血清脂蛋白(a)、胆红素水平与冠状动脉病变程度关系研究

目的 检测冠心病(CHD)患者的血清脂蛋白(a)和胆红素水平,并探讨其与CHD的关系.方法 对196例疑诊冠心病而接受冠状动脉造影的患者检测血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白(a)[Lp(a)]、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL).根据冠状动脉狭窄情况分为非冠心病组(冠状动脉狭窄小于50%,52例)、单支病变组(仅有一支冠状动脉分支狭窄大于或等于50%,53例)和多支病变组(有一支以上冠状动脉分支狭窄大于或等于50%,91例).分析影响冠状动脉病变的相关因素及冠状动脉病变程度与血脂、胆红素的关系.结果 各组间LDL-C、Lp(a)水平依次呈递增趋势,差异有统计学意义(P＜0.05)各组间间接胆红素水平呈依次递减趋势,多支病变组与非冠心病组、单支病变组差异有统计学意义(P＜0.05).单因素logistic回归结果表明血清脂蛋白(a)、间接胆红素均为影响冠状动脉病变的因素(回归系数分别2.125、-1.557,P＜0.01).进一步多因素logistic回归分析表明脂蛋白(a)对冠状动脉病变的影响要弱于低密度脂蛋白胆固醇、甘油三酯(0R值分别为1.238、5.031、3.996,95%CI分别为1.069-6.322、2.457-12.356、2.785-14.764).结论 血清Lp(a)水平升高、IBIL水平降低是CHD发病及病变程度的危险因素. Abstract： Objective To investigate the association of Lipoprotein (a) and bilirubin with coronary heart disease(CHD). Methods One hundred and ninty -six patients undergone coronary angiography and completed clinical examination of TC, TG, HDL - C, LDL - C, Lp ( a), TBIL, DBIL, IBIL were divided into the without coronary diseases group ( coronary artery stenosis ＜50% ,52 cases) ,the single vessel disease group(with only one vessel stenosis ≥50% ,53 cases) and the multi -vessel disease group (with more than one vessel stenosis ≥50% ,91 cases)according to the coronary angiographic results. The correlative factors of coronary lesion and the relationship between Lipid,bilirubin and the severity of coronary lesion were analyzed. Results Higher levels of LDL - C and Lp(a) were found in the single vessel disease group and in the multi -vessel disease group compared with the without coronary disease group, significant difference was found in the LDL- C and Lp(a) level among the 3 groups(P＜0.05). The levels of IBIL were lower in the single vessel disease group and in the multi -vessel disease group compared with the without coronary disease group,significant difference was found in indirect bilirubin level in the multi -vessel disease group compared with in the without coronary disease group and in the single vessel disease group(P＜0.05). Single factor logistic regression showed that Lp (a) and indirect bilirubin are both correlation factors with coronary lession (r =2. 125 and - 1. 557, P ＜0.01 respectively). Advanced multi - factor logistic regression showed weaker correlation of Lp (a) with coronary lesion compared with LDL - C and TG (OR = 1. 238,5.031 and 3.996,95% CI1.069 - 6.322,2.457 - 12.356,2.785 - 14.764 respectively). Conclusions High level of Lp(a) and Low level of IBIL in human significantly influence the severity of coronary heart disease(CHD).     

探讨血清视黄醇结合蛋白4与冠心病的相关性

目的 观察冠心病患者血清视黄醇结合蛋白4(RBP4)水平,并探讨RBP4与冠心病的关系.方法 64例冠心病患者分为急性心肌梗死(AMI)组10例,不稳定型心绞痛(UAP)组42例,稳定型心绞痛(SAP)组12例,另选择21例冠状动脉造影结果正常者为对照组.采用酶联免疫吸附法(ELISA)测定血清RBP4水平.结果 血清RBP4在AMI和UAP组中高于SAP组和对照组,差异有统计学意义(P＜0.05),在SAP组与对照组之间差异无统计学意义(P＞0.05);血清RBP4在单支、双支、三支病变组中均高于对照组(P＜0.05),但在单支、双支与三支病变组之间差异均无统计学意义(P＞0.05).结论 RBP4可作为预测斑块稳定性的标志物,为冠心病危险分层及采取积极干预措施提供依据,但不能反映冠状动脉狭窄程度及范围. Abstract： Objective To investigate the serum retinol - binding protein 4 ( RBP 4 ) of coronary heart disease (CHD)patients and evaluate whether plasma macrophage migration inhibitory factor were associated with CHD. Methods Sixty -four patients with CHD were divided into the acute myocardial infarction (AMI) group ( n = 10), the unstable angina pectoris (UAP) group ( n = 42) and the stable angina pectoris(SAP) ( n = 12),21 normal subjests without CHD diagnosed by CAG served as the control group. The serum level of RBP4 measured by enzyme linked immune sorbent assay (ELISA). Results The serum level of RBP4 were higher in AMI and UAP group thai in SAP group and control group ( P ＜ 0. 05 ). The mean level of RBP4 in SAP group was not differently significantly, compared with that in control ( P ＞ 0. 05 ) ;The mean level of in single, double and three vessel lesion group were higher than that in control group (P ＜0. 05 ),but the serum levels of RBP4 among single, double and three were not significant different ( P ＞ 0. 05).Conclusions RBP4 may act as one of vulnerable plaques,we can take active to stabilize vulnerable plaques and decrease the occurrence of cardiac events,but may not reflect the severity of artery stenosis.     

