动脉粥样硬化病变处血管新生的病理意义

发生动脉粥样硬化的冠状动脉内膜往往出现血管新生.这些新生血管可以促进粥样硬化病变的发展,甚至诱发斑块出血和斑块破裂.进一步研究新生血管的发生机制及其病理生理意义并寻求较佳的防治方法,可以为认识动脉粥样硬化的发病机制和防治动脉粥样硬化提供一个新的视点.     

动脉粥样硬化患者血管内皮功能检测及意义

血管内皮细胞功能障碍不仅是动脉粥样硬化(AS) 的早期病理改变,而且对AS 的进展及并发症(如血管痉挛、血栓形成)的发生发展有重要影响[1].近年来, 有研究发现降胆固醇治疗可有效改善内皮细胞功能[2,3].我们采用超声多普勒观察了祛瘀消斑胶囊对AS患者肱动脉内皮依赖性舒张功能的改善作用,旨在探讨血清胆固醇水平与内皮细胞功能的关系.     

血管内皮,冠状血管舒张及硝酸酯类药物

讨论硝酸酯与内源性ＥＤＦＲ的相似处，以及两者之间的相互作用。     

冠状血管张力的局部调节

本文阐述血管内皮诸因子对冠状血管舒张和收缩机理的作用。     

抗血管生成--动脉粥样硬化治疗的新策略

器官和组织的血管系统形成有3种方式,即“血管发生”(vasculogenesis)、“血管生成”(angiogenesis)和“动脉生成”(arteriogenesis).“血管发生”是在胚胎形成早期,由内皮细胞的前体成血管细胞形成血管腔结构的过程;“血管生成”则是指无发育完整中膜的新血管的形成;而“动脉生成”是指有发育完整的中膜的新动脉的出现[1,2].生理意义的血管形成在胚胎发育,创伤修复和侧支循环代偿缺血等方面发挥重要作用,而病理意义的血管形成,即血管生成异常则在动脉粥样硬化(AS)[BFQ、肿瘤生长及转移、糖尿病性视网膜病变、风湿性关节炎等疾病的发生中发挥重要作用.近年来,血管生成在AS发生、发展中的作用已日益得到阐明,抗血管生成将成为AS治疗一个引人注目的新策略.     

冠状静脉窦的解剖和电生理

随着心内电生理检查及射频消融技术的发展,人们已日益认识到,冠状静脉窦（coronary sinus,CS）与多种心律失常有着密不可分的关系.这主要与冠状静脉窦独特的解剖位置及组织学结构有关.本文综述其解剖学和电生理特性及其与多种心律失常的关系.     

血管滋养血管及血管内皮生长因子与动脉粥样硬化斑块研究进展

血管滋养血管其主要功能是运送营养物质和氧至动静脉血管壁,同时清除血管壁细胞及通过动静脉血管内皮扩散转运所产生的"废物"。尽管血管滋养血管特性的改变与动脉粥样硬化斑块进展之间的关系已得到很好的证实,但血管滋养血管的作用,特别是疾病过程中如动脉粥样硬化,以何种方式存在及消失,是该疾病的成因或仅仅起作用,目前仍未完全明了。然而,即使其增值作用较小,其新生的微血管由于内皮损害而作为单核细胞移行至早期疾病位点的通路,成为疾病进展的根源之一。鉴于血管滋养血管以上两种功能特点,现就血管滋养血管及血管内皮生长因子与动脉粥样硬化斑块形成之间的关系作相关综述。     

血管外膜与动脉粥样硬化

动脉粥样硬化(AS)是一种由脂质沉积引起的血管系统多病灶慢性免疫炎性疾病,主要累及大、中动脉,其发病机制十分复杂.长期以来,对AS机制的研究主要集中在内膜和中膜.最近越来越多的研究表明,血管外膜与动脉硬化形成密切相关.现就血管外膜及其相关血管活性肽在AS发生中所起的作用作一综述.     

