冠状动脉心肌桥的预后因素分析

目的分析冠状动脉心肌桥的造影特征与临床事件的关系,为冠状动脉心肌桥的预后提供预测指标。方法分析46例心肌桥患者的造影资料和临床资料。依据心肌桥是否合并肌桥前动脉粥样硬化性狭窄将患者分为单纯肌桥组和复杂肌桥组,比较两组患者的年龄、性别、收缩压、舒张压、脉压、肌桥压迫程度、左心室重量指数、吸烟、血糖、血脂等因素,进一步通过Logistic回归分析上述因素与心肌桥合并桥前狭窄的相关性。结果复杂肌桥组临床主要表现为急性冠脉综合征．而单纯狭窄组则多无临床症状。复杂肌桥组的收缩压、脉压、心肌桥的压迫程度、左心室重量指数等均显著高于单纯肌桥组(P值均＜0．05)。Logistic回归分析发现,脉压、心肌桥的压迫程度、左心室重量指数与是否合并肌桥前狭窄显著相关(P值均＜0．05)。结论心肌桥患者的临床表现主要与是否合并肌桥前动脉粥样硬化性狭窄有关。脉压、心肌桥的压迫程度、左心室重量指数是合并肌桥前狭窄的主要决定因紊。     

双源CT在冠状动脉心肌桥的应用价值

目的:分析冠状动脉心肌桥的双源CT特征与临床事件的关系.方法:分析40例心肌桥患者的双源CT资料和临床资料,依据心肌桥是否合并桥前动脉粥样硬化性狭窄将患者分为单纯心肌桥组和复杂心肌桥组,比较2组患者的年龄、性别、收缩压、舒张压、脉压、左心室重量指数、心肌桥长度、LVEF、血糖、血脂等因素,比较上述因素与心肌桥合并桥前狭窄的相关性.结果:复杂心肌桥组收缩压、脉压、左心室重量指数均显著高于单纯心肌桥组(P<0.05),收缩压、脉压、左心室重量指数与心肌桥合并桥前狭窄相关.结论:心肌桥合并桥前动脉粥样硬化性狭窄可以引起急性冠脉综合征,收缩压、脉压、左心室重量指数是合并桥前动脉粥样硬化性狭窄的主要危险因素.     

冠状动脉心肌桥相关粥样斑块的CT研究

目的:研究冠状动脉心肌桥相关粥样斑块的特性,探讨其与心肌桥的关系。方法:选取近年本院心内科收治的168例患者作为研究对象,分析其基本临床资料和冠状动脉CT检查数据,根据左前降支有无心肌桥及是否合并粥样斑块分为肌桥组(左前降支心肌桥合并粥样斑块)、斑块组(左前降支仅有粥样斑块)及对照组(左前降支无异常),比较各组数据。再将肌桥组患者根据心肌桥近侧段血管粥样斑块处管腔狭窄程度分组分析斑块特性与心肌桥的关系。结果:肌桥组34例,心肌桥均为单发,位于血管近段3处,中段30处,远段1处,合并有粥样斑块40处,位于血管近段36处,中段0处,远段4处;斑块组77例,粥样斑块84处,位于血管近段55处,中段27处,远段2处;对照组57例。肌桥组与斑块组基本临床资料比较,差异均无统计学意义(P0.05);两组间斑块性质、长度、管腔狭窄程度比较,差异均无统计学意义(P0.05),但肌桥组患者左前降支近段血管易形成粥样斑块(P0.05),心肌桥近侧段血管粥样斑块处管腔狭窄程度与患者年龄有关(P0.05),而与斑块性质和长度、肌桥长度及壁冠状动脉类型无关(P0.05)。结论:合并有心肌桥的冠状动脉在各种危险因素的长期作用下,心肌桥近侧段血管易形成粥样斑块,斑块处管腔狭窄程度随年龄增长而加重,与斑块及心肌桥本身的特性无关。     

急性ST段抬高型心肌梗死合并心源性休克危险因素观察与研究

目的:研究急性ST段抬高型心肌梗死合并心源性休克的危险因素。方法:随机抽取60例急性ST段抬高型心肌梗死者,其中合并心源性休克的27例患者作为观察组、未合并心源性休克的33例患者作为对照组,比较两组患者心源性休克发生的危险因素且予以多因素logistic回归分析。结果:血压、心率、糖尿病史、吸烟史、病变血管前降支、病变范围单支和多支、心肌酶、肌钙蛋白、B型钠尿肽、左心室射血分数、溶栓治疗差异有统计学意义(P<0.05);血压下降、心率加快、糖尿病史、吸烟史、病变血管前降支、病变范围多支、心肌酶升高、肌钙蛋白升高、B型钠尿肽升高、左心室射血分数下降以及溶栓治疗失败是急性ST段抬高型心肌梗死合并心源性休克的危险因素。结论:及时对危险因素进行评估,能有效降低急性ST段抬高型心肌梗死合并心源性休克发生的风险程度,改善预后。     

