颈动脉粥样硬化斑块与血清胆红素水平的研究

目的探讨脑梗死患者血清胆红素水平与颈动脉粥样硬化斑块之间的关系。方法选择脑梗死伴有颈动脉超声检测有颈动脉斑块的患者120例,按照颈动脉超声检测结果分为颈动脉内膜增厚组、硬斑组和软斑组（混合斑块归为软斑组）,选择100例同期健康体检者并经颈动脉超声检测为颈动脉内膜正常者（内膜正常组）。测定各组患者的血清胆红素水平,同时调查饮酒、吸烟、高血压、体重指数、肝肾功能等其他危险因素,并进行统计学分析。结果脑梗死组血清总胆红素及间接胆红素较内膜正常组为低,差异有统计学意义（P〈0.05）。总胆红素和间接胆红素差异有统计学意义（P〈0.05）。软斑组血清总胆红素及间接胆红素比内膜增厚组低,差异有统计学意义;软斑组血清总胆红素及间接胆红素比硬斑组低,差异具有统计学意义。结论血清胆红素水平变化与颈动脉粥样硬化斑块关系密切,低胆红素水平是颈动脉动脉粥样硬化重要的危险因素。     

Double‐stent method

Coronary artery aneurysm (CAA) is an uncommon and often incidental finding on coronary angiography but can present with symptoms related to myocardial ischemia. The most common etiology is atherosclerosis, accounting for over 50% of cases, but CAAs can also be congenital or secondary to percutaneous coronary artery revascularization procedures, inflammatory arterial diseases, connective tissue disorders, and perhaps drug‐eluting‐stent (DES) implantation. A current lack of uniform guidelines for their therapeutic management, especially in the setting of DES, leaves their optimum treatment somewhat controversial. Polytetrafluoroethylene‐covered stents have gained popularity in recent years for percutaneous treatment of CAAs; however, their failure to endothelialize is associated with increased risk of thromboocclusive events. We describe two symptomatic patients presenting with large CAAs, one forming after DES implantation, that we treated using the double‐stent method, in which one stent is placed within another. The intent is to reduce stent permeability across the aneurysm and promote blood stasis within it, thereby encouraging aneurysm thrombosis and meanwhile preserving the stents' ability to endothelialize. The immediate angiographic result revealed markedly reduced filling of the aneurysms and aneurysm thrombosis was later confirmed at follow‐up. Both patients have remained asymptomatic during at least 9 months of follow‐up. To the best of our knowledge, this is the first case report describing the use of the double‐stent method as an alternative to treat CAAs percutaneously.© 2011 Wiley‐Liss, Inc.     

In‐hospital outcomes of very elderly patients (85 years and older) undergoing percutaneous coronary intervention

Objective : To compare in‐hospital outcomes of a large cohort of very elderly patients (age ≥85 years) with younger patients (age <85 years) undergoing percutaneous coronary intervention (PCI) for all indications at our institution. Background : Interventionist cardiologists are often reluctant to undertake PCI in very elderly patients due to the perception of poor outcome in this high‐risk cohort. However, the prognostic significance of advanced age itself is not clear. Methods : Baseline clinical, angiographic and procedural variables, and in‐hospital outcome data were entered into a prospective registry of 17,572 consecutive patients undergoing PCI at the University Health Network between April 2000 and December 2008. Patients were stratified according to age (<85 years, n = 17,168, or ≥85 years, n = 404) and in‐hospital mortality, major adverse cardiac events (MACE), and complication rates were calculated. Logistic regression‐analysis identified independent predictors of unadjusted mortality and MACE. Very elderly patients were propensity matched with younger patients (1:2 ratio), and the analysis repeated. Results : Very elderly patients had a mean age of 87.5 ± 2.9 (range, 85–97 years) vs. 62.8 ± 11.1 years for the younger cohort and had a greater number of comorbid conditions. This cohort were more likely to present as an urgent or primary PCI, underwent more complex interventions, and achieved less angiographic success. Unadjusted mortality and post procedure myocardial infarction were significantly higher in very elderly patients (6.93% vs. 1.20%, P < 0.0001 and 4.46% vs. 2.74%, P = 0.04). Renal, neurological, and access‐site complications were all greater in the very elderly cohort. Although age ≥85 years was a significant independent predictor of both mortality (OR, 2.62; CI, 1.44–4.78, P = 0.0016) and MACE (OR, 1.94; CI, 1.25–3.01, P = 0.003), other variables such as cardiogenic shock were more potent predictors of adverse outcomes. Conclusion : Very elderly patients represent a high‐risk cohort, with significantly increased in‐hospital mortality and complication rates after PCI. Death occurred predominantly in very elderly patients undergoing nonelective PCI. Decisions to proceed with PCI in very elderly patients should be based on other prognostic variables in combination with advanced age, and these patients should not be excluded from revascularization based on age alone. © 2011 Wiley‐Liss, Inc.     

