溶栓治疗对急性心肌梗死患者血浆内皮素和一氧化氮水平的影响

目的 :探讨溶栓治疗对急性心肌梗死 (AMI)患者内皮素 (ET)和一氧化氮 (NO)水平的影响。方法 :治疗组 32例 ,采用尿激酶 15 0万U于 6 0min内静脉滴注 ,分别测出治疗前及治疗后溶栓再通组 (18例 )和未通组 (14例 )ET和NO水平的动态变化。对照组 2 0例 ,测治疗前ET和NO水平。结果 :①治疗组的ET水平高于对照组 (P <0 .0 5 ) ,NO水平低于对照组 (P <0 .0 5 ) ;②溶栓再通组的ET、NO水平显著增高 ,峰值分别是 196 .2 8± 2 0 .14ng/L和5 6 .82± 13 .6 2 μmol/L ,显著高于溶栓未通组的峰值 (ET 112 .18± 15 .2 2ng/L和NO43.87± 10 .12 μmol/L ,P <0 .0 5 ) ;③再通组ET和NO峰值提前 ,都在溶栓后 2h ,而溶栓未通组ET和NO峰值均为溶栓后 6h。结论 :①ET/NO代谢失衡是构成AMI发生的一个重要机制 ;②溶栓后NO水平升高可拮抗再灌注损伤引起的ET水平增高。     

急性心肌梗死患者早期不同剂量阿托伐他汀对hs-CRP、血脂水平的影响

目的:探讨不同剂量阿托伐他汀治疗对急性心肌梗死（AMI）患者早期超敏C反应蛋白(hs-CRP)、血脂水平的影响。方法:选取2014年1月~5月入院确诊的AMI患者60例,随机分为20 mg组和40 mg组,每组30例,所有患者入院后均在常规治疗的基础上加用阿托伐他汀,分别给予20 mg和40 mg。比较两组患者入院时和治疗l周后不同剂量对血清hs-CRP、血脂水平的影响。结果:两组治疗前后1周血清hs-CRP、总胆固醇、低密度脂蛋白胆固醇（LDL-C）及高密度脂蛋白胆固醇水平均较入院时显著下降,且40 mg组较20 mg组治疗后LDL-C水平显著下降,两组间差异有统计学意义（P<0.05）。结论:AMI患者早期（1周内）阿托伐他汀治疗对降低hs-CRP、血脂水平有效,并且40 mg组在LDL-C降低幅度上优于20 mg组。     

急性心肌梗死患者血浆内皮素-1水平的观察

测定21例急性心肌梗死患者入院后第1、2、3、4和8天血浆内皮素-1水平。第1、2和3天明显升高；其中12例KillipⅠ级患者各天均无明显改变，而9例KillipⅡ级及以上患者各天均明显升高；7例合并高血压和14例无合并高血压的患者，第1、2和3天都显著升高。     

OSAHS合并高血压患者血清ET-1、NO和CRP水平与血压增高的关系

目的探讨血清一氧化氮（NO）、内皮素-1（ET-1）和超敏C反应蛋白（CRP）水平与阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并高血压患者夜间及日间血压增高的关系。方法162例确诊为OSAHS患者根据高血压诊断标准分为OSAHS组和OSAHS并高血压组,进行多导睡眠图（PSG）和动态血压（ABPM）监测。以同期PSG和ABPM监测均正常的61例健康人作为对照组。各组均测定血清ET-1、NO和CRP水平并行相关性分析。结果与对照组比较,单纯OSAHS组和OSAHS合并高血压组血清ET-1和CRP水平升高,NO水平降低,且后两组间亦有统计学差异;血清ET-1水平与日间平均收缩压、日间平均舒张压、夜间平均舒张压呈正相关。结论OSAHS患者尤其合并高血压者血清ET-1和CRP水平增高,NO水平降低;ET—1水平升高与OSAHS患者高血压有关。     

