Diagnostic Value of the Padua Score Combined with Thrombotic Biomarker Tissue Plasminogen Activator Inhibitor-1 (tPAI-1) Detection for the Risk of Deep Vein Thrombosis in Patients with Pulmonary Heart Disease

This study explores the diagnostic value of combining the Padua score with the thrombotic biomarker tissue plasminogen activator inhibitor-1(tPAI-1)for assessing the risk of deep vein thrombosis(DVT)in patients with pulmonary heart disease.These patients often exhibit symptoms similar to venous thrombosis,such as dyspnea and bilateral lower limb swelling,complicating differential diagnosis.The Padua Prediction Score assesses the risk of venous thromboembolism(VTE)in hospitalized patients,while tPAI-1,a key fibrinolytic system inhibitor,indicates a hypercoagulable state.Clinical data from hospitalized patients with cor pulmonale were retrospectively analyzed.ROC curves compared the diagnostic value of the Padua score,tPAI-1 levels,and their combined model for predicting DVT risk.Results showed that tPAI-1 levels were significantly higher in DVT patients compared to non-DVT patients.The Padua score demonstrated a sensitivity of 82.61%and a specificity of 55.26%at a cutoff value of 3.The combined model had a significantly higher AUC than the Padua score alone,indicating better discriminatory ability in diagnosing DVT risk.The combination of the Padua score and tPAI-1 detection significantly improves the accuracy of diagnosing DVT risk in patients with pulmonary heart disease,reducing missed and incorrect diagnoses.This study provides a comprehensive assessment tool for clinicians,enhancing the diagnosis and treatment of patients with cor pulmonale complicated by DVT.Future research should validate these findings in larger samples and explore additional thrombotic biomarkers to optimize the predictive model.

Oxygen affinity and 2,3-diphosphoglycerate level of erythrocytes in patients with cor pulmonale

Arterial blood gases,intraerythrocytic pH (pHi),2,3-diphosphoglycerate,standardP 50 (P 50std) and in vivo P 50 (P 50iv) were determined in 54 patients with cor pulmonale and23 normal subjects.It was found that no significant change of pHi was observed but the differ-ence of pHi and extraerythrocytic pH was decreased.P 50std was significantly decreased whileP 50iv remained essentially unchanged in those cases showing type I respiratory failure.Thesefindings suggest that P 50std cannot accurately reflect the changes of P 50iv in patients of corpulmonale;P 50iv in cases of cor pulmonale usually keeps relatively stable and coincides withthe ‘optimal P 50’,which indicates the adaptation of the organism to chronic hypoxia;and rel-ative intraerythrocytic alkalosis plays an important role in the relief of hypercapnia in cases ofcor pulmonale.

Effect of sequential mechanical ventilation on cardiac function, endothelial injury and oxidative stress response in patients with cor pulmonale

Objective: To study the effect of sequential mechanical ventilation on cardiac function, endothelial injury and oxidative stress response in patients with cor pulmonale (CCP). Methods: Patients with cor pulmonale complicated by respiratory failure who were treated in Dongfeng People's Hospital between May 2014 and February 2017 were selected and randomly divided into the sequential group who received sequential mechanical ventilation combined with conventional therapy and the control group who received invasive positive pressure ventilation combined with conventional therapy. The serum levels of cardiac function-related neurohumoral indicators, endothelial injury indicators and oxidative stress response indicators were detected before treatment as well as 3 d and 7 d after treatment. Results: 3 d and 7 d after treatment, serum NT-proBNP, Copeptin, Ang-II, ALD, ET-1, vWF, sST2 levels of both groups of patients were significantly lower than those before treatment while NO, SOD, GSH-Px and T-AOC levels were significantly higher than those before treatment;serum NT-proBNP, Copeptin, Ang-II, ALD, ET-1, vWF, sST2, NO, 8-iso-PGF2a, MDA, SOD, GSH-Px and T-AOC levels of sequential group 3 d after treatment were not significantly different from those of control group;serum NT-proBNP, Copeptin, Ang-II, ALDET-1, vWF, sST2, 8-iso-PGF2a and MDA levels of sequential group 7 d after treatment were significantly lower than those of control group while NO, SOD, GSH-Px and T-AOC levels were significantly higher than those of control group. Conclusion: Sequential mechanical ventilation for cor pulmonale can improve the cardiac function and reduce the degree of endothelial injury and oxidative stress response.

