血清胆红素水平与冠状动脉病变程度的关系

目的:研究血清胆红素水平与冠状动脉病变严重程度的关系,为冠心病(CHD)的防治提供新思路和新途径。方法:200例患者按照冠状动脉造影结果被分为CHD组(149例)和非CHD组(51例),采用钒酸氧化法测定两组患者的血清胆红素水平,比较两组血清胆红素水平差异,采用直线相关分析冠脉病变积分与血清胆红素水平的关系。结果:CHD组血清总胆红素[TBIL,(8.97±1.16)μmol/L∶(11.58±1.24)μmol/L]、直接胆红素[DBIL,(2.90±0.78)μmol/L∶(3.78±0.84)μmol/L]水平明显低于非CHD组(P均0.01),冠状动脉病变积分与TBIL和DBIL均呈负相关(r=-0.460,-0.772,P均0.01)。结论:血清胆红素水平与冠状动脉病变严重程度呈负相关,低血清胆红素水平是冠状动脉粥样硬化的危险因素。     

血清缺血修饰白蛋白和同型半胱氨酸对冠心病临床诊断价值及与造影结果的相关性

目的探讨血清缺血修饰白蛋白(IMA)和同型半胱氨酸(Hcy)对冠心病(CHD)患者的诊断价值及与冠状动脉造影的相关性。方法选择2015年4月至2017年9月收治的CHD患者300例,另外选择同期健康志愿者60例作为对照组。比较血清IMA和Hcy水平在不同疾病类型、不同冠状动脉病变支数及不同冠脉狭窄程度CHD患者中的差异,同时对比冠状动脉造影参数的差异,分析CHD患者血清IMA和Hcy水平与冠状动脉造影参数的相关性。结果 CHD患者血清IMA和Hcy水平均明显高于对照组(P<0.05);随着疾病程度的加重、冠状动脉病变支数及冠脉狭窄程度的增加,IMA和Hcy水平均明显升高(P<0.05);疾病程度越重,冠状动脉病变支数及Gensini评分均明显升高(P<0.05);冠状动脉狭窄率越高,冠状动脉病变支数显著增加(P<0.05);CHD患者血清IMA和Hcy水平与冠状动脉病变支数和Gensini评分均呈正相关(P<0.05)。结论 CHD患者血清IMA和Hcy能够反映CHD的发生及发展过程,同时与冠状动脉造影参数密切相关。     

血脂代谢特征与冠心病合并代谢综合征患者冠脉狭窄程度的关系

目的探讨冠心病(CHD)合并代谢综合征(MS)患者的血脂代谢特征及其与冠状动脉狭窄程度的关系。方法选取2009年1月到2012年1月被收治的符合标准的CHD患者共89例,按照是否合并MS分为合并MS组(43例)和非MS组(46例),测定入选患者的血糖及血脂水平和冠脉狭窄指数,根据冠脉造影结果来评价冠脉病变严重程度。结果合并MS组患者在BMI指数、高血压患病率上明显高于非MS组;合并MS左回旋支狭窄指数高于非MS组(P<0.05);右冠状动脉和左前降支的狭窄指数比非MS组稍高,差异不具有统计学意义(P>0.05);但合并MS组总狭窄指数高于非MS组(P<0.05)。合并MS组患者的FBG、LDL-C、TG、TC、Apo B及UA明显升高,其中LDL-C、Apo B差异有显著统计学意义(P<0.05),Apo A1水平两组间差异无统计学意义(P>0.05)。结论合并MS的CHD患者血脂代谢异常和冠状动脉狭窄更加显著,应及时进行干预。     

