心脏与血管病的预防论文

那些用机器翻译的人会为了这200分帮你翻的， 不过对于有些像我一样手工翻译的人是绝对不会费尽去翻译那10页的东西的。 只能帮你找论文。。。。

顶一楼不要把别人的热心帮助当成不劳而获的有效途径哦。

Chronic kidney disease is a risk factor for cardiovascular diseaseChronic kidney disease (CKD) is a widespread concern of public health, the incidence increased gradually, at the same time brought about serious consequences and problems. We note that the patient's renal failure is dialysis and kidney transplantation, but few scholars concerned about CKD and cardiovascular disease (CVD) relationship. Now that CKD with CVD-related, and progress than acute renal failure more likely die of cardiovascular disease, CVD is the most common CKD the cause of death [1]. Recognized that CKD is a risk factor for CVD that is very important. Only in this way will it be possible to conduct an in-depth, and then search for the prevention and treatment of related measures to ensure greater benefits for these patients. CKD is defined as biopsy or the markers of renal damage confirmed> 3 months, or GFR <60ml / ()> 3 months. Cause of disease and the general based on credits for the diabetic and non-diabetic renal disease and transplantation. Renal dysfunction by renal biopsy or related markers such as proteinuria, abnormal urinary sediment, abnormal imaging to diagnose and so on. Proteinuria is not only to prove the existence of CKD, renal disease may also become an important basis for the type of diagnosis and the severity of kidney disease and cardiovascular disease-related. Urinary albumin and creatinine ratio or total protein and creatinine ratio can be used to assess proteinuria. GFR <60ml / () renal damage as a critical value, which indicates the level of GFR is often the beginning of renal failure, including increased incidence of cardiovascular disease and the degree of risk. GFR <15ml / () will need dialysis treatment. GKD especially terminal kidney disease (ESRD) patients, CVD risk of a marked increase in general through the vascular tree to achieve. ESRD with atherosclerosis may be a causal relationship to each other, on the one hand, accelerated atherosclerosis in kidney disease progress, on the other hand, ESRD is the deterioration of many of the traditional atherosclerotic risk factors [2]. In general, CVD is the basic types of vascular disease and cardiomyopathy, the two subtypes of vascular disease is atherosclerosis and vascular remodeling, and CKD are the role of these two subtypes. Atherosclerotic plaque formation and the main obstruction in the main, CKD in atherosclerosis and the high incidence of a much wider range of diffuse atherosclerosis in a marked increase in cardiovascular disease mortality and accelerated