不稳定性心绞痛的临床特点和冠状动脉造影结果分析

对８２例不稳定性心绞痛患者进行回顾性研究。结果表明：该病多见于老年男性（占８６．６％）。高血压、高胆固醇血症、糖尿病、吸烟、饮酒史、冠心病家族史和高血压（或）脑血管病家族史均是其危险因素，分别占６３．４％、３６．６％、２２．０％、８２．９％、３４．１％、３４．１％和７０．７％。冠状动脉造影病变部位最多见于前降支（占８４．１％）。其次为右冠脉（占４８．８％），左旋支（占３２．９％），左冠脉主干（占６．１％），其中Ⅲ—Ⅴ级病变占７６．６％，７７．３％为偏心性狭窄。初发劳力型心绞痛８５．７％为单支病变，自发型心绞痛５０％为Ⅰ－Ⅱ级病变，且有４例冠脉造影结果大致正常，９６．３％的恶化劳力型心绞痛，８４．６％的梗塞后心绞痛为多支病变。９例有室壁瘤形成，既往均有心肌梗塞病史。     

45岁以下不稳定性心绞痛与非ST段抬高心肌梗死患者冠状动脉造影与临床特征

目的　了解年龄≤ 45岁不稳定心绞痛 (UA)或非ST段抬高心肌梗死 (NSTEMI)住院患者的冠状动脉造影和临床特征。方法　SUNDAY注册研究为单中心回顾性登记研究 ,选择首次因UA/NSTEMI在我院住院的患者 ,按年龄分为≤ 45岁和 >45岁组 ,分析其冠状动脉造影 (CAG)和临床特征。结果　共入选 10 13例患者 ,其中≤ 45岁的患者 72例 ( 7.1% )。年龄≤ 45岁组男性更多( 93 .1%与 68.7% ,P <0 .0 0 1) ,吸烟比例较高 ( 5 9.7%与 3 6.7% ,P <0 .0 0 1) ,而高密度脂蛋白胆固醇(HDL C)较低 ( 3 7.0 4± 7.80mmol/L与 40 .48± 9.3 5mmol/L ,P <0 .0 1) ,高血压 ( 3 6.1%与 65 .4% ,P <0 .0 0 1)、糖尿病 ( 9.7%与 2 1.3 % ,P <0 .0 1)和缺血性卒中 ( 0 %与 9.1% ,P <0 .0 1)病史少。年龄≤ 45岁的患者单支病变更多 ( 4 4.8%与 2 8.4% ,P <0 .0 1)。结论　年龄≤ 45岁UA/NSTEMI的住院患者中男性和单支病变更多 ,吸烟比率更高 ,HDL C更低     

不稳定性心绞痛的冠脉造影

不稳定性心绞痛（ＵＡ）是介于稳定性心绞痛与心肌梗死（ＭＩ）之间的一组急性心肌缺血综合征。由于ＵＡ有向ＭＩ转化的倾向,故曾有多个术语描述此综合征,如：梗塞前心绞痛、急性冠脉不全、中间冠脉综合征和即将发生的冠脉阻塞等。近期发作的ＵＡ病人中,自诊断后１月内...     

不稳定性心绞痛临床与冠状动脉造影分析

为了解不同类型不稳定性心绞痛的冠状动脉（冠脉）造影特点，对３８８例不稳定性心绞痛患者进行临床及冠脉造影对照分析。结果表明：初发劳力型心绞痛单支血管病变占６９．６４％，较其他各型多见（Ｐ＜０．０５）；静息型心绞痛三支血管病变和左主干病变较其他各型多见（Ｐ＜０．０５），复杂性病变和Ｃ型病变检出率也较其他各型高（Ｐ＜０．０５）；恶化劳力型心绞痛病变特征介于上述二者之间；梗塞后早期心绞痛“罪犯”病变多为次全闭塞或完全闭塞，较其他各型多见（Ｐ＜０．０５）；变异型心绞痛多半仅有轻度冠脉狭窄；梗塞后早期心绞痛血栓比初发、恶化型多见（Ｐ＜０．０５）。提示静息时心绞痛发作者病变更严重，应予积极治疗，对梗塞后早期心绞痛患者应加强抗凝治疗。     

