冠状动脉微血管疾病评估技术新进展

冠状动脉微血管疾病(CMVD)与心血管疾病的不良预后密切相关,是近年来的研究热点。但由于冠脉造影术无法直接观察到冠状动脉微循环系统,CMVD的诊断通常是基于对微循环的功能评估,目前临床使用侵入性检测方式(例如:冠状动脉内多普勒导丝、微循环阻力指数等)跟非侵入性检测方式(正电子发射断层扫描、心脏核磁共振等)对微循环功能进行间接评估。各种检测方式在评估微循环功能方面具有不同的优势和局限。本文主要对CMVD近年来评估方式的研究进展进行综述,以期提高临床医务工作者对CMVD评估技术的认识。     

冠状动脉微循环侵入性检测方法研究进展

冠状动脉微循环功能障碍在梗阻和/或非梗阻性冠状动脉疾病以及心力衰竭的发病过程中起重要作用，且与长期的不良心血管事件密切相关。此外，在肥厚型心肌病、应激性心肌病和糖尿病心脏病等心血管疾病中，亦可发现冠状动脉微循环功能障碍存在。因此，冠状动脉微血管的功能评估十分重要，其有助于对患者进行风险分层。目前，评估冠状动脉微循环的侵入性及非侵入性技术众多，新的检测技术也不断出现。相比非侵入性技术，侵入性检测方法可提供更加及时和准确的信息。     

冠状动脉微循环侵入性诊疗用于急性ST段抬高型心肌梗死患者的研究进展

对梗死相关冠状动脉行早期直接经皮冠状动脉介入治疗（PPCI）是指南推荐治疗急性ST段抬高型心肌梗死（STEMI）的常规手段,可以有效减少心肌梗死面积并保留左心室收缩功能。尽管PPCI可以成功恢复心外膜冠状动脉血流,但仍有部分患者因微循环功能障碍无法实现最佳心肌灌注并影响远期预后。因此,及时评估STEMI患者微循环功能并采取相应治疗策略至关重要。本文针对冠状动脉微循环侵入性诊断技术及治疗策略用于STEMI患者的最新研究进展进行综述。     

急性胰腺炎中微循环障碍的特征

急性胰腺炎（acute pancreatitis，AP）是临床急症之一，病因较多，发病机制尚不明确。20世纪90年代以来，对AP中微循环障碍的研究越来越多，对胰腺生理和病理条件下微循环结构和功能的认识也不断深入。在AP的动物模型中可以观察到胰腺和胰腺外组织的微循环变化。大量实验证明，微循环障碍在AP发生、发展的过程中起着重要作用。改善微循环的治疗，可以减轻AP的病变程度。     

冠状动脉微循环障碍检测方法进展

冠状动脉再灌注后微循环障碍极大地影响着急性心肌梗死患者的预后。目前,临床上有多种检测微循环障碍的方法。心脏磁共振成像是非侵入性评估心肌微循环功能的金标准,但其在临床上的普及不及心肌声学造影。冠状动脉TIMI血流分级、校正TIMI计帧法(CTFC)、心肌灌注分级(TMPG)、心肌呈色分级(MBG)及TIMI心肌灌注帧数计算(TMPFC)能直接通过造影图像评估微循环功能。冠状动脉微循环阻力指数等技术方法利用特殊导丝对微循环功能进行检测。本文将对上述方法进行总结归纳,为临床工作者选择微循环障碍评估手段提供参考。     

如何理解感染性休克患者的微循环障碍

微循环功能障碍在感染性休克发病机制中发挥重要作用,且与全身循环状况并不平行。除传统的评估手段外, 近年来的技术进步使医生能够在床旁对感染性休克患者的微循环状态进行直接和间接的评估。手持视频显微镜能 够对微循环改变进行半定量评估。感染性休克的特征性微循环改变包括灌注毛细血管密度减少以及明显的灌注异 质性,且与临床预后相关。然而,微循环指导的血流动力学治疗能否使患者获益,尚有待临床研究证实。     

016 糖尿病人最大冠脉血流储备及代谢性冠脉血管扩张

０１６糖尿病人最大冠脉血流储备及代谢性冠脉血管扩张［英］／ＰｈｉｌｉｐＪ…／／Ｃｉｒｃｕｌａｔｉｏｎ。－１９９５，９１（３）．－６３５～６３９在临床及实验性糖尿病已报道了冠脉微循环的异常性不同于大血管动脉粥样硬化，本文旨在评估糖尿病人的冠脉微循环功能...     

