老年冠心病367例临床分析

目的探讨老年冠心病的临床特点.方法对2001年1月～2004年12月收治的367例老年冠心病住院患者的临床资料进行回顾性分析.结果 367例患者的临床表现为,无明显症状42例、单纯心绞痛92例、单纯心肌梗死56例、单纯心律失常66例、心绞痛或心肌梗死合并心律失常74例、心绞痛或心肌梗死合并心功能不全37例.79例有心肌梗死的病例中,47例表现为Q波心肌梗死;32例表现为非Q波心肌梗死;140例有心律失常的病例中,部分病例有多种心律失常表现,其中房颤51例、室性期前收缩37例、房性期前收缩34例、室内传导阻滞27例、房室传导阻滞12例、病窦综合征8例.结论老年冠心病具有无症状型冠心病多、心绞痛症状不典型者多、心律失常检出率高、易合并心功能不全、多种类型的冠心病合并出现者多、非Q波型心肌梗死发生率高等临床特点.     

The value of exercise tests after acute myocardial infarction.

The aim of the present study was to relate the clinical course in patients after a first acute myocardial infarction with the response to exercise-tests performed one month after discharge. 90 consecutive patients who suffered an acute myocardial infarction for the first time were followed-up after 12 months in general practice. Six patients had died, and nine patients had suffered another MI. 23 patients were being treated for heart failure, 51 for angina pectoris, and 8 for arrhythmias. 14 patients received treatment for both heart failure and angina pectoris. Of the patients at work, 17.6% did not return to work because of the heart disease. 80 patients were in function groups I-II and 10 in function groups III-IV (New York Heart Association's Classification). Occurrence of ST-segment displacements was without prognostic value. Left ventricular function index (dRPP) and working capacity (W) were predictive with respect to mortality, heart failure, and angina pectoris requiring drug treatment. Exercise tests following acute myocardial infarction could not predict the chances of returning to work.     

心肌肌钙蛋白Ⅰ和肌钙蛋白T对急性缺血性心脏病预后相关性分析

目的探讨心肌肌钙蛋白I(cTnI)和肌钙蛋白T(cTnT)对急性缺血性心脏病转归的影响。方法对就诊的急性缺血性心脏病患者定性测定入院时及距胸痛发作间隔10h的cTnI和定量测定相同时点的cTnT。同时随访患者发病后1、3、6、12个月的疾病转归,以心绞痛、心肌梗死、心力衰竭、心源性猝死为终点评价指标。结果cTnI或cTnT异常患者与正常者相比较,不稳定型心绞痛、心肌梗死、心力衰竭、心源性猝死的发生率具有显著性差异(P<0.01)。cTnI或cTnT异常与终点事件(不稳定型心绞痛、心肌梗死、心力衰竭、心源性心源性猝死)发生率呈正相关。结论cTnI或cTnT对急性心肌梗死,尤其是微小心肌坏死诊断具有高度的敏感性和特异性,并与急性缺血性心脏病的预后密切相关。     

The comparative value of myoglobin determination in patients with different forms of ischemic heart disease]

The hemagglutination test was used to measure the content of myoglobin (MG) in the blood serum in 92 patients suffering from coronary heart disease (myocardial infarction, unstable and stable angina pectoris). The content of MG turned out a safe indicator attesting to acute myocardial infarction. In complications and spreading of necrosis, the MG level was returning to normal slowly. In patients with angina pectoris, the MG level did not on the average differ from control. However, in patients with unstable angina pectoris, there was an increase of the MG content after long-term attacks and in the development of small-focal necroses in the myocardium.     

冠心病患者血清超敏C反应蛋白测定意义

目的 研究血清超敏C反应蛋白(high sensitivly C reactive protein,hs-CRP)在冠心病患者中的变化及意义。方法 随机选取138例冠心病患者,包括心肌梗塞患者43例,不稳定心绞痛患者45例,稳定心绞痛患者50例,50健康人做对照。应用散射速率比浊法测定血清超敏hsCRP浓度。结果急性心肌梗塞、不稳定心绞痛和稳定性心绞痛患者血清中hsCRP的浓度与正常对照组相比明显增高,差异具有统计学意义(P<0.001),血清hsCRP的P25为2.61mg/L,P50为9.50mg/L,P75为33.40mg/L,冠心病患者的血清hsCRP在各百分位点的分布与正常对照在各百分位点的分布相比有显著性差异(P<0.001)。而急性心肌梗塞患者、不稳定心绞痛和稳定性心绞痛患者之间无显著性差异(P>0.05)。结论 血清hsCRP在冠脉事件发生时增高,可以作为冠脉事件预报,并且是一个独立的心血管疾病危险因素。     

