Prognostic value of N -terminal pro B-type natriuretic peptide and troponin I in children with dengue shock syndrome

Objective:To investigate the contribution of N-terminal pro B-type natriuretic peptide(NT-pro BNP)and troponin I to mortality in children with dengue shock syndrome.Methods:A longitudinal study was conducted on children with dengue shock syndrome in a hospital in southern Vietnam.Detailed clinical histories,physical examinations,and laboratory parameters,including NT-pro BNP and troponin I,were recorded.A comparison between survival and non-survival was carried out to identify factors influencing mortality.Results:A total of 107 patients with a median age of 9 years were included in the study.Among them,63.6%(68/107)presented with compensated shock,36.4%(39/107)had hypotensive shock,23.4%(25/107)required mechanical ventilation,and 12.1%(13/107)died.The NT-pro BNP levels were 3.9 pmol/L(IQR:1.9,10.3)and 15.2 pmol/L(5.8,46.3),while the median high sensitivity troponin I levels were 20 pg/L(6,95)and 62 pg/L(12,325)at the first and second measurements,respectively.The mortality group exhibited higher rates of hypotensive shock,prolonged shock,lactate levels,liver damage,NT-pro BNP,and troponin I levels.Hypotensive shock(OR 12.96,95%CI 2.70-62.30,P=0.004),prolonged shock(OR 39.40,95%CI 6.68-232.70,P<0.001),AST>1000 IU/L(OR 9.50,95%CI 2.63-34.34,P=0.041),and NT-pro BNP>7 pmol/L(OR 44.40,95%CI 5.44-362.20,P=0.001)were identified as predictive factors for mortality in dengue shock syndrome.Conclusions:The NT-pro BNP level could serve as a potential biomarker for predicting mortality in children with dengue shock syndrome.

Changes in Urinary Metabolomics of Female Kashin-Beck Disease Patients in Qinghai-Tibet Plateau,China

Kashin-Beck disease(KBD)is a chronic,endemic,degenerative osteoarthropathic condition that is predominantly found in China's Mainland.KBD is a progressive disease,and the signs and symptoms become more severe in adulthood owing to the continuous development of lesions in the joint cartilage[1].Although childhood KBD has largely been controlled,adult KBD is an important health concern in rural regions.Unfortunately,in the last century,many adult KBD patients still remain during serious epidemics.

Metabolomic Profiling of Mice Exposed toα-amanitin Using Ultra-performance Liquid Chromatography Quadrupole Time-of-flight Tandem Mass Spectrometry

Numerous instances of poisoning caused by the ingestion of mushrooms are reported annually worldwide,with most mushroom poisoning deaths caused by the ingestion of toxic amanita fungi.Amatoxin is the main toxic component of amanita,andα-amanitin is one of the most potent toxins present in amatoxin[1].

Metabotropic glutamate receptor 1 alpha:a unique receptor variant with variable implications for Alzheimer’s disease pathogenesis

Alzheimer’s disease (AD) is the leading neurodegenerative disorder globally.Despite this,there is minimal effective therapeutics proven to reduce or prevent the progression of this disease.Glutamate is the main excitatory neurotransmitter within the central nervous system and plays a crucial role in neuronal and synaptic functions.

Computed tomography coronary angiography after excluding myocardial infarction:high-sensitivity troponin versus risk score-guided approach

BACKGROUND:Patients with suspected acute coronary syndrome (ACS) in whom myocardial infarction has been ruled out are still at risk of having obstructive coronary artery disease (CAD).This rate is higher among patients with intermediate high-sensitivity troponin I (hsTnI) concentrations (5 ng/L to 99th percentile) than low concentrations (<5 ng/L).Therefore,an intermediate concentration has been suggested as a candidate for downstream investigation with computed tomography coronary angiography(CTCA).We tried to compare the HEART score-guided vs.hsTnI-guided approach for identifying obstructive CAD.METHODS:From a prospective cohort study of patients presenting to the emergency department with suspected ACS,433 patients without elevated hsTnI who also underwent CTCA were selected and analyzed.The performances of hsTnI concentration and HEART score were compared using sensitivity,specificity,positive predictive value (PPV),and negative predictive value (NPV).RESULTS:Overall,120 (27.7%) patients had obstructive CAD.Patients with intermediate hsTnI concentrations were more likely to have obstructive CAD than those with low hsTnI concentrations(40.0%vs.18.1%);patients with non-low-risk HEART scores (≥4 points) were also more likely to have obstructive CAD than those with low-risk scores (0 to 3 points)(41.0%vs.7.6%).The HEART score had higher sensitivity and NPV for detecting obstructive CAD in each classification than hsTnI concentration (sensitivity:89.2%vs.63.3%;NPV:92.4%vs.81.9%,respectively).CONCLUSION:After excluding myocardial infarction in patients with suspected ACS,adding the HEART score for selecting candidates for CTCA could improve patient risk stratification more accurately than relying on hsTnI concentration.

