两种超声心动图诊断慢性心功能衰竭标准比较

目的比较两种超声心动图诊断慢性心功能衰竭标准。方法选取2012年6月—2013年9月我院收治的老年慢性心脏病患者200例,以左室射血分数(LVEF)、左室舒张早期(E)与晚期血流速度(A)的比值进行分析,以美国纽约心脏病协会心功能分级标准(NYHA)作为金标准,对两种超声心动图(欧洲心脏病学会超声心动图及我国以往超声心动图)诊断慢性心功能衰竭标准进行比较。结果我国以往超声心动图诊断慢性心功能衰竭标准诊断老年慢性心功能衰竭的敏感度为80%、特异度为93%、准确度为96%;欧洲心脏病学会超声心动图诊断慢性心功能衰竭标准诊断老年慢性心脏病的敏感度为100%、特异度为38%、准确度为53%。我国以往超声心动图诊断慢性心功能衰竭标准诊断老年慢性心脏病的准确度高于欧洲心脏病学会超声心动图(P0.05)。结论我国以往超声心动图诊断慢性心功能衰竭标准比欧洲心脏病学会超声心动图更加严格,准确度更高。     

超声心动图联合血清H-FABP、cTnI检测评估慢性心力衰竭病人左心功能的效果观察

目的观察超声心动图联合血清心脏型脂肪酸结合蛋白(H-FABP)、肌钙蛋白(cTnI)检测评估慢性心力衰竭(CHF)病人左心功能的效果。方法选取2016年10月—2019年4月本院收治的72例确诊为CHF的住院病人,纽约心脏病协会(NYHA)心功能分级Ⅰ级17例,Ⅱ级22例,Ⅲ级18例,Ⅳ级15例。采用超声心动图检测受试者左心功能指标,主要包括左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、每搏输出量(SV)、心脏指数(CI)及二尖瓣舒张早期与舒张晚期血流峰值速度比值(E/A)。采用酶联免疫吸附试验(ELISA)检测血清H-FABP、cTnI水平,采用Spearman法分析超声心动图参数、血清H-FABP、cTnI水平与心功能分级的相关性。采用多元回归分析超声心动图参数联合血清H-FABP、cTnI水平对CHF病人心功能分级的预测价值。结果不同心功能分级病人LVEDV、SV、CI参数比较,差异无统计学意义(P>0.05)。与心功能Ⅰ级、Ⅱ级比较,心功能Ⅲ级、Ⅳ级CHF病人LVEF降低,LVEDD、LVESD、LVESV、E/A水平升高(P<0.05)。CHF病人血清H-FABP、cTnI水平随心功能分级增加升高(P<0.05)。Spearman分析结果显示,LVEF与心功能分级呈负相关(P<0.05),LVEDD、LVESD、LVESV、E/A、血清H-FABP、cTnI水平与心功能分级呈正相关(P<0.05)。LVEF、E/A、H-FABP、cTnI是预测CHF病人心功能分级的独立因素(P<0.05)。结论超声心动图可有效评估CHF病人左心功能,联合检测血清H-FABP、cTnI对CHF病人心脏分级有一定预测价值。     

参附注射液治疗扩张型心肌病心力衰竭的效果

1对象和方法1.1对象20008年1月～2009年12月我院住院患者100例,诊断标准参照扩张型心肌病(DCM)的诊断标准[1],心功能分组标准参照美国纽约心脏病学会(NYHA)制定的标准[2],纳入标准:符合诊断标准并年龄为18～45岁;心功能Ⅱ～Ⅳ级的充血性心力衰竭(CHF);超声心动图证实左室射血分数(LVEF)<50%;符合1971年美国Framingham心衰诊     

超声心动图及血浆脑钠肽水平对老年高血压性心功能不全的诊断意义

目的:探讨超声心动图及血浆脑钠肽(BNP)对老年高血压性心功能不全的诊断价值.方法:收集180例资料完整的老年高血压患者的临床资料,观察不同心功能分级的超声心动图检查的相关指标以及血浆BNP水平的改变.结果:超声心动图检测的相关指标在心功能损害严重时(NYHA分级Ⅲ～Ⅳ级)出现明显改变:左房、左室增大,室间隔及左室后壁增厚,射血分数下降.但在早期心功能损害时(NYHA分级Ⅱ级),这些指标改变不明显,心功能Ⅰ级与心功能Ⅱ级之间相比较,差异无统计学意义.而血浆BNP水平则随着心功能损害程度的加重而逐渐增高,在不同心功能分级组之间差异均有统计学意义.同时我们发现:心功能异常组无论射血分数是否小于50%,血浆BNP水平均明显高于心功能正常组,差异有统计学意义.结论:超声心动图检查对老年高血压患者严重心功能不全(心功能Ⅲ级～Ⅳ)具有重要的诊断性意义,但对早期心功能不全诊断意义不太大.而血浆脑钠肽水平的检测对不同程度心功能不全都有诊断性意义,且对舒张性心功能不全同样具有诊断性意义.尤其适用于早期老年高血压性心功能不全的鉴别诊断.临床上将若两者相结合,无疑会大大提高临床诊断的准确性.     

