Improving Survival Rate of Korean Patients Initiating Dialysis

Purpose

The aim of this study was to investigate whether the survival rate among Korean dialysis patients changed during the period between 2005 and 2008 in Korea.

Materials and Methods

A total of 32357 patients who began dialysis between January 1, 2005 and December 31, 2008 were eligible for analysis. Baseline demographics, comorbidities, and mortality data were obtained from the database of the Health Insurance Review & Assessment Service.

Results

Kaplan-Meier curves according to the year of dialysis initiation showed that the survival rate was significantly different (log-rank test, p=0.005), most notably among peritoneal dialysis (PD) patients (p<0.001), although not among hemodialysis (HD) patients (p=0.497). In multivariate analysis, however, patients initiating either HD or PD in 2008 also had a significantly lower risk of mortality compared to those who began dialysis in 2005. Subgroup survival analysis among patients initiating dialysis in 2008 revealed that the survival rate of PD patients was significantly higher than that of HD patients (p=0.001), and the survival benefit of PD over HD remained in non-diabetic patients aged less than 65 years after adjustment of covariates.

Conclusion

Survival of Korean patients initiating dialysis from 2005 to 2008 has improved over time, particularly in PD patients. In addition, survival rates among patients initiating dialysis in 2008 were different according to patients'' age and diabetes, thus we need to consider these factors when dialysis modality should be chosen.     

Relationship between Cognitive Impairment and Depression in Dialysis Patients

Purpose

Patients with chronic kidney disease frequently show cognitive dysfunction. The association of depression and cognitive function is not well known in maintenance dialysis patients. We evaluated cognitive impairment and depression, as well as their relationship in regards to methods of dialysis, maintenance hemodialysis (MHD) and chronic peritoneal dialysis (CPD).

Materials and Methods

Fifty-six maintenance dialysis patients were recruited and their clinical and laboratory data were collected. The Korean version of the mini-mental state exam (K-MMSE) was applied to screen the patient''s cognitive function, while the Korean version of the Beck Depression Inventory (K-BDI) was used for depression screening.

Results

The average age of the participants was 54.2±10.2 years; 29 (51.8%) were female. The average dialysis vintage was 4.2±3.8 years. The CPD group showed significantly higher K-MMSE score (27.8±2.9 vs. 26.1±3.1, p=0.010) and lower K-BDI score (12.0±8.4 vs. 20.2±10.4, p=0.003) compared with the MHD group. The percentage of patients with depression symptoms was higher in the MHD group (51.7% vs. 18.5%). There was a negative correlation between cognitive function and prevalence of depressive symptoms. Depression and education level were shown to be independent predictors for cognitive impairment in multivariate analysis.

Conclusion

Cognitive impairment was closely correlated with depression. It is important to detect cognitive impairment and depression early in maintenance dialysis patients with simple bedside screening tools.     

Predicting One-Year Mortality in Peritoneal Dialysis Patients: An Analysis of the China Peritoneal Dialysis Registry

This study aims to investigate basic clinical features of peritoneal dialysis (PD) patients, their prognostic risk factors, and to establish a prognostic model for predicting their one-year mortality. A national multi-center cohort study was performed. A total of 5,405 new PD cases from China Peritoneal Dialysis Registry in 2012 were enrolled in model group. All these patients had complete baseline data and were followed for one year. Demographic and clinical features of these patients were collected. Cox proportional hazards regression model was used to analyze prognostic risk factors and establish prognostic model. A validation group was established using 1,764 new PD cases between January 1, 2013 and July 1, 2013, and to verify accuracy of prognostic model. Results indicated that model group included 4,453 live PD cases and 371 dead cases. Multivariate survival analysis showed that diabetes mellitus (DM), residual glomerular filtration rate (rGFR), , SBP, Kt/V, high PET type and Alb were independently associated with one-year mortality. Model was statistically significant in both within-group verification and outside-group verification. In conclusion, DM, rGFR, SBP, Kt/V, high PET type and Alb were independent risk factors for short-term mortality in PD patients. Prognostic model established in this study accurately predicted risk of short-term death in PD patients.     

