NT-proBNP与慢性充血性心力衰竭预后临床分析

目的：探讨慢性心力衰竭患者血浆N末端B型利钠肽原(NT-proBNP)测定水平与预后的关系。方法40例慢性心力衰竭患者(病程≥1年)于入院时急诊抽血测定血浆NT-proBNP水平,并分为两组院NT-proBNP≥2000pg/ml组26例,NT-proBNP<2000pg/ml组14例,追踪观察26个月再住院率及死亡率。结果 NT-proBNP≥2000pg/ml组患者在正规抗心衰治疗症状明显改善出院后再入院率为80.8%、死亡率为19.2%,NT-proBNP<2000pg/ml组患者再入院率42.9%,死亡率为0%,两组比较,再入院率(P<0.05)、死亡率(P<0.05)有显著的差异性。结论NT-proBNP是慢性充血性心力衰竭最敏感和最重要的标志物,对慢性充血性心力衰竭诊断和预后评估具有重要的临床价值。     

CX3CL1、CXCL10及CXCL5在慢性阻塞性肺疾病急性加重期患者中的表达及其预后评估价值北大核心CSCD

目的:探讨CX3趋化因子配体1(CX3CL1)、CX趋化因子配体10(CXCL10)及CXCL5在慢性阻塞性肺疾病急性加重期(AECOPD)患者中的表达及其预后评估价值。方法:选取2018年1月至2021年6月儋州市人民医院收治的226例慢性阻塞性肺疾病患者(COPD组)和60例健康志愿者(对照组),根据COPD患者病情严重程度分为稳定期COPD组(124例)和AECOPD组(102例),并根据AECOPD患者发病入院后28 d的死亡情况,将其分为存活组(64例)和死亡组(38例)。比较各组血清CX3CL1、CXCL10及CXCL5表达水平。应用多因素Logistic回归分析影响AECOPD预后的危险因素。绘制受试者工作特征(ROC)曲线分析CX3CL1、CXCL10及CXCL5对AECOPD患者预后评估的价值。Pearson相关分析探究AECOPD患者血清CX3CL1、CXCL10及CXCL5间的相关性。结果:AECOPD组血清CX3CL1[(370.52±102.16)pg/ml vs(274.18±84.35)pg/ml、(108.52±27.36)pg/ml]、CXCL10[(115.73±34.60)pg/ml vs(73.26±25.17)pg/ml、(21.45±8.10)pg/ml]及CXCL5[(226.48±75.20)pg/ml vs(153.62±58.74)pg/ml、(87.20±31.15)pg/ml]水平均明显高于COPD组和对照组(P<0.001)。死亡组血清CX3CL1[(426.73±126.35)pg/ml vs(327.18±96.70)pg/ml]、CXCL10[(139.42±41.15)pg/ml vs(95.84±30.16)pg/ml]及CXCL5[(270.83±81.46)pg/ml vs(191.25±67.30)pg/ml]水平均明显高于存活组(P<0.001)。多因素Logistic回归分析显示病程[OR(95%CI)=2.103(1.361~4.217)]、CX3CL1[OR(95%CI)=3.195(2.116~9.215)]、CXCL10[OR(95%CI)=2.328(1.480~5.942)]及CXCL5[OR(95%CI)=2.719(1.895~8.416)]是影响AECOPD预后的危险因素。ROC曲线显示CX3CL1、CXCL10及CXCL5三项联合评估AECOPD患者预后的曲线下面积为0.937(95%CI:0.874~0.986),敏感度为96.8%,特异度为84.5%。相关分析显示,AECOPD患者血清CX3CL1、CXCL10及CXCL5水平均呈正相关(P<0.001)。结论:血清CX3CL1、CXCL10及CXCL5水平在AECOPD患者中明显升高,三项联合检测对AECOPD患者预后评估具有较好的价值。     