急性心肌梗死患者溶栓前后患者血浆中NO、vWF的动态观察

目的　探讨急性心肌梗死 (AMI)溶栓前后患者血浆中NO、vWF的动态变化及其临床意义。方法　对 4 1例AMI溶栓前及溶栓后 2h、2 4h分别采血 ,测取血浆中NO及vWF的含量 ,并进行统计学处理比较。结果　 2 4例溶栓再通后2h ,患者血浆中NO显著降低 ,P <0 0 1,vWF无明显变化 >0 0 5 ;2 4h ,患者血浆中NO显著增高 ,P >0 0 1,vWF显著降低 ,P <0 0 1;而未再通组溶栓后 2h、2 4hNO及vWF的含量均无显著差异P >0 0 5。结论　AMI溶栓再通患者血浆中NO明显增高 ,vWF明显下降 ;溶栓后无再通患者血浆中NO和vWF无明显变化     

支气管哮喘患者外周血ET-1、TXB2水平变化及临床意义

目的 探讨支气管哮喘患者外周血中内皮素(ET-1)、血栓素B2(TXB2)的动态变化及临床意义.方法 支气管哮喘急性发作期患者75例(其中轻度42例,中重度33例),健康对照组38例.采用放射免疫法测定血浆中ET-1、TXB2的水平.结果 1、血浆中ET-1、TXB2水平轻度与中重度哮喘组患者高于健康对照组,差异有统计学意义(P<0.01).中重度哮喘组高于轻度组,差异有统计学意义(P<0.01).2、哮喘组血浆中ET-1与TXB2水平呈正相关(r=0.601,P<0.01).结论 ET-1、TXB2可能在哮喘的急性发病过程中起作用,以及影响哮喘的发生、发展.     

急性心肌梗死患者血浆BNP、hs-CRP检测的临床意义

近年研究显示，心肌缺血可使B型钠脲肽（BNP）及超敏C-反应蛋白（hs-CRP）释放增加。2005年1月-2006年4月，我们观察了急性心肌梗死（AMI）患者溶栓治疗前后血浆BNP及hs-CRP浓度的变化，以探讨其临床意义。     

急性心肌梗死患者PCI术后血清CX3CL1及hs-CRP水平与不良预后的关系

目的 探讨急性心肌梗死(AMI)患者行经皮冠状动脉介入治疗(PCI)后血清CX3C趋化因子配体1(CX3CL1)及超敏C反应蛋白(hs-CRP)的水平变化,其对主要不良心血管事件(MACE)的预后评估效果。方法 选取2018年4月至2019年7月于郑州大学第一附属医院诊断为AMI并首次行PCI的患者430例为研究对象,收集其临床资料,根据随访1年内是否发生MACE将430例患者分为MACE组(72例)和非MACE组(358例)。采用Cox比例风险模型对血清CX3CL1、hs-CRP以及基线资料和临床生化指标等进行危险因素分析。结果 MACE组的年龄、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、CX3CL1、hs-CRP、左室射血分数、病变支数均显著高于非MACE组(P<0.05)。Cox单因素及多因素回归分析结果显示年龄(HR=1.048,95%CI:1.016～1.092,P<0.01)、CX3CL1(HR=1.116,95%CI:1.057～1.179,P<0.01)、hs-CRP(HR=1.320,95%CI:1.145～1.688,P<0.01)...     

阿司匹林对急性冠脉综合征患者血清COX-2和TXA2水平的影响

抗血小板试验协作组认为阿司匹林用于心脑血管疾病高危患者,可分别使心脑血管病事件如死亡,心肌梗死或脑卒中降低25%,冠脉搭桥及动脉血栓事件降低48%,肺栓塞减少67%,深静脉血栓形成减少23%。但是部分患者应用阿司匹林治疗不能充分抑制血小板聚集仍出现急性冠脉综合征(ACS),     

辛伐他汀对急性冠脉综合征病人ET、NO及CRP水平的影响

目的探讨辛伐他汀对急性冠脉综合征（ACS）病人的抗炎和保护内皮的作用.方法将58例ACS病人随机分为治疗组和对照组,另选择20名健康成人为正常对照组.对照组给予常规治疗;治疗组在常规治疗基础上给予辛伐他汀口服,28 d为1个疗程.治疗前后抽静脉血检测内皮素（ET）、一氧化氮（NO）、C反应蛋白（CRP）含量.结果治疗组经辛伐他汀治疗后,ET、 CRP水平下降（P〈0.01）,NO水平上升（P＜0.05）;对照组治疗后ET水平略下降,CRP下降明显（P〈0.05）.结论辛伐他汀通过降低ET、CRP,升高NO来发挥其抗炎,提高血管内皮功能等非降脂作用.     

