ESC-Cardiology and Vascular Medicine 2011
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英文原版教材(国内影印版)书目教材中英文名称主编国内出版社适用专业国内出版年月定价法学类保险法Insurance 1aw★Dobbyn 法律出版社法学1999产品责任法(美国法精要系列)Products Liability★JeIly J.Phillips 法律出版社法学1999 ¥17.50公司法(美国法精要系列)Robert W.Hamilton 法律出版社法学已出版¥28.50 合同法(美国法精要系列)Contracts★Rohwer,Schaber 法律出版社法学1999 ¥23.50 家庭法(美国法精要系列)Harry D.Krause 法律出版社法学己出版¥25.00联邦证据法(美国法精要系列)Michael HGraham 法律出版社法学已出版¥25.50 侵权法(美国法精要系列)Torts★Edward J.Kionka 法律出版社法学1999 ¥21.50 宪法公民权(美国法精要系列)Norman V ieira 法律出版社法学己出版¥17.50 刑事程序法(美国法精要系列)Jerold H.Israel 法律出版社法学己出版¥24.50 证券管理法(美国法精要系列)David L.Ratner 法律出版社法学已出版¥18.00不动产(第三版)[美]贝哈安特中国人民大学法学2002.04 ¥39.00 反垄断法律与经济Antitrust lawand Economy cs,4ed★[美]E·吉尔霍恩中国人民大学法学2001.12 ¥39.00公司法(影印注释本)The Lawof Corporations,4ed★[美]R.Hamilton 中国人民大学法学、管理类2001.01 ¥45.00国际商事交易(第五版,影印注释本)[美]R.H.佛罗森中国人民大学法学2001.01 ¥36.00 生物类动物生物学Instant Notes inAnimal Biology▲英Richaed D.Jurel 科学出版社2000.04 ¥38.00发育生物学Instant Notes inDevelopmental Biology R.M.Twyman 科学出版社生物类2002.05 ¥50.00分子生物学Instant Notes inMolecular Biology 英国P.C.Turner 科学出版社医学1999.03 ¥39.00分子主物学Molecular Biology (研)Robert F.Weaver科学出版社生物类2000.08¥77.00分子生物学精要Essentials of Molecular Biology ,3rd ed. G .M.Malacinski 科学出版社 2002.07 ¥66.00哈伯生物化学Harpcr'sBiochemistry美Robert K.Murray 科学出版社2001.01 ¥118.00进化生物学Evolution,3rd ed. MonroeW.Strickberger 科学出版社 2002.04 ¥78.00 免疫学Instant Notes in Immunology▲英国R.M.Lydrard科学出版社 2000.03 ¥40.00 神经科学Instant Notes inNeuroscience英国A. Longstaff 科学出版社2000.11¥56.00生态学:概念与应用Ecology :Concepts and Application (研) M.C. Molles科学出版社 2001.07 ¥50.00 生态学Instant Notes inEcology▲英国A.Machenzie 科学出版社 1999.03 ¥43.00 生物化学Instant Notes in Biochemistry▲英国B.D.Hames科学出版社1999.03¥48.00生物化学导论Biochemistry :An Introduction (第二版)(研) Trudy McKee ,James R.McKee 科学出版社 2000.09 ¥62.00 生物技术导论BasicBiotechnology Colin Ratledge 科学出版社 2002.04 ¥55.00 生物学中的化学Instant Notes in Chemistry for biologist ▲ 英国J .FiSher科学出版社 1999.08 ¥38.00 微生物学Instant Notes inMic robiology▲英国J.Nicklin 科学出版社 1999.04 ¥45.00 无机化学Instant Notes in Inorganic Chemistry 英国P .A.Cox科学出版社 2000.10 ¥38.00 物理化学Instant Notes inPhysical ChemistryA.G .Whittaker科学出版社2001.02¥38.00遗传学--基因与基因组分析Genetics: Analysis of Genes and Genomes ,5th ed. Daniel L.Hartl Elizabeth W.Jones 科学出版社 生物类 2002.04 ¥88.00 有机化学Instant Notes in OrganicChemistry▲英国G .Patrick 科学出版社2000.09¥40.00植物生物学Instant Notes in Plant Biology ck and D. Evans 科学出版社2002.05 ¥42.00 分子生物学导论Peter Paolella清华大学出版社2002.02¥38.00酵母遗传实验方法:冷泉港实验课手册D.Burke清华大学出版社2002.01¥26.00生态学:原理与应用Ecology :Principles and Applications (第二版) J .L.Chapman 清华大学出版社 2001.09 ¥35.00 生物统计学导论Glover &Mitchell清华大学出版社 2001.10 ¥38.00 生物序列分析,蛋白质和核酸的概率论模型 R.Durbin清华大学出版社2002.01¥38.00营养学:概念与争论(第八版) Frances sizer Eleanor Whitney 清华大学出版 2001.11 ¥68.00 真核生物转录调控概念、策略和方法 Michael Carey 清华大学出版社 2002.01 ¥68.00医学类埃伦堡-里弗金斯糖尿病学(5版研)美Daniel Porte科学出版社 医学 2000.09 ¥230.00艾弗里新生儿病学第7版(研) 美H.W.Taeusch 科学出版社医学 2001.03 ¥269.00安德鲁斯皮肤病学An drews’ Diseases of the Skin (第9版)(研) 美国加州大学Richard B.Odom 科学出版社 医学 2001.01 ¥228.00 病毒性肝炎Virus Hepatitis ,2E (研) Arie J.Zuckerman 科学出版社 医学 2001.01 ¥131.00 病理学Pathology 英Jones ,B.J.科学出版社医学 2001.12 ¥49.00 病史与查体History andExamination英James March 科学出版社 医学 2001.10 ¥39.00 代谢与营养Metabolism and Nutrition英Sarah Benyon科学出版社 医学 2001.11¥39.00戴维森内科学Davidson'sPrinciples and Practice of Medicine(18ed)(研) 英国爱丁堡大学 Christopher Haslett 科学出版社 医学 2002.03 ¥186.00 儿科学Paediatrics英Christine Budd科学出版社医学 2002.04¥42.00骨科与创伤学基础Essential Orthopaedics and Trauma (第3版)英Dandy D.J 科学出版社 医学 2001.11 ¥86.00 呼吸系统Respiratory System英Angus Jefferies科学出版社 医学 2001.10 ¥39.00 肌肉骨骼系统MusculoskeletalSystem英Sona V . Biswas 科学出版社医学 2001.01¥29.00脊柱外科手术学Operative Spine Surgery (研)美国匹兹堡大学William C.Welch科学出版社 医学 2000.06 ¥59.00解剖学Anatomy艾米罗利飞利浦 科学出版社 医学 2000.06 ¥29.00临床肿瘤学(第二版,上下册)Clinical Oncology (研) 阿贝洛夫【美] 科学出版社 医学 1999.09 ¥548.00 麻醉学(第3版)Anesthesia 英Ailkenhead 科学出版社 医学 2001.02 ¥98.00 免疫、血液及淋巴系统 英Saimah Arif 科学出版社 医学 1999.03 ¥29.00 内分泌及生殖系统 Madeleine Debuse 科学出版社 医学 2001.01 ¥39.00 内科学Internal Medicine 英 霍夫曼 科学出版社 医学 2001.10 ¥49.90 神经病学Neurology Bahra科学出版社 医学 2001.12¥34.00神经介入放射学(研) 美J .J .Onnors 科学出版社医学 2001.08 ¥199.00 神经系统及特殊感觉 英DanielLasserSon科学出版社医学 2002.02 ¥39.00 神经系统急症(研)美Julio Cruz科学出版社医学 2001.12¥98.00肾及泌尿系统Renal and Urinary Systems英Nisha Mirpuri ,Pratiksha Patel科学出版社 医学 2001.03¥29.00肾脏病学第6版(上下册)(研) Barry M.Brenner 科学出版社 医学 2001.01 ¥480.00 生理医学Physiological Medicine 美V .R.Lingappa 科学出版社医学 2001.11 ¥165.00 生殖内分泌学(第4版)美Samuel S .C.Y en 科学出版社医学 2001.12 ¥166.00生殖内分泌学Reproductive Endocrinology (第四版) 美国加州大学Samuel.S .C.Y en 科学出版社 医学 2000.08 ¥166.00实用血管外科学Practical V ascular Surgery美芝加哥西北大学James S.T.Y ao科学出版社医学 2000.09 ¥95.00史密斯普通泌尿外科学Smith's General Urology (第15版) 美国加州大学Enil A.Tanagho 科学出版社 医学 2001.03 ¥138.00 疼痛学Textbook of Pain (4版,研) 英Patrick DWall 科学出版社医学 2001.04 ¥250.00透析与移植Dialysis and Transplantation(研)美willamF .Owen,MohamedH.Sayegh科学出版社医学 2001.01¥98.00外科学Surgery英Helen SweetlandJames Cook科学出版社医学 2002.04¥39.00威廉姆斯产科学(第21版)Williams Obstetrics (研) 美Cunningham.F.G 科学出版社医学 2002.04 ¥299.00威廉姆斯内分泌学第9版(研) Jean D.Wilson 科学出版社 医学 2001.01 ¥298.00胃肠病学上、下册Gastrointestinal and Liver Disease (研〕 施莱辛格-福德特兰 科学出版社 医学 2001.01 ¥448.00 胃肠病学Gastroenterology英EmmaLam科学出版社 医学 2001.10 ¥39.00 胃肠系统Gastrointestinal System 英Cheshire.E科学出版社医学 2001.11¥28.00系统病理学General and Systematic Pathology(第25版) 英国Sheffield 大学 J.C.E.Underwood 科学出版社 医学 2002.03 ¥120.00细胞生物学与遗传学Cell Biology and Genetics英Emma Jones,Anna Morris科学出版社 医学 2002.04 ¥29.00 心血管系统Cardiovascular System Sunthareswaran 科学出版社 医学 2001.11 ¥29.00 心脏病学Cardiology英Anjana Siva科学出版社医学 2001.10¥35.00胸外科学第6版(上下册)DavidC.SabinstonFrank C.Spencer科学出版社 医学 2001.01 ¥398.00 血液病学第三版Hematology (研) 美Ronald Hoffman 科学出版社 医学 2001.01 ¥488.00 亚当斯一维克托神经病学第七版(研)美Maurice Victor科学出版社医学 2000.06 ¥279.00 医学分子生物学Molecular Biology in Medicine 英国剑桥大学T.M.Cox 科学出版社 医学 2000.06 ¥55.00 医学微生物学Medical Microbiology (第15版) 英国诺丁汉大学D.Greenwood 科学出版社 医学 1999.09¥88.00医学微主物学与免疫学Medical Microbiology and Immunology ,5E 加利福利亚大学Warren Levinson 科学出版社 医学 2001.02 ¥60.00 遗传学Instant Notes in Genetics▲ 英国P .C.Winter 科学出版社医学 1999.03¥45.00重症监护学Textbook of Critical Care (第4版)(研)美国南加州大学W.C.Shoemaker 科学出版社 2001.01 ¥398.00癌症医学 AmericanCancerSociety 人民卫生出版社 医学 2001.10 ¥450.00分子神经药理学 E.S.Nerstl 人民卫生出版社 医学 2001.12 ¥126.00 归产科学--原理与实践Fremk.W.Ling人民卫生出版社 医学 2001.08 ¥360.00骨科基础科学骨关节肌肉系统生物学和生物力学Joseph A Buckwalter 人民卫生出版社医学2002.02 ¥108.00化学,有机化学,生物化学Benuiston 人民卫生出版社医学2001.12 ¥298.00 基础与临床内分泌学Greenspan 人民卫生出版社医学2001.03 ¥116.00 基础与临床药理学Bertram&Katzang 人民卫生出版社医学2001.01 ¥157.00 精神病学概要W.F.Ganong 人民卫生出版社医学2001.11 ¥79.00 临床清理生理学S.J.Mcphe 人民卫生出版社医学2001.12 ¥88.00 临床神经病学Roger.P 人民卫生出版社医学2000.08 ¥77.00 人类生物学S.S.Mader 人民卫生出版社医学2001.12 ¥299.00 神经解剖学纲要S.G.Waxman 人民卫生出版社医学2001.11 ¥55.00 现代儿科疾病诊断与治疗William W.Hay 人民卫生出版社医学2001.01 ¥162.00 现代感染疾病诊断与治疗W.R.Wilson 人民卫生出版社医学2001.11 ¥128.00 心血管疾病分子生物学Kenneth R.Chier 人民卫生出版社医学2002.04 ¥180.00 眼科学总论 D.V aughan 人民卫生出版社医学2001.12 ¥102.00 医学流行病学R.S.Greenberg 人民卫生出版社医学2002.01 ¥35.50 医学微生物学G.F.Ganorg 人民卫生出版社医学2001.11 ¥92.00医用生理学概要W.F.Ganorg 人民卫生出版社医学2001.11 ¥113.00 电气信息类射频电路设计(第3版)(美)Joscph J.Carr 电子工业出版社通信2002.03 ¥38.00 数字调制与编码图书策划开发部电子工业出版社通信2001.07 ¥39.00 数字通信(第4版)[美]John G.Proakis 电子工业出版社通信2002.04 ¥59.00无线通信原理与应用▲Theodore S.Raooap 电子工业出版社通信2001.06 ¥35.00 电子商务一管理视角ElectronicCommerce:A ManagerialPerspective Efraim Turban 高等教育出版社经济、管理2001.05 ¥33.00管理信息系统--网络化企业的组织与技术(6版,研〕Management Information System :Organization and Technology in the Networked Enterpriseudon高等教育出版社2001.05 ¥39.00 计算机科学引论(附光盘〕(美)T.J.O'ary 高等教育出版社2000.07¥32.00计算机算法--设计与分析导论Computer Algorithms: Introduction to Design and Analysis,3ESara B aase高等教育出版社2001.07¥39.50计算机网络一自顶向下方法与Internet 特色ComputerNetworking: A Top-down Approach Featuring the Internet JamesF .Kurose 高等教育出版社2001.07¥37.00计算机组织与结构一性能设计(5版)Computer Organization and Architecture: Designing for Performancewllliam Stallings高等教育出版社 计算机2001.07¥39.00离散数学结构(第4版)Discrete Mathematical StructuresBernad Kolman高等教育出版社2001.07¥29.50软件工程一理论与实践(第二版)Software Engineering: Theory and Practice Shari LawrencePfleeger 高等教育出版社2001.07 ¥35.00 实用操作系统概念AppliedOperating System Concepts Abrahan Silberschatz 高等教育出版社 2001.05¥45.00数据结构与程序设计一C++语言描述Date Structures and ProgramDesign in C++ RobetL.Kruse 高等教育出版社2001.05 ¥29.00数据库一原理、编程与性能Database:Principles,Programming and Performance2E Patrick O'Neil 高等教育出版社2001.05 ¥49.50数据挖掘·概念和技术DataMining :Concepts and TechniquesJiawei Han高等教育出版社 2001.05 ¥35.00数据与计算机通信(第六版〕Data and Computer Communications William Stallings 高等教育出版社 2001.05 ¥46.00 数值分析(第7版)NumericalAnalysisRichard L.Burden高等教育出版社2001.07¥48.00数字设计一原理与实践(第三版〕Digital Design: Principles and Practices John F .Hutchinson 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1999.07 ¥23.00 C 程序设计语言习题解答(第二版)Clovis L. Tondo清华大学出版社 2001.12 ¥12.00 C 的应用:入门和提高Applied C: An Introduction and MoreAlice E. Fischer清华大学出版社2001.06¥79.80IBM PC 汇编语言与程序设计IBM PC Assembly Language and Programming,4EPeter Abel清华大学出版社1999.08¥30.00Inter 微机处理器—从8086到Pentium 系列体系结构、编程与接口技术The Intel Microprocessors, 5EBarry B. Brey清华大学出版社2001.7¥49.00IP 与A TM 网络中的QoS 和业务量管理QoS& Traffic Management in IP & A TM NetworksDavid McDysan清华大学出版社 2001.12 ¥46.00 Jave 面向对象程序设计(第2版) C.Thomas Wu 清华大学出版社2001.10¥72.00TCP/IP 网络互联技术(3)客户服务器编程应用BSD 套接字版Client-Server Programming and Applications(第2版) Douglas er 清华大学出版社 2000.04 ¥32.00TCP/IP 网络互联技术(3)客户服务器编程应用Windows 套接字版Client-Server Programming and Applications,3E Douglas er 清华大学出版社 1999.11 ¥30.00TCP/IP 网络互联技术(1)原理,协议和体系结构Principles, Protocols and Architecture, 3EDouglas er清华大学出版社 2002.02 ¥30.00TCP/IP 网络互联技术(2)设计与实现Design, Implementation andInternals Douglas er 清华大学出版社 2002.02 ¥30.00 TCP/IP 协议族TCP/IP ProtocolSuite Behrouz A. 清华大学出版社2000.12 ¥69.00 UNIX 网络编程(卷一)(第二版)UNIX Network ProgrammingW. Richard Stevens 清华大学出版社1999.10 ¥43.00 XDSL 体系结构XDSL Architecture Padmanand Warrier 清华大学出版社 2000.12¥48.00操作系统:设计及实现(第2版,配光盘)Operating Systems Design and ImplementationAndrew S.Tanenbaum清华大学出版社1998.07 ¥69.00操作系统:设计及实现(第2版,配光盘)Operating Systems Design and ImplementationWillam Stallings清华大学出版社 1998.05 ¥35.00程序设计语言设计与实现Programming Language Design and Implementation, 3E Terrence W .Pratt 清华大学出版社1998.08 ¥32.00电磁学及其应用(第5版)Programming Language Design and Implementation, 3EJohn D.Kraus,Daniel A. Fleisch清华大学出版社 2001.08 ¥58.00 电力电子系统——理论与设计 Jai P . Agrawal 清华大学出版社 2001.09 ¥55.00 电路基础(配光盘)C. K. Alexander清华大学出版社2001.01¥88.00电子电路分析与设计(配光盘) Donald A. Neamen 清华大学出版社 2001.3 ¥99.80动态系统的数字控制Digital Control of Dynamic Systems (第3版) Gene F. Franklin 清华大学出版社 2001.09 ¥59.00 多媒体技术:计算、通信和应用 Ralf Steinmetz 清华大学出版社 2000.12 ¥52.00 仿真建模与分析第3版(美)Law, A.M.清华大学出版社 2000.12 ¥65.00 分布式操作系统Distributed Operating Systems Andrew S.Tanenbaum 清华大学出版社1998.10 ¥30.00 管理动态 IP 网络 Managing Dynamic IP NetworksPaul T.Ammann清华大学出版社 2000.12 ¥46.00 计算机控制系统——理论与设计(3版) Karl J.Astrom 清华大学出版社 2001.12 ¥49.00 计算机图形学C 语言版(第2版)Computer GraphicsDorald Hearn清华大学出版社 1998.05 ¥68.00 计算机网络Computer Networks 3E ▲A.S. Tanenbaum清华大学出版社2000.08 ¥45.00 计算机网络与因特网(第3版) Douglas er 清华大学出版社 2002.03 ¥62.00 计算机系统体系结构Computer System Architecture, 3th Ed. M. Morris Mano 清华大学出版社 1998.06 ¥28.00 计算机组成与结构(第3版)John P .Hayes 清华大学出版社2001.10¥49.00计算机组织与结构:性能设计(第4版)Computer Organization and Architecture: DesigningforPerformanceWillam Stallings清华大学出版社1999.08¥43.00计算理论基础(第2版)Elements of the theory of computation Harry R. Lewis清华大学出版社 1999.10 ¥19.00 交换式局域网Switched LANs John J. Roese清华大学出版社2000.02¥40.00科学计算导论ScientificComputing: An Introductory Survey, 2E(数学类) Micharel T. Heath 清华大学出版社 2001.10 ¥55.00 控制系统设计Control System DesignGraham C. Goodwin 清华大学出版社 2001.12¥68.00宽带网络技术基础A TM:Foundation forBroadbandNetworksUyless Black清华大学出版社 1998 ¥22.00 宽带网络信令A TM: Signaling in Broadband NetworksUyless Black清华大学出版社 1998 ¥12.00 宽带网络性能分析Broadband Integrated Networks Mischa Schwartz清华大学出版社1998¥19.80离散数学结构(第3版)DiscreteMathematical Structures Bernard Kolman 清华大学出版社1999.12 ¥32.00 面向对象软件构造(第2版)Object-Oriented SoftwareConstruction Bernard Meyer 清华大学出版社1999.10 ¥96.00 面向对象系统分析与设计Object-Oriented Systems Analysisand Design R.J. Norman 清华大学出版社1999.10 ¥23.00 模糊控制Fuzzy Control Kevin M. Passino 清华大学出版社2001.11 ¥47.50 千兆以太网Gigabit EthernetNetworking David G. William 清华大学出版社2000.01 ¥49.00 软件体系结构SoftwareArchitecture Mary Shaw 清华大学出版社1999.10 ¥15.00 神经网络的综合基础(第2版)Simon Haykin 清华大学出版社2001.10 ¥78.00 实时系统Real-time Systems C. M. 