血浆内脂素在不同体质指数冠心病患者的表达

目的:比较不同体质指数(BMI)冠心病组和对照组之间的血浆内脂素水平,并探讨不同BMI冠心病组内脂素与冠状动脉病变程度的关系.方法:选取59例经冠状动脉造影确诊的冠心病患者和49例健康志愿者,分别根据BMI分为非肥胖组(BMI＜25 kg/m2)和肥胖组(BMI≥25 kg/m2).抽血测定内脂素等,并记录冠状动脉病变支数、Gensini积分等.比较不同BMI冠心病组内脂素水平和冠状动脉病变支数、Gensini积分的关系.结果:①冠心病组内脂素明显高于对照组(P<0.01).②非肥胖冠心病组的内脂素、TG、腰围高于非肥胖对照组(P<0.01),肥胖冠心病组的内脂素水平高于肥胖对照组(P<0.01).③非肥胖冠心病组和肥胖冠心病组,随着冠状动脉病变支数的增加,内脂素、Gensini积分逐渐增加(P<0.05,P<0.01).④非肥胖冠心病组和肥胖冠心病组的相关分析发现内脂素和冠状动脉病变支数(r1=0.513,P1=0.012;r2=0.607,P2<0.01)、Gensini积分(r1=0.576,P1=0.004;r2=0.716,P2<0.01)呈正相关.结论:冠心病组的内脂素明显高于对照组,肥胖冠心病组内脂素升高的更明显,不同BMI冠心病患者血浆内脂素与冠状动脉病变支数、Gensini积分均呈正相关,内脂素可能是冠心病发生的危险因素.     

血浆内脂素在冠心病合并2型糖尿病患者中的表达

目的探讨血浆内脂素在冠心病合并2型糖尿病患者中的表达。方法 90例经过冠状动脉造影确诊为冠心病患者(冠心病组)中,其中合并2型糖尿病患者(冠心病合并2型糖尿病组)51例,不合并2型糖尿病患者(冠心病不合并2型糖尿病组)39例;另外选择32名健康者作为对照组。检测所有入选人群的血浆内脂素的水平。结果不合并2型糖尿病组的内脂素水平明显高于对照组(P<0.01)。冠心病组各亚组间比较,合并2型糖尿病组的内脂素高于不合并2型糖尿病组(P<0.01),血浆内脂素水平随着冠状动脉病变支数的增加而升高,各亚组间的比较差异有统计学意义(P<0.01)。冠心病组血浆内脂素水平与冠状动脉病变支数呈正相关(P<0.01)。结论冠心病患者血浆内脂素水平明显高于健康者,合并2型糖尿病者血浆内脂素水平升高更明显,而且与冠状动脉病变程度密切相关。     

血浆骨桥蛋白水平与冠状动脉病变狭窄程度的关系研究

目的:探讨血浆骨桥蛋白水平与冠状动脉病变狭窄程度的关系.方法:选取我院住院经冠状动脉造影证实的冠心病患者70例(冠心病组),非冠心病患者30例(对照组).并根据其冠状动脉血管病变支数又将冠心病组分为1支病变亚组(n=24)、2支病变亚组(n=21)和3支病变亚组(n=25).分别比较冠心病和非冠心病患者以及冠心病患者3亚组之间血浆骨桥蛋白的水平.结果:冠心病组患者血浆骨桥蛋白水平明显高于对照组(P＜0.05).冠心病组不同冠状动脉病变支数亚组间两两比较,血浆骨桥蛋白水平差异具有统计学意义(P＜0.05).多元线性回归分析显示,不同冠状动脉病变支数间的血浆骨桥蛋白水平差异仍具有统计学意义(P＜0.05).结论:冠心病患者中血浆骨桥蛋白水平明显升高,与冠状动脉病变的狭窄程度密切相关.     

