OX40L/OX40基因组变异与早发冠心病风险之间的关系

目的:研究OX40L/OX40基因组变异与早发冠心病风险之间的关系。方法:用序列特异性引物—聚合酶链反应技术对243例年龄55岁早发急性冠状动脉(冠脉)综合征(PACS)的患者为PACS组、209例早发稳定性心绞痛(PSAP)为PSAP组和138例对照组检测OX40L基因rs3850641 A/G变异位点和OX40基因rs2298212 G/A位点变异的基因型、等位基因及其单倍型;用冠脉造影测量病变血管支数和狭窄程度积分;用酶链免疫吸附法(ELISA)测试血浆可溶性OX40L(sOX40L)、血管细胞黏附分子1(VCAM-1);用散射比浊法测试血浆C反应蛋白(CRP)水平;分析OX40L/OX40基因变异与冠心病风险、冠脉病变程度和血浆3个细胞因子之间的关系。结果:OX40L GG基因型和G等位基因发生PACS风险比AA基因型和A等位基因显著增高(OR=1.99,1.83;P=0.021,P=0.0001);而OX40 A等位基因比G等位基因发生PACS风险显著降低(OR=0.49,P=0.002);单倍型GGGG比AAGG(野生型)的PACS风险显著增加(OR=2.11,P=0.033);在4种高危因素(高血压、高脂血症、糖尿病和吸烟)被校正后OX40L G等位基因和GG基因型及单倍型GGGG与PACS风险仍具有独立关联性(OR=1.97、1.78、2.01,P=0.026、0.001、0.038),OX40 A等位基因和AA基因型对PACS风险仍有独立的关联性(OR=0.31、0.45;P=0.043、0.0001);OX40L基因型GG+AG比AA型血管病变支数≥3支的百分率和狭窄程度积分均显著增加;OX40基因型AA+GA比GG型血管病变支数≥3支的百分率和狭窄程度积分显著减低;差异均有统计学意义(P0.05)。基因型变异与炎性细胞因子表达:OX40L基因型GG+AG比AA型血浆可溶性OX40L、C反应蛋白、血管细胞黏附分子1水平均显著增高;OX40基因型AA+GA比GG型三指标显著降低。差异均有统计学意义(P0.05)。结论:OX40L/OX40基因组变异可能与PACS风险、冠脉病变程度及炎性因子的表达的正反调节有关。     

IL-12RB2 rs3790567A/G位点单核苷酸多态性与原发性胆汁性肝硬化易感性的Meta分析

目的评价IL-12RB2 rs3790567A/G位点单核苷酸多态性与原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)易感性的关系。方法通过计算机检索Pub Med、Embase、the Cochrane Library、Web of Science、中国知网、万方等中英文数据库,检索IL-12RB2 rs3790567A/G位点单核苷酸多态性与PBC相关的病例-对照研究。以PBC组与对照组人群基因型频率的OR值和95%CI为效应指标,采用随机或固定效应模型进行定量合并分析,并进行偏倚评估和敏感性分析。采用Rev Man 5. 3软件进行Meta分析。结果本研究共纳入文献6篇,PBC组(病例组) 1 584例,健康对照组2 648名。Meta分析结果表明,IL-12RB2 rs3790567A/G位点与PBC发病因素密切相关。5个基因型结果如下:显性模型:AA+AG vs GG,OR=1. 20,95%CI:1. 11～1. 29,差异有统计学意义(P 0. 05);隐性模型:AA vs AG+GG,OR=1. 59,95%CI:1. 25～2. 02,差异有统计学意义(P 0. 05);共显性模型:AG vs AA,OR=0. 83,95%CI:0. 53～1. 32,差异有统计学意义(P 0. 05); GG vs AA,OR=0. 03,95%CI:0～0. 07,差异有统计学意义(P 0. 05);等位基因模型A vs G,OR=1. 02,95%CI:0. 72～1. 45,差异无统计学意义(P 0. 05)。以研究地理位置及种族不同进行亚组分析,亚洲人显性基因模型:AA+AG vs GG,OR=1. 17,95%CI:0. 89～1. 55,差异无统计学意义(P=0. 26)。高加索人显性基因模型:AA+AG vs GG,OR=1. 30,95%CI:1. 17～1. 44,差异有统计学意义(P 0. 05);亚洲人隐性基因模型AA vs AG+GG,OR=1. 39,95%CI:1. 01～1. 91,差异无统计学意义(P=0. 05)。高加索人隐性基因模型:AA vs AG+GG,OR=1. 94,95%CI:1. 34～2. 81,差异有统计学意义(P 0. 05);亚洲人等位基因模型A vs G:OR=1. 26,95%CI:0. 70～2. 26,P 0. 05,高加索人A vs G,OR=1. 02,95%CI:0. 72～1. 45,差异无统计学意义(P 0. 05)。结论 IL-12RB2 rs3790567A/G在PBC AA和AA+AG基因模型中易感性显著增加,且通过亚组分析,证明种族间差异有统计学意义。     

