急性ST段抬高型心肌梗死患者血浆PTX3水平与GRACE评分的相关性研究

目的 研究急性ST段抬高型心肌梗死(STEMI)患者血浆PTX3水平与全球急性冠状动脉事件注册(GRACE)风险评分的相关性,评价PTX3对急性心肌梗死的早期诊断及远期预后的评估价值.方法 急性ST段抬高型心肌梗死患者86例,依据患者入院时GRACE评分分值将患者分为低危组(32例)、中危组(26例)、高危组(28例),另选30名体检健康成人作为正常对照组,入院后1h内采集血液标本,送检肌钙蛋白、心肌酶等常规化验;应用酶联免疫法测血浆PTX3水平.结果 急性心肌梗死患者血浆PTX3水平明显高于正常对照组(P＜0.05).高危组患者血浆PTX3高于中、低危组(P＜0.05),中危组患者血浆PTX3高于低危组,但差异无统计学意义(P＞0.05).STEMI患者PTX3水平与年龄、GRACE评分、Killip分级、肌钙蛋白T呈正相关(P＜0.05).多元线性回归分析显示PTX3与GRACE评分中的Killip分级独立相关(P＜0.05).结论 PTX3可作为心肌坏死的早期分子指标,是急性ST段抬高型心肌梗死患者不良心血管事件发生的有效独立预测因子.     

急性ST段抬高心肌梗死患者PCI术后死亡危险因素分析及CTRP-1联合GRACE评分在预后评估中的价值

  目的  探讨急性ST段抬高性心肌梗死(STEMI)患者经皮冠状动脉介入治疗术(PCI)出院后12个月内死亡的危险因素，以及炎症因子补体Cq1/肿瘤坏死因子相关蛋白1(CTRP-1)联合全球急性冠脉事件注册(GRACE)评分的危险分层对STEMI患者PCI术后出院12个月死亡风险的临床预测价值。  方法  回顾性连续纳入急性STEMI患者326例，死亡组33例，存活组293例。收集患者资料、酶联免疫吸附法(ELISA)检测的血清CTRP-1质量浓度资料，对所有患者进行GRACE评分。以随访期间患者心源性死亡作为终点事件，受试者工作曲线(ROC)评估CTRP-1预测死亡的最佳截点值，单因素及多因素Cox回归分析患者死亡危险因素，生存分析检验CTRP-1在GRACE评分基础上对急性STEMI患者死亡的预测价值。  结果  与存活组比较，死亡组患者平均动脉压、左心室射血分数(LVEF)低及左主干病变率高，肌酐、肌钙蛋白T较高(P < 0.05)，死亡组患者CTRP-1质量浓度高于存活组(P < 0.001)，死亡组患者中66.7%属于GRACE评分的高危组，高于存活组患者中20.1%属于GRACE评分的高危组。ROC曲线分析，CTRP-1的曲线下面积为0.874(P < 0.001)，其截点值为187.9 ng/mL时，预测患者死亡的敏感性为92.5%，特异度为73.6%。Cox生存回归分析显示，平均动脉压、LVEF值、GRACE评分高危及CTRP-1高值(≥187.9 ng/mL)是预测患者死亡的独立危险因素之一。生存分析显示，在GRACE评分高危组中，CTRP-1高值的患者累计生存率低于CTRP-1水平较低的患者(P < 0.001)。  结论  平均动脉压、LVEF值、GRACE评分高危及CTRP-1高值是预测患者死亡的危险因素, CTRP-1联合GRACE评分对急性STEMI患者预后评估具有临床价值。     

