阿托伐他汀对糖尿病合并急性冠脉综合征病人高敏C反应蛋白的影响

目的 观察糖尿病和非糖尿病急性冠脉综合征（ACS）病人炎症反应的差异，评价阿托伐他汀治疗糖尿病合并ACS病人炎症指标的变化及对院内心脏不良事件的影响。方法 检测52例糖尿病ACS病人与年龄和性别匹配的52例非糖尿病ACS病人入院时的高敏C反应蛋白（hs—CRP）和白细胞计数，并分析糖尿病组使用阿托伐他汀（阿托伐他汀治疗组）和未使用阿托伐他汀（常规治疗组）治疗前后hs—CRP和白细胞计数的差异及院内心脏不良事件的发生率。结果 糖尿病组ACS病人hs—CRP和白细胞计数明显高于非糖尿病组，糖尿病组中阿托伐他汀治疗组治疗后hs—cRP和白细胞计数明显低于治疗前及常规治疗组。阿托伐他汀治疗组较常治疗组心脏不良事件发生率降低。结论 ACS合并糖尿病病人的炎性指标较非糖尿病病人明显升高，阿托伐他汀能明显降低糖尿病合并急性冠脉综合征病人的炎症指标及心脏不良事件发生率。     

GRACE评分联合白细胞计数及hsCRP对冠状动脉病变程度的预测

目的 了解GRACE评分联合白细胞计数及高敏C-反应蛋白（hsCRP）对急性冠脉综合征（ACS）患者冠状动脉病变程度预测的价值.方法 选取2009年7月至2011年7月住院的ACS患者共290例,分为不稳定型心绞痛（UA）组173例,急性非ST段抬高型心肌梗死（NSTEMI）组31例及急性ST段抬高型心肌梗死（STEMI）组86例,对其进行GRACE危险评分、行冠脉造影、检测血常规和hsCRP,并分析与冠脉病变程度的关系.结果 NSTEMI组和STEMI组患者的GRACE评分、白细胞计数、中性粒细胞比例、hsCRP的结果均高于UA组,差异有统计学意义（P＜0.05）.低分患者以单支病变和轻中度狭窄为主,高分患者以三支病变和重度狭窄为主.当白细胞计数和hsCRP值超过正常范围时,三支病变和重度狭窄的患者比例明显增高.结论 随着GRACE危险评分分值、白细胞计数和hsCRP值的增加,ACS患者三支病变和重度狭窄的发生率呈升高趋势,故对冠脉病变程度有一定的预测价值.     

白介素-18等炎性标记物与冠状动脉病变程度的关系研究

目的：探讨炎性标记物白介素-18和白细胞计数在不同程度的冠状动脉病变中的表达情况，以期根据炎性标记物的血浆水平甄别冠状动脉病变的严重程度。方法：测定经冠脉造影确诊的急性冠脉综合征（ACS）病人血浆中白介素-18（IL-18）的含量以及全血白细胞计数，然后比较不同程度冠脉病变组的炎性标记物水平；并比较糖尿病（DM）组和非DM组的差异。结果：白介素-18的含量以及全血白细胞计数在冠状动脉复杂病变组明显高于简单病变组（P〈0．05）。合并有DM的ACS病人白介素-18的含量以及全血中的白细胞计数水平明显高于非DM组（P〈0．05）。结论：在不同程度的冠状动脉病变组和不同危险因素组炎性标记物水平存在着显著性差异。     

空腹血糖水平对老年急性冠脉综合征患者临床心血管事件及死亡率的影响

目的:探讨不同空腹血糖水平对老年急性冠脉综合征(ACS)患者近期和远期临床事件的影响.方法:将我院心脏中心2007年12月至2009年12月住院的老年ACS患者360例,根据入院首次空腹血糖水平分3组,A组(＜7.0mmol/L组),B组(7.0～11.0mmol/L组),和C组(＞11.1mmol/L组).对其住院期间临床心血管事件及出院6个月的总死亡率进行分析.结果:随着空腹血糖水平的增高,患者在住院期间急性心肌梗死、严重心律失常、心源性猝死、左室功能不全、心源性休克发生率与明显增高;与A组比较,随空腹血糖增高,患者出院6个月内的总死亡率逐渐增高,OR及95%可信期间分别为:B组2.25[1.74～2.710];C组6.06[4.78～9.8]; 经过Logistic多元逐步回归分析发现,住院首次空腹血糖与出院6个月的总死亡率显著相关.结论:随着空腹血糖水平的增高,老年ACS患者住院期间临床事件及出院6个月的总死亡率逐渐增加.     

