冠状动脉粥样硬化性心脏病合并糖尿病患者冠状动脉病变与C反应蛋白的相关性研究

目的 探讨冠状动脉粥样硬化性心脏病(简称冠心病)合并糖尿病患者冠状动脉病变程度与高敏C反应蛋白(hsCRP)的关系.方法 接受冠状动脉造影枪杏的患者161例进入此研究,冠心病但血糖正常组52例,冠心病伴有糖耐量异常组24例,冠心病合并2型糖尿病组85例.记录各组临床资料、冠状动脉造影评分,并检测各组患者血浆hsCRP水平.结果 冠心病合并2型糖尿病组冠状动脉造影评分明显高于血糖正常组,差异有统计学意义(P＜0.01);冠心病合并2型糖尿病组患者hsCRP水平明显高于血糖正常组(P＜0.01).冠状动脉造影评分与hsCRP水平之间呈正相关(r=0.309).结论 冠心病合并糖尿病患者的冠状动脉病变严重程度与血浆hsCRP水平正相关.     

老年冠状动脉粥样硬化性心脏病患者外科治疗的特点

目的 观察老年冠状动脉粥样硬化性心脏病(冠心病)患者外科治疗的特点.方法 回顾性分析215例冠心病患者的外科治疗,其中≥70岁75例,＜70岁患者140例.所有患者均行冠状动脉旁路移植术(CABG),108例行非体外循环CABG;107例行体外循环CABG,其中同时行二尖瓣成形术11例,二尖瓣置换术8例,主动脉瓣置换术7例,室壁瘤切除术18例.≥70岁组有2例同期行肿瘤手术.比较两组手术前一般情况、并存疾病、围手术期情况和转归情况. 结果 ≥70岁组和＜70岁组比较,手术前冠状动脉介入治疗两组分别为17.3%和7.1%(P＜0.05),不稳定心绞痛分别为91.4%和78.7%(P＜0.01).吻合动脉桥数分别为(1.1±0.5)支和(0.9±0.5)支(P＜0.01)应用大剂量儿茶酚胺类药物分别为12.0%和4.3%(P＜0.05),术后总并发症发生率分别为49.3%和28.6%(P＜0.01),术后心房颤动发生率分别为12.0%和4.3%(P＜0.05),伤口感染分别为7例和1例(P＜0.01),术后住院时间分别为(24.2±21.5)d和(17.5±7.4)d(P＜0.01);两组病死率(分别为5.3%和2.1%)比较,差异无统计学意义(P＜0.05).结论 70岁以上冠心病患者接受外科治疗安全、有效,但手术并发症发生率高,术后住院时间延长.     

C反应蛋白与冠状动脉粥样硬化性心脏病

冠状动脉粥样硬化性心脏病中炎症扮演了重要的角色,而炎症的重要标记物C反应蛋白与冠心病的关系正逐渐成为研究的热潮。现综述C反应蛋白的来源、特性、代谢等问题,并通过临床试验、药物试验、细胞分子水平实验及动物实验几个方面的论述来认识C反应蛋白与冠心病的关系,试图了解目前的证据能支持C反应蛋白在冠状动脉疾病发生发展中所起的作用。     

冠状动脉粥样硬化性心脏病患者血清尿酸特点分析

目的分析冠状动脉粥样硬化性心脏病（冠心病）患者血清尿酸浓度的特点,探讨检测血清尿酸浓度在预防冠心病发生中的作用。方法选取2010年3月至2011年2月在广东省人民医院住院,怀疑冠心病的患者430例为研究对象。首先根据造影结果分为冠心病组316例,对照组114例,测定两组的血清尿酸浓度,并进行对比分析。然后,根据世界卫生组织高尿酸血症诊断标准,将患者分成高尿酸血症组和非高尿酸血症组,比较两组的冠心病患病率。最后,患者按血清尿酸浓度分为4个浓度组,比较4组冠心病的患病率。结果冠心病组血尿酸浓度高于对照组,差异有统计学意义[（374.42±98.54）μmol.L-1vs.（374.42±98.54）μmol.L-1,P〈0.05]。高尿酸组中冠心病患病率高于非高尿酸组,但差异无统计学意义（P=0.217）。不同血清尿酸浓度的4组中,血清尿酸浓度越高,冠心病患病率也越高,与浓度最低组比较,差异有统计学意义（P=0.001）。结论血清尿酸浓度可能是冠心病的危险因素之一,血清尿酸浓度高者患冠心病的可能性较大;加强血清尿酸浓度检测对预防冠心病的发生具有重要意义。     

