急性胸痛患者的病因调查及胸痛中心对胸痛患者诊疗时间的影响

目的:对急性胸痛患者的病因进行调查研究,并观察胸痛中心对急性胸痛患者诊疗时间的影响.方法:胸痛中心每周开诊3 d,时间随机确定,其余时间由急诊科按常规流程对胸痛患者进行诊疗,由研究者对急性胸痛患者的病因和诊疗时间进行注册登记.结果:2006-01-2007-12因急性非创伤性胸痛就诊急诊科非胸痛中心或胸痛中心的患者共696例,心源性胸痛244例(35%),包括急性心肌梗死141例(20%),不稳定型心绞痛81例(12%),稳定型心绞痛17例(2.4%),主动脉夹层2例(0.3%),急性肺栓塞3例(0.4%);非心源性胸痛452例(65%),呼吸系统41例(6%),消化系统70例(10%),胸膜骨骼肌肉41例(6%),神经精神或其他299例(42%).经胸痛中心诊治的急性心肌梗死、不稳定心绞痛、非心源性胸痛患者的诊疗时间分别为(70.1±31.7)min、(3.8±0.9)h、(1.8±1.1)h,较非胸痛中心诊治时间[(115±40.5)min、(4.4±1.3)h、(2.1±1.6)h]均有所缩短(P<0.01、P<0.05、P<0.05).结论:急性胸痛患者的病因中,心源性者占35%(以急性心肌梗死和不稳定型心绞痛为主),非心源性者占65%;胸痛中心模式能显著缩短急性胸痛患者的诊疗时间.     

急诊心源性胸痛患者临床特征分析

目的 总结心源性胸痛患者临床特征,加深临床对此类疾病的认识。方法 选取2021年1月至2021年12月经山东省济宁医学院附属医院急诊胸痛中心收治的心源性胸痛患者作为研究对象,对患者性别、年龄、来院方式、发病时间、既往史、合并症、临床表现、诊断及转归情况等进行归纳总结。结果共纳入心源性胸痛患者3107例,发病率男性多于女性,男女比为1.54:1,发病率最高的年龄段为65～74岁,84.84%的心源性胸痛患者自行来院就诊,发病时间好发于冬季,且凌晨、上午和晚上发病率最高。按照诊断进行分型包括：急性心肌梗死（AMI）1099例（35.37%）,不稳定型心绞痛（UA）1573例（50.63%）,非急性冠脉综合征（ACS）心源性胸痛435例（14.00%）。AMI患者多为持续性胸痛,UA和非ACS心源性胸痛患者多为间歇性胸痛,不同类型患者伴随症状、既往史/合并症各异,各型患者占比最高的既往史均为冠心病。心源性胸痛患者院内死亡率为1.71%(53/3107),死亡率最高为AMI患者,死亡原因均为心源性死亡。结论 心源性胸痛患者有一定的发病规律,各型患者临床特征不同,AMI患者死亡率最高。     

急诊科急性胸痛病人病因临床分析

目的分析急诊科以胸痛或胸部不适为主诉就诊病人的病因。方法对2016年12月—2017年12月在我院急诊科就诊的胸痛或胸部不适为主诉的2 409例病人,按胸痛中心的流程要求,10 min内完成第一份心电图,抽血后20 min内获取肌钙蛋白结果,30 min内完成心脏彩超或主动脉超声检查,对于疑似肺栓塞或主动脉夹层的病人30 min内进行主动脉或肺动脉CT血管造影(CTA)检查。对合并呼吸困难、腹痛的病人行急诊胸片或胸部CT检查、腹部彩超等相关检查。结果 2 409例胸痛病人中,心源性胸痛1 329例,其中急性ST段抬高型心肌梗死533例(22.1%),急性非ST段抬高心肌梗死284例(11.8%),不稳定型心绞痛222例(9.2%),稳定型心绞痛235例(9.8%),扩张型心肌病12例(0.5%),心肌炎10例(0.4%),主动脉夹层33例(1.4%);非心源性胸痛1 080例,其中呼吸系统疾病367例(15.2%),消化系统疾病289例(12.0%),骨骼肌肉源性210例(8.7%),神经精神系统及其他186例(7.7%),肺栓塞28例(1.2%)。结论在急诊科以胸痛或胸部不适为主诉就诊的病人比例较大,其病因复杂,在接诊中应首先想到高危性胸痛,然后在考虑低危型胸痛。高危性胸痛病人严重者可危及生命,漏诊或误诊可能致命或严重影响病人预后,需要急诊科医师提高胸痛的早期诊断和救治能力。     

