Evaluation of Carotid Atherosclerotic Plaque Stability with Contrast-enhanced Ultrasonography

This study was aimed to evaluate the relationship between carotid atherosclerotic plaque stability and the clinical symptoms in patients with carotid atherosclerotic plaques by using contrast-enhanced ultrasonography. Fifty patients with carotid atherosclerotic plaques were enrolled and examined with contrast-enhanced ultrasonography. The correlation of contrast agent enhancement of the carotid atherosclerotic plaques and the clinical symptoms was analyzed. The results showed that among the 50 patients, plaques were enhanced in the 23 patients with obvious clinical symptoms. In 27 patients without apparent clinical symptoms, plaques were enhanced sparsely in 15 patients and not enhanced in 12 patients. It was suggested that contrast-enhanced ultrasonography could be used for the examination of the microcirculation in carotid atherosclerotic plaques on real-time basis and serve as a new noninvasive approach for the assessment of stability of carotid atherosclerotic plaques.     

脑梗死患者颅外段颈动脉及椎动脉的超声诊断价值

目的 探讨彩色多普勒超声对脑梗死患者颅外段颈动脉及椎动脉超声检查的临床价值.方法 对91例脑梗死住院患者行颅外段颈动脉、椎动脉彩色多普勒检查,观察其动脉壁的形态病变性质和动脉管腔的内径及椎动脉的最大流速(PSV)、阻力指数(RI).结果 91例脑梗死患者中,内径超过正常范围的颈总动脉最多,其中左侧17例,右侧22例.斑块生长部位以颈总动脉多见,类型以扁平斑最多,其次为硬斑.椎动脉PSV减低多见,其中左侧52例,右侧57例;RI超出正常范围的,左侧22例,右侧36例.结论 脑梗死患者颅外段颈动脉及椎动脉的彩色多普勒超声常规检查,提供了形态学及血流动力学改变,为临床诊断及治疗提供了重要的信息. Abstract： Objective To evaluate the clinical value of the color Doppler ultrasound for cerebral infarction in patients with extracranial carotid artery and vertebral artery. Methods Ninty-one cases of cerebral infarction patients in the hospital were examined of extracranial internal carotid artery, vertebral artery by color Doppler ultrasound. The pathological change patterns of arterial wall and the inner diameter of the arterial lumens and the peak flow rate (PSV), resistent index (RI)of the vertebral artery were observed.Results In the 91 cases of cerebral infarction patients, the inner diameter of carotid artery beyond the normal range, there were 17 cases in the left, 22 cases in the right.The most plaqueslie in carotid artery.The type of plaques was flat applanation spot at most, following was hard spot.Vertebral artery's peak flow rate was usually reduce, 52 cases in left, 57 cases in right. 22 patients' resistent index beyond the normal range in the left, and 36 cases in right.Conclusions The color Doppler ultrasound to extracranial carotid artery and vertebral artery provides the morphology and hemodynamics's change, offers important messages for the clinical diagnosis and treatment in the cerebral infarction.     

