全数字化X线摄影联合MR动态增强检查诊断早期乳腺癌的临床价值研究

目的：分析早期乳腺癌的全数字X线摄影与MRI影像学表现,评价全数字X线摄影联合MRI检查在早期乳腺癌诊断中的临床价值。方法：回顾性分析2009年10月至2012年5月在我院经穿刺或手术病理证实为早期乳腺癌的42例患者的临床资料,术前均行数字X线及动态增强MR检查,比较两种方法单独使用和联合使用的诊断乳腺癌的准确率。结果：全数字化X线摄片诊断早期乳腺癌的准确率为69．0％（29／42）,动态增强MR检查为95．2％（40／42）,两者比较差异有统计学意义（P〈0．05）;两者联合使用诊断早期乳腺癌的准确率为97．6％（41／42）。结论：动态增强MR检查对早期乳腺癌的诊断价值明显优于全数字X线摄影,但后者对微小钙化显示较好,两者联合可提高诊断正确率,尤其对多腺体型和致密型乳腺的早期乳腺癌的检出具有重要的价值。     

宫腔镜联合腹腔镜在女性不孕症诊治中的应用

目的：探讨宫腔镜联合腹腔镜在女性不孕诊断及治疗中的临床应用价值。方法：回顾性分析60例我院收治的采用宫腔镜联合腹腔镜进行诊断和治疗的女性不孕症患者为研究对象,对其临床资料进行分析。结果：宫腔镜联合腹腔镜检查发现,60例不孕症患者中,56．7％的患者患有慢性盆腔炎,16．7％的患者为子宫内膜异位症,11．7％的患者为多囊卵巢综合征;单纯腹腔镜检查的阳性检出率为60．0％,单纯宫腔镜检查的阳性检出率为28．3％,宫腔镜联合腹腔镜检查的阳性检出率高达91．7％,宫腔镜联合腹腔镜镜栓阳性发现率明显高于前二者（P〈0．05）。治疗前,双侧不通、一侧通畅和双侧输卵管通畅的患者分别为38．3％、48．3％和13．3％,经宫腔镜联合腹腔镜治疗后分别为11．7％、50．o％和38．3％,差异均有统计学意义（P〈0．05）。34例原发性不孕患者,术后13例妊娠,妊娠率38．2％;26例继发性不孕患者,术后15例妊娠,妊娠率57．7％;总妊娠率为46．7％,其中宫外孕2例。结论：宫腔镜联合腹腔镜检查可帮助明确女性不孕症患者明确原因及发病部位,并可针对病因进行治疗,提高女性不孕症的病因诊断准确率及治愈率。     

原发性十二指肠恶性肿瘤的临床分析

目的：探讨原发性十二指肠恶性肿瘤的临床特点、诊断方法和预后影响因素。方法：回顾性分析随访资料完整的45例原发性十二指肠恶性肿瘤患者的临床病理资料。结果：腺癌33例（73.3％）为主要的病理类型。主要临床表现为腹痛、上腹部不适、黄疸、消化道出血等。胃十二指肠镜、内镜逆行胰胆管造影（Endoscopic Retrograde Cholangio—Pancreatography,ERCP）、十二指肠低张造影、超声内镜、CT及B超确诊率分别为91．1％（41／45）,93．3％（42/45）,82．2％（37／45）,75．6％（34N5）,68．9％（31／45）及26．7％（12／45）。本组45例均行开腹手术,包括根治性手术,胰十二指肠切除术36例;姑息性手术,胃肠吻合术2例、肿瘤局部切除术5例、短路手术2例。根治术和姑息术后5年生存率分别为46．7％和4．4％,两组生存率差异有统计学意义（P〈O．05）。对全组45例患者的预后因素进行Cox回归分析的结果显示,手术方式、肿瘤浸润深度和淋巴节转移是影响预后的独立危险因素（均P〈0．05）。结论：原发性十二指肠恶性肿瘤缺乏特异性临床表现;胃十二指肠镜、ERCP以及十二指肠低张造影等联合检查可提高诊断率;根治性手术远期疗效较好;淋巴结转移和局部侵犯是肿瘤预后不良的重要影响因素。     

