肌钙蛋白T对急性非典型性心肌梗死的临床诊断价值

目的：探讨心肌肌钙蛋白T对急性非典型性心肌梗死的诊断意义，协助临床治疗。方法：对60例急性心肌梗死(AMI)或陈旧性心肌梗死再发急性心肌梗死患者，入院后即行心肌肌钙蛋白T(cTnT)的测定。结果：60例中阳性占55例，阴性5例，确诊率达91％。结论：冠心病急性心肌梗死是临床危重症之一，及时准确的诊断，对指导治疗极为重要，本文探讨了心肌肌钙蛋白T对非典型性心肌梗死的诊断意义及价值，协助迅速制定有效的治疗方案，挽救了患者的生命。

急性心肌梗死患者血清几种常用肿瘤标志物检测

目的观察急性心肌梗死(AMI)患者血清CA125、CA199、甲胎蛋白(AFP)、癌胚抗原(CEA)水平的变化及其临床意义。方法观察组40例检测心肌型肌酸磷酸激酶同工酶(CK-MB)、肌钙蛋白Ⅰ(TnI)的峰值浓度,并在入院后72小时测血清CA125、CA199、CEA、AFP水平。对照组40例既往无器质性心脏病史和异常心脏彩超改变,排除引起CA125、CA199、CEA、AFP升高的恶性和良性因素及可能引起CKMB和TnI升高的其他因素。结果急性心肌梗死组与对照组CA199、CEA、AFP差异无显著性;急性心肌梗死患者血清CA125、CKMB、TnI水平升高,与对照组相比差异具有显著性。心肌梗死组患者CA125水平与CK-MB和TnI差异无显著性。结论急性心肌梗死组患者血清CK-MB、TnI、CA125水平升高。

心脏不停跳心内直视术中心肌肌钙蛋白T的测定及意义

目的 研究心脏不停跳心内直视术围手术期心肌肌钙蛋白T(cTn-T)的变化及意义。方法 检测26例心脏不停跳心内直视术患者术前,术中及术后血清cTn-T及肌酸磷酸激酶同功酶(CK-MB)。结果 cTn-T明显增高,于停机时达到最高峰后,出现下降趋势,术后2周仍高于术前水平。术后心功能不良患者,cTn-T持续上升。CK-MB于术后2小时达最高峰,术后1周即恢复至术前水平。结论 心脏不停跳心内直视术中,血清cTn-T可用于监测围手术期心肌细胞损伤和估价心肌保护效果。并有可能作为反映预后的指标,其敏感性、特异性及持续时间优于CK-MB。

连续性和间歇性血液透析滤过对老年急性重度药物中毒的心肾保护疗效观察

目的研究老年人急性重度药物中毒后应用连续性和间歇性血液透析滤过治疗对于心肾功能衰竭的辅助治疗效果。方法将2013年1月至2014年1月急诊科收治急性重度药物中毒老年患者随机分为试验组(n=84)和对照组(n=83),试验组患者给予连续性血液透析滤过治疗;对照组给予间歇性血液透析滤过治疗;分别测定2组患者治疗前后的血浆脑钠素、心肌肌酸磷酸激酶同工酶、乳酸脱氢酶、血肌酐、尿素氮含量。结果治疗后试验组患者的血浆脑钠素、心肌肌酸磷酸激酶同工酶、乳酸脱氢酶、血肌酐、尿素氮均低于对照组(P<0.05),治愈率高于对照组(P<0.05)。结论给予相同治疗方案,连续性血液透析滤过治疗对于老年急性药物中毒疗效优于间歇性血液透析滤过治疗,且对老年人心肾保护作用明显,有显著疗效。