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Solomon清华大学出版社2001.05 ¥36.00 因特网与万维网基本原理与技术 Raymond Greenlaw 清华大学出版社2000.11¥49.00用于面向对象系统开发的使用实例图UseCaseMapsforObject-Oriented SystemR.J.A.Buhr清华大学出版社 1999.08 ¥20.00 语音识别基本原理Fundamentalsof Speech Recognition Lawrence Rabiner 清华大学出版社1999.10¥41.00TCP/IP 网络互连(1):原理协议和体系结构Internetworking with TCP/IP , V ol.1 Douglas E. Comer,David L. Stevens 人民邮电出版社 2002.01 ¥70.00TCP/IP 网络互连(1):原理协议和体系结构Internetworking with TCP/IP , V ol.3 Douglas E. Comer,David L. Stevens 人民邮电出版社 2002.01 ¥57.00 编译原理技术与工具Compilers: Principles, Techniques, and Tools Alfred V . Aho Ravi 人民邮电出版社2002.02¥63.00多媒体技术:计算、通信和应用Multimedia: Computing,Communications, and Applications Ralf Steinmetz 人民邮电出版社2002.01 ¥68.00计算机科学概论(第六版)Computer Science: An Overview,6th Ed. J. Glenn Brookshear 人民邮电出版社 2002.01 ¥49.00计算机系统组成与体系结构Computer Systems Organization & ArchitectureJohn D. Carpinelli人民邮电出版社 2002.01 ¥48.00人工智能:一种现代方法Artificial Intelligence: A Modern ApproachStuart J. Russell人民邮电出版社2002.04¥75.00数据结构的C++伪码实现DataStructures: A Pseudocode ApproachWith C++ Richard F. Gillberg 人民邮电出版社2002.01 ¥55.00 图像处理、分析与机器视觉ImageProcessing: Analysis and MachineVision, 2E Milan Sonka V aclav 人民邮电出版社2002.01 ¥67.00 经济管理类经济学Economics★Paul A. samuelson 北京华章图文信息有限公司经济学、工商管理类1998经济学原理Principles ofEconomics★N. Gregory Mankiw 北京华章图文信息有限公司经济学、工商管理类1998发展经济学DevelopmentEconomics★Pari Kasliwal 东北财大出版社经济学类1998.05 ¥38.00宏观经济学Macroeconomics, 8ed★Rudiger Dornbush 东北财大出版社经济学类2001 ¥56.00微观经济学Microeconomics, 3ed★Michael L. 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Ann.N.Y.Acad.Sci.ISSN0077-8923 ANNALS OF THE NEW YORK ACADEMY OF SCIENCESIssue:The Year in Diabetes and ObesityCardiovascular disease and glycemic control in type2 diabetes:now that the dust is settling from largeclinical trialsFrancesco Giorgino,Anna Leonardini,and Luigi LaviolaDepartment of Emergency and Organ Transplantation,Section of Internal Medicine,Endocrinology,Andrology and Metabolic Diseases,University of Bari Aldo Moro,Bari,ItalyAddress for correspondence:Francesco Giorgino,M.D.,Ph.D.,Department of Emergency and Organ Transplantation, Section of Internal Medicine,Endocrinology,Andrology and Metabolic Diseases,University of Bari Aldo Moro,Piazza Giulio Cesare,11,I-70124Bari,Italy.francesco.giorgino@uniba.itThe relationship between glucose control and cardiovascular outcomes in type2diabetes has been a matter of controversy over the years.Although epidemiological evidence exists in favor of an adverse role of poor glucose control on cardiovascular events,intervention trials have been less conclusive.The Action to Control Cardiovascular Risk in Diabetes(ACCORD)study,the Action in Diabetes and Vascular Disease(ADV ANCE)study,and the Veterans Affairs Diabetes Trial(V ADT)have shown no beneficial effect of intensive glucose control on primary cardiovascular endpoints in type2diabetes.However,subgroup analysis has provided evidence suggesting that the potential beneficial effect largely depends on patients’characteristics,including age,diabetes duration,previous glucose control,presence of cardiovascular disease,and risk of hypoglycemia.The benefit of strict glucose control on cardiovascular outcomes and mortality may be indeed hampered by the extent and frequency of hypoglycemic events and could be enhanced if glucose-lowering medications,capable of exerting favorable effects on the cardiovascular system,were used.This review examines the relationship between intensive glucose control and cardiovascular outcomes in type2diabetes,addressing the need for individualization of glucose targets and careful consideration of the benefit/risk profile of antidiabetes medications.Keywords:type2diabetes;HbA1c;macrovascular disease;blood pressure;lipids;hypoglycemia;glucagon-like peptide-1;ADV ANCE;ACCORD;V ADTIntroductionCardiovascular disease(CVD)is the major cause of death in patients with type2diabetes(T2D), as more than60%of T2D patients die of my-ocardial infarction(MI)or stroke,and an even greater proportion of patients have serious burden-some complications.1The impact of glucose low-ering on cardiovascular complications is a hotly debated issue.The United Kingdom Prospective Di-abetes Study(UKPDS)was thefirst clinical trial to provide key evidence of the importance of using in-tensive therapy for diabetes control in individuals with newly diagnosed T2D.However,although the insulin or sulphonylurea-based intensified glucose-control treatment was effective in reducing the risk of major microvascular endpoints,the effects on CVD risk were modest and did not reach statisti-cal significance.2Recent large clinical trials(often referred to as“megatrials”),the Action in Diabetes and Vascular Disease(ADV ANCE),3Action to Con-trol Cardiovascular Risk in Diabetes(ACCORD),4 and the Veterans Affairs Diabetes Trial(V ADT),5 reported no significant decrease in primary cardio-vascular endpoints with intensive glucose control. In the ADV ANCE study,11,140type2diabet-ics were randomly assigned to receive either stan-dard or intensive glucose control,defined as the use of gliclazide plus any other drug required to achieve a glycosylated hemoglobin(HbA1c)level of 6.5%or less(Table1).3After a median follow-up of 5.0years,the mean HbA1c was lower in thedoi:10.1111/nyas.12044Giorgino et al.Intensive glucose control and cardiovascular risk Table1.Age,diabetes duration,median follow-up,HbA1c values,and outcomes in the ACCORD and ADV ANCE studies and the V ADTDiabetes HbA1c(%):duration(year):Median intensive Primary All-cause Age intensive follow-up History versus endpoint HR mortality HR Study(year)versus standard(year)of CVD standard Primary endpoint(95%CI)(95%CI)ACCORD(n=10,251)62.2±6.810vs.10 3.435% 6.4vs.7.5Nonfatal MI,nonfatalstroke,or death fromCVD0.90(0.78–1.04) 1.22(1.01–1.46)ADV ANCE (n=11,140)66±6.08.0±6.4vs.7.9±6.35.032%6.53±0.91vs.7.30±1.26Death fromcardiovascular causes,nonfatal MI,ornonfatal stroke0.94(0.84–1.06)0.93(0.83–1.06)V ADT(n=1,791)60±9.011.5±8vs.11.5±75.640%6.9vs.8.4MI,stroke,death fromCVD,CHF,surgery forvascular disease,inoperable CAD,oramputation forischemic gangrene0.88(0.74–1.05) 1.07(0.81–1.42)intensive control group(6.5%vs.7.3%),with a reduction in the incidence of combined major macrovascular and microvascular events primarily because of a reduction in the incidence of nephropa-thy.There were no significant effects of the inten-sive glucose control on major macrovascular events, death from cardiovascular causes,or death from any cause.Similarly,in the V ADT,1,791suboptimally controlled type2diabetics,40%with established CVD,were randomized to receive either intensive glucose control,targeting an absolute reduction of 1.5%in HbA1c levels,or standard glucose control (Table1).5After a median follow-up of5.6years, HbA1c was lower in the intensive-therapy group (6.9%vs.8.4%).Nevertheless,there was no sig-nificant difference between the two groups in the incidence of major cardiovascular events,or in the rate of death from any cause.ACCORD was another study designed to determine whether intensive glu-cose control would reduce the rate of cardiovas-cular events(Table1).4In this study,10,251type 2diabetics with median baseline HbA1c of8.1% were randomly assigned to receive either intensive therapy targeting an HbA1c level within the normal range,that is,below6.0%,or standard therapy tar-geting HbA1c between7.0%and7.9%.The primary outcome was a composite of nonfatal MI,nonfatal stroke,or death from cardiovascular causes.Even though the rate of nonfatal MI was significantly lower in the intensive therapy arm,thefinding of higher all-cause and cardiovascular cause mortal-ity in this group led to discontinuation of the in-tensive therapy after a mean follow-up of3.5years (Fig.1).Notably,hypoglycemia requiring assistance and weight gain of more than10kg were more fre-quent in the intensive therapy group.The results of the ACCORD study raised concern about not only the effectiveness but also the safety of inten-sive glycemic control in type2diabetics.Prespec-ified subgroup analysis of the participants in this trial suggested that patients in the intensive group without history of cardiovascular event before ran-domization or whose baseline HbA1c level was8.0% or less may have had fewer fatal or nonfatal car-diovascular events than did patients in the standard therapy group.Several recent meta-analyses of randomized con-trolled trials have also investigated the effects of intensive glucose lowering on all-cause mortal-ity,cardiovascular death,and vascular events in T2D.6–10In the largest and most recent meta-analysis by Boussageon et al.,13studies were in-cluded.6Of the34,533patients evaluated,18,315 received intensive glucose-lowering treatment and 16,218standard treatment.Intensive treatment did not significantly affect all-cause mortality or cardiovascular death.The results of this meta-analysis showed limited benefit of intensive glucose-lowering therapy on all-cause mortality and deaths from cardiovascular causes,and a10%reduction in the risk of microalbuminuria.6Results from other meta-analyses have also shown no effects ofIntensive glucose control and cardiovascular risk Giorgino etal.Figure 1.Effects of intensive glucose control on all-cause and cardiovascular mortality and myocardial infarction in the ACCORD study.CV,cardiovascular.∗P<0.05.Adapted from Ref.4.intensive glucose control on all-cause or cardiovas-cular mortality,while indicating a modest15–17% reduction in the incidence of nonfatal MI in these cohorts.7–10Several potential factors could have contributed to limit the potential benefit of intensive glucose-lowering therapies on CVD prevention in T2D in-dividuals in studies such as the ACCORD and AD-V ANCE and the V ADT:(1)Concomitant targeting of other potentiallymore potent cardiovascular risk factors,suchas blood pressure and lipids,might havedampened the favorable effects of controllinghyperglycemia.(2)Intensive control of hyperglycemia could havebeen directed to patients unable to exhibit theexpected benefit due to their specific clinicalcharacteristics(“wrong”patients).(3)Limited benefit might have derived from usingglucose-lowering drugs with no favorable im-pact on the global cardiovascular risk profile.(4)Glucose-lowering drugs might have producedadverse effects on the cardiovascular systemby inducing weight gain and hypoglycemicevents,resulting in somewhat increased riskfor CVD and mortality(“imperfect”drugs).