冠状静脉窦及其属支的X线解剖研究

目的　研究冠状静脉窦及其属支的Ｘ线解剖特征。方法　利用冠状动脉造影的静脉相对１０２ 例患者的冠状静脉窦及其属支的形态、位置、数目、直径及角度进行观测。结果　所有患者均可见冠状静脉窦和心大静脉，绝大多数患者可见心中静脉及１～３支左室后静脉。心中静脉直径（４．１２±１．２５）ｍ ｍ 和左室后静脉（３．１０±１．０３）ｍ ｍ 多呈直角汇入冠状静脉窦，可能会给左室电极导线植入造成技术上的困难，心大静脉在左房室沟内与冠状静脉窦保持同轴。结论　冠状动脉造影是显示冠状静脉窦及其属支的简单、易行方法，心大静脉可作为左室电极导线植入的部位     

血管内皮功能障碍与动脉粥样硬化

内皮功能障碍是动脉粥样硬化发病的早期事件，其主要特征内皮细胞释放的内皮源性舒张因子－一氧化氮减少或其活性降低，失活增加，应用非介入性超声探测法探测肱动脉扩张反应可评估动脉血管内皮的功能状态，是检测内皮细胞的重要手段，应用降血脂，抗氧化剂，钙拮抗剂和Ｌ－精氨酸治疗动脉粥样硬化粥样硬化斑块，明显减少心血管意发生，联合治疗效果更好，故进行早期逆转内皮功能障碍的治疗对动脉粥样硬化的发病具有积极的预防作用。     

Hormones and coronary atherosclerosis in women

Heart disease is the major health issue facing women in the United States today. Yet, less than 50% of women are aware cardiovascular disease is a health problem. Atherosclerosis begins in childhood and lipid streaks have been identified in girls ages 15–19 in the abdominal aorta and the right coronary artery. Risk factors for cardiovascular disease in women include smoking, diabetes, hypertension, lipid disorders, and menopause. Observational studies have reported a 30–50% reduction in cardiovascular events when estrogen was administered to younger women for menopausal symptoms, yet randomized trials in older patients have failed to show benefit with hormonal replacement therapy. Recent studies have reported preservation of lipid and vascular vasodilatation with low-dose conjugated equine estrogens (CEE) in women and an absence of inflammatory and clotting changes that were observed in high-dose CEE. Recommendations for reducing cardiovascular risk in postmenopausal women include smoking cessation, regular exercise, and weight control. Should hormone therapy be continued beyond management of menopausal symptoms and treatment for osteoporosis, a statin drug should be added to eliminate future cardiovascular complications. Future research will examine low-dose hormonal therapy, earlier administration after menopause, newer agents, and routes of estrogen administration.     

同型半胱氨酸与冠状动脉粥样硬化的相关性

目的 :观察血清同型半胱氨酸 （Hcy）与冠状动脉粥样硬化 （CAS）程度的关系 ,探讨其血清浓度在预测冠心病中的意义。方法 :对 168名行冠状动脉造影 （CAG）患者按狭窄程度分为 A,B,C,D组 ,另设正常对照组 5 4名 ,取清晨空腹静脉血测定血清 Hcy水平 ,比较各组间的差异。结果 :CAS各组 Hcy均显著高于正常对照组 （均 P<0 .0 1） ,且随着 CAS狭窄程度的加重 ,Hcy水平升高 （趋势检验 P<0 .0 1）。结论 :Hcy水平与 CAS狭窄程度密切相关 ,在预测冠心病的发作中 ,是一敏感而可靠指标     

颈动脉粥样硬化与冠状动脉粥样硬化的关系

目的　探讨颈动脉粥样硬化与冠状动脉粥样硬化的关系。方法　对 94例老年患者进行了冠状动脉造影和颈动脉超声检查。颈动脉粥样硬化斑块积分采用Sutton法。结果　单支组及多支组内膜中膜厚度、斑块积分显著高于正常组 ,多支组显著高于单支组 (P<0 .0 5 )。斑块指数与年龄、吸烟、低密度脂蛋白胆固醇与高密度脂蛋白胆固醇的比值、收缩压以及高血压病程的程度呈正相关。结论　颈动脉粥样硬化与冠状动脉粥样硬化的病变是平行的     