流感疫苗对冠心病患者的保护作用

目的:随访观察流感疫苗对冠心病患者的保护作用.方法:2008年9月～2008年11月收治冠心病患者(CAD)患者300例,随机分为两组,对照组给予最佳药物治疗,流感疫苗接种组在最佳药物治疗的基础上接种流感疫苗,随访1年,比较接种组和对照组全因死亡率,非致死性心肌梗死,急性冠脉综合征(ACS)住院率,肺部感染发生率差异.结果:对照组1年中死亡6例,非致死性心肌梗死8例,因ACS住院39人次,肺部感染38人次.接种组死亡3例,非致死性心肌梗死5例,因ACS住院24例,肺部感染22例.结论:心血管病患者接种流感疫苗可减少肺部感染的发病率和ACS住院率,全因死亡率和非致死性心肌梗死有减少趋势,但未达到统计学意义.目前流感疫苗的心血管保护作用尚不可靠.     

急性冠状动脉综合征病人肺炎衣原体感染对外周炎症反应的影响

目的探讨急性冠状动脉综合征（ACS）病人肺炎衣原体感染与外周炎症反应的关系。方法45例急性冠脉综合征病人为观察组，44例正常体检者为对照组，分别检测血清肺炎衣原体特异性抗体（IgG）、周围血高敏C反应蛋白（hs-CRP）、血沉（ESR）、血白细胞计数（WBC）。结果急性冠脉综合征病人外周炎症指标显著高于正常对照组（P〈0．01），肺炎衣原体特异性抗体IgG阳性组病人hs-CRP水平、ESR和白细胞计数均高于阴性组，但无显著的统计学意义（P＞0．05）。结论肺炎衣原体感染可能参与急性冠状动脉综合征病人外周炎症反应，并且与其它致冠状动脉缺血因素共同引起急性期外周血炎症指标水平增高。     

急性冠脉综合征患者CRP检测的临床意义

目的 :探讨C反应蛋白 (C -reactionproteinCRP)升高在急性冠脉综合征 (ACS)患者中的临床意义。方法 :测定经冠脉造影确诊的冠心病患者 65例 ,其中急性冠脉综合征 (ACS) 4 5例 ,稳定型心绞痛 (SAP) 2 0例 ,及冠脉造影排除冠心病的患者 3 0例的血清CRP浓度。结果 :ACS组血CRP浓度显著增高 ,与SAP组及对照组之间比较有显著性差异 (P <0 .0 5 ) ,SAP组与对照组之间CRP浓度无显著性差异。结论 :急性冠脉综合征与炎症反应显著相关。CRP升高提示冠心病患者病情不稳定。CRP可作为临床ACS患者的监测指标     

老年人急性坏疽性胆囊炎的临床特点及诊断体会

目的总结老年人患急性坏疽穿孔性胆囊炎的诊治特点。方法分析60岁-89岁共79例坏疽性胆囊炎的临床资料。结果随着年龄的增大,患者在体温、腹肌紧张、并存心血管病、并存3种以上疾病,白细胞计数、胆囊穿孔、休克、误诊率以及术后并发症和死亡率方面有着明显升高的趋势。结论老年病人病史模糊,症状体征不典型,并存病复杂,病情发展迅速,术后并发症多,所以对老年病人病情应高度重视,做到早诊断、早治疗。     

钩体病人治疗前后白细胞计数的临床意义

钩端螺旋体病简称钩体病,俗称打谷黄.是由各种不同类型的致病性钩端螺旋体引起的一种急性传染病.本文通过87例钩体病人入院与出院时外周血白细胞计数与分类计数变化的观察,旨在探讨白细胞计数与分类计数变化在钩体病人诊断与治疗中的临床意义.结果发现,钩体病人白细胞总数轻度增高,而白细胞分类计数中嗜酸性粒细胞显著增高,因此,观察白细胞计数与分类计数的变化对钩体病具有一定的诊断价值.现将结果报告如下.     