Validation of the Chinese version of the MacNew heart disease health-related quality of life questionnaire

Rationale Patient‐reported outcomes such as health‐related quality of life (HRQL) describe or characterize what patients have experienced as a result of their health care. However, treatment outcome comparisons among different pure or mixed populations of patients with myocardial infarction, angina or heart failure cannot be made using existing coronary heart disease (CHD)‐specific HRQL instruments. Aims and objectives The aim of this study was to evaluate the psychometric properties of the Chinese version of the MacNew in a cohort of Hong Kong patients diagnosed with CHD. Methods Chinese translations of a CHD‐specific HRQL instrument, the MacNew Heart Disease HRQL questionnaire (MacNew), the Short‐form 36 Health Survey and the Hospital Anxiety and Depression Scale were administered to 365 Chinese‐speaking patients with CHD at baseline and again 3 months later (n = 363). The Medical Outcomes Trust Scientific Advisory Committee criteria were used to examine the psychometric properties of the Chinese MacNew Heart Disease HRQL questionnaire. Results The results warrant recommending the use of the MacNew as an outcome measure to enhance treatment evaluation in Chinese patients with CHD and a diagnosis of myocardial infarction, angina or heart failure, substantiating previous psychometric data on the MacNew in a number of different studies in patients speaking seven different languages. Conclusion The MacNew questionnaire may have value as a core CHD questionnaire for treatment outcome comparisons among pure or mixed populations of patients with myocardial infarction, angina or heart failure.     

Elevated plasma procalcitonin level predicts poor prognosis of ST elevation myocardial infarction in Asian elderly

Previous studies have focused on relationship between plasma procalcitonin level and myocardial infarction risk, but this relationship in Asian elderly has not been investigated. The aim of this study was to reveal the association of peripheral procalcitonin concentration (both immediate and average levels) with myocardial infarction prognosis in Asian elderly. A total of 400?ST-elevation myocardial infarction patients, 400 unstable angina patients and 400 controls were included. Plasma levels of high-sensitivity C-reactive protein and procalcitonin were measured using commercially available kits. Each myocardial infarction patient received a standard therapy and a 12-month follow-up unless major adverse cardiac events occurred. On admission, plasma procalcitonin level was higher in myocardial infarction patients than in unstable angina patients and controls (p?r?=?0.650, p?相似文献   

Serum homocysteine does not associate with uncomplicated coronary heart disease

BACKGROUND: Elevated serum homocysteine concentrations have been related to coronary heart disease. However, the association has not indisputably been proven, and the mechanisms by which homocysteine may be atherogenic have only partially been elucidated. The objective of the present study was to investigate whether serum homocysteine is associated with angina pectoris and myocardial infarction. METHODS: We compared serum homocysteine concentrations in subjects with clinical evidence of angina pectoris or history of myocardial infarction to age-matched controls. The study included 248 males, who participated in a large cross-sectional risk factor survey carried out in five geographic areas in Finland. RESULTS: Serum homocysteine concentration was significantly higher in subjects with a history of myocardial infarction compared to controls (15.3 micromol L-1 and 13.9 micromol L-1 respectively, P = 0.037). In a logistic regression model including several cardiovascular risk factors, serum homocysteine was significantly associated with myocardial infarction (95% CI 1.0157-1.2990, P = 0.027). Serum homocysteine concentrations did not differ between subjects with angina pectoris and age-matched controls (13.9 micromol L-1 and 14.2 micromol L-1 respectively). CONCLUSIONS: Our results suggest that elevated serum homocysteine is associated with myocardial infarction but not with uncomplicated coronary heart disease.     

Differentiated prophylaxis of recurrent myocardial infarction

149 patients stated at primarily examination as healthy had subsequently myocardial infarction (MI) at the age of 28-55 years. Preinfarction mean level of the risk factors was 3.3 per a man. For 5 years after MI the patients received differentiated therapy oriented to individual features of ischemic heart disease (IHD). The response was achieved in the majority of patients. To the end of the trial repeated MI occurred in 12.8% of the patients. 80.1% of them had angina pectoris (89.2%-angina of class I and II). 89.3% of the patients were able to work, 87.2% have lowered their mean level of risk factors to 1.5. It is demonstrated that a favourable course of postmyocardial infarction IHD was determined by adequacy of prophylactic measures rather than by health status before MI.     

