Doppler ultrasonographic indices in diagnosing nutcracker syndrome in children

To elucidate the Doppler ultrasonographic cut-off value of nutcracker syndrome causing hematuria in children, we analyzed Doppler spectral findings between 15 children with nutcracker syndrome and 15 age- and sex-matched normal control subjects. A follow-up Doppler ultrasound (US) was also performed in children with nutcracker syndrome when hematuria subsided completely after a median period of 1.7 years (range: 1.0–3.5 years) (relieved nutcracker syndrome). The peak velocity (PV) ratios of the left renal vein (LRV) were significantly higher in children with nutcracker syndrome than in those with relieved nutcracker syndrome (P < 0.0001) and normal children (P < 0.0001). The PV ratios of the LRV at the follow-up US were significantly higher than those in the control subjects (P = 0.019). None of the 15 normal children showed PV ratios of the LRV > 3.7, but five of the 15 children with relieved nutcracker syndrome without hematuria had PV ratios of 3.91–5.02. When we set the cut-off values for nutcracker syndrome at the mean ± 2 SD (mean: 2.95 ± 0.92, range: 1.60–5.02) of 30 controls (normal children and relieved nutcracker without hematuria), the calculated cut-off value was 4.8, and the sensitivity and specificity were 100% and 93%, respectively. Given its high sensitivity, renal Doppler US can be used as a useful initial non-invasive test in the diagnosis of nutcracker syndrome in children with hematuria.     

急性冠脉综合征患者脉搏波传导速度异常的观察

目的：探讨老年急性冠脉综合征（ACS）患者脉搏波传导速度（PWV）的变化。方法：将142名老年患者分为ACS组和对照组,进行PWV及总胆固醇（TC）、甘油三脂（TG）、低密度胆固醇脂蛋白（LDL-C）、空腹血糖（FBG）、血压和体重指数（BMI）的测量,用聚类分层法对不同PWV及各危险因素分层下两组中PWV的检出率进行统计分析。结果：ACS组PWV在小于1550cm／s亚层中的检出率显著低于对照组,而在1550-1850cm／s和大于1850cm／s亚层中的检出率则高于对照组（P〈0.01）,PWV是ACS的一个相对独立的危险因子。结论：PWV可以为心血管疾病的预防和诊断提供可靠的信息。     

Changes of Left Ventricular Geometry Shape and Left Ventricular Regional Function in Patients With Dilated Cardiomyopathy

To assess the left ventricle regional systolic and diastolic function, left ventricle geometry and left venticle sphericity indexes in patients with dilated cardiomyopathy （DCM） by quantitative tissue velocity imaging （QTVI）. Methods Thirty normal subjects and 52 DCM patients underwent QTVI and colour Doppler flow imaging study in order to measure the left ventricular regional function along left ventricle apical long-axis view and the left ventricle geometry. Peak tissue velocities of left venticle regional muscular tissue during systole （ Vs）, systolic acceleration （ a）, early diastole（Ve） and left atrium contraction（Va） along left venticle apical long axis view were measured. The indexes of left ventricular regional systolic and diastolic function were mearsured at the same time. The left ventricle geometry shape was reflected from the systolic and diastolic sphericity index （Sis and Sid）, the left ventricular ejection fraction （LVEF） and D wave / A wave （PVd/PVa） of pulmonary veins flowing spectrum reflected the global left ventricular systolic and diastolic function. The Vs, Ve, Va, a, PVd/PVa ratio, LVEF, Sis, Sid and their correlations between normal subjects and patients with DCM were compared and analyzed. Results Vs, Ve, Va, a, PVd/PVa, Sis and Sid in patients with DCM were lower than those in normal persons. There were significant relations between Sis and a （ r = 0. 6142, P 〈 0. 05）, Ve/Va and Sid （ r = 0. 6271, P 〈 0. 05 ）. Conclusions QTVI offer a newer method which has a higher sensitivity and accuracy in evaluating the left venticle regional systolic and diastolic function in DCM patients. There was significant relation between regional cardiac function and left venticle sphericity. （ S Chin J Cardiol 2009; 10（1） ： 9 -14）     

早期使用辛伐他汀对2型糖尿病患者动脉硬化的影响

目的研究早期使用他汀类药物对2型糖尿病患者动脉硬化的影响。方法60例血脂正常且无严重并发症的2型糖尿病患者在降糖等同一方案治疗基础上,随机分为两组,30例加服辛伐他汀调脂治疗作为治疗组,30例未行调脂作为对照组,采用臂一踝脉搏波传导速度（baPWV）评价治疗前后两组患者动脉弹性的变化。结果辛伐他汀治疗组与对照组治疗6个月后比较baPWV明显降低（P〈0．05）。结论早期使用他汀类药物能明显降低2型糖尿病患者baPWV,抑制动脉硬化。     

