急性冠状动脉综合征病人血尿酸浓度变化

目的探讨急性冠状动脉综合征（ACS）病人血清尿酸的变化。方法抽取67例ACS病人与62例正常人空腹静脉血,测定血清尿酸浓度,并进行统计学处理。结果ACS组中不稳定型心绞痛、非ST段抬高心肌梗死及ST段抬高心肌梗死各组血尿酸浓度均明显高于对照组,差异均有显著性（F=8.64,q=4.31～5.92,P〈0.01）。结论ACS与血尿酸浓度关系密切。     

ROLE OF ENDOGENOUS CARBON MONOXIDE IN ENDOTOXIN SHOCK

Objective. To study the role of endogenous carbon monoxide (CO) in endotoxin shock. Methods. The changes of CO levels and the effects of zinc protoporphyrin IX (ZnPP), an inhibitor of hemeoxygenase (HO), in endotoxin shock and the efficacy of heroin, an inducer of HO were investigated. Results. The plasma CO levels were found to be significantly increased during the comse of endotoxin shock. Injection of ZnPP was shown to abrogate the endotoxin-induced hypotension and metabolic derangements markedly. Administration of hemin to healthy rabbits revealed the hypotension and metabolic derangements similar to the animsls given endotoxin. Conclusion. CO is a newly found endogenously produced mediator which may play an important role in the pathogenesis of endotoxin shock.     

EVIDENCE OF INCREASED ENDOGENOUS CARBON MONOXIDE PRODUCTION IN NEWBORN RAT ENDOTOXICOSIS

INTRODUCTIONJram-negativesepsisandsepticshockinneonateshaveahighincidenceandmortalityinspiteofmedicaladvances.Althoughtheroleofanumberofcytokines,suchastumornecrosisfactor(TNF),interleukin-1(IL-1),interleukin-6(lL-6),andendothelium-depen-dentrelaxingfactor(EDRF)andnitricoxide(NO),inmediatingthehemodynamicandmetabolicderangementofthisconditionisbecomingclear,thepathogenesisofsepsisandsepticshockisstillnotentirelyunderstood(l).Inrecentyears,biomedicalinterestinendogenouscarbonmonoxide(…     

CHANGE OF CARBON MONOXIDE IN PLASMA AND TISSUE DURING ACUTE HYPOXIA

Objective. To investigate the role of endogenous carbon monoxide (CO) in hypoxia.Methods. After rats were inhaled with hypoxic gases and the heme oxygenase inhibitor ZnPPIX was administered, we measured the CO levels in plasma, liver, lung and kidney. Meanwhile plasma cGMP levels were observed. Furthermore, we recorded the changes of hemodynamic and blood gases.Results. Acute mild hypoxia (10% O2) significantly increased CO levels in plasma as well as liver, kidney and lung, while acute severe hypoxia (5% O2) significantly decreased CO levels in plasma as well as liver, kidney and lung. In addition, the former significantly elevated cGMP levels in plasma while the latter markedly reduced cGMP levels in plasma. The hemodynamic changes occurred in accordance with the changes of carbon monoxide.Conclusions. Our results indicate, for the first time , that the endogenous carbon monoxide plays an important role in regulating the vessel tone during hypoxia.     

ROLE OF ENDOGENOUS CARBON MONOXIDE IN NEOINTIMAL FORMATION INDUCED BY BALLOON-INJURY IN RAT AORTA

ＩＮＴＲＯＤＵＣＴＩＯＮＰｅｒｃｕｔａｎｅｏｕｓｔｒａｎｓｌｕｍｉｎａｌａｎｇｉｏｐｌａｓｔｙｉｓｎｏｗａｗｅｌ－ｅｓｔａｂｌｉｓｈｅｄａｎｄｆｒｅｑｕｅｎｔｌｙｐｅｒｆｏｒｍｅｄｐｒｏｃｅｄｕｒｅｔｈａｔｉｓｃｏｍｐｌｉｃａｔｅｄｂｙｒｅｓｔｅｎｏ...     

