急性脑梗死患者心电图及心肌酶谱分析

目的探讨急性脑梗死患者心电图及心肌酶谱的变化及其意义。方法对同期住院的126例首次急性脑梗死患者（脑梗死组）及98例门诊体检健康者（对照组）的心电图及心肌酶谱资料进行对照分析。结果脑梗死组患者心电图异常率（57.1%）与对照组（16.3%）相比差异有统计学意义（P〈0.05）;脑梗死组患者肌酸激酶（CK）、AST、低密度脂蛋白（LDH）和α-羟丁酸脱氢酶等（α-HBDH）与对照组间差异有统计学意义（P〈0.05）。结论急性脑梗死心电图及心肌酶谱变化与脑梗死程度及预后有关,心电图及心肌酶谱可作为判断病情轻重及预后的早期参考指标之一。     

轮状病毒肠炎心肌酶检测及心电图分析

目的探讨轮状病毒（RV）肠炎伴发心肌损害所致心肌酶、CTnI及心电图异常表现。方法对150例确诊为RV肠炎患者（A组）的心肌酶谱和心电图进行分析。结果①A盟与正常者（B组）比较心肌酶谱明显升高（P〈0．01）;②A组心电图异常率迭85％;③A组CTnI异常率为83．3％;④心肌酶谱、CTnI、心电图三者具有相关性。结论RV肠炎伴发心肌损害时心肌酶谱和CTnI可明显升高、心电图出现异常改变。     

重型病毒性肝炎58例并发心肌损伤的临床观察

目的了解重型病毒性肝炎（重型肝炎）并发心肌损伤的临床特点。方法对58例重型肝炎患者进行回顾性分析,记录临床表现、心肌酶谱、心电图及心脏彩色多普勒检查结果。结果重型肝炎患者CK、CK—MB、α—HBDH升高水平显著高于正常对照组,且差异有统计学意义（P〈0．01）;重型肝炎常致各种心律失常,以S—T段压低、T波低平、倒置的发生率最高（34．9％～57．1％）;心脏彩色多普勒提示重型肝炎患者可并发室间隔增厚,室腔扩大,主动脉瓣、二尖瓣轻度返流,射血分数下降或上升。结论重型肝炎并发心肌损害临床常见,应监测心肌酶谱和心电图及心脏彩色多普勒,以做到早发现,及时治疗。     

重型病毒性肝炎并发心肌损伤的临床观察

重型病毒性肝炎（重型肝炎）并发心肌损伤临床虽非少见,但以临床表现、心肌酶谱、心电图及心脏彩色多普勒综合系统分析文献甚少.我们将本院收治的105例各类重型肝炎的心肌损伤情况作一回顾性总结.     

重型病毒性肝炎并发心肌损伤的临床观察

目的了解近年来重型肝炎并发心肌损伤情况。方法回顾性分析92例重型肝炎病人的临床资料。结果急性重型肝炎组心肌酶谱较亚急性、慢性重型肝炎组升高更明显，但差异无统计学意义（P〉0．05），各类重型肝炎心肌酶谱升高与正常对照组比较差异均有统计学意义（P〈0．01）。结论重型肝炎常并发心肌损害，需常规监测心肌酶、心电图、心脏彩超并及时给予保护心肌治疗。     

肝性黄疸心脏损伤的临床研究

目的观察肝性黄疸对心肌的影响。方法选取黄疸型肝炎患者324例为观察组,97例健康体检者为正常对照组。以总胆红素值持续1周以上,在正常值5倍和10倍为界分为轻度组、中度组和重度组。对入选病例进行心电图、动态心电图检查,同时观察心肌酶的变化。结果心电图、动态心电图异常率轻、中、重度观察组与对照组各组间比较差异有统计学意义（P均〈0.05）。磷酸肌酶、磷酸肌酶同功酶及α-羟丁酸脱氢酶异常率轻、中度组均较重度组降低（P〈0.05）。结论肝性黄疸可引起心肌损害,出现心肌酶、常规心电图尤其是动态心电图的改变。     

