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Objective To investigate the value of emergency observation time of chest pain patients for ruling-out myocardial infarction by using high-sensitive troponin T. Method Total 1 687 patients with chest pain from December 2015 to August 2016 visiting Sichuan University Huaxi Hospital emergency department were en-rolled.We included 1082 patients who diagnose with AMI finally.We define the time from the start of the chest pain to visiting the emergency as the onset time.We analyzed the level of high-sensitive troponin T of AMI patients at dif-ferent onset time and calculated the rate of patients with hs-cTnT level lower than the conventional hs-cTnT thresh-old of 14 ng/L. Result Among 1082 cases of AMI patients,32 patients with hs-cTnT level below threshold(14 ng/L).The for whose The onset time over 5h was observed in AMI patients with hs-cTnT level over 14 ng/L.Con-clusion AMI can not be excluded in chest pain patients whose hs-cTnT levels below the conventional threshold value of 14 ng/L,and these people should be dynamically monitored for 5h in emergency department.The patients can exclude AMI if the hs-cTnT levels are below 14 ng/L after 5 hours.
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Objective The aim of this study was to evaluate the diagnostic value of rule-out strategy for acute myocardial infarction (AMI) in chest pain patients with normal high-sensitivity troponin T (hs-cTnT).Methods Adults presenting chest pain to the West China hospital of Sichuan university from January 2016 to January 2017 were enrolled.Clinical data including ECG and hs-cTnT concentration was obtained.The diagnostic value of three strategies were evaluated.The optimal rule-out strategy for AMI were finally established in chest pain patients.Results A total of 153 patients were enrolled.In patients with chest pain time less than 5 h,the first hscTnT level was less than 14 ng/L.The negative predictive value (NPV) of 0/3 h dynamic observation and 5 minus the time of chest pain were 100％.The NPV was 99.8％ to rule-out AMI directly using the first hs-cTnT level.Conclusions For patients with chest pain time less than 5 h,the first hs-cTnT level less than 14 ng/L,0/3 h dynamic observation and the strategy of 5 h minus chest pain time have the same diagnosis value for ruling out AMI alternatively.It was not suggested to use the first hs-cTnT level to rule out AMI .
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Objective To study thyroid function in patients with depression.Methods The average levels of TSH,FT3,FT4 in 5 316 patients with depression were compared with 5 316 healthy controls.The average levels of TSH,FT3,FT4 were compared between male and female patients with depression.The differences of thyroid disease detection rate were compared between elder and group younger group.Results The differences of TSH,FT3,FT4 levels between the depression patients and healthy controls have statistically significant(P＜0.05).The differences of TSH,FT3,FT4 levels between the male depression patients and the female depression patients have statistically significant (P＜ 0.05).The hyperthyroidism prevalence were as follows:6.50 ％ versus 6.10 ％ (P＞0.05),compared between older and younger depression patients.The subclinical hypothyroidism prevalence 24.30 ％ versus 9.40 ％ (P＜0.05),compared between older and younger depression patients.The hypothyroidism prevalence 14.30 ％ versus 2.90％ (P＜0.05),compared between older and younger depression patients.Conclusion Depression is easily caused by low thyroid hormone levels.Women and elder people with hypothyroidism should more prevent depression.Thyroid hormones can be used as routine screening index of depression,but not specific indicators.
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Objective To study thyroid function in patients with depression.Methods The average levels of TSH,FT3,FT4 in 5 316 patients with depression were compared with 5 316 healthy controls.The average levels of TSH,FT3,FT4 were compared between male and female patients with depression.The differences of thyroid disease detection rate were compared between elder and group younger group.Results The differences of TSH,FT3,FT4 levels between the depression patients and healthy controls have statistically significant(P＜0.05).The differences of TSH,FT3,FT4 levels between the male depression patients and the female depression patients have statistically significant (P＜ 0.05).The hyperthyroidism prevalence were as follows:6.50 ％ versus 6.10 ％ (P＞0.05),compared between older and younger depression patients.The subclinical hypothyroidism prevalence 24.30 ％ versus 9.40 ％ (P＜0.05),compared between older and younger depression patients.The hypothyroidism prevalence 14.30 ％ versus 2.90％ (P＜0.05),compared between older and younger depression patients.Conclusion Depression is easily caused by low thyroid hormone levels.Women and elder people with hypothyroidism should more prevent depression.Thyroid hormones can be used as routine screening index of depression,but not specific indicators.
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Objective The aim of this study was to evaluate the negative predictive value (NPV) and Sensitivity(Sen) of ruling out acute myocardial infarction(AMI) using low risk electrocardiogram(ECG) and baseline high-Sensitivity troponin T(hs-cTnT) immediately in chest pain patients. Methods Patients presenting to chest pain center with complain of chest pain in West China hospital of Sichuan university were enrolled. Clinical data including ECG and hs-cTnT concentration were gained .According to different diagnosis cutoff point, the NPV and Sen of ruling out AMI using low risk ECG and baseline hs-cTnT immediately in chest pain patients were evaluated. Results An hs-cTnT cutoff of 5 ng/L resulted in a NPV of 99.9%ruling out of all non-AMI patients. Adding the information of a low risk ECG resulted in a 100%NPV (19.51%ruled out). At any diagnosis cutoff point, present hs-cTnT concentration can not rule out AMI completely . Adding the information of a low risk ECG , the NPV of present hs-cTnT was improved and more non-AMI patients were ruled out safely. Conclusions It is safe to rule out AMI among the chest pain patients when the level of hs-cTnT less than 5 ng/L combined with low risk electrocardiogram.
