Increased levels of markers of vascular inflammation in patients with coronary heart disease

Elevated levels of soluble cell adhesion molecules (sCAMs), inflammatory cytokines and C-reactive protein (CRP) have been associated with atherosclerotic disease states. The aim of the present study was to evaluate whether circulating levels of vascular cell adhesion molecule-1 (sVCAM-1), intercellular adhesion molecule-1 (sICAM-1), E- and P-selectin were significantly elevated in patients with coronary heart disease (CHD) compared with healthy controls, and to study possible associations between these sCAMs, tumour necrosis factor &#102 (TNF &#102 ), interleukin-6 (IL-6), CRP and major CHD risk factors. The study included 193 patients in various stages of CHD and 193 matched controls. To evaluate any possible influence of acute phase reaction, reinvestigation was performed after 6 months. After adjustment for major CHD risk factors, sVCAM-1, sICAM-1, P-selectin, IL-6 and CRP remained significantly elevated in the CHD patients (p for all < 0.001). In multivariate analysis sVCAM-1 was predicted by age (p = 0.015), sICAM-1 by smoking (p < 0.001) and total cholesterol (p = 0.026), E-selectin by body mass index (BMI) (p = 0.004) and P-selectin by male gender (p = 0.015). TNF &#102 significantly predicted sICAM-1 and E-selectin levels, while IL-6 predicted CRP but none of the sCAMs measured. This might indicate that TNF &#102, but not IL-6, plays a major role in the regulation of sCAM levels in vivo .     

Platelet activation and inflammation markers in patients with coronary heart disease and depression

AIM: To study morphological features and functional activity of platelets, their relations with the level of inflammation markers in coronary heart disease (CHD) patients with depression. MATERIAL AND METHODS: The study group consisted of 33 CHD patients with stable effort angina (NY-HA FC I-III), 14 had depression, 19 were free of depression. Sixteen healthy volunteers comprised the control group. Platelet aggregation was registered by a mean size of aggregates and turbidometrically. Platelets shape, leukocytic-thrombocytic and erythrocytic-thrombocytic aggregates (LTA, ETA) in the whole blood were studied electron-microscopically. The levels of IL-2, IL-6, TNF-alpha, sVCAM, hsCRP were measured in the blood, serotonin--in platelets. RESULTS: Spontaneous aggregation enhanced in 52.6% CHD patients (p < 0.05). The blood contained reticular platelets, high number of prothrombocytes (p < 0.05), mean volume of thrombocytes was greater (p < 0.05). This reflected changes in megakaryocytopoiesis. Some of the patients had LTA and ETA. Out of inflammation markers, only IL-6 and sVCAM were elevated (p < 0.01), hsCRP concentration rose, but not above normal range. Serotonin in platelets was the same in the patients and controls. Depression aggravated the disorders and elevated other indices. Spontaneous aggregation was high in 71.4% of depressive CHD patients. The count of reticular platelets, prothrombocytes, mean volume platelets were also elevated. LTA and ETA were high in all the depressive patients. Elevated were also concentrations of IL-6, sVCAM, IL-2, hsCRP. Serotonin in platelets was low (p < 0.05). CONCLUSION: Depression stimulates functional activity of platelets, is a factor of risk of intravascular inflammation and contributes to development of thrombotic complications in CHD patients.     

Relationship of adiponectin with markers of systemic inflammation, atherogenic dyslipidemia, and heart failure in patients with coronary heart disease

