RAGE基因多态性与冠状动脉粥样硬化性心脏病患者MHR比值和心率变异的相关性分析

目的:探讨晚期糖基化终产物受体(receptor of advanced glycation end products, RAGE)基因多态性与冠状动脉粥样硬化性心脏病(简称冠心病)患者单核细胞/高密度脂蛋白胆固醇比值(monocyte-to-HDL cholesterol ratio,MHR)和心率变异的...     

颈动脉超声对冠状动脉粥样硬化性心脏病评估价值研究

目的:探讨颈动脉超声对冠状动脉粥样硬化性心脏病评估价值。方法:选择2018年2月至2019年9月的疑似冠心病患者107例进行研究。患者入组后均行冠状动脉造影剂颈动脉超声检查,根据冠状动脉造影结果将患者分为阴性组(n=33)、单支病变组(n=31)、双支病变组(n=27)及三支病变组(n=16)。对比各组血管内中膜厚度(Intimate-media thickness,IMT))、脉搏波传导速度(Pulse wave velocity,PWV)及硬度指数β(Lβ),并将颈动脉超声参数与冠状动脉病变程度进行相关性分析进行相关性分析。以ROC法评估各指标诊断价值。结果:不同组患者IMT、PWV及Lβ对比差异均具有统计学意义,且均随病变严重程度增加而增加(P0.05)。各颈动脉超声参数与冠状动脉病变支数呈显著正相关关系(P0.05)。ROC分析结果显示:联合诊断灵敏度和特异度均显著高于单独诊断(P0.05)。结论:颈动脉超声检查IMT、PWV及Lβ对冠状动脉心脏病均有较高的诊断灵敏度、特异度,联合诊断后灵敏度、特异度更高。     

中国冠状动脉粥样硬化性心脏病患者MEF2A基因的新突变研究

目的研究冠状动脉粥样硬化性心脏病（简称冠心病）患者MEF2A基因在中国人群突变情况。方法应用聚合酶链反应．单链构象多态性（polymerase chain reaction-single strand conformation polymorphism，PCR-SSCP）和DNA测序技术检测156例散发性冠心病（coronary artery disease，CAD）患者及93名健康人MEF2A基因第11外显子。结果在SSCP泳动异常标本中进行DNA直接测序后发现1例患者MEF2A基因147130（C→A）错义突变（P431Q）、147191（G→T）同义变异以及147108-147128位点21个碱基缺失而导致了7个氨基酸（424QQQQQQQ430）丧失。另有两例患者仅在147108-147128位点发现上述同样的21个碱基缺失而无错义突变和同义变异的改变。健康对照组未发现此错义与缺失突变，却发现存在同样的同义变异。结论冠心病患者在MEF2A基因第11外显子存在新的突变，此突变可能为病理性突变。     

冠状动脉粥样硬化性心脏病合并糖尿病的血脂检验结果分析

目的 分析冠状动脉粥样硬化性心脏病合并糖尿病患者的血脂检验结果。方法 选取2017年1月~6月我院诊治的22例CHD合并糖尿病患者作为观察组,选取同期的22例CHD患者作为对照组,对两组患者进行血脂检测,对比其血脂、载脂蛋白-A和载脂蛋白-B水平。结果 观察组TG、TC、LDL-C指标分别为（2.71±1.31）mmol/L、（6.54±2.14）mmol/L、（3.74±0.81）mmol/L,均高于对照组的（1.79±0.14）mmol/L、（5.17±1.25）mmol/L、（2.27±0.41）mmol/L,观察组HDL-C为（2.73±0.85）mmol/L,低于对照组的（3.72±0.14）mmol/L,两组差异有统计学意义（P＜0.05）。观察组载脂蛋白-A、载脂蛋白-B水平分别为（1.01±0.17）g/L、（0.68±0.01）g/L,低于对照组的（1.35±0.26）g/L、（0.89±0.14）g/L,差异具有统计学意义（P＜0.05）。结论 对CHD合并糖尿病患者进行血脂检测,能有效诊断患者的继发性并发症,降低并发症发生率,临床诊断价值明显,可在临床推广。     

PAI-1基因多态性与冠状动脉粥样硬化性心脏病患者预后的相关性研究

目的 研究汉族人群纤溶酶原激活物抑制物-1(plasminogen activator inhibitor-1,PAI-1)基因4G/5G多态性与冠心病(coronary artery disease,CAD)患者主要不良心脏事件(major adverse cardiovascular event,MACE)及冠脉病变严重程度的关联.方法 应用聚合酶链反应-限制性片段长度多态性分析155例冠心病患者及190名正常人PAI-l基因的4G/5G多态性,随访患者是否发生MACE,并分析PAI-1基因4G/5G多态性与冠脉病变的关联.结果 (1)冠心病组4G/4G型频率(58/155,37.42%)明显高于对照组(52/190,27.37%),差异有统计学意义(P＜0.01).(2)PAI-1基因4G/4G型频率在MACE组(40/81,49.38%)均明显高于无MACE组(18/74,23.42%),差异有统计学意义(P＜0.01);(3)冠心病患者中PAI-1基因4G/4G型频率在多支病变组(30/47,44.77%)明显高于单支病变组(9/37,24.32%),差异有统计学意义(P＜0.05).结论 携带PAI-l基因4G/4G基因型易患冠心病,易侵犯多支冠状动脉.     

