冠心病患者血浆β内啡肽动态变化及其临床意义

目的 探讨冠心病患者血浆β内啡肽(β-EP)水平动态变化及临床意义.方法 动态检测急性心肌梗死(AMI)22例和心绞痛(AP)36例患者(冠心病组)血浆β-EP、血清肌钙蛋白T(cTnT)和肌酸激酶同工酶(CK-MB),并行超声心动图左心室舒张末期内径(LVEDD)、收缩末期内径(LVESD)和射血分数(LVEF)测定,临床心功能评定.其结果与20例健康体检者为对照组(C组)比较.结果 冠心病组AMI发病、AP入院发作后12、24、48、96 h及7 d血β-EP、cTnT、CK-MB水平均显著高于C组(P＜0.05);均于12 h内开始升高,24 h达峰值,7 d内逐渐下降;三项指标均随心功能不全升级而升高.血β-EP与cTnT、CK-MB水平及LVEDD、LVESD旱正相关(P＜0.05或P＜0.01),与LVEF值呈负相关(P＜01.05).结论 血浆β-EP水平可作为冠心病急性事件和心功能状况的辅助监测指标.     

血清hs-CRP、CK-MB、cTnI在急性心肌梗塞早期诊断中的临床价值

目的探讨血清hs-CRP、CK-MB与cTnI在急性心肌梗塞(AMI)早期中的临床价值。方法对36例AMI胸痛发作在3￣4h患者,50例AMI胸痛发作4￣12h患者,采用定时免疫散射比浊法检测其血清hs-CRP,免疫抑制法测定血清CK-MB,化学发光法检测血清cTnI,并与40例健康对照作比较,探讨三者在AMI早期中的变化情况。结果AMI胸痛发作3￣4h组、4￣12h组hs-CRP含量分别为(7.42±3.27)mg/L、(25.26±18.15)mg/L,均明显高于对照组(0.84±0.73)mg/L(P<0.01);CK-MB含量AMI胸痛发作3￣4h组(25.4±14.6)U/L与4￣12h组(64.6±53.2)U/L均较对照组(5.6±3.4)U/L有显著性差异(P<0.05);而AMI胸痛发作3￣4h组cTnI含量(0.08±0.06)μg/L与对照组(0.06±0.04)μg/L无显著性差异(P>0.05),4￣12h组的cTnI含量(28.9±37.6)μg/L与其它两组比较均有显著性差异(P<0.05)。AMI患者胸痛发作4h内,以hs-CRP(91.7%)最敏感,CK-MB(55.6%)次之,阳性检出率均明显高于cTnI(25%);胸痛发作4￣12h,hs-CRP(100%)、CK-MB(92%)、cTnI(84%)均具有较高的阳性检出率。结论联合检测hs-CRP、CK-MB、cTnI对于AMI早期诊断具有很高的灵敏度与特异性,可将诊断与治疗提前到4h以内,并能作为AMI的预后监测及疗效观察的指标。     

CK-MB、PCT、MYO对急性心肌梗死诊断价值分析

目的 探讨CK-MB、PCT、MYO对急性心肌梗死患者的诊断价值。方法 将自2018年6月～2020年6月间收治的急性心肌梗死患者130例作为研究组,随机选择同期入院体检的健康者128例作为对照组,使用东芝TBA-120FR全自动生化分析仪检测两组对象CK-MB水平,使用化学发光免疫分析法检测MYO的水平,使用化学发光免疫分析法检测PCT水平,探讨上述三项指标在早期诊断心肌梗死的临床价值。结果 研究组患者在入院3 h内、3～6 h、6～12 h、12～24 h和> 24 h时检测CK-MB、PCT、MYO水平均明显高于对照组,组间差异具有统计学意义（P<0.05）,其中随着时间增加,研究组患者CK-MB和PCT水平呈先上升后下降的“抛物线”型趋势,MYO水平呈直线升高趋势;CK-MB、PCT、MYO三项指标联合检测诊断AMI的灵敏度、特异性和约登指数均高于三者单独使用,差异具有统计学意义（P <0.05）。结论 使用CK-MB、PCT、MYO三者联合诊断急性心肌梗死具有较高的诊断价值,相较于单独检测来说,能够提高诊断的灵敏度和特异性。     