Effect of Yiqi Huoxue (益气活血) Herbs on Vascular Endothelial Cells and Platelets in Patients with Chronic Cor Pulmonale

Objective: To observe the clinical effect of Yiqi Huoxue (益气活血, YQHX) herbs in treating the patients with chronic cor pulmonale and to explore its mechanism by determining the relationship of oxida-tion/antioxidation system and how such herbs change on the function of endothelial cells and platelets. Methods: Fifty-eight patients were divided into two groups: conventional therapy group (control group, 28 patients) and convention plus YQHX herbs group (treated group, 30 patients). The control group received conventional management. The treated group were treated with YQHX 150 ml, twice a day, plus the conventional treatment, and the clinical efficacy was recorded. The lipid peroxidation (LPO), superoxide dismutase (SOD), ot-granule membrane protein (GMP140), partial pressure of arterial oxygen (PaO2), partial pressure of carbon dioxide in artery (PaCO2) and circulating endothelial cells (CEC) were measured respectively before and after treatment, and the relationship between various parameters were analyzed. The results were compared with those of 10 healthy subjects got at the same period. Results: (1) The effective rate and PaO2 of the treated group was higher than that of the control group and there were no difference in PaCO2 between the two groups. (2) The levels of LPO, GMP140, CEC in all the patients before therapy were significantly higher than those of the healthy group, and there were marked decrease in the levels of those after treatment (all P<0. 01). On the contrary, the levels of SOD in all the patients before therapy were markedly lower than those in the healthy subjects and increased after treatment, P<0. 01. (3) The increase of SOD in the treated group was significantly more obvious than that of the control group. In the treated group, the decrease of LPO, GMP140, CEC were markedly more obvious than those in the control group (all P<0. 01). (4) The number of CEC, as well as GMP140, was negatively correlated to PaO2(P<0.01) and SOD (P< 0. 01), which was positively correlated to LPO (P<0. 01). There was a positive correlation between CEC and GMP140 (P<0.05). Conclusion: YQHX herbs in treating chronic cor pulmonale proved to be effective by balancing the oxidation and antioxidation, protecting the pulmonary endothelial cells and activated platelets and helpful in treating respiratory failure.

Magnesium Deficiency in Patients with Cor-pulmonale Caused by COPD

Since 1934,when Hirschfelder first reported magnesium(Mg) deficiency syndrome in man, considerable clinicalworks related to hypomagnesemia have appeared in medicalliterature. Recently, it is considered that Mg is a kind ofnatural antagonist of calcium (Ca). Mg has some effects onthe smooth muscles of the bronchial and pulmonary arteries,and to relax the spasm of them. Therefore, there may exista close relation between Mg and cor pulmonale caused bychronic obstructive pulmonay desease (COPD).

Cor pulmonale

950272 A clinicopathological study of cor pulmonalewith coronary heart disease.TANG Peihua(汤佩华),et al.Beijing Red Cross Chaoyang Hosp.Beijing,100020.Chin J Intern Med 1995;34(3):185-189.The necropsy findings of 18 patients with cot pui-monale and coronary heart disease(CHD) were com-pared with those of a control group of 30 patients withcor pulmonale alone.The results showed that therewas no significant statistical difference between

Cor Pulmonale

930077 The aminophyllin and cefatoxin fortreatment pulmonary heart disease of mutual in-fluence.LI Shenqi(李胜岐),et al.2nd ClinColl Dept,China Med Univ,Shenyang 110003.Chin J Tuberd & Respir Dis 1992;15(5):272-273.The serum Aminophyllin(TP)and Cefatoxin(CTX)concentration of the patients with pul-monary heart disease during acute attack weremeasured by HLPC at 2 hrs and 6 hrs after infu-sion.(1)TP and CTX alone were used.(2)TPand CTX were used simultaneously.The resultshowed that the concentrations of TP weremuch higher,but those of CTX were much low-er when CTX and TP simultaneously,at 2 hrsand 6 hrs(P【0.01,P【0.05).The concentra-

