急性心肌梗死与慢性稳定型心绞痛患者血清α-Klotho蛋白浓度对比分析

目的　比较急性心肌梗死（AMI）和慢性稳定型心绞痛（CSA）患者血清α-Klotho蛋白浓度的差异。方法　选择拟诊冠心病（CAD）准备行冠状动脉造影（CAG）的患者为研究对象。入院24　h内采集病史、生化数据、血清α-Klotho蛋白浓度。应用单因素、多因素分析急性心肌梗死组（n＝84）与慢性稳定型心绞痛组（n＝90）血清α-Klotho蛋白浓度的差异。结果　急性心肌梗死组血清α-Klotho浓度低于慢性稳定型心绞痛组（903.19±558.13　ng/L比1075.10±535.29　ng/L）,组间差异有统计学意义（P＜0.05）。Logistic回归分析显示,校正性别、年龄、吸烟史、饮酒史、早发冠心病家族史、高血压病病史、总胆固醇（TC）、高密度脂蛋白（HDLC）、肌酐清除率、2型糖尿病病史后,血清α-Klotho蛋白浓度与急性心肌梗死呈负相关（OR＝0.995,95%CI为0.993～0.997,P＜0.05）。结论　慢性稳定型心绞痛患者血清α-Klotho蛋白浓度高于急性心肌梗死患者。血清α-Klotho蛋白浓度与急性心肌梗死呈负相关。     

稳定型心绞痛患者血清miR-33a、miR-126与急性心肌梗死发生的相关性研究

目的 探究稳定型心绞痛（stable angina pectoris, SAP）患者血清微小RNA-33a(miR-33a)、微小RNA-126(miR-126与急性心肌梗死（acute myocardial infarction, AMI）发生的相关性。方法 选取2020年8月至2022年4月收治的146例SAP患者及同期健康体检者48例（对照组）。依据是否发生AMI将SAP患者分为发生AMI组、未发生AMI组。对比各组的一般资料、糖脂代谢指标及血清miR-33a、miR-126表达,分析不同分级的SAP患者各指标及其与AMI发生的相关性。结果SAP患者的血清miR-33a表达水平高于对照组,而miR-126低于对照组（P <0.05）。发生AMI组血清miR-33a高于未发生AMI组,miR-126低于未发生AMI组（P <0.05）;发生AMI组空腹血糖（fasting plasma glucose, FPG）、甘油三酯（triglyceride, TG）、总胆固醇（total cholesterol, TC）、低密度脂蛋白胆固醇（low density lipopr...     

血清胰岛素样生长因子浓度与稳定型心绞痛及急性心肌梗死的关系

目的 通过分析急性心肌梗死患者血清胰岛素样生长因子Ⅰ和Ⅱ浓度的变化。来探讨其与稳定型心绞痛及其与急性心肌梗死之间的关系。方法 选取急性心肌梗死患者23例、稳定型心绞痛患者20例和对照组健康体检者20例，动态测定各组血清胰岛素样生长因子Ⅰ和Ⅱ的浓度。结果 稳定型心绞痛组血清胰岛素样生长因子Ⅰ和Ⅱ浓度明显低于对照组（P〈0．05），急性心肌梗死组胰岛素样生长因子Ⅰ和Ⅱ浓度显著高于稳定型心绞痛组和对照组（P〈0．05），稳定型心绞痛组与对照组差异无显著性（P〉0．05）。急性心肌梗死组中血清胰岛素样生长因子Ⅰ浓度和胰岛素样生长因子Ⅱ浓度峰值分别出现于第24h和72h。血清胰岛素样生长因子Ⅱ浓度与血清胰岛素样生长因子Ⅰ浓度呈正相关（r=0．642，P〈0．01）。它们与心肌酶谱无相关性（P〉0．05）。结论 在稳定型心绞痛组中胰岛素样生长因子Ⅰ和胰岛素样生长因子Ⅱ浓度明显低于对照组。急性心肌梗死组中胰岛素样生长因子Ⅰ和胰岛素样生长因子Ⅱ水平明显高于稳定型心绞痛组和对照组。     

