用心肌灌注显像靶心图定量分析评价AMI患者骨髓干细胞移植术疗效

目的 探讨靶心图上心肌灌注缺损区定量分析方法的可靠性、重复性及应用价值。方法 16例急性心肌梗死（AMI）行自体骨髓单个核细胞移植治疗的住院患者，于治疗前、治疗后45和90d行^99Tc^m-MIBI静息心肌灌注显像。在靶心图上勾画缺损区（在左心室靶心图中放射性计数低于40％的区域），并进行定量分析。结果 （1）不同操作者所得ROI结果之间的差异无统计学意义（t=0．52，P〉0．05）。（2）治疗后45d心肌灌注缺损区面积较治疗前缩小34．32％，差异有统计学意义（t=2．83，P〈0．05）；治疗后90d心肌灌注缺损区面积较治疗后45d缩小14．77％，差异有统计学意义（t=2．51，P〈0．05）。示自体骨髓单个核细胞移植对缺血心肌的恢复有一定疗效，能够缩小梗死面积，且自体骨髓单个核细胞冠状动脉内移植治疗AMI的疗效在移植后早期（45d内）即有体现。（3）面积百分比是观察心肌灌注变化的重要定量指标。结论 该方法对心肌病变范围及严重程度能准确定量；对评价AMI骨髓于细胞移植术疗效有一定的价值。     

血管内皮型一氧化氮合酶基因Glu298 Asp多态性与老年脑梗死的相关性研究

目的　通过病例对照研究 ,了解中国老年人群血管内皮型一氧化氮合酶 (eNOS)基因目的　通过病例对照研究 ,了解中国老年人群血管内皮型一氧化氮合酶 (eNOS)基因Glu2 98Asp多态性的分布 ,分别探讨其与老年脑梗死及血脂以及一氧化氮等脑梗死危险因素的关系。 方法对门诊及住院中确诊的 4 0例老年脑梗死和 16 9例性别、年龄相匹配的老人 ,测量他们的身高、体重及座位血压 ,并测定他们的空腹血脂、空腹血糖 (FBS)及一氧化氮 (NO)等 ,应用聚合酶链反应 (PCR)和限制性片断长度多态性 (RFLP)检测eNOS基因Glu2 98Asp多态性。结果　脑梗死和对照组eNOS基因Glu2 98Asp多态性构成有显著性差异 (χ2 =4 31,P =0 0 38) ,脑梗死组Glu/Asp基因型高于对照组(32 5 %vs 17 8% ) ;脑梗死组 2 98Asp等位基因频率高于对照组 (16 2 5 %vs 8 9% ) ,但是两组等位基因频率的分布比较 ,没有显著性差异 (χ2 =3 81,P =0 0 5 1)。结论　eNOS基因Glu2 98Asp多态性在中国老年人群中存在 ,并且基因...     

益气复智颗粒对多发脑梗死性痴呆模型大鼠脑组织细胞凋亡的影响

目的 观察益气复智颗粒对多发脑梗死性痴呆模型大鼠脑皮质形态学、细胞凋亡的影响。方法 采用颈内动脉注射血栓的方法，复制多发梗死性痴呆大鼠模型，观察益气复智颗粒12．42g/kg分别于手术前、手术前后、手术后灌胃对实验动物脑皮质形态学、细胞凋亡的影响。结果 益气复智颗粒能使脑缺血后脑内神经细胞凋亡数目下降。结论 益气复智颗粒具有较好的保护脑神经元，阻断脑缺血致神经细胞死亡病理过程的作用。     

Platelet function in patients with acute coronary syndrome (ACS) predicts recurrent ACS

BACKGROUND: Platelet hyperfunction contributes to acute coronary syndromes (ACS). Thus, we hypothesized that platelet function under high shear stress predicts recurrent ACS during long-term follow-up of ACS patients. PATIENTS AND METHODS: Consecutive ACS patients (n = 208) were prospectively followed-up for an average of 28 months. Platelet function was measured with the platelet function analyzer (PFA-100; Dade Behring, Marburg, Germany) at baseline for collagen/adenosine diphosphate closure times (CADP-CT) and for collagen/epinephrine closure times (CEPI-CT) after infusion of a uniform dose of 250 mg aspirin. RESULTS: Of the conventional risk factors, only the prevalence of diabetes was higher in ACS patients with re-events. However, use of clopidogrel and use of beta blockers were also slightly lower in patients with re-events (P < 0.05). The unadjusted risk hazard ratio (HR) for re-events was 3.3 [95% confidence interval (95% CI): 1.4-7.4; P = 0.005] in those patients with the shortest CADP-CT values (lowest quartile). Similarly, the risk was 2.0-fold higher (95% CI: 1.1-3.6; P = 0.02) in ACS patients with CEPI-CT < 300 s as compared with CEPI-CT >or = 300 s. Inclusion of diabetes, clopidogrel and beta blockers in a multivariate Cox regression model enhanced the predictive value of CEPI-CT (HR: 2.7). Inclusion of von Willebrand factor levels did not alter the HR for recurrent ACS (HR: 2.1; 95% CI: 1.1-5.2; P = 0.03) for CEPI-CT < 300 s, but reduced the HR for CADP-CT (HR: 2.8, 95% CI: 0.8-9.8; P = 0.11). CONCLUSION: Shortened CT values reflect biologically relevant platelet hyperfunction in patients with ACS because they predict recurrent ACS.     

