急性冠状动脉综合征病变程度与血清骨保护素和脑钠尿肽水平有相关性

目的:探讨血清骨保护素(OPG)和脑钠尿肽(BNP)水平与急性冠状动脉综合征的关系。方法: 160例患者分为2组:急性冠脉综合征（ACS）90例,对照组70例;入院时检测血浆OPG和BNP水平并进行冠脉造影。根据造影结果将冠状动脉狭窄的数目分为1支,2支,3支病变组并分析其与冠脉病变Gensini评分的相关性。结果: 与对照组相比ACS患者OPG、BNP水平都较高,差异有统计学意义（P<0.01）,且随病变支数的增加显著升高。OPG与冠脉病变Gensini评分间存在显著的相关性(r=0.61,P<0.01);BNP与冠脉病变Gensini评分也有相关性(r=0.34,P<0.01)。多元回归分析发现OPG与BNP与冠心病发生独立相关（均P<0.01 ）。结论: 血清OPG、BNP水平的升高与ACS病变程度有关。     

急性冠脉综合征患者血清OPG、sRANKL、OPG/sRANKL比值与冠状动脉粥样硬化斑块稳定程度的相关性

目的:探讨急性冠脉综合征（ACS）患者血清骨保护素（osteoprotegerin,OPG）及其配体（souble-RANKL,sRANKL）和OPG/sRANKL比值与冠状动脉粥样硬化稳定程度的相关性。方法: 纳入研究者分成3组:ACS患者（335例）、稳定型心绞痛（SAP）患者（120例）与正常对照组（120例）。其中ACS组又分为不稳定心绞痛（UAP组）134例,非ST段抬高型心肌梗死（NSTEMI组）80例以及ST段抬高型心肌梗死（STEMI）组121例3组。通过ELISA检测其血清OPG和sRANKL水平,并将二者血清水平及比值（OPG/sRANKL）与ACS冠状动脉粥样硬化斑块稳定程度进行比较分析。结果: ACS、SAP及对照组3组间血清OPG、sRANKL、OPG/sRANKL比值均有显著差异（均P<0.01）。 ACS组内3组血清OPG、sRANKL、OPG/sRANKL比值也均有显著差异（均P<0.05）,其中STEMI组与UAP组有显著差异（P<0.05）,UAP组与NSTEMI组、NSTEMI与STEMI组间无显著差异。 冠脉Gensini积分与血清OPG水平呈正相关（r=0.252,P<0.01）,与OPG/sRANKL呈正相关（r=0.284,P<0.01）,与血清sRANKL水平呈负相关（r=-0.235,P<0.05）。结论: 血清OPG、sRANKL、OPG/sRANK比值与ACS病情及冠状动脉粥样硬化斑块稳定程度有关联。     

急性冠状动脉综合征患者血清脑钠肽、和肽素和高敏C反应蛋白水平观察

目的:探讨急性冠脉综合征(ACS)患者脑钠肽(BNP)、和肽素和高敏C反应蛋白(hs-CRP)水平变化与疾病的相关性、危险程度与预后的关系。方法:选取近1年我院心内科以诊断为ACS而收入院患者86例,按随机数字表将患者分为2组,其中急性心肌梗死(AMI)41例为实验组,不稳定型心绞痛45例为对照组;另42例健康成人作为正常组,对3组患者的血浆BNP、和肽素以及血清hs-CRP水平进行检测,分析BNP、和肽素及hs-CRP水平与冠状动脉病变支数、冠状动脉Gensini评分以及左主干病变之间的关系。结果:3组患者BNP,和肽素,hs-CRP数据比较,差异具有显著性(P0.01);ACS患者BNP及和肽素水平,hs-CRP水平与冠状动脉病变支数、Gensini评分、左主干病变具有显著正相关(P0.05)。结论:ACS患者BNP、和肽素和hs-CRP显著升高,其表达水平与冠状动脉病变程度具有相关性。     

