Cardiopulmonary exercise test(CPET) is the most commonly used non-invasive tool in the world to objectively evaluate cardiopulmonary reserve function and exercise tolerance. CPET play an important role in diagnosis, risk stratification, prognosis evaluation and therapeutic planning in heart failure(HF) patients. In recent years, due to the increasing number of advanced HF patients and the paucity of heart donors, left ventricular assist device(LVAD) has represented a valid alternative to heart transplantation(HT) from bridge to transplantation indication to destination therapy. This article summarizes several topical issues regarding the current use of CPET in assessing the prognosis of HF patients, implantation and withdrawal of LVAD, postoperative right ventricular failure, and the effects of exercise rehabilitation in LVAD patients.

Objective To analyze the effect of levosimendan combined with recombinant human brain natriuretic peptide（rh-BNP） on left ventricular structure, serum cardiac troponin（cTnI）,N-terminal B-type natriuretic peptide precursor（NT-proBNP） and indicators of glomerular filtration function in patients with acute decompensated heart failure with reduced ejection fraction.Methods Clinical data of 174 patients suffering from acute decompensated heart failure with reduced ejection fraction admitted to Heart Failure Center of Sichuan Provincial People’s Hospital from May 2020 to November 2021 were collected and retrospectively analyzed.According to their treatment, they were divided into levosimendan group（81 cases） and combined treatment group（93 cases）.The therapeutic efficacy of both groups was observed, and changes in left ventricular structure indicators, tricuspid annulus plane systolic excursion（TAPSE）,serum cTnI and NT-proBNP levels and indicators of glomerular filtration function before and after treatment, and occurrence of adverse reactions were compared between the two groups.Results After treatment, the total effective rate of combined group was significantly higher than that of levosimendan group（92.47% vs 79.01%,P=0.010）.Compared with the levosimendan group, LVEDD value（55.92±3.08 mm vs 59.43±3.67 mm）,and cTnI（2.46±0.44 μg/L vs 2.83±0.49 μg/L）,NT-proBNP（864.58±153.46 ng/L vs 1152.84±191.25 ng/L） and creatinine levels（129.65±19.98 μmol/L vs 141.06±22.34 μmol/L） were significantly lower（P＜0.05,P＜0.01）,and LVEF,TAPSE and eGFR were significantly higher（P＜0.05,P＜0.01） in the combined group after treatment.There were no statistical differences in incidence rates of adverse reactions between the two groups（P＞0.05）.Conclusion Levosimendan combined with rh-BNP can improve the left ventricular structure, cardiac function and renal function, with good safety in the treatment of acute decompensated heart failure with reduced ejection fraction.

慢性心力衰竭(心衰)恶化是心衰症状和临床状态未得到改善甚至恶化,进入终末期心衰的表现,是心衰病程中的一个阶段,目前国内外尚未有统一的定义.针对该阶段临床上需要重视和加强院内外长期一体化管理.早期识别,优化方案,并将改善心衰预后的新型药物早期规模化应用.

目的 探讨不同肾小球滤过率的进展期心力衰竭间断重复使用左西孟旦的疗效差异.方法 纳入住院的进展期射血分数降低性心力衰竭患者,分为常规治疗组和左西孟旦组,随访观察6个月,按照肾小球滤过率估算值(eGFR)分为eGFR≥60 mL/(min·1.73 m2)组和＜ 60 mL/(min·1.73 m2)组,分别评估治疗前后eGFR、脑钠肽(BNP)、左室射血分数(LVEF)的变化,非计划再入院率和住院时间.结果 共有177例射血分数降低性心力衰竭患者,常规治疗组118例,左西孟旦组59例;两组性别、年龄、肌酐、eGFR、BNP、LVEF和NYHA心功能分级等无差异(P＞0.05).左西孟旦组基线时收缩压偏低[(111.86±22.59) mm Hg vs(124.36±22.59)mm Hg,P＜0.001].两组无论基线eGFR水平,治疗后eGFR增加30％的比例无差异(23.96％ vs 23.92％,P=0.691);左西孟旦组的非计划再入院率低于常规治疗组(80.56％ vs 100％,P＜0.008);非计划再入院住院时间＞7d的比例低于常规治疗组(61.11％ vs 96.97％,P＜0.001);BNP下降＞30％的比例显著高于常规治疗组(84.75％ vs 27.97％,P＜0.061),LVEF恢复到40％以上的比例高于常规治疗组(36.00％ vs 28.44％).上述差异在[eGFR＜ 60 mL/(min·1.73 m2)]的患者中显著.结论 间断重复使用左西孟旦治疗进展期心力衰竭[eGFR＜ 60 mL/(min·1.73 m2)]的患者,相对于常规治疗组可减少心力衰竭患者的非计划再入院,缩短非计划再住院时间,BNP水平下降以及LVEF恢复更加明显.

