脑梗死颈动脉粥样硬化斑块形成的危险因素分析

目的:研究脑梗死颈动脉粥样硬化斑块形成的危险因素.方法:选取我院2018年2月至2021年6月期间收治的158例脑梗死患者,根据患者颈动脉超声检查示有无斑块形成将患者分为斑块组(92例)和无斑块组(66例).统计所有患者的年龄、体质量指数(Body Mass Index,BMI)、颈动脉内膜中层厚度(intima-media thickness,IMT)等一般资料.多元Logistic回归分析影响脑梗死颈动脉粥样硬化斑块形成的因素.结果:年龄、高血压病史、糖尿病病史、甘油三酯(triglyceride,TG)、高密度脂蛋白胆固醇(High density lipoprotein cholesterol,HDLC)、低密度脂蛋白胆固醇(Low density lipoprotein cholesterol,LDLC)、吸烟史,饮酒史,IMT是影响脑梗死颈动脉粥样硬化斑块形成的单因素(P<0.05).年龄、高血压病史、高血糖病史、吸烟史以及IMT是影响脑梗死颈动脉粥样硬化斑块形成的独立危险因素(P<0.05).结论:通过评估颈动脉部超声相关参数,对脑梗死颈动脉粥样硬化斑块的形成有预测价值.     

脂蛋白a与冠状动脉粥样硬化疾病的研究进展

<正>脂蛋白(lipoprotein)作为研究动脉粥样硬化疾病的常客,目前已得到广泛研究。而脂蛋白a [lipo-protein (a), Lp(a)]是一种密度介于高密度和低密度之间的特殊脂蛋白,与遗传因素息息相关。它富含载脂蛋白A(apolipoprotein A, apoA),可与胆固醇相结合,沉积于血管壁,促使动脉粥样硬化,形成血栓;     

双源CT检测和定性冠状动脉粥样硬化斑块的评价

目的　双源CT增强扫描检测和定性冠状动脉粥样硬化斑块的评价。 方法　使用双源CT对冠状动脉进行0.6 mm层厚横断面增强扫描,根据CT值将斑块分为钙化、非钙化和混合斑块。病理分型作为对比标准。 结果　病理切片发现75个斑块,63个斑块被双源CT检测, 双源CT对检测所有斑块的敏感性为84%(63/75),对检测I~III型的敏感性为0%,对检测IV型、Va型、Vb型和Vc型的敏感性分别为77.8%、80%、97.9% 和85.7%。 钙化斑块、混合斑块和非钙化斑块的平均CT值 (分别是：416.5±94.4 HU、142.8±48.6 HU和46.3±34.2 HU;P<0.05) 有明显差异。以脂质为主的斑块（IV型和Va型）和以纤维为主的斑块( Vc型)的平均CT值(分别是：30.4±24.4 HU和73.3±23.3 HU;P<0.05)有显著差异。 结论　双源CT增强扫描能够检测不同类型的冠状动脉粥样硬化斑块,斑块的平均CT值能够代表斑块的主要成分,且与病理分型有很好的一致性。     

冠状动脉粥样硬化的超高速CT检测与病理学对照I-钙化参数与粥样硬化面积之间的相关性

目的;为探讨超高速CT检测的冠状动脉钙化与冠状动脉粥样硬化面积之间的关系。方法从8例(年龄在42—84岁)压力灌注固定后的心脏标本中分离出20支冠状动脉,拉直后,超高速CT扫描;每支冠状动脉分成相应的3mm血管段,组织切片,地衣红染色,Leica图像分析仪上计算粥样硬化面积。结果在血管、心脏水平,总的粥样硬化面积与钙化面积、钙化积分高度相关,在血管段水平,每个标本内粥样硬化面积与钙化面积、钙化积分呈等级相关;有一些粥样斑块的血管段,超高速CT未检测出钙化。结论超高速CT检则的钙化参数与粥样硬化面积在血管、心脏水平高度相关;能检出钙化的血管段,其粥样斑块面积可能有一定的阈值。     

基质金属蛋白酶-2与冠状动脉粥样硬化性疾病的研究进展

基质金属蛋白酶-2是基质金属蛋白家族中的一个重要成员,在生理情况下参与人体的正常发育,病理状态下潜在基质金属蛋白酶-2被激活,通过削减斑块纤维帽参与心室重构在多种心血管疾病的发生、发展中起重要作,并且有望成为反映心血管疾病的一种生物标志物,而对基质金属蛋白酶-2的调节将是一个可能的治疗靶点。现就基质金属蛋白酶-2的基因、蛋白、活性调节、信号转导及其在冠状动脉粥样硬化性心脏病中的研究进展予以综述。     

