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Heart Failure and Diabetes: Perspective of a Dangerous Association. 心力衰竭和糖尿病:危险关联的观点。
IF 2.3 Q2 Medicine Pub Date : 2021-01-01 DOI: 10.2174/1573402117666210406111927
Liliana E Favaloro, Roxana D Ratto, Carla Musso

The relationship between diabetes and risk of heart failure has been described in previous trials, releasing the importance of the hyperglycemic state that, added to other risk factors, favors the development of coronary heart disease. The mechanism by which, in the absence of hypertension, obesity and/or dyslipidemia, diabetic patients develop cardiomyopathy has been less studied. Recently, the Sodium Glucose Co-transporter type 2 inhibitors (SGLT2 inhibitors) used for the treatment of heart failure patients with or without diabetes has been a breakthrough in the field of medicine. This review describes the established pathophysiology of diabetic cardiomyopathy and SGLT2 inhibitors, their mechanisms of action, and benefits in this group of patients.

糖尿病和心力衰竭风险之间的关系在以前的试验中已经被描述,释放了高血糖状态的重要性,加上其他风险因素,有利于冠心病的发展。在没有高血压、肥胖和/或血脂异常的情况下,糖尿病患者发生心肌病的机制研究较少。近年来,用于治疗伴有或不伴有糖尿病的心力衰竭患者的葡萄糖共转运蛋白2型抑制剂(SGLT2抑制剂)在医学领域取得了突破性进展。本文综述了糖尿病心肌病的病理生理学和SGLT2抑制剂,它们的作用机制,以及在这组患者中的益处。
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引用次数: 2
Renal Function, Albumin-Creatinine Ratio and Pulse Wave Velocity Predict Silent Coronary Artery Disease and Renal Outcome in Type 2 Diabetic and Prediabetic Subjects. 肾功能、白蛋白-肌酐比值和脉搏波速度预测2型糖尿病和前驱糖尿病患者无症状冠状动脉疾病和肾脏预后
IF 2.3 Q2 Medicine Pub Date : 2021-01-01 DOI: 10.2174/1573402116999201210194817
Ramiro A Sanchez, Maria J Sanchez, Agustin J Ramirez

Introduction: Silent coronary heart disease is frequently undetected in type 2 diabetes mellitus (DM2) and pre-diabetes determined by glucose intolerance (GI). Pulse wave velocity (PWV) and albumin-creatinine ratio (ACR) have been considered markers of cardiovascular mortality, coronary heart disease and chronic renal failure.

Aim: To evaluate the incidence of coronary artery disease (CAD) and the relationship between urinary albumin-creatinine ratio, glomerular filtration rate (GFR) and PWV in type 2 DM with silent CAD.

Methods: We analyzed 92 individuals (44 male), 49 (60±7y) type 2 DM non-insulin dependents and 43 prediabetics (43±4y), with Grade I-II hypertension and no symptoms of CAD. All type 2 DM patients were under antidiabetic treatment with A1C hemoglobin between 5.5 and 6.5%. Every patient underwent a myocardial perfusion SPECT scan. In those subjects with ischemic patterns, coronary angiography was performed. In addition, PWV, glomerular filtration rate, and ACR were evaluated.

Statistics: mean±SEM, and ANOVA among groups.

Results: 48.59% of DM2 and 25.58% of GI patients had silent coronary artery had silent coronary artery disease and higher ACR, PWV and reduced GFR. Higher ACR and PWV and reduced GFR. DM2 and GI showed a negative relationship between GFR and ACR. Moreover, this relation was also observed in different levels of GFR (>60 ml/min and <60ml.min (p<0.05) in patients with CAD, suggesting a cardio-renal interaction in DM2.

Conclusion: Higher PWV, lower GFR and ACR predict the incidence of CAD in DM2. Dysglycemic individuals also represent a group of higher risk for coronary artery disease with similar predictors as in DM2. Diabetic and prediabetics still develop renal microalbuminuria. Thus, PWV seems to represent a reliable marker of renal impairment and coronary artery disease.

