老年急性冠脉综合征患者血浆P选择素、糖蛋白/Ⅲa、纤维蛋白原和高敏C反应蛋白的变化及临床意义

目的 观察老年急性冠脉综合征(ACS)患者血浆血小板活化指标P选择素(CD62p)、糖蛋白(GP)Ⅱb/Ⅲa、纤维蛋白原(FIB-C)和血管内炎症指标高敏C反应蛋白(hs-CRP)的变化及其临床意义.方法 100例ACS患者晨起空腹抽肘静脉血用流式细胞仪检测定血清CD62p和GPⅡb/Ⅲa受体复合物的表达水平;用散射比浊法测定血浆FIB-C的水平;用乳胶免疫增强比浊法试剂盒测定血清hs-CRP的水平.选择健康体检者40例和稳定型心绞痛(SAP)患者50例进行对照.结果 ACS患者中不稳定型心绞痛(UAP)组血浆CD62p、GPⅡb/Ⅲa、 FIB-C和hs-CRP的表达水平均明显高于健康对照组(均P<0.01)和SAP组(P<0.05);急性心肌梗死(AMI)组明显高于UAP组(P<0.05).冠脉病变程度不同上述指标也有所不同,急性闭塞组(AMI组)高于UAP组的三支病变组(均P<0.05),三支病变组高于双支病变组(均P<0.05),双支病变组较单支病变组也明显增高(P<0.05).ACS合并糖尿病或糖耐量异常的患者血清CD62p、GPⅡb/Ⅲa、 FIB-C和hs-CRP水平均明显高于血糖正常的ACS组(P<0.05,P<0.01),且血小板活化程度和炎症因子的表达水平呈正相关.结论 老年ACS患者CD62P、GPⅡb/Ⅲa、FiB-C及hs-CRP的浓度明显升高,且与冠心病类型和冠脉病变程度以及血糖水平有关系.高血糖状态可以激活血小板活化因子和炎症反应因子.     

雷尼替丁对冠心病患者介入治疗后双重抗血小板治疗所致消化道出血和血栓事件的影响

目的探讨雷尼替丁对冠心病(CHD)患者介入治疗(PCI)后双重抗血小板治疗对消化道出血和血栓事件的影响。方法选择2008年4月-2009年9月在本院住院治疗的200例冠心病患者,PCI术后随即分为常规治疗组(简称常规组100例,包括阿司匹林、氯比格雷,他汀类药物等)和雷尼替丁治疗组(简称雷尼替丁组100例,在常规治疗基础上加雷尼替丁),两组病例在PCI术后次日凌晨分别空腹抽肘静脉血,用流式细胞仪检测定血清CD62p和GPⅡb/Ⅲa的水平;用电阻抗法(impedance platelet aggregometry,IPA)检测ADP诱导的血小板聚集率;用散射比浊法测定血浆FIB-C的水平,选择健康体检者100例作对照,雷尼替丁治疗12周后复查上述指标与对照组进行比较,随访观察消化道出血和血栓事件(包括急性心肌梗死,脑卒中,心源性猝死)。结果冠心病患者血清CD62p、GPⅡb/Ⅲa和血浆FIB-C以及血小板聚集率较健康对照组明显增高(均P<0.01),PCI术后CD62p、GPⅡb/Ⅲa和FiB-C以及血小板聚集率与术前相比也明显增高(分别为P<0.01,P<0.05,P<0.01,P<0.05,),雷尼替丁组和对照组分别治疗12周后,CD62p、GPⅡb/Ⅲa、FiB-C和血小板聚集率均有较PCI前或PCI后均显著下降(均P<0.01),但两组之间无统计学差异(均P>0.05),随访6个月,雷尼替丁组和对照组各出现3例血栓事件,雷尼替丁组未见消化道出血的发生,而对照组出现8例消化道出血。结论雷尼替丁可预防CHD患者PCI后双重抗血小板药物所致消化道出血并发症的发生,未见干扰氯比格雷抗血小板活性及增加血栓事件的发生。     