Remdesivir, dexamethasone and angiotensin-converting enzyme inhibitors use and mortality outcomes in COVID-19 patients with concomitant troponin elevation

BACKGROUND There are indications that viral myocarditis,demand ischemia,and renin-angio-tensin-aldosterone system pathway activation play essential roles in troponin elevation in coronavirus disease 2019(COVID-19)patients.Antiviral medications and steroids are used to treat viral myocarditis,but their effect in patients with elevated troponin,possibly from myocarditis,has not been studied.AIM To evaluate the effect of dexamethasone,remdesivir,and angiotensin-converting enzyme(ACE)inhibitors(ACEI)on mortality in COVID-19 patients with elevated troponin.METHODS Our retrospective observational study involved 1788 COVID-19 patients at seven hospitals in Southern California,United States.We did a backward selection Cox multivariate regression analysis to determine predictors of mortality in our study population.Additionally,we did a Kaplan Meier survival analysis in the subset of patients with elevated troponin,comparing survival in patients that received dexamethasone,remdesivir,and ACEI with those that did not.RESULTS The mean age was 66 years(range 20-110),troponin elevation was noted in 11.5%of the patients,and 29.9%expired.The patients'age[hazard ratio(HR)=1.02,P<0.001],intensive care unit admission(HR=5.07,P<0.001),and ventilator use(HR=0.68,P=0.02)were significantly associated with mortality.In the subset of patients with elevated troponin,there was no statistically significant difference in survival in those that received remdesivir(0.07),dexamethasone(P=0.63),or ACEI(P=0.8)and those that did not.CONCLUSION Although elevated troponin in COVID-19 patients has been associated with viral myocarditis and ACE II receptors,conventional viral myocarditis treatment,including antiviral and steroids,and ACEI did not show any effect on mortality in these patients.

Role of NT-proBNP and Troponin I in Assessing the Severity of Pulmonary Embolism

Introduction: Pulmonary embolism is a diagnostic and therapeutic emergency that can be life-threatening. Its mortality is largely attributable to severe forms classically defined by clinical and morphological criteria. The aim of this study is to establish the role of two cardiac biomarkers (NT-proBNP and troponin) in assessing the severity of pulmonary embolism. Patients and Methods: We conducted a descriptive and analytical cross-sectional study. Data collection was retrospective over the period from January 1, 2011 to December 31, 2021. All patients hospitalized for pulmonary embolism in two cardiology referral clinics in Cotonou (Atinkanmey Polyclinic and CICA Clinic) were included. Results: The hospital prevalence of pulmonary embolism was 9.08%. The mean age was 52.6 years, with extremes of 18 and 92 years. The sex ratio was 0.73. Pulmonary embolism was severe according to hemodynamic, morphological and sPESI criteria in 12%, 24% and 39% of cases respectively, and mortality was 61.53%. Mean NT-ProBNP and troponin I levels were significantly higher in patients with severe criteria than in those without. NT-proBNP and troponin had good specificity for predicting cardiovascular arrest (99% and 90%), shock (100% and 98%), and hypotension (99% and 96%). NT-proBNP has the best positive predictive values in relation to the occurrence of shock (100%) and right ventricular dilatation (93%). The best correlation coefficient was obtained between right ventricular dilatation and NT-proBNP (0.78). Conclusion: NT-proBNP and troponin I are good biomarkers for predicting the severity of pulmonary embolism and allowing therapeutic adaptation when they are elevated.