对急性呼吸系统感染患儿血清CK-MB增高的再认识

目的 探讨急性呼吸系统感染患儿血清CK MB增高而无心肌炎临床症状和心电图改变的原因。方法 对急性呼吸系感染患儿于病程的 1～ 5天内采静脉血同时测定CK MB(采用免疫抑制法 )和CTnⅠ (采用夹心ELISA法 ) ,并动态观察病人临床症状、心电图改变以判断是否合并心肌炎。结果 13 0例急性呼吸系感染患儿中血清CK MB增高 5 8例 ,血清CTnⅠ增高 3例 ,其阳性率为 10 0 % ,经卡方检验P <0 .0 5 ,差异有显著性。 12 7例临床无心肌炎的病例中 ,血清CK MB增高 5 5例 ,正常 72例 ,12 7例患儿中血清CK MB增高组、CK MB正常组与正常儿童对照组三组间CTnⅠ值经方差分析P >0 .0 5 ,差异无显著性。结论 应用免疫法测定的血清CK MB值不能作为判断呼吸系感染时有无心肌损伤的“金指标” ,应改用质量法测定血清CK MB ,或测定血清CTnⅠ来补充。

Association of the phosphatidylinositol signal pathway with prolonged myocardial ischemia

OBJECTIVE: To study the changes in activity of phosphatidylinositol 4 kinase (PI 4 kinase), phosphatidylinositol 4 phosphate 5 kinase (PIP 5 kinase) and protein kinase C (PKC) during myocardial ischemia and elucidate the relationship between phosphatidylinositol signal pathways and prolonged myocardial ischemia. METHODS: In vivo an ischemic rat model was used. Activity of PI 4 kinase, PIP 5 kinase and PKC were measured at different times in postischemic heart cells using isotope analysis. RESULTS: The activity of PI kinase, PIP kinase and PKC in the myocardium increased to peak at 1 hour postischemia, with activities 6.1, 3.0 and 4.0 fold over control levels, respectively. Their activities declined to normal levels with time. CONCLUSION: The phosphatidylinositol signal pathway is involved in prolonged myocardial ischemia, but its mechanism needs further study.

Effect of Yiqihuoxue prescription on myocardial energy metabolism after myocardial infarction via cross talk of liver kinase B1-depen-dent Notch1 and adenosine 5'-monophosphate-activated protein kinase

OBJECTIVE: To investigate the effect of Yiqihuoxue prescription(YQHX) from Traditional Chinese Medicine(TCM) on myocardial glucose and lipid metabolism after myocardial infarction via the cross talk between the liver kinase B1(LKB1)-dependent Notch1 and adenosine 5'-monophosphate(AMP)-activated protein kinase(AMPK). YQHX was prepared with substances with properties that benefit, to activate blood circulation based on the TCM theory.METHODS: Animal models of myocardial infarction were established by ligating Sprague Dawley rats' left anterior descending coronary arteries. The animals were randomly divided into a myocardial infarction(MI) group, a YQHX group, a perindopril group, a γ-secretase inhibitor, Notch signal inhibitor(DAPT) group, a DAPT+YQHX group and a sham group. The related drugs were administered on the second day after operation, and changes in the relevant indexes were examined on weeks 1 and 4.Changes in cardiac structure and function were examined by echocardiography. The glucose and free fatty acids(FFA) were examined by ELISA. The expression of Notch, LKB1 and AMPK m RNA was examined by a real-time fluorescence quantitative method. The expression of glucose transporter 4(GLUT4), and the expression of total acetyl-Co A carboxylase(ACC) and its phosphorylation were examined by western blotting.RESULTS: Compared with the sham group, the expression of Notch, LKB1 and AMPK m RNA in the MI group was lower. Compared with the MI group, the expression of these m RNAs in the YQHX and perindopril groups was higher, and their expression in the DAPT group was lower. At all time points, the protein expression of GLUT4 and p ACC decreased in the MI group. On week 1, the expression of p ACC protein was higher. In the DAPT group, the expression of p ACC protein decreased. Compared with the YQHX group, the expression of p ACC protein in the DAPT + YQHX group was lower. On week 4,compared with the MI group, the expression of GLUT4 protein in the YQHX group and the perindo-pril group was higher. The expression of GLUT4 protein in the DAPT group decreased. Compared with the YQHX group, the expression of GLUT4 protein in the DAPT+YQHX group was lower. There was no significant difference in the expression of ACC protein between the groups.CONCLUSION: YQHX promoted cross talk between the LKB1-dependent Notch1 and AMPK in myocardial tissue after myocardial infarction. Furthermore,it regulated the glucose and lipid metabolism of cardiomyocytes at different time points, thereby ameliorating the cardiac energy metabolism via different mechanisms and protecting the heart.