络泰注射液对慢性肺源性心脏病病人血小板活化功能的影响

目的观察络泰注射液对慢性肺源性心脏病活化血小板的影响。方法应用洛秦注射液:应用流式细胞仪(FCM)对62例慢性肺源性心脏病人和60名健康体检者进行血小板活化功能的检测,测定血小板活化依赖性颗粒膜蛋白(CD62p)、血小板糖蛋白GPⅡb/GPⅢa复合物的数值。对照组CD62p,GPⅡb/GPⅢa复合物的变化以及应用洛秦注射液;治疗组用药前后CD62p,GPⅡb/GPⅢa复合物的变化。结果慢性肺源性心脏病病人CD62p较对照组升高(P<0.05);治疗组治疗后其CD62p的均值(2.51±0.68)较对照组(2.89±0.92)下降;治疗组治疗后GPⅡb/GPⅢb的均值(92.72±7.15)较对照组的(98.81±8.53)下降,治疗后治疗组CD62p、GPⅡb/GPⅢb均较治疗前明显下降(P<0.05)。结论肺心病病人存在血小板功能活化;络泰注射液对肺心病病人血小板的活化具有抑制作用。     

冠心病患者阿司匹林抵抗与血小板膜糖蛋白CD62p及GPⅡb/Ⅲa相关性的研究

目的:观察冠心病(CHD)患者阿司匹林治疗前后血小板膜糖蛋白CD62p和GPⅡb/Ⅲa的变化,探讨其与阿司匹林抵抗(AR)的关系。方法:采用流式细胞术检测60例CHD患者(CHD组)及20例健康人(对照组)的血小板CD62p、GPⅡb/Ⅲa表达的阳性率。根据血小板聚集率(PAG)将CHD组分为AR亚组和阿司匹林敏感亚组(AS亚组)。60例CHD患者接受阿司匹林(100mg,qd)等治疗,2周后复检CD62p、GPⅡb/Ⅲa,并采用比浊法分别测定由二磷酸腺苷(ADP)、花生四烯酸(AA)诱导的PAG。结果:CHD患者治疗后血小板CD62p、GPⅡb/Ⅲa表达阳性率均比治疗前明显降低(P<0.01),但仍高于对照组(P<0.01)。入选60例CHD患者中有8例(13.3%)存在AR。AR亚组血小板GPⅡb/Ⅲa表达阳性率高于AS亚组(P<0.01)。结论:GPⅡb/Ⅲa可作为CHD患者阿司匹林治疗中早期识别AR的指标之一。     

通心络胶囊对急性冠脉综合征介入治疗不同时期血小板活化和内皮功能以及预后的影响

目的探讨通心络胶囊对急性冠状动脉综合征(ACS)患者介入治疗后不同时期血小板活化状态和内皮功能以及预后的影响。方法 160例ACS患者随机分为通心络胶囊治疗组(80例)和常规治疗组(80例),并设健康对照组50名,分别检测血浆血小板活化因子CD62p、CD63和糖蛋白(G)Ⅱb/Ⅲa水平,测定反映血管内皮功能的血浆血管性假血友病因子(vWF),内皮素1(ET-1)和一氧化氮(NO),并测量内皮依赖性血管舒张功能(FMD)。并在服用通心络胶囊治疗2个月和6个月后分别复查上述指标并进行治疗前后比较及两组间比较。结果与健康对照组比较,ACS患者血小板活化指标CD62p、CD63及GPⅡb/Ⅲa受体复合物、vWF因子及ET-1显著升高(P<0.01),NO及FMD显著降低(P<0.01)。且冠脉介入术后CD62p、CD63、GPⅡb/Ⅲa受体复合物及vWF因子升高较术前也升高(P<0.05),FMD降低(P<0.05),但ET-1和NO差异无统计学意义(P>0.05)。治疗2个月和6个月后,常规组和通心络胶囊组CD62p、CD63、GPⅡb/Ⅲa及vWF因子、ET-1均较治疗前显著下降(P<0.05,P<0.01)、NO和FMD增加(P<0.05,P<0.01)。与常规治疗组比较,通心络组CD62p、CD63、GPⅡb/Ⅲa复合物、vWF因子以及ET-1的水平降低更明显(P<0.05,P<0.01),NO和FMD的水平明显增加(均P<0.01),治疗6个月与治疗2个月比较以上指标变化更明显(P<0.05,P<0.01)。常规治疗组6个月发生心绞痛7例,心力衰竭6例,室速/室颤3例,猝死发生2例,而通心络治疗组6个月发生心绞痛1例,心力衰竭1例,无室速/室颤和猝死的发生。结论通心络胶囊可用于ACS患者介入治疗后预防和治疗冠脉内血栓及保护血管内皮功能,改善预后。     

