心肌梗死患者血浆同型半胱氨酸水平变化及临床意 义

目的 探讨血浆同型半胱氨酸（Hcy）水平与心肌梗死的关系.方法 选取47例心肌梗死患者作为研究组,选择同期49例健康体检者作为健康组,比较2组血浆Hcy水平,利用条件Logistic回归模型分析心肌梗死的危险因素.结果 研究组：治疗前血浆Hcy水平明显高于健康组（P＜0.01）,治疗后患者的血浆Hcy水平显著下降（P＜0.05）.高水平Hcy为心肌梗死独立危险因素.结论 检查血浆Hcy水平可为诊断心肌梗死提供有效的依据.     

急性心肌梗死溶栓治疗时血浆凝血酶抗凝血酶复合物水平的变化

目的观察急性心肌梗死(AMI)患者溶栓治疗后凝血系统的变化.方法对临床确诊的34例AMI患者和33名正常对照者,采用ELISA法检测血浆凝血酶抗凝血酶复合物(TAT),对其中6名患者溶栓前、溶栓6 h及溶栓12 h血浆TAT进行动态观察并与正常对照组进行比较.结果 AMI患者的TAT[(13.10±6.70) μg/L]较正常对照组[(6.96±3.60) μg/L]显著升高(P<0.01).6例患者TAT在溶栓治疗前[(11.60±5.10) μg/L]较正常对照组显著升高.溶栓治疗6 h后,TAT[(15.10±7.60) μg/L]较治疗前均有显著升高.溶栓治疗12 h后,TAT[(13.75±5.80) μg/L]下降接近治疗前水平,但仍高于正常人.结论 AMI患者的凝血酶活力增加,溶栓治疗后,导致TAT短时间内进一步提高.     

检测血浆D-二聚体、FDP、TNT对心肌梗死病人的临床意义

目的探讨D-二聚体、FDP和TNT在心肌梗死患者病程中的临床意义。方法对32例AMI,28例UAP,22例SAP患者采用乳胶凝集法进行D-二聚体及FDP检测,采用干化学分析法进行TNT检测。结果AMI组与UAP组、SAP组、对照组阳性率比较有显著性差异(P0.01),SAP组与对照组阳性率比较无显著性差异(P0.05)。结论血浆D-二聚体可作为急性心肌梗死诊断的参考指标及稳定性心绞痛和不稳定性心绞痛鉴别的参考指标,TNT能对AMI做出早期诊断,并且有特异性,且灵敏度高,其检测迅速、方便,与D-二聚体、FDP联用有助于提高AMI的诊断。     

急性心肌梗死患者血浆BNP、ET、CRP、ANP水平变化与临床观察分析

目的观察急性心肌梗死(AMI)患者血浆中B型钠尿肽(BNP)、内皮素(ET)、C-反应蛋白(CRP)、A型钠尿肽(ANP)水平变化,为治疗及预后判断提供依据.方法应用酶联免疫法及免疫放射分析法对46例AMI患者治疗前后和30名正常对照者血浆中BNP、ET、CRP、ANP水平进行检测.结果 AMI患者血浆中BNP、ET、CRP、ANP治疗前后比较差异有显著性(P<0.001),正常对照组与AMI治疗前比较差异有显著性(P<0.001),BNP与CRP在AMI治疗前水平呈正相关(r=0.874),治疗后呈明显的下降趋势(r=0.654),AMI治疗前后ANP与ET呈正相关,但AMI经溶栓和相应的支持治疗后ANP基本恢复到正常水平(P>0.05),而BNP、ET、CRP水平虽然下降明显,但与正常组比较差异仍有显著性(P<0.05).结论 AMI患者血浆中BNP、ANP、ET、CRP水平的变化说明其参与了AMI的发生、发展,特别是冠状动脉粥样斑块的形成和(或)破裂及血栓形成,其炎症因子是主要因素.因此,4项指标的观察分析对AMI治疗、预后判断具有重要意义.     