颈动脉粥样硬化危险因素的研究

颈动脉粥样硬化（carotid atherosclerosis，CAS）与脑血管发病密切相关。目前研究认为颈动脉内-中膜厚度（carotid intima—media thickness，CIMT）是反映CAS的早期指标。本文综述CAS研究进展。     

固醇调节元件结合蛋白-1c基因多态性与冠状动脉粥样硬化的关系

目的:探讨固醇调节元件结合蛋白-1c(SREBP-1c)基因18号外显子54G/C多态性与湖北汉族人冠状动脉粥样硬化(ACD)的关系。方法:采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法和基因测序技术,对166例ACD患者(ACD组)和122例健康人(对照组)SREBP-1c基因18号外显子54G/C位点进行分析,并测定血脂水平。结果:SREBP-1c基因18号外显子54G/C在ACD组和对照组中基因型频率分别为CC型6.63%和4.92%,GC型39.76%和28.69%,GG型53.61%和66.39%,差异无显著性意义(P>0.05);ACD组C等位基因频率高于对照组(26.51%vs19.26%,P<0.05)。不同基因型间血脂水平差异均无显著性意义(P>0.05)。结论:等位基因C可能增加ACD发生的风险。     

冠状动脉粥样硬化患者外周血Th17细胞与 IL-17的水平及意义

目的 探究冠状动脉粥样硬化患者外周血Th17细胞与IL-17水平变化的意义。方法 收集青岛阜外心血管病医院冠状动脉粥样硬化患者200例,根据疾病类型分为心肌梗死（AMI）组（52例）、不稳定型心绞痛（UA）组（68例）、稳定型心绞痛（SA）组（80例）,另外选取同期200例体检者作为对照组。采用流式细胞术检测患者Th17细胞频率,ELISA法检测各组血清中IL-17、CRP表达水平。结果 流式细胞检测结果显示,与对照组比较,各组Th17细胞的频率表达均升高,差异具有统计学意义（P＜0.05）,且AMI组升高水平高于SA组和UA组,差异具有统计学意义（P＜0.05）; ELISA检测结果显示,与对照组比较,各组IL-17及CRP表达水平均升高,差异具有统计学意义（P＜0.05）,且AMI组升高水平高于SA组和UA组,差异具有统计学意义（P＜0.05）。结论 冠状动脉粥样硬化患者血中Th17及IL-17水平的升高,可能是导致冠状动脉粥样硬化患者板块不稳定的原因。     

检测血脂及血清ApoB/ApoA1比值对冠状动脉粥样硬化临床诊断意义

目的 探究血脂及血清生化指标载脂蛋白B(ApoB)与载脂蛋白A(ApoA1)比值ApoB/ApoA1在冠状动脉粥样硬化临床诊断中的应用价值.方法 选取我院2018年3月至2019年10月收治的冠状动脉粥样硬化患者98例为观察组,同期于我院健康体检者102例为对照组.检测两组研究对象血脂及血清生化指标,分析ApoB/Ap...     

冠状动脉搭桥术后CTA对桥血管的临床评价

目的：探讨冠状动脉搭桥术后CTA对桥血管的临床评价。方法收集2012年7月~2014年7月来我院进行冠状动脉旁路搭桥术的患者作为研究对象,共计90例。其中男性50例,女性40例,平均年龄(53.1±12.8)岁,冠状动脉旁路搭桥术后时间<4~5年。患者来我院就诊时表现为心绞痛、气短、活动后心悸等典型冠状动脉缺血表现。其中动脉桥44支,静脉桥115支。分别对所有研究对象进行冠状动脉旁路搭桥术CTA。评价冠状动脉旁路搭桥血管CTA图像(质量、血管狭窄率、板块显示情况),将冠状动脉造影图像与CTA图像中动脉桥血管和静脉桥血管显示率进行对比。结果所有研究对象均能完成检查,检查的过程中没有出现不良反应。其中1级图像的有55例,有12例二级图像质量,39例3级图像质量通过计算机重建后均满足诊断要求。静脉桥血管中闭塞28支,狭窄率为24.3%,见图1。动脉桥血管中闭塞7支,狭窄率为15.9%。血管钙化斑块12支,软斑8支,混合斑块5支。冠状动脉旁路搭桥血管CTA共检测出动脉桥血管为95.5%(42/44),静脉桥血管为98.3%(113/115),冠状动脉造影共检测出动脉桥血管为100%(44/44),静脉桥血管为100%(115/115),差异无统计学意义(>0.05)。结论我们认为冠状动脉旁路搭桥血管CTA能较好评估桥血管,操作简单,无不良反应,简便安全。     

