血浆脑钠肽水平检测在慢性心力衰竭患者病情严重程度及预后评估中的价值分析

目的:分析血浆脑钠肽(BNP)水平检测在慢性心力衰竭严重程度及预后评估中的临床价值。方法:115例慢性心力衰竭患者根据美国纽约心脏病学会(NYHA)标准分级为四组,Ⅰ级组27例,Ⅱ级组,28例,Ⅲ级组31例、Ⅳ级组29例,根据预后不同分为死亡组(n=32)和存活组(n=83),比较各组患者血浆BNP表达水平。结果:各组血浆BNP表达水平、左室舒张末内径、左室射血分数比较,差异有统计学意义(P<0.05),随着心功能加重,血浆BNP表达水平明显升高,差异有统计学意义(P<0.05),左室舒张末内径增厚(P<0.05),而左室射血分数明显降低(P<0.05),血浆脑钠肽表达水平与左室射血分数呈负相关(r=-0.572,P<0.05),与左室舒张末期内径呈正相关(r=0.625,P<0.05);死亡组患者血浆BNP表达水平[(978.54±402.61)pg/ml]明显高于存活组[(362.16±171.05)pg/ml],差异有统计学意义(P<0.05)。结论:血浆BNP水平检测在慢性心力衰竭严重程度及预后评估中具有重要的临床价值。     

N末端脑钠肽前体判断慢性重度心力衰竭患者预后的价值

目的研究N末端脑钠肽前体(NT-proBNP)在判断慢性重度心力衰竭患者预后中的价值。方法采用电化学发光免疫试验(ECLIA)测定98例慢性重度心力衰竭患者血浆NT-proBNP浓度,计算中位数血浆NT-proBNP浓度,将患者分为>中位数血浆NT-proBNP浓度组(A组)和≤中位数血浆NT-proBNP浓度组(B组),前瞻性观察两组6个月病死率、因心力衰竭再入院率的发生。采用logistic回归分析判断血浆NT-proBNP浓度是否是慢性重度心力衰竭患者心血管事件发生的独立预测因素。通过ROC曲线下面积评价血浆NT-proBNP浓度在判断慢性重度心力衰竭患者心血管事件发生率的价值。结果两组血浆NT-proBNP浓度均明显升高,但A组6个月病死率、因心力衰竭再入院率明显高于B组(P<0.05),回归分析表明血浆NT-proBNP浓度是慢性重度心力衰竭患者心血管事件发生率的独立预测因素,依据ROC曲线,血浆NT-proBNP浓度>5 000 pg/mL的慢性重度心力衰竭患者6个月心血管事件明显增加。结论 NT-proBNP明显升高的慢性重度心力衰竭患者,尤其是血浆NT-proBNP浓度>5 000 pg/mL的慢性重度心力衰竭患者6个月心血管事件明显增加。     

心力衰竭治疗中血浆脑钠肽的变化及其意义

目的观察心力衰竭患者血浆脑钠肽(BNP)值及其治疗前后的变化,并探讨其临床意义。方法 75例心力衰竭患者,心功能按纽约心脏协会(NYHA)分级标准分为3级,l～Ⅱ级39例,Ⅲ级21例,Ⅳ级l5例;23例正常对照组,测定血浆BNP浓度和左心室射血分数(LVEF)。75例再按BNP水平分成3组:<100 pg/ml组、l00～400pg/ml组和>400 pg/ml组,测定各组治疗前后血浆BNP的变化。结果心力衰竭组BNP值明显高于正常对照组,差异有统计学意义(P<0.01),且心力衰竭组随NYHA分级升高其BNP水平越高。心力衰竭患者血浆BNP水平与LVEF呈负相关,各组治疗前后13NP变化差异有统计学意义(P<0.01)。结论心力衰竭患者血浆BNP值及其治疗前后变化对心力衰竭的诊断具有临床价值。     

