二尖瓣环自动追踪技术评价冠心病患者左心室收缩功能

目的 应用二尖瓣环自动追踪技术评价冠心病患者左心室收缩功能.研究该方法与改良Simpson法测量左心室收缩功能间的相关性.方法 冠心病患者33例,取心尖四腔心,应用改良Simpson法测量左室舒张末容积、收缩末容积、每搏量、心输出量、左室射血分数、每搏指数、心排指数,转换二尖瓣环自动追踪技术模式分别测量以上指标,采用相关分析,比较二尖瓣环自动追踪技术与改良Simpson法对左室功能的相关性.结果 2种方法测量指标相关系数分别为:左室舒张末容积0.875、收缩末容积0.912、每搏量0.693、心输出量0.664、左室射血分数0.725、每搏指数0.688、心排指数0.684.结论 二尖瓣环自动追踪技术与改良Simpson法在测量左心室收缩功能方面相关性很好.二尖瓣环自动追踪技术是评价冠心病患者左室收缩功能的一项简便而准确的方法.     

原发性高血压患者心功能特征100例分析

背景：高血压患者心功能常有不同程度损害,不同分期高血压患者心功能损害程度有何差异？目的：观察高血压不同分期患者的心功能,并与健康者相应指标进行对照.设计：病例-对照,对比观察.单位：解放军沈阳军区总医院特诊科.对象：选择2002-10/2003-05解放军沈阳军区总医院内科住院原发性高血压患者100例.其中高血压Ⅰ期30例,高血压Ⅱ期40例,高血压Ⅲ期30例.选择同期本院健康体检者30人为对照.纳入对象均知情同意.方法：纳入对象心功能测定采用XJS-Ⅰ型心功能检测仪.患者取仰卧位,按四电极法放置电极.于呼气末屏气,同步描记Ⅰ导联心电图、心音图、心导纳微分图、颈动脉搏动图.通过微机处理显示各种指标.检测指标为：心率,排血前时间,左室排血时间,排血前时间/左室排血时间,电机械延迟时间,等容收缩时间,等容收缩时间/左室排血时间,脉搏波传递时间,每搏量,心排血量,心脏指数,心肌收缩强度指数,总外周阻力,血管顺应性.主要观察指标：不同分期高血压患者与健康者心功能状况比较.结果：原发性高血压患者100例和健康者30人均进入结果分析.[1]排血前时间、等容收缩时间、总外周阻力、排血前时间/左室排血时间和等容收缩时间/左室排血时间：高血压患者明显大于或长于健康者（P＜0.01）,Ⅱ,Ⅲ期高血压患者明显高于或长于Ⅰ期高血压患者（P＜0.01）.[2]每搏量、心排血量、心肌收缩强度指数、血管顺应性、脉搏波传递时间、心脏指数：高血压患者明显低于或短于健康者（P＜0.01）,Ⅱ,Ⅲ期高血压患者明显低于或短于Ⅰ期高血压患者（P＜0.01）.在上述指标中,Ⅲ期高血压患者血管总外周阻力明显高于Ⅱ期高血压患者（P＜0.05）,血管顺应性明显低于Ⅱ期高血压患者（P＜0.05）.结论：高血压患者心功能较健康者明显下降,随着高血压病情发展,心功能进一步下降.     

二尖瓣环自动追踪技术对正常人左心室收缩功能分析

目的 应用二尖瓣环自动追踪技术评价正常人左心室收缩功能.研究该方法与改良Simpson法测量左心室收缩功能间的相关性.方法 取心尖四腔心,转换二尖瓣环自动追踪技术模式分别测量左室射血分数、左室舒张末容积、收缩末容积、每搏量、每搏指数、心输出量、心排指数.同时应用改良Simpson法测量以上指标.采用相关分析,比较二尖瓣环自动追踪技术与改良Simpson法对左室功能的相关性.结果 2种方法测量指标相关系数分别为:左室射血分数0.648、左室舒张末容积0.838、收缩末容积0.917、每搏量0.611、每搏指数0.514、心输出量0.579、心排指数0.541.结论 二尖瓣环自动追踪技术与改良Simpson法在测量左心室收缩功能方面中度及高度相关.二尖瓣环自动追踪技术是评价左室收缩功能的一项简便、准确的方法.     

