Parathormone and calcitonin in men suffering from ischemic heart disease

It has been shown that in men with coronary heart disease (CHD), the basal concentrations of parathyroid hormone (PTH) and calcitonin (CT) in blood serum were increased both during an angina pectoris attack and the interparoxysmal period. During an angina pectoris attack, the highest CT concentration was detected in CHD patients with angina pectoris of effort on the day of the anginal attack. In acute myocardial infarction (AMI), the basal PTH level in the patients' blood serum was increased, particularly during the subacute disease stage. The blood serum CT content during AMI depended on the disease onset: in patients with a sudden disease onset, the parameter under study was increased, whereas in AMI patients with a history of angina pectoris, the CT concentration remained within normal. The authors discuss the pathogenetic role of the shifts in the function of the parathyroid glands and C cells of the thyroid during CHD and the possibility of the use of calcium antagonists and CT in the treatment of myocardial infarction.     

Dynamics of changes in the levels of myoglobin and anti-myoglobin autoantibodies in the blood serum of patients with myocardial infarction

The mean level of myoglobin and autoantibodies to myoglobin in the blood of healthy donors was 77.57 +/- 8.17 ng/ml and 18.01 +/- 1.85 micrograms/ml respectively. The level of myoglobin in the blood of patients with primary transmural myocardial infarction was rapidly increased, reaching its maximum in 9-12 h and returning to normal in 9 days. The mean level of autoantibodies was decreased in the first 66 h and got back to normal by the 6th day of disease. In primary large focal nontransmural myocardial infarction the concentration of myoglobin in the blood of patients was also increased, reaching its maximum in 3-9 h and returning to normal by the end of the 2nd day after onset of an angina attack. A decrease in the level of autoantibodies to myoglobin was observed up to the 18th day of disease. The peculiarity of repeated large focal nontransmural myocardial infarction was a two-peak curve of changes in a MG level with maximum levels in 9-12 and 21-24 h after onset of a pain attack. Final normalization of the level of myoglobin in the blood of patients of this group occurred in 69 h. The concentration of autoantibodies to myoglobin was more than once decreased up to the 6th day of disease. The results obtained showed that groups of examinees differed in the time course of changes in the level of myoglobin and autoantibodies to myoglobin. Such differences can be used for diagnostic purposes.     

The content of fibronectin, fibrinogen, its degradation products and myoglobin in patients with ischemic heart disease

ELISA using the test systems and a complex of equipment manufactured by Flow Company was employed to study over time the content of fibronectin, fibrinogen, products of its degradation and myoglobin in 178 patients suffering from coronary heart disease (stable and progressive angina pectoris, acute myocardial infarction). The concentration of myoglobin, fibronectin, fibrinogen and products of its degradation was established to depend on the gravity of coronary heart disease and the tame elapsed since the disease onset. In patients with progressive disease, there was an increased consumption of fibronectin which may be due both to its expenditure during blood coagulation and fulfillment of angioprotective function because of exacerbation of systemic atherosclerosis.     

氯沙坦对心绞痛患者心肌缺血的影响

目的　探讨氯沙坦对心绞痛患者血流动力学指标与心肌缺血发作的影响。方法　 4 6例稳定型和不稳定型心绞痛患者随机分为氯沙坦组和对照组 ,测定两组患者血流动力学指标的变化及其对心肌缺血发作的影响。结果　氯沙坦能显著降低心绞痛患者高、低切变率时的全血粘度 ,全血高、低切还原粘度 ;明显改善心绞痛患者红细胞的变形性 ,心绞痛程度显著降低 ,持续时间显著缩短。但对心绞痛患者血浆粘度、红细胞压积、纤维蛋白原、血压、血糖均无明显影响。结论　氯沙坦能改善微循环灌注和心脏供血与供氧 ,有利于预防动脉血栓形成和降低急性心肌梗死的发病率     

The comparative value of myoglobin determination in patients with different forms of ischemic heart disease]

The hemagglutination test was used to measure the content of myoglobin (MG) in the blood serum in 92 patients suffering from coronary heart disease (myocardial infarction, unstable and stable angina pectoris). The content of MG turned out a safe indicator attesting to acute myocardial infarction. In complications and spreading of necrosis, the MG level was returning to normal slowly. In patients with angina pectoris, the MG level did not on the average differ from control. However, in patients with unstable angina pectoris, there was an increase of the MG content after long-term attacks and in the development of small-focal necroses in the myocardium.     

