Xpert MTB/RIF试验检测结核分枝杆菌及其耐药性研究

目的 探讨利福平耐药实时荧光定量核酸扩增技术(Xpert MTB/RIF)在检测结核分枝杆菌(M.tubercutosis,MTB)及其利福平耐药性方面的应用价值.方法 收集151例疑似结核患者标本,分别进行液体变色培养基培养、涂片镜检、传统比例法药敏试验以及Xpert MTB/RIF试验检测,分析Xpert MTB/RIF试验检测MTB及其耐药性的敏感度和特异度.结果 以液体变色培养基培养试验作为金标准,Xpert MTB/RIF试验检测MTB的敏感度和特异度分别为75.8％(25/33)和79.7％(94/118),两者一致性好(K=0.472).以传统比例法药敏试验为金标准,Xpert MTB/RIF试验检测利福平耐药的敏感度和特异度分别为80.0％(4/5)和89.3％(25/28),两者一致性好(K=o.595).结论 Xpert MTB/RIF试验检测MTB及其耐药性具有较高的灵敏度和特异度.     

平均血小板容积预测非瓣膜性心房颤动并发缺血性脑卒中的价值

目的 探讨平均血小板容积(MPV)预测非瓣膜性心房颤动并发缺血性脑卒中的价值.方法 选择非瓣膜性心房颤动患者199例,根据随访结果分为缺血性脑卒中组50例及非脑卒中组149例.比较两组患者的临床资料、入院24 h内MPV水平,分析心房颤动发生缺血性脑卒中的危险因素,并采用ROC曲线对MPV预测心房颤动并发缺血性脑卒中的价值.结果 与非脑卒中组相比,脑卒中组MPV、血小板分布宽度、大血小板比例、CHADS2评分、左心房内径(LAD)明显增高,既往合并高血压病史及饮酒史患者比例更高(P＜0.05).MPV、LAD及高血压为心房颤动并发缺血性脑卒中的危险因素(P＜0.05).MPV预测心房颤动并发脑梗死的ROC曲线下面积为0.740(P ＜0.05),最佳诊断值为10.65 fl,敏感度和特异度分别为82.0％和55.7％.结论 MPV与心房颤动并发脑梗死密切相关,对心房颤动患者监测MPV水平具有重要意义.     

椎动脉椎前段血流频谱变化对椎动脉起始部重度狭窄的诊断价值

目的:探讨椎动脉椎前段血流频谱变化对椎动脉起始部狭窄的诊断价值.方法:分析76例椎动脉起始部狭窄患者的超声血流频谱特征,对照CTA结果,对比分析重度狭窄组与非重度狭窄组椎动脉椎前段收缩期峰值流速(PSV)、健侧与患侧收缩期峰值流速比值(PSV1/PSV2)、阻力指数(RI),加速时间(AT)、加速度(AV)、健侧与患侧加速度比值(AV1/AV2)等指标的统计学意义;应用ROC曲线分析以上指标对椎动脉起始部重度狭窄的诊断价值.结果:共发现椎动脉起始部狭窄76例,均为单侧,其中,轻度狭窄30例,中度狭窄19例,重度狭窄27例.重度狭窄组与非重度狭窄组对比,PSV、PSVVPSV2、RI、AT、AV、AV1/AV2均有统计学差异(P＜0.05);在诊断椎动脉起始部重度狭窄的指标中,AV1/AV2、PSV1/PSV2、AT曲线下面积均＞0.9.PSVVPSV2=1.37时,诊断重度狭窄的灵敏度和特异度分别为100％和98.2％;AV1/AV2=2.08时,诊断重度狭窄的灵敏度和特异度分别为100％和99.5％;AT=0.11s时,诊断重度狭窄的灵敏度和特异度分别为100％和99.8％.结论:椎动脉椎前段血流频谱分析对椎动脉起始部重度狭窄有较高诊断价值.     

