肥厚型心肌病发病机制及治疗进展

肥厚型心肌病(hypetrophic cardiomyopathy,HCM)是单基因常染色体显性遗传病,临床表现复杂多样,包括无症状、心绞痛、晕厥、猝死等,其治疗以缓解症状和防止并发症为主。近年来,HCM在基础和临床研究方面取得了长足的进展,尤其是分子生物学领域。现已证实HCM是一种单基因遗传性疾病。本文旨在对HCM的发病机制及治疗领域的研究进展做一综述。

血清Hcy、sST2水平变化与冠心病患者PCI术后MACE风险的关联性及临床意义

目的:研究血清同型半胱氨酸(Hcy)、可溶性致癌抑制因子2(sST2)水平变化与冠心病(CHD)患者经皮冠状动脉介入术(PCI)后心脏不良事件(MACE)风险的关联性。方法:选取2018年8月~2019年8月我院CHD患者93例,均检测血清Hcy、sST2水平,并根据PCI术后1年是否发生MACE分为预后不良组(n=20)与预后良好组(n=73)。比较两组一般资料及血清Hcy、sST2水平,分析冠心病患者PCI术后预后不良的影响因素及联合检测对预后不良的预测价值。结果:预后不良组血清Hcy、sST2水平高于预后良好组(P<0.05);血清Hcy、sST2水平是CHD患者PCI术后预后不良的重要影响因素(P<0.05);联合预测AUC值0.852高于Hcy、sST2单一检测(P<0.05)。结论:CHD患者PCI术后发生MACE与血清Hcy、sST2水平密切相关,联合检测对预后不良具有较高预测价值,临床意义重大。

Long-term follow up of interventional therapy of secundum atrial septal defect

Background The percutaneous transcatheter closure of secundum atrial septal defect （ASD） is increasingly a widespread alternative to surgical closure.The aim of this study was to assess long-term results of percutaneous closure of secundum-type atrial septal defect （ASD Ⅱ）.Methods Between January 2001 and December 2005,61 patients underwent a successful percutaneous closure of ASD Ⅱ; including 25 male and 36 female.All were included in the patient study and were followed up to monitor by electrocardiogram and echocardiography,at intervals of 3 days,3 months,6 months,1 year,2 years,and 5 years after operation.Results Three days after percutaneous transcatheter septal closure （PTSC）,the right atrium diameter,right ventricular end-diastolic left-right diameter and right ventricutar end-diastolic volume （RVEDV） decreased significantly （P 〈0.05）.Right ventricular end-diastolic anteroposterior diameter （RVEDD）,right ventricular end-systolic volume （RVESV） and right ventricular ejection fraction （RVEF） also decreased （P〈0.01）.During the period from 3 to 6 months,the size of the right atrium and right ventricle returned to normal range.Three days after PTSC,the left ventricular end-diastolic diameter （LVEDD）,left ventricular end-diastolic volume （LVEDV）,left ventricular end-systolic volume （LVESV）,left ventricular-systolic volume （LVSV） and left ventricular ejection fraction （LVEF） were significantly increased （P 〈0.05）.At 1 year,the size of the left atrium,left ventricle and left cardiac function returned to normal range （P 〈0.01）.There were no deaths or significant complications during the study.At five year follow-up,all defects were completely closed and remained closed thereafter.Conclusion Transcatheter closure of ASD Ⅱ effectively eliminated the abnormal shunt and,subsequently improved the dimensions of each chamber and cardiac function.

血管内超声判定不稳定斑块的敏感性与特异性及其可靠性研究

目的探讨血管内超声判定不稳定斑块的敏感性与特异性及其可靠性。方法选择2017年5月—2020年5月郑州市第七人民医院接治的80例冠心病患者,均行冠状动脉造影诊断,诊断完成后行血管内超声,其中脂质斑块患者为A组,纤维钙化斑块患者为B组,利用血管内超声对两组患者的斑块情况进行定量分析。结果急性冠状动脉综合征患者经血管内超声共明确诊断出37例脂质斑块患者,纤维钙化斑块患者43例,病理学诊断确认脂质斑块患者46例,纤维钙化斑块患者34例,检出率为80.43%,敏感度80.43%,特异性79.07%,准确率88.75%。A组患者脂核面积、脂核与斑块比例、偏心程度均大于B组(P<0.05),但是纤维帽厚度、面积狭窄率均小于B组(P<0.05),A、B两组患者的斑块大小无明显差异(P>0.05)。结论不稳定斑块患者的诊断过程中采取血管内超声诊断的准确率较为理想,对斑块电量数据测量进准,能够快速测量斑块的大小、形态及表面情况,快速给出鉴别,为临床治疗提供可靠依据。