心脏X综合征患者血清γ-谷氨酰转肽酶水平与颈动脉内膜中层厚度的关系

目的：探讨心脏X综合征（ CSX）患者血清γ-谷氨酰转肽酶（ GGT）水平与颈动脉内膜中层厚度（ CMIT）的关系。方法选择CSX患者83例（ CSX组）、冠心病患者67例（ CAD组）和健康体检者40例（对照组）,采用彩色多普勒超声诊断仪检测各组CMIT,采用全自动生化分析仪检测各组血清GGT、CRP、血糖和其他生化指标。采用Pearson相关分析血清GGT水平与CIMT的相关性。结果 CSX组、CAD组CMIT及血清GGT、CRP水平均高于对照组（P均＜0．01）,但CSX组与CAD组比较差异无统计学意义。相关分析发现,CSX组血清GGT水平与CIMT呈正相关（r＝0．681,P＜0．01）,与血清CRP水平无关。结论 CSX患者血清中GGT水平较正常健康者明显升高,与CAD患者趋于一致;其CIMT与血清GGT水平呈正相关关系。     

绝经后女性心脏X综合征患者性激素水平与血管内皮生长因子的相关性研究

摘要：目的 探讨绝经后女性心脏X综合征患者性激素、血管内皮生长因子（VEGF）关系 方法 选取绝经后女性心脏X综合征患者55例（实验组）和健康无心脏X综合征的绝经后女性50例（健康对照组）。所有入选对象均采用ELISA法测定性激素和血管内皮生长因子（VEGF）水平,其中测定的性激素主要包括雌二醇（E2）、促黄体生成素（LH）、促卵泡刺激素（FSH）、孕酮和睾酮。结果 CSX组血清E2及血清VEGF水平均显著低于健康对照组（P＜0.05）;而血清LH、FSH水平均显著高于对照组（P＜0.05）,CSX组雌二醇/睾酮比值明显降低（P＜0.05）;线性相关分析显示,CSX患者血清E2和VEGF呈显著正向相关性。以VEGF为因变量进行多元线性回归分析,结果提示E2与VEGF密切相关（P＜0.05）,而促黄体生成素（LH）、促卵泡刺激素（FSH）、孕酮和睾酮与VEGF无明显相关性。结论 绝经后女性CSX患者雌激素缺乏促使血管内皮生长因子表达降低,导致冠脉微血管的生成受限,进而导致冠脉微循环障碍发生。     

阿尔茨海默病血浆总抗氧化状态与同型半胱氨酸水平的临床研究

目的探讨血浆总抗氧化状态（TAS）和同型半胱氨酸水平（Hcy）在阿尔茨海默病（AD）中的发病机制。方法选择浦东新区精神卫生中心门诊AD患者198例,以酶法检测血浆TAS与Hcy水平。此期间选择健康体检者77例作对照组对比分析。结果AD患者组血浆TAS和Hcy水平与正常对照组比较差异有统计学意义（P均〈0．01）;AD患者血浆TAS与Hcy水平呈明显负相关（r=-0．545,P〈0．01）。结论高Hey血症（HHcy）导致机体抗氧化能力下降,TAS水平的持续低下是AD发病的又一个重要原因。     

73例心脏X综合征患者危险因素分析

目的:探讨心脏X综合征(CSX)的常见危险因素。方法:回顾性调查73例CSX患者设为CSX组;60例冠心病患者即冠心病组和80例健康体检者即对照组,检测其血中性粒细胞与淋巴细胞比率(NLR)、红细胞分布宽度(RDW)、同型半胱氨酸(HCY)及血尿酸浓度等,并分析上述指标与CSX的相关性。结果:CSX组与冠心病组血NLR、RDW、HCY及血尿酸水平明显高于健康对照组(均P0.05)。NLR、RDW、HCY、尿酸是CSX的危险因素,血钙是CSX的保护因素(OR5=0.001,P5=0.003)。结论:血NLR、RDW、HCY、尿酸是CSX的独立危险因素;血钙是CSX的保护因素。     

脂联素与心脏X综合征发病的关系

目的：探讨脂联素（APN）水平与心脏X综合征发病的关系。方法：心脏X综合征患者22例,对照组18例,抽取静脉血分别检测两组血清APN水平。结果：心脏X综合征组血清APN水平明显低于对照组[（9.17±1.98）mg/L∶（11.32±2.15）mg/L,P〈0.01]。结论：心脏X综合征患者血清脂联素水平明显低于对照组,脂联素可能参与了心脏X综合征的发病机制。     