冠心病患者纤溶系统的异常变化

目的探讨冠状动脉病变中血清纤维蛋白原（Fg）、组织型纤溶酶原激活物（t-PA）、血浆D-二聚体（D-Dimer）与血栓形成关系，并就其作用机理进行研究，为临床治疗提供科学依据。方法急性心肌梗死（AMI）组28例、不稳定心绞痛（UAP）组24例、稳定心绞痛（SAP）组30例和正常对照组20例。分别检测血清Fg、血浆D-Dimer、t-PA及其抑制物（PAI）活性，并对照比较其含量与冠状动脉粥样硬化血栓形成的关系。结果血浆t-PA活性：AMI和UAP明显低于SAP与健康对照组（P〈0．01）；AMI组和UAP组之间，SAP组与健康对照组之间差异无统计学意义（P〉0．05）。血浆PAI活性、D-Dimer和Fg含量：AMI和UAP组明显高于SAP和健康对照组（P〈0．01）；AMI组和UAP组之间，SAP组与健康对照组之间差异无统计学意义（P〉0．05）。结论监测冠状动脉粥样硬化患者血清中血清Fg含量、t-PA、D-Dimer含量，可以及时判断凝血和纤溶功能失衡状况，预防和干扰血栓形成，提高患者良性预后。     

Determining myoglobinemia in acute myocardial infarction by the immunoenzyme method

Like radioimmunoassay, immunoenzyme assay permits detecting myoglobinemia both in healthy persons and in patients with acute myocardial infarction (AMI). In AMI patients, myoglobinemia reaches a maximum 5 to 12 hours since the onset of a powerful anginal attack whereupon it gradually and spasmodically decreases, without returning to normal toward outcome of the 3d day of the observation period. A single assay of myoglobinemia in AMI patients is of diagnostic importance within 2 to 27 hours since the disease onset.     

冠心病患者血小板膜糖蛋白CD_(62)P表达和血粘度的临床研究

目的　探讨血小板膜糖蛋白CD62 P表达及血粘度与冠心病的关系。方法　利用流式细胞仪和单克隆抗体技术测定 82例冠心病患者 (稳定型心绞痛 2 6例A组 ;不稳定型心绞痛 2 8例B组 ;急性心肌梗死2 8例C组和 2 8例健康人D组 )的CD62 P活性及血液流变学指标。结果　A组、B组、C组和D组的CD62 P阳性表达率分别为 3 6 2± 1 2 4 %、5 2 6± 1 4 9%、6 0 8± 1 75 %和 2 4 6± 0 81%。A组、B组和C组与健康人D组比较 ,差异均有显著意义 (P值均 <0 0 5 )。以上各组的血浆粘度分别为 1 31± 0 30、1 6 4± 0 2 2、2 19±0 35及 1 30± 0 18。B组、C组与对照组相比差异均有显著意义 (P值均 <0 0 5 ) ,CD62 P与血浆粘度和纤维蛋白原浓度呈正相关 (r =0 872 ,P <0 0 5 ;r =0 793,P <0 0 5 )。结论　CD62 P及血浆粘度均可能成为判断冠心病患者病情进展程度的良好指标     

缺血修饰性清蛋白的临床应用研究

目的探讨缺血修饰性清蛋白（IMA）在急性冠状动脉综合征（ACS）早期诊断价值。方法将89例ACS患者分别于胸痛发作2、4、6、12h及24h采血检测IMA、肌钙蛋白I（cTnI）和肌酸激酶MB同功酶（CK—MB）。其中急性心肌梗死41例,心绞痛48例。分析IMA对ACS的诊断价值。结果ACS患者IMA水平于胸痛发作2h明显增高,4h达到高峰,6h后降至正常。而cTnI,CK—MB在胸痛发作4h开始增高,6h明显增高,以后逐步递增至24h。在心绞痛、心肌梗死中,IMA水平升高以心绞痛最明显（P〈0．05）。结论IMA是诊断ACS早期敏感指标,是诊断心肌缺血的生化标志物。     

