内蒙古地区蒙古族与汉族高血压患者ACE基因多态性分布

目的:调查分析蒙古族与汉族人群高血压(EH)患者血管紧张素转换酶(ACE)基因插入/缺失(I/D)多态性分布情况.方法:对76例蒙古族EH患者,150例蒙古族正常人,100例汉族EH患者及100例汉族正常人采用聚合酶联反应方法(PCR)检测其ACE基因I/D多态性.结果:蒙古族EH患者中DD型为30.3%,Ⅱ型为22.4%,ID型为47.3%,与蒙古族正常人群(分别为20.0%,36.7%,43.3%)比较,基因型分布无差异,D等位基因频率分布存在差异(53.9%和41.6%).汉族EH患者中DD型为36.0%,Ⅱ型为30.0%,ID型为34.0%,与汉族正常对照组(分别为19.0%,35.0%,46.0%)比较,基因型分布明显增高,D等位基因频率分布也存在差异(53.0%和42.0%).但蒙古族EH人群与汉族EH人群间进行比较,基因型及D等位基因频率分布均没有差异.结论:在内蒙古地区无论汉族还是蒙古族,ACE基因的D等位基因与EH发病有关,DD基因型与汉族EH发病有关.     

α-内收蛋白基因及内皮型一氧化氮合酶基因多态性与大动脉弹性相关性研究

目的 探讨α-内收蛋白基因变异（Gly460Trp）及内皮型一氧化氮合酶基因（G894T、T786C）变异与大动脉弹性相关性研究。方法 （1）采用Complior SP脉搏波速度测定仪测量股-颈动脉PWV（C—FPwV），共319例，其中C—FPWV异常组204例，对照组115例；（2）采用聚合酶链反应和限制性酶切的片段长度多态分析方法检测α-内收蛋白基因变异（Gly460Trp）及一氧化氮合酶（eNOS）基因变异（G894T、T786C）。结果 （1）C—FPWV升高组收缩压（SBP）、舒张压（DBP）均显著高于对照组（P〈0．05）；（2）C—FPWV异常组WW、TG＋TT基因型、W、T等位基因频率显著高于对照组（P〈0．05）。C—FPWV异常组T786C（CT、CC）基因型及C等位基因频率与对照组比较差异无显著性（P〉0．05）；（3）WW和TG＋TT基因型与WG＋GG、TT基因型比较C—FPWV、收缩压、舒张压差异有显著性（P〈0．05）；（4）Logistic回归结果显示：α-内收蛋白460WW基因型（P=0．001，OR=3．234，95％CI1．655—6．320）及内皮型一氧化氮合酶（eNOS）基因G894T多态性TT、TG基因型是动脉弹性减退的危险因素（P=0．025，OR=0．477，95％C10．249～0．911）结论 α-内收蛋白基因变异（Gly460Trp）及一氧化氮合酶基因变异（G894T）与大动脉弹性有密切相关性，WW、TT、TG型是大动脉弹性减退的敏感基因型。     

急性冠脉综合征伴发作性宽QRS心电图表现

男患，76岁。以发作性胸闷3d，加重4h入院。患者入院前3d，于休息时感胸闷，无心前区疼痛，历时3～5min，可自行缓解。上述症状反复发作，入院前4h胸闷加重伴全身大汗。既往无高血压、糖尿病史。无家族性遗传病史。体格检查：体温35．6℃，血压100／70mmHg，心率60次／min，呼吸20次／min。     

氧化修饰的低密度脂蛋白及血脂与冠心病关系的探讨

目的 探讨氧化修饰的低密度脂蛋白及血脂与冠心病的关系。方法 本研究对６６名冠心病患及５０名健康对照组进行ＯＸ－ＬＤＬ、ＴＣ、ＴＧ、apoA,apoB的测定，并记录血压、年龄。采用spss分析软件进行统计学处理，经Logistic回归分析。结果 OX－LDL与冠心病相关性最强（P＝0．0005、R＝02529、exp(B)=5.4956)，TC，TG，apoB与冠心病也呈正相关（P＝0．0295、R＝0．1314；P＝0．0432、R＝0．1147；P＝0．0185、R＝0．1495），apoA与冠心病无相关性（P＝0．8596、R＝0．0000）， apoA/apoB的比值与冠心病呈负相关（P＝0．02140，R＝01441）。结论 OX－LDL与冠心病相关性最强。     

