眼动脉彩色多普勒血流频谱检测在甲亢诊断中的应用

采用ＣＤＦＩ对３４例初诊甲亢患者的眼动脉进行检测，３４例患者根据Ｔ３结果分为两组，同时１０位患者治疗前后的眼动脉血流速度对照。结果表明，甲亢患者的眼动脉血流速度高于正常人，但与Ｔ３值无相关。１０例患者的眼动脉血流速度随着Ｔ３、Ｔ４下降而恢复正常。结论：ＣＤＦＩ测定眼动脉血流频谱可用于甲亢的诊断和治疗观察。     

藏药复方对犬实验性心肌缺血时心肌收缩力学性能的影响

本研究选用健康杂种犬35只,随机分为正常组(n=5),缺血对照组(n=15),藏药复方药物组(n=15)。在左冠状动脉前降支第2—3分支间结扎冠脉.造成心肌缺血模型,观察药物对心肌收缩力学指标的影响。结果表明,心肌缺血后,对照组DT、Lvsp,dp/dtmax降低,t-dp/dtmax延长,与缺血前及正常组比较均有显著性差异(均P<0.01).提示左室心肌收缩力学性能受到了较严重损害;药物组十二指肠给药后,可使心肌缺血过程中心肌收缩力学性能增强,与对照组比较,除Lvsp外,其余指标均有显著性差异(P<0.05),表明藏药复方具有保护缺血心脏功能的作用。     

探讨超声心动图对诊断甲状腺功能亢进性心脏病的意义

目的应用彩色多普勒超声心动图检测甲亢患者的心脏形态及心功能的变化,并与20例正常人超声心动图作对比。方法采用超声诊断仪测量甲亢心患者（38例）以及正常人（20名）心脏各房室的大小值,计算心功能指标,并比较2组之间的差异。彩色血流观察二尖瓣、三尖瓣反流程度。结果甲亢心患者以左室增大为主,部分合并瓣膜反流,心功能测值部分参数低下,与正常人对照组相比,有显著性差异（P〈0.01）,甲亢心检出率明显高于X线及EKG检查。结论彩色多普勒超声心动图是甲亢性心脏病诊断及随访的简单、无创性检查方法。     

甲状腺功能亢进症大鼠心肌抗氧化能力的变化

目的探讨甲状腺功能亢进症（甲亢）大鼠心肌抗氧化能力的变化。方法建立甲亢大鼠模型，采用酶法测定甲亢组和正常组大鼠心脏匀浆中超氧化物歧化酶（SOD）、丙二醛（MDA）和谷胱苷肽过氧化物酶（GPX）等抗氧化指标的活性或含量。结果甲亢组大鼠心肌SOD活性和GPX含量与正常组比较明显降低（t=8．50、4．52，P＜0．01），而MDA含量明显升高（t=2．46，P＜0．05）。结论甲亢大鼠心肌抗氧化能力明显下降。     

甲状腺机能亢进症的介入治疗(9例报告)

目的 :探讨栓塞法治疗甲亢的临床应用价值。方法 :对 9例甲亢病人的 2 9支甲状腺上、下动脉进行超选择性插管 ,并用聚乙烯醇颗粒进行栓塞。结果 :8例病人栓塞后甲状腺逐渐恢复正常大小 ,T3 、T4、FT3 、FT4逐渐下降接近或恢复正常 ,1例病人术后 6个月症状复发 ,再次栓塞后 ,甲状腺机能逐渐恢复至正常水平。结论 :介入法治疗甲亢是一种安全有效的方法。     

188例冠心病患者冠状动脉侧支循环的临床研究

目的：探讨冠状动脉侧支循环对心肌缺血、左室功能的保护作用及对心律失常的影响。方法：随机选取188例冠心病患者选择性冠状动脉造影资料，分析其冠状动脉侧支循环不同程度开放情况。同时记录心电图ST段改变、彩色超声心动图LVEF、E／A比值及动态图心律失常情况。结果：其中81例冠状动脉侧支循环开放良好(A组)，107例冠状动脉侧支循环开放不良(B组)。心肌缺血程度A组较B组轻，左室功能指标A组明显优于B组，A组心律失常发生率少于B组。结论：良好的冠状动脉侧支循环对心肌缺血、左室功能具有保护作用，并可减少心律失常的发生。     

Acute myopericarditis masquerading as acute myocardial infarction

Patients with abrupt onset of chest pain,ischemic ECG abnormalities and elevated levels of cardiac markers could be given a diagnosis of acute myocardial infarction.However,some other diseases should be taken into consideration in this clinical setting when coronary arteries are proven to be normal.Here we report a case of acute myopericarditis with clinical presentation of myocardial infarction and normal coronary anatomy.The Herpes Simplex Virus II was considered as the organism causing myopericarditis and the patient was recovered by the treatment with valacicloavir.A precise diagnosis is a prerequisite of successful treatment and favorable prognosis.     

