老年超重/肥胖患者冠状动脉慢血流与血管内皮功能及氧化应激的关系

目的探讨老年超重/肥胖患者冠状动脉慢血流(slow coronary flow,SCF)与血管内皮功能及氧化应激的关系。方法选取2014年12月至2017年4月在成都医学院第一附属医院195例行冠状动脉造影的老年超重/肥胖患者为研究对象。根据校正的心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流帧计数(corrected TIMI frame count,c TFC)方法评价冠状动脉血流,将患者分为慢血流组(96例)和正常血流组(99例)。入院时收集患者的临床资料及血生化指标,测定并比较两组血管内皮功能及氧化应激相关指标。结果慢血流组丙二醛(malonaldehyde,MDA)、内皮素(endothelin-1,ET-1)及血管性假血友病因子(von Willebrand factor,v WF)均显著高于对照组,超氧化物歧化酶(superoxide dismutase,SOD)、谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)及一氧化氮(nitric oxide,NO)明显低于对照组,差异均有统计学意义(均P0.05)。相关分析结果显示,MDA(r=0.249)、v WF(r=0.867)与SCF呈正相关,SOD(r=-0.508)、GSH-Px(r=-0.440)、NO(r=-0.368)与SCF呈负相关(均P0.01)。多因素Logistic回归分析发现SOD、NO是SCF的保护因素,而MDA、尿酸、γ-谷氨酰转移酶(Gamma glutamyl transferase,GGT)是SCF的独立危险因素。结论尿酸及GGT浓度升高可能在老年超重/肥胖患者SCF的病理生理过程中发挥一定作用,而血管内皮功能及氧化应激与老年超重/肥胖患者SCF的发病机制存在密切联系。     

TRPA1激动剂桂皮醛防止高糖介导的心肌细胞氧化应激损伤

目的 探讨桂皮醛对高糖介导的心肌细胞氧化应激损伤的作用及机制。方法 大鼠心肌细胞（H9C2）以高糖培养基（33 mmol/L D-葡萄糖）培养,以低糖培养基（5.5 mmol/L D-葡萄糖）作为对照。首先利用Western blot和免疫组织化学证实瞬时受体电位通道A1亚型（TRPA1）在H9C2心肌细胞中的表达;在此基础上分别利用线粒体超氧化物荧光探针（mitoSOX）及TUNEL细胞凋亡试剂盒观察桂皮醛对高糖环境下H9C2细胞线粒体活性氧(ROS)水平以及细胞凋亡的影响,以Western blot法观察Nrf2和TRPA1的表达;利用荧光定量PCR观察TRPA1及Nrf2 mRNA水平。结果 TRPA1在H9C2细胞中有表达,桂皮醛可显著抑制高糖介导线粒体ROS生成（P<0.01）,并可减少心肌细胞的凋亡（P<0.01）,而上述作用可被TRPA1的阻断剂HC 030031所阻断。桂皮醛可上调TRPA1、Nrf2的蛋白及mRNA表达（P<0.01）,而通过HC 030031抑制TRPA1可显著减弱桂皮醛的上述作用（P<0.01）。结论 桂皮醛可防止高糖介导的心肌细胞氧化应激损伤,而该作用可能与其激活TRPA1,上调Nrf2有关。     

素食与动脉粥样硬化危险因素相关性研究进展

动脉粥样硬化是心血管疾病的重要原因,其后期所致器官缺血坏死不可逆转。因此,对于动脉粥样硬化的早期预防有助于延缓或避免疾病的发生,减少致残致死率。动脉粥样硬化是多因素作用的结果,对于该病的预防需从相关危险因素着手,以素食为主的饮食干预起到了一级预防的作用。国内外大量研究表明,素食有利于健康及心血管疾病的预防;但何种素食类型最佳?长期素食是否有益?目前仍存在争议。现回顾近年来关于素食与动脉粥样硬化危险因素的研究,对不同素食类型及持续时间进行阐述。     

高龄女性PCI术后小脑出血1例

正高龄冠心病患者是一个特殊的群体,特别是针对年龄75岁的冠心病患者在经皮冠状动脉介入治疗(PCI)围手术期发生脑出血的防治目前尚无统一标准,相关病例亦鲜有报道。国内外学者对此类患者的治疗进行了一些探索,但仍未提出明确的治疗指南。笔者治疗并随访了1例高龄女性PCI术后发生脑出血的患者,现报道如下。1病例资料患者,女,79岁。因反复胸闷痛10年,加重20d入院。入院体检:脉搏70次/min,血压182/82     

Effectiveness of enalapril for lowering extremity edema caused by levamlodipine in essential hypertensive population: a randomized comparison to furosemide

