BackgroundPatients with apical hypertrophic cardiomyopathy (ApHCM) have marked inverted T-waves that vary over several years. Inverted T-waves in ApHCM are unstable, but it is unclear whether this change is due to coronary artery disease (CAD) or if it is a characteristic of ApHCM itself. We aimed to study the characteristics of inverted T-waves in patients with ApHCM over the course of 24 h to improve the diagnostic indices of ApHCM.MethodsWe examined 83 patients with ApHCM and 89 patients with CAD (who served as the control group). All patients underwent a 24-h dynamic electrocardiogram (ECG). We analyzed the average depth of inverted T-waves per minute and sorted them from shallow to deep; the sorted ECG segments at the 10th, 50th, and 90th positions of the T-wave were subsequently analyzed.ResultsThe amplitudes of inverted T-waves in ApHCM corresponding to the 10th, 50th, and 90th percentiles were −5.13 ± 4.11, −8.10 ± 4.55, and −10.9 ± 5.04 mm, respectively. Changes in the degree of inverted T-waves were greater in ApHCM than in CAD. T-wave amplitudes in ApHCM were strongly associated with heart rate and circadian rhythm and only weakly associated with CAD and posture. Maximum T-wave amplitudes in the CAD group were <10 mm, while 68% of patients with ApHCM had maximum T-wave amplitudes >10 mm, and all patients with ApHCM aged <50 years had maximum T-wave amplitudes >10 mm.ConclusionNotable variations in the T-waves of patients with ApHCM were observed over 24 h. ECG examinations during states of inactivity (comparable to sleep) improved the sensitivity of the diagnosis of ApHCM. Inverted T-wave amplitudes correlated with heart rate and circadian rhythm, where T-wave changes in ApHCM may be due to the normalization of abnormal T-waves effect. Identifying T-wave amplitudes >10 mm can effectively improve the diagnostic rate of ApHCM, especially in patients aged <50 years. The short-term change in T-waves in patients with ApHCM could serve as a novel index that will help in the diagnosis of ApHCM.

淀粉样变性的机制是淀粉样物质在组织或器官中浸润,并导致功能障碍,几乎任何器官均可受累.病变累及心肌即心肌淀粉样变性(cardiac amyloid-osis,CA)则预后差[1～3].CA的症状和体征缺乏特异性,容易导致误诊、漏诊.但心电图、超声心动图、心脏磁共振、心肌核素扫描等无创检查具有特征性表现,可协助诊断,给临床治疗提供依据.本文报道1例结合无创检查诊断系统性轻链型(systemic light chain(AL)amyloidosis,简称 AL 型)CA 的病例并复习相关文献.

目的:分析2019冠状病毒疾病(COVID-19)危重症和重症患者心律失常的发生情况.方法:回顾性分析COVID-19危重症(117例)和重症(311例)患者的临床资料,比较2组患者心律失常发生情况、血浆氨基末端B型脑钠肽(NT-proBNP)、心肌肌钙蛋白Ⅰ(cTnI)、血氧饱和度(SpO2)、D-二聚体及超敏C反应蛋白(hs-CRP)水平等.采用单因素和多因素logistic回归分析,研究COVID-19患者发生心律失常的相关因素.结果:COVID-19患者心律失常发生率43.9％,最常见的心律失常依次为:窦性心动过速、右束支阻滞、心房扑动或心房颤动、窦性心动过缓及房性早搏;危重症组与重症组患者中窦性心动过速、心房扑动或心房颤动、房性早搏的发生率比较,差异有统计学意义(P＜0.05或P＜0.01).单因素logistic回归分析显示:高血压、SpO2≤93％、cTnI、NT-proBNP、D-二聚体及hs-CRP水平升高、危重症与COVID-19患者发生窦性心动过速相关(P均＜0.05).年龄、脑卒中、SpO2≤93％、cTnI、NT-proBNP、D-二聚体水平升高、危重症与COVID-19患者发生心房扑动或心房颤动相关(P均＜0.05).多因素logistic回归分析显示:高血压、cTnI水平升高、危重症是COVID-19患者发生窦性心动过速的独立相关因素(P均＜0.05);年龄、NT-proBNP水平升高是COVID-19患者发生心房扑动或心房颤动的独立相关因素(P均＜0.05).结论:COVID-19患者易发生心律失常,常见心律失常为窦性心动过速、心房扑动或心房颤动.心肌损伤、高血压病史及危重症是引起COVID-19患者发生窦性心动过速的主要原因;年龄及NT-proBNP水平升高是COVID-19患者发生心房扑动或心房颤动的主要原因.

