目的 分析急性心肌梗死并发医院感染患者外周血miR-19b、白细胞介素-37(IL-37)的表达水平及预后的影响因素.方法 选择2017年1月-2019年12月海南医学院第一附属医院心血管内科收治的68例急性心肌梗死并发医院感染患者设为感染组,另选择同期收治的68例急性心肌梗死无医院感染患者设为未感染组,比较两组患者外周血miR-19b、IL-37水平.依据预后情况将感染组患者分为预后良好患者和预后不良患者,分析不同预后患者临床资料,归纳急性心肌梗死并发医院感染患者预后不良的影响因素.结果 感染组外周血miR-19b、IL-37分别为(3.47±0.84)、(41.65±6.48)ng/ml均高于未感染组(P＜0.001).68例急性心肌梗死并发医院感染患者中,预后良好52例,预后不良16例.急性心肌梗死并发医院感染预后良好患者糖尿病史、慢性阻塞性肺疾病(COPD)史、心功能分级、卧床时间与预后不良患者比较差异有统计学意义(P＜0.05),且不良预后组患者外周血miR-19b、IL-37水平均高于预后良好患者(P＜0.05).多因素Logistic回归分析显示,miR-19b是急性心肌梗死并发医院感染患者预后不良的影响因素(OR =2.552,95％ CI:1.193～5.460,P=0.016).结论 急性心肌梗死并发医院感染患者外周血miR-19b、IL-37水平较高,miR-19b为急性心肌梗死并发医院感染患者预后不良的影响因素.

目的:研究沉默信息调节因子1(SIRT1)在肿瘤坏死因子-α(TNF-α)诱导的心肌细胞炎症损伤中的作用.方法:用20μg·L-1的TNF-α处理大鼠心肌细胞H9c2,分别用real-time PCR和Western blotting方法测定细胞中SIRT1表达水平.用含有SIRT1的慢病毒感染H9 c2细胞,筛选稳定感染的细胞株,给予TNF-α刺激以后,采用real-time PCR和Western blotting方法测定感染效果.用四甲基偶氮唑蓝(MTT)法测定细胞增殖,流式细胞术测定细胞凋亡,同时用Western blotting方法检测细胞中p-p65蛋白水平.用核转录因子κB(NF-κB)激活剂PMA处理过表达SIRT1的H9c2细胞,再用上述方法分析NF-κB激活剂对TNF-α环境下SIRT1对H9 c2细胞增殖凋亡的逆转作用.结果:TNF-α处理后细胞中SIRT1表达水平降低,稳定感染SIRT1慢病毒上调TNF-α条件下心肌细胞中SIRT1的表达水平.TNF-α处理后H9 c2细胞增殖活性降低,细胞凋亡率升高.与只经过TNF-α诱导的细胞比较,过表达SIRT1的H9 c2细胞经TNF-α诱导后,细胞增殖活性升高,细胞凋亡率降低,细胞中p-p65蛋白水平降低,差异均有统计学意义(P<0.05).NF-κB激活剂PMA可逆转过表达SIRT1对H9 c2细胞增殖活性和凋亡的作用.结论:SIRT1通过抑制NF-κB减少TNF-α诱导的心肌细胞凋亡,提高细胞增殖活性,减少炎症损伤.

目的 观察依折麦布片联合氟伐他汀片治疗高危冠心病的临床疗效及安全性.方法 将78例高危冠心病患者随机分为对照组和试验组,每组39例.对照组予以氟伐他汀每次40 mg,qd,口服;试验组在对照组治疗的基础上,予以依折麦布每次10 mg,qd,口服.2组患者均治疗4周.比较2组患者的临床疗效、左心室功能,以及药物不良反应的发生情况.结果 治疗后,试验组和对照组的总有效率分别为87.18％(34例/39例)和64.10％(25例/39例),差异有统计学意义(P＜0.05).治疗后,试验组和对照组的左心室舒张末期内径分别为(58.32±7.42)和(62.36±8.27) mm,左心室收缩末期内径分别为(40.83±5.21)和(43.68±5.72)mm,左心室射血分数分别为(59.83±8.37)％和(54.76±7.21)％,差异均有统计学意义(均P＜0.05).2组患者发生药物不良反应均以胃肠道症状、肌痛/肌酶升高和疲乏无力为主.试验组和对照组的总药物不良反应发生率分别为17.95％和15.38％,差异无统计学意义(P＞0.05).结论 依折麦布片联合氟伐他汀片治疗高危冠心病的临床疗效确切,其能有效地改善患者的左心室功能,且不增加药物不良反应的发生率.

