血浆Hcy与急性心肌梗死预后关系的临床研究

目的探讨血浆高同型半胱氨酸(Hcy)血症与急性心肌梗死(AM I)预后的关系。方法102例AM I患者分为高Hcy血症AM I组及Hcy正常AM I组,比较两组临床事件(泵衰竭、休克、心律失常、死亡)发生情况及梗死面积等。同时选择健康体检者25例为正常对照组,检测Hcy浓度并与AM I患者进行比较。结果AM I患者血浆Hcy浓度〔(28.29±5.14)μmol/L)〕明显高于正常对照组〔(10.66±2.75)μmol/L)〕(P<0.01);高Hcy AM I组梗死面积、病死率、心律失常、休克及泵衰竭发生率均高于Hcy正常AM I组(P<0.05);冠脉造影显示高Hcy血症与病变血管总数成正相关;多元回归分析表明高Hcy血症是强的心血管事件发生的预测因子(P<0.05)。结论高Hcy血症的AM I患者临床事件发生率明显增多,血管病变程度较Hcy正常者严重,高Hcy血症是AM I心血管事件发生的预测因子。     

急性心肌梗死早期二周康复的临床观察

目的：观察急性心肌梗死（ＡＭＩ）患早期康复活动对病情的影响。方法：对无并发症的急性心肌梗死病人在住院２４小时后,有并发症的ＡＭＩ病人在病情稳定后进行二周早期双步行为主。结果：程序结束时左室射血分数（ＬＶＥＦ）〉５０％康复组２６例（６７％）,对照组１４例（３７％）,两组差异显（Ｐ〈０．０５）;康复组心室晚电位阳性、ｌｏｗｎⅡ级以上室性心律失常、坠积性肺炎的发生率和平均住院天数均低于对照组,差异     

急诊冠状动脉腔内成形术与溶栓治疗急性心肌梗塞的临床分析

目的　探讨急诊冠状动脉腔内成形术 (PTCA)对急性心肌梗塞 (AMI)的临床疗效。方法　对 5 2例AMI患者行急诊PTCA治疗 (PTCA组 ) ,5 8例AMI患者行溶栓治疗 (溶栓组 ) ,比较两组住院和随诊期间的情况。结果　PTCA组住院期间死亡 3例 ,抢救成功率为 94 2 % ,平均住院天数为 14 6天(9 5± 4 2天 ) ,左室射血量数 (LVEF)为 45 5 %± 4 3% ;随诊 2～ 18个月 ,心绞痛发作 3例 ,择期再次PTCA 3例。溶栓组住院期间死亡 8例 ,抢救成功率为 86 2 % ,平均住院天数为 2 6 4天 (17 2± 7 5天 ) ,LVEF为 37 6 %± 6 2 % ;随诊 2～ 18个月 ,心绞痛发作 17例 ,行择期PTCA 17例。结论　急性心肌梗塞急诊PTCA可即时开通梗塞相关血管 (IRA) ,大大降低AMI的住院死亡率 (P <0 0 1) ,缩短住院天数 (P <0 0 1) ,有效保护心脏功能 (P <0 0 5 )。     

急性心肌梗死患者冠状动脉造影正常的临床分析

目的探讨急性心肌梗死(AMI)患者冠状动脉造影正常的发生率,并分析其临床特点.方法回顾分析了1987年5月至2001年5月869例AMI患者冠状动脉(冠脉)造影结果及有关冠心病的危险因素.结果869例AMI患者中冠脉造影正常者为67例,占7.7%.分析其临床特点,该组患者中以年龄较轻,多无心绞痛病史、高血压病史、糖尿病史及血脂异常,大量吸烟者居多为特征.结论AMI患者中,冠脉造影正常者并非少见,提示,冠脉痉挛在心肌梗死的发病中可能起着十分重要的作用;急性血栓形成伴血栓自溶亦是其病理改变之一.     