deterioration of renal function. Atherosclerosis can lead to arterial wall thickening and myocardial ischemia matrix. In CKD patients, ischemic heart disease such as angina, myocardial infarction and sudden death, and cerebrovascular disease, peripheral vascular disease and heart failure are more common. Initially that the dialysis patients may be secondary to ischemic heart disease in easy to overload, left ventricular hypertrophy and small artery disease, resulting in reduced oxygen supply. However, studies have found that EPO in the former region, the low level of hemoglobin that also may be associated with ischemia-related. CKD patients the incidence of major vascular remodeling is higher, can lead to vascular remodeling in pressure overload, through the wall and the cavity wall thickening and increased the ratio of traffic overload, or to achieve, but mainly to increase the diameter and the wall thickness of main. Vascular remodeling in arterial compliance often dropped, resulting in increased systolic blood pressure, pulse pressure increased, left ventricular hypertrophy and reduced coronary perfusion [3,4]. Decreased arterial compliance and increased pulse pressure in dialysis patients are cardiovascular disease (CVD) risk factors independent [5].水钠潴留period as a result of dialysis treatment by ultrafiltration, dialysis patients with the diagnosis of heart failure more difficult, but the decline in blood pressure, fatigue, loss of appetite and other signs of heart failure diagnosis can be used as an important clue; On the other hand, more水钠潴留inappropriate to reflect the ultrafiltration rather than heart failure or heart failure combined ultrafiltration inappropriate. In fact, during dialysis ultrafiltration is inappropriate for one of the reasons why high blood pressure, heart failure often prompts. Therefore, dialysis patients with heart failure is an important indicator of poor prognosis, which often prompts the patient is in progress of cardiovascular disease. 1 chronic kidney disease risk factors of cardiovascular disease Is well known that patients suffering from kidney disease increase in cardiovascular disease mortality, largely attributable to high blood pressure caused by kidney disease, dyslipidemia, and anemia, but may lead to the causes of plaque rupture is not clear. Light to moderate CKD patients significantly increased the risk of vascular events, and when GFR <45ml / () at the risk greater. Recent studies suggest that due to ACEI (such as captopril, etc.) can reduce chronic kidney disease patients after myocardial infarction risk, if there is no clear contraindication, it is recommended conventional [6]. In