血清P-选择素水平与冠脉病变严重度关系的研究

目的：探讨检测血清P-选择素水平与冠脉病变严重度的关系。方法：70冽冠D病患者，按临床诊断分为2组：急性冠脉综合症组32冽和稳定型冠心病组38例，对照组患者30例。ELISA检测各组患者血清中P-选择素水平．并比较各组间的差异；冠脉造影术对冠脉病变进行Gensini评分，并了解其与血清中P-选择素的相关性。结果：冠心病患者血清中的P-选择素水平显著高于正常对照组；在冠D病组内，急性冠脉综合症组的P-选择素水平显著高于稳定型冠心病患者，但两组冠脉病变Gemini评分无显著差别；而且冠脉病变Gemini评分与血清中P-选择素水平呈明显的相关性。结论：P-选择素可能参与了冠状动脉粥样硬化的发生和发展过程，血清P-选择素水平可能是冠脉病变严重度的一个预测指标。     

Platelet function in patients with acute coronary syndrome (ACS) predicts recurrent ACS

BACKGROUND: Platelet hyperfunction contributes to acute coronary syndromes (ACS). Thus, we hypothesized that platelet function under high shear stress predicts recurrent ACS during long-term follow-up of ACS patients. PATIENTS AND METHODS: Consecutive ACS patients (n = 208) were prospectively followed-up for an average of 28 months. Platelet function was measured with the platelet function analyzer (PFA-100; Dade Behring, Marburg, Germany) at baseline for collagen/adenosine diphosphate closure times (CADP-CT) and for collagen/epinephrine closure times (CEPI-CT) after infusion of a uniform dose of 250 mg aspirin. RESULTS: Of the conventional risk factors, only the prevalence of diabetes was higher in ACS patients with re-events. However, use of clopidogrel and use of beta blockers were also slightly lower in patients with re-events (P < 0.05). The unadjusted risk hazard ratio (HR) for re-events was 3.3 [95% confidence interval (95% CI): 1.4-7.4; P = 0.005] in those patients with the shortest CADP-CT values (lowest quartile). Similarly, the risk was 2.0-fold higher (95% CI: 1.1-3.6; P = 0.02) in ACS patients with CEPI-CT < 300 s as compared with CEPI-CT >or = 300 s. Inclusion of diabetes, clopidogrel and beta blockers in a multivariate Cox regression model enhanced the predictive value of CEPI-CT (HR: 2.7). Inclusion of von Willebrand factor levels did not alter the HR for recurrent ACS (HR: 2.1; 95% CI: 1.1-5.2; P = 0.03) for CEPI-CT < 300 s, but reduced the HR for CADP-CT (HR: 2.8, 95% CI: 0.8-9.8; P = 0.11). CONCLUSION: Shortened CT values reflect biologically relevant platelet hyperfunction in patients with ACS because they predict recurrent ACS.     

非体外循环紧急转为体外循环冠状动脉旁路移植术的分析

目的了解导致非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,off-pumpCABG)紧急转为体外循环冠状动脉旁路移植术(on-pump coronary artery bypass grafting,on-pump CABG)的临床的原因,为手术方法的选择提供借鉴。方法回顾分析2002年1月～2006年5月期间546例冠心病患者行off-pumpCABG的临床资料,对术中需紧急转为体外循环下完成手术的患者(off-pump转on-pump组,24例)与同期顺利完成off-pump CABG患者(off-pump组,522例)进行对比分析,并行logistic多因素分析。结果在行off-pump CABG中,24例患者因心室颤动或血流动力学不稳定需紧急改变术式。Off-pump转on-pump组患者中死亡4例,死亡率为16.7%(4/24),明显高于off-pump组[16.7%vs.2.7%(14/522),P<0.001]。多因素logistic回归分析结果提示急性心肌梗死(OR=3.142,P=0.004)、急诊CABG(OR=1.571,P=0.011)和右冠状动脉狭窄≤90%(OR=1.922,P=0.024)为off-pump转为on-pump的危险因素。结论Off-pump紧急转为on-pump时死亡率明显增高,对同时合并有右冠状动脉狭窄≤90%、急性心肌梗死和急诊CABG等高危因素行off-pump CABG时,要做好体外循环的准备。     

