目的 探讨老年原发性高血压患者血压变异性与颈动脉粥样硬化的关系.方法 选择2019年1—12月在首都医科大学附属北京朝阳医院心内科门诊就诊的年龄≥60岁的原发性高血压患者140例.所有患者均行颈动脉超声检查、24h动态血压监测以及生化指标检测.根据颈动脉超声结果分为颈动脉粥样硬化组(49例)和颈动脉正常组(91例),比较分析两组的24h动态血压监测以及生化指标检测结果.结果 与颈动脉正常组相比,颈动脉粥样硬化组患者的夜晚收缩压、夜晚舒张压、24h收缩压标准差、24h舒张压标准差、白天收缩压标准差、夜晚收缩压标准差、夜晚舒张压标准差及颈动脉内膜中层厚度均显著增高,差异有显著性(P<0.05或P<0.01).以颈动脉内膜中层厚度为因变量,采用多重线性回归进行相关因素的分析,结果显示颈动脉内膜中层厚度与24h收缩压标准差、白天收缩压标准差、白天舒张压标准差、夜晚收缩压标准差呈正相关(均P<0.05).结论 老年原发性高血压患者的血压变异性,尤其是收缩压标准差与颈动脉粥样硬化的形成密切相关.

目的 探讨慢性心力衰竭患者长期死亡率及其影响因素.方法 纳入1998年9月至2000年3月于首都医科大学附属北京朝阳医院住院的慢性心力衰竭(射血分数≤45％)患者601例,所有患者出院后均进行门诊或电话随访,根据随访期间存活情况分为存活组与死亡组.根据随访期平均收缩压水平将患者分为四组,A组平均收缩压(systolic blood pressure,SBP)＜110mmHg, B组110mmHg≤SBP＜120mmHg,C组120mmHg≤SBP＜130mmHg,D组SBP≥130mmHg,记录并分析各组患者生存状态及死亡原因等.结果 601例慢性心力衰竭患者5年全因死亡率为46.1％,15年全因死亡率为74.7％.与死亡组比较,存活组患者年龄更大,男性比例更高,射血分数更低,左心室舒张末期内径更大,心功能NYHA分级更高,6分钟步行距离更短.扩张型心肌病患者5年全因死亡率显著高于冠状动脉粥样硬化性心脏病患者及高血压心脏病患者(分别为57.3％、40.4％、42.5％,P=0.003).C组患者5年全因死亡率最低(P＜0.05),不同血压组患者15年全因死亡率差异无显著性(P＞0.05).结论 心力衰竭的基础病因是影响心力衰竭患者5年死亡率的因素,扩张型心肌病患者5年死亡率高于冠心病心力衰竭及高血压心脏病心力衰竭患者.随访期间SBP维持在120～130mmHg的患者5年死亡率最低.

Objective This study was undertaken to evaluate vascular endothelial function and various influencing fac-tors in patients with coronary heart disease ( CHD ) by using the Endo-PAT2000 Noninvasive Diagnostic System. Method A total of 183 consecutive patients treated at the Department of Cardiology were enrolled. They were divided into a CHD group (n=126), no-CHD group (n=57). The reactive hyperemia index (RHI) was determined with the Endo-PAT2000 Noninvasive Diagnostic System. The reactive hyperemia index ( RHI) was used as a main indicator to assess the endothelial function of the patients with coronary heart disease. Multiple linear regression analysis was used to analyze the correlations between RHI and various influencing factors. Result The results of Endo-PAT test showed that mean RHI was (1. 58±0. 39)in patients with coronary heart disease, and it was (1. 70±0. 24) in the control group, there was significant difference between the two groups (P<0. 05). Multiple linear regression showed that RHI was correlated with smoking history, fasting blood glucose,hemoglobin A1c, and high-sensitivity C-reactive protein, RHI is also related to the number of risk factors for CHD (P<0. 05). Conclusion Endothelial function decreased in patients with coronary heart disease. Smoking, FBG, HbA1c, and hs-CRP are significantly associated with endothelial dysfunction. The endothelial dysfunction is also related to the number of risk factors for CHD.