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Objective To investigate the association of chest pain patients with primary level in high-sensitivity troponin T (hs-cTnT) level no more than 14 ng/L in the onset of acute myocardial infarction in pa-tients with chest pain. Methods We enrolled 3 096 participants from January 2012 to December 2013 in West China Hospital, Sichuan University. All patients were classified two groups (hs-cTnT > 14 ng/L, hs-cTnT ≤14 ng/L and no ischemia on ECG) according to hs-cTnT levels and ECG. We evaluated the risk of myocardial in-farction and death and negative predictive value in 30 days. Results Thirty-seven patients were diagnosed in having acute myocardial infarction (AMI) and 4 patients were dead in the hs-cTnT > 14 ng/L group in 30 days in the absolute risk 2.35(1.86-2.74) and 0.29(0.12-0.53); 9 patients were diagnosed as having AMI and no patients were dead in the hs-cTnT ≤ 14 ng/L group in 30 days in the absolute risk 0.58 (0.42-0.74). Conclu-sion Chest pain patients whose primary levels no more than 14 ng/L in hs-cTnT with no ischemia on ECG can be ruled out AMI in negative predictive value 99.6%. the levels of hs-cTnT which were dynamic monitored at least 5 h and still no more than 14 ng/L can rule out AMI directly.
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Objective To investigate the diagnostic threshold value and diagnostic performance of high-sensitivity troponin T (hs-cTnT)for elderly patients with acute myocardial infarction(AMI).Methods 835 emergency department patients with chest pain were recruited in the study,then these patients were divided into elderly group (≥65 years old)and control group(<65 years old).Hs-cTnT concrentrations were compared between the two groups;The difference of hs-cTnT concentrations between AMI pa-tients and non-AMI patients were compared in elderly group and control group respectively;The optimal threshold values of the hs-cTnT for acute myocardial infarction were determined by receiver operating characteristic(ROC)curve.Results The hs-cTnT con-centrations of non-AMI patients in elderly group were 18.4(14.5-32.5)ng/L,which were higher than those of non-AMI patients in control group[3.2(3.0-8.2)ng/L],and the difference were statistically significant(P <0.05);The hs-cTnT concentrations of AMI patients in elderly group were 136.1 (51.6 - 384.1 )ng/L,which were higher than those of AMI patients in group 68.5 (25.6-217.1)ng/L,and the difference were statistically significant(P <0.05).According to the ROC curve,the optimal threshold value for AMI diagnosis in elderly group by using hs-cTnT was 32 ng/L,which was higher than that in control group(14 ng/L). The specificity and the positive predictive value of the optimal threshold value determined by ROC were apparently higher than the 99th percentile(P 99 )in elderly group respectively,the difference were statistically significant(P <0.05).Conclusion The hs-cTnT levels were positively related with age.The optimal threshold value of hs-cTnT for AMI(32 ng/L)was higher than the P 99 (14ng/L)in elderly group.
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Objective To research the levels of thyroid hormone in patients with Sheehan′s syndrome .Methods The difference of thyroid‐stimulating hormone(TSH) or free triiodothyronine(fT3 ) or free thyroxine(fT4 ) levels was compared between 100 pa‐tients with sheehan′s syndrome and 100 cases of female healthy controls included in this study .The difference for TSH or fT3 or fT4 levels was compared between before and after treatment in Sheehan′s syndrome patients .The difference of TSH or fT3 or fT4 levels was compared when time from a large bleeding to disease onset below 1 year ,1‐5 years and over 5 years respectively in Shee‐han′s syndrome patients .Results The difference of TSH or fT3 or fT4 levels between patients with Sheehan′s syndrome and female healthy controls had obvious statistical significance .TSH :1 .60(0 .79 -2 .86)mU/L versus 3 .08(1 .97 -5 .08)mU/L ,fT3 :2 .09 (1 .44-3 .69)pmol/L versus 4 .86(4 .49-5 .40)pmol/L ,fT4 :8 .01(3 .45 -12 .64)pmol/L versus 14 .56(13 .63 -16 .11)pmol/L (P<0 .001 for comparisons respectively) .The difference of TSH or fT3 or fT4 levels between before and after treatment had obvi‐ous statistical significance .TSH :1 .60(0 .79-2 .86)mU/L versus 1 .16(0 .57-2 .11)mU/L ,fT3 :2 .09(1 .44-3 .69)pmol/L versus 3 .27(2 .38-4 .11)pmol/L ,fT4 :8 .01(3 .45 -12 .64)pmol/L versus 14 .32(10 .48 -15 .92)pmol/L(P<0 .05 for comparisons re‐spectively) .Time from a large bleeding to disease onset were below 1 year ,1-5 years and over 5 years ,TSH levels were respective‐ly 2 .85(2 .21-3 .51)、1 .82(1 .24-2 .98) and 1 .52(0 .65-2 .64)mU/L(P<0 .05 for comparisons) .The fT3 levels were respective‐ly 3 .74(2 .24-4 .45) ,2 .54(1 .87-3 .32) and 1 .89(1 .13-3 .11)pmol/L(P<0 .05 for comparisons) .The fT4 levels were respec‐tively 12 .21(10 .45-14 .32) ,8 .52(5 .13-12 .34) and 7 .85(3 .12 -10 .12)pmol/L(P<0 .05 for comparisons) .Conclusion TSH could serve as an identifiable index for sheehan′s syndrome and primary hypothyroidism .The time from a large bleeding to the dis‐ease onset is longer ,the anterior pituitary function is more serious .Thyroid hormone should be monitored regularly in order to pre‐vent the happening of hyperthyroidism during the process of the treatment .For postpartum hemorrhage patients ,thyroid hormone should be early detected and combine with the clinical manifestations .They should early diagnose and timely treat in order to pre‐vent the sheehan′s syndrome and its crisis .