(5)Excess mortality might have potentially re-sulted from using too many drugs and/or toocomplex drug regimens,leading to undesir-able drug–drug interactions with a potentiallyharmful impact on patients’health.These diverse factors and their potential role in the relationship between intensive glucose control and CVD/mortality are outlined in Figure2,and will be discussed individually below.Limited benefit due to other therapies Although several studies have focused on intensive glycemic control to decrease the risks of macrovas-cular and microvascular diseases in T2D,glucose control is only one of the factors to be considered. Comprehensive risk factor management,including blood pressure control,lipid management,weight reduction in overweight or obese individuals,and smoking cessation,are also needed.The results of the ACCORD and ADV ANCE studies and the V ADT should be interpreted in the context of comprehen-sive care of patients with diabetes.Interventions for simultaneous optimal control of comorbidities of-ten present in type2diabetics,such as hyperten-sion and hyperlipidemia,have been shown to be a more effective strategy in reducing cardiovascular risk than targeting only blood glucose levels per se.11 Evidence for an aggressive approach to lipid and blood pressure control was supported by the re-sults from the Steno-2study.11,12In Steno-2,inves-tigators used intensified multifactorial intervention with improved glycemia,renin–angiotensin system blockers,aspirin,and lipid-lowering agents and evaluated whether this approach would have an ef-fect on the rates of death from cardiovascular causes and from any cause.11,12The primary endpoint at 13.3years of follow-up was the time to death from any cause.Intensive therapy was also associated with a significantly lower risk of death from cardiovascu-lar causes and of cardiovascular events.The Steno-2study did demonstrate a difference in levels of glycemia achieved when compared with the AC-CORD study:4,11HbA1c was a mean of8.4%at study entry and7.9%at end of study intervention for the intensively treated group,whereas it was8.8%at baseline and9.0%at study end for conventional treatment.In addition,only a limited proportion of subjects in the intensively treated group reached an HbA1c level of less than6.5%(i.e.,∼15%),and this proportion was not statistically different than in the conventionally treated group,indicating poor success in achieving the prespecified glucose target and somewhat reducing the relevance of the spe-cific intervention on the hyperglycemia component for CVD and microvascular disease prevention.The observational study has continued,and the differ-ences observed in glycemia between intensive andGiorgino et al.Intensive glucose control and cardiovascularriskFigure2.Relationship between intensive glucose control and cardiovascular outcomes and mortality in the ACCORD study and other megatrials.The potential mechanisms affecting this relationship and limiting the clinical benefit are outlined in the box on the left.CV,cardiovascular;CVD,cardiovascular disease.conventional treatments are much less than at endof intervention.Nevertheless,over the long-termperiod of follow-up,intensive intervention with avaried drug regimen and lifestyle modification hadsustained beneficial effects with respect to vascularcomplications and rates of death from any cause andfrom cardiovascular causes.12Blood pressureThe ACCORD study also had an embedded bloodpressure trial that examined whether blood pressurelowering to systolic blood pressure(SBP)less than120mm Hg provided greater cardiovascular protec-tion than a SBP of130–140mm Hg in T2D patientsat high risk for CVD.13A total of4,733participantswere randomly assigned to intensive therapy(SBP <120mm Hg)or standard therapy(SBP<140mm Hg),with the mean follow-up being4.7years.Theblood pressure levels achieved in the intensive andstandard groups were119/64mm Hg and133/70mm Hg,respectively;this difference was attainedwith an average of3.4medications per participantin the intensive group and2.1in the standard ther-apy group.The intensive antihypertensive therapyin the ACCORD blood pressure trial did not consid-erably reduce the primary cardiovascular outcomeor the rate of death from any cause.However,theintensive arm of blood pressure control reduced therate of total stroke and nonfatal stroke,with the estimated number needed to treat with intensive blood pressure therapy to prevent one stroke over five years being89.There were indicators of possi-ble harm associated with intensive blood pressure lowering(SBP<120mm Hg),including a rate of serious adverse events in the intensive arm.It should be noted that of the subjects investigated in the ACCORD glucose control trial∼85%were on antihypertensive medications,and their blood pres-sure levels were126.4/66.9and127.4/67.7in the intensive and standard groups,respectively,a differ-ence that was statistically significant(P<0.001) (Table2).4Thus,the effects of intensive glucose lowering on the CVD and other outcomes were ex-amined in a context in which blood pressure was being actively targeted,with possible differences between the intensively and conventionally treated cohorts.The ADV ANCE study also included a blood pres-sure intervention trial.In this study,treatment with an angiotensin converting enzyme(ACE)inhibitor and a thiazide-type diuretic reduced the rate of death but not the composite macrovascular out-come.However,this trial had no specified targets for the randomized comparison,and the mean SBP in the intensive group(135mm Hg)was not as low as the mean SBP in the ACCORD standard-therapy group.14However,a post hoc analysis of blood pres-sure control in6,400patients with diabetes andIntensive glucose control and cardiovascular risk Giorgino et al. Table2.Blood pressure and lipid levels and use of statin,antihypertensive medications,and aspirin in the ACCORD and ADV ANCE studies and the V ADT participants at study end(adapted from Refs.3–5)ACCORD(n=10,251)aADV ANCE(n=11,140)b V ADT(n=1,791)cStandard Intensive Standard Intensive Standard Intensive Blood pressure(mm Hg)Systolic128±16126±17137±18135±17125±15127±16 Diastolic68±1067±1074±1073±1069±1068±10 Cholesterol(mg/dL)LDL87±3387±33103±41102±3880±3180±33 HDL49±13(♂)49±13(♂)48±1448±1441±1240±1140±11(♀)40±10(♀)Total164±42163±42153±40150±40 Triglycerides(mg/dL)166±114160±125161±102151±94159±104151±173 On statin(%)888848468385 On antihypertensivemedications(%)858389887576 On aspirin(%)767655578586a Intensive(target HbA1c<6%)vs.standard(HbA1c7–7.9%).b Intensive(target HbA1c<6.5%)vs.standard(HbA1c>6.5%).c Intensive(target HbA1c4.8–6.0%)vs.standard(HbA1c8–9.0%).Abbreviations:HDL,high-density lipoprotein;LDL,low-density lipoprotein;♂,men;♀,women.coronary artery disease enrolled in the International Verapamil/Trandolapril Study(INVEST)demon-strated that tight control(<130mm Hg)was not associated with improved cardiovascular outcomes compared with usual care(130–140mm Hg).15In the V ADT,blood pressure,lipids,diet,and lifestyle were treated identically in both arms.By improving blood pressure control in an identical manner in both glucose arms,the V ADT excluded the effect of blood pressure differences on cardiovas-cular events between treatment arms and reduced the overall risk of macrovascular complications dur-ing the trial.5Participants in the V ADT(n=1,791) with hypertension(72.1%of total)received stepped treatment to maintain blood pressure below the tar-get of130/80mm Hg in standard and intensive glycemic treatment groups.Blood pressure levels of all subjects at baseline and on-study were analyzed to detect associations with cardiovascular risk.The primary outcome was the time from randomiza-tion to thefirst occurrence of MI,stroke,conges-tive heart failure,surgery for vascular disease,in-operable coronary disease,amputation for ischemic gangrene,or cardiovascular death.From data analy-sis,increased risk of cardiovascular events with SBP ≥140mm Hg emphasizes the need for treatment of systolic hypertension.Also,this study for the first time demonstrated that diastolic blood pressure (DBP)<70mm Hg in T2D patients was indepen-dently associated with elevated cardiovascular risk, even when SBP was on target.16Lipid profileIt has been widely demonstrated that intensive targeting of low-density lipoprotein(LDL)choles-terol contributes to CVD prevention in T2D.As a consequence,most guidelines suggest a target LDL-cholesterol level below100mg/dL as the primary goal in T2D individuals,with the option of achieving an LDL-cholesterol level below70mg/dL in those with overt CVD.Regarding the overall lipid-lowering approach in the ACCORD glucose control study,it should be observed that mean LDL cholesterol was below90mg/dL in both the intensive and standard glucose control arms,and that88%of subjects were on statin therapy.4Thus, the results from this study do not clarify whether lipid control and glycemic control,respectively,areGiorgino et al.Intensive glucose control and cardiovascularriskFigure3.All-cause mortality in intensive versus standard glycemia groups according to use of antihypertensive medications, statins,and aspirin in the ACCORD and ADV ANCE studies.∗P=0.0305for subjects on aspirin versus subjects not on aspirin. Adapted from Refs.3and18.related or synergistic,since the large majority of enrolled subjects were already receiving a lipid control regimen.Data from the Steno-2trial on combined control of glucose,lipids,and blood pressure levels demonstrated significant short-and long-term benefits from this multifactorial approach.11In the study,the effect seemed to be cumulative rather than synergistic.Recent results from the ACCORD-LIPID study indicate that intensive lipid control(i.e.,addition of afibrate to statin therapy)does not reduce car-diovascular events.17Specifically,the lipid-lowering arm of ACCORD failed to demonstrate any ben-efit of add-on therapy with fenofibrate to LDL-lowering treatment with HMG-CoA reductase in-hibitors(statins)on vascular outcomes in patients with diabetes.However,data from earlier studies and from a subgroup analysis of ACCORD indi-cate a probable benefit of adding treatment with fibric acid derivatives to individuals with persis-tently elevated triglyceride levels and low high-density lipoprotein(HDL)cholesterol despite statin therapy.17In the ACCORD and ADV ANCE studies and the V ADT,a large proportion of subjects,ranging from55%to85%,were also treated with aspirin (Table2).Thus,results from ADV ANCE,ACCORD, and V ADT suggest that a large proportion of par-ticipants in these trials,which were being treated intensively or less intensively for glucose targets, received extensive antihypertensive,lipid-lowering, and antiplatelet medications.Median levels of SBP, SDP,and LDL cholesterol in these cohorts were also indicative of a significant proportion of them be-ing adequately controlled for blood pressure and lipid targets(Table2).Therefore,the possibility ex-ists that active interventions for simultaneous con-trol of hypertension and hyperlipidemia and use of aspirin may have affected the impact of intensive glucose control on cardiovascular outcomes in the megatrials.Subgroups analyses,however,do not ap-parently support this conclusion(Fig.3).Whether patients were on antihypertensive or lipid-lowering medications was not associated with a different out-come of the intensive glucose control on mortality in ACCORD and ADV ANCE patients,even thoughIntensive glucose control and cardiovascular risk Giorgino et al.the different groups were largely unbalanced in size. Only aspirin use in the ACCORD study seemed to modulate the effects of intensive versus standard glucose control on mortality.18The“wrong patient”concept and the need for individualization of glucose targets The ADV ANCE and ACCORD studies and the V ADT provide conflicting evidence of mortality risk with intensive glycemic control.These trials showed an approximate15%reduction in nonfatal MI with no benefit or harm in all-cause or cardiovascular mortality.Potential explanations for the lack of im-pact of intensive glycemic control on CVD can be found in the patients’characteristics.Indeed,these studies were of shorter duration and enrolled gener-ally older patients than previous studies,including the DCCT and UKPDS in which the intensive con-trol had shown better outcomes.In addition,mean diabetes duration was longer and a greater portion of patients had established CV disease in the mega-trials(approximately32–40%)than in earlier trials (Table1).It is also possible that the follow-up of these studies was too short to detect a clinical ben-efit.Consistent with this hypothesis,in the UKPDS no macrovascular benefit was noted in the inten-sive control arm in thefirst10years of follow-up. Nevertheless,posttrial monitoring for an additional 10years(UKPDS80)revealed a15%risk reduction in MI and13%reduction in all-cause mortality in the intensive treatment group.19A possible explanation is that the wrong patients were investigated in the megatrials(Fig.2).Indeed, the population of the ACCORD study may not rep-resent the average patient with T2D in clinical prac-tice.Participants in this trial had T2D on average for10years at the time of enrollment,had higher HbA1c levels than most type2diabetic patients in the United States and most Western countries to-day(average of8.2%at baseline),and had known heart disease or at least two risk factors in addi-tion to diabetes,such as high blood pressure,high cholesterol levels,obesity,and smoking.4In the UKPDS,the benefits of intensive glycemic control