不稳定型心绞痛118例临床演变及转归

目的：提高及加强临床对不稳定型心绞痛（ｕｎｓｔａｂｅｌ ａｎｇｉｎａ ｐｅｃｔｏｒｉｓ ＵＰ）的分型以及国内对ＡＰ的补充分型标准。结合冠心病（ＣＨＤ）心绞痛病人发病的临床特点，ＥＣＧ和心肌酶谱的动态观察，个别病例做冠脉造影（ＣＡＧ０而进行确诊。结果：１１８例ＵＡＰ中演变为ＡＭＩ５１例，达４３．２％，心脏性死亡２８例，死亡率达２２％，其中，冠心病猝死２３例，泵衰Ｖ级（急性左心衰＋心源性休克）５例，非心脏性死亡（脑出血）２例。结论：从ＵＡＰ的演变、转归而言，经过正确诊断和治疗可逆转而为稳定劳累型心绞痛（ＳＡＰ），否则可演变为ＡＭＩ或猝死，临床应高度重视，及时确诊进行有效治疗，大部分病人是可以挽救的。     

血清肿瘤标志物MG7Ag TAG72 CA19—9诊断胃癌的前瞻性对照研究

对胃癌单抗ＭＧ７所识别的胃癌新的相关抗原ＭＧ７Ａｇ、ＴＡＧ７２、ＣＡ１９－９（均为ＩＲＭＡ法）进行了前瞻性规范的诊断试验对照研究，评价ＭＧ７Ａｇ及其联合应用诊断胃癌的价值。结果：ＲＯＣ曲线法选择ＭＧ７Ａｇ界值为７．５ｋＵ／Ｌ。ＭＧ７Ａｇ、ＴＡＧ７２、ＣＡ１９－９诊断胃癌的敏感性分别为４８．８％、４５．３％、３８．５％，无显著性差别（Ｐ〉０．０５）；３者特异性分别为９２．８％、９１．６％、９２．８％     

高血压冠心病与高胰岛素血症之间关系的探讨

通过检测１１例高血压病（ＥＨ）、７例冠心病（ＣＡＤ）、８例对照组糖耐量前后胰岛素（ＩＳ）、Ｃ肽（ＣＰ）及其曲线下面积（ＡＵＣ）的变化，发现ＥＨ组与ＣＡＤ组空腹及服糖水后１、２、３小时血清ＩＳ、ＣＰ及其ＡＵＣ均高于对照组，服糖水后２小时值的差别具有高度显著性。还发现ＥＨ患者空腹血清ＩＳ水平与空腹甘油三脂水平呈正相关（ｒ＝０．６１，Ｐ＜０．０５）。提示ＥＨ及ＣＡＤ患者均可能有胰岛素抵抗（ＩＲ），且高胰岛素血症与脂质代谢异常有关。     

血清肿瘤标志物MG7AgTAG72CA19－9诊断胃癌的前瞻性对照研究

对胃癌单抗ＭＧ７所识别的胃癌新的相关抗原ＭＧ７Ａｓ、ＴＡＧ７２、ＣＡ１９．９（均为ＩＲＭＡ法）进行了前瞻性规范的诊断试验对照研究，评价ＭＧ７Ａｇ及其联合应用诊断胃癌的价值。结果：ＲＯＣ曲线法选择ＭＧ７Ａｇ界值为７．５ｋＵ／Ｌ。ＭＧ７Ａｇ、ＴＡＧ７２、ＣＡ１９－９诊断胃癌的敏感性分别为４８．８％、４５．３％、３８．５％，无显著性差别（Ｐ＞０．０５）；３者特异性分别为９２．８％、９１．６％、９２．８％（Ｐ＞０．０５）。ＭＧ７Ａｇ与ＴＡＧ７２，ＣＡ１９－９诊断Ⅲ、Ⅳ期胃癌的敏感性显著高于Ⅰ、Ⅱ期，其中ＭＧ７Ａｇ分别为６９．６％和２７．３％。ＭＧ７Ａｇ是一种有价值的胃癌标志物，与ＴＡＧ７２或（和）ＣＡ１９－９联合应用可显著提高诊断胃癌的敏感性。     

