冠状动脉小血管支架术的远期预后

目的　评价冠状动脉小血管支架植入术的远期结果。方法　收集 1999年 7月～ 2 0 0 0年 12月行选择性冠状动脉支架术的冠心病患者 4 4 0例 ,其中 10 3例支架直径 <3mm为小支架组 ,337例支架直径≥ 3mm为大支架组 ,比较两组术后远期随访结果。结果　平均随访 (13± 6 )个月 (1～ 30个月 ) ,随访率为 92 .7%。小支架组硝酸酯药物停用 2 8例 (2 8.6 % ) ,与大支架组 (111例 ,35 .8% )相比差异无显著性 ;小支架组再次入院 4 0例(4 0 .8% ) ,与大支架组 (97例 ,31.3% )相比差异无显著性 (P >0 .0 5 )。但小支架组心绞痛复发 5 5例 (5 6 .1% ) ,较大支架组 (12 7例 ,4 1.0 % )显著增高 (P <0 .0 5 ) ;小支架组心脏事件发生率 (2 9.6 % )、再次血运重建发生率(2 7.6 % )及再狭窄发生率 (2 1.4 % )均较大支架组 (分别为 18.7%、14 .2 %和 11.3% )显著增加 (P均 <0 .0 5 )。结论　冠心病患者小支架植入术后生活质量改善和远期获益较大支架植入术患者差     

雷帕霉素药物涂层支架治疗冠心病60例临床分析

评价雷帕霉素药物涂层支架治疗冠心病的临床效果。方法我院在2006年7月至2008年3月的60例冠心病患者置入ExcelTM支架治疗,对60例冠心病患者共置入支架75个,其中40例为长病变(病变长度≥20mm)术前病变狭窄程度88.9%±8.6%,血管直径(3.00.±0.9)mm,5例慢性闭塞病变,2例支架内再狭窄.。其中10例,置入2个支架重叠.观察药物涂层支架的手术成功率,术中并发症,住院期间1-6个月随诊期间的心绞痛,心肌梗死,猝死,再次血管重建等发生。结果手术即刻成功率100%,术后造影残余狭窄5.0%±4.8%,支架完全覆盖病变,支架近远端无新夹层,血流TIMI3级。临床随访1-6个月,全部患者心绞痛症状消失。其中6例术后3-6个月复查冠状动脉造影,无血管再狭窄。结论雷帕霉素药物涂层支架ExcelTM治疗冠心病是安全有效的,短期临床随访结果明显优于普通支架。     

丹红注射液防治冠脉支架术后再狭窄的临床观察

目的探讨丹红注射液对冠心病患者冠脉支架植入术后再狭窄(in.stent restenosis,ISR)的影响。方法 78例实施经皮冠状动脉介入(percutaneous comnary inte nrernjon,PCI)治疗的冠心病患者,随机分为丹红治疗组(n=32)和对照组(n=46),对照组常规采用肠溶阿司匹林片和氯比格雷片口服,治疗组在此基础上静脉滴注丹红注射液,术后6个月常规行冠状动脉造影(cAG),比较两组支架植入术后再狭窄率的差别。结果 CAG示:治疗组冠脉支架术后再狭窄率明显低于对照组,两组相比差异有统计学意义(P<0.01),无论是普通支架亚组还是药物涂层支架亚组(DES)均有相似的结果(P均<0.01)。两组均无严重不良反应发生。结论丹红可明显降低冠脉支架术后再狭窄率,安全性良好。     