Myocardial infarction in a pre-menopausal woman with angiographically normal coronary arteries

A young pre-menopausal non-drug-addict woman without risk factors for coronary artery disease suffered from a non-Q-wave acute myocardial infarction. She presented with epigastric pain and vomiting. Diagnosis of acute myocardial infarction was not suspected at first because of her young age and lack of risk factors. She was treated for gastritis but worsening of epigastric pain and its radiation to chest warranted the diagnosis of acute myocardial infarction, which was confirmed by serial serum cardiac enzymes. Subsequent coronary angiogram revealed normal coronary arteries.     

甲状腺功能亢进患者治疗前后血浆B型钠尿肽的改变及机制

目的:探讨甲亢不伴有明显心功能不全患者治疗前后血浆B型钠尿肽(BNP)的改变及机制。方法:采用酶联免疫法(ELISA)检测66例甲状腺功能亢进患者治疗前及治疗4周后BNP水平,并分析BNP与血浆FT3、FT4的相关性,同时入选48例甲状腺功能正常患者作为对照组。结果:甲状腺功能亢进患者治疗前BNP水平显著高于对照组(P<0.01),经抗甲状腺药物治疗8周后,甲状腺功能亢进患者血浆BNP、FT3、FT4显著下降,BNP下降水平与FT3、FT4下降水平呈正相关。结论:在不伴有心功能不全甲状腺功能亢进患者中,BNP水平较对照组也明显增高,其机制与甲状腺激素对心肌的刺激作用有关,在抗甲亢治疗后,伴随着甲状腺激素的下降,BNP水平也逐渐恢复正常。     

急性缺血再灌注后心肌微血管床损伤的心脏MR影像研究

目的应用心肌首过灌注MR影像分析单支冠状动脉闭塞和多支冠状动脉狭窄无闭塞所造成的心肌微血管床闭塞差异.方法33例患者临床诊断为急性心肌梗死,其中15例为单支冠状动脉完全闭塞,18例为多支冠状动脉狭窄.发病后6～12周进行心脏MR影像检查.结果11例单支冠状动脉完全闭塞和4例多支冠状动脉狭窄患者的左心室内膜下心肌内存在首过灌注缺损区,前者显著多于后者(P＜0.01).心肌首过灌注缺损区域的信号强度峰值和信号增加的最大斜率显著小于灌注正常心肌(P＜0.05).结论心肌灌注首过时相影像能够显示急性缺血再灌注损伤所导致的心内膜下微血管床闭塞.单支冠状动脉闭塞的患者较多支冠状动脉狭窄的患者更容易发生心内膜下的微血管床闭塞.     

Stress, emotion and the heart: tako-tsubo cardiomyopathy

Tako-tsubo cardiomyopathy is a cardiac syndrome precipitated by profound emotional stress and anxiety, particularly in middle-aged women. It presents as a mimic of acute myocardial infarction, but coronary angiography shows normal coronary arteries and a characteristic left ventriculogram resembling an "octopus pot". The condition seems to have a favourable prognosis. Initially described in Japan, and with many names in the literature, it is being increasingly recognised in the West owing to early coronary angiography and primary coronary intervention, accounting for up to 1 in 30 primary cases of angioplasty in some institutions. A typical case is described, and the clinical features, pathophysiology and management reviewed.     

数字化血管造影图像评价冠状动脉内皮功能

采用数字化冠脉造影图像，测量由内皮依赖性扩张物质引起的冠脉直径变化。评价血管内皮功能，３５例受试者，９例冠脉造影正常进为对照组，２６例冠造影明显改变者为冠心病组。     

心脏淋巴引流阻断慢性期冠状动脉病变

手术阻断羊心脏淋巴引流后３０～１８０ｄ，用光镜、电镜观察冠状动脉及其分支病理变化。结果显示，术后３０ｄ，动脉壁病变明显，动脉壁增厚、水肿，内皮细胞和平滑肌细胞超微结构破坏，内膜局灶性增厚，动脉壁外膜及其周围心肌间质结缔组织增生并存在局灶性水肿。６０ｄ以后，无明显病理改变。提示心淋巴引流障碍慢性期仍可引起冠状动脉病理改变，主要是在术后３０ｄ     

选择性冠状动脉造影评价常规心电图ST-T改变在冠心病中的诊断价值

目的:评价常规心电图检查中ST-T改变在冠心病诊断中的价值。方法:以选择性冠状动脉造影为对照,研究连续194例病人临床症状及心电图ST-T改变与造影结果的关系。结果:造影发现136例病人有明显的冠状动脉狭窄性病变,58例未发现明显病变。非典型心脏症状的病人无论是否有ST-T的异常,冠状动脉造影的阳性率仅4%～14％,而典型症状伴有ST-T异常的病人阳性率较高(89.4％)。结论:ST-T异常伴有典型心脏症状的诊断冠状动脉病变的可靠指标。     

冠状动脉慢血流现象对P波离散度和QT离散度的影响

目的:探讨"正常"冠状动脉的慢血流现象对P波离散度(Pd)和QT离散度(QTd)的影响。方法:因疑诊冠心病行冠状动脉造影检查未发现冠状动脉管径狭窄的患者,根据血流情况分为慢血流组(n=31)和正常血流组(n=40)。对两组进行同步12导联心电图监测,比较Pd与QTd的变化。结果:慢血流组与正常血流组比较,Pd显著延长(45±9msvs35±11ms,P<0.05),QTd明显延长(56±15msvs39±13ms,P<0.05)。结论:冠状动脉的慢血流影响心肌灌注,使心肌电活动的非均质性增加。     