缺血性脑卒中牛津郡社区卒中项目亚型与颈动脉病变特点的关系

目的 观测缺血性脑卒中颅外段颈动脉狭窄的发生率及粥样硬化斑块性质;了解患者牛津郡社区卒中项目(OCSP)分型与颅外段颈动脉病变之间的关系.方法 纳入并登记2008年1月至2009年12月郑州大学第一附属医院神经内科连续入院的缺血性脑卒中患者,行颈部双功能彩色多普勒超声检查,观测患者的颈动脉狭窄程度及粥样斑块性质.结果 符合标准的缺血性脑卒中患者854例,其中675例(79%)患者进行了颈动脉彩超检查,OCSP各亚型构成比如下:部分前循环梗死占32.7%,腔隙性脑梗死占26.1%,完全前循环梗死占23.0%,后循环梗死占18.2%.颅外段颈动脉狭窄215例(31.9%),其中颈动脉狭窄≥50%包括颈动脉闭塞在内共93例(13.8%).在386例(57.2%)患者中共检出515个粥样硬化斑块,其中不稳定斑块占51.0%,发生部位以颈动脉分叉处最常见,占61.5%(317/515).OCSP亚型间比较,重度颈动脉狭窄患者中,部分前循环梗死发生率最高(14.5%),中度颈动脉狭窄患者中,完全前循环梗死发生率最高(22.6%),且不稳定斑块的检出率最高(P＜0.05).结论 缺血性脑卒中患者颈动脉病变常见,OCSP分型可能与颈动脉病变有相关性. Abstract： Objective To observe the incidence of extracranial carotid artery stenosis and plaque nature,and to understand the relationship between Oxfordshire community stroke project (OCSP) classification and extracranial carotid artery in ischemic stroke. Methods From Jan. 2008 to Dec. 2009 in department of neurology of the first affiliated hospital of Zhengzhou university, the consecutive patients with ischemic stroke admitted to hospital were registered, and by neck color Doppler ultrasound the degree of carotid stenosis and the characteristics of atherosclerotic plaque were recorded.Results Eight hundred and fifty-four cases of ischemic stroke were registered in two years, of which 675 cases (79%) underwent carotid ultrasonography examination. The proportion of ischemic stroke subtype according to OCSP criteria was as following: 32.7% for partial anterior circulation infarcts, 23.0% for total anterior circulation infarcts, 18.2% for posterior circulation infarcts and 26.1% for lacunar infarcts. In 215 cases of extracranial carotid artery stenosis (31.9%), there were 93 cases (13.8%) with carotid artery stenosis ≥50% including occlusion. Five hundred and fifteen carotid plaques were found in 386 cases (57.2%), Composed of 263 unstable plaque (51.0%),carotid plaque were commonly seen most in the carotid bifurcation 61.5% (317/515). Among OCSP subtypes, the propotion of severe carotid artery stenosis was the highest for PACI patients and the propotion of moderate carotid artery stenosis and unstable plaque were the highest for TACI patients(P＜0.05). Conclusions Ischemic stroke patients with carotid artery disease is common, the carotid artery disease is different among OCSP subtypes, the type can be used to predict severe carotid artery stenosis.     

高血压病患者颈动脉粥样硬化与血尿酸及载脂蛋白水平的相关性

目的 通过对高血压病患者颈动脉超声多普勒检查和血尿酸及载脂蛋白水平的测定,探讨血尿酸及载脂蛋白与颈动脉硬化程度的关系.方法 测定100例高血压病患者血尿酸及载脂蛋白水平,用超声多普勒检测颈动脉粥样硬化程度.结果 颈动脉粥样硬化程度与血尿酸及载脂蛋白水平有关.结论 血尿酸及载脂蛋白水平与颈动脉粥样硬化的程度具有相关性,血尿酸及载脂蛋白B水平升高、载脂蛋白A水平降低是动脉粥样硬化的危险因素. Abstract： Objective To evaluate the correlation among the level of serum uric acid, apolipoproteins and the degree of carotid artery atherosclerosis in patients with hypertension. Methods The serum uric acid, apolipoproteins in 100 patients with hypertension were detected, and the degree of carotid artery atherosclerosis was determined by ultrasonic Doppler examination. Results The serum uric acid,apolipoproteins had the positive correlation to the degree of carotid artery atherosclemsis. Conclusions The concentrations of serum uric acid, apolipoproteins have positive relationship to the degree of carotid artery atherosclerosis. Increase of level of serum uric acid and ApoB, reduce of level of ApoA are risk factors for carotid artery atherosclerosis.     

Evaluation of Carotid Plaque Neovascularization in Patients with Diabetes Mellitus by Contrast-enhanced Ultrasonography简

This study investigated the relationship between carotid plaque neovascularization and diabetes mellitus（DM） by using contrast-enhanced ultrasonography. Contrast-enhanced ultrasonography was performed in 104 patients with carotid plaque thicker than 2.0 mm. There were 36 patients with DM and 68 patients without DM. The enhanced intensity in the plaque and the ratio of enhanced intensity in the plaque to that in the lumen of the carotid artery in patients with DM were significantly greater than those in patients without DM. Our study demonstrated that the enhanced intensity in patients with DM is greater than that their counterparts without DM, suggesting that carotid plaque in DM patients may have more neovessels and may be more vulnerable.     

