急性心肌梗塞100例临床分析

急性心肌梗塞（ＡＭＩ）１００例临床分析表明：４８例有梗塞前先兆症状。梗塞面积与ＡＭＩ早期的有效治疗时机有关。４６例导管检查和５２例静脉溶栓情况表明了介入性检查和溶栓治疗在ＡＭＩ救治中的重要作用。     

Histochemical study of transmyocardial laser channels in dogs

目的　了解激光心肌血运重建术时激光对心肌的损伤。方法　在狗心肌上用CO2 激光打孔。术后即刻、两周时于打孔处取材 ,用硝基蓝四唑法作琥珀酸脱氢酶、乳酸脱氢酶组织化学染色。结果　术后即刻 ,孔道及其周围心肌分为五个区。中央为孔道即组织汽化区 ,向外依次为碳化区、酶消失区、酶减少区、酶浓缩区。两周后孔道区被肉芽组织取代 ,周围心肌细胞酶活性正常。结论　激光心肌血运重建术术后即刻 ,孔道周围心肌细胞酶活性由内向外依次呈消失、减少、浓缩改变。术后两周可逆性损伤的心肌细胞酶活性恢复。     

冠状动脉长病变介入治疗后再狭窄

经皮腔内冠状动脉成形术(percutaneous transluminal coronary angioplasty, PTCA)治疗长病变的手术成功率较低, 并发症率较高, 对术后再狭窄的发生也有一定的影响[1].本文旨在分析病变长度和再狭窄的关系.     

冠状动脉心肌桥的临床表现及超声特点

目的　探讨冠状动脉心肌桥的临床意义及超声特点。方法和结果　对 32 16例冠状动脉造影中检出的 4 7例心肌桥患者进行回顾性分析。其中合并冠状动脉粥样硬化者 13例 ,瓣膜病 1例 ,肥厚性心肌病 3例 ,孤立性心肌桥 30例。孤立性心肌桥者中约 4 0 %临床表现为心肌缺血。与非缺血组相比 ,心肌缺血组收缩期狭窄程度更重 [(6 7 6± 15 4 ) %vs (4 9 9± 2 1 8) % ],左室重量亦更大[(2 15 6± 4 2 2 )gvs (178 7± 5 1 0 )g],E A比小于 1,P值均 <0 0 5。结论　冠状动脉心肌桥可引起心肌缺血 ,临床表现的不同与收缩期狭窄程度、左室重量、左室舒张功能有关。     

经冠状动脉注射骨髓单个核细胞影响心肌细胞凋亡的实验研究

目的观察经冠状动脉注射方式移植骨髓单个核细胞对心脏功能的改善和心肌细胞凋亡的影响。方法结扎小型猪冠状动脉制备心肌梗死模型，然后经冠状动脉注射骨髓单个核细胞，术后3周用超声心动图以及左心室造影检测心功能．核素心肌显像观察心肌灌注，冠状动脉造影观察侧支循环形成．用TUNEL检测心肌细胞凋亡。结果把骨髓单个核细胞通过冠状动脉注射到猪心肌梗死模型，显示左心室dp／dtmax较对照组增高，心肌灌注显著改善。冠状动脉有侧支循环形成，缺血心肌细胞；较对照组减少了53．6％结论骨髓单个核细胞心肌内移植可改善心脏收缩功能，可能与移植细胞抑制心肌细胞凋亡有关。     

冠状动脉侧支循环及其临床意义

目的研究冠状动脉侧支循环开放的条件、影响因素及其对心肌缺血、心功能的保护作用。方法回顾性分析１６３例经冠状动脉造影证实管腔直径狭窄≥７５％的２１４支血管的侧支循环开放情况。结果７９支见侧支循环开放,６３例７２支完全闭塞血管中,３１例３８支侧支循环发展良好（Ａ组）,３２例３４支侧支循环发展不良（Ｂ组）。心肌缺血病程长、无高血压病或糖尿病史及右冠状动脉闭塞者,侧支循环发展良好率高。心功能指标Ａ组明显优于Ｂ组,运动负荷试验阴性率两组间无差异。结论侧支循环开放依赖冠状血管完全闭塞或次全闭塞,发展受多种因素影响,良好的侧支循环对缺血心肌和心功能有保护作用,但多数不能消除负荷所致心肌缺血。     

