冠心病合并糖尿病患者血清hs-CRP水平与冠脉病变程度的相关分析

目的：探讨冠心病合并糖尿病患者血清高敏C反应蛋白(hs-CRP)水平与冠脉病变程度的相关性。方法：选取130例住院的冠心病患者分为两组：冠心病合并糖尿病组患者61例,单纯冠心病组患者69例。所有患者应用免疫比浊法测定hs-CRP、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)浓度,行冠状动脉造影检查,以Gensini冠状动脉积分评价冠状动脉病变程度。结果：冠心病合并糖尿病组患者的血清hs-CRP、FPG水平和Gensini冠状动脉积分均高于单纯冠心病组患者(P<0.05),采用多元线性回归分析表明,冠心病合并糖尿病组患者血清hs-CRP水平升高与Gensini冠状动脉积分呈正相关(t=2.22,P＜0.05)。结论：血清hs-CRP水平升高与冠心病合并糖尿病患者冠脉病变严重程度相关。     

分析血清YKL-40水平与2型糖尿病患者冠状动脉病变程度的关系

目的该文主要探讨血清YKL-40水平与2型糖尿病患者冠状动脉病变程度两者之间的关系。方法在该院2013年7月—2015年7月期间所收治的2型糖尿病患者中选取60例作为此次研究对象,所有患者都是因为心绞痛进行冠状动脉造影,根据造影结果,30例冠状动脉病变患者作为观察组,其余30例冠状动脉正常患者作为对照组。观察比较两组患者在吸烟率、糖化血红蛋白水平、餐后2 h血糖、脂蛋白、载脂蛋白B、低密度脂蛋白胆固醇、总胆固醇、收缩压、hs-CRP以及血清YKL-40等方面的差异。结果两组患者在高敏C反应蛋白、血清YKL-40水平、HbA1c、餐后2 h血糖、脂蛋白、载脂蛋白、低密度脂蛋白胆固醇、总胆固醇、收缩压以及吸烟率等多方面的差异具有统计学意义(P0.05);不同冠状动脉病变支数组血清YKL-40水平和Gensini积分的差异具有统计学意义(P0.05);Logistic回归分析结果表明血清YKL-40是导致2型糖尿病患者患有冠心病的重要因素。结论该次研究结果表明,2型糖尿病粥样硬化的整个发展过程,都有血清YKL-40的影响,并且血清YKL-40水平和2型糖尿病患者冠状动脉病变程度有着直接的关系。     

冠心病合并糖尿病患者冠脉病变与血清YKL-40水平的关系

目的探讨冠心病合并糖尿病患者冠脉病变情况与血清YKL-40(几丁质酶-3样蛋白-1)水平的关系。方法选取2010年1月—2014年1月于该院心内科住院并行选择性冠状动脉造影检查的患者126例,根据患者的造影结果及血糖水平将126例患者分为三组:正常组、冠心病组和冠心病合并糖尿病组。测定所有患者的血清YKL-40水平并进行组间比较,对所有患者的冠脉病变情况采用Gensini评分系统进行评判,并将患者的冠脉病变情况与血清YKL-40水平进行相关性分析。结果 1三组血清YKL-40水平比较:冠心病合并糖尿病组血清YKL-40水平最高,其次为冠心病组,三组间比较差异均有统计学意义(P<0.05);2冠心病合并糖尿病组血清YKL-40水平与患者Gensini评分呈正相关,r=0.620(P<0.05),冠心病组患者的血清YKL-40水平与Gensini评分具有一定正相关关系,但差异不具有统计学意义,r=0.354(P>0.05)。结论冠心病合并糖尿病患者血清YKL-40水平与冠脉病变严重程度密切相关,提示YKL-40可能为冠心病合并糖尿病患者评价冠脉病变进展的新型指标。     