目的:探讨左西孟旦间断重复使用对于进展期心力衰竭合并不同肾功损害患者的治疗作用.方法:纳入我院心衰中心住院的进展期射血分数降低心力衰竭(HFrEF)患者,分为常规治疗组和左西孟旦组.左西孟旦组在常规治疗基础上联用左西孟旦,按照0.1 μg·kg-1·min-1速度静脉泵入24 ～ 48 h,每2～4周治疗1次,连续3个月.两组共随访观察6个月,按照肾小球滤过率估计值(eGFR)分组(eGFR≥30 mL·min-1·m-2和＜30 mL·min-1·m-2),分别评估两组患者治疗前后eGFR,脑钠肽(BNP)以及体重变化情况,比较两组非计划再入院率和非计划再入院的住院时间.结果:共有517例HFrEF患者纳入本组研究,其中常规治疗组430例,平均年龄(62.77±15.88)岁;左西孟旦组87例,平均年龄(65.79±15.10)岁;左西孟旦组男性比例更高(65.52％ vs 50.93％,P=0.013)、纽约心功能分级(New York Heart Association,NYHA)更差[(3.264 9±0.49) vs (3.0410±0.56),P＜0.001]、BNP水平更高[(2 049.67±2 218.70) pg·mL-1 vs(978.24±1 695.18) pg·mL-1,P ＜0.001],且基线收缩压较低[(114.60±22.84) mmHg vs(127.01±22.09) mmHg,P＜0.001].两组肾功能情况(肌酐和eGFR水平)及肾功能重度受损(eGFR＜ 30 mL· min-1·m-2)患者比例无统计学差异.重度肾功能受损的心衰患者(eGFR ＜30 mL·min-1 ·m-2)治疗观察随访6个月后,左西孟旦组eGFR增加30％及以上或降低超过30％及以上的比例高于对照组(P =0.002),而eGFR≥30 mL·min-1 ·m-2患者治疗前后eGFR变化无统计学差异(P=0.813).左西孟旦组非计划再入院率低于常规治疗组(65.31％ vs 94.83％,P＜0.001);非计划再入院住院时间长于常规治疗组[(14.23±7.4)d vs(11.16±5.27)d,P＜0.001];体重下降超过1 kg的患者比例高于常规治疗组(30.36％ vs20.39％,P＜0.001);BNP下降超过30％的患者比例高于常规治疗组(85.00％ vs 57.25％,P＜0.05).上述差异在eGFR≥30 mL· min-1 ·m-2的患者中有统计学意义,而GFR ＜30 mL·min-1·m-2的患者无统计学差异.结论:间断重复使用左西孟旦治疗进展期心力衰竭合并轻中度肾功受损(eGFR≥30 mL·min-1 ·m-2)可减少心衰患者的非计划再入院并降低体重和BNP水平,但肾功能重度受损(eGFR ＜30 mL·min-1·m-2)的进展期心衰患者未见统计学差异.

目的 了解不同类型心力衰竭患者的诱因、临床特点,为开展心衰患者差异化治疗提供科学依据.方法 收集2015-2016四川省人民医院心衰中心住院治疗的确诊心衰患者的基本信息、心衰诱因和临床特点等资料,按照射血分数分为射血分数降低心衰组(HFrEF)、射血分数中间范围心衰组(HFmrEF)和射血分数保留心衰组(HFpEF)3组,采用卡方或者方差检验对比分析3组心衰患者各项指标,探讨不同类型心衰患者临床特点.结果 共收集380例心衰患者相关资料,其中HFrEF组95人,HFpEF组249人,HFmrEF组36人.HFrEF组平均年龄小于其他2组,与HFpEF组比较差异有统计学意义(F=12.854,P＜0.01);3组心衰患者性别构成比较,差异有统计学意义(x2=10.233,P＜0.05);HFpEF组平均收缩压大于其他两组,且组间比较差异均有统计学意义(F=7.182,P＜0.05);HFpEF组平均心率则小于其他两组,且组间比较差异均有统计学意义(F=6.272,P＜0.05).结论 心衰患者治疗已进入新时期,探讨不同心衰类型患者基本临床特征,将有助于临床实施精准治疗方案,提升心衰患者治疗效果.

