踝臂指数与老年冠心病患者冠状动脉病变严重程度的相关性研究

目的 探讨老年病患者踝臂指数与冠状动脉狭窄严重程度的相关性,评价踝臂指数对冠状动脉狭窄严重程度的预测价值.方法 选择2010年9月至2012年3月行冠状动脉造影的老年住院患者98例,其中男68例,女30例.根据踝臂指数分为踝臂指数≥0.9组(72例)和踝臂指数＜0.9组(26例).评价踝臂指数与SYNTAX评分的相关性、踝臂指数与不同病变支数的关系以及踝臂指数对3支或左主干病变的预测价值.结果 ①踝臂指数＜0.9组与踝臂指数≥0.9组的SYNTAX评分和左心室射血分数差异有统计学意义[SYNTAX评分:(26±8)分比(12±6)分,左心室射血分数:(46±9)％比(54±10)％,均P＜0.05].②Pearson直线相关分析结果显示,踝臂指数与SYNTAX评分呈负相关(r=-0.598,P=0.001),即踝臂指数越低,冠状动脉病变程度越重,狭窄程度越重.③冠状动脉造影结果显示无病变、单支病变、2支病变、3支或左主干病变患者例数分别为8、33、29、28例,踝臂指数分别为1.02 ±0.19、1.01 ±0.19、1.03±0.09、0.81 ±0.16.3支或左主干病变的踝臂指数低于无病变、单支病变和2支病变者,差异有统计学意义(P＜0.01);无病变、单支病变、2支病变的踝臂指数差异无统计学意义(P＞0.05).④受试者工作特征(ROC)曲线下面积为0.748[95％置信区间(CI):0.668～0.829,P＜0.01],以踝臂指数＜0.9作为截断值预测3支或左主干病变具有较高的特异性(78.5％)和敏感性(67.6％).Logistic多元回归分析显示SYNTAX评分、踝臂指数＜0.9、左心室射血分数是预测3支或左主干病变的独立危险因素[SYNTAX评分:优势比(OR)=3.004,95％ CI:2.001 ～6.007,P=0.022;踝臂指数＜0.9:OR=1.624,95％ CI:1.091 ～3.067,P=0.035;左心室射血分数:OR=2.185,95％ CI:2.042～5.815,P=0.016].结论 老年冠心病患者踝臂指数与冠状动脉狭窄严重程度呈负相关,踝臂指数可能是预测冠状动脉病变严重程度的指标之一.     

冠心病合并2型糖尿病患者临床和冠脉造影特点分析

目的 探讨冠心病(CHD)合并2型糖尿病(DM)患者的临床和冠脉造影特点.方法 选择经冠脉造影证实的冠心病患者515例,根据是否合并糖尿病将其分为糖尿病组(353例)和非糖尿病组(162例),比较两组患者的临床和冠脉造影资料.结果 合并2型糖尿病的冠心病患者发生高血压和急性心肌梗死的比例明显高于非糖尿病的冠心病患者(P＜0.01),前者血甘油三酯水平也明显高于后者(P＜0.01).冠心病合并2型糖尿病患者多发生多支病变,左主干病变也明显高于非糖尿病者(P＜0.01).结论 冠心病合并2型糖尿病患者临床和冠脉病变复杂.     

