脑梗死患者血脂水平检测及临床意义

目的探讨血脂水平与脑梗死的关系。方法通过对137例急性脑梗死患者与对照组血脂变化观察,多因素分析用SPSS10.0软件包中的Logistic回归方程,计算相对危险度(RR),RR的95%可信限(CI)。结果脑梗死组TC、TG、LDL-C浓度均明显高于对照组,而HDL-C浓度明显低于对照组。结论血清TC>6.0mmol/L才增加脑梗死的风险,而HDL-C浓度≥0.85mmol/L可降低脑梗死的风险。     

Vascular endothelial growth factor expressing mesenchymal stem cells improves cardiac function in chronic myocardial infarction in pigs

Transplantation of mesenchymal stem cells （MSCs） for myocardial reconstruction has shown promise in both animal models and human phase 1 clinical studies. Vascular endothelial growth factor （VEGF） is a strong therapeutic agent for treating ischaemia by inducing angiogenesis. The feasibility of ex vivo MSCs mediated gene transfer is documented. Matsumoto and colleagues have recently reported genetically engineered MSCs carrying VEGF165 delivery for revascularization in a model of acute myocardial infarction （MI）. The promising data from our laboratory in both angiogenesis and MSCs transplantation in cunicular heart model of acute MI have prompted us to attempt the combined and simultaneous application of the two strategies.     

Progress in the treatment of myocardial infarction with stem cells transplantation

1Introduction Myocardialinfarctionisischemicmyocardial necrosisresultedfromabruptreductionincoronary bloodflowtoasegmentofmyocardium.Myocardial infarctioncaninducecardiacremoldingandresultin heartfailure.Generalmethodsincludingthrombolytic therapy,PTCA,CABGandTMGcanonlyredredge theobturatlybloodvessel,improvemyocardialis chemiaandsavecardiacmuscleclosingtoputres cence,buttheycannotregeneratenecroticcardiac muscle.Thelong datedprognosisisnotgood.Heart transplantationisprobablythebestaltern…     

急性ST段抬高型心肌梗死10年间临床治疗及病死率分析

目的：了解本院10年前后2个时段STEMI的临床使用药物治疗情况和病死率变化。方法：对我院1993-1994年45例和2003-2004年85例急性心肌梗死患者的资料进行比较分析。结果：住院病死率从1993—1994年的15．2％降至2003—2004年的8．5％。结论：10年前后急性心肌梗死的药物治疗变化及早期溶栓治疗致使STEMI住院病死率明显下降。     

Watershed infarction associated with dementia and cerebral atrophy

A 63-year-old man was admitted with progressive left hemiparesis and left homonymous hemianopsia of 1 month's duration. During the 2 months before admission, he had suffered from slowly progressive dementia. The diagnosis of right-sided watershed (WS) infarction was made. He exhibited slow progression of dementia and cerebral atrophy during the period of observation after discharge. There was a positive relationship between cerebral atrophy and the degree of dementia. In the present case, WS infarction caused by right internal carotid artery occlusion might be related to dementia and cerebral atrophy.     

Hyperlipidemia as a risk factor for Trousseau syndrome-related cerebral infarction in patients with advanced gastrointestinal cancer

Trousseau syndrome-related cerebral infarction rarely occurs during chemotherapy in patients with gastrointestinal (GI) cancer, and its clinical features remain unclear. The present study aimed to examine the clinical features of Trousseau syndrome-related cerebral infarction developed during chemotherapy for GI cancer. The present retrospective cohort study consecutively enrolled 878 patients with unresectable GI cancer who received chemotherapy at the Multidisciplinary Treatment Cancer Center, Kurume University Hospital (Kurume, Japan) between April 2014 and March 2020. Patients with colorectal cancer (n=308) were the most common, followed by those with pancreatic (n=242), gastric (n=222) and biliary tract (n=59) cancer, neuroendocrine tumors (n=34) and duodenal cancer (n=11). Among the 878 patients, Trousseau syndrome-related cerebral infarction occurred in 8 (0.9%) patients with a median age of 70.5 years (range, 58–75 years), and 50% of the patients were male (4/8). In total, 3 patients had gastric cancer, 3 had pancreatic cancer and 2 had biliary tract cancer. A greater percentage of patients with Trousseau syndrome-related cerebral infarction had hyperlipidemia (38.0%) than those without (8.2%; P=0.005). Hyperlipidemia was a risk factor for occurrence of Trousseau syndrome-related cerebral infarction with an odds ratio of 7.009 (95% confidence interval, 1.785-27.513). Trousseau syndrome-related cerebral infarction developed during GI chemotherapy was rare and hyperlipidemia may predict its onset.     

