急性冠状动脉综合征患者血清sCD40L升高的临床价值

目的观察冠心病不同类型患者中可溶性CD40L(sCD40L)水平的变化及其与白细胞介素-6(IL-6)和白细胞介素-1β(IL-1β)之间的关系,进一步探讨急性冠状动脉综合征(ACS)临床识别和预测的炎症指标。方法采用酶联免疫吸附法测定血清可溶性CD40L浓度,采用放免方法测定IL-6和IL-1β浓度。结果急性心肌梗死(AMI)患者sCD40L水平[(4.923±3.41)ng/ml]和不稳定型心绞痛(UAP)患者sCD40L水平[(5.387±3.04)ng/ml]显著高于稳定型心绞痛(SAP)[(2.856±2.34)ng/ml,P<0.05]和对照组患者[(2.221±2.42)ng/ml,P<0.01]。ACS患者sCD40水平与IL-6呈正相关(r=0.49,P=0.008),与IL-1β无相关性(r=0.258,P=0.183),而SAP和对照组患者sCD40L与IL-6、IL-1β无相关性。同时ACS患者sCD40L水平与低密度脂蛋白有显著相关性(r=0.471,P=0.011)。结论ACS患者血清sCD40L与IL-6、IL-1β水平升高,提示其可能与ACS发生有关,是动脉粥样硬化和斑块不稳定的标志。     

血清胆红素水平与冠脉支架植入术后再狭窄的关系

根据再次冠脉造影结果,将91例行经皮冠脉腔内成形术及冠脉支架植入术患者分为再狭窄组和非再狭窄组．对两组临床情况及生化指标进行回顾性分析。结果显示,再狭窄组胆固醇高于非再狭窄组,总胆红素低于非再狭窄组（P〈0．05）。二分类logistic多因素回归分析显示,空腹血糖、胆固醇是再狭窄的危险因素,而总胆红素是再棼窄的保护因素。提示血清总胆红素与冠脉支架内再狭窄密切相关,高水平胆红素可降低冠脉支架内再狭窄的发生。     

抗血小板聚集药物对急性冠脉综合征患者血清sCD40L及磷脂酶A2的影响

目的探讨不同抗血小板聚集药物对急性冠脉综合征患者血清sCD40L和磷脂酶A2(phospholipase A2,PLA2)的影响。方法选择2010年2月至2011年5月在粤北人民医院住院,诊断为急性冠脉综合征的患者80例为研究对象,其中稳定型心绞痛20例设为A组,不稳定型心绞痛40例设为A+C组,急性心肌梗死20例设为A+H+C组。A组20例在标准药物治疗方案基础上采用阿司匹林治疗,A+C组40例在上述标准治疗基础上采用阿司匹林加氯吡格雷治疗,A+H+C组20例在上述标准治疗基础上采用阿司匹林加低分子肝素加氯吡格雷治疗。另外,选择20例经冠状动脉造影检查无冠状动脉病变的患者作为正常对照组。检测并比较分析治疗前和治疗后不同时刻各组血清sCD40L、PLA2浓度。结果 A组的血清sCD40L和PLA2与对照组比较,差异无统计学意义(P>0.05),但在A+C组和A+H+C组中,这两种炎症因子显著升高,与正常组和A组比较,差异有统计学意义(P<0.01)。A+H+C组及A+C组治疗后各时间点血清sCD40L、PLA2浓度均比治疗前降低,差异有统计学意义(P<0.01),且A+H+C组下降更明显。结论 sCD40L和PLA2是急性冠脉综合征的炎症因子;对急性冠脉综合征患者早期强化抗凝治疗可以获得积极治疗效果。     