慢性心力衰竭患者外周BNP的水平与心功能相关性的分析

目的 :分析慢性心力衰竭患者外周脑钠肽的水平与其心功能的相关性,评价BNP指标在评估慢性心力衰竭患者心功能方面的临床价值。方法 :将我院心内科收治的60例慢性心力衰竭患者作为心衰组,将60例同期在我院进行体检的健康人设为健康组,采用化学发光法测定两组受试者血浆BNP的水平,采用心脏彩色超声测定慢性心力衰竭患者的左室射血分数(LVEF),并与其血浆BNP水平进行相关性分析。结果 :心衰组患者血浆BNP的平均水平为(960.45±219.80)ng/L,健康组受试者血浆BNP的平均水平为(64.45±19.80)ng/L,心衰组患者血浆BNP的平均水平明显高于健康组受试者,差异显著(P<0.01),有统计学意义。心衰组患者血浆BNP的水平可随着其心功能NYHA分级的增加而增高,呈正相关。心衰组患者中心功能NYHA分级为Ⅱ级、Ⅲ级、Ⅳ级患者血浆BNP的水平相比较差异显著(r=0.72,P<0.05),有统计学意义。心衰组患者左室射血的分数可随着其心功能NYHA分级的增加而下降,呈负相关。心衰组患者中心功能NYHA分级为Ⅱ级、Ⅲ级、Ⅳ级患者左室射血的分数相比较差异显著(r=-0.56,P<0.05),有统计学意义。结论 :血浆BNP检测的方法简便、可重复性好,可用于评估慢性心力衰竭患者的病情及心功能分级,预测其预后,值得在临床上推广应用。     

血浆B型利钠肽、胱抑素C水平与慢性心力衰竭的关系

目的探讨血浆B型利钠肽(BNP)、胱抑素C(CysC)水平与慢性心力衰竭(HF)的关系。方法选取慢性心力衰竭患者100例(NYHAⅡ～Ⅳ级)及对照组30例为研究对象,测定血浆BNP及CysC水平。结果心力衰竭患者血浆BNP、CysC水平显著高于对照组(P<0.01);并随NYHA心功能分级的增加而升高,各组间比较差异均有统计学意义(P<0.01)。结论慢性心力衰竭患者血浆BNP、CysC水平明显升高,且二者呈正相关,可能共同参与了心力衰竭的发生和发展。     

不同类型心力衰竭患者心电图QRS波时限与血浆N末端B型利钠肽原水平的关系研究

目的探讨不同类型心力衰竭患者心电图QRS波时限与血浆N末端B型利钠肽原(NT-proBNP)水平的关系及其临床意义。方法入选慢性心力衰竭患者112例(试验组),并选取年龄和性别与试验组匹配的非慢性心力衰竭患者50例为对照组。入选者均测定心电图QRS波时限、血浆NT-proBNP水平及左室射血分数(LVEF),并进行美国纽约心脏病协会(NYHA)心功能分级。以LVEF≤45%为收缩功能不全诊断标准,将所有入选的心力衰竭病例分为收缩性心力衰竭组(SHF组,LVEF≤45%,n=52)和舒张性心力衰竭组(DHF组,LVEF>45%,n=60),比较各组QRS波时限、血浆NT-proBNP水平及NYHA分级,并对SHF组进行上述指标间的相关性分析。结果心电图QRS波时限在SHF组为(135.17±39.75)ms,显著长于DHF组的(100.93±27.13)ms及对照组的(80.56±7.76)ms,差异有统计学意义(P<0.05)。血浆NT-proBNP水平在SHF组及DHF组分别为(1 248.25±45.84)pg/ml、(664.07±35.75)pg/ml,均显著高于对照组(104.96±47.84)pg/ml,且SHF组和DHF组比较显示前者血浆NT-proBNP水平显著升高,差异均有统计学意义(P<0.01)。相关分析显示,SHF组患者QRS波时限与血浆NT-proBNP水平、NYHA分级呈正相关(P<0.05),与LVEF呈负相关(P<0.01)。结论心力衰竭患者心电图QRS波时限延长与血浆NT-proBNP水平升高及左室收缩功能减退密切相关,可用于辅助判断心力衰竭类型及指导治疗。     

