血浆脑钠素测定对心衰的诊断价值

目的测定心衰患者血浆脑钠素水平,探讨脑钠素测定对心衰的诊断价值。方法随机选择106例住院心衰患者及65例无器质性心脏病患者作为研究对象,入院当日采静脉血,应用ELISA法测定血浆脑钠素水平。结果随着心衰程度的加重,血浆脑钠素水平逐渐升高。结论血浆脑钠素水平可以判断心衰的严重程度,具有广泛的临床应用价值。     

CTGF和NT-ProBNP联合检测在心衰诊断中的应用价值

目的探讨分析结缔组织生长因子与N末端B型钠尿肽原联合检测在心衰诊断中的应用价值。方法回顾性分析我院于2010年1月-2012年11月收治的96例心衰患者的临床资料,并将同时期来我院进行体检的96例健康者作为对照组。比较两组间血浆CTGF与NT-ProBNP水平的差异,并观察CTGF联合NT-ProBNP在诊断中的准确性。结果心衰组左室射血分数明显低于对照组{（58.2±9.7vs 66.5±10.4）%t=5.718 P〈0.05},心衰组血清CTGF与NT-ProBNP水平要显著高于对照组{（6.7±2.1vs 4.0±2.5）μg.L-1,（694.8±257.3vs 70.5±24.6）ng.L-1,t=8.103,23.665 P〈0.05）};随着心功能分级的升高,心衰患者血清CTGF与NT-ProBNP的水平显著上升（P〈0.05）,Pearson’s相关性分析结果显示心衰患者左室射血分数与血清CTGF及NT-ProBNP水平呈负相关（r=-0.392,-0.528 P〈0.05）;CTGF与NT-ProBNP联合检测的ROC曲线下面积大于单独诊断。结论 CTGF与NT-ProBNP联合检测在心力衰竭的诊断中有着较为重要的意义,能够作为新的检测指标进行推广。     

联合检测CTGF和NT-ProBNP在心衰诊断中的应用价值

目的：探讨血清结缔组织生长因子（CTGF）和N末端B型脑钠肽（NT-ProBNP）联合检测在心衰临床诊断中的价值。方法：对100例心衰患者和100例健康人群的血清CTGF、NT-ProBNP水平进行对比分析,观察CTGF、NT-ProBNP联合应用在心衰诊断中的意义。结果：随着NYHA分级的增加,CTGF、NT-ProBNP水平检查结果明显增加（P〈0.05）;Pearson＇s分析结果显示：慢性心衰患者的CTGF和NT-ProBNP水平与LVEF呈显著负相关（P〈0.05）;ROC曲线分析结果显示：与单独检测NT-ProBNP相比,联合检测CTGF和NT-ProBNP诊断心衰时的ROC曲线下面积明显增大（P〈0.05）。结论：在心衰的检测中,联合检测CTGF和NT-ProBNP有着较理想的灵敏度和特异性,能有效提高心衰诊断的准确性,且血清学检测简单方便,可作为诊断心衰的较为理想的辅助指标。     

血浆BNP测定对老年人心衰诊断价值及预后评估

目的测定心衰患者的血浆BNP水平,探讨血浆BNP对老年人心衰的诊断价值及心功能的评估。方法选择本院住院心力衰竭的老年患者77例,健康对照老年组46例,分别测定血浆BNP浓度,比较不同患者的血浆BNP水平。结果心衰组血浆BNP水平[(662.31±326.18)ng/L]显著高于对照组[(51.26±19.16)ng/L](P0.01);且随着心衰程度的加重,心力衰竭患者的血浆BNP水平逐渐增高。结论血浆BNP测定对心力衰竭的诊断和心功能的分级及预后判断都有重要的临床价值。     

心力衰竭患儿血浆NT-pro BNP水平与心功能的研究

目的探讨心力衰竭患儿血浆氨基末端脑钠肽(NT-pro BNP)水平与心功能的相关性,评价其对心力衰竭患儿诊断的临床价值。方法分别选取健康婴幼儿、心力衰竭患儿各30例作为对照组和患儿组,采用化学发光法测定两组研究对象治疗前后血浆NT-pro BNP的水平,检测患儿组心功能参数及临床症状的变化,并与其血浆NT-pro BNP水平作相关性回顾分析。结果患儿组治疗前血浆NT-pro BNP水平显著高于对照组,差异有统计学意义(P<0.05)。经治疗,患儿临床症状明显缓解,且患儿血浆NT-pro BNP水平显著降低,超声心动图左室射血分数(LVEF)亦有明显提高,差异均有统计学意义(P<0.05)。患儿组治疗后血浆NT-pro BNP水平亦显著高于对照组,且差异有统计学意义(P<0.05)。患儿组治疗前后其血浆NT-pro BNP水平和LVEF均呈负相关(r=-1.32,r=-1.78)。结论血浆NT-pro BNP水平检测对心力衰竭患儿的临床诊断、病情评估、预后考核及患儿心功能分级具有重要临床指导意义。     

