冠心病患者冠脉病变程度与心外膜脂肪脂联素表达的关系

目的 探讨冠心病患者心外膜脂肪(EAT)脂联素(APN)表达与冠脉病变程度的关系.方法 两组患者冠心病组52例,瓣膜病组54例,获取静脉血和心外膜脂肪,冠心病组按Gensini's评分分为＜30分、30～90分、＞90分3组.采用酶联免疫吸附试验(EUSA)、逆转录-聚合酶链反应(RT- PCR)和免疫印迹分析(Western blot)检测APN血清mRNA和蛋白表达.结果 血清APN瓣膜病组(14.1±4.2) mg/L,冠心病组(9.3±4.5) mg/L (P＜0.01);冠心病3组血清APN分别为(10.9±5.5) mg/L(n=16)、(8.4±4.2) mg/L(n=20)、(6.2±5.3) mg/L(n=18) (P ＜0.05);心外膜脂肪RT-PCR和Western blot法检测APN显示随着Gensini's积分增加APN呈下降趋势.结论 冠心病心外膜脂肪APN表达下降与冠状动脉病变程度相关.     

超声测量心外膜脂肪厚度联合二维纵向应变预测冠状动脉粥样硬化性心脏病

目的探讨常规超声心动图测量的心外膜脂肪(EAT)厚度联合二维纵向应变对冠状动脉粥样硬化性心脏病(CAD)的预测价值。方法将106例疑诊为CAD的患者根据CAG检查结果分为CAD组(n=60)和对照组(n=46),采用二维超声测量收缩末期EAT厚度(EAT_S)、舒张末期EAT厚度(EAT_D),采用二维应变软件分析左心室心尖三个切面的图像,获取左心室17节段心肌纵向应变均值(GLS_(17))和12节段(除外5个心尖节段)纵向应变均值(GLS_(12))。绘制ROC曲线,根据最大Youden指数确定EAT_S、GLS_(12)最佳预测截断值,分析EAT_S、GLS_(12)及二者联合诊断CAD的曲线下面积(AUC),并比较3种方法对CAD的预测价值。结果CAD组EAT_S、EAT_D均大于对照组(P均0.05);EAT_S(OR=1.79)、GLS_(12)(OR=1.20)均为CAD的独立危险因素(P均0.05),其对CAD的最佳预测截断值分别为5.55mm、-16.95。EAT_S、GLS_(12)及二者联合预测CAD的AUC分别为0.67±0.05、0.64±0.06及0.71±0.05,差异有统计学意义(P0.05)。结论 EAT_S与GLS_(12)均可以作CAD预测评估的有效指标,二者联合对CAD的预测价值更高。     

周围血管动脉粥样硬化与冠状动脉粥样硬化相关性的研究

目的应用超声方法检测外周动脉内-中膜厚度（IMT）及斑块情况,探讨外周动脉与冠状动脉粥样硬化的相关性,评价超声检测外周动脉粥样硬化对冠状动脉病变的预测价值及其临床意义。方法对110例天津医科大学第二医院心脏科住院行冠状动脉造影（CAG）的患者术后1—2周内,行外周动脉（包括颈总、颈内、颈外、股总、股浅、股深、胭、足背动脉）粥样硬化情况进行超声检查,以动脉IMT和粥样硬化斑块厚度作为观测指标,对各组病例外周动脉粥样硬化的情况进行比较,进行统计学分析,探讨动脉粥样硬化发生的危险因素,外周动脉与冠状动脉粥样硬化的相关性。结果（1）CCA IMT、颈动脉IMT、CFA IMT、SFA IMT、DFA IMT、下肢动脉IMT在冠脉未见异常组与其余三组任一组均差异有统计学意义（P〈0．05）,冠脉未见异常组IMT值小于其余三组。（2）随着冠状动脉粥样硬化血管的数量增加,颈动脉和下肢动脉动脉粥样硬化情况加重,斑块形成呈明显增加趋势。（3）多因素Logistic回归分析（STEPWISE）,CFAIMT和P下肢与冠状动脉粥样硬化具有显著相关性,有统计学意义（P〈0．05）。结论（1）颈动脉、下肢动脉和冠状动脉粥样硬化的趋势一致。（2）颈部和下肢血管的IMT及斑块对冠状动脉粥样硬化有很好的预测价值;P下肢、CFAIMT可作为预测冠状动脉粥样硬化的重要指标。（3）年龄、吸烟时间、患有高血压及高血压患病时间、甘油三酯、空腹血糖、胰岛素水平是动脉粥样硬化的高危因素。     

