目的 探讨QTc间期预测阵发性心房颤动伴2型糖尿病病人导管消融预后的临床研究.方法 选自2017年1月—2018年6月首次进行心房颤动导管射频消融术的2型糖尿病合并心房颤动病人39例,所有病人均行心房颤动导管消融,根据其病症是否复发分为复发组和未复发组.应用12导联心电图机,同步记录术前12导联常规体表心电图;术后观察病人有无心房颤动、心房扑动等症状性房性快速心律失常发作,并进行相关心电图检查;检测病人生化指标及血液学指标,分析其相关性;分析2型糖尿病合并心房颤动病人导管消融术后心房颤动复发的QTc分布,多因素Logistic逐步回归分析及Cox多元回归分析.结果 阵发性心房颤动伴2型糖尿病病人导管消融术后复发25例,未复发14例,且复发组年龄较未复发组偏大,阵发性心房颤动次数多于未复发组.两组空腹血糖、三酰甘油、低密度脂蛋白胆固醇和丙氨酸氨基转移酶比较,差异有统计学意义(P<0.05);复发组和未复发组血小板和活化部分凝血活酶时间比较,差异有统计学意义(P<0.05).血液学指标和生化指标与阵发性心房颤动伴2型糖尿病病人导管消融预后临床复发存在相关性.结论 QTc间期与阵发性心房颤动伴2型糖尿病病人导管消融预后存在相关性,QTc间期可能预测阵发性心房颤动伴2型糖尿病病人导管消融预后,可能是今后临床有效的检查及治疗手段.

Objective :To explore influence of Tongxinluo capsule ,Shuxuetong injection combined carvedilol on ECG , serum levels of matrix metalloproteinase (MMP)‐9 and P‐selectin in patients with unstable angina pectoris (UAP). Methods :A total of 105 UAP patients were randomly divided into routine treatment group (n＝52) and combined treatment group (n＝53 ,received Tongxinluo capsule ,Shuxuetong injection and carvedilol based on routine treat‐ment group) ,both groups were continuously treated for one month .LVEF ,cardiac output (CO) ,serum levels of MMP‐9 and P‐selectin , therapeutic effects of ECG and angina pectoris , and incidence of adverse reactions were measured and compared between two groups before and after treatment .Results :Compared with routine treatment group , there were significant rise in total effective rates of ECG (59. 62% vs.79. 25%) and angina pectoris (71.15% vs.90.57%) in combined treatment group , P＜0. 05 both .Compared with routine treatment group after one‐month treatment ,there were significant rise in LVEF [ (45.30 ± 5.60 )% vs.(59. 33 ± 5. 31 )%] and CO [ (3.15 ± 1.14) L／min vs .(4. 92 ± 1. 18) L／min] ,and significant reductions in serum levels of P‐selectin [ (25. 40 ± 2.34) ng／ml vs.(16.85 ± 1. 62) ng／ml] and MMP‐9 [ (37. 30 ± 8. 91) μg／L vs.(27.80 ± 8.63) μg／L] in com‐bined treatment group , P＝0. 001 all.There was no significant difference in incidence of adverse reactions between two groups , P＝0.334. Conclusion :Tongxinluo capsule ,Shuxuetong injection combined carvedilol possess significant therapeutic effect on UAP patients .They can significantly improve cardiac function ,serum levels of P‐selectin and MMP‐9 with satisfying safety ,which is worth extending .

Objective To investigate the changes of B-type brain natriuretic peptide (BNP), high-sensitivity C-reactive protein (hs-CRP), troponin (cTnI) in peripheral blood of children with heart failure and their correlation with disease and prognosis. Methods A total of 103 cases of hospitalized children with heart failure, who admitted to De-partment of Pediatrics in our hospital from January 2014 to September 2016, were selected and divided into the mild group (n=24), moderate group (n=41) and severe group (n=38) according to modified Ross score. The peripheral blood BNP, hs-CRP, cTnI levels were detected immediately on admission and after 5 d of the treatment. Using the improved Ross score as a reference, Pearson correlation analysis was used to analyze its correlation with disease severity. Of the 103 children, 92 were alive, 11 were dead, and the correlation of the BNP, hs-CRP, cTnI to prognosis were analyzed by Pearson correlation analysis. Results There was significant difference between the mild, moderate, and severe group in the levels of BNP, hs-CRP and cTnI on admission (P<0.05). At the fifth day of treatment, the levels of BNP, hs-CRP and cTnI in the severe group were significantly higher than those in mild group and moderate group;the level of BNP in the moderate group was significant higher than that in the mild group (P<0.05);there was no significant difference between the mild and moderate group in the levels of hs-CRP and cTnI (P>0.05). The survival rate of the children in the mild group was 100.00%, 90.24% in the moderate group, 81.58% in the severe group, and the difference in survival rates were statistically significant (P<0.05). At the fifth day of treatment, the levels of BNP, the hs-CRP, and cTnI in the dead children of the severe group were significantly higher than those in the children who were alive (P<0.05);there was no significant difference between the dead children of the mild, moderate and servere group in the levels of BNP, hs-CRP, and cTnI (P>0.05). The levels of BNP, hs-CRP and cTnI in patients with heart failure were positively correlated with the severity of the disease (r=0.747, 0.562, 0.381), and negatively correlated with prognosis (r=-0.817,-0.741,-0.776). Conclusion The levels of peripheral blood BNP, hs-CRP, cTnI were positively correlated with the severity of the dis-ease in children with heart failure, and negatively correlated with the prognosis, which can be used as a secondary indica-tor for diagnosis and treatment.

目的:探讨替罗非班对急性ST段抬高型心肌梗死(STEMI)诊经皮冠状动脉介入(PCI)治疗后,患者心肌生化标志物及心功能的影响.方法:104例STEMI患者随机分为观察组与对照组,每组52例,均给予急诊经皮冠状动脉介入术(PCI)治疗,术后对照组给予常规治疗,观察组在对照组基础上加用替罗非班治疗,对比两组患者治疗后血小板聚集率、血清肌酸激酶同工酶(CK-MB)水平、肌钙蛋白Ⅰ水平、心肌梗死溶栓治疗(TIMI)分级、心电图ST段回落情况、左室射血分数(LVEF)、不良心血管事件(MACE)发生率.结果:治疗后两组患者CK-MB水平、肌钙蛋白Ⅰ水平及血小板聚集率、TIMI分级、LVEF均显著优于治疗前,观察组显著优于对照组(P＜0.01);观察组治疗后ST段回落幅度显著优于对照组(P＜0.01),治疗后MACE发生率显著低于对照组(P＜0.05).结论:替罗非班可能能够通过抑制血小板聚集,有效改善PCI术后患者心肌生化指标及心功能.