两种方法对上海及周边地区实验大小鼠螺杆菌携带情况的调查

目的了解上海及周边地区实验小鼠、大鼠螺杆菌携带情况,为我国实验动物等级及监测标准的制定提供参考和依据。方法PCR法共检测了352只小鼠（清洁级101只,SPF级251只）,101只大鼠（清洁级69只,SPF级32只）;ELISA法共检测了88只小鼠（清洁级26只,SPF级62只）,165只大鼠（清洁级84只,SPF级81只）;并对其中88只小鼠、101只大鼠的PCR和ELISA法阳性检测率进行比较。结果PCR法检测小鼠平均阳性率为35．8％（126／352）,清洁级阳性率为51．5％（52／101）,SPF级阳性率为29．5％（74／251）;大鼠平均阳性率为70．3％（71／101）,清洁级阳性率为69．6％（48／69）,SPF级阳性率为71．9％（23／32）;ELISA法检测小鼠平均阳性率为15．9％（14／88）,清洁级阳性率为19．2％（5／26）,SPF级阳性率为14．5％（9／62）;大鼠平均阳性率为52．7％（87／165）,清洁级53．6％（45／84）,SPF级51．9％（42／81）;88只小鼠PCR法阳性检测率为72．7％（64／88）,ELISA法阳性检测率为15．9％（14／88）;101只大鼠PCR法阳性检测率为70．3％（71／101）,ELISA法阳性检测率为49．5％（50／101）。结论上海及周边地区实验大鼠、小鼠中皆存在着不同程度的螺杆菌感染,两种方法阳性检出率比较结果表明回盲部内容物PCR法较检测血清中抗螺杆菌抗体ELISA法更为敏感。     

P16^INK4、Rb基因表达在肺癌发生中协调性研究

采用mRNA原位双杂交和免疫组织化学方法对31例非小细胞肺癌组织进行P16^INK、Rb基因、Rb基因表达水平及其相关性的研究。结果显示,以Dig-碱性磷酸酶－NBT／BCIP系统检测P16^INK4基因转录,阳性结果呈蓝色,阴性杂交率为22．6％（7／31）;以Bio－辣根过氧化物酶－AEC系统检测Rb基因转录,阳性结果为红色,阴性率为16．1％（5／31）。免疫组织化学检测显示P16^INK4蛋白质阴性率为42％（13／31）;Rb蛋白表达阴性率为19．4％（6／31）。Rb、P16^INK4基因在非小细胞肺癌发生中起协同调控作用,以P16^INK4基因表达异常为主。     

VEGF—A和VEGF—C在皮肤恶性黑色素瘤表达的临床病理意义

目的：内皮细胞生长因子（Vascularendothelialgrowthfactor,VEGF）与恶性肿瘤转移密切相关,研究发现VEGF过度表达与恶性黑色素瘤转移有关,在本研究中通过研究VEGF在恶性黑色素瘤中的表达及与临床病理指标的相关性,为以VEGF为靶的抗转移治疗提供依据。方法：应用免疫组织化学技术检测恶性黑色素瘤中VEGF-A和VEGF-C表达,及与临床病理特点和生存状态的关系。结果：VEGF—A在皮肤恶性黑色素瘤中的阳性表达率是83．33％（30／36）,在色素痣中阳性表达率是15％（3／20）,两组间有显著性差异（P〈O．05）。VEGF—C在皮肤恶性黑色素瘤中的阳性表达率是88．9％（32／36）,在色素痣中阳性表达率是10％（2/20）,两组间有显著性差异（P〈0．01）。VEGF-A和VEGF—C表达与年龄、性别、肿瘤形态、肿瘤大小无显著关系,但与淋巴结转移和封闭血管环形成有关,VEGF-A和VEGF—C阳性病例淋巴结转移率和封闭血管环出现率显著高于VEGF-A和VEGF-C阴性病例。有统计学意义。对VEGF-A和VEGF-C表达与恶性黑色素瘤生存状态的关系分析显示,VEGF-A和VEGF-C表达阴性的病例的生存期和生存率均显著高于VEGF-A和VEGF-C表达阴性的病例,有统计学意义。结论：VEGF-A和VEGF-C表达与恶性黑色素瘤的淋巴结转移、血管形成和生存期相关,这两种蛋白过度表达反映黑色素瘤处于进展状态和预后差,可以作为黑色素瘤诊断、预后和复发预测的指标和靶向治疗的靶蛋白。     

