联合检测缺血修饰白蛋白与心脏型脂肪酸结合蛋白在急诊心源性胸痛早期诊断中的价值

目的 评价联合检测缺血修饰白蛋白（IMA）与心脏型脂肪酸结合蛋白（H-FABP）在急诊心源性胸痛（CCP）早期诊断中的临床意义.方法 选取2013年1月至2014年1月我院收治的急诊胸痛＜3h的患者106例,检测IMA、H-FABP、心肌肌钙蛋白抗体（cTn1）、肌酸激酶同工酶（CK-MB）和心电图.结果 最后97例确诊为心源性胸痛,其中,IMA或H-FABP阳性81例（83.5％）,cTn1阳性62例（63.9％）,CK-MB阳性52例（53.6％）,心电图阳性43例（44.3％）,IMA联合H-FABP检测与cTn1、CK-MB、心电图检测阳性率比较差异有统计学意义（P＜0.05）.结论 联合检测IMA与H-FABP在急诊心源性胸痛早期诊断中阳性检出率高,敏感度高,值得临床推广应用.     

Predicting cancer therapy-induced cardiotoxicity: the role of troponins and other markers.

Several anticancer drugs have been associated with cardiac toxicity, especially the anthracyclines and trastuzumab. The pathogenesis of anthracycline-associated toxicity has been well described, whereas the mechanism of trastuzumab-associated toxicity is unknown. Although routine cardiac imaging studies (e.g. echocardiogram or multiple gated acquisition scans) may identify subclinical evidence of myocardial dysfunction, available data do not support their routine use for monitoring asymptomatic patients undergoing cancer therapy. Other modalities such as nuclear medicine scintigraphy with indium-111-antimyosin antibody and endomyocardial biopsy have been shown to be useful in identifying early cardiac damage, but their routine use is limited by practical considerations such as feasibility and cost. Consequently, there is significant interest in developing simple and reproducible methods for identifying patients at risk for treatment-induced myocardial damage. Available data suggest that circulating markers such as troponins and natriuretic peptides could potentially be useful for this purpose. Measurement of plasma troponin levels are commonly used in clinical practice in order to provide diagnostic and prognostic information in patients with myocardial ischaemia. Elevated levels may likewise correlate with anthracycline-induced cardiac damage, although plasma levels are only minimally elevated (well below that associated with ischaemia), and elevations may persist for weeks or months after anthracycline exposure. Clinical trials are currently evaluating the role of these markers in predicting both early and late, clinical and subclinical damage associated with anthracyclines and trastuzumab.     

急性心肌梗死患者血清肌钙蛋白Ⅰ抗体检测的临床意义

目的通过分析急性心肌梗死患者血清中肌钙蛋白I抗体水平的变化,探讨其在急性心肌梗死中的临床意义。方法 2011年4月-2012年3月急性心肌梗死68例,分别于确诊及确诊后24 h内取静脉血检测肌钙蛋白I（cTnI）及肌钙蛋白I自身抗体,根据检测结果分为肌钙蛋白I自身抗体阳性组（13例）及阴性组（55例）。比较两组患者确诊时及24 h血清cTnI水平,同时采用Gensini积分和SYNTAX评分评价冠脉病变程度;分别记录、比较两组于确诊7 d及随访180 d的左室射血分数（LVEF）、左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）,评价肌钙蛋白I自身抗体与急性心肌梗死患者近期、远期的心功能变化的关系。结果两组患者确诊时cTnI水平无显著性差异,但24 h cTnI阳性组水平[（13.57±7.38）μg/L]明显高于阴性组[（7.37±9.24）μg/L]（P〈0.01）;两组中多支病变患者比例差异无统计学意义,但阳性组Gesini积分（85.54）、SYNTAX积分（15.73）明显高于阴性组（Gesini积分52.73,SYNTAX积分9.99）（P〈0.01）,PCI术后7 d与180 d两组患者的左室重构指数、LVEF也存在显著差异（P〈0.05）。结论肌钙蛋白I自身抗体可能影响急性心肌梗死患者早期cT-nI的浓度,并导致cTnI峰值的延迟;而肌钙蛋白I自身抗体阳性往往提示患者血管病变较重,心肌梗死时累及范围较广,梗死面积较大。远期随访结果提示,肌钙蛋白I自身抗体的存在可能影响心肌梗死患者术后心功能的恢复。     