脑梗死患者颅内外动脉粥样硬化性狭窄及影响因素分析

目的 分析脑梗死患者颅内外动脉粥样硬化性狭窄的分布情况,探讨动脉粥样硬化危险因素与病变部位的关系.方法 搜集2008年7月至2010年6月间在北京大学人民医院神经内科住院的由经颅多普勒、颈动脉彩色超声、颅内磁共振血管成像和数字减影血管造影诊断存在颅内和(或)颅外动脉粥样硬化性狭窄的428例脑梗死患者资料,根据血管病变部位分组,比较各组间动脉粥样硬化危险因子的差别.结果 颅内动脉病变组199例(46.5%),颅外动脉病变组129例(30.1%),颅内合并颅外动脉病变组100例(23.4%);颅内动脉病变组总胆固醇(TC)、低密度脂蛋白胆固醇酯(LDL-C)水平高于其他两组(TC:P1=0.001,P2=0.000;LDL-C:P1=0.004,P2=0.039),颅内合并颅外动脉病变组男性比例高于颅内动脉病变组(P=0.003).结论 脑梗死患者颅内动脉粥样硬化性狭窄多于颅外,单纯颅内动脉狭窄组血脂控制欠佳,大多数传统的动脉粥样硬化危险因素并不是动脉狭窄发生部位的决定因子.

Abstract：

Objective To investigate the distribution of atherosclerotic stenosis of cerebral arteries in Chinese patients suffered from cerebral infarction,and to determine if there are any factors correlating with intracranial and extracranial atherosclerosis.Methods For this study,we enrolled 428 consecutive inpatients with cerebral infarction,All patients were examined with transcranial Doppler ultrasonography (TCD) and carotid duplex ultrasound to detect atherosclerotic lesions in intracranial and extracranial cerebral arteries,some also were examined by magnetic resonance angiography (MRA) and/or digital subtraction angiography(DSA),they were all diagnosed as atherosclerotic cerebral artery stenosis.The patients were divided into three groups according to the different location of lesions,the frequency of risk factors of atherosclerosis and the demographic parameters were compared among these groups.Results 199 cases (46.5%) had only intracranial artery stenosis,129 cases (30.1%) had only extracranial artery stenosis,100 cases (23.4%) had both intracranial and extracranial stenosis (combine group).Compared with the other two groups,the levels of total cholesterol and low density lipoprotein-cholesterol of the intracranial artery group are both significantly higher(TC:P1 = 0.001,P2 = 0.000;LDL-C:P1 = 0.004,P2 = 0.039),the combine group had a significant higher ratio of male than that of the intracranial artery group (P =0.003),there were no any other atherosclerosis risk factors had association with the location of cerebral artery stenosis.Conclusion The occurrence of stenosis in intracranial arteries is more frequent than that in extracranil arteries in Chinese patients with cerebral infarction,and the lipid level is higher in the intracranial artery group,most risk factors of atherosclerosis may not be major determinants of location for cerebral atherosclerosis.     

Evaluating non-invasive medical imaging for diagnosis of carotid artery stenosis with ischemic cerebrovascular disease

Objectives To assess the value of non-invasive medical imaging for diagnosis of carotid artery stenosis and to study the relationship between stenosis and brain infarction.Methods Thirty-one patients with a total of 62 carotid arteries were studied using Doppler ultrasound (DUS)and magnetic resonance angiography(MRA),Eleven of the 31 patients were studied using CT angiography(CTA).CT and MRI of the brain were also done in all patients.The imaging results in 5 patients were compared with those of digital subtraction angiography(DSA).Eight patients with severe stenosis received carotid endarterectomy.The comparisons between the imaging results and pathological data were conducted in 2 patients. Results Of the 62 carotid arteries,mild stenosis was seen in 11,moderate in 14,severe in 21,obstructed in 4 and normal in 12.In 25 patients with severe stenosis or occlusion of carotid arteries,there were a total of 35 focal or multifocal infarcts on the ipsilateral cerebral hemisphere,and 15 infarcts on the contrary side.Compared with the results of the operations,DUS correctly diagnosed 6 stenoses,while MRA identified 7 correctly and CTA 8.Agreement on location of stenosis as performed by endarterectomy,DUS,MRA and CTA occurred in all patients.Histologically,areas of calcification and fibrousness were related to high densities on CTA,strong echoes on DUS,and low signal intensities on MRA.Relatively large amounts of necrotic material and foam cells filled with lipolytic materials on the intimal surface of arteries were observed during pathologically,corresponding to low and iso-densities of CTA.low echoes on DUS,and inhomogeneous signal intensities on MRA.Conclusions A strong link exists between carotid stenosis and brain infarction.The combined use of DUS,MRA and CTA can improve diagnostic accuracy for the assessment of carotid artery stenosis,as well as assist in ascertaining the nature of the plaque.     

