定量组织多普勒技术评价2型糖尿病患者的左室功能

目的:应用定量组织多普勒技术(QTVI)评价2型糖尿病患者的左室收缩舒张功能,为糖尿病性心肌病的早期预防和诊断提供可靠依据。方法:研究资料分为两组,2型糖尿病患者(DM组)和健康体检人员(NC组)各30例,应用QTVI测量二尖瓣环6个位点的收缩期峰值速度(Sa)、舒张早期峰值速度(Ea)、舒张晚期峰值速度(Aa)、舒张早期与舒张晚期峰值速度比值(Ea/Aa),计算6个位点平均值代表瓣环的整体运动。结果:二尖瓣环运动速度Sa在DM组与NC组之间比较差异无显著性,Ea、Ea/Aa在DM组显著低于NC组。Aa在DM组与NC组之间比较差异均无显著性。结论:QTVI可以敏感、准确地评价2型糖尿病患者的左室功能,糖尿病患者左室舒张功能受损较早,随后才出现左室收缩功能减低。     

多普勒组织成像鉴别陈旧性心肌梗死患者舒张功能假性正常

目的 探讨应用多普勒组织成像（DTI）检测二尖瓣环舒张期运动速度可否鉴别陈旧性心肌梗死（OMI）患者舒张功能假性正常。 方法 OMI舒张功能假性正常患者68例，正常对照组50例，应用脉冲多普勒（PWD）分别测量二尖瓣口舒张早期峰值流速（E）、舒张晚期峰值流速（A）、E／A、E峰减速时间（DT）、左室等容舒张时间（IRT）、肺静脉收缩波（S）、舒张波（D）、S／D及心房收缩波（Ar）；转换DTI速度模式，测量左室侧壁缘二尖瓣环舒张早期运动峰值速度（Ea）、舒张晚期运动峰值速度（Aa）并计算Ea／Aa。 结果 OMI舒张功能假性正常患者与正常人的年龄和血流频谱E、A、E／A、IRT、D、S／D及二尖瓣环Aa测值比较无显著性差异（P〉0.05），DT缩短和S波降低具有显著性差异（P〈0．05），肺静脉血流Ar较正常人升高，而二尖瓣环Ea及Ea／Aa较比正常人明显减低，具有显著性差异（P〈0．01）。 结论 DTI检测二尖瓣环Ea及Ea／Aa比值可鉴别OMI患者舒张功能假性正常。     

定量组织速度成像评价2型糖尿病患者左心功能

目的应用定量组织速度成像技术观察2型糖尿病患者是否存在左心舒张和收缩功能异常.方法运用定量组织速度成像技术观测33例2型糖尿病患者和24例健康人心尖左心长轴、二腔和四腔切面二尖瓣环运动速度曲线,测量收缩期峰值速度Vs,舒张早期峰值速度Ve和舒张晚期峰值速度Va,计算Ve/Va比值;彩色多普勒血流显像法测量二尖瓣口舒张早期血流频谱E峰速度,舒张晚期血流频谱A峰速度,计算E/A比值.结果糖尿病组收缩期峰值速度Vs与健康人无显著差异 (P＞0.05);糖尿病组舒张早期峰值运动速度Ve较健康人减低(舒张早期峰值速度Ve糖尿病组/健康人:9.96±3.10/13.29±3.99,P＜0.05);舒张晚期峰值速度Va较健康人升高(舒张晚期峰值速度Va糖尿病组/健康人:11.58±2.21/10.13±1.36,P＜0.05),Ve/Va比值较健康人明显减低(Ve/Va比值糖尿病组/健康人: 0.88±0.32/1.33±0.40,P＜0.01).结论糖尿病患者早期即存在左室舒张功能异常,运用定量组织速度成像技术检测糖尿病患者左室舒张功能可检出松弛延迟和血流频谱假性正常化的病例.     

组织多普勒超声心动图对左室舒张功能的诊断价值

目的探讨组织多普勒超声心动图对左室舒张功能的诊断价值。方法对病人组（扩张型心肌病8例、冠状动脉粥样硬化性心脏病12例、高血压性心脏病12例、糖尿病性心脏病8例）40例及正常人40例（对照组）：①应用组织多普勒成像技术（TDI）检测二尖瓣环运动频谱,测量舒张早期峰值速度（Ea）和舒张晚期峰值速度（Aa）,并计算Ea/Aa比值;②应用脉冲多普勒技术检测二尖瓣口血流频谱,测量舒张早期峰值流速（E）和舒张晚期峰值流速（A）,并计算E/A比值。结果病人组40例均出现二尖瓣环运动频谱异常,其中32例Ea〈12 cm·s^-1（Ea/Aa〈1）（即二尖瓣血流频谱表现为弛张异常型舒张功能减低22例＋假性正常化10例）,8例Ea明显减小（〈8 cm·s^-1）（即二尖瓣血流频谱表现为限制异常型舒张功能减低）,与对照组比较差异有统计学意义（P〈0.05）;而二尖瓣口血流频谱异常共30例,包括22例E/A〈1（表现为驰张异常型舒张功能减低）和8例E峰明显高于A峰,E/A≥2（表现为限制异常型舒张功能减低）,与对照组比较差异有统计学意义（P〈0.05）。病人组有10例二尖瓣口血流频谱与对照组相似,E/A为1~2（表现为假性正常化）。结论TDI检测二尖瓣环运动频谱比脉冲多普勒技术检测二尖瓣口血流频谱对左室舒张功能的评价更敏感,二者结合应用可提高对左室舒张功能评价的准确性。     

