Activation of clotting factors XI and IX in patients with acute myocardial infarction

In acute coronary events, plaque rupture and the subsequent formation of the catalytic tissue factor-factor VIIa complex is considered to initiate coagulation. It is unknown whether clotting factors XI and IX are activated in acute coronary events. Therefore, we prospectively investigated the activation of clotting factors XI and IX as well as activation of the contact system and the common pathway in 50 patients with acute myocardial infarction (AMI), in 50 patients with unstable angina pectoris (UAP), and in 50 patients with stable angina pectoris (SAP). Factor XIa-C1 inhibitor complexes, which reflect acute activation of factor XI, were detected in 24% of the patients with AMI, 8% of the patients with UAP, and 4% of the patients with SAP (P<0.05), whereas factor XIa-alpha(1)-antitrypsin complexes, which reflect chronic activation, were observed equally in all 3 study groups. Factor IX peptide levels were significantly higher in the patients with AMI and UAP compared with the patients with SAP (P<0.01). No differences regarding markers of the common pathway were demonstrated. Fibrinopeptide A levels were elevated in patients with AMI compared with patients with UAP and those with SAP (P<0.01). Factor XIIa- or kallikrein-C1 inhibitor complexes were not increased. In conclusion, this is the first demonstration of the activation of clotting factors XI and IX in patients with acute coronary syndromes. Because these clotting factors are considered to be important for continuous thrombin generation and clot stability, their activation might have clinical and therapeutic consequences.     

急性心肌梗死患者血清高迁移率族蛋白1含量变化及意义

目的探讨急性心肌梗死（AMI）患者血清高迁移率族蛋白1（HMGB1）含量的变化及其意义。方法采用ELISA法测定23例AMI患者、33例稳定型心绞痛患者（SAP）、27例不稳定型心绞痛患者（UAP）和30名健康查体者的血清HMGB1含量,并测定血清高敏C-反应蛋白（hs—CRP）。结果与对照组相比,SAP组、UAP组和AMI组血清HMGB1和hs—CRP水平均显著升高（P〈0．01）,而UAP组和AMI组显著高于SAP组（P〈0．01）,AMI组显著高于SAP组（P〈0．01）,表明冠心病患者病情越重,血清HMGB1和hs—CRP升高越明显（均P〈0．01）,且UAP、SAP和AMI组血清HMGB1和hs—CRP均分别呈正相关（r=0．4532、0．3247、0．4557,均P〈0．05）。结论血清HMGB1可能参与了AMI的发生发展过程,可用于冠心病患者严重程度的判断。     

Effectiveness of excimer laser coronary angioplasty in acute myocardial infarction or in unstable angina pectoris

This study was conducted to evaluate the feasibility, safety, and acute results of percutaneous excimer laser coronary angioplasty (ELCA) in acute coronary syndromes. Fifty-nine patients were treated with ELCA (308 nm), including 33 patients with unstable angina pectoris (UAP) (35 vessels with 39 lesions) and 26 patients with acute myocardial infarction (AMI) (26 vessels with 29 lesions). In each patient the target lesion had a complex morphology. Overall, 71% of the patients had contraindications for pharmacologic thrombolytic agents or glycoprotein IIb/IIIa receptor antagonists. All patients received adjunct balloon dilation followed by stent implantation in 88% of patients with AMI versus 76% of patients with UAP (p = NS). Quantitative angiography was performed at an independent core laboratory; 86% laser success and 100% procedural success was achieved in the AMI group versus 87% laser success and 97% procedural success in the UAP group (p = NS). In the AMI group, the minimal luminal diameter increased from 0.77 +/- 0.56 to 1.44 +/- 0.47 mm after lasing to a final 2.65 +/- 0.47 mm versus 0.77 +/- 0.38 to 1.35 +/- 0.4 mm after lasing to 2.66 +/- 0.5 mm final in the UAP group. A prelaser percent stenosis of 76 +/- 17% for the AMI group versus 70 +/- 16% for the UAP group (p = NS) was decreased after lasing to 52 +/- 16% for the AMI group versus 51 +/- 14% for the UAP group (p = NS) and to a final stenosis of 15 +/- 17% for the AMI group versus 12 +/- 15% for the UAP group (p = NS). A 96% laser-induced reduction of thrombus burden area was achieved in the AMI group versus 97% in the UAP group (p = NS). Preprocedure Thrombolysis In Myocardial Infarction flow of 1.3 +/- 0.9 in the AMI group versus 2.3 +/- 1.2 for the UAP group (p = 0.01) increased to a final flow of 3.0 +/- 0 for the AMI group versus 3.0 +/- 0 for the UAP group (p = NS). There were no deaths, cerebrovascular accident, emergency bypass surgery, acute closure, major perforation or major dissection, distal embolization, or bleeding complications in either group. One patient with AMI had localized perforation (caused by guidewire) without sequelae and 1 patient with UAP had an abnormal increase in creatine kinase levels. All 59 patients survived the laser procedure, improved clinically, and were discharged. Thus, early experience in patients with acute coronary syndromes suggest that percutaneous ELCA is feasible and safe.     