急性冠状动脉综合征患者sCD40L的变化及他汀类药物的影响

目的探讨急性冠状动脉综合征(ACS)患者血清可溶性CD40L(sCD40L)水平的变化及他汀类药物对其的影响。方法102例ACS患者随机分为2组:安慰剂组,辛伐他汀和普伐他汀组(他汀组)。用间接免疫荧光流式细胞术和酶联免疫吸附法(ELISA)及常规酶法分别测定2组患者用药前和用药2、4、6周后血清sCD40L水平及总胆固醇(TC)水平。结果(1)他汀组患者服药2,4及6周后血清sCD40L水平明显低于安慰剂组(均P<0.05)。(2)他汀组患者服药2、4、6周后血清sCD40L水平呈逐渐下降趋势,同用药前相比差异均有统计学意义(均P<0.05)。(3)他汀组患者服药2、4、6周后血浆TC水平与用药前相比差异均有统计学意义(均P<0.05)。(4)他汀组患者血清sCD40L水平的降低与血浆TC水平的降低无明显相关性(r=0.014,P>0.05)。结论他汀类药物能明显降低ACS患者体内sCD40L水平,对减轻炎症反应、稳定斑块有一定作用。     

冠状动脉内支架植入术后再狭窄的危险因素和预测

目的：回顾性分析冠状动态支架植入术后再狭窄发生的危险因素。方法：自１９９３年７月至２０００年５月我院共行选择性冠状动脉支架植入术１５４６例,对进行了冠状动脉造影随访的１２５例资料进行了分析,冠状动脉病变狭窄程度及长度用定量冠状动脉造影分析,统计学采用Ｌｏｇｉｓｔｉｃ多因素逐步回归分析。结果：１２５例患在１６０处病变植入支架。冠状动脉造影显示支架内再狭窄（狭窄直径≥５０％）６１例、６８处病变,无再狭窄６４例、９２年病变。多因素逐步回归分析显示再狭窄与术前甘油三酯浓度、术前狭窄程度和术后残余狭窄呈显正相关,其比数比（ＯＲ）分别为１．５８９,１．０８９和１．６６５;与术前参考血管直径和在梗塞相关动脉植入支架呈负相关,ＯＲ分别为０．２６２和０．１１４。结论：冠状动脉支架植入术后再狭窄与甘油三酯浓度、术后残余狭窄与狭     

冠脉再通汤防治冠脉支架术后再狭窄的临床观察

目的观察自拟冠脉再通汤对冠脉支架术后再狭窄的防治作用。方法92例冠心病患者随机分为治疗组（50例）与对照组（42例）．两组均在冠脉支架置入术后服用西药标准化治疗方案氯吡格雷、阿司匹林等,治疗组配合活血化瘀中药冠脉再通汤,服用3个月,两组患者均于3个月和6个月进行随访。结果治疗组再狭窄率为6．00％;对照组再狭窄率为19．05％,治疗组再狭窄率明显低于对照组（P〈0．05）。结论中西医结合是防治冠脉支架术后再狭窄的理想方法。     

CD40-CD40L与急性冠脉综合征的研究进展

本文介绍了CD40与CD40L的生物学特性,包括其分布、来源、信号转导机制。综述了CD40-CD40L与慢性炎症、免疫调节、血栓形成、斑块不稳定的相关性,提示抗CD40L治疗是未来防治急性冠脉综合征的一个方向。     

