目的 探究慢性心衰合并SARS-CoV-2感染的高龄老年患者临床特征及预后相关因素.方法 收集2022-12-28～2023-01-31西安交通大学第二附属医院心血管内科收治的慢性心衰合并2019冠状病毒病老年患者.根据年龄分为老年患者组(<80岁)与高龄老年患者组(≥80岁),组间比较两组患者在临床特征、实验室化验与药物治疗方面的差异,Spearman相关性与多元线性回归分析老年慢性心衰合并2019冠状病毒病患者住院天数的影响因素.结果 ① 两组患者性别构成比、基础疾病与ICU重症患者比例相近,高龄老年患者组吸烟、饮酒者比例较低,住院天数延长(P<0.05);相比老年患者组,高龄老年患者外周血淋巴细胞计数更低(P<0.05),谷草转氨酶与胱抑素C水平明显升高(P>0.05;P>0.05),纤维蛋白降解产物更高(P>0.05),钠离子与氯离子水平显著降低(P<0.05;P<0.05).② 高龄老年患者中接受糖皮质激素治疗者更为普遍(51.9％vs 21.2％,P<0.05),乙酰半胱氨酸、雾化治疗比例更高(74.1％vs 48.5％,P<0.05;66.7％vs 27.3％,P<0.05).早期抗病毒药物在两组患者中使用比例均较低;心血管疾病药物方面,高龄老年患者中接受阿司匹林与P2Y12受体拮抗剂治疗比例较低(60.6％vs 37.0％,P>0.05;54.5％vs 22.2％,P<0.05),袢利尿剂使用比例则更高(78.8％vs 96.3％,P<0.05).③Spearman相关性分析显示,年龄、外周血淋巴细胞计数减低、低钠血症与老年心衰合并2019冠状病毒病患者住院时间延长显著相关(r=0.291,P<0.05;r=0.373 P<0.05;r=0.285,P<0.05).④ 线性回归结果显示,女性、淋巴细胞计数减低、接受雾化治疗可能是老年心衰合并2019冠状病毒病患者住院天数延长的危险因素(B=2.719,P<0.05;B=2.885,P<0.05;B=3.115,P<0.05).结论 慢性心衰合并2019冠状病毒病的高龄老年患者入院时淋巴细胞耗竭更为严重,更易出现肝肾功损害与凝血纤溶亢进,常伴乏力纳差与低钠、低氯血症,接受糖皮质激素、祛痰、雾化与袢利尿剂治疗的比例更高,住院天数更长,尤其是淋巴细胞显著耗竭、需要雾化治疗的老年女性患者.

目的 用光学比浊法检测血小板聚集率,评估缺血性脑卒中患者二级预防阿司匹林抵抗的疗效.方法 征集脑卒中后阿司匹林治疗者,随机分为基础治疗对照组和基础治疗+三七(3 g/d)治疗组,连续检测血小板聚集率变化,以治疗前、治疗14 d、治疗30 d为时间点采集数据,分析治疗前后血小板聚集率变化差异.结果 两组基础治疗后抗血小板聚集率不达标,血小板聚集率分别为(26.30±3.30)％,(26.20±3.35)％,差异无统计学意义(P=0.590);加用三七治疗14 d,对照组和治疗组血小板聚集率分别为(25.89±2.46)％,(15.12±3.42)％,差异有统计学意义(P=0.042);加用三七治疗30 d,对照组和治疗组血小板聚集率分别为(24.35±2.97)％,(10.30±2.62)％,差异有统计学意义(P=0.025).结论 添加中药三七治疗脑卒中阿司匹林抵抗患者可使血小板聚集率下降,达到抗血小板聚集治疗的标准.

目的:比较血栓四项与血栓弹力图对脓毒血症合并弥散性血管内凝血(DIC)的早期诊断价值.方法:选取脓毒血症患者215例,根据中国弥散性血管内凝血诊断积分系统(CDICS)评分分为显性DIC组(CDICS评分≥7分)、非显性DIC组(5分≤CDICS评分<7分)以及未发生DIC的对照组(CDICS评分<5分).比较三组血栓四项[凝血酶-抗凝血酶复合物(TAT)、血栓调节蛋白(TM)、组织纤溶酶原激活物-纤溶酶原激活物抑制剂-1复合物(t-PAI-C)、纤溶酶-α2纤溶酶抑制物复合物(PIC)]及血栓弹力图参数[凝血因子激活时间(R)、血块形成的速率(K)、弹力图最大切角(α角)、弹力图最大振幅(MA)].采用受试者工作特征(ROC)曲线分析上述指标的诊断效能.对两种检测方法与CDICS评分结果进行Kappa一致性分析.结果:显性DIC组TM、TAT、PIC、t-PAI-C、R、K、α角均高于非显性DIC组,MA低于非显性DIC组(P<0.05).血栓四项和血栓弹力图单独检测结果虽然有效,但诊断效能低于CDICS评分.血栓四项及血栓弹力图参数与CDICS评分具有弱至中等的一致性(P<0.05).结论:在脓毒血症合并DIC的早期诊断中,血栓四项阳性诊断率更高,但无法快速、全面地评估凝血全貌,不可代替血栓弹力图的动态监测,临床可以将两者联合应用,进而提高诊断效能.