临床相关因素对急性一氧化碳中毒性心脏病患者近期预后的影响

目的探讨临床相关因素对急性一氧化碳中毒性心脏病患者近期预后的影响。方法回顾性分析2020年8月—2023年2月于阜阳市人民医院收治的100例急性一氧化碳中毒患者的临床资料,其中合并中毒性心脏病的患者60例,根据患者心脏病严重程度分为A组、B组及C组。A组31例为轻度心脏病,B组20例为中度心脏病,C组9例为重度心脏病,未合并中毒性心脏病患者40例作为对照组。记录三组患者基础资料,比较其入院时、入院3d时及出院时的肌酸激酶同工酶(CK-MB)、心肌酶肌钙蛋白(cTnI)水平。采用二元回归分析法和Spearman相关法分析CK-MB、cTnI等临床因素和患者近期预后的相关性。结果C组患者APACHEⅡ评分、住院时间及昏迷时间均明显高于A、B组(P<0.05)。入院3d时,C组的CK-MB、cTnI水平明显高于A、B组(P<0.05)。经多因素分析显示,cTnI是急性一氧化碳中毒性心脏病患者近期预后的主要影响因素(P<0.05),而CK-MB与近期预后无关(P>0.05)。结论cTnI水平和急性一氧化碳中毒性心脏病患者的病情程度显著相关,cTnI水平的升高,标志着患者病情的加重。

肌钙蛋白即时检验在急性冠状动脉综合征疑似患者院前急救中的应用

目的探讨疑似急性冠状动脉综合征(ACS)在院前急救车上应用即时检验(POCT)检测肌钙蛋白Ⅰ(cTnⅠ)的优势及可行性分析。方法将2019年5月—2020年5月北京急救中心院前接诊的60例疑似急性冠状动脉综合征(ACS)患者,通过现场抽签的方式随机分为试验组30例和对照组30例,对照组常规收集患者病史资料、进行体格检查和心电图测量,试验组在对照组基础上增加POCT检测cTnⅠ,比较两组患者急诊停留时间(EDLOS)、从首次医疗救治(FMC)到接受血运重建时间、出院45 d不良心血管事件发生率。结果试验组EDLOS较对照组更短(P<0.05),试验组从FMC到接受血运重建时间较对照组更短(P<0.05),试验组出院45 d不良心血管事件发生率较对照组更低(P<0.05)。结论院前应用POCT检测cTnⅠ能够缩短疑似ACS患者的EDLOS、缩短从FMC到接受血运重建时间、降低出院45 d不良心血管事件的发生率,对院前疑似ACS患者的早期诊断及预后具有一定的临床参考价值。

急性心肌梗死合并急性左心衰患者血清铁调素/铁蛋白比值与临床救治效果的关系

目的 探讨急性心肌梗死合并急性左心衰竭(简称急性左心衰)患者血清铁调素/铁蛋白比值与临床救治效果的关系。方法 将绵阳市中心医院2020年1月至2023年5月收治的303例急性心肌梗死合并急性左心衰患者作为研究对象,根据其治疗1周的临床救治效果分为有效组与无效组,观察两组入院时、治疗1周时血清铁调素、铁蛋白及其比值变化情况,统计并比较两组一般资料及其他实验室指标包括血红蛋白、高敏肌钙蛋白、N端脑利钠肽前体等,通过点二列相关性分析入院时血清铁调素、铁蛋白及其比值与患者临床救治效果的关系,并通过受试者工作特征(ROC)曲线评价入院时血清铁调素、铁蛋白及其比值预测患者救治效果的价值;同时选取2023年5月至2023年10月医院收治的另外68例急性心肌梗死合并急性左心衰患者作为验证对象,通过ROC曲线进一步验证血清铁调素/铁蛋白比值对患者救治效果的预测价值。结果 本研究根据纳入、排除标准共选取308例患者为研究对象,最终303例患者完成救治效果评价,其中有效257例(84.82%)。与有效组比较,无效组入院时、治疗1周时血清铁调素及其与铁蛋白比值均较高,血清铁蛋白水平较低(P<0.05)。与入院时比较,有效组治疗1周时血清铁调素及其与铁蛋白比值均降低,血清铁蛋白水平均升高(P<0.05),但无效组入院时、治疗1周时血清铁调素、铁蛋白及其比值差异无统计学意义(P>0.05)。两组入院时高敏肌钙蛋白、N端脑利钠肽前体、血红蛋白水平比较差异有统计学意义(P<0.05)。点二列相关性发现,患者临床救治效果与入院时血清铁调素水平及其与铁蛋白比值呈正相关(r>0,P<0.05),与入院时血清铁蛋白水平呈负相关(r<0,P<0.05)。ROC曲线发现,入院时血清铁调素、铁蛋白及其比值对患者救治效果均有一定预测价值,且二者比值预测价值更高。加以验证的ROC曲线结果显示,入院时血清铁调素/铁蛋白比值对患者救治效果仍有良好的预测价值。结论 急性心肌梗死合并急性左心衰患者入院时血清铁调素/铁蛋白比值与临床救治效果有关,可辅助临床早期预测患者救治效果,指导救治方案的及时调整。

