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Objective To observe the effects of recombinant human B-type natriuretic peptide (rhBNP) on cardiac function and heart rate variability (HRV) in patients with heart failure after acute myocardial infarction (AMI). Methods One hundred and twenty patients with heart failure after AMI admitted to the Department of Cardiology of Cangzhou Central Hospital of Hebei Province from January 2015 to January 2018 were enrolled. The patients were divided into a conventional treatment group and an rhBNP treatment group according to random number table method, with 60 cases in each group. The two groups were treated according to the AMI guidelines, the conventional treatment group received west medicine anti-myocardial ischemia and anti-heart failure treatment; the rhBNP treatment group received rhBNP on the basis of routine treatment; the first load dose was 2 μg/kg intravenous injection impact treatment, followed by maintaining dose 8.5 ng·kg-1·min-1 intravenous drip for 7 days. The changes of hypersensitivity C-reactive protein (hs-CRP), N-terminal B-type natriuretic peptide precursor (NT-proBNP), left ventricular ejection fraction (LVEF) and HRV index were observed before and after treatment in the two groups [HRV indexes including the changes of average normal RR interval standard deviation (SDNN), the average value of the normal RR interval standard deviation (SDANN), the root mean square (RMSSD) of the adjacent RR interval difference, and the percentage of adjacent RR interval difference > 50 ms (PNN50)]; the incidences of adverse reactions in the two groups were observed. Results After treatment, the levels of hs-CRP and NT-proBNP in the two groups were significantly lower than those before treatment (all P < 0.05). LVEF, SDNN, SDANN, RMSSD and PNN50 were higher than those before treatment, and the changes of the above indicators in the rhBNP treatment group were more significant than those in the conventional treatment group [hs-CRP (mg/L): 6.2±3.3 vs. 11.8±5.5, NT-proBNP (ng/L): 2.5±2.0 vs. 6.4±4.3, LVEF: 0.49±0.02 vs. 0.44±0.04, SDNN (ms): 93.3±18.1 vs. 79.1±16.0, SDANN (ms): 87.3±17.8 vs. 70.9±14.9, RMSSD: 30.3±11.0 vs. 23.8±10.4, PNN50: (15.9±7.3)% vs. (9.6±5.5)%, all P < 0.05]; No significant adverse reactions occurred during the treatment of the two groups. Conclusion rhBNP can significantly improve the heart function of patients with heart failure after AMI, reduce the levels of inflammatory response indicators and improve HRV;since its clinical efficacy is good, and its application safe, it is worthy to promote its clinical use.
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Objective To observe the effect of low-dose dabigatran etexilate on the clinical efficacy of elderly patients with venous thromboembolism (VTE). Methods Seventy-five elderly (≥ 80 years old) VTE patients admitted to Cangzhou Central Hospital from October 2016 to June 2018 were enrolled, they were treated according to the VTE guidelines, and low dose dabigatran etexilate was the anticoagulant therapy selected, 110 mg once daily for 6 months. After treatment for 6 months, the thrombus regression situation with color Doppler ultrasonography;clinical efficacy was evaluated by clinical symptoms and ultrasonographic results, the changes in platelet count (PLT), coagulation parameters [international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (Fib)] before and after treatment were detected and the occurrence of adverse reactions were recorded and safety of drug was evaluated. Results There were no significant differences in PLT, INR and Fib before and after treatment [PLT (×109/L): 197.88±58.00 vs. 199.88±65.15, INR: 1.02±0.10 vs. 1.05±0.13, Fib (g/L): 2.89±0.67 vs. 2.84±0.70, all P > 0.05], the APTT after treatment was significantly prolonged compared with that before treatment (seconds:40.9±7.34 vs. 26.2±3.16), the difference being statistically significant (P < 0.05), the amount of APTT prolongation after treatment did not exceed 2 times [average (1.75±0.24) times] of the baseline value before treatment. The total effective rate of low-dose dabigatran etexilate for treatment of elderly patients with VTE for 6 months was 90.7% (68/75);no obvious adverse reactions occurred during the treatment. Conclusion Low-dose dabigatran etexilate for treatment of elderly patients with VTE is safe and effective without any obvious adverse reactions, and is worthy to be promoted for clinical use.
