H型高血压与初发急性心肌梗死患者近期预后的关系

目的探讨H型高血压与初发急性心肌梗死(AMI)患者近期预后的关系。方法选取本院收治的发病24 h内初发急性心肌梗死合并高血压患者316例,根据血浆同型半胱氨酸(Hcy)水平将其分为H型高血压组(Hcy≥10μmol/L) 176例与对照组(Hcy 10μmol/L) 140例,收集患者病史、化验检查、心脏彩超、冠状动脉造影结果等住院资料,分析2组患者住院期间不良心血管事件的发生情况。结果 2组充血性心力衰竭、心源性休克、死亡、心脏破裂和联合事件的发生率差异均有统计学意义(P 0. 01); Logistic回归分析结果显示,H型高血压是初发急性心肌梗死预后的不良危险因素。结论 H型高血压是初发急性心肌梗死患者近期预后的独立危险因素。     

体力活动和体质量指数与冠状动脉粥样硬化性心脏病患者心血管事件的关系

目的:分析体力活动和体质量指数是否与冠状动脉粥样硬化性心脏病(简称冠心病)心血管事件有关。方法:①入选2003-08/2004-07于北京朝阳医院门诊就诊确诊为冠心病的患者941例,其中男691例,女250例,平均年龄(61.4±9.7)岁。②将入选冠心病患者按体质量指数分为正常体质量组(18.5￣23.9kg/m2)、超重组(24.0￣27.9kg/m2)和肥胖组(>28kg/m2);按有无体力活动分为体力活动组(每周3次以上,每次不少于30min的有氧体力活动)和无体力活动组。③使用统一设计的调查问卷,对患者体质量指数、危险因素、实验室检查结果等相关资料进行收集比较,并应用SPSS12.0软件包进行Logistic回归模型分析。结果:①正常体质量组、超重组和肥胖组相比,吸烟、呼吸睡眠障碍、血脂、最高舒张压、心肌梗死、冠状动脉介入术、冠状动脉搭桥手术、再梗死、缺血再入院、主要不良心脏事件无统计学差异(P>0.05),而肥胖组男性比例高于其他2组,年龄、最高收缩压、糖尿病和体力活动比例低于其他2组(P<0.05)。②有无体力活动组比较:性别、吸烟、呼吸睡眠障碍、胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、心肌梗死、冠状动脉搭桥手术、再梗死、血管重建、主要不良心脏事件无统计学差异(P>0.05),无体力活动组年龄、最高收缩压和糖尿病比例高于体力活动组,三酰甘油、冠状动脉介入术比例低于体力活动组(P<0.05)。③Logistic回归显示年龄(OR=1.029)、冠状动脉搭桥手术(OR=2.659)、高脂血症(OR=1.434)、心肌梗死(OR=7.972)是主要不良心脏事件事件的独立危险因素(P<0.05),体力活动和体质量指数不是其独立危险因素(P>0.05)。④对主要不良心脏事件事件中的血管重建、心肌缺血再入院和再梗死分别作为因变量进行Logistic回归分析,结果表明体质量指数与此3项均不相关(P>0.05),但体力活动是心肌缺血再入院的独立危险因素(OR=1.633,P=0.014)。结论:体力活动减少为缺血再入院患者的独立危险因素,体质量指数不是心血管事件的独立危险因素。     