老年男性冠心病患者冠状动脉病变特点

目的探讨老年与中青年男性冠心病患者冠状动脉病变特点的不同。方法对475例经过冠状动脉造影检查诊断为冠心病的男性患者,其中老年组260例;中青年组215例。对比分析两组冠状动脉病变的不同特点。结果在老年组中,不稳定型心绞痛患者平均冠状动脉病变支数（1.9±0.1vs1.6±0.1）与冠状动脉积分（45±6vs27±3）均显著高于中青年组,老年组与中青年组稳定型心绞痛患者冠状动脉病变支数相同（1.9±0.1vs1.9±0.1）,冠状动脉积分（46±5vs44±5）接近。老年男性急性心肌梗死（AMI）患者冠状动脉病变支数（2.4±0.1vs2±0.1）和冠状动脉积分（68±4vs56±4）显著高于中青年AMI患者。两组之间的病变血管的分布无显著性差异。老年组单支病变显著低于中青年组（31.9%vs44.7%）,3支病变（43.8%vs33.0%）和4支病变显著高于中青年组（2.5%vs1.0%）。结论老年患者不稳定型心绞痛和AMI冠状动脉病变程度高于中青年,而稳定型心绞痛和陈旧性心肌梗死两者病变程度相似。     

胸痛中心处理急性胸痛患者的临床对照研究

目的分析胸痛中心在处理急性胸痛患者中的有效性和安全性。方法回顾性分析2012年1月至2016年12月在成都中医药大学附属医院就诊的315例急性胸痛患者的临床资料,将2014年12月前非胸痛中心处理的123例急性胸痛患者设为对照组,2014年12月至2016年12月由胸痛中心处理的192例患者设为观察组,比较两组患者急性心肌梗死确诊率、接受急诊经皮冠状动脉介入治疗(PCI)率、门-球(D to B)时间、住院时间及主要不良心血管事件的发生情况。结果观察组对胸痛患者急性心肌梗死确诊率显著大于对照组(82.3%比75.6%,P=0.027),差异有统计学意义。确诊的急性心肌梗死患者中,观察组患者接受急诊PCI比例显著大于对照组(92.4%比83.9%,P=0.001),而住院时间显著小于对照组[(7.41±3.78)d比(10.09±4.03)d,P=0.025];接受急诊PCI的患者中,观察组D to B时间显著小于对照组[(58.08±16.26)min比(64.12±34.76)min,P=0.025]。急性心肌梗死患者住院期间,观察组患者主要不良心血管事件发生率显著低于对照组(47.5%比50.5%,P=0.027),其中观察组患者心源性猝死(5.7%比6.5%,P=0.041)、心力衰竭(31.6%比33.3%,P=0.019)比例显著低于对照组,而两组间心源性休克、再发心肌梗死比例比较,差异均无统计学意义(均P0.05)。结论胸痛中心处理急性胸痛患者更加安全有效。     

冠状动脉临界病变是否支架治疗的临床预后比较研究

目的观察和比较冠状动脉临界病变的非心肌梗死患者,采用介入、药物两种不同治疗方案的临床预后。方法选取2005年12月-2009午9月于我院住院的非心肌梗死冠心痛患者,经冠状动脉造影（CAG）证实为冠状动脉临界病变患者105例。根据患者意愿是否行冠状动脉内介入治疗将患者分为介入治疗组（PCI组）51例和单纯药物治疗组（MT组）54例,临床观察6～18个月内稳定心绞痛、不稳定心绞痛及心血管不良事件（心肌梗死,冠状动脉内血运重建,心源性死亡）发生情况。结果PCI组和MT组共发生心血管不良事件4例,PCI组发生1例为心脏性死亡,MT组发生3例为再次血运重建术。两组患者稳定型心绞痛的发生率分别为31．4％和37．0％,不稳定型心绞痛的发生率分别为19．6％和29．6％。以上比较差异均无统计学意义（P〉0．05）。结论冠状动脉临界病变患者行PCI与MT治疗相比发生心绞痛及心血管不良事件无显著差异。     