心脏磁共振在冠状动脉微循环障碍评估中的应用进展

冠状动脉微循环障碍指冠状动脉微循环的结构或功能异常所导致的冠状动脉血流储备降低,其是未来发生不良心血管事件的强预测因子。冠脉微循环的结构、功能完整性对存活心肌的恢复和永久性损伤的防止具有重要的意义。心脏磁共振近来被认为是无创评估心肌微循环功能的金标准,其无辐射、无衰减,具有良好的空间分别率及动态追踪对比剂分布的特点,有很好的发展潜力。     

冠状动脉微循环障碍评估现状及进展

冠状动脉微血管功能障碍会导致不良心血管事件风险增加，准确识别冠状动脉微血管功能障碍对疾病干预和预后意义重大。随着有创和无创技术的发展，出现多种方法评估冠状动脉微循环，如核素显像、磁共振成像以及有创的冠状动脉微循环阻力指数，其中基于冠状动脉造影的微循环阻力指数受到了更多的关注。本文将对各种冠状动脉微循环评估方法的原理、准确性、预后研究、优势和局限性进行综述。     

心肌微循环障碍评估方法的研究进展

近年来冠心病发病率和死亡率呈逐年上升趋势，随着经皮冠状动脉介入治疗的普及和冠脉慢血流现象的认识，心肌微循环障碍日益受到临床医生的关注。目前评估心肌微循环障碍的方法主要有冠状动脉血流储备分数、心肌声学造影、心肌磁共振成像及冠脉微循环阻力指数（IMR）,但上述方法各有一定的局限性，部分指标特异性及敏感性有待于询证医学的进一步验证，本文对心肌微循环障碍的评估方法及研究进展做一综述。     

155例心脏病患者合并妊娠的临床观察

目的探讨和分析妊娠合并心脏病患者不同心功能状况对妊娠结局的影响。方法选取2011年10月-2013年10月我院妊娠合并心脏病患者155例为研究对象,对上述选取对象的临床资料进行分析和整理。结果本组155例妊娠合并心脏病患者,以先天性心脏病(56例,36.13%)、心律失常(75例,48.39%)、风湿性心脏病(8例,5.16%)较为常见,其中合并先天性心脏病患者心功能在Ⅰ-Ⅱ级、Ⅲ-Ⅳ级患者人数依次为48例和8例;合并心律不齐患者心功能均在Ⅰ-Ⅱ级;其中心脏功能在Ⅰ-Ⅱ级的患者其妊娠孕周明显长于心脏功能位于Ⅲ-Ⅳ级患者(P0.05)。结论心脏功能Ⅲ-Ⅳ级患者主要以先天性心脏病、妊娠期高血压性心脏病以及围生期心肌病为主,其中围产儿和医源性早产死亡率均明显增加。妊娠合并心脏病患者不同心功能状态对孕产妇及围产儿结局影响不同。     

Liver function in COVID-19 infection

Coronavirus disease 2019 (COVID-19) disease affects multiple organs, including anomalies in liver function. In this review we summarize the knowledge about liver injury found during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with special attention paid to possible mechanisms of liver damage and abnormalities in liver function tests allowing for the evaluation of the severity of liver disease. Abnormalities in liver function observed in COVID-19 disease are associated with the age and sex of patients, severity of liver injury, presence of comorbidity and pre-treatment. The method of antiviral treatment can also impact on liver function, which manifests as increasing values in liver function tests. Therefore, analysis of variations in liver function tests is necessary in evaluating the progression of liver injury to severe disease.     