血清MCP-1、SFRP5水平与急性ST段抬高型心肌梗死患者心功能及预后的关系研究

目的探讨血清单核细胞趋化蛋白-1(MCP-1)、分泌型卷曲相关蛋白5(SFRP5)水平与急性ST段抬高型心肌梗死(ASTEMI)患者心功能及预后的关系。方法选取2017年1月至2019年1月于该院行经皮冠状动脉介入术治疗的ASTEMI患者215例作为研究对象,根据术后6个月内是否发生主要不良心脏事件(MACE)分为预后不良组(60例)和预后良好组(155例)。检测两组患者血清中MCP-1、SFRP5水平,分析MCP-1、SFRP5水平与ASTEMI患者心功能及预后的关系。结果 6个月的随访时间内,ASTEMI患者预后不良的发生率为27.91%(60/215)。单因素分析显示,预后不良组患者血清SFRP5水平、左心室射血分数(LVEF)明显低于预后良好组,而血清MCP-1水平、支架置入数、冠状动脉多支病变率、Killp分级高于预后良好组(P均0.05)。ASTEMI患者血清MCP-1水平与LVEF呈负相关(r=-0.544,P0.001),而SFRP5与LVEF呈正相关(r=0.523,P0.001);ASTEMI患者血清MCP-1水平与Killp分级呈正相关(r=0.384,P0.001),而SFRP5水平与Killp分级呈负相关(r=-0.363,P0.001)。多因素Logistic回归分析显示,MCP-1(OR=1.789)、冠状动脉多支病变(OR=3.049)及Killp分级(OR=1.628)是ASTEMI患者预后不良的危险因素,SFRP5(OR=0.634)是其保护因素(P均0.05)。MCP-1、SFRP5水平预测ASTEMI患者预后不良的曲线下面积(AUC)分别为0.804、0.821,MCP-1联合SFRP5预测患者预后不良的AUC为0.902,高于二者单独预测。结论血清MCP-1、SFRP5均可较好地反映ASTEMI患者心功能损伤程度,且二者是患者预后不良的预测因子,二者联合检测可为ASTEMI患者的治疗及预后评估提供一定的参考。     

缺血性脑卒中合并糖尿病患者短期生存状况的影响因素研究

目的研究缺血性脑卒中合并糖尿病患者短期生存状况的影响因素。方法回顾性分析2014年1月至2015年12月收治的120例缺血性脑卒中合并糖尿病患者的临床资料,将患者分为预后良好组和预后不良组,每组60例。比较两组患者的临床资料、生化指标并对影响患者短期生存状况的因素进行Logistic回归分析。结果预后良好组患者的平均年龄为(60.12±6.92)岁、出现住院并发症的百分比为5.00%,两项指标均明显低于预后不良组患者(P0.05);预后良好组患者的白细胞计数为(7.33±2.77)×109/L,明显低于预后不良组患者(P0.05);Logistic多元回归分析结果显示,年龄、住院并发症以及白细胞计数均为缺血性脑卒中合并糖尿病患者短期生存状况的危险因素(P0.05)。结论年龄、住院并发症以及白细胞计数均为缺血性脑卒中合并糖尿病患者短期生存状况的危险因素,可以通过尽力预防患者住院期间发生并发症来改善患者的预后情况。     

hs-CRP、Lp-PLA2和DD在预测冠心病患者预后中的价值研究

目的研究超敏C反应蛋白(hs-CRP)、脂蛋白相关的磷脂酶A2酶活性(Lp-PLA2)、D-二聚体(DD)与冠状动脉粥样硬化性心脏病(CHD)患者预后的关系。方法选取2009年8月至2010年9月鄂州二医院和鄂钢医院行冠状动脉造影明确诊断为CHD的住院患者480例,记录患者入院后24h内空腹hs-CRP、Lp-PLA2、DD及其他临床资料。于2012年8月至10月进行电话、门诊或者住院随访,了解心脏不良事件的发生情况。依据是否发生心脏不良事件进行单因素分析和多因素Logistic回归分析。结果 (1)成功随访458例(95.4%),随访时间为(30.8±3.9)个月。72例发生不良事件(15.7%),死亡14例(3.1%)。(2)单因素分析显示:性别、高血压、糖尿病、hs-CRP、Lp-PLA2、DD、左心室舒张末期直径(LVEDD)是心脏不良事件发生的危险因素(P0.05)。(3)多因素Logistic逐步回归分析显示性别、hs-CRP、Lp-PLA2、DD水平进入回归方程,与未发生不良事件组相比,发生不良事件组的性别OR值1.647(95%CI:1.543~1.759,P0.001),hs-CRP的OR值为2.235(95%CI:2.064~2.420,P0.001),Lp-PLA2的OR值为0.644(95%CI:0.569~0.729,P0.001),DD的OR值为1.918(95%CI:1.594~2.309,P0.001)。结论 hs-CRP、Lp-PLA2、DD水平可以预测CHD患者的不良预后。     

