阻塞性睡眠呼吸暂停综合征老年患者血管内皮功能变化及其与冠心病的关系

目的　探讨老年阻塞性睡眠呼吸暂停综合征 (OSAS)患者血管内皮功能变化与冠心病 (CHD)的内在联系。方法　随机选择 31例无OSAS、无心血管疾病的老年单纯鼾症者为对照组 ,4 5例老年中、重度OSAS患者为OSAS组 ,OSAS组内又分为有CHD(16例 )和无CHD(2 9例 )两个亚组。测定和比较组间的血浆一氧化氮 (NO)、内皮素 (ET)及其比值的动态变化及OSAS组内CHD有无的区别。结果　与对照组相比 ,OSAS组患者的NO水平明显降低〔(2 7.6 9± 9.17)vs(6 1.90± 13.4 7) μmol/L〕 ,ET水平明显增高〔(5 8.0 8± 14 .2 1)vs (34.77± 8.2 3)ng/L〕 ,NO/ET比值明显下降〔(0 .4 7± 0 .18)vs (1.72± 0 .97) ,均P <0 .0 1)〕。CHD的发生率在OSAS组达 35 .6 %。与对照组相比 ,OSAS组中不伴CHD者降低的NO水平 (35 .5 3± 9.39) μmol/L、升高的ET水平 (47.78± 11.13)ng/L和下降的NO/ET比值 (0 .75± 0 .13)已有显著性差异 (P <0 .0 5 ) ;伴有CHD者的NO水平 (2 2 .17± 8.76 )μmol/L、ET水平 (6 9.14± 12 .17)ng/L和NO/ET比值 (0 .32± 0 .14 )较对照组相差更为明显 (P <0 .0 1)。结论　OSAS老年患者存在明显的血管内皮功能障碍 ,尤以CHD者为甚 ,血管内皮功能损伤可能是OSAS患者并发CHD的原因     

冠心病患者血管内皮生长因子水平变化及其与冠状动脉病变程度的关系

目的观察冠心病(CHD)患者血管内皮生长因子(VEGF)水平,探讨其与冠状动脉病变程度的关系。方法应用酶联免疫吸附法检测68例CHD患者和18例冠状动脉造影正常者血浆VEGF水平,并作冠状动脉病变程度Gensin i记分,分析VEGF水平与Gensin i记分的关系。结果CHD患者血浆VEGF水平明显高于正常对照组〔(154.9±117.8)pg/m l vs(81.8±63.8 pg/m l),P<0.01〕;急性冠脉综合征患者血浆VEGF水平明显高于稳定型心绞痛组〔(171.2±126.4)pg/m l vs(97.5±50.9)pg/m l,P<0.05;〕CHD患者VEGF水平与Gensin i记分呈正相关(r=0.240,P<0.05)。结论VEGF水平升高不仅反映CHD患者心肌缺血损伤的严重程度,而且可能是不稳定斑块的标志物;VEGF可能在冠状动脉粥样硬化的发生与发展中起作用。     

可溶性E-选择素对冠心病心绞痛的诊断意义

目的 :探讨可溶性E 选择素 (sE selectin)在冠心病 (CHD)中的临床意义及其对心脏缺血性胸痛与非心脏缺血性胸痛的鉴别诊断价值。方法 :用ELISA法检测了 72例经冠状动脉造影 (CAG)诊断的胸痛患者血清sE selectin水平 ,并以 18例健康体检者作为对照。结果 :CAG阳性组sE selectin水平〔(6 8.4± 17.8) μg/L〕较CAG阴性组〔(5 4 .6± 19.6 ) μg/L〕及对照组〔(5 2 .8± 17.4 ) μg/L〕均明显增高 (P <0 .0 5 ) ,尤以急性心肌梗死患者增高更为显著〔(74 .3± 18.6 ) μg/L〕。以≥ 6 0 μg/L为低限 ,其诊断CHD的敏感性为 74 % ,特异性为 83%。 结论 :CHD患者血清sE selectin水平增高 ,并反映病情严重程度 ,可作为可疑胸痛患者的辅助鉴别诊断手段     

