无创性压力-应变环评估中老年心肌梗死PCI术后左心室心肌做功

目的 应用无创性压力-应变环(PSL)技术观察中老年心肌梗死患者经皮冠状动脉介入(PCI)术后的心肌做功。方法 选取30例健康体检者、30例左室收缩功能正常及30例收缩功能减低的心肌梗死PCI术后患者进行PSL分析,获得整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)、做功效率(GWE)等心肌做功参数,比较3组差异,分析做功参数与左心室整体纵向应变(GLS)和左心室射血分数(LVEF)的相关性。结果 病例组LVEF、GLS及GWI、GCW、GWE显著低于对照组(P<0.01),PSD、GWW显著高于对照组(P<0.01),GWI、GCW、GWE与LVEF呈正相关(r=0.681、0.650、0.764,均P<0.001),GWW、GLS与LVEF呈负相关(r=-0.327,-0.773,均P<0.001)。结论 PSL可以定量评估心肌梗死患者PCI术后的心肌做功,为临床评估左心室收缩功能提供新的方法。     

心肌做功测定在冠心病左心室功能评估中的应用价值

目的 探讨心肌做功测定在冠心病左心室功能评估中的应用价值。方法 选择2020年5月至2021年9月于衢州市中医医院就诊的冠心病患者83例作为观察组,另择同期本院健康体检者50例作为对照组。冠心病患者分为节段性室壁运动异常亚组（25例）和无异常亚组（58例）。超声心动图测定左心室结构和功能。应用二维斑点追踪技术,测定整体纵向应变（GLS）、整体无用功（GWW）、整体做功效率（GWE）、整体做功指数（GWI）、整体有用功（GCW）。分析心肌做功参数诊断冠心病的价值及心肌做功参数与左心室射血分数（LVEF）、GLS的相关性。结果 观察组患者LVEF、GWE、GWI、GCW低于对照组,GWW、GLS高于对照组,差异均有统计学意义（均P<0.05）。异常亚组患者LVEF、GWE、GWI、GCW低于无异常亚组,GWW、GLS高于无异常亚组,差异均有统计学意义（均P<0.05）。冠心病患者GWW与LVEF呈负相关（r=-0.606,P<0.05）,GWE、GWI、GCW与LVEF均呈正相关（r=0.646、0.625、0.630,均P<0.05）,GWW与GLS呈正相关（r=...     

无创左心室压力-应变环定量评价冠心病患者冠状动脉狭窄

目的 探讨无创左心室压力-应变环（LVPSL）对冠状动脉不同程度狭窄的冠心病（CAD）患者心肌做功的评价。 方法 回顾性选择2019年12月～2021年10月就诊于湖南中医药高等专科学校附属第一医院心血管内科临床诊断为疑似CAD且行冠状动脉造影检查的患者130例,所有患者均行常规超声心动图、二维斑点追踪（2D-STI）和LVPSL检查。根据冠状动脉造影结果将其分为冠状动脉无狭窄组（n=33）,冠状动脉有狭窄组（n=97）。依据冠状动脉Gensini评分将冠状动脉有狭窄组分为三个亚组,轻度狭窄组（Gensini评分<25,n=37）,中度狭窄组[Gensini评分（25～50）,n=32],重度狭窄组（Gensini评分>50,n=28）。采集常规超声心动参数的同时,取左心室心尖四腔心、三腔心、两腔心切面三个心动周期在二维斑点追踪（2D-STI）模式下获得左心室整体纵向应变（GLS）。输入实时血压,进入LVPSL模式,可获得左心室整体做功指数（GWI）、整体有效做功（GCW）、整体无效做功（GWW）和整体做功效率（GWE）参数。比较不同程度冠状动脉狭窄对心肌做功的影响。 结果 与冠状动脉无狭窄组相比,冠状动脉轻度狭窄组GLS的减低、GWI减低、GCW减低、GWE减低和GWW增加（均P<0.01）;冠状动脉中度狭组GLS减低、GWI减低、GCW减低、GWE减低和GWW增加（均P<0.01）;冠状动脉重度狭窄组GLS减低、GWI减低、GCW减低、GWE减低和GWW增加（均P<0.01）。与冠状动脉轻度狭窄相比,冠状动脉中度狭窄组GLS减低、GWI减低、GCW减低、GWE减低和GWW增加（均P<0.01）;冠状动脉重度狭组GLS减低、GWI减低、GCW减低、GWE减低和GWW增加（均P<0.01）;与冠状动脉中度狭窄相比,冠状动脉重度狭窄组GLS减低、GWI减低、GCW减低、GWE减低和GWW增加（均P<0.01）。冠状动脉狭窄组的Gensini评分与GLS的绝对值、GWI、GCW、GWE呈负相关（r=?0.554, ?0.661, ?0.619, ?0.829）,与GWW呈正相关（r=0.718）,其中与GWE的相关性最高。 结论 LVPSL技术测得的GWI、GCW、GWE和GWW可定量分析不同程度冠状动脉狭窄的CAD患者心肌做功情况,心肌做功参数GWE与Gensini评分的相关性最高。     