Serum ferritin-a novel risk factor in acute myocardial infarction

BackgroundA possible association between body iron status and risk of coronary heart disease (CHD) has been found to be controversial from the data obtained from various studies.ObjectivesTo study the relationship of serum ferritin with acute myocardial infarction (AMI) in univariate and multivariate analysis and to assess the relationship of high serum ferritin with established conventional risk factors.MethodsHospital based case-control study of 75 cases of AMI, and 75 age and equal number of age, and gender-matched controls without having AMI in the age group of 30–70 years.ResultsMedian serum ferritin levels were significantly higher in cases (220 μg/L) than controls (155 μg/L) (P ≤ 0.0001. In univariate analysis in addition to ferritin > 200 μg/L (odds ratio [OR] 6.71, 95% confidence interval [CI] = 3.22–12.89, P<0.05), diabetes (OR=7.68, 95% CI=2.95–19.13, P<0.05), hypertension (HTN) (OR=2.36, 95% CI=1.02–5.14, P<0.05) high-density lipoprotein (HDL) < 35 mg/dL (OR = 11.9, 95% CI = 2.66–52.57, P<0.05) and smoking (OR=2.17, 95% CI = 1.12–3.87, P< 0.05) were found to be significantly associated with AMI. After controlling for all conventional risk factors, in multiple logistic regression analysis, high ferritin was significantly associated with AMI. (adjusted OR=5.72, 95% CI=2.16–15.17, P < 0.001). Serum ferritin was significantly higher in diabetics than non-diabetics (P < 0.01).ConclusionHigh serum ferritin is strongly and independently associated with AMI.     

曲美他嗪对急性心肌梗死大鼠胶原的影响

目的 探讨曲美他嗪对急性心肌梗死(AMI)模型大鼠梗死区、非梗死区胶原蛋白分子表达的影响.方法 将结扎冠状动脉左前降支AMI鼠48只随机分成模型组、倍他乐克(琥珀酸美托洛尔)组(2 mg·kg-1·d-1)、曲美他嗪组(10 mg·kg-1·d-1).另设假手术组.同步药物干预8 w后,RT-PCR检测梗死区胶原-I mRNA.结果 与模型组比较,倍他乐克组、曲美他嗪组梗死区胶原-I mRNA表达均明显下调(P＜0.05);倍他乐克组与曲美他嗪组水平接近,差别不显著(P＞0.05).与模型组比较,倍他乐克组、曲美他嗪组非梗死区胶原-I mRNA表达均明显下调(P＜0.05);倍他乐克组与曲美他嗪组表达水平接近,差别不显著(P＞0.05).结论 曲美他嗪既能减少AMI大鼠梗死区胶原分子的合成又能减少非梗死区胶原分子的合成,可有效延缓整个心肌纤维化的进程.     

溶栓后介入治疗急性心肌梗死的临床观察

目的观察溶栓后冠状动脉介入治疗急性心肌梗死的疗效及安全性。方法将35例急性心肌梗死患者分为静脉溶栓后冠状动脉介入治疗组(A组)和直接冠脉介入治疗组(B组)。观察两组开始介入治疗时间、相关动脉血流分级、冠状动脉造影至球囊开通梗塞相关动脉时间、介入治疗时再灌注心律失常发生率、心肌梗死后心绞痛发生率、介入治疗前心功能分级、治疗后4周左心室射血分数及并发症。结果A组开始介入治疗时间较B组晚(6.63±0.93)hvs(5.28±0.67)h,P<0.05。A组冠状动脉造影时梗塞的相关动脉(TIMI)血流2～3级达55%,而B组为20%(P<0.05)。冠状动脉造影至球囊开通梗塞的相关动脉时间,在两组间无显著性差异(P>0.05)。A组再灌注心律失常发生率较B组低(P<0.05)。A组和B组心绞痛发生率无显著性差异(P>0.05)。介入治疗术后4周后左心室射血分数,在A组和B组间无明显性差异(P>0.05)。两组均无出血性并发症。结论急性心肌梗死后,如暂无条件进行急诊冠脉介入治疗的患者,尽早给予静脉溶栓;静脉溶栓后再行冠状动脉介入治疗急性心肌梗死仍是有效可行的。     

Association between red blood cell distribution width and in-hospital mortality in acute myocardial infarction

Previous studies have shown an independent association between increased red cell distribution width (RDW) and mortality after acute myocardial infarction (AMI). However, evidence regarding the predictive significance of repeated measures of RDW in patients with AMI remains scarce. We aimed to investigate the association between the dynamic profile of RDW and in-hospital mortality in patients with AMI.This was a cross-sectional study. We extracted clinical data from the Medical Information Mart for Intensive Care IIIV1.4 database. Demographic data, vital signs, laboratory test data, and comorbidities were collected from the database. The clinical endpoint was in-hospital mortality. Cox proportional hazards models were used to evaluate the prognostic values of basic RDW, and the Kaplan–Meier method was used to plot survival curves. Subgroup analyses were performed to measure mortality across various subgroups. The repeated-measures data were compared using a generalized additive mixed model.In total, 3101eligible patients were included. In multivariate analysis, adjusted for age, sex, and ethnicity, RDW was a significant risk predictor of in-hospital mortality. Furthermore, after adjusting for more confounding factors, RDW remained a significant predictor of in-hospital mortality (tertile 3 vs tertile 1: hazard ratio 2.3; 95% confidence interval 1.39–4.01; P for trend <.05). The Kaplan–Meier curve for tertiles of RDW indicated that survival rates were highest when RDW was ≤13.2% and lowest when RDW was ≥14.2% after adjustment for age, sex, and ethnicity. During the intensive care unit stay, the RDW of nonsurvivors progressively increased until death occurred.Our findings showed that a higher RDW was associated with an increased risk of in-hospital mortality in patients with AMI.     

