经皮冠状动脉介入治疗急性心肌梗死过程中超敏C-反应蛋白的动态观察

目的观察经皮冠脉介入治疗急性心肌梗死（AMI）患者血清高敏C-反应蛋白（hs—CRP）的动态变化规律。方法选择60例确诊急性心肌梗死患者于发病6h内行急诊经皮冠脉介入治疗为介入组,用免疫比浊法分别测定所有患者冠状动脉介入治疗（PCI）术前、即刻、术后6、12、24、72h及7d hs-CRP水平,同时30例健康体检者为正常对照,并进行统计学分析。结果PCI组介入治疗后AMI患者血浆hs-CRP水平随时间逐渐升高,在术后72h上升至高峰值,并于7d后恢复至术后12h水平,术后6、12、24、72h及7dhs—CRP水平显著高于正常对照组（P〈0．05）,术后72h高峰值与其他时间点比较均有显著性差异（P〈0．05）。结论经皮冠脉治疗急性心肌梗死患者,发病后短期hs—CRP水平随时间呈动态变化,可作为PCI治疗AMI疗效观察指标之一。     

体质指数与急性心肌梗死后左心室功能的关系

目的观察体质指数(BMI)对急性心肌梗死后左心室功能的影响。方法入选首次急性心肌梗死患者共161例,根据BMI分为正常组(n=50)、超重组(n=85)与肥胖组(n=26)三组,所有患者分别于发病后72 h内、发病后30 d行超声心动图检查测量左心室舒张末期容积(LVEDV)和左心室射血分数(LVEF)及E峰/A峰。结果超重或肥胖组在入院时及30 d随访时的左室舒张末期容积均显著大于正常组(入院时:134.9 ml±33.4 ml/146.9 ml±60.6 ml比134.9 ml±33.4 ml,P=0.016;30 d随访时:149.9 ml±36.6 ml/159.4 ml±54.5 ml比136.0 ml±36.2 ml,P=0.030),超重或肥胖组在入院时及30 d随访时的LVEF水平均显著低于正常组(入院时:49.7%±7.7%或46.8%±7.1%比51.7%±7.6%,P=0.030;30 d随访时:52.9%±7.6%或50.88%±7.1%比55.3%±7.5%,P=0.042)。超重及肥胖组的E/A值与正常组相比在发病72 h及30 d随访时均无显著差异(入院时分别为:0.86±0.23、0.84±0.23比0.85±0.25,P=0.951;30 d随访时分别为:0.97±0.25、0.97±0.20比0.99±0.25,P=0.835)。结论合并超重或肥胖的急性心肌梗死患者的左心室的扩大与LVEF降低更为明显。     

三种心钠素前体肽在急性心肌梗死患者PCI治疗前后的变化及临床意义

目的探讨急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)后ProANF1-31、ProANF31-67、ProANF79-98的变化及意义。方法2002-04~2005-04急诊PCI患者30例,观察时间为入院时(平均4.5h)、PCI术后7d和PCI术后30d,正常对照组为20例健康体检志愿者。放免药盒检测血浆ProANF1-30、ProANF31-67和ProANF79-98水平,彩色超声心动图测定左室舒张末期左室长径(LVEDD)和左室射血分数(LVEF)。结果治疗组ProANF1-30、ProANF31-67、ProANF79-98入院时均明显升高,术后7d变化不显著,术后30dProANF31-67仍高于正常水平,其他两个指标与正常水平比较差异无统计学意义。治疗组各观察点LVEDD和LVEF分别显著高于和低于正常水平,分别呈下降和上升趋势。结论ProANF1-30、ProANF31-67、ProANF79-98在AMI患者入院时(距发病平均4.5h)较正常人明显升高,ProANF可作为诊断AMI的一种新型指标应用于临床。     