NT-proBNP在急性心肌梗死中的应用

目的：分析不同部位急性心肌梗死(AMI)NT-proBNP的关系及急诊PCI术对前壁AMI NT-proBNP的影响。方法选取2012年3月~2014年7月入住中南大学湘雅二医院心内科的急性AMI患者共263例,按梗死部位分为：非ST段抬高型、下壁和前壁三组。选取无器质性心脏病患者为对照组,选取行急诊PCI术的急性前壁AMI患者为PCI组;各组均测定血清NT-proBNP。结果各AMI组的NT-proBNP均高于对照组(P<0.05)。前壁AMI组的NT-proBNP最高(P<0.05)。前壁AMI,行PCI术组的NT-proBNP低于未行PCI术组(P<0.05)。结论血清NT-proBNP可作为评价急性AMI梗死部位的指标。 PCI术可降低急性AMI患者的NT-proBNP。     

VVI及DDD起搏术对病态窦房结综合征患者血清NT-proBNP水平及左心功能的影响

目的:观察右心室起搏术(VVI)及双心腔起搏术(DDD)对病窦综合征(SSS)患者血清N-末端脑钠肽前体(NT-proBNP)水平和左心功能的影响。方法:118例患者被分为VVI组(68例)和DDD组(50例)。术前及术后三个月观察比较两组患者血清NT-proBNP水平、左室射血分数(LVEF)及二尖瓣血流频谱E峰、A峰比值(E/A)的差异。结果:术后三个月,VVI组血清NT-proBNP水平由术前128.05±50.16pg/ml升至381.26±70.22pg/ml,LVEF由术前58.65±3.82%降至42.32±4.42%,E/A由术前0.98±0.23降至0.67±0.16(P均<0.05);DDD组术后三个月血清NT-proBNP、LVEF及E/A与术前比较均无统计学差异。结论:DDD起搏术对左心功能影响小,而VVI影响较大,建议选用DDD。     

IL-23与IL-17在强直性脊柱炎患者中表达的初步研究

目的:通过研究IL-23与IL-17在强直性脊柱炎(AS)患者中的表达情况,为进一步阐明As发病机制和寻找新的治疗靶点提供理论依据.方法:AS患者与健康对照血清及培养的外周血单个核细胞(PBMCs)上清中IL-23与IL-17水平应用ELISA方法检测;应用RT-PCR方法检测PBMCs中IL-23p19 mRNA的表达.结果:39例活动期AS患者血清IL-23与IL-17水平分别为(1 159.71±139.45)pg/ml和(172.21±73.81)pg/ml,均较健康对照明显升高(P<0.001);AS患者培养的PBMCs上清IL-23与IL-17水平分别为(108.63±34.53)pg/ml和(134.59±38.32)pg/ml,明显高于健康对照(P<0.001),IL-23p19 mRNA表达明显高于健康对照,平均光密度分析差异有极显著统计学意义(P<0.001);IL-23可促进健康对照和AS患者的PBMCs IL-17的分泌,此作用在AS患者更显著.结论:IL-23与IL-17可能在AS的发病中发挥作用,IL-23可能通过诱导IL-17的产生而使后者在AS的发病中发挥作用.     

PCI联合IABP治疗急性心肌梗死伴心衰/心源性休克对患者心功能、血流动力学和心衰相关实验室指标的影响及其临床转归

目的:回顾性分析经皮冠状动脉介入(PCI)联合主动脉内球囊反搏术(IABP)治疗急性心肌梗死(AMI)伴心衰/心源性休克患者的心功能、血流动力学和心衰相关实验室指标水平的影响以及临床转归。方法:选取2014-01-2016-12复旦大学附属华山医院收治的AMI伴心衰/心源性休克患者91例。将进行PCI治疗者设为PCI组(n=45),PCI基础上联合IABP治疗者设为PCI+IABP组(n=46)。两组同时给予急性心肌梗死常规药物治疗。分析比较两组患者治疗前后心功能指标左室舒张末期内径(LVEDd)、左心室射血分数(LVEF),血流动力学指标肺动脉楔压(PCWP)、有创平均动脉压(MABP)、有创动脉收缩压(SBP),心衰相关实验室指标脑钠肽(BNP)、超敏C反应蛋白(hs-CRP)、血肌酐(Cr)水平变化及其临床转归。结果:两组患者治疗后LVEDd、PCWP、hs-CRP、BNP和Cr水平均较治疗前降低(P0.01),LVEF、MABP、SBP水平均较治疗前升高(P0.01)。PCI+IABP组治疗后上述指标的升高和降低均较PCI组明显(LVEDd:51.02±3.64vs 53.69±4.10,PCWP:13.25±5.22vs 18.48±7.14;hs-CRP:3.89±1.02vs 4.52±1.22;BNP:349.21±72.14vs 428.59±102.41;Cr:85.94±15.20vs 349.21±72.14;LVEF:40.75±6.14vs 37.56±6.10;MABP:71.20±11.22vs 62.44±10.55;SBP:99.84±13.01vs91.01±12.89;均P0.05)。PCI+IABP组患者存活率高于PCI组(89.13%vs 68.89%),死亡率低于PCI组(10.87%vs 31.11%)(均P0.05)。结论:PCI联合IABP治疗可有效改善AMI伴心衰/心源性休克患者心功能和血流动力学,降低心衰相关指标水平,提高患者存活率。     