The Prognostic Value of Abdominal Aortic Calcification in Peritoneal Dialysis Patients

Objective: This study evaluated the prognostic value of the aortic calcification index (ACI), an estimate of abdominal aortic calcification by plain abdominal computed tomography (CT), in terms of left ventricular (LV) diastolic dysfunction, mortality, and nonfatal cardiovascular (CV) events in peritoneal dialysis (PD) patients.Method: PD patients who received both abdominal CT and echocardiography were divided into a low-ACI group (n=46) and a high-ACI group (n=46).Results: During follow-up (median, 35.2 months; range, 3.6 - 111.3), 30 patients (32.6%) died and 10 patients (10.9%) developed nonfatal cardiovascular (CV) events. The 5-year event-free survival rates for mortality and nonfatal CV events were significantly lower in the high-ACI group compared with those in the low-ACI group (35.7% vs. 64.1%, P = 0.01). The ACI was positively correlated with left atrial diameter and ratio of peak early transmitral flow velocity to peak early diastolic mitral annular velocity (E/E'' ratio; a marker of left ventricular diastolic function). Using multivariate analyses, the high-ACI group (vs. low-ACI group, HR 5.25, 95% CI 1.77 - 15.58, P = 0.003) and increased E/E'' ratio (HR 1.16, 95% CI 1.03 - 1.31, P = 0.013) were independent predictors for mortality and CV events. The ACI provided a higher predictive value for adverse outcomes (AUC = 0.755, P = 0.002) than the E/E'' ratio (AUC = 0.543, P = 0.61).Conclusion: The ACI was significantly associated with left ventricular diastolic dysfunction and predicted all-cause mortality and nonfatal CV events in PD patients.     

Citrobacter Peritoneal Dialysis Peritonitis: Rare Occurrence with Poor Outcomes

Introduction: Non-Pseudomonas gram-negative bacteria are responsible for an increasing proportion of cases of peritoneal dialysis (PD)-related peritonitis. The role of Citrobacter species in the etiology of PD-related peritonitis is often underestimated. In the present study, we aimed to describe the clinical features, laboratory findings, and short- and long-term outcomes in PD-related peritonitis caused by Citrobacter.Methods: A retrospective review of all episodes of PD-related peritonitis caused by Citrobacter from a single center between 1990 and 2010 was performed. Clinical features, microbiological data, and outcomes of these episodes were analyzed.Results: Citrobacter species was responsible for 11 PD-related episodes (1.8% of all peritonitis episodes) in 8 patients. Citrobacter freundii was the most common etiologic species (73%), and mixed growth was found in the other 3 episodes (27%). Approximately half (46%) of the episodes were associated with constipation and/or diarrhea. Of the Citrobacter isolates from all episodes, 54% were resistant to cefazolin, and only 18% were susceptible to cefmetazole. All isolates were susceptible to ceftazidime, cefepime, carbapenem, and aminoglycosides. More than half of the patients (54%) were hospitalized for index peritonitis, and 27% of the episodes involved a change in antibiotic medication. One patient had relapsing peritonitis caused by C. koseri (9%). The mortality rate of PD-related peritonitis caused by Citrobacter was 18%, and 89% of surviving patients developed technique failure requiring a modality switch after an average of 12 months of follow-up (range 1.2-31.2 months).Conclusion: PD-related peritonitis caused by Citrobacter is associated with poor outcomes, including high rates of antibiotic resistance, a high mortality rate, and a high rate of technique failure among survivors during the follow-up period.     

Overhydration Negatively Affects Quality of Life in Peritoneal Dialysis Patients: Evidence from a Prospective Observational Study

Backgound: This study evaluated whether the hydration status affected health-related quality of life (HRQOL) during 12 months in peritoneal dialysis (PD) patients.Methods: The hydration status and the HRQOL were examined at baseline and after 12 months using a bioimpedance spectroscopy and Kidney Disease Quality of Life-Short Form, respectively in PD patients. Four hundred eighty-one patients were included and divided according to the baseline overhydration (OH) value; normohydration group (NH group, -2L≤ OH ≤+2L, n=266) and overhydration group (OH group, OH >+2L, n=215). Baseline HRQOL scores were compared between the two groups. The subjects were re-stratified into quartiles according to the OH difference (OH value at baseline - OH value at 12 months; <-1, -1 - -0.1, -0.1 - +1, and ≥+1L). The relations of OH difference with HRQOL scores at 12 months and the association of OH difference with the HRQOL score difference (HRQOL score at baseline - HRQOL score at 12 months) were assessed.Results: The OH group showed significantly lower baseline physical and mental health scores (PCS and MCS), and kidney disease component scores (KDCS) compared with the NH group (all, P<0.01). At 12 months, the adjusted PCS, MCS, and KDCS significantly increased as the OH difference quartiles increased (P<0.001, P=0.002, P<0.001, respectively). In multivariate analysis, the OH difference was independently associated with higher PCS (β = 2.04, P< .001), MCS (β=1.02, P=0.002), and KDCS (β=1.06, P<0.001) at 12 months. The OH difference was independently associated with the PCS difference (β = -1.81, P<0.001), MCS difference (β=-0.92, P=0.01), and KDCS difference (β=-0.90, P=0.001).Conclusion: The hydration status was associated with HRQOL and increased hydration status negatively affected HRQOL after 12 months in PD patients.     