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Objective To investigate the clinical efficacy and mechanism of rosuvastatin combined with telmisartan in the treatment of persistent atrial fibrillation. Methods One hundred and twenty patients with persistent atrial fibrillation admitted to Cangzhou Central Hospital from February 2015 to February 2018 were enrolled and they were divided into study group and control group by random envelope method, with 60 patients in each group. The patients in study group were treated with rosuvastatin combined with telmisartan; and in control group they were treated with telmisartan, and after treatment for 6 weeks the clinical efficacy was observed. Resting heart rates were observed in two groups. The left atrial inner diameter, left atrium left and right diameter, left atrial sphericity index and left ventricular end diastolic volume, left ventricular end systolic volume, left ventricular posterior wall thickness of two groups were detected by ultrasond before and after treatment; the levels of serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were tested by enzyme linked immunosorbent assay (ELISA) in two groups before and after treatment; and the level of serum hypersensitive C-reactive protein (hs-CRP) was detected by immunoturbidimetry;the level of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) was tested by immunoluminometric assay. Results Resting heart rate was significantly decreased in study group after treatment compared with that before treatment (bpm: 76.37±7.25 vs. 89.76±8.79, P < 0.05), while in control group, the comparison of resting heart rate before and after treatment was of no statistical significant differences (bpm: 90.71±8.56 vs. 87.80±6.26, P > 0.05), resulting that the post-treatment resting heart rate of study group was significantly lower than that of control group (bpm:76.37±7.25 vs. 87.80±6.26, P < 0.05). After treatment, the left atrial inner diameter, left atrium left and right diameter, left atrial sphericity index and left ventricular end diastolic volume were increased compared with those before treatment in both groups; after treatment, above various index levels in study group were lower than those of control group [left atrial inner diameter (mm): 40.68±3.86 vs. 41.99±3.97, left atrium left and right diameter (mm): 41.07±2.85 vs. 42.69±2.90, left atrial sphericity index: 0.77±0.08 vs. 0.86±0.07, left ventricular end diastolic volume (mL): 107.48±32.90 vs. 118.98±35.75, all P < 0.05]. There were no statistical significant differences between the two groups in left ventricular end systolic volume and posterior wall thickness of left ventricle after treatment [study group: left ventricular end systolic volume (mL) was 38.59±12.37 vs. 39.81±12.03, posterior wall thickness of left ventricle (mm) was 11.34±2.39 vs. 12.80±3.27, control group: left ventricular end systolic volume (mL) was 39.90±11.54 vs. 40.65±11.50, posterior wall thickness of left ventricle (mm) was 11.90±2.57 vs. 12.99±3.16, all P > 0.05]. Besides, the serum levels of TNF-α, IL-6 and hs-CRP were obviously decreased in two groups after treatment (all P < 0.05), after treatment, above indexes in study group were significantly lower than those in control group [TNF-α (ng/L): 29.76±5.31 vs. 36.63±5.11, IL-6 (ng/L): 14.37±3.36 vs. 22.65±4.58, hs-CRP (mg/L): 13.68±2.75 vs. 20.63±2.69, all P < 0.05]. Plasma NT-proBNP was increased in control group after treatment compared with that before treatment (μg/L: 431.80±42.54 vs. 365.89±39.81, P < 0.05), whereas there was no significant difference in the study group between pre- and post-treatment (μg/L: 351.80±38.76 vs. 346.89±35.82, P > 0.05), resulting in post-treatment plasma NT-proBNP significantly lower in study group (P < 0.05). Conclusions Rosuvastatin combined with telmisartan can prevent left atrial remodeling in patients with persistent atrial fibrillation and delay the dysfunction of left ventricular pump. The therapeutic mechanism was related to the decrease in the levels of serum inflammatory factors in patients treated with such therapy.