冠心病患者的血浆BNP水平分析

目的探讨冠心病患者血浆脑钠肽(BNP)浓度的变化及其临床意义。方法入选住院AMI患者30例、UAP患者30例及对照组30例,测定BNP浓度,同时测定磷酸肌酸激酶同工酶(CK-MB),进行比较分析及相关分析。结果冠心病患者血浆BNP水平显著高于对照组(P<0.05),急性心肌梗死组BNP水平高于不稳定型心绞痛组(P<0.05),急性心梗及不稳定型心绞痛患者的BNP与其他指标进行相关性分析,结果表明,BNP与CK-MB之间有良好的正相关(P<0.05)。结论冠心病患者血浆BNP水平明显升高,在急性心肌梗死和不稳定型心绞痛患者中两者有明显的相关性,提示血浆BNP在冠心病发病机制中起重要作用,对疾病的危险分层和预后判断具有重要的临床价值。     

血清CRP、cTnI联合检测在急性心肌梗死诊断中的应用

目的探讨血清超敏C-反应蛋h（hs—CRP）、肌钙蛋白I（cTnI）及肌酸激酶同T酶（CK—MB）联合检测在急性心肌梗死（AMI）诊断中的临床价值。方法对38例心肌梗死胸骨后疼痛发作2～6h的患者及48例心肌梗死胸骨后疼痛发作12～24h的患者采用免疫散射比浊定量法检测其血清CPR．采用免疫抑制法检测CK—MB．采用免疫荧光法检测其血清cTnI,并与39例正常对照组进行比较。结果两AMI组患者的CRP、cTnI及CK—MB浓度较正常对照组高;联合检测CRP＋CK—MB、CRP＋cTnI＋CK—MB、cTnI＋CRP阳性检出率均为100．0％．结论联合检测hs-CRP、cTnI在AMI早期诊断中有很高的特异性及灵敏度,可作为AMI的预后临测及疗效观察的指标。     

心肌肌钙蛋白I和肌红蛋白对急性心肌梗死的诊断价值及预后评价

目的　探讨血清心肌损伤标志物心肌肌钙蛋白 I(c Tn I)和肌红蛋白 (Mb)对急性心肌梗死 (AMI)的诊断价值及预后评价。方法　连续搜集了急性胸痛的患者 12 1例 ,其中 AMI患者 6 3例 ,非 AMI患者 5 8例 ,对上述病例进行血清 c Tn I、Mb和肌酸激酶同工酶 (CK- MB)测定 ,观察其变化规律 ,分组比较心脏事件发生率。结果　 AMI发病 6 h以内 ,Mb首先升高 ,敏感性达 87.1%。发病 18～ 2 4 h,c Tn I敏感性达 10 0 .0 % ,且于发病第 5日仍维持敏感性达 6 1.1%。入院即刻 Mb敏感性 92 .1% ,高于 c Tn I 5 5 .6 %和 CK- MB 5 7.1% ;Mb特异性82 .8% ,低于 c Tn I96 .7%。入院次日晨 c Tn I敏感性 96 .8% ,高于 Mb6 1.9%和 CK- MB77.8%。AMI患者入院即刻 c Tn I增高组与正常组心脏事件发生率分别为 2 2 .9%和 3.6 % (P<0 .0 5 ) ,校正基线特征等多变量因素后 ,c Tn I是 AMI患者发生心脏事件独立的危险性预测因子 ,OR值 1.171(P<0 .0 5 )。结论　 c Tn I联合 Mb是诊断AMI的良好指标 ,其灵敏性和特异性能得到最佳体现。c Tn I亦有助于中后期 AMI的诊断。c Tn I是 AMI患者发生心脏事件独立的危险性预测因子     