冠状动脉慢血流性心绞痛患者血清胱抑素C及髓过氧化物酶水平的变化及其相关性

目的探讨冠状动脉慢血流性心绞痛患者血清胱抑素C(Cys C)、髓过氧化物酶(MPO)水平的变化及其相关性。方法选取冠状动脉慢血流性心绞痛患者100例(心绞痛组),依据疗效分为预后良好组(59例)和预后不良组(41例),以100名健康体检者作为正常对照组,检测所有研究对象血清Cys C、MPO水平及校正心肌梗死溶栓试验(TIMI)血流帧数。采用Pearson相关分析评价Cys C、MPO与校正TIMI血流帧数的相关性,采用Logistic回归分析评估血清Cys C、MPO水平升高是否是冠状动脉慢血流性心绞痛患者预后不良的危险因素。结果心绞痛组血清Cys C、MPO水平及校正TIMI血流帧数均明显高于正常对照组(P0.001)。预后良好组血清Cys C、MPO水平明显低于预后不良组(P0.001)。相关分析显示血清Cys C、MPO水平与校正TIMI血流帧数呈正相关(r值分别为0.705、0.643,P0.05)。Logistic回归分析显示血清Cys C、MPO升高是冠状动脉慢血流性心绞痛患者预后不良的独立危险因素[Cys C:比值比(OR)=4.125,95%可信区间(CI)3.658~4.756,P=0.000;MPO:OR=6.986,95%CI 5.356~7.967,P=0.000]。结论血清Cys C、MPO水平与冠状动脉慢血流性心绞痛的发生、发展有关,是患者预后不良的独立危险因素,动态检测Cys C、MPO水平的变化可辅助判断患者的病情和预后。     

入院时白细胞计数对急性ST段抬高型心肌梗死患者长期预后的影响

目的探讨入院时外周血白细胞计数对急性ST段抬高型心肌梗死(STEMI)患者长期预后的影响。方法回顾性分析2015年1月至2020年1月于首都医科大学附属北京友谊医院和清华大学玉泉医院心脏重症监护病房确诊急性STEMI且接受急诊经皮冠状动脉介入治疗(PCI)的274例患者的临床资料。到院时采集静脉血,测定白细胞计数(WBC),按照WBC水平不同分为两组,≤9.5×10⁹/L为A组,>9.5×10⁹/L为B组,对两组患者的临床资料、心血管事件以及长期预后进行比较。出院后对患者进行随访,评价长期预后。患者出院后随访36个月的主要心脏不良事件(MACE),MACE发生率的比较使用生存分析Kaplan-Meier法;采用Cox回归分析多个变量与临床长期预后的关系。结果随访36个月,两组患者的累积MACE发生率A组(4.8%)明显低于B组(10.3%),差异有统计学意义(P=0.012)。Cox回归分析显示年龄(HR:1.135,95%CI:1.011~1.275,P=0.033)、吸烟史(HR:0.689,95%CI:0.519~0.915,P=0.010)、WBC(HR:1.356,95%CI:1.005~1.831,P=0.046)是MACE的危险因素。结论入院时外周血WBC计数可能是影响急性STEMI且接受PCI患者的长期预后的危险因素。     

高危冠心病患者冠状动脉旁路移植术后发生院内主要不良事件的危险因素

目的探讨行冠状动脉旁路移植术(coronary artery bypass grafting, CABG)高危冠心病患者院内主要不良事件发生的危险因素。方法 560例行CABG高危冠心病患者,院内发生主要不良事件者103例为观察组,未发生主要不良事件者457例为对照组。比较2组一般资料,术前左室射血分数(left ventricular ejection fraction, LVEF),血肌酐水平,欧洲心脏手术风险评分系统(European System for Cardiac Operative Risk Evaluation, EuroSCORE)评分,围术期红细胞输注量及NYHA心功能Ⅲ～Ⅳ级、心律失常、术前90 d内发生心肌梗死、冠状动脉病变血管、颈动脉狭窄≥50%、应用正性肌力药物、体外循环(cardiopulmonary bypass, CPB)比率;多因素logistic回归分析高危冠心病患者CABG后发生院内主要不良事件的危险因素。结果观察组术前LVEF[58(52,61)%]低于对照组[59(55,62)%],术前EuroSCORE评分[7(7,8)分]、术前应用正性肌力药物比率(12.61%)、围术期红细胞输注量[6(2,10)u]、CPB比率(42.72%)高于对照组[7(6,8)分、5.03%、2(0,4)u、10.72%](P0.05);2组年龄,性别比例,吸烟比率,合并糖尿病、高血压、高脂血症、慢性阻塞性肺疾病及心功能NYHAⅢ～Ⅳ级、心律失常、术前90 d内发生心肌梗死、左主干病变、多支血管病变、颈动脉狭窄≥50%比率,血肌酐水平比较差异均无统计学意义(P0.05);多因素logistic回归分析结果显示,CPB(OR=2.577,95%CI:1.340～4.957,P=0.005)、围术期红细胞输注量(OR=1.170, 95%CI:1.089～1.257,P0.001)是高危冠心病患者CABG后发生院内主要不良事件的危险因素,LVEF(OR=0.951, 95%CI:0.910～0.994,P=0.026)是其保护因素。结论高危冠心病患者行CABG前调整LVEF,术中尽可能减少CPB应用,围术期减少红细胞输注,可能会降低院内主要不良事件发生率。     

