脂蛋白a水平与冠脉病变的相关性研究

目的通过对冠心病患者的血脂水平进行监测,阐明各种血脂指标对冠心病危险因素的预测价值.方法行冠状动脉造影术的患者,其中冠心病79例,男39例,女40例,对照组61例,男26例,女35例,测定其总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)及脂蛋白a(Lpa)水平.结果冠心病患者TC、TG、LDL和HDL水平与对照组无明显差异,Lpa水平较对照组明显升高(P＜0.05),Lpa水平与冠状动脉狭窄程度呈正相关(r=0.90,P＜0.01).结论Lpa与冠状动脉粥样硬化范围及程度相关.     

脂蛋白a水平与冠脉病变的相关性研究

目的:通过对冠心病患者的血脂水平进行监测,阐明各种血脂指标对冠心病危险因素的预测价值。方法:行冠状动脉造影术的患者,其中冠心病79例,男39例,女40例,对照组61例,男26例,女35例,测定其总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)及脂蛋白 a(Lpa)水平。结果:冠心病患者TC、TG、LDL和HDL水平与对照组无明显差异,Lpa水平较对照组明显升高(P<0.05),Lpa水平与冠状动脉狭窄程度呈正相关(r=0.90,P<0.01)。结论:Lpa与冠状动脉粥样硬化范围及程度相关。     

Prognostic importance of anginal symptoms in angiographically defined coronary artery disease

To evaluate the prognostic importance of anginal symptoms, 44 patients with angiographically defined coronary artery disease and no anginal symptoms at time of cardiac catheterization were selected from the Duke Harvard Collaborative Data Bank. They were “matched” with 127 symptomatic patients in the Data Bank who had similar coronary anatomy and ventricular function. Follow-up data indicated that the patients without anginal symptoms had a significantly better prognosis over a 7 year period than did those with symptoms: Annual mortality in the asymptomatic group was 2.7 percent compared with 5.4 percent in the group with angina (p 0.05). Although the patient population was a highly selective one and the matching categories were relatively broad, these results suggest that the presence of anginal symptoms may be an important independent correlate of prognosis in patients with coronary artery disease. The absence of angina did not preclude the presence of multivessel disease and did not necessarily imply a benign prognosis, because the yearly mortality rate was nearly 5 percent in the subgroup of asymptomatic patients with three vessel disease.     

血尿酸水平与冠状动脉病变的相关性

目的:通过对冠心病患者血尿酸(UA)水平的检测,阐明UA与冠状动脉粥样硬化病变程度和范围的相关性。方法:行冠状动脉造影术的患者共113例,其中冠心病组64例,男51例,女13例;对照组49例,男24例,女25例。通过测定UA、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、脂蛋白a(Lpa)及血糖(Glu)水平进行2组间比较。结果:冠心病组患者TG、TC、LDL、HDL、Lpa及Glu水平与对照组比较差异无统计学意义(P>0.05),但UA水平明显高于对照组(P<0.05);UA水平与冠状动脉狭窄程度呈正相关(r=0.53,P<0.05)。结论:UA水平与冠状动脉病变程度和范围呈正相关。     

Correlation between plasma calcium and coronary artery disease burden in patients with preserved renal function

An implantable cardioverter defibrillator (ICD) has been implanted in a 69-year-old patient with arrhythmogenic right ventricular cardiomyopathy (ARVC) for treatment of syncopal ventricular tachycardia (VT). Two types of ICD-related emergencies complicated the clinical course within 15 months. The first arrhythmic event occurred 3 months after ICD implantation as electrical storm with repetitive fast VT, resulting in 87 consecutive shocks at maximal output. Intravenous administration of amiodarone and reprogramming of the device were the measures to control VT. A year later, the patient experienced a cluster of 97 inappropriate shocks. Lead insulation failure produced electrical noise on the ventricular sensing channel and was misidentified as ventricular fibrillation (VF). The depleted ICD and the dual-coil lead were explanted and replaced by a new system. Multiple ICD shocks constitute a medical emergency in ICD patients, which requires immediate device interrogation for differentiation of appropriate and spurious discharges.     

