冠状动脉造影中血压升高患者冠状动脉狭窄与血管内皮功能及炎症因子的相关性研究

目的探讨冠状动脉造影中血压升高的非高血压患者的冠状动脉狭窄与血管内皮功能及炎症因子的相关性。方法选择1141例疑诊冠心病的非高血压患者,所有患者均行冠状动脉造影检查,其中将冠状动脉造影过程中监测收缩压升高≥30 mm Hg（1 mm Hg=0.133 kPa）和（或）舒张压升高≥15 mm Hg的患者分为观察组,反之为对照组,测定两组患者一氧化氮（NO）、肱动脉介导的血管内皮功能（FMD）及超敏C反应蛋白（hs-CRP）、可溶性白细胞分化抗原配体（sCD40L）水平。观察术中血压升高者其冠状动脉狭窄与血管内皮功能及炎症因子的关系。结果两组术前及术后血压比较,差异均无统计学意义。冠状动脉造影结果显示,对照组以正常和狭窄〈50%为主,而观察组则以狭窄〈50%和狭窄≥50%为主,观察组冠状动脉狭窄≥50%者比例显著高于对照组（χ2=79.87,P〈0.05）,而对照组冠状动脉造影正常者比例显著高于观察组（χ2=79.87,P〈0.05）。观察组血浆NO水平（P=0.004）及代表血管内皮依赖性舒张功能的FMD（P=0.023）显著低于对照组;而代表炎症反应的hs-CRP（P=0.036）及sCD40L（P=0.015）显著高于对照组。结论冠状动脉造影术中血压升高的非高血压患者已存在冠状动脉狭窄、血管内皮功能障碍及血浆炎症因子升高。     

叶酸对冠心病患者支架术后血管内皮功能的影响

目的 探讨叶酸能否改善冠心病患者支架术后的血管内皮功能.方法 共184例冠心病患者,在行冠状动脉支架术后,随机分为叶酸治疗（20 mg/d）92例和对照组92例.随访6个月,观察两组同型半胱氨酸水平.以超声测定肱动脉血流介导的舒张功能（FMD）变化来评价血管内皮功能,并观察两组间的差别.结果 叶酸治疗组血浆同型半胱氨酸水平低于对照组[（8.83±3.33）μmol/L比（13.18±5.08）μmol/L,P＜0.01].叶酸治疗后,FMD由（4.72±1.73）%增加至（8.54±1.45）%,P＜0.01.结论 叶酸治疗可能通过降低同型半胱氨酸以外的途径改善血管内皮功能,对介入治疗后的冠心病患者发挥潜在益处.     

The effect of atorvastatin on platelet function in patients with coronary artery disease

BACKGROUND: Lipid-lowering therapy was shown to have several beneficial effects in patients with coronary artery disease (CAD). AIM: The objective of this study was to investigate the effect of atorvastatin on platelet aggregation in patients with CAD. METHODS: Twenty-five hypercholesterolaemic patients who had angiographically proven CAD and 16 normal subjects were enrolled. All patients received 10 mg/day atorvastatin for two months. Anti-platelet agents were discontinued 15 days prior to blood sampling at the beginning and at the end of the atorvastatin therapy. Aggregometric curves of the platelets in response to ADP, collagen and epinephrine were obtained using the aggregometry (turbidimetric) technique. RESULTS: In patients with CAD, total cholesterol (TC) and LDL cholesterol (LDL-C) basal levels were measured (230 +/- 49 mg/dl, 140 +/- 41 mg/dl, respectively). Following lipid-lowering therapy, TC and LDL-C decreased significantly (p < 0.05). The activation measurements of aggregometric curves decreased significantly compared with basal parameters in response to ADP but not in response to collagen and epinephrine. CONCLUSION: Lipid-lowering therapy with the HMG-CoA reductase inhibitor, atorvastatin, had a marked reduction effect on platelet aggregation.     

