血浆内脂素在冠心病合并2型糖尿病患者中的表达

目的探讨血浆内脂素在冠心病合并2型糖尿病患者中的表达。方法 90例经过冠状动脉造影确诊为冠心病患者(冠心病组)中,其中合并2型糖尿病患者(冠心病合并2型糖尿病组)51例,不合并2型糖尿病患者(冠心病不合并2型糖尿病组)39例;另外选择32名健康者作为对照组。检测所有入选人群的血浆内脂素的水平。结果不合并2型糖尿病组的内脂素水平明显高于对照组(P<0.01)。冠心病组各亚组间比较,合并2型糖尿病组的内脂素高于不合并2型糖尿病组(P<0.01),血浆内脂素水平随着冠状动脉病变支数的增加而升高,各亚组间的比较差异有统计学意义(P<0.01)。冠心病组血浆内脂素水平与冠状动脉病变支数呈正相关(P<0.01)。结论冠心病患者血浆内脂素水平明显高于健康者,合并2型糖尿病者血浆内脂素水平升高更明显,而且与冠状动脉病变程度密切相关。     

内脂素与冠心病

内脂素是一种新的脂肪因子,主要来源于内脏脂肪,具有类胰岛素样作用。近年来的许多研究发现,内脂素与缺氧、易损斑块、内皮功能紊乱、炎症、血管增生等冠心病,尤其动脉粥样硬化的发生和发展过程相关。此外,内脂素还能通过延长氧化应激状态下线粒体渗透转运孔（mPTP）的开放时间,发挥一定的心血管保护作用。     

内脂素与冠心病

内脂素是一种新的脂肪因子,主要来源于内脏脂肪,具有类胰岛素样作用。近年来的许多研究发现,内脂素与缺氧、易损斑块、内皮功能紊乱、炎症、血管增生等冠心病,尤其动脉粥样硬化的发生和发展过程相关。此外,内脂素还能通过延长氧化应激状态下线粒体渗透转运孔（mPTP）的开放时间,发挥一定的心血管保护作用。     

老年冠心病患者血浆网膜素1及内脂素水平分析

目的　观察老年冠心病患者血浆网膜素1、内脂素水平的变化,并探讨其临床意义。方法　采用酶联免疫吸附法测定59例老年冠心病患者（年龄≥60岁;冠心病组）及31例健康者（年龄≥60岁;对照组）的血浆网膜素1、内脂素浓度。依据临床症状将冠心病组分为2个亚组：稳定型心绞痛（SAP）组29例,不稳定型心绞痛（UAP）组30例;依据NYHA心功能分级将冠心病组分为3个亚组：即心功能Ⅰ级组11例,心功能Ⅱ、Ⅲ级组36例,心功能Ⅳ级组12例。结果　（1）冠心病组血浆网膜素1水平显著低于对照组（717.63±229.11　ng/L比1115.49±361.41　ng/L,P＝0.000）;SAP组、UAP组均显著低于对照组（780.32±273.19　ng/L比1115.49±361.41　ng/L,652.81±152.94　ng/L比1115.49±361.41　ng/L,均P<0.05）。（2）冠心病组血浆内脂素水平显著高于对照组（19.22±6.73　μg/L比13.31±1.69　μg/L,P＝0.002）,且SAP组、UAP组显著高于对照组（17.92±4.19　μg/L比13.31±1.69　μg/L,20.43±8.31　μg/L比13.31±1.69　μg/L,均P<0.05）。（3）心功能Ⅰ级组、Ⅱ和Ⅲ级组、Ⅳ级组,血浆网膜素1水平（1033.87±277.84　ng/L、676.58±137.25　ng/L、540.35±59.49　ng/L）逐渐下降,内脂素水平（13.00±1.19　μg/L、19.08±2.97　μg/L、25.23±11.30　μg/L）逐渐升高,3组之间比较这两项指标均有显著差异（均P<0.05）。（4）血浆网膜素1水平与收缩压呈显著负相关（r＝－0.264,P＝0.041）,与血浆高密度脂蛋白胆固醇（HDLC）水平呈显著正相关（r＝0.271,P＝0.038）;血浆内脂素水平与总胆固醇呈显著正相关（r＝0.292,P＝0.025）,与HDLC水平呈显著负相关（r＝－0.266,P＝0.039）。（5）血浆网膜素1与内脂素水平之间呈显著负相关（r＝－0.280,P＝0.032）;多元线性逐步回归分析显示网膜素1、内脂素均可能受HDLC水平的影响;Logistic回归分析显示在冠心病的发生中内脂素可能是危险因素。结论　（1）网膜素1水平的降低及内脂素水平的升高均可能参与了冠心病的发生发展过程。（2）网膜素1与内脂素可能分别为保护因子及致炎因子,且均可能与脂代谢有关。（3）内脂素是冠心病发生的独立危险因素。     