normal circumstances, the application of chronic kidney disease treatment of ACEI or ARBs should be careful, it is necessary to understand the benefits of the application, but also take into account blood pressure, renal function, blood electrolyte changes, and possible interactions between drugs, such as the decline in renal function occur, increased serum potassium, etc. must be stopped [1]. In CKD in CVD risk factors to be divided into two types of traditional and non-traditional, traditional risk factors are the main means used to assess symptoms of ischemic heart disease factors such as age, diabetes, systolic blood pressure, left ventricular hypertrophy, and low HDL - C and so on, these factors and the relationship between cardiovascular disease and most people are the same. And define the non-traditional risk factors need to meet the following conditions: (1) to promote the development of CVD rationality biology; (2) the risk factors increased with the severity of kidney disease-related evidence; (3) reveals the CKD and the risk of CVD factors relevant evidence; (4) risk factors in the control group after treatment to reduce CVD evidence. Has been identified in non-traditional risk factors are mainly Hyperhomocysteinemia, oxidative stress, abnormal lipid levels, and atherosclerosis-related increase in markers of inflammation [7]. Recent study found that dialysis patients with oxidative stress and inflammatory markers significantly higher than the general population. Oxidative stress and inflammation may become the basic medium, while other factors such as anemia and cardiac disease, and calcium and phosphorus metabolic abnormalities and vascular remodeling and a decline in vascular compliance. Failure cardiovascular disease CVD mortality in dialysis patients than the general population 10 to 30 times, and the emergence of heart failure after acute myocardial infarction and high mortality rates, myocardial infarction within 1 to 2 years up to 59% mortality ~ 73%, significantly higher than the general crowd, and the Worcester heart Attack Study found that 3 / 4 males and 2 / 3 of women suffering from acute myocardial infarction in diabetic patients still alive after 2 years. At the same time hemodialysis patients atherosclerosis, heart failure and left ventricular hypertrophy abnormally high incidence of nearly 40% of the patients of ischemic heart disease or heart failure. Cardiovascular disease after renal transplantation Renal transplant patients, 35% ~ 50% of CVD death, CVD mortality than the general population of high 2-fold, but was significantly lower than that in hemodialysis patients. The most likely reason is