重组人粒细胞—集落刺激因子预防肺癌化部期感染的效果

目的 总结重组人粒细胞－集落刺激因子（ｒｈＧ－ＣＳＦ）预防肺癌化疗期感染的效果。方法 回顾分析１６３例（３０８例次）肺癌患化疗期辅用或不同ｒｈＧ－ＣＳＦ中性粒细胞恢复和感染情况。结果 化疗期用ｒｈＧ－ＣＳＦ患（Ｇ－ＣＳＦ组）感染率（５４／２１７，２５％）明显低于非Ｇ－ＣＳＦ期（５１／９１，５６％）（Ｐ〈０．００５）；Ｇ－ＣＳＦ组化疗期中性粒细胞减少的发生率明显低于非Ｇ－ＣＳＦ组（Ｐ〈０．００５     

急性心肌梗死患者动员和采集外周血干细胞的安全性观察

目的　观察急性心肌梗死 (AMI)患者外周血干细胞分离与采集的可行性与安全性。方法　我院自 2 0 0 3年 11月至 2 0 0 4年 1月收治的 2 7例AMI患者 ,入院后在常规急性心肌梗死治疗 (药物与介入治疗 )基础上随机给予包涵体型粒细胞集落刺激因子 (包涵体型G CSF ,商品名 :惠尔血 )或分泌型G CSF(商品名 :金磊赛强 ) ,30 0～ 6 0 0 μg d皮下注射连续 5d ,第 6天分离外周血干细胞 ,进行经皮经腔冠状动脉内移植自体外周血干细胞。观察外周血干细胞动员和采集过程中的不良反应。结果　AMI患者在外周血干细胞的动员期间不良反应发生率为 4 4 4 % (12 2 7) ,在外周血干细胞采集过程中的不良反应发生率约为 2 5 9% (7 2 7) ,未见其他不良反应。结论　AMI患者经G CSF动员后 ,分离与采集外周血干细胞是安全的。     

82例中青年急性心肌梗死临床特点分析

目的分析中青年AMI的临床特点。方法回顾性分析82例中青年AMI患者危险因素、诱发因素、初发症状、并发症、住院期间病死率和死亡原因等,并与同期住院的112例老年AMI患者比较。结果中青年AMI患者男性明显多于女性,吸烟、酗酒比例高于老年AMI组;发病前多有明显的诱因;胸痛症状典型,多为单支冠脉病变,而严重心律失常、心力衰竭发生率及病死率明显低于老年A-MI组。结论中青年AMI患者发病多有明显的诱因、胸痛症状典型、冠脉病变多累及单支血管、并发症和急性期病死率低于老年患者。     

Effect of pre-infarction angina on ventricular late potentials in patients with acute myocardial infarction and successful thrombolysis

OBJECTIVE: Pre-infarction angina is considered as a good clinical model of ischaemic preconditioning which facilitates myocardial protection. Late potentials (LP) have prognostic significance following acute myocardial infarction (AMI). It is also well established that thrombolytic therapy reduces the incidence of LP. Our aim was to evaluate the relationship between pre-infarction angina and LP in patients receiving successful thrombolytic therapy. METHODS AND RESULTS: We prospectively studied 55 patients presenting with AMI (<6 hours). All patients received thrombolytic therapy and were evaluated with coronary angiography at predischarge. Signal-averaged recordings (SAECG) were obtained serially prior to thrombolysis, 48 hours after and 10 days later. Pre-infarction angina was present in 14 (25%) patients. There were no significant differences between the clinical characteristics and angiographic findings of the groups. Baseline SAECG parameters of the groups were also similar. After thrombolysis, the 48th hour values of LAS (the duration of the terminal low amplitude signals), and both the 10th day values of LAS and RMS (root mean square voltage of the last 40 ms of the QRS) were significantly better in the pre-infarction angina group. The mean filtered QRS duration and RMS 40 values changed significantly at the 10th day recordings of patients with pre-infarction angina [QRS duration, 110+/-34 ms before to 91+/-11 ms after (p = 0.039); RMS 40, 40+/-17 microV before to 50+/-14 microV after (p = 0.02)]. The incidence of LP significantly decreased after thrombolytic therapy in the pre-infarction angina group, however, this change was not observed in patients without angina. CONCLUSION: Presence of pre-infarction angina reduces the incidence of LP following thrombolysis in AMI. This might be explained by the possible beneficial effect of ischaemic preconditioning on the arrhythmogenic substrate.     