急性冠状动脉综合征患者介入术前后血小板活化及血管内皮功能的变化

目的观察急性冠状动脉综合征患者介入治疗后血小板活化指标CD62p、CD63及糖蛋白Ⅱb/Ⅲa受体复合物及内皮功能的改变。方法60例急性冠状动脉综合征患者在冠状动脉介入术前和术后即刻以及次日采用流式细胞仪检测血小板活化指标CD62p、CD63及糖蛋白Ⅱb/Ⅲa受体复合物;双抗体夹心固相酶联免疫吸附试验测定血浆假血友病因子的表达水平;放射免疫测定法测定血浆内皮素1表达水平;酶法测定血浆一氧化氮的含量;彩色多谱勒超声诊断仪测量内皮依赖性血管舒张功能。选择健康体检者和稳定型心绞痛患者各30例作对照,观察急性冠状动脉综合征患者冠状动脉介入前后指标的变化并与对照组比较。结果与健康对照组和稳定型心绞痛组比,急性冠状动脉综合征组CD62p、CD63及糖蛋白Ⅱb/Ⅲa受体复合物明显增高(P<0.05或0.01);急性冠状动脉综合征患者介入术后即刻CD62p、CD63和糖蛋白Ⅱb/Ⅲa受体复合物与术前相比明显增高(P<0.01),但术后24h较术前无明显变化(P>0.05)。与健康对照组和稳定型心绞痛组比,急性冠状动脉综合征组假血友病因子、内皮素1的表达水平明显增高(P<0.01),内皮依赖性血管舒张功能和一氧化氮降低(P<0.05或<0.01);急性冠状动脉综合征患者介入术后即刻血浆假血友病因子和内皮素1水平升高(P<0.05或P<0.01),内皮依赖性血管舒张功能和一氧化氮水平降低(P<0.05),且介入术后24h假血友病因子水平也较术前升高(P<0.05),内皮依赖性血管舒张功能降低(P<0.05),但内皮素1和一氧化氮水平与术前差异无显著性(P>0.05)。结论血小板活化和内皮功能的损伤在急性冠状动脉综合征发生和发展过程中起重要的作用,冠状动脉介入术后血管内皮受到一定损伤,血小板有一定程度的激活。     

通心络对急性冠状动脉综合征患者介入术后血小板活化及血管内皮功能的影响

目的评价通心络胶囊对急性冠状动脉综合征(ACS)介入治疗术后血小板活化状态及血管内皮功能的影响。方法90例ACS患者(ACS组)随机分为通心络胶囊治疗组(45例)和常规治疗组(45例),另选健康对照组45例,分别检测血小板表面活性标记蛋白CD62P、CD63和膜糖蛋白(GP)Ⅱb/Ⅲa,测定血浆血管性假血友病因子(vWF),并测量内皮依赖性血管舒张功能(FMD)。服用通心络胶囊治疗8周后复查上述指标并进行治疗前后比较及两组间比较。结果与健康对照组比较,ACS组患者血小板活化指标CD62P、CD63及GPⅡb/Ⅲa受体复合物显著升高(P<0.01),vWF显著升高(P<0.01),FMD显著降低(P<0.01)。冠状动脉介入术后vWF升高(P<0.05),FMD降低(P<0.05)。与常规治疗组比较,通心络胶囊治疗组更明显降低CD62P、CD63、vWF(P<0.05)及GPⅡb/Ⅲa复合物(P<0.01),增加FMD的水平(P<0.05)。结论通心络胶囊可用于冠状动脉介入术前后预防和治疗冠状动脉内血栓及保护血管内皮功能。     

不稳定心绞痛冠脉病灶特征与血小板膜糖蛋白Ⅱb/Ⅲa受体表达率的联系

目的 :确立冠状动脉造影所示病灶特征与血小板膜GPⅡb Ⅲa受体表达率的联系。方法 :临床诊断为不稳定性心绞痛 (UAP)患者 31例 ,根据冠状动脉造影下病灶特征分为 :复杂病变组和简单病变组 ,流式细胞仪检测每例患者外周血糖蛋白 (GP)Ⅱb Ⅲa受体呈阳性表达的血小板比率 ,比较组间GPⅡb Ⅲa受体表达差异。 9例健康成人作健康观察组。结果 :冠脉造影示对应于心电图变化的罪犯病灶19例为复杂病变 ,12例为简单病变。复杂病变组血小板膜GPⅡb Ⅲa受体表达率 (5 9± 1 6 ) % ,显著高于简单病变组 2 2± 0 8% (P <0 0 1)。结论 :UAP患者冠造显示为复杂性病变者多伴有血小板膜GPⅡb Ⅲa受体表达率增加 ,可能更适合强化抗血小板治疗     