手足口病患儿心肌酶检测及心电图分析

目的探讨手足口病（HFMD）患儿伴发心肌损害所致心肌酶、心电图及cTnI异常表现。方法对180例确诊患儿和我院同期住院的小儿外科患儿100例同时于入院次日和病程结束后,行心肌酶谱、心电图和cTnI检查。结果①HFMD患儿与正常小儿比较心肌酶谱明显升高（P〈0.01）;②HFMD患儿心电图异常率71.3%,以ST-T改变为主;③HFMD患儿cTnI异常44例（占24.4%）;④心肌酶谱、cTnI、心电图三者具有相关性。结论部分HFMD患儿伴发心肌损害时心肌酶谱和cTnI明显升高,心电图出现异常改变。早期进行心肌酶学、cTnI和心电图等检测,有助于HFMD患儿心肌损害的早期诊断和治疗。     

急性脑卒中患者心电图与心肌酶谱的变化

目的探讨急性脑卒中心电图与心肌酶谱变化的临床意义。方法对226例首次急性脑卒中患者（出血性脑卒中114例，缺血性脑卒中112例）进行心电图与心肌酶谱的检测，并与105例健康体检者做对照分析。结果（1）出血性脑卒中组心电图异常发生率明显高于缺血性脑卒中组（P〈0．001），发生在基底节、丘脑部位病变者的心电图异常发生率明显高于脑叶和小脑部位病变者（P均〈0．05）；（2）急性脑卒中组心肌酶谱水平明显高于对照组（P均〈0．001），出血性脑卒中组心肌酶谱水平明显高于缺血性脑卒中组（P均〈0．001），发生在蛛网膜下腔部位病变者心肌酶谱水平明显高于脑叶和小脑部位病变者（P均〈0．001）。结论对急性脑卒中患者要加强心电监护和心肌酶谱水平的检测，有异常者及早进行干预，对患者预后具有重要临床意义。     

急性脑卒中436例心电图与心肌酶谱变化的临床意义

目的探讨急性脑卒中心电图与心肌酶谱变化的临床意义。方法对436例首次急性脑卒中患者（出血性脑卒中230例,缺血性脑卒中206例）进行心电图与心肌酶谱的检测,并与162例健康体检者做对照分析。结果（1）血性脑卒中组心电图异常发生率明显高于缺血性脑卒中组（P〈0．001）,发生在基底节、丘脑部位病变者的心电图异常发生率明显高于脑叶和小脑部位病变者（P均〈0．05）;（2）急性脑卒中组心肌酶谱水平明显高于对照组（P均〈0．001）,出血性脑卒中组心肌酶谱水平明显高于缺血性脑卒中组（P均〈0．001）。发生在蛛网膜下腔部位病变者心肌酶谱水平明显高于基底节丘脑、脑干、脑叶和小脑部位病变者（P均〈0．05）。结论对急性脑卒中患者要加强心电监护和心肌酶谱水平的检测,有异常者及早进行干预,对患者预后具有重要临床意义。     

成人麻疹心肌酶谱测定及临床意义

目的了解成人麻疹心肌酶谱异常的情况及探讨测定心肌酶谱的意义。方法选择2008年1—7月我院收治的成人麻疹56例和儿童麻疹60例,分别进行心肌酶谱检测,并行心电图检查。结果成人麻疹心肌酶谱异常率为82％,与同期儿童麻疹心肌酶谱异常率（22％）比较,差异有统计学意义。成人麻疹心电图异常率为17％,与儿童麻疹心电图异常率（15％）比较,差异无统计学意义。结论心肌酶谱异常是成人麻疹特征性改变,治疗中要注意保护心肌。     

不明原因肝功能异常2510例临床资料分析

目的探讨不明原因肝功能异常患者的病因分布和临床特点。方法回顾性分析上海交通大学医学院附属瑞金医院感染科自2010年1月至2015年5月入院治疗的不明原因肝功能异常出院患者的临床资料,对疾病诊断进行分类,并对其构成和变化趋势等情况进行分析。结果共收治不明原因肝功能异常患者2510例,其中明确病因925例(36.85%),诊断涉及19个病种,居前4位的疾病分别是:病毒性肝炎17.65%(443/2510)、药物性肝损伤7.81%(196/2510)、胆源性肝炎3.75%(94/2510)、自身免疫性肝病3.23%(81/2510)。结论在不明原因肝功能异常患者中,临床仍有大部分病例(63.15%)难以确定病因,除病毒性肝炎外,药物性肝损伤、胆源性肝炎、自身免疫性肝病不可忽视。     