急性脑出血患者早期体温变化及外周血白细胞计数与预后的关系

目的探讨急性脑出血患者早期体温变化及外周血白细胞计数与预后的关系。方法将77例脑出血患者按体温与外周血白细胞计数分别分成发热组与不发热组;白细胞数正常组与白细胞数增高组;白细胞数轻度增高组与显著增高组,观察各组死亡率并进行统计学分析。结果发热组死亡率(67.3%)高于不发热组的死亡率(20.0%)(P<0.01);白细胞数正常组死亡率(32.4%)低于白细胞数增高组的死亡率(67.4%)(P<0.01);白细胞数轻度增高组死亡率(43.5%)低于显著白细胞数增高组的死亡率(95.0%)(P<0.01)。结论根据急性脑出血患者早期体温变化及外周血白细胞计数可对预后做出较为准确的判断,且方法简单、易行,有很高的临床应用价值。     

白细胞计数与急性冠状动脉综合征的相关性

目的 探讨外周血白胞(WBC)计数和血脂水平变化与急性冠状动脉综合征(ACS)发生发展及冠状动脉病变程度和范围的关系.方法 对ACS患者、稳定性心绞痛(SAP)患者和健康对照者WBC计数和血脂水平进行分析比较.其中67例冠心病(CAHD)患者行冠状动脉造影,按照造影结果 分为单支和多支病变组.比较其WBC数和血脂水平.结果 ACS组WBC计数与血清TC(总胆固醇)、TG(甘油三脂)、LDL-C(低密度脂蛋白胆固醇)水平均显著高于SAP组和对照组(均P<0.05),而HDL-C水平则显著低于后两组(P<0.05).CAHD患者WBC计数与血清TC、TG、LDL-C水平呈正相关.而与血清HDL-C水平呈负相关.多支病变组WBC计数显著高于单支病变组和对照组(P<0.05).结论 外周血WBC参与了ACS的发生与发展,并且WBC数升高与冠脉病变的程度和范围密切相关,为临床评价动脉粥样斑块的不稳定性提供了一个简单、方便、价廉的良好指标.     

The serum levels of MMP-9, slCAM-1, CRP and WBC increased in patients with acute coronary syndrome

Objective：To evaluate the association of the peripheral levels of the defined inflammatory markers with different types of acute coronary syndrome （ACS） and stable angina, and the role inflammation played in the pathogenesis of ACS. Methods ：For understanding the variation of serum concentrations of matrix metalloproteinase-9 （MMP-9）, soluble intercellular adhesion molecule-1 （sICAM-1） ,C-reactive protein （CRP）, and white blood cell count （WBC） and their association with ACS, 90 patients with coronary heart disease （CHD） and 30 healthy volunteers were recruited. The enrolled people were assigned into four equal groups, including acute myocardial infarction （AMI） group, unstable angina pectoris（UAP） group, stable angina pectoris（SAP） group and healthy control group. The serum levels of MMP-9 and sICAM-1 were measured with ELISA kits, CRP were measured with im munoturbidimetric assay, and WBC number were assessed all before any treatment was administrated. Results： （1）The serum levels of MMP-9 ,sICAM-1 ,CRP and WBC in the patients with ACS were significantly higher than those in the control group （P 〈 0.01 ）. （2）Compared with control group, patients with SAP only had higher serum level of sICAM-1 （P 〈 0.01 ）. While the levels of MMP-9, CRP, and WBC had no significant difference between them （P 〉 0.05 all）. （3）Significant positive correlation between the serum levels of MMP-9 and sICAM-1 and CRP and WBC all were observed in the patients with ACS （P 〈 0.05）. Conclusion： The elevation of serum concentrations of inflammatory markers including MMP-9, slCAM-1, CRP and WBC were associated with initiation and progression of ACS, and they may help predicting cardiovascular events.     

The serum levels of MMP-9, sICAM-1, CRP and WBC increased in patients with acute coronary syndrome

Objective:To evaluate the association of the peripheral levels of the defined inflammatory markers with different types of acute coronary syndrome(ACS) and stable angina, and the role inflammation played in the pathogenesis of ACS. Methods:For understanding the variation of serum concentrations of matrix metalloproteinase-9(MMP-9), soluble intercellular adhesion molecule-1(sICAM-1),C-reactive protein(CRP), and white blood cell count(WBC) and their association with ACS, 90 patients with coronary heart disease (CHD) and 30 healthy volunteers were recruited. The enrolled people were assigned into four equal groups, including acute myocardial infarction (AMI) group, unstable angina pectoris(UAP) group, stable angina pectoris(SAP) group and healthy control group. The serum levels of MMP-9 and sICAM-1 were measured with ELISA kits, CRP were measured with immunoturbidimetric assay, and WBC number were assessed all before any treatment was administrated. Results:(1)The serum levels of MMP-9,sICAM-1,CRP and WBC in the patients with ACS were significantly higher than those in the control group(P < 0.01). (2)Compared with control group, patients with SAP only had higher serum level of sICAM-1(P < 0.01). While the levels of MMP-9, CRP, and WBC had no significant difference between them(P > 0.05 all). (3)Significant positive correlation between the serum levels of MMP-9 and sICAM-1 and CRP and WBC all were observed in the patients with ACS(P < 0.05). Conclusion: The elevation of serum concentrations of inflammatory markers including MMP-9, sICAM-1, CRP and WBC were associated with initiation and progression of ACS, and they may help predicting cardiovascular events.     

