H-FABP与BNP在快速心房纤颤诊断与评估中的应用

目的旨在研究心脏型脂肪酸结合蛋白(H-FABP)与前体B型钠尿肽(pro-BNP)在快速心房纤颤(简称房颤)中的诊断和评估价值。方法应用双抗夹心酶联免疫吸附试验(ELISA)对2021年1月至2022年12月间,潍坊市坊子区人民医院急诊收治的79例快速房颤患者的血浆中H-FABP和pro-BNP进行检测。进一步结合患者的临床表现、心功能检测进行综合分析。结果在阵发性、持续性和永久性房颤患者中,血浆H-FABP的平均含量分别为(7.0±1.7)ng/mL、(8.3±2.2)ng/mL和(9.5±3.0)ng/mL,而pro-BNP的平均含量则分别为(819±125)pg/mL、(1630±215)pg/mL和(2189±165)pg/mL。阵发性房颤患者经过胺碘酮转复心律后,H-FABP和pro-BNP水平均显著下降至(6.2±1.1)ng/mL和(561±117)pg/mL。根据NYHA心功能分级,Ⅲ级和Ⅳ级患者的H-FABP和pro-BNP含量显著高于心功能较好的患者。结论H-FABP和pro-BNP的血浆水平与快速房颤患者的心功能状态显著关联,因此有潜力作为房颤诊断和心功能评估的生物标志物。

Maraviroc promotes recovery from traumatic brain injury in mice by suppression of neuroinflammation and activation of neurotoxic reactive astrocytes

Neuroinflammation and the NACHT,LRR,and PYD domains-containing protein 3 inflammasome play crucial roles in secondary tissue damage following an initial insult in patients with traumatic brain injury(TBI).Maraviroc,a C-C chemokine receptor type 5 antagonist,has been viewed as a new therapeutic strategy for many neuroinflammatory diseases.We studied the effect of maraviroc on TBI-induced neuroinflammation.A moderate-TBI mouse model was subjected to a controlled cortical impact device.Maraviroc or vehicle was injected intraperitoneally 1 hour after TBI and then once per day for 3 consecutive days.Western blot,immunohistochemistry,and TUNEL(terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling)analyses were performed to evaluate the molecular mechanisms of maraviroc at 3 days post-TBI.Our results suggest that maraviroc administration reduced NACHT,LRR,and PYD domains-containing protein 3 inflammasome activation,modulated microglial polarization from M1 to M2,decreased neutrophil and macrophage infiltration,and inhibited the release of inflammatory factors after TBI.Moreover,maraviroc treatment decreased the activation of neurotoxic reactive astrocytes,which,in turn,exacerbated neuronal cell death.Additionally,we confirmed the neuroprotective effect of maraviroc using the modified neurological severity score,rotarod test,Morris water maze test,and lesion volume measurements.In summary,our findings indicate that maraviroc might be a desirable pharmacotherapeutic strategy for TBI,and C-C chemokine receptor type 5 might be a promising pharmacotherapeutic target to improve recovery after TBI.

Disease burden,antimicrobial resistance and molecular characterization of invasive group B Streptococcus among non-pregnant adults in Malaysia:A protocol study

and pili genes are also investigated.Methods:This multicentre,prospective,observational study is conducted in seven major tertiary hospitals in Malaysia among non-pregnant adults.Simultaneously,a retrospective study is conducted in the selected hospitals with similar approaches.GBS isolates are subjected to phenotyping,serotyping by multiplex PCR,antimicrobial susceptibility testing and PCR-detection of GBS virulence and pilus genes.Seven housekeeping genes are amplified and sequenced for multi-locus sequence typing.Discussion:Findings from the study may contribute to the management of clinical practice to diagnose and prevent GBS related diseases in a timely manner.Prudent use of antibiotics is encouraged by monitoring antimicrobial resistance.