冠心病患者冠状动脉病变与心率变异性的关系

目的了解冠心病患者冠状动脉病变与心率变异性（HRV）的关系。方法回顾性分析111例患者冠状动脉造影及24小时动态心电图检查资料,按冠状动脉造影结果分为3组:冠状动脉造影完全正常（正常组）、至少有一支冠状动脉狭窄>50%（狭窄组）、至少有一支冠状动脉完全阻塞（闭塞组）;通过动态心电图检查分析HRV的时域指标:SDNN、SDANNind、SDNNind、rMSSD、PNN50。结果①随冠状动脉狭窄程度加重,SDNN、SDANNind、SDNNind逐渐下降,完全阻塞组这些指标下降最显著;②随冠状动脉病变支数增加,SDNN、SDANNind、SDNNind、rMSSD、PNN50有进一步下降趋势,但只有3支病变HRV下降才有统计学意义;③左冠状动脉病变SDNN、SDAN-Nind显著下降,而右冠状动脉病变下降不显著。结论冠心病患者HRV显著下降提示冠状动脉狭窄程度重、病变范围广、病变在左冠状动脉。     

Low plasma levels of oxygenated carotenoids in patients with coronary artery disease

Background and aimsLow circulating levels of carotenoids have been associated with cardiovascular disease. The distribution of different carotenoids in blood may have an impact on the cardioprotective capacity. The aim of the present study was to determine the plasma levels of 6 major carotenoids in patients with coronary artery disease (CAD) and relate the findings to clinical, metabolic and immune parameters.Methods and resultsPlasma levels of oxygenated carotenoids (lutein, zeaxanthin, β-cryptoxanthin) and hydrocarbon carotenoids (α-carotene, β-carotene, lycopene) were determined in 39 patients with acute coronary syndrome, 50 patients with stable CAD and 50 controls. Serological assays for inflammatory activity and flow cytometrical analysis of lymphocyte subsets were performed. Both patient groups had significantly lower plasma levels of oxygenated carotenoids, in particular lutein + zeaxanthin, compared to controls. Low levels of oxygenated carotenoids were associated with smoking, high body mass index (BMI), low high density lipoprotein (HDL) cholesterol and, to a minor degree, inflammatory activity. Plasma levels of lutein + zeaxanthin were independently associated with the proportions of natural killer (NK) cells, but not with other lymphocytes, in blood.ConclusionAmong carotenoids, lutein + zeaxanthin and β-cryptoxanthin were significantly reduced in CAD patients independent of clinical setting. The levels were correlated to a number of established cardiovascular risk factors. In addition, the relationship between NK cells and lutein + zeaxanthin may indicate a particular role for certain carotenoids in the immunological scenario of CAD.     

老年肾动脉狭窄与冠状动脉病变的关系及其相关因素

目的 在冠状动脉造影（CAG）的老年患者中观察并发肾动脉狭窄(RAS)的发生率,并分析并发RAS的影响因素。方法 CAG同时行肾动脉造影（RAG）患者277例,分析动脉粥样硬化的危险因素与RAS发生的关系。结果 经CAG证实冠心病患者212例,RAS发生率19%,CAG正常患者RAS发生率8%,冠脉多支病变组中RAS发生率明显高于单支病变组及冠状动脉正常组（P<0.01）,多因素分析,独立预测因子为冠状动脉病变程度（OR=1.89,95%可信区间:1.35-2.65,P<0.01）。结论 冠心病患者有较高RAS发生率,发现冠状动脉多支病变患者应常规行RAG检查。     