慢性心绞痛史及梗死前心绞痛对急性心肌梗死心肌损伤及预后的影响

目的探讨有无慢性心绞痛史及梗死前心绞痛对急性心肌梗死患者心肌损伤及预后的影响。方法选择2003年1月至2007年12月确诊为急性心肌梗死而收住院的93例急性心肌梗死患者,根据其急性心肌梗死发病前心绞痛病史情况分为4组,慢性心绞痛组（Ⅰ组）、梗死前心绞痛组（Ⅱ组）、慢性心绞痛伴梗死前心绞痛组（Ⅲ组）、无心绞痛组（Ⅳ组）,分别观察心肌梗死范围,测定心脏肌酸磷酸激酶（CPK）、同功酶（CK—MB）、血清肌钙蛋白（CTnT）、C-反应蛋白（CRP）和尿微自蛋白分泌率（AER）变化,以及住院期间严重心脏并发症（严重心律失常、KillipⅡ级以上心力衰竭、心源性休克）、心源性病死率、梗死后心绞痛发生率。结果小面积心肌梗死前发生率Ⅰ、Ⅱ、Ⅲ组明显高于Ⅳ组,差异有统计学意义（P〈0．05）;CK、CK—MB、CTnT峰值浓度、CRP、AER变化,Ⅰ、Ⅱ、Ⅲ组明显低于Ⅳ组,差异有统计学意义（P〈0．05）;严重心脏并发症,除心律失常外,Ⅰ、Ⅱ、Ⅲ组明显低于Ⅳ组,差异有统计学意义（P〈0．05）,心律失常Ⅱ、Ⅲ组明显低于Ⅰ、Ⅳ组,差异有统计学意义（P〈0．05）;梗死后心绞痛及住院病死率Ⅰ、Ⅱ、Ⅲ组明显低于Ⅳ组,差异有统计学意义（P〈0．05）。结论梗死前有心绞痛史及梗死前心绞痛可减少其后发生急性心肌梗死时心肌损伤的程度,并影响预后。     

The effect of the COVID-19 pandemic on emergency department visits for serious cardiovascular conditions

ObjectiveWe examine how emergency department (ED) visits for serious cardiovascular conditions evolved in the coronavirus (COVID-19) pandemic over January–October 2020, compared to 2019, in a large sample of U.S. EDs.MethodsWe compared 2020 ED visits before and during the COVID-19 pandemic, relative to 2019 visits in 108 EDs in 18 states in 115,716 adult ED visits with diagnoses for five serious cardiovascular conditions: ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), ischemic stroke (IS), hemorrhagic stroke (HS), and heart failure (HF). We calculated weekly ratios of ED visits in 2020 to visits in 2019 in the pre-pandemic (Jan 1-March 10), early-pandemic (March 11–April 21), and later-pandemic (April 22–October 31) periods.ResultsED visit ratios show that NSTEMI, IS, and HF visits dropped to lows of 56%, 64%, and 61% of 2019 levels, respectively, in the early-pandemic and gradually returned to 2019 levels over the next several months. HS visits also dropped early pandemic period to 60% of 2019 levels, but quickly rebounded. We find mixed evidence on whether STEMI visits fell, relative to pre-pandemic rates. Total adult ED visits nadired at 57% of 2019 volume during the early-pandemic period and have only party recovered since, to approximately 84% of 2019 by the end of October 2020.ConclusionWe confirm prior studies that ED visits for serious cardiovascular conditions declined early in the COVID-19 pandemic for NSTEMI, IS, HS, and HF, but not for STEMI. Delays or non-receipt in ED care may have led to worse outcomes.     

