瑞舒伐他汀对老年急性冠脉综合征患者血浆内皮微粒的影响

目的探讨老年急性冠脉综合征(ACS)患者应用不同剂量瑞舒伐他汀治疗后血浆内皮微粒(EMP)及血脂水平的变化。方法 76例老年ACS患者随机分为瑞舒伐他汀10 mg组(低剂量组)、20 mg组(高剂量组)各38例。两组治疗前后分别应用流式微球技术检测外周血CD31+/CD42b-EMP水平,全自动生化仪检测血脂水平。结果治疗2 w后,两组血浆CD31+/CD42b-EMP水平均较治疗前下降,而高剂量组与低剂量组相比血浆CD31+/CD42b-EMP下降更明显(P<0.05)。两组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL)-C水平较治疗前下降,高剂量脂蛋白胆固醇(HDL)-C较治疗前升高,高剂量组TC、TG、LDL-C水平下降幅度较低剂量组明显增大,高剂量组HDL-C上升幅度较低剂量组更明显(均P<0.05)。血浆EMP与TG、LDL-C呈线性相关(r=0.541、0.538,P<0.05)。与HDL-C呈负相关(r=-0.303,P<0.05)。结论每日1次20 mg瑞舒伐他汀对老年ACS患者是安全的,能迅速调节血脂水平,降低血浆EMP水平,减轻内皮功能障碍,从而稳定粥样硬化斑块,尽早获益。     

急性冠脉综合征患者冠脉血小板微粒水平

目的利用流式细胞法检测急性冠脉综合征(ACS)患者冠状动脉血中血小板微粒(PMPs)水平,探索其与冠心病发生发展的关系及其机制。方法入选患者共92例分为4组,其中ST段抬高型急性心肌梗死(STEAMI)组28例,非ST段抬高型急性冠脉综合征(NSTE-ACS)组24例,稳定型心绞痛(SA)组20例,正常对照组20例。冠脉造影术中取冠脉内血液3 ml,离心制得贫血小板血浆,依次加入CD61荧光抗体及0.82μm标准微球,流式细胞仪测定PMPs的相对水平。结果 STEAMI组、NSTEACS组PMPs水平(分别为8.9%±3.3%,7.8%±2.4%)均高于正常组(4.7%±2.9%);STEAMI组、NSTE-ACS组也均高于SA组(5.9%±2.6%,P均0.05)。STEAMI组和NSTE-ACS组组间比较、SA组和冠脉正常组组间比较,差异无统计学意义(P均0.05)。结论 ACS患者冠脉血中的PMPs水平明显升高,稳定性心绞痛患者PMPs无明显升高,提示PMPs与冠心病发生发展有关。其机制可能通过PMPs与血小板的相互激活,导致动脉粥样硬化进程的加速。检测PMPs水平可能有助于高危ACS患者的早期诊断。     

老年急性冠脉综合征患者血清铁蛋白检测的临床意义

目的研究老年急性冠脉综合征血清铁蛋白检测的临床意义。方法选择2012年1月至2013年1月在贵州省人民医院接受治疗的老年急性冠脉综合征患者56例纳入检验,按照血糖与血脂水平是否正常分为检验1组与检验2组,选择同期在我院接受复查的老年心绞痛患者54例纳入对照1组,再选择同期在我院接受体检的健康老年人60例纳入对照2组,检验组与对照1组、对照2组患者一般资料比较无统计学意义(P>0.05)。检测三组成员TG、TCH、FPG、HDL、LDL以及SF水平。结果检验组SF水平显著高于对照1组与对照2组(P<0.05)。HDL正常情况下的检验1组SF水平与HDL异常情况下的检验2组SF水平存在显著差异(P<0.05)。老年急性冠脉综合征患者SF水平与TG、TCH、FPG、LDL水平均无显著的相关性(P>0.05),与HDL水平存在显著的负相关(P<0.05)。结论血清铁蛋白水平与老年急性冠脉综合征存在着明显的相关关系,加强对冠心病患者血清铁蛋白的监测,能够有效控制老年急性冠脉综合征。     