on CVD were observed only after a long duration of intervention in newly diagnosed younger patients.2 In older patients with T2D with longer disease dura-tion,atherosclerotic disease may already have been established and thus intensive glucose control may have had little benefit.Conversely,patients with shorter disease duration,lower HbA1c,and/or lack of established CVD might have benefited signifi-cantly from more intensive glycemic control.20,21 Relevant to this concept,the V ADT showed that ad-vanced CVD,as demonstrated by computed tomog-raphy(CT)-detectable coronary artery calcium,was associated with negative outcomes.In a substudy co-hort of301T2D participants in V ADT,the ability of intensive glucose therapy compared with standard therapy to reduce cardiovascular events was exam-ined based on the extent of coronary atherosclerosis as measured by a CT-detectable coronary artery cal-cium score(CAC).The data showed that there was a progressive diminution of the benefit of intensive glucose control with increasing CAC.In patients with CAC≤100,1of52individuals experienced an event(HR for intensive therapy=0.08;range, 0.008–0.770;P=0.03),whereas11of62patients with a CAC>100had an event(HR=0.74;range, 0.46–1.20;P=0.21).Thus,this subgroup analy-sis indicates that intensive glycemic therapy may be most effective in those with less extensive coronary atherosclerosis.22Why does intensive treatment of hyperglycemia appear to be ineffective in reducing cardiovascular events in T2D with advanced atherosclerosis?Two potential mechanisms may be involved.First,once the atherosclerotic plaque has developed,modified lipoproteins,activated vascular cells,and altered im-mune cell signaling may generate a self-propagating process that maintains atherogenesis,even in the face of improved glucose control.Second,advanced glycosylation end-product formation,which may be involved in CVD,is not readily reversible and may require more than three tofive years of in-tensive glucose control to be reverted.Thus,the presence of multiple cardiovascular risk factors or established CVD may have reduced the benefits of intensive glycemic control in the high-risk cohort of ACCORD,ADV ANCE,and V ADT compared with the low-risk population of the UKPDS cohort,of whom only a minority had prior CVD.23The pres-ence of long-standing disease and prolonged prior poor glycemic control may be additional factors ac-celerating the progression of atherosclerotic lesions in T2D.The goal of individualizing HbA1c targets has gained more attraction after these recent clinical trials in older patients with established T2D failed to show a benefit from intensive glucose-loweringGiorgino et al.Intensive glucose control and cardiovascular riskTable3.Potential criteria for individualization of glucose targets in type2diabetes2–5,25,29HbA1c HbA1c Criterion<6.5–7.0%7.0–8.0% Age(years)<55>60 Diabetes duration(years)<10>10Life expectancy(years)>5<5 Possibility to performIGC for>5yearsYes No Usual HbA1c level(%)<8.0>8.0 CVD No Yes Prone to hypoglycemia No No Reduction of HbA1clevel upon IGCYes NoAbbreviations:CVD,cardiovascular disease;IGC,in-tensive glucose control.therapies on CVD outcomes.Recommendations suggest that the goals should be individualized,such that(1)certain populations(children,pregnant women,and elderly patients)require special con-siderations and(2)more stringent glycemic goals (i.e.,a normal HbA1c<6.0%)may further re-duce complications at the cost of increased risk of hypoglycemia.24For the latter,the recommen-dations also suggest that less intensive glycemic goals may be indicated in patients with severe or frequent hypoglycemia.With regard to the less intensive glycemic goals,perhaps consideration should be given to the high-risk patient with mul-tiple risk factors and CVD,as evaluated in the ACCORD study.4Thus,aiming for a HbA1c of 7.0–8.0%may be a reasonable goal in patients with very long duration of diabetes,history of se-vere hypoglycemia,advanced atherosclerosis,sig-nificant comorbidities,and advanced age/frailty (Table3),even though with what priority each one of these criteria should be considered is not clear at present(current recommendations from scientific societies also do not provide this spe-cific information).In younger patients without documented macrovascular disease or the above-mentioned conditions,the goal of attaining an HbA1c<6.5–7.0%may provide long-lasting bene-fits.In patients with limited life expectancy,more liberal HbA1c values may be pursued.In deter-mining the HbA1c target for CVD prevention,one should consider that at least three tofive years are usually required before possible differences in the incidence of nonfatal MI in T2D are observed.2 Thus,a clinical setting that allows tight glucose control to be implemented for this period of time should be available.Finally,an excess mortality was observed in the ACCORD study in those T2D in-dividuals who showed an unexpected increase in HbA1c levels upon institution of intensive glucose control.25Accordingly,patients exhibiting the pat-tern of worsening glycemic control when exposed to intensive treatment should be set at higher glucose targets(Table3).The above guidelines are apparently incorpo-rated into the updated version of the American Diabetes Association and the European Associa-tion for the Study of Diabetes recommendations on the management of hyperglycemia in nonpreg-nant adults with T2D.The new recommendations are less prescriptive and more patient centered.In-dividualized treatment is explicitly defined as the cornerstone of success.Treatment strategies should be tailored to individual patient needs,preferences, and tolerances and based on differences in age and disease course.Other factors affecting individual-ized treatment plans include specific symptoms,co-morbid conditions,weight,race/ethnicity,sex,and lifestyle.26Current“imperfect”glucose-lowering drugsThe inability of ACCORD,ADV ANCE,and V ADT to demonstrate significant reductions in CVD out-comes with intensive glycemic control also suggests that current pharmacological tools for treating hy-perglycemia in patients with more advanced T2D may have counterbalancing consequences for the cardiovascular system.The available agents used to treat diabetes have not been conclusively shown to reduce macrovascular disease and,in some in-stances,their chronic use may promote negative cardiovascular effects in diabetic subjects despite improvement of hyperglycemia.Importantly,these adverse cardiovascular side effects appear in several instances to be directly due to the mode of drug ac-tion.Selection of a treatment regimen for patients with T2D includes evaluation of the effects of med-ications on overall cardiovascular risk.27 Sulfonylureas have the benefit of acting rapidly to lower glucose levels but,unfortunately,on a。
㊃综述㊃家族性乳糜微粒血症综合征的研究进展梁芙萌㊀王方芳㊀唐熠达100191北京大学第三医院心内科㊁血管医学研究所,血管稳态与重构全国重点实验室,国家卫生健康委心血管分子生物学与调节肽重点实验室,心血管受体研究北京市重点实验室通信作者:王方芳,电子信箱:doctorfancy@DOI:10.3969/j.issn.1007-5410.2024.01.015㊀㊀ʌ摘要ɔ㊀家族性乳糜微粒血症综合征是一种罕见的常染色体隐性遗传疾病,主要由脂蛋白脂肪酶基因突变引起,导致血浆中乳糜微粒浓度和三酰甘油水平显著升高㊂目前国内尚无有关家族性乳糜微粒血症综合征的诊疗指南,因此本文重点回顾并总结其流行病学㊁发病机制及临床诊疗进展㊂ʌ关键词ɔ㊀家族性乳糜微粒血症综合征;㊀多因素乳糜微粒血症综合征;㊀脂蛋白脂肪酶;㊀三酰甘油;㊀胰腺炎基金项目:首都卫生发展科研专项(2022-2Z-40916)Research progress in familial chylomicronemia syndrome㊀Liang Fumeng,Wang Fangfang,Tang YidaDepartment of Cardiology and Institute of Vascular Medicine,Peking University Third Hospital;State KeyLaboratory of Vascular Homeostasis and Remodeling,Peking University;NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides,Peking University;Beijing Key Laboratory of Cardiovascular Receptors Research,Beijing100191,ChinaCorresponding author:Wang Fangfang,Email:doctorfancy@ʌAbstractɔ㊀Familial chylomicronemia syndrome is a rare autosomal recessive disease,mainly causedby mutations in the lipoprotein lipase gene,leading to a significant increase of plasma chylomicrons and triglyceride levels.So far there is no guidelines on the diagnosis and treatment of familial chylomicronemia syndrome in China,this review summarized the epidemiology,pathogenesis,and clinical diagnosis and treatment progress of this disease.ʌKey wordsɔ㊀Familial chylomicronemia syndrome;㊀Multifactorial chylomicronemia syndrome; Lipoprotein lipase;㊀Triglyceride;㊀PancreatitisFund program:Capital Health Development Scientific Research Project(2022-2Z-40916)㊀㊀家族性乳糜微粒血症综合征(familial chylomicronemia syndrome,FCS),也被称为Ⅰ型原发性高脂蛋白血症(T1HLP)(OMIM#238600),或脂蛋白脂肪酶缺乏症(lipoprotein lipase deficiency,LPLD),是一种罕见的常染色体隐性遗传疾病[1-2],最早于1932年由Bürger和Grütz提出㊂1㊀流行病学特点随着人们对FCS的不断深入研究,很多学者认为其实际发病率高于1/100万㊂2018年Khavandi等[3]分析了2008 2017年纽约州385000份电子病历记录,发现FCS的发病率约为1/10万㊂Pallazola等[4]回顾性分析了2013 2017年在约翰霍普金斯医院就诊的1627763例患者,统计FCS患病率高达13/100万㊂Shah等[5]回顾性分析了2006 2016年在克利夫兰诊所脂质中心就诊的70201例患者,发现FCS患病率至少为1/5000,比报告的发病率高出200倍㊂目前我国尚无FCS发病率相关数据报道㊂FCS多由脂蛋白脂肪酶(lipoprotein lipase,LPL)基因的双等位基因(纯合)变异引起[6],从而使LPL的活性下降或功能缺失,导致血浆中乳糜微粒(chylomicron,CM)浓度升高和高三酰甘油血症(hypertriglyceridemia,HTG)㊂到目前为止,已知参与CM脂肪分解且与FCS相关的基因有5种,即LPL㊁载脂蛋白C2(apolipoprotein C-Ⅱ,APOC2)㊁载脂蛋白A5 (apolipoprotein A-Ⅴ,APOA5)㊁脂肪酶成熟因子1(lipase maturation factor1,LMF1)和甘油磷酸肌醇锚定高密度脂蛋白结合蛋白1(glycosylphosphatidylinositol-anchored high-density lipoprotein binding protein1,GPIHBP1),其中LPL基因突变率在欧美FCS人群中高达80%以上[7-8]㊂大多数导致家族性LPL功能缺陷的基因突变位于LPL基因的外显子4㊁5和6上[9]㊂2㊀发病机制CM是在摄入高脂肪食物后,由肠壁细胞合成的富含三酰甘油(triglyceride,TG)的巨大脂蛋白,是循环血液中外源性TG及胆固醇的主要运输形式㊂在外周血中成熟的CM借助APOC2激活LPL,TG在LPL的作用下水解为甘油一酯和脂肪酸,然后被肌肉㊁脂肪组织㊁心肌组织等摄取或利用㊂CM中的载脂蛋白和磷脂转移到高密度脂蛋白中,而剩下的CM残粒,分别被肝脏低密度脂蛋白(low-density lipoprotein, LDL)受体和清道夫受体识别后摄取[10]㊂健康人血浆中的CM在空腹12h后会被完全清除,因此健康人血浆中几乎无CM㊂但在FCS患者中,由于缺乏功能性的LPL(如LPL基因突变),或其他相关基因编码的蛋白质与LPL相互作用等,使血浆中CM的清除能力受损,导致TG堆积在血浆中而使血浆呈乳糜状[8,11]㊂2018年Hegele等[12]对52例FCS患者的临床研究发现,41例(79%)患者携带LPL双等位基因突变;在11例(21%)非LPL基因突变FCS患者中,1例携带APOC2基因突变,5例发生GPIHBP1基因突变,1例包含LMF1基因突变,2例发生APOA5基因突变,2例携带双杂合子突变㊂2020年葡萄牙一所医学研究中心对26例FCS患者进行研究,其中7例患者进行的基因检测结果显示,3例为LPL纯合子突变,3例为LPL复合杂合子突变,1例为APOC2纯合子突变[13]㊂2018年法裔加拿大人一项队列研究显示,在25例FCS患者中,8例携带LPL207(P234L)纯合突变,7例包含LPL188(G215E)纯合突变,6例患者为LPL杂合子携带者(LPL207+LPL188),1例发生GPIHBP1移码纯合突变[14]㊂总之,对欧美人群FCS患者的基因突变检测分析表明,LPL 基因相关的纯合或双重杂合突变是最常见的患病机制㊂2018年中国医学科学院阜外医院报道了其血脂门诊既往7年来就诊的45例极高TG血症(ȡ11.3mmol/L)患者的基因检测结果,包括11.1%的LPL变异和17.8%的LPL 调控基因(APOA5㊁APOC2㊁GPIHBP1和LMF1)变异[15]㊂另外,最近研究报道,载脂蛋白C3(apolipoprotein C-Ⅲ, APOC3)和血管生成素样3(angiopoietin-like proteins3, ANGPTL3)在脂质代谢中也发挥重要作用,可作为FCS患者的药物治疗靶点[16-21]㊂FCS相关基因及各基因作用机制见表1㊂3㊀临床表现和诊断FCS是一种罕见的常染色体隐性遗传病,通常由多种单基因突变引起,区别于多因素乳糜微粒血症综合征(multifactorial chylomicronemia syndrome,MCS),后者是一种多基因疾病,通常与危险因素或合并疾病有关,如饮酒㊁富含碳水化合物(果糖)的饮食㊁控制不佳的糖尿病㊁甲状腺功能减退㊁胆道疾病㊁肾脏疾病㊁妊娠和某些药物等[22-23]㊂所以相比之下,MCS比FCS要多见一些㊂FCS多始于儿童期㊁青少年期或成年早期,其特征是空腹血浆TG水平非常高(未治疗情况下ȡ11.3mmol/L),这个TG阈值水平(11.3mmol/L)既是血浆中CM血症存在的水平,也是急性胰腺炎(acute pancreatitis,AP)发作的高风险阈值水平㊂FCS主要临床特征包括急性发作性腹痛㊁乏力㊁皮肤黄色瘤㊁肝脾肿大㊁视网膜脂质症㊁反复发作AP及神经症状,如易怒㊁记忆丧失和抑郁,严重者影响患者的生活质量[10-11,24]㊂国外研究报道,高三酰甘油血症性急性胰腺炎(hypertriglyceridemia-induced acute pancreatitis,HTG-AP)占所有胰腺炎发作的10%,是继饮酒和胆石症引起AP后最常见的原因,而TG水平高于11.3mmol/L也被认为是导致胰腺炎发作的必要诱因[25-27]㊂早期识别并诊断FCS患者非常关键,因为这些患者发生严重AP的风险很高,而且更有可能出现严重的不可逆的胰腺坏死和器官衰竭㊂随着CM浓度升高,血液黏度增加及血管内皮受损,导致胰腺内的缺血性损伤和酸中毒,加上游离脂肪酸对于胰腺的直接毒性,进一步增加了AP的发作风险㊂AP除了是一种可能危及生命的紧急疾病外,还可能导致一些临床并发症,如慢性胰腺炎㊁胰腺功能不全㊁2型糖尿病等[28-29]㊂欧洲专家小组研究认为,诊断FCS的标准包括:(1)严重的原发性HTG(多次空腹TG水平>10mmol/L),对传统降低TG药物治疗无效或无反应;(2)发病起始年龄小,有早发(幼儿㊁青少年时期)AP史㊁不明原因腹痛史;(3)排除其他影响因素如妊娠㊁药物㊁酒精中毒㊁胆石症等[30-31]㊂基因检测也是支持诊断的方法之一,当临床表现强烈提示患者可能表1㊀FCS相关基因及作用机制FCS相关基因作用机制LPL促进分解TG,FCS大多数因LPL基因突变引起,缺乏会导致血浆中清除CM能力受损㊁TG分解受阻GPIHBP1在毛细血管内皮细胞上表达的蛋白质之一,可与LPL结合并将其转运至毛细血管腔的作用部位,缺乏会导致LPL与其毛细血管腔上的结合位点的结合缺陷及血管内脂肪分解缺陷,被认为是FCS的第二大常见原因APOA5促进CM和VLDL与毛细血管内皮细胞表面LDL的相互作用,缺乏会导致LPL功能下降APOC2激活骨骼肌组织㊁脂肪组织㊁心肌组织等毛细血管内皮细胞表面LPLLMF1LPL胞内正确折叠和激活所需的胞内蛋白质,缺乏可导致LPL分泌明显减少ANGPTL3调节LPL活性的重要因子,尤其是肝源性脂蛋白代谢的关键调节因子,可以抑制LPL活性,从而减少肌肉和脂肪组织中TG水解APOC3LPL的关键抑制剂,通过促进VLDL的组装和生成,从而抑制LPL的活性㊀㊀注:FCS:家族性乳糜微粒血症综合征;LPL:脂蛋白脂肪酶;TG:三酰甘油;CM:乳糜微粒;GPIHBP1:甘油磷酸肌醇锚定高密度脂蛋白结合蛋白1;APOA5:载脂蛋白A5;VLDL:极低密度脂蛋白;APOC2:载脂蛋白C2;LMF1:脂肪酶成熟因子1;ANGPTL3:血管生成素样3;APOC3:载脂蛋白C3患有FCS时,可以进行基因检测,但其也并不能百分之百确诊,如在没有临床症状的情况下可能携带基因突变,或临床症状可能提示FCS,而致病基因突变在当前检测技术下仍无法确定㊂O Dea等[32]研究报道称,对基因确诊的FCS和MCS患者进行比较,空腹低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)㊁体质指数(body mass