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1.
Ryu DR Park JT Chung JH Song EM Roh SH Lee JM An HR Yu M Pyun WB Shin GJ Kim SJ Kang DH Choi KB 《Yonsei medical journal》2011,52(4):595-602
Purpose
Cardiac troponin T (cTnT), a useful marker for diagnosing acute myocardial infarction (AMI) in the general population, is significantly higher than the usual cut-off value in many end-stage renal disease (ESRD) patients without clinically apparent evidence of AMI. The aim of this study was to evaluate the clinical usefulness of cTnT in ESRD patients with acute coronary syndrome (ACS).Materials and Methods
Two hundred eighty-four ESRD patients with ACS were enrolled between March 2002 and February 2008. These patients were followed until death or June 2009. Medical records were reviewed retrospectively. The cut-off value of cTnT for AMI was evaluated using a receiver operating characteristic (ROC) curve. We calculated Kaplan-Meier survival curves, and potential outcome predictors were determined by Cox proportional hazard analysis.Results
AMIs were diagnosed in 40 patients (14.1%). The area under the curve was 0.98 in the ROC curve (p<0.001; 95% CI, 0.95-1.00). The summation of sensitivity and specificity was highest at the initial cTnT value of 0.35 ng/mL (sensitivity, 0.95; specificity, 0.97). Survival analysis showed a statistically significant difference in all-cause and cardiovascular mortalities for the group with an initial cTnT ≥0.35 ng/mL compared to the other groups. Initial serum cTnT concentration was an independent predictor for mortality.Conclusion
Because ESRD patients with an initial cTnT concentration ≥0.35 ng/mL have a poor prognosis, it is suggested that urgent diagnosis and treatment be indicated in dialysis patients with ACS when the initial cTnT levels are ≥0.35 ng/mL. 相似文献2.
目的 分析老年慢性肾脏病基础上急性肾损伤(A/C)的基础疾病、发病诱因及影响预后的危险因素.方法 回顾性分析2005年12月至2009年12月于本院住院治疗的65例老年A/C患者的临床资料,分析A/C患者的基础疾病、发病诱因及影响预后的危险因素.根据治疗后肾功能恢复情况将患者分为2组:肾功能恢复患者和肾功能部分恢复患者合并为肾功能恢复组,肾功能未恢复患者与死亡患者合并为肾功能未恢复组,比较两组患者的少尿持续时间、入院时血清白蛋白水平和最高血清肌酐(Scr)水平.结果 糖尿病肾病是老年A/C患者的主要基础疾病(38.5%,25/65),药物因素(30.8%,20/65)和严重感染(27.7%,l8/65)是老年A/C患者的主要发病诱因.与肾功能恢复组比较,肾功能未恢复组患者少尿持续时间较长[(1 1.5±3.4)d比(4.2±1.8)d,P<0.05]、入院时血清白蛋白水平较低[(23.6±3.1)g/L比(26.6± 4.5) g/L,P<0.05],而最高Scr水平较高[(601.2± 142.7) μmol/L比(421.3±107.3) μmol/L,P<0.05].结论 老年A/C患者应对其基础疾病进行有效治疗,积极消除发痫诱因和控制影响预后的危险因素. 相似文献
3.
目的: 了解急性冠脉综合征患者炎性指标pentraxin-3与血栓指标纤维蛋白原(FIB)的变化。方法: 回顾性研究35例急性心肌梗死患者、27例不稳定心绞痛患者及15例健康体检者,所有研究对象清晨空腹抽血,检测其血浆pentraxin-3、FIB水平,并进行比较。结果: 急性冠脉综合征患者血pentraxin-3、FIB水平明显高于健康体检者,差异显著(P<0.01);急性心肌梗死组高于不稳定性心绞痛组,差异显著(P<0.05)。Pentraxin-3浓度与FIB浓度之间存在正相关关系(P<0.01)。结论: 作为炎性指标pentraxin-3与血栓指标纤维蛋白与冠心病发生急性冠脉综合征相关,且两者相辅相成,可能共同促进急性冠脉综合征的发生。 相似文献
4.
