AMI患者PCI术对血浆BNP水平变化的初步临床观察

目的:观察PCI术对AMI患者血浆中BNP的水平变化,初步探讨PCI对AMI患者预后的影响.方法:采用快速荧光免疫测定法对20例AMI患者PCI治疗前后和20例对照组血浆BNP水平进行检测.结果:AMI患者血浆BNP在AMI患者PCI术与对照组比较有显著性差异(P＜0.05),PCI治疗后呈明显下降趋势.结论:AMI患者PCI治疗血浆BNP水平变化说明PCI术能对改善AMI患者的预后有重要意义.     

直接和延迟PCI对AMI患者血浆BNP影响的对比研究

目的:探讨通过序列地测定急性心肌梗死(AMI)患者经皮冠脉介入(PCI)前后血浆 BNP浓度,探讨了直接和延迟PCI对AMI患者心功能转归的影响.方法:顺序选入2005-12-2006-11月就诊于河北医科大学第三医院心内科的ST段抬高型心肌梗死(STEMI)患者45名.采用酶联免疫吸附法(ELISA)分别检测入院即时、术后7d和30d时的血浆脑利钠肽(BNP)浓度.结果:直接PCI组和延迟PCI组血浆BNP浓度在术前无显著性差异,PCI术后7d、30d的血浆BNP浓度与治疗前比较均有显著下降(P<0.05),术后30d下降更为显著(P<0.01);两组间比较PCI术后7d(183.4±56.2pg/mL vs 243.7±85.2pg/mL P<0.05)和30d(108.3±36.7pg/mL vs 139.4±76.8pg/mL P<0.05)均有显著性差异,前者均低于后者.结论:AMI患者接受PCI治疗后,血浆BNP浓度逐渐下降,直接PCI较延迟PCI治疗血浆BNP浓度下降显著,直接PCI治疗对住院期间AMI患者心功能的改善优于延迟PCI治疗.     

澳特斯小儿止咳露对儿童支气管哮喘发作时ET、TNF-α水平变化观察

目的:观察澳特斯小儿止咳露对儿童支气管哮喘发作时ET、TNF-α水平变化.方法:将78例支气管哮喘患儿随机分为二组,在按照儿童支气管哮喘防治常规的治疗原则的同时,治疗组口服澳特斯小儿止咳露,对照组未提供口服止咳药物;并在治疗前和治疗后48小时进行监测血桨内皮素(ET)、肿瘤坏死因子(TNF-α)浓度.结果:治疗前后血浆ET、TNF-α比较,治疗组存在显著差异(P<0.05),而对照组无显著差异(P>0.05).结论:澳特斯与干扰血浆ET、TNF-α浓度有关.     

颅脑损伤患者术后出现迟发性颅内血肿的影响因素分析

目的:探讨颅脑损伤术后迟发性血肿、发生机制和临床治疗手段.方法:从2014年3月-2015年3月我院收治的颅脑损伤患者中抽取35例的临床资料进行回顾性分析,患者均接受颅内血肿清除术.结果:GOS评分结果显示35例患者的预后情况为:12例良好、15例轻残、2例重残、4例植物生存、2例死亡.其中,观察组的20例患者中,有80%预后良好,而对照组的15例患者中,有60%为预后良好.对比可得,观察组患者的接受ICP监测后,预后情况显著比不接受ICP监测的对照组患者好,差异显著(P0.05),有统计学意义.结论:颅脑损伤术后迟发性血肿预后工作应该重在早期预防、及早发现并针对性给予早期治疗,辅以颅内压监测.     

血浆内皮素水平在Graves''''病患者治疗前后的变化

目的探讨血浆内皮素(ET)在Grraves'(GD)病治疗前后的变化及相关性.方法选择61例(GD)患者对其治疗前后ET、TT3、TT4的含量进行检测,并以对照组进行对照.结果治疗前血浆ET水平显著高于对照组(P＜0.01),治疗后血浆ET水平显著低于治疗前(P＜0.01),但仍明显高于对照组.结论ET水平的高低与GD患者的病情相关,所以测定和研究ET在GD患者中的水平,对于GD的预防、诊断和治疗将有理论和实践意义.     

321例心脏疾病患者血浆B型钠尿肽浓度监测结果分析

目的:回顾性分析心脏疾病患者血清中B型钠尿肽(B-type natriuretic peptide,BNP)的水平,探讨对该类疾病检测BNP浓度的临床诊断意义.方法:汇总弋矶山医院2007年至2013年988例患者血清BNP浓度测定的结果,根据临床诊断筛选321例心脏疾病患者数据,按性别、年龄、科室及血清BNP浓度值等进行分析.结果:经统计学处理,患者血清BNP的水平与年龄之间未见正相关系,BNP浓度差异与性别之间也未见显著相关性,BNP浓度区间以48.9ng/L、266.4ng/L、1526.0ng/L三截点最为集中.结论:血浆中BNP的浓度与年龄和性别间的相关性未能体现,但BNP的测定的确是临床科室评估心功能的快捷手段,也是应用于心力衰竭的诊断、预后和判断的重要补充.     