血清可溶性LOX-1在急性冠脉综合征患者外周血及冠状动脉斑块局部表达水平的变化

目的探讨血清可溶性凝素样氧化低密度脂蛋白受体－1（L0x－1）对急性冠脉综合征（ACS）的旱期诊断价值。方法用酶联免疫法测定ACS组（90例）、稳定型心绞痛（SAP）组（40例）、正常对照组（50例）肘静脉、股动脉及冠状动脉介入治疗时抽取斑块局部血液的LOX－1和hs—CRP水平。结果ACS组中的LOX－1和hs—CRP的水平明显高于SAP组及对照组（Pd0．01）,冠脉斑块部位的LOX－1水平明显高于股动脉和肘静脉的LOX－1水平（P〈0．01）,冠脉斑块处的LOX－1ROC曲线下的面积是0．900（95％C10．858－0．942）,明显高于hs—CRPROC曲线下的面积（Pd0．01）,斑块部位LOX－1水平与hs—CRP水平呈正相关（P〈0．01）。结论LOX－1可以作为诊断早期ACS的一个有效指标,且冠脉斑块处的Lox－1水平对冠状动脉损伤的炎症反应更敏感。     

ENDOGENOUS HEME OXYGENASE/CARBON MONOXIDE SYSTEM MEDIATES LIPOPOLYSACCHARIDE-INDUCED INTUSSUSCEPTION IN RATS

ＩＮＴＲＯＤＵＣＴＩＯＮ　　Ｉｎｔｕｓｓｕｓｃｅｐｔｉｏｎ(ＩＮ)ｉｓｏｎｅｏｆｔｈｅｃｏｍｍｏｎｅｓｔａｂｄｏｍｉｎａｌｅｍｅｒｇｅｎｃｉｅｓｉｎｐｅｄｉａｔｒｉｃｓｕｒｇｅｒｙ .Ｔｈｅｃｏｍｐｒｅｓｓｉｏｎａｎｄａｎ ｇｕｌａｔｉｏｎｏｆｔｈｅｍｅｓｅｎｔｅｒｉｃｂｌｏｏｄｖｅｓｓｅｌｓｏｆｔｈｅｉｎｖａｇｉｎａｔｅｄｂｏｗｅｌａｎｄｔｈｅｐｒｅｓｓｕｒｅｏｎｔｈｅｂｏｗｅｌｗａｌｌｃａｎｌｅａｄｔｏｎｅｃｒｏ ｓｉｓａｎｄｐｅｒｆｏｒａｔｉｏｎ .Ｔｈｅｉｎｃｉｄｅｎｃｅｉｓ 2 4ｐｅｒ 10 0 0ｌ…     

高压氧治疗急性一氧化碳中毒298例疗效分析

目的分析高压氧治疗急性一氧化碳中毒的临床疗效。方法回顾性分析2008年1月-2011年1月我院收治的298例急性一氧化碳中毒患者,分为轻、中、重度中毒,均给予高压氧治疗,然后对其疗效予以观察。结果经高压氧治疗及随后半年随访,轻度中毒患者均痊愈,治愈率100％;中度中毒患者中5例好转,2例发生迟发性脑病,治愈率95％;重度中毒患者中10例好转,2例死亡,7例发生迟发性脑病,治愈率85％。结论高压氧可有效治疗急性一氧化碳中毒。     

阻塞性睡眠呼吸暂停低通气综合征血管活性物质失衡的研究

目的 :测定阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)患者血浆中一氧化碳 (CO)和一氧化氮 (NO)水平 ,了解其在OSAHS患者体内的变化情况以及它们与血压的关系 ,探讨 OSAHS患者合并高血压发生率高的原因。方法 :对 30例正常人 ,1 1 1例 OSAHS患者进行整晚多导睡眠图检查 ,次晨醒时马上抽取标本并测量血压 ,检测血浆中 CO和 NO。此外 ,对其中的 2 0例中～重度 OSAHS患者于治疗前、治疗的第 1天、1个月后分别抽血测定其 CO和 NO水平 ,对所测得的 CO和 NO之间作直线相关分析 ,并分别以 CO和 NO作因变量 ,以体块指数 (BMI)、收缩压 (SBP)、舒张压 (DBP)、呼吸暂停低通气指数 (AHI)和小于 90 %血氧饱和度的睡眠时间与总睡眠时间的比例 (R)作自变量 ,分别对它们作多元回归分析。结果 :1 OSAHS患者血浆中 CO和 NO显著高于正常人 (P <0 .0 5 ) ,重度者亦显著高于轻、中度者 (P <0 .0 5 ) ,OSAHS合并高血压者血浆 CO和 NO显著高于无高血压者 (P <0 .0 5 ) ;2 2 0例 OSAHS患者血浆中 CO和 NO于治疗的第 1天与治疗前比较差异无统计学意义(P >0 .0 5 ) ,但治疗 1个月后 CO和 NO显著降低 (P <0 .0 5 ) ;3多元回归分析提示 OSAHS患者血浆 CO与 R、AHI和 DBP均呈正相关 (r=0 .4 2 ,P<0 .0 1 ;r=0 .32 ,P<0 .0 5 ;r=0 .2 3,     

MMP-2,MMP-9及TIMP-1在通心络治疗急性冠脉综合征中介导作用的研究

目的:观察通心络对动脉粥样硬化(AS)模型兔基质金属蛋白酶MMP-2,MMP-9(简称MMP-2,9)和其天然抑制物(TIMP-1)介导作用的影响及其可能机制.方法:运用球囊损伤腹主动脉加高脂饮食建立兔AS模型.38只新西兰兔随机分成5组:空白组(6只)、模型组(8只)、通心络组(8只)、辛伐他汀组(8只)和通心络加辛...     

