国内进展性脑梗死危险因素的系统评价

目的综合评价国内进展性脑梗死患病人群的危险因素。方法采用Meta分析的方法对国内有关进展性脑梗死发病危险因素的研究结果进行定量综合分析;使用Review Manager 5.17对研究结果进行异质性检验以及OR值的合并和95%CI的计算。结果共纳入15篇文献,病例组1 345例,对照组2 643例。Meta分析结果显示:中国人群进展性脑梗死的危险因素有糖尿病(OR=3.51,95%CI:2.43~5.06,P=0.003)、高血压(OR=3.90,95%CI:1.98~7.67,P0.000 1)、发热(OR=4.42,95%CI:2.64~7.39,P=0.01)、空腹血糖(OR=1.33,95%CI:0.77~1.90,P0.000 01)、白细胞计数(OR=1.48,95%CI:0.28~2.69,P0.00001)、C反应蛋白(OR=1.59,95%CI:0.34~2.84,P=0.000 3)、收缩压(OR=-20.85,95%CI:-30.18~-11.51,P0.000 01)。结论现有的证据表明中国人群进展性脑梗死的危险因素有糖尿病、高血压、发热、空腹血糖、白细胞计数、C反应蛋白、收缩压。     

老年男性急性心肌梗死患者冠状动脉病变程度列线图模型的建立和验证

目的:构建加重老年男性急性心肌梗死(AMI)患者冠状动脉(冠脉)病变程度的列线图模型,为加重老年男性冠脉病变程度危险因素的初步筛查提供更直观的新方法。方法:回顾性分析行冠脉造影术的1 358例老年男性AMI患者的临床资料,计算并合并Gensini积分等级得出轻度病变组和重度病变组。比较2组间的各项危险因素,采用Logistic多因素回归分析加重老年男性患者冠脉病变程度的危险因素,然后应用Nomogram法建立列线图模型进行验证。结果:①轻度病变组和重度病变组吸烟、年龄和空腹血糖的差异均有统计学意义(均P0.05);②多因素Logistic回归分析结果显示,年龄(OR=2.883,95%CI:1.746～4.759)和空腹血糖(OR=3.649,95%CI:2.259～5.896)是加重老年男性AMI患者冠脉病变程度的独立危险因素(均P0.001);③Nomogram模型分析显示,总分越高的老年男性AMI患者加重冠脉病变程度的风险越大;④Nomogram模型的ROC曲线预测风险能力指数为0.751,具有良好的一致性。结论:年龄和空腹血糖是加重老年男性冠脉病变的独立危险因素,构建加重老年男性AMI患者冠脉病变程度的列线图模型,可以更直观、快捷地定量评价加重老年男性患者冠脉病变程度的危险因素,为老年男性预防AMI的发生和加重提供理论依据。     

急性ST段抬高型心肌梗死与急性非ST段抬高型心肌梗死的对比性研究

目的对比急性ST段抬高型心肌梗死(acute ST-segment elevation myocardial infarction,STEMI)与急性非ST段抬高型心肌梗死(acute non-ST-segment elevation myocardial infarction,NSTEMI)的临床特征。方法收集2012年1月至2013年12月在高淳区人民医院住院的急性心肌梗死(acute myocardial infarction,AMI)患者480例的临床资料,分为STEMI组205例,NSTEMI组275例。对比两组相关临床资料。应用多因素Logistic逐步回归分析AMI患者中发生NSTEMI的危险因素。结果与STEMI组比较,NSTEMI组女性、既往合并心纹痛、心肌梗死及经皮冠状动脉介入治疗、原发性高血压(高血压)、三支病变、侧支循环的患者比例偏高,差异有统计学意义(P0.05);空腹血糖、总胆固醇、低密度脂蛋白胆固醇、纤维蛋白原、超敏C-反应蛋白浓度偏低,差异有统计学意义(P0.05)。陈旧性心肌梗死、侧支循环、心纹痛是发生NSTEMI的独立危险因素(OR=8.049,95%CI:2.081~31.130,P=0.003;OR=3.327,95%CI:1.387~7.981,P=0.007;OR=2.435,95%CI:1.418~4.181,P=0.001)。结论陈旧性心肌梗死病史、侧支循环建立、心纹痛病史可能是AMI患者中发生NSTEMI的独立危险因素。     

