硝酸甘油对冠状循环中血小板聚集功能的影响

Ｄｉｏｄａｔｉ等［１］证实，在稳定型心绞痛（ＳＡＰ）患者中，当冠状动脉（冠脉）血流加速时，从至少１支左冠脉狭窄≥５０％的病人中观察到，冠脉血管床中发生可逆性血小板聚集性增强。本研究观察治疗剂量的硝酸甘油对ＳＡＰ病人中由快速心房起搏引发的冠状循环中高血...     

冠心病患者血浆IL－8的变化及临床意义

为进一步探讨冠心病的病因及防治措施，本文采用夹心法ＥＬＩＳＡ测定了５０例正常人及５０例冠心病患者血浆白细胞介素８（ＩＬ－８）的含量，其中１４例进行了经皮冠状动脉（冠脉）腔内成形术（ＰＴＣＡ），并观察了ＰＴＣＡ对血浆ＩＬ－８的影响。结果表明：冠心病患者血浆ＩＬ－８含量显著高于正常人（Ｐ＜０．０１），ＰＴＣＡ术后血浆ＩＬ－８含量下降与术前比较差异显著（Ｐ＜０．０１）。冠脉狭窄程度与血浆ＩＬ－８含量呈显著正相关（ｒ＝０．９７２５）。提示ＩＬ－８与冠心病患者冠脉狭窄程度及病情变化有密切关系。     

降钙素基因相关肽对心肌缺血时心脏功能的影响

冠脉内注射降钙素基因相关肽（ＣＧＲＰ）０．３μｇ／ｋｇ，对正常及不同程度冠脉狭窄犬的心功能产生不同影响。结果表明，正常犬冠脉内注射ＣＧＲＰ后，平均动脉压（ＭＡＰ）下降１．２ｋＰａ（Ｐ＜０．０５），同时，心率（ＨＲ）、心输出量（ＣＯ）、左室收缩压峰值（ＬＶＳＰ）均不同程度增加；左室舒张末压（ＬＶＥＤＰ）轻度降低。在中度狭窄３０ｍｉｎ后冠脉内注射ＣＧＲＰ对ＨＲ、ＭＡＰ无明显影响；而重度狭窄后注射ＣＧＲＰ，ＭＡＰ由狭窄时降低逐渐增高，ＨＲ由增快而变慢。ＣＯ、ＬＶＳＰ均显著增高，ＬＶＥＤＰ降低，此作用较冠脉狭窄前更为明显。提示ＣＧＲＰ能扩张冠状动脉，增加冠脉血流量和心排血量，增强心肌收缩力，对缺血心脏功能有保护作用     

降钙素基因相关肽对心肌缺血时心脏功能的影响

冠脉内注射降钙素基因相关肽（ＣＧＲＰ）０．３μｇ／ｋｇ，对正常及不同程度冠脉狭窄犬的心功能产生不同影响。结果表明，正常犬冠脉内注射ＣＧＲＰ后，平均动脉压（ＭＡＰ）下降１．２ｋＰａ（Ｐ＜０．０５），同时，心率（ＨＲ）、心输出量（ＣＯ）、左室收缩压峰值（ＬＶＳＰ）均不同程度增加；左室舒张末压（ＬＶＥＤＰ）轻度降低。在中度狭窄３０ｍｉｎ后冠脉内注射ＣＧＲＰ对ＨＲ、ＭＡＰ无明显影响；而重度狭窄后注射ＣＧＲＰ，ＭＡＰ由狭窄时降低逐渐增高，ＨＲ由增快而变慢。ＣＯ、ＬＶＳＰ均显著增高，ＬＶＥＤＰ降低，此作用较冠脉狭窄前更为明显。提示ＣＧＲＰ能扩张冠状动脉，增加冠脉血流量和心排血量，增强心肌收缩力，对缺血心脏功能有保护作用     