血浆内脂素在老年冠心病患者合并颈动脉粥样硬化中的临床应用

颈动脉粥样硬化与冠状动脉粥样硬化关系密切[1],研究证实,判断颈动脉粥样硬化的特异性指标-颈动脉内膜中厚度(IMT)是预测冠心病的主要危险因素之一,可作为冠心病的独立预测因子[2,3].     

冠心病患者血浆内脂素及基质金属蛋白酶-9的相关性及临床意义

目的探讨内脂素及基质金属蛋白酶-9(MMP-9)在冠心病(CHD)中的相关性及临床意义。方法选择80例经冠脉造影确诊为冠心病并排除糖尿病的患者和30名健康体检者。冠心病诊断标准为冠状动脉至少一支血管狭窄程度≥50%。将80例CHD患者分为急性冠脉综合征(ACS)组(50例)与稳定型心绞痛(SAP)组(30例)。根据冠脉造影将患者分为单支病变组(26例)、双支病变组(27例)、三支病变组(27例)。以酶联免疫吸附试验法检测80例患者及30例健康对照者血浆内脂素和MMP-9水平。结果 ACS与稳定型心绞痛患者血浆内脂素和MMP-9显著高于对照组(P<0.05),ACS患者血浆内脂素和MMP-9高于与稳定型心绞痛(P<0.05),三支病变组内脂素与MMP-9高于双支病变组(P<0.05),双支病变组高于单支病变组(P<0.05),单支病变组高于对照组(P<0.05)。内脂素水平与MMP-9水平显著正相关(r=-0.763,P<0.05)。结论内脂素、MMP-9与冠心病密切相关,且对冠心病的诊断及预测冠状动脉病变严重程度具有重要临床意义。     

不同糖耐量冠心病患者血清内脂素水平与冠状动脉狭窄程度的关系

目的 比较血清内脂素(visfatin)在不同糖耐量水平冠心病患者和正常个体中的表达情况,评价血清内脂素水平与冠状动脉狭窄程度的关系.方法 经冠状动脉造影确诊冠心病患者85例,按1999年世界卫生组织糖尿病诊断标准分为冠心病正常糖耐量组(CHD)34例、冠心病合并糖调节异常组(CIG)25例、冠心病合并2型糖尿病组(CDM)26例,选择健康志愿者30名(冠状动脉CT血管造影阴性)作为正常对照组(CON).检测受试者人体测量学指标及糖、脂代谢指标;应用Gemini冠状动脉评分系统对冠状动脉狭窄程度进行评估;用SPSS 12.0统计软件包进行统计学分析.结果 与CON组比较,CHD、CIG及CDM组血清内脂素水平均显著增高(均P<0.05);与CHD组相比较,CIG和CDM组血清内脂素水平均显著增高(均P<0.05);内脂素水平与Gesini冠状动脉病变积分呈正相关(r=0.669,P<0.01);内脂素与腰围、腰臀比、甘油三酯呈正相关(r=0.200,P=0.032;r=0.185,P=0.047;r=0.321,P<0.01),与高密度脂蛋白胆固醇(HDL-C)呈负相关(r-0.354,P<0.01),多元回归分析显示,腰围、甘油三酯水平为影响内脂素水平的主要因素.结论 (1)血清内脂素水平较好地反映冠状动脉病变的严重程度,检测内脂素水平有助于冠心病的早期诊断.(2)在合并2型糖尿病及糖调节异常的冠心病患者中,血清内脂素表达显著增高,与临床糖尿病患者更重的冠状动脉病变相符合.(3)腰围、甘油三酯水平为影响血清内脂素水平的主要因素,提示内脂素水平与腹型肥胖密切相关.

