<正>病例:女,48岁。因"反复活动后气促1个半月余"收治入我院。患者自入院前1个月余起,在无明显诱因下出现活动后气促,行走等轻微活动即可诱发,并伴有心悸、低热等症状。患者无胸闷、胸痛、咳嗽、咳痰等,夜间可平卧睡眠,亦

To identify the disease-causing gene for a large multi-generational Chinese family affected by familial hypertrophic cardiomyopathy (FHCM), genome-wide screening was carried out in a Chinese family with FHCM using micro-satellite markers, and linkage analysis was performed using the MLINK program. The disease locus was mapped to 1q32 in this family. Screening for a mutation in the cardiac troponin T (cTnT) gene was performed by a PCR and sequencing was done with an ABI Prism 3700 sequencer. A novel C-->G transition located in the ninth exon of the cTnT gene, leading to a predicted amino acid residue change from Ile to Met at codon 90, was identified in all individuals with hypertrophic cardiomyopathy (HCM). The results presented here strongly suggest that Ile90Met, a novel mutation in the cTnT gene, is causative agent of HCM in this family.

Objective:To observe long term prognostic value of N-terminal pro-brain natriuretic peptide(NT-proBNP)in the acute coronary syndrome(ACS)patients.Method:Eighty-five patients were enrolled in this study,all of these patients had ACS within 24 hours,they were divided into three groups(ST-elevation AMI,nonST-elevation AMI and unstable angina).All patients hadn't heart failure history.NT-proBNP and high sensitive C reactive protein(hs-CRP)were examined at 0 h,24 h and 1week after admission in all cases,and echocardiagram was also examined during the 7th to 10th day of the hospitalization.Result:NT-proBNP concentrations were high in all ACS patients,it increased rapidly to peak at 24 h.During 1 year follow up,5(5.9%),15(17.6%)and 9(10.6%)patients suffered death,all cause cardiovascular hospitalization and heart failure hospitalization respectively.In multivariate analysis,the independent predictors of late cardiac death were peak hs-CRP,peak NT-proBNP,CK-MB,LVEF and severe arrythmia.But only peak NT-proBNP and LVEF were the independent predictors of late heart failure.Conclusion:NT-proBNP was a strong independent predictor for ACS,and its prognostic value maybe better than hs-CRP.

Objective To observe the N-terminal pro-brain natriuretic peptide(NT-proBNP)level in acute coronary syndrome patients with different status.Methods 52 patients enrolled in this study had acute coronary syndrome within 24 hours after onset were divided into three groups(ST-elevation AMI,Non ST-elevation AMI and unstable angina).Another 10 stable angina patients constituted SAP group.All patients had no history of heart failure.NT-proBNP and highly sensitive C reactive protein were determined at 0 h,24 h and 1 week after ad- mission,and echocardiogram was also performed during the 7th to 10th day of hospitalization.Results NT-proB- NP level was high in all acute myocardial infarction patients,it increased rapidly to the peak at 24 h.High NT- proBNP level was also demonstrated in 80% unstable angina patients and 20% stable angina patients.In AMI pa- tients without emergency pereutaneous coronary interventional(PCI)therapy,the peak NT-proBNP level was posi- tively correlated with peak creatine kinase(CK)and peak creatine kinase MB(CK-MB) which reflected the infarcted area (CK:r=0.511,P=0.002;CK-MB:r=0.528,P=0.002),but was not correlated with left ventricular ejection fraction,left ventricular diastolic terminal and atrial diameters which reflected heart function in all AMI ca- ses,and it also had no correlationship with Gensini scoring which reflected the severity of coronary artery disease. The NT-proBNP level was higher in KillipⅡAMI patients than in KillipⅠpatients(P＜0.01).After one week, the NT-proBNP level decreased more quickly in emergency PCI patients than that in the other acute myocardial in- farction patients,and the peak blood NT-proBNP/peak CK-MB ratio of emergency PCI patients was also lower than that in the others.Conclusion Increment of plasma NT-proBNP level is a reaction of ischemic myocardial cells in acute coronary syndrome,and it is correlated with the infarct area.But NT-proBNP level is much higher in heart failure complicating AMI patients.(Shanghai Med J,2006,29..621-624)