Variations in indicated care of patients with acute coronary syndromes in Queensland hospitals

OBJECTIVE: To identify variation in the rates of use of key evidence-based therapies and in clinical outcomes among patients hospitalised with acute coronary syndromes (ACS). DESIGN: Retrospective analysis of data on care processes and clinical outcomes of representative patient samples recorded by the Queensland Health Cardiac Collaborative registry. SETTING: 18 public hospitals (3 tertiary, 15 non-tertiary) in Queensland, August 2001 to December 2003. STUDY POPULATION: 2156 patients who died or were discharged after troponin-positive ACS. MAIN OUTCOME MEASURES: Comparison of proportions of highly eligible patients receiving indicated care and in-hospital mortality between subgroups categorised by age, sex, comorbidities (diabetes, renal failure, chronic obstructive pulmonary disease and mental disorder), type of admitting hospital (tertiary or non-tertiary), and cardiologist involvement (transfer or non-transfer to cardiology unit). RESULTS: Patients aged > or = 65 years were less likely than younger patients to receive heparin (79% v 87%), beta-blockers (79% v 87%), lipid-lowering agents (78% v 87%), coronary angiography (51% v 66%), and referral to cardiac rehabilitation (17% v 33%). Patients with diabetes were less likely than others to receive coronary angiography (50% v 63%), while those with moderate to severe renal failure were less likely to receive thrombolysis (52% v 84%), heparin (71% v 83%), beta-blockers (69% v 84%), lipid-lowering agents (61% v 84%), in-hospital cardiac counselling (46% v 64%) and referral to cardiac rehabilitation (9% v 25%). Patients admitted to tertiary hospitals were more likely than those admitted to non-tertiary hospitals to receive coronary angiography (85% v 55%) and referral to cardiac rehabilitation (36% v 21%). Risk-adjusted mortality was highest in patients with moderate to severe renal failure (15% v 3%) and older patients (6% v 2%). CONCLUSIONS: Variations exist in the provision of indicated care to patients with ACS according to age, diabetic status, renal function and type of admitting hospital. Excess mortality in elderly patients and in those with advanced renal disease may be partially attributable to failure to use key therapies.     

五聚素3对急性冠脉综合征患者预后的评估价值

目的:通过分别检测急性冠脉综合征(ACS)患者和对照者血浆五聚素3(PTX3)的水平,探讨PTX3在ACS发生发展中的作用及其对ACS患者预后的临床价值。方法:连续入选ACS患者80例,其中ST段抬高心肌梗死组(STEMI)组32例、非ST段抬高心肌梗死组(NSTEMI)组23例、不稳定性心绞痛组(UAP)组25例,同期选取经冠脉造影排除冠心病的20例患者作为对照组,取所有入院患者的静脉血用ELISA法测定PTX3水平,随访ACS患者出院后3个月不良心血管事件的发生情况。结果:ACS患者血浆PTX3水平显著高于对照组(P<0.001),ACS患者血浆PTX3水平与WBC(r=0.359,P=0.001)、hs-CRP(r=0.405,P<0.000 1)以及NT-ProB-NP(r=0.883,P<0.0001)有显著相关性。PTX3≥5.51μg/L组3个月联合心血管事件发生率高于PTX3<5.51μg/L组(39.5%比17.5%,P<0.05)。多元Logistic回归分析结果显示,只有PTX3(OR=4.11,95%CI:1.37-12.38,P=0.012)和NT-ProBNP(OR=2.56,95%CI:1.12-4.53,P=0.021),而非hs-CRP,是ACS患者3个月不良心血管事件的独立预测因子。结论:PTX3可能促成了动脉粥样硬化的发病机制,PTX3和NT-proBNP是ACS患者3个月主要不良心血管事件强力且独立的预后指标。联合检测PTX3和NT-proBNP可能有助于ACS患者早期危险分层。     

