C反应蛋白水平与急性心肌梗死溶栓患者预后的临床研究

目的　观察血清C反应蛋白 (CRP)水平变化与急性心肌梗死 (AMI)溶栓治疗后再通以及 4周内患者预后的相互关系。方法　根据溶栓后血管再通情况 ,将 43例患者分为血管再通组 (32例 )和血管未通组 (11例 ) ,将溶栓后 1周内不同时间血清CRP水平变化与梗死血管再通关系、梗死后 4周内心脏事件发生率即梗死后心绞痛、再梗死、严重心律失常的发生率以及心功能状态进行对比分析。结果　 (1)血清CRP水平升高后持续下降者显示较持续升高者梗死血管再通率所占比例明显升高 ,分别为 71.9%和 3.1%(P <0 .0 1) ;(2 )前者 4周内梗死后心脏事件发生率较后者明显减少 ,其中梗死后心绞痛发生率分别为 8.3%和 6 2 .5 %(P <0 .0 1)。结论　AMI溶栓后血清CRP水平的变化在预测溶栓后再通和患者预后中具有一定的临床价值。     

冠心病急性心肌梗死患者血浆心肌营养素-1和血清白介素-18的变化

目的观察冠心病急性心肌梗死（AMI）患者溶栓治疗前后血浆心肌营养素-1（CT-1）和血清白介素-18（IL-18）的变化及意义。方法溶栓组于溶栓即刻,溶栓后2、4、6、8、10、12h测定血中CT-1和IL-18浓度,未溶栓组于症状出现后2、4、6、8、10、12、14h测定血中CT-1和IL-18浓度;同时测定血清cTnI浓度。结果AMI患者IL-18浓度明显高于对照组,升高时间早于cTnI升高的时间（P〈0．01）;AMI患者CT—1水平明显高于对照组,升高时间早于cTnI及IL-18升高的时间（P〈0．01）。与cTnI相比,CT-1和IL-18检测的灵敏度和特异性均较高,尤其是发病早期患者血中尚不能检测到cTnI,而CT-1和IL-18水平即明显升高。②溶栓后4、6、8h,再通组CT—1和IL-18浓度显著高于未再通组（P〈0．01）,未再通组CT-1和IL-18浓度与未溶栓组相比差异无统计学意义。结论@AMI患者血清中很早即可测到较高浓度的cT-1和IL—18,且水平明显高于对照组,时间早于cTnI升高的时间,故认为CT-1和IL-18可作为AMI早期诊断的参考指标之一。②溶栓后4、6、8h,溶栓再通组可检测到明显升高的CT-1和IL-18,故认为CT-1和IL-18可以作为判定AMI溶栓治疗是否再通的指标之一。     

急性心肌梗死静脉溶栓疗效与血脂相关性

目的 :观察血脂水平对急性心肌梗死 （AMI）患者静脉溶栓治疗效果的影响。方法 :对 3 8例 AMI患者的总胆固醇 （TC）、甘油三酯 （TG）、低密度脂蛋白 -胆固醇 （L DL -C）及高密度脂蛋白 -胆固醇 （HDL -C）于发病后 2 4h内进行测定 ,以中华心血管病杂志编委会 ,AMI溶栓疗法参考方案为标准 ,分为再通组 （3 0例 ） ,未通组 （8例 ）。结果 :溶栓再通组与未通组 TC、L DL -C、HDL -C比较差异无显著意义 ,未通组 TG明显高于再通组 （P<0 .0 5）。结论 :TG水平升高可能影响 AMI患者静脉溶栓效果 ,其机制及临床意义有待于进一步研究     

血清结缔组织生长因子水平与急性心肌梗死病人溶栓疗效的关系探讨

目的探讨血清结缔组织生长因子(CTGF)水平与急性心肌梗死(AMI)病人溶栓疗效的关系。方法选择2014年1月—2016年4月重庆市巴南区人民医院心内科收治的37例AMI病人作为研究对象,均接受静脉尿激酶溶栓治疗,根据梗死相关血管是否再通而将其分为再通组(n=27)与未通组(n=10),并选择20名健康体检者纳入对照组,对照组于入组时、AMI病人于溶栓前后检测血清CTGF水平。结果溶栓前再通组及未通组血清CTGF水平均明显高于对照组,差异有统计学意义(P0.05);再通组病人溶栓后血清CTGF水平较溶栓前明显下降,未通组病人溶栓后血清CTGF水平较溶栓前明显上升,差异有统计学意义(P0.05)。结论对于静脉溶栓治疗的急性心肌梗死病人,动态观察溶栓前后血清CTGF水平对判断病人溶栓疗效具有一定的临床应用价值。     