Abstract：

Objective To investigate the relationship between serum visfatin level and coronary artery stenosis.Methods Based on coronary angiography,85 patients were diagnosed as coronary heart disease.According to oral glucose tolerance test,these patients were divided into 3 groups,34 patients with normal glucose tolerance(CHD group),25 with impaired glucose regulation(CIG group),and 26 with type 2 diabetes mellitus(CDM group).30 non-comary heart disease subjects with normal glucose tolerance were selected as the control group(CON group),and they underwent coronary CT angiography scan and were confirmed coronary disease-free.Blood pressure,body mass index(BMI),waist circumference(WC),waist hip ratio(WHR),fasting plasma glucose(FPG),blood lipid analysis,fasting insulin,and HbA1C were determined.Serum visfatin concentration was assayed and the status of coronary artery was assessed.Coronary artery stenosis was screened by coronary interventional angiography and assessed by Gemini scoring system in CHD,CIG,and CDM groups.Results Compared with control group,serum visfatin in CHD,CIG,and CDM groups were significantly higher(all P<0.05).Compared with CHD group,serum visfatin in CIG and CDM groups were significantly higher(all P<0.05).The correlation analysis showed that serum visfatin level was positively correlated with the involved branches of coronary arteries(r=0.807,P<0.01),serum visfatin level was positively related with Gensini coronary artery score(r=0.669,P<0.01).Visfatin was also positively correlated with WC,WHR,triglyceride(TG,r=0.200,P=0.032,r=0.185,P=0.047,r=0.321,P<0.01),while high density lipoprotein cholesterol(HDL-C)was negatively correlated with visfatin(r=-0.354,P<0.01).Multiple regression analysis showed that senlm hvel of TG and WC were the main influencing factors of visfatin.Conclusion (1)The level of serum visfatin may reflect the severity of coronary artery stenosis,detection of visfatin helps to make early diagnosis of CHD.(2)The raised serum level of visfatin in comary heart disease patients with imparied glucose tolerance is consistent with clinical evidence that diabetic patients have more severe coronary diseases.(3)WC and serum TG are main inilucencing factors,suggesting that visfatin is correlated with abdominal obesity.     

不同糖耐量冠心病患者血清内脂素水平与冠状动脉狭窄程度的关系

目的 比较血清内脂素(visfatin)在不同糖耐量水平冠心病患者和正常个体中的表达情况,评价血清内脂素水平与冠状动脉狭窄程度的关系.方法 经冠状动脉造影确诊冠心病患者85例,按1999年世界卫生组织糖尿病诊断标准分为冠心病正常糖耐量组(CHD)34例、冠心病合并糖调节异常组(CIG)25例、冠心病合并2型糖尿病组(CDM)26例,选择健康志愿者30名(冠状动脉CT血管造影阴性)作为正常对照组(CON).检测受试者人体测量学指标及糖、脂代谢指标;应用Gemini冠状动脉评分系统对冠状动脉狭窄程度进行评估;用SPSS 12.0统计软件包进行统计学分析.结果 与CON组比较,CHD、CIG及CDM组血清内脂素水平均显著增高(均P<0.05);与CHD组相比较,CIG和CDM组血清内脂素水平均显著增高(均P<0.05);内脂素水平与Gesini冠状动脉病变积分呈正相关(r=0.669,P<0.01);内脂素与腰围、腰臀比、甘油三酯呈正相关(r=0.200,P=0.032;r=0.185,P=0.047;r=0.321,P<0.01),与高密度脂蛋白胆固醇(HDL-C)呈负相关(r-0.354,P<0.01),多元回归分析显示,腰围、甘油三酯水平为影响内脂素水平的主要因素.结论 (1)血清内脂素水平较好地反映冠状动脉病变的严重程度,检测内脂素水平有助于冠心病的早期诊断.(2)在合并2型糖尿病及糖调节异常的冠心病患者中,血清内脂素表达显著增高,与临床糖尿病患者更重的冠状动脉病变相符合.(3)腰围、甘油三酯水平为影响血清内脂素水平的主要因素,提示内脂素水平与腹型肥胖密切相关.     

