不同部位脑梗死患者心率变异性与血浆肌酸激酶同工酶活性变化

目的 了解不同部位脑梗死对心脏自主神经活性和心脏的影响。方法 选择130例不同部位急性大脑半球梗死患者及130例年龄匹配的健康体检者(对照组),检测心率变异性(HRV)和血浆肌酸激酶同工酶(CK-MB)活性,分析其.HRV和CK-MB活性变化的关系。结果 右侧岛叶梗死患者HRV指标高频功率谱(HF)、均方根、相邻RR间期差≥50 ms的心搏数占总窦性心搏数的百分比明显下降和低频功率谱(LF)/HF明显增高;CK-MB活性升高主要见于岛叶梗死患者,双侧无明显差异;CK-MB活性升高者LF和LF/HF高于CK-MB活性正常者,HF明显低于CK-MB活性正常者;CK-MB活性升高者病死率明显升高。结论 大脑半球梗死患者时心脏的影响主要与岛叶病变有关。     

脑梗死患者心脏自主神经活性变化与心电图异常的关系

目的 探讨不同部位脑梗死与心脏自主神经活性变化和ECG异常的关系。方法 检测156例急性大脑半球梗死患者和206名正常对照组心率变异性和标准12导联ECG，分析不同部位大脑半球梗死对心脏自主神经活性和ECG的影响。结果 与对照组比较，仅右侧岛叶梗死组心率变异性相邻心搏间期差的均方根(RMSSD)、相邻心搏间期差大于50ms的心搏问期数占心搏问期总数的百分比(PNN50)和高频功率谱(HF)明显降低，心脏副交感神经活性降低；低频功率谱(LF)与高频功率谱的比值(LF／HF)明显升高，心脏交感神经活性增强；腔隙性脑梗死组、非岛叶梗死组和左侧岛叶梗死组的心率变异性各项指标均无明显差异；右侧岛叶梗死患者快速心律失常和QTc延长发生率显著增加．左侧岛叶脑梗死患者srr段上升或下降显著增加；快速心律失常组RMSSD、PNN50和HF明显低于非快速心律失常组．LF／HF则明显高于非快速心律失常组。结论 影响脑梗死患者心脏自主神经活性和ECG的主要病变部位为岛叶。     

急性脑梗死患者的动态心电图异常

目的 了解急性脑梗死患者心电图复极改变和心律失常情况及其与岛叶病变的关系。方法 检测７４例急性脑梗死患者和３９例对照的２４小时动态心电图，分析其心电图复极改变和心律失常。结果 右侧大脑半球岛叶梗死患者急性期室上性快速心律失常和房颤发生率明显增高；左侧大脑半球岛叶梗死患者急性期心电图ＳＴ段降低发生率明显增高。结论 左侧和右侧大脑半球梗死对心脏的影响不同，岛叶病变在其中起着主要作用。     

不同部位急性脑梗死早期心电图改变的临床意义

目的探讨急性脑梗死患者早期心电图改变的临床意义。方法分析304例急性脑梗死患者的心电图资料。结果①304例患者中发生早期心电图异常占64．47％，表现为ST-T改变、窦性心律失常、Q-T间期延长、起搏点异常和传导异常。②岛叶梗死组早期心电图异常显著多于非岛叶梗死组（81．97％、52．75％，P〈0．01）。⑧中、重型患者在心电图异常组显著多于无心电图异常组（96例、5例，P〈0．01）．岛叶梗死组显著多于非岛叶梗死组（68例、28例，P〈0．01）。④心电图异常的岛叶梗死组死亡率显著高于非岛叶梗死组（17例、2例，P〈0．05）。结论急性脑梗死早期心电图异常与梗死部位、病情严重程度及预后有关，而岛叶梗死患者的心电图异常发生率高、病情重及预后差。     