急性冠脉综合征患者血浆N端B型脑钠肽前体与心脏血流动力学的相关性

目的：研究急性冠脉综合征（ACS）患者N端B型脑钠肽前体（NT-proBNP）与心脏血流动力学相关参数的相关性。方法：入选复旦大学附属中山医院心内科监护室ACS患者共37例,其中男性32例,女性5例,年龄36~84岁,对所有患者进行无创心脏血流动力学检测并收集NT-proBNP等血液指标数据。分析NT-proBNP与无创血流动力学各参数间的相关性,并采用多元逐步回归分析进行多因素分析。结果：NT-proBNP水平与左室射血分数、每搏输出量、心输出量、搏指数、心指数、血管最大扩张速度、左室射血期、收缩指数、收缩功能指数、电机械收缩期、左室舒张末期容积、主动脉顺应性、左室每搏作功、左室每分作功、搏功指数、心功能指数呈负相关,与射血前期/左室射血期、主外周阻力、血管最大再扩张速度呈正相关;多元回归显示,左室射血期及电机械收缩期在本研究中受其他因素影响比较大,故将其剔除。结论：ACS患者NT-proBNP水平与心脏血流动力学部分指标有相关性。     

电生物阻抗测定左室收缩功能和舒张功能

胸腔生物阻抗的基本原理是记录心脏收缩，射血所致主动脉容积变化，引起胸腔阻抗变化。１收缩功能Ｌａｂａｂｉｄｉ（１９７０）［１］已证实胸腔阻抗变化的一阶导数图中各特征点与相应生理时相吻合，因此生物阻抗技术是无损伤性定量分析左室收缩功能和舒张功能的有用技术...     

原发性高血压病不同左室舒张功能状态与左房收缩功能关系

目的：实时三维超声心动图（RT-3DE）和组织多普勒显像技术（TDI）评价高血压病患者左房收缩功能。方法：RT3-DE检测左房最大容积（LAVmax）及最小容积（LAVmin）、左房射血量（LASV）及射血分数（LAEF），TDI检测左房游离壁（LA）及房间隔（IAS）舒张峰值速度（Va）及收缩期应变率（SRa）。结果：左室舒张功能正常及轻度降低组LA-D、LAEF、IAS-S、LA-S、IAS-SRa、LA-SRa、IAS-Va及LA-Va增高（P〈0.05）；假性正常化或舒张功能受限组显著降低。结论：高血压病患者，早期左房收缩功能增强；晚期左房收缩功能显著下降。     

184例小儿法乐氏四联症手术前后左室功能的超声研究

应用超声技术测定184例小儿法乐氏四联症(TOF)手术前后左室功能,包括:1、左室收缩力指标:射血分数(EF)及短轴缩短率(SF),2、左室容量指标:舒张末容积指数(EDVI),3、左室排血量指标:每搏指数(SI)及心脏指数(CI)。结果显示EF及SF术前后均在正常范围,EDVI、SI及CI术前明显降低,术后两周显著增加,平均3个月达正常水平,2年内无异常改变。SI及CI与EDVI呈直线正相关。从而提出,只要手术条件成熟,TOF小儿应尽早施行根治术,及时改善左室容量,提高左室排血量。     

彩色超声心动图评价心肌梗死恢复期经皮冠状动脉介入治疗对左心室重构及收缩功能改变的研究

目的彩色超声心动图评价心肌梗死恢复期经皮冠状动脉介入治疗对左心室重构和收缩功能的影响。方法将择期行经皮冠状动脉介入治疗成功的70例冠心病患者按有无急性心肌梗死分为2组,心肌梗死组48例（前壁梗死者38例,下壁梗死者8例,其他部位梗死2例）,非心肌梗死组22例。采用彩色超声心动图检测2组患者左心室各项左心室重构和功能值：左室舒张末容积（LVEDV）、左室舒张末容积指数（LVESVI）、收缩末容积（LVESV）、每搏量（SV）、每搏量指数（SVI）、左室射血分数（LVEF）及左室收缩末压（LVESP）,观察其变...     

