华法令对经皮冠状动脉介入治疗术后心肌缺血的疗效观察

为观察华法令对经皮冠状动脉介入治疗术后心绞痛与无症状性心肌缺血的疗效.将我院经皮冠状动脉介入治疗术后有心绞痛或无症状性心肌缺血的86例患者,随机分为两组,对照组按常规治疗,治疗组除常规治疗外加华法令,对比观察两组心绞痛缓解与消失时间,无症状性心肌缺血发作次数及心肌缺血总负荷的改变,并观察华法令的副作用.结果发现,治疗组和对照组的心绞痛缓解时间分别为3.28±1.67d和4.98±1.69d(P＜0.01);消失时间分别为8.87±0.60d和11.04±3.68d(P＜0.01);有效率分别为90.0%和73.9%(P＜0.05).心肌缺血总负荷差值分别为659.1±257.6 mms和369.7±297.2 mms(P＜0.01).说明治疗组心绞痛与无症状性心肌缺血改善比对照组明显,极少数患者虽出现出血副作用,但不严重.此结果提示,华法令对经皮冠状动脉介入治疗术后心绞痛与无症状性心肌缺血有一定疗效,可作为重要辅助治疗,只要严格按用药要求是安全的.     

不稳定型心绞痛介入治疗前后C反应蛋白的变化

目的　观察C 反应蛋白在不稳定型心绞痛患者行经皮冠状动脉介入治疗术前后的变化 ,探讨C 反应蛋白对冠心病预后的影响。方法　选择经皮冠状动脉成形术及支架植入术患者 2 0例及同期仅行冠状动脉造影术患者 30例。在行冠状动脉造影术或经皮冠状动脉介入治疗术前 12h及术后 12h分别采静脉血 2mL ,采用透射比浊法 ,应用日立自动分析仪测C反应蛋白。结果　行经皮冠状动脉介入治疗术组患者术前C反应蛋白为 5 .8± 0 .3mg L ,术后为18.5± 1.2mg L ,与术前比较差异具有显著性意义 (P <0 .0 5 ) ;仅行冠状动脉造影术的患者术前C反应蛋白为 4 .3±0 .5mg L ,术后为 4 .5± 0 .6mg L ,与术前比较差异无显著性意义 (P >0 .0 5 )。另两组病人同期的C反应蛋白比较差异有显著性意义 (P <0 .0 5 )。结论　经皮冠状动脉介入治疗术后C 反应蛋白增高与内皮损伤、斑块破裂、局部炎症反应密切相关 ;且C 反应蛋白可能与介入治疗术后再狭窄相关。因此C 反应蛋白可作为临床评估冠心病预后的独立危险因素。     

经皮腔内冠状动脉成形术和旋磨术治疗冠心病的早期疗效和安全性比较

对40创经皮腔内冠状动脉成形术和10例经皮腔内冠状动脉旋磨术的早期疗效及安全性进行比较。结果发现经皮腔内冠状动脉成形术和旋磨术成功率分别为82.5%和80%;经立腔内冠状动脉成形术组46处病变经扩张后狭窄度由80%±14%降至20%±10%,经皮腔内冠状动脉旋磨术组17处病变经旋磨后狭窄度由84%±9%降至29%±2%,两组残余狭窄有显著性差别(p<0.05);经文腔内冠状动脉成形术和旋詹本并发症总发生率分别为17.5%和80%(p<0.001),重要并发症发生率为2.5%和50%(p<0.001),经皮腔内冠状动脉成形术组无死亡病例,放房本组死亡一例。由此认为,经皮腔内冠状动脉成形术疗效及安全性均高于经皮腔内冠状动脉旋废水,且适应症疗;经皮腔内冠状动脉旋磨术适用于某些“硬”病变或解剖类型不适合作经皮腔内冠状动脉成形术者,残余狭窄显著时需辅以经皮腔内冠状动脉成形术以提高疗效。     