Objective:To investigate the expression of microRNA (miR)-938, its effect on cell proliferation and its regulatory mechanism in hepatocellular carcinoma (HCC).Methods:HCC and paracancerous tissues were collected from 40 patients with HCC who underwent surgical resection in the Second Affiliated Hospital of Nantong University from January 2015 to June 2019, including 25 males and 15 females, with an average age of 61.4 years. HepG2 cells in the miR-938 overexpression group were transfected with miR-938 mimics, and the negative control group was transfected with the negative control sequence. Cell proliferation was detected by kit, the expression of miR-938 and the succinate dehydrogenase complex subunit D (SDHD) was detected by fluorescence quantitative polymerase chain reaction, and SDHD protein expression was detected by Western blot. The target genes of miR-938 were verified by dual luciferase reporting.Results:The relative expression of miR-938 in HCC tissues was (0.060±0.002), which was higher than that in adjacent tissues (0.030±0.002), and the difference was statistically significant ( P<0.05). The mRNA relative expression of SDHD in HCC tissues was (0.028±0.002), lower than that in adjacent tissues (0.062±0.002), and the protein expression of SDHD in HCC tissues was (0.963±0.008), lower than that in adjacent tissues (1.083±0.037), with statistical significance (both P<0.05). The proliferation activity of miR-938 overexpression group was significantly higher than that of negative control group, and the difference was statistically significant ( P<0.05). MiR-938 significantly inhibited the luciferase activity of SDHD wild-type 3’-untranslated regions. In the overexpression miR-938 cells, SDHD mRNA and protein levels were significantly lower than those in the negative control group ( P<0.05). Conclusion:MiR-938 was highly expressed in HCC tissues. MiR-938 promoted the proliferation of HCC cells by inhibiting the expression of SDHD.

目的 评价Sysmex HISCL-5000全自动血凝仪检测凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2纤溶酶抑制物复合物(PIC)、血栓调节蛋白(TM)、组织纤溶酶原激活物/纤溶酶原激活物抑制剂-1复合物(tPAIC)项目的性能.方法 参照美国临床和实验室标准化协会(CLSI)系列指南文件和仪器厂家标准对Sys-mex HISCL全自动血凝仪检测的不精密度、线性、检出限、参考区间、携带污染率性能进行验证.结果 Sys-mex HISCL检测TAT、TM、PIC、tPAIC项目的批内不精密度和日间精密度的CV均小于15％.TAT线性验证试验理论值和实测值的回归方程为Y=0.9947X+0.2916,r 2=0.9999;TM线性验证试验理论值和实测值的回归方程为Y=0.9991X-0.1458,r 2=0.9997;PIC线性验证试验理论值和实测值的回归方程为Y=1.0285X-0.0531,r 2=0.9968;tPAIC线性验证试验理论值和实测值的回归方程为Y=1.0242X+0.3233,r 2=0.9959.TAT最低检出限0.0068 ng/mL,TM最低检出限0.0671 TU/mL,PIC最低检出限0.0012μg/mL,tPAIC最低检出限0.0265 ng/mL.携带污染率各参数CV<10％,参考值范围验证结果显示各项检测指标R(R=结果落在参考范围内的样本数/总的实验样本数)≥0.9.结论 Sysmex HISCL-5000血凝仪检测TAT、TM、PIC、tPAIC项目的精密度、线性、检出限、携带污染率结果均符合质量控制的要求,能够保证检验准确性.

目的 研究尾加压素Ⅱ(urotensinⅡ,UⅡ)对大鼠血管外膜成纤维细胞分泌肿瘤坏死因子α(TNF-α)的影响和可能的细胞内信号转导机制.方法 贴块法培养大鼠胸主动脉血管外膜成纤维细胞,取3～5代细胞于无血清DMEM培养基中加入不同浓度UⅡ(10-10～10-7 mol/L)孵育1～24 h,观察UⅡ促进TNF-α分泌的浓度、时间曲线.在培养的细胞中加入不同信号转导通路抑制剂,处理30 min后,加入UⅡ(10-7 mol/L)共孵育6 h.提取上清,采用酶联免疫吸附测定法检测TNF-α分泌水平.结果 ‰UⅡ呈浓度、时间依赖性促进外膜成纤维细胞中TNF-α分泌,10-7 mol/L、6 h达高峰(P<0.01).②UⅡ促进外膜成纤维细胞分泌TNF-α的作用能被UⅡ受体阻断剂SB710411(10-7mol/L)、蛋白激酶C抑制剂H7(10-5mol/L)、ERK1/2抑制剂PD980959(10-5mol/L)所抑制(P<0.01).结论 UⅡ呈时间依赖性及浓度依赖性方式促进血管外膜成纤维细胞TNF-α表达,该作用通过激活UⅡ受体、蛋白激酶C和ERK1/2等信号通路来实现.

