血清新蝶呤与急性冠状动脉综合征之间的关系

目的 :探讨急性冠状动脉综合征 (ACS)患者血清新蝶呤浓度的变化。方法 :对 4 7例ACS患者 ,其中急性心肌梗死 (AMI) 2 4例 ,不稳定型心绞痛 (UAP) 2 3例和 30例稳定型心绞痛 (SAP)患者 ,以酶联免疫法测定其血清新蝶呤水平 ,所有患者均为接受冠状动脉造影。结果 :血清新蝶呤浓度 ,在ACS病人中 ,AMI组 (1 1 88±3 0 9)nmol/L和UAP组 (9 85± 2 2 7)nmol/L ,均显著高于稳定型心绞痛患者的水平 (8 2 0± 1 5 2 )nmol/L ,(P <0 .0 0 0 1 ,P <0 .0 1 )同为ACS病人 ,AMI组与UAP之间其血清新蝶呤水平有显著差异 (P <0 .0 5 )。ACS的血清新喋呤水平与其不稳定斑块病变的数量有明显相关性。结果 :ACS病人血清新蝶呤浓度显著升高 ,可作为不稳定性动脉粥样硬化斑块的炎性标志     

CD40-CD40L与急性冠状动脉综合征的研究进展

急性冠状动脉综合征（Acute Coronary Syndrome，ACS）是心肌急性缺血的一组临床表现，包括不稳定心绞痛，无ST段抬高的急性心肌梗死和有ST段抬高的急性心肌梗死，也包括猝死性冠心病。目前认为ACS的病理生理机制是粥样硬化斑块不稳定，发生溃破、出血，随后血栓形成，引起冠状动脉不同程度堵塞，造成心肌血和氧供应急剧减少。免疫和炎症反应在ACS的发生发展过程中起着重要作用，CIM0-CD40L作为免疫和炎症反应中的重要信号转导系统，在动脉粥样硬化（Atherosclerosis，AS）炎症调节中的作用已日益明确，它几乎贯穿AS发生发展乃至斑块破裂的全过程。Yan等最近报道，ACS患者血小板表面CD40、CD40L显著升高，且不稳定型心绞痛病人的CD40、CD40L水平显著高于稳定型心绞痛病人；Wu等在兔AS模型中发现CD40、CD40L也显著升高，且与斑块中基质金属蛋白酶（Matrix Metalloproteinases，MMPs）成线性相关；Schonbeck证实CD40共刺激信号在AS鼠的血管内皮及斑块中大量表达，且抑制CD40信号系统，限制AS的进展。故认为CD40、CD40L对斑块不稳定性及ACS的发展起一定作用。     

急性主动脉夹层11例误诊分析

目的 急性主动脉夹层发病突然,病情发展迅速,临床表现复杂多变,较易被误诊,为此做一总结分析.方法 搜集我院近5年内科收治的11例急性主动脉夹层的特殊表现及确诊过程.结果 发现曾被误诊为急性心肌梗塞6例,急腹症2例,急性肺栓塞1例,急性左心衰1例,偏瘫1例.最后均经心脏彩超及CT、MRI确诊.结论 急性主动脉夹层表现复杂多变,极易误诊,对一些表现不典型的急性主动脉夹层要密切观察及排除.     

52例急性主动脉夹层术前监护体会

目的总结急性主动脉夹层入院后监护治疗经验,以提高早期监护质量,为患者顺利接受手术治疗提供必要条件。方法患者入院后采取紧急措施包括：①有效镇痛、充分镇静;②控制血压和心率,延缓夹层进一步发展;③严格控制活动量;④严密观察生命体征,正确进行病情判断和处理;⑤实施健康教育。结果本组患者入院后配合治疗,心率、血压控制良好。1例在术前麻醉过程中因夹层破裂死亡,其余51例均顺利接受手术治疗。术后痊愈出院47例,死亡5例（8%）,死亡患者均为急性A型夹层,死亡原因分别为夹层破裂、心衰、急性肾功能衰竭和吻合口出血。结论个体化止痛、镇静治疗;密切观察并及时、有效的控制血压、心率等生命体征变化;及时处理相关并发症,可使患者平稳渡过早期危险期,平稳接受手术治疗。     