Underuse of Thrombolytic Therapy in Acute Myocardial Infarction and Left Bundle Branch Block

Thrombolytic therapy reduces mortality in patients with acute myocardial infarction (AMI) and left bundle branch block (LBBB). The difficulty in accurately diagnosing AMI in patients with LBBB, however, might result in their undertreatment. Among 3,890 patients hospitalized with chest pain, 241 (6.2%) had LBBB at presentation. The only variable independently associated with AMI among patients with LBBB was in‐hospital left ventricular failure (odds ratio [OR]: 4.32, 95% confidence interval [CI]: 1.95–9.57, p < 0.0005). Only 16 (29%) of the LBBB patients with AMI received thrombolytic therapy compared with 583 (78%) of the 747 patients with ST‐elevation AMI (p < 0.0005). A further 19 (10%) LBBB patients without AMI also received thrombolysis. Difficulty in making an accurate early diagnosis in patients with LBBB ensures that the majority of those with AMI fail to receive thrombolytic therapy while others without AMI are treated inappropriately. Improved diagnostic and therapeutic strategies are needed for patients with acute coronary syndromes and LBBB. Copyright © 2010 Wiley Periodicals, Inc.     

急性心肌梗死溶栓药物疗效的循证医学评价

根据大量临床试验结果对治疗急性心肌梗死(AMI)的溶栓药物从疗效、并发症等进行了比较,发现溶栓药物从第1代到第3代在纤维蛋白选择性、半衰期、给药方式等方面有了较大的改进,使AMI的病死率降至7%~8%,但新型溶栓药物在有效率方面并没有明显超过组织型纤溶酶原激活剂,仍存在着颅内出血并发症、价格昂贵等缺点。因此,积极联用抗栓药物和经皮冠状动脉介入术治疗AMI,乃是降低病死率的倡用办法。     

女性急性心肌梗塞患者溶栓疗效观察

目的　观察女性急性心肌梗塞 (AMI)患者接受静脉溶栓治疗的临床效果。方法　回顾分析 3年内接受静脉溶栓 3 0 2例 (AMI)患者中的 83例女性AMI的临床疗效。结果　 ( 1 ) 83例女性AMI与 2 1 9例男性患者比较 ,溶栓后梗塞相关血管 (IRA)再通率明显为低 ( 57 8%比 73 5% ,P <0 0 1 ) ,尤其3 8例≥ 60岁的老年女性比 92例老年男性明显为低 ( 55 9%比 73 0 % ,P <0 0 2 5)。 ( 2 )经溶栓治疗的男性AMI患者比女性的 5周死亡率 ( 4 1 %比 1 4 5% ,P <0 0 1 )及中度以上心衰率 ( 1 4 2 %比 2 6 5% ,P<0 0 5)明显为低。结论　国人女性AMI患者接受溶栓治疗安全有效 ,但其临床疗效似乎低于男性患者。     

Routine Coronary Arteriography Following Thrombolytic Therapy for Acute Myocardial Infarction: An Unsettled Controversy

Although coronary artery disease remains the leading cause of death in industrialized countries, the management of patients recovering from acute myocardial infarction varies significantly. The issue of routine arteriography and revascularization following thrombolytic therapy remains controversial despite substantial evidence associating infarct-related artery patency with improved cardiac function and survival. Randomized trials of routine intervention after myocardial infarction have generally failed to demonstrate advantages of this invasive approach but methodological problems limit their application to current practice. High-risk patients should be referred for arteriography. While awaiting definitive trials addressing the influence of routine arteriography on patient survival and its cost effectiveness, the management of other patient groups must be individualized.     