依那普利与地尔硫卓治疗心脏X综合征疗效的比较

目的 观察应用依那普利与地尔硫卓治疗心脏X综合征（CSX）患者的疗效。 方法 将43例心脏X综合征患者随机接受依那普利 (21例,依那普利组) 或地尔硫卓(22例,地尔硫卓组)治疗,随访治疗3个月后的临床情况并复查平板运动试验、冠状动脉血流储备（CFR）及一氧化氮（NO）、血浆内皮素-1（ET-1）的含量。结果 与本组治疗前比较,用药3个月后两组胸痛例数及最大ST段压低幅度明显减少,ET-1水平明显下降,CFR及NO的水平明显升高,运动总时间、ST段压低1 mm时间明显延长（P<0.01或P<0.05）。与地尔硫卓组相比,依那普利组胸痛例数及最大ST段压低幅度明显减少 (均为P<0.05),ET-1水平明显下降（P<0.01）,CFR及NO的水平明显升高(均为P<0.05),运动总时间、ST段压低1 mm时间明显延长（P<0.01,P<0.05）。结论 依那普利与地尔硫卓均能改善CSX患者的内皮细胞功能提高患者的运动耐量及CFR,且依那普利较地尔硫卓更为有效。     

法舒地尔与地尔硫卓治疗心脏X综合征疗效比较

目的观察应用法舒地尔与地尔硫卓治疗心脏X综合征（CSX）患者的疗效。方法49例心脏X综合征患者随机接受法舒地尔（24例）或地尔硫卓（25例）治疗，随访治疗3个月后的临床情况并复查平板运动试验、冠状动脉血流储备（CFR），以及一氧化氮（NO）、血浆内皮素-1（ET-1）的含量。结果与本组治疗前比较，用药3个月后两组胸痛例数及最大ST段压低幅度明显减少，ET-1水平明显下降，CFR及NO水平明显升高，运动总时间、ST段压低1mm时间明显延长（P〈0．01，P〈0．05）。与地尔硫卓组相比，法舒地尔组胸痛例数及最大ST段压低幅度明显减少（均为P〈0．05），ET-1水平明显下降（P〈0．01），CFR及NO的水平明显升高（均为P〈0．05），运动总时间、ST段压低1mm时间明显延长（P〈0．01，P〈0．05）。结论法舒地尔与地尔硫卓均能改善CSX患者的内皮细胞功能，提高患者的运动耐量及CFR，且法舒地尔较地尔硫卓更为有效。     

心脏X综合征患者血清半乳糖凝集素3的表达和价值研究

目的:通过检测心脏X综合征(CSX)患者血清半乳糖凝集素3(Galectin-3)水平,探讨其与CSX发病的相关性及临床意义。方法:纳入115例CSX患者(CSX组)和74名健康对照者(对照组),测定血清Galectin-3和高敏C反应蛋白(hs-CRP)及一些生化指标的浓度。结果:CSX患者血清Galectin-3浓度较对照组高(CSX组:0.90ng/ml,IQR:0.40~1.70ng/ml;对照组:0.40ng/ml,IQR:0.36~0.44ng/ml;P0.0 001)。单因素Logistic分析显示,LnGalectin-3、Ln空腹葡萄糖、Lnhs-CRP、Ln尿酸的血清浓度与冠心病家族史都与CSX相关。多因素Logistic回归分析显示,LnGalectin-3、冠心病家族史、空腹血糖、Lnhs-CRP和Ln血尿酸是CSX的独立预测因子。糖尿病、高血压与CSX无明显相关性。Pearson相关分析表明血清LnGalectin-3与Ln hs-CRP显著正相关(r=0.16,P=0.03)。结论:CSX患者中血清Galectin-3浓度明显升高,Galectin-3表达与hs-CRP相关。     

