C反应蛋白与传统心血管危险因子的相关性研究

目的 探讨C反应蛋白（CRP）与传统心血管危险因子的相关性。方法 按CRP水平分为高CRP组213例，低水平CRP对照组202例，分析两组各心血管危险因子；分别以危险因子：性别（女／男）、吸烟（吸烟／不吸烟）、糖尿病（糖尿病／非糖尿病）、体重指数（BMI）（超重／正常）、血脂（异常／正常）、血压（高血压／正常）为切入点分析与高CRP的相关性。结果高CRP组各危险因子参数均比低水平CRP对照组异常明显（P＜0．05），相关分析高CRP与肥胖、糖尿病、血脂异常、女性性别、高血压、吸烟相关联。结论 CRP与传统心血管危险因子相关联。     

C反应蛋白与传统心血管危险因子的相关性

目的探讨C反应蛋白(CRP)与传统心血管危险因子的相关性。方法按CRP水平分为高CRP组213例,低水平CRP对照组202例,分析两组各心血管危险因子;分别以危险因子:性别(女/男)、吸烟(吸烟/不吸烟)、糖尿病(糖尿病/非糖尿病)、体重指数(BMI)(超重/正常)、血脂(异常/正常)、血压(高血压/正常)为切入点分析与高CRP的相关性。结果高CRP组各危险因子参数均比低水平CRP对照组异常明显(P<0.05),相关分析高CRP与肥胖、糖尿病、血脂异常、女性性别、高血压、吸烟相关联。结论CRP与传统心血管危险因子相关联。     

血浆ⅡA分泌型磷脂酶A_2与冠心病相关性研究

目的：研究血浆A分泌型磷脂酶A2（A-sPLA2）与冠心病的相关性。方法：40例确诊冠心病患者（冠心病组）及46例非冠心病患者（对照组）,用酶免法测定血浆中的A-sPLA2浓度 用免疫比浊法测定血清中载脂蛋白A1、载脂蛋白B、脂蛋白a、C-反应蛋白含量 酶法测定血糖、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白。结果：冠心病组体内A-sPLA2浓度显著高于对照组（P〈0.05）。A-sPLA2与CRP呈显著正相关（P〈0.05）,与传统的危险因子（年龄、吸烟、糖尿病、高血压、高胆固醇血症、低HDL-C）的数目及血管病变支数无相关性。多变量Logistic回归分析显示：高浓度A-sPLA2、吸烟、糖尿病是区分冠心病与非冠心病显著的变量。结论：血浆A-sPLA2是冠心病重要的危险因子,与冠心病相关。     

沈阳地区铁路职工内科住院患者冠状动脉性心脏病危险因素结构及强度变化趋势10年分析

目的：分析10年中沈阳地区铁路职工内科住院患者冠状动脉性心脏病（冠心病）危险因素结构及强度的变化趋势，为早期防治冠心病提供依据。 方法：①选择1993／2002沈阳铁路局中心医院心内科住院患者，包括冠心病、风湿性心脏病、高血压、心肌病、心律失常及其他患者。1993／1995组1500例，2000／2002组1500例，调查体质量指数、收缩压、舒张压、血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、吸烟等危险因素结构及强度的变化趋势及与冠心病构成比、住院期间病死率的相关关系。 ②在沈阳铁路局中心医院，调查2003年内科各科系及体检中心就诊的4900例患者的血脂异常，高血压、吸烟、糖尿病、体质量指数、焦虑状态、血半胱氨酸、脂蛋白（a）、C-反应蛋白、年龄及家族史情况。分析冠心病危险因素的强度、结构与冠心病构成比、住院期间病死率的联系。预测沈阳地区铁路职工心血管事件发病的绝对危险度。 结果：1993／1995组1500例，2000／2002组1500例患者全部进入结果分析。2003年来沈阳铁路局中心医院内科就诊的患者4900例全部进入结果分析。①1993／2002冠心病危险因素强度中体质量指数，舒张压、三酰甘油呈显著上升趋势。冠心病危险因素结构排序为：原发性高血压、体质量指数超过标准（肥胖）、高三酰甘油血症、高胆固醇血症、吸烟、糖尿病。②2003年调查资料分析显示：收缩压、舒张压、高三酰甘油血症、高胆固醇血症、吸烟、焦虑、年龄与冠心病构成比呈正相关（r=0．79～0．80，P〈0．01）。收缩压、舒张压、焦虑、年龄与冠心病住院期间病死率呈正相关（r=0.71～0.73，P〈0.05）。沈阳地区铁路职工心血管事件发病绝对危险度男性为13．2％，女性9．7％。 结论：原发性高血压、体质量指数超标、焦虑、高甘油三酯血症、高胆固醇血症、吸烟、糖尿病是沈阳地区铁路职工冠心病危险因素。强度呈上升趋势的危险因素是：高血压（舒张压）、高甘油三酯血症、焦虑。     

