肌钙蛋白I、CK、CK-MB的测定在心肌损伤性疾病中的诊断价值

[目的]通过测定心肌梗死、不稳定心绞痛患者的血清肌钙蛋白I(CTNI)、肌酸激酶(CK)及其同工酶(CK-MB),探讨其对早期心肌损伤性疾病的诊断价值.[方法]CTNI的测定利用BeckmanAccess全自动免疫分析仪,采用免疫散射比浊法;CK-MB的测定利用日本OLYMPUSAU400全自动生化分析仪,采用酶法.测定56例急性心肌梗塞(AMI)患者、43例不稳定性心绞痛(UAP)患者和50例健康体检者血清肌钙蛋白I(CTNI)、CK、CK-MB;并作相关统计学分析.[结果]AMI组血清CTNI明显高于正常对照组(P<0.01),敏感度为92.98％,特异性为97.96％,UAP组血清CTNI亦明显高于正常对照组(P<0.01).[结论]肌钙蛋白I联合检测CK、CK-MB,在早期心肌损伤的诊断、疗效检测方面具有重要意义.     

肌钙蛋白Ⅰ、CK、CK-MB的测定在心肌损伤性疾病中的诊断价值

[目的]通过测定心肌梗死、不稳定心绞痛患者的血清肌钙蛋白I(CTNI)、肌酸激酶(CK)及其同工酶(CK-MB),探讨其对早期心肌损伤性疾病的诊断价值.[方法]CTNI的测定利用Beckman Access全自动免疫分析仪,采用免疫散射比浊法;CK-MB的测定利用日本OLYMPUS AU400全自动生化分析仪,采用酶法.测定56例急性心肌梗塞(AMI)患者、43例不稳定性心绞痛(UAP)患者和50例健康体检者血清肌钙蛋白I(CTNI)、CK、CK-MB;并作相关统计学分析.[结果]AMI组血清CTNI明显高于正常对照组(P＜0.01),敏感度为92.98%,特异性为97.96%,UAP组血清CTNI亦明显高于正常对照组(P＜0.01).[结论]肌钙蛋白Ⅰ联合检测CK、CK-MB,在早期心肌损伤的诊断、疗效检测方面具有重要意义.     

肌钙蛋白T定性和磷酸肌酸激酶同功酶对急性心肌梗塞实验室诊断价值的比较

本文对150例疑为急性心肌梗塞的门诊及住院病人用ELISA双抗体夹心法定性测定心肌肌钙蛋白T(CTnT),用NAC-ACTIVAED法定量磷酸肌酸激酶同工酶(CK-MB),并对两种方法的诊断价值进行比较,结果表明:(1)在急性心肌梗塞(AMI)发病6h以内,CTnT定性测定的敏感性大于(CK-MB(P<0.01);(2)发病6-48h两指标同样敏感(P>(0.25);(3)对于隐匿型心肌梗塞的诊断CTnT的敏感性和特异性均大于CK-MB。且CTnT定性快速、方便,对于AMI的早期诊断,早期溶栓治疗,降低死亡率及改善预后有重要意义。     

预测脓毒症患者心脏功能障碍和死亡率的多生物标记物策略（英文）

目的:评估联合应用多种生物标记物以预测脓毒症患者早期心脏功能障碍及28天死亡率的可行性。创新点:(1)通过净重分类改善(NRI)和综合辨别改善(IDI)指标,评估多种生物标志物策略相比单一生物标志物策略对脓毒症患者心脏功能障碍及28天死亡率的预测价值。(2)评估心脏型脂肪酸结合蛋白(h-FABP)、髓过氧化物酶(MPO)以及妊娠相关血浆蛋白A(PAPP-A)等新型生物标记物在脓毒症中的临床预测价值。方法:检测147例脓毒症患者在入院后6小时内血浆中脑钠肽(BNP)、心肌肌钙蛋白I(cTnI)、h-FABP、MPO及PAPP-A的水平。使用受试者工作特征(ROC)曲线来评估各种单一生物标志物在脓毒症患者心脏功能障碍诊断和28天死亡率预测中的最佳截止值。采用ROC曲线、NRI和IDI指标评估多种生物标志物策略相比单一生物标志物策略在预测脓毒症相关心脏功能障碍及28天死亡率中的价值。结论:MPO、cTnI和h-FABP联合应用显著提高了对脓毒症患者心脏功能障碍的预测能力,同时PAPP-A、MPO和h-FABP联合应用显著提高了预测脓毒症患者28天死亡率的能力。     