不稳定型心绞痛患者血清肌酸激酶MM3/MM1比值的变化及意义

目的 :探讨不稳定型心绞痛 ( UA)患者血清肌酸激酶 ( CK) MM3/ MM1比值的变化及意义。方法 :对 60例 UA、30例稳定型心绞痛 ( SA)和 30例急性心肌梗死 ( AMI)患者在胸痛发作后不同时间采血样 ( 30例对照组仅采血 1次 ) ,采用不连续缓冲体系电泳方法检测 CKMM3/ MM1比值和用速率法测定 CK同工酶 ( CK- MB)和 CK变化。结果 :UA患者按 CKMM3/ MM1比值有 1次≥0 .5为酶学升高的 UA〔 UA( )〕,否则为酶学正常的 UA〔 UA( - )〕。对照组、SA组和 UA( - )组各指标无显著性差异。UA( )组中 ,CKMM3/ MM1比值在 0 .5～ 12 h,CK- MB在 2～ 12 h之间高于以上 3组 ( P <0 .0 5 ) ,但 CKMM3/ MM1比值无任何一个超过 1.0 ,且总 CK正常。AMI组 CKMM3/MM1比值在 0 .5～ 12 h,CK- MB在 2～ 12 h之间明显高于 UA( )组 ( P <0 .0 1)。结论 :部分 UA患者血清 CKMM3/ MM1比值显著升高 ,并早于 CK- MB,为识别 UA患者的高危人群提供了一个简单、可靠、经济的方法     

血浆白介素18/白介素10比值与稳定型心绞痛患者发生急性冠脉综合征的关系

目的探讨白介素（IL）-18/IL-10比值与稳定型心绞痛患者发生急性冠脉综合征的关系,探索防治急性冠脉综合征发生的新途径。方法采用酶联免疫吸附法检测215例稳定型心绞痛患者IL-18和IL-10的水平变化,并对所有患者进行24个月随访,根据随访的结果将患者分为发生急性冠脉综合征组（A组,38例）及未发生急性冠脉综合征组（B组,173例）。结果 A组患者血浆IL-18水平及IL-18/IL-10比值显著高于B组[（229±77）vs（166±5 0）ng/L,（2.4±0.7）vs（1.6±0.6）,P〈0.01],A组患者血浆IL-10水平低于B组[（101±37）vs（115±38）ng/L,P〈0.05];高血浆IL-18/IL-10比值使稳定型心绞痛患者发生急性冠脉综合征的优势比值增加3.935倍（P〈0.01）。结论稳定型心绞痛患者血浆IL-18和IL-10水平与急性冠脉综合征的发生密切相关;IL-18/IL-10比值增高对稳定型心绞痛患者发生急性冠脉综合征有一定预测价值,提示机体炎症活动增强是促进急性冠脉综合征发生的重要因素,抗炎治疗可能是防治急性冠脉综合征的途径之一。     

急性心肌梗死与稳定型心绞痛患者尿biopyrrin含量的比较及其对预测心血管事件的应用

新近发现,biopyrrin作为胆红素氧化代谢产物,可考虑作为氧化应激的潜在标志物。有报道大鼠肝缺血和(或)再灌注模型尿biopyrrin含量增加,然而有关急性心肌梗死(AMI)和稳定型心绞痛(SPA)患者尿biopyrrin的排泄研究     