电子束CT冠状动脉血管造影与冠状动脉造影结果的关联性研究

目的　探讨电子束CT冠状动脉血管造影 (eletronbeamcomputedtomographicangiography ,EBA)与冠状动脉造影结果的关联性。方法　 2 4例临床怀疑冠心病患者分别行EBA及冠状动脉造影 (coronaryangiography,CAG) ,所有EBCT图像均经三维重建显像 ,按照AHA分段方法进行分段 ,每套重建显像血管分成左主干 (leftmainartery ,LM)及前降支 (leftanteriordescendingcoronaryartery ,LAD)、左旋支 (leftcircumflexartery ,LCx)、右冠脉 (rightcoronaryartery,RCA)各近、中、远三段共 10段血管 ,由 2名医生对LM和LAD、LCx、RCA的近、中段共 16 8段血管进行分析 ,其结果与CAG结果对比 ,比较EBA与CAG所示冠状动脉狭窄间的关系。结果　在 16 8个近段和中段血管中有 147段 (87.5 0 %)EBA能够清楚显像 ,其中LAD近段和中段清晰显像的百分比都为 95 .83%,而RCA近段和中段分别为 91.6 7%和 5 8.33%,LCx近段和中段为 91.6 7%、79.17%,而在 16 8个近段和中段血管中CAG全部清晰显像 ;如果以 >5 0%狭窄作为有意义狭窄 ,则EBA与CAG比较发现狭窄的敏感性和特异性是 83.33%和 92 .13%,其中LM是 10 0 .0 0%和 95 .6 5 %,LAD近段是 10 0 .0 0 %和 75 .0 0 %,LAD中段是 82 .35 %和 6 6 .6 7%,RCA近段是 80 .0 0 %和 71.43%,RCA中段是 5     

Development of Digital Subtraction Angiography for Coronary Artery

The purpose of this research is to develop a new method of digital subtraction angiography (DSA) that can be applied to real time with reducing motion artifacts caused by heart movement and respiration. To create the mask image for DSA, the maximum pixel value at each pixel (which is the opposite pixel value to that of a vessel filled by contrast medium) was selected from the previous 14 image frames. The search area for the maximum pixel value was selected using the value of the standard deviation (SD) for each pixel from the previous 14 image frames. When the SD value in the 14 frames was greater than a threshold level, the search area of the maximum value became 1 pixel × 1 pixel × 14 frames; otherwise, 7 pixels × 7 pixels × 7 frames. The image quality of new DSA was evaluated on 20 coronary arteriogram images, including various degrees of occlusion or stenosis. The results indicated a considerable improvement in DSA image quality; thus, the coronary arteries, carotid artery, and vein were clearly enhanced.     

Nonalcoholic Fatty Liver Disease Is Associated with the Presence and Morphology of Subclinical Coronary Atherosclerosis

Purpose

In this study, we aimed to evaluate whether nonalcoholic fatty liver disease (NAFLD) was associated with the presence and morphology of coronary atherosclerotic plaques shown by multidetector computed tomography (MDCT) in asymptomatic subjects without a history of cardiovascular disease.

Materials and Methods

We retrospectively enrolled 772 consecutive South Korean individuals who had undergone both dualsource 64-slice MDCT coronary angiography and hepatic ultrasonography during general routine health evaluations. The MDCT studies were assessed for the presence, morphology (calcified, mixed, and non-calcified), and severity of coronary plaques.

Results

Coronary atherosclerotic plaques were detected in 316 subjects (40.9%) by MDCT, and NAFLD was found in 346 subjects (44.8%) by hepatic ultrasonography. Subjects with NAFLD had higher prevalences of all types of atherosclerotic plaque and non-calcified, mixed, and calcified plaques than the subjects without NAFLD. However, the prevalence of significant stenosis did not differ between groups. After adjusting for age, smoking status, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome, NAFLD remained a significant predictor for all types of coronary atherosclerotic plaque [odds ratio (OR): 1.48; 95% confidence interval (CI): 1.05-2.08; p=0.025] in binary logistic analysis, as well as for calcified plaques (OR: 1.70; 95% CI: 1.07-2.70; p=0.025) in multinomial regression analysis.