急性冠状动脉综合征患者外周血CD31~(bright)/Annexin V~+内皮微粒水平增高

目的 观察急性冠状动脉综合征患者与非冠心病患者外周血内皮微粒水平,探讨CD31bright/AnnexinV+内皮微粒与心血管危险因素的相关性.方法 急性冠状动脉综合征患者56例,非冠心病患者26例,采用流式细胞仪检测外周血CD31bright/Annexin V+内皮微粒水平.结果 与非冠心病患者比较,急性冠状动脉综合征患者外周血CD31bright/Annexin V+内皮微粒显著增加(P<0.01),而急性心肌梗死与不稳定型心绞痛亚组之间外周血CD31bright/Annexin V+内皮微粒水平无显著性差异(P>0.05).所有入选患者中,2型糖尿病患者外周血CD31bright/Annexin V+内皮微粒水平较非糖尿病患者显著升高(P<0.05);多因素回归分析显示,血清甘油三酯水平与外周血CD31bright/Annexin V+内皮微粒数量独立正相关(r=0.28,P<0.05).急性冠状动脉综合征组血清高敏C反应蛋白水平与外周血CD31bright/Annexin V+内皮微粒数量呈正相关(r=0.31,P<0.05).结论 急性冠状动脉综合征患者和糖尿病患者外周血CD31bright/Annexin V+内皮微粒增多,提示急性冠状动脉综合征患者和2型糖尿病患者内皮损伤严重.CD31bright/Annexin V+内皮微粒水平增高可能与血清甘油三酯和血清高敏C反应蛋白水平增高有关.     

血小板微粒对急性冠脉综合征患者危险程度及对疾病预后的预测作用

目的观察急性冠脉综合征(ACS)患者血小板微粒(PMP)的变化对危险程度及对疾病预后的预测作用。方法收集ACS患者ST段抬高型心梗(STEAMI组)20例,非ST段抬高型心梗(NSTEAMI组)20例,不稳定心绞痛20例(UA组)临床资料进行回顾性分析,另选择同期健康体检者20例为对照组。采用流式细胞仪测定每组的血小板活化标志物CD62P、PAC-1和CD40L含量的变化。根据GRACE评分法将ACS组60例患者分为高危组(GRACE评分≥133分)34例、低中危组(GRACE评分<133分)26例,检测两组患者血小板微粒CD62P、PAC-1和CD40L的水平,并观察两组的住院期间的心律失常发生率,住院心衰发生率、28天的死亡率,并继续随访24个月的再次心梗、1年死亡率情况。分析血小板微粒值的高低与疾病预后的相关性。结果 ACS组患者CD62P、PAC-1和CD40L的水平与对照组比较差异有统计学意义(P<0.01);UA组、NSTEAIM组CD62P、PAC-1和CD40L的水平明显低于STEAIM组(P<0.05);UA组CD62P、PAC-1和CD40L的水平明显低于STEAIM组(P<0.05);低中危组患者CD62P、PAC-1和CD40L的水平明显低于高危组(P<0.05);低中危组患者心律失常发生率、住院心衰发生率、28 d死亡率明显低于高危组患者(P<0.05);继续随访24个月后低中危组患者再次心梗率、1年死亡率明显低于高危组患者(P<0.05)。结论 PMP的变化可以预测老年ACS患者危险程度及对疾病预后。     

急性冠脉综合征患者外周血内皮祖细胞与冠状动脉病变程度的关系研究

目的：探讨急性冠脉综合征患者外周血内皮祖细胞（ EPCs）与冠状动脉病变程度的关系。方法选择2011年7月—2012年11月我院收治的急性冠脉综合征患者90例,根据冠状动脉造影结果分为复杂病变组48例和简单病变组42例。比较两组患者外周血EPCs计数,并分析其与冠状动脉病变程度的相关性。结果复杂病变组患者外周血EPCs计数为（30.4±7.0）个,少于简单病变组的（51.7±11.1）个（P＜0.05）。直线相关分析结果显示,外周血EPCs计数与冠状动脉病变程度呈负相关（ r＝－0.427, P＜0.05）。结论冠状动脉病变程度较重的急性冠脉综合征患者外周血EPCs计数减少,外周血EPCs或可成为预测冠状动脉病变程度的标志物。     