冠心病患者心理因素与冠状动脉病变严重程度相关

目的:观察冠心病患者的心理因素与冠状动脉病变程度的相关性。方法: 收集我院住院冠心病患者434例,分为伴有焦虑抑郁症组（A组）162例,不伴有焦虑抑郁症组（B组）272例,对两组患者的临床表现及冠状动脉造影结果进行对照研究。结果: 伴有抑郁或焦虑等心理障碍的冠心病患者（A组）,心悸、乏力、失眠、烦躁等临床症状表现和冠状动脉病变程度都高于不伴有心理障碍的冠心病患者（B组）,统计学有显著性差异（P<0.05）。冠心病患者的心理障碍因素与冠状动脉病变程度正相关,统计学有显著性（P<0.01）,抑郁症更甚于焦虑症。结论: 冠心病患者心理因素与冠状动脉病变程度有相关性。     

微量尿蛋白与冠状动脉病变相关性研究

目的：分析微量尿蛋白与冠状动脉病变程度和范围的相关性。方法：入选连续179例冠状动脉造影患者,根据尿白蛋白肌酐比值(UACR)分为微量尿蛋白组(30～300μg/mg,n=43)和对照组(UACR＜30μg/mg,n=136)。比较两组冠状动脉造影结果差异,同时分析微量尿蛋白与冠状动脉病变之间的相关性。结果：与对照组相比,微量蛋白尿组高血压、糖尿病患者多见,且其造影阳性率(46．51%比30．15%,P＜0．05)、多支冠状动脉病变发病率(30．23%比8．82%,P<0．01)显著增高。结论：微量蛋白尿患者更易发生严重的冠状动脉病变。     

冠心病患者血清磷脂转运蛋白活性与冠状动脉病变严重程度的相关分析

目的分析冠心病患者血清磷脂转运蛋白活性水平与冠状动脉病变严重程度的相关性。方法 2015年6月至2016年6月期间,无锡市锡山人民医院心血管科顺序入选胸痛患者202例,行冠状动脉造影术后分为冠心病组(n=121)和非冠心病组(n=81),计算Gensini评分,测定血清磷脂转运蛋白活性水平并行常规实验室检查。结果冠心病组磷脂转运蛋白活性水平和Gensini评分显著高于非冠心病组[90.3(67~118)mg/dL比77.4(54.6~103.3)mg/dL,P0.05;29(8~48)比2(0~6),P0.001]。70~79岁与69岁及以下、男性与女性、糖尿病与非糖尿病患者相比,磷脂转运蛋白活性水平和Gensini评分明显升高(P0.05)。多重线性回归分析提示冠心病组患者磷脂转运蛋白与Gensini评分相关(Beta=0.356,P0.001)。ROC曲线分析显示磷脂转运蛋白曲线下面积为0.749(P0.001)。结论冠心病组磷脂转运蛋白活性水平与冠状动脉病变严重程度相关,磷脂转运蛋白活性水平可预测冠状动脉病变严重程度。     

Psychophysical responses to a speech stressor: Correlation of plasma beta-endorphin levels at rest and after psychological stress with thermally measured pain threshold in patients with coronary artery disease

Objectives. We tested the hypothesis that psychological stress alters plasma levels of opioid peptides and that these plasma levels are related to pain perception in patients with coronary artery disease.

Background. Public speaking psychological stress has previously been shown to be associated with silent ischemia.

Methods. After instrumentation and a 30-min rest period, venous blood samples for beta-endorphin were obtained before and immediately after psychological stress in 20 patients with coronary artery disease. Pain threshold was then assessed using a thermal probe technique at baselin and immediately after stress. Patients gave three brief speeches lasting a total of 15 min about real-life hassle situations.

Results. Psychological stress significantly increases plasma beta-endorphin levels (4.3 ± 0.9 pmol/liter [mean ± SE] at rest to 8.3 ± 2 pmol/liter after stress, p < 0.05). There was a significant positive correlation between pain threshold and beta-endorphin levels after stress (r = 0.577, p = 0.008). This significant positive correlation was still present while rest blood pressure and change in blood pressure during stress were controlled for by analysis of covariance techniques.