急性心肌梗塞和不稳定性心绞痛GMP—140和TXB2的动态变化

为了解急性心肌梗塞（ＡＭＩ）和不稳定性心绞痛（ＵＡ）患者体内血小板活化程度，用放射免疫分析法测定２０例ＡＭＩ、３０例ＵＡ病人和２０例健康人血小板α颗粒膜蛋白（ＧＭＰ１４０）与血浆血栓素Ｂ２（ＴＸＢ２）的浓度。结果：①ＡＭＩ患者起病１２小时ＧＭＰ１４０和ＴＸＢ２浓度即明显高于对照组（Ｐ＜００１），第４８小时达高峰（Ｐ＜０００１），ＧＭＰ１４０在第５天降至正常，ＴＸＢ２第７天时仍高于对照组（Ｐ＜００５）；②ＵＡ患者在心绞痛发作时ＧＭＰ１４０、ＴＸＢ２明显高于对照组（Ｐ＜００１），心绞痛缓解后３０分钟降至正常，其ＧＭＰ１４０、ＴＸＢ２的升高幅度和持续时间均小于ＡＭＩ患者。表明ＡＭＩ和ＵＡ患者体内血小板高度激活，ＡＭＩ较ＵＡ患者冠状动脉内有更强的促凝因素。     

急性心肌梗死致心脏破裂11例分析

急性心肌梗死（ＡＭＩ）致心脏破裂是十分严重的并发症,往往引起猝死。１９８７～１９９６年,我院ＣＣＵ病房共收治 ＡＭＩ１４５６例,住院期间死亡 １６８例（１１． ５％）,经开胸或心包穿刺证实为心脏破裂１１例（６．６％）,现将其临床和心电图特点分析如下。１临床资料１．１一般情况本组病例的病史、心电图及（或）血清酶变化均符合ＡＭＩ诊断标准,并经开胸或心包穿刺证实为心脏破裂。男５例,女６例;年龄６０～７９岁,平均６７．４±７．１岁。梗死部位：前壁５例,前壁、前间壁及下壁各１例,前壁、高侧壁２例,广泛前壁及…     

糖尿病和非糖尿病急性心肌梗死的梗死区延伸的观察

对本院近７年收入ＣＣＵ的３２０例心肌梗死（ＡＭＩ）患者进行了观察，按（１）ＣＫ－ＭＢ和（或）ＣＰＫ复升；（２）心电图ＳＴ段再次抬高及出现新的病理性Ｑ波或原有Ｑ波加深伴Ｒ波降低；（３）临床症状恶化等３项中２项作为梗死区延伸（ＩＥｘｔ）的临床诊断标准。糖尿病组５６例中共检出ＩＥｘｔ１７例（３０．３６％），无糖尿病组２６４例中检出ＩＥｘｔ２４例（９．１％），差异显著。糖尿病ＡＭＩ并发ＩＥｘｔ较多与其冠脉     

抵克立得治疗女性不稳定性心绞痛56例临床观察

不稳定性心绞痛（ＵＡＰ）是介于稳定性心绞痛和急性心肌梗塞（ＡＭＩ）之间的一组综合征，病情较重，极易发展为ＡＭＩ和猝死。本文通过对常规治疗（包括钙离子拮抗剂、硝酸酯类，β受体阻滞剂）效果不理想的５６例女性ＵＡＰ患者给予抵克立得口服，取得了良好的治疗效果，现报告如下。１　资料和方法１１　一般资料　抵克立得（化学名：盐酸噻氯匹定，杭州赛诺菲民生制药有限公司生产，２５０ｍｇ／片）治疗组５６例，年龄５０～６８岁，平均年龄５５３岁，初发劳力型心绞痛６例，恶化劳力型心绞痛２２例，静息型心绞痛６例，心肌梗塞…     

血清α－L－岩藻糖苷酶对原发性肝癌诊断价值的研究

本文报道了４７５例血清α－Ｌ－岩藻糖苷酶（ＡＦＵ）检测结果，其中５３例原发性肝癌（ＰＨＣ）病人的血清ＡＦＵ活性（３２３．４±１１２．５ｎｋａｔ／Ｌ）显著高于健康组（１０８．５±３５．９ｎｋａｔ／Ｌ）和其它各疾病组。以ＡＦＵ≥２１６ｎｋａｔ／Ｌ（健康组的＋３ｓ）为阳性界值，对ＰＨＣ的诊断敏感性和特异性分别达８４．９％和８９．４％，诊断效率达８８．８％；对ＡＦＰ（－）的ＰＨＣ病人的阳性率为８４．２％；与ＡＦＰ联合检测对ＰＨＣ总的阳性率达９４．３％。表明：血清ＡＦＵ的检测对ＰＨＣ的诊断和疗效是一项十分有用的观察指标。     