青年急性心肌梗死及不稳定型心绞痛临床特点及院内降脂强度分析

目的 探讨青年不稳定型心绞痛（UAP）和急性心肌梗死（AMI）患者临床特点的差异、临床指标的鉴别价值及院内降脂强度分析。方法 本研究纳入患者467例及AMI患者168例。收集患者的一般临床资料、实验室检查、院内降脂方案等,评价Gensini积分。ROC曲线分析部分指标对UAP和AMI患者鉴别的敏感性和特异性。结果 AMI患者男性患者占比、吸烟史占比、既往他汀治疗史占比以及血清三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、残余胆固醇（RC）、非高密度脂蛋白胆固醇（non-HDL-C）、空腹血糖、Gensini积分、冠脉病变数目均显著高于UAP组,在高血压史、高密度脂蛋白胆固醇（HDL-C）低于UAP组,差异具有统计学意义（P<0.05）。多因素logistic回归显示男性（OR=3.580）、既往无高血压史（OR=1.541）、既往他汀治疗史（OR=1.816）、较高的LDL-C(OR=1.357)及空腹血糖（OR=1.091）更可能是AMI,但这些指标的鉴别能力有限,其中五项指标联合的曲线下面积最高（AUC=0.659）,(P<0.05)。两组间85%的患者属于超高危...     

不稳定型心绞痛演变急性心肌梗死临床分析

不稳定型心绞痛的临床意义与心绞痛不同,若处置不当或不及时,短期内很可能演变成急性心肌梗死或发生猝死,因此一定要高度重视,现将我院治疗不稳定型心绞痛患者55例报告如下。1临床资料1.1不稳定性心绞痛的诊断标准出现心肌缺血性胸痛或证实心肌缺血,但无急性心肌梗死的心电图及心肌酶谱的改变,     

急性心肌梗死与心绞痛患者血清胆红素水平的比较

目的 探讨心绞痛和急性心肌梗死患者血清胆红素的差异。方法 收集符合1979年WHO诊断标准的心绞痛(AP)患者71例,急性心肌梗死(AMI)患者61例,其中单纯前壁AMI 11例,下壁AMI 14例。采清晨空腹静脉血测定血清总胆红素(Tbil)、直接胆红素(Dbil)、间接胆红素(Ibil)浓度并进行比较。结果 AMI组各型血清胆红素(Tbil 14.56±6.46μmol/L,Dbil 6.20±2.71μmol/L,Ibil 8.31±4.66μmol/L)均高于AP组(Tbil 11.25±4.79μmol/L,Dbil 4.94±1.82μmol/L,Ibil 6.25±3.99μmol/L),P<0.01。前壁AMI患者血清胆红素水平(Tbil 15.99±8.79μmol/L,Dbil 6.88±4.99μmol/L,Ibil 9.11±5.12μmol/L)较下壁AMI患者血清胆红素水平(Tbil 12.34±2.86μmol/L,Dbil 5.15±0.81μmol/L,Ibil 7.18±2.32μmol/L)高,但无统计学差异(P>0.05)。结论 AMI患者与AP患者血清胆红索水平存在显著性差异,但前壁AMI患者与下壁AMI患者血清胆红素水平的差异无统计学意义。     

心绞痛与急性心肌梗死的心率功率谱分析

研究３１名心绞痛和３１名急性心肌梗死患者７２名正常人的心率功率谱。结果发现心绞冯痛组心率变异性下降；急性心肌梗死心绞痛组心率功率变在极低频段和高频段分别下降４８．２％和６５．１％。说明急性心肌梗死组交感神经和迷走神经功能进一步受损，尤以迷走神经功能受损为著。     

IL-6 and IL-1 receptor antagonist in stable angina pectoris and relation of IL-6 to clinical findings in acute myocardial infarction