不同糖耐量冠心病患者血清内脂素水平与冠状动脉狭窄程度的关系

目的 比较血清内脂素(visfatin)在不同糖耐量水平冠心病患者和正常个体中的表达情况,评价血清内脂素水平与冠状动脉狭窄程度的关系.方法 经冠状动脉造影确诊冠心病患者85例,按1999年世界卫生组织糖尿病诊断标准分为冠心病正常糖耐量组(CHD)34例、冠心病合并糖调节异常组(CIG)25例、冠心病合并2型糖尿病组(CDM)26例,选择健康志愿者30名(冠状动脉CT血管造影阴性)作为正常对照组(CON).检测受试者人体测量学指标及糖、脂代谢指标;应用Gemini冠状动脉评分系统对冠状动脉狭窄程度进行评估;用SPSS 12.0统计软件包进行统计学分析.结果 与CON组比较,CHD、CIG及CDM组血清内脂素水平均显著增高(均P<0.05);与CHD组相比较,CIG和CDM组血清内脂素水平均显著增高(均P<0.05);内脂素水平与Gesini冠状动脉病变积分呈正相关(r=0.669,P<0.01);内脂素与腰围、腰臀比、甘油三酯呈正相关(r=0.200,P=0.032;r=0.185,P=0.047;r=0.321,P<0.01),与高密度脂蛋白胆固醇(HDL-C)呈负相关(r-0.354,P<0.01),多元回归分析显示,腰围、甘油三酯水平为影响内脂素水平的主要因素.结论 (1)血清内脂素水平较好地反映冠状动脉病变的严重程度,检测内脂素水平有助于冠心病的早期诊断.(2)在合并2型糖尿病及糖调节异常的冠心病患者中,血清内脂素表达显著增高,与临床糖尿病患者更重的冠状动脉病变相符合.(3)腰围、甘油三酯水平为影响血清内脂素水平的主要因素,提示内脂素水平与腹型肥胖密切相关.     

血清内脂素水平与慢性稳定性冠心病的关系

目的评价外周血清内脂素水平与慢性稳定性冠心病的相关性。方法 76例住院患者根据冠状动脉造影结果和临床表现分为慢性稳定性冠心病组(n=54)和非冠心病组(n=22)。用酶联免疫吸附法测定血清内脂素水平。比较两组临床资料及血清内脂素水平的差异。分析内脂素水平的影响因素。用Logistic回归模型分析血清内脂素水平与慢性稳定性冠心病的相关性。结果慢性稳定性冠心病组的血清内脂素水平的中位数为2.79μg/L(2.03μg/L,5.08μg/L),明显高于非冠心病组[2.54μg/L(1.48μg/L,2.97μg/L)](P=0.040)。多变量线性回归分析显示,慢性稳定性冠心病组血清内脂素水平受高敏C反应蛋白的影响(β=0.458,95%CI 0.065~0.308,P=0.004)。Logistic回归分析显示,血清内脂素水平是慢性稳定性冠心病的一个独立危险因素(OR 2.086,95%CI 1.046~4.160,P=0.037)。结论血清内脂素水平在慢性稳定性冠心病患者中明显升高,可能与该疾病的发生密切相关。     

