Damage In Elderly Patients Research Articles

Cardiac Radiofrequency Ablation Exacerbates Myocardial Injury through Pro-Inflammatory Response and Pro-Oxidative Stress in Elderly Patients with Persistent Atrial Fibrillation.

There is a need to assess myocardial damage after radiofrequency ablation of the pulmonary veins (PV) for persistent atrial fibrillation (PAF) in elderly patients. To evaluate oxidative stress, inflammatory response and myocardial damage in elderly patients with PAF after radiofrequency ablation of the PV. High-sensitivity troponin T (hsTnT), malondialdehyde-modified low-density lipoprotein (MDA-LDL), acrolein (ACR), lipid hydroperoxide (LHP), toll-like receptor 4 (TLR4), soluble growth stimulation expressed gene 2 (sST2), angiotensin II (Ang II) and myocardial blood flow (MBF) were determined before ablation and at 1, 3 and 5 months after radiofrequency ablation. The levels of hsTnT, MDA-LDL, ACR, LHP, TLR4, sST2 and Ang II were increased 3 months after ablations compared with before ablation and 1 month after ablation, respectively (P<0.001); they were further increased at 5 months after ablation compared with the 1- and 3-month groups, respectively (P<0.001). MBF was decreased in the 3 months group after ablations compared with before ablation and 1-month after ablation, respectively (P<0.001), and was further decreased in 5-months after ablations compared with 1-month and 3-month groups, respectively (P<0.001). Patients with epicardial monopolar radiofrequency ablation had higher levels of hsTnT, MDA-LDL, ACR, LHP, TLR4, sST2, Ang II and lower MBF than patients with endocardial monopolar and bipolar radiofrequency ablations, respectively (P<0.001). Monopolar radiofrequency ablation method could result in more myocardial injury than bipolar radiofrequency ablation. Oxidative stress and inflammatory response may be involved in cardiac radiofrequency ablation-induced myocardial injury, resulting in myocardial ischemia in elderly patients with PAF.

Cognitive training programimprovescognitive ability and daily living ability in elderly patients with mild cognitive impairment.

Mild cognitive impairment (MCI) is a clinical syndrome of mild memory or other cognitive impairment without dementia and is a clinical transition state between normal aging and dementia. Careful and meticulous nursing intervention can improve the clinical symptoms of MCI and delay the progression of the disease. This research aimed to evaluate the efficacy of cognitive function training interventions in elderly patients with MCI. 106 patients were randomized into the intervention group or the control group. They received conventional nursing intervention and those in the intervention group received additional cognitive training program for 6weeks. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), activities of daily living (ADL) scales, and Barthel index (BI) were evaluated before and 6weeks after the intervention, as well as the serum levels of S100β and neuron-specific enolase (NSE) at two time points. After intervention, the MMSE scores and MoCA scores in both groups were significantly increased and the score in the intervention group was significantly higher. In the intervention group, the performance of conventional nursing intervention and cognitive training program significantly increased the scores of ADL and BI (p < 0.001). The serum levels of NSE and S100β in the intervention group were significantly lower. The performance of cognitive training program alleviated the brain tissue damage in elderly patients with MCI. The performance of cognitive training program in elderly patients with MCI improved their cognitive ability and daily living ability.

Clinical Characteristic, Prognosis and Treatment Outcome of Elderly Multiple Myeloma Patients with Impaired Renal Function

To explore the risk factors, prognosis and curative effect of elderly patients with MM renal damage. 118 patients with primary elderly MM treated in our hospital from January 2011 to December 2018, were enrolled analyzed retrospectively. The clinical characteristics and prognosis of renal function impairment group (RI group) and normal renal function group (non-RI group) were compared. The difference of renal efficacy and survival benefit between the patients treated with bortezomib, thalidomide (combination group) and chemotherapy regimen containing only one of them (single drug group) in RI group was compared. Univariate analysis showed that DS stage, pulmonary infection, uric acid, β 2 microglobulin and leukocyte in RI group were higher than those in non-RI group, but hemoglobin was lower than that in non-RI group (P<0.05). Multivariate logistic regression analysis showed that β 2 microglobulin was the independent risk factor for renal damage in elderly patients with MM. Kaplan-Meier method showed that the OS and PFS in RI group were significantly lower than those in non-RI group (P<0.05). The renal efficacy in the combined treatment group was significantly better than that of the single drug group (P<0.05), and it could bring benefit to the PFS of the elderly patients with MM renal damage (P<0.05). The prognosis of elderly MM patients with impaired renal function is poor. The prognosis of these patients can be improved by selecting chemotherapy regimen containing bortezomib and thalidomide at the same time, and monitoring, controlling all kinds of risk factors actively.

