胱抑素C与多项血清学指标对急性心力衰竭患者预后价值的相关性研究

目的探讨血清胱抑素C（Cys-C）及几多项血清指标（NT-proBNP、肌钙蛋白T、超敏C反应蛋白、肌酐等）在急性心力衰竭（AHF）患者中的表达水平和评价其预后价值及相关性。方法入选2007～2009年因急性心力衰竭患者136例,入院即测定Cys-C、NT-proBNP、c-TNT、hs-CRP、SCr等多项血清学指标观察其表达水平。平均随访1年,记录各组心脏全因死亡率和因心衰再次住院率,评价各项指标对急性心衰预后预测价值及相关性。结果 136名患者中61名发生不良临床事件,随着Cys-C浓度升高发生率增加（分别为29.3%、40.8%、63.1%,P〈0.05）;且Cys-C、NT-proBNP、c-TNT同时升高的数量越多,发生率也随之增加（分别为38.1%,44.2%,67.7%,P〈0.05）。结论 Cys-C、NT-proBNP、c-TNT具有独立预测价值,而联合三者对急性心力衰竭进行危险评估可提高其预测价值,有助于识别高危患者。     

内源骨髓间充质干细胞在心肌梗死后的迁移、归巢与分化

背景：目前的大多数研究主要集中在移植外源干细胞来源的心肌细胞对受损心肌进行修复与再生,而有关内源干细胞迁移、归巢及分化的研究比较少。 目的：观察内源骨髓间充质干细胞在心肌梗死后迁移、归巢以及分化情况。 方法：成年雌性C57BL/6小鼠随机分为2组：心肌梗死组(n=4)小鼠建立骨髓重建模型,于骨髓重建4周后行冠状动脉左前降支结扎术建立急性心肌梗死模型,1周后处死;对照组(n=3)小鼠进行单纯骨髓重建,于骨髓重建4周后处死。取心脏组织,采用免疫荧光染色检测心肌特异性蛋白Troponin Ⅰ的表达,观察心肌梗死后表达绿色荧光蛋白的骨髓间充质干细胞在心肌组织中的分布、分化情况。 结果与结论：骨髓重建小鼠心肌梗死组与对照组均可见到发绿色荧光的骨髓间充质干细胞,心肌梗死组骨髓间充质干细胞数量比对照组明显增多。两组切片均可见部分骨髓间充质干细胞呈GFP、Troponin Ⅰ和PI三阳性,心肌梗死组三阳性的细胞比对照组明显增多,表明心肌梗死后内源骨髓间充质干细胞能迁移、归巢到受损的心肌组织并获得心肌分化表型。     

12导联动态心电图在心肌缺血与心律失常检测上的优势分析

目的：探讨12导联动态心电图在心肌缺血与心律失常检测上的优势。方法：采用回顾性方法分析,选取我院门诊以及住院自2012年8月-2013年8月以来收治的86例要求检测动态心电图患者的临床资料,随机将其分为对照组以及观察组,各43例,对照组患者采用3导动态心电图检测,观察组患者采用12导动态心电图检测,比较两种检测方法结果。结果：观察组检测出ST段下斜型以及ST段抬高患者的例数高于对照组患者,同时分析时间长于对照组患者,两组具有明显的差异,具有统计学意义（P＜0．05）;观察组患者检测率高于对照组患者（房性期除外）,差异具有统计学意义（P＜0．05）。结论：12导联动态心电图能够及时检测出缺血性ST-T段的改变,并且准确定位,具有较高的敏感性以及有效性,值得临床推广应用。     

Study of the Fibriolytic Inhibition and Clinical Prognosis in Acute Coronary Syndrome Patients Complicated with Type H Diabetes Mellitus