急性心肌梗死自溶现象及其影响因素分析

目的分析急性心肌梗死（AMI）梗死相关血管（IRA）的自溶（SR）现象,探讨SR现象的影响因素。方法连续观察205例未予静脉溶栓治疗,直接行急诊冠状动脉造影的AMI患者,根据TIMI血流分为自溶组（前向血流TIMI 2-3级）和非自溶组（前向血流TIMI 0-1级）,分析其临床和造影特点,并寻求发生SR的影响因素。结果自溶组共49例（23.9%）。与非自溶组比较,一般临床情况差异无统计学意义（P〉0.05）,但自溶组发生梗死前心绞痛的比例较高（38.8%比22.4%,P〈0.05）。而非自溶组多支病变和存在侧支循环的比例高于自溶组（P〈0.05）。Logistic回归分析则提示多支病变和侧支循环是发生SR现象的独立影响因素。结论SR是AMI患者较常见的现象,其独立影响因素是多支病变和侧支循环。     

应激性血糖浓度对急性心肌梗死的影响

目的观察应激性高血糖浓度对急性心肌梗死预后的影响。方法选择符合急性心肌梗死诊断标准且有糖耐量异常患者183例,按入院后空腹血糖数值分为两组;糖耐量减低组65例,糖尿病组118例;观察两组患者血糖的变化、并发症发生的情况和死亡率。结果糖耐量减低组组患者出现并发症者18例,糖尿病组出现并发症者51例,χ2=4.30,P<0.05;糖耐量减低组30 d死亡6例,糖尿病组30 d死亡15例,χ2=0.50,P>0.05;糖耐量减低组1年内死亡12,糖尿病组1年内死亡38例,χ2=3.99,P<0.05。结论应激性高血糖浓度对缺血心肌的损害是肯定的,要及时监测和调控急性心肌梗死的血糖,阻断其对心肌细胞的进一步损害,以降低急性心肌梗死的病死率和并发症等。     

全血肌钙蛋白T即时检测诊断急性心肌梗死的意义

目的探讨床边全血即时检测心肌肌钙蛋白T(cTnT)早期诊断急性心肌梗死(AMI)的临床意义和不良后果预测价值。方法对收入急诊抢救室的128例高度可疑的AMI患者24 h内抽取静脉血检测cTnT,同时用同一份标本分别检测肌酸激酶(CK)及其同工酶(CK-MB)活性。结果在发病6 h和24 h内cTnT检测AMI的敏感性分别为74.3%和97.1%,特异性为97.7%。而CK及CK-MB的活性6 h内检测AMI的敏感性分别为40%和35.7%。结论cTnT快速即时检测对诊断AMI具有高度的敏感性和特异性,该方法简单快速,适宜床边检测,有助于早期确诊AMI,特别适用于急诊及院前急救。     

动态动脉硬化指数联合血清肿瘤坏死因子受体相关因子 6、前蛋白转化酶枯草溶菌素 9对急性分水岭脑梗死病人的预后价值

目的探究动态动脉硬化指数( AASI)联合血清肿瘤坏死因子受体相关因子 6(TRAF6)、前蛋白转化酶枯草溶菌素 9(PCSK9)对急性分水岭脑梗死( CWI)病人的预后价值。方法选取 2019年 8月至 2021年 8月保定市第二中心医院收治的 96例急性 CWI病人为研究组,另取同期体检健康者 80例为对照组。收集病人一般临床资料,并对研究组和对照组的血清 TRAF6、 PCSK9水平及 AASI进行检测;根据研究组病人预后情况将其分为预后良好组(67例)和预后不良组( 29例)多因素 logistic回归分析急性 CWI病人预后的影响因素;绘制 AASI与血清 TRAF6、PCSK9对急性 CWI病人预后评估的受试者操,作特征曲线( ROC曲线)。结果研究组血清 TRAF6(1.48±0.34)μg/L、PCSK9(97.25±14.25)μg/L水平及 AASI(0.56±0.15)高于对照组( 0.87±0.19) μg/L、(82.78±9.17)μg/L、(0.36±0.11)(P<0.05)。预后良好组与预后不良组年龄、美国国立卫生研究院卒中量表( NIHSS)评分、空腹血糖、狭窄程度及血管斑块性质差异有统计学意义( P<0.05)。预后不良组血清 TRAF6(1.77±0.37)μg/L、PCSK9(104.82±17.93)μg/L水平及 AASI(0.62±0.12)高于预后良好组( 1.35±0.21)μg/L、(93.97±12.65)μg/L、0.53±0.09(P<0.05)。多因素 logistic回归分析结果显示 NIHSS评分、狭窄程度、血管斑块性质、 AASI、血清 TRAF6、PCSK9水平是急性 CWI病人预后的影响因素( P<0.05)。 AASI联合血清 TRAF6、PCSK9预测急性 CWI病人预后的 AUC是 0.92,灵敏度为 93.10%,特异度为 76.12%,Youden指数为 0.69,优于 AASI、TRAF6、PCSK9各自单独预测(P<0.05)。结论急性 CWI病人血清 TRAF6、PCSK9水平显著升高,联合 AASI对病人的预后状况具有较高的预测效能,可为临床的合理干预和改善病人预后提供依据。