目的:探讨微伏极T波电交替(MTWA)是否有助于选择预防性植入心脏复律除颤器(ICD)的慢性心力衰竭(心衰)患者,尤其是否有助于排除从ICD治疗中获益较少的低危患者.方法:入选左室射血分数(LVEF)≤35％并且无持续性室性心律失常的39例缺血性或非缺血性心肌病患者,所有患者用动态心电图时域分析法检测MTWA最大值.V3导联电压＞47 μV为阳性,电压≤47 μV为阴性.MTWA测定后所有心衰患者植入ICD进行一级预防.术后1、3、6个月各随访1次,以后每6个月随访1次.主要终点为全因死亡或非致死性持续性室性心律失常.结果:有19例患者(48.7％) MTWA检查结果为阳性.在(20±4)个月的随访期内,MTWA阳性组发生13例终点事件(1例死亡和12例非致死性持续性室性心律失常),MTWA阴性组发生1例终点事件(1例非致死性持续性室性心律失常).MTWA阳性预测价值为68.4％,阴性预测价值为95％.结论:对于LVEF≤35％且无持续性室性心律失常的缺血性或非缺血性心肌病患者,MTWA不仅有助于选择预防性植入心脏ICD的高危患者,而且有助于确定从预防性ICD植入中获益较少的低危患者.

目的:观察止痛汤对急性痛风的疗效,分析其结果,为临床治疗提供依据.方法:随机选取我院1993-2002年收治的急性痛风患者244例,将其分为治疗组(自拟止痛汤治疗组)148例和对照组(常规秋水仙碱治疗组)96例,治疗一疗程后对比分析其疗效.结果:治疗组总有效率为97.3％,明显高于对照组患者的79.6％.结论:自拟止痛汤治疗急性痛风针对性强,能有效缓解痛风的急性发作,疗效确切,无明显毒副反应,且效果优于秋水仙碱治疗急性痛风,值得临床推荐.

目的 探讨老年高血压患者血尿酸水平与颈动脉内-中膜厚度及左室重构的相关性.方法 检测患者血尿酸、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、甘油三酯(TG)、胆固醇(TC)水平,测定颈动脉内-中膜厚度及左室质量指数,按颈动脉内-中膜厚度分正常组、增厚组、斑块组,按左室质量指数分正常组与增高组,比较各组尿酸水平及其他指标.结果 颈动脉内-中膜厚度正常组、增厚组、斑块组患者TG、TC、HDL、LDL比较,组间差异无显著性(P＞0.05)；颈动脉内-中膜增厚组平均尿酸水平明显高于正常组(t=4.03,P＜0.05)；斑块组平均尿酸水平明显高于颈动脉内-中膜增厚组(t=2.98,P ＜0.05).左室质量指数正常组与增高组TG、TC、HDL、LDL无明显差异(P＞0.05)；左室质量指数正常组血尿酸水平明显高于正常组(=5.78,P＜0.05).结论 老年高血压患者血尿酸水平与颈动脉内-中膜厚度及左室重构密切相关.

目的 观察阿托伐他汀在急性冠脉综合征患者抗炎中的应用效果.方法 选择我院2011年4月-2012年5月收治的80例急性冠脉综合征患者,随机分为观察组和对照组,每组各40例.观察组患者应用阿托伐他汀10mg/d进行抗炎治疗;对照组患者采用常规治疗方法.两组患者入院24h内和1周后分别测定其总胆固醇(TC)、高敏C-反应蛋白(hs-CRP)和血清白介素-6(IL-6)水平.结果 1周后测定结果显示观察组患者总胆固醇、高敏C-反应蛋白和血清白介素-6水平均有明显下降,与对照组比较差异有统计学意义(P＜0.05).结论 阿托伐他汀能够降低急性冠脉综合征患者的血脂、高敏C-反应蛋白和血清白介素-6水平,减轻患者的炎症反应,有效改善患者的预后.

