急性胰腺炎患者血浆H2S、Apelin-36水平与血栓弹力图参数及病情严重程度的关系

目的 检测急性胰腺炎（AP）患者血浆硫化氢（H2S）、Apelin-36水平,并分析其与血栓弹力图参数及病情严重程度的关系。方法 选取2016年3月到2017年12月期间在我院接受治疗的AP患者80例作为研究对象,根据AP患者的病情严重程度将其分为轻症急性胰腺炎（MAP）组45例和重症急性胰腺炎（SAP）组35例。另选取同期在我院进行体检的健康志愿者30例作为对照组。比较三组受试者血浆H2S、Apelin-36水平、急性生理与慢性健康评分（APACHEⅡ）、血栓弹力图参数,分析H2S、Apelin-36水平与血栓弹力图参数、APACHEⅡ评分的相关性。结果 SAP组血浆H2S、Apelin-36水平及APACHEⅡ评分均高于MAP组和对照组,且MAP组高于对照组,差异均有统计学意义（均P<0.05）;SAP组的最大振幅（MA）值、凝血块强度（G）值大于MAP组和对照组,凝固角（α）角大于对照组（P<0.05）,MAP组的α角、MA值、G值大于对照组（P<0.05）;AP患者血浆H2S水平与血凝时间（R）值、血块成型时间（K）值、Apelin-36无明显的相关性（P>0.05）,与α角、MA值、G值、APACHEⅡ评分呈正相关（P<0.05）;Apelin-36水平与R值、K值、α角、MA值、G值均无明显的相关性（P>0.05）,与APACHEⅡ评分呈正相关（P<0.05）。结论 AP患者存在一定的凝血功能障碍,H2S与Apelin-36在AP患者血浆中呈高表达,且表达水平与病情严重程度密切相关,其中H2S表达水平与部分血栓弹力图参数存在一定的相关性。     

内毒素及其诱生细胞因子与急性胰腺炎患者临床预后的关系

目的动态观察血浆内毒素及其诱生细胞因子TNF-α、IL-1β水平在急性胰腺炎(AP)患者中的变化,探讨其在AP发生、发展中的作用及其与AP患者临床预后的关系.方法联合应用Ranson标准、APACHEⅡ评分和Balthazar CT分级系统将17例确诊为AP的患者分为轻型急性胰腺炎(MAP)13例和重症急性胰腺炎(SAP)4例,并于入院后第1、2、3、4、5天连续监测患者血浆内毒素水平和血清TNF-α、IL-1β水平.结果 SAP组患者内毒素水平于入院后第2天起较MAP组显著升高,血清TNF-α和IL-1β水平于入院后第1天和入院后第5天较MAP组显著升高(P ＜ 0.05).AP患者血浆内毒素水平于入院后第4天起与血清TNF-α水平呈直线正相关,AP患者血浆内毒素水平自第2天起与IL-1β水平呈直线正相关.结论内毒素及其诱生细胞因子水平的高低与AP病情严重程度一致.因此这些指标在判断MAP和SAP以及衡量AP预后方面具有重要的参考价值.     

急性胰腺炎患者血清肿瘤坏死因子-α水平检测的临床价值

[目的]探讨急性胰腺炎（AP）患者血清肿瘤坏死因子-α（TNF-α）水平动态变化对病情判断的价值以及与APACHEⅡ评分的相关性。[方法336例AP患者分为轻症AP（MAP）组26例和重症AP（SAP）组10例，评定APACHEⅡ评分；对照组10例，均为健康志愿者。采用ELISA法检测血清TNF-α水平。[结果]①入院第1天2患者组血清TNF-α水平较对照组明显升高（P〈0．05）；随后MAP组逐渐下降，第7天降至正常；SAP组则持续升高，第3天达峰值；第3、7、14天明显高于MAP组（P〈0．05）。②SAP组的TNF-α水平和APACHEⅡ评分明显高于MAP组，血清TNF-α水平与APACHEⅡ评分呈显著正相关（r=0．837，P〈0．01）。[结论]AP患者血清TNF-α水平变化与APACHEⅡ评分有良好的相关性；TNF-α水平变化与AP的发生发展密切相关，入院第3天的TNF-α水平可作为AP病情程度判断的参考指标，测定TNF-α水平有助于判断预后。     