参附注射液对心衰患者BNP、血浆ET-1、左心收缩功能指标影响观察63例

目的：观察在常规药物治疗慢性心力衰竭（简称心衰）的基础上,加用参附注射液治疗,患者血液中的BNP、血浆ET-1、左心室收缩功能指标及临床症状的变化。方法：将63例患者随机分为对照组31例,参附治疗组32例。2组均根据2009ACC/AHA心力衰竭指南采用抗心衰治疗。参附治疗组在此基础上加用参附注射液50ml,1次/d,疗程为10d。治疗前后分别测定患者脑钠肽、血浆内皮素-1指标,左心室收缩功能指标[（左室射血分数（LVEF）,左心室收缩末期容积（SV）,心排血量（CO）,排指数（CI）],并进行统计学比较。结果：2组患者症状均有所改善,治疗后较治疗前的BNP、血浆ET均有下降,且左心室收缩能力均有增强,同时参附治疗组优于对照组,总有效率93.7%,差异有统计学意义（P〈0.05）。结论：心衰在常规治疗基础上联合参附注射液能更有效干预心衰患者BNP、血浆ET、左心收缩功能指标,改善心衰患者症状。     

左房追踪技术评价肥厚型心肌病患者左房功能

目的：左房追踪技术评价肥厚型心肌病患者左房功能的临床应用价值。方法：肥厚型心肌病患者21例,27例健康志愿者为正常对照组,运用左房追踪技术（LA Tracking）,获取左房容积变化速率曲线、左房容积-时间变化曲线及左房周长-时间变化曲线,分别测量收缩期左房速率峰值（dv/dt s）,左室舒张早期左房排空率峰值（dv/dt E）,左室舒张晚期左房排空率峰值（dv/dt A）,左房最大容积（LAVmax）,左房最小容积（LAVmin）,左房收缩前容积（LAVp）,计算左房被动射血分数（LAPEF）,左房主动射血分数（LAAEF）,左房最大周长（LACmax）,左房最小周长（LACmin）,对以上各参数进行对比分析,所有左房容积测值均经体表面积校正得到左房容积指数（LAVI）。结果：HCM组与正常对照组相比,收缩期dv/dt s,左室舒张晚期dv/dt A,左房最大容积指数（LAVImax）,左房最小容积指数（LAVImin）,左房收缩前容积指数（LAVIp）,LAAEF明显增大,左室收缩早期dv/dt E,LAPEF明显减小,差异有统计学意义（P<0.05）,相应的左房储存功能,管道功能下降,左房辅泵功能增加。LACmax,LACmin无显著性差异（P>0.05）,测值略大于正常组。结论：左房追踪技术可定量评估肥厚型心肌病患者的左房功能,可以作为综合评价肥厚型心肌病患者左房功能的新参数,为评价左房功能提供的一种新型的无创性方法。     

超声评价2型糖尿病患者左心房功能的研究进展

2型糖尿病患者早期心脏病理生理改变为舒张功能障碍,而左心房通过调整其储存器功能、管道功能以及助力泵功能的再分配,以维持左心室正常充盈量及心搏量,因此通过对左心房功能的评价可间接反映左心室舒张功能的变化.随着超声的蓬勃发展,应用于评价左心房结构及功能的超声技术亦逐渐增多,本文就其各种超声技术特点作一简要综述.     

凝血联合纤溶功能检测在急性胰腺炎中的临床应用

目的 探讨急性胰腺炎患者血凝系统和纤溶系统变化的临床意义.方法 急性胰腺患者350例及正常健康体检者50例,均用专用的凝血管静脉采血,采用Beckman coulter ACL-ADVANcE全自动血凝仪检测凝血酶原时间(PT)、纤维蛋白原(Fig)、活化部分凝血酶原时间(APTT)、凝血酶原时间(TT)和D-二聚体(D-D)含量.结果 (1)急性胰腺炎(AP)患者与正常健康体检者比较:其中PT、APTT和TT值均明显延长,Fig和D-D值也明显升高,两组比较差异有统计学意义(P<0.01).(2)轻症胰腺炎(MAP组)、重症胰腺炎(SAP组)和正常健康体检者组组间比较:随症状的加重,PT、APTT和TT值延长越明显,Fig和D-D值升高越明显,且组间比较,差异有统计学意义(P<0.01).结论 急性胰腺炎患者的凝血和纤溶指标的监测有助于对其病情的判断与评估,为临床医生制定合理的治疗方案提供可靠实验依据.     