超声心动图联合血清cTnI、GDF-15检测对老年乳腺癌患者术后化疗心脏损伤的评估价值

目的探究超声心动图联合血清心肌肌钙蛋白I(cTnI)、生长分化因子-15(GDF-15)对老年乳腺癌(BC)患者术后化疗心脏损伤的评估价值。方法选取北京市大兴区人民医院2019年9月至2022年8月收治的112例老年BC术后应用表柔比星为主的化疗患者为研究对象,按照是否发生心脏损伤将其分为:心脏损伤组(40例)和心脏未损伤组(72例)。评估超声心动图对老年BC患者术后化疗心脏损伤的诊断价值;采用酶联免疫吸附法检测两组血清cTnI、GDF-15水平;采用受试者工作特征曲线评估血清cTnI、GDF-15对老年BC患者术后化疗心脏损伤的诊断价值;以心脏损伤判定标准为金标准,评价超声心动图、血清cTnI、GDF-15及三者联合对老年BC患者术后化疗心脏损伤的诊断价值。结果超声心动图诊断老年BC患者术后化疗心脏损伤的灵敏度、特异度、准确度分别为77.50%、88.89%、84.82%;心脏损伤组患者血清cTnI、GDF-15水平均明显高于心脏未损伤组(P<0.05);血清cTnI、GDF-15诊断老年BC患者术后化疗心脏损伤的曲线下面积分别为0.864、0.834,截断值分别为221.88 ng/L、8.06 ng/L,灵敏度分别为75.00%、80.00%,特异度分别为94.44%、87.50%,准确度分别为87.50%、84.82%;超声心动图联合血清cTnI、GDF-15诊断老年BC患者术后化疗心脏损伤的灵敏度、特异度、准确度分别为97.50%、86.11%、90.18%,优于单独诊断。结论超声心动图联合血清cTnI、GDF-15对老年BC患者术后化疗致心脏损伤有较高诊断价值,可有效提高灵敏度、准确度,具有较高特异度。

COPD急性加重期患者外周血单个核细胞SOCS-1、TLR4 mRNA及血清cTnT、尿酸水平变化分析

目的探讨慢性阻塞性肺疾病(COPD)急性加重期患者外周血单个核细胞中细胞因子信号抑制蛋白-1(SOCS-1)、Toll样受体4(TLR4)mRNA水平及血清心肌肌钙蛋白T(cTnT)、尿酸水平变化。方法收集COPD急性加重期(组)患者70例,COPD稳定期(组)患者40例,对照组健康志愿者40名。检测外周血单个核细胞SOCS-1、TLR4 mRNA水平及血清cTnT、尿酸浓度;行肺功能检查并记录相关指标(FEV1、FEV1%、FEV1/FVC%)。对COPD急性加重期患者进行1 a随访,分为预后不良组和预后良好组。对外周血单个核细胞SOCS-1、TLR4 mRNA水平、血清cTnT、尿酸浓度行Pearson相关性分析,并对COPD急性加重期患者预后评估价值进行ROC曲线分析。结果COPD急性加重期组SOCS-1 mRNA表达水平明显低于COPD稳定期组、对照组,TLR4 mRNA水平及血清cTnT、尿酸浓度明显高于COPD稳定期组和对照组(均P<0.01)。COPD急性加重期组FEV1、FEV1%、FEV1/FVC%明显低于COPD稳定期组和对照组(P<0.05)。COPD急性加重期患者FEV1/FVC%与外周血单个核细胞SOCS-1 mRNA表达水平呈正相关关系(P<0.01),与外周血单个核细胞TLR4 mRNA水平及血清cTnT、尿酸浓度呈负相关关系(P<0.01)。预后不良组SOCS-1 mRNA水平明显低于预后良好组,TLR4 mRNA水平及血清cTnT、尿酸浓度明显高于预后良好组(P<0.05)。外周血单个核细胞SOCS-1、TLR4 mRNA水平及血清cTnT、尿酸联合检测对COPD急性加重期患者预后具有较高的评估价值。结论COPD急性加重期患者SOCS-1低表达,TLR4、cTnT、尿酸高表达,且与肺功能水平密切相关,联合检测对患者预后具有较高的评估价值。