急性淋巴细胞白血病患儿血清sTNFRs水平测定的临床价值

目的 :探讨急性淋巴细胞白血病患儿血清 TNFa、s TNFR- 和 s TNFR- 水平及其临床意义。方法 :采用 EL ISA法测定血清 TNFa、s TNFR- 和 s TNFR- 水平。结果 :2 4例 AL L患儿血清 TNFα〔(173.2 2±74.5 1) ng/L〕明显高于 2 0例正常对照儿童〔(78.5 9± 18.45 ) ng/L〕,初发与复发患儿血清 s TNFR- 〔(2 .76±1.0 5 )、(2 .44± 1.37) μg/L〕、s TNFR- 〔(2 .33± 1.18)、(2 .0 9± 1.2 2 ) μg/L〕明显高于正常儿童〔(0 .75± 0 .2 6 )、(0 .71± 0 .14) μg/L〕,均为 P <0 .0 1;血清 TNFα与 s TNFR- 呈显著性正相关 (r =0 .6 31,P <0 .0 1) ;8例患儿经有效治疗完全缓解后血清 s TNFRs均降至正常水平〔(0 .83± 0 .2 5 )、(0 .92± 0 .17) μg/L〕;血清 s TNFRs在WBC≥ 10 0× 10 9/L患儿的阳性率明显高于 WBC<10 0× 10 9/L者 (P <0 .0 1) ,其与外周血幼稚细胞数呈显著正相关 (R =0 .72 4 ,R =0 .582 ,P <0 .0 5)。结论 :AL L患儿血清 s TNFRs异常升高与白血病细胞有关 ,血清 s TNFRs水平可作为估计肿瘤负荷及治疗效果的一项指标。     

2型糖尿病肾病患者血清细胞粘附分子变化与氧化应激的关系

目的　探讨 2型糖尿病肾病患者 (DN)血清细胞粘附分子变化及其与氧化应激的关系。　方法　检测DN患者血清可溶性细胞间粘附分子 1(sICAM 1)、可溶性血管细胞粘附分子 1(sVCAM 1)、血清丙二醛 (MDA)含量和超氧化物歧化酶 (SOD)活性。　结果　早期DN及DN患者血清sVCAM 1水平〔分别为 (1 75± 0 48)、(1 91± 0 2 7)mg/L〕明显高于对照组〔(1 6 7± 0 72 )mg/L ,P <0 0 5和0 0 1〕 ,DN组明显高于单纯糖尿病 (DM)组〔(1 5 8± 0 39)mg/L ,P <0 0 5〕 ;DM组、早期DN组和DN组患者血清sICAM 1〔分别为 (75 6 0 0± 12 5 47)、(80 2 2 1± 12 4 81)、(897 6 0± 10 5 80 ) μg/L〕明显高于对照组〔(5 82 6 4± 10 2 73) μg/L ,P <0 0 0 1〕 ,其中DN组明显高于单纯DM组和早期DN组 (分别P <0 0 1和<0 0 5 ) ;单纯DM组、早期DN组和DN组患者血清SOD活性〔分别为 (86 5 9± 13 85 )、(85 6 9±11 32 )、(71 73± 16 35 )NU/L〕显著性低于对照组〔(92 73± 11 2 5 )NU/ml,P <0 0 1〕 ,MDA含量〔分别为(3 99± 1 36 )、(4 2 6± 1 95 )、(6 5 0± 2 98)nmol/ml〕显著性高于对照组〔(3 72± 0 5 7)nmol/ml,P <0 0 1〕。DM患者血清sVCAM 1与sICAM 1、收缩压、尿素氮 (BUN)和肌酐 (Cr)呈正相     

组织蛋白酶K、胱抑素C与冠心病及其危险因素的相关性

目的探讨组织蛋白酶K(Cat K)、胱抑素C(Cys C)与冠心病(CHD)发病、冠脉狭窄程度以及CHD危险因素之间的关系。方法采用酶联免疫吸附法(ELISA)测定252例CHD患者和135例对照组血清Cat K水平,同时测定Cys C、血脂、高敏C反应蛋白(hs-CRP)、糖化血红蛋白(Hb A1c)以及肌酐(Cr)水平;所有受试者均行冠脉造影,以Syntax评分评估冠脉狭窄程度。结果 CHD组血清Cat K水平(130.8±24.5)ng/dl与对照组〔(86.9±23.5)ng/dl〕比较显著升高(P0.001);CHD组血清Cys C水平〔(0.79±0.13)mg/L〕与对照组〔(0.95±0.21)mg/L〕比较显著降低(P0.001);急性冠脉综合征(UAP-AMI)组血清Cat K水平〔(137.2±24.9)ng/dl〕与稳定型心绞痛(SAP)组〔(100.8±12.8)ng/dl〕比较显著升高(P0.001);UAP-AMI组血清Cys C水平〔(0.78±0.13)mg/L〕与SAP组〔(0.87±0.13)mg/L〕比较显著降低(P0.001);CHD患者的血清Cat K水平与冠脉狭窄的Syntax评分呈显著正相关(r=0.236,P0.01);血清Cys C水平与冠脉狭窄的Syntax评分呈显著负相关(r=-0.197,P0.05)。结论Cat K、Cys C可能与CHD的发病独立相关,其血清水平可反映CHD患者冠状动脉病变狭窄程度,可作为诊断及判断预后的新的生物标志物。     