血清Hcy、NT-proBNP及脂联素与老年冠心病冠状动脉病变的相关性

目的探讨血清同型半胱氨酸(Hcy)、N末端B型利钠肽原(NT-proBNP)、脂联素(ANP)与老年冠心病(CHD)冠状动脉病变的相关性。方法选择109例行冠脉造影(CAG)检查的老年患者,根据CAG检查和临床诊断结果将患者分为CHD组(67例)和非CHD(NCHD)组(42例)。分析血清Hcy、NT-proBNP、ANP在CHD不同冠脉病程度患者之间的差异及与SYNTAX积分、冠脉病变支数、冠脉狭窄率和CHD发病之间的关系,受试者工作特征(ROC)曲线分析血清Hcy、NT-proBNP、ANP对CHD的诊断价值。结果 CHD组血清Hcy、NT-proBNP水平显著高于NCHD组(P<0.05),ANP水平显著低于NCHD组(P<0.05)。CHD患者血清NT-proBNP水平与冠脉病变支数、冠脉狭窄率、SYNTAX积分均呈正相关(均P<0.05),Hcy与冠脉狭窄率、SYNTAX积分呈正相关(均P<0.05),ANP与冠脉病变支数、SYNTAX积分呈负相关(均P<0.05)。回归分析Hcy、NT-proBNP是CHD发病的危险因素,ANP是保护因素。ROC分析NT-proBNP预测老年CHD发病的ROC曲线下面积(AUC)最高达0.942,灵敏度和特异度分别为100.00%、90.48%。结论老年CHD患者血清Hcy、NT-proBNP水平明显升高,ANP水平明显下降,且其水平与冠脉病变支数、狭窄程度、SYNTAX积分均存在不同程度相关性,可以作为早期诊断老年CHD的生物学指标。     

血清胆红素水平与冠状动脉粥样硬化性心脏病的相关性研究

目的对患者血清胆红素含量与冠状动脉粥样硬化性心脏病(CHD)的严重程度、临床分型进行相关性分析。方法选取2016-01~2016-12该院住院的183例CHD患者作为CHD组,并选择同期住院其他疾病(呼吸疾病、心率失常、肺炎等)患者90例作为非CHD对照组。根据冠脉造影的结果将CHD组患者分为单支血管病变组62例,双支血管病变组77例和多支血管病变组44例。根据患者病史及临床表现分为ST段抬高型心肌梗死(STEMI)组41例,急性非ST段抬高型心肌梗死(NSTEMI)组43例,不稳定型心绞痛(UAP)组49例和稳定型心绞痛(SAP)组50例。结果 CHD组患者总胆红素(TBIL)值、间接胆红素(IBIL)值和直接胆红素(DBIL)值均显著低于对照组(P0.05);多支病变组患者血清中TBIL、IBIL和DBIL含量显著低于双支及单支病变组,且双支病变组显著低于单支病变组(P0.05)。将冠脉病变的支数与TBIL、IBIL、DBIL含量进行相关性分析,相关系数分别为r=-0.433,P0.05;r=-0.392,P0.05;r=-0.415,P0.05,血管病变的支数与TBIL、IBIL、DBIL水平呈负相关。STEMI组和NSTEMI组TBIL、DBIL和IBIL水平显著低于UAP组和SAP组,并且UAP组TBIL值显著低于SAP组(P0.05)。将冠心病的不同临床分型与TBIL、DBIL、IBIL值进行相关性分析,相关系数分别为r=-0.388,P0.05;r=-0.314,P0.05;r=-0.353,P0.05,TBIL、DBIL和IBIL值随冠心病严重程度增加而降低。结论血清胆红素水平与冠状动脉粥样硬化血管的病变支数、CHD严重程度有负相关性,其水平可以反映冠脉病变的严重程度及斑块稳定性。     

血清胆红素、尿酸及血脂与冠心病患者冠脉狭窄程度的相关性研究

目的 探讨血清胆红素、尿酸及血脂与冠心病(CHD)患者冠状动脉狭窄程度之间的关系.方法 抽取CHD患者与同期健康对照组清晨空腹静脉,检测血清胆红素、尿酸(uric acid,UA)、血脂.所有患者均行冠状动脉造影检查,并计算Gensini积分.结果 与对照组相比,CHD组血清总胆红素(total bilirubin,TBIL)、直接胆红素(direct bilirubin,DBIL)、间接胆红素(indirect bilirubin,IBIL)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)浓度明显低于对照组(P<0.01);CHD组血清尿酸、总胆固醇(TC)、血清三酰甘油(triglyceride,TG)、低密度脂蛋白胆固醇(LDL-C)水平明显高于对照组(P<0.01);血清TBIL、DBIL、IBIL、HDL-C水平随着Gensini积分的增加而降低,呈负相关(P<0.01),血清UA、TC、TG、LDL-C水平随着Gensini积分的增加而升高,呈正相关(P<0.01).结论 血清胆红素浓度降低、尿酸升高、血脂异常与冠状动脉狭窄程度密切相关,对CHD患者冠脉病变程度的预测有一定的价值.     

