声学密度定量技术评价轻度心肌缺血的价值探讨

目的探讨声学密度定量技术在评价轻度心肌缺血中的价值。方法经单光子发射型计算机断层扫描检测的32例患者,采集舒张末期左室乳头肌水平短轴切面超声图像。应用超声定量分析仪分别测量各节段心内膜及相邻心肌平均回声强度,并计算其比值。比较缺血区与非缺血区回声强度及其心内膜与心肌回声强度比值。结果缺血节段心内膜较相邻心肌回声强度更高,缺血节段心内膜与心肌回声强度比值较同一患者非缺血节段及无病变患者相应节段更高。结论区域性心内膜与心肌回声强度比值增高可能是心肌轻度缺血的一个重要指标。     

彩色编码显示技术对左、右冠状动脉主干壁回声强度诊断价值的探讨

本研究用二维超声心动图及彩色编码显示技术对61人的左冠状动脉及91人的右冠状动脉主干壁回声强度进行分析。受检者包括冠心病、风心病、先心病等和正常人。用36个色量级观察。冠心病患者的左、右冠状动脉主干壁回声色量级都显著高于非冠心病患者及正常人,P<0.01。而非冠心病患者与正常人之间,以及按年龄分组计算的左、右冠状动脉壁色量级则无显著差异。结论:1.用彩色编码技术分析冠状动脉灰阶图象,可以提高对组织回声强度分析的准确性;2.实时二维超声心动图与彩色编码技术相结合,可以对左、右冠状动脉主干的解剖学以至某些组织学异常改变作出较为细致的判断。     

超声引导下经皮穿刺活检对浅表肺和胸膜病变的临床意义

目的探讨超声定位引导下经皮穿刺对浅表肺和胸膜病变进行活检及病理诊断,以提高超声声像图分析诊断准确性.方法对82例患者先行超声扫查,确定病变部位,记录病变形态、大小、边界、内部回声、活动度、胸膜变化等指标,消毒局麻后超声定位引导穿刺针进入病变中心,取材组织送病理组织学检查并行常规涂片细胞学检查.结果超声定位引导穿刺活检(18 G针)病理组织学诊断率达81.7%(67/82);细胞学诊断率60.9%(50/82).术后仅有2例患者2.4%(2/82)出现轻度咳嗽伴有少量血痰,经对症处理后症状消失,其余患者均无出血等并发症发生.病理诊断肺癌18例,超声显示病变呈类圆形低水平回声或中等回声;病理诊断局灶性肺炎性实变47例,超声表现为片状或楔形的低回声及双线状强回声;病理诊断肺结核瘤12例及肺炎性假瘤4例,超声显示病变均呈类圆形的低回声表现,肺结核瘤部分病变内可见强回声钙化灶;病理诊断肺错构瘤1例,超声显示病变呈欠均匀的弱回声团.结论超声引导下经皮对浅表肺和胸膜病变进行组织学穿刺活检,可快速明确诊断,超声与病理对照检查有利于提高超声声像分析诊断准确性并对临床选择和制定合理的治疗方案有重要指导意义.     

正常肝脏声象图定量分析研究

B型超声诊断疾病,通常是根据图象所显示某一器官或病变的大小、形态及内部结构等变化作出诊断。而这些变化在B超仪屏幕上又是以点状回声、带状回声、团状回声及无回声区等组成的一幅幅声象图显示出来。每一幅图象中感兴趣区的回声强度不同,就有可能作出不同的诊断,如若回声强度判断不准确,就可能发生误诊。多年来,人们判断声象图的回声强度,都是根据操作人员的视感觉和经验而定,实际上是定性分析,这其中     

恶性胸腔积液彩阶B超显示与分析

恶性胸腔积液彩阶Ｂ超显示与分析辽宁省鞍山市第四医院周雅元本文介绍５３例不同性质恶性胸腔积液彩阶Ｂ超显示结果，同时对该组病例彩阶Ｂ超显示过程中产生色量级变化的可能因素加以分析。资料和方法全部病例为本院住院患者，原发病经病理和／或细胞学诊断为恶性肿瘤，彩...     

