OBJECTIVE:To explore the genetic basis for a patient with Dilated cardiomyopathy.METHODS:A patient admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University in April 2022 was selected as the study subject. Clinical data and family history of the patient was collected. Targeted exome sequencing was carried out. Candidate variant was verified by Sanger sequencing and bioinformatic analysis based on guidelines of the American College of Medical Genetics and Genomics (ACMG).RESULTS:DNA sequencing revealed that the patient has harbored a heterozygous c.5044dupG frameshift variant of the FLNC gene. Based on the ACMG guidelines, the variant was predicted to be likely pathogenic (PVS1+PM2_Supporting+PP4).CONCLUSION:The heterozygous c.5044dupG variant of the FLNC gene probably underlay the pathogenesis in this patient, which has provided a basis for the genetic counseling for his family.

Background Saphenous veins are regular bypass conduits selected in non-left anterior descending artery (LAD) coronary artery bypass graft (CABG) surgery. Despite the technical errors, acute thrombosis, intimal hyperplasia and arteriosclerosis which could lead to saphenous vein graft (SVG) failure, the metal-clipping-related SVG failure is unique and rare. This study was conducted to investigate the clinical and underlying mechanisms of the metal-clipping-related SVG failure. Methods We collected 6 typical cases of the metal-clipping-related SVG failure in 41 patients who were diagnosed graft stenosis by coronary angiograph after CABG in the Department of Cardiology, Beijing Anzhen Hospital, from January 2020 to September 2021. Furthermore, we built an in vitro model to verify the identical intravascular ultrasound (IVUS) pattern of metal clip. Results There were 6 in 41 cases of SVG stenosis caused by clipping of the side branches. We found that the stenosis of SVG caused by metal clipping mostly occurred at the corner and multipole clipping points. In this situation, great resistance could be felt when pushing the instruments through the stenosis and crystallized cholesterol was rarely caught by the distal protection device. We verified the similar IVUS pattern of metal clip at the side-branches of SVG in vitro. Conclusions The metal-clipping-related stenosis may lead to SVG failure. The stenosis of SVG caused by metal clipping mostly occurred at the corner and multipole clipping points. IVUS showed great modality for clarification.

Objective To evaluate the clinical effect of sacubitril valsartan sodium tablets on patients with hypertension and chronic heart failure (CHF) in plateau area.Methods Ninety-six patients with CHF caused by hypertension were enrolled in Lhasa People's Hospital from October 2017 to February 2018.They were randomly divided into observation group (47 cases) and control group (49 cases).The observation group took sacubitril valsartan sodium tablets 100 mg twice per day and the control group took enalapril maleate 10 mg twice per day on the basis of routine treatment for heart failure for 6 months.Main outcome measurements included left ventricular ejection fraction (LVEF) and 6 minutes walking distance (6MWD).Secondary outcome indicators included total death,cardiogenic death,readmission due to heart failure,systolic blood pressure,estimated glomerular filtration rate(eGFR) and blood potassium level.Results After 6 months of treatment,LVEF and 6MWD in observation group were significantly higher/longer than those in control group [(38 ± 4) ％ vs (36 ± 4) ％,(325 ± 70) m vs (274 ± 72)m] (both P ＜ 0.05).Systolic blood pressure significantly decreased after treatment in both groups (P ＜ 0.05),but there was no significant difference between them(P ＞0.05).There was no significant difference of eGFR and blood potassium between groups before and after treatment(all P ＞0.05).Readmission rate due to heart failure within 6 months in observation group was significantly lower than that in control group[21.3％ (10/47) vs 42.9％ (21/49)](P ＜0.05).There was no significant difference of total mortality and cardiogenic mortality between groups[2.1％(1/47) vs2.0％(1/49),2.1％(1/47) vs2.0％(1/49)](P＞0.05).Conclusion Sacubitril valsartan sodium tablets treating hypertensive patients with CHF at high altitude can more effectively improve left ventricular function,exercise tolerance,quality of life,reduce recurrence and readmission than enalapril.