Treatment of dyslipidemia in the elderly

Dyslipidemia is a well-established risk factor for atherosclerosis. Treating dyslipidemia in elderly patients requires specific knowledge and understanding of common dyslipidemias and the relative safety of various pharmacologic agents in the presence of possible multiple comorbidities. Lifestyle modification remains the first step in the treatment of dyslipidemia; however, it can be difficult to sustain and achieve acceptable compliance in the elderly and it is best used in combination with drug therapy. Statins are widely accepted as the first-line therapy. Several recent studies have demonstrated that statins are safe and effective in the elderly. However, it is important to note that there is very limited data regarding the effects of dyslipidemia treatment on morbidity and mortality in patients over 85 years of age. In summary, the clinicians must recognize that the presence of dyslipidemia in the elderly poses substantial risk of coronary events and stroke. The available evidence has demonstrated that in most elderly patients who are at increased risk for cardiovascular morbidity and mortality, treatment of dyslipidemia with appropriate therapy reduces the risk, and when used carefully with close monitoring for safety, the treatment is generally well tolerated. With increasing life expectancy, it is critical for physicians to recognize the importance of detection and treatment of dyslipidemia in the elderly.     

氧化型低密度脂蛋白对单核细胞表达尿激酶型纤溶酶原激活物受体的影响

目的探讨不同浓度的氧化型低密度脂蛋白（oxLDL）对体外培养单核细胞表达尿激酶型纤溶酶原激活物受体（uPAR）的影响。方法采用密度梯度离心法及黏附法分离、提取并纯化健康人外周血单核细胞,对原代培养的单核细胞分别加入25,50,100mg/L浓度的oxLDL,分别培养12,24,48h,测定单核细胞的uPAR蛋白表达量及uPAR mRNA的水平变化。药物干预组加入含阿托伐他汀（终浓度为5.0μmo/L）和50mg/L的ox-LDL的培养液培养12,24,48h,同样方法测定单核细胞的uPAR蛋白表达量及uPAR mRNA的水平变化。结果与正常组比较,oxLDL刺激组单核细胞uPAR蛋白表达水平有显著升高,并呈剂量依赖关系;oxLDL刺激组单核细胞uPAR mRNA的合成量被显著上调。阿托伐他汀干预组uPAR蛋白的表达水平及uPAR mRNA合成量的刺激效果均被显著抑制。结论 oxLDL刺激单核细胞高表达uPAR是通过转录水平的上调来刺激蛋白质合成增加的;阿托伐他汀对uPAR表达的抑制是通过下调uPAR转录水平来实现的。     

老老年高血压病患者昼夜血压节律对颈动脉硬化的影响

目的探讨老老年高血压病患者昼夜血压节律对颈动脉硬化的影响。方法应用24h动态血压监测仪监测82例年龄≥80岁的高血压病患者血压水平,根据夜间血压下降率将患者分为非杓型组和杓型组。测定两组患者颈动脉内膜中层厚度(IMT)。结果非杓型组与杓型组的IMT分别为(0.17±0.08)cm、(0.14±0.04)cm,差异有统计学意义(P<0.01)。结论昼夜血压节律异常的老老年高血压病患者颈动脉硬化更明显。     