心肌肌钙蛋白I、肌红蛋白和CK-MB监测对急性心肌梗塞的诊断价值比较

血清心肌肌钙蛋白I (cTnI)、肌红蛋白 (Mb)和CK -MB (肌酸激酶同工酶MB)等心肌酶谱是目前诊断急性心肌梗塞 (AMI)时应用最多和最广的生化标志物 .自 1999年 10月以来 ,对急性胸痛就诊怀疑AMI的病人 ,进行血清cTnI、Mb和CK -MB等心肌酶谱的单次或连续监测 ,结果 :cTnI监测的诊断灵敏度为 10 0 % ,诊断特异性为 96 8% ,诊断准确度为97 1% ;Mb监测的诊断灵敏度为 10 0 % ,诊断特异性为 76 2 % ,诊断准确度为 80 0 % ;CK -MB监测的诊断灵敏度为 10 0 % ,诊断特异性为 35 0 % ,诊断准确度为 4 8 0 % .cTnI监测的诊断特异性和诊断准确度均明显高于Mb ,而Mb监测的诊断特异性和诊断准确度又明显高于CK-MB .对于患AMI的病人 ,血清Mb出现阳性的时间比血清cTnI早 ,转为阴性的时间比cTnI快 ,而cTnI阳性持续时间较长     

一道解几高考题引发的思考

2004年数学科高考北京卷中有如下一道解析几何试题:y P如图,过抛物线xy2=2px(p>0)上O一定点P(xo,yo)(yo A>0),作两条直线分B别交抛物线于A(x1,y1),B(x2,y2).(I)求该抛物线上纵坐标为p/2的点到其焦点F的距离;(II)当PA与PB的斜率存在且倾斜角互补时,求(y1 y2)/yo的值,并证明直线A     

老年患者经皮冠状动脉介入术后急性肾损伤的早期诊断的研究（英文）

目的:探索老年患者尿液中肝型脂肪酸结合蛋白(L-FABP)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)及肾损伤分子1(KIM-1)三种新型肾损伤标志物对经皮冠状动脉介入(PCI)术后急性肾损伤(AKI)的早期预测作用。创新点:本研究主要评估PCI术后肾损伤标志物的上升倍数对AKI早期诊断的价值,对基线标志物水平不同的患者而言,具有一定意义。方法:采用巢式病例对照研究的方法来比较PCI术后AKI患者和对照组患者围手术期肾损伤标志物的变化。结论:老年患者PCI术后6小时尿L-FABP和NGAL的上升倍数对AKI具有一定的预测价值。二者联合检验预测价值更高。而尿KIM-1的早期预测价值较低。     

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哺乳动物α-羟基丁酸脱氢酶的测定及临床意义

α-羟基丁酸脱氢酶（HBDH）是心肌酶谱中的一种酶，在哺乳动物体内普遍存在，主要分布于心肌红细胞、白细胞及肾脏等。HBDH活性升高常见于急性心肌梗塞、骨骼肌损伤、急性肝炎、白血病及恶性肿瘤等。可用紫外动力学法、速率法、酶学比色法、连续检测等方法来测定HBDH的活性。LDH／HBDH比值可以帮助诊断肝病或心脏病。HBDH活性测定在临床诊断中有重要意义，在某些临床诊断中HBDH、CK、CK-MB需联合测定，但就心肌受损相关疾病而言，没必要同时检测。由于酶基因表达的多样性，基因表达调控上的差异性，产生了各种动物酶结构的多样性，进行HBDH的分子遗传研究非常必要。     

肢体缺血预处理对大鼠坏死心肌的保护作用

目的:研究肢体缺血预处理(LIP)对大鼠缺血再灌后心脏损伤的影响。方法:采用反复捆绑后肢造成缺血预适应的方法,观察其对心肌缺血再灌后梗死面积和形态学改变的影响,对心肌CK-MB和cTn-I的影响,以及对抗氧化物酶的影响。结果:与缺血再灌组比较,预处理能明显降低心肌梗死面积,减轻心肌细胞的损害,减少心肌酶的漏出并能提高SOD的活性。结论:LIP对心肌损伤具有保护作用。     

联合检测尿液α_1-MG、NAG及尿液Cystatin C对肾损害早期诊断的临床意义

[目的]探讨尿液α1-微球蛋白(α1-MG)、N-乙酰-β-D氨基葡萄糖苷酶(NAG)、半胱氨酸蛋白酶抑制剂(Cystatin C)联合检测对诊断肾脏早期损害的临床价值.[方法]采用免疫比浊法检测尿液α1-MG、CystatinC的含量,连续监测法检测尿液N乙酰β-D氨基葡萄糖苷酶(NAG).[结果]患者尿中α1-MG、NAG、Cystatin C水平均显著高于对照组(P<0.01).单纯检测上述指标中的一项或两项阳性率较低,联合检测三项阳性率较高.[结论]检测尿液α1-MG、NAG、Cystatin C是早期肾损害的敏感指标,联合检测对患者肾脏损伤的早期诊断和疗效观察有重要的意义.     

