酷似急性心肌梗死的病毒性心肌炎1例

1病例报告 患者女,51岁,因“咳嗽、气促1d,加重半天”于2006-12-30入院。入院前1周有头痛、发热,体温约38℃,伴全身酸痛、乏力,次日热退。4d前自觉头晕乏力,到外院就医,当时血压偏低（80／50mmHg,1mm Hg=0．133kPa）。2d前开始咳嗽,干咳无痰。入院前1日下午开始咳嗽加重并气促,坐位可缓解。     

外泌体非编码RNA与心肌缺血再灌注损伤的研究进展

<正>急性心肌梗死（AMI）是全球高发病率、高死亡率的主要疾病之一,心肌再灌注治疗是AMI最重要的处理措施之一,包括溶栓、经皮冠状动脉介入治疗（PCI）等,可最大限度挽救缺血心肌,缩小心肌梗死（心梗）范围,降低心梗后的死亡率。然而,心肌缺血再灌注损伤（MIRI）可显著增加AMI患者不良事件的发生。研究表明~[1],50%的心肌梗死面积是由缺血再灌注损伤导致。MIRI的发生涉及一系列的病理生理过程,包括炎症反应、氧化应激、     

Impact of prolonged dual antiplatelet therapy on patients after drug-eluting stents implantation

Background Impact of dual antiplatelet therapy beyond 12 months on patients implanted with DES remains unsolved.Methods From January 2010 to June 2011,1873 patients who have been taking DAPT and free from death,myocardial infarction,stroke,repeat coronary revascularization,stent thrombosis,and major or minor bleeding according to TIMI criteria for 12 months after implantation of DES were randomly assigned to continuous (prolonged DAPT group) or discontinuous (standard DAPT group) clopidogrel (75 mg/day).The primary outcome was major adverse cardiovascular events (MACEs) which compose of death,nonfatal myocardial infarction (MI),nonfatal stroke,target vessel revascularization (TVR) or stent thrombosis (ST) at 180 days.Results There was no significant difference in the incidence of 180-day MACEs between prolonged DAPT group and standard DAPT group (8.98 % versus 10.13 %,respectively,P=0.400).The frequency of major bleeding was 0.64 % in prolonged DAPT arm and 0.43% in standard DAPT arm (P=0.523),that of minor bleeding was 3.32 % versus 2.87 % (P=0.585),respectively.Conclusions Prolonged DAPT beyond 12 months neither improve prognosis nor increase risk of bleeding in patients implanted with DES.     

Comparison of benefit and safety between different loading dose of clopidogrel on elderly patients undergoing primary percutaneous cronary intervention for ST-segment elevation myocardial infarction

Background Despite the proven benefit of 600-mg loading dose of clopidogrel in patients with acute ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous cronary intervention (PCI), there is still concern about its benefit and safety on elderly population. Methods Data of 172 consecutive elderly patients (≥75 years) with STEMI who underwent primary PCI at Guangdong Provincial Cardiovascular Institute from January 2008 to December 2011 were retrospectively collected. Patients were divided into 600-mg loading clopidogrel group and 300-mg clopidogrel group accoring to the loading dose of clopidogrel before primary percunaeous coronary intervention(PCI). Enzymatic myocardial infarction size estimated by peak creatine kinase-myocardial band (CK-MB) and patency of the infarct-related artery (IRA) were compared. Thirty-day major adverse cardiac events (MACEs), which consist of death, nonfatal myocardial infarction (MI), nonfatal stroke, target vessel revascularization (TVR) or stent thrombosis (ST) were compared to assess the efficacy of different loading dose. Bleeding information was compared as well to assess the safety of different pretreatment stragety before primary PCI. Results 96 patients were adminstered with 600-mg loading clopidogrel before primary PCI while 76 were administered with 300-mg. Patency of the IRA was significantly higher in patients administered with 600-mg loading clopidogrel therapy as compared with those who received 300-mg loading clopidogrel (94.8% vs. 85.5%, P = 0.038). 600-mg loading dose of clopidogrel was associated with lower incidence of 30-day MACEs compared with 300-mg loading dose of clopidogrel (8.3% vs. 19.7%, P = 0.029) while did not increase the risk of TIMI major (3.1% vs. 3.9%, P = 0.770) and minor bleeding (10.4% vs. 6.6%, P = 0.376). Conclusion 600-mg loading clopidogrel improves final patency of the IRA and clinical outcome as compared with 300-mg loading clopidogrel without increasing bleeding hazard.     

