冠心病合并2型糖尿病患者冠状动脉造影临床分析

目的 探讨冠心病合并2型糖尿病患者冠状动脉造影的特点.方法 选择120例冠心病患者进行冠状动脉造影,其中合并糖尿病60例,无糖尿病60例,根据临床特点及造影结果进行对比.结果 冠心病合并糖尿病患者冠状动脉血管病变明显重于单纯冠心病组.多表现为多支血管病变及弥漫性病变(P＜0.05).结论 冠心病合并糖尿病患者冠状动脉造影主要表现为广泛和严重的冠状动脉血管病变. Abstract： Objective To study the coronary artery disease characteristics by coronary angiography in coronary heart diseases patients with type 2 diabetes mellitus. Methods 120 cases of coronary heart disease were treated with coronary angiography, including 60 cases with type 2 diabetes,60 cases of non -diabetic, clinical characteristics and imaging results were compared. Results Coronary artery disease in patients with coronary artery disease with diabetes mellitus was more serious than the other group ( P ＜ 0.05). Conclusions Coronary angiography in patients with coronary heart disease with diabetes mellitus for coronary artery disease mainly manifested more extensive and severe.     

糖尿病合并急性心肌梗死临床分析

目的 对糖尿病(DM)合并急性心肌梗死(AMI)患者的临床特点及预后进行研究.方法 对40例糖尿病合并急性心肌梗死患者(DM组)和42例非糖尿病急性心肌梗死患者(NDM组)的临床特点及预后进行对比分析.结果 糖尿病患者发生急性心肌梗死组无痛性心梗发生率、冠脉血管病变程度、严重并发症发生率、病死率均明显高于非糖尿病组(P<0.05).结论 糖尿病合并急性心肌梗死临床症状不典型者多,严重并发症发生率高、病情重、病死率高、预后差. Abstract： Objective To investigate the clinical characteristic and prognosis of diabetes mellitus (DM) complicated with acute myocardial infarction (AMI). Methods To compare the clinical characteristic and prognosis of 40 cases of DM complicated with AMI and 42 cases of non-DM with AMI. Results The painless myocardia infarction rate,coronary vascular disease extent,incidence of severe complications and matality were higher in DM patients complicated with AMI than in no-DM patients with AMI. Conclusions The clinical manifestation of DM patients complicated with AMI were atypical and with higher incidence of severe complication and mortality,which leads to poor prognosis.     

脂蛋白相关磷脂酶A2与冠状动脉粥样硬化病变程度及斑块稳定性的关系

目的 探讨脂蛋白相关磷脂酶A2(Lp-PLA2)与冠状动脉粥样硬化病变程度及斑块稳定性的关系.方法 对160例可疑冠心病患者行冠状动脉造影,根据冠状动脉造影结果分为冠状动脉造影正常的对照组(34例)和冠心病组(126例),冠心病组根据临床类型分为急性冠状动脉综合征组(86例)和稳定型心绞痛组(40例).以病变支数和Gensini积分评价动脉粥样硬化病变程度,以临床类型评价斑块稳定性.检查所有患者血清Lp-PLA2水平、高敏C-反应蛋白(hs-CRP)等指标,分析Lp-PLA2、hs-CRP等与病变支数、Gensini积分、斑块稳定性的关系.结果 冠心病组Lp-PLA2水平显著高于对照组(P＜0.05),而且随着冠状动脉病变支数的增加和Gensini积分的增加而逐渐升高,在急性冠状动脉综合征组较稳定型心绞痛组升高.Lp-PLA2水平与hs-CRP无明显相关性.结论 冠心病患者血清Lp-PLA2水平与冠状动脉粥样硬化病变程度及斑块稳定性有关. Abstract： Objective To investigate the correlations between serum levels of lipoprotein -associated pospholipase A2 ( Lp - PLA2 ) and the severity and stability of coronary atherosclerosis. Methods Coronary angiography (CAG) was performed in 160 patients who were suspected as having coronary artery disease(CAD). According to the coronary artery chanrges and plaque characters in CAG, all patients were divided into control group( n =34) and CAD group( n = 126). According to the clinical types,the CAD patients were divided into acute coronary syndrome (ACS) group ( n = 86) and stable angina pectoris (SAP) group ( n = 40). The number of diseased coronary branches and Gensini' s score was used for evaluate the severity of atherosclerosis. The clinical types was used for evaluate the stability of plaque. Lp - PLA2 and hs - CRP were measured in all the patients. The correlation between serum LpPLA2 with hs - CRP and the number of diseased coronary branches, Gensini's score, clinical types were analyzed. Results Lp - PLA2 in CAD patients was significantly higher than that in control group ( P＜0.05) and increased with the increasing number of diseased coronary branches and Gensini's score.Lp -PLA2 in ACS group was higher than SAP group. Lp -PLA2 level had no correlated with hs -CRP.Conclusions CAD patients serum Lp - PLA2 level is correlated with the severity of atherosclerosis and the stability of plaque.     