BACKGROUND: Adiponectin, an adipocyte-derived hormone, appears to be a modulator of lipid metabolism and systemic inflammation and is present in particularly low concentrations in patients with coronary heart disease (CHD). However, the clinical importance of adiponectin in individuals at markedly high risk for future cardiovascular morbidity and mortality has not been fully elucidated. We examined the associations between serum adiponectin and several biomarkers related to cardiovascular disease and heart failure in a large high-risk population comprising patients with prevalent CHD. METHODS: We measured fasting adiponectin, interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and markers of lipoprotein metabolism in 1174 patients with CHD. RESULTS: After adjustment for age and sex, adiponectin was associated with HDL-cholesterol (HDL-C; r = 0.25; P <0.0001), NT-proBNP (r = 0.17; P <0.0001), and plasma triglyceride (r = -0.21; P <0.0001) concentrations. There was, however, no statistically significant association between adiponectin and markers of systemic inflammation. In partial correlation analyses further adjusted for body mass index, alcohol intake, smoking status, presence of diabetes and/or hypertension, lipid-lowering drug therapy, and fasting plasma glucose, adiponectin remained significantly associated with HDL-C (r = 0.21; P <0.0001), NT-proBNP (r = 0.15; P <0.0001), and plasma triglycerides (r = -0.16; P <0.0001). CONCLUSIONS: Serum adiponectin is associated with the presence of atherogenic dyslipidemia and with NT-proBNP concentration but not with markers of systemic inflammation in patients with manifest CHD. Thus, atherogenic dyslipidemia may link adiponectin with the progression of atherosclerosis. Moreover, serum adiponectin may be related to BNP in patients with CHD.     

不同性别冠心病患者血管病变程度的比较分析

目的研究不同性别的需行PCI的冠心病患者的血管病变严重程度,旨在为不同性别的冠心病患者采取行之有效的二级预防措施提供循证医学证据。方法选择已成功施行PCI手术的262例冠心病患者,对患者的常见的危险因素严格测量评估,根据患者不同血管病变严重程度的危险因素进行分组比较。结果研究结果显示,在侵犯病变血管男性和女性几乎一致,而在病变严重程度二者更是趋于一致。不同性别冠心病患者血管病变严重程度LM、LAD、LCX和RCA男性分别为25（11．8％）、176（83．4％）、105（49．8％）和148（70．1％）。女性患者为6（11．8％）、43（84．3％）、22（43．1％）、36（70．6％）;构成比比较男女患者无差别,差异无显著意义,P〉0．05。结论研究结果提示,尽管女性患者比男性患者需行支架植入大约推迟5年,而且随着年龄增长,二者病变血管和血管病变严重程度并无区别,而女性患者随着年龄增长,患高血压的病人比男性患者多;高密度脂蛋白胆固醇（HDL-C）可能是女性患者的保护因素。     

老年冠心病患者与健康老年人血清中C-反应蛋白的比较

目的研究老年冠心病患者与健康老年人血清C反应蛋白的浓度变化和临床意义。方法对我院2006年3月至2009年3月的56例老年冠心病患者发病时血清超敏CRP值进行监测,同时与60例健康老年人进行比较,观察两组之间的差异。结果老年冠心病发生时超敏CRP值明显增高,治愈后迅速下降,但与健康老年人比较其HSCRP基础水平仍偏高,HSCRP_x=3.0mg/L,正常老年人超敏CRP_x≤1.6mg/L。结论超敏CRP具有更高的灵敏度,检测超敏CRP对老年人冠心病的发生及危险度具有监测作用。     

回声跟踪技术评价冠心病患者的外周血管功能

动脉弹性功能不仅是收缩压、舒张压和脉压水平的决定因素,而且相当程度上反映了动脉内皮功能状况[1-2].血管回声跟踪(Echo-tracking,ET)技术能够动态跟踪和描记动脉壁的运动轨迹,自动显示和计算血管内径的变化幅度,为临床准确评价血管弹性提供了新的手段[3-4].近年来国内有学者应用ET技术对正常人、高血压及高血压合并糖尿病患者进行研究,但ET技术针对冠心病患者血管功能的系统研究很少报道.本研究旨在应用ET技术评价冠心病患者外周血管功能的改变,为临床早期血管病变检测提供新方法和基础数据,并指导临床治疗.     