Treatment-related damage in elderly-onset ANCA-associated vasculitis: safety outcome analysis of two nationwide prospective cohort studies

BackgroundIt is not elucidated that there is treatment-related damage in elderly patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV).MethodsElderly (≥ 75 years of age) patients were enrolled from two nationwide prospective inception cohort studies. The primary outcome was 12-month treatment-related Vasculitis Damage Index (VDI) score. Secondary outcomes included serious infections within 6 months, total VDI score, remission, and relapse. Patient characteristics and outcomes were compared across three different initial glucocorticoid (GC) dose groups: high-dose, prednisolone (PSL) ≥ 0.8 mg/kg/day; medium-dose, 0.6 ≤ PSL < 0.8 mg/kg/day; and low-dose, PSL < 0.6 mg/kg/day.ResultsOf the 179 eligible patients, the mean age was 80.0 years; 111 (62%) were female. The mean Birmingham Vasculitis Activity Score was 16.1. Myeloperoxidase-ANCA findings were positive in 168 (94%) patients, while proteinase 3-ANCA findings were positive in 11 (6%). The low-dose group was older and had higher serum creatinine levels than the other groups. There were no statistically significant intergroup differences in remission or relapse, whereas serious infection developed more frequently in the high-dose (29 patients [43%]) than the low-dose (13 patients [22%]) or medium-dose (10 patients [19%]) groups (p = 0.0007). Frequent VDI items at 12 months included hypertension (19%), diabetes (13%), atrophy and weakness (13%), osteoporosis (8%), and cataracts (8%). Logistic regression analysis revealed that GC dose at 12 months (odds ratio, 1.14; 95% confidence interval, 1.00–1.35) was a predictor for diabetes.ConclusionA reduced initial GC dose with rapid reduction might be required to ensure the safe treatment of elderly AAV patients.

Low Level of 25(OH)D Aggravates Target Organ Damage of Elderly Type 2 Diabetes

BACKGROUND: It is unclear about the association between vitamin D level and target organ damage in elderly patients with type 2 diabetes in China. Aim of this study was to investigate the relationship between vitamin D level and target organ damage in elderly patients with type 2 diabetes of Chinese population. &#x0D; &#x0D; METHODS: A retrospective study was performed on 254 elderly patients with type 2 diabetes (148 males and 106 females). According to assay of 25-hydroxy vitamin D [25(OH)D], the participants were divided into a deficiency group (n=129), an insufficiency group (n=77) and a sufficiency group (n=48). The clinical indicators of target organ damages among these groups were analyzed, and multivariate logistic regression analysis was performed to predict the target organ damage. &#x0D; &#x0D; RESULTS: Approximately 81.1% of patients were the low level of 25(OH)D with mean 25(OH)D below 30ng/ml. When compared with those in the sufficiency group, the level of left ventricular absolute mass index (LVMI), the morning urine albumin/uric creatinine ratio (ACR) and carotid intimal medial thickness (cIMT) increased significantly and creatinine clearance rate (CcR) decreased significantly in the deficiency group (P&amp;lt;0.05). The level of ACR and cIMT in the insufficiency group also increased significantly (P&amp;lt;0.05). There was a higher proportion in kidney, brain, artery and total target organ damage in the deficiency group or insufficiency group than those in the sufficiency group (P&amp;lt;0.05). Logistic regression analysis showed that low-level 25(OH)D&amp;nbsp; (&amp;lt; 30ng/ml) was independently associated with total target organ damage in patients with elderly type 2 diabetes (OR = 3.58; 95%CI: 1.60-8.02,P =0.002)&#x0D; &#x0D; CONCLUSIONS: A condition of hypovitaminosis D is commonly present in Chinese patients with elderly type 2 diabetes. The low level of 25(OH)D may contribute to aggravate target organ damage of elderly type 2 diabetes.