Is the beneficial effect of preinfarction angina related to an immune response?

Immune-mediated mechanisms are thought to play a key role in the development of coronary artery disease and its thrombotic complications. Preinfarction angina has been suggested to improve left ventricular function and short-term outcomes. The purpose of the present study was to investigate the relation between the immune response and in-hospital clinical course in preinfarction angina. We prospectively evaluated 93 patients. Forty-three patients exhibited preinfarction angina within 24 hours before the onset of acute myocardial infarction (AMI) (preinfarction angina group) and 50 patients were free from preinfarction angina (sudden onset group). The incidence of complications (heart failure, recurrent angina, arrhythmia and coronary interventions) and in-hospital mortality were assessed in the two study groups. We detected some immune markers, including white blood cells, C-reactive protein, immunoglobulins, and complement. White blood cells and CRP were significantly lower in the preinfarction angina group than in the sudden onset group (P < 0.001, P < 0.005, respectively). Conversely, IgE and C(4) were significantly higher in the preinfarction angina group than in the sudden onset group (P < 0.001, P < 0.001, respectively). The incidences of heart failure and severe arrhythmias were lower in the preinfarction group than in the sudden onset group (P < 0.005, P < 0.05 respectively). The beneficial effect of preinfarction angina may be associated with an immune-inflammatory response modified by a brief ischemic episode.     

伴高血压的急性心肌梗塞临床特点

目的探讨高血压（ＨＴ）对急性心肌梗塞（ＡＭＩ）临床表现与预后的影响。方法对照分析了５３５例有ＨＴ病史和６１７例无高血压病史（ＮＨＴ）的ＡＭＩ临床资料。结果ＨＴ组吸烟、饮酒、家族史阳性者,既往有糖尿病、脑卒中、心绞痛和陈旧性心肌梗塞史者均多于ＮＨＴ组（Ｐ＜０．０５～０．００１）,心绞痛的病程也较长（Ｐ＜０．００１）。ＡＭＩ于睡眠中发病,因劳累诱发者均少于ＮＨＴ组（Ｐ＜０．０５～０．００１）。ＨＴ组合并心衰、休克、室速室颤者与住院病死率均高于ＮＨＴ组（Ｐ＜０．０５～０．００１）。结论伴高血压的ＡＭＩ具有更多的冠心病危险因素,严重心脏并发症较多,近期预后较差。     

血浆血栓调节蛋白水平与冠心病关系的研究

目的:分别测定正常人及冠心病患者的血浆血栓调节蛋白(Thrombomodulin,TM)含量并探讨及与冠心病的关系。方法:观察对象分成正常对照组,稳定性心绞痛(SAP)组,不稳定性心绞痛(UAP)组及急性心肌梗死(AMI)组。采用酶联免疫吸附试验测量血浆TM值。结果:UAP组及AMI组TM水平无显著性差异(P=0.711),但这两组TM水平均明显高于SAP组及正常对照组(P<0.01),SAP组TM水平又高于正常对照组(P=0.05)。结论:血浆血栓调节蛋白水平是反映冠心病患者内皮细胞损伤程度和范围以及冠脉斑块稳定性的良好指标,对急性冠脉综合征与SAP的鉴别有较好的价值。     

冠心病患者可溶性CD105与hs-CRP水平相关分析

目的:探讨冠心病患者血浆超敏C反应蛋白(hs-CRP)与血清可溶性CD105水平的关系。方法:将冠心病82例住院患者,根据冠状动脉造影结果分为4组:稳定型心绞痛(SA)组16例;不稳定型心绞痛(UA)组24例;急性心肌梗死(AMI)组22例;对照组20例。测定所有研究对象血浆hs-CRP、血清可溶性CD105的水平。结果:1.对照组、SA组、UA组及AMI组血浆hs-CRP水平呈逐渐增高的趋势。AMI组血浆hs-CRP水平高于UA组(P<0.05),UA组血浆hs-CRP水平高于SA组(P<0.05),SA组血浆hs-CRP水平与对照组类似(P>0.05)。2.对照组、SA组、UA组及AMI组血浆可溶性CD105水平逐渐增高。AMI组显著高于UA组(P<0.05),UA组高于SA组(P<0.05),SA组高于对照组(P<0.05)。3.冠心病患者中可溶性CD105与hs-CRP水平成正相关。结论:冠心病hs-CRP水平与血清可溶性CD105呈正相关,提示炎症与斑块新生血管在动脉粥样硬化(As)过程中可能有相互促进作用,从而降低了斑块的稳定性。     