心肌三联检测卡在急性心肌梗死中的诊断价值

目的探讨心肌三联检测卡在急性心肌梗死中的诊断价值。方法用心肌三联检测卡定性测定41例AMI患者和21例健康体检者血清中的Mb,CTnI,CK-MB和用日立7020型全自动生化分析仪定量测定CK-MB(CK-MB≥25IU/ml为阳性)。结果用心肌三联检测卡定性测定AMI患者的Mb,CtnI,CK-MB早期的阳性率分别为87.80%,51.00%,21.95%;健康体检者阳性率为4.76%;用日立7020型全自动生化分析仪测定CK-MB的阳性率为26.83%,健康体检者阳性率为4.76%。心肌三联检测卡和日立7020型全自动生化分析仪测定AMI患者CK-MB阳性率比较无差别(P>0.05)。结论心肌三联检测卡对AMI早期诊断具有高灵敏度和高特异性,心肌三联检测卡操作方便,实用,实验结果快速准确,对诊断AMI具有较好的临床诊断价值。     

血清肌钙蛋白I与心肌酶谱对急性心肌梗死诊断价值的对比分析

目的观察比较血清心肌肌钙蛋白I(cTnI)与心肌酶谱[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)]对急性心肌梗死(AMI)的诊断价值。方法用化学发光酶免法分别测定50例AMI患者和48例稳定型心绞痛(SA)患者胸痛发作3～24h内cTnI含量,并与80例非AMI患者、45例健康对照组进行比较。同时用全自动生化分析仪测定相应的心肌酶谱。结果 AMI患者组cTnI阳性率为100%,非AMI患者组阳性率为0。而AMI患者组心肌酶谱阳性率分别为CK 74%、CK-MB 70%、LDH 90%,且非AMI组三个酶的阳性率均大于SA组。结论诊断AMI,血清cTnI较心肌酶谱更特异、更敏感。     

肌钙蛋白Ⅰ在急性心肌梗死诊断中的应用价值

目的 通过肌钙蛋白Ⅰ(cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)在急性心肌梗死(AMI)诊断中的比较研究,探讨各指标对于在心肌梗死诊断中的应用价值.方法 将63例AMI患者分成未溶栓组和溶栓再通组,采用Access全自动微粒子化学发光免疫分析系统,检测两组患者血清cTnI、CK、CK-MB的检出时间、达到高峰时间及恢复时间,进行统计学处理及分析比较.结果 cTnI升高对急性心肌梗死诊断的灵敏度高于CK、CK-MB;在心肌梗死后cTnI的增高和峰值出现时间均先于CK和CK-MB,且增高持续时间长.结论 cTnI的检测有助于早期诊断AMI,对延迟入院的AMI患者检测cTnI也有重要意义.     

联合检测血浆和肽素与肌钙蛋白在急性心肌梗死诊断中的应用

目的:观察急性胸痛患者血浆和肽素(Copeptin)与肌钙蛋白(cTnI)水平的变化,寻找早期快速诊断急性心肌梗死(AMI)的方法。方法:收集急诊科2010年11月—2012年5月就诊的100例发病6h内的急性胸痛患者,其中AMI者48例,不稳定心绞痛32例,非心源性胸痛20例,进行血浆Copeptin及cTnI的定量测定。结果:AMI组血浆Copeptin水平较其他两组明显升高,差异有统计学意义(P<0.05),cTnI阴性AMI患者血浆Copeptin水平明显高于cTnI阳性AMI患者。结论:AMI患者早期Copeptin水平明显升高,血浆cTnI浓度变化与Copeptin水平呈负相关,故联合检测血浆和肽素与肌钙蛋白,有助于急诊科胸痛的排查,提高AMI早期诊断率。     

Serum levels of NT-ProBNP as an early cardiac marker of carbon monoxide poisoning