颈动脉粥样硬化与冠心病的相关性

目的 :研究颈动脉粥样硬化 （CAS）与冠心病 （CHD）的相关性。方法 :非脑血管病患者 5 2例分为对照组 （10例 ） ,心绞痛组 （16例 ） ,心肌梗死组 （2 6例 ）。冠心病依据心电图 ,运动 -静息 99m Tc- MIBI心肌显像 （SPECT）诊断 ;颈动脉粥样硬化用多普勒超声诊断仪检测。结果 :对照组颈动脉超声未见狭窄及粥样斑块 ,颈动脉内膜厚度 /腔内径<0 .1。心绞痛或心肌梗死组其中 1例 （2 ,3% ）颈动脉狭窄 >5 0 % ,80 % （34/ 42 ）发现颈动脉粥样斑块 ,颈动脉内膜厚度 /腔内径 >0 .1,收缩期颈内动脉血流速 （IC） /颈总动脉血流速 （CC） >0 .8,与对照组比较均有显著差异 ,但心绞痛组与心肌梗死组上述指标未见显著差异。结论 :颈动脉粥样硬化与冠心病密切相关     

冠状动脉粥样硬化相关生物力学因素的研究进展

冠状动脉是动脉粥样硬化最早发和最好发的部位,严重的冠状动脉粥样硬化可造成心肌缺血、心肌梗死,危害人们健康。相比人体其他部位动脉,冠状动脉具有独特的解剖结构和血流动力学特征,这些特征与其粥样硬化发生具有明显的相关性。文章就冠状动脉粥样硬化相关生物力学因素作一综述。     

Application of intravascular ultrasound for detection and quantitation of coronary atherosclerosis

Although angiography is widely utilized to assess the extent and severity of coronary artery disease (CAD), arteriography yields only a silhouette of the vessel lumen. Coronary intravascular ultrasound supplements angiography by providing a tomographic perspective of lumen geometry and vessel wall structure. Intracoronary ultrasound can now be performedin vivo utilizing small, flexible probes capable of negotiating tortuous vessles. We have performed coronary ultrasound in more than 100 patients, including a group of normal subjects, with no serious complications. Measurements of coronary lumen dimensions by angiography and ultrasound correlated closely for normal vessels (r=0.92) and for concentrically narrowed atherosclerotic vessels (r=0.90). However, the correlation between angiography and ultrasound was only fair for eccentrically narrowed arteries (r=0.79) and was poor following angioplasty (r=0.30). Coronary artery wall motion was measured by intravascular ultrasound and demonstrated significant differences between normal arteries (18% lumen area change) and atherosclerotic vessels (11% change). Coronary ultrasound demonstrated important differences in the structure of normal and altherosclerotic vessel walls. Arteries in normal subjects exhibited a thin intimal leading-edge echo (mean 0.20 mm) and subadjacent sonolucent zone (mean 0.12 mm). Atherosclerotic vessels typically demonstrated increased thickness of both structures and often exhibited dense fibrocalcific plaques that shadowed underlying anatomy. These ultrasound abnormalities were often present at angiographically normal sites. Several limitations of coronary intravascular ultrasound were apparent, including echo dropout, distortions produced by non-coaxial imaging, and inability to image small or severely narrowed vessels. Coronary intravascular ultrasound holds great promise for the detection and quantification of CAD in the clinical setting.     

细胞黏合素C对冠心病及冠状动脉粥样硬化严重程度的预测价值

目的 评估细胞黏合素C(TNC)对冠心病(CHD)及冠状动脉粥样硬化严重程度的预测价值。方法 纳入160例经冠状动脉造影的胸痛患者,根据造影结果,患者被分为两组:CHD组(n＝90)和non-CHD组(n＝70)。冠状动脉粥样硬化严重程度采用Gensini评分评价,并将CHD患者分为3组:低Gensini评分组(n＝39)、中Gensini评分组(n＝27)、高Gensini评分组(n＝24)。比较各组血清TNC水平。Pearson相关性分析、多因素线性回归分析评估TNC与Gensini评分的相关性。ROC曲线分析TNC对冠心病及高Gensini评分患者的预测价值。结果 CHD组血清TNC水平显著高于non-CHD组(P＜0.001);高Gensini评分组血清TNC水平显著高于中Gensini评分组,中Gensini评分组TNC水平显著高于低Gensini评分组(P＜0.001)。Pearson相关性分析、多因素线性回归分析显示,CHD组血清TNC水平与Gensini评分呈显著正相关(P＜0.001)。ROC曲线分析显示,TNC预测CHD的曲线下面积(AUC)为0.811(95%CI:0.768～0.974),Cut-off值为11.94 μg/L,灵敏度和特异度分别为83.5%和76.4%;TNC预测高Gensini评分患者的AUC为0.944(95%CI:0.816～0.989),Cut-off值为16.47 μg/L,灵敏度和特异度分别为82.6%和78.4%。结论 血清TNC水平与CHD患者Gensini评分明显相关,对CHD及冠状动脉粥样硬化严重程度有一定的预测价值。     