在2型糖尿病(DM2)和糖尿病前期,通过葡萄糖耐受不良(GI)检测,往往无法发现隐匿性冠心病。脉搏波速度(PWV)和白蛋白-肌酐比(ACR)被认为是心血管疾病死亡率、冠心病和慢性肾功能衰竭的标志。目的:探讨2型糖尿病合并隐匿性冠心病的冠心病(CAD)发病率及尿白蛋白-肌酐比值、肾小球滤过率(GFR)和PWV的关系。方法:我们分析了92例(男性44例),49例(60±7y) 2型糖尿病非胰岛素依赖性患者和43例(43±4y)糖尿病前期患者,均为I-II级高血压,无冠心病症状。所有2型糖尿病患者均接受降糖治疗,A1C血红蛋白在5.5 - 6.5%之间。每位患者均行心肌灌注SPECT扫描。缺血型患者行冠状动脉造影。此外,评估PWV、肾小球滤过率和ACR。统计学:组间均值±SEM,方差分析。结果:48.59%的DM2和25.58%的GI患者有无症状冠状动脉疾病,ACR、PWV升高,GFR降低。提高ACR和PWV,降低GFR。DM2和GI与GFR和ACR呈负相关。结论:较高的PWV、较低的GFR和ACR可预测DM2中CAD的发生。血糖异常的个体也代表了冠状动脉疾病的高风险群体,其预测指标与DM2相似。糖尿病和糖尿病前期患者仍会出现肾微量白蛋白尿。因此,PWV似乎是肾脏损害和冠状动脉疾病的可靠标志。
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引用次数: 3
Association of Low BMI with Aortic Stiffness in Young Healthy Individuals 年轻健康个体低BMI与主动脉僵硬的关系
IF 2.3 Q2 Medicine Pub Date : 2021-01-01 DOI: 10.2174/1573402117666210121100936
Satish G Patil, Sneha Arakeri, Vitthal Khode

Background: Increased arterial stiffness is an independent predictor of cardiovascular morbidity and mortality. It is unknown whether low BMI has any detrimental effect on the arterial wall during young age.

Objectives: The present study was aimed to determine if low BMI can increase arterial stiffness in young, healthy individuals.

Methods: A cross-sectional study was conducted on young, healthy subjects (n=100) with low BMI <18.5 (n=50) and normal BMI: 18.5-24.9 (n=50) with ages ranging between 15-23 years. BMI, heart rate, blood pressure, and arterial stiffness indices such as regional pulse wave velocity (PWV) between brachial-ankle (baPWV), carotid-femoral (cfPWV), heart-ankle (haPWV), heartbrachial (hbPWV) were measured.

Results: A significantly increased pulse pressure (p=0.014), baPWV (1059.2 ± 140.26 cm/s vs 994.66 ± 129.23 cm/s; p=0.019) and cfPWV (641.03 ± 113.83 cm/s vs 583.96 ± 120.48 cm/s; p=0.017) was found in individuals with low BMI than normal BMI group. There was a significant negative correlation between BMI and central arterial PWV. Further multiple regression analysis showed that BMI was robustly associated with cf-PWV (p=0.004) and baPWV (p=0.016) even after multiple adjustments with potential confounders using several models.

Conclusion: These findings show a significant increased aortic stiffness and pulse pressure in low BMI subjects compared to those with normal BMI. Low BMI was inversely and independently associated with central arterial or aortic stiffness. These findings suggest that low BMI may be a risk factor for aortic stiffness in young, healthy individuals.