血清生长分化因子15、超敏C反应蛋白水平与老年冠心病患者冠状动脉病变严重程度的相关性研究

目的探讨血清生长分化因子15(GDF-15)、超敏C反应蛋白(hs-CRP)水平与老年冠心病患者冠状动脉病变严重程度的相关性。方法选取2016年2—11月在四川省人民医院行冠状动脉造影的老年患者123例,根据冠状动脉造影结果分为冠心病组94例和非冠心病组29例;根据冠状动脉病变支数将冠心病组患者分为单支病变组28例、双支病变组35例、多支病变组31例,根据Gensini积分将冠心病组患者分为低分组24例(Gensini积分32分)、中分组38例(Gensini积分32~82分)、高分组32例(Gensini积分82分)。比较冠心病组与非冠心病组患者实验室检查指标,并比较不同冠状动脉病变支数、不同Gensini积分冠心病患者血清GDF-15、hs-CRP水平,血清GDF-15、hs-CRP水平与冠心病患者Gensini积分的相关性分析采用Pearson相关分析。结果冠心病组与非冠心病组患者血清总胆固醇(TC),三酰甘油(TG)、肌酐(Cr)、尿酸(UA)水平比较,差异无统计学意义(P0.05);冠心病组患者血清HDL-C水平低于非冠心病组,血清低密度脂蛋白胆固醇(LDL-C)、超敏心肌肌钙蛋白I(hs-c Tn I)、GDF-15、hs-CRP水平高于非冠心病组(P0.05)。多支病变组患者血清GDF-15、hs-CRP水平高于双支病变组、单支病变组,双支病变组患者血清GDF-15、hs-CRP水平高于单支病变组(P0.05)。高分组患者血清GDF-15、hs-CRP水平高于中分组、低分组,中分组患者血清GDF-15、hs-CRP水平高于低分组(P0.05)。Pearson相关分析结果显示,血清GDF-15(r=0.683)、hs-CRP(r=0.524)水平与老年冠心病患者Gensini积分呈正相关(P0.01)。结论老年冠心病患者血清GDF-15、hs-CRP水平明显升高并与冠状动脉病变严重程度呈正相关,血清GDF-15、hs-CRP水平可在一定程度上反映老年冠心病患者冠状动脉病变严重程度。     

冠心病合并糖尿病患者冠脉病变与血清YKL-40水平的关系

目的探讨冠心病合并糖尿病患者冠脉病变情况与血清YKL-40(几丁质酶-3样蛋白-1)水平的关系。方法选取2010年1月—2014年1月于该院心内科住院并行选择性冠状动脉造影检查的患者126例,根据患者的造影结果及血糖水平将126例患者分为三组:正常组、冠心病组和冠心病合并糖尿病组。测定所有患者的血清YKL-40水平并进行组间比较,对所有患者的冠脉病变情况采用Gensini评分系统进行评判,并将患者的冠脉病变情况与血清YKL-40水平进行相关性分析。结果 1三组血清YKL-40水平比较:冠心病合并糖尿病组血清YKL-40水平最高,其次为冠心病组,三组间比较差异均有统计学意义(P0.05);2冠心病合并糖尿病组血清YKL-40水平与患者Gensini评分呈正相关,r=0.620(P0.05),冠心病组患者的血清YKL-40水平与Gensini评分具有一定正相关关系,但差异不具有统计学意义,r=0.354(P0.05)。结论冠心病合并糖尿病患者血清YKL-40水平与冠脉病变严重程度密切相关,提示YKL-40可能为冠心病合并糖尿病患者评价冠脉病变进展的新型指标。     

血清OX40L水平与冠状动脉病变程度的相关性研究

目的探讨血清OX40配体蛋白(OX40L)水平与冠状动脉病变程度的相关性。方法选取冠脉造影检查者共458例作为研究对象,根据冠脉病变支数,分为1支病变组、2支病变组、3支病变组和冠脉造影正常的对照组(0支病变组),冠状动脉病变程度由冠状动脉病变支数和Gensini积分表示,对OX40L水平与冠脉病变程度进行单因素和多因素分析。结果 (1)冠状动脉病变各组OX40L水平显著高于正常对照组(P<0.05或P<0.01),血清OX40L水平与冠状动脉病变程度和Gensini积分呈正相关(P<0.01)。(2)多元逐步回归分析结果显示在校正了年龄、高血压病史和高密度脂蛋白胆固醇(HDL-C)后,血清OX40L水平与冠状动脉病变总积分(r=4.763,P<0.01)仍然独立相关,随着血清OX40L水平的升高,冠脉病变支数增加。结论冠心病患者的血浆COX40L水平与冠脉病变程度密切相关,可能对冠心病有预测和诊断意义。     