HNF1B基因多态性与冠心病、2型糖尿病及其共病的相关性研究

目的探讨中国北方人群HNF1B基因位点rs4430796单核苷酸多态性(SNP)与冠心病及其共病的相关性。方法采用病例对照研究,入选2016年2~12月于北京医院心内科和内分泌科就诊的冠心病患者160例、2型糖尿病患者126例、冠心病合并2型糖尿病患者175例,及健康对照者238名。采用高分辨率熔解曲线分析和直接测序的方法检测HNF1B基因位点rs4430796多态性,同时测定血清中尿酸(UA)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)水平,评估rs4430796多态性与上述生物标志物的相关性。结果与健康对照组比较,冠心病合并2型糖尿病组HNF1B基因rs4430796在基因型(P=0.005)、等位基因(OR=1.50,95%CI:1.05~2.13,P=0.026)、显性模型(OR=1.83,95%CI:1.23~2.72,P=0.003)、隐性模型(OR=2.07,95%CI:1.07~3.98,P=0.027)、加性模型(OR=2.53,95%CI:1.29~4.98,P=0.006)差异均有统计学意义。与野生型(AA)比较,冠心病组携带rs4430796 G突变位点(GG+AG)的患者体质指数增高,2型糖尿病组携带rs4430796 G突变位点(GG+AG)的患者尿酸增高,冠心病合并2型糖尿组携带rs4430796 G突变位点(GG+AG)的患者HDL-C较低(均为P0.05)。结论HNF1B基因位点rs4430796多态性与冠心病合并2型糖尿病相关,可能通过代谢因素参与冠心病及其共病的发生。     

MTTP基因rs1800591位点多态性与非酒精性脂肪性肝病的相关性研究

目的研究微粒体甘油三酸酯转移蛋白(MTTP)基因rs1800591位点多态性与非酒精性脂肪性肝病(NAFLD)的关系。方法采用聚合酶链式反应(PCR)-限制性片段长度多态性检测219例NAFLD患者和210例正常对照组MTTP基因rs1800591位点基因型和等位基因。应用方差分析、卡方检验、非条件Logistic回归分析等方法判断NAFLD患者与正常对照组的各项指标。结果 NAFLD组与对照组两者rs1800591位点的基因型分布和等位基因频率差异有统计学意义(χ2=9.007,P=0.011;χ2=9.599,P=0.002)。经混杂因素校正后,非条件Logistic回归分析结果显示,与TT基因型相比,GG+GT基因型发生NAFLD的风险比值比:OR=1.623,95%CI为1.070~1.648,P=0.030。等位基因G携带者患NAFLD的风险是T等位基因的1.521倍(OR=1.521,95%CI为1.089~2.123,P=0.014)。TT基因型与GG+GT组ALT、LDL、TG的差异有统计学意义(ALT:P=0.001;LDL:P=0.008;TG:P=0.024)。结论青岛地区汉族人群中MTTP基因rs1800591位点多态性与患NAFLD的风险有相关性。     