循环内皮细胞中内皮脂肪酶的表达与冠心病患者临床表现的关系

目的通过检测冠心病患者循环内皮细胞(CEC)中内皮脂肪酶(EL)的表达,探讨内皮细胞中EL表达与冠心病患者临床表现的关系。方法根据冠心病患者临床表现和冠状动脉造影结果将81例患者分为对照组(有冠心病危险因素但冠状动脉造影正常者21例)、稳定性心绞痛组(SAP组,24例)、不稳定性心绞痛组(UAP组,22例)、急性心肌梗死组(AMI组,14例),分别进行CECs计数、用免疫组织化学法检测患者CECs中EL表达情况、检测高敏C反应蛋白(hsCRP),并计算EL阳性CECs比例(EL~+/CECs)、低密度脂蛋白/高密度脂蛋白(LDL/HDL)。结果在冠心病患者CECs中存在EL表达,且随病变危险性增加而增强;UAP组和AMI组的CECs计数、hsCRP、LDL/HDL与对照组比较,均有显著性差异(P＜0．05);EL~+/CECs在各组间均有显著性差异(P＜0．05),EL~+/CECs与CECs计数、hsCRP、LDL/HDL呈显著正相关(P＜0．05)。结论冠心病患者CECs中存在EL表达,EL~+/CECs可作为冠心病危险性增加和冠心病患者临床病情的预测指标。     

超敏C反应蛋白与冠状动脉粥样硬化性心脏病

临床试验证实超敏C反应蛋白是心血管疾病的危险因素,现阐述超敏C反应蛋白与冠状动脉粥样硬化性心脏病与其预后的关系及可能机制。     

内皮型一氧化氮合酶在冠状动脉粥样硬化性心脏病的作用

一氧化氮合酶包括三种亚型(内皮型,诱导型,神经型),内皮型一氧化氮合酶合成体内一氧化氮,在冠状动脉粥样硬化性疾病的发生发展中起着重要的作用。三种亚型的一氧化氮合酶全部缺失的大鼠会发生自发性心梗。病例对照和前瞻性研究都证实内皮型一氧化氮合酶的基因多态性与冠心病相关,突变型携带者(TT型,rs2070744)比其他基因型者会有较高的患冠心病甚至心血管病死亡的风险。     

代谢综合征与冠状动脉粥样硬化性心脏病

代谢综合征(Metabolic syndrome,MS)是一种涉及多种心血管疾病危险因子的聚集状态,据初步研究资料显示我国MS患病率已高达13．25％,随着年龄的增加而增高,55岁以上人群患病率高达20．26％。MS使发生糖尿病和冠心病的危险性明显上升。本文着重对MS与冠状动脉硬化性心脏病(CAD)的相关性作一综述。     

心率震荡在冠状动脉粥样硬化性心脏病研究中的应用

心率震荡是近几年提出的一项新的临床心电生理学指标。其在冠状动脉粥样硬化性心脏病(冠心病)方面主要用于急性心肌梗死后患者病死率的预测和危险分层、心肌缺血再灌注的疗效判断、筛选需要植入埋藏式自动复律除颤器(ICD)的患者及冠状动脉旁路移植术后的疗效评价等。     

Impact of left ventricular ejection fraction on endothelial function in patients with coronary artery disease

BACKGROUND: Endothelial dysfunction is present in patients with coronary artery disease (CAD) or with congestive heart failure. HYPOTHESIS: This study was performed to evaluate the impact of systolic heart function on endothelial function in patients with CAD. METHODS: The study population consisted of 283 consecutive patients (mean age 59 years, 176 men) undergoing coronary angiography. Endothelial function was assessed by measuring flow-mediated vasodilation (FMD) of the brachial artery. RESULTS: Patients (n = 236) with an ejection fraction (EF) > or = 55% on routine echocardiogram were younger (mean age 58 vs. 62 years), showed a lower prevalence of diabetes (15 vs. 38%) and myocardial infarction (13 vs. 66%), and showed a higher FMD (4.8 +/- 2.4 vs. 4.0 +/- 2.0%, p < 0.05) than patients (n = 47) with an EF < 55%. The correlation coefficient between FMD/endothelial function and EF/systolic heart function was 0.149 (p < 0.02) in the overall study population. Multivariate analysis showed that of age, gender, frequency of diabetes mellitus, myocardial infarction, and CAD extent, EF was the only significant independent parameter correlating with FMD in patients with CAD. CONCLUSIONS: Compared with the other tested risk factors, EF surprisingly was the only significant independent parameter correlating with endothelial function in patients with CAD. Our results support the view that endothelial function is an independent prognostic factor in patients with CAD.     

