中青年与老年2型糖尿病患者非高密度脂蛋白胆固醇、动脉硬化指数的对比分析

目的对比分析中青年和老年2型糖尿病患者非高密度脂蛋白胆固醇(non-HDL-C)、动脉硬化指数(AI)。方法选取2017年江苏大学附属武进人民医院内分泌科收治的2型糖尿病患者346例,根据发病年龄分为中青年组138例(发病年龄24~59岁)和老年组208例(发病年龄60~90岁),对比分析两组患者一般资料和血脂指标。结果老年组患者女性比例、高血压发生率高于中青年组,糖化血红蛋白(Hb A1c)低于中青年组(P0.05);两组患者体质指数(BMI)、冠心病发生率、吸烟率比较,差异无统计学意义(P0.05)。老年组患者总胆固醇(TC)、三酰甘油(TG)、载脂蛋白B(Apo B)、non-HDL-C、AI低于中青年组(P0.05);两组患者低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(Apo A1)比较,差异无统计学意义(P0.05)。亚组分析结果显示,老年组男性患者TC、TG、Apo B、non-HDL-C、AI低于中青年组,而两组男性患者LDL-C、HDL-C、Apo A1比较,差异无统计学意义(P0.05);两组女性患者TC、TG、LDL-C、HDL-C、Apo A1、Apo B、non-HDL-C、AI比较,差异无统计学意义(P0.05)。结论中青年2型糖尿病患者尤其是男性患者non-HDL-C、AI高于老年2型糖尿病患者,non-HDL-C、AI能更全面地反映2型糖尿病患者血脂代谢状况,临床应重视non-HDL-C、AI的控制。     

心电图与冠状动脉造影诊断冠心病的临床分析

目的探讨心电图与冠状动脉造影对诊断冠心病的临床价值.方法观察575例临床诊断为冠心病的病人,均行18导联心电图(ECG)检查并行冠状动脉造影(CAG)检查.结果575例病人中有392例病人CAG阳性,临床符合率68.2%.ECG检查冠心病的灵敏度为76.9%,特异度为34.9%.心电图ST-T改变伴典型胸痛病人,CAG阳性率85.1%,心电图ST-T改变伴不典型胸痛病人,CAG阳性率43.3%,典型胸痛无心电图ST-T改变,CAG阳性率74.7%,不典型胸痛无心电图ST-T改变,CAG阳性率35.8%.结论典型胸痛伴心电图ST-T改变,对冠心病的诊断价值要优于不典型胸痛伴心电图ST-T改变,无心电图ST-T改变的典型胸痛病人不能排除冠心病,CAG检查可避免ECG检查对冠心病诊断造成的误诊、漏诊.     

冠心病患者年龄与血脂异常的关系

目的:探讨不同年龄冠心病病人血脂水平的差异,为临床更合理地调脂治疗提供依据。方法:采用回顾性方法对120例70～86岁(A组)和 162例 35～60岁(B组)的冠心病病人的血脂水平进行对比分析。结果:老年冠心病病人的血清总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)水平略高于中年组,但无统计学意义;高密度脂蛋白胆固醇(HDL-C)老年组高于中年组(P<0.05);而血清甘油三酯(TG)水平则中年组非常显著高于老年组(P<0.01)。结论:在各年龄组都要严格控制TC和LDL-C水平以预防冠心病,对于中年人群还需注意降低过高的TG水平,提高HDL-C水平。     

高甘油三酯/低高密度脂蛋白胆固醇、心电图ST-T改变与冠心病的关系

目的:探讨无明显心血管病(CVD)临床症状,有高甘油三酯(TG≥1.60mmol/L),低高密度脂蛋白胆固醇(HDL-C≤1.18mmol/L),静息心电图缺血型ST-T改变与冠心病(CAD)的关系。方法:对无明显CVD临床症状,有高TG/低HDL-C血症的550例[其中静息ECG有缺血型ST-T改变者250例(A组),无缺血型ST-T改变者300例(B组)]进行2年随访对比观察,观察其的CAD发生率和死亡率。结果:2年随访期中,A组的CAD的发生率为16.00%,死亡率为3.20%;均显著高于B组的CAD发生率(2.00%),死亡率(0.66%),P均0.001。结论:结果显示无明显CVD临床症状,有高TG/低HDL-C血症,伴有静息ECG缺血型ST-T改变对冠心病的危险性更大。     

