Objective To analyze risk factors of liver injury after intravenous administration of amiodarone.Methods Clinical data of 1 919 patients with intravenous administration of amiodarone were analyzed retrospectively;the patients were treated in 5 hospitals in Beijing from June 10,2011 to May 10,2012.According to the occurrence of liver injury after drug administration,patients were divided into liver injury group(185 cases)and normal liver function group(1 734 cases).Gender,age,body mass index,cardiac function,history of alcohol drinking,history of liver diseases,solvent of amiodarone,the loading dose,the total dose during the first 24 h of administration,type of arrhythmia,glomerular filtration rate and drug-related adverse reactions were analyzed.Results In 1 919 patients,370 cases(19.3％) had corrected QT interval(QTc interval) prolongation;185 cases (9.6％) had liver function injury;42 cases(2.2％) had severe hypotension;30 cases(1.6％) had bradyarrhythmia and 14 cases had phlebitis (0.7％).Multivariate logistic regression analysis showed that male was an independent risk factor of liver injury after amiodarone administration (odds ratio =1.805,95％ confidence interval:1.152-2.829,P =0.010);using 5％ glucose solution as the solvent of amiodarone was a protective factor(odds ratio =0.594,95％ confidence interval:0.393-0.898,P =0.013).Conclusions Liver injury and QTc interval prolongation are main adverse effects of intravenous administration of amiodarone.Male is an independent risk factor and using 5％ glucose solution as solvent is a protective factor of amiodarone-induced liver injury.

Objective:To determine the occurrence of amiodarone-induced side effects,and analyze risk factors for amiodarone-induced QTc interval (QT interval corrected by heart rate) prolongation.Methods:Clinical data of 534 in-patients with intravenous amiodarone administration in our hospital from June 10,2011 through May 10,2012 were analyzed retrospectively.According to whether or not the QTc interval prolonged after intravenous amiodarone administration,patients were divided into QTc interval prolongation group(L-QTc) and QTc interval non-prolongation group (N-QTc),then demographic characteristics,medical history,operation,acute kidney injury following cardiac surgery,bonus dose,total dose of amiodarone during the first 24 hours,and types of arrhythmia were compared between two groups,using chi-square or t-student test first and multivariable logistic regression analysis finally.Results:After cases with incomplete ECG records before or after amiodarone administration were picked out,total 243 cases were analyzed.It revealed that 62 patients (25.5％) occurred QTc interval prolongation,18 (5.62％) patients had liver injury,5 patients (2.1％) appeared severe decreased blood pressure,and 2 (0.8％) patients got phlebitis,but nobody had allergic response,bradyarrhythmia or atrioventricular block.Multivariable logistic regression analysis showed that acute kidney injury following cardiac surgery were an independent risk factor for QTc prolongation.Conclusion:Intravenous amiodarone used to be administrated in patients after cardiac surgery in our hospital.Intravenous amiodarone administration induced higher occurrence of QTc interval prolongation.Acute kidney injury following cardiac surgery is an independent risk factor for QTc prolongation.

OBJECTIVE:To compare the clinical features and long-term outcome of patients with midventricular obstructive hypertrophic cardiomyopathy (MVOHCM) and patients with apical hypertrophic cardiomyopathy (AHCM) in China. METHODS:This retrospective study analyzed clinical data of 66 patients with MVOHCM and 263 patients with AHCM from a consecutive single-center cohort consisting of 2 413 patients with HCM. The clinical features, cardiovascular mortality and morbidity were compared between the two groups. RESULTS:Compared with the AHCM, patients in the MVOHCM group was younger and more likely to be symptomatic over a mean follow-up of 7 years. The proportion of MVOHCM and AHCM were 2.7% (66/2 413) and 10.9% (263/2 413) (P < 0.001), respectively, in this cohort. Cardiovascular mortality of the two groups were 13.6% (9/66) and 0.8% (2/263) (P < 0.001), and cardiovascular morbidity of the two groups were 53.0% (35/66) and 14.4% (38/263) (P < 0.001). CONCLUSION:MVOHCM is rarer, but the clinical manifestations and long-term outcomes are worse compared with AHCM in this patient cohort.