急性冠脉综合征患者外周血内皮祖细胞与冠状动脉病变程度的关系研究

目的：探讨急性冠脉综合征患者外周血内皮祖细胞（ EPCs）与冠状动脉病变程度的关系。方法选择2011年7月—2012年11月我院收治的急性冠脉综合征患者90例,根据冠状动脉造影结果分为复杂病变组48例和简单病变组42例。比较两组患者外周血EPCs计数,并分析其与冠状动脉病变程度的相关性。结果复杂病变组患者外周血EPCs计数为（30.4±7.0）个,少于简单病变组的（51.7±11.1）个（P＜0.05）。直线相关分析结果显示,外周血EPCs计数与冠状动脉病变程度呈负相关（ r＝－0.427, P＜0.05）。结论冠状动脉病变程度较重的急性冠脉综合征患者外周血EPCs计数减少,外周血EPCs或可成为预测冠状动脉病变程度的标志物。     

脑钠尿肽检测在急性冠脉综合征患者中的临床意义

急性冠脉综合征（ACS）是一组心肌缺血性疾病,包括不稳定型心绞痛（uA）、非ST段抬高性心肌梗死（NSTEMI）和ST段抬高性心肌梗死（STEMI）,其共同病理生理特征是粥样斑块破裂、血小板聚集和血栓形成。血浆B型脑钠尿肽（BNP）是一种神经内分泌激素,临床作为诊断心力衰竭的血清标记物已得到共识,近年发现,心肌缺血也可以引起BNP水平特异性改变,本文通过测定血浆BNP水平,探讨分析ACS患者血浆BNP水平与病变的严重程度、心功能之间的相关性,为临床对ACS早期客观评估及诊疗选择提供理论依据。     

急性冠脉综合征患者cTnT和Hcy水平及其临床意义

近年来许多研究结果表明，高同型半胱氨酸血症亦是导致冠心病的一个独立危险因素…。血浆同型半胱氨酸（Hcy）水平在不同类型急性冠脉综合征（ACS）中均可升高。本文通过对不同类型ACS患者进行对比，观察检测Hcy在ACS中的临床意义。     

丹红注射液联合脑心通胶囊对急性冠脉综合征介入治疗患者内皮祖细胞的影响

目的观察丹红注射液联合脑心通胶囊对急性冠脉综合征(ACS)介入治疗患者近期预后和外周血循环内皮祖细胞(EPCs)的影响。方法选择该院进行介入治疗的91例ACS患者,随机分为丹红组(n=48)和常规组(n=43),常规组患者PCI术后常规冠心病二级预防治疗,丹红组在此基础上加用丹红联合脑心通。观察住院期间和术后3个月患者主要心血管不良事件和心功能情况,并比较治疗前后外周血EPCs变化。结果两组在死亡、心肌梗死、脑卒中、心绞痛、再次入院等指标上无显著差异(均P0.05),但是丹红组在术后3个月时射血分数(61.5%vs55.3%)、6min步行试验(562mvs513m)较常规组明显增高(均P0.05),外周血EPCs细胞常规组和丹红组均较正常人明显减少(28.6±5.9,28.9±7.3vs63.5±6.2,P0.01),术后3个月丹红组较常规组明显增加(37.1±5.8vs32.4±4.6,P0.05)。结论丹红注射液联合脑心通胶囊对ACS介入治疗患者可明显增加外周血EPCs水平,改善患者心脏功能。     

内皮微粒与冠心病相关性研究

目的:探讨血浆内皮微粒(EMP)与冠心病的相关性。方法:冠心病组367例,其中稳定型心绞痛(SA)119例,急性冠状动脉综合征(ACS)248例,后者含不稳定型心绞痛(UA)158例,急性心肌梗死(AMI)90例。非冠心病组166例。ELISA法测定血浆ET-1,流式微球技术检测血浆EMP。结果:冠心病组ET-1、EMP水平升高,呈正相关(r=0.233,P=0.001)。ACS组EMP(547.405)显著高于非冠心病组(148.185)及SA组(429.890),亚组分析中UA组EMP(551.660)升高最为显著;冠心病冠状动脉病变支数与EMP无明显相关;AMI患者EMP与BNP、TnT、TnI间无明显相关;EMP与ACS患者短期预后相关(r=0.280,P<0.01)。结论:血浆EMP水平可反映冠心病内皮功能障碍,与冠心病的发生、冠状动脉斑块的不稳定性有关。     

