丹红注射液合并硝酸甘油对急性心肌梗死患者PCI治疗中无复流现象及C-反应蛋白的影响

目的:研究急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)前静脉注射丹红注射液对术中无复流血流的改善及C-反应蛋白(CRP)的影响。方法:对120例AMI患者术前均给予阿司匹林300 mg、氯吡格雷300 mg等治疗。随机分成A组与B组两组,各60例。A组PCI术前予以丹红注射液,术中出现无复流2例,再予以硝酸甘油冠脉内给药;B组直接行PCI术,术中出现无复流8例,再予以硝酸甘油冠脉内给药,对比两组患者冠脉血流恢复情况。同时两组患者均在术前及术后监测CRP。结果:A组全部冠脉血流恢复TIMI3级,B组有4例冠脉血流恢复TIMI3级,且用丹红注射液组术后CRP降低更明显。结论:PCI术前静脉注射丹红注射液可以降低AMI患者的CRP值,且联合硝酸甘油后较单一给予硝酸甘油可更有效恢复无复流血管的TIMI血流值。     

氟伐他汀对冠心病患者PAPP-A和ox-LDL水平的影响

目的观察氟伐他汀治疗对冠心病患者妊娠相关血浆蛋白-A（PAPP-A）和氧化型低密度脂蛋白（ox-LDL）水平的影响。方法选择冠心病组患者75例,包括急性心肌梗死（AMI）患者32例,不稳定型心绞痛（UAP）患者22例和稳定型心绞痛（SAP）患者21例。正常对照组60例。采用双抗体夹心酶联免疫吸附试验检测冠心病患者PAPP-A和ox-LDL水平。结果PAPP-A在急性冠脉综合征组（ACS,包括AMI、UAP）浓度较SAP及正常对照组均明显偏高（P<0.05）;ox-LDL在冠心病组中的浓度较正常对照组高（P<0.05）,且在AMI、UAP、SAP各组组间比较均有显著性差异（P<0.05）;氟伐他汀治疗后冠心病患者PAPP-A和ox-LDL浓度均显著下降（P<0.01）;PAPP-A与ox-LDL水平呈正相关（P<0.01）。结论氟伐他汀治疗后冠心病患者PAPP-A和ox-LDL浓度降低,氟伐他汀可能通过抑制炎症反应,减少氧化应激来发挥心血管的保护作用。     

急性下壁心肌梗死心电图胸前导联ST段变化与冠脉病变关系的探讨

在３８例急性下壁心肌梗死患者中，将冠状动脉造影结果与体表心电图改变相对照。发现胸前导联ＳＴ段改变时，尤其是ＳＴ段压低时，提示有多支冠脉病变，特别是前降支病变。     

Myocardial ischemia-reperfusion injury: Possible role of melatonin

Our knowledge and understanding of the pathophysiology of coronary atherosclerosis has increased enormously over the last 20 years. Reperfusion through thrombolysis or percutaneous coronary angioplasty is the standard treatment for preventing acute myocardial infarction. Early reperfusion is an absolute prerequisite for survival of the ischemic myocardium, but reperfusion itself may lead to accelerated and additional myocardial injury beyond that generated by ischemia alone. These outcomes, in a range of reperfusion-associated pathologies, are collectively termed "reperfusion injuries". Reactive oxygen species are known to be produced in large quantities in the first few minutes of the post-ischemia reperfusion process. Similarly, scientific evidence from the last 15 years has suggested that melatonin has beneficial effects on the cardiovascular system. The presence of vascular melatoninergic receptor binding sites has been demonstrated; these receptors are functionally linked to vasoconstrictor or vasodilatory effects of melatonin. It has been shown that patients with coronary heart disease have a low melatonin production rate, especially those with higher risk of cardiac infarction and/or sudden death. Melatonin attenuates molecular and cellular damage resulting from cardiac ischemia-reperfusion in which destructive free radicals are involved.     

37例青年心肌梗塞的临床分析

在本院住院的800例急性心肌梗塞病人中发现年龄≤40岁的青年心肌梗塞患者37例,男性36例(97.3%),危险因素中吸烟、家族史阳性和高血脂分列前三位.冠脉造影,27例为动脉粥样硬化.1例肌桥,3例正常.冠脉病变以单支病变最多见,病变部位以左前降支最易受累,左室射的分数(LVEF)值仅2例低于40%.青年心肌梗塞发病仍以动脉粥样硬化为主要原因,预后较好.     

