冠心病患者介入治疗前后血清C-反应蛋白变化与心血管事件和再狭窄的关系

目的探讨冠心病患者介入治疗前后血清C-反应蛋白(CRP)水平变化与术后住院期间及术后6个月内心血管事件和再狭窄发生的关系.方法选择97例住院接受经皮冠状动脉腔内成形术(PTCA)及单支病变的冠状动脉支架置入术(CS)冠心病患者[其中30例稳定型心绞痛(SAP)和67例急性冠脉综合征(ACS)]术前及术后48h测定血清CRP水平.按术后CRP水平分为2组,即A组(CRP水平＜3.0mg/L,n=35)及B组(CRP水平≥3.0mg/L,n=62),分析并记录患者术后1周以及术后6个月内心血管事件及支架内再狭窄发生等情况.结果ACS组PT-CA术后48h血清CRP水平较术前明显升高(P＜0.01);血清CRP水平ACS组比SAP组明显升高(P＜0.01);B组术后1周内的心血管事件发生率显著高于A组(P＜0.05);B组术后6个月的心血管事件及支架内再狭窄发生率显著大于A组(P＜0.01).结论PTCA术后48h血清CRP水平较术前增高,是单支冠状动脉病变支架置入术后6个月内预后的预测指标,提示术后近、远期的临床疗效与支架置入术后血管壁的炎症反应增强有关.     

冠状循环内巨噬细胞集落刺激因子浓度与冠状动脉介入治疗术后再狭窄的关系

目的 :评价经皮冠状动脉腔内成形术 (PTCA)前和支架置入术后即刻、4h、2 4h冠状循环内巨噬细胞集落刺激因子(MCSF)浓度的变化及其与术后再狭窄的关系。方法 :62例接受了PTCA及冠状动脉支架置入术的稳定性心绞痛患者纳入本研究 ,均为左冠状动脉单支、单处病变。检测入选者PTCA术前和支架置入术后即刻、4h、2 4h冠状循环内血清MCSF浓度的变化 ,并对其进行了 6个月的随访 ,61例随访结束时进行冠状动脉造影 ,按有无术后再狭窄分成两组 :支架置入术后发生再狭窄 (再狭窄组 ,n =2 2 ) ,支架置入术后无再狭窄 (无再狭窄组 ,n =3 9)。结果 :支架置入术后 4h(P <0 0 1)、2 4h(P <0 0 0 1)冠状循环内血清MCSF浓度较术前显著增高 ;术后 2 4h冠状循环内血清MCSF浓度与术后 6个月靶血管直径丧失指数呈显著正相关 (r =0 49,P <0 0 1)。随访结束时 ,再狭窄组患者支架置入术后 2 4h冠状循环内MCSF浓度显著高于无再狭窄组患者 (P <0 0 0 1)。结论 :冠心病患者PTCA及支架置入术导致冠状循环内MCSF浓度显著增高 ;术后 2 4h冠状循环内血清MCSF浓度增高可能是支架置入术后再狭窄的预测因子。     

C-反应蛋白水平与冠脉支架术后心血管事件和再狭窄的相关性研究

目的探讨血清C反应蛋白(CRP)对支架术后6个月内心血管事件和1年内再狭窄的相关预测价值。方法对62例单支病变行冠状动脉支架植入术患者术后72小时测定血清CRP水平并记录患者术后3天至6个月来心血管事件(心绞痛、心肌梗死及死亡)及1年来支架内再狭窄情况。结果发生心血管事件组CRP水平明显高于未发生组(9.65±2.98mg/LVS7.53±2.76mg/L,P<0.05),CRP增高组与CRP正常组心血管事件发生率相似(18.0%VS8.3%P>0.05),血清CRP水平与冠脉支架术后6～12个月再狭窄无显著差异(7.58±2.16mg/LVS7.21±2.34mg/L,P>0.05;14.6%VS16.7%,P>0.05)。结论冠脉支架术后发生心血管事件与CPR水平明显相关,术后再狭窄与CPR水平无显著相关性。     