糖化血红蛋白水平对急性ST段抬高型心肌梗死患者住院期间及近期预后的影响

目的评价糖化血红蛋白(Hb A1c)水平对急性ST段抬高型心肌梗死(STEMI)患者住院期间及出院30 d左心室射血分数(LVEF)的影响。方法选取诊断为STEMI的患者121例作为研究对象,所有研究对象均行冠状动脉造影检查,根据Hb A1c水平分为Hb A1c升高组(51例)和Hb A1c正常组(70例)。测量Hb A1c水平,记录患者冠状动脉造影结果、肌钙蛋白峰值、B型钠尿肽(BNP)峰值、住院期间主要心血管不良事件(MACE)、住院时间及出院30 d后的LVEF,对比两组以上各指标的情况,分析糖化血红蛋白Hb A1c水平对STEMI患者住院期间及近期预后的影响。结果 Hb A1c升高组在双支或三支病变的发生率较Hb A1c正常组高,差异有统计学意义(P0.05);Hb A1c正常组中局限性狭窄发生率[32例(45.7%)]较Hb A1c升高组[6例(11.8%)]高,差异有统计学意义(χ~2=15.786,P0.001),而弥漫性狭窄在Hb A1c升高组更为常见,差异有统计学意义(P0.05)。两组B型钠尿肽(BNP)峰值和出院30天LVEF相比,差异有统计学意义(均P0.05)。Hb A1c升高组住院时间长于Hb A1c正常组,差异有统计学意义(P0.05);两组患者住院期间肌钙蛋白峰值和MACE的发生率差异无统计学意义(均P0.05)。结论 Hb A1c水平升高是导致STEMI患者发生复杂冠状动脉病变的重要因素,并可以导致患者心功能恶化,延长患者住院时间,进而影响近期预后。     

探讨脂蛋白a在急性心肌梗死患者中的变化及意义

目的 探讨脂蛋白a[lipoproteina,LP(a)]是否具有急性时相反应蛋白的特点,判断能否作为炎症反应的标志物及对心肌梗死患者病情预测价值。方法 连续入选2016年11月至2017年7月首都医科大学附属北京朝阳医院西区稳定型冠状动脉粥样硬化性心脏病患者52例（稳定型冠心病组）及急性心肌梗死患者49例（急性心肌梗死组）,两组患者在入院24h、72h、7d、30d连续检测LP(a)水平,7d内同时间段观察白细胞介素-6、超敏C反应蛋白水平,分析其变化趋势及相关性。结果 急性心肌梗死组超敏C反应蛋白水平在入院24h、72h均高于稳定型冠心病组,差异有显著性（P<0.05）;急性心肌梗死组白细胞介素-6水平在入院24h高于稳定型冠心病组（P<0.05）;LP(a)水平两组比较,在各时间段差异无显著性（P>0.05）。在急性心肌梗死组,LP(a)水平第1～7天逐渐升高,第3～7天达高峰,1个月时基本降至基线水平。白细胞介素-6在入院24h水平升高,24h后逐渐下降;超敏C反应蛋白变化最显著,在24h开始升高,在72h达到最高峰,7d降至正常。结论 超敏C反应蛋白、白细胞...     

急性冠状动脉综合征及介入术后再狭窄患者血浆中单核细胞趋化蛋白1水平的变化

目的:观察急性冠状动脉综合征(包括急性心肌梗死及不稳定型心绞痛)及介入术后再狭窄患者血浆炎症因子单核细胞趋化蛋白1的水平,并与正常对照组对比。方法:选择于2005-12/2006-04在北京大学第三医院心内科就诊的患者68例,其中急性心肌梗死32例,不稳定型心绞痛20例,介入术后再狭窄16例。另选择同期健康体检者30例作为正常对照组。所有观察对象均知情同意。测定所有观察对象的血脂水平:①急性心肌梗死组于入院后即刻(距发病2￣12h)采肘静脉血。②不稳定型心绞痛组及介入术后再狭窄组于入院后即刻(发病24h内)取血。③正常对照组于清晨空腹采血。采血后离心,分离血浆,-70℃冻存,通过酶联免疫吸附反应法集中测定血浆单核细胞趋化蛋白1水平并进行统计分析。结果:98例观察对象全部进入结果分析,无脱落。各组观察对象的血浆单核细胞趋化蛋白1水平比较:急性心肌梗死组、不稳定型心绞痛组、介入术后再狭窄组及正常对照组的血浆单核细胞趋化蛋白1水平分别为(166.7±46.5,149.4±54.9,119.7±25.0,89.2±26.4)ng/L,急性心肌梗死组、不稳定型心绞痛组及介入术后再狭窄组显著高于正常对照组(F=21.27,P<0.01),并且急性心肌梗死组显著高于介入术后再狭窄组(F=3.45,P<0.01)。结论:急性冠状动脉综合征及介入术后再狭窄患者血浆趋化因子单核细胞趋化蛋白1水平明显增高,提示单核细胞趋化蛋白1可能在急性冠状动脉综合征及介入术后再狭窄发病过程中发挥潜在的作用。     