急性冠状动脉综合征患者NT-proBNP与心肌肌钙蛋白的相关性分析

目的 探讨急性冠状动脉综合征(ACS)患者N末端-前B型钠尿肽(NT-proBNP)与心肌肌钙蛋白(cTn)之间的关系.方法 将2011年6月至2013年6月该院收治的206例ACS患者分为ST段抬高型急性心肌梗死(STEMI)、非ST段抬高型急性心肌梗死(NSTEMI)和不稳定型心绞痛(UAP)组 ,通过荧光免疫法检测NT-proBNP ,ELISA测定cTn ,采用Spearman秩相关分析它们之间的相关性.结果 STEMI组NT-proBNP水平最高 ,NSTEMI组次之 ,UAP组最低 ,3组患者的NT-proBNP水平比较 ,差异有统计学意义(P＜0 .01).3组患者cTnT、cTnI、肌钙蛋白C(TnC)比较 ,差异有统计学意义(P＜0 .05) ,STEMI组cTnT、cTnI高于NSTEMI组和UAP组 ,NSTEMI组高于UAP组 ,STEMI组与NSTEMI组的 TnC高于UAP组(P＜0 .05) ,差异有统计学意义(P＜0 .01).ACS患者血NT-proBNP与cTnT、cTnI、TnC的 r分别为0 .791、0 .825、0 .764 ,差异均有统计学意义(P＜0 .05).结论 NT-proBNP、cTn可作为能够反映ACS严重程度的心肌标志物.     

总胆红素联合GRACE评分对急性ST段抬高型心肌梗死患者院内不良心血管事件的预测价值

目的 探讨总胆红素(TB)联合全球急性冠状动脉事件注册风险(GRACE)评分对急性ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)后,院内发生主要不良心血管事件(MACE)的预测价值.方法 选取2017年7月至2020年1月于成都医学院第一附属医院心内科确诊为STEMI并行急诊PCI的患者230例为研究对象,根据患者院内是否发生MACE分为MACE组(n=35)和非MACE组(n=195),对两组基线资料、生化指标、介入及超声资料进行比较.运用二分类Logistic回归确立TB+GRACE评分的联合方程,并绘制ROC曲线.多因素二分类Logistic回归分析得到STEMI患者发生院内MACE的独立危险因素.结果 MACE组的年龄、白细胞(WBC)、中性粒细胞、TB、直接胆红素(DB)、GRACE评分值均高于非MACE组(P<0.05).TB+GRACE评分的联合方程(AUC=0.728,P<0.001)、TB(AUC=0.621,P=0.023)、GRACE评分(AUC=0.703,P<0.001)对院内MACE有一定预测能力,TB+GRACE评分的联合方程AUC在数值上较单一指标大.多因素二分类Logistic分析显示,WBC、DB、TB+GRACE联合方程与STEMI患者院内MACE独立相关(P<0.05).结论 与单一的TB、GRACE评分相比,TB+GRACE联合方程评分在一定程度上更适合预测STEMI患者院内MACE.WBC、DB水平及TB+GRACE的联合方程是STEMI患者发生院内MACE的独立危险因素.     

急性冠状动脉综合征患者的临床特征及预后因素分析

目的 研究行经皮冠状动脉介入治疗(PCI)的不同类型急性冠状动脉综合征(ACS)患者的临床特征及影响介入治疗的预后因素.方法 选取2014年1月至2015年3月于该院住院诊断为ACS并行PCI的患者377例,其中ST段提高型ACS患者(ST-ACS组)172例,非ST段提高型急性冠状动脉综合征(NST-ACS组)205例,收集患者的基线资料及检查指标,计算患者入院时全球急性冠状动脉事件注册(GRACE)评分,并建立数据库、规律随访,对预后进行分析.结果 吸烟史、急诊PCI、冠状动脉造影TIMI分级(0～1级)、高迁移率族蛋白B1(HMGB1)、GRACE评分、入院时心率、白细胞计数、中性粒细胞比率、淋巴细胞比率、单核细胞比率、中性粒细胞绝对值、高密度脂蛋白、载脂蛋白b、病变血管支数、左室射血分数在ST-ACS与NST-ACS组间比较差异有统计学意义(P＜0.05),相关性分析显示HMGB1与GRACE评分显著相关(r=0.836,P＜0.01).为期2年的随访结果显示既往心肌梗死及PCI病史、Killip分级(Ⅱ～Ⅳ)、冠状动脉造影TIMI分级(0～1级)、HMGB1、GRACE评分、血小板平均体积、年龄、病变血管支数在发生与未发生规定终点事件患者间比较差异有统计学意义(P＜0.05),Logistic回归分析显示HMGB1、GRACE评分、年龄、PCI病史、Killip分级(Ⅱ～Ⅳ)为心血管事件的独立危险因素(P＜0.05).COX生存分析显示HMGB1、PCI病史、Killip分级(Ⅱ～Ⅳ)为心血管事件的独立危险因素(P＜0.05).受试者工作特征曲线显示HMGB1准确性较好,曲线下面积为0.844(95％CI 0.803～0.885,P＜0.05),预测终点事件的临界值为480.44 ng/mL.结论 HMGB1在ST-ACS与NST-ACS组间有差异,且与GRACE有很好的相关性.     