目的：研究和分析冠脉介入术中碘造影剂发生过敏样反应的特点，为降低碘造影剂在冠脉介入手术中的使用风险提供参考。<br>　　方法：选用回顾性研究方法，对阜外心血管病医院2007年-2011年住院冠脉介入手术（包括冠脉造影）中发生碘造影剂过敏样反应病例资料，分别按照患者性别、年龄、临床表现以及引起过敏样反应的碘造影剂种类等进行描述性统计分析。

目的:研究和分析冠状动脉（冠脉）介入诊疗手术中碘造影剂过敏性休克发生的特点与抢救对策,为提高冠脉介入诊疗手术安全提供参考。方法:回顾性分析我院近5年进行的住院冠脉介入诊疗手术病例中,术中发生的碘造影剂过敏性休克病例资料,并对抢救措施进行总结。结果:79 102例冠脉介入诊疗手术病例均使用非离子型碘造影剂,过敏性休克发生率为0.019%（15/79 102）。首发表现包括血压迅速下降（9例）、突发意识障碍（2例）、皮肤黏膜表现等（4例）。发生顽固性休克的患者5例,其中3例患者早期使用大剂量甲基强的松龙冲击治疗最终存活,另外2例死亡患者未早期使用或未使用。5例顽固性过敏性休克中有4例再次接触碘造影剂者,其中2例死亡。结论:冠脉介入诊疗手术中碘造影剂过敏性休克发生率低,但发生过敏性休克的后果严重,尤其是再次接触碘造影剂者。过敏性休克首发表现多样。发生过敏性休克后抢救中在使用肾上腺素等常规抢救药物的基础上及早应用大剂量甲基强的松龙可能有益。

Objective To evaluate the impact on QTc interval and relevant adverse drug reaction of amiodarone injection for inpatients.Methods 1 111 inpatients from 4 upper first class hospitals in Beijing were enrolled from May 2011 to July 2012,the QTc intervals were measured to evaluate whether there would be change before and after amiodarone injection within 24 hours,and suspected proarrhythmia adverse effects due to study drug were monitored during the entire period of administration.Results The average heart rate was slowed(87.4±21.2bpm vs 99.6±27.9bpm,P 0.001) and QT interval was prolonged(388.5±55.9ms vs 366.0±55.9ms,P 0.001) significantly after amiodarone administration as compared with the baseline,but QTc interval was not changed with statistical significance(456.8±51.0ms vs 457.8±50.2ms,P =0.554).One patient with atrial tachycardia experienced TdP after 54 hours amiodarone injection concomitant with oral amiodarone showed a prolonged QTc interval up to 756ms previously,TdP didn't occur again after amiodarone discontinuation and appropriate treatment.Conclusion Amiodarone injection within 24 hours does not impact on QTc interval with statistical significance in inpatients.Electrocardiograph should be monitored in a continuous amiodarone injection to avoid the relevant adverse drug reaction,especially when using oral amiodarone concomitantly.

Objectives Analysing and summarising the clinical and echocardiographic characteristics of male patients with apical hypertrophic cardiomyopathy (ApHCM). Methods Male patients with ApHCM patients who were diagnosed by echocardiography or magnetic resonance imaging between Januray 1994 and Januray 2009 at Fuwai hospital were consecutively enrolled in this study. Results A total of 153 male patients with ApHCM were enrolled, and the average age is (51.3 ± 11.6) years.The proportions of patients complicated by chest pain, dyspnea, palpitation and syncope are 24.84% (38 cases), 64.71% (99 cases), 26.14% (40 cases) and 8.50% (13 cases), respectively. The incidence of palpitation and dyspnea is higher in patients with atrial fibrillation (AF) (P < 0.05). Compared with patients without AF, patients with AF have greater LAD (42.6 mm ± 8.0 mm vs 36.7 mm ± 5.4 mm, P = 0.003) and LVEDd (34.3 mm ± 3.2 mm vs 29.4 mm ± 4.6 mm, P < 0.001), higher NYHA class (2.2 ± 1.1 vs 1.5 ± 0.6, P = 0.008) and lower LVEF (60.3% ± 9.6% vs 67.8% ± 9.1%, P = 0.008). Conclusions There is a high incidence of dyspnea in male ApHCM patients, and the incidence of palpitation and dyspnea may be increased by AF. Cardiac remodelling is more serious in patients with AF and the impairment of cardiac function may be aggravated by AF.