趋化因子CCL21、CCL19与急性冠状动脉综合征的相关性研究

目的:通过研究急性冠脉综合征(ACS)患者血清趋化因子CCL21、CC19的变化,探讨其与冠状动脉病变的相关性。方法: 选取102例ACS患者,其中急性ST段抬高的心肌梗死(STEMI)患者33例,非ST段抬高的心肌梗死（NSTEMI）37例,不稳定型心绞痛(UA)患者32例,稳定型心绞痛患者36例,非心源性胸痛并经冠状动脉造影排除冠心病的患者为对照组30例,采用酶联免疫法法测定CCL21、CCL19水平,所有ACS患者进行冠状动脉造影用目测法和Gensini评分对冠脉血管进行损害程度进行评价,来探讨CCL21、CCL19与冠状动脉狭窄范围及程度的关系。结果: ACS组CCL21及CCL19水平明显高于稳定型心绞痛组和对照组,分别为［(149.33±26.24)ng/L vs.(111.45±24．31)ng/L vs.(108.38±22.28)ng/L,P<0.01］,［(77.45±16.27)ng/L vs.(54.74±19.44) vs.(57.38±21.28)ng/L,P<0.01］。 ACS中STEMI、NSTEMI、UA组内血清CCL21、CCL19水平在组内差异无统计学意义［CCL21:(155.39±21.56)ng/L vs.(154．38±20．74)ng/L vs.(157.39±24.33)ng/L,P>0.05;CCL19:(75.34±15.34)ng/L vs.(77.25±16.21)ng/L vs.(74.23±24.19)ng/L,P>0.05］,冠状动脉狭窄程度及Gensini评分法积分在ACS组内STEMI组、NSTEMI组、UA组比较差异无统计学意义,三组内冠状动脉狭窄程度与外周血CCL21、CCL19水平无明显相关性。结论: 外周血CCL21、CCL19水平与急性冠脉综合症血管病变有关,在斑块不稳定中可能扮演着重要的角色。     

胸痛中心对于急性ST段抬高型心肌梗死患者救治疗效及预后分析

目的观察胸痛中心(CPC)对急性ST段抬高型心肌梗死(STEMI)患者行直接经皮冠状动脉介入术(PPCI)疗效及预后分析。方法纳入2015年12月至2017年11月于南宁市第二人民医院就诊,并接受PPCI治疗的STEMI患者179例为研究对象。按时间顺序将胸痛中心成立前接诊的患者定义为非胸痛中心组(2015年12月至2016年11月)82例,将胸痛中心成立后接诊的患者定义为胸痛中心组(2016年12月至2017年11月)97例。研究两组患者临床资料,分析CPC质控指标首次医疗接触(FMC)、门-球时间(D-to-B),近期预后及医疗费用等情况。结果胸痛中心组与非胸痛中心组相比,FMC时间[(126.23±56.72)min vs.(180.72±77.56)min,P=0.042]、D-to-B时间[(120.63±81.42)min vs.(161.90±109.54)min,P=0.004]下降明显,D-to-B达标率[51.22% vs.21.56%,P=0.01]明显提高。两组住院死亡率、院内心力衰竭发生率及人均住院费用比较差异均无统计学意义(P0.05)。结论 CPC建设能明显减少FMC及D-to-B时间,提高D-to-B达标率,提高对急性STEMI患者救治能力及效率。     

以急性胸痛为主诉的患者的病因分析

目的分析以急性胸痛为主诉的患者的病因。方法选择我院2012年6月—2013年10月急诊科收治的以急性胸痛为主诉的患者402例,分析其病因。结果 402例患者中心源性胸痛253例,占62.94%;非心源性胸痛149例,占37.06%。结论急性胸痛以心源性胸痛为主,医护人员应加强对急诊胸痛病因的认识,避免漏诊和误诊。     