Clinical value of studies with radioiodinated heptadecanoic acid in patients with coronary artery disease

The results described in the literature of myocardial scintigraphy with radioiodinated heptadecanoic acid (IHDA) to detect coronary stenoses are contradictory. In the present study, IHDA scintigraphy was performed in nine control subjects and 67 patients with coronary artery disease. The acquisition time was 75 min and background correction was not applied. The time-activity curves of regions of interest were analyzed by curve fitting with a monoexponential plus constant. Two parameters were used: the halftime value of the monoexponential (T1/2 in min) and the ratio of the amplitude (A) of the monoexponential and the total activity at time t = 0 (amplitude + constant = A + C): A/A + C as a percentage. Based on the control group, a region of normal T1/2 values and A/A + C ratios was defined, for each calculated T1/2-A/A + C pair the probability of originating from a normal region was calculated. The value of the IHDA test, using the index of merit (sensitivity + specificity-100%), increased in the patient group without MI with the severity of the stenosis (21%, 24% and 47% for stenoses greater than or equal to 75%, greater than or equal to 90% and greater than or equal to 99%). In patients with MI, only small positive values in regions of non-infarct-related vessels were found (-1%-16%). It is concluded that the value of the IHDA test to detect stenoses of coronary arteries is too low to apply this test in clinical practice. However, a new type of analysis is offered, based on curve fitting of individual pixels.(ABSTRACT TRUNCATED AT 250 WORDS)     

C反应蛋白与冠心病病变程度的相关性

目的研究C反应蛋白（CRP）与冠心病病变程度的关系。方法测定经冠状动脉造影确诊的98例冠心病患者血浆CRP浓度。98例患者被分为3组:稳定型心绞痛组（n=32）、不稳定型心绞痛组（n=46）和急性心肌梗死组（n=20）;又根据血管病变程度分为单支血管病变组（n=56）及多支血管病变组（n=42）;同时以冠状动脉造影排除冠心病的23例患者作为对照组,比较各组间血浆CRP浓度。结果冠心病患者各组CRP浓度均较正常对照组增高（P<0.05）。在冠心病各亚组中,不稳定型心绞痛组血浆CRP浓度高于稳定型心绞痛组,而急性心肌梗死组CRP浓度分别高于稳定型心绞痛和不稳定型心绞痛组（P<0.01）。多支血管病变组CRP含量更显著高于单支血管病变组（P<0.01）。结论血浆CRP浓度与冠心病病变程度有密切关系。     

血浆髓过氧化酶与冠心病的临床研究

目的探讨血浆髓过氧化酶（MPO）与冠状动脉粥样硬化性心脏病（CAD）的临床关系。方法利用酶联免疫法测定78例CAD患者血浆MPO、C反应蛋白（CRP）和白细胞（WBC）值，并与46例非CAD患者进行对比。结果CAD中急性冠脉综合征（Acs）组患者血浆髓过氧化酶水平显著增高，且与CRP、WBC呈正相关；而稳定型心绞痛（SAP）组MPO水平与对照组差异无统计学意义。结论血浆MPO水平可以预测冠心病ACS的危险性，对严重心血管事件的发生有一定的预警作用。     

经尺动脉途径行冠状动脉介入术的临床应用

目的:分析经尺动脉途径行冠状动脉介入术的临床应用价值和安全性。方法:回顾总结2006年6月至2007年5月51例疑似冠心病患者经桡动脉途径穿刺失败后改经尺动脉途径行冠状动脉介入术的资料。结果:47例患者经尺动脉穿刺行冠状动脉介入术获得成功,成功率92.2%,手术无冠脉开口损伤、穿刺口血肿和肌间血肿等严重并发症发生。结论:经尺动脉途径行冠状动脉介入术成功率高,无严重并发症,是一种安全、有效的冠状动脉介入检查和治疗方法。     

Plasma vascular endothelial growth factor level is elevated in patients with multivessel coronary artery disease

BACKGROUND: Vascular endothelial growth factor (VEGF) has been implicated in both angiogenesis and ischemia. However, the relationship between plasma VEGF level and coronary artery disease remains unknown. HYPOTHESIS: Plasma VEGF level may be associated with severe coronary artery disease and other cardiovascular risk factors. METHODS: We examined plasma VEGF concentration and coronary risk factors in 73 patients who underwent coronary angiography and 70 apparently healthy control subjects. According to the number of the three major coronary vessels with significant (> or = 75%) stenosis, we divided the patients into two groups: the mild stenosis group (0- and single-vessel disease, n = 36) and the severe stenosis group (double- and triple-vessel disease, n = 37). RESULTS: The log VEGF value of the severe stenosis group was significantly higher than that of the mild stenosis (p < 0.05) and control groups (p < 0.05). Furthermore, there was a significant positive trend in the log VEGF value according to the number of vessels with significant stenosis (p = 0.016). However, there was no significant difference in log VEGF value between the mild stenosis and control groups. Soluble vascular cellular adhesion molecule, soluble intracellular adhesion molecule, and other coronary risk factors were found to be associated with the presence of vessel stenosis. CONCLUSION: Unlike established coronary risk factors, the plasma VEGF level may be associated with only severe coronary ischemia such as multiple coronary vessel disease.     