血乳酸、乳酸清除率与急性心肌梗死患者冠状动脉病变严重程度及预后相关性分析

目的探究血乳酸、乳酸清除率与急性心肌梗死(AMI)患者冠状动脉病变严重程度及预后的相关性。方法选取2022年11月—2023年12月收治的150例AMI作为研究对象,所有患者入院后行动脉血乳酸检查,根据入院时乳酸水平分为对照组(乳酸正常)66例与观察组(乳酸升高)84例,2组均进行冠状动脉造影检查,比较2组一般资料、冠状动脉病变严重程度、预后情况,并采用多因素Logistic回归分析探究乳酸与AMI患者冠状动脉病变严重程度及预后的关系。结果观察组吸烟、高血压病、糖尿病比例以及B型脑钠肽、肌钙蛋白、血乳酸水平高于对照组,左心室射血分数、乳酸清除率低于对照组(P<0.05,P<0.01);观察组单支病变比例低于对照组,多支病变比例高于对照组(P<0.05);观察组主要心血管不良事件总发生率高于对照组(P<0.05)。多因素Logistic回归分析结果显示:AMI患者冠状动脉病变支数(OR=3.271;95%CI:1.487,7.192;P=0.003)、预后(OR=2.622;95%CI:1.233,5.577;P=0.013)与乳酸升高有关。结论血乳酸水平、乳酸清除率与AMI患者冠状动脉病变严重程度、预后存在密切联系,入院时乳酸水平检测有利于临床对AMI病情与预后进行判断。

晚发型母乳性黄疸对患儿心肌损害的临床研究

目的 探讨晚发型母乳性黄疸对患儿心肌细胞影响及早期干预治疗的临床价值。方法 回顾复习本院儿科中心2020年4月至2022年1月收治的晚发型母乳性黄疸患儿86例病历资料,依据胆红素水平分别分为轻度组和中重度组。选取同期在本院儿童保健门诊查体足月健康新生儿60例为对照组。研究组患儿于入院当日黄疸高峰期、黄疸消退期留取静脉血2~3 mL检测血清总胆红素、心肌酶谱(CK、CK-MB)、肌钙蛋白I(cTnI);对照组常规检测上述项目,并对检测结果进行统计学分析。结果 在黄疸高峰期,中重度组心肌酶谱(CK、CK-MB)、cTnI水平较轻度组和对照组均有升高,差异均有统计学意义(P<0.05);轻度组心肌酶谱(CK、CK-MB)、cTnI水平与对照组比较差异无统计学意义(P>0.05)。在黄疸消退期,轻度组、中重度组心肌酶谱(CK、CK-MB)、cTnI水平与对照组比较差异均无统计学意义(P>0.05)。中重度组患儿黄疸高峰期,cTnI检出率为51.4%(18/35),明显高于CK、CK-MB检出率[17.1%(6/35),25.7%(9/35)],差异有统计学意义(P<0.05)。结论 检测血清心肌酶谱(CK、CK-MB)、cTnI能够及早发现晚发型母乳性黄疸患儿心肌损害情况,血清胆红素水平越高,心肌损害越严重,早期干预治疗有一定的临床价值。

