老年人Barrett食管的内镜表现及病理特征分析

Objective To explore the similarities and differences in endoscopic and pathological characteristics between elderly and non-elderly patients with Barrett esophagus (BE). Methods Three hundred and seventy-one cases with BE were divided into elderly group (n=254) and nonelderly group (n=117). The detection rate, endoscopic findings and pathological changes were assessed. Results The detection rate of BE was 2.9% in the elderly, and 0. 9% in the non-elderly(χ2 =127.8, P＜0.01). The 112 cases (44.1%) of the elderly had reflux symptoms, and so did 87cases (66.7%) of the non-elderly (χ2 =55.9, P＜0.01). The detection rate of BE in the two groups was increased year by year from 2004 to 2008. The detection rate of ring pattern was significantly higher in elderly group than in non-elderly group (28.7% vs. 10.3%, χ2=14.5, P＜0.01). Nonelderly patients had higher rate of island pattern than elderly patients (59.5% vs. 71.7%, χ2=4.7,P＜0.05). There were significant differences in the rate of specialized intestinal metaplasia between elderly and non-elderly patients (42.1% vs. 27.4%, χ2=6.9, P＜0.01). The difference in low and medium grade intraepithelial neoplasm between the two groups had statistical significance (21.3% vs.11.1%, χ2=4.9, P＜0.05). There were two cases with adenocarcinoma in elderly group, but no case was found in non-elderly group. The detection rate of H. pylori was comparable between elderly group and non-elderly group (35.5% vs. 40.9%, χ2=0.40, P＞0.05). Conclusions The elderly patients have the 3.2 times higher detection rate of BE than non-elderly patients. The detection rates of specialized intestinal metaplasia and intraepithelial neoplasm are higher in elderly group than in nonelderly group.     

老年人Barrett食管的内镜表现及病理特征分析

Objective To explore the similarities and differences in endoscopic and pathological characteristics between elderly and non-elderly patients with Barrett esophagus (BE). Methods Three hundred and seventy-one cases with BE were divided into elderly group (n=254) and nonelderly group (n=117). The detection rate, endoscopic findings and pathological changes were assessed. Results The detection rate of BE was 2.9% in the elderly, and 0. 9% in the non-elderly(χ2 =127.8, P＜0.01). The 112 cases (44.1%) of the elderly had reflux symptoms, and so did 87cases (66.7%) of the non-elderly (χ2 =55.9, P＜0.01). The detection rate of BE in the two groups was increased year by year from 2004 to 2008. The detection rate of ring pattern was significantly higher in elderly group than in non-elderly group (28.7% vs. 10.3%, χ2=14.5, P＜0.01). Nonelderly patients had higher rate of island pattern than elderly patients (59.5% vs. 71.7%, χ2=4.7,P＜0.05). There were significant differences in the rate of specialized intestinal metaplasia between elderly and non-elderly patients (42.1% vs. 27.4%, χ2=6.9, P＜0.01). The difference in low and medium grade intraepithelial neoplasm between the two groups had statistical significance (21.3% vs.11.1%, χ2=4.9, P＜0.05). There were two cases with adenocarcinoma in elderly group, but no case was found in non-elderly group. The detection rate of H. pylori was comparable between elderly group and non-elderly group (35.5% vs. 40.9%, χ2=0.40, P＞0.05). Conclusions The elderly patients have the 3.2 times higher detection rate of BE than non-elderly patients. The detection rates of specialized intestinal metaplasia and intraepithelial neoplasm are higher in elderly group than in nonelderly group.     

Capsule oxymatrine in treatment of hepatic fibrosis due to chronic viral hepatitis:A randomized,double blind,placebo-controlled,multicenter clinical study