岛叶出血后血清肌钙蛋白T水平与预后的关系

目的探讨急性脑出血中岛叶出血患者血清肌钙蛋白T(cTnT)变化与临床预后的关系。方法回顾性分析我院急性脑出血患者150例(研究组)及体检中心健康体检者150例(对照组),并根据是否累及岛叶,将脑出血患者分为岛叶出血组59例和非岛叶出血组91例。检测并比较各组血清cTnT水平及心电图的变化,随访6个月并了解其预后情况。结果研究组血清cTnT水平升高比例及心电图异常发生率明显高于对照组,差异有统计学意义(22.00%vs 0.67%,63.33%vs 13.33%,P0.01)。岛叶出血组血清cTnT水平升高、心电图异常、异位搏动、窦性心动过速、窦性心动过缓、ST段异常及QTc间期延长的发生率均明显高于非岛叶出血组,差异有统计学意义(P0.05,P0.01)。右侧岛叶出血患者血清cTnT水平升高、异位搏动及心房颤动发生率明显高于左侧患者(P0.05,P0.01),窦性心动过缓、ST段异常发生率明显低于左侧患者,差异有统计学意义(P0.05)。研究组中血清cTnT水平升高者的病死率明显高于血清cTnT水平正常者,差异有统计学意义(18.18%vs 3.42%,P0.05)。在研究组生存患者中,血清cTnT水平升高者神经功能障碍重度比例明显高于血清cTnT水平正常者,轻度比例明显低于正常者,差异有统计学意义(P0.01)。结论在急性岛叶出血初期,血清cTnT水平即可升高,其升高比例及心电图异常与出血部位、预后有一定相关,其中岛叶出血患者血清cTnT水平升高明显,心电图异常发生率高,右侧岛叶出血患者心肌损伤更重,预后差。     

脑梗死伴发的心脏异常

急性脑梗死引起的心脏相关性神经调节功能障碍,尤其是岛叶部位受累导致的交感、副交感神经功能失衡,可引起心电图和心率变异性改变、心肌酶谱异常、心肌损伤和梗死等,对脑梗死的近期和远期预后带来不利影响.对伴有心脏异常的急性脑梗死患者进行心脏相关性对症治疗,有可能在一定程度上改善其心脏功能,从而改善急性脑梗死的预后.     

CT阴性急性脑梗死患者心电图改变的研究

目的通过对疑诊急性脑梗死而头颅CT阴性患者,进行MR和心电图研究,探讨心电图能否对脑梗死的早期诊断提供帮助。方法选择71例疑诊急性脑梗死而头颅CT阴性患者,进行MR和心电图检查,比较脑梗死与非脑梗死组,不同部位脑梗死之间心电图异常率及变化程度。结果(1)脑梗死组心电图异常率增加有显著意义。(2)不同部位脑梗死心电图异常率及变化程度增加有显著意义。(3)心电图多表现为ST-T改变、Q-Tc改变、窦性心动过速、窦性心动过缓等。结论对于头颅CT阴性的患者,如果心电图短期内出现明显的改变,特别是同时出现上述变化时,应当早期进行MRI检查,以获得确诊并改善预后。     

脑岛叶梗死与ECG异常的关系探讨

目的通过观察急性大脑中动脉供血区脑梗死患者的ECG改变来分析岛叶梗死与ECG的关系。方法回顾性分析280例急性大脑中动脉供血区的非腔隙性脑梗死患者，根据其头MRI弥散相上是否有岛叶受累分为岛叶梗死组和非岛叶梗死组，通过回顾患者入院时的ECG，观察岛叶梗死与ECG异常的关系。结果124例（44％）患者的MRI弥散相上见到岛叶不同程度的梗死，ECG分析发现ST—T异常见于85例岛叶梗死患者和78例无岛叶梗死的患者（P〈0．01）。QT间期延长在右侧岛叶梗死更常见。结论岛叶梗死患者的ECG改变主要表现为非特异性的ST—T异常。     

血浆脑利钠肽和D-二聚体水平与急性脑梗死临床亚型的关系

目的 探讨急性脑梗死不同病因学亚型患者血浆脑利钠肽(brain natriuretic peptidk,BNP)和D-二聚体(D-dimer,DD)含量变化的意义.方法 146例发病24 h内的急性脑梗死患者,根据TOAST分型方法进行病因学分型:大血管动脉粥样硬化血栓性脑梗死(1arge-artery atherosclerosis,LAA;n=48)、小血管闭塞性脑梗死(small-artery occlusion,SAO;n=32)、心源性脑栓塞(cardioembolism,CE;n=41)和原因不明性脑梗死(n=25).急诊行血浆BNP和DD含量测定,并分析二者与脑梗死不同亚型、梗死体积和病情严重程度的相关性.结果 CE组患者血浆BNP水平显著高于非CE组(P均＜0.01),其血浆DD含量亦显著升高(与LAA组比较,P＜0.05;与SAO组和原因不明性脑梗死组比较,P均＜0.01),而各种非CE组之间血浆BNP和DD水平均无显著差异.大梗死组患者血浆BNP和DD含量显著高于中梗死组(t分别为2.748和4.218,P分别为0.040和0.008)和小梗死组(t分别为3.766和3.029,P分别为0.013和0.029),而中梗死组与小梗死组无显著差异.美国国立卫生研究院卒中量表评分≥7分组血浆BNP和DD含量显著高于＜7分组(t分别为-3.454和-4.044,P分别为0.018和0.010).结论 急性脑梗死,尤其是CE患者血浆BNP和DD水平显著升高,而且梗死体积越大、病情越严重,二者水平越高.早期检测血浆BNP和DD水平有助于脑梗死病因学亚型,尤其是CE的诊断以及梗死体积和病情严重程度的判断.     