一个新的实验性冠状动脉痉挛动物模型

本研究探索一个实验性冠状动脉痉挛（ＣＡＳ）动物模型。健康犬１２只，分三组，静脉麻醉开胸分离左冠脉前降支。Ⅰ组（５只）:冠脉滴敷脑垂体后叶注射（ＩＰＰ）诱发ＣＡＳ；Ⅱ组（５只）:先形成冠脉部分狭窄再加上诱发ＣＡＳ；对照组（２只）:冠脉滴敷生理盐水。ＣＡＳ的判断及结果:Ⅰ、Ⅱ组施药后冠脉血流量（ＣＢＦ）明显减少（阳性例数５／５），心电图呈缺血性改变（阳性例数４／５）及严重室性心律紊乱，第Ⅱ组改变更显著。对照组的ＣＢＦ及心电图无改变。本实验诱发ＣＡＳ方法易行，成功率高，重复性好。其优点是诱发ＣＡＳ的部位可以选择，作用时间相对可控；血管收缩剂不直接进入血液循环，对冠脉以外其它血管动力学无影响，也控制了血液内各种因子检测的准确性。本实验模型可以用于进行ＣＡＳ的病理生理、生化、病理形态和治疗学的研究。     

冠状动脉支架植入后相关再狭窄预测因素评价

冠脉支架植入（ＣＳ）能有效地纠治病损冠脉狭窄，预防经皮腔内冠状动脉成形术（ＰＴＣＡ）后再狭窄。然而迄今关于ＣＳ后冠脉再狭窄相关特点及其预测因素尚未见报告。本文就此进行了分析。４６３例冠心病患者，男８６％，年龄５９±１１岁。术前冠造证实存在５００处重度...     

心得安食管心房调搏超声心动图复合试验对冠心病诊断价值的评价

以冠状动脉造影为标准，对４３例冠脉狭窄大于或等于５０％的冠心病患者及１７例冠脉狭窄小于５０％或腔径正常的临床可疑冠心病患者作为“正常”对照，用心得安食管心房调搏超声心动图（ＴＲＡＳ－Ｐｒｏｐ－Ｅｃｈｏ），食管心房调搏超声心动图（ＴＲＡＳ－Ｅｃｈｏ）和心得安食管心房调搏心电图（ＴＲＡＳ－Ｐｒｏｐ－ＥＣＧ）试验对冠心病的诊断价值进行评价。发现ＴＲＡＳ－Ｐｒｏｐ－Ｅｃｈｏ的敏感性为９３％，特异性为９４．１％，准确性为９７．６％；而ＴＲＡＳ－Ｅｃｈｏ及ＴＲＡＳ－Ｐｒｏｐ－ＥＣＧ的敏感性、特异性、准确性分别为９３．０％及８３．７％，７６．５％及７６．０％，９０．９％及９０．０％。试验中未发现严重不良反应发生。结果显示ＴＲＡＳ－Ｐｒｏｐ－Ｅｃｈｏ试验是安全、准确性较好的无创性冠心病诊断试验，尤适用于年老体衰、肥胖及有生理缺陷不宜运动者。     

~（201）T1心肌断层显像定量分析的临床价值──与冠状动脉造影定量分析的对比研究

对３０例冠脉造影患者的~（２０１）Ｔ１心肌断层显像定量分析与冠脉造影定量测量结果进行比较。以造影所显示动脉狭窄的最小直径、最小横截面积和与狭窄前后动脉的百分比表示冠脉狭窄程度。心肌显像用ＳｏｐＨＡ四片法以短轴及长轴的心肌浓度比及洗出率来表示，结果表明：~（２０１）Ｔ１心肌断层显像定量分析与冠状动脉造影测量结果有明显的相关性，说明~（２０１）Ｔ１心肌断层显像定量分析结果可间接反映冠脉的血流状况，可作为诊断冠脉疾病和冠脉疾病介入性治疗前后动态观察的有效手段。     

48例主动脉瓣下狭窄的外科治疗

本文报告４８例（分散性）主动脉瓣下狭窄（ＤＳＡＳ）。其中隔膜型狭窄８例（１６．７％），肌纤维型狭窄３９例（８１．８％），隧道型狭窄１例（２％）。单纯ＤＳＡＳ组（１５例）术后无死亡，合并其它心内畸形组（３３例）术后早期死亡２例。作者认为，ＤＳＡＳ手术早期效果良好，并就影响远期疗效的因素进行了讨论。     