AIM:To evaluate the efficacy and safety of oxymatrine capsule in treatment of hepatic fibrosis in patients with chronic viral hepatitis. METHODS:It was a randomized,double blind,placebo- controlled,multicenter clinical study.One hundred and forty- four patients were divided into oxymatrine capsule group (group A)and placebo group(group B).The course was 52 wk.Patients were visited once every 12 wk and the last visit was at 12 wk after cessation of the treatment.All patients had liver biopsy before treatment,part of them had a second biopsy at the end of therapy.Clinical symptoms,liver function test,serum markers of hepatic fibrosis were tested.Ultrasound evaluation was performed before,during and at the end of therapy. RESULTS:One hundred and forty-four patients enrolled in the study.Of them 132 patients completed the study according to the protocol,49 patients had liver biopsy twice(25 patients in group A and 24 in group B).At the end of therapy,significant improvements in hepatic fibrosis and inflammatory activity based on Semi-quantitative scoring system(SSS)were achieved in group A.The total effective rate of the treatment was 48.00%,much higher than that of 4.17% in group B (P<0.05).Significant improvement in serum markers of hepatic fibrosis such as hyaluronic acid(HA)and type Ⅲ procollagenic peptide(P Ⅲ P)in group A was seen(P<0.05).The total effective rate of serum markers at the end of therapy in group A was 68.19%,much higher than that of 34.85% in group B(P<0.05).The total effective rate of noninvasive markers at the end of therapy in group A was 66.67%,much higher than that of 30.30% in group B(P<0.05).The rate of adverse events was similar in two groups. CONCLUSION:Oxymatrine capsule is effective and safe in treatment of hepatic fibrosis due to chronic viral hepatitis.     

Connective tissue diseases in primary biliary cirrhosis:A population-based cohort study

AIM:To establish the frequency and clinical features of connective tissue diseases(CTDs)in a cohort of Chinese patients with primary biliary cirrhosis(PBC).METHODS:Three-hundred and twenty-two Chinese PBC patients were screened for the presence of CTD,and the systemic involvement was assessed.The differences in clinical features and laboratory findings between PBC patients with and without CTD were documented.The diversity of incidence of CTDs in PBC of different countries and areas was discussed.For the comparison of normally distributed data,Student’s t test was used,while non-parametric test(Wilcoxon test)for the non-normally distributed data and 2×2χ2or Fisher’s exact tests for the ratio.RESULTS:One-hundred and fifty(46.6%)PBC patients had one or more CTDs.The most common CTD was Sj gren’s syndrome(SS,121 cases,36.2%).There were nine cases of systemic sclerosis(SSc,2.8%),12of systemic lupus erythematosus(SLE,3.7%),nine of rheumatoid arthritis(RA,2.8%),and 10 of polymyositis(PM,3.1%)in this cohort.Compared to patients with PBC only,the PBC+SS patients were more likely to have fever and elevated erythrocyte sedimentation rate(ESR),higher serum immunoglobulin G(IgG)levels and more frequent rheumatoid factor(RF)and interstitial lung disease(ILD)incidences;PBC+SSc patients had higher frequency of ILD;PBC+SLE patients had lower white blood cell(WBC)count,hemoglobin(Hb),platelet count,γ-glutamyl transpeptidase and immunoglobulin M levels,but higher frequency of renal involvement;PBC+RA patients had lower Hb,higher serum IgG,alkaline phosphatase,faster ESR and a higher ratio of RF positivity;PBC+PM patients had higher WBC count and a tendency towards myocardial involvement.CONCLUSION:Besides the common liver manifestation of PBC,systemic involvement and overlaps with other CTDs are not infrequent in Chinese patients.When overlapping with other CTDs,PBC patients manifested some special clinical and laboratory features which may have effect on the prognosis.     

Capsule oxymatrine in treatment of hepatic fibrosis due to chronic viral hepatitis： A randomized, double blind, placebo-controlled, multicenter clinical study

AIM: To evaluate the efficacy and safety of oxymatrine capsule in treatment of hepatic fibrosis in patients with chronic viral hepatitis. METHODS: It was a randomized, double blind, placebocontrolled, multicenter clinical study. One hundred and fortyfour patients were divided into oxymatrine capsule group (group A) and placebo group (group B). The course was 52wk. Patients were visited once every 12wk and the last visit was at 12wk after cessation of the treatment. All patients had liver biopsy before treatment, part of them had a second biopsy at the end of therapy. Clinical symptoms, liver function test, serum markers of hepatic fibrosis were tested. Ultrasound evaluation was performed before, during and at the end of therapy. RESULTS: One hundred and forty-four patients enrolled in the study. Of them 132 patients completed the study according to the protocol, 49 patients had liver biopsy twice (25 patients in group A and 24 in group 13). At the end of therapy, significant improvements in hepatic fibrosis and inflammatory activity based on Semi-quantitative scoring system (SSS) were achieved in group A. The total effective rate of the treatment was 48.00%, much higher than that of 4.17% in group B (P&lt;0.05). Significant improvement in serum markers of hepatic fibrosis such as hyaluronic acid (HA) and type Ⅲ procollagenic peptide (PⅢ P) in group A was seen (P&lt;0.05). The total effective rate of serum markers at the end of therapy in group A was 68.19%, much higher than that of 34.85% in group B (P&lt;0.05). The total effective rate of noninvasive markers at the end of therapy in group A was 66.67%, much higher than that of 30.30% in group B (P&lt;0.05). The rate of adverse events was similar in two groups. CONCLUSION: Oxymatrine capsule is effective and safe in treatment of hepatic fibrosis due to chronic viral hepatitis.     