急性脑出血患者24小时心率变异性变化与动态心电图异常

目的：了解急性脑出血对心脏自主神经活性改变，心电图复极改变和心律失常的影响。方法：检测61例急性大脑半球壳核和额顶颞叶出血患者和39例对照的24h动态心电图，分析其心率变异性变化，心电图复极改变和心律失常。结果：右侧壳核和额顶颞叶出血患者急性期室上性快速心律失常和心房颤动发生率明显增高，左侧壳核和额顶颞叶出血患者急性期心电图ST段降低发生率明显增高，右侧壳核和额顶颞叶出血组心率变异性指标HF，RMSSD，PNN50明显下降和LF／HF明显增高，伴室上性快速心律失常者LF／HF高于无室上性快速心律失常者，HF明显低于无室上性快速心律失常者。结论：左侧和右侧大脑半球出血对心脏的影响不高，岛叶病变在其中起着主要作用。     

Detection of coronary artery reperfusion with creatine kinase-MB determinations during thrombolytic therapy: correlation with acute angiography

Increases in plasma creatine kinase-MB (MB CK) were correlated with the onset of coronary artery reperfusion determined angiographically in 32 patients with acute myocardial infarction who were treated with recombinant human tissue-type plasminogen activator (rt-PA). Reperfusion occurred in 14 (70%) of 20 patients with left anterior descending coronary artery occlusion and in 8 (73%) of 11 patients with right coronary artery occlusion. One patient had persistent left circumflex coronary artery occlusion. Plasma MB CK levels (radioimmunometric assay) did not increase significantly in patients with persistent occlusion, but increased by a mean (+/- SEM) of 8 +/- 1 and 6 +/- 1 times over pretreatment levels at the end of the infusion in patients with a reperfused left anterior descending and right coronary artery, respectively. When a greater than or equal to 2.5-fold increase in MB CK levels at the end of the rt-PA infusion was taken as evidence of reperfusion of the left anterior descending coronary artery, 13 (93%) of 14 patients with reperfusion and 5 (83%) of 6 with persistent occlusion were correctly identified. When a greater than or equal to 2.2-fold increase in MB CK levels was used to identify right coronary artery reperfusion, seven (89%) of eight patients with persistent occlusion were correctly identified. The sensitivity and specificity of these indexes, derived from and applied to the same patient group, were 91 and 89%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

颈动脉粥样硬化致血小板活化及其与急性脑梗死的关系

为探讨颈动脉粥样硬化致血小板活化机制及其与急性脑梗死的关系,采用彩色多普勒血流显像仪和流式细胞仪分别测定115例急性脑梗死患者颈动脉及其周围血血小板表面CD62p、CD63的表达,并与30例非脑梗死头晕患者对照.结果发现,急性脑梗死患者颈动脉粥样硬化斑块较对照组明显增多,单侧脑梗死者同侧颈动脉斑块明显增加,达68.75%,双侧脑梗死者双侧颈动脉斑块达58.47%.斑块处狭窄,局部血流增快.颈动脉斑块患者血CD62p和CD63水平较正常动脉者明显增高,单侧颈内动脉粥样硬化斑块患者血CD62p和CD63的阳性率及荧光强度分别达4.72%±4.52%、5.38%±3.73%和1.50±0.26、1.38±0.14,双侧斑块者达7.72%±4.96%、6.78%±4.02%和1.59±0.37、1.41±0.18,后者较前者明显增高(P<0.05).脑梗死患者血小板活化率明显较对照组增高,并与颈动脉粥样硬化程度相关(P<0.05).结果提示,颈动脉粥样硬化构成"高剪切力+低剪切力"的特殊剪切力梯度活化血小板,可能是颈动脉粥样硬化导致急性脑梗死的一个重要发病因素.     

