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血管内皮功能诊断——循环系统疾病管理的评价指标与实践
$39.07
本书分为7个大章节,分别为:血管内皮功能总论、血管内皮功能检测方法、血管内皮功能检测所提供的信息、血管内皮功能异常导致的疾病发展因素、血管内皮功能提供的临床依据、心血管疾病与血管内皮功能的相关因素、临床中血管内皮功能应用实践。目前心血管疾病已成为人类健康的*杀手,血管健康与心血管健康息息相关,血管健康正是确保身体健康长寿的关键。本书覆盖了血管健康的基础理论、临...
本书分为7个大章节,分别为:血管内皮功能总论、血管内皮功能检测方法、血管内皮功能检测所提供的信息、血管内皮功能异常导致的疾病发展因素、血管内皮功能提供的临床依据、心血管疾病与血管内皮功能的相关因素、临床中血管内皮功能应用实践。目前心血管疾病已成为人类健康的*杀手,血管健康与心血管健康息息相关,血管健康正是确保身体健康长寿的关键。本书覆盖了血管健康的基础理论、临床诊断、应用实践等方面,汇集了多个相关领域的医生和学者的智慧,力求提供血管内皮功能的基础知识以及全新的临床知识。
王宏宇,男,汉族,1967年12月出生,山西大同人,医学博士,北京大学教授,心脏和血管医学专业主任医师,博士/硕士生导师。国家重点研发计划“高可信强智能的心脑血管疾病诊疗服务模式解决方案”课题负责人,北京大学首钢医院副院长兼血管医学中心主任,北京大学医学部血管健康研究中心主任,北京大学医学部血管疾病社区防治中心主任,北京大学临床研究所心脏和血管健康研究中心主任,分子心血管学*重点实验室特聘教授,北京大学医学部睡眠医学中心和北京大学睡眠研究中心专家委员会委员,北京大学医学部血管医学、北京大学血管探秘课程教研室主任。1997年开始进行血管功能研究,2004年作为国家卫生部十年百项计划“血管病变早期检测技术推广”项目负责人,在国际上率先提出血管病变早期检测系统,组织制订了国际上个血管病变早期检测技术应用指南,2010年4月创建了我国家血管医学专业临床诊疗中心—北京大学首钢医院血管医学中心,2011年和2019年分别主持我国针对血管健康管理与预后心血管疾病关系的人群队列研究和多中心临床干预研究(BEST,NCT02569268;EndoFIND,NCT04013204)。目前已发表学术文章240余篇,其中SCI收录文章26篇。主编我国部血管医学领域专著《血管病学》(北京:人民军医出版社,2006)和《中国血管健康行科普系列丛书》(共8册)(北京:北京大学医学出版社,2011)等著作10余部。主持和负责多项北京市和国家科研项目。获“北京市优秀人才”称号,为北京大学医学部优秀教师、首届北京大学“临床医疗奖”获得者。目前担任国际血管健康学会(International Society of Vascular Health,ISVH)执行委员会委员,国际血管健康学会中国分会主席,美国高血压学会院士(Fellow of American Society of Hypertension,FASH),中国医药教育协会血管医学专业委员会主任委员,中日医学科技交流协会心脏和血管医学专业委员会主任委员,中国心脏和血管健康学院院长,中央电视台纪录频道(CCTV-9)和《健康之路》栏目、北京电视台《健康北京》和《养生堂》栏目特邀专家,《中国循环杂志》等国内外多家专业杂志的编委。
章 血管内皮功能总论 ···············································································1一、血管内皮细胞的作用 ················································································1二、血管内皮功能异常的机制 ··········································································3三、血管内皮功能异常反映出的问题 ·································································9四、血管内皮功能检测的临床应用 ·································································· 10五、血管内皮功能障碍到动脉硬化 ·································································· 12六、血管内皮功能异常导致冠状动脉痉挛性心绞痛 ············································· 15七、当前血管内皮功能为何受到关注? ···························································· 16八、血管内皮功能在循环系统预防医学中的定位 ················································ 16第二章 血管内皮功能检测技术 ······································································· 21一、体积描记法 ·························································································· 21二、 基于血管超声检测的血流介导的血管扩张 ··················································· 21三、 可替代FMD 的踝肱指数轻度异常值 ·························································· 22四、 