屋尘螨过敏性哮喘患者白介素-2和白介素-4血清水平及基因多态性

目的:检测分析屋尘螨过敏性哮喘患者白介素-2(IL-2)、IL-4血清水平及基因多态性。方法:首次诊断为屋尘螨过敏性哮喘患者73例(过敏性哮喘组),按其临床表现再分为急性发作期组(n=25)、慢性持续期组(n=23)和临床缓解期组(n=25),另选体检健康人群作为对照组(n=81)。采用ELISA检测各组血清IL-2、IL-4和屋尘螨特异性IgE(SIgE)水平,采用等位基因特异性PCR检测各组IL-2基因rs6534349和IL-4基因rs2227284的单核苷酸多态性(SNP)位点基因多态性。结果:血清IL-2水平在急性发作期组(170.58±29.08pg/ml)及慢性发作期组(179.45±45.34pg/m)均较对照组(227.45±43.34pg/ml)明显降低(P0.01);两组血清IL-4水平分别为98.45±28.85pg/ml和89.34±39.21pg/ml,均较对照组(68.41±30.01pg/ml)明显升高(P0.05);临床缓解期组血清IL-2和IL-4水平与对照组差异无统计学意义(P0.05)。血清SIgE水平在急性发作期组(21.27±2.96pg/ml)、慢性持续期组(19.45±10.38pg/ml)和临床缓解期组(18.34±4.21pg/ml)均明显高于对照组(8.90±4.00pg/ml)(P0.01)。SIgE水平变化与IL-2变化呈负相关(r=-0.421,P0.01),与IL-4变化呈正相关(r=0.522,P0.01)。基因多态性分析显示,过敏性哮喘组患者IL-2rs6534349中GG型明显低于对照组(P0.01),而IL-4rs2227284CC型明显高于对照组(P0.01)。结论:屋尘螨过敏性哮喘与其血清IL-2、IL-4水平及基因多态性具有一定关系。     

尿激酶辅助 PCI 术治疗 STEMI 患者的疗效评价

目的:探究尿激酶(Urokinase,UK)辅助经皮冠状动脉介入术(Percutaneous coronary intervention,PCI)治疗急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者的效果.方法:回顾性收集2017年1月至2020年4月我院104例STEMI患者,按治疗方案不同分成A组、B组,各52例.B组接受PCI治疗,A组接受UK辅助PCI治疗.对比两组患者术后即刻心肌灌注情况、治疗前与治疗30 d后血清细胞因子指标、半乳糖凝集素-3(Galectin-3,Gal-3)、N末端脑钠肽元(N-terminal pro-brain natriuretic peptide,NT-proBNP)水平及心脏不良事件发生率等.结果:A组心肌梗死溶栓实验血流分级较B组优,ST段回落率较B组高,心脏不良事件发生率较B组低(P<0.05);与治疗前相比,各治疗组的血清白细胞介素-6、肿瘤坏死因子-α、NT-proBNP、GAL-3水平均明显降低(P<0.05),其中A组更为显著(P<0.05).结论:UK辅助PCI术治疗STEMI患者能进一步改善心肌灌注情况,缓解炎性反应,促进病情恢复,降低心脏不良事件发生风险.     