Serum levels of sexual hormones in young and middle-age healthy subjects with risk factors of coronary heart disease and patients with coronary heart disease

AIM: To study sexual hormones levels in risk of beginning and development of coronary heart disease (CHD) in young and middle-aged (up to 50 years) men and women. MATERIAL AND METHODS: Sexual hormones were studied in 105 patients (53 males and 52 females) aged 25-50 years. Of them, 88 suffered from IHD and 17 had CHD risk factors. Twenty healthy controls were matched by age and gender. LH, FSH, estradiol, testosteron were measured in blood serum by enzyme immunoassay (Elecsys kit, Beringer Mannheim). RESULTS: Young and middle-aged (under 50 years of age) males and females with IHD or its risk factors have changed levels of sexual hormones. CONCLUSION: In IHD male hormones levels increase in women but decrease in men while female hormones increase in men and decrease in women.     

Selectin-P and interleukin-8 plasma levels in coronary heart disease patients

BACKGROUND: Alterations of the immune system are now believed to play crucial role in the pathogenesis of atherosclerosis. The aim of this study was analysis of soluble forms of selectin-P and interleukin-8 levels in patients with different form of coronary heart disease. MATERIALS AND METHODS: In the study took part 18 patients with stable coronary heart disease, 20 patients with unstable coronary heart disease and 15 healthy persons from control group. Soluble selectin-P and interleukin-8 levels were measured in EDTA plasma with the use of enzyme immunoassay ELISA. RESULTS: The level of soluble selectin-P was significantly higher in unstable coronary heart disease patients in comparison to the stable coronary heart disease patients (P < or = 0.01) and nonsignificantly higher in comparison to the control group. The level of interleukin-8 were significantly higher in unstable coronary heart disease patients in comparison to the stable coronary heart disease patients (P < or = 0.01) and in comparison to the control group (P < or = 0.02). CONCLUSION: Our findings suggest that soluble form of selectin-P and interleukin-8 may be useful clinical predictors of unstable coronary heart disease. The assessment of the risk for the development of coronary heart disease requires further serial investigation.     

血清CRP浓度与冠心病严重程度的关系

目的探索冠心病(CHD)患者血清CRP浓度与冠脉病变严重程度的关系及与相关指标间的相关性。方法测定101例冠心病患者血清CRP、CK、CK-MB、TC、TG和HDL-C,比较CRP与冠脉病变支数及各相关指标间的相关性,并以40名健康者的结果为对照。结果血清CRP冠心病组与健康对照组有显著性差异,冠心病组内AMI、冠状动脉一支病变、二支病变及三支病变间也有显著性,冠心病组的CRP水平与CK、CK-MB、TC、TG水平有相关性。结论冠心病患者血清CRP的水平升高,其升高程度与冠心病的严重程度相关且与相关指标有一定的相关性。     

血清CRP浓度与冠心病严重程度的关系

目的探索冠心病(CHD)患者血清CRP浓度与冠脉病变严重程度的关系及与相关指标间的相关性.方法测定101例冠心病患者血清CRP、CK、CK-MB、TC、TG和HDL-C,比较CRP与冠脉病变支数及各相关指标间的相关性,并以40名健康者的结果为对照.结果血清CRP冠心病组与健康对照组有显著性差异,冠心病组内AMI、冠状动脉一支病变、二支病变及三支病变间也有显著性,冠心病组的CRP水平与CK、CK-MB、TC、TG水平有相关性.结论冠心病患者血清CRP的水平升高,其升高程度与冠心病的严重程度相关且与相关指标有一定的相关性.     