Melatonin Changes Domain Structure and Protects Model Neuronal Membranes Against Damage Caused by Amyloid-Beta

The amyloid-β(1-42) peptide is a major player in Alzheimer's disease—a debilitating neurodegenerative disorder that causes memory loss and neuronal damage in elderly patients. Amyloid-β(1-42) forms toxic oligomers that bind to neuronal membranes through interactions with cholesterol-rich lipid rafts. These interactions result in damage to the lipid membrane through the insertion of the amyloid-β(1-42) peptide and subsequent formation of an ion channel or pore. Melatonin, a hormone naturally produced in the brain during sleep, has been identified as a potentially protective native molecule in cellular and animal studies however the molecular mechanisms of its protection are not well understood. Due to its lipophilicity, melatonin partitions into neural model membranes and associates with the lipid headgroups. In this study we used atomic force microscopy (AFM), and Kelvin probe force microscopy (KPFM) techniques to elucidate the effect of melatonin on the structure and domain organization in neuronal model membranes composed of DOPC, POPC, gangliosides, sphingomyelin, and cholesterol. In addition we measured membrane permeability using black lipid membrane (BLM) techniques on the same neuronal models to elucidate the protective effect of melatonin against the damage induced by amyloid-β peptide ion channels. We demonstrated that melatonin changes the structure of neuronal model membranes (both topographical and electrostatic changes in the nanoscale domains) and reduces the ion current (a measure of damage) across model membranes induced by the binding of the amyloid-β(1-42) peptide.

Characterization of DNA hydroxymethylation in the hypothalamus of elderly mice with post-operative cognitive dysfunction.

Post-operative cognitive dysfunction (POCD) is a common syndrome characterized by perioperative cerebral damage in elderly patients, including cognitive impairment and memory loss. Recent studies have revealed that anesthesia is one of the key causes of POCD. Ubiquitin-like with PHD and ring finger domains 2 (Uhrf2) has been reported to play a crucial role in regulating DNA methylation and hydroxymethylation, which are closely connected with memory building and erasure. However, whether narcotic drugs can affect Uhrf2 to impact on DNA methylation and hydroxymethylation in POCD is poorly understood. In this study, a POCD model was established in elderly mice through sevoflurane treatment, and these mice were found to have compromised levels of global DNA 5′-hydroxymethylcytosine (5hmC) and Uhrf2 in the hippocampus and the amygdaloid nucleus, when compared with non-POCD and control mice. The results of immunoprecipitation and quantitative PCR revealed that 5hmC modification of the promoters of genes associated with neural protection and development, such as glial cell-derived neurotrophic factor, brain derived neurotrophic factor, glucocorticoid receptor and acyl-CoA sythetase short chain family member 2, was reduced in the hippocampus of POCD mice when compared with non-POCD and control mice. Taken together, the findings of the present study suggest that loss of 5hmC, in the hippocampus and the amygdaloid nucleus modulated by Uhrf2 suppression, may result in the learning and memory ability impairment seen in mice with POCD.

Step-by-Step Sublaminar Approach With a Newly-Designed Spinal Endoscope for Unilateral-Approach Bilateral Decompression in Spinal Stenosis.

ObjectiveSpinal stenosis is increasingly common due to population aging. In elderly patients with lumbar central canal stenosis (LCCS), minimizing muscle damage and bone resection is particularly important. We performed a step-by-step operation with a newly designed spinal endoscope to obtain adequate decompression in patients with spinal stenosis. MethodsFrom April 2015 to August 2016, 78 patients (48 males, 30 females) with LCCS (91 segments) underwent endoscopic decompression using a newly designed endoscope system. The inclusion criteria were: (1) neurogenic intermittent claudication with or without radiculopathy, (2) LCCS, and (3) having exhausted conservative treatment (>3 months). The exclusion criteria were: (1) >10° of instability, (2) spondylolisthesis grade II or greater according to the Meyerding criteria, (3) foraminal stenosis, (4) vascular intermittent claudication, (5) infection, and (6) stenosis combined with malignancy. We performed a step-by-step procedure using a newly designed endoscope system for unilateral-approach bilateral decompression. We used the same incision for 2–3 segments, only moving the skin. ResultsThe mean follow-up was 2.3±1.3 years. Excellent or good results were found according to the MacNab criteria in 85.9% of cases (67 of 78). The visual analogue scale, Japanese Orthopedic Association score, and Oswestry Disability Index showed significant decreases at 1 month, persisting until the 2-year follow-up. Dural tear occurred in 4 cases (5.1%), and patch repair was performed under endoscopy. No patients experienced aggravated instability requiring surgery. ConclusionWe obtained good results with endoscopic decompression surgery using a newly designed instrument that minimized muscle and bone damage in elderly patients with spinal stenosis.

