心脏肌钙蛋白Ⅰ在急性心肌梗死中的临床意义

目的：探讨心脏肌钙蛋白Ⅰ(cTnⅠ)在急性心肌梗死(AMI)中的临床意义。方法：60例AMI,其中Q波型AMI 42例,非Q波型AMI 18例,分别于入院即刻、24小时、72小时、7天抽血,测定cTnⅠ、CK-MB,随访半年。结果：(1)cTnⅠ阳性率在AMI即刻、24小时、72小时、7天的Q波型AMI和非Q波型AMI依次分别为23.8%,100%,90.48%,26.19%;11.11%,77.78%,55.56%,16.61%。Q波型AMI的cTnⅠ水平明显依次高于CK-MB的11.9%、90.48%、11.97%、0%;(2)第7天持续阳性的14例中,4例死于心脏骤停,5例发生心衰,5例发生心绞痛。结论：(1)AMI后24小时cTnⅠ阳性率高于CK-MB;(2)cTnⅠ阳性持续者预后不佳。     

心脏肌钙蛋白I在急性心肌梗死中的临床意义

目的：探讨心脏肌钙蛋白I（cTnI)在急性心肌梗死（AMI）中的临床意义。方法：60例AMI,其中Q波型AMI42例,非Q波型AMI18例,分别于入院即刻、24小时、72小时、7天抽血,测定cTnI、CK－MB,随访半年。结果：（1）cTnI阳性率在AMI即刻、24小时、72小时、7天的Q波型AMI和非Q波型AMI依次分别为23．8％,100％,90．48％,26．19％;11．11％,77．78％,55．56％,16．61％。Q波型AMI的cTnI水平明显依次高于CK－MB的11．9％、90．48％、11．97％、0％;（2）第7天持续阳性的14例中,4例死于心脏骤停,5例发生心衰,5例发生心绞痛。结论：（1）AMI后24小时cTnI阳性率高于CK－MB;（2）cTnI阳性持续预后不佳。     

床旁临时心脏起搏在急性心肌梗死抢救中的应用

目的评价床旁临时心脏起搏在急性心肌梗死抢救治疗中的应用价值。方法45例急性心肌梗死合并缓慢性心律失常患者，男性28例，女性17例，平均年龄48-81（62±13．5）岁，通过床旁置入临时心脏起搏抢救治疗。结果所有患者均成功置入临时心脏起搏，平均置入时间（3．5±1．2）min。起搏位点：38例为右室心尖部，5例为右室流出道起搏，2例为心房起搏。平均起搏时间（3．8±1．3）d，电极导管脱位4例。结论床旁临时心脏起搏置入是治疗急性心肌梗死合并缓慢性心律失常安全有效的方法。     

急性心肌梗死中H-FABP和NT-proBNP检测的临床意义

采用ELSA法和电化学发光法检测98例急性心肌梗死(AMI)患者血清心肌脂肪酸结合蛋白(H-FABP)及N末端B型钠尿肽(NT-proBNP)的水平变化,随诊6个月.采用AMI发病6个月时左心室舒张末期容积(ΔLVEDV)＞20%作为发生左室重构的标准.发现AMI患者第3天血清NT-proBNP为(1.784.4±1.593.4)ng/L,与6个月ΔLVEDV呈正相关(r=0.42,P<0.05).认为H-FABP可作为AMI的早期诊断指标,同时NT-proBNP的水平可预测AMI患者的预后.     