高敏C反应蛋白与不稳定心绞痛行介入术预后的关系

目的　探讨低密度脂蛋白(LDL-C)正常的不稳定心绞痛患者超敏C-反应蛋白(hs-CRP) 浓度对经皮穿刺冠脉介入治疗(PCI)术后预后的影响。方法　不稳定心绞痛患者在PCI术前测定血清hs-CRP浓度，术后随访9个月，期间观察主要不良心血管事件（MACE）的发生率。结果　hs-CRP浓度正常组主要不良心血管事件发生率显著低于hs-CRP浓度增高组(P < 0.05)。结论 hs-CRP浓度水平与PCI术后主要不良心血管事件的发生有相关性，可作为PCI术后主要不良心血管事件的预测指标。     

单纯性肾囊肿与Stanford B型主动脉夹层患者腔内修复术后不良事件的关系

目的探讨合并单纯性肾囊肿(SRC)对Stanford B型主动脉夹层(TBAD)患者施行胸主动脉腔内修复术(TEVAR)后近中期不良事件的影响。方法本研究为回顾性队列研究。连续性入选2010年1月至2015年12月间在广东省人民医院诊断为TBAD并接受TEVAR的患者, 根据是否合并SRC, 分为SRC组和无SRC组。以性别、年龄±2岁作为匹配因素, 按1∶1匹配SRC组和无SRC组。收集并比较两组临床资料的差异, 并通过门诊、电话随访及住院复查, 记录患者随访期间不良事件。校正影响预后的混杂因素后, 采用多因素Cox回归分析主动脉不良事件的危险因素。采用Kaplan-Meier法分析SRC组及无SRC组生存曲线。结果共纳入692例TBAD患者, 其中SRC组235例, 非SRC组457例。1∶1匹配后, SRC组和无SRC组各229例, SRC组年龄(62.3±10.4)岁, 男性209例(91.3%), 无SRC组年龄(62.0±10.2)岁, 男性209例(91.3%)。多因素Cox回归分析显示, 合并SRC(HR=1.991, 95%CI:1.090～3.673, P=0.02...     

阵发性睡眠性血红蛋白尿患者血细胞的特点及临床意义

目的 探讨阵发性睡眠性血红蛋白尿(PNH)患者血细胞的特点及临床意义。方法 对刚入院的33例PNH患者通过骨髓涂片或/和活检分成2组:骨髓增生活跃组21例,占64％;骨髓增生减低组12例,占36％。将2组患者的红细胞、血红蛋白、白细胞、血小板进行比较分析。结果 2组PNH患者的血红蛋白分别为(57.47±17.87)g/L和(71.30±19.52)g/L,红细胞分别为(1.58±0.49)×10~(12)/L和(2.15±0.59)×10~(12)/L,无明显差异(P>0.05);而白细胞分别为(6.14±4.21)×10~9/L和(2.34±0.90)×10~9/L,血小板分别为(110.29±89.06)×10~9/L和(23.42±12.06)×10~9/L,有明显差异(P<0.05)。结论 结果提示,PNH患者的血红蛋白和红细胞与骨髓增生情况似无明显相关的关系;白细胞、血小板与骨髓增生可能有关。     

肝硬化患者门静脉宽度与上消化道出血发生的相关性探讨

目的 探讨肝硬化患者门静脉宽度与上消化道出血发生的相关性。方法 通过B超对32例无上消化道出血肝硬化患者和30例有上消化道出血肝硬化患者进行门静脉宽度测定。结果 无上消化道出血组门静脉宽度平均为(14.37±1.33)mm,上消化道出血组门静脉宽度平均为(16.40±1.79)mm。两者统计学上有显著差异。结论 肝硬化患者门静脉宽度与上消化道出血有相关性。     

Diagnosis and management of coronary dissection and perforation in percutaneous coronary intervention

<正>With 20 years of instrumental progress and technical creativity, percutaneous coronary intervention (PCI) hasbecome one of the most important treatments for coronary artery disease. As PCI depends either on the mechanical dilatation of the artery or on the ablation