老年慢性心力衰竭患者心室结构-心电重构与心律失常的关系

目的探讨老年心肌梗死后慢性心力衰竭（CHF）患者心室结构-心电重构与心律失常的关系。方法收集老年心肌梗死后CHF患者55例[心功能（NYHA分级）:II级23例,III级15例,Ⅳ级17例]及心肌梗死后心功能（NYHA）I级患者30例,采用超声心动图,标准12导联心电图及24小时动态心电图检测其心室腔大小,QT间期,校正QT间期（QTc）及心律失常。结果与心功能I级组比较,CHF组心室腔显著扩大[CHF组:左室舒张末直径（LVEDD）（57±8）mm,左室收缩末直径（LVESD）（45±8）mm;心功能I级组:LVEDD（45±5）mm,LVESD（31±5）mm,P<0.05]。两组间心室复极指标无显著差异[CHF组:QT（0.41±0.07）s,QTc（0.44±0.06）s;心功能I级组:QT（0.41±0.04）s,QTc（0.44±0.04）s]。两组间室性心律失常亦无显著差异[CHF组:室性早搏（VPB）（219±598）次/24h;心功能I级组:VPB（345±504）次/24h]。结论老年心肌梗死后CHF时,心室结构重构显著,心室腔显著扩大,但在本研究中心室结构重构未见引起显著心电重构,心室复极延长及室性心律失常未见显著增加。     

N端脑钠肽前体对老年慢性心力衰竭的诊断价值

目的探讨老年慢性心力衰竭（CHF）患者血浆脑钠肽前体（NT-proBNP）水平与左室功能的关系及临床意义。方法将93例老年CHF患者按美国心脏病协会（NYHA）分级方法分为心功能Ⅱ、Ⅲ、Ⅳ级3组,25名健康老年人纳入对照组。采用电化学发光免疫分析技术测定4组血浆NT-proBNP水平,用超声心动图测定左室舒张末期内径（LVEDD）和左心室射血分数（LVEF）。结果心力衰竭NT-proBNP、LVEDD显著高于对照组（P〈0.01）,且血清NT-proBNP浓度随着心功能分级的增加而升高（3组两两比较均有统计学意义,P〈0.01）。NT-proBNP水平与LVEDD呈正相关（r=0.711,P〈0.01）,而与LVEF呈负相关（r=-0.85,P〈0.01）。结论血浆NT-proBNP水平可作为CHF患者心功能检测的有效生化指标,可以用来评估老年心力衰竭患者的左室功能。     

血浆N端脑钠肽前体与老年慢性心力衰竭患者心功能的关系及其临床意义

目的 探讨老年慢性心力衰竭(CHF)患者N端脑钠肽前体(NT-proBNP)与纽约心脏病协会(NYHA)心功能分级,左室结构和功能的关系及其临床意义.方法 110例老年CHF患者,按照NYHA分级方法分为心功能Ⅱ、Ⅲ、Ⅵ级3组,21例健康老年人(心功能Ⅰ级)纳入对照组.电化学发光双抗体免疫夹心法测定4组血浆NT-proBNP水平;超声心动图测定左室结构和功能.结果 老年心衰组患者血浆NT-proBNP水平高于健康对照组(P＜0.01),且随NYHA心功能分级的增高而逐渐升高(P＜0.01),NT-proBNP水平在心功能Ⅲ级与Ⅵ级2组间存在一定的重叠.老年人NT-proBNP水平与左室射血分数(LVEF)呈负相关(P＜0.01),与左室质量指数(LVMI)呈正相关(P＜0.05).结论 血浆NT-proBNP水平能客观定量地反映老年CHF患者心功能状态,也是对患者进行危险分层的一个有价值的工具.     