同型半胱氨酸、肿瘤坏死因子-α和白细胞介素-6对急性胰腺炎严重程度及预后的评价

目的 探讨同型半胱氨酸（HCY）、肿瘤坏死因子（TNF）-α和白细胞介素（IL）-6与急性胰腺炎（AP）病情严重程度的相关性以及对AP患者预后的评估价值.方法 选取AP患者64例,将其分为轻症AP组41例（MAP组）、重症AP组23例（SAP）;另选取健康体检者72例作为对照组.分别于入院第1、3和7天抽取静脉血检测血清HCY、TNF-α和IL-6水平,同时进行急性生理和慢性健康评分标准Ⅱ（APACHEⅡ）评分.结果 与对照组比较,入院第1天MAP组和SAP组血清HCY、TNF-α和IL-6水平均升高（P＜0.01）,其中SAP组升高更加明显（P＜0.01）;入院第3天时MAP组和SAP组血清HCY、TNF-α和IL-α水平均明显升高达到峰值;经常规治疗后（入院第7天）,两组HCY、TNF-α和IL-6水平均明显下降.HCY、TNF-α和IL-6水平与APACHEⅡ评分呈正相关（P＜0.01）.结论 血清HCY、TNF-α和IL-6水平与AP的发生、发展相关,早期密切观察血清HCY、TNF-α和IL-6水平变化对评估AP的严重程度和判断预后有一定的临床价值.     

急性胰腺炎患者早期凝血功能及血管内皮功能检测及临床意义

[目的]探讨急性胰腺炎患者早期凝血功能及血管内皮功能变化及其临床意义。[方法]选择2016年5月～2018年5月于本院就诊的急性胰腺炎(AP)患者作为研究对象,发病时间均24 h,根据相关分类诊断标准,将纳入患者分为轻症AP(MAP)与重症AP(SAP)2组,其中MAP患者59例,SAP患者51例,另选择同期于我院体检的健康人员50例作为正常对照组(NC)。比较各组凝血功能、血管内皮功能及炎症因子变化,并分析其与急性生理与慢性健康评分Ⅱ(APACHEⅡ)的相关性。[结果]在凝血功能方面,NC组与MAP组的凝血酶原时间(PT)、纤维蛋白原浓度(FIB)、D-二聚体(D-dimer)和部分活化凝血酶原时间(APTT)比较,差异无统计学意义(P0.05);SAP组患者的PT、APTT、FIB、D-Dimer均明显高于NC组与MAP组,差异有统计学意义(P0.05)。在血管内皮功能方面,NC组与MAP组的反应性充血指数(RHI)差异无统计学意义(P0.05);SAP组的RHI明显低于NC组与MAP组,差异有统计学意义(P0.05);3组增强指数(AI)的差异无统计学意义(P0.05)。在炎症因子方面,NC组与MAP组的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)比较,差异无统计学意义(P0.05);SAP组患者的IL-6、TNF-α均明显高于NC组与MAP组,差异有统计学意义(P0.05)。在APACHEⅡ评分方面,SAP组高于MAP组,差异有统计学意义(P0.05)。Pearson相关分析显示,MAP组患者的PT、APTT、FIB、D-Dimer、RHI、IL-6、TNF-α与APACHEⅡ评分无相关性(P0.05);SAP组患者的PT、APTT、FIB、D-Dimer、IL-6、TNF-α与APACHEⅡ评分呈正相关(r=0.49、0.61、0.32、0.37;P0.05);RHI与APACHEⅡ评分呈负相关(r=-0.27;P0.05)。[结论]MAP患者凝血功能与血管内皮功能基本正常,而SAP患者出现凝血功能与血管内皮功能异常,且与患者严重程度具有相关性。观察AP患者的凝血功能与血管内皮功能指标变化,有助于判断患者严重程度与评估预后。     