心血管疾病在老年人中患病率高,同时由于人口老龄化及医学技术的发展,使既往死于急性心肌梗死、脑卒中及急性心力衰竭的患者得以存活.美国Framinghan研究结果显示,心力衰竭发病率在50～59岁为1％,50岁以后,每增加10岁,患病率增加1倍;心力衰竭是≥65岁老年人住院的主要原因;老年心力衰竭预后差,5年生存率为25％～50％,低于多数的恶性肿瘤,也是老年人死亡的最常见原因,猝死发生率是正常人的5倍[1].截至2015年底,我国≥60岁老年人口已达2.22亿,其中≥80岁者占13.9％,≥80岁人群心力衰竭患病率近12％[2].老年患者由于器官老化,功能减退,血管硬化,神经反应不灵敏,多种疾病共同存在,使得老年心力衰竭的诊断和治疗有一定的特点.

目的 探讨血浆B型钠尿肽(BNP)和肌钙蛋白I(cTnI)在老年急性失代偿性心力衰竭(ADHF)患者中的临床价值.方法 选取老年ADHF患者155例;根据心功能分级(NYHA)分为Ⅲ级组83例和Ⅳ级组72例;根据病情转归分为预后良好组106例和预后不良组49例;同期选取老年健康人群30例作为对照组.超声心动图检测左心室舒张末期内径(LVEDD)和左心房内径(LAD)等,进行相关性分析和logistic回归模型分析,采用ROC曲线评估血清cTnI和BNP水平对ADHF患者死亡预测价值.结果 心功能Ⅲ级组、Ⅳ级组与对照组血清BNP和cTnI水平比较,差异有统计学意义(P＜0.01);预后不良组血清BNP和eTnI水平明显高于预后良好组(P＜0.05).血清BNP和cTnI水平与LVEF呈负相关(r=-0.521,r=-0.535,P＜0.01),与LVEDD(r=0.319,r=0.366,P＜0.01)和LAD(r=0.282,r=0.293,P＜0.05)呈正相关;BNP(OR=3.229,P=0.027)和心功能分级(OR=3.554,P=0.004)是影响ADHF患者预后的独立危险因素;血清BNP和cTnI预测ADHF患者死亡的临界值分别为1700 ng/L和0.45 μg/L.结论 血清BNP和cTnI水平与老年ADHF患者心功能及预后有关,BNP是老年ADHF患者不良预后的危险因素,且对患者死亡有一定预测价值.

目的 观察间断重复静脉使用左西孟旦治疗老年扩张型心肌病患者的有效性.方法 选择2016年1月～2018年3月在四川省人民医院心力衰竭中心住院的老年扩张型心肌病患者43例,随机分为左西孟旦组21例和对照组22例.对比分析应用左西孟旦治疗前后的B型钠尿肽(BNP)、LVEF等相关临床指标.结果 左西孟旦组治疗后LVEF、体质量较治疗前明显升高[(35.75±9.17)％ vs (27.96±4.69)％,P=0.000;(62.05±9.16)kg vs(61.24±9.94)kg,P=0.025],心率、收缩压、舒张压、BNP、尿酸较治疗前明显降低[(81.48±8.79)次/min vs(92.10士11.48)次/min,P=0.000;(116.62±11.45)mm Hg vs (126.71±14.89)mm Hg,P=0.000;(72.48±7.23)mm Hg vs (77.52±8.13)mm Hg,P=0.000;(785.85±1107.76)ng/L vs (2296.43±1305.11)ng/L,P=0.001;(437.52±87.13)μmol/L vs (517.67±113.88)μmol/L,P=0.019].对照组治疗后LVEF较治疗前明显升高,心率、体质量、BNP较治疗前明显降低,差异有统计学意义(P＜0.01).左西孟旦组再次住院间隔时间为130(120,147)d,对照组再次住院间隔时间为32(22,69)d.2组生存曲线比较,差异有统计学意义(HR=0.3601,95％CI:0.1842～0.7038,P=0.000).结论 老年扩张型心肌病患者间断重复静脉滴注左西孟旦,可显著改善心功能,减少住院率.