冠心病患者血浆TF、TFPI水平的变化及其临床意义

目的　观察冠心病患者血浆组织因子 (TF)、组织因子途径抑制物 (TFPI)水平的变化及其临床意义。方法　 79例临床确诊的冠心病患者 ,其中急性心肌梗死 (AMI组 ) 32例、不稳定型心绞痛 (UAP组 ) 2 7例、稳定型心绞痛 (SAP组 ) 2 0例 ,15例健康对照组作为对照组。采用发色底物法测定血浆TF、TFPI活性。结果　与对照组、SAP组比较 ,AMI组血浆TF、TFPI显著增高 ,三组差异具有显著性意义 (P<0 0 5 ) ;AMI组血浆TF活性与UAP组比较差异无统计学意义 (P >0 0 5 ) ,但TFPI活性较UAP组明显升高 ,两者差异具有显著性意义 (P <0 0 5 )。UAP组血浆TF活性较健康对照组及SAP组明显升高 ,三组间差异具有显著性意义 (P <0 0 5 ) ,UAP组血浆TFPI活性较健康对照组及SAP组差异无统计学意义 (P >0 0 5 ) ;SAP组血浆TF、TFPI活性较健康对照组差异无统计学意义 (P >0 0 5 )。结论　 (1)AMI、UAP患者存在异常激活的高凝状态 ,TF触发的外源性凝血途径在冠脉内血栓形成上发挥重要作用。 (2 )AMI、UAP患者体内TF、TFPI系统存在严重失衡     

急性DIC时FDP和3P试验的阳性对照

实验诊断是确诊DIC的关键,所用化验指标贵在简易快速,纤维蛋白（原）降解产物检测（FDP）和血浆鱼精蛋白副凝试验（3P试验）是帮助诊断DIC的继发性纤溶亢进期最常用的化验指标之一,但其阳性率并不相符。现对临床55例急性DIC患者进行检测,结果如下。 　1材料与方法 1.1　检测对象与标本处理 临床表现以休克和出血为主的急性DIC病人,其中男39例,女16例,年龄在42一71岁。抽取静脉血1.8ml,注入有0.2ml（浓度为109mmol/L）枸橼酸钠抗凝剂的试管中,2500r/min常温离心10min,分离血浆。 1.2 方法 FDP含量测定:血浆标本用缓冲液作对半稀释（100μl血浆+100μl缓冲液）,用微量吸液器吸取15μl Latex乳胶试剂,     

急性心肌梗死后血浆脑钠肽水平与心室重构的关系研究

目的探讨急性心肌梗死（AMI）后血浆脑钠肽（BNP）水平对心梗后心室重构的预测价值及判断作用。方法纳入120例首发AMI患者,根据心脏多普勒超声的检测情况分为心室重构组和心室非重构组。在发病后72h内及90d时,检测血浆BNP和ANP含量。出院后90d时随访。半年后进行超声检测,综合评价心室重构情况。结果纳入120例,成功随访101例。依据ΔLVEDVI值分为重构组39例,非重构组62例。重构组发病后72h内及90d时的血浆BNP、ANP水平均显著高于非重构组。BNP2水平与LVEDVI相关系数最大。多元线性回归分析显示,心梗发病90d时的血浆BNP水平与心室重构的关系最为密切,可作为独立预测指标。ROC曲线分析表明BNP对心室重构的判断价值大于ANP,其中BNP2价值最大。血浆BNP2≥410pg／mL,判断心室重构的敏感度为0．80,特异度为0．70。结论心梗后90d的血浆BNP水平可作为心室重构的独立相关指标,这对预测AMI患者发生心室重构提供了一一种新的无创且有效的实验室指标。     