糖尿病大鼠一氧化氮与骨代谢变化的研究

目的　研究糖尿病 (DM )大鼠血清一氧化氮 (NO)与早期骨代谢改变的关系。方法2 0只SD大鼠分为 2组 ,一组以链脲佐菌素诱导建立糖尿病 (STZ DM )大鼠模型 ,另一为正常对照组 ,测定 2组大鼠的空腹血糖 (FBG)、HbA1c、血清胰岛素、全身、股骨和腰椎骨密度 (BMD)、骨代谢相关指标〔血清钙、骨钙素、降钙素、甲状旁腺素 (PTH)、维生素D3 及尿吡啶酚 /肌酐比〕和血清NO水平。结果　STZ DM大鼠与正常对照组相比 ,血清NO水平显著升高〔(5 1.3± 11.9vs 38.1± 12 .0 )μmol/L ,P <0 .0 1〕 ;全身、股骨和腰椎的BMD显著降低〔(0 .15± 0 .0 7vs 0 .2 1± 0 .0 2 ) g/cm2 ,P<0 .0 1;(0 .16± 0 .0 2vs 0 .19± 0 .0 3) g/cm2 ,P <0 .0 5 ;(0 .12± 0 .0 4vs 0 .18± 0 .0 6 ) g/cm2 ,P <0 .0 5〕 ;血清钙浓度显著升高〔(135 .9± 11.3vs 117.2± 6 .5 )mg/L ,P <0 .0 0 1〕 ,骨钙素水平显著升高〔(0 .0 7± 0 .0 4vs 0 .0 5± 0 .0 1) μg/L ,P <0 .0 5〕 ,维生素D3 水平显著降低〔(7.6± 1.9vs 11.6± 4 .1)μg/L ,P <0 .0 5〕 ,尿吡啶酚 /肌酐显著降低〔(4.8± 0 .8vs 75 .8± 6 0 .7)nmol/mmolCr,P <0 .0 1〕 ;而降钙素和PTH水平改变无统计学意义。相关性分析显示 ,血清NO与尿吡啶酚排泄呈负相关 (r= - 0 .74 ,     

系统性硬化病肺间质病变与血管内皮细胞生长因子的关系

目的　探讨血清血管内皮细胞生长因子 (VEGF)与系统性硬化病 (SSc)肺间质病变的关系。方法　采用免疫学酶联免疫吸附测定 (ELISA)方法检测了病例组 (SSc 2 0例 )及正常对照组( 3 0名 )的血清VEGF ,并分析血清VEGF与肺功能的关系。结果　病例组血清VEGF ( 3 63± 178)ng/L较正常对照组 ( 183± 5 9)ng/L明显升高 (P <0 0 0 1) ,VEGF升高的SSc患者肺间质病变的发生率 ( 87 5 % )显著高于VEGF正常的SSc病患者肺间质病的发生率 ( 3 3 3 % ) (P <0 0 5 ) ,SSc患者血清VEGF浓度与肺活量占预计值百分比 (VC % )及肺一氧化碳弥散量占预计值百分比 (DLCO % )呈负相关 (r =- 0 86,P <0 0 0 1;r =- 0 87,P <0 0 0 1)。结论　血清VEGF水平的测定 ,对评估SSc肺间质病变的病情活动性有意义     

