脑外伤患者心肌酶谱改变的临床意义

目的观察脑外伤患者血清心肌酶谱的改变,探讨其临床意义。方法选择120例脑外伤患者,根据Glascow标准将伤情评估为三组：3分组（极重度组）、4～5分组（重度组）和6～8分组（中度组）,每组40例;同时选择门诊健康体检者40例为对照组,比较各组患者血清心肌酶变化。结果脑外伤各组患者的血清心肌酶均高于对照组;极重度组的血清心肌酶含量高于重度组和中度组（P〈0.05）;重度组血清心肌酶含量高于中度组（P〈0.05）。结论脑外伤急性期血清心肌酶升高程度与病情轻重相关,血清心肌酶检测有助于判断脑外伤患者的病情及预后。     

缺血性QTc间期改变临床意义

目的:观察QTc间期在心肌急性缺血发作时变化特点,探讨其在急性心肌梗死心电图诊断中的价值.方法:回顾性分析3例心电图出现QT间期变化的急性心肌梗死患者的心电图,观察缺血发作时与缓解(静息)时心电图QT间期、RR间期以及QTc间期的变化特点.QTc间期按Bazett's公式计算.结果:3例患者出现缺血性QTc间期改变,其中2例表现为QTc间期延长,1例QTc间期缩短.在QT间期改变中以ST段、T波时限改变为主,QRS波时限未变化,伴T波振幅绝对值增大,ST段可抬高、压低或不变.结论:缺血性QTc间期异常可能是急性心肌梗死超急期的心电图特征之一.     

Clinical and instrumental diagnosis of cardiac affection in patients with toxic diphtheria]

AIM: To specify myocardial affection in adult patients with toxic diphtheria (TD). MATERIALS AND METHODS: Along with routine clinical examination 150 patients with toxic diphtheria underwent ECG, echo-CG and biochemical tests. 22, 81, 26, 14 and 7 patients had subtoxic TD, toxic form of the first degree, second degree, third degree and hemorrhagic TD, respectively. RESULTS: Myocardial impairment in TD develops very early, but is diagnosed in different time depending on the diagnostic technique. Early signs of myocardial involvement are activation of cardiospecific enzymes and echo-CG changes. Poor myocardial prognosis in TD is predetermined by progressive cardiac failure (primarily right ventricular), marked conduction disorders, diminished contractility, hyper- or hypoactivity of cardiospecific enzymes. CONCLUSION: The knowledge of myocardial affection variants in TD enables the clinician not only to predict the disease course but to conduct more adequate therapy resultant in less numerous lethal outcomes of toxic TD.     

Increased myocardial collagen turnover in patients with progressive cardiac conduction disease

Background: Histopathologically, progressive cardiac conduction disease (PCCD) is characterized by progressive fibrosis and sclerodegenerative changes in the proximal and distal conduction system of the heart. Therefore, we sought to determine the serum levels of myocardial collagen turnover markers, extracellular matrix components, transforming growth factor β₁ (TGFβ₁), and bone morphogenic protein‐7 (BMP‐7) in this population. Methods: Study population included 20 patients (6 M/14 F, mean age 76 ± 8 years) with acquired, permanent 2:1, or complete atrioventricular block and compared with age‐ and sex‐matched, asymptomatic, healthy control subjects (n = 18, 6 M/12 F, mean age 75 ± 7 years). Serum myocardial collagen turnover markers:matrix metalloproteinases (MMP‐1, 2, 9), tissue inhibitor of matrix metalloproteinase (TIMP‐1), amino‐terminal propeptide of procollagen type I (PINP) and type III (PIIINP), carboxy‐terminal telopeptide of collagen type I (CITP), and carboxy‐terminal propeptide of procollagen type I (PICP), serum extracellular matrix components (laminin and fibronectin), TGFβ₁, and BMP‐7 levels were measured in both groups. Results: Serum PICP (849 ± 396 vs 631 ± 294 ng/mL, P = 0.04), PIIINP (3.7 ± 1.3 vs 3 ± 1 μg/L, P = 0.03), CITP (0.68 ± 0.35 vs 0.48 ± 0.25 ng/mL, P = 0.037), and plasma MMP‐9 (58.8 ± 56 vs 25.9 ± 17.3 ng/mL, P = 0.006) levels were higher in patient population compared to control subjects. Serum MMP‐1 (24.1 ± 20.5 vs 13.6 ± 7.5 ng/mL, P = 0.045) and MMP‐2 (1310 ± 139 vs 1186 ± 163 ng/mL, P = 0.01) levels were higher in control subjects compared to patient population. There was no difference in serum TIMP‐1, PINP, laminin, fibronectin, TGFβ₁, and BMP‐7 levels between two groups. Conclusion: Our findings demonstrate the presence of increased myocardial collagen turnover and active fibrotic process in patients with PCCD compared to control subjects.     

Clinical significance of the functional and structural changes in the intestines in chronic cholecystitis

The aim of the study was to determine the clinical significance of intestinal functional and structural alterations in biliary pathology. Clinical, endoscopic, morphological, and morphometric methods were used. The subjects of the study were 62 patients with functional gall bladder disorder, 90 patients with chronic calculous cholecystitis, and 90 patients who had undergone cholecystectomy for cholelithiasis. The study found that biliary lithogenesis was associated with intestinal dysbiosis, changes in the qualitative density of erythrocytes immunopositive to motilin and substance P, and inflammatory changes in the intestines. After cholecystectomy, changes in intestinal microecology progressed, inflammatory and atrophic changes in the intestinal mucosa appeared or deepened, the qualitative density of erythrocytes immunopositive to motilin and substance P decreased, and colon polyps appeared more frequently.     

