冠状动脉慢血流的危险因素及冠状动脉病变特点的研究

目的研究冠状动脉慢血流现象(CSFP)患者的危险因素和分析累及冠状动脉病变的特点。方法回顾性收集本院2019年1月—2021年1月因疑似冠心病行冠状动脉造影术的514例患者,分析患者的临床资料、实验室指标及冠状动脉造影结果等相关资料,按照TIMI血流分级分为慢血流组(n=288)和对照组(n=226),比较两组之间的差异,并通过logistics回归分析探讨CSFP患者的危险因素。结果 (1)两组间在性别、民族、吸烟及饮酒史上存在统计学差异(P<0.05)。(2)CSFP组的血红蛋白、游离三碘甲状原氨酸、血肌酐值、血尿酸水平、空腹血糖水平和左室舒张末期大小均高于对照组(P<0.05);而CSFP组的血小板分布宽度、游离甲状腺素、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A1和白蛋白水平均低于对照组(P<0.05);(3)CSFP以三支血管病变最多见,为124例(43.0%),而单支血管病变和双支血管病变病例数一样,均为82例(28.5%)。单支血管病变中最多见的是前降支67例(81.7%),其次是右冠状动脉12例(14.6%),左回旋支较少见;(4)多因素logistic回归分析发现:性别、民族、游离甲状腺素、载脂蛋白A1和白蛋白水平是CSFP患者的独立危险因素。结论 (1)男性、少数民族、游离甲状腺素、载脂蛋白A1和白蛋白水平是CSFP的独立危险因素;(2)CSFP更常见于三支冠状动脉病变组,单支冠状动脉病变者更常见于左前降支。     

衰减伪影对冠心病患者门控心肌灌注显像图像质量及灌注结果的影响

目的探讨衰减伪影对冠心病患者门控心肌灌注显像(GMPI)图像质量及灌注结果的影响。资料与方法回顾性分析2020年3月—2021年3月在郑州大学第一附属医院核医学科经冠状动脉造影证实且于造影前后1周行GMPI的99例冠心病患者的图像,定性及半定量分析衰减校正前后GMPI图像结果,比较衰减校正前后左心室各壁段平均放射性计数及灌注结果的差异,进一步分析衰减校正前后灌注结果不一致部分的受检者的节段性室壁运动及增厚情况。结果与衰减校正前比较,衰减校正后左心室间隔、下后壁及侧壁的平均放射性计数较高(Z=-7.302、-8.014、-3.991,P均<0.001),心尖部较低(Z=-8.021,P<0.001)。其中女性衰减校正后前壁平均放射性计数减低(Z=-2.314,P=0.021)。男性衰减校正前后下后壁放射性计数差值明显高于女性(t=-8.408,P<0.05)。衰减校正后44%(44/99)的左前降支及37%(37/99)的右冠状动脉分支供血区域显像结果发生改变,结合超声心动图及GMPI结果显示其中85%(35/41)的左前降支及81%(29/36)的右冠状动脉分支供血区域室壁运动及室壁增厚率均正常。结论衰减伪影对GMPI的图像质量和灌注结果有较大影响,结合室壁运动和增厚情况等有助于鉴别衰减伪影,提高诊断准确度与特异度。     

稳定性冠心病血瘀证的血浆定量蛋白质组学探析＊

目的 基于数据非依赖性采集的定量蛋白质组学技术（data independent acquisition，DIA）对稳定性冠心病血瘀证患者的血浆蛋白质进行研究分析，初步探索冠心病血瘀证的关键生物学过程与核心靶点。方法 选择中国中医科学院广安门医院心血管科收治的5例稳定性冠心病患者作为疾病观察组，同时选取健康成人5人作为对照组，采用DIA蛋白质组学技术对受试者的血浆进行检测，确定蛋白质表达量后进行差异蛋白质表达分析、GO富集分析、KEGG信号通路图查询和蛋白质互作网络分析。结果 在差异倍数为1.5倍时，疾病观察组相比于健康对照组，共鉴定到22个蛋白质下调，9个蛋白质上调。进一步的生物信息学分析表明，冠心病血瘀证的生物学过程与补体参与的慢性炎症反应有关，关键信号通路是补体与凝血级联反应的信号通路，核心蛋白质为C反应蛋白、转甲状腺素蛋白、补体因子H、维生素D结合蛋白等。结论 冠心病血瘀证的生物学过程与补体参与的慢性炎症反应有关。     

A cross-sectional study on coronary artery disease diagnosis in patients with peripheral artery disease

PurposeCompared with healthy individuals, patients with peripheral artery disease (PAD) generally have a very high risk of subclinical Coronary artery disease (CAD) and cardiovascular events. To determine the correlation between CAD in PAD patients, thereby promoting the lifetime of PAD patients and reducing the serious impacts of CAD.MethodsThis clinical-based cross-sectional study comprised 100 consecutive patients in India from 2014 to 2016. In this research, PAD patients were screened for CAD by treadmill stress test and cardiac colour Doppler examination. In addition, this study performed coronary angiography followed by peripheral angiography for patients who could not perform the treadmill test.ResultsWith the statistical results, the study observed a high prevalence of CAD in PAD patients that can be detected only with angiography. Further, 30.93% of asymptomatic CAD prevalence was observed in PAD patients. The study strengthens the need for coronary angiography in all symptomatic lower limb PAD cases to detect early CAD, particularly in patients with diabetes and dyslipidemia.ConclusionThere exists a strong correlation between PAD and CAD. Hence, precise diagnosis followed by supervision of PAD patients is significant for avoiding local progression of cardiovascular risk.     

Safety and feasibility of robotic assisted percutaneous coronary intervention compared to standard percutaneous coronary intervention- a systematic review and meta-analysis

ObjectiveRobotically assisted PCI offers a great alternative to S–PCI. This has gained even more relevance during the COVID-19 pandemic era however safety of R–PCI compared to S–PCI has not been studied well. This study explores the safety and efficacy of robotically assisted PCI (R–PCI) compared to standard PCI (S–PCI) for the treatment of coronary artery disease (CAD).MethodsPubMed, Scopus, Ovid, and Google scholar databases were searched for studies comparing R–PCI to S–PCI. Outcomes included clinical success, procedure time, fluoroscopy time, contrast use and radiation exposure.ResultsTheauthors included 5 studies comprising 1555 patients in this meta-analysis. Clinical success was comparable in both arms (p = 0.91). Procedure time was significantly longer in R–PCI group (risk ratio: 5.52, 95% confidence interval: 1.85 to 9.91, p = 0.003). Compared to S–PCI, patients in R–PCI group had lower contrast use (meandifference: −19.88, 95% confidence interval: −21.43 to −18.33, p < 0.001), fluoroscopy time (mean difference:-1.82, 95% confidence interval: −3.64 to −0.00, p = 0.05) and radiation exposure (mean difference:-457.8, 95% confidence interval: −707.14 to −208.14, p < 0.001).ConclusionR–PCI can achieve similar success as S–PCI at the expense of longer procedural times. However, radiation exposure and contrast exposure were lower in the R–PCI arm.