老年急性心肌梗死患者的血脂异常特点

目的探讨老年急性心肌梗死(AMI)患者的血脂异常特点。方法回顾性分析2007年5月至2011年7月该院收治的符合入选标准的AMI患者1 213例。比较老年与非老年以及老年各年龄组间AMI患者各血脂参数〔总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、非高密度脂蛋白胆固醇(N-HDL-C)等〕的差异。结果与非老年组比较,老年组的TC、LDL、TG、TC/HDL-C、LDL-C/HDL-C、TG/HDL-C、N-HDL-C、载脂蛋白B低于非老年组(P=0.000),而HDL-C、脂蛋白(a)、载脂蛋白A高于非老年组(P<0.05)。60⁶9岁女性AMI患者的TC、LDL、HDL、N-HDL-C、载脂蛋白A、载脂蛋白B高于男性;在7069岁女性AMI患者的TC、LDL、HDL、N-HDL-C、载脂蛋白A、载脂蛋白B高于男性;在70⁷9岁老年AMI患者,女性的TC、TG、HDL-C、N-HDL-C、载脂蛋白A高于男性(P<0.05);在≥80岁老年AMI患者,女性的TC、N-HDL-C、载脂蛋白A高于男性(P<0.05)。不同年龄组的老年AMI同性别间比较,6079岁老年AMI患者,女性的TC、TG、HDL-C、N-HDL-C、载脂蛋白A高于男性(P<0.05);在≥80岁老年AMI患者,女性的TC、N-HDL-C、载脂蛋白A高于男性(P<0.05)。不同年龄组的老年AMI同性别间比较,60⁶9岁年龄组的TC、LDL、TG、N-HDL-C高于7069岁年龄组的TC、LDL、TG、N-HDL-C高于70⁷9岁及≥80岁年龄组(P<0.05),但三组间HDL-C无差异(P>0.05),7079岁及≥80岁年龄组(P<0.05),但三组间HDL-C无差异(P>0.05),70⁷9岁组与≥80岁组同性别间各血脂参数无差异(P>0.05)。老年AMI患者的血脂正常比例明显高于非老年AMI患者(20.21%,P<0.05),单纯性低HDL占AMI患者血脂四项联合异常的最大比例。结论老年AMI患者的血脂异常危害暴露水平低于非老年患者。老年AMI各年龄组内女性较男性存在更为严重的血脂异常;低龄老年组的血脂异常较中高龄老年组更为严重。单纯性低HDL-C是老年及非老年AMI患者最常见的血脂组合异常类型。     

2型糖尿病合并冠心病脂质及ApoA1/ApoB变化分析

目的研究2型糖尿病(T2DM)合并冠心病患者脂质及载脂蛋白A1/载脂蛋白B(ApoA1/ApoB)变化的临床意义。方法收集本院收治的住院病人155例,按是否有冠心病分成两组,即A、B两组,A组为合并冠心病组,共60人;B组为不合并冠心病组,共95人。另外收集门诊健康体检病人作为对照组,即C组,共70人。比较三组间总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、ApoA1、ApoB及ApoA1/ApoB值。结果 A、B两组相比,A组TC、TG、LDL-C、ApoB较B组明显升高(P<0.05),HDL-C和ApoA1/B比值较B组明显下降,差异有统计学意义(P<0.05);与C组相比,A、B两组中HDL-C及ApoA1下降(P<0.05),TC、TG、LDL-C、ApoB水平升高,差异有统计学意义(P<0.05)。结论 2型糖尿病合并冠心病存在多种脂质代谢紊乱。血清HDL-C、ApoA1水平和ApoA1/ApoB值与2型糖尿病合并冠心病病变严重程度呈负相关。     

Ⅱ型糖尿病患者颈动脉粥样硬化与血尿酸、纤维蛋白原的关系

目的:探讨Ⅱ型糖尿病(T2DM)患者血清尿酸（UA）、纤维蛋白原(Fg)水平是否与颈动脉粥样硬化(AS)有关。方法: T2DM患者218例,根据有无颈AS分为2组, 对患者年龄、病程、高血压病、UA、肌酐(Cr)、总胆固醇（TC）、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇（HDL-C）、糖基化血红蛋白和Fg等AS危险因素进行单因素和多因素分析。结果: logistic回归分析显示年龄、病程、UA、Cr、UA /Cr、LDL-C,Fg与T2DM颈AS有相关性。UA危险因素的多元逐步回归分析显示病程、颈AS、Cr、TG、TC与UA相关;Fg危险因素的多元逐步回归分析显示,颈AS与Fg相关。结论: T2DM颈AS患者血清中UA、Fg明显升高,是AS的危险因素。     