基于左心室压力-应变环的心肌做功评估对稳定性冠心病预后的预测价值

目的 探讨基于左心室压力-应变环(LVPSL)的左心室心肌做功评估对稳定性冠心病预后的预测价值。方法选择2019年1月至2021年3月衢州市人民医院行保守治疗的稳定性冠心病患者202例,所有患者入院时均接受超声心动图检查获取心肌做功参数,根据1年后是否发生主要不良心血管事件(MACE)分为预后不良组(28例)和预后良好组(174例),比较两组间临床资料和心肌做功参数。分析年龄、血压水平、整体纵向应变(GLS)、整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)、整体做功效率(GWE)对预后的影响,采用logistic回归分析冠心病预后影响因素,采用ROC曲线分析心肌做功参数预测预后的价值。结果 预后不良组患者年龄、高血压比例均高于预后良好组(均P<0.05);预后不良组患者LVEF、GWI、GCW、GWE均低于预后良好组,GLS、GWW均高于预后良好组(均P<0.05)。年龄、高血压、GLS、GWI、GCW、GWW、GWE均是影响患者预后的因素(均P<0.05)。LVEF与预后无关。高龄、高血压、高GLS、低GCW、高GWW、低GWI、低GWE患者MA...     

心肌做功在糖尿病患者伴有左室重构中的应用

目的:本研究旨在探讨心肌做功在糖尿病(DM)伴有左室重构患者早期左心室功能障碍中的应用价值。方法:本研究最终纳入45例健康受试者作为正常对照组,51例DM患者为DM组。DM组被进一步分为左室几何构型正常组(RWT<0.42,25例)和左室重构组(RWT≥0.42,26例)。所有研究对象均接受常规超声心动图和二维斑点追踪超声心动图检查,并使用GE Echo PAC分析软件获取左心室常规超声参数、应变参数及心肌做功参数：整体有效做功(GCW)、整体做功指数(GWI)、整体无效做功(GWW)、整体做功效率(GWE)等。结果:与正常对照组比较,DM组GCW、GWI、GWW、GWE、整体纵向应变(GLS)、峰值应变离散度(PSD)均受损(P<0.05)。与正常对照组比较,左室几何构型正常组和左室重构组的GCW、GWI均减低,且在左室重构组受损明显(P<0.05)。GWW、GWE、GLS、PSD在左室几何构型正常组与正常对照组之间差异无统计学意义,而与正常对照组相比,左室重构组的GCW、GWI、GWW、GWE、GLS、PSD受损(P<0.05)。结论:左室心肌做功可以用于评...     

