吡格列酮对2型糖尿病合并冠心病患者动脉粥样硬化相关因素及其预后的影响

目的:观察吡格列酮对冠心病合并2型糖尿病患者动脉粥样硬化相关因素及预后的影响.方法:将98例冠心痛合并2型糖尿病患者随机分为两组,均给予肠溶阿司匹林、β-受体阻滞剂、氯吡格雷、他汀类和冠脉介入术等治疗冠心病.磺脲类药物或二甲双胍治疗糖尿痛,在此基础上,吡格列酮组(48例)接受吡格列酮(15 mg/d),对照组(50例)不接受吡格列酮.随访12个月,用EHSA法分别检测两组治疗前后血浆纤溶酶原激活物抑制物1(PAI-1)活性和P-选择素水平,并记录主要心脏不良事件(MACE)发生率.结果:吡格列酮治疗12个月后PAI-1和P-选择素均有显著性下降[(7.9±1.4 vs 4.2±0.5)ng/mL,(16.6±6.8 vs 12.4±3.6)ng/mL].吡格列酮组MACE发生率较对照组有显著降低(两组急性冠脉综合征发生率分别为32.0%和10.4%.靶血管重建发生率为22.0%和6.3%),差异均有统计学意义(P<0.05).结论:吡格列酮能有效降低老年冠心病合并糖尿病患者血浆PAI-1活性和P-选择素水平,减少心血管事件的发生.     

Effects of pioglitazone on arteriosclerotic-related factors and short term prognosis in patients with coronary disease and diabetes

Background Thiazolidinediones (TZDs) not only improve insulin resistance, lowering blood sugar, also has anti-atherosclerotic effect. However, whether the protective effect on cardiovascular pioglitazone is still controversial. Methods Totally 98 patients with coronary disease and diabetes mellitus were randomly divided into pioglitazone group (n = 48) receiving conventional therapy and pioglitazone (15 mg/day), and control group (n = 50) merely receiving conventional therapy. The patients were followed up for 12 months. The plasma level of Plasminogen activator Inhibitor 1 (PAI-1) and P-selectin were detected at baseline and after treatment for 12 months by ELISA, and major adverse cardiac events (MACE) were studied. Results Pioglitazone therapy for 12 months was associated with a significant decrease of PAI-1 [(7.9 ± 1.4 vs 4.2 ± 0.5)ng/mL, P < 0.05] and P-selectin[(16.6 ± 6.8 vs 12.4 ± 3.6)ng/mL, P < 0.05], MACE was significantly lower in the pioglitazone group than in the control group [acute coronary syndrome (ACS): 32.0% vs 10.4%, P < 0.05; target vessel revascularization:22.0% vs 6.3%, P < 0.05]. Conclusions Pioglitazone can effectively reduce the plasma level of PAI-1, P-selectin and the occurrence of MACE in patients with coronary heart disease and diabetes mellitus.     

瑞舒伐他汀防治对比剂肾病效果观察

目的 观察短期大剂量瑞舒伐他汀防治慢性肾病患者行冠状动脉介入术(PCI) 后对比剂肾病及主要心脏不良事件(MACE)的效果. 方法 将120 例拟行 PCI 术的轻度慢性肾病 患者随机分为强化治疗组和常规治疗组各60例. 在全部采用水化治疗基础上,强化治疗组患者在住院期间给予瑞舒伐他汀20 mg.d-1,常规治疗组给予常规剂量瑞舒伐他汀10 mg.d-1,观察 PCI 术前基础血清肌酐(Scr),术后24～72 h Scr、术前及术后eGFR、mALB等指标. 观察两组对比剂肾病及随访6个月内的MACE发生情况. 结果 120例患者中有13例(10.83%) 患者发生对比剂肾病,强化治疗组对比剂肾病发生率低于常规治疗组(8.3%和13.3%,χ²=0.428,P=0.358) ,术后mALB高于常规治疗组(14.41±8.32 和 13.75±12.13,P=0.531),但两组间差异均无统计学意义. 随访6个月MACE发生率较常规治疗组显著降低(6.6%和18.3%,χ²=5.13,P=0.023),差异有统计学意义. 结论 短期大剂量瑞舒伐他汀治疗可显著降低轻度慢性肾病患者行冠脉介入治疗后MACE的发生率,有降低对比剂肾病发生率的趋势,且无显著增加蛋白尿的肾脏不良反应.     