Objective To study the cause,clinical characteristics and treatment of HFmrEF,HFrEF and HFpEF patients.Methods Three hundred and eighty-five heart failure (HF) patients aged ≥60 years admitted to our hospital from January 2016 to March 2017 were divided into HFrEF group (n=96),HFmrEF group (n=34) and HFpEF group (n=255) according to their ejection fraction.Their demographic data,HF cause,clinical characteristics,cardiac ultrasonographic data,laboratory testing data and therapies were recorded.Their clinical characteristics were compared.Results The number of males was greater and the cardiac function grade Ⅳ was higher in HFmrEF group than in HFrEF and HFpEF groups.The incidence of hypertension was the highest followed by that of valvular disease.The number of HFmrEF patients who used intravenous nitrates,spironolactone and milrinone was greater than that of HFpEF and HFrEF patients who used intravenous nitrates,spironolactone and milrinone.The serum creatinine level was higher in HFmrEF patients than in HFpEF and HFrEF patients at the time when they were discharged.Conclusion Hypertension and valvular disease are the mian risk factors for HFmrEF.The number of males is greater and the cardiac function grade Ⅳ is higher in HFmrEF patients than in HFrEF and HFpEF patients.The serum creatinine level is higher and the outcome is better in HFmrEF patients than in HFrEF and HFpEF patients at the time when they are discharged.

目的 观察不同年龄段的扩张型心肌病(DCM)患者应用左西孟旦后的临床疗效.方法 选择2016-01/2017-05在四川省人民医院心衰中心住院治疗诊断为扩张型心肌病患者33例,从年龄、性别等角度分析该药物与心衰治疗的关系.对比分析应用左西孟旦治疗前后的B型利钠肽(BNP水平)、左室射血分数(LVEF)和相关临床指标.结果 与治疗前比,不同年龄、性别组应用左西孟旦后LVEF均有提高,差异有统计学意义(P＜0.05).尿酸水平均有下降,中青年组及男性组差异有统计学意义(P＜0.05),老年组及女性组差异无统计学意义(P＞0.05).患者治疗前后血钠水平差异无统计学意义(P＞0.05).与治疗前比,左西孟旦治疗后中不同年龄、性别组BNP水平差异均有统计学意义(P＜0.05),但各组治疗后BNP下降比值差异均无统计学意义(P＞0.05).结论 研究提示,左西孟旦治疗扩张型心肌病,短期内对扩心病患者心功能均有改善.

Objective To investigate the clinical application value of mitral annular displacement (MAD)and aortic annular displacement (AAD)in the evaluation of left ventricular longitudinal systolic function in patients with dilated cardiomyopathy (DCM).Methods A total of 38 DCM patients treated in Sichuan Provincial People's Hospital from July of 2013 to December of 2014 were selected and divided into the DCM group,and the other 46 age-matched healthy subjects were selected and divided into the control group.The routine echocardiography was performed to collect the real-time grayscale ultrasound images of three continuous cardiac cycles from the left ventricular apical four-chamber,three-chamber and two-chamber views.The image workstation Q-lab 9.1 was used to measure the maximum displacements respectively at the mitral posterior interventricular septum,lateral wall and midpoint of the line from the posterior interventricular septum to the lateral wall,the mitral anterior and inferior walls and the midpoint of the line from the anterior wall to the inferior wall,and the aortic noncoronary cusp,right coronary cusp,and midpoint of the line from the noncoronary cusp to the right coronary cusp.The two-plane Simpson's method was adopted to calculate the left ventricular ejection fraction (LVEF).The changes of MAD and AAD were analyzed and compared between the DCM patients and the healthy subjects,and the correlations were explored among the parameters of MAD,AAD and LVEF.Results Firstly,Compared with those in the control group,the levels of MAD,AAD and LVEF in the DCM group decreased significantly (P<0.01).Secondly,the levels of left ventricular LVEF in the control group were positively correlated with the levels of MAD (P<0.01) and those of AAD at the right coronary cusp and midpoint of the line from the noncoronary cusp to the right coronary cusp (P<0.01),and at the aortic noncoronary cusp (P<0.05),while those in the DCM group were positively correlated with all the levels of MAD and AAD (P<0.05)except those of MAD at the posterior wall and anterior interventricular septum (P>0.05)and those of AAD at the noncoronary cusp (P>0.05).Conclusion MAD and AAD can indicate the left ventricular systolic function of DCM patients quickly and objectively,so it can be a new method to evaluate the left ventricular systolic function.