男性病人冠状动脉病变与吸烟关系的研究

[目的]探讨吸烟对病人冠状动脉病变的影响。[方法]对吸烟组(5 0例)与不吸烟组(3 0例)进行冠状动脉造影,观察记录冠状动脉病变情况并进行统计学分析。[结果]两组冠状动脉病变记分、每日不同吸烟量与冠状动脉病变记分、不同的吸烟年限与冠状动脉病变记分比较均有统计学意义(P <0 .0 1)。[结论]长期吸烟可使冠状动脉病变程度加重,应加强对长期吸烟及冠状动脉介入术后病人的健康教育,有效预防和控制冠心病,提高人群的健康水平。     

Vascular Centerline Extraction in 3D MR Angiograms for Phase Contrast MRI Blood Flow Measurement

The accuracy of 2D phase contrast (PC) magnetic resonance angiography (MRA) depends on the alignment between the vessels and the imaging plane. PC MRA imaging of blood flow is challenging when the flow in several vessels is to be evaluated with one acquisition. For this purpose, semi-automatic determination of the plane most perpendicular to several vessels is proposed based on centerlines extracted from 3D MRA. Arterial centerlines are extracted from 3D MRA based on iterative estimation-prediction, multi-scale analysis of image moments, and a second-order shape model. The optimal plane is determined by minimizing misalignment between its normal vector and the centerlines’ tangent vectors. The method was evaluated on a phantom and on 35 patients, by seeking the optimal plane for cerebral blood flow quantification simultaneously in internal carotids and vertebral arteries. In the phantom, difference of orientation and of height between known and calculated planes was 1.2° and 2.5 mm, respectively. In the patients, all but one centerline were correctly extracted and the misalignment of the plane was within 12° per artery. Semi-automatic centerline extraction simplifies and automates determination of the plane orthogonal to one vessel, thereby permitting automatic simultaneous minimization of the misalignment with several vessels in PC MRA.     

Surgical treatment for coronary artery aneurysm

Two successful cases of the surgical treatment for coronary artery aneurysm (non-Kawasaki disease) were reported. The first case had a saccular aneurysm on the left circumflex coronary artery (LCx) #14. Resection of the LCx aneurysm was performed subsequent to single vessel coronary artery bypass grafting (CABG) to the distal portion of LCx#14 under the cardioplegic cardiac arrest. The second case had aneurysms on both the left anterior descending artery (LAD) #7 (fusiform) and the LCx#11 (saccular). After double vessel CABG to LAD#7 and LCx#11, ligation or resection of two aneurysms was performed successfully. Postoperative courses have been uneventful with good angiographic results achieved. Since these surgical procedures demonstrated safety, the patients are expected to achieve a good long-term prognosis.     

Tissue plasminogen activator genetic polymorphisms do not influence tissue plasminogen activator release in patients with coronary heart disease

OBJECTIVES: To determine if polymorphisms of the tissue plasminogen activator (t-PA) gene influence acute endogenous t-PA release in patients with coronary heart disease (CHD). METHODS: Forearm blood flow and plasma t-PA concentrations were measured in response to intra-brachial infusion of substance P and sodium nitroprusside in 96 patients with stable CHD. Genotyping was performed using a Taqman polymerase chain reaction assay specifically designed to detect the polymorphisms of interest: (i) Alu-repeat insertion/deletion sequence; (ii) C-->T substitution in an upstream enhancer region (-7351 C/T); (iii) T-->C in exon 6 (20 099 T/C); and (iv) T-->A (27 445 T/A) in intron 10. RESULTS: Substance P and sodium nitroprusside caused dose-dependent increases in forearm blood flow in all patients (P < 0.001 for all) that were independent of the four genetic polymorphisms. Similarly, there were no differences in basal plasma t-PA antigen concentrations or net t-PA release between genotypes. Compared to non-smokers, smokers exhibited impaired substance P-induced vasodilatation (P < 0.001) and t-PA release (P = 0.05). CONCLUSIONS: Despite confirming our previous findings in cigarette smokers, we have found no effect of polymorphisms of the t-PA gene on two complementary aspects of endothelial function. We conclude that genetic variation of the t-PA locus is unlikely to have a major influence on acute t-PA release in subjects with established CHD.     

Myocardial perfusion imaging and cardiac events in a cohort of asymptomatic patients with diabetes living in southern France.