《Transfusion Clinique et Biologique》2022,29(2):129-133
IntroductionAcute coronary syndrome is a manifestation of coronary artery disease caused by decreased blood flow to the heart musculature resulting in ischaemia and infarction of the heart. The Lewis (Le) blood group system comprise mainly Lewis a & b antigens which are secreted in plasma and are expressed on red cells, platelets and endothelium. This study assesses the risk of multivessel disease in acute coronary patients with lewis negative (a? b?) phenotype.Materials and methodsThe study included 183 patients diagnosed with acute coronary syndrome and who underwent coronary angiography to detect stenosis of the coronary vessels. The severity of the disease was classified based upon the number of vessels stenosed and their blood sample was phenotyped for Lewis antigens. The patients’ risk factors, GRACE score and management were included for the study and multivariate logistic regression was carried out for analysis.ResultsThe prevalence of Lewis (a? b?) was 27.4% and there was a significant association with multivessel disease (P < 0.05). However, there was no association of lewis (a? b?) with any of the risk factors causing coronary disease. The adjusted odds ratio of triple vessel disease in lewis (a? b?) was 2.6, female gender was 0.6 and patients with diabetes mellitus was 3.1, respectively. The GRACE score showed a significant association with ABO blood group (P < 0.05) but not with lewis (a? b?).DiscussionLewis negative patients are more likely to develop triple vessel disease compared to other lewis blood groups. This warrants further studies to investigate the link between lewis system and atherothrombosis. 相似文献
5.
《Turkish Journal of Medical Sciences》2021,51(3):947
Background/aim Hospital-acquired acute kidney injury (HA-AKI) may commonly develop in Covid-19 patients and is expected to have higher mortality. There is little comparative data investigating the effect of HA-AKI on mortality of chronic kidney disease (CKD) patients and a control group of general population suffering from Covid-19.Materials and methodsHA-AKI development was assessed in a group of stage 3–5 CKD patients and control group without CKD among adult patients hospitalized for Covid-19. The role of AKI development on the outcome (in-hospital mortality and admission to the intensive care unit [ICU]) of patients with and without CKD was compared.Results Among 621 hospitalized patients (age 60 [IQR: 47–73]), women: 44.1%), AKI developed in 32.5% of the patients, as stage 1 in 84.2%, stage 2 in 8.4%, and stage 3 in 7.4%. AKI developed in 48.0 % of CKD patients, whereas it developed in 17.6% of patients without CKD. CKD patients with HA-AKI had the highest mortality rate of 41.1% compared to 14.3% of patients with HA-AKI but no CKD (p < 0.001). However, patients with AKI+non-CKD had similar rates of ICU admission, mechanical ventilation, and death rate to patients with CKD without AKI. Adjusted mortality risks of the AKI+non-CKD group (HR: 9.0, 95% CI: 1.9–44.2) and AKI+CKD group (HR: 7.9, 95% CI: 1.9–33.3) were significantly higher than that of the non-AKI+non-CKD group.ConclusionAKI frequently develops in hospitalized patients due to Covid-19 and is associated with high mortality. HA-AKI has worse outcomes whether it develops in patients with or without CKD, but the worst outcome was seen in AKI+CKD patients. 相似文献
6.