Roles of human epicardial adipose tissue in coronary artery atherosclerosis

This study examined the adipocytokine-vascular interactions and link between epicardial adipose tissue and coronary artery atherosclerosis.Thirty-four patients undergoing open heart surgery were chosen randomly, and divided into groupⅠ(non-coronary artery disease group) and group Ⅱ(coronary artery disease group).Blood samples were taken through peripheral vein prior to surgery.Plasma levels of a panel of proteins (adiponectin, IL-10, TNF-α) were detected by using ELISA.Epicardial adipose tissue was taken near the proximal tract of the right coronary artery and subcutaneous adipose was taken from the leg before cardiopulmonary bypassing, adiponectin and CD68+ were detected by using RT-PCR and immunohistochemistry.Our results showed that plasma adiponectin level was significantly lower in the group Ⅱ as compared with group Ⅰ(P<0.05).There were no differences in plasma concentration (IL-10, TNF-α, tatal-chol, HDL-chol, LDL-chol) between group Ⅰ and group Ⅱ.The number of CD68+ cells in epicardial adipose tissue of group Ⅱ was significantly higher than that in subcutaneous adipose tissue.Adiponectin mRNA expression was 6 fold higher in subcutaneous adipose tissue than in epicardial adipose tissue of group Ⅱ (P<0.01).Furthermore, the level of adiponectin mRNA in the epicardial adipose tissue in group Ⅱ was also significantly lower than in group Ⅰ (P<0.05).We are led to conclude that inflammation that occurs locally in epicardial adipose tissue of CAD contributes to the pathogenesis of coronary artery disease.     

Comparison of 99mTc-methoxyisobutylisonitrile myocardial single-photon emission computed tomography and electron beam computed tomography for detecting coronary artery disease in patients with no myocardial infarction

Background Previous studies have compared single-photon emission computed tomography (SPECT) and electron beam computed tomography (EBCT) in detection of coronary artery disease (CAD) in patients with myocardial infarction (MI). The purpose of this study was to compare SPECT with EBCT in detection of CAD in patients with no MI.Methods One hundred and forty-seven patients with suspected CAD underwent stress-rest 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) myocardial SPECT, cardiac EBCT and coronary angiography (CAG) within one month. Of them, 73 patients (aged 52.6±10.6 years old) with no history of MI were included in this study. Coronary artery calcium (CAC) was defined as a CT value ≥130 HU within the boundary of coronary artery on EBCT. Results There were 35 and 38 patients with or without CAD according to CAG. Ninety-six percent of the patients with abnormal SPECT and CAC had a coronary arteries stenosis ≥50%, and 90.9% patients with normal SPECT and EBCT showed no CAD. The sensitivity of SPECT and EBCT in detection of CAD was comparable, and the specificity of SPECT (92.1%) was significantly higher than that of EBCT (55.3%) (P&lt;0.005). For the detection of individual coronary artery stenosis, both sensitivity and specificity of SPECT (75.0% and 93.7%) were significantly higher than those of EBCT (53.3% and 76.7%) (P&lt;0.025 and P&lt;0.005, respectively). In patients without chest pain, the sensitivity and specificity of SPECT (76.9% and 91.4%) were significantly higher than those of EBCT (23.1% and 69.0%) in detection of a coronary artery stenosis of ≥50% (P&lt;0.01 and P&lt;0.005, respectively). However, in patients with chest pain, both sensitivity and specificity of SPECT were comparable to those of EBCT. In patients ≤45 years old, the sensitivity of SPECT (77.8%) was significantly higher than that of EBCT (27.8%) in assessing a coronary artery stenosis of ≥50% (P&lt;0.005), and the specificity of SPECT was comparable to that of EBCT. In patients &gt;45 years old, the specificity of SPECT (94.3%) was significantly higher than that of EBCT (70.5%) (P&lt;0.005), and the sensitivity of SPECT was comparable to that of EBCT. Conclusion 99mTc-MIBI myocardial perfusion SPECT has higher accuracy than that of EBCT in detection of CAD in patients without MI.     