Outcomes of pancreaticoduodenectomy in elderly patients

BACKGROUND: Although the mortality and morbidity of pancreaticoduodenectomy(PD) have improved significantly over the past years, the concerns for elderly patients undergoing PD are still present. Furthermore, the frequency of PD is increasing because of the increasing proportion of elderly patients and the increasing incidence of periampullary tumors. This study aimed to analyze the outcomes of PD in elderly patients.METHODS: We studied all patients who had undergone PD in our center between January 1995 and February 2015. The patients were divided into three groups based on age: group I(patients aged 60 years), group II(those aged 60 to 69 years) and group III(those aged ≥70 years). The primary outcome was the rate of total postoperative complications. Secondary endpoint included total operative time, hospital mortality, length of postoperative hospital stay, delayed gastric emptying, re-exploration, and survival rate.RESULTS: A total of 828 patients who had undergone PD for resection of periampullary tumor were included in this study. There were 579(69.9%) patients in group I, 201(24.3%) in group II, and 48(5.8%) in group III. The overall incidence of complications was higher in elderly patients(25.9% in group I, 36.8% in group II, and 37.5% in group III; P=0.006). There were more patients complicated with delayed gastric emptying in group II compared with the other two groups. There was no significant difference in the incidence of postoperative pancreatic fistula, biliary leakage, pancreatitis, pulmonary complications and hospital mortality.CONCLUSIONS: PD can be performed safely in selected elderly patients. Advanced age alone should not be a contraindication for PD. The outcome of elderly patients who have undergone PD is similar to that of younger patients, and the increased rate of complications is due to the presence of associated comorbidities.     

Clinicopathologic features of surgically resected primary gastric lymphoma

AIM:To analyze the clinicopathologic characteristics ofsurgically resected gastric lymphoma patients.METHODS:We retrospectively analyzed 57 surgicallyresected gastric lymphoma patients,dividing them into 2subgroups:Low grade MALToma (the LG group),High gradeMALToma and Diffuse large B cell lymphoma (the HG group).RESULTS:The numbers of patients were:20 in the LG group,37 in the HG group.The diagnostic rate of gastroscopy was34.8% at primary diagnosis and 50% including differentialdiagnoses.The positive rates of Hpyloriwere similar betweenthe 2 groups (68% vs77%).Multiple lesions were found in19.3%.The proportion of mucosal and submucosal lesionswas 80.0%(16/20) in the LG group,and 24.3%(9/37) inthe HG group (P<0.001).Lymph node invasion rates were10.5%(2/19) in the LG group and 44.1%(15/34) in the HGgroup (P=0.031).The numbers of recurred patients werenone in the LG group,and 8 in the HG group.By univariantanalysis,group (P=0.024) and TNM stage (stage Ⅰ,Ⅱ vsstages Ⅲ,Ⅳ,P=0.002) were found to be the significantrisk factors.There was a tendency of higher recurrence ratein the subtotal gastrectomy group than in the total gastrectomygroup (P=0.50).CONCLUSION:The HG groups had a more advanced stageand a higher recurrence rate than the LG group.Althoughthere was no difference between subtotal and totalgastrectomies,more careful assessments of multiplicitiesand radical resections with lymph node dissections seemto be needed because of multiplicity and LN invasion evenin LG group.     