高敏C反应蛋白结合血管内超声对冠心病临界病变介入术后心脏不良事件的评价

目的 探讨高敏C反应蛋白(hs-CRP)联合血管内超声(IVUS)检查对冠心病临界病变介入治疗术后患者主要心脏不良事件的评价作用.方法 82例临床诊断冠心病的患者,均于术前检测hs-CRP,经冠状动脉造影检查,明确至少有一支主要冠状动脉狭窄程度在40％ ～ 70％,所有患者均行血管内超声检查,明确最小管腔面积( MLA)≤4 mm2(非左主干)或≤6 mm2(左主干)后行支架植入,将患者分为hs-CRP升高组(≥3 mg/L)和hs-CRP正常组(＜3 mg/L),比较两组在住院期间和随访期间发生典型心绞痛、非致死性心肌梗死、心源性死亡和靶血管重建等主要心脏不良事件(MACE)的发生率.结果 hs-CRP升高组主要心脏事件发生率显著高于hs-CRP正常组(P ＜0.01);hs-CRP升高组再狭窄发生率高于hs-CRP正常组(P＜0.01).结论 hs-CRP能预测冠心病临界病变介入术后的心脏不良事件发生率,对hs-CRP升高的临界病变冠心病患者术后应强化抗血小板、抗炎等治疗.     

对140例女性心电图及冠脉造影特点与冠状动脉病变的探讨

目的 探讨女性冠心病的心电图及冠脉造影特点.方法 对140例临床诊断为冠心病和疑为冠心病女性患者的心电图及冠脉造影结果进行分析,并与同期检查的男性患者270例对比.结果女性心电图阳性率74.2%,男性阳性率54.1%;女性T波改变(45.5%)明显高于男性(31.9%);女性冠脉造影阳性率54.3%,男性冠脉造影阳性率68.9%;二者对比差异具有统计学意义(P＜0.05).女性冠脉病变以单支病变为主,其次为三支、双支病变,病变部位以左前降支为主,其次为左回旋支、右冠脉、左主干.冠脉重度狭窄明显低于男性(P＜0.05).结论 女性心电图阳性率高,T波改变多见;冠脉造影阳性率低,冠脉病变受累支数低于男性,重度狭窄明显低于男性(P＜0.05).冠脉造影对女性冠心病的诊断有重要价值,但亦可能造成女性冠心病漏诊.     

高龄急性冠状动脉综合征患者临床特征及介入治疗预后分析

目的 研究分析≥75岁的急性冠状动脉综合征(acute coronary syndrome,ACS)患者临床特征及介入治疗的预后情况.方法 选取2012年1月-2015年5月收治的100例≥75岁ACS患者作为观察组,另选同期100例＜75岁ACS患者作为对照组.两组患者均行经皮冠状动脉介入治疗(PCI),回顾性分析比较两组患者的临床特点及介入手术的预后情况.结果 观察组患者体重指数低于对照组(P＜0.01).观察组收缩压、空腹血糖和肌酐水平均明显高于对照组(P＜0.05).观察组3支病变、前降支、右冠状动脉和左主干病变明显多于对照组(P ＜0.05,P＜0.01).随访12个月后观察组总体不良心血管事件发生率明显高于对照组(P＜0.05).结论 尽管PCI术治疗高龄ACS患者会产生较多的不良心血管事件,但临床疗效较好,仍可作为治疗高龄ACS的有效手段.     

冠状动脉造影164例临床分析

目的探讨冠状动脉病变以及与临床多种因素的关系。方法对164例患者采用Seldinger法多个投射角度作选择性左、右冠状动脉造影,分析冠状动脉造影结果以及临床多种因素。结果冠状动脉造影阳性率为72.0%(118/164),其中冠状动脉狭窄65.9%(108/164),包括合并心肌桥病变6例,合并冠状动脉瘤样扩张4例。累及单支44.4%(48/108),双支14.8%(16/108),3支35.2%(38/108),左主干 3支5.56%(6/108)。共累及218支冠状动脉,累及前降支40.4%(88/218),右冠30.3%(66/218),回旋支35.7%(56/218),左主干3.7%(8/218)。单发心肌桥病变3.7%(6/164),单发冠状动脉瘤样扩张病变2.4%(4/164)。年龄>45岁、伴糖尿病、高尿酸血症、高血脂、吸烟以及有心肌梗死、典型心绞痛史,典型心肌缺血心电图表现者,冠状动脉造影阳性率明显增高。结论对疑诊冠心病者,应积极行冠状动脉造影检查。     