血清脂蛋白(a)水平与冠状动脉病变的关系

目的 探讨血清脂蛋白水平与冠心病患者冠状动脉病变的关系.方法 冠状动脉造影患者323例,分为冠心病组和正常对照组,其中根据冠状动脉病变狭窄程度分为轻度、中度、重度狭窄组,根据冠状动脉病变范围分为单支病变组、双支病变组和多支病变组.分别测定其血清脂蛋白、总胆固醇、低密度脂蛋白、甘油三酯水平.结果 冠心病组血清脂蛋白、总胆固醇、低密度脂蛋白、甘油三酯水平明显高于正常对照组.其中血清脂蛋白、总胆固醇和低密度脂蛋白水平与冠状动脉病变呈正相关;双支及多支病变组明显高于对照组和单支病变组(P<0.01),中度狭窄和重度狭窄组明显高于对照组和轻度病变组(P<0.01).结论 血清脂蛋白、总胆固醇和低密度脂蛋白能够反映冠状动脉的病变情况,其水平随冠状动脉病变范围及病变程度的加重而升高,可作为预测冠状动脉病变的一个因素. Abstract： Objective To investigate the possible relationship between the serum LP(a) and coronary artery changes in patients with coronary heart disease (CHD). Methods Coronary angiography (CAG) was performed in 323 patients. The patients were divided into CHD group and control group. The serum levels of lipids were measured. According to the coronary number of stenosis, CHD group was further divided into 1-vessel group, 2-vessel group and 3-vessel group according to the degree of coronary lesion, CHD group was further divided into light stenosis group, moderate stenosis group and severe stenosis group. Results The levels of total cholesterol (TC),LP(a),LDL-C and triglyceride (TG) in CHD patients were significant higher than those in the control group. The serum levels of TC,LP(a) and LDL-C were significantly related to CHD (P<0.01).The serum levels of TC,LP(a) and LDL-C were higher in the 2-vessel group and 3-vessel group than that in the control group and 1-vessel group (P<0.01).The serum levels of TC,LP(a) and LDL-C were higher in the moderate stenosis group, severe stenosis group than that in the control group and light stenosis group(P<0.01). Conclusions The increasing of TC, LP(a) and LDL-C are associated with the stenosis degrees and lesion degrees of coronary artery in patients with CHD which indicated that TC,LP(a) and LDL-C have clinical significance for evaluating the change of degree of coronary artery lesion.     

Long term efficacy and safety of Chinese made sirolimus eluting stents: results, including off label usage, from two centres over three years

Background Multiple randomized clinical trials have demonstrated that drug eluting stents can significantly reduce the rates of restenosis and subsequent adverse events across lesion and patient. We investigated the medium term clinical efficacy and safety of Firebird sirolimus eluting stent （SES） in coronary artery disease. Methods The sample was 509 consecutive patients with coronary artery disease （CAD） who were treated by Firebird SES and finished three-year clinical follow-up. The occurrences of major adverse cardiac events （MACE） and Academic Research Consortium defined stent thrombosis （ST） were evaluated in patients with and without diabetes mellitus. Results Three hundred and thirty three patients （65. 4%） were treated by Firebird SES by off label indications. Angiographic success was achieved in 98.3% of the lesions. MACE and target vessel revascularization rates at 6-month, 1 year＇s and 3 years＇ clinical follow-up were 2.4% and 1.4%, 4.1% and 2.8%, 7.9% and 5.1%, respectively. The cumulative 3-year MACE free survival rate was 92.1%. After 3 years, DM patients had significantly higher rates of MACE （13.7% vs 6.4%, P 〈0.05） and TVR （9.8% vs 4.0%, P 〈0.05） and the cumulative MACE free survival rate was very significantly lower in the DM group （86.4% vs 93;6%, P 〈0.05）. ST occurred in 7 patients （1.4%） at the end of 3 years＇ follow-up, 5 of them had definite ST with 4 cases presenting with myocardial reinfarction and 1 with unstable angina, the other 2 with probable ST had reinfarction in the stented coronary territory without angiographic follow-up. There was no difference in occurrence of ST between off label （1.5%） and on label groups （1.1%, P=-0.07）. Conclusions In daily practice, about 2/3 of patients were treated by Firebird SES by off label indications. Medium term clinical follow-up of 3 years indicated CAD patients treated by Firebird SES had a low MACE and acceptable ST rate. DM patients had higher rates of adverse events and than non DM.     