多种无创检查组合在冠心病诊断中的价值

目的：评价多种无创辅助检查组合对冠状动脉粥样硬化性心脏病（冠心病）辅助诊断价值,筛选有效的冠心病确诊和排除指标,初步确定优化的冠心病早期诊断策略。方法：回顾性分析6419例冠心病患者多项无创辅助检查结果（包括静息心电图、24小时动态心电图、负荷心电图、负荷核素心肌显像、16或64排CT冠状动脉成像）,以冠状动脉造影阳性（至少一支主要冠状动脉或其主要分支的内径有≥50％的狭窄）为金标准,观察各种无创辅助检查组合对冠心病诊断的特异性、敏感性、误诊率、漏诊率、阳性预测值和阴性预测值。结果：多项无创辅助检查组合在冠心病的诊断中敏感性56．02-87．43％,特异36．13-87．61％,阳性预测值58．83．97．16％,阴性预测值30．21．73．36％,非介入手段中,敏感性和阴性预测值以动态心电图联合核素心肌灌注显像组最高,特异性和阳性预测值以动态心电图联合冠脉CT成像组最高。结论：辅助检查组合可作为无创性诊断、评价冠心病的重要方法,动态心电图可作为各级别医院冠心病筛查的基本及重要手段。     

核素骨显像诊断肺癌骨转移瘤的临床价值

目的：探讨核素骨显像诊断肺癌骨转移的临床价值。方法：收集近2年来已确诊的71例肺癌病人进行核素骨显像扫描,结合临床与X线检查进行回顾性分析。结果：本组71例肺癌病人经核素骨显像发现骨转移56例,阳性率为78．9％。显示各部位病灶共124个。累及部位依次为肋骨45个占36．3％（45／124）,脊椎骨35个占28．2％（35／124）,骨盆17个占13．7％（17／124）,四肢骨12个占9．7％（12／124）,胸锁骨10个占8．1％（10／124）,颅骨5个占4％（5／124）。其中肋骨转移灶多见于原发肿瘤的同侧,本组就有37个占82％（37／45）。有骨转移的56例中,多发骨转移45例占80．4％。结论：核素骨显像诊断肺癌骨转移的临床价值是有利于骨转移的早发现,对肺癌的临床分期,化疗方案的选择,化疗效果的评价及预后的估计均有很高参考价值。     