Ⅰ型血小板结合蛋白基序解聚蛋白样金属蛋白酶7基因rs3825807位点单核苷酸多态性与冠心病易感性关系的Meta分析

目的:通过系统评价与Meta分析探索Ⅰ型血小板结合蛋白基序的解聚蛋白样金属蛋白酶7(ADAMTS7)基因rs3825807位点单核苷酸的多态性与冠心病发病风险的关联。方法:计算机检索PubMed, Web of Science, Cochrane Library,中国知网,万方,维普和中国生物医学数据库,以获取ADAMTS7基因rs3825807多态性与冠心病易感性的原始研究。检索时限均为建库至2019年12月6日。由两位研究者独立筛选文献、提取数据并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:共纳入6个病例-对照研究,观察组包括4 989例病例,对照组包含5 471例。Meta分析结果显示,患者ADAMTS7基因rs3825807多态性与冠心病的发病风险增加有相关性(AA vs, GG:OR=21.07,95%CI:1.61～275.95,P=0.02;AG vs. GG:OR=6.80,95%CI:0.77～60.11,P=0.08;AA+AG vs. GG:OR=13.19,95%CI:1.09～158.97,P=0.04;AA vs. AG+GG:OR=2.39,95%CI:1.44～3.96,P=0.0007;A vs. G:OR=23.44,95%CI:8.19～67.10,P0.00001)。结论:患者ADAMTS7基因rs3825807多态性是冠心病的发病风险因素之一。受纳入研究数量和质量限制,本研究需更多的高质量临床研究予以验证。     

CXCL12 rs1801157基因多态性与乳腺癌易感性关联的Meta分析

目的探讨CXCL12 rs1801157基因多态性与乳腺癌易感性的关系。方法通过计算机检索和手工检索,收集有关CXCL12 rs1801157基因多态性与乳腺癌易感性关系的文献,筛选出符合条件的文献,应用M eta分析软件对各项研究进行异质性检验,计算合并OR值及其95%可信区间,并行敏感性分析和发表偏倚的评估。结果共5篇符合条件文献纳入本研究,病例组1 058例,对照组1023例。Meta分析合并结果显示CXCL12 rs1801157基因A等位基因携带者乳腺癌发生率明显高于G等位基因携带者（OR=1.32,95%CI=1.15~1.51,P〈0.01）;AA∶GG,GA∶GG和AA＋GA∶GG合并OR值及其95%可信区间分别是1.64（95%CI=1.16~2.33）、1.42（95%CI=1.18~1.70）和1.44（95%CI=1.21~1.72）。敏感性分析表明合并结果不受单个研究的影响,未发现发表偏倚,结论可靠。结论 CXCL12 rs1801157基因多态性可能与乳腺癌易感性有关,A等位基因可能增加乳腺癌的发病。     

中国2型糖尿病人群脂联素受体1基因多态性与冠心病风险的相关性研究

目的 研究我国2型糖尿病(T2DM)人群脂联素受体1(AdipoR1)基因多态性与冠心病(CAD)风险的相关性. 方法 以307例T2DM患者为研究人群,其中205例伴有CAD,102例不伴CAD.应用聚合酶链式反应-限制性内切酶片断长度多态性(PCR-RFLP)技术或基因测序方法,研究AdipoR1 10个单倍型标记单核苷酸多态性(Haplotype-tagging SNPs)与CAD风险的关系. 结果 (1)Ad-ipoR1 SNP rs1342387 GG和AG基因型携带者均较AA型携带者发生CAD的风险显著增加(GG vsAA:校正OR'=2.491,95%CI' 1.354～6.885,P'=0.031;AG vs AA:校正OR'=3.053,95%CI' 1.085～5.718,P'=0.007).(2)SNP rs12045862基因型CC携带者与TT携带者相比,CAD的风险显著增加(校正OR'=2.751,95%CI' 1.063～7.115,P'=0.037).(3)SNPs rs1342387、rs12045862 GX/CC基因型组合携带者较非携带者CAD的风险显著增加(校正OR'=3.646,95%CI' 1.253～10.608,P'=0.018).保护性基因型组合AA/TX携带者较非携带者发生CAD的风险显著降低(校正OR'=0.260,95%CI'0.113～0.601,P'=0.002).(4)在超重和肥胖(BMI≥24)的T2DM人群中,发现肥胖与SNPs rs1342387、rs12045862对CAD的风险有相互作用(P<0.05);在总人群中发现的与CAD风险相关的SNPs rs1342387和rs12045862在这一亚组仍具有相关性;同时发现SNP rs7539542基因型CC携带者较GG携带者CAD的风险增加(校正OR'=4.714,P'=0.036). 结论 中国T2DM人群中,AdipoR1 SNPs与CAD的风险可能相关.在超重或肥胖T2DM人群中,AdipoR1 SNPs与肥胖对CAD风险的影响有协同作用.     

