联合检测cTnI、MYO和CK-MB mass对病毒性心肌炎诊断的评价

目的 探讨联合检测心肌肌钙蛋白(cTnI)、肌红蛋白(MYO)和肌酸激酶同工酶MB质量(CK-MB mass)对病毒性心肌炎(VMC)的诊断价值.方法 在61例VMC和74例非病毒性心肌炎(NVMC)患儿及46例健康对照组中,用微粒子化学发光免疫分析法检测血清cTnI、MYO、CK-MB mass,并用连续监测法测定血清LDH、AST、CK和α-HBDH的活性.cTnI、MYO和CK-MB mass不同组合的诊断效率运用矩阵决策法评价.结果 入院当日VMC组cTnI(0.46±0.21μg/L)、MYO(98.7±38.2μg/L)、CK-MB(6.1±4.2μg/L)均明显高于NVMC组(分别为0.06±0.04、39.2±26.8、2.2±1.7μg/L)和对照组(分别为0.07±0.04、36.5±24.7、2.1±1.5μg/L,P＜0.01).cTnI、MYO、CK-MB mass联合检测对VMC诊断的灵敏度、特异性、阳性预报值、阴性预报值和诊断准确度分别为90.16%、85.14%、83.33%、91.30%和87.41%,其特异性、阳性预报值和诊断准确度明显比四种心肌酶联合检测法高(P＜0.05),而灵敏度和阴性预报值与后者相比差异无显著性(P＞0.05).MYO对VMC初诊的灵敏度较高,特异性欠佳,阳性持续时间短;cTnI与CK-MB对VMC诊断的特异性好,持续时间长,初诊时的灵敏度不够理想.VMC患者康复时以MYO恢复最快,CK-MB次之,cTnI最慢.结论 联合动态检测cTnI、MYO和CK-MB mass可使VMC的诊断效率进一步提高.     

主动固定电极在右室流出道间隔部起搏的

目的探讨临床应用主动固定电极在右室流出道间隔部起搏的可行性及安全性。方法收集心脏起搏适应证患者118例。其中病态窦房结综合征40例,房室传导阻滞78例。所有患者均采用心室主动固定电极在右室流出道室间隔部起搏。结果118例患者均顺利完成手术,在右室流出道间隔部电极定位成功率为98.3%,起搏参数达到起搏标准,其中出现术中电极穿孔1例,术后电极脱位2例,脱位率1.7%。结论临床应用主动固定电极行右室流出道间隔部起搏安全可行。     

四项指标联合检测对急性心肌梗死早期诊断价值的探讨

目的探讨心肌肌钙蛋白I(cTnI)、肌红蛋白(Myo)、肌酸激酶同工酶(CK-MB)以及超敏C-反应蛋白(hs-CRP)四项指标的联合检测在急性心肌梗死诊断中的临床应用价值。方法对40例急性心肌梗死患者(A组),35例不稳定型心绞痛患者(B组)和50例健康体检者(C组)在首诊(胸痛发作4 h之内)时进行cTnI、Mb、CK-MB和hs-CRP检测,比较它们各自及联合检测时对急性心肌梗死诊断的敏感性。结果急性心肌梗死患者血中cTnI、Myo、CK-MB和hs-CRP水平显著高于不稳定型心绞痛患者和对照组,差异有显著统计学意义(P<0.01),且急性心肌梗死患者血中cTn I、Myo、CK-MB和hs-CRP水平高于不稳定型心绞痛患者(P<0.05)。cTnI、Myo、CK-MB、hs-CRP及四项指标联合测定急性心肌梗死的阳性率分别为75%、82.5%、65%、87.5%和97.5%。结论 cTnI、Myo、CK-MB和hs-CRP对急性心肌梗死诊断有重要临床意义,联合检测可以提高急性心肌梗死诊断的灵敏度,具有较高临床价值。     

