60岁以上心肌梗死患者血脂、脂蛋白水平分析

目前，上海人口已进入老龄化，原发性高血压、冠心病、腔隙性脑梗死、糖尿病等均为老年人的常见病、多发病，而这些疾病又不同程度地伴有高血脂、高脂蛋白血症。本文测定了116例心肌梗死患者的血脂及脂蛋白，以探讨血脂及脂蛋白水平与心肌梗死的相关性。     

急性心肌梗死患者血脂水平变化与中医辩证分型的临床研究

目的：分析急性心肌梗死（AMI）患者血脂水平变化与中医辩证分型的关系。方法：AMI患者110例和冠心病组（对照组）100例进行总胆固醇（TC）、甘油三酯（TG）、甘油三酯（TG）、高密度脂蛋白－胆固醇（HDL－C）、低密度脂蛋白－胆固醇（LDL－C）水平的测定,并按中医辩证分4型：心脉瘀阻型、痰热扰心型、气阴两虚型、心阳虚脱型。结果：在AMI急性期TC＞6.2mmol/L占17.3％,4.6-6.2mmol／L占38.2％;TG＞2.2mmol／L占12.7％,1.7-2.2mmol／L占13.6％;HDL－C＜0.8mmol/L占18.2％;LDL－C＞3.5mmol／L占19.1％。且心脉瘀阻型及痰热扰心型2组TC及LDL－C升高,而HDL－C下降,与对照组比较有显著性差异。死亡15例患者中有7例HDL－C降低,占46.7％。心阳虚脱型HDL－C下降及LDL－C升高与对照组比较有显著差异。结论：高脂血症与AMI发生率有关,在AMI急性期可出现高脂血症。心脉瘀阻型及痰热扰心型易出现TC、LDL－C升高和HDL－C降低,尤以LDL－C及HDL－C改变更为突出。HDL－C降低是AMI死亡危险因子之一。     

急性心肌梗死患者恢复期心率变异性的变化

急性心肌梗死 (ａｃｕｔｅｍｙｏｃａｒｄｉａｌｉｎｆａｒｃｔｉｏｎ ,ＡＭＩ)时心率变异性 (ｈｅａｒｔｒａｔｅｖａｒｉａｂｉｌｉｔｙ ,ＨＲＶ)降低 ,并且ＨＲＶ降低与预后有密切的关系[1] ,本文用动态心电图 (Ｈｏｌｔｅｒ)对ＡＭＩ患者恢复期ＨＲＶ进行分析 ,以探讨ＡＭＩ后ＨＲＶ的变化。1　临床资料1.1　研究对象心肌梗死组 :ＡＭＩ患者 5 6例 (依据 1979年ＷＨＯ急性心肌梗死诊断标准 ) ,男 4 4例 ,女 12例 ;年龄 3 5— 77岁 ,平均 5 6± 11岁 ;前壁梗塞 3 3例 ,下、后壁梗塞 2 3例 ;3 2例经冠状动脉造影证实。所有患者均在ＡＭＩ…     

急性心肌梗死患者血脂水平变化与中医辨证分型的临床研究

目的：分析急性心肌梗死(AMI)患者血脂水平变化与中医辨证分型的关系。方法：AMI患者110例和冠心病组(对照组)100例进行总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)水平的测定,并按中医辨证分4型：心脉瘀阻型、痰热扰心型、气阴两虚型、心阳虚脱型。结果：在AMI急性期TC>6.2 mmol/L占17.3％,4.6～6.2 mmol/L占38.2％;TG>2.2 mmol/L占12.7％,1.7～2.2 mmol/L占13.6%;HDLC<0.8 mmol/L占18.2％;LDLC>3.5 mmol/L占19.1％。且心脉瘀阻型及痰热扰心型2组TC及LDLC升高,而HDLC下降,与对照组比较有显著性差异。死亡15例患者中有7例HDLC降低,占46.7％。心阳虚脱型HDLC下降及LDLC升高与对照组比较有显著差异。结论：高脂血症与AMI发生率有关,在AMI急性期可出现高脂血症。心脉瘀阻型及痰热扰心型易出现TC、LDLC升高和HDLC降低,尤以LDLC及HDLC改变更为突出。HDLC降低是AMI死亡危险因子之一。     