BiPAP无创呼吸机配合布地奈德在CPHD患者中的应用分析

目的:探讨BiPAP无创呼吸机配合常规治疗对慢性肺源性心脏病(CPHD)患者血清氨基末端B型脑钠肽前体(NT-proBNP)、肺功能及血气分析指标的影响。方法:选择2020年1月—2022年12月本院60例CPHD患者,随机数字表法分为对照组(30例)和观察组(30例),对照组实施常规治疗,观察组在对照组基础上采用BiPAP无创呼吸机配合治疗。治疗前、治疗7 d后测定两组血清NT-proBNP水平、肺功能指标[一秒用力呼气容积(FEV1)、用力肺活量(FVC)、并比较两者比值即FEV1/FVC]、血气分析指标[动脉二氧化碳分压(PaCO_(2))、动脉氧分压(PaO_(2))和pH]并比较。结果:治疗前两组NT-proBNP、FVC、FEV1、FEV1/FVC、PaCO_(2)、PaO_(2)和pH比较,差异无统计学意义(P>0.05);治疗7 d后,两组血清NT-proBNP水平和PaCO_(2)均降低,且观察组低于对照组(P<0.05);两组FVC、FEV1、FEV1/FVC、PaO_(2)和pH均升高,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:BiPAP无创呼吸机配合常规治疗对CPHD患者的NT-proBNP水平、肺功能和血气分析指标具有显著的改善作用。

慢性心力衰竭患者血清NT-proBNP、ACT-A、sST2、Adropin水平与心功能的相关性分析

目的:分析慢性心力衰竭(CHF)患者血清氨基末端B型利钠肽前体(NT-proBNP)、激活素A(ACT-A)、可溶性生长刺激表达基因2蛋白(sST2)、Adropin水平与心功能的相关性。方法:选取2022年2月-2023年1月北京市海淀区青龙桥社区卫生服务中心收治的355例CHF患者作为观察组,选取同期50例健康体检者作为对照组。采用纽约心脏病协会(NYHA)心功能分级评估CHF患者心功能,检测研究对象血清NT-proBNP、ACT-A、sST2、Adropin水平。比较两组组不同NYHA心功能分级CHF患者血清NT-proBNP、ACT-A、sST2、Adropin水平,分析血清NT-proBNP、ACT-A、sST2、Adropin水平与NYHA心功能分级的相关性。结果:观察组血清NT-proBNP、ACT-A、sST2、Adropin水平高于对照组,差异有统计学意义(P<0.001)。不同NYHA心功能分级CHF患者血清NT-proBNP、ACT-A、sST2、Adropin水平比较,Ⅱ级<Ⅲ级<Ⅳ级,差异有统计学意义(P<0.05)。血清NT-proBNP、ACT-A、sST2、Adropin水平与NYHA心功能分级呈正相关(P<0.05)。结论:CHF患者血清NT-proBNP、ACT-A、sST2、Adropin水平与心功能呈正相关,临床医师根据上述指标辅助判断CHF患者心功能,为患者制定针对性治疗方案。

Influence of folic acid and vitamin B12 combined therapy on plasma Hcy, inflammatory factor levels and blood vessels endothelial function in patients with vascular dementia and type H hypertension

Objective:To investigate influence of folic acid and vitamin B12 combined therapy on plasma homocysteine (Hcy) level, blood vessels endothelial function and inflammatory factors in patients with vascular dementia and type H hypertension.Methods:100 cases of patients with vascular dementia and type H hypertension accorded with the inclusion criteria were selected as research objects. They were randomly divided as the control group and the therapeutic group, 50 cases each. For control group, Enalapril tablets were administered by mouth for treatment. For therapeutic group, folic acid and vitamin B12 treatment were provided on the basis of treatment for control group. Treatments were continued for 12 weeks. Plasma Hcy levels, inflammatory factors [(interleukin-6 (IL-6), interleukin-8 (IL-8) and hypersensitive C reaction protein (hs-CRP)], blood vessels endothelial function indexes variation in patients before and after treatment were observed and detected.Results:Plasma Hcy, IL-6, IL-8 and hs-CRP levels in two groups of patients after treatment were significantly decreased comparing with the same group before treatment, and the above index levels in therapeutic group after treatment were significantly lower than control group (P<0.05);For comparison of blood vessels endothelial function indexes in the patients, NO levels in two groups after treatment were increased in various degrees, and endothelin-1 (ET-1) were decreased. The differences between levels of the two indexes in therapeutic group before and after treatment were significant, and levels after treatment in therapeutic group were significantly better than in control group (P<0.05). While variations of the differences in control group before and after treatment were not significant (P>0.05);After treatment, diastolic pressure and systolic pressure in the two groups of patients were significantly improved comparing with before treatment (P<0.05). However, after treatment, the differences of levels between therapeutic group and control group were not significant (P>0.05). MMSE score in therapeutic group after treatment was significantly higher than before treatment, and significantly higher than in control group (P<0.05).Conclusions: Combined therapy of folic acid and vitamin B12 for treating vascular dementia with type H hypertension could effectively decrease plasma Hcy and inflammatory factor levels, and improve blood vessels endothelial function and dementia degree on patients. It has certain clinical value which deserves to be promoted.