B超彩阶色量级对宫外孕诊断价值与分型的初步研究

本文报道了彩阶B超对宫外孕的诊断与分型58例,根据宫外孕的不同彩阶声象图表现。并经手术对照,将宫外孕分为胎囊型、囊肿型、混合型,实性包块型及漂浮型,总结了彩阶图象的各型特点,灰阶超声由于低回声信号不易为人眼识别,甚至有用信息丢失。彩阶超声利用色量级的对比。可提高诊断正确率,本文结果表明：彩阶超声有助于对宫外孕的类型作出较为客观的评估,对临床确定治疗方案有一定的参考价值。     

超声心动图新技术评价左心室功能的研究进展

一、声学定量技术 1．基本概念与成像特点：声学定量（acoustic quantification，AQ）技术是在心肌与血液背向散射积分值不同的基础上，辅以计算机数字化图像边缘检测技术，对心脏回声信号进行联机实时分析，能实时区分血液与心肌组织的散射回声信号，并进一步描绘心内膜轮廓和显示心腔容量随时间变化的曲线。声学定量评价心功能可实时计算心腔面积、容积及其变化率，检澳¨心脏泵功能和心肌收缩力的各项指标。根据所检测的参数还可进一步计算面积变化率、容积变化率、心搏出量和心功能指数等。     

多普勒超声评价系统性红斑狼疮的心脏改变

目的：了解ＳＬＥ患者的心脏损害。方法：采用多普勒超 声检测ＳＬＥ患者的心脏结构及功能。结果：ＳＬＥ患者左心收缩功能正常组出现心内膜、心肌损害者１０例（２０％），出现心包积液者５例（１０％）。左心收缩功能减低组，全部病例有心肌、瓣膜及心包的损害。结论：多普勒超声可显示ＳＬＥ患者的早期心脏改变。     

超声心动图心肌造影观察心内膜下心肌缺血

心肌缺血在心电图上的表现是ST段降低,因为当冠状动脉血流减少时,全层心肌血流分布倾向于近心外膜层而产生心内膜层心肌的明显缺血。超声心动图心肌造影是用图象的方法去显现人类这种穿壁性心肌血流分布改变的。 选择21例患者,其中11例有冠状动脉病变(男6,女5,年龄51～78岁,平均63岁)和10例没有     

尖端扭转型室性心动过速与临床

尖端扭转型室性心动过速临床并不少见,虽建立在心脏异质性增大基础上的Q T间期延长被认为是其发生的主要原因,但对其发生机制仍意见不一。该现象是触发于心肌动作电位时程超常期,原发于心内膜的病变在心脏异质性增大时,因兴奋频率低于心外膜,心脏自身调节抑制心肌电紊乱的基础上,出现心律失常起源点游移于心内膜与心外膜之间,进而出现相应心电图改变。心肌缺血、缺氧、离子通道变异、内环境紊乱及药物因素等均可致心脏异质性增大。如何去除诱因,降低心脏异质性,保证心脏复极同步是治疗的关键。     

Enzyme-linked immunosorbent assay for anti-tropomyosin antibodies and its clinical application to various heart diseases

Tropomyosin is one of the key proteins for muscle contraction. We developed an enzyme-linked immunosorbent assay for antibodies to porcine muscle tropomyosin and measured serum anti-tropomyosin antibodies in patients with heart diseases and in normal controls. The mean values of absorbance in the ELISA assay of patients with ischemic heart disease (n=36, P<0.001), dilated cardiomyopathy (n=28, P<0.005), valvular heart disease (n=27, P<0.05), and collagen disease (n=38, P<0.05) were significantly higher than those of normal controls (n=53), but the value in patients with hypertrophic cardiomyopathy (n=19) was not significantly different from that of normal controls. When the cut-off value was fixed at the mean+2 SD of absorbance in normal controls, positive reactions were found in 19.4%, 7.1%, 18.5% and 15.8% of patients with ischemic heart disease, dilated cardiomyopathy, valvular heart disease, and collagen disease, respectively. An inhibition study revealed that anti-tropomyosin antibodies were different from anti-myosin antibodies, but there was a partial cross-reactivity between the two. Thus, there was a weak correlation of the titers of the two types of antibody within the group of heart diseases. These data indicate that measurement of anti-tropomyosin antibodies by ELISA is helpful for detecting autoimmune abnormalities in various heart diseases.     