PPIA基因rs6850位点多态性与冠心病合并2型糖尿病的关系

目的 探讨PPIA基因rs6850位点多态性与冠心病（CAD）患者合并2型糖尿病（T2DM）的关系。方法选取CAD、CAD合并T2DM患者各100例,采集患者静脉血,采用直接测序法检测PPIA基因rs6850位点的基因多态性。比较两组基因型和等位基因频率分布情况,对比不同基因型患者的临床资料,采用Logistic回归分析冠心病患者发生2型糖尿病的影响因素。结果 PPIA基因rs6850位点基因型、等位基因、显性模型和隐性模型在CAD+T2DM组和CAD组间的分布差异无统计学意义（P均>0.05）。GA基因型携带者BMI较AA、GG基因型携带者升高（P均<0.05）。调整混杂因素后,Logistic回归分析显示,GG、GA、AA三种基因型均不是冠心病患者发生2型糖尿病的影响因素（P均>0.05）。结论 PPIA基因rs6850位点多态性与冠心病合并2型糖尿病患者的遗传易感性无关。     

中国北方汉族人群CYP4F2基因rs2108622多态性与原发性高血压的相关性研究

目的：探讨我国北方汉族人群CYP4F2基因单核苷酸多态性位点rs2108622与原发性高血压的相关性。方法：采用病例-对照研究的方法,选取在北京安贞医院就诊的北方汉族原发性高血压者765例（HT组）和同期健康体检血压正常者477例（NT组）。应用TaqMan荧光定量法对CYP4F2基因rs2108622进行基因分型,评估该多态性位点与我国北方汉族人群原发性高血压发病风险的关系。结果：rs2108622位点在HT组和NT组的基因型分别为AA型61/35、AG型296/162、GG型403/273;A等位基因频率分别为27.5%/24.7%,G等位基因频率分别72.5%/75.3%。两组间基因型和等位基因频率分布,差异均无统计学意义（分别为P=0.218,P=0.123）。多因素Logistic回归分析显示：等位基因模型（OR=1.147,95%CI=0.853!1.543）、显性模型（OR=0.788,95%CI=0.549!1.131）、隐性模型（OR=1.153,95%CI=0.549!2.422）、纯合子模型（OR=1.018,95%CI=0.48!2.157）、加性模型（OR=0.872,95%CI=0.649!1.172）均未发现该多态性位点与原发性高血压存在相关性。根据性别进行亚组分析显示：男性亚组中A等位基因频率在HT组（27.5%）高于NT组（23.7%）,但差异无统计学意义（P=0.096）。而在女性亚组中各基因型和等位基因频率分布两组间比较,亦均差异无统计学意义（P=0.579和P=0.677）。结论：本研究发现CYP4F2基因rs2108622多态性位点可能与中国北方汉族人群原发性高血压的发病不存在相关性。     