抗线粒体抗体阴性原发性胆汁性肝硬化患者的临床及病理学特点

Objective To explore the clinical and pathological features of primary biliary cirrhosis (PBC) patients with negative anti-mitochondria antibody (AMA). Methods Two hundreds and eight PBC patients were enrolled. The clinical and histological data of the negative AMA cases were compared with the AMA/AMA-M2 positive cases. Results 30 out of the 208 cases (14.4%) were AMA negative patients in our study. The general status, biochemical tests and histological findings between the two groups had no significant difference (P> 0.05). The γ -globulin, IgG, IgM and IgA levels of AMA/AMA-M2 positive PBC patients were higher than that of the AMA negative cases (P < 0.05). The abnormal rate of cholesterol in AMA negative PBC patients was 65.4% as compared to 50.4% in AMA/AMA-M2 positive cases, no significant difference existed between (P > 0.05). Anti-nuclear antibody (ANA) was observed in 29 (96.7%) AMA negative PBC patients, including 14 (48.3%) with granular pattern, 8 (27.6%) with nuclear membrane pattern, 6 (20.7%) with kinetochore pattern and 1 (3.4%) with homogeneous pattern. AMA negative PBC patients had elevated serum ALP, GGT, IgM and cholesterol levels, and decreased serum AST, IgG and IgA levels as compared with that of autoimmune hepatitis patients (P < 0.05, respectively). Conclusion In cholestatic patients with elevated IgM and cholesterol levels, ANA positive with non-homogeneous pattern, the diagnosis of PBC should be suspected, albeit AMA negative. The clinical, biochemcial and histological features of the AMA negative PBC patients were similar to classic PBC patients, but quite different from autoimmune hepatitis.     

Etiology spectrum and clinical characteristics of renal artery stenosis in a Chinese cohort

OBJECTIVE To analyze the causes of renal artery stenosis(RAS)and compare the clinical characteristics in accordance with the primary disease among patients aged from 30 to 50.METHODS Patients were grouped by etiologies of RAS.Groups were retrospectively examined and compared regarding demographic data,clinical manifestations,laboratory findings,and imaging findings.RESULTS A total of 152 patients(74 females,78 males;mean age:40.70±6.01 years)were enrolled,including 84 patients(55.3%)with atherosclerosis(AS),46 patients(30.3%)with Takayasu arteritis(TA),18 patients(11.8%)with fibromuscular dysplasia(FMD),and four patients(2.6%)with other etiologies.Patients in AS group had greater body mass index,higher prevalence of comorbidities and higher rate of smoking and drinking history.TA patients showed more constitutional symptoms and vascular findings,and higher erythrocyte sedimentation rate.RAS in both AS group and TA group mainly located on ostia and proximal segments,but RAS in FMD group mainly involved middle to distal segment of renal artery.The AS group had significantly lesser stenosis than the other groups.Although renal function evaluated by the estimated glomerular filtration rate did not significantly differ among the groups,the incidence of kidney shrinkage was significantly higher in the TA and FMD groups(39.1%and 50%,respectively)than in the AS group(8.3%).The FMD group had milder cardiac damage than other groups.CONCLUSIONS AS was the most common cause of RAS in patients aged from 30 to 50,followed by TA and FMD.The etiology of RAS should be carefully distinguished based on clinical manifestations,laboratory findings,and imaging to ensure that proper treatment is provided.     

Efficacy of a newly developed dilator for endoscopic ultrasound-guided biliary drainage

AIM To evaluate the efficacy of a newly developed dilator for endoscopic ultrasound(EUS)-guided drainage(ES Dilator).METHODS Fourteen consecutive patients who had undergone EUSguided choledochoduodenostomy(EUS-CDS) with the ES Dilator were identified from a prospectively maintained database and enrolled in the study group.Fourteen other patients who had undergone EUS-CDS without the dilator just prior to its introduction were analyzed as the control group.A historical cohort study was carried out comparing the two groups.The main outcome measurement was the procedure time.The technical success rate and early AE rate were also compared between the two groups.RESULTS There were no significant differences in age,sex and etiology of biliary obstruction.The utilization rate of a plastic stent was higher in the control group(36% vs 0%).The technical success rate was 100% in both groups.The mean procedure time was significantly shorter in the study group than in the control group(27 ± 7 min vs 44 ± 26 min,P = 0.026).Additionally,there were no patients who required more than 40 min for the procedure in the study group.Early adverse events occurred in 29%(4/14) of the control group whereas none in the study group.The adverse events in all 4 patients was bile peritonitis,including pan-peritonitis in one patient.All patientsrecovered with conservative treatment by medication.CONCLUSION The newly developed dilator was found to be useful for shortening procedure time and would prevent adverse events related to bile leakage in EUS-CDS.     

