C-反应蛋白与冠状动脉病变的相关性及其临床意义

目的 :探讨血浆 C-反应蛋白 （CRP）与冠脉病变的稳定性、程度及范围的关系。方法 :根据冠状动脉造影结果和临床表现 ,将 135例冠心病患者分组比较他们的血浆 CRP水平。结果 :1不稳定型心绞痛患者血浆 CRP水平高于稳定型心绞痛患者 （15 .0± 3.4 vs5 .8± 0 .8m g/ L,P<0 .0 1） ;2冠脉堵塞组患者的血浆 CRP较狭窄组患者高 （18.2± 3.1vs9.3± 1.9mg/ L,P<0 .0 1） ;3多支病变组患者的血浆 CRP明显高于单支病变组患者 （15 .0± 2 .7vs6 .8± 0 .8mg/ L,P<0 .0 1）。结论 :血浆 CRP水平与冠状动脉病变相关 ,对判断冠脉病变稳定性、程度及范围具有一定价值     

血浆纤维蛋白原和D-二聚体水平与冠状动脉病变程度的相关研究

目的研究血浆纤维蛋白原（FG）和D-二聚体（DD）水平与冠心病患者冠状动脉病变程度的相关性。方法分别测定18例急性心肌梗死患者,23例不稳定型心绞痛患者,34例稳定型心绞痛患者和对照组58例患者中的FG和DD含量,并根据冠脉造影结果将冠心病组分为单支病变组25例,两支病变组21例,三支病变组29例。结果冠脉两、三支病变组FG和DD含量显著高于对照组和一支病变组（P<0.01）,三支病变组显著高于两支病变组（P<0.05）,对照组和一支病变组差异无显著性。结论冠心病患者血浆纤维蛋白原和D-二聚体较正常对照组显著升高,其值愈高,冠脉病变愈重。     

纤维蛋白原与冠心病相关分析

目的探讨纤维蛋白原（Fg）与冠心病（CHD）类型及冠状动脉病变程度的相关性。方法将经冠状动脉造影的195例患者分为冠心病组（158例）与健康对照组（37例）,其中冠心病组又分为急性心肌梗死（AMI）组50例,不稳定型心绞痛（UAP）组60例,稳定型心绞痛（SAP）组48例。再将冠心病组按冠状动脉造影结果分为单支54例,双支55例,和三支病变组49例。应用Clauss凝固法测定195例全部入选者的Fg水平。比较各CHD类型及冠脉病变程度组间血浆Fg水平差异。结果Fg水平在正常对照组与SAP、UAP、AMI中差异有统计学意义,并随冠心病的严重程度呈上升趋势,Fg水平（g/L）分别为2.47±0.30、2.53±0.49、3.02±0.54和3.26±0.64,4组间比较,差异有统计学意义,P〈0.05。CHD患者Fg水平（g/L）在冠状动脉病变不同支数中分别为2.66±0.54、2.98±0.54和3.22±0.69,3组间比较,单支与其他支病变差异有统计学意义,P〈0.05,双支与多支病变间比较差异无统计学意义。结论CHD患者血浆Fg水平与冠心病的发展方向有关,随着斑块的不稳定呈现上升趋势,且与冠脉病变的程度呈正相关。     

冠心病患者高敏C反应蛋白和脉搏波传导速度检测的意义

目的:探讨血清高敏C-反应蛋白(hs-CRP)和脉搏波传导速度(PWV)对冠心病诊断及冠脉病变严重程度的预测价值。方法:入选114例冠脉造影阳性的心绞痛患者为冠心病组,50例冠脉造影阴性者为正常对照组。根据心绞痛类型冠心病组进一步分为稳定型心绞痛组(SAP组,50例)和不稳定型心绞痛组(UAP组,64例);又根据冠脉造影结果分为单支病变组(24例)、双支病变组(26例)和三支病变组(64例),并计算冠脉病变积分。测定各组患者hs-CRP和PWV,并将其分别与冠脉病变支数及积分进行相关性分析。结果:冠心病组的hs-CRP和PWV均显著高于正常对照组(P0.01),UAP组的hs-CRP和PWV均显著高于SAP组[(6.86±1.36)mg/L:(3.75±1.03)mg/L,(11.59±1.32)m/s:(9.60±1.75)m/s,P均0.05];双支病变组的hs-CRP和PWV较单支病变组明显升高[(5.32±1.17)mg/L:(3.05±0.95)mg/L,(10.51±1.23)m/s:(9.84±1.62)m/s,P均0.05],三支病变组的hs-CRP和PWV较双支病变组明显升高[(7.21±1.13)mg/L:(5.32±1.17)mg/L,(11.30±2.65)m/s:(10.51±1.23)m/s,P均0.05]。hs-CRP水平与冠脉病变支数、冠脉病变积分呈正相关(r=0.56,0.32,P均0.01);PWV与冠脉病变支数、病变积分呈正相关(r=0.29,0.37,P均0.01)。结论:联合检测血清hs-CRP和PWV对诊断冠心病、评价冠脉病变严重程度有一定价值。     

