瑞舒伐他汀对冠状动脉粥样硬化性心脏病患者血液流变学及血管内皮功能的影响

目的探讨瑞舒伐他汀对冠状动脉粥样硬化性心脏病(冠心病)患者血液流变学及内皮功能的影响。方法105例冠心病患者随机分为观察组52例和对照组53例。对照组接受常规治疗方案,观察组在对照组基础上给予瑞舒伐他汀口服,10 mg/次,1次/d。2组均连续治疗3个月。评价临床疗效,对比2组治疗前和治疗后血液流变学、血管内皮功能指标变化。结果观察组临床总有效率92.31%,显著高于对照组的77.36%(P<0.05)。治疗后2组血浆黏度、全血低切黏度、全血高切黏度及纤维蛋白原水平较治疗前显著下降(P<0.05或P<0.01),且观察组各指标下降幅度较对照组更为显著(P<0.01)。治疗后2组一氧化氮(NO)水平较治疗前显著升高,内皮素(ET)水平较治疗前显著下降(P<0.01),且观察组NO和ET水平改善幅度优于对照组(P<0.01)。结论冠心病患者在常规治疗基础上加用瑞舒伐他汀,可有效提高临床疗效,改善血液流变学及血管内皮功能。     

组织多普勒成像评价冠心病患者左心房功能的临床研究

目的应用组织多普勒超声技术（TDI）检测冠心病患者左心房功能,评价左心房功能与冠脉病变程度的关系,并观察经皮冠状动脉介入治疗术（PCI）后冠心病患者左心房功能的变化。方法研究对象共200例,其中160例为疑诊冠心病,接受冠状动脉造影术或PCI治疗的患者,根据冠脉造影结果,分为动脉粥样硬化组和冠心病组,并按照Gensini积分分为4组,对所有研究对象行左心房功能常规超声指标测量并利用TDI测量左心房侧壁运动的峰值速度（Va）及左心房收缩起始时间（To）、达峰时间（Tp）、终止时间（Te）。行PCI术患者于术后3 d、1个月复查以上指标。选取40例正常人作为对照组。结果①与正常组相比,动脉粥样硬化组常规超声指标无统计学差异（P〉0.05）,冠心病组左心房内侧横径、面积、容积增大,面积排空分数、容积排空分数下降,二尖瓣血流E/A减低（P〈0.05）;②随着Gensini积分的增加,Va值下降（P〈0.05）,To、Tp、Te值增加（P〈0.05）;③与术前相比,冠心病患者PCI术后3 d左心房功能有所改善,但无显著差异（P〉0.05）;术后1个月,左心房内侧横径、面积、容积减小,面积排空分数、容积排空分数增加,Va值上升、To、Tp、Te值减小,E/A增加（P〈0.05）。结论利用组织多普勒成像技术可以客观准确地评价冠心病患者左心房功能;左心房功能与冠脉病变程度有良好的相关性,随着冠脉病变程度加重,左心房功能逐渐减低;PCI术可以改善冠心病患者的左心房功能。     

冠心病患者心率变异性分析

目的了解冠心病（CHD）患者的心率变异性（HRV）特点,探讨CHD患者自主神经变化的临床意义。方法测定93例CHD患者和49例健康对照者24h心率变异性的时域指标,并进行比较分析。结果CHD组24hHRV指标水平明显低于健康对照组（P〈0．01）,差异有统计学意义。结论CHD患者HRV降低提示心血管自主神经系统功能受损害。     

经皮冠状动脉介入对冠心病合并心力衰竭患者心血管事件的预防作用

目的 探讨经皮冠状动脉介入对冠心病合并心力衰竭患者心血管事件的预防作用.方法 选择2015年1月至2018年12月我院收治的460例冠心病合并心力衰竭患者为研究对象,通过随机数字表法将其分为对照组(230例)和试验组(230例).对照组采取常规保守治疗,试验组采取经皮冠状动脉介入治疗.比较两组的干预效果.结果 治疗后,...     