Background The incidence of leg edema caused by calcium channel blockers(CCB) is so high, some studies tried combination with angiotension converting enzyme inhibitors(ACEI) or diuretics to overcome this problem.However, there is no comparison about which is better to improve edema at present. Methods This study was designed as a single-center, prospective, randomized, double-blind, parallel-group, clinical trial. 224 hypertensive patients with leg edema after 4 weeks since taking levamlodipine were enrolled, and they were randomly divided into levamlodipine + furosemide(CD) group and levamlodipine + enalapril(CA) group for another 4 weeks. Ankle circumference(AC), edema score(ES), blood pressure(BP) and cure rate of leg edema were evaluated. Results Altogether 179 patients(89 in CD group and 90 in CA group) completed the 4-week treatment. After the 4-week therapy with furosemide or enalapril, most subjects were free of edema in either group(96.51% vs.96.67%, P 0.05). Only 4 in CD group and 3 in CA group had mild edema. Enalapril was more effective than furosemide to reduce AC(10.92 ± 1.84 mm vs. 12.97 ± 2.46 mm, P 0.05). But for ES, there was no significant difference. And there were no significant differences in antihypertensive effect between them. Uric acid(UA)was increased significantly in CD group(10.70 ± 18.48 μmol/L vs. 0.22 ± 28.13 μmol/L, P 0.05). Conclusion Enalapril is more effective than furosemide in attenuating lower extremity edema caused by levamlodipine in essential hypertensive population, with equal antihypertensive efficacy and less uric acid increasing.     

血浆致动脉硬化指数对早发急性冠状动脉综合征患者PCI术后预后的影响

目的评价血浆致动脉硬化指数(AIP)对早发急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后预后的影响。方法入选208例接受单纯PCI术的早发ACS患者(男性≤55岁,女性≤65岁),以AIP=0.06为切点分为致动脉硬化表型组(n=155)和非致动脉硬化表型组(n=53),比较两组患者的临床特征。PCI术后对患者进行1年的随访,比较两组患者的病死率和主要心脑血管不良事件(MACCE)的发生率。结果致动脉硬化表型组的全因死亡率、MACCE发生率明显高于非致动脉硬化表型组(分别为11.0%比1.9%,P0.05;24.5%比11.3%,P0.05)。Logistic多因素回归分析显示,AIP与早发ACS患者PCI术后1年MACCE独立相关(OR=2.139,95%CI:1.426~3.209,P0.05);多变量Cox比例风险模型分析结果显示,AIP为早发ACS患者PCI术后1年全因死亡的独立预测因子(HR=1.347,95%CI:1.137~2.879,P0.05)。结论 AIP对早发ACS患者PCI术后全因死亡和MACCE的发生具有一定的预测价值。     

高龄PCI术后并发下消化道出血1例

高龄冠心病患者是一个特殊的群体,特别是年龄>75岁的冠心病患者PCI围手术期发生消化道出血的防治尚无统一标准供临床医生借鉴。国内外学者对此类患者的治疗进行了一些探索,但仍未提出明确的治疗指南。本文所报道的高龄女性PCI术后消化道出血,经积极治疗后,好转出院,1年后随访情况良好。现报道如下。     

静脉应用尼非卡兰与胺碘酮对阵发性心房颤动患者疗效的比较

目的比较静脉应用尼非卡兰与胺碘酮对阵发性心房颤动(房颤)患者的疗效。方法收集2017年7月至2018年7月期间成都医学院第一附属医院60例阵发性房颤患者,根据不同治疗方法随机分为两组,每组各30例,胺碘酮组给予胺碘酮治疗,尼非卡兰组给予尼非卡兰治疗,观察比较两组患者房颤转复情况、复律时间、心室率变化及药物不良反应。结果尼非卡兰组转复25例,无效5例,治疗有效率为83.3%(25/30);胺碘酮转复24例,无效6例,治疗有效率为80.0%(24/30),两组治疗转复率比较,差异无统计学意义(χ2=0.111,P0.05)。尼非卡兰组转复时间比胺碘酮组转复时间短,差异有统计学意义[(134.2±60.87)min vs.(162.77±70.82)min,t=-5.91,P0.01]。胺碘酮组出现6例不良反应,尼非卡兰组出现10例不良反应,两组不良反应发生率比较,差异无统计学意义(χ2=0.382,P0.05)。结论在阵发性房颤患者转复治疗中,尼非卡兰与胺碘酮均有较好的疗效,尼非卡兰转复时间较胺碘酮更短,能较快改善患者临床症状,在临床上值得推广。     

Application advances of catheter modification in difficult coronary artery Intervention

Background Judkins catheter is widely used in recent years, for clinical angiography and intervention of most normal coronary arteries, but still incapable to deal with the problems caused by difficult coronary artery(DCA). DCA may influence the procedure of diagnosis and intervention of ischemic heart disease(IHD). To cope with different subtypes of DCA, catheters like Amplatz, EBU, Leya, etc. were born at that moment, but these standard catheters are used just in special cases and have so many sequences that a local hospital may not be able to keep all of them available routinely at any time. To overcome this problem, some centers perform angiography and intervention using modified catheters based on their own condition and have obtained some experiences.Catheter modification techniques used in these years are reviewed, and are stated respectively based on dealing with different subtypes of DCA to provide practical guidance for clinical diagnosis and intervention for IHD pa-tients having DCA.