心脏康复指导联合舒适护理对急性心肌梗死PCI术后患者的影响

目的:探讨心脏康复指导联合舒适护理对急性心肌梗死经皮冠状动脉介入治疗(PCI)术后患者的影响。方法:选取2017年1月1日～2019年10月31日收治的急性心肌梗死PCI术后患者200例作为研究对象,按住院号的单双号分为对照组和观察组各100例,对照组给予常规护理干预,观察组给予心脏康复指导联合舒适护理干预;比较两组干预前后心理状态[采用汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)]、6 min步行试验(6MWT)、心脏功能[包括左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)]、生活质量[采用世界卫生组织生活质量测量量表简表(WHOQOL-BREF)],比较两组心血管不良事件发生情况和满意度。结果:干预后,观察组HAMA、HAMD评分低于对照组(P0.01);干预后,两组6MWT、LVEF、LVESD、LVEDD均优于干预前(P0.05),且观察组优于对照组(P0.01);干预后,两组WHOQOL-BREF中生理、心理、社会关系、环境评分均高于干预前(P0.05),且观察组高于对照组(P0.01);观察组不良心血管事件发生率低于对照组(P0.05),满意度高于对照组(P0.01)。结论:心脏康复指导联合舒适护理可改善急性心肌梗死PCI术后患者不良情绪和心脏功能,提高生活质量,降低不良事件发生率。     

冠状动脉造影正常急性心肌梗死患者临床分析

目的分析冠状动脉造影正常的急性心肌梗死（AMI）患者临床特点,探讨其发病机制、危险因素和预后。方法回顾分析了447例AMI患者冠状动脉造影（CAG）结果及临床资料,根据CAG结果分为冠状动脉正常组（A组）57例和冠状动脉异常组（B组）390例。分析2组患者冠心病的危险因素,比较2组左室射血分数（LVEF）、心脏事件发生率。结果A组年龄均小于B组,心绞痛、高血压、糖尿病、血脂异常、家族史均低于B组（均P〈0.05）;吸烟、大量饮酒者高于B组（P〈0.01）。Logistic多变量分析发现,吸烟、大量饮酒为CAG正常AMI患者独立危险因子。住院期间,严重心律失常、心力衰竭发生情况2组比较差异无统计学意义（P〉0.05）;A组总心脏事件发生率明显低于B组,LVEF值大于B组（均P〈0.05）。随访结果：再次AMI、心力衰竭、严重心律失常、复合终点事件比较,A组均低于B组（均P〈0.05）;2组心绞痛、心源性死亡比较差异无统计学意义（P〉0.05）。结论冠状动脉造影正常AMI患者是高危人群;大量吸烟、饮酒是其危险因素或诱因之一;CAG正常者与CAG异常者总心血管事件预后无明显差异。     

Prognostic Value of Cardiac Magnetic Resonance Imaging in Acute Coronary Syndrome Patients With Troponin Elevation and Nonobstructive Coronary Arteries