95例拟诊冠心病心绞痛患者冠状动脉造影分析

目的:总结95例临床拟诊冠心病心绞痛患者的冠状动脉造影结果,分析其临床症状及其心电图ST-T改变与冠状动脉造影确诊冠心病的相关性。方法:从发作性胸痛、胸闷为主诉或伴心电图ST-T改变的患者中,筛选出符合或疑似心绞痛,并经心脏超声、胸片检查排除了其他心脏病患者95例,其中典型心绞痛36例;疑似心绞痛的非典型胸痛59例;伴有ST-T改变者87例(缺血型改变25例、非特异性改变62例)。分别接受选择性冠状动脉造影。血管内径狭窄≥50%为造影阳性,诊断冠心病的依据。结果:95例患者造影阳性的45例,其中36例典型心绞痛造影者阳性34例(伴ST-T典型缺血型改变23例、非特异性改变者10例、无改者1例),阳性率94.44%;59例非典型胸痛造影阳性11例(伴非特异性ST-T改变),阳性率18.64%。两组阳性率有显著差异(P<0.01)。结论:典型心绞痛患者冠脉造影诊断冠心病相关性高,非典型胸痛或心电图非特异性ST-T改变患者冠脉造影诊断冠心病阳性率低。     

不稳定性心绞痛病人冠状动脉造影病变特点

不稳定性心绞痛 (ＵＡＰ)病人临床不稳定性的主要决定因素是病变的形态 (所谓不稳定病变 ) ,而非病变狭窄程度及范围。本研究主要比较ＵＡＰ与稳定性心绞痛 (ＳＡＰ)病人的冠状动脉造影 ,并观察ＵＡＰ的造影病变特点。1　资料与方法冠状动脉造影异常 (血管直径狭窄≥ 5 0 %)的心绞痛病人 176例 ,其中 14例因难以确定缺血相关病变被剔除 ,能确定缺血相关病变的ＵＡＰ病人 12 0例及ＳＡＰ病人 42例入选。ＵＡＰ组男 84例 ,女 36例 ,年龄 45～ 6 8岁 ,平均 (6 1± 8)岁 ;ＳＡＰ组男 31例 ,女 11例 ,年龄 42～ 72岁 ,平均 (6 0± 12 )岁。所有病…     

不稳定性心绞痛冠状动脉造影病变与临床的相关性

目的：分析不稳定性心绞痛（UA）临床表现,心电图与冠状动脉（冠脉）造影病变形态的关系。确定不稳定性病变及住心院心脏事件的临床预测因子,方法：选择冠脉造影异常（血管狭窄≥50％）的住院UA病人120例,观察不同Braunwald分级病人造影病变形态等的发生率,评估心电图ST段异常对复杂病变、住院心脏事件等的预测价值。结果：复杂病变的检出率Ⅲ级（20／33例）最高,较Ⅰ级（13／43例）差异有显著性（P＜0．05）,血栓的检出率Ⅲ级（6／33例）亦高于Ⅰ、Ⅱ级,与Ⅱ级（1／44例,2％）比较差异有显著性（P＜0．05）。住院心脏事件发生率Ⅲ级明显高于Ⅰ级（58％与195,P＜0．01）与Ⅱ级（58％与25％,P＜0．01）。Logistic回归分析示,心电图ST段异常及BraunwaldⅢ级均能预测复杂病变的存在（P＜0．01,OR为4．9;P＜0．01,OR为3．3）,心电图异常能预测三支病变（P＜0．01,OR为3．9）和心脏事件（P＜0．01,OR为4．8）。结论心电图ST段异常及48h内发作的静息心绞痛对复杂病变有预测价值。ST段异常的病人,三支血管病及发生心脏事件的危险性高。     

不稳定性心绞痛的最新治疗策略

近年来提出的不稳定性心绞痛的最新治疗策略分为三个阶段，即通过对病人最初估测，观察对治疗的反应和心脏功能检查，以决定进一步治疗方案和估计病人预后，进而提高对不稳定性心绞痛病人治疗水平。     