老年冠心病患者血管内皮功能与动脉粥样硬化的关系

目的 观察老年冠心病(CAD)患者血管内皮舒张功能、动脉硬化的状况及与冠状动脉病变的相关性.方法 选择经冠状动脉造影确诊为CAD的患者90例(CAD组),冠状动脉造影证实无冠状动脉狭窄并无其他疾病史的患者30例为对照组,采用二维超声检测肱动脉内皮依赖性和非依赖性舒张功能及动脉内膜的变化,应用二维彩色多普勒超声检查颈动脉、股动脉,观察管腔、管径、内膜及有无斑块、血流变化、血流频谱形态及性质.动脉粥样硬化斑块积分采用Crouse法.对血管内皮细胞功能、动脉硬化与冠状动脉病变程度进行分析.结果 反应性充血引起的肱动脉内径变化在单支组及多支组明显减弱[(9.08±2.28)%、(6.14±2.21)%],与对照组[(15.58±2.20)%]比较,差异有统计学意义(P<0.01).CAD组颈动脉内膜中层厚度(IMT)高于对照组(P<0.05).结论 内皮细胞功能障碍和动脉粥样硬化与冠状动脉粥样硬化的病变密切相关.     

The effects of atorvastatin on coronary endothelial function in patients with recent myocardial infarction

BACKGROUND: Endothelial dysfunction is a key early event in atherosclerosis that occurs in acute coronary syndrome. It was reported that atorvastatin improves the endothelial function of skeletal muscle vessels, but the effect on the coronary artery is unknown. HYPOTHESIS: The purpose of this study is to determine the effects of atorvastatin on coronary endothelial function in humans. METHODS: Non-infarct-related coronary arteries of 48 patients with acute myocardial infarction who had undergone successful percutaneous transluminal coronary angioplasty were examined. Three groups were studied: hyperlipidemia with use of atorvastatin (Group 1, n=17), hyperlipidemia without statin use (Group 2, n=18), and normal cholesterol level controls (Group 3, n=13). Statin treatment was started at discharge. Acetylcholine (Ach) was infused into the coronary artery and the diameter was assessed by quantitative angiography at baseline and after 6 months. RESULTS: Acetylcholine given in doses of 1, 3, 10, and 30 mg/min increased the coronary artery diameter change in a dose-dependent manner. In the initial study, patients in the three groups had similar responses to Ach. The mean diameter change after 6 months was significantly improved in Group 1 compared with Groups 2 and 3 (-11 +/- 3% vs. -20 +/- 7% and -21 +/- 6%, respectively; p < 0.01 in each case). Multivariate regression analysis showed that atorvastatin (p < 0.01) was the significant determinant for improvement of endothelial function. CONCLUSIONS: These findings suggest that atorvastatin improves endothelial function of the coronary artery in patients with myocardial infarction.     

罗格列酮对冠心病合并2型糖尿病患者介入治疗后血管内皮功能的影响

目的观察罗格列酮对冠心病合并2型糖尿病患者介入术后血管内皮功能的影响。方法选择冠心病合并2型糖尿病行PCI患者102例,按照是否服用罗格列酮,随机分为治疗组(51例)和对照组(51例)。分别检测患者血液中NO、一氧化氮合酶(NOS)、内皮素1的含量变化,并观察患者的预后情况。结果与术前比较,2组患者在术后1、7 d时NO、NOS明显降低,内皮素1明显升高,差异有统计学意义(P0.05,P0.01);1个月时,对照组NO和NOS仍明显降低,差异有统计学意义(P0.05)。与对照组比较,治疗组患者的冠状动脉事件发生率明显降低,差异有统计学意义(P0.05)。结论罗格列酮可以通过改善血管内皮功能,并能减少冠心病合并2型糖尿病患者介入治疗后心血管事件的发生。     

阿托伐他汀对冠心病患者血清ghrelin水平的影响

目的：检测冠心病患者血清ghrelin的水平,探讨其与疾病严重程度的关系,并进一步观察阿托伐他汀治疗对其水平有无影响。方法：纳入64例冠心病患者和56名正常对照者,检测两组血清ghrelin水平有无差异。采用Gensini积分标准对冠心痛的病变程度进行定量评定,并分析其与血清ghrelin有无联系。64例冠心病患者再进一步随机分为常规治疗组和阿托伐他汀组,后者在常规治疗的基础上,另外服用阿托伐他汀10mg／d,治疗4周,观察治疗前后两组患者血清ghrelin水平的变化。结果：与正常组相比,冠心病患者的血清ghrelin水平明显降低,差异有统计学意义。Logistie回归分析表明,血清ghrelin降低是冠心病的独立危险因子。Spearman相关分析显示,血清ghrelin水平与Gensini积分呈显著负相关。治疗4周后,阿托伐他汀组的血清ghrelin水平较治疗前明显升高（P〈0．05）;而常规治疗组其血清水平无明显变化（P〉0．05）。结论：冠心病患者的血清ghrelin水平明显降低,并与疾病严重程度相关,阿托伐他汀具有升高冠心病患者血清ghrelin的作用。     