Effects of fructose-1,6-diphosphate on concentration of calcium and activities of sarcoplosnic Ca^2＋-ATPase in cardiomyocytes of Adriamycin-treated rats

Objective: To observe the effects of fructose-1,6-diphosphate (FDP) on serum levels of cardiac troponin 1 (cTnl) and creatine kinase-MB (CK-MB), as well as the concentration of calcium in cardiomyocytes (Myo[Ca2 ]) and activity of sarcoplosnic Ca2 -ATPase (SRCa2 -ATPase) in Adriamycin (ADR)-treated rats. Methods: Rats were intraperitoneally injected with ADR (2.5 mg/kg every other day for 6 times) and then with different dosages of FDP (every other day for twenty-one times). Bi-antibodies sandwich Enzyme linked immune absorption assay (ELISA) was performed to detect serum level of cTnl. CK-MB was detected by monoclonal antibody, Myo[Ca2 ] was detected by fluorescent spectrophotometry and the activity of SRCa2 -ATPase was detected by inorganic phosphate method. Results: FDP (300, 600, 1200 mg/kg) significantly reduced the serum levels of cTnl and CK-MB, while at the same time decreased calcium concentration and increased SRCa2 -ATPase activity in cardiomyocytes of ADR-treated rats (P<0.01). Conclusions: FDP might alleviate the cardiotoxic effects induced by ADR through decreasing calcium level as well as increasing SRCa2 -ATPase activity in cardiomyocytes.     

Study on the effect of doxorubicin on expressions of genes encoding myocardial sarcoplasmic reticulum Ca~( 2+) transport proteins and the effect of taurine on myocardial protection in rabbits

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潘南金对急性心肌梗塞心律失常影响的对比研究

目的观察潘南金(门冬氨酸钾镁)对急性心肌梗塞后心律失常、泵功能及死亡率的影响.方法本文对我院1998.3～1999.10月收入CCU病房的40例患者进行单盲、随机分为治疗组和对照组,治疗组第1～5天给予潘南金静脉输注,第6～15天改为口服,检测两组治疗前、第5、10天的血清钾、镁离子浓度,记录治疗前后血压及第一天24hHolter,统计两组并发症及死亡率,所得数据进行统计学处理.结果两组间在年龄、性别、发病时间及合并用药等方面无差异,所有资料具有可比性.治疗组第5、10天的血镁较治疗前及对照组显著增高(P＜0.01),治疗组的心衰、室早、室速较对照组明显减少(P值分别为＜0.05、＜0.01及＜0.05),治疗组再灌注心律失常发生率较对照组减少(P＜0.05),死亡率两组间无显著差异(P＜0.05).治疗组治疗前后血压变化较对照组明显(P＜0.05).结论潘南金可以减少AMI后心衰的发生,改善心功能,减少AMI后室性心律失常的发生.在溶栓的患者,潘南金能减少再灌注心律失常的发生,减小再灌注损伤.但潘南金对血压有较大的影响,尤其血压在正常低限时,静脉输注潘南金可使低血压发生率增加,因此临床应用时需注意.     

碎裂QRS波对急性心肌梗死患者的短期预后评估(英文)简

This study is aimed to investigate the clinical significance and the short-term prognostic value of frag- mented QRS （fQRS） for patients with acute myocardial infarction （AMI）. Three hundred patients with AMI were tested with retrospective analysis on the patients＇ clinical information, hospitalized treatment, fQRS onset time, location of lesions, and other relevant data, in order to assess the relationship between the presence of fQRS and its prognosis. The rates of malignant cardiac arrhythmia, left ventricular systolic dysfunction （LVSD）, and mortality in the positive fQRS group were 13.6%, 29.2%, and 23.7%, respectively, with all showing a p value 〈0.05. For the ST segment elevation myocardial infarction （STEMI） subgroup, all the rates showed significant differences with a p value 〈0.01, while for the non-STEMI （NSTEMI） subgroup showed no significant differences. In patients with a positive fQRS, there were no differences in malignant cardiac arrhythmia between patients with and without percutaneous coronary in- tervention （PCI） （p〉0.05）. As for the LVSD and mortality, the p values between patients with and without PCI were 0.031 and 0.000, respectively, suggesting statistical significance. The results imply that AMI patients with positive fQRS especially for the patients with STEMI had higher rates of malignant cardiac arrhythmia, LVSD, and mortality than the non-fQRS group. Patients of AMI with positive fQRS, who underwent early revascularization, could lower the incidence of the cardiovascular event. In addition, the presence of fQRS could be used as an indication of early in- tervention treatment for patients.     