超质量和肥胖急性冠状动脉综合征患者超敏C-反应蛋白水平与冠状动脉Gensini积分的关系

目的:分析超质量和肥胖急性冠状动脉综合征(ACS)患者超敏C反应蛋白(hs-CRP)水平与冠状动脉病变复杂程度之间的关系。方法:入选2012年1月至2012年12月,于北京安贞医院行冠状动脉造影并确诊为ACS的患者304例,根据体质量指数(BMI)分为肥胖ACS组[BMI≥27(kg/m2)]84例、超质量ACS组[24≤BMI27/(kg/m2)]133例,正常体质量ACS对照组[18.5≤BMI24/(kg/m2)]87例。根据造影结果,按狭窄病变血管数分为单支病变及多支病变(2支病变以上);采用Gensini积分方法对冠状动脉狭窄程度进行定量评分,检测hs-CRP水平,分析hs-CRP与Gensini积分之间关系。结果:超质量和肥胖ACS患者hs-CRP水平显著高于对照组,超质量和肥胖ACS患者冠状动脉多支血管病变者较多,发生ACS的年龄较早;超质量和肥胖ACS患者hs-CRP水平与Gensini积分之间成显著正相关。结论:与正常体质量ACS患者相比,超质量及肥胖ACS患者的hs-CRP水平较高;血清hs-CRP水平与Gensini积分正相关,hs-CRP对于预测超质量和肥胖ACS患者冠状动脉病变复杂程度有一定价值,超质量及肥胖者应加强冠心病的一级预防。     

急性冠状动脉综合征患者P-选择素水平与冠状动脉病变的关系

目的探讨急性冠状动脉综合征(ACS)患者可溶性P-选择素(sP-选择素)水平及其与冠状动脉病变的关系。方法应用酶联免疫吸附法检测54例ACS患者(ACS组)、15例稳定性心绞痛患者(SA组)和19例冠状动脉造影正常者(对照组)血浆sP-选择素水平,对冠状动脉粥样硬化病变程度按照病变支数、Gensini评分和美国心脏病学会和美国心脏病协会A、B、C型分型进行评估。结果ACS组sP-选择素水平高于SA组和对照组(P<0.01);sP-选择素水平与冠状动脉病变数量,Gensini评分,A、B、C型冠状动脉病变程度均为正相关。结论ACS患者P-选择素水平明显升高,提示P-选择素是ACS临床识别和预测的炎症指标;P-选择素水平受冠状动脉粥样硬化程度的影响。     

血清缺血修饰白蛋白和同型半胱氨酸对冠心病临床诊断价值及与造影结果的相关性

目的探讨血清缺血修饰白蛋白(IMA)和同型半胱氨酸(Hcy)对冠心病(CHD)患者的诊断价值及与冠状动脉造影的相关性。方法选择2015年4月至2017年9月收治的CHD患者300例,另外选择同期健康志愿者60例作为对照组。比较血清IMA和Hcy水平在不同疾病类型、不同冠状动脉病变支数及不同冠脉狭窄程度CHD患者中的差异,同时对比冠状动脉造影参数的差异,分析CHD患者血清IMA和Hcy水平与冠状动脉造影参数的相关性。结果 CHD患者血清IMA和Hcy水平均明显高于对照组(P<0.05);随着疾病程度的加重、冠状动脉病变支数及冠脉狭窄程度的增加,IMA和Hcy水平均明显升高(P<0.05);疾病程度越重,冠状动脉病变支数及Gensini评分均明显升高(P<0.05);冠状动脉狭窄率越高,冠状动脉病变支数显著增加(P<0.05);CHD患者血清IMA和Hcy水平与冠状动脉病变支数和Gensini评分均呈正相关(P<0.05)。结论 CHD患者血清IMA和Hcy能够反映CHD的发生及发展过程,同时与冠状动脉造影参数密切相关。     

血清同型半胱氨酸、高敏C反应蛋白水平与冠心病的关系

目的探讨血清同型半胱氨酸(HCY)、高敏C反应蛋白(hs-CRP)水平与冠心病(CHD)患者病情严重性和冠状动脉病变支数的关系。方法选取疑似或已确诊CHD接受冠脉造影的197例患者,其中急性心肌梗死(AMI)51例、不稳定型心绞痛(UA)56例、稳定型心绞痛(SA)40例、非冠心病(NCHD)50例。采用循环酶法测定HCY,乳胶增强免疫比浊定量法测定hs-CRP水平。结果SA组、UA组、AMI组HCY及hs-CRP水平均高于NCHD组(P<0.0 1);UA组、AMI组HCY水平高于SA组(P<0.01);hs-CRP水平AMI组>UA组>SA组(P<0.01);随着冠状动脉病变的发展,单支病变、双支病变到三支病变,HCY、hs-CRP的水平也随之升高(P<0.05),且二者与冠脉病变支数相关(r分别为0.498、0.679,P<0.01);CHD患者血清HCY与hs-CRP呈正相关(r=0.880,P<0.01)。结论血清HCY和hs-CRP水平与CHD病情严重性及冠脉病变支数相关,HCY与hs-CRP具有相关性。联合检测血清HCY和hs-CRP水平,可更好地了解病情、指导治疗及判断预后。     