Conclusions. In patients with coronary artery disease and exercise-induced ischemia, public speaking produces psychological stress manifested by increased cardiovascular reactivity and causes an increase in plasma beta-endorphin levels that is significantly correlated with pain thresholds. These findings may explain the predominance of silent ischemia during psychological stress in patients with coronary artery disease.     

冠心病患者冠状动脉狭窄程度与循环B型利钠肽水平的关系

目的探讨冠心病患者冠状动脉狭窄与循环B型利钠肽(BNP)水平的相关性。方法选取冠心病患者85例作为冠心病组,同期无血管病变者46例作为对照组。采用Gensini评分系统评定冠状动脉狭窄程度,心脏超声测定左心室舒张未内径(LVDd)、左心室舒张末期容积(LVEDV)、LVEF、二尖瓣舒张早期运动速度(E)及舒张晚期运动速度(A),并计算E/A比值。用放射免疫法测定BNP浓度。结果冠心病组心功能(NYHA)Ⅲ级患者的E A值较Ⅰ、Ⅱ级降低,血清BNP水平较Ⅰ、Ⅱ级增加,血清BNP水平与E/A呈负相关(r=-0.61,P<0.05);冠心病组心功能Ⅲ级患者LVEDV、BNP水平较对照组显著升高(P<0.05),血清BNP与LVEDV呈正相关(r=0.65.P<0.05)。冠心病组LVEF较对照组明显减低(P<0.05),血清BNP较对照组升高(P<0.01)。Gensini积分与血清BNP水平呈正相关(r=0.851,P<0.01)。结论冠心痛患者血清BNP水平升高除与心功能不全相关外,心肌缺血亦可影响BNP分泌,导致循环BNP升高。     

Association between plasma inflammatory markers and morphology of coronary artery lesion in patients with coronary artery disease

The atherosclerotic plaque vulnerability may be related to inflammation,immunity,metabolism and blood clotting.One of the key factors affecting plaque stability is inflammatory reaction.This study was to investigate the relationship between vulnerability of coronary artery plaque evaluated with coronary angiography (CAG),intravascular ultrasound (IVUS) and the levels of plasma inflammatory markers.Methods Fifty-eight consecutive patients with acute coronary syndrome who had coronary lesion of a single vessel were divided into 3 groups based on angiographic morphology of the lesions:type Ⅰ lesion group (n =16),type Ⅱ lesion group (n =25) and type Ⅲ lesion group (n =17).The control group consisted of 17 patients with stable angina.Plasma levels of high sensitivity C reaction protein (hs-CRP),matrix metalloproteinase (MMP,including MMP-2 and MMP-9),CD40 ligand (CD40L) and pregnancy associated plasma protein-A (PAPP-A) were measured by ELISA.A subgroup of 28 patients (including 18 ACS patients and 10 stable angina control patients) who underwent IVUS study,were analyzed.Results The plasma levels of MMP-2,MMP-9 and PAPP-A in type Ⅱ lesion group were significantly higher than those in other groups (all P＜0.05).In type Ⅱ lesion group,linear correlation analyses showed significant positive correlation between levels of hs-CRP and MMP-2 (r=0.508);MMP-2 and MMP-9,CD40L,PAPP-A (r=0.647,0.704 and 0.751,respectively);MMP-9 and CD40L,PAPP-A (r=0.491 and 0.639,respectively);CD40L and PAPP-A (r=0.896).IVUS subgroup analysis showed that the area of plaques and plaque burden in culprit lesion,the incidence of high-risk plaques,remodeling index (RI) and positive remodeling percentage in ACS patients were significantly greater than those in control subgroup (P=0.000,0.037,0.028,0.015 and 0.040,respectively).Compared with control subgroup,the plasma levels of hs-CRP,MMP-2,MMP-9 and PAPP-A were markedly elevated (P=0.033,0.000,0.000 and 0.027,respectively).Conclusions CAG and IVUS combined with study on plasma levels of inflammation mediators are helpful in judging the vulnerability of coronary artery plaques.(J Geriatr Cardiol 2008;5:207-211)     