ObjectiveTo define the diagnostic yield of cardiac magnetic resonance (CMR) in differentiating the underlying causes of myocardial infarction with nonobstructive coronary arteries (MINOCA) and to determine the long-term prognostic implications of such diagnoses.MethodsCardiac magnetic resonance evaluation was performed in 227 patients (mean age, 56.4±14.9 years; 120 [53%] female) with a “working diagnosis” of MINOCA as defined by presentation with a troponin-positive acute coronary syndrome (troponin I >0.04 μg/L) and nonobstructed coronary arteries between January 1, 2007, and February 28, 2013. Follow-up was performed to assess the primary composite end point of myocardial infarction, heart failure, and all-cause mortality.ResultsCardiac magnetic resonance identified nonstructural cardiomyopathies in 97 (43%) patients, myocardial infarction in 55 (24%) patients, structural cardiomyopathies in 27 (12%) patients, and pulmonary embolism in 1 patient. No CMR abnormalities were identified in the remaining patients. Kaplan-Meier analysis demonstrated the ability of a CMR diagnosis to predict the risk of the primary composite end point (P=.005) at 5-year follow-up. Worse outcomes were seen among patients with “true” MINOCA and a normal CMR image compared with those with CMR-confirmed myocardial infarction (P=.02). Use of antiplatelets (78% [37/45] vs 95% [52/55]; P=.01), beta blockers (56% [25/45] vs 82% [45/55]; P=.004), and statins (64% [29/45] vs 85% [47/55]; P=.01) was significantly lower in patients with true MINOCA with normal CMR imaging compared with those with CMR-confirmed myocardial infarction.ConclusionsCardiac magnetic resonance carries a high diagnostic yield in patients with MINOCA and predicts long-term prognosis. Patients with MINOCA with normal CMR imaging had an increased rate of major adverse cardiac events and lower use of guideline-recommended myocardial infarction therapy compared with those with CMR-confirmed myocardial infarction.     

急性心肌梗死并发心源性休克的临床特征与救治

目的　评价急性心肌梗死 (AMI)并心源性休克的临床特征 ,总结救治经验。方法　 10 8例 AMI患者 ,分为休克组 (11例 )与非休克组 (97例 ) ,对比分析两组患者的临床特征、处理与近期预后的异同。结果　两组患者年龄、性别、糖尿病、冠心病、高脂血症、陈旧性心肌梗死病史及梗死部位无显著性差异 (P均 >0 .0 5 )。与非休克组比较 ,休克组肌酸磷酸激酶和心肌肌钙蛋白 I升高〔(31979.7± 2 2 2 71.1) nm ol· s- 1· L- 1比 (17795 .2± 14 979.7) nmol· s- 1· L- 1和 (90 .7± 6 1.1) μg/ L 比 (39.9± 5 2 .1) μg/ L,P均 <0 .0 5〕,左室射血分数降低 (0 .4 6± 0 .12比 0 .5 5± 0 .12 ,P<0 .0 5 ) ,急性肺水肿、心律失常和肺炎合并症增多 (6 4 %比 14 % ,P<0 .0 0 1;5 5 %比 2 1% ,P<0 .0 5 ;4 6 %比 12 % ,P<0 .0 1) ,采用溶栓治疗、冠状动脉造影、主动脉内气囊反搏者多 (46 %比 18% ,73%比 2 6 %和 36 %比 4 % ,P均 <0 .0 5 )。两组住院期病死率无显著性差异 (0比 4 % ,P>0 .0 5 )。结论　 AMI并休克者心肌梗死面积大 ,急性肺水肿、心律失常和肺炎合并症多 ,需主动脉内气囊反搏者多。正确判断、严密监测、及时有效处理 ,可明显改善患者的早期预后。     

Evaluation neointimal coverage in patients with coronary artery aneurysm formation after drug-eluting stent implantation by optical coherence tomography

The neointimal coverage in patients with coronary artery aneurysms (CAA) formation after drug eluting stent (DES) implantation is not clear. Total of 175 patients who had been implanted DES were identified. Patients were divided into the CAA group (n = 31) and non-CAA group (n = 144) based on the results of the coronary angiography. The cardiac events including angina and acute myocardial infarction were noted, in addition, the neointimal thickness and the frequence of strut malapposition and strut uncoverage were noted. A greater proportion of incomplete neointimal coverage (17.17 vs. 1.9 %, P < 0.001) and malapposition struts (18.2 vs. 1.38%, P < 0.001) were observed in the CAA group. 8 patients in CAA group underwent OCT examination twice in the period of follow-up. The proportion of incomplete neointimal coverage increased significantly as compared the second OCT results with the first examination (18.45 vs. 2.66 %, P < 0.001). Hyperplasia neointimal desquamated from struts and acquired struts incomplete neointimal coverage were detected. Patients with CAA had a higher frequency of cardiac events including angina pectoris (25.81 vs. 6.25 %, P = 0.001) and acute myocardial infarction (9.68 vs. 0.13 %, P = 0.002) and thrombosis (16.13 vs. 0.69 %, P < 0.001). The longitudinal length of CAA in cardiac event group was significantly longer than no cardiac event group (20.0 ± 9.07 vs. 12.05 ± 5.38 mm, P = 0.005). CAA formation after DES implantation frequently associated with cardiac events as a result of stent malapposition and incomplete neointimal coverage. Acquired incomplete neointimal coverage associated with CAA formation.     