心肌桥对冠状动脉粥样硬化的作用

目的:探讨心肌桥与冠状动脉粥样硬化病变之间的关系。方法:回顾性分析冠脉造影术中检出的心肌桥患者92例的冠脉病变与临床资料。结果:1500例冠脉造影患者检出心肌桥92例,检出率6.1%;心肌桥近段冠状动脉粥样硬化病变发生率71.7%,远段冠状动脉粥样硬化病变发生率10.9%,两者差异有显著性（P<0.01）。结论:心肌桥可能导致冠状动脉心肌桥近段冠脉粥样硬化病变。     

Aortic sclerosis--a marker of coronary atherosclerosis

Aortic valve sclerosis is defined as calcification and thickening of a trileaflet aortic valve in the absence of obstruction of ventricular outflow. Its frequency increases with age, making it a major geriatric problem. Of adults aged > 65 years, 21-29% exhibit aortic valve sclerosis. Incidence of aortic sclerosis increases with age, male gender, smoking, hypertension, high lipoprotein (Lp) (a), high low-density lipoprotein (LDL), and diabetes mellitus. Aortic valves affected by aortic sclerosis contain a higher amount of oxidized LDL cholesterol and show increased expression of metalloproteinases. Clinically, it can be suspected in the presence of soft ejection systolic murmur at the aortic area, normal split of the second heart sound, and normal volume carotid pulse, but it can be best detected by echocardiography. Aortic sclerosis may be accompanied by mitral annulus calcification up to 50% of cases. It is associated with an increase of approximately 50% in the risk of death from cardiovascular causes and the risk of myocardial infarction. The mechanism by which aortic sclerosis contributes to or is associated with increased cardiovascular risk is not known. Aortic sclerosis is associated with systemic endothelial dysfunction, and a small percentage of cases may progress to aortic stenosis. Lowering of LDL cholesterol by 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors have been shown to decrease progression of aortic valve calcification. Aortic sclerosis is not a mere benign finding. Once diagnosis of aortic sclerosis has been made, it should be considered a potential marker of coexisting coronary disease. Aggressive management of modifiable risk factors, especially LDL cholesterol lowering, may slow progression of the disease.     

Measuring progression and regression of coronary atherosclerosis in clinical trials: problems and progress

Interventions that may influence the evolution of coronary atherosclerosis can be evaluated more rapidly and efficiently in clinical trials with angiographic endpoints as opposed to using coronary events as endpoints. Quantitative coronary arteriography provides precise and reproducible measurements of coronary artery dimensions for this purpose. The variability of 2 quantitative systems was assessed in 54 lesions under 4 different conditions:-same film, same frame; -same film, same view; different frame; -same view from different films obtained within one month; and -same view from different films obtained one to 6 months apart. With the Cardiovascular Angiographic Analysis System (CAAS), variability of repeat measurement of minimum diameter, expressed as 1 standard deviation of the mean, increased from 0.088 mm (same frame) to 0.197 mm (films 1 to 6 months apart) as conditions decreased from optimal to those encountered in clinical studies. With the Cardiovascular Measurement System (CMS), 1 standard deviation for repeat measurements of minimum diameter increased from 0.087 mm (same frame) to 0.240 mm (films one to 6 months apart). The differences between the two systems for measurements of minimum diameter were not statistically significant and CMS tracked the arterial edge more meticulously than did CAAS. A change in minimum diameter 0.4 mm for CAAS or 0.48 mm for CMS is more than 2 standard deviations of the mid-term variability and therefore represents a true change, either progression or regression, with greater than 95% probability.Quantitative coronary arteriography is an essential tool in clinical trials to assess the effect of an intervention upon the evolution of coronary atherosclerosis. Some of the problems in data analysis related to this methodology are discussed.