冠状动脉介入术后妊娠相关蛋白A及C反应蛋白的变化及意义

目的探讨冠状动脉介入术(PCI)前后血浆妊娠相关蛋白-A(PAPP-A)及C反应蛋白(CRP)水平[以高敏CRP(hs-CRP)衡量]的变化,以及其对术后6个月内心血管事件和再狭窄发生的预测价值。方法观察56例PCI患者(不稳定型心绞痛35例,稳定型心绞痛17例,心肌梗死4例)手术前及术后24h的PAPP-A、肌钙蛋白Ⅰ、肌酸激酶同工酶及CRP浓度,随访术后6个月内主要心血管事件(心肌梗死、再次血运重建及死亡)的发生情况,并于术后6个月复查冠状动脉造影,采用定量分析冠状动脉的狭窄,并计算后期内径丢失指数。分析手术前后PAPP-A和CRP水平与再狭窄及心血管事件的发生的关系。结果56例患者经PCI均成功,成功率100%;PCI后PAPP-A较术前高(P<0·05);且PCI前后的PAPP-A水平与CRP水平有较好的相关性(P<0·01),而与肌钙蛋白Ⅰ、肌酸激酶同工酶无相关性(P>0·05)。术后6个月内有心血管事件组患者PAPP-A及CRP水平较无心血管事件组高(P<0·01及P<0·05);PCI后6个月内有再狭窄的患者PAPP-A及CRP水平较无再狭窄的患者高((P<0·05及P<0·01),且PAPP-A及CRP与PCI后冠状动脉后期内径丢失指数呈正相关(r=0.70,P<0·01及r=0.71,P<0·01)。结论PCI后可导致体内PAPP-A与CRP合成增加,并在术后6个月内心血管事件及再狭窄的发生有重要作用。     

冠心丹参滴丸对冠心病支架置入术后再狭窄的防治作用

目的观察冠心丹参滴丸对冠心病支架置入术后再狭窄的疗效及其作用机制。方法将60例行冠脉支架置入术治疗的冠心病患者随机分为观察组与对照组各30例,对照组在支架置入术后予常规西药治疗,观察组在常规西药治疗基础上加用冠心丹参滴丸。观察术后6个月再狭窄发生率、心血管事件发生率、临床症状变化,并比较术后心室功能及血清IL-18、hs—CRP水平。结果术后6个月,观察组中医症候总有效率高于对照组（P〈0．05）;不良心血管事件发生率低于对照组（P〈0．05）;室壁运动指数、左室射血分数及IL-18、hs—CRP水平两组比较有统计学差异（P均〈0．05）。结论冠心丹参滴丸可以降低冠脉介入术后再狭窄率。     

不稳定型心绞痛患者血清白细胞介素-6、肌钙蛋白和C-反应蛋白在切割球囊血管成形术前后的变化

目的　比较切割球囊血管成形术 (CBA)与普通球囊血管成形术 (BA)对血清白细胞介素 (IL 6 )、肌钙蛋白 (cTnI)和C 反应蛋白 (CRP)浓度的影响。方法　选择 6 5例入院拟行冠状动脉介入治疗的不稳定型心绞痛患者 ,随机分为两组 ,分别接受CBA或BA (即CBA组和BA组 ) ,球囊扩张后均放置支架。采用ELESCA双抗体夹心法分别测定血清IL 6、cTnI和CRP的浓度。结果　两组患者靶病变情况无显著差异。CBA组的球囊最大充盈压和支架置入压力明显低于BA组(P <0 .0 1)。BA组IL 6浓度在术后即刻开始高于CBA组 (P <0 .0 5 ) ,术后 2h和 6h差异进一步增大 (P <0 .0 1)。BA组 2 4h的血清cTnI水平明显高于CBA组 (P <0 .0 5 )。BA组的CRP浓度在术后 6h、2 4h和 48h都明显高于CBA组 (P <0 .0 1)。结论　单纯CBA或其联合支架置入术对不稳定型心绞痛患者血清IL 6、cTnI和CRP浓度的影响均小于单纯BA或其联合支架置入术 ,这可能是前者通过减轻对炎症反应的影响 ,减少再狭窄及心血管事件发生的机制之一。     