冠心病患者血浆同型半胱氨酸和高敏C-反应蛋白与冠状动脉病变支数的关系

目的 :探讨冠心病患者血浆同型半胱氨酸 （HCY）和高敏C 反应蛋白 （hs CRP）与冠状动脉病变支数的关系。方法 :选择在我院住院并进行冠状动脉造影的患者 10 2例 ,以冠状动脉造影未发现任何可辨认的斑块或狭窄者列入对照组 （4 3例 ） ,将至少有一支血管狭窄≥ 5 0 %者列入冠心病组 （5 9例 ） ,并根据冠状动脉病变支数进一步分为单支病变组 （2 1例 ） ,双支病变组 （17）和 3支病变组 （2 1例 ）。冠状动脉造影前取静脉血待测HCY和hs CRP。HCY检测采用荧光衍生化后HLPC分离法。hs CRP检测以高敏感酶联免疫吸附试验定量检测。结果 :冠心病组的血浆HCY和hs CRP水平显著高于对照组 （P <0 .0 1）。除了单支病变组的hs CRP与对照组无显著差异外 ,其余冠状动脉病变组的血浆HCY和hs CRP水平均高于对照组 （P <0 .0 5 ）。血浆HCY与冠状动脉病变支数相关 （r =0 .4 4 8,P <0 .0 1）。hs CRP与冠状动脉病变支数相关 （r=0 .35 0 ,P <0 .0 1）。结论 :血浆HCY、hs CRP与冠状动脉病变程度呈正相关。     

血浆纤维蛋白原、血脂水平和冠心病的关系

目的探讨血浆纤维蛋白原(Fib)、血脂水平与冠心病的关系。方法收集59例经冠状动脉造影证实为冠心病的患者,22例经冠状动脉造影证实无冠状动脉病变的对照者,测定其血浆Fib和血清胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)。根据冠状动脉造影结果将冠心病组分为1支、2支和3支病变组,观察其Fib及TC、TG、LDL-C、HDL-C的水平及与冠状动脉病变程度的关系。血浆Fib水平与血脂进行回归分析。结果冠心病组的血浆Fib及TC、LDL-C明显高于对照组(P<0.05),HDL-C低于对照组(P<0.05),Fib、TC和LDL-C水平随冠状动脉病变支数增加而升高(P<0.05)。Fib、TC和LDL-C冠状动脉狭窄分数相关(r=0.666、0.378和0.429P<0.001)。Fib和LDL-C相关(r=0.534P<0.01)。结论血浆Fib水平的升高及血脂异常和冠心病有密切关系,并且和冠状动脉病变程度相关。血浆Fib水平和LDL-C相关。     

河北地区人群血浆骨桥蛋白水平与冠心病的关系

目的探讨血浆骨桥蛋白(OPN)水平与冠心病发病之间的关系。方法随机选择中国河北地区72例经冠状动脉造影检查并确诊为冠心病的患者及65例正常对照者。将冠心病患者按照病变血管支数分为单支病变亚组和多支病变亚组。抽取所有观察对象清晨空腹静脉血,用ELISA法测定血浆OPN浓度,观察血浆OPN水平与冠心病的关系。结果冠心病组血浆OPN水平高于对照组(P0.01),而单支亚组和多支亚组比较血浆OPN浓度无明显差异(P0.05)。结论冠心病病人血浆OPN水平升高,而血浆OPN水平与病变血管支数无关。     