中国2型糖尿病人群内皮细胞一氧化氮合酶基因多态性与冠心病风险的相关性研究

目的 观察中国2型糖尿病人群中内皮细胞一氧化氮合酶（eNOS）基因多态性位点rs1799983与rs2070744是否与冠心病风险相关.方法 以2005年3月至2010年10月412例2型糖尿病胸痛患者为研究人群,其中266例患有冠心病[男性171例,女性95例,平均年龄（64±9岁）],146例为无冠心病对照[男性67例,女性79例,平均年龄（62±10）岁].选取eNOS的2个单核苷酸多态性（SNPs）：rs1799983（G＞T）和rs2070744（T＞C）.应用聚合酶链反应-限制性内切酶片段长度多态性（PCR-RFLP）技术对eNOS基因SNPs读取个体基因型,采用病例-对照研究的方法,研究eNOS基因多态性与冠心病风险的关系.结果 SNP rs1799983在冠心病组与无冠心病组中T等位基因频率分别为10.4％和9.3％,T等位基因携带者较非携带者冠心病风险有增高趋势（OR=1.214）,但差异无统计学意义（P＞0.05）.SNP rs2070744在冠心病组与无冠心病组中C等位基因频率分别为10.5％和9.4％,C等位基因携带者较非携带者冠心病风险有增加趋势（OR=1.117）,但差异亦无统计学意义（P＞0.05）.校正其他已知冠心病风险因素如性别、年龄、BMI、糖尿病病程、高血压病病史、脂代谢异常病史以及吸烟史后,仍未发现rs1799983和rs2070744与冠心病风险的相关性.结论 在中国2型糖尿病人群中,eNOS基因SNP rs1799983和rs2070744可能不是冠心病的主要风险因子.     

Natural history of left anterior descending coronary artery obstruction: significance of location of stenoses in medically treated patients

We examined the prognostic significance of an obstructive lesion in the proximal left anterior descending (LAD) coronary artery. Five-year or longer follow-up data were examined from 311 patients with greater than 70% obstruction of the LAD treated without surgery. Mortality was compared in subsets with lesions proximal to and distal to the first septal perforating artery. Survival curves were worse in patients with proximal than with distal LAD disease (p less than 0.05); lesion location remained a significant determinant of survival when ejection fraction, age, and sex were controlled using a Cox regression model. However, when patient subsets were examined, survival with proximal LAD disease was worse than with distal obstruction only in the presence of an associated right coronary artery lesion and an ejection fraction of less than 40% (p less than 0.01). Patients with proximal LAD plus right coronary lesions had a 5-year mortality rate (34.08 +/- 8.9%) that was not significantly (p greater than 0.05) different from that of a group of 66 patients with greater than 50% narrowing of the left main coronary artery (24.02 +/- 4.3%). Thus, proximal LAD disease is more significant than is a distal lesion only in the presence of right coronary obstruction. This two-vessel combination results in a mortality rate as high as that associated with left main coronary artery obstruction.     

Coronary angioplasty using new 6 french guiding catheters

Coronary angioplasty (PTCA) was performed with specially constructed 6-French guiding catheters with an internal lumen of 0.051 inches. In 154 patients these guiding catheters were used in a variety of configurations in conjunction with miniature balloon-on-a-wire dilatation catheters in 1.5 to 3.5 mm sizes to perform PTCA. Overall patient success was 94%. PTCA was attempted in 24 totally occluded arteries with a success rate of 83% and 174 stenoses with a success rate of 97%. 6 French guiding catheters can be used to successfully perform PTCA.     

Coronary Artery Disease with and without Angina—Two Different Entities?

ABSTRACT. Coronary heart disease (CHD), previously neither diagnosed nor suspected, was strongly suspected in 115 of 2014 men aged 40–59 years during a cardiovascular survey examination. Sixty-nine of 105 men who underwent diagnostic coronary angiography had pathologic angiograms. Twenty-six of these 69 had angina pectoris (AP) with and without pathologic exercise ECGs and 43 had pathologic exercise ECG as the only indicator of CHD. The extent of coronary artery changes was similar in the two groups. The men without AP were in almost all respects similar to 1832 men labelled as normals. The men with AP differed in several respects from their non-AP angiographic counterparts and from the normals: they had more dyspepsia, a higher stress score, higher serum cholesterol and triglycerides, lower antithrombin III levels in the blood and lower blood platelet retention values. These results indicate that coronary artery disease with and without AP may represent somewhat different pathogenetic entities.     