Evaluation of oxidative DNA damage in elderly patients with type 2 Diabetes mellitus living in Ivoti, State of Rio Grande do Sul

Due to the increase in life expectancy and changes in eating habits, the elderly and obese population has increased in recent years. The objective of this study was to analyze the correlation between type 2 Diabetes mellitus (DM2) and oxidative DNA damage in elderly residents of the municipality of Ivoti, State of Rio Grande do Sul. This study had an exploratory, descriptive, cross-sectional and quantitative approach based on the data bank of the institutional project of the Feevale University. There was a predominant population of married women, retired, with monthly income up to 2 minimum wages, with education until to the 4th grade of fundamental school and bilingual. Statistical difference was detected for fasting glycemia, HbA1c and 8-hydroxydioxy-2-guanosine (8-OHdG) between DM2 and control subjects, as well as a positive Spearmann correlation between HbA1c and 8-OHdG in patients with DM2. It was possible to identify through fasting glycemia and HbA1c that elderly people who had poor glycemic control also showed a significant increase in the production of reactive oxygen species and consequent DNA damage when compared to the elderly with good glycemic control.

A13088 Subclinical target organ damage in elderly patients with resistant hypertension

Objectives: to study subclinical target organ damage in elderly hypertensive patients in comparison with younger hypertensive ones, which were resistant to previous therapy Methods: The study included 137 patients with 2–3 stage of arterial hypertension, which were resistant to previous therapy in average age 55.84 ± 9.95 yrs. The patients divided into 2 groups: 1st group n = 25 (≥65 yrs.) patients in average age 69.2 ± 2.56 yrs., 2nd group n = 112 (<65 yrs.) patients in average age 52.9 ± 8.47 yrs. Office blood pressure (BP) was measured by Korotkov method. Echocardiography performed to all patients with evaluating of left ventricular mass index (LVMI) and left ventricular diastolic function (LVDF). Serum creatinine was measured with biochemical assay method. Glomerular filtration rate (GFR) was estimated using CKD-EPI. Results:.: Baseline blood pressure (BP) was 163.4 ± 15.4/97.4 ± 9.1 mmHg and 159.1 ± 15.1/99.1 ± 8.7 mmHg for 1st and 2nd groups respectively without statistically differs, but pulse BP was higher in 1st group: 65.6 ± 11.3 mmHg vs. 60.0 ± 10.7 mmHg, p = 0.021. 1st group patients had higher LVMI (151.7 ± 39.5 g/m2 vs. 139.3 ± 32.2 g/m2, p = 0.098), statistically worse of LVDF (E/A 0.69 ± 0.1 vs. 0.85 ± 0.3, p = 0.009) and significantly lower GFR (58.7 ± 13.5 ml/min/1.73m2 vs. 66.6 ± 13.6 ml/min/1.73m2, p = 0.01). Conclusion: Elderly patients with resistant hypertension had higher pulse pressure, significantly reduce of left ventricular diastolic function and renal function in comparison with younger untreated hypertensive patients.

A13359 Arterial elastic property correlates with target organ damage in elderly patients with hypertension

A13359 Arterial elastic property correlates with target organ damage in elderly patients with hypertension

Immunological, vascular, metabolic, and autonomic changes seen with aging possible implications for poor outcomes in the elderly following decompressive hemicraniectomy for malignant MCA stroke: a critical review.

Stroke is one of the leading causes of mortality and morbidity worldwide and requires rapid and intensive treatment to prevent adverse outcomes. Decompressive hemicraniectomy stands as the gold standard for surgical resolution of the intracranial swelling which accompanies cerebral infarction; however, the benefits of this procedure are not as well achieved in the elderly (age >65 years) compared to the younger population. This is a critical review performed on all available literature relating to middle cerebral artery (MCA) stroke in the elderly with emphasis on articles examining causality of adverse outcomes in this group over younger populations. Utilizing PRISMA guidelines, we initially identified 1462 articles. After screening, four clear areas of physiological change associated with aging were identified and expounded upon as they relate to MCA stroke. These four areas include: immunological, autonomic, mitochondrial, and vascular changes. Elderly patients have a decreased and declining capacity to regulate the inflammation that develops postinfarction and this contributes to adverse outcomes from a neurological stand point. Additionally, aging decreases the ability of elderly patients to regulate their autonomic system resulting in aberrant blood pressures systemically post infarction. With age, the mitochondrial response to ischemia is exaggerated and causes greater local damage in elderly patients compared to younger populations. Finally, there are numerous vascular changes that occur with age including accumulation of homocysteine and atherosclerosis which together contributed to decreased structural integrity of the vasculature in the elderly and render decreased support to the recovery process post infarction. We conclude that physiological changes inherent in the aging process serve to intensify adverse outcomes that are commonly associated with strokes in the elderly. Identification and subsequent minimization of these risk factors could allow for more effective management of elderly patients, post stroke, and promote better clinical outcomes.