Significance of the preoperative guidance of dual-source CT in carotid body tumor

Background Accurate views of the head and neck vessels, tumor angiogenesis and the relationship of tumor and the surrounding blood vessels are especially crucial to carotid body tumor （CBT） patients. The aim of this study was to explore the value of dual-source CT （DSCT） cerebral and carotid angiography in CBT diagnosis.Methods DSCT cerebral and carotid angiography was performed on nine patients with CBT. Two-dimensional and three-dimensional reconstruction images were obtained by means of multiple planar reconstructions （MPR）,maximum intensity projection （MIP） and volume rendering （VR）. All patients were subjected to color Doppler flow imaging （CDFI） examination. Two kinds of examinations were performed in 3 days, and all patients were confirmed by surgery.Results DSCT angiography was successful in all patients. CBTs were diagnosed in 9 patients with 10 lesions （1 case had multiple bilateral CBTs）. The largest lesion was 12 cm in diameter, and the smallest one was 1.6 cm in diameter. All patients had clearly demonstrated head and neck vessels, tumor angiogenesis, and tumor relationship with the surrounding blood vessels. The internal and external carotid artery （ICA, ECA） were involved in 2 cases. There were 7 cases with basilar artery ring integrity, and 1 case had the posterior communicating artery absent; 1 case had middle cerebral artery stenosis; 4 cases （4 tumors） showed arterial phase homogeneous enhancement; 5 cases （6 tumors） had obvious heterogeneous enhancement where irregular low-density necrosis could be seen in the tumors. CDFI could demonstrate the nearby blood vessels and tumor structure, instead of tumor angiogenesis. However, DSCT can display both the tumor and the peripheral vascular tumor angiogenesis consistent with surgical findings.Conclusions DSCT cerebral and carotid angiography can provide reliable information for the operation. It might be a valuable CBT diagnostic method by showing accurate views of the CBT along with the bilateral neck and brain blood vessels.     

MRI与DSA对颈动脉支架置入术适应证选择的比较

目的 比较3.0T磁共振(MRI)和数字减影血管造影(DSA)对颈动脉粥样硬化患者支架置入术适应证选择的效能差异.方法 收集2009年1月至2010年12月卫生部北京医院神经外科就诊的46例初发或复发脑缺血疾病的患者,超声检查发现颈动脉粥样硬化斑块后分别行颈动脉MRI及DSA检查.比较两种方法对血管狭窄程度、溃疡斑块的检出和对手术适应证确定的效能差异.结果 共92支颈动脉,除3支血管为支架置入后,症状性血管组25支血管,无症状血管组64支血管.MRI和DSA对颈动脉管腔狭窄的判断具有很好的一致性(Kappa值为0.882);对溃疡斑块检出的差异有统计学意义(P<0.01);对手术适应证的确定,症状组的差异无统计学意义(分别为14支和13支血管,P>0.05),无症状组的差异具有统计学意义(分别为22支和14支血管,P＜0.05).在接受手术的14例患者中2例的手术依据仅参照MRI.MRI发现37支血管有斑块内出血,71支有斑块内钙化,而DSA未能检出.结论 与DSA相比,MRI可以更好地检出符合手术适应证要求的血管.

Abstract：

Objective To compare the efficacy of cardiovascular MRI and DSA in stent-treatment selection for patients with carotid atherosclerosis.Methods Forty-six patients with carotid plaque detected by ultrasound were enrolled in this study.Carotid plaque MRI and DSA was performed.Images were evaluated for luminal stenosis(NASCET standard), fibrous cap rupture, intra-plaque hemorrhage and calcification.Kappa value and paired chi-square test were used for the statistical analysis.Results These 92 carotid arteries were divided into two groups, that were the symptomatic artery group with 25 vessels and asymptomatic artery group with 64 vessels, and the other 3 arteries were excluded due to stent placement.There was good concordance between the degree of stenosis measured by MRI and DSA (Kappa value 0.882).There was significant difference in detecting FC rupture by two modalities (P<0.01).As to the indication selection for stent treatment by two modalities, there was significant difference for asymptomatic group(22 vessels by MRI and 14 vessels by DSA, P<0.05), neither did the symptomatic group.There were two patients, among those 14 who underwent the stent treatment, that decided stent treatment only rely on the FC rupture detected by MRI.Furthermore, MRI detected 37 vessels with intra-plaque hemorrhage and 71 vessels with calcification in the plaque.Conclusion MRI was much more suitable for the selection of stent treatment for patients with carotid atherosclerosis as compared with DSA.     