老年不稳定型心绞痛合并2型糖尿病患者血清NF-κB、YKL-40水平和Gensini评分的变化

目的探讨老年不稳定型心绞痛合并2型糖尿病患者的血清核因子(NF)-κB、YKL-40水平和Gensini评分的变化。方法单纯不稳定型心绞痛患者79例作为A组,66例不稳定型心绞痛合并2型糖尿病患者作为B组,同期体检健康者75例作为对照组(C组)。检测各组的血脂、血糖、血清NF-κB、YKL-40、超敏C反应蛋白(hs-CRP)水平;采用Gensini积分评价冠状动脉病变程度。结果 B组的空腹血糖(FPG)、糖化血红蛋白(Hb A1c)高于C组(t=17.901,14.467),A组、B组hs-CRP水平均高于C组(t=25.321、4.782,P均<0.05);B组的FPG、Hb A1c、hs-CRP高于A组(t=13.987,13.198,27.094,P均<0.05)。A组、B组NF-κB(t=14.728,21.426)、YKL-40(t=30.757,32.825)水平均高于C组(P均<0.05);B组的NF-κB、YKL-40水平和Gensini积分均高于A组(t=9.759、5.604、5.347,P均<0.05)。Spearman相关分析结果表明,不稳定型心绞痛患者的血清NF-κB水平与hs-CRP、YKL-40水平、Gensini积分均呈正相关(P均<0.05);血清YKL-40水平与hs-CRP、Gensini积分均呈正相关(r=0.627、0.580,P<0.05)。结论血清NF-κB、YKL-40水平检测可用于诊断老年不稳定型心绞痛合并2型糖尿病,具有较高的临床应用价值。     

冠心病合并糖尿病患者血清炎症因子水平变化及其临床意义

目的:探讨冠心病合并糖尿病患者可溶性细胞间粘附分子(ICAM-1)、几丁质酶-3样蛋白-1(YKL-40)、脂蛋白相关磷脂酶A2(Lp-PLA2)水平变化及临床意义。方法:入选冠心病患者120例,分为单纯冠心病组84例和冠心病合并糖尿病组36例,另选同期有胸痛症状冠状动脉造影正常的患者20例为对照组。采用Gensini评分系统评定冠状动脉血管病变狭窄程度,用酶联免疫吸附试验(ELISA)法分别检测血清ICAM-1、YKL-40、Lp-PLA2水平。对各组进行比较分析,并分别与Gensini积分进行相关性分析。结果:与对照组相比,单纯冠心病组和冠心病合并糖尿病组ICAM-1、YKL-40、LP-PLA2性均明显升高,差异有统计学意义(P0. 05或P0. 01);冠心病合并糖尿病组ICAM-1、YKL-40、LP-PLA2活性高于单纯冠心病组,差异有统计学意义(P均0. 01);非参数Spearman相关分析显示单纯冠心病组ICAM-1、YKL-40水平与Gensini积分无明显相关性(r=0. 184,r=0. 180,P均 0. 05),LP-PLA2水平与Gensini积分呈正相关(r=0. 180,P 0. 01)。冠心病合并糖尿病组ICAM-1、YKL-40、LP-PLA2水平与Gensini积分无明显相关性(r=0. 054,r=0. 031,r=-0. 045,P均 0. 05)。结论:炎症因子ICAM-1、YKL-40、LP-PLA2可能在冠心病合并糖尿病的发病机制中起重要作用,但与冠状动脉病变程度之间的关系值得进一步研究。     