Relationship between blood pressure variability and target organ damage in elderly patients.

To investigate the relationship between 24 h systolic blood pressure variability (SBPV) and target organ damage in elderly patients with essential hypertension. 180 elderly patients (≥ 80 y) with hypertension admitted to our hospital from January 2015 to January 2017 were selected as hypertension group and divided into high blood pressure variability (BPV) group and low BPV group according to the 50th percentile (P50) of 24 h SBPV, while 90 elderly non-hypertension patients admitted during the same period were enrolled as control group. 24 h ambulatory blood pressure values of patients in the three groups were recorded. The total cholesterol (TC), left ventricular mass index (LVMI), carotid artery intima-media thickness (IMT), 24 h microalbuminuria (MA) and complications with cardiovascular disease in patients of the three groups were compared and analyzed. Logistic analysis was conducted with MA, IMT and LVMI as the dependent variables and the remaining risk factors as the independent variables. 24 h SBPV and daytime SBPV (d SBPV) in patients of the hypertension group were significantly higher than those in the control group (p < 0.01); the incidences of coronary heart disease and atherosclerotic plaque as well as IMT, LVMI and MA were higher in the high BPV group than those in the low BPV group (p < 0.05 or p < 0.01). The multivariate results showed that 24 h SBPV was associated with IMT, LVMI and MA. BPV can serve as an important indicator to predict target organ damage in elderly patients with essential hypertension. 24 h SBPV can reflect the degree of target organ damage in elderly hypertensive patients.

Relationship between kidney findings and systemic vascular damage in elderly hypertensive patients without overt cardiovascular disease.

Few studies have investigated the influence of age on the relationships between systemic vascular damage, kidney dysfunction, and intrarenal hemodynamic changes in patients with hypertension without overt cardiovascular disease. The authors enrolled 126 elderly patients with hypertension (aged ≥65years) and 350 nonelderly patients with hypertension (aged <65 years). Carotid intima-media thickness, renal resistive index, and aortic pulse wave velocity were performed in all patients. Elderly patients with hypertension had lower estimated glomerular filtration rates and higher albuminuria, renal resistive index, carotid intima-media thickness, and aortic pulse wave velocity compared with nonelderly patients with hypertension (P<.001). Carotid intima-media thickness independently correlated with renal resistive index and estimated glomerular filtration rate in nonelderly patients with hypertension, whereas it was significantly related to renal resistive index only in elderly patients with hypertension. Aortic pulse wave velocity was independently associated with albuminuria in nonelderly patients with hypertension, whereas it did not independently correlate with any indexes of renal damage in elderly patients with hypertension. Age is an important modifier of the relationships between renal function and renal hemodynamics with subclinical vascular involvement in elderly persons without cardiovascular disease.

Expression of intercellular adhesion molecule-1 and myeloperoxidase in peripheral blood and its significance in elderly patients with OSAHS