血液透析与腹膜透析对终末期肾病患者血脂、氧化应激及炎症因子的影响

目的分析血液透析与腹膜透析对终末期肾病(ESRD)患者血脂、氧化应激及炎症因子的影响。方法选取2016年1月至2018年1月我院收治的终末期肾病患者200例为研究对象,采用随机数字表法将其分为观察组、对照组各100例,对照组予以血液透析治疗,观察组实施腹膜透析治疗,比较两组治疗前后血脂[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)]、氧化应激指标[丙二醛(MDA)、髓过氧化物酶(MPO)、超氧化物歧化酶(SOD)]、炎症因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]水平、生存质量[健康状况调查简表(SF-36)]及并发症的情况。结果治疗后观察组血清TC、TG、HDL-C、LDL-C水平明显低于对照组(P <0.05);治疗后观察组血清MDA、MPO、hs-CRP、TNF-α、IL-6水平低于对照组,而SOD水平高于对照组(P <0.05);治疗3个月、治疗6个月观察组SF-36评分高于对照组(P <0.05);观察组治疗期间并发症发生率12.0%低于对照组24. 0%(P <0.05)。结论与血液透析相比,腹膜透析治疗ESRD疗效更好,可明显改善患者血脂、氧化应激及炎症因子水平,提高其生活质量,减少并发症,值得在临床推广实践。     

Palliative Care for Patients with Malignancy and End-Stage Renal Failure on Peritoneal Dialysis

Background:

Many patients on peritoneal dialysis experience a poor quality of life because of a high burden of comorbid conditions. Dialysists must pay more attention to reducing a patient''s pain and suffering, both physical and psychological and improve the quality of life for the patients as much as possible. A consensus regarding eligibility for palliative care and the delivery of these inventions does not currently exist.

Objective:

The present study aimed to describe the implementation of palliative care for end-stage renal failure patients on peritoneal dialysis.

Design:

A report on three cases.

Materials and Methods:

This study included three outpatients on peritoneal dialysis who received palliative care and died between January 2008 and June 2010.

Measurements:

The patients'' comorbidities, nutritional status, and functional status were evaluated using the Charlson comorbidity score, subjective global assessment, and Karnofsky Performance Score index, respectively. The Hamilton depression and Hamilton anxiety scales were also employed. The patients'' clinical manifestations and treatments were reviewed.

Results:

Each patient displayed 11-16 symptoms. The Charlson comorbidity scores were from 11 to 13, the subjective global assessment indicated that two patients were class assigned to “C” and one to class “B”, and the mean Karnofsky index was <40. Among these patients, all experienced depression and two experienced anxiety, Low doses of hypertonic glucose solutions, skin care, psychological services, and tranquillizers were intermittently used to alleviate symptoms, after making the decision to terminate dialysis. The patients died 5 days to 2 months after dialysis withdrawal.

Conclusion:

The considerable burden associated with comorbid conditions, malnutrition, poor functional status, and serious psychological problems are predictors of poor patient prognoses. Withdrawal of dialysis, palliative care, and psychological interventions can reduce patient distress and improve the quality of life before death, with the care provided.     

Modified Peritoneal Dialysis Catheter Insertion: Comparison with a Conventional Method

Purpose

The conventional trocar and cannula method in peritoneal dialysis (PD) catheter insertion has its limitation in clinical setting. The aim of this study was to compare a modified method for percutaneous PD catheter insertion with the conventional method, and demonstrate advantages of the modified method.

