急性ST段抬高型心肌梗死患者血浆微小核糖核酸-208a水平对并发急性心力衰竭的预测价值

目的:探讨血清微小核糖核酸-208a(miR-208a)表达水平对急性ST段抬高型心肌梗死(STEMI)患者并发急性心力衰竭的预测关系。方法:连续性收集2018年1月至2019年6月,就诊于我科的152例急性STEMI患者纳入病例组,并随机选择同期在我院行健康体检的志愿者60例为对照组。根据发病48 h内是否发生急性心力衰竭(AHF)将病例组分为AHF亚组和非AHF亚组。采用实时荧光定量PCR(RT-qPCR)法检测血浆miR-208a的相对表达水平。结果:病例组血浆miR-208a相对表达水平显著高于对照组(Z=10.919,P=0.000)。AHF亚组血浆miR-208a相对表达水平显著高于非AHF亚组(Z=9.573,P=0.000)。Pearson相关性分析结果显示,病例组患者血浆miR-208a相对表达水平与BNP、hsCRP和cTnI均呈正相关关系(r=0.612,P=0.000;r=0.447,P=0.000;r=0.378,P=0.000)。二分类Logistic回归分析结果显示血浆miR-208a相对表达水平是急性STEMI患者并发AHF的危险因素(OR=2.118,95%CI 1.127~3.982,P=0.007)。血浆miR-208a预测AHF的AUC为0.896(0.844,0.948),cut-off值为32.00,对应的敏感性和特异性分别为88.4%和83.3%。结论:急性STEMI患者血浆miR-208a表达水平显著升高,且可能是并发AHF的危险因素。     

心电图墓碑样ST段抬高与AMI早期左室重构的关系

目的　评价墓碑样ST段抬高对AMI早期左室重构的影响。方法　对 12 5例初发的AMI,按梗死部位分为前壁和下壁组 ,根据ECG的ST段变化再分为墓碑样抬高亚组和非墓碑样抬高 (通常型 )亚组。在起病第四周用超声心动图检查室壁运动情况 ,测量并计算左室收缩末期容积(ESV) ,舒张末期容积 (EDV) ,每搏输出量 (SV)和射血分数(EF) ,并与对照组比较。结果　在前壁梗死墓碑样抬高组EDV =(16 8 19± 11 0 3)mL ,ESV =(116 93± 19 31)mL ,SV =(5 1 2 6± 7 94 )mL ,EF(30 4 7± 12 37) % ,P <0 0 1;通常组EDV =(133 4 3± 5 73)mL ,ESV =(6 6 92± 9 0 7)mL ,SV =(6 6 5 1± 9 7)mL ,EF =(49 84± 13) %。在下壁梗死 ,墓碑样抬高组EDV =(14 3 0 5± 15 4 7)mL ,ESV =(88 12± 14 75 )mL ,SV =(5 4 93± 12 0 9)mL ,EF =(38 39± 10 8) % ,P <0 0 5。通常组EDV =(12 8 78± 12 2 5 )mL ,ESV =(5 7 5 1± 8 0 4 )mL ,SV=(71 2 7± 4 4 7)mL ,EF =(5 5 34± 9 3) %。墓碑样抬高组较通常组更多发生室壁瘤。结论　心电图墓碑样ST段抬高与AMI早期左室重构高度相关     

肺癌患者血清VEGF-B和PIGF的表达及临床意义

目的 探讨肺癌患者和健康人的血清样本中血管内皮生长因子-B(VEGF-B)和胎盘生长因子(PIGF)的含量,及其与分期、肿瘤的分化程度、远处转移、化疗效果等特征的相关性.方法 通过酶联免疫吸附法分别检测肺癌患者化疗前后和健康对照者的血清样本中的VEGF-B、PIGF的浓度,并进行统计学处理.结果 VEGF-B和PIGF在肺癌患者血清中的含量明显高于健康人群(P＜0.01),并与分期、远处转移呈正相关(P＜0.05);与分化程度、年龄、性别、肿瘤的病理类型无关(P＞0.05).经EP方案治疗后,肺癌患者血清中VEGF-B和PIGF的水平在治疗前后的变化与治疗效果相关(P＜0.05).经Pearson相关性检验发现VEGF-B和PIGF显著相关(r=0.514,P＜o.01).结论 VEGF-B和PIGF共同参与肺癌的发生发展、侵袭转移过程;治疗前后血清VEGF-B和PIGF含量变化可作为肺癌患者疗效预测的指标.     