CT和MRI诊断颅内鞍区肿瘤的价值对比研究

目的探讨CT和磁共振(MRI)检查对诊断鞍区肿瘤的临床价值。方法本文对我院2010年3月至2014年8月手术后病理确诊的101例鞍区肿瘤患者的术前CT、MRI检查资料进行回顾性分析,比较CT和MRI检查判定结果与手术后病理检查结果的一致性,并计算两种影像学检查的诊断学评价指标。结果 CT与MRI对垂体瘤、脑膜瘤的诊断结果与病理检查结果的符合率比较差异不显著(P0.05),CT检查颅咽管瘤、胶质瘤与术后病理检查结果的符合率分别为(59.09%)、(47.37%)显著低于MRI检查与术后病理检查结果的符合率(P0.05)。CT检查术前诊断垂体瘤的敏感度(88.89%)、特异度(92.31%),诊断颅咽管瘤的灵敏度(59.09%)、特异度(82.28%),诊断脑膜瘤的灵敏度(79.17%)、特异度(89.61%),诊断胶质瘤的灵敏度(47.37%)、特异度(85.37%);MRI检查诊断垂体瘤的灵敏度(91.67%)、特异度(93.85%),诊断颅咽管瘤的灵敏度(86.36%)、特异度(92.31%),诊断脑膜瘤的灵敏度(95.83%)、特异度(96.10%),诊断胶质瘤的灵敏度(94.74%)、特异度(96.34%)。结论对于垂体瘤、脑膜瘤CT、MRI的诊断能力差异不显著,MRI诊断颅咽管瘤、胶质瘤的能力强于CT,总体上MRI的诊断学评价指标诊断鞍区肿瘤优于CT。     

高频超声与CT对腮腺混合瘤的诊断价值比较

目的:比较高频超声与CT对腮腺混合瘤的诊断价值。方法:回顾性分析弋矶山医院91例腮腺肿瘤手术患者资料(共91个瘤体),术前均接受高频超声和CT检查,依据瘤体直径将91个瘤体分为A组53例(瘤体直径>2.0 cm),B组38例(瘤体直径≤2.0 cm)。以病理诊断为金标准,分别计算出总体以及A、B两组两种检查方法的符合率、灵敏度及特异度。结果:高频超声诊断腮腺混合瘤总体符合率、灵敏度和特异度分别为75.8%、76.0%、75.6%,CT分别为72.5%、78.0%、65.9%,两种检查方法的符合率、灵敏度、特异度差异均无统计学意义(P>0.05)。A组高频超声诊断腮腺混合瘤符合率、灵敏度和特异度分别为81.1%、84.6%、77.8%;CT分别为58.5%、61.5%、55.6%,两种检查方法的符合率差异有统计学意义(P<0.05)。B组高频超声诊断腮腺混合瘤的符合率、灵敏度和特异度分别为68.4%、66.7%、71.4%;CT分别为92.1%、95.8%、85.7%,两种检查方法的符合率和灵敏度差异有统计学意义(P<0.05)。结论:对于大瘤体直径的腮腺混合瘤高频超声诊断效率优于CT检查,而对于小瘤体直径的腮腺混合瘤CT检查的诊断效率优于高频超声。     

SELDI-TOF质谱技术分析乳腺癌血清蛋白质谱的变化

目的 研究乳腺癌患者血清蛋白质的变化,建立灵敏度和特异度高的乳腺癌诊断模型.方法 利用SELDI-TOFMS技术对194例乳腺癌患者和60例正常人血清蛋白质分别进行检测,IMAC30芯片结合蛋白质后,用蛋白芯片仪读取数据,分析得到区分乳腺癌患者和正常人的树状分类规则,并构建诊断模型.结果 M11368、M7768、M2943等3个蛋白质组成的模型1可将2组准确分组,灵敏度和特异度分别为94.8%(184/194)和96.7%(58/60);以M11368蛋白质单独组成诊断模型2进行区分,灵敏度和特异度分别为89.69%(174/194)和93.33%(56/60).结论 SELDI-TOFMS技术可以应用于乳腺癌的诊断.     