内毒素及其诱生细胞因子与急性胰腺炎患者临床预后的关系

目的 动态观察血浆内毒素及其诱生细胞因子TNF—α、IL—lβ水平在急性胰腺炎(AP)患中的变化，探讨其在AP发生、发展中的作用及其与AP患临床预后的关系。方法 联合应用Ranson标准、APACHE I评分和Batthazar CT分级系统将17例确诊为AP的患分为轻型急性胰腺炎(MAP)13例和重症急性胰腺炎(SAP)4例，并于人院后第1、2、3、4、5天连续监测患血浆内毒素水平和血清TNF—α、IL—1β水平。结果 SAP组患内毒素水平于人院后第2天起较MAP组显升高，血清TNF—α和IL—1β水平于人院后第1天和人院后第5天较MAP组显升高(P＜0．05)。AP患血浆内毒素水平于入院后第4天起与血清TNF—α水平呈直线正相关，AP患血浆内毒素水平自第2天起与IL—1β水平呈直线正相关。结论 内毒素及其诱生细胞因子水平的高低与AP病情严重程度一致。因此这些指标在判断MAP和SAP以及衡量AP预后方面具有重要的参考价值。     

急性胰腺炎患者血浆凝血和纤溶功能变化与病情的关系

目的 了解急性胰腺炎患者早期血浆凝血和纤溶指标的变化规律及其与病情严重程度的关系.方法 将通过临床症状、血清酶学、影象学和病理学诊断的42例急性胰腺炎患者分为重症急性胰腺炎(n=21)和轻症急性胰腺炎(n=21)2组,另选择20例健康正常人作为对照组,测定其血浆凝血酶原时间(PT)、部分活化凝血酶原时间(aPTT)、凝血酶原时间国际标准化比率(INR)、纤维蛋白原(Fbg)、血小板(PLT)和D-二聚体(D-D).记录患者入院后各项实验室指标、48 h Ranson和24 h APACHE Ⅱ评分,了解以上指标含量与急性胰腺炎评分是否存在相关性.结果 ①与轻症急性胰腺炎(MAP)比较,重症急性胰腺炎(SAP)患者白细胞计数、甘油三脂、血糖、肌苷、24 h APACHEⅡ评分和48 h Ranson评分显著升高(P＜0.05);红细胞压积、白蛋白和血钙显著降低(P＜0.05).②与对照组比较,MAP组血浆PT、aPTT、INR和Fbg均升高(P＞0.05),D-D升高显著(P＜0.05);与MAP组比较,SAP患者血浆PT、aPTT、INR和Fbg均升高(P＜0.05),D-D升高显著(P＜0.05);与MAP组比较,SAP患者血浆PT、aPTT、INR、Fbg和D-D含量均显著升高(P＜0.05).③血浆PT、aPTT、INR、Fbg和D-D含量与48 h Ranson和24 h APACHEⅡ分值均呈显著正相关(P＜0.05).结论 急性胰腺炎患者凝血纤溶障碍与病情严重程度相关.     

Seldinger法区域动脉乌司他丁灌注联合奥曲肽治疗重症急性胰腺炎的疗效及其机制

目的:探讨Seldinger法区域动脉乌司他丁灌注联合奥曲肽对重症急性胰腺炎(SAP)患者血清Ghrelin、巨噬细胞炎性蛋白-1α(MIP-1α)、巨噬细胞炎性蛋白-1β(MIP-1β)水平的影响及临床疗效。方法:将132例SAP患者按照随机数字表法,分为观察组(乌司他丁+奥曲肽)和对照组(奥曲肽),每组66例。比较2组的临床疗效和血清中C反应蛋白(CRP)、白介素-6(IL-6)以及Ghrelin、MIP-1α、MIP-1β水平,并分析2组并发症发生率及病死率。结果:观察组治疗有效率高于对照组(80.3%vs 60.6%,P0.05),且在腹痛缓解时间、首次排便时间、胃肠减压时间及住院时间上均短于对照组(均P0.05);治疗7 d后,2组血清中CRP、IL-6、Ghrelin、MIP-1α、MIP-1β水平均较治疗前明显下降,且观察组均低于对照组(P0.05);观察组急性肾衰竭、急性呼吸窘迫综合征、休克及病死率均低于对照组(均P0.05)。结论:应用Seldinger法区域动脉乌司他丁灌注联合奥曲肽治疗SAP患者,有利于抑制Ghrelin、MIP-1α、MIP-1β表达,抑制炎症反应,提高临床疗效。     