心脑血管疾病患者血浆脂蛋白(a)及其他脂类水平的观察

目的:探讨心脑血管疾病患者脂蛋白(a)水平及其他脂类的关系,进一步阐明血浆高脂蛋白(a)水平为心脑血管疾病的独立危险因素,支持脂蛋白(a)的检测具有极为重要的意义.方法:采用ELISA法和酶法分别测定心肌梗塞、心绞痛、脑梗死等心脑血管疾病患者及健康对照者的Lp(a)、LDL-C、HDL-C、TG、TC含量.结果:心脑血管疾病患者血浆Lp(a)水平显著高于健康对照组(P＜0.01).血浆脂蛋白(a)水平变化与LDL-C、HDL-C、TG、TC含量无明显相关性.结论:Lp(a)是独立于其他血脂指标的心脑血管疾病的危险因子.     

慢性肾功能衰竭患者及健康人血浆脂蛋白(α)水平

目的:为了研究血浆脂蛋白(α)[Lp(α)]水平与慢性肾功能衰竭(CRF)的关系,探讨Lp(α)在CRF(常)合并心脑血管疾病中的作用.方法:用酶联免疫吸附法测定了36例CRF与30名健康对照者的Lp(α)浓度,并同时测定了TG、TC、LDL-C和HDL-C的含量.结果:CRF患者Lp(α)、TC、LDL-C水平均明显高于正常对照组,而HDL-C显著低于对照组,血浆Lp(α)水平变化与LDL-C、HDL-C、TG、TC含量无明显相关性.结论:CRF患者体内存在着Lp(α)等脂代谢紊乱的情况,高血浆Lp(α)水平是CRF合并心脑血管疾病的独立危险因素之一.     

心脑血管疾病患者血浆脂蛋白(a)及其他脂类水平的观察

目的:探讨心脑血管疾病患者脂蛋白(a)水平及其他脂类的关系,进一步阐明血浆高脂蛋白(a)水平为心脑血管疾病的独立危险因素,支持脂蛋白(a)的检测具有极为重要的意义.方法:采用ELISA法和酶法分别测定心肌梗塞、心绞痛、脑梗死等心脑血管疾病患者及健康对照者的Lp(a)、LDL-C、HDL-C、TG、TC含量.结果:心脑血管疾病患者血浆Lp(a)水平显著高于健康对照组(P＜0.01).血浆脂蛋白(a)水平变化与LDL-C、HDL-C、TG、TC含量无明显相关性.结论:Lp(a)是独立于其他血脂指标的心脑血管疾病的危险因子.     

碎裂QRS波联合TIMI危险评分预测急性心肌梗死患者的短期预后（英文）

目的:探讨碎裂QRS波(fQRS)联合心肌梗死溶栓治疗临床试验(TIMI)危险评分对急性心肌梗死(AMI)患者短期预后的评估价值。创新点:TIMI危险评分常用于AMI患者入院即刻的风险评估,TIMI评分4分的患者被评定为中危组。本研究发现,无论TIMI评分如何,出现fQRS而未行经皮冠状动脉介入治疗(PCI)的患者,其死亡率均显著升高。fQRS联合TIMI危险评分更利于AMI患者的预后评估,TIMI评分4分但同时合并fQRS的患者,可以从早期PCI介入治疗获益。方法:回顾300例AMI患者的临床资料及院内诊治经过,记录分析患者fQRS出现的时间、部位及其他临床转归,评价fQRS联合TIMI危险评分与患者临床预后的关系。结论:(1)fQRS联合TIMI危险评分可提高恶性心律失常、左室收缩功能不全(LVSD)和死亡预测的敏感度和特异度;(2)fQRS阳性的AMI患者,进行早期血运重建可降低患者心血管事件发生率,fQRS可能作为TIMI评分4分患者早期介入治疗的指征。     

Elevated high sensitive C-reactive protein and apelin levels after percutaneous coronary intervention and drug-eluting stent implantation