HPV-16、EB病毒对细胞增殖的影响及与子宫颈癌发病的关系

目的 了解宫颈癌患者人乳头瘤病毒16（HPV 16）、EB病毒（EBV）感染情况,探讨HPV-16、EBV对细胞核增殖性抗原（PCNA）表达的影响及在子宫颈癌发病中的意义。方法 免疫组织化学SP法检测59例宫颈癌和20例非癌性子宫颈上皮细胞中HPV-16、EBV蛋白表达和PCNA表达的情况,并分析它们的表达与病理参数的关系。结果 子宫颈癌和非癌性子宫颈上皮细胞中HPV-16、EBV及PCNA的阳性表达率依次分别为69．49％、57．63％及77．97％和30％、25％及15％;子宫颈癌和非癌性子宫颈上皮细胞中HPV-16、EBV的共同阳性表达率分别为35．59％和0％,子宫颈癌中HPV-16、EBV及PCNA的阳性表达率均高于非癌性子宫颈上皮（P〈0．05）。病理Ⅰ级、Ⅱ级和Ⅲ级子宫颈癌中HPV-16、EBV、PCNA的阳性表达率分别为65．00％、55．00％、60．00％,69．57％、60．87％、82．61％和75．OO％、56．25％、93．75％。各级子宫颈癌间HPV-16、EBV的阳性表达率差异无显著性,但PCNA的表达率随病理分级的增加显著上升（P〈0．05）。不同期别子宫颈癌问HPV-16、EBV及PCNA的阳性表达率差异无显著性。HPV-16阳性与阴性组子宫颈上皮PCNA的阳性表达率分别为82．98％（39／47）与43．75％（14／32）,两者差异有显著性（P〈0．05）。EBV阳性及阴性组子宫颈上皮PCNA的阳性表达率分别为71．79％（28／39）及42．50％（17／40）,两者差异有显著性（P〈0．05）。HPV-16和EBV共同阳性表达的21例子宫颈癌PCNA阳性表达率均为100％。结论 HPV-16、EBV通过增加PCNA表达的促细胞增生作用可能是子宫颈癌的发生机制之一。     

无症状性脑梗塞218例分析

无症状性脑梗塞２１８例分析冯周琴谢春祥韦永淼李蕴琛＊河南省人民医院神经内科４５０００３＊天津医学院附属医院神经科随着ＣＴ尤其是ＲＭＩ检查的普及,脑血管病的诊断取得了令人瞩目的进展。无症状性脑梗塞的发现率明显增高。由于无症状性脑梗塞是症状性脑梗寒的早期...     

Infarction in the territory of the anterior cerebral artery: clinical study of 51 patients

Background

Little is known about clinical features and prognosis of patients with ischaemic stroke caused by infarction in the territory of the anterior cerebral artery (ACA). This single centre, retrospective study was conducted with the following objectives: a) to describe the clinical characteristics and short-term outcome of stroke patients with ACA infarction as compared with that of patients with ischaemic stroke due to middle cerebral artery (MCA) and posterior cerebral artery (PCA) infarctions, and b) to identify predictors of ACA stroke.

Methods

Fifty-one patients with ACA stroke were included in the "Sagrat Cor Hospital of Barcelona Stroke Registry" during a period of 19 years (1986–2004). Data from stroke patients are entered in the stroke registry following a standardized protocol with 161 items regarding demographics, risk factors, clinical features, laboratory and neuroimaging data, complications and outcome. The characteristics of these 51 patients with ACA stroke were compared with those of the 1355 patients with MCA infarctions and 232 patients with PCA infarctions included in the registry.

Results

Infarctions of the ACA accounted for 1.3% of all cases of stroke (n = 3808) and 1.8% of cerebral infarctions (n = 2704). Stroke subtypes included cardioembolic infarction in 45.1% of patients, atherothrombotic infarction in 29.4%, lacunar infarct in 11.8%, infarct of unknown cause in 11.8% and infarction of unusual aetiology in 2%. In-hospital mortality was 7.8% (n = 4). Only 5 (9.8%) patients were symptom-free at hospital discharge. Speech disturbances (odds ratio [OR] = 0.48) and altered consciousness (OR = 0.31) were independent variables of ACA stroke in comparison with MCA infarction, whereas limb weakness (OR = 9.11), cardioembolism as stroke mechanism (OR = 2.49) and sensory deficit (OR = 0.35) were independent variables associated with ACA stroke in comparison with PCA infarction.

Conclusion

Cardioembolism is the main cause of brain infarction in the territory of the ACA. Several clinical features are more frequent in stroke patients with ACA infarction than in patients with ischaemic stroke due to infarction in the MCA and PCA territories.     

