甲减性心脏病患者血清促甲状腺激素受体抗体、抗甲状腺过氧化物酶抗体水平的变化

目的研究甲状腺功能减退性心脏病患者血清促甲状腺激素受体(TR)、抗甲状腺过氧化物酶(TPO)抗体水平的变化。方法甲减心脏病患者60例,根据患者肌酸激酶(CK)及其同工酶(CKMB)、乳酸脱氢酶(LDH)等水平分两组,即心肌酶谱正常组、心肌酶谱升高组。观察患者TR、TPO抗体水平变化,分析甲减性心脏病患者TR、TPO抗体水平变化及其与心肌酶谱的相关性。结果与心肌酶谱正常者相比,心肌酶谱升高组患者血清TR、TPO抗体水平明显升高(P<0.05),直线相关分析显示TR、TPO抗体与各心肌酶呈正相关(P<0.05)。结论甲减性心脏病患者TR、TPO抗体水平明显增高,且与心肌损伤程度呈正相关。     

甲状腺功能减退性心脏病误诊11例分析

甲状腺功能减退性心脏病(简称甲减心)并不少见。因甲状腺激素(TH)不足或缺如引起代谢障碍波及心脏引起。成人甲减心病情隐匿，发展缓慢，临床表现多样化，有较高误诊、漏诊率。本文报告1999-2003年有11例甲减心误诊情况，现报告如下。     

原发性甲状腺功能减退症血脂和心肌酶谱的变化

原发性甲减患者40例,在诊断初和经左旋甲状腺素治疗4～12周后,分别测定空腹血清FT3、FT4、TSH、总胆固醇（TC）、甘油三酯（TG）、门冬氨酸氨基转移酶（AST）、肌酸激酶（CK）及其同工酶（CK—MB）、乳酸脱氢酶。结果甲减可致血脂、心肌酶谱显著增高,优甲乐替代治疗12周后,甲状腺功能恢复正常,TC、LDL—C、心肌酶谱均明显下降。结论原发性甲减患者应用左旋甲状腺素治疗可显著降低TC、LDL—C、心肌酶谱水平。     

原发性甲状腺功能减退患者左旋甲状腺素治疗后心肌酶学的变化

原发性甲状腺功能减退症（甲减）多数起病隐匿，70％～80％患者有心血管系统表现，极易漏诊、误诊。近年来陆续有甲减患者心肌酶增高的报道。本文观察了青海地区36例原发性甲减患者在左甲状腺激素替代治疗后心肌酶学的变化。     

甲状腺功能减退性心脏病15例误诊分析

甲状腺功能减退性心脏病（简称甲减心）并不少见，因甲状腺激素（TH）不足或缺如引起代谢障碍波及心脏引起。成人甲减心病情隐匿，发展缓慢，临床表现多样化，有较高的误、漏诊率。本文报告武汉市第十三医院2000年5月-2005年5月15例甲减心误诊情况，并分析原因。[第一段]     

甲状腺素对原发性甲减患者心肌酶谱、血脂的影响

原发性甲状腺功能减退症(甲减)是由于各种原因造成甲状腺合成、分泌甲状腺激素缺乏,机体的代谢和身体的各个系统功能减退,而引起的临床综合征.近年来陆续有原发性甲减患者心肌酶谱增高的个案报道~([1,2]),亦有研究~([3])显示甲减时血总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平增高,但对原发性甲减患者心肌酶谱、血脂水平的升高及甲状腺素治疗后对其动态影响缺乏系统性的研究资料.     

甲状腺功能减退症患者睡眠呼吸障碍的临床研究

本研究采用多导睡眠监测仪(polysomnography,PSG)对甲状腺功能减退症(甲减)患者进行监测,15例甲减患者经PSG检查,14例诊断为阻塞性睡眠呼吸暂停(OSA)。治疗前心肌酶谱显著增高(磷酸肌酸激酶384～2140U/L,乳酸脱氢酶270～624U/L,门冬氨酸转氨酶40～138U/L)。甲减病情重者,PSG呼吸参数变化明显。甲减引起心肌酶谱增高,可能与OSA导致低氧血症密切相关。用甲状腺激素替代治疗前后睡眠呼吸参数、动脉血氧饱和度(SaO)及心肌酶谱等的改善,差异有显著性(均P<0.05)。     

甲状腺功能减退性心脏病2例误诊分析

目的提高对甲状腺功能减退性心脏病的临床认识,减少误诊和漏诊。方法回顾总结、分析曾收治的2例甲状腺功能减退性心脏病患者的临床资料。结果发现甲状腺功能减退性心脏病首诊症状表现不一,多无典型的临床症状可循,初次多被误诊、漏诊。结论甲状腺功能减退性心脏病临床表现酷似冠心病或其他器质性心脏病的某此症状,容易误诊,故对心肌酶增高、心电图异常但无动态改变者,应考虑到本病的可能,及时进行甲状腺功能检查,以便早期诊断,降低误诊率。     

