急性ST段抬高心肌梗死患者肾功能不全的发生率和预后价值

目的 评估急性ST段抬高心肌梗死(STEMI)患者肾功能不全的发生率及其预后价值.方法 采用改良的简化肾脏病改良饮食(MDRD)方程估算.肾小球滤过率(GFR),以GFR<60ml/(min·1.73 m~2)判断肾功能不全.采用Logistic回归分析筛选STEMI患者住院期间死亡的危险因素.结果 共349例STEMI患者,男241例(69.1%),女108例(30.9%),平均年龄(66.7±11.7)岁.肾功能不全患者94例(26.9%).若以肌酐(Cr)>133 μmol/L判断肾功能不全,则其漏诊率为42.6%(40/94).伴肾功能不全的STEMI患者年龄较大,陈旧性心肌梗死、血脂异常患病率高,Killip分级较高,入院时尿素氮(BUN)、Cr水平较高.用Logistic回归分析筛选出年龄、肾功能不全、未再灌注治疗是STEMI患者住院期间死亡的危险因素.伴肾功能不全的STEMI患者院内死亡的相对危险度为2.411(95%可信区间为1.249～4.656).结论 STEMI患者肾功能不全的发生率高,并且是STEMI患者住院期间死亡的危险因素.     

Cocaine-induced myocardial infarction associated with severe reversible systolic dysfunction and pulmonary edema

Myocardial infarction (MI) associated to cocaine use was originally reported in 1982 and cases are being encountered more frequently in our milieu. The literature regarding this diagnosis has included mostly cases of cocaine associated chest pain and MI without serious sequelae. A lesser number of reports however focus on the clinical presentation of severe myocardial dysfunction and severe pulmonary edema, with the mechanism for pulmonary edema still being debated. Although previously described individually, these manifestations are thought to be an uncommon complication of cocaine ingestion. In this article the subject is reviewed and we report our experience with two patients that presented to our care with severe pulmonary edema and concomitant severe left ventricular systolic dysfunction that resolved spontaneously with supportive therapy. It is felt that this clinical picture after cocaine use may be more common than expected. In this article we discuss the possible mechanisms associated to this presentation as well as review the literature regarding this subject.     

ACE2基因多态性与心肌梗死后心功能不全及心室重构的相关性研究

目的研究血管紧张素转换酶2基因A9570G多态性与心肌梗死后心功能不全及心室重构的关系。方法收集252例陈旧性心肌梗死患者,采取外周血2ml提取DNA,多聚酶链扩增反应及限制性内切酶法检测ACE2基因A9570G基因型,按基因型进行分组,采用超声心动图比较不同基因型间患者LVEF,E／A,LVEDd及LVMI的差异。结果在男性,G基因型组LVEF、LVEDd、LVMI与A基因型组比较,差异有统计学意义（t=2．609、3．527、2．063,P〈0．05）,而E／A两组比较,差异无统计学意义（P〉0．05）;在女性,3种基因型间患者LVEF、E／A、LVEDd及LVMI差异均无统计学意义（P〉0．05）。结论ACE2基因A9570G多态性与男性心肌梗死后心室重构及心功能不全相关,ACE2基因A9570G多态性可能是影响心梗后心室重构及心功能不全的遗传因素。     

心肌损伤标志物在急性心肌梗死诊断中的应用评价（综述）

血清心肌损伤标志物水平的升高是诊断急性心肌梗死的重要依据.寻找能在心梗后早期升高,并能提供早期诊断 而且特异性高的指标一直是努力的方向.就近年来在血清心肌酶以及其它损伤标志物的研究进展和临床应用价值, 尤其是 CK- MB、肌红蛋白、肌钙蛋白 I、肌钙蛋白 T等做一综述.     

Effects of granulocyte-colony stimulating factor on cardiac remodeling after myocardial infarction

BACKGROUND: Recent studies suggest that granulocyte colony-stimulating factor (G-CSF) may be beneficial in the treatment of myocardial infarction (MI). However, the effects of G-CSF on MI are still controversial and the molecular mechanism of G-CSF treatment for repair of the infarcted heart is not fully understood. METHODS: Mice were divided into three groups: Control, MI and MI treated with G-CSF. Four weeks after MI, we examined cardiac function by Doppler echocardiography and measured non-infarcted myocardial mRNA expression by northern blot analysis. RESULTS: Cardiac function decreased significantly in the MI groups compared with the sham-operated groups. Additionally, the ratios of E wave to A wave peak velocity (E/A) in the MI groups were higher than in the control group. E/A in G-CSF MI mice was significantly lower than in control MI mice (p<0.01). Matrix metalloproteinase-2 (MMP-2) mRNA expression was significantly increased in the MI groups compared with the control group (p<0.01). Furthermore, mRNA expression in the G-CSF MI group was significantly higher than in the Control MI group (p<0.05). CONCLUSIONS: G-CSF can prevent the LV remodeling process after MI that accompanies progressive cardiac dysfunction. One of the mechanisms of G-CSF treatment for cardiac remodeling after MI may be overexpression of MMP-2 in non-infarcted myocardium.     