血清胰蛋白酶原-2和血细胞比容在急性胰腺炎病情评估中的作用

背景:我国急性胰腺炎(AP)发病率逐年上升,病死率居高不下,探索可用于判断AP病情严重程度的血液生化指标对AP的诊断和治疗具有重要的临床意义。目的:探讨血清胰蛋白酶原-2(TAT-2)和血细胞比容(HCT)在AP病情严重程度中的预测价值。方法:收集2016年9月—2018年6月江阴市人民医院收治的175例AP患者,根据病情严重程度分为轻度急性胰腺炎(MAP)组、中重度急性胰腺炎(MSAP)组、重度急性胰腺炎(SAP)组,并选取同期健康体检者作为对照组。测定血清TAT-2、HCT,并行BISAP评分、APACHEⅡ评分、Balthazar CT评分。采用ROC曲线分析各指标诊断SAP的价值。结果:四组间TAT-2、HCT、BISAP评分、APACHEⅡ评分、Balthazar CT评分相比差异有统计学意义(P 0. 05)。SAP组TAT-2、HCT明显高于MAP组、MSAP组、对照组(P 0. 05),MSAP组TAT-2、HCT明显高于MAP组、对照组(P 0. 05),MAP组TAT-2、HCT显著高于对照组(P 0. 05)。ROC曲线分析示,TAT-2、HCT以及两者联合预测SAP的敏感性分别为69. 7%、84. 7%、88. 5%,特异性分别为95. 3%、67. 8%、65. 1%,AUC分别为0. 858、0. 783、0. 875。结论:TAT-2、HCT可有效评估AP病情的严重程度,两者联合检测更有助于进一步预测SAP的发生,对于AP的治疗起有重要指导作用。     

降钙素原、高迁移率族蛋白1与急性胰腺炎严重程度和预后的相关性研究

目的 检测急性胰腺炎(AP)患者血清降钙素原(PCT)和高迁移率族蛋白1(HMGB1)的水平,探讨它们与AP严重程度及患者预后的相关性.方法 收集80例AP患者血标本,其中重症急性胰腺炎(SAP)38例,轻症急性胰腺炎(MAP) 42例.应用酶联免疫分析法检测血清HMGB1水平,采用免疫化学发光法检测血清PCT水平,分析它们与其他生化指标、AP病情严重程度及患者预后的相关性.以30例健康成年人作为对照组 结果 SAP组患者血清PCT及HMGB1水平分别为(8.18±3.24) μg/L和(11.79±3.98) μg/L,MAP组分别为(5.67±2.43) μg/L和(5.38 ±2.06)μg/L,均显著高于对照组的( 1.85 ±0.86)μg/L和(1.87±1.47) μg/L(p值均＜0.01) AP患者血清PCT水平与HMGB1水平呈正相关(r=0.276,P=0.014),且两者与 Ranson评分、24 h APACHE Ⅱ评分、Balthazar CT评分均呈正相关(P＜0.05或＜0.01).此外,器官功能不全患者的血清HMGB1水平显著高于未出现器官功能不全者(P＜0.05).结论 AP患者的血清PCT及HMGB1水平显著升高,且与 AP病情严重程度呈正相关,因此PCT和HMGB1可作为评估AP严重程度潜在的血清指标.     

Coronary aneurysms: A case report and review

This case report describes a large coronary aneurysm and poses questions regarding management. The discussion that follows addresses what is known about the natural history of and options for management of coronary aneurysms.     

Right coronary arteriography: experience with standard-torque and limited-torque techniques in children and young adults.

