直接和延迟PCI治疗对急性心肌梗死后左室重构及心功能的影响效果对比观察

目的比较直接和延迟经皮冠状动脉介入术(PCI)对急性心肌梗死(AMI)后左室重构及心功能的影响。方法纳入2012年1月~2015年12月于重庆市开州区人民医院收治的108例AMI患者临床资料,按照治疗措施不同分为3组,直接组38例(行直接PCI治疗),延迟组35例(行延迟PCI治疗),对照组36例(行保守治疗)。测定三组患者AMI治疗后1周、6个月的左室收缩末期容积(ESV)、左房内径(LAd)、舒张末期容积(EDV)、左室射血分数(LVEF),观测AMI后1周、6个月时血流动力学指标:肺动脉平均压(m PAP)、平均二尖瓣压力差(m MPG),并记录患者6个月内复发情况。结果治疗后6个月,直接组和延迟组LAd、ESV、EDV均低于对照组,且直接组LAd(34.04±5.10)mm、ESV(46.01±15.40)ml、EDV(114.24±25.68)ml均较延迟组低,各组间比较差异均具有统计学意义(P0.05);直接组和延迟组治疗后6个月LVEF均显著高于对照组,且直接组LVEF(60.41%±10.06%)高于延迟组,差异具有统计学意义(P0.05);治疗后6个月直接组和延迟组m PAP、m MPG均低于对照组,且直接组m PAP(4.36±0.51)P/k D、m MPG(0.98±0.36)P/k D低于延迟组(P0.05);直接组在治疗后6个月内AMI再次发作7.89%,心力衰竭再住院2.63%,均显著低于对照组(P0.05)。结论直接和延迟PCI治疗均可改善AMI患者左室重构和心功能,且直接PCI效果更佳。     

冠状动脉介入术对急性心肌梗死患者B型脑钠肽、肌钙蛋白及心室重塑的影响

目的研究经皮冠状动脉介入术(PCI)对急性心肌梗死(AMI)患者进行早期再灌注后血中B型脑钠肽(BNP)及肌钙蛋白I(TnI)水平的动态变化及对心室重塑的影响。方法 68例急性心肌梗死患者分为PCI组(34例)和非PCI组(34例),检测所有患者的BNP和TnI;彩色多普勒超声仪测定患者左心室内径、左心室收缩末容积(ESV)、左心室舒张末容积(EDV)、左心室射血分数(LVEF)。结果 BNP测值PCI组与非PCI组患者治疗第2天比较差异无统计学意义(P>0.05),但治疗第4天PCI组明显低于非PCI组(P<0.05),TnI水平PCI术组治疗第2天、第4天均明显低于非PCI组(P<0.05),治疗第7天EDV、ESV值PCI组明显低于非PCI组(P<0.05),但两组间的LVEF值比较差异无统计学意义(P>0.05)。结论 AMI患者急诊PCI进行早期再灌注治疗可明显降低治疗第4天BNP水平、及第2、4天TnI水平,进而能改善AMI患者的左心室功能及左室重塑。     

急性心肌梗死患者行经皮冠状动脉介入术对血清B型钠利尿肽及心室重塑的影响

目的研究采用经皮冠状动脉介入(PCI)术对急性心肌梗死(AMI)患者血清B型钠利尿肽(BNP)及心室重塑的影响。方法将60例AMI患者按有无行PCI术分为PCI组和非PCI组,检测不同时期血清BNP水平以及采用PhillipsIE33型多普勒超声仪测定患者1周左右的左心室内径、左心室收缩末期容积(ESV)、左心室舒张末期容积(EDV)、左室射血分数(LVEF)。结果两组患者EDV、ESV和LVEF比较,差异均有统计学意义(P<0.05)。两组患者在24h、48h、72h时点血清BNP水平比较,差异均无统计学意义(P>0.05);7d时两组比较,差异有统计学意义(P<0.05)。结论采用PCI术对AMI患者进行早期再灌注可明显降低患者第7天的BNP水平,进而能改善AMI患者的左室功能及减轻左室重塑。     