电子束CT检出冠状动脉钙化及其与心肌灌注显像的对比研究

目的比较电子束ＣＴ（ＥＢＣＴ）检查冠状动脉钙化（ＣＡＣ）及核素心肌灌注显像（ＭＰＩ）评价冠心病（ＣＨＤ）的价值。材料与方法本组５０例均为临床疑诊或确诊为ＣＨＤ患者。所有患者均行ＥＢＣＴ、ＭＰＩ及冠状动脉造影。结果４０例患者共８４支血管冠状动脉造影证实有明显的冠状动脉病变（ＣＡＤ）（狭窄＞５０％），其中１４例为单支病变，８例为双支病变，１８例为三支病变，另有１０例冠状动脉造影正常。ＥＢＣＴ预测ＣＡＤ的敏感性、特异性及准确性为８３％、８０％及８２％，ＭＰＩ预测ＣＡＤ的敏感性、特异性及准确性分别为８５％、８０％及８４％，ＥＢＣＴ与ＭＰＩ的结果间无显著性差异（Ｐ＞０．０５）。ＣＡＣ血管供血区出现心肌缺血者达６５％。结论ＣＡＣ是预测ＣＡＤ的有价值指标。在有症状的人群中ＥＢＣＴ检出ＣＡＣ预测ＣＡＤ的敏感性、特异性及准确性与ＭＰＩ相似。有症状人群中检出ＣＡＣ患者多有心肌缺血或梗死，因此为早期诊断冠心病，应对无症状人群进行筛选。     

急诊院前猝死事件的发生特点分析

了解院前猝死事件的发生规律,以便更好地对于院前猝死事件、特别是心源性猝死进行有效的求治,降低病死率。系统分析解放军总医院近20年来院前急诊救治病例1030例,其中院前发生猝死106例。结果显示,猝死高发年龄段有两个：一个为66－75岁年龄段（为27.3%),另一为46－55岁年龄（非退休 年龄,为22.6%)。既往有明确心血管病史的病例68例 （占64.2%),不明原因23例（占21.6%),其他原因15例（占14.2%) 。引发猝死的直接原因为;室速、室颤（构成比55.0%)、心源性休克（16.7%)。院前猝死事件,是目前需要院前急诊救治主要的急危重症之一,而其中以急性心血管事件所致猝死的救治原则更为重要。对于已有心血管病基础的患者应注意其发生猝死的高度危险性,同时应高度注意低年龄组人群也有相当比例的猝死的事件的发生。     

直接经皮冠脉成形术治疗急性心肌梗死住院死亡原因探讨

目的　探讨直接经皮冠脉成形术 (PCI)治疗心肌梗死 (AMI)住院期间死亡原因。方法　按入选标准对连续入院的 2 35例AMI患者行直接PCI,记录住院期间病死率、死亡原因及相关因素。结果　 15例患者住院期间死亡 ,住院总病死率为 6 .4 % ,心脏性病死率为 6 .0 %。直接死亡原因包括心脏破裂 5例 (33.3% ) ,室颤 5例 (33.3% ) ,泵衰竭 4例 (2 6 .7% ) ,脑卒中死亡 1例 (6 .7% )。心脏破裂患者中继发于再次心肌梗死者 1例。所有室颤患者均为继发性 ,继发于再次心肌梗死的室颤 2例 ,继发于不稳定性心绞痛 2例 ,继发于左室衰竭 1例 ;1例为迟发性室颤 (PCI后 2周 )。泵衰竭患者中 ,心源性休克 3例 ,左室衰竭 1例。结论　直接PCI治疗AMI患者住院期间病死率为 6 .4 % ,心脏破裂、室颤和泵衰竭是主要的死亡原因 ,术后严重心肌缺血和心力衰竭是重要诱因     

Sudden adult death: An autopsy series of 534 cases with gender and control comparison

The aim of our study was to highlight the epidemiological difference in adult sudden death between males and females. The type of pathologies found in adult victims of sudden death was compared to control cases in order to determine the most significant pathologies involved in sudden death.Among all autopsies performed between 1995 and 2009, 534 adult cases of sudden death and 154 cases who violently died were respectively selected. For each case, a complete autopsy was carried out, including systematic histological examination of all major organs.The sudden death population was composed of 369 males and 165 females. There was no statistical difference regarding age between males and female. Sudden death took place more often at home in women than in men (p < 0.0001). A stressful event was more frequently found in men than in women (p = 0.03). Deaths caused by cardiovascular diseases were more frequent in males than in females, especially Coronary Artery Disease (CAD) (p < 0.0001). Cardiomyopathy was more often the cause of death in women, particularly Arrythmogenic Right Ventricular Cardiomyopathy (ARVC). Cardiac pathologies were found in 45% of the control cases. CAD and ARVC were statistically more frequent in the sudden death group than in the control group.According to our study, profile of sudden death is different between males and females. Those data seem to be important for clinicians involved in prevention programs of sudden death, as they can adapt their screening according to the gender.     