非ST段抬高型急性冠脉综合征患者血清Hcy水平和GRACE评分与冠状动脉病变的相关性

目的：探讨非ST段抬高型急性冠脉综合征(NSTE-ACS)患者血清同型半胱氨酸(Hcy)水平和全球急性冠状动脉事件注册(GRACE)评分与冠状动脉病变严重程度的关系。方法选取2015年1月至2016年1月就诊于湖南省人民医院符合纳入标准的NSTE-ACS患者116例,其中非ST段抬高型心肌梗死(NSTEMI)组49例,不稳定型心绞痛(UAP)组67例,入院后所有患者均进行GRACE评分,同时第2天清晨空腹采集肘静脉血检测Hcy,与48例非冠心病患者进行对照比较,分析Hcy水平与GRACE评分的关联性以及Hcy水平和GRACE评分与冠脉病变支数的关系。结果①NSTE-ACS患者血清Hcy水平、GRACE评分与非冠心病组比较差异有统计学意义,UAP组、NSTEMI组Hcy水平分别为(16.3±5.7)μmol/L和(19.6±4.6)μmol/L,明显高于非冠心病组的(11.3±2.7)μmol/L;UAP组、NSTEMI组GRACE评分分别为(108.9±21.0)分和(133.4±26.3)分,明显高于非冠心病组的(99.0±16.0)分,差异均具有统计学意义(P<0.05);②NSTE-ACS患者血清Hcy水平随GRACE危险程度增加而显著升高,低危组、中危组、高危组Hcy水平分别为(12.7±3.1)μmol/L、(18.4±5.2)μmol/L、(22.4±5.1)μmol/L,差异具有统计学意义(P<0.05);相关性分析结果显示,NSTE-ACS患者血清Hcy水平与GRACE评分呈明显正相关(r=0.546,P<0.01);③NSTE-ACS患者Hcy水平和GRACE评分与冠脉病变支数相关,三支血管病变组中Hcy水平、GRACE评分高于双支血管病变组,双支血管病变组高于单支血管病变组,差异均有统计学意义(P<0.05)。结论 NSTE-ACS患者Hcy水平与GRACE评分密切相关,结合Hcy水平测定与GRACE危险评分可提高对NSTE-ACS的预测,且一定程度上能反映冠状动脉病变程度,对NSTE-ACS早期介入治疗风险和预后评估有重要价值。     

冠心病患者血浆脑钠肽N末端前体浓度的变化及临床意义

目的 分析稳定型心绞痛(SAP)、不稳定型心绞痛(UAP)和非ST段抬高型心肌梗死(NSTEMI)患者以及冠脉介入治疗前后血浆中的脑钠肽(BNP)N末端前体(NT-proBNP)水平的变化,评价血浆NT-proBNP水平与不同冠心病类型的关系,以及心肌缺血改善后血浆NT-proBNP水平的变化.方法 选择住院冠心病患者345例,其中NSTEM组29例,UAP组151例,SAP组165例:同时设正常对照组140例.采用电化学发光双抗体夹心免疫法检测血浆NT-proBNP水平,同时对180例急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)后的上述指标进行分析.结果 NSTEMI组NT-proBNP水平明显高于其他三组(P＜0.05),UAP组高于SAP组(P＜0.05),SAP组高于正常对照组(P＜0.05),其中180例ACS患者在经皮冠脉介入术后12～24 h内,血浆NT-proBNP水平UAP组从术前的(1720.53±610.77)ng/L降为(1020.52±510.70)ng/L(P＜0.05),NSTEMI组从术前的(5660.23±1290.53)ng/L降为(2640.20±890.50) ng/L(P＜0.05);术后1周NT-proBNP水平,UAP组降为(359.05±230.33) ng/L;NSTEMI组降为(360.30±210.26)ng/L;与对照组比较均无显著性差异(P＞0.05).血浆NT-proBNP值与心肌TIMI血流评分相关(r=-0.402,P＜0.001).结论 冠心病患者血浆NT-proBNP浓度增高;NT-proBNP水平增高可以预测冠心病的严重程度;ACS患者冠脉介入治疗后血浆NT-proBNP含量明显降低,可作为观察疗效的指标,对临床病情的评估具有重要价值.     