冠脉介入术后患者血中B型钠利尿肽变化及对心室重塑的影响

目的探讨急性心肌梗死患者通过经皮冠脉介入术(PCI)进行早期再灌注后其血中B型钠利尿肽(BNP)的动态变化及对心室重塑的影响。方法用ARCHITECTI2000全自动免疫分析仪测定2005年12月至2006年5月在中国医科大学盛京医院就诊的60例急性心肌梗死(AMI)患者血中BNP的质量浓度及用PHILLIPSIE3S型多普勒超声仪测定患者左心室内径、左心室收缩末期容积(ESV)、左心室舒张末期容积(EDV)、左室射血分数(LVEF)。结果BNP的质量浓度在接受PCI与未接受PCI的患者早期第1天、第2天内无明显改变(P>0.05),但在第3天、第7天,PCI组明显低于未PCI组(P<0.05)。1周左右的EDV、ESV值在PCI组明显低于非PCI组(P<0.05),但两组间EF值差异无显著性意义。结论AMI患者行PCI进行早期再灌注可明显降低第3,7天的BNP质量浓度,进而能改善AMI患者的左室功能及左室重塑。     

自体外周血干细胞移植治疗急性心肌梗死对左心室功能的影响研究

目的探讨自体外周血干细胞(PBSCs)移植治疗急性心肌梗死(AMI)对左心室功能的影响。方法选择2003年11月至2005年9月辽宁省人民医院收治的69例AMI患者,分成干细胞移植组35例和对照组34例,两组均接受药物和冠状动脉内介入治疗,干细胞移植组在此基础上动员自体骨髓干细胞,进行外周血干细胞移植。两组均于治疗前、治疗后6个月进行超声心动图检查。结果6个月时干细胞移植组心脏收缩末容积(ESV)明显减小(P<0·05);舒张末容积(EDV)无显著性变化(P>0·05);左室射血分数(LVEF)显著增高(P<0·05);左室壁节段性运动积分指数(WMSI)明显减低(P<0·001);对照组于介入术前及术后6个月随访ESV、EDV、LVEF及WMSI差异均无显著性意义;术后6个月随访移植组与对照组比较ESV下降,LVEF升高,WMSI降低(P<0·05)。结论自体外周血干细胞治疗AMI可以在近期有效地缩小缺血梗死面积,减轻左室重构,改善心功能。     

急性心肌梗死后延迟冠状动脉介入治疗对左室重构和远期预后的影响

目的探讨急性心肌梗死(AMI)后延迟经皮冠状动脉介入治疗(PCI)对左室重构(LVRM)和远期预后的影响。方法93例初次AMI患者分为PCI组(47例)和非PCI组(46例)。分别在心肌梗死后(23±10)d(术前)和术后6个月测量左心室容量指数、射血分数(LVEF)和异常室壁运动积分指数,并观察6个月期间主要不良心脏事件的发生情况。结果6个月时两组左室射血分数和室壁活动异常积分与术前相比差异无统计学意义,但对照组左室舒张末期容积指数(LVEDVI)和左室收缩末期容积指数(LVESVI)较术前明显增大(P<0.01,P<0.05),且与PCI组相比差异有统计学意义(P<0.01,P<0.05)。6个月随访期间主要不良心脏事件发生率对照组为11%,成功PCI组为4%,但差异无统计学意义。结论AMI后延迟PCI可抑制左室扩大,延缓慢性期左室重构,并显著减少心脏事件的发生。     

急性心肌梗死后ST段持续抬高的临床观察

目的探讨急性心肌梗死(AMI)后ST段持续抬高的临床意义。方法取AMI后ST段持续抬高的静息心电图40例(A组),以无ST段持续抬高的AMI患者48例为B组。两组均进行冠状动脉造影及左心室造影,并观察2组病例的左室收缩末期容积(ESV)、左室舒张末期容积(EDV)、左室射血分数(LVEF)、局部室壁运动情况及冠状动脉阻塞部位、程度。结果A组较B组LVEF减低(P<0.05)、ESV增大(P<0.01),冠状动脉完全闭塞、局部室壁无收缩或矛盾运动比例A组明显高于B组(P<0.01),而2组EDV、室壁瘤发生比例差异无显著性意义(P>0.05)。结论急性心肌梗死后ST段持续抬高与冠状动脉完全的闭塞、LVEF的显著降低、ESV的明显扩大直接相关;与室壁瘤、EDV无显著相关,是一种简而易行、无创伤的临床检测手段,对急性心肌梗死后患者的治疗和预后提供积极的帮助。     