Comparison of magnetic resonance imaging findings in non-ST-segment elevation versus ST-segment elevation myocardial infarction patients undergoing early invasive intervention

To define causes and pathological mechanisms underlying differences in clinical outcomes, we compared the findings of contrast-enhanced magnetic resonance imaging (CE-MRI) between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). In 168 patients undergoing early invasive intervention for STEMI (n = 113) and NSTEMI (n = 55), CE-MRI was performed a median of 6 days after the index event. Infarct size was measured on delayed-enhancement imaging, and area at risk (AAR) was quantified on T2-weighted images. The median infarct size was significantly smaller in the NSTEMI group than in the STEMI group (10.7% [5.6–18.1] vs. 19.2% [10.3–30.7], P < 0.001). Although there was a trend toward a greater myocardial salvage index ([AAR ? infarct size] × 100/AAR) in the NSTEMI group compared to the STEMI group (48.2 [30.4–66.8] vs. 40.5 [24.8–53.5], P = 0.056), myocardial salvage index was similar between the groups in patients with anterior infarction (39.6 [20.0–54.9] vs. 35.5 [23.2–53.4], P = 0.96). The NSTEMI group also had a significantly lower extent of microvascular obstruction and a smaller number of segments with >75% of infarct transmurality relative to the STEMI group (0% [0–0.6] vs. 0.9% [0–2.3], P < 0.001 and 3.0 ± 2.3 vs. 4.6 ± 2.9, P = 0.001, respectively). Myocardial hemorrhage was detected less frequently in the NSTEMI group than the STEMI group (22.6% vs. 43.8%, P = 0.029). In the multivariate analysis, baseline Thrombolysis In Myocardial Infarction flow grade 3 and hemorrhagic infarction were closely associated with ST-segment elevation (OR 0.32, 95% CI 0.13–0.81, P = 0.017; OR 5.66, 95% CI 1.77–18.12, P = 0.003, respectively). In conclusion, in vivo pathophysiological differences revealed by CE-MRI assessment include more favorable infarct size, AAR, myocardial salvage and reperfusion injury in patients with NSTEMI compared to those with STEMI undergoing early invasive intervention.     

Preoperative versus postoperative initiation of thromboprophylaxis following major orthopedic surgery: safety and efficacy of postoperative administration supported by recent trials of new oral anticoagulants

Background

Patients with vasospastic (VA) or non vasospastic angina (NVA) without significant coronary stenosis have a reduced risk of infarction but is unclear whether or not this may be attributable to a lack of prothrombotic profile - similar to that present in patients with stable coronary artery disease (CAD).

Methods

Plasma levels of von Willebrand factor, total and free tissue factor pathway inhibitor, plasminogen activator inhibitor-1, and fibrinogen were analyzed in 15 patients with stable VA and 23 with NVA, all with vasoconstrictive response to acetylcholine although with different severity. Results were compared with those of 20 age-matched controls and 10 patients with CAD.

Results

Plasma levels of von Willebrand factor in patients with VA or NVA were higher than in controls (207 ± 62 and 203 ± 69% vs 121 ± 38%, p < 0.001) and tended to be lower than in CAD patients (264 ± 65, p = 0.145). They also presented higher total tissue factor pathway inhibitor (123 ± 18 and 111 ± 25 vs 88 ± 14, ng/ml p < 0.001) and plasminogen activator inhibitor-1 levels than controls (51 ± 30 and 52 ± 31% vs 19 ± 9 ng/ml, p < 0.001) and similar to CAD patients (134 ± 23 and 62 ± 31, respectively, ns). Moreover, free tissue factor pathway inhibitor plasma levels were lower than controls (18 ± 5 and 17 ± 5 vs 23 ± 8 ng/ml, p = 0.002) and similar to CAD patients (14 ± 5, ns). Despite this prothrombotic condition none of VA or NVA patients presented a myocardial infarction during a 9 year follow-up, an observation also reported in larger series.