负荷动态CT心肌灌注成像对冠状动脉粥样硬化的诊断价值

目的探讨负荷动态CT心肌灌注成像(CT-MPI)对冠状动脉粥样硬化的诊断价值。方法纳入疑似冠状动脉粥样硬化患者60例,记录其CT-MPI灌注结果及量化指标[心肌血流量(MBF)、心肌血容量(MBV)、达峰时间(TTP)],依据冠状动脉造影将心肌节段分为灌注正常组(狭窄面积50%)、灌注异常组(狭窄面积50%),比较两组MBF、MBV、TTP,应用ROC曲线分析CT-MPI诊断效能。结果CT-MPI显示35例共52支血管、329个节段显示心肌灌注减低,灌注异常率为58.33%(35/60);灌注异常组MBF、MBV低于灌注正常组,而TTP较灌注正常组延长(P0.05);在患者、血管、节段水平上,CT-MPI诊断冠状动脉粥样硬化的灵敏度为90.00%、93.75%、91.17%%,特异度为57.50%、85.13%、97.21%,准确度为68.33%、86.67%、95.20%,Kappa值为0.400、0.634、0.891,ROC曲线下面积为0.697、0.719、0.951。结论负荷动态CT-MPI诊断冠状动脉粥样硬化有较高诊断价值,值得在临床推广应用。     

阿奇霉素颗粒联合小儿消积止咳口服液治疗支原体肺炎合并地图舌临床研究

目的：观察阿奇霉素颗粒联合小儿消积止咳口服液治疗支原体肺炎合并地图舌的临床疗效。方法：选取405例支原体肺炎合并地图舌患儿进行回顾性分析,根据不同治疗方案分为治疗组和对照组。对照组采取常规对症治疗联合阿奇霉素颗粒治疗,治疗组在对照组基础上服用小儿消积止咳口服液治疗。观察2组治疗前后中医症状积分、肺炎症状评分、地图舌症状评分、血清免疫球蛋白（IgM）、免疫球蛋白A (IgA)特异性抗体含量,并评价2组临床疗效和不良反应发生情况。结果：治疗组疗效优于对照组（P<0.05）。治疗后,2组中医症状积分较治疗前下降（P<0.05）,且治疗组低于对照组（P<0.05）;治疗后,2组肺炎各项评分及地图舌症状评分均下降（P<0.05）,且治疗组低于对照组（P<0.05）;治疗后2组血清IgM、IgA含量均降低（P<0.05）,且治疗组低于对照组（P<0.05）;2组不良反应发生率比较,差异无统计学意义（P>0.05）。结论：阿奇霉素颗粒联合小儿消积止咳口服液治疗支原体肺炎合并地图舌疗效较好,可显著减轻患儿气喘、咳嗽以及地图舌症状,改善患儿体液免疫功能,且...     

超声检测颈动脉股动脉内中膜厚度及肱动脉血管内皮功能对冠心病的诊断价值

目的探讨超声检测颈动脉、股动脉内中膜厚度（IMT）及肱动脉血管内皮功能对冠心病的诊断价值。方法对入院时诊断为冠心病的99例患者行冠状动脉造影术（CAG）检查,分为冠心病组62例及非冠心病组37例,冠心病组分为单支病变组27例及多支病变组35例,应用超声对99例患者行颈动脉、股动脉IMT检查及肱动脉血管内皮功能检查并与CAG结果对比。结果冠心病单支病变组与多支病变组颈动脉、股动脉IMT均高于非冠心病组,且多支病变组高于单支病变组。冠心病组与非冠心病组、单支病变组与多支病变组血流介导的血管舒张反应（FMD）,硝酸甘油介导的血管舒张反应（NMD）比较,有统计学差异。结论通过超声检查发现,颈动脉、股动脉IMT及肱动脉血管内皮功能对冠心病的早期诊断具有重要价值。     

门诊口服抗高血压药合理用药分析

目的:分析我院门诊口服高血压药物的使用情况,同时也为抗高血压的合理用药提供了参考依据。方法:选取三林社区卫生服务中心2016年1月-12月一年期间门诊部门所收集的200例高血压患者为主要研究对象,并且从这些患者的用药处方中分析高血压的用药数量以及合理用药的基本情况。结果:对收治的患者资料用药处方进行分析发现,患者的用药情况比较复杂,所使用的药品主要有钙通道阻滞药、氯塞嗪、非竞争型α受体阻滞药、ACEI。患者在治疗高血压的过程中,对合理用药是非常重要的。结论:对三林社区卫生服务中心门诊患者口服抗高血压的药物进行对比,在此基础上降低患者的高血压疾病的困扰,提高患者的用药效果,因此,要密切关注高血压患者的药物使用情况。     

