不稳定性心绞痛患者hs-CRP水平与冠心病危险因素的关系及其与预后的相关性实验观察

探讨不稳定性心绞痛(UA)患者血浆高敏C-反应蛋白(hs-CRP)水平与冠心病危险因素的关系及其对临床预后预测的价值。对483例入院UA患者进行了血浆hs-CRP检测及其他相关检查,并对其中472例进行1~30(25.6±5.6)个月的随访,以观察其不良心血管事件的发生率。结果发现,472例UA患者中hs-CRP增高者出现高血压、血脂异常、2型糖尿病(2DM)等血管事件的比率显著较高,hs-CRP增高者中吸烟者比例较大。作者认为入院时hs-CRP水平增高是UA患者心血管事件增高的危险预测因子之一。     

长期尼可地尔治疗对冠状动脉慢血流患者血管内皮功能和血清超敏C反应蛋白水平的影响

目的:探讨长期尼可地尔治疗对冠状动脉慢血流(CSF)患者血管内皮功能和血清超敏C反应蛋白(hs-CRP)水平的影响。方法:选择冠状动脉造影正常但存在CSF患者66例,随机分为尼可地尔组和常规治疗组,常规治疗组(33例)予以阿司匹林、他汀类药物等常规治疗,尼可地尔组(33例)在常规治疗基础上加用尼可地尔5mg,3次/日,连续治疗6个月。另选取18例年龄和性别匹配的正常老年人为对照组。对照组及治疗前后患者利用彩色多普勒超声测定血管内皮功能指标及血清hs-CRP水平。结果:(1)治疗前,CSF患者hs-CRP与对照组比较明显升高(P<0.01),CSF患者的加压反应性充血前后内径变化百分率(FMD)与对照组比较明显降低(P<0.01)。(2)经过6个月尼可地尔治疗后,尼可地尔组hs-CRP较常规治疗组明显下降(P<0.01),FMD较常规治疗组明显升高(P<0.01)。结论:经过尼可地尔治疗减少炎症反应,可以有效改善CSF患者血管内皮功能。     

幽门螺杆菌感染对冠心病患者血清hs-CRP水平及其疾病进展的影响

目的 探讨幽门螺旋杆菌及hs-CRP对冠心病患者的影响,为其可能的致病机制提供参考依据.方法 选取2014年7月至2015年6月我院心内科收治的80例冠心病患者作为CHD组,选取同期健康体检者80例作为对照组,比较两组患者Hp抗体阳性率、血清中hs-CRP含量以及Hp感染对患者血脂和hs-CRP水平的影响.结果 CHD组患者抗Hp IgG阳性率61.3％,对照组抗Hp IgG阳性率33.8％,差异有统计学意义(P＜0.01).CHD组各病型hs-CRP水平均高于对照组(P＜0.05),随着病情的加剧,hs-CRP水平逐渐上升.CHD患者中Hp感染阳性患者的总胆固醇(TC)、低密度脂蛋白(LDL)、甘油三酯(TG)及hs-CRP水平显著高于Hp感染阴性患者,差异有统计学意义(P＜0.05);但高密度脂蛋白(HDL)水平无显著差异(P＞0.05).结论 Hp感染会导致hs-CRP水平升高,进而影响冠心病的发展进程.     

应用二尖瓣环运动速度和时间指标评价冠心病患者左室整体舒张功能

目的：应用脉冲多普勒组织成像（DTI）定量分析并比较心绞痛与心肌梗死（心梗）患者二尖瓣环长轴方向上舒张运动速度和时间变化，探讨其评价左室整体舒张功能异常的价值。方法：冠心病心绞痛组16例、心梗组34例、对照组16例。记录二尖瓣环侧壁、间隔、前壁和下壁的运动频谱。测量舒张早、晚期峰值运动速度及其比值，舒张早期波开始时间、达峰时间和局部等容舒张时间，并计算4个位点的均值，分别以Em、Am、Em/Am、QEm、TEm和IVRTm表示。结果：心绞痛组和心梗组Em和Em/Am显著低于对照组（P<0.01），心梗组Em又低于心绞痛组（P<0.01）；心绞痛组和心梗组QEm、TEm及IVRTm显著长于对照组（P<0.01或P<0.05），心梗组IVRTm又长于心绞痛组（P<0.01）；IVRTm与Em呈显著负相关（r=-0.64, P<0.01）。结论：脉冲DTI所测Em、Em/Am、QEm、TEm及IVRTm均可反映冠心病患者左室整体舒张功能异常，Em和IVRTm尚可反映心肌缺血损害的严重程度。     

