Non-alcoholic fatty liver disease, the metabolic syndrome and the risk of cardiovascular disease: the plot thickens.

Non-alcoholic fatty liver disease (NAFLD) affects a substantial proportion of the general population and is frequently associated with many features of the metabolic syndrome (MetS). Currently, the importance of NAFLD and its relationship with the MetS is being increasingly recognized, and this has stimulated an interest in the possible role of NAFLD in the development of atherosclerosis. Recent studies have reported the association of NAFLD with multiple classical and non-classical risk factors for cardiovascular disease (CVD). Moreover, there is a strong association between the severity of liver histopathology in NAFLD patients and greater carotid artery intima-media thickness and plaque, and lower endothelial flow-mediated vasodilation (as markers of subclinical atherosclerosis) independent of obesity and other MetS components. Finally, it has recently been demonstrated that NAFLD is associated with an increased risk of all-cause death and predicts future CVD events independently of other prognostic factors, including MetS components. Overall, therefore, the evidence from these recent studies strongly emphasizes the importance of assessing the global CVD risk in patients with NAFLD. Moreover, these novel findings suggest a more complex picture and raise the possibility that NAFLD, as a component of the MetS, might not only be a marker but also an early mediator of CVD.     

瘦素、C-反应蛋白与老年急性冠脉综合征患者的相关研究

目的探讨急性冠脉综合征(ACS)患者血浆瘦素(LP)及C-反应蛋白(CRP)水平的变化及其临床意义。方法测定急性心肌梗死组(AMI组)、不稳定型心绞痛组(UA组)、对照组(健康体检者)血浆LP及CRP浓度,分析LP、CRP与病情严重程度的关系以及LP与CRP的相关性。结果AMI组、UA组患者血浆LP、CRP浓度较对照组显著升高(P<0.01),2组患者血浆LP与CRP浓度之间均呈显著正相关;AMI组血浆LP、CRP浓度比UA组明显升高(P<0.05)。结论血浆LP及CRP浓度与ACS病情严重性呈正相关,且LP与CRP浓度呈正相关。说明LP与CRP共同参与组织炎症反应,是ACS重要的危险因素及预测因子。     

黄连解毒汤对高胆固醇兔血液流变学和动脉粥样硬化干预作用

目的:观察黄连解毒汤对肺炎衣原体(Cpn)感染后高胆固醇饮食兔血液流变学和动脉粥样硬化的影响.方法:造模前60只新西兰兔经采血检测Cpn IgG均为阴性.随机选取8只兔作正常组,其余52只以含2.5 g·kg~(-1)胆固醇的饲料喂养并接种Cpn.经检测血清Cpn IgG阳性者随机分为4组:黄连解毒汤高、低剂量(3.34,1.67 g·kg~(-1)·d~(-1))组、阳性药阿奇霉素(20 mg·kg~(-1)·d~(-1))组和模型组(生理盐水),每组11只,灌胃给药6周;Cpn IgG阴性者作高胆固醇组,不予药物干预.治疗结束后采血测定高、中、低全血黏度、血浆黏度和红细胞压积,并计算RBC聚集指数、变形指数和刚性指数;取主动脉弓近左颈总动脉分叉处血管,测定和计算最大血管内膜厚度(MIT)、动脉粥样硬化病变占管周百分比(P_(LCI))、动脉粥样硬化斑块面积指数(Ⅰ_(PA)).结果:高胆固醇组和模型组血液流变学均显著紊乱,主动脉均有典型的动脉粥样硬化病理变化,后者最大MIT(23.65±8.19 vs 12.76±4.06)μm、动脉粥样硬化病变P_(LCI)(41.08±12.51 vs 22.43±9.45)%、动脉粥样硬化斑块Ⅰ_(PA)(9.57±1.82 vs 2.84±0.25)%显著较前者高(均P＜0.01);黄连解毒汤高、低剂量组、阿奇霉素组血液流变学紊乱和动脉粥样硬化病理变化与模型组比较显著改善,其中黄连汤高剂量组MIT(6.45±1.27 vs 23.65±8.19),(P＜0.01),P_(LCI),(22.39±6.74 vs41.08±12.51),(P＜0.05);Ⅰ_(PA)(1.44±0.33 vs 9.57±1.82),(P＜0.01)显著降低.结论:Cpn感染加重高胆固醇饮食兔血液流变学紊乱和动脉粥样硬化损害,黄连解毒汤可减轻Cpn感染所致高胆固醇饮食兔的血液流变学紊乱和动脉粥样硬化损害.     