急诊冠状动脉介入治疗对急性心肌梗死患者脑钠肽水平的影响

目的 观察急诊冠状动脉介入治疗(PCI)对急性心肌梗死患者血浆脑钠肽(BNP)水平的影响,并进一步探讨其对左室重构的影响.方法 急性心肌梗死患者118例,其中PCI组52例,在发病后6～12 h内成功行急诊PCI;保守治疗组66例,为同期拒绝急诊PCI或急诊PCI失败者.两组均于入院即刻,12、24、48和72 h以及7、14和28 d测定血浆BNP浓度;采用多普勒超声诊断仪测量两组患者人院3～5 d和28 d的左室射血分数(LVEF).以同期20例健康体检者的检测值作为正常参考值.结果 两组患者入院即刻血浆BNP水平均高于正常健康者,同组不同时间点BNP浓度比较差异亦有统计学意义(P均＜0.01).保守治疗组血浆BNP水平呈双峰曲线,12～24 h达高峰,7 d时出现第二次峰值.PCI组血浆BNP水平呈单峰曲线,于12～24 h达到峰值.PCI组各时间点BNP水平均显著低于保守治疗组(P均＜0.01).两组患者3～5 d的LVEF值比较差异无统计学意义;28 d时PCI组LVEF值明显高于保守治疗组(P＜0.01).结论 急诊PCI能够降低急性心肌梗死患者血浆BNP水平,提高LVEF值,从而减轻左室重构.     

老年高血压合并2型糖尿病患者餐后血糖与血压关系的研究

临床纳入30例我院2013年8月~2015年8月收治的高血压合并2型糖尿病老年患者为混合组,另选取同期30例单纯高血压老年患者为高血压组以及30例正常健康体检人群为对照组。分别对三组对象进行空腹血糖(FPG)、餐后2h血糖(2h PG)、糖化血红蛋白(Hb Alc)、空腹血浆胰岛素(FINS),并对高血压患者进行动态血压监测(ABPM)。混合组患者糖代谢指标FPG、2h PG、Hb Alc以及FINS水平均明显高于其他两组(P0.05);高血压组FINS水平高于对照组(P0.05)。混合组患者治疗后2h PG、Hb Alc以及FINS水平明显低于治疗前(P0.05)。混合组患者治疗后dm SBP、nm SBP水平明显低于治疗前,但仍然高于高血压组(P0.05);而dm DBP与nm DBP治疗前后以及与高血压组均无差异(P0.05)。高血压患者与糖尿病患者均存在胰岛素抵抗,高血压合并糖尿病患者对餐后血糖的控制可有助于调节血压,延缓动脉粥样硬化的发展。     