床旁检测N末端脑钠肽前体对非ST段抬高性急性冠脉综合征患者的意义

目的探讨非sT段抬高性急性冠脉综合征（Non-STelevationacutecoronarysyndrome,NSTEACS）患者血浆N末端脑钠肽前体（N-terminalpro-B-typenatriureticpeptide,NT-pro-BNP）浓度与冠状动脉病变程度及住院期主要心血管事件的关系。方法入选NSTEACS患者129例,其中不稳定型心绞痛（UA）组84例,非ST段抬高性急性心肌梗死non-STelevationmyocardialinfarction,NSTEMI）组45例,另外选择同期住院的稳定型心绞痛（SA）组58例作为对照组。所有患者均测定血浆NT-pm-BNP浓度及左心室射血分数（LVEF）,行冠状动脉造影术,采用Gensini积分评价冠状动脉病变的严重程度,并记录住院期间主要心血管事件。结果NSTEMI组和不稳定型心绞痛组的血浆NT-pro-BNP浓度及Gensini积分明显高于稳定型心绞痛组,且NSTEMI组高于不稳定型心绞痛组,差异有统计学意义[1g（NT-pro-BNP）：（2．31±0．21）pg／mL vs．（1．92±0．17）pg／mLm（1．46±0．11）pg／mL,P〈0．05;Gensini积分：（36．3±16．7）分VS．（16．3±10．3）分US．（8．7±4．6）分,P〈0．05]。NSTE-ACS组的1g（NT-pro-BNP）与Gensini积分相关（r=0．57,P〈0．05）。NT-pro-BNP〉154pg／mL组主要心血管事件发生率增加。结论床旁检测NT-pro-BNP是预测NSTEACS患者的冠状动脉病变程度及短期预后的有效临床手段。     

冠心病患者血小板参数的变化及其临床意义

目的研究血小板参数在冠心病(CHD)和急性心肌梗死(AMI)患者中的变化及其临床意义。方法278例患者分为3组,分别为稳定性心绞痛组(SA)、不稳定性心绞痛(UA)和急性心肌梗死组,非心源性胸痛为对照组。采集所有患者静脉血并用COULTER-750五分类血细胞分析仪检测血小板参数。结果血小板计数在SA组、UA和AMI组、非心源性胸痛对照组间无明显差别。不稳定性心绞痛和急性心肌梗死组与稳定性心绞痛组和非心源性胸痛对照组相比,血小板平均体积(MPV)和血小板分布宽度(PDW)都明显增大。结论血小板体积变大和活化过程可能与冠状动脉血栓形成有关。     

Diagnostic implications for myocardial ischemia of the circadian variation of the onset of chest pain

To determine whether the occurrence of chest pain is randomly distributed during the day and to study whether the time of onset is useful in discriminating among causes of chest pain, patients older than 30 years who presented to 7 emergency departments with a chief complaint of chest pain unexplained by trauma or chest x-ray abnormalities were studied. A total of 7,759 patients presented during the study period; of these, 3,990 presented within 6 hours of the onset of pain and were included in the primary analysis. Chest pain caused by acute myocardial infarction, unstable angina pectoris and stable angina pectoris was more likely to begin during the period from 6 AM to noon than would be expected if the onset were uniformly distributed during the day (relative risks 1.15, 1.29 and 1.32, respectively), but chest pain that was caused by nonischemic cardiac causes and by noncardiac causes was also more likely to begin during the same time period (relative risks 1.28 and 1.17). Although chest pain from coronary arterial causes had a distinct circadian variation, the time of onset of pain was not a helpful criterion for determining the cause of chest pain.     

Beat-to-beat morphologic variability of the electrocardiogram for the evaluation of chest pain in the emergency room.