急性ST段抬高性心肌梗死NT-proBNP与急性非ST段抬高性心肌梗死NT-proBNP对比观察

目的探讨急性ST段抬高性心肌梗死NT-proBNP的水平与急性非ST段抬高性心肌梗死NTproBNP水平有无差异。方法对201例即符合＂急性心肌梗死诊断标准＂又距离发病时间小于12小时的病人,入院后立即采静脉血3毫升,使用广州万孚生物技术股份有限公司生产的＂飞测＂免疫荧光检测仪检测NT-proBNP;根据心电图分为急性ST段抬高性心肌梗死组与急性非ST段抬高性心肌梗死组,将两组的NT-proBNP进行对比观察,进行统计学分析。结果急性ST段抬高性心肌梗死组NT-proBNP的水平明显高于急性非ST段抬高性心肌梗死组NT-proBNP水平,两组对比有显著差异,P〈0.01。结论 NT-proBNP的水平与急性心肌梗死时冠状动脉是否完全闭塞,导致心肌细胞坏死的多少有密切关系。     

心电图在急性心肌梗死诊断中的应用

目的 探究心电图检查在急性心肌梗死诊断中的应用价值.方法 课题纳入对象为笔者单位收治的急性心肌梗死患者,病历开展时间为2019年1月到12月,共计60例,发病至入院时间在2 h以内的患者设为1组,共20例,发病至入院时间在2-6h的患者设为2组,共20例,发病至入院时间超6 h的患者设为3组,共20例,均予以心电图检查.结果 1组阳性率较2组、3组低;结合血清心肌损伤标志物(cTn、CK-MB)检查,ST段抬高型急性心肌梗死阳性检出率90.0%,ST段非抬高型急性心肌梗死阳性检出率10.0%.结论 心电图在诊断急性心肌梗死应用中具有显著价值.     

血清心脏肌球蛋白结合蛋白C检测在急性心肌梗死患者诊断中的作用

目的探讨血清心脏肌球蛋白结合蛋白C(c My BP-C)在急性心肌梗死(AMI)患者诊断中的价值。方法选择2014年3月至2015年11月心血管内科收治的AMI患者62例作为病例组,选取正常体检者60例作为对照组。采用双抗体夹心酶联免疫吸附试验(ELISA)法检测血清c My BP-C浓度。比较AMI组与对照组间c My BP-C、肌钙蛋白Ⅰ(c TnⅠ)、肌酸激酶同工酶(CK-MB)和肌红蛋白(Myo)浓度的差异,分析AMI组c My BP-C与c TnⅠ、CKMB和Myo的相关性,同时分析发病时间小于4 h的AMI患者入院时血清c My BP-C和c TnⅠ浓度与对照组的差异,比较急诊经皮冠状动脉介入(PCI)术后12 h与入院时血清c My BP-C和c TnⅠ的差异。结果 AMI组患者血清c My BP-C、c TnⅠ、CK-MB和Myo浓度较对照组均明显升高(P0.05)。相关性分析显示,AMI组患者c My BP-C浓度与c TnⅠ、CK-MB和Myo浓度均存在正相关(分别为r=0.876、P0.05;r=0.632、P0.05和r=0.903、P0.05)。发病时间小于4 h的AMI患者入院时血清c My BP-C浓度较对照组明显升高(P0.05),而血清c TnⅠ浓度与对照组比较差异无统计学意义(P0.05)。行急诊PCI术后12 h血清c My BP-C浓度较入院时明显下降,而c TnⅠ浓度较入院时明显升高(P0.05)。结论 AMI患者入院时血清c My BP-C、c TnⅠ、CK-MB和Myo浓度较对照组均显著升高且c My BP-C浓度与c TnⅠ、CK-MB和Myo浓度均存在正相关;c My BP-C在发病4 h内即开始升高,提示c My BP-C可以作为诊断AMI的早期生化标志物。AMI患者行急诊PCI术后12 h血清c My BP-C浓度较入院时明显下降,表明c My BP-C可以作为评估PCI术效果的早期指标。     

人工神经网络在急性心肌梗死诊断中的应用

目的:提高急性心肌梗死诊断准确性。方法:选取已被确诊的心血管病人100例在设计的人工神经网络进行训练,另外对100例高度怀疑急性心肌梗死病例采取随机双盲形式,交叉经人工神经网络进行处理及临床医生常规诊断。结果:临床医生诊断敏感性为77.7％,诊断特异性84.7％.准确性79％,人工神经网络诊断敏感性97.2％,特异性为96.2％,诊断准确性96％,较临床医生诊断能力有显著提高,P分别为<0.05,<0.01,<0.05。结论:人工神经网络可提高急性心肌梗死诊断的准确性。     