Stent fracture: an unusual cause of late restenosis after sirolimus-eluting stent placement.

Stent fracture is uncommon but may have consequences including restenosis. To date, stent fractures reported have been related to aggressive post dilation. We describe a case that involves fracture of a stent deployed to nominal pressure. Unlike most stent fractures reported that involve stent struts only our case demonstrated circumferential disruption with complete separation of the stent segments.     

老年颈动脉硬化患者血清炎症因子与中医证型的关系

目的研究老年颈动脉硬化患者不同中医证型血清内皮细胞粘附分子-1（ICAM-1）、血管细胞粘附分子-1（VCAM-1）、E选择素（E-selectin）、P选择素（p-selectin）、白细胞介素-6（IL-6）和C反应蛋白（CRP）等炎症因子水平。方法收集176例颈动脉硬化患者，采用酶联免疫吸附法测定血清ICAM-1、VCAM-1、E-selectin、p-selectin、IL-6和CRP等水平，比较痰证、血瘀证和精髓亏虚证型颈动脉硬化患者血清粘附分子水平变化。结果发现各型颈动脉硬化患者血清炎症因子水平均较对照组显著上升；颈动脉硬化痰证组患者血清ICAM-1和VCAM-1均较血瘀证和精髓亏虚证患者显著上升（P〈0．05）。结论老年患者外周血中炎症因子水平可以在一定程度上反映患者的颈动脉硬化程度，老年颈动脉硬化痰证患者外周血中粘附分子水平的变化具有一定特异性，痰的微观实质可能与粘附分子之间存在某种内在联系。     

对冠心病患者实施康复护理的现状与进展

众所周知，在大多数国家中，冠心病已经成为普遍存在的发病率较高的疾病和主要的致死疾病之一。对冠心病的主要危险因素调查通过康复护理治疗，有效的社区普及卫生教育，同时对高危个体进行目标跟踪管理，这三者相结合形成了一个有效的治疗监督手段。     

人胎冠状动脉原位杂交c-myc和jun原癌基因表达

目的研究原癌基因c-myc和jun在人胎冠状动脉发育过程中的表达与平滑肌细胞增殖的关系.方法用原位杂交方法检测,胎龄分别为16周、22周(因治疗需要引产)的胎儿和意外死亡的足月胎儿冠状动脉前降支c-myc mRNA和jun mRNA的表达水平.杂交反应产物用图像分析仪(MIAS300)作定量分析.结果C-myc mRNA原位杂交反应产物与被测血管区域面积的百分比在16周、22周和足月胎儿分别是70、56和10;Jun mRNA的杂交信反应产物与被测血管区域面积的百分比在这三个时期分别是68、53和8.两个原癌基因在不同阶段的表达均具有显著性差异.结论本实验首次报道c-myc和jun在人胎冠状动脉发育过程中平滑肌的表达图型,c-myc和jun在胎儿冠状动脉平滑肌细胞增殖和内膜的形成过程中可能具有重要的调控作用.     

冠心病危险因素与冠状动脉病变程度的相关性研究

目的:探讨冠心病危险因素与冠状动脉病变程度的关系.方法:选取150例冠心病患者行冠状动脉造影术及各项化验检查,冠状动脉病变程度以Gensini积分值表示,对冠心病危险因素和冠状动脉病变程度进行统计分析.结果:经多因素线性回归证实:非高密度脂蛋白胆固醇为冠状动脉病变程度的独立危险因素(P=0.030),而性别、年龄、空腹血糖、糖尿病、高血压、吸烟、家族史及甘油三酯、低密度脂蛋白胆固醇均与冠状动脉病变程度无明确相关.结论:非高密度脂蛋白胆固醇对冠状动脉病变严重程度具有重要的影响.