目的 评价心率减速力(deceleration capacity,DC)和心率变异性(heart rate variability,HRV)对中老年血管迷走性晕厥(vasovagal syncope,VVS)患者的诊断价值.方法 对57例不明原因晕厥的中老年患者进行直立倾斜试验(HUTT)及动态心电图监测,根据结果将研究对象分为HUTT阳性组(25例)和HUTT阴性组(32例).分析两组DC和HRV各指标的差异.绘制ROC曲线,分析DC和HRV对中老年VVS患者的诊断价值.结果 HUTT阳性组DC和HRV各指标均高于阴性组,其中DC、SDNNi、rMSSD、LF显著增高,差异有统计学意义(P＜0.05).ROC曲线分析结果显示,DC和LF对VVS的检出存在预测价值,最佳的临界值分别为6.6 ms、340 Hz.结论 中老年VVS患者在无症状期间自主神经功能紊乱.DC和LF适用于临床筛查中老年VVS患者.

Objective To observe the expressions of leptin,insulin-like growth factor-1 (IGF-1),and insulin-like growth factorbinding protein-3 (IGFBP-3) in serum of postmenopausal women with osteoporosis,explore the clinical significance. Methods Sixty postmenopausal women with osteoporosis (observation group) were divided into non-fracture group (34 cases) and fracture group (26 cases) according to complicating with fracture or not. During the same period,40 postmenopausal women without osteoporosis were selected as control group. ELISA was used to detect the expression levels of serum leptin,IGF-1,ad IGFBP-3 in the three groups. Body mass density (BMD) detection equipment was used to detect BMD values of lumbar vertebra (L1-L4),femoral neck,and Wards triangle area in the three groups. The detection results were compared. The correlations between serum leptin,IGF-1,IGFBP-3 and BMD were analyzed. Results The expression levels of serum leptin,IGF-1,and IGFBP-3 in observation group were statistically significantly lower than those in control group (P＜0. 05). The expression levels of serum leptin,IGF-1,IGFBP-3 and BMD in fracture group were statistically significantly lower than those in non-fracture group (P＜0. 05). There were positive correlations among the four indexes (leptin,IGF-1, IGFBP-3,and BMD) (P＜0. 05). Conclusion Serum leptin,IGF-1,and IGFBP-3 can be used as sensitive laboratory indicators for early diagnosis of postmenopausal women with osteoporosis and assessment of the severity.

目的 探讨淫羊藿苷(icariin,ICA)促进前成骨细胞MC3T3-E1成骨分化的机制.方法 采用不同浓度(10-10 ～10-5 mol/L)的ICA干预前成骨细胞MC3T3-E1 3、6、9天后采用碱性磷酸酶(alkalinephosphatase,ALP)活性检测试剂盒测定ALP活性,确定ICA最适促分化浓度.最适ICA浓度干预前成骨细胞MC3T3-E1 7天后应用实时定量PCR法(real time-polymerase chain reaction,RT-PCR)检测骨形态发生蛋白(BMP)和Wnt/β-catenin信号通路相关分子(BMP-2、Runx2、β-catenin、cyclinD1)基因表达.ICA分别与BMP、Wnt/β-catenin信号通路抑制剂(Noggin、DKK-1)联合干预前成骨细胞MC3T3-E1后,茜素红钙结节染色观察钙化程度以及Western blot检测BMP-2蛋白表达变化.结果 ICA促进前成骨细胞MC3T3-E1成骨分化,且10-9mol/L ICA促进分化的能力最强.与对照组比较,ICA能明显上调BMP和Wnt/β-catenin信号通路相关分子(BMP-2、Runx2、β-catenin、cyclinD1) mRNA表达(P＜0.01).Noggin或DKK-1能抑制前成骨细胞MC3T3-E1钙化,且两者联合作用时抑制更加明显.与ICA单独作用比较,ICA与DKK1联合干预后BMP-2蛋白表达水平下降(P＜0.01).结论 ICA可能通过Wnt/β-catenin/BMP-2信号通路调控前成骨细胞MC3T3-E1的成骨分化.