冠心病合并糖尿病患者金属裸支架置入术后再狭窄的临床和造影预测因素

目的探讨冠心病合并糖尿病患者支架术后再狭窄发生的危险因素,建立冠心病合并糖尿病患者支架术后再狭窄发生概率的预测模型,为中国冠心病合并糖尿病患者药物洗脱支架的合理使用提供循证医学证据。方法分析我院2002-2004年1126例冠状动脉内非药物洗脱支架置入术患者（2376处病变）,使用多元逻辑回归分析比较术后出现再狭窄组和无再狭窄组冠心病合并糖尿病患者临床数据和造影资料,并使用上述数据库建立支架术后再狭窄发生概率预测表。结果在889例（78．9％）有6个月随访冠状动脉造影资料的患者中,151例（17％）有糖尿病。再狭窄定义为支架内及前后5mm范围内狭窄≥50％参考管腔直径。在非糖尿病组（738例）,再狭窄的发生率为21．2％,糖尿病组（151例）再狭窄的发生率为35．9％（P〈0．001）。多元逻辑分析结果显示参考血管直径（≤3．0mm）,病变长度（〉15mm）和胰岛素治疗是冠心病合并糖尿病患者术后再狭窄的可预见危险因素（P〈0．05）。支架术后再狭窄发生概率的预测表结果显示冠心病合并糖尿病患者再狭窄发生概率首要依赖于参考血管直径。结论冠心病合并糖尿病患者支架术后再狭窄发生概率显著增加。参考血管直径、病变长度和需要胰岛素治疗是冠心病合并糖尿病患者支架术后再狭窄的可预见危险因素。非糖尿病患者合并短病变（〈15mm）而无论参考血管直径,糖尿病患者合并冠状动脉大直径血管（〉3．0mm）合并短病变（〈15mm）预期再狭窄发生率〈15％,可以考虑使用金属裸支架。除此之外,建议使用药物洗脱支架。     

冠状动脉内支架植入术及其术后再狭窄的防治研究近况

本文综述了目前冠状动脉支架的种类、理想支架的特点及冠脉内支架置入术的适应症、并发症及其处理方法,以及术后再狭窄的发病机制、影响因素、防治方法与改进措施。     

可溶性CD40L(sCD40L)可作为预测急性冠脉综合症危险性的一项新指标

CD40L是肿瘤坏死因子超基因家族的一种,它是各种免疫与炎症调节的重要通路,包括调节动脉粥样硬化的演变.已有研究证实在动脉粥样硬化斑块内、血管内皮细胞、血管平滑肌细胞、巨噬细胞,循环中的血小板中可出现CD40L的表达.循环中出现的可溶性CD40L可能主要来源于血小板及T淋巴细胞.CD40L在急性冠脉综合征的作用与其产生的生物学效应有关.有研究发现CD40L可刺激血管内皮细胞、巨噬细胞及血管平滑肌细胞产生与动脉粥样硬化有关的生物活性因子,如E选择素、血管粘附分子、细胞因子等.CD40L还可通过调节粥样斑块的金属蛋白酶表达影响斑块的稳定性.越来越多的研究显示炎症与免疫在动脉粥样硬化的发生、发展中起着重要的作用,并且提示动脉粥样硬化可能是一种慢性炎症性疾病,炎症反应的激活可导致斑块的不稳定,从而引起急性冠脉综合征的发生.     

Risk factors for in-stent restenosis after coronary stent implantation in patients with coronary artery disease: A retrospective observational study

To explore the risk factors for in-stent restenosis (ISR) after stent implantation in patients with coronary heart disease (CHD) using logistic regression analysis. From February 2020 to February 2022, 350 patients with CHD after percutaneous coronary intervention (PCI) were divided into a stent stenosis group and a stent nonstenosis group based on coronary angiography results performed 2 years after PCI. Univariate and multivariate logistic regressions were used to analyze the factors related to ISR after coronary stent implantation in patients with CHD. This study was approved by the Ethics Committee of Shandong University of Traditional Chinese Medicine. Patient signed informed consent. Of the 350 patients with CHD, 138 (39.43%) had stent restenosis while 212 did not. Univariate analysis showed that a family history of CHD, history of type 2 diabetes, hypertension, smoking, and drinking, discontinuation of aspirin, use of conventional dose statins, calcified lesions, ≥ 3 implanted stents, stent length ≥ 30 mm, stent diameter < 3 mm, and tandem stent increased the risk of restenosis. The incidence of restenosis was higher in the stent group than that in the nonstent group (P < .05). There were no significant differences in the blood lipid level, left ventricular ejection fraction, clopidogrel/ticagrelor or beta-blocker withdrawal, location of culprit vessels, and thrombotic lesions between the 2 groups (P > .05). Multivariate logistic regression analysis showed that family history of CHD, history of type 2 diabetes, hypertension, smoking, and drinking, aspirin withdrawal, use of conventional doses of statins, calcified lesions, ≥ 3 implanted stents, stent length ≥ 30 mm, stent diameter < 3 mm, and tandem stenting were risk factors for ISR within 2 years after PCI. A family history of CHD, history of type 2 diabetes, hypertension, smoking, and drinking, discontinuation of aspirin, use of conventional dose statins, calcified lesions, ≥ 3 stent implantations, stent length ≥ 30 mm, stent diameter < 3 mm, and tandem stenting are risk factors for ISR within 2 years after PCI in patients with CHD.     