目的 探讨促甲状腺激素(TSH)和apoB/apoA与支架内再狭窄的关系.方法 连续收集于西安交通大学第二附属医院行支架植入术后复查造影的患者340例,根据造影结果将研究对象分为再狭窄组(ISR,n=31)和非再狭窄组(non-ISR,n=309).根据血清TSH水平,将ISR组按照三分位数法分为低(n=10)、中(n=10)、高(n=11)TSH水平组(A、B、C组),并比较3组间血脂水平的差异.应用相关性分析研究TSH和apoB/apoA的关系.结果 ISR组的TSH、apoB/apoA较non-ISR组高(P＜0.05).C组的TSH、apoB/apoA较A、B组高(P均＜0.05),B组的TSH、apoB/apoA水平较A组高(P＜0.05).ISR组apoB/apoA、总胆固醇(TC)与TSH呈正相关,r分别为0.725和0.448(均为P＜0.05).TSH为支架内再狭窄的独立危险因素,OR值为1.475(P＜0.001).结论 apoB/apoA、TC与TSH呈正相关;TSH为支架内再狭窄的独立危险因素.

Objective To investigate the clinical therapeutic methods and their curative effects in recurrent ischemic angina for internal mammary artery resterosis after coronary artery bypass grafting (CABG).Methods We enrolled the patients who had recurrence of ischemic angina for restenosis of internal mammary artery graft after CABG as research subjects in the Affiliated Hospital of Yan'an University from January 2014 to January 2016.The 42 patients were divided into three groups according to the different treatment approaches for recurrence of ischemic angina:Group A (n=22)who received internal mammary artery interventional therapy;Group B (n=12)who received coronary artery bypass grafting treatment;and Group C (n=8)who received left subclavian artery proximal stent treatment.Then we compared the clinical therapeutic effects in the three groups.Results The success rate in Group C was 100%,which was the highest in the three groups,and the post-operative restenosis rate was 0.The hospitalization time was significantly shorter in Group A than in Group B (P＜0.05).However,the two groups did not significantly differ in mortality,success rate or restenosis rate (P＞0.05).Conclusion We should select the appropriate treatment according to the patient's specific situation for recurrent ischemic angina. Endovascular treatment has evident therapeutic effects,rapid postoperative recovery,and lower treatment risk, making it the preferred treatment when possible.

Objective To study the correlation between coronary artery stenosis and endothelial dysfunction in patients with coronary heart disease and subclinical hypothyroidism.Methods According to the results of coronary angiography and thyroid function,the patients were divided into coronary heart disease with subclinical hypothyroidism (group A,n=71),coronary heart disease without subclinical hypothyroidism (group B,n=73), and normal coronary angiography (control group,n=59).The degree of coronary artery stenosis was evaluated by Gensini integral method.Fasting blood was taken to measure nitric oxide (NO),high sensitivity C reactive protein (hs-CRP),and endothelin (ET)to evaluate endothelial dysfunction.Results TC,TG,LDL-c,FT3,TSH,hs-CRP,ET and Gensini score were higher in Group A than in Group B and control group (P＜0.05).The level of NO in Group A and Group B were lower than that in control group (P＜0 .0 5).Multivariate Logistic regression analysis showed that age,TSH,ET and NO were independent risk factors for coronary heart disease.ET and NO levels in patients with coronary heart disease combined with subclinical hypothyroidism were correlated with Gensini scores (r=0.431,r=-0.383,P＜0.001).Conclusion Subclinical hypothyroidism may cause endothelial dysfunction in patients with coronary heart disease,which may increase cardiovascular risk in these patients.

