目的 探讨血清补体1q(C1q)联合载脂蛋白(Apo)B/ApoA1比值对短暂性脑缺血发作(TIA)患者发生脑梗死的预测价值.方法 选取2019年1月至2021年1月北京市和平里医院急诊科收治的TIA患者108例,根据TIA后1个月内是否发生脑梗死将其分为梗死组(n=31)和对照组(n=77).比较两组患者实验室检查指标,TIA患者血清C1q与ApoB/ApoA1比值的相关性分析采用Pearson相关分析,绘制ROC曲线以评价血清C1q、ApoB/ApoA1比值及二者联合(并联)对TIA患者发生脑梗死的预测价值.结果 梗死组患者血清C1q、ApoB/ApoA1比值及同型半胱氨酸(Hcy)、载脂蛋白(a)〔Lp(a)〕、TC、LDL、TG、超敏C反应蛋白(hs-CRP)高于对照组,HDL低于对照组(P<0.05).Pearson相关分析结果显示,TIA患者血清C1q与ApoB/ApoA1比值呈正相关(r=0.210,P=0.029).ROC曲线分析结果显示,血清C1q、ApoB/ApoA1比值及二者联合预测TIA患者发生脑梗死的AUC分别为0.837〔95％CI(0.757,0.918)〕、0.802〔95％CI(0.718,0.886)〕、0.910〔95％CI(0.857,0.962)〕,二者联合预测TIA患者发生脑梗死的AUC分别大于血清C1q、ApoB/ApoA1比值单独预测TIA患者发生脑梗死的AUC(P<0.05).结论 TIA患者血清C1q与ApoB/ApoA1比值呈正相关,血清C1q联合ApoB/ApoA1比值对TIA患者发生脑梗死的预测价值较高,可能作为TIA病情监测及脑梗死风险评估的生物学指标.

目的:探讨慢性阻塞性肺疾病(COPD)急性加重期患者血清铁蛋白(Ferr)、癌胚抗原(CEA)和D-二聚体(D-D)水平变化及意义.方法:210例COPD患者根据病情将急性加重期患者设为观察组(n=100),稳定期患者设为对照组(n=110).比较两组患者入院第1天、第3天、第7天及第14天血清Ferr、CEA和D-D水平,分别比较不同病情(入院7 d内)和不同预后(出院时)COPD急性加重期患者血清Ferr、CEA和D-D水平,分析出院时Ferr、CEA、D-D水平对COPD急性加重期患者预后的预测价值.结果:观察组入院第1天、第3天、第7天血清Ferr、CEA、D-D水平均高于对照组(P<0.05),两组第14天血清Ferr、CEA、D-D水平比较,差异无统计学意义(P>0.05);GOLD分级4级的COPD急性加重期患者入院7 d内Ferr、CEA、D-D水平高于GOLD分级3级者(P<0.05);COPD急性加重期患者28 d内死亡者血清Ferr、CEA、D-D水平高于存活者(P<0.05).ROC曲线分析发现,出院时血清Ferr、CEA、D-D水平联合预测COPD急性加重期患者28 d死亡的曲线下面积(0.869)均高于单项预测值.结论:血清Ferr、CEA和D-D水平随COPD病情加重而升高,出院时Ferr、CEA和D-D水平对COPD预后有一定预测价值.