低舒张压的收缩期高血压中医证型与颈动脉粥样硬化的相关性研究

目的探讨低舒张压的收缩期高血压患者中医证型与颈动脉粥样硬化之间的相关性。方法将132例低舒张压的收缩期高血压(SBP>140 mmHg,DBP<70 mmHg)患者辨证分型,分为血瘀证、痰浊证、气虚证、阴虚证、阳虚证。所有患者均行颈动脉超声检查。常规检查颈动脉血管内-中膜厚度及粥样斑块并进行评分。结果血瘀证和痰浊证组颈动脉病变程度显著高于其他证型(P<0.05)。结论血瘀证及痰浊证是低舒张压收缩期高血压的多发证型;低舒张压收缩期高血压可作为心脑血管病预后提示之一。血瘀证和痰浊证是低舒张压收缩期高血压的危险证型。     

吡非尼酮改善载脂蛋白E缺失小鼠晚期动脉粥样硬化

目的初步评估小分子药物吡非尼酮对晚期动脉粥样硬化的治疗作用。方法以普通饲料诱导载脂蛋白E缺失小鼠动脉粥样硬化病变,自40周龄开始给予吡非尼酮治疗,同时设厄贝沙坦给药组作为对照。给药18周后处死,检测血脂水平;取头臂干血管石蜡包埋,连续切片,分别行HE染色和Movat染色分析血管病变和斑块成分,统计分析平均斑块面积,最大管腔狭窄程度,斑块内坏死核心比重,中膜厚度,钙化发生率和斑块内平均钙化面积。此外使用天狼星红染色统计斑块内胶原含量,免疫组化染色半定量观察斑块内平滑肌细胞和巨噬细胞阳性面积。结果经过18周给药治疗,各组小鼠的血脂水平没有明显差异。吡非尼酮能够发挥与厄贝沙坦相似的治疗作用,显著减小头臂干血管斑块面积,改善管腔狭窄程度,降低斑块内坏死核心比重,增加最小中膜厚度,增加斑块内胶原含量,增加α-SMA＋平滑肌细胞表达,抑制巨噬细胞募集等,发挥减小和稳定晚期动脉粥样硬化斑块的作用。但是在斑块钙化发生率和平均钙化面积方面,吡非尼酮没有显著的改善作用。结论小分子药物吡非尼酮对载脂蛋白E缺失小鼠晚期动脉粥样硬化病变具有一定的治疗作用,虽然不能改善斑块钙化,但在减小和稳定斑块方面仍具有进一步开发和研究的潜力。     

耐力训练对ApoE~(-/-)小鼠AS形成及病理变化的干预作用研究

目的:采用复制的实验动物AS模型,观察耐力运动对AS形成的预防作用和对已经形成的AS的治疗或干预效果。方法:选取48只8周龄ApoE基因敲除(ApoE-/-)小鼠,饲以高脂高胆固醇膳食,实验动物分组为14周AS模型组(H组)、14周跑台运动组(HE组)、26周AS模型组(HH组)、14周造模+12周跑台运动组(H+E组),并选取8周龄C57BL/6J小鼠24只作为对照组,每组12只。令HE组和H+E组小鼠在活动跑台上进行耐力性运动(13 m/min,60 min/次,每周5次)。取主动脉组织制备主动脉根部冰冻切片,油红O染色评估AS斑块面积,HE染色分析主动脉组织病理学变化等。结果:(1)H组小鼠主动脉血管内膜可见大量AS斑块,其面积占血管腔总面积的41.79±6.93%,HE组主动脉斑块面积为25.07±7.04%,显著低于H组(P<0.01),且病变程度较H组明显减轻。(2)与H组相比,HH组小鼠主动脉AS病变进一步加重,斑块面积与血管腔总面积比例达58.80±6.40%,H+E组斑块面积为50.35±3.52%,显著低于HH组(P<0.05),且病变进展程度相对减缓。结论:14周耐力训练能有效地预防ApoE-/-小鼠AS的形成,12周耐力训练对ApoE-/-小鼠已经形成的AS起到了减缓其病变进展的作用。