心脏X综合征患者同型半胱氨酸与血管内皮功能关系研究

目的：研究心脏X综合征患者血浆同型半胱氨酸（Hcy）与肱动脉血流介导血管扩张功能（FMD）的关系。方法：选择心脏X综合征患者30例（心脏X综合征组）,另选取与心脏X综合征患者同时期住院的其它疾病患者30例（对照组）,采用高分辨率超声技术检测FMD,采用循环酶法检测血浆Hcy水平。结果：1.心脏X综合征患者血浆同型半胱氨酸水平明显高于对照组（13.4±6.25umol/l vs. 9.78±4.3umol/l, P<0.05）;2.心脏X综合征患者肱动脉血流介导的血管扩张功能（FMD）明显低于对照组（5.21%±3.19% vs. 10.99%±4.06%, P<0.001）;3. 直线相关分析显示：心脏X综合征患者血浆同型半胱氨酸水平与肱动脉血流介导的血管扩张功能（FMD）之间存在负相关（r = -0.782,P<0.01）。结论：心脏X综合征患者血浆同型半胱氨酸水平明显升高,肱动脉血流介导的血管扩张功能（FMD）受损,且血浆同型半胱氨酸水平与FMD呈负相关,表明心脏X综合征患者血浆同型半胱氨酸可能损害肱动脉血流介导的血管扩张功能。     

老年高血压患者血浆总抗氧化能力水平变化及临床价值

目的 研究老年原发性高麻压患者血浆总抗氧化能力 （total antioxidant capacity,TAS） 水平变化;分析 TAS相关因素;探讨老年高血压患者TAS检测的临床价值.方法 选取上海交通大学附属仁济医院老年病科住院男性患者100 例,年龄69～92岁,平均 （83.3±6.2） 岁,分为非高血压组 （n=37） 和高血压组 （n=63）,通过化学发光定量法榆测其血浆TAS,同时测定超敏C反应蛋白（high-sensitivity C-reaction protein,hsCRP）、尿微量白蛋白 （MAU）、血脂、血尿酸、转铁蛋白等,并利用彩色多普勒超声测定颈动脉内膜厚度 （CIMT）.结果 高血压组患者 TAS 值低于对照组（分别为1.068±0.058 mmol/L与1.094±0.048 mmol/L,P=0.045）.单变量分析显示：TAS 与尿微量白蛋白 （r=-0.311,P=0.014）、血尿酸 （r=-0.399.P=0.001）,超敏CRP （hsCRP） （r=-0.269,P=0.011） 呈负相关;校年龄以后作偏相关分析提示TAS与hsCRP （r=-0.334,P=0.02） 呈负相关.结论老年高血压患者存在TAS降低,且与超敏CRP有一定相关性,通过TAS来评估老年原发性高血压炎症反应和抗氧化状态具有一定的临床价值.     

Paraoxonase and arylesterase activities in patients with cardiac syndrome X, and their relationship with oxidative stress markers

OBJECTIVES: Paraoxonase-1 is a high-density lipoprotein-associated enzyme with three activities, which are paraoxonase, arylesterase and dyazoxonase. Paraoxonase-1 was shown to decrease in patients with cardiovascular diseases. We aimed to examine serum paraoxonase and arylesterase activities, and their relation with oxidative stress markers such as lipid hydroperoxide and total antioxidant status in patients with cardiac syndrome X. METHODS: Forty-one consecutive patients with cardiac syndrome X (CSX group), 33 consecutive patients without cardiac syndrome X (non-cardiac syndrome X group) and 20 healthy volunteers as control group were taken into the study. Serum paraoxonase and arylesterase activities were measured spectrophotometrically. Lipid hydroperoxide levels were measured by ferrous oxidation with xylenol orange assay. Total antioxidant status was determined using an automated measurement method. RESULTS: Basal paraoxonase, salt-stimulated paraoxonase and arylesterase activities were significantly lower in patients with cardiac syndrome X than those of the non-cardiac syndrome X and control groups (P<0.001, for both). Moreover, lipid hydroperoxide was found at high level, and total antioxidant status was found at low level in patients with cardiac syndrome X than control and non-cardiac syndrome X groups (P<0.001, for all). In patients with cardiac syndrome X, in multiple linear regression analysis, both paraoxonase and arylesterase activities were independently correlated with lipid hydroperoxide levels (P=0.001, P=0.003, respectively), and also arylesterase activity was independently correlated with magnitude of ST depression (P=0.002). CONCLUSION: Reduced paraoxonase and arylesterase activities and total antioxidant status levels and enhanced lipid hydroperoxide levels in patients with cardiac syndrome X might indicate increased oxidative stress that can play a role in pathogenesis of cardiac syndrome X.     