Objective To evaluate the clinical effects and critical reasons of cardiac resynehronization therapy( CRT) in patients with chronic heart failure( CHF) and coexistent persistent atrial fibrillation( AF). Methods A total of 26 patients were included in the study. All patients were on an optimal medical heart failure regime and CRT therapy. 16 with chronic AF were on CRT and pharmacological blockade of atrioventricular conduction( pharmacological group),10 with chronic AF underwent CRT and AV nodal ablation( AVNA group). All patients were followed up for 1. 2 ± 0. 2 years after the procedure. The changes of clinical parameter( NYHA class,6-min walk test),QRS width,left ventricular ejection fraction( LVEF) and left ventricular end-diastolic dimension( LVEDD) were observed. Results In patients with chronic AF were pharmacological blockade of atrioventricular conduction and CRT therapy,NYHA class improved( 2. 0 ± 0. 1 vs 3. 0 ± 0. 2),6-min walk test increased( 418. 9 ± 81. 3 m vs 311. 5 ± 65. 2 m),QRS width decreased( 138. 1 ± 5. 6 ms vs 169. 6 ± 4. 4 ms),LVEF increased( 0. 40 ± 0. 01 vs 0. 23 ± 0. 01) and LVEDD decreased( 61. 9 ± 1. 6 mm vs 69. 0 ± 1. 2 mm),which showed the clinical effects no significant difference between pharmacological and AVNA group. Conclusion In CHF patients and coexistent persistent AF,CRT therapy and pharmacological blockade of atrioventricular conduction can improve clinical effects as in those with AVNA patients. The key factors influencing the response of CRT in this group is optimized medication to control ventricular rate and high percentage of biventricular pacing.

目的:探讨黛力新与降压联合应用对高血压伴焦虑、抑郁患者降压疗效和生活质量的影响及其临床疗效与安全性。方法:以随机数字表法将2011年1月-2012年6月笔者所在医院收治的172例高血压伴焦虑、抑郁患者分为观察组与对照组,每组86例。对照组予以降压治疗,观察组在对照组的基础上予以黛力新1片,口服,每日1次。两组患者均有规律地治疗12周,治疗前后分别检测172例患者的血压、焦虑和抑郁症状,以及生活质量相关指标。结果:治疗后,两组患者血压和焦虑程度均较治疗前降低,且生活质量有所改善。观察组与对照组的降压总有效率分别为93.02%、76.74%。观察组治疗后,93.02%的患者血压平稳,焦虑得到有效缓解,其他指征未见显著性变化。治疗过程中,所有患者均未见明显的副作用。结论:黛力新与降压联合应用对高血压伴焦虑、抑郁患者的降压疗效显著,改善了患者的焦虑和抑郁状态,提高患者生活质量,明显优于单纯的降压治疗,且未见明显的副作用,值得在临床诊疗中推广应用。

目的 探讨老年心衰患者脑尿钠肽(BNP)监测对β1受体阻滞剂合理使用的指导意义.方法 将50例心衰患者随机分为对照组和观察组,对照组根据患者临床体征及症状表现,评估患者病情,制订治疗方案,考虑琥珀酸美托洛尔缓释片的使用时间、剂量；观察组根据患者BNP水平变化,控制美托洛尔使用时间、使用剂量.观察两组美托洛尔的使用时间及平均每天使用剂量、心衰复发、病死情况.结果 观察组美托洛尔启用时间[(6.7±2.4)d]明显小于对照组[(8.1±1.8)d](t=2.33,P=0.006),美托洛尔平均用量[(33.3±8.1)mg/d]明显大于对照组[(28.5±7.3) mg/d](=2.20,P =0.008).观察组心衰复发率12.0％、病死率8.0％,对照组的心衰复发率为20.0％、病死率为4.0％,两组的心衰复发率及病死率均无明显差异(P＞0.05).结论 老年心衰患者BNP监测对β1受体阻滞剂合理使用的指导作用较大,有利于短期β1受体阻滞剂及时、有效、剂量准确地使用,值得在老年性心衰治疗中更广泛地应用.