血清尿酸含量及脉搏波传导速度与冠心病的关系

目的：研究血清尿酸（SUA）水平及肱踝脉搏波速度（baPWV）与冠脉病变严重程度的关系。方法：选择我院心血管内科2011年1月至2012年7月住院的121例患者,根据冠脉造影结果分为冠心病组（59例）和正常对照组（62例）,再根据冠脉病变支数冠心病组分为单支（30例）、双支（14例）、多支病变组（15例）,比较各组SUA及 baPWV,并分析其与冠脉病变程度的关系。结果：SUA浓度随着冠脉病变血管支数的增加而逐渐升高,正常、单支、双支、多支病变组分别为（349.26±96.58）μmol/L、（400.37±70.96）μmol/L、（517.57±85.26）μmol/L、（602.60±77.03）μmol/L （P＜0.05或＜0.01）;baPWV亦随着冠脉病变血管支数的增加而逐渐升高,与正常对照组比较,单支组、双支组和多支组baPWV显著升高[（1499.04±193.82）cm/s比（1885.32±319.73） cm/s、（2036.00±406.40）cm/s、（2171.03±348.53）cm/s],且双支病变组显著高于单支病变组（P＜0.05-＜0.01）。Logistic回归分析显示,SUA、baPWV是冠心病患病的独立危险因素（OR＝13.011,14.008,P＝0.000）结论：血尿酸水平及脉搏波速度对预测冠心病及其严重程度有重要价值。     

C反应蛋白与冠心病病变程度相关的研究

目的 :探讨血浆 C反应蛋白 （CRP）与冠心病 （CHD）病变程度之间的关系。方法 :测定经选择性冠状动脉造影（CAG）证实为 CHD患者 （n=86 ）的血浆 CRP浓度 ,并与 CAG结果正常组 （n=80 ）的血浆 CRP浓度相比较 ,分析两组之间以及 CHD组中 ,冠状动脉 （冠脉 ）病变支数与相应 CRP浓度的关系。结果 :CRP浓度在对照组、稳定型心绞痛组、不稳定型心绞痛组依次增高 ,分别为 2 2 93± 198,5 12 6± 5 0 8和 12 96 9± 10 76 μg/ L。在 CHD组中 ,单支病变组、双支病变组以及三支病变组 ,其 CRP浓度也依次增高 ,分别为 5 131± 5 13,70 2 4± 6 89,11970± 2 0 75 μg/ L。结论 :CRP浓度与冠脉病变程度关联密切     

冠心病患者血浆组织因子活性及凝血因子VII水平改变

目的研究汉族冠心病患者血浆中组织因子活性（aTF）、活化凝血因子VII（FVIIa）和凝血因子VII抗原（FVII:Ag）水平并探讨其与冠脉病变支数之间的关系。方法aTF采用发色底物法,FVIIa和FVII:Ag采用ELISA法。结果与对照组相比,冠心病患者血浆中aTF（P<0.05）、FVIIa（P<0.01）及FVII:Ag（P<0.05）水平均显著升高;急性冠状动脉综合征（ACS）患者中aTF高于稳定型心绞痛（SAP）组（P<0.05）和对照组（P<0.01）,后两者之间无显著差异;ACS和SAP患者之间血浆中FVIIa水平无显著差异,但均高于对照组;ACS组中FVII:Ag水平明显高于对照组。在不同冠脉病变支数的患者之间,aTF、FVIIa及FVII:Ag水平没有差异。结论SAP和ACS患者均可出现外源性凝血途径的激活,血浆中aTF增强可能预示了急性冠脉事件的发生;FVIIa可能可以作为冠心病的早期分子标志物;冠脉病变支数可能不能反映凝血激活的程度。     