麝香保心丸对合并高脂血症心脏X综合征患者的临床疗效

目的 观察常规治疗联合麝香保心丸对合并高脂血症心脏X综合征患者的近期临床疗效.方法 纳入56例合并高脂血症的心脏X综合征患者,随机分为观察组（麝香保心丸＋常规治疗）28例和对照组（常规治疗）28例,治疗6周后观察其临床总有效率,包括治疗前后患者胸痛发作次数,舌下含服硝酸甘油用量,运动平板试验总时间,ST段压低最大值时间以及C-反应蛋白（CRP）和血脂水平指标的变化.结果 观察组与对照组临床总有效率分别为92.86%和71.43%,差异有统计学意义（P＜0.05）.与对照组相比,观察组上述六项指标均明显改善,差异有统计学意义（P＜0.05或P＜0.01）.结论 常规治疗基础上联用麝香保心丸可以进一步改善心脏X综合征的近期疗效.     

心脏X综合征与血尿酸水平的相关性研究

目的研究心脏X综合征与血尿酸水平的关系。方法回顾性调查60例心脏X综合征患者、200名健康体检者血尿酸、血糖、血脂等指标水平,同时进行血尿酸与心脏X综合征的相关性、危险因素分析。结果心脏X综合征组尿酸水平为(418.64±46.78)μmol/L、血糖水平为(5.46±1.43)mmol/L与对照组[(336.45±34.98)μmol/L,(5.09±1.01)mmol/L]比较差异有统计学意义(均为P<0.05),两组血脂水平比较差异无统计学意义(P>0.05)。病例对照研究,表明尿酸与心脏X综合征的发生有关联(OR:4.19,95%CI:2.259～7.768,P<0.01)。结论血尿酸水平升高与心脏X综合征的发生具有一定的相关性。     

丹红注射液治疗心脏X综合征的临床疗效

目的观察常规治疗基础上加用丹红注射液治疗心脏X综合征(CSX)患者的近期临床疗效。方法选择CSX患者60例,随机分为观察组(n=30)和对照组(n=30),对照组给予常规治疗,观察组在常规治疗基础上加用丹红注射液治疗,治疗10 d,在治疗前后观察患者的临床疗效,包括心绞痛的发作情况、心电图及运动负荷试验的变化情况,以及血清中内皮素-1(ET-1)、血栓调节蛋白(TM)及选择素-E(Es)的水平。结果观察组与对照组胸痛症状缓解总有效率分别为93.33%vs.73.33%;心电图改善总有效率分别为83.33%vs.56.67%,差异均有统计学意义(P0.05)。观察组与对照组运动负荷试验中运动总时间分别为(486.9±83.0)s vs.(438.3±85.6)s;从运动开始至ST段压低1 mm的时间分别为(351.9±69.2)s vs.(310.7±79.2)s,观察组患者运动负荷改善情况优于对照组,差异具有统计学意义(P0.05)。观察组与对照组治疗前血清ET-1、TM、Es水平无统计学差异(P0.05);治疗后两组血清ET-1水平分别为(54.58±7.95)ng/L vs.(76.21±1.78)ng/L;TM水平分别为(7.01±1.49)μg/L vs.(11.10±1.68)μg/L;Es水平分别为(7.50±2.71)ng/m L vs.(10.71±3.56)ng/m L,差异均具有统计学意义(P0.01)。两组均未见不良反应发生。结论丹红注射液能够改善心脏X综合征患者临床症状,降低CSX患者血清ET-1、TM及Es水平。     

The relation between Helicobacter pylori infection and cardiac syndrome X: a preliminary study

Cardiac syndrome X is defined by an angina pectoris with normal or near normal coronary angiogram.We evaluated the association of Helicobacter pylori (HP) infection with cardiac syndrome X (CSX). We studied 30 patients with CSX, 30 cases with stable angina and also 30 healthy controls. All three groups underwent urea breath test (UBT). Fifty percent (15 out of 30) of CSX patients had positive UBT result (> or =200 dpm), while two other groups did not have the positive results. Regarding high prevalence of HP infection in patients with CSX in our study and probable causative effect of chronic infection in coronary artery diseases, possible role of HP infection in the pathogenesis of CSX is suggested. However well designed clinical trial studies are needed to confirm this preliminary result.     

Chronic inflammation and increased arterial stiffness in patients with cardiac syndrome X.