冠心病急性心肌梗死并发糖尿病患者血清PPARγ的变化

目的: 探讨血清过氧化物酶体增殖物激活受体γ（PPARγ）与冠心病、Ⅱ型糖尿病并发急性心肌梗死(AMI)的关系。方法: 经冠脉造影证实的冠心病患者,分为稳定型心绞痛 (SAP)组、不稳定型心绞痛(UAP)组、AMI组、Ⅱ型糖尿病并发AMI（AD）组,经冠脉造影证实冠脉正常者为对照组。入院后抽取静脉血,测定PPARγ、血脂、空腹血糖（FPG）等。结果: 各组间比较PPARγ水平,SAP组与对照组无显著差异,UAP组、AMI组、DA组与对照组比较,PPARγ水平显著下降(P<0.01)。结论: 与单纯AMI组相比,AD组PPARγ降低更加显著。     

抵克力得对冠心病患者血小板聚集功能的影响及意义

目的:探讨冠心病患者血小板聚集功能和抵克力得的影响。方法:选择体检正常者、不稳定心绞痛(UAP)和急性心肌梗死(AMI)患者各20例,测定三组血小板聚集功能和后两组服用抵克力得后,由二磷酸腺苷(ADP)、肾上腺素(EP)诱导的血小板聚集功能的变化。结果:UAP组和AMI组血小板聚集率明显高于对照组(P<0.001); 服抵克力得后血小板聚集率均明显降低(P<0.001)。结论:冠心病患者血小板聚集功能明显增强,抵克力得对它有明显抑制作用。     

梗死前心绞痛对急性心肌梗死患者直接经皮冠状动脉介入治疗术后的影响

目的　探讨梗死前心绞痛对首次急性心肌梗死(AMI)患者直接经皮冠状动脉介入治疗(PCI)术后的近期影响。方法　将120例首次AMI患者分成有梗死前心绞痛史组(A组, 68例)和无梗死前心绞痛史组(B组, 52例),在发病12小时内行直接PCI术,分析梗死前心绞痛对肌酸肌酶(CK)峰值浓度、左心室功能和临床转归的影响。结果　(1)A组CK及CK MB峰值浓度均显著低于B组(P<0. 05); (2)A组冠状动脉自发再通率高于B组(P<0. 05),A组无再流现象发生率低于B组(P<0. 05); (3)A组左室射血分数高于B组(P<0. 05); (4)A组心力衰竭发生率及再梗死率低于B组(P<0. 05)。结论　梗死前心绞痛可能促进AMI患者梗死相关动脉自发再通的发生,减少直接PCI术后无再流现象发生,改善患者左心室功能和临床预后。     

不稳定性心绞痛尿激酶溶栓治疗的临床疗效——多中心随机对照研究

目的　对比尿激酶 (UK)与肝素在治疗不稳定性心绞痛 (UA)中的疗效。方法　采用单盲 ,有对照的完全随机化方法。UK溶栓组中按UK使用剂量分为高剂量组和低剂量组 ,后者在溶栓前增加静脉推注 3 0 0 0U肝素。研究以 3 0天病死率和急性心肌梗塞 (AMI)发生率为终点指标。结果　总共入选UA患者 5 3 4例 ,高剂量UK组 14 8例 ,低剂量UK组 113例 ,相应肝素作为对照组各为 15 5和 118例。在心脏事件 (死亡 AMI例数 )的发生率上 ,高剂量UK组高于肝素对照组 ( 10 1%与5 2 % ,P >0 0 5 ) ;而低剂量UK组低于肝素对照组 ( 3 5 %与 5 1% ,P >0 0 5 ) ,但均未达到统计学差异 ,而溶栓组间比较 ,低剂量UK组的心脏事件发生率明显低于高剂量UK组 ( 3 5 %与 10 1% ,P <0 0 5 ) ,并达到统计学显著性差异。在心脏事件的发生时间上 ,高剂量UK组心脏事件大多发生在溶栓治疗首日 ,其中发生在UK治疗的头 2个小时内占 4 6 7% ,而对照组大多数发生在入选治疗的 2 4小时后 ( 80 %与 12 5 % ,P <0 0 0 5 )。结论　高剂量UK组溶栓首日AMI发生率明显增加 ,提示该溶栓治疗方案不适于不稳定性心绞痛的治疗 ,降低UK剂量 ,溶栓前加强抗凝血酶治疗 ,虽可明显减少AMI的发生率 ,但是否优于对照组仍需进一步探讨。     