急性心肌梗死患者血浆外泌体mRNA表达谱分析

目的 比较分析急性心肌梗死(AMI)患者和非心源性胸痛(NCCP)患者血浆外泌体中mRNA的表达差异,并探讨差异表达mRNA对AMI发生发展可能的影响。方法 入选北京朝阳医院和内蒙古包头市中心医院NCCP患者和AMI患者各15例。提取入选者血浆外泌体及外泌体总RNA,高通量测序技术检测AMI患者和NCCP患者血浆中外泌体信使RNA(mRNA)的表达谱,筛选出AMI患者中差异表达的mRNA。对差异表达mRNA进行基因本体(GO)分析和京都基因与基因组百科全书(KEGG)信号通路分析。结果 提取的外泌体为粒径在30~200 nm之间的双层膜小囊泡,表达外泌体标志分子分化簇63(CD63)和热休克蛋白70(HSP70),而不表达甘油醛-3-磷酸脱氢酶(GAPDH),符合外泌体的特征。对入选AMI患者和NCCP患者血浆外泌体中的mRNA表达量进行检测,AMI患者血浆中外泌体转录本数量为64 258条,NCCP患者血浆中外泌体转录本数量为64 374条。其中差异表达的mRNA共1 800条(上调951条,下调849条)。GO和KEGG分析表明上述差异表达的mRNA参与了AMI的生物学调节功能和通路。结论 AMI患者血浆外泌体中mRNA的表达水平与NCCP组比较存在明显的差异,这些差异表达的外泌体mRNA可能在AMI的发生发展过程中发挥重要的作用。     

血清微小RNA可能是急性心肌梗死的标志物

目的观察急性心肌梗死患者血清中微小RNA（miRNA）水平的变化。方法采用3＇端加多聚poly（A）尾的反转录后荧光定量PCR的方法测定17例急性心肌梗死患者和11例健康对照者血清中miR-1的水平,并测定其血清肌酸激酶（CK）、肌酸激酶同工酶MB（CK-MB）及心肌肌钙蛋白T（cTnT）水平。结果心梗组miR-1水平较对照组升高（P〈0.01）;心梗组患者血清miR-1较对照组均值升高的倍数与其血清CK-MB较对照组均值升高的倍数存在正相关关系（r=0.52,P〈0.05）。结论 miR-1有可能作为急性心肌梗死的标志物,miR-1水平升高的机制可能与心肌梗死灶周围的缺血组织释放增加有关。     

Increased plasma thioredoxin in patients with acute myocardial infarction

BACKGROUND AND HYPOTHESIS: Thioredoxin is an important biomarker for oxidative stress. We investigated whether thioredoxin levels were elevated in patients with acute myocardial infarction (AMI) and were associated with the results of coronary reperfusion. METHODS: The present study determined plasma thioredoxin levels in 51 patients with AMI, 30 patients with stable exertional angina (SEA), and 30 patients with chest pain syndrome (CPS). Plasma sampling was performed on admission, at 12 h, 1 week, 2 weeks, and 4 weeks in patients with AMI, and after admission in patients with SEA and CPS. RESULTS: Plasma thioredoxin levels on admission were higher in patients with AMI than in those with SEA and CPS. Plasma thioredoxin levels in patients with AMI were decreased in 12 h without further change thereafter. However, thioredoxin levels in patients with AMI remained higher than in those with SEA. In multivariate analysis, higher levels of thioredoxin on admission were a risk factor for failure in emergent reperfusion therapy in patients with AMI independent of other factors. CONCLUSION: Plasma thioredoxin levels are elevated in patients with AMI, and higher thioredoxin levels may predict subsequent failed coronary reperfusion therapy in patients with AMI.     

Effect of distal protection device on prognosis of acute myocardial infarction combined with emergency percutaneous coronary intervention

Background The no-reflow and slow blood flow in the process of PCI treatment may reduce its effectiveness and lead to expansion of infarct in size sometimes.Also the application of thrombolytic agent inside of coronary artery,platelet inhibitors GPⅡ/Ⅲ or direct thrombectomy can't improve short or long-term clinical outcomes,So we evaluated the safety and efficacy of distal protection device(GuardWire PlusTM)in the acute myocardial infarction(AMI)combined with percutaneous coronary intervention(PCI).Method S...     