Background Previous studies on the association between the distribution of left ventricle hypertrophy and the clinical features of hypertrophic cardiomyopathy (HCM) have yielded unclear results. The aim of this study was to investigate the differences in the prevalence, clinical features, management strategies, and long-term outcomes between patients with midventricular hypertrophic obstructive cardiomyopathy (MVHOCM) and patients with apical HCM (ApHCM). Methods A retrospective study of 60 patients with MVHOCM and 263 patients with ApHCM identified in a consecutive single-centre cohort consisting of 2068 patients with HCM was performed. The prevalence, clinical features, and natural history of the patients in these 2 groups were compared. Results Compared with ApHCM patients, patients with MVHOCM tended to be much younger and more symptomatic during their initial evaluation. Over a mean follow-up of 7 years, the probability of cardiovascular mortality and that of morbidity was significantly greater in MVHOCM patients compared with ApHCM patients (log-rank, P < 0.001). Conclusions Our results suggest that, compared with ApHCM, MVHOCM represents an uncommon presentation of the clinical spectrum of HCM that is characterized by progressive clinical deterioration leading to increased cardiovascular mortality and morbidity. Our results also underscore the importance of the timely recognition of MVHOCM for the prediction of prognosis and the early consideration of appropriate management strategies.

目的 研究和分析冠脉介入术中碘造影剂发生过敏反应的特点,为降低碘造影剂在冠脉介入手术中的使用风险提供参考.方法 选用回顾性研究方法,对阜外心血管病医院2007~2012年住院冠脉介入手术(包括冠脉造影)中发生碘造影剂过敏反应病例资料,分别按照患者性别、年龄、临床表现以及引起过敏反应的碘造影剂种类等进行描述性统计分析.结果 在79 102监测到48例非离子型碘造影剂过敏反应,发生率0.61‰(48/78 600).其中男性患者为44例、女性患者为4例,男女比例11:1;涉及药品包括碘海醇、碘佛醇、碘帕醇、碘克沙醇、碘普罗胺等常用的非离子型碘造影剂,以碘普罗胺和碘克沙醇为多.过敏反应临床表现多样,以皮疹等皮肤黏膜表现最为常见,过敏性休克最为严重,其中死亡2例.结论 在冠脉介入术中应用非离子型碘造影剂安全性良好,但仍需重视对其药品不良反应的监测、报告与分析;早期识别、早期干预,以提高用药安全与冠脉介入手术安全.

Objective To summarize and analyze the adverse reactions(ADR)induced by amiodarone injection from Jan.2011 to Mar.2012 at our hospital,and to guide the rational drug use.Methods A retrospective study was conducted on the use and medical records of amiodarone injection(n=396)from Jan.2011 to Mar.2012 at our hospital,the adverse reactions of abnormal hepatic function,hypotension and bradycardia needing intervention,Torsade de Pointes which were caused by amiodarone injection were counted and analyzed.Results The incidence of the abnormal hepatic function induced by amiodarone injection was 14.6%,the more total quantity of intravenous amiodarone in 24 hours,the more hepatotoxicity the patients got.There were 8 patients with hypotension and 4 with severe bradycardia needing intervention,and there were 2 patients with Torsade de Pointes.Conclusion The incidence of adverse reactions of amiodarone injection is low and it's safe under intensive monitoring.

