【摘要】 目的 观察70岁以上老年心肌梗死急性期血清胱抑素C（cystatin C，CysC）水平，探讨急性心肌梗死后CysC水平变化的意义。 方法 顺序入选2010年7月-2011年7月期间70岁以上急性心肌梗死患者58例及正常对照58例。入选对象均经冠状动脉造影检查确诊或排除诊断，记录急性心肌梗死患者梗死部位和梗死相关血管，并计算Gensini积分。所有入选对象采血，使用乳胶增强免疫透射比浊法测定急性期血清CysC水平。 结果 心肌梗死急性期，血清CysC水平低于正常对照组（Plt;0.05）；不同冠状动脉病变评分与血清CysC水平呈负相关，Gensini积分越高，血清CysC水平越低。 结论 血清CysC与冠心病关系密切。检测CysC，为冠心病的风险预测、老年患者危险分层和治疗提供一条新的线索和途径。
Objective To explore the risk factors for long-term death of patients with acute myocardial infarction (AMI) and reduced left ventricular ejection fraction (LVEF), and develop and validate a prediction model for long-term death. Methods This retrospective cohort study included 1013 patients diagnosed with AMI and reduced LVEF in West China Hospital of Sichuan University between January 2010 and June 2019. Using the RAND function of Excel software, patients were randomly divided into three groups, two of which were combined for the purpose of establishing the model, and the third group was used for validation of the model. The endpoint of the study was all-cause mortality, and the follow-up was until January 20th, 2021. Cox proportional hazard model was used to evaluate the risk factors affecting the long-term death, and then a prediction model based on those risk factors was established and validated. Results During a median follow-up of 1377 days, 296 patients died. Multivariate Cox regression analysis showed that age≥65 years [hazard ratio (HR)=1.842, 95% confidence interval (CI) (1.067, 3.179), P=0.028], Killip class≥Ⅲ[HR=1.941, 95%CI (1.188, 3.170), P=0.008], N-terminal pro-brain natriuretic peptide≥5598 pg/mL [HR=2.122, 95%CI (1.228, 3.665), P=0.007], no percutaneous coronary intervention [HR=2.181, 95%CI (1.351, 3.524), P=0.001], no use of statins [HR=2.441, 95%CI (1.338, 4.454), P=0.004], and no use of β-blockers [HR=1.671, 95%CI (1.026, 2.720), P=0.039] were independent risk factors for long-term death. The prediction model was established and patients were divided into three risk groups according to the total score, namely low-risk group (0-2), medium-risk group (4-6), and high-risk group (8-12). The results of receiver operating characteristic curve [area under curve (AUC)=0.724, 95%CI (0.680, 0.767), P<0.001], Hosmer-Lemeshow test (P=0.108), and Kaplan-Meier survival curve (P<0.001) showed that the prediction model had an efficient prediction ability, and a strong ability in discriminating different groups. The model was also shown to be valid in the validation group [AUC=0.758, 95%CI (0.703, 0.813), P<0.001]. Conclusions In patients with AMI and reduced LVEF, age≥65 years, Killip class≥Ⅲ, N-terminal pro-brain natriuretic peptide≥5598 pg/mL, no percutaneous coronary intervention, no use of statins, and no use of β-blockers are independent risk factors for long-term death. The developed risk prediction model based on these risk factors has a strong prediction ability.
Objective To detect the bile acid profile in serum based on liquid chromatography-tandem mass spectrometry, and construct a combined biomarker diagnostic model for differentiating acute myocardial infarction (AMI) from unstable angina (UA). Methods A total of 180 patients with acute coronary syndrome who visited Huludao Central Hospital between August 2023 and February 2024 were randomly selected, and there were 117 patients with UA and 63 patients with AMI. Using liquid chromatography-tandem mass spectrometry, 15 bile acid subtypes in serum were detected. Orthogonal partial least squares discriminant analysis was used to compare the serum bile acid metabolic profiles of the subjects. Differences in metabolites were screened based on a significance level of P<0.05 and variable importance in projection (VIP)>1. Multiple logistic regression analysis was performed to construct a diagnostic model for differentiating AMI from UA, and the diagnostic performance of the model was evaluated using receiver operating characteristic (ROC) curve and other statistical methods. Results The differential bile acid biomarkers in the serum of UA and AMI patients included glycodeoxycholic acid, glycochenodeoxycholic acid (GCDCA), deoxycholic acid (DCA), glycocholic acid, and aurodeoxycholic acid (TDCA) (P<0.05, VIP>1). A binary logistic stepwise regression analysis showed that three bile acid biomarkers (GCDCA, DCA, and TDCA) and three common biochemical indicators (aspartate aminotransferase, creatine kinase, and total bile acid) were factors differentiating AMI from UA (P<0.05). The area under the ROC curve of the model was 0.986 [95% confidence interval (0.973, 0.999), P<0.001], demonstrating a good diagnostic performance. Conclusions GCDCA, DCA, and TDCA can serve as potential biomarkers for distinguishing AMI from UA. The model combining these three bile acids with aspartate aminotransferase, creatine kinase, and total bile acid can effectively identify AMI.