目的 探讨心脏舒张功能障碍中血清Ⅰ型前胶原羧基端肽(P Ⅰ CP)和Ⅲ型前胶原氨基端肽(PⅢNP)水平的变化及其与心脏舒张功能障碍、胶原重构的关系.方法 60只兔随机均分为对照组、心肌梗死(MI)组、左室肥厚(LVH)组(n=20).第2、4、8、12周ELISA检测PⅠCP、PⅢNP水平及多普勒血流和组织超声检测各组E/e'比值;第12周苦味酸天狼猩红染色偏振光法测定各组标本胶原容积分数(CVF)和Ⅰ/Ⅲ型胶原比值.结果 与对照组比较,MI组和LVH组PⅠ CP、PⅢNP水平明显升高(p＜0.05),MI组与LVH组比较PⅠCP、PⅢNP水平亦明显升高(P＜0.05),并随时间增加;与对照组比较,MI组和LVH组E/e'比值明显升高(P＜0.05),并随时间增加;与对照组比较,MI组和LVH组CVF明显升高(P＜0.05).PⅠCP、PⅢNP水平与E/e'比值呈正相关(P＜0.05).P Ⅰ CP/PⅢNP比值与Ⅰ/Ⅲ胶原比值呈正相关(P＜0.05).结论 PⅠCP、PⅢNP水平可以评估不同病理状态下心脏舒张功能的改变及心肌胶原重构情况.

Objective Investigate the influences of C-natriuretic peptides on langendorff-perfused swine heart coronary. Reveal the underlying vasodilatory ability and mechanism of C-natriuretic peptides. Methods Three different groups named the C-Natriuretic Group ( CNP Group) , the Nitroglycerol Group ( GTN Group) , and the NPR-C Receptor Agonist Group ( cANF4-23 Group) were set up.①Each of above groups was perfused by solution of NE,and then was perfused by GTN、CNP and cANF4-23.&nbsp;The vasodilatory influences of CNP and GTN on swine heart coronary arteries and whether cANF4-23 were involved in this procedure were studied .②cANF4-28 was given first, and then CNP were added, the vasodilatory influences were observed.③K + solutions ( at the concentration of 80 nM) were used to preserve the arteries, so they were all in contracted state, and then CNP and cANF4-23 were added, and the vasodilatory influences were observed. Results ①CNP,GTN and cANF4-23 all had significant vasodilatory in-fluences on swine heart coronary artery. no significant difference of vasodilation influences was found between CNP Group and cANF4-23 Group(P>0. 05). The vasodilatory influence of CNP Group was weaker than GTN Group (P<0. 05).②In cANF4-28 preserved arteries, The largest circulus vasculosus vasodilatory ratios of CNP was significantly weaker than Control Group , and had statistical significance (P<0. 01).③The vasodilatory influences of CNP and cANF4-23 Groups were significantly decreased in high concentration K + solution in contrast with the Control Group ( P<0. 05 ) , but not blocked. Conclusions C- Natriuretic peptides have significant vasodilatory influence on swine heart coronary artery. The vasodilatory mechanism of CNP involves NPR-C. NPR-C is not only the well-known clearance receptor, but also leads to vasodilation of the coronary artery. the vasodilatory of CNP/NPR-C sig-naling involves K+ channel.