Acute endothelial tissue plasminogen activator release in pregnancy

Summary. Objective: Pregnancy is associated with marked changes in vascular physiology and an increased risk of thrombosis. The aim of the study was to assess the effect of pregnancy on the acute release of tissue plasminogen activator (t‐PA) from the endothelium. Methods and results: Ten primigravida pregnant women were recruited in the third trimester of pregnancy (week 36 ± 1) and compared with 20 age‐matched non‐pregnant women (day 9.8 ± 0.3 of menstrual cycle). Blood flow and plasma fibrinolytic factors were measured in both forearms by venous occlusion plethysmography and blood sampling, respectively, during unilateral brachial artery infusions of bradykinin (100–1000 pmol min^?1). Pregnant women had higher plasma plasminogen activator inhibitor type 1 (PAI‐1) antigen concentrations (77.1 ± 12.4 vs. 21.5 ± 9.8 ng mL^?1; P = 0.004) that resulted in lower basal t‐PA/PAI‐1 ratios (0.2 ± 0.1 vs. 0.6 ± 0.1; P = 0.02) and plasma t‐PA activity concentrations (0.17 ± 0.02 vs. 0.58 ± 0.06 IU mL^?1; P < 0.0004). In both groups, bradykinin caused dose‐dependent increases in blood flow and local release of plasma t‐PA antigen and activity (P < 0.005 for all). Both the plasma t‐PA/PAI‐1 ratios and the net release of active t‐PA were markedly reduced in pregnant women (P < 0.05 for both). Area under the curve for net active t‐PA release was reduced by 36%. Conclusions: Pregnancy is associated with major perturbations of endogenous fibrinolytic capacity with an overwhelming increase in plasma PAI‐1 concentrations and an inadequate release of active t‐PA. These prothrombotic effects may, in part, explain the increased risk of arterial and venous thrombosis in pregnant women.     

冠状动脉粥样硬化性心脏病血小板参数变化

目的探讨冠心病患者血小板参数变化的临床意义。方法采用深圳迈瑞BC5800血细胞分析仪测定60例冠心病患者和50例健康对照者外周血中血小板计数(PLT)、血小板平均体积(MPV)、血小板体积分布宽度(PDW)和大血小板比率(P-LCR),并进行统计分析。结果冠心病患者与健康对照组的PLT、MPV、PDW及P-LCR比较,差异均有统计学意义(P<0.05),其中MPV、PDW和P-LCR明显高于健康对照组,而PLT则明显低于健康对照组。结论临床上动态监测冠心病患者的血小板参数变化,对冠心病的预防、诊治及预后有一定的参考意义。     

定量组织速度成像评价冠心病左室心肌局部功能

目的探讨定量组织速度成像(QTVI)对冠心病患者的左室心肌的局部功能评价价值。方法 53例患者根据冠脉造影结果将其分为:冠状动脉无狭窄病变对照组(n=14)及单支病变组(n=12)、双支病变组(n=16)和三支病变组(n=11)。所有患者在冠状动脉造影术前在心肌组织多普勒曲线上测量最大收缩期峰值速度和峰值位移。结果在左室长轴、心尖四腔、心尖两腔不同切面上,双支、三支病变左室不同节段的收缩峰速度和峰值位移均低于无狭窄病变对照组(P<0.01),而单支组与无狭窄病变对照组之间比较无统计学差异。结论定量组织速度成像可以敏感地评价冠心病患者左室心肌的局部功能。     

曲美他嗪联合比索洛尔治疗冠心病伴心力衰竭的效果及安全性

目的 评价曲美他嗪联合比索洛尔治疗冠心病伴心力衰竭的效果及安全性.方法 选取2018年4月至2020年4月我院收治的150例冠心病伴心力衰竭患者,根据系统抽样法将其分为对照组(75例,曲美他嗪)和试验组(75例,曲美他嗪联合比索洛尔).比较两组的临床疗效、不良反应发生情况、心率变异性指标及血管内皮功能指标.结果 试验组...     

不同中医体质冠心病病人冠状动脉病变程度的比较分析

[目的]探讨冠心病中医体质与冠状动脉病变程度的关系。[方法]选择经冠状动脉造影确诊为冠心病的290例病人进行中医体质判定,应用Gensini积分和冠状动脉病变支数来评价冠状动脉病变程度,比较平和质和偏颇体质间冠状动脉病变的特点。[结果]290例病人中医体质分布情况:平和质(正常质)18例,占总病例数的6.21%;偏颇体质(病理体质)272例,占总病例数的93.79%。偏颇体质病人冠状动脉Gensini评分中、高分组所占比例高,且Gensini总评分高于平和质病人,两者比较差异有统计学意义(P0.05)。[结论]偏颇体质发生冠心病的倾向较平和质高,冠状动脉狭窄程度较平和质严重。说明冠状动脉病变与中医体质类型有一定的关系,由此可预测冠心病发病的危险体质因素。     

von Willebrand factor plasma levels,genetic variations and coronary heart disease in an older population