1 临床资料 患者男性,50岁,因"反复胸痛半年,再发作加重20 天"于 2017 年 2 月 21 日入院.既往有高血压及高脂血症病史 2 年.有吸烟史 30 年.入院查体:血压 118/88 mmHg(1mmHg=0.133kPa),心前区可闻及持续性杂音.动态心电图示窦性心律,偶发房性早搏,ST-T 改变(Ⅱ、Ⅲ、aVF、V3～6 导联 ST 段水平型压低 0.1 mV,>1 min,>3 阵次,T 波低平、倒置).超声心动图发现左心房稍扩大(前后径 39 mm,左右径 41 mm),右冠状动脉(冠脉)- 肺动脉瘘(图 1).

目的 观察替罗非班注射液治疗老年非ST段抬高型急性冠状动脉综合征(NSTE-ACS)的临床疗效及安全性.方法 将94例老年NSTE-ACS患者随机分为对照组和试验组,每组47例.对照组予以阿司匹林肠溶片首剂300mg,后以100 mg·d-1长期维持,顿服+氯吡格雷首剂300 mg,后以75 mg·d“长期维持,顿服+1 mg·kg-1依诺肝素,q12 h,持续5d,皮下注射;试验组在对照组治疗的基础上,予以10 μg·kg-1·min-1替罗非班在3 min内静脉注射,后以0.15 μg·kg-1·min-1的速度持续微量泵入,维持36 h.2组患者均治疗3个月.比较2组患者的血小板聚集率(PAR)、肌酸激酶同工酶(CK-MB)、肌钙蛋白Ⅰ (cTnⅠ)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)变化,并记录主要心血管事件(MACE)发生率和出血发生率.结果 治疗后,试验组和对照组的PAR分别为(28.71 ±4.04)％和(39.88 ±5.54)％,CK-MB分别为(212.34±28.53)和(246.18±32.67)U·L-1,cTn Ⅰ分别为(4.04 ±0.52)和(4.83±0.64) ng·mL-1,LVEF分别为(59.45±8.22)％和(54.83 ±7.61)％,LVEDD分别为(42.09±5.26)和(45.19 ±6.01)mm,LVESD分别为(33.87±4.46)和(36.43±5.01)mm,差异均有统计学意义(P＜0.01,P＜0.05).试验组和对照组的MACE发生率分别为12.77％和29.79％,差异有统计学意义(P＜0.05).试验组和对照组的出血发生率分别为14.89％和8.51％,差异无统计学意义(P＞0.05).结论 替罗非班注射液治疗NSTE-ACS的临床疗效确切,其可有效地改善PAR、心肌酶水平和心脏功能,且安全性较高.

目的 探讨术前应用瑞舒伐他汀对非ST段抬高急性冠脉综合征(ACS)患者血清hs-CRP、sLOX-1水平和LVEF的影响.方法 通过对我院2014年2月-2017年10月收治的104例择期行PCI术的非ST段抬高ACS患者的临床资料做回顾性分析,根据治疗方式的不同分为观察组、对照组(各52例).对照组在PCI术前给予阿托伐他汀治疗,观察组在PCI术前给予瑞舒伐他汀治疗.比较两组患者住院期间MACE及不良反应发生率和各时段的血清hs-CRP、sLOX-1水平和LVEF.结果 观察组的MACE发生率(1.92％)低于对照组(11.54％) (x2 =3.829,P=0.049);两组患者术后24 h sLOX-1、hs-CRP水平均升高,术后1个月sLOX-1、hs-CRP水平均降低(P＜0.05),且观察组术后24 h、术后1个月sLOX-1、hs-CRP水平均较对照组低(P＜0.05);术后1个月两组患者LVEF均较术前上升(P＜0.05),且观察组LVEF高于对照组(P＜0.05);两组患者不良反应发生率比较(7.69％ vs 5.77％)无明显差异(x2=0.153,P=0.696).结论 在非ST段抬高ACS患者行PCI术前应用瑞舒伐他汀可有效地降低住院期间MACE发生率,降低血清hs-CRP、sLOX-1水平,提高LVEF,且安全可靠.