降钙素基因相关肽对心肌缺血时心脏功能的影响

冠脉内注射降钙素基因相关肽（ＣＧＲＰ）０．３μｇ／ｋｇ，对正常及不同程度冠脉狭窄犬的心功能产生不同影响，结果表明，正常犬烷脉内注射ＣＧＲＰ后，平均动脉压（ＭＡＰ）下降１．２ｋＰａ（Ｐ〈０．０５）。同时，心率（ＨＲ），心输出量（ＣＯ），左室收缩压峰值（ＬＶＳＰ）均不同程度增加，左室舒张末压（ＬＶＥＤＰ）轻度降低，在中度狭窄３０ｍｉｎ后冠脉内注射ＣＧＲＰ对ＨＲ，ＭＡＰ无明显影响，而重度狭窄后注射ＣＧＲ     

急性冠脉综合征患者冠脉病变与临床预后的关系

目的：探讨急性冠脉综合征（ACS）患者不同冠脉病变程度与临床预后的相关性,并分析其影响因素。方法纳入2007年4月～2008年4月解放军总医院确诊的729例ACS患者,按照冠脉造影（CAG）结果分为轻度病变组（冠脉狭窄＜50%且不伴血管闭塞,n=51）和显著病变组（冠脉狭窄≥50%伴或不伴血管闭塞,n=678）,随访终点为主要不良心血管事件（MACE,包括心源性死亡、心绞痛、心肌梗死和心源性休克）,最长随访时限为5年。结果所有患者中位随访时间为4.3年,随访成功率为95.34%（695/729）,其中轻度病变组49例,显著病变组646例。显著病变组MACE发生率高于轻度病变组（32.67%vs.18.37%,P=0.038）,显著病变组在随访期间共有18例（2.79%）患者死亡,轻度病变组无死亡发生,两组生存率有统计学差异（P=0.0016）。Cox多元回归分析显示,糖尿病和年龄均是不良心血管事件的危险预测因子（糖尿病：OR=1.5,95%CI：1.13～2.08,P=0.006;年龄：OR=1.0,95%CI：1.00～1.03,P=0.037）。结论 ACS患者冠脉狭窄越严重则MACE发生率越高,糖尿病是MACE发生的因素。     

Coronary pressure measurement based decision making for percutaneous coronary intervention

The fractional flow reserve (FFR) is a simple, reliable, and reproducible physiologic index of lesion severity. In patients with intermediate stenosis, FFR≥0.75 can be used to safely defer percutaneous coronary intervention (PCI), and patients with FFR≥0.75 have a very low cardiac event rate. Coronary pressure measurement can determine which lesion should be treated with PCI in patients with tandem lesions, and PCI on the basis of FFR has been demonstrated to result in an acceptably low repeat PCI rate. FFR can identify patients with equivocal left main coronary artery disease who benefit from coronary bypass surgery. Coronary pressure measurement distinguishes patients with an abrupt pressure drop pattern from those with a gradual pressure drop pattern, and the former group of patients benefit from PCI. Coronary pressure measurement is clinically useful in evaluating sufficient recruitable coronary collateral blood flow for prevention of ischemia, which affects future cardiac events. FFR is useful for the prediction of restenosis after PCI. As an end-point of PCI, FFR ≥0.95 and ≥0.90 would be appropriate for coronary stenting and coronary angioplasty, respectively. In summary, if you encounter a coronary stenosis in doubt you should measure pressure rather than dilate it.     