缺血性心脏病患者C-反应蛋白的变化及临床意义

目的 :观察缺血性心脏病 (IHD)时血清中C -反应蛋白 (CRP)的变化 ,以探讨CRP与IHD的关系及临床意义。方法 :选择体检健康者 3 0例、心绞痛患者 45例、急性心肌梗死患者 3 0例各作为正常对照 (C)组、心绞痛 (AP)组和急性心肌梗死 (AMI)组。C组于清晨、AP组于入院次日清晨取血 ,而AMI组于发病 6、12、2 4、48及 72h取血。采用散射比浊法检测CRP。结果 :AP组及AMI组各时间点CRP较C组显著增高 (P <0 0 1) ;AMI组各时间点CRP较AP组显著增高 (P <0 0 5 ) ;CRP在急性心肌梗死后的 72h内呈明显动态变化 ,6h开始升高 ,48h达高峰 ,后渐下降 ,72h时仍明显高于正常。结论 :CRP参与IHD的发病过程 ,其水平的高低与IHD的严重程度有关 ,急性心肌梗死时CRP动态演变具有判断病情发展趋势和预后的价值。     

重组人脑利钠肽对经溶栓治疗急性前壁心肌梗死合并心力衰竭患者预后的影响

目的 研究静脉应用重组人脑利钠肽(rhBNP)对经静脉溶栓治疗急性心肌梗死合并心力衰竭患者左心功能和左室重构的影响.方法 将78例首发急性前壁ST段抬高心肌梗死合并心力衰竭患者分为rhBNP治疗组(36例)和对照组(42例).比较两组患者治疗前及治疗后24、48 h血浆NT-proBNP水平,并观察两组患者出院时及出院后1个月的心功能和左室重构变化.结果 治疗48 h时,与对照组比较,rhBNP组血浆rhBNP水平下降更明显(P＜0.05);两组患者出院时左心室舒张末期容积(LVEDV)比较差异无统计学意义(P＞0.05),而rhBNP组LVEF值较对照组明显升高(P＜0.05);出院后1个月时,rhBNP组LVEF值较对照组仍明显升高(P＜0.05),而rhBNP组LVEDV及△LVEDV％较对照组明显降低(P＜0.05).结论 rhBNP能有效改善急性心肌梗死后心力衰竭患者心功能,延缓左室重构.     

硝酸甘油联合托拉塞米在高血压危象并发急性肺水肿患者的应用

目的研究硝酸甘油联合托拉塞米治疗高血压危象合并急性肺水肿的效果。方法选取我院收治的高血压危象合并急性肺水肿患者80例作为研究对象。随机分为对照组40例,采用托拉塞米治疗;试验组40例,采用硝酸甘油联合托拉塞米治疗。比较两组患者治疗效果、临床指标改善程度及并发症发生率。结果治疗后对照组患者血压、呼吸频率及氧分压改善程度均低于试验组,且治疗有效率(77.5%)低于试验组(92.5%),差异显著(P0.05);对照组患者并发症发生率(20.0%)高于试验组(7.5%),差异显著(P0.05)。结论采用硝酸甘油联合托拉塞米在治疗高血压危象合并急性肺水肿安全性高,可减少并发症,改善治疗效果,提高患者生活质量。     

Hyponatraemia in Patients with Cirrhosis

Hyponatraemia occurs in nearly half of patients in hospitalwith cirrhosis and ascites, and is due to the excessive retentionof free water which results from the kidney's inability to excreteit normally. The morbidity and mortality associated with hyponatraemiais largely attributable to central nervous system disturbances.The degree to which brain water content increases depends onthe duration of hyponatraemia and on compensatory mechanisms.Altered steroid and peptide hormones in cirrhotic patients maycontribute to the development of hyponatraemia encephalopathy,symptoms of which overlap with hepatic encephalopathy and uraemia.The occurrence of central pontine myelinolysis is unrelatedto the rate of correction of hypnatraemia. The appearance ofhyponatraemia in cirrhotic patients, long regarded as a poorprognostic sign, may be a function of unrecognized underlyingimpaired renal function. Therapy for hyponatraemia remains suboptimal.     

Headache in Patients with Hypertension

SYNOPSIS
The relationship between high blood pressure and headache (HA) was assessed retrospectively among 241 patients attending a hypertension clinic. HA was common (45.6%), particularly among women (68%). Patients with systolic blood pressure higher than 170 mmHg andor diastolic blood pressure higher than 110 mmHg had nocturnal andor early morning HA more often. Fifty-four subjects became HA free during antihypertensive therapy. Their blood pressure (BP) decrease was significantly greater than the BP fall of those whose HA did not disappear with treatment. Nocturnal and early morning HA may be a symptom of hypertension in subjects with markedly elevated BP, and control of BP may be beneficial in some hypertensive patients.     