Effect of a distal protection device on epicardial blood flow and myocardial perfusion in primary percutaneous coronary intervention

Objective: The beneficial effect of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has been well established, but there is the problem of no-reflow phenomenon which is an adverse prognostic factor in primary PCI. In the present study the effect of a distal protection device (PercuSurge GuardWire; GW) on epicardial blood flow and myocardial perfusion was evaluated. Methods and Results: Patients with AMI were randomly divided into 2 groups, the GW and the control groups. The GW group included 52 patients with AMI who underwent primary PCI with GW protection and the control group included 60 patients who underwent primary PCI without GW protection. Epicardial blood flow in the infarct-related artery (IRA) and myocardial perfusion were evaluated according to the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade (MBG). We found TIMI score of 3 was obtained significantly more frequently in the GW group (96%) than in the control group (80%). The MBG score of 3 was obtained also significantly greater in the GW group (65%) than in the control group (33%). Conclusion: Primary PCI with GW protection can significantly improve epicardial blood flow and myocardial perfusion.     

Study on the effect of doxorubicin on expressions of genes encoding myocardial sarcoplasmic reticulum Ca2+ transport proteins and the effect of taurine on myocardial protection in rabbits

To investigate the effect of doxorubicin(DOX) on gene expression of the myocardial sarcoplasmic reticulum (SR)Ca2+ transport proteins and the mechanism of taurine(Tau) protecting cardiac muscle cells, 9 rabbits were injected with DOX , 8 rabbits with DOX and Tau, and 9 rabbits with normal saline. Cardiac function , concentration of calcium in cardiomyocytes (Myo[Ca2+]i), activity of SR Ca2+-ATPase(SERCA2a), level of SERCA2a mRNA and Ca2+ released channels(RYR2)mRNA were detected. The left ventricle tissues were observed by electron microscopy. The results showed that cardiac index, left ventricular systolic pressure, activity of SR Ca2+-ATPase and level of SERCA2a mRNA decreased , while Myo[Ca2+]i increased in DOX-treated rabbits. DOX could not affect the level of RYR2 mRNA. Tau intervention could alleviate the increase of left ventricular diastolic pressure, Myo[Ca2+]i and the decrease of SERCA2a mRNA induced by doxorubicin. The results suggested that downregulation of SERCA2a gene expression was an important mechanism of DOX-induced cardiomyopathy and that Tau could partially improve the heart function by reducing calcium overload and alleviating downregulation of SERCA2a mRNA.     

Study on the effect of doxorubicin on expressions of genes encoding myocardial sarcoplasmic reticulum Ca<Superscript>2+</Superscript> transport proteins and the effect of taurine on myocardial protection in rabbits

To investigate the effect of doxorubicin(DOX) on gene expression of the myocardial sarcoplasmic reticulum (SR) Ca²⁺ transport proteins and the mechanism of taurine(Tau) protecting cardiac muscle cells, 9 rabbits were injected with DOX, 8 rabbits with DOX and Tau, and 9 rabbits with normal saline. Cardiac function, concentration of calcium in cardiomycocytes (Myo [Ca²⁺] _i ), activity of SR Ca²⁺-ATPase (SERCA2a), level of SERCA2a mRNA and Ca²⁺ released channels (RYR2) mRNA were detected. The left ventricle tissues were observed by electron microscopy. The results showed that cardiac index, left ventricular systolic pressure, activity of SR Ca²⁺-ATPase and level of SERCA2a mRNA decreased, while Myo[Ca²⁺] _i increased in DOX-treated rabbits. DOX could not affect the level of RYR2 mRNA. Tau intervention could alleviate the increase of left ventricular diastolic pressure, Myo[Ca²⁺] _i and the decrease of SERCA2a mRNA induced by doxorubicin. The results suggested that downregulation of SERCA2a gene expression was an important mechanism of DOX-induced cardiomyopathy and that Tau could partially improve the heart function by reducing calcium overload and alleviating downregulation of SERCA2a mRNA.