DUAL FUNCTIONALS OF SAID-BZIER TYPE GENERALIZED BALL BASES OVER TRIANGLE DOMAIN AND THEIR APPLICATION

A family of Said-Bézier type generalized Ball （SBGB） bases and surfaces with a parameter H over triangular domain is introduced,which unifies Bézier surface and Said-Ball surface and includes several intermediate surfaces. To convert different bases and surfaces,the dual functionals of bases are presented. As an application of dual functionals,the subdivision formulas for surfaces are established.

B(A)血型的鉴定及其输血策略分析

目的探讨B(A)血型患者的血清学及其基因型鉴定分析方法。方法应用试管法(血清学)对3名患者的临床疑难ABO血型标本做ABO血型正反定型;应用实时荧光定量PCR技术对3例标本做ABO血型基因分型,并采用基因测序方法对其ABO基因1-7外显子测序确定基因型。结果3名患者血清学ABO血型正反定型均表现为“B(A)血型”的格局;3例ABO基因分型均为B/O2,测序均在第7外显子B等位基因基础上发生c.640A>G突变,符合ABO*BA.04基因型特点。结论对于ABO血型亚型等疑难血型的鉴定,采用血清学和基因检测相结合的方法可以准确鉴定血型,保证临床用血安全。

小麦新型Avenin-like type b基因克隆、功能预测及品质相关分析

为进一步明确Avenin-like type b基因的功能特性,以小麦品种西农188为材料,通过设计简并引物克隆小麦Avenin-like type b基因,对克隆得到的序列进行同源性比对,分析编码蛋白的理化性质、结构特点,结合系统发育树、亚细胞定位预测及结构域分析探讨其可能具有的功能特性,同时对该基因进行体外原核表达及品质功能相关分析。结果表明,从西农188克隆得到4条序列,Genbank登录号为KY794919~KY794922,其中KY794922在信号肽区段碱基缺失导致移码突变。KY794919~KY794921序列与Aveninlike type b家族中大麦、柱穗山羊草、二穗短柄草及节节麦的同源性较高。蛋白序列分析表明,Avenin-like type b编码氨基酸序列具有较高的保守性,其Cys的数目及位置也较为保守,具有两个典型的AAI结构域,推测其可能为一类具有α-淀粉酶抑制剂活性的蛋白。亚细胞定位显示,该类蛋白可能在合成加工后通过运输小泡转运至细胞外行使功能。SDS-PAGE分析表明,KY794919~KY794921体外原核表达成功。通过纯化表达产物及掺粉试验表明,KY794919~KY794921编码蛋白对小麦面粉品质均具有显著正向效应,但仅有KY794919可显著提高面粉吸水量进而延长面筋扩展时间,说明其可能在品质功能研究资源中更具有优越性。

Effect of partial splenic embolization on the immune function of cirrhosis patients with hypersplenism