老年急性冠状动脉综合征患者CRP与TNF-α、IL-1β相关性研究

目的:观察老年冠心病不同类型患者中肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)水平变化及其与C反应蛋白(CRP)之间的关系, 进一步探讨急性冠状动脉综合征临床识别和预测的炎症指标。方法:采用放射免疫分析法测定血清TNF-α、IL-1β和CRP的浓度。结果:急性冠脉综合征患者(ACS)TNF-α和IL-1β水平均显著高于对照(P＜0.05, P＜0.01)和稳定性冠心病(SCHD)患者(P＜0.05, P＜0.01)。ACS患者CRP水平显著高于SCHD组和对照组。CRP水平与TNF-α呈显著正相关(r＝0.545, P＜0.01);与IL-1β亦呈明显正相关(r＝0.31, P＜0.05)。TNF-α水平受甘油三酯(r=0.66, P＜0.01)、低密度脂蛋白胆固醇(r=0.53, P＜0.01)等因素影响。结论:老年冠心病患者细胞因子表达异常与炎性标志物CRP密切相关, 提示可能与急性冠脉综合症的发生有关, 是动脉粥样硬化斑块不稳定的标志。     

冠心病患者血清胱抑素C、一氧化氮、超氧化物歧化酶及超敏C反应蛋白水平变化及与冠脉狭窄程度的相关性

目的:分析血清胱抑素C(CysC)、一氧化氮(NO)、超氧化物歧化酶(SOD)及超敏C反应蛋白(hs-CRP)水平与冠状动脉狭窄程度的关系及其临床意义。方法:162例心血管病患者依据冠脉造影结果分为对照组(冠脉狭窄50%,n=40);单支病变组(一支冠脉狭窄≥50%,n=44);双支病变组(两支冠脉狭窄≥50%,n=43);多支病变组(两支以上冠脉狭窄≥50%,n=35)。对四组患者进行冠脉狭窄Gensini积分及血清CysC、NO、SOD及hs-CRP水平检测,分析冠心病患者各指标变化及其与Gensini积分的相关性。结果:单支病变组、双支病变组、多支病变组的CysC和hs-CRP水平均高于对照组(P0.05),并依次递增;单支病变组、双支病变组、多支病变组的NO及SOD水平均低于对照组(P0.05),并依次递减。冠心病患者Gensini积分与血清CysC和hs-CRP水平呈正相关,相关系数分别为0.473,0.429(P0.05);与NO和SOD水平呈负相关,相关系数分别为-0.356,-0.384(P0.05)。结论:冠心病患者冠脉狭窄程度的增加与CysC、hs-CRP水平升高及NO、SOD水平降低有明显相关性。     

高血压患者血管内皮依赖性舒张功能失调的研究

目的观察不同程度高血压时血管内皮依赖性舒张功能失调状况并探讨其可能发生的机制。方法５１例原发性高血压患者按照高血压轻重程度分为３组。采用高分辨超声影像技术，测量肱动脉反应性充血前后血管内径的变化。测定各组受试者反应性充血前后血浆ＮＯ、ＰＧＩ２、ＴＸＢ２、ＥＴ等血管活性物质。结果随高血压分期级别增加，肱动脉血管内皮依赖性舒张能力逐步变小，血浆ＮＯ、ＰＧＩ２逐渐下降，ＴＸＢ２、ＥＴ逐渐增高。结论随着高血压病程的延长。血管内皮依赖性舒张功能受损也加重，可能是由于内皮ＮＯ、ＰＧＩ２等舒张因子合成释放减少而缩血管因子ＥＴ、ＴＸＢ２合成释放增加造成。     

HO-1参与葛根素对抗高糖诱导的大鼠血管舒张功能下降

目的： 研究葛根素对抗急性高糖刺激引起的血管舒张功能的下降,并分析血红素加氧酶（HO-1）在其中的作用。方法: 采用血管环灌流装置,观察大鼠胸主动脉环的舒张效应。结果: ①与空白对照组（含11 mmol/L葡萄糖）相比,经44 mmol/L葡萄糖（高糖）孵育血管2 h后,主动脉环对ACh引起的内皮依赖性血管舒张反应下降。②葛根素（10-10-10-8 mol/L）与高糖联合孵育,可剂量依赖性地改善高糖诱导的血管ACh舒张反应的下降。③葛根素孵育血管后可引起血管HO-1活性增高;用ZnPPIX抑制HO-1的活性后,葛根素抗高糖损伤的作用被取消。结论: 葛根素可以对抗高糖引起的血管舒张功能的下降,其机制可能是通过诱导HO-1而实现的。     