AMI患者血浆脑钠肽水平测定及其与左室重构的关系

测定对68例急性心肌梗死(AM I)患者发病后48 h内(早期)血浆脑钠肽(BNP)水平;于发病后28~30 d行超声心动图检查,测量左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)和左心室射血分数(LVEF)。对血浆BNP水平与LVESV、LVEDV、LVEF进行相关性分析。结果LVEF≤40%者血浆BNP水平显著高于LVEF>40%者,P<0.05;血浆BNP水平与LVESV、LVEDV呈正相关,与LVEF呈负相关。认为AM I早期血浆BNP水平升高与其28~30 d左室重构程度密切相关,应积极进行干预治疗。     

肝细胞生长因子对急性心肌梗死后左室重构的预测作用

目的: 探讨血清肝细胞生成因子(HGF)对急性心肌梗死(AMI)后早期左室重构的预测价值。方法: 36例AMI患者入院时及发病7 d测定血清HGF水平;AMI其中的26例分别于发病后7~10 d及发病后3个月行超声心动图检查,3个月时左室舒张末期容积指数（LVEDVI）与7~10 d时比增加≥5 ml/m2定义为左室重构组(n=11),对两组血清HGF值进行比较。结果: AMI患者入院时血清HGF浓度较对照组明显升高［(809±288)ng/L vs.(620±162)ng/L,P<0.01］,7 d时升高更显著［(1 607±1 355)ng/L,P<0.01］。发病7 d时血清HGF浓度在左室重构组较非左室重构组升高［(2 216±1 522)ng/L vs.(1 176±593)ng/L,P<0.05］,而入院时两组浓度则无显著差异。结论: AMI时血清HGF浓度升高,AMI后7 d时增高的血清HGF可能预示心室重构。     

sPE患者血清miR-199a-5p、miR-142-3p表达变化及与产妇血管内皮损伤、围产儿结局的关系

目的 观察重度子痫前期（sPE）患者血清微小核糖核酸-199a-5p(miR-199a-5p)、微小核糖核酸-142-3p(miR-142-3p)表达变化,并分析其与产妇血管内皮损伤、围产儿结局的关系,为围产儿结局的改善提供参考。方法选取sPE患者200例（观察组）和产检健康孕妇200例（对照组）,采用RT-PCR法测算两组血清miR-199a-5p、miR-142-3p,酶联免疫吸附试验检测两组血清可溶性细胞内皮因子（sEng）、可溶性血管内皮生长因子受体-1(sFlt-1)、内皮素-1(ET-1)、血管内皮生长因子（VEGF）,Pearson相关分析法分析观察组血清miR-199a-5p、miR-142-3p与血管内皮功能相关指标的相关性。根据围产儿结局将观察组分为结局不良组（29例）和结局良好组（171例）,采用单因素分析法及多因素Logistic回归分析法分析患者血清miR-199a-5p、miR-142-3p表达与围产儿结局的关系。结果 与对照组比较,观察组血清miR-199a-5p表达及VEGF水平降低,血清miR-142-3p表达及sEng、sFlt-1、ET-1水平升高...     