大鼠运动性骨骼肌损伤后血液白细胞介素-6、肌酸激酶及其同工酶的时相性变化

目的:观察大鼠进行不同性质和强度的跑台运动后血液白细胞介素-6(IL-6)、肌酸激酶(CK)及其同工酶(CK-MM)含量不同时相的变化,结合观察比目鱼肌超微结构的改变,探讨各指标与运动性骨骼肌损伤的关系。方法:成年健康雌性SD大鼠72只,随机分为对照组(A组,n=8)、运动1组(B组,n=32)和运动2组(C组,n=32),B、C组又分别分为运动后即刻组、24h组、48h组和72h组。B、C两组大鼠均进行一次性跑台运动,其中B组跑速15~16m/min,坡度为0°,运动60分钟;C组跑速19~21m/min,坡度为-16°,运动90分钟。运动后取大鼠股动脉血测定IL-6、CK及CK-MM水平,并通过电镜和光镜观察比目鱼肌超微结构变化。结果:(1)B、C两组大鼠运动后骨骼肌超微结构均发生明显损伤,且以运动后24小时较为严重,B组损伤较C组轻微。(2)两运动组大鼠运动后血浆IL-6水平显著高于运动前,C组差异更显著,IL-6在运动后48小时达到峰值。(3)运动后即刻两运动组大鼠血液CK及CK-MM均出现峰值,其变化时相性相似。C组运动后24小时CK活性较运动后即刻显著下降,而CK-MM无显著性变化。结论:血清CK和CK-MM均可作为评价运动性骨骼肌损伤的指标。CK-MM变化可能与肌肉损伤的关系更加紧密。血浆IL-6可能与由剧烈运动导致的肌肉损伤有关,提示可以考虑作为评价运动性骨骼肌损伤的指标。     

γ-IFN雾化吸入对大鼠重型颅脑损伤继发肺损伤支气管肺泡灌洗液中TNF-α和IL-6水平的影响

目的 探讨γ-干扰素（γ-IFN）雾化吸入对大鼠重型颅脑损伤继发肺损伤后支气管肺泡灌洗液（BALF）中肿瘤坏死因子（TNF-α）和白介素-6（IL-6）水平的影响。方法 采用大鼠颅脑局部气压冲击伤模型,将74只雄性SD大鼠随机分为正常组（N）和脑损伤组（T）,T组又分为对照组（C）、庆大霉素组（Gen）和γ-IFN组3个亚组,分别给予生理盐水、生理盐水＋庆大霉素、生理盐水＋γ-干扰素雾化吸入,监测各组BALF中TNF-α和IL-6水平。结果 γ-IFN组TNF-α伤后1、3天、IL-6在伤后3天时均明显低于C组和Gen组,而IL-6在伤后7天时却显著高于C组和Gen组。结论 重型颅脑损伤后,早期雾化吸入γ-IFN可降低大鼠BALF中TNF-α和IL-6水平。     

真性及假性室间隔膜部瘤的临床研究

目的探讨真、假性室间隔膜部瘤的诊断、外科治疗方法及疗效。方法回顾性分析2005年1月—2011年12月我院对真性或假性室间隔膜部瘤485例患者,于全麻低温体外循环下行心内直视修补术的临床资料,并对451例患者进行术后随访。结果超声心动图是术前诊断的主要手段,术中所见最后确定真性或假性膜部瘤,并采用不同的手术方法。485例患者手术治疗无死亡,无合并症。术后对451例膜部瘤患者随访10月～7年(平均4.8±2.73)年,近、远期疗效均满意。结论对于真、假性膜部瘤患者均应行手术治疗,手术中根据不同情况采用相应手术方式均能获得满意的效果。     

