Search

风湿性心脏病二尖瓣和主动脉瓣胶原变化的研究

摘要 目的 研究风湿性心脏病二尖瓣和主动脉瓣瓣膜胶原含量及其类型对瓣膜成形术病例选择的影响。方法 采用羟脯氨酸法测定瓣膜胶原含量的变化，并用十二烷基磺酸钠-聚丙烯酰胺凝胶电泳(SDS-PAGE)分离法测定心瓣膜胶原的类型。结果 正常二尖瓣腱索的胶原含量较瓣叶高（Plt;0.01），主动脉瓣胶原含量较二尖瓣低（P＜0.01）。风湿性心脏病患者二尖瓣和主动脉瓣的胶原含量较正常瓣膜有显著升高（P＜0.01）。正常瓣膜以Ⅰ型胶原为主，Ⅲ型胶原含量较少，而病变二尖瓣和主动脉瓣其Ⅰ型、Ⅲ型胶原均明显增加，且以Ⅰ型胶原为主。有钙化的二尖瓣腱索胶原含量高于无钙化瓣膜（P＜0.05）。二尖瓣病变以狭窄为主的病例其二尖瓣腱索的胶原含量较以关闭不全为主的病例高（P＜0.01），且二尖瓣瓣叶及腱索的胶原含量与二尖瓣口面积呈负相关（r=-0.5431和r=-0.8819，P＜0.01）。结论 风湿性心脏病心瓣膜胶原含量和类型的变化与心瓣膜功能的改变密切相关，瓣膜有无钙化以及二尖瓣病变的性质，可作为施行心瓣膜成形术的选择条件。

Analysis of the influencing factors of death anxiety in rural elderly based on structural equation model

Objective To identify the key influencing factors of death anxiety in rural elderly and their mechanisms of action. Methods A total of 701 rural elderly individuals from 6 prefecture-level cities (prefectures) in Sichuan Province were selected for a questionnaire survey on death anxiety, health-related physical fitness, and subjective well-being. A structural equation model was constructed to thoroughly analyze the influencing factors of death anxiety and their mechanisms of action. Results Higher levels of health-related physical fitness, higher levels of subjective well-being, and having more children were the top three protective factors against death anxiety among elderly people in rural Sichuan, with effect values of −0.392, −0.287, and −0.154, respectively. In contrast, suffering from chronic diseases was the leading risk factor for death anxiety, with an effect value of 0.127. Suffering from chronic diseases was the leading risk factor for death anxiety, with an effect value of 0.127. The structural equation model fitting results showed that the medical insurance type of rural elderly in Sichuan (β=−0.062, P=0.002), suffering from chronic diseases (β=0.127, P=0.001), hospitalization due to health reasons in the past year (β=0.086, P=0.002), and educational level (β=−0.067, P=0.001) had indirect effects on death anxiety through health-related physical fitness. Not seeking medical treatment due to financial difficulties in the past year had an indirect effect on death anxiety through subjective well-being (β=0.060, P=0.002). The number of children had both a direct effect on death anxiety (β=−0.119, P=0.004) and an indirect effect through subjective well-being (β=−0.034, P=0.001). Health-related physical fitness had both a direct effect on death anxiety (β=−0.278, P=0.001) and an indirect effect through subjective well-being (β=−0.114, P=0.002). Conclusion Multiple factors directly or indirectly affect the level of death anxiety in the rural elderly population. Health-related physical fitness, subjective well-being, and the number of children are important protective factors. Moreover, health-related physical fitness and subjective well-being act as mediating variables in the chain of effects of multiple factors on death anxiety.

COVID-19合并或继发细菌感染的诊治研究进展