老年慢性充血性心力衰竭患者生活质量与心功能的相关性

目的探讨老年慢性充血性心力衰竭(CHF)患者生活质量与心功能的相关性。方法 80例老年慢性CHF患者采用纽约心脏病协会(NYHA)心功能分级评价所有患者心功能等级,采用明尼苏达CHF生活质量调查表(Li HFe)评价患者生活质量,采用超声心动图检查患者的左心室射血分数(LVEF),比较不同心功能分级患者Li HFe得分和LVEF差异并分析其相关性。结果 LVEF在不同心功能分级患者中差异有统计学意义(均P<0.05),其中Ⅱ级、Ⅲ级、Ⅳ级患者均显著高于Ⅰ级(均P<0.05),Ⅱ级与Ⅲ级患者之间差异无统计学意义(P>0.05),Ⅳ级患者LVEF水平高于其余分级患者(均P<0.05);不同NYHA心功能分级患者在Li HFe各项目得分及总得分上差异均有统计学意义(均P<0.05),随着心功能分级增加,各项目得分均随之增加,差异均有统计学意义(均P<0.05);Li HFe总得分及各项目得分与NYHA分级均呈显著正相关(均P<0.05),其中体力限制和症状得分与NYHA心功能分级相关性最高;Li HFe总得分及各项目得分与LVEF均无明显相关性(均P>0.05)。结论老年慢性CHF患者生活质量与NYHA心功能评价密切相关,在临床工作中可用于患者管理和生活质量评估。     

改良早期预警评分联合超声心动图及血清标志物预测老年慢性心力衰竭病人长期预后的临床价值

目的 探讨改良早期预警评分(MEWS)联合超声心动图及血清标志物对老年慢性心力衰竭(CHF)病人长期预后的预测价值。方法 选取2016年1月—2018年1月我院收治的180例CHF病人为研究对象,根据纽约心脏病协会(NYHA)心功能分级分为4组,其中Ⅰ级28例,Ⅱ级37例,Ⅲ级68例,Ⅳ级47例。比较4组超声心动图参数[包括左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室收缩末期容积(LVESV)]、血清标志物脑钠肽(BNP)、可溶性生长刺激表达基因2(sST2)及MEWS差异。根据随访期间病人临床结局分为两组,其中死亡组48例,存活组132例,对两组临床资料进行比较并进行多因素Logistic回归分析,筛选出影响病人死亡的独立危险因素;基于独立危险因素构建病人死亡风险的列线图模型。采用受试者工作特征(ROC)曲线和校正曲线评估列线图模型的区分度和准确度。结果 随着老年CHF病人心功能分级增加,LVEDD、LVESD、BNP、sST2、MEWS升高,LVEF降低,差异有统计学意义(P<0.05)。多因素分析结果显示,LVEF、LVED...     

慢性心力衰竭合并肾功能不全患者心功能与TLR4/NF-κB信号通路表达分析

目的 分析慢性心力衰竭（CHF）合并慢性肾功能不全（CRI）患者心功能与外周血Toll样受体4(TLR4)/核因子-κB(NF-κB)信号通路表达水平。方法 纳入2017年1月至2018年1月于中国中医科学院广安门医院心血管科住院的CHF患者147例,根据估算的肾小球滤过率（eGFR）是否<60 ml/（min·1.73 m2）分为CHF组（n=65）和CHF+CRI组（n=82）,比较两组患者心脏功能、心脏结构和外周血TLR4/NF-κB通路炎性因子表达水平。结果 CHF+CRI组患者左室射血分数（LVEF）[54.0(50.0,58.0)%vs. 47.5(44.0,54.0)%,P<0.01]、NYHA心功能分级：Ⅱ级41.5%vs. 20.5%,Ⅲ级36.9%vs.54.9%,Ⅳ级21.5%vs. 24.4%,P<0.05,心功能明显下降。N末端脑钠肽前体（NT-ProBNP）水平[3971(2001,8978)pg/ml vs. 7478(3433,16 018)pg/ml,P<0.05]、外周血炎症因子TLR4[(0.87±0.43)ng/μlvs....     

Selection of donor and organ viability criteria: expanding donation criteria

Donation criteria have been becoming more flexible over the years. Currently, the only absolute exclusion criteria are human immunodeficiency virus infection (HIV), uncontrolled tumor disease and bacterial or viral infections. ClinicaL. conditions dictate organ viability criteria: biochemical, morphological and functional, that must be fulfilled by the donors and their organs in order to focus the decision on which donor organs can be used. These criteria attempt to assure that the transplanted organs function after the extraction, transformation, implantation and reperfusion process without transmitting any infectious or tumour disease. In recent years, the gross and microscopic appearance has become one of the fundamental criteria for selection of potentially viable organs. At present, there is no age limit for hepatic and renal donation; the principal contra-indication is chronic organ damage. The use of each organ must be decided individually after a profound analysis of all the viability criteria, weighing the advantages and disadvantages of the implant of a certain organ for the recipient.     