目的 分析老年重症急性胰腺炎(SAP)合并应激性高血糖患者血清微小RNA-223(miR-223)、高迁移率族蛋白1(HMGB1)表达水平及临床意义.方法 选取2017年9月—2020年9月于北京市和平里医院急诊科诊治的老年SAP患者108例为研究对象,根据入院后24 h空腹血糖(FPG)水平将其分为合并应激性高血糖组57例和正常血糖组51例,合并应激性高血糖组老年SAP患者又根据预后情况分为预后良好亚组26例和预后不良亚组31例.利用荧光定量PCR技术检测血清miR-223水平,利用酶联免疫吸附法(ELISA)检测血清HMGB1水平,比较2组患者一般资料及血清miR-223、HMGB1水平,采用受试者工作特征曲线(ROC)预测血清miR-223、HMGB1对合并应激性高血糖老年SAP患者预后不良的诊断价值,利用多因素Logistic分析影响合并应激性高血糖老年SAP患者预后不良的危险因素.结果 合并应激性高血糖组患者急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、FPG、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、血清miR-223、HMGB1水平明显高于正常血糖组,差异有统计学意义(t/P=6.492/0.000、9.488/0.000、2.063/0.042、2.296/0.024、8.130/0.000、8.316/0.000);预后不良亚组患者APACHEⅡ评分及血清miR-223、HMGB1水平显著高于预后良好亚组(t/P=3.730/0.000、3.375/0.001、7.163/0.000);ROC曲线分析结果显示,血清miR-223、HMGB1预测合并应激性高血糖老年SAP患者预后不良的曲线下面积(AUC)分别为0.881(95％CI 0.768～0.952)、0.911(95％CI 0.805～0.960),二者联合诊断的AUC为0.952(95％CI 0.860～0.971),敏感度和特异度分别为93.55％、88.46％.多因素Logistic分析结果显示,高血清miR-223水平、高HMGB1水平及高APACHEⅡ评分是影响合并应激性高血糖老年SAP患者预后不良的危险因素[OR(95％CI)=1.862(1.170～3.255)、2.104(1.346～3.289)、2.070(1.316～2.173)].结论 合并应激性高血糖老年SAP患者血清miR-223、HMGB1水平升高,与患者不良预后有关,可作为评估病情发展及预后的潜在指标.

目的：探讨休克治疗中多巴胺与去甲肾上腺素的疗效比较。方法：将120例休克病人经液体复苏后按照约1：1的比例随机分配到多巴胺组和去甲肾上腺素组，同时又分为感染性，心源性，低血容量性休克分为三个亚组，比较两组28天病死率。结果：两组28天病死率无统计学意义，但多巴胺组的心率失常发生率高，加用去甲肾上腺素比例高，对于三个亚组多巴胺死亡率稍高。结论：多巴胺和去甲肾上腺素治疗的病死率无明显差异，但多巴胺出现心率失常的比例高且在心源性休克中死亡率高。

Objective To compare the predictive value of C-reactive protein(CRP) and urine albumin excretion rate for long-term mortality after acute myocardial infarction(AMI). Methods From January 2001 to December 2005,209 consecutive patients with AMI were enrolled in this study.CRP,albumin excretion rate and albumin-to-creatinine ratio(ACR) were measured at day 1,day 3,and day 7 after admission in all subjects.All the patients were followed up for 5 years. Results Off the 209 patients(age from 47 to 83 years old),62 were female(29.7%) and 81 with heart failure(38.8%).Survival analysis showed that,after adjusting for age,hypertension,diabetes mellitus,pre-hospital time delay,creatine kinase-MB isoenzyme peak,heart failure,and creatinine clearance,both CRP and ACR were associated with increased risk of 5-year all-cause mortality.CRP was not correlated with long-term mortality [HR(95%CI): 1.1(0.7-1.8),P=0.65],while ACR was independently correlated with both short-term and long-term mortality [OR(95%CI): 3.9(2.0-9.0),P0.0001;1.4(1.1-1.8),P=0.01]. Conclusions ACR is a better predictor than CRP for long-term mortality after AMI.

Objective: Objective: To investigate the differences of the scores from different raters in taking the Acute Physiology and Chronic Health Evaluation(APACHEII) and the causes of the difference.Methods: Two doctors got the APACHE II scores from the same 32 cases of severe patients.The consistency of the data and scores of each indicator were prospectively analyzed and the causes of the inconsistence were discussed.Results: The consistency of APACHE II score from two doctors was low(Kapp = 0.695).The consistency of chronic health score(Kappa = 0.75) and age score(Kappa = 0.956) were better,but they were of poor agreement(Kappa = 0.728) in terms of acute physiology score(APS).From the indicators of APS,the two doctors recorded a total of 160 different raw data,and eventually got 52 different physiological scores.The highest proportion of three items,were first for the serum potassium(8 / 11),second for AaDO2(9 / 20),and third for the mean arterial pressure(11/25).The main reason causing the difference scores was the differences of physiological indicators(85.2%).Nine differences in scores were found when taking the same data,of which eight were caused by not following oxygenation rate score,and the other one is caused by different values.Conclusion: In order to further improve the accuracy of scores,it is necessary to strengthen the assessment criteria and do professional training positively.