Prevalence of CMV in arterial walls and leukocytes in patients with athero sclerosis

Objective To investigate the association of cylomegalovirus with atherosclerosis.Methods The presence of cylomegalovirus (CMV) nucleic acids was demonstrated in carotid and coronary arteries of patients with and without atherosclerosis by polymerase chain reaction (PCR).CMV was detected by PCR in the blood of patients with an d without atherosclerosis.Results 83.3%-86.7% of the samples obtained from atherosclerotic patient arterial wall s were shown to contain viral nucleic acids (CMV), CMV could be found among 6.7 % of patients’ arterial wall without atherosclerosis, significant difference can be found between them (P&lt;0.01).In blood CMV could be found in 42.4% of patients with atherosclerosis, in the control group, only 3% of samples had CMV, P&lt;0.01.Conclusion CMV plays an important role in the pathologic process of the atherosclerosis and the atherosclerotic cerebral infarction.     

单侧颈动脉重度狭窄或闭塞CEA围术期的综合治疗

目的 探讨单侧颈动脉重度狭窄甚至闭塞的患者的围术期处理,寻找使患者安全平稳度过围术期的措施.方法 选择我院自2008年1月至2009年3月收治自康复科和神经内科转入我科并伴有神经功能缺陷的患者,按指定标准选入34例行颈内动脉内膜剥脱术(CEA)手术.结合脑血流监测,探讨围术期对血压控制、转流管应用、抗凝及脱水治疗等方面的综合处理措施,注意全程脑保护.结果 34例患者中,除1例术中血压波动较大,估计远处栓子脱落,术后CT及MRI证实术侧多发梗死灶,1例患者未使颈内动脉再通,余患者术后恢复满意,NIHSS评分均有所下降.结论 病情稳定患者,越早手术干预颈动脉重度狭窄甚至闭塞的患者,可能对患者带来越大的收益.围术期平稳控制血压是全程脑保护的中心问题,对颈动脉重度狭窄甚至闭塞的患者尤为重要. Abstract： Objective To explore the perioperative management of patients with unilateral carotid artery severe stenosis or occlusion in order to carry the patients through the perioperative period safely.Methods In our hospital from January 2008 to March 2009,patients were treated in Rehabilitation Division and department of Neurology and transferred to our department, accompanied by neurological dysfunction in patients selected according to specified standards into the thirty-four cases CEA surgery. Combination of cerebral blood flow monitoring, to explore perioperative blood pressure control and shunt applications, anticoagulation and dehydration treatment in a comprehensive treatment measures and pay attention to whole brain protection.Results Thirty-four patients, except one case of intraoperative blood pressure fluctuations, the estimated distance off emboli, postoperative CT and MRI confirmed the surgery side of multi-infarct foci, one patient did not make the internal carotid artery recanalization, the rest patients after satisfactory recovery, NIHSS scores have been reduced.Conclusions The patients in stable condition, the earlier the surgical intervention of severe carotid artery stenosis or occlusion in patients may bring greater benefits for patients. Perioperative control of blood pressure is stable throughout the central issue of cerebral protection, right carotid artery severe stenosis or occlusion in patients is particularly important.     