阿昔单抗降低急性心肌梗死直接PTCA术缺血危险性的观察

目的　探讨血小板Ⅱb/Ⅲa受体拮抗剂阿昔单抗在急性心肌梗死直接经皮冠状动脉腔内成形术 (PTCA)术中应用的安全性 ,合理性和对PTCA术后缺血并发症及预后的影响。方法　对 6 0例胸痛小于 2h施行直接PTCA治疗的急性心肌梗死患者 ,随机分成对照组 30例和阿昔单抗组 30例 ,对照组静脉注射常规剂量肝素 10 0U/kg ,阿昔单抗组静脉注射小剂量肝素 70U/kg和阿昔单抗 0 .2 5mg/kg,随后以阿昔单抗 10 μg/min持续静脉滴注 12h ,观察 30d时两组死亡率、心肌梗死、再次急诊冠脉血运重建术和出血发生率。结果　随访 30d ,两组均未见出血并发症 ,对照组复合终点事件发生率为 10 %;阿昔单抗组无 1例死亡 ,也未发生心肌梗死和施行再次冠脉血运重建术。结论　在急性冠脉缺血综合征中 ,应用血小板Ⅱb/Ⅲa受体拮抗剂是安全合理的 ,血小板Ⅱb/Ⅲa受体拮抗剂阿昔单抗能降低急性心肌梗死患者直接PTCA术后缺血并发症 ,改善患者预后。     

Endogenous G-CSF and CD34+ cell mobilization after acute myocardial infarction

BACKGROUND: Several reports showed an increase of CD34(+) stem/progenitor cell count early after an acute myocardial infarction (AMI), suggesting a contribution of bone marrow cells in myocardial regeneration after the acute event. Nevertheless, at present plasma mediators of CD34(+) cell mobilization from bone marrow to peripheral blood in patients with AMI are poorly understood. Aim of our study was to establish the impact of different well-known mobilizing cytokines on spontaneous stem cell mobilization in patients with different ischemic heart syndromes, such as the AMI and the chronic stable angina (CSA), compared to healthy controls. METHODS: In 16 patients with AMI, 18 with CSA and 22 healthy blood donors the concentration of CD34(+) cells, and mobilizing cyokines (G-CSF, SCF, VEGF, SDF1-alpha) were assessed. RESULTS: The peak number of circulating CD34(+) cells in AMI patients (8.58+/-2.08 cells/microl) was higher than that observed in patients with CSA (3.41+/-0.56 cells/microl, p=0.0061) or in healthy controls (2.18+/-0.35 cells/microl, p<0.001). However endogenous G-CSF was significantly higher in the serum of patients with AMI compared to CSA patients and to controls and in CSA patients compared to controls. Interestingly, as regards VEGF, while this cytokine was increased in AMI with respect to control and CSA group, the latter showed a significantly lower concentration with respect to controls. Finally SDF-1 alpha was higher in AMI patients with respect to controls. CD34(+) cells were significantly correlated to G-CSF (directly) and to SCF (inversely) in patients with AMI. CONCLUSION: In the present study, we have demonstrated for the first time that the spontaneous mobilization of CD34(+) cells into the peripheral blood of patients with AMI is significantly correlated to endogenous G-CSF. Considering recent data suggesting a potential favourable effect of circulating CD34(+) cells on left ventricular function, the present evidence of a correlation between endogenous G-CSF and CD34(+) cell levels supports the pharmacological administration of G-CSF as a non-invasive option for regeneration of myocardial tissue after AMI.     