Attenuation of nitroglycerin-induced coronary hyperemic blood flow in patients with left anterior descending coronary collaterals

Although intracoronary nitroglycerin (NTG) is frequently administered to patients having occluded coronary arteries undergoing invasive procedures such as percutaneous transluminal coronary angioplasty or thrombolysis, the extent of NTG-induced augmentation of myocardial blood flow in patients with collaterally filled occluded arteries is incompletely understood. To examine NTG-induced increases in coronary blood flow in patients with occluded left anterior descending coronary arteries (LAD), coronary and systemic hemodynamics were measured during bolus administration of NTG into the left coronary artery in 10 patients with normal LAD (Group 1), 11 patients with greater than 70% and less than 100% narrowing of the LAD (Group 2), and 10 patients who had total occlusion of the LAD with angiographic collateral filling and anterior ventricular wall motion abnormalities (Group 3). NTG increased anterior regional great vein flow (thermodilution) from 72 +/- 19 to 140 +/- 60 ml/min (p less than 0.05), 67 +/- 27 to 108 +/- 66 ml/min (p less than 0.05), and 59 +/- 27 to 74 +/- 36 ml/min (p = NS vs. control, p less than 0.05 vs. peak flow for Group 1) with relative increases from control of 91 +/- 41%, 56 +/- 34%, and 25 +/- 22% for the three groups, respectively. The percent change for Group 3 was significantly lower than both Groups 1 (p less than 0.01) and 2 (p less than 0.05). These data indicate that myocardial hyperemic blood flow responses to intracoronary NTG are markedly attenuated in patients with occluded but collaterally supplied vessels. During invasive procedures in these patients, although significantly attenuated, intracoronary NTG may potentially provide a beneficial effect by augmenting blood flow through collaterals or in adjacent regions.     

Implication of transstenotic coronary pressure gradient measurement during coronary angioplasty

The aim of this study was to establish a criterion for the success of an angioplasty based upon pressure gradients across coronary lesions. Sixty-two percutaneous transluminal coronary angioplasties (PTCA) in 56 patients with isolated left anterior descending artery disease were examined. Pressure gradients measured before and after PTCA were expressed as normalized mean pressure gradients (NMPG) computed by dividing mean pressure gradient by mean aortic or proximal coronary artery pressure. Angiographic severity was expressed as percentage area stenosis (AS) calculated from diastolic caliper measurements of diameter of each lesion and the nearest normal adjacent segment in at least two projections. The relationship between AS and NMPG was nonlinear with a steep increase in gradients beyond a critical value of AS of about 60%. This relationship was unaffected by angiographically visualized collaterals. All except one of 65 coronary stenotic lesions with NMPG of more than 0.32 had an AS of more than 60%. Only three of 57 coronary stenoses with NMPG of less than 0.32 had severe AS (p < 0.001). The results indicate that NMPG is a reliable, practical guide to the severity of coronary stenosis and is therefore a useful measurement for assessing either the success or the residual stenosis during PTCA.     

Accuracy and reproducibility of visual coronary stenosis estimates using information from multiple observers.

The reliability of visual estimation of severity of coronary artery stenosis may be improved using data from multiple independent observers. Data were collected from the results of a video format examination used on an experimental basis in 1987 by the American Board of Internal Medicine to test 61 candidates for certification in cardiovascular diseases. Twenty arteriographic cases were presented in a standardized format. Each artery was viewed in multiple projections including angled views. Each view was shown in both real time and slow motion, and each case was seen twice in its entirety. The observers rated stenosis severity on a four-point scale ranging from 1-4. A two-way repeated measures analysis of variance was performed on the tabulated results, yielding variance components for the arteriographic data (signal), the differences among observers, and the observer by case interaction (both considered noise). These components then allowed calculation of 68 and 95% confidence intervals, the signal-to-noise ratio, and the reproducibility coefficient for any number of observers. When a single observer was considered, reproducibility was low, with 95% confidence intervals of +/- 0.9 points, corresponding to approximately +/- 22% diameter stenosis. However, when data of three observers were averaged, the 95% confidence interval decreased to +/- 0.52 points (13% stenosis), signal-to-noise ratio rose to 12.2, and reproducibility coefficient was 0.92. Relatively small increments in these values were noted when data from a fourth or fifth observer were added. In comparison to a computer-assisted quantitative method, 86% accuracy was found for the results of averaged subjective determinations of stenosis severity.(ABSTRACT TRUNCATED AT 250 WORDS)     