目的 探讨在中国普通人群中高甘油三酯腰围(hypertriglyceridemic waist,HTGW)与亚临床动脉粥样硬化的关系.方法 随机抽取2011年6月至2012年6月在四川省人民医院进行常规体检者,纳入其中行颈动脉彩超检查且否认相关动脉缺血症状者,对其进行相关心血管危险因素(包括腰围及血清甘油三酯等)筛查.根据腰围及甘油三酯水平,将研究对象分为腰围及甘油三酯均正常组(组Ⅰ)、腰围或甘油三酯升高组(组Ⅱ)和腰围及甘油三酯均升高组(组Ⅲ).分析HTGW对亚临床动脉粥样硬化的影响.结果 共纳入484例研究对象,其中男性占72.1％,平均年龄47.3± 11.1岁.组Ⅰ、组Ⅱ及组Ⅲ中心血管疾病危险因素的水平逐渐升高,差异有统计学意义.按年龄对人群进行分层,老年人群(≥60岁,n=75人)中组Ⅰ、Ⅱ及Ⅲ中亚临床动脉粥样硬化的患病率分别为73.7％、79.3％及70.4％,单因素及多因素分析均显示HTGW与亚临床动脉粥样硬化相关性较弱;而在中青年人群(＜60岁,n=409人)中,组Ⅰ、Ⅱ及Ⅲ中亚临床动脉粥样硬化的患病率分别为19.8％、35.1％及36.1％,以组Ⅰ为对照,调整相关混杂因素后,组Ⅱ及Ⅲ依然与亚临床动脉粥样硬化密切相关,OR值分别为1.987 [95％CI (1.073,3.679),P=0.029]及2.060[95％CI (1.020,4.161),P=0.044].结论 HTGW人群中各种心血管疾病危险因素的水平较高,且存在聚集趋势.在中青年人群中,HTGW与亚临床动脉粥样硬化密切相关;而在老年人群中,HTGW与亚临床动脉粥样硬化的相关性较弱,但该人群中亚临床动脉粥样硬化的患病率较高.

Objective To analyze the clinical and echocardiographic features in patients with apical hypertrophic Cardio-myopathy(AHCM)and typical hypertrophic Cardiomyopathy(HCM). Methods This retrospective analysis included 90 patients hospitalized in our hospital. Patients were divided into three groups: apical hypertrophic Cardiomyopathy(AHCM,n=26)group, non-obstructive typical hypertrophic Cardiomyopathy ( NOHCM, n = 39 ) and obstructive typical hypertrophic Cardiomyopathy (OHCM, n=25). Clinical and echocardiographic features. Results The age at disease onset was older in AHCM group than in OHCMgroup[(48.9±12.6)yearsvs.(38.5±12.0)years,P<0.01].PlasmaCK-MB,TPIandMYOlevelsweresimilara-mong the Three groups. The frequency of giant negative T waveson ECG was 57. 7%、12. 8% and 8. 0%(P<0. 01)in AHCM, NOHCM and OHCM respectively. Half of AHCM patients showed left ventricular high voltage on ECC. Conclusion AHCM pa-tients differ from typical OHCM patients in clinical characteristics. There were significant differences on echocardiography and elec-trocardiography features among three groups. Echocardiography and giant negative T waves on ECC are helpful for the diagnosis of AHCM.

Objective: To examine the association between survival and serum concentrations of cTnI, CK-MB, and myoglobin in patients with idiopathic dilated cardiomyopathy (IDC).Background: It has been suggested that elevated circulating biomarkers of myocardial damage such as cardiac troponin-I (cTnI), creatine kinase MB, (CK-MB) and myoglobin are independent risk factors for mortality in patients with heart failure, and recent studies, although limited, showed that there was a potential association between cTnI and the prognosis of patients with dilated cardiomyopathy (DCM).Methods: A cohort study was undertaken in 310 patients with IDC. Standard demographic information, transthoracic echocardiography, and routine blood tests were obtained shortly after hospital admission. Outcome was assessed with all-cause mortality.Results: Among the 310 patients studied, 61 (19.7%) died during a mean follow-up of 2.2 years. Thee was a significant difference in the all-cause mortality rate between patients with serum cTnI>0.05 ng/mL and with cTnI <= 0.05 ng/mL (37.5% vs 15%, log-rank chi(2)=18.423, P<0.001). After adjustment for other factors associated with prognosis at baseline, serum cTnI>0.05 ng/mL, QRS duration, NYHA functional class and systolic blood pressure predicted all-cause mortality in patients with IDC. There was no association between circulating CK-MB and myoglobin levels and all-cause mortality in the studied IDC patients.Conclusion: Serum concentrations of cTnI but not CK-MB or myoglobin are an independent predictor of all-cause mortality in patients with IDC. (C) 2014 Elsevier Inc. All rights reserved.

