冠状动脉造影正常的急性心肌梗死的临床特点及预后

目的:评估冠状动脉造影正常的急性心肌梗死患者的临床特点,并分析影响其预后的因素。方法:选取2010年1月至2014年3月收治的40例因急性心肌梗死而行冠状动脉造影检查正常患者作为观察组,同期40例行冠状动脉造影结果显示有冠状动脉病变的心肌梗死患者作为对照组,随访12个月,综合比较两组患者的临床特点、随诊及预后情况。结果:两组患者在吸烟率、家族冠心病史、前壁心梗发生率等方面比较差异无统计学意义(P>0.05),观察组患者高血压、糖尿病、肥胖、高血脂等发生率均低于对照组(P<0.05)。结论:冠状动脉造影正常的急性心肌梗死患者预后优于冠心病所致心肌梗死患者,影响预后的两个独立预测因素为左室射血分数和糖尿病。     

青年ST段抬高型心肌梗死患者的临床、冠状动脉造影特点及预后

目的 探讨年龄≤40岁青年ST段抬高型心肌梗死(STEMI)患者的临床发病、危险因素、冠状动脉病变特点及预后.方法 回顾性分析2005年5月-2010年5月在复旦大学附属中山医院心内科行经皮冠状动脉介入治疗(PCI)的STEMI患者,按年龄段分组:青年组(≤40岁),中年组(≥41岁且≤59岁组),老年组(≥60岁).分析各组的危险因素、冠状动脉造影特点、PCI治疗情况,并随访患者12个月的预后.结果 接受直接PCI的青年STEMI患者占所有STEMI患者的2.2％.青年组的男性构成比最高(95.0％);青年组的吸烟构成比为85.0％,显著高于老年组的64.8％(P＜0.05);青年组有冠状动脉性心脏病家族史的构成比也显著高于中、老年组(P值均＜0.05).青年组单支病变构成比为65.0％,显著高于中年组的24.8％和老年组的20.6％(P值均＜0.05);罪犯血管以左前降支最为多见,在青年组达到70.0％,显著高于中年组的57.5％和老年组的45.1％(P值均＜0.05).3组间PCI治疗成功率的差异均无统计学意义(P值均＞0.05).青年组在住院期间及随访12个月时严重心力衰竭发生率显著低于老年组;虽然3组间病死率的差异无统计学意义(P＞0.05),但随访12个月时青年组主要心血管不良事件发生率显著低于中、老年组(P值均＜0.05).结论 青年心肌梗死患者的临床危险因素特征、冠状动脉病变特点及预后与老年患者均存在较大的差异,心脏功能及主要心血管不良事件等远期预后较好.     

冠状动脉造影正常心肌梗死患者的临床特点和预后

目的评估冠状动脉造影正常的心肌梗死患者的临床转归,分析其病因和影响预后的因素。方法回顾分析我院近10年因心肌梗死而行冠状动脉造影检查大致正常患者32例的临床资料,并根据年龄、性别选择32例同期行冠状动脉造影结果有冠状动脉病变的心肌梗死患者为对照组。比较两组间的基本临床情况、可能病因、随诊临床预后等。结果冠脉造影正常组与冠心病组在吸烟率、冠心病家族史方面无差异。冠心病组患者有更高的肥胖、高血压、高血脂和糖尿病发生率(P=0.02～0.05)。冠脉正常组24例疑为冠脉痉挛或血栓自溶,1例有先天性凝血功能障碍,1例有结缔组织病,1例为主动脉夹层动脉瘤,2例冠状动脉畸形,3例发现有梗死相关血管肌桥。冠脉正常组的左室射血分数高于冠心病组(P=0.04)。平均随访42个月(12～118个月),联合终点(死亡、再发心梗、心衰、中风)在冠脉正常组为28.2%,冠心病组为68.8%(P<0.01)。冠脉正常组生存率为93.7%,冠心病组90.6%,两组无显著性差异。单变量分析冠脉正常组的预后预测因子为左室射血分数、年龄、糖尿病和吸烟,多变量分析冠脉正常组长期预后的独立预测因子为左室射血分数和糖尿病。结论冠状动脉造影正常的心肌梗死患者长期预后比冠心病所致心肌梗死者要好,死亡率亦明显低。冠脉正常并心肌梗死患者预后差的两个独立预测因素为左室射血分数和糖尿病。     

青年急性心肌梗死患者的临床及冠状动脉造影特点

①目的 探讨青年急性心肌梗死(AMI)患者的临床、冠状动脉造影及预后特点.②方法 回顾性分析40例靑年(年龄＜45岁)AMI患者的临床资料,并与40例老年(年龄≥60岁)AMI患者进行比较.③结果 两组患者性别、典型心绞痛、吸烟史、心血管病家族史、高血压、糖尿病构成比,差异均有统计学意义(P＜0.01).与老年组AMI患者比较,青年AMI患者冠状动脉病变以单支病变多见(P＜0.01),心力衰竭、心源性休克、心律失常及病死率均较低(P＜0.05).④结论 青年AMI患者临床表现典型,冠心病危险因素多,冠状动脉狭窄程度轻,并发症少,预后好.     