Summary. Background: High von Willebrand factor (VWF) levels are associated with an increased risk of coronary heart disease (CHD). However, it remains unclear whether VWF is causally related to the occurrence of CHD or primarily mirrors endothelial dysfunction, which predisposes to atherosclerosis and subsequent CHD. Objectives: Because VWF is largely determined by genetic factors, we investigated whether VWF antigen levels (VWF:Ag) and the risk of CHD are affected by common variations in the VWF gene. Methods: We included 7002 participants (≥ 55 years) from the large prospective population‐based Rotterdam Study in the discovery cohort. The extension cohort of the Rotterdam Study, consisting of 3011 participants, was used as a replication cohort. We determined VWF:Ag levels and genotype data of 38 single‐nucleotide polymorphisms (SNPs) in VWF. Subsequently, hazard ratios for CHD were calculated and genetic analyses were performed to assess the relationship between SNPs, VWF:Ag levels and CHD risk. Results: We identified and replicated three SNPs that were associated with VWF:Ag: rs216321 (β = 0.10 [95% confidence interval, CI, 0.06;0.13]) (Ala852Gln), rs1063856 (β = 0.05 [95% CI 0.03;0.07]) (Thr789Ala) and rs2283333 (β = 0.09 [95% CI 0.05;0.21]) (intron 15). However, genetic polymorphisms in the VWF gene were not associated with the risk of CHD. Conclusions: In this study we have shown that genetic variations in VWF strongly affect VWF plasma levels, but are not associated with the risk of CHD. Our findings therefore do not support a strong causal relationship between VWF and CHD in elderly individuals of ≥ 55 years, but suggest that VWF is primarily a marker of CHD.     

Lipoprotein(a), tissue plasminogen activator and plasminogen activator inhibitor 1 levels in hyperlipidaemic patients in Kuwait

Plasma levels of lipoprotein(a) [Lp(a)], tissue plasminogen activator (tPA) and plasminogen activator inhibitor type 1 (PAI-1) were assessed in addition to anthropometry and levels of glucose, total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and apo A1 and B in 73 patients (36 men and 37 women) with primary hyperlipidaemia (group NDHL) in Kuwait. Lp(a) levels (212 mg L^?1, 8–600 mg L^?1, median and range) were similar to those obtained in a matched group of 32 non-insulin-dependent diabetes mellitus (NIDDM) patients with hyperlipidaemia (218 mg L^?1, 50–610 mg L^?1) and slightly higher, although not significantly so (P = 0.06), than levels seen in 68 healthy normolipidaemic control subjects (182 mg L^?1, 70–488 mg L^?1). tPA levels (8.4 ng mL^?1, 3.8–18.4 ng mL^?1, median and range) in group NDHL were lower than in the diabetic group (11.4 ng mL^?1, 5.2–14.2 ng mL^?1) but higher than in the healthy control subjects (7.4 ng mL^?1, 2.8–12.6 ng mL^?1). PAI-1 levels in group NDHL (40.4 ng mL^?1, 8.6–55 ng mL^?1, median and range) were higher than in the control subjects (32.5 ng mL^?1, 14.6–46.4 ng mL^?1) but lower than in diabetic patients (43.8 ng mL^?1, 15.6–55 ng mL^?1). Hyperlipidaemia phenotype (hypercholesterolaemia or hypertriglyceridaemia) did not influence tPA and PAI-1 levels, but Lp(a) levels were significantly lower with hypertriglyceridaemia. Gender, cigarette smoking and racial origin (Kuwaitis, other Arabs or South Asians) did not affect Lp(a), tPA and PAI-1 levels, but tPA levels were higher in postmenopausal subjects. Low-density lipoprotein (LDL) levels (whether in total cholesterol or as apo B) correlated significantly (P < 0.05) with Lp(a) levels. tPA levels were correlated with age and the plasma levels of glucose and uric acid (P < 0.05); this correlation with glucose may explain the high levels associated with diabetes, whereas the age association might account not only for the differences observed between group NDHL and the younger control group but also for the higher levels in the postmenopausal women. PAI-1 levels correlated with tPA and triglyceride (TG) levels in the groups of subjects (normo- and hyperlipidaemic). In the normolipidaemic control group, the significant associations of tPA and PAI-1 were with body mass, expressed as the body mass index or the waist–hip ratio. These results suggest that different factors influence the plasma levels of the prothrombotic factors Lp(a), tPA and PAI-1 in healthy control subjects and in patients with hyperlipidaemia. In the latter, hyperlipidaemia phenotype, age, glycaemic status and uric acid levels are important determinants of the levels of these prothrombotic variables, whereas in the healthy, young control population, body mass was the single important association with tPA and PAI–1.     