Objective:To investigate the detection and significance of serum intercellular adhesion molecule-1 (ICAM-1) and myeloperoxidase (MPO) in elderly patients with OSAHS in adults.Method:Ninety-three cases of elderly OSAHS patients who confirmed by PSG were observed. According to the range of AHI, they were divided into 3 groups (severe, moderate and mild). 31 cases of healthy person were observed as control group. The serum ICAM-1 and MPO were determined by ELISA method; ICAM-1 and MPO were measured after comprehensive treatment in patients with elderly severe OSAHS, and the correlation between ICAM-1, MPO and PSG were analyzed.Result:①With the severity of snoring increased, the serum levels of ICAM-1 and MPO increased gradually (F=29.937,18.946; P< 0.01); The concentration of ICAM-1 and MPO in each group showed that there was no significant difference between the mild group and the control group (P> 0.05), there were significant differences between the rest each two groups (P< 0.05). ②There was no correlation between serum levels of ICAM-1, MPO, BMI, age in OSAHS patients (P> 0.05). There was a positively relationship between ICAM-1 and MPO . Both of them were negatively correlated with AHI, and positively correlated with LSaO2 (P< 0.01). ③The concentration of ICAM-1, MPO and AHI in 31 elderly patients with severe OSAHS decreased and LSaO₂ increased significantly after 3 months of comprehensive treatment (P< 0.01).Conclusion:The increase of ICAM-1 and MPO concentration in peripheral blood is one of the mechanisms of cardiovascular damage in elderly patients with OSAHS. Determination of peripheral blood ICAM-1, MPO levels in elderly patients with OSAHS to help determine the severity of disease, the evaluation of treatment,which may have a certain reference value for the prediction of cardiovascular disease risk in patients with severe OSAHS.

Vulnerability of the frontal and parietal regions in hypertensive patients during working memory task.

Hypertension is related with cognitive decline in the elderly. The frontal-parietal executive system plays an important role in cognitive aging and is also vulnerable to damage in elderly patients with hypertension. Examination of the brain's functional characteristics in frontal-parietal regions of hypertension is likely to be important for understanding the neural mechanisms of hypertension's effect on cognitive aging. We address this issue by comparing hypertension and control-performers in a functional MRI study. Twenty-eight hypertensive patients and 32 elderly controls were tested with n-back task with two load levels. The hypertensive patients exhibited worse executive and memory abilities than control subjects. The patterns of brain activation changed under different working memory loads in the hypertensive patients, who exhibited reduced activation only in the precentral gyrus under low loads and reduced activation in the middle frontal gyrus, left medial superior frontal gyrus and right precuneus under high loads. Thus, more regions of diminished activation were observed in the frontal and parietal regions with increasing task difficulty. More importantly, we found that lower activation in changed frontal and parietal regions was associated with worse cognitive function in high loads. The results demonstrate the relationship between cognitive function and frontoparietal functional activation in hypertension and their relevance to cognitive aging risk. Our findings provide a better understanding of the mechanism of cognitive decline in hypertension and highlight the importance of brain protection in hypertension.

Development and Application of Glove Type Restraints for Elderly Patients in Nursing Care Facilities: A Pilot Study

Purpose The purpose of this study was to compare newly designed glove type restraints with traditional restraints and to evaluate the applicability for nurses to use the restraints. Methods This study was designed as a one group pretest-posttest study. For this study nurses used both types of restraints with 19 elderly patients to prevent self-extubation. The researcher measured physical indicators, including skin edema, skin temperature, skin moisture and self-extubation, in the elderly patients and evaluated applicability of restraint for nurses. Results There were no significant differences in pretest-posttest for the physical indicators in elderly patients except for circumference of the mid hand (z=2.60, p=.018). There were significant differences between pretest and posttest in evaluating applicability of restraints by nurses. ‘overly restrictive (z=-2.81, p=.005)’ and ‘maintaining (z=-2.75, p=.006)’ were higher in traditional restraints than in the new ones and ‘applicability for skin damaged patients (z=-2.54, p=.011)’ was higher for new restraints than traditional ones. Conclusion The results show that the newly developed restraints do not increase the risk of skin damage in elderly patients. Also nurses need to consider alternative ways for minimizing physical restraint application for patients and continue to develop strategies for a safe environment. 주요어: ì–µì œëŒ€, ë ¸ì¸, 간호사 Key Words: Physical restraint, Aged, Nurses

Clinical and pathological analysis of renal damage in elderly patients with type 2 diabetes mellitus.

The aim of this study was to investigate the causes and influential factors of renal damage in elderly patients with type 2 diabetes mellitus (T2DM). Clinical data and pathological findings at autopsy of 161 elderly T2DM patients died between October 1994 and August 2011 were retrospectively reviewed. The mean age of these patients was 80.8±8.3years (range 60-105years). The incidences of diabetic nephropathy (DN), non-diabetic renal diseases (NDRD), and DN complicated with NDRD were 31.1, 62.7, and 16.2%, respectively. In patients with NDRD, the incidence of hypertensive renal damage (HRD) was 54.7%. In the factors causing renal damage, DN and NDRD accounted for 1/3 and 2/3, respectively. HRD accounted for the largest proportion of NDRD. Blood pressure control may provide additional benefits for elderly T2DM patients by preventing and delaying the occurrence and development of renal disease.