原发性甲状腺功能减退症治疗前后心肌酶谱变化

目的 检测42例原发性甲状腺功能减退症(甲减)思考治疗前后的血清心肌酶谱，了解其心肌酶谱的动态变化。方法 分为甲减组与对照组，采用酶连续法检测心肌酶谱，放射免疫法检测甲状腺激素和TSH。结果甲减组治疗前心肌酶谱比对照组明显升高(P＜0．01)，给予左甲状腺素钠替代治疗后，心肌酶谱逐渐下降，治疗6周后心肌酶谱恢复至对照组水平（P＞0．05)。甲减组心肌酶谱各酶与TT3、TT4水平均成负相关(P＜0．01)，与TSH水平呈正相关(P＜0．01)。结论 甲减可引起心肌酶谱升高，随着甲减的病情好转，心肌酶谱逐渐恢复。     

甲状腺功能减退性生心脏病的临床研究

目的 总结甲状腺功能减退性心脏病(甲减心)临床特点.方法 回顾分析39例甲减心病人临床材料.结果 甲减心病人以心脏外表现为主,心脏受累表现常不典型.结论 甲减心起病隐匿,进展缓慢,易于误诊,及时检查甲状腺功能等有助于明确诊断,指导治疗.     

29例甲型H1N1流感患者心肌标志物心肌酶的变化及临床意义

目的通过对甲型H1N1流感患者肝酶、心肌酶及心电图变化的研究,探讨甲型H1N1流感患者是否存在心肌损害。方法总结29例临床资料完整而无基础心脏疾病的甲型H1N1流感患者血清天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白T(cTnT)和乳酸脱氢酶(LDH)活性的变化规律。并对甲型H1N1流感患者在病程初期和恢复期的心电图变化进行回顾性分析。结果甲型H1N1流感患者血清AST在病程初期即已升高,但其升高幅度小于ALT,并在治疗稳定期基本恢复正常[AST:(52±35)U/L,(30±29)U/L,(21±17)U/L;ALT:(79±54)U/L,(52±37)U/L,(45±54)U/L];CK、LDH亦在病程初期升高,并随病情好转逐渐降低[CK:(441±223)U/L,(318±146)U/L,(229±67)U/L;LDH:(172±101)U/L,(99±77)U/L,(64±49)U/L],但CK-MB、cTnT始终未见异常;9例(31.0%)患者出现一过性的心电图改变(包括窦性心动过速、房性期前收缩、室性期前收缩等情况)。结论甲型H1N1患者血清AST、ALT、CK、LDH呈一过性升高,但cTnT、CKMB不高,甲型H1N1流感病毒引起心肌损害的几率不高。     

射频消融术对室上性心动过速并存冠心病患者心肌损伤的探讨

目的　根据心肌酶变化计算射频消融术 (RFCA)后心肌受损量 ,探讨RFCA对室上性心动过速 (室上速 )并存冠心病患者心肌的影响。　方法　 90例行RFCA的患者 ,分为冠心病、老年、青年组 ,每组 30例 ,根据其RFCA术前和术后 72h内血清磷酸肌酸激酶 (CK)、磷酸肌酸激酶同工酶 (CK MB)动态变化计算心肌受损量。　结果　冠心病组CK、CK MB恢复正常时间为 (5 2 2 6± 13 35 )h、(36 40± 12 2 0 )h ;CK、CK MB峰值均数为 (2 35 45± 35 2 5 )、(2 3 32± 6 34 )IU/L ;心肌受损量为 (3 6 7±2 13)CK g、(3 41± 2 2 1)CK MB g。冠心病组CK、CK MB恢复正常时间、峰值及心肌受损量均高于老年组及青年组 (P <0 0 5 )。　结论　室上速并存冠心病患者行RFCA时 ,心肌损伤的程度较非冠心病者为重 ,需引起注意。     

肺心病患者血清hs-CRP与心肌酶的临床观察

目的探讨血清hs-CRP(超敏C反应蛋白)、CK-MB(磷酸肌酸激酶同工酶MB)、CK(磷酸肌酸激酶)、LDH(乳酸脱氢酶)、AST(天门冬酸氨基转移酶)在慢性肺心病患者急性发作期及治疗缓解期的变化情况。方法测定95例确诊为肺心病急性发作期患者治疗前后、60例肺心病治疗缓解期患者及30例正常人血清hs-CRP、心肌酶水平。结果肺心病患者血清hs-CRP、心肌酶明显高于健康人群,且急性发作期明显高于临床缓解期(P<0.05);急性发作期患者治疗前后血清hs-CRP、心肌酶差异显著(P<0.05);死亡组血清hs-CRP、心肌酶明显高于存活组(P<0.05)。结论血清hs-CRP与心肌酶的变化可作为肺心病患者的预后及疗效判断的有效指标。     

Usefulness of preoperative and postoperative Tc-99m (Sn)-pyrophosphate scans in patients with ischemic and valvular heart disease.