【Objective】 To assess serum uric acid(SUA) levels determined on admission as a potential predictor of short-term mortality and long-term survival in acute myocardial infarction(AMI) patients.【Method】 We included consecutive patients with verified AMI admitted within 48 hours since the symptom onset.The primary end point was short-term mortality(in-hospital and thirty-day),secondary end points were long-term survival(long-term all-cause mortality).【Result】 A total of 523 patients(312 men,age 67.3±15.6 years) were included.Higher SUA on admission was independently associated with higher in-hospital mortality(RR,1.016;95%CI,1.001-1.031,P =0.043) and higher thirty-day mortality(RR,1.016;95%CI,1.003-1.029,P =0.018).Higher SUA on admission was also independently associated with poorer long-term survival(higher all-cause mortality)(HR,1.105;95% CI,1.020-1.195,P =0.010).【Conclusion】 Higher serum uric acid on admission is associated with higher short-term mortality and poorer long-term survival after AMI.

【Objective】 To investigate the changes of serum C-reactive protein(CRP) and troponin I(TnI) in patients with acute coronary syndrome(ACS) including acute myocardial infarction(AMI) and unstable angina(UA),and to figure out their relationship with ACS and the clinical significance.【Methods】 The serum levels of CRP and TnI were measured in 53 ACS patients and 25 health control people(CP).【Results】 The serum levels of CRP and TnI in ACS patients were significantly higher than those in health controls(P 0.05).The serum CRP and TnI levels in both AMI and UA groups were markedly higher than those in SA(stable angina) group(P 0.05).【Conclusion】 Elevated serum CRP and TnI levels are closely correlated with acute coronary syndrome.

目的 评估颅面部疼痛是否可以是心肌缺血的唯一症状,以及由心脏起源的颅面部疼痛的发生率、分布情况和性别差异.方法 连续选取到我院急诊室就诊并已证实有心肌缺血的患者186例,评估是否存在颅面部疼痛.对存在颅面部疼痛的患者研究其疼痛位置、放射区域及疼痛的细节.结果 71例(38%)在心肌缺血时感觉到颅面部区域疼痛;女性的发生率高于男性(P=0.031).11例(6%)颅面部疼痛是心肌缺血过程中的唯一症状,其中3例为急性心肌梗死(AMI).结论 颅面部疼痛可由心肌缺血引起,并且可以是心肌缺血的唯一症状,这一点必须在对牙痛和口面部疼痛的诊断时被考虑到.

目的探讨不同剂量的阿托伐他汀治疗急性冠状动脉综合症的疗效.方法90例急性冠脉综合征患者随机分为3组:A组为常规治疗组(30例)予以常规治疗但不用降脂药物;B组(30例)为20mg阿托伐他汀治疗组;C组为40mg阿托伐他汀治疗组(30例);30例稳定性心绞痛患者为对照组。90例急性冠脉综合征患者在治疗2周前后分别测定血清高敏C反应蛋白(hs-CRP)及血脂水平。结果90例急性冠脉综合征患者就诊时的血清高敏CRP水平明显高于对照组稳定性心绞痛患者(P<0.05),B、C组治疗2周后血清高敏CRP较前有明显下降(P<0.05),而以C组作用更明显。结论急性冠脉综合征患者血清高敏CRP水平增高,早期他汀类药物强化治疗可使急性冠脉综合征患者获益更大。