老年心肌梗死患者牙周病龋齿缺齿情况调查分析

目的 分析老年心肌梗死患者牙周病、龋齿、缺齿发生情况，探讨牙周病、龋齿、缺齿与缺血性心脏病的关系。方法 对我院70例老年男性心肌梗死患者和60例老年健康疗养者的牙周指数、龋齿、缺齿情况进行了检测、统计、分析。结果 老年心肌梗死组各项牙周指数、龋齿、缺齿数明显高于老年健康组。结论 牙周病、龋齿、缺齿、是缺血性心脏病的重要发病因素之一。     

p38MAPK信号通路的变化在心力衰竭病人心肌重塑中的意义

目的：了解不同程度充血性心力衰竭（DHF）病人心肌细胞信号传导通路p38MAPK的变化与心肌重塑和心功能的关系。方法：通过手术取材，采用Western blotting技术测定31例瓣膜病所致CHF病人不同心功能组与5例正常人心肌细胞p38MAPK蛋白基础表达和激活情况。结果：瓣膜病所致心力衰竭病人心肌组织呈心肌重塑的病理改变。心衰组p38MAPK基础表达受抑，激活的磷酸化p38MAPK在轻度心衰者降低，重度心衰病人增高，结论：心衰病人心肌细胞存在MAPK信号传导通路的变化。中，重度心衰病人通过激活p38MAPK诱导心肌细胞凋亡，坏死效应，在心功能恶化中发挥重要病理作用。     

应用超声心动图多项参数综合评价心脏瓣膜病变患者的整体心功能

目的采用心力衰竭综合超声心动图多项参数来评价左心室射血分数基本正常的心脏瓣膜病变患者的整体心功能，为临床评价心脏瓣膜病患者心功能提供一个更为全面、客观、量化的指标。方法选取心脏瓣膜病变患者56例和对照组37例，所有入选者均采用我院制定的综合超声心动图多项参数的心力衰竭超声指数进行评分，并将该评分与同期血浆脑钠素（BNP）检测结果及纽约心功能分级进行比较。结果心力衰竭超声指数在心脏瓣膜病变患者组明显高于对照组（P〈0．01），且随着纽约心功能分级的升高而升高，心功能Ⅱ、Ⅲ、Ⅳ级患者的心力衰竭超声指数分别为2．38±0．92、3．51±0．93、4．35±1．22，各亚组间比较差异均有统计学意义（P〈0．05），相关性分析得出心力衰竭超声指数与血浆BNP高度相关（r=0．822，P〈0．05）。结论应用心力衰竭超声指数结合临床表现评价心脏瓣膜病变患者的整体心功能是可行的，可作为一个新指标值得临床推广应用。     

Morphometric study of human myocardium in acquired valvular diseases

To study the effect of various valvular heart diseases on the quantitative histology of myocardium, 38 human hearts with valvular lesions were examined (11 aortic stenoses, nine mitral stenoses, nine mitral incompetence and nine combined aortic and mitral valve lesions). The control group consisted of ten hearts without any valvular lesions. With morphometrical methods the volume fractions of myocardial components (myocardial fibres, interstitial space and diffuse connective tissue), the numerical density of arterioles and the mean fibre diameter were estimated. Myocardial fibrosis was more severe in hearts with valvular lesions than in the controls (5.4% vs 3.3%, P less than 0.01), but did not correlate with the anatomical severity of the valvular lesions. The most severe myocardial fibrosis was found in hearts with mitral incompetence (6.7%). Fibre hypertrophy was most severe in hearts with aortic stenosis and in hearts with mitral incompetence (22 microns and 23 microns, respectively). In hearts with severe valvular lesions the mean fibre diameter was 23 microns and in hearts with mild to moderate lesions 19 microns (P less than 0.01). Good correlation was observed between the mean fibre diameter and the weight of the left ventricle (r = 0.81, P less than 0.01). The volume fractions of connective tissue and interstitial space were significantly higher and the volume fraction of myocardial fibres was correspondingly lower in the subendocardium than in the subepicardium in hearts with either pressure overload (aortic stenosis) or volume overload (mitral incompetence). In conclusion, myocardial fibrosis occurs in patients with various valvular lesions, but the severity of the fibrosis does not correlate with the anatomical severity of valvular lesions.(ABSTRACT TRUNCATED AT 250 WORDS)     

Changing demographics of valvular heart disease and impact on surgical and transcatheter valve therapies

Valvular heart disease remains frequent in industrialised countries since the decrease in frequency of rheumatic heart diseases has been accompanied by an increase in degenerative valve diseases. The prevalence of valvular disease increases sharply with age, as a consequence of the predominance of degenerative valvular diseases. Aortic stenosis and mitral regurgitation are the two most frequent diseases among patients referred because of valvular disease in Europe. The burden of heart valve disease in the elderly has an important impact on patient management, given the frequency of comorbidity and the increase in the risk of interventions. The changes in demographics explain why new procedures, such as transcatheter aortic valve implantation and percutaneous mitral valve repair, are potentially attractive in patients with high risk or even contraindications for surgery.     