血小板膜糖蛋白和D-二聚体变化与老年冠心病合并高血压患者的研究

目的探讨老年冠心病合并高血压患者体内血小板膜糖蛋白(GP)、D-二聚体的变化及意义。方法选择老年冠心病患者116例,其中稳定性心绞痛(SAP)患者36例(SAP组),不稳定性心绞痛(UAP)患者38例(UAP组),UAP合并高血压患者42例(高血压组),健康体检者48例(对照组),冠心病患者根据有无心绞痛事件发生分为有心绞痛事件发生56例和无心绞痛事件发生60例。分别测定各组体内D-二聚体、GP水平,分析有无心绞痛事件发生之间的差异,检测其与心绞痛事件发生的敏感性。结果高血压组、UAP组D-二聚体、GP水平明显高于SAP组、对照组(P<0.05,P<0.01);高血压组D-二聚体、GP水平明显高于UAP组(P<0.05);有心绞痛事件发生患者D-二聚体、GP水平明显高于无心绞痛事件发生患者(P<0.01);有心绞痛事件阳性检出率D-二聚体、GPⅡb、GPⅢa敏感性较GPⅠb明显增高。结论 GP、D-二聚体在老年冠心病合并高血压患者心绞痛事件发生中起重要的作用,D-二聚体、GPⅡb、GPⅢa可以作为预测心绞痛事件发生较为敏感的指标。     

氯吡格雷、阿司匹林对高血压患者血小板微粒CD62p、GPⅡ b/Ⅲa的影响

目的 探讨血小板膜糖蛋白微粒CD62p、GPⅡb/Ⅲa与高血压的关系,以及抗血小板药物对其影响.方法 采用流式细胞术（FCM）和单克隆抗体标记法,检测60例高血压患者、20名健康对照者的血液标本,以20 μmol/L ADP为激活剂激活血小板,30例服用阿司匹林,30例服用氯吡格雷,检测高血压患者血小板膜糖蛋白微粒CD62p、GPⅡb/Ⅲa水平,观察药物对其的作用.结果 高血压组CD62p、GPⅡb/Ⅲa的百分率（85.3%±11.2%、91.6±12.4%）比正常对照组高（69.8%±8.9%、72.5%±10.2%）,P＜0.01,服用阿司匹林组CD62p、GPⅡb/Ⅲa的百分率降至（64.2%±9.6%、69.2%±9.8%）,P＜0.05与服药前有显著性差异,服用波立维组CD62p、GPⅡb/Ⅲa的百分率降至（39.8%±10.2%、32.8%±11.6%）,P＜0.01与服药前比较有显著性差异.结论 高血压与血小板膜糖蛋白微粒CD62p、GPⅡb/Ⅲa 的表达存在一定的联系,阿司匹林、氯比格雷可降低血小板微粒CD62p、GPⅡb/Ⅲa水平.     

Atherosclerosis of coronary arteries, coronary heart disease and sudden coronary death

Correlation between the severity of coronary atherosclerosis, thrombosis and sudden cardiac death was examined in 721 autopsied cases. Severe coronary atherosclerosis with stenosis was found in most of them; however a similar grade of atherosclerosis was discovered in patients with ischaemic heart disease not dying suddenly. Acute coronary thrombosis in the studied subjects was diagnosed post mortem in about 20 percent of those who died suddenly. Other studies indicate frequencies between 4-93%. There was no consistent time dependence.     

冠脉微循环与冠心病

冠心病急性心肌梗死的再灌注治疗是现代医学发展的里程碑,它使被动、保守治疗转为积极、主动的血运重建,随着包括静脉溶栓、冠状动脉内溶栓、经皮冠状动脉腔内成形术(PTCA)、冠状动脉内支架置入术以及冠状动脉搭桥术等再灌注治疗技术的成熟、普及,挽救了无数患者的生命.     