Predictive value of postprocedural leukocyte count on myocardial perfusion, left ventricular function and clinical outcomes in ST-elevated myocardial infarction after percutaneous coronary intervention

Background  Baseline white blood cell (WBC) count was correlated with ischemic events occurrence in patients with ST-elevated myocardial infarction (STEMI). However, circulating WBC count is altered after percutaneous coronary intervention (PCI). The aim of this study was to assess the relationship between postprocedural WBC count and clinical outcomes in STEMI patients who underwent PCI.

Methods  A total of 242 consecutive acute STEMI patients who underwent successful primary PCI were enrolled and followed up for two years. WBC counts were measured within 12 hours after PCI. ST-segment resolution (ST-R) and myocardial blush grades (MBG) were evaluated immediately after PCI. Left ventricular ejection fraction (LVEF) was obtained at baseline and 12–18 months after PCI.

Results  Postprocedural WBC count was an independent inverse predictor of ST-R (OR 0.80, P <0.0001) and MBG 3 (OR 0.82, P <0.0001). It was negatively correlated with LVEF (baseline r=–0.22, P=0.001; 12–18 months r=–0.29, P <0.0001). The best cutoff value of WBC for predicting death was determined to be 13.0×10⁹/L. The patients with a postprocedural WBC count above 13.0×10⁹/L showed a significantly lower cumulative survival rate (30 days, 82.4% vs. 99.0%, P <0.0001 and 2 years 75.0% vs. 96.4%, P <0.0001). Multivariate Cox regression analysis showed that a postprocedural WBC count was a strong independent predictor of 30-day mortality (HR 8.48, P=0.019) and 2-year mortality (HR 4.93, P=0.009).
Conclusions  Increased postprocedural WBC count is correlated with myocardial malperfusion and left ventricular dysfunction, and is an independent predictor of poor clinical outcomes in STEMI patients who underwent PCI.

     

C反应蛋白及外周血白细胞计数对冠脉病变的预测价值

目的:探讨C反应蛋白(CRP)、外周血白细胞计数(WBC)及中性粒细胞计数(PMN)对冠脉病变的预测价值。方法:检测60例急性冠脉综合征(ACS)、30例稳定性心绞痛(SA)及45例对照者CRP、WBC及PMN,按冠状动脉狭窄支数进行分组,研究冠脉狭窄范围与上述三指标的关系。结果:ACS组CRP、WBC及PMN与SA组及对照组比较,差异显著(P<0.01);急性心肌梗死(AMI)组三指标均显著高于不稳定心绞痛(UA)组、SA组及对照组(P<0.01),UA组CRP水平显著高于SA组及对照组(P<0.01);CRP在冠脉狭窄1支、2支、多支之间比较,差异有显著性(P<0.05)。结论:冠心病患者血浆CRP、外周血WBC与PMN对冠脉急性病变及狭窄支数有较好的预测价值。     

Relationship between Physical Inactivity and Long-term Outcome in Patients Aged≥80 Years with Acute Coronary Syndrome

Physical inactivity is very common in octogenarians. However, association between physical inactivity and mortality in octogenarians with acute coronary syndrome (ACS) remains unclear. In this study, we aimed to investigate association between physical inactivity and allcause mortality in octogenarian patients with ACS. In this study, we included a total of 353 hospitalized patients, aged >80 years, with ACS during the period of 5-year follow-up. The association between physical inactivity and all-cause mortality was analyzed by multivariable Cox aggression. Of the enrolled patients, 132 (37.4%) were defined as physically inactive, and 221 (62.6%) as physically active. Patients with physical inactivity tended to have lower survival rate (21.2% vs. 56.5%, P<0.001) and higher mortality rate (78.8% vs. 43.5%, PcO.OOl), and had a worse long-term outcome than those with physical activity (chi-square=27.52, and log rank PcO.OOl). The physical inactivity was still an independent predictor for long-term allcause mortality independent of confounders including age, prior heart failure, stroke, ejection fraction, beta-blocker, clopidogrel and percutaneous coronary intervention (HR: 2.35, 95% CI: 1.26-4.37, P=0.007). Our study demonstrates that physical inactivity is independently related to increased all-cause mortality in octogenarians with ACS.