血清低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇水平与冠状动脉病变严重程度的相关性研究

目的探究血清低密度脂蛋白胆固醇(LDL-C)和非高密度脂蛋白胆固醇(non-HDL-C)水平与冠状动脉病变严重程度的相关性。方法选取2015年2月—2016年8月因胸口疼痛或胸闷等症状在东营胜利石油管理局胜利医院行冠状动脉造影的患者194例,根据造影结果分为正常组71例、冠状动脉粥样硬化组30例、冠心病组93例;根据冠状动脉病变支数将93例冠心病患者分为单支病变组34例、双支病变组30例和三支病变组29例。比较正常组、冠状动脉粥样硬化组及冠心病组患者血生化检查指标,不同冠状动脉病变支数冠心病患者血生化检查指标及Gensini积分,并分析血清LDL-C、non-HDL-C水平及non-HDL-C/高密度脂蛋白胆固醇(HDL-C)比值与Gensini积分的相关性。结果正常组、冠状动脉粥样硬化组及冠心病组受试者血糖及血清总胆固醇(TC)、三酰甘油(TG)、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、丙氨酸氨基转移酶(ALT)及天冬氨酸氨基转移酶(AST)水平比较,差异无统计学意义(P>0.05);冠心病组患者血清HDL-C水平低于正常组和冠状动脉粥样硬化组,血清LDL-C、non-HDL-C水平及non-HDL-C/HDL-C比值高于正常组和冠状动脉粥样硬化组(P<0.05)。不同冠状动脉病变支数冠心病患者血糖及血清TC、LDL-C、BUN、Cr、UA、ALT及AST水平比较,差异无统计学意义(P>0.05);双支病变组患者血清TG、non-HDL-C水平及non-HDL-C/HDL-C比值高于单支病变组,血清HDL-C水平低于单支病变组(P<0.05);三支病变组患者血清non-HDL-C水平及non-HDL-C/HDL-C比值高于单支病变组(P<0.05);双支病变组和三支病变组患者Gensini积分高于单支病变组,三支病变组患者Gensini积分高于双支病变组(P<0.05)。Pearson相关性分析结果显示,血清LDL-C水平与Gensini积分呈正相关(r=0.157,P=0.031),血清non-HDL-C水平与Gensini积分呈正相关(r=0.301,P=0.010),non-HDL-C/HDL-C比值与Gensini积分呈正相关(r=0.401,P=0.020)。结论血清LDL-C和non-HDL-C水平均与冠状动脉病变严重程度相关,且血清non-HDL-C水平与冠状动脉病变严重程度的相关性优于血清LDL-C水平。     

肾功能正常的冠心病患者血清胱抑素C、超敏C反应蛋白水平及内皮祖细胞数量变化及其临床意义

目的探讨肾功能正常的冠心病患者血清胱抑素C(Cys-C)、超敏C反应蛋白(hs-CRP)水平及内皮祖细胞(EPCs)数量变化及其临床意义。方法选取2016年5—12月在四川省医学科学院·四川省人民医院心内科就诊的疑似冠心病患者128例,肾功能均正常,其中冠心病患者95例作为冠心病组,非冠心病患者33例作为对照组;根据冠状动脉病变支数将冠心病患者分为单支病变组27例,双支病变组36例,多支病变组32例;根据Gensini积分将冠心病患者分为高分组(Gensini积分82分)29例,中分组(Gensini积分32～82分)40例,低分组(Gensini积分32分)26例。比较对照组和冠心病组患者一般资料和实验室检查指标,不同冠状动脉病变支数、Gensini积分冠心病患者血清Cys-C、hs-CRP水平及CD_(34)~+细胞分数;血清Cys-C、hs-CRP水平及CD_(34)~+细胞分数与肾功能正常的冠心病患者Gensini积分的关系分析采用Pearson相关分析。结果 (1)对照组和冠心病组患者性别、年龄、高血压发生率、吸烟史、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、血尿素及血尿酸比较,差异无统计学意义(P0.05);冠心病组患者低密度脂蛋白胆固醇(LDL-C)、血肌酐及血清Cys-C、hs-CRP水平高于对照组,CD_(34)~+细胞分数低于对照组(P0.05)。(2)双支病变组、多支病变组患者血清Cys-C、hs-CRP水平高于单支病变组,多支病变组患者血清Cys-C、hs-CRP水平高于双支病变组(P0.05);不同冠状动脉病变支数患者CD_(34)~+细胞分数比较,差异无统计学意义(P0.05)。(3)中分组、高分组患者血清Cys-C、hs-CRP水平高于低分组,高分组患者血清Cys-C、hs-CRP水平高于中分组;高分组患者CD_(34)~+细胞分数低于低分组(P0.05)。(4)Pearson相关分析结果显示,血清Cys-C、hs-CRP水平与肾功能正常的冠心病患者Gensini积分呈正相关(r值分别为0.328、0.810,P0.01);CD_(34)~+细胞分数与肾功能正常的冠心病患者Gensini积分呈负相关(r=-0.444,P0.01)。结论肾功能正常的冠心病患者血清Cys-C、hs-CRP水平升高,EPCs数量减少,血清Cys-C、hs-CRP水平及EPCs数量可在一定程度上判断冠心病及冠状动脉病变严重程度。     

