肝硬化患者Pd、QTd和JTd测定的临床意义

目的测定肝硬化患者心电图P波离散度(Pd)、QT离散度(QTd)及JT离散度(JTd)数值,探讨其临床意义。方法按Child分级标准将60例肝硬化患者分为A、B、C级三组,测量同步12导联心电图Pd、QTd和JTd数值变化以及与总胆红素、白蛋白的相关性,并与30例健康者(对照组)比较。结果肝硬化患者出现心电图改变者占61.7%,高于对照组(36.7%,P<0.05);Pd、QTd和JTd数值高于对照组(P<0.01);且三组间比较,差异有统计学意义(P<0.01);Pd、QTd和JTd与总胆红素呈正相关(P<0.01),与白蛋白呈负相关(P<0.01)。结论肝硬化患者存在着心电图的改变,Pd、QTd和JTd数值的变化可评价肝硬化的严重程度,并能了解预后及指导临床治疗。     

心绞痛患者QT离散度与经皮腔内冠状动脉成形术的关系

目的 :探讨经皮腔内冠状动脉成形术 ( PTCA)对心绞痛患者 QT及 JT离散度 ( QTd及 JTd)的作用。方法 :测定 5 0例心绞痛患者 (心绞痛组 ) PTCA术前和术后的 QTd及 JTd,并以 5 0例正常冠状动脉者作对照 (对照组 )。结果 :1心绞痛组于 PTCA后 QTd及 JTd显著减小 ( P <0 .0 1) ,而对照组于冠状动脉造影术后 QTd及JTd与术前比较 ,无明显改变。 2与对照组比较 ,心绞痛组 PTCA前 QTd及 JTd明显增大 ( P <0 .0 1)。术后心绞痛组 QTd及 JTd值虽高于对照组 ,但无统计学意义 ( P >0 .0 5 )。结论 :PTCA能使 QTd及 JTd减小     

Diagnostic challenges due to phenocopies: lessons from Multiple Endocrine Neoplasia type1 (MEN1)

Phenocopies may confound the clinical diagnoses of hereditary disorders. We report phenocopies in Multiple Endocrine Neoplasia type 1 (MEN1), an autosomal dominant disorder, characterised by the combined occurrence of parathyroid, pituitary and pancreatic tumours. We studied 261 affected individuals from 74 families referred with a clinical diagnosis of MEN1 and sought inconsistencies between the mutational and clinical data. We identified four patients from unrelated families with phenocopies. Patients 1 and 2 from families with MEN1, developed prolactinomas as the sole endocrinopathy but they did not harbour the germlineMEN1 mutation present in their affected relatives. Patient 3, had acromegaly and recurrent hypercalcaemia following parathyroidectomy, whilst patient 4 had parathyroid tumours and a microprolactinoma. Patients 3 and 4 and their relatives did not haveMEN1mutations, but instead had familial hypocalciuric hypercalcaemia (FHH) due to a calcium‐sensing receptor mutation (p.Arg680Cys), and the hyperparathyroidism‐jaw tumour (HPT‐JT) syndrome due to a hyperparathyroidism type 2 deletional‐frameshift mutation (c.1239delA), respectively. Phenocopies may mimic MEN1 either by occurrence of a single sporadic endocrine tumour in a patient with familial MEN1, or occurrence of two endocrine abnormalities associated with different aetiologies. Phenocopies arose in >5% of MEN1 families, and awareness of them is important in the clinical management of MEN1 and other hereditary disorders. ©2009 Wiley‐Liss, Inc.     

急性心肌梗死QT离散度和JT离散度与心功能的相关性

作者测定分析１００例急性心肌梗死（ＡＭＩ）患者住院第３ｄ的１７导联心电图ＱＴ间期离散度（ＱＴｄ）及ＪＴ间期离散度（ＪＴｄ），并以１００例正常人作对照。结果表明:ＡＭＩ组的ＱＴｄ及ＪＴｄ较正常组明显增大，差异非常显著（Ｐ＜０．０１）。ＡＭＩ泵功能级别（Ｋｉｌｉｐ分法）与ＱＴｄ及ＪＴｄ呈正相关，即泵功能级别愈高，则ＱＴｄ，ＪＴｄ值愈大（ｒ分别为０．９９与０．９５）。     

低分子肝素干预不稳定型心绞痛后QTcd、JTcd及CRP的变化

目的观察应用低分子肝素（lowmolecularweightheparin,LMWH）干预后不稳定型心绞痛（UAP）患者的校正QT离散度（QTcd）、校正JT离散度（JTcd）及C反应蛋白（CRP）的变化及其相关关系。方法将145名UAP患者随机分成干预组（n=76）给予LMWH,对照组（n=69）给予常规治疗。观察两组QTcd、JTcd及CRP的变化并进行统计分析。结果干预组与对照组的心绞痛缓解、消失的天数有显著性差异（P<0.01）。QTcd、JTcd及CRP亦存在显著性差异（均P<0.01）。QTcd、JTcd与CRP在治疗的变化中呈正相关（r分别为0.62、0.51,均P<0.01）。结论LMWH对UAP的QTcd、JTcd及CRP有显著的降低作用,QTcd、JTcd与CRP呈正相关。     

Comparison of imaging findings on three-dimensional black-blood enhanced MR imaging between intracranial atherosclerotic occlusion and thrombotic occlusion

PurposeThe purpose of this study was to compare the imaging findings on three-dimensional (3D) black-blood (BB) contrast-enhanced MR imaging between intracranial atherosclerotic occlusion (IAO) and thrombotic occlusion (TO) of the middle cerebral artery (MCA) territory.Materials and methodsFrom August 2020 to September 2021, we retrospectively reviewed the BB contrast-enhanced MR imaging of patients visiting the emergency room for evaluation of acute ischemic stroke. In total, 77 patients with complete occlusion of the MCA territory on 3D BB contrast-enhanced MR imaging and cerebral angiography were enrolled in this study. We divided the IAO and TO groups according to occlusion causes based on angiography findings.ResultsOf 77 patients, 44 (57.1%) had an IAO in the M1 and M2 and 33 had a TO. Lesion length contrast enhancement (CE) in patients with a TO was significantly longer than that in patients with an IAO (18.95 mm [IQR: 20.91] vs. 7.1 mm [8.92], p <0.001). Overall, 38 (39.4%) patients showed a disconnection of CE on 3D BB contrast-enhanced MR imaging, and 35 showed CE before and after the stenotic or thrombotic lesion. Symptomatic lesions on diffusion-weighted imaging in the TO group were significantly higher than that of the IAO group (97.0% vs, 70.5%, p = 0.003).ConclusionThe long segment CE on 3D BB contrast-enhanced MR imaging was related to TO of MCA. CE before and after a stenotic or thrombotic lesion is a common finding on 3D BB contrast-enhanced MR imaging.