Usefulness of preprocedural soluble CD40 ligand for predicting restenosis after percutaneous coronary intervention in patients with stable coronary artery disease

CD40-CD40 ligand interaction is involved in the inflammatory pathogenesis of atherosclerosis but clinical data about its role in stent restenosis are still limited. We investigated the effect of preprocedural CD40 ligand (sCD40L) on stent restenosis. We enrolled 36 patients (mean age 61.4 +/- 8.5 years) with stable angina who underwent successful stent implantation. Control angiograms were performed in all patients after 6 months. Plasma sCD40L and high-sensitive C-reactive protein levels were measured before stent implantation and at 1 and 6 months after the procedure. Angiographically proven restenosis rate was 27.8%. Plasma sCD40L levels were significantly higher (preprocedural 0.74 +/- 0.79) and more prolonged in patients with stent restenosis compared with patients without stent restenosis (0.02 +/- 0.22 ng/ml, p < 0.001). According to receiver-operator characteristic analysis, sCD40L > 0.41 ng/ml was the best distinguished parameter between patients with and without restenosis. At the multivariate logistic regression analysis, preprocedural sCD40L was an independent predictor (RR 39.4, 95% confidence interval 4.05 to 383.8, p = 0.002) of stent restenosis after adjusting for confounding variables, including diabetes, reference vessel diameter, lesion length, stent diameter, stent length, and baseline high-sensitive C-reactive protein. Sensitivity, specificity, and positive and negative predictive values and likelihood ratio of preprocedural sCD40L levels in stent restenosis were 78%, 92%, 78%, 92%, and 9.37%, respectively. In conclusion, enhanced inflammation of plaque (increased sCD40L) before percutaneous coronary intervention may increase the rate of stent restenosis. Increased preprocedural sCD40L level is an independent predictor of stent restenosis. We can use this marker for the assessment of risk stratification before planning stent implantation.     

冠心病合并2型糖尿病患者经皮冠状动脉介入治疗前后CD40L、P选择素水平及临床意义

目的探讨冠心病(CHD)合并2型糖尿病(T2DM)患者经皮冠状动脉介入治疗(PCI)前后CD40配体(CD40L)、P选择素(Ps)水平的变化及其临床意义。方法入选CHD合并T2DM患者36例作为试验组,另入选CHD 36例作为对照组。入选者于PCI术前、术后即刻、2h、6h、24h采血测CD40L、Ps。结果试验组CD40L、Ps水平在PCI术前及术后即刻、2h、6h、24h均高于对照组,在术前及术后24h明显高于对照组(P<0.05)。组内比较,试验组CD40L及Ps在术后即刻较术前明显增高(P<0.05),而于术后2h、6h、24h逐渐回落,但水平仍高于术前;对照组CD40L及Ps在术后即刻亦明显增高(P<0.05),但于2h、6h、24h回落较快,24h水平同术前相似,与术后即刻有显著性差异(P<0.05)。结论CHD合并T2DM患者CD40L和Ps两种因子水平高于单纯CHD患者;CHD合并T2DM患者行PCI治疗可导致CD40L和Ps术后即刻明显增高,此后逐渐回落,在术后24h基本可降至术前水平,但同CHD患者相比较,CD40L和Ps无论术前术后均处于较高水平。     