Serum YKL-40 levels in patients with coronary artery disease

Atherosclerosis is considered to be an inflammatory disease in which the initial process is the augmented infiltration of monocytes into the vessel wall and their subsequent differentiation from macrophages into lipid-laden foam cells. Human cartilage glycoprotein-39 (YKL-40) is a new inflammatory marker found to be secreted by lipid-laden macrophages inside human atherosclerotic vessel wall. The aim of this study was to investigate the association of serum YKL-40 levels with the presence and extent of coronary artery disease (CAD) assessed by coronary angiography. We also studied the relation of high-sensitivity C-reactive protein with the presence and angiographic severity of CAD. A total of 200 participants undergoing to coronary angiography was divided into four subgroups: control patients without CAD (n=53), and those with one-vessel disease (n=52), two-vessel disease (n=47), or three-vessel disease (n=48). Serum YKL-40 levels were measured by enzyme-linked immunosorbent assay. Both serum YKL-40 levels and high-sensitivity C-reactive protein concentrations in patients with CAD were significantly higher than in control participants (P<0.001). We also found a significant association between the levels of YKL-40 and the extent of CAD defined by the number of stenosed vessels (P<0.001). The relationship between the serum YKL-40 level and atherosclerosis may represent a new opportunity for the possible utility of serum YKL-40 as an inflammatory marker for coronary artery disease. Moreover, our findings revealed that plasma YKL-40 measurement might also be regarded as a quantitative indicator of disease extent besides being a marker of disease presence.     

2型糖尿病与冠状动脉病变程度的相关性分析

目的探讨冠状动脉病变程度与2型糖尿病(type 2 diabetes mellitus,T2DM)的相关性。方法收集9289例行诊断性冠状动脉造影疑诊冠状动脉疾病(coronary artery disease,CAD)的患者进行回顾性分析,以冠状动脉造影阳性(主要血管直径狭窄≥50%)作为诊断CAD的标准,确诊CAD者6119例(65.9%),未确诊CAD患者3170例(34.1%),其中合并T2DM的2150例(23.1%)患者作为观察组,未合并T2DM的7139例(76.9%)患者作为对照组。采用Gensini积分评价冠状动脉造影病变程度,并计数冠状动脉病变的支数。采用单因素方差分析及多因素回归分析评价糖尿病与冠状动脉狭窄程度间的关系。结果 2150例合并T2DM患者中确诊CAD患者1717例,占79.9%;7139例未合并T2DM患者中确诊CAD的患者4402例,占61.7%。糖尿病患者CAD患病率显著高于非糖尿病组(79.9%比61.7%,χ2=4.027,P<0.001),且冠状动脉病变程度更为严重,表现为患者平均病变支数更多(1.63±1.11比1.11±1.10,t=19.20,P<0.001)、Gensini积分更高(35.47±36.80比22.65±31.42,t=15.92,P<0.001);多因素Logistic回归分析显示糖尿病是CAD发生的的最强独立危险因素(OR值2.127,95%CI1.869～2.419,P<0.001)。结论糖尿病患者的CAD发病率明显高于非糖尿病组;糖尿病组患者冠状动脉狭窄程度更为严重;糖尿病与CAD发生的具有明显正相关性。     

Relationship between aortic valve sclerosis and the extent of coronary artery disease in patients undergoing diagnostic coronary angiography

