心电图运动试验非S—T段参数

现将心电图运动试验非——段参数简介如下,供参考。1、Q—Tc:运动后Q—Tc<运动前Q—Tc为阴性,≥运动前Q—Tc为阳性。2、△R<0为阴性,≥0为阳性。△R为V_5R波运动后与运动前平均振幅之差,单位为mm。3、△RST<0为阴性,≥0为阳性。     

趋化性细胞因子对人Tc1和Tc2细胞内Ca~(2+)浓度变化的影响

为了探讨趋化性细胞因子在体外对人Tc1和Tc2亚群细胞内Ca2 + 浓度变化的影响 ,从PBMC中分离纯化CD8+ T细胞 ,在特定细胞因子及细胞因子抗体作用下 ,体外定向诱导出能长期培养的Tc1和Tc2细胞系 ,用免疫荧光染色结合流式细胞术分析对其进行鉴定后 ,通过流式细胞术检测在趋化性细胞因子刺激前后 ,细胞内Ca2 + 浓度的变化。发现受SDF 1作用后 ,Tc1及Tc2细胞内Ca2 + 浓度变化均不明显 ,而IP 10刺激后 ,Tc1及Tc2细胞内Ca2 + 水平在短时间内明显上调 ,且在Tc1胞内的上升幅度远高于Tc2细胞 ,在MIP 1β刺激后 ,也观察到类似趋势 ;受Eotaxin刺激后 ,Tc1及Tc2细胞内Ca2 + 水平均有微小上升 ,在Tc2细胞内的上升幅度略高于Tc1细胞。说明Tc1和Tc2细胞受趋化性细胞因子作用后 ,细胞内Ca2 + 浓度有不同程度的变化 ,且与趋化性细胞因子受体的表达呈现一定的相关性。     

人同种异体抗原诱导的T细胞克隆在体外的建立及鉴定

目的：在体外建立长期培养的人T细胞克隆。方法：以^60Co照射的无关PBMC作为饲养细胞，在条件培养液中以有限稀释法对经单向混合淋巴细胞反应活化的T细胞进行克隆化。用免疫荧光染色和流式细胞术分析鉴定所获克隆。结果：获得的16株克隆中，除1株外，均为αβT细胞。15株αβT细胞克隆中，有9株为Th(3株Th0、6株Th2)，6株为Tc(5株Tc0，1株Tc2)。结论：建立了15株稳定的T细胞克隆并进行了鉴定，为Tc1和Tc2亚群标记和功能的研究打下了基础。     

特发性血小板减少性紫癜患儿Th1/Th2、Tc1/Tc2亚群漂移的研究

目的 :探讨特发性血小板减少性紫癜 (ITP)患儿外周血Th/Tc、Th1/Th2、Tc1/Tc2细胞的平衡状态。方法 :收集ITP患儿及健康儿童外周抗凝静脉血 ,分离纯化得T细胞 ,以PE标记的抗CRTH2单抗和Cy5标记的抗CD4、CD8单抗作双色流式细胞术 ,分析ITP患儿Th/Tc、Th1/Th2、Tc1/Tc2比例的变化。结果 :ITP患儿外周血T细胞与健康儿童相比 ,Th细胞百分率及Th/Tc比例明显下降 (P <0 0 5 ) ,Tc细胞百分率无明显变化 (P >0 0 5 ) ;Th1及Th2细胞百分率明显下降 (P <0 0 5 ) ,Tc1及Tc2细胞百分率无明显变化 (P >0 0 5 ) ,Th1/Th2及Tc1/Tc2比例明显升高 (P <0 0 5 )。结论 :ITP患儿外周血存在细胞免疫功能低下及T细胞亚群漂移 ,Th1及Tc1细胞比例升高 ,呈明显Th1类细胞优势。     