小而密低密度脂蛋白胆固醇与冠心病患者经皮冠状动脉介入治疗术后围术期心肌损伤的相关性

目的 探讨小而密低密度脂蛋白胆固醇(sdLDL-C)与冠心病患者经皮冠状动脉介入治疗(PCI)围术期心肌损伤(PMI)的相关性及其预测价值。方法 选取2021年1月至2022年6月在江苏大学附属宜兴医院行择期PCI治疗的冠心病患者141例,包括心绞痛98例和急性心肌梗死43例;以及同期非冠心病66例。收集临床基线资料及术中冠状动脉病变情况,常规检测术前血脂以及术前术后心肌肌钙蛋白I(cTnI)等指标。接受PCI治疗的患者根据术后cTnI是否升高分为观察组(cTnI升高,n=86)和对照组(cTnI正常,n=55),对比2组间各项指标的差异。同时比较非冠心病,心绞痛,急性心肌梗死3组间sdLDL-C水平的差异。采用SPSS 16.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ²检验。3组之间两两比较采用方差分析及趋势检验。采用二分类logistic回归分析评价sdLDL-C与术后cTnI升高的关系。结果 观察组sdLDL-C、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、植入支架数、支架总长度均高于对照组,差异均有统计学意义[(0.74±0.26)和(0.56±0.27)mmol/L,(4.51±1.17)和(3.90±1.04)mmol/L,(2.77±0.80)和(2.25±0.73)mmol/L,(1.74±0.91)和(1.33±0.62),(52.52±27.93)和(36.92±19.41)mm;均P<0.05]。logistic回归分析显示,sdLDL-C(OR=14.798,95%CI 1.112~196.904),LDL-C(OR=3.074,95%CI 1.138~8.302)是冠心病患者PCI术后PMI的独立危险因素(P<0.05)。sdLDL-C在受试者工作特征(ROC)曲线下面积是0.727(95%CI 0.637~0.817,P<0.05),最佳截断值为0.518mmol/L,诊断PMI灵敏度为86.0%,特异度为56.4%,约登指数为0.424。非冠心病、心绞痛、急性心肌梗死3组的sdLDL-C分别是(0.541±0.144),(0.621±0.257),(0.776±0.289)mmol/L,两两比较差异均有统计学意义(P<0.05),呈显著上升趋势(P<0.05)。结论 术前高水平sdLDL-C是冠心病患者PCI术后围术期心肌损伤的危险因素,sdLDL-C与疾病严重程度呈正相关。     

既往心绞痛对急性心肌梗死介人治疗成功后心肌微循环功能的影响及其临床意义

目的 探讨既往心绞痛对急性心肌梗死介入治疗成功后心肌微循环功能的影响及其临床意义。方法 46例首次急性心肌梗死患者,根据既往有无心绞痛史分为A组(有心绞痛史,24例)和B组(无心绞痛史,22例)。所有患者在发病后6h内接受经皮冠状动脉腔内成形术(PTCA)及支架置入术。分组对照观察冠心病危险因素、心电图、心肌酶谱及左心室和冠状动脉造影结果。结果 A组与B组比较:①两组患者在大量吸烟、高血压病、糖尿病、高脂血症及阳性家族史等方面的比较差异无显著性(P>0.05)。②肌酸激酶峰值(CKmax)分别为(1790±255)U/L和(2530±360)U/L,(t=8.098,P<0.01);③左心室射血分数(LVEF)分别为(0.60±0.14)和(0.51±0.12)(t=2.331,P<0.05);④介入治疗成功后抬高的ST段于0.5h内降幅≥50％或于2h内恢复至等电位线者与未达上述标准者分别为87.5％和45.5％(x~2=7.419,P<0.01),均有显著性差异。结论 既往有心绞痛史的急性心肌梗死患者较无上述病史者心肌微血管损伤为轻,原因可能与既往心绞痛通过心肌缺血预适应机制保护心肌微血管结构与功能完整性有关。     

非高压扩张和无抗凝植入冠状动脉内支架治疗不稳定型心绞痛

目的 :评估 Wiktor- Gx Hepamed冠状动脉内支架的临床疗效。方法 :对 15例不稳定型心绞痛患者植入冠状动脉内支架。植入支架的压力为 (982 .9± 182 .4) k Pa。术后即刻残余狭窄 (10 .3± 9.8) % ,支架术的急性获得 (1.96± 0 .5 1) m m,后期丢失 (0 .5 8± 0 .91) mm。术后未给肝素和华法令 ,仅服抗血小板药物。结果 :术后住院 (3± 1) d。随访 (378± 6 6 ) d,其中 2例再狭窄。在住院期和随访期 ,无一例发生严重心脏事件及出血、血栓形成、再阻塞。结论 :非高压扩张和无抗凝的 Wiktor- GX Hepamed冠状动脉内支架术是安全和有效的。     

不稳定型心绞痛早期冠脉介入治疗疗效观察

目的评价早期经皮冠状动脉介入治疗（PCI）对不稳定型心绞痛（UAP）患者的近期疗效。方法62例UAP患者入院后随机分为PCI组和药物治疗组。PCI组在联合强化药物治疗基础上,尽早行冠状动脉造影和介入治疗术。药物治疗组单纯强化药物保守治疗。观察30d内心脏事件（包括急性心肌梗死、猝死）的发生率、症状缓解率、症状缓解时间及住院天数等指标。结果与药物治疗组比较,PCI组30d内心脏事件（急性心肌梗死、猝死）的发生率明显降低（P〈0.05或P〈0.01）;缩短了症状缓解时间及住院时间（P〈0.01）。结论早期PCI联合强化药物治疗对不稳定型心绞痛患者近期疗效好,风险小,可作为首选治疗方案。     

