目的 探讨血清可溶性ST2(sST2)、可溶性白细胞分化抗原40配体(sCD40L)、生长分化因子11(GDF11)在慢性心力衰竭患者中的表达及与心功能的相关性.方法 选择2018年3月～2020年3月我院接诊的74例慢性心力衰竭患者为观察组,并选择我院同期体检健康者65例作为对照组.分析血清sST2、sCD40L、GDF11与左室射血分数(LVEF)、左室前后径(LAD)及左室舒张末期内径(LVEDD)的相关性.结果 观察组患者血清sST2、sCD40L、GDF11、LAD及LVEDD水平显著高于对照组,LVEF水平显著低于对照组(P<0.05).Ⅱ级心功能患者sST2、sCD40L、GDF11、LAD及LVEDD水平显著低于Ⅲ级、Ⅳ级心功能患者,LVEF水平显著高于Ⅲ级、Ⅳ级心功能患者,Ⅲ级患者sST2、sCD40L、GDF11、LAD及LVEDD水平显著低于Ⅳ级患者,LVEF水平显著高于Ⅳ级心功能患者(P<0.05).相关性分析结果显示,血清sST2、sCD40L、GDF11分别与LAD、LVEDD均呈正相关(r=0.565,0.696,0.756,0.600,0.705,0.797,P<0.05),血清sST2、sCD40L、GDF11分别与LVEF均呈负相关(r=0.513,0.574,0.659,P<0.05).结论 慢性心力衰竭患者中血清sST2、sCD40L、GDF11的表达和心功能之间存在着密切关系,可促使疾病进展.

目的:探讨早期肠内营养支持对超高龄老年肺部感染患者的疗效.方法:选择70例超高龄老年肺部感染患者,按是否愿意接受肠内营养分为研究组(n=34)和对照组(n=36).两组患者均给予常规治疗,研究组另外接受早期肠内营养支持,对照组则进行自由饮食.比较治疗前后两组的营养指标、治愈情况和不良反应发生情况.结果:治疗后,研究组的身体质量指数(body mass index,BMI)、血红蛋白、血清总蛋白、血清白蛋白、前白蛋白水平均较对照组有明显上升,logNT-proBNP较对照组明显下降,差异均有统计学意义(P＜0.05);治疗后,两组的上臂中部周径(mid-arm circumference,MAC)、肱三头肌皮褶厚度(triceps skim fold,TSF)和治愈率比较,差异均无统计学意义(P＞0.05);研究组的不良反应发生率低于对照组,差异有统计学意义(P＜0.05).结论:早期肠内营养支持可以改善超高龄老年肺部感染患者的营养状况及预后,值得推广.

目的 探讨同型半胱氨酸(Hcy)在老年高血压患者评估及治疗中的意义.方法 选取2017年南京医科大学附属苏州医院收治的老年高血压病患者60例,根据Hcy水平将所有患者分为对照组(Hcy<15μmol/L)和研究组(Hcy≥15μmol/L),各30例.比较两组患者Hcy、脂蛋白(a)〔Lp(a)〕、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、肌酐(Cr)、收缩压(SBP)、舒张压(DBP)、尿微量清蛋白与尿Cr比值(UmACR);分析Hcy与Lp(a)、LDL、SBP、DBP及UmACR间的相关性.结果 研究组患者Hcy、Lp(a)、LDL水平,SBP、DBP及UmACR高于对照组(P<0.05);两组患者TC、TG、HDL、Cr水平比较,差异无统计学意义(P>0.05).Hcy与Lp(a)、LDL、SBP、DBP、UmACR呈正相关(P<0.05).结论 Hcy在老年高血压患者的评估及治疗中有重要的指导意义.

Objective To investigate the value of CRUSADE scoring system in the baseline assessment of upper gastrointestinal hemorrhage after percutaneous coronary intervention(PCI).Methods 476 patients with upper gastrointestinal hemorrhage following PCI in our hospital from May 2008 to October 2009 were included in this study.According to the evaluation results of CRUSADE scoring system on admission,they were divided into very low-risk group(105 cases),low-risk group(190 cases),moderate-risk group(92 cases),high-risk group(70 cases)and very high-risk group(19 cases).The relationship between CRUSADE scores and obvious upper gastrointestinal hemorrhage within a year after PCI was analyzed.Results Obvious upper gastrointestinal bleeding occurred in 7 cases within 1 year after PCI,including 2 cases(1.05%)in low-risk group,1 case(1.09%)in moderate-risk group,1 case(1.43%)in high-risk group,3 cases(15.8%)in very high-risk group,and no case in very low-risk group.The total hemorrhage rate was 1.47%.It demonstrated that the incidence of gastrointestinal bleeding increased with the increase of CRUSADE score,and the hemorrhage rate in very high-risk group was significantly higher than that in other groups(P<0.05).Conclusion CRUSADE scoring system is of good value in the baseline assessment of the incidence of upper gastrointestinal bleeding after PCI.

Objective To study the clinical manifestations and coronary artery disease features in coronary heart disease(CHD) patients with type 2 diabetes mellitus(DM).Methods 148 patients with coronary heart disease diagnosed by coronary angiography were involved in the present study,in which 70 patients with DM as the observation group and 78 patients without DM as the control group.The clinical characters and coronary angiographic features were analyzed.Results Age,sex,hypertension,hyperlipidemia and smoking history had no significant difference between two groups(P0.05).The TG,LDL-L levels in the observation group were significantly higher than the control group,and the HDL-L level is significantly lower(P0.05),the coronary artery lesions of observation group is dominated by multi-vessel disease and diffuse lesions,the stenosis is severe(P0.05).Conclusion Dyslipidemia is more pronounced in patients with coronary heart disease and type 2 diabetes mellitus,the characteristics of coronary artery lesions is multi-vessel,widespread and diffused.

目的:探讨慢性心力衰竭患者微量白蛋白尿(MAU)、红细胞分布宽度(RDW)与NYHA心功能分级之间的关系。方法:选择162例CHF患者,按照NYHA心功能分级标准分为1组(NYHAⅡ级)、2组(NYHAⅢ级)、3组(NYHAⅣ级)。选择同期正常体检者和住院的阵发性室上性心动过速患者共83例作为对照组。测定并比较4组UACR、RDW、肌酐、HSCRP、BNP、LVEF、LEVDD水平,分析UACR、RDW、BNP、LVEF之间的相关性。结果:UACR、RDW随着心功能分级增高呈逐渐增高的趋势,各组间比较差异均有统计学意义(P<0.05),两者与BNP呈明显正相关,与LVEF呈明显负相关,两者之间呈正相关。结论:UACR、RDW水平与心功能分级有关,可以评估心力衰竭的严重程度。