老年冠心病患者血清瘦素及可溶性瘦素受体检测分析

目的　研究老年冠心病患者血清瘦素及可溶性瘦素受体水平变化及影响因素。方法　应用放射免疫分析法 (RIA)及酶联免疫吸附分析法 (ELISA)检测 34例老年冠心病患者及其 36例对照者血清瘦素 (Lp)、可溶性瘦素受体 (sLR)、空腹血糖 (FBG)、总胆固醇 (TC)、甘油三酯 (TG)、高密度脂蛋白 (HDL)、低密度脂蛋白 (LDL)、胰岛素 (Ins)、HOMA胰岛素抵抗指数 (HOMA IR)、体质量指数 (BMI)、腰围、臀围、腰臀比 (WHR)等临床指标 ,分析Lp、sLR与血脂、胰岛素抵抗及冠心病的关系。结果　老年冠心病组Lp、Ins及HOMA IR水平明显高于对照组 ,sLR水平明显低于对照组 (P <0 .0 5或 0 .0 0 1)。Lp与BMI、腰围、臀围、Ins、HOMA IR、TC、TG呈正相关 ,与sLR呈负相关 ;sLR与Lp、BMI、腰围、臀围呈负相关 (P <0 .0 5或 0 .0 1)。结论　瘦素及瘦素受体水平异常可能与冠心病的发病密切相关。     

Leptin predicts short-term major adverse cardiac events in patients with coronary artery disease

Introduction: Leptin is an adipose tissue-derived hormone associated with cardiovascular risk factors. We examined whether leptin predicts major adverse cardiac events (MACE) in coronary artery disease (CAD) patients.

Methods: Fasting plasma leptin levels were measured in 1327 male and 619 female CAD patients. The patients were followed up for two years. The primary endpoint (MACE) was the composite of a hospitalisation for congestive heart failure (CHF) or a cardiac death. The secondary endpoint was the composite of an acute coronary syndrome (ACS) or a stroke.

Results: In regression analysis including established risk variables, high leptin levels were associated with a significantly increased risk of MACE (HR 3.37; 95%CI 1.64–6.90; p?=?0.001) and ACS or stroke (HR 1.95; 95%CI 1.29–2.96; p?=?0.002). Adding leptin to the risk model for MACE increased the C-index from 0.78 (95%CI 0.71–0.85) to 0.81 (0.74–0.88) and improved classification (NRI 0.36; 95%CI 0.13–0.60; p?=?0.002) and discrimination of the patients (IDI 0.016; 95%CI 0.001–0.030; p?=?0.031).

Conclusions: High plasma leptin levels predict short-term occurrence of CHF or cardiac death and ACS or stroke in patients with CAD independently of established risk factors. The possible harmful effects of leptin should be thoroughly investigated.

• Key messages

• Leptin is a peptide hormone secreted mainly by adipose tissue. It has been associated with several cardiovascular risk factors.

• High leptin levels predict the short-term occurrence of congestive heart failure or cardiac death and ACS or stroke in patients with CAD independently of established risk factors.

• The possible detrimental effects of leptin on the cardiovascular system should be thoroughly investigated.

     

两种负荷心电图试验对冠心病的诊断价值研究

目的 评价运动心电图试验(EET)、双嘧达莫心电图负荷试验(DPET)及联合应用(联合试验AD对冠心病的诊断价值。方法 选择183例冠状动脉造影(CAG)检查的患者，并在同期内(间隔小于1周)接受。EET、DPET检查。将CAG结果分别与EET、DPET和AT结果进行对比分析。结果 这两种无伤检查和联合检查诊断冠心病的敏感性分别为67．2％、60．3％和55．2％，特异性分别为：70．4％、74．4％和92．8％，准确性分别为：69．4％、69．9％和85．3％。结论 EET和DPET联合应用对冠心病的诊断具有较高的特异性和准确性，且费用低、无创伤，适宜基层医院推广。     

高血压病患者血清瘦素及可溶性瘦素受体水平检测分析

目的　研究血清瘦素和可溶性瘦素受体水平与高血压病的关系。方法　应用放射免疫分析法(RIA)及 酶联免疫吸附分析法(ELISA)检测45例高血压病患者及33例健康对照组血清瘦素(Lp)、可溶性瘦素受体(sLR),同 时检测总胆固醇(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)、载脂蛋白 ApoA、ApoB、ApoA/B、胰岛素(Ins)、C肽(C P)、胰岛素抵抗指数(HOMA IR)、体质量指数(BMI)、腰围、臀围等指 标,分析Lp、sLR与高血压、血脂异常、体形改变、BMI及胰岛素抵抗(IR)的关系。结果　高血压病组血清Lp、TC、 LDL C、ApoB明显高于对照组(P<0.05),sLR、ApoA/B明显低于对照组(P<0.01),TG、HDL C及BMI差异无 统计学意义。Lp与Ins、C P、HOMA IR、BMI、腰围及臀围呈正相关,与sLR呈负相关(P<0.05);sLR与Lp、C P、 BMI、腰围及臀围呈负相关(P<0.05),与Ins及HOMA IR无显著相关。结论　高血压病与Lp及sLR异常有关,其 与血脂异常、体形改变、BMI、IR密切相关,共同参与高血压病的形成。     