目的 探讨老年心房颤动(AF)合并急性冠脉综合征(ACS)患者不同抗栓治疗的长期安全性和有效性,并分析影响出血的危险因素.方法 采用回顾性队列研究方法连续选取2014年1月-2016年12月在首都医科大学附属某医院诊治的≥60岁老年AF合并ACS患者389例,根据抗栓方案将患者分为2组,华法林+阿司匹林+氯吡格雷三联抗栓组简称TT组112例和华法林+氯吡格雷二联抗栓组简称WC组277例.随访18个月,评估2组患者抗栓治疗后出血风险和缺血性心脑血管事件.结果 389例患者中男性174例占44.7％,女性215例占55.3％,平均年龄为77.6±11.8岁,2组的基线临床资料无明显差别.平均随访17.8±2.1个月后,发现2组的INR值和INR达标率均无明显差异,TT组严重出血和中度出血发生率显著高于WC组,但2组间缺血性心脑血管事件发生率无显著差异.高龄(OR=1.57,95％CI:1.26～1.88,P=0.007)、高HAS-BLED评分(OR=2.14,95％CI:1.46～2.77,P=0.037)和三联抗栓(OR=2.24,95％CI:1.73～2.51,P=0.012)为中重度出血的危险因素.结论 在老年AF合并ACS患者治疗过程中相对联合华法林、阿司匹林及氯吡格雷的三联抗栓治疗,华法林联合氯吡格雷的二联抗栓治疗在不增加缺血性脑卒中和心血管事件情况下可降低严重和中度出血风险.高龄、高HAS-BLED评分和三联抗栓为中重度出血的危险因素.

目的:对主动脉内球囊反搏(IABP)辅助的急性心肌梗死(AMI)患者的院内死亡及生存的比较,分析影响IABP辅助的急性心肌梗死患者院内死亡的危险因素.方法:连续收录本院心内科2005年7月至2013年7月间,发病在72h之内并应用IABP辅助治疗的急性心肌梗死患者572例,其中发生院内死亡患者81例.比较死亡与存活患者入院一般情况、介入治疗情况及IABP辅助情况等临床特点,以二分类Logistic回归分析导致院内死亡的独立危险因素.结果:与院内生存组相比,院内死亡组年龄较高,女性患者多,Killip Ⅲ ～ Ⅳ级患者多;患者发病至入院时间较长,入院时心率较快,血压较低,血肌酐较高,左心室射血分数较低,合并高血压及糖尿病的比例更高,犯罪血管为左主干及多支血管病者较多.二分类Logistic回归分析显示:高龄(年龄＞65岁)(OR=2.224,95％ CI:1.106 ～4.475,P=0.025)、发病至入院时间长(OR=1.021,95％ CI:1.005 ～1.038,P=0.012)、心功能Killip分级Ⅲ ～ Ⅳ(OR=11.167,95％ CI:3.895～32.019,P＜0.001)、中度以上肾功能不全(OR=2.497,95％ CI:1.325～4.705,P＜0.01)及左心室射血分数降低(OR=1.060,95％ CI:1.035～1.086,P＜0.01)为导致院内死亡的独立危险因素.结论:IABP辅助可以改善急性心肌梗死患者的生命体征,为下一步治疗提供机会;但对于高危患者,包括老年、就诊时间延迟、心功能差及严重肾功能不全的患者,IABP辅助收效甚微,院内病死率高.