甲亢患者血清NT-proBNP水平的变化

目的:探讨甲状腺机能亢进症(以下简称甲亢)患者NT-proBNP水平的变化及其临床意义.方法:将门诊甲亢患者分为甲亢组(A组,34例),甲亢缓解组(B组,30例)两组,另选取31例健康体检者作为正常对照组(C组).测定上述受检者血清游离T3(FT3)、游离T4(FT4)及N端脑钠肽激素原(NT-proBNP)水平.结果:A、B、C三组NT-proBNP水平分别为89.41pg/ml(21.05～969.30)、36.31 pg/ml(16.95～72.70)、34.43 pg/ml(16.39～77.47).A组NT-proBNP水平明显高于B、C组(P＜0.01),约为B、C组的3倍;而B、C两组比较则无统计学差异(P＞0.05).多元回归分析示甲亢组中NT-proBNP与FT4独立相关(P＜0.01).结论:血清NT-proBNP水平显著受甲状腺激素(TH)影响,TH对NT-proBNP的影响可能是一种直接、正面效应.     

血浆NT-proBNP水平评价慢性肾病患者左心室功能

目的:血清N-末端脑钠肽前体(N-terminal-pro-B-type natriuretic peptide,NT-proBNP)为诊断心功能衰竭的特异性生物学指标。由于肾脏清除率降低可使NT-proBNP的清除减少,而使肾功衰竭的患者血清NT-proBNP水平升高。本文NT-proBNP水平评估慢性肾脏疾病患者左心室功能。方法:收集慢性肾脏疾病患者60例(男44,女16),检测其左心室射血分数(left ventricular ejection fraction,LVEF),体重指数(body mass index,BMI),血清肌酐(creatinine,Cr),NT-proBNP。结果:NT-proBNP与BMI、年龄、性别均显著相关。NT-proB-NP水平为150.0pg/ml和510.0pg/ml,在诊断慢性肾脏疾病患者左心室功能紊乱的敏感度、特异度分别为93.5%、29.2%和53.2%、88.1%。结论:NT-proBNP水平在510.0pg/ml时对慢性肾脏疾病患者发生心功能衰竭有良好的预测价值。     

冠状动脉造影微循环阻力指数对急性ST段抬高型心肌梗死患者急诊PCI术后预后的评估价值

目的 探究冠状动脉造影微循环阻力指数(coronary angiography-derived index of microcirculatory resistance, caIMR)对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者行急诊经皮冠状动脉介入(percutaneous coronary intervention, PCI)术后发生主要心血管不良事件(major adverse cardiovascular events, MACE)的预测价值。方法 连续纳入2019年9月～2022年3月在徐州医科大学附属医院诊断为STEMI的患者541例。使用FlashAngio系统(苏州润迈德医疗科技有限公司)计算caIMR。按照住院或随访期间MACE发生与否将患者分为MACE组和非MACE组,MACE定义为全因死亡、心力衰竭再入院、非计划性血运重建。采用COX回归分析、受试者工作特征(receiver operating characteristics, ROC)曲线、Kaplan-Meier生存曲线探...     

The effect of direct communication between emergency physicians and interventional cardiologists on door to balloon times in STEMI

We developed an institutional protocol mandating emergency physicians to contact the interventional cardiologist directly in all cases of ST-segment elevation myocardial infarction (STEMI) and hypothesized that this would reduce door-to-balloon-times (DTBT). From January 2004 to July 2006, 208 patients with STEMI were treated with primary percutaneous coronary intervention (PCI). A total of 144 patients were treated before implementing the new protocol ("before") and 64 patients were treated after the implementation ("after"). The DTBT was significantly reduced from 148+/-101 min to 108+/-56 min (p<0.05). While only 25% of the "before' patients received PCI within 90 min after arrival, 50% of the "after' patients received PCI within 90 min (p<0.05). There were no significant differences between two groups in other outcomes (postprocedural TIMI flow, mortality, subsequent stroke, heart failure, shock, reinfarction, length of stay in intensive care unit, and the total hospital length of stay). In conclusion, mandating emergency physicians to directly notify interventional cardiologists of all STEMI patients reduces DTBT.     