阿加曲班研究进展

阿加曲班是合成的小分子药物,为一价直接凝血酶抑制剂,阿加曲班直接与凝血酶的催化活性位点结合,不但灭活液相凝血酶,还能够灭活与纤维蛋白血栓结合的凝血酶,目前已批准用于肝素诱导的血小板减少及血栓症、经皮冠状动脉介入治疗、脑卒中溶栓等血栓性疾病.体内外研究表明,它还抑制凝血酶的其他作用,如可以抑制肿瘤转移、炎症过程及血管成形术后的再狭窄等.     

Changes in serum interleukin-6 and high-sensitivity C-reactive protein levels in patients with acute coronary syndrome and their responses to simvastatin

The role of inflammation in acute coronary syndrome (ACS) and the mechanism by which statin treats ACS is explored. Serum high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) levels were measured in 50 patients with ACS [including 30 cases with unstable angina (UA) and 20 patients with acute myocardial infarction (AMI)], 34 patients with stable angina (SA), and 30 controls. Patients in the ACS group were randomly assigned to a simvastatin group (including a simvastatin AMI subgroup, n = 11 and a simvastatin UA subgroup, n = 14) and a routine group (including a routine AMI subgroup, n = 9 and a routine UA subgroup, n = 16). The simvastatin group was given simvastatin 20mg/day and the routine group a placebo. After a 3-week follow-up, serum hs-CRP, IL-6 levels, and serum lipid concentrations were measured again. Both serum IL-6 and hs-CRP levels were significantly higher in the ACS group (including the UA and AMI subgroups) than in the SA and control groups (P < 0.001). After 3 weeks of treatment with simvastatin, the serum IL-6, hs-CRP, total cholesterol, and low-density lipoprotein cholesterol levels were decreased significantly in the simvastatin group (P < 0.001), but no significant changes were observed in the routine group. No relationship was observed between the rate of decrease of serum IL-6 or hs-CRP and serum lipids levels. The hs-CRP level showed a significant correlation with IL-6 by Spearmans rank correlation analysis (P < 0.01). Inflammation plays an important role in the initiation of ACS. Simvastatin possesses an anti-inflammatory effect, independent of its lipid-lowering action, which may play an important role in the early treatment of ACS.     

冠状动脉介入治疗后相关细胞因子含量的变化及其意义

目的：通过检测经皮冠状动脉介入治疗（PCI）术前、后冠状动脉血液中内皮因子含量的变化，探讨介入治疗再狭窄的影响因素及其解决方法。方法：50例患者依据冠状动脉造影结果分为三组：冠状动脉三支血管正常（血管狭窄〈20％）者为A组（15例）；单支血管病变狭窄50％～70％，未行支架植入者为B组（15例）；单支血管狭窄〉70％，并植入支架1枚及以上者为C组（20例）。观察造影前后，PCI治疗前后及组间肿瘤坏死因子（TNF），内皮素（ET-1），血小板源性生长因子（PDGF）含量的变化。结果：（1）A组上述各项指标均显著低于B组、C组术前各项指标（P〈0．01）；（2）B组术前、后各项指标差异不显著；（3）C组术后30min各项指标均显著高于术前（P〈0.01）。结论：血管内皮因子（TNF，ET-1，PDGF）可能参与动脉硬化形成，冠脉介入术可能损伤血管内皮，导致血管内皮因子水平的升高。     

非体外循环冠状动脉旁路移植术疗效初步评价

随着手术技术及器械研制的进步 ,非体外循环冠状动脉旁路移植术 (OPCABG)已广泛应用于临床。与传统冠状动脉旁路移植术 (CCABG)比较 ,OPCABG术后桥血管通畅率无明显变化 ,术后心、脑、肺等常见并发症减少 ,死亡率低 ,ICU及总住院时间缩短 ,费用低 ,对高危患者更具安全性。是冠心病患者有效可靠的治疗手段     

冠脉造影正常胸痛患者的病因辨析

胸痛是心血管科常见症状,临床医师常较重视冠心病引起的胸痛而忽略了胸痛的其它原因,造成了一定的误诊.有资料显示一半以上胸痛患者冠脉造影正常,临床明确诊断为冠心病的患者中有10%～30%冠脉造影正常.现就这一问题总结了冠脉造影正常胸痛患者的常见病因,希望为正确的诊断和治疗胸痛患者提供帮助.