慢性心力衰竭患者循环中蛋白标志物与心功能的关系探讨

目的探讨不同病因慢性心力衰竭(CHF)患者循环中蛋白标志物与心功能的相关性。方法运用蛋白芯片技术同步联检64例CHF者及40例健康对照组血清或血浆中的炎性因子、炎性相关因子及心肌损伤因子7种蛋白标志物。结果 CHF组与对照组比较,血清中的MMP-9、 sCD40L、CRP、IL-6、H—FABP,血浆中的sVCAM-1及ET-1浓度升高,差异有显著性意义(P<0．05, P<0．01);缺血性心脏病心力衰竭与其它类型心脏病心力衰竭患者心功能级别构成,差异无显著性意义(P>0．05),两组患者血清中MMP-9、sCD40L及血浆中sVCAM-1比较,差异无显著性意义(P >0．05),与正常对照组比较,差异有显著性意义(P<0．01);CHF患者血清中MMP-9、sCD40L及血浆中sVCAM-1与心功能分级显著正相关(rs=0．640,rs=0．818,与rs=0．845,P<0．001)。结论 CUF患者循环中7种蛋白标志物水平异常,可作为CHF分子水平的标志物。其中MMP-9、 sCD40L、sVCAM-1与心功能的严重程度密切相关,提示上述蛋白标志物参与了不同病因CHF的发生、发展过程。     

肌钙蛋白T和B型尿钠肽水平改变对心力衰竭患者预后的影响分析

目的探讨肌钙蛋白T和B型尿钠肽水平改变对心力衰竭患者预后影响。方法选择我院慢性心力衰竭患者共46例,作为观察组,心功能Ⅱ级、心功能Ⅲ级和心功能Ⅳ级患者分别为12例,23例和11例。同时选择同期到我院体检的健康者40例,作为对照组。检测所选对象肌钙蛋白T和B型尿钠肽水平。结果观察组肌钙蛋白T、B型尿钠肽水平高于对照组,差异有统计学意义(P<0.05);心功能Ⅳ级患者肌钙蛋白T和B型尿钠肽水平高于心功能Ⅲ级患者,差异有统计学意义(P<0.05);心功能Ⅲ级患者B型尿钠肽水平高于心功能Ⅱ级患者,差异有统计学意义(P<0.05)。结论肌钙蛋白T和B型尿钠肽水平有助于了解慢性心力衰竭患者预后,具有重要临床意义。     

Pharmacodynamic modeling of cardiac biomarkers in breast cancer patients treated with anthracycline and trastuzumab regimens

Trastuzumab is associated with cardiotoxicity, manifesting as a decrease of the left-ventricular ejection fraction (LVEF). Administration of anthracyclines prior to trastuzumab increases risk of cardiotoxicity. High-sensitive troponin T and N-terminal-pro-brain natriuretic peptide (NT-proBNP) are molecular markers that may allow earlier detection of drug-induced cardiotoxicity. In this analysis we aimed to quantify the kinetics and exposure–response relationships of LVEF, troponin T and NT-proBNP measurements, in patients receiving anthracycline and trastuzumab. Repeated measurements of LVEF, troponin T and NT-proBNP and dosing records of anthracyclines and trastuzumab were available from a previously published clinical trial. This trial included 206 evaluable patients with early breast cancer. Exposure to anthracycline and trastuzumab was simulated based on available dosing records and by using a kinetic-pharmacodynamic (K-PD) and a fixed pharmacokinetic (PK) model from literature, respectively. The change from baseline troponin T was described with a direct effect model, affected by simulated anthracycline concentrations, representing myocyte damage. The relationship between trastuzumab and LVEF was described by an indirect effect compartment model. The EC₅₀ for LVEF decline was significantly affected by the maximum troponin T concentration after anthracycline treatment, explaining 15.1% of inter-individual variability. In this cohort, NT-proBNP changes could not be demonstrated to be related to anthracycline or trastuzumab treatment. Pharmacodynamic models for troponin T and LVEF were successfully developed, identifying maximum troponin T concentration after anthracycline treatment as a significant determinant for trastuzumab-induced LVEF decline. These models can help identify patients at risk of drug-induced cardiotoxicity and optimize cardiac monitoring strategies.     

