急性冠脉综合征患者外周血MMP-9及CRP的变化及其临床意义

目的观察急性冠脉综合征（ACS）患者外周血中基质金属蛋白酶-9（m atrix m etalloproteases-9,MMP-9）及C反应蛋白（CRP）的水平变化,探讨MMP-9、CRP与ACS发生的关系。方法选取ACS患者39例,采用双抗体夹心ELISA测定血清MMP-9的水平,CRP用免疫散射比浊法检测。结果ACS患者入院即刻血浆MMP-9、CRP水平均显著高于对照组[（66±16）vs（24±11）μg/L,P<0.01;（12.3±9.2）vs（3.5±2.0）mg/L,P<0.01]。ACS组内UA亚组与AM I亚组比较,MMP-9水平显著增高[（78±11）vs（50±14）μg/L,P<0.01],而CRP水平显著下降[（7.2±2.2）vs（18.7±10.7）mg/L,P<0.01]。ACS组患者中MMP-9和CRP水平无明显相关性。结论冠心病患者外周血MMP-9、CRP水平升高。ACS患者中MMP-9和CRP水平无明显相关性。     

急性冠状动脉综合征患者MMP-9、MMP-2的临床意义

目的观察不同冠心病患者的血清的基质金属蛋白酶(MMPs)及其演变,探讨MMPs与急性冠状动脉综合征的关系。方法用酶联免疫吸附法(ELISA)检测了32例急性心肌梗死(AMI),30例不稳定型心绞痛,20例稳定型心绞痛和16例健康对照者血清MMP-9,MMP-2和组织型基质金属蛋白酶抑制物-2(TIMP-2)水平,并比较上述指标与不同类型冠心病的关系及其演变。结果AMI患者血清MMP-9水平高于不稳定型心绞痛组、稳定型心绞痛组和对照组,分别为(191.91±150.10)ng/ml,(110.84±96.29)ng/ml,(69.30±55.85)ng/ml和(80.13±34.94)ng/ml。MMP-2、TIMP-2四组间比较差异无显著性。MMP-9在AMI患者中发病早期升高后持续到3~5d。MMPs与心肌损伤标志物无相关关系。结论血清MMP-9是预示斑块破裂中的主要MMPs之一,但它不能预测心肌坏死的程度。     

替罗非班对急性冠脉综合征患者PCI术后MMP-9及IL-6水平的影响

目的: 观察替罗非班对急性冠脉综合征(ACS)患者经皮冠状动脉成形术(PCI)术后基质金属蛋白酶-9(MMP-9)及白介素-6（IL-6）水平的影响。方法: 选择我院2007年2月~2008年12月住院的ACS患者68例,随机分为对照组(n=34)和替罗非班组(n=34)。两组均急诊行PCI术,分别于PCI术前及术后12 h,用ELISA法检测患者血清MMP-9及IL-6的水平。结果: 替罗非班组与对照组相比,PCI术前两组之间MMP-9及IL-6的差异无统计学意义;PCI术后12 h,二者MMP-9的水平［(492±65) vs.(560±82)μg/L］和IL-6的水平［(46.0±7.2) vs.(59.7±8.2)ng/L］差异明显(P<0.05)。结论: 血小板GPⅡb/Ⅲa受体拮抗剂替罗非班能显著降低ACS患者介入术后MMP-9及IL-6的水平,抑制炎症反应,从而对血管具有一定的保护作用。     

瑞舒伐他汀短期治疗急性冠脉综合征患者血清MMP-9水平变化研究

目的通过观察瑞舒伐他汀短期治疗急性冠脉综合征（ACS）患者基质金属蛋白酶-9（MMP-9）水平变化,探讨瑞舒伐他汀对ACS患者炎症反应及稳定斑块的影响。方法选择ACS患者69例及正常对照组30名,ACS患者在常规治疗基础上采用瑞舒伐他汀短期（2周）治疗,比较治疗前后血清MMP-9的水平变化。结果 ACS患者治疗前血清MMP-9水平显著高于对照组;瑞舒伐他汀治疗2周后,血清血清MMP-9水平显著低于治疗前,但仍显著高于正常对照组。结论 ACS患者存在着高水平的MMP-9,在经过瑞舒伐他汀短期治疗后血清MMP-9水平显著降低,显示瑞舒伐他汀可降低炎症反应及稳定斑块,动态检测血清MMP-9水平变化可作为ACS发生的预测指标。     