三叉神经痛经皮球囊压迫术的脑血管并发症——10例报道

目的 探讨三叉神经痛经皮球囊压迫术（percutaneous balloon compression,PBC）并发脑血管病的相关因素,以减少手术相关并发症的发生。方法 回顾性分析辽宁省人民医院2000年12月至2010年12月期间采用PBC治疗三叉神经痛中并发脑血管病患者的临床资料,探讨其发生的原因。结果 在6 759例接受PBC治疗的三叉神经痛患者中,共有10例(0.15％)发生脑血管病,其中动静脉瘘2例;颅内出血5例：急性硬膜下出血2例,脑室出血伴蛛网膜下腔出血2例,脑干少量出血1例;1例在术中穿刺时发生颈内动脉出血而暂时停止手术,2周后再次手术成功;脑梗死2例,均为脑血管病危险人群,治疗3周后病情均有改善,其中1例出院时遗留较严重肢体瘫痪。结论 PBC治疗三叉神经痛安全,脑血管病并发症发生率较低,手术操作和血压变化是发生脑血管病并发症的重要原因。     

经皮穿刺球囊压迫术治疗肿瘤源性三叉神经痛的疗效分析

目的探讨经皮穿刺球囊压迫术（PBC）治疗肿瘤源性三叉神经痛（TN）的疗效。 方法回顾性分析辽宁省人民医院神经外科自2005年1月至2017年5月行PBC治疗的72例继发性TN患者的临床资料，评估患者术后的短期和长期的疼痛控制情况和并发症情况。 结果短期结果：疼痛完全缓解69例，部分缓解3例；术后面部麻木63例，角膜反射减弱7例，感觉异常但可忍受2例，脑脊液漏1例，角膜炎1例，疱疹2例。失访患者32例，可随访患者40例，平均随访72.1个月（范围10~162个月），其中2例死亡。随访结果：远期疼痛完全缓解28例，部分缓解5例，复发5例，并发症包括面部麻木19例，其中7例较术后无明显变化，12例已经明显减轻或局部麻木，脑脊液漏1例，较前减轻，偶尔会有脑脊液渗出，感觉异常难以忍受1例。 结论PBC是一种简单、安全及有效的治疗方法，针对部分肿瘤源性TN患者，能够起到对开颅手术的有益的补充。     

The Long-Term Effective Rate of Different Branches of Idiopathic Trigeminal Neuralgia After Single Radiofrequency Thermocoagulation: A Cohort Study

To evaluate the efficacy of computed tomography (CT) guided single radiofrequency thermocoagualtion (RFT) in 1137 patients with idiopathic trigeminal neuralgia after a follow-up period of 11 years, specially focused on duration of pain relief in different branches of trigeminal nerve, side effect, and complications.Retrospective study of patients with idiopathic trigeminal neuralgia treated with a single CT guided RFT procedure between January 2002 and December 2013.The mean follow-up time was 46.14 ± 30.91 months. Immediate postprocedure pain relief was 98.4%. V2 division obtained the best pain relief rate: 91%, 89%, 80%, 72%, 60%, and 54% at 1, 3, 5, 7, 9, and 11 years, respectively. No statistical difference pairwise comparison was in other groups. The complications included masseter muscle weakness, corneitis, diplopia, ptosis, hearing loss, limited mouth opening, and low pressure headache. Masticatory weakness mostly occurred in patients with V3 branch involvement, while Corneitis and Diplopia all in patients with V1 branch involvement. No mortalities observed during or after RFT.All different branches division of trigeminal neuralgia achieved comparable satisfactory curative effect; V2 obtained the best excellent pain relief, after RFT procedure. Facial numbness is inevitable after RFT, which patients who have pain in all 3 trigeminal divisions and patients who desire no facial numbness should be cautious. Masticatory weakness is mainly related with V3 injured, while Corneitis and Diplopia in patients with V1 injured by RFT.     