Increased immunoglobulin E response in acute coronary syndromes

The role of inflammation and mast cell activation has been implicated in atherosclerotic plaque destabilization and rupture. To investigate the role of immunoglobulin E (IgE) in acute coronary syndrome, a prospective clinical study was conducted in patients with acute myocardial infarction (AMI), unstable angina pectoris (UAP), stable angina pectoris (SAP), and healthy controls. IgE levels were serially measured and compared in consecutive patients with AMI (n = 16) and UAP (n = 14) on days 1, 3, 7, 21 after admission and 3 months later and only once in stable angina pectoris (n = 15) and healthy controls (n = 14). In addition, blood eosinophil and basophil levels on admission were measured in all groups and compared. Initial IgE levels determined at admission in patients with AMI, UAP, and SAP were significantly higher than levels in the control group (p = 0.002). Initial high IgE level in AMI on day 1 increased to a peak by day 7 (p = 0.024), then gradually decreased by day 21 and at 3 months (p = 0.052). High IgE level in UAP persisted by day 7 and gradually decreased by day 21 and 3 months (p = 0.037 and p = 0.018, respectively). Blood eosinophil count on admission was significantly higher in UAP than in the control group (p = 0.005). Basophil levels of both AMI and UAP groups on admission were found to be elevated as opposed to control group (p = 0.02 and p = 0.012, respectively). This study demonstrates that the level of IgE significantly increased during the acute phase of acute coronary syndromes and gradually decreased, supporting the role of acute inflammatory response and mast cell involvement in plaque rupture.     

Association of C-reactive protein and myocardial perfusion in patients with ST-elevation acute myocardial infarction

This study sought to evaluate the relation between C-reactive protein (CRP) on admission of patients with acute myocardial infarction (AMI) and myocardial perfusion as defined by postintervention angiographic myocardial blush grade (MBG) and their impact on subsequent mortality. The patient population comprised 191 consecutive patients with AMI undergoing PTCA within 12h of symptom onset on a native vessel. Patients were divided based on the CRP level on admission (Rolf Greiner BioChemica, Germany, cutpoint for the assay CRP: 5mg/l) into a group with elevated CRP (>or=5mg/l) and a group with normal CRP. Angiographic myocardial blush grade (MBG) after revascularization of the infarct-related artery was determined to evaluate myocardial reperfusion. Revascularization of the infarct-related artery was successful in 176 (92.6%) patients. The frequency of impaired perfusion (MBG 0-2) was higher in the elevated CRP group than in the normal CRP group (74.5% versus 59.7%, respectively, p=0.046). Elevated CRP on admission was an independent predictor of impaired myocardial perfusion (MBG 0-2, OR 1.92, 95% CI 1.02-4.01, p=0.042) in addition to age >70 years. Elevated CRP (OR 2.64, 95% CI 1.26-5.53, p=0.009) and MBG 0-2 (OR 4.58; 95% 1.73-12.20, p=0.002) were independent predictors of mortality during a 22.4+/-15.3 months follow-up in addition to heart rate on admission >100 beats/min (OR 3.07; 95% CI 1.30-7.25, p=0.009). In sequential Cox models, the predictive power of clinical data and MBG for mortality (model chi-squared 18.3) was strengthened by the inclusion of CRP levels (model chi-squared 24.3). In conclusion, there is a relation between elevated admission CRP and impaired reperfusion in the myocardium subtended to the infarct-related artery. The combination of clinical data, myocardial reperfusion levels after primary angioplasty for AMI and admission CRP increases the predictive value for subsequent survival.     