辛伐他汀对急性冠脉综合征病人校正Q-T离散度及室性心律失常的影响

目的:观察辛伐他汀对急性冠脉综合征(ACS)病人校正Q-T离散度(QTcd)及室性心律失常的影响.方法:60例ACS病人随机分为2组,A组为常规治疗组,B组为辛伐他汀治疗组,疗程均为8WK,观察两组ACS病人治疗前后QTcd的变化以及室性心律失常的发生率.结果:两组ACS病人治疗后QTcd均有减少,而辛伐他汀组更为明显,差异有显著性(P＜0.01),辛伐他汀组室性心律失常的发生率显著减少(P＜0.05).结论:辛伐他汀可以明显降低ACS病人的QTcd,减少室性心律失常的发生率.     

急性冠状动脉综合征病人血浆和肽素、cTnI和Hs-CRP变化及意义

目的探讨急性冠状动脉综合征(ACS)病人血浆和肽素、肌钙蛋白I(cTnI)与高敏C-反应蛋白(Hs-CRP)的变化及其临床意义。方法因胸痛入院的病人196例,经冠状动脉造影术(CAG)检查后分为CAG正常组、不稳定型心绞痛(UAP)组、非ST段抬高急性心肌梗死(NSTEMI)组和ST段抬高急性心肌梗死(STEMI)组,测定各组病人入院时血浆和肽素、cTnI及Hs-CRP含量。结果 UAP组、NSTEMI组和STEMI组和肽素、cTnI及Hs-CRP水平高于CAG正常组(H=42.57～141.35,P<0.05);NSTEMI组和STEMI组和肽素、cTnI及Hs-CRP水平高于UAP组(H=9.72～107.45,P<0.05)。左主干病变组较单支病变组、双支病变组、三支病变组和肽素、cTnI及Hs-CRP水平明显升高(H=7.26～35.72,P<0.05)。结论 ACS病人血浆和肽素、cTnI及Hs-CRP水平升高,并且和肽素和cTnI在一定程度内可以反映冠状动脉病变严重程度,对ACS病人的危险分层、治疗决策及预后判断具有一定临床价值。     

心率震荡对急性冠脉综合征患者危险分层的意义

目的：探讨心率震荡（HRT）对急性冠脉综合征（ACS）患者危险分层的意义。方法：研究对象263例,其中ACS者177例,不稳定型心绞痛（UAP）109例（A组）,急性心肌梗死（AMI）68例（B组）,门诊健康体检者86例（C组）,均行24h动态心电图及超声心动图检查,分别计算HRT的两个参数：震荡起始值（TO）和震荡斜率（TS）。结果：①A组[TO：（0．32±5．40）％,TS：（9．04±7．71）ms／RR13、B组[TO：（0．32±1．94）％,TS：（8．97±6．77）ms／RRI]分别与c组[TO：（-0．83±5．14）％,TS：（13．81±13．21）ms／RRI]比较,A组、B组T0明显增高（P〈0．05）,而TS明显降低（P〈0．05）;②A组与B组比较,B组左室射血分数（LVEF）（0．53±0．12）显著低于A组（0．65±0．08）（P〈0．05）,左室最大舒张内径（LVD）[（50．47±8．59）cm]大于A组[（48．29±6．93）cm]（P〈0．05）;但TO、TS在组间差异无统计学意义（P〉0．05）;③ACS患者中,LVEF与TO存在负相关性（r=0．256,P〈0．05）,与TS存在正相关性（r=0．187,P〈0．05）;④ACS患者合并高血压或（和）糖尿病时,HRT异常发生率较正常对照组高（P〈0．05）。结论：HRT可以对ACS患者进行危险分层及预后判断;当ACS合并高血压、糖尿病时,自主神经功能受损更加严重。     

血清尿酸与急性冠状动脉综合征的临床探讨

目的 探讨急性冠状动脉综合征患者血清尿酸水平的变化.方法 随机选取50例ACS患者和50例健康查体者,分别测定其血清UA、HDL-C、TC、TG水平,并比较各组间的差异.结果 2组各指标比较均有统计学意义,除HDL-C外,ACS组UA、TC、TG水平均高于对照组(P<0.01),血清尿酸与其他指标没有相关性(P>0.05).结论 高尿酸浓度与ACS的发生有关.     