血脂及部分血脂比值对冠心病的诊断价值

目的 分析探讨血脂及部分血脂比值对冠心病的诊断价值.方法 对210例患者行冠状动脉造影,根据造影结果分为对照组(冠状动脉无狭窄者)和冠心病组,冠心病组再根据Gensini评分分为轻度、中度和重度组,测定血脂水平并对其单项血脂和部分血脂比值与冠脉狭窄程度进行比较分析.结果 冠心病组的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B(ApoB)高于正常对照组,载脂蛋白A1(ApoA1)和高密度脂蛋白胆固醇(HDL-C)低于正常对照组(P均＜0.05).冠心病组的TC/HDL-C、TG/HDL-C、LDL-C/HDL-C高于正常对照组,ApoA 1/ApoB低于正常对照组(P均＜0.05).随着冠脉病变程度增加,TG/HDL-C、TC/HDL-C、LDL-C/HDL-C值升高,ApoA1/ApoB值降低(P＜0.05).结论 血脂和血脂比值异常对冠心病的诊断及其严重程度的判断上具有一定意义,血脂比值较单项血脂有更好的临床价值.     

老年冠心病患者抑郁与血脂水平的关系

目的:探讨老年冠心病患者抑郁与血脂水平之间的关系。方法:采用病例对照研究方法,将老年冠心病患者168例按抑郁自评量表(SDS)及综合医院焦虑抑郁量表抑郁分表(HAD)评分分为冠心病伴抑郁组(抑郁组,87例)和冠心病不伴抑郁组(非抑郁组,81例)。测定所有研究对象的血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和脂蛋白α(Lp(α))。结果:抑郁组TG、LDL-C水平显著高于非抑郁组(P0.01),而TC显著低于非抑郁组(P0.01)。多元逐步回归分析,TC、TG、LDL-C是抑郁的影响因素。结论:血脂的变化与抑郁情绪有关,伴有抑郁情绪的冠心病患者血脂异常更为明显。     

久居亚高原地区的冠心病患者血脂异常分析

目的探讨久居亚高原地区的冠心病患者总胆固醇(TC)/高密度脂蛋白胆固醇(HDL-C)和(TC-HDL-C)/HDL-C值异常及其它传统危险因素对冠心病发病的影响.方法分析105例冠状动脉造影(CAG)确诊的冠心病患者(冠心病组)及65例CAG阴性者(非冠心病组)的TC/HDL-C和(TC-HDL-C)/HIDL-C值及血压、血糖、吸烟等与冠心病之间的关系.结果TC、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)浓度升高率在2组中无显著性差异,但TC/HDL-C、(TC-HDL-C)/I-IDLC值异常率在冠心病组显著高于非冠心病组,有非常显著性差异(P<0.001),其比值升高与冠心病的危险性是非冠心病组的7倍.结论TC/HDL-C、(TC-HDL-C)/HDL-C值升高可能对亚高原地区冠心病发病更为敏感;冠心病的一级预防重点在于提高体内HDL-C水平,降低TC水平外,更重要的是调整二者之间的比值.     

Pseudoaneurysm of coronary artery following rupture of coronary artery during coronary angioplasty.

Rupture of the coronary artery is a rare complication of percutaneous transluminal coronary angioplasty (PTCA). We describe a case of coronary artery rupture during PTCA resulting in the formation of a coronary artery pseudoaneurysm. The pseudoaneurysm was successfully treated by percutaneous spring-coil embolization of the coronary artery.     

Percutaneous coronary intervention of bifurcation coronary disease

Bifurcation coronary artery disease is a frequent problem faced by interventional cardiologists and it affects approximately 15-20% of patients undergoing percutaneous coronary intervention (PCI). The application of drug-eluting stents (DES) technology to prevent restenosis after PCI represents one of the success stories in cardiology, but DES have not resolved the bifurcation PCI challenge. Bifurcation PCI remains associated with higher procedural failure and worse outcomes compared with PCI of non-bifurcated lesions even in DES era. A dependable strategy for PCI of bifurcation lesions has yet to be established, which is likely due to the paucity of studies evaluating the anatomical intricacies of the bifurcation as well as the lack of large scale randomized therapeutic trials. Further, bifurcation has many anatomical variants and it is unlike that one technique will fit all. Currently, we are left with the option of a tailor-made strategy for each patient and bifurcation anatomy and make the most of the limited evidence available to support our therapeutic decisions. In this review, we attempted to describe the current understanding of bifurcation anatomy and corresponding PCI strategies.     