冠状动脉周围脂肪:冠心病临床诊疗“新靶点”

冠状动脉周围脂肪(PCAT)可通过旁分泌途径产生脂肪因子、血管生成因子及炎症因子等活性物质,调节血管重构和血管周围炎症,并参与调节斑块发生、发展及脱稳定化过程。PCAT表型和定量参数在不同性质冠状动脉粥样硬化斑块之间有所差别。本文主要对PCAT在冠状动脉粥样硬化斑块形成与演变中的作用和相关影像学研究现状与进展进行综述。     

前列地尔脂肪乳剂在体外循环冠状动脉旁路移植术中对炎症反应的作用

目的探讨前列地尔脂肪乳剂（1iposomalprostaglandinEl,Lipo-P（厄,）在体外循环（CPB）冠状动脉旁路移植术（CAPG-）中对炎症反应的作用。方法选取2006年7月至2008年12月锦州市中心医院32例冠心病需行CAB（9治疗患者,按随机数字表法分为两组,每组16例。实验组：男9例,女7例;年龄54．4418．1岁;CPB开始前至CPB结束持续经中心静脉泵人Lipo-PGE,Els．ong／（kg·min）];对照组：男9例,女7例;年龄54．8±20．4岁;除不使用I．ipc-PGE。外,其他操作均与实验组相同。分别于CPB前,升主动脉开放后1h、2h、6h和24h抽取两组患者的动脉血,检测血浆白细胞介素6（IL-6）、肿瘤坏死凶子a（TNFa）及可溶性细胞间黏附分子l（sICAM-1）的浓度,并对两组检测结果进行比较。结果升主动脉开放后两组血浆II,6、TNF-a和sICAM-1浓度均逐渐升高,后两者于升主动脉开放后6h达峰值。实验组升主动脉开放后各时间点血浆1L-6（升主动脉开放后24h：16．1±2．2μg／Lvs．19．2±4．5肛g／L,P〈0．05）、TNF-a（升主动脉开放后24h：1．8±0．4μg／LVS．2．2±0．5μg／L.P〈0．05）和sicAM-1（升主动脉开放后24h：233．6±36．6μg／L.VS．294．2±55．7μg／L,P〈O．05）浓度均较对照组明显降低。结论Lipo-PGE。可减轻CPB引起的中性粒细胞聚集,抑制血管内皮细胞的激活,减轻血管内皮细胞损伤和全身炎症反应。     

脂肪因子与肝细胞癌的研究进展

肥胖与肿瘤是全球两大健康问题,肥胖增加肝细胞癌的发病及死亡风险.脂肪组织能够分泌具有多种生物学活性的脂肪因子,如瘦素、脂联素、抵抗素等.近年研究发现脂肪因子在慢性肝脏疾病的纤维化、硬化及癌变中发挥重要作用.本文就脂肪因子与肝细胞癌的研究进展进行综述.     

脂肪细胞因子导致不孕症的相关生殖内分泌机制研究进展

脂肪组织是机体内重要的内分泌和旁分泌器官,可分泌多种生物活性肽,称为脂肪细胞因子,其中瘦素(LEP)、脂联素(ADPN)、抵抗素(resistin)等因子水平与肥胖症密切相关,可作用于机体局部和系统水平,影响女性生殖内分泌系统,甚至导致不孕症。本文通过整理和分析相关研究,进一步揭示脂肪细胞因子与生殖内分泌系统功能的相关性,及其导致女性不孕症的作用机制。     