Elevated serum lipoprotein(a) is significantly associated with angiographic progression of coronary artery disease

BackgroundLipoprotein(a)[Lp(a)] has been considered as an independent risk factor for coronary artery disease (CAD). The present study aimed to evaluate the association between baseline serum Lp(a) and CAD progression determined by angiographic score.MethodsA total of 814 patients who had undergone two or more coronary computed tomography angiography at least 6 months apart were consecutively enrolled and the coronary severity was determined by the Gensini score system. Patients were stratified into two groups according to Lp(a)>300 mg/L and Lp(a) ≤ 300 mg/L or classified as “progressors” and “non‐progressors” based on the Gensini score rate of change per year. The association of continuous Lp(a) and Lp(a)>300 mg/L with CAD progression were respectively assessed by logistic regression analysis. Moreover, further evaluation of those association was performed in subgroups of the study population.ResultsPatients in the “progressors” group had significant higher Lp(a) levels. Furthermore, the multivariate logistic regression analysis showed that elevated Lp(a) (odds ratio [OR]: 1.451, 95% confidence interval [CI]: 1.177–1.789, p<.001) and Lp(a)>300 mg/L (OR:1.642, 95% CI:1.018–2.649, p = .042) were positively associated with CAD progression after adjusting for confounding factors. In addition, those relation seemed to be more prominent in subjects with lower body mass index (OR: 1.880, 95% CI: 1.224–2.888, p for interaction = .060).ConclusionsElevated baseline serum Lp(a) is positively and independently associated with angiographic progression of CAD, particularly in participants with relatively low body mass index. Therefore, Lp(a) could be a potent risk factor for CAD progression, assisting in early risk stratification in cardiovascular patients.     

血清胃泌素与老年冠心病患者冠状动脉病变程度的相关分析

目的探讨血清胃泌素水平与老年冠心病(CHD)患者冠状动脉病变程度的相关性。方法入选2015年10月至2016年12月东南大学医学院附属盐城医院住院并行冠状动脉造影(CAG)的老年CHD患者104例,根据冠状动脉狭窄程度分为CHD组(n=82)和对照组(n=22)。CHD组患者根据病变血管数又分为单支病变组(n=42)、双支病变(n=27)和三支病变组(n=13),按照Gensini评分计算冠状动脉病变狭窄程度的总评分,酶联免疫吸附法测定空腹血清胃泌素(FG)及餐后1h血清胃泌素(PG1h)水平。计量资料用均数±标准差(±s)表示,两组比较采用t检验。计数资料用百分率表示,组间比较用χ~2检验。结果两组患者年龄、性别、吸烟、CHD家族史、消化道疾病、血肌酐(SCr)水平、质子泵抑制剂(PPIs)使用方面差异无统计学意义(P0.05)。CHD组患者体质量指数(BMI)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、FG、FG1h、及高血压和糖尿病患者例数高于对照组,差异有统计学意义(P0.05)。三支病变组患者PG1h、PG1h/FG和Gensini评分显著高于单支和双支病变组患者,差异具有统计学意义(P0.05)。Spearman相关分析结果表明,血清胃泌素与性别、BMI、吸烟、CHD家族史、TG、LDL-C无关,与年龄、消化道疾病、使用PPIs、高血压史、SCr、病变血管数和Gensini评分有关(P0.05)。偏相关分析校正混杂因素后,血清胃泌素水平与病变血管数(r=0.58)和Gensini评分(r=0.63)呈正相关。结论血清胃泌素水平与老年CHD患者冠状动脉病变程度呈正相关,提示血清胃泌素水平越高,越可能对老年冠状动脉粥样硬化的发生和发展存在潜在不利影响。     