不稳定性心绞痛患者冠状动脉内超声成像的研究

不稳定性心绞痛患者冠状动脉内超声成像的研究樊朝美高润霖黄云洲杨跃进刘延玲乔树宾陈纪林程克正孟宪强刘汉英陶寿淇本研究利用冠状动脉内超声成像（ＩＣＵＳ）技术观察了６例不稳定性心绞痛患者的病变冠状动脉管壁结构及形态学变化，目的在于进一步探讨ＩＣＵＳ技术在不...     

不稳定性心绞痛冠状动脉病变与患者临床表现的相关性

４８例不稳定性心绞痛（ＵＰＡ）患者冠状动脉造影显示７４处有意义的冠状动脉狭窄（直径＜５０％），以前降支病变最常见。ＵＰＡ患者绝大多数（４５／４８、９３．７％）有明显冠状动脉病变，随年龄增长冠状动脉病变有增多趋势，３支病变的冠心病病程明显长于单支病变（Ｐ＜０．０５）。初发型劳累性心绞痛多数为单支病变，自发性心绞痛与恶化型劳累性心绞痛以单支、双支病变为多，混合型心绞痛以双支或３支病变为多。ＵＡ可发生冠状动脉闭塞。     

不稳定型心绞痛患者心电图T波变化的临床意义

目的　探讨不稳定型心绞痛 (UA)患者心电图T波变化的临床意义。方法　分析2 0 3例冠状动脉造影阳性的UA患者 ,其心电图T波、ST段有异常改变 ,并分析其与临床危险分层及冠状动脉病变的关系。结果　心电图出现T波异常≥ 2个导联者 173例 ( 85 .2 %) ,而T波异常≥ 6个导联在多支病变组为 73 .9%,显著高于单支病变组 2 0 .5 %;显著T波倒置在UA高危组为65 .9%,明显多于低中危组 8.3 %;T波异常伴ST段压低在UA高危组为 80 .8%,明显多于低中危组 10 .2 %。T波异常的导联数同冠状动脉病变程度有明显相关性 (r =0 .874,P <0 .0 1)。结论　对UA患者T波异常进行定量分析将有助于病情评价及危险分层     

不稳定型心绞痛患者凝血纤溶活性及冠状动脉斑块形态的关系及其临床意义

目的探讨不稳定性心绞痛患者不同形态斑块的稳定性及对疾病转归的预测价值。方法85例不稳定性心绞痛患者根据冠状动脉造影结果分为Ⅰ型病变组（21例）、Ⅱ型病变组（45例）、Ⅲ型病变组（19例），40例冠状动脉造影排除冠心病者为对照组，均测定血浆Ⅶ因子凝血活性及组织型纤溶酶原激活物、纤溶酶原激活物抑制物、纤维蛋白原和D二聚体值；其中56例不稳定型心绞痛患者随诊一年，观测预后。结果不稳定性心绞痛患者血浆凝血纤溶因子较正常对照组明显异常，其中Ⅱ型病变组Ⅶ因子凝血活性、纤维蛋白原、纤溶酶原激活物抑制物较其他两组明显升高、组织型纤溶酶原激活物有所下降（P〈0．05）；D二聚体改变无显著性（P〉0．05）。一年内急性心肌梗塞和心源性猝死的发生率亦明显高于其它两型（P〈0.01）。结论冠状动脉造影不同形态斑块凝血纤溶活性明显不同，可以作为判断不稳定型心绞痛斑块稳定性及疾病转归的重要手段。     

Comparison of Results of Coronary Angioplasty in Patients with Unstable vs. Stable Angina