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Objective@#To observe the clinical effects and safety of orthokeratology(OK) lens in the treatment of mild and moderate myopia, and to evaluate the effects on the myopia control.@*Methods@#The study included a total of 166 eyes in 83 myopia children who were treated in Jiaxing Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University from January 2014 to December 2014.They were randomly divided into two groups according to the digital table, 43 cases(86 eyes) in the observation group underwent standard OK lens, and the other 40 cases(80 eyes) in the control group were given common spectacles.The patients were followed up for two years.The uncorrected visual acuity, corneal curvature and ocular surface in the, observation group were examined, and diopter, axial length were examined in the two groups.@*Results@#The visual acuity of the observation group improved significantly at 1 day, trended to be stable at 1 week, and then was basically stable within 1 year, but decreased at 2 years.After 3 months, the mean corneal curvature[(41.93±1.12)D]was significantly lower than before orthokeratology[(43.56±1.44)D], and the difference was statistically significant(t=11.539, P<0.05). However, the effect didn’t persist without continued OK lens wear 1 month later.Compared with the control group, the growth of the diopter and axial length in the observation group were significantly slower(t=16.784, P<0.05; t=5.623, P<0.05). At the initial wearing, 34% of the observation group occurred corneal epithelial injury, but they all recovered by stop wearing and appropriate medication.With the prolong of wear time, the proportion of injury reduced.@*Conclusion@#Uncorrected visual acuity of mild and moderate myopia children wearing OK lens can significantly improve at 1 day, then is basically stable after 1 year, but declines within 2 years, which indicates the need for timely replacement of the lens.Long-term wearing is effective and safe to control the development of myopia.
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Objective To investigate the clinical significance of the levels of serum C-reactive protein (CRP), peripheral blood ratio of neutrophil to lymphocyte (N/L) and plasma D-dimer in patients with different types of atrial fibrillation (AF) and the predictive value of the above index levels in occurrence of complicated left atrial appendage thrombosis in such patients. Methods A prospective study was conducted, one hundred and forty patients with non-valvular AF admitted to Cangzhou Central Hospital from May 2013 to December 2016 were enrolled, including 57 patients with paroxysmal AF in paroxysmal AF group and 83 patients with persistent AF in persistent AF group; in the mean time, 40 healthy persons having passed physical examination with normal sinus rhythm were volunteers assigned in a healthy control group. 83 patients with persistent AF were followed up for 1 year, and by the esophageal echocardiography, 13 cases with left atrial appendage thrombosis (AF combined with thrombosis group) and 70 cases with non-thrombotic patients (simple AF group) were found. In the morning on the day of entrance into the respective group, fasting venous blood was taken from the patients, and the peripheral blood N/L ratio, serum CRP, plasma D-dimer and B-type natriuretic peptide (BNP) levels were checked; the left atrial diameter (LAD), left atrial ejection fraction (LAEF), left atrial peak strain rate (LASRs) during left ventricular systolic phase, early diastolic peak blood flow velocity of mitral annulus/mitral annulus root side wall velocity peak value (E/Ea) ratio were measured by the trans-thoracic echocardiography, and the differences in above indexes were compared among various groups; the risk factors of persistent AF associated with left atrial appendage thrombosis were analyzed by multivariate Logistic regression; the receiver operation characteristic (ROC) curve was used to analyze the predictive value of D-dimer and BNP levels for persistent AF associated with left atrial appendage thrombosis. Results The peripheral blood N/L ratio (2.68±0.58, 2.59±0.62 vs. 1.82±0.29), CRP (mg/L: 19.87±3.28, 20.74±4.31 vs. 8.65±1.06), BNP (ng/L: 364.79±54.18, 145.86±51.90 vs. 139.40±48.29), LAD (mm: 40.79±3.90, 34.28±2.13 vs. 33.90±2.51), LAEF (0.16±0.07, 0.39±0.08 vs. 0.56±0.10), LASRs (s-1: -1.65±0.23, -1.98±0.32 vs. -3.49±0.53), E/Ea ratio (4.38±0.48, 4.29±0.52 vs. 4.09±0.64) levels in the persistent AF group and the paroxysmal AF group were significantly higher than those of healthy control group, and BNP, LAD, LAEF in persistent AF group were significantly higher than those of the paroxysmal AF group (all P ＜ 0.05). N/L ratio (3.19±0.47 vs. 2.62±0.58), serum CRP (mg/L:24.38±5.26 vs. 18.92±3.45), plasma D-dimer (mg/L: 2.56±0.41 vs. 1.57±0.39), BNP (ng/L: 659.35±78.29 vs. 381.22±69.43) and LAD (mm: 42.12±4.28 vs. 36.78±3.42), E/Ea ratio (6.79±0.62 vs. 4.59±0.59) in AF combined with thrombosis group were significantly higher than those in simple AF group (all P ＜ 0.05), and LAEF (0.29±0.05 vs. 0.30±0.06), LASRs (-1.79±0.27 vs. -1.86±0.39) were lower than those in simple AF group, but the differences were of no statistical significance (all P ＞ 0.05). Multivariate Logistic regression analysis showed: plasma D-dimer [odds ratio (OR) = 2.458, 95% confidence interval (95%CI) = 1.764 - 3.016, P = 0.035], BNP (OR = 2.631, 95%CI =1.589 - 3.127, P = 0.021), LAD (OR = 5.572, 95%CI = 4.031 - 6.452, P = 0.001) and E/Ea ratio (OR = 1.995, 95%CI =1.674 - 3.851, P = 0.003) were the independent risk factors for persistent AF combined with left atrial appendage thrombosis. The ROC curve showed: when plasma D-dimer and BNP levels could predict the patients with persistent AF complicated with left atrial appendage thrombosis, the area under the ROC curve (AUC) was 0.872 and 0.741, respectively, and when the plasma D-dimer was 1.45 mg/L and BNP was 569.33 ng/L respectively, the sensitivity of diagnosis for the above patients was 67.81%, 62.25%, and the specificity was 75.90% and 57.62% respectively. Conclusions The levels of serum inflammatory markers, plasma biological markers and left atrial function were different in patients with different types of AF. The left atrial enlargement, left ventricular diastolic dysfunction, elevation of plasma D-dimer and plasma BNP levels are the independent risk factors for patients with persistent AF complicated with left atrial appendage thrombosis. When diastolic dysfunction occurs in the left ventricle, the elevated levels of plasma D-dimer and natriuretic peptide have predictive value for left atrial appendage thrombosis.
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Objective To compare the effects of ticagrelor and clopidogrel on levels of inflammatory factors after emergent percutaneous coronary intervention (PCI) combined with thrombus aspiration in patients with acute myocardial infarction (AMI). Methods Two hundreds and sixteen patients with AMI undertaking emergent PCI plus thrombus aspiration admitted to Cangzhou Central Hospital from April 2014 to April 2017 were enrolled, and they were randomly assigned into a ticagrelor group and a clopidogrel group, each group 108 cases. After admission, the clopidogrel group received 300 mg aspirin and 300 mg clopidogrel loading, after operation, aspirin 100 mg and clopidogrel 75 mg were given, once a day maintaining for 12 weeks; ticagrelor group after admission received 300 mg aspirin and 180 mg ticagrelor loading and after operation 100 mg aspirin (once per day) and 90 mg ticagrelor (twice per day) were given, maintaining for 12 weeks. Venous blood was taken immediately after admission and 24 hour and 1, 4, and 12 weeks after PCI plus thrombus aspiration, and the plasma levels of C-reactive protein (CRP), interleukin-6 (IL-6) and soluble CD40 ligand (sCD40L) were measured by double antibody enzyme linked immunosorbent assay (ELISA). Results Twenty-four hours after the operation, the levels of inflammatory factors, CRP, IL-6 and sCD40L were significantly higher than those before operation, the levels of the above inflammatory factors continued to decrease at the time points 1, 4, and 12 weeks later, reaching the lowest level at 12 weeks, and the above levels in ticagrelor group were significantly lower than those in clopidogrel group [CRP (μg/L): 2.96±0.63 vs. 4.44±0.34, IL-6 (ng/L): 2.50±0.51 vs. 2.81±0.21, sCD40L (ng/L): 519.60±12.53 vs. 570.25±11.55, all P < 0.05]. Conclusion The anti-inflammatory effect of ticagrelor is greater and more durable than that of clopidogrel after emergent PCI plus thrombus aspiration in patients with AMI.