背景:动脉僵硬度升高是心血管疾病发病率和死亡率的独立预测因子。目前尚不清楚低BMI是否对年轻时的动脉壁有任何有害影响。目的:本研究旨在确定低BMI是否会增加年轻健康个体的动脉硬化。方法:对100名BMI较低的年轻健康受试者进行横断面研究。结果:患者脉压(p=0.014)、baPWV(1059.2±140.26 cm/s vs 994.66±129.23 cm/s)显著升高;p=0.019)和cfPWV(641.03±113.83 cm/s vs 583.96±120.48 cm/s;p=0.017)。BMI与中央动脉PWV呈显著负相关。进一步的多元回归分析显示,BMI与cf-PWV (p=0.004)和baPWV (p=0.016)存在显著相关,即使在多个模型中对潜在混杂因素进行了多次调整后也是如此。结论:这些发现表明,与BMI正常的受试者相比,低BMI受试者的主动脉僵硬度和脉压明显增加。低BMI与中央动脉或主动脉僵硬度呈负相关且独立相关。这些发现表明,低BMI可能是年轻健康个体主动脉僵硬的一个危险因素。
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引用次数: 2
Endothelial Dysfunction Induced by Cadmium and Mercury and its Relationship to Hypertension. 镉、汞所致内皮功能障碍及其与高血压的关系。
IF 2.3 Q2 Medicine Pub Date : 2021-01-01 DOI: 10.2174/1573402117666210121102405
Airton C Martins, Alessanda A D Santos, Ana C B A Lopes, Anatoly V Skalny, Michael Aschner, Alexey A Tinkov, Monica M B Paoliello

Hypertension is an important public health concern that affects millions globally, leading to a large number of morbidities and fatalities. The etiology of hypertension is complex and multifactorial, and it involves environmental factors, including heavy metals. Cadmium and mercury are toxic elements commonly found in the environment, contributing to hypertension. We aimed to assess the role of cadmium and mercury-induced endothelial dysfunction in the development of hypertension. A narrative review was carried out through database searches. In this review, we discussed the critical roles of cadmium and mercury in the etiology of hypertension and provided new insights into potential mechanisms of their effect, focusing primarily on endothelial dysfunction. Although the mechanisms by which cadmium and mercury induce hypertension have yet to be completely elucidated, evidence for both implicates impaired nitric oxide signaling in their hypertensive etiology.

高血压是影响全球数百万人的重要公共卫生问题,导致大量发病和死亡。高血压的病因是复杂的、多因素的,它涉及环境因素,包括重金属。镉和汞是环境中常见的有毒元素,会导致高血压。我们的目的是评估镉和汞诱导的内皮功能障碍在高血压发展中的作用。通过数据库检索进行了叙述性审查。在这篇综述中,我们讨论了镉和汞在高血压病因学中的关键作用,并对其影响的潜在机制提供了新的见解,主要集中在内皮功能障碍上。虽然镉和汞诱发高血压的机制尚未完全阐明,但两者的证据都暗示了其高血压病因中一氧化氮信号受损。
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引用次数: 8
Phyto-derived Products as Matrix Metalloproteinases Inhibitors in Cardiovascular Diseases. 植物衍生产品作为基质金属蛋白酶抑制剂在心血管疾病中的应用。
IF 2.3 Q2 Medicine Pub Date : 2021-01-01 DOI: 10.2174/1573402116666200510011356
Alejandro F do Prado, Cahy M Bannwart, Victoria M T Shinkai, Ildercílio M de Souza Lima, César A Meschiari

Matrix metalloproteinases (MMPs) are enzymes that present a metallic element in their structure. These enzymes are ubiquitously distributed and function as extracellular matrix (ECM) remodelers. MMPs play a broad role in cardiovascular biology regulating processes such as cell adhesion and function, cellular communication and differentiation, integration of mechanical force and force transmission, tissue remodeling, modulation of damaged-tissue structural integrity, cellular survival or apoptosis and regulation of inflammation-related cytokines and growth factors. MMPs inhibition and downregulation are correlated with minimization of cardiac damage, i.e., Chinese herbal medicine has shown to stabilize abdominal aorta aneurysm due to its antiinflammatory, antioxidant and MMP-2 and 9 inhibitory properties. Thus phyto-derived products rise as promising sources for novel therapies focusing on MMPs inhibition and downregulation to treat or prevent cardiovascular disorders.