老年急性心肌梗死的临床特点

目的 观察老年急性心肌梗死的发病特点和预后。方法 将1213例急性心肌梗死患者按年龄分为老年组和非老年组加以比较分析。结果 老年患者女性和非sT段抬高心肌梗死比例以及死亡率、心脏事件均明显高于非老年组。老年组中随年龄的增加，女性、非ST段抬高心肌梗死、死亡率和心脏事件亦增加；老年组中女性发病年龄更高；女性心脏事件和死亡均明显多于男性。结论 老年急性心肌梗死患者非sT段抬高心肌梗死增多，心脏事件多，死亡率高。其中老年女性心脏事件更多，死亡率更高。     

青年人急性心肌梗死的高危因素和临床特点

目的:探讨青年人急性心肌梗死的高危因素和临床特点。方法:将临床确诊为急性心肌梗死、年龄≤40岁的患者148例(青年组)与年龄≥60岁的患者156例(老年组)进行病例对照研究,分析青年人急性心肌梗死的高危因素、冠脉造影特点及预后。结果:青年组与老年组比较,急性心肌梗死危险因素中吸烟史、冠心病家族史明显增高,而合并高血压或糖尿病则低于老年患者。青年组患者的TG水平明显高于老年组,且HDL-C水平明显低于老年组患者。青年组与老年组患者比较,其单支冠脉病变患者所占的比例(57%)明显高于老年组(9%)。青年组患者的死亡率(3%)明显低于老年组(15%)。结论:吸烟及冠心病家族史是青年人急性心肌梗死的主要危险因素;青年组急性心肌梗死的冠脉病变程度及死亡率显著低于老年组。     

老年急性心肌梗死患者临床及冠状动脉造影特点

目的 探讨老年人急性心肌梗死(AMI)的临床特征与冠状动脉病变特点.方法 280例住院AMI患者分为老年组(年龄71.5±6.1岁)150例和非老年组(年龄49.7±6.5岁)130例,分析两组患者的临床特征及冠状动脉造影特点.结果 老年AMI女性发病明显增高,住院时间长,有高血压、非ST段抬高心肌梗死、3支病变及左主干病变、并发心衰、合并感染的患者明显高于非老年组,而冠心病阳性家族史、肥胖、吸烟、造影见新鲜血栓、典型胸痛的比例明显低于非老年组,两组就诊时间、有糖尿病、高脂血症、陈旧心梗及接受直接PCI的病人差异无显著性,两组表现为ST段抬高的心肌梗死患者的梗死部位、梗死相关血管的分布及狭窄程度、直接PCI患者从发病至球囊扩张时间、PCI即刻成功率差异无显著性,两组梗死后心绞痛、心源性休克、死亡、再梗死及心律失常的发生率差异无显著性.结论 老年AMI患者症状不典型,易合并心衰,冠脉病变严重,PCI的即刻成功率与非老年组差异无显著性,住院期间病死率无增高,提示介入治疗是老年AMI患者的很好的可供选择的治疗方法.     

冠状动脉造影正常的心肌梗死患者临床特征分析

目的：分析冠状动脉造影（CAG）正常的急性心肌梗死（AMI）患者的临床特征、可能的发病机制及预后。方法：对838例临床诊断为AMI患者行冠状动脉造影，观察冠状动脉造影正常的AMI患者临床特征，并进行随访观察预后。结果：838例AMI患者中，冠状动脉造影显示正常42例，占5．0％，CAG正常组年龄、既往心绞痛病史明显低于CAG异常组（P〈0．05），高血压、高脂血症、糖尿病史较异常组明显降低（P〈0．05），吸烟、起病前诱因较异常组显著增多（P〈0．01）。CAG正常组预后较好，发生心衰及总心血管事件少（P〈0．05）。结论：冠状动脉造影正常的心肌梗死发病机制可能是由于冠状动脉痉挛或微小斑块破裂形成血栓，继而发生血栓自溶而致造影无异常，预后相对较好。     

老年急性心肌梗死并心源性休克72例临床分析

目的回顾性分析老年心源性休克(cardiogenic shock,CS)患者临床特点,探讨不同干预措施对老年CS患者近期预后的影响。方法126例由急性心肌梗死所至的CS患者按年龄被分为两组:年龄大于或等于65岁为老年组(A组,n=72);年龄小于或等于64岁为成年组(B组,n=54);并将老年组根据是否接受PCI治疗分为两个亚组。回顾性分析两组患者的临床特征及不同再灌注治疗下老年心肌梗死并CS患者近期预后的差异。结果(1)老年组临床症状不典型者多;冠心病危险因素、并发症多(P<0.05);侵入性的积极治疗措施应用较少(如冠脉造影I、ABP及PCI,P<0.05);住院病死率高(P<0.05)。(2)经皮冠状动脉介入(PCI)治疗与非介入治疗相比能显著降低老年CS患者住院病死率(P<0.05)。结论严密监测,积极处理各种并发症,及时介入治疗,可明显改善老年CS患者的早期预后。     

急性心肌梗死的老年患者行冠状动脉造影术

背景：尽管急性心肌梗死（AMI）老年患者的死亡率很高，但冠状动脉造影（CA）在老年患者中的价值因其不理想的预后而受到质疑。本研究旨在确定在真实实践中，CA对老年AMI患者死亡率的预后意义。方法：从1996-2000年间以色列全部25个CCU中进行的3项全国性前瞻性调查中，人选了1009例老年AMI患者（年龄≥75岁）。将274例（27％）住院期间行CA的老年患者的基线特征、住院情况、治疗和预后与735例（73％）未行CA的对照患者进行比较。[第一段]     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.