心脏型脂肪酸结合蛋白在急性心肌梗死早期诊断中的价值

目前临床早期诊断急性心肌梗死(AMI)的指标主要有肌酸激酶(CK)、肌酸激酶异构酶(CK-MB)、肌钙蛋白I(TroponinI)、肌钙蛋白T(Troponin T)和肌红蛋白(Myoglobin)等。但CK-MB、肌钙蛋白I、肌钙蛋白T缺乏敏感性,它们在胸痛后6～8h浓度才上升;肌红蛋白则缺乏特异性,虽然在胸痛后2～3h浓度上升,但其不能区分骨骼肌和心肌损伤。近来Alhadi等〔1,2〕报道心脏型脂肪酸结合蛋白(h-FABP)在胸痛后2～3h后浓度开始上升,在4～8h内达到最高值,在12～24h内恢复到正常水平,且h-FABP的免疫性不同于其他类型的FABP,具有特异性,不会发生交叉反应,…     

血栓抽吸导管在老年人急性心肌梗死治疗中的应用

目的 评估ZEEK血栓抽吸导管在老年人急性心肌梗死患者治疗中的应用.方法 将94例行急诊介入治疗的老年急性ST抬高心肌梗死患者分为两组,其中使用ZEEK血栓抽吸导管52例(抽吸组),未使用ZEEK血栓抽吸导管42例(对照组).观察无复流发生率、术后ST段下降率、住院病死率及左心室射血分数等.结果 ZEEK组1例(1.9%)发生无复流,住院期间无死亡;对照组中5例(11.9%)发生无复流,死亡2例(4.8%).两组患者的无复流发生率、ST段下降率、住院病死率及心功能差异有统计学意义(均P＜0.05).结论 老年人急性心肌梗死在急诊介入治疗中,应用ZEEK血栓抽吸导管安全可行,可清除冠状动脉内血栓,改善心肌组织灌注,有可能改善术后心脏功能.     

急性心肌梗死再灌注治疗后血浆NT-proBNP和SvO2水平与预后的关系

目的：探讨急性心肌梗死（AMI）患者血浆N末端脑钠肽前体（NT-proBNP）和混合静脉血氧饱和度（SvO2）水平与AMI患者预后的关系。方法纳入2011年7月~2012年7月包头市中心医院初发AMI患者且胸痛6h内行再灌注治疗（静脉溶栓或急诊PCI）的患者120例,测定N末端脑钠肽（NT-proBNP）及SvO2,根据以上两结果将入选患者分为A组（n=60,SvO2＞60%、NT-proBNP＜1000 pg/ml）和B组（n=60,SvO2＜60%、NT-proBNP＞1000 pg/ml）。比较两组患者左室射血分数（LVEF）和6个月内心血管不良事件（包括心源性猝死、心源性休克、恶性心律失常）的发生率,并对NT-proBNP和SvO2与不良事件的发生率进行相关性分析。结果治疗后A组患者LVEF高于B组（54.75%±5.18% vs.34.65%±8.11%）,同时不良心血管事件发生率明显低于B组（10.0% vs.16.7%）,差异均有统计学意义（P＜0.05）。双变量相关分析显示NT-proBNP水平与心血管不良事件发生呈正相关（r=0.474,P＜0.01）;SvO2与不良事件发生呈负相关（r=-0.834,P＜0.01）。结论急性心肌梗死患者NT-BNP＜1000 pg/ml且SvO2＞60%治疗后心功能恢复较好,且预后良好,NT-proBNP和SvO2均与心功能具有相关性。     

N-乙酰半胱氨酸对心肌梗死心室重构的影响

目的:观察N-乙酰半胱氨酸(NAC)对急性心肌梗死(AMI)左室重构的影响.方法:比较常规治疗组(对照组)和常规治疗基础上加用NAC组(实验组)的超声指标、氨基末端脑钠肽(NT-proBNP)和严重心脏不良事件(MACE).结果:实验组术后3个月左室舒张末容积、左室收缩末容积、心室重构发生率、NT-proBNP、MACE发生率显著低于术前和对照组(P<0.05),左室球形指数和左室射血分数显著高于术前和对照组(P<0.05).结论:NAC可能通过降低NT-proBNP水平而显著改善AMI心室重构.     