基质金属蛋白酶(MMPs)是在其结构中呈现金属元素的酶。这些酶是普遍分布和功能作为细胞外基质(ECM)重塑。MMPs在心血管生物学调控过程中发挥着广泛的作用,如细胞粘附和功能、细胞通讯和分化、机械力和力传递的整合、组织重塑、受损组织结构完整性的调节、细胞存活或凋亡以及炎症相关细胞因子和生长因子的调节。MMPs的抑制和下调与心脏损伤的最小化相关,即中草药因其抗炎、抗氧化和MMP-2和9抑制特性而被证明具有稳定腹主动脉动脉瘤的作用。因此,植物衍生产品有望成为关注MMPs抑制和下调以治疗或预防心血管疾病的新疗法的来源。
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引用次数: 0
Beta Blockers and Chronic Obstructive Pulmonary Disease (COPD): Sum of Evidence. -受体阻滞剂和慢性阻塞性肺疾病(COPD):证据总结。
IF 2.3 Q2 Medicine Pub Date : 2021-01-01 DOI: 10.2174/1573402116999201209203250
Katerina Baou, Vasiliki Katsi, Thomas Makris, Dimitris Tousoulis

Approximately half a century has passed since the discovery of beta-blockers. Then, their prime therapeutic purpose was to treat angina and cardiac arrhythmias; nowadays, beta-blockers' usage and effectiveness are extended to treat other cardiovascular diseases, such as hypertension, congestive heart failure, and coronary artery disease. Safety concerns were raised about beta- blockers and their use for chronic obstructive pulmonary disease (COPD) patients with concurrent cardiovascular disease. After thorough research of the literature, this review summarizes the evidence proving that beta-blockers not only might be well tolerated in COPD patients, but they might also have a beneficial effect in this group of patients.

自从发现受体阻滞剂以来,大约半个世纪过去了。当时,它们的主要治疗目的是治疗心绞痛和心律失常;如今,受体阻滞剂的使用和疗效已扩展到治疗其他心血管疾病,如高血压、充血性心力衰竭和冠状动脉疾病。对-受体阻滞剂及其用于并发心血管疾病的慢性阻塞性肺疾病(COPD)患者的安全性担忧有所提高。经过对文献的深入研究,本综述总结了证明-受体阻滞剂不仅在COPD患者中具有良好耐受性,而且可能对这组患者有有益作用的证据。
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引用次数: 2
Pesticides-induced Cardiovascular Dysfunctions: Prevalence and Associated Mechanisms. 农药诱导的心血管功能障碍:患病率和相关机制。
IF 2.3 Q2 Medicine Pub Date : 2021-01-01 DOI: 10.2174/1573402117666210111102508
Joseph A Adeyemi, Victor O Ukwenya, Olatunbosun K Arowolo, Christian C Olise

Increased applications of pesticides, mainly in agriculture and public health, have resulted in increased chances of human exposure to pesticides. Chronic exposure to pesticides has been implicated in several human diseases, including cardiovascular diseases. Cardiovascular diseases are broadly used for various heart pathological conditions, including a defect in blood vessels, and they include myocardial infarction, atherosclerosis, stroke, cardiomyopathy, coronary heart disease, etc. In this review, the association between human exposure to pesticides and the development of cardiovascular diseases was discussed using epidemiological and laboratory data. The toxicokinetics of pesticides in humans was reviewed, as well as the risk factors for cardiovascular diseases. The important role of oxidative stress principally the induction of reactive oxygen species as the signaling molecules for various signaling pathways involved in pesticides-induced cardiovascular disease, was discussed.

农药的使用增加,主要是在农业和公共卫生领域,导致人类接触农药的机会增加。长期接触农药与包括心血管疾病在内的几种人类疾病有关。心血管疾病广泛用于包括血管缺陷在内的各种心脏病理状况,包括心肌梗死、动脉粥样硬化、中风、心肌病、冠心病等。本文利用流行病学和实验室资料讨论了人类接触农药与心血管疾病之间的关系。综述了农药在人体内的毒性动力学以及心血管疾病的危险因素。讨论了氧化应激的重要作用,主要是诱导活性氧作为信号分子参与农药诱导的心血管疾病的各种信号通路。
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引用次数: 8
Ambulatory Blood Pressure Monitoring in the Diagnosis and Management of Arterial Hypertension in Current Medical Practice in Algeria. 动态血压监测在诊断和管理动脉高血压在阿尔及利亚目前的医疗实践。
IF 2.3 Q2 Medicine Pub Date : 2021-01-01 DOI: 10.2174/1573402116666200324144223
Naima Hammoudi-Bendib, Leila Manamani, Souhila Ouabdesselam, Dalila S Ouamer, Sofiane Ghemri, Laurene Courouve, Amine Cherif, Lamine Mahi, Salim Benkhedda

Objective: There are limited data on the management of hypertension (HT) in Algeria. The aim of this study was to assess, in current medical practice, the use and benefits of ambulatory blood pressure monitoring (ABPM) for the diagnosis and management of HT.