Vascular disease and cognitive function in older men in the Caerphilly cohort

OBJECTIVES: Stroke can impair cognitive function, but the associations between other manifestations of vascular disease and cognitive function have not been adequately studied in representative population samples of subjects. We report the associations between cardiac and peripheral vascular disease and cognitive function for a large representative sample of men in Caerphilly, South Wales, UK. DESIGN: The Caerphilly cohort is the basis of on-going studies of vascular disease, of cognitive function and of predictors of these. We have made intensive attempts to identify all cases of vascular disease: myocardial infarction, angina, ECG ischaemia, peripheral vascular disease (intermittent claudication) and stroke. Here we present data on associations between vascular disease and cognitive function. SETTING: The study is based upon a representative population sample of over 1,500 men in South Wales, aged 55-69 years when cognitive function was measured. The men, and hospital and GP notes relating to them, had been repeatedly examined for evidence of vascular disease during the previous ten years. MAIN OUTCOME MEASURES: Standard tests of cognitive function: the AH4, CAMCOG, MMSE and choice reaction time. RESULTS: After the omission of men who had had a stroke, we detected significant associations between cognitive function and the presence of angina, ECG ischaemia, past myocardial infarction and intermittent claudication. The strength of the associations between cognitive function and the various manifestations of vascular disease were similar, and the various cognitive function tests showed effects of similar size. Overall, cardiac and peripheral vascular disease is associated with a significant reduction in cognitive function equivalent to about one sixth of the standard deviation of a number of tests of cognitive function. The size of this effect is roughly equivalent to the decline in cognitive performance over five years of ageing. CONCLUSIONS: Subjects with evidence of cardiac or peripheral vascular disease have on average a significant reduction in cognitive function equivalent to about four or five years of additional age. The effect of long-term, low-dose aspirin on cognitive decline should now be tested.     

冠心病病人免疫功能紊乱及中医药干预

冠心病(CHD)病人免疫机能常处于紊乱状态,表现为体液免疫功能亢进、细胞免疫功能低下、T细胞亚群比例失衡、补体系统处于活化状态等.临床药物干预对调整冠心病病人免疫功能有着积极作用,其中中医药的干预研究较多,临床症状、有效指标的显著改善表明了中医药对冠心病病人免疫功能的调整作用.     

The utility of the arthritis impact measurement scales for patients with psoriatic arthritis.

The Arthritis Impact Measurement Scales (AIMS) consists of 9 scales that measure physical function, pain and psychosocial function. It has been validated for use in various forms of arthritis, but not in psoriatic arthritis (PsA). The AIMS was administered to 145 patients attending our PsA clinic. We carried out simultaneous assessment of clinical measures of function, measures of disease activity, and measures of disease severity. Most scales of physical function were moderately to highly correlated with clinical measures of function (r = 0.33-0.57; p = 0.0001), measures of disease activity (r = 0.24-0.53, p = 0.003-0.0001), and measures of disease severity (r = 0.23-0.6; p = 0.02-0.0001). The pain scale was highly correlated with clinical measures of function and measures of disease activity (r = 0.38-0.58; p = 0.0001) but not with measures of disease severity. Of the psychosocial scales, the depression scale was moderately correlated with clinical measures of function (r = 0.27-0.3; p = 0.001-0.0001). Our data suggest that the physical function and pain scales are good indicators of overall function and disease activity and are valid for use in PsA.     

Studies on suppressor cell function in thyroid diseases.

Suppressor cell function of peripheral mononuclear cells has been examined in patients with Graves' disease, Hashimoto's thyroiditis, and thyroid cancer, as well as in healthy subjects. Suppressor cell function was assessed through two methods: 1) measurement of enhanced blastogenesis after 24-h preculture and 2) concanavalin A-inducible suppressor activity. The results from the two tests were coincident and indicate that suppressor cell function was significantly decreased in the Graves' disease population but not changed in either the Hashimoto's thyroiditis or the thyroid cancer groups compared to healthy controls. The impairment of suppressor cell function in the Graves' disease population was still observed when patients became euthyroid by treatment with antithyroid drugs, although the treated patients had improved suppressor cell function compared to untreated patients (P = NS). Low activity of suppressor cell function in the Graves' disease population might be a constitutional character based on an inherited abnormality specific for the disease population.     