高血压性脑出血患者血清miR-141-3p、 miR-29a-3p水平变化及临床意义

目的 观察高血压性脑出血(HICH)患者血清miR-141-3p、miR-29a-3p水平变化,并探讨其与病情以及预后的关系.方法 选择167例HICH患者(HICH组),根据斯堪纳维亚卒中量表(SSS)评分将患者分为轻型组(0～15分,42例)、中型组(16～30分,67例)和重型组(31～45分,58例),根据出院3个月后格拉斯哥预后(GOS)评分分为预后良好组(>4分,87例),预后不良组(≤4分,80例),另选择同期于我院体检的64例健康志愿者(对照组).比较组间血清miR-141-3p、miR-29a-3p和肿瘤坏死因子-α(TNF-α)、IL-1β和IL-6水平.采用Pearson相关分析miR-141-3p、miR-29a-3p与炎性因子的相关性,多因素Logistic回归分析HICH患者预后不良的危险因素,受试者工作特征(ROC)曲线分析miR-141-3p、miR-29a-3p预测HICH患者预后不良的价值.结果 HICH组血清miR-141-3p、miR-29a-3p水平低于对照组,血清TNF-α、IL-1β和IL-6水平高于对照组(P均<0.01).重型组血清miR-141-3p、miR-29a-3p水平低于中型组和轻型组,血清TNF-α、IL-1β、IL-6水平高于中型组和轻型组(P均<0.01);中型组血清miR-141-3p、miR-29a-3p水平低于轻型组,血清TNF-α、IL-1β、IL-6水平高于轻型组(P均<0.01).HICH组血清miR-141-3p、miR-29a-3p水平与TNF-α、IL-1β、IL-6水平均呈负相关(P均<0.01).高水平miR-141-3p(OR=0.656,95％CI:0.500～0.862,P<0.01)、miR-29a-3p(OR=0.733,95％CI:0.581～0.926,P<0.01)是HICH预后的保护因素.miR-141-3p、miR-29a-3p预测HICH预后不良的曲线下面积为0.675、0.688,联合预测曲线下面积为0.898,高于单独指标预测(Z分别为4.950、5.325,P均<0.05).结论 HICH患者血清miR-141-3p、miR-29a-3p水平均降低,且与神经损伤程度加重以及预后不良有关.     

急性冠脉综合征患者循环miR-208b-3p与心室重构的关系研究

目的 探究急性冠脉综合征患者循环miR-208b-3p表达水平与心室重构的关系。方法 收集140例西安市第九医院心血管内科2015年11月至2016年12月确诊为急性冠脉综合征患者,实时定量PCR（quantification PCR,qPCR）检测样本miR-208b-3p的表达水平,根据miR-208b-3p表达水平高低以每组同样患者数分为四组,分别比较四组住院及出院1年随访超声测量结果,并对测量值变化率做进一步对比分析。结果 住院期间各超声测量组患者例数之间差异无统计学意义（p>0.05）,出院1年各左心室舒张末期内径（left ventricular end-diastolic dimension,LVDd）组和各左心室射血分数（left ventricular ejection fraction,LVEF）组患者例数的差异具有统计学意义（p=0.046;p=0.036）,各左心室短轴缩短率（fraction shortening,FS）组差异无统计学意义（p>0.05）。变化率分析显示各组LVDd变化率分别为（-0.410±0.125、0.024±0.156、0.082±0.152、0.004±0.078）（p=0.326）;各组FS变化率分别为（0.081±0.379、0.074±0.209、0.061±0.258、0.123±0.310）（p=0.896）;各组LVEF变化率分别为（0.082±0.035、0.046±0.035、0.022±0.037、-0.082±0.052）（p=0.034）。对各组LVEF测量值变化率进行两两对比显示高危组分别与低危组及中低危组差异具有统计学意义（p=0.010;p=0.042）。结论 循环miR-208b-3p与远期心室重构相关,并且对LVEF值的影响最大。     