BACKGROUND: Aortic valve sclerosis (AVS) is considered to be a manifestation of coronary atherosclerosis. Recent studies demonstrated an association between AVS and significant coronary artery disease (CAD). AIM: We sought to determine the association between AVS and the extent of coronary atherosclerosis by means of the Gensini score system, which was calculated to yield a measure of the extent and severity of coronary atherosclerosis in patients referred for coronary angiography. METHODS: A total of 160 consecutive patients referred for coronary angiography were subjected to echocardiography for screening of AVS and coronary risk assessment. Absence (group 1, n = 110) and presence of AVS (Group 2, n = 50) was established. The cardiac risk factors considered in this study were age, gender, family history of CAD, diabetes mellitus, hypertension, hypercholesterolemia and history of smoking. The body mass index was also measured. Atherosclerotic plaque burden was determined using the Gensini score. Significant CAD was defined as >50% reduction in the internal diameter of at least one coronary artery. Multivessel coronary disease was based on the presence of 2- or 3-vessel disease. RESULTS: The AVS patients had a higher rate of 3-vessel disease (AVS group vs. non AVS: 40 vs. 13.6%; p < 0.001). No significant correlations were found between AVS and 1- and 2-vessel disease. Individuals with AVS were found to have a higher Gensini score (40.7 +/- 38.05 vs. 18 +/- 16.4; p < 0.001). Multivariate analysis identified age (p < 0.001), male sex (p = 0.01), triglycerides (p = 0.02), LDL cholesterol (p = 0.001) and Gensini score (p = 0.003) as independent predictors of AVS. CONCLUSION: AVS is strongly interrelated with the coronary angiographic Gensini score. Echocardiographic detection of AVS in patients undergoing coronary angiography can provide a new surrogate marker of the extent of coronary atherosclerosis.     

老年冠心病合并代谢综合征患者平均血小板体积的相关性研究

目的研究合并代谢综合征(MS)老年冠心病患者的平均血小板体积(MPV)变化及相关影响因素。方法选择冠状动脉造影确诊的老年冠心病患者288例,根据诊断分为MS组154例和非MS组134例。测定入院时MPV、脂联素、高敏C反应蛋白(hs-CRP)等指标,并进行相关性分析。结果与非MS组比较,MS组MPV和血小板分布宽度显著升高,差异有统计学意义(P<0.05,P<0.01);相关性分析显示,MS组患者MPV与体质量指数、空腹胰岛素、胰岛素抵抗指数(HOMA-RI)、hs-CRP和冠状动脉病变积分呈正相关(P<0.05,P<0.01),与HDL-C和脂联素呈负相关(P<0.01);多重线性回归分析显示,MS组MPV与hs-CRP、HOMA-RI显著独立正相关,与脂联素和HDL-C显著独立负相关(P<0.05)。结论合并MS的老年冠心病患者MPV显著升高,与hs-CRP、HOMA-RI、脂联素及HDL-C有密切关系。     

Comparison of presence and extent of coronary narrowing in patients with left bundle branch block without diabetes mellitus to patients with and without left bundle branch block but with diabetes mellitus

We prospectively analyzed the clinical, echocardiographic, and coronary arteriographic data of 51 patients with type 2 diabetes mellitus with left bundle branch block (LBBB), 51 patients with type 2 diabetes mellitus without LBBB, and 51 patients with isolated LBBB matched for age and gender. Extent of coronary artery disease (CAD) was classified according to the standard method into 1-, 2-, or 3-vessel disease and was estimated by calculation of the Gensini score. The left ventricular ejection fraction was analyzed by echocardiography. Age, gender, and percentage of patients with a smoking habit or family history of CAD did not differ among the groups. The rates of hypertension and levels of serum creatinine, cholesterol, and triglycerides were statistically higher in group I compared with the other 2 groups. Patients with diabetes and LBBB (group I) had significantly higher scores for the severity (Gensini score) of CAD (p <0.001) and more 3-vessel disease (p <0.001). After adjustment for hypertension, hypertriglyceridemia, and hypercholesterolemia with covariance analysis, the presence of LBBB was also associated with a higher Gensini score in patients with diabetes compared with those with diabetes but without LBBB and those with isolated LBBB (p <0.001). The present study, for the first time, has shown that patients with type 2 diabetes mellitus and concomitant LBBB have more severe and extensive CAD and advanced left ventricular dysfunction compared with those with diabetes but without LBBB and those with isolated LBBB.     