ACS合并糖尿病患者血清LP(a)水平与冠脉病变程度的关系研究

目的探讨急性冠脉综合征(ACS)合并糖尿病患者血清脂蛋白[LP(a)]水平与冠状动脉病变程度的关系。方法根据空腹血糖(FPG)水平将168例ACS患者分为三组:A组为单纯ACS组(FPG6.1 mmol/L)52例、B组为ACS合并血糖升高组(6.1 mmol/L≤FPG7.1 mmol/L)56例、C组为ACS合并糖尿病组(FPG≥7.1 mmol/L)58例,另选取50例正常健康体检者为对照组。分别测定各组收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血清LP(a)、C反应蛋白(CRP)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)水平,同时应用冠脉造影术测定ACS患者冠脉病变支数及病变程度(Gensini积分)。结果 A组、B组、C组SBP、DBP、TC、TG、LDL-C、LP(a)、CRP、CK、CK-MB水平高于对照组,而HDL-C水平低于对照组(P0.05)。C组FPG、TG、LP(a)、CRP、CK、CK-MB显著高于A组和B组(P0.05),而HDL-C水平低于A、B组(P0.05),而B组LP(a)、CRP水平高于A组(P0.05)。随着ACS患者冠脉病变支数增加,患者Gensini积分及血清LP(a)水平显著升高。Pearson相关分析显示,FPG、TG、LDL-C、LP(a)、CRP、CK、CK-MB与Gensini积分呈正相关(P0.05)。经Logistic多因素分析显示,TG、LP(a)、CRP、CK是ACS合并糖尿病患者Gensimi评分的独立危险因素。结论 ACS合并糖尿病患者血清LP(a)水平显著高于ACS非糖尿病患者,LP(a)水平与ACS冠脉病变程度有关。     

脑梗死患者血浆内脂素水平的变化及临床意义

目的 探讨脑梗死患者血浆内脂素水平的变化及其与血糖、血脂、同型半胱氨酸( Hcy)的关系.方法 选取脑梗死患者35例和健康对照者32例,分别检测二者血浆内脂素、空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、Hcy水平,并分析脑梗死患者Hcy水平与血糖、血脂水平的关系.结果 脑梗死患者血浆内脂素水平为( 25.14±8.06) μg/L,健康对照者为(18.73 ±7.05)μg/L,脑梗死患者血浆内脂素水平明显升高(P＜0.01).直线相关性分析显示,血浆内脂素水平与FPG、LDL-C及Hcy均呈正相关(r分别为0.37、0.22、0.39,P＜0.05或＜0.01).多元线性逐步回归分析显示,FPG、LDL-C及Hcy分别是影响血浆内脂素水平的独立相关因素.结论 脑梗死患者血浆内脂素水平显著升高,检测该指标对脑梗死的预防及病情监测有重要作用.     

血浆三酰甘油浓度升高增加冠状动脉狭窄风险的横断面研究

目的探讨血浆三酰甘油(triglyceride,TG)浓度与冠状动脉粥样硬化性心脏病(冠心病)严重程度的相关性。方法采用横断面研究方法,收集2015年1月至2016年4月在惠州市第三人民医院行冠状动脉造影检查的患者共396例,依据冠状动脉造影检查结果,将入选者分为冠状动脉无明显狭窄组、单支病变和多支病变组,进行组间比较。同时采用单因素和多因素Logistic回归分析分析血浆TG浓度和冠状动脉病变支数的相关性。结果 (1)与无明显狭窄组相比,冠状动脉多支病变组年龄较大,吸烟患者比例较高,合并基础疾病如原发性高血压(高血压)和糖尿病患者比例也较高,差异有统计学意义(P0.05);同时,血浆糖化血红蛋白、空腹血糖、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)和TG浓度在多支病变组也较高,差异有统计学意义(P0.05)。(2)单因素Logistic回归分析显示,年龄,男性、吸烟、糖尿病、高血压患者比例,血浆TC、LDL-C和TG浓度均与冠状动脉病变支数具有正相关性(P0.05),而他汀类药物使用与冠状动脉病变支数具有负相关性(P0.05);进一步行Logistic多因素回归分析提示,在校正年龄,性别、吸烟、高血压和糖尿病后,血浆LDL-C(OR=2.01,95%CI:1.47~2.58,P0.05)和TG(OR=1.38,95%CI:1.17~2.06,P0.05)浓度仍与冠状动脉病变支数具有独立相关性。结论血浆TG浓度升高可能增加冠状动脉病变狭窄风险。     