目的:观察经皮冠状动脉介入治疗(PCI)对心肌细胞外基质重构的影响.方法:选择急性ST段抬高型前壁心肌梗死患者47例,按照是否行急诊PCI分为急诊PCI组(n=32)和非PCI组(n=15),并设置同期稳定性冠状动脉粥样硬化性心脏病患者30例为对照组.比较3组患者入院即刻,PCI术后1、7、30、45 d血清胶原Ⅰ型C端胶原前肽(PⅠCP)、Ⅲ型N端胶原前肽(PⅢNP)及Fibulin-5水平.结果:不同处理方法对患者心肌细胞外基质重构有显著影响.对照组血清中PⅠCP、PⅢNP及Fibulin-5水平无显著变化;急诊PCI组及非PCI组PⅠCP、PⅢNP及Fibulin-5水平升高,7 d后达到峰值,但急诊PCI组上述指标较非PCI组在同一时间窗明显降低(P均<0.05).结论:急诊PCI可减轻患者心肌细胞外基质重构,改善心脏功能.

Objectives To investigate the changes of plasma growth differentiation factor 15 (GDF-15) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with dilated cardiomyopathy (DCM) and their correlations. Methods 50 DCM patients were enrolled and divided into group A and group B, and 30 controls were enrolled as control group. GDF-15 and NT-proBNP were measured in patients who were enrolled in this study. DCM patients were classified into grade II, III and IV according to the New York Heart Association (NYHA). The correlation between cardiac function grade and GDF-15 and NT-proBNP levels was observed. Results Compared with the control group, GDF-15 and NT-proBNP were increased in group A and B, the difference was statistically significant (P<0.05). Compared with group B, GDF-15 and NT-proBNP in group A increased, the difference was statistically significant (P<0.05). The higher the NYHA cardiac function grade, the higher the level of GDF-15 and NT-proBNP. Conclusions GDF-15 and NT-proBNP levels are instructive for the risk stratification and prognosis of DCM patients.

Objective To explore clinical effect of metoprolol on elderly patients with ventricular arrhythmias. Methods A total of 142 elderly patients with ventricular arrhythmias were selected in the Affiliated Hospital of Hainan Medical University from November 2011 to March 2015,and they were divided into A group( treated with amiodarone,n = 61),B group(treated with verapamil,n = 33)and C group( treated with metoprolol,n = 48)according to treatment methods. The overall effect,the supraventricular tachycardia effect,the atrial fibrillation effect and the atrial flutter effect were compared among the three groups. Results No statistically significant differences of the overall effect,the supraventricular tachycardia effect,the atrial fibrillation effect or the atrial flutter effect was found among the three groups(P > 0. 05). Conclusion There is no differences of clinical effect between metoprolol and traditional verapamil,amiodarone on elderly patients with ventricular arrhythmias.

Objective To investigate the function measurement situation of sinoatrial node after the radiofrequency ablation surgery for chronic atrial fibrillation(AF) combined with long R-R interval( > 1.5 s) in order to understand whether there exists sinoatrial function disorders in patients with chronic AF combined with long RR interval. Methods Fifteen patients with chronic AF combined with long RR interval that received radiofrequency ablation treatment for the first time and regained sinus rhythm were selected. The postoperative routine cardiac electrophysiology examination was conducted to measure the patients' sinoatrial node recovery time and sinoatrial conduction time in order to know whether there existed sinoatrial function disorders. The postoperative 24-hour dynamic electrocardiography(Holter) was conducted to determine whether there was long R-R interval recurrence.The change of mean heart rate between before and after the surgery was observed. Results The sinoatrial function measurement results showed that the sinoatrial recovery time and sinoatrial conduction time of all the 15 patients were within normal range,and the postoperative Holter did not find long R-R intervals. Conclusion The sinoatrial node function of patients with chronic atrial fibrillation combined with long R-R interval has no abnormal changes.

