心力衰竭(HF)是多种心血管疾病发展的终末期阶段.随着社会老年化的加重,其发病率、再住院率和死亡率逐年增加.根据HF的类型和病情不同,患者的病死率可能存在明显差异.目前许多国家和地区已经建立了多种用于预测HF患者死亡风险的客观评估模型,在为不同危险分层的患者拟定医疗管理策略和治疗方案时提供了重要的决策辅助支持.不同的临床预测模型各有其临床使用特点,适用于不同HF类型的临床患者.现旨在从不同HF类型患者人群入手,对国际上预测HF患者发生不良预后的预警模型研究现状进行概述.

心房颤动(AF)和乳腺癌均为临床常见疾病,发病率及患病率均呈上升趋势.研究表明,女性乳腺癌患者比一般人群存在更高的AF风险,但二者之间的机制尚不完全明确.另外,女性是AF患者发生卒中的危险因素之一,乳腺癌的存在会增加缺血风险及出血风险,使抗凝效果难以预测,且目前对于乳腺癌合并AF患者抗凝方案尚无权威指南明确推荐.现就女性乳腺癌相关性AF的流行病学、机制、抗凝治疗等相关研究进行综述.

心房颤动(房颤)是临床中最常见的心律失常之一,全球发病率和患病率正在逐年增加.目前国际权威指南提出并提倡针对房颤采用"CC To ABC"管理路径进行综合管理,其中复律和抗凝是房颤综合管理中最重要的组成部分.近年来,尽管对于节律控制及抗凝治疗的策略研究持续深入,研究证据不断积累,但对于复律和抗凝时机的选择以及所需的可作为指南证据的高水平研究仍较为缺乏,且各国各学术组织对房颤治疗时机的选择也存在较大分歧.现就何时启动抗凝及复律治疗进行详细阐述,并总结已有文献,分析目前研究存在的问题,旨在为实现房颤的最佳治疗提供参考.

BackgroundExisting studies have shown that sacubitril-valsartan ameliorated atrial remodeling in atrial fibrillation (AF) and favored maintenance of sinus rhythm in patients with AF and heart failure. However, the effect of sacubitril-valsartan in patients with persistent AF is yet unknown. We aimed to evaluate the effect of sacubitril-valsartan on restoration and maintenance of sinus rhythm in patients with persistent AF who underwent electrical cardioversion (ECV).MethodConsecutive patients with persistent AF who underwent ECV between 1 January 2016 and 30 September 2020 were investigated in this retrospective cohort study. All eligible patients were categorized into sacubitril-valsartan users and sacubitril-valsartan non-users based on whether they received treatment with sacubitril-valsartan or not. The endpoint was ineffictive ECV, defined as the composite of failure to terminate AF or any recurrence of AF during 30 days follow-up.ResultsA total of 76 patients were enrolled in this study, including 28 sacubitril-valsartan users and 48 non-users. Within a follow-up of 30 days after ECV, the endpoint had occurred in 7 (25%) of 28 sacubitril-valsartan users and 25 (52%) of 48 non-users. Significantly lower rate of ineffictive ECV in sacubitril-valsartan users compared with non-users was shown in Kaplan-Meier survival curves (P = 0.02; Log-rank test). Multivariate Cox regression analysis indicated that sacubitril-valsartan use (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.14–0.91), amiodarone use (HR, 0.32; 95% CI, 0.13–0.78), left atrial diameter ≤ 39 mm (HR, 0.21; 95% CI, 0.06–0.71) were independently associated with a decreased rate of ineffective electrical cardioversion.ConclusionUse of sacubitril-valsartan is associated with a significantly decreased risk of ineffective ECV compared with non-users in patients with persistent AF.

目的 分析量子点免疫荧光法新型冠状病毒(简称新冠病毒)IgM、IgG抗体检测对新型冠状病毒肺炎(简称新冠肺炎)的诊断效能.方法 纳入新冠肺炎确诊患者74例(非康复期患者26例,康复期患者48例),以48例体检健康献血者作为阴性对照,以血清或血浆标本进行新冠病毒IgM、IgG抗体检测,分析抗体检测对疾病的诊断效能.结果 IgM抗体单独检测的诊断灵敏度为74.32％,符合临床检出率大于70％的标准,特异度为97.92％;IgG抗体单独检测的诊断灵敏度为83.78％,符合临床检出率大于80％的标准,特异度为100.00％;IgM、IgG抗体联合检测的诊断灵敏度为91.89％、特异度为97.92％,均大于90％的标准.结论 量子点免疫荧光法检测新冠病毒IgM、IgG抗体可用于新冠肺炎的辅助诊断,具有较高的灵敏度和特异度.