Coronary spasm and intimal injury may occur during selective right coronary arteriography. The safety and efficacy of right coronary arteriography in children and young adults were retrospectively reviewed for this report. Right coronary arteriography was performed in 200 patients. A standard-torque technique was used in 150 patients, a limited-torque technique was used with a reshaped left coronary catheter in 53 patients. The standard-torque technique was associated with proximal coronary spasm in nine patients, nonsustained ventricular tachycardia in one patient, and ST segment changes in one patient. The limited-torque technique was associated with no complications. The standard-torque technique was effective in one patient when the limited-torque technique failed to define distal coronary branches clearly. The limited-torque technique was effective in nine patients when the right coronary artery could not be engaged while attempting the standard-torque technique. In conclusion, right coronary arteriography may be performed in a safe and potentially more effective manner using a new catheter design and a limited-torque technique.     

Terminology and anatomy of angulated coronary arteriography

Angulated views in coronary arteriography have been increasingly utilized because of their superiority in demonstrating lesions not well seen in standard right and left oblique projections. The importance of these angulated views has been repeatedly demonstrated. It is the purpose of this article to review some basic coronary anatomy angulation terminology, and then to describe the particular advantages of the angulated views in coronary arteriography. Illustrations of these particular views of both coronary systems will be provided.     

Radiographically detectable calcium and atherosclerosis: the connection and its exploitation

The early detection of coronary atherosclerosis may be impossible if we continue to depend on its pathophysiologic effects (ischemia) for our screening tests. Insoluble crystalline calcium phosphate, which is ubiquitous in our inorganic and biologic worlds, precipitates relatively early in atherosclerotic lesions. Since coronary calcification is specific for atherosclerosis and since calcium is a strong radiation absorber in the X-ray frequency range, sensitive radiographic techniques such as dual-energy subtraction fluoroscopy and ultrafast computed tomography hold promise as screening tests for this disease.     

Concept of the homemade coronary stent: Experimental results and initial clinical experience

To defray the escalating cost of coronary stenting, we handmade a balloon expandable coil stent with stainless steel wire. Preliminary comparison with the Palmaz-Schatz stent showed that, when implanted in porcine illac arteries, there was no difference in immediate angiographic results or in the degree of foreign body reaction at 6 wk. Subsequently, a total of 73 stents were implanted in 52 patients, either as a bailout device (54%) or for suboptimal angiographic results (46%). All but two implantations were successful. The postprocedural regimen consisted of heparin 1,000 IU/hr, aspirin 250 mg daily, and ticlopidine 500 mg daily. In-hospital complications were limited to two groin hematomas, one necessitating blood transfusion. Importantly, stent thrombosis was not observed. While 6-mo follow-up is pending, we already conclude that a balloon expandable coil stent can be handmade easily at low cost and implanted safely in patients. © 1996 Wiley-Liss, Inc.     

Provisional T-stenting and kissing balloon in the treatment of coronary bifurcation lesions: results of the French multicenter "TULIPE" study.

BACKGROUND: In previous prospective studies, a strategy of (a) stenting of the main branch, (b) provisional T-stenting of the side branch, and (c) final kissing balloon inflation, was associated with high success and low target lesion revascularization (TLR) rates on the long-term. OBJECTIVES: To examine the performance of this strategy in a multicenter study. METHODS: Consecutive patients were treated at 14 French medical centers for de novo coronary bifurcation lesions with the same technique used. Immediate results and clinically-driven TLR at 7 months were examined. RESULTS: The mean reference diameters of the main and side branches were 3.2 +/- 0.6 mm and 2.4 +/- 0.5 mm, respectively. The side branch was stented in 34% of patients. A <30% residual stenosis in the main branch was achieved in 99%, <50% in the side branch in 90%, and both in 89% of procedures. The in-hospital major adverse cardiovascular event were a Q-wave and 5 non-Qwaves MI (0.54% and 2.7%). At 7 months of follow-up, 3 patients (1.76%) had died, 1 suffered a non-Q-wave MI (0.59%), and 28 (15.88%) underwent TLR. By multivariate analysis, a lower left ventricular ejection fraction (OR: 0.934), moderate calcifications (OR: 7.86), and non-use of the "jailed" wire technique (OR: 4.26) were associated with reinterventions during follow-up. CONCLUSIONS: A strategy of provisional T-stenting with a tubular stent and final kissing balloon angioplasty for the treatment of coronary bifurcation lesions was safe and associated with a low TLR rate at 7 months. This strategy should be applicable to the new era of drug eluting stents.     