Objectives To compare the short and mid - term outcomes in cases of percutaneous transluminal coronary angioplasty (PTCA) in patients with unstable v stable angina. Methods Patients selected for PTCA/stenting were divided in to two groups, one with stable angina pectoris (SA group, n = 92) and one with unstable angina pectoris (UA group, n = 112). The outcomes of coronary an giographies (CAG), initial (30-d) success of the procedure, and follow - up status in the two groups were compared. Results Baseline characteristics were similar, although the patients with unstable symptoms more females ( P< 0. 05), and had a higher average CCS class (P< 0. 05) and a higher incidence of postinfarction angina ( P< 0. 01). The frequency of ' complex stenosis in patients with unstable angina was higher than that of patients with stable angina, 33% v 20% ( P< 0. 01). A total of 309 vessels ac cepted the procedure; including 210 stents were sue cessfully delivered to 156 patients. 143 and 67 stents were implanted in the     

C-反应蛋白与冠心病患者冠状动脉斑块形态的关系

目的 :检测冠状动脉 (冠脉 )造影显示Ⅱ型斑块的患者血清C 反应蛋白 (CRP)水平 ,从临床的角度探讨斑块破裂发生的原因。方法 :112例接受了冠脉造影的冠心病患者纳入本研究。对其冠脉造影的斑块形态进行分型。根据斑块形态 ,患者分为两组 ,即Ⅰ型病变 (表面光滑 )组 (n =45 )及Ⅱ型病变 (表面不规则 )组 (n =6 7)。所有患者于冠脉造影前采血进行血清CRP、全血心脏肌钙蛋白T(cTnT)、血清肌酸激酶 (CK)及肌酸激酶MB同工酶 (CK MB)的测定。结果 :Ⅱ型病变组平均血清CRP水平显著高于Ⅰ型病变组 ( 4 32± 0 35mg/L对 2 18± 0 2 2mg/L ,P <0 0 0 0 1)。而两组患者之间 ,年龄、性别、4个主要冠心病危险因素的合并率、全血cTnT、血清CK及CK MB水平均无显著差别 (P>0 0 5 )。结论 :冠脉造影显示斑块破裂的冠心病患者血清CRP水平明显升高。从临床的角度提示 ,炎症反应是导致斑块破裂的原因 ,进而也是导致急性冠脉综合征 (ACS)发生的重要始动因素之一     

Intravenous Nitroglycerine in Refractory Unstable Angina Pectoris

Abstract: Sixteen patients with severe coronary artery disease and unstable angina, refractory to standard therapy with nitrates, beta-blockers or calcium antagonists, were given intravenous nitroglycerine (500 μg/ml) in an open trial. The infusion was started at 0–17 ml/min. The final infusion rate ranged from 0 17 ml/min to 2 04 ml/min, depending on the symptomatic and haemodynamic response of the individual patient. At the slow infusion rates, the actual dose was probably only 15% of the delivered dose because of the adsorption of nitroglycerine to PVC tubing.
There was significant pain relief in all patients. In six patients, pain relief was complete; in ten patients, occasional episodes occurred during the nitroglycerine infusion but they were less frequent and less severe and few were associated with ST segment changes. Systolic blood pressure fell by a mean of 100 mmHg at the commencement of therapy but there was no significant change in heart rate. Apart from mild headaches, no other adverse effects were observed. The mean treatment time was 3-2 days (range 1–8 days). Eight patients were discharged on oral and/or cutaneous nitrate therapy and eight patients had coronary artery surgery.
Intravenous nitroglycerine is useful for controlling symptoms in patients with unstable angina refractory to conventional therapy and may be particularly valuable for settling these patients before coronary arteriography and during preparation for coronary surgery.     

The Study of hemodynamics and coronary arteriography of Patients with Different Types of Unstable Angina Pectoris

Objectives To explore the basic heart functional state and cardiac reserve function of patients with different types of unstable angina pectoris (UAP) and observe the relations between the heart function and severity of coronary arterial disease. Methods 70 cases with UAP were enrolled including 25 patients with angina decubitus (AD), 23 patients with mixed angina (MA) , and 22 patients with accelerated effort angina (AEA). All patients underwent a series of examination such as UCG, ECT, hemodynamics and volume-loading test. The patients were divided into three groups in light of the results of the hemodynamic examination: ① diastolic dysfunction group ② systolic dysfunction group ③ normal heart function group. We assessed the basic heart function and cardiac reserve function of patients with different types of UAP and also observed the relations between coronary arteriography and heart function. Results ① Under basic conditions, patients with angina decubitus suffered from the systolic (36%) or dia     