Objective To evaluate the predictive value of shock index on in-hospital mortality of patients with critical acute myocardial infarction.Methods Totally 572 adult patients with critical acute myocardial infarction (AMI) who underwent intra-aortic balloon pump (IABP) from July 2005 to July 2013 were retrospectively analyzed.The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of shock index,then the patients were divided into two groups based on the cut-off value.The general informations,clinical indicators,status of diagnosis and treatment,pre and post-IABP vital life signs were compared between groups.Results The area under ROC curve was 0.719,indicating a good predictive value of shock index on in-hospital mortality of patients with critical acute myocardial infarction.According to the cut-off value,the patients were divided into shock index ≥1.21 group (151 cases) and shock index ＜ 1.21 group (421 cases).The general informations were not significantly different between groups (P > 0.05).The first visit time,heart rate on admission,proportion of heart function degree Ⅲ-Ⅳ in shock index ≥ 1.21 group were significantly higher than those in shock index ＜1.21 group [6 (4,12) h vs5 (3,10) h,100 (77,110) times/min vs 80 (70,90) times/min,67.5％ (102/151) vs 34.9％ (147/421)],the systolic blood pressure and diastolic blood pressure in shock index ≥1.21 group were significantly lower than those in shock index ＜ 1.21 group[95 (80,120) mmHg vs 106 (90,125) mmHg,60 (50,70) mmHg vs 70 (60,80) mmHg] (P＜0.05).Antetheca myocardial infarction took majority in both groups.The ratio of patients undergoing emergency percutaneous coronary intervention,left ventricular ejection fraction in shock index ≥ 1.21 group were significantly lower than those in shock index ＜ 1.21 group [61.6％ (93/151) vs 77.0％ (324/421),44％ (37％,53％) vs 48％ (40％,56％)];the IABP support duration in shock index ≥ 1.21 group was significantly longer than that in shock index ＜ 1.21 group [2 (1,3) vs 1 (1,2) d];the proportion of patients receiving single drug treatment,the in-hospital mortality,the incidence of cardiac shock in shock index ≥ 1.21 group were significantly higher than those in shock index ＜ 1.21group [27.8％ (42/151) vs 14.7％ (62/421),29.8％ (45/151) vs 8.6％ (36/421),49.7％ (75/151) vs 18.3％ (77/421)] (P ＜ 0.05).After IABP placement,the variations of systolic and diastolic blood pressure,heart rate in shock index ≥ 1.21 group were significantly greater than those in shock index ＜ 1.21 group [29 (12,40) mmHg vs21 (10,31) mmHg,13 (4,25) mmHg vs9 (0,19) mmHg,-15 (-30,-4) times/min vs 0 (-9,10) times/min] (P ＜ 0.05).Conclusions Shock index is a simple and effective clinical index for predicting death risk of severe acute myocardial infarction;when shock index is ≥ 1.21,the in-hospital mortality increases significantly and the effect on IABP support is poor.

Objective To evaluate the safety and efficacy of predilation of branch vessels with dual wire balloon or conventional balloon during percutaneous coronary intervention (PCI) with simple strategy in treating bifurcation lesions of coronary artery.Methods Totally 162 patients with 170 bifurcation lesions of coronary artery confirmed by coronary angiography who underwent PCI with simple strategy from Janunary 2011 to Janunary 2014 retrospectively analyzed.During PCI,the branch vessels were predilated with dual wire balloon (DB group,78 cases) or conventional balloon (PB group,84 cases).The procedural success rate of PCI and percutaneous transluminal coronary angioplasty (PTCA),involvement of branch vessel,complications and incidence of major adverse cardiac events (MACEs) were compared between the two groups.Results The clinic characteristics,site and Duke classification of bifurcation were not significantly different between the two groups (P ＞ 0.05).The procedural success of PCI for the main vessels was 100％ (84/84) in DB group and 97.7％ (84/86) in PB group,without significant difference (P ＞ 0.05),but the procedural success rate of PTCA for branch vessels in DB group was significantly higher than that PB group [94.0％ (79/84) vs 81.4％ (70/86)] (P ＜ 0.05).The incidence of perioperative myocardial infarction in DB group was significantly lower than that in PB group [5.1％ (4/78) vs 17.9％ (15/84)] (P ＜ 0.05).During 12-months of follow-up,the incidence of MACEs in DB group was significantly lower than that in PB group [6.7％ (5/75) vs 15.0％ (12/80)] (P＜0.05).Conclusion During PCI with simple strategy in treating bifurcation lesions of coronary artery,it is safe and effective to pre-dilate the branch vessels with dual wire balloon,with higher success rate and less complications compared with conventional balloon.

Objective:To compare efficacy and safety of Enoxaparin combined Tirofinban with Unfractionated heparin combined Tirofinban in the process of treating acute myocardial infarction.Methods: We enrolled on 256 consecutive patients admitted with AMI in our hospital.Patients were randomly divided into 129 of Enoxaparin group and 127of Unfractionated heparin group,both of them using Tirofiban,Aspirin and Clopidogrel treatment.To investigate the incidence in total deaths,cardiac death,recurrent myocardial infarction,stent thrombosis and other clinical events within 30d,and incidence in bleeding and platelet count in 72 hours.Results: Enoxaparin group had lower incidence of total deaths,cardiac death,recurrent myocardial infarction,stent thrombosis and other clinical events within 30d compared to Unfractionated heparin group,but no statistically significant difference(P0.05);Enoxaparin group had higher incidence in bleeding within 72 hours,but no statistically significant difference(P0.05).There was statistically significant difference(P0.05) in platelet count drop before and after treating with Enoxaparin group compared to Unfractionated heparin in 72 hours.Conclusion:Instead of unfractionated heparin,Enoxaparin is feasible for AMI patients combined Tirofiban.