急性白血病患者血脂变化及临床意义

为探讨急性白血病(AL)患者血脂的变化及其临床意义,用全自动生化分析仪检测了86例AL患者血脂的含量。结果显示,AL患者甘油三酯(TG)较正常对照组显著升高(P<0.05),总胆固醇(TC),低密度脂蛋白-胆固醇(LDL-C)和高密度脂蛋白-胆固醇(HDL-C)较正常对照组显著降低(P<0.05);AL患者化疗后达完全缓解者TG较治疗前显著降低(P<0.05),TC,LDL-C及HDL-C显著升高(P<0.05);未缓解者上述各项指标均无显著变化。结论:监测血脂水平的变化对AL患者的疗效判断和病情监测是一项简单而又重要的辅助指标。     

急性心肌梗死患者的职业康复

急性心肌梗死（Acute Myocardial Infarction,AMI)患由于冠状动脉和心肌的严重损害而常常导致心肌收缩功能减低，从而引起心功能不全或心绞痛，不但造成患体力工作能力的下降，还使患的心理健康受到一定的损害，影响了病人的工作恢复。现代康复医学通过康复评定、康复训练及职业训练等手段，使得大部分病人（70％－80％）心身得以恢复，可以重新恢复原有的工作。     

男性吸烟者急性心肌梗死患者血脂特点

目的 探讨男性吸烟者急性心肌梗死(AMI)患者的血脂特点.方法 将222例男性AMI患者按是否吸烟分为两组:A组77例为未吸烟组;B组145例为吸烟组,分析两组血脂六项的差别.结果 与未吸烟组相比,吸烟组的平均年龄较低,差异有统计学意义(P＜0.01);低密度脂蛋白胆固醇(LDL-c)和载脂蛋白B(apoB)的增高差异有统计学意义(P＜0.05);总胆固醇(TC)和甘油三酯(TG)的增高差异有统计学意义(P＜0.01).结论 男性吸烟者可使血脂增高,致使AMI早发10年余.     

血脂水平对急性心肌梗死患者预后的影响

目的　探讨血脂水平对急性心肌梗死(AMI)患者近期预后的影响。方法　测定190例AMI患者入院时 的血清总胆固醇(Tc)、甘油三酯(TG)、高密度脂蛋白-胆固醇(HDL-c)、低密度脂蛋白-胆固醇(LDL-c)及计 算TG/HDL-c和LDL-c/HDL-c比值。并根据患者年龄、是否吸烟、有无并发糖尿病、高血压病进行分组,比较 各组间的血脂水平。同时分析AMI患者不同心功能分级及住院4周内死亡与血脂水平的关系。结果　心肌梗死 急性期Tc≥6.24mmol/L者占17%,4.68～6.24mmol/L者占47%,TG≥2.2mmol/L者占18%,1.70～2.2mmol/ L者占16%,LDL-c≥4.16mmol/L者占29%,2.6～4.16mmol/L者占50%,HDL-c<0.91mmol/L(男)占19%, HDL-c<1.17mmol/L(女)占33%,TG/HDL-c≥2.37%者占17%,LDL-c/HDL-c≥2.8者占53%。心功能 3～4级与心功能1～2级比较,住院4周内死亡者与生存者比较除TG外,其它各项血脂水平差异有显著性。结论 　AMI患者急性期即可发现血脂异常,Tc、HDL-c、LDL-c及TG/HDL-c和LDL-c/HDL-c比值水平对 AMI患者近期预后有一定的影响,LDL-c/HDL-c比值作为AMI重要的决定治疗的指标。     

急性心肌梗死患者血压、血脂及肥胖的相关性分析

探讨高血压、血脂及肥胖与急性心肌梗死的相关性。选取收治的急性心肌梗死患者150例为研究对象,归为试验组,选取同期体检的无心肌梗死健康人150例为对照组。对两组血压、血脂、肥胖进行观察统计,探讨急性心肌梗死与高血压、血脂及肥胖的相关性。试验组高血压、高血脂和肥胖者明显高于对照组,为急性心肌梗死的危险因素,两组比较,差异有统计学意义(P0.05),而高血压、高血脂和肥胖与急性心肌梗死呈明显正相关。高血压、血脂异常及肥胖为急性心肌梗死的危险因素,且其程度与急性心肌梗死呈明显相关,对急性心肌梗死预防和治疗有重要的指导意义。     