肝硬化患者血浆内皮素-1水平的变化

目的：探讨血浆内皮素－1（ET－1）水平的变化，了解它与肝硬化门脉高压形成发展和肝功能损伤的关系。方法：用放免法检测24例正常人和61例肝硬化患者血浆ET－1。结果：肝硬化组血浆ET－1水平显著高于对照组（P均＜0．001）且在肝功能分级中，呈现ChildC＞ChildB＞ChildA的规律，组间分析表明肝硬化患食道静脉曲张伴大中量腹水组（LC4）血浆ET－1显著高于大中量腹水组（LC3），LC3组高于食道静脉曲张伴少量腹水或无腹水组（LC2），LC2组高于无腹水和静脉曲张组（LC1）（P均＜0．05），LC1组及ChildA级患者对照组无明显差别（P＞0．05）。相关分析显示肝硬化者血浆ET－1与白蛋白水平间呈明显负相关，与sGOT、总胆红素间呈显著正相关，结论：肝硬化者血浆ET－1水平反映了肝硬化的严重程度，并在门脉高压的形成发展中起重要作用。     

绝经前后妇女血浆血栓素A2和前列环素水平的变化

目的：为探讨绝经对妇女血浆血栓素A2(TXA2)和前列环素(PGI2）水平的影响。方法：将72例研究对象按月经情况分四组，即：月经正常组(Ⅰ)；月经紊乱组(Ⅱ)；绝经≤5年组(Ⅱ)；绝经>5年组(Ⅳ)。用同位素放射免疫方法集中测定各组妇女外周血浆TXA2、PGI2的稳定代谢产物血栓素B2(TXB2)及6-酮前列腺素F1。(6-K-PGF1α)的含量。结果：(1)各组妇女血浆TXB2及6-K-PGF1α水平无显性差异(P>0.05)；(2)各组妇女TXB2／6-K-PGF1α。的比值较恒定(1．04±0.05)。结论：绝经对妇女体内TXA2和PGI2的水平和稳定无明显影响。有血管舒缩不稳定症状(如潮热)的绝经前后妇女，由于其血浆TXA2／PGI2总保持动态平衡，故不会增加心血管疫病的发病风险。     

Serial Myoglobin Levels for Patients with Possible Myocardial Infarction

Objectives: To determine the sensitivity and specificity of a new myoglobin assay for acute myocardial infarction (AMI), considering both the total amount of serum myoglobin and its percentage change over 2 hours.
Methods: A prospective, observational test performance study for the recognition of AMI was done using serial myoglobin assays of 42 admitted chest pain patients at a large, urban teaching hospital ED. Myoglobin testing was performed at presentation (time 0) and at 1 and 2 hours after arrival. A myoglobin level >100 g/L (ng/mL) or a change >50% from baseline (increase or decrease) any time during the 2–hour period was considered positive. Patients and their physicians were blinded to the myoglobin results. The managing clinician's final diagnosis of the presenting event was used as the diagnostic criterion standard.
Results: The sensitivity of the myoglobin technique for detection of AMI in the first hours in the ED was 13/14 (93%; 95% CI: 66–100%). The 1 patient who had a false-negative test had evidence of AMI on the ECG and an initially abnormal creatine kinase-MB (CK-MB) assay. The specificity was 22/28 (79%; 59–92%). However, of the 6 patients who had "false-positive" myoglobin tests, all had serious illness: significant cardiac disease (n = 4), in-hospital death (n = 1), or deep venous thrombosis (n = 1).
Conclusion: Myoglobin level determinations are sensitive tests to detect AMI during the first 2 hours of a patient's stay in the ED and may complement current clinical tools.     

Plasma Catecholamines and Carbohydrate Metabolism in Patients with Acute Myocardial Infarction

Blood glucose, glucose tolerance, serum insulin, free fatty acids in serum, plasma noradrenaline, and plasma adrenaline were measured in 10 patients with acute myocardial infarction (AMI) as well as in healthy subjects. Both noradrenaline and adrenaline in plasma were elevated in patients with AMI, the level being fairly constant in the individual patients and dependent on their degree of illness.In the fasting state, blood glucose, serum insulin, and free fatty acids were elevated in patients with AMI. Plasma noradrenaline showed a highly significant correlation with the fasting blood glucose concentration, but not with serum insulin or free fatty acids. The concentration of free fatty acids in serum could be predicted only if both plasma noradrenaline and the basal insulin concentration were known.Intravenous glucose tolerance was reduced in patients with AMI, especially in patients with high plasma noradrenaline and a low initial rise in insulin. There was a significant negative correlation between the initial rise in insulin expressed in percentage of the basal insulin concentration and the plasma noradrenaline level. The statistical effects of serum insulin and plasma noradrenaline on the glucose tolerance could not be separated from each other. The decline in free fatty acids after intravenous injection of glucose showed a negative correlation with plasma noradrenaline and a positive correlation with the initial rise in insulin.Plasma adrenaline did not correlate with any of the metabolic parameters mentioned above.The plasma noradrenaline concentration was elevated to such a degree in patients with AMI that the observed changes in metabolism might have been caused directly by the circulating noradrenaline.During the glucose tolerance tests, the effects of noradrenaline was probably carried out indirectly via a suppression of insulin secretion. It is conceivable that any effect of plasma noradrenaline on the basal insulin secretion was neutralized by the fasting hyperglycemia.     