Our study focused on urine protein of patients with bladder cancer. By using 2-dimensional electrophoresis with matrix-assisted laser desorption ionization time-of-flight mass spectrometry, we identified 14 differentially expressed protein spots between 3 patients with bladder cancer and 3 normal controls. Apolipoprotein A-I is one of the proteins that was at increased levels in the bladder cancer urine specimens, and it was confirmed by using Western blot analysis. We concluded that 14 differential spots included apolipoprotein A-I and could be potential urinary biomarkers for bladder cancer.Objective: We searched for bladder tumor markers by analyzing urine samples from patients with bladder cancer and from normal controls. Methods: Proteins in urine samples of patients with bladder cancer and with normal controls were systematically examined by 2-dimensional electrophoresis combined with matrix-assisted laser desorption ionization time-of-flight mass spectrometry. The expression of the protein apolipoprotein A-I (apoA-I) was confirmed by Western blot analysis and further evaluated. Results: We successfully obtained the 2-dimensional electrophoresis gel maps of urinary proteins in patients with bladder cancer and in normal controls. Thirty differentially expressed protein spots were successfully matched by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Combined with the SWISS-PROT database, only 14 proteins (beta-2-microglobulin, fatty acid-binding protein adipocyte, gelsolin, isoform 1 of gelsolin, myoglobin, isoform 2 of fibrinogen alpha chain, apoA-I, prostaglandin D 2 synthase 21 kDa [ brain], protein AMBP, transthyretin, keratin type II cytoskeletal 1, type II cytoskeletal 8, putative uncharacterized protein ALB, putative uncharacterized protein MASP2 [ fragment]) were identified, including 2 putative proteins. Furthermore, apoA-I was confirmed by Western blot analysis, and the high level of apoA-I was found in urine samples from patients with bladder tumors compared with normal controls. Conclusions: Analysis of urinary proteome may be a feasible, noninvasive, and efficient strategy for searching for potential bladder tumor biomarkers. A significant relationship of expressed apoA-I was established between bladder cancer and normal controls. We concluded that 14 differential spots included the apoA-I and would be potential urinary biomarkers for the diagnosis and surveillance of bladder cancer. Clinical Genitourinary Cancer, Vol. 11, No. 1, 56-62 (C) 2013 Elsevier Inc. All rights reserved.

目的 研究围术期阿托伐他汀强化治疗对急性冠状动脉综合征(ACS)患者择期介入治疗术后炎症因子的影响.方法 将84例ACS患者按随机数字表法随机分为2组,常规剂量组予常规治疗加阿托伐他汀20 mg每晚1次,强化剂量组在常规治疗基础上,从术前开始到术后1周,予阿托伐他汀40 mg每晚1次,1周后继续服用阿托伐他汀20 mg 1次/d.分别在术前及术后1、4、8周测定患者血清高敏C反应蛋白(hs-CRP)、基质金属蛋白酶9(MMP-9)、可溶性细胞间黏附分子1(sICAM-1)的浓度,检测治疗期间TC、TG、HDL-C、LDL-C ALT、Cr及肌酸激酶变化.结果 术后8周强化剂量组TC、LDL-C明显低于常规剂量组[分别为(3.8 ±0.8)mmol/L比(4.1 ±0.8)mmol/L,(2.0 ±0.7)mmol/L比(2.4 ±0.6) mmol/L,均P＜0.05].强化剂量组在术后8周hs-CRP、MMP-9、sICAM-1明显低于常规剂量组[分别为(11±4) mg/L比(13±4)mg/L,(231±25) μg/L比(255±30) μg/L,(318±58) μg/L比(322±49)μg/L,均P＜0.05].相关性分析显示,强化剂量组PCI术后8周hs-CRP、MMP-9、sICAM-1的水平变化与LDL-C变化呈正相关(r=0.816、0.765、0.697,均P＜0.05).结论 围术期强化剂量阿托伐他汀治疗可以更好地降低ACS患者经皮冠状动脉介入术后血脂及炎症因子水平,与常规剂量相比,并未增加不良反应的发生率.