窦性心率震荡对急性冠脉综合征的诊疗价值

目的探讨窦性心率震荡（heart rate turbulence,HRT）在急性冠脉综合征（acute coronary syndrome,ACS）患者诊疗中的临床价值。方法选择2005年1月—2008年2月在我院心内科住院并确诊的ACS患者160例,其中不稳定型心绞痛57例,急性心肌梗死103例,健康对照组57例,所有入选患者均接受动态心电图检查,测量HRT的参数TO、TS、心率变异的参数SDNN及左室射血分数（left ventricular ejection fraction,LVEF）。结果ACS患者HRT较正常健康人群显著减弱,急性心肌梗死患者HRT减弱更加明显,ACS患者HRT减弱程度与LVEF呈显著负相关。结论HRT可作为检测ACS患者压力感受器敏感性减退和自主神经功能受损,尤其是迷走神经反射功能受损以及判断ACS患者心功能状态的有价值参考指标。     

OUTCOMES OF INVASIVE STRATEGY TO PATIENTS WITH NON-ST-ELEVATION ACUTE CORONARY SYNDROMES

To compare the outcomes of an invasive with a conservative strategy in the management of patients with non-ST-elevation acute coronary syndromes. Methods From January 2000 to June 2001,505 patients presenting with unstable angina or non-Q wave myocardial infarction were divided into two groups (conservative vs. invasive) according to management strategy. Patients assigned to an early invasive strategy underwent coronary angiography within 7d of enrollment after intensive antiplatelet, antithrombotic and antiangina therapy and revascularization as appropriate. All patients were followed up at least 6 months. The primary endpoints were cardiac death and acute myocardial infarction. Recurrence angina and readmission were the secondary endpoint. Results There were 194 patients in conservative group and 311 patients in invasive group. Overall, coronary angiography was performed in 100% and 56%, and revascularization in 93% and 52% in the invasive and conservative groups, respectively. During a mean of 11 5. 7 months ( range 6 ~ 24 months) of follow-up, the occurrence of primary endpoint was significantly lower in the invasive group than that in the conservative group (3.9% vs8. 2% , P =0. 036). The rate of recurrent angina (48% vs 17% , P =0. 001 ) , readmission (41% vs 13% , P =0. 001 )and revascularization ( 12% vs 35%, P =0. 001 ) was also significantly lower in patients assigned to invasive strategy. Conclusion The study indicates that the early invasive approach may be the preferred strategy in patients with unstable angina or non-Q wave myocardial infarction.     

急诊检测IMA对急性冠状动脉综合征早期诊断价值

目的 探讨急诊检测缺血修饰清蛋白（I MA）对早期诊断急性冠状动脉综合征（ACS）的价值。方法采用终点比色法测定85例ACS病人（ACS组）发病2 h内和96例健康体检者（对照组）入院2 h内血清I MA浓度。绘制I MA诊断ACS的受试者工作曲线（ROC曲线）,计算特异度、灵敏度、阴性预测值、阳性预测值。结果ACS组血清I M A浓度显著高于对照组（t=8.729,P〈0.01）。I M A诊断ACS的曲线下面积为0.822（95%CI=0.760～0.884,P〈0 0.1）。当最佳诊断标准订为80.26 k U/L时,I M A诊断ACS的灵敏度和特异度分别为61.2%和90.6%,阳性预测值和阴性预测值分别为85 2.%和72.5%。结论 I M A诊断ACS具有高灵敏度和高阴性预测值的特点,对早期诊断心肌缺血及辅助排除ACS具有较大的价值。     

高压氧早期抢救治疗重度急性一氧化碳中毒的疗效观察

我院自93年购置高压氧舱后，对急性一氧化碳中毒患者不失时机地进行了早期抢救治疗。根据对46例患者的治疗疗效观察证明，高压氧抢救治疗一氧化碳中毒确有特效：一快：恢复时间快。二高：重症病例之有效率及总治愈率高。二低：严重神经精神后续症发病率低和死亡率低。     

急性CO中毒后迟发牲脑病139例疗效与预后分析

本文报告急性 CO 中毒后迟发性脑病综合治疗139例和出院随访58例。结果:近期有效率为74.8%,远期继续好转率为90.2%。本组资料表明,随时间推移,有效率可逐步提高;无并发症和其它伴随疾病者疗效较好;而在综合治疗基础上加用大剂量菸酸并不能提高疗效。作者认为本病预后较好。