Materials and Methods

Patients at a single center who had percutaneous PD catheters inserted by nephrologists from January 2006 until September 2012, using either a modified method (group M) or the conventional trocar and cannula method (group C), were retrospectively analyzed, in terms of baseline characteristics, complications experienced up to 3 months after the procedure, and the suitability of the procedure for patients.

Results

Group M included 82 subjects, while group C included 66 cases. The overall early complication rate in group M (1.2%) was significantly lower than that in group C (19.7%) (p<0.001). The catheter revision rate during timeframe for early complications was significantly lower in group M (0%) than in group C (6.1%) (p=0.024). When comparing Procedure time (1 h 3 min±16 min vs. 1 h 36 min±19 min, p<0.01), immediate post-procedural pain (2.43±1.80 vs. 3.14±2.07, p<0.05), and post-procedure days until ambulation (3.95±1.13 days vs. 6.17±1.34 days, p<0.01), group M was significantly lower than group C. There was no significant difference in total hospitalization period (14.71±7.05 days vs. 13.86±3.7 days).

Conclusion

Our modified PD catheter insertion method shows its advantages in early complication rate, early complications revision rate, and the patients'' conveniences.     

The perception of the Illness with Subsequent Outcome Measure in More Favorable in Continuos Peritoneal Dialysis vs Hemodialysis in the Framework of Appraisal Model of Stress

The aim of the study was to use the appraisal model of stress to compare hemodialysis (HD) and continuous peritoneal dialysis (CAPD) patients with special focus on the perception of end-stage renal disease and subsequent emotional profile and health related quality of life (HQoL) in. We hypothesize that different circumstances related to both modes of therapies will result in dissimilar perception of chronic illness with subsequent changes in emotional profile and heath related quality of life. The total of 88 patients with end stage renal disease (ESRD) enrolled in hemodialysis (n=52; HD) or continuous peritoneal dialysis (n=36; CAPD) were given a battery of psychological tests: The Profile of Mood States, The Nottingham Health Profile, The Stress Situation Assessment Questionnaire, The Social Appreciation Questionnaire and The Situation and Trait and Anxiety Inventory. All patients perceived ESRD in terms of a loss and a threat. Moreover, CAPD patients evaluated ESRD as a challenge. Despite different perception of ESRD no significant difference in the level of fear, anxiety or emotional profile was found. Both HD and CAPD patient were reported more fatigue/inertia and confusion/bewilderment than control groups. The main health related complaints were similar in both ESRD patients with major complaints of sleeping disturbances, motor limitations and lack of energy. From the psychological point of view, CAPD treatment seems more like challenge to the enrolled patient which is positive outcome. Despite different appraisal of stress mood and health related complaints were similar in both groups. This may be a result of optimal regulation of cognitive perception of the stress depending on the circumstances of therapy.     

颈动脉粥样硬化与冠心病远期心脏事件的关系探讨

目的探讨超声检测颈动脉粥样硬化与冠心病远期心脏事件的相关性.方法将233名疑似冠心病、心肌梗死患者行选择性冠状动脉造影、高分辨率的颈动脉超声检查,根据超声检测颈动脉粥样硬化的改变分组列出患者的一般临床资料,选择性冠状动脉造影、心电图、超声心动图、平板运动试验的结果等,同时随访其心脏事件发生情况.分析超声检测颈动脉粥样硬化与冠心病心脏事件发生情况的相关性.结果233例患者有140例颈动脉超声阳性即颈动脉内中膜厚度(IMT)≥0.8 mm(60.1%),233例中221例有随访结果,随访率为94.8%,随访时间为(21.29±6.26)月,有26例患者发生28件心脏事件,其发生与体重指数、不稳定性心绞痛、冠脉造影阳性、冠脉造影二支病变、冠脉造影三支病变、颈动脉超声阳性、颈动脉斑块正相关,关系密切(P《0.05);多因素非条件Logistic回归分析排除混杂因素影响,显示颈动脉超声阳性与颈动脉超声阴性患者的心脏事件有统计学差异(P《0.05).结论颈动脉超声检测颈动脉粥样硬化可作为预测冠心病心脏事件的独立危险因子.     

Early Repolarization and Myocardial Scar Predict Poorest Prognosis in Patients with Coronary Artery Disease

Purpose

Recent studies show positive association of early repolarization (ER) with the risk of life-threatening arrhythmias in patients with coronary artery disease (CAD). This study was to investigate the relationships of ER with myocardial scarring and prognosis in patients with CAD.