Cor pulmonale

930475 The study of prethrombotic state in pa-tients with COPD and cor pulmonale.MA Duan（马端）,et al.Thrombosis & HaemostasisLab,Shandong Traffic Hosp,Jinan,250031.ChinJ Tuberc & Respir Dis 1993;16（2）:95—97.We measured PT,TT,KPTT,Fg,vWF,AT—IILAg,AT—ⅢA,a2M,TXB2,6—keto—PGFla,PLg,tPAAg,tPAA and PAl of patients with a-cute onset of chronic bronchitis,pulmonary em-physema,and cor pulmonale.The results

Cor pulmonale

970286 Efficacy of prostaglandin EI in treatment ofcor pulmonale patients with heart failure. ZHOUShuneheng(周顺成), et al. Dept Respir Dis, 2ndPeople’S Hosp, Hubei, 434000. Chin J Tuberc RespirDis 1997; 20(2): 88-90. objective: To investigate the effects of

Adult Congenital Heart Disease in the Veteran Population:A Case-Based Report

Simple forms of congenital heart disease can allow patients to go undiagnosed until they reach adulthood.Furthermore,improvements in care of patients with complex congenital heart disease are now allowing most patients to reach adulthood.As some patients with adult congenital heart disease can remain asymptomatic until later in life,it is possible for them to serve in the military and eventually fall under the care of Veterans Administration(VA)providers.Therefore it is important for providers,especially cardiologists at VA centers,to have fundamental understanding of the management of adult congenital heart disease.This article provides multiple cases of adult congenital heart disease experienced at a single VA medical center and reviews the anatomy,physiology,and surgical management of each condition.

右美托咪定对冠心病行腹腔镜胆囊切除术患者凝血功能及Cor水平的影响

目的观察右美托咪定(Dexmedetomidine,Dex)对冠心病行腹腔镜胆囊切除术患者凝血功能及Cor水平的影响。方法选择符合2013年美国制定的有关高脂血症的诊断标准和1979年WHO制定的有关冠心病的诊断标准,择期拟行腹腔镜胆囊切除的高脂血症合并冠心病患者40例。随机分为右美托咪定0.6μg/kg组(D组)和生理盐水对照组(C组),每组20例。均采用静吸复合全麻,麻醉诱导前10 min D组患者静脉泵注右美托咪定0.6μg/kg(10 min注完),输注时间30 min;C组与D组用同样方式输注等剂量0.9%氯化钠溶液。给药后2 h取肘静脉血测定凝血功能及应激反应指标:PT、APTT、TT、FIB水平及血Cor水平,并记录手术时间、麻醉时间、手术出血量、拔管时间。结果 D组术后2 h、术后24 h的血Cor水平明显低于C组,两组比较差异有统计学意义(P<0.05)。D组的PT、APTT、TT显著长于C组,FIB含量显著低于C组,差异有统计学意义(P<0.05)。两组患者的手术时间、麻醉时间、气管拔管时间及手术出血量差异无统计学意义(P>0.05)。结论右美托咪定能改善冠心病腹腔镜胆囊切除术患者的高凝状态,并明显抑制气管拔管期引起的应激反应,不延迟术后苏醒,不增加手术出血量,适用于冠心病患者围术期。

17-OH、17-KS、VMA、ALD和COR在心血管疾病中的诊断价值

目的:探讨尿17羟皮质类固醇(17-OH)、17酮皮质类固醇(17-KS)、香草扁桃酸(VMA)、血浆醛固酮(ALD)和血清皮质醇(COR)在心血管疾病中的水平变化及应用价值。方法:应用微柱比色法和电化学发光法对116例原发性高血压(PH)患者、52例继发性高血压(SH)患者和21例冠心病(CHD)患者进行24h尿液17-OH、17-KS、VMA和血浆ALD、血清COR的检测,以30例健康人作为正常对照组。结果:与正常对照组比较,SH组17-OH、17-KS、VMA、ALD和COR水平均较对照组和PH组增高,具统计学意义(P<0.01,P<0.001);CHD组尿17-OH、17-OH和血浆ALD、血清COR水平较正常对照组明显增高,具统计学意义(P<0.01,P<0.05);相关实验显示,ALD与17-OH、17-KS之间呈正相关(r=0.502、0.796,P<0.01);COR与17-OH、17-KS之间亦呈正相关(r=0.648、0.584,P<0.01);ALD、COR与VMA之间无相关性(P>0.05)。结论:尿17-OH、17-KS、VMA、血浆ALD、血清COR水平联检在PH和SH的鉴别诊断、针对性治疗和CHD的预后判断等方面具有重要临床价值。