Sarah Jamil Gohar Jamil Hanaa Mesameh Anwer Qureshi Juma AlKaabi Charu Sharma Faisal Aziz Ali Rashed Al-Shamsi Javed Yasin 《International journal of medical sciences》2021,18(15):3526
Background: Acute myocardial infarction is a relatively rare phenomenon in the young population. The incidence has nevertheless increased from years past, likely due to the presence of multiple risk factors from an increasingly younger age. Regardless of whether they have atherosclerotic coronary artery disease or normal coronary angiogram, young patients with risk factors for coronary artery disease (CAD), chest pain, and positive troponin, are initially treated in a similar fashion. Our goal was to shed light on whether risk factors between these two groups differ to help guide physicians in clinically determining whether or not an atherosclerotic cardiovascular event has occurred, as well as to potentially identify young patients at risk of acute coronary syndrome (ACS) despite normal coronary arteries.Methods: A retrospective cross sectional study was undertaken over an 8 year period at Tawam Hospital. 576 patients aged 50 or under who underwent coronary angiography were selected for the study. Medical records were analyzed for the patient''s demographics and CAD risk factor profile, including the following variables: family history of CAD, smoking status, Body Mass Index category, lipid profile, and diagnosis of hyperlipidemia, diabetes, or hypertension. Details of the coronary angiogram were also reviewed.Results: Statistically significant outcomes included a higher prevalence of diabetes, hyperlipidemia, and smoking history in patients with CAD compared to the patients with normal coronary angiogram. Diabetes was one of the strongest risk factors in CAD patients, with an odds ratio of 1.98 (p= 0.011), followed by hyperlipidemia at 1.85 (p= 0.021). Smoking history had an odds ratio of 2.93 (p <0.001).Conclusion: Risk factors were present in both groups, but significantly more in the CAD group. No particular risk factor stood out for the development of ACS in those with normal coronary arteries, other than mean BMI being slightly higher in this group. Based on our analysis, no single variable can accurately predict the risk for ACS in normal coronaries. To our knowledge, few studies have been done in the young population with angiographically normal coronary arteries to determine possible risk factors for development of ACS. Further research needs to be done to determine whether the risk factors that were common amongst both groups are coincidental, or a cause of ACS in those with normal coronary arteries. 相似文献
7.
8.
Yildiz Oner-Iyidogan Pernur Oner Hikmet Kocak Figen Gurdol Seldag Bekpinar Yesim Unlucerci Yasar Caliskan Pinar Cetinalp-Demircan Taner Kocak Aydin Turkmen 《Clinical and experimental medicine》2009,9(3):235-241
The aim of this study was to investigate the pro-oxidant and proinflammatory biomarkers and their relationship with dimethylarginines
(DMAs) in patients at various stages of chronic kidney disease (CKD). We studied 114 CKD patients, 36 were hemodialyzed, 41
peritoneal dialyzed and 37 nondialyzed (early stage) CKD patients. The control group consisted of 31 healthy subjects. Plasma
levels of asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), l-arginine, nitric oxide (NO) and proinflammatory cytokines (TNF-alpha and IL-6) were determined, and their relationships with
the degree of disease were evaluated. Both DMAs were at high levels in all CKD patients, whereas arginine concentrations were
low in patients undergoing dialysis. Elevated TNF-α and IL-6 in CKD patients were indicative of ongoing chronic inflammatory
state. A significant positive correlation between SDMA and creatinine suggests that plasma SDMA level may be an index for
renal function. 相似文献
9.
Li Zhu Yigang Yin Ruifang Zhou Jie Lin Jianming Li Jun Ye 《International journal of clinical and experimental pathology》2015,8(6):7266-7271
Objective: To explore the changes of peripheral blood monocytes subsets in acute coronary syndrome (ACS) and its clinical significance. Methods: A total of 68 ACS patients and 27 healthy subjects (HS) were enrolled. Monocyte subset analysis was performed using flow cytometry: CD14++CD16-(Mon1), CD14++CD16+ (Mon2), and CD14+CD16++ (Mon3). Results: 1. The number of Mon1 and Mon3 were significantly increased in ACS patients compared with HS (P<0.05) and Mon2 decreased in ACS patients (P<0.05). 2. The number of Mon1, Mon2, Mon3 was positively correlated with WBC count (P<0.05). The Mon2% was negatively correlated with the serum levels of LDH, CK, CK-MB (P<0.05). The number of Mon1, Mon3 was positively correlated with the serum levels of LDH, CK, CK-MB (P<0.05). Conclusion: The changes in different subsets of monocytes may be associated with pathogenesis of ACS and myocardial injury. The findings might be useful in the assessment of myocardial injury. 相似文献
10.