D-二聚体和肌钙蛋白I在急性心肌梗死与主动脉夹层早期鉴别中的应用

目的 探讨D-二聚体、肌钙蛋白I(cTnI)在急性心肌梗死(acute myocardial infarction,AMI)与主动脉夹层(aortic dissection,AD)早期鉴别中的诊断价值.方法 选取2019年1月至2020年12月来我院住院治疗的相关病例进行回顾性分析,比较2组患者一般资料、入院后首次D-二聚体及cTnI的检测水平;绘制ROC曲线分析D-二聚体、cTnI及二者联合检测对AMI与AD早期鉴别的诊断价值.结果(1)2组患者年龄、高血压、高血脂、糖尿病病史比较,差异具有统计学意义(P<0.05),男性比例比较,差异无统计学意义(P>0.05);(2)AD组患者血浆D-二聚体水平显著高于AMI组患者,AMI组患者血浆cTnI水平显著高于AD组患者,差异均具有统计学意义(P<0.05);(3)ROC曲线显示,D-二聚体鉴别诊断AMI和AD的AUC为0.955,95％CI在0.930～0.981之间,最佳界点值为1.40μg/mL,灵敏度、特异性为0.877、0.934;cTnI鉴别诊断AMI和AD的AUC为0.843,95％CI在0.801～0.885之间,最佳界点值为0.07ng/mL,灵敏度、特异性为0.886、0.705;D-二聚体联合cTnI鉴别诊断AMI和AD的AUC为0.982,95％CI在0.969～0.994之间,灵敏度、特异性为0.930、0.958,差异具有统计学意义(P<0.05).结论 D-二聚体、cTnI联合检测对急性心肌梗死与主动脉夹层的早期鉴别有较高的诊断价值.     

血清腱糖蛋白-C、hs-CRP与急性冠脉综合症的相关性分析

目的 通过观察血清腱糖蛋白-C(TN-C)和高敏C反应蛋白(hs-CRP)在不同类型急性冠状动脉综合征患者血中表达水平,探讨二者与不同类型冠脉综合征的相关性.方法 总共入组诊断为急性冠脉综合症的患者90例,进一步分为两组:急性心肌梗死(AMI)组(n=48),不稳定性心绞痛(UAP)组(n=42),以及另入组稳定性心绞痛60例稳定心绞痛(SAP)组,及健康体检者55例为对照组.采用酶联免疫吸附试验(ELISA法)、放射免疫法分别测定血清TN-C和hs-CRP水平,并在各组间进行比较.结果 AMI组和UAP组TN-C表达水平明显高于SAP组、对照组,差异有统计学意义(P＜0.05);SAP组TN-C水平高于对照组但差异无统计学意义(P＞0.05).AMI组、UAP组和SAP组hs-CRP水平明显高于对照组,差异有统计学意义(均P＜0.05),而AMI组和UAP组hs-CRP较SAP相比差异无统计学意义(均P＞0.05).结论 TN-C、hs-CRP在ACS患者血清中升高,TN-C可作为急性冠状动脉综合征斑块稳定性病变严重程度的预测因子.     

红细胞压积变化对急性ST段抬高型心肌梗死患者临床预后的影响

目的 探讨红细胞压积的变化对急性ST段抬高型心肌梗死（STEMI）接受急诊经皮冠状动脉支架植入术患者的临床预后的影响。方法 连续性纳入我院心肌梗死绿色通道收治行急诊支架植入患者603例,根据住院期间红细胞压积的变化分为A组（红细胞压积降低组,255例）和B组（红细胞压积升高组,348例）。收集两组患者资本资料、手术相关信息、化验室资料、住院期间临床事件、1个月内临床事件以及1年内临床事件并予以统计分析。结果 A组年龄大于B组[（60.33±11.06）岁 vs（58.44±10.88）岁,P＜0.05],B组脑血管病史发生率高与A组（13.50% vs 8.24%,P＜0.05）,A组梗死相关动脉中血栓病变发发生率高于B组（97.25% vs 88.51%,P＜0.05）。支架植入后最终TIMI血流:3级血流A组较B组高（85.88% vs 79.02%,P＜0.05）。A组较B组住院期间心源性死亡发生率低（0 vs 2.01%,P＜0.05）;出院1年内LVEF低于B组[（55.53±6.42）% vs （57.19±6.82）%,P＜0.05];出院1年室壁运动异常发生率高于B组（92.88% vs 87.69%,P＜0.05）。结论 住院期间红细胞压积升高增加STEMI患者在院期间心源性死亡的发生,红细胞压积降低预示着心功能的下降及室壁运动功能受损。     

130例男性与劳力相关的急性冠脉综合征临床分析

急性冠状动脉综合征(ACS)包括不稳定心绞痛,非S-T段抬高心急梗死和ST段抬高心急梗死。急性冠状动脉综合征(ACS)的主要病理机制是动脉粥样斑块破裂和血栓形成。     

脑钠素检测与急性冠状动脉综合征

急 性冠状动脉综合征 (AcuteCoronarySyndrome ,ACS)是一组临床综合征 ,是指由于冠状动脉内粥样斑块破裂、表面破损或出现裂纹继而出血和血栓形成 ,严重的ACS可导致猝死。不稳定性心绞痛和急性心肌梗死都属于本综合征范畴 ,及时诊断和治疗可减少该综合征的死亡率和致残率。在AC     