替罗非班对急性心肌梗死患者高水平血小板聚集率和预后的影响

目的 观察替罗非班在择期经皮冠状动脉介入治疗(PCI)急性心肌梗死患者应用过程中的高水平血小板聚集率(＞40%),及其与临床结果的关系.方法 收集2007年6月至2009年6月在河南省人民医院行择期行经皮冠状动脉介入治疗(PCI)的急性ST段抬高心肌梗死患者资料,满足术后12 h血小板聚集率＞40%的共140例,术后应用替罗非班组72例,未应用替罗非班的对照组68例.替罗非班的应用方法为PCI术后即刻静脉注射替罗非班10μg/kg(3 min注完),然后以0.1 μg/(kg·min)静脉滴注维持36 h.所有患者均接受皮下注射低分子肝素及口服二磷酸腺酐(ADP)受体拮抗剂和阿司匹林.观察两组患者7 d、30 d和6个月复合终点事件发生率(死亡、顽固性心肌缺血、再发心肌梗死和靶血管重建术)和出血事件.结果 替罗非班组与对照组7 d、30 d复合终点事件发生率差异无统计学意义(2.7%vs 1.5%,P＞0.05;6.9%vs 4.4%,P＞0.05);6个月复合终点事件发生率替罗非班组明显高于对照组(19.4%vs7.4%,P＜0.05).替罗非班组出血事件有增多趋势(11.1%vs 7.4%,P＞0.05),主要是穿刺点出血,两组均无颅内出血等严重出血事件发生.结论 行择期PCI的急性心肌梗死患者,替罗非班应用过程中血小板聚集率处于较高水平(40%以上)者,6个月心血管不良事件发生率增加. Abstract： Objective To observe the relationship between high (above 40% ) platelet aggregation rate(PAR) and clinical outcomes in ST segment elevation myocardial infarction(STEMI) patients undergoing selective percutaneous coronary artery intervention (PCI) after utiliity of tiroban. Methods The clinical materials of 140 STEMI patients with platelet aggregation rate above 40% at 12 hours after selective PCI in the People Hospital of Henan Province from June 2007 to June 2009 were collected, in which 72 patients received tirofiban 10 μg/kg by intravenous injection within 3 minutes immediately after PCI, followed by pump infusion at 0. 10 μg/( kg· min) for 36 hours and 68 patients as the control group received no tirofiaban therapy after PCI. All patients received subcutaneous low molecular heparin injection and oral ADP receptor antagonist and aspirin. Incidence of 7,30 days and 6 months composite end point events (death persistent myocardial ischemic, reinfarction and target vessel revascularization) and bleeding complications were observed in both groups. Results The 7 and 30 days end point events rates of the two groups showed no significant differences(2.7% vs 1.5%, P ＞0.05 ;6.9% vs 4.4%, P ＞0. 05, respectively) , but the 6 months end point events rates of tirofiban group was significant higher than that of the control group( 19.4% vs 7.4%, P ＜ 0.05 ). Bleeding complications occurred more frequently in the tirofiban group ( 11.1% vs 7.4% , P ＞ 0.05 ), mostly at the arterial puncturing site, but there was no intracranial hemorrhage in either group. Conclusions Myocardial infarction patients with higher platelet aggregation( above 40% ) after selective PCI, whom received tirofiban therapy,may have a higher cardiac events rates in the long term.     

螺内酯对心肌梗死大鼠血流动力学及血清TGF-β1的影响

目的 研究螺内酯对大鼠心肌梗死后血清转化生长因子-β1(TGF-β1)的影响.方法 结扎SD大鼠冠状动脉前降支,建立心肌梗死模型,将术后存活24 h大鼠随机分为两组:螺内酯(MIS)组给予螺内酯20 mg/(kg·d)溶于2 ml生理盐水灌胃,连续4周;心肌梗死(MI)对照组给予等体积的生理盐水,穿针但不结扎前降支的作为假手术组,给予等体积的生理盐水,4周末行血流动力学测定,同时断尾取血测血清TGF-β1含量.结果 与假手术组相比,4周末AMI组血清TGF-β1含量显著升高(P＜0.01),左室舒张末压(LVEDP)显著增加(P＜0.01),左室内压最大收缩速率(+dp/dtmax)显著下降(P＜0.01).与AMI组相比,4周末螺内酯组血清TGF-β1含量显著下降(P＜0.01),LVEDP显著下降(P＜0.01),而+dp/dtmax显著增加(P＜0.01).结论 螺内酯可能通过抑制TGF-β1产生而改善心功能,抑制心肌纤维化. Abstract： Objective To observe the effects of aldactone on blood serum TGF - β1 in acute myocardial infarction rats. Methods Rats surviving 24 h after AMI induced by left anterior descending branch ligation were randomized to aldactone and control group compared with sham - operated group. The aldactone group was given aldactone 20 mg/( kg · d) , the MI control group and sham -operated group were given an equal volume of saline, continued for 4 weeks. At the end of 4th week,the hemodynamics change was detected, then tails to take blood and measure the serum TGF - β1.Results Compared with the sham - operated rats,the serum TGF - β1 level and the LVEDP of the AMI rats were significantly elevated at the end of the 4th week ( P ＜0.01 ) , while the + dp/dtmax were significantly reduced ( P ＜0.01 ) compared with the AMI control group, the serum TGF - β1 level and the LVEDP of the aldactone group rats decrease significantly at the end of the 4th week (P ＜ 0.01 ) ,while the + dp/dtmax were significantly elevated ( P ＜ 0.01 ). The difference had statistical significance. Conclusions Aldactone may improve the cardiac fibrosis and inhibit myocardial fibrosis by inhibiting the production of the TGF - β1.     