血管内支架在冠状动脉复杂病变中的临床应用

因冠状动脉复杂病变或经皮冠状动脉腔内成形术（PTCA）并发内膜夹层12例，成功植入冠状动脉支架（CS）17支，取得显著临床效果，且并发症少。初步结果提示，冠心病介入治疗中选择性应用CS，有益于PTCA后急性并发症的防治，亦可减少冠状动脉再狭窄的形成。     

高负荷剂量氯吡格雷对急性冠脉综合征患者介入治疗后血清sCD40L和hs-CRP浓度的影响

目的探讨高负荷剂量氯吡格雷对急性冠脉综合征(acute coronary syndrome,ACS)患者介入治疗后血清sCD40L和高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)水平的影响。方法选择ACS患者190例分为高负荷剂量组94例(首剂负荷剂量600 mg,以后每天氯吡格雷150 mg,共用7 d,而后以每天氯吡格雷75 mg维持治疗)和标准剂量组96例(首剂负荷剂量300 mg,以后每天氯吡格雷75 mg维持治疗)。于服氯吡格雷前,经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗前,术后第1天,术后第7天,术后第30天血清sCD40L和hs-CRP的浓度,并记录患者术后1、3、6个月发生主要心血管事件、出血事件的情况。结果高负荷剂量组PCI治疗后不同时间点血清可溶性CD40配体(sCD40L)、hs-CRP浓度均低于标准剂量组,差异有统计学意义(P<0.05)。sCD40L与hs-CRP的变化趋势的相关性检验结果显示两者呈正相关(皮尔森相关系数r=0.128,P<0.001)。结论高剂量氯吡格雷比标准剂量氯吡格雷对sCD40L、hs-CRP的抑制作用更强;当氯吡格雷抑制炎症反应产物hs-CRP产生的同时也会抑制炎症产物sCD40L的产生。     

冠心丹参滴丸对冠心病支架置入术后再狭窄的防治作用

目的观察冠心丹参滴丸对冠心病支架置入术后再狭窄的疗效及其作用机制。方法将60例行冠脉支架置入术治疗的冠心病患者随机分为观察组与对照组各30例,对照组在支架置入术后予常规西药治疗,观察组在常规西药治疗基础上加用冠心丹参滴丸。观察术后6个月再狭窄发生率、心血管事件发生率、临床症状变化,并比较术后心室功能及血清IL-18、hs—CRP水平。结果术后6个月,观察组中医症候总有效率高于对照组（P〈0．05）;不良心血管事件发生率低于对照组（P〈0．05）;室壁运动指数、左室射血分数及IL-18、hs—CRP水平两组比较有统计学差异（P均〈0．05）。结论冠心丹参滴丸可以降低冠脉介入术后再狭窄率。     

冠状动脉内支架置入术在冠心病治疗中的价值

目的 评价冠状动脉内支架置入术在冠心病治疗中的临床应用价值。方法 对157例206支冠状动脉病变内置入203只支架，其中置入左前降支103只，右冠状动脉57只，左回旋支42只，左主干1只。结果 157例全部置入成功。置入后经冠状动脉造影证实狭窄消失，效果良好。其中5例急性心肌梗死患者由于急诊置入支架后，病情迅速缓解。择期冠状动脉支架置入术全部置入成功，无一例发生严重并发症。结论 冠状动脉内支架置入术是治疗冠心病的一种安全可靠、效果良好的介入性治疗方法、有良好的应用价值。     