血管内超声测量心外膜脂肪厚度与冠状动脉病变程度的相关性

目的评价血管内超声(IVUS)测量心外膜脂肪厚度(EAT)与冠状动脉病变的相关性。方法收集92例接受冠状动脉IVUS患者,应用常规超声测量EAT,并用IVUS测算冠状动脉狭窄率及斑块类型,根据检查结果将患者分为冠状动脉疾病(CAD)组和非CAD组,再根据冠状动脉狭窄率将CAD组患者分为轻度病变亚组、中度病变亚组及严重病变亚组;比较各组EAT的差异,观察EAT与冠状动脉狭窄率、斑块类型以及CAD相关危险因素之间的关系。结果 CAD组EAT值为(6.54±1.21)mm,非CAD组为(4.98±1.33)mm,二者差异有统计学意义(t=5.12,P<0.01)。随着CAD病变程度的加重,轻度、中度及严重病变亚组间EAT值逐渐升高,两两比较差异均有统计学意义(P均<0.05)。软斑块亚组EAT较钙化斑块亚组[(7.16±1.00)mm vs(5.34±1.40)mm,F=0.085,P<0.05]及混合斑块亚组[(6.20±1.95)mm,F=0.005,P<0.01]明显升高。EAT是CAD的独立危险因子(Wald值5.057,P=0.028)。结论超声测量EAT与冠状动脉病变严重程度具有相关性,可用于CAD患者的筛查。     

基于CT定量心外膜脂肪组织与冠状动脉疾病的关系:Meta分析

目的 采用Meta分析评价CT定量心外膜脂肪组织（EAT）与冠状动脉疾病（CAD）的相关性。方法 检索中国知网、万方医学网、维普网及PubMed、Web of science、Medline数据库中自建库至2019年12月31日关于CT定量EAT与CAD相关性的病例对照研究,以Stata 12.0软件分析CAD组与非CAD组之间标准化均数差（SMD）及95% CI。结果 纳入19篇文献,CAD组5 129例,非CAD组7 434例;CAD组EAT厚度[SMD=0.46,95% CI（0.26,0.66）,P<0.01）]和容积[SMD=0.65,95% CI（0.46,0.86）,P<0.01）]均大于非CAD组。结论 CT定量EAT与CAD存在相关性。     

MSCT检测冠心病患者心外膜脂肪组织容积与左心室舒张功能的相关性

目的观察冠心病(CAD)患者心外膜脂肪组织(EAT)容积与左心室舒张功能的相关性。方法纳入55例接受冠状动脉CTA的CAD患者,将冠状动脉CTA薄层图像导入GE AW 4.4工作站,手动勾画心包线,测量EAT容积;采用彩色多普勒超声测量舒张早期、舒张晚期经二尖瓣血流峰值流速(E、A)以及舒张早期二尖瓣隔部组织运动峰值速度(Ea),计算E/A和E/Ea值。分析EAT容积与E/A和E/Ea的相关性。结果 CAD患者EAT容积与E/A呈负相关(r=-0.376,P=0.005),与E/Ea呈正相关(r=0.368,P=0.006)相关;校正CAD危险因子后,EAT容积是E/Ea的独立影响因子(b=0.011,t=2.12,P=0.04)。结论 CAD患者EAT容积与左心室舒张功能相关性较好;MDCT定量测量EAT容积对评价左心室舒张功能异常具有重要意义。     

Echocardiographic evaluation of epicardial adipose tissue in non-diabetic,non-hypertensive hemodialysis patients

Abstract

Purpose: It has been found out that the epicardial adipose tissue (EAT) measured by echocardiography is related with various metabolic parameters. Being accepted as the new cardiovascular risk indicator, there have been few studies on EAT in relation to the patients with end-stage renal failure. In our study, we aim to evaluate EAT and carotid intima media thickness (CIMT) in non-diabetic, non-hypertensive hemodialysis (HD) patients. Methods: Our study recruited 47 non-diabetic, non-hypertensive HD patients (22 males, 25 females, median age 54 (44.3–60.8) years) and an age-gender matched control group consisting 41 healthy subjects (17 males, 24 females, median age 52 (48–56) years). In all patients, EAT was measured by echocardiography and CIMT by ultrasonography; and routine laboratory parameters were studied. Results: In our study, we obtained laboratory findings matching with the profiles of uremic patients among HD patients and CIMT values of HD patients are significantly higher than that of the control group [0.79 (0.64–0.93) vs. 0.6 (0.53–0.68) p?<?0.001], and EAT values are similar [0.5 (0.33–0.6) vs. 0.4 (0.4–0.53) p?>?0.05]. Conclusions: EAT is not a cardiovascular risk indicator in HD patients without diabetes mellitus and hypertension. Besides, echocardiographic measurement of EAT is easy, non-invasive, cheap and credible method.     