急性心肌梗死患者新发心房颤动与功能性二尖瓣反流的相关性研究

目的 评价急性心肌梗死患者新发的心房颤动(NOAF)与功能性二尖瓣反流(FMR)的相关性.方法 入选2019年1月至2020年5月于佛山市第一人民医院心血管内科收治的497例急性心肌梗死患者,住院期间采用床旁心电监测联合遥测心电监护的双系统监测患者是否发生NOAF,采用二维超声及彩色多普勒观察二尖瓣的反流情况,根据反流...     

心外膜脂肪组织厚度与急性心肌梗死的相关性研究

目的:探讨心外膜脂肪组织厚度与急性心肌梗死的相关性。方法:选取2015年1月~2016年12月我院收治的冠心病患者200例,随机分为甲组(稳定型心绞痛)66例,乙组(不稳定型心绞痛)67例,丙组(急性心肌梗死)67例。所有患者均进行超声心动图检查,测量心外膜脂肪组织厚度,比较三组患者的临床各指标情况、并发症发生率,观察急性心肌梗死与心外膜脂肪组织厚度的相关性以及心外膜脂肪组织厚度对急性心肌梗死的诊断效能。结果:丙组患者空腹血糖、尿酸、肌酐水平及心外膜脂肪组织厚度高于甲组和乙组,乙组患者空腹血糖、尿酸、肌酐水平及心外膜脂肪组织厚度高于甲组(P<0.05);心外膜脂肪组织厚度与患者的年龄、体重指数、低密度脂蛋白胆固醇水平呈正相关,与高密度脂蛋白胆固醇水平呈负相关(P<0.05)。心外膜脂肪组织厚度诊断急性心肌梗死患者绘制的ROC曲线下的面积是0.846,95%CI:0.75~0.94(P<0.01);切点值是7.01 mm,特异度是67.53%,敏感度是81.52%。丙组患者并发症发生率高于甲组和乙组,乙组并发症发生率高于甲组(P<0.05)。结论:急性心肌梗死患者心外膜脂肪组织厚度明显增加,说明心外膜脂肪组织厚度是急性心肌梗死的危险因素,且随着心外膜脂肪组织厚度的增加,患者并发症发生率也随之增高。     

Relation between pre-procedural glucose levels and incidence of major adverse cardiac events in chronic kidney disease patients without established diabetes undergoing percutaneous coronary intervention

Background It is well known that there was a significant link between preprocedural blood glucose levels and short-term and long-term adverse outcomes in patients undergoing elective PCI. However, the role of pre-procedural blood glucose levels as a predictor of adverse events in CKD patients who underwent PCI out of established diabetes has yet to be identified. Methods In our study, we conducted a prospective study of 331 acute coronary syndrome (ACS) patients with CKD who underwent PCI out of established diabetes. Patients were divided into two groups based on pre-procedural glucose levels (hypoglycemia < 7.0 mmol/L; hyperglycemia ≥ 7.0 mmol/L). All patients were followed up prospectively for major adverse cardiovascular events (MACEs) and mortality for 6 months. Results In our cohort, hyperglycemia patients reported a higher incidence of in-hospital mortality than hypoglycemia patients (7.5% vs. 0%, P < 0.001). Hyperglycemia patients reported a significantly higher rate of 6-month MACEs (10% vs. 2.4%, P = 0.007), all cause mortality (7.5% vs. 1.6%, P = 0.015), and cardiovascular mortality (6.2%vs 1.6%, P = 0.041) compared with hypoglycemia patients with pre-procedural glucose levels < 7.0 mmol/L. Multivariate analysis disclosed that a pre-procedural glucose level ≥7.0 mmol/L was a significant independent predictor of MACEs (OR = 2.53, 95% CI 1.68-17.15, P = 0.004), all cause mortality(OR = 4.6, 95% CI 1.10-18.84, P = 0.036), and cardiovascular mortality(OR = 6.2, 95% CI 1.53-24.94, P = 0.011) at 6 months in patients after PCI. Conclusion The study suggested that pre-procedural glucose levels are associated with short-term cardiovascular outcome CKD patients who underwent PCI without established diabetes in the setting of ACS.     