NKT细胞、NK细胞和T细胞亚群在活动性肺结核患者外周血的表达及意义

目的:探讨活动性肺结核病人外周血CD3+T、CD3+CD4+Th、CD3+CD8+Tc、CD3-CD16+56+NK、CD3+CD16+56+NKT、Th/Tc的表达变化及其临床意义。方法:采用流式细胞术分析45例肺结核病人、16例肺部感染病人及30例健康人外周血CD3+Th、CD3+CD4+Th、CD3+CD8+Tc、CD3-CD16+56+NK、CD3+CD16+56+NKT、Th/Tc的表达和变化情况。结果:初、复治肺结核患者的外周血NKT比例明显高于健康人(P<0.05);Th低于健康人(P<0.05);Tc高于健康人(P<0.05);Th/Tc低于健康人(P<0.05)。初、复治肺结核患者之间T、Th、Tc、NK、NKT、Th/Tc未见明显差异。肺部感染、活动进展Ⅰ期、活动进展Ⅱ期病人NKT阳性细胞数高于健康人和吸收好转期病人且结果有统计学意义(P<0.05);活动进展Ⅱ期组高于肺部感染组且结果有统计学意义(P<0.05)。活动进展Ⅰ期、活动进展Ⅱ期病人Tc阳性细胞数高于健康人组且结果有统计学意义(P<0.05)。Th/Tc吸收好转期、肺部感染、活动进展期、活动进展Ⅱ期均低于健康人组且结果有统计学意义(P<0.05)。轻症、中症、重症患者,重症者Th升高、Tc下降、Th/Tc升高。结论:NKT细胞与肺结核的发展和转归有关。Tc细胞的升高是免疫系统对于结核杆菌的反应,与肺结核病变的发展、范围和程度紧密相关。重点监测外周血NKT细胞和Tc细胞对于掌握活动性肺结核发展和预后有特殊的意义。     

对冠心病患者预后心理社会影响因素的2年随访研究

目的:分析冠心病患者2年中生存率和心血管事件再发率,探讨多种因素对冠心病患者预后的影响。方法:采用DS14中文版、A型行为问卷、应付方式问卷、汉密尔顿抑郁量表和焦虑量表对203名冠心病患者进行测查,并随访2年的生存情况和心血管事件再发情况。结果:①心功能、年龄和D型人格是冠心病患者死亡的独立危险因素。②D型人格、空腹血糖是冠心病患者再发心血管事件的独立危险因素,运动是冠心病患者再发心血管事件的保护因素。结论:冠心病患者预后受生物学和心理社会多种因素影响。     

Th1/Th2、Tc1/Tc2亚群在乙肝肝硬化患者中的作用

目的 :探讨乙肝肝硬化患者外周血 (PBMC)中CD4 和CD8 T细胞内Th1和Th2类细胞的平衡状态 ,探明Th1、Th2类细胞在乙肝肝硬化中的作用。方法 :乙肝肝硬化患者CD4 T细胞和CD8 T细胞中IFN γ 和IL 4 细胞的百分率 ,观察乙肝肝硬化患者Th1 Th2、Tc1 Tc2比例的变化。结果 :乙肝肝硬化患者PBMC中CD4 ,CD8细胞 ,CD4 CD8比值与健康对照者相比无统计学差异 (P >0 0 5 ) ,Th1细胞及Tc1细胞百分率为 8 8% ,9 0 % ,较健康对照者 7 5 % ,7 7%升高 (P <0 0 5 )。结论 :乙肝肝硬化患者外周血T细胞亚群发生Th1类偏移 ,在乙肝肝硬化的发生和发展中可能起重要作用     

利用Lorenz散点图分析高血压患者的运动心率变异信号

目的探讨高血压患者运动心率变异信号的非线性特征,为临床诊断高血压患者的心血管功能状况提供参考。方法以高血压患者作为研究对象,以健康者作为对照组,采集阶梯试验运动过程中两组人群的运动心电信号,提取其中包含的运动心率变异信号进行分析,运用散点图的定性和定量分析方法,将两组人群的散点图形状和散点图的6个参数进行对比。结果高血压患者与健康者的运动心率变异信号散点图在运动前后的表现差异明显,且高血压患者的各散点图参数数值较低。结论提示运动心率变异信号的散点图可用于高血压疾病患者的心血管系统功能损伤评测。     

类风湿关节炎患者血清和关节液增加体外培养健康人PBMC中Th1/Tc1比例的研究

探讨类风湿关节炎(rheumatoid arthritis,RA)患者血清和关节液干预对体外培养的健康人PBMC分泌IFN-γ的影响及临床意义。本研究采用Bio-plex法检测RA患者及健康人血浆中37种炎性细胞因子及可溶性受体的含量;分别用RA患者血清(体积分数为20%)和关节液(体积分数10%)处理体外分离培养的健康人PBMC 5d,流式细胞术分析CD3+CD8-IFN-γ+(Th1)和CD3+CD8+IFN-γ+(Tc1)的细胞含量变化;real-time PCR技术检测转录因子T-bet mRNA的表达变化。结果发现RA患者血浆中多种炎性细胞因子和可溶性受体含量升高;RA患者血清和关节液处理后的健康人PBMC中Th1和Tc1比例升高;Th1和Tc1相关的转录因子T-bet mRNA表达上调。这说明RA患者血清和关节液可使体外培养的健康人PBMC中Th1和Tc1比例增加,原因可能与RA患者血清及关节液中异常存在的炎性因子和其他可溶性介质有关。     