急性心肌梗死窦性心律震荡现象临床分析

目的 探讨窦性心律震荡现象对急性心肌梗死的影响.方法 分析急性心肌梗死(98例)与对照组(30例),急性心肌梗死存活组(75例)与死亡组(23例)的24 h动态心电图,比较各组间的心律震荡(HRT)的震荡初始(TO)和震荡斜率(TS).结果 ①与对照组TO、TS比较,急性心肌梗死组TO值高、TS值低,差异均有统计学意义(P＜0.05);②与急性心肌梗死存活组TO、TS比较,死亡组TO值高、TS值低,差异均有统计学意义(P＜0.05).结论 窦性心律震荡现象可作为急性心肌梗死死亡率的预测指标. Abstract： Objective To investigate the clinical value of heart rate turbulence(HRT) in acute myocardial infarction ( AMI). Methods HRT onset (TO) and HRT slope (TS) were calculat ed based on holter recorded in 75 survivors of AMI,23 cases died of AMI and 30 normal subjects.Results ①TO was higher and TS was lower in AMI patients than in normal subjects. ②TO was higher and TS was lower in cases died of AMI than in survivors of AMI. Conclusions HRT is relative to death and prognosis of with AMI.     

血清超敏C-反应蛋白检测在急性心肌梗死诊断中的临床意义

目的 探讨血清中超敏C-反应蛋白(HSCRP)水平的变化对急性心肌梗死(AMI)的临床诊断价值.方法 分别对76例AMI患者血清中HSCRP、肌酸激酶MB型同功酶(CKMB)、肌钙蛋白I(cTnI)和肌红蛋白(Mb)水平进行动态监测.结果 HSCRP在AMI发病后血清水平不断升高,并在第3天时达到峰值(16.2±4.1) mg/L,1周后基本降至正常水平,其水平变化与心肌损伤指标CKMB、cTnI、Mb呈正相关(P<0.01).结论 HSCRP与CKMB、cTnI及Mb联合检测对AMI病情诊断及预后评估有重要的临床价值. Abstract： Objective To investigate the clinical significance value of serum high-sensitivity C-reactive protein (HSCRP) levels change on acute myocardial infarction (AMI). Methods Seventy-six cases of AMI in patients with serum HSCRP, creatine kinase MB isoenzyme (CKMB), troponin I (cTnI) and myoglobin (Mb) level of dynamic monitoring. Results HSCRP serum levels after onset of the AMI rising and peak at 3 days(15.2±4.1)mg/L, one week after basically returned to normal levels, the level of change and indicators of myocardial injury CKMB, cTnI, MB was positively correlated (P<0.01). Conclusions HSCRP and CKMB,cTnI and Mb combined detection of AMI diagnosis and prognosis of disease has important clinical value.     

急性心肌梗死患者抑郁状况分析及心理护理干预

目的 调查急性心肌梗死(AMI)患者的抑郁状况,并进行心理护理干预.方法 采用随机抽样的方法,对符合入选条件的78例患者进行问卷调查,问卷由Zung自我评定量表(SDS)以及一般资料调查表组成.并对患者进行心理护理干预对比分析.结果 AMI患者较常模更易发生抑郁状况,平均SDS得分为(59.7±5.7)分.通过护理干预,患者抑郁状况明显改善,平均SDS得分为(47.2±6.3)分.结论 急性心肌梗死病人更易发生抑郁状况.针对AMI患者的心理状况,加强针对性的心理护理,避免因抑郁导致的不良后果,有利于提高AMI患者的身心康复. Abstract： Objective To investigate depression state in patients after acute myocardial infarction and analyze psychological nursing intervention. Methods The Zung SDS and generaldata questionnaire were systematically applied to the 78 eligible patients who were randomly sampled. To analysis psychological nursing intervention of these patients. Results The patients of acutemyocardial infarction were more susceptible to depression than the normal. The average SDS score was (39.7±5.7). And the average SDS score was (47.2±6.3) after psychological nursing intervention. Conclusions Patients of acute myocardial infarction were more susceptible to depression. It is suggested that in the clinical care, nurses should paymore attention to psychological care in patients after acute myocardial infarction, so as to improve the nursing quality and avoid the adverse consequences of depression.     