心肌肌钙蛋白Ⅰ和肌钙蛋白T对急性缺血性心脏病预后相关性分析

目的探讨心肌肌钙蛋白I(cTnI)和肌钙蛋白T(cTnT)对急性缺血性心脏病转归的影响。方法对就诊的急性缺血性心脏病患者定性测定入院时及距胸痛发作间隔10h的cTnI和定量测定相同时点的cTnT。同时随访患者发病后1、3、6、12个月的疾病转归,以心绞痛、心肌梗死、心力衰竭、心源性猝死为终点评价指标。结果cTnI或cTnT异常患者与正常者相比较,不稳定型心绞痛、心肌梗死、心力衰竭、心源性猝死的发生率具有显著性差异(P<0.01)。cTnI或cTnT异常与终点事件(不稳定型心绞痛、心肌梗死、心力衰竭、心源性心源性猝死)发生率呈正相关。结论cTnI或cTnT对急性心肌梗死,尤其是微小心肌坏死诊断具有高度的敏感性和特异性,并与急性缺血性心脏病的预后密切相关。     

基于随机森林的男性急性心肌梗死诊断模型建立及验证

目的利用随机森林建立及验证男性急性心肌梗死诊断模型。 方法检测2016年1至6月于武汉大学人民医院心内科住院的205例心绞痛或急性心肌梗死男性患者的血清生化及生物标志物指标,其中151例患者作为训练集,54例患者作为验证集。用随机森林对指标预测急性心肌梗死的重要性进行排序。根据袋外数据误差,赤池信息量准则和贝叶斯信息量准则对排序指标进行筛选并构建诊断模型;多维标度法(MDS)观察模型对急性心肌梗死和心绞痛的区分能力;用验证集数据验证模型对心绞痛和急性心肌梗死的鉴别能力。 结果19个指标根据平均准确度下降程度和平均基尼(Gini)指数下降程度进行重要性排序。用袋外数据误差,赤池信息量准则和贝叶斯信息量准则筛选出C-反应蛋白、中性粒细胞绝对值和血糖3个变量,并纳入模型。通过MDS法观察到多半样本得到良好的区分,但部分样本仍难以区分开。在外部验证中,31例急性心肌梗死患者有26例(83.87%)被正确识别;在23例心绞痛患者中有19例(82.61%)被正确识别。 结论基于随机森林的诊断模型建立能较好区分急性心肌梗死与心绞痛。     

冠心病、高血压患者血浆P物质水平的临床观察

方法 选择符合WHO诊断标准的急性心肌梗塞(AMI)20例,心绞痛(AP)30例,高血压病(EH)30例,应用放射免疫分析法动态观察血浆P物质(SP)含量变化,并以30例正常人作对照。结果冠心病(CHD)对照组SP水平为126.99±15.96pg/ml,AMI组发病第1天SP含量为62.85±16.76pg/ml,显著低于对照组(P<0.01)。发病第7天开始升高为72.60±15.20pg/ml,第21天趋于正常,为110.10±27.95pg/ml,与对照组比较无显著差异(P>0.05)。AP组心绞痛发作期SP含量为48.38±12.92pg/ml,显著低于对照组(P<0.001),经治疗2周症状缓解后复查血浆SP含量升高至78.70±9.15pg/ml,前后比较有显著差异(P<0.001)。EH组SP含量为59.75±17.89pg/ml,明显低于对照组(126.99±15.96pg/ml,P<0.001),EH的病情越严重,血浆SP的含量降低越明显。结论 循环血中SP含量不足可能是引发CHD、EH的重要因素之一;SP参与了CHD及EH的发病机理及病理生理过程。     

Clinical value of studying fibrinogen degradation products in patients with ischemic heart disease

Study of fibrinogen degradation products in patients with angina pectoris and acute myocardial infarction proved to be of clinical importance. Their content in patients with acute myocardial infarction was increased more considerably than that in patients with angina pectoris. This parameter can be used for the differential diagnosis of angina pectoris and acute myocardial infarction.     