血浆NT-proBNP及H-FABP联合检测在小儿重症肺炎合并心力衰竭中的应用价值

目的 探讨N末端脑钠肽前体(NT-proBNP)及心型脂肪酸结合蛋白(H-FABP)联合检测对小儿重症肺炎合并心力衰竭的诊断价值.方法 选择2014年8月—2015年8月小儿重症肺炎396例,根据是否合并心力衰竭分为单纯肺炎组356例和肺炎合并心力衰竭组40例,并选择同期健康体检儿童200名为对照组.检测3组血浆NT-proBNP、H-FABP水平及左心室射血分数(LVEF).将肺炎合并心力衰竭组按心功能分为轻、中、重度,观察不同心力衰竭分级患儿血浆NT-proBNP、H-FABP及LVEF变化.NT-proBNP、H-FABP单独和联合检测对小儿重症肺炎合并心力衰竭诊断效果,并分析血浆NT-proBNP及H-FABP水平与LVEF的相关性.结果 肺炎合并心力衰竭组血浆NT-proBNP和H-FABP水平均高于单纯肺炎组和对照组,LVEF低于单纯肺炎组和对照组(P<0.05).血浆NT-proBNP和H-FABP水平随心力衰竭分级增高而升高,LVEF随心力衰竭分级增高而降低(P<0.05).联合检测H-FABP和NT-proBNP对小儿重症肺炎合并心力衰竭的诊断效果优于单一检测(P<0.05).小儿重症肺炎合并心力衰竭患儿NT-proBNP和H-FABP与LVEF均呈负相关(r=-0.697和-0.317,P均<0.05).结论 联合检测NT-proBNP和H-FABP可早期、准确诊断小儿重症肺炎合并心力衰竭.     

The evaluation of myocardial damage in 83 young adults with carbon monoxide poisoning in the East Anatolia region in Turkey

Carbon monoxide (CO) poisoning is the leading cause of death from intoxication. In CO poisoning, it is important to know if there are any symptoms regarding myocardial damage, which are usually unobserved as a result of hypoxia. This study was planned to assess myocardial damage in young healthy patients with CO poisoning. Eighty-three young healthy cases who had been exposed to CO were included in this study. The demographic and clinical characteristics, the origin of CO gas and smoking habits of the patients were recorded. The evaluation of ECG, peripheral ABG, complete blood count and serial cardiac biomarkers (creatine kinase, creatine kinase-myocardial band and troponin I) measurements were performed in all cases. Additionally, echocardiogram (ECHO) and myocardial perfusion single-photon emission computed tomography (SPECT) were performed at the appropriate times in all cases. The mean age of the patients was 27.3 +/- 10.9 years. The main complaint of the patients was loss of consciousness with a 62.7% rate. The average carboxyhaemoglobin level of the patients was 34.4 +/- 15.9%. Sinus tachycardia was present in 26.5% of patients. Diagnostic ischaemic ECG changes were present in 14.4% of patients. In myocardial SPECT, myocardial ischaemic damage was observed in 9 cases, in 6 of whom ECHO findings were also confirmed. Myocardial damage due to CO poisoning should not be ignored. If patients are at risk in terms of myocardial damage, further studies, such as ECHO and scintigraphy are needed to determine myocardial damage resulting from CO poisoning. However, in the young adults of the risk group, if the baseline ECG and serial cardiac biomarkers are normal, further studies such as ECHO and scintigraphy, considering the length of exposure and the severity of poisoning, may not be necessary for the evaluation of myocardial damage due to CO poisoning.     