红细胞分布宽度联合超敏-C反应蛋白在急性冠脉综合征中的临床价值陶波,蒋学俊,方钊,刘浙波,王建铭,鲁明

【】目的 观察急性冠脉综合症患者红细胞分布宽度、超敏-CRP的变化,分析与冠脉病变的关系,并探讨RDW与hs-CRP的关系。方法 选取在我院住院的ACS患者,按冠状动脉造影的病变支数分为单支病变组、双支病变组及三支病变组,同期收集冠脉正常的为对照组,比较两组患者主要临床资料,应用改良Gensini积分评估冠脉病变程度,分析RDW、hs-CRP与Gensini积分的关系,及RDW与hs-CRP的关系。结果①与对照组相比,ACS患者的RDW、hs-CRP明显升高,具有统计学差异(F=31.39,P<0.01;F=38.52, P<0.01);②RDW和hs-CRP水平随着冠脉病变支数增加而增加;③冠状动脉病变程度多元logistic回归分析示,hs-CRP (OR=2.265,95%CI:1.817-3.621,P<0.01)、RDW与冠脉病变程度独立相关(OR=1.988,95%CI:1.162-3.399,P=0.012);④ACS患者hs-CRP、RDW与Gensini积分呈显著正相关(r=0.785,P<0.001;r=0.69,P<0.01); RDW与hs-CRP呈显著的正相关(r=0.659,P<0.01)。结论 RDW与hs-CRP可作为急性冠脉综合征冠脉病变程度的独立预测因素。     

心型脂肪酸结合蛋白、肌钙蛋白I与急性冠脉综合征冠状动脉病变程度的相关分析

目的探讨心型脂肪酸结合蛋白(H-FABP)、肌钙蛋白I(cTnI)与近期发作急性冠脉综合征(ACS)的患者冠状动脉病变严重程度的相关性及原因分析。方法ACS患者于发作12h内入院,1周内行冠脉造影者98例入选,其中急性心肌梗死(AMI)21例、不稳定型心绞痛(UAP)77例。采用双抗体夹心ELISA法定量测量待测血清H-FABP、cTnI;根据美国心脏病协会所规定的冠状动脉血管图像记分分段评价标准,对病变狭窄程度进行分度、累及血管支数计算,采用Gensini积分系统,对冠脉血管病变狭窄程度、病变部位、范围进行定量评定;用卡方检验分析血H-FABP、cTnI与狭窄程度、病变支数的相关性;采用二元回归分析方法分析血清H-FABP、cTnI与患者冠状动脉病变严重程度的相关性。结果H-FABP≥8.0mg/L组与H-FABP<8.0mg/L组冠状动脉狭窄程度、累及支数及Gensini积分有明显差异(P<0.01);cTnI≥1.0mg/L组与cTnI<1.0mg/L组冠状动脉狭窄程度、累及支数及Gensini积分有明显差异(P<0.01);血清H-FABP、cTnI与患者冠状动脉病变严重程度的二元线性回归方程:Y=15.664 2.833x1 1.034x2(Y为Gensini积分,x1血中H-FABP浓度,x2为cTnI浓度);标准回归系数r为0.518和0.253(P<0.01)。结论H-FABP、cTnI与近期发作ACS的患者冠状动脉病变严重程度呈正相关,H-FABP与冠脉病变程度相关程度更高。血清H-FABP、cTnI升高是冠状动脉病变急性加重的直接结果,临床可根据血清H-FABP升高推断冠脉病变的危险度并采取积极的治疗措施。     