index, BMI)和胰腺炎病史对疾病的鉴别准确率高达91.0%,因此提出将低BMI(<26.1kg/m2)和低LDL-C(<1.01mmol/L)两项指标也纳入诊断FCS标准中㊂4 治疗FCS治疗目的包括降低发生胰腺炎的风险㊁减轻因血浆TG水平升高相关的短期临床症状㊂血浆TG水平是评估治疗效果最合适的标志物,2002年美国国家胆固醇教育计划(national cholesterol education program,NCEP)提出降低TG 水平并维持在5.65mmol/L以下,可改善患者的炎症反应程度,促进胰腺组织修复㊁改善预后,并有效预防胰腺炎复发㊂Gallo等[16]提出,FCS患者TG目标值应<11.3mmol/L,或较治疗前降低50%水平,当然首先需要根据临床实际情况来判断㊂极低脂肪(每日不高于20g)饮食是目前治疗FCS的主要方法,但多数人很难长期坚持㊂对于患有FCS的成年人,建议将饮食中的脂肪能量限制在摄入总能量的15%以内,但不建议儿童将其水平降低到20%以下[1-2,10,16,33],需综合考虑年龄增长及身体发育等具体情况来调整能量摄入量,以确保摄入相对较平衡的营养物质如维生素㊁微量元素等㊂相较于长链TG,中链TG因与CM的结合少,适量摄入可能对疾病预后有益[34]㊂虽然CM的水平取决于饮食中的脂肪含量,但仍建议限制酒精摄入量,限制摄入过量的糖,避免服用已知会升高TG水平的药物如大剂量噻嗪类药物㊁β受体阻滞剂和外源性雌激素等[35]㊂但对于FCS患者,长期坚持极低脂肪饮食显著影响其生活质量㊂FCS患者因缺乏分解代谢脂肪的能力,与绝大多数严重高三酰甘油血症(severe hypertriglyceridemia,SHTG)患者不同,对标准降脂药物反应不佳㊂Chaudhry等[36]研究发现,贝特类(纤维酸衍生物类)或Ω-3脂肪酸制剂等药物治疗对MCS患者可能有益,但对FCS患者基本无效㊂曾有研究提出高剂量(4~6g/d)的Ω-3脂肪酸类药物可降低SHTG患者的TG和APOC3水平[37],但目前未提示对FCS患者有效,可能是因为FCS患者中TG水平与脂肪摄入量增加相关, FCS患者应严格控制脂肪摄入量,应避免摄入高剂量的Ω-3脂肪酸㊂血浆置换术多用于TG非常高(如妊娠期间)的患者,以避免AP发生或降低AP并发症的风险㊂Lu等[38]研究认为,在病程早期,将TG控制到5.65mmol/L以下可能会减少胰腺炎带来的持续性器官衰竭的风险㊂萨格勒布大学曾报道1例患FCS的妊娠女性采用血浆置换来预防胰腺炎及母婴潜在并发症的治疗成功案例[39]㊂阿根廷也有一项对2002 2019年4个中心21例儿童FCS患者进行的回顾性综合研究,结果提示限制脂肪饮食及血浆置换治疗有效[40]㊂Alipogene tiparvovec(Glybera)基因替代疗法是使用腺病毒相关病毒(adeno-associated virus,AAV)作为载体将LPL基因传递到LPL缺乏(功能缺失突变)的FCS患者中,从而表达功能正常的LPL基因㊂该药通过多次肌肉注射达到治疗效果,包括降低胰腺炎发生率,但因治疗效果短暂且非常昂贵,已于2017年被公司召回[36,41]㊂微粒体三酰甘油转移蛋白(microsomal triglyceride transfer protein,MTTP)主要存在于肝细胞和肠上皮细胞,其生理功能是将TG转移到肝细胞中的载脂蛋白B100(ApoB-100)和肠上皮细胞中的载脂蛋白B48(ApoB-48),是极低密度脂蛋白和CM合成与分泌不可缺少的脂质转运蛋白㊂MTTP抑制剂洛米他滨(lomitapide)通过抑制富含TG的脂蛋白合成和分泌来降低血浆中的TG浓度㊂Cefalu等[42]研究认为,lomitapide可有效降低FCS患者的TG水平,预防AP 复发,但lomitapide对FCS患者的长期疗效仍需进一步试验研究来评估㊂目前多项研究发现,长期口服lomitapide可能导致肝脏脂肪变性和肝硬化[42-44],因此尚未获得批准用于治疗FCS患者㊂Pradigastat(LCQ908)是一种二酰甘油-O-酰基转移酶同源物1(diacylglycerol acyltransferase1,DGAT1)抑制剂㊂Gaudet等[45]研究显示,20mg/d的pradigastat即可降低FCS 患者的空腹TG水平,40mg/d的pradigastat在12周治疗中有更高的应答率㊂此外,有研究报道pradigastat可以有效降低FCS患者的空腹TG水平及餐后TG[46-47],但腹泻的发生率很高㊂近年来已研发出一种第二代反义寡核苷酸药物volanesorsen,通过反义结合APOC3信使核糖核酸(mRNA)㊁抑制APOC3合成来调节TG水平[48]㊂Volanesorsen是全球第一个正式获批用于治疗FCS的药物,可有效降低TG水平(94%),并观察到胰腺炎发作明显减少[49],还可有效降低肝脏脂肪分数[50]㊂但多项报道显示其严重血小板减少的不良反应[48-49,51-53]㊂尽管存在潜在的严重不良反应,但考虑到使用volanesorsen的获益可能高于风险,在欧洲和巴西被批准用于治疗AP高风险的FCS患者㊂此外,Witztum等[54]研究显示,延长使用volanesorsen可持续降低FCS患者空腹TG 水平(48%~55%)㊂目前在研的olezarsen(AKCEA-APOCⅢ-LRx),已显示可显著降低TG水平(23%~60%),无血小板下降及肝肾功能变化等不良反应[55],2022年开展了用于FCS 患者的全球Ⅲ期BALANCE研究,可能于近期公布研究结果[56]㊂Vupanorsen(AKCEA-ANGPTL3-LRx),主要用于降低心血管风险和治疗HTG,在24周时观察到,该药所有剂量下均可显著降低非高密度脂蛋白胆固醇水平(22.0%~ 27.7%)和TG水平(41.3%~56.8%),但在安全性方面观察到,较高剂量的vupanorsen可引起注射部位反应及丙氨酸氨基转移酶㊁天门冬氨酸氨基转移酶升高,肝脏脂肪含量增加等[57]㊂小干扰RNA类药物采用新的配体耦连技术,使用N-乙酰半乳糖胺三聚体(GalNAc)修饰RNA药物后靶向结合肝细胞特异表达的去唾液酸糖蛋白受体(ASGPR),该类药物治疗效果持久,并且可以最大限度减少全身暴露,药物耐受性良好,不良反应少,为FCS患者提供了一个额外的治疗选择㊂目前临床在研的用于FCS患者的小干扰RNA类药物包括ARO-APOC3㊁LY-3561774和ALN-ANG,处于晚期临床研发阶段,尚未获批上市㊂ARO-APOC3已发表的临床数据显示,其可显著降低FCS和MCS患者的TG水平(91%和90%),显著升高高密度脂蛋白胆固醇;且患者可能只需要每3个月或6个月注射一针,耐受性良好,最常见不良事件主要为注射部位反应[58]㊂此外,重组人单克隆抗体evinacumab是一种结合并抑制ANGPTL3蛋白的全人源单克隆抗体,可以阻断ANGPTL3对多种血脂成分的调控功能,是一种新的降脂治疗方法,对LDL-C有明显疗效(40%~50%),亦可降低TG,其主要不良事件包括鼻咽炎㊁鼻漏㊁头晕㊁头痛㊁恶心㊁上腹痛㊁腹泻等,在治疗FCS患者中也可能有应用前景[59-60]㊂5 小结综上所述,FCS是一种较为罕见的疾病,多由LPL及其调控基因突变引起,主要表现为TG水平显著升高及AP发作,治疗目的包括降低发生胰腺炎的风险及减轻因血浆TG 水平升高相关的短期临床症状,治疗方式包括极低脂肪饮食㊁血浆置换术及抑制TG合成药物等,目前研发中的新型小核酸药物可能会成为该疾病的特效治疗手段㊂此外,FCS 的中国人群流行病学调研尚空白,亟待开展中国人群队列研究,以明确该疾病的中国人群诊断标准,并规范治疗及改善预后㊂利益冲突:无参㊀考㊀文㊀献[1]Falko JM.Familial chylomicronemia syndrome:a clinical guidefor endocrinologists[J].Endocr Pract,2018,24(8):756-763.DOI:10.4158/EP-2018-0157.[2]Paquette M,Bernard S,Hegele RA,et al.Chylomicronemia:Differences between familial chylomicronemia syndrome andmultifactorial chylomicronemia[J].Atherosclerosis,2019,283:137-142.DOI:10.1016/j.atherosclerosis.2018.12.019. [3]Khavandi M,Victory J,Myerson M.Prevalence of familialchylomicronemia syndrome(FCS):Are we underestimating?[J].Clin Lipidol,2018,12(2):529-530.DOI:10.1016/j.jacl.2018.03.021.[4]Pallazola VA,Sajja A,Derenbecker R,et al.Prevalence offamilial chylomicronemia syndrome in a quaternary care center[J].Eur J Prev Cardiol,2020,27(19):2276-2278.DOI:10.1177/2047487319888054.[5]Shah NP,Cho L,Ahmed HM.Familial chylomicronemiasyndrome:Clinical characteristics and long-term cardiovascularoutcomes[J].J Am Coll Cardiol,2018,72(10):1177-1179.DOI:10.1016/j.jacc.2018.06.042.[6]Santos RD,Lorenzatti A,Corral P,et al.Challenges in familialchylomicronemia syndrome diagnosis and management acrossLatin American countries:an expert panel discussion[J].J ClinLipidol,2021,15(5):620-624.DOI:10.1016/j.jacl.2021.10.004.[7]Rabacchi C,Pisciotta L,CefalùAB,et al.Spectrum ofmutations of the LPL gene identified in Italy in patients withsevere hypertriglyceridemia[J].Atherosclerosis,2015,241(1):79-86.DOI:10.1016/j.atherosclerosis.2015.04.815.[8]Hegele RA,Borén J,Ginsberg HN,et al.Rare dyslipidaemias,from phenotype to genotype to management:a EuropeanAtherosclerosis Society task force consensus statement[J].Lancet Diabetes Endocrinol,2020,8(1):50-67.DOI:10.1016/S2213-8587(19)30264-5.[9]Truninger K,Schmid PA,Hoffmann MM,et al.RecurrentAcute and Chronic Pancreatitis in Two Brothers With FamilialChylomicronemia Syndrome[J].Pancreas,2006,32(2):215-219.DOI:10.1097/01.mpa.0000202942.93578.dd. [10]Goldberg RB,Chait A.A Comprehensive Update on theChylomicronemia Syndrome[J].Front Endocrinol(Lausanne),2020,11:593931.DOI:10.3389/fendo.2020.593931. [11]陈超,黄轲,梁黎.家族性高乳糜微粒血症1例[J].中国现代药物应用,2011,5(4):198-199.DOI:10.3969/j.issn.1673-9523.2011.04.178.㊀Chen C,Huang K,Liang L.A case of familial chylomicronemiasyndrome[J].Chin J Mod Drug Appl,2011,5(4):198-199.DOI:10.3969/j.issn.1673-9523.2011.04.178. [12]Hegele RA,Berberich AJ,Ban MR,et al.Clinical andbiochemical features of different molecular etiologies of familialchylomicronemia[J].Clin Lipidol,2018,12(4):920-927(e4).DOI:10.1016/j.jacl.2018.03.093.[13]Alves AC,Abrantes LB,Sequeira S,et al.FamilialChylomicronemia Syndrome:Clinical and molecularcharacterization of individuals with clinical diagnosis in Portugal[J].Atherosclerosis,2020,315:e205-e206.DOI:10.1016/j.atherosclerosis.2020.10.643.[14]Alexis B,Martine P,Robert D.Familial ChylomicronemiaSyndrome:Description of a french canadian cohort[J].Atherosclerosis,2018,32:15.DOI:10.1016/j.atherosclerosissup.2018.04.044.[15]Jin JL,Sun D,Cao YX,et al.Intensive genetic analysis forChinese patients with very high triglyceride levels:Relations ofmutations to triglyceride levels and acute pancreatitis[J].EBioMedicine,2018,38:171-177.DOI:10.1016/j.ebiom.2018.11.001.[16]Gallo A,Béliard S,Erasmo LD,et al.Familial chylomicronemiaSyndrome(FCS):Recent Data on Diagnosis and Treatment[J].Curr Atheroscler Rep,2020,22(11):63.DOI:10.1007/s11883-020-00885-1.[17]Chen PY,Gao WY,Liou JW,et al.Angiopoietin-Like Protein3(ANGPTL3)Modulates Lipoprotein Metabolism andDyslipidemia[J].Int J Mol Sci,2021,22(14):7310.DOI:10.3390/ijms22147310.[18]Wen Y,Chen YQ,Konrad RJ.The Regulation of TriacylglycerolMetabolism and Lipoprotein Lipase Activity[J].Adv Biol(Weinh),2022,6(10):e2200093.DOI:10.1002/adbi.202200093.[19]Jin N,Matter WF,Michael LF,et al.The Angiopoietin-LikeProtein3and8Complex Interacts with Lipoprotein Lipase andInduces LPL Cleavage[J].ACS Chem Biol,2021,16(3):457-462.DOI:10.1021/acschembio.0c00954. [20]DiDonna NM,Chen YQ,Konrad RJ.Angiopoietin-like proteinsand postprandial partitioning of fatty acids[J].Curr OpinLipidology,2022,33(1):39-46.DOI:10.1097/MOL.0000000000000798.[21]Li J,Li L,Guo DM,et al.Triglyceride metabolism andangiopoietin-like proteins in lipoprotein lipase regulation[J].Clin Chim Acta,2020,503:19-34.DOI:10.1016/a.2019.12.029.[22]Warden BA,Minnier J,Duell PB,et al.Chylomicronemiasyndrome:Familial or not?[J].J Clin Lipidol,2020,14(2):201-206.DOI:10.1016/j.jacl.2020.01.014. [23]Tremblay K,Gaudet D,Khoury E,et al.Dissection of Clinicaland Gene Expression Signatures of Familial Versus MultifactorialChylomicronemia[J].J Endocr Soc,2020,4(6):bavv056.DOI:10.1210/jendso/bvaa056.[24]Baass A,Paquette M,Bernard S,et al.Familialchylomicronemia syndrome:an under-recognized cause of severehypertriglyceridaemia[J].Intern Med,2020,287(4):340-348.DOI:10.1111/joim.13016.[25]De Pretis N,De Marchi G,Frulloni L.Hypertriglyceridemicpancreatitis[J].Minerva Gastroenterol Dietol,2020,66(3):238-245.DOI:10.23736/S1121-421X.19.02641-2.[26]Valdivielso P,Ramírez-Bueno A,Ewald N.Current knowledgeof Hypertriglyceridemic pancreatitis[J].Eur J Intern Med,2014,25(8):689-694.DOI:10.1016/j.ejim.2014.08.008.[27]Webb CB,Leveno M,Quinn AM,et al.Effect of TPE vsmedical management on patient outcomes in the setting ofhypertriglyceridemia-induced acute pancreatitis with severelyelevated triglycerides[J].Clin Apher,2021,36(5):719-726.DOI:10.1002/jca.21922.[28]Deng LH,Xue P,Xia Q,et al.Effect of admissionhypertriglyceridemia on the episodes of severe acute pancreatitis[J].World J Gastroenterol,2008,14(28):4558-4561.DOI:10.3748/wjg.14.4558.[29]Lu ZH,Li M,Guo F,et al.Timely reduction of triglyceridelevels is associated with decreased persistent organ failure inhypertriglyceridemic pancreatitis[J].Pancreas,2020,49(1):105-110.DOI:10.1097/MPA.0000000000001463. [30]Moulin P,Dufour R,Averna M,et al.Identification anddiagnosis of patients with familial chylomicronaemia syndrome(FCS):expert panel recommendations and proposal of an FCSscore [J].Atherosclerosis,2018,275:265-272.DOI:10.1016/j.atherosclerosis.2018.06.814.[31]P Moulin P,Dufour R,Averna M,et al.Characterisation ofpatients with familial chylomicronaemia syndrome(FCS)andmultifactorial chylomicronaemia syndrome(MCS):Establishmentof an FCS clinical diagnostic score[J].Data Brief,2018,21:1334-1336.DOI:10.1016/j.dib.2018.10.125. [32]O Dea LSL,MacDougall J,Alexander VJ,et al.Differentiatingfamilial chylomicronemia syndrome from multifactorial severehypertriglyceridemia by clinical profiles[J].J Endocr Soc,2019,3(12):2397-2410.DOI:10.1210/js.2019-00214. [33]Paragh G,Némethá,Harangi M,et al.Causes,clinicalfindings and therapeutic options in chylomicronemia syndrome,aspecial form of hypertriglyceridemia[J].Lipids Health Dis,2022,21(1):21.DOI:10.1186/s12944-022-01631-z. [34]Williams L,Rhodes KS,Karmally W,et al.Familialchylomicronemia syndrome:Bringing to life dietaryrecommendations throughout the life span[J].J Clin Lipidol,2018,12(4):908-919.DOI:10.1016/j.jacl.2018.04.010.[35]Davidson M,Stevenson M,Hsieh A,et al.The burden offamilial chylomicronemia syndrome:Results from the global IN-FOCUS study[J].J Clin Lipidol,2018,12(4):898-907.e2.DOI:10.1016/j.jacl.2018.04.009.[36]Chaudhry R,Viljoen A,Wierzbicki AS.Pharmacologicaltreatment options for severe hypertriglyceridemia and familialchylomicronemia syndrome[J].Expert Rev Clin Pharmacol,2018,11(6):589-598.DOI:10.1080/17512433.2018.1480368.[37]Roth EM.ω-3carboxylic acids for hypertriglyceridemia[J].Expert Opin Pharmacother,2015,16(1):123-133.DOI:10.1517/14656566.2015.991307.[38]Lu ZH,Li M,Guo F,et al.Timely Reduction of TriglycerideLevels Is Associated With Decreased Persistent Organ Failure inHypertriglyceridemic Pancreatitis[J].Pancreas,2020,49(1):105-110.DOI:10.1097/MPA.0000000000001463. [39]Leskovar D,Šabic'M,Perica D,et al.Pregnancy in FamilialChylomicronemia Syndrome:Plasmapheresis as TherapeuticApproach[J].Endocr Soc,2021,5(suppl1):A311.DOI:10.1210/jendso/bvab048.635.[40]Araujo MB,Pacheco G,Etcheverri N,et al.Familalchylomicronemia syndrome in children and adolescents inArgentina[J].Atherosclerosis,2020,315:e148.DOI:10.1016/j.atherosclerosis.2020.10.457.[41]ReinerŽ.Triglyceride-Rich Lipoproteins and Novel Targets forAnti-atherosclerotic Therapy[J].Korean Circ J,2018,48(12):1097-1119.DOI:10.4070/kcj.2018.0343. [42]Cefalu A,D Erasmo L,Giammanco A,et al.LomitapideEffectively Reduces Triglyceride(TG)Levels in FamilialChylomicronemia Syndrome(FCS)[J].Clin Lipidol,2022,16(Suppl1):e17.DOI:10.1016/j.jacl.2021.09.024. [43]D Erasmo L,Bini S,Arca M.Rare Treatments for RareDyslipidemias:New Perspectives in the Treatment of HomozygousFamilial Hypercholesterolemia(HoFH)and FamilialChylomicronemia Syndrome(FCS)[J].Curr Atheroscler Rep,2021,23(11):65.DOI:10.1007/s11883-021-00967-8.[44]Brahm AJ,Hegele RA.Lomitapide for the treatment ofhypertriglyceridemia[J].Expert Opin Investig Drugs,2016,25(12):1457-1463.DOI:10.1080/13543784.2016.1254187.