甲状腺动脉阻断乙醇灌注腺体治疗甲亢研究

目的研究甲状腺动脉阻断乙醇灌注治疗甲状腺机能亢进的效果。方法对甲状腺上动脉、静脉、中静脉及下动脉分支的上支结扎，断其血供，保留下静脉及下动脉下支，保证保留下极内侧少部分腺体血供回流，并在其上动脉、下动脉分支切断腺体端动脉腔内置管灌注乙醇。结果经36例患者治疗结果和动物实验证明，灌注的乙醇能迅速弥散到甲状腺内小动脉，导致小血管痉挛、内皮损伤、管壁肿胀、组织变性，使小动脉形成永久性闭塞．不致发生侧枝血管形成。致闭塞血域的甲状腺组织逐渐出现变性、萎缩纤维化、失去分泌功能，而被保留的少部分腺体分泌维持正常生理功能，达治愈甲亢之目的。结论该方法简单安全可靠，疗效确切，并发症少，不复发，是治疗甲亢的一个新方法，临床上有很好的实用价值。     

冠状动脉造影对女性冠心病的诊断意义

目的：为了解女性冠心病的临床诊断问题,本组回顾性分析５０例女性患者临床诊断冠心病心绞痛行冠状动脉（冠脉）造影检查的临床资料。方法：冠心病组：以冠脉造影血管狭窄≥７５％诊断为冠心病,冠脉狭窄５０％－７５Ａ％且临床有心肌缺血证据者也诊断为冠心病,共２３例。将冠状动脉狭窄〈５％或正常者为非冠心病组、共２７例。     

292例冠状动脉造影与诊断和临床表现对比分析

目的对冠状动脉造影(CAG)结果与诊断和临床表现的特点进行对比分析。对象和方法对临床已确诊或拟诊为冠心病(CHD)292例行CAG,男216例,女76例,年龄21～76岁,其中急性和陈旧性心肌梗死64例,典型心绞痛59例,不典型心绞痛或无症状但至少有一项CHD易患因素,同时心电图有ST-T改变者123例,心律失常42例,心脏瓣膜病术前检查4例。采用经股动脉途径287例,桡动脉途径5例。结果冠脉正常者168例,狭窄124例,其中单支病变占42.7％,2～3支(含左主干)占58.3％;轻度狭窄1.6％;中度狭窄19.4％,重度狭窄为79％。结论通过CAG可以明确诊断CHD及全面了解冠状动脉病变的严重程度,为外科手术依据,也提示CHD患者一旦出现临床症状,冠脉病变已比较严重。     

Role of the vascular endothelium in patients with angina pectoris or acute myocardial infarction with normal coronary arteries

Chest pain with normal coronary angiograms is a relatively common syndrome. The mode of presentation of this syndrome includes patients with syndrome X and patients with an acute myocardial infarction and angiographically normal coronary arteries. Different mechanisms have been proposed to elucidate the exact cause and to explain the various clinical presentations in these patients. Abnormalities of pain perception and the presence of oesophageal dysmotility have all been reported in patients with syndrome X. In situ thrombosis or embolization with subsequent clot lysis and recanalization, coronary artery spasm, cocaine abuse, and viral myocarditis have been described as potential mechanisms responsible for an acute myocardial infarction in patients with angiographically normal coronary arteries. Recent data suggest that both microvascular and epicardial endothelial dysfunction may play an important role in the pathophysiological mechanism of the syndrome of stable angina or acute myocardial infarction with normal coronary arteries.     

Corrected thrombolysis in myocardial infarction frame counts in diabetic patients with angiographically normal coronary arteries

OBJECTIVE: To evaluate corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) in patients with angiographically normal coronary arteries and diabetes mellitus, a condition known to be associated with microvascular dysfunction. METHODS: Patients who underwent coronary angiography in Gazi University Hospital, Ankara, Turkey between January 2000 and January 2005 were studied. Corrected TIMI frame count was calculated over the left anterior descending (LAD), left circumflex (Cx) and right coronary arteries (RCA) in 118 diabetic and 122 non-diabetic patients with normal coronary angiogram. RESULTS: The mean CTFC values of the LAD, Cx, and the RCA were similar in diabetics and nondiabetics 21.0 +/= 7.5 versus 21.3 +/= 9.6, 23.3 +/= 9.7 versus 23.5 +/= 10.8, 17.9 +/= 6.7 versus 18.7 +/=7.4 respectively, p>0.05 for all comparisons. In stepwise multivariate linear regression analysis, body surface area had a significant correlation with CTFC of all the 3 coronary arteries. CONCLUSION: We conclude that CTFC in diabetics and non-diabetics with angiographically normal coronary arteries is similar. Since microvascular disease is an inherent component of diabetes, our finding may reflect the inadequacy of CTFC in predicting microvascular disease in diabetic patients with normal coronary angiograms.