Value of combined coronary angioplasty and coronary angiography

Combined coronary angioplasty and coronary angiography is performed in most catheter laboratories and has become a routine procedure. The aim of this study was to assess its clinical results and economic value. This was a retrospective monocenter study performed over an 11 year period (1990-2000) which included 2,727 patients requiring coronary angioplasty after coronary angiography. The angioplasty procedure was performed at the same time as angiography (combined, n = 1,809) or after angiography (deferred, n = 631). Patients admitted for acute coronary syndromes not stabilised by pharmacological interventions were excluded from the study. The comparison of these two modes of angioplasty was based on primary success rates, complications, duration of hospital stay and hospital costs. The combined procedure was used progressively more frequently over the study period, increasing from 54% to 88% in 2000. The hospital clinical results (Success and complication rates) were comparable in the two groups. The predictive factors of failure were the year of the angioplasty procedure and occlusive lesions on multivariate analysis. The combined procedure was associated with a shorter hospital stay than deferred angioplasty (8.2 +/- 6.1 days versus 15.0 +/- 8.0 days, p = 0.0001) and with lower costs. The authors conclude that combined coronary angiography-angioplasty is as effective and as safe as deferred angioplasty. It is associated with a shorter hospital stay and lower hospital costs.     

冠状动脉256排CT与冠状动脉造影对冠心病的诊断比较

目的冠状动脉256排CT成像技术与冠状动脉造影检查对冠状动脉粥样硬化性心脏病的诊断比较。方法选取2013年5月至2014年5月内蒙古兴安盟人民医院心血管内科疑似冠心病患者50例,其中男性29例,女性21例,年龄37~68岁。先行冠状动脉256排CT扫描及图像后处理,后行冠状动脉造影检查,将两结果进行对比分析。结果以冠状动脉狭窄≥50%者为阳性。冠状动脉256排CT诊断冠心病灵敏度为40.00%,特异度98.18%,阳性预测值88.89%,阴性预测值81.82%,正确指数38.18%,符合率82.67%,KAPPA值46.28%。结论冠状动脉造影诊断冠心病准确性优于冠状动脉CT。冠状动脉CT可对冠心病患者进行初筛诊断。     

壁冠状动脉心肌桥的造影和临床分析

目的:观察、分析壁冠状动脉(冠脉)和心肌桥的临床特点与诊断、治疗方法。方法:观察、分析经冠脉造影确诊的96例109处心肌桥患者的心肌桥分布特点、临床症状、心电图、心肌酶谱、肌钙蛋白T、心脏超声,评价药物或支架治疗心肌桥的疗效。结果:心电图、临床症状、心肌酶谱、肌钙蛋白T和心脏超声对心肌桥的诊断均无特异性。造影发现93.7%的心肌桥发生于冠脉前降支(LAD)。心肌桥患者临床症状与收缩期狭窄程度有关。药物治疗、手术治疗均有一定疗效。结论:冠脉造影发现"收缩期狭窄"为目前确诊心肌桥的主要方法。心肌桥与心绞痛、动脉粥样硬化、心肌梗死的发生有密切关系。药物治疗可选用肾上腺素β受体阻滞剂和Ca2+拮抗剂。     

Combined dissection of the right coronary artery and right coronary cusp during coronary angiography

Dissection of coronary arteries during diagnostic coronary angiography is infrequent; dissection of the coronary cusp is extremely rare. The combination of coronary artery and coronary cusp dissection has not been reported previously. A case of right coronary artery dissection and right coronary cusp dissection during diagnostic coronary angiography is described. © 1995 Wiley-Liss, Inc.     

Serial quantitative coronary angiography and coronary events

BACKGROUND: Although assessment of progression of atherosclerosis by quantitative coronary angiography (QCA) is used as a surrogate for coronary events, no validation study has compared the several QCA measures used. METHODS AND RESULTS: The Cholesterol Lowering Atherosclerosis Study was a clinical trial testing the efficacy of colestipol-niacin on the progression of coronary atherosclerosis. Baseline/2-year coronary angiograms were obtained on 156 men with prior coronary artery bypass graft surgery. Changes in percent diameter stenosis and minimum lumen diameter (both measured in coronary lesions and segments) and coronary segment measures of average diameter, percent involvement, and vessel edge roughness were measured by QCA. Coronary events ascertained over 12 years of follow-up included myocardial infarction (MI), coronary death, and coronary artery revascularizations. Proportional hazards models evaluated the relation between QCA change measures and coronary events. Changes in percent diameter stenosis and minimum lumen diameter of coronary artery lesions were significantly related to the risk of MI/coronary death. All QCA measures were significantly related to the risk of any coronary event. Relative risks for each QCA measure were of similar magnitude when estimated separately within each treatment group. Change in minimum lumen diameter of lesions was the only measure independently associated with the risk of coronary events. CONCLUSIONS: All QCA measures of progression of coronary artery disease were related to all coronary events (including revascularizations). Only QCA measures of lesion progression were related to MI/coronary death. QCA measures of lesion change may be better surrogate end points for "hard" coronary events than measures of change in coronary segments.