床旁主动脉气囊反搏术在急性心肌梗死并发心源性休克的临床应用疗效分析

目的 研究主动脉气囊反搏(IABP)联合急诊经皮冠状动脉介入治疗(PCI)对急性心肌梗死合并心源性休克的疗效.方法 比较24例患者急性心肌梗死合并心源性休克治疗前后的心脏指数(CI)、中心静脉压(CVP)、平均动脉压(MAP)和小时尿量变化.结果 接受IABP联合PCI治疗后,患者的CVP治疗前后明显降低(10.1±6.6) mm Hg vs (4.2±3.9)mm Hg(P<0.05),而CI、MAP和每小时尿量均较治疗前明显增加,分别为(2.4±1.3) L·min·m2vs (1.4±0.8) L·min·m2,(89.2±12.7) mm Hg vs (52.6±14.3) mm Hg,(48.3±13.8) ml/h vs (10.6±5.9) ml/h(P<0.05).结论 对于急性心肌梗死并发心源性休克的患者,IABP联合急诊PCI治疗,疗效确切.这对不能开展急诊冠状动脉旁路手术的医院,IABP联合急诊PCI治疗具有特殊的临床意义.     

白介素-18与急性冠状动脉综合征

动脉粥样硬化斑块的不稳定导致冠心病特殊疾病谱——急性冠状综合征的发生。炎症机制在动脉粥样硬化斑块的发生、发展中扮演重要角色。近年来，不断有研究证实前炎症因子白介素-18密切参与了此过程，并且与急性冠状动脉综合征的发生有着极强的关联。     

急性心肌梗死后心脏性猝死的探讨

目的探讨急性心肌梗死后心脏性猝死（SCD）预防的关键环节。方法回顾56例急性心肌梗死后心脏性猝死患者的病历及随访资料,分析其原因或诱因、发病季节与发病时间、溶栓治疗与SCD的关系、致命性心律失常与SCD的相关性与预后等。结果严重心律失常为SCD的主要诱因,冬秋季多于春夏季,白天多于晚上,上午多于下午;住院治疗1周后、出院1周后为SCD的高发期,血钾偏低者多见,前壁多于下壁,未溶栓及溶栓未再通者SCD死亡率高。结论综合分析患者病例资料,密切观察病情变化,加强对关键环节的管理,对降低急性心肌梗死后心脏性猝死的发生具有积极的意义。     

The Relative Impact of Obstructive Sleep Apnea and Hypertension on the Structural and Functional Changes of the Thoracic Aorta

Background:

Recent studies suggest that obstructive sleep apnea (OSA) causes thoracic aortic dilatation; but it is well accepted that hypertension can cause aortic dilatation, and hypertension is a common finding in patients with OSA. We aimed to investigate the relative impact of OSA and hypertension on the structural and functional changes of the thoracic aorta.

Methods:

This was an echocardiography substudy of our prospective OSA study in patients with acute myocardial infarction (AMI). Ninety-four male patients who completed both echocardiography and polysomnography were recruited. OSA was defined as an apnea-hypopnea index (AHI) ≥ 15/hour.

Results:

The patients'' mean age was 53 ± 10 years, and mean body mass index (BMI) was 24.6 ± 3kg/m². Sixty-four (68.1%) patients had OSA; of these, 39 (41.5%) had severe OSA. Thirty-three (52.6%) of the OSA cohort had hypertension. There was no correlation between any of the echocardiographic parameters and thoracic aortic size. Stepwise multivariate regression showed that BMI (P = 0.024), older age (P = 0.044), and hypertension (P = 0.025) were the only determinants. There was no significant independent relationship between OSA/ AHI and thoracic aortic size. Systolic blood pressure but not AHI correlated significantly with aortic distensibility and compliance (r = −0.40 and −0.26, P < 0.001 and 0.022, respectively).

Conclusions:

Hypertension is a common finding in male AMI patients with OSA. In these patients, increased afterload from systemic hypertension rather than mechanical stress on the aortic wall determines the thoracic aortic size and abnormalities in aortic functional indices. BMI and age were also independent predictors of thoracic aortic dilatation.

Citation:

Lee LC; Torres MC; Khoo SM; Chong EY; Lau C; Than Y; Shi DX; Kailasam A; Poh KK; Lee CH; Yeo TC. The relative impact of obstructive sleep apnea and hypertension on the structural and functional changes of the thoracic aorta. SLEEP 2010;33(9):1173-1176.     