AIMS: Endothelial dysfunction and subangiographic atheroma have been reported in patients with cardiac syndrome X (CSX) but little is known regarding chronic inflammation and reduced arterial distensibility as pathogenic mechanisms. We assessed whether markers of inflammation and arterial distensibility differ in CSX patients compared to control subjects. METHODS AND RESULTS: We studied 30 consecutive CSX patients (mean age 57+/-6 years, 25 women) and 30 healthy controls (mean age 54+/-8 years, 25 women). High sensitivity C-reactive protein (hs-CRP) levels were significantly higher in patients with CSX compared to controls (2.6 [1.7-4.5] vs 1.5[0.7-2.7] mg/l, P=0.02). Hs-CRP levels correlated with carotid intima-media thickness (IMT) (Spearman's rho=0.51; P=0.013). CSX patients also had significantly increased mean IMT values than controls (P<0.0001). Arterial stiffness and elastic modulus were also significantly increased in CSX patients compared to control subjects (P=0.04 and P=0.04, respectively). Distensibility tended to be lower in CSX patients than controls although this difference did not reach statistical significance. CONCLUSIONS: This study showed for the first time that compared to control subjects, patients with CSX have higher hs-CRP serum levels, increased mean common carotid artery IMT and increased arterial stiffness. The role of these abnormalities in the pathogenesis of CSX deserves investigation.     

冠状动脉造影数字跟踪技术测定心脏X综合征患者冠状动脉血流储备的临床观察

目的通过常规冠状动脉造影,运用数字跟踪技术软件测定心脏X综合征患者冠状动脉血流储备（coronary flow reserve, CFR）,探讨其变化意义。方法98例拟诊冠状动脉粥样硬化性心脏病（冠心病）患者,其中心脏X综合征患者62例,对照组36例。冠状动脉造影同时运用数字跟踪技术软件测算CFR,抽血检测血清高敏C反应蛋白（high—sensitivity C—reactive protein,hsCRP）浓度,利用统计软件比较两组检测结果。结果X综合征组患者CFR低于对照组,差异有统计学意义（P〈0．05）;血清hsCRP浓度高于对照组,差异有统计学意义（P〈0．01）。结论X综合征患者存在CFR降低及血清hsCRP浓度升高,提示CFR降低及炎症反应可能是其临床症状的病理生理基础。     

COPD患者血清SOD、LPO、GSH-PX含量的变化及临床意义

目的探讨COPD患者血清中SOD、LPO和GSH—PX含量的变化及意义。方法应用放射免疫分析法和化学法对33例COPD患者进行了SOD、LPO、GSH—PX水平的检测,并与35名正常健康人作比较。结果COPD患者血清SOD、GSH—PX水平明显低于正常人组（P〈0．01）,而LPO水平则显著高于正常人组（P〈0．01）,且血清SOD水平与GSH—PX呈正相关（ty=0．6138 P〈0．01）,与LPO水平呈负相关（y=-0．4384,P〈0．01）。结论血清SOD、LPO、GSH—PX水平的变化与COPD患者的发生和发展密切相关。     

Serum paraoxonase 1 activity and oxidative markers of LDL in patients with cardiac syndrome X

OBJECTIVE: Myocardial ischaemia in cardiac syndrome X (CSX) is believed to be due to microvascular dysfunction. Increased oxidative stress is one of the suspected mechanisms of microvascular dysfunction. The aim of this study was to evaluate the oxidative status in patients with CSX, by determining serum paraoxonase-1 (PON 1) activity in addition to LDL-oxidation markers. METHODS AND RESULTS: This cross-sectional study consisted of patients with CSX (group I, n = 30), patients with coronary artery disease (group II, n = 31), and healthy controls (group III, n = 32). Lipid parameters, PON-1 activity, and LDL oxidation markers (conjugated-diene and thiobarbituric acid-reactive substance-TBARS) were measured. Endothelium-dependent vasodilatation was determined by brachial artery ultrasonography. There were no significant differences in serum LDL, apolipoprotein-B, baseline LDL-diene, and LDL-TBARS levels between groups. There were no differences in both apolipoprotein-A1 and HDL levels between group I and group III. Apolipoprotein-A1 and HDL levels were significantly lower in group II than group I patients (P < 0.001). PON-1 activity was lowest in group II patients. Average PON-1 activity in group I was in between of group II and group Ill. The percent change of LDL-diene levels after stimulation was significantly higher in group II than in groups I and III (P = 0.005 and P = 0.02, respectively). The percent change of LDL-TBARS levels was lowest in group I (P = 0.03). There was a moderate correlation between endothelium-dependent vasodilatation and PON-1 activity in group I (r = 0.43, P = 0.04). CONCLUSIONS: Enhanced oxidative stress might be one of the causes of impaired endothelial functions resulting in myocardial ischaemia and chest pain in patients with CSX. The relatively preserved HDL and apolipoprotein-A1 levels in patients with CSX might be a protective mechanism against progression of coronary microvascular dysfunction to atherosclerotic coronary artery disease.