冠状动脉粥样硬化性心脏病的自身免疫机制

目前研究认为冠心病是一种多因素相关的慢性炎症,而自身免疫在冠心病的发病过程中起重要作用。部分冠心病的传统危险因素与自身免疫有所交叉。自身免疫疾病患者的冠心病早发与好发趋势也提示冠心病与自身免疫相关。对于有明确临床症状的自身免疫疾病患者,自身抗体与冠心病发病各个环节有关。进一步研究无临床症状但自身抗体阳性的人群,发现部分自身抗体与冠心病关系密切。同时细胞免疫也参与冠心病的发生,而其中Th1细胞通过INF-γ轴影响冠心病的发生。冠心病的上述特点符合自身免疫疾病特征,因此,有观点认为,冠心病是自身免疫疾病。这个观点将为临床诊断和治疗冠心病提供新的方向。     

冠状动脉粥样硬化性心脏病患者脂蛋白酯酶基因的单核苷酸多态性的初步研究

目的　探讨脂蛋白酯酶基因 (lipoprotein lipase,L PL)单核苷酸多态性 (single nucleotidepolymorphisms,SNP)与冠状动脉粥样硬化性心脏病 (简称冠心病 )的关系。方法　利用聚合酶链反应扩增110名健康人和 10 2例冠心病患者 L PL 基因第 6外显子和第 6内含子的片段 ,采用温度调控高效液相色谱技术对扩增的片段进行了筛查 ,对筛查到的杂合片段进行序列测定 ,并与正常序列进行对照分析。结果　在L PL 基因第 6内含子中发现了 3个尚未报道的 SNP(42 12 t/ c、45 0 9t/ c、45 76 a/ c)。它们的频率在被检测的冠心病患者和健康人群中存在差异 ,其中 42 12 t/ c、45 76 a/ c两组间差异显著 (P<0 .0 5 )。结论　补充了 L PL基因 SNPs的数据库信息。L PL基因 SNPs的研究可能对冠心病等复杂疾病机理的认识有重要价值     

冠状动脉粥样硬化性心脏病临证处方活血化瘀药运用规律分析

目的:应用方剂计量学方法探讨现代医家对冠心病医治过程中活血化瘀药物的运用规律.方法:对现代医家医治冠心病的临证处方中的活血化瘀药使用方剂计量学方法进行频数、构成比和同用度分析.探讨医治冠心病的高频活血化瘀药及临证处方中活血化瘀药的应用规律.结果:高频活血化瘀药依次为丹参,桃仁,红花,当归,川芎.含有 2 味活血化瘀药的处方最多,占比高达 18.01％.平均每方含 2.36 味活血化瘀药.活血化瘀药的性味以苦、温、辛、甘为主,归经以肝经、心经、心包经为主.主要症状依次为胸闷,胸痛,心悸,怔仲、短气、气喘、胸痞、呕吐、头晕、恶心.桃仁,红花,当归,赤芍同用度指数高,其中以桃仁、红花同用度指数最大.丹参、姜黄的同用度指数最小.冠心病急性期活血化瘀药多以破血消徵为主,如三棱,莪术,土鳖虫.缓解期活血化瘀药以活血通络,养血和血为主,如当归,川芎,丹参.结论:本文运用方剂计量学方法对众多医家医治冠心病进行经验提取,剖析活血化瘀药的应用规律,为该病辨证、分期、用药提供科学依据.     