Cardiopulmonary resuscitation does not cause left ventricular rupture of the heart with acute myocardial infarction: a pathological analysis of 77 autopsy cases

Cardiac rupture during acute myocardial infarction (AMI) is one of the most frequent causes of sudden cardiac death. However, some reports have indicated the possibility that the cardiac rupture during AMI may occur by external cardiac massage. We pathologically examined the hearts of 77 patients who died suddenly due to ventricular free wall rupture during AMI (51 men and 26 women; aged 47-94 years; mean age: 69.9 years). We divided the cases into two groups, 44 cases with and 33 cases without cardiopulmonary resuscitation (CPR), and compared the two groups with respect to 12 pathological items. There were no statistical differences in any of the investigated items between the two groups (P>0.05). In addition, mural thrombi were identified along the rupture tract in all cases. Moreover, they were more matured at the subendocardial zone than at the subepicardial or middle zone, irrespective of the groups. From the pathological findings, we concluded that the rupture of the left ventricle during AMI originates from the subendocardial region and precedes the external cardiac massage. Our present study strongly suggests that CPR does not cause the left ventricular rupture of the heart during AMI.     

Sudden unexpected death in epilepsy in childhood

Sudden unexpected death in epilepsy (SUDEP) is the most feared complication of a seizure disorder. It has been less studied in childhood, probably because the incidence of sudden death is higher in adults than in children. SUDEP occurs more commonly in children where there is an underlying neuropathological disorder and a high rate of seizure. The literature reports rates of SUDEP in childhood between 1.1 and 4.3/10,000 patient years. Children with what has been called idiopathic epilepsy have an incidence of sudden death that is similar to the general population. Many children have a witnessed seizure before death, but in other witnessed deaths no seizure was identified. Cardiac arrhythmias and central apnea have been proposed as mechanisms of sudden death in SUDEP. At autopsy, apart from the underlying neuropathological disorder, there may be evidence of seizure activity in the form of bite marks and a voided bladder, though often the autopsy will prove negative. These autopsies remain challenging for the pathologist because acute findings are often absent. Before a diagnosis of SUDEP is made, a full knowledge of the history and scene information is required, as well as autopsy and ancillary investigation information.     

Postmortem cardiac troponin I and creatine kinase MB levels in the blood and pericardial fluid as markers of myocardial damage in medicolegal autopsy

The present study investigated cardiac troponin I (cTnI) and creatine kinase MB (CK-MB) in the blood and pericardial fluid from medicolegal autopsy cases (n=234, within 48h postmortem) with regard to the cause of death. The cTnI and CK-MB levels in cardiac, peripheral blood and pericardial fluid generally showed a mild and gradual postmortem time-dependent elevation (r=0.231-0.449, P<0.05-0.001). However, postmortem elevation of cTnI was larger for specific causes of death including acute myocardial infarction (AMI), cerebrovascular diseases (CVD), hyperthermia, fatal methamphetamine (MA) abuse and carbon monoxide (CO) intoxication and insignificant for recurrent myocardial infarction (RMI), chronic congestive heart diseases (CHD) and drowning, while that of CK-MB was greater for CO intoxication and insignificant for drowning. Cardiac blood and pericardial cTnI levels were relatively high for AMI, RMI, hyperthermia, MA abuse and CO intoxication, and was low for drowning. Elevated CK-MB level was observed for cardiac blood in asphyxiation and MA abuse cases and for peripheral blood in hyperthermia and MA abuse cases. When the cTnI/CK-MB ratio was estimated, it was independent of postmortem time, and the ratios for cardiac blood and pericardial fluid were significantly higher in cases of AMI, RMI, hyperthermia and CO intoxication but lower in cases of drowning. Elevations of cTnI levels in cardiac blood and pericardial fluid were related to the morphological severity of myocardial damage. These findings suggest that elevated cTnI and CK-MB levels in blood and pericardial fluid are related to ischemic, hypoxic and/or cytotoxic myocardial damage, which are characteristic of the cause of death, although the levels increase after death depending on myocardial damage at the time of death.     