冠心病患者全血中miR-126表达的临床意义

目的探讨微小RNA(miR-126)在不同类型冠心病患者中的表达情况,为冠心病早期诊断、治疗及治疗后检测提供实验依据。方法将实验分成健康对照组(n=6)及冠心病组(n=36),对冠心病组(分为稳定性心绞痛组,不稳定性心绞痛组,非ST段抬高性心肌梗死组,ST段抬高性心肌梗死组,每组9例)接受经皮冠状动脉介入治疗(PCI)术前,术后第1天,术后第5天等时间点的观察。应用实时荧光定量PCR(qRT-qPCR)技术检测确诊为不同类型冠心病患者术前、术后全血标本中miR-126的表达量。结果 qRT-qPCR结果显示:①健康对照组、稳定性心绞痛组、不稳定性心绞痛组3组miR-126的表达量无显著性差异,但在急性心肌梗死组(包括非ST段抬高性组、ST段抬高性组)患者中miR-126的表达量与上述三组明显减少,有显著性差异(P0.05)。②miR-126在不同时间水平有显著性差异(P0.05),ST段抬高或非ST段抬高型心肌梗死的miR-126的表达量术前明显低,术后随观察时间延长逐渐增加。③在不同时间时不同分组之间miR-126的表达量存在显著的交互效应(P0.05)。结论 miR-126在急性心肌梗死患者中及冠心病各组术前、术后的表达量明显不同,这为miR-126应用于不同类型冠心病诊断及术后疗效判断提供实验依据。     

Coronary heart disease in residents of Rochester, Minnesota. V. Prognosis of patients with coronary heart disease based on initial manifestation

During the period 1960 through 1979, 1,014 residents of Rochester, Minnesota, had a diagnosis of classic angina pectoris as the first manifestation of coronary heart disease, and 1,013 had a myocardial infarction as the initial manifestation. In the angina cohort, about 50% were men, and of them, 20% were 70 years old or older. The female patients were an average of 6 years older than the men, and 43% were 70 years old or older. In this cohort, the 5-year survival rate increased from 77% in the 1960s to 87% in the 1970s (P less than 0.01). The 5-year net survivorship free of a myocardial infarction increased from 76% to 85% during that same time (P less than 0.01). In the myocardial infarction cohort, the 5-year death rate among the 30-day survivors of myocardial infarction was the same during both decades of the study. The age-adjusted reinfarction rate per 100 person-years at risk during teh first 5 years of follow-up decreased very slightly among men and increased among women; thus, it remained essentially unchanged overall. Although the case fatality rate in the myocardial infarction cohort declined sharply from the 1960s to the 1970s, the long-term prognosis of the 30-day survivors of a myocardial infarction did not improve.     

抑郁症对冠心病患者预后的影响

目的分析抑郁症对冠心病患者预后的影响。方法将246例冠心病患者分为抑郁症组和非抑郁症组,比较两组患者近期心血管事件发生率,分析抑郁症与心血管事件的关系。结果冠心病合并抑郁症患者心绞痛、急性ST段抬高型心梗、急性非ST段抬高型心梗、心力衰竭、短阵室性心动过速、心室颤动、心脏性死亡的发生率分别为75.6%、11.1%、17.8%、26.7%、12.2%、8.9%和7.8%,抑郁症为心血管事件发生的独立预测因素。结论冠心病合并抑郁症患者心血管事件发生率升高,且抑郁症为心血管事件发生的独立预测因素。     

基于健康信念模型稳定性心绞痛患者服药依从性的影响因素研究

目的探讨基于健康信念模型稳定性心绞痛患者服药依从性的影响因素。方法对2013年1月-12月参与慢性病管理的107例稳定性心绞痛患者,采用面对面问卷调查方法评定服药依从性及对冠心病认知的影响因素。采用多重逐步线性回归进行统计分析。结果“心肌梗死可能导致死亡”、“稳定性心绞痛患者可能会突发心肌梗死”、“过去1年心绞痛发病次数”、“规范治疗对预防心肌梗死有好处”、“要是发生心肌梗死,就算不死也基本没什么指望了”、“按时服药可以得到家人的赞扬”、“在我认识的人当中就有心肌梗死导致死亡的患者”为提高服药依从性影响因素（P〈0．05）,其偏回归系数分别为0．245、0．251、0．248、0．099、0．234、0．162、0．095;而“担心药品的副作用”、“承受不起药费”为降低服药依从性影响因素（P〈0．05）,其偏回归系数为-0．164和-0．114。结论健康信念模型有助于社区医生判定影响稳定性心绞痛患者服药依从性的相关因素。     

冠状动脉心肌桥的诊断及临床意义

目的探讨冠状动脉心肌桥的诊断以及临床意义.方法对486例行冠状动脉造影(CAG)检查资料进行了回顾性分析.结果共检出13例心肌桥,检出率为2.67%;其中位于左前降支(LAD)12例,左回旋支(LCX)1例;合并冠状动脉粥样硬化症2例;临床表现急性心肌梗死1例,心绞痛4例.结论冠脉造影是冠状动脉心肌桥的特异性诊断方式;局部冠状动脉收缩期狭窄是心肌桥的主要征象;心肌桥患者多数无临床症状,严重者可致心绞痛甚至心肌梗死.     