NSTEMI患者GRACE评分与cTnI、BNP、GA水平相关性及其预测价值

［摘要］ 目的探究非ST段抬高性心肌梗死（non ST segment elevation myocardial infarction,NSTEMI）患者全球急性冠状动脉事件注册（global registry of acute coronary events,GRACE）评分与心肌肌钙蛋白I（cardiac troponin I,cTnI）、脑利钠肽（brain natriuretic peptide,BNP）、糖化血清白蛋白（glycated albumin,GA）水平相关性及其预测价值。 方法选取NSTEMI患者153例作为研究对象,根据 GRACE评分分为3组,高危组（49例）GRACE评分＞140分,中危组（58例）GRACE评分109～140 分,低危组（46例）GRACE评分≤108分。检测各组患者cTnI、BNP、GA水平,术后6个月随访主要心血管事件（major adverse cardiac event,MACE）发生情况,并采用受试者工作特征曲线（receiver operating characteristic,ROC）分析GRACE评分、cTnI、BNP、GA水平对MACE的预测价值。 结果不同GRACE危险分级患者cTnI、BNP、GA水平比较差异有统计学意义（P＜0.01）;高危组、中危组cTnI、BNP、GA水平高于低危组,而高危组cTnI、BNP、GA水平又高于中危组（P＜0.05）。GRACE评分与cTnI、BNP、GA水平呈显著正相关（P＜0.05）。术后6个月内高危组发生MACE 12例,中危组发生MACE 5例,低危组MACE 1例（P＜0.05）。12例ROC曲线分析结果显示,GRACE评分、cTnI、BNP、GA水平对MACE预测结果的AUC分别为0.761、0.674、0.662、0.669;Cut-off值分别为151.00分、3.83 mg/L、340.72 μg/L、20.01%;敏感度分别为66.70%、94.40%、77.80%、50.00%,特异度分别为74.10%、45.20%、54.10%、81.50%,Youden指数分别为0.408、0.396、0.374、0.318。 结论NSTEMI患者GRACE评分与cTnI、BNP、GA水平呈显著正相关,且均对MACE有预测价值及其预测价值,其中GRACE评分的预测价值相对较高。     

髓过氧化化酶水平与急性冠脉综合征不良事件发生率的关系

目的 通过对血清促炎症介质髓过氧化物酶(MPO)在急性冠脉综合征(ACS)患者中的测定,探讨其在ACS危险分层的临床意义.方法 病人分为两组: ACS组( STEMI患者32例, UAP/NSTEMI组患者38例)和对照组(SAP患者20例).用分光光度比色法检测血清MPO活性.随访各组于30、90 d的后继心血管事件发生率,并对结果 进行统计学分析.结果 ①STEMI和UAP /NSTEMI组患者的血清MPO水平较SAP组明显升高,差异有显著性(P＜0.01);其中STEMI患者血清MPO水平高于UAP /NSTEMI组(P＜0.01);②具有高水平MPO的患者在随后30 d及90 d的心血管事件发生率明显增高.结论 ①血清炎症标志物MPO可能独立预测近期心血管事件危险性;②降低高MPO水平患者近期心血管事件发生的风险性下降.     

不稳定型心绞痛患者连续心率减速力与心率减速力的关系分析

目的 探讨不稳定型心绞痛 (UAP) 患者的连续心率减速力 (DRs) 和心率减速力 (DC) 的变化及其相关性.方法 随机选择2012年3-8月在郑州人民医院心内科住院治疗的58例UAP患者(UAP组),同时选取同期在本院住院的性别、年龄相匹配的58例非急性冠脉综合征患者为对照组,进行24 h动态心电图检查,离线计算DC、DR2、DR4及DR8值,并依据DC值和DRs值分别得出相应的猝死风险分层(低危、中危、高危).结果 UAP患者的DC、DR4及DR8值均较对照组降低(P＜0.05),DC值与DR2、DR4、DR8值均呈正相关(r=0.036、0.651、0.521,P＜0.05).根据DC和DRs值分别得出的猝死风险分层间差异无统计学意义(χ2=0.346,P=0.556).结论 UAP患者DC、DR4及DR8值降低,DC值和DRs值间具有良好的相关性,两者在临床应用中可相互补充,提高猝死风险预测能力.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.