Valsartan in the treatment of heart failure or left ventricular dysfunction after myocardial infarction

The physiological role of the renin angiotensin aldosterone system (RAAS) is to maintain the integrity of the cardiovascular system. The effect of angiotensin II is mediated via the angiotensin type I receptor (AT1 ) resulting in vasoconstriction, sodium retention and myocyte growth changes. This causes myocardial remodeling which eventually leads to left ventricular hypertrophy, dilation and dysfunction. Inhibition of the RAAS with angiotensin converting enzyme (ACE) inhibitors after acute myocardial infarction has been shown to reduce cardiovascular morbidity and mortality. Angiotensin receptor blockers (ARBs) specifically inhibit the AT1 receptor. It has not been known until the performance of the VALIANT (valsartan in acute myocardial infarction trial) whether blockade of the angiotensin receptor with an ARB or combination of an ACE inhibitor and ARB leads to similar outcomes as an ACE inhibitor. The VALIANT trial demonstrated equal efficacy and non-inferiority of the ARB valsartan 160 mg bid compared with captopril 50 mg tds, when administered to high risk patients with left ventricular dysfunction or heart failure in the immediate post myocardial infarction period. The combination therapy showed no incremental benefit over ACE inhibition or an ARB alone and resulted in increased adverse effects. This review examines the role of valsartan in left ventricular dysfunction post myocardial infarction. We also discuss pharmacokinetics, dosing, side effects, and usage in the elderly.     

高敏肌钙蛋白T检测在心肌梗死中应用价值的研究

目的:观察高敏肌钙蛋白T(hs-cTnT)、肌酸激酶同工酶质量(CK-MBmass)、肌红蛋白(Myo)和肌钙蛋白T(cTnT)在疾病发生及发展过程中的变化特征,研究高敏肌钙蛋白T检测在诊断急性心肌梗死方面的应用价值。方法:选取100例急性心肌梗死患者,分别在0 h、4 h、12 h抽取静脉血,正常对照组为68例空腹抽取静脉血,分别测定4项指标的含量,比较它们在不同时间内对AMI的诊断特性。结果:AMI患者发病入院后,hs-TnT的敏感性为91%,特异性为83%,阳性预测值为89%,阴性预测值为86%。结论:高敏心肌肌钙蛋白具有最好的灵敏度和较好的组织特异性,适合作为AMI早期检测指标。     

Socioeconomic inequities in invasive cardiac procedures after first myocardial infarction in Finland in 1995

OBJECTIVE: We examined socioeconomic disparities in coronary procedure rates after first events among hospitalized myocardial infarction (MI) patients. STUDY DESIGN AND SETTING: Information on MI patients in 1995 in Finland was obtained from the Finnish Cardiovascular Disease Register Project. Data on comorbidity, invasive treatments, hospitalizations, mortality, and socioeconomic status were obtained by linking data from the Finnish Hospital Discharge Register, cause of death register, population census, and the health insurance register using personal identity numbers. RESULTS: In 1995, 5172 patients aged 40 to 74 years were hospitalized for first MI. This corresponds to age-standardized event rates of 354/100,000 for men and 152/100,000 for women. Within 2 years, 33% of men and 21% of women underwent an invasive coronary procedure. Men in the lowest income third underwent 25% (95% confidence interval [CI] 12-36) fewer procedures than men in the highest third. Among women, the corresponding difference was 43% (95% CI 24-57). These disparities persisted throughout the 2-year follow-up, and they were not reduced by adjustment for comorbidity or hospital district. CONCLUSION: Socioeconomic disparities were observed in receipt of invasive cardiac procedures. More attention should be paid to equitable distribution of scarce health care resources.     

Health status of survivors of cardiac arrest and of myocardial infarction controls.

We interviewed 308 survivors of out-of-hospital cardiac arrest and matched controls who had suffered a myocardial infarction. The Sickness Impact Profile (SIP) scores of controls were somewhat lower (better) than those of cases, but responses of cases and controls to additional questions about stair climbing, irritability and mood were virtually identical. Half as many (18 per cent) controls as cases (38 per cent) reported poorer memory function; nevertheless, 63 per cent of cases and 79 per cent of controls who had been working outside the home at the time of the event were employed at the time of the interview.     

急性心肌梗死患者采用早期心脏康复护理的效果

目的 探讨五级法早期活动对急性心肌梗死患者心脏康复护理的临床效果.方法 选取高唐县人民医院2019年3月-2020年1月收治急性心肌梗死患者86例作为研究对象,随机分为干预组和对照组各43例.干预组采用早期心脏康复护理,对照组采用常规护理,比较两组患者并发症发生率、护理满意率及心理状态.结果 干预后,干预组患者SAS、...     

肌钙蛋白对心脏外科手术后急性心肌梗死的诊断价值

目的 探讨肌钙蛋白对心脏外科手术后急性心肌梗死的诊断价值.方法 采用前瞻性研究方法,选择134例心脏手术患者作为观察组,同期36例胸科手术患者作为对照组,两组患者术后持续心电监护,检测肌钙蛋白I,并对结果进行比较.结果 两组麻醉前肌钙蛋白I比较差异无统计学意义（P＞0.05）.观察组术后4h肌钙蛋白I为（13.010±14.829） μg,/L,与对照组的（0.019±0.007） μg/L比较差异有统计学意义（P＜0.05）.观察组发生急性心肌梗死1例,其肌钙蛋白Ⅰ＞40.000 μg/L.结论 心脏外科手术后早期绝大部分患者的肌钙蛋白明显增高,根据肌钙蛋白诊断术后急性心肌梗死的假阳性率较高,有待更多循证医学证据制定肌钙蛋白对心脏外科手术后急性心肌梗死的诊断标准.     

microRNAs与心肌梗死

microRNAs(miRNAs)是一类内源性的非编码单链小分子RNA,约22个核苷酸。miRNAs通过调控其靶基因的表达,参与细胞发育、增殖、分化、凋亡等一系列重要的生理学途径。近些年的研究发现,miRNAs在心肌梗死的发生、发展过程中起着关键的作用。现就miRNAs在心肌梗死发生、发展过程中的作用机制进行阐述。