Dynamics of blood fibronectin level in myocardial infarction

The fibronectin level in the blood of patients with myocardial infarction was measured at varying times from the onset of an angina pectoris attack in order to elucidate the diagnostic importance of blood fibronectin. At the same time these patients were examined over time for the blood content of myoglobin, MB creatine kinase protein and C-reactive protein playing a well-known role in the diagnosis. The blood concentrations of these substances reached the maximal values at different times of myocardial infarction. The mean concentrations of fibronectin in the blood of patients with myocardial infarction ranged within normal starting from the first till the 28th day since the onset of an angina pectoris attack. Moreover, the mean blood fibronectin level in myocardial infarction patients did not differ within the first-third days since the disease onset from that in patients with a clinical picture of unstable angina pectoris which was not accompanied by the development of myocardial infarction. Based on the data obtained it is concluded that measurement of blood fibronectin level does not play any diagnostic role in myocardial infarction. On the other hand, progressive increase in blood fibronectin level throughout 4 weeks starting from the 3d day of the disease and a significantly higher fibronectin content on the 28th day as compared with that on the 3d day is likely to mirror the activity of repair processes occurring in the myocardium.     

Hyperinsulinaemia in ischaemic heart disease: the importance of myocardial infarction and left ventricular function

Elevated circulating insulin levels have been reported in ischaemicheart disease, and may be of aetiological importance. Previousstudies have not considered the potential influence of heartfailure or of previous myocardial infarction, as opposed tostable angina. We therefore measured the insulin response toa 75 g oral glucose tolerance test in five groups with normalglucose tolerance, comparing normal male controls to men withchronic stable angina, men with recent myocardial infarction(two groups, 3 weeks and 3 months post infarction), and menwith chronic severe heart failure. Only patients with chronicheart failure had fasting hyperinsulina-emia, probably reflectingassociated neuroendocrine abnormalities. Stimulated hyperinsulinaemiawas present in all patient groups, but was less pronounced andof shorter duration in patients with angina. At 120 min, onlypatients with heart failure or previous myocardial infarctionwere hyperinsulinaemic. The degree of stimulated hyperinsulinaemiawas not influenced by the presence of heart failure or by thelength of time from infarction. Hyperinsulinaemia is associatedwith impaired peripheral muscle glucose uptake and metabolism,and might contribute to muscular fatigue on exertion in patientswith previous myocardial infarction or heart failure.     

经皮冠状动脉介入术后支架再狭窄因素临床评价

目的:分析冠心病患者经皮冠状动脉介入术后支架内再狭窄的影响因素,并探讨其规律。方法:回顾性分析本院行冠状动脉介入治疗术后再次行冠状动脉造影的167例患者临床资料,分析急性心肌梗死组和非心肌梗死组、有症状组和无症状组冠状动脉支架再狭窄的发生率。结果:急性心肌梗死组患者支架术后支架再狭窄率高于非心肌梗死组患者(P<0.05);合并糖尿病患者再狭窄率高于未合并糖尿病患者(P<0.05);术后有可疑心绞痛症状者支架内再狭窄率高于无症状定期随访者(P<0.05)。结论:(1)急性心肌梗死、糖尿病可能由于其本身的病变特征,易致冠状动脉介入治疗术后支架内再狭窄。(2)根据临床症状可以初步诊断支架内再狭窄。     

C-反应蛋白与肿瘤坏死因子-a检测指标对冠心病临床意义探讨

目的探讨C-反应蛋白（cRP）和肿瘤坏死因子-a（TNF—a）与冠心病严重程度关系。方法选择30例心绞痛患者,20例心肌梗死患者,30例健康者,分别检测CRP和TNF—a水平。结果心绞痛组和急性心肌梗死组和TNF—a水平均高于非冠心痛患者组,差异极显著（P〈0．01）,急性心肌梗死组cRP水平显著高于心绞痛组（P〈0．01）,急性心肌梗死组TNF—a水平明显高于心绞痛组（P〈0．05）。结论血清CRP和TNF—a水平作为冠心病患者病情检测指标,其升高程度与冠状动脉粥样硬化程度有明显相关性。