The value of electrocardiographic, morphologic variability in the early diagnosis of acute myocardial infarction (AMI) and myocardial ischemia was evaluated in 49 nonselected patients presenting to the emergency room with chest pain. High-resolution electrocardiography was used to determine the morphologic variability of consecutive electrocardiographic complexes, and the ratio of the variance of the QRS onset to that of the entire electrocardiogram was calculated. A final diagnosis of AMI was confirmed in 8 patients, acute coronary insufficiency in 8, angina pectoris in 19, and a noncardiac origin for chest pain in 14. Patients with AMI had a significantly higher beat-to-beat electrocardiographic morphologic variability of the QRS onset (1.4 +/- 0.2) than did those with acute coronary insufficiency (1.1 +/- 0.2), angina pectoris (0.9 +/- 0.1) or noncardiac chest pain (0.8 +/- 0.1) (p < 0.05). The sensitivity of the clinical presentation, typical electrocardiographic changes and creatine phosphokinase levels for the diagnosis of an acute ischemic event on admission to the emergency room was 62, 25 and 37.5%, respectively. Relative variance of the QRS onset of > 0.86 had a sensitivity of 75% and a specificity of 61% for diagnosing an acute ischemic event. Logistic regression of these variables showed that the QRS onset relative variability is an independent predictor for an acute ischemic event. It is concluded that an increased beat-to-beat electrocardiographic variability in patients with AMI is present on admission to the emergency room and may assist in establishing the diagnosis in this setting.     

体外反搏联合丹红注射液治疗不稳定型心绞痛的临床疗效

目的：观察体外反搏联合丹红注射液对不稳定型心绞痛患者的治疗效果.方法：选择183例不稳定型心绞痛患者,随机均分成三组：A组给予常规药物治疗;B组给予常规药物治疗和体外反搏,1 h/次,1次/d;C组在B组治疗方案的基础上给予丹红注射液40ml＋生理盐水250ml或5％葡萄糖250ml静脉滴注,1次/d;12d为一疗程.一疗程后观察三组患者治疗效果、半年内心绞痛再次发作情况及急性心肌梗死（AMI）发生情况.结果：与A组比较,B组和C组患者治疗总有效率显著升高（79.31％比87.72％比96.61％）,发作次数[（4.18±1.01）次/周比（2.27±0.96）次/周比（1.25±0.42）次/周]和持续时间[（3.42±0.76） min/次比（2.36±0.87） min/次比（1.15±0.63） min/次]显著减少,半年后心血管事件发生率显著降低（32.76％比22.81％比11.86％）,且C组的心绞痛发作次数和持续时间显著少于B组,P＜0.01.结论：体外反搏对不稳定型心绞痛患者疗效显著,与丹红注射液联合应用,有协同作用.     

老年人2型糖尿病患者无胸痛性急性心肌梗死临床观察

目的观察老年2型糖尿病患者无胸痛性心肌梗死的临床特点。方法临床确诊的60岁以上老年人2型糖尿病无胸痛性心肌梗死患者作为观察组(A组,41例),老年2型糖尿病心肌梗死伴典型心绞痛患者(B组,49例)及非老年人2型糖尿病心肌梗死伴典型心绞痛患者作为对照组(C组,43例)。比较3组基线临床资料,发作至入院时间、急性心肌梗死发作时的主要临床表现、合并症、并发症、心电图特点,并比较院内病死率。结果 3组临床基线资料比较显示,A组较B、C组患者年龄大[(74±9)岁],糖尿病病程长[(18±5)年],合并疾病比例高,发作至入院诊时间长[(19±13)h](均为P<0.05)。C组男性较A、B组多(88.4%),A、B组间差异无统计学意义(均为P<0.05)。A组以呼吸困难、恶心呕吐、乏力、头晕为主要临床表现,室性心律失常较多见(34.1%)。ECG表现为ST段抬高型心肌梗死较少(31.7%)非sT段抬高型心肌梗死较多(48.8%),梗死部位为下壁(36.6%)和后壁(26.8%)较多。A组病死率为17.1%,B组为8.1%,C组为7.0%。A组病死率较B、C组高,有统计学意义(均为P<0.05)。结论老年人2型糖尿病无胸痛性心肌梗死患者年龄较大,糖尿病病程较长,合并疾病较多,临床症状多变,ECG表现为STEMI较少NSTEMI较多,梗死部位为下壁和后壁较多,病死率较高,临床应提高对其的认识。     