急性冠状动脉综合征的抗血小板治疗

急性冠状动脉综合征 (ACS)发生的成因主要由冠状动脉内不稳定的斑块形成及破损。在此基础上 ,血小板发生活化并介导血栓形成 ,因此抗血小板药物在 ACS的治疗中有着重要的地位。本文就抗血小板药物应用进展作一综述     

可溶性CD40配体与急性冠状动脉综合征的关系

目的探讨急性冠脉综合征(ACS)患者血清可溶性CD40L水平变化的临床意义。方法正常对照组22名,将患者分为稳定型心绞痛(SA)组20例、不稳定型心绞痛(UA)组22例和急性心肌梗死(AMI)组15例。其中20例(UA组15例、AMI组5例)行经皮冠状动脉介入术(PCI)。所有受试者均采用双抗夹心酶联免疫测定法(ELISA)对sCD40L水平进行检测,同时观察冠脉造影和PCI术前和术后30dsCD40L的水平变化。结果①UA组及AMI组血清sCD40L水平明显较对照组高(P<0.01)。②UA组与SA组相比差异有统计学意义(P<0.05),AMI组明显较SA组高(P<0.01)。③SA组与对照组相比差异有统计学意义(P<0.01)。④AMI组患者血清sCD40L水平与UA组差异有统计学意义(P<0.01)。⑤PCI后30d血清sCD40L明显低于PCI前(P<0.01)。结论血清可溶性sCD40L的升高在ACS发生和发展中起重要作用,是反应斑块不稳定性的指标之一。     

C-reactive protein is released in the coronary circulation and causes endothelial dysfunction in patients with acute coronary syndromes

Background

C-reactive protein (CRP) plasma levels correlate with cardiovascular events. Although a direct role for CRP in atherothrombosis has been suggested, at the moment little is known about its involvement in the pathophysiology of acute coronary syndromes (ACS). Thus, the aim of this study was to determine whether CRP is produced in the culprit lesion and released within the coronary circulation of patients with ACS and whether it may affect coronary endothelial function.

Methods

Blood samples were simultaneously obtained from the aorta (Ao) and the coronary sinus (CS) of patients with normal coronary artery (n = 16), stable angina (n = 30), and ACS (n = 29) for later measurement of plasma CRP levels. Endothelium-dependent and -independent coronary vasodilation were evaluated by means of a Doppler Flow Wire in response to the increasing intracoronary doses of acetylcholine and adenosine, respectively.

Results

CRP plasma levels were significantly higher across the coronary circulation only in ACS patients with the culprit lesion located in the left coronary artery, while no differences between CS and Ao CRP plasma levels were observed in all other groups. Transcardiac CRP levels were correlated with impairment in coronary endothelium-dependent vasodilation. In six additional patients (SA = 3 and ACS = 3), subjected to coronary atherectomy, real-time quantitative PCR revealed presence of CRP mRNA only in unstable plaques.

Conclusions

Thus, CRP is produced and released within the coronary circulation of patients with ACS; this is associated with impairment of endothelial function, suggesting a new pathophysiological link between CRP and ACS.     

急性冠状动脉综合征患者血清基质金属蛋白酶-9水平的临床意义

目的　探讨血清基质金属蛋白酶 ( MMP) -9水平与粥样斑块破裂的关系及其作为粥样斑块破裂的血清学指标的意义。方法　急性冠状动脉综合征 ( ACS)组 3 4例 ,其中不稳定型心绞痛 ( UAP) 18例、急性心肌梗死 ( AMI) 16例。稳定型心绞痛 ( SAP)组 3 0例。正常对照组 3 0例。比较 3组之间血清 MMP-9水平的差异。结果　 ACS组血清 MMP-9水平高于 SAP组及正常对照组 ,具有显著性差异。 SAP组血清 MMP-9水平高于正常对照组 ,也具有显著性差异。结论　血清 MMP-9水平增高与粥样斑块破裂相关 ,可作为判断粥样斑块不稳定的血清学指标     