急性心肌梗死患者血脑钠尿肽前体N末端的变化

目的:观察B型脑钠尿肽前体N末端（NT-proBNP）在急性心肌梗死（AM I）患者的变化。方法:应用电化学发光-夹心免疫分析法检测26例首次发生的ST段抬高型透壁性心肌梗死患者的血NT-proBNP,分析其与肌酸激酶MB同工酶、梗死部位和心功能的关系。对照组采用经临床和超声心动图检查无心脏结构和功能异常或其它伴随疾病的轻度高血压或稳定劳力性心绞痛患者22例。结果:AM I患者血NT-proBNP显著高于正常心功能对照组（2097±2008 ng/Lvs70±51 ng/L,P<0.01）。心功能≥Ⅱ级组血NT-proBNP显著高于心功能Ⅰ级组,分别为3172.6±2448.9 ng/L和1175±710.0 ng/L（P<0.01）。NT-proBNP与K illip分级呈正相关。结论:AM I后心脏钠尿肽系统激活,其改变与心功能分级有关,但无心室功能障碍和心房压升高者亦显著升高。     

N-terminal pro B-type natriuretic peptide in the early evaluation of suspected acute myocardial infarction

Background

Myocardial ischemia is a strong trigger of N-terminal pro-B-type natriuretic peptide (NT-proBNP) release. As ischemia precedes necrosis in acute myocardial infarction, we hypothesized that NT-proBNP might be useful in the early diagnosis and risk stratification of patients with suspected acute myocardial infarction.

Methods

In a prospective multicenter study, NT-proBNP was measured at presentation in 658 consecutive patients with acute chest pain. The final diagnosis was adjudicated by 2 independent cardiologists. Patients were followed long term regarding mortality.

Results

Acute myocardial infarction was the adjudicated final diagnosis in 117 patients (18%). NT-proBNP levels at presentation were significantly higher in acute myocardial infarction as compared with patients with other final diagnoses (median 886 pg/mL vs 135 pg/mL, P <.001). The diagnostic accuracy of NT-proBNP for acute myocardial infarction as quantified by the area under the receiver operating characteristic curve (AUC) was 0.79 (95% confidence interval [CI], 0.75-0.83). When added to cardiac troponin T, NT-proBNP significantly increased the AUC from 0.89 (95% CI, 0.84-0.93) to 0.91 (95% CI, 0.88-0.94; P = .033). Cumulative 24-month mortality rates were 0% in the first, 1.3% in the second, 8.3% in the third, and 23.3% in the fourth quartile of NT-proBNP (P <.001). NT-proBNP (AUC 0.85, 95% CI, 0.81-0.89) predicted all-cause mortality independently of and more accurately than both cardiac troponin T (AUC 0.66, 95% CI, 0.58-0.74; P <.001) and the Thrombolysis in Myocardial Infarction risk score (AUC 0.79, 95% CI, 0.74-0.84; P <.001). Net reclassification improvement (Thrombolysis in Myocardial Infarction vs additionally NT-proBNP) was 0.188 (P <.009), and integrated discrimination improvement was 0.100 (P <.001).

Conclusions

Use of NT-proBNP improves the early diagnosis and risk stratification of patients with suspected acute myocardial infarction.     