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Objective To study the effect of corrected TIMI frame count (CTFC) of infarction related artery on systolic function of infarct area of myocardium after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods One hundred and six patients with AMI having undergone successful PCI in Cangzhou Central Hospital were selected, and they were divided into two groups (each, 53 cases). The standard of fast or slow flow was in accord to the CTFC of infarction related artery (IRA) measured soon after successful PCI. The patients with greater value of CTFC were enrolled in the slow flow group, while the patients with smaller such value were assigned in the fast flow group. At 6, 12, 24 and 48 hours after PCI, the venous plasma MB isoenzyme of creatine kinase (CK-MB) level was measured. And at 1 week, 1 month and 3 months after PCI, the left ventricular ejection fraction (LVEF) was measured by cardiac ultrasound, and the levels of radial strain (RS) and longitudinal strain (LS) of the infarct area were measured via speckle tracking imaging (STI). The differences in CTFC, CK-MB, RS and LS between the two groups were analyzed, and the correlations between the strains and CTFC, CK-MB were analyzed by Pearson linear correlation method. Results After successful PCI, the CK-MB of fast flow group was higher than that of the slow flow group at 6 hours. However, the CK-MB of slow flow group was higher than that of the fast flow group after 12 hours, appearing separate phenomenon, and the statistical significance occurred beginning from 24 hours after PCI (U/L, 24 hours:98.43±11.65 vs. 86.43±18.97, 48 hours:51.09±8.94 vs. 49.80±6.92, both P 0.05). RS and LS in fast flow group were higher than those in slow flow group, and the statistically significant difference appeared from 1 month after PCI (1 month RS:29.74±6.66 vs. 26.86±5.61, LS:-16.37±3.91 vs. -15.27±3.22, 3 months RS: 30.03±6.31 vs. 27.63±5.67, LS: -17.74±3.96 vs. -15.75±4.17, all P 0.05). Both RS and LS at 1 week, 1 month and 3 months were of significantly positive correlation with CTFC of each group (fast flow group:r value of CTFC and RS was respectively-0.526,-0.515,-0.532, r value of CTFC and LS was respectively-0.532,-0.541,-0.572;slow flow group:r value of CTFC and RS was respectively-0.691,-0.685,-0.702, r value of CTFC and LS was respectively-0.621,-0.584,-0.605, all P<0.01). Conclusion CTFC has some relationship with the recovery of the systolic function in area of infarct myocardium after PCI, and can be regarded as an important index to predict the long-term prognosis in patients with AMI.
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Objective To observe the therapeutic effect of Qili Qiangxin capsule combined with glucocorticoid for treatment of patients with dilated cardiomyopathy accompanied by refractory heart failure. Methods A prospective study was conducted. Forty-eight patients with dilated cardiomyopathy and refractory heart failure in Hebei Cangzhou Central Hospital were enrolled,and they were randomly divided into three groups:control group,treatmentⅠand treatmentⅡgroups(each,16 cases). All groups were treated with conventional anti-heart failure western treatment, meanwhile additionally prednisone was given to treatment groupⅠand groupⅡ,firstly 40 mg/d,then the dosage of 5 mg was decreased in every 5 days until reaching 5 mg per day;in treatment groupⅡ,besides the same treatment of group I,the traditional Chinese medicine therapy Qili Qiangxin capsule 4 granules(one capsule 0.3 g)each time and 3 times a day was added,2 months being the therapeutic course in all the patients. The clinical efficacy and cardiac functional indexes,such as the left ventricular end-diastolic volume(LVEDV),the left ventricular end-systolic volume(LVESV),the left ventricular ejection fraction(LVEF)and the plasma B type brain natriuretic peptide (BNP),etc. were observed in 1 week and 2 months after treatment. Meanwhile the electrocardiogram(ECG),aspartate transaminase(AST),alanine aminotransferase(ALT),urea nitrogen(BUN),serum creatinine(SCr),blood routine, urine routine examination and the adverse effects were investigated. Results The total effective rates in treatment groupⅠand treatment groupⅡwere significantly higher than those in the control group〔after treatment for 1 week:81.2%(13/16),81.2%(13/16)vs. 43.8%(7/16);after 2 months:87.5%(14/16),93.7%(15/16)vs. 50.0%(8/16), all P<0.05〕. After treatment,the LVEDV,LVESV and BNP were lowered and the LVEF was increased in the three groups,and the above indexes in treatment groupⅡwere improved more significantly than those in groupⅠ〔LVEDV (mL):142.4±33.0 vs. 174.8±52.5,LVESV(mL):111.6±23.7 vs. 132.4±29.0,LVEF:0.421±0.037 vs. 0.390±0.045,BNP(μg/L):1.944±0.751 vs. 3.038±1.905,all P<0.05〕. Conclusion Qili Qiangxin capsule combined with glucocorticoid may effectively improve the cardiac function and clinical symptoms in near and forward future in patients with dilated cardiomyopathy accompanied by refractory heart failure,thus it may elevate the patients' life quality.