Off-pump bypass grafting in patients with significant left main coronary artery stenosis

The aim of this study was to investigate and determine whether patients with significant (%50) left main coronary artery stenosis could undergo coronary bypass on the beating heart and compare the results to those obtained using the conventional method. Prospectively collected data of patients with significant left main coronary artery disease who had undergone coronary bypass on the beating heart (group A, n = 100) or with the conventional method (group B, n = 100) were evaluated retrospectively. EuroSCORE values, preoperative and operative details, postoperative morbidity and mortality, and early results were compared. Groups were similar in terms of EuroSCORE, demographics, and preoperative variables. Number of distal anastomoses per patient was 3.1 ± 0.9 in the beating heart group while it was 3.3 ± 0.9 in the conventional group (P = 0.09). Patients operated on with the conventional method had higher levels of peak creatine kinase-myocardial band, blood and blood product transfusions, and inotropic requirements, while mechanical ventilation times and hospital stay were longer. The incidence of postoperative atrial fibrillation, mediastinitis, and intra-aortic balloon usage were comparable between the groups. There was no neurological complication in group A whereas five major neurological complications (three transient ischemic attacks, two strokes) occurred in group B (P = 0.06). Thirty-day mortality occurred in one patient in the beating heart group whereas five early deaths were observed in the conventional group (P = 0.21). In significant left main coronary artery stenosis coronary bypass on the beating heart is a safe and effective alternative to the conventional method with the same or better early results. The long-term results need to be evaluated.     

The effect of rapid lipid lowering with atorvastatin on autonomic parameters in patients with coronary artery disease

Many cardiovascular disease states are associated with autonomic dysfunction, specifically sympathetic activation and parasympathetic withdrawal. Both these autonomic derangements are independently associated with adverse prognostic outcomes. HMG CoA reductase inhibitors (statins) reduce cardiovascular mortality and morbidity when compared to placebo in subjects with proven coronary artery disease (CAD), including sudden presumed arrhythmic death. As autonomic dysfunction is associated with arrhythmogenesis, statins may be having a beneficial effect on autonomic function in these subjects. We conducted a randomised, double-blind, placebo-controlled, cross-over study examining the effect of rapid short-term lipid lowering with a statin on autonomic function in CAD patients. Ten subjects with proven CAD (8 male, 2 female; mean age 63.4 years) were randomised to receive either 80 mg atorvastatin or placebo over a 4 week period followed by a 4 week washout, then the alternative treatment for a further 4 weeks. Autonomic parameters assessed were plasma noradrenaline levels on recumbency and 80 degrees head-up tilt, cold pressor testing, and heart rate variability (HRV) analysis. Plasma noradrenaline levels were significantly reduced (p=0.050) after 20 min rest in the recumbent position, with atorvastatin compared to placebo. A nonsignificant reduction in plasma noradrenaline with atorvastatin compared to placebo was observed in the prolonged 80 degrees head-up position (p=0.207). In addition, sympathovagal balance was shifted to greater vagal predominance with atorvastatin (low-frequency/high-frequency ratio in the HRV frequency domain) when compared to placebo, p=0.06. We found that rapid lipid lowering with atorvastatin reduces sympathetic nervous system in this pilot study of CAD patients. Larger trials are required to definitively address the effects of statins on autonomic activity in these patients.     