目的:应用可视化血液流变性检测仪(MC-FAN)并结合血小板功能指标的检测,观察急性冠脉综合征(ACS)介入术后患者血液流变性的变化特点,并探讨患者血液流变性可视化结果与血小板功能指标的相关性。方法:纳入74例ACS介入术后1~3年的患者,21例健康者为健康对照组,应用MC-FAN检测2组人群的血液通过模拟人体毛细血管的时间(MC-FAN TT)和比较不同时段的结果,同时检测血小板聚集性、血小板黏附性、血小板P-选择素、血小板衍生生长因子BB和血管假性血友病因子指标,观察ACS介入术后患者的MC-FAN 结果与血小板功能的相关性。结果:与健康对照组相比,ACS介入术后患者的血流MC-FAN TT延长(P<0.01),红细胞变形能力减弱,白细胞附壁及血小板的黏附、聚集相对增多;ACS介入术后患者的血小板最大聚集率、血小板黏附率、血小板P-选择素水平及血小板衍生生长因子BB水平均高于健康对照组(P<0.01);2组间血管假性血友病因子差异无统计学意义(P>0.05)。组内相关性分析显示:MC-FAN TT与血小板功能存在相关性,其中10 μL MC-FAN TT和30 μL MC-FAN TT与P-选择素呈正相关(r=0.601,P<0.01;r=0.334,P<0.01);60 μL MC-FAN TT与血小板最大聚集率呈正相关(r=0.527,P<0.01);100 μL MC-FAN TT与血小板黏附率呈正相关(r=0.815,P<005)。结论:ACS介入术后患者的可视化血液流变性及血小板功能异常,MC-FAN TT与血小板功能存在相关性,MC-FAN检测仪可客观地评价介入术后患者血液流动的状态。 相似文献
11.
12.
Meili Zheng Ruijuan Han Wen Yuan Hongjie Chi Yeping Zhang Kai Sun Jiuchang Zhong Xiaoyan Liu Xinchun Yang 《Archives of Medical Science》2023,19(1):46
IntroductionThe concept of chronic coronary syndrome (CCS) was first presented at the European Society of Cardiology Meeting in 2019. However, the roles of exosomal lncRNAs in CCS remain largely unclear.Material and methodsA case-control study was performed with a total of 218 participants (137 males and 81 females), including 15 CCS patients and 15 controls for sequencing profiles, 20 CCS patients and 20 controls for the first validation, and 100 CCS patients and 48 controls for the second validation. Exosomes were isolated from the plasma of CCS patients and controls, and exosomal lncRNAs were identified by sequencing profiles and verified twice by qRT-PCR analysis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic value of exosomal lncRNAs for CCS patients.ResultsA total of 152 significantly differentially expressed lncRNAs with over two-fold changes were detected in plasma exosomes of CCS patients, including 90 upregulated and 62 downregulated lncRNAs. Importantly, 6 upregulated lncRNAs with the top fold changes were selected for validations. Exosomal lncRNAs ENST00000424615.2 and ENST00000560769.1 were significantly elevated in CCS patients in both validations compared with controls. The areas under the ROC of lncRNAs ENST00000424615.2 and ENST00000560769.1 were 0.654 and 0.722, respectively. Additionally, exosomal lncRNA ENST00000560769.1 was significantly higher in the CCS patients with more diseased vessels (p = 0.028).ConclusionsExosomal lncRNA ENST00000424615.2 and ENST00000560769.1 were identified as novel diagnosis biomarkers for patients with CCS. Moreover, exosomal lncRNA ENST00000560769.1 was significantly higher in the CCS patients with more diseased vessels, and might be associated with a poor prognosis. 相似文献
13.
Cruz MC Andrade C Urrutia M Draibe S Nogueira-Martins LA Sesso Rde C 《Clinics (S?o Paulo, Brazil)》2011,66(6):991-995
AIM:
To compare the dimensions of quality of life in the stages of chronic kidney disease and the influence of sociodemographic, clinical and laboratory data.INTRODUCTION:
The information available on the quality of life of patients on conservative treatment and the relationship between the quality of life and glomerular filtration rate is limited.METHODS:
155 patients in stages 1–5 of chronic kidney disease and 36 in hemodialysis were studied. Quality of life was rated by the Medical Outcomes Study Short Form 36-Item (SF-36) and functional status by the Karnofsky Performance Scale. Clinical, laboratory and sociodemographic variables were investigated.RESULTS:
Quality of life decreased in all stages of kidney disease. A reduction in physical functioning, physical role functioning and in the physical component summary was observed progressively in the different stages of kidney disease. Individuals with higher educational level who were professionally active displayed higher physical component summary values, whereas men and those with a higher income presented better mental component summary values. Older patients performed worse on the physical component summary and better on the mental component summary. Hemoglobin levels correlated with higher physical component summary values and the Karnofsky scale. Three or more comorbidities had an impact on the physical dimension.CONCLUSION:
Quality of life is decreased in renal patients in the early stages of disease. No association was detected between the stages of the disease and the quality of life. It was possible to establish sociodemographic, clinical and laboratory risk factors for a worse quality of life in this population. 相似文献14.