腹部内脏脂肪厚度与冠状动脉狭窄关系的研究

目的探讨冠心病患者腹部内脏脂肪厚度(VFT)与冠状动脉狭窄的关系。方法选择2007年9月至2009年1月在广西医科大学第五临床医院行冠状动脉造影的216例患者,其中冠心病148例,记录身高、体重、腰围、血压等,检测血脂、空腹血糖、尿酸、肾功能等指标,对冠状动脉狭窄程度进行定量Gensi-ni积分,同时应用超声测量VFT,根据VFT值将患者分为低、中、高值3组。结果与低值组比较,中、高值组患者腰围、体重指数较大,高血压、糖尿病比例高(P<0.05),三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)明显增高,高密度脂蛋白胆固醇(HDL-C)显著降低。VFT与年龄、腰围、体质量指数、TG、LDL-C呈正相关,与HDL-C呈负相关。随着VFT值增加,Gensini积分明显增大。Logistic回归分析显示年龄、TG、低HDL-C、糖尿病和VFT是冠心病的独立危险因素,校正腰围后VFT的OR值有所减小,但差异仍有统计学意义。结论冠心病患者VFT与冠状动脉狭窄严重程度呈明显正相关,VFT测量可以作为冠心病患者危险评估的有用指标。     

高浓度血浆血小板衍生生长因子C对冠心病患者冠状动脉病变的影响

目的探究血浆血小板衍生生长因子C(PDGF-C)浓度变化与冠心病及冠状动脉病变程度的关系。方法选择行冠状动脉造影住院的急性冠状动脉综合征(ACS)患者52例、稳定型心绞痛(SAP)患者52例,以及造影结果正常的其他患者为对照组50例。冠心病(ACS和SAP)患者中冠状动脉多支病变者60例,双支病变者25例,单支病变者19例。酶联免疫吸附试验(ELISA)法测定各组患者血浆PDGF-C浓度。比较各组间血浆PDGF-C浓度水平,并进行Spearman相关性分析、Logistic回归分析及绘制ROC曲线。结果 ACS组及SAP组血浆PDGF-C浓度比对照组高(P0.05)。冠状动脉多支及双支病变组血浆PDGF-C浓度比单支病变组高(P0.05)。Spearman相关性分析发现,血浆PDGF-C浓度与Gensini评分有一定相关性(r=0.218,P0.05)。Logistic回归分析发现,高浓度血浆PDGF-C相比于低浓度血浆PDGF-C,患者发生冠心病的风险增加(OR=1.006, 95%CI 1.002～1.011)。血浆PDGF-C浓度的ROC曲线下面积为0.645,灵敏度为77.88%。结论高浓度血浆PDGF-C可能是冠心病发病的危险因素,与冠状动脉病变的严重程度可能存在一定的关联。     

急性心肌梗死患者TyG指数与冠状动脉病变严重程度的相关性

目的]探讨急性心肌梗死(AMI)患者甘油三酯-葡萄糖(TyG)指数与冠状动脉病变严重程度的相关性。 [方法]回顾性选择2020年1月─2023年3月期间就诊于新疆医科大学第四附属医院确诊为AMI的424名患者作为研究对象,收集临床资料及冠状动脉造影(CAG)结果,Gensini评分用以定量评估冠状动脉病变程度。根据Gensini评分三分位法分为低Gensini评分组(＜45分,n＝140)、中Gensini评分组(45～86分,n＝143)和高Gensini评分组(≥87分,n＝141)。采用单因素和多因素Logistic回归模型分析TyG指数与高Gensini评分冠状动脉病变发生的关系;采用Spearman相关分析法分析TyG指数与AMI患者Gensini评分之间的相关性;采用ROC曲线分析TyG指数对冠状动脉病变严重程度的预测价值。 [结果]高Gensini评分组TyG指数较低、中Gensini评分组明显升高(P＜0.05)。Logistic回归分析显示,TyG指数为AMI患者严重冠状动脉病变发生的独立危险因素(OR＝13.327,95%CI:2.642～67.235,P＝0.002)。Spearman相关分析显示,TyG指数与冠状动脉病变严重程度呈正相关(r＝0.331,P＜0.001)。ROC曲线分析显示,TyG指数的曲线下面积为0.680(95%CI:0.630～0.731,P＜0.001)。当TyG指数临界值取1.555时,其预测AMI患者发生严重冠状动脉病变风险的效能最高,灵敏度为79.4%,特异度为50.5%。 [结论]TyG作为一种新型生物标志物,与AMI患者冠状动脉病变的严重程度显著且独立相关。     