用光学相干断层扫描比较两种类型冠心病受累血管病变的特点

目的：用光学相干断层扫描（OCT）比较急性心肌梗死（AMI）及稳定型心绞痛（SAP）受累血管病变的特征。方法：选取140例接受冠脉造影（CAG）及OCT检查的患者,其中61例AMI患者,79例SAP患者。分析患者的临床相关信息,用OCT评价受累血管的病变特点。结果：纤维帽厚度在AMI组比SAP组薄［（45±13） μm vs.（80±39） μm,P〈0.01）］;薄纤维帽富含脂质的斑块更多见于AMI组（56% vs. 25%,P〈0.01）;血栓更多见于AMI组（52% vs. 5%,P〈0.01）;斑块破裂的发生率分别是（67% vs. 25%）,P〈0.01）,溃疡和夹层等较重的斑块破裂均发生AMI组;4个象限的富含脂质斑块更易出现在AMI组;钙化斑块的深度及广度在2组间没有明显区别,但≥2象限的钙化斑块有多见SAP组趋势。结论：OCT能准确评价冠状动脉受累血管病变的病变特点及结构特征。AMI患者脂质斑块纤维帽更薄,更多见斑块破裂、血栓及不稳定脂质斑块。     

Impact of a public campaign on pre-hospital delay in patients reporting chest pain.

OBJECTIVE: To decrease pre-hospital delay in patients with chest pain. DESIGN: Population based, prospective observational study. SETTING: A province of Switzerland with 380000 inhabitants. SUBJECTS: All 1337 patients who presented with chest pain to the emergency department of the Hôpital Cantonal Universitaire of Geneva during the 12 months of a multimedia public campaign, and the 1140 patients who came with similar symptoms during the 12 months before the campaign started. MAIN OUTCOME MEASURES: Pre-hospital time delay and number of patients admitted to the hospital for acute myocardial infarction (AMI) and unstable angina. RESULTS: Mean pre-hospital delay decreased from 7h 50 min before the campaign to 4 h 54 min during it, and median delay from 180 min to 155 min (P < 0.001). For patients with a final diagnosis of AMI, mean delay decreased from 9 h 10 min to 5 h 10 min and median delay from 195 min to 155 min (P < 0.002). Emergency department visits per week for AMI and unstable angina increased from 11.2 before the campaign to 13.2 during it (P < 0.02), with an increase to 27 (P < 0.01) during the first week of the campaign; visits per week for non-cardiac chest pain increased from 7.6 to 8.1 (P = NS) during the campaign, with an increase to 17 (P < 0.05) during its first week. CONCLUSIONS: Public campaigns may significantly reduce pre-hospital delay in patients with chest pain. Despite transient increases in emergency department visits for non-cardiac chest pain, such campaigns may significantly increase hospital visits for AMI and unstable angina and thus be cost effective.     

尼可地尔在持续性肌钙蛋白I弱阳性心绞痛患者中的作用

目的：探讨尼可地尔在持续性肌钙蛋白 I （TnI）弱阳性不稳定型心绞痛患者中的作用。方法：选择伴有持续性肌钙蛋白 I （TnI）弱阳性的不稳定性心绞痛患者111例,随机分为对照组（55例,接受常规治疗）和干预组（56例,在常规治疗基础上加用尼可地尔片（5mg,3次/d）;观察,比较两组患者治疗1周内胸痛缓解情况,3个月内因胸痛加重的再住院情况,1年内心源性死亡情况。结果：与对照组比较,干预组1周内两组症状缓解率显著上升（63.6％比91.1％,χ^2＝11.97,P＝0.0005）;3个月内胸痛加重再发住院显著减少（56.4％比19.6％,χ^2＝15.91,P＝0.0001）;但1年内两组心源性死亡率无显著差异（5.5％比8.9％,χ^2＝0.50,P＝0.4792）。结论：尼可地尔可明显改善持续性TnI弱阳性不稳定型心绞痛患者的症状,而且减少患者因心绞痛加重的再住院率,但一年内死亡率两组没有明显差别。     