Hematological characteristics in blood autoanalysis in children with congenital heart defects

Hematological status of infants with congenital heart disease (CHD) was evaluated by automated systems. Blood analyses were carried out in 40 infants with the pale type and in 20 with the blue type CHD. Increased erythrocyte count and hematocrit were detected in the blue type CHD. Evaluation of the leukocytic formula showed correlation of the results of automated analysis and microscopic analysis of a blood smear. Automated method is preferable for estimating platelet count. Platelet count was decreased and the cells were larger in patients with the blue type disease in comparison with the pale type group. Hence, automated analyzer gives a wide spectrum of blood values with high accuracy and productivity and helps evaluate hemopoiesis in patients with CHD.     

Immune response to allograft implantation in children with congenital heart defects

Cryopreserved valved allografts are frequently used in the repair of congenital heart defects in children. Although the longevity of these grafts is generally good in most patients, there continue to be ongoing problems with allograft dysfunction and subsequent failure, particularly in infants and young children. The aim of this review is to discuss the immunogenicity of cryopreserved allograft tissue and measures that may minimize the deleterious effect of the immune system on allograft function and durability.     

Immune response to allograft implantation in children with congenital heart defects

Cryopreserved valved allografts are frequently used in the repair of congenital heart defects in children. Although the longevity of these grafts is generally good in most patients, there continue to be ongoing problems with allograft dysfunction and subsequent failure, particularly in infants and young children. The aim of this review is to discuss the immunogenicity of cryopreserved allograft tissue and measures that may minimize the deleterious effect of the immune system on allograft function and durability.     

Hemorheology and morphofunctional characteristics of blood cells in children with congenital heart defects

Patients with congenital heart diseases (CHD) aged 4 months to 12 years, hospitalized for surgical treatment, were examined. Complex viscosity of the blood and the constituents of this parameter (dynamic viscosity and elastic component) were evaluated in the range of shift strain corresponding to the range of shift velocities 0.37-500 s-1 at a frequency of 2 Hz. The threshold blood fluidity was estimated for evaluating the conditions under which erythrocyte disaggregation begins. The relationship between blood rheology and morphofunctional characteristics of blood cells was evaluated. In accordance with the findings, the patients were divided into 3 groups with different suspension stability of the blood. In group 1 the threshold fluidity approximated the norm. In group 2 with normal blood rheology the shifts were compensated and regulation of rheology was in general intact. In group 3 the hematocrit values, mean erythrocyte volume, mean concentration of hemoglobin in erythrocyte, leukocyte counts, and complex viscosity of the blood were the highest, while the suspension stability was the lowest, which indicates depletion of the adaptive potential of the organism. Hence, blood rheology in patients with CHD differs by the type of regulation, mechanisms and compensation of changes, and depend largely on the mean erythrocyte volume, mean hemoglobin concentration in erythrocytes, and leukocyte counts.     

Diagnosing heart failure in children with congenital heart disease and respiratory syncytial virus bronchiolitis

ObjectiveThe objective of this study is to examine if the B-type natriuretic peptide (BNP) can be used in diagnosing heart failure (HF) in children with congenital heart disease (CHD) who present to the emergency department (ED) with acute bronchiolitis.MethodsA prospective cohort single-group study of children with CHD and respiratory syncytial virus bronchiolitis was conducted in a pediatric ED. The reference standard for the presence of HF was the clinical and echocardiographic assessment of a pediatric cardiologist blinded to the BNP test results.ResultsEighteen cases were diagnosed, 7 (39%) had acute HF and 11 (61%) did not have acute HF. Patients with HF had a higher level of BNP compared with patients who did not have HF (783 pg/mL [interquartile range, 70-1345] vs 59 pg/mL [interquartile range, 23-90]; P < .013). A BNP level of 95 pg/mL was the optimal cutoff point, having a sensitivity of 0.71 (95% confidence interval, 0.29-0.96) and a specificity of 0.91 (95% confidence interval, 0.58-0.99).ConclusionThe results of this small study suggest that the BNP test can be useful to ascertain the presence of HF in children with CHD who present to the ED with respiratory syncytial virus bronchiolitis.     

睡眠状态下头皮静脉穿刺在先天性心脏缺损患儿中的应用

静脉输液是临床上用于纠正人体水、电解质及酸减平衡失调,恢复内环境,维持机体正常生理功能的重要治疗措施[1].头皮静脉输入药物是婴儿治疗的主要途径,也是护理的基本操作技能.     