Usefulness of C-reactive protein and left ventricular function for risk assessment in survivors of acute myocardial infarction

The additional prognostic information provided by C-reactive protein (CRP) to parameters of left ventricular function in survivors of acute myocardial infarction (AMI) was investigated in 665 patients (326 with ST elevation and 339 with non-ST elevation). Cox multivariable analysis identified the following predictors of 6-month cardiac death: age (per 5 years hazard ratio [HR] 1.2, 95% confidence interval [CI] 1.1 to 1.4, p = 0.004), Killip class >I at presentation (HR 2.4, 95% CI 1.3 to 4.5, p = 0.0001), a reduced ejection fraction (per 5% HR 1.3, 95% CI 1.2 to 1.4, p = 0.0001), and greater CRP (per 5 mg/L HR 1.02, 95% CI 1.01 to 1.04, p = 0.02); the C-index of the model was 0.77 without and 0.78 with CRP. CRP is associated with mortality in addition to age and parameters of ventricular function (Killip class and ejection fraction) in survivors of AMI, although the relevance of its additive predictive role seems marginal.     

Predictors of ten-year event-free survival in patients with acute myocardial infarction (from the Adria, Bassano, Conegliano, and Padova Hospitals [ABC] study on myocardial infarction)

The long-term event-free survival (EFS) after acute myocardial infarction (AMI) is largely uninvestigated. We analyzed noninvasive clinical variables in association with long-term EFS after AMI. The present prospective study included 504 consecutive patients with AMI at 3 hospitals from 1995 to 1998 (Adria, Bassano, Conegliano, and Padova Hospitals [ABC] study). Thirty-seven variables were examined, including demographics, cardiovascular risk factors, in-hospital characteristics, and blood components. The end point was 10-year EFS. Logistic and Cox regression models were used to identify the predictive factors. We compared 3 predictive models according to the goodness of fit and C-statistic analyses. At enrollment, the median age was 67 years (interquartile range 58 to 75), 29% were women, 38% had Killip class >1, and the median left ventricular ejection fraction was 51% (interquartile range 43% to 60%). The 10-year EFS rate was 19%. Both logistic and Cox analyses identified independent predictors, including young age (hazard ratio 1.2, 95% confidence interval 1.1 to 1.3, p = 0.0006), no history of angina (hazard ratio 1.4, 95% confidence interval 1.1 to 1.8, p = 0.009), no previous myocardial infarction (hazard ratio 1.4, 95% confidence interval 1.1 to 1.7, p = 0.01), high estimated glomerular filtration rate (hazard ratio 0.8, 95% confidence interval 0.7 to 0.9, p = 0.001), low albumin/creatinine excretion ratio (hazard ratio 1.2, 95% confidence interval 1.1 to 1.3, p <0.0001), and high left ventricular ejection fraction (hazard ratio 0.8, 95% confidence interval 0.7 to 0.9, p = 0.006). These variables had greater predictive power and improved the predictive power of 2 other models, including Framingham cardiovascular risk factors and the recognized predictors of acute heart damage. In conclusion, 10-year EFS was strongly associated with 4 factors (ABC model) typically neglected in studies of AMI survival, including estimated glomerular filtration rate, albumin/creatinine excretion ratio, a history of angina, and previous myocardial infarction. This model had greater predictive power and improved the power of 2 other models using traditional cardiovascular risk factors and indicators of heart damage during AMI.     

Comparison of levels of serum matrix metalloproteinase-9 in patients with acute myocardial infarction versus unstable angina pectoris versus stable angina pectoris

Matrix metalloproteinases (MMPs) are important for resorption of extracellular matrixes and may degrade the fibrous cap of an atherosclerotic plaque, thus contributing to coronary plaque rupture. Histologic studies have shown MMP expression in lesions of acute coronary syndrome. In this study, we evaluated the relation between plaque morphology as obtained by intravascular ultrasound before percutaneous coronary intervention and serum MMP levels in patients who had coronary artery disease. We enrolled consecutive 47 patients who had acute myocardial infarction (AMI), 23 who had unstable angina pectoris (UAP), and 19 who had stable effort angina pectoris and underwent intravascular ultrasound before percutaneous coronary intervention followed by successful primary percutaneous coronary intervention. Peripheral blood was obtained from all patients before angiography and serum levels of MMP-1,-2, and -9 were analyzed. Serum levels of MMP-9 in the AMI and UAP groups were significantly higher than that in the stable effort angina pectoris group (p = 0.007 and 0.04, respectively). From the intravascular ultrasound findings before percutaneous coronary intervention, plaque rupture was detected in 26 patients (55%) in the AMI group and in 11 patients (48%) in the UAP group. In these 2 groups, patients with plaque rupture had significantly higher levels of MMP-9 than patients who did not have plaque rupture (p = 0.03 and 0.01, respectively). Multiple logistic regression analysis showed that MMP-9 was the only independent predictor of plaque rupture (p = 0.004). In conclusion, high levels of MMP-9 in patients who have AMI and UAP are related to the presence of plaque rupture in the culprit lesion.     