冠心病患者血清超敏C反应蛋白、肌钙蛋白、血脂水平的变化及临床意义

目的 探究冠心病患者血清超敏C反应蛋白（hs-CRP）、肌钙蛋白Ⅰ（cTnⅠ）、血脂水平的变化及临床意义。方法 选择2017年2月~2019年2月我院收治的80例冠心病患者作为研究对象,根据疾病类型分为稳定型心绞痛（SAP）组35例、急性心肌梗死（AMI）组20例及不稳定性心绞痛（UAP）组25例,另选取同期在我院进行体检的50例健康者作为对照组,比较四组hs-CRP、cTnⅠ、血脂水平（TC、TG、HDL-C、LDL-C）。结果 SAP、UAP、AMI组hs-CRP、cTnⅠ高于对照组,AMI组hs-CRP、cTnⅠ高于SAP组、UAP、SAP组hs-CRP、cTnⅠ高于SAP组,差异有统计学意义（P＜0.05）。SAP、UAP、AMI组TC、TG、LDL-C高于对照组,HDL-C低于对照组,差异有统计学意义（P＜0.05）;UAP、AMI组TC、TG、LDL-C低于SAP组,HDL-C高于SAP组,差异有统计学意义（P＜0.05）。结论 冠心病患者检测血清hs-CRP、cTnⅠ、血脂水平可有效预防疾病,对判断病情及评估预后有重要的临床意义。     

碱性成纤维细胞生长因子对兔血管舒张功能及左旋精氨酸／？…

本文观察了碱性成纤维细胞生长因子对离体主动脉舒张反应，一氧化氮生成及左旋精氨酸转运的影响。方法离体大鼠动脉测定张力，主动脉薄孵育测定ＮＯ生成和Ｌ－精氨酸转运。     

冠心病患者血小板聚集和心功能关系的研究

本文观察了肾上腺素诱导的全血血小板聚集活性和心功能指标的关系。结果表明：血小板聚集性和每搏输出量呈非常显著负相关（Ｐ＜０．００１），和射血前期／左室射血时间（ＰＥＰ／ＬＶＥＴ，等容收缩期／左室射血时间呈显著正相关（Ｐ＜０．００２），与心舒早期功能指标无显著相关。因此，监测血小板聚集性的动态变化对了解心脏收缩功能和预报心肌梗塞，心性猝死发生的危险性具有一定的临床价值。     

24 bp duplication of CHIT1 gene is not correlated with coronary artery disease in Corsica Island (France)

In this study we analyzed allele and genotype distributions of 24 bp duplication of the CHIT1 gene in a sample of patients (N=300) with coronary artery disease (CAD) and in a control group (N=300) from central Corsica (France), with the aim to investigate the possible association between CHIT1 genotypes and CAD in Corsican population. Serum chitotriosidase activity is increased in individuals experiencing an ischemic stroke of atherothrombotic etiology and in subjects with ischemic heart disease. Our results suggest that 24 bp duplication of CHIT1 gene is not correlated with CAD in Corsican population, according to a previous study carried out on a Spanish sample. Gene prevalence and perhaps gene-disease associations vary according to ethnicity. Further studies, based on different ethnic groups, could be suitable to determine the implication of this polymorphism with respect to CAD.     

Function of T regulatory type 1 cells is down-regulated and is associated with the clinical presentation of coronary artery disease

T regulatory type 1 (Tr1) cells can promote tolerance and suppress inflammation. Atherosclerosis may be induced by the proinflammatory activation of cells in the vasculature and the immune system. Hence, we wondered whether defects in Tr1 function were a contributing factor to coronary artery disease (CAD). Data showed that the frequency of IL-10⁺ Tr1 cells was significantly lower in CAD patients than in controls. Compared to healthy controls, Tr1 cells from CAD patients presented lower CTLA-4 but higher PD-1 expression, in addition to lower IL-10 secretion. When co-incubated with Tconv cells, the CD4⁺CD49b⁺LAG-3⁺CD45RO⁺ Tr1 cells presented IL-10-dependent inhibitory effects, and those from CAD patients presented significantly lower suppression capacity than those from healthy controls. Interestingly, the characteristics of Tr1 cells were associated with clinical features of CAD patients. The frequency of Tr1 cells and the IL-10 and LAG-3 expression by Tr1 cells were negatively correlated with the BMI of the CAD patients. In addition, the Tr1 frequency and the LAG-3 and CTLA-4 expression on Tr1 cells were lower in CAD patients with higher numbers of narrowed vessels. Together, these results suggest that in CAD, Tr1 cells present multiple defects, which are associated with the clinical presentation of the disease.     