老年冠心病患者冠状动脉粥样硬化严重程度有效评估的血脂指标

目的探讨老年冠心病(CHD)患者冠状动脉粥样硬化严重程度有效评估的血脂指标。方法选取2012年2月至2013年2月由于疑似CHD在该院心内科住院接受冠状动脉照影的患者152例,依据冠状动脉照影结果分为CHD组、非CHD组,CHD组患者进一步依据冠脉病变程度和冠脉病变血管数进行分组,对比各患者各项血脂指标。结果按冠脉病变程度分组研究显示,非CHD组与轻度病变组之间各项血脂指标均无统计学差异(P>0.05);CHD组内高密度脂蛋白胆固醇(HDL-C)随着冠脉病变程度的增加而降低,其余指标均升高;相关性分析显示,病变程度与低密度脂蛋白(LDL-C)/HDL-C、血浆促动脉硬化指数(AIP)之间呈正相关(P<0.05);同HDL-C之间呈负相关(P<0.01)。按冠脉病变血管数分组研究显示,HDL随着病变血管范围扩大而下降,多支病变组低于单支组和非CHD组,两支病变组低于单支组和非CHD组(P<0.05);病变血管范围与LDL-C/HDL-C、AIP、载脂蛋白(Apo)A/ApoB之间呈正相关(P<0.05);同HDL-C之间呈负相关(P<0.01)。结论高水平HDL-C在预防老年CHD的发生、发展有着十分重要的意义;ApoA/ApoB水平可能是评估冠状脉粥样硬化程度的一个重要指标,AIP和LDL-C/HDL-C值可更加准确地显示老年CHD患者脂类代谢水平。     

青年冠心病伴代谢综合征患者的临床特点和危险因素

目的:探讨青年冠心病(CHD)合并代谢综合征(MS)患者的临床特点及其危险因素。方法:选择我院200例CHD青年患者,100例患者合并MS(CHD+MS组),100例为无合并MS的冠心病患者(CHD对照组)。根据冠状动脉病变积分对病变程度作出评价,对两组患者一般资料进行比较,同时对CHD+MS组患者危险因素进行评估。结果:CHD+MS组的人体质量指数(BMI),总胆固醇(TC)、餐后2h血糖(2hPG)、空腹血糖(FBG)、甘油三酯(TG)、血压、血尿酸(UA)和血肌酐(Cr)水平,胰岛素抵抗指数(HOMA-IR)明显高于CHD对照组,高密度脂蛋白胆固醇(HDL-C)水平明显低于CHD对照组(P均0.01);与CHD对照组比较,CHD+MS组冠状动脉多支病变发生率(6%比32%)和冠状动脉造影Gensini评分[(5.1±2.0)分比(8.4±5.3)分]明显增加(P均0.01)。Logistic回归分析表明,低HDL-C、HOMA-IR、高血压、糖尿病史是青年人CHD合并MS的危险因素(OR=1.097~2.246,P均0.01)。结论:青年冠心病合并代谢综合征患者有多种危险因素,代谢异常且冠脉病变更严重。     