冠心病患者血浆正五聚蛋白-3、血清超敏C-反应蛋白与血脂的相关性

目的：通过分别检测冠心病患者及正常人的血浆正五聚蛋白-3（PTX3）、血清超敏C-反应蛋白（hs—CRP）及各项血脂水平,探讨血浆PTX3水平在各组间的差异以及血浆PTX3、血清hs—CRP与血脂的相关性。方法：入选经冠脉造影正常的40例患者为对照组;冠脉造影确诊为冠心病的60例,分为稳定型心绞痛（SAP）组,20例;不稳定型心绞痛（UAP）组,20例;急性心肌梗塞（AMI）组,20例。分别检测各组入院第2d的血浆PTX3、血清h～CRP及各项血脂水平。血浆PTX3和血清hs—CRP水平取对数后均服从正态分布。对所得数据进行单因素方差分析、两变量相关分析及多元线性回归分析。结果：UAP组和AMI组患者的血浆PTX3对数水平显著高于SAP组和对照组的（P均〈0．05）;SAP组与对照组之间差异元显著性（P〉0．05）;UAP组和AMI组之间差异有显著性（P％0．05）。患者血浆PTX3对数水平与低密度脂蛋白－胆固醇（LDL-C）水平存在正相关（r＝0．641。P〈0．05）,与总胆固醇（TC）、甘油三酯（TG）及高密度脂蛋白－胆固醇（HDL—C）无线性相关（P均〉0．05）;而血清hs—CRP对数水平与TG、TC、LDL—C呈正相关．且与HDL-C呈负相关（r值分别为0．325、0．228、0．625、－0．312,P均〈0．05）。患者血浆PTX3对数水平与血清hs—CRP对数水平呈正相关（r=0．729,P〉0．05）。多元线性回归分析显示血浆PTX－3和LDL—C的相关性优于血清hs—CRP和LDL—C的（B=0．492,P=0．001：β＝0．382,P=0．03）。结论：血浆PTX3水平与血清hs-CRP水平呈正相关,PTX3是心血管疾病的独立危险因素,其与LDL—C的相关性优于hs—CRP。     

老年冠心病患者不同临床类型血脂水平的观察

目的　探讨老年冠心病患者不同临床类型血脂水平的差异。方法　将确诊为冠心病的 70岁以上老年患者6 4 7例 ,分为急性心肌梗死 (AMI)组、稳定性心绞痛 (SAP)组、不稳定性心绞痛 (UAP)组 ,另选无冠心病的老年患者 70例作为对照组 ,比较各组间的血脂水平。结果　AMI组和UAP组血清胆固醇水平与对照组及SAP组比较 ,差异有显著性意义 ;血清甘油三酯水平随着冠心病病情程度加重 ,呈逐渐升高的趋势 ;SAP组、UAP组和AMI组低密度脂蛋白胆固醇 (LDL C)水平高于对照组 ,高密度脂蛋白胆固醇 (HDL C)水平低于对照组 ,差异有显著性意义 ;SAP组、UAP组和AMI组LDL C HDL C比值均高于对照组 ,AMI组LDL C HDL C比值高于UAP组和SAP组 ,差异有显著性意义。结论　在 70岁以上老年冠心病患者中 ,LDL C HDL C比值与AMI的发生关系密切     

Safety and efficacy of sirolimus-eluting stent implantation in patients with acute coronary syndrome in the real world