目的：观察原发性高血压患者在平板运动试验过程中的血压变化,并分析运动性高血压的相关影响因素。方法610例行平板运动试验的心内科门诊患者,分为高血压组230例和非高血压组380例,观察患者在运动中出现运动性高血压的情况,并分析运动性高血压的相关影响因素。结果高血压组出现运动性高血压较非高血压组显著增高,差异有显著性(P<0.05)。多重线性回归分析显示,运动性高血压与吸烟、体质量指数、高血压、高血压家族史显著相关(β=-0.002,P=0.038；β=0.005,P=0.014；β=0.007,P=0.005；β=-0.009,P=0.045),差异有显著性(P<0.05)。结论原发性高血压患者出现运动性高血压明显高于非高血压患者,运动性高血压与吸烟、体质量指数、高血压病史及高血压家族史显著相关。

Background There is conflicting evidence regarding two different insulin regimens for acute myocardial infarction (AMI), one focusing on delivering insulin ('insulin focus', glucose-insulin-potassium (GIK)) and one focusing on tight glycaemic control ('glycaemia focus', insulin-glucose). A longstanding controversy has focused on which strategy provides the greatest reduction in mortality. The aim of this study was to perform a meta-analysis of randomised controlled trials (RCTs) comparing GIK or insulin-glucose therapy versus standard therapy for AMI in the reperfusion era.Methods A MEDLINE/EMBASE/CENTRAL search was conducted of RCTs evaluating GIK or insulin-glucose as adjunctive therapy for AMI. The primary endpoint was all-cause mortality. The data were analysed with a random effect model.Results A total of 11 studies (including 23 864 patients) were identified, eight evaluating insulin focus with GIK and three evaluating glycaemia focus with insulin-glucose. Overall, insulin focus with GIK was not associated with a statistically significant effect on mortality (RR 1.07, 95% CI 0.89 to 1.29, p=0.487). Before the use of reperfusion, GIK also had no clear impact on mortality (RR 0.92, 95% CI 0.70 to 1.20, p=0.522). Pooled data from the three studies evaluating glycaemia focus showed that insulin-glucose did not reduce mortality in the absence of glycaemia control in patients with AMI with diabetes (RR 1.07, 95% CI 0.85 to 1.36, p=0.547).Conclusions Current evidence suggests that GIK with insulin does not reduce mortality in patients with AMI. However, studies of glycaemia are inconclusive and it remains possible that glycaemic control is beneficial.

Background Postconditioning has been shown to reduce infarct size, ischemic/reperfusion injury and myocardial injury in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). This study tested the hypothesis that postconditioning attenuates the elevation of tumor necrosis factor-alpha (TNF-alpha) and improves heart function in patients with AMI after PCI.Methods A total of 75 patients were randomly assigned to 1 of 3 groups: the routine group (n=26), in which no intervention was given at the onset of reperfusion; and the Postcon-30s (n=25) or Postcon-60 s (n=24) groups, in which 3 cycles of 30- or 60-second balloon deflation and inflation were repetitively performed. TNF-alpha serum concentration was measured by ELISA. Global and regional left ventricular systolic function was determined by echocardiography at 1 year. Thirty-four normal controls (NC) were enrolled in the study.Results The TNF-alpha concentration in patients with AMI was significantly elevated at baseline compared to controls (P <0.01). Concentration levels increased in the routine and Postcon-30s, but not in Postcon-60s group at 7 days (P <0.05). As for linear associations among the three groups, left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) were ranked as follows: Postcon-60s >Postcon-30s>routine (P values all <0.05, 65% vs. 57% vs. 52% and 1.10 vs. 1.27 vs. 1.53) after 1 year. More importantly, there was a significant relevance between the soluble TNF-alpha serum concentration at 7 days and LVEF or WMSI after 1 year (P values all <0.0001).Conclusions Postconditioning, in particular Postcon-60s was associated with long-term cardioprotective effects for inhibition of the inflammatory response and reperfusion injury. The soluble TNF-alpha serum concentration provided powerful prognostic information of global and regional left ventricular systolic function in patients with AMI. Chin Med J 2010;123(14):1833-1839

目的 观察质子泵抑制剂、H2受体拮抗剂和胃黏膜保护剂对急性心肌梗死患者住院期间消化道出血(中低危人群)的预防作用.方法 将113例接受诊治的急性心肌梗死患者随机分为三组,均接受抗凝抗血小板治疗.同时分别接受奥美拉唑、法莫替丁、吉法酯治疗.结果 三组患者的基线水平、相关治疗、住CCU时间及出现消化道出血方面差异无显著性.结论在急性心肌梗死急性期应用胃黏膜保护剂可取得和质子泵抑制剂、H2受体拮抗剂同样预防消化道出血的效果.