Materials and Methods

Of 570 consecutive CAD patients, patients with and without ER were assigned to ER group (n=139) and no ER group (n=431), respectively. Myocardial scar was evaluated using cardiac single-photon emission computed tomography.

Results

ER group had previous history of myocardial infarction (33% vs. 15%, p<0.001) and lower left ventricular ejection fraction (57±13% vs. 62±13%, p<0.001) more frequently than no-ER group. While 74 (53%) patients in ER group had myocardial scar, only 121 (28%) patients had in no-ER group (p<0.001). During follow up, 9 (7%) and 4 (0.9%) patients had cardiac events in ER and no-ER group, respectively (p=0.001). All patients with cardiac events had ER in inferior leads and horizontal/descending ST-segment. Patients with both ER in inferior leads and horizontal/descending ST variant and scar had an increased adjusted hazard ratio of cardiac events (hazard ratio 16.0; 95% confidence interval: 4.1 to 55.8; p<0.001).

Conclusion

ER in inferior leads with a horizontal/descending ST variant was associated with increased risk of cardiac events. These findings suggest that ER in patients with CAD may be related to myocardial scar rather than pure ion channel problem.     

冠心病冠脉病变严重程度与红细胞分布宽度及尿酸的相关性分析

目的 探讨冠心病冠脉病变严重程度与红细胞分布宽度及血尿酸的相关性。方法 选取中医药大学第一附属南院心血管病区2016年12月~2017年12月因胸痛疑诊冠心病或已明确冠心病患者134例,根据既往或入院后冠状动脉造影结果,左主干、左前降支、左回旋支、右冠状动脉或其主要分支血管直径狭窄≥50％者为冠心病组共96例,上述主要分支血管直径狭窄＜50％者共40例为对照组。根据冠状动脉病变支数分为单支病变组、双支病变组和三支病变组,采用Gensini法分别对冠脉病变进行评分。结果 冠脉病变严重程度与红细胞分布宽度与血尿酸水平呈正相关,尿酸（OR=1.006,P＜0.05）和红细胞分布宽度（OR=2.450,P＜0.05）的升高为冠心病的独立危险因素,且红细胞分布宽度与UA水平随着冠脉病变支数的增加逐渐递增,三支病变组红细胞分布宽度、血尿酸水平高于单支病变组（P=0.004、0.016＜0.05）,三支病变组红细胞分布宽度水平高于双支病变组（P＜0.05）;双支病变组红细胞分布宽度、血尿酸水平高于单支病变组,三支病变组血尿酸水平高于双支病变组,差异无统计学意义（P＞0.05）,考虑与样本量较小及患者用药控制因素有关。结论 冠心病冠脉病变严重程度与红细胞分布宽度及血尿酸呈正相关。     

Peripheral Artery Disease in Korean Patients Undergoing Percutaneous Coronary Intervention: Prevalence and Association with Coronary Artery Disease Severity

Peripheral artery disease (PAD) is an important marker for the risk stratification of patients with coronary artery disease (CAD). We investigated the prevalence of PAD in patients undergoing percutaneous coronary intervention (PCI) with CAD and the relationship between ankle-brachial pressure index (ABPI) and CAD severity. A total of 711 patients undergoing PCI for CAD from August 2009 to August 2011 were enrolled. PAD diagnosis was made using the ABPI. The prevalence of PAD was 12.8%. In PAD patients, mean values of right and left ABPI were 0.71 ± 0.15 and 0.73 ± 0.15. Patients with PAD had a higher prevalence of left main coronary disease (14.3% vs 5.8%, P = 0.003), more frequently had multivessel lesions (74.9% vs 52.1%, P < 0.001) and had higher SYNTAX score (18.2 ± 12.3 vs 13.1 ± 8.26, P = 0.002). Using multivariate analysis, we determined that left main CAD (OR, 2.954; 95% CI, 1.418-6.152, P = 0.004) and multivessel CAD (OR, 2.321; 95% CI, 1.363-3.953, P = 0.002) were both independently associated with PAD. We recommend that ABPI-based PAD screening should be implemented in all patients undergoing PCI with CAD, especially in severe cases.     