Objective:To discover the effect of partial splenic embolization on the immune function of cirrhotic patients with hypersplenism.Methods:Patients involved in the study were enrolled and divided into three groups,including control group,experimental group,and complication group.Numbers of CD3^+,CD4^+ and CD8^+ T cells and CD4^+CD25^+CDl27^(low/-) Treg cells in the peripheral blood of patients before surgery,1 month,6 months,1 year,and 2 years after surgery were analyzed by fluorescence active cell sorting(FACS).Contents of immunoglobulins(IgA,IgG and IgM) were analyzed by auto immunoassay analyzer.Results:In the peripheral blood of patients from experimental group,numbers of CD3^+,CD4^+ and CD8^+ T cells initially declined,but afterwards increased to normal level;in the peripheral blood of patients from complication group,CD3^+ and CD8^+ T cells showed the same trend,but the number of CD4^+ T cells was below normal level at all detection times.Furthermore,CD3^+,CD4^+ and CD8^+ T cells in the peripheral blood of patients from complication group were initially less than those in experimental group,and afterwards were comparable between two groups.In patients from both experimental group and complication group,the number of CD4^+CD25^+CDl27^(low/-)Treg cells increased 1 month and 6 months after surgery,and gradually restored to normal level.CD4^+CD25^+CDl27^(low/-)Treg cell counts in patients from complication group were initially more than those in patients from experimental group 1 month and 6 months after surgery,but then they were comparable.Furthermore,contents of immunoglobulins(IgA,IgG and IgM) were comparable in three groups at all detection times.Conclusion:Partial splenic embolization influenced the immune function of cirrhotic patients with hypersplenism in the short term but the immune function could afterwards gradually restore to normal.Our results implicated that measures that prevent infection and improve immune function were necessary in early stage after undergoing PSE in order to reduce complications.

湖南地区携带HLA-B*27꞉04等位基因人群与强直性脊柱炎的易感性具有强相关性

目的:人类白细胞抗原(human leukocyte antigen,HLA)B27是强直性脊柱炎(ankylosing spondylitis,AS)的易感等位基因,HLA-B27抗原分型是临床诊断AS的重要指标,但目前的分型方法如序列特异引物聚合酶链反应技术(polymerase chain reaction-sequence specific primer,PCR-SSP)等仍存在一定的缺陷。因此,本研究旨在应用高分辨率聚合酶链反应直接测序分型法(polymerase chain reaction-sequence-based typing,PCR-SBT)分析B27亚型与湖南地区强直性脊柱炎易感性的相关性。方法:收集2020年1至12月在湘雅二医院门诊就医的116例疑似AS患者(疑似AS组)和121名健康志愿者(对照组)的外周血,采用PCR-SBT进行HLA-B基因分型。在疑似AS组患者中,23名患者最终被确诊为AS(AS确诊组),其余的93名未能确诊的患者为非AS确诊组。采用PCR-SBT和PCR-SSP检测116例疑似AS患者的HLA-B27分型,并比较2种方法的检测结果。结果:疑似AS组HLA-B27等位基因频率显著高于对照组[11.63%vs 2.48%;P<0.001,优势比(odds ratio,OR)=5.18,95%置信区间(confidence interval,CI)2.097~12.795]。疑似AS组和对照组均检出B*27:04、B*27:05、B*27:06、B*27:07。疑似AS组B*27:04等位基因频率明显高于对照组[9.48%vs 1.24%;P<0.001,OR=8.346,95%CI 2.463~28.282]。疑似AS组和AS确诊组B27阳性率(B27+/+和B27+/-)均显著高于对照组(分别χ^(2)=16.579,P<0.001;χ^(2)=94.582,P<0.001)。在AS确诊组中,21例为HLA-B27携带者,AS确诊组B27阳性率为91.3%。PCR-SBT方法可对HLA-B基因位点进行高分辨分型,其敏感度、特异度、阳性预测值、阴性预测值、准确度均高于PCR-SSP法。结论:应用PCR-SBT检测出HLA-B*27:04与湖南地区AS具有强相关性。PCR-SBT可作为临床AS辅助诊断的优选方案。