Complementary value of two-dimensional exercise echocardiography to routine treadmill exercise testing

Two-dimensional echocardiograms were done during rest and after exercise in 95 patients who subsequently had coronary arteriography. Prior myocardial infarction was present in 36 patients, 35 of whom had wall motion abnormalities. There was no evidence of prior infarction in 59 patients, 44 of whom had coronary disease. In these 44 patients, the exercise electrocardiogram showed ischemia in 19, was normal in 13, and was nondiagnostic in 12. Exercise echocardiograms were abnormal in 35 of these 44 patients. In 15 patients without coronary disease, the treadmill response was nondiagnostic in 6, ischemic in 1, and normal in 8. Exercise echocardiograms were normal in 13 of these 15 patients. We conclude that exercise echocardiography is a valuable addition to routine treadmill testing. It may be of special value in patients with an abnormal resting electrocardiogram or a nondiagnostic response to treadmill testing or when a false-negative treadmill test is suspected.     

Relation of electrocardiographic abnormalities and patterns of left ventricular hypertrophy identified by 2-dimensional echocardiography in patients with hypertrophic cardiomyopathy

Distribution of left ventricular (LV) hypertrophy was assessed by wide-angle, 2-dimensional (2-D) echocardiography in 153 patients with hypertrophic cardiomyopathy and compared with the scalar electrocardiogram in the same patients. The most common electrocardiographic alterations were S-T segment changes and T-wave inversion (61%), LV hypertrophy (47%), abnormal Q waves (25%), and left atrial enlargement (24%). LV hypertrophy on the electrocardiogram was significantly more common in patients with the most extensive distribution of LV hypertrophy on 2-D echocardiogram involving substantial portions of both the ventricular septum and LV free wall (type III; 51 of 69, 74%) than in those with more limited distribution of LV hypertrophy (21 of 84, 25%; p less than 0.001). Most patients with hypertrophic cardiomyopathy and normal electrocardiograms (13 of 23) had localized (type I) hypertrophy, but only 4 had the extensive type III pattern of hypertrophy. Abnormal Q waves were significantly more common in those patients without hypertrophy of the anterior, basal septum (type IV; 15 of 27, 56%) than in those with basal septal hypertrophy (23 of 126, 18%; p less than 0.001); abnormal Q waves were uncommon in extensive type III distribution of hypertrophy (13 of 69, 19%). Thus, although no single electrocardiographic abnormality is characteristic of hypertrophic cardiomyopathy, 2-D echocardiography clarifies the significance of certain electrocardiographic patterns: (1) LV hypertrophy on the electrocardiogram, although present in only about half of the study group, was a relatively sensitive (74%) marker for extensive (type III) LV hypertrophy; (2) abnormal Q waves cannot be explained by ventricular septal hypertrophy alone; and (3) a normal electrocardiogram was most commonly a manifestation of localized LV hypertrophy.     

The spectrum of liver disease in systemic lupus erythematosus: Report of 33 histologically-proved cases and review of the literature

The charts of 238 patients with systemic lupus erythematosus (SLE) were reviewed. Although not routinely screened for biochemical evidence of liver disease, 124 of 206 patients tested had at least one abnormal result, and 43 met strict criteria for the existence of liver disease. In most patients, a specific viral or drug etiology could not be implicated. The spectrum of liver disease in 33 patients from whom liver tissue was available included cirrhosis, chronic active hepatitis, granulomatous hepatitis, chronic persistent hepatitis and steatosis. Three of four cirrhotic patients demonstrated a peculiar form of cholestasis which resembled a “canalicular cast” of bile. Of the nine patients who had serial liver biopsies, four showed progression of their disease. Three patients died of liver failure. Liver involvement in SLE is more common than previously recognized. Severe and even fatal liver disease can occur.     