症状性心肌桥与冠状动脉硬化关系探讨

目的探讨冠状动脉心肌桥与冠状动脉粥样硬化之间的关系。方法回顾性分析接受冠状动脉造影的47例症状性心肌桥患者,其中27例为心肌桥近段动脉粥样硬化者,20例为单纯性心肌桥患者。结果肌桥的检出率3.67%,全部患者均有心绞痛症状,其收缩期狭窄在20%～60%,均发生在左前降支的中、远段。合并动脉硬化的肌桥组收缩期狭窄程度明显重于单纯肌桥组,且差异有统计学意义(P<0.05)。结论心肌桥有促进其近段冠状动脉发生粥样硬化病变的倾向,且与心肌桥的狭窄程度有关。β受体阻滞剂可缓解心肌桥所致的心绞痛。     

糖尿病患者前降支心肌桥与桥前血管冠状动脉粥样硬化的相关性

目的探讨糖尿病患者前降支心肌桥与心肌桥前血管冠状动脉粥样硬化的相关性,以确定前降支心肌桥是否为心肌桥前
段冠状动脉粥样硬化发生的一个独立危险因素。方法回顾性分析2011年3月~2012年12月间拟诊为冠心病的患者的ＣＴ冠
状动脉血管成像资料（只记录前降支有无心肌桥及桥前血管有无狭窄大于50%冠脉粥样硬化）及临床资料。首先对糖尿病受试
者按照有无心肌桥进行分组,比较心肌桥前段和无心肌桥组的对等段血管冠状动脉粥样硬化有无差别以及差别是否具有统计
学意义。然后对所有心肌桥受试者按照有无糖尿病进行分组,比较两组间心肌桥前段冠状动脉粥样硬化有无差别以及差别是
否具有统计学意义。最后应用Logistic回归模型分别分析糖尿病及非糖尿病患者前降支心肌桥及桥前血管冠状动脉粥样硬化
病变的关系。结果糖尿病患者2345例,其中1373例心肌桥中,827例桥前段冠脉存在动脉粥样狭窄,972例无心肌桥,与心肌
桥组桥前血管对等部位血管中254例存在动脉粥样狭窄,差别具有统计学意义（P<0.05）。Logistic回归模型结果显示经最终校
正后,糖尿病及非糖尿病患者桥前血管发生动脉粥样硬化病变的Odds Ratio值分别为3.91、2.69（P<0.05）。结论糖尿病患者心
肌桥桥前段更易发生粥样硬化狭窄,心肌桥均为桥前血管发生狭窄大于50%的冠状动脉粥样硬化病变的独立危险因素,与非糖
尿病组相比,糖尿病组的心肌桥致桥前血管发生狭窄大于50%的冠状动脉粥样硬化病变的危险性更高。
     

前降支心肌桥与桥前段冠状动脉粥样硬化狭窄的相关性

目的 探讨前降支心肌桥与心肌桥前段冠状动脉粥样硬化狭窄的相关性,以确定前降支心肌桥是否与心肌桥前段冠状动脉粥样硬化狭窄的发生存在独立的关联。方法 回顾性分析2011年3月至2012年12月9 862例拟诊为冠心病患者的CT冠状动脉血管成像资料(只记录并分别按照前降支有无冠脉粥样硬化及有无心肌桥进行分组)及临床资料(包括年龄、性别、吸烟情况、有无家族心脏病史、糖尿病、高血压、高脂血症、体重指数、静息心率),应用Logistic回归模型分析发生于前降支心肌桥与桥前段冠状动脉粥样硬化狭窄的关系。结果 9 862例患者中3 359例患者前降支存在50%以上狭窄,前降支心肌桥为3 182(32.3%)例,心肌桥平均长度为(17.3±5.2)mm,覆盖的心肌平均厚度为(1.2±0.9)mm。前降支动脉硬化狭窄组含有心肌桥1 658例,前降支无动脉硬化狭窄组含有心肌桥1 524例,两组比较差异具有统计学意义(χ²=681.12,P＜0.05),Logistic回归表明心肌桥的OR值为3.07,95%置信区间2.81~3.37(P＜0.001),最终经过年龄、性别、吸烟情况、家族心脏病史、高血压、高脂血症、体重指数、糖尿病、静息心率等因素校正后,OR值为2.86,95%置信区间2.60~3.16(P＜0.001)。结论 前降支心肌桥与心肌桥前段冠状动脉粥样硬化狭窄的发生存在独立的相关性。     