The use of drug-eluting stents in patients with acute coronary syndrome (ACS), particularly those with acute myocardial infarction (AMI), is controversial owing to concerns about late adverse events. We evaluated the long-term safety of sirolimus-eluting stent implantation in patients with ACS. Of 10,778 patients treated exclusively with a sirolimus-eluting stent in the j-Cypher registry, the 3-year outcomes of 2,308 patients with ACS (953 patients with AMI) were compared to those of 8,470 patients without ACS. Compared to patients without ACS, the patients with ACS had a significantly greater adjusted risk of death or myocardial infarction (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.12 to 1.37, p <0.0001) and definite or probable stent thrombosis (HR 1.43, 95% CI 1.11 to 1.82, p = 0.006) within the first year after sirolimus-eluting stent implantation. However, after 1 year, patients with ACS no longer had a greater risk of death or myocardial infarction (HR 1.01, 95% CI 0.90 to 1.13, p = 0.87) and stent thrombosis (HR 1.32, 95% CI 0.92 to 1.86, p = 0.13). Of the patients with ACS, those with AMI had a greater risk of death or myocardial infarction (HR 1.33, 95% CI 1.12 to 1.6, p = 0.001) and stent thrombosis (HR 1.57, 95% CI 1.05 to 2.39, p = 0.03) than those with unstable angina pectoris within the first year. However, they had a similar risk of death or myocardial infarction (HR 1.00, 95% CI 0.78 to 1.22, p = 0.83) and stent thrombosis (HR 0.83, 95% CI 0.38 to 1.6, p = 0.59) after 1 year. The risk of late adverse events >1 year after sirolimus-eluting stent implantation was similar between those with and without ACS and between those with AMI and those with unstable angina pectoris.     

冠心病患者C反应蛋白变化的临床意义

目的　探讨 C反应蛋白 (CRP)与冠心病之间的关系。方法　冠心病组 (12 8例 )分为 3组 ,急性心肌梗死(AMI)组 34例 ,不稳定心绞痛 (U AP)组 49例 ,稳定性心绞痛 (SAP)组 45例。比较冠心病组各组间及与对照组(12 8例 )之间 CRP、白细胞 (WBC)、纤维蛋白原 (FIB)及血脂水平的差异。结果　冠心病组 CRP和 WBC水平高于对照组 (P分别为 0 .0 0 6和 0 .0 13) ,经调整性别、年龄、体重指数、吸烟史、高血压病及糖尿病史、血脂指标后 ,CRP和 WBC水平仍与冠心病患病率显著相关 ,OR(比数比 )分别为 1.6 83和 1.46 8(均 P<0 .0 5 )。 AMI组及 U AP组CRP水平与对照组相比有显著性差异 (P<0 .0 5 ,P<0 .0 0 1) ;UAP组与 SAP组相比 ,CRP水平也有显著性差异 (P<0 .0 5 ) ;而 SAP组与对照组相比 CRP水平则无明显差异 (P>0 .0 5 )。结论　 CRP是冠心病的独立危险因素。CRP升高提示冠心病患者病情不稳定     

纤溶指标的变化与急性冠状动脉事件的关系

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冠心病患者血清C反应蛋白和可溶性细胞间粘附分子1与肺炎衣原体感染的相关性

目的探讨冠心病患者血清炎症标志物C反应蛋白和可溶性细胞间粘附分子1水平的变化及其与肺炎衣原体感染的关系。方法采用酶联免疫吸附法检测60例急性心肌梗死、不稳定型心绞痛、陈旧性心肌梗死、稳定型心绞痛及40例对照者血清C反应蛋白、可溶性细胞间粘附分子1及肺炎衣原体抗体IgG、IgM。结果冠心病组肺炎衣原体IgG阳性率和浓度均高于对照组(P<0.01),冠心病各组之间肺炎衣原体IgG和IgM阳性率差异无显著性(P>0.05),急性心肌梗死组肺炎衣原体IgG浓度高于陈旧性心肌梗死组、不稳定型心绞痛组和稳定型心绞痛组(P<0.05);冠心病组C反应蛋白、可溶性细胞间粘附分子1水平高于对照组(P<0.01),急性心肌梗死组C反应蛋白、可溶性细胞间粘附分子1水平高于不稳定型心绞痛组、陈旧性心肌梗死组和稳定型心绞痛组(P<0.01),不稳定型心绞痛组C反应蛋白、可溶性细胞间粘附分子1水平高于稳定型心绞痛组(P<0.05);肺炎衣原体IgG浓度、C反应蛋白、可溶性细胞间粘附分子1之间有很好的相关性(P<0.05)。结论炎症标志物水平变化在一定程度上反映了冠心病患者病情变化,肺炎衣原体感染与冠心病有关,炎症、感染可能共同参与了冠心病的发生发展。     