急性大脑半球梗塞患者24小时心率变异性变化

目的了解急性脑梗塞患者２４小时心率变异性变化及其与岛叶病变的关系。方法采用动态心电图记录６６例急性脑梗塞患者和３９例对照的２４小时心电信号,分析其心率变异性变化。结果岛叶梗塞组、非岛叶梗塞组和腔梗塞组与对照组比较,仅发现岛叶梗塞组心率变异性指标ＨＦ、ＲＭＳＳＤ、ＰＮＮ５０下降和ＬＦ／ＨＦ增高差异有显著性。结论岛叶及其联系纤维受损在脑梗塞患者心率变异性变化中起主要作用,岛叶病变患者有明显的心脏迷走神经活性降低,心脏交感神经活动优势更加明显。     

Prognostic implications of an early peak in plasma MB creatine kinase in patients with acute myocardial infarction

To determine the prognostic implications of an early peak in plasma MB creatine kinase (MB CK) in patients with acute myocardial infarction who were not treated with an acute intervention, 342 patients with myocardial infarction confirmed by MB CK were retrospectively studied. The patients were classified into those with an early peak MB CK (less than or equal to 15 hours after the onset of symptoms, n = 84) and those with a late peak MB CK (greater than 15 hours after the onset of symptoms, n = 258). Patients with an early peak MB CK were slightly older, were more frequently female and had a higher incidence of prior myocardial infarction, congestive heart failure and arrhythmias compared with patients with a late peak MB CK. Patients with an early peak MB CK more frequently presented with ST segment depression (23 versus 11%, p less than 0.01), with anterior location of ischemia or infarction (71 versus 52%, p less than 0.01) and with a lower mean left ventricular ejection fraction (41.4 versus 47.4%, p less than 0.01). Despite more extensive left ventricular dysfunction at initial presentation, patients with an early peak MB CK had a smaller mean MB CK infarct size index (12.6 versus 18.9 g-Eq/m2, p less than 0.01), with no difference in the incidence of in-hospital complications, including death. The early left ventricular dysfunction improved in the patients with an early peak MB CK, evidenced by a 4.5% increase in ejection fraction from admission to 10 days after infarction, whereas the ejection fraction did not improve in patients with a late peak MB CK. However, the patients with an early peaking MB CK had myocardium in jeopardy as reflected by a higher incidence of ST segment depression and a decrement in the global left ventricular ejection fraction with exercise. The 4 year life table estimate for the rate of recurrent myocardial infarction after hospital discharge was higher in patients with an early peak MB CK (33 versus 22%, p less than 0.05), with an even more striking difference in the 4 year estimate for the rate of fatal recurrent infarction (20 versus 8%, p less than 0.001). The 4 year mortality estimate was markedly higher in hospital survivors with an early peak MB CK than in those with a late peak (47 versus 19%, p less than 0.0001) and, even after adjustment for differences in baseline characteristics, the residual excess mortality in those with an early peak was still significant (p less than 0.02).(ABSTRACT TRUNCATED AT 400 WORDS)     

Plasma resistin associated with myocardium injury in patients with acute coronary syndrome

BACKGROUND: Resistin, a novel adipocytokine, has been suggested as representing a link between metabolic signals, inflammation and atherosclerosis. The aim of the present study was to investigate the alteration in level of plasma resistin in patients with acute coronary syndrome (ACS) to uncover the role of resistin. METHODS AND RESULTS: The 39 patients with ACS and 26 age-matched healthy subjects in this cross-sectional study were investigated. Plasma resistin levels were measured using radioimmunoassay. Plasma resistin levels were significantly increased in patients with ACS at 24 h after symptoms onset and remained at a high level for 1 week, and were significantly higher in patients with acute myocardial infarction than in those with unstable angina. In addition, plasma resistin level was correlated positively with peak plasma creatine kinase (CK), the MB isoform of CK and troponin I, and was correlated negatively with left ventricular ejection fraction. No correlation was found between plasma resistin level with level of metabolic parameters or inflammatory markers. CONCLUSIONS: Plasma resistin levels in patients with ACS are elevated significantly within the first week after symptoms onset. Increased resistin levels may be a marker of myocardial ischemia and injury in ACS.     

Measurement of serum C-reactive protein concentration in myocardial ischaemia and infarction.

Serum C-reactive protein (CRP) and creatine kinase (CK) MB levels were measured prospectively in patients with definite myocardial infarction, patients with spontaneous or exercise-induced angina, subjects undergoing coronary arteriography, and patients with non-cardiac chest pain. All individuals with infarction developed raised CRP levels and there was a significant correlation between the peak CRP and CK MB values. The CRP, however, peaked around 50 hours after the onset of pain at a time when the CK MB, which peaked after about 15 hours, had already returned to normal. In 20 patients who recovered uneventfully, CRP levels fell, returning to normal about seven days after infarction in four cases who were followed to this point. In eight complicated cases, including four who died within the first 10 days, the CRP level remained high. Angina alone or coronary arteriography did not cause a rise in the CRP or CK MB concentrations. Increased CRP production is a non-specific response to tissue injury and raised CRP levels in cases of chest pain with a normal CK MB indicated a pathological process other than myocardial infarction. Regular monitoring of CRP levels may also assist in early recognition of intercurrent complications occurring after myocardial infarction.