急性心肌梗死院内死亡危险因素分析

目的:探讨急性心肌梗死(AMI)病人院内死亡的独立危险因素。方法:回顾性分析我院2011~2013年在我院住院期间,确诊为AMI的患者614例的临床资料,根据AMI患者住院期间存活与否,分为死亡组(62例)和存活组(552例),用单变量和多变量Logistic回归分析所有患者的基线特征因素和治疗方法与院内死亡的关系。结果:62例死亡患者平均年龄(66.58±12.87)岁,男性39例(62.9%),院内死亡率为10.10%(62/614),多变量Logistic回归分析筛选出与AMI院内死亡相关的独立危险因素为:年龄(OR=3.065,95%CI:1.188~7.915)、女性(OR=2.775,95%CI:1.200~6.419)、心率(OR=2.836,95%CI:1.405~5.722)、血糖(OR=1.943,95%CI:1.186~3.184)、Killip IV级(OR=1.744,95%CI:1.211~2.513)、3支或左主干病变(OR=3.157,95%CI:1.244~8.014),P<0.05~<0.01。结论:高龄、女性、心率增快、入院血糖水平高、KillipIV级、3支或左主干病变可能是急性心肌梗死院内死亡的独立危险因素。     

应激性高血糖对接受经皮冠状动脉介入治疗的急性心肌梗死患者临床预后的影响

目的:探讨应激性高血糖(SHG)对接受经皮冠状动脉(冠脉)介入治疗(PCI)的急性心肌梗死(AMI)患者近、远期临床预后的影响。方法:对2010-02至2016-03首次患AMI于我院心内科接受PCI的患者655例进行回顾性分析。比较SHG组(空腹血糖≥7.0 mmol/L,67例)、无SHG组(空腹血糖7.0 mmol/L,320例)和糖尿病组(既往或此次入院后明确诊断,268例)患者住院期间及发病1年主要不良心血管事件(MACE)。结果:三组患者GRACE评分比较,SHG组糖尿病组无SHG组,三组比较差异均有统计学意义(P均0.05)。三组患者Gensini积分比较,糖尿病组SHG组无SHG组,糖尿病组与无SHG组比较差异有统计学意义(P0.05),其余差异无统计学意义(P0.05)。SHG组患者住院期间全因死亡、心力衰竭及恶性心律失常比例高于无SHG组(P0.05)。多因素Cox回归模型分析显示SHG、GRACE评分及Gensini积分是患者住院期间全因死亡的独立危险因素,其中SHG是最强的危险因素(OR=4.455,95%CI:1.805~10.997,P=0.001)。SHG组发病1年全因死亡及心力衰竭患者比例高于无SHG组(P0.05)。Cox回归分析显示年龄、空腹血糖、入院Killip心功能分级Ⅱ~Ⅳ级及Gensini评分是患者发病1年全因死亡的独立危险因素,其中入院Killip心功能分级Ⅱ~Ⅳ级是最强的危险因素(OR=6.901,95%CI:2.812~16.940,P0.001),其他依次是空腹血糖、年龄和Gensini积分。结论:SHG会影响接受PCI的AMI患者近期及远期预后,和其他危险因素相比,SHG是接受PCI的AMI患者住院期间全因死亡的一项较强的独立危险因素。     

急性心肌梗死介入治疗后ST段回落不良的多元Logistic回归分析

目的分析急性ST段抬高型心肌梗死(AMI)病人冠脉介入治疗后ST段回落不良相关因素,为AMI危险分层及预后提供依据。方法选择我院行急诊经皮冠脉介入治疗(PCI)病人92例为研究对象,根据病人PCI术后即刻ST段回落情况分为回落完全组(ST段回落≥50%)和回落不全组。分析比较两组病人的临床病理特征,采用Logistic回归方法分析ST段回落不良的独立危险因素。结果 21例(22.8%)AMI病人PCI术后即可ST段回落不良,单因素分析显示ST段回落不良与病人年龄(≥70岁)、左前降支病变、血小板糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)拮抗剂应用和总缺血时间有关(P0.05)。Logistic回归分析显示,年龄≥70岁(OR=3.3,95%CI:1.2~11.6,P0.05)、未应用GPⅡb/Ⅲa拮抗剂(OR=2.9,95%CI:1.4~9.6,P0.05)和总缺血时间较长(OR=1.7,95%CI:1.2~3.9,P0.05)是AMI冠脉介入治疗后ST段回落不良独立危险因素。结论 PCI术前未应用GPⅡb/Ⅲa拮抗剂且存在缺血时间较长的高龄病人是ST段回落不良的高危人群。     