OBJECTIVES: To determine if increased inflammatory activity, as reflected by interleukin-6 (IL-6) and interleukin-1 receptor antagonist (IL-1ra) levels, is present in patients with stable angina pectoris and if IL-6 levels on admission to the coronary care unit in patients with acute myocardial infarction (AMI) are related to heart failure and fever response. SUBJECTS AND METHODS: We studied 28 patients with stable angina pectoris enrolled for coronary angiography, and compared them with sex- and age-matched controls. Thirty-four patients with AMI were studied and samples for determination of IL-6 levels were taken on admission within 36 h of onset of symptoms. IL-6 and IL-1ra were determined in serum by enzyme immunoassay. RESULTS: Levels of IL-6 and IL-1ra were higher in patients with stable angina pectoris than in controls (mean 4.6 +/- 3.6 vs. 3.0 +/- 2.9 ng L-1, P < 0.03, and 774 +/- 509 vs. 490 +/- 511 ng L-1, P < 0.01, respectively). IL-6 and IL-1ra levels were not related to angiographic findings. IL-6 levels were high in patients with AMI (38.9 +/- 75.6 ng L-1). Patients with prolonged fever (duration > 4 days) had higher IL-6 levels (94.7 +/- 138.2 vs. 21.7 +/- 29.7 ng L-1, P < 0.05). IL-6 levels were not related to heart failure. CONCLUSIONS: Our results indicate that increased inflammatory activity is present not only in acute coronary syndromes, but also in a chronic form of ischaemic heart disease, giving further evidence for a central role of inflammatory processes in coronary artery disease. With regard to AMI, we found increased inflammatory activity in patients with prolonged fever.     

The prognostic significance of angina pectoris experienced during the first month following acute myocardial infarction

Background: Angina pectoris accompanied by transient ST-segment changes during the in-hospital phase of acute myocardial infarction (AMI) is a well established marker of subsequent cardiac death and reinfarction. Hypothesis: This study was undertaken to record the prognostic significance of angina pectoris experienced during the first month following discharge from AMI. Methods: In all, 803 patients included in the placebo arm of the Danish Verapamil Infarction Trial II were followed up for 18 months in 20 coronary care units in Denmark. The patients were randomized to placebo and were still on study treatment 1 month after discharge. Of these patients, 311 (39%) reported chest pain during the first month following discharge. Results: Patients with angina pectoris had a significantly increased risk of reinfarction [hazard 1.71; 95%-confidence limit (CL): 1.09, 2.69] and increased mortality risk which, however, only reached borderline statistical significance (hazard 1.52; 95%-CL: 0.96, 2.40). When patients were subdivided according to both angina pectoris and heart failure, those with one or both of these risk markers had significantly increased mortality (p 0.03) and reinfarction (p 0.02) rates compared with patients free of both angina pectoris and heart failure. Conclusion: Patients with postinfarction angina pectoris have a significantly increased morbidity risk.     

梗塞前心绞痛对急性心肌梗塞患者的有益作用

43例首次穿壁性急性心肌梗塞(AMI)患者于静脉内溶栓后90min行冠状动脉造影.其中24例AMI前6h内有心绞痛(甲组),另19例梗塞前无心绞痛(乙组).尽管两组多支冠状动脉病变及侧支循环发生率相似.但甲组异常Q波导联数、QRS积分、CPK峰值及CPK峰值距发病时间显著低于乙组.而梗塞相关冠状动脉再通率显著高于乙组.22例IRA开通患者中,有心绞痛者其基础左心室功能较无心绞痛者好.出院前超声心动图检查显示,甲组左心室局部和整体收缩功能、舒张充盈明显改善,而乙组收缩功能降低、舒张充盈无明显变化.住院期心脏事件发生率甲组显著低于乙组.本文提示,梗塞前心绞痛可能由于早期心肌再灌注和缺血预适应对梗塞大小、左心室功能及预后具有益作用.     

不稳定性心绞痛、急性心肌梗死病人血清铁蛋白变化的临床意义

目的　研究不稳定性心绞痛（ＵＡＰ）、急性心肌梗死（ＡＭＩ）病人血清铁蛋白（ＳＦ） 的变化。方法　将住院治疗的４９ 例冠状动脉粥样硬化性心脏病（ＣＨＤ） 患者分为稳定性心绞痛（ＳＡＰ）、ＵＡＰ、ＡＭＩ组。其中ＳＡＰ９ 例,ＵＡＰ２７ 例,ＡＭＩ１３ 例,对照组３０ 例。ＡＰ和ＡＭＩ发作２４ 小时内的抽取空腹静脉血,分离血清,－ ４５ ℃保存,利用双抗体１２５Ｉ放射免疫法测定ＳＦ。结果　ＡＭＩ组ＳＦ 与对照组比较,ＡＭＩ组ＳＦ 增高,差异呈高度显著性（ Ｐ ＜０－０１）。结论　ＳＦ增高可能是ＣＨＤ的一个危险因素。ＳＦ在ＡＭＩ时增高与心肌损伤有关,用络合剂减少ＳＦ释放的Ｆｅ３＋ 有可能减轻心肌损伤     