Computed tomography imaging,coronary calcium and atherosclerosis

Coronary calcium score measured by electron beam tomography provides an indication of current atherosclerotic burden in the coronary arteries. It correlates with conventional risk factors, but less so with Type 2 diabetes. Measurement of coronary calcium score has been shown to be a powerful predictor of coronary heart disease events in the general population, in different racial groups, and in Type 2 diabetes. It adds incremental value to conventional risk factors and risk scores. Its role in monitoring therapy remains to be proven.     

冠状动脉与眼底动脉粥样硬化的相关研究

目的　观察冠状动脉粥样硬化与眼底动脉粥样硬化的发生是否相关。方法　根据冠状动脉造影将 117例确诊的冠心病患者和 76例正常对照者进行眼底彩色照相 ,并对其结果进行对照性分析。结果　冠心病组眼底动脉粥样硬化发生率明显较正常对照组高 (P <0 .0 5 ) ;冠心病组合并高血压和糖尿病患者眼底动脉粥样硬化发生率明显高于其他患者。结论　心脏的冠状动脉粥样硬化与眼底的动脉粥样硬化密切相关 ,可通过眼底照相这一无创性检查作为初诊或筛选冠心病的检测手段、了解冠心病的病情或观察治疗效果。     

踝臂指数与冠状动脉病变严重程度的相关性研究

目的评价踝臂指数(ABI)与冠状动脉病变严重程度的相关性。方法选择162例冠状动脉造影术或介入治疗的患者,采用全自动动脉硬化测定仪测定ABI,重点观察ABI与冠状动脉病变Gensini评分的相关性及对严重冠状动脉病变的预测价值。结果冠心病组与非冠心病组相比较ABI差异具有统计学意义(0.97±0.22 vs 1.09±0.11,P<0.001),比较无病变组、轻度病变组、严重病变组的SBP[(137±17),(147±17)和(159±21)]、PP[(57±12),(67±12)和(81±17)]、HDL-C[(1.28±0.21),(1.22±0.31)和(1.14±0.33)]、ABI值[(1.12±0.16),(1.01±0.18)和(0.85±0.21)],差异有统计学意义(P<0.05),观察SBP、PP值,严重病变组高于轻度病变组(P<0.05),轻度病变组高于无病变组(P<0.05)。观察ABI值则是无病变组高于轻度病变组(P<0.05),轻度病变组高于严重病变组(P<0.05)。冠状动脉入选患者的Gensini评分与ABI呈显著负相关(r=-0.522,P<0.001)。多变量logistic回归分析显示糖尿病史、HDL-C、SBP、ABI≤0.9是严重冠状动脉病变的预测因子。结论踝臂指数与冠状动脉病变程度关系密切,有助于预测冠状动脉病变严重程度。     

老年冠心病患者血清瘦素、脂联素、血脂水平分析及其与冠状动脉病变的关系

目的：探讨老年冠心病患者血清瘦素、脂联素及血脂水平与冠状动脉病变程度的关系。方法选择2011年1月～2012年6月收治的冠心病患者86例,其中稳定性心绞痛（SA）26例,不稳定性心绞痛（UA）28例,急性心肌梗死（AMI）32例,并选择同期门诊体检健康人30名作为对照组,应用酶联免疫吸附法（ELISA）检测各组血清瘦素、脂联素、甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）水平。应用Gensini评分评价冠心病患者冠状动脉病变情况。结果①SA组、UA组、AMI组血清瘦素水平逐渐升高且明显高于对照组,组间差异有统计学意义（P＜0.05）;SA组、UA组、AMI组血清脂联素水平逐渐降低且明显低于对照组,组间差异有统计学意义（P＜0.05）。②AMI组、UA组、SA组TG、TC、LDL明显高于对照组（P＜0.05）;AMI组、UA组HDL水平明显低于对照组（P＜0.05）。③冠心病患者血清脂联素水平随Gensini评分升高而逐渐降低,瘦素、TG、TC、LDL水平随Gensini评分升高而逐渐升高,组间差异有统计学意义（P＜0.05）。结论老年冠心病患者血清瘦素、TG、TC、LDL水平异常升高,血清脂联素水平异常降低,两者变化与冠状动脉病变程度密切相关。     

Does diffuse coronary atherosclerosis affect the relation between coronary stenoses and uptake of Thallium-201 after exercise?