Coronary artery quantitation and data management system for paired cineangiograms

A computerized system designed to optimize the quantitation of coronary vessels on 35 mm cineangiograms is described and validated. Because the system has two cine film digitizers, it processes paired coronary arteriograms for the evaluation of serial changes in coronary arteries. A database system was specifically designed for the storage of coronary artery quantitation data which resides on a file server in a local area network and may be accessed by multiple workstations. In radiographic phantom studies of nine contrast-filled lucite cylinders of known size, the overall accuracy and precision for the measured diameters were 0.069 mm and 0.066 mm respectively. Measurements of minimum diameter and percent diameter stenosis of 21 coronary lesions selected from 17 routine cineangiograms showed high degree of intraobserver and interobserver reproduclbllity.     

Coronary anomalies: Incidence and importance

Most patients with coronary anomalies are asymptomatic. The knowledge of those variations could be important in regard to invasive catheter treatment or bypass surgery. In a retrospective study, the angiographic findings based on 4, 016 patients (1985-1989) were analyzed concerning coronary anomalies and malformations. Of the patients studied, 39 (0.97%) had coronary anomalies, and in 26 of these patients it was an anomalous circumflex branch. In 14 cases, the circumflex branch arose from a separate origin in the left aortic sinus. In 11 patients the origin was from the proximal segment of the right coronary artery. A singular coronary artery was found in five patients, originating from the right aortic sinus in two patients and from the left aortic sinus in three patients. An origin of the left coronary artery from the pulmonary artery, a coronary fistula, or an origin of the left anterior descending coronary artery from the RCA could be found in only one patient. Unexpected findings during invasive procedures would suggest a possibly existing coronary anomaly, especially when main branches cannot be opacified by selective contrast medium injection.     

Angiographic outcomes with biodegradable polymer and permanent polymer drug‐eluting stents

Background : In the Intracoronary Stenting and Angiographic Results: Test Efficacy of 3 Limus‐Eluting Stents (ISAR‐TEST‐4) trial, we demonstrated the noninferiority of biodegradable polymer (BP) sirolimus‐eluting stent to permanent polymer (PP) sirolimus/everolimus‐eluting stent (Cypher/Xience‐V) on the basis of clinical outcomes. In this study, we compare the antirestenotic efficacy of these stents in ISAR‐TEST‐4 patients with paired angiographic studies. Methods : Patients with de novo coronary lesions in native vessels (excluding left main lesions) were randomly assigned to receive a BP stent or a PP stent. Endpoints of interest of this study were in‐stent late lumen loss, in‐segment binary restenosis, and restenosis morphology at 6–8‐month follow‐up angiogram. Results : Of the 2,603 patients (3,372 lesions) enrolled in ISAR TEST‐4 trial, 2,016 patients (2,637 lesions) underwent repeat angiographic examination 6–8 months after randomization: 1,006 patients (1,323 lesions) treated with BP stents and 1,010 patients (1,314 lesions) treated with PP stents. No difference was observed between BP and PP stents in in‐stent late lumen loss (0.24 ± 0.6 vs. 0.26 ± 0.5 mm, respectively, P = 0.49) or in in‐segment binary restenosis (11.6% [153 lesions] vs. 11.8% [155 lesions], P = 0.85). Focal pattern of restenosis was observed in the majority of patients receiving either BP or PP stents. The diffuse pattern of restenosis was observed in 26.8% of patients treated with BP stent and 26.5% of patients treated with PP stent (P = 0.79). Conclusion : Angiographic characteristics of restenosis after BP‐based limus‐eluting stents are similar to those of PP‐based limus‐eluting stents. © 2011 Wiley‐Liss, Inc.