin in patients with chronic obstructive pulmonary disease( COPD ) and to explore their clinical significances.Methods Plasma ghrelin,GH,GHRH,TNFα,IL-6 and C reactive protein (CRP) were measured in 40 COPD patients and 20 controls with chronic bronchitis. Correlated factors of plasma ghrelin,TNFα,IL-6,CRP were analyzed. Body composition was assessed with bioelectrical impedance analysis.The expression of gastric ghrelin in patients with COPD was detected.Results Plasma ghrelin was higher in the underweight patients than in the normal weight patients and in the controls [ ( 1.78 ± 0.46 ) ng/L,( 1.39 ± 0.46 ) ng/L,( 1.36 ± 0.39 ) ng/L,respectively].Plasma GH was lower in the underweight patients than in the normal weight patients and in the controls [(4.12 ±0.83) μg,/L,(5.17 ±0.72) μg/L,(6.49 ± 1.13) μg/L,respectively].Plasma GHRH was lower in the underweight patients than in the normal weight patients and in the controls [ (20.43 ± 4.41 ) ng/L,(23.47 ± 3.97) ng/L,( 27.48 ± 10.06) ng/L,respectively ].Plasma ghrelin was higher in the underweight patients than in the controls ( P ＜ 0.01 ).Plasma ghrelin was higher in the underweight patients than in the normal weight patients with COPD.Plasma ghrelin (log transformed) was negatively correlated with BMI and percentage of body fat in the COPD patients.Plasma GHRH was positively correlated with ghrelin in the underweight patients ( r =0.515,P ＜ 0.05 ),while no correlation was found between plasma G H and ghrelin in the underweight patients (r =0.415,P ＞ 0.05 ).Plasma ghrelin was positively correlated with TNFα and IL-6 in the underweight patients.The gastric expression of ghrelin showed no evident difference between the patients with COPD and the controls.Conclusions The plasma GH in COPD patients may not be correlated with ghrelin.The plasma ghrelin level may be a useful indicator for malnutrition in COPD patients.Plasma ghrelin might be involved in the pathogenesis of CODP by affecting the body energy metabolism.%目的 探讨慢性阻塞性肺疾病(COPD)患者生长激素释放肽(ghrelin)、生长激素(GH)、生长激素释放激素(GHRH)的变化及其临床意义.方法 选40例COPD稳定期患者,根据BMI,将COPD患者分为BMI≥20 kg/m2组和BMI ＜20 kg/m2组；另选20例慢性支气管炎稳定期患者作为对照组.测上述患者血生长激素释放肽、GH、GHRH、TNFα、IL-6和C反应蛋白(CRP)水平.观察胃黏膜组织中生长激素释放肽表达.结果 (1) COPD BMI＜ 20 kg,/m2组患者血生长激素释放肽水平[ (1.78±0.46) ng/L]高于对照组[(1.39±0.46) ng/L]和COPD BMI≥20 kg/m2组[(1.36±0.39) ng/L],血GH水平[(4.12±0.83) μg/L]低于BMI ≥20 kg/m2组[(5.17±0.72) μg/L]和对照组[(6.49±1.13)μg/L],血GHRH水平[(20.43±4.41) ng/L]低于BMI≥20 kg/m2组[(23.47±3.97) ng/L]和对照组[(27.48±10.06)ng/L].(2)COPD患者胃黏膜生长激素释放肽表达与对照组无明显差异.(3)COPD BMI＜20 kg/m2组血生长激素释放肽水平与BMI、体脂百分比呈负相关(r=-0.565,P＜0.01;r=-0.615,P＜0.01),血GH、GHRH水平与BMI呈正相关(r=0.602,P＜0.01；r=0.742,P＜0.01),GHRH与生长激素释放肽呈正相关(r=0.515,P ＜0.05),血生长激素释放肽水平与TNFα、IL-6呈正相关(r=0.621,P＜0.01；r =0.701,P＜0.01).结论 COPD患者GH水平低可能与高生长激素释放肽水平无关,血生长激素释放肽水平可反映COPD患者营养不良状态,并可能通过影响机体的营养状态而参与COPD的发病.

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