老年急性心肌梗死住院期康复

目的:探讨老年急性心肌梗死(AMI)患者住院期康复治疗的疗效、安全性。方法:比较20例接受四周程序康复治疗的老年AMI患者和19例对照患者的临床疗效、安全性。结果:20例老年AMI患者康复治疗未发生并发症;出院3个月后能生活自理的有18例(90％),左室射血分数(LVEF)>50％的患者13例(65％),未发生心绞痛和再梗。对照组发生心绞痛3例,再梗死1例,心衰2例,心源性猝死1例;出院3个月后能生活自理的仅12例(63％),LVEF>50％的患者仅6例(32％)。康复组的临床疗效及心功能(LVEF)均显著好于对照组(P<0.05)。结论:老年急性心肌梗死康复治疗是安全、有效、可行的。     

急诊介入与溶栓治疗急性心肌梗死患者疗效对比分析

目的比较经皮冠状动脉介入治疗与静脉溶栓治疗急性心肌梗死的疗效。方法将60例急性心肌梗死患者随机分为介入组（30例）和静脉组（30例）,介入组采用对梗死相关动脉行经皮冠状动脉腔内成形术（PTCA）＋支架术治疗,静脉组按照中华心血管病杂志编辑委员会制定的溶栓方案进行治疗,比较两组患者ST回落情况、再通率、病死率、心血管事件发生率和心功能情况。结果介入组与静脉组比较,ST回落明显迅速,病死率、再通率、心血管事件发生率及心功能改善均明显优于静脉组。结论采取经皮冠状动脉介入治疗急性心肌梗死,能及时有效地开通梗死相关动脉,挽救濒死的心肌,改善心功能,降低病死率,可作为急性心肌梗死的首选治疗方法。     

急性心肌梗塞病人运动康复治疗的临床分析

目的 :了解康复运动对急性心肌梗塞后 2 8天病人的运动贮量及心脏功能的影响。方法 :将 2 0例急性心肌梗塞病人随机分为运动康复组与对照组 ,治疗组应用 Med Graphics心肺运动功能仪进行康复治疗 2 0次。对照组给予心肌梗塞常规治疗。结果 :治疗组峰值 V· O2 (耗氧量 )、 AT(无氧阈 )、 RPP(二项乘积 )值均较对照组明显升高。结论 :急性心肌梗塞后病人进行康复运动能提高其运动贮量和功能     

Beta-endorphins in acute myocardial infarction

The endogenous peptide B-endorphin (B-EP) is closely connected with different aspects of homeostasis, behavior, and in particular with the perception of pain. The purpose of this study was to investigate the correlation between: the level of plasma B-EP and the intensity of pain in acute myocardial infarction (AMI); and the B-EP and specific enzymes for AMI serum glutamic oxolo-acetic transferase, lactate dehydrogenase, and creatine phosphokinase and some stress hormones (cortisol, growth hormone). Twenty-six patients hospitalized in the CCU for acute MI were studied during the first 72 hours from the onset of symptoms. Seven normal subjects served as controls. Blood was taken for hormone and B-EP evaluation before treating the patients by opiates. Plasma B-EP levels were determined using the protocol of the Immunonuclear Corporation (Stillwater, MN). Statistical analysis of the results showed: Nonsignificant differences between B-EP levels of all MI patients and control group. Unaltered B-EP levels in patients with acute MI suffering from moderate pain. Significant differences in drop of B-EP in the group with most severe pain (p less than 0.025). A tendency toward decreased B-EP in patients suffering from more prolonged pain (greater than 6 hours). Significant negative correlation was shown between B-EP and chest pain intensity (0-4 graduation) (r = 0.8, p less than 0.01); lactate dehydrogenase (r = 0.7, p less than 0.01); serum glutamic oxolo-acetic transferase (r = 0.6, p less than 0.01); creatine phosphokinase (r = 0.6, p less than 0.05; plasma cortisol level (r = 0.5, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Incidence of systemic thromboembolic lesions in acute myocardial infarction

In a series of 1277 cases of acute myocardial infarction, 30 episodes of systemic, noncerebral, thromboembolic lesions in 22 patients have been detected. Locations most frequently involved were the extremities (60%), kidneys (16.6%), spleen (13.3%), and mesentery (10%). The incidence of thromboembolism has been higher in patients over the age of 60. In the great majority of cases, the myocardial infarction has been anterolateral, often with a superimposed pump failure. Mortality has been very high (54.5%), perhaps in relation to the advanced age of the patients and to the extension of the infarction. Embolism at the extremities has been well treated with Fogarty's catheter. Among patients whose postmortem examination has been performed a high incidence of ventricular aneurysm (3 of 7) and mural thrombosis (5 of 7) has resulted. In the cases of ventricular aneurysm, episodes of atrial fibrillation have always occurred.