Headache in Patients with Cancer

Contemporary cancer research has led to unparalleled advances in therapeutics and improved survival. Even as treatment options continue to improve, quality of life should remain a priority. Headache drastically impacts the quality of life of patients with cancer and has a wide etiological scope, making diagnosis a challenge. Intracranial mass lesions are only one cause; others include extracranial tumors, paraneoplastic processes, and the consequences of diagnostic and therapeutic interventions used in cancer care. Fortunately, cancer-related headache is treatable, but a sound understanding of the variable etiologies is crucial to appropriate diagnostic evaluation and treatment. In this review, we highlight the important causes of headache in the patient with cancer, and consider the epidemiology, pathophysiology, clinical course, and treatment options for each.     

Defective Mononuclear Phagocyte Function in Patients with Myelomonocytic Leukemia and in Some Patients with Lymphoma

Mononuclear phagocytes from 8 of 10 patients with myelomonocytic leukemia and 2 of 9 patients with lymphoma phagocytized several species of bacteria but did not inhibit intracellular bacterial replication normally. Intracellular organisms were protected from the lethal effects of antibiotics in the medium. This defect of microbicidal function of malignant monocytes may explain in part the frequency of infection and the mechanism of antibiotic-resistant infection in some patients with malignant myeloproliferative and lymphoproliferative diseases.     

Risk of Dementia in Peritoneal Dialysis Patients Compared with Hemodialysis Patients

♦ Background: Compared with similarly aged controls, patients with end-stage renal disease (ESRD) have a higher prevalence of cognitive impairment and more rapid cognitive decline, which is not explained by traditional risk factors alone. Since previous small studies suggest an association of cognitive impairment with dialysis modality, we compared incident dementia among patients initiating hemodialysis (HD) vs peritoneal dialysis (PD) in a large national cohort.♦ Methods: This is a retrospective cohort study of incident dialysis patients in the United States from 2006 to 2008 with no diagnosis of dementia prior to beginning dialysis. We evaluated the effect of initial dialysis modality on incidence of dementia, diagnosed by Medicare claims data, adjusted for baseline demographic and clinical data from the USRDS registry.♦ Results: Our analysis included 121,623 patients, of whom 8,663 initiated dialysis on PD. The mean age of our cohort was 69.2 years. Patients who initiated PD had a lower cumulative incidence of dementia than those who initiated HD (1.0% vs 2.7%, 2.5% vs 5.3%, and 3.9% vs 7.3% at 1, 2, and 3 years, respectively). The risk of dementia for patients who started on PD was lower compared with those who started on HD, with a hazard ratio (HR) = 0.46 [0.41, 0.53], in an unadjusted model and HR 0.74 [0.64, 0.86] in a matched model.♦ Conclusions: Dialysis modality is associated with incident dementia in a cohort of older ESRD patients. This finding warrants further investigation of the effect of dialysis modality on cognitive function and evaluation for possible mechanisms.     

抑郁症患者注意功能的反应时研究

目的评定抑郁症患者的注意功能。方法 35例根据ICD-10和CCMD-Ⅲ诊断为抑郁症的患者以及与之在受教育程度、年龄、性别相匹配的35名健康人接受了持续注意、选择注意、注意瞬脱测试。结果与健康人相比，抑郁症被试在持续作业测试（CPT）中反应时延长，错误率增加；但反应时段差别无显著性差异。在Stroop颜色命名测试中，抑郁患者选择反应时延长，干扰效应明显。在注意瞬脱范式下，两组被试能同等程度地捕捉靶刺激，均存在注意瞬脱现象，但抑郁患者瞬脱更多，时间更长。结论抑郁症患者警觉性较差，Stroop干扰效应明显，注意瞬脱更多，时间更长。