MSCT检查对直肠癌浸润和淋巴结转移的诊断价值

①目的:评价多层螺旋CT(MSCT)扫描检查对直肠癌浸润和淋巴结转移的诊断价值。②方法:对41例直肠癌病人行扫描前充气灌肠、MSCT增强扫描，扫描后在工作站行多层面重建、薄层重叠重建，将影像诊断结果与手术病理结果进行对照。③结果:MSCT扫描对直肠癌浸润和淋巴结转移诊断的总准确率分别为85．3％、78．0％。评价肿瘤浆膜外浸润的灵敏度和特异度分别为91．1％和71．4％。判断淋巴结转移的灵敏度和特异度分别为96．6％和72．7％。④结论:MSCT扫描重建能充分显示直肠癌与盆腔内组织的关系，能清楚显示直肠周围的淋巴结,对直肠癌浸润和淋巴结转移诊断价值较高。     

性别特异的hs-cTnT对老年胸痛患者急性心肌梗死的诊断价值

目的使用性别特异的超敏心肌肌钙蛋白T(hs-cTnT)第99百分位值,评估老年胸痛患者急性心肌梗死(AMI)的诊断价值。方法纳入因胸痛就诊于四川大学华西医院胸痛中心年龄> 65岁、心电图无典型ST段升高的可疑AMI患者,收集患者临床资料,分别使用传统的和性别特异的hs-cTnT第99百分位值来评估老年胸痛患者诊断AMI的临床价值。结果共纳入757例符合标准的研究对象,平均年龄75岁,男522例(68. 96%),女235例(31. 04%)。对符合标准的研究对象,使用hs-cTnT传统值(14 ng/L)对男性和女性诊断为AMI的灵敏度和特异度分别为99. 12%、34. 04%和100. 00%、53. 02%;使用15. 5 ng/L(男)和9 ng/L(女)对男性和女性诊断为AMI的灵敏度和特异度分别为100. 00%、51. 62%和100. 00%、30. 94%。使用性别特异的cutoff值重新分类后有1例(0. 96%)男性患者由AMI调整为不稳定心绞痛(UA),随访30天内未发生心血管不良事件(MACE)。结论使用性别特异的hs-cTnT cutoff值提高了男性患者诊断的特异度和灵敏度,对女性患者诊断的灵敏度无变化,特异度稍有降低,传统的hs-cTnT第99百分位值(14 ng/L)依然可作为老年胸痛患者诊断AMI的标准。     

血清降钙素原对骨折术后感染的诊断价值

目的 探讨在骨折术后感染中血清降钙素原(PCT)水平检测的诊断价值.方法 2008年9月至2011年9月骨折术后感染患者30例为感染组,同期未发生感染者30例为非感染组.检测2组血清PCT和C-反应蛋白(CRP)的水平,对比两指标在诊断骨折术后感染诊断中的敏感度和特异度.结果 PCT水平在感染组明显高于非感染组[(8.68±2.73)vs(0.18±0.09)ng/ml,P＜0.01].PCT和CRP对骨折术后并发感染诊断的敏感度分别是93.3％、100.0％,特异度分别是90.0％、10.0％,阳性预测值分别为90.3％、52.6％,阴性预测值分别为93.1％、100.0％.PCT对骨折术后并发感染的特异度和阳性预测值高于CRP(P均＜0.01).结论 PCT可用于诊断骨折术后感染,不易受创伤及手术因素干扰,具有较高敏感度和特异度.     

阵发性房颤射频消融术后心率变异性和心率减速力变化与早期复发的关系

目的:观察心率变异性(HRV)、心率减速力(DC)与阵发性心房颤动射频消融术(RFCA)后早期复发的关系。方法:纳入120例阵发性心房颤动行RFCA术治疗患者,利用心电图、动态心电图、便携式远程心电记录仪监测术后3个月内快速房性心律失常的发生情况,并根据结果将患者分为心房颤动早期复发组与无复发组,分析患者术前及术后1周内心电图与24小时动态心电图,分析HRV、DC的变化特点与早期复发的关系。结果:120例患者均完成3个月随访,早期复发54例。心房颤动RFCA术后HRV指标显著降低,两组相比,早期复发组低频功率/高频功率比值(L/H)下降更显著,早期无复发组DC下降更显著。经Spearman相关性分析显示,早期复发与总功率(TP)、低频功率(LF)无相关性(P>0.05),早期复发与高频功率(HF)、L/H及DC呈正相关,差异具有统计学意义(P<0.05)。结论:心房颤动RFCA术可引起自主神经功能的变化,L/H显著下降可能与心房颤动早期复发有关,DC显著降低可能与消融术后早期窦律的维持有关。     