<正>患者:女,25岁。入院前4d午后睡眠时出现胸痛,呈压榨样,伴牙痛及面色苍白,无胸闷,当时做心电图示:V1-V5ST段上抬0.05～0.8mv,含服硝酸异山梨酯(消心痛)5mg后2min症状缓解,复查心电图ST段回落。既往史:1年前因家庭装

目的:研究在非ST段抬高心肌梗死(NSTEMI)病人中伴或不伴ST段下降的临床特点和意义并行早期危险分层.方法:128 名 NSTEMI病人根据入院时心电图(FCG)相邻2个导联伴或不伴ST段下降分为2组:ST段下降＜1mm组(Ⅰ组)和ST段下降≥1mm组(Ⅱ组),分析比较2组间各种临床指标的差异及冠状动脉造影(CAG)的结果.结果:在两组间病人基本临床特点中,Ⅱ组病人的糖尿病发病率及血浆中心肌肌钙蛋白Ⅰ(cTNI)的峰值显著高于Ⅰ组[26/68 vs 13/60;(19.6±15.4)vs(11.6±6.9),P＜0.05];在CAG检查中,Ⅱ组病人中冠状动脉三支及左主干病变的比率显著高于Ⅰ组(26/44 vs 10/38,P＜0.005);心动超声检查左室功能(LVEF)Ⅱ组显著低于Ⅰ组[(51.9±10.5)vs(64.2±8.6),P＜0.05].结论:在NSTEMI病人中,ECG上伴有ST段下降≥1mm,表明多合并有糖尿病和冠状动脉多支血管病变,存在有心肌广泛及严重缺血,致心功能下降,预后不良.

Objective To study the clinical significance of increasing QRS duration in the absence of bundle block(BBB) on the presenting electrocardiogram of patients with non-ST elevation acute myocardial infarction(NSTEMI). Method Depending on the QRS duration, the 59 patients with NSTEMI were divided into the two groups: QRS≥100ms (36)and 100ms(23). The clinical characters, creatine kinase isozyme( CK-MB) and tropin( Tni) ,cardiac function and coronary angiogram(CAG)were determined and compared. Result In patients with QRS≥100ms were more likely to be elder(69±11.8 vs 61.8±13.1, P 0.05) and diabetes(15/23 vs 10/36, P 0.01) and be in Killip II,III or IV(8/23 vs 4/36, P 0.05), to higher peak value of CK-MB and Tni (60±49.5 vs 38.6±21.4;17.75±15.1 vs5.57±5.46, P 0.05),to have lower left ventricular ejection fraction(LVEF, 49.1±9.8 vs 56.2±6.2, P 0.05) and to have more 3-vessel and left main disease in CAG(10/12 vs 12/28, P 0.05) .Conclusion For the NSTEMI patients, QRS prolongation ≥100ms is associated with severe ischemia and multivessel coronary artery disease and left ventricular dysfunction, indicate patients of NSTEMI with QRS≥100ms have a poor prognosis.

目的通过对急性心肌梗死(AMI)患者血浆C反应蛋白进行观察,旨在探讨CRP浓度与临床指标的关系.方法选择首次发生AMI的患者87例,于入院当时及发病第2、3天抽血测量CRP浓度.记录住院期间是否发生心力衰竭、严重心律失常、梗死后心绞痛、死亡等事件.结果①AMI发病第2天CRP浓度(3.71±4.15)mg/dl达峰值.②梗死相关血管(IRA)开通组CRP峰值浓度(2.71±2.80)mg/dl明显低于血管未通组(4.93±5.13)mg/dl.③左室射血分数(LVEF)＞50%的患者CRP峰值浓度(2.21±2.18)mg/dl明显低于LVEF＜50%的患者(5.03±4.81)mg/dl.④有无心脏不良事件的患者CRP浓度无明显差异.结论AMI发病后CRP峰值浓度与IRA是否开通和左室收缩功能有关,是否提示心脏不良事件尚有待进一步研究.

目的研究心肌梗死(AMI)病人T波交替变异性(TWA)与心脏功能及其他因素的关系.方法对71名AMI病人进行TWA,TWA导联数目,左室射血功能(LVEF),磷酸肌酸激酶心肌同工酶(CK-MB)检测,同时对临床上恶性室性心律失常(室速,室颤)的发生进行观察.根据LVEF将病人分为二组;LVEF＜50%(Ⅰ组)和LVEF≥50%(Ⅱ组),比较二组各指标的差异.结果二组病人在LVEF有显著差异的情况下(43.1±5.6%vs63.1±8.2%,P＜0.05),Ⅰ组的TWA,TWA导联数目,CK-MB峰值及达到CK-MB峰值的时间均分别显著高于Ⅱ组(3.5±3.7vs1.7±2.7;11.9±9.2vs7.5±7.6;120.8±94.4IU/mlvs65.9±36.9IU/ml:17.3±7.5hvs12.6±3.3h,P＜0.05);同时临床上恶性心律失常事件的发生率Ⅰ组也显著高于Ⅱ组(24.1%vs7.1%,P＜0.05).结论AMI病人的TWA与LVEF及CK-MB的释放量有密切关系,TWA和LVEF均为预测室性心律失常的有力因子,表明AMI病人的LVEF越低,易形成TWA,引发恶性心律失常.