Angiographic morphology and intraluminal coronary artery thrombus in patients with angina pectoris: clinical correlations

A prospective study was conducted in 104 consecutive patientswho underwent coronary angiography for the evaluation of anginapectoris. 50 patients experienced unstable symptoms, while therest of them were stable. Coronary lesions reducing the luminaldiameter by at least 50% were compared between both groups accordingto localization, grade, length, type and collateralization.Eccentric irregular lesions (EIL) appeared more frequently inthe unstable group of patients (27% vs 3%, P<0.01), whilethe incidence of concentric lesions was higher in stable group(45% vs26%, P <0.02). There was no significant differencein localization, grade, length, or collateralization. EIL weremost frequently identified as spontaneous AP producing lesions(55%, P <0.001) in 29 patients in the unstable group. Spontaneousangina was associated in 86% with EIL, occlusions, or fillingdefects— all of these lesions might contain occlusiveor nonocclusive thrombi. EIL with a narrow neck appeared onangiograms earlier than EIL with a wall irregularity. We concludethat EIL is a sensitive and very specific angiographic markerof unstable AP. The morphologic details of EIL may help oneto choose appropriate therapy.     

不同类型的不稳定性心绞痛病人冠脉血管病变的特征及治疗

为观察不稳定性心绞痛病人冠脉血管病变的特征，来指导正确的治疗。55例不稳定性心绞痛病人行冠脉造影结果提示：血管病变最轻的类型为变异型和自发型心绞痛，多为较轻的A型病变（85．7％），其心肌缺血主要原因为冠状动脉痉挛或张力性改变，首选钙括抗剂治疗。冠脉病变最重的是梗塞后心绞痛，多支血管病变发生率高且均为B、C型病变，应争取冠脉搭桥。初发心绞痛为严重单支血管病变，且侧支循环不丰富，可能存在心肌梗塞的危险，应积极药物或PTCA治疗。非Q波型心梗血管完全性闭塞的发生率明显高于其他类型（33．3％）（P＜0．001），侧支循环在该类型中具有重要的保护作用，如药物治疗下仍有心绞痛发作，应行冠脉搭桥术保护存活心肌，维持心脏功能。     

不稳定性心绞痛病人白细胞变形能力、粘附功能和白细胞CD18表达的变化

目的：探讨白细胞流变性、粘附性与急性心肌缺血的关系，为不稳定性心绞痛（ＵＡ）的治疗提供理论参考。方法：４７例不稳定性心绞痛病人，其中男２９例，女１８例。自发型心绞痛１６例，心肌梗死后心绞痛２２例，初发劳力型心绞痛９例。采用红细胞变形能力测定仪、血栓血小板粘附两用仪和酶联免疫吸附法（ＥＬＩＳＡ）分别检测了４０例健康人和４７例不稳定性心绞痛病人心绞痛发作期和缓解后２４小时的白细胞滤过指数（ＩＦ）、白细胞粘附率（ＬＡＲ）和白细胞不同组别第１８（ＣＤ１８）表达。结果：不稳定性心绞痛病人白细胞变形能力（ＬＤ）明显降低，白细胞粘附功能（ＬＡＦ）和白细胞ＣＤ１８表达明显增加（Ｐ＜０．００１，Ｐ＜０．０１），心绞痛发作时，ＬＤ降低和白细胞粘附功能、白细胞ＣＤ１８表达增高较心绞痛缓解后２４小时更明显（Ｐ＜０．００１），且白细胞滤过指数、白细胞粘附率和白细胞ＣＤ１８表达之间均呈正相关（Ｐ＜０．０１）。心绞痛发作时和缓解后２４小时，自发型心绞痛白细胞滤过指数、白细胞粘附功能和白细胞ＣＤ１８表达较心肌梗死后和劳力型心绞痛变化更明显（Ｐ＜０．０１）。结论：心肌缺血与白细胞流变性和粘附性改变有一定关系