BNP、CRP与急性心肌梗死并发恶性室性心律失常的相关分析

目的:探讨急性心肌梗死(AMI)患者合并恶性室性心律失常的危险因素。方法:回顾性分析我院接受急诊冠状动脉介入(PCI)的ST段抬高心肌梗死患者322例。分为恶性室性心律失常组(A组)68例和无恶性室性心律失常组(B组)254例。通过观察比较患者的一般临床情况,进行心脏超声检查,检测生化指标、C反应蛋白(CRP)及血浆脑钠肽(BNP)。并将可能的相关因素进行Logist多因素回归分析。结果:两组患者在年龄、性别构成、高血压、陈旧心肌梗死、既往血运重建病史、基础心率、血压等方面具有可比性。但A组患者的空腹血糖、CRP及BNP水平明显高于B组患者[空腹血糖(8.83±4.81)mmol/L∶(6.02±2.25)mmol/L,P=0.012;CRP(18.24±12.19)mg/L∶(11.06±10.06)mg/L,P=0.016;BNP(446.04±146.37)pg/L∶(315.01±121.11)pg/L,P=0.009]。Logist多因素回归分析示:BNP、CRP的升高是AMI患者合并恶性室性心律失常的独立危险因素(BNP:OR=1.416,95%CI:0.921~3.012,P=0.021;CRP:OR=1.367,95%CI:1.040~4.312,P=0.015)。结论:AMI患者BNP、CRP水平的升高可能预示发生恶性室性心律失常风险的增加。     

他汀类药物对急性心肌梗死患者应激性高血糖的影响

目的探讨他汀类药物对于急性心肌梗死(AMI)患者应激性高血糖的影响。方法纳入2009年1月至2012年12月间,发生AMI的非糖尿病患者,分别调查血糖、血脂、肝肾功能、合并疾病以及口服药物,分析入院后出现应激性高血糖的相关的危险因素。结果 316例非糖尿病AMI患者符合入选标准,其中男性183例,女性133例,年龄47~89(67±12.8)岁。33.23%(105例)患者发生了应激性高血糖。二分类Logistic回归分析提示年龄(OR=2.992,95%CI:1.045~8.565,P=0.041),以及他汀类药物使用(OR=2.852,95%CI:1.051~7.741,P=0.040)为AMI患者应激性高血糖发生的危险因素。结论他汀类药物的使用促进AMI患者应激性高血糖的发生。     

探讨高敏C反应蛋白对急性心肌梗死患者并发恶性室性心律失常的预测价值史云桃 蒋廷波

目的 探讨急性心肌梗死(AMI)患者住院期间合并恶性心律失常的相关危险因素。方法 收集325例2012年因AMI患者的临床特征及冠脉造影(CAG)结果。分为恶性室性心律失常组(A组)48例,非恶性室性心律失常(B组)277例,应用多因素logistic逐步回归分析急性心肌梗死患者发生恶性心律失常的危险因素。结果。(1)与B组比较,A组年龄偏大,空腹血糖、尿酸、血肌酐、甘油三酯、高敏C反应蛋白、ST段抬高型心肌梗死、右冠状动脉病变比例均明显升高(P<0.05)。收缩压、舒张压、血红蛋白、白蛋白、肌酐清除率、EF值明显下降(P<0.05)。其余各项指标差异无统计学意义。(2)多因素logistic回归分析显示罪犯血管、高敏C反应蛋白是AMI患者合并恶性心律失常的危险因素(OR=1.963,95%CI:1.302～2.958,P=0.001; OR=1.102,95%CI:1.020～1.190,P=0.001)。结论：AMI发生恶性心律失常比例较高,且受多种因素影响。其中右冠状动脉(RCA)梗死、高敏C反应蛋白可能是AMI发生恶性心律失常的独立危险因素,具有预测价值。     

