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慢性心力衰竭患者中的贫血、肾功能不全及其相互作用

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世界核心医学期刊文摘（心脏病学分册） 2006年第12期2卷 25-页

作者： de Silva R. Rigby A.S. Witte K.K.A. 雷聪 Academic Cardiology University of Hull Castle Hill Hospital Cottingham United Kingdom

Anemia and renal dysfunction(RD) are frequent complications seen in chronic heart failure(HF). However, the prevalence and interaction of these co-morbidities in a representative population of outpatients with chronic HF is poorly described. In this study, it was sought to determine the association between RD and anemia in patients with HF enrolled in a community-based HF program. Nine hundred fifty-five patients with HF due to left ventricular systolic dysfunction were investigated for the prevalence of anemia and its cause and followed for a median of 531 days. Anemia was defined as hemoglobin< 12.0 g/dl in women and< 13.0 g/dl in men. RD was defined as a calculated glomerular filtration rate of< 60 ml/min. The prevalence of anemia was 32%. Fifty-three percent of patients with and 27%of those without anemia had ≥1 test suggesting hematinic deficiency. The prevalence of RD was 54%. Forty-one percent of patients with and 22%of patients without RD had anemia, with similar proportions associated with iron deficiency in the presence or absence of RD. Anemia and RD independently predicted a worse outcome, and this effect was additive. In conclusion, in outpatients with chronic HF, anemia and RD are common and co-exist but confer independent prognostic information. A deficiency of conventional hematinic factors may cause about 1/3 of anemia in this clinical setting.

关键词：慢性心力衰竭肾功能不全肾功能障碍患者

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黏多糖贮积症I型酶替代治疗后的心脏改变

世界核心医学期刊文摘（心脏病学分册） 2006年第12期2卷 24-页

作者： Braunlin E.A. Berry J.M. Whitley C.B. 雷聪 Department of Pediatrics University of Minnesota Medical School Minneapolis MN United States Dr.

Mucopolysaccharidosis type I is a lethal autosomal recessive storage disease caused by a deficiency of lysosomal α-l-iduronidase and the consequent systemic accumulation of glycosaminoglycan. Cardiomyopathy and valvar insufficiency occur as glycosaminoglycan accumulates in the myocardium, expands the spongiosa of cardiac valves, and proliferates within the myointima of the epicardial coronary arteries. Congestive heart failure and death occur within the first decade of life in the most severe cases. Allogeneic hematopoietic stem cell transplantation, used in severe forms of the disease, markedly prolongs survival, alleviates ventricular hypertrophy, and preserves cardiac function, but cardiac valves continue to thicken and valvular insufficiency progresses. Enzyme replacement therapy with human recombinant α-l-iduronidase has been proposed as an alternative therapy for patients with mucopolysaccharidosis type I in whom the risk/benefit ratio of hematopoietic stem cell transplantation seems unfavorable. The investigators report the cardiac findings in a small series of 5 children with mucopolysaccharidosis type I who received enzyme replacement therapy for as long as 7 years. No deaths occurred during treatment. Left ventricular hypertrophy,which was present before therapy, resolved in all cases, and myocardial function remained normal. In contrast, the mitral and aortic valves remained thickened and, in some instances, developed progressive thickening and regurgitation. In conclusion, long-term enzyme replacement therapy has some clear benefits for the myocardium, but the cardiac valves appear unresponsive, and the ultimate effect on the coronary vasculature is unknown.

关键词：黏多糖贮积症替代治疗长期治疗心脏

高血压对左室收缩和舒张功能的影响:一项组织多普勒超声心动图研究

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世界核心医学期刊文摘（心脏病学分册） 2006年第11期2卷 21-21页

作者： Bountioukos M. Schinkel A.F.L. Bax J.J. D. Poldermans 雷聪 Department of Cardiology Thoraxcenter Erasmus MC Rotterdam Netherlands Dr.