平静心电图正常的177例冠心病病人冠状动脉造影分析

为了解平静心电图正常的冠心病病人冠脉造影特点,以提高诊断水平,对177例平静心电图正常的冠心病心绞痛病人的临床资料及冠状动脉造影结果进行分析。结果表明,冠状动脉造影显示≥2支血管病变占77.4%(137/177),单支血管病变占19.2%(34/177)。2～3支血管病变137例中118例(86.1%)血管狭窄部位相互对应。2支血管病变为前降支和右冠者多见,占47.7%(42/88),单支血管病变以前降支者多见,占61.8%(21/34)。82.4%(28/34)单支血管狭窄为50%～74%。单纯左主干病变2例。结论:冠心病心绞痫病人冠状动脉2支以上血管病变者平静心电图正常与血管狭窄部位相互对应有关;单支血管病变则与狭窄程度较轻有关。对临床疑为冠心病的病人,如平静心电图正常,应及早作冠脉造影检查以明确诊断。     

变异型心绞痛冠脉病变动态心电图监测分析

目的探讨24h动态心电图监测对变异型心绞痛冠脉病变的诊断价值。方法对67例确诊变异型心绞痛患者的动态心电图(dynam ic electrocard iogram,DCG)监测和选择性冠状动脉造影(CAG)检查结果进行回顾性分析。结果CAG检查示:冠状动脉有临床意义狭窄58例,中度以上狭窄38例(65.5%),单支病变39例,双支病变19例。DCG监测:阵发性ST段抬高≥0.20mv者53例,其中狭窄程度≥75%者27例(50.9%);ST段抬高最长持续时间≥3m in者43例,狭窄程度≥75%者16例(37.2%),<3m in者24例;ST段抬高≥0.20mv且持续时间≥3m in者均可见冠状动脉不同程度狭窄病变。结论变异型心绞痛更易在冠状动脉狭窄病变的基础上发生冠脉痉挛,阵发性ST段抬高的高度、持续时间与冠脉狭窄的程度呈正相关。DCG诊断变异型心绞痛无创伤、简便、易行,适宜在广大基层医院推广应用。     

2型糖尿病患者冠状动脉病变的特点

目的通过冠状动脉造影方法评估2型糖尿病患者的冠状动脉病变状况.方法经冠状动脉造影证实有冠状动脉狭窄的313例冠心病患者,根据有无糖尿病(DM)分为冠心病(CHD)组和DM组,观察各组冠状动脉病变状况的特点.结果两组在年龄及血管病变的分布上无明显差异;DM组女性所占比例高于CHD组;DM组比CHD组血压更高、高脂血症发生率;DM组冠状动脉左主干或多支血管病变发生率、重度狭窄及完全闭塞的发生率均高于CHD组.结论DM合并冠心病患者冠状动脉多支病变及完全闭塞的发生率高,糖尿病可促进冠状动脉病变的发生和发展,是CHD的重要危险因素.     

冠状动脉介入治疗多支架术全部置入药物洗脱支架的临床研究

目的 探讨全部置入药物洗脱支架(DES)在冠状动脉介入治疗多支架术中应用的安全性和有效性.方法 选取行冠状动脉介入治疗多支架术的患者共406例,根据置入支架的种类不同,将患者分为全部DES组(141例)、全部裸金属支架(BMS)组(152例)和混合支架组(113例).回顾性分析3组患者的临床基本情况、住院期间诊治情况、主要的心脑血管事件发生情况和出院后的随访情况等,采用Logistic多元逐步回归分析不同血运重建方式对临床结果的影响.结果 全部DES组中单支病变患者、弥漫性病变患者、支架内再狭窄病变患者的比例,明显多于其他2组(均P＜0.01);混合支架组中3支病变患者、左主干病变患者、开口病变患者的比例,明显多于其他2组(均P＜0.01);混合支架组中前降支近端病变患者68例(60.2%),全部DES组中86例(61.0%),均明显多于BMS组(75例,49.3%),差异有统计学意义(均P＜0.01).出院后随访用药方面,全部DES组及混合支架组应用阿司匹林、二磷酸腺苷(ADP)拮抗剂(噻氯匹定+氯吡格雷)的患者数(分别为129、104例)及用药时间(分别为22、20个月)多于全部BMS组(88例、6个月).随访时主要心脑血管事件发生率,全部BMS组(19.1%)明显高于DES组(9.4%)和混合支架组(10.8%)(均P＜0.01).结论 在冠状动脉介入治疗多支架术中全部置入DES后,主要临床不良事件的中期发生率明显少于全部置入BMS,表明DES在冠状动脉介入治疗多支架术中的应用是安全、有效的.     