慢性冠状动脉闭塞病变介入治疗136例分析

目的探讨慢性冠状动脉闭塞(CTO)患者的冠状动脉介入治疗(PCI)的安全性、可行性和影响因素。方法 136例CTO患者,术前给予常规药物治疗,经桡动脉或股动脉途径行PCI治疗,总结靶病变导丝通过率、PCI治疗即刻成功率、手术成功率的影响因素、手术时间、造影剂用量、术中及住院期间严重并发症发生率、术后心绞痛发作情况和心功能恢复情况。结果 136例患者人均CTO病变1.2处,人均置入支架1.3个。闭塞处导丝通过率为89%,PCI即刻成功率为80.9%,手术时间1～5 h,平均2.3 h。术后心绞痛发作显著减少(术前心绞痛均在Ⅱ级及以上,而术后Ⅱ级及以上心绞痛仅占36.3%),心功能明显改善(术前LVEF 0.43±0.08,术后3、6、12个月分别为0.48±0.09、0.53±0.11和0.55±0.10),术中或住院期间无死亡患者,未发生不可救治的严重并发症。结论CTO患者成功PCI治疗可提高患者生活质量,无严重并发症发生,且随着术者技术的成熟和器材改进,手术成功率明显提高。手术成功率与术者经验、患者全身情况、冠状动脉闭塞时间及闭寒病变的部位及特征、介入器械和手术技巧的合理应用等因素密切相关,与介入途径无明显相关。     

稳定型心绞痛及急性冠脉综合征患者脑钠肽浓度的变化和意义

目的探讨冠状动脉粥样硬化性心脏病稳定型心绞痛(SAP)及急性冠脉综合征(ACS)患者血浆脑钠肽(BNP)浓度的变化及其临床意义。方法采用荧光免疫抗原抗体结合方法测定22例冠脉造影正常、心功能正常者,15例SAP患者及64例ACS患者静脉血BNP浓度。结果ACS组血浆BNP浓度(397.57±472.12)高于SAP组(38.39±36.50)及对照组(22.15±19.90)(P<0.005,P<0.005);心梗(AMI)亚组BNP浓度(460.55±518.90)高于不稳定型心绞痛(UAP)亚组(208.62±203.18)(P<0.01)。SAP组和对照组BNP浓度差异无统计学意义(P>0.05)。结论ACS患者血浆BNP浓度明显升高,心梗较不稳定型心绞痛患者变化更为明显,说明心肌缺血是BNP释放的重要刺激因素。     

经皮冠状动脉介入治疗术后合并焦虑状态临床研究

目的 急性冠状动脉综合征患者经皮冠状动脉介入治疗术后合并焦虑状态应用中药乌灵胶囊的疗效观察。方法 选择经皮冠状动脉介入治疗术后合并焦虑状态患者65 例，随机分为常规治疗加用乌灵胶囊（治疗组）和常规治疗组（对照组），疗程均为8周。结果 两组患者用药8 周后，症状及实验室指标均有所改善，患者焦虑情绪改变，两组间差异 显著 (P<0．05)。加用乌灵胶囊治疗组心绞痛、心肌梗死发生率明显降低(P相似文献   

Cardiac Shock Wave Therapy for Chronic Refractory Angina Pectoris. A Prospective Placebo‐Controlled Randomized Trial

Background: Cardiac shock wave therapy (CSWT) delivered to the myocardium increases capillary density and regional myocardial blood flow in animal experiments. In addition, nonenzymatic nitric oxide production and the upregulation of vascular growth factor's mRNA by CSWT have been described. The aim of the study was therefore to test its potential to relieve symptoms in patients with chronic stable angina pectoris. Methods: Twenty‐one patients (mean age 68.2 ± 8.3 years, 19 males) with chronic refractory angina pectoris and evidence of inducible myocardial ischemia during MIBI‐SPECT imaging, were randomized into a treatment (n = 11) and a placebo arm (n = 10). The region of exercise‐induced ischemia was treated with echocardiographic guidance during nine sessions over a period of 3 months. One session of CSWT consisted of 200 shots/spot (9‐‐12 spots/session) with an energy intensity of 0.09 mJ/mm². In the control group acoustic simulation was performed without energy application. Medication was kept unchanged during the whole treatment period. Results: In the treatment group, symptoms improved in 9/11 patients, and the ischemic threshold, determined by cardiopulmonary exercise stress testing, increased from 80 ± 28 to 95 ± 28 W (P= 0.036). In the placebo arm, only 2/10 patients reported an improvement and the ischemic threshold remained unchanged (98 ± 23 to 107 ± 23 W; P= 0.141). The items “physical functioning” (P= 0.043), “general health perception” (P= 0.046), and “vitality” (P= 0.035) of the SF‐36 questionnaire significantly improved in the treatment arm, whereas in the placebo arm, no significant change was noted. Neither arrhythmias, troponin rise nor complications were observed during treatment. Conclusions: This placebo controlled trial shows a significant improvement in symptoms, quality of life parameters and ischemic threshold during exercise in patients with chronic refractory angina pectoris treated with CSWT. Thus, CSWT represents a new option for the treatment of patients with refractory AP.     