“正常”冠状动脉慢血流现象与血浆同型半胱氨酸水平的相关分析

目的:探讨冠状动脉慢血流现象(SCF)与血浆同型半胱氨酸(Hcy)水平的相关关系.方法:选择我院行冠状动脉造影(CAG)显示心外膜主要冠状动脉无明显病变的患者64例.通过校正TIMI血流计帧法(cTFC)计算各支冠状动脉的TIMI帧数.冠状动脉平均帧数大于27帧定义为SCF,将患者分为SCF组(24例)和对照组(40例).应用t检验和卡方检验比较2组各项临床资料的差异,并采用多元逐步回归和Logistic回归分析方法对相关因素进行分析.结果:2组患者性别、高血压、糖尿病、吸烟所占比例、血脂水平、血糖水平的差异无统计学意义,而SCF组的Hcy水平显著高于对照组[(12.55±2.65)μmol/L∶(8.39±1.98)μmol/L,P＜0.001],年龄小于对照组[(53.25±8.67)岁∶(57.85±8.08)岁,P=0.036].多元逐步回归方程:cTFC=9.979+2.256×Hcy-0.14×年龄(F=122.268, P＜0.001).Logistic回归分析表明Hcy是影响SCF的危险因素(OR2.214,P＜0.001).结论:Hcy与SCF有关,Hcy可能参与了SCF发生的病理生理过程.     

臂踝脉搏波传导速度与2型糖尿病大血管病变的相关性

目的探讨臂踝脉搏波传导速度（baPWV）与2型糖尿病大血管病变的相关性。方法148例住院的2型糖尿病患者,根据有无大血管病变分为无大血管病变组（A组）82例,大血管病变组（B组）66例,所有患者均测量baPWV、颈动脉内中膜厚度（IMT）及相关生化指标。结果B组的baPWV明显高于A组,且baPWV与IMT及大血管病变危险因素之间呈明显正相关;ROC曲线分析表明baPWV用于诊断2型糖尿病大血管病变时具有较好的敏感性和特异性。结论baPWV与2型糖尿病大血管病变之间具有显著相关性,对2型糖尿病大血管病变的早期诊断及指导治疗具有重要参考价值。     

糖尿病痛性周围神经病的临床及电生理特点分析

目的探讨糖尿病痛性周围神经病（PDPN）的临床和电生理特点。方法严格入选32例PDPN患者,病程〉1年,疼痛视觉模拟评分〉4,未伴有其他内科系统合并症,进行视觉模拟评分（VAS）并记录疼痛性质。电生理检测包括：常规神经传导速度（NCV）、定量感觉检测（温度觉）（QST-t）。结果PDPN往往有客观的感觉异常,但神经系统体征不典型,NCV检测可正常,而QST—t可有异常表现,本组NCV检测13例正常,其中11例QST-t异常;本组NCV异常率为59．4％,QST异常率为87．5％,QST＋NCV异常率为93．7％。VAS与QST的上下肢热痛觉（HP）呈正相关（t=0．595、P=0．009;t=0．784、P=0．004）,与胫神经的感觉神经传导速度（SCV）呈负相关（t=-0．554;P=0．032）;与其它电生理各项参数不相关,与空腹血糖、糖化血红蛋白、病程及疼痛病程不相关。结论PDPN以小纤维受累为主,QST可为早期PDPN提供客观的临床依据;疼痛程度与C类纤维及下肢胫神经感觉纤维病变有一定的相关性。     

中心动脉压及其相关指标的临床意义

中心动脉压不同于肱动脉血压,其与一些相关指标是心血管疾病及事件的真正关联因素。在许多生理及病理状态下中心动脉压及其相关指标会发生变化,检测中心动脉压及其相关指标具有重要的临床意义。     

Improved left and right ventricular functions with trimetazidine in patients with heart failure: a tissue Doppler study

Downregulation of glucose and fatty acid oxidation occurs in heart failure (HF). Trimetazidine reduces fatty acid oxidation and increases glucose oxidation. In this single-blind study, trimetazidine, 20 mg three times per day (n = 51) or placebo (n = 36) was added to treatment of 87 HF patients receiving optimal HF therapy. Etiology of heart failure was coronary artery disease in 35 patients (68.6%) in the trimetazidine group and 22 (62.9%) in the placebo group. Fourteen (27.5%) patients in the trimetazidine group and 11 (31.4%) patients in the placebo group had diabetes. Peak systolic velocity (Vs), and the peak early diastolic (Vd) and late diastolic (Va) velocities of various segments left and right ventricles (RV) were obtained with tissue Doppler imaging (TDI) and averaged. Patients were re-evaluated three months later. Significant increases in mean left ventricular ejection fraction (LVEF) (33.3% ± 5.6% to 42.4% ± 6.3%, P < 0.001 and 30.6% ± 8.2% to 33.2% ± 6.6%, P = 0.021) and LV and RV myocardial velocities and mitral and tricuspid annular TDI velocities were observed in both groups. However, compared to placebo, increments in LVEF (9.1% ± 4.2% vs. 2.5% ± 1.4%, P < 0.001) and myocardial velocities were significantly higher with trimetazidine (P < 0.001 for LV Vs, Vd, Va; P = 0.035 for RV Vd; and P < 0.001 for RV Va and Vs). Increase in LVEF with trimetazidine was significantly correlated with presence of diabetes (r = 0.524, P < 0.001). With trimetazidine LVEF increased significantly more in diabetic patients compared to nondiabetics (P < 0.001). Also, patients having both diabetes and ischemic HF tended to have greater improvement in LVEF compared to ischemic HF patients without diabetes (P = 0.063). Addition of trimetazidine to current treatment of HF, especially for those who are diabetic, may improve LV and RV functions.