Acute carbon monoxide (CO) poisoning may cause cardiotoxicity. The natriuretic peptides, including atrial natriuretic peptide, brain natriuretic peptide (BNP), N-BNP, and NT-proBNP (N-terminal pro brain natriuretic peptide), are endogenous cardiac hormones that may be secreted upon myocardial stress. The aim of this study was to assess the plasma NT-proBNP level in acute CO poisoning and to compare it with healthy control. After approval by the ethical committee, 15 healthy controls and 15 patients admitted to the Gaziantep University Hospital (Gaziantep, Turkey) between January 2005 and July 2005 with the diagnosis of carbon monoxide poisoning were studied. Echocardiography was performed to all patients. Serum NT-proBNP, creatine kinase (CK), creatine kinase-MB (CK-MB), and troponin-T were also analyzed, along with the carboxyhemoglobin (COHb) level. The correlation between serum NT-proBNP and COHb level was investigated. Electrocardiography (ECG) was performed to all patients and healthy controls, and the results were compared. Differences in troponin, CK, and CK-MB levels were not statistically significant between groups (p > 0.05). The level of NT-proBNP and COHb were found to be increased in the study group. There was a positive correlation between the COHb and the NT-proBNP (r = 0.829, p < 0.01), and between the COHb and the CK (r = 0.394, p < 0.01). There was no difference between groups in other parameters, all of which were within normal range. Thus, in this study we showed that the plasma NT-proBNP level may contribute to the early diagnosis of cardiotoxicity in patients with carbon monoxide poisoning.     

Serum Levels of NT-ProBNP as an Early Cardiac Marker of Carbon Monoxide Poisoning

Acute carbon monoxide (CO) poisoning may cause cardiotoxicity. The natriuretic peptides, including atrial natriuretic peptide, brain natriuretic peptide (BNP), N-BNP, and NT-proBNP (N-terminal pro brain natriuretic peptide), are endogenous cardiac hormones that may be secreted upon myocardial stress. The aim of this study was to assess the plasma NT-proBNP level in acute CO poisoning and to compare it with healthy control. After approval by the ethical committee, 15 healthy controls and 15 patients admitted to the Gaziantep University Hospital (Gaziantep, Turkey) between January 2005 and July 2005 with the diagnosis of carbon monoxide poisoning were studied. Echocardiography was performed to all patients. Serum NT-proBNP, creatine kinase (CK), creatine kinase-MB (CK-MB), and troponin-T were also analyzed, along with the carboxyhemoglobin (COHb) level. The correlation between serum NT-proBNP and COHb level was investigated. Electrocardiography (ECG) was performed to all patients and healthy controls, and the results were compared. Differences in troponin, CK, and CK-MB levels were not statistically significant between groups (p > 0.05). The level of NT-proBNP and COHb were found to be increased in the study group. There was a positive correlation between the COHb and the NT-proBNP (r = 0.829, p < 0.01), and between the COHb and the CK (r = 0.394, p < 0.01). There was no difference between groups in other parameters, all of which were within normal range. Thus, in this sudy we showed that the plasma NT-proBNP level may contribute to the early diagnosis of cardiotoxicity in patients with carbon monoxide poisoning.     

The pharmacodynamics of the new anti-arrhythmia preparation bonnecor in patients with extrasystoles]

The pharmacodynamics, antiarrhythmic activity and tolerance of bonnecor were studied in 25 patients with acute myocardial infarction (AMI) and 23 patients with chronic ischemic heart disease (IHD) complicated by cardiac rhythm disorders in the form of extrasystoles. Extrasystoles were revealed in 92% of AMI patients at a single administration of bonnecor and in 82.5% of IHD patients at long-term oral administration of the drug. Bonnecor exerted no influence on arterial blood pressure and heart rate, did not change the parameters of the intracardiac hemodynamics. Bonnecor is well tolerated by patients, its main side effect is the prolongation of PQ interval of the ECG.     