Objective: To evaluate the clinical value of 64-slice spiral computed tomographic coronary angiography(64-SCTCA) for diagnosing the significant stenosis of coronary artery in elderly patients.Methods: Both 64-SCTCA and coronary angiography(CAG) were performed on 16 elderly patients aged over 60 from January 2010 to January 2011.Coronary artery was segmented according to segmenting method of American Heart Association,and sensitivity,specificity,accuracy,positive and negative predictive rate of 64-SCTCA in diagnosis of coronary artery stenosis were evaluated.Results: In the 144 segments assessable by CAG,139(96.53%) were clear enough for identification and evaluation by 64-SCTCA,while 5 were unclear.There were more clear segments in the left main,left anterior descending and left circumflex coronary arteries than in the right coronary arteries(χ2=10.36,P=0.016).There was no significant difference in amount of clear segments among proximal segments,middle segments and distal segments(P>0.05).The sensitivity,specificity,positive and negative predictive value,accuracy of 64-SCTCA for diagnosing coronary artery disease were 88.89%,71.43%,81.25%,80.00%,83.33%,respectively.The calculation of assessable segments by 64-SCTCA showed the sensitivity,specificity,positive and negative predictive value,accuracy of 64-SCTCA for segmental coronary stenosis were 85.00%,97.58%,95.83%,85.00% and 97.58%,respectively.The diagnostic value of 64-SCTCA for significantly segmental coronary stenosis was similar to CAG,and was similar in left main,left anterior descending,left circumflex coronary arteries and right coronary artery,as well as in proximal,middle and distal segments.Conclusions: 64-SCTCA in as valuable as CAG in diagnosis of coronary stenosis,with a significantly higher accuracy in the left main,left anterior descending,left circumflex coronary arteries and the proximal,middle segments.

背景随着对慢性心力衰竭基础和临床研究的深入,心衰已不再被认为是单纯的血流动力学障碍,更重要的是由于多种神经体液因子的参与,促使心衰持续发展。在心力衰竭过程中,交感活性增高起着重要的作用。目的脑钠肽主要是由心室的心肌细胞所分泌的一种肽类神经激素,心力衰竭时,导致脑钠肽分泌增加。本文旨在探讨两种β-受体阻滞剂——比索洛尔与美托洛尔干预下,心衰患者血浆脑钠肽水平的改变,以及疗效对比。方法将38例Ⅱ～Ⅲ级心功能患者随机分为两组,在常规抗心衰治疗的基础上,分别给予比索洛尔(20例)和美托洛尔(18例)治疗,7 d后观察血浆脑钠肽水平变化,并对两组的差值进行比较。结果比索洛尔组、美托洛尔治疗前与治疗7 d后比较,使用比索洛尔组和美托洛尔组血浆脑钠肽水平均有显著下降(P<0.001),其中比索洛尔组血浆脑钠肽水平下降值较美托洛尔组显著(P<0.05)。讨论比索洛尔组和美托洛尔均能显著降低严重心衰患者的血浆脑钠肽水平,改善心功能,且比索洛尔对血浆脑钠肽水平的影响比美托洛尔更显著。

Objective: To explore change and significance of neutrophil elastase(NE),high sensitive C-reactive protein(hs-CRP) in patients with impaired fasting glucose(IFG) and acute coronary syndrome(ACS).Methods: Fasting glucose and oral glucose tolerance were determined in 63 ACS patients,and patients were divided into ACS-IFG group(Group A)(27 cases) and ACS group(Group B)(36 cases).Another 30 cases with normal coronary arteriongraphy and without IFG were selected as control group(Group C).Besides physical examination and conventional lab tests,NE and hs-CRP were determined.Results: Levels of NE and hs-CRP were significantly higher in Group A and B than in Group C,and it was more significant in Group A(P0.005).NE was positively correlated to hs-CRP(r=0.671,P0.001).Conclusions: ACS patients complicated with IFG have more severe general inflammation.Comprehensive intervention should be carried out to improve the prognosis.