Sudden death of a young woman due to aortic dissection caused by Turner's syndrome

A 24-year-old woman was found dead in her bed. There had been an episode of fainting with cervicodynia 1 day before death but no significant past medical history, except for menstrual irregularities. Post-mortem examination revealed that death was due to hemopericardium caused by rupture of the ascending aorta by thoracic aortic dissection (Stanford type A). Microscopically, weakness of the aorta was due to cystic medial necrosis. On external examination, short stature, a short neck and multiple pigmented nevi were observed, while internal examination revealed coarctation of the aorta and funicular ovaries. Examination of the X chromatin showed a decrease in numbers of Barr bodies in the tissues, and a 45,X/46,XX mosaicism was suspected. It is concluded that the cause of death was aortic dissection due to Turner's syndrome.     

Examination of serum pregnancy-associated plasma protein A clinical value in acute coronary syndrome prediction and monitoring

Introduction

Chronic vascular inflammatory process promotes and intensifies all atherogenic events. The aim of this research was to estimate the clinical value of pregnancy-associated plasma protein A (PAPP-A) measurement associated with plaque destabilization and rupture in prediction and monitoring of acute coronary syndromes (ACS) as well as to assess the predictive value of this biomarker in comparison to traditional myocardial infarction (MI) risk markers.

Material and methods

The study included 119 patients in 2 investigated groups and one control group. PAPP-A assay was performed using manual ELISA kit, DRG. All other parameters were determined using automatic analyzers: Olympus and Dade Behring.

Results

A statistically significant difference between PAPP-A concentration median value was found in the investigated group MI individuals’ serum and control group individuals’ serum (11.42 ng/ml and 7.22 ng/ml respectively, p = 0.003). PAPP-A assay had the highest specificity (83.3%) and sensitivity (53.8%), and therefore the highest clinical value. In patients with clinically and laboratory confirmed MI we proved that PAPP-A serum level is a clinically useful biomarker in ACS prediction, better than C-reactive protein (hsCRP) and fibrinogen (FBG) level.

Conclusions

The highest diagnostic efficiency for ACS prediction was proved for simultaneous panel assays consisting of 2-3 parameters (PAPP-A – hsCRP, PAPP-A – FBG, PAPP-A – hsCRP – FBG), while PAPP-A itself does not show characteristics necessary for it to be used as a biomarker for MI dynamic monitoring. It is possible that prothrombotic component is mainly responsible for repeated major adverse cardiac events, more than inflammatory process.     

急性心肌梗死患者经急诊介入治疗后心肌顿抑的临床观察

目的探讨急性心肌梗死患者经急诊介入治疗后心肌顿抑发生情况,为急性期心功能的维护提供依据。方法筛选62例首次急性前壁及前间壁心肌梗死患者,其中男性43例,女性19例,年龄47—72岁,平均年龄58．76岁。32例行急诊冠状动脉介入治疗（PCI组）,30例为内科保守治疗患者（药物治疗组）,于术后或入院后0（即刻）～2d及10～14d静息状态下分别行超声心动图检查,记录左心室内径（舒张末前后径）、心输出量及左心室射血分数,同时监测肌酸激酶、肌酸激酶同工酶、肌钙蛋白T,找出酶峰值。结果与药物治疗组比较,PCI组术后0（即刻）-2d左心室内径明显增加（P〈0．01）,心输出量明显减少（P〈0．01）,左心室射血分数明显降低（P〈0．01）,心肌酶峰值提前出现,且低于药物治疗组酶峰值（P〈0．05）;治疗前后比较,PCI组术后10。14d较前左心室内径明显减小（P〈0．01）,心输出量增加（P〈0．05）,左心室射血分数明显升高（P〈0．01）,而药物治疗组入院后10-14d较治疗前左心室内径、心输出量及左心室射血分数无显著变化（P〉0．05）。结论急性心肌梗死患者行急诊PCI治疗可有效减少心肌坏死面积,但存在心肌顿抑,因此术后心功能的维护非常重要。     

Mesothelial/monocytic incidental cardiac excrescences (cardiac MICE) associated with acute aortic dissection: a study of two cases

Acute aortic dissection is a life-threatening condition mainly caused by hypertension, atherosclerotic disease and other degenerative diseases of the connective tissue of the aortic wall. Mesothelial/monocytic incidental cardiac excrescences (cardiac MICE) is a rare benign reactive tumor-like lesion composed of admixture of histiocytes, mesothelial cells, and inflammatory cells set within a fibrinous meshwork without a vascular network or supporting stroma. Cardiac MICE occurring in association with aortic dissection is exceptionally rare (only one such case reported to date). We herein report on the surgical repair of two Stanford type A aortic dissections caused by idiopathic giant cell aortitis in a 66-year-old-woman and by atherosclerotic disease in a 58-year-old-man, respectively. In both cases, the dissections could be visualized via computed tomography. Histopathology showed cardiac incidental MICE within the external aortic wall near the pericardial surface which was confirmed by immunohistochemistry.