A Retrospective Clinical Evaluation of an Artificial Intelligence Screening Method for Early Detection of STEMI in the Emergency Department

BackgroundRapid revascularization is the key to better patient outcomes in ST-elevation myocardial infarction (STEMI). Direct activation of cardiac catheterization laboratory (CCL) using artificial intelligence (AI) interpretation of initial electrocardiography (ECG) might help reduce door-to-balloon (D2B) time. To prove that this approach is feasible and beneficial, we assessed the non-inferiority of such a process over conventional evaluation and estimated its clinical benefits, including a reduction in D2B time, medical cost, and 1-year mortality.MethodsThis is a single-center retrospective study of emergency department (ED) patients suspected of having STEMI from January 2021 to June 2021. Quantitative ECG (QCG™), a comprehensive cardiovascular evaluation system, was used for screening. The non-inferiority of the AI-driven CCL activation over joint clinical evaluation by emergency physicians and cardiologists was tested using a 5% non-inferiority margin.ResultsEighty patients (STEMI, 54 patients [67.5%]) were analyzed. The area under the curve of QCG score was 0.947. Binned at 50 (binary QCG), the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 98.1% (95% confidence interval [CI], 94.6%, 100.0%), 76.9% (95% CI, 60.7%, 93.1%), 89.8% (95% CI, 82.1%, 97.5%) and 95.2% (95% CI, 86.1%, 100.0%), respectively. The difference in sensitivity and specificity between binary QCG and the joint clinical decision was 3.7% (95% CI, −3.5%, 10.9%) and 19.2% (95% CI, −4.7%, 43.1%), respectively, confirming the non-inferiority. The estimated median reduction in D2B time, evaluation cost, and the relative risk of 1-year mortality were 11.0 minutes (interquartile range [IQR], 7.3–20.0 minutes), 26,902.2 KRW (22.78 USD) per STEMI patient, and 12.39% (IQR, 7.51–22.54%), respectively.ConclusionAI-assisted CCL activation using initial ECG is feasible. If such a policy is implemented, it would be reasonable to expect some reduction in D2B time, medical cost, and 1-year mortality.     

Health-Related Quality-of-Life after Percutaneous Coronary Intervention in Patients with UA/NSTEMI and STEMI: the Korean Multicenter Registry

Compared with ST elevation myocardial infarction (STEMI), long-term outcomes are known to be worse in patients with unstable angina/non-STEMI (UA/NSTEMI), which might be related to the worse health status of patients with UA/STEMI. In patients with UA/NSTEMI and STEMI underwent percutaneous coronary intervention (PCI), angina-specific and general health-related quality-of-life (HRQOL) was investigated at baseline and at 30 days after PCI. Patients with UA/NSTEMI were older and had higher frequencies in female, diabetes and hypertension. After PCI, both angina-specific and general HRQOL scores were improved, but improvement was much more frequent in angina-related HRQOL of patients with UA/NSTEMI than those with STEMI (44.2% vs 36.8%, P < 0.001). Improvement was less common in general HRQOL. At 30-days after PCI, angina-specific HRQOL of the patients with UA/NSTEMI was comparable to those with STEMI (56.1 ± 18.6 vs 56.6 ± 18.7, P = 0.521), but general HRQOL was significantly lower (0.86 ± 0.21 vs 0.89 ± 0.17, P = 0.001) after adjusting baseline characteristics (P < 0.001). In conclusion, the general health status of those with UA/NSTEMI was not good even after optimal PCI. In addition to angina-specific therapy, comprehensive supportive care would be needed to improve the general health status of acute coronary syndrome survivors.     

Efficacy of an adjusted treatment strategy on the management and in-hospital outcome of patients with STEMI during the COVID-19 pandemic

<正>Dear Editor,The coronavirus disease 2019(COVID-19) broke out in early December 2019 in Wuhan, China^[1], which put tremendous pressure on the medical system. A nationwide lockdown and strict quarantine measures proved effective in reducing the spread of the pandemic. However, it might have affected the management of time-dependent diseases such as STelevation myocardial infarction(STEMI)^[2].