目的探讨非ST段抬高急性冠状动脉综合征(ACS)患者早期介入治疗与单纯药物治疗对预后的影响。方法收集2005年9月至2007年11月入院的非ST段抬高ACS患者共181例临床资料,分成单纯药物治疗组和介入治疗组,随访患者发病30d和6个月心血管不良事件的发生率。结果与早期单纯药物治疗相比,早期介入治疗能够降低30d和6个月时心血管不良事件(P<0.05)。经随访,中危患者早期介入治疗组与药物治疗组30d时心血管不良事件发生率分别为8.1%和9.5%,6个月随访时分别为11.7%和15.0%,差异均无统计学意义(P>0.05);高危患者心血管不良事件30 d时的发生率分别为14.6%和43.4%,6个月时发生率分别为25.8%和86.9%,差异均有统计学意义(P<0.05)。结论对于中危患者早期介入治疗和药物保守治疗对心脏事件的影响差异无统计学意义,而对于高危患者早期介入治疗可显著降低近期和远期的心脏事件的发生率。

目的探讨cTnI、Mb和CK-MB在早期诊断急性心肌梗死中的价值。为急性心肌梗死的早期诊断和预后评估提供更准确合理的检测指标。方法对120例急性心肌梗死患者及120例非心肌梗死性胸痛的患者(对照组)进行cTnI、Mb和CK-MB检测。结果急性心肌梗死组血清cTnI、Mb和CK-MB含量显著高于对照组(P<0.01)。结论急性心肌梗死患者cTnI、Mb和CK-MB的联合检测有助于早期诊断急性心肌梗死和病情分析。

目的探讨血清CRP水平变化在感染性肺炎治疗中的应用。方法对160例确诊为感染性肺炎的住院患者和同期门诊上呼吸道感染80例以及87例健康人分别进行CRP、白细胞总数和白细胞分类测定。结果门诊患者的CRP(73.3±3.6)mg/L显著低于我院患者(132±11.3)mg/L;住院患者治疗前为(132±11.3)mg/L,治疗后降低到(33.7±28.8)mg/L,差异有显著性(P<0.001)。结论血清C-反应蛋白增高可作为诊断感染性肺炎时判断其愈后及疗效判定的一项指标。

目的 探讨血清CRP水平变化在感染性肺炎治疗中的应用.方法 对160例确诊为感染性肺炎的住院患者和同期门诊上呼吸道感染80例以及87例健康人分别进行CRP、白细胞总数和白细胞分类测定.结果 门诊患者的CRP(73.3±3.6)mg/L显著低于我院患者(132±11.3)mg/L;住院患者治疗前为(132±11.3)mg/L,治疗后降低到(33.7±28.8)mg/L,差异有显著性(P＜0.001).结论 血清C-反应蛋白增高可作为诊断感染性肺炎时判断其愈后及疗效判定的一项指标.

Objective To assess the relationship of C-reactive protein(CRP) elevation with long-term outcomes and heart failure in patients with acute coronary syndrome(ACS).Methods CRP level was measured in 446 ACS patients on admission in emergency department.All-cause mortality and rate of rehospitalisation for acute myocardial infarction(AMI) and congestive heart failure(CHF) were obtained for up to 3 years' follow up.Results Patients with CRP level above cut-off had a higher rate for death and CHF readmission.After adjusting for troponin T level,high CRP level(>7.44 mg/L) was still significantly associated with high risk for death and CHF.Conclusions ACS patients with early CRP level elevation have higher risk for death and heart failure.

1资料与方法 选取我院1999年1月～2002年8月收治的非ST段抬高急性冠状动脉综合征(NSTACS)患者348例,根据入院即刻的白细胞计数按照四分位法将入选患者分成4组.1～4组的白细胞计数分别是＜6.8×109/L(91例);(6.8～8)×109/L(85例);(8～10)×109/L(82例)和＞10×109/L(90例).NSTACS的诊断符合美国心脏病学院和美国心脏病协会的诊断标准.合并各种急性或慢性感染性疾病、免疫性疾病、肿瘤、周围血管病、凝血功能障碍、肝肾功能不全的患者不入选.