门控断层心室显像评价右室不同部位起搏患者的同步性

Objective To compare the effect of right ventricular outflow tract (RVOT) and right ventricular apex (RVA) pacing on ventricular systolic synchrony using gated blood pool SPECT (GBPS).Methods A total of 50 patients implanted with pacemaker due to high degree or complete atria-ventricular block were enrolled in the study. Twenty-three patients were RVOT paced ( Group A, n = 23) and 27 were RVA paced (Group B, n=27). Twenty-four patients with malignancy, normal echocardiographic findings and no history of cardiac diseases were scheduled for pre-chemotherapy evaluation of cardiac structure and function and were enrolled as control group ( Group C, n = 24). All patients underwent GBPS imaging and the values of phase angle (PS), mean phase of each wall, standard deviation (SD) of mean phase of each wall, lateral-septal motion delay of left ventricle ( LV Sep-Lat Delay), septal-right ventricular (RV) delay of LV ( LV Sep-RV Delay) and LV-RV Delay were acquired. The parameters of ventricular systolic synchrony among the three groups were compared using one-way ANOVA. Results The mean phase of LV lateral wall in Groups A and B were significantly higher than that in Group C: Group A (120.50 ±40.58) ms; Group B (103.23±28.34) ms; Group C (84.63 ±22.38) ms (F=7.72, P ＜0.05). There was no significant difference between Groups A and B ( t = 1.30, P ＞ 0.05 ). The mean phase of RV in Group A was significantly larger than those in Groups B and C: Group A ( 137.05 ± 39.27) ms, Group B ( 100.85 ± 23.79) ms,Group C (59. 13 ±30.52) ms (F=35.55, P＜0.05). PS, SD and LV Sep-Lat Delay in Groups A and B were significantly higher than those in Group C: (85.73 ± 12.00)°vs (89.85 ± 15.61 )°vs (58.95 ±9.87)°, (27.68±10.66) ms vs (26.15 ±13.02) ms vs (15.63 ±8.35) ms, (25.06±34.23) ms vs (2. 62 ± 60. 31 ) ms vs ( - 23.66 ± 31.39) ms, F = 41.54,8.55,6.81, all P ＜ 0.01 ), however, there was no significant difference between Groups A and B ( t = 0. 68, 0.68, 1.30, all P ＞ 0.05 ). LV Sep-RV Delay and LV-RV Delay were significantly different among the three groups ( LV Sep-RV Delay: Group A (57.60 ±56.77) ms, Group B (6.36 ±61.88) ms, Group C ( -41.89 ±35.78) ms; LV-RV Delay:Group A (47.36 ±42.59) ms, Group B ( 3.08 ± 38.81 ) ms Group C ( - 26.50 ± 20.99 ) ms, F = 20. 32,25.38, both P ＜ 0.01 ). Conclusion Both RVA and RVOT pacing increase the segmental phases detected by GBPS, causing inter- and intra- ventricular asynchrony compared with patients without pacemakers.     

门控断层心室显像评价右室不同部位起搏患者的同步性

目的 采用平衡法门控断层心室显像（GBPS）比较右室流出道（RVOT）和右室心尖部（RVA）起搏患者的心脏收缩同步性.方法 因三度或高度房室传导阻滞植入起搏器的患者50例,其中RVOT起搏组（A组）23例,RVA起搏组（B组）27例.另取24例初次化疗前肿瘤患者为对照组（C组）,对照组经心脏超声检查证实心脏结构和功能正常,既往无心脏疾病史.3组患者均行GBPS检查,获得相角程（PS）、各壁段平均位相、各壁段平均位相标准差（SD）、室间隔与左室侧壁延迟（LV Sep-Lat Delay）、室间隔与右室延迟（LV Sep-RV Delay）和左右室延迟（LV-RV Delay）等同步性数据,采用单因素方差分析对3组患者心室同步性参数进行比较.结果 A、B组中共分析48例患者.A、B 2组的左室侧壁平均位相均高于C组,分别为（120.50±40.58）ms、（103.23±28.34）ms、（84.63±22.38）ms（F=7.72,P＜0.05）,但A、B 2组间差异无统计学意义（t=1.30,P＞0.05）.右室游离壁平均位相3组间的差异均有统计学意义（F=35.55,P＜0.01）,A组为（137.05±39.27）ms,高于B组的（100.85±23.79）ms和C组的（59.13±30.52）ms.A、B 2组的PS、SD和LV Sep-Lat Delay均高于C组,差异有统计学意义（F=41.54,P＜0.01）,PS：A组（85.73±12.00）°,B组（89.85±15.61）°与C组（58.95±9.87）° SD：A组（27.68±10.66）ms,B组（26.15±13.02）ms与C组（15.63±8.35）ms（F=8.55,P＜0.01） LV Sep-Lat Delay：A组（25.06±34.23）ms,B组（2.62±60.31）ms与C组（-23.66±31.39）ms（F=6.81,P＜0.01）,但A、B 2组间差异无统计学意义（t=0.68,0.68,1.30,P均＞0.05）.A、B、C组间LV Sep-RV Delay[（57.60±56.77）,（6.36±61.88）和（-41.89±35.78）ms]和LV-RV Delay[（47.36±42.59）,（3.08±38.81）和（-26.50±20.99）ms]差异均有统计学意义（F=20.32,25.38,P均＜0.01）.结论 不论是RVA起搏还是RVOT起搏,起搏器植入术后患者心脏均存在节段性位相增加,左室内及双室间同步性均比未植入起搏器差.     