外周血半乳糖凝集素-3及脑钠肽与急性心肌梗死患者预后的关系

目的探讨急性心肌梗死患者外周血循环中Galectin-3及BNP浓度变化与其危险度及预后的关系。方法选取确诊为急性心肌梗死患者80例,入院后24 h内检测外周血Galectin-3浓度,所有患者均定期随访6个月,观察外周血Galectin-3及BNP浓度与急性心肌梗死预后的关系。结果与健康对照组(40例)相比较,AMI组外周血Galectin-3及BNP浓度明显升高(P<0.01),且Galectin-3表达水平高的患者心血管事件发生率高(P<0.05)。结论 AMI组外周血半乳糖凝集素-3及BNP的表达水平可反映AMI的严重程度,可作为心血管事件预测指标。     

依替巴肽联合瑞舒伐他汀治疗急性心肌梗死临床研究

目的探讨依替巴肽联合瑞舒伐他汀治疗急性心肌梗死的临床疗效,以及对血清心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)、心肌营养素1(CT-1)水平的影响。方法选取河北省任丘市人民医院2018年3月至2020年3月收治的急性心肌梗死患者93例,随机分为研究组(48例)和对照组(45例)。两组均给予瑞舒伐他汀治疗,研究组加用依替巴肽。两组均连续治疗4周。结果研究组总有效率为87.50%,显著高于对照组的68.89%(P<0.05);研究组患者的左室射血分数(LVEF)、每搏输出量(SV)均显著高于对照组,左室舒张末期内径(LVEDd)显著短于对照组(P<0.05);研究组患者的cTnT和CK-MB水平均显著低于对照组,CT-1水平显著高于对照组(P<0.05);研究组患者的血管内皮素1(ET-1)、血管性血友病因子(vWF)水平均显著低于对照组,血管内皮生长因子(VEGF)水平显著高于对照组(P<0.05);研究组和对照组不良反应发生率相当(16.67%比8.89%,P>0.05)。结论依替巴肽联合瑞舒伐他汀治疗急性心肌梗死疗效良好,可改善患者的心功能和cTnT,CK-MB,CT-1等水平,调节血管内皮功能,促进血管新生,且安全性良好。     

缺血预适应对急性心肌梗死临床及预后的影响

目的探讨心肌缺血预适应(IP)对急性心肌梗死临床及预后的影响。方法对209例急性心肌梗死(AMI)患者的临床资料进行回顾性分析。根据梗死前有无心绞痛分为IP组和无IP的对照组。结果IP组小面积心肌梗死发生率高于对照组,而肌酸磷酸激酶(CK)和肌酸磷酸激酶同工酶(CK-MB)峰值、KollipⅡ级以上泵衰竭和梗死后心绞痛发生率、住院病死率均明显低于对照组,但两组恶性心律失常发生率无明显差异。结论梗死前心绞痛对AMI具有保护作用,主要表现为限制梗死面积的扩大,维护梗死后心功能,降低泵衰竭发生率和住院病死率。     

肌红蛋白检测对急性心肌梗死早期诊断的临床意义

目的探讨肌红蛋白（MYO）检测在急性心肌梗死（AMI）早期诊断中的临床意义。方法选择2013年l～10月确诊为AMI的50例患者作为观察组,选择同期50例健康体检者作为对照组,同时测定入选者的MY0、肌酸激酶（CK）及肌酸激酶同工酶（CK-MB）水平,并行心电图检查,对结果进行统计学分析。结果排除基线水平混杂影响,观察组患者MY0、CK和CK—MB水平均显著高于对照组,差异有统计学意义（P〈0．01）。胸痛早期组（0—6h）患者MY0水平显著高于胸痛中、晚期组（〉6～24h、〉24～48h）患者,差异有统计学意义（P〈0．05）,而胸痛早、中、晚期组患者CK和CK—MB水平比较．差异无统计学意义（P〉0．05）。胸痛早期患者MY0阳性检出率为78．0％,高于心电图、CK和CK-MB阳性检出率（60．O％、56．0％、46．0％）,差异有统计学意义（P〈0．05）。结论MYO可作为早期诊断AMI较理想的指标,具有出现时间早、阳性检出率高等特点,能为病情鉴别、治疗以及预后等提供可靠依据。     