Objective To investigate the relationship of galectin-3 (Gal-3)and matrix metalloproteinase-9 (MMP-9)with in-stent restenosis (ISR).Methods We consecutively recruited 434 patients who had undergone successful drug eluting stent (DES)implantation.Then we divided them into ISR group (n=41)and NO-ISR group (n=393)according to the results of coronary angiography review.Independent risk factors for ISR were found out by multivariate analysis and the two groups were matched for these factors except for Gal-3 and MMP-9 .After elim-ination of the influence of confounders,serum Gal-3 and MMP-9 were compared between the groups and their rela-tions with the severity of ISR were analyzed.Patients were grouped based on Gal-3 and MMP-9 concentrations and major adverse cardiac events (MACEs)were compared between the two groups.Results After elimination of the influence of confounders,the results showed that serum levels of Gal-3 and MMP-9 were significantly higher in ISR group than in NO-ISR group (P＜0.001).Serum levels of Gal-3 and MMP-9 increased with the increased grade of classification.Serum levels of Gal-3 and MMP-9 were obviously higher in classes Ⅲ and Ⅳ ISR than in class Ⅰ (P＜0.05).Patients with higher levels of Gal-3 and MMP-9 had a higher incidence of MACEs (P＜0.01).ISR group had a higher incidence of MACEs than NO-ISR group (P＜0.05).Conclusion Serum levels of Gal-3 and MMP-9 are correlated with ISR and its severity,and they are independent risk factors for ISR.The rate of MACEs during follow-up period was increased with the increased levels of Gal-3 and MMP-9 .

Objective To investigate the relationship between ischemia-modified albumin (IMA) and coronary artery stenosis in patients without myocardial infarction.Methods For this study we consecutively enrolled 345 patients who received coronary angiography (CAG).According to the results,the subjects were divided into coronary stenosis group (232 cases)and control group (113 cases)to investigate the the relationship of IMA and IMA/albumin (IMAr)with coronary stenosis.Results ① The levels of IMA and IMAr in coronary stenosis group were higher than those in control group (P＜0.001).② The IMA and IMAr were higher in single-branch and multi-branch lesion groups than in control group (P＜0.05),whereas there was no significant difference between single-branch lesion group and multi-branch lesion group (P＞0.05).③ In receiver operating characteristics curve analysis,the sensitivity of IMA and IMAr was 64.4% and 78.0%,respectively (AUC:0.653,0.705,P＜0.001)in predicting coronary stenosis.④ Multivariate logistic regression analysis showed that IMAr was an independent risk factor for coronary stenosis in patients without myocardial infarction (OR=73.05,P＜0.001).Conclusion IMA and IMAr are closely correlated with coronary stenosis and have a value in predicting coronary artery stenosis in patients without myocardial infarction.

Objective To investigate the association of low level of free thyroxin (FT4)within normal range with the severity of coronary artery disease (CAD)and carotid atherosclerosis.Methods We enrolled 312 consecutive patients who underwent coronary angiography (CAG)and divided them into CAD group (196 cases)and non-CAD group (116 cases)according to CAG results.We calculated Gensini score and divided CAD group into≤10 Gensini score group (n=65),10-30 Gensini score group (n=67)and ＞30 Gensini score group (n=64).Thyroid hormone level,carotid intima-media thickness (CIMT)and other clinical data were measured and compared between the groups,and the correlation analysis was used to find the relationship of FT4 level with Gensini score.By taking CIMT reference value of 0.9 mm as the standard,we divided the patients into thickened IMT group (IMT≥0.9 mm)and normal IMT group (IMT＜0.9 mm).Results The level of FT4 was significantly lower in CAD group and subgroups than in non-CAD group (P＜0.05).The level of FT4 was negatively correlated with Gensini score (P＜0.05).The levels of FT4 and TT4 were significantly lower in thickened CIMT group than in normal CIMT group (P＜0.05).Conclusion Low level of FT4 within normal range is significantly related to the severity of CAD,and low level of FT4 can be used as an independent risk factor for the severity of CAD.Low levels of FT4 and TT4 are significantly related to carotid atherosclerosis.

AIM:To generate type specific and conformation dependent monoclonal antibodies against human papillomavirus 16 major capsid L1 protein (HPV16 L1).METHODS:HPV16 L1 protein was expressed by modified insect-baculovirus expression system and purified by ProBond(TM); purification system in nature conditions. BALB/c mice were immunized with the purified HPV16 L1 protein. Hybridoma technique was used to prepare the hybridoma cell lines. Positive colonies were screened by ELISA. The non-denaturing electrophoresis and Western blot methods were used for detecting the conformation dependent antibodies. Immunocytochemistry was used to confirm the type specific of the antibodies. The sub-class, isotype and titer were also identified respectively.RESULTS:One hybridoma cell line named 2E3 was obtained which can constantly secret type-specific and conformation-dependent HPV16 L1 mAb. The titers of the antibody are 1:800 in the cell culture medium and 1:12 800 in ascetic fluid. The sub-class and isotype were IgG1kappa. The antibody could selectively recognize non-denaturing HPV16 L1 protein and there was no cross-reaction with HPV18, HPV58 and HPV11 L1 protein.CONCLUSION:One cell line which secretes type specific and conformation dependent HPV16 L1 monoclonal antibody is successfully generated. This monoclonal antibody can be used in study HPV16 L1 protein epitope.