Contribution of plasma lipid disturbances to vascular endothelial function in patients with slow coronary flow

Previous studies have suggested that microcirculatory abnormalities cause slow coronary flow (SCF). However, the underlying mechanism of this phenomenon has not yet been well documented. Therefore, the aim of this study was to determine the role of plasma lipid disturbances in pathogenesis of slow coronary flow (SCF). Forty patients with SCF (group I) and 37 subjects with normal coronary arteries (group II) were included in the study. In each subject plasma lipid concentrations (total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglyceride [TG]) and brachial artery flow-mediated dilatation (FMD) and nitroglycerin (NTG)-induced dilatation were measured. Total cholesterol level was found to be similar in the 2 groups. In group I, HDL-C level was lower than in group II (34 +/-3 vs 40 +/-4 mg/dL, p=0.0001). In group I, TG level was higher than in group II (213 +/-29 vs 198 +/-24 mg/dL p=0.002). In group I, FMD was smaller than that of group II (3.48 +/-3.1% vs 10.4 +/-5.6%, p=0.0001). The percent NTG-induced dilatation was not different between the groups (15.5 +/-5.3% vs 17.3 +/-6.9%, p=0.27). On regression analysis; there was a significant relationship between percent of FMD and HDL-C (r =0.65, p=0.0001). When the 2 groups were analyzed separately, HDL-C was still related to percent of FMD in both groups (r =0.47 p=0.002 and r =0.45 p=0.005, respectively). Multivariate regression analysis showed that only plasma HDL-C was independently related to FMD (F=7.5 p=0.0001). In patients with SCF, reduced flow-mediated dilatation was detected and was found to be associated with plasma lipid disturbances, principally low HDL and high TG levels.     

有氧运动对冠状动脉支架术后患者血管内皮功能的影响

目的探讨有氧运动对冠状动脉支架术后患者血管内皮细胞功能的影响。方法收集深圳市盐田区人民医院2017年1月至2018年12月行冠状动脉支架植入治疗的患者78例,其中有氧运动组40例,对照组38例,对比两组干预前后一氧化氮(nitric oxide,NO)、内皮素-1(endothelin-1,ET-1)浓度的变化。结果试验前,两组患者NO和ET-1浓度比较,差异均无统计学意义(P>0.05)。完成6周的有氧运动治疗后,有氧运动组患者的NO浓度明显高于干预前,差异有统计学意义[(13.29±3.42)pg/mL vs.(10.26±2.30)pg/mL,P<0.05];且显著高于对照组,差异有统计学意义[(13.29±3.42)pg/mL vs.(10.28±2.32)pg/mL,P<0.05]。完成6周的有氧运动治疗后,有氧运动组患者ET-1浓度明显低于干预前,差异有统计学意义[(54.87±4.52)pg/mL vs.(59.49±4.55)pg/mL,P<0.05];且显著低于对照组,差异有统计学意义[(54.87±4.52)pg/mL vs.(58.94±4.52)pg/mL,P<0.05]。结论有氧运动治疗可有效调节冠状动脉支架术后患者NO及ET-1浓度,从而改善血管内皮功能。     

Clinical impact of coronary artery spasm in patients with no significant coronary stenosis in acute coronary syndromes

Background and objectiveTo clarify the clinical features of coronary artery spasm (CAS) with no significant coronary stenosis in patients with suspected acute coronary syndrome (ACS) in real practice.MethodsThis is a retrospective observational study of patients with suspected ACS (n = 645) based on symptoms, electrocardiographic changes, and/or positive cardiac biomarkers and vasospastic angina (VSA, n = 90). ACS patients were divided into two groups: (1) organic ACS (n = 515), culprit lesion ≥75% coronary stenosis with/without thrombosis; (2) spastic ACS (n = 70), coronary stenosis <75%, either with positive acetylcholine (ACh) test (n = 51) or without ACh test but verified spontaneous spasm (n = 19). The study compared clinical characteristics among organic ACS, spastic ACS, and VSA.ResultsOne hundred and thirty suspected ACS patients had a coronary organic stenosis <75% (130/645, 20%). Seventy of those patients (70/130, 54%) were confirmed to have CAS, and these accounted for 11% of all ACS patients (70/645). The rate of cigarette smoking was highest in the spastic ACS. No spastic ACS patients died during their hospital stay or after discharge, whereas acute myocardial infarction occurred in 19%, aborted sudden cardiac death in 6%, multivessel spasm was provoked in 78%, and diffuse spasm was more frequently provoked than in the VSA group (82% vs. 62%).ConclusionsCAS is not a rare cause of ACS. Although the prognosis of spastic ACS is good, there are occasional critical cases. An initial differential diagnosis including an ACh test is thus important to decide the treatment strategy of ACS.     