同期不停跳冠脉旁路移植术与颈动脉内膜剥脱术治疗冠心病合并颈动脉狭窄的初步结果

Background Coronary and carotid artery diseases frequently coexist and patients with concomitant significant disease of coronary and carotid arteries remain at high risk of perioperative stroke and myocardial infarction after coronary bypass surgery. The aim of this study was to investigate the effect of combined carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting on patients with carotid and coronary artery disease. Methods Consecutive patients with carotid and coronary artery disease underwent one-staged unilateral CEA and off-pump coronary artery bypass grafting between January 2002 and December 2007 in our heart institute. Perioperative complications including neurological events or major adverse cardiac events were assessed and follow-up was carried out. Results A total of 51 cases of isolated off-pump coronary artery bypass grafting and unilateral CEA including 34 right and17 left was performed. Mean blocked time of carotid artery in CEA was 25.5 ± 7 mins. Mean number of distal grafts per patient was 3.30 ± 0.45. Mean ventilation time,ICU stay and postoperative hospital stay were 11.3±5.4 hours,2.1 ± 0.9 days and 12.5 ± 6.1days respectively. None of the patients had stroke or myocardial infarct and there was one perioperative death due to acute cardiac failure, with operative mortality of 1.96%. Follow-up was complete in 47 patients (92.16%). After mean follow-up of 39.5 ±12.5 months (6～73 months) , none of patient manifested with stroke , new angina or new-born cardiac infarct and there was also no late death. Conclusions Concomitant off-pump coronary artery bypass grafting and CEA is a safe and effective procedure in selective patients with significant carotid and coronary artery disease.     

Relation of coronary vulnerable plaque instability to serum levels of C-reactive protein and B-type natriuretic peptide in ACS.

Objective To explore the relationship between coronary vulnerable plaque instability and serum C-reactive protein(CRP) , B-type natriuretic peptide(BNP) levels in 85 patients with coronary heart disease. Methods Eighty-five patients( aged 63±16,M= 52 ) were divided into two groups.The control group was 28 patients with stable angina pectoris (SAP). The study group was 57 patients with acute coronary syndrome (ACS) .which were further divided into 21 patients with non ST elevated myocardial infarction (NSTEMI) and 36 patients with unstable angina pectoris (UAP). Plasma BNP and CRP were measured as well as coronary angiography made for all 85 patients. Plaques of coronary culprit arteries were classified as I -III three types according to Ambrose classification. Results (1). BNP and CRP levels of NSTEMI and UAP groups were significant higher than in SAP group. (2).The levels of BNP and CRP correlated with Ambrose classification, especially positively with Ambrose II type ,but no relation with coronary narosis. (3). The levels of BNP was much higher in patients of left anterior descending or multiple coronary artery diseases .(4). The Plaques of coronary culprit arteries in high risk of NSTEMI and UAP patients were mostly Ambrose II or III type. Conclusions The prevalence of higher levels of plasma BNP and CRP in patients with ACS ,when compared with those of SAP, was associated with the instability of coronary vulnerable plaques (ie, Ambrose II type). The level of BNP was much higher in patients of left anterior descending or multiple complicated coronary diseases. So, BNP and CRP are not only markers of vulnerable plaques, but also indicators of ACS prognosis.     

L''''ANGINE DE POITRINE PRECEDENT L''''INFARCTUS DU MYOCARDE:RELATION AVEC LES LESIONS CORONAIRES ET LA CIRCULATION COLLATERALE

To determine the relationship between angina pectoris before myocardial infarction (MI) and the extent of coronary artery disease and collateral circulation, 28 patients with (group Ⅰ)and 22 patients without (group Ⅱ) angina one month prior to acute MI underwent left ventriculography and coronary arteriography within 6 months of a first transmural MI. 23 patients in group Ⅰbut only 6 patients in group Ⅱhad multivessel disease. Despite a similar incidence of total occlusion of infarct-related artery, the collateral score in group Ⅰwas significantly higher than that in group Ⅱ. Abnormal regional left ventricular motion score was lower in group Ⅰthan in group Ⅱ. The study suggests that a history of angina before MI may predict the presence o f multivessel disease and the formation of collateral circulation in patients with MI.     