螺旋CT头颈部血管成像对急性脑梗死患者颈动脉狭窄的诊断价值

目的:探讨螺旋CT头颈部血管成像对急性脑梗死患者颈动脉狭窄的诊断价值。方法:选取2014年1月至2016年1月期间来我院就诊的60例急性脑梗死患者作为观察组,另选同期来我院就诊的非急性脑梗死患者60例作为对照组。两组患者均进行螺旋CT头颈部血管成像检查,比较两组患者的颈动脉狭窄程度及各段血管斑块分布情况,并根据检查结果评价螺旋CT头颈部血管成像对急性脑梗死患者颈动脉狭窄的诊断价值。结果:观察组轻度狭窄与中度狭窄检出率均显著高于对照组(P0.05),重度狭窄与闭塞检出率与对照组比较无统计学差异(P0.05),观察组总检出狭窄率高于对照组(P0.05)。观察组与对照组在颈动脉分叉处、颈总动脉、颈内动脉及颈外动脉均有斑块检出,观察组斑块总检出率为69.4%,显著高于对照组的41.2%(P0.05)。结论:临床上应用128层螺旋CT头颈部血管成像技术对急性脑梗死患者颈动脉狭窄情况可进行有效评估,该方法对患者轻、中度狭窄以及双侧颈动脉斑块检出率更高,在临床诊断及预后防治中具有应用推广价值。     

175例侧脑室体旁脑梗死的发病部位与临床对照研究

目的：探讨侧脑室体旁脑梗死的发病部位与临床关系的特点及发病机理,以便给予相应治疗对策。方法：收集175例侧脑室体旁脑梗死的患者,均经头颅CT或MRI证实为侧脑室体旁的梗死,其中小梗死120例,大梗死55例,结合文献就两者的临床症状及影像学表现进行分析,通过这些分析推测出在侧脑室体旁放射冠处锥体束排列与躯体存在定位关系。同时,对其发病机理进行探讨,以采取不同的相应治疗对策。结果：小梗死与大梗死的临床表现略有差别,发病机制有所不同。小梗死以腔隙性脑梗死为多,发病机制同腔隙性脑梗死类似;大梗死以分水岭脑梗死为多,发病机制同分水岭脑梗死类似。但就目前研究上来说,以上两种脑梗死的病因及发病机理仍存在不小的争议,本文就研究所见一并加以探讨。结论：侧脑室体旁放射冠区由前向后依次排列着支配头面部、上肢及下肢的锥体束纤维。可推测皮质脑干束与皮质脊髓束经侧脑室体旁放射冠区纤维由前向后重叠排列,支配感觉的传导束纤维则排列于放射冠的中部至后部,锥体束的后外侧。Broca区语言中枢和Wernicke区语言中枢的皮质下白质传导束在侧脑室体旁放射冠区由前向后排列,Broca区的纤维可能主要走行于放射冠的前部,Wernicke区的纤维可能主要走行于放射冠的后部,而侧脑室体旁放射冠的中部可能存在两种纤维的重叠。同时,针对发病的不同的病理生理机制,采取不同的相应治疗对策。     

Accuracy of Non-Enhanced CT in Detecting Early Ischemic Edema Using Frequency Selective Non-Linear Blending

Purpose

Ischemic brain edema is subtle and hard to detect by computed tomography within the first hours of stroke onset. We hypothesize that non-enhanced CT (NECT) post-processing with frequency-selective non-linear blending (“best contrast”/BC) increases its accuracy in detecting edema and irreversible tissue damage (infarction).

Methods

We retrospectively analyzed the NECT scans of 76 consecutive patients with ischemic stroke (exclusively middle cerebral artery territory—MCA) before and after post-processing with BC both at baseline before reperfusion therapy and at follow-up (5.73±12.74 days after stroke onset) using the Alberta Stroke Program Early CT Score (ASPECTS). We assessed the differences in ASPECTS between unprocessed and post-processed images and calculated sensitivity, specificity, and predictive values of baseline NECT using follow-up CT serving as reference standard for brain infarction.