Extubation criteria in infants and children

Predictors of extubation outcome attempt to provide objective data that may help to modify clinical decision making at the bedside. This article reviews the subjective and objective extubation readiness predictors tested in the pediatric medical literature. An understanding of the predictive capacity of the extubation criteria is vital for the critical care physician. No test is likely to predict the extubation outcome for an individual patient with absolute certainly. Therefore, weaning and extubation practices in the pediatric critical care setting remain variable, and teh development of standardized protocols for extubation remains controversial. Perhaps future well-designed, large-scale trials will provide more accurate predictors of extubation readiness to guide the safe and timely extubation of the pediatric patient.     

Axial spondyloarthritis criteria and modified NY criteria: issues and controversies

The Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axial spondyloarthritis (axSpA) developed in 2009 was a major step forward, since the 1984 modified New York (mNY) criteria for classification of ankylosing spondylitis (AS) were too insensitive to identify patients with early signs of axial inflammation. In the absence of “diagnostic” criteria for either axSpA or AS, both of these “classification” criteria are routinely used in clinical practice to diagnose patients. However, there is a real danger of “misdiagnosis” if classification criteria are applied erroneously by ticking “yes” or “no” boxes in an undiagnosed patient. This concern was raised and discussed at the FDA Arthritis Advisory Committee meeting in June 2013, and the committee warned that if TNF inhibitors are approved to treat axSpA, such misdiagnosis could lead to serious consequences. To gauge the SPARTAN members’ familiarity with these criteria and these issues surrounding them, as well as to investigate how they are using these criteria in daily practice, two questionnaires (one each for mNY and ASAS axSpA criteria) were sent to the “full” members of SPARTAN before the annual meeting. The results showed that more than 60 % of the responders used these criteria most of the time in practice to help them diagnose a patient, and nearly three fourth of responders agreed with the FDA Advisory Committee and would like to see some objective signs before prescribing TNF inhibitors to axSpA patients. A majority of responders looked at the sacroiliac joint x-rays themselves to diagnose sacroiliitis, even though they had difficulty in grading the x-rays. In a live vote at the meeting, 88 % of the members suggested that SPARTAN should engage in either modifying the existing criteria or develop new diagnostic criteria for axial spondyloarthritis.     

Hepatocellular carcinoma beyond Milan criteria: Management and transplant selection criteria

Liver transplantation(LT) for hepatocellular carcinoma(HCC) has been established as a standard treatment in selected patients for the last two and a half decades. After initially dismal outcomes, the Milan criteria(MC)(single HCC ≤ 5 cm or up to 3 HCCs ≤ 3 cm) have been adopted worldwide to select HCC patients for LT, however cumulative experience has shown that MC can be too strict. This has led to the development of numerous expanded criteria worldwide. Morphometric expansions on MC as well as various criteria which incorporate biomarkers as surrogates of tumor biology have been described. HCC that presents beyond MC initially can be downstaged with locoregional therapy(LRT). Post-LRT monitoring aims to identify candidates with favorable tumor behavior. Similarly, tumor marker levels as response to LRT has been utilized as surrogate of tumor biology. Molecular signatures of HCC have also been correlated to outcomes; these have yet to be incorporated into HCC-LT selection criteria formally. The ongoing discrepancy between organ demand and supply makes patient selection the most challenging element of organ allocation. Further validation of extended HCCLT criteria models and pre-LT treatment strategies are required.     

Definition and diagnostic criteria of osteoporosis in Japan

The concept of osteoporosis was introduced in Japan after the World War II and become a major medical problem with rising social and economic consequence according to increasing population of old peoples. Osteoporosis is defined as " a disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk". In Japan a diagnostic criteria was drafted for clinical practice in 1996 by Japanese Society of Bone and Mineral Research.     

Classification and diagnostic criteria in systemic vasculitis

Approximately 20 different primary forms of vasculitis are recognized, not all of which have been included in classification schemes or consensus statements regarding nomenclature. A variety of classification schemes have been proposed over the past 50 years, many predicated upon the size of the primary type of vessel involved in a given disease, as well as other considerations that include demographic features, organ tropism, the presence or absence of granulomatous inflammation, the role of immune complexes in pathophysiology and the association of autoantibodies with some forms of vasculitis. All classification schemes to date have had shortcomings owing to the substantial gaps in knowledge about vasculitis, but the American College of Rheumatology criteria for the classification of some forms of vasculitis are useful for the purpose of including patients in research studies. The Chapel Hill Consensus Conference has clarified some existing controversies in nomenclature of the systemic vasculitides. Robust diagnostic criteria for the various forms of vasculitis have, however, remained elusive.