Clinical and instrumental evaluation of the myocardial reserve in patients with prior myocardial infarction

The clinical manifestations of heart failure (HF), myocardial systolic and diastolic functions and the indices of remodeling of the left ventricle (L V) were compared to define the most informative characteristics of the myocardial reserve (MR) in patients with prior myocardial infarction (MI). Examination of 220 patients with MI indicated that the low LV ejection fraction reliably determined only a high functional class (FC) of HF. Myocardial diastolic dysfunction (DD) was equally characteristic of any FCs of HF and the restrictive type of blood filling was most commonly associated with FC III-IV of HF. LV concentric hypertrophy, as well as DD, occurred in all FCs of HF. The detection rate of LV eccentric remodeling significantly increased from 5.1% in FC I to 98.7% in FC IV, which characterized this process as the most characteristic while grading the decrease in MR in patients with MI.     

血红蛋白氧合酶-1在急性心肌梗死中的表达

目的　观察血红蛋白氧合酶 1( HO 1)在急性心肌梗死中的表达情况。方法　选择急性心肌梗死确诊病例 4 5例及经冠状动脉造影确诊的非心肌梗死冠状动脉粥样硬化性心脏病患者 5 0例作为研究对象 ,以冠状动脉造影正常的 4 0例患者作为正常对照组。利用免疫组化方法对心绞痛患者外周血单个核细胞中HO 1的表达进行定位分析 ,并通过计算机图像分析系统分析 HO 1表达的程度及强度。通过 Western blot对 HO 1表达水平进行定量分析。结果　 HO 1表达于胞浆。冠心病患者 HO 1表达水平高于对照组 ,急性心肌梗死患者 HO 1表达明显高于非心肌梗死冠状动脉粥样硬化性心脏病患者 ( P<0 .0 1)。结论　急性心肌梗死时 ,HO 1表达水平明显升高     

Clinical significance of reciprocal changes in the ECG in acute myocardial infarction

A total of 206 patients with acute myocardial infarction marked by infarction localization in the anterior and inferior walls were examined. It is revealed that reciprocal changes, namely the depression of the ST segment are of prognostic significance in the assessment of the clinical course of the disease, with the ST depression being recorded for over one day. The patients demonstrated a reduction in left ventricle (LV) function, namely a decrease in the ejection fraction of the LV. Moreover, in this group of patients, a greater number of cases with multiple lesions of the coronary vessels were recorded. The reciprocal changes correlated well with the size of myocardial injury.     

急性心肌梗死溶栓治疗时抗凝血酶和纤溶功能的关系

目的探讨急性心肌梗死(AMI)溶栓治疗时抗凝血酶(AT)与纤维蛋白溶解系统的变化.方法32例急性心肌梗死患者,进行尿激酶溶栓治疗,分别于溶栓治疗前、后0.5h、1h、2h、4h、8h采血.采用发色底物法测定AT、纤溶酶原(PLG)活性,凝固法测定纤维蛋白原(FIB)含量,动态观察AT、PLG和FIB在溶栓治疗时的变化.结果AMI溶栓治疗前AT:A(83.2%±14.8%)明显低于对照组(102.4%±10.4%)(P＜0.01),而溶栓前FIB(4.436±1.201)g/L、PLG:A(107.2%±10.3%)均显著高于对照组HB(2.883±0.74)g/L、PGL(95.6%±8.2%),(P＜0.01);溶栓治疗后0.5h,FIB含量和PLG:A均逐渐下降(P＜0.01).4h时最低,[FIB(1.373±0.951)g/L、PGL(57.9%±8.6%)];AT:A在溶栓治疗前后各时间段变化不明显(P＞0.05).结论急性心肌梗死患者抗凝血酶呈消耗性下降,纤维蛋白溶解功能受抑制;采用尿激酶溶栓治疗对抗凝血酶影响不明显.     

Immunotherapy in patients with diphtheria

Patients with suspected diphtheria were treated with 600–18,000 IU human antidiphtheria immunoglobulin in 13 cases and with 80,000 IU equine anti-diphtheria immunoglobulin in one case. There were three fatal cases of diphtheria; two attended hospital too late for an expected effect of therapy (> day 5), while one was treated with 10,000 IU human anti-diphtheria immunoglobulin on the third day of disease. Four patients with diphtheria and later neurological complications were given immunotherapy on days 2–4 after the start of the disease. Antitoxin antibody levels, assessed by microculture neutralization test in Vero cells, following therapy with human immunoglobulin did not reach above 2 IU per ml during the first week of disease. The higher dose of equine immunoglobulin resulted in an antitoxin level of 12·8 IU per ml on the second day after therapy. Equine immunoglobulin with higher antitoxin concentration than human immunoglobulin may be the preferable therapy in severe diphtheria.     

Clinical features, personality changes and anti-oxidative system activity in patients with peptic ulcer

Examination of 54 patients with duodenal peptic ulcer revealed significant correlations between the psychological traits of the patients and their plasma antioxidative activity in the mild and moderate courses of the disease. There were no correlations in patients with severe duodenal peptic ulcer. A correlation analysis of the correlation between the personality traits and plasma antioxidative activity in patients with peptic ulcer may be used to for its prognosis.