Endothelin-1 immunoreactivity in plasma is elevated in HIV-1 infected patients with retinal microangiopathic syndrome

Endothelin-1 is a recently identified cytokine with potent vasoconstrictor activity which is associated with various diseases involving blood vessels. HIV-1 related retinal microangiopathic syndrome is a frequent finding in patients with AIDS or AIDS-related complex, presenting predominantly with retinal cotton-wool spots. We investigated 55 HIV-1 infected patients by ophthalmoscopy and for endothelin-I immunoreactivity in plasma and an additional 76 HIV-1 infected patients only for endothelin-1 levels. For reference values 13 age-matched healthy subjects were studied. In 18 of 55 patients (33%) investigated ophthalmoscopically we found evidence of microangiopathic syndrome. Overall, the mean endothelin-1 immunoreactivity in plasma of HIV-1 infected patients was significantly elevated as compared to controls (4.28 ± 3.62 versus 2.72 ± 0.67 fmol/ml, P < 0.0001). HIV-1 infected patients with retinal microangiopathic syndrome had significantly higher plasma levels of endothelin-1 immunoreactivity (4.59 ± 1.38 fmol/ ml) compared to HIV-1 infected patients without microangiopathic syndrome (3.18 ± 1.64 fmol/ml, P = 0.003). Correlation analysis revealed that endothelin-1 immunoreactivity in plasma had no significant association with disease progression, CD4 cell count, ₂-mi-croglobulin, neopterin, or age. Endothelin-1 immunoreactivity in plasma was correlated exclusively with retinal microangiopathic syndrome in one or both eyes (r = 0.45, P = 0.0006) and with the number of cotton-wool spots (r = 0.50, P = 0.0001). In conlusion, HIV-1 related retinal microangiopathic syndrome is associated with elevated plasma levels of endothelin-1. By virtue of its potent vasoconstrictor activity endothelin-1 may be involved in the pathogenesis of HIV-1 related vascular disease.Abbreviations AIDS aquired immunodeficiency syndrome - ET-1 endothelin-1 - HIV human immunodeficiency virus - IR immunoreactivity - WR Walter Reed classification Correspondence to: B. Rolinski     

Testosterone and coronary artery disease in men

Coronary artery disease (CAD) is the leading cardiovascular cause of death, and in men, endogenous testosterone concentrations are inversely related to the extent and severity of CAD. Testosterone is known to affect a number of risk factors for CAD and has effects on vascular tone, vasoreactivity and blood flow of blood vessels beyond the reproductive system, indicating that testosterone may be involved in the pathogenesis of CAD. In this review we will present and discuss the actions of endogenous testosterone and testosterone treatment on risk factors for CAD, on the blood vessel wall and blood flow, and on atheroma development and progression, and discuss the potential for testosterone use in men with CAD.     

冠心病患者血浆循环miR-126的表达及其对血管内皮细胞的影响

目的: 检测血浆循环miR-126和miR-16在冠心病患者和健康人群血浆中的表达,进一步探讨miR-126对血管内皮细胞的影响。方法: (1)收集52例冠心病心肌梗死型患者和52例健康人群的血样标本,采用Trizol LS提取血浆中总RNA,检测血浆miR-126和miR-16的表达;(2)通过转染在人血管内皮细胞株EA.hy926中抑制miR-126的表达,转染30 h后检测血管内皮生长因子的表达。结果: (1)与健康人群相比,循环miR-126在冠心病患者中的表达显著下降(P<0.05);miR-16在两组间的表达无显著差异(P>0.05);(2)内皮细胞株EA.hy926中miR-126被抑制后,血管内皮生长因子的表达为对照组的2.08倍(P<0.05)。结论: 血浆循环miR-126在冠心病患者表达下降,血浆循环miR-16在人群中的表达较稳定;miR-126通过负性调节血管内皮生长因子的表达,对血管内皮细胞产生调节作用。