Acquired von Willebrand syndrome in two children with congenital heart defects and abnormal haemodynamics

Acquired von Willebrand syndrome is a rare bleeding disorder associated with other primary diseases such as cardiovascular disorders which can cause severe haemorrhage during surgery or interventional procedures. It should be suspected if there is no history of bleeding and abnormal von Willebrand factor (VWF) values in patients with predisposing disorders. We present two children with congenital heart defects and no personal or family history of bleeding. In these patients we preoperative diagnosed acquired von Willebrand syndrome with coagulation tests including analysis of the VWF multimeric pattern.     

The role of BNP testing in heart failure

Brain natriuretic peptide (BNP) levels are simple and objective measures of cardiac function. These measurements can be used to diagnose heart failure, including diastolic dysfunction, and using them has been shown to save money in the emergency department setting. The high negative predictive value of BNP tests is particularly helpful for ruling out heart failure. Treatment with angiotensin-converting enzyme inhibitors, angiotensin-II receptor blockers, spironolactone, and diuretics reduces BNP levels, suggesting that BNP testing may have a role in monitoring patients with heart failure. However, patients with treated chronic stable heart failure may have levels in the normal range (i.e., BNP less than 100 pg per mL and N-terminal proBNP less than 125 pg per mL in patients younger than 75 years). Increases in BNP levels may be caused by intrinsic cardiac dysfunction or may be secondary to other causes such as pulmonary or renal diseases (e.g., chronic hypoxia). BNP tests are correlated with other measures of cardiac status such as New York Heart Association classification. BNP level is a strong predictor of risk of death and cardiovascular events in patients previously diagnosed with heart failure or cardiac dysfunction.     

辛伐他汀对缺血性心力衰竭大鼠脑钠肽及射血分数的影响

目的:探讨3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂辛伐他汀对缺血性心力衰竭大鼠模型血清脑钠肽及射血分数的影响。方法:选择健康雄性SD大鼠100只,制作急性心肌梗死后心力衰竭模型,造模成功后随机选取16只大鼠分为对照组及他汀组,每组8只,另设假手术组8只大鼠,他汀组直接予辛伐他汀5 mg/(kg.d)灌胃,对照组及假手术组予等量蒸馏水灌胃,4周后行射血分数的超声测定及血清脑钠肽水平检测。结果:4周后他汀组与对照组脑钠肽水平均升高,同时射血分数下降,与假手术组比较差异均有统计学意义(P均<0.05);其中他汀组的脑钠肽水平低于对照组,射血分数高于对照组(P均<0.05)。血清脑钠肽水平与射血分数呈负相关关系(r=-0.71,P<0.01),心力衰竭大鼠血清脑钠肽浓度随射血分数升高而降低。结论:缺血性心力衰竭大鼠在接受辛伐他汀治疗时可明显改善心功能。     

阿托伐他汀对慢性心力衰竭患者血清脑钠肽水平及心功能的影响

目的探讨阿托伐他汀对慢性心力衰竭(CHF)患者血清脑钠肽(BNP)水平及心功能的影响。方法将95例CHF患者随机分为治疗组和对照组。对照组给予常规ACEI、地高辛等基础治疗;治疗组进一步随机分为A、B、C共3个组,均在对照组基础上分别加用不同剂量的阿托伐他汀。治疗前及治疗后6、12周检测所有患者的左心室射血分数(LVEF)和血浆BNP浓度。结果与对照组比较,治疗组BNP下降水平和LVEF上升水平均更为显著(P<0.05);治疗后6周,B、C组血浆BNP水平及LVEF均较A组显著降低(P<0.05),但B、C组血浆BNP水平及LVEF经比较无显著差异(P>0.05);治疗后12周,A、B、C组BNP水平及LVEF与同组治疗后第6周比较均无显著差异(P>0.05)。结论阿托伐他汀能明显降低CHF患者血浆BNP水平,改善LVEF,有利于CHF患者心功能的改善。     

The role of cardiovascular MRI in heart failure and the cardiomyopathies

Heart failure (HF) is a common syndrome related to varied pathophysiologic processes. Individualization of care according to the patient's pathologic and modifiable substrate is of increasing importance. The use of modern cardiovascular MRI (CMR) provides for the centralization of diagnostic testing with the ability to assess cardiac morphology, function, flow, perfusion, acute tissue injury, and fibrosis in a single setting. This offers the potential for a paradigm shift in the noninvasive diagnosis and monitoring of patients with HF. This article outlines a diagnostic approach for the primary use of CMR in the phenotypic characterization, risk stratification, and therapeutic management of patients with HF.