QTc离散度在冠心病介入诊治中的意义

目的　研究QTc离散度 (QTcd)对冠心病的诊断价值及观察经皮冠状动脉腔内成形 (PTCA)和支架术对其的影响。方法　 15 0例接受了冠状动脉造影术者 ,根据其结果分为 3组 ,即正常组 (n =44 ) ,有易患因素而冠脉造影正常组 (n =60 )和冠心病组 (n =46)。测量标准 12导联心电图 ,计算其校正的QT离散度 (QTcd) ,并测量其中 2 0例接受了PTCA及支架术的患者术前 ,术后 2h和 7d的QTcd。按临床流行病学诊断试验方法计算QTcd对冠心病诊断的敏感性、特异性、准确性。结果　冠心病组QTcd显著大于正常组〔( 70 5± 8 2 )ms对 ( 4 4 3± 7 6)ms ,P <0 .0 1〕和有易患因素而冠脉造影正常组〔( 70 5± 8 2 )ms对 ( 4 4 8± 8 0 )ms ,P <0 .0 1〕 ,PTCA及支架术后 2h、7d的QTcd均小于术前〔( 76 2± 8 1)ms对 ( 4 0 2± 4 6)ms,P <0 .0 1;( 76 2± 8 1)ms对 ( 3 8 9± 4 3 )ms,P <0 .0 1〕。QTcd≥ 5 0ms为标准 ,诊断冠心病的敏感性 87 0 %、特异性 5 1 9%、准确性62 7%。结论　QTcd离散度增加对冠心病诊断有一定临床价值     

冠状动脉内药物洗脱支架植入术后冠状静脉窦血中内皮素-1水平的变化

目的: 观察冠心病患者冠状动脉内支架安置术后冠状静脉窦血浆内皮素-1(ET-1)浓度的动态变化,探讨药物洗脱支架对术后再狭窄防治的作用机制.方法:冠心病患者42例,随机植入药物洗脱支架26例,普通支架16例,分别于冠状动脉球囊扩张术(PTCA)前、支架术后即刻、1 h、3 h和6 h自冠状静脉窦采血检测血浆ET-1的浓度.结果:药物洗脱支架组与普通支架组ET-1水平在术后即刻均降至最低点后即开始回升,到1 h时已超过术前水平,以后普通支架组ET-1水平继续升高,出现释放的第二峰.但药物洗脱支架组程度较为缓和,未出现明显的第二峰,2组ET-1水平在术后6 h差异有统计学意义(P<0.01).结论:药物洗脱支架可有效抑制冠状静脉窦血浆ET-1浓度的升高,可能是其防治再狭窄机制之一.     

他汀药物预治疗对高龄冠心病患者支架术预后的影响

目的 探讨术前他汀类药物治疗对高龄冠心病患者经皮冠状动脉支架治疗近期和远期预后的影响.方法 回顾性分析90例85岁以上冠心病患者术前他汀应用情况,观察其对预后的影响.结果 90例患者中,33例经皮冠状动脉介入(PCI)术前接受他汀治疗,57例PCI术前未接受他汀治疗.80例(88.9%)为急性冠状动脉综合征.术前接受他汀治疗组血脂异常、既往心肌梗死病史、既往PCI、开口病变、药物涂层支架(DES)植入比例比例略高.住院期间主要心血管不良事件(MACE)发生率要低于术前未接受他汀治疗组(3.0%比10.5%,P=0.05).随访1年时MACE发生率两组相似(6.1%与3.8%,P=0.07).整个研究人群1年生存率较高.结论 他汀预治疗对高龄冠心病支架术后可能降低住院期间MACE,而不一定能改善1年预后.     

国产可降解涂层西罗莫司洗脱支架在冠状动脉长病变中的应用

目的 初步评价国产可降解涂层西罗莫司洗脱支架(Tivoli支架)治疗冠状动脉长病变的可行性、安全性及有效性.方法 2007年8月-2008年2月共有55例原位冠状动脉长病变的患者分别接受Tivoli支架(Tivoli组,28例)和进口左他莫司洗脱支架(Endeavor组,27例)治疗,观察两组患者的手术即刻成功率、术后8个月冠状动脉造影结果、术后270 d时的主要不良心脏事件(MACE)及支架内血栓事件的发生率.结果 治疗前,Tivoli组既往有心肌梗死者占50.0%(14/28),显著高于Endeavor组的11.1%(3/27,P=0.002);左心室射血分数为(0.600±0.044),显著低于Endeavor组的(0.659±0.060)(P=0.003);平均病变长度为(29.5±12.5)mm,显著高于Endeavor组的(22.19±9.43)mm(P=0.006).两组支架植入的成功率均为100%.术后8个月,Tivoli组和Endeavor组的造影随访率分别为92.9%(26/28)和92.6%(25/27),支架内再狭窄的发生率分别为10.5%(4/26)和3.3%(1/25)(P=0.370),支架内晚期管腔丢失分别为(0.37±0.47)和(0.59±0.49)mm(P=0.108);术后270 d的随访率为100%,两组均无死亡、心肌梗死和血栓事件发生,MACE的发生率分别为10.7%(3/28)和7.4%(2/27,P=1.000),均为靶病变血运重建.结论 Tivoli支架在冠状动脉长病变中应用的中期疗效及安全性与进口左他莫司洗脱支架相似,初步表明其用于冠状动脉长病变的治疗是可行的.     