Early diagnosis of myocardial infarction by arginase activity determination

In blood serum of healthy persons the activity of arginase (EC 3.5.3.1) is very low, whereas in patients with myocarcial infarction it increases within a few hours after the first attack of coronary pain, and returns to normal values after 3–5 days. No increase of arginase activity was observed in sera of patients with angina pectoris, coronary insufficiency or cardiac failure.

Determination of arginase activity in blood serum may serve as a useful test in early differential diagnosis of myocardial infarction.     

Nickel concentrations in serum of patients with acute myocardial infarction or unstable angina pectoris

Nickel was measured, by electrothermal atomic absorption spectrophotometry, in sera from (a) 30 healthy adults, (b) 54 patients with acute myocardial infarction, (c) 33 patients with unstable angina pectoris without infarction, and (d) five patients with coronary atherosclerosis who developed cardiac ischemia during treadmill exercise. Mean (and SD) concentrations in Group a were 0.3 (0.3) microgram/L (range less than 0.05-1.1 microgram/L). Within 72 h after hospital admission, hypernickelemia (Ni greater than or equal to 1.2 microgram/L) was found in 41 patients of group b (76%) and in 16 patients of group c (48%). Hypernickelemia was found before and after exercise in one patient of Group d (20%). Peak values averaged 3.0 micrograms/L (range 0.4-21 micrograms/L) in Group b, 1.5 microgram/L (range less than 0.05-3.3 micrograms/L) in Group c. In Group b, the mean time interval between the peak values for creatine kinase activity and for nickel was 18 h. Serum nickel concentrations were unrelated to age, sex, time of day, cigarette smoking, medications, clinical complications, or outcome. Mechanisms and sources of release of nickel into the serum of patients with acute myocardial infarction or unstable angina pectoris are conjectural, but hypernickelemia may be related to the pathogenesis of ischemic myocardial injury.     

心肌梗死患者溶栓治疗疗效与D-二聚体水平的关系

目的评价血浆D-二聚体（DD）在判断急性心肌梗死（AMI）溶栓治疗疗效中的应用价值。方法采用酶联免疫吸附试验（ELISA）检测健康人（对照组）心绞痛、陈旧性心肌梗死（OMI）及AMI患者血浆DD含量（AMI患者发病后进行连续测定），并比较其结果。结果对照组、心绞痛患者、OMI患者、未接受溶栓的AMI患者、接受溶栓治疗的AMI患者DD含量分别为0．41±0．30mg／L、0．55±0．36mg／L、0．60±0．48mg／L、1．01±0．52mg／L和2．91±1．04mg／L。与对照组相比较，心绞痛组和OMI组DD含量差异无显著性（P〉0．05），而未溶AMI组和溶栓AMI组DD含量明显升高，差异具有非常显著性（P〈0．001）。溶栓AMI组DD含量显著高于未溶AMI组，差异具有显著性（P〈0．001）。结论血浆DD测定不仅可作为观察心肌梗死病情的指标，对溶栓药物的疗效监测也具有重要价值。     

The clinical and prognostic information value of painless myocardial ischemia in the early postinfarct period]

A study was made of painless myocardial ischemia in the early postinfarction period (day 14) in order to define its influence on the clinical course and immediate prognosis. 25 patients aged 32 to 60 years with acute primary myocardial infarction were examined. 17 patients had large-focal and 8 small-focal infarction. The patients received diurnal ECG monitoring and physical exercise test on a treadmill. An overwhelming majority of the patients manifested myocardial ischemia not correlating with the rate of angina pectoris attacks. In the patients with small-focal infarction, angina pectoris occurred more frequently and was longer. It has been discovered that the total diurnal duration of transitory myocardial ischemia in the early postinfarction period is a more informative indicator of the immediate prognosis as compared to physical exercise tolerance.     