老年冠心病患者血清铁蛋白及血脂水平与冠脉狭窄的相关性

目的：观察老年冠心病患者血清铁、铁蛋白、转铁蛋白及血脂水平与冠状动脉狭窄程度的关系,探寻冠心病的发病原因。方法：对201例疑似冠心病的老年患者行冠脉造影及血清铁、铁蛋白、转铁蛋白、总胆固醇（TC）、甘油三酯、高密度脂蛋白-胆固醇（HDL-C）及低密度脂蛋白-胆固醇（LDL-C）的测定,采用Gensini评分系统衡量冠状动脉造影结果。按照Gensini评分结果将观察对象分为对照组和冠心病轻、中、重度组,应用方差分析比较各参数在四组中的分布情况,应用多因素回归分析研究Gensini评分与各参数的关系。结果：单因素方差分析显示,血清铁、血清铁蛋白、转铁蛋白/铁蛋白比值、TC及LDL-C在各组间分布差异具有显著性（F=3.519~9.414,P均〈0.05）;多因素逐步线性回归分析显示,血清铁蛋白与冠状动脉狭窄程度的评分独立相关（偏相关系数=0.182,P〈0.05）。结论：老年冠心病的发生与血清铁、铁蛋白、总胆固醇和低密度脂蛋白-胆固醇有一定的相关性,血清铁蛋白与冠状动脉狭窄程度呈独立正相关。     

冠心病患者血清血管内皮生长因子水平与冠状动脉病变程度的关系

目的 :探讨冠心病 (CHD)患者血清血管内皮生长因子 (VEGF)水平与冠状动脉病变的关系。方法 :采用酶联免疫吸附法 (ELISA)检测了 12 4例经冠状动脉造影证实有一支以上主要冠状动脉狭窄≥ 5 0 %的CHD患者血清VEGF水平 ,并作相关分析。结果 :CHD组血清VEGF水平明显高于正常对照组〔(2 93.2± 12 6 .3)ng/L∶(12 0 .1± 31.5 )ng/L ,P <0 .0 1〕 ,双支和三支血管病变患者血清VEGF水平高于单支组〔(2 83.4± 85 .0 )ng/L ,(398.1± 10 5 .5 )ng/L∶ (191.7± 2 7.3)ng/L ,P <0 .0 1〕 ,随着血管狭窄程度的加重 ,血清VEGF水平升高越明显 ,两者呈显著正相关 (r =0 .78,P <0 .0 0 1) ,CHD并发高血压和 (或 )糖尿病对血清VEGF水平无显著影响 (P >0 .0 5 )。结论 :CHD患者血清VEGF水平升高 ,其升高程度与冠状动脉病变程度有良好的相关性     

大剂量叶酸对介入治疗后的冠心病患者血管内皮功能的影响

目的探讨大剂量叶酸能否改善冠心病患者介入治疗后的血管内皮功能。方法共46例冠心病患者,在行冠状动脉介入治疗术后分为叶酸治疗(20mg/d)组23例和对照组23例,随访6个月,观察两组间同型半胱氨酸水平,以超声测定肱动脉血流介导的舒张功能(FMD)变化来评价血管内皮功能,并观察两组间的差别。结果大剂量叶酸治疗组血浆同型半胱氨酸水平低于对照组(8·82±3·32μmol/L比12·67±3·07μmol/L,P<0·01)。叶酸治疗后FMD由4·70%±1·71%增加至8·53%±1·44%(P<0·01)。结论大剂量叶酸治疗可能通过降低同型半胱氨酸以外的途径改善血管内皮功能,对介入治疗后的冠心病患者发挥潜在益处。     