Background: The purpose of this study is to assess the impact of hypertension on systolic function and diastolic function using 2-dimensional echocardiography, conventional Doppler imaging of the transmitral inflow, and tissue Doppler imaging(TDI) of the mitral annulus. Methods: From an outpatient clinic population, 414 consecutive patients underwent 2-dimensional echocardiography, conventional Doppler imaging of the transmitral inflow, and TDI of the septal, lateral, inferior, and posterior walls near the mitral annulus. Parameters of systolic left ventricular(LV) function and diastolic LV function were assessed. Patients were divided according to the presence or absence of systemic hypertension(blood pressure ≥140/90mm Hg on ≥3 measurements or treatment with antihypertensive medication). Results: A complete echocardiographic evaluation was obtained in 397 patients. Among these, 269(68%) had hypertension. There was no difference with respect to age between patients with and without hypertension. Patients with hypertension had higher LV mass index and relative wall thickness and lower TDI peak systolic velocity(VS) when compared with patients without hypertension. In addition, indices of diastolic LV function were significantly impaired in hypertensive patients. Conclusions: Quantitative echocardiography using TDI reveals that hypertensive patients with preserved global LV systolic function often have combined impairment of systolic function and diastolic function.

关键词：左室收缩降压药物室间隔多普勒成像二尖瓣环收缩期峰值室壁厚度二维超声心动图二尖瓣血流

一种预测先兆子痫的联合方法:同步进行子宫灌注测量和心率、血压变异性分析

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世界核心医学期刊文摘（心脏病学分册） 2006年第9期2卷 53-53页

作者： Walther T. Wessel N. Malberg H. R. Faber 雷聪(译) 刘少伟(校) 不详 Universitatsfrauenklinik Philipp-Rosenthalstr. 55 04103 Leipzig Germany

Objective: Pre-eclampsia is a serious complication of pregnancy with high mor bidity and mortality and an incidence of 3-5%in all pregnancies. Early predict ion is still insufficient in clinical practice. Although most pre-eclamptic pat ients have pathological uterine perfusion in the second trimester, perfusion dis turbance has a positive predictive accuracy(PPA) only of approximately 30%. Met hods: Non-invasive continuous blood pressure recordings were taken simultaneous ly via a finger cuff for 30 min. Time series of systolic as well as diastolic be at-to-beat pressure values were extracted to analyse heart rate and blood pres sure variability and baroreflex sensitivity in 102 second-trimester pregnancies , to assess predictability for pre-eclampsia(n=16). All women underwent Doppler investigations of the uterine arteries. Results: We identified a combination of three variability and baroreflex parameters to best predict pre-eclampsia seve ral weeks before clinical manifestation. The discriminant function of these thre e parameters classified patients with later pre-eclampsia with a sensitivity of 87.5%, a specificity of 83.7%, and a PPA of 50.0%. Combined with Doppler inv estigations of uterine arteries, PPA increased to 71.4%. Conclusions: This tech nique of incorporating onestop clinical assessment of uterine perfusion and vari ability parameters in the second trimester produces the most effective predictio n of pre-eclampsia to date.

关键词：血压变异性先兆子痫早期预测变异性分析病理性子宫灌注障碍心率压力反射敏感性

从儿童期到青年期肥胖增加与左室质量增加之间的关系

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世界核心医学期刊文摘（心脏病学分册） 2006年第12期2卷 23-页

作者： Sivanandam S. Sinaiko A.R. Jacobs Jr. D.R. J. Steinberger 雷聪 Department of Pediatrics University of Minnesota Medical School Minneapolis MN United States Dr.