高血压患者左室重构与心功能及心律失常关系

研究高血压患者左室重构对心律失常及心功能影响。方法应用多普勒超过心动图声学定量技术和动态心电图检测８７例高血压压患者。结论左室重构对高血压早期左室收缩功能有一定代偿作用,但随着心室重构、左室肥大,心脏功能损害更加明显,同时心室重构明显增加室性心律失常的发生。     

Echocardiographic measures of diastolic function in pediatric heart disease

PURPOSE OF REVIEW: The past year has seen a continued evolution in the echocardiographic assessment of diastolic function in children. This paper reviews published studies from the past year that have helped characterize diastolic function using echocardiography in children. RECENT FINDINGS: Characterization of diastolic function using Doppler and Doppler tissue imaging in the normal infant and child was a primary focus of pediatric echocardiographic investigation. These technologies appear to hold significant promise as tools to improve understanding of diastolic function in the normal child as the heart matures. Diastolic function in children with congenital heart disease has also been better characterized using these tools, specifically in patients with atrial septal defects, tetralogy of Fallot, single ventricle physiology, and following cardiac transplantation. Finally, diastolic function in acquired heart disease or with systemic disease in the child has been evaluated using echocardiography, with recent reports describing findings in children with dilated cardiomyopathy, chronic renal disease, obesity, type I diabetes, juvenile rheumatoid arthritis, obstructive sleep apnea, and after anthracycline exposure for childhood cancer. SUMMARY: Pediatric echocardiography has clearly become the primary tool for describing and characterizing diastolic function in infants and children both with and without heart disease. It is becoming an important noninvasive diastolic monitoring tool that allows serial assessment of pathologic diastolic disease in both primary myocardial and systemic disease states.     

Vascular disease and cognitive function: evidence from the Whitehall II Study

OBJECTIVES: : To test the hypothesis of an inverse association between indicators of vascular disease and cognitive function in the general, stroke-free population. DESIGN: : A longitudinal, British civil service-based cohort study. Measures of vascular disease examined were prevalent at baseline or traced over a median of 11 years, between Phases 1 (1985-1988) and 5 (1997-1999) of data collection. Cognitive function was assessed at Phase 5 of data collection. SETTING: : Twenty London-based Civil Service departments. PARTICIPANTS: : Four thousand one hundred forty-one men and 1,681 women, aged 46 to 68 when tested for cognitive function. MEASUREMENTS: : A battery of cognitive tests consisting of: memory test, Alice Heim 4, Mill-Hill, phonemic, and semantic fluency. RESULTS: : The occurrence of angina pectoris (P<.001), myocardial infarction (P=.02), all coronary heart disease (P<.001), and intermittent claudication (P=.004) was associated with poor cognitive function. These effects were independent of age and socioeconomic status. The association between indicators of vascular disease and cognitive function applied to the entire range of cognitive function measures examined in the study. CONCLUSION: : The findings support the view that vascular disease is predictive of poor cognitive function in the general population. The fact that presence of vascular disease was associated with diminished cognitive function even in a relatively young cohort has implications for the management of vascular disease.     

Genetic and environmental determinants of fibrin structure and function: relevance to clinical disease

The formation of a fibrin clot is one of the key events in atherothrombotic vascular disease. The structure of the fibrin clot and the genetic and environmental factors that modify it have effects on its biological function. Alterations in fibrin structure and function have implications for the clinical presentation of vascular disease. This review briefly describes the key features involved in the formation of a fibrin clot, its typical structure, and function. This is followed by a review of the current literature on genetic and environmental influences on fibrin structure/function and the relationship to clinical disease. The formation of a fibrin clot is one of the key events in atherothrombotic vascular disease. This review discusses how genetic and environmental factors alter fibrin structure and function and the implications this has for the clinical presentation of vascular disease.