acceptable from a kidney transplant and dialysis-related hemodynamic abnormalities and abnormal toxins. CVD after renal transplantation is the multiple risk factors, and not only include traditional factors such as hypertension, diabetes, hyperlipidemia, left ventricular hypertrophy, and have a decline in GFR of the non-traditional factors such as hyperhomocysteinemia, as well as immune suppression and exclusion. of cardiovascular disease in diabetic nephropathy Early diabetic nephropathy is mainly expressed in microalbuminuria, and progression of cardiovascular disease. Although type 1 diabetes patients with normal blood pressure, but was found in 24h at night to monitor the existence of "Nondipping" mode, may lead to microalbuminuria. "Nondipping" is identified the risk factors of cardiovascular disease, microalbuminuria with the diabetic patients are more vulnerable to dyslipidemia, blood glucose and blood pressure difficult to control. The study has confirmed that microalbuminuria with CVD have a clear relationship between the two types of diabetes in both the presence, but because of the age factor in type 2 diabetes in the more significant. Microalbuminuria is now considered that the prognosis of diabetic patients with cardiovascular disease and other factors in the risk of death indicators point of view can be explained as follows: (1) traditional microalbuminuria individual a higher incidence of risk factors; (2) micro - proteinuria can reflect the endothelial dysfunction, increased vascular permeability, abnormal coagulation and fibrinolysis system; (3) and inflammatory markers related; (4) are more vulnerable to end-organ damage. Prior studies suggest that the recent high blood pressure and vascular endothelial dysfunction, and therefore these patients may further aggravate the endothelial damage. However, the mechanism is not entirely clear at present that may be related to L-arginine transport by endothelial cells to damage, which led to the cell matrix of the lack of NO synthesis. Non-diabetic renal disease cardiovascular disease We mainly albuminuria and decreased GFR as a sign of chronic kidney disease, proteinuria than at the same time that microalbuminuria is more important, because whether or not there is diabetes, nephrotic syndrome and cardiovascular disease are related to the existence of the abnormal changes, such as serious hyperlipidemia and high blood coagulation status, etc. This explains the importance of reducing proteinuria. At present, we risk groups were divided into 3 groups, has been suffering from CVD, other vascular disease or diabetes as a high-risk groups; with traditional CVD risk factors such as high blood pressure, age, etc., as the crowd in danger; the community known as the low-risk group members 翻译.. 