Objective To evaluate the application of thrombus aspiration catheter in treatment of coronary stent thrombosis.Methods From October 2008 to October 2012,32 consecutive patients with stent thrombosis who received ZEEK thrombus aspiration catheter were involved in a single center retrospective analysis.Primary endpoints were device pushability and trackability,myocardial blush grade (MBG),thrombolysis in myocardial infarction (TIMI) flow grade and aspiration efficacy as indicated by size distribution of aspirated thrombi.Cardiac death and recurrent stent thrombosis as major adverse cardiac events (MACE).Results ZEEK thrombus aspiration catheter was delivered through culprit lesions successfully in 30 patients (93.8％).TIMI reached 3 degrees in 25 patients (78.1％) and increased in 23 patients after thrombus aspiration; the MBG reached 3 degrees in 21 patients(65.6％)and increased with 19 patients after thrombus aspiration;there was no new coronary artery dissection in the culprit lesions.There were 3 (9.4％)and 2 recurrent stent thrombosis (6.2％)death in hospital.Conclusion Application of ZEEK thrombus aspiration catheter in treatment of stent thrombosis is safe and effective.

Objective:To evaluate the effect of late endothelial progenitor cells(EPCs) on the proliferation,apoptosis of cardiomyocytes(CM) from bone marrow of rats and analyze its mechanism.Methods:The late EPCs were cultured and characterized.Then,we co-cultured late EPCs with CM of different ratios(0∶1-10∶1) and time(12-48 h),and tested the proliferation and apoptosis.Furthermore,we tested the vascular endothelial growth factor(VEGF) of co-culture supernatant for 48 h of different ratios(0∶1-10∶1).Results: The early EPCs became long spindle on the 7th day,and then became cornerstone shape on the 28th day.Moreover,late EPCs can take in Dil-acLDL and FITC-UEA-I.After co-cultured with late EPCs of different ratios and time,CM demonstrated better proliferation(P 0.05) and apoptosis(P 0.05),respectively.Besides,compared with the control,the protection was highest(P 0.05) when the ratio was 10∶1 for 48 h.After co-cultured for 48 h,the VEGF of co-culture supernatant increased significantly(P 0.05).Conclusion: This study demonstrates that late EPCs can improve the proliferation and apoptosis of CM in ratio-and time-dependent manner,which may be related to VEGF secreted by late EPCs.

Objective To study the risk factors of contrast-media induced nephropathy(CIN) in patients undergoing selective percutaneous coronary intervention(PCI) with routine hydration.Methods A total of 216 patients undergoing selective PCI from February 2010 to October 2011 were enrolled in this study,all patients were received infusion of saline [1.5 mL/(kg·h)] in preoperative period of PCI.Levels of serum creatinine were determined 24 hours before and 72 hours after PCI.Results Among the 216 patients,18 patients developed CIN(8.33%).The age,diabetic mellitus,decreased renal function,and contrast medium dosage in CIN patients were significantly different from those in non-CIN patients(P0.05 or P0.01).Identified by regression,age≥70,diabetes mellitus,preoperative eGFR60 mL/(min·1.73 m2) and volume of contrast medium were independent risk factors of CIN.Conclusions With routine hydration,incidence of CIN was 8.33% among patients undergoing selective PCI.Age,accompanied with diabetic mellitus,decreased renal function and contrast medium dosage are the independent risk factors,which should be highly alerted in high risk patients.