高血压伴冠心病患者冠状动脉狭窄与周围动脉功能关系的研究

目的分析冠状动脉的病变支数及狭窄程度与周围动脉弹性功能的关系。方法对88例高血压病患者与41例无高血压病临床怀疑冠心病的患者,在冠状动脉造影前后采用美国FDA批准的PULSEMETRIC动脉功能测定仪通过测定肱动脉脉搏图计算出反应血管弹性的参数,包括系统血管顺应性（SVC）、系统血管阻力（SVR）、肱动脉顺应性（BAC）及肱动脉阻力（BAR）,分析高血压伴及不伴冠状动脉病变者的动脉弹性的特点。结果（1）高血压组严重冠状动脉病变（冠状动脉病变〉12支以上）发生率[64．7％（57／88）]高于血压正常组[27．1％（11／41）,P〈0．05）;（2）高血压组的SVC[（0．85±0．10）ml／mmHg（1mmHg=0．133kPa）]、BAC[（0．047±0．011）ml／mmHg]明显低于非高血压组[SVC（1．17±0．11）ml／mmHg,BAC（0．063±0．010）ml／mmHg,均P〈0．05],高血压组的脉压则明显高于非高血压组[（78±20）mmHg比（47±19）ml／mmHg,P〈0．01];（3）高血压组内,动脉弹性有随冠状动脉病变加重而下降的趋势,而动脉弹性功能参数在不同的性别存在不同的变化;（4）当血压水平达到2～3级,SVC有随冠状动脉病变程度加重而降低的趋势。结论在高血压病患者中,无创方法测得的动脉功能参数在一定程度上可以反映其冠状动脉病变程度。     

Anti-cardiolipin antibodies and endothelial function in patients with coronary artery disease

Endothelial dysfunction is considered an important marker in atherosclerosis, having a prognostic value. Antiphospholipid antibodies are considered prothrombotic and have recently been reported to be associated also with atherosclerosis. This study was conducted to investigate a possible association of endothelial dysfunction with various antiphospholipid autoantibodies in healthy subjects and patients with cardiovascular disease. In a single-center, prospective study, 2 groups were included. The study group included patients with cardiovascular diseases (coronary disease and/or cerebrovascular disease) and healthy subjects without apparent heart disease who were referred to the endothelial function laboratory for the assessment of endothelial function. Flow-mediated dilatation, which indicates endothelial function, and nitroglycerin-mediated vasodilatation, which indicates smooth-muscle function, were measured. The 2 groups were evaluated for autoantibodies, including anticardiolipin (aCL; immunoglobulin G [IgG], immunoglobulin M [IgM], and immunoglobulin A [IgA]), antinuclear antibody, anti-beta2-glycoprotein I (IgG, IgM, and IgA), and oxidized low-density lipoprotein. One hundred seven subjects were included in the study: 45 patients (42%) and 62 healthy controls (58%). Flow-mediated dilatation was significantly lower in patients compared with healthy controls (8.0 +/- 9.5% vs 8.0 +/- 13.5%, p = 0.012). In addition, nitroglycerin-mediated vasodilatation was nonsignificantly lower in patients than in healthy controls (8.0 +/- 13.4% vs 11.0 +/- 16.7%, p = 0.084). The mean levels of anti-beta2-glycoprotein I (IgG, IgM, and IgA), aCL (IgM and IgA), antinuclear antibody, and oxidized low-density lipoprotein were not different between groups. However, the mean level of IgG aCL was significantly higher in patients than in healthy controls. In conclusion, in accordance with previous reports of an association between aCL and atherosclerosis, patients with cardiovascular disease had endothelial dysfunction and elevated levels of aCL.     

依折麦布联合阿托伐他汀治疗老年冠心病患者的降脂疗效

目的：观察联合应用依折麦布和阿托伐他汀对老年冠心病患者血脂水平的影响。方法：选择常规应用阿托伐他汀钙片20mg／d但血脂仍未达标的,符合入选标准的老年冠心病患者176例,随机分成两组,对照组为高剂量他汀组：阿托伐他汀钙片40mg／d;试药组为联合用药组：依折麦布10mg／d联合阿托伐他汀钙片20mg／d;比较两组治疗前后血总胆固醇（TC）、低密度脂蛋白胆固醇（LDL—C）水平变化。结果：经12周治疗后,两组TC、LDI。一C与治疗前比较均有显著降低（均P〈0．05,P〈0．01）;与高剂量他汀组相比,联合用药组治疗效果更显著（P〈0．05）,TC、LDL—C下降更明显（P〈0．05）;而肝损害及肌溶解等副作用的发生率却无明显增加。结论：与高剂量阿托伐他汀相比,依折麦布联合阿托伐他汀具有更好的降低LDL—C效果,显著提高冠心病患者的血脂达标率,且具有良好的安全性和药物耐受性。