Conclusion

Our study demonstrated that NAFLD was significantly associated with the presence and the calcified morphology of coronary atherosclerotic plaques detected by MDCT. Further prospective clinical studies are needed to clarify the exact physiopathologic role of NAFLD in coronary atherosclerosis.     

Value of Coronary Angiography in the Cardiac Myxoma

Preoperative coronary angiography for cardiac myxoma not only excludes coronary artery disease but also detects the artery feeding the cardiac myxoma, which has several clinical implications. In this study, we examined cardiac myxoma cases in two tertiary hospitals using coronary angiography to identify the artery feeding the myxoma. We retrospectively reviewed 42 patients with cardiac myxoma who had undergone surgical removal between July 2008 and December 2015 in two tertiary hospitals, and recorded their baseline characteristics, echocardiographic findings, and coronary angiography. Among those 42 patients, 23 (55%) had coronary angiography before surgery and in no case was significant luminal narrowing observed. In 21 of the coronary angiograms, the artery feeding the cardiac myxoma had a vascular branch (100%), clusters of tortuous vessels with contrast medium pooling (67%), an arteriocavity fistula (33%), and a mobile feeding artery (67%). No significant relationship was found between coronary artery dominance type and the origin of the artery feeding the cardiac myxoma (P = 0.362). Identification of the artery feeding the cardiac myxoma, with a distinctive vascular appearance in coronary angiography, is important for several clinical applications such as helping to diagnose cardiac myxoma and to plan the surgical approach. Clin. Anat. 33:833–838, 2020. © 2019 Wiley Periodicals, Inc.     

成年人群下肢动脉疾病早期变化与脂质代谢特点的相关性分析

目的 研究成年人群下肢动脉硬化早期变化与脂质代谢的临床特点,为有效地开展下肢动脉粥样硬化的一级和二级预防提供依据。方法 调查对象为年龄大于或等于40周岁的某单位人群共525人。下肢动脉硬化诊断方法使用动脉硬化早期测定仪筛检。检测成年人群耾动脉-踝动脉搏波传导速度（brachial-anklepulse wave velocity,baPWV）和踝臂指数（brachial-ankle index,ABI）,了解成年人群的血管弹性状况。血脂异常的诊断依据1997年全国血脂防治建议。结果 体检的525人中,40～49岁baPWV检测值升高者占32.8%;50～59岁baPWV检测值升高者占56%;60～69岁baPWV检测值升高者占69.8%;70～79岁baPWV检测值升高者占75%;年龄越大,baPWV检出率越高。525人中,baPWV检测值轻度升高者占13%;baPWV中度升高者占22%;重度升高者占8%。525人中血脂异常者309人,其中总胆固醇值升高、低密度脂蛋白升高伴同型半胱氨酸升高者179人,伴baPWV检测值升高者136人,达76%。结果 显示,总胆固醇值和低密度脂蛋白升高伴同型半胱氨酸升高者下肢动脉硬化发生率高（76%）。结论 深圳地区成年人群早期下肢动脉硬化与脂质代谢异常密切相关。积极治疗脂质代谢异常,开展下肢动脉粥样硬化的一级和二级预防是降低心脑血管事件的关键。     

基于冠状动脉CT造影的生物机械应力在斑块评估及不良心血管事件预测中的应用

冠状动脉长期暴露于危险因素会引起粥样硬化,进而导致斑块形成与进展。通过早期识别高危斑块特征将有助于预防斑块破裂或糜烂,从而避免急性心血管事件的发生。而生物机械应力(biomechanical stress)在动脉粥样硬化斑块进展及破裂中发挥重要的作用。近些年,已经可以通过无创冠脉CT血管造影(coronary computed tomography angiography, CCTA)利用计算流体力学(computational fluid dynamic, CFD)进行建模,从而得到相应的生物机械应力参数,尤其是壁面剪切应力(wall shear stress, WSS)将有助于更好地构建临床模型从而预测斑块进展及主要不良心血管事件(major adverse cardiac events, MACE)。本文重点介绍生物机械应力以及CCTA所计算得出的WSS在动脉粥样硬化中的作用,并讨论有关CCTA生物机械应力与冠心病相关的研究。     

Prediction of Coronary Atherosclerotic Ostial Lesion with a Damping of the Pressure Tracing during Diagnostic Coronary Angiography

Purpose

When performing coronary angiography (CAG), diagnostic catheter intubation to the ostium can cause damping of the pressure tracing. The aim of this study was to determine the predictors of atherosclerotic ostial stenosis in patients showing pressure damping during CAG.