慢性肾病是心血管疾病的危险因素慢性肾病（CKD）是值得广泛关注的公共健康，发病率逐渐上升，同时带来了严重的后果和问题。我们注意到肾衰病人的主要是透析和肾移植，但是很少有学者关注CKD与心血管疾病（CVD）的关系。现已认为CKD也与CVD有关，且比急性进展中的肾功能衰竭更容易死于心血管疾病，CVD是 CKD最常见的死亡原因〔1〕。认识到CKD是CVD的高危因素这一点，是很重要的。只有这样，才有可能进行深入，进而寻求相关的预防和治疗措施，使这些病人获得更大益处。 CKD是指由肾活检或有关的标志物证实的肾功损害＞3个月，或GFR＜60ml/（）＞3个月。一般依据病和病因学分为糖尿病性、非糖尿病性和移植后肾病。肾功能损害可通过肾活检或相关的标志物如蛋白尿、异常尿沉积物、影像学异常等来诊断。蛋白尿不仅可以证明CKD的存在，亦可成为肾病类型诊断的重要依据，并与肾脏疾病的严重程度和心血管疾病的有关。尿白蛋白与肌酐比率或总蛋白与肌酐比率可用于评估蛋白尿。GFR＜60ml/（）作为肾功损害的临界值，该水平GFR往往预示肾衰的开始，其中也包括增加心血管疾病的发生及危险程度。GFR＜15ml/（）则需要透析治疗。 GKD尤其是终末肾病（ESRD）患者，CVD危险明显增加，一般通过血管树来实现的。ESRD与动脉粥样硬化可能互为因果关系，一方面粥样硬化加速肾病进展，另一方面ESRD恶化是许多传统粥样硬化的危险因素〔2〕。一般而言，CVD的基本类型是血管疾病和心肌病，血管疾病的两种亚型是动脉粥样硬化和大血管重塑，而CKD对这两种亚型均有作用。动脉粥样硬化主要以斑块形成和闭塞为主，CKD中动脉粥样硬化发生率很高而且范围更广，弥漫的粥样硬化明显增加心血管疾病死亡率和加速肾功能恶化。动脉粥样硬化可导致动脉壁基质增厚和心肌缺血。在CKD病人中，缺血性心脏病如心绞痛、心梗和猝死，以及脑血管疾病、外周血管疾病和心衰都是比较常见的。最初认为透析病人出现缺血性心脏病可能继发于容易超载、左室肥厚和小动脉病变，导致氧供减少。但是后来的研究发现，在前促红素区域，血红蛋白水平低，说明亦可能与缺血有关。CKD病人大血管重塑发生率亦较高，血管重塑可导致压力超载，通过管壁增厚和管壁与内腔比值增高或者流量超载来实现，但主要以增加的管壁直径和厚度为主。血管重塑常常使动脉顺应性下降，导致收缩压增加、脉压增大、左室肥厚和冠脉灌注减少〔3，4〕。动脉顺应性下降和脉压增大均为透析病人心血管疾病（CVD）的独立危险因素〔5〕。由于透析期间水钠潴留可通过超滤得到治疗，透析病人心衰的诊断比较困难，但血压下降、疲劳、食欲减退等征象，可作为心衰诊断的重要线索；另一方面，水钠潴留更能反映超滤不合适，而不是心衰或心衰合并超滤不恰当。实际上，透析期间超滤不合适的原因之一就是高血压，往往提示心衰。因此，心衰是透析病人预后不良的重要指标，这往往提示病人心血管疾病正在进展。 1 慢性肾病的心血管疾病危险因素 众所周知，患肾脏疾病的病人心血管病死亡率增加，很大程度上归因于肾病所致的高血压、血脂异常和贫血，但可能导致粥样斑块破裂的原因还不是很清楚。轻到中度CKD病人血管事件危险明显增高，而当GFR＜45ml/（）时这种危险更大。近期有关研究认为因 ACEI（如卡托普利等）可降低慢性肾病病人心梗后的危险，如没有明显禁忌证，建议常规〔6〕。而在一般情况下，慢性肾病应用ACEI或ARBs治疗要慎重，既要了解应用的益处，又要考虑到血压、肾功能、血电解质变化和可能的药物间相互作用，如出现肾功能下降、血钾增高等就必须停药〔1〕。 在CKD中把CVD的危险因素分为传统和非传统两种，传统的危险因素主要指用于评估有症状缺血性心脏病的因素，如年龄、糖尿病、收缩性高血压、左室肥厚、低HDL-C等，这些因素与心血管疾病的关系与一般人是一致的。 而界定非传统危险因素需要满足如下条件：（1）促进CVD发展的生物学方面的合理性；（2）危险因素升高与肾病严重程度相关的证据；（3）揭示CKD中CVD与危险因素关系的相关证据；（4）有对照组中危险因素经治疗后CVD降低的证据。目前已确定的非传统危险因素主要有高同型半胱氨酸血症、氧化应激、异常脂血症、与粥样硬化有关的增高的炎症标志物〔7〕。近来研究发现，透析病人氧化应激和炎症标志物水平明显高于一般人群。氧化应激和炎症有可能成为基本的介质，而其他因素如贫血与心肌病有关，钙磷代谢异常与血管重塑和血管顺应性下降有关。 肾衰中心血管疾病 透析病人中CVD死亡率比普通人群高10～30倍，而出现急性心梗和心衰后致死率很高，心梗后1～2年死亡率达59%～73%，明显高于一般人群，而Worcester heart Attack研究发现，有3/4男性和2/3女性糖尿病病人患急性心梗后仍存活2年以上。同时血液透析病人动脉粥样硬化、心衰和左室肥厚发生率异常增高，有接近40%的病人出现缺血性心脏病或心衰。 肾移植后心血管疾病 肾移植病人中有35%～50%因CVD死亡，CVD死亡率比普通人群高2倍，但明显低于血液透析病人。最可能的原因是接受肾移植后免除了与透析有关的血流动力学异常和毒素异常。肾移植后CVD的危险因素是多重的，既包括传统因素如高血压、糖尿病、高脂血症、左室肥厚，亦有与GFR 下降有关的非传统因素如高同型半胱氨酸血症以及免疫抑制和排斥。 糖尿病肾病的心血管疾病 糖尿病肾病的早期主要表现为微量白蛋白尿，与心血管疾病进展有关。尽管1型糖尿病病人血压正常，但在24h监测中发现夜间存在 “Nondipping”模式，可能导致微量白蛋白尿。“Nondipping”是已确认的心血管疾病的危险因素，伴有微量白蛋白尿的糖尿病病人也更易出现血脂异常、血糖难以控制和血压升高。有关研究已证实微量白蛋白尿与CVD有明确关系，在两种类型糖尿病中均存在，但由于年龄因素在2型糖尿病中更显著。现已认为微量白蛋白尿是糖尿病病人心血管疾病预后和其他致死因素的危险指标，可通过如下观点来解释：（1）微量白蛋白尿个体传统危险因素发生率更高；（2）微量白蛋白尿能反映内皮功能异常、血管渗透性增加、凝血纤溶系统异常；（3）与炎症标志物有关；（4）更易出现终末器官损害。最近Prior研究认为高血压与血管内皮功能异常有关，因此在这类病人中可能进一步加重内皮损害。但有关机制不完全清楚，目前认为可能与L-精氨酸转运至内皮细胞受到损害有关，进而导致细胞内合成NO的基质缺乏。 非糖尿病性肾病的心血管疾病 我们主要把蛋白尿和GFR下降作为慢性肾病的标志，同时认为蛋白尿比微量白蛋白尿更重要，因为无论是否存在糖尿病，肾病综合征均存在与心血管疾病有关的异常改变，如严重高脂血症和高凝血状态等，这就说明降低蛋白尿具有重要意义。目前我们把危险人群分为3组，已经患CVD、其他血管病或糖尿病作为高危人群；具有CVD传统的易患因素如高血压、年龄等作为中危人群；将社区人员称为低危人群