代谢综合征与冠心病冠状动脉病变相关性分析

目的研究代谢综合征(MS)与冠状动脉粥样硬化性心脏病(冠心病,CHD)冠状动脉病变特征的相关性。方法连续入选2014年1月~2015年1月于甘肃省人民医院经冠状动脉造影检查确诊冠心病的患者434例,按照是否合并代谢综合征分为代谢综合征组(MS组)和非代谢综合征组(NMS组),依据冠状动脉病变支数、病变形态特点及Gensini积分对两组患者的冠状动脉造影结果进行评估,分析MS各组成部分及其他危险因素与Gensini积分和冠脉病变严重程度的关系。结果 MS组患者年龄、腰围、臀围、体重、体质指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、尿酸(UA)、高敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)、双支及多支病变例数、复杂病变例数和Gensini积分高于NMS组,差异有统计学意义(P0.01~0.05),高密度脂蛋白胆固醇(HDL-C)和总胆红素(TBIL)低于NMS组,差异有统计学意义(P0.05);Pearson相关分析表明BMI、SBP、DBP、FPG、Hb A1c、TG、TC、LDL-C和UA与Gensini积分正相关(r=0.090~0.278,P0.05),HDL-C和TBIL与Gensini积分负相关(r=-0.120、-0.097,P0.05),Hcy和hs-CRP与Gensini积分无相关(r=0.090、0.098,P0.05);Logistic回归分析示年龄、BMI、SBP、Hb A1c和TC是冠状动脉病变严重程度的独立危险因素(OR1.0,P0.05),HDL-C和TBIL是冠状动脉病变严重程度的保护因素(OR1.0,P0.05)。结论 MS患者有更高的CHD危险因素,更复杂和严重的冠状动脉病变程度,采取有效措施控制MS患者血糖、血脂、血压水平等危险因素,对于防治CHD尤为重要。     

老年冠心病患者血尿酸及左室质量指数与冠状动脉病变程度的相关性

目的探讨老年冠心病(CHD)患者血尿酸(SUA)和左室质量指数(LVMI)与冠状动脉病变程度的关系。方法选取行冠状动脉造影的270例老年患者,根据冠状动脉造影结果分为对照组(n=60)和CHD组(n=210)。CHD组根据病变冠脉支数分为单支病变组(n=63)、双支病变组(n=66)、3支病变组(n=81)。比较各组SUA、LVMI的差异,分析二者与冠状动脉病变程度的相关性。结果 CHD组SUA、LVMI显著高于对照组(P<0.05),单支病变组与对照组SUA水平差异无统计学意义(P>0.05)。SUA、LVMI在CHD各亚组间随着病变冠状动脉支数增多而增加(P<0.05)。SUA、LVMI与冠状动脉病变积分呈正相关(r=0.365,0.389;P<0.01)。结论 SUA、LVMI是CHD的独立危险因素,有助于发现CHD及预测冠脉病变程度。     

Atherosclerosis of coronary arteries, coronary heart disease and sudden coronary death

Correlation between the severity of coronary atherosclerosis, thrombosis and sudden cardiac death was examined in 721 autopsied cases. Severe coronary atherosclerosis with stenosis was found in most of them; however a similar grade of atherosclerosis was discovered in patients with ischaemic heart disease not dying suddenly. Acute coronary thrombosis in the studied subjects was diagnosed post mortem in about 20 percent of those who died suddenly. Other studies indicate frequencies between 4-93%. There was no consistent time dependence.     

Value of combined coronary angioplasty and coronary angiography

Combined coronary angioplasty and coronary angiography is performed in most catheter laboratories and has become a routine procedure. The aim of this study was to assess its clinical results and economic value. This was a retrospective monocenter study performed over an 11 year period (1990-2000) which included 2,727 patients requiring coronary angioplasty after coronary angiography. The angioplasty procedure was performed at the same time as angiography (combined, n = 1,809) or after angiography (deferred, n = 631). Patients admitted for acute coronary syndromes not stabilised by pharmacological interventions were excluded from the study. The comparison of these two modes of angioplasty was based on primary success rates, complications, duration of hospital stay and hospital costs. The combined procedure was used progressively more frequently over the study period, increasing from 54% to 88% in 2000. The hospital clinical results (Success and complication rates) were comparable in the two groups. The predictive factors of failure were the year of the angioplasty procedure and occlusive lesions on multivariate analysis. The combined procedure was associated with a shorter hospital stay than deferred angioplasty (8.2 +/- 6.1 days versus 15.0 +/- 8.0 days, p = 0.0001) and with lower costs. The authors conclude that combined coronary angiography-angioplasty is as effective and as safe as deferred angioplasty. It is associated with a shorter hospital stay and lower hospital costs.     

冠脉微循环与冠心病

冠心病急性心肌梗死的再灌注治疗是现代医学发展的里程碑,它使被动、保守治疗转为积极、主动的血运重建,随着包括静脉溶栓、冠状动脉内溶栓、经皮冠状动脉腔内成形术(PTCA)、冠状动脉内支架置入术以及冠状动脉搭桥术等再灌注治疗技术的成熟、普及,挽救了无数患者的生命.     