抗酿酒酵母细胞抗体在原发性胆汁性肝硬化患者中的临床意义

目的 检测原发性胆汁性肝硬化(PBC)患者血清抗酿酒酵母细胞抗体(ASCA),探讨其在PBC中的阳性状况和临床意义.方法 采用酶联免疫吸附试验(ELISA)检测162例PBC患者、44例自身免疫性肝炎(AIH)患者、41例肝病对照组(LDC)患者、144例炎症性肠病(IBD)患者及35名健康体检者血清ASCA的IgA和IgG亚型.采用χ2检验和非参数U检验进行分析.结果 ASCA-IgA在PBC患者中的阳性率为24.1%,高于溃疡性结肠炎(UC)组11.6%(χ2=5.5,P＜0.05)和健康对照组0(χ2=10.5,P＜0.01),与AIH组(20.5%)、LDC组(14.6%)和克罗恩病(CD)组(34.5%)比较,差异无统计学意义(P＞0.05);ASCA-IgG在PBC患者中的阳性率为11.1%,明显低于CD组27.6%(χ2=8.9,P＜0.01),高于健康对照组0(χ2=10.5,P＜0.01),与AIH组(15.9%)、LDC组(7.3%)和UC组(8.1%)比较,差异无统计学意义(P＞0.05);ASCA-IgA和IgG同时阳性的PBC患者仅占6.2%,显著低于CD组17.2%(χ2=6.3,P＜0.05);ASCA-IgA或IgG阳性的PBC患者占29.0%,显著低于CD组44.8%(χ2=4.8,P＜0.05),高于UC组(χ2=5.9,P＜0.05)和健康对照组(χ2=13.3,P＜0.01).抗GP210抗体阳性的PBC患者ASCA阳性率高于抗GP210抗体阴性PBC患者(38.6%和23.8%,χ2=3.9,P＜0.05);抗线粒体抗体(AMA)、抗SP100抗体阳性和阴性PBC患者间ASCA的阳性率差异无统计学意义.ASCA-IgA阳性PBC患者总胆红素、直接胆红素、总胆汁酸、乳酸脱氢酶(LD)、IgA、IgM、红细胞沉降率(ESR)高于ASCA-IgA阴性PBC患者,而白蛋白(ALB)、白蛋白/球蛋白和胆碱酯酶低于ASCA-IgA阴性PBC患者(P均＜0.05).ASCA-IgG阳性PBC患者与阴性患者间肝功能损伤指标和免疫功能指标差异均无统计学意义.结论 ASCA并不是IBD特异性自身抗体,在PBC患者有较高的阳性率,且以IgA亚型为主.ASCA-IgA与PBC患者肝功能损伤指标和免疫活动指标改变有关,而ASCA-IgG与PBC患者肝功能损伤指标和免疫活动指标改变无关.     

缺血后适应对老年冠心病患者缺血再灌注肢体血管内皮功能的影响

目的 观察缺血再灌注不同时刻给予缺血后适应,对老年冠心病患者血管内皮功能的保护作用.方法 选取老年冠心病患者54例,随机分为3组,缺血再灌注组、后适应组及延迟后适应组.建立肢体缺血再灌注模型,在再灌注不同时刻(1 min内及1 min后)分别给予后适应组及延迟后适应组缺血后适应干预,通过超声检测肱动脉血流介导的舒张功能(FMD),观察缺血再灌注前后反应性充血血管内径的变化.结果 缺血再灌注组再灌注后FMD明显减小(P＜0.05),再灌注1 min内给予缺血后适应有明显的血管内皮功能保护作用,与缺血再灌注组比较,后适应组FMD明显提高(6.70±2.36 vs 3.05±0.91,P＜0.05),而延迟后适应组则失去了内皮功能保护作用(3.17±1.04 vs 3.05±0.91,P＞0.05).结论 再灌注1 min内给予缺血后适应可以改善血管内皮功能,但延迟后适应的保护作用消失.     