冠心病患者sPLA2与hs—CRP联合测定及其临床意义

目的探讨血清分泌型磷脂酶A2（sPLA2）联合高敏C反应蛋白（hs—CRP）测定对冠状动脉粥样硬化性心脏病（简称冠心痛）患者远期心血管事件的临床预测意义。方法经冠状动脉造影证实的172例冠心病患者,分别在入院时测定其sPLA2、hs—CRP,并按不同测定水平分组,通过2年随访,观察sPLA2、hs—CRP对远期心血管事件的预测意义。结果2年后共发生心血管事件49例．高sPLA2组（≥66．48u／m1）的心血管事件发生率为38-46％,调整了高血压、糖尿病、吸烟、冠脉3支病变等传统危险因素后。Cox风险回归提示高sPLA2是预测远期事件的独立危险因素之一,相对危险度（RR）2．76;2年后高hs—CRP组（≥0．03g／L）的心血管事件发生率为39．24％,其RR为2．55;而两者同时升高的患者（sPLA2≥66．48u／ml合并hs～CRP≥0．03g／L）远期心血管事件发生率为52．08％,RR为3.34;在低LDL—C冠心病患者中,高sPLA2、高hs—CRP及高sPLA2＋高hs—CRP组患者2年后发生心血管事件的RR分别为2．66、2．77、3．73。结论sPLA2是冠心病发生远期心血管事件的独立危险因素之一,联合hs—CRP测定能提高对冠心病,特别是LDL—C患者心血管事件的临床预测意义。     

ⅡA分泌型磷脂酶A2与冠心病的关系

目的 测定冠心病患者及非冠心病患者体内ⅡA分泌型磷脂酶A2（ⅡA-sPLA2）的浓度；分析它与高敏C-反应蛋白（hs-CRP）之间的相关性。方法 40例确诊冠心病患者及46例非冠心病患者对照，采用酶免法测定EDTA抗凝血浆中的ⅡA-sPLA2浓度；采用免疫比浊法测定血清中hs-CRP含量；同时，应用酶法测定血糖、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白的浓度。结果 冠心病患者ⅡA-sPLA2浓度的中位数（242．5ng／d1）显著高于非冠心病组的浓度中位数（198．7ng／d1）（P〈0．05）；ⅡA-sPLA2与hs-CRP呈显著正相关（P〈0．05），与传统的危险因子（年龄、吸烟、糖尿病、高血压、高胆固醇血症、低HDL-C）无相关性。多变量Logistic回归分析显示：高浓度ⅡA-sPLA2（333．9ng／d1，非冠心病组90％分布）、吸烟、糖尿病是区分冠心病与非冠心病显著的变量。结论 体内高浓度的ⅡA-sPLA2是冠心病重要的危险因子，它可能与发生动脉粥样硬化时炎症的活化有关。     

原发性高血压患者血浆同型半胱氨酸水平的变化及相关性研究

目的了解原发性高血压患者血浆同型半胱氨酸（Hcy）水平,探讨其与传统心血管危险因素及亚临床靶器官损害之间的关系。方法收集106例原发性高血压患者的相关资料,依据《中国高血压防治指南》行超声心动图、颈动脉超声、估算的肾小球滤过率（iGFR）判断是否存在靶器官损伤（若患者同时存在2种或2种以上的靶器官损伤,则归人各组分别统计）,将106例患者分为单纯高血压组（44例）、高血压伴左心室肥厚组（18例）、高血压伴颈动脉硬化组（46例）及高血压伴iGFR下降组（27例）。同时检测血浆Hcy、血糖（FPG）、血脂、血肌酐（Cr）等,并采用Spearman相关性分析及多元logistic回归对各组数据进行分析。结果Hcy与各靶器官损害呈明显正相关（P〈0,05）,且与传统心血管危险因素[性别、年龄、吸烟、收缩压（SBP）、FPG、Cr]明显相关（P〈0．05）。单纯高血压组血浆Hcy水平[（12．184-3．30）p~mol／L]明显低于高血压伴iGFR下降组[（19．05±8．58）~mol／L]、高血压伴左心室肥厚组[（18．63±7．99）Ixmol／L]、高血压伴颈动脉硬化组[（16．80±6．34）~mol／L]（P均〈0．05）。高血压伴颈动脉硬化组年龄、Hcy、血糖、iGFR与单纯高血压组比较差异有统计学意义（P〈0．05）。以有无颈动脉粥样硬化为因变量,年龄、血糖、iGFR和Hcy为自变量,通过多元logistic回归分析,结果表明仅有年龄是高血压患者颈动脉粥样硬化的独立危险因素。按美国心脏病协会制定的Hcy异常临界值标准（〉15μmol／L）将Hcy区分为正常和升高,高血压伴Hcy升高者罹患颈动脉粥样硬化的风险比Hcy正常者高出2．74倍。结论年龄是高血压患者颈动脉粥样硬化的独立危险因素;Hcy升高与高血压患者亚临床靶器官损害密切相关,且罹患颈动脉粥样硬化的风险上升。     