血管内皮生长因子与冠心病的关系分析

目的 通过测定不同冠状动脉粥样硬化性心脏病(CHD)患者血清中血管内皮生长因子(VEGF)的水平,分析在不同情况下VEGF水平变化,并分析其与冠心病的关系.方法 选取诊断为CHD,并完成冠状动脉造影术患者142例,其中男性67例,女性75例,应用双抗夹心ELISA法检测患者血清VEGF水平.结果 不稳定型心绞痛(UAP)患者VEGF水平明显高于稳定型心绞痛(SAP)患者[(663.58±109.21)pg/ml和(537.47±29.37)pg/ml](P＜0.05);SAP患者与陈旧性心肌梗死(OMI)患者相比差异无统计学意义;SAP患者、UAP患者、OMI患者较冠状动脉造影正常者VEGF水平明显增高[(537.47±29.37)pg/ml、(663.58±109.21)pg/ml、(544.53±30.60)pg/ml和(463.58±60.12)pg/ml],(P＜0.05),而急性心肌梗死(AMI)患者发病第1天VEGF水平较SAP者无明显升高,但第2、3天VEGF水平较SAP者明显升高.结论 不同程度CHD患者中VEGF水平差异有统计学意义,VEGF与心肌缺血,以及缺血的时间密切相关,可能对于患者病情评价存在较大价值.     

冠心病心绞痛患者血浆IL-8水平和中性粒细胞CD11 b/CD18 表达与冠状动脉狭窄程度及病变稳定性的相关性

目的 :探讨冠心病心绞痛患者血浆白细胞介素 8(IL 8)水平和中性粒细胞CD11b/CD18表达与冠状动脉狭窄程度和病变稳定性的关系。方法 :选择 6 8例不稳定型心绞痛患者 (UA组 )和 5 2例稳定型劳累性心绞痛患者 (SA组 ) ,用夹心ELISA法测定IL 8水平 ;用流式细胞仪检测其CD11b/CD18受体表达。同期测定 2 0例正常人以作对照。依据冠状动脉造影结果 ,按直径法和ABC分型综合评定心绞痛患者冠状动脉病变程度。结果 :UA组患者血浆IL 8为 (10 0 .11± 31.89)ng/L ,显著高于SA组患者〔(5 9.0 8± 19.2 9)ng/L ,P <0 .0 1〕和正常对照组〔(47.6± 2 0 .8)ng/L ,P <0 .0 1)〕 ;CD11b/CD18表达UA组患者 (433± 6 1)也显著高于SA组患者 (2 4 0± 5 3,P <0 .0 1)和对照组 (2 2 5± 37,P <0 .0 1)。UA组患者血浆IL 8和CD11b/CD18表达在A型、B型及C型病变组依次增加 ,并与冠状动脉狭窄直径呈正相关 (r =0 .6 72 3,P <0 .0 0 1和r =0 .5 5 94 ,P <0 .0 0 1)。SA组上述参数与正常对照组比较以及在A、B、C 3种病变组之间比较均无统计学差异。结论 :心绞痛患者血浆IL 8和CD11b/CD18表达增加与冠状动脉狭窄程度和病变稳定性有关。     

Pseudoaneurysm of coronary artery following rupture of coronary artery during coronary angioplasty.

Rupture of the coronary artery is a rare complication of percutaneous transluminal coronary angioplasty (PTCA). We describe a case of coronary artery rupture during PTCA resulting in the formation of a coronary artery pseudoaneurysm. The pseudoaneurysm was successfully treated by percutaneous spring-coil embolization of the coronary artery.     

Percutaneous coronary intervention of bifurcation coronary disease

Bifurcation coronary artery disease is a frequent problem faced by interventional cardiologists and it affects approximately 15-20% of patients undergoing percutaneous coronary intervention (PCI). The application of drug-eluting stents (DES) technology to prevent restenosis after PCI represents one of the success stories in cardiology, but DES have not resolved the bifurcation PCI challenge. Bifurcation PCI remains associated with higher procedural failure and worse outcomes compared with PCI of non-bifurcated lesions even in DES era. A dependable strategy for PCI of bifurcation lesions has yet to be established, which is likely due to the paucity of studies evaluating the anatomical intricacies of the bifurcation as well as the lack of large scale randomized therapeutic trials. Further, bifurcation has many anatomical variants and it is unlike that one technique will fit all. Currently, we are left with the option of a tailor-made strategy for each patient and bifurcation anatomy and make the most of the limited evidence available to support our therapeutic decisions. In this review, we attempted to describe the current understanding of bifurcation anatomy and corresponding PCI strategies.     

Atherosclerosis of coronary arteries, coronary heart disease and sudden coronary death

Correlation between the severity of coronary atherosclerosis, thrombosis and sudden cardiac death was examined in 721 autopsied cases. Severe coronary atherosclerosis with stenosis was found in most of them; however a similar grade of atherosclerosis was discovered in patients with ischaemic heart disease not dying suddenly. Acute coronary thrombosis in the studied subjects was diagnosed post mortem in about 20 percent of those who died suddenly. Other studies indicate frequencies between 4-93%. There was no consistent time dependence.     