冠心舒通胶囊对冠状动脉支架置入术后支架内再狭窄的影响

目的 研究冠心舒通胶囊对冠脉支架置入术后支架内再狭窄的影响,初步探讨其作用机制.方法 将冠脉支架置入术成功的102例患者随机分为对照组（51例）及冠心舒痛胶囊组（51例）,检测两组患者术前,术后1d、3d、7d、2周时C反应蛋白（CRP）及白细胞介素-6（IL-6）水平.术后6个月,观察两组患者的心血管事件发生率及心电图ST段、心脏彩超左室射血分数变化情况;复查冠脉造影,观察两组患者支架内再狭窄情况.结果 两组患者术后1d、3d、7d时的CRP及IL-6水平均较术前明显升高（P＜0.05）.术后2周冠心舒通胶囊组的CRP及IL-6水平与术前相比差异无统计学意义（P＞0.05）,但对照组较术前仍偏高（P＜0.05）.冠心舒通胶囊组在术后1d、3d、7d、2周时的CRP及IL-6水平与对照组同时间点相比均明显偏低（P＜0.05）.术后6个月时,冠心舒通胶囊组的各种心血管事件发生率均明显低于对照组（P＜0.05）,心电图有效率、左室射血分数显著高于对照组（P＜0.05）;与对照组相比,支架内再狭窄率明显明显降低（P=0.0285）.结论 冠心舒通胶囊能减少冠脉支架置入术后各种心血管事件的发生率,并且能降低冠脉支架置入术后支架内再狭窄.这种作用可能与冠心舒通胶囊降低支架置入术后炎症反应有关.     

血清骨保护素和基质交感分子1水平预测冠脉介入术后心血管事件和支架内再狭窄的价值

目的探讨老年冠心病患者行经皮冠状动脉介入治疗术(PCI)后,血清骨保护素(OPG)和基质交感分子(STIM)1水平对术后6个月内心血管事件和再狭窄的预测价值。方法选择行PCI的老年冠心病患者125例,测定术后即刻患者血清OPG及STIM1水平变化,分析并记录患者术后6个月内心血管事件发生率及支架内再狭窄情况。结果血清OPG、STIM1水平和PCI术后6个月内心血管事件的支架内再狭窄高度相关。结论血清OPG和STIM1水平对PCI术后心血管事件和支架内再狭窄事件的发生有较好的预测价值。     

冠心病患者经皮冠状动脉介入术后支架内再狭窄的认识现状

<正>支架内再狭窄(in-stent restenosis,ISR)的早期定义是指支架置入术后6~9个月,冠状动脉造影发现其管腔丢失率50%。经皮冠状动脉腔内血管成形术(percutaneous transluminal coronary angioplasty,PTCA)术后,血管再狭窄发生率高达30%~50%。金属裸支架(bare metal stent,BMS)的应用,不但降低了再狭窄的发生率(20%~30%),也大大提高了冠状动脉介入的安全性,药物洗脱支架(drug eluting     

急性冠状动脉综合征支架置入术临床分析

目的探讨急性冠状动脉综合征(ACS)患者置入冠状动脉内支架的临床疗效。方法选择2003年5月~2006年5月入院的90例ACS患者,均行多体位多角度选择性冠状动脉造影(CAG),确定靶血管后,经皮腔内冠状动脉成形术(PTCA)预扩张再置入支架76例,直接置入支架14例,观察置入不同大小、类型支架手术成功率,住院和随访期间的临床心脏事件、心功能情况。结果90例患者置入支架115枚。支架直径2.5~4.0mm,长度8~32mm;支架类型为Evolution5枚,MedtronicS660 7枚,Vismed 10枚,B/BRAUN 27枚,Biodiv Ysiooc 47枚,Firebird 19枚。全部随访3至12个月,2例不稳定型心绞痛(UAP)患者手术即刻出现急性心肌梗死(AMI);1例1个月后行冠状动脉旁路移植术;2例术后未规律抗凝,半年后出现支架内再狭窄,重新置入支架;1例多支病变置入3枚支架,1年后死于心肌梗死;1例多发冠状动脉瘤半年后心脏性猝死。手术即刻成功率97.78%,心脏事件发生率6.67%,心功能改善62.50%。结论ACS行支架置入术安全有效,随访心脏事件发生少,心功能得到改善。但多支病变置入多枚支架再狭窄发生率高,易出现心脏事件。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.