Halothane relaxes previously constricted human epicardial coronary artery segments more than isoflurane.

To compare the vasodilatory effects of isoflurane versus halothane on coronary arteries in vitro, we studied the capacity of isoflurane and halothane to relax resting and previously constricted human coronary artery segments with use of in vitro tension recording. Human epicardial coronary artery segments (1.5-2.0 mm outside diameter) were obtained from hearts excised from recipient patients at time of heart transplantation. The effects of 0.5%, 1.0%, 2.0%, and 3.0% isoflurane or halothane on resting coronary artery segments stretched to their optimal resting tension were determined. Next, after removal of anesthetic from the bathing solution, the segments were constricted with K+ (60 mM), and this contraction was allowed to plateau. The arteries were then again exposed to isoflurane or halothane at 0.5%, 1.0%, 2.0%, and 3.0% concentrations. Isoflurane and halothane had no effect on noncontracted coronary artery segments stretched to their optimal resting tension. Halothane caused significant relaxation of K(+)-induced (60 mM) contractions at 2.0% and 3.0% but not at lower concentrations. Isoflurane did not cause significant relaxation of K(+)-induced (60 mM) contractions at any concentration studied. Our studies indicate that under the conditions studied, isoflurane at clinically relevant concentrations is not a significant coronary dilator.     

Current status of coronary artery bypass grafting for coronary artery atherosclerosis

Coronary artery bypass grafting has now undergone 18 years of proven benefit in the treatment of myocardial ischemic disease. The technique of CABG has been further extended to other situations in which myocardial blood supply is threatened, such as cardiac trauma, aneurysms of coronary arteries, and congenital lesions. The emphasis in choosing CABG over medical therapy in 1985 should be preservation of myocardium at jeopardy of infarction as well as relief of angina. Proximal stenoses in vessels subserving viable muscle that is ischemic at rest or with minimal exercise should be treated with reperfusion by angioplasty or CABG to prevent further injury. After infarction occurs and ventricular function is impaired, CABG is also necessary to preserve remaining myocardium at jeopardy. Such an aggressive approach seems warranted with today's excellent surgical results. Long-term results have also improved, as more attention has been paid to saphenous vein graft preparation, use of mammary artery grafts, complete revascularization, use of antiplatelet agents, control of spasm, and identification of hypercoagulable states that may require sodium warfarin (Coumadin). Angioplasty of vein grafts and distal anastomoses also appears promising to help extend the results of initial CABG. Figure 1 is our recommended approach for the treatment of coronary atherosclerosis.     

Attenuated adiposopathy in perivascular adipose tissue compared with subcutaneous human adipose tissue

Background

We hypothesized that human perivascular and subcutaneous adipose tissues hold distinct phenotypic signatures. We also evaluated the impact of clinical parameters on the adipose phenotype. Our overall goal is to understand the determinants of adipose biology so that this tissue can be manipulated therapeutically to lessen peripheral vascular disease.

Methods

Perivascular and subcutaneous adipose tissues were collected from patients undergoing lower-extremity amputation (n = 27) and protein assayed for proinflammatory mediators (ie, interleukin 6, interleukin 8, leptin, tumor necrosis factor α, monocyte chemoattractant protein-1, and resistin), atheroprotective adiponectin, and the fibrinolysis inhibitor plasminogen activator inhibitor-1.

Results

Leptin (2.7-fold, P = .015), TNF-α (2.2-fold, P = .013), MCP-1 (1.5-fold, P = .047), and adiponectin (1.8-fold, P = .004) were more abundant in subcutaneous vs perivascular adipose tissue. Age positively correlated with perivascular adipose tissue PAI-1 expression (β = .64, P = .042), and hyperlipidemia negatively correlated with perivascular adiponectin (β = −1.18, P = .039).

Conclusions

Human perivascular and subcutaneous adipose tissues hold distinct phenotypic signatures. In amputation patients, the subcutaneous adipose tissue proinflammatory phenotype was relatively attenuated in perivascular adipose tissue.