肾综合征出血热患者TH1/TH2、Tc1/Tc2亚群比例及有关细胞因子变化的研究

目的：探讨肾综合征血热（HFRS）患者TH1样和TH2样细胞平衡状态以及血清中细胞因子的变化，方法：收集HFRS患者和健康个体血清，采用夹心ELISA方法测定IFN－γ、IL－4和TNF－α的水平，分离PBMC，采用三色流式细胞术分析HFRS患者CD4^ T细胞和CD8^ T细胞中IFN－γ^ 和IL－4^ 细胞的百分率。观察HFRS患者TH1／TH2，Tc1/Tc2比例的变化，比较了不同病程和病情HFRS患者血清中上述指标的变化，结果：HFRS患者血清中TH1类和TH2类细胞因子水平均明显升高，其中IFN－γ和IL－4的平均水平显著高于健康个体（P＝0．016，P＝0．019）。HFRS患者PBMC中TH1、TH2、Tc1,Tc2细胞的平均百分率均高健康个体Tc细胞比例的改变较TH细胞明显，TH1样细胞的比例较TH2样细胞变化明显。发热期患者血清中IFN－γ、IL－4和TNF-α的水平明显升高于恢复期患者，发热期的重症患者的IFN－γ水平升高较轻症明显。结论：HFRS患者血清中IFN－γ和IL－4水平以及PMBMC中TH1、TH2、Tc1和Tc2细胞的比例均有所升高，发热期的患者和重症HFRS患者上述参数变化更明显，表明感染机体总体的免疫平衡偏向TH1类。     

Regional myocardial metabolism of high-energy phosphates during isometric exercise in patients with coronary artery disease

BACKGROUND. The maintenance of cellular levels of high-energy phosphates is required for myocardial function and preservation. In animals, severe myocardial ischemia is characterized by the rapid loss of phosphocreatine and a decrease in the ratio of phosphocreatine to ATP. METHODS. To determine whether ischemic metabolic changes are detectable in humans, we recorded spatially localized phosphorus-31 nuclear-magnetic-resonance (31P NMR) spectra from the anterior myocardium before, during, and after isometric hand-grip exercise. RESULTS. The mean (+/- SD) ratio of phosphocreatine to ATP in the left ventricular wall when subjects were at rest was 1.72 +/- 0.15 in normal subjects (n = 11) and 1.59 +/- 0.31 in patients with nonischemic heart disease (n = 9), and the ratio did not change during hand-grip exercise in either group. However, in patients with coronary heart disease and ischemia due to severe stenosis (greater than or equal to 70 percent) of the left anterior descending or left main coronary arteries (n = 16), the ratio decreased from 1.45 +/- 0.31 at rest to 0.91 +/- 0.24 during exercise (P less than 0.001) and recovered to 1.27 +/- 0.38 two minutes after exercise. Only three patients with coronary heart disease had clinical symptoms of ischemia during exercise. Repeat exercise testing in five patients after revascularization yielded values of 1.60 +/- 0.20 at rest and 1.62 +/- 0.18 during exercise (P not significant), as compared with 1.51 +/- 0.19 at rest and 1.02 +/- 0.26 during exercise before revascularization (P less than 0.02). CONCLUSIONS. The decrease in the ratio of phosphocreatine to ATP during hand-grip exercise in patients with myocardial ischemia reflects a transient imbalance between oxygen supply and demand in myocardium with compromised blood flow. Exercise testing with 31P NMR is a useful method of assessing the effect of ischemia on myocardial metabolism of high-energy phosphates and of monitoring the response to treatment.     

Physical fitness as a predictor of cardiovascular mortality in asymptomatic North American men. The Lipid Research Clinics Mortality Follow-up Study