Viral Hepatitis and Intrahepatic Cholestasis of Pregnancy

Summary: Specific serological tests which are now available for the diagnosis of infection with hepatitis A and hepatitis B viruses, were used to distinguish viral hepatitis from other causes of liver disease in pregnancy. Forty-nine (51·6%) of 95 pregnant patients had viral hepatitis, 24 hepatitis A and 25 hepatitis B. The majority of patients (26 of 28) presenting before 22 weeks gestation had viral hepatitis. By contrast, 23 (34·3%) of the remaining 67 patients presenting with abnormal liver function tests at ≫ 22 weeks gestation, had viral hepatitis; the majority of the remainder had features compatible with intrahepatic cholestasis of pregnancy. Although there were significant clinical and biochemical differences between the two groups, accurate diagnosis was only possible by using specific virological tests.     

Clinical Significance of Serum and Urinary Neopterin Levels in Patients with Various Liver Diseases

Serum and urinary neopterin levels were measured by radioimmunoassay in 120 healthy controls, 16 asymptomatic HBsAg carriers, 12 patients with acute hepatitis, 13 with chronic inactive hepatitis, 35 with chronic active hepatitis, 46 with liver cirrhosis, 18 with hepatocellular carcinoma, and 6 with alcoholic liver disease. Serum and urinary neopterin levels were significantly higher in almost all patients than in normal subjects. Neopterin levels were highest in acute hepatitis and correlated with the results of liver function tests, but did not show this correlation in chronic liver disease. In chronic liver disease, the levels of serum neopterin in non-A non-B viral patients was significantly increased, compared with those in B viral and alcoholic patients. The rate of abnormal urinary neopterin levels in chronic liver disease was higher than the rate of abnormal serum neopterin levels, but no difference was observed between the rates of abnormal serum and urinary levels in acute hepatitis and asymptomatic HBsAg carriers. These results indicate that serum and urinary neopterin levels may be useful markers for cell-mediated immunity in liver disease, and that the immune system response in chronic liver disease may be different for different pathogens.     

Positive T wave overshoot as a sign of ventricular enlargement

A consecutive series of 86 patients with an inverted T wave showing terminal positivity (overshoot) of a specific pattern in the resting electrocardiogram were studied. Patients with bundle branch block or electrocardiographic evidence of acute infarction and those taking digoxin or a similar drug were excluded. In 67 patients the heart was examined by echocardiography and in a further two by direct inspection. Sixty six of the 69 patients had an abnormal thickness of the left (or right) ventricle or a calculated left ventricular mass greater than 200 g. Seven of the patients examined by echocardiography had clinically pure ischaemic heart disease; all showed evidence of left ventricular enlargement. In only 39 of the 63 patients with anatomical evidence of left ventricular hypertrophy or dilatation did the electrocardiogram satisfy the standard voltage criterion of left ventricular hypertrophy. In the absence of acute infarction, bundle branch block, or digitalisation positive T wave overshoot of the pattern described is a sign of increased ventricular mass.     

Positive T wave overshoot as a sign of ventricular enlargement.

A consecutive series of 86 patients with an inverted T wave showing terminal positivity (overshoot) of a specific pattern in the resting electrocardiogram were studied. Patients with bundle branch block or electrocardiographic evidence of acute infarction and those taking digoxin or a similar drug were excluded. In 67 patients the heart was examined by echocardiography and in a further two by direct inspection. Sixty six of the 69 patients had an abnormal thickness of the left (or right) ventricle or a calculated left ventricular mass greater than 200 g. Seven of the patients examined by echocardiography had clinically pure ischaemic heart disease; all showed evidence of left ventricular enlargement. In only 39 of the 63 patients with anatomical evidence of left ventricular hypertrophy or dilatation did the electrocardiogram satisfy the standard voltage criterion of left ventricular hypertrophy. In the absence of acute infarction, bundle branch block, or digitalisation positive T wave overshoot of the pattern described is a sign of increased ventricular mass.     

Usefulness and limitations of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. A multicentre study.