Summary It has been proposed that diffuse coronary atherosclerosis influences the myocardial perfusion. We performed a study of 94 young men with previous myocardial infarction in order to find out whether the presence and extent of diffuse coronary atherosclerosis affected the relation between maximal stenosis and myocardial perfusion in areas remote from the infarction. The patients were examined by planar-imaging thallium-201 scintigraphy, following exercise, and coronary angiography within 6 months after myocardial infarction. The maximal distinct stenosis and diffuse coronary atherosclerosis, comprising both plaque size and extent, were semi-quantitatively assessed. The correlation coefficients between maximal stenosis within the LAD, RCA, and LCX vascular territories and the corresponding initial uptake of thallium were 0.52 (P= 0.0001), 0.30 (P= 0.04), and 0.46 (P = 0.02), respectively. No change of the correlations was found, except for a slight increase of the r-value from 0.30 to 0.37 in regions corresponding to RCA, after controlling for the diffuse atherosclerosis score in a multiple stepwise regression analysis. These findings indicate no impact of diffuse coronary atherosclerosis on regional myocardial perfusion in areas remote from the infarction.     

冠状动脉病变程度与D-二聚体及大动脉弹性的相关性研究

目的 探讨冠状动脉病变与D-二聚体及大动脉弹性的相关性.方法 对所有入选病例行冠状动脉造影,用Gensini法行冠状动脉病变评分,并根据冠状动脉造影(CAG)结果分为单支病变组、多支病变组与正常对照组.在CAG前后进行双侧颈动脉彩色超声检查,同时测量血压,并检测所有入选病例D-二聚体及纤维蛋白原(Fib)水平.结果 ①多支病变组、单支病变组冠状动脉Gensini评分、收缩压(SBP)、脉压差(PP)、PP指数(PI)、D-二聚体及Fib水平高于对照组,Gensini评分多支病变组(29.25±14.20)分、单支病变组(11.97±7.36)分vs对照组(1.36±1.16)分(均P＜0.01);SBP多支病变组(133.99±21.04)mmHg、单支病变组(129.06±19.64)mmHg vs对照组(114.75±10.83)mmHg(均P＜0.01);PP多支病变组(53.93±17.36)mmHg、单支病变组(54.69±22.75)mmHg vs对照组(35.05±10.53)mmHg(均P＜0.01);PI多支病变组0.39±0.09、单支病变组0.41±0.11 vs对照组0.31±0.07(均P＜0.01);D-二聚体多支病变组(1.91±0.84)mg/L、单支病变组(1.26±0.60)mg/L vs对照组(0.26±0.03)mg/L(均P＜0.01);Fib多支病变组(4.54±0.93)g/L、单支病变组(3.89±0.68)g/L vs对照组(3.13±0.52)g/L(均P＜0.01);颈总动脉平均管壁张力(CWS)水平低于对照组(P＜0.01),多支病变组(30.75±10.51)mmHg、单支病变组(41.13±9.82)mmHg vs对照组(60.02±12.68)mmHg(均P＜0.01).②Gensini评分与PP、PI、D-二聚体、Fib呈正相关,与CWS负相关.③多元逐步回归分析显示Gensini评分与D-二聚体呈正相关,与CWS呈负相关.结论 D-二聚体、CWS与冠状动脉Gensini积分相关,可反映冠状动脉病变程度.     

冠心病患者颅外颈动脉狭窄的发生率及危险因素

目的 观察可疑冠心病者颅外颈动脉狭窄（ECCAS）的发生率,评价致ECCAS的危险因素.方法 对106例患者行冠状动脉造影（CAG）后作颈动脉数字减影血管造影（DSA）;据CAG结果分正常及冠心病组,后者分为1、2、3支病变组;据DSA结果分为无ECCAS及有ECCAS组,后者分为轻、中、重度狭窄;危险因素与ECCAS的关系用单变量及多变量Logistic回归分析.结果 冠心病组ECCAS发生率（36.5%）明显高于对照组（6.3%）（P〈0.01）;冠状动脉病变程度与ECCAS程度显著正相关（rs=0.431,P〈0.01）;老龄（OR=1.183,P〈0.01）、高血压（OR=5.456,P〈0.01）、冠状动脉病变程度（OR=1.799,P〈0.05）是ECCAS的独立危险因素.结论 同时行CAG和颈动脉DSA显示,ECCAS多见于有高血压的老年严重冠心病患者.     