急性冠脉综合征患者血浆可溶性Fas配体水平变化及其意义

目的：探讨急性冠脉综合征患者血浆可溶性Fas配体（sFasL）水平的变化及其意义。方法：入选急性冠脉综合征患者50例,其中急性心肌梗塞（AMI）30例（AMI组）、不稳定型心绞痛（UAP）20例（UAP组）,另有稳定型心绞痛（SAP）患者20例为SAP组,30例健康对照者为健康对照组。采用酶联免疫吸附试验检测各组sFasL水平,并比较其结果。结果：（1）血浆sFasL水平在AMI组[（100.56±30.61）pg/ml]和UAP组[（51.13±23.46）pg/ml]显著高于SAP组[（7.08±1.20）pg/ml]和健康对照组[（6.19±1.11）pg/ml],P均〈0.01;（2）病程观察显示AMI患者经皮冠状动脉成形术后3h内血浆sFasL水平迅速下降,此后再次上升,而SAP患者则否;（3）冠状窦内sFasL水平明显高于外周血[（210±40）pg/ml∶（78±21）pg/ml,P〈0.05];（4）体外研究表明FasL信使核糖核酸表达在AMI患者离体单核细胞上调,低氧可刺激离体单核细胞sFasL释放。结论：急性冠脉综合征患者sFasL水平显著升高提示Fas/FasL系统活化,可能参与急性冠脉综合征的发病过程。     

D-二聚体定量检测对判定急性冠脉综合征血栓形成的研究

目的：探讨D-二聚体定量检测对于判定急性冠脉综合征（ACS）血栓形成的意义。方法：选择住院不稳定型心绞痛（UAP）患者36例,急性心肌梗塞（AMI）患者13例,稳定型心绞痛（SAP）患者23例,采用胶体金标法动态检测患者静脉血中的D-二聚体含量。结果：D-二聚体含量：UAP组（0．95±0．32）mg／L,AMI组（1．82±0．63）mg／L,UAP组与SAP组（0．39±0．15）mg／L比较有显著差异（P〈0．05）,AMI组与SAP组比较,差异非常显著（P〈0．01）。结论：D-二聚体定量检测是判定ACS血栓形成相对特异的敏感指标。     

心型脂肪酸结合蛋白和缺血修饰白蛋白在UAP危险分层中的诊断价值

目的探讨心型脂肪酸结合蛋白（H-FABP）和缺血修饰白蛋白（IMA）在不稳定型心绞痛（UAP）危险分层中的诊断价值。方法将110例冠心病患者分为稳定型心绞痛（SAP组）20例,急性冠脉综合征（ACS组）90例,ACS组又分成急性心肌梗死（AMI组）35例,UAP组55例（其中低危组18例、中危组20例、高危组17例）;另选30例体检正常者作为对照组。检测各组血清H-FABP、IMA。结果 AMI组血清H-FABP、IMA明显高于其他组（P均〈0.01）;ACS组明显高于SAP组、对照组、UAP低危组（P〈0.05或〈0.01）;UAP低危组、中危组、高危组间比较均有统计学差异（P均〈0.05）。结论血清H-FABP、IMA水平随UAP危险程度增加而升高,根据二者的血清水平可判断UAP患者的危险程度。     

Levels and values of serum high-sensitivity C-reactive protein within 6 hours after the onset of acute myocardial infarction