Introduction Statistic showed that hospital is the most hazardous workplace. More than 3 00 000 healthcare workers were employed in approximately 2627 public and 321 private hospitals in Thailand. Methods The cross-sectional study aimed to investigate the occupational health and safety management in five Thai hospitals. The questionnaire consisted of characteristic of healthcare workers both working directly with patient such as inpatient, out- patient and not working directly with patients such as nutrition service and hospital supporting service departments, accident statistics and occupational health and safety management. Results The result showed that healthcare workers in inpatient department had highest percentage reporting all 29 items of occupational health and safety management such as having safety policy, communication of policy to staff, having safety committee meeting, alarm system preparedness, fire prevention and protection preparedness, personal protective equipment provided, etc. followed by out-patient, nutrition service and hospital supporting service departments. The accident in the past three months indicated that the accident of sharp injury and falling from slippery floor in the nutrition service were 57.7% and 26.9%, respectively. Furthermore, the comparison of the accident of sharp injury and falling from slippery floor of nutrition service with other departments was statistically significant different (p<0.001). The accident of needle stick and contact with chemicals, body fluid in surgery and anaesthesia department were 26.9% and 11.5%, respectively. The comparison of needle stick and contact with chemicals, body fluid of surgery and anaesthesia department with other departments was statistically significant different that were p<0.001 and p=0.024, respectively. Conclusion The situations of occupational health and safety management in Thai hospital were crucial for problem recognition and making the further control measure

Objective To study interaction effects between body mass index(BMI)and genetic polymorphisms of L-type calcium channelα1Cgene(CACNA1C)on predicting the efficacy of amlodipine in the treatment of hypertension. Methods A pharmacogenetic analysis was performed on 181Chinese individuals with essential hypertension who were treated with a low dose amlodipine based antihypertensive drugs. SNPs rs1051375,rs2238032, rs2239050,rs2239128 in CACNA1Cgene were genotyped using PCR and direct sequencing method. Multiple linear regression was used to association analysis between BMI(genotypes)and efficacy of amlodipine. Multivariate analysis of variance and ordinal logistic regression was used to interaction effects analysis between BMI and genotypes on efficacy of amlodipine. Results After adjustment of the influence of confounding factors including basic blood pressure,age,gender,uric acid,triglyeride and drug,both BMI and genotypes of rs2238032G/T in CACNA1C were associated with systolic BP reduction after treatments(B=-0.612,P=0.044;B=11.818,P=0.037,respectively),and rs2238032 G/T also was related to diastolic BP reduction(B=12.450,P=0.001). Multivariate analysis of variance showed a significant interaction effect between BMI and genotypes of rs2238032 G/T on efficacy of amlodipine(P0.05). The carriers of the TT genotype with a normal BMI had a better treatment response to amlodipine contrasted to the carriers of other genotypes with abnormal BMI. And ordinal Logistic regression showed a similar trend in interaction effect between BMI and rs2238032 G/T genotype GT on efficacy of amlodipine(B=0.212,P=0.066). Conclusion BMI and SNP rs2238032 in CACNA1Cgene may have a interaction effect on efficacy of amlodipine in the treatment of essential hypertension.

This paper covered the latest updates in imaging studies on aortic dissection(AD),aortic intramural hematoma or hemorrhage,and penetrating aortic ulcer.Relationship among these three conditions was also addressed.The authors proposed the significant role of imaging study in the diagnosis and differential diagnosis of these conditions.

目的:分析高胆固醇血症患者服用他汀类调脂药前后血清触珠蛋白(haptoglobin,Hp)水平的变化,探讨其与他汀类药物治疗的关系和临床意义。方法:入组原发性高胆固醇血症患者32例,分别服用洛伐他汀/烟酸缓释片(10 mg/500 mg.d-1)和匹伐他汀(2 mg.d-1),治疗8周后,观察药前、药后血清Hp水平的变化。结果:高胆固醇血症患者分别服用2种他汀类调脂药物后,两组Hp水平均高于治疗前(P<0.05)。其中,服用洛伐他汀/烟酸缓释片的患者,Hp增加了17.87%;服用匹伐他汀的患者,Hp增加了19%。结论:服用他汀药物后,高胆固醇血症患者的血清Hp水平增加。