Halophyte Vegetation Influences Soil Microbial Community of Coastal Salt Marsh

Coastal wetlands are the most productive ecosystems worldwide and can provide important ecosystem services,yet the characteristics of microbial community within these systems remain poorly understood.Microbial community of salt marsh vegetation and the associated soil physio-chemical properties were investigated in this study.Three typical Suaeda australis,Phragmites australis,Spartina alterniflora wetlands,and non-vegetated bare mudflats in the Zhoushan Islands were studied to advance the understanding of the characteristics of soil bacterial communities in coastal wetlands.Results showed that the bare mudflats exhibited high pH value and soil moisture content compared with the vegetated samples.In different vegetation types,the organic matter content,total nitrogen,and total potassium content decreased in the order:S.alterniflora wetland>P.australis wetland>S.australis wetland,and there was no obvious difference in total phosphorous content.The halophytes could decrease soil salinity compared with bare mudflats.Proteobacteria,Nitrospinae,Bacteroidetes,Acidobacteria,and Nitrospirae were the predominant level across all samples.Functional prediction showed that SPA-covered soil might play vital roles in sulphur cycling,while SUA and PHR covered soils were involved in nitrogen cycling.This study could provide the first insight into the microbial community of this study area and contribute to a better understanding of vegetation microbiota and bioremediation in coastal wetland ecosystem.

慢性心力衰竭患者血浆BNP、UA水平与心力衰竭严重程度及预后的相关性研究

目的评价慢性心力衰竭(CHF)患者血浆脑利钠肽(BNP)、尿酸(UA)值对心力衰竭严重程度和预后的预测价值。方法选择100例慢性心力衰竭患者,按纽约心功能分级标准分为4组,检测治疗前后血浆BNP、UA值,观察二者和纽约心功能分级、左心室射血分数(LVEF)、预后的关系。结果心功能的分级越高,BNP、UA值越高,LVEF越低,且相同心功能等级患者治疗前后比较,BNP、UA值降低,LVEF升高,差异有统计学意义(P<0.05)。血浆BNP、UA值和心功能分级呈正相关,和LVEF呈负相关。治疗后发生心脏事件组患者的血浆BNP、UA值比未发生心脏事件组患者高,心源性死亡组患者血浆BNP、UA值比因心衰再次入院组患者高,差异有统计学意义(P<0.05)。结论血浆BNP、UA值能够判断心力衰竭的严重程度,且血浆BNP、UA值高者心脏事件发生率高、临床预后差。

血清CysC、hs-cTnT、BNP水平变化与慢性心力衰竭患者NYHA分级的关系及临床意义

目的:探讨血清CysC、hs-cTnT、BNP水平变化与慢性心力衰竭患者NYHA分级的关系及临床意义。方法:选取2020年3月-2022年3月我院收治的慢性心力衰竭患者145例作为观察组,根据NYHA心功能分级将其分为Ⅱ级36例、Ⅲ级71例、IV级38例;并选择同期健康体检志愿者95例作为对照组。检测并比较观察组、对照组及不同心功能分级患者血清CysC、hs-cTnT、BNP水平,并分析血清CysC、hs-cTnT、BNP水平与NYHA分级的相关性。结果:与对照组相比,观察组血清CysC、hs-cTnT、BNP水平较高;血清CysC、hs-cTnT、BNP水平与慢性心力衰竭患者NYHA分级呈正相关关系;心功能ⅡI级、Ⅲ级、IV级患者血清CysC、hs-cTnT、BNP水平呈依次升高趋势,且任意两组间经比较,差异有统计学意义(P<0.05)。结论:血清CysC、hs-cTnT、BNP水平升高可增加慢性心力衰竭的发病风险,其水平变化与慢性心力衰竭患者的NYHA分级存在显著的相关性,可反映患者病情的严重程度和心功能的改善情况,为临床诊断及后续治疗提供一定的参考依据。

PROXIMINAL SUBSPACES OF 2-NORMED SPACES

In 1965 Gohler introduced 2-normed spaces and since then, this topic have been intensively studied and developed. We shall introduce the notion of 1-type proximinal subspaces of 2-normed spaces and give some results in this field.