Limited data are available on the relation between physical fitness and mortality from cardiovascular disease. We examined this question in a study of 4276 men, 30 to 69 years of age, whom we followed for an average of 8.5 years. Examinations at base line included assessment of conventional coronary risk factors and treadmill exercise testing. The heart rate during submaximal exercise (stage 2 of the exercise test) and the duration of exercise were used as measures of physical fitness. Men with incomplete data (n = 308) or who were using cardiovascular drugs (n = 213) were excluded from the analysis. Men who had clinical evidence of cardiovascular disease at base line (n = 649) were analyzed separately. Forty-five deaths from cardiovascular causes occurred among the remaining 3106 men. A lower level of physical fitness was associated with a higher risk of death from cardiovascular and coronary heart disease, after adjustment for age and cardiovascular risk factors. The relative risk of death from cardiovascular causes was 2.7 (95 percent confidence interval, 1.4 to 5.1; P = 0.003) for healthy men with an increment of 35 beats per minute in the heart rate during stage 2, and 3.0 (95 percent confidence interval, 1.6 to 5.5; P = 0.0004) for those with a decrement of 4.4 minutes in the exercise time spent on the treadmill. The corresponding values for death from coronary heart disease were 3.2 (95 percent confidence interval, 1.5 to 6.7; P = 0.003) and 2.8 (95 percent confidence interval, 1.3 to 6.1; P = 0.007), respectively. We conclude that a lower level of physical fitness is associated with a higher risk of death from coronary heart disease and cardiovascular disease in clinically healthy men, independent of conventional coronary risk factors.     

Beat-to-beat analysis method for magnetocardiographic recordings during interventions

Multichannel magnetocardiography (MCG) during exercise testing has been shown to detect myocardial ischaemia in patients with coronary artery disease. Previous studies on exercise MCG have focused on one or few time intervals during the recovery period and only a fragment of the data available has been utilized. We present a method for beat-to-beat analysis and parametrization of the MCG signal. The method can be used for studying and quantifying the changes induced in the MCG by interventions. We test the method with data recorded in bicycle exercise testing in healthy volunteers and patients with coronary artery disease. Information in all cardiac cycles recorded during the recovery period of exercise MCG testing is, for the first time, utilized in the signal analysis. Exercise-induced myocardial ischaemia was detected by heart rate adjustment of change in magnetic field map orientation. In addition to the ST segment, the T wave in the MCG was also found to provide information related to myocardial ischaemia. The method of analysis efficiently utilizes the spatial and temporal properties of multichannel MCG mapping, providing a new tool for detecting and quantifying fast phenomena during interventional MCG studies. The method can also be applied to an on-line analysis of MCG data.     

阿托伐他汀对老年冠心病患者血小板α颗粒膜蛋白GMP-140的影响

目的探讨阿托伐他汀对老年冠心病患者血小板α颗粒膜蛋白（GMP-140）的影响。方法80例老年冠心病患者服用阿托伐他汀8周。测定冠心病患者和正常对照者的GMP-140含量并比较冠心病患者服用阿托伐他汀前后总胆固醇、甘油三脂、低密度脂蛋白、血小板α颗粒膜蛋白（GMP-140）的变化。结果发现冠心病患者治疗后总胆固醇、低密度脂蛋白、GMP-140浓度均明显降低，高密度脂蛋白浓度增高。结论阿托伐他汀治疗老年冠心病患者能有效地降低胆固醇。抑制血小板活性。     

Rehabilitation training improves exercise tolerance after percutaneous coronary intervention

The aim of this present study was to investigate the effects of training on exercise tolerance of patients with coronary heart disease after percutaneous coronary intervention.Fifty-seven cases of coronary heart disease after percutaneous coronary intervention were divided randomly into the rehabilitation training group(26 cases) and control group(31 cases).Patients in the rehabilitation training group received rehabilitation training at different stages and exercise intensities 3 d after percutaneous coronary intervention for 3 months.The heart rate,blood pressure,ECG changes in treadmill exercise test,and the frequency of anginal episodes were observed.The results showed that NST and ΣST of ECG and the frequency of anginal episodes were significantly reduced in the rehabilitation training group.In addition,exercise tolerance was improved and the total exercise time was lengthened in these patients.Moreover,ST segment depression time and emergence time of angina with exercise were also lengthened compared with controls(P < 0.05,or 0.01).However,the heart rate and blood pressure before and after exercise of the two groups were similar.The study indicated that rehabilitation training could significantly relieve angina,amend ischemic features of ECG,and improve exercise tolerance of coronary heart disease patients after percutaneous coronary intervention.     

Exercise echocardiography: a methodological study comparing peak-exercise and post-exercise image information.