心肌损伤标记物在经皮冠状动脉腔内成形术中的应用研究

目的　通过动态观察行经皮冠状动脉腔内成形术 (PTCA)患者血清心肌肌钙蛋白 I(c Tn I)及肌酸激酶同功酶 (CK- MB)的变化 ,部分病例测定血清心肌肌钙蛋白 T(c Tn T)及肌红蛋白 (Mb)浓度 ,以评价该手术对心肌的可能影响。方法　对 10 2例行 PTCA的冠心病患者 ,分别测定其术前 ,术后 6、12、2 4、48、72 h的血清c Tn I及 CK- MB水平 ,并进行分组比较相关因素 ,2 2例患者同时测定血清 c Tn T及 Mb浓度。结果　 2 6例患者术前 c Tn I正常 ,术后 6 h升高 ,12～ 2 4h达峰值 ,48～ 72 h渐降至正常 ;48例术前术后 c Tn I均正常 ;2 0例术前术后c Tn I均高于正常值。 7例 CK- MB增高。 16例 c Tn I阳性者中 c Tn T增高 11例 ,Mb变化无规律。 c Tn I升高与球囊扩张总时间、扩张压力和扩张次数以及支架植入数有关。 16例血清 c Tn I阳性者中 11例检出阳性。结论　PTCA术可能会造成心肌微小损伤 ,c Tn I监测心肌损伤比 CK- MB更敏感 ,特异性更高 ,c Tn T与 c Tn I有相似的作用 ,但敏感性稍差。而用 Mb监测作用有限。     

心型脂肪酸结合蛋白在急性非ST抬高心肌梗死早期鉴别诊断中的价值

目的探讨心型游离脂肪酸结合蛋白在急性非ST抬高心肌梗死超早期(<6h)的应用价值。方法选取2009年6月至2012年3月我院就诊的106名NSTEMI患者,以冠状动脉造影结果、冠状动脉CTA结果作为最终诊断,入院即刻定性测定H-FABP及定量测定cTnI。结果在本研究入组的患者中,H-FABP、cTnI相比具有较好的敏感性和特异性;同时检测H-FABP与cTnI两项诊断NSTEMI,均有较高敏感性、特异性、阳性预测值、阴性预测值。结论 H-FABP可作为急性心肌损伤检测的一项快速、准确、敏感、特异的指标。     

缺血修饰白蛋白和心脏型脂肪酸结合蛋白联合检测对急性心肌梗死早期诊断的价值

目的 探讨缺血修饰蛋白(IMA)和心脏型脂肪酸结合蛋白(H-FABP)联合检测在急性心肌梗死(AMI)早期诊断中的价值.方法 急性胸痛患者47例,发病时间在3h以内,其中确诊为AMI者26例,不稳定性心绞痛者18例,非心源性胸痛者3例.所有患者在就诊即刻和3、6、9、24h时间点动态检测IMA、H-FABP、肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)及肌红蛋白(Mb)水平,对其敏感性与特异性进行分析.结果 患者就诊即刻IMA、H-FABP、cTnI、CK-MB、Mb敏感性分别为65.3％ (17/26)、69.2％ (18/26)、15.4％ (4/26)、15.4％ (4/26)、42.3％ (11/26);IMA、H-FABP联合检测敏感性为84.6％ (22/26),与单项指标差异有统计学意义(P＜0.05).入院3h时,IMA、H-FABP、cTnI、CK-MB、Mb敏感性分别为80.8％ (21/26)、92.3％(24/26)、23.1％ (6/26)、34.6％ (9/26)、76.9％ (20/26);IMA、H-FABP联合检测敏感性96.2％(25/26),与单项指标差异有统计学意义(P＜0.05).6h时CK-MB敏感性61.5％ (16/26),IMA、H-FABP敏感性分别为88.4％ (23/26)、96.2％ (25/26),IMA、H-FABP联合检测敏感性高达100％ (26/26),与单项指标差异仍有统计学意义(P＜0.05).9h时IMA、H-FABP、cTnI、CK-MB、Mb敏感性分别为76.9％(20/26)、73.1％( 19/26)、96.2％ (25/26)、96.2％ (25/26)、92.3％ (24/26),IMA、H-FABP联合检测的敏感性为92.3％ (24/26),与单项指标差异无统计学意义(P＞0.05).入院后24 hcTnI、CK-MB敏感性为100％ (26/26),此时检测cTnI、CK-MB敏感性优于IMA、H-FABP[分别为38.5％ (10/26)和34.6％ (9/26)],亦优于IMA、H-FABP联合检测[敏感性为50.0％ (13/26)],差异有统计学意义(P＜0.05).入院后3h,IMA、H-FABP、cTnI、CK-MB、Mb的特异性分别为80.9％( 17/21)、90.5％( 19/21)、100.0％ (21/21)、95.2％ (20/21)、76.2％( 16/21).入院后6h,IMA、H-FABP、cTnI、CK-MB、Mb的特异性分别为95.2％ (20/21)、85.7％( 18/21)、95.2％( 20/21)、85.7％ (18/21)、71.4％( 15/21).在AMI早期IMA、H-FABP与cTnI、CK-MB检测AMI的特异性差异无统计学意义(P＞0.05),但与Mb的特异性差异有统计学意义(P＜0.05).结论 联合检测IMA和H-FABP对AMI的早期诊断具有较高的敏感性及特异性,值得进一步研究.     