无症状心衰陈旧性心肌梗死患者血浆N端B型脑钠肽的变化及其临床意义

目的:探讨既往有心肌梗死病史的无症状心衰患者血浆N端B型脑钠肽(NT-proBNP)的浓度变化及其临床意义。方法:入选83例既往有心肌梗死病史,无任何临床心衰症状至少1年以上的门诊体检者,采用酶联免疫吸附法测定血浆NT-proBNP浓度,以心脏彩色多普勒超声诊断仪测定心室结构功能,分为射血分数(EF)≥0.5组(41例)和EF<0.5组(42例)。结果:EF<0.5组血浆NT-proBNP浓度[(1 123.8±234.3)fmol/mL]显著高于EF≥0.5组[(505.0±86.9)fmol/mL],P<0.001。在EF<0.5组,射血分数(EF)、左心室短轴缩短率(FS)与血浆NT-proBNP浓度呈显著负相关(r=-0.96,P<0.001;r=-0.93,P<0.001);而在EF≥0.5组,EF、FS与血浆NT-proBNP浓度无相关关系。受试者工作特征曲线(ROC)显示,界值为675 fmol/mL时,血浆NT-proBNP浓度诊断无症状心衰的敏感性95.24%,特异性92.68%,阳性预测值93.02%,阴性预测值95.00%,阳性似然比13.02,曲线下面积为0.940。结论:血浆NT-proBNP水平可以作为诊断既往有心肌梗死病史的患者发生无症状心衰的一个良好指标,且NT-proBNP的水平随着心功能受损程度的加重而升高,能较好地反映左心室的功能。     

Plasma Catecholamines in Patients with Acute Myocardial Infarction and in Cardiac Arrest

Plasma catecholamine concentrations in cardiac arrest (ventricularfibrillation and asystole) are significantly higher than aftermyocardial infarction. The levels reached are well above thosenormally required to stimulate cardiac activity. Possible reasonsfor the failure of the myocardium to respond to the catecholaminesare discussed and the rationale for giving more catecholaminesis questioned.     

急性心肌梗死患者血浆内皮素水平及临床意义

目的 :探讨内皮素 ( ET)在急性心肌梗死 ( AMI)发病中的作用。方法 :采用放射免疫法检测了 33例急性心肌梗死患者 (其中溶栓治疗 6例 )及 33例正常人血浆内皮素含量。结果 :心肌梗死患者血浆内皮素水平明显高于正常组 ( P<0 .0 1 ) ,但溶栓治疗前后无明显差异 ( P>0 .0 5)。结论 :内皮素在急性心肌梗死发病中具有重要意义。     

胸前导联ST-T改变与急性下壁心肌梗死患者预后的关系

目的:研究胸前导联ST-T改变与急性下壁心肌梗死患者预后的关系。方法:把60例下壁心肌梗死患者根据心电图有无ST-T改变分为甲乙两组进行比较。结果:下壁心肌梗死合并ST-T改变的患者心绞痛发生率及死亡率明显高于下壁心肌梗死不合并ST-T改变的患者。结论:下壁心肌梗死合并ST-T改变患者预后较差。     