血浆微小核糖核酸对急性心肌梗死患者左心室重构及预后的相关性分析

目的:评估急性心肌梗死(AMI)患者血浆miRNA-21、miRNA-29b和miRNA-92a水平与左心室重构及预后的相关性。方法:根据纳入及排除标准纳入57例AMI患者作为AMI组及健康体检者20例作为对照组,检测两组受试者血浆miRNA-21、miRNA-29b和miRNA-92a相对表达量,检测AMI患者发病1 d及6个月时的心室重构指标,分析miRNA-21、miRNA-29b和miRNA-92a水平与左心室重构的相关性。对AMI患者随访6个月,采用受试者工作特征(ROC)曲线分析上述指标的诊断价值及最佳阈值,并根据最佳阈值将患者分为高表达组和低表达组,采用Kaplan-Meier生存曲线分析不同表达水平的miRNA-21、miRNA-29b和miRNA-92a表达患者无新发主要心脏不良事件(MACE)生存情况。结果:AMI组血浆miRNA-21、miRNA-29b和miRNA-92a相对表达量显著高于对照组(P <0. 001)。AMI组患者血浆miRNA-92a水平与LVESV、LVEDV呈显著正相关(P<0. 05),与LVEF呈显著负相关(P<0.05)。血miRNA-92a对AMI的诊断价值的ROC曲线下面积为0. 851,血浆miRNA-92a诊断最佳阈值为41. 30,将miRNA-92a≤41. 30的14例AMI患者视为低表达组,余43例视为高表达组,结果显示高表达组患者新发MACE事件显著多于低表达组(χ~2=4. 272,P=0. 039),提示miRNA-92a高表达组预后较差。结论:AMI早期患者血浆miRNA-21、miRNA-29b和miRNA-92a水平显著升高,而miRNA-92a与AMI左心室重构及预后严重程度呈正相关,miRNA-92a可作为患者临床AMI诊断和预后监测指标。     

血浆Copeptin、VEGF-B水平联合心电图检查对AMI的诊断价值

目的:探究血浆和肽素(Copeptin)、血管内皮生长因子-B (VEGF-B)联合ECG检查对急性心肌梗死(AMI)的诊断价值.方法:以本院的126例AMI患者为AMI组,同期98例健康者为健康对照组.比较两组血浆Copeptin等水平.采用ROC曲线评价血浆Copeptin水平等对AMI的诊断价值,并分析比较Cop...     

急性心肌梗死患者侧支血流分数与左室重塑关系的临床研究

目的应用压力导丝,通过冠状动脉内压力测定,评价急性心肌梗死(AMI)患者侧支血流分数(QC/QN)与左室重塑的关系.方法 21例AMI患者,于经皮腔内冠状动脉成形术(PTCA)时,对梗死相关动脉远端侧支血流行Rentrop分级并记录梗死相关动脉病变远端嵌楔压(Pw)及主动脉压(Pa),据QC/QN值将21例患者分为A组(QC/QN≥0.25),B组(QC/QN<0.25).所有患者于AMI后3 d和1个月行二维超声心动图检查,并进行统计学分析.结果 AMI后3 d A、B两组间EF分别为(51.7±7.1)%和(45.6±5.8)%(P<0.05);ESVI分别为(25.0±5.4) ml/m2和(30.5±6.2) ml/m2(P<0.05);EDVI分别为(51.9±9.8) ml/m2和(55.4±7.5) ml/m2(P>0.05).AMI后1个月,两组间EF分别为(53.7±7.1)%和(43.9±8.1)%(P<0.01);ESVI分别为(27.1±5.8) ml/m2和(38.7±11.5) ml/m2(P<0.01);EDVI分别为(58.3±7.5) ml/m2和(67.8±13.0) ml/m2(P<0.05).AMI后1个月较3 d,A组患者EF有明显改善(P<0.05),B组EF变化不明显(P>0.05);A、B两组患者ESVI和EDVI均有显著增大.结论造影Rentrop分级对侧支循环的评价存在局限性;AMI时侧支循环的开放是影响左室重塑的重要因素,侧支血流分数的大小是决定AMI后左室重塑及其预后的重要指标.     