QTVI评价SLE患者左室舒张功能的临床研究

目的 探讨定量组织速度成像(QTVI)技术在检测系统性红斑狼疮(SLE)患者左室舒张功能损害中的应用价值.方法 20例SLE患者,按有无窦性心动过速分为两组:Ⅰ组13例,心率≤100次/min,平均(83±17)次/min;Ⅱ组7例,心率＞100次/min,平均(134±19)次/min;另选20例正常人作为对照组;测量二尖瓣口血流频谱E峰、A峰及组织多普勒二尖瓣环Ea,计算E/A、E/Ea比值及6个壁瓣环Ea平均值,并与对照组作比较.结果 Ⅰ组常规超声心动图二尖瓣口血流频谱E峰、A峰及E/A比值与对照组比较无明显差异,Ⅱ组E峰较对照组增高QTVI发现Ⅰ组中有4例二尖瓣口血流频谱出现假性正常化,与对照组比较Ea及Ea值降低,E/Ea增高(P＜0.01);Ⅱ组Ea及与对照组比较无明显差异,但E/Ea较对照组增高(P＜0.05).结论 QTVI可为临床检测SLE患者左室舒张功能提供重要的量化指标,其敏感性优于常规超声法;E/Ea可间接反映SLE伴有心动过速患者的左室舒张功能.     

定量组织速度成像测定二尖瓣环运动速度对尿毒症患者左心舒张功能的评价

目的应用定量组织速度成像(QTVI)测定二尖瓣环运动速度评价尿毒症病患者左室舒张功能。方法应用定量组织速度成像测定30例正常人和32例尿毒症患者的二尖瓣环舒张早期峰值速度(Ve)、左房收缩期峰值速度(Va),计算Ve/Va比值;并用脉冲多普勒测定二尖瓣口舒张早期峰值血流速度E峰、舒张晚期峰值血流速度A峰,计算E/A值。结果正常组舒张早期峰值速度(E)>左房收缩期峰值速度(A),E/A>1;二尖瓣环舒张早期峰值速度(Ve)>左房收缩期峰值速度(Va),Ve/Va>1,正常组与尿毒症患者组二尖瓣口血流频谱及二尖瓣环运动组织速度成像测值有显著性差异,尿毒症患者组中二尖瓣环运动速度Ve/Va与二尖瓣血流频谱V/A无显著性差异。但在检出病例数中QTVI阳性例数明显高于血流频谱。结论应用定量组织速度成像测定二尖瓣口运动速度能较准确估计尿毒症患者左室舒张功能。     

多普勒组织成像鉴别肥厚型心肌病舒张功能假性正常

目的　探讨应用多普勒组织成像 (DTI)二尖瓣环舒张速度鉴别肥厚型心肌病舒张功能假性正常。方法　在正常人与肥厚型心肌病患者中应用脉冲多普勒技术分别测量二尖瓣口舒张早期峰值速率 (E)、舒张晚期峰值速率 (A) ,肺静脉收缩波 (S)、舒张波 (D)及心房收缩波 (Ar)。转换DTI速度模式 ,测量二尖瓣环各点舒张早期峰值速率 (Ea)、舒张晚期峰值速率 (Aa)并计算Ea/Aa。结果　肥厚型心肌病舒张功能假性正常患者与正常人二尖瓣E、A、E/A差异无显著性意义 (均 P >0 .0 5 ) ,肺静脉S、S/D、Ar差异有显著性意义 (均 P <0 .0 1) ,二尖瓣环Ea及Ea/Aa差异有显著性意义 (P <0 .0 1) ,Aa差异无显著性意义 (P >0 .0 5 )。结论　多普勒组织成像二尖瓣环Ea及Ea/Aa可鉴别肥厚型心肌病舒张功能假性正常     