目的:观察急性心肌梗死(AMI)患者血清白细胞介素-6(IL 6)水平的动态变化及其与再灌注疗效的关系.方法:以酶联免疫法分别测定69例AMI患者距发病6、12、16、24、48及72h的IL-6血清水平,并与30例健康对照(NS)作对比.结果:①AMI患者血清IL-6水平在发病后72h内均高于NS组,以发病后6h最显著(1.27±1.99:0.22±0.04,P＜0.002);②经再灌注治疗血管再通的AMI患者血清IL-6水平明显低于未通组,日发病24h时两组比较有显著统计学意义(0.48±0.39:1.08±1.61,P＜0.05).结论:AMI发病早期血清IL-6水平明显升高,血管再通后血清IL-6水平显著降低.

目的比较急性心肌梗死患者有或无糖尿病早期静脉溶栓治疗的有效性和安全性以及溶栓后五周内再发心肌缺血事件及心功能状况.方法 380例急性心肌梗死患者给予不同的溶栓剂治疗.结果有糖尿病组和无糖尿病组的血管再通率分别为:56.8%和74.3%(P＜0.05);出血等不良反应发生率为5.2%和3.8%(P＜0.05);死亡率为20.7%和5.96%(P＜0.05);溶栓后五周内再发心肌缺血事件的发生率有糖尿病组和无糖尿病组分别为15.5%和3.5%(P＜0.05);心肌射血分数EF值分别为52.1±11.1和60.9±12.3(P＜0.05).结论急性心肌梗死患者合并糖尿病溶栓治疗血管再通率明显低于无糖尿病患者且近期预后亦差.

持续性室性心动过速(室速)和心室颤动(室颤)是心脏性猝死和心脏骤停的主要原因.有效中止室速和室颤的方法是直流电复律除颤,随着室颤时间延长,存活率会迅速下降,所以尽早识别室颤和有效电除颤是提高患者存活率的关键.

目的:探讨直接经皮冠状动脉腔内球囊成形术(PTCA)治疗急性心肌梗死(AMI)后心电图抬高的ST段的变化与临床预后的关系.方法:108例成功行直接PTCA的AMI患者,分析术后1h 12导联心电图抬高的ST段下移幅度,分为四组:A组:抬高ST段下移100%;B组:抬高ST段下移50%～100%;C组:抬高ST段下移0～50%;D组:ST段无下移.结果:四组梗死相关血管(IRA)开通时间相似,A组患者下壁和/或后壁、右室梗死占84.6%,与其余三组比较均有显著性差异(P<0.01～0.05).抬高ST段下降≥50%组比<50%组的CPK、CK-MB峰值,梗死延展发生率及病死率明显下降(分别为3266.1±2157.6比4364.0±2873.0,134.5±80.1比176.9±107.5,0比6.1%,1.3%比12.1%,P<0.05),LVEF明显升高(58.5±12.9比51.5±16.0,P<0.05).结论:AMI成功再灌流治疗后抬高ST段下移幅度可作为判断预后的一个重要指标,迅速下降≥50%组梗死面积小,左室收缩功能好,近期心脏事件发生率及病死率低.

目的评价主动脉内球囊反搏(IABP)在高危急性心肌梗死(AMI)患者辅助治疗中的作用。方法 28例高危AMI患者在不同的病情及治疗状况下，给予LABP治疗。结果 23例患者(82％)接受IABP治疗后，血流动力学稳定。所有接受血运重建治疗的患者辅以IABP，没有发生血管再闭塞事件。心原性休克患者经IABP辅助治疗存活率为58％。结论对于高危AMI合并血流动力学不稳定或心原性休克的患者，IABP可以完全地使用并有效地稳定血流动力学状态，为患者争取了进行经皮腔内冠状动脉成形术和冠状动脉旁路移植术(CABG)的时间，同时可增加冠脉内血流，减少再闭塞率。