Objective:Percutaneous coronary intervention(PCI) triggers an acute inflammatory response,while sirolimus is known to have anti-inflammatory properties;the inflammatory system response to PCI after sirolimus-eluting stent placement remains unclear.The purpose of this study is to determine the changes in high sensitive C-reactive protein(hs-CRP) and apelin after PCI procedure and drug-eluting stent implantation in patients with and without reduced left ventricular systolic function.Methods:Forty-eight consecutive patients undergoing PCI at the Beijing Anzhen Hospital between July and September 2006 were recruited.Sirolimus-eluting stents were employed in all patients.Blood samples were drawn immediately before and 24 h after the procedure.Plasma hs-CRP and apelin levels were determined by enzyme immunoassay.Results:Paired t-test revealed a significant increase in both hs-CRP and apelin post-procedure(P=0.006 and P0.0001,respectively).Patients with reduced left ventricular ejection fraction(LVEF) had significantly lower baseline apelin levels compared to those with normal ventricular function [(46.8±10.8) vs.(72.0±8.4) pg/ml,P0.001].However,apelin increased to a level similar to the level of those with normal left ventricular systolic function 24 h after the PCI procedure [(86.7±11.6) vs.(85.1±6.1) pg/ml,P=0.72].Conclusions:hs-CRP and apelin levels increased after PCI and sirolimus-eluting stent implantation.Patients with impaired left ventricular systolic function had significantly lower baseline apelin levels,which increased significantly after PCI.     

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.     

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.     

Relationship between resistin level in serum and acute coronary syndrome or stable angina pectoris

Objective To investigate the relationship between serum resistin level and acute coronary syndrome (ACS) or stable angina pectoris (SAP). Methods Sixty-five patients, with coronary artery disease, were enrolled and divided into three subgroupsacute myocardial infarction (AMI), unstable angina pectoris (UAP) and SAP, and 26 healthy people were recruited as controls in the cross-sectional study. Serum resistin levels were determined by ELISA (enzyme-linked immunosorbent assay), and WBC (white blood cell count), hsCRP (high sensitive C-reaction protein), CKmax (maximum ofcreatinkinase), CK-MBmax (maximum of isozyme of creatinkinase) and cTnImax (maximum oftroponin) were measured by standard laboratory methods. Results The serum resistin levels were 4 folds higher in AMI patients, 2.43 folds in UAP patients and 1.12 folds in SAP patients than in the healthy controls (P＜0.05). The resistin levels were also significantly different between AMI [(8.16±0.79) ng/ml], UAP [(5.59±0.75) ng/ml]and SAP [(3.45±0.56) ng/ml] groups (P＜0.01); WBC, hsCRP, CKmax, CK-MBmax and cTnImax were significantly increased in AMI patients over UAP and SAP patients. Spearman analysis showed that serum resistin levels were positively correlated with WBC (r=0.412, P=0.046), hsCRP (r=0.427, P=0.037), CKmax, CK-MBmax and cTnImax (r=0.731, 0.678, 0.656; P＜0.01). ConclusionSerum resistin levels increased with inflammatory factors and myocardial impairment. The results suggest that human resistin might play an important role in the pathogenesis of atherosclerosis and AMI as an inflammatory factor.     

Risk of cardiac rupture after acute myocardial infarction is related to a risk of hemorrhage

Although cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI), to date no predictive model for CR has been described. CR has common pathological characteristics with major bleeding. We aimed to investigate the relationship between the risk factors of major bleeding and CR. A total of 10 202 consecutive AMI patients were recruited, and mechanical complications occurred in 72 patients. AMI patients without CR were chosen as control group. Clinical characteristics including bleeding-related factors were compared between the groups. The incidences of free wall rupture (FWR), ventricular septal rupture (VSR), and papillary muscle rupture (PMR) were 0.39%, 0.21%, and 0.09%, respectively, and the hospital mortalities were 92.5%, 45.5%, and 10.0%, respectively. Female proportion and average age were significantly higher in the groups of FWR and VSR than in the control group (P<0.01); higher white blood cell count and lower hemoglobin were found in all CR groups (P<0.01). Compared to the control group, patients with CR were more likely to receive an administration of thrombolysis [26.39% vs. 13.19%, P<0.05], and were less likely to be treated with primary percutaneous coronary intervention (PCI) [41.67% vs. 81.60%, P<0.05]. The major bleeding scores (integer scores) of FWR, VSR, and PMR were (17.70±7.24), (21.91±8.33), and (18.60±7.88), respectively, and were significantly higher than that of the control group (11.72±7.71) (P<0.05). A regression analysis identified age, increased heart rate, anemia, higher white blood cell count, and thrombolysis as independent risk factors of CR, most of which were major bleeding-related factors. The patients with CR have a significantly higher risk of hemorrhage compared to the group without CR. Risk of CR after AMI is related to the risk of hemorrhage.     