单极起搏标测法在右室流出道快速心律失常射频消融术中的应用

目的探讨单极起搏标测法在右室流出道室性心动过速（室速）和频发室性早搏（室早）射频消融术中的应用。方法选择99例特发性右室流出道室速或频发室早的患者,随机分为两组,一组采用常规起搏标测法及激动顺序标测法,另一组在常规标测法的同时加用单极起搏标测法进行标测,比较两组的手术成功率及消融功率、消融温度、放电时间、放电次数和平均阻抗。结果加用单极起搏标测法治疗组与对照组相比手术成功率分别是（48/50）96.0%,（46/49）93.8%,两组比较无显著性差异。但加用单极起搏标测法治疗组的消融功率、消融温度、放电时间及放电次数均低于常规标测法治疗组,且两组比较P〈0.05,有显著性差异。结论在导管消融治疗右室流出道特发性室速或频发室早过程中,加用单极起搏标测法可用较低的功率、温度进行消融治疗,并缩短了靶点标测时间,提高准确性,从而提高了手术效率。     

超声评价左室E/e'比率增大与右心功能损伤的临床价值

目的探讨左室E/e'比率增大与右心功能损伤的相关性。方法选择左室舒张功能不全E/e'比率增大伴有继发性肺动脉高压(PAH)患者87例,获取右室功能参数,并分析E/e'比率增大与右室功能相关性。结果 E/e'比率增大继发PAH时,右室功能参数RVEF、TVSPV、GLS均减低。与正常对照组比较,轻度PAH患者的右室功能参数RVEF、TVSPV、GLS差异无统计学意义(P>0.05);中、重度PAH的右室功能参数RVEF、TVSPV、LGS差异有统计学意义(P<0.05);与中度PAH组相比较,重度PAH组的RVEF、TVSPV、LGS减低更明显(P<0.05);多元线性回归分析表明,两组E/e'与右室功能参数PASP、RVEF、TPSPV、GLS均有良好的相关性(P<0.01)。结论左心舒张功能减低时,随着PAH程度的增加,右室功能损伤的程度亦逐步增加,且损伤程度与E/e'比率增大相关,E/e'比率增大对评价此类患者右心损伤的发生发展有重要的临床价值。     

Sympathetic innervation of the left ventricle is impaired in arrhythmogenic right ventricular disease

Arrhythmogenic right ventricular disease (ARVD) is a disease of unknown origin that primarily affects the right ventricle and is characterized by ventricular tachyarrhythmias which may lead to syncope and even, though rarely, sudden cardiac death. In 25 patients with ARVD, sympathetic innervation of the left ventricle was assessed by iodine-123 metaiodobenzylguanidine single photon emission tomography (1231-MIBG SPET). In addition, thallium-201 SPET was performed. The diagnosis of ARVD was made by an electrophysiological study and right and left heart catheterization including right ventricular endomyocardial biopsy. Ischaemic heart disease was excluded by coronary angiography. A group of seven patients without any evidence of heart disease served as a control group. Twenty-two of the 25 patients showed reduced uptake of ¹²³I-MIBG. The abnormal areas were located predominantly in posterior and posteroseptal segments of the heart. No focus of increased ¹²³I-MIBG activity could be demonstrated. No patient had signs of left ventricular involvement on left ventricular angiography. In contrast to the results of the ¹²³I-MIBG SPET, those of ²⁰¹TI SPET were normal in 16 patients. The remaining nine patients showed areas of slight hypoperfusion not correlated with the reduced ¹²³I-MIBG uptake. ¹²³I-MIBG scintigraphy allows detection of left ventricular adrenergic dysinnervation in ARVD patients without morphological or functional abnormalities of the left ventricle. Correspondence to: H. Lerch     

