肌钙蛋白与CK-MB对急诊胸痛监护的价值评估

目的 评估肌钙蛋白T与CK—MB在急诊监护室对胸痛患者的诊断价值及成本效益。方法 选择因胸痛就诊而收入监护窒的58例患者资料进行回顾性分析。记录患者就诊时及在监护窒肌钙蛋白T定性与CK-MB检查结果以及最终的诊断．运用成本-效益分析法对以上两种检测方法进行分析。结果 监护室AMI发生率为3．4％，肌钙蛋白比CK-MB对诊断AMI更准确及有成本效益。结论 推荐使用肌钙蛋白为监护室胸痛患者再次评估的诊断方法。     

急性心肌梗死溶栓后检测肌红蛋白、肌钙蛋白I、肌酸激酶同工酶对冠脉再通的诊断价值

目的探讨血清肌红蛋白(Mb)、肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)对急性心肌梗死溶栓冠脉再通的早期诊断价值。方法应用酶联免疫分析法测定106例急性心肌梗死患者溶栓治疗后Mb、cTnI、CK-MB浓度的变化,分析急性心肌梗死患者溶栓再通组(73例)和溶栓未通组(33例)上述指标的变化。结果急性心肌梗死溶栓再通组Mb、cTnI和CK-MB达到峰值浓度的时间较未通组明显提前(P<0.05),其中Mb较cTnI、CK-MB峰值出现更早,分别为(5.9±2.5)h、(14.5±3.2)h和(14.8±3.9)h(P<0.01);Mb、cTnI和CK-MB对判断冠脉再通的敏感性、特异性、预测值无显著性差异(P>0.05)。结论血清Mb、cTnI和CK-MB可以较好地预测急性心肌梗死患者溶栓再通,其中Mb较cTnI、CK-MB能更早的判定冠状动脉是否再灌注。     

床旁肌钙蛋白Ⅰ定量检测在急性冠脉综合征中的应用

目的：探讨心肌肌钙蛋白Ⅰ（cTnⅠ）快速床旁定量测定对急性冠脉综合征（ACS）诊断、鉴别诊断及预后判断的临床应用价值．方法：对60例ACS患者，其中23例急性心肌梗死（AMI）、37例不稳定型心绞痛（UAP）。24例非心源性胸痛患者同时做dThI定量及CK-MB测定，进行各组间比较分析．结果：AMI组cTnI、CK-MB明显高于UAP组及对照组，有显著差异（P〈0．0001）．UAP组cTnI明显高于对照组（P〈0．001）。CK-MB无显著差异（P〉0．05）；UAPⅢ级的cTnI阳性率明显高于Ⅰ、Ⅱ级（P〈0．001）．结论：cTnI床旁快速定量测定方便、省时，对ACS患者的诊断、鉴别诊断及预后预测具有重要的意义和临床实用价值．     

冷氧合血与冷晶体停搏液对心脏瓣膜手术中心肌保护作用的对比研究

目的 评价4 ：1冷氧合血心脏停搏液同冷晶体停搏液在短主动脉阻断时间心脏瓣膜手术中的心肌保护作用。方法 30例风湿性心脏瓣膜病变病人随机分为冷氧合血灌注组（实验组n=15）及冷晶体灌注组（对照组n=15）。术中主动脉根部灌注冷灌注液，观察主动脉阻断前和开放后6h心肌肌钙蛋白Ⅰ（cTnI）、心肌肌酸激酶CK及其同工酶CK-MB、术后自动复跳率、10ws电除颤次数及辅助循环时间的影响和改变。结果（1）主动脉阻断前实验组与对照组cTnI、CK、CK-MB值无差异性，主动脉开放后对照组cTnI升高较实验组有显著性差异（P〈0．05）；（2）术后两组CK、CK-MB、自动复跳率、10ws电除颤次数、辅助循环时间无差异性。结论 冷氧合血停搏液较冷晶体停搏液在成人瓣膜手术中有更好的心肌保护作用。     

急性冠状动脉综合征

急性冠状动脉综合征是指由于急性心肌缺血所致的一组冠状动脉事件,包括不稳定型心绞痛和急性心肌梗死。通常根据临床表现、心电图或心肌酶改变来诊断。而肌钙蛋白T或I、肌红蛋白是诊断心肌坏死的可靠标志物。急性冠状动脉综合征的治疗方法有心肌缺血再灌注治疗、抗血栓治疗、抗心肌缺血治疗和调脂治疗等,临床上应根据不同情况选择合适的治疗方法。     

单胺类递质在大鼠癫痫发作心脏损伤中的作用

目的:观察癫痫发作前、发作时及发作后血浆去甲肾上腺素(NE)及血清心肌肌钙蛋白I(cTnI)含量以及心脏病理变化。探讨癫痫发作致心脏损害的发生、发展机制。方法:健康Wistar大鼠40只随机分成癫痫组(EP)和对照组(Control)。癫痫由青霉素诱导发作,动态监测大鼠癫痫发作时和发作后不同时间点血浆NE含量及血清cTnI水平的变化。NE的测定采用高效液相-电化学法,cTnI的测定采用光化学发光法。结果:大鼠癫痫发作时血浆NE明显升高,NE升高持续约1h以上。癫痫发作后1h血清cTnI水平开始升高,12h达高峰,随后逐渐下降。心脏病理检查证实癫痫发作可引起心脏损害。结论:癫痫发作时NE含量升高在癫痫发作致心脏损害过程中起重要作用。     