冠状动脉内强化溶栓治疗对AMI直接PCI患者预后的影响

将急性心肌梗死（AMI）直接经皮冠状动脉介入治疗（PCI）患者50例随机分为行PCI术后冠状动脉内注入尿激酶（UK）治疗（观察组）和对照组各25例,观察两组临床事件、心律失常、ST—T改变、QT离散度、心功能及左室重塑情况。结果两组临床事件的发生率及QT离散度比较差异有统计学意义。观察组左心室舒张末期容积（EDV）、左心室收缩末期容积（ESV）显著低于对照组（P〈0.05）,左心室射血分数（LVEF）显著高于对照组（P〈0．05）。提示AMI直接PCI后强化溶栓治疗对于抑制和逆转心肌梗死后患者的左心室重构、改善左心功能和远期预后要优于单纯PCI治疗。     

RT3DE评价延迟PCI对急性心肌梗死患者心功能的影响

目的应用实时三维超声心动图(RT3DE)评价延迟经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)患者左心室功能的影响。方法选择首次AMI住院患者56例,根据是否行延迟PCI治疗,将患者分为PCI治疗组(30例)和药物治疗组(26例)。所有患者于治疗前和治疗后3个月、6个月分别进行RT3DE检查,对采集的三维超声图像进行脱机处理,得出左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)及左心室射血分数(LVEF),比较两组患者左心功能的差异。结果PCI治疗组治疗后3个月、6个月较术前LVEDV、LVESV降低(P0.05),LVEF提高(P0.05)。药物治疗组治疗3个月、6个月时,各指标差异均无统计学意义。治疗后3个月及6个月时PCI治疗组与药物治疗组比较,LVEDV、LVESV、LVEF均有统计学意义(P0.05)。结论延迟PCI能明显改善AMI后左室重构,提高左心功能,改善患者预后。RT3DE可准确、方便的评价AMI患者左室整体心功能。     

急性前壁心肌梗死后梗死相关血管延迟开通对晚期左室重构的影响

目的　探讨急性前壁心肌梗死(AMI)后延迟经皮冠状动脉介入治疗(PCI)使梗死相关动脉(IRA)开通对AMI晚期左室重构的影响。方法　选择64例急性前壁、前间壁及广泛前壁Q波性AMI后病情稳定,发病2~14天,平均(9 .1±2 .3)天冠状动脉造影证实左前降支完全闭塞者,依据是否成功行PCI,分为成功PCI组和对照组,分别于急性期、术后2个月和6个月应用超声心动图随访左室大小、左室功能和室壁活动异常情况,并观察6个月期间心力衰竭事件的发生情况。结果　AMI后2个月两组左室射血分数、左室收缩末期容积指数、左室舒张末期容积指数和室壁活动异常积分与急性期相比差异无统计学意义,急性期和2个月时两组上述各指标之间差异也无统计学意义。6个月时两组左室射血分数和室壁活动异常积分与急性期和2个月相比差异无统计学意义,但对照组左室舒张末期容积指数和左室收缩末期容积指数较急性期明显增大(P<0 .01, P<0. 05 ),且与成功PCI组相比差异有统计学意义(P<0 .01, P<0 .05)。6个月随访期间心力衰竭事件发生率对照组为19%,成功PCI组为2%,但差异无统计学意义。结论　急性前壁AMI后IRA延迟开通能明显减少AMI后晚期的左室重构,而对AMI后早期左室重构的影响不大。延迟PCI可能有利于减少AMI后远期心力衰竭事件的发生。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。