12导联穿戴心电设备在院前诊断急性ST段抬高型心肌梗死中的应用

目的 探索12导联穿戴心电设备在院前诊断急性ST段抬高型心肌梗死（STEMI）的应用价值。方法 选取2019年1月～2021年8月“全国心电一张网”中使用12导联穿戴心电设备危急值预警ST改变的441例患者心电图,回顾性分析STEMI病例的基本特点、响应时间及被检者主诉;分析院前穿戴心电图人工判读的STEMI病例、穿戴设备AI智能诊断的STEMI病例的诊断准确性。结果 院前穿戴心电图医生判读为STEMI的患者共89例,其中58例线上预警后去医院就诊,转诊率为65.17%。心电图诊断评估平均用时为153.02 s,心电图诊断审核平均用时为178.06 s。院前穿戴心电图人工判读STEMI、院前穿戴心电设备AI诊断STEMI的敏感度分别为100%、88.37%,特异度分别为95.40%、79.31%。院前穿戴心电图人工判读STEMI、穿戴心电设备AI智能诊断STEMI与临床确诊STEMI具有较高的一致性。结论 12导联穿戴心电设备能够在医院外场景准确记录STEMI患者的心电图,并实现短时间内上传且快速获得诊断。院前穿戴心电图无论是人工判读还是AI诊断STEMI的准确性率均较高。     

典型房扑射频消融术后部分患者发生房颤的危险因素分析

目的分析典型房扑射频消融术后部分患者发生房颤的危险因素。方法选择2015年2月至2018年2月六安市人民医院体表心电图提示典型房扑、电生理检查均证实为三尖瓣环峡部依赖性房扑并成功给予三尖瓣峡部线性消融(CTIA)手术的患者68例,随访6～34个月。根据术后随访是否发生房颤分为两组,其中发生房颤组23例,未发生房颤组45例,比较两组患者年龄、基础疾病、P波宽度及离散度、左房内径(LAD)、左室舒张末内径(LVEDD)、左室射血分数(LVEF)及口服药物的差异。结果两组患者的P波宽度、P波离散度、LAD、LVEDD、LVEF进行比较,差异有统计学意义(P <0. 05)。logistic回归分析显示,LAD、P波宽度及离散度是典型房扑射频消融术后发生房颤的独立危险因素。结论 LAD、P波宽度及离散度是预测典型房扑射频消融术后发生房颤的重要指标。     

Impact of different ablation strategies on the delayed cure after trans-catheter ablation for treating patients with atrial fibrillation

Background Delayed cure had been observed in recurrent cases after index ablation of atrial fibrillation (AF), however, its mechanism and incidence have not been elucidated in detail. This study aims to investigate the impact of different ablation strategies on the incidence of delayed cure and its possible mechanisms after trans-catheter ablation of AF. Methods One hundred and fifty-one consecutive cases with highly symptomatic, drug refractory AF were included in this study ［M/F=109/42, mean age （56.0±11.2） (18-79) years］. Segmental pulmonary vein ablation (SPVA) was performed in 83 patients with the guidance of circular mapping catheter (SPVA Group), circumferential PV linear ablation (CPVA) was carried out in the rest 68 cases under the guidance of 3 dimensional mapping system in conjunction with circular mapping catheter (CPVA Group). Delayed cure was defined as that early recurrence of atrial tachyarrhythmias (AF, atrial tachycardia, or atrial flutter) after ablation procedure was no longer observed during subsequent follow-up, and stable sinus rhythm was maintained ≥2 months. Results Early recurrence of atrial tachyarrhythmias was detected in 41 cases from SPVA group and 23 cases from CPVA group, and delayed cure occurred in 21.9% (9/41) of the cases from SPVA group and 47.8% (11/23) of the cases from CPVA group, more delayed cure in later group was observed (P&lt;0.05). Meanwhile, patients in SPVA group took a longer time to achieve a delayed cure ［(27.0±18.0) days vs （14.0±8.1） days, P&lt;0.05］, and presented more recurrent episodes ［(3.50±1.08) times a week vs （2.42±1.11） times a week, P&lt;0.05］. However, recurrent episodes after index ablation were markedly decreased in cases with delayed cure from both groups (P&lt;0.05). Conclusions Despite of an early recurrence of atrial tachyarrhythimas after index ablation of AF, delayed cure occurs in a significant number of patients undergoing either SPVA or CPVA. However, different ablation strategies place different impact on the delayed cure, more delayed cure is obtained with CPVA approach, and the delayed cure occurs earlier with this approach; the average recurrent episodes before delayed cure are also less frequently detected in CPVA group compared with those in SPVA group.     