Corrigendum to"SEMA4D acts as a novel oligogenic pathogenic gene of idiopathic hypogonadotropic hypogonadism through the PlexinB1/MET/RND1/RHOA/RAF1/MAPK signaling axis"[Genes&Diseases 10(2023)65-68]

The authors regret to correct the error in the order of the institute of the first author,which should go as the following.

预测慢性肺心病合并心力衰竭患者不良预后的列线图和网络计算器

目的开发和验证用于预测慢性肺心病合并心力衰竭患者发生死亡的列线图并制作在线网络计算器。方法回顾性纳入美国重症监护医学信息数据库(MIMIC-Ⅳ)中2012~2018年间慢性肺心病合并心力衰竭患者资料,按7∶3比例随机分为训练集(n=820)和内部验证集(n=352),采用最小绝对值收缩和选择算子(LASSO)回归算法,单因素及多因素Logistic回归分析患者不良预后的独立危险因素,绘制预测患者不良预后的列线图并建立网络计算器。收集2022~2023年间入住于新乡医学院第一附属医院急救医学科重症监护室和呼吸与危重症医学科重症监护室的慢性肺心病合并心力衰竭患者121例作为外部验证集,通过受试者工作特征(ROC)曲线下面积(AUC)、校准曲线及临床决策曲线评价该预测模型的预测效能。结果经过LASSO及单因素及多因素Logistic回归分析发现,年龄(OR=1.026,95%CI 1.006~1.049)、乳酸(OR=1.308,95%CI 1.042~1.393)、无创收缩压(OR=0.988,95%CI 0.978~0.998)、动脉血氧分压(OR=0.998,95%CI 0.996~1.000)及是否合并肺炎并发症(OR=1.883,95%CI 1.183~2.990)是导致慢性肺心病合并心力衰竭患者出现不良预后的独立危险因素;以此构建列线图预测模型,在训练集、内部验证集及外部验证集中AUC分别为0.730(95%CI 0.679~0.781)、0.856(95%CI 0.792~0.920)及0.816(95%CI 0.740~0.892),校准曲线及临床决策曲线分析该列线图模型具有较好的预测能力。结论年龄、乳酸、无创收缩压、动脉血氧分压及是否合并肺炎并发症是导致慢性肺心病合并心力衰竭患者不良预后的独立危险因素,基于其构建的列线图及网络计算器对慢性肺心病合并心力衰竭患者具有良好的预测能力,有助于临床医师更快的进行危险分层并实施临床干预。

复方丹参注射液联合西医治疗慢性肺源性心脏病心力衰竭疗效的Meta分析

目的:系统评价复方丹参注射液联合西医治疗肺源性心脏病心力衰竭的有效性和安全性。方法:检索中国知网、万方、维普、中国生物医学文献服务系统(SinoMed)、PubMed、the Cochrane Library、EMbase等数据库建库至2022年10月1日有关复方丹参注射液联合西医治疗肺源性心脏病心力衰竭的随机对照试验(RCT)。依据纳入及排除标准筛选得到相关文献,使用RevMan 5.4和Stata 14.0对纳入研究进行Meta分析。结果:共纳入29篇文献,涉及2879例病人,其中试验组1456例,对照组1423例。试验组总有效率高于对照组[RR=1.29,95%CI(1.25,1.34),P<0.001];试验组心率减慢时间[WMD=-3.08,95%CI(-3.66,-2.51),P<0.00001]、发绀缓解时间[WMD=-2.00,95%CI(-2.72,-1.28),P<0.00001]、水肿消退时间[WMD=-2.23,95%CI(-2.51,-1.96),P<0.00001]短于对照组;试验组血流动力学指标血细胞比容[WMD=-17.36,95%CI(-29.33,-5.39),P=0.004]、全血高切黏度[WMD=-1.55,95%CI(-2.03,-1.07),P<0.00001]、全血低切黏度[WMD=-3.04,95%CI(-3.91,-2.17),P<0.001]、血浆黏度[WMD=-0.21,95%CI(-0.23,-0.19),P<0.00001]、纤维蛋白原[WMD=-0.71,95%CI(-1.03,-0.39),P<0.001]低于对照组。结论:现有证据表明,复方丹参注射液联合西医治疗肺源性心脏病心力衰竭疗效显著且安全性较好。