无创左心室压力-应变循环技术在左心室功能参数与肝硬化的相关性分析

目的 探讨无创左心室压力-应变循环技术(LVPSL)与肝硬化患者肝功能分级(ChildPugh)之间的相关性。方法 前瞻性纳入2020年1月1日至2022年12月31日山东大学齐鲁医院德州医院收治的肝硬化患者120例及健康对照40例。根据Child-Pugh评分,将肝硬化患者分为三个亚组,Child-Pugh A级组(A组)、B级组(B组)和C级组(C组),各40例。采集常规超声心动图参数、左心室整体纵向应变(LVGLS)、左心室整体做功指数(GWI)、整体有效做功(GCW)、整体无效做功(GWW)和整体做功效率(GWE)参数。分析常规超声心动图参数、GLS、GWWI、GCCW、GWW和GWI与Child-Pugh评分之间的相关性。结果 与对照组相比,肝硬化组常规超声心动图参数无明显改变,而LVGLS、GWI、GCW和GWE明显降低,GWW升高(P <0.01);与肝硬化A组比较,B组LVGLS、GWI、GCW和GWE降低,而GWW升高(P <0.01);与肝硬化B组比较,C组LVGLS、GWI、GCW和GWE降低,而GWW升高(P <0.01);肝硬化患者的Chil...     

压力-应变环对终末期肾病不同替代治疗患者左心室做功的研究

目的 探讨压力-应变环（PSL）评估肾移植和血液透析（下称血透）后左心室做功的价值。方法 选取2021年10月至12月在浙江大学医学院附属第一医院就诊的左心室射血分数（LVEF）保留的肾移植患者77例（移植组）和血透患者76例（血透组）,均行超声心动图检查并分为正常构型亚组、向心性重构亚组、向心性肥厚亚组和离心性肥厚亚组,又分为低透析龄亚组和高透析龄亚组、血压正常亚组和高血压亚组。另择同期本院体检者63名作为对照组。采用PSL获取心肌做功参数,包括心肌整体做功（GWI）、整体有用功（GCW）、整体无用功（GWW）、整体做功效率（GWE）,比较3组间及不同亚组间心肌做功参数,采用Spearman秩相关分析心肌做功参数与其余各参数的相关性;绘制ROC曲线分析心肌做功参数及LVEF对左心室心肌受损的预测价值。结果 肾移植组和血透组GWE均低于对照组,血透组最低（均P<0.05）;GWW在向心性肥厚亚组和离心性肥厚亚组高于正常构型亚组和向心性重构亚组,高透析龄亚组高于低透析龄亚组,高血压亚组高于正常血压亚组（均P<0.05）;GWE在向心性肥厚亚组和离心性肥厚亚组低于正常构型亚组,...     

不同冠状动脉损伤程度川崎病患儿发病早期超声心动图、左心室心肌做功参数研究

目的 分析不同冠状动脉损伤程度川崎病（KD）患儿发病早期（确诊后1 d）超声心动图、左心室心肌做功参数。方法 选取2021年6—12月在陕西省人民医院确诊的KD患儿50例。根据患儿冠状动脉损伤情况，将其分为研究组1（冠状动脉内径正常、管壁增厚毛糙，20例）、研究组2（冠状动脉扩张，20例）、研究组3（冠状动脉瘤形成，10例）。患儿于确诊后1 d、健康儿童于体检当天进行二维超声心动图检查及二维斑点追踪超声心动图（2D-STE）检查，记录超声心动图参数[包括左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）及左心室短轴缩短率（LVFS）]、左心室心肌做功参数[整体做功指数（GWI）、整体有用功（GCW）、整体无用功（GWW）、整体做功效率（GWE）、整体纵向应变（GLS）]。结果 四组LVEDD、LVESD、LVEF、LVFS比较，差异无统计学意义（P>0.05）。四组GWI、GWW、GWE、GLS比较，差异无统计学意义（P>0.05）；研究组3 GCW低于对照组（P<0.05）。结论 冠状动脉内径正常、管壁增厚毛糙的KD患儿和...     

