目的:探讨尿肝素结合蛋白(urinary heparin-binding protein,U-HBP)、中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)、尿亚硝酸盐(urinary nitrite,U-NIT)诊断糖尿病合并无症状性菌尿(asymptomatic bacteriuria,ABU)价值及对疗效的影响.方法:选取2017年1月至2020年10月诸城市人民医院和解放军总医院第四医学中心收治的98例糖尿病合并ABU患者(ABU组)、98例单纯糖尿病患者(糖尿病组)及90例健康体检者(对照组),比较各组基线资料、尿U-HBP、NGAL、U-NIT阳性率,应用多因素logistic回归方程分析ABU的相关影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线及ROC下面积(area under the curve,AUC)分析各指标的诊断价值,应用Spearman分析各指标与疗效相关性.结果:ABU组U-HBP、NGAL及U-NIT阳性率高于糖尿病组、对照组(P<0.05);多因素logistic回归方程分析结果显示,U-HBP、NGAL、U-NIT阳性均与ABU相关(均P<0.05);U-HBP、NGAL、U-NIT阳性诊断ABU的AUC依次为0.837、0.815、0.877,联合诊断的AUC达0.953;无效患者的U-HBP和NGAL水平最高,其次为有效患者,显效患者最低;显效患者U-NIT阳性率低于有效、无效患者(P<0.05),有效、无效患者的U-NIT阳性率差异无统计学意义(P>0.05);Spearman进行相关性分析显示,U-HBP、NGAL与疗效呈负相关(P<0.05),U-NIT与疗效无相关性(P>0.05).结论:U-HBP、NGAL、U-NIT均可有效诊断糖尿病合并ABU,且对疗效具有一定预测价值,对临床诊治具有指导价值.

目的 观察老年急性冠脉综合征(ACS)患者服用替格瑞洛6个月内作用的有效性、安全性,并评价6个月内炎性因子及心功能的变化.方法 选取收治的65岁以上ACS患者87例,根据抗血小板的方案不同,分为替格瑞洛组(n＝44)和氯吡格雷组(n＝43),观察6个月内心源性死亡、心肌梗死、心绞痛、充血性心力衰竭、脑卒中等主要事件的发生率,以及出血事件、呼吸困难、尿酸升高、心动过缓等不良事件的发生率.以及两组治疗前、治疗1个月、3个月、6个月后超敏C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF)-α、白细胞介素-6(IL-6)和血利钠肽(BNP)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)的变化.结果 替格瑞洛可减少心绞痛(P＝0.02)的发生,在心源性猝死、心肌梗死、充血性心力衰竭方面,两组差异无统计学意义(P＞0.05).替格瑞洛显著增加呼吸困难(P＝0.04)、尿酸升高(P＝0.04)、心动过缓(P＝0.03)的发生概率,具有减少出血事件发生的趋势,但与氯吡格雷组比较,差异无统计学意义(P＞0.05).治疗后替格瑞洛与氯吡格雷均可减少血浆中hs-CRP、TNF-α、IL-6炎性因子,但替格瑞洛组减少更加明显(P＜0.05);两组均可改善LVEF、LVEDD和BNP水平,但替格瑞洛组改善更加明显(P＜0.05).结论 在老年急性冠脉综合征患者中,替格瑞洛可显著减少心绞痛的发生,但同时增加呼吸困难、尿酸升高、心动过缓等不良反应的发生率.替格瑞洛较氯吡格雷更显著减少hs-CRP、TNF-α、IL-6炎性因子水平以及改善LVEF、LVEDD和BNP.

Objective:To analyze the risk factors affecting on prognosis of aged patients with acute coronary syndrome(ACS) post-PCI operation.Methods:A total of 72 patients with ACS in our hospital received PCI operation were divided into two groups,senility group(age>75) and young group(age<75),each group involved 36 patients,according to the age.The factors of HbA1c,NT-proBNP and platelet aggregation rate(PAGR) were ananlyzed the correlation to the value of LVEF and LVEDd after 1 year follow-up.And major adverse cardiac events(MACE),such as recurrent MI and mortality death rate,were compared between two groups.Results:The negative correlation coefficients of NT-proBNP and PAGR with LVEF were -0.891 and -0.901,respectively.The positive correlation coefficients of NT-proBNP and PAGR with LVEF were 0.857 and 0.924,respectively.The rate of MACE was different between two groups,and the values of P were 0.0148 and 0.0254,respectively.Conclusion:The rate of MACE in aged patients with ACS received PCI operation was higher than young patients,and cardie fuction had correlation to NT-proBNP and PAGR.