To assess the usefulness of myocardial imaging with technetium-99m-stannous pyrophosphate for detecting acute myocardial necrosis in patients undergoind cardiac surgery, 66 such patients were stldied. Tc-99m (Sn)-pyrophosphate scans were obtained in all patients 3 to 6 days postoperatively and in 45 preoperatively. Electrocardiograms and serum samples for measuring myocardial isoenzyme of creatine kinase (MB CK) levels were obtained before and serially after cardiac surgery. Seven of the 46 patients undergoing myocardial revascularization had a definite new myocardial infarction as indicated by electrocardiogram and MB CK isoenzyme concentrations, and postoperative pyrophosphate scans were abnormal in all but one. In addition, six of the eight patients with possible myocardial infarction (elevated MB CK levels and persistent ST-T wave depressions) had an abnormal scan postoperatively. Seven of the 20 patients undergoing aortic or mitral valve replacement, or both, had a possible postoperative myocardial infarction by electrocardiogram and MB CK criteria and the myocardial scan was positive in two. All the patients with a normal electrocardiogram and normal MB CK levels had a normal pyrophosphate scan. Preoperative scans were obtained in 22 patients wit; valvular heart disease and were positive in two with a heavy calcified mitral valve on fluoroscopy and in one with a calcified aortic valve. After valve replacement, the pyrophosphate scan became normal in two patients and remained abnormal in the third patient with electrocardiograms and MB CK levels suggesting acute myocardial infarction. We conclude that the Tc-99m (Sn)-pyrophosphate scan is useful for analyzing the occurrence of acute myocardial infarction in patients undergoing cardiac surgery and that, in conjunction with the electrocardiogram, it permits confirmation or exclusion of that diagnosis. Furthermore, false positive pyrophosphate scans may occur in patients with heavy valve calcifications.     

晶体心脏停搏液优于血液心脏停搏液对风湿性心脏病患者的心肌保护

目的比较血液心脏停搏液和晶体停搏液对风湿性心脏病患者心肌保护的效果,为临床选择提供依据。方法将75例择期手术的风湿性心脏病患者分为两组:血液心脏停搏液组(B-rh)和晶体心脏停搏液组(C-rh)。分别于术前1d,术后1,3,5,8d晨分别取静脉血,测定血清天门冬氨酸氨基转氨酶(AST),肌酸激酶(CK)及同工酶MB(CK-MB),乳酸脱氢酶(LDH)及同工酶1(LDH-1)。结果术前除B-rh的LDH略高于正常水平外其它心肌酶的测定结果均在正常范围;术后1d两组的心肌酶分别升高到术前的3~19倍(P<0.05);术后3d两组的CK-MB虽说已恢复到正常值,但五种心肌酶仍明显高于术前水平(P<0.05);术后5dC-rh的CK和CK-MB,B-rh的CK,CK-MB和AST与术前相比已无明显差别(P>0.05);术后8d两组的LDH与LDH-1仍未恢复正常(P<0.05)。两组间有显著差异的心肌酶释放均是B-rh的高。心肌酶的释放量与主动脉阻断时间(CCT)和体外循环时间(ECCT)呈良好的正相关。两组患者的年龄,体重和ECCT无明显差异(P>0.05),CCT以B-rh为短[(77.2±34.6)min比(61.7±26.7)min,P<0.05]。结论从心肌酶的释放来判断,晶体心脏停搏液优于血液心脏停搏液对风湿性心脏病患者的心肌保护效果。     

慢性阻塞性肺病急性加重期心肌酶谱的变化

目的:探讨慢性阻塞性肺疾病(COPD)患者急性加重期低氧血症对心肌酶水平的影响。方法:68例COPD急性加重期患者按动脉血氧分压的水平分成3组。测定各组患者动脉血氧分压(PaO2)及血清天冬氨酸转氨酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(HBDH),并分析其PaO2与血清心肌酶水平的相关性。结果:重度低氧血症组患者血清心肌酶水平明显高于中度低氧血症组和轻度低氧血症组(P<0.01)。COPD急性加重期患者PaO2水平与对应的血清心肌酶呈直线负相关(r=-0.67～-0.87,P<0.01)。结论:低氧血症可导致COPD患者血清心肌酶水平增高,且动脉血氧分压与相应的心肌酶呈直线负相关。     