Conclusions

During a stable phase of their disease, patients with VA or NVA present a prothrombotic profile that might eventually contribute to occurrence of myocardial infarction. The rarity of these events, however, may suggests that ill defined factors would protect these patients from coronary plaque rupture/fissure.     

Myocardial area at risk after ST-elevation myocardial infarction measured with the late gadolinium enhancement after scar remodeling and T2-weighted cardiac magnetic resonance imaging

To evaluate the myocardial area at risk (AAR) measured by the endocardial surface area (ESA) method on late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) when applied after scar remodeling (3 months after index infarction) compared to T2-weighted CMR imaging. One hundred and sixty nine patients with ST-elevation myocardial infarction, treated with primary percutaneous coronary intervention, underwent one CMR within 1 week after index treatment to determine the AAR with T2-weighted imaging and a second scan 3 months after to measure AAR with the ESA method. There was a moderate correlation between the two methods (r = 0.86; P < 0.001). The AAR was significantly higher measured with T2-weighted imaging than with the ESA methods (32 ± 11% of left ventricle (LV) vs. 26 ± 10%LV; P < 0.001). The mean difference was 6 ± 6%LV. Furthermore, the mean difference between the two methods was statistical higher in the patients with myocardial salvage index ≥0.90 than in the remaining patients (9 ± 8%LV vs. 6 ± 5%LV; P = 0.02). The ESA method performed after scar remodeling (3 months following STEMI) yields significantly lower AAR′s and myocardial salvage indices compared to the T2-weighted method. Therefore, T2-weighted CMR plus LGE is the method of choice to assess AAR and myocardial salvage index using CMR. However, the ESA method is an easy and valid method for determining AAR, which can be used in settings where T2-weighted imaging has not been obtained in the acute phase.     

中性粒细胞/淋巴细胞与急性冠状动脉综合征及其预后的关系

目的探讨中性粒细胞/淋巴细胞(NLR)与急性冠状动脉综合征(ACS)及其预后的关系。方法入选我院经冠状动脉造影检查的160例可疑冠心病患者,其中不稳定型心绞痛组(UA组)50例,急性心肌梗死(AMI)组60例,正常对照组50例,对照组为冠状动脉造影阴性的非冠心病患者。检测各组的白细胞计数(WBCC)、中性粒细胞计数(NC)、淋巴细胞计数(LC)、超敏C反应蛋白(hs-CRP),并计算NLR。比较各组之间各项指标水平的差异,并进行Logistic回归分析。另对行PCI术的48例AMI患者按NLR大小均分为两组,分别进行为期一年的随访,记录或计算各组的死亡率、死亡原因、再住院率及左心室重构率。结果 (1)随着病情严重程度的升高WBCC、NC、hs-CRP、NLR水平逐渐升高(P<0.05或P<0.01),AMI组的LC水平较对照组明显升高[(1.7±0.7)×109/Lvs.(1.2±0.4)×109/L,P<0.05]。(2)多因素Logistic回归分析WBCC(OR5.960,95%CI5.278～6.729,P<0.01),hs-CRP(OR10.827,95%CI7.498～15.632,P<0.001)、NLR(OR9.915,95%CI7.958～12.351,P<0.001)均为ACS的独立危险因素,NLR与hs-CRP预测ACS的价值相当。(3)随访结果:NLR较高组的PCI术患者一年全因死亡率(25.0%vs.4.2%,P<0.05)、左心室重构率(37.5%vs.12.5%,P<0.05)较低NLR组明显偏高。结论 NLR是ACS的独立危险因素,其预测价值较WBCC高,与hs-CRP相当。NLR与PCI术患者术后一年全因死亡率、左心室重构率密切相关。     

Plasma iron status and lipid peroxidation following thrombolytic therapy for acute myocardial infarction