下腔静脉滤器的发展与临床应用现状

<正>下腔静脉滤器(inferior vena cava filter,IVCF)是为预防下腔静脉(IVC)系统及下肢深静脉系统血栓脱落导致肺栓塞(PE)而设计的放置于腔静脉的一种器具。滤器出现以前防止PE的主要方法是结扎或折叠肾静脉以下的IVC,1934年Homans提出IVC结扎法并在20世纪50年代初流行。1958年De Weese、1959年Spencer提出IVC格状缝合     

H型高血压患者斑块特征与同型半胱氨酸相关性研究

目的 对冠状动脉造影显示轻中度狭窄病变作血管内超声(WUS)检查,分析H型高血压患者冠状动脉粥样硬化斑块形态特征,探讨同型半胱氨酸(Hcy)水平与病变程度的关系及临床意义.方法 回顾性分析H型高血压患者42例和单纯高血压患者38例.所有患者均接受血浆Hcy水平检测,IVUS分别检测冠状动脉病变段和正常参考段外弹力膜横截面积(EEMCSA)、最小管腔横截面积(MLA)、斑块面积(PA)、斑块负荷(PB)等,并作定性指标和定量指标分析.结果 H型高血压组患者冠状动脉病变处软斑块、偏心斑块和正性重构多见,钙化少;单纯高血压组患者斑块多表现为纤维斑块、钙化、无重构和负性重构(P＜0.05).H型高血压组患者病变段MLA＜单纯高血压组患者,EEMCSA、PA、PB＞单纯高血压组患者(P＜0.05);H型高血压组患者正常参考段MLA＜单纯高血压组患者,RPA、RPB＞单纯高血压组患者(P＜0.05).病变段Hcy水平与病变段PA、PB呈正相关(P＜0.05),与病变段MLA呈负相关(P＜0.05).结论 IVUS对评价轻中度病变有较高价值,H型高血压患者冠状动脉病变程度较单纯高血压患者严重和弥漫.Hcy水平对判断冠状动脉病变程度有一定价值,高Hcy水平可能是导致斑块不稳定的因素之一.     

急性冠状动脉综合征患者心外膜脂肪组织体积与冠状动脉斑块特征相关性研究

【摘要】 目的 通过iMap-血管内超声（IVUS）分析急性冠状动脉综合征（ACS）患者冠状动脉粥样硬化斑块成分,探讨心外膜脂肪组织体积（EATV）与冠状动脉斑块特征的相关性。 方法 连续筛选2018 年1月至 2020 年 1月在佛山市第一人民医院接受择期冠状动脉造影（CAG）或经皮冠状动脉支架植入术,并完成iMap-IVUS分析的ACS患者89 例。所有患者入院后均接受心脏CTA检查,测算EATV。根据EATV水平将患者分为高水平组（H组,≥86 cm3,n=47）和低水平组（L组,＜86 cm3,n=42）,分析比较两组患者CAG和iMap-IVUS影像学结果。 结果 H组患者高敏C反应蛋白（hs-CRP）、肌钙蛋白（Tn）I、肌酸激酶同工酶（CK-MB）、肌酐（Cr）、脂蛋白相关磷脂酶（Lp-PLA）2均高于L组（P＜0.05）;冠状动脉斑块含钙化成分明显少于L组（P=0.002）,坏死核心明显多于L组（P=0.007）,且薄纤维帽斑块（TCFA）发生率显著高于L组（P=0.002）。logistic回归分析发现,EATV（OR=2.465,95%CI=1.35～4.50,P=0.002）是TCFA的独立预测因子。结论 iMap-IVUS分析证实,ACS患者EATV升高与易损斑块有良好相关性,可作为预测TCFA的潜在标志物。     

慢性静脉血栓治疗中抗凝药物的选择与疗程

急性深静脉血栓因治疗的延误或不彻底,病程超过30天后即进入慢性静脉血栓期,被列为慢性静脉疾病(chronic venous diseases,CVD)的范畴,以下肢深静脉或腔静脉最为常见。2008年,国际血管学杂志发表的《基于循证医学证据下肢慢性静脉疾病治疗指南》给出CVD的定义是指因静脉的结构或功能异常,而使静脉回流不畅,静脉压力过高产生一系列症状和体征为特征的综合征,以下肢沉重、疲劳和胀痛、水肿,严重者出现皮肤营养改变和