不同冠状动脉病变程度冠心病患者血浆脂联素水平及其相关性研究

目的:了解不同冠状动脉(冠脉)病变程度的冠心病(CHD)患者血浆脂联素(APN)水平及其与胰岛素抵抗(IR)、血糖(FPG)、血脂、血压、肥胖、冠脉病变程度的关系.方法:选取冠脉造影检查者共128例作为研究对象,根据冠脉病变支数,分为单支病变组32例、双支病变组30例、多支病变组32例和冠脉造影正常的对照组34例.测量血压、身高、体重、腰围(WC)和臀围.采空腹静脉血,测定血浆APN、胰岛素(FINS)、FPG、TC、TG、HDL-C、LDL-C、载脂蛋白A1(apo-A1)和载脂蛋白B(apo-B).计算体质指数(BMI)、腰臀比(WHR)、胰岛素敏感指数(ISI)和Gensini积分.结果:CHD各组血浆APN水平低于对照组(P＜0.01).血浆APN水平与收缩压、舒张压、WC、BMI、WHR、TC、LDL-C、FINS、Gensini积分均呈负相关(P＜0.05或0.01),与ISI呈正相关(P＜0.01).均衡年龄、血压、FPG、血脂、肥胖等影响后,APN仍与Gensini积分、FINS、ISI存在相关性(P＜0.01).回归分析显示,ISI、WC和Gensini积分是影响血浆APN水平的独立因素.结论:CHD患者血浆APN水平降低并与冠脉病变程度密切相关,与IR、血脂、血压和肥胖存在一定的相关性.     

Complications of cardiac catheterization, coronary angiography, and coronary interventions

Cardiac catheterization and coronary angiography have evolved, especially after the advent of percutaneous coronary interventions. Although older patients with more advanced disease are being studied, the overall rate of complications has not dramatically increased and the spectrum of complications has somewhat changed to select the more acute nature of the procedures performed. Careful prophylactic measures such as anticoagulation, ischemia prevention, blood pressure control, hydration as well as the availability of defibrillation and pharmacologic and mechanical means of circulatory support have helped minimize these complications and improve outcome.     

Atherosclerosis of coronary arteries, coronary heart disease and sudden coronary death

Correlation between the severity of coronary atherosclerosis, thrombosis and sudden cardiac death was examined in 721 autopsied cases. Severe coronary atherosclerosis with stenosis was found in most of them; however a similar grade of atherosclerosis was discovered in patients with ischaemic heart disease not dying suddenly. Acute coronary thrombosis in the studied subjects was diagnosed post mortem in about 20 percent of those who died suddenly. Other studies indicate frequencies between 4-93%. There was no consistent time dependence.     

Alcohol consumption, coronary calcium, and coronary heart disease events.

This study was performed to determine if alcohol intake was associated with reduced coronary risk in a high-risk asymptomatic population, and whether this effect was independent of coronary risk factors and coronary calcium. In 1,196 asymptomatic subjects with coronary risk factors, we assessed alcohol consumption history, performed risk factor measurements, and quantified coronary calcium with electron beam computed tomography. These subjects were then followed for a mean of 41 months, and coronary events (myocardial infarction or coronary death) were noted. Significant inverse predictors of coronary events included alcohol use and serum high-density lipoprotein cholesterol level. Direct predictors of events were history of systemic hypertension, smoking, diabetes mellitus, serum cholesterol, and coronary calcium score. Subjects with coronary calcium were 3.1 times more likely to suffer a coronary event than those without calcium (95% confidence interval [CI] limits 1.3 to 7.2). Subjects who drank alcohol had a relative risk of 0.3 (95% CI limits 0.2 to 0.6) for developing coronary events. After controlling for age, gender, and other risk factors with logistic regression, these differences in relative risk persisted (relative risk 0.58; 95% CI limits 0.41 to 0.82). Alcohol consumption is a significant inverse predictor of coronary events, comparable in magnitude to standard risk factors and to radiographically measured coronary calcium. This effect is independent of coronary risk factors and coronary calcium.     