替格瑞洛在行PCI治疗的STEMI伴DM患者中的应用及对血栓弹力图检测的影响

目的:探究替格瑞洛在行经皮冠脉介入治疗(PCI)的ST段抬高型心肌梗死(STEMI)伴糖尿病(DM)患者中的应用价值及对血栓弹力图(TEG)检测的影响.方法:将2015年6月～2016年12月间收治的108例STEMI伴DM患者采用随机数表法分为研究组和对照组,每组54例.2组均行PCI治疗及心肌梗死综合治疗,研究组应用替格瑞洛进行抗血小板治疗,对照组应用氯吡格雷.观察2组患者入组时及PCI术后1w、6个月时TEG指标水平[血小板抑制率(IPA)],评估2组患者入组时及PCI术后24h、72h时心肌肌钙蛋白(cTnI)水平,随访6个月观察心血管不良事件发生率.结果:①IPA水平2组均为术后6月时<术后1w时<入组时(P<0.05),且术后1w、6月时研究组均低于对照组(P<0.05);②cTnI水平2组均为入组时>术后24h时>术后72h时(P<0.05),且术后72h研究组低于对照组(P<0.05),2组术后24h时差异对比无统计学意义(P>0.05);③随访6个月,研究组心血管不良事件发生率较对照组低(P<0.05).结论:替格瑞洛应用于行PCI治疗的STEMI伴DM患者能降低TEG检测的IPA水平,于减少术后心血管不良事件发生率和减轻心肌损伤程度均有利.     

联合应用培哚普利和氯沙坦改善心肌梗死后左室重构和心功能的临床研究

目的:观察培哚普利和氯沙坦联合治疗对于急性前壁心肌梗死患者左室重构、心功能和血清Ⅲ型前胶原肽(PⅢNP)水平的影响。方法:急性前壁心肌梗死患者,随机分为培哚普利组、氯沙坦组和培哚普利+氯沙坦组。入院后行急诊冠脉造影和介入治疗,术后分别给予:培哚普利2-4mg/d;氯沙坦25-50mg/d;或二者联合。所有患者常规给予抗血小板、抗凝、他汀类调脂药等。3个月后超声心动图检测左室大小、左室容量和左室射血分数。酶免法和放免法测定血液脑钠肽(BNP)、C反应蛋白(CRP)和PⅢNP水平。结果:3组患者的基础临床特征无显著区别。与基础值相比,3个月后,所有患者均表现出血液中CRP水平下降、BNP和PⅢNP水平上升,且有不同程度的左室扩大和左心功能下降。与培哚普利组和氯沙坦组相比,联合用药组患者CRP、BNP和PⅢNP水平显著降低,且左室扩张和射血功能障碍程度均减轻。血清PⅢNP水平与CRP水平及左室舒张末期容积指数均呈显著正相关(r=0.597,r=0.543,均P0.01),与左室射血分数呈显著负相关(r=-0.565,P0.01)。结论:急性前壁心肌梗死患者,早期联合培哚普利和氯沙坦治疗可以进一步改善左室重构和心功能,其机制可能与抑制胶原合成、抑制心肌纤维化有关。     

原发性高血压患者胰岛素抵抗与血管紧张素Ⅱ的相关性

目的 探讨原发性高血压(EH)患者胰岛素抵抗与血管紧张素Ⅱ(AngⅡ)、左室重构的相关性.方法 收集120例EH患者,根据HOMA-IR公式计算的胰岛素抵抗指数将其分为两组:胰岛素抵抗组(IR)、非胰岛素抵抗组(N-IR),测量并比较两组间电解质、血脂、血肌酐清除率、AngⅡ、左室射血分数、左室质量指数(LVMI)水平.结果 LVMI、AngⅡ水平IR组均明显高于N-IR组(P＜0.05).结论 EH患者胰岛素抵抗与血AngⅡ水平有关,并可能与左室重构有关. Abstract： Objective To investigate the relationship between insulin resistance and angiotensin Ⅱ , the left ventricular remodeling in patients with essential hypertension(EH). Methods According to the insulin resistance index, 120 cases of EH were divided into two groups: insulin resistance group (IR), non- insulin resistant group (N-IR). And the electrolyte, blood lipids, creatinine clearance rate, Ang Ⅱ , left ventricular ejection fraction and left ventricular mass index (LVMI) were measured and the results were compared between the two groups. Results LVMI and Ang Ⅱ levels of IR group were significantly higher than those of N - IR group ( P ＜ 0.05). Conclusions Insulin resistance is related with the levels of Ang Ⅱ , and may be related with left ventricular remodeling.