以环肺静脉消融为基础分步消融治疗心房颤动

目的探讨在三维标测系统指导下，以环肺静脉消融为基础，分步消融治疗心房颤动（房颤）的可行性和有效性。方法对12例药物治疗无效的阵发性房颤（10例）和持续性房颤（2例）患者，以三步消融方法进行消融：环肺静脉前庭消融、节段性肺静脉消融和碎裂电位 (CFAEs) 消融。以每个阶段房颤不再被诱发作为消融终点,或完成三个阶段。结果消融结束时，10例阵发性房颤不再被诱发，其中第1阶段7例，第2阶段2例，第3阶段1例。2例持续性房颤在完成所有3个阶段后仍持续发作，最后经体外电转复。3例于术后2d内短暂复发，继续随访后未再房颤复发，1例房颤并典型心房扑动（房扑）患者术后复发房扑，无房颤复发。所有患者经(10±4)个月随访后，均无房颤复发，无左房房性心律失常出现。手术无并发症发生。手术中放电时间(38±11)min, X线透视时间(37±11)min，操作时间(3.0±0.5)h。结论 以房颤不再被诱发为手术终点、以环肺静脉消融为基础的分步消融治疗房颤策略是安全可行的。对于阵发性房颤采用环肺静脉消融术式即有良好效果，而对单纯环肺静脉消融不成功者结合节段性肺静脉消融及碎裂电位消融可进一步提高成功率。     

糖皮质激素对阵发性心房颤动射频消融术后复发的影响

目的：探讨糖皮质激素的使用对阵发性心房颤动（AF）患者导管射频消融（RFCA）术后 AF 复发的影响。方法本研究连续入选2011年1月至2014年4月在该院心血管内科行环肺静脉 RFAC 术,并在术后使用糖皮质激素的阵发性 AF 患者50例（激素治疗组）,并选取同期行 RFCA 术,术后未使用糖皮质激素的阵发性 AF 患者37例作对照组。术后1周、1个月、3个月、6个月、9个月、12个月,由固定医生进行电话或门诊随访,询问患者有无心悸症状或脉搏不齐,收集患者院外心电图报告,行十二导联心电图和24 h 动态心电图检查,分析、比较激素治疗组和对照组的 AF 复发情况。结果术后1周,激素治疗组和对照组窦性心律维持率分别为80．0％和54．1％,两组差异有统计学意义（P＜0．05）,激素治疗组复发率显著降低;术后1个月,激素组和对照组窦性心律维持率分别为80．0％和67．6％,两组差异无统计学意义（P＝0．187）;激素组和对照组术后12个月的 AF 复发率差异无统计学意义（P＝0．711）。绘制 Kaplan-Meier 生存率曲线,行 Log-rank 检验,两组 AF 复发率差异无统计学意义（P ＝0．711）。结论术后早期小剂量糖皮质激素使用能够降低 RFCA 术后超早期（7 d 内）的房颤复发,但对术后极早期（术后1个月）和中期（术后12个月）房颤复发率无影响。     

Catheter ablation of persistent atrial fibrillation with and without a history of paroxysmal atrial fibrillation

Background  It is unclear whether a history of paroxysmal atrial fibrillation (PAF) would impact the effect of catheter ablation on persistent atrial fibrillation (AF). This study aimed to compare the effect of catheter ablation on persistent AF with and without a history of PAF.