BackgroundFrailty has been identified as a risk factor for mortality in patients with acute coronary syndrome (ACS). This meta-analysis aimed to evaluate the association between frailty and all-cause mortality outcome in patients with ACS.MethodsPubmed and Embase databases were searched up to September 26, 2018 for the observational studies evaluating the association between frailty and all-cause mortality in elderly ACS patients. Outcome measures were in-hospital death, short-term all-cause mortality (≤6 months),and long-term all-cause mortality (≥12 months).The impact of frailty on all-cause mortality was summarized as hazard ratios (HR) with 95% confidence intervals (CI) for the frail versus nonfrail patients.ResultsA total of 9 cohort studies involving 2475 elderly ACS patients were included. Meta-analysis showed that ACS patients with frailty had an increased risk of in-hospital death (HR 5.49; 95% CI 2.19–13.77), short-term all-cause mortality (HR 3.56; 95% CI 1.96–6.48), and long-term all-cause mortality (HR 2.44; 95% CI 1.92–3.12) after adjustment for confounding factors. In addition, prefrailty was also associated with an increased all-cause mortality (HR 1.65; 95% CI 1.01–2.69).ConclusionsThis meta-analysis demonstrates that frailty independently predicts all-cause mortality in elderly ACS patients. Elderly ACS patients should be assessed the frailty status for improving risk stratification. 相似文献
15.
目的:探讨急性冠脉综合征(ACS)患者外周血辅助性T淋巴(Th)细胞亚群1和亚群2(TH1/Th2)的变化及意义。方法:64例ACS患者(其中急性心肌梗死(AMI)28例,不稳定心绞痛(UA)36例)、18例稳定型心绞痛(SA)、12例陈旧性心肌梗死(OMI)、21例胸痛综合征(CPS)患者和23例对照(C)外周血单个核细胞(PBMC)经植物血凝素(PHA)刺激培养后,应用酶联免疫吸附方法(ELISA)检测培养液上清中干扰素γ(IFN-γ)和白介素4(IL-4)水平。结果:ACS组培养液上清中IFN-γ水平及IFN-γ/IL-4比值明显高于SA组、OMI组、CPS组和C组,OMI组、SA组、CPS组与C组间无显著性差异;各组间IL-4水平无显著性差异。ACS患者培养液上清中IFN-γ水平随发病时间的延长而逐渐下降,但AMI患者IFN-γ高表达持续时间更长。结论:ACS患者存在Th1/Th2功能失衡,主要表现为Th1细胞功能亢进,可能是ACS的发病机制之一;AMI患者Th1/Th2功能失衡可能参与了AMI后自身免疫因素引起的心肌损伤和心室重塑过程。 相似文献
16.
目的:检测原发性肾病综合征(PNS)患者血清及肾组织中中性粒细胞明胶酶相关脂质运载蛋白(NGAL)的水平,探讨PNS合并急性肾损伤(AKI)时患者血清及肾组织中NGAL浓度的变化。方法:72例PNS患者根据病理结果分为:(1) PNS合并急性肾小管坏死(ATN)组15例,其中微小病变(MCD)合并ATN 10例,系膜增生(MsPGN)合并ATN 5例;(2) PNS不合并ATN组57例,其中MCD组24例,膜性肾病(MN)组23例和MsPGN组10例。15例健康体检者的血液及5例正常肾组织作为正常对照组。采用ELISA检测血清NGAL的水平;采用免疫组化法检测肾组织中NGAL的表达。结果:(1) PNS患者血清NGAL水平及肾组织中NGAL表达明显高于正常对照组(P<0.05),其中MN组较MCD组和MsPGN组血清NGAL水平明显升高(P<0.05)。(2) MCD合并ATN组和MsPGN合并ATN组血清NGAL水平及肾组织中NGAL表达较不合并ATN组显著升高(P<0.05)。(3)血清中NGAL与24 h尿蛋白定量、血尿素氮和血肌酐呈正相关(P<0.05),与血清白蛋白和β2微球蛋白无明显相关性(P>0.05);血清中NGAL与肾组织NGAL的表达呈正相关(P<0.01)。结论:血清NGAL可能作为判断原发性肾病综合征并发急性肾损伤的早期、无创、敏感指标。 相似文献
17.