肌钙蛋白Ⅰ诊断早期急性心肌梗死的临床研究

目的对比探讨肌钙蛋白Ⅰ(cTnⅠ)和心肌酶谱早期急性心肌梗死(AMI)早期诊断中的方法及价值。方法抽取2011年1月至2012年1月于本院诊断治疗的48例早期急性心肌梗死患者,并选取同期健康对照者32例,两组均同时行肌钙蛋白Ⅰ和心肌酶谱检查,对比两组患者的检验阳性率。结果两组间相比,治疗后AMI组患者心肌酶谱阳性率为83.3%,低于cTnⅠ组的95.8%,健康对照组心肌酶谱阳性率为9.4%,高于cTnⅠ组的3.1%,差异均有统计学意义(P<0.05)。结论运用肌钙蛋白诊断早期急性心肌梗死,可有效提高阳性诊断率,避免漏诊、误诊的发生。     

高敏心肌肌钙蛋白T、心肌酶及C反应蛋白的检测在手足口病患儿中的应用

目的探讨高敏心肌肌钙蛋白T、心肌酶及C反应蛋白在检测手足口病患儿中的临床应用价值。方法选取2011年5月至2012年12月来我院就诊治疗的72例手足口病患儿,将其作为观察组,同时选取48例健康儿童作为对照组,检测并对比分析两组儿童在高敏心肌肌钙蛋白T、心肌酶及C反应蛋白的差异。结果观察组患儿的高敏心肌肌钙蛋白T、心肌酶谱及c反应蛋白均明显高于对照组（P〈0．05）。结论手足口病患儿往往存在着不同程度的心肌损害情况,检测其高敏心肌肌钙蛋白T、心肌酶及C反应蛋白可以较好的辅助临床诊断。     

艾司洛尔对常温不停跳心内直视手术期间心肌损伤标志物的影响

目的 探讨艾司洛尔对常温不停跳心内直视手术期间心肌损伤标志物的影响。方法选择48例择期二尖瓣置换术病人随机分为对照组(C组)和艾司洛尔组(E组),每组各24例,常规建立心肺转流(CPB),平行循环后不降温及不主动复温,阻断腔静脉,不阻断主动脉,平均动脉压(MAP)维持在50～70mmHg,在心脏跳动下进行手术。E组在心内直视手术开始前予艾司洛尔1～2mg/kg静脉注射后,以0.3％的浓度静滴维持心率在30～50次/分。分别于手术前、术后即刻、术后6小时、12小时、24小时、48小时取动脉血测定血清C—反应蛋白(CRP)、肌酸激酶同工酶(CK—MB)、肌钙蛋白T(cTnT)和肌钙蛋白I(cTnI)浓度变化。结果 两组病人性别、年龄、心功能、心胸比值(C/T)差异无显著意义;术前两组间CRP、CK—MB、cTnT、cTnI差异无显著意义(P>0.05),两组患者血清CRP、CK—MB、cTnT、cTnI浓度在CPB后即刻显著升高(P<0.01),E组于术后6小时达峰值,术后24小时降至正常水平,C组于术后12小时达峰值,术后48小时降至正常值,同一时点比较,E组明显低于C组(P<0.05 or 0.01)。结论 艾司洛尔用于常温不停跳心内直视手术中可显著降低心肌损伤标志物升高程度,使酶峰提前,促进术后心功能恢复,具有良好的心肌保护作用。     