Results

NECT detected brain tissue hypoattenuation in 35 of 76 patients (46.1%). This number increased to 71 patients (93.4%) after post-processing with BC. Follow-up NECT confirmed brain infarctions in 65 patients (85.5%; p = 0.012). Post-processing increased the sensitivity of NECT for brain infarction from 35/65 (54%) to 65/65 (100%), decreased its specificity from 11/11 (100%) to 7/11 (64%), its positive predictive value (PPV) from 35/35 (100%) to 65/69 (94%) and increased its accuracy 46/76 (61%) to 72/76 (95%).

Conclusions

This post-hoc analysis suggests that post-processing of NECT with BC may increase its sensitivity for ischemic brain damage significantly.     

脑磁共振灌注成像在大脑中动脉狭窄与闭塞患者中的应用价值分析

目的:研究脑磁共振灌注成像(PWI)在大脑中动脉(MCA)狭窄与闭塞患者中的应用价值。方法:纳入我院从2017年5月~2019年3月收治的单侧MCA狭窄与闭塞患者80例,对所有患者均实施经颅内数字减影血管造影(DSA)以及PWI检查,并将所有患者按照狭窄程度的不同分成轻度/中度组与重度/闭塞组。分析两组患者患侧与健侧大脑半球PWI相关参数,并作相关性分析。此外,分析PWI检查MCA狭窄或闭塞所致脑梗死类型分布情况。结果:DSA诊断结果显示:MCA轻度/中度狭窄患者35例,MCA重度/闭塞患者45例,其中MCA重度/闭塞的PWI检出率为100.00%,显著高于MCA轻度/中度狭窄的80.00%(P<0.05)。MCA轻度/中度组、重度/闭塞组患者患侧大脑半球的平均通过时间(rMTT)、达峰时间(rTTP)均显著高于健侧(均P<0.05)。经Spearman相关性分析可得:MCA患者狭窄程度与患侧大脑半球rMTT、rTTP均呈正相关关系(均P<0.05)。PWI检查结果显示,80例患者共检查出脑梗死患者53例,其中重度/闭塞组脑梗死总检出率以及纹状体内囊区脑梗死检出率分别为82.22%、11.11%,均明显高于轻度/中度组的45.71%、0.00%(均P<0.05)。结论:PWI应用于MCA狭窄与闭塞患者中的价值较高,可作为临床诊断MCA狭窄与闭塞的有效手段之一,值得临床推广应用。     

Clinical presentation and diffusion weighted MRI of acute cerebral infarction. The Bergen Stroke Study

Background

No large study has compared the yield of diffusion-weighted imaging (DWI) with clinical examination in order to differentiate lacunar stroke from other stroke subtypes. This differentiation is important for guiding further investigations and treatment.

Methods

Consecutive patients admitted with cerebral infarction were classified according to the Oxfordshire Community Stroke Project scale. Based on DWI and CT stroke was classified as lacunar (LI) and non-lacunar (NLI). Acute ischemic lesion <1.5 cm and located in subcortex or in brainstem were classified as LI. All other infarctions were classified as NLI.

Results

DWI was performed in 419 (69%) patients. Among patients with lacunar syndrome (LACS) 45 (40.5%) had NLI on DWI. All patients with total anterior syndrome (TACS) and 144 (88.3%) with partial anterior syndrome (PACS) had NLI on DWI.

Conclusion

DWI is important among patients presenting with clinical symptoms suggestive of lacunar syndrome to differentiate between LI and NLI. On the other hand, there is good correspondence between TACS or PACS and NLI on DWI.     

Appearance of Nuclear-sorted Caspase-12 Fragments in Cerebral Cortical and Hippocampal Neurons in Rats Damaged by Autologous Blood Clot Embolic Brain Infarctions

Following endoplasmic reticulum (ER) stress, cerebral infarctions have been reported to involve an apoptotic process, including the activation of the caspase cascade. To confirm whether fragmented caspase-12, which is activated by cleavage and is detectable during ER stress, is also involved in embolic cerebral infarctions in rats, we adopted an autologous blood clot model for the analysis of cerebral infarctions. We performed experiments in rats with brain infarctions, which are closely related to embolic cerebral infarctions. We utilized a homologous blood clot, i.e., natural materials, to form the infarct area. Our findings reveal that caspase-12 is fragmented when infarct areas form in cerebral cortical neurons. Interestingly, we observed that these fragments translocated to the nuclei of not only cerebral cortical neurons but hippocampal neurons. We further found that glucose-regulated protein 78 (GRP78), a marker of ER stress, is up-regulated in both cerebral cortical and hippocampal neurons during cerebral infarction. This result suggests that the fragmentation of caspase-12 and the subsequent nuclear translocation of these fragments are involved in the brain infarction process in rats.     