原发性高血压患者C-反应蛋白与动脉粥样硬化的关系

目的 对不同程度的原发性高血压患者进行血浆高敏C-反应蛋白（C—reactive protein。CRP）检测，探讨超敏C-反应蛋白（hs—CRP）在动脉粥样硬化疾病中的临床意义。方法 对30例1～2级原发性高血压患者（第1组）和30例3级原发性高血压患者（第2组）进行hs—CRP、内皮素、同型半胱氨酸（HCY）和血脂检测、颈动脉超声检查，与除外原发性高血压、冠心病、糖尿病以及各种感染、肿瘤患者进行比较分析。结果 第2组hs—CRP、内皮素、HCY浓度明显高于第1组，差异有显著性（P〈0．05）。两组分别与对照组比较差异有非常显著性（P〈0．01）。第2组颈动脉硬化最严重。血脂除低密度脂蛋白胆固醇（LDL—C）两组间比较差异有显著性外（P〈0．05），均无明显差异。结论 原发性高血压患者血液中hs—CRP、内皮素、HCY浓度与原发性高血压和颈动脉粥样硬化程度呈正相关。对血脂正常的患者测定hs—CRP尤其重要，对血脂和hs—CRP两个危险因子联合测定，对心血管事件的发生会有更高的预报作用。     

早发冠心病的高血压患者危险因素分析

目的探讨早发冠状动脉粥样硬化性心脏病(简称冠心病)的高血压患者传统冠心病危险因子的流行病学特点。方法对比冠状动脉造影证实的267例合并早发冠心病的高血压患者(病变组)与96例冠状动脉正常的高血压患者的临床资料和实验室检查结果,分析其中主要心血管危险因素。结果病变组比正常组的男性、早发冠心病家族史、糖尿病、吸烟、饮酒比例显著增高,且在体重指数、甘油三酯、极低密度脂蛋白胆固醇、尿素氮、尿酸、白细胞计数和C反应蛋白水平上显著增高,但高密度脂蛋白胆固醇水平较低(P<0.05)。多元Logistic回归分析表明,早发冠心病家族史、低高密度脂蛋白胆固醇血症、高甘油三酯血症、糖尿病年数、性别对早发冠心病有显著的预测价值,OR值分别为12.317、3.267、2.894、1.140、0.088。结论低高密度脂蛋白胆固醇血症和高甘油三酯血症是我国汉族人群年轻高血压患者出现早发冠心病的重要的可控危险因素。     

阿尔茨海默病与动脉硬化及其危险因素的关系探讨

目的探讨阿尔茨海默病(Alzheimer disease,AD)与动脉硬化及其危险因素之间的关系。方法选取临床诊断为AD患者106例作为观察组,认知功能正常老年人80例为对照组。两组性别、职业及受教育程度相匹配,分析两组中高血压、糖尿病、血脂代谢异常、颈部血管狭窄及斑块、颈部血管内膜增厚、颅内血流速度减慢、吸烟、饮酒以及脑梗死的分布情况。以Logistic回归模型分析各因素与AD的关系。结果高血压、糖尿病、血脂代谢异常、颈部血管狭窄及斑块、颈部血管内膜增厚、双侧大脑前、中、后动脉血流速度减慢以及脑梗死在AD与对照组之间差异有统计学意义(P<0.05),而吸烟、饮酒在AD与对照组之间差异无统计学意义(P>0.05)。结论 AD与血管性因素有关,高血压、糖尿病、血脂代谢异常、脑梗死、颈部血管狭窄及斑块、颈部血管内膜增厚、颅内血流速度减慢是AD的独立危险因素。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.