Clinical trials of coronary revascularization: coronary angioplasty vs. coronary bypass grafting

In the absence of diabetes mellitus, rates of survival and of survival free of myocardial infarction (MI) are almost identical among patients with multivessel disease assigned to percutaneous transluminal coronary angioplasty (PTCA) versus those assigned to coronary artery bypass grafting (CABG) after 6.5 to 8 year follow-up period. Additional revascularization occurs 2.5 to 4.5 times more frequently in PTCA-treated than in CABG-treated patients and prevalence of angina is no longer statistically different between the two treatment groups. The excess health care costs of bypass surgery, which are important early after revascularization, almost disappear 5 to 8 years later. In patients with single vessel disease, survival free of MI is also comparable in both treatment groups at 5 years. Additional revasculariztion occurs two to four times more often in PTCA-treated than in CABG-treated patients and prevalence of angina does not differ between the two treatment groups. Thus, in nondiabetic patients with multivessel disease, the choice of a revascularization strategy rests on the patient's and treating physician's preference between the invasive nature of bypass surgery and the risk of recurrent procedures. In patients with single vessel disease, these long-term data suggest that bypass surgery is at least as safe and effective as coronary angioplasty and therefore may be a treatment option in selected cases.     

冠状动脉256排CT与冠状动脉造影对冠心病的诊断比较

目的冠状动脉256排CT成像技术与冠状动脉造影检查对冠状动脉粥样硬化性心脏病的诊断比较。方法选取2013年5月至2014年5月内蒙古兴安盟人民医院心血管内科疑似冠心病患者50例,其中男性29例,女性21例,年龄37~68岁。先行冠状动脉256排CT扫描及图像后处理,后行冠状动脉造影检查,将两结果进行对比分析。结果以冠状动脉狭窄≥50%者为阳性。冠状动脉256排CT诊断冠心病灵敏度为40.00%,特异度98.18%,阳性预测值88.89%,阴性预测值81.82%,正确指数38.18%,符合率82.67%,KAPPA值46.28%。结论冠状动脉造影诊断冠心病准确性优于冠状动脉CT。冠状动脉CT可对冠心病患者进行初筛诊断。     

冠脉微循环与冠心病

冠心病急性心肌梗死的再灌注治疗是现代医学发展的里程碑,它使被动、保守治疗转为积极、主动的血运重建,随着包括静脉溶栓、冠状动脉内溶栓、经皮冠状动脉腔内成形术(PTCA)、冠状动脉内支架置入术以及冠状动脉搭桥术等再灌注治疗技术的成熟、普及,挽救了无数患者的生命.     

Percutaneous transluminal coronary angioplasty of coronary artery embolism

A 35-yr-old woman with known valvular heart disease presented with acute myocardial infarction. Angiography demonstrated a totally occluded distal left anterior descending coronary artery. Though initially successful, angioplasty ultimately failed to maintain arterial patency, leaving a more distal total occlusion after several balloon inflations. In spite of this, PTCA possibly provided a more localized infarction via a peripheral mobilization of the embolus.     

Right coronary artery coronary sinus fistula with coronary sinus ostium stenosis

Coronary artery fistula (CAF) is a rare anomaly of the coronary artery. The draining site of a right coronary artery (RCA) fistula may usually be the right ventricle, right atrium, or pulmonary artery. Here, we present a patient with right coronary artery to coronary sinus fistula (RCACSF) complicated by aneurysmal dilatation of the coronary sinus (CS) and stenosis of CS ostium.     

Detecting of coronary dissection by coronary magnetic resonance

A 75-year-old man, who had a history of coronary dissection after percutaneous coronary intervention in left anterior descending coronary artery, underwent coronary magnetic resonance. Magnetic resonance demonstrated coronary dissection in the distal portion of the left anterior descending artery. Both the true lumen with thick vessel wall and the false lumen with thin vessel wall were demonstrated in the cross-sectional images using T1-weighed black blood technique and T2-weighed black blood technique. Soft plaque was located at the twelve o'clock in the true lumen. Invasive coronary angiogram showed long coronary dissection from middle to distal portion of left anterior descending coronary artery. Magnetic resonance was thought to be useful to detect and follow up the coronary dissection noninvasively.