Atherosclerosis of coronary arteries, coronary heart disease and sudden coronary death

Correlation between the severity of coronary atherosclerosis, thrombosis and sudden cardiac death was examined in 721 autopsied cases. Severe coronary atherosclerosis with stenosis was found in most of them; however a similar grade of atherosclerosis was discovered in patients with ischaemic heart disease not dying suddenly. Acute coronary thrombosis in the studied subjects was diagnosed post mortem in about 20 percent of those who died suddenly. Other studies indicate frequencies between 4-93%. There was no consistent time dependence.     

Clinical trials of coronary revascularization: coronary angioplasty vs. coronary bypass grafting

In the absence of diabetes mellitus, rates of survival and of survival free of myocardial infarction (MI) are almost identical among patients with multivessel disease assigned to percutaneous transluminal coronary angioplasty (PTCA) versus those assigned to coronary artery bypass grafting (CABG) after 6.5 to 8 year follow-up period. Additional revascularization occurs 2.5 to 4.5 times more frequently in PTCA-treated than in CABG-treated patients and prevalence of angina is no longer statistically different between the two treatment groups. The excess health care costs of bypass surgery, which are important early after revascularization, almost disappear 5 to 8 years later. In patients with single vessel disease, survival free of MI is also comparable in both treatment groups at 5 years. Additional revasculariztion occurs two to four times more often in PTCA-treated than in CABG-treated patients and prevalence of angina does not differ between the two treatment groups. Thus, in nondiabetic patients with multivessel disease, the choice of a revascularization strategy rests on the patient's and treating physician's preference between the invasive nature of bypass surgery and the risk of recurrent procedures. In patients with single vessel disease, these long-term data suggest that bypass surgery is at least as safe and effective as coronary angioplasty and therefore may be a treatment option in selected cases.     

冠状动脉256排CT与冠状动脉造影对冠心病的诊断比较

目的冠状动脉256排CT成像技术与冠状动脉造影检查对冠状动脉粥样硬化性心脏病的诊断比较。方法选取2013年5月至2014年5月内蒙古兴安盟人民医院心血管内科疑似冠心病患者50例,其中男性29例,女性21例,年龄37~68岁。先行冠状动脉256排CT扫描及图像后处理,后行冠状动脉造影检查,将两结果进行对比分析。结果以冠状动脉狭窄≥50%者为阳性。冠状动脉256排CT诊断冠心病灵敏度为40.00%,特异度98.18%,阳性预测值88.89%,阴性预测值81.82%,正确指数38.18%,符合率82.67%,KAPPA值46.28%。结论冠状动脉造影诊断冠心病准确性优于冠状动脉CT。冠状动脉CT可对冠心病患者进行初筛诊断。     

冠脉微循环与冠心病

冠心病急性心肌梗死的再灌注治疗是现代医学发展的里程碑,它使被动、保守治疗转为积极、主动的血运重建,随着包括静脉溶栓、冠状动脉内溶栓、经皮冠状动脉腔内成形术(PTCA)、冠状动脉内支架置入术以及冠状动脉搭桥术等再灌注治疗技术的成熟、普及,挽救了无数患者的生命.     

Right coronary artery coronary sinus fistula with coronary sinus ostium stenosis

Coronary artery fistula (CAF) is a rare anomaly of the coronary artery. The draining site of a right coronary artery (RCA) fistula may usually be the right ventricle, right atrium, or pulmonary artery. Here, we present a patient with right coronary artery to coronary sinus fistula (RCACSF) complicated by aneurysmal dilatation of the coronary sinus (CS) and stenosis of CS ostium.     

Percutaneous transluminal coronary angioplasty of coronary artery embolism

A 35-yr-old woman with known valvular heart disease presented with acute myocardial infarction. Angiography demonstrated a totally occluded distal left anterior descending coronary artery. Though initially successful, angioplasty ultimately failed to maintain arterial patency, leaving a more distal total occlusion after several balloon inflations. In spite of this, PTCA possibly provided a more localized infarction via a peripheral mobilization of the embolus.     

Detecting of coronary dissection by coronary magnetic resonance

A 75-year-old man, who had a history of coronary dissection after percutaneous coronary intervention in left anterior descending coronary artery, underwent coronary magnetic resonance. Magnetic resonance demonstrated coronary dissection in the distal portion of the left anterior descending artery. Both the true lumen with thick vessel wall and the false lumen with thin vessel wall were demonstrated in the cross-sectional images using T1-weighed black blood technique and T2-weighed black blood technique. Soft plaque was located at the twelve o'clock in the true lumen. Invasive coronary angiogram showed long coronary dissection from middle to distal portion of left anterior descending coronary artery. Magnetic resonance was thought to be useful to detect and follow up the coronary dissection noninvasively.