中药注射液治疗肺心病的系统评价再评价

[目的]本研究对中药注射液治疗肺心病的系统评价/Meta分析进行再评价,以期为临床应用中药注射液提供循证支持。[方法]计算机检索中国知网(CNKI)、中国生物医学文献数据库(SinoMed)、Embase、The Cochrane Library等8个中英文数据库,检索年限为建库至2023年3月,搜集中药注射液治疗肺心病的系统评价/Meta分析。分别使用AMSTAR-2、PRISMA 2020、GRADE系统对纳入研究的方法学质量、报告质量及证据质量进行评价。[结果]共纳入26篇系统评价/Meta分析,涉及16种中药注射液,29个结局指标。AMSTAR-2评价结果表明,纳入文献的方法学质量整体较低,无中、高质量文献,条目2(前期方案)、3(研究类型选择原因)、4(文献检索)、8(研究特征描述)、10(资助来源)具有明显缺陷。PRISMA 2020结果显示8个主题条目的报告完整度<50%,分别为检索策略、方法综合、可信度评价、结果综合、证据可信度、注册与计划书、利益冲突和补充材料。GRADE评估结果表明纳入研究中无高质量证据体,方法学质量低、结果不一致、存在发表偏倚是证据质量降级的主要因素。[结论]基于现有证据,提示中药注射液治疗肺心病有效且基本安全,有助于纠正肺心病患者的缺氧状态、改善心室收缩和舒张功能、降低肺动脉压、改善血液流变学指标。但目前已发表系统评价/Meta分析的方法学质量较低,文献报告存在一定缺陷,且证据质量等级不高,影响结果的可靠性。因此,未来需要更多高质量的临床研究和证据为中药注射液治疗肺心病的有效性和安全性提供循证支持。

Assessment of the right and left ventricular function in patients with cor pulmonale using high-definition CT

Background Cor pulmonale is often associated with changes of structure and function of the right ventricle （RV） and thus further affects functional changes of the left heart.Our study aimed to assess the left ventricular （LV） and RV function in patients with cor pulmonale using high-definition CT （HDCT）.Methods We prospectively studied 18 cor pulmonale patients determined by the pulmonary function test,clinical examination,chest radiograph,electrocardiogram,and echocardiogram.The subject group was compared to a control group consisting of 18 subjects.The RV and LV functions and RV myocardial mass （MM） were obtained by HDCT in the two groups.The results were compared between the two groups using the independent sample t test.Echocardiographic examination for cardiac function analysis was performed on the same day.Results The RV end-diastolic volume （EDV）,RV end-systolic volume （ESV） and RV myocardial mass were significantly larger in the 18 cor pulmonale patients than in the control group （P〈0.05）.The right ventricular ejection fraction （RVEF） was significantly lower in the 18 cor pulmonale patients than in controls （P〈0.01）.The left ventricular EDV （LVEDV） and LVEF were significantly lower in cor pulmonale patients than in controls （P〈0.01）.There were strong correlations between MDCT and echocardiography,rRVEF=0.839 and rLVEF=0.916,respectively.Conclusions HDCT can accurately quantify RV and LV function.The right ventricular function is impaired in patients with cor pulmonale,while at the same time the left ventricular function is also impaired.