N-末端脑钠尿肽原诊断急性心肌梗死患者左室舒张功能的价值及其判断预后的意义

目的: 利用超声心动图,探讨N-末端脑钠尿肽原（NT-proBNP）对急性心肌梗死(AMI)患者左室舒张功能的评价及其意义。方法: 入选左室收缩功能正常的AMI患者66例,测定血浆NT-proBNP水平。根据组织多普勒超声（TDI）及二尖瓣血流频谱指标评价的左室舒张功能,将患者分为4组:A组:左室舒张功能正常组（n=16）;B组:轻度左室舒张功能减低（LVDD）组（n=21）;C组:中度LVDD组（n=24）;D组:重度LVDD组（n=5）。对患者随访12个月,临床终点是因心衰加重或再梗所致再住院和心源性死亡。结果: NT-proBNP水平随着LVDD的加重而显著增高（P<0.01）。NT-proBNP能够独立于其它影响因素判断LVDD,当其水平为962.1 μg/L时,判断LVDD的敏感性是76%,特异性是75%。12个月后发生终点事件患者的血浆NT-proBNP水平与未发生者相比差异有统计学意义（P<0.05）。结论: AMI后NT-proBNP水平能够独立评价LVDD并判断预后。它可用于对AMI患者危险分层并指导临床治疗。     

NT-proBNP predicts impaired myocardial function in newly diagnosed hypertensive patients with preserved ejection fraction

N-terminal pro-brain natriuretic peptide (NT-proBNP) is an excellent biomarker to diagnose left ventricular (LV) dysfunction. LV myocardial performance index (MPI-Tei index) is commonly used as a measure of combined systolic and diastolic function. We aimed to investigate the relationship between NT-proBNP and tissue Doppler derived MPI in newly diagnosed hypertensive patients with preserved LV ejection fraction (LVEF). We studied 236 patients with newly diagnosed HT (mean age; 52.9?±?5.2 years). Echocardiographic examination was performed in all patients. LV mass index (LVMI) was calculated. Conventional Doppler indices (E and A waves) were recorded. The MPI value was obtained from the tissue Doppler derived ejection time, isovolumic contraction and relaxation times. The patients were divided into two groups according to the median NT-proBNP value (NT-proBNP_low group <114?pg/ml and NT-proBNP_high group ≥114?pg/ml). Patients with NT-proBNP_high were older and had higher levels of glucose and creatinine, lower E/A ratio and higher LVMI and MPI values than patients with NT-proBNP_low. However, LVEF were similar among the groups. Multiple linear regression analysis showed that NT-proBNP was independently associated with age, LVMI, MPI and E/A ratio. Increased NT-proBNP level was independently associated with impaired myocardial performance index in newly diagnosed hypertensive patients with preserved LVEF.     

Prognostic utility of NT-proBNP in acute exacerbations of chronic pulmonary diseases

Background

The prognostic value of NT-proBNP levels in patients admitted to hospital due to acute exacerbations of chronic pulmonary diseases (CPDs) is unknown.

Setting

Internal Medicine units at two general hospitals.

Methods

NT-proBNP levels were obtained within 72 h after admission in 192 consecutive patients with acute exacerbations of CPDs and no history of heart failure or diuretic treatment. Clinical characteristics and main outcomes were assessed over a 12-month follow-up. NT-proBNP cut-points for outcomes were obtained by ROC (receiver operating characteristics) curve analysis.

Results

Chronic obstructive lung disease (69.3%) and chronic asthma (22.4%) were the most prevalent CPDs, and non-pneumonic acute respiratory infection (72.4%) and pneumonia (22.9%) were the most frequent causes of exacerbation. Atrial flutter or fibrillation rate was 11%. During the one-year follow-up period, 22 patients died, 42 were re-admitted, 46 received new long-term oxygen therapy, and 39 received new diuretic treatment.NT-proBNP values correlated with hospitalisation days. NT-proBNP values over 587.9 pg/ml were associated with significantly raised one-year mortality (OR = 3.90; 95% IC 1.46-10.47; p = 0.006) and over 782.2 pg/ml with cardio-pulmonary deaths (OR = 6.38; 95% IC 1.91-21.3; p = 0.002). That association persisted after adjustment for age, gender, creatinine levels and cardiac rhythm. NT-proBNP values over 628.7 pg/ml were associated with significantly higher probability of new diuretic treatment (OR = 4.38; IC 95% 2.07-9.25; p < 0.001). The negative predictive values for these cut-points ranged from 89% to 97%.