辛伐他汀＋胰岛素对急性心肌梗死患者血清炎症因子和脂联素的影响

目的探讨辛伐他汀＋胰岛素对急性心肌梗死（AMI）患者血清炎症因子和脂联素的影响。方法将48例AMI患者随机分为对照组和治疗组各24例，两组均采用常规治疗；在此基础上，治疗组加用辛伐他汀和胰岛素治疗，维持血糖4．4—6．1mmol／L。治疗前和治疗72h用酶联免疫吸附法检测IL-6、脂联素，免疫比浊法检测C反应蛋白（CRP）。同时设50例健康者（正常组）进行比较。结果与正常组比较，AMI患者的血清IL-6和CRP均显著升高，脂联素显著降低；与对照组比较，治疗组脂联素明显升高，IL-6及CRP明显降低（P〈均0．01）。结论辛伐他汀＋胰岛素可明显升高AMI患者的血清脂联素，降低其IL-6和CRP水平。     

尿激酶静脉溶栓治疗急性心肌梗死的疗效观察

目的探讨早期尿激酶静脉溶栓治疗急性心肌梗死（AMI）的临床疗效。方法回顾性分析45例经溶栓治疗的心肌梗死患者,23例使用尿激酶静脉溶栓治疗的AMI患者作为观察组,22例常规治疗的AMI患者作为对照组,比较两组的再通情况。结果尿激酶观察组与对照组的冠脉再通率分别为68.5%和16.7%,两组再通率比较,差异有统计学意义。结论尿激酶溶栓治疗可提高急性心肌梗死疗效,值得基层医院推广应用。     

血浆 H-FABP 含量变化对预测急性心肌梗死血管再通的价值

目的：观察急性心肌梗死（AMI）患者溶栓治疗前后血浆心脏型脂肪酸结合蛋白（H-FABP）含量的变化,并探讨其临床意义。方法选择AMI患者44例,均行溶栓治疗,7 d后行冠脉造影,根据冠脉造影结果分为再通组、非再通组。分别检测两组入院时及溶栓后1、2、3、4、5、6、8、12、24、48 h血浆H-FABP含量,比较两组血浆H-FABP含量升高、达峰及恢复时间。结果再通组血浆H-FABP 达峰时间及恢复时间均早于非再通组（ P均＜0．05）。结论血浆H-FABP峰值提前在AMI患者溶栓治疗中可预测血管再通。     

PAI-1与AMI患者冠状动脉内血栓形成溶栓后及复通的关系

目的 分析纤溶酶激活物抑制剂（PAI）-1与急性心肌梗死（AMI）患者冠状动脉内血栓形成溶栓后及再通间的关系。方法 采用Logistic线性回归分析法对我院2013年1月~2015年2月收治的AMI冠脉内血栓形成并符合溶栓治疗适应证的患者41例,设为溶栓组,进行静脉溶栓治疗;再选取40例体检健康的人群作为正常对照组,分别记录溶栓组溶栓前后及与对照组对照的血浆PAI-1的检测值差异;并对溶栓后2 h冠脉再通组与未通组患者血浆PAI-1水平进行比较。结果 溶栓组溶栓前与对照组相比,血浆PAI-1水平显著高于正常对照组,有统计学差异（P<0.05）。溶栓组溶栓后0.5 h、1 h时血浆PAI-1水平与溶栓前比较,有所上升但差异无统计学意义,1.5 h、2 h时血浆PAI-1水平与溶栓前比较,显著上升有统计学差异（P<0.05）,溶栓后2 h冠脉再通组血浆PAI-1水平显著低于未通组（P<0.05）,具有统计学意义。结论 心肌梗死溶栓后PAI-1的水平在2 h内逐渐下降,且与血管再通有关联。     

急性心肌梗死溶栓治疗的监测与护理

目的探讨尿激酶溶栓治疗急性心肌梗死（AMI）的监测与护理措施。方法对52例发病在6h内的AMI患者进行静脉内溶栓治疗,在溶栓前、中、后进行监测与护理。结果溶栓治疗开始距发病时间〈3h的35例患者再通成功34例（97.1%）,3～6h的17例再通成功16例（94.1%）,总的再通成功率为96.7%。结论对AMI患者及时进行溶栓治疗并进行有效的监测与护理,能提高急性心肌梗死患者的治愈率,减少并发症。     

52例AMI患者的溶栓疗效及溶栓后心律失常发生情况分析

目的探讨急性心肌梗死（AMI）患者的溶栓效果及其再灌注心律失常发生情况。方法对52例AMI患者进行静脉溶栓治疗,观察血管再通情况及再灌注后心律失常发生情况。结果 43例血管再通（82.69%）、9例（17.31%）未达血管再通标准,其溶栓后心律失常发生率分别为58.1%、22.2%（P〈0.05）。结论 AMI患者溶栓治疗效果确切;溶栓后血管再通者易并发心律失常,但一般对症处理后可有效控制。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.