血小板微粒与急性冠脉综合征危险分层及临床预后的关系

目的:评价循环血小板微粒(PMPs)与急性冠脉综合征(ACS)危险分层及临床预后的关系。方法:选取53例ACS患者为ACS组,招募同期就诊的稳定性心绞痛(SA)及体检的非冠心病(CAD)患者共53例为对照组。所有受试者入院即刻检测循环PMPs水平,同时随访ACS患者出院后1个月内发生主要不良心血管事件(MACE)情况。分析PMPs在各组及亚组间差异性。结果:①PMPs水平在急性心肌梗死(AMI)亚组(12.78%±3.61%)最高,不稳定性心绞痛(UA)亚组(8.64%±5.29%)PMPs水平显著高于SA(4.27%±2.45%)及非CAD亚组(3.55%±1.81%);②高危亚组患者PMPs水平显著高于中危及低危亚组(P<0.05);③发生MACE的ACS患者入院时PMPs水平显著高于非MACE患者(13.53%±3.54%vs 7.57%±1.69%,P<0.05)。结论:PMPs是潜在的评估ACS疾病病情与近期临床预后的标记物。

缺血修饰白蛋白对急性心肌梗死患者在院期间不良心血管事件的预测价值

【目的】探讨缺血修饰白蛋白(IMA)对急性心肌梗死(AMI)患者在院期间不良心血管事件(MACE)的预测价值。【方法】AMI患者80例,入院时检测外周血循环IMA水平。根据患者住院治疗期间发生MACE情况将患者分为MACE组5 = 16)及非MACE组5 = 64)。比较两组患者临床资料及IMA水平的差异;分析肌钙蛋白I(cTnI)及肌酸激酶同工酶MB(CK-MB)与IMA之间的相关性,同时应用受试者工作特征(ROC)曲线评估IMA对AMI在院期间MACE的预测价值,通过Logistic回归分析IMA与AMI患者在院期间MACE的关系。【结果】MACE组患者IMA、CK-MB及cTnI水平显著高于非MACE组(P<0.05);IMA与cTnI为正相关关系(r = 0.573);ROC曲线显示IMA可以作为预测AMI患者在院期间MACE的指标,其曲线下面积(AUC)(95%CI)为0.89(0.79-0.97),其最佳诊断界值为65.33 U/mL。Logistic回归分析发现1MA>65.33 U/mL是AMI患者在院期间发生MACE的独立危险因素。【结论】IMA可以作为预测AMI在院期间发生MACE的指标,且IMA>65.33 U/mL是其独立危险因素。

Effects of 3-aminobenzamide on expressions of poly（ADP ribose） polymerase and apoptosis inducing factor in cardiomyocytes of rats with acute myocardial infarction

Background Poly（ADP-ribose） polymerase （PARP） plays an important role in cell survival and death. However, the mechanisms involved are not fully understood. Therefore, we investigated the effect of inhibition of PARP on acute myocardial infarction （AMI） at different time points in rats. Methods AMI was induced in rats by ligating the left anterior descending coronary artery. One group received 3-aminobenzamide （3-AB, a kind of PARP inhibitor） （30 mg/kg） by intraperitoneal injection. The changes of ultramicrostructure of cardiocytes in infarction region were noted, PARP cleavage was measured by Western blotting, and expressions of protein of PARP and apoptosis inducing factor （AIF） were measured by immunohistochemical staining after treatment with 3-AB for 2 hours, 4 hours, 6 hours, 1 week, 4 weeks and 8 weeks. Results Few damages to the ultramicrostructure of cardiocytes were observed after treatment with 3-AB. PARP cleavage was detected as early as 4 hours and markedly increased by 6 hours following AMI without 3-AB, but was not found until 6 hours following AMI treated with 3-AB. There were significant differences between 3-AB and AMI groups at the same time points. The expression of PARP was observed gradually increased, but that of AIF was suppressed for 6 hours after treatment of 3-AB, compared with AMI groups in positive cells at the same time points. There was significantly less cleavage of PARP and more PARP expression in 3-AB treated group compared with AMI and control groups at all matched time points. Conclusions Our results suggest that 3-AB inhibits degradation of PARP, increases the expression of PARP protein, and suppresses the expression of AIF protein. Inhibition of PARP activity may protect cardiocytes in rats with AMI and reduce apoptosis.

急诊科患者携带金黄色葡萄球菌情况调查

目的对急诊科患者携带金黄色葡萄球菌耐药情况进行分析,为金黄色葡萄球菌感染治疗提供参考。方法采集血液、尿液、痰液和切口分泌物等标本,培养后进行菌落形态观察,进行涂片、染色和镜检,并经全自动微生物鉴定系统鉴定为金黄色葡萄球菌。采用头孢西丁筛选耐甲氧西林金黄色葡萄球菌(MRSA),采用PCR扩增金黄色葡萄球菌耐药基因,并对利福平耐药株进行测序。结果290株金黄色葡萄球菌中共检出MRSA 158株,检出率54.48%。研究中痰液、分泌物、脓液、穿刺液、血液和尿液金黄色葡萄球菌检出率分别为56.90%、21.03%、11.03%、5.52%、3.45%和2.07%。金黄色葡萄球菌对青霉素、四环素、红霉素、头孢唑林、氨苄西林/舒巴坦、克林霉素、庆大霉素、左氧氟沙星、利福平和万古霉素耐药率分别为84.14%、66.90%、74.83%、65.17%、50.34%、58.97%、50.69%、22.41%、1.72%和0.00%。金黄色葡萄球菌携带ermA、ermB、ermC、aac(6′)/aph(2″)、aph(3′)-Ⅲ和ant(6′)-Ⅰ耐药基因检出率:43.45%、1.72%、23.45%、11.03%、5.52%和7.59%,未检出VanA。本次研究中,I型~Ⅴ型SCCmec检出率共计96.57%,Ⅰ型~Ⅴ型检出率分别为:6.96%、16.46%、58.23%、10.76%和3.16%。rpoB基因测序结果显示:4株同时发生481His/Asn和466Leu/Ser突变,1株仅发生481His/Asn突变。结论金黄色葡萄球菌对青霉素、四环素和红霉素具有较高程度的耐药。SCCmecⅢ型检出率较高,应注意交叉感染。