血清C反应蛋白对急性心肌梗死的预后价值

目的：观察血清C-反应蛋白（CRP）水平与急性心肌梗死（AMI）患者6个月时心功能及病死率的关系。方法：入选我院572例AMI住院患者,根据入院时CRP水平分为CRP升高组及CRP正常组,随访6个月,记录超声心动图结果及死亡例数。结果：两组基线资料无明显差异。与入院时CRP正常组比较,CRP升高组患者6个月时LVEDD、LVESD,住院期间及随访期间病死率显著增加,而6个月时LVEF显著降低（P〈0.05）。多因素分析结果显示入院时CRP升高是AMI患者住院期间及6个月病死率的独立危险因素。结论：血清CRP升高是AMI患者心功能及病死率的预测因素,关注AMI患者血清CRP水平,尽早开始控制,有利于改善AMI的预后。     

易化PCI治疗对急性心肌梗死患者血浆脑钠肽和左心室重构的影响

目的:探讨易化经皮冠状动脉腔内成形术(PCI)治疗对急性心肌梗死患者血浆脑钠肽水平和左心室重构的影响。方法:选择急性心肌梗死患者212例,其中易化PCI组116例,直接PCI组96例。所有患者分别于入院即刻、24 h、48 h、7 d、14 d及28 d时测定血浆脑钠肽水平;入院后24 h、28 d超声心动图测量左心室舒张末期容积指数、左心室收缩末期容积指数和左心室射血分数。结果:与直接PCI治疗组相比,易化PCI组血浆脑钠肽水平明显降低,左心室射血分数明显升高,左心室客积下降。结论:易化PCI可明显降低血浆脑钠尿肽水平并减轻左心室重构。     

高血压合并急性心肌梗死患者CK-MB、Hcy水平与Gensini评分的相关性分析

目的 分析高血压合并急性心肌梗死(AMI)心肌型肌酸激酶同工酶(CK-MB)、同型半胱氨酸(Hcy)水平变化情况及临床意义。方法 选择2019年9月—2020年11月收治的高血压合并AMI 83例作为研究组。另选取同期未合并AMI的64例单纯高血压作为对照组。比较两组CK-MB、Hcy水平变化情况,分析不同病变支数、Gensini评分患者CK-MB、Hcy水平情况及CK-MB、Hcy与Gensini评分的相关性。分析上述因子水平对高血压合并AMI的预测价值。结果 研究组CK-MB、Hcy水平均高于对照组(P<0.05)。单支组CK-MB、Hcy水平及Gensini评分均低于双支组、三支组,双支组低于三支组(P<0.05)。A组CK-MB、Hcy水平低于B、C、D组,且B组低于C、D组,C组低于D组(P<0.05)。CK-MB、Hcy与Gensini评分均呈正相关(P<0.01)。CK-MB和Hcy联合检测对高血压合并AMI预测敏感度、特异度和曲线下面积高于各项指标单独预测。结论 高血压合并AMI患者中CK-MB、Hcy呈异常表达,且与Gensini评分具有一定相...     

Prognostic Importance of Admission Plasma Glucose in Diabetic and Non-diabetic Patients with Acute Myocardial Infarction

SUMMARY We assessed the relationship of plasma glucose concentrationsmeasured on admission to mortality during the acute phase ofmyocardial infarction in 143 diabetic patients and 277 patientswithout a previous history of diabetes. Mortality in hospital in patients not known to have diabetesincreased significantly from 4 per cent in patients with admissionplasma glucose below 8 mmol/1 to 35 per cent in patients withadmission plasma glucose above 11 mmol/1. In diabetic patientsthe mortality increased with increasing admission plasma glucosebut the difference was not significant. In patients with diabetesmean admission plasma glucose levels of the survivors and thosewho died were similar, whilist in the non-diabetic group themean plasma glucose levels of the patients who did not survivewere significantly higher than those of the survivors. Stepwiselogistic regression analyses identified admission plasma glucoselevel as an important predictor of mortality in the non-diabeticgroup but not in the diabetic patients. Plasma glucose level on admission is an important prognosticindicator in non-diabetic patients, in that hyperglycaemia isassociated with a higher mortality. In diabetic patients a clearrelationship between admission plasma glucose and mortalitywas not demonstrated.