AIMS: To assess the association between abnormal stress myocardial perfusion imaging (MPI) and cardiac events (CE) in asymptomatic patients with diabetes and with > or = 1 additional risk factor. Predictors of abnormal stress MPI were also evaluated. METHODS: Four hundred and forty-seven consecutive patients who underwent stress MPI were prospectively followed for 2.1 [0.5-4.1] years for the subsequent occurrence of hard CE (myocardial infarction and sudden or coronary death) and soft CE (unstable angina and ischaemic heart failure requiring hospitalization). Re-vascularization procedures performed as a result of the screening protocol were not included in the analysis. RESULTS: Follow-up was successful in 419 of 447 patients (94%), of whom 71 had abnormal MPI at baseline. Medical therapy was intensified in all subjects and especially in those with abnormal MPI. Twenty-three patients with abnormal MPI underwent a re-vascularization procedure. CEs occurred in 14 patients, including six of 71 patients (8.5%) with abnormal MPI and eight of 348 patients (2.3%) with normal MPI (P < 0.005). Only two patients developed a hard CE and 12 a soft CE. In multivariate analysis, abnormal MPI was the strongest predictor for CEs [odds ratio (OR) (95% CI) = 5.6 (1.7-18.5)]. Low-density lipoprotein cholesterol > or = 3.35 mmol/l [OR (95% CI) = 7.3; 1.5-34.7] and age > median [OR (95% CI) = 6.0 (1.2-28.6)] were additional independent predictors for CE. The independent predictors for abnormal MPI were male gender, plasma triglycerides > or = 1.70 mmol/l, creatinine clearance < 60 ml/min and HbA1c > 8%, with male gender the strongest [OR (95% CI) = 4.0 (1.8-8.8)]. CONCLUSIONS: Asymptomatic patients with diabetes in this study had a very low hard cardiac event rate over an intermediate period. This could be explained by the effects of intervention or by the low event rate in the background population. Randomized studies of cardiac heart disease screening are required in asymptomatic subjects with diabetes to determine the effectiveness of this intervention.     

羟乙基淀粉130/0.4对非体外循环冠状动脉搭桥术患者凝血功能的影响

目的比较非体外循环冠状动脉搭桥术(0PCAB)中临床剂量的羟乙基淀粉(HES)130／0．4和琥珀酰明胶对凝血功能的影响。方法选择24例美国麻醉医师协会(ASA)分级Ⅱ～Ⅲ级、择期行OPCAB的患者,随机均分为琥珀酰明胶组(GEL组)和HES组。分别于麻醉诱导前(T0)、术毕即时(T1)和术后24 h(T2)测定血小板计数、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)和D-二聚体等凝血功能指标。记录术中失血量、术后24 h内的胸管引流量和输血量。结果两组间手术时间、术中补液量、术中出血量和24 h胸管引流量的差异均无显著性(P值均>0．05)。两组间T0、T1和T2时间点的血小板计数、PT、APTT、Fib及D-二聚体的差异均无显著性(P值均>0．05)。结论临床剂量的HES 130／0．4与琥珀酰明胶对OPCAB患者凝血功能的影响无明显差异,可安全应用于OPCAB的容量治疗。     

茶色素对冠心病及高血压病病人血小板功能的影响

目的：探索茶色素对冠心病、高血压病病人血小板功能的影响。方法：冠心病病人３６例（男性２１例，女性１５例；年龄６４±ｓ４ａ）；高血压病病人３０例（男性１８例，女性１２例；年龄５８±８ａ）。采用茶色素２５０ｍｇ，ｐｏ，ｔｉｄ，３０ｄ为一个疗程。结果：治疗后ＴＸＢ２下降，６－ｋｅｔｏ－ＰＧＰ１α上升，ＴＸＢ２／６－ｋｅｔｏ－ＰＧＦ１α比值下降（Ｐ＜０．０１或Ｐ＜０．０５），ＧＭＰ－１４０下降（Ｐ＜０．０５），ＰａｇＴ，ＰａｄＴ下降（Ｐ＜０．０５）。结论：茶色素具有降低血小板表面活性作用，抑制血小板聚集和粘附，抗血栓形成，改善微循环，对冠心病和高血压病病人起到积极的防治作用。