Renal insufficiency is an independent predictor of in-hospital mortality for patients with acute myocardial infarction receiving primary percutaneous coronary intervention

Objective:To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infarction (ASTEMI), who were treated with emergency percutaneous coronary intervention (PCI). Methods: 420 patients hospitalized in Peking University First Hospital, diagnosed with ASTEMI treated with emergency (PCI) from January 2001 to June 2011 were enrolled in this study. Estimated glomerular filtration rate (eGFR) was used as a measure of renal function. We compared the clinical parameters and outcomes between ASTEMI patients combined renal insufficiency and the patients with normal renal function. Results:There was a significant increase in the concentrations of fibrinogen and D-Dimer (P<0.05) and a much higher morbidity of diabetes mellitus in the group of patients with chronic kidney disease (CKD; eGFR<60 ml/(min·1.73 m2)) (P<0.01). CKD (eGFR<60 ml/(min·1.73 m2)) was an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI receiving PCI therapy rapidly (P=0.032, odds ratio (OR) 4.159, 95% confidence interval (CI) 1.127-15.346). Conclusions:Renal insufficiency is an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI treated with primary PCI.     

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.     

Computed tomography angiography-guided percutaneous coronary intervention in chronic total occlusion

Objective:The aim of this study is to investigate if dual-source computed tomography(DSCT) could guide the percutaneous coronary intervention(PCI) of chronic total occlusion(CTO).Methods:We enrolled patients who were confirmed to have at least one native coronary artery CTO by DSCT before they underwent selective PCI in the period from December 2007 to October 2008.A CTO was defined as an obstruction of a native coronary artery with no luminal continuity.The CT-guided PCI procedure involved placing CT and fluoroscopic images side-by-side on the screen.DSCT images were analyzed for location,segment,plaque characteristics,calcification,and proximal lumen diameter of the CTO before PCI.The guidewire was advanced and manipulated under CT guidance.The PCI was carried out and the results were compared.Results:Seventy-four CTOs were assessed.PCI was successful in 57 cases of CTOs(77.0%).According to the results,CTOs were divided into two groups:successful-PCI and failed-PCI.All coronary artery paths of CTOs were clearly recognized by DSCT.In the successful-PCI group,soft plaques were detected much more often than those in the failed-PCI group,but fibrous and calcified plaques were seen more often in the failed-PCI group.Calcification severity in CTO segments showed a significant difference between the groups(P=0.014).Calcified plaques were detected in 20(35.1%) lesions in the successful-PCI group.More than 70% of the failures were calcified plaques,of which there were two arc-calcified and one circular-calcified lesions.Occlusions were longer in the failed-PCI group than those in the successful-PCI group [(38.8±25.0) vs.(18.0±15.3) mm,respectively,P0.01].Fewer guidewires were used in the successful-PCI group compared with the failed-PCI group(1.7±1.0 vs.2.5±0.9,respectively,P0.01).The logistic regression analysis indicated that predictors of recanalization of CTOs included occlusion length(P=0.0035,risk ratio(RR)=0.93) and calcification severity(P=0.05,RR=0.27).Multi-linear trends analysis showed that the factors affecting procedural time were CTO location(P=0.0141) and occlusion length(P=0.0035).Conclusions:DSCT could delineate the path of CTOs and characterize plaques.The outcomes of PCI were related to thrombolysis in myocardial infarction(TIMI) flow grade,CTO characteristics,severity of calcified plaques,and the length of occlusive segments.Occlusion length and calcification severity were independent predictors of CTOs.Occlusion length and CTO segments could also help to estimate the duration of interventional procedures.     

A correlation between acute kidney injury and myonecrosis after scheduled percutaneous coronary intervention

Slight elevations in cardiac troponin I and T are frequently observed after percutaneous coronary intervention (PCI). Contrast-induced acute kidney injury (CI-AKI) is a complex syndrome induced by exposure to intravascular contrast media (CM). Currently, the relationships between the CM, pre-existing kidney insufficiency, CI-AKI, and myonecrosis after elective PCI are unclear. To investigate the relationship between CI-AKI and post-procedural myonecrosis (PMN) after PCI, we analyzed 327 non-ST-segment elevation acute coronary syndrome subjects undertaking elective PCI. The levels of cardiac troponins (cTns), cTnI and cTnT, at baseline and on at least one occasion 18–24 h after PCI were measured. We also recorded serum levels of creatinine (SCr) and the urine albumin:creatinine ratio (ACR) before coronary angiography, and 24–48 h and 48–72 h after contrast administration. A post-procedure increase in cTns was detected in 16.21% (53/327) of subjects with cTns levels >99th to 599th percentile upper reference limit (URL). Twenty-seven patients (8.26%) developed CI-AKI. CI-AKI occurred more often in subjects with PMN than in those without PMN (20.8% versus 5.8%, respectively, P=0.001). Multiple logistic regression analysis revealed that pre-existing microalbuminuria (MA) was an important independent predictor of PMN (OR: 3.31; 95% CI: 1.26–8.65, P=0.01). However, there was no correlation between the incidence of CI-AKI and PMN (OR: 2.38; 95% CI: 0.88–6.46, P=0.09). We conclude that pre-existing MA was not only an important independent predictor of CI-AKI but also of PMN.