BACKGROUND: C-reactive protein (CRP), which has been suggested to directly enhance inflammation in plaques, is rapidly synthesized and secreted in the liver 6 h after an acute inflammatory stimulus. Therefore, serum levels of CRP within 6 h after the onset of acute myocardial infarction (AMI) merely reflect a chronic and persistent inflammatory process and are not due to acute myocardial damage. We hypothesized that the serum CRP level, which would abnormally elevate thereafter, is followed by a plaque rupture in the clinical setting of AMI. METHODS AND RESULTS: CRP was prospectively measured by high-sensitivity CRP assay (hs-CRP) in 157 consecutive patients (106 patients within 6 h, and 51 patients >/= 6 h but < 12 h after the onset of AMI) with ST-segment elevation AMI undergoing primary percutaneous coronary intervention (PCI). Serum levels of hs-CRP were also measured in 30 patients with stable angina undergoing elective PCI and in 30 healthy control subjects. The serum level of hs-CRP was significantly higher in patients with an onset of AMI < 6 h than in patients with angina pectoris (2.7 +/- 2.3 mg/L vs 1.4 +/- 0.7 mg/L, p < 0.0001 [mean +/- SD]) and in healthy subjects (2.7 +/- 2.3 mg/L vs 1.0 +/- 0.6 mg/L, p < 0.0001). There were no significant differences in serum levels of hs-CRP in patients with an onset of AMI 3 h but < 6 h (2.7 +/- 2.5 mg/L vs 2.7 +/- 2.2 mg/L, p = 0.87). However, the serum level of hs-CRP was significantly higher in patients with an onset >/= 6 h than in patients with an onset < 6 h (14.1 +/- 16.5 mg/L vs 2.7 +/- 2.3 mg/L, p < 0.0001). CONCLUSIONS: Serum levels of hs-CRP were significantly higher in patients with an onset of AMI < 6 h than in healthy subjects and in patients with angina pectoris undergoing PCI. The inflammatory process has been proved as one of the mechanisms causing plaque rupture. Elevated serum hs-CRP levels in patients with AMI < 6 h may portend vulnerable plaque rupture.     

血浆血栓调节蛋白水平与冠心病关系的研究

目的:分别测定正常人及冠心病患者的血浆血栓调节蛋白(Thrombomodulin,TM)含量并探讨及与冠心病的关系。方法:观察对象分成正常对照组,稳定性心绞痛(SAP)组,不稳定性心绞痛(UAP)组及急性心肌梗死(AMI)组。采用酶联免疫吸附试验测量血浆TM值。结果:UAP组及AMI组TM水平无显著性差异(P=0.711),但这两组TM水平均明显高于SAP组及正常对照组(P<0.01),SAP组TM水平又高于正常对照组(P=0.05)。结论:血浆血栓调节蛋白水平是反映冠心病患者内皮细胞损伤程度和范围以及冠脉斑块稳定性的良好指标,对急性冠脉综合征与SAP的鉴别有较好的价值。     

血清淀粉样蛋白A1在急性心梗中的早期诊断及预后

[摘要] 目的：本研究探讨SAA1表达水平与急性心肌梗死及其预后的相关性,以及急性心肌梗死患者、不稳定心绞痛患者、稳定性心绞痛患者与健康人群的差异性表达。方法：选取2016年10月至2018年7月于我院行冠状动脉造影术的110例患者和健康体检的30例患者,作为研究对象;其中急性心肌梗死组（AMI组）50人,不稳定心绞痛组（UA组）32人,稳定性心绞痛组（SAP组）28人,正常组（CON组）30人;其中急性心肌梗死组分为发病当天（AMI0组）及入院7天组（AMI7组）,对比各组间SAA1指标的差异性。并收集患者的一般资料及相关化验检查。Pearson相关分析方法分析HDL-C及BNP水平与急性心梗组SAA1水平的相关性;同时初步探究SAA1水平与心梗后心功能不全发生风险的相关性。结果：AMI组SAA1水平明显高于其他三组（UAP、SAP、CON组）,两两比较均具有统计学意义（P=0.000）;UA组SAA1水平明显高于CON组,且高于SAP组,两两比较均有统计学差异（P=0.047,P=0.009）; SAP组与CON组差异无统计学意义（P=0.507）。 BNP升高水平同AMI组中SAA1水平具有明确正相关（r=0.421,P=0.045）;HDL-C水平同AMI组中SAA1水平具有明确负相关（r=-0.445,P=0.033）;而LDL-C及cTnI同AMI组中SAA1水平无统计学差异（r=0.015,P=0.945;r=-0.171,P=0.436）。AMI0组SAA1水平明显高于AMI7组,差异存在统计学意义（P=0.002）。结论：SAA1蛋白在急性心肌梗死、不稳定心绞痛、稳定性心绞痛与健康人群中存在明显差异。在急性心梗组中SAA1升高水平与BNP呈正相关,提示心梗后心衰风险升高。 SAA1蛋白在急性心肌梗死中发病当天及7天后存在的明显差异。