氧化型低密度脂蛋白和同型半胱氨酸与冠状动脉病变的相关性研究

目的 通过研究冠状动脉粥样硬化性心脏病（冠心病）患者血浆氧化型低密度脂蛋白（oxidized low-densitylipoprotein cholesterol,OX-LDL-C）和同型半胱氨酸（homoeysteine,HCY）浓度与Gensini评分的相关性,探讨其对冠状动脉病变严重程度的预测价值.方法 选择疑似冠心病患者86例,据冠状动脉造影结果分为冠心病组（67例）及对照组（19例）,冠心病组根据Gensini评分分为轻度亚组（23例）、中度亚组（22例）和重度亚组（22例）.分析各组血浆OX-LDL-C和HCY浓度与Gensini评分的相关性.结果 （1）冠心病组与对照组血浆OX-LDL-C、HCY浓度比较,冠心病组较高,差异有统计学意义（P＜0.05）.（2） Gensini评分三个亚组间血浆OX-LDL-C和HCY浓度比较,差异有统计学意义（P＜0.05）;随着冠状动脉狭窄程度加重,血浆OX-LDL-C、HCY浓度有增高趋势,差异有统计学意义（P＜0.05）.（3） Gensini评分与血浆OX-LDL-C（r=0.805,P＜0.01）、HCY （r=0.700,P＜0.01）浓度呈正相关,且OX-LDL-C与Gensini评分相关性较HCY高;血浆OX-LDL-C与HCY浓度呈正相关（r=0.698,P＜0.01）.结论 血浆OX-LDL-C和HCY浓度与Gensini评分有关,血浆OX-LDL-C与HCY具有相关一致性,联合检测血浆OX-LDL-C和HCY浓度可更好地了解病情、指导治疗及判断预后.     

Value of coronary artery calcium score to predict severity or complexity of coronary artery disease

Background

Prediction of severity or complexity of coronary artery disease (CAD) is valuable owing to increased risk for cardiovascular events. Although the association between total coronary artery calcium (CAC) score and severity of CAD, Gensini score was not used, it has been previously demonstrated. There is no information about the association between total CAC score and complexity of CAD.

Objectives

To investigate the association between severity or complexity of coronary artery disease (CAD) assessed by Gensini score and SYNTAX score (SS), respectively, and coronary artery calcium (CAC) score, which is a noninvasive method for CAD evaluation in symptomatic patients with accompanying significant CAD.

Methods

Two-hundred-fourteen patients were enrolled. Total CAC score was obtained before angiography. Severity and complexity of CAD was assessed by Gensini score and SS, respectively. Associations between clinical and angiographic parameters and total CAC score were analyzed.

Results

Median total CAC score was 192 (23.0-729.8), and this was positively correlated with both Gensini score (r: 0.299, p<0.001) and SS (r: 0.577, p<0.001). At multivariate analysis, it was independently associated with age (ß: 0.154, p: 0.027), male gender (ß: 0.126, p: 0.035) and SS (ß: 0.481, p< 0.001). Receiver-operating characteristic (ROC) curve analysis revealed a cut-off value > 809 for SS >32 (high SS tertile).

Conclusion

In symptomatic patients with accompanying significant CAD, total CAC score was independently associated with SS and patients with SS >32 may be detected through high Agatston score.     