Objective The aim of the study was to explore whether the microvolt T-wave alternans (MTWA) can predict the life-threatening tachyarrhythmia after early acute myocardial infarction (AMI).Methods Two hundred and fifty-seven subjects were enrolled in present study. One hundred and seventy-fiye consecutive patients with ST-elevation AMI within 7 days, of which 68 received primary percutaneous coronary intervention (PCI) as la group and 107 without PCI as lb group. Eighty-two persons without MI were enrolled as the control group. The MTWA was analyzed using the modified moving average method by 24 h digital ambulatory electrocardiogram. Left ventricular ejection fraction (LVEF) was evaluated by echocardiography. Late potentials (LP) were analyzed by signal averaged electrocardiogram. The primary outcome was ventricular tachyarrhythmia/ ventricular fibrillation (VT/VF) during the hospital. These indexes were compared among the three groups and the predictors of VT/VF were evaluated by Logistic regression. Results The patients with diabetes in AM1 group were more than in lb group,and lb group were more in the control group. The MTWA,positive LP and VT/VF evidence in AMI group were higher than in the control group,and in lb group were higher than in Ⅰa group too;while the LVEF in AMI group was lower than in the control group and that in Ⅰb group was lower than in Ⅰa group too. Multivariate analysis identified the following as independent correlates of VT/VF:MTWA, LVEF, LP and diabetes. Correlation R was 0. 34、0. 29、0. 21 and 0. 13 respectively, and odds ratio was 2. 82、1.55、1, 36 and 0. 87 respectively. The best correlation and odds ratio was the MTWA. Coefficient of determination R2 was 0. 448 when the LVEF and LP went into regression ,whereas that was 0. 628 when The MTWA, LVEF and LP went into regression. Conclusions The MTWA, LVEF and LP were the predictors of VT/VFin patients with early AMI, and the prognostic value of the MTWA was better than that of the LVEF and LP. The better predictive value was obtained if the MTWA, LVEF and LP were combined.

Objective To investigate methods of isolating Spraque-Dawley rat ventricular myocytes and assaying cytosolic calcium. Methods Calcium-tolerant ventricular myocyte was obtained by three-step retrograde perfusation, and cytosolic calcium concentrations were assayed by fluorescent probe Furo-2/AM. Results If the whole heart remained red in the process of isolation, the numbers of total cell and calcium-tolerant cell were more than 90 percent and about 70 percent respectively. The numbers of total cell and calcium-tolerant cell in local red parts were more than 80 percent and about 60 percent respectively, however, there were a great varieties in numbers in pale parts, which were generally less than 50 percent and calcium-tolerant cells were less. If the whole heart remained pale in the process of isolation, the numbers of total cell were less than 30 percent and almost no calcium-tolerant cells. Cytosolic calcium concentrations were accurately assayed by fluorescent probe Fura-2/AM. Conclusion If this method is adopted strictly in the process of isolation,Not only a large number of calcium-tolerant cells can be obtained, but also cytosolic calcium concentrations can be accurately assayed.

Objective To investigate the effect of smoking on large arterial stiffness in patients with essential hypertensive.Methods The aortic,carotid and brachial arterial dimension,intimal-medial thickness were determined by vascular ultrasound technique.Wall cross sectional area and indices of compliance and distensibility were calculated in essential hypertensive patients with smoking(n=75) or without smoking(n=70).Results Hypertensive patients with smoking have increased wall intimal-medial thickness and wall cross sectional area in aortic,carotid and brachial arteries associated with decreased compliance and distensibility.After adjusting for the confounding effects of other variables including Age,BMI,HR,BP,PP,FPG,LDL-C and TG,covariance analysis show smoking remained as predisposed factors for vascular remodeling.Conclusion Smoking aggravates large arterial stiffness in essential hypertensive patients.