炎症因子基因多态性与冠状动脉粥样硬化性心脏病的相关性

目的 研究中国南方汉族人群炎症因子基因多态性与冠状动脉粥样硬化性心脏病(简称冠心病)的相关性.方法 采用基质辅助激光解吸电离飞行时间质谱技术对283例经冠状动脉造影确诊的冠心病患者和176名对照者的5个炎症因子的基因多态性进行检测,评估不同基因型和等位基因与冠心病患病风险的关联性.结果 在受检测的5个炎症因子[乳腺癌易感基因1相关蛋白( BRCA1-associated protein,BRAP)、去整合素-金属蛋白酶8、中间a胰蛋白酶抑制因子H3、白细胞介素-15和环氧化酶-2]中,BRAP基因的270T/C及90A/G多态性在冠心病组与对照组间的差异有统计学意义,其等位基因和基因型的分布频率符合Hardy-Weinberg平衡(分别为:x2=0.878,P＞0.05;x2=0.776,P＞0.05).冠心病组BRAP 270C等位基因和90G等位基因频率高于对照组(分别为:29.51％vs.21.31％,P=0.006;30.04％ vs.21.31％,P=0.004).Logistic回归分析提示,BRAP 270CC和90GG基因型携带者患冠心病的发病风险高于BRAP 270TT和90AA基因型携带者(分别为:OR=4.51,95％CI:1.41～14.45,P=0.011;OR=5.09,95％CI:1.60～16.26,P=0.006),且该关联独立于性别、年龄、吸烟、高血压、糖尿病及血清总胆固醇、低密度脂蛋白胆固醇水平等风险因素之外.没有证据表明其余单核苷酸多态性与冠心病易感性相关.结论 BRAP基因内含子270T/C和外显子90A/G多态性可能是中国南方汉族人群冠心病发病的风险因素之一.     

老年患者冠状动脉钙化检出率初步报告

目的：探讨老年患者冠状动脉钙化（CAC）的检出率。方法：358例老年患者用电子束CT检测冠状动钙化，并与其它年龄组进行比较，结果：69－69岁组总CAC率达77％。＞70岁达86％。老年患者冠状动脉钙化积分与其它年龄组比较有显著差异。结论：老年患者冠状动脉钙化检出率和各分值均高于其它年龄段。     

Late-outgrowth endothelial progenitors from patients with coronary artery disease: Endothelialization of confluent stromal cell layers

Patients with coronary artery disease (CAD) are the primary candidates to receive small-diameter tissue-engineered blood vessels (TEBVs). Peripheral blood derived endothelial progenitor cells (EPCs) from CAD patients (CAD EPCs) represent a minimally invasive source of autologous cells for TEBV endothelialization. We have previously shown that human CAD EPCs are highly proliferative and express many of the hallmarks of mature and healthy endothelial cells; however, their behavior on stromal cells that comprise the media of TEBVs has not yet been evaluated. Primary CAD EPCs or control human aortic endothelial cells (HAECs) were seeded over confluent, quiescent layers of human smooth muscle cells (SMCs) using a direct co-culture model. The percent coverage, adhesion strength, alignment under flow and generation of flow-induced nitric oxide of the seeded CAD EPCs were compared to that of HAECs. The integrin-binding profile of CAD EPCs was also evaluated over a layer of confluent, quiescent SMCs. Direct comparison of our CAD EPC results to analogous co-culture studies with cord blood EPCs show that both types of blood-derived EPCs are viable options for endothelialization of TEBVs.     

镁离子与冠心病关系的研究进展

镁离子(Mg2+)为细胞内含量最多的二价阳离子.人体内Mg2+的主要来源为饮食摄人,主要经回肠吸收,肾脏为其重要排泄器官.机体中Mg2+浓度受多种因素调节,如甲状旁腺激素、降钙素、去甲肾上腺素和肾上腺素等多种激素都影响镁的转运.近年来研究发现细胞膜上瞬时受体电位阳离子通道M7 (transient receptor potential cation channel subfamily M member 7,TRPM7)和M6(TRPM6)对机体Mg2+稳态的调控起重要作用,其介导的Mg2+电流亦有重要生理作用[1-2].     

Effect of nondipper hypertension on coronary artery disease progression in patients with chronic coronary syndrome

Background/aimIt has been suggested that there is a significant progress in coronary artery disease (CAD) by many pathophysiological mechanisms. Nondipper hypertension (NDH) has been shown to have higher target organ damage and have a higher rate of cardiovascular mortality and morbidity. In this study, we investigated the effect of nondipper hypertension on the progression of coronary atherosclerosis.Materials and methodsA total of 186 patients who underwent coronary angiography twice between 6 months and 3 years were included in the study. Coronary angiography was repeated on the admission day due to angina or positive exercise test and the patients were divided into groups.ResultsProgression of coronary artery disease was detected in 58 of 186 patients. Seventy-one of the total patients were found to be nondipper hypertensive. Nondipper hypertension, hypertension, diabetes mellitus, low-density lipoprotein, and total cholesterol were found to be effective in the progression of CAD. Among these parameters, it was seen that nondipper hypertension and hyperlipidemia were the most important independent risk factors.Conclusion Coronary artery disease is a progressive disease, and this progression depends on many reasons. In our study, we showed that nondipper hypertension is a new parameter that is effective in CAD progression.     