原发性高血压患者冠状动脉病变狭窄程度与脉压及脉压指数的相关性分析

目的探讨原发性高血压患者冠状动脉病变狭窄程度与脉压指数的相关性。方法对拟诊冠心病（CHD）的164例高血压病患者以标准Judkins法行冠状动脉造影术，计算机定量分析系统（QCA）分析冠状动脉狭窄程度并计算其冠状动脉病变积分（CSS）。标准台式水银血压计测定外周肱动脉收缩压（SBP）和舒张压（DBP）并计算脉压指数（PPI）。结果原发性高血压患者CHD的发生与其PPI及PP的相关性显著。结论PPI及PP是高血压病患者CHD发展的一个重要的、独立的预测指标。     

冠心病患者可溶性OX40配体与白细胞介素10的相关性分析

目的观察冠心病稳定型心绞痛患者及高危因素患者和健康人血浆可溶性OX40配体(sOX40L)和白细胞介素10(IL-10)水平及两者之间的相关性,探讨sOX40L在冠心病中的作用及其相关因素。方法采用酶联免疫吸附法测定35例稳定型心绞痛患者、30例高危因素患者以及20名健康人血浆中sOX40L及IL-10的水平。结果稳定型心绞痛患者血浆OX40L水平[(24.95±15.60)ng/L]高于健康对照组[(16.44±11.31)ng/L],差异有统计学意义(P<0.05),略高于高危因素组[(19.99±9.35)ng/L],但差异无统计学意义(P>0.05)。与健康对照组相比,稳定型心绞痛组IL-10水平显著降低[(27.3±9.9)ng/L比(20.5±8.9)ng/L,P<0.05]。血浆sOX40L与IL-10呈显著负相关(r=-0.394,P=0.000)。结论本研究首次观察到血浆可溶性OX40L水平与抗炎细胞因子IL-10的水平呈显著负相关,提示sOX40L可能通过影响IL-10的水平而影响冠心病的危险程度。     

低密度脂蛋白胆固醇水平与冠状动脉病变的关系

目的探讨血清低密度脂蛋白胆固醇（low density lipoprotein cholesterol，LDL—C）水平与冠心病患者冠状动脉病变的关系。方法经选择性冠状动脉造影328例，根据冠状动脉造影结果分为冠心病组和对照组；冠心病组根据病变范围分为单支病变、双支病变、多支病变：根据病变狭窄程度分为轻度、中度、重度狭窄组。分别测定其血脂水平。结果冠心病组甘油三酯、LDL-C和总胆固醇水平明显高于对照组。总胆固醇和LDL—C水平与冠状动脉病变呈正相关；双支病变组与三支病变组明显高于对照组及单支病变组（P〈0．01），中度狭窄组和重度狭窄组明显高于对照组及轻度狭窄组（P〈0．01）。结论总胆固醇与LDL-C能够反映冠心病患者冠状动脉的病变情况，其水平随冠状动脉病变范围及病变程度的加重而升高，可作为预测冠状动脉病变的一个因素。     

D-二聚体与冠状动脉病变形态学的相关研究

目的:探讨血浆D-二聚体(D-dimer,D-D)与冠心病(CAD)冠状动脉病变形态学的关系。方法:按照冠状动脉造影结果对88例观察对象进行分组:(1)按照冠状动脉病变形态特征分为:简单病变组,复杂病变组;(2)按照冠状动脉病变范围分为:单支病变组,多支病变组;(3)按照冠状动脉狭窄程度(Gensini积分法)分为:轻度狭窄组(A组),重度狭窄组(B组)。用酶免法(ELASA)检测血浆D-D含量,比较各组间D-D含量变化。结果:血浆D-D含量:复杂病变组高于简单病变组及正常对照组(P<0.01);多支病变组高于单支病变组(P<0.01);狭窄程度A组略高于B组,但不显著(P>0.05)。结论:血浆D-D含量与冠状动脉病变稳定性及病变范围相关,与狭窄程度不相关。