[45]Gaudet D,Bernelot-Moens S,Zhou Y,et al.Pradigastat,aDiacylglycerol Acyltransferase1Inhibitor,Reduces FastingTriglyceride Levels in Familial Chylomicronemia[J].ClinLipidol,2015,9(3):449-450.DOI:10.1016/j.jacl.2015.03.065.[46]Upthagrove A,Chen J,Meyers CD,et al.Pradigastat dispositionin humans:in vivo and in vitro investigations[J].Xenobiotica,2017,47(12):1077-1089.DOI:10.1080/00498254.2016.1263405.[47]Gras J.Pradigastat Diacylglycerol O-acyltransferase1(DGAT1)inhibitor Treatment of lipoprotein disorders[J].Drugs of theFuture,2016,41(2):123-129.DOI:10.1358/dof.2016.041.02.2443235.[48]Kolovou G,Kolovou V,Katsiki N.Volanesorsen:A New Era inthe Treatment of Severe Hypertriglyceridemia[J].J Clin Med,2022,11(4):982.DOI:10.3390/jcm11040982. [49]Paik J,Duggan S.Volanesorsen:First Global Approval[J].Drugs,2019,79(12):1349-1354.DOI:10.1007/s40265-019-01168-z.[50]Prohaska TA,Alexander VJ,Prokopczuk EK,et al.APOC3inhibition with volanesorsen reduces hepatic steatosis in patientswith severe hypertriglyceridemia[J].J Clin Lipidol,2023,17(3):406-411.DOI:10.1016/j.jacl.2023.04.007. [51]Gesner M,Frishman WH.Drug Therapy for Hypertriglyceridemiaand Familial Chylomicronemia Syndrome:Focus on Volnesorsen[J].Cardiol Rev,2023,31(6):325-329.DOI:10.1097/CRD.0000000000000468.[52]Khetarpal SA,Wang M,Khera AV.Volanesorsen,familialchylomicronemia syndrome,and thrombocytopenia[J].N Engl JMed,2019,381(26):2582-2584.DOI:10.1056/NEJMc1912350.[53]Lazarte J,Hegele RA.Volanesorsen for treatment of familialchylomicronemia syndrome[J].Expert Rev Cardiovasc Ther,2021,19(8):685-693.DOI:10.1080/14779072.2021.1955348.[54]Witztum JL,Gaudet D,Arca M,et al.Volanesorsen andtriglyceride levels in familial chylomicronemia syndrome:Long-term efficacy and safety data from patients in an open-labelextension trial[J].Clin Lipidol,2023,17(3):342-355.DOI:10.1016/j.jacl.2023.03.007.[55]Tardif JC,Karwatowska-Prokopczuk E,Amour ES,et al.Apolipoprotein C-III reduction in subjects with moderatehypertriglyceridaemia and at high cardiovascular risk[J].EurHeart J,2022,43(14):1401-1412.DOI:10.1093/eurheartj/ehab820.[56]Alexander V,Prokopczuk E,Stroes ESG,et al.Rationale anddesign of the balance study:a randomized,double-blind,placebo-controlled,phase3study of Olezarsen in patients withfamilial chylomicronemia syndrome[J].American College ofCardiology,2023,81(8):1764.DOI:10.1016/s0735-1097(23)02208-8.[57]Bergmark BA,Marston NA,Bramson CR,et al.Effect ofVupanorsen on Non-High-Density Lipoprotein Cholesterol Levelsin Statin-Treated Patients With Elevated Cholesterol:TRANSLATE-TIMI70[J].Circulation,2022,145(18):1377-1386.DOI:10.1161/CIRCULATIONAHA.122.059266. [58]Peter C,David S,John b,et al.ARO-APOC3,anInvestigational RNAi Therapeutic,Shows Similar Efficacy andSafety in Genetically Confirmed FCS and Non-FCS Participantswith Severe Hypertriglyceridemia[J].Circulation,2021,144(1):A10357.DOI:10.1161/circ.144.suppl_1.10357. [59]Markham A.Evinacumab:First Approval[J].Drugs,2021,81(9):1101-1105.DOI:10.1007/s40265-021-01516-y. [60]Rosenson RS,Gaudet D,Ballantyne CM.Evinacumab in severehypertriglyceridemia with or without lipoprotein lipase pathwaymutations:a phase2randomized trial[J].Nat Med,2023,29(3):729-737.DOI:10.1038/s41591-023-02222-w.(收稿日期:2023-05-19)(本文编辑:谭潇)。
运动对心血管系统的保护作用研究进展一、概述心血管疾病是全球性的健康问题,在许多国家都是导致死亡和致残的主要原因。
随着人们生活方式的改变,缺乏体育锻炼成为了心血管疾病发生率增加的一个重要因素。
然而,越来越多的科学研究显示,适度运动对心血管系统具有积极的保护作用。
本文将从不同角度探讨运动对心血管系统的保护作用。
二、运动与高血压高血压被认为是引起心血管疾病发生和发展的重要风险因素之一。
大量证据表明,适度有规律的运动可以有效预防和改善高血压。
通过长期锻炼,运动可以增加人体内氧化还原平衡,减少氧化应激反应,并促进降低外周阻力和中枢神经系统紧张。
此外,合理的运动还可以促进静息时能量消耗,并提高胰岛素敏感性,维持良好的葡萄糖代谢。
三、运动与动脉硬化动脉硬化是心血管疾病的主要原因之一,然而适度运动可以减缓动脉硬化的进程。
通过运动,体内会产生大量一氧化氮(NO),这种物质能够抑制血小板聚集和粘附,并扩张血管,从而改善血液循环,减少动脉粥样硬化斑块形成。
此外,适度运动还能增加细胞色素C氧化酶(Cytocrome C oxidase)的活性,提高线粒体功能及配体激活受体(PPARs)表达水平。
四、运动与冠心病冠心病是心血管系统常见的一种疾病,但适度运动对预防和治疗冠心病都有明显效果。
长期经常参与有氧运动可以显著降低罹患冠心病的风险。
有氧运动通过增加最大摄氧量和改善心肺功能来提高机体整体耐力,并且能够降低低密度脂蛋白胆固醇(LDL-C)水平,增加高密度脂蛋白胆固醇(HDL-C)水平,改善血脂代谢。
此外,通过适度运动还可以提高冠状动脉内皮细胞功能,促进新生血管形成,并减少炎症反应。
五、运动与心律失常心律失常是心血管系统的一种常见疾病,而适度运动对改善心律失常有着积极的效果。
适度运动有助于提高心肌收缩力和耐力,增加自主神经调节机制的灵活性,使得心律更加稳定。
此外,运动还可以降低交感神经系统的兴奋性,减少室上性和室性早搏的发生。
·综述·SYSTEMS MEDICINE系统医学系统医学2019年10月第4卷第20期卫生健康事业发展70年巡礼增强型体外反搏(EECP)又被称为被动的“运动”,以其安全、有效、经济、简便、无创等独特优势受到学术界的广泛关注。
目前,EECP 已成为冠心病患者长期治疗的重要选择,也已成为了冠心病一、二级预防的有效手段。
1EECP 的发展简史增强型体外反搏(EECP)英文全称为enhanced external counterpulsation,其雏形的诞生应上溯至20世纪60年代,当时在美国哈佛大学有位名为Soroff 的教授,发明了一种“液压非序贯式”ECP,但因存在设计上的不合理性而未能得到推广。
20世纪70年代初期,中山医科大学郑振声教授带领团队在前人经验基础之上,攻关研发出四肢气囊序贯加压式ECP,10年后再加用了臀部反搏气囊,即研发成型了EECP,由于其设计合理、效果突出而广受国内外学术界的认可[1-3]。
至20世纪90年代,EECP 正式获批进入了美国市场,在临床应用的过程中又逐步迈入全球市场,其应用范围涵盖全世界30多个国家、地区。
21世纪初期,EECP 又被美国心脏协会和美国心脏病学会(AHA/ACC)纳入冠心病临床治疗指南中,其后又被中华医学会心血管病分会、欧洲心脏病学会(ESC)纳入指南,成为具有有力理论、实践依据的冠心病康复治疗方法之一。
2EECP 的结构特点EECP 主要是由3对充气囊套构成的,它们分别在小腿、大腿和臀部进行缠绕。
EECP 可跟踪人体的心电波,当出现R 波时就作为信号进行触发,并且与心脏搏动是同步的,当心脏处于舒张早期时,EECP 由远端向近端序贯式充气、加压,促使循环血液反流向主动脉,有助于增加重要器官如心、脑、肾血液灌DOI:10.19368/ki.2096-1782.2019.20.193增强型体外反搏在冠心病康复治疗中的应用研究进展贾晓云南宁市第三人民医院心内科,广西南宁530003[摘要]近年来随着冠心病发病率的逐年走高,它成为严重威胁人类的健康问题之一。
常用标识中英文对照(医院各科室中英文对照)急诊室——Emergency Room 医院——Hospital 内科病房——Medical Ward 外科病房——Surgical Ward 儿科病房——Pediatric Ward 接生房——Labor and Delivery 手术室——Operation Room (OR) 心脏重症室——Coronary Care Unit (CCU) 重症室——Intensive Care Unit (ICU) 内科重症室——Medical Intensive Care Unit (MICU) 初生婴儿重症室——Neonatal Intensive Care Unit (NICU) 儿科重症室——Pediatric Intensive Care Unit (PICU) 外科重症室——Surgical Intensive Care Unit (SICU) 末期护理——Hospice 居家健康服务、药疗、物理治疗等——Home Health Service 化验所(进行化验研究)——Laboratory 门诊手术中心(一般非严重性手术)——Outpatient Surgical Center 药房(药物、医疗用品)——Pharmacy 医疗服务——Health Care Provider 医生——Physician 针灸——Acupuncture 过敏性专科——Allergy and Immunology 麻醉科——Anesthesiology 心脏科——Cardiology 心胸外科——Cardio-Thoracic Surgery 脊椎神经科——Chiropractic 结肠直肠外科——Colorectal Surgery 牙科——Dentistry 皮肤科——Dermatology 内分泌科——Endocrinology 家庭科——Family Practice 肠胃科——Gastroenterology 普通全科——General Practice 普通外科——General Surgery 老人病专科——Geriatrics 血液科——Hematology 肝病专科——Hepatology 传染病科——Infectious Disease 内科——Internal Medicine 肾脏科——Nephrology 神经科——Neurology 神经外科——Neurosurgery 妇产科——Obstetrics-Gynecology 癌症专科——Oncology 眼科——Ophthalmology 验光科——Optometry 骨外科——Orthopedic Surgery 整骨疗科——Osteopathy 耳鼻喉科——Otolaryngology (ENT) 病理科——Pathology 小儿科——Pediatrics 整形外科——Plastic surgery 足科——Podiatry 精神治疗科——Psychiatry 物理康复科——Physiatry 物理疗法及恢复正常生活护理——Physical Medicine and Rehabilitation 肺科——Pulmonary Medicine 癌症放射疗科——Radiation Oncology X光科——Radiology 泌尿科——Urology 血管外科——Vascular Surgery 其它医疗专业人员——Other Health Care Professionals 听觉学专家——Audiologist 牙医助理——Dental Assistant 饮食指导员——Dietitian 遗传病辅导员——Genetic Counselor 健康技员——Health Technician 化验技员——Laboratory Technician 医务助理——Medical Assistant 医学技师——Medical Technologist 护士——Nurse 家访护士——Home Visiting Nurse 接生护士——Nurse Midwife 营养专家——Nutritionist 药剂师——Pharmacist 药理学专家——Pharmacologist 物理治疗员——Physical Therapist 医生助手——Physician#39;s Assistant 心理学专家——Psychologist 心理辅导员——Psychologic Counselor 呼吸治疗员——Respiratory Therapist X光科技员——X-Ray Technician 总值班室——general staff on call 康复门诊——rehabilitation out-parient 神经外科——department of neurosurgery 卫生间——rest room 男卫生间——toilet(male) 女卫生间——toilet(female) 开水间——water supply room 储藏室——store 静——keeping quite 医生办公室——doctor office 处置室——disposal room 换药室——dressing room 医务人员洗手间——medical workers toilet 盥洗室——laundry room 挂号收费处——registration charge 门诊——out-parient 急诊——emergency 请勿吸烟——no smooking 神经内科门诊——neurology consultant room 抢救监护室——critical care and monitoring room 神经外科门诊——neurosurgery out-patient clinic 急诊外科——surgery 清创手术室——operation room 骨科急诊——orthopaedics emergency 石膏室——plaster room 急诊内科——internal medicine 眼科急诊——ophthal mology emergency 住院收费——inpatient charging service 西药房——pharmacy 化验室——laboratory 输液室——transfusion room CT、拍片、B 超——X-ray、B ultrasound 病理科——department of pathology检验中心——laboratory center emergency 急诊 ICU 病房——ICU ward 检验诊断中心——Lab.Diagnosis center 急诊手术室——emergency operation room 神经内科病房——neurology ward 综合病房——general ward 康复病房——rehabilitation ward 创伤病房——trauma ward 急救中心——first aid center 急诊化验室——emergency laboratory 急诊住院收费处——emergency inpatient charging service 被服室——quilt and clothing room 急诊挂号收费——registration charge emergency 拍片室——radiographic room 值班室——staff on call 内科值班室——physican on call 外科值班室——surgeon on call 骨科值班室——orthopaedics onwatch 护士值班室——nurse staff on call 行政办公——administrative office 科研中心——scientific research center 方便门诊——easy-access clinic 骨科1-3 ——orthopaedics1-3 疼痛门诊——pain clinic 肿瘤外科(甲状腺乳腺专科——oncology surgery(thyroidbreast) 血管外科、肛肠外科——vascular surgery. Anorectal surgery 肝胆外科、肝移植外科——hepatobiliary surgery liver transplantation surgery 小儿外科——pediatrics surgery 换药室——dressing room 肝病门诊——liver disease clinic 肠道门诊——intestine clinic 1-5 号 X 机房——x-ray room 1-5 肠道门诊治疗室——treatment room 肠道门诊观察室——observation infectious disease room 呼吸道传染病门诊——respiratory infectious clinic 感染科更衣室——dressing room 感染科门诊——infectious disease 腹部外科、腹腔镜外科——abdominal surgery laparoscope surgery 洗片室——filming room 呼吸内科(哮喘门诊)——respiratory medicine asthma clinic 呼吸内科(鼾症门诊)——respiratory medicine snoring clinic 放疗科——radiotherapy 读片室——diagnosis room CT2 室——CT 2 room 乳腺钼靶机房——mammography room 核医学科——nuclear medicine 神经内科(失眠门诊)——neurology(insomnia clinic) 神经内科(癫痫门诊)——neurology(epilepsy clinic) 神经外科——neurosurgery 心胸外科微创外科——cardiothoracic surgery. mini-invasive surgery 心血管内科高血压门诊——cardiology hypertension clinic 心血管内科——cardiology 消化一科 1-2——gastroenterology1-2 血液内科化疗科——hematology chemotherapy clinic 数字胃肠——digital gastrointestinal graphy 导管室——catheter lab 普通内科门诊——medicine 消化二科——gastroenterology 干部保健门诊——VIPclinic 病理质控中心——pathology quality control center 学术活动室——academic room 暗室——dark room 标本存放室——specimen deposit 计划生育室(无痛人流室)——family planning 高位妊娠门诊——high-risk pregnancy clinic 产科宣教室——obstetrics education 真菌室——fungus lab 肾内科——nephrology 男性科——andrology 泌尿外科——urology 妇科 1-4——gynecology 1-4 产前筛查中心不孕不育遗传病咨询门诊——antenatal screening center inferitillity clinic 皮肤病性病科——dermatology STP clinic 足病门诊脱发门诊——podiatry clinic trichology clinic 光治疗室——phototherapy room 内分泌内科、糖尿病科——endocrinology diabetes clinic 甲状腺内科、风湿病科——thyroid clinic、rheumatology 冷冻切片室——frozen section room 染片室——stain room 专家门诊——specialist clinic 主任办公室——directors office 免疫组化室——immunohistology lab 巨检室——cutting room 测听室——audiometry room 检查室——examination room 细菌室——bacteriology lab 示教室——conference room 免疫室——immunology lab 出凝血室——thrombushemostasia room 生化室——biochemistry lab 放射室——radio-immunology room HIV 初筛实验室——HIV screen lab 护士站——nurse station 护士值班室——on-duty room B 超心电图室——ultrasonography room ECG room 被服消毒室——disinfection room 配餐室——kitchen 病区洗手间——toilet 人工肝治疗室——alss room 医生办公室——doctor’s office 病区淋浴房——bath room 抢救室——intensive-care room 妇瘤门诊——gynecologic tumour clinic 核医学科——nuclear medicine clinic 制模室——mould room 物理室——physical room 热疗室——thermotheraphy room 钴 60 治疗室——CO-60 room 后装治疗室——brachytherapy room 直线加速器机房——accelerator room 术中放疗手术室——IORT room 操作室——operation room 模拟定位机——simulator 病房大楼——inpatient building 产科——obstetrics ward 新生儿护理中心——newborn nursing center 配电室——power station 污洗间——washing room 隔离产房——isolated delivery room 分娩室——labour room 产前准备室——antepartum preparation room 电子监护中心——electronic monitoring room 公共空间大厅 Hall 中药局 Chinese Medicine Pharmacy 公用电话Public Telephone/Pay Phone/Telephone/Public Phone 日常生活训区 Daily Activity Training 日间门诊Clinic Area 日间院 Adult Day Care Center 日间照护 Day Care Center 出院室 Discharge Office 加护病房 Intensive Care Unit(ICU) 打卡刷卡区Clock In / Out 民众意箱Suggestions 各科门诊 Out-Patient Departments(OPD) 早产儿室 Premature Babies 自动提款机 ATM 住院室 Admissions佛堂 Buddhist Prayer Room 吸烟区 Smoking Area 志工服务台Volunteer Services 志工室 Volunteers 衣室 Dressing Room 巡箱 Patrol Box 夜间门诊 Evening Clinic 居家护 Home Health Care 居家护室Home Health Care 服务台(询问处)Information 注射室 Injections 治室 Treatment Room 社福卫教室Social Work and Health Education 门诊大厅Outpatient Hall 门诊注射室 Outpatient Injection 门诊部Out-patient 门诊满意调查回收意箱 Suggestion Box 门诊检验 OPD Laboratory 待产室 Labor Room 急诊暂观察室 ER Observation Room 恢室 Recovery Room 候诊区 Waiting Area 员工意箱 Suggestions 晒衣场 Clothes Drying 气喘卫教室Asthma Health Education Room 消毒室 Sterilization 消毒锅区Equipment Sterilization 病房Ward 病毒室Viral Laboratory 健儿门诊 Well Baby Clinic 医院常用中英文对照汇编公共空间健保卡换卡服务中心National Health Insurance Card Renewal 健检中心Physical Examination Center 健检室Physical Examination 产后妇中心Postpartum