红细胞分布宽度对老年慢性心力衰竭患者预后的影响研究

目的探讨红细胞分布宽度(RDW)对老年慢性心力衰竭患者预后的影响。方法选择60例老年慢性心力衰竭患者,按照纽约心脏病学会(NYHA)心功能分级标准分为心功能Ⅱ级20例、心功能Ⅲ级19例、心功能Ⅳ级21例,比较3组间RDW和血浆N-末端原脑利钠肽(NT-proBNP)的水平。再根据RDW分为RDW正常组42例和异常组18例,比较两组间心脏事件的发生率。结果不同心功能级别的慢性心力衰竭患者RDW间差异有统计学意义(P<0.05),组间两两比较差异均有统计学意义(P<0.05);不同心功能级别的慢性心力衰竭患者NT-proBNP水平间差异有统计学意义(P<0.05),组间两两比较差异均有统计学意义(P<0.05)。RDW异常组发生恶性心律失常6例(33.3%),心力衰竭反复或加重8例(44.4%),死亡3例(16.7%);RDW正常组发生恶性心律失常1例(2.4%),心力衰竭反复或加重2例(4.8%),死亡1例(2.4%),RDW异常组的心脏事件发生率高于RDW正常组,差异有统计学意义(P<0.05)。结论 RDW升高可能与老年慢性心力衰竭患者的心功能严重程度有关;RDW升高的老年慢性心力衰竭患者的心脏事件发生率高,预后不良。     

血浆脑钠肽正常水平对重度慢性心力衰竭患者预后的影响

目的探讨血浆脑钠肽(BNP)正常水平对重度慢性心力衰竭(CHF)患者预后的影响。方法回顾性分析心功能分级为Ⅲ～Ⅳ级的CHF患者临床资料,对所有入选患者进行电话随访。根据首次入院时血浆BNP水平将患者分为BNP正常组(≤100 pg/mL)和BNP升高组(>100 pg/mL);根据患者预后分为存活组和死亡组。通过组间单因素比较及多因素logistic回归分析等方法评价各因素对重度CHF患者不良预后的预测价值相关性。结果共592例重度CHF患者纳入本次研究,平均随访2年。BNP正常组和BNP升高组分别为106例(17.91%)和486例(82.09%),存活组和死亡组分别为416例(70.27%)和176例(29.73%)。BNP正常组和BNP升高组全因死亡率分别为68.85%和24.91%。存活组与死亡组组间基线资料比较发现年龄、心力衰竭病程、收缩压、心功能分级、左室射血分数(LVEF)、左室舒张末期内径(LVEDd)、血浆BNP正常患者人数构成比及β受体阻滞剂使用率差异有统计学意义,此8项指标经多因素logistic回归分析结果显示血浆BNP正常(OR=2.68,95%CI:2.47～2.84,P<0.01)、心力衰竭病程(OR=1.56,95%CI:1.41～1.68,P<0.01)、心功能分级(OR=1.79,95%CI:1.67～1.91,P<0.01)、LVEF(OR=0.91,95%CI:0.87～0.93,P<0.01)、LVEDd(OR=1.37,95%CI:1.25～1.42,P<0.01)以及β受体阻滞剂使用(OR=0.87,95%CI:0.82～0.94,P<0.01)与重度CHF患者死亡有显著相关性。结论对于重度CHF而言,血浆BNP水平正常患者较血浆BNP水平升高患者预后差,血浆BNP水平正常是影响重度CHF患者预后的独立危险因素。     

血浆脑钠肽对老年慢性心力衰竭的诊断价值及预后评估

目的探讨血浆脑钠肽(BNP)水平对老年慢性心力衰竭(CHF)的诊断价值及预后评估。方法依据美国弗明汉心脏病研究中心Framingham危险评分诊断48例心力衰竭患者,按美国纽约心脏病学会心功能分级(NY-HA)、左室射血分数(LVEF)分组,采用免疫荧光法检测血浆BNP水平。结果 BNP>400 pg/ml可作为诊断CHF的界值,BNP水平随着NYHA分级增高而升高,差异有统计学意义(P<0.01)。结论 BNP水平可作为临床诊断CHF的指标并可评估患者预后。     

脑钠肽测定在心力衰竭早期诊断和预后评估中的应用

目的：研究心力衰竭患者血浆脑钠肽（BNP）水平在诊断心力衰竭以及预后评估中的临床价值。方法：采用ELISA法测定80例心力衰竭患者的BNP水平,以纽约心脏功能NYHA分级评定心功能。结果：按NYHA分级,从Ⅰ～Ⅳ级,血浆BNP水平差异有高度统计学意义（P〈0.001）,随心功能分级的增加和心功能的恶化,BNP水平逐渐增加,二者呈正相关;血浆BNP〉800pg/ml患者2年内死亡率为75.00%,明显高于血浆BNP〈200pg/ml患者的心力衰竭死亡率（5.26%）。结论：血清BNP水平对慢性心衰患者的诊断、病情和预后判断具有重要的临床意义。     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.