Serum levels of YKL-40 increases in patients with acute myocardial infarction

OBJECTIVES: YKL-40 is secreted by macrophages, including those in atherosclerotic plaques, neutrophils, and vascular smooth muscle cells. Circulating YKL-40 is elevated in patients with inflammation and increased tissue remodeling. The aim was to examine the sequential changes in serum YKL-40 in patients with acute myocardial infarction (AMI), with and without thrombolytic therapy, as compared with patients with stable coronary artery disease (CAD). METHODS: YKL-40 was measured by radioimmunoassay in serum from 63 patients. A total of 47 patients had their first AMI [30 with ST segment elevation myocardial infarction (STEMI) were thrombolyzed, 17 with non-STEMI were not thrombolyzed] and 16 patients had CAD. RESULTS: Serum YKL-40 at the time of admission was higher in patients with AMI (median: 156 microg/l, range: 40-3000 microg/l) than in patients with CAD (median: 106 microg/l, range: 54-300 microg/l, P=0.048) and healthy participants (median: 102 microg/l, range: 38-514 microg/l, P<0.001). No difference in serum YKL-40 between CAD patients and healthy participants (P=0.89) was observed. No difference in serum YKL-40 between the AMI patients with or without ST-elevations (P=0.12) was observed. The maximum serum YKL-40 during the first 24 h after admission was higher in thrombolyzed STEMI patients than in the nonthrombolyzed, non-STEMI patients (P=0.01) and the CAD patients (P<0.0001). Serum YKL-40 declined consistently from the maximum value just after the AMI and during follow-up. Serum YKL-40 at 90, 180, and 360 days after AMI were significantly higher in nonthrombolyzed than in thrombolyzed patients (P=0.004, P=0.008, P=0.017, respectively). CONCLUSION: These results demonstrated that serum concentrations of YKL-40 are greatly increased in AMI patients with and without thrombolytic therapy.     

糖尿病患者非高密度脂蛋白胆固醇和载脂蛋白A-Ⅰ比值与冠状动脉病变程度的相关性

目的探讨非HDL-C(NHDL-C)/载脂蛋白A-Ⅰ(apoA-Ⅰ)比值与2型糖尿病患者冠状动脉病变严重程度的相关性。方法选择因劳力性胸痛而行冠状动脉造影的2型糖尿病患者373例,依据Gensini评分三分位分为3组,低分组<8分(143例);中分组8²8分(109例);高分组>28分(121例),评价NHDL-C/apoA-Ⅰ比值与冠状动脉病变严重程度的相关性。结果 3组患者HDL-C、脂蛋白(a)、apoB、NHDL-C、NHDL-C/apoA-Ⅰ比值等比较,差异有统计学意义(P<0.05,P<0.01);Pearson相关分析和Spearman相关分析均显示,2型糖尿病患者NHDL-C/apo-A-Ⅰ比值与Gensini评分呈正相关(r=0.146,P<0.01;r=0.127,P<0.05)。多元线性回归分析显示,2型糖尿病患者NHDL-C/apoA-Ⅰ比值与冠状动脉病变严重程度独立相关(偏相关回归系数=3.361,P<0.05)。结论 NHDL-C/apoA-Ⅰ与2型糖尿病患者冠状动脉病变严重程度独立相关。     