儿童腺样体扁桃体切除前后血清炎性介质的动态变化

目的 观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿行腺样体扁桃体切除手术前、后血清中炎性因子的变化,并评估手术的影响.方法 将45例行扁桃体腺样体切除术的OSAHS患儿作为治疗组,另选45例性别和年龄等与治疗组相匹配的健康儿童为对照组.用超敏ELISA法检测血清α-肿瘤坏死因子(TNF-α)和白介素-6(IL-6),用胶乳增强免疫比浊法检测血清中超敏C-反应蛋白(hs-CRP).治疗组手术治疗后6个月复查上述指标.结果 治疗组术前血清TNF-α、IL-6和hs-CRP水平均高于对照组(P<0.01);经手术治疗后1年,上述指标均低于术前水平(P<0.01);TNF-α、IL-6和hs-CRP水平与AHI呈正相关,与LSaO2呈负相关.结论 手术治疗可有效逆转OSAHS患儿血中TNF-α、IL-6和Hs-CRP的水平,可以将其作为手术治疗效果的评价指标. Abstract： Objective To observe the changes of circulating tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) levels in children with obstructive sleep apnea-hypopnea syndrome (OSAHS) before and after operation,and to assess the effect of surgical treatment on the levels of these inflammatory factors. Methods Forty-five children with OSAHS underwent adenoidectomy and tonsillectomy were selected as OSAHS group and matched for age and sex to 45 health children control group. Serum levels of TNF-α and IL-6 were detected by high sensitivity ELISA. The hs-CRP was measured by latex-enhanced turbidometry. The serum levels of these factors in OSAHS group before operation were compared with those of the control group and OSAHS group 6 months after operation. Results Serum levels of TNF-α, IL-6, and hs-CRP in OSAHS group were higher than those in the control group (P<0.01), and the levels in OSAHS group 6 months after operation were significantly lower than those before operation (P<0.01). All the serum parameters were correlated positively with AHI, and negatively with LSaO2. Conclusions Operative treatment can effectively correct circulating serum levels of TNF-α,IL-6 and hs-CRP in children with OSAHS. The changes of TNF-α,IL-6 and hs-CRP levels can be a valuable measure in treatment follow-up.     

探讨血清视黄醇结合蛋白4与冠心病的相关性

目的 观察冠心病患者血清视黄醇结合蛋白4(RBP4)水平,并探讨RBP4与冠心病的关系.方法 64例冠心病患者分为急性心肌梗死(AMI)组10例,不稳定型心绞痛(UAP)组42例,稳定型心绞痛(SAP)组12例,另选择21例冠状动脉造影结果正常者为对照组.采用酶联免疫吸附法(ELISA)测定血清RBP4水平.结果 血清RBP4在AMI和UAP组中高于SAP组和对照组,差异有统计学意义(P＜0.05),在SAP组与对照组之间差异无统计学意义(P＞0.05);血清RBP4在单支、双支、三支病变组中均高于对照组(P＜0.05),但在单支、双支与三支病变组之间差异均无统计学意义(P＞0.05).结论 RBP4可作为预测斑块稳定性的标志物,为冠心病危险分层及采取积极干预措施提供依据,但不能反映冠状动脉狭窄程度及范围. Abstract： Objective To investigate the serum retinol - binding protein 4 ( RBP 4 ) of coronary heart disease (CHD)patients and evaluate whether plasma macrophage migration inhibitory factor were associated with CHD. Methods Sixty -four patients with CHD were divided into the acute myocardial infarction (AMI) group ( n = 10), the unstable angina pectoris (UAP) group ( n = 42) and the stable angina pectoris(SAP) ( n = 12),21 normal subjests without CHD diagnosed by CAG served as the control group. The serum level of RBP4 measured by enzyme linked immune sorbent assay (ELISA). Results The serum level of RBP4 were higher in AMI and UAP group thai in SAP group and control group ( P ＜ 0. 05 ). The mean level of RBP4 in SAP group was not differently significantly, compared with that in control ( P ＞ 0. 05 ) ;The mean level of in single, double and three vessel lesion group were higher than that in control group (P ＜0. 05 ),but the serum levels of RBP4 among single, double and three were not significant different ( P ＞ 0. 05).Conclusions RBP4 may act as one of vulnerable plaques,we can take active to stabilize vulnerable plaques and decrease the occurrence of cardiac events,but may not reflect the severity of artery stenosis.     