急性心肌梗塞患者血气和酸碱变化及其临床意义

对９１例首次急性心肌梗塞患者进行动脉血气分析。结果表明：①２５．２％（２３／９１）患者ＰａＯ２＜８．００ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ），４０．６％（３７／９１）患者ＰａＯ２＜９．３３ｋＰａ。ＰａＯ２＜９．３３ｋＰａ的３７例中１１例死亡，病死率明显高于ＰａＯ２＞９．３３ｋＰａ者（Ｐ＜０．０５）。ＰａＯ２＜８．００ｋＰａ的１１例患患者中９例死亡，病死率明显高于ＰａＯ２８．００～９．３３ｋＰａ者（Ｐ＜０．０１）。②９１例患者中８２例发生不同类型酸碱失衡（９０．１％），３８例混合型酸碱失衡者１３例死亡，病死率明显高于单纯性酸碱失衡者（Ｐ＜０．０１）。ｐＨ＞７．５００者１４例中９例死亡，病死率明显高于ｐＨ７．３００～７．５００者（Ｐ＜０．０１）。③９１例患者ｐＨ为７．４６５±０．０６９。提示：动脉血气分析有利于对心肌梗塞患者的预后和病情判断及指导治疗。     

State of lipid peroxidation,blood antioxidant defense in patients with myocardial infarction aggravated by circulatory insufficiency

AIM: To study free radical processes in patients with myocardial infarction (MI) aggravated by heart failure. MATERIAL AND METHODS: Forty seven patients taken to the clinic within the first 5 hours of MI were examined. The patients were divided into 2 groups: 1) those with left ventricular failure-complicated IM (n = 25); 2) those with uncomplicated MI (n = 22). A control group included 17 apparently healthy males. The activity of lipid peroxidation (LPO) and blood antioxidative defense was determined in the patients' red blood cells prewashed off the plasma with saline solution at a temperature of 4 degrees C. RESULTS: The tension of free radical lipid oxidation mechanisms in patients with MI aggravated by circulatory insufficiency is followed by an increased antiradical activity. In patients with uncomplicated higher LPO activity is attended the less marked activation of antioxidative enzymes. The examinees were found to show a correlation of the global systolic function of the left ventricle with the concentration of LPO products and with the activity of antioxidative enzymes. CONCLUSION: More significant LP activation coupled with left ventricular systolic dysfunction was noted in patients with MI aggravated by acute heart failure.     

原发性甲减患者应用左旋甲状腺素治疗后血脂、心肌酶谱的变化

目的观察原发性甲减患者应用左旋甲状腺素治疗后血脂、心肌酶谱的变化。方法原发性甲减患者30例,在诊断初和经左旋甲状腺素治疗4周时分别测定空腹血清FT3、FT4、TSH、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL-C）、门冬氨酸氨基转移酶（AST）、肌酸激酶（CK）、乳酸脱氨酶（LDH）及其同功酶HBDH。结果治疗前,TC、LDL-C水平与FT3、FT4、TSH水平显著相关,而TG水平与甲状腺功能无相关性;心肌诸酶水平与甲状腺功能显著相关。冶疗后,血清TC水平下降44．6％（P〈0．01）,LDL-C下降39．3％（P〈0．01）,TG下降27．1％（P〉0．05）。血清CK、AST、LDH及HBDH平均下降幅度则分别为79．3％、51．0％、37．9％、38．2％（P均〈0．01）。结论原发性甲减患者应用左旋甲状腺素治疗可显著降低胆固醇、甘油三酯、低密度脂蛋白与心肌诸酶水平。     

Changes in blood viscosity and plasma proteins in myocardial infarction

A clinical study of some biological and biochemical factors was carried out on patients with acute myocardial infarction. It was shown that: (i) the plasma viscosity was highly correlated to the clinical evolution of myocardial infarction; (ii) the variations of plasma viscosity were related to changes in the connection of fibrinogen and globulin; (iii) the highest correlation was between the plasma viscosity and a2-globulin concentration, The monitoring of these may be useful in the clinical evaluation of myocardial infarction.     