冠心病患者血脂和胆红素变化的研究

目的探讨血脂、胆红素与冠心病发生、发展的关系。方法随机抽取139例冠心病患者和118例健康者进行血清甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDI,C）、低密度脂蛋白胆固醇（LDL—C）及胆红素水平检测与对比分析。结果冠心病组患者TG、TC、LDL—C、TG／HDL-C、LDLC／HDL-C显著升高（P〈0．01）,HDL-C、总胆红素（TBil）及间接胆红素（IBil）显著降低（P〈0．01）,且与冠脉病变程度相关;但直接胆红素（DBil）水平无明显差异（P〉0．05）。结论血脂异常和胆红素水平降低与冠心病密切相关。早期干预有可能预防心血管事件的发生。     

血清骨保护素与冠状动脉病变程度的关系研究

目的探讨血清骨保护素与冠状动脉病变严重程度的关系。方法对70例因胸痛入院的患者均行冠状动脉造影检查,按结果分为正常对照组、单支、双支、多支病变四组,用酶联免疫吸附试验(ELISA)法检测血清骨保护素,同时收集患者的一般临床资料及相应生化指标,并进行多因素Logistic回归等分析。结果与对照组相比,冠状动脉有病变患者血清骨保护素水平明显增加,差异有统计学意义(P<0.001);血清骨保护素水平随冠状动脉病变支数增加明显升高,冠状动脉病变支数越多,血清骨保护素水平升高越明显,差异有统计学意义(P<0.001)。多元回归分析示:骨保护素与血管病变支数独立正相关(P<0.001),Logistic分析示:骨保护素与冠心病独立正相关(OR1.011,95%CI1.006～1.016,P<0.001)。骨保护素与Gensini评分正相关(r=0.623,P<0.001)。结论血清骨保护素水平与冠状动脉疾病的发生、进展及严重程度有直接关系。     

冠心病患者半胱氨酸蛋白酶抑制剂C及同型半胱氨酸水平与冠状动脉病变程度的关系

目的探讨冠心病患者半胱氨酸蛋白酶抑制剂C(Cys C)、同型半胱氨酸(Hcy)水平与冠状动脉病变程度的相关性。方法根据冠状动脉造影结果将研究对象分为冠心病组(268例)和非冠心病组(268例),统计冠心病组患者病变累及支数,并按冠状动脉狭窄程度计算Gensini积分。分别测定并比较两组血清Hcy、Cys C等生化指标结果,分析Cys C、Hcy水平与Gensini积分、病变支数的相关性。结果冠心病组Cys C、Hcy水平明显高于非冠心病组(P均0.01);Cys C、Hcy水平与Gensini积分呈正相关(r分别为0.245,0.232,P均0.01);多元逐步回归分析表明Cys C、Hcy对Gensini积分的影响有统计学意义(β=20.255,t=2.749,P0.05;β=0.327,t=2.093,P0.05);随着病变支数的增加,Cys C、Hcy水平与Gensini积分均增高(P0.05)。结论Cys C和Hcy水平增高在一定程度上可以反映冠状动脉病变的严重程度,可为临床开展危险分层与治疗提供参考。     

经皮冠状动脉介入治疗老年冠心病患者周围血管并发症的相关因素分析

目的了解老年冠心病患者经皮冠状动脉介入治疗（PCI）术后周围血管并发症的发生状况，探讨老年冠心病患者PCI术后周围血管并发症发生的相关因素。方法采用横断面调查研究方法，以便利抽样抽取行PCI术的老年冠心病患者103例，并采用自行设计的PCI术老年冠心病患者人口学资料表和疾病相关资料表进行数据收集。结果老年冠心病患者PCI术后有21．4％发生了周围血管并发症，发生最多的是局部渗血13．6％，其次是血肿4．9％、穿刺点周围皮下淤斑2．9％、前臂肿胀2．9％；不同年龄、不同婚姻状况，术前是否合并高脂血症、不同穿刺部位、不同手术时机、不同手术持续时间、不同病变血管支数、术中不同肝素用量、术中及术后不同盐酸替罗非班氯化钠注射液用量、术中硫酸氢氯吡格雷片用量，PCI术后的老年冠心病患者周围血管并发症发生状况有所不同，差异有统计学意义（P〈0．05）；Logistic回归分析发现，婚姻状况、穿刺部位、病变血管支数、术中肝素用量、术后硫酸氢氯吡格雷片是PCI术后发生周围血管并发症的危险因素。结论年龄越大、非在婚、合并高脂血症、急诊手术、手术持续时间长、经股动脉穿刺、病变血管支数多、前降支狭窄程度大、术中肝素用量大、术后使用盐酸替罗非班氯化钠注射液、硫酸氢氯吡格雷片的患者更易发生周围血管并发症，提示在今后的护理工作中，应该把此类患者作为护理的重点。     

Inflammatory markers in men with angiographically documented coronary heart disease.