Objective:To investigate the etiologies of acute chest pain and the value of chest pain center (CPC) for hospital improvement in time for diagnosis and treatment in patients with acute chest pain.Method:CPC was set up at the emergency department (ED) and there were three open days weekly which were randomly selected at the CPC.The patients were diagnosed and treated by ED physicians according to routine clinical pathway at the rest time of the week.The etiologies of chest pain and time for diagnosis and treatment were recorded.Result:The total of 696 nontraumatic chest pain patients visited ED/CPC from January 2006 to December 2007,of which 244 (35%) cases were cardiac chest pain cases including 141 (20%) cases of AMI,81 (12%) cases of unstable angina pectoris,17 (2.4%) cases of stable angina pectoris,2 (0.3%) cases of acute aortic dissection and,3 (0.4%) cases of acute pulmonary embolism.452 cases were noncardiac chest pain patients including 41 (6%) cases of respiratory diseases,70 (10%) cases of digestive diseases,41 (6%) cases of chest wall diseases and,299 (42%) cases of psychological-psychotic diseases and other undetermined clinical conditions.Time for diagnosis and treatment for chest pain patients who visited CPC was significantly shortened.AMI:(70.1±31.7) vs (115±40.5) min,P0.01;unstable angina pectoris:(3.8±0.9) vs (4.4±1.3)h,P0.05;noncardiac chest pain:(1.8±1.1) vs (2.1±1.6)h,P0.05.Conclusion:This study reveals among chest pain visitors to ED/CPC,cardiac etiologies account for 35% mainly including AMI and unstable angina pectoris,noncardiac etiologies account for 65%.Time for diagnosis and treatment for chest pain patients is significantly shortened by CPC.

目的:观察急性心肌梗死(AMI)患者冠状动脉介入治疗(PCI)后长期服用曲美他嗪的临床疗效和不良反应.方法:初发AMI患者90例,PCI后随机分为3组:A组(30例)作为对照;B组(30例)PCI后口服曲美他嗪治疗6个月;C组(30例)PCI后口服曲美他嗪治疗12个月.各组有关冠心病2级预防用药均相同.观察各组患者肾功能、24 h尿蛋白定量、超声心动图变化.结果:与A组相比,B组和C组肾功能未见恶化,24 h尿蛋白定量无增加,心功能恢复较好(均P＜0.05或P＜0.01).B组和C组比较各指标均差异无统计学意义(均P＞0.05).结论:AMI患者PCI后长期服用曲美他嗪安全有效,心功能改善明显.

合并糖尿病的初发急性心肌梗死(AMI)患者60例,经皮冠状动脉介入治疗(PCI)术后随机分为3组,A组PCI术后不服用曲美他嗪;B、C组PCI术后分别口服曲美他嗪6、12个月。观察各组患者糖化血红蛋白、肌酐清除率、超声心动图变化。结果与A组比较,B、C组肾功能未见恶化;糖化血红蛋白控制良好;心功能各项指标恢复较好。提示合并糖尿病的AMI患者PCI术后长期服用曲美他嗪安全有效。

Objective To investigate the therapeutic effect and side effects of long-term therapy of trimetazidine after PCI in acute myocardial infarction(AMI)patients accompanied by chronic renal dysfunction.Methods Forty newly AMI patients with chronic renal dysfunction were assigned into 2 groups after PCI randomly,and the ages,sexes,complications and heart functions were well matched.In control group(n=30),patients didn't take trimetazidine after PCI;in treatment group(n=30),trimetazidine was taken for 12 months.All patients accepted the same coronary secondary preventive treatment.Creatinine clearance rate,24 h urine protein quantity and echocardiography were evaluated 12 months after PCI.Results Compared with control group,trimetazidine couldn't aggravate renal dysfunction and increase 24 h urine protein quantity(P>0.05),while the heart function was reserved better in treatment group(P<0.05).Conclusion Long-term therapy of trimetazidine after PCI is safe and effective in AMI patients with chronic renal dysfunction.Longer treatment results in better heart function.