结合OCT分析DES术后晚期或晚晚期支架内血栓形成的危险因素

目的:结合光学相干断层成像技术(OCT)分析药物洗脱支架(DES)术后支架内晚期或晚晚期血栓发生的危险因素。方法:回顾性分析曾在本院或外院行药物支架术,经冠状动脉(冠脉)造影和(或)OCT确诊的发生晚期或晚晚期支架内血栓的19例患者。按年龄、性别(2∶1)匹配原则抽取曾行药物支架术,冠脉造影证实未发生支架内血栓患者38例作为对照组。对晚期或晚晚期支架内血栓的主要危险因素、冠脉造影和OCT分析。采用条件Logistic回归分析晚期或晚晚期支架内血栓形成的独立危险因素。结果:支架内血栓组糖尿病史、既往心肌梗死病史、空腹血糖、左室射血分数(LVEF)与对照组差异有统计学意义(均P0.01)。定量冠脉造影分析及OCT检查结果显示:支架内血栓组患者置入支架数目、支架长度、支架贴壁不良率、支架内皮未被覆盖率均显著高于对照组(P0.05)。条件Logistic回归分析显示:既往心肌梗死病史(OR:7.642,95%CI:1.412~41.152,P0.01)、支架长度(OR:13.285,95%CI:3.198~55.189,P0.01)、支架数量(OR:1.645,95%CI:1.106~2.447,P=0.014)、支架贴壁不良率(OR:5.132,95%CI:4.800~5.464,P=0.001)、未被覆盖支架柱比例(OR:12.549,95%CI:3.657~43.067,P0.01)、糖尿病(OR:7.256,95%CI:1.721~30.591,P0.01)为DES术后晚期或晚晚期血栓的危险因素。正常的LVEF(OR:0.714,95%CI:0.574~0.887,P=0.002)为其保护因素。结论:长支架、多支架置入、支架贴壁不良和支架内皮化不全、心肌梗死病史是晚期或晚晚期血栓的独立危险因素,正常的LVEF是其保护因素。     

Myocarditis associated with acute nasopharyngitis and acute tonsillitis

Thirty-five instances of fatal myocarditis atributable to acute nasopharyngeal and tonsillar infections have been reported. The available evidence indicates that these are samples of a not uncommon type of cardiac disease which fortunately has a relatively good prognosis. Further investigation should be carried on to establish fully the etiological agent and the pathogenesis of the lesion. Although the pathologic observations indicated that all patients died of cardiac failure, heart disease was suspected clinically in only three, and in fifteen patients death was unexpected. Significant clinical observations which would seem to be of importance in the recognition of the process were: disproportion of the temperature and pulse rate, hypotension, thready or feeble pulse, and substernal oppression. Cyanosis, dyspnea, and orthopnea occurred frequently.Autopsy findings included significant enlargement of the heart in many cases. The microscopic changes, similar in both nasopharyngeal and tonsillar infections, have been classified in three overlapping groups. In all of these the inflammatory process was observed to be patchy, frequently showing considerable variation in intensity from one area to another and having no predilection for a particular portion of the myocardium. Significant (moderate or marked) degrees of muscle degeneration observed in the diffuse type of myocardial lesion were not present in the interstitial form. The cellular reaction, which was characteristically more intense than that observed in diphtheritic myocarditis, was predominantly mononuclear, but significant numbers of polymorphonuclear leucocytes accumulated at sites of more severe inflammation.Although the figures are too small to justify conclusions, there appears to be significant correlation between the clinical occurrence of hypotension and the estimated severity of the myocarditis, since it was a feature in every severe case in which the blood pressure was recorded. The only available electrocardiograms (four), abnormal in every case, were from patients whose hearts showed muscle degeneration of moderate or marked degree. Anginal pains were related to the presence of hypotension. Fibrosis of the heart muscle was related both to the muscle degeneration and to duration of illness.In therapy, attention is called to the danger involved in the administration of intravenous fluids.     

Fatal idiopathic acute eosinophilic pneumonia with acute lung injury

A fatal case of idiopathic eosinophilic pneumonia with acute lung injury is described. The patient required treatment with mechanical ventilation and intravenous corticosteroids, however, she died on the third hospital day. At autopsy, both exudative and proliferative phases of diffuse alveolar damage were observed bilaterally. Marked eosinophilic infiltrate was noted in the alveolar wall and within the alveolar cavities with occasional abscess-like features. To our knowledge, this is the first report of fatal acute eosinophilic pneumonia, and provides important information for the management of this condition.     