A new tool for the early diagnosis of carbon monoxide intoxication

Invasive measurement of carboxyhemoglobin (COHb) by blood gas analysis (BGA) is accepted as the standard diagnostic procedure in diagnosis of inhalation injury and carbon monoxide (CO) intoxications. The main disadvantage of BGA with COHb testing is the unavailability in pre-hospital rescue conditions. The non-invasive SpCO analysis using pulse CO oximetry (Rad57, Masimo Corp., USA) represents an easy-to-handle device to facilitate the diagnosis of CO intoxication. Between January 2006 and August 2008, 20 patients who were admitted with CO intoxication to our burn centre were included in this study. Blood gas analysis including COHb testing was performed on the first day, hourly. At the same time, SpCO was determined using the Rad57 pulse CO oximeter. Patients received inhalative oxygen according to the parameters of blood gas analysis or hyperbaric oxygenation if COHb?>?10%. Five young healthy volunteers served as control group. The SpCO of the volunteers was cross-checked against their COHb levels, which were measured by blood gas analysis. Results of pulse CO oximetry revealed a mean error of approximately 3.15% from the results achieved by blood gas analysis. If COHb resulted in values higher than 10%, the bias remained approximately the same (3.43%/precision 2.362%). When different blood gas analyzers in our department were tested with the same patient sample, a mean error of 2.4% was found. This is only 1% lower compared to the mean error of pulse CO oximetry. Therefore, pulse CO oximetry represents a reliable measurement technique that is easy to handle and could facilitate the early diagnosis of CO intoxication in pre-hospital rescue conditions.     

不同灌注方法心脏术后心肌型脂肪酸结合蛋白水平的变化及意义

目的探讨不同灌注方法体外循环心脏术后外周血中心肌型脂肪酸结合蛋白的变化及意义。方法选择先天性心脏病患者40例,按入院顺序以奇偶数随机分为晶体停搏液组和含血停搏液组2组,每组20例。测定麻醉诱导前、体外循环结束后不同时间点外周血心肌型脂肪酸结合蛋白（H—FABP）的浓度。结果2组间H—FABP的术前水平无差异,2组患者术后血清H—FABP水平均不同程度升高,于体外循环结束后1h达峰值[晶体停搏液组（50．13±3．98）μg／L,含血停搏液组（39．27±4．22）μg/L],冷晶停搏液灌注组升高更明显（P〈0．05）。在体外循环结束后24h逐渐下降趋于术前水平,但术中及术后各时点的水平冷晶体组均高于冷血灌注组。体外循环结束后1hH．FABP水平与体外循环主动脉阻断时间呈正相关（晶体停搏液组r=0．901,含血停搏液组r=0．673,均P〈0．01）。结论体外循环心脏术后H-FABP显著升高,峰值浓度出现早,可作为一项早期判断心肌损伤的敏感实验指标。升高的程度与心肌损伤程度有关,与主动脉阻断时间有关。灌注含血停搏液可明显减轻心肌损伤,减少H—FABP的释放,与灌注晶体停搏液相比,含血停搏液有良好的心肌保护作用。     