LOGISTIC REGRESSION ANALYSIS ON RELATIONSHIP OF SERUM HOMOCYSTEINE, FOLIC ACID, AND VITAMIN B12 WITH CORONARY ARTERIOPATHY

Objective To investigate the relationship among the serum homocysteine (Hcy), folic acid and vitamin B12 with coronary arteriopathy.Methods In a cross-sectional study, serum Hcy levels of 210 cases with (CHD), 115 non CHD subjects from a consecutive series of subjects with chest pain or myocardial infarction(MI) undergoing diagnostic coronary angiography and 63 subjects undergoing health examination were measured using high-performance liquid chromatography (HPLC) with fluorescence detection. Serum folic acid and vitamin B12 level were measured by radioimmunoassay method. Serum cholesterol and lipoproteins were also measured. The information on conventional risk factors were collected by interviews.Results The coronary arteriopathy was correspondingly related with male, smoking, diabetes, folic acid, vitamin B12, ApoA1, and Hcy level. The mean serum Hcy level were significantly higher in CHD patients than in non CHD patients(19.01±10.36 μmol/L n=210 vs 11.5 4.97 μmol/L n=115, P<0.01). The mean serum folic acid level and vitamin B12 level were significantly lower in CHD patients (4.5±1.5 pg/ml vs 414.6±142.3 pg/ml) than in non CHD patients (5.6±1.4ng/ml vs 537.7±136.6 ng/ml), P<0.01. There is no difference on the mean serum Hcy level in NCHD cases and the healthy subjects. The mean serum ApoA1 (1188.8±206.1 mmol/L vs 1262.1±201.4 mmol/L)level was significantly lower in CHD patients than in non CHD patients, P<0.05. CHD patients had higher rates of smoking, aging and suffering from diabetes than non CHD patients. By multivariate logistic regression, the OR of Hcy, aging, male and diabetes were all≥1, P<0.01, which means all these factors are independent risk factors. With forward method, when folic acid, vitamin B12 and Hcy entering the regression model, the coefficients of Hcy changed greatly, showed multivariate co-liner on logistic regression.Conclusion The results of our study showed that Hcy, male, senility and diabetes were all independent risk factors in the development of arteriopathy. Hcy, vitamin B12 and folic acid have similar effects on the development of arteriopathy. Elevated serum Hcy level is a more stable index than serum lipids.     

急性心肌梗死经皮冠状动脉介入治疗后心肌灌注的方法评价

目的　联合应用TIMI心肌灌注分级 (TMP)、校正的TIMI画面记帧 (CTFC)、心电图ST段变化 (sumSTR)方法评价急性心肌梗死 (AMI)急诊经皮冠状动脉介入治疗 (PCI)后心肌灌注程度 ,探讨心肌灌注程度对临床预后的影响。方法　 77例AMI患者PCI后即刻采用TMP CTFC、TMP sumSTR、CTFC sumSTR三种联合方法评价心肌灌注程度 ,PCI术后 1个月检查双核素心肌灌注显像 ,记录 6个月心脏事件。结果　评价心肌灌注程度 ,与双核素心肌灌注显像对比 ,TMP sumSTR敏感性 86 7%、特异性 85 7%、准确性 86 2 % ;TMP CTFC敏感性 80 %、特异性 77 1%、准确性 78 5 % ;多变量回归分析TMP 0 / 1级 sumSTR <30 %为 6个月心脏事件的独立危险因子 (OR=2 1 5 ,95 %可信区间 2 7～ 6 5 7,P =0 0 0 3) ;Kaplan Meier分析曲线显示TMP sumSTR方法评价的心肌灌注不良组 6个月心脏事件高于心肌灌注良好组 (P <0 0 5 )。结论　TMP sumSTR、TMP CTFC能更好的评价心肌灌注程度 ;TMP sumSTR可预测 6个月心脏事件。