Vascular injury following cardiac catheterization, coronary angiography, and coronary angioplasty

All vascular injuries occurring at this hospital departmentover a 5-year period (1987–91) as a result of cardiaccatheterization, coronary angiography, or coronary angioplasty(PTCA) and requiring transfusion, surgical consultation, orrepair, are reviewed. Such complications may occur late and,to detect cases not apparent from the protocol accompanyingevery examination, a questionnaire was sent to all surgicalclinics in the region asking for details of vascular surgicalintervention after angiography. The present review of 4879 examinationsdisclosed 18 patients with 19 vascular injuries (0·39%),four of them were detected by the questionnaire. The types ofinjury were: pseudoaneurysm (12), thrombembolic episode (4),and excessive bleeding (3). Of the patients with a vascularcomplication 11 (61%) were receiving anticoagulation treatment,compared to 10% n the whole series; two others suffered froma coagulopathic state. Catheterization was difficult or severeatherosclerosis was present in three, inadvertent mobilizationoccurred in one, and unintentional puncture distal to the commonfemoral artery occurred in two patients. With the increasinguse of invasive diagnostic and interventional procedures incardiovascular diseases, knowledge of the type and frequencyof possible complications is important, especially of thosethat may occur late. In the present study anticoagulation, coagulationdisorders, and cardiac catheterization combined with brachialpuncture and angiography all predisposed to a vascular complication.     

Incidence, management, and outcome of coronary artery perforation during percutaneous coronary intervention

We have analyzed the incidence, management, and outcome of 84 cases of coronary artery perforation in patients who underwent percutaneous coronary intervention at our institution. This complication was more frequent in female patients and in patients who underwent lesion modification with atheroablative devices. A total of 8 patients (9.5%) died after the procedure. They were usually older and had a higher incidence of cardiac tamponade; a larger percentage of these patients underwent emergency surgery than those who survived.     

Complex coronary angioplasty in patients with prior coronary artery bypass surgery, in situations utilizing multiple coronary angioplasties, and in coronary occlusions

Coronary artery bypass surgery not only provides symptomatic relief but also may prolong life in a significant percentage of patients. Repeat bypass surgery succeeds in providing symptomatic relief in a lesser number of patients, but it is associated with a higher morbidity and mortality than primary operations. Angioplasty, an interventional, therapeutic catheter technique, is applicable to a large number of patients who have undergone bypass surgery and who are sufficiently symptomatic to require consideration of another revascularization procedure. The gratifying results of successful lesion dilatation coupled with clinical improvement of the patient, the acceptable mortality and morbidity statistics, and the long-term symptomatic relief are comparable to those for repeat coronary bypass graft surgery. In addition, technologic advances in angioplasty equipment, as well as more knowledgeable interventionists, will enable more lesions to be successfully reached, traversed, and dilated with, it is hoped, a lower morbidity and mortality. We would estimate that 30 to 50 per cent of those patients requiring repeat revascularization operations today can undergo an angioplasty procedure with at least comparable clinical results and better morbidity and mortality statistics than those achieved with repeat bypass surgery. Selected patients underwent transluminal coronary angioplasty of varying combinations of arterial and/or vein graft stenoses. A multiple dilatation procedure was defined as successful when dilatation was achieved in all lesions in which it was attempted or when the considered-critical stenosis was dilated successfully and the patient was clinically improved. Angioplasty was successful in 93 per cent of all lesions in which it was attempted, and these successful dilatations produced a clinical improvement in 92 per cent of the patients. No complication whatsoever was experienced in 81 per cent of cases. The complications encountered included a 1.3 per cent mortality rate, a myocardial infarction rate of 6.9 per cent (3.0 per cent per lesion attempted), and an emergency surgery rate of 2.6 per cent (1.1 per cent per lesion attempted). Follow-up data show that a sustained clinical improvement was obtained in 96.8 per cent of the patients in whom the procedure was successful (with or without a repeat angioplasty). These data indicate that multiple coronary angioplasties can be performed during the same procedure, that clinical improvement can be achieved, and that the complication rate is acceptable.(ABSTRACT TRUNCATED AT 400 WORDS)