Methods  One hundred and eighty-three patients underwent catheter ablation of persistent AF lasting for >1 month and were reviewed. Patients were divided into two groups according to whether they had a history of PAF or not. Group I consisted of persistent AF patients with a history of PAF, and group II consisted of persistent AF patients without such a history. All patients received catheter ablation focused on pulmonary vein isolation and were observed for arrhythmia recurrences, which were defined as documented episodes of AF or atrial tachycardia after a blanking period of 3 months.

Results  One hundred and three patients (60.9%) in group I and sixty-six patients (39.1%) in group II were successfully followed and included in analysis. There were no significant differences in clinical and echocardiographic characteristics between both groups except for a younger age and more male patients in group II. After (15.5±10.7) months of follow-up, 59 (57.3%) patients in group I and 49 (74.2%) patients in group II maintained sinus rhythm free of anti-arrhythmia drugs (P=0.025). Multivariate analyses found left atrial anteroposterior diameter (P=0.006) and persistent AF with a history of PAF (OR 1.792, 95% CI 1.019–3.152; P=0.043) as the only independent statistical predictors of arrhythmia recurrences.

Conclusion  The arrhythmia recurrence rate of catheter ablation based on pulmonary vein isolation in persistent AF with a history of PAF was higher than those without a history of PAF

     

Brugada综合征心电图检出情况的初步分析

目的 初步分析52 461份心电图Brugada综合征的检出情况。方法 2009年3月—2011年12月,从我院门诊心电图室收集常规心电图52 461份,严格按照筛选标准检出具有Brugada综合征特征的心电图,并对检出的病人进行随访。结果 共检出Brugada心电图征病人39例（0.74‰）,均为男性,其中Ⅰ型10例,Ⅱ型26例,Ⅲ型3例。39例中确诊Brugada综合征6例,疑似诊断1例。确诊的6例病人,4例安装了埋藏式心律转复除颤器（ICD）,现生存良好;2例拒绝安装ICD者死亡。结论 Brugada综合征在本组人群中检出率为0.11‰,占已检出Brugada心电图征的15％;建议对于确诊的Brugada综合征病人给予ICD治疗,否则发生猝死的可能性较大。     

Serum uric acid levels correlate with recurrence of paroxysmal atrial fibrillation after catheter ablation

Background  Recently there has been a great deal of interest in the role of serum uric acid (SUA) in atrial fibrillation (AF). The objective of this study was to establish whether there is a relationship between levels of SUA and recurrence of paroxysmal AF after catheter ablation.

Methods  Three hundred and thirty patients diagnosed with paroxysmal AF were analyzed. Patients were categorized into quartiles on the basis of their pre-operative SUA measurement and follow-up, and Kaplan-Meier estimation with a Log-rank test was used for the analysis of the influence of SUA on the recurrence of AF. Pre-procedural clinical variables were correlated with the clinical outcome after ablation using multivariate Logistic analysis. A Cox proportional hazards model was used to estimate the relationship between SUA and the recurrence of AF.

Results  After a mean follow-up of (9.341±3.667) (range 3.0–16.3) months, recurrence rates from the lowest SUA quartile to the highest SUA quartile were 16.0%, 26.4%, 28.3%, and 29.3% respectively (P=0.014). After adjustment for gender, body mass index (BMI), hypertension, serum levels of high sensitivity C-reactive protein (hsCRP), triglyceride (TG), left atrial diameter (LA), estimated glomerular filtration rate (eGFR), and SUA, there was an increased risk of recurrence in subjects in the highest SUA quartile compared with those in the lowest quartile (hazard ratio 2.804, 95% confidence interval 1.466–5.362, P=0.002). Following multivariate Logistical analysis, SUA was found to be an independent predictor of recurrence (hazard ratio 1.613, 95% confidence interval 1.601–1.625, P=0.014).

Conclusion  In a retrospective study of patients with paroxysmal AF undergoing catheter ablation, elevated preoperative SUA levels were associated with a higher rate of recurrence of AF.

     

Early-phase changes of P-wave characteristics after circumferential pulmonary vein isolation

Background Circumferential pulmonary vein isolation (CPVI),as the basal ablation strategy for treating atrial fibrillation (AF),not only isolates the connection between the left atrium (LA) and the pul...