Objectives To study the status of fibrinolytic inhibition in patients of acute coronary syndrome(ACS) complicated with type Ⅱ diabetes mellitus (NIDDM) and to evaluate the effect of fibrinolytic inhibition to the clinical prognosis.Methods Type Ⅱ diabetes mellitus was defined by ADA 1997/WH0 1998 criteria. The subjects were divided into treatment groups that included 39 patients of ACS with 20 cases of acute myocardiac infarction (AMI), 36 patients of ACS + NIDOM with 20 cases of AMI. Twenty cases of healthy people were randomized to control group. The plasma level of tissue type plasminogen activator (t-PA), plasminogen activator in-hibitor type-1 (PAI-1) and plasma D -dimer were detected by using elisa technique. The index of statue in fibrinolysis was detected with the plasma level of D-dimer and the rate of PAI- 1/D- dimer in percentage. This index was used to evaluate the fibrinolytic inhibition and the clinical outcome in all the patients with AMI in treatment groups. The clinical outcome in patients with AMI consisted of the rate of reperfusion, the incidences of reinfarction, severi-ous arrhythmia, pump failure and death in the early period of AMI. Results The plasma level of PAI-1 and D-dimer was higher in the two treatment groups than that in the control group ( P < 0.01). The plasma level of PAI- 1 significantly higher in ACS + NIDDM patients than that in ACS (P<0.05), but the plasma level of D- dimer raised from basic level was significanfly lower in ACS + NIDDM than that in ACS ( P<0. 05) . The rate of PAI- 1/D - dimer in percentage was significantly higher in ACS + NIDDM than that in ACS or in control group (P< 0. 01). For AMI patients in two treatment groups, the rate of reperfusion after the throrabolytic therapy was signifi-candy lower in ACS + NIDDM than that in ACS( P<0. 01) . The rate of incidences in pump failure was significantly higher in ACS + NIDDM than that in ACS too ( P<0. 05). The morbidity of severious arrhythmia, re-infarction and the mortality were also higher in ACS + NIDDM; however the difference was not significant (P<0.05) . Conclusions The plasma level of D-dimer combined with the rate of PAl - 1/D - dimer in percentage could be used to be the evidence and the index to evaluate the status of fibrinolytic in-hibition in patients of ACS + NIDDM, and could be used to evaluate the effect of the fibrinolytic inhibition to the outcome of treatment and clinical prognosis in ACS patient.     

D-二聚体及与纤溶酶原激活物抑制剂-1比值评价合并糖耐量减低急性冠状动脉综合征患者纤溶受抑的研究

目的 :探讨合并糖耐量减低 (IGT)的急性冠状动脉综合征 (ACS)患者纤溶受抑状态及其对治疗和预后的影响。方法 :非糖尿病 ACS组 39例 ,IGT+ACS组 37例 ,非胰岛素依赖性糖尿病 (NIDDM) +ACS组 36例 ;同时设正常对照组 2 0例 ,检测各组组织型纤溶酶原激活剂 (t PA) ,纤溶酶原激活物抑制剂 1(PAI 1)及D 二聚体的血浆水平 ,并计算 PAI 1/ D 二聚体百分比。观察各组急性心肌梗死 (AMI)患者的临床及预后。结果 :IGT+ACS及 NIDDM+ACS组的 PAI 1显著高于正常对照组和 ACS组 (P均 <0 .0 5 ) ,而 D 二聚体上升幅值则显著低于 ACS组 (P<0 .0 5 ) ,两组 PAI 1/ D 二聚体比值也均显著高于正常对照组及 ACS组(P均 <0 .0 1)。两糖代谢异常组溶栓再通比例显著低于 ACS组 (P<0 .0 1) ,泵衰竭的发生率显著高于 ACS组(P<0 .0 5 )。结论 :IGT的 ACS患者存在纤溶受抑状态。 D二聚体血浆水平结合 PAI 1/ D二聚体比值能反映患者纤溶受抑的状态及预后。     

中青年原发性高血压患者循环内皮祖细胞CD34+水平与颈动脉粥样硬化的相关性研究

Objective To explore the relationship between the level of circulating endothelial progenitor cells (EPCs) CD34+with the Framingham cardiovascular risk factors, or with the carotid artery intima-madia thickness (IMT), and to evaluate the value of circulating EPCs CD34+level as a cytologicalmarker of early vascular lesion in youth and middle aged essential hypertension (EH) patients.Methods A total of 62 patients with EH aged between 25 to 45 were enrolled as study group and 20 healthy people were enrolled as control group.EH patients were stratified with cardiovascular risk factors according to Framingham risk factors score into low-risk group with 18 cases, mid-risk group with 14 cases, high-risk group with 17 cases, and extremely high-risk group with 13 cases.The level of circulating EPCs CD34+,carotid artery IMT were respectively measured.The relationship between the level of circulating EPCsCD34+ and Framingham cardiovascular risk factors score, carotid artery IMT was analyzed.Results The level of circulating EPCs CD34+ was gradually decreased with an increase of the Framingham risk factors score in each hypertensive subgroup [low-risk group:(0.12±0.02)%, mid-risk group:(0.07±0.03)%,high-risk group:(0.04±0.03)%, extremely high-risk group:(0.01±0.01)%], and they were significantly lower than that in control group [(0.15±0.03)%], and there was a significant difference among hypertensive subgroups (P＜0.05 or P＜0.01).Carotid artery IMT was significantly thicker among hypertensive subgroups [low-risk group:(0.80±0.07)mm, mid-risk group:(1.11±0.08)mm, high-risk group: (1.26±0.10)mm, extremely high-risk group:(1.45±0.09)mm], and there was a significant difference between each hypertensive group and that of control group [(0.73±0.08)mm, all P＜0.01].There was also statistical significance among hypertensive subgroups(P＜0.05 or P＜0.01).There was a negative correlation between the level of circulating EPCs CD34+and Framingham risk factors score (r=-0.875, P＜0.01), and also a negative correlation with carotid artery IMT (r=-0.852, P＜0.01).Conclusion There was a significant correlation between the level of circulating EPCs CD34+with Framingham risk factors score and also carotid artery IMT in EH patients.Circulating EPCs CD34+could be a cytological marker of early vascular lesion in hypertension patients.     