急诊冠脉介入治疗高龄急性心肌梗死患者的临床特征和预后

目的分析75岁以上高龄ST段抬高急性心肌梗死（STEM I）急诊经皮冠状动脉介入治疗（PC I）患者住院期间的临床特征和术后12个月的随访结果。方法回顾性分析2005年3月至2010年3月,实行急诊PC I术的STEM I患者297例,年龄（59.33±11.42）岁,将高龄组（≥75岁）患者49例的临床特征、治疗结果和预后与对照组（〈75岁）患者进行对比。结果高龄组患者占16.5%,年龄（77.46±2.37）岁,其中女性患者比例高于对照组（34.7%比19.8%,P〈0.05）。高龄患者既往陈旧心梗、卒中较对照组多,分别是（18.3%比7.7%;30.6%比10.8%;P〈0.05）;其缺血时间较对照组长（4.66±2.49）h比（3.76±2.05）h,左室射血分数低（52.88±6.70）%比（55.66±7.51）%,P〈0.01;高龄组冠脉介入手术成功率、并发症发生率与对照组差异无统计学意义,分别是（93.9%比97.2%,4.1%比2.0%）,P〉0.05;高龄组患者病变复杂,三支血管病变、术中再灌注心律失常发生率高于对照组,分别为（38.7%比23.5%;44.8%比28.6%,P〈0.05）。住院期间和术后12个月两组患者在死亡、再梗死、卒中及靶血管重建率方面差异无统计学意义,术后12个月高龄组总体MACE高于对照组（22.4%比7.2%）,P〈0.05。结论尽管高龄组患者术后12个月的总体MACE高于对照组,但在手术成功率、并发症发生率、死亡、再梗死、卒中及靶血管重建率方面相似,急诊PC I是年龄≥75岁的高龄STEM I患者安全、有效的再灌注治疗策略。     

173例高龄冠心病患者直接经皮冠状动脉介入治疗的临床疗效观察

目的评价高龄冠心病(CAD)患者直接经皮冠状动脉介入治疗(PCI)的安全性、临床疗效。方法回顾分析我院CAD年龄≥70岁173例(高龄组)和年龄<70岁134例(非高龄组)行PCI患者的临床病变特点、手术成功率、手术并发症、近中期临床疗效。结果高龄组行PCI的总成功率与非高龄组比较差异无显著性(99%vs 98%,P>0.05);高龄组死亡率(0.00%)与非高龄组死亡率(1.49%)比较差异无显著性(P>0.05),两组间冠状动脉、外周血管并发症无明显差异;高龄组冠状动脉病变较非高龄组重,支架置入率高于非高龄组(92.6%vs 90.1%)。随访24月,两组间恶性心脏事件发生率无明显差异。结论高龄CAD患者行PCI是安全的,其手术成功率、围手术期死亡率、并发症及近中期疗效与非高龄患者比较无差异。PCI同样是高龄冠心病患者治疗的一种理想选择。     

精准医疗在经皮冠状动脉介入术后抗血小板药物选择中的作用

目的:探讨精准医疗、个体化给药在经皮冠状动脉介入术(PCI)后抗血小板药物选择中的作用。方法:入选PCI后服用常规剂量阿司匹林(100 mg/d)和氯吡格雷(75 mg/d)且疗程在3个月左右的患者,根据CYP2C19基因多态性检测结果,将患者分为快代谢组、中代谢组和低代谢组,并给予个体化干预治疗。快代谢组继续服用常规剂量的阿司匹林和氯吡格雷;中代谢组将氯吡格雷调整为1.5倍剂量;低代谢组分为两组,氯吡格雷组将氯吡格雷调整为2倍剂量,替格瑞洛组将氯吡格雷改换为替格瑞洛(90 mg、2次/d)。检测各组个体化干预治疗前后凝血指标和血小板聚集率的变化及干预治疗后的出血事件。结果:各组患者干预治疗前后组间和组内比较,凝血指标差异均无统计学意义(P均0.05)。干预治疗前,血小板聚集率为快代谢组中代谢组低代谢组,3组间差异均有统计学意义(P均0.05);干预治疗后,中代谢组患者血小板聚集率较干预治疗前明显下降(P0.05),低代谢组中氯吡格雷组血小板聚集率与干预治疗前比较差异无统计学意义,替格瑞洛组血小板聚集率较干预治疗前明显下降(P0.05)。干预治疗后快代谢组、中代谢组血小板聚集率差异无统计学意义;低代谢组中替格瑞洛组血小板聚集率明显低于快/中代谢组,氯吡格雷组仍明显高于快/中代谢组(P均0.05)。干预治疗后,中代谢组、低代谢组与快代谢组比较出血风险均未增加(P均0.05)。结论:根据CYP2C19基因多态性检测结果个体化给药,可提高抗血小板治疗效果,且不增加出血风险。对于CYP2C19基因型为低代谢型的患者建议改用替格瑞洛治疗。     

