目的：观察高血压患者免疫球蛋白、C反应蛋白和CD细胞值的变化并探讨其相关性。方法：选择2013年1-6月在我院就诊的原发性高血压患者，按照血压水平分为高血压病2级组（HBP2）；高血压病3级组（HBP3）；正常人组（HC），每组均为60人。观察三组患者的血清免疫球蛋白IgG、IgA、IgM 值；细胞因子 C 反应蛋白（ CRP ）；CD 细胞 CD3、CD4、CD8及 CD4/CD8值。结果：HBP2组和HBP3组的IgG、CRP、CD4和CD4/CD8值较HC组明显升高（P＜0．01），而HBP3组的升高水平较HBP2组更为明显（P＜0．01）；HBP2组和HBP3组的CD3、CD8较HC组明显降低（P＜0．01），而HBP3组的降低水平较HBP2组更为明显（ P＜0．01）。 IgA、IgM值各组差异无统计学意义（ P＞0．05）。结论：高血压患者IgG、CRP升高及CD细胞值异常并与血压水平具有明显的相关性。

AIM To study the pharmacokinetics of enalapril-felodipine extended release tablet after a single-dose and multi-dose oral administration in Chinese healthy volunteers,and to evaluate the extended- release characteristics of felodipine in this test combined preparation.METHODS Eleven healthy male volunteers were randomly administered the test and reference formulation preparations in a single-dose and multi-dose, under two-way crossover design.Serum felodipine,enalapril and the active metabolite enalaprilat concentrations were determined by a liquid chromatography-tandem mass spectrometry(LC-MS/MS) method, and the pharmacokinetic parameters were calculated by DAS 2.0 program.RESULTSρ_(max),t_(max),AUC_(0-t) of test and reference tablets after single dose were as follows:(1.8±s 1.0) vs.(2.2±1.5)μg·L~(-1),(8±4) vs.(4.1±2.0) h,(38±24) vs.(28±22)μg·h·L~(-1) in felodipine;(44±16) vs.(38±12)μg·L~(-1)(0.77±0.18) vs. (1.2±0.6) h,(70±22) vs.(76±20)μg·h·L~(-1) in enalapril,and(23±12) vs.(21±9)μg·L~(-1),(4.4±1.1) vs.(4.5±0.9) h,(211±78) vs.(215±79)μg·h·L~(-1) in enalaprilat.The steady state concentrations (ρ_(ss-av)) and fluctuate degree(DF) of test and reference tablets after multi-dose were as follows:(1.8±1.3) vs. (1.5±0.9)μg·L~(-1) and(0.96±0.24) vs.(2.7±1.4) respectively in felodipine,and(10±3) vs.(10±3)μg·L~(-1),(2.8±0.5) vs.(2.8±0.5) in enalaprilat.CONCLUSION Comparing with the reference tablet,felodipine in the test combination tablet shows extended release characteristics and the pharmacokinetic process of enalapril and the active metabolite enalaprilat reveals as basically similar in healthy male volunteers.

为贯彻落实上海市综合医院管理评估标准要求,2008年-2009年上半年,我院以病人为中心,创优质服务,树行业新风,创造良好环境,以一流的管理、一流的医疗水平、一流的服务,方便病人就医,让病人满意,让医院放心.

<正>急性心力衰竭是临床常见的重症疾病,住院病死率和1年病死率分别为12%～46%和28%～70%[1,2],对其预后评价一直缺乏较好的指标。心肌肌钙蛋白Ⅰ(cTnI)因其敏感性和特

患者女性,51岁,咳嗽、呼吸紧迫感4天,于2008年8月20日住院,患者于24年前临床诊断垂体瘤.行手术切除术,病理证实为胶质瘤,术后出现尿崩症,经抗利尿激素治疗后2月余症状消失.术后经常低热因呼吸道感染住院治疗.发病3年后超声心动图检查右室流出道长轴观显示肺动脉后瓣有直径7mm大小实质光团附着.随瓣膜启闭飘动.证实垂体瘤并发感染性心内膜炎(IE).经抗感染治疗后症状稳定[1].

Objective:To observe the effects of AAI pacing in patients with sick sinus syndrome and normal atrio-ventricular conduction. Methods:A total of 117 patients with normal atrioventricular conduction and sick sinus syndrome undertaken AAI pacing were included in this retrospective study. Effects were evaluated by parameters of heart function,clinical symptoms and the incidence of atrioventricular block and atrial fibrillation. Results:Neither the heart function nor the dopplar echo-cardiogram LVEF (53.4±6.1)% vs (56.1±7.2)%,P>0.05 has changed after (8.6±5.2) years follow-up (P>0.05). During all cases,cardiogenic syncope was in none,atrioventricular block in 3(2.6%) and atrial fibrillation in 5(4.3%). Conclusion:AAI pacing for patients with normal atrioventricular conduction and sick sinus syndrome maybe a wise choice. The implantation of atrial demand pacemaker was a simple operation with good clinical outcome,little complications and cheap price.

Objective:To investigate the relationship between plasma B type natriuretic peptide(BNP) and the severity of atrial fibrillation complicated congestive heart failure(CHF).Methods:BNP was measured in 54 patients with atrial fibrillation complicated CHF by radioimmunoassay on admission.Doppler echocardiography was performed to measure the left ventricular function.According to the NYHA heart functional class,54 patients were divided into 4 groups,and 30 healthy persons served as control group.Then analyzed the correlation of BNP and NYHA heart functional class.Results:Plasma levels of BNP were a positive correlation with left ventricular functional class(P0.01).To compare the value of LVEF,The group of left ventricular functional class Ⅳ was compare to control group,there was a significant change(P0.05).Conclusion:The serial BNP measurements during the treatment of atrial fibrillation complicated CHF provide the severity of the disease and prognostic information over clinical presentation.

