目的 研究红细胞体积分布宽度(RDW)与急性心肌梗死合并心源性休克(AMI-CS)患者住院期间预后的相关性.方法 选择徐州市中心医院2015年7月到2020年10月AMI-CS患者160例,根据患者入院24 h内的RDW,采用四分位法将其分为4组(RDW≤12.5％、12.5％15.3％),每组40例.分析各组患者的临床特征,主要不良心血管事件(MACE)的发生率,使用logistic多因素回归分析,绘制ROC曲线,评估RDW预测AMI-CS患者住院期间发生MACE的价值.结果 4组患者的病死率分别为5％,20％,35％,35％,MACE发生率分别为20％,35％,45％,50％(P<0.05).校正RDW、年龄、性别、糖尿病病史、白细胞计数、低密度脂蛋白、血糖、尿酸、肌酐、左心室射血分数、肌钙蛋白I、B型脑钠肽、C反应蛋白等变量后,最高四分位组发生MACE风险是最低四分位组的4.000倍(95％CI 1.483～10.788,P<0.05).ROC曲线下面积为0.654,截断点选择13.75,灵敏度为0.633,特异性为0.640.即随着RDW的升高,患者发生死亡和MACE风险显著升高,RDW≥13.75％可以作为预测AMI-CS患者发生MACE的独立危险因素.结论 RDW对AMI-CS患者住院期间的预后具有预测价值.

Objective:To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) support in acute myocardial infarction (AMI) complicated by cardiogenic shock.Methods:Thirty-seven AMI patients received ECMO from March 2016 to October 2020 in Emergency Department of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. Gensini score was used to evaluate the coronary lesion severity, vasoactive-inotropic score (VIS) was used to assess the usage of vasoactive-inotropic drugs, and cumulative fluid balance (CFB) was used to calculate the fluid balance status, respectively. According to the infarct-related artery, positive/negative fluid balance, and survival/death outcome, the patients were divided into the negative and positive fluid balance groups, and the survival and death groups, respectively. The relationship between Gensini score, 24-hVIS, CFB and patient outcome was analyzed.Results:Thirty AMI-ECMO patients were enrolled, 12 patients survived and 18 died with a mortality rate of 60.0%, and 80.0% of the infarct-related artery were left main and proximal left anterior descending artery. The Gensini score was 77 (52, 120), 24-h VIS 50.0 (31.1, 80.4), daily fluid volume 28.7 (26.6, 34.4) mL/(kg·d), and CBF -1.8 (-9.7, 8.0) mL/kg. The mortality and 24-h VIS of the negative fluid balance group were significantly lower than those of the positive fluid balance group, and the Gensini score, 24-h VIS and CBF of the survival group were significantly lower than those of the death group.Conclusions:LM and pLAD are the most common infarct-related arteries in AMI-ECMO patients, the Gensini score and 24-h VIS have a certain prognostic value, and early negative fluid balance may improve the survival rate.

Objective: To investigate whether Schisandrin B (Sch B) could improve cardiac structure and function in myocardial infarction (MI) mice and related mechanisms. Methods: Male C57BL/6J mice were randomized into sham (n=8), MI+ Sch B (n=24, 80 mg·kg(-1)·d(-1) per gavage) or MI+ vehicle (n=24, equal volume). After treatment for 3 weeks, cardiac function was detected by echocardiography measurement.Infarction size was measured by Evans blue and TTC staining.HE and Masson trichrome staining were used to observe the myocardial inflammation, structure and fibrosis.TNF-α, TGF-β, IL-1β were detected by ELISA. The apoptosis index of ischemic myocardial cells was detected by immunofluorescence. NF-κB, Bcl-2, Bax, Akt phosphorylated Akt(p-Akt), eNOS, phosphorylated eNOS (p-eNOS) were detected by Western blot. Results: Three weeks after operation, survival rate (83.33% vs. 54.17%, P<0.05), LVEF((51.77±8.50)% vs.(40.23±8.30)%, P<0.05), LVFS((26.44±5.15)% vs. (19.53±4.56)%, P<0.05)were significantly higher; LVEDD ((4.13±0.40) mm vs.(4.44±0.46)mm, P<0.05), LVESD((3.07±0.39) mm vs. (3.46±0.52)mm, P<0.05), the heart weight/body weight ratio((0.59±0.06)% vs. (0.68±0.10)%, P<0.05)was significantly lower and infarct size ((23.4±2.36)% vs. (39.4±2.06)%, P<0.05) was significantly reduced in MI+ Sch B group than those in MI+ vehicle group. In MI+ vehicle group, HE staining showed a large number of inflammatory cells in the peri-infarctl region, and the permutation structure was very disorganized, while above changes were significantly reduced in the MI+ Sch B group. Masson staining results showed that the degree of myocardial fibrosis in MI+ Sch B group was significantly less than that of MI+ vehicle group.Moreover, Sch B could down-regulate some inflammatory cytokines, like NF-κB、TGF-β、TNF-α and IL-1β, activate Akt-eNOS pathway, upgrade Bcl-2 and downgrade Bax and reduce cell apoptosis as compared with MI+ vehicle group (all P<0.05). Conclusions: Our results demonstrate that Sch B can reduce inflammation, inhibit apoptosis, and attenuate cardiac remodeling and improve cardiac function in this mice MI model.Sch B might serve as a potential novel therapeutic agent for ischemic heart disease.