高血糖对老年急性ST段抬高心肌梗死急诊介入治疗患者心功能及预后的影响

目的 观察入院时随机血糖对老年急性ST段抬高心肌梗死急诊经皮冠状动脉介入治疗(PCI)患者心功能及术后1年病死率的影响.方法 对284例急诊PCI的老年急性ST段抬高心肌梗死患者的资料进行回顾性分析.根据入院后即刻的随机血糖,将患者分为3组:A组(血糖<7.8mmol/L)、B组(血糖7.8～10.9 mmol/L)及C组(血糖≥11.0 mmol/L).结果 (1)与A组比较,B组、C组患者女性所占比例较高(分别为26.5%比33.3%、40.2%,均P<0.01),平均住院时间较长(分别为13.9 d比16.0 d、16.6 d,均P<0.05).C组有高血压病史患者的比例高于A组(72.1%比54.9%,P<0.01).(2)急诊PCI后,合并高血糖的B组、C组患者TIMI心肌灌注分级(TMPG)0～1级所占比例高于血糖正常的A组(分别为22.6%、34.1%比13.3%,均P<0.05),TMPG达3级所占比例低于A组(分别为74.3%、57.6%比84.4%,均P<0.05).C组术中并发症发生率高于A组及B组(分别为42.5%比20.6%、26.6%,均P<0.01),术中应用主动脉内球囊反搏比例高于A组及B组(分别为19.5%比4.9%、6.4%,均P<0.01).(3)C组心功能Killip分级≥2级患者所占比例明显高于A组及B组(分别为44.8%比23.5%、27.7%,均P<0.01).与A组比较,C组患者住院期间病死率(8.0%比1.1%,P<0.05)及术后1年病死率(18.7%比3.4%,P<0.05)较高.结论 合并高血糖的老年急性ST段抬高心肌梗死患者急诊PCI术后心肌组织水平灌注、心功能及预后均较差.     

老年人急性心肌梗死的临床特征分析

目的　探讨老年人急性心肌梗死 (AMI)的临床特点。方法　对住院的 AMI患者的临床资料进行统计 ,分析年龄≥ 6 0岁的老年 AMI患者 (老年组 )及年龄 <6 0岁 (非老年组 )患者的临床特点。结果　本研究包括 2 5 8例老年AMI患者 (平均年龄 6 8.5± 6 .6岁 )及 117例非老年 AMI患者 (平均年龄 5 1.2± 6 .8岁 )。与非老年患者比较 ,老年AMI患者更多患有心绞痛或陈旧性心肌梗死 (7.8%与 18.2 % ,P <0 .0 2 )及高血压病 (43.6 %与 5 8.1% ,P <0 .0 1)。表现为无 Q波心肌梗死 (NQMI)的老年患者明显高于非老年组 (13.1%与 6 .0 % ,P<0 .0 5 ) ,肌酸激酶 (CK)峰值在老年组则显著低于非老年组 (1198.7± 132 2 .1U /L与 15 70 .4± 15 0 7.0 U /L ,P<0 .0 2 )。老年组较非老年组中有更多的患者伴有心力衰竭 (8.5 %与 2 .6 % ,P<0 .0 2 ) ,心房颤动 (14 .7%与 5 .1% ,P<0 .0 1)及右束支传导阻滞 (RBBB) (8.9%及 0 % ,P<0 .0 0 1) ,死亡率也显著增高 (13.5 %与 5 .1% ,P<0 .0 2 ) ,但老年患者却较少接受静脉溶栓治疗 (2 0 .1%及 4 1.9% ,P<0 .0 0 1)及择期经皮腔内冠状动脉成形术 (PTCA) (13.5 %与 33.3% ,P<0 .0 0 1)。结论　本研究提示老年 AMI患者较非老年患者更多表现为 NQMI,更多伴有心房颤动、心力衰竭及 RBBB等