颈动脉粥样硬化与冠心病的相关性研究

目的:探讨颈动脉粥样硬化与冠心病的相关性。方法:选择因心绞痛、心肌梗死及胸痛待查入院患者80例,行冠状动脉造影检查,并在造影前后1周内对上述患者行颈动脉血管彩色多普勒超声检查,根据造影结果分为冠心病单支病变组、多支病变组和正常对照组,比较各组间所测得的颈动脉内膜中层厚度及斑块发生率。结果:随着冠状动脉病变严重程度的增加,颈动脉内膜中层厚度和斑块发生率随之增高。结论:颈动脉粥样硬化与冠心病有明显相关性,颈动脉血管彩色多普勒超声检查可用于预测冠状动脉粥样硬化的病变程度。     

冠心病患者中肾动脉狭窄发病率及危险因素的临床研究

目的 探讨冠心病患者中肾动脉狭窄的发生率及危险因素。方法 103例行冠状动脉造影的患者同时行肾动脉造影，并对高血压、糖尿病、吸烟、高胆固醇血症等危险因素进行分析。结果 非冠心病患者中肾动脉狭窄发生率为0％，冠心病中为29％，1支、2支、3支病变肾动脉狭窄发生率分别为0％、10％、69．2％。对危险因素分析发现，冠脉病变支数及吸烟为肾动脉狭窄的最危险因素。结论 对多支冠状动脉病变应常规行肾动脉造影分析，肾动脉狭窄严重者先干预肾动脉再进一步干预冠状动脉。     

乌鲁木齐地区维汉两民族中冠心病患者糖蛋白Ⅲa基因多态性研究

Objective To determine whether a variant(PlA2) of the membrane glycoprotein IIIa(GP IIIa) gene is associated with CAD. Furthermore,the association of the polymorphism with the classical risk factors was analyzed.Methods Blood was drawn from 105 patients (pt) and 56 controls, some of those undergoing angiography. A 266 base pair fragment of the GP IIIa gene was amplified by the polymerase chain reaction(PCR) and digested with the MspI restriction enzyme. Genotypes were identified after electrophoresis of digestion products in 2.0% agarose gel. Results Of the 105 patients(pt), 65 had acute (n=19) or previous MI,20 had unstable angina (UAP), and 20 had stable angina(SAP).The PlA2 allele was carried by 0% of CAD pt versus 1.8% of Non CAD control subjects in Chinese Urumqi Uygur and Han population. The PlA2 allele was carried by 0% of CAD pt versus 7.7% of Non CAD control subjects in Uygur population.The PlA2 allele was found in 0% of CAD pt versus 0% of Non CAD control subjects in Han population.Conclusions The PlA2 variant of the gene GP IIIa is not associated with CAD in Uygur population and Han population in Urumqi city of Xinjiang Uygur Autonomous Region.     

静息心电图正常冠心病患者的冠脉病变特征

目的　了解静息心电图正常冠心病患者的冠脉病变特征。方法　分析 86例静息心电图正常冠心病患者的临床资料与冠脉病变情况 ,并与同期 330例静息心电图异常冠心病患者相比较。结果　与静息心电图异常冠心病患者相比 ,静息心电图正常冠心病患者以单支病变多见 [5 2 .3% (4 5 / 86 )对 38.79% (12 8/ 330 ) ,P =0 .0 38],多血管病变较少 [4 7.7% (4 1/ 4 5 )对 6 1.2 1% (2 0 2 / 330 ) ,P =0 .0 4 3],平均冠脉病变支数较少 [(1.6 7± 0 .80 )对 (1.95±0 .85 ) ,P =0 .0 0 6 ],Gensini积分低 [(38.1± 30 .78)对 (5 4 .4 4± 38.79) ,P <0 .0 0 1]。在 4 5例单支病变中 ,以前降支病变多见 [6 6 .6 7% (30 / 4 5 ) ];在 4 1例多血管病变中 ,有 31例 (75 .6 1% )血管狭窄部位相互对应。结论　静息心电图正常冠心病患者以单支血管病变多见 ,冠脉病变不太严重 ;在多血管病变中 ,大部分血管狭窄部位相互对应     

血清氧磷酶-1活性与冠心病的关系

目的　观察和探讨中国人血清对氧磷酶 1(PON 1)活性与冠状动脉粥样硬化性心脏病的关系。方法　分光光度法测定入选研究对象 (包括 6 1例非冠心病患者 ,15 1例冠心病患者 )的血清PON 1活性 ;以冠状动脉造影结果作为分组依据 ,并分析PON 1活性与冠状动脉病变支数的关系。结果　冠心病组血清PON 1活性明显低于对照组 (t=17.2 5 ,P <0 .0 0 0 1) ;血清PON 1活性单支病变组明显高于双支、三支病变组 (F =9.5 36 ,P <0 .0 5 ) ;而双支和三支病变组比较差异无统计学意义 (P =0 .13)。结论　冠心病患者血清PON 1活性水平明显降低 ,随着病变支数增加 ,血清PON 1活性水平有逐步降低趋势。