冠心病患者血清同型半胱氨酸及血脂水平的诊断价值研究

观察血清同型半胱氨酸（Hcy）及血脂水平在冠心病辅助诊断中的应用价值。利用全自动生化分析仪测定190例确诊的冠心病患者及123名健康查体者血清同型半胱氨酸及血脂水平。结果显示,冠心病患者血清同型半胱氨酸（Hcy）、脂蛋白a[Lp（a）]、载脂蛋白B（ApoB）、载脂蛋白C2（ApoC2）、载脂蛋白C3（ApoC3）、甘油三脂（TG）高于正常人群（P〈0.05）;高密度脂蛋白胆固醇（HDL）、载脂蛋白A1（ApoA1）、载脂蛋白A2（ApoA2）水平显著低于正常人群（P〈0.01）。女性冠心病患者血清CH、HDL、ApoA1水平高于男性冠心病患者（P〈0.01）。不同年龄组冠心病患者的比较发现,随年龄的增长,同型半胱氨酸有升高趋势,而部分血脂水平有降低趋势。以上结果表明,老年男性应适当补充叶酸、维生素B12,冠心病患者血清同型半胱氨酸及血脂水平的监测对于冠心病的诊断及预后具有重要的意义。     

Correlations between Oxidative DNA Damage, Oxidative Stress and Coenzyme Q10 in Patients with Coronary Artery Disease

The correlation of coronary artery disease (CAD) with pro-oxidant/antioxidant balance and oxidative DNA damage was investigated.Seventy-seven patients with CAD and 44 healthy individuals as control were included in this study. The comparative ratios of ubiquinol-10/ubiquinone-10, 8-hydroxy-2^''-deoxyguanosine/deoxyguanosine and the level of MDA measured by HPLC and the activities of GPX and SOD by colorimetric approach in blood samples obtained from patients with CAD were unraveled.8-OHdG/dG ratios, serum MDA level and GPX activity were found significantly elevated level in serum of CAD patients compared to control group. The SOD activity was observed in stable levels in CAD patients. Ubiquinol-10/ubiquinone-10 ratio was significantly lower in patients with CAD than the controls.The positive correlation was observed between 8-OHdG/dG ratios in both MDA levels and GPX activity, while the significant negative correlation was seemed between the ratio of 8-OHdG/dG and ubiquinol-10/ ubiquinone-10 as well as MDA levels and ubiquinol-10/ ubiquinone-10 ratio.We conclude that, both the disruption of pro-oxidant/antioxidant balance and oxidative stress in DNA may play an important role in the pathogenesis of coronary artery disease.     

Association of Exercise Capacity with Physical Functionality and Various Aspects of Fatigue in Patients with Coronary Artery Disease

The aim of this study was to examine associations between exercise capacity—indexed as the metabolic equivalent of the task—and various aspects of subjective fatigue, physical functionality, and depression in patients with coronary artery disease. A cross-sectional design was used. Patients with stable coronary artery disease (N = 240) underwent an exercise stress test and completed self-report assessments of depression, subjective physical limitations, vital exhaustion, and the impact of fatigue on physical, social, and cognitive functions. Associations between exercise capacity and these self-report variables were assessed using bivariate correlations and a series of multivariate regressions. Exercise capacity was negatively associated with vital exhaustion, physical limitations, and impact of fatigue on physical and social functioning but not on cognitive functioning. There was a marginal association between exercise capacity and depression. The associations between exercise capacity and fatigue remained significant even after controlling for effects of age, body mass index, gender, education, and comorbid diabetes mellitus. The main conclusion of the study is that in patients with coronary artery disease, exercise capacity has the strongest predictability for physical fatigue, but, importantly, it also independently predicts the feeling of loss of energy and malaise.     