BACKGROUND: Recent evidence suggests that atherosclerosis is a chronic inflammatory process. In this study, we examined several markers of inflammation in men with coronary heart disease (CHD) and appropriate controls. METHODS: The concentrations of C-reactive protein (CRP), serum amyloid A (SAA), interleukin-6 (IL-6), and soluble intracellular adhesion molecule (sICAM-1) were examined in 100 men with angiographically documented CHD and 100 age-, gender-, and smoking-matched controls with no history of CHD. We assessed the association of these markers with severity of disease as indicated by >50% obstruction in one vessel (n = 30), two vessels (n = 39), or three vessels (n = 31). RESULTS: Significant increases were noted in serum CRP (median for cases vs controls, 3.4 vs 1.5 mg/L; P <0.0001), SAA (5.9 vs 3.7 mg/L; P <0.005), and IL-6 (2.3 vs 1.7 ng/L; P <0. 013) in patients with CHD compared with controls. These differences remained significant after correction for age, smoking, hypertension, diabetes, and lipid and homocysteine concentrations. Plasma sICAM-1 was not significantly different between the two groups (335 vs 339 microg/L). No significant correlation was seen between these markers and the severity of coronary disease. CONCLUSIONS: Concentrations of CRP, SAA, and IL-6 were increased in patients with CHD but failed to correlate with severity of coronary disease. These markers might reflect the diffuse atherosclerotic process in the vascular system rather than the degree of localized obstruction from coronary lesions.     

经皮冠状动脉介入治疗对冠心病合并心力衰竭患者疗效评价

目的观察经皮冠状动脉介入治疗对冠心病患者左心室收缩和舒张功能的疗效。方法选择72例冠心病合并心力衰竭的患者,行经皮冠状动脉介入治疗,术前、术后1周和术后6个月分别行心脏超声检查左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室短轴缩短率(FS)、左室射血分数(LVEF)、舒张早期血流峰值速度(E)、舒张晚期血流峰值速度(A)以及E峰和A峰比值(E/A),比较术前和术后患者心功能变化情况。结果通过行介入治疗后,支架植入术后冠心病合并心力衰竭患者心功能较前有了明显的好转,术后6个月LVEF、FS、LVESD、LVEDD、E、A和E/A与术前相比均有明显改善(P<0.05和0.01),术后一周LVEF和FS与术前相比有改善(P<0.05)。术后6个月与术后一周相比LVEF、FS、LVESD和LVEDD有明显改善(P<0.05)。结论经皮冠状动脉介入治疗能够明显改善冠心病合并心力衰竭患者的心功能。     

Abdominal syndrome in patients with coronary heart disease

The article discusses diagnostic difficulties in acute abdominal pain. The author adduces data on the frequency of diagnostic errors in diagnostics of coronary heart disease (CHD) before admission and in the admission department of an urgent aid hospital. The analysis of the causes of delayed diagnosis in patients with CHD and acute myocardial infarction is exemplified with 3 clinical observations. The article also covers ways of prevention of diagnostic errors in patients with abdominal pain.     

冠心病患者的心理干预

<正>现代医学模式把疾病分成躯体疾病、心身疾病及精神疾病三大类。综合国内外学者对于心身疾病的见解,认为心身疾病是指心理社会因素作为重要原因参与发病的躯体疾病,心身疾病又叫心理生理疾病。