心肌肌钙蛋白I对体外循环心内直视手术心肌损伤的判定价值

目的探讨心肌肌钙蛋白I（cTnI）对体外循环心内直视手术心肌损伤的判定价值。方法40例心脏瓣膜置换手术病人随机分为两组，冷晶体停跳液组（A组），温血停跳液组（B组），每组20例，分别于围手术期多时点采取中心静脉血，测定血清cTnI、心肌肌酸激酶（CK）及其心肌肌酸激酶同工酶（CK-MB）。结果术前两组的cTnI、CK及CK-MB水平均在正常范围，开放主动脉后1h至术后24h达峰值．其后缓慢下降。术后24h、48hB组cTnI水平明显低于A组（P〈0．05），CK—MB在开放主动脉后1hB组低于A组。cTnI峰值浓度与主动脉阻断时间呈直线正相关。结论cTnI判定心内直视手术围手术期心肌损伤的敏感性及特异性明显优于CK、CK—MB，对围手术期心肌缺血损伤的诊断、预后及心肌保护效果的评价具有重要的临床价值。     

心肌肌钙蛋白I测定对判定体外循环心内直视手术心肌损伤的价值

目的探讨心肌肌钙蛋白I(cTnI)的测定对体外循环心内直视手术心肌损伤的判定价值。方法40例心脏瓣膜置换手术患者随机分为两组,冷晶体停跳液组(A组),温血停跳液组(B组),每组20例,分别于围术期多时点采取中心静脉血,测定血清cTnl、CK及CK—MB的水平。结果术前两组患者的cTnI、CK及CK—MB水平均在正常范围,开放主动脉后1h至术后24h达峰值,其后缓慢下降。术后24h、48h B组cTnI水平明显低于A组(P＜0．05)。CK—MB在开放主动脉后1hB组低于A组(P＜0．05)。cTnI峰值浓度与主动脉阻时间呈直线正相关(P＜0．05)。结论cTnI判定心内直视手术围术期心肌损伤的敏感性及特异性明显优于CK、CK—MB,对围术期心肌缺血损伤的诊断、预后及心肌保护效果的评价具有重要的临床价值。     

Isoenzyme spectrum of creatine kinase and lactate dehydrogenase in the myocardium of patients with ischaemic heart disease

The purpose of the study was to find out the character of the restructuring of enzymes and isoenzymes of creatine kinase (CK), lactate dehydrogenase (LDH) and glucose-6-phosphate-dehydrogenase (G 6 P-DH) in the myocardium, which occurs in patients with ischaemic heart disease (IHD), and to compare the activity of the aforementioned enzymes in the myocardium of patients with IHD, examined intra vitam, and in patients who died suddenly. An analysis was made of 11 samples obtained by myocardial biopsy from the left ventricle of patients with IHD and of 11 samples obtained at autopsy of patients with IHD who have died a sudden death. Serving as controls was bioptic material from the myocardium of 12 patients without IHD. In the myocardium of patients with IHD, examined intra vitam, a decrease in the activity of the mitochondrial isoenzyme CK (MiMi) and the isoenzyme LDH-1, and a considerable rise in the activity of G 6 P-DH were found. In patients with IHD, who have died suddenly, there was found only a decrease in isoenzyme LDH-1 activity and a reduced concentration of CK B-units. The experiments proved that the differences in the myocardial isoenzyme spectrum between the two groups of patients with IHD are not connected with the process of autolysis.     

Enzymic analysis of endomyocardial biopsy specimens from patients with cardiomyopathies.

Myocardial biopsies have been obtained from patients with hypertrophic or congestive cardiomyopathies. Marker enzymes for the principal subcellular organelles of the myocardium were estimated using highly sensitive assay procedures. The results were compared with those obtained in tissue from patients with valvular heart disease with good or poor left ventricular function. Left ventricular myocardial tissue from patients with hypertrophic cardiomyopathy showed essentially normal levels of enzymic activities. In congestive cardiomyopathy, right ventricular tissue showed reduced levels of mitochondrial enzymes with increased levels of lactate dehydrogenase. Left ventricular tissue from patients with congestive cardiomyopathy showed reduced levels of mitochondrial and myofibril enzymes but high levels of lactate dehydrogenase. The reduced levels of myofibril Ca++-activated ATP in congestive cardiomyopathy is similar to that found in patients with impaired left ventricular function secondary to valvular disease. It is suggested that defective mitochondrial function is a characteristic feature of congestive cardiomyopathy and that the increased levels of lactate dehydrogenase reflect a compensatory response.