Severity of coronary artery disease in obese patients undergoing coronary angiography: "obesity paradox" revisited

BACKGROUND: Recent studies have highlighted the existence of an 'obesity paradox' in patients undergoing coronary angiography, i.e., a high body mass Index (BMI) is associated with less severe coronary lesions. We sought to confirm the existence of this phenomenon in the US patient population. METHODS: Study subjects included 770 consecutive patients (470 men, 428 African-Americans, 212 Caucasians) referred for coronary angiography to a tertiary care center. Duke myocardial jeopardy score, a prognostication tool predictive of 1-year mortality in coronary artery disease (CAD) patients, was assigned to angiographic data. Patients were classified according to their BMI (kg/m2) as normal (21-24), overweight (25-29), obesity class I (30-34), class II (35-39) and class III (40 or above). RESULTS: Patients in the increasing obesity class had a higher prevalence of diabetes, hypertension and dyslipidemia and were more likely to be women. A negative correlation was observed between BMI and age (R = - 0.15 p < 0.001) as well as between BMI and Duke Jeopardy score (r = - 0.07, p < 0.05) indicating that patients with higher BMI were referred for coronary angiography at a younger age, and had a lower coronary artery disease (CAD) burden. BMI was not an independent predictor of coronary lesion severity on multivariate stepwise linear regression analysis. CONCLUSION: Obese patients are referred for coronary angiography at an earlier age and have a lower CAD burden lending further credence to the existence of an apparent "obesity paradox". However, obesity per se, after adjustment for comorbidities, is not an independent predictor of severity of coronary artery disease.     

冠心病患者腹部内脏脂肪厚度与冠状动脉狭窄程度的关系

目的探讨冠心病患者腹部内脏脂肪厚度（VFT）与冠状动脉狭窄程度的关系。方法对158例冠心病患者的冠状动脉狭窄（CAS）程度进行Gemini积分,应用超声测量VFT。结果与低值组比较,中、高值组患者腰围、体重指数、甘油三酯（TG）明显增高,高密度脂蛋白胆固醇（HDL-C）显著降低。随着VFT增加,Gensini积分明显增大。Gensini积分与年龄、腰围、体重指数、TG、低密度脂蛋白和胆固醇呈正相关,与HDL—C呈负相关。校正年龄、性别、腰围后,VFT仍然与Gensini积分相关,但进一步校正其他心血管危险因素后不再明显。结论VFT与冠状动脉狭窄程度关系密切。     

Association of thyroid autoimmunity with the presence and severity of coronary atherosclerosis in patients undergoing coronary angiography

Studies on the association of thyroid autoimmunity with cardiometabolic risk and coronary artery disease (CAD) have produced conflicting results. This study aimed to investigate the relationship of thyroid autoimmune bodies (thyroid peroxidase antibody [TPOAb] and thyroglobulin antibody [TgAb]) with CAD in euthyroid subjects undergoing coronary angiography.A total of 307 subjects who underwent coronary angiography were included. The severity of coronary atherosclerosis was evaluated by using Gensini score. Serum TSH, total T3, total T4, TPOAb, TgAb, lipid levels et al were measured and compared between the groups with and without CAD. Logistic multivariate regression analysis were performed to assess the associations. Levels of thyroid hormones were comparable between the two groups.The positive percentage of anti-Tg antibodies was higher in non-CAD group (15.22% vs 7.91%, χ² = 3.95, p = .047) while no significant difference was observed for anti-TPO antibodies (19.57% vs 17.21%, χ² = 0.243, p = .622). The natural log-transformed Gensini score (ln (Gensini score)) was lower in the TgAb+ group (2.94 ± 1.11 vs 2.41 ± 1.18, P = .015). There was no significant difference for ln (Gensini score) between TPOAb− and TPOAb+ group (2.90 ± 1.14 vs 2.85 ± 1.09, P = .782). Logistical regression analysis revealed that positive TgAb was inversely associated with the presence of CAD (OR: 0.387, 95% CI: 0.157–0.952, p = .039) independent of other risk factors.The results showed that TgAb positivity might be an independent protective factor for CAD.