ObjectiveTo investigate the influencing factors of serum NT-proBNP level in elderly patients with acute myocardial infarction (AMI) after PCI, and to analyze its predictive value for the short-term prognosis of patients. MethodsA total of 98 elderly patients with AMI in Zhengzhou central hospital from May 2020 to August 2022 were selected, all of whom underwent PCI. The level of serum NT-proBNP before and after PCI was detected. The level of serum NT-probNP after PCI was ≥125 pg/mL, and the level of serum NT-probNP after PCI was normal. Univariate analysis of the general data of the elevated NT-proBNP group and the normal group, Lasso regression model was used to screen the screening variables, and Logistic regression was used to analyze the influencing factors of serum NT-proBNP level in elderly AMI patients after PCI. The prognosis recovery of patients with different NT-proBNP and the level of NT-proBNP in patients with different prognosis were compared and analyzed. ROC curve was drawn to analyze the predictive value of NT-proBNP level in patients with short-term prognosis after PCI. ResultsLogistic regression analysis showed that the time from onset to PCI, age, left ventricular ejection fraction (LVEF), stroke, number of stents implanted, no recirculation and stent diameter were the influencing factors of serum NT-proBNP level in elderly AMI patients after PCI. The incidence of adverse cardiovascular events (MACE) was 21.43% (21/98) in 98 patients followed up 6 months after surgery, and the incidence of NT-proBNP increased group was 68.00% (17/25), which was significantly higher than that of normal group (5.48% (4/73) (P<0.05). The level of NT-proBNP in the group with MACE was significantly higher than that in the group without MACE (P<0.05). ROC curve showed that AUC was 0.813 (95%CI 0.721 to0.884), sensitivity and specificity were 80.95% and 79.22%, respectively, suggesting that serum NT-proBNP level after PCI had certain predictive value for short-term prognosis of patients. ConclusionSerum NT-proBNP level in elderly AMI patients after PCI has a good ability to predict the short-term prognosis of patients. Comprehensive consideration of the number of stents inserted, the presence of stroke, the presence of reflow and age and other factors to strengthen the monitoring of NT-proBNP level is helpful to prevent and control the occurrence of MACE, so as to improve the prognosis of patients.
目的 探讨急性心肌梗死冠状动脉介入治疗（PCI）术后患者梗死区心肌存活性对左室重构及功能的影响。 方法 2006年2月－2010年12月208例急性心肌梗死急诊PCI术后的患者接受静息状态下18氟-脱氧葡萄正电子断层显像进行心肌代谢显像检查，根据基线梗死区心肌有无存活分为两组，同时进行超声心动图检查，评价左室壁运动、左室射血分数，左室舒张末内径、左房内径及舒张期二尖瓣血流速度峰值的比值。血运重建术后12个月随访超声心动图，观察梗死区心肌存活状态对于左室重构以及心功能的影响。 结果 PCI术后12个月，有存活心肌组左室射血分数（46.7 ± 6.98）%高于无存活心肌组（45.1 ± 7.12）%，两组差异有统计学意义（P＜0.01），有存活心肌组左室舒张末期内径（53.17 ± 3.89） mm小于无存活心肌组（55.46 ± 4.75） mm，两组差异有统计学意义（P＜0.05）。左房内径及舒张期二尖瓣血流速度峰值的比值两组随访时均无明显变化。 结论 急性心肌梗死行PCI治疗后的患者，在有存活心肌的情况下，心功能改善明显；而梗死区无心肌存活的患者，12个月后，心功能减低，左室重构更加明显。
In order to construct and express human cardiac troponin C-linker-troponin I(P) fusion protein, detect its activity and prepare lyophilized protein, we searched the CDs of human cTnC and cTnI from GenBank, synthesized cTnC and cTnI(30-110aa) into cloning vector by a short DNA sequence coding for 15 neutral amino acid residues. pColdⅠ-cTnC-linker-TnI(P) was constructed and transformed into E. coli BL21(DE3). Then, cTnC-linker-TnI(P) fusion protein was induced by isopropyl-β-D-thiogalactopyranoside (IPTG). Soluable expression of cTnC-linker-TnI(P) in prokaryotic system was successfully obtained. The fusion protein was purified by Ni2+ Sepharose 6 Fast Flow affinity chromatography with over 95% purity and prepared into lyophilized protein. The activity of purified cTnC-linker-TnI(P) and its lyophilized protein were detected by Wondfo FinecareTM cTnI Test. Lyophilized protein of cTnC-linker-TnI(P) was stable for 10 or more days at 37℃and 4 or more months at 25℃and 4℃. The expression system established in this research is feasible and efficient. Lyophilized protein is stable enough to be provided as biological raw materials for further research.
ObjectiveTo systematically review the efficacy of early use of heparin for thrombolytic therapy in patients with acute myocardial infarction (AMI). MethodsThe Chinese databases involving VIP, CNKI, WanFang Data, CBM and foreign language databases including PubMed and The Cochrane Library (Issue 1, 2013) were electronically searched from inception to January 2013. Randomized controlled trials (RCTs) on early use of heparin in the treatment of AMI were included. Two reviewers assessed the quality of each trial and extracted data independently according to the Cochrane Handbook. RevMan5.2 software was used for statistical analysis. ResultsA total of 23 RCTs involving 2 697 patients were included. The results of meta-analysis showed that the heparin group was superior to the control group in increasing of the rate of coronary artery recanalization, decreasing the time of recanalization, reducing the rate of re-infarction and the death rate, and decreasing the time of ST-T fell for 50%, the time of enzyme peak showed and the time of chest pain relief. There had no significant difference observed in the incidence of adverse reaction between the two groups. ConclusionIt is effective to use heparin before thrombolytic therapy in AMI.