According to an open randomized cross-over design,the pharmacokinetics and bioequivalence of ursodeoxycholic acid preparations in eighteen healthy male volunteers were investigated. The plasma concentrations of ursodeoxycholic acid were determined by LC-MS/MS method. The main pharmacokinetic parameters for the single oral administration of 750 mg ursodeoxycholic acid tablets (test preparation) and capsules (reference preparation) were as follows: AUC0-t (33.79±14.98) and (36.79±18.85) μg·ml-1·h,AUC0-∞ (58.93±5.31) and (51.28±32.85) μg·ml-1·h,cmax (5.250±2.72) and (7.21±4.52) μg/ml,tmax (3.41±1.56) and (2.83±0.97)h,t1/2 (25.71±26.23) and (20.22±12.64)h,respectively. The relative bioavailability of ursodeoxycholic acid tablets was (101.60±38.81)%. The results showed that the test and reference preparations were bioequivalent.

目的评估肌酸激酶同工酶(CK-MB)及肌钙蛋白I(cTnI)在老年急性心肌梗死(AMI)早期诊断中的价值.方法回顾本院近年收治的老年AMI病人71例(男50例,女21例),平均年龄72.24±10.21岁,52～59岁8例,60～69岁14例,70～79岁32例,80～90岁17例,有较明确的发病时间,检测心肌酶学、cTnI,对上述指标进行对比研究.结果胸痛发作时间在4h以内、4h、5～11h及大于12h首次测定CK-MB阳性率分别为70.59%、85.71%、95.24%和89.47%,首次测定cTnI阳性率分别为41.18%、50.00%、52.38%和47.37%,CK-MB在各时间段阳性率均达到70%以上,且阳性率随胸痛发作时间有逐渐上升趋势,而cTnI在各时间段阳性率在40%～53%,相对固定,CK-MB各时间段阳性率均高于cTnI,但统计学无显著差异(P＞0.05).结论 CK-MB、cTnI在AMI早期诊断中具有较高的特异性和灵敏度,二者结合可能提高早期AMI的诊断率,避免不典型病人的漏诊.

目的分析急性心肌梗死部位同预后的关系.方法我院心内科CCU病房1997年1月～2002年4月收住的急性心肌梗死患者104例,分为甲、乙两组,甲组61例,包括前壁、下壁和后壁等急性心肌梗死,乙组43例,合并右室心肌梗死,住院期间观察心力衰竭和心源性休克等症状、心肌酶谱变化、溶栓疗效,住院死亡率、出院后随访(平均2.6±1.3年).结果乙组有心力衰竭和心源性休克症状分别为44.2%和27.9%,住院死亡率20.9%,与甲组比较差异有显著性(分别为P＜0.05和P＜0.01).此外,两组经过静脉溶栓治疗与未溶栓者相比住院死亡率有明显下降(P＜0.05).结论有心源性休克和心力衰竭的右室心梗患者,住院死亡率明显增高,早期接受血管再通治疗是降低住院死亡率的有效手段之一.

室性心动过速、室扑、室颤为致命性心律失常,积极采取电复律、电除颤是主要复苏手段,现将电除颤53次成功抢救顽固性心律失常1例报告如下.

目的探讨急性心肌梗死(AMI)伴恶性室性心律失常对预后的影响.方法以74例AMI患者为对象,按是否合并恶性室性心律失常分A组和B组,A组(伴恶性室性心律失常)32例,B组(不伴恶性室性心律失常)42例,对比两组患者的临床资料,分析恶性室性心律失常对预后的影响.结果A组住院病死率显著高于B组(P＜0.05),A组3年再发心脏事件发生率和3年再发心脏事件病死率均显著高于B组(P＜0.05).结论AMI伴恶性室性心律失常患者,住院病死率高,再发心脏事件发生率高,再发心脏事件病死率高,预后差.改善预后关键除积极治疗原发病外,及时有效的预防和控制恶性室性心律失常也极为关键.

Objective:To study the heredity of atrial fibrillation. Methods:Thirteen series of family members with atrial fibrillation including 3~-4 generations were survey. Blood samples of some patients were collected for DNA analysis. Results: There were 39 patients with atrial fibrillation (without organic cardiopathy) in 13 series of family memyers with atrial fibrillation, in which 27 patients with atrial fibrillation survived, their atrial fibrillation oCCUrred after the age of 40 years (age ranged from 45 to 81 years old). Atrial fibrillation including persistent or paroxysmal was observed. In 2 nd generation of 1, 8, 10 series of family members with atrial fibrillation, there were 4, 3, 3 patients with atrial fibrillation respectively. Conclusion: Part of familial atrial fibrillation is related with gene. Further study should be carried out in more.

急性心肌梗死(AMI)是危害人民健康的常见病,其主要特征是发病急、并发症多、死亡率高.以静脉内溶栓为主的再灌注治疗,可以挽救濒死的心肌细胞,减少梗死的范围,防止左室重塑,改善预后,降低死亡率[1～3].本文旨在讨论重组键激酶(r-SK)与重组组织型纤溶酶原激动剂(rt-PA)在AMI静脉内溶栓的疗效与安全性[4].

从Skakibara和Konno(1962)[1]首创心内膜心肌活检(EMB)以来已有30余年历史 .以后EMB的病理学观察心肌疾患的报道日趋增多,已成为心血管疾病的主要创伤性诊断技术之一,并逐步完善.现将我院1984年至1997年住院病人因患心肌疾患67例所作EMB分析的报道如下.