病毒性心肌炎患儿心肌损伤标志物检测分析

目的:探讨联合检测心肌损伤标志物对病毒性心肌炎(VMC)患儿心肌损伤的诊断价值.方法:对52例VMC、58例非病毒性心肌炎(NVMC)患儿和50例健康对照者,分别检测血清3种心肌损伤标志物[心肌肌钙蛋白Ⅰ(cTnⅠ)、肌酸激酶同工酶MB质量(CK-MB mass)、肌红蛋白(MYO)]浓度和4种心肌酶活性.结果:入院当日VMC组cTnⅠ(0.41±0.19)μg/L、CK-MB mass(6.02±3.89)μg/L、MYO(102.33±41.42)μg/L,均明显比NVMC组和对照组高(P<0.01);联合检测cTnⅠ、CK-MB mass和MYO对VMC心肌损伤的诊断灵敏度(SE)、特异性(SP)、阳性预报值(PPV)、阴性预报值(NPV)和准确度(AC)分别为71.15%、96.30%、90.24%、87.39%和88.13%:SE和NPV与联合检测4种心肌酶相近(P>0.05),而SP、PPV和AC却明显比联合检测4种心肌酶高(P<0.01).结论:联合并动态检测3种心肌损伤标志物比联合检测4种心肌酶能够为VMC心肌损伤的诊断、治疗和预后转归判断提供更好的诊断方法.     

肌钙蛋白T和B型脑钠肽对心力衰竭患者预后评价的临床意义分析

目的 探讨肌钙蛋白T和B型脑钠肽对心力衰竭患者预后评价的临床意义.方法 所选的100例心力衰竭患者根据心功能评定标准进行心功能分级,分为Ⅱ级组、Ⅲ级组、Ⅳ级组,同时,选择同期到本院体检的健康者60例,作为对照组,测定所选对象的肌钙蛋白T和B型脑钠肽水平.结果 Ⅱ级、Ⅲ级、Ⅳ级组的肌钙蛋白T和B型脑钠肽水平均高于对照组（P＜0.05）,左室射血分数均低于对照组（P＜0.05）;Ⅳ级组肌钙蛋白T和B型脑钠肽水高于Ⅲ级组,左心室射血分数低于Ⅲ级组（P＜0.05）;Ⅲ级组肌钙蛋白T和B型脑钠肽水平高于Ⅱ级组,左心室射血分数低于Ⅱ级组,（P＜0.05）.结论 肌钙蛋白T和B型脑钠肽水平的改变对了解心力衰竭患者的病情严重程度、评估患者预后具有重要意义.     

H nuclear magnetic resonance spectroscopic investigation of urine for diagnostic and clinical assessment of methanol intoxication

Occasional or suicidal methanol intoxications are a permanent problem for most Poisoning Centers around the World. Therefore it is important to look for new diagnostic and clinical prognostic methods. In the present paper 5 cases of methanol intoxication were analyzed. At first the methanol concentrations in blood and urine were estimated with headspace gas chromatography technique. Next the urine samples were examined with 1H NMR spectroscopy, then the levels of ethanol, methanol and its metabolite, formate, lactate and trimethylamine-N-oxide with dimethylamine were evaluated. The concentrations of the above compounds were correlated with the patient's clinical status, the level of ethanol and methanol and biochemical parameters. The results indicate the correlation between clinical course of intoxication, prognostication and lactate level. There were no significant parallels for formate level as acidosis causing metabolite and initial methanol levels. In the urine samples of intoxicated patients the increased trimethyl-N-oxide and dimethylamine levels were observed, which may indicate renal cortex damage. Contrary to the opinion of some clinicians, methanol intoxication may be connected with renal functional disturbances. 1H NMR examination of urine appears to be an excellent tool to evaluate the clinical course of methanol intoxication.     

新生儿感染患儿测定血清心肌肌钙蛋白水平的临床研究

目的:分析新生儿感染患儿测定血清心肌肌钙蛋白水平的临床价值.方法:从2018年7月～2019年6月择取56例新生儿感染患儿纳入研究组,另外择取同期56例正常足月新生儿纳入对照组,分别在两组研究对象出生后1d、3d、6d对血清心肌肌钙蛋白水平进行测定,对比两组检测结果.结果:出生后1d、3d,研究组血清心肌肌钙蛋白水平均...