<正>心尖肥厚型心肌病(AHCM)是肥厚型心肌病的一种特殊类型,心肌肥厚主要局限于左室乳头肌以下的心尖部。该病最早由日本学者报道[1]。近年来随着临床经验积累及影像学的发展,我国对该病报道日渐增多,但因心尖肥厚型心肌病临床症状不典型以及心电图的非特异性改变,极易误

Objective To investigate the effect of 24 h mean pule pressure on left ventricular remodeling of essential hypertensive patients.Methods 207 essential hypertensive patients were divided into two groups according to 24 h mean pule pressure≥60 mm Hg,or60 mm Hg by ambulatory blood pressure monitoring.LVDd,IVSd,LVPWd,LVMI and EF were measured by ultrasound technique in 207 essential hypertensive patients.After adjusting for the confounding effect of MSBP and MDBP by analysis of covariance,the difference of indices of left ventricular remodeling were compared between the two groups.Results The LVDd,IVSd,LVPWd and LVMI are more in the group of 24 h MPP≥60 mm Hg than one of MPP60 mm Hg(P0.05).The statistical significance remained after adjusting for the confounding effects of MSBP and MDBP which may affect on LV remodeling(P0.05).Conclusion 24 h MPP is one of important factors causing LV remodeling.

临床中常遇到"痛风"、"肩周炎"、"风湿病"患者,以局部及肢体或关节疼痛为主要症状来诊,在中医辨证基础上,加入薏苡仁50～100g对止痛能起到很好疗效.兹举例说明.

本文应用放射免疫分析(RIA)与电化学发光分析法(ECLIA)测定了86例CEA浓度,对比其各自的优势,现报道如下.

1临床资料 患者女性,54岁.因反复上腹部疼痛2年,加重2d入院.查体:BP 170/108mmHg.

目的用99mTc-MIBI显像对甲状腺包块进行定性分析并与病理结果进行分析.方法颈部包块168例,全部病例均行常规高锝酸钠显像,若不显影,再行99mTc-MIBI显像.结果凡99mTc-MIBI显像原包块部位显影度增高者为高代谢性(热结节).凡是冷结节而99mTc-MIBI显像为高代谢的癌变发生率更高(39/168例,占23.2%).结论99mTc-MIBI显像对颈部结节的性质确定具有较高的准确性,尤其是对甲癌的定位比过去单纯的常规显像的阳性率大大提高.

过敏性紫癜是一种常见的血管变态反应性出血疾病,多由食物、药物、物理及化学、生物等物质刺激机体致皮肤紫癜并伴有不同程度的水肿、关节炎和胃肠道、眼及肾脏出血[1].根据临床表现可将其分为单纯皮肤紫癜型、关节炎型、肠胃型、眼型、肾型和混合型.1999年10月～2002年8月,笔者采用桃红四物汤合失笑散加味治疗过敏性紫癜51例,取得了较好疗效,现报道如下.

为了探讨弥漫性甲状腺肿并甲状腺功能亢进(Graves病)患者在131I治疗前后血清促甲状腺受体抗体(TRAb)的变化,我们采用放射受体分析法(RRA)对接受131I治疗后不同阶段的Graves病患者作血清TRAb测定,以观察其变化情况及临床价值.

热痹是临床上痹证中的常见病,采用四妙散加味治疗58例,疗效尚满意,现总结如下.

在十多年的临床工作中,每遇慢性支气管炎(慢支炎)和支气管哮喘久病者,虽根据临床表现来辨证施治,风寒客表者用小青龙汤加减,风寒外束,痰热内蕴定喘汤,脾肺虚寒,痰饮内停者久咳保肺合剂(我省省中医院验方)等等之加减治疗,虽治疗已有一百多例,但觉临床症状改善较缓,舌暗夹青,舌下脉络紫暗,变化不明显.