培垛普利对冠心病患者经皮冠状动脉介入术后肱动脉内皮功能障碍的影响

目的探讨培垛普利对经皮冠状动脉介入（PCI）操作所诱发的肱动脉内皮功能不全的影响。方法实行PCI的冠心病患者62例,随机分为2组,培垛普利组31例,对照组31例,应用高频超声探头分别测量2组PCI术前及术后的肱动脉基础内径、反应性充血内径、含服硝酸甘油后内径,计算肱动脉血流介导的舒张反应（FMD）,并运用多普勒技术测定血流速度峰值,最后比较2组间及组内上述参数的差异。超声测量于PCI术前2h和术后30min内完成。结果培垛普利组的FMD明显改善[（5．9±0．3）％术前vs（7．7±0．4）％术后PCI,P〈0．0013,而对照组明显恶化[（6．0±0．5）％术前vs（4．8±0．6）％术后PCI,P〈0．0013。两组硝酸甘油介导的血管舒张反应及反应性充血血流速度峰值均无明显变化。结论培垛普利可改善PCI介导的肱动脉内皮功能不全。     

冠心病患者肾动脉狭窄及其相关因素分析

目的　探讨接受冠状动脉造影及冠心病患者合并肾动脉狭窄的发生率及其危险因素。方法　对连续 15 7例接受冠状动脉造影的患者进行腹主动脉数字减影血管造影检查。结果　 15 7例患者中 ,肾动脉狭窄发生率为 14 0 % ;经冠状动脉造影证实的 81例冠心病患者中 ,肾动脉狭窄的发生率为 2 5 9% ;冠状动脉造影完全正常的 62例患者中 ,无 1例有肾动脉狭窄。多元Logistic回归分析表明 ,冠心病、糖尿病及血肌酐 >10 0 μmol/L是存在肾动脉狭窄的独立预测因素。 结论　对冠心病合并高血压、糖尿病、特别是血肌酐 >10 0 μmol/L的患者 ,冠状动脉造影时应常规进行腹主动脉造影检查 ,以尽早发现肾动脉狭窄。     

青年冠心病患者冠状动脉病变特点及相关危险因素分析

目的探讨冠状动脉粥样硬化性心脏病(冠心病)的临床特点在青年与老年患者间的差异。方法回顾性分析48例青年冠心病患者与156例老年冠心病患者的临床资料,着重分析比较两组的危险因素及冠状动脉造影结果。结果青年组冠心病患者女性比例占6.25%(3/48),明显低于老年组的33.33%(52/156),差异有统计学意义(P0.01)。青年组体质量指数明显高于老年组,差异有统计学意义[(27.03±2.73)kg/m2vs.(25.16±3.05)kg/m2,P0.01]。青年组大量吸烟的比例也远高于老年组,差异有统计学意义[75.00%(36/48)vs.36.54%(57/156),P0.01]。老年组合并原发性高血压、糖尿病的发生率高于青年组,差异有统计学意义[51.28%(80/156)vs.16.67%(8/48),P0.01;30.77%(48/156)vs.6.25%(3/48),P0.01]。青年组血浆总胆固醇,低密度脂蛋白胆固醇及三酰甘油浓度与老年组比较,差异无统计学意义(P0.05)。青年组高密度脂蛋白胆固醇浓度低于老年组,差异有统计学意义[(0.85±1.80)mmol/Lvs.(1.08±0.23)mmol/L,P0.01]。青年组血浆尿酸浓度高于老年组,差异有统计学意义[(349.10±67.02)mmol/lvs.(323.77±73.82)mmol/L,P0.01]。青年组冠状动脉病变以单支病变为主,且左前降支病变发生率最高。结论男性、肥胖、大量吸烟为青年冠心病主要发病危险因素,低高密度脂蛋白胆固醇浓度和高尿酸浓度也可能为青年冠心病的危险因素;青年冠状动脉病变轻,以单支病变为主。