血尿酸与冠心病程度及心血管事件的相关性

目的：探讨血尿酸（UA）水平与冠心病（CHD）病变严重程度及与心血管事件的相关性。方法：回顾性分析于我院行冠脉造影403例患者的临床资料,其中308例CHD患者[稳定型心绞痛（SAP ,137例）、急性冠脉综合征（ACS ,171例）],95例非CHD患者（正常对照组）,比较各组间UA水平的差异,并进一步分析其与冠脉病变严重程度的相关性。再根据UA水平CHD患者被分为低尿酸组（147例）和高尿酸组（161例）,经12个月随访,比较两组随访期间主要不良心血管事件（MACE）的发生率。结果：ACS组血 UA水平显著高于正常对照组[（318.44±69.07）μmol/L比（295.38±80.08）μmol/L ,P＝0.003];随着冠脉病变支数的增加及冠脉病变程度的加重（Gensini评分增高）,血UA水平呈显著升高趋势[单支（316.58±95.27）μmol/L比双支（335.26±43.26）μmol/L比多支（346.53±86.74）μmol/L ;低分组（312.42±48.26）μmol/L比中分组（346.58±47.36）μmol/L比高分组（363.84±54.68）μmol/L , P＜0.05或＜0.01], Pearson相关分析显示,血UA水平与Gensini评分呈正相关（r＝0.583, P＜0.05）;高尿酸组MACE发生率明显高于低尿酸组（58.38％比36.24％, P＝0.012）。结论：血尿酸水平与冠心病严重程度呈正相关,可能为冠心病独立危险因素。     

老年男性冠心病患者冠状动脉病变特点

目的探讨老年与中青年男性冠心病患者冠状动脉病变特点的不同。方法对475例经过冠状动脉造影检查诊断为冠心病的男性患者,其中老年组260例;中青年组215例。对比分析两组冠状动脉病变的不同特点。结果在老年组中,不稳定型心绞痛患者平均冠状动脉病变支数（1.9±0.1vs1.6±0.1）与冠状动脉积分（45±6vs27±3）均显著高于中青年组,老年组与中青年组稳定型心绞痛患者冠状动脉病变支数相同（1.9±0.1vs1.9±0.1）,冠状动脉积分（46±5vs44±5）接近。老年男性急性心肌梗死（AMI）患者冠状动脉病变支数（2.4±0.1vs2±0.1）和冠状动脉积分（68±4vs56±4）显著高于中青年AMI患者。两组之间的病变血管的分布无显著性差异。老年组单支病变显著低于中青年组（31.9%vs44.7%）,3支病变（43.8%vs33.0%）和4支病变显著高于中青年组（2.5%vs1.0%）。结论老年患者不稳定型心绞痛和AMI冠状动脉病变程度高于中青年,而稳定型心绞痛和陈旧性心肌梗死两者病变程度相似。     

巨噬细胞移动抑制因子与冠状动脉病变的关系

目的探讨冠心病患者血浆巨噬细胞移动抑制因子（MIF）水平与冠状动脉粥样硬化病变的关系。方法根据选择性冠状动脉造影结果将142例患者分为冠心病组和对照组。冠心病组根据临床诊断分为稳定型心绞痛（SAP）和急性冠脉综合征（ACS）组;根据冠状动脉病变范围将冠心病组分为单支病变、双支病变和三支病变组。血浆MIF浓度通过ELISA法测定。结果冠心病组MIF水平明显高于对照组〔（14.97±4.11）vs（9.07±1.28）μg/L〕,ACS组MIF浓度又明显高于SAP组〔（16.66±3.56）vs（11.01±2.12）μg/L〕。随冠状动脉病变范围的增加,MIF浓度逐渐升高,各组间差异有显著统计学意义。结论MIF增高与冠状动脉粥样硬化发生显著相关,其可以做为预测冠状动脉粥样硬化病变情况的一个指标,与冠状动脉粥样硬化斑块不稳定关系更密切。     

Case Report: A Rare Case of a Giant Right Coronary Artery Aneurysm

We report the case of a 34-year-old female patient with a giant thrombus-filled aneurysm of the right coronary artery presenting as a spherical cardiac mass on echocardiography. The cardiac mass was found to be an 8-cm right coronary artery aneurysm on cardiac magnetic resonance imaging, which also revealed a 3.5-cm proximal left coronary aneurysm and a very small aneurysm at the origin of the obtuse marginal coronary artery. Due to the extent and size of the right coronary aneurysm, a decision for surgical intervention was made. Resection of the right coronary artery aneurysm with vein graft replacement and a bypass to the left anterior descending followed by subsequent exclusion of the aneurysm was successfully performed.     