游柏稳教授基于“肺主治节”论治慢性肺源性心脏病

随着时代发展,生活水平的提高,人们不再局限于简单的衣食住行,开始追求生活幸福感,对于健康也越发关注。近年来慢性肺源性心脏病发生率逐年上升,其可逐步发展出现肺、心功能衰竭及其他器官损害的征象,严重影响患者的生活质量,甚至威胁患者生命安全。时代在进步,中医也在不断地传承、发展和创新。目前,中医药治疗肺源性心脏病的有效性已被证实,并且中医治疗慢性肺源性心脏病也有其独特的优势。游柏稳教授行医近40年,医德高尚,自幼习读中医四大经典,擅长运用张机(字仲景)经方加减化裁治疗呼吸内科疾病,对于呼吸内科疾病有着丰富的临床经验与独到的临床辨证用药心得体会,中医临床诊疗技术卓越。研究通过总结游柏稳教授对于“肺主治节”理论的内涵,结合肺心病的病机演变及中医药治疗,介绍游柏稳教授从“虚”立足,认为肺心病“虚”是本,“瘀血、痰浊、气滞”等皆是标的治疗思路,为从事慢性肺心病防治的中医临床诊疗提供借鉴。

A cross-sectional study of acute cor pulmonale in acute respiratory distress syndrome patients in China

Background:Increased right ventricle afterload during acute respiratory distress syndrome(ARDS)may induce acute cor pulmonale(ACP),which is associated with a poor clinical outcome.Echocardiography is now considered as a rapid and non-invasive tool for diagnosis of ACP.The aims of this study were to investigate the morbidity and mortality rates of ACP in ARDS patients in intensive care units(ICUs)across the mainland of China and to determine the severity and prognosis of ACP in ARDS patients through an ultrasound protocol(TRIP).And the association between ACP related factors and the ICU mortality will be revealed.Methods:This study is a multicenter and cross-sectional study in China which will include ICU participants when diagnosed as ARDS.The ultrasound protocol,known as the TRIP,is proposed as severity assessment for ACP,which includes tricuspid regurgitation velocity(T),right ventricular size(R),inferior vena cava diameter fluctuation(I),and pulmonary regurgitation velocity(P).The 28-day mortality,ICU/hospital mortality,the length of stay in ICU,mechanical ventilation days,hemodynamic parameters and lab parameters of liver function and kidney function are all recorded.Discussion:This large-scale study would give a sufficient epidemic investigation of ACP in ARDS patients in China.In addition,with the TRIP protocol,we expect that we could stratify ACP with more echocardiography parameters.

帕金森病患者血清CysC SAA水平的变化及其与认知功能损伤的关联性分析

目的:分析帕金森(PD)患者血清胱抑素C(CysC)、淀粉样蛋白A(SAA)水平的变化及其与认知功能损伤的关系。方法:选取2019年8月至2023年8月本院接受治疗及健康体检的人群为研究对象,其中:150例PD患者为病例组,90例体检健康志愿者为对照组。采用蒙特利尔认知评估量表(MoCA)评估认知功能,对比两组人员一般资料、血CysC、SAA水平和MoCA评分。对比不同Hoehn和Yahr(H-Y)分期患者CysC、SAA水平,对比认知障碍与认知正常组CysC、SAA水平,CysC、SAA水平与H-Y分期及MoCA评分的相关性用Pearson进行分析。结果:病例组CysC、SAA水平均高于对照组,病例组MoCA评分低于对照组,差异比较均有统计学意义(P<0.05)。对照组CysC、SAA水平<早期PD组<中晚期PD组,对照组MoCA评分>早期PD组>中晚期PD组,差异比较均有统计学意义(P<0.05)。对照组CysC、SAA水平<认知正常组<认知障碍组,差异比较有统计学意义(P<0.05)。PD患者血清CysC、SAA水平与H-Y分期均呈正相关(r=0.610、0.565,P<0.05),与MoCA评分均呈负相关(r=-0.352、-0.533,P<0.05)。结论:PD患者血清中CysC、SAA水平均升高,随着H-Y分期增加CysC、SAA水平升高,MoCA评分降低,且PD患者血清CysC、SAA水平与H-Y分期均呈正相关,与MoCA评分均呈负相关。