急性冠状动脉综合征患者血浆MMP-2、MMP-9水平变化的临床观察

目的探讨MMP-2和MMP-9在急性冠状动脉综合征(ACS)患者中的变化及意义。方法通过对141例ACS(其中急性心肌梗死98例,不稳定性心绞痛43例)患者,与40例稳定性心绞痛(SAP)和40例冠状动脉正常(NCA)患者作对照,测定血清中MMP-2、MMP-9的浓度,同时对急诊PCI术者在术后1周再次测血浆中MMP-2和MMP-9的表达。结果与NCA组及SAP组比较,ACS组中MMP-2、MMP-9显著升高,差异有统计学意义(P0.01),且术后1周病情稳定后明显降低,与术前比较差异有统计学意义(P0.01)。与冠状动脉单支病变相比,双支及三支病变的患者血清中MMP-2、MMP-9显著升高,差异有统计学意义(P0.01)。结论 MMP-2、MMP-9可作为反映ACS患者动脉粥样硬化斑块不稳定或破裂的血清学指标,并有助于冠状动脉病变严重程度的危险分层。     

急性冠脉综合征患者血清炎性因子及MMP-9水平变化研究

目的通过检测急性冠脉综合征（ACS）患者血清高敏C反应蛋白（hs-CRP）、白细胞介素-18（IL-18）及基质金属蛋白酶-9（MMP-9）水平变化,观察ACS患者炎症反应及冠脉斑块的稳定性。方法选取ACS患者95例及正常对照组30例,检测血清hs-CRP、IL-18及MMP-9的水平变化。结果 ACS患者血清hs-CRP、IL-18及MMP-9水平均显著高于对照组（P〈0.01）;hs-CRP与IL-18及MMP-9分别呈显著性正相关（r=0.658,P〈0.01;r=0.507,P〈0.01）;IL-18与MMP-9呈显著性正相关（r=0.627,P〈0.01）。结论 ACS患者存在着高水平的hs-CRP、IL-18及MMP-9,表明ACS患者存在着炎症反应及斑块不稳定因素,动态联合检测血清hs-CRP和IL-18水平变化,可作为ACS发生的预测指标。     

MMP-2、MMP-9和hs-CPR与急性冠脉综合征关系的研究

目的探讨基质金属蛋白酶2（MMP-2）、基质金属蛋白酶9（MMP-9）和超敏C-反应蛋白（hs-CPR）在急性冠脉综合征（ACS）中的变化及对预后的影响。方法选择2006年3月～2010年5月住院的ACS患者120例为观察组;其中不稳定型心绞痛（UA）40例、无ST段抬高心肌梗死（NSTEMI）40例、急性ST段抬高心肌梗死（STE-MI）40例。另选择同期稳定心绞痛患者40例为对照组,采用酶联免疫吸附法测定MMP-2、MMP-9水平,用免疫散射比浊法测定hs-CRP水平,并分析MMP-2、MMP-9及hs-CRP的变化和冠脉病变之间的关系。结果观察组血清MMP-2、MMP-9及hs-CRPR水平高于对照组（P〈0.05）,NSTEMI组和STEMI组血清MMP-2、MMP-9及hs-CRP的水平高于UA组（P〈0.05）;观察组患者血清MMP-2与hs-CRP无明显相关性（r=0.25,P〉0.05）,而血清MMP-9与hs-CRP水平呈正相关（r=0.599,P〈0.05）。结论联合检测ACS患者血清MMP-2、MMP-9和hs-CRP对判断斑块稳定性、预测ACS的危险分层及预后有重要的指导意义。     

