肌钙蛋白Ⅰ在不稳定性心绞痛患者中的临床意义

目的：观察不稳定性心绞痛患者（UAP）入院后血清肌钙蛋白Ⅰ（cTnⅠ）的变化，探讨UAP与心脏事件的近期、远期预测价值。方法：60例UAP患者分别在入院、入院后12h、24h、48h、10d各采血一次。用免疫发光法（IM—MULITE系统）测定cTnⅠ浓度，分析其与心脏事件的关系。结果：在近期（30d）内，cTnⅠ≥0．4ng／ml组与cTnⅠ〈0．4ng／ml组心脏事件发生率分别为48.15％和9．1％（P〈0.05）。cTnⅠ对近期发生心脏事件的阳性预测值48．15％，阴性预测值90．90％。远期：cTnⅠ≥0．4ng／ml组病死率为18．52％（5／27）；cTnⅠ〈0．4ng／ml组病死率为3.03％（1／33）；（P〈0．05）。结论：cTnⅠ定量测定对UAP患者进行危险度分层有重要预测价值。     

非ST段抬高的急性冠脉综合征介入治疗后的肌钙蛋白Ⅰ和C反应蛋白水平检测的价值

目的 探讨非ST段抬高的急性冠脉综合征（ACS）患者经皮冠脉介入治疗（PCI）后的肌钙蛋白Ⅰ和C反应蚤白（CRP）水平对预后的预测价值。方法 测定连续行PCI的非ST段抬高的心肌梗死（NSTEMI）和不稳定型心绞痛（UA）患者PCI术后的cTn Ⅰ和CRP水平，根据PCI术后cTn Ⅰ和CRP检测结果分组，观察患者PCI术后主要不利心血管事件（MACE）发生率并随访MACE发生情况。结果 与cTn Ⅰ正常组比较，cTn Ⅰ升高组非致命性心肌梗死、心脏性死亡和总MACE发生率显著增加（P均〈0.05）。与CRP正常组比较，CRP升高纽总MACE发生率显著增加（P〈0．05）。与A组（cTn Ⅰ〈0．4μg／L和CRP〈3mg／L）相比，B组（cTn Ⅰ≥0．4μg/L和CRP≥3mg/L）和C组（cTnⅠ≥0．4μg／L和CRP≥3mg／L）的总MACE发生率均显著增加（P均〈0．01）；与B组相比，C组的总MACE发生率显著增加（P〈0.05）。结论 非ST段抬高的ACS患者PCI术后的肌钙蛋白Ⅰ和C反应蛋白水平与总MACE发生率密切相关，它们可作为非ST段抬高的ACS患者PCI术后的危险分层的指标，两者联合应用对预后判断更具有价值。     

肌钙蛋白Ⅰ对老年不稳定型心绞痛患者危险分层的判断价值

目的探讨心脏肌钙蛋白Ⅰ（cTnⅠ）对老年不稳定型心绞痛（UAP）患者危险分层的价值。方法对72例老年UAP患者、27例稳定型心绞痛（SAP）患者及22例健康对照者分别进行血清cTnⅠ测定,并观察住院1个月内心脏事件发生情况。结果UAP组血清cTnⅠ值为（1．96±0．61）μg／L,明显高于sAP组的（0．68±0．19）μg／L及对照组的（0．46±0．10）μg/L（P均〈0．01）。UAP组内,随着Braunwald临床分级增高,Ⅰ～Ⅲ级血清cTnⅠ值相应增高[分别为（1．25±0．38）μg/L、（2．12±0．34）μg/L及（3．06±0．72）μg/L]（P〈0．05）。对照组、SAP组及BraunwaldⅠ级UAP患者无一例发生心脏事件;18例Ⅱ级患者中,1例（其血清cTnⅠ≥1．5μg／L）发生非致命性心肌梗死（MI）;33例Ⅲ级UAP患者中,21例血清cTnⅠ≥1．5μg/L患者中的9例发生心脏事件（6例非致命性心肌梗死、3例心脏猝死）,总心脏事件发生率16．7％;16例血清cTnⅠ〈1．5μg／L者仅1例发生非致命性MI,其总心脏事件发生率6．3％。血清cTnⅠ≥1．5μg/L者心脏事件发生率明显高于cTnⅠ〈1．5μg/L者（P〈0．05）,比数比（OR）为2．05（16．7％／6．3％）,95％可信限为1．02～9．78。血清cTnⅠ≥1．5μg／L时判断心脏事件的阳性预测值为44．3％,阴性预测值为84．8％。结论血清cTnⅠ检测对老年UAP患者危险分层有一定的临床价值。     