急性冠状动脉综合征患者血清纤维连接蛋白的变化

目的观察急性冠状动脉综合征不同类型患者血清纤维连接蛋白(Fn)水平的变化,探讨其在急性冠状动脉综合征发病中的作用和临床意义。方法急性冠状动脉综合征患者分为急性心肌梗死组50例、不稳定型心绞痛组17例,另设健康对照组13例,采用双抗体夹心固相酶联免疫吸附法测定血清Fn的水平。结果急性冠状动脉综合征组血清Fn的水平显著低于健康对照组[(233.38±119.15)μg/ml,(296.46±65.44)μg/ml,P<0.05];急性心肌梗死组与不稳定型心绞痛组血清Fn的水平差异无统计学意义。血清Fn的水平在不同的冠状动脉病变程度之间的差异无统计学意义[单支血管病变(226.83±112.35)μg/ml,双支病变(231.15±128.06)μg/ml及三支病变(277.32±139.61)μg/ml,F=0.825,P=0.445]。结论急性冠状动脉综合征患者血清Fn的水平显著低于健康对照组,与冠状动脉病变的程度无相关性。     

不同类型冠心病患者血浆游离脂肪酸水平变化及其与病变程度的关系

目的探讨血浆游离脂肪酸(NEFA)水平变化与冠心病(CAD)病变程度的相关性。方法选取疑为CAD患者84例,分别行生化检验和冠状动脉造影检查;根据冠状动脉造影结果将其分为4组,分别为不稳定型心绞痛组(n=46)、稳定型心绞痛组(n=9)、急性心肌梗死组(n=20)、阴性对照组(n=9),对比组间血脂指标与NEFA是否存在差异分析,CAD患者发生急性心肌梗死风险与造影特点。结果 CAD组NEFA水平均高于阴性对照组,差异有统计学意义(P0.05);急性心肌梗死组NEFA水平高于稳定型心绞痛组和不稳定型心绞痛组,差异有统计学意义(P0.05);Logistic回归分析显示,校正后NEFA≥0.415mmol/L组出现急性心肌梗死的风险是NEFA0.415mmol/L组的2.61倍,95%CI:1.33~5.02,P0.05;不同水平的NEFA患者GENSINI积分、狭窄冠状动脉支数与3支冠状动脉病变数量差异无统计学意义(P0.05)。结论 CAD患者血浆NEFA出现升高,急性心肌梗死患者升高明显,但其与病变程度相关性未明确。     

Differentiation of myocardial infarction and angina pectoris by processing ultrasonic color kinesis images

Purpose The aim of this study was to develop a method for early, accurate differentiation between old myocardial infarction (OMI) and angina pectoris (AP) using color kinesis (CK) images. We first extracted exact end-diastolic and end-systolic contours from CK images and then extracted the features of cardiac function from two CK images (one at rest, the other after exercise) and investigated their effectiveness in differentiating old myocardial infarction and angina pectoris. We then evaluated the effectiveness of several features in recognizing coronary artery disease and used the effective features to show the differentiation results.Methods First, we extracted exact end-diastolic and end-systolic contours from CK images with an active contour model. Second, we defined the features that seemed to be effective in recognizing coronary artery disease. The features are extracted from the region between the end-diastolic endocardial contour and end-systolic endocardial contour in two CK images: one obtained when the subject was at rest and the other after exercise. Nine features were considered effective for differentiating old myocardial infarction and angina pectoris, and the effectiveness in recognizing coronary artery disease, which includes old myocardial infarction and angina pectoris, was evaluated. Third, coronary artery disease is recognized by the effective features.Results Contours near a manual trace by a skilled physician were obtained using the proposed method. Multiple comparisons of the mean values of the extracted features were drawn among three groups: a healthy-subject group; an old myocardial infarction patient group; and an angina pectoris patient group. The feature effective in differentiating old myocardial infarction was the “area at rest”; those effective in differentiating angina pectoris were a “decrease in area” and a “decrease in movement.” These effective features have almost always differentiated old myocardial infarction and angina pectoris.Conclusions This study used the endocardial contour extraction technique with the dynamic contour model and evaluated the validity of the features of cardiac function; it then recognized coronary artery disease from the effective features. Multiple comparisons of the mean value of the extracted features among the healthy-subject group, the old myocardial infarction patient group, and the angina pectoris patient group has proved that the “area at rest” is effective in differentiating old myocardial infarction, and the “decrease in area” and “decrease in movement” are effective for differentiating angina pectoris.