ObjectiveTo investigatethe therapeutic efficacy and safety of domestic nifedipine GITS(XINRAN GITS)in treatment of essential hypertension.MethodsThis was multi-center, randomized, open-label, parallel-group comparative study.After a two-week wash-out phase, eligible patients were randomized to receive either XINRAN GITS(n=60) orADALAT GITS(nefidepine GITS made in Germany, n=60) 30 mg once daily for 6 weeks.Results(1) Both XINRAN GITS and ADALAT GITS caused significant falls in systolic (SBP) and diastolic blood pressure(DBP) by average (18.3±1.7/ 12.2±1.1)mm Hg(SBP P0.001;DBP P0.001)and (24.8±2.2/15.1±1.1)mm Hg(SBP P0.001;DBP P0.001), respectively.(2) The resoinse rate XINRAN GITS group was 90.8%, and in ADALAT GITS group was 91.5%(P0.05).(3) Heart rate remained unchanged in two groups.(4) The adverse effects in both group were very mild.ConclusionXINRAN GITS is effective and safe in treatment of essential hypertension.

目的:观察冠心病患者应用雷帕霉素洗脱支架与紫杉醇洗脱支架后临床不良心血管事件的发生率.方法:本研究为随机开放平行对照研究,共入选患者168例,雷帕霉素支架组83例,紫杉醇支架组85例.两组患者在年龄,性别组成,吸烟比例,糖尿病比例,血压水平,总胆固醇水平,冠状动脉病变支数,冠状动脉病变积分(Gensini法),左心室射血分数均无统计学上的差异.术后严格要求患者服用阿司匹林和噻氯匹定或氯比格雷9个月.通过门诊或电话随访术后患者临床不良心血管事件的发生率,部分患者进行了冠状动脉造影复查.结果:平均随访10.6个月,失访患者3例(包括2例雷帕霉素支架组患者与1例紫杉醇支架组患者),失访率为1.79%.在随访的81例雷帕霉素支架组共7例(8.64%)发生了临床不良心血管事件.在随访到的84例紫杉醇支架组8例(9.52%)患者发生了不良心血管事件.以上2组患者不良心血管事件发生率差异无统计学意义(卡方检验P>0.05).雷帕霉素支架组冠状动脉造影再狭窄率为20%(3/15),紫杉醇支架组冠状动脉造影再狭窄率为25%(6/24),两组之间无统计学差异(P>0.05).结论:短期临床随访结果表明,冠心病患者应用雷帕霉素洗脱支架与紫杉醇洗脱支架临床心血管事件的发生率较低,两组无统计学差异.冠状动脉造影复查两组再狭窄率无统计学差异.

Obiective:To observe changes of plasma soluble P-selectin, TNF-α and IL-6 in patientswith acute myocardial infarction (AMI) and effects of early reperfusion therapy on them. Method:The plasma sP-selectin, TNF-α and IL-6 were measured at the time of 6, 12, 24, 48, 72 hours afterAMI onset in 26 patients admitted within 6 hours after symptom onset. All patients were given antithrombus and successful reperfusion therapy at the time of admission . And the concentration of those in 21 patients with stable angina pectoris and 20 normal controls demonstrated by coronary angiography were also measured. Result:①The level of sP-selectin was higher significantly within 6 hours of symptom onset in patients with AMI than those in patients with stable angina and controls [ (177.6±20.1)μg/L vs (75.4±6.8) μg/L vs (67.9±7.7) μg/L , P 0.01]. The levels of sP-selectin reached their peak after 12 hours of symptoms onset (4 hours after reperfusion therapy successfully) in patients with AMI [(226.2±33.6) μg/L ,P 0.01], and decreased significantly at 24 hours of symptoms onset, but still higher than that in controls (P 0.05). There was no difference between the levels of sP-selectin at 48 and 72 hours of symptoms onset in AMI patients and those in controls. ②The TNF-α and IL-6 increased at 6 hours, climaxed at 24 hours, and were still high at 72 hours after the symptoms onset in patients with AMI. ③The levels of sP-selectin was correlated significantly with those of TNF-α and IL-6 at 6 hours of symptoms onset in AMI patients (r=0.74,P 0.01;r=0.68,P 0.01). Conclusion:sP-selectin increase significantly after 6 hours of symptoms onset in patients with AMI. Levels of sP-selectin reach their peak soon after early antithrombus and reperfusion therapy and decreaes significantly at 24 hours of AMI onset. But early reperfusion therapy do not affect TNF-α and IL-6.