心肌肌钙蛋白Ⅰ曲线对不稳定型心绞痛危险分层的价值

目的 探讨肌钙蛋白Ⅰ（cTnⅠ）曲线对不稳定型心绞痛（UA）危险分层的临床价值。方法 用酶联免疫法测定136例UA患者入院即刻、2、4、6、8、24、48、72小时血cTnⅠ水平并绘制cTnⅠ曲线，根据曲线类型分为有峰曲线组和水平曲线组；比较住院期间和半年后两组心绞痛、急性心肌梗死（AMI）、左室射血分数、心源性死亡的发生率。结果 136例UA患者中有峰曲线组67例，水平曲线组69例。有峰曲线组与水平曲线组比较，住院期间心绞痛反复发作、AMI、左室射血分数，P〈0．05；无血管重建6个月后心绞痛复发、再发AMI、心源性死亡、左室射血分数有峰曲线组与水平曲线组比较，P〈0．05；血管重建6个月后心绞痛复发、再发AMI、心脏性死亡、左室射血分数有峰曲线组与水平曲线组比较，P≥0．05。结论 cTnⅠ曲线能评估UA患者的近期预后和指导治疗，可作为UA危险分层指标之一。     

入院早期急性心肌梗死患者血清肌钙蛋白Ⅰ浓度与近、远期预后的关系

目的 探讨发病早期血清肌钙蛋白Ⅰ（cTnⅠ）水平在生心肌梗死（AMI）预后判断方面的意义。方法 53例胸痛后12h内入院的AMI患者在入院时及入院初取静脉血作血清cTnⅠ浓度检测，并对44例存活出院患者中的30例成功随访。安急性胸痛发作后的时间以及血清cTnⅠ浓度将患者分组，比较AMI早期血清cTnⅠ浓度与心脏事件的关系。结果 胸痛后6h入院且血清cTnⅠ升高者，住院期间死亡、心脏事件发生率明显升高，长期随访心功能明显下降。胸痛后6－12h入院者其入院时血清cTnⅠ均升高，超过90μg/L者住院期间心脏事件发生率有增高趋势，入院时心功能明显下降。结论 AMI 6h内血清cTnⅠ浓度升高对住院期间发生心脏事件的危险度有预测作用。     

心肌肌钙蛋白Ⅰ与冠心病患者远期心脏事件关系的探讨

目的探讨血清心肌肌钙蛋白Ⅰ（cTnⅠ）水平与冠心病患者远期心脏事件的相关性。方法测定169例冠心病患者的血清cTnⅠ、肌酸激酶同功酶（CK-MB），根据cTnⅠ水平将患者分为cTnⅠ正常组和升高组，列出患者一般临床资料、冠脉造影及心电图结果，随访患者远期心脏事件，分析cTnⅠ与远期心脏事件的相关性。结果169例患者中有59例cTnⅠ升高（34.9%）；cTnⅠ升高与心电图异常Q波、ST段改变呈正相关（P〈0.05），与糖尿病呈负相关（P〈0.05）。162例近期生存者中152例有远期随访结果，随访率为93.8%，随访时间为（26±10）个月，共有27例患者发生32件远期心脏事件，其发生与女性患者、cTnⅠ升高呈正相关（P〈0.05）；多因素非条件Logistic回归分析排除混杂因素的影响，cTnⅠ升高与cTnⅠ正常患者的远期心脏事件发生率及人均心脏事件差异有统计学意义（P〈0.05）。结论cTnⅠ是心肌损伤敏感而特异性的指标，血清cTnⅠ水平是冠心病患者远期心脏事件的独立预测因子。     