Objective To evaluate the effect of rosuvastatin on the proliferation,migration and apoptosis of late endothelial progenitor cells(EPCs) from bone marrow of rats.Methods The late EPCs were cultured and characterized by DiLDLuptake and lectin binding.Then,we co-cultured the EPCs with culture medium containing rosuvastatin of different concentrations(0.001,0.01,0.1,1.0,10,100 μmol/L),and tested the proliferation,migration and apoptosis;furthermore,we co-cultured EPCs with medium containing 0.1 μmol/L rosuvastatin for different hours(1,3,6,12,24,48 h),and the functions including proliferation,migration and apoptosis were analyzed again.Results The early EPCs became long spindle on the seventh day,and then became cornerstone shape on the 28th day.Moreover,late EPCs can take in Dil-acLDL and FITC-UEA-I.After co-cultured with rosuvastatin of different concentrations,it was demonstrated that proliferation(P0.05),migration(P0.05) and apoptosis(P0.05) were improved.Furthermore,compared with the control,the protection was highest when the rosuvastatin concentration was 0.1 μmol/L.It was also found that proliferation(P0.05),migration(P0.05) and apoptosis(P0.05) of late EPCs were improved at the concentration of 0.1 μmol/L rosuvastatin,and the protection increased with time,but did not changed significantly after 24 hours.Conclusion This study demonstrated that rosuvastatin could improve the proliferation,migration and apoptosis of late EPCs from bone marrow in concentration-and time-dependent manner.

Objective To investigate the characteristics,treatment and prognosis of thrombocytopenia application intro-aortic balloon pump treating acute myocardial infarction patients.Methods From August 2005 to January 2011,we identified 128 acute myocardial infarction patients who accepted intro-aortic balloon pump treatment,and analyzed clinical characteristics of platelet retrospectively.Results Mean duration of intro-aortic balloon pump insertion of 128 acute myocardial infarction patients was(86.4±7.1) hours,52 patients have thrombocytopenia,37 patients with mild decreased platelet and 15 patients with severe decreased platelet;no extreme severe reduction condition;initial time of thrombocytopenia was 12 hours when intro-aortic balloon pump was used;platelet returned to normal of 97.4% patients when intro-aortic balloon pump was stopped.Conclusions Intro-aortic balloon pump treating acute myocardial infarction patients can induce thrombocytopenia.In order to reduce occurrence of condition,we should pay more attention and monitor strictly.

OBJECTIVE:Proteomics-based approach was applied to analyze and compare the difference of proteins among human nasal inverted papilloma (NIP), nasal polyposis and normal nasal mucosa, in order to screen different proteins as marker.METHODS:The total proteins of NIP, nasal polyposis and normal nasal mucosa were separated by two-dimensional gel electrophoresis (2-DE). Protein image obtained by using the gel of Calibrated GS-800 Densitometer system, and determined different protein spots.RESULTS:Six differential proteins between NIP and nasal polyp tissue were identified, which were galectin-1, Manganese-superoxide dismutase, galectin-7, trichostatin A, prohibitin and transferring. All of them were increased in NIP.CONCLUSIONS:Six differential proteins were possibly involved in NIP, which provided a new way for discriminating NIP from nasal polyposis. The data would be good for the establishment of NIP protein 2-DE map.

Objective Prostate cancer and benign prostatic hyperplasia(BPH) can not be differentiated by serum prostate-specific antigen (PSA) in clinical medicine,especially when the level of PSA is in the range of 4 μg/L~10 μg/L. To find out some methods for differential diagnosis,proteomic analysis was made on proteins precipitated from urine specimens of patients with benign prostatic hyperplasia and prostate cancer. Methods Proteins were precipitated with acetone from urine specimens of 3 cases with benign prostatic hyperplasia,3 cases with prostate cancer,and 3 healthy persons. Then proteins were separated with two-dimensional polyacrylamide gel electrophoresis(2D-PAGE). The proteins were identified by peptide mass fingerprinting. Results Via the analysis,20 spots were obtained and a total of 17 different proteins were identified,including serum albumin,plasma retinol-binding protein precursor etc. Conclusion Proteomic analysis of urinary protein is a promising tool to study benign prostatic hyperplasia and may become a potential diagnostic biomarker.

目的探讨静脉推注美托洛尔在冠状动脉CT检查中的作用。方法受检者72例,随机分为美托洛尔静脉推注组(静脉组)和口服组各36例。静脉组推注美托洛尔总剂量10 mg,如心率下降至65次.min-1或血压下降至90/60 mmHg时,停止静脉推注美托洛尔,行冠状动脉多排CT检查;口服组一次给予美托洛尔50 mg。结果静脉组患者50.0%在用药后10 min达到目标心率,口服组中只有19.4%的患者用药后30 min达到目标心率(P<0.01)。结论静脉推注美托洛尔可以快速、有效、安全地减慢心率,使心率过快患者顺利、快速完成冠状动脉CT检查。