Risk factors of sudden cardiac death in women: A 10 years study in Tunisia

BackgroundSudden cardiac death (SCD) represents a frequent etiology of sudden death. It represents a major public health issue. Few data about SCD in women are available from the Arab world. Our work aimed to analyze the risk factors of sudden cardiac death in Tunisian women in comparison with men.MethodsA cross-sectional retrospective study including all sudden cardiac death cases, conducted in the Forensic Medicine Department of the main teaching hospital of Tunis, between January 2010 and December 2019.ResultsWe counted 417 cases of sudden cardiac death in women representing 17.5% of the total number of sudden cardiac deaths recorded during the study period. The average age was 60.03 ± 15.01 years with a predominance of urban married women. The most frequent cardiac risk factors were high blood pressure (50%), diabetes (36.2%), and cardiac disease history (34.2%). Predominately married women with a history of High blood pressure and diabetes, had a high predictive of sudden cardiac death.ConclusionCardiac sudden death is no longer a male focused issue. As a matter of facts Rates of SCD in women are rising with a different pattern. We will highlight the importance of adopting specific preventive measures of SCD in female.     

Early isonitrile SPECT in acute myocardial infarction: feasibility and results before and after fibrinolysis

Early 99Tcm-labelled methoxy-isobutyl-isonitrile (MIBI) SPECT was performed in 14 patients with suspected acute myocardial infarction (AMI). The radiopharmaceutical was administered immediately upon admission to the intensive care unit and before any diagnostic confirmation. Then, if decided, thrombolytic therapy was started. Cardiac imaging was performed 1 h later, and as there is no significant re-distribution, the pictures still showed the pre-treatment MIBI uptake. In three cases acute myocardial infarction was not confirmed. For one of them, the result was normal and this patient was ultimately considered to have had a transient ischaemic event. The two other cases had acute chest pain with a previous history of myocardial infarction (MI) and a pathological MIBI SPECT. In the 11 cases with confirmed first AMI significant perfusion defect was seen. For every patient a new MIBI injection with a control SPECT was repeated 72 h after admission. Eight patients were seen 1 h 15 min to 3 h 15 min after the onset of chest pain and had thrombolytic therapy. Defects were always in agreement with coronary angiography and 2D echocardiography performed in the same period. After thrombolysis, control SPECT showed no recovery in three cases, partial recovery in four, and nearly complete recovery in one. Using this technique, it was then possible to get high quality myocardial perfusion imaging without delaying treatment of AMI. This preliminary series suggests that MIBI SPECT may be useful in accurately showing the size and location of the immediate perfusion defect, and in assessing the response to emergency therapy of AMI, especially thrombolysis.     

Sudden death in a teaching hospital of the Wuxi area: a retrospective autopsy study

Sudden death (SD) has a great impact on the medical community and on society in general. The aim of this study was to investigate the autopsy causes and associated pathological characteristics of SD in a teaching hospital of the Wuxi area and to discuss suitable methods for diagnosis and prophylaxis. In this retrospective study, data were collected from 134 SD patients. Ancillary studies covering histology and toxicology were also performed and analysed for the presence of risk factors. The subjects included 94 men and 40 women (M:F ratio = 2.35:1; P < 0.05). The peak age was 20–39?years, accounting for 32.1% (43 cases) of the total number of cases. The most common cause of SD in all cases was cardiovascular disease (n = 79, 59.0%). Cases in which coronary atherosclerotic heart disease was the prime culprit were named sudden cardiac death (SCD). Other causes of death included respiratory disease, neurological disease, and other diseases. Sudden death causes are numerous. This study aims to help prevent SD and to improve the processes of diagnosis and prevention. The results of completely accurate autopsies are necessary, in order to encourage epidemiological and preventive studies on sudden death.     

GRACE评分对急性心肌梗死患者主要心脑血管不良事件与出血事件预测价值

目的研究GRACE评分对急性心肌梗死(AMI)患者1年内主要心脑血管不良事件(MACCE)与出血事件的预测价值。方法回顾性分析2009-2013年收治的6 787例AMI患者的临床资料,应用GRACE评分将患者分为低危组(评分≤88分)、中危组(89~118分)及高危组(评分>118分)。随访患者1年,记录1年内MACCE[包括全因死亡、心肌梗死、缺血性卒中及靶血管血运重建(TVR)]与出血事件发生情况,应用生存曲线计算累积发生风险,评价GRACE评分对AMI患者MACCE与出血事件的预测价值。结果 1年内发生MACCE 361例(5.32%),其中,全因死亡167例(2.46%)、心肌梗死65例(0.96%)、TVR 105例(1.55%)及缺血性卒中24例(0.35%);发生出血事件91例(1.34%)。单支与三支病变、全因死亡与心肌梗死的发生概率随着GRACE评分的增加而显著增加,差异有统计学意义(P<0.05)。MACCE与出血事件的累积发生风险随着GRACE评分的增加而显著增加,差异有统计学意义(P<0.05)。结论 GRACE评分对AMI患者出院后1年内MACCE具有较高的预测价值,对出血事件也具有一定的预测价值。