Validation of the GRACE score for prognosis in Indian patients with acute coronary syndromes

AimTo validate the global registry of acute coronary events (GRACE) score in acute coronary syndromes (ACS) patients and study its angiographic correlation.Methods and resultsTwo-hundred and thirty-five ACS patients were studied for the combined endpoint of all-cause in-hospital mortality and non-fatal infarction/reinfarction. We tested the predictive accuracy of the composite GRACE score using the receiver operating characteristics (ROC) curve.Lower systolic blood pressure (SBP) (odds ratio [OR] 7.93, P=0.005), ST-segment deviation (OR 7.79, P=0.02) and cardiac biomarker positivity (OR > 6.52, P=0.01) were significantly associated with events. Serum creatinine > 1.4 mg/dL showed a trend towards statistical significance (OR 4.14, P=0.05), whereas age > 50 years (OR 3.62, P=not significant [NS]) and Killips class 4 (OR 2.71, P=NS) showed good association. The best value for predicting events was a GRACE score of > 217 and these patients were more likely to have double/triple vessel disease (P = 0.0009). The C statistic for the GRACE score was 0.75.ConclusionHigher GRACE score predicts in-hospital events and more severe angiographic coronary artery disease (CAD).     

Medication performance measures and mortality following acute coronary syndromes

PURPOSE: To identify patient and health care factors which are related to the use of medical treatments that comprise quality measures and to assess the relation of these measures with mortality. METHODS: The study sample consisted of 20 140 patients with acute coronary syndromes from the international GRACE registry. Multivariable logistic regression modeling was used to determine predictors of quality performance. Quality indicators were use of aspirin and beta-blockers within 24 hours and at hospital discharge, use of angiotensin-converting enzyme (ACE) inhibitors at discharge, and in-hospital mortality. RESULTS: Use of medications in eligible patients at discharge ranged from 73% for ACE inhibitors to 93% for aspirin. High-risk features (eg, heart failure, older age) were related to failure to use aspirin and beta-blockers. Being at a teaching hospital and care by a cardiologist were associated with better use of aspirin and beta-blockers. Coronary artery bypass surgery was associated with failure to use ACE inhibitors and aspirin. When hospitals were divided into quartiles of quality performance, adjusted in-hospital mortality was 4.1% in the top versus 5.6% in the bottom quartile, representing a 27% (95% confidence interval: 11% to 42%) lower relative mortality. CONCLUSION: Identification of factors associated with failure to use proven treatments, including high-risk groups that would derive particular benefit from effective therapies, provides an opportunity to focus quality improvement interventions. The association of lower hospital mortality with better use of selected medical treatments supports their measurement to improve quality of care.     

C-reactive protein as a marker for acute coronary syndromes

BACKGROUND: For several years, acute coronary syndromes have been perceivedas causing the most hospital admissions, and even hospital mortality.The syndrome of unstable angina frequently progresses to acutemyocardial infarction but its pathogenesis is poorly understood,and prognosis determination is still problematic. We testedthe hypothesis that measurement of the C-reactive protein inpatients admitted for chest pain could be a marker for acutecoronary syndromes. METHODS AND RESULTS: We studied 110 patients admitted with suspected ischaemic heartdisease, but without elevated serum creatine-kinase levels atthe time of hospital admission. Patients were subsequently dividedinto two groups based on their final diagnosis: group 1 comprisedpatients with unstable angina; group 2 patients with acute myocardialinfarction. We measured the C-reactive protein at the time ofhospital admission. The concentration of C-reactive proteinwas elevated in 59% of the patients with a final diagnosis ofacute myocardial infarction, and in 5% of the patients witha final diagnosis of unstable angina, (P<0·001). CONCLUSION: This study indicates that C-reactive protein levels measuredat the time of admission in patients with suspected ischaemicheart disease could be a marker for acute coronary syndromes,and helpful in identifying patients at high risk for acute myocardialinfarction. Measurement of C-reactive protein may have practicalclinical significance in the management of patients hospitalizedfor suspected acute coronary syndromes.