我院冠心病患者的临床特点及冠状动脉造影分析

目的探讨我院冠状动脉粥样硬化性心脏病（CHD）患者的临床特征及冠状动脉（CA）病变特点。方法回顾性分析我院76例疑诊CHD患者的临床特征及冠状动脉造影（CAG）资料。结果合并原发性高血压、高脂血症及糖尿病者分别为75．0％、52．6％和30．2％。有吸烟史者占31．2％。其中心肌梗死组、典型心绞痛组、不典型胸痛组的CAG阳性率分别为100％、81．08％、22．22％。心电图ST—T改变与冠状动脉造影总的符合率为60．4％。CAG显示：冠脉供血呈右优势型者57例（75％），均衡型者11例（14％），左优势型者8例（11％）。病变累及CA136支，单支病变占31．6％，2支病变占21．0％，多支病变占45．6％；A型病变38支（27．9％），B型病变52支（38．2％），C型病变46支（33．8％），重度以上狭窄占65．2％，23例（40．4％）有不同程度的侧支循环，其中5例（21．7％）为3级。结论我院CHD患者普遍高龄，且合并多种危险因素，临床表现可不典型，CA分布以右优势型居多，CA病变以2支及多支病变为主，B型及C型病变占多数、CA狭窄程度较严重，部分病例已有不同程度的侧支循环。     

Radiographically detectable calcium and atherosclerosis: the connection and its exploitation

The early detection of coronary atherosclerosis may be impossible if we continue to depend on its pathophysiologic effects (ischemia) for our screening tests. Insoluble crystalline calcium phosphate, which is ubiquitous in our inorganic and biologic worlds, precipitates relatively early in atherosclerotic lesions. Since coronary calcification is specific for atherosclerosis and since calcium is a strong radiation absorber in the X-ray frequency range, sensitive radiographic techniques such as dual-energy subtraction fluoroscopy and ultrafast computed tomography hold promise as screening tests for this disease.     

Coronary angiography using 4 Fr catheters with acisted power injection: A randomized comparison to 6 Fr manual technique and early ambulation.

Coronary angiography using 4 Fr catheters may reduce access site complications, promote better utilization of outpatient facilities, but at a cost of suboptimal image quality. To determine whether 4 Fr diagnostic angiography with power injection (Acist, Minneapolis, MN) was equivalent to 6 Fr manual technique, 101 unselected patients were randomized to transfemoral coronary angiography with 4 or 6 Fr catheters. Procedural characteristics, angiographic quality scores, and results of 90 min ambulation were analyzed. Coronary angiographic quality scores using 4 Fr and 6 Fr catheters were equivalent (left coronary artery 4.73 +/- 0.6 vs. 4.80 +/- 0.65, P = 0.28; right coronary artery 4.98 +/- 90.13 vs. 4.97 +/- 0.16, P = 0.48). However, 4 Fr left ventriculographic image score was lower (4.53 +/- 0.68 vs. 4.83 +/- 0.42, P = 0.0002), attributed, in part, to a smaller injected contrast volume (32 +/- 11 vs. 37 +/- 4 mL, P = 0.001). The total study contrast volume was significantly less in the 4 Fr group (119 +/- 35 vs. 159 +/- 52 mL, P = 0.001). Complications related to early ambulation at 90 min were similar and minimal in both groups. Compared to 6 Fr manual contrast injection technique, diagnostic angiography through 4 Fr catheters with power contrast injection resulted in equivalent coronary angiographic image quality, slightly reduced but diagnostic left ventricular image quality, and significantly less contrast volume. Four Fr angiography facilitates early ambulation without compromising safety and image quality.