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细胞因子TNF-α和血管内皮细胞功能标志物与多器官功能衰竭综合征的关系
目的探讨在多器官功能衰竭综合征(MODS)患者中细胞因子TNF-α和血管内皮细胞功能标志物的变化.方法动态观察MODS及非MODS患者一氧化氮(NO)、内皮素(ET-1)、组织纤溶酶原激活物(t-Pa)、纤溶酶原激活物抑制物-1(PAI-1)、循环内皮细胞(CEC)、肿瘤坏死因子(TNF-α)的浓度,同时给予Marshall评分.结果与非MODS组相比,MODS组、死亡组的TNF-α、ET-1、PAI-1、CEC、Marshall评分显著升高(P<0.05),而NO、t-Pa显著降低(P<0.05).结论TNF-α作为炎性因子在MODS的进展中起重要作用;在MODS时内皮细胞的损伤表现为ET-1、PAI-1、CEC增加,NO、t-PA减少,Marshall评分对于危重症患者的评估是敏感指标.
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胰岛素抵抗与内皮功能障碍关系的研究进展
胰岛素抵抗(insulin resistance,IR)就是机体对一定量的胰岛素产生的生物学效应低于实际应有水平,即组织的胰岛素敏感性减低.IR是2型糖尿病、肥胖、血脂障碍、高血压、动脉粥样硬化和冠心病等一系列代谢性和心血管疾病同时并存和共同联系的基础,同时这些疾病也有内皮功能障碍这一特性.
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糖尿病高游离脂肪酸血症与血管内皮细胞功能障碍
研究发现,血管内皮细胞功能障碍(vascular endothelial dysfunction,VED)是糖尿病视网膜病变(diabetic retinopathy,DR)、糖尿病肾病、动脉粥样硬化(atherosclerosis,AS)等糖尿病血管并发症发生的共同早期阶段,与糖尿病高血糖、血脂代谢紊乱、肾素-血管紧张素系统上调等多种因素有关,其中,VED与游离脂肪酸(FFA)升高关系密切,日益受到关注。本文就二者之间的关系及相关机制作一综述。
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Background Hyperhomocysteinemia (prevalent in rural northern China)is an emerging risk factor for arterial endothelial dysfunction in CAD, which can be improved with folic acid supplementation. Such homocysteine-lowerying dosage of folio acid ( < 1 mg/d ) can reduce restenosis after PTCA, but not the cardiovascular events.Folic acid has additional vascular protection in antixidation, NO synthase protection, angiogenesis-promotion and cytokines reduction.
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To evaluate the effect of statins for erectile dysfunction (ED), a systematic review of the literature was conducted in the Cochrane Library, Embase and PubMed from the inception of each database to June 2013. Only randomized controlled trials (RCTs) comparing treatment for ED with statins were identiifed. Placebo RCTs with the International Index of Erectile Function (IIEF) as the outcome measure were eligible for meta-analysis. A total of seven RCTs including two statins with a total of 586 patients strictly met our criteria for systematic review and ifve of them qualiifed for the meta-analysis. A meta-analysis using a random effects model showed that statins were associated with a signiifcant increase in IIEF-5 scores (mean difference (MD):3.27;95%conifdential interval (CI):1.51 to 5.02;P<0.01) and an overall improvement of lipid proifles including total cholesterol (MD:-1.08;95%CI:-1.68 to-0.48;P<0.01), low-density lipoprotein (LDL) cholesterol (MD:-1.43;95%CI:-2.07 to-0.79;P<0.01), high-density lipoprotein (HDL) cholesterol (MD:0.24;95%CI:0.13 to 0.35;P<0.01) and triglycerides (TGs) (MD:-0.55;95%CI:-0.61 to -0.48;P< 0.01). In summary, our study revealed positive consequences of these lipid-lowering drugs on erectile function, especially for nonresponders to phosphodiesterase type 5 inhibitors (PDE5Is). However, it has been reported that statin therapy may reduce levels of testosterone and aggravate symptoms of ED. Therefore, larger, well-designed RCTs are needed to investigate the double-edged role of statins in the treatment of ED.