宝石能谱CT冠状动脉成像在冠心病诊断中的应用

目的 评价宝石能谱CT冠状动脉成像(CTA)在冠心病诊断中应用价值.方法 63例疑似冠心病分别接受CTA和冠状动脉造影检查,以冠状动脉造影结果为“金标准”对照,评估冠状动脉CTA检查的准确度.结果 冠状动脉CTA可以清晰显示冠状动脉狭窄病变,与冠状动脉造影相比,两者的符合率达96.0％.结论 CTA安全、简便和无创伤,对冠状动脉疾病具有较大的诊断价值.     

经皮冠状动脉介入治疗79例临床分析

目的探讨经皮冠状动脉介入治疗的可行性、安全性和成功率。方法选择该院2005年1月~2009年7月经皮股动脉穿刺冠状动脉腔内成形术（PTCA）及支架术79例患者为研究对象。结果A型病变支架术成功率100%（36/36）,B型病变成功率98.9%（88/89）,C型病变成功率95.3%（41/43）。1例分叉、弯曲、偏心性病变和2例慢性闭塞性病变（CTO）因指引导丝不能通过病变致手术失败,总成功率为98.2%。结论经皮冠状动脉介入治疗创伤小,恢复快,安全且成功率高。     

左室室壁瘤造影诊断分析

目的探讨室壁瘤形成与冠状动脉粥样硬化的关系，以及室壁瘤对心室功能的影响。方法采用冠状动脉造影方法对168例临床疑诊冠心病患者进行检查。结果发现室壁瘤26例，其中冠状动脉单支病变11例，双支7例，三支7例，冠状动脉正常1例，受累血管狭窄程度均在III级以上。室壁瘤累及心室壁一段、二段、三段及四段的左室射血分数分别平均为(50±31)％、(32±16)％、(29±21)％及(18±14)％(r=-0.65，P     

声学密度定量技术与冠状动脉造影术的对比研究

目的：探讨声学密度定量（AD）技术评价正常、狭窄及闭塞血管支配区域心肌的组织特征。方法：对疑诊冠心病的64例患者，根据冠状动脉造影结果将192支冠状动脉分组：正常组（A组）、狭窄组（B组）、闭塞组（C组），检测其相应血管支配区域心肌的背向散射积分参数。结果：与A组相比，B组心肌的背向散射积分的标化值（IBS％）增高；而背向散射积分周期变化幅度（CVIB）减小；C组心肌的IBS％增高更明显；CVIB减小也更明显。且14支闭塞血管支配区域心肌的CVIB曲线与正常节段呈反向，N－delay在B组及C组明显延长，同一参数组间比较差异均有显著性（P＜0．01），结论：AD技术能客观反映正常，狭窄及闭塞冠状动脉脉供血区域心域心肌的不同组织特性变化，对鉴别冠心病不同病变心肌的灌流特征具有一定的诊断意义。     