[Objective] To investigate the correlation between the concentration of plasma neutrophil elastase (NE) and the stability of coronary lesions in patients with CHD. [Methods] The one hundred thirty-nine subjects were divided into six groups, according to coronary angiography and clinical manifestation, electrocardiogram and echocardiogram: acute coronary syndrome group (group A); stable coronary artery disorder group (group B); chronic bronchitis group (group C); the healthy human group (group D). The blood routine, troponin T (cTn), and creatine phosphokinase (CK) of patients in group A were detected in the 24 hours after admission, other patients were determined after admission. The concentrations of plasma NE were determined by ELASA method. [Results] ① The plasma concentration of NE was higher in group A than that of other groups, which had the statistical significance (χ2 = 34.503, P﹤0.000 1). ② The plasma concentration of NE had the positive correlation with cTn, CK and total white blood cells, the percentage of neutrophile granulocyte, which didn’t have correlation with HBP, diabetes and hyperlipemia (P﹥0.05). We found total white blood cells and the percentage of neutrophile granulocyte in the group A and group C had no statistical significances (P﹥0.05). ③ We found plasma concentrations of NE were higher in acute period than in stable period in the same group (P﹤0.005). That meant the plasma concentrations of NE had the close relationship with the stability of coronary heart disease. [Conclusion] The concentration of plasma neutrophil elastase is related to the acute coronary syndrome, as well as the severity of CHD. NE may be a infl. marker of the unstability for the coronary artery plaque.

目的冠状动脉介入治疗(PCI)后,有6%～30%的病人肌酸激酶同工酶(CK-MB)升高,且与心脏事件的发生率增高相关。CK-MB升高原因有多种,包括侧支闭塞、血流慢、一过性血管闭塞、痉挛、远端血栓形成及球囊扩张时间较长等。β-受体阻滞剂对急性心肌梗死、高血压、心律失常及心力衰竭病人的治疗有明确疗效。本研究观察PCI前应用β-受体阻滞剂是否可减少介入并发症。方法行PCI患者34例,随机分为β-受体阻滞剂组(19例)及对照组(15例)。分别于术前6～8 h、术后24 h抽取血标本,检测CK-MB、肌钙蛋白T(TnI)水平,并随访病人院内、院外1年心脏事件的发生率。结果 PCI治疗后,两组CK-MB及TnI水平均有所升高,TnI升高幅度较明显。PCI治疗后16～24 h,β-受体阻滞剂组TnI的升高幅度较对照组低,差异有统计学意义(P<0.05)。β-受体阻滞剂组并发症发生率较对照组低,差异有统计学意义(P<0.05))。院内病死率及1年随诊病死率较低(P<0.05)。结论已有证明,再灌注治疗之前服用β-受体阻滞剂,可减少梗死面积,其疗效明显优于再灌注治疗本身。胸痛、心肌缺血、心肌坏死及急性再灌等均可增加交感神经冲动的发放,随之而来的心动过速、高血压及增加的心肌需求均可进一步增加心肌的损害。PCI前对病人进行有效的交感活性抑制治疗,如服用β-受体阻滞剂,可减少交感刺激的有害影响。CK-MB及TnI均为检测心肌受损的敏感指标,在PCI治疗后,CK-MB及TnT水平均有升高,但TnI升高幅度较CK-MB明显。本研究结果显示,PCI治疗后β-受体阻滞剂组TnI水平的升高幅度较对照组低,差异有统计学意义。冠心病尤其是心肌梗死后长期应用β-受体阻滞剂,可通过减少梗死面积的扩大及心律失常的发生而减少病死率。本研究显示,冠心病患者于PCI治疗前服用β-受体阻滞剂可减少术中并发症,降低院内病死率及1年随诊病死率。

Objective: To evaluate the safety and efficacy analysis of transradial coronary intervention therapy(PCI).Methods: A total of 261 hospitalized patients that underwent PCI were divided into the radial artery diameter group(139 cases) and femoral artery diameter group(122 cases).Success rate,PCI success rate,operation time,X-ray exposure time,the number of planted stenting,amount of consumed contrast agent,as well as incidence of both local and systemic complications,hospital stay and other indicators were observed and compared between the two groups.Results: There were no significant differences in Success rate,PCI success rate,operation time,X-ray exposure time,the number of planted stenting,amount of consumed contrast agent,as well as incidence of both local and systemic complications,hospital stay between the two groups(P0.05).But the radial artery diameter group showed significant lower incidence of local bleeding,hematoma and other complications(5.7% vs.11.48%,P0.05),it also showed shorter time lying on bed(12 h vs.26 h,P0.05).Conclusions: With great safety and efficacy,radial artery diameter shows similar treatment outcomes as femoral artery diameter for patients with coronary heart disease,while it can reduce local complications,and bed bounded-time.