压力-应变环评估蒽环类药物对乳腺癌患者左室心肌做功的影响

目的 应用左心室压力-应变环（PSL）探讨蒽环类药物化疗对乳腺癌患者左心室心肌做功的影响。 方法 选取新疆医科大学第四临床医学院40例准备接受蒽环类药物化疗的乳腺癌患者,分别于化疗前及化疗第2、4、6周期后（T0、T2、T4、T6）采集患者左心室心尖四腔心、两腔心及三腔心切面超声心动图图像,测定并比较左心室心内膜、中层、外膜心肌纵向应变（EndoGLS、MidGLS、EpiGLS）和整体心肌做功指数（GWI）、整体有用功（GCW）、整体无用功（GWW）和整体做功效率（GWE）。 结果 常规超声心动图参数LVDD、IVSTD、E峰、A峰、E/A及LVEF于化疗各周期比较,差异均无统计学意义。T4、T6时GWI（1927.68±207.58mmHg和1853.30±208.32mmHg）和GCW（2191.68±212.14mmHg和2127.32±217.13mmHg）低于T0,差异有统计学意义（P<0.05）;T6时EndoGLS（-22.97±1.81%）、MidGLS（-20.32±1.62%）和EpiGLS（-18.06±1.53%）绝对值低于T0,差异有统计学意义（P<0.05）。相关性分析显示EndoGLS与GWI和GCW相关性较明显（r=-0.57和r=-0.56,均P<0.001）。 结论 PSL较斑点追踪分层应变技术能更早发现蒽环类药物化疗乳腺癌患者的左心室心肌做功改变,为定量评估蒽环类药物化疗乳腺癌患者的左心室收缩功能提供了一种新方法。     

左室压力-应变环对冠心病患者心肌做功评价的初步研究

目的 应用左室压力-应变环（LVPSL）评价冠状动脉狭窄患者心肌做功的改变情况,探讨心肌做功参数在诊断冠心病中的临床价值。 方法 疑诊冠心病患者111例,根据冠脉造影结果分为两组:对照组（冠脉无狭窄或狭窄<50%）33例;冠心病组（至少一支冠脉狭窄≥50%）78例,将冠心病组分为有节段性室壁运动异常组26例,无节段性室壁运动异常组52例;分别采集心尖四腔、两腔、左室长轴切面动态图像,应用Echo PAC工作站获取左室整体纵向应变(GLS),进入心肌做功分析模式,得出LVPSL,最终获取长轴整体做功指数（GWI）、整体有效功（GCW）、整体无效功（GWW）、整体做功效率（GME）。 结果 与对照组相比,冠心病组GLS、GWI、GCW、GME均显著减低,GWW显著升高（均P<0.01）,冠心病有节段性室壁运动异常组GLS、GWW显著升高（P<0.01）,冠心病无节段性室壁运动异常组GWI、GCW、GME均显著减低（P<0.01）,GLS显著减低、GWW显著升高（P<0.01）。ROC曲线显示GWI、GCW、GWW、GME的曲线下面积分别为0.36、0.40、0.75、0.27;GWW截断值为70.5%,预测冠心病的灵敏度、特异度分别为67%、97%,约登指数0.64。 结论 LVPSL可量化分析冠心病患者心肌做功,其中GWW是反映冠心病患者心肌做功和心室功能改变的较敏感指标。     

Subclinical thyroid disease in patients with Parkinson's disease

The objective of this study was to determine whether hypothyroidism is more common in Parkinson patients than in a control group without Parkinson, as suggested in the past. We performed a retrospective file review of all admissions to the geriatric ward during a 1-year period. Concentrations of thyroid stimulating hormone (TSH) and thyroxine (T4) from 92 Parkinson patients were compared with those of 225 randomly selected controls from the same ward. Hypothyroidism was not found to be more common in patients with Parkinson disease as previously suggested. Incidentally, we found an unexpected increase in the prevalence of abnormal thyroid laboratory tests in this group. Statistically significant differences were found in two subgroups, (1) men with Parkinson were more likely to have abnormal thyroid laboratory tests as compared with controls; and (2) 'subclinical' hyperthyroidism was found to be more prevalent in Parkinson patients than in controls. Further research in this field is warranted in non-hospitalized patients.     

Metabolic bone disease in patients with liver disease

The coexistence of liver disease and osteopenic bone disease has been recognized for many years and is now the subject of increasing attention. Osteoporosis has been characterized well in patients with cholestatic liver disease, but new research suggests that osteopenia and osteoporosis may also be prevalent in patients with other chronic liver diseases. Although the precise mechanism of bone loss remains unclear, advances in treatment and prevention are bringing heightened awareness to this common problem.     