瑜伽练习对精神分裂症住院患者躯体功能和心理功能影响的研究

目的探讨瑜伽练习对精神分裂症住院患者躯体和心理功能的影响。方法将152例精神分裂症住院患者随机分为瑜伽组、书画组、音乐组、手工组和常规精神科治疗组,各为38例、24例、26例、21例和43例,常规组给予精神科常规治疗,其余工娱疗组除精神科常规治疗外,分别进行8周的瑜伽练习、书画治疗、音乐治疗和手工治疗。用GQOLI-74中的躯体和心理功能维度评定各组患者治疗前后的躯体和心理功能。结果工娱疗组患者（瑜伽练习、书画治疗、音乐治疗和手工治疗）经治疗8周后,躯体和心理功能总分及10个因子分都显著高于常规组（P〈0.01）。瑜伽组患者在躯体功能和心理功能总分上明显高于音乐组和手工组,在心理功能总分上显著高于书画组和音乐组（P〈0.05）。结论瑜伽练习、书画治疗、音乐治疗和手工治疗等工娱疗法均能够促进精神分裂症住院患者的躯体和心理功能的恢复;瑜伽练习对促进住院患者躯体和心理功能方面恢复优于书画治疗、音乐治疗和手工治疗。     

先天性心脏病患者心功能与肺功能相互关系的临床研究

目的讨论先天性心脏病患者心功能与肺功能的相互关系。方法随机选择60例先天性心脏病患者于术前、术后近期、术后远期,拍心脏前后位远达片,进行肺功能检查及运动前后血气检测。对不同时期的心功能级别、心胸比例与肺功能参数,经统计学处理进行比较。结果资料显示随心功能的降低,心胸比例增大,肺损害加重;术后近期肺功能改善不明显,术后远期随心功能的改善,心胸比的缩小,肺功能明显改善;但小气道阻塞及肺弥散功能、功能残气比改善较慢。结论心功能直接影响肺功能,两者呈正相关关系。     

EB病毒DNA载量与患儿机体免疫及肝肾功能的相关性研究

目的探讨EB病毒(EBV)感染患儿EBV-DNA载量与机体免疫及肝肾功能的相关性。方法选择该院2016年5月至2019年5月收治的EBV-DNA阳性患儿90例为研究对象,按照EBV-DNA载量的差异分成低载量组(<5×10⁴ copy/mL)44例、中载量组(5×10⁴~5×10⁵ copy/mL)24例和高载量组(>5×10⁵ copy/mL)22例,另取同期于该院接受体检的健康儿童50例作为对照组。比较各组T淋巴细胞亚群、免疫球蛋白(Ig)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBil)、尿素(BUN)、血清肌酐(Scr)、尿酸(UA)水平。分析EBV-DNA载量与T淋巴细胞亚群、Ig、ALT、AST、TBil、BUN、Scr、UA的相关性。采用受试者工作特征(ROC)曲线分析EBV-DNA载量对EB病毒感染患儿肝肾功能异常和免疫状态的预测价值。结果随着EBV-DNA载量升高,CD3⁺T细胞、CD8⁺T细胞、IgM、ALT、AST、TBil、BUN、Scr、UA水平逐渐升高(P<0.05),而CD4⁺T细胞、CD4⁺/CD8⁺、IgA水平逐渐降低(P<0.05);低载量组、中载量组、高载量组的IgG水平高于对照组(P<0.05);EBV-DNA载量与CD3⁺T细胞、CD8⁺T细胞、IgM、IgG、ALT、AST、TBil、BUN、Scr、UA均呈正相关(P<0.05),与CD4⁺T细胞、CD4⁺/CD8⁺、IgA均呈负相关(P<0.05)。EBV-DNA载量预测患儿免疫状态异常的曲线下面积(AUC)为0.849,灵敏度为85.46%,特异度为82.53%;预测患儿肝功能异常的AUC为0.754,灵敏度为82.20%,特异度为80.37%;预测患儿肾功能异常的AUC为0.701,灵敏度为79.24%,特异度为80.02%。结论EBV感染患儿EBV-DNA载量与机体免疫状态及肝肾功能存在一定关联,随着EBV-DNA载量的增加,机体免疫及肝肾功能下降。     