肌钙蛋白Ⅰ在非ST段抬高急性冠脉综合征预后中的应用

目的探讨cTnⅠ与非ST段抬高急性冠状动脉综合征近期和远期预后的关系。方法将258例急性冠状动脉综合征患者以cTnⅠ水平0．04μg／L为分界点进行分组，比较cTnⅠ升高组和cTnⅠ正常组30d内和1年内心脏事件的发生情况。结果cTnⅠ升高组30d内和1年内心脏事件的发生率较cTnⅠ正常组（均为0）显著升高（P〈0．05）。结论cTnⅠ对ACS患者的预后判断具有重要价值。     

红细胞分布宽度与非ST段抬高型心肌梗死患者住院期间主要心脏不良事件的相关性研究

目的研究红细胞分布宽度（RDW）与非ST段抬高型心肌梗死（NSTEMI）患者住院期间发生主要心脏不良事件（MACE）的相关性。方法选取因NSTEMI而住院治疗的患者64例,收集其临床基本资料、血常规、生化指标、左心室射血分数（LVEF）等,根据RDW水平中等分位分成高水平组（RDW≥13.4%）32例和低水平组（RDW＜13.4%）32例,并记录两组患者住院期间MACE。采用ROC曲线及多因素logistic回归,分析RDW水平与NSTEMI住院患者发生MACE的关系。结果高水平组患者住院期间MACE发生率高于低水平组,差异有统计学意义（P＜0.05）。ROC的AUC为0.699,提示RDW在13.4%时预测NSTEMI住院患者MACE的灵敏度和特异度分别为64.0%和66.7%;多因素logistic回归分析表明,RDW是NSTEMI患者住院期间MACE发生风险增高的独立危险因素（OR=2.122,95%CI：1.188~3.769,P＜0.05）。结论RDW水平增高与NSTEMI患者住院期间发生MACE相关。     

血清白蛋白与非ST段抬高型急性冠脉综合征患者预后的相关性研究

目的：探讨非ST段抬高型急性冠脉综合征fnon-STEacutecoronarysyndrome,NSTE-ACS）患者血清白蛋白falbumin,ALB）水平变化及其临床意义。方法：选择NSTE-ACS患者100例。稳定型心绞痛（stableanginapectoris,SAPl组87例,并设立正常对照组95例,检测血清ALB水平,记录高血压病、2型糖尿病、高脂血症、吸烟等病史及NSTE-ACS组患者住院期间主要不良心脏事件（majoradversecardiacevent,MACE）包括：再发心肌梗死、恶性心律失常、新发心力衰竭、心原性死亡。将NSTE-ACS组患者按ALB均值分为高ALB组、低ALB组,比较高低组间住院期间MACE的发生率。结果：NSTE-ACS组的血清ALB水平较心绞痛组及正常对照组低fP〈0．05）,低ALB组患者住院期间MACE的总发生率较高ALB组明显增加（P〈0．01）。结论：NSTE-ACS患者的血清ALB水平明显降低,低ALB值可作为NSTE-ACS患者短期预后的独立预测因子。     

不同剂量瑞舒伐他汀对急性冠脉综合征患者的临床疗效及对hs—CRP的影响

目的观察瑞舒伐他汀对急性冠脉综合征（ACS）患者的临床疗效及对血清中高敏C反应蛋白（hs—CRP）的影响。方法选取2010年11月～2012年3月于我院心内科住院的256例ACS患者,其中试验组（n=130）自入院始服用瑞舒伐他汀20mg／d,对照组（n=126）自入院始服用瑞舒伐他汀10mg／d,观察住院期间及4周内的主要不良心脏事件（MACE）,同时采用酶联免疫吸附法测定两组患者服用瑞舒伐他汀前后血清hs—CRP水平。结果两组患者住院期间及服瑞舒伐他汀4周后,在不良心脏事件（MACE）发生率方面,试验组低于对照组,差异有统计学意义（P〈0,05）;肌溶解发生率方面差异无统计学意义;试验组与对照组治疗前后血清hs—CRP水平均显著降低,差异有统计学意义（P〈0．05）。结论瑞舒伐他汀可显著降低ACS患者血清hs—CRP水平,安全性好,能改善ACS患者的预后。     

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.