冠心病患者血清Chemerin、hs-CRP水平变化及临床意义

摘要：目的：探讨冠心病（CHD）患者血清中脂肪因子Chemerin与超敏C反应蛋白（hs-CRP）的水平变化及临床意义。方法：选取于2016年12月至2018年5月期间我院心内科确诊为CHD且行冠状动脉造影术的患者143例作为研究组,选取同期进行入院进行冠脉造影检查单支轻度狭窄,冠状动脉阻塞程度＜30%的109例患者为对照组,采集受试者入院次日清晨空腹静脉血检测血清Chemerin、hs-CRP水平,并采用Gensini积分法评估患者冠状动脉病变程度。比较不同病变支数、Gensini积分CHD患者血清Chemerin、hs-CRP水平差异,并分析相关性。结果：研究组血清Chemerin、hs-CRP水平和Gensini积分均高于对照组（P均<0.05）。随着CHD患者的病变支数增加,血清Chemerin、hs-CRP水平、Gensini积分均显著增高;随着Genisini积分增高,血清Chemerin、hs-CRP水平均显著增高,组间差异均有统计学意义（P均<0.05）。经Pearson相关性分析,CHD患者血清Chemerin水平与hs-CRP水平呈正相关（r=0.702,P<0.05）,血清Chemerin水平、hs-CRP水平均与Genisini积分成正相关（r=0.643、0.593,P均<0.05）。结论：血清Chemerin、hs-CRP升高可以反应CHD患者病变累积及病变程度,可以作为反映冠状动脉病变程度的有效指标。     

高水平纤维蛋白原与冠状动脉狭窄严重程度相关性探讨

目的　探讨高水平的纤维蛋白原 (FIB)与冠状动脉 (冠脉 )病变严重程度的相关性。方法　对 195例疑诊为冠心病的患者进行冠状动脉 (冠脉 )造影 ,图像分析后根据冠脉损害程度评分。所有患者检测FIB、总胆固醇 (TC)、甘油三酯 (TG)、低密度脂蛋白 (LDL C)、高密度脂蛋白 (HDL C)和D二聚体。在控制其他影响因素后 ,分析FIB与冠脉病变程度的定性和定量关系。结果偏相关分析在控制可能影响FIB水平的其他因素如性别、年龄、血脂、D二聚体、高血压、糖尿病后 ,显示FIB与冠脉的病变程度明显相关 ,相关系数为 0 2 89,P <0 0 1。多元逐步回归分析发现FIB和年龄是影响冠脉病变程度的 2个重要变量 (F值分别为 16 89,15 4 7,P <0 0 1;复相关系数为 0 2 9,0 38,P <0 0 1)。在排除了年龄、性别、血压、血脂、糖尿病和吸烟的影响之后 ,证明FIB水平与冠脉病变程度之间存在有意义的回归关系。将所有资料根据FIB水平的 2 5 %、5 0 %、75 %分界点分为 4组 ,发现冠脉病变程度随着FIB的提高而加重 ,其中男性、合并有糖尿病的患者更为明显。结论　高水平的FIB可以反映冠脉病变的严重程度 ,同时又是简单易行的临床监测指标     

Relationship between arterial stiffness parameters and the extent and severity of coronary artery disease

BackgroundThe association between arterial stiffness (AS) and coronary artery disease (CAD) has been previously demonstrated. In the present study, we aim to investigate the relationship between various AS parameters and the extent and severity of CAD.MethodsThe study population consisted of 411 patients with CAD documented by coronary angiography. We measured various AS parameters including augmentation index (AIx), augmentation pressure (AP), pulse wave velocity (PWV), central systolic pressure (cSys), central diastolic pressure (cDia) and central pulse pressure (cPP) with pulse wave analysis. Angiographic images were used to calculate Gensini score and Syntax score. AS parameters were compared using Gensini score and Syntax score.ResultsSyntax score is correlated with age, cSys, cPP, PWV, AP, brachial pulse pressure (bPP), hemoglobin, urea, diabetes mellitus, left main coronary artery disease (p < 0.10 for each). However, Gensini score is correlated only with age, diabetes mellitus, left main coronary artery disease and bPP (p < 0.10 for each). Multivariate analysis revealed age, diabetes mellitus, left main coronary artery disease and bPP as significant predictors of Syntax score; however, for Gensini score, age, diabetes mellitus, gender, left main coronary artery disease, and bPP are determined as predictors.ConclusionAS parameters are not associated with Syntax score or Gensini score. Apart from traditional risk factors, bPP appears to be the only significant predictor for Syntax score and Gensini score.