目的 探讨急性心肌梗死患者甲状腺激素水平的变化与心功能和冠脉病变程度的关系.方法 64例急性心肌梗死患者,据冠状动脉造影结果分为单支病变组(n=22)和多支病变组(n=42),射血分数(EF)结果分为冠心病非心力衰竭组(n=36)和冠心病心力衰竭组(n=28).选取同期经冠状动脉造影检查排除冠心病的30例患者为对照组.分别测定各组甲状腺激素水平和高敏C反应蛋白(hs-CRP)等.结果 与对照组和冠心病非心力衰竭组相比,冠心病心力衰竭组血清三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)降低(P＜ 0.05,P＜0.01),反三碘甲状腺原氨酸(rT3)和hs-CRP增高(P＜ 0.05,P＜ 0.01);与单支病变组比较,多支病变患者FT3明显降低(P＜0.01),rT3和hs-CRP增高(P＜0.05).在校正其他因素后,FT3水平下降与冠脉病变严重程度相关(风险比为0.72,P＜ 0.05).结论 急性心肌梗死患者的甲状腺激素水平在心功能不全时会有改变,TT3,FT3降低,rT3升高,且FT3水平与冠状动脉病变严重程度相关,因此其可作为反映心肌梗死患者病情严重程度的重要指标之一.急性心肌梗死患者hs-CRP升高,反映炎症在急性心肌梗死患者的发生、发展过程中发挥一定的作用.

Objective To study the correlation of heart function with plasma BNP and serum uric acid (UA) levels in elderly heart failure patients .Methods One hundred and thirty-two elderly patients with chronic heart failure (CHF)served as a CHF group in this study .They were divided into class Ⅰ group (n=26) ,class Ⅱ group (n=38) ,class Ⅲ group (n=40) ,and class Ⅳ group (n=28) according to the NYHA Classification .Fifty healthy subjects undergoing physical exami-nation served as a control group .Their plasma BNP and erum UA levels were measured and com-pared .Results The plasma BNP and erum UA levels were significantly higher in CHF group than in control group (784 .19 ± 206 .00 ng/L vs 41 .25 ± 15 .34 ng/L ,405 .24 ± 90 .16 μmol/L vs 286 .43 ± 78 .68 μmol/L ,P<0 .01) and were significantly different in class Ⅰ - Ⅳ groups (P<0.05 ,P<0 .01) .The plasma BNP level was positively correlated with the NYHA Classification , serum UA level and LVEDD ,and negatively correlated with the LVEF in CHF patients (r=0 .76 , 0 .33 ,0 .22 ,P<0 .05 ;r= -0 .34 ,P<0 .0 5) .The serum UA level was positively correlated with the NYHA Classification and LVEDD ,and negatively correlated with the LVEF in CHF patients (r=0 .41 ,0 .23 ,P<0 .05 ;r= -0 .24 ,P<0 .05) .Conclusion Plasma BNP and serum UA levels are correlated with the cardiac function classification in CHF patients .

Objective To study the application of 5diagnostic criteria for metabolic syndrome(MS) in elderly population of Chengdu.Methods The incidence of MS in Qingyang community elderly population of Chengdu was assessed according to its 5diagnostic criteria,namely NCEP-ATPⅢ,CDS,IDF,AHA/NHLBI and new consensus definition.The difference and consistency of these diagnostic criteria for MS were compared.Results The incidence of MS according to the NCEP-ATPⅢ,CDS,IDF,AHA/NHLBI and new consensus definition was 15.5%,16.5%,21.5%,26.7%and 26.7%,respectively(P<0.01)and higher in female MS patients than in male MS patients(P<0.01).The highest consistency of IDF,AHA/NHLBI and new consensus definition for the diagnosis of MS was 94.9% with their Kappa value being 0.860(P=0.001).The consistency of the other 2criteria for the diagnosis of MS was lower than 90.0% with their Kappa value less than 0.7.Conclusion The incidence of MS according to its 5diagnostic criteria is rather high in Qingyang community elderly population of Chengdu and higher in female MS patients than in male MS patients.Updated diagnostic criteria for MS lead to a greater difference in its diagnostic consistency in the same population.Problems in relation with the diagnosis of MS should be considered in clinical practice and assessment of medical support for the society.