急性冠脉综合征患者外周血白细胞内基质金属蛋白酶-9含量的变化

目的 通过对急性冠脉综合征(ACS)患者外周血白细胞内基质金属蛋白酶-9(MMP-9)含量和血清超敏C-反应蛋白(hs-CRP)浓度的测定,以及对两者的相关性分析,探讨白细胞内MMP-9含量对ACS斑块易损性的判断价值.方法 选择急性冠脉综合征患者20例为研究组(ACS组),其中不稳定型心绞痛8例、急性心肌梗死12例;选择稳定型心绞痛患者20例(SA组)、无冠心病的成年人20例(对照组)作为对照.所有研究对象抽取肘静脉血5ml,流式细胞仪检测白细胞内MMP-9含量及细胞阳性率,同时检测血清hs-CRP的浓度,比较各组患者的测量值,并进行相关性分析.所有数据用SPSS12.0进行统计分析.结果①ACS组MMP-9的含量与SA组和对照组相比明显增加[(125.71±49.92)μg/L比(51.60±18.99)μg/L、(11.26±13.00)μg/L,均P＜0.01],而SA组与对照组相比差异无统计学意义(P=0.20).ACS组含MMP-9的细胞阳性率也明显增加.②ACS组血清hs-CRP浓度与SA组和对照组相比明显升高[(12.90±1.98)mg/L比(4.33±1.98)mg/L、(3.73±1.68)mg/L,P均<0.01],而sA组与对照组相比差异无统计学意义(P=0.53).③ACS组hs-CRP浓度与白细胞内MMP-9含量呈正相关(r=0.51,P=0.02).结论 ①ACS患者白细胞内MMP-9含量明显升高,测量白细胞内MMP-9浓度可作为预测冠脉斑块易损性的有效方法.②ACS患者血清hs-CRP水平与白细胞内MMP-9含量呈正相关,在炎症反应时两者的含量都增加.     

急性冠脉综合征患者治疗前后血清D-二聚体和MMP-9水平变化研究

目的观察瑞舒伐他汀治疗急性冠脉综合征（ACS）患者血清D-二聚体和基质金属蛋白酶-9（MMP-9）水平变化,探讨瑞舒伐他汀对ACS患者稳定斑块的影响,及其临床检测价值。方法选择ACS患者85例及正常对照组30例,ACS患者在常规治疗基础上采用瑞舒伐他汀治疗,比较治疗前后血清D-二聚体和MMP-9的水平变化。结果 ACS患者治疗前血清D-二聚体和MMP-9水平均显著高于对照组;瑞舒伐他汀治疗2周后,血清血清D-二聚体和MMP-9水平均显著低于治疗前,但仍显著高于正常对照组;血清D-二聚体与MMP-9呈显著性正相关。结论 ACS患者存在着高水平的D-二聚体及MMP-9,在经过瑞舒伐他汀治疗后血清D-二聚体及MMP-9水平显著降低,显示瑞舒伐他汀可稳定斑块,动态检测血清D-二聚体及MMP-9水平变化可作为ACS发生的预测指标。     

急性冠脉综合征患者冠脉斑块稳定性和血清MMP-9、IL-6的相关性研究

目的 检测急性冠脉综合征患者冠脉斑块稳定性与血清白介素-6(IL-6)、基质金属蛋白酶-9(MMP-9)水平的相关性并探讨其临床意义.方法 选择72例疑诊冠心病患者,所有入选患者均行冠脉造影及64层螺旋CT冠脉扫描,并根据斑块的CT值分为软斑块组(11例)、混合斑块组(14例)、硬斑块组(25例)及对照组(22例).同时以ELISA法测定血清IL-6、MMP-9值,比较各组的差异及相互关系.结果 软斑块组与混合斑块组血清IL-6、MMP-9水平高于硬斑块组和对照组(P＜0.05).MMP-9水平与IL-6水平显著相关.结论 MMP-9、IL-6与斑块的不稳定性密切相关,64层螺旋CT冠脉斑块检查联合血清IL-6、MMP-9水平检测可作为冠脉斑块不稳定性的预测指标.     