阿托伐他汀干预对急性冠状动脉综合征患者PCI术后粘附分子水平的影响

Objective To explore the impact of different dose atorvastatin on the adhesion molecules level in the acute coronary syndrome (ACS) patients who had received percutaneous coronary intervention (PCI). Methods Eighty-eight ACS patients were divided into three groups, group A (normal treatment group), group B (normal treatment plus atorvastatin 10mg per day) and group C (normal treatment plus atorvastatin 80mg per day). The patients in group B received atorvastatin 10 mg per day orally before PCI and after PCI subsequently, and the patients in group C received atorvastatin 80 mg per day orally before PCI and after PCI subsequently for three days, then the dose of atorvastatin was decrease to 10 mg per day. The concentrations of soluble intercellular adhesionmolecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) were detected before PCI and at the 3rd, 7th 14th day after PCI. Results At the 7th day, the concentrations of sICAM-1 and sVCAM-1 in group C were significantly lower than those in group B, which showed sICAM-1 (68.35±23.80) μg/L vs (131.45±29.12) μg/L and sVCAM-1 (251. 65±36.61)μg/L vs (334.87±32.98) μg/L, respectively. Compared to group A, the adhesion molecule level in group B and group C were significantly decreased (P<0.05) and had no obviously affect on blood fat level. Conclusion The treatment of atorvastatin could significantly decrease the adhesion molecules' level after PCI, which may play an important role in lowing inflammation and coronary artery restenosis after PCI.     

阿托伐他汀干预对急性冠状动脉综合征患者PCI术后粘附分子水平的影响

Objective To explore the impact of different dose atorvastatin on the adhesion molecules level in the acute coronary syndrome (ACS) patients who had received percutaneous coronary intervention (PCI). Methods Eighty-eight ACS patients were divided into three groups, group A (normal treatment group), group B (normal treatment plus atorvastatin 10mg per day) and group C (normal treatment plus atorvastatin 80mg per day). The patients in group B received atorvastatin 10 mg per day orally before PCI and after PCI subsequently, and the patients in group C received atorvastatin 80 mg per day orally before PCI and after PCI subsequently for three days, then the dose of atorvastatin was decrease to 10 mg per day. The concentrations of soluble intercellular adhesionmolecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) were detected before PCI and at the 3rd, 7th 14th day after PCI. Results At the 7th day, the concentrations of sICAM-1 and sVCAM-1 in group C were significantly lower than those in group B, which showed sICAM-1 (68.35±23.80) μg/L vs (131.45±29.12) μg/L and sVCAM-1 (251. 65±36.61)μg/L vs (334.87±32.98) μg/L, respectively. Compared to group A, the adhesion molecule level in group B and group C were significantly decreased (P<0.05) and had no obviously affect on blood fat level. Conclusion The treatment of atorvastatin could significantly decrease the adhesion molecules' level after PCI, which may play an important role in lowing inflammation and coronary artery restenosis after PCI.     

阿托伐他汀干预对急性冠状动脉综合征患者PCI术后粘附分子水平的影响

Objective To explore the impact of different dose atorvastatin on the adhesion molecules level in the acute coronary syndrome (ACS) patients who had received percutaneous coronary intervention (PCI). Methods Eighty-eight ACS patients were divided into three groups, group A (normal treatment group), group B (normal treatment plus atorvastatin 10mg per day) and group C (normal treatment plus atorvastatin 80mg per day). The patients in group B received atorvastatin 10 mg per day orally before PCI and after PCI subsequently, and the patients in group C received atorvastatin 80 mg per day orally before PCI and after PCI subsequently for three days, then the dose of atorvastatin was decrease to 10 mg per day. The concentrations of soluble intercellular adhesionmolecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) were detected before PCI and at the 3rd, 7th 14th day after PCI. Results At the 7th day, the concentrations of sICAM-1 and sVCAM-1 in group C were significantly lower than those in group B, which showed sICAM-1 (68.35±23.80) μg/L vs (131.45±29.12) μg/L and sVCAM-1 (251. 65±36.61)μg/L vs (334.87±32.98) μg/L, respectively. Compared to group A, the adhesion molecule level in group B and group C were significantly decreased (P<0.05) and had no obviously affect on blood fat level. Conclusion The treatment of atorvastatin could significantly decrease the adhesion molecules' level after PCI, which may play an important role in lowing inflammation and coronary artery restenosis after PCI.     