冠状动脉病变与胰岛素抵抗、高敏C反应蛋白的关系

目的:探讨冠心病患者胰岛素抵抗与高敏C反应蛋白(hs-CRP)及冠状动脉严重程度间的关系。方法:连续收集冠状动脉造影证实至少有1支血管狭窄≥50%的92例患者作为研究对象,按临床表现分为稳定型心绞痛(SA)41例和急性冠状动脉综合征(ACS)51例,按冠状动脉病变程度分为单支病变组35例、双支病变组28例及3支以上病变组29例。分别测定其空腹血糖、血浆胰岛素、hs-CRP、冠状动脉Genisini评分,用自我平衡模式分析法(HOMA-IRI)作为评价胰岛素抵抗程度的指标。分析胰岛素抵抗、hs-CRP、冠状动脉病变3者间的关系。结果:①SA组与ACS组:hs-CRP(3.34±3.91∶18.39±15.93)、胰岛素抵抗指数(IRI)(1.57±0.96∶3.09±1.64)、Genisini评分(35.31±28.32∶64.74±32.83)差异均有统计学意义(均P<0.01)。②单支病变组与双支、≥3支病变组比较:hs-CRP差异无统计学意义,P>0.05;IRI(2.04±1.17∶2.28±1.64∶3.61±1.53)差异有统计学意义,P<0.05;进一步两两比较后,单支病变组与≥3支病变组的hs-CRP(8.68±11.08∶18.24±18.30)差异有统计学意义,P<0.05。③Gensini评分与IRI、hs-CRP呈正相关(r=0.508,P<0.01;r=0.489,P<0.01),hs-CRP与IRI亦呈正相关(r=0.536,P<0.01)。结论:胰岛素抵抗、hs-CRP与冠状动脉病变程度呈正相关。     

Complications of cardiac catheterization, coronary angiography, and coronary interventions

Cardiac catheterization and coronary angiography have evolved, especially after the advent of percutaneous coronary interventions. Although older patients with more advanced disease are being studied, the overall rate of complications has not dramatically increased and the spectrum of complications has somewhat changed to select the more acute nature of the procedures performed. Careful prophylactic measures such as anticoagulation, ischemia prevention, blood pressure control, hydration as well as the availability of defibrillation and pharmacologic and mechanical means of circulatory support have helped minimize these complications and improve outcome.     

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.     

Alcohol consumption, coronary calcium, and coronary heart disease events.

This study was performed to determine if alcohol intake was associated with reduced coronary risk in a high-risk asymptomatic population, and whether this effect was independent of coronary risk factors and coronary calcium. In 1,196 asymptomatic subjects with coronary risk factors, we assessed alcohol consumption history, performed risk factor measurements, and quantified coronary calcium with electron beam computed tomography. These subjects were then followed for a mean of 41 months, and coronary events (myocardial infarction or coronary death) were noted. Significant inverse predictors of coronary events included alcohol use and serum high-density lipoprotein cholesterol level. Direct predictors of events were history of systemic hypertension, smoking, diabetes mellitus, serum cholesterol, and coronary calcium score. Subjects with coronary calcium were 3.1 times more likely to suffer a coronary event than those without calcium (95% confidence interval [CI] limits 1.3 to 7.2). Subjects who drank alcohol had a relative risk of 0.3 (95% CI limits 0.2 to 0.6) for developing coronary events. After controlling for age, gender, and other risk factors with logistic regression, these differences in relative risk persisted (relative risk 0.58; 95% CI limits 0.41 to 0.82). Alcohol consumption is a significant inverse predictor of coronary events, comparable in magnitude to standard risk factors and to radiographically measured coronary calcium. This effect is independent of coronary risk factors and coronary calcium.     

Vascular injury following cardiac catheterization, coronary angiography, and coronary angioplasty

All vascular injuries occurring at this hospital departmentover a 5-year period (1987–91) as a result of cardiaccatheterization, coronary angiography, or coronary angioplasty(PTCA) and requiring transfusion, surgical consultation, orrepair, are reviewed. Such complications may occur late and,to detect cases not apparent from the protocol accompanyingevery examination, a questionnaire was sent to all surgicalclinics in the region asking for details of vascular surgicalintervention after angiography. The present review of 4879 examinationsdisclosed 18 patients with 19 vascular injuries (0·39%),four of them were detected by the questionnaire. The types ofinjury were: pseudoaneurysm (12), thrombembolic episode (4),and excessive bleeding (3). Of the patients with a vascularcomplication 11 (61%) were receiving anticoagulation treatment,compared to 10% n the whole series; two others suffered froma coagulopathic state. Catheterization was difficult or severeatherosclerosis was present in three, inadvertent mobilizationoccurred in one, and unintentional puncture distal to the commonfemoral artery occurred in two patients. With the increasinguse of invasive diagnostic and interventional procedures incardiovascular diseases, knowledge of the type and frequencyof possible complications is important, especially of thosethat may occur late. In the present study anticoagulation, coagulationdisorders, and cardiac catheterization combined with brachialpuncture and angiography all predisposed to a vascular complication.     