新疆维汉两民族冠心病患者载脂蛋白E基因多态性研究

目的探讨新疆乌鲁木齐地区维汉两民族冠心病患者载脂蛋白E(Apo E)基因多态性与冠心病的关系.方法用酚氯仿抽提核酸法从凝血块中分离DNA,用多聚酶链式反应-限制性片段长度多态性(PCR-RFLP)方法对新疆乌鲁木齐地区维汉两民族103例冠心病患者和54例对照组人群进行Apo E基因多态性(由ε2、ε3和ε4决定的E2/2、E3/3、E4/4、E4/2、E4/3和E3/2)HhaI酶切研究.结果(1)维族中Apo E之ε2,ε3和ε4等位基因频率分别为0.221±0.373,0.647±0.380和0.132±0.224,与汉族(0.081±0.196,0.772±0.315和0.146±0.237)比较,ε2明显增高(P＜0.05),ε3和ε4虽有减低但无显著差别(P＞0.05).(2)Apo E之ε2,ε3和ε4等位基因频率在冠心病组分别为0.073±0.215,0.777±0.311和0.151±0.241,与对照组(0.185±0.296,0.685±0.367和0.130±0.221)比较,ε2明显减低(P＜0.05),维族中更明显(0.105±0.315对0.367±0.296,P＜0.05),ε3和ε4虽有升高但无显著差别(P＞0.05).(3)由ε2到ε4低密度脂蛋白胆固醇(LDL)、总胆固醇(TC)和甘油三酯逐渐升高.ε2缺失与冠心病其它危险因子一起作Logistic回归分析,ε2缺失(危险比RR=3.45,P＜0.05)为冠心病的危险因子之一.结论新疆乌鲁木齐地区维汉两民族人群中(1)维族和汉族人群中Apo E基因型分布有非常显著性差异(P＜0.01);维族人群中ε2等位基因频率明显高于汉族.(2)CAD患者Apo E基因之ε2等位基因频率明显降低,其中维族更明显,ε3和ε4有所升高;从ε2到ε4,LDL、TG和TC有升高趋势.(3)Apo E基因多态性(ε2等位基因缺失)为冠心病的危险因子之一,亦即ε2与冠心病负相关.     

Efficacy of Sirolimus-Eluting Stents Compared with Paclitaxel-Eluting Stents in an Unselected Population with Coronary Artery Disease: 24-Month Outcomes of Patients in a Prospective Non-randomized Registry in Southern Turkey

Background: The efficacy of drug-eluting stents has been shown in randomized trials, but some controversy exists regarding which stent sirolimus-eluting or paclitaxel-eluting is more effective in unselected Turkish patients. Therefore, we investigated the clinical outcomes of patients who were treated with one type of these drug-eluting stents in the real world.Methods: We created a registry and prospectively analyzed data on a consecutive series of all patients who presented to our institution with symptomatic coronary artery disease between February 2005 and March 2007 and who were treated with the sirolimus- or the paclitaxel-eluting stent. The follow-up period after stent implantation was approximately 24 months. The primary end point was a major cardiac event, and the secondary end point was stent thrombosis. Informed consent was obtained from all subjects, and the study protocol was approved by the local ethical committee.Results: In total, 204 patients were treated with either the sirolimus-eluting stent (n = 103) or the paclitaxel-eluting stent (n = 101). The lesions in the 2 arms of the study were treated similarly by conventional technique. At 24-month follow-up, patients who received the paclitaxel-eluting stent showed significantly higher rates of non-Q-wave myocardial infarction (1.9% vs 5.9%; P: .002), target vessel revascularization (1.9% vs 4.9%; P: .002), coronary artery bypass graft surgery (1.9% vs 6.9%; P: .001), and late stent thrombosis (1.9% vs 3.9%, P: .002).Conclusions: Patients who received the sirolimus-eluting stent showed better clinical outcomes compared with those who had the paclitaxel-eluting-stent.     

Interleukin 8 and Susceptibility to Coronary Artery Disease: a Population Genetics Perspective.

INTRODUCTION: Interleukin 8 is a strong chemoattractant factor for neutrophils and T lymphocytes. We investigated the potential influence of two common polymorphisms of the interleukin-8 gene, -251A/T, and 781C/T on susceptibility to coronary artery disease. MATERIALS AND METHODS: The hypothesis was tested by screening for the prevalence of the above polymorphisms in 241 angiographically diagnosed coronary artery disease patients compared to 157 selected controls with negative coronary angiography. RESULTS AND DISCUSSION: We found no significant differences between cases and controls concerning the allelic and genotypic frequencies of both the studied polymorphisms. Nevertheless, a statistically significant lower frequency of the AA containing genotypes was observed in cases presenting with acute coronary syndromes compared to asymptomatic subjects or patients with stable coronary artery disease (OR = 0.44, 95%CI: 0.2-0.98, p = 0.04). The strongest statistical significance was observed in the AA(251)TT(781) combined genotype (OR = 0.34, 95%CI: 0.14-0.85, p = 0.02). CONCLUSION: Our results suggest that the genetic diversity of the interleukin-8 gene influences the clinical manifestation of CAD.