Chest pain of cardiac and noncardiac origin

Chest pain is one of the most common symptoms driving patients to a physician's office or the hospital's emergency department. In approximately half of the cases, chest pain is of cardiac origin, either ischemic cardiac or nonischemic cardiac disease. The other half is due to noncardiac causes, primarily esophageal disorder. Pain from either origin may occur in the same patient. In addition, psychological and psychiatric factors play a significant role in the perception and severity of the chest pain, irrespective of its cause. Chest pain of ischemic cardiac disease is called angina pectoris. Stable angina may be the prelude of ischemic cardiac disease; and for this reason, it is essential to ensure a correct diagnosis. In most cases, further testing, such as exercise testing and angiography, should be considered. The more severe form of chest pain, unstable angina, also requires a firm diagnosis because it indicates severe coronary disease and is the earliest manifestation of acute myocardial infarction. Once a diagnosis of stable or unstable angina is established, and if a decision is made not to use invasive therapy, such as coronary bypass, percutaneous transluminal coronary angioplasty, or stent insertion, effective medical treatment of associated cardiac risk factors is a must. Acute myocardial infarction occurring after a diagnosis of angina greatly increases the risk of subsequent death. Chest pain in women warrants added attention because women underestimate their likelihood to have coronary heart disease. A factor that complicates the clinical assessment of patients with chest pain (both cardiac and noncardiac in origin) is the relatively common presence of psychological and psychiatric conditions such as depression or panic disorder. These factors have been found to cause or worsen chest pain; but unfortunately, they may not be easily detected. Noncardiac chest pain represents the remaining half of all cases of chest pain. Although there are a number of causes, gastroesophageal disorders are by far the most prevalent, especially gastroesophageal reflux disease. Fortunately, this disease can be diagnosed and treated effectively by proton-pump inhibitors. The other types of non-gastroesophageal reflux disease–related noncardiac chest pain are more difficult to diagnose and treat. In conclusion, the cause of chest pain must be accurately diagnosed; and treatment must be pursued according to the cause, especially if the cause is of cardiac origin.     

急性冠脉综合征患者血浆尾加压素Ⅱ与脑钠肽的关系

目的：观察急性冠脉综合征（ACS）患者血浆尾加压素Ⅱ（UⅡ）以及血浆脑钠肽（BNP）含量的变化及其关系以及血管紧张素转换酶抑制剂（ACEI）和β受体阻滞剂联合治疗的效果。方法：选择60例ACS患者,其中急性心肌梗塞（AMI）29例,不稳定型心绞痛（UAP）31例;另选21例稳定型心绞痛（SAP）患者,34例健康人（健康对照组）作比较。各疾病组均给予ACEI和β受体阻滞剂治疗两周。采用放射免疫分析法测定血浆UⅡ和BNP含量。结果：ACS两组与SAP组、健康对照组比较血浆UⅡ含量均明显降低[AMI组（3.02±0.75）pg/ml∶UAP组（4.13±1.14）pg/ml∶SAP组（5.58±1.04）pg/ml∶健康对照组（6.75±1.55）pg/ml,P〈0.01];ACS两组血浆BNP含量明显高于健康对照组[AMI组（54.72±12.17）pg/ml∶UAP组（48.01±10.12）pg/ml∶健康对照组（14.41±4.88）pg/ml,P〈0.01],并且也显著高于SAP组[（20.73±8.70）pg/ml,P分别〈0.01,〈0.05];治疗后ACS两组血浆BNP水平较治疗前显著降低[AMI组（35.63±11.03）pg/ml∶（54.72±14.17）pg/ml,UAP组（38.72±10.09）pg/ml∶（50.01±13.12）pg/ml,P〈0.05~〈0.01];AMI组血浆UⅡ含量显著增加[（4.24±0.77）pg/ml∶（3.02±0.75）pg/ml,P〈0.05]。血浆UⅡ与血浆BNP水平呈显著负相关（r=-0.308,P〈0.01）。结论：急性冠脉综合征患者血浆尾加压素II含量明显降低,血浆脑钠肽含量显著增高,而且与疾病严重程度有关,可以作为冠心病危险分层以及药物治疗效果评定的重要指标之一。