Sweating function and retinal vasomotor reactivity in migraine

Sweating function and retinal arterial reactivity in patients with migraine were examined during headache-free intervals. The sweat glands were stimulated by intradermal injection of pilocarpine hydrochloride, and molds of sweat droplets were obtained using Silastic. The number of droplets in classic migraine was significantly lower than that in the controls. The retinal arterial response to changes in perfusion pressure was measured by means of a fundus camera. The retinal vasomotor index (-change in retinal arterial diameter (%)/change in effective MABP (mmHg)) was significantly lower in classic and in common migraine than in controls. The above results suggest that sweating function and retinal arterial reactivity are impaired in patients with migraine and that the impairment may play an important role in the pathophysiology of migraine attacks.     

LEJ-1全方向M型超声心动图对正常人左室局部收缩舒张功能的研究

目的　采用全方向M型超声心动图测定左室各节段室壁的收缩、舒张功能参数 ,了解正常人左心室上、中、下三个节段不同室壁的短轴方向局部运动状况 ,作为进一步研究的正常对照。方法　国产LEJ 1全方向M型心动图系统 ,对胸骨旁左室短轴二尖瓣水平、乳头肌水平、心尖水平的二维图像进行采集和定标 ,用手动分析法对左室 16个室壁节段的运动曲线进行测量 ,测量参数包括 :收缩期最大运动幅度 (R) ,收缩末期室壁厚度 (Ts) ,舒张末期室壁厚度 (Td) ,舒张三分之一时室壁厚度 (T1/3d) ,心内膜舒张早期运动速度 (Vd)与收缩期最大运动速度 (Vs) ,以及心电图R波顶点到室壁舒张开始的时间间隔 (R d) ,每种测定取连续三次测量的平均值 ,并计算室壁增厚率 (△T % )、舒张早期运动速度与收缩期最大运动速度的比值 (Vd/Vs)及舒张三分之一时室壁变薄率 (△T1/3d % ) ,以及 16节段室壁R d的最大差值R D。结果　左室各节段室壁的局部功能指标平均测值 :R为 ( 8.97± 1.5 )mm ,△T %为 ( 5 6.47± 8.2 ) % ,Vs为 ( 3 8.0 7± 9.0 )cm/s ,Vd为 ( 4 7.67± 13 .9)cm/s ,Vd/Vs为 1.2 5± 0 .17,△T1/3d %为 ( 64 .84± 6.2 7) %。总体看 ,后壁各项指标测值较大 ,而室间隔的较小 ;中、上段室壁的收缩和舒张运动较心尖段强。结论　全     

Impaired albumin function: a novel potential indicator for liver function damage?

Abstract

Albumin is the most abundant plasma protein and albumin infusion is commonly used. Conventionally, the biologic and therapeutic effects of albumin have been thought to be due to its oncotic properties. However, albumin has a variety of biologic functions, including molecular transport, anti-oxidation, anti-inflammation, endothelial stabilisation, anti-thrombotic effects, and the adjustment of capillary permeability. Despite this, the functions of albumin have not been thoroughly investigated. Recent studies have shown non-alcoholic fatty liver disease (NAFLD), viral hepatitis, cirrhosis, and liver failure to be associated with impairments in albumin function, which are associated with impairments in liver function and disease prognosis. Post-translational modifications of albumin cause structural modifications that affect protein function. Recently, the concentration of albumin associated with normal function, the ‘efficient albumin concentration’, has been attracting more interest. In addition, although many biologic markers, including albumin concentration, are widely used for the assessment of early liver dysfunction in patients with liver diseases, the predictive values are unsatisfactory. However, clinical evidence has suggested that albumin function may represent a novel biomarker of early impairment in liver function. In this review, we summarise the factors affecting albumin function and discuss the clinical significance of impairments in albumin function in various liver diseases.