冠心病住院患者冠状动脉介入诊疗依从性的初步研究

目的探讨影响冠心病患者对冠状动脉介入诊疗的依从性的主要因素。方法回顾性分析2008年10月至2009年7月间我科住院的临床诊断为冠心病的505名患者,观察资费来源、冠心病亚型及年龄阶段三个不同因素对住院期间冠状动脉介入诊疗依从性的影响。结果随着年龄的增长,对冠状动脉介入的依从性逐步减低;军队医保组与自费组较社会医保组依从性较高;疾病类型对介入依从性影响则相对较小。结论在当前医疗保障体制下,心脏冠状动脉介入诊疗的依从性明显受到包括医疗资源保障程度、年龄阶段等多种因素的影响。     

阿托伐他汀干预对急性冠状动脉综合征患者PCI术后粘附分子水平的影响

Objective To explore the impact of different dose atorvastatin on the adhesion molecules level in the acute coronary syndrome (ACS) patients who had received percutaneous coronary intervention (PCI). Methods Eighty-eight ACS patients were divided into three groups, group A (normal treatment group), group B (normal treatment plus atorvastatin 10mg per day) and group C (normal treatment plus atorvastatin 80mg per day). The patients in group B received atorvastatin 10 mg per day orally before PCI and after PCI subsequently, and the patients in group C received atorvastatin 80 mg per day orally before PCI and after PCI subsequently for three days, then the dose of atorvastatin was decrease to 10 mg per day. The concentrations of soluble intercellular adhesionmolecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) were detected before PCI and at the 3rd, 7th 14th day after PCI. Results At the 7th day, the concentrations of sICAM-1 and sVCAM-1 in group C were significantly lower than those in group B, which showed sICAM-1 (68.35±23.80) μg/L vs (131.45±29.12) μg/L and sVCAM-1 (251. 65±36.61)μg/L vs (334.87±32.98) μg/L, respectively. Compared to group A, the adhesion molecule level in group B and group C were significantly decreased (P<0.05) and had no obviously affect on blood fat level. Conclusion The treatment of atorvastatin could significantly decrease the adhesion molecules' level after PCI, which may play an important role in lowing inflammation and coronary artery restenosis after PCI.     

阿托伐他汀干预对急性冠状动脉综合征患者PCI术后粘附分子水平的影响

Objective To explore the impact of different dose atorvastatin on the adhesion molecules level in the acute coronary syndrome (ACS) patients who had received percutaneous coronary intervention (PCI). Methods Eighty-eight ACS patients were divided into three groups, group A (normal treatment group), group B (normal treatment plus atorvastatin 10mg per day) and group C (normal treatment plus atorvastatin 80mg per day). The patients in group B received atorvastatin 10 mg per day orally before PCI and after PCI subsequently, and the patients in group C received atorvastatin 80 mg per day orally before PCI and after PCI subsequently for three days, then the dose of atorvastatin was decrease to 10 mg per day. The concentrations of soluble intercellular adhesionmolecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) were detected before PCI and at the 3rd, 7th 14th day after PCI. Results At the 7th day, the concentrations of sICAM-1 and sVCAM-1 in group C were significantly lower than those in group B, which showed sICAM-1 (68.35±23.80) μg/L vs (131.45±29.12) μg/L and sVCAM-1 (251. 65±36.61)μg/L vs (334.87±32.98) μg/L, respectively. Compared to group A, the adhesion molecule level in group B and group C were significantly decreased (P<0.05) and had no obviously affect on blood fat level. Conclusion The treatment of atorvastatin could significantly decrease the adhesion molecules' level after PCI, which may play an important role in lowing inflammation and coronary artery restenosis after PCI.