Low levels of vascular endothelial growth factor B predict left ventricular remodeling after acute myocardial infarction

BackgroundLeft ventricular (LV) remodeling is a prognostically important development after acute myocardial infarction (AMI). We recently reported that vascular endothelial growth factor B (VEGFB) may be a potential new biomarker of LV remodeling. This potential biomarker was evaluated in the present study.Methods and ResultsPatients with AMI (n = 290) and healthy volunteers (n = 42) were included. Plasma VEGFB levels were assessed before discharge. LV remodeling was determined by echocardiography at 6 months’ follow-up. Levels of VEGFB were elevated in AMI patients compared with healthy volunteers (1.5-fold; P = .001). Mean plasma levels of VEGFB were 64% higher (P < .001) in patients in whom LV end-diastolic volume (EDV) decreased during follow-up (ΔEDV ≤ 0; n = 144; reverse remodeling) compared with patients in whom ΔEDV increased (ΔEDV > 0; n = 146; remodeling). Using logistic regression models, independent relationships were found between VEGFB (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.7–0.9; P = .0007) and infarct territory (OR 1.7, 95% CI 1.1–2.8; P = .02). Patients with anterior MI and low levels of VEGFB had the highest risk of remodeling. VEFGB outperformed N-terminal pro–B-type natriuretic peptide to predict LV remodeling, and low levels of VEGFB (<100 pg/mL) provided a specificity of 90%. Adding VEGFB to a clinical model involving age, sex, smoking habit, and infarct territory resulted in a net reclassification index of 11.7%.ConclusionsPlasma levels of VEGFB increase after AMI and correlate with preservation of cardiac function. Low levels of VEGFB accurately predict LV remodeling. Therefore, circulating VEGFB may have clinical utility in the identification of patients at high risk of remodeling after AMI.     

MiRNA-423-5p与急性心肌梗死后心室重构的关系

目的探讨急性心肌梗死(AMI)患者血浆miRNA-423-5p水平与心肌梗死后心室重构严重程度的关系及对AMI患者临床预后的影响。方法选择2012年6月至2014年6月在我院心内科住院并诊断为急性ST段抬高型心肌梗死(STEMI)患者248例,根据入院血浆miRNA-423-5p水平的三分位数间距将患者分为低水平组(miRNA-423-5p0.35)80例,中水平组(0.36≤miRNA-423-5p≤0.72)86例和高水平组(miRNA-423-5p0.72)82例。测定患者入院即刻N末端脑钠肽前体(NTproBNP)水平,并于入院7~10 d内及半年后行超声心动图测定患者左室舒张末期内径(LVEDd)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)。动态追踪观察三组患者随访期间(6个月内)心脏不良事件(MACE)的发生情况。结果三组患者随miRNA-423-5p水平升高,NT-proBNP水平升高,术后半年的LVEDV和LVESV显著增加,LVEF降低[(1075.33±98.54)pg/L比(832.17±86.55)pg/L比(552.66±68.58)pg/L;(132.35±11.56)ml比(130.66±12.25)ml比(127.51±10.35)ml;(61.86±11.53)ml比(59.92±10.25)ml比(59.02±11.23)ml;47.05%±4.16%比48.14%±3.78%比49.82%±4.53%,均为P0.05],STEMI患者miRNA-423-5p与NT-proBNP水平呈正相关(r=0.412,P0.05)。直接PCI术后随访6个月,Kaplan-Meier生存分析发现三组患者累积无MACE事件生存率差异有统计学意义(96.25%比90.70%比81.71%,Log rank=9.605,P=0.008),多因素Logistic回归分析显示miRNA-423-5p、NT-proBNP均为STEMI患者近期MACE发生的独立预测因子。结论 AMI患者入院血浆miRNA-423-5p水平与心肌梗死后心室重构密切相关,并对AMI患者的近期预后具有预测意义。     

Dynamics of left ventricular remodeling in patients with acute myocardial infarction

Dynamics of structural and functional left ventricular parameters was investigated in 51 patients with acute anterior myocardial infarction by means of serial (on days 1, 2, 3, 5, 7, 10 and 21 of infarction) echocardiographical study. Increase of end-diastolic volume index relative to initial values became significant on 5th-7th days and continued to progress until 3rd week of infarction. Left ventricular cavity became dilated and attained more occurred shape predominantly at the account of increased transverse diameters. Abnormalities of left ventricular contractile and pump functions were most pronounced during first 3 days of the disease. Between 5th and 10th days improvement and stabilization of myocardial functional state took place accompanied by progression of left ventricular dilation and increase of its sphericity with lessening of degree of myocardial asynergy.     