Changes in the binding properties of albumin in patients with myocardial infarction

The purpose of the study was to measure the levels of albumin and to evaluate its binding properties in patients with acute large-focal myocardial infarction (AMI) hospitalized within the first 24 hours of AMI onset. Two groups were formed: group one--41AMI patients without cardiogenic shock (CS) and group two--15 patients with AMI complicated by true CS. Blood samples were taken from an ulnar vein on the first, second, third, fifth, seventh, and fourteenth day after AMI onset. The properties of binding albumin centers were determined using fluorescent method (K-35 probe). Total albumin concentration (TAC), effective albumin concentration (EAC), and albumin binding reserve (ABR) were determined. The results were presented as M +/- m. A significant increase in TAC on the fifth day (from 43 +/- 1 to 40 +/- 1 g/l) and EAC on the second, third, fifth, and seventh days (from 36 +/- 1 to 32 +/- 1 g/l with the minimal level on the fifth day), and in ABR on the second day (from 83.3 +/- 1.3 to 78.8 +/- 8%) were registered in group one. TAC returned to the normal level on the seventh day, EAC did not become normal until the fourteenth day, while ABR did not normalize within the period of two weeks. Eleven patients in group two died (hospital CS-associated mortality was 73.3%). TAC and EAC in discharged patients were 43.4 +/- 0.9 g/l and 35.8 +/- 0.8 g/l, respectively, while these parameters in the deceased were 35.5 +/- 1.7 g/l (p < 0.0001) and 27.3 +/- 1.7 g/l (p < 0.0001), respectively. CS developed in 70% of cases (seven out of ten patients) in whom TAC was less than 36 g/l vs. 17.4% of cases (eight out of 46) with a TAC of 36 g/l or more (p = 0.0013). When EAC was less than 30 g/l CS developed in 72.7% of cases (eight out eleven patients) vs. 15.6% of cases (seven out of 45) with an EAC of 30 g/l or more (p = 0.0003). Six out of ten patients (60%) with a TAC of less than 36 g/l died. Lethal outcome also occurred in five cases out of 46 or 10.9% with a TAL of 36 g/l or more (p = 0.0008). Seven out of eleven or 63.6% patients with an EAC of less than 30 g/l died. Four out of 45 patients (8.9%) with an EAC of 30 g/l or more died (p = 0.0001). Thus, the study found that a low (less than 36 g/l) TAC and EAC (less than 30 g/l) during the first 24 hours of AMI was associated with a significantly higher frequency of true CS and with a significantly higher hospital lethality. Determining albumin parameters during the first 24 hours of AMI will be useful in distinguishing a group of patients with a high risk of lethal outcome, which will make it possible to begin early aggressive therapy directed towards limiting myocardial necrosis.     

Changes in blood viscosity and plasma proteins in myocardial infarction.

A clinical study of some biological and biochemical factors was carried out on patients with acute myocardial infarction. It was shown that: (i) the plasma viscosity was highly correlated to the clinical evolution of myocardial infarction; (ii) the variations of plasma viscosity were related to changes in the connection of fibrinogen and globulin; (iii) the highest correlation was between the plasma viscosity and alpha2-globulin concentration. The monitoring of these may be useful in the clinical evaluation of myocardial infarction.     

急性心肌梗死静脉溶栓疗效与血脂相关性

目的观察血脂水平对急性心肌梗死（AMI）患者静脉溶栓治疗效果的影响。方法对28例AMI患者的总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白-胆固醇（LDL-C）及高密度蛋白-胆固醇（HDL-C）于发病后24h内进行测定，以中华心血管病杂志编委会，AMI溶栓疗法参考方案为标准，分为再通组（20例），未通组（8例）。结果溶栓再通组与未通组TC、LDL-C、HDL-C比较差异无显著意义，未通组TG明显高于再通组（P〈0．05）。结论TG水平升高可能影响AMI患者静溶栓效果，其机制及临床意义有待于进一步研究。     

Study of blood cholesterol and triglycerides in patients with acute myocardial infarction

The levels of cholesterol (C) and triglycerides (TG) were studied by a standard biochemical assays and the amount of C and TG was examined by a fluorescence assay in 55 patients with complicated (n=32) and uncomplicated (n=23) acute myocardial infarction (AMI) and in 25 apparently healthy donors. The content of C did not differ significantly in the study groups. As compared with the controls, the patients with complicated AMI had lower values of C + TG (p < 0.01) and TG (p < 0.001). In the patients with uncomplicated AMI, these indices were also lower than those in the control, but not significantly. The patients with complicated AMI were found to have insignificantly lower levels of TG and C + TG than those with uncomplicated AMI. The lower level of TG seems to be responsible for the decreased C + TG amount detectable in AMI by a fluorescence assay.