Objective To investigate the relationship between morning blood pressure and 24-hour blood pressure in elderly people.Methods The research objects were selected from the elderly people who had undergone ambulatory blood pressure monitoring (ABPM)in our hospital from Sep-tember to October in 201 5.According to ABPMresults,44 hypertensive patients with increased av-erage 24-hour blood pressure and another 44 cases with normal average 24-hour blood pressure were taken into our study,separately as hypertension group(group A)and control group(group B).Be-tween the two groups,both of the average morning and 24-hour blood pressure were compared,and the relativity between morning and 24-hour systolic(diastolic)pressure was explored.Results In group A,the average level of morning and 24-hour blood pressure were higher than those in group B.The morning systolic(diastolic)pressure in group B was positively correlated with 24-hour systolic (diastolic)pressure,and the differences were statistically significant(P <0.001 ).Conclusion To a certain extent,morning blood pressure can reflect the level of 24-hour blood pressure in elderly peo-ple.It is suggested to promote morning blood pressure management actively in elderly people.

目的 分析清晨血压监测在高血压诊治中的临床价值.方法 选取2014年9月～2014年10月我院接收的高血压患者308例,通过动态血压监测,选取全天收缩压、舒张压均增高的高血压患者100例,将清晨血压、下午血压与全天血压进行比较.结果 清晨收缩压、舒张压与全天收缩压、舒张压无统计学差异.下午收缩压、舒张压与全天收缩压、舒张压有统计学差异.进一步行相关性分析,得出清晨血压与全天血压存在较好的相关性,其中清晨收缩压与全天收缩压相关性最高,(R=0.6339,p ＜0.001).结论 清晨血压可真实地反映全天血压,有利于高血压的筛查及临床诊治效果的评估.

目的 探讨中老年男性血脂水平与腰椎骨密度(BMD)的关系.方法 根据BMD将232名中老年男性分为3组:骨量正常组、骨量减少组和骨质疏松组.单因素方差分析比较3组间血脂谱的差异,对其BMD和胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、有氧运动等变量之间的关系进行有序Logistic回归分析.结果 骨质疏松组TC和LDL-C显著高于骨量正常组(P＜0.05).有序Logistic回归分析发现,影响BMD情况的独立因素有TC和有氧运动,其中前者为危险因素,后者为保护因素.结论 血脂异常促进骨质疏松的发展,而有氧运动能减缓骨量丢失.预防中老年男性骨质疏松应采用综合干预的方法.

Objective To explore the effect of peroxisome proliferator activated receptor gamma agonist pioglitazone on the osteoblasts metabolism in rats in vitro.Methods Osteoblasts were obtained from calvaria.After identified as osteoblasts,methyl tetrazolium (MTT) assay and alkaline phosphatase (ALP) detection were used to observe the proliferation and differentiation of osteoblasts stimulated pioglitazone (0,2.5.0,5.0,10.0,20.0 μmoL/L).The protein expression of Smad2/3 and p-Smad3 of osteoblasts induced by transforming growth factor-β1 (TGF-β1) (5 μg/L) was observed by Western blotting.Results Pioglitazone had no effect on stimulating cell proliferation,but the activity of ALP declined from 0.0731 ±0.0041 to 0.0204 ±0.0029 103 U/gprot.Compared to TGF-β1 (5 μg/L),the protein expression of Smad2/3 and p-Smad3 were declined (P ＜ 0.01).Conclusion Peroxisome proliferator activated receptor gamma can inhibit differentiation,and may influence the bone metabolism by regulating the Smad2/3 protein and mRNA expression.