急性心血管事件院前急救的应急策略及流程探讨

Objective To study the strategy and process of out-hospital emergency care of acute cardiovascular events. Methods One hundred and eighty-three patients in the Second Affiliated Hospital of Baotou Medical College were prospectively studied. The patients were divided into two groups according to the different ways of out-hospital care, one group consisted of patients who received first-aid care after calling " 120" (94 cases), another was self-aid group consisting of patients sent to hospital by relatives (89 cases). The proportion of persons with higher than high school education and better knowledge for emergency care of patients with heart disease in first-aid group was higher than self-aid group (50. 0% vs. 29. 2%, 83.0% vs. 60. 7%, both P<0. 05). When the patients were brought to the emergency room, they were all treated according to our standard procedure and then registered. All patients were followed up at the end of first and third month after illness. Results Cardiovascular events were mainly myocardial infarction (61.7%) among 183 patients. There were statistically significant differences between two groups in self-aid response time, first disposal time and out-hospital rescuing time [(32.3 ± 5.6) minutes vs. (89.6±8.4) minutes, (47.3±7.3) minutes vs. (149.8±13.5) minutes, (61.7±8.3) minutes vs. [(149.8±13.5) minutes, all P<0. 01], but no difference was found in in-hospital rescuing time [(29. 9±5.3) minutes vs. (31.1±4.5) minutes, P>0. 05]. Morbidity rate was lower in first-aid group than self-aid group in 1st and 3rd month, respectively (2.1% vs. 9. 0%, 4. 2% vs. 12.4%, both P<0. 05). Conclusion Excellent emergency system and procedure can shorten initial disposal time and out-hospital rescuing time, thus improve patients' prognosis. The education level and health knowledge of patients and their raletives directly affect their mode of arriving hospital and prognosis.     

急性心肌梗死经皮冠状动脉腔内成形术对QT离散度的影响

目的观察急性心肌梗死(AMI)患者成功的经皮冠状动脉腔内成形术(PTCA)后对QT离散度(QTd)的影响。方法选择32例AMI后成功的PTCA患者，分别记录术前1天、术后1天的心电图，测量QTd及校正的QTd(QTcd)，并与30例同期行冠状动脉造影结果正常者进行对照。结果AMI组行PTCA术前，QTd及QTcd均较对照组显著延长；PTCA术后QTd及QTcd均较术前显著缩短；而单纯行冠脉造影对QTd及QTcd无明显影响；冠状动脉造影及PTCA对心率亦无明显影响。结论AMI患者QTd及QTcd显著高于正常人，成功的PTCA可使QTd及QTcd明显缩短。     

蒙古族高血压患者血浆纤溶活性的研究

目的 研究蒙古族高血压人群血浆纤溶活性的变化。方法 分别对62例蒙古族患者、54例汉族高血压患者、42例汉族正常人采晨起空腹静脉血，用免疫比浊法和酶联免疫吸附法，检测其血浆纤维蛋白原(Fbg)、组织型纤溶酶原激活剂(t-PA)及纤溶酶原激活剂抑制物-1(PAI-1)含量。比较各组间年龄、性别与Fbg、t-PA、PAI-1的相关性及其在各组间的差别。结果汉族、蒙古族高血压、汉族正常组的年龄性别与Fbg、t-PA、PAI-1无相关性，汉族高血压组与汉族正常组比较Fbg、PAI-1均高于汉族正常组t-PA低于正常组；蒙古族高血压族与汉族正常组比较t-PA低于对照组；但蒙古族高血压组与汉组高血压组比较只有t-PA较汉族高血压低，Fbg、PAI-1无统计学差异。结论高血压患者存在血浆纤溶活性降低：蒙古族高血压患者较汉族高血压患者血浆纤溶活性的降低，主要与t-PA水平降低有关。     

三腔起搏器成功安装1例

近期我科对1例充血性心力衰竭(CHF)的患者进行了三腔起搏器心室再同步化(CRT)治疗,并对其术后1个月的心功能改善情况进行观察,现报道如下.     

急性心血管事件院前急救的应急策略及流程探讨

Objective To study the strategy and process of out-hospital emergency care of acute cardiovascular events. Methods One hundred and eighty-three patients in the Second Affiliated Hospital of Baotou Medical College were prospectively studied. The patients were divided into two groups according to the different ways of out-hospital care, one group consisted of patients who received first-aid care after calling " 120" (94 cases), another was self-aid group consisting of patients sent to hospital by relatives (89 cases). The proportion of persons with higher than high school education and better knowledge for emergency care of patients with heart disease in first-aid group was higher than self-aid group (50. 0% vs. 29. 2%, 83.0% vs. 60. 7%, both P<0. 05). When the patients were brought to the emergency room, they were all treated according to our standard procedure and then registered. All patients were followed up at the end of first and third month after illness. Results Cardiovascular events were mainly myocardial infarction (61.7%) among 183 patients. There were statistically significant differences between two groups in self-aid response time, first disposal time and out-hospital rescuing time [(32.3 ± 5.6) minutes vs. (89.6±8.4) minutes, (47.3±7.3) minutes vs. (149.8±13.5) minutes, (61.7±8.3) minutes vs. [(149.8±13.5) minutes, all P<0. 01], but no difference was found in in-hospital rescuing time [(29. 9±5.3) minutes vs. (31.1±4.5) minutes, P>0. 05]. Morbidity rate was lower in first-aid group than self-aid group in 1st and 3rd month, respectively (2.1% vs. 9. 0%, 4. 2% vs. 12.4%, both P<0. 05). Conclusion Excellent emergency system and procedure can shorten initial disposal time and out-hospital rescuing time, thus improve patients' prognosis. The education level and health knowledge of patients and their raletives directly affect their mode of arriving hospital and prognosis.