阿托伐他汀对冠心病合并充血性心力衰竭患者血管内皮功能的影响

目的 研究阿托伐他汀对冠心病(CHD)合并充血性心力衰竭(CHF)患者血浆中一氧化氮(NO)、降钙素基因相关肽(CGRP)和内皮素(ET)的影响.方法 将68例CHD并CHF患者随机分为两组,常规治疗组(地高辛、氢氯噻嗪、硝酸异山梨酯)34例,联用组常规用药加阿托伐他汀34例,另选34例健康体健者为正常对照组.采用Greiss法测定NO水平,放射性免疫法测定治疗前后血中CGRP和ET的水平.结果 CHD并CHF患者中NO和CGRP水平明显低于正常组(P＜0.01),ET显著高于正常组(P＜0.01),治疗后均显著改善(P＜0.01),且以联用组改善更为显著,与常规组治疗后比较差异有统计学意义(P＜0.05).结论 常规用药加阿托伐他汀能显著改善CHD合并CHF患者的NO、CGRP和ET的代谢失衡. Abstract： Objective To study the effect on levels of plasma calcitonin gene-related peptide (CGRP) and endothelin(ET) of atorvastatin in patients with coronary artery heart disease(CHD) complicated with congestive heart failure(CHF). Methods Patients with CHD complicated with CHF were divided into two groups usual medicine group(usual medicine) and atorvastatin group. The plasma CGRP and ET levels were observed before and after treatment. Results The levels of CGRP in patients with CHF were lower than that in normal group before treatment (P＜0.05),and the level of ET was higher (P＜0.05),the improvement of CGRP and ET in atorvastatin group was better than that in the usual medicine group(P＜0.05). Conclusions Atorvastatin had the action of improving the imbalance of CGRP and ET in Patients with CHD complicated with CHF.     

D-二聚体与纤维蛋白原在冠心病中的临床意义

目的 研究D-二聚体(D-Dimer,DD)与纤维蛋白原(Fg)的含量在冠心病患者中的差异.方法 将入选的130例经冠状动脉造影(CAG)的患者分为确诊的冠心病组94例与正常对照组36例,其中冠心病组又分为急性心肌梗死(AMI)组25例、不稳定型心绞痛(UAP)组36例和稳定型心绞痛(SAP)组33例;再将冠心病组按CAG结果分为轻度病变组24例、中度病变组27例和重度病变组43例.用免疫透射比浊法分别测定DD、Fg含量进行比较.结果 AMI、UAP两组DD、Fg含量及阳性检出率明显高于SAP和对照组(P＜0.05),AMI组的DD、Fg含量明显高于UAP组(P＜0.05),重度病变组DD、Fg含量高于轻、中度病变组(P＜0.05).结论 联合检测DD与Fg在冠心病的诊断中具有重要的临床意义. Abstract： Objective To examine the diversity of D -dimer(DD) and fibrinogen (Fg)in the patients with coronary heart disease(CHD). Methods The 130 subjects were divided into CHD group(94 cases) which were confirmed by coronary artery angiography(CAG) and control group (36 cases). CHD group was divided into acute myocardial infarction (AMI) group (25 cases), unstable angina pectoris (UAP) group (36 cases) and stable angina pectoris (SAP) group ( 33 cases). In addition, CHD group was divided into slight (24 cases), moderate (27 cases)and severe (43 cases)lesion groups according to the outcome of CAG. The levels of DD and Fg were measured respectively and compared among all groups. Results The levels of DD, Fg in AMI and UAP groups were significantly elevated as compared with that of SAP and control groups ( P＜0.05), and DD, Fg in AMI group were higher than that of UAP group. The levels of DD and Fg in severe lesion group were higher than that of moderate and slight groups ( P＜0.05 ). Conclusions To measure the levels of DD and Fg simultaneously has important clinical significance in CHD.     