NT-proBNP、cTnI、Mb对风湿性心脏病患者人工瓣膜置换术预后情况的预测价值

目的:探讨N-末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)、肌红蛋白(Mb)对风湿性心脏病(RHD)人工瓣膜置换术预后情况的预测价值。方法:选取2020年1月-2022年12月烟台市烟台山医院收治的RHD患者60例为研究对象,均接受人工瓣膜置换术治疗。比较预后良好组(n=47)、预后不良组(n=13)NT-proBNP、cTnI、Mb、左室射血分数(LVEF)水平,分析NT-proBNP、cTnI、Mb与LVEF的相关性,分析NT-proBNP、cTnI、Mb对RHD预后不良的预测效能。结果:预后不良组NT-proBNP、cTnI、Mb水平高于预后良好组,LVEF水平低于预后良好组,差异有统计学意义(P<0.05)。Pearson相关性分析结果显示,NT-proBNP、cTnI、Mb分别与LVEF呈负相关,差异有统计学意义(r=-0.685、-0.636、-0.614,P=0.016、0.022、0.027)。NT-proBNP、cTnI、Mb联合预测RHD预后不良的曲线下面积高于各单一指标,差异有统计学意义(P<0.05)。结论:NT-proBNP、cTnI、Mb与RHD预后情况相关,RHD患者血清NT-proBNP、cTnI、Mb含量升高,提示病情恶化风险增加,NT-proBNP、cTnI、Mb联合预测RHD预后有一定价值。

电刺激和延迟冷却对宰后牛肉肌原纤维Troponin-T降解的影响

为了探讨牛肉嫩化的机理,选择24头24月龄,体重约500kg杂交牛(鲁西黄牛×西门塔尔)随机分成4组,在宰前或宰后分别进行以下4种处理:常规预冷组,延迟冷却组,电刺激处理组,电刺激和延迟冷却处理组。用SDS-PAGE和蛋白免疫印迹的方法比较分析了4种处理牛肉成熟1,3,7,10d其肌原纤维骨架蛋白Troponin-T的降解情况。结果表明:与常规冷却组相比,电刺激处理在1、3、7d时显著加快了Troponin-T的降解,而10d时差异不显著;延迟冷却处理在1、3d时显著加快了Troponin-T的降解,而7、10d时差异不显著;1、3d时延迟冷却对Troponin-T的降解影响比电刺激显著,而7、10d时则是电刺激比较显著;电刺激和延迟冷却处理的结合对Troponin-T降解的影响比电刺激处理组、延迟冷却处理组显著。综上可见,延迟冷却、电刺激无论在速度和数量上显著加快了Troponin-T的降解,加快了牛肉成熟,缩短了成熟时间,且二者有协同作用。

虾过敏原Troponin C(Pen m6)的克隆表达、免疫学鉴定及生物信息学分析

目的对斑节对虾(Penaeus monodon)第6组过敏原(Pen m6),肌钙蛋白C(Troponin C)进行克隆表达、免疫学鉴定并研究其生物学意义。方法提取斑节对虾总RNA;根据Gen Bank:HM034316.1设计引物及构建表达载体PET-24a-Pen m6;转化至大肠杆菌BL21(DE3)进行表达;纯化后的重组Pen m6用Western bolt来鉴定免疫学特性;用生物信息学相关工具对Pen m6进行同源性分析,并预测其蛋白质的结构和功能。结果克隆出斑节对虾Pen m6基因开放阅读框453 bp,编码150个氨基酸。重组Pen m6蛋白呈可溶性,分子量约35kDa,能够与斑节对虾过敏患者血清IgE结合。斑节对虾与凡纳滨对虾亲缘关系比较近,其中斑节对虾Pen m6蛋白与凡纳滨对虾Troponin C1(gb|AET36896.1|)同源性为98%。理化性质预测Pen m6蛋白质不稳定。蛋白质结构预测结果显示Pen m6的结构主要以α螺旋组成。T细胞抗原表位预测得到4个肽序列(15~23、35~43、91~99、112~120)。B细胞抗原表位预测得到4个肽序列(7~16、21~30、28~37、58~67)。结论克隆的重组斑节对虾Pen m6蛋白具有良好的免疫原性,为进一步研究斑节对虾过敏原的结构成分及其理化性质奠定理论基础。