Methods: A prospective, observational, multicenter study was performed in 2017. Patients aged ≥ 18 years with suspected or treated HT were included. A 24-hour ABPM was performed at baseline in all patients. Therapeutic decision was taken by the physician according to ABPM results and patients were then followed up to 6 weeks.

Results: The analysis included 1027 patients (mean age, 51.0 years; women, 61.6%) with treated HT (37.3%) or suspected HT (62.7%). Major cardiovascular risk factors were diabetes (15.7%) and lipid disorders (7.2%). ABPM was pathological in 55.1% of patients on antihypertensive treatment and in 60.8% of patients with suspected HT. A therapeutic adjustment or a treatment switch was performed after pathological ABPM in 37.4% of patients already on antihypertensive treatment and an antihypertensive therapy was initiated in 54.9% of patients with initially suspected HT.

Conclusion: This study is the first evaluation of the usefulness of ABPM for the management of HT in Algeria. Our results emphasize that ABPM is a highly valuable method for avoiding the whitecoat effect and for detecting patients who are insufficiently treated with antihypertensive drugs.

目的:阿尔及利亚高血压(HT)的治疗数据有限。本研究的目的是评估,在目前的医疗实践中,动态血压监测(ABPM)在HT的诊断和管理中的应用和益处。方法:2017年进行了一项前瞻性、观察性、多中心研究。年龄≥18岁疑似或已治疗的HT患者纳入研究。所有患者均在基线时进行24小时ABPM。医生根据ABPM结果作出治疗决定,然后随访患者至6周。结果:纳入1027例患者,平均年龄51.0岁;接受治疗的HT患者(37.3%)或疑似HT患者(62.7%)为女性(61.6%)。主要的心血管危险因素是糖尿病(15.7%)和脂质紊乱(7.2%)。接受降压治疗的患者中有55.1%的ABPM是病理性的,疑似HT患者中有60.8%的ABPM是病理性的。37.4%已经接受抗高血压治疗的患者在病理性ABPM后进行了治疗调整或治疗转换,54.9%最初疑似HT的患者开始了抗高血压治疗。结论:本研究首次评价了ABPM在阿尔及利亚治疗HT的有效性。我们的研究结果强调ABPM是一种非常有价值的方法,可以避免白衣效应和发现降压药物治疗不足的患者。
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引用次数: 1
Serum Uric Acid and Progression of Autosomal Dominant Polycystic Kidney Disease: Results from the HALT PKD Trials. 血清尿酸与常染色体显性多囊肾病的进展:来自HALT PKD试验的结果
IF 2.3 Q2 Medicine Pub Date : 2021-01-01 DOI: 10.2174/1573402116666200817113125
Godela M Brosnahan, Zhiying You, Wei Wang, Berenice Y Gitomer, Michel Chonchol

Background: Epidemiological studies have suggested that elevated serum uric acid may contribute to the progression of chronic kidney disease. However, no large prospective study has examined whether hyperuricemia is an independent risk factor for the progression of autosomal dominant polycystic kidney disease (ADPKD).

Methods: We measured uric acid in stored serum samples from the 2-year study visit of 671 participants from the HALT PKD multicenter trials. Participants were categorized according to uric acid tertiles. For Study A (participants aged 15-49 years with preserved kidney function, n=350), we used linear mixed effects models to examine the association between uric acid and repeated measures of height-adjusted total kidney volume (htTKV), the primary outcome for Study A. For Study B (participants aged 18-64 with decreased kidney function, n=321), we used Cox proportional hazards models to assess the hazard for the combined endpoint of 50% loss in estimated glomerular filtration rate (eGFR), end-stage kidney disease (ESKD), or death, the primary outcome for Study B. To assess the association of uric acid with the slope of eGFR decline (secondary outcome of HALT A and B), we used linear mixed effects models for the combined population of Study A and B.