急性心肌梗死经皮冠状动脉介入治疗患者心肌胶原与左心室重构的关系

目的探讨急性心肌梗死经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗患者心肌胶原变化与左心室重构关系。方法选择2011年12月至2012年9月入住宝安区人民医院的急性心肌梗死患者共70例为研究对象。按照入院后患者是否行直接PCI治疗分为直接PCI治疗组(n=30)和择期PCI治疗组(n=30),其中10例(其中直接PCI治疗组5例,择期PCI治疗组5例)患者出院后不愿意随访。所有入选患者术前、术后3 d及术后30 d均分别以酶联免疫吸附法测定血清Ⅰ型C端胶原前肽(carboxy-terminal propeptide of type I procollagen,PICP)、Ⅲ型N端胶原前肽(amino-terminal propeptide of type III procollagen,PⅢNP)和Ⅰ型C端胶原末肽(carboxy-terminal telopeptide of collagen type I,CITP)浓度;术后3 d、术后30 d均行心脏超声检查;术后30 d行单光子发射计算机断层显像测量心肌梗死面积。结果术后30 d直接PCI治疗组血清PICP、PⅢNP、CITP浓度较择期PCI治疗组明显降低,差异有统计学意义[PICP:(7.76±1.47)ng/mL vs.(10.73±1.67)ng/mL,P﹤0.05;PⅢNP:(11.17±4.72)ng/mL vs.(37.80±6.83)ng/mL,P﹤0.05;CITP:(31.18±6.78)ng/mL vs.(45.10±9.70)ng/mL,P﹤0.05]。术后30 d直接PCI治疗的左心室舒张末期内径、左心室收缩末期内径、心肌梗死面积明显低于择期PCI治疗组[(46.57±6.10)mm vs.(52.63±6.50)mm,P﹤0.05;(34.25±4.86)mm vs.(37.33±3.56)mm,P﹤0.05;22.8%±3.4%vs.28.2%±6.8%,P﹤0.05]。结论直接PCI治疗可有效地挽救濒死的心肌,减轻心室重构,保护心功能,改善患者远期预后。检测血清心肌胶原浓度能作为预测心室重构的指标。     

Relationship between transcardiac extraction of aldosterone and left ventricular remodeling in patients with first acute myocardial infarction: extracting aldosterone through the heart promotes ventricular remodeling after acute myocardial infarction.

OBJECTIVES: The purpose of this study was to evaluate whether plasma aldosterone (ALD) is extracted or produced through the heart in patients with acute myocardial infarction (AMI) and to determine the relationship between transcardiac extraction of plasma ALD and left ventricular (LV) remodeling. BACKGROUND: Although we demonstrated that circulating ALD was extracted through the failing heart and that transcardiac extraction of ALD correlated with LV end-diastolic volume index (LVEDVI) in patients with congestive heart failure, the existence and increase of ALD synthase in the hearts of infarct rats were reported, suggesting cardiac production of ALD in patients with AMI. METHODS: We measured plasma ALD in the aortic root (Ao) and coronary sinus (CS) in 57 consecutive patients who received successful revascularization and enalapril, with first AMI at acute phase and after one month. We also measured plasma procollagen type III aminoterminal peptide (PIIINP) in the CS. RESULTS: Plasma ALD was significantly lower in the CS than it was in the Ao at the acute phase (84.7 +/- 6.3 pg/ml vs. 105.5 +/- 8.0 pg/ml, p < 0.0001). Significant positive correlations exist between the transcardiac gradient of ALD at the acute phase and the LVEDVI at one month. Moreover, the transcardiac gradient of plasma ALD at the acute phase has a significant correlation with plasma PIIINP, a biochemical marker of fibrosis, after one month. Stepwise multivariate analysis showed that transcardiac extraction of plasma ALD at the acute phase had an independent and significant positive relationship with a large LVEDVI after one month. CONCLUSIONS: These results indicate that plasma ALD is extracted through the heart in patients with AMI at the acute phase and that the extracted ALD plays an important role in modulating post-infarct LV remodeling.     