急性心肌梗死患者血清miR-208a检测及其临床意义

目的探讨检测miR-208a在急性心肌梗死(AMI)患者早期血清中的表达及其临床意义。方法采用实时荧光定量RT-PCR(Real-timeRT-PCR)检测我院收治的35例AMI患者发病后不同时间与30例正常对照组人员血清miR-208a表达水平,并与血清肌酸激酶同工酶(CK-MB)和心肌肌钙蛋白I(CTnI)水平进行对比分析。结果正常人血清miR-208a维持在相对较低的水平。AMI发作后1h患者血清miR-208a的表达水平可明显升高(P<0.05),AMI发作后3h血清miR-208a即可达到峰值。皮尔森相关分析结果显示血清miR-208a的表达与CK-MB和CTnI呈正相关(P<0.01)。结论 AMI患者早期血清miR-208a表达显著升高,可能是潜在的AMI早期血清标志物。     

Evaluation of platelet activation in depressed patients with ischemic heart disease after paroxetine or nortriptyline treatment

This study investigated the effects of antidepressant treatment on platelet activation in depressed patients with ischemic heart disease (IHD). Plasma levels of platelet alpha-granule release products beta-thromboglobulin (BTG) and platelet factor 4 (PF4) were measured in 17 depressed patients with IHD who were treated in a 6-week, double-blind trial with either paroxetine (10 patients) or nortriptyline (7 patients). Baseline measurements of BTG and PF4 were significantly elevated in both drug treatment groups before the initiation of antidepressant therapy compared with those of healthy control subjects. In the paroxetine group, mean PF4 and BTG levels significantly decreased from these elevated baseline values within 1 week of treatment and remained low at 3- and 6-week measurements. In contrast, the nortriptyline group did not exhibit a significant decrease in PF4 or BTG plasma levels after 1, 3, or 6 weeks of treatment. Therefore, platelet activation in depressed patients with IHD seems to be inhibited by the selective serotonin reuptake inhibitor paroxetine. The effect of paroxetine on PF4 and BTG plasma levels suggests that it may reduce platelet aggregation in vivo and may positively impact IHD-related mortality in this population.     

螺内酯对急性心肌梗死患者左室收缩功能及血浆脑钠肽水平的影响

目的观察螺内酯对急性心肌梗死(AMI)患者左室收缩功能及血浆脑钠肽(BNP)水平变化的影响.方法经超声心动图检查,测出80例AMI患者以及20例健康对照者的左室舒张末内径(LVEDd)、左室射血分数(LVEF)及左室短轴缩短率(LVFS),应用酶联免疫吸附法(ELISA)测定2组脑钠肽(BNP)的浓度;将AMI患者随机分为常规治疗组(38例)和螺内酯组(42例),3周和3个月时再测定上述指标.结果AMI患者在治疗后3周LVEDd、LVEF及LVFS与治疗前比较差异均无统计学意义(P＞0.05),3个月时的上述指标与治疗前比较差异有统计学意义(P＜0.01),而螺内酯组LVEF较常规治疗组升高更明显(P＜0.05).AMI患者在梗死后24h血浆BNP水平均高于正常对照组,治疗3周和3个月时血浆BNP水平均明显下降,而螺内酯组与常规治疗组同期比较下降更明显(P＜0.05).两组患者血浆BNP水平与LVEF呈负相关(P＜0.01).结论长期应用螺内酯可以改善AMI患者心功能和降低血浆BNP水平,而后者的改变早于心脏结构的变化,提示血浆BNP水平可作为治疗AMI的一个灵敏观察指标.