运动可分为耐力或动力性(dynamic)和力量或静力性(static)两种,前者包括马拉松、滑雪等,其特点是运动强度小,有氧供能,骨骼肌长度发生变化,而肌张力相对变化小;后者包括举重、投掷等,具有运动强度大、无氧供能的特点,其骨骼肌张力显著升高,而肌长度不变.有些运动项目则兼有上述两种特点,如划船等.本文重点概述不同运动项目对运动员心脏的生理学、形态学、内分泌的影响,以及运动员心脏的临床特征.

探讨水飞蓟宾对兔球囊血管损伤后内膜增生的影响.将新西兰大白兔随机分为对照组(n=6)、小剂量水飞蓟宾组[n=8, 20 mg/(kg*d)]、大剂量水飞蓟宾组[n=8, 40 mg/(kg*d)].用球囊导管对实验兔行髂动脉损伤,用药组于术前3 d分别用小剂量及大剂量水飞蓟宾,术后28 d取病变血管染色并免疫组织化学检查,以计算机图像分析系统分析血管内膜、中膜厚度和腔面积的变化,计算内膜增生细胞核抗原增殖指数.结果发现,小剂量水飞蓟宾对血管内膜和中膜厚度、腔面积、内膜增生细胞核抗原阳性细胞百分比无明显影响(P>0.05);大剂量水飞蓟宾使腔面积扩大、内膜厚度减少、内膜增生细胞核抗原阳性细胞百分比减少(P<0.05).提示水飞蓟宾能抑制血管内膜增生,有可能用于防治再狭窄.

人体利钠素系统包括脑钠素(BNP)、心钠素(ANP)和C型利钠素(CNP),BNP主要由心室分泌,对心室功能的变化更具敏感性和特异性.国外已有多项研究证实BNP与心力衰竭的关系极为密切,其浓度与心力衰竭的严重程度呈正相关[1-3].成熟BNP(BNP-32)是由高分子前体(pro-BNP)转化而来,有资料显示心功能受损时,氨基末端脑钠素前体(NT-proBNP)增高的比例及绝对值超过BNP-32.因此,作为早期心功能损害的标志物,NT-proBNP可能更为敏感[4].本研究通过测定不同程度心力衰竭患者的NT-proBNP水平,研究其对心力衰竭的诊断价值及对心功能状况的评估作用.

报道1例心脏血管肉瘤伴房室阻滞(AVB).男性,43岁,多次因头昏、心悸而就诊,ECG检查示AVB逐渐由Ⅰ度演变至Ⅲ度.安装起搏器3周后出现发热,抗炎治疗无效,超声心动图发现右房肿块,开胸探查明确诊断为心脏血管肉瘤.结论:AVB病例若发现右房肿块需考虑心脏恶性肿瘤的可能.

AIM: To discuss the effect of carvedilol on DNA synthesis in vascular smooth muscle cells(VSMC) and its possible mechanism. METHODS: Rat aortic VSMC model was established in vitro,[ 3H]TDR incorporation technique was used to detect the effect of carvedilol on proliferation in VSMC induced by reactive oxygen species(ROS), angiotensin Ⅱ(Ang Ⅱ) and fetal calf serum(FCS). RESULTS: Carvedilol showed a dose dependent inhibition on DNA synthesis induced by ROS, Ang Ⅱ and FCS, the maximal inhibition rate was (48±15) %,(42±7) % and (44±14) %, respectively. CONCLUSION: The inhibition on DNA synthesis induced by ROS and Ang Ⅱ shows that carvedilol has an antiproliferative action which is probably relative to its antioxidate feature.

<正> 不稳定心绞痛的发生机制是冠状动脉粥样斑块破裂,血小板粘附、活化及集聚,血栓形成,冠状动脉痉挛,冠状动脉管腔不完全性阻塞。因此,寻找有力的抗凝、抗血小板药物以期阻断正在进展的及其血栓形成所致的急性心肌梗死(AMI)过程是当前研究不稳定心绞痛治疗的正确方向。在联合用药中,低分子肝素愈

心肌肌钙蛋白作为心肌损伤时的一种高敏感度和特异性的无创检测指标,可以为临床提供大量的诊断和预后信息.