138例双心疗法治疗急性冠脉综合征患者的临床分析

目的 研究双心疗法治疗急性冠脉综合征(ACS)患者的疗效.方法 选择ACS患者138例,随机分为研究组69例和对照组69例,所有病例均给予常规心血管药物规范性治疗.治疗组在规范治疗基础上加用心理干预治疗,包括药物治疗和认知治疗、行为干预、生物反馈放松治疗,其中药物治疗用盐酸舍曲林和氯硝安定.观察两组用药3个月后,患者ACS症状的改善情况以及用药期间的不良反应.结果 ①ACS症状的改善情况:研究组总有效率为95.65%;对照组总有效率为76.81%.研究组与对照组相比,差异有统计学意义(P<0.05).②不良反应:两组用药期间均未见药物不良反应,无意外死亡病例.结论 双心疗法治疗急性冠脉综合征患者安全、有效、可行,而且比常规规范治疗更有效,但尚需进行大样本的循证研究来更完善地进一步深入探讨.     

外周血CD34^＋水平与高血压病患者动脉血管功能的关系

目的探讨能否根据外周血内皮祖细胞（endothelial progenitor cells,EPCs）CD34^＋水平评价高血压病患者动脉血管病变程度。方法高血压病患者组62例,对照组20例。高血压病患者采用Framingham心血管危险因素积分分层心血管危险因素,分为低危组18例,中危组14例,高危组17例,极高危组13例。作外周血循环EPCsCD34^＋水平、内皮依赖性血管舒张功能（flow—mediated dialation,FMD）测定并作EPCsCD34^＋水平与Framingham心血管危险因素积分、FMD的相关性分析。结果高血压病患者外周循环EPCsCD34^＋水平随着其心血管危险程度的增加,逐步下降,各组间比较川差异均有显著性（P〈0．05）.高血压病患者肱动脉FMD随着其心血管危险程度的增加显著下降（P〈0．01）。各研究组高血压病患者循环EPCs CD34^＋水平与Framingham心血管危险因素积分呈负相关（r=-0．875,P〈0．01）,与肱动脉FMD呈正相关r=0．859,P〈0．01）.结论高血压病患者循环EPCs CD34^＋水平下降与心血管危险因素、动脉血管功能损伤有显著的相关性。说明循环EPCs CD34^＋水平可以作为评价高血压病患者动脉血管病变的指标.     

心脏康复综合治疗对PCI术后患者预后影响研究

目的探讨不同心脏综合治疗模式对PCI术后患者临床预后的影响。方法将PCI术后患者随机分成A、B、C、D 4组,分别采用"药物-宣教"、"药物-宣教-运动"、"药物-宣教-心理"、"药物-宣教-运动-心理"模式治疗,同时记录观测指标,最后统计4组治疗效果。结果 D组在心功能恢复及生活质量改善方面效果最优,B组较C组能明显改善患者预后,传统"药物-宣教"模式对患者预后无积极影响。结论 "药物-宣教-运动-心理"模式的心脏综合治疗能明显改善患者预后,减少患者痛苦,减轻社会医疗负担,值得临床推广。     

睡眠剥夺对大鼠动脉粥样硬化的影响

目的探讨睡眠剥夺（sleep deprivation,SD）对动脉粥样硬化（atherosclerosis,AS）进程的影响及其机制。方法 50只Wistar AS雄性大鼠随机分为5组（每组10只）：AS组、SD1d组、SD3d组、SD5d组、SD7d组。建立AS大鼠SD模型,制备主动脉组织标本,苏木精伊红（hematoxylin and eosin,HE）染色,光镜观察切片。检测主动脉组织还原型谷胱甘肽（glutathione,GSH）及脂质过氧化物丙二醛（malondialdehyde,MDA）含量、谷胱甘肽过氧化物酶（glutathione peroxidase,GSH-Px）及超氧化物歧化酶（superoxide dismutase,SOD）活性。检测血清肿瘤坏死因子α（tumor necrosis factor-α,TNF-α）、高敏C反应蛋白（hypersensitivity-C reactive protein,hsCRP）、白细胞介素6（interleukin-6,IL-6）水平。结果随着睡眠剥夺时间的延长,大鼠AS病变进展逐渐加重。主动脉组织GSH含量逐渐降低,MDA含量逐渐增高,GSH-Px及SOD活性逐渐降低。血清中TNF-α、hsCRPI、L-6水平也在逐渐增高。结论睡眠剥夺可通过引起机体的氧化应激反应及加速炎症发展,从而促进AS进程。