Complex coronary angioplasty in patients with prior coronary artery bypass surgery, in situations utilizing multiple coronary angioplasties, and in coronary occlusions

Coronary artery bypass surgery not only provides symptomatic relief but also may prolong life in a significant percentage of patients. Repeat bypass surgery succeeds in providing symptomatic relief in a lesser number of patients, but it is associated with a higher morbidity and mortality than primary operations. Angioplasty, an interventional, therapeutic catheter technique, is applicable to a large number of patients who have undergone bypass surgery and who are sufficiently symptomatic to require consideration of another revascularization procedure. The gratifying results of successful lesion dilatation coupled with clinical improvement of the patient, the acceptable mortality and morbidity statistics, and the long-term symptomatic relief are comparable to those for repeat coronary bypass graft surgery. In addition, technologic advances in angioplasty equipment, as well as more knowledgeable interventionists, will enable more lesions to be successfully reached, traversed, and dilated with, it is hoped, a lower morbidity and mortality. We would estimate that 30 to 50 per cent of those patients requiring repeat revascularization operations today can undergo an angioplasty procedure with at least comparable clinical results and better morbidity and mortality statistics than those achieved with repeat bypass surgery. Selected patients underwent transluminal coronary angioplasty of varying combinations of arterial and/or vein graft stenoses. A multiple dilatation procedure was defined as successful when dilatation was achieved in all lesions in which it was attempted or when the considered-critical stenosis was dilated successfully and the patient was clinically improved. Angioplasty was successful in 93 per cent of all lesions in which it was attempted, and these successful dilatations produced a clinical improvement in 92 per cent of the patients. No complication whatsoever was experienced in 81 per cent of cases. The complications encountered included a 1.3 per cent mortality rate, a myocardial infarction rate of 6.9 per cent (3.0 per cent per lesion attempted), and an emergency surgery rate of 2.6 per cent (1.1 per cent per lesion attempted). Follow-up data show that a sustained clinical improvement was obtained in 96.8 per cent of the patients in whom the procedure was successful (with or without a repeat angioplasty). These data indicate that multiple coronary angioplasties can be performed during the same procedure, that clinical improvement can be achieved, and that the complication rate is acceptable.(ABSTRACT TRUNCATED AT 400 WORDS)     

Biomarkers, age, and coronary artery remodeling in patients with acute coronary syndrome

To investigate the relationship between age and coronary artery remodeling in patients with acute coronary syndrome (ACS), 56 patients with ACS were identified by intravascular ultrasound (IVUS). Remodeling index (RI) (37 cases of RI > or =1 vs 19 cases of RI <1) and dimidiate age groups (27 patients younger than 60 years vs 29 patients 60 years or older) were compared, and the relationships among biomarkers, age, and arterial remodeling were analyzed. There was a significant difference in age between positive and negative remodeling groups (55+/-13 vs 62+/-10 years; P=.038); RI and triglyceride level showed a statistical correlation (r=0.32; P=.02) and a significant inverse correlation between age and RI (r=-0.47; P<.001). The multivariable linear regression analysis demonstrated that age was an independent predictor of RI (Bate -0.37; 95% confidence interval, 0.93-1.08; P=.04). Age may be an important factor of arterial remodeling. Low-density lipoprotein or triglyceride level may be associated with attenuated coronary vascular remodeling with aging.     

Incidence, management, and outcome of coronary artery perforation during percutaneous coronary intervention

We have analyzed the incidence, management, and outcome of 84 cases of coronary artery perforation in patients who underwent percutaneous coronary intervention at our institution. This complication was more frequent in female patients and in patients who underwent lesion modification with atheroablative devices. A total of 8 patients (9.5%) died after the procedure. They were usually older and had a higher incidence of cardiac tamponade; a larger percentage of these patients underwent emergency surgery than those who survived.