Conclusion

NT-proBNP levels below 587.9 pg/ml in patients with acute exacerbations of CPD were associated with favourable one-year outcomes.     

检测NT-proBNP在鉴别急性呼吸困难病因的应用价值

目的探究利用床旁快速检测B型钠尿肽前体(NT-proBNP)鉴别急性呼吸困难病因的应用价值。方法采用免疫定量分析法对300例急性呼吸困难患者的血浆NT-proBNP浓度进行测定。结果心源性呼吸困难患者的NT-proBNP水平显著高于肺源性呼吸困难患者(P0.05);不同心功能分级患者的NTproBNP水平对比,差异有统计学意义(P0.05)。结论利用床旁快速检测血浆NT-proBNP浓度,能够有效鉴别心源性呼吸困难和肺源性呼吸困难,具有较高的应用价值,值得临床进一步推广。     

ST段抬高型心肌梗死患者N末端脑利钠肽前体水平及其相关因素分析

目的探讨N末端脑利钠肽前体(NT-proBNP)在ST段抬高型心肌梗死患者的水平及其相关影响因素。方法入选诊断明确的急性ST段抬高型心肌梗死患者,并对NT-proBNP水平与可能的相关因素如性别、年龄、病史、心肌梗死范围、心房心室大小、冠状动脉病变情况、治疗情况以及肌钙蛋白I峰值等进行分析。结果在70例患者中未发现性别、高血压或糖尿病病史以及心房心室大小影响NT-proBNP水平。前壁心肌梗死或者心肌梗死累及部位更多的患者,NT-proBNP水平较高[累及前壁的心肌梗死(5116.7±2657.3)ng/L比非前壁心肌梗死(1150.5±916.1)ng/L,P=0.002;3部位受累患者(6269.3±3394.9)ng/L比2部位受累患者(4468.6±2259.8)ng/L或1部位受累患者(1282.1±946.4)ng/L,P=0.027]。年龄(r=0.335,P=0.009)和血肌酐水平(r=0.495,P=0.000)与NT-proBNP水平正相关,LVEF与其呈负相关(r=-0.343,P=0.01),差异有统计学意义。罪犯血管为前降支病变也与较高的NT-proBNP水平相关[前降支(4179.1±2728.2)ng/L比右冠状动脉或回旋支(670.7±359.2)ng/L,P=0.011]。接受直接冠心病介入治疗(PCI)者NT-proBNP水平较低[接受直接PCI(2690.8±1459.9)ng/L比未接受直接PCI的患者(6260.0±3191.2)ng/L,P=0.039]。结论 ST段抬高型前壁心肌梗死患者NT-proBNP较高,其升高程度与心电图判断的心肌受累范围相关,接受直接PCI的患者NT-proBNP水平较低。低LVEF与NT-proBNP水平升高的相关性不受年龄和血肌酐水平的影响。     

老年AMI患者急诊PCI前后NT-proBNP水平变化对心功能的预测价值

目的探讨老年急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)前后,血浆氨基末端B型利钠肽前体(NT-proBNP)水平变化对心脏功能的预测价值。方法 52例老年(62～79岁)AMI患者入院时和急诊PCI术后7d应用免疫荧光法测定血浆NT-proBNP浓度,按其PCI治疗前后变化的程度分为明显降低组(A组)和无明显降低组(B组),比较两组PCI术后15d及180d超声心动图心功能相关参数的变化。结果 PCI术180d后A组左心室射血分数(LVEF)和E/A比值显著高于B组,差异有统计学意义(P0.01);左心室舒张末内径(LVDd)、左心室等容舒张时间(IVRT)显著低于B组,差异有统计学意义(P0.05)。结论急诊PCI术后血浆NT-proBNP的动态变化程度能预测老年AMI患者心脏功能。