先天性心脏病患儿左心室舒张功能改变的超声研究

目的研究小儿先天性心脏病(先心病)左心室舒张功能状态及其变化规律，寻找超声评价左心室舒张功能的最佳方法和指标。方法35例患病组根据心室负荷分左心型和右心型，应用经胸二尖瓣口血流、肺静脉血流频谱以及多普勒组织成像技术测定二尖瓣环舒张期运动速度，三种方法测量左室舒张功能并与37例正常对照组进行对比研究。结果左心型二尖瓣口血流频谱E／A比值下降，肺静脉血流频谱S／D比值减小，Ts／TD比值减小，二尖瓣环运动频谱Ea／Aa比值减小；右心型E／A比值下降，S／D比值升高，Ts／TD比值下降，Ea／Aa比值下降，去除心率对时间指标的影响后，E峰减速时间、左室等容舒张时间的差异显著性消失。患病组中71％E／A比值正常，其中92％Ts／TD比值异常，56％S／D比值异常，68％Ea／Aa比值异常。结论Ts／TD、Ea／Aa、S／D比值可能是评价小儿先心病左室舒张功能的可靠指标，可鉴别E／A比值假性正常。     

组织多普勒显像检测二尖瓣环速度评价冠心病左室舒张功能

目的：探讨应用组织多普勒显像（TDI）检测二尖瓣环运动速度评价冠心病左室舒张功能的应用价值。方法：冠心病患者45例,正常对照组30例,应用脉冲多普勒（PWT）检测二尖瓣口舒张早、晚期血流峰值流速（E、A）、计算E／A;应用TDI速度模式,在心脏四腔心切面检测二尖瓣内、外环运动速度（Ea、Aa）,计算Ea／Aa。结果：冠心病组左室舒张功能假性正常组（E／A〉1）与正常对照组比较,二尖瓣血流频谱E、A、E／A及二尖瓣环Aa差异无统计学意义（P〉0．05）,TDI检测二尖瓣环Ea及Ea／Aa较正常组明显减低,差异有统计学意义（P〈0．01）。冠心病组左室舒张功能减低组（E／A〈1）与正常对照组比较,二尖瓣环Aa差异无统计学意义（P〉0．05）,二尖瓣血流频谱A较正常对照组增高,E、E／A及二尖瓣环Ea、Ea／Aa较正常组明显减低,差异有统计学意义（P〈0．01）。结论：TDI检测二尖瓣内、外环运动速度Ea、Aa,计算Ea／Aa,可评价冠心病左室舒张功能,与二尖瓣血流检测左室舒张功能（E／A〈1）减低者有很好相关性,并可鉴别左室舒张功能假性正常化,估测舒张功能受损的程度。     

应变率评价尿毒症患者血液透析前后左心房功能的变化

目的 应用应变率成像(SRI)技术评价单次血液透析对尿毒症患者左心房功能的影响.方法 31例既往无心血管病史的尿毒症患者,分别于透析前、后1h行超声心动图检查.测量左房最大长径、横径并计算左房最大容积;脉冲多普勒测量二尖瓣口血流峰值速度E峰、A峰,并计算E/A;脉冲组织多普勒(PW-TDI)测量二尖瓣环舒张早期峰值速度(Ea)、舒张晚期峰值速度(Aa),并计算Ea/Aa;应变率成像分别测量房间隔、左房侧壁、前壁及下壁的心室收缩期左房峰值应变率(SRs)、心室舒张早期左房峰值应变率(SRe)、心房收缩期左房峰值应变率(SRa),并计算4个位点的平均值.结果 尿毒症患者透析后与透析前相比,二尖瓣口血流频谱E峰降低(P＜0.01),A峰差异无统计学意义(P＞0.05),E/A下降(P＜0.01);二尖瓣环PW-TDI指标:Ea降低(P＜0.05),Aa差异无统计学意义(P＞0.05),Ea/Aa下降(P＜0.01);左房壁SRI指标:SRa升高(P＜0.01),SRs,SRe差异无统计学意义(P＞0.05).结论 应变率不受前负荷的影响,与脉冲多普勒血流成像、脉冲组织多普勒技术相比,能更准确评价透析对尿毒症患者左心房功能的影响.     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

甲状旁腺功能减退性心肌病的系统综述

目的 甲状旁腺功能减退（甲旁减）性心肌病是一种罕见的心脏疾病,为扩张型心肌病中少数可逆转的一种,常被误诊为不明原因或难治性心力衰竭。本文旨在探寻甲旁减性心肌病的规律性特征。方法 检索Pubmed、SinoMed、万方数据库中符合标准的甲旁减性心肌病病例,采用统计分组法对纳入研究的文献进行分析,依据系统综述和meta分析优先报告条目（PRISMA声明）进行报告。结果 在我们筛查出的41例患者中,女性居多（68.29%）,平均年龄为45.5岁,各年龄段均有发病。甲旁减性心肌病最常见的病因为特发性甲旁减（78.05%）,颈部手术导致的甲旁减性心肌病次之（17.07%）。患者均以心力衰竭就诊,伴不同程度的低钙血症。51%的患者有神经肌肉兴奋性增加的病史,90%的患者左心室射血分数降低。该病误诊漏诊率较高,仅36%的患者于入院后即明确诊断为甲旁减性心肌病。低血钙的纠正是治疗的关键,90%的患者心脏功能在血钙浓度正常化后恢复至正常。结论 对所有不明原因或难治性心力衰竭患者都应警惕甲旁减性心肌病的可能。     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.