This study evaluated the influence of adiposity on the progression of left ventricular(LV) mass from childhood to adulthood and the relation of LV mass to insulin resistance in young adulthood. One hundred thirty-two healthy children recruited into a longitudinal study at a mean age of 13 years and reevaluated at 27 years, at which time insulin resistance studies were also performed, were studied. Echocardiographic assessment of LV mass was made and indexed for height2.7. Body mass index(BMI) at 13 years was highly correlated with BMI at 27 years, as was LV mass index at 13 and 27 years. The cross-sectional correlation of LV mass index and BMI at 13 years(r=0.38, p< 0.0001) had strengthened considerably by 27 years(r=0.55, p< 0.0001). A BMI increase ≥5.5 kg/m2 from 13 to 27 years was associated with a significantly greater increase in the LV mass index(p< 0.0001) than a BMI change< 5.5 kg/m2, and this relation was similar in children who were thin and heavy at baseline. In young adulthood, the relation of LV mass index to lean mass was weaker than that of LV mass index to fat mass. The association of LV mass with insulin resistance was dependent on adiposity. In conclusion, adiposity and LV mass are related in childhood, and this association tracks and becomes stronger in young adulthood. Moreover, the increase in LV mass from childhood to young adulthood is related to the degree of increase in BMI, independent of BMI at 13 years, suggesting that an excessive increase in LV mass could be limited by controlling gain in body fat during adolescence.

关键词：青年期儿童期质量指数

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使用桡动脉脉搏传输波分析预测动脉增强指数

世界核心医学期刊文摘（心脏病学分册） 2006年第9期2卷 51-51页

作者： Lau E.O.Y. Tse H.-F. C.-P.Lau 雷聪 Cardiology Division(Academic) Queen Mary HospitalBlock K102 Pokfulam RoadHong KongProf

Objective: Current arterial transfer functions have low capability in predicti ng aortic augmentation index(AIx) from radial pulse contour(RPC), because of the difficulty in accurately identifying the merging point(inflection point) in the derived aortic pulse contour(APC). We hypothesize that the formation time betwe en each characteristic wave in APC is about one-third of ejection duration(ED/3 ). We sought to assess the accuracy of ED/3 in identifying the merging point in APC as compared to the conventional differential method. In addition, we sought to derive the AIx from RPC based on an arterial transfer function and the ED/3 m ethod. Methods: APC and RPC sequences were measured digitally and simultaneously in 60 subjects(37 males; aged 60±10 years). An ensemble-averaged RPCto-APC t ransfer function was determined from 30 randomly selected subjects and was used to derive APC sequences in the 30 additional subjects. The accuracy of AIx predi cted from RPC was determined. Results: In patients with a clearly identifiable m erging point in APC, the ED/3 method identified the merging point of measured AP C within 1.97±0.60 ms of that identified by the conventional differential metho d, with identical AIx. The AIx and merging point of derived APC using the ED/3 m ethod were also within 0.22±1.01%and 1.81±1.64 ms, respectively, of those of the measured APC using the conventional differential method. The accuracy of the predicted AIx was independent of age, sex, body-mass index and presence of hyp ertension. Conclusion: In a quiet resting state, the ED/3 is an alternative meth od for identifying the merging point in APC. In conjunction with transfer-funct ion technique, AIx can be derived accurately from RPC.

关键词：脉搏波形增强指数桡动脉预测波分析传统鉴别方法 APC 受试者

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八方联谊

诗词月刊 2012年第5期 60-72页

作者：马一骏任征雷芳蔺东光王树强赵海平杜荣升张自发冯延辰聂英杰张三元赵津铭何连波王传秋马国忠箫竹宋勤台卢春杰翟利军王富友范峻海孟德林赵振生李景隆李铁夫李洪玉苏敏彭景东霍德峰周宝英赵威孙乃一陈继豪王敏健郑友顺李先本鲁纯堂马文萱罗奎彬王凡葛立存王淑芳王耀华马瑞翔耿泽荣万学庸赵树生毛荣耀梅荣其叶明德王振生叶传雄陈华敏毛彬土石一芝陈舒李开晴张立法陈正春张可芳潘碧筠雷聪琳蓝丽玲