Cardiac disease in diabetic patients with renal disease

Patients with diabetes represent an increasing proportion of end-stage renal disease (ESRD) patients. Cardiovascular risk, already formidable among patients on dialysis, is significantly higher among those who also have diabetes. Diabetic ESRD patients are not only at higher risk of ischaemic events, but are also subject to haemodynamic overload, because of anaemia, hypertension, and arteriovenous dialysis connections. Mortality rates are also significantly higher in these patients. Hypertension and anaemia stand out as opportunities for intervention in these patients. Anaemia per se is associated with an increased risk of cardiovascular abnormalities, including left ventricular hypertrophy, and with an increased risk of mortality. The interplay of multiple risk factors in diabetic patients with ESRD demands a multidisciplinary approach for the early identification and management of cardiovascular risk factors--hypercholsterolaemia, hypertension, blood glucose and anaemia--in order to optimise outcomes in these patients.     

Inflammatory bowel disease in patients with celiac disease

BACKGROUND: Several case reports and series report an association between celiac disease and inflammatory bowel disease (IBD); however, there is no current data assessing this association. We therefore studied the occurrence of these conditions in a cohort of patients with celiac disease seen at a referral center. METHODS: A database of patients with celiac disease seen between 1981 and 2002 was analyzed. Only biopsy-proven adults were included. Patients who had endoscopic and pathologic evidence of IBD were identified, and their pathology was reviewed. Age- and sex-adjusted prevalence rate ratios were determined by comparing results with population-based prevalence data. RESULTS: Among 455 patients with celiac disease, IBD was identified in 10 (5 had ulcerative colitis and 5 had Crohn's disease). This represented an age- and sex-adjusted prevalence rate ratio for ulcerative colitis of 3.56 (95% confidence interval, 1.48-8.56) and for Crohn's disease of 8.49 (95% confidence interval, 3.53-20.42). CONCLUSION: Within our cohort of patients with celiac disease, IBD was significantly more common than in the general population.     

Racial differences in disease phenotypes in patients with Crohn's disease

BACKGROUND: Our objectives were to assess the differences in perforating disease behavior, disease severity, and extraintestinal manifestations (EIM) in patients with Crohn's disease (CD) by race. MATERIALS AND METHODS: We identified outpatients with CD evaluated at the University of Maryland Gastroenterology Faculty Practice office or the Baltimore Veterans Affairs Maryland Health Care System, from 1997 to 2005. We assessed age at diagnosis, disease behavior, disease location, need for surgery and EIM. RESULTS: Race was not associated with perforating disease behavior (relative risk [RR] 0.79, 95% confidence interval [CI] 0.46-1.35), need for surgery (RR 0.89, 95% CI 0.56-1.12), and EIM of CD (RR 0.77, 95% CI 0.46-1.27). White patients were significantly more likely to have ileal disease, whereas African American patients were significantly more likely to have ileocolonic and colonic disease. Age at diagnosis younger than 40 years (odds ratio [OR] 4.41, 95% CI 1.84-10.56) and ileocolonic disease (OR 2.39, 95% CI 1.24-4.63) were independent risk factors for perforating disease behavior. Similarly, age at diagnosis younger than 40 (OR 2.79, 95% CI 1.45-5.33), ileal disease (OR 3.76, 95% CI 1.66-8.48), and ileocolonic disease (OR 2.57, 95% CI1.21-5.46) were associated with the need for surgery. Female gender (OR 4.23, 95% CI 1.87-9.58) and a positive family history of CD (OR 3.45, 95% CI 1.49-8.0) were associated with joint manifestations of CD. DISCUSSION: We did not detect differences in disease behavior, severity, or joint EIM by race. Although African American patients were more likely to have ileocolonic or colonic disease, these factors did not affect disease behavior or severity.     