预防心血管疾病饮食注意以下几点：1、限制总热量：不论进食何种食物，一定要限制总热量，也就是一次不能吃得过多，不能吃得过饱；2、低钠高钾饮食：低钠，世界卫生组织要求一天钠的摄入量应该在5g以下，中国指南要求是6g以下；高钾饮食就是多吃水果蔬菜，特别是香蕉、橘子之类含钾量比较高的食品；3、多运动，控制体重：运动可以预防很多心血管疾病，而且对预防肿瘤都有益；4、饮食结构：中国心血管疾病预防指南要求奶类一天补充300g，蔬菜300-350g，水果200-350g，禽蛋类120-200g，谷黍类250-400g，这是比较好的食品结构。

医学技术的发展日新月异，但是离人文渐行渐远，医学需要丰富的人文内涵和哲学思考才能腾飞。医学最根本的是人道主义关怀，应该到达最需要接受治疗、最可能获益的患者。循证医学是临床医学，没有针对个体化患者充分的实践，不可能成为一名合格的医生。高举公益、规范、预防和创新四面旗帜。实现五个转变：从主要针对疾病终末期的救治转变为重视疾病早期的预防；从经验医学转向循证医学、科学决策；从大医院转向社区和农村保健网络；从不同学科、围墙文化转向各学科广泛联盟；从重视疾病转向疾病管理。热切期盼医学回归人文！回归临床！回归基本功！ 冠心病二级预防措施有两个ABCDE（Aspirin and Anticoagulants、Beta blockers and Blood pressure、Cholesterol and Cigarettes、Diet and Diabetes、Education and Exercise），缺一不可。 β受体阻滞剂在治疗冠心病中全部是Ⅰ类推荐、A 级证据，是既能改善症状，又能改善预后的首选用药，也是冠心病合并高血压患者的首选降压药物。脂溶性的选择性 1受体阻滞剂美托洛尔（倍他乐克）无内在拟交感活性，在冠心病一级预防、二级预防以及心肌梗死后长期治疗中具有显著的心脏保护作用。 LDL-C升高是冠心病的主要致病性危险因素。针对心血管高危人群，使用他汀进行强化降脂治疗，大幅度地降低LDL-C，能有效减少心血管病临床事件，并可使动脉粥样斑块进展延缓甚至消退，瑞舒伐他汀（可定）是目前所有他汀中已取得延缓动脉粥样硬化进展适应证的药物。升高HDL-C的治疗目前尚在探索中。新的指南对LDL-C的治疗目标有了更明确的要求，在临床工作中应熟悉指南，通过积极的降LDL-C治疗，达到指南的治疗要求可以使广大患者更多获益。 心血管疾病在发展中国家呈上升趋势，危险因素干预和治疗能够显著降低冠心病死亡风险，预防的作用明显高于治疗。Framingham评分系统和SCORE评分系统是国外广泛采用的评估系统。中美合作研究建立了针对中国人群的量表，在中国心血管病流行病学多中心合作（MUCA）队列研究中得到了验证，对于中国人群10年危险的预测更为合适。推荐与理想水平而不是平均水平相比，从最低到危险分为6个阶段，能更为客观地预测相对危险。 中华医学会系列杂志秉承为中国读者服务的初衷，报道范围涵盖读者关心的全部问题，优先发表各类有关争鸣的文章。以出版速度更快、期刊质量更高、期刊影响力更强为目标，立志成为我国的医学期刊群体。 中国女性心脑血管疾病呈上升趋势，是中国女性首要死亡原因。中国女性心血管病危险因素水平较高，其中肥胖和糖尿病问题较男性更为严重，运动和健康膳食习惯能有效降低女性心血管病的危险。应更加关注女性心血管的健康。 血管紧张素Ⅱ类似物降压疫苗成功进行了Ⅱa期临床试验，新型降压疫苗正在研发，治疗性降压疫苗用于人类的梦想已不再遥远。与传统化学合成药物相比，降压疫苗作用时间长、能够保持长期平稳有效地降压、可改善治疗依从性。降压疫苗需要解决的技术问题包括免疫靶向蛋白的选择、靶分子功能表位的确定、载体分子的选择以及抗体表达量与降压疗效的关系等。 他汀是目前研究最充分，被认为最有效的抗动脉粥样硬化药物，他汀治疗每降低1 mmol/L 低密度脂蛋白胆固醇（LDL-C），可使1年主要冠脉事件减少23%，这是他汀具有的类效应。他汀降脂需遵循“低些好些”、“越长久越好”、“越快越好”、“越早越好”及“越价廉越好”的原则。在安全性相同的情况下，选择强效、价廉及药物代谢相互作用较小的他汀是临床的选择。瑞舒伐他汀（可定）是目前他汀类药物中效的一种，与其他他汀类药物相比，其剂量更小，在药物经济学方面有一定的优势。 降低血压是抗高血压治疗获益的根本原因。目前指南推荐使用5大类降压药物，但不同药物，对某些并发症或某些患者的获益会有所不同，在不同种族间也存在一定差异。总体而言，二氢吡啶类钙拮抗剂（CCB）和利尿剂可能对东亚和非洲人降压作用更强。选择合适的起始治疗药物、合理的联合降压治疗方案，配合积极的多重危险因素干预，能够最终大幅度降低心脑血管并发症风险。 CCB的多效性奠定了其在心血管领域的广泛应用和重要地位。循证医学提示CCB非洛地平（波依定）具有高度血管选择性，无负性肌力作用，心、脑血管保护作用明确，使用更加安全。各国权威指南推荐，非洛地平可在心衰患者中安全使用，但不推荐低血管选择性CCB. 心血管疾病是老年人患病率和致死率的疾病，老年人各脏器的组织结构和生理功能呈退行性改变，尤其是肝肾功能衰退，使老年人对药物的吸收、分布、代谢和排泄以及对药物的反应性、敏感性和耐受性均不同于其他人群。老年心血管病患者症状常不典型，血管病变、病情复杂，治疗难度增大，治疗不及时病情可急剧恶化甚至导致死亡。老年患者的治疗应个体化，注重的效益-风险比，重在改善生活质量。应关注老龄化对心血管病的影响，重视心血管疾病的早期防治。保持健康生活方式、控制相关的危险因素，都是预防心脑血管疾病的有效措施。

自己去网上搜啊！谁有闲情逸致写啊