Spontaneous regression of post-percutaneous transluminal coronary angioplasty aneurysm

We report a case of a 67-year-old male with spontaneous regression of post-percutaneous transluminal coronary angioplasty (PTCA) aneurysm. This case substantiates the benign prognosis of post-PTCA aneurysms.     

Triple origin of left coronary arteries from right coronary artery: Unusual case of single coronary artery

A rare case of coronary anomaly is presented: all of the coronary arteries originated from a single ostium located in the right coronary cusp. No clinical evidence of coronary pathology was recognized until the age of 57 years when the patient was found to have coronary obstructive disease. The single coronary artery had a main branch corresponding to the usual dominant right coronary artery. Three other branches separated from this and vascularized the areas normally receiving the circumflex and ramus medianus, the left anterior descending, and a large septal branch.     

Coronary artery-left ventricular communications: A report of two cases and review of the literature

Two patients with chest pain had angiographically-demonstrated communications between the three coronary arteries and the left ventricular chamber. Communications between coronary arteries and the left ventricle are unusual and communications between all three coronary arteries and the left ventricle are rare. These anomalies are, however, commonly associated with symptoms of chest pain. The presence of left ventricular hypertrophy and a widened pulse pressure may suggest a greater hemo-dynamic effect of the shunt flow than often suspected angiographically.     

Anomalous origin of the right coronary artery from the left anterior descending: Angiographic diagnosis in a patient with coronary artery disease

The coronary angiographic findings of an individual whose right coronary artery originates from the proximal left anterior descending coronary artery are described.     

Myocardial ischemia in patients with fixed occlusive coronary artery disease secondary to vasospasm in the “normal” vessel

Seven patients with significant fixed occlusive coronary artery disease had coronary artery spasm in a “normal” vessel. All patients had one or more episodes of rest angina and six had exertional angina as well. Four sustained previous myocardial infarction. During spontaneous angina, five patients had ST-segment elevation in the inferior electrocardiographic leads. One patient had ST-segment elevation in anterior leads. During angiography, spasm was demonstrated in the right coronary artery in three patients and in the left anterior descending coronary artery in one patient. This study emphasizes the interaction of fixed and vasospastic disease and has strong implications concerning the management of patients with ischemic heart disease.     

A Clinically Useful Coding System for Normal Coronary Artery Anatomy

Cine coronary arteriograms of 121 patients with normal coronary arteriograms with and without associated valvular or myocardial disease were reviewed to describe normal coronary artery anatomy and the distribution of potentially graftable vessels. Coronary arterio grams were divided into right, mixed, and left interior emphasis systems, depending upon the blood supply to the inferior surface of the left ventricle. Whether a coronary artery at its origin was less than 50%, between 50–70%, or greater than 70% of the left anterior descending coronary artery (LAD) at its origin was described in a simple lettering and numbering code to allow easy comparison. The diameter of the LAD at its origin averaged 4.2 mm. All vessels greater than 70% of the LAD were clearly graftable. The frequency (in percent) with which that vessel was greater than 70% of the LAD in right, mixed, and left systems, respectively, was as follows: This simple method of classification is recommended to provide more accurate comparison in published series and to assist the coronary arteriographer in his interpretations.     

Coronary artery aneurysms

There is no consensus on the best management of coronary artery aneurysms (CAA) in adults. We describe two patients with CAA and review transcatheter approaches to exclude them from the circulation. © 2013 Wiley Periodicals, Inc.     

Left main stem coronary artery dissection during coronary angiography

This paper describes a case of dissection of the main stem of the left coronary artery during coronary angiography with an uneventful clinical course. As far as we know, only one comparable case has been reported before. A brief survey of the pertinent literature is presented. Some possible pathogenetic factors are considered. No specific preventive or therapeutic measurement can be recommended.