冠状动脉256排CT与冠状动脉造影对冠心病的诊断比较

目的冠状动脉256排CT成像技术与冠状动脉造影检查对冠状动脉粥样硬化性心脏病的诊断比较。方法选取2013年5月至2014年5月内蒙古兴安盟人民医院心血管内科疑似冠心病患者50例,其中男性29例,女性21例,年龄37~68岁。先行冠状动脉256排CT扫描及图像后处理,后行冠状动脉造影检查,将两结果进行对比分析。结果以冠状动脉狭窄≥50%者为阳性。冠状动脉256排CT诊断冠心病灵敏度为40.00%,特异度98.18%,阳性预测值88.89%,阴性预测值81.82%,正确指数38.18%,符合率82.67%,KAPPA值46.28%。结论冠状动脉造影诊断冠心病准确性优于冠状动脉CT。冠状动脉CT可对冠心病患者进行初筛诊断。     

壁冠状动脉心肌桥的造影和临床分析

目的:观察、分析壁冠状动脉(冠脉)和心肌桥的临床特点与诊断、治疗方法。方法:观察、分析经冠脉造影确诊的96例109处心肌桥患者的心肌桥分布特点、临床症状、心电图、心肌酶谱、肌钙蛋白T、心脏超声,评价药物或支架治疗心肌桥的疗效。结果:心电图、临床症状、心肌酶谱、肌钙蛋白T和心脏超声对心肌桥的诊断均无特异性。造影发现93.7%的心肌桥发生于冠脉前降支(LAD)。心肌桥患者临床症状与收缩期狭窄程度有关。药物治疗、手术治疗均有一定疗效。结论:冠脉造影发现"收缩期狭窄"为目前确诊心肌桥的主要方法。心肌桥与心绞痛、动脉粥样硬化、心肌梗死的发生有密切关系。药物治疗可选用肾上腺素β受体阻滞剂和Ca2+拮抗剂。     

Regulation of coronary resistance vessels and large coronary arteries

There is now considerable evidence for alpha-adrenergic regulation of coronary resistance vessels and large coronary arteries based on studies of chronically instrumented, conscious animals. Infusion of norepinephrine at low doses causes reduction of coronary blood flow with a slight increase in arterial pressure, indicating intense coronary vasoconstriction. This coronary constrictor response was reversed to coronary vasodilation with infusion of norepinephrine after alpha-adrenergic blockade. Stimulation of alpha 1- and alpha 2-adrenergic receptors with phenylephrine and B-HT 920, respectively, also increased calculated coronary vascular resistance in the conscious animal. These effects were eliminated by selective alpha 1-adrenergic blockade with prazosin and by selective alpha 2-adrenergic blockade with rauwolscine. Stimulation of the carotid chemoreceptor reflex elicits a period of intense coronary vasoconstriction, characterized by a decrease in coronary blood flow despite increased arterial driving pressure. This response was eliminated by prior alpha-adrenergic blockade or a combination of cardiac sympathetic denervation and adrenalectomy. Using chronically implanted ultrasonic crystals to measure the epicardial coronary diameter instantaneously and continuously in conscious dogs, marked vasodilation of the large coronary arteries was observed with administration of nitroglycerin or calcium-channel antagonists; in contrast, activation of alpha-adrenergic receptors with methoxamine induced substantial constriction, characterized by a reduction in coronary artery diameter in the face of elevated distending pressure. The regulation of large coronary arteries is further complicated by the fact that these vessels are responsive to changes in myocardial metabolic demands and coronary blood flow.(ABSTRACT TRUNCATED AT 250 WORDS)     

Combined dissection of the right coronary artery and right coronary cusp during coronary angiography

Dissection of coronary arteries during diagnostic coronary angiography is infrequent; dissection of the coronary cusp is extremely rare. The combination of coronary artery and coronary cusp dissection has not been reported previously. A case of right coronary artery dissection and right coronary cusp dissection during diagnostic coronary angiography is described. © 1995 Wiley-Liss, Inc.