冠状动脉多支血管病变合并左心室功能障碍患者临床特征及危险因素研究

目的 探讨冠状动脉多支血管病变合并左心室功能障碍患者的临床特征及危险因素.方法 选择2009年6月-2012年9月384例在我院行冠状动脉造影检查提示存在多支血管病变的患者为研究对象,依据心脏超声结果分为两组:左室射血分数(LVEF)≥50%组(n=266)和LVEF＜50%组(n=118),记录两组患者住院期间的临床资料,对相关因素进行单因素和多因素Logistic回归分析.结果 与LVEF≥50%组比较,LVEF＜50%组男性比例及心肌梗死病史、糖尿病病史、不稳定性心绞痛的发生率高,高血压和血脂异常发生率低,差异均有统计学意义(P＜0.05).单因素Logistic回归分析显示:男性、心肌梗死病史、糖尿病病史、高血压、血脂异常及不稳定性心绞痛进入回归方程[比值比(OR)及95%可信区间(CI)分别为:1.808(1.070,3.057),3.289(2.094,5.165),1.641(1.028,2.620),0.556(0.359,0.861),0.497(0.292,0.844),1.579(1.005,2.479)].多因素Logistic回归分析显示:心肌梗死病史、糖尿病病史、高血压及血脂异常进入回归方程[OR(95%CI)分别为:3.314(2.048,5.363),2.415(1.346,4.332),0.597(0.366,0.973),0.364(0.197,0.675)].结论 心肌梗死病史、糖尿病是多支血管病变(严重冠心病)患者合并左心室功能障碍的危险因素;高血压,血脂异常则为保护因素.     

25(OH)D水平对高血压合并冠心病患者心肌重构及左心室舒张功能的影响

目的分析25羟基维生素D[25(OH)D]水平对高血压合并冠心病患者心肌重构及左心室舒张功能的影响。方法选择80例高血压合并冠心病患者,根据左心室质量指数及左心室舒张功能分为心肌重构组和无心肌重构组、舒张功能障碍组和无舒张功能障碍组。Logistic回归分析影响高血压合并冠心病患者心肌重构及左心室舒张功能的独立危险因素,ROC曲线分析其诊断效能。结果与无心肌重构组比较,心肌重构组收缩压、总胆固醇(TC)、低密度脂蛋白胆固醇(LDLC)升高,25(OH)D降低(P＜0.05)。与无舒张功能障碍组比较,舒张功能障碍组体质指数(BMI)、25(OH)D水平降低,LDLC升高(P＜0.05)。25(OH)D是患者心肌重构及左心室舒张功能的危险因素(P＜0.05)。25(OH)D水平对患者心肌重构、舒张功能障碍有较好的诊断效能。结论25(OH)D水平是影响高血压合并冠心病患者心肌重构及左心室舒张功能的独立危险因素,早期检测其水平有助于临床诊疗。     

老年性高血压病静息心率与血压水平及靶细胞损害的相关性分析

目的:观察不同静息心率老年性高血压病患者与血压水平、靶器官损害的关系。方法:研究对象为老年性高血压病患者128例,根据静息心率水平分为A、B、C组。观察不同静息心率与血压水平、靶器官损害程度的相关性。结果:A组入院时舒张压高于B组,C组入院时收缩压、舒张压高于B组。随着静息心率增加,左心室射血分数(LVEF)、内生肌酐清除率(CCr)呈下降趋势,左心室重量指数(LVMI)、尿微量白蛋白(MAU)呈升高趋势,A、B、C组间差异有统计学意义(P<0.05)。相关性分析结果显示,静息心率与LVEF、CCr呈负相关(r值分别为-0.635、-0.512,P<0.05),静息心率与LVMI、MAU呈正相关(r值分别为0.558、0.578,P<0.05)。结论:临床上在治疗老年高血压合并靶器官损害时,需在控制血压的同时,密切观察心率变化。     

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.