血管回声跟踪技术检测颈动脉弹性变化及主动脉瓣钙化与冠心病的相关性

目的 应用血管回声跟踪技术检测颈动脉弹性变化及二维超声观察主动脉瓣钙化,研究二者与冠状动脉粥样硬化关系及预测价值.方法 应用血管回声跟踪技术对196例行冠脉造影(CAG)受检者进行颈总动脉检查,记录血管弹性指标,包括弹性系数(Ep)、僵硬度(β)、顺应性(AC)、脉搏波传导速度(PWVβ).同时二维超声观察主动脉瓣有无钙化,并将上述结果与CAG结果进行t检验.结果 颈动脉弹性减退与冠脉病变的相关性:β、Ep与CHD呈正相关(r=0.281,r=0.253,P＜0.01,P＜0.05),AVC与CHD呈正相关(r=0.173,P＜0.05).结论 颈动脉弹性减退及主动脉瓣钙化是冠心病的高危因素,对冠心病有较大的预测价值. Abstract： Objective To study the relationship and predictive value of variation of carotid artery elasticity detected by echotracking (ET) technique and aortic valve calcification detected by two - dimensional ultrasonography with coronary heart disease (CHD). Methods The carotid artery elasticity of 196 cases who underwent coronary angiography(CAG) for suspected CHD were detected by echotracking (ET) technique and the indicators of artery elasticity were recorded, which includes elasticity modulus ( Ep), stiffness parameter ( β ), arterial compliance ( AC ) and pulse wave velocity ( PWVβ ).And aortic valve calcification was detected by two - dimensional ultrasonography, T test was carried out between the results of ultrasound examination and CAG. Results The indicators β, EP of carotid artery elasticity were positively correlated with the extent of CHD( r =0. 281,0.253; P ＜ 0.01, ＜ 0.05). In the mean time, positive correlation between aortic valve calcification and the extent of CHD was found (r = 0. 173, P ＜ 0.05). Conclusions Carotid artery elasticity reducing and AVC are high risk factors of CHD and have great values in predicting CHD.     

血清脂蛋白(a)、胆红素水平与冠状动脉病变程度关系研究

目的 检测冠心病(CHD)患者的血清脂蛋白(a)和胆红素水平,并探讨其与CHD的关系.方法 对196例疑诊冠心病而接受冠状动脉造影的患者检测血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白(a)[Lp(a)]、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL).根据冠状动脉狭窄情况分为非冠心病组(冠状动脉狭窄小于50%,52例)、单支病变组(仅有一支冠状动脉分支狭窄大于或等于50%,53例)和多支病变组(有一支以上冠状动脉分支狭窄大于或等于50%,91例).分析影响冠状动脉病变的相关因素及冠状动脉病变程度与血脂、胆红素的关系.结果 各组间LDL-C、Lp(a)水平依次呈递增趋势,差异有统计学意义(P＜0.05)各组间间接胆红素水平呈依次递减趋势,多支病变组与非冠心病组、单支病变组差异有统计学意义(P＜0.05).单因素logistic回归结果表明血清脂蛋白(a)、间接胆红素均为影响冠状动脉病变的因素(回归系数分别2.125、-1.557,P＜0.01).进一步多因素logistic回归分析表明脂蛋白(a)对冠状动脉病变的影响要弱于低密度脂蛋白胆固醇、甘油三酯(0R值分别为1.238、5.031、3.996,95%CI分别为1.069-6.322、2.457-12.356、2.785-14.764).结论 血清Lp(a)水平升高、IBIL水平降低是CHD发病及病变程度的危险因素. Abstract： Objective To investigate the association of Lipoprotein (a) and bilirubin with coronary heart disease(CHD). Methods One hundred and ninty -six patients undergone coronary angiography and completed clinical examination of TC, TG, HDL - C, LDL - C, Lp ( a), TBIL, DBIL, IBIL were divided into the without coronary diseases group ( coronary artery stenosis ＜50% ,52 cases) ,the single vessel disease group(with only one vessel stenosis ≥50% ,53 cases) and the multi -vessel disease group (with more than one vessel stenosis ≥50% ,91 cases)according to the coronary angiographic results. The correlative factors of coronary lesion and the relationship between Lipid,bilirubin and the severity of coronary lesion were analyzed. Results Higher levels of LDL - C and Lp(a) were found in the single vessel disease group and in the multi -vessel disease group compared with the without coronary disease group, significant difference was found in the LDL- C and Lp(a) level among the 3 groups(P＜0.05). The levels of IBIL were lower in the single vessel disease group and in the multi -vessel disease group compared with the without coronary disease group,significant difference was found in indirect bilirubin level in the multi -vessel disease group compared with in the without coronary disease group and in the single vessel disease group(P＜0.05). Single factor logistic regression showed that Lp (a) and indirect bilirubin are both correlation factors with coronary lession (r =2. 125 and - 1. 557, P ＜0.01 respectively). Advanced multi - factor logistic regression showed weaker correlation of Lp (a) with coronary lesion compared with LDL - C and TG (OR = 1. 238,5.031 and 3.996,95% CI1.069 - 6.322,2.457 - 12.356,2.785 - 14.764 respectively). Conclusions High level of Lp(a) and Low level of IBIL in human significantly influence the severity of coronary heart disease(CHD).     