Bone density improves with disease remission in patients with inflammatory bowel disease

BACKGROUND AND AIMS: Patients with inflammatory bowel disease (IBD) are at risk of low bone mineral density (BMD). The aim of this cross-sectional study was to investigate (i) whether patients with IBD in long-term remission have greater bone density relative to patients with active disease, (ii) the effect of remission on BMD in ulcerative colitis and Crohn's disease, and (iii) the effect of azathioprine treatment, used to induce remission, on BMD. PATIENTS AND METHODS: BMD relative to the age-standardised mean (Z-score) was measured by dual-energy X-ray absorptiometry at the left femoral neck and lumbar spine in consecutive patients with IBD. Patients were divided into the following groups: (i) active disease, (ii) remission of less than one year, (iii) remission of one to three years, and (iv) remission of more than three years. Active disease was defined as three or more bowel motions per day, treatment with oral or rectal corticosteroids, and/or presence of a fistula. The subgroups with ulcerative colitis and Crohn's disease and the effect of taking azathioprine were compared. All results were controlled for confounding variables.RESULTS A total of 137 (64 ulcerative colitis, 73 Crohn's disease) patients were evaluated. Patients in remission for more than three years had a normal mean Z-score that was significantly higher than those with active disease at both the femoral neck and the lumbar spine for both ulcerative colitis and Crohn's disease. Patients taking azathioprine and in remission had significantly higher mean Z-scores at the lumbar spine than patients with active disease and who were not taking azathioprine. CONCLUSION: In patients with ulcerative colitis and Crohn's disease, age-matched BMD is higher with increasing duration of disease remission and induction of remission by azathioprine.     

Pulmonary vascular disease in adults with congenital heart disease

Pulmonary arterial hypertension of variable degree is commonly associated with adult congenital heart disease. Depending on size and location of the underlying cardiac defect as well as on repair status, pulmonary arterial hypertension may present with or without reversed shunting and associated cyanosis (ie, Eisenmenger syndrome). We review available data on etiology, clinical presentation, prognosis, and management strategies of pulmonary arterial hypertension in adult patients with congenital heart disease. In addition, we discuss the numerous complications associated with Eisenmenger syndrome, representing a multisystem disorder. Finally, we present general management strategies and emerging disease-targeting therapies.     

Factors associated with disease evolution in Greek patients with inflammatory bowel disease

Background  

The majority of Crohn's disease patients with B1 phenotype at diagnosis (i.e. non-stricturing non-penetrating disease) will develop over time a stricturing or a penetrating pattern. Conflicting data exist on the rate of proximal disease extension in ulcerative colitis patients with proctitis or left-sided colitis at diagnosis. We aimed to study disease evolution in Crohn's disease B1 patients and ulcerative colitis patients with proctitis and left-sided colitis at diagnosis.     

免疫缺陷者易发的肺疾病

免疫缺陷性疾病极易发生呼吸系统感染。约50％以上的获得性免疫缺陷综合征(AIDS)病人会出现卡氏肺孢子虫病(PCP)。治疗PCP可选用复方新诺明、喷他脒和克林霉素-伯氨喹等药物。巨细胞病毒肺炎(CMV)感染可引起短时间免疫缺陷，而免疫缺陷亦易引发CMV感染。丙氧鸟苷和抗CMV免疫球蛋白有一定治疗作用。免疫缺陷患者发生结核病的机率较正常人高得多，部分免疫缺陷者并发肺结核表现为无反应性，且死亡率高。治疗最好采用包括利福平和吡嗪酰胺的强效化疗方案，一律实行直接面视下督导治疗(DOT)。免疫缺陷者分支杆菌感染机率明显增加，其中主要是鸟型胞内分支杆菌复合体(MAC)。可采用目前常用的抗结核药物进行联合治疗，但疗程要长，一般2年。军团菌肺炎在有免疫缺陷的病人中易发，尤其是细胞免疫缺陷者。治疗首选红霉素，可以加用利福平。弓形虫感染在免疫缺陷的患者中也经常碰到，应积极预防，常用药物有乙胺嘧啶、磺胺嘧啶或大环内酯类抗生素。