Asymptomatic myocardial ischemia in patients with stable and typical angina pectoris

The existence of transient myocardial ischemia (TMI) and the value of the serial dynamic electrocardiogram (DCG) in patients with variant or unstable angina pectoris are known. However, less information is available on the frequency and characteristics of TMI in patients with stable angina pectoris. For this study, we selected 40 patients with stable and typical angina pectoris. The presence of coronary artery disease and the ejection fraction were evaluated by means of angiocardiography. The DCG monitoring was performed with bichannel portable recorders for three 24-h periods at 7-day intervals. The patients were on optimal doses of beta blockers and isosorbidilate throughout the study. We detected 788 episodes of TMI in 22 of the 40 patients. The ejection fraction was poorer in the 22 patients with ST-T changes than in the 18 without such changes. The repolarization changes were: (1) ST elevation (55 symptomatic and 87 asymptomatic episodes, (2) ST depression (138 symptomatic and 236 asymptomatic episodes, and (3) T-wave changes (83 symptomatic and 164 asymptomatic episodes). All 22 patients with TMI presented a combination of the above changes. It appears, therefore, that ST-T changes are more frequent in patients with stable angina pectoris than was hitherto suspected. The DCG is valuable in assessing these changes, especially when one considers that the asymptomatic episodes are almost twice as frequent as the symptomatic ones. The asymptomatic episodes lasted a mean of 1.8±1.3 min (mean±SD), while the symptomatic episodes lasted 3.8±2.7 min (p <0.02, by sign test). Heart rate was unchanged during the episodes of TMI, and did not show any significant difference between asymptomatic and symptomatic episodes. Additional investigation is necessary, however, to determine the clinical implications of these findings.     

Prognostic implications of renal dysfunction in patients with stable angina pectoris

OBJECTIVE: Impaired renal function is emerging as an independent risk factor for cardiovascular (CV) disease. We analysed the prognostic implications of estimated renal function in patients with angina pectoris. DESIGN: Post hoc analysis of the Angina Prognosis Study In Stockholm (APSIS). The estimated creatinine clearance (eCrCl) was calculated according to the Cockcroft-Gault formula in 808 patients. Outcomes were compared for subgroups with CrCl > or =90, 60-89 and<60 mL min(-1). Setting. Hospital-based study with patients referred from primary care and hospital. SUBJECTS: A total of 809 patients (248 women) with clinically diagnosed stable angina pectoris. Intervention. Double-blind treatment with metoprolol or verapamil. RESULTS: One hundred and sixty-four patients (91 women) had an eCrCl below 60 mL min(-1). During a median follow-up of 40 months, 38 patients suffered CV death and 31 patients had a nonfatal myocardial infarction (MI). In a univariate analysis a lower eCrCl was related to a higher risk for CV death or MI amongst men (log rank P = 0.036). A multivariate Cox analysis showed an independent prognostic importance of eCrCl for CV death (P = 0.046) and for CV death or MI (P = 0.042) amongst all patients. When analysed as a continuous variable, a 1 mL min(-1) decrease in eCrCl was associated with a 1.6% (0.1-3.1) increase in the risk for CV death or MI, and a 2.1% (0-4.1) increase in the risk for CV death alone. CONCLUSION: Renal dysfunction was found to be common in patients with stable angina pectoris and estimated creatinine clearances carried significant independent prognostic information regarding CV death and nonfatal MI.