High-sensitivity C-reactive protein and left ventricular remodeling in patients with acute myocardial infarction

 Inflammatory cytokines are suspected to play an important role in the pathophysiology of left ventricular (LV) remodeling. We investigated whether high-sensitivity C-reactive protein (CRP) (hs-CRP) is a predictor for LV remodeling in patients with acute myocardial infarction (AMI) with successful reperfusion, and also whether such a situation can be avoided by the administration of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB). The subjects were 139 patients with an initial attack of anterior myocardial infarction successfully treated by reperfusion therapy. They were randomly divided into the following two groups: an angiotensin (AG) group (91 patients treated with ACEI/ARB) and a NON-AG group (48 patients not treated with ACEI/ARB). Levels of hs-CRP, creatine kinase, human atrial natriuretic polypeptide, brain natriuretic peptide (BNP), fasting blood glucose, serum lipids, fibrinogen, fibrin degradation product, prothromloin time, and activated partial thromboplastin time were measured immediately after 1, 2, 3, and 7 days, and 1 months after the onset of AMI. ACEI or ARB administration lowered hs-CRP levels and prevented the development of LV remodeling. Peak CRP levels significantly correlated with BNP levels during the acute stage (r = +0.54, P < 0.0001), end-diastolic volume index (r = +0.78, P < 0.0001), end-systolic volume index (r = +0.36, P = 0.0405), ejection fraction (r = −0.45, P = 0.0052), left ventricular end-diastolic diameter (r = +0.61, P < 0.0001), cardiac output (r = −0.52, P = 0.0005), cardiac index (r = −0.41, P = 0.0099), and systolic pulmonary arterial pressure (r = +0.48, P = 0.0017) 1 month after the onset of AMI in the NON-AG group but not in the AG group. Logistic multivariate analysis revealed that peak CRP alone was an independent risk factor for the development of LV remodeling in the NON-AG group (odds ratio = 1.79, P = 0.002). These results suggest that hs-CRP is a useful factor for predicting LV remodeling. Furthermore, ACEI or ARB administration to AMI patients showing increased hs-CRP levels during the early stage of the disease could prevent LV remodeling. Received: October 18, 2002 / Accepted: February 7, 2003     

同型半胱氨酸、N-末端脑钠肽前体与急性心肌梗死后左心室重构的关系

目的 探讨急性心肌梗死（acute myocardical infarction,AMI）患者同型半胱氨酸（homocysteine,Hcy）、N-末端脑钠肽前体（N-terminal pro-brain natriuretic peptide,NT-proBNP）浓度对心肌梗死后左心室重构的预测价值及对AMI患者临床预后的影响.方法 选择2009年6月至2011年6月在广州市第一人民医院心内科住院并诊断为急性ST段抬高型心肌梗死（STEMI）的患者266例,根据入院后空腹Hcy浓度的三分位数间距将患者分为A组（Hcy＜15.6μmol/L）83例,B组（15.6～24.6 μmol/L）组93例和C组（Hcy＞24.6μmol/L）90例.测定患者入院时即刻NT-proBNP浓度,并于入院48 h内及半年后行超声心动图测定患者左心室舒张末期内径（LVEDd）、左心室舒张末期容积（LVEDV）,左心室收缩末期容积（LVESV）,左心室射血分数（LVEF）.动态追踪观察3组患者随访期间内（6个月）的主要心血管事件（MACE）的发生情况.结果 三组患者随Hcy浓度升高,NT-proBNP浓度升高,左心室舒张末期容积和左心室收缩末期容积显著增加,左心室射血分数降低（P＜0.05 or P＜0.01）.ST段抬高型心肌梗死患者Hcy与NT-proBNP浓度呈正相关（r=0.380,P＜0.05）.直接经皮冠状动脉介入治疗随访6个月,Kaplan-Meier生存分析发现三组患者累积无主要心血管事件生存率比较,差异有统计学意义（91.6％ vs.86.0％ vs.77.8％,Log rank=6.630,P=0.036）.多因素Logistic回归分析显示Hcy、NT-proBNP均是ST段抬高型心肌梗死患者近期主要心血管事件发生的独立预测因子.结论 AMI患者Hcy、NT-proBNP浓度与梗死后心室重构密切相关,Hcy、NT-proBNP对患者的近期预后具有预测意义.     