目的:探讨急性冠脉综合征病人血中粘附分子表达在识别不稳定冠脉粥样硬化斑块中的作用。方法:选取急性冠脉综合征病人80例, 其中急性心肌梗死病人40例, 不稳定心绞痛病人40例, 急性冠脉综合征病人经治疗4个月后进行随访, 同时选取正常对照40例。采用酶联免疫法(ELISA)测定血清中E-选择素、可溶性细胞间粘附分子-1(sICAM-1)和可溶性血管细胞间粘附分子-1(sVCAM-1)的水平。结果:外周血中E-选择素、sICAM-1、sVCAM-1水平在急性心肌梗死组、不稳定心绞痛组显著高于对照组, 除sVCAM-1外在随访时明显降低。结论:外周血中E-选择素、sICAM-1的水平可能作为诊断和预测急性冠脉综合征发生的敏感指标, 并可以反映冠脉粥样硬化斑块的稳定情况。 相似文献
18.
Atul Abhishek Jha Vineet Behera Anantharam Jairam Krishna Venkatesh Baliga 《Indian Journal of Critical Care Medicine》2014,18(9):609-611
Osmotic Demyelination Syndrome (ODS) is associated with rapid correction of hyponatremia or fluid shifts, and is characterized by neurological involvement related to pons, brainstem or other areas of the brain. All possible measures should be taken to prevent this serious disorder. Diagnosing this condition early is very important and requires a high index of suspicion. The treatment is purely supportive and most patients may show dramatic recovery. ODS occurring in normonatremic and hypernatremic patients is very rare. We report a case of an 18-year-old boy of end-stage renal disease who presented with an episode of acute gastroenteritis. He was managed with aggressive intravenous fluids, hemodialysis and other supportive therapy. But, he developed altered sensorium and seizures that progressed to features of spastic quadriparesis and lower cranial nerve palsy. Neuroimaging showed hyperintensities in pons and midbrain suggestive of ODS. The patient had normal sodium levels at all times and had no evidence of hyponatremia. The patient was managed with hemodialysis, physiotherapy and other conservative measures and had a gradual clinical and radiological recovery. 相似文献
19.
目的: 探讨急性冠脉综合征(ACS)患者外周血单核细胞表达OX40配体(OX40L)及血清可溶性OX40L(sOX40L)水平变化的临床意义。方法: 应用流式细胞术和双抗夹心酶联免疫测定法(ELISA)分别对正常对照组30例、稳定心绞痛(SA)40例(包括20例PTCA)、不稳定心绞痛(UA)50例、急性心肌梗死(AMI)30例患者血单核细胞表达OX40L及血清可溶性sOX40L水平进行检测。结果: UA组[(67.1±12.3)MFI]及AMI组[(70.2±18.3)MFI]血单核细胞表达OX40L,血清sOX40L水平[(35.7±8.4)ng/L,(38.1±10.5)ng/L]明显高于SA组[(23.1±6.7)MFI, (13.6±4.1)ng/L]和对照组[(20.8±8.1)MFI,(12.8±3.6)ng/L]。AMI患者血清sOX40L水平与UA组无明显差异,但AMI发病后24 h sOX40L有一升高峰值。PTCA后血清sOX40L明显高于PTCA前, 但血单核细胞表达OX40L无差异。结论: OX40L表达可能参与ACS的发生机制,且可能是冠脉斑块不稳定的活动性标志物。 相似文献
20.
Yun Jung Choi Jeong Han Kim Ja Kyung Koo Cho I Lee Ji Young Lee Jae Hoon Yang Soon Young Ko Won Hyeok Choe So Young Kwon Chang Hong Lee 《Clinical and molecular hepatology》2014,20(2):185-191