A comparison of the associations between seven hemostatic or inflammatory variables and coronary heart disease

BACKGROUND: While meta-analyses of prospective studies have established that plasma levels of several hemostatic variables are associated with the risk of coronary heart disease (CHD), these have been suggested to be acute-phase reactant proteins. This study examines their associations with inflammatory markers [C-reactive protein (CRP) and interleukin-6 (IL-6)] and the effect of adjustment on their associations with CHD risk. METHODS AND RESULTS: In a nested case-control study, 247 CHD cases and 473 controls were matched for age and sex from 10 529 men and women in the Fletcher Challenge cohort. Plasma levels of all hemostatic variables except von Willebrand factor (VWF) and lipoprotein (a) [Lp(a)] showed significant associations with CRP and IL-6. Fibrinogen, VWF, tissue plasminogen activator antigen (t-PA), D-dimer, Lp(a), CRP and IL-6 levels were significantly associated with risk of CHD. After adjustment for conventional risk factors, CRP, D-dimer and IL-6 levels were significantly associated with risk of CHD. On further adjustments for the other six hemostatic and inflammatory variables these associations were reduced, but remained significant for D-dimer and IL-6; odds ratios (95% CI), comparing the highest to lowest third, were 3.10 (1.25-7.67) and 2.79 (1.11-6.99), respectively. CONCLUSION: The associations of plasma levels of some hemostatic variables (fibrinogen, VWF, t-PA and Lp(a); but not fibrin D-dimer) with CHD risk are attenuated when inflammatory markers (CRP and IL-6) as well as conventional risk factors are included in multivariable analyses. D-dimer and IL-6 each have the potential to increase the prediction of CHD, in addition to conventional risk factors.     

冠心病患者的治疗依从性与健康教育

冠心病（coronary heart disease，CHD）是一种心血管系统疾病，目前冠心病的控制情况并不理想，患者对康复治疗方案不依从的现象相当普遍，以至于认为“不依从”即是心血管病的一个危险因素。本文综述了依从性的概念，介绍了冠心病患者治疗依从性的内容、现状和影响因素，探讨了护理健康教育对提高冠心病患者依从性的影响和作用，提出健康教育是提高冠心病患者治疗依从性，提高患者生活质量的有效途径，为有效实施护理干预提供重要依据。     

Selectin-P and interleukin-8 plasma levels in coronary heart disease patients

BACKGROUND: Alterations of the immune system are now believed to play crucial role in the pathogenesis of atherosclerosis. The aim of this study was analysis of soluble forms of selectin-P and interleukin-8 levels in patients with different form of coronary heart disease. MATERIALS AND METHODS: In the study took part 18 patients with stable coronary heart disease, 20 patients with unstable coronary heart disease and 15 healthy persons from control group. Soluble selectin-P and interleukin-8 levels were measured in EDTA plasma with the use of enzyme immunoassay ELISA. RESULTS: The level of soluble selectin-P was significantly higher in unstable coronary heart disease patients in comparison to the stable coronary heart disease patients (P < or = 0.01) and nonsignificantly higher in comparison to the control group. The level of interleukin-8 were significantly higher in unstable coronary heart disease patients in comparison to the stable coronary heart disease patients (P < or = 0.01) and in comparison to the control group (P < or = 0.02). CONCLUSION: Our findings suggest that soluble form of selectin-P and interleukin-8 may be useful clinical predictors of unstable coronary heart disease. The assessment of the risk for the development of coronary heart disease requires further serial investigation.     

阿托伐他汀联合曲美他嗪对冠心病患者心功能、炎性因子及血管内皮功能的影响

目的探讨阿托伐他汀联合曲美他嗪对冠心病患者心功能、炎性因子及血管内皮功能的影响。方法将128例冠心病患者随机分成对照组与观察组,各64例。对照组给予曲美他嗪治疗,观察组在此基础上加用阿托伐他汀,比较治疗前后2组心功能、炎性因子水平及血管内皮功能的变化。结果治疗后,2组左心室舒张末期内径(LVEDD)、左室后壁厚度(LVPWd)明显降低,而左心室射血分数(LVEF)明显升高(P0.05或P0.01),观察组改善程度明显优于对照组(P0.01)。治疗后,2组肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-9(MMP-9)及超敏C反应蛋白(hs-CRP)水平均明显降低(P0.01),且观察组各指标水平明显低于对照组(P0.01)。治疗后,2组血管内皮素-1(ET-1)和外周血循环内皮微颗粒(c EMPs)水平明显降低,且观察组显著低于对照组P0.01);一氧化氮(NO)明显升高,且观察组明显高于对照组(P0.01)。结论阿托伐他汀联合曲美他嗪可明显改善冠心病患者的心功能,降低炎症因子水平,改善血管内皮功能。     