急性心肌梗死患者室壁运动及心功能损害与发病-超声检查时间的关系

目的 探索急性心肌梗死患者室壁运动及心功能损害与发病-超声检查时间的关系.方法 收集初发急性心肌梗死患者219例,均已排除陈旧性心肌梗死、早期心肌再梗死、严重的瓣膜性心脏病、先天性心脏病、心肌病等影响室壁运动及心功能的疾病.所有患者均在予冠状动脉介入干预前行经胸超声心动图检查,采用二维超声等方法测量或（和）计算左心室舒张末期内径（left ventricular diameters in diastasis,LVDd）、收缩末期内径（left ventricular diameters in systole,LVDs）、左心室射血分数（left ventricular ejection fraction,LVEF）、室壁运动计分指数（wall motion index,WMI）及运动正常节段（fragments with normal wall motion,FM）百分比等参数,并精确记录发病-超声检查时间.结果 WMI、LVDd、LVDs、LVEF、FM百分比与发病-超声检查时间的相关关系均有统计学意义（P＜0.05）,相关系数分别为0.167,0.235,0.258,-0.196,-0.144.在WMI的多重线性回归分析结果显示,变量FM百分比、LVEF、左回旋支和（或）右冠状动脉进入方程（R2=0.878,justed R2=0.876）,偏回归系数分别为-1.103,-0.030,-0.001.结论 对于未予冠状动脉介入干预的急性心肌梗死患者,其室壁运动及心功能均随发病-超声检查时间的增加而减弱.     

血管紧张素转化酶基因多态性与急性前壁心梗后患者左心室重塑及预后的相关性研究

目的 探讨血管紧张素转化酶(ACE)基因多态性与急性前壁心梗后患者左心室重塑及预后的关系。方法 选取164例急性前壁心肌梗死(AMI)患者作为研究对象。超声检测患者左心室收缩末期内径(LVSD)、左心室舒张末期内径(LVDD)、左室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、心肌做功指数(MPI)等指标。提取所有患者外周血DNA,多聚酶链反应检测ACE插入(I)/缺失(D)多态性。对所有患者随访1年,记录主要心血管事件(MACE)发生情况。比较不同ACE基因型与左室重塑及1年内MACE发生频率的关系。结果 164例AMI患者ACE基因I/I型80例、D/D 型67例、I/D型17例,分布频率分别为48.8%、40.8%、10.4%。第7天时,三组患者MPI、LVEDV、LVESV和LVSD差异有统计学意义(P＜0.05)。D/D基因型组患者第7 天MPI、LVESV、LVDD较第1天时显著下降,而LVEDV、LVEF较第1天显著升高(P＜0.05)。I/D基因型组患者第7 天MPI和LVEF与第1天时差异具有统计学意义(P＜0.05)。D/D基因型患者发生MACE的风险显著增加,其OR值为17.16,而I/I基因型患者发生MACE的风险显著下降,其OR值仅为0.39(P<0.05)。结论 ACE基因多态性可能会影响早期心肌梗死后重塑,而D/D型更易发生左室重塑并且1年内发生MACE的风险显著高于其余两种基因型。