绝经后2型糖尿病患者尿路感染的雌激素治疗

目的 研究雌激素治疗绝经后2型糖尿病患者尿路感染的疗效.方法 将83例绝经后2型糖尿病尿路感染患者随机分为两组,对照组(42例)根据药敏给予抗生素治疗配合胰岛素控制血糖,治疗组(41例)在对照组的基础上加用雌二醇凝胶.观察两组的临床疗效及细菌学疗效.结果 治疗组痊愈31例,有效7例,无效3例;对照组痊愈15例,有效14例,无效13例.两组临床疗效比较差异有统计学意义(P<0.05),两组治疗后细菌学疗效比较差异亦有统计学意义(P<0.05).结论 在抗生素治疗的基础上加用雌二醇,对绝经后2型糖尿病合并尿路感染患者疗效显著. Abstract： Objective To investigate the curative effect of estrogen therapy on urinary tract infection of type 2 diabetes mellitus in postmenopausal women. Methods Eithty-three postmenopausal women who had urinary tract infection of type 2 diabetes mellitus were enrolled and were randomly divided to receive antibiotic therapy(levofloxacin was used before obtaining of drug susceptibility results) alone (control group) or in combination with estradiol gel (treatment group). The clinical efficacy and bacteriological therapeutic effect in the two groups were evaluated. Results The treatment group was better than control group in both clinical efficacy and bacteriaological therapeutic effect. Conclusions Antibiotic therapy in combination with estradiol gel showed remarkable efficacy for patients with type 2 diabetes mellitus associated with urinary tract infection in postmenopusal women.     

胸腔内置管并甘露聚糖肽联合白细胞介素-2注药治疗肺癌致恶性胸腔积液34例

目的 观察胸腔内置管并甘露聚糖肽联合白细胞介素-2注药治疗肺癌致恶性胸腔积液的疗效.方法 将我院收治的恶性胸腔积液患者34例,尽量排尽胸腔积液后胸腔内注入药物,治疗组为甘露聚糖肽60 mg/次、白细胞介素-2 100～200万U/次,每周1～2次,连用4次,无效停止治疗;对照组为甘露聚糖肽60 mg/次,每周1～2次,连用4次无效停用,随访3个月.结果 甘露聚糖肽+白细胞介素-2组有效率为82.35%;甘露聚糖肽组有效率为41.18%,两组有效率比较差异有统计学意义(P＜0.05).结论 中心静脉导管行胸腔闭式引流术操作简单,创伤小,无痛苦,带管活动方便,引流效果满意.甘露聚糖肽和白细胞介素-2联合用于胸膜腔内注射可充分发挥协同作用,迅速促进癌性渗出液的吸收,值得临床上进一步研究和推广. Abstract： Objective To discuss the clinical value of closed drainage of pleural cavity with central venous catheterand to evaluate the effect of mannatide and interleukin-2 in the treatment of the patients with pulmonary neoplasm combined with malignant pleural effusion by thoracic cavity perfusion drainage.Methods Thirty-four patients with pulmonary neoplasm combined with malignant pleural effusion were randomly divided into two groups.In group A, injection of mannatide (60 mg) and interleukin-2(10-20 million U) each time.In group B, injection of mannatide (60 mg)each time.The procedures were performed at an interval of a week for 1-2 times.The course of treatment was 4 weeks and the follow-up period was 3 months.Results The total efficiencies in groups A and B were 82.35% and 41.18%, respectively; the difference was considered significant (P ＜ 0.05).Conclusions The closed drainage of pleural cavity with central venous catheter is easy to manipulate, with minor trauma, no complaints, convenience in patient activity and satisfactory drainage effect.Mannatide and interleukin-2were effective and safe on patients with pulmonary neoplasmcombined with malignant pleural effusion, and they take effect synergetically.This method worth being studied and extended clinically.