代谢综合征对冠心病患者冠脉病变程度的预测价值

目的：研究合并代谢综合征（MS）的老年冠心病（CAD）患者冠脉病变的严重程度，分析MS预测CAD冠脉病变程度的特异性和敏感性。方法：连续入选151例经冠状动脉造影检查明确诊断为CAD的老年患者（≥60岁），评估冠脉病变情况，根据是否存在MS进行分组，分析MS对冠脉病变程度的影响。结果：151例CAD患者中合并MS者64例。相对于非MS组，MS组3支病变（狭窄≥50％）显著增多（60．9％：32．2％，P=0．000）。2支以上严重狭窄病变（狭窄≥75％）显著增多（64．1％：39％，P=0．002）。MS在CAD患者中预测3支病变（≥50％）的敏感性为58．2％．特异性为70．2％，预测2支以上严重狭窄病变（≥75％）的敏感性为64．1％，特异性为60．9％。结论：合并MS的冠心病患者冠脉狭窄严重，病变广泛。MS可以作为预测严重冠脉病变的指标。     

Acceleration of the left main coronary artery stenosis following PTCA: a report of a case

Acceleration of the left main coronary artery (LMCA) stenosis induced by guiding catheter which was used for percutaneous transluminal coronary angioplasty (PTCA) was demonstrated in a 68 years old man with post-infarction angina. He underwent PTCA to a subtotal lesion in the left anterior descending coronary artery (LAD). The LMCA with mild stenosis of 18% reduction of luminal diameter was unchanged during the course of PTCA. The guiding catheter was pushed repeatedly with considerable force for introducing balloon catheter due to the rigid lesion in LAD. Progression of the LMCA stenosis to a 64% was demonstrated at 6 months later angiographic restudy. It was considered that repetitive sliding of guiding catheter through the LMCA caused subangiographic intimal trauma and facilitate subsequent progression of stenosis. We examined the guiding catheter to the LMCA diameter ratio, the angle of the tip portion of the guiding catheter with LMCA, and severity of the target lesion in this case compared with other 27 controls in whom PTCA was performed to the lesion in left coronary artery. No difference of these 3 factors between this case and other 27 controls was obtained. Thus it might be difficult to predict progression of LMCA stenosis by these angiographic factors. Although the incidence of catheter-induced progression of LMCA stenosis was as low as 1 of 160 cases (0.6%) in our experience, it is important to attend to catheter-induced progression of LMCA stenosis and to make an early detection.     

Moderate coronary lesion with severe vasospasm and the development of collateral circulation in a patient with effort angina and ST-segment depression

Coronary collateral circulation usually develops as a consequence of recurrent ischemia associated with severe stenosis. In exceptional cases, it can develop with moderate coronary lesions if there is severe recurrent vasospasm. In this situation, the presenting clinical features of vasospastic angina (i.e., effort angina with ST-segment depression) can be identical to those of a severe permanent lesion. We present a patient who exhibited effort angina and ST-segment depression on treadmill testing. Angiography showed severe right coronary artery stenosis and the development of coronary collateral circulation from the other main artery. After repeated intracoronary bolus injection of nitroglycerin, only a moderate stenosis was still apparent and the collateral circulation had disappeared.     

急性下壁心肌梗塞伴房室传导阻滞发生与冠状动脉病变的关系

目的 :研究急性下壁心肌梗塞伴房室传导阻滞 (AVB)发生与冠状动脉病变之间的关系。　　方法 :40例急性下壁心肌梗塞患者分为房室传导阻滞组 (AVB组 ,n=16 )和无房室传导阻滞组 (NAVB组 ,n=2 4) ,分析两组间肌酸激酶峰值、冠状动脉病变支数、多支冠状动脉严重病变及优势型冠状动脉狭窄程度对 AVB发生的影响。　　结果 :AVB发生与优势型冠状动脉狭窄严重程度有关 ,狭窄程度越高 ,则 AVB发生率越高 ,L ogistic多元回归分析显示优势型冠状动脉狭窄程度是唯一有意义的危险因素 (P=0 .0 0 2 9,OR=8.86 0 1)。　　结论 :优势型冠状动脉的严重阻塞是 AVB发生的一个独立因素。     

Iatrogenic left main coronary artery stenosis following PTCA or valve replacement

We report three patients who developed iatrogenic severe left main coronary artery stenosis. In two, it was secondary to coronary cannulation during aortic valve replacement and in one it followed distention of the artery during balloon dilatation of a proximal lesion in the left anterior descending artery. In all three, the stenosis was clinically manifest a few months after the intervention. All were successfully treated by aortosaphenous coronary bypass. A common mechanism for the three cases may be mechanical distention of the left main coronary artery resulting in intimal damage with secondary fibrosis and stenosis. The percutaneous transluminal coronary angioplasty-related stenosis is, to our knowledge, the first reported case of this nature, and represents a previously unrecognized complication of this procedure.     