Changes in the cardiac valvular apparatus in patients with end-stage chronic renal failure on long-term programmed hemodialysis

AIM: To examine the specific features of development of cardiac valvular diseases, biochemical changes in the blood composition, and changes in the density of bone tissue in patients with chronic renal failure (CRF) treated with programmed hemodialysis. MATERIALS AND METHODS: 118 patients with CRF (Group 1 patients (n = 69) aged 18-40 years and Group 2 patients (n = 49) aged 55-73 years) were examined. RESULTS: Mitral valvular prolapse or disease mainly developed in Group 1 patients having profound phophorous and calcium metabolic changes and significantly elevated concentrations of blood parathyroid hormone; developed aortic valvular disease and calcium salt-impregnated cardiac tissues were observed in Group 2 patients. CONCLUSION: The revealed regularities occur in chronic renal failure regulated by programmed hemodialysis and they are risk factors for chronic heart failure in elderly patients in particular.     

2086例右心增大患者病因回顾性分析与超声诊断

目的分析采用超声心动图诊断为单纯性右心增大患者的临床病因,为右心增大的超声诊断提供思路。 方法回顾性分析华中科技大学附属协和医院2013年1月至2015年5月2086例单纯右心增大患者的超声图像特征及临床资料,总结右心增大的临床病因。 结果2086例单纯右心增大患者中,先天性心脏病1098例（52.64%）,其中简单先天性心脏病804例（38.54%）,以房间隔缺损为主674例（32.31%）,复杂先天性心脏病294例（14.09%）;先天性心脏病及瓣膜病术后继发右心增大373例（17.88%）;肺心病140例（6.71%）;瓣膜疾病113例（5.42%）,其中三尖瓣57例（2.73%）,风湿性心脏病36例(1.73%）,非风湿性心脏病21例（1.01%）,乏氏窦瘤破入右心42例（2.01%）,联合瓣膜疾病8例（0.96%）,肺动脉瓣关闭不全4例（0.19%）;心肌病30例（1.44%）,以致心律失常性右心室心肌病及右心室心肌致密化不全常见;冠心病21例（1.0%）;冠状动脉瘘入右心系统20例（0.96%）;肺栓塞14例（0.67%）;心律失常14例（0.67%）;其他原因265例（12.51%）。 结论引起单纯性右心增大的主要原因为简单先天性心脏病,以房间隔缺损为主,其次依次为先天性心脏病及瓣膜病术后继发、瓣膜疾病、心肌病、冠心病等。     

实时三维超声心动图技术在心脏外科手术前的应用

目的 探讨实时三维超声心动图对心脏外科术前心血管疾病的诊断价值。方法 对20例心脏病患者进行二维、实时三维超声心动图检查，并与手术结果对照。结果 三维超声心动图可实时显示室间隔或房间隔缺损的空间位置、形态，测量缺损最大直径与手术结果对照差异无显著性意义(P＞0．05)，二维超声则显著低估手术测值(P＜0．05)；对瓣膜疾病可显示瓣膜的立体结构，尤其在瓣膜的短轴观方位显示瓣叶的数目、功能及狭窄口的最小面积更为清晰。结论 实时三维超声心动图操作简单，应用方便，为心血管疾病的定性和定量诊断提供了可靠的新方法。     

超声心动图诊断心肌致密化不全45例分析

目的探讨心肌致密化不全（noncompaction of ventricular myocardium,NVM）的超声心动图影像学特征,评价超声心动图对NVM的诊断价值。方法回顾性分析45例NVM患者的超声心动图资料,参照Jenni超声诊断标准,确定超声心动图诊断该病的价值。结果 45例患者超声心动图均具有明显特征,均可探及错综排列的肌小梁以及大小不等深陷的小梁隐窝,并形成网状或峰窝状,以近心尖1/3室壁节段为明显,可波及室壁中段,一般不累及基底段室壁,彩色多普勒可测及隐窝之间低速血流与心腔相通。40例累及左室,5例累及右室。此外,13例患者伴有二尖瓣、三尖瓣、主动脉瓣轻至中度关闭不全,4例患者发现左室假腱索,1例并发瓣膜病变,1例并发心室内血栓。结论 NVM有典型的超声心动图特征性表现,超声心动图是诊断本病的最佳选择。