指端脉搏波反应性充血外周动脉张力 ························································· 23五、FMD 与RHI 的区别 ··············································································· 24六、前臂充血与上臂充血 ·············································································· 25七、反映血管内皮功能的生物标志物 ······························································· 25八、冠状动脉的内皮功能 ·············································································· 28第三章 血管内皮功能检测所提供的信息 ··························································· 31一、血管内皮功能检测的筛查作用 ·································································· 31二、血管内皮功能检测是动脉硬化进程的评价指标 ············································· 31三、预测冠状动脉疾病的预后 ········································································ 32四、冠状动脉痉挛性心绞痛的诊断 ·································································· 33五、心脏微血管障碍的诊断与疗效评估 ···························································· 33六、深静脉血栓症的筛查 ·············································································· 34七、预测外周动脉疾病的预后 ········································································ 35
……
译者前言血管内皮功能障碍源于氧化与抗氧化机制、损伤与修复机制的失衡,是以内皮细胞结构和功能的异常为表现的病理变化。这一功能性改变的出现会早于血管、器官的结构性病变。其不仅在心脑血管病变的发生、发展乃至恶化的过程中起到了至关重要的作用,还是肾、大脑等各种器官病变以及糖尿病并发症进展的重要因素。当前,心脑血管疾病防治策略日新月异,新的诊疗技术不断涌现,但全球的心血管疾病患病人数仍然居高不下,这一现状显然需要我们重新审视现阶段心脑血管疾病的管理策略。笔者从1997年开始血管功能的相关研究,20余年血管疾病综合诊治的临床实践和研究经验告诉我们仅仅到终末期对血管疾病管腔狭窄采取介入或手术治疗,并不能有效减少血管疾病的发病和致死致残后果,正确的出路是围绕血管进行全生命周期的健康管理,对血管疾病进行早期检测,早期治疗,才能使我国血管疾病防治现状得到改善。2004年,笔者提出血管疾病早期检测技术系统的概念并将其作为全身血管病防治基础的思想,获得国家卫生部批准作为十年百项计划之一,并向全国进行推广;同时发起中国心脏和血管健康促进计划。2010年,笔者从北京大学人民医院来到北京大学首钢医院成立了我国家血管医学中心,对推动中国心脏和血管健康促进计划、降低我国心脑血管疾病的发病率、提高全民健康水平具有重要意义。血管内皮功能在血管健康的维护和心血管疾病发生发展中发挥着重要作用,早期检测和逆转血管内皮功能障碍,维护血管内皮健康有利于系统预防心脏和血管相关疾病。研究显示冠状动脉病变的严重程度与反应性充血指数(reactive hyperemia index,RHI)呈负相关性,提示内皮功能障碍与冠状动脉粥样硬化关系密切。北京血管健康分级系统(Beijing Vascular Health Stratification,BVHS)中血管内皮功能是分级血管病变的一个重要指标,在BVHS的指导下,能够实现智能化全生命同期血管健康管理;通过无创内皮功能检测评估血管健康状态,能为心血管疾病的病变分级和防控以及精准治疗提供方向。对存在内皮功能障碍的人群,利用无创内皮功能检测技术,能在疾病的发生、发展的多个阶段为指导临床诊断、治疗提供良好参考,以延缓疾病进展和并发症的发生,从而降低心血管事件发生风险。在Ira Prigat先生的支持下,2018年12月,笔者与日本北里大学东条美奈子教授讨论学术合作过程中应邀将她编著的日文版《血管内皮功能诊断——循环系统疾病管理的评价指标与实践》(血管内皮機能を診る——循環器疾病管理に生かす評価と実際)一书译成中文,供中国血管医学相关专业人员参考。2019年我们启动了国际上个针对非狭窄性冠状动脉疾病患者内皮功能检测指导价值的多中心临床试验(endothelial function guidedtheropy in patient with non obstructive coronary artery disease,EndoFIND,NCT04013204),相信该书中文版的问世和相关临床研究的结果,对我国普及内皮功能诊断技术和血管健康维护理念,降低我国心血管疾病的致死致残率,助力“健康中国2030”具有积极的推动作用。由于时间仓促,书中不妥之处,不吝指正。2020年6月6日(农历庚子年闰四月十五月于北京)
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