Results: In the unadjusted model, the annual change in htTKV was 2.7% higher in the highest uric acid tertile compared to the lowest (p<0.001), but this difference became insignificant after adjustment for gender. Men had faster TKV growth than women (p<0.001). There was no difference in eGFR decline between the 3 uric acid tertiles. Hazard ratios for the clinical endpoint were 2.9 (95% confidence interval, 1.9-4.4) and 1.8 (1.1-2.8) respectively in the high and medium uric acid groups in unadjusted and partially adjusted models (p<0.001), but the significance was lost after adjustment for baseline eGFR. Results were similar when uric acid was examined as a continuous variable.

Conclusion: Elevated serum uric acid is not an independent risk factor for disease progression in ADPKD.

背景:流行病学研究表明,血清尿酸升高可能与慢性肾脏疾病的进展有关。然而,尚无大型前瞻性研究检验高尿酸血症是否是常染色体显性多囊肾病(ADPKD)进展的独立危险因素。方法:我们测量了来自HALT PKD多中心试验的671名参与者为期2年的研究访问中储存的血清样本中的尿酸。参与者根据尿酸等级进行分类。对于研究A(年龄15-49岁,肾功能保存,n=350),我们使用线性混合效应模型来检验尿酸与重复测量身高调整后的总肾体积(htTKV)之间的关系,这是研究A的主要结局。对于研究B(年龄18-64岁,肾功能下降,n=321),我们使用Cox比例风险模型来评估肾小球滤过率(eGFR)估计损失50%的联合终点的风险。为了评估尿酸与eGFR下降斜率(HALT A和B的次要结局)之间的关系,我们对研究A和B的合并人群使用了线性混合效应模型。结果:在未经调整的模型中,尿酸最高的人群的htTKV年变化比最低的人群高2.7% (p)。血清尿酸升高不是ADPKD疾病进展的独立危险因素。
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引用次数: 2
Endogenous Bufadienolide, Blood Pressure and Alcohol Withdrawal. 内源性丁二烯内酯对血压和戒酒的影响。
IF 2.3 Q2 Medicine Pub Date : 2021-01-01 DOI: 10.2174/1573402116999200819162306
Vladimir A Kashkin, Alexei Y Egorov, Evgeniy M Krupitsky, Alexei Y Bagrov

Background and objective: Previously, it was demonstrated that marinobufagenin (MBG) is implicated in the development of ethanol withdrawal in rats. It has been shown that ethanol withdrawal is associated with a pressor response in the alcoholics. We hypothesized that elevated levels of sodium pump ligand, MBG, would underline the increase in systolic blood pressure during alcohol withdrawal in humans.

Methods: The cohort included 9 patients with the diagnosis "alcohol dependence syndrome" (F10.(1-3) according to ICD-10). The blood samples for measurement of MBG concentration were collected from the subjects on the first day of withdrawal and after 7 days treatment of the abstinence. Arterial blood pressure was measured via plethysmography at the same time points.

Results: The beginning of the alcoholic abstinence was associated with the rise of arterial blood pressure with enhanced levels of plasma MBG. At day 7 following withdrawal, the systolic blood pressure and MBG levels were decreased to normal values.

Conclusion: The development of alcohol withdrawal is accompanied by an increase in arterial blood pressure, which is associated with increased plasma MBG concentration.

背景与目的:先前有研究表明,marinobufagenin (MBG)与大鼠乙醇戒断的发生有关。研究表明,酒精戒断与酗酒者的升压反应有关。我们假设钠泵配体(MBG)水平的升高会强调人类在戒酒期间收缩压的升高。方法:纳入9例诊断为“酒精依赖综合征”的患者(根据ICD-10评分F10.(1-3))。分别于停药第一天和停药7天后采集受试者血样测定MBG浓度。在同一时间点通过容积描记仪测量动脉血压。结果:开始戒酒与动脉血压升高和血浆MBG水平升高有关。停药后第7天,收缩压和MBG水平降至正常值。结论:酒精戒断的发生伴随着动脉血压升高,而动脉血压升高与血浆MBG浓度升高有关。
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引用次数: 0
期刊
Current Hypertension Reviews
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