血清Troponin I,CK-MBmass,Myoglobin在急性心肌梗塞诊断中的应用评价

为了解CTnI，CK－MBmass和Mb指标对急性心肌梗塞（AMI）早期诊断、后期监测及预后判断的临床意义，采用微粒子化学发光法，对20例AMI患者、24例不稳定心绞痛（UA）患者、17例骨骼肌损伤（SM）患者和19例健康者（对照组）进行血清CTnI，CK－MBmass和Mb的测定，并对AMI患者胸病发生3～5小时，8～14小时，20～24小时，72小时和7天共五个时段进行了测定。结果：AMI患者发病早期CTnI，CK－MBmass和Mb的阳性检出率分别为65％，70％，70％，CTnI在UA患者组和SM患者组中未检出。CTnI，CK－MBmass和Mb测定值含量在AMI组中明显高于UA组和SM组，AMI患者组CTnI分别是UA组和SM组的84倍和91.63倍，CK－Mbmass分别是该二组的8．82倍和4．67倍，Mb分别是该二组的11．57倍和2．25倍，AMI组与UA组和SM组比较，有显著性差异（P＜0．001）。AMI患者组中该三项指标的动态测定显示，在疾病发生早期（3～5小时）时，CTnI，CK－MBmass和Mb都有显著性升高，随时间延长而逐渐升高，高峰值期均在8～14小时段，72小时时Mb已基本回到正常。7天时血清中仍有CTnI的持续存在，但CK－MBmass已接近正常。以上显示，CTnI，CK－MBmass和Mb在早期诊断AMI时，都具有较高的敏感性，CTnI在AMI患者中的阳性检出率具有心肌特异性。

内源性因素对抗体夹心免疫法检测血清心肌肌钙蛋白Ⅰ的干扰及解决方案研究进展

心肌肌钙蛋白Ⅰ(cardiac troponinⅠ,cTnⅠ)是临床上诊断心肌损伤的首选血清学标志物。cTnⅠ检测基于抗体夹心免疫法,不同检测试剂中检测和捕获抗体所针对的cTnⅠ抗原表位不一致,易造成cTnⅠ检测结果的异质性。内源性干扰因素如cTnⅠ自身抗体、异嗜性抗体、类风湿因子等可严重的干扰cTnⅠ检测结果,影响临床上对心肌损伤类疾病的诊断、治疗及预后判断。该文就cTnⅠ的抗体夹心免疫检测和内源性因素对cTnⅠ检测的干扰及解决方案等方面研究进展作一综述,为临床上鉴别诊断cTnⅠ异常检测结果提供理论依据。

基于心脏磁共振组织追踪技术评估合并T_(2)高信号的肥厚型心肌病患者左心室心肌损伤

目的:采用心脏磁共振组织追踪技术(CMR-FT)评估合并T_(2)高信号的肥厚型心肌病(HCM)患者左心室心肌损伤,同时探讨血清心肌酶学指标与心肌T_(2)高信号的相关性。方法:回顾性分析50例HCM患者的病例资料,根据是否合并T_(2)高信号分为HCM-T_(2)(+)组(20例)和HCM-T_(2)(-)组(30例),根据肌钙蛋白是否升高分为肌钙蛋白升高组[cTnI(+)组]和肌钙蛋白正常组[cTnI(-)组]。另外收集26例无明显心血管疾病受试者为对照组。比较上述各组间心脏磁共振左心室应变整体纵向应变(GLS)、整体环向应变(GCS)及整体轴向应变(GRS)的差异。绘制ROC曲线评价心肌损伤标记物诊断心肌内T_(2)高信号的能力。结果:HCM组左心室GLS、GCS、GRS均较健康对照组降低(P均<0.05)。此外,HCM-T_(2)(+)组左心室GLS、GCS、GRS均较HCM-T_(2)(-)组降低更为明显(P均<0.05)。cTnI(+)组较cTnI(-)组GRS明显降低(P<0.05),血清中肌钙蛋白的升高对预测心肌内T_(2)高信号有一定的价值。结论:HCM患者左心室整体应变存在损伤,其中合并局灶性心肌水肿的HCM患者应变损伤更为明显。血清中肌钙蛋白的升高意味着HCM患者心肌损伤更严重,HCM患者血清中肌钙蛋白的升高可以提示HCM患者局灶性心肌水肿的出现。