Summary— Free radical species have been implicated as important agents involved in myocardial ischemic and reperfusion injuries. Superoxide is capable of mobilizing iron from ferritin and the released iron can cause hydroxyl formation from H₂O₂. The aim of this study was to evaluate the time-dependent increase in lipid peroxidation assessed by plasma thiobarbituric acid reactive substances (TBARS) and the relationship between lipid-peroxidation and the iron status. Peripheral venous blood samples were obtained from 17 men with acute myocardial infarction (AMI) before thrombolytic treatment (T0***) and 1, 2, 3, 4, 8, 12, 16, 20, 24 and 48 hours after commencing fibrinolytic treatment. The concentration of TBARS, the parameters of iron metabolism, serum myoglobin, creatine kinase, and creatine kinase-MB were measured. Early reperfusion was judged by regression of sinus tachycardia (ST) elevation and reduction of chest pain. Recanalization of coronary artery was evaluated by a late coronary angiography 24–96 hours after thrombolysis. After thrombolytic therapy, the TBARS level was raised from 2.98 ± 0.80 (T0***) to 4.57 ± 1.24 (peak), and decreased to 2.96 ± 0.40 nmol/mL plasma at T48 (T0 vs peak: P < 0.001, peak vs T48: P < 0.001, TO vs T48: NS). The mean time of the peak was observed at 9.7 ± 7.5 hours. The iron increased significantly from 0.67 ± 0.34 (T0) to 1.15 ± 0.52 mg/L (peak), and returned to the pre-reperfusion to levels: 0.53 ± 0.28 UI/L at T48 (T0 vs peak: P < 0.001, peak vs T48: P < 0.001, TO vs T48: NS). The mean time of the peak was observed at 9.4 ± 7.3 hours. In return, no correlation was found between the increase of plasma creatine-kinase activity, myoglobin and iron or between the biochemical markers and time of fibrinolytic therapy. The results confirmed the importance of the temporal relationship between lipid peroxidation and iron status after thrombolytic therapy. Our results are in agreement with the concept that antioxidant agents used in association with thrombolytic therapy might be useful.     

优化护理在心肌梗死PCI患者中的临床应用观察及疗效分析

目的探讨优化护理在心肌梗死PCI患者中的临床应用。方法回顾性分析急性心肌梗死患者并行PCI术的患者80例,按入院时间分为观察组与对照组,观察组47例患者在PCI围术期采用针对性的全面优化护理模式,对照组33例给予常规护理。在不同护理模式下,对患者再灌注后血管动力学指标、术后并发症发生情况、住院天数、日常生活活动能力Barthel指数、焦虑自评量表SAS、抑郁自评量表SDS评分进行比较,评价优化护理的临床疗效。结果治疗前后左室舒张末直径(LVEDD)与射血分数(EF)水平比较,观察组LVEDD为(52.8±1.7)mm较对照组(54.2±1.6)mm降低趋势显著,观察组EF为(54.0±1.8)%,显著高于对照组(48.3±1.4)%,差异有统计学意义(P0.05)。观察组患者不良反应发生率为12.76%显著低于对照组患者30.30%;同时观察组患者住院时间也显著短于对照组患者。通过统计术后患者填写的日常生活能力Barthel指数自评表、焦虑自评表(SAS)及抑郁自评表(SDS)判断患者生活及心理恢复状态。观察组患者治疗后日常生活能力Barthel指数高于对照组;同时观察组SAS、SDS指数均低于对照组,2组比较差异有统计学意义(P0.05)。结论针对心肌梗死患者PCI围术期的全方面强化护理可有效提高患者治疗有效率,促进患者身体及心理康复进程。     

动能递进式运动对急性心肌梗死经皮冠状动脉介入术后患者早期运动功能的改善作用

目的 探讨动能递进式运动干预对急性心肌梗死经皮冠状动脉介入(percutaneous coronary intervention, PCI)术后患者早期运动功能的改善作用。 方法 选取2017年3月-2018年3月于我院接受PCI术治疗的急性心肌梗死患者84例作为观察对象,将其以随机抽签法分成实验组与对照组,每组各42例。对照组予以常规护理,实验组在对照组的基础上增用动能递进式运动干预。比较2组干预前后心功能(左心室射血分数、左心室舒张末期容积、左心室收缩末期容积)、早期运动功能、不良事件发生情况及患者生活质量。 结果 干预后,实验组左心室射血分数高于对照组(t=4.281,P＜0.001);运动时间、最大运动负荷、代谢当量水平均好于对照组(P＜0.05);不良事件发生率低于对照组(χ²=4.480,P=0.034),症状、躯体功能、心理社会功能、认知功能、满意度评分高于对照组(P＜0.05)。 结论 动能递进式运动干预可显著改善急性心肌梗死PCI术后患者早期运动功能,同时有利于改善患者心功能,降低不良事件发生风险,提高患者的生活质量。