BACKGROUND: Patients with left bundle branch block exhibit abnormal septal motion which may limit the interpretation of stress echocardiograms. This study sought to assess the diagnostic value of dobutamine-atropine stress echocardiography in left bundle branch block patients. METHODS AND RESULTS: Sixty-four left bundle branch block patients (mean age 59 years, 24 men) with suspected coronary artery disease underwent dobutamine-atropine stress echocardiography and coronary arteriography. Myocardial ischaemia was defined as new or worsening wall thickening abnormalities. Coronary artery disease was quantitatively defined as a diameter stenosis >/=50% in a major epicardial artery. Rest septal motion was normal (apart from the early systolic septal notch) in 34 patients (53%) and abnormal in 30 patients (47%). Rest septal thickening was normal in 32 patients (50%) and abnormal in 32 patients (50%). All seven patients with a QRS duration >/=160 ms and an abnormal QRS axis had abnormal rest septal motion and thickening. Inter-observer agreement for ischaemia was 88%. In all but one patient disagreement was in the septum. For the anterior and posterior circulation, respectively, sensitivity was 60% (9/15) and 67% (8/12), specificity was 94% (46/49) and 98% (51/52), and accuracy was 86% (55/64) and 92% (59/64). Sensitivity for the anterior circulation tended to be better in patients with normal rest septal thickening (83% vs 44%). CONCLUSIONS: Dobutamine-atropine stress echocardiography has excellent diagnostic specificity in left bundle branch block patients with suspected coronary artery disease. In patients with abnormal rest septal thickening, however, dobutamine-atropine stress echocardiography may lack good sensitivity for detection of coronary artery disease in the anterior circulation. Left bundle branch block patients who potentially most benefit from dobutamine-atropine stress echocardiography may initially be selected by their resting electrocardiogram.     

Relations between resting ventricular long axis function, the electrocardiogram, and myocardial perfusion imaging in syndrome X.

OBJECTIVE--To investigate interrelations between ventricular long axis function, resting electrocardiogram, and myocardial perfusion imaging in a group of patients with syndrome X in order to define possible underlying mechanisms. DESIGN--Prospective echocardiographic, electrocardiographic, and myocardial perfusion imaging. SETTING--A tertiary referral centre for cardiac diseases with invasive and non-invasive facilities. PATIENTS--50 consecutive patients with syndrome X selected on the basis of a history of angina, ST segment depression on exercise, and normal coronary arteriograms and 21 controls of similar age. RESULTS--Long axis motion of one or both ventricles assessed by echocardiography was abnormal in 37 patients. The onset of systolic shortening was delayed by > 130 ms (upper limit of normal 95% confidence interval) in eight patients, and was associated with prolonged shortening during the isovolumic relaxation period in seven (p < 0.01) (systolic abnormalities). The onset of diastolic lengthening was delayed by > 80 ms in 20. Early diastolic peak lengthening rate was < 4.5 cm.s-1 in 13 patients, and the relative amplitude of lengthening during atrial systole was > 45% in 18. On the resting electrocardiogram septal q waves were absent in 12 patients. This was associated with long axis systolic disturbances in seven patients (p < 0.05). T waves were abnormal in 10 and associated with delayed onset of early diastolic lengthening in all (p < 0.001). Late diastolic long axis disturbances were not associated with any consistent electrocardiographic abnormality. Myocardial perfusion imaging was abnormal in six of 33 patients, four of whom had systolic abnormalities (p < 0.03). Imaging was normal in the rest, but in 13 of them long axis function was abnormal in the left side and in four it was abnormal on the right ventricle. Both electrocardiography and imaging were normal in 10 patients. No patient with an abnormal electrocardiogram or myocardial perfusion had normal long axis motion on echocardiography. CONCLUSION--The function of the left and right ventricular long axes was abnormal in about 70% of a sample of patients with syndrome X. Systolic disturbances were consistently associated with absent septal q wave and abnormal myocardial perfusion imaging, while early diastolic disturbances correlated with T wave abnormalities. These associations suggest that the three different investigations detect related objective abnormalities in one or more subgroups of patients with syndrome X.