比索洛尔治疗冠心病的疗效及对患者心功能、炎症因子水平的影响

目的探讨比索洛尔治疗冠心病(CHD)的疗效及对患者心功能、血液流变学、血清炎症因子水平的影响。方法选取2016年10月至2018年12月于该院就诊的CHD患者152例为研究对象,采用随机数表法分为两组,对照组给予CHD常规药物治疗,观察组在对照组基础上加用比索洛尔治疗。比较两组治疗3个月后的疗效、心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)与收缩末期内径(LVESD)、6 min步行试验(6MWT)]、血液流变学指标[全血黏度高切(HWBV)、黏度低切(LWBV)及血浆黏度(PV)]、血清炎症因子[肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、超敏C反应蛋白(hs-CRP)]、降钙素原(PCT)及氨基末端脑钠肽前体(NT-proBNP)水平。结果观察组总有效率高于对照组(P<0.05)。治疗后两组LVEF与6MWT水平均较治疗前升高(P<0.05),LVEDD、LVESD、LWBV、HWBV、PV、TNF-α、IL-6、hs-CRP、PCT及NT-proBNP水平均较治疗前下降(P<0.05);且治疗后观察组LVEF、6MWT水平均高于对照组,LVEDD、LVESD、LWBV、HWBV、PV、TNF-α、IL-6、hs-CRP、PCT及NT-proBNP水平均低于对照组(P<0.05)。结论比索洛尔治疗CHD疗效确切,可改善患者的心功能与血液流变学,降低机体炎性反应水平。     

硫氮(艹卓)酮加硝酸异山梨酯与硝酸异山梨酯对冠心病患者心功能的影响

应用硫氨(艹桌)酮加硝酸异山梨酯与硝酸异山梨酯,对65例冠心病心绞痛患者进行9项心功能指标及临床疗效观察。结果表明:硫氮革酮与硝酸异山梨酯合用组(治疗组)用药前后,左心收缩功能指标SV、EF、Fs、PEP/LVET,舒张功能指标LA、E、A、A/E、DC均有显著差异(P<0.01),改善心绞痛症状有效率为94％。而单用硝酸异山梨酯组(对照组)用药后除每搏输出量及射血分数有明显差异外(P<0.01),其它各项指标无明显差异,改善心绞痛症状有效率为59％。提示:两药联合应用对改善冠心病患者左心功能疗效好,副作用少,值得在临床进一步观察。     

对冠心病患者实施疾病管理的实践与效果

目的探讨对冠心病患者进行疾病管理的效果。方法对305例冠心病患者进行生活方式问卷调查,综合评估危险因素后建立健康档案,制订相应的疾病管理计划,有针对性地实施健康教育和随访,并进行个体化的健康指导,观察并分析疾病管理效果。结果患者的不良生活方式较管理前有明显改善(P0.05或P0.01)。其中患者戒烟率达92.57%,戒酒率达90.10%,能够坚持低盐低脂饮食的患者达64.85%,能够坚持运动锻炼的患者达89.60%。结论对冠心病患者实施疾病管理,患者不良生活方式有明显改善,可有效提高患者的自我防护意识,对预防不良心脏事件的发生有重要作用。     

氯吡格雷治疗冠心病合并脑梗塞的临床效果及对患者凝血功能的影响

目的探讨氯吡格雷治疗冠心病合并脑梗塞的临床效果及对患者凝血功能的影响。方法选择我院心内科2017年1月至2019年5月收治的80例冠心病合并脑梗塞患者作为研究对象,按照随机数字表法将其分为对照组与观察组,每组40例。对照组采用常规治疗,观察组在对照组基础上给予氯吡格雷治疗。比较两组的临床疗效、血脂水平、血小板抑制率、凝血功能指标、神经功能缺损评分及不良反应发生情况。结果观察组的治疗总有效率高于对照组(P<0.05)。治疗后,两组的总胆固醇、甘油三酯水平均低于治疗前(P<0.05)。观察组二磷酸腺苷、花生四烯酸途径的血小板抑制率均高于对照组(P<0.05)。治疗后,两组的TT、PT、APTT均长于治疗前,且观察组长于对照组(P<0.05)。治疗后,两组的神经功能缺损评分均明显降低,且观察组的低于对照组(P<0.05)。两组的不良反应发生率比较,差异无统计学意义(P>0.05)。结论氯吡格雷可提高冠心病合并脑梗塞患者的临床疗效,还可有效抑制血小板聚集,改善凝血功能和神经功能,且不影响患者的降血脂效果,不会增加不良反应发生风险,安全性良好。