Care Center 产后护之家 Postpartum Care 发烧筛检站 Fever Clinic 诊室 Consulting Room 新生儿病房Neonatal Ward 隔检疫舍 Quarantine House 团体治室 Group Therapy 语言治室 Speech Therapy 药处 Medicine Receiving 卫教公布 Health Education Bulletin Board 卫教室 HealthEducation Office 婴儿室Baby Room 检查室Examination Room 总层引 Floor Plan 转诊中心 Referral Center 药物谘询 Drug Information 药库 Drug Storage 护之家 Nursing Home 台Terrace 接待,服务及休闲区水间Kitchen / Drinking water / Hot Water 饮水机 Drinking Fountain 配膳间 Meal Checking 发厅 Barbershop 美发(容)院 Beauty Salon 商店街Shopping Arcade 员工餐厅Staff Restaurant / Cafeteria 餐厅 Restaurant 西餐厅 Western Restaurant 贵宾室 Guest Room / Reception 会客室 Reception Room 休息室Lounge 家属休息室 Lounge 图书室 Library 阅览室 Reading Room 放映室Projection Room 影印室Copy Room 育婴室Nursery Room / Mother and Baby Room 哺乳室 Nursery Room 值班室 Duty Room 驻警室 Security 警卫室 Security Room 接待,服务及休闲区停管中心Parking Service Center 调室Dispatch Room 司机室/司机调室Drivers‘ Lounge 值日室Duty Room 值班休息室Duty Office 医师休息室Physicians‘ Lounge 宿舍Dormitory 儿童游戏场Recreation Area 医器材贩卖部 Medical Supply Dispensary 爱心椅 Courtesy Wheelchairs 椅借用区 Movable Beds 政单位人资源部 Human Resources Department 人事室 Personnel Office 人事组Personnel Section 人事处Department of Personnel 公安室Industrial Safety Office 工务科Maintenance 公关室 Public Relations Room (Office) 文卷室Documentation and Archives Office 主计室Comptroller Office 出纳室Cashier 出纳课Cashier Section 民诊处Civilian Administration Division 企划室Strategy Planning Office 企划组 Planning Section 企划组 Planning and Management Section 企划管部 Planning and Management Division 安全卫生室 Labor Safety and Hygiene 成本执组Cost Management Section 收发室Mail Room 政副院长室Administrative Deputy Superintendent 政管中心Administration 住/出/转院 Admission/Discharge/Transfer 住院病组 Inpatient Records Unit 兵役复检室 Military Service Examination 批价柜台Cashier 系统组System Engineering Section 防台中心 Typhoon Emergency Center 社会服务室Social Worker Room 社区副院长室Community Deputy Superintendent 社会服务科 Social Service Section 门诊病组 Outpatient Records Unit 保险作业组 Insurance Declaration Section 急诊批价 ER Cashier 科主任办公室Dept. Chief Office 政单位疾病分析组Diseases Classification Unit 病室/组Medical Records Room/Unit/Section 医院常用中英文对照汇编门诊组Outpatient Unit/Section 住院组 Inpatient Admissions 秘书室 Administration Office 院长室 Superintendent 挂号柜台Registration 采购组 Procurement Section 教学组 Teaching Section 工安全卫生室Occupational Safety Office 安室Work Safety Office 安课Labor Safety Section 程式组Application Programming Section 勤务中心 Service Office 感染控制委员会Infection Control Commission 会计室Accounting Office 会计组 Accounting Section 资讯管部Information Management Division 稽核组 Auditing Section 卫材供应组 Medical Supply Section 档案室 Archives 营养部Food & Nutrition Department 总务室 General Affairs Office 总务组 General Affairs Section 医品组 Quality Assurance Section 医勤组Medical Service Section 医学工程室Medical Engineering Office 医副院长室 Medical Deputy Superintendent 药剂科主任室 Pharmacy Chief 床科部中医科Chinese Medicine 中医科-内科 Chinese Internal Medicine 中医科-针灸科 Chinese Acupuncture 小儿科 Pediatrics 小儿科-心脏 Pediatric Cardiology 小儿科-外科 Pediatric Surgery 小儿科-心肺 Pediatric Cardiopulmonary 小儿科-感染 Pediatric Infectious Diseases 小儿科-胃肠 Pediatric Gastroenterology 小儿科-眼科 Pediatric Ophthalmology 小儿科-神经科 Pediatric Neurology 小儿科-遗传科 Pediatric Genetics 小儿科-预防注射 Pediatric Vaccinations 床科部小儿科-一般门诊 Pediatrics 医院常用中英文对照汇编小儿科-青少门诊 Adolescent Health 小儿科-过敏免疫风湿科Pediatric Allergy Immunology 小儿科-血液肿瘤科 Pediatric Hematology & Oncology 小儿科- 科 Pediatric Urology 小儿科-内分科 Pediatric Endocrinology 小儿科-重症医学科Pediatric Intensive Care 新生儿科加护病房 Newborn ICU 小儿加护病房 Pediatric ICU 儿童急救加护医学科 Pediatric Emergency and Critical Care Medicine 小儿心肺功能室Pediatric PFT 优生保健科Perinatal Genetics 内科Internal Medicine 内科-一般门诊Internal Medicine:General 内科-日间化学治 Day Chemotherapy 内科-胃肠科 Gastroenterology 内科-胸腔科 Pulmonary Medicine 内科-肾脏科 Nephrology 内科-内分科 Endocrinology 内科-内分暨代谢科 Endocrinology and Metabolism 内科-心脏(血管)内科 Cardiology Dept. 内科-血液肿瘤科 Hematology and Oncology 内科- 人医学门诊 Geriatrics 内科-过敏免疫风湿科 Rheumatology/Immunology/Allergy 内科-神经 Neurology 内科加护病房MICU 内科-肝胆胰内Hepatic-biliary-pancreatic Medicine 内科-感染科Infectious Disease 牙科 Dentistry(Dental)Dept. 家庭牙医科Family Dentistry 牙科-特别门诊Dental Specialty Clinic 牙科一般门诊(初诊)Dental Clinic-Initial Visit 牙科复诊(约诊)Dental Clinic-Appointment Only 口腔颚面外科Oral Maxillo-facial Surgery 口腔病诊断科 Oral Pathology 齿颚矫正科 Orthodontics 儿童牙科 Pediatric Dentistry 牙周病科 Periodontics 补缀科 Prosthodontics 外科 Surgery 外科-小儿 Pediatric Surgery 外科-骨科 Orthopedics 外科-神经 Neurosurgery 外科-手外科 Hand Surgery 外科-消化系Gastrointestinal Surgery 外科-一般门诊 Surgery-General Clinic 床科部外科-大肠直肠 Colo-rectal Surgery 外科-整形 Plastic Surgery 医院常用中英文对照汇编外科-甲腺乳腺 Thyroid and Breast Surgery 外科-乳房 Breast Surgery Clinic 外科-心脏Cardiac Surgery 外科-心脏血管Cardiovascular Surgery 外科-胸腔 Thoracic Surgery 外科-美容外科 Cosmetic Surgery 外科-肝胆 Hepatic Surgery 外科-肝胆胰外 Hepatic-biliary-pancreatic Surgery 外科-重建整形 Plastic & Reconstructive Surgery 外科-胃肠及一般Gastroenterology & General Surgery 骨外伤科 Orthopedic Traumatology 外科加护病房Surgery ICU 皮肤科Dermatology 皮肤科-一般门诊 Dermatology-General Clinic 皮肤科-职业性皮肤病 Occupational Dermatology 耳鼻喉科ENT Dept.(Otolaryngology) 耳鼻喉科-一般门诊 General ENT Clinic 耳鼻喉科-门诊小手术 Minor Surgery 耳鼻喉科-鼻窦内视镜门诊Sinus Endoscopy 科Urology 科-一般门诊Urology-General Clinic 科- 性失禁 Incontinence Clinic科-男性孕症Male Infertility Clinic 科-性功能障碍Sexual Dysfunction Clinic 孕症学科 Infertility 妇产科Obstetrics and Gynecology 妇产科- 孕症Infertility Clinic 妇产科-子宫颈癌 Cervical Carcinoma Clinic 妇产科-羊水穿Amniocentesis 妇产科-妇科肿瘤Gynecological Oncology 妇产科-子宫颈病变 Cervical Dysphasia Clinic 妇产科-妇期Menopause Clinic 妇产科-快速子宫颈抹片Express Smear Service 妇产科-抹片及乳房检查 Pap Smear 妇癌科 Gynecologic Oncology 妇科学科 Gynecology Urology 眼科 Ophthalmology 眼科-青光眼 Glaucoma Clinic 眼科-斜弱视 Strabismus and Amblyopia 眼科-视网膜 Retina Section 眼科-一般门诊 Optometry-General Clinic 眼科-兵役检查Military Service Eye Exam 眼科-配光检查 Optometry 眼科-视保健 Vision Protection Clinic 床科部眼科-萤光摄影Fluorescent Photography 眼科射Ophthalmologic Laser Therapy 精神科 Psychiatry 医院常用中英文对照汇编精神科-身心内科 Psychosomatic Clinic 精神科-焦虑忧郁失眠门诊Anxiety and Insomnia Clinic 精神科-癌症团体心治 Group Cancer Therapy 精神科-儿童青少特别门诊(限 18 岁以下) Youth Psychiatry 放射线科Radiology 核医科Nuclear Medicine 疼痛科Pain Management 麻醉科Anesthesiology(Anesthesia) Dept. 健科 Rehabilitation 解剖病科Anatomical Pathology 预防注射科Prophylactic Immunization 病科 Pathology 青少谘询特别门诊 Juvenile Psychiatry Department 肿瘤科Oncology 神经内科Neurology 神经外科Neurosurgery 家庭医学科Family Medicine 社区医学部 Community Medicine 心血管加护病房Cardiac CU(CCU) 心血管中心 Cardiovascular Center 心脏血管外科加护病房 Cardiovascular Surgery ICU 急诊 Emergency Dept. 急诊医学科 Emergency Medicine 内视镜科 Endoscopy Section 血液透析 Hemodialysis 肝胆科 Hepatology 高危险妊娠症学科 High-risk Pregnancy 安护 Hospice Center 职业病科 Occupational Medicine 放射肿瘤科 Radiation Oncology 保健科 Preventive Medicine 运动医学科 Sport Medicine 肺结核加护病房 TBICU 外伤加护病房 Trauma ICU 健康检查中心Health Evaluation Center 脑血管中心Cerebral Vascular Clinic 神经医学中心 Brain Center 烧伤中心 Burn Center 癌症中心 Cancer center 癌症防治中心 Cancer Control and Prevention Center 高压氧治中心Hyperbaric Oxygen Therapy Center 肥胖防治中心 Weight Reducing 床科部洗肾中心Hemodialysis Center 医学美容中心Medical Cosmetic Center 医学影像中心 Medical Image Center 运动健中心Rehabilitation-Exercise Center 医院常用中英文对照汇编病人保健推广中心Diabetic Center 中西合作医中心Chinese-Western Cooperative Treatment Center 社区护 Home Care 护之家 Nursing Home 护部 Nursing Dept. / Nursing Department 护长室Head Nurse 医技术CT 登记处CT Admission X 光摄影室(借片室)X-ray Room 孕症谘询室Infertility Consultation Room 内分检查室Endocrine Examination Room 内科诊查室 Internal Medicine Clinic 内视镜室 Endoscopy 化学治 Chemo-Therapy 心电图室 EKG 心导管室Cardiac Catheterization Room 心脏血管中心Cardiovascular Center 心脏血管检查室Cardiovascular Examinations 心脏超音波Heart Echo 水室Hydrotherapeutics 生化实验室 Biochemical Lab 生检查科Physiological Exam 皮肤病诊断中心Dermological Pathological Center 石膏室 Plaster Room 光子刀治中心Photon Knife Center 多功能超音波室 Multi-Function Echo Room 肌电图室 EMG 血库 Blood Bank 血液肿瘤科 Hematology 血清免疫学实验室 Immu-serological Lab 血管功能检查室Vascular Function Test 血管摄影室 Cardiac Angiography 动检查室 Urokinetic Exam. Room 技术室 Technical Support Division 乳房超音波 Breast Echo 乳房摄影室 Mammography 儿童治室 Pediatric Therapy Room 儿童物治室 Pediatric Physical Therapy 儿童职能治室 Pediatric Occupational Therapy 呼吸治Respiratory Therapy 放射免疫分析室Radioimmunoassay Unit 放射科登记室Radiology Registration 医技术放射线治科 Radiotherapy 科微波热室 Genitouro Urologic 超音波 Urology Echo 物治 Physical Therapy 物职能治室 Occupational and Physical Therapy 医院常用中英文对照汇编肺功能 PFT 肺功能室 Pulmonary Function Testing 门诊检验 Oupatient Check-UPS 门诊体检Physical Check-Ups 急诊X 光室ER X-Ray Room 胃镜室Endoscopy Room 胎儿影像中心 3D Live Image Center 气管镜室 Bronchoscopy Room 特殊检查室 Special Examination 胸部超音波 Chest Echo 闪烁摄影室 Diagnostic Imaging Unit 骨质密检查室Bone Density 骨骼肌肉超音波室Echo for Skeletal Muscles 采室Urine Collection Room 产房Delivery Room 细胞遗传室Cytogenetics 细菌研究室Bacterial Laboratory 麻醉科实验室Anesthesiology Laboratory 健科治室 Rehabilitation Therapy 紫外线光室Ultraviolet Therapy 肾功能室 Renal Function 肾脏超音波Renal Echo 视检查室 Check-up for Eye Sight 周边血管室Peripheral Vascular Examination 微生物实验室Microbiological Lab 新生儿观察室Observation Room-New Born Babies 眩检查室Vertigo Test 准分子射室Laser Treatment 腹部超音波 Abdominal echo 腹膜透析室 CAPD 脑波室EEG Unit 解剖病科实验室Anatomical PathologyLaboratory 运动治室 Therapeutic Exercise Room 射治室Laser Therapy 电脑断层摄影室CT Scan Unit 电室Electrotherapy Room 磁振造影扫描室 MRI Unit 膀胱功能室Bladder Function Test 膀胱镜室 Cystoscopy Room 语言治Speech Therapy 器官移植 Organization Transplantation 医技术检伤分 Triage 检验室 Laboratory 检验科 Laboratory Medicine 检体收发室 Specimen Collection 检体受紧急报告取 Emergency Procedure 检体处室 Lab Samples 医院常用中英文对照汇编营养室 Nutrition Dept. 床病室 Clinical Pathology 职能治Occupational Therapy 医务室(医站)Clinic 药剂科(药局)Pharmacy 摄影室 Digital Image 听检查室 Hearing Exam. Room 体外震波碎石机 Lithotripsy 机械及电器场所总机Phone Operator‘s Room 库房/储藏室/材库Storeroom / Storage 卸货区Loading Area 变电室Transformer Room / Substation /Power Room 变电站 Power Sub-station 电气室Electrical Control Room / Electric Room 配电室Electrical Distribution Facilities 中控室Central Control Room 中央控制室 Control Center 能源设施部 Power Supply Division 机械室 Machine Room 工具间 Tool Room 电脑机房Computer Facilities 资讯室机房Data Processing 发电机房Generators 空调机房Air Conditioning Facilities 空调机械室Air ConditioningFacilities / Air-con Plant 紧急出口/安全门 Emergency Exit 安全门Exit 避难方向Evacuation Route 灭火器Fire Extinguisher 缓机/缓梯Escape Sling 消防箱Fire Hose/Hydrant 逃生梯Emergency Ladder 通报设备Alert Facilities 紧急照明Emergency Light 消防设备/消防栓Hydrant 紧急电源 Emergency Power 紧急避难梯 Emergency Ladder / Emergency Staircase 防空避难处 Air-raid Shelter 会议场所及教室会议室 Conference Room 简报室 Briefing Room 讨室 Meeting Room / Seminar Room 阅览室 Reading Room 研讨室Meeting Room,Seminar Room 医师研究室Physicians‘ Office 医师讨室Physicians‘ Meeting Room 医院常用中英文对照汇编研究室 Study Room 音控室 Audio Contral Room 演讲厅(大堂)Auditorium 演讲室 Lecture Room 国际会议厅 Conference Hall 第一会议室 Conference Room I 第二会议室 Conference Room II 会议室及图书室 Conference Room and Library 盥洗场所化妆室/ 厕所Women‘s Restroom / Ladies‘ Restroom 男化妆室/男厕所Men‘s Restroom / Gentlemen‘s Restroom 洗手间/盥洗室 Restroom 身心障碍专用厕所 Disabled Restroom 浴室 Shower 储藏及仓库中央供应室 Central Supply Center 中央库房 Central Storage 供应室Supply Room 清洁工具室Janitors Room 急诊清洁室ER Janitor 洗衣房 Laundry 汅物间 Soiled Materials 清洁班Cleaning Crew 告示或警告标示施工中 Under Construction 禁止吸烟 No Smoking 禁止饮食 No Food or Drink 禁食槟榔Chewing betel nut is prohibited 禁止携带物 No Pets 严禁烟火 No Open Flames 请勿(禁止)进入 No Entry 闲人勿进Authorized Personnel Only 节约用水 Please Conserve Water 请勿攀爬No Climbing 请用雨伞套Please Use Plastic Umbrella Cover 随手关门 Keep Closed 随手关灯 Turn Off Lights When Leaving 高压危险,有电勿靠近 Keep Clear-High Voltage 电器设备,严禁擅入 Do not enter!Power Equipment 告示或警告标示请取号码牌,静候叫号时迳往挂号处挂号 Take a number. Go to counter when number is called. 防火门火警时随手关门 Fire Escape-Please Keep Closed 避难出口高逃生缓机 Emergency Exit & Escape Sling 紧急疏散方向图Evacuation Plan 禁止将投手伸出扶梯外Please do not stretch out your hand or head 您的位置 You are here 电梯内请勿交谈,请戴口罩 Do not talk in elevator,Please put on respirator 医院常用中英文对照汇编严禁工作人员戴手套触摸按钮 Employee, pushing buttom with your grove on is prohibited 资源回收及垃圾资源回收/垃圾分 Recycling 塑胶Plastic 垃圾桶 Trash 垃圾处室 Disposal Area 特殊空间太平间Morgue 其它药物医药分业谘询专线Medical and Pharmaceutical Consultation Inquiries 申诉案件及政革新专线Citizens‘ Hotline 身体健康检查谘询预约服务专线Physical Examination 出入口及专用道请勿停 No Parking 请勿暂停 No Standing 身心障碍专用坡道 Disabled Ramp 入口Entrance 出口 Exit / Way Out(标示於地面) 遵方向 This Way 汽出入口 Vehicles Exiting 入口道 Parking Entrance 位已满请勿进入No Vacancy 限高Max Headroom 停场停场(区)Parking Lot 平面停场Parking Lot 地下停场Underground Parking 体停场 Parking Tower 宾专用停位Reserved Parking 机停位 Motorcycle Parking 身心障碍专用停位 Disabled Parking Only 院内员工专用停场 Staff Only 计程招呼站 Taxi Stand 停场救护 Ambulance 电(扶)梯及梯电梯Elevator 电扶梯Escalator 紧急用电梯Emergency Elevator 梯 Stairs 访客电梯 Visitor Elevator 本电梯直达 6-12 Floor 6 and 12 Only 本电梯限停 1-5 层1,2,3,4,5 Only 医院常用中英文对照汇编书表慢性病续处方笺Chronic Illness Prescription Slip 慢性病续处方笺Chronic Continuous Prescription 慢性病续处方笺 Refill Presriptions For Chroni Disease 诊断书Medical Certificate 挂号费Registration Fee 证明费Certification Fee 费Ambulance Fee 特定医费Special Medical Fee 部份负担费Self-Payment Fee 诊察费Diagnostic Fee 病房费 Ward Fee 伙食费 Diet Fee 检查费Laboratory Fee 放射线诊费X-Ray Fee 治处置费Therapeutic Treatment Fee 手术费 Operation Fee 健治费Rehabilitation Therapy 血液血浆费 Blood Product Fee 血液透析费 Hemodialysis Fee 麻醉费 Anesthetic Fee 特殊材费Special Medical Supply Fee 药费 Medicine Fee 药事服务费Medicine Service Fee 精神科治费 Psychiatric Treatment Fee 注射技术费 Injection Fee 婴儿费 Infant Fee 特定健保费 Special N.H.I. Fee 病影印 Medical Records Copying 出院病Dischargged Medical Records 门诊申报Outpaitent Declareation 住院申报 Inpatient Declareation 卫生部对医院各科室中英文对照的标识牌作出了规范以便于医院的引导标识导卫生部对医院各科室中英文对照的标识牌作出了规范以便于医院的引导标识导向设计规范化,国际化。