急性心肌梗死药物治疗研究进展

急性心肌梗死的治疗主要涉及药物和介入两个方面。及时有效的介入治疗能迅速开通阻塞的冠状动脉、挽救濒死心肌,降低急性心肌梗死病人的病死率和病残率。与介入治疗相比,强化的药物治疗方案不仅价格便宜,而且更容易推广实施。现就有关的药物治疗现状及进展作一综述。     

静脉溶栓治疗急性右室心肌梗塞的疗效观察

目的探讨静脉溶栓治疗急性右室心肌梗塞之临床疗效及安全性。方法连续选择4年内649例AMI患者中，67例右室AMI（均合并下、后壁心肌梗塞）患者诊治资料，进行各亚组疗效比较。结果（1）67例右室AMI患者中，42例接受溶栓治疗，高于平均接受率（62．7％比46．1％，P＜0．01）。（2）未接受溶栓治疗之患者中，右室AMI在住院期病死率（28．0％比13．6％）、右心衰合并左心功能不全≥KillipⅢ级（60％比32．6％）及恶性心律失常发生率（44％比21．8％）均比非右室AMI患者明显为高（P＜0．05～0．01）。（3）右室AMI患者比非右室组，在溶栓后的病死率（-20．9％比-7．4％）、心功能≥Ⅲ级（-31．4％比-19．0％）及严重心律失常发生率（-25．0％比-11．7％）的净减少率均更为显著（P＜0．05～0．01）。结论右室AMI患者接受静脉溶栓治疗安全、有效，并比非右室AMI患者得益更大。     

Serum Amyloid A Protein in Acute Myocardial Infarction

ABSTRACT Tissue injury including myocardial infarction leads to a variety of changes in plasma proteins commonly referred to as “the acute phase response”. In this report the concentrations of serum amyloid A protein (SAA) were measured serially in 6 patients with myocardial infarction and 4 with angina. SAA was found to be increased in all patients with infarction, but in no patients with angina. Significantly increased SAA levels were detected 12 hours after the peak level of creatine kinase, and the concentrations of SAA seemed to correlate to the amount of damaged tissue. The SAA-response was both faster and more extensive than the response of C-reactive protein (CRP), but the correlation between SAA and CRP was very good.     

AMI患者尿激酶与组织型纤溶酶原激活剂治疗结果的对比

比较31例尿激酶(UK)及14例组织型纤溶酶原激活剂(t-PA)静脉溶栓辅以阿斯匹林及肝素治疗急性心肌梗塞(AMI)的疗效.t-PA组与UK组相比较:血管再通率分别为78.6%与58.1%(P>0.05);脑、消化道及呼吸道出血并发症在t-PA组稍多,而UK组以局部皮肤出血较多.血管再通组心力衰竭、严重性心律失常、室壁瘤及梗塞后心绞痛的发生率较低,但两组间均无显著性差异;再通组病人心脏破裂的发生明显低于未再通组(0与17.6%P<0.05).本研究提示静脉t-PA溶栓治疗血管再通率高于静脉UK,有条件者可以首选t-PA.溶栓再通可以减少心力衰竭、室壁瘤、心梗后再缺血的发生,特别是心脏破裂的发生,从而改善病人的预后.     

Bolus Administration of Saruplase in Europe (BASE), a Pilot Study in Patients with Acute Myocardial Infarction