急性脑梗死选择性动脉溶栓治疗与护理

综述了急性脑梗死选择性动脉溶栓治疗与护理,详细介绍了脑梗死的发病机理、溶栓时机、适应证、介入治疗方法及护理.     

小剂量尿激酶溶栓治疗老年高龄急性心肌梗死65例临床观察

目的尝试用小剂量尿激酶治疗老年高龄急性心肌梗死,旨在使老年高龄患者亦从溶栓治疗中获益.方法采用WHO关于急性心肌梗死(AMI)的诊断标准,收治老年高龄患者65例.随机分为两组,溶栓组31例,给予小剂量尿激酶(50×104U)30min 静脉滴入;并与非溶栓组34例对照观察.结果溶栓组冠脉再通率、五周病死率、休克、心衰分别为54.8%、6.4%、3.2%、9.7%;而对照组分别为14.7%、23.5%、26.5%:41.2%,有明显差异(P<0.01).结论有条件的基层医院依然有可能实施小剂量尿激酶对老年高龄患者的溶栓治疗,且可挽救更多老年高龄患者的生命.     

肺心病合并脑梗死39例分析

目的:分析肺心病合并脑梗死的临床特点.方法:对39例肺心病合并脑梗死患者的临床资料进行回顾性分析.结果:肺心病合并脑梗死发病率6.2%,48小时内确诊率48.7%.结论:肺心病合并脑梗死临床表现不典型,及时确诊困难.     

神经肽Y对心肌蛋白质合成的影响及其意义

用~3H-亮氨酸参入法与放射免疫分析法分别测定大鼠心肌蛋白质合成速度与心脏组织中神经肽Y(NPY)含量。结果显示NPY能显著促进心肌蛋白质合成,其最大效应较去甲肾上腺素(NE)大35%,所需浓度是NE的1/100。心肌梗塞后非梗塞区组织内NPY的含量在2天时无显著改变,15天时则降低71%,提示2～15天期间该区域NPY释放增加,此为非梗塞区心肌肥大的机制之一     

社区干预治疗对促进脑梗死患者功能恢复效果分析

目的探讨社区干预治疗对促进脑梗死患者功能恢复的效果。方法以自愿的方式选择通州区经委社区卫生服务站和八里桥社区卫生服务站所管辖社区内38例脑梗死恢复期患者随机分为治疗组和对照组,对治疗组患者进行为期1年的社区干预治疗,比较治疗组与对照组患者功能恢复情况(日常生活活动能力)。结果通过1年的早期社区干预治疗,治疗组较对照组患者功能恢复效果明显提高(P<0.01)。结论早期社区干预治疗对脑梗死患者功能恢复有促进作用。     

Effect of moderate red wine intake on cardiac prognosis after recent acute myocardial infarction of subjects with Type 2 diabetes mellitus

Background Oxidative stress and increased inflammation have been reported to be increased in subjects with diabetes and to be involved in the pathogenesis of cardiovascular complications after myocardial infarction (MI). It is well recognized that red wine has antioxidant and anti‐inflammatory activities. We examined the effects of moderate red wine intake on echocardiographic parameters of functional cardiac outcome in addition to inflammatory cytokines and nitrotyrosine (oxidative stress marker), in subjects with diabetes after a first uncomplicated MI. Methods One hundred and fifteen subjects with diabetes who had sustained a first non‐fatal MI were randomized to receive a moderate daily amount of red wine (intervention group) or not (control group). Echocardiographic parameters of ventricular dys‐synchrony, circulating levels of nitrotyrosine, tumour necrosis factor‐α (TNF‐α), interleukin‐6 (IL‐6), interleukin‐18 (IL‐18) and C‐reactive protein (CRP) were investigated at baseline and 12 months after randomization. Results After 1 year of diet intervention, concentrations of nitrotyrosine (P < 0.01), CRP (P < 0.01), TNF‐α (P < 0.01), IL‐6 (P < 0.01) and IL‐18 (P < 0.01) were increased in the control group compared with the intervention group. In addition, myocardial performance index (P < 0.02) was higher, and transmitral Doppler flow (P < 0.05), pulmonary venous flow analysis (P < 0.02) and ejection fraction (P < 0.05) were lower in the control group, indicating ventricular dys‐synchrony. The concentrations of nitrotyrosine, CRP, TNF‐α and IL‐6 were related to echocardiographic parameters of ventricular dys‐synchrony. Conclusions In subjects with diabetes, red wine consumption, taken with meals, significantly reduces oxidative stress and pro‐inflammatory cytokines as well as improving cardiac function after MI. Moderate red wine intake with meals may have a beneficial effect in the prevention of cardiovascular complications after MI in subjects with diabetes.