冠心病患者肺炎衣原体感染的研究

目的：探讨肺炎衣原体感染与冠心病之间的关系。方法：采用微量免疫荧光方法检测76例冠心病（包括急性心肌梗塞）患者和76例对照组患者的外周血肺炎衣原体IgG、IgM抗体；采用PCR法检测以上所有病人的鼻咽拭子。结果：两组患者IgG抗体的几何平均滴度差异显著（P<0.05）。IgG、IgM抗体阳性率在冠心病组（包括急性心肌梗塞）分别为75.4%、23.1%，而在对照组分别为52.1%和5.2%，差异显著（P<0.05）。PCR检测冠心病组（包括急性心肌梗塞）20例阳性，阳性率为26.3%（n=76）；对照组4例阳性，阳性率为53%，两组显著差异（P<0.01）。结论：肺炎衣原体感染与冠心病可能有密切的关系。     

Impact of diabetes on mortality and complications after coronary artery by-pass graft operation in patients with left main coronary artery disease

PurposeLeft main disease (LMD) is a severe form of coronary artery disease (CAD). Fifty percent of patients with LMD treated conservatively die within 3–5 years of diagnosis. The aim of the study was to assess the influence of type 2 diabetes on early and late (2-year) prognosis and the risk of complications after coronary artery by-pass graft (CABG) surgery in patients with LMD.Material/methodsWe enrolled 257 patients diagnosed with LMD. 169 (67%) underwent CABG, 19 (8%) percutaneous coronary intervention (PCI) without left main stem protection. 30 (12%) patients had CABG previously. Patients treated with CABG were divided into two groups – with and without diabetes. There were 43 (25.4%) patients with diabetes and 126 (74.6%) without diabetes.ResultsWe observed more complications with wound healing (40.5% vs. 12.8%, p < 0.001) and sternal dehiscence (23.8% vs. 4.0%, p < 0.001) after CABG in patients with diabetes. There were no differences in 7-day, 30-day, 3-month and 1-year mortality. 2-Year mortality was also similar in both groups (11.6% vs. 11.1%, p = 0.928). Patients with diabetes were more frequently hospitalized due to other reasons than angina (39.5% vs. 20.6%, p = 0.014).ConclusionsPatients with diabetes and LMD had more often complications with wound healing and sternal dehiscence after CABG than patients without diabetes. Type 2 diabetes did not influence early and late mortality in patients with LMD treated with cardiac surgery, but the presence of diabetes was associated with more frequent hospitalizations.     

Dynamical analysis of diastolic heart sounds associated with coronary artery disease

In a new approach to noninvasively diagnose coronary artery disease (CAD), auditory correlates attributed to blood flow turbulence have been associated with stenosed coronary arteries. These auditory components have been detected in diseased subjects by spectral estimation of diastolic heart sound recordings made on the surface of the chest. In this study, we investigated the dynamics of the process that produces these sounds in diseased subjects by applying the techniques of dimensional analysis. Our results indicate a difference in the “correlation dimension” between heart sounds of diseased and normal subjects. In particular, diseased subjects show a fractal dimension, implying the presence of a strange attractor and the possible existence of low-dimensional chaos in sounds associated with coronary artery disease.     

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。     

冠心病介入治疗患者体外反搏的疗效探讨

目的探讨增强型体外反搏(enhancedexternalcouterpulsationEECP)对冠心病经皮冠状动脉介入治疗患者的疗效。方法经选择性冠状动脉造影确诊为冠心病且介入治疗成功的患者共469例,其中85例在药物治疗的基础上行体外反搏治疗(EECP组),另384例予单纯药物治疗(药物组)。临床随访6~72个月,部分行超声心动图和冠脉造影复查,比较两组随访病例临床终点事件、左室功能和造影结果的差异。结果(1)基线资料:对EECP组81例(95%)和药物组350例(91%)成功进行了随访,两组在临床资料、造影特征和介入治疗等方面差异均无统计学意义(P>0.05)。⑵临床终点事件:EECP组心绞痛复发率显著低于药物组(8·6%比17.4%,P<0.05);EECP组总的临床终点事件发生率明显低于药物组(18.5%比35.4%,P<0.01)。(3)超声心动图:两组基线室壁运动指数和左室射血分数相似,但复查时EECP组明显优于药物组(P<0.01)。⑷冠状动脉造影:两组再狭窄发生率差异无统计学意义P>0.05,但EECP组出现侧支循环患者数明显多于药物组(17.9%比5·1%,P<0.05),复查时病变血管参考内径[(3.29±0.61)mm比(3.06±0.50)mm,P<0.05]和支架内最小腔径[(3.02±0.59)mm比(2.67±0.62)mm,P<0.01]均显著大于药物组。结论对于介入治疗成功的冠心病患者,增强型体外反搏可减少心绞痛复发,改善预后和心功能,并可能有预防再狭窄的作用。