PP.04.23

Objective: To investigate the relationship between arterial elastic property and target organ damage(TOD) in elderly patients with hypertension. Design and method: One hundred and fifty-five elderly hypertensive inpatients divided into A and B two subgroups according to 24 h average blood pressure level were enrolled, sixty-one elderly patients without hypertension during the same period were enrolled as the control(group C).The body mass index(BMI), urinary albumin to creatinine ratio(ACR)and blood biochemical indicators were collected. Twenty-four hour ambulatory blood pressure monitoring(ABPM), carotid intima-media thickness(IMT) measurement and ultrasonic cardiogram(UCG) were recorded. The association between AASI and 24hPP was analyzed. AASI, ambulatory pulse pressure(24hPP), ACR, IMT and LVMI were compared between patients with hypertension and without. And analyzed the correlation between risk factors and ACR, IMT,LVMI and TOD principal component with multiple linear regression analysis. Results: There was a significant association between AASI and 24hPP (r = 0.39,P < 0.01). Compared with the non-hypertensive group, the AASI, 24hPP, ACR, and LVMI were significantly higher in hypertensive patients[0.50vs0.43,57.7vs44.5(mmHg),8.1vs3.7(mg/g),120.4vs96.9(g/m2),P < 0.05 or P < 0.01], and the estimated glomerular filtration rate was lower[84.4vs76.6(ml/min/1.73m2),P < 0.01]. A subgroup analysis in hypertensive patients found that 24 h SBP, AASI, 24hPP, ACR were all higher in group A than those in group B[135.0vs120.5(mmHg)(P < 0.05),0.53vs0.48,64.1vs53.0(mmHg),12.9vs5.5(mg/g)(SNK method)]. The multivariable regression analysis showed that AASI was correlated with LVMI, IMT and TOD principle component(all P < 0.05). Conclusions: High AASI is associated with target organ damage in elderly patients with primary hypertension. AASI can be used as the evaluation index of arterial elastic property.

The expressions and the effects of cystatin C, retinol-binding protein and β2-microglobulin on predicting renal damage in elderly patients with hypertension

Objective To investigate the expressions of serum cystatin C (CysC), retinol-binding protein (RBP), serum and urinary β2-microglobulin (β2-MG) and their effects on predicting renal damage in primary hypertension in elderly patients. Methods A total of 149 patients were divided into 3 groups of hypertension grade 1 (n=50), hypertension grade 2 (n=50) and hypertension grade 3 group (n=49). 92 healthy controls who took physical examination were selected as control group. The levels of serum CysC, RBP, serum and uric β2-MG, blood urea nitrogen, creatinine and other biochemical indexes were detected. The complications of hypertension were observed. The differences in renal function indexes between groups and their correlations were analyzed. Results There were 86 cases with hyperlipidemia (57.7%), 71 cases with atherosclerosis (47.7%), 59 cases with type 2 diabetes mellitus (39.6%), 56 cases with coronary heart disease (37.6%), and 49 cases with cerebral vascular disease (32.9%) in 149 hypertensive patients. The levels of serum CysC, RBP, serum and uric β2-microglobulin were increased in hypertensive patients as compared with healthy controls (P<0.05 or 0.01), and the extents of increments in the above indexes were positively correlated with blood pressure level 〔CysC: (1.2±0.5) mg/L, (1.7±0.6) mg/L, (2.2±0.9) mg/L; RBP: (53.1±10.2) mg/L, (65.2±16.3)mg/L, (75.8±17.5) mg/L; serum β2-MG: (2.7±1.5) mg/L, (4.0±2.1) mg/L, (4.9±2.0) mg/L; uric β2-MG: (178.3±73.9) ng/L, (237.9±78.6) ng/L, (277.5±87.5) ng/L; respectively, P<0.05 or 0.01〕. Conclusions Elderly hypertensive patients are complicated with a variety of diseases. The levels of serum CysC, retinol-binding protein, serum and uric β2-microglobulin have significant diagnostic values on renal impairment caused by hypertension, and can be considered as sensitive factors for early renal impairment in essential hypertension. Key words: Chalones C; Retinol blinding proteins; Beta 2-microglobulin; Hypertension