Objective To study association between genetic polymorphisms of L-type calcium channel alpha subunit 1C gene(CACNA1C) and efficacy of amlodipine in the treatment of hypertension.Methods A pharmacogenetic analysis was performed on 181 Chinese individuals with essential hypertension who were treated with amlodipine based antihypertensive drugs.Seven SNPs(rs1051375,rs2238032,rs7311382,rs2239050,rs2239127,rs2239128,rs2239129) in CACNA1C were chosen for genotypic analysis using direct sequencing method.Multiple linear regression was used to association analysis between genetic polymorphisms and efficacy of amlodipine.Results After adjustments of the influence of confounding factors on blood pressure,the comparison of 4th week′s △SBP and △DBP over genotypes of these single nucleotide polymorphisms showed that rs2238032G/T had a more significant association with BP reduction after treatments(△SBP:P=0.02;△DBP:P=0.01).Both SBP and DBP were significantly decreased in patients with TT+GT carrier in rs2238032 G/T when compared with patients with GG carrier.And rs2239050C/G,rs7311382C/T,rs2239127C/T,rs2239128C/T,rs2239129C/T,rs1051375A/G showed a significant difference in BP reduction over genotypes respectively.Conclusion SNPs rs2238032 in CACNA1C are associated with efficacy of amodipine in the treatment of essential hypertension.

Haptoglobin(HP),an acute phase protein,can be found in mammalian animal plasma of human-being and other mammals.It plays important role in anti-infection,reparation of injured tissue,homeostasis.Different from other mammals,human-being have three different HP genotypes,HP1-1,HP2-2,HP2-1.Many studies have show that HP gene had been established as the susceptibility gene of diabetic cardiovascular disease.The review will introduce the structure and physiologic function of HP,summarize the basic and clinical researches about relationship between HP genotype and prevalence of cardiovascular diseases especially the cardiovascular complication of diabetic patients,prospect the prevention of cardiovascular complication of HP2-2 diabetic mellitus individual.

Objective To investigate the effects of high density lipoprotein cholesterol(HDL-C) and its related factors, apolipoprotein A-Ⅰ(apoA-Ⅰ) and serum amyloid A(SAA),on the non-diabetic patients with coronary heart disease(CHD).Methods One hundred and eighty consecutive patients were enrolled in this study,with 94 in CHD group and 86 in control group.The data on demography,lipid,and inflammation related factors were obtained from hospital records.Serum concentrations of apoA-ⅠI and SAA were measured by ELISA.The association of HDL-C,apoA-Ⅰand SAA with CHD was analyzed.Results There were more patients with hypertension,smoking,and early onset CHD history in CHD group than in control group.Compared with control group,the concentrations of triglyceride,lipoprotein,high-sensitivity C-reactive protein(hsCRP) and SAA were significantly higher in CHD group (P0.05),while concentrations of HDL-C(P=0.000) and apoA-Ⅰ(P=0.000) were significantly lower in control group(P0.05).Logistic analysis showed that the unadjusted odd ratio(OR) for HDL-C,apoA-Ⅰand SAA in the presence of CHD was 0.125(95%CI 0.039-0.397),0.012(95%CI 0.001-0.99) and 1.166(95%CI 1.054-1.291),respectively.The associations between apoA-Ⅰand the presence of CHD remained strong,regardless of confounding variables.The association of HDL-C and SAA with the presence of CHD were lost after adjusting for lipid status and inflammation related parameters.Conclusion Decreased concentration of apoA-Ⅰis an independent risk factor for non-diabetic CHD.Change in apoA-Ⅰconcentration can reflect the effects of HDL-C on CHD more accurately and effectively.

<正>近年来,医学影像学包括心血管影像学发展迅速,新技术、新方法不断涌现,临床应用日趋广泛,在推动、提高心血管疾病的诊治水平中发挥着愈为重要的作用。面对医学科技整体进展,如何进一步提高心血管疾病的影像学诊断水平,笔者提出以下