24h动态脉压与冠状动脉病变程度的相关性研究

目的探讨24h动态脉压(24hPP)与冠状动脉病变程度之间的关系。方法选择2011年8月至2013年3月行冠状动脉造影检查(CAG)拟诊冠心病患者230例。入选患者均进行动态血压监测(ABPM)及冠脉Gensini评分。比较冠状动脉正常者与不同冠状动脉狭窄支数病变患者24hPP水平差异;比较24hPP50 mmHg组和≥50 mmHg组患者冠状动脉狭窄病变情况。采用二元Logistic回归分析冠状动脉病变与24hPP等因素的关系。结果冠状动脉双支及三支病变组24hPP显著高于冠状动脉正常组(P0.05)。24hPP≥50 mmHg组的冠状动脉病变率及Gensini积分显著高于24hPP50 mmHg组(P0.05)。Logistic回归分析表明24hPP是冠状动脉发生狭窄病变的独立危险因素(OR=1.14,95%CI:1.07~1.53)。结论 24hPP是冠心病的独立危险因素,临床可作为预测冠状动脉狭窄程度的指标。     

代谢综合征组分的聚集加重了冠状动脉狭窄程度和左心室肥厚

目的从冠状血管造影和超声心动图的角度探讨不同特征代谢综合征（MS）组分的聚集与冠状动脉病变程度和左心室肥厚（LVH）的关系。方法2000年至2004年间入院并进行冠状动脉造影的患者492例,根据MS定义中代谢异常组分的累加评分（0-4分）分为5组。比较各组间冠心病（CHD）发生比例、严重程度及左心室质量等差异。结果随着代谢异常的增加,左前降支血管狭窄百分数,狭窄血管数目,冠脉狭窄积分及CHD比例均随之增加（P值分别为0.002,0.008,0.007,0.042）;室间隔厚度、左心室后壁厚度和左心室质量也随之增加（P值分别为0.016,0.02,0.03）。Logistic回归分析结果显示,代谢异常评分每增加1分,发生CHD的相对危险度增加1.29倍（95%CI：1.09-1.53）。结论MS患者更易发生冠状动脉狭窄和LVH,且随着代谢异常的累积,冠脉狭窄程度、受累血管数目和左心室质量也有所增加。     

Usefulness and limitations of stress 201-thallium myocardial imaging in patients with Kawasaki disease]

Thallium-201 myocardial imaging was performed in 150 patients with a history of Kawasaki disease, aged 6 months to 16 years old. Forty-five patients were studied with ergometer exercise and 105 patients had dipyridamole administration. The findings of thallium imaging were compared with those of coronary angiography. Seventy-two cases with severe coronary stenosis (over 75%) were classified in 3 groups; 13 with the left anterior descending artery lesion, 31 with only the right coronary artery lesion and 28 with multi-vessel involvement. In 72 cases with severe coronary stenosis, the sensitivity of thallium imaging for detecting coronary stenotic lesions was 85%, 74% and 67% in the 3 groups, respectively. In 78 cases without severe coronary stenosis, 5 cases (6%) had persistent perfusion defects on thallium imaging, 3 of which were associated with dyskinesis of the left ventricle documented by cineangiography. They were considered to have damaged myocardium probably due to peripheral myocardial infarction or myocarditic problems. Thallium-201 myocardial imaging was proved to be a useful method to detect coronary stenosis, however its sensitivity for detecting lesions of the right coronary artery or multi-vessels was relatively low. This may be attributable to a significantly higher incidence of segmental stenosis (recanalization) with sufficient coronary flow and multiple coronary collateral vessels in patients with such lesions.