Long-term outcome of primary percutaneous transluminal coronary angioplasty for low-risk acute myocardial infarction in patients older than 80 years: a single-center, open, randomized trial

Background Although coronary reperfusion therapy with thrombolytic agents or percutaneous transluminal coronary angioplasty (PTCA) immediately after acute myocardial infarction (AMI) has survival benefits for younger patients, the effect of coronary reperfusion therapy for very elderly (aged 80 years and older) patients with AMI remains controversial. Methods and Results We studied 120 patients aged 80 years and older at relatively low risk with AMI. The patients were randomized into a primary PTCA group (n = 61) or a “conservative” no-PTCA group (n = 59). Long-term follow-up examination was conducted with regard to endpoints, which included all causes of death, cardiac death, nonfatal re-MI, the development of congestive heart failure, and cerebral vascular accident. End-diastolic volume index and end-systolic volume index were significantly increased in both groups at follow-up examination 6 months after AMI. However, left ventricular ejection fraction, end-diastolic volume index, and end-systolic volume index were similar between both groups. With endpoints of all causes of death, cardiac death, reinfarction, congestive heart failure, and cerebral vascular accident, a 3-year Kaplan-Meier event-free survival rate analysis revealed no significant benefits in the PTCA group. Anteroseptal MI, multivessel disease, and left ventricular ejection fraction were significantly associated with the combined events with multivariate Cox proportional hazards analysis results. Conclusion First, primary PTCA for very elderly patients with AMI appears to have few beneficial effects on combined events during a 3-year period. Second, early PTCA did not prevent left ventricle remodeling after AMI in patients with AMI at relatively low risk. (Am Heart J 2002;143:497-505.)     

The prevalence of coronary heart disease in Type 2 diabetic patients in Italy: the DAI study

Aims Type 2 diabetes is associated with at least a twofold increase in risk of coronary heart disease (CHD). We aimed to estimate the prevalence of CHD in the population of Type 2 diabetics cared for by the Italian network of outpatient diabetic units. Methods The DAI ( D iabetes and Informatics study group, Italian A ssociation of Diabetologists, and I talian National Institute of Health) study is a multicentre cohort study of patients with Type 2 diabetes. Patients were classified as having CHD if they had: (i) a history for hospital admission for either an acute myocardial infarction (AMI) or angina; (ii) a positive ECG for prior AMI or angina; (iii) a positive history for coronary artery bypass graft; or (iv) a positive history for percutaneous transluminal coronary angioplasty. Results A cohort of 19 468 patients was analysed: 3157 patients had CHD. The majority of events (80%) had occurred after the diagnosis of diabetes and were considered in the CHD prevalence estimate. The prevalence of CHD, adjusted by age and sex, was 9.9%: 11.0% male and 9.0% female. Angina without AMI occurred in 1306 patients; this condition was more frequent in females while a documented AMI was more frequent in males. Therapeutic procedures were performed more frequently in males. A positive association with CHD was found for gender, age at visit, duration of diabetes, hypertension, relatives with CHD, tryglicerides and microvascular complications. Conclusions The prevalence of CHD in this cohort is lower than previously reported; nevertheless, patients attending the diabetic care units may not be fully representative of the general diabetic population in Italy. Revascularization is less frequent in females than in males; microvascular complications and a worse metabolic control are significantly associated with CHD.     

IL-6 and IL-1 receptor antagonist in stable angina pectoris and relation of IL-6 to clinical findings in acute myocardial infarction

OBJECTIVES: To determine if increased inflammatory activity, as reflected by interleukin-6 (IL-6) and interleukin-1 receptor antagonist (IL-1ra) levels, is present in patients with stable angina pectoris and if IL-6 levels on admission to the coronary care unit in patients with acute myocardial infarction (AMI) are related to heart failure and fever response. SUBJECTS AND METHODS: We studied 28 patients with stable angina pectoris enrolled for coronary angiography, and compared them with sex- and age-matched controls. Thirty-four patients with AMI were studied and samples for determination of IL-6 levels were taken on admission within 36 h of onset of symptoms. IL-6 and IL-1ra were determined in serum by enzyme immunoassay. RESULTS: Levels of IL-6 and IL-1ra were higher in patients with stable angina pectoris than in controls (mean 4.6 +/- 3.6 vs. 3.0 +/- 2.9 ng L-1, P < 0.03, and 774 +/- 509 vs. 490 +/- 511 ng L-1, P < 0.01, respectively). IL-6 and IL-1ra levels were not related to angiographic findings. IL-6 levels were high in patients with AMI (38.9 +/- 75.6 ng L-1). Patients with prolonged fever (duration > 4 days) had higher IL-6 levels (94.7 +/- 138.2 vs. 21.7 +/- 29.7 ng L-1, P < 0.05). IL-6 levels were not related to heart failure. CONCLUSIONS: Our results indicate that increased inflammatory activity is present not only in acute coronary syndromes, but also in a chronic form of ischaemic heart disease, giving further evidence for a central role of inflammatory processes in coronary artery disease. With regard to AMI, we found increased inflammatory activity in patients with prolonged fever.     

