心电图劳损改变与高血压预后因素的关系探讨

目的 探讨心动图劳损改变与高血压预后因素的关系.方法 对31例有劳损的高血压患者与38例无劳损的高血压患者的预后因素进行对比分析.结果 有劳损组在空腹血糖水平、尿白蛋白/肌酐比值、超声心动图室间隔或左室后壁厚度、颈总动脉内中膜厚度、心脑肾疾病史方面均比无劳损组高,差异有显著性(P＜0.05或P＜0.01);有劳损组的高密度脂蛋白胆固醇水平比无劳损组低,差异有显著性(P＜0.05);而有劳损组总胆固醇水平和腰围与无劳损组相比虽较高但差异均无显著性(P＞0.05).结论 心电图劳损改变与多种高血压预后因素相关,可做为高血压危险分层及高血压疗效评价的一个有用指标.     

心电图同期CT脑血管造影诊断动脉瘤小泡样突起

目的了解心电图同期CT脑血管造影(CTA)技术对于未破裂动脉瘤的小泡样突起诊断的准确性。方法2004年间对15例患者进行了心电图同期CTA检查。结果其中10例患者在心电图同期CTA图像上发现有搏动部位存在,提示动脉瘤上有小泡样突起,手术中也有同样发现。切除的15例动脉瘤标本组织学检查均发现肌层和内弹力层部分或完全缺失,而有小泡的10例动脉瘤中发现胶原层减少,这与小泡样突起的存在相吻合。结论心电图同期CTA可用于未破裂动脉瘤的小泡样突起的诊断,其准确性可用标本的组织学检查加以证明。     

The value of pulse wave velocity in the diagnosis of coronary heart disease

Objective: Using receiver operating characteristics (ROC) curve to evaluate the value of pulse wave velocity (PWV) in the diagnosis of coronary heart disease (CHD). Methods: By using coronary angiography as golden diagnostic standard of CHD, 218 patients were divided into both CHD group (n=121) and non-CHD group (n = 97). All these patients received PWV test. The efficacy of PWV of each artery segments in the diagnosis of CHD was evaluated by ROC curve. The sensitivity and specificity were calculated with the golden diagnostic standard of CHD. Results:The PWV of right carotid to femoral artery (Rc-f), left carotid to femoral artery (Lc-f), right radial to carotid artery (Rc-r), left radial to carotid artery (Lc-r) in CHD group were significantly higher than that of non-CHD group (9. 31±1. 75 vs 7.60±1.59, P<0. 01; 9. 02±1.71 vs 7. 52±1.50, P<0. 01; 8. 69±1. 37 vs 8. 00±1. 27, P<0. 01; 8.52±1. 03 vs 8. 03±1. 2, P<0. 01 respectively). However, the PWV of both right and left femoral to ankle artery (Rf-a and Lf-a) had no significant differences between the two groups. We then compared the area under curve (AUC) of each ROC(AUCROC) of PWV of Rc-f, Lc-f Rc-r and Lc-r to evaluate their diagnostic efficacy for CHD. We found that AUCROC of Rc-f PWV was the biggest (AUCROC = 0. 818), at the peak point of its ROC curve, the PWV was 8. 32 m/s. PWV>8. 32 m/s of Rc-f could predict the presence of CHD with a sensitivity of 79% and specificity of 77%. Conclusion: The PWV of Rc-f, Lc-f, Rc-r, Lc-r are significantly higher in CHD group than that in non-CHD group, and PWV of Rc-f is the most accurate in the detection of CHD. The PWV>8. 32 m/s of RC-F is a valuable predictor of CHD.     

心力衰竭患儿血浆心房利钠肽水平变化及临床意义

目的:探讨心力衰竭患儿血浆心房利钠肽(ANP)的变化及其临床意义。方法:心力衰竭患儿34例,分成3个亚组,Ⅰ度心衰组14例,Ⅱ度心衰组13例,Ⅲ度心衰组7例。分别测定治疗前后血浆ANP水平、血清肌酸激酶同工酶(CK-MB)水平,并作超声心动图检查,观察血浆ANP水平与左室射血分数(LVEF)之间的关系。选取健康儿童20例作为对照组,以了解小儿心力衰竭时ANP、CK-MB变化情况。结果(:1)心力衰竭组ANP、CK-MB水平均明显高于正常对照组,随着心力衰竭程度的加重,血浆ANP水平逐渐增高,与心衰程度呈正相关,与LVEF呈负相关。而CK-MB与心衰程度、LVEF之间均没有相关性。(2)心功能好转后ANP、CK-MB水平均明显下降(P<0.01),LVEF明显增高(P<0.01)。结论:心力衰竭时,血浆ANP水平明显增高,并且与心衰程度、LVEF有较好的关联。     

Rendu–Osler–Weber syndrome presenting with pulmonary arteriovenous fistula

A pulmonary arteriovenous fistula is an abnormal connection between pulmonary arteries and veins. Patients with Rendu–Osler–Weber syndrome may present with this vascular malformation, which is a typical finding of the disease. Approximately 5–15% of Rendu–Osler–Weber syndrome patients have pulmonary arteriovenous malformations (AVM) and there is usually a family history of AVM in these patients. The malformations are usually located in the lower lobes. In this paper, I describe a 49‐year‐old male patient with dyspnoea, cough, haemoptysis and epistaxis. Physical examination showed nasal telangiectasias, cyanosis of the lips and nails, and a systolic bruit over the left lung. Chest X‐ray revealed a 5‐cm mass in the left lower lobe and after magnetic resonance examination, together with 3‐D magnetic resonance angiography, it was demonstrated to be a pulmonary arteriovenous fistula. The history of a niece with a similiar history of suspected pulmonary arteriovenous fistula led me to consider the possibility of Rendu–Osler–Weber syndrome presenting with a pulmonary arteriovenous fistula.     

Diagnosis of pulmonary embolism: Ventilation perfusion scintigraphy versus helical computed tomography pulmonary angiography

The present study compared the accuracy of ventilation perfusion scintigraphy (VQS) and CT pulmonary angiography (CTPA) for the diagnosis of pulmonary embolism. This was a prospective observational study of 112 patients with suspected pulmonary embolism (PE) who could be studied with both investigations within 24 h. Results were compared to final diagnosis at completion of 6-month follow up, using receiver operating characteristic (ROC) analysis. Pulmonary embolism was diagnosed in 27 referred patients (24%). The sensitivity and specificity of VQS and CTPA were similar to that reported from the literature. A normal VQ scan had the highest negative predictive value (100%), while a high-probability VQ scan had the highest positive predictive value (92%). There was no overall difference (area under the ROC curve (AUC)) between VQS (AUC (95% CI) = 0.82 (0.75,0.89)) and CTPA (AUC = 0.88 (0.81,0.94)) for the diagnosis of PE. Among patients with abnormal chest X-rays, CTPA (AUC 0.90 (0.83,0.97)) appeared somewhat better than VQS (AUC 0.78 (0.68,0.88)) but this difference did not reach statistical significance. In this instance, CTPA is at least as accurate as VQS and may provide an opportunity to make alternative diagnoses.     

留守因素、家庭关系对留守中学生人格的影响

目的 了解留守因素、家庭关系对留守中学生人格的影响。方法 于2019-2022年采用《艾森克人格问卷》少年版和《家庭亲密度与适应性量表》对眉山市某县级中学1 424名中学生进行调查。结果 纳入的受访者中,616名为留守中学生(占43.26%)。除了人格的精神质维度外,留守与非留守中学生在人格的其余维度及家庭关系的亲密度、适应性两个维度得分比较,差异有统计学意义(P<0.05)。结构方程模型分析显示,在留守初中生中,母亲外出时个体年龄对家庭亲密度有正向影响,路径系数为0.169;家庭亲密度对精神质与神经质有正向影响,路径系数分别为0.310、0.296;父亲在外时间长短对神经质有负向影响,路径系数为-0.146(P<0.05)。在留守高中生中,父亲外出时个体年龄对人格中的内外向有负向影响,路径系数为-0.111;母亲外出时个体年龄对精神质有负向影响,路径系数为-0.125;父亲在外时间长短对家庭亲密度、家庭适应性有负向影响,路径系数分别为-0.146、-0.163;家庭亲密度对精神质、神经质有正向影响,路径系数分别为0.253、0.266;家庭适应性对内外向有负向影响,路径系数为-0.241(P<0.05)。结论 留守经历会影响中学生的人格和家庭关系,但留守初中生和高中生在留守因素、家庭关系对人格特征的影响有所不同。     

特发性视神经炎患者视盘及黄斑区血流密度的定量研究

目的：评估特发性视神经炎(ON)患者的患眼和未受累对侧眼的视盘及黄斑的血流密度改变情况,为特发性ON的治疗和随访提供一定的临床指导。

方法：横断面研究。收集2019-12/2021-12于扬州大学附属苏北人民医院眼科确诊的初次发病且病程≤3 mo的单眼特发性ON患者16例,分为患眼组16眼与未受累对侧眼组16眼,另收集性别、年龄相匹配的健康者20例20眼作为对照组。所有眼均行视盘区4.5 mm×4.5 mm及黄斑区6 mm×6 mm光相干断层扫描血管成像(OCTA)检查,收集视盘区及黄斑区各血流指标,并对三组间各指标进行对比及分析。

结果：与对照组及未受累对侧眼组相比,ON患眼组视盘全区域及视盘周围各分区毛细血管、全部血管血流密度均降低(P<0.05)。与未受累对侧眼组相比,ON患眼黄斑区整体及中心凹周围全部分区SCP血流密度均显著降低(P<0.05),旁中心凹SCP血流密度仅在上半侧及上侧分区显著降低(P<0.05)。与对照组相比,ON患眼组黄斑中心凹周围下半侧、鼻侧、下侧SCP密度降低(均P<0.05)。与对照组相比,未受累对侧眼组黄斑区整体及各分区SCP血流密度均增加(P<0.05),旁中心凹SCP血流密度增加(P<0.05),但下半侧、鼻侧分区改变无统计学差异(P>0.05),中心凹周围SCP血流密度增加仅在上半侧及上侧分区有统计学意义(P<0.05)。

结论：病程3 mo以内的ON患者会出现视盘周围各分区血管密度的降低和黄斑中心凹周围部分分区SCP血流密度的降低,同时伴随着对侧眼黄斑区部分分区的SCP血流密度的增加。     

应变率成像对正常儿童左心室心肌形变能力的定量研究

目的 定量研究我国正常儿童左心室心肌应变率参数及其随年龄变化的特点。方法 正常儿童92名,按年龄分为4组,应用GEVivid7超声仪及Q-analyze软件分别对各组儿童左心室侧壁、下壁、前壁、后壁及前、后室间隔心肌各节段进行应变率定量分析。结果 前3组（1～9岁）儿童左心室心肌应变率在各节段的分布不一致,差异有统计学意义;10～14岁组左心室心肌各节段收缩期和舒张早期应变率差异无统计学意义,呈均衡分布。结论 正常儿童左心室心肌各节段收缩期、舒张早期应变率随年龄增长逐渐趋向一致,10岁后分布模式与成人相似。