阿托伐他汀对冠心病合并充血性心力衰竭患者血管内皮功能的影响

目的 研究阿托伐他汀对冠心病(CHD)合并充血性心力衰竭(CHF)患者血浆中一氧化氮(NO)、降钙素基因相关肽(CGRP)和内皮素(ET)的影响.方法 将68例CHD并CHF患者随机分为两组,常规治疗组(地高辛、氢氯噻嗪、硝酸异山梨酯)34例,联用组常规用药加阿托伐他汀34例,另选34例健康体健者为正常对照组.采用Greiss法测定NO水平,放射性免疫法测定治疗前后血中CGRP和ET的水平.结果 CHD并CHF患者中NO和CGRP水平明显低于正常组(P＜0.01),ET显著高于正常组(P＜0.01),治疗后均显著改善(P＜0.01),且以联用组改善更为显著,与常规组治疗后比较差异有统计学意义(P＜0.05).结论 常规用药加阿托伐他汀能显著改善CHD合并CHF患者的NO、CGRP和ET的代谢失衡. Abstract： Objective To study the effect on levels of plasma calcitonin gene-related peptide (CGRP) and endothelin(ET) of atorvastatin in patients with coronary artery heart disease(CHD) complicated with congestive heart failure(CHF). Methods Patients with CHD complicated with CHF were divided into two groups usual medicine group(usual medicine) and atorvastatin group. The plasma CGRP and ET levels were observed before and after treatment. Results The levels of CGRP in patients with CHF were lower than that in normal group before treatment (P＜0.05),and the level of ET was higher (P＜0.05),the improvement of CGRP and ET in atorvastatin group was better than that in the usual medicine group(P＜0.05). Conclusions Atorvastatin had the action of improving the imbalance of CGRP and ET in Patients with CHD complicated with CHF.     

TIMI评分对急性心肌梗死患者危险分层及预后评估的临床价值

目的 探讨心肌梗死溶栓疗法(TIMI)危险评分系统对急性心肌梗死(acute myocardialinfarction,AMI)患者危险分层及预后评估的临床价值.方法 应用TIMI危险评分对133例AMI患者入院时进行评分,根据其分值分为低分组、中分组和高分组.观察患者12个月的主要心血管事件(包括非致命性再次心肌梗死、非致命性心力衰竭、反复心绞痛发作与心脏性死亡)发生率.结果 133例AMI患者12个月共发生心血管事件27例(发生率20.3%),随危险评分值的逐渐递增,其心血管事件发生率进行性增高.结论 入院时AMI患者TIMI危险评分值高,临床预后较差;TIMI危险评分系统对AMI患者危险分层方便实用,评估预后具有一定的临床价值. Abstract： Objective To investigate the treatment of thrombolysis in myocardial infarction (TIMI) risk scoring system for acute myocardial infarction (AMI) patients risk stratification and prognosis of clinical value. Methods The TIMI risk score was used for 133 AMI patients admitted to hospital, and the patients were divided into low, medium group and high group according to their scores. The major cardiovascular events ( including non - fatal myocardial re - infarction, non - fatal heart failure, recurrent angina and cardiac death) rate of the patients in 12 months were observed. Results The 12 - month cardiac events occurred in 27 cases ( incidence 20.3 %) , with the value of the incremental risk score, their rates of cardiovascular events increased. Conclusions Patients with high TIMI risk score value have poorer clinical prognosis, TIMI risk score is convenient and practical in risk stratification of patients with AMI, and has some clinical value in assessing the prognosis of the disease.     

脑梗死与颈动脉斑块的关系

目的探讨颈动脉粥样硬化（CAS）与脑梗死之间的关系。方法收集100例患者,经头颅CT或MRI诊断为脑梗死,行多普勒超声检查颈总动脉（CCA）、颈内动脉（ICA）、椎动脉（VA）,同时伴有颈动脉斑块。结果颈动脉分叉处斑块发生脑梗死最高,其次为颈内动脉、颈总动脉起始部,椎动脉较少。斑块引起同侧脑梗死发生率明显高于对侧脑梗死,软斑块和溃疡斑块最易于脱落形成脑梗死。结论颈动脉粥样硬化与脑梗死之间有着密切的关系。