A case of acute intermittent porphyria with acute pancreatitis.

A case of acute pancreatitis in a 29-year-old female associated with an attack of acute intermittent porphyria (AIP) is reported. Following the attack of AIP, serum pancreatic amylase originating from the pancreas increased transiently, and mild swelling of the pancreas was detected by ultrasonography. On this basis acute pancreatitis was diagnosed. Additionally, this patient had mild hepatic dysfunction. Laparoscopy disclosed diffuse slightly dark bluish pigmentation on the irregular surface of the liver. Mild fibrous dilatation of the portal area with lymphocytic infiltration was seen histologically. Acute pancreatitis and hepatic damage with AIP is extremely rare, however it is possible that these findings are etiologically connected in this patient.     

Recurrent acute pulmonary emboli in association with acute myocardial infarction

Left ventricular mural thrombi are a common complication of myocardial infarction, but right-sided mural thrombi have been reported only in blunt chest trauma, right ventricular catheterization, and pacemaker insertion. We describe a patient with AMI and subsequent right ventricular mural thrombi and ultimately pulmonary emboli. We believe a prospective study should be conducted first to evaluate the MI as a cause of right-sided mural thrombi and second to assess the right ventricle as a source of pulmonary emboli.     

急性脑卒中的降压治疗

目的观察和比较地尔硫卓和赖诺普利在急性脑卒中患者中的降压作用。方法有急性脑卒中的高血压病人105例，根据血压值不同分为3组，A组33例，先给予地尔硫卓针剂50mg溶于0．9％氯化钠注射液或5％葡萄糖注射液250ml中静滴，2～4h滴完。24h后，给予地尔硫卓缓释片剂90mg口服，每13一次，服用二周。B组37例，给予地尔硫卓缓释片剂90mg口服，每日一次，服用二周。C组35例，给予赖诺普利片剂10mg口服，每13一次，服用二周。结果A组病例用药后第14天降压有效率达87．9％，B组86．5％，C组85．7％，3组病例有效率差别无显著意义。A组病例静脉用药后10、20、30、60、120min血压降压幅度（差值）与其前一观察时刻的血压值差别有显著意义，3组病例用药后第1天，第2天，第7天，第14天的血压降压幅度（差值）与其前一观察值差别均有显著意义，B组与C组组间的相应降压幅度差别均无显著意义。A组病例静滴降压安全性达87．9％。所有病例用药后不良反应轻微。结论地尔硫卓和赖诺普利在急性脑卒中患者中的降压作用疗效确切、二者之间无显著差异、安全性高。     

妊娠合并重症急性胰腺炎

妊娠合并重症急性胰腺炎,是一种严重的妊娠期疾病,具有起病急、临床表现不典型及母婴病死率高等特点。国内外报道妊娠合并急性胰腺炎的发病率约为1／1000—1／12000,而合并重症急性胰腺炎（出血坏死型胰腺炎）的更少。由于妊娠牵涉到母婴健康和安全的特殊情况,所以该病的临床治疗有一定的特殊性。作者报道了南京医科大学第一附属医院胰腺外科中心近1年来4例妊娠合并重症急性胰腺炎的诊治体会。     

Thrombocytosis associated with acute osteomyelitis

Summary Thrombocytosis is rarely observed during infection. We are describing a patient with acute osteomyelitis and bacteremia who developed thrombocytosis. In the patient described the platelet count paralleled the activity of the infection and the response to therapy. The causes of thrombocytosis and its implications are briefly reviewed.

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Thrombozytose in Verbindung mit akuter Osteomyelitis

Zusammenfassung Thrombozytose tritt während Infektionen selten auf. Wir beschreiben eine Patientin mit akuter Osteomyelitis und Bakteriämie, bei der es zu einer Thrombozytose kam. Die Thrombozytenzahl ging dabei mit der Aktivität der Infektion und dem Ansprechen auf die Therapie parallel. Ursachen der Thrombozytose und ihre Auswirkungen werden kurz dargestellt.