药物洗脱支架治疗糖尿病多支冠脉病变

目的 探讨药物洗脱支架治疗糖尿病多支冠脉病变患者的安全性和可行性,并与冠脉旁路移植术的疗效进行比较.方法 150例糖尿病多支冠脉病变患者,84例行药物洗脱支架置入术(DES组),66例行冠脉旁路移植术(CABG组).比较两组住院期和随访期不良心血管事件(死亡、心肌梗死、再次血管重建术和脑血管意外)的发生情况.结果 两组的大多数临床和冠脉病变特征相似,CABG组左主干病变(30%比4%,P=0.001)和三支病变(70%比54%,P=0.045)显著增多,完全血管重建化率更高(82%比67%,P=0.037).住院期CABG组术后病死率显著增高(6.1%比0%,P=0.022),但两组总体不良心血管事件发生率仍相似(2.4%比9.1%,P=0.069).在平均(18±8)个月随访期,DES组再次血管重建化率显著增加(13.1%比3.0%,P=0.03),导致总体不良心血管事件发生率增高(21.4%比9.1%,P=0.041),其中相当部分(45%)由于病变进展所致.结论 药物洗脱支架置入术应用在糖尿病多支冠脉病变患者中安全可行,缩小了再次血管重建化发生率上与冠脉旁路移植术的差距.     

Significance of chemokines and soluble CD40 ligand in patients with autoimmune thrombocytopenic purpura

We investigated the levels of various chemokines and soluble CD40L (sCD40L) in ITP patients, in order to determine the influence of CD40-CD40L interaction on the pathogenesis of ITP. We found increases in MCP-1 and RANTES levels in ITP patients compared with those in healthy individuals. Thirty-eight of the 65 ITP patients (58.5%) had elevated levels of sCD40L. We found significant decreases in platelet counts in sCD40L-positive ITP patients. Although the sCD40L level did not differ significantly between the control and nonimmune thrombocytopenia groups, but among ITP patients. sCD40L level was significantly higher in those with untreated ITP than in those with treated ITP. In addition, significant increases in RANTES, MCP-1, sCD14, and sP-selectin levels were observed in sCD40L-positive ITP patients, although sE-selectin levels were not increased in such patients. For other factors examined, however, there were no differences in level between sCD40L-positive and -negative ITP patients. These findings suggests that there are two groups of ITP patients, one with elevated and one with normal of sCD40L. ITP cases in which sCD40L was increased appeared to involve changes in platelet counts and monocyte activation. The pathogenesis of ITP may in some patients include alterations of the CD40/CD40L pathway.     

Plasma levels of C-reactive protein after coronary stent implantation.

AIMS: This study was designed to investigate the role of inflammation on the occurrence of angiographic restenosis 6 months after coronary stent implantation and the influence of different kinds of antithrombotic and antiplatelet strategies on inflammation. METHODS AND RESULTS: In an open randomized trial, 40 consecutive patients were treated with aspirin (100 mg. day(-1)) and either ticlopidine (2x250 mg. day(-1)) (n=17), or phenprocoumon (INR 2.0-3.0) and dipyridamole (3x160 mg. day(-1)) (n=23) after successful elective coronary stent implantation. Plasma levels of C-reactive protein were determined one day before stent implantation and serially thereafter twice daily up to 120 h. C-reactive protein plasma levels increased significantly (P<0.0001) after stent implantation. Phenprocoumon and dipyridamole or ticlopidine had no effect on C-reactive protein plasma levels (P=0.51) or the occurrence of angiographic restenosis (P=0.48). C-reactive protein plasma levels were significantly higher in patients with lesion type C compared to types A or B (P=0.035), respectively. C-reactive protein plasma levels were significantly higher and mean shoulder levels occurred 48 h later in patients with restenosis compared to patients without restenosis after 6 months (P=0.038). CONCLUSIONS: Elevated C-reactive protein plasma levels still persisting 96 h after stent implantation might reflect a prolonged inflammatory reaction to coronary stent implantation which might causally be involved in pathophysiological mechanisms leading to restenosis.