磷酸肌酸对室间隔缺损合并肺动脉高压手术的心肌保护作用

目的观察含血STH2液加入外源性磷酸肌酸(CP)后对室间隔缺损合并肺动脉高压进行室间隔缺损修补术的心肌保护作用。方法20例室间隔缺损合并肺动脉高压患儿随机分为两组,CP治疗组在含血STH2心灌注液中加入CP,对照组用等量含血STH2液,分别在术后16h、第6天,采集患儿静脉血,测磷酸肌酸激酶同工酶(CK-MB)、心肌钙蛋白(cTnT),同时在术后观察呼吸机辅助呼吸时间、第6天检查患儿左室射血分数,肺动脉压力。结果CP治疗组术后CK-MB、cTnT、呼吸机辅助呼吸时间、左室射血分数、肺动脉压力较对照组相比均有明显改善。结论CP加入心停搏液中能显著提高心肌保护作用,同时可间接降低肺动脉压力。     

Comparison of left and right ventricular volume measurement using the Simpson's method and the area length method

Purpose

To compare ventricular volume measurement using a volumetric approach in the three standard cardiac planes and ventricular volume estimation by a geometrical model, the Area–Length method (ALM).

Materials and methods

Fifty-six healthy volunteers were examined (27 males, 29 females) on a 1.5 T MR-unit with ECG-triggered steady state free precision (SSFP) Cine-MR sequences and parallel image acquisition. Multiple slices in standardized planes including the short-axis view (sa), 4-chamber view (4ch), left and right 2-chamber views (2ch) were used to cover the whole heart. End-systolic and end-diastolic ventricular volumes (EDV, ESV), stroke volume (SV), and ejection fraction (EF) were calculated with Simpson's rule in all planes and with ALM in the 2ch and 4ch planes. Global function parameters measured in the sa plane were compared with those obtained in the other imaging planes.

Results

A very good correlation is observed when comparing functional parameters calculated with Simpson's rule in all imaging planes: for instance, the mean EDV/ESV of the left and right ventricle of the female population group measured in sa, 4ch, and 2ch: left ventricle EDV/ESV 114.3/44.4, 120.9/46.5, and 117.7/45.3 ml; right ventricle EDV/ESV 106.6/46.0, 101.2/41.1, and 103.5/43.0 ml. Functional parameters of the left ventricle calculated with ALM in 2ch and 4ch correlate to parameters obtained in sa with Simpson's rule in the range of 5–10%: for instance, the EDV/ESV of the left ventricle of the male population group measured in the sa, 4ch, and 2ch: 160.3/63.5, 163.1/59.0, and 167.0/65.7 ml. Functional parameters of the right ventricle measured with ALM in 4ch are 40–50% lower and calculated in 2ch almost double as high as compared with the parameters obtained in sa with Simpson's rule: for instance, male right ventricular EDV/ESV measured in sa, 4ch, and 2ch: 153.4/68.1, 97.5/34.5, and 280.2/123.2 ml. The EF correlates for all imaging planes measured with the Simpson's rule in both ventricles and using ALM in the left ventricle except for males with an overestimation of less than 6%. The EF of the right ventricle is calculated higher using ALM in 4ch and 2ch compared to the EF calculated in sa: female/male EF of the right ventricle measured in the sa, 4ch, and 2ch: 56.8/55.7, 66.0/65.0, and 60.0/57.0%.

Conclusion

In the setting of healthy volunteers the ALM method should not be used in 2ch and 4ch planes of the right ventricle because of lacking correlation of global functional parameters compared to those obtained in the sa plane. Using Simpson's rule functional parameters correlate well to each other in the different imaging planes.     

糖皮质激素受体减少对过度运动疲劳形成的影响

为认识糖皮质激素受体(GR)结合量减少对过度运动疲劳发生发展过程的影响 ,观察了7周递增负荷训练过程中大鼠GR结合量减少的同时血清磷脂酶A2 (PLA2 )活性 ,血清和肝组织脂质过氧化物 (LPO)含量 ,脾细胞白细胞介素 -1 β(IL -1 β)和白细胞介素 -6(IL -6)mRNA表达的变化。结果发现 ,GR结合量减少积极参与了过度运动疲劳的发生 ,主要表现为由GR介导的糖皮质激素 (GC)作用减弱 ,造成PLA2 活性增强 ,LPO含量升高 ,IL -1 βmRNA和IL -6mRNA表达增加。结果提示 ,过度训练引起的GR结合量减少所致的受体水平的GC功能减弱 ,参与了过度运动疲劳的形成机理。