Weighted ebyev-Ostrowski type inequalities

In account of the famous Cebysev inequality, a rich theory has appeared in the literature. We establish some new weighted Cebysev type integral inequalities. Our proofs are of independent interest and provide new estimates on these types of inequalities.

COMPLETE CONVERGENCE FOR A CLASS OF MIXING SEQUENCES

Under some conditions on probability, the author obtains some results on the complete convergence for partial sums of not necessary identically distributed p-mixing se- quences, and the complete convergence for partial sums of B-valued martingale differences is also studied. As application the author gives the corresponding results on the complete convergence for randomly indexed partial sums.

抗滑钢板内固定治疗Danis-Weber B型踝关节骨折的回顾性分析

目的探讨对Danis-Weber B型踝关节骨折患者采用抗滑钢板内固定治疗的效果。方法回顾性分析2019年1月至2022年3月邳州市中医院收治的50例Danis-Weber B型踝关节骨折患者的临床资料,根据治疗方法的不同分成观察组(n=25)与对照组(n=25),对照组采用手法整复石膏固定治疗,观察组采用抗滑钢板内固定治疗,对两组临床疗效、踝关节功能、并发症发生情况进行比较。结果观察组治疗优良率显著高于对照组(92.00%vs 64.00%,P<0.05)。观察组患者的住院时间和术后恢复时间显著短于对照组(P<0.05)。在疼痛评分上,两组术前比较无显著差异(P>0.05);术后疼痛评分均显著低于术前,且观察组的疼痛评分显著低于对照组(P<0.05)。在踝关节功能上,两组术前比较无显著差异(P>0.05);术后6个月较术前均显著提高(P<0.05),且观察组术后的踝关节功能评分[(52.83±4.61)分]高于对照组的(43.51±3.97)分,组间比较差异有统计学意义(P<0.05)。结论将抗滑钢板内固定应用于Danis-Weber B型踝关节骨折患者治疗中,可提高临床疗效,改善踝关节功能,减轻患者疼痛,缩短患者恢复时间,值得临床借鉴。

甲状腺功能正常的缺血性心肌病患者血清甲状腺激素浓度与血清NT-proBNP、同型半胱氨酸浓度的相关性

目的 探讨甲状腺功能正常的缺血性心肌病(ischemic cardiomyopathy,ICM)患者血清甲状腺激素浓度与血清N末端B型脑钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-proBNP)、同型半胱氨酸(homocysteine,Hcy)浓度的相关性。方法 选择界首市人民医院2021年8月至2022年8月收治的124例甲状腺功能正常的ICM患者作为研究对象。对所有患者根据美国纽约心脏协会(New York Heart Association,NYHA)心功能分级分为Ⅰ级组29例,Ⅱ级组27例,Ⅲ级组43例,Ⅳ级组25例;同时根据颈动脉内膜中层厚度(carotid intimamedia thickness,CIMT)分为CIMT增厚组41例,CIMT正常组83例。检测所有受试者的血清甲状腺激素[游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、促甲状腺激素(thyroid stimulating hormone,TSH)]浓度以及血清NT-proBNP、Hcy浓度;测定入选对象超声心动图指标,包括左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左心房内径(left atrial diameter,LAD),对入选对象行冠状动脉计算机断层扫描(computed tomography,CT)血管造影检查,并计算Gensini积分。分析血清甲状腺激素浓度与血清NT-proBNP、Hcy浓度等实验室指标的相关性。结果 采用Bonferroni法行多重比较发现,Ⅰ、Ⅱ、Ⅲ、Ⅳ级组患者和CIMT组患者之间血清TSH、NT-proBNP、Hcy浓度比较,差异均有统计学意义(P<0.0083)。Ⅲ级组患者血清FT3浓度显著低于Ⅰ级组,Ⅳ级组患者血清FT3浓度均显著低于Ⅰ级组和Ⅱ级组,差异有统计学意义(P<0.0083,P<0.0083)。Ⅲ级组和Ⅳ级组患者的LVEF均显著低于Ⅰ级组和Ⅱ级组,差异有统计学意义(P<0.0083)。Ⅲ级组和Ⅳ级组患者的LVEDD均显著高于Ⅰ级组,差异有统计学意义(P<0.0083)。Ⅱ级组、Ⅲ级组和Ⅳ级组Gensini积分均显著高于Ⅰ级组,差异有统计学意义(P<0.0083)。CIMT增厚组患者血清FT3、FT4浓度和LVEF均显著低于CIMT正常组,血清TSH、NT-proBNP、Hcy浓度和LVEDD、Gensini积分均显著高于CIMT正常组,差异有统计学意义(P<0.05)。血清FT3、FT4浓度与血清NT-proBNP、Hcy浓度和NYHA心功能分级、CIMT、Gensini积分均呈负相关(P<0.05),血清FT3、FT4浓度与LVEF均呈正相关(P<0.05),血清TSH浓度与LVEF呈负相关(P<0.05),血清TSH浓度与血清NT-proBNP、Hcy浓度和NYHA心功能分级、CIMT、LVEDD、LAD、Gensini积分均呈正相关(P<0.05)。结论 甲状腺功能正常的ICM患者的血清甲状腺激素浓度与血清NT-proBNP、Hcy浓度以及心功能分级、CIMT增厚与否、心脏结构与功能状态、冠状动脉病变程度密切相关;血清FT3、FT4浓度与血清NT-proBNP、Hcy浓度以及NYHA心功能分级、CIMT、Gensini积分均呈负相关,与LVEF均呈正相关;血清TSH浓度与血清NT-proBNP、Hcy浓度以及NYHA心功能分级、CIMT、LVEDD、LAD、Gensini积分均呈正相关,与LVEF呈负相关。