OMERACT: An international initiative to improve outcome measurement in rheumatology

Background and objective

Cerebral microembolism detected by transcranial Doppler (TCD) occurs systematically during cardiac catheterization, but its clinical relevance, remains unknown. Studies suggest that asymptomatic embolic cerebral infarction detectable by diffusion-weighted (DW) MRI might exist after percutaneous cardiac interventions with a frequency as high as 15 to 22% of cases. We have set up, for the first time, a prospective multicenter trial to assess the rate of silent cerebral infarction after cardiac catheterization and to compare the impact of the arterial access site, comparing radial and femoral access, on this phenomenon.

Study design

This prospective study will be performed in patients with severe aortic valve stenosis. To assess the occurrence of cerebral infarction, all patients will undergo cerebral DW-MRI and neurological assessment within 24 hours before, and 48 hours after cardiac catheterization and retrograde catheterization of the aortic valve. Randomization for the access site will be performed before coronary angiography. A subgroup will be monitored by transcranial power M-mode Doppler during cardiac catheterization to observe cerebral blood flow and track emboli. Neuropsychological tests will also be recorded in a subgroup of patients before and after the interventional procedures to assess the impact of silent brain injury on potential cognitive decline. The primary end-point of the study is a direct comparison of ischemic cerebral lesions as detected by serial cerebral DW-MRI between patients explored by radial access and patients explored by femoral access. Secondary end-points include comparison of neuropsychological test performance and number of microembolism signals observed in the two groups.

Implications

Using serial DW-MRI, silent cerebral infarction rate will be defined and the potential influence of vascular access site will be evaluated. Silent cerebral infarction might be a major concern during cardiac catheterization and its potential relationship to cognitive decline needs to be assessed.

Study registration

The SCIPION study is registered through National Institutes of Health-sponsored clinical trials registry and has been assigned the Identifier: NCT 00329979.     

心肌酶和红细胞形态学参数与心肌梗死的相关性研究

目的:研究红细胞形态学参数对心肌梗死患者诊断作用及其与心肌酶谱的相关性。方法:选取40例心肌梗死患者,40例稳定型心绞痛组患者,40例健康对照组人群。对比分析稳定性心绞痛、急性心肌梗死(入院1h内)和对照组红细胞形态学参数(MCV、MCH、MCHC、RDW)、及心肌酶谱(CK-MB、c Tn I)。分析心肌梗死不同时间MCV、MCH、MCHC、RDW变化趋势。结果:稳定性心绞痛、心肌梗死组1 h内MCV、RDW明显高于正常对照组,差异有统计学意义(P0.05);稳定性心绞痛、心肌梗死组1 h内MCHC、MCH低于对照组,差异有统计学意义(P0.05)。心肌梗死组MCV、RDW在发病后1 h、24 h、48 h、7 d水平逐渐升高,各时间点间差异有统计学意义(P0.05)。心肌梗死组发病后1 h、24 h、48 h、7 d、14 d MCHC、MCH水平逐渐降低,各时间点间差异有统计学意义(P0.05)。RDW和CK-MB、c Tn I呈正相关性(P0.05)。RDW对心肌梗死诊断的灵敏度最高达到93.4%,特异度为69.7%,RDW对急性心肌梗塞的诊断临界值为14.04%。结论:RDW对心肌梗死的诊断具有较高的敏感性,可用于临床早期诊断心肌梗死,为临床诊断提供一新的诊断标准。