It is unclear whether echocardiography at peak bicycle exercise adds information to registrations obtained recumbent immediately after the test and what factors influence image quality. Therefore, exercise echocardiography was performed consecutively and prospectively in 66 men, unselected with regard to echocardiography, one month after an episode of unstable coronary artery disease. Of 594 segments (9 x 66), 569 (96%) were adequately visualized recumbent at rest. The corresponding figures recumbent directly after exercise, seated before exercise, and seated at peak exercise were 544 (92%), 474 (80%), and 428 (72%), respectively. In the majority of our patients, acceptable images at peak exercise were obtained for the septal region, while for the anterior, lateral, and inferior segments the success rate varied from 50 to 70%. Recumbent after exercise, the success rate was acceptable for most segments, possibly with the exception of the apical and lateral segments. Fifty-five patients developed new wall motion abnormalities or worsening of wall motion in connection with exercise. Echocardiography at peak exercise provided more information than afterwards in patients with images of good quality. However, in patients with inferior image quality, the registrations obtained recumbent after the test revealed wall motion abnormalities which were not obtained seated at peak exercise. Patients with worse image quality had significantly higher respiratory rate and weight, and rated a higher degree of dyspnoea at peak exercise than those with good quality. We conclude that in middle aged men with coronary artery disease, image acquisition at peak bicycle exercise and immediately after exercise are of complementary value.     

The effect of participation in an exercise training program on cardiovascular reactivity in sedentary middle-aged males.

Exaggerated cardiovascular reactivity to mental stressors may be a risk factor for cardiovascular disease. To determine if participation in a moderate intensity aerobic exercise training program reduces cardiovascular reactivity to laboratory stressors, 40 sedentary middle-aged males were randomly assigned: training group (n = 25) and control group (n = 15). Cardiovascular reactivity during and after three mental stressors (passive responding, push-button Stroop and verbal Stroop) and mild exercise (bicycle ergometer) was assessed before and after an 8-week intervention. VO2(peak) was determined using the Balke protocol. Among 19 subjects who completed the training, VO2(peak) increased 13.7%. Also, trained compared to untrained subjects showed significant reductions in baseline and absolute heart rate responses to all stressors. Baseline adjusted heart rates were significantly lower during push-button Stroop recovery and during verbal Stroop. Blood pressure, T-wave amplitude, finger pulse amplitude and pulse transit time responses were unaffected by exercise training. It was concluded that participation in a short-term, moderate intensity aerobic exercise training program may have a cardioprotective effect by significantly reducing absolute and baseline-adjusted heart rate responses to stressors.     

Comparative analysis of pathophysiologic mechanisms of myocardial infarction development under conditions of physical and information load in patients with ischemic heart disease

The results of examination on a bicycle ergometer and the information test with continuous electrocardiographic and hemodynamic control by means of impedance plethysmography showed that the cardiovascular system of patients with ischemic heart disease is desadapted to physical and informative load, which was manifested by ischemia of the myocardium and disorders of its contractility in both types of loading. The pathogenetic mechanisms of the development of myocardial ischemia in most patients with ischemic heart disease under conditions of physical and information loads differ. In information load, ischemia of the myocardium is a consequence of coronary vasospasm in 72.7% of patients and only in 27.3% of cases it is caused by deficient perfusion of the myocardium with blood in stenosed coronary arteries and increased myocardial requirements for oxygen. Inverse tendencies are encountered in physical load.     

Meeting the National Service Framework for coronary heart disease: which patients have untreated high blood pressure?

BACKGROUND: The National Service Framework for coronary heart disease requires primary care teams to identify patients who are at high risk of cardiovascular events and treat those with high blood pressure. However, there are no data on how many must be assessed, how much cardiovascular disease can be prevented or which patients are most likely to benefit. AIM: To estimate the potential number of patients who are eligible for blood pressure assessment, the number of preventable cardiovascular disease events and the relative efficiency of the strategy in different age groups. DESIGN OF STUDY: Modelling exercise. SETTING: Hypothetical population of 100,000. METHOD: The age-sex specific prevalence of cardiovascular risk factors and of current anti-hypertensive treatment were obtained from published sources and combined with published estimates of the effectiveness of anti-hypertensive treatment. From these data were calculated numbers of persons eligible for assessment and treatment, and numbers of preventable cardiovascular events. RESULTS: There were 79,607 persons eligible for assessment and 5888 eligible for treatment. Treatment could prevent between 101 and 139 cardiovascular events annually. There were 11,571 persons aged over 65 years and eligible for assessment and 4655 eligible for treatment. Treatment could prevent 85 to 117 cardiovascular events annually. No cardiovascular events are prevented in persons aged under 45 years. CONCLUSION: Confining assessment to the 16% who are aged over 65 years prevents 85% of the population's avoidable cardiovascular disease. Primary care teams should assess and treat persons aged over 65 years before assessing younger patients. No health benefit results from assessing persons aged under 45 years.