No. 定期刊名称排列定期刊简称排列参考中文名称影响因子降序 1 Circulation Circulation 循环14.595 ↑ 2 Journal of the American College of Cardiology J Am Coll Cardiol 美国心脏病学会志11.438 ↑ 3 Circulation Research Circ Res 循环研究9.989 ↑ 4 European Heart Journal Eur Heart J 欧洲心脏杂志8.917 ↑ 5 Hypertension Hypertension 高血压7.368 ↑ 6 Arteriosclerosis, Thrombosis, and Vascular Biology Arterioscler Thromb Vasc Biol 动脉硬化、血栓形成与血管生物学6.858 ↓ 7 Atherosclerosis Supplements Atheroscler Suppl 动脉粥样硬化6.559 ↑ 8 Nature Clinical Practice Cardiovascular Medicine Nat Clin Pract Cardiovasc Med 自然临床诊疗:心血管医学5.972 ↑9 Cardiovascular Research Cardiovasc Res 心血管研究5.947 ↓ 10 Basic Research in Cardiology Basic Res Cardiol 心脏病学基础研究 5.407 ↑ 11 Journal of Hypertension J Hypertens 高血压杂志5.132 ↑ 12 Journal of Molecular and Cellular Cardiology J Mol Cell Cardiol 分子与细胞心脏病学杂志 5.054 ↓ 13 Heart Heart 心脏 4.964 ↑ 14 Progress in Cardiovascular Diseases Prog Cardiovasc Dis 心血管病研究进展4.714 ↑ 15 Atherosclerosis Atherosclerosis 动脉粥样硬化4.601 ↑ 16 Heart Rhythm Heart Rhythm 心脏节律4.444 ↑ 17 American Heart Journal Am Heart J 美国心脏杂志4.285 ↑ 18 Trends in Cardiovascular Medicine Trends Cardiovasc Med 心血管医学趋势4.121 ↓ 19 Cardiovascular Drug Reviews Cardiovasc Drug Rev 心血管药物评论4.114 ↑ 20 Heart Failure Reviews Heart Fail Rev 心力衰竭评论4.015 ↑ 21 American Journal of Cardiology Am J Cardiol 美国心脏病学杂志 3.905 ↑ 22 Thrombosis & Haemostasis Thromb Haemost 血栓形成和止血 3.803 ↑ 3 Seminars in Thrombosis and Hemostasis Semin Thromb Hemost 血栓形成与止血法论文集 3.695 ↑ 24 American Journal of Physiology - Heart and Circulatory Physiology Am J Physiol Heart Circ Physiol 美国生理学杂志-心脏与循环生理学3.643 ↓ 25 Current Vascular Pharmacology Curr Vasc Pharmacol 最新血管药理学3.582 ↓ 26 Nutrition, Metabolism, and Cardiovascular Diseases (NMCD) Nutr Metab Cardiovasc Dis 营养、代谢与心血管疾病3.565 ↑ 27 European Journal of Heart Failure Eur J Heart Fail 欧洲心力衰竭杂志3.398 ↑ 28 Shock Shock 休克3.394 ↑ 29 Current Problems in Cardiology Curr Probl Cardiol 当前心脏病问题3.292 ↑ 30 Hypertension Research Hypertens Res 高血压研究 3.146 ↑ 31 American Journal of Hypertension Am J Hypertens 美国高血压症杂志3.122 ↑ 32 International Journal of Cardiology Int J Cardiol 国际心脏病学杂志3.121 ↑ 33 Current Opinion in Cardiology Curr Opin Cardiol 心脏病学新见 2.915 ↑ 34 Revista Española de Cardiología Rev Esp Cardiol 西班牙心脏病学杂志2.88 ↑ 35 Journal of Human Hypertension J Hum Hypertens 人类高血压杂志 2.637 ↑ 36 Journal of Atherosclerosis and Thrombosis J Atheroscler Thromb 动脉硬化与血栓症杂志 2.625 ↓ 37 Steroids Steroids 类固醇2.588 ↑ 38 Resuscitation Resuscitation 复苏2.513 ↓ 39 Cardiovascular Drugs and Therapy Cardiovasc Drugs Ther 心血管药物与治疗2.453 ↑ 40 Thrombosis Research Thromb Res 血栓形成研究2.449 ↑ 41 Clinical Research in Cardiology Clin Res Cardiol 临床心脏病学研究2.418 ↑ 42 Circulation Journal Circ J 循环杂志2.387 ↑ 43 European Journal of Cardiovascular Prevention & Rehabilitation Eur J Cardiovasc Prev Rehabil 欧洲心血管疾病预防与康复杂志2.361 ↑ 44 Journal of Cardiovascular Pharmacology J Cardiovasc Pharmacol 心血管药理学杂志2.29 ↑ 45 Journal of Thrombosis and Thrombolysis J Thromb Thrombolysis 血栓形成与血栓溶解杂志2.266 ↑ 46 Cardiovascular Toxicology Cardiovasc Toxicol 心血管毒理学2.222 ↑ 47 Journal of Cardiovascular Magnetic Resonance J Cardiovasc Magn Reson 心血管磁共振杂志 2.152 ↑ 48 Cardiovascular Pathology Cardiovasc Pathol 心血管病理学 1.956 ↑ 49 Current Hypertension Reports Curr Hypertens Rep 高血压症最新陈述1.885 ↑ 50 Cardiology Cardiology 心脏病学 1.837 ↑ 51 CardioVascular and Interventional Radiology Cardiovasc Intervent Radiol 心血管与介入放射学1.721 ↑ 52 Europace Europace 欧洲心脏起搏、心律失常和心脏电生理会议1.706 ↑ 53 Journal of Cardiovascular Pharmacology and Therapeutics J Cardiovasc Pharmacol Ther 心血管药物学与治疗学杂志 1.672 ↑ 54 Blood Pressure Blood Press 血压1.625 ↑ 55 Blood Pressure Monitoring Blood Press Monit 血压监测1.605 ↓ 56 Pacing and Clinical Electrophysiology Pacing Clin Electrophysiol 起搏与临床电生理学1.59 ↑ 57 Journal of Cardiovascular Nursing J Cardiovasc Nurs 心血管病护理杂志 1.471 ↑ 58 Echocardiography: A Journal of Cardiovascular Ultrasound & Allied Techniques Echocardiography 超声心动图 1.429 ↑ 59 Clinical and Applied Thrombosis/Hemostasis Clin Appl Thromb Hemost 临床与应用血栓形成与止血研究1.421 ↑ 60 Heart and Vessels Heart Vessels 心脏与脉管1.351 ↑61 Coronary Artery Disease Coron Artery Dis 冠心病1.254 ↓62 Clinical Cardiology Clin Cardiol 临床心脏病学1.211 ↑ 63 Journal of Renal Nutrition J Ren Nutr 肾病营养学杂志1.204 ↓ 64 Journal of Electrocardiology J Electrocardiol 心电学杂志 1.126 ↑ 65 Annals of Noninvasive Electrocardiology Ann Noninvasive Electrocardiol 无创心电学年鉴1.12 ↓ 66 Heart & Lung: The Journal of Acute and Critical Care Heart Lung 心与肺;危急护理杂志1.094 ↑ 67 Clinical and Experimental Hypertension Clin Exp Hypertens 临床与实验高血压 1.079 ↑ 68 Journal of Interventional Cardiac Electrophysiology J Interv Card Electrophysiol 心脏介入电生理学杂志1.075 ↓69 Cardiology in the Young Cardiol Young 青少年心脏病0.956 ↑ 70 International Heart Journal Int Heart J 国际心脏杂志0.947 ↑ 71 Vascular Vascular 脉管0.941 ↑ 72 Reviews in Cardiovascular Medicine Rev Cardiovasc Med 心血管医学评论0.935 ↑ 73 Scandinavian Cardiovascular Journal Scand Cardiovasc J 斯堪的那维亚心血管杂志0.908 ↓ 74 Texas Heart Institute Journal Tex Heart Inst J 德克萨斯心脏病学会志0.873 ↑ 75 Cardiology Clinics Cardiol Clin 心脏病临床0.753 ↓ 76 V ASA V asa 脉管病杂志0.564 ↑ 77 Herz - Kardiovaskuläre Erkrankungen Herz 心脏0.51 ↑ 78 Klinische Monatsblätter für Augenheilkunde Klin Monatsbl Augenheilkd 眼科学临床月刊0.47 ↓ 79 Journal des Maladies Vasculaires J Mal Vasc 血管疾病杂志0.373 ↑ 80 Archives des Maladies du Coeur et des Vaisseaux Arch Mal Coeur Vaiss 法国心血管集刊0.265 ↓ 81 Indian Heart Journal Indian Heart J 印度心脏病杂志 0 - 82 Japanese Heart Journal Jpn Heart J 日本意天良脏杂志0 - 83 Minerva Cardioangiologica Minerva Cardioangiol 心脏脉管学 0 - 84 Japanese Circulation Journal Jpn Circ J 日本循环杂志0 - 85 Kardiologia Polska / Polish Heart Journal Kardiol Pol 波兰心脏病杂志0 - 86 Revista Brasileira de Cirurgia Cardiovascular Rev Bras Cir Cardiovasc 巴西心血管外科杂志0 - 87 Advances in Cardiology Adv Cardiol 心脏学研究进展 0 - 88 Arquivos Brasileiros de Cardiologia Arq Bras Cardiol 巴西心脏集刊 0 - 89 Cardiovascular Diseases Cardiovasc Dis 心血管疾病 0 - 90 Arteriosclerosis Arteriosclerosis 动脉硬化 0 - 91 Zeitschrift für Kardiologie Z Kardiol 心脏病学杂志0 ↓ 92 Blood Pressure - Supplement Blood Press Suppl 血压-增刊0 - 93 Journal of Cardiopulmonary Rehabilitation (JCR) J Cardiopulm Rehabil 心肺疾病康复杂志0 - 94 Asian Cardiovascular & Thoracic Annals Asian Cardiovasc Thorac Ann 亚洲心血管与胸腔纪事 0 - 95 General Pharmacology: The Vascular System Gen Pharmacol 普通药物学 0 - 96 Cardiovascular Surgery Cardiovasc Surg 心血管外科0 - 97 Cardiovascular Journal of Southern Africa Cardiovasc J S Afr 南非心血管杂志 0 - 98 Journal of Invasive Cardiology J Invasive Cardiol 侵袭性心脏病学杂志0 - 99 Seminars in Thoracic and Cardiovascular Surgery Semin Thorac Cardiovasc Surg 胸心血管外科论文集0 - 100 Journal of Hypertension - Supplement : J Hypertens Suppl 高血压杂志-增刊 0 -。
血栓弹力图检测与临床科学合理用血的关系谭春泽;杨雪;李鹏社;傅明玮;李聚林【摘要】血栓弹力图检测是利用离体血液在体外的凝血模拟试验,操作简单、结果准确、省时、实用性强,对监测出、凝血,提示血液高凝或低凝状态,指导临床科学合理用血,发挥着重要的作用;尤其对凝血因子、血小板水平与功能的及时调整补充,包括抗凝药物的使用与控制,其针对性强,使输血更安全、有效,并减少血液浪费.应用时需注意把握不同人群各参数正常参考值的水平与个体差异.【期刊名称】《微创医学》【年(卷),期】2016(011)004【总页数】4页(P483-486)【关键词】血栓弹力图;临床输血;用血【作者】谭春泽;杨雪;李鹏社;傅明玮;李聚林【作者单位】解放军第一八一医院输血科,桂林市541002;解放军第一八一医院输血科,桂林市541002;解放军第一八一医院输血科,桂林市541002;解放军第一八一医院输血科,桂林市541002;解放军第一八一医院输血科,桂林市541002【正文语种】中文【中图分类】R457.1输血有风险,包括经血传播疾病[1,2]与非感染性并发症的风险,如过敏反应、输血相关性移植物抗宿主病(transfusion associated graft versus host disease,TA-GVHD)、输血相关急性肺损伤(transfusion related acure lung injury,TRALI)、输血相关循环超负荷(transfusion associated circulatory overload,TACO)和血型不合的溶血和免疫损害等[3]。
滥用血液还将导致临床用血越来越紧张。
在临床开展血栓弹力图(Thrombelastography,TEG)检测,可减少盲目输血,使输血更科学合理[4]。
现就有关问题综述如下。
TEG技术于1948年用于全血单个血样在体外的整体凝血功能检测[5],后被逐渐广泛应用于外科手术、重症医学、创伤、血液科等许多涉及出凝血功能领域的基础理论研究或疾病的诊治与监测[6,7]。
Cardiology and Vascular Medicine - 2011
An ESC UPDATE programme in Cardiology
Each session starts with a clinical problem, presented by the chairman (1 or 2 slides, 3 minutes). This case will be discussed in more detail in the “case presentation” at the end of the session. Monday May 23, 2011
1. An obese 67 year old man, whose brother recently had a stroke
13.30 Preventive live style
D.A. Wood (London)
14.00 Prevention of development of diabetes in high risk subjects
H.J.G. Bilo (Zwolle)
14.30 Which (primary) preventive drugs to prescribe?
J.W. Jukema (Leiden)
15.00 Secondary preventive therapy in patients with cardiovascular disease
presentation
Case
D. Poldermans (Rotterdam)
15.30 Break
2. An elderly patient with heartfailure
16.00 Heartfailure with preserved LV function
P. Ponikowski (Wroclaw)
16.30 Assessment of LV dyssynergy in heartfailure, is it possible? Is it useful?
T. Gillebert (Gent)
17.00 Convert AF in patients with heartfailure
K. Dickstein (Stavanger)
17.30 Heartfailure with mitral insufficiency, operate?
presentation
Case
K. Caliskan (Rotterdam)
reception
18.00 Welcome
Tuesday May 24, 2011
3. A young woman with a big heart
8.30 A family with sudden death (Cardiopmyopathy?)
P. Elliott (London)
9.00 Cardiomyopathy or sport-heart, how to distinguish these entities?
Mats Börjesson (Göteborg)
9.30 Myocarditis and dilated cardiomyopathy, diagnosis and management
(Maastricht)
Heymans
S.
10.00 HOCM and non-compaction cardiomyopathy
Case presentation
M. Michels (Rotterdam)
10.30 Break
4. A patient with a borderline abnormal ECG
11.00 Cost-effectiveness of primary ICD implantation for primary prevention of sudden death
L. Jordaens (Rotterdam)
11.30 Indications for ICD in patients with wide QRS
I.C. van Gelder (Groningen)
12.00 How to reduce inappropriate ICD shocks?
T. Szili Torok (Rotterdam)
12.30 Long QT syndromes
Case presentation
A.A.M. Wilde (Amsterdam)
13.00 Lunch
5. A patient with atrial fibrillation, asymptomatic
14.00 Atrial fribrillation, medical management, rate and rhythm control
H.J.G.M. Crijns (Maastricht)
14.30 Anticoagulant therapy in patients with atrial fibrillation, when, how?
L. Rydén (Stockholm)
15.00 Atrial fibrillation when to opt for ablation? Which method?
A.J. Camm (London)
15.30 A patient with atrial fibrillation
Case presentation
N.M.S. de Groot (Rotterdam)
16.00 Break
6. A young boy with abdominal pain, who cannot walk
16.30 Endocarditis with negative cultures, diagnosis
K.M. Akkerhuis (Rotterdam)
17.00 Surgical therapy for endocarditis, which patient?
A.P. Kappetein (Rotterdam)
17.30 A young boy with abdominal pain, who cannot, endocarditis
Case presentation
T.W. Galema (Rotterdam)
Wednesday May 25, 2011
7. A patient admitted with chestpain, multivessel disease after previous MI
8.30 Optimal anti-platelet therapy in Acute Coronary Symdromes
J.P. Bassand (Besançon)
9.00 PCI for multivessel disease after MI
B. De Bruyne (Aalst)
9.30 Bioabsorbable stents, restoration of “normal” vascular structure?
P.W.J.C. Serruys (Rotterdam)
10.00 A patient admitted with chestpain
Case presentation
F. Zijlstra (Rotterdam)
10.30 Break
8. A rich patient who requests the newest (drug) therapy
11.00 The long road from discovery of new drugs to reimbursement
P.A. de Graeff (Groningen)
11.30 Tele-monitoring for heartfailure
J.G.F. Cleland (Hull)
12.00 Pharmacogenetics of anti-platelet drugs
P.G. Steg (Paris)
12.30 The balance of efficacy and safety in clinical trials
M.L. Simoons (Rotterdam)
remarks
13.00 Concluding
13.15 Lunch。