To study the safety and efficacy of the thrombolytic agent saruplase as a bolus, the angiographic and clinical outcomes of three bolus regimens were investigated in a pilot study conducted in 192 patients with an acute myocardial infarction and were compared with the standard regimen. Fifty-two patients received a double bolus of 40 mg and 40 mg after 30 minutes, 51 patients a bolus of 80 mg, and 36 patients a bolus of 60 mg. Fifty-three patients received the standard regimen (a bolus of 20 mg and 60 mg IV infusion over 1 hour). At 60 minutes TIMI 2 and 3 flow were, respectively, 9.6% and 61.5% with the 40/40-mg bolus, 15.7% and 51.0% with the 80-mg bolus, 16.7% and 30.6% with the 60-mg bolus, and 7.5% and 54.7% with the standard 20/60-mg infusion. At 90 minutes TIMI 2 and 3 flow improved to 9.6% and 73.1%, 15.7% and 56.9%, 13.9% and 36.1%, and 5.7% and 71.7%, respectively. The primary endpoint, persistent patency (TIMI 2 + 3) at 24–45 hours, was seen in 69.2%, 64.7%, 44.4%, and 67.9% of patients who had no rescue PTCA, respectively. Inclusion in the 60-mg bolus group was prematurely stopped because of their low patency rates. The 40/40-mg bolus group had the highest mortality rate (13.5%), whereas the 60-mg bolus group had no deaths. Other adverse event rates were similar in the four groups. This clinical outcome is highly influenced by rescue PTCA of patients with insufficient TIMI flow. This pilot study indicates that in patients with an acute myocardial infarction, a double bolus of 40/40 mg resulted in the highest patency but also had the highest complication rate. The 80-mg single bolus is an attractive alternative for further evaluation because of its acceptable patency and event profile, and its easy form of administration.     

Changes in Autonomic Tone Following Thrombolytic Therapy for Acute Myocardial Infarction:

Heart Rate Variability in Acute MI. Introduction: Little data are available on changes in autonomic tone during the first 24 hours of acute infarction in patients undergoing thromholytic therapy. Particularly, the association of changes in autonomic tone to reperfusion of the infarctrelated artery has not been evaluated in man. Heart rate variability (HRV) is a noninvasive tool to assess cardiac autonomic tone, which carries prognostic information in postinfarction patients. Methods and Results: To assess changes in autonomic tone with ungiographically assessed success of thrombolysis in patients with acute infarction, the proportion of adjacent RR intervals different by greater than 50 msec (pNN50) was analyzed from 24-hour Holler monitoring initiated before the start of thrombolytic therapy in 103 consecutive patients. Mean heart rate (HR) and pNN50 were available in 95 of 103 patients and were separately analyzed for the first hour after initiation of thrombolysis (reperfusion phase) and the first 24 hours. As assessed by coronary angiography 90 minutes after start of thrombolysis, 74 patients (78%) had successful coronary artery reperfusion. HR averaged 72 ± 13/min for the first hour in all 95 patients and 74 ± 13/min for the first 24 hours. The respective values for pNN50 were 11±2%± 11±7% for the first hour and 9±7%± 9±2% for the first 24 hours. Patients with inferior myocardial infarction (MI) had a lower mean HR of 72 ± 12/min versus 76 ± 13/min (P = 0±11) and a higher pNN50 (11±2%± 9±8% versus 7±6%± 8±3%, P = 0±01) compared to patients with anterior MI. The mean HR correlated weakly with pNN50 (r = -0±33, P < 0±01). For patients with coronary artery patency after 90 minutes, mean HR was 70 ± 12/min for the first hour compared to 80 ± 13/min for patients without (P = 0±003). For the first 24 hours, these values were 72 ± 12/min compared to 80 ± 14/min (P = 0±02). For the first hour, pNN50 averaged 12±6%± 12±4% for patients with successful reperfusion compared to 6±6%± 7±3% for patients without (P = 0±024). For the first 24 hours, these values were 9±2%± 8±5% compared to 11±5%± 11±3% (P = NS). Patients with inhospital ventricular fibrillation (n = 8) had a higher mean HR throughout the first 24 hours (88 ±16/min vs 73 ± 12/min, P = 0±008) compared to patients with an uneventful course. Additionally, there was a trend toward a lower HRV in patients with ventricular fibrillation. Conclusion: Thrombolysis-induced reperfusion of the infarct-related artery results in a higher vagal tone during the early hours of MI as compared to failed reperfusion. This finding is independent from intfarct location and associated with a trend toward a lower incidence of ventricular fibrillation during the acute phase of infarction.