Materials and Methods

In total, 2926 patients who underwent diagnostic CAG were screened in this study. Pressure damping was defined as an abrupt decline of the coronary blood pressure with a blunted pulse pressure after engagement of the diagnostic catheter. According to CAG and intravascular ultrasound (IVUS), we divided damped ostia into two groups: atherosclerotic ostial lesion group (true lesion group) and non-atherosclerotic ostium group (false lesion group). Clinical and angiographic characteristics were compared between the two groups.

Results

The overall incidence of pressure damping was 2.3% (68 patients and 76 ostia). Among the pressure damped ostia, 40.8% (31 of 76 ostia) were true atherosclerotic ostial lesions (true lesion group). The true lesion group had more frequent left main ostial damping and more percutaneous coronary interventions (PCIs) performed on non-ostial lesions, compared to the false lesion group. On multivariate logistic regression analysis, left main ostial damping [hazard ratio (HR) 4.11, 95% confidence interval (CI) 1.24-13.67, p=0.021] and PCI on non-ostial lesion (HR 5.34, 95% CI 1.34-21.27, p=0.018) emerged as independent predictors for true atherosclerotic ostial lesions in patients with pressure damping.

Conclusion

Left main ostial damping and the presence of a non-ostial atherosclerotic lesion may suggest a significant true atherosclerotic lesion in the coronary ostium.     

多排CT血管成像显示脑循环血管变异研究进展

目的:探讨多排CT血管成像(MD-CTA)显示脑循环血管变异的价值.方法:查阅国内外相关文献,对各种脑循环血管变异影像学表现、发生率及临床意义进行总结分析.结果:脑循环血管变异包括:颅内动脉开窗和重复、Willis环变异、永存颈动脉-基底动脉吻合、颅底部动脉变异等.有些与动脉瘤形成有关,具有重要临床意义.结论:MD-CTA可检出大多数脑循环血管变异,有利于颅内动脉瘤、脑出血的检查和治疗计划的制定.     

Predictors of Coronary and Carotid Atherosclerosis in Patients with Severe Degenerative Aortic Stenosis

Background. Patients with degenerative aortic stenosis (AS) exhibit elevated prevalence of coronary artery disease (CAD) and internal carotid artery stenosis (ICAS). Our aim was to investigate prevalence of significant CAD and ICAS in relation to demographic and cardiovascular risk profile among patients with severe degenerative AS.Methods. We studied 145 consecutive patients (77 men and 68 women) aged 49-91 years (median, 76) with severe degenerative AS who underwent coronary angiography and carotid ultrasonography in our tertiary care center. The patients were divided into two groups according to the presence of either significant CAD (n=86) or ICAS (n=22).Results. The prevalence of significant CAD or ICAS was higher with increasing number of traditional risk factors (hypertension, hypercholesterolemia, diabetes, smoking habit) and decreasing renal function. We found interactions between age and gender in terms of CAD (p=0.01) and ICAS (p=0.06), which was confirmed by multivariate approach. With the reference to men with a below-median age, the prevalence of CAD or ICAS increased in men aged >76 years (89% vs. 55% and 28% vs. 14%, respectively), whereas the respective percentages were lower in older vs. younger women (48% vs. 54% and 7% vs. 17%).Conclusions. In severe degenerative AS gender modulates the association of age with coronary and carotid atherosclerosis with its lower prevalence in women aged >76 years compared to their younger counterparts. This may result from a hypothetical “survival bias”, i.e., an excessive risk of death in very elderly women with severe AS and coexisting relevant coronary or carotid atherosclerosis.     

脑动脉粥样硬化斑块的分布及其临床意义

目的：为我国研究脑血管疾病提供脑动脉粥样硬化形态学基础。方法：全脑血管造影检查结果阳性患者259例，对其斑块的发生部位以及与高血压、糖尿病及高血脂状态等合并症的关系进行分析。结果：脑动脉粥样硬化的好发部位主要为颈内动脉起始部和椎动脉起始部，其次为大脑前动脉、大脑中动脉和锁骨下动脉。27．6％合并糖尿病，24．1％合并高脂血症，58．7％合并高血压。结论：脑动脉粥样硬化是多因素疾病，脑动脉粥样硬化斑块以多病变、双侧共同病变及复杂病变为主。