急性冠脉综合征患者血浆BNP和MCP-1的变化

目的观察急性冠脉综合征（ACS）患者外周血中脑纳尿肽（BNP）及单核细胞趋化蛋白-1（MCP-1）的变化,探讨BNP,MCP-1与ACS的关系。方法住院ACS患者39例,采用ELISA测定血清BNP,MCP-1的水平。结果ACS患者入院即刻血浆BNP和MCP-1水平均显著高于对照组,分别为（560±25）ng/Lvs（42±24）ng/L（P<0.01）和（152±19）ng/Lvs（113±22）ng/L（P<0.01）。ACS组内不稳定心绞痛（UAP）亚组与急性心肌梗死（AM I）亚组比较,AM I亚组BNP水平高于UAP亚组[（557±24）ng/Lvs（172±62）ng/L,P<0.01],而MCP-1水平在AM I亚组和UAP亚组间无显著性差异[（153±19）ng/Lvs（150±22）ng/L]。ACS组患者中BNP和MCP-1水平呈明显正相关（r=0.625,P<0.01）。结论ACS患者外周血BNP和MCP-1水平升高而且两者水平呈正相关。     

Black-white differences in severity of coronary artery disease among individuals with acute coronary syndromes

Objective: To determine whether the extent of coronary obstructive disease is similar among black and white patients with acute coronary syndromes.
Design: Retrospective chart review.
Patients: We used administrative discharge data to identify white and black male patients, 30 years of age or older, who were discharged between October 1, 1989 and September 30, 1995 from 1 of 6 Department of Veterans Affairs (VA) hospitals with a primary diagnosis of acute myocardial infarction (AMI) or unstable angina (UnA) and who underwent coronary angiography during the admission. We excluded patients if they did not meet standard clinical criteria for AMI or UnA or if they had had prior percutaneous transluminal coronary angioplasty or coronary artery bypass grafting.
Measurements and Main Results: Physician reviewers classified the degree of coronary obstruction from blinded coronary angiography reports. Obstruction was considered significant if there was at least 50% obstruction of the left main coronary artery, or if there was 70% obstruction in 1 of the 3 major epicardial vessels or their main branches. Of the 628 eligible patients, 300 (48%) had AMI. Among patients with AMI, blacks were more likely than whites to have no significant coronary obstructions (28/145, or 19%, vs 10/155 or 7%, P = .001). Similarly, among patients with UnA, 33% (56/168) of blacks but just 17% (27/160) of whites had no significant stenoses ( P = .012). There were no racial differences in severity of coronary disease among veterans with at least 1 significant obstruction. Racial differences in coronary obstructions remained after correcting for coronary disease risk factors and characteristics of the AMI.
Conclusions: Black veterans who present with acute coronary insufficiency are less likely than whites to have significant coronary obstruction. Current understanding of coronary disease does not provide an explanation for these differences.     

Pre‐loading therapy with statins in patients with angina and acute coronary syndromes undergoing PCI

Statins constitute the most powerful class of drugs for cardiovascular risk reduction associated to atherosclerosis. Their important pharmacological properties include reduction of serum lipid concentrations and non‐lipid related, pleotropic effects such as anti‐inflammatory action. Previous largescale randomized studies have demonstrated the beneficial effects of statin loading prior to elective percutaneous coronary intervention (PCI) for the reduction of periprocedural myocardial infarction and prevention of major adverse cardiac events at 30 days. The present review summarizes the data from major randomized trials that evaluated the clinical benefit of statin pretreatment in the setting of PCI resulting in a better understanding of their impact on reduction of interventional complications.