Objective To explore the clinical significance of coronary CT angiography(CTA) combined with TIMI risk scores in patients with acute chest pain. Methods To patients with acute chest pain in emergency department and cardiovascular department of affiliated hospital of Hainan medical college from June 2008 to June 2010 were examined. History taking, physical examination, bedside ECG and biomarkers of myocardial injury were performed. Patients were stratified into different groups according to the accumulative risk scores of the seven variables. All of these patients were given 64-slice coronary CT angiography and invasive coronary angiography to detect the lesions in coronary artery.TIMI sores,GTA and invasive coronary angiography were anlyzed.The three relationshios were compoved Results Patients with ischemic chest pain had much higher TIMI scores than those without ischemic chest pain. Higher accuracy of coronary lesions detection was seen with TIMI score combined with coronary CTA. Conclusion TIMI risk scores combined with coronary CTA will give more information in patients with acute chest pain and should be performed routinely.

目的:探讨临床急性冠脉综合征(ACS)患者血浆促心肌素-1(CT-1)的浓度变化及意义。方法:ACS患者56例,其中不稳定型心绞痛(UA)患者27例,急性心肌梗死(AMI)患者29例,并纳入同期正常人20例作为对照组。用ELISA方法测定CT-1浓度;同期检测血肌酸磷酸激酶同功酶(CK-MB)与血清肌钙蛋白(cTnI)水平。用SPSS软件包进行统计学分析。结果:(1)血浆CT-1浓度UA组,AMI组与正常对常组对比均有显著差异。AMI组的CT-1浓度[(419.50±166.32)ng/L]明显高于UA组[(180.06±125.05)ng/L]及正常对照组[(19.05±18.65)ng/L(均P<0.01),而UA组也高于正常对照组(P<0.01)。(2)AMI患者CT-1浓度与CK-MB峰值(r=0.614,P<0.01)与cTnI峰值(r=0.555,P<0.01)存在良好的相关性。结论:血浆CT-1在ACS各组患者中都有升高,其浓度与疾病的严重程度有一定相关性。血浆CT-1在心肌损伤的修复中发挥作用。CT-1可做为ACS严重程度的预测指标。

【Objective】 To study the effect of lovastatin on serum concentration of adiponectin in patients with acute myocardial infarction(AMI).【Methods】56 patients with AMI were divided into conventional treatment group(n =26) and lovastatin group(n =30).Patients in both groups were given conventional treatment for 2 weeks,and patients in the lovastatin group were given orally lovastatin(20 mg/day) simultaneously.Triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C) and adiponectin were measured and contrasted before and after treatment in all subjects.【Results】①In the conventional treatment group,the serum concentrations of TG,TC and LDL-C had no changes and adiponectin was obviously increased after treatment(P 0.05);②Compared to those before treatment,all of TG,TC and LDL-C were obviously lower,and adiponectin was apparently higher in the lovastatin group.Moreover,increasing of adiponectin after treatment in the lovastatin group was more apparent compared to those in the conventional treatment group(P 0.05).【Conclusion】 Lovastatin can improve lipid levels,and apparently increase serum concentrations of adiponectin in patients with AMI.

目的 探讨常规治疗情况下给予无创正压通气治疗急性左心力表竭的效果.方法 将30例急性左心力衰竭患者分为观察组和对照组,观察组在常规药物治疗基础上,采用BIPAP呼吸机,通气模式采用双向正压通气,对照组在上述药物治疗基础上给予鼻导管或面罩吸氧.结果 30例患者治疗前后各项监测指标变化显示,观察组在治疗前后患者的呼吸频率、心率、平均血压均有下降,手指血氧饱和度、动脉血气分析有明显改善,且效果显著优于对照组.结论 本病的病理改变主要是肺泡表面活性物质破坏,导致肺顺应性下降,使通气/血流比例失调而致换气功能障碍,严重缺氧.正压通气可扩张陷闭肺泡,增加呼气末肺容量,使血氧交换增加,改善肺顺应性,改善左心功能.