慢性心力衰竭患者阳虚血瘀证与心功能及血清NT-proBNP表达的相关性及二者对预后的影响

【目的】探究慢性心力衰竭患者阳虚血瘀证与心功能及血清B型氨基端利钠肽原(NT-proBNP)表达的相关性以及二者对患者预后的影响。【方法】选取2019年1月至2021年1月期间唐山市中医医院收治的320例慢性心力衰竭患者作为研究对象,根据中医辨证分型结果,将辨证为阳虚血瘀证的160例患者作为观察组,将辨证为气虚血瘀证或气阴两虚证的160例患者作为对照组;并对慢性心力衰竭阳虚血瘀证患者出院后进行为期1年的随访,根据随访结果,将患者分为良好预后组104例和不良预后组56例。采用Spearman相关性分析患者中医证型与血清NT-proBNP水平及心功能指标左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、每分钟搏出量(SV)、心排血量(CO)之间的相关性;采用多因素Logistic回归分析探讨影响患者不良预后的危险因素。【结果】(1)观察组患者的血清NT-proBNP水平及LVEDD值均明显高于对照组,LVEF、SV、CO值均低于对照组,差异均有统计学意义(P<0.05或P<0.01)。(2)Pearson相关性分析结果显示,慢性心力衰竭患者中医证型与血清NT-proBNP水平及LVEDD值呈正相关,与LVEF、SV、CO值呈负相关,差异均有统计学意义(P<0.01)。(3)慢性心力衰竭阳虚血瘀证患者不良预后组血清NT-proBNP水平及LVEDD值均明显高于良好预后组,LVEF、SV、CO值均低于良好预后组,差异均有统计学意义(P<0.01)。(4)血清NT-proBNP联合心功能指标对预后不良评估的曲线下面积(AUC)为0.942。Logistic回归分析结果显示,血清NT-proBNP高水平、LVEDD高水平均为影响慢性心力衰竭阳虚血瘀证患者发生不良预后的危险因素(P<0.01),而LVEF高水平、SV高水平、CO高水平均为保护因素(P<0.05或P<0.01)。【结论】慢性心力衰竭阳虚血瘀证患者血清NT-proBNP水平升高,阳虚血瘀证与血清NT-proBNP水平及心功能关系密切,且NT-proBNP水平及心功能与患者预后有关。