     

阿托伐他汀治疗急性冠脉综合征对血浆MMP-9及GMP-140的影响

目的探讨阿托伐他汀对急性冠脉综合征（ACS）患者血浆基质金属蛋白酶（MMP-9）及血小板α-颗粒膜蛋白（GMP-140）的影响。方法选择60例健康人做对照,200例ACS患者随机分为两组：常规治疗组（未服用任何调脂药物,n=80例）和阿托伐他汀组（10mg/d,n=120例）治疗1周,测定治疗前后MMP-9、GMP-140及血脂水平的变化。结果ACS患者血浆MMP-9、GMP-140水平显著高于健康对照组（P〈0.01）。ACS两组治疗前后血脂各组成分的变化差异均无显著性（P〉0.05）,阿托伐他汀治疗后血浆MMP-9、GMP-140水平明显下降,与治疗前比较有统计学意义（P〈0.01）,但下降程度与TC（r=0.327,P=0.576;r=0.123,P=0.591）,LDL-C（r=-0.312,P=0.921;r=-0.125,P=0.652）的变化无相关性。结论ACS患者早期给予阿托伐他汀强化干预,可明显减少细胞外基质的降解、抗血小板活化及改善内皮功能,对于ACS的临床预后有着重要的意义。     

Sleep apnoea in ischaemic heart disease: differences between acute and chronic coronary syndromes

OBJECTIVE—To evaluate the incidence of sleep apnoea in acute and chronic coronary syndromes.
DESIGN—Analysis of sleep and breathing characteristics in a polysomnographic study.
SETTING—Cardiology department in tertiary referral centre.
PATIENTS—23 patients were studied soon after acute myocardial infarction (group 1), 22 after clinical stabilisation of unstable angina (group 2), and 22 who had stable angina (group 3). Conditions liable to cause sleep apnoea, such as obesity, chronic obstructive pulmonary disease, neurological disorders, or the use of benzodiazepines, were exclusion criteria.
MAIN OUTCOME MEASURES—Sleep apnoea and hypopnoea, oxygen saturation, and sleep indices evaluated soon after clinical stabilisation in groups 1 and 2 and also in group 3.
RESULTS—Sleep apnoea, mainly of the central type, was equally present in groups 1 and 2 (mean (SD) apnoea-hypopnoea index: 11.10 (19.42) and 14.79 (20.52), respectively) and more severe than in group 3 (2.82 (6.43), p < 0.01). Total time spent at SaO₂ < 90%, although significantly greater in group 1 and 2 (0.89 (2.4), 1.42 (3.23) min) than in group 3 (0.01 (0.05) min, p < 0.05), was clinically irrelevant. More arousals per hour of sleep (p < 0.05) were detected in group 1 (5.15 (3.71)) and group 2 (5.31 (2.14)) than in group 3 (2.83 (1.51)).
CONCLUSIONS—Sleep apnoea, chiefly of the central type, not only characterises acute myocardial infarction, as found by others, but also unstable angina studied after recent stabilisation. Patient selection by exclusion of other causes of breathing disorders shows that coronary disease related apnoea is absent in the chronic coronary syndrome. In acute syndromes the lack of clinically significant apnoea related oxygen desaturation, together with the low associated incidence of major ischaemic and arrhythmic events, suggests that sleep apnoea is benign in these circumstances, despite a worsening of sleep quality.


Keywords: acute myocardial infarction; unstable angina; stable angina; sleep apnoea     

The role of cardiac troponin t and other new biochemical markers in evaluation and risk stratification of patients with acute chest pain syndromes

Background and hypothesis: Increased serum creatinine kinase (CK) and CK-MB enzyme levels have been used for years to detect myocardial infarction (MI). However, serum myoglobin and CK-MB mass or protein levels may indicate MI earlier; cardiac troponin T is the most specific marker of myocardial injury and it can detect even minor myocardial necrosis. The diagnostic and prognostic utility of the traditional and new markers of cardiac injury in the emergency evaluation of patients with acute chest pain syndromes were therefore compared. Methods: One hundred and fifteen consecutive patients with an acute coronary syndrome, and 64 controls recruited during the same period, were examined. The time elapsed from onset of symptoms to blood collection was recorded. Cardiac markers were measured in specimens collected upon arrival (0 h), and 2 and 5–9 h, and later in cases of longer observation. The major cardiac events occurring up to 40 months after the index examination were recorded. Results: cTnT levels provided unique information: they were the most specific indicators of myocardial damage and identified unstable angina patients at high risk of future major events. Up to 6 h after the onset of chest pain, the new markers were elevated more frequently than the traditional ones and permitted earlier MI recognition. The worst prognosis (nonfatal myocardial infarction or death) was noted in subjects with chest pain at rest within 48 h before the index examination and elevated cTnT levels. Conclusions: The new markers, particularly cardiac troponin T, offer considerable advantages and they should be more widely used in the diagnosis and risk stratification of acute coronary syndromes.     

Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE).

AIMS: There have been no large observational studies attempting to identify predictors of major bleeding in patients with acute coronary syndromes (ACS), particularly from a multinational perspective. The objective of our study was thus to develop a prediction rule for the identification of patients with ACS at higher risk of major bleeding. METHODS AND RESULTS: Data from 24045 patients from the Global Registry of Acute Coronary Events (GRACE) were analysed. Factors associated with major bleeding were identified using logistic regression analysis. Predictive models were developed for the overall patient population and for subgroups of patients with ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina. The overall incidence of major bleeding was 3.9% (4.8% in patients with STEMI, 4.7% in patients with NSTEMI and 2.3% in patients with unstable angina). Advanced age, female sex, history of bleeding, and renal insufficiency were independently associated with a higher risk of bleeding (P<0.01). The association remained after adjustment for hospital therapies and performance of invasive procedures. After adjustment for a variety of potential confounders, major bleeding was significantly associated with an increased risk of hospital death (adjusted odds ratio 1.64, 95% confidence interval 1.18, 2.28). CONCLUSIONS: In routine clinical practice, major bleeding is a relatively frequent non-cardiac complication of contemporary therapy for ACS and it is associated with a poor hospital prognosis. Simple baseline demographic and clinical characteristics identify patients at increased risk of major bleeding.     

Holmium laser-assisted coronary angioplasty in acute ischemic syndromes

Background and hypothesis: Initial studies have shown holmium laser to be effective in ablation of coronary atheromam, and small studies suggest that it may be helpful in ablation of thrombotic stenoses. Therefore, holmium laser-assisted coronary angioplasty was studied in 85 consecutive patients with acute ischemia syndromes. Methods: Indications for therapy were acute myocardial infarction (MI) in 7 patients (8%), post-MI ischemic in 32 patients (38%), and crescendo angina pectoris in 46 patients (54%). Coronary morphology characteristics by multivessel angioplasty prognosis group criteria were Type A in 9 (10%), Type B1 in 15 (18%), Type B2 in 44 (52%), Type C in 17 patients (20%). Results: Angiographic evidence of thrombus was seen in 37 (44%) of patients. The laser successfully crossed the total length of the coronary narrowing in 76 patients (89%). Procedure/clinical success was 92% for the total study population, 100% for patients with acute MI, 94% for post-MI ischemia patients, and 89% for patients with crescendo angina. Lesions with and without thrombus had identical procedure succes rates. Major complication rate was 3.5%, (deaths 0%, Q-wave MI 0%, and emergent bypass surgery 3.5%). Six-month angiographic restenosis rate (>50% stenosis) was 45%. Conclusion: Holmium laser-assisted balloon angioplasty appears promising in the treatment of acute ischemic syndromes and thrombotic coronary lesions.     

Indications for coronary angioplasty in acute myocardial ischemic syndromes

Summary The role of coronary angioplasty for the treatment of patients with evolving myocardial infarction, unstable angina, and early postinfarction unstable angina is discussed.It has been shown that coronary angioplasty in patients with an evolving myocardial infarction is feasible and can be performed with a high initial success rate. The most beneficial timing of dilatation is still unclear, and acute reocclusion following coronary angioplasty remains a problem. Current data suggest that the left ventricular function is greater improved and peri-infarction ischemia is less with angioplasty when compared with sole thrombolytic treatment.Coronary angioplasty for unstable angina and early post-infarction unstable angina can be performed with a high initial success rate, but at an increased risk of major complications.Thus, coronary angioplasty has nowadays obtained a definitive place in the treatment of acute myocardial ischemic syndromes. Further research is needed to improve the initial and late results of coronary angioplasty, and additional randomized clinical studies are necessary to more accurately define the indications and timing of dilatation in these acutely ill patients.