Clinical features and prognosis analysis of 36 cases with post-infarction ventricular septal rupture / 心血管康复医学杂志

Objective :To explore clinical features ,therapeutic program and prognosis of patients with post-infarction ventricular septal rupture (PI-VSR).Methods :Clinical data of 36 PI-VSR patients ,who were treated in our hospital from Dec 2009 to Dec 2016 ,were retrospectively analyzed .According to in-hospital death condition ,patients were divided into in-hospital survival group (n＝14) and in-hospital death group (n＝22).General data were compared between two groups .Multi-factor Logistic regression analysis was used to analyze influencing factors for in-hospital death in PI-VSR patients .Results :All PI-VSR patients received routine medication ,10 cases received intra-aortic balloon pump (IABP) simultaneously , eight cases received transcatheter intervention to occlude VSR and stent im- plantation ,and two cases received ventricular septal repair surgery .In-hospital mortality of PI-VSR patients was 61.1%(22/36).Compared with in-hospital survival group ,there were significant rise in age [55 (46 ,64) years vs . 67 (52 ,82) years] ,percentages of diabetes mellitus (21.4% vs.59.1%) and renal insufficiency (42.9% vs. 90. 9%) ,and significant reductions in LVEF [41 (20 , 48 )% vs.31 (20 , 38 )%] and percentage of surgery (57.1% vs.9.1%) in in-hospital death group ,P＜0.05 or ＜0.01. Multi-factor Logistic regression analysis indica-ted that LVEF and surgery were independent protective factors for in-hospital death in PI-VSR patients (OR＝0.519 ,0.001 ,P＝0.032 ,0.023).Conclusion : PI-VSR is a rare fatal complication of myocardial infarction ,and therapeutic effect of conservative treatment is poor .Transcatheter interventional occlusion is an alternative transi-tional program that might replace surgery in PI-VSR treatment .

Serum uric acid prevalence and changes post various antihypertensive agents in patients with essential hypertension / 中华心血管病杂志

<p><b>OBJECTIVE</b>To survey the prevalence of hyperuricacidemia and serum uric acid (SUA) changes and electrolyte changes after 6 weeks antihypertensive treatment with thiazide diuretics, losartan or losartan+hydrochlorothiazide (Hyzaar) in patients with essential hypertension (EH).</p><p><b>METHODS</b>A total of 1080 consecutive EH patients [662 males, mean age (60.9 +/- 12.3) years] who seeked for medical consultation in study hospitals in Fuzhou city during October 2004 and October 2006 were included in this study. The blood pressure before and after antihypertensive treatments were obtained in 1000 patients, and the renal function and electrolyte before and after antihypertensive treatments were obtained in 600 patients. Patients with SBP > 140 and/or DBP > 90 mm Hg 2 weeks after initial antihypertensive agents were cotreated with felodipine, patients with SBP > 140 and/or DBP > 90 mm Hg 4 weeks after initial antihypertensive agents were cotreated with beta and/or alpha blockers.</p><p><b>RESULTS</b>The prevalence of hyperuricacidemia in EH patients was 25.83% (279/1080). Body mass index (BMI) and creatinine were significantly higher while creatinine clearance rate (Ccr) calculated by Cockcroft-Gault equation was significantly lower in EH patients with hyperuricacidemia than EH patients without hyperuricacidemia (all P < 0.05). Similar antihypertensive effects were observed in EH patients treated with thiazide diuretics (n = 200), losartan (n = 324) or losartan + hydrochlorothiazide (Hyzaar, n = 476) and SBP was lower than 140 mm Hg in 69.40% and DBP was less than 90 mmHg in 85.30% EH patients 6 weeks after antihypertensive treatments. SUA was significantly increased (43.81 micromol/L +/- 71.79 micromol/L) low dose diuretics group (P < 0.01 vs. pretreatment), significantly reduced (44.96 micromol/L +/- 90.63 micromol/L) in losartan group (P < 0.0001 vs. pretreatment) and remained unchanged in Hyzaar group (7.46 +/- 84.72 micromol/L, P > 0.05 vs. pretreatment). Serum potassium was significantly decreased (0.30 +/- 0.44 mmol/L) in diuretic group (P < 0.01 vs. pretreatment) and remained unchanged in losartan group (+0.06 +/- 0.43 mmol/L) and Hyzaar group (-0.04 +/- 0.44 mmol/L, all P > 0.05 vs. pretreatment).</p><p><b>CONCLUSION</b>Hyperuricacidemia prevalence was 25.83% and associated with higher BMI and abnormal renal function in examined EH patients. The low dose thiazide diuretics could further aggravate hyperuricacidemia and induce hypopotassemia while losartan could reduce hyperuricacidemia in EH patients.</p>

Association of alpha-adducin and angiotensin converting enzyme gene polymorphisms with salt-sensitive hypertension and early renal injury / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the association between the alpha-adducin gene G460T, angiotensin converting enzyme (ACE) insertion/deletion (I/D) polymorphisms and salt-sensitive hypertension and early renal injury in Chinese people.</p><p><b>METHODS</b>The case-control study was performed in 200 essential hypertension (EH) and 200 normal control subjects in China. The 200 EH patients were divided into salt-sensitive(SS= 109) and non-salt-sensitive(NSS= 91) groups according to modified Sullivan's method. The genotypes of alpha-adducin gene were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The ACE genotypes were determined by PCR. The urine microalbum (Alb) in 200 EH subjects was measured by radioactive immunoassay.</p><p><b>RESULTS</b>(1) A higher frequency of alpha-adducin gene G460T TT in EH patients was observed (P< 0.05). No significant difference of the ACE gene I/D polymorphism was found between the EH patients and normal control (P> 0.05). There were significant differences in the alpha-adducin gene TT genotype and combined genotype of TT+ II between SS and NSS subjects (P< 0.05). (2) The levels of urine Alb/Cr in SS patients were significantly higher than that in NSS patients (P< 0.05); in SS group, the levels of urine Alb/Cr in ACE II and alpha-adducin gene TT genotypes were higher than that in ACE ID, DD genotype and alpha-adducin gene GT and GG genotypes. The levels of urine Alb/Cr in the group of alpha-adducin gene TT+ ACE II combined genotype were higher than that in other combined genotypes (P< 0.05).</p><p><b>CONCLUSION</b>The alpha-adducin gene TT genotype or combined with ACE II are significantly associated with SS hypertension. The alpha-adducin gene TT and ACE II genotypes might be genetic susceptibility factors to hypertension accompanying renal injury.</p>