Double-blind randomized multicenter study on the efficacy of trapidil versus isosorbide dinitrate in stable angina pectoris

Background: Trapidil is an inhibitor of phosphodiesterase I-IV with resulting positive lusitropic, vasodilating, and antiplatelet effects. Hypothesis: This study was undertaken to compare the antianginal efficacy of trapidil with that of isosorbide dinitrate (ISDN) in patients with stable angina pectoris. Methods: We studied 95 patients with stable angina pectoris who were randomized into a double-blind parallel group study with either oral trapidil or ISDN. After a 1-week run-in period and a 2-week wash-out phase, the patients received either trapidil 200 mg t.i.d. (n = 48) or ISDN 20 mg t.i.d. (n = 47) for 12 weeks. All antianginal medication, except sublingual glyceryl trinitrate (GTN), was discontinued during the study. Patients underwent an exercise electrocardiogram on an ergometer bicycle according to a modified Bruce protocol before and at 6 and 12 weeks during treatment. Results: The workload capacity increased from 583 ± 281 W-min before treatment to 833 ± 444 W-min after 12 weeks of treatment in the trapidil group (p<0.01) and from 555 ± 276 W-min to 827 ± 361 W-min in the ISDN group (p<0.01). The anginal attacks per week as well as the use of GTN decreased significantly in both groups. After 12 weeks of therapy, the cumulative ST-segment depression during exercise decreased by 67% in the trapidil patients and by 23% in the ISDN patients. Compared with baseline, the double product at the 75 W level was reduced in both groups after 12 weeks of treatment. Blood pressure and heart rate at rest remained nearly unchanged. Overall, no statistical difference was found between the two study groups. The tolerability was good. Conclusion: Oral trapidil therapy is safe and effective in stable angina pectoris and is equivalent to standard therapy with ISDN.     

Effect of the Composition of Atherosclerotic Plaques and Rate of Platelet Aggregation on Elevation of Serum Levels of Cardiac Troponin T After Percutaneous Coronary Interventions

Purpose: Elevation of the levels of myocardial biomarkers after percutaneous coronary intervention (PCI) has prognostic value in patients with coronary heart disease. We explored the relationship between elevation of the serum level of cardiac troponin T (cTnT) after PCI and platelet aggregation rate and coronary plaque composition. Methods: Eighty patients with unstable angina pectoris underwent PCI and were divided into two groups according to serum cTnT level 24 hours after PCI: group I (cTnT ≥2 times the normal level) and group II (cTnT <2 times the normal level). Coronary plaque composition was measured with virtual histology‐intravascular ultrasound. Platelet aggregation rate was detected immediately before and 24 hours after PCI. Results: Compared with the patients in group II, patients in group I showed more unstable plaques, a larger necrotic core area (20.88 ± 8.04% vs. 15.31 ± 5.48%, P < 0.05), higher platelet aggregation rate (51.47 ± 12.72% vs. 44.78 ± 13.29%, P < 0.05), and longer stents. The serum cTnT level 24 hours after PCI was positively correlated with the necrotic core area. Conclusions: In patients with unstable angina pectoris, a large necrotic core, high rate of platelet aggregation, and stent length are predictors of cTnT elevation after PCI. (J Interven Cardiol 2012;25:433–438)     

负荷剂量瑞舒伐他汀对心绞痛患者介入治疗围术期程序性细胞死亡因子4的影响

目的探讨负荷剂量瑞舒伐他汀对不稳定性心绞痛患者PCI围术期CD4T淋巴细胞程序性细胞死亡因子4(PDCD4)表达的影响。方法选择入住我院不稳定性心绞痛患者92例,随机分为负荷剂量瑞舒伐他汀组(负荷剂量组,术前2d给予20mg/d,术后10mg/d)46例