1. Key messages

2. The importance of albumin depends not only on its concentration, but also on its various physiological functions.

3. Impaired albumin function has been reported in a variety of liver diseases, and is associated with disease severity and prognosis, thereby proposing the concept of ‘effective albumin concentration’.

4. Albumin dysfunction occurs earlier than other conventional indicators, and albumin dysfunction may be a new biomarker of early impairment in liver function.

5. Many exogenous and endogenous factors lead to post-translational modifications of albumin, which alters the three-dimensional structure of albumin, resulting in a decrease in its biological activity.

     

Structure and function of HIV-1 and SIV Tat proteins based on carboxy-terminal truncations, chimeric Tat constructs, and NMR modeling

To further define the structure and function of the domains in HIV-1 and SIV Tat proteins, chimeric Tat cDNA expression constructs were generated with crossover points at the carboxy-terminal end of the cysteine rich domain. The chimera containing the amino-terminal region of SIV and carboxy-terminal region of HIV exhibited activity similar to HIV-1 Tat and SIV Tat on both the HIV-1 and SIV LTRs. In contrast, the reciprocal chimera functioned poorly. As determined by the activity of carboxy-terminal truncation mutants, the region immediately downstream of the basic domain is critical for efficient transactivation by HIV-1 Tat, but not SIV Tat protein. In this report, we present a model for Tat domains based on NMR data and the known functional properties of Tat protein. According to our modeling two sites for protein :protein interactions are present in HIV-1 and SIV Tat proteins. Site I, which is presumably involved in cyclin T binding, is similar in both HIV-1 and SIV Tat proteins as well as in Tat chimeras. Site II, however appears structurally different in HIV-1 and SIV Tat models, although in both cases is comprised of amino and carboxy-terminal residues. Differences in Site II may thus account for the differential activities of HIV-1 and SIV Tat carboxy-terminal truncations. Site II in the poorly active chimera differs significantly from that found in HIV-1 and SIV Tat proteins. The two site structural model presented here may have important implications for the role of Tat in HIV pathogenesis and may provide insights for the design of Tat vaccines and targeted therapeutics.     

Effects of Stimulation Site on Diastolic Function in Cardiac Resynchronization Therapy

Background : Cardiac resynchronization therapy (CRT) improves left ventricular (LV) systolic function and clinical status, and prolongs survival of patients suffering from heart failure. An optimal LV site selection is key with respect to improvements in systolic function, though whether a site-specific effect on diastolic function exists is unclear. This study compared the effects of CRT on changes in systolic and diastolic function from 2 LV stimulation sites.
Methods : We studied 21 patients in New York Heart Association functional classes ≥III, and a LV ejection fraction <0.30 and QRS duration > 130 ms. CRT leads were placed in the right ventricle, right atrium, and coronary sinus tributaries. LV stimulation was applied from the postero-lateral and antero-lateral wall. A LV conductance catheter was used to measure LV systolic and diastolic function. Systolic responders had >10% changes in dP/dt_max, and diastolic responders <10% changes in τ during CRT versus baseline. Response was highly dependent on LV lead position for both diastolic and systolic function. Diastolic responders decreased from 29% to 10% of patients, and systolic responders from 76% to 48%, in the best versus the worst lead position, respectively. Improvements in diastolic function were less pronounced than in systolic function (relative change −14% vs +28%, P < 0.05). Overall, 45% were both systolic and diastolic responders, 17% were both systolic and diastolic nonresponders, and 38% had opposite responses .
Conclusions : Changes in systolic and diastolic function were both highly dependent on the LV stimulation site. Diastolic function was less influenced by CRT and a high proportion of patients had discordant results.