老年冠心病患者行冠状动脉内支架置入术的近期临床评估

目的　评估老年冠心病患者的冠状动脉内支架置入术 (支架术 )的安全性和有效性。方法　对 5 6例年龄≥ 6 0岁 (老年组 )和 4 3例年龄 <6 0岁 (非老年组 )已行支架术的冠心病患者的临床病灶特点 ,手术成功率、手术并发症及近、远期临床随访结果进行对照分析。结果　老年组在经皮冠状动脉腔内成形术 (PTCA)的基础上行支架术总成功率与非老年组比较无显著差异性 (96 .3%与 97.6 % ,P >0 .0 5 ) ;两组间冠状动脉血管 ,外周血管并发症无明显差异 ;老年组因冠状动脉扩张后发生急性血管闭塞或严重内膜撕裂而置入支架比例明显高于非老年组 (P <0 .0 0 1) ;老年组左主干病变化比例明显高于非老年组 (P <0 .0 0 1)。随访 6 - 18个月 ,两组患者恶性心脏事件发生率无明显差异 ,但老年组患者再次血运重建率明显高于非老年组 (P <0 .0 5 )。结论　对 6 0岁以上冠心病患者行PTCA治疗是安全有效的 ,成功率较高 ,并发症少 ,但应严格掌握手术适应症。     

冠脉支架术后血浆降钙素基因相关肽水平与支架术后疗效的关系

目的 探讨冠状动脉支架术前后血浆降钙素基因相关肽(CGRP)水平对支架术后6个月内心血管事件及再狭窄的相关预测价值.方法 对53例冠心病心绞痛患者行冠状动脉支架术治疗,测定术前及术后血浆CGRP水平,并记录术后6个月内心血管事件及再狭窄情况.结果 发生心血管事件及再狭窄组CGRP水平明显低于未发生组(166.36±10.18,182.5±11.36,P＜0.05);发生心血管事件及再狭窄组糖尿病患者所占比例明显高于未发生组(53%,34%,P＜0.01).结论 冠状动脉支架术后血浆CGRP水平相对降低及糖尿病与冠状动脉支架术后心血管事件及再狭窄相关.     

丹参片在冠状动脉支架介入治疗后应用的初步观察

目的观察丹参片与抗血小板药物联合应用对冠状动脉支架介入治疗后血栓等术后冠状动脉事件的预防作用。方法选择支架植入成功的冠心病患者82例,随机分为治疗组(42例)和对照组(40例),两组均服用支架植入术常规用抗血小板药,治疗组加用丹参片,每次4片,每日3次。采用双缩尿法、激光散射比浊法和流式细胞术检测两组患者行支架植入术前、术后即刻和术后30 d时的血浆纤维蛋白原(Fg)、C反应蛋白(CRP) 和血小板膜糖蛋白((3P)Ⅱb／Ⅲa、P选择素(CD62P)的变化。结果与对照组比较,治疗组血浆CRP显著下降 (P<0．05),GPⅡb／Ⅲa和CD62P也有降低的趋势。经6个月临床随访,治疗组心绞痛复发5例(11．9%),未发生支架术后再狭窄;对照组心绞痛复发21例(52．5％),支架术后再狭窄9例,心肌梗死3例;治疗组心绞痛复发率显著低于对照组(P<0．05)。结论丹参片与抗血小板药联合应用能预防冠状动脉支架血栓等术后冠状动脉事件,且疗效优于单用抗血小板药。     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.     

Development Is A High Level Inheritance for China Time-honored Brand Products

<正>As culture is the soul of a nation,the three books,"History of Chinese Philosophy,""History of Chinese Culture"and"History of Chinese Science and Technology"have demonstrated the superiority of our great Chinese culture,and its significant impact in the field of international culture.Both core value and practical value of the Chinese culture are very clear,reflected in the views of universe,nature,life,health,disease,and therapy and related considerations,concepts,and technical methods.