Uncomplicated acute myocardial infarction -- when should the patient be discharged?]

INTRODUCTION AND OBJECTIVES: Hospital discharge on day 10 after acute myocardial infarction (AMI) is still frequent in our hospital. The present study aims at evaluating the occurrence of cardiac events on day 5, 7 and 10, in patients with AMI who had an uncomplicated course for 72 hours after thrombolysis, as well as a cost-effectiveness analysis on an earlier discharge. METHODS: We retrospectively studied consecutive patients admitted with AMI for a period of 5 years, submitted to thrombolysis who suffered no events (recurrent ischemia, reinfarction, coronary revascularization, heart failure, arrhythmias implicating electric cardioversion or dysfibrilation, pacemaker or death) within the first 72 hours (n = 128; 101 males and 27 females, mean age 64.1 +/- 12.8). Patients were divided into two groups, with no events occurring by discharge (group I, n = 119) or with events between 72 hours and discharge (group II, n = 9). The latter were subdivided according to whether events occurred between 72 hours and day 5, between days 6 and 7 or between 8 and 10. RESULTS: Group I and II were not significantly different regarding vascular risk factors, prior coronary disease and infarction location. Group I was mainly constituted of males, younger than those in group II and with preserved systolic LV function. Between 72 hours and discharge, there were no events in 93% of the patients (119) and events occurred in 7% (9 patients). Two cases of cardiac events occurred until day 5 (1.6%) one angina and one death, two patients with complications between days 6 and 7 (1.6%), both heart failure, and 5 patients suffered events after day 7 (4%), 3 angina and 2 deaths. Dead patients (3 cases--2.3%) were older, had prior AMI, mostly with unpreserved systolic LV function and prior ischemic heart disease. All of them had sudden death. The most frequent non-fatal complications were recurrent ischemia and heart failure. CONCLUSIONS AND IMPLICATIONS: In patients with AMI who had an uncomplicated course for 72 hours after thrombolysis, the risk of cardiac events by the 10th day is low. It occurs randomly in time. In this group of patients it seems of no effectiveness to lengthen hospitalization. An earlier discharge may be advantageous since it does not significantly increase the risk that a longer hospitalization could prevent.     

经桡动脉介入治疗高龄冠心病患者的可行性

目的:评价高龄冠心病患者经桡动脉穿刺介入治疗的安全性及可行性。方法:380例70岁以上的老年冠心病行介入治疗患者按动脉穿刺途径随机分成桡动脉组(n=190)和股动脉组(n=190),观察两组间动脉穿刺成功率、手术操作时间、造影剂用量、局部及全身并发症发生情况。结果:经桡动脉穿刺途径成功共182例,经股动脉穿刺途径成功共188例。两组间动脉穿刺成功率、介入手术时间、造影剂用量差异无显著性。局部出血并发症迷走反射桡动脉组明显少于股动脉组(P0.05)。结论:高龄冠心病患者经桡动脉途径穿刺行介入治疗方法可行、治疗有效,较股动脉并发症发生少,是高龄冠心病患者介入治疗可选择的穿刺途径。     

运动对心绞痛患者的康复作用

目的：观察运动对心绞痛患的康复作用。方法：48例心绞痛患被随机分为A，B两组，所有病例均接受心绞痛常规药物治疗，A组患同时进行运动训练，隔日1次，运动靶心率为该病人运动试验能达到的最大心率的75％－85％，运动持续时间30分钟左右；B组患采取自然生活。结果：随访1年，A组在心绞痛发作频率，持续时间，缺血性心电图，心功能改善方面均优于B组（P＜0．05）。A组运动期间未发生心肌梗死，猝死。结论：运动康复对心绞痛患安全有效，应大力提倡。