逆行灌注对心脏瓣膜置换术患者血清可溶性细胞间黏附分子-1、可溶性P-选择素和心肌肌钙蛋白Ⅰ的影响

目的 探讨风湿性心脏病行心脏瓣膜置换术患者,经冠状静脉窦逆行灌注对血清可溶性细胞间黏附分子(sICAM)-1、可溶性P-选择素(sPs)和心肌肌钙蛋白Ⅰ(cTnI)的影响.方法 将56例风湿性心脏病行体外循环(CPB)下心脏瓣膜置换术患者随机分为两组:主动脉根部顺行灌注心肌停跳液(AC)组和持续经冠状静脉窦逆行灌注心肌停跳液(RC)组,每组28例.于6个时点采静脉血,检测sICAM-1、sPs和cTnI水平.结果 CPB开始后,两组患者sICAM-1、sPs和cTnI水平均升高,术后8 h达到峰值,但RC组峰值均低于AC组[sICAM-1为(817.9±133.2)μg/L比(901.1±132.0)μg/L,sPs为(83.46±16.24)μg/L比(107.82±19.68)μg,L,cTnI为(10.50±2.03)μg/L比(14.45±2.26)μg/L],且RC组回落速度快于AC组.结论 逆行灌注能有效抑制sICAM-1、sPs和cTnI的表达,减轻炎性反应,从而起到更好的心肌保护作用.     

左心辅助循环后心肌功能恢复的预测研究

目的研究急性缺血性左心功能不全时左心辅助装置(LVAD)对左心功能的影响，筛选合适的心肌功能预后指标。方法将15只健康成年犬随机分为对照组(A)、心衰组(B)、辅助组(C)，仅对C组进行左心辅助。监测6h内3组实验犬的血流动力学指标及血浆心钠素(ANP)、脑钠素(BNP)、心肌肌钙蛋白Ⅰ(cTnⅠ)水平变化情况。结果辅助组实验犬各项血流动力学指标明显改善，ANP、BNP、cTnⅠ降至正常水平，心肌超微结构基本恢复正常。通过相关性分析，血浆。BNP水平不受血流动力学变化影响。结论血浆BNP更适于作为预测心肌功能恢复的预后指标。     

Postoperative 12-lead ECG predicts peri-operative myocardial ischaemia associated with myocardial cell damage

Peri-operative myocardial ischaemia is the single most important risk factor for an adverse cardiac outcome after non-cardiac surgery. The present study examines whether intermittent 12-lead ECG recordings can be used as an early warning tool to identify patients suffering from peri-operative myocardial ischaemia and subsequent myocardial cell damage. Fifty-five vascular surgery patients at risk for or with a history of coronary artery disease were monitored for peri-operative myocardial ischaemia using intermittent 12-lead ECG recordings taken pre-operatively and at 15 min, 20 h, 48 h, 72 h and 84 h postoperatively. The effectiveness of the 12-lead ECG was gauged by examining concordance with continuous 3-channel Holter monitoring and capturing peri-operative myocardial ischaemia by serial analyses of creatine kinase myocardial band isoenzyme and cardiac troponin T and I. The incidence of peri-operative myocardial ischaemia detected by 12-lead ECG was 44% and was identifiable in most patients (88%) 15 min after surgery. The incidence of peri-operative myocardial ischaemia detected by continuous monitoring was 53%, with the most severe episodes occurring intra-operatively and during emergence from anaesthesia. The concordance of the 12-lead method with continuous monitoring was 72%. The concordance of creatine kinase myocardial band isoenzyme activity with the 12-lead method was 71% and with Holter monitoring 57%. The concordance of mass concentration of creatine kinase myocardial band with 12-lead ECG recordings was 75%, and the corresponding value for Holter monitoring was 68%. The concordance of cardiac troponin T and I levels with the 12-lead method was 85% and 87%, respectively, and concordance with Holter monitoring was 72% and 66%, respectively. The postoperative 12-lead ECG identified peri-operative myocardial ischaemia associated with subsequent myocardial cell damage in most patients undergoing vascular surgery.     

A Spatially Explicit Nanomechanical Model of the Half-Sarcomere: Myofilament Compliance Affects Ca2+-Activation

The force exerted by skeletal muscle is modulated by compliance of tissues to which it is connected. Force of the muscle sarcomere is modulated by compliance of the myofilaments. We tested the hypothesis that myofilament compliance influences Ca2+ regulation of muscle by constructing a computational model of the muscle half sarcomere that includes compliance of the filaments as a variable. The biomechanical model consists of three half-filaments of myosin and 13 thin filaments. Initial spacing of motor domains of myosin on thick filaments and myosin-binding sites on thin filaments was taken to be that measured experimentally in unstrained filaments. Monte-Carlo simulations were used to determine transitions around a three-state cycle for each cross-bridge and between two-states for each thin filament regulatory unit. This multifilament model exhibited less "tuning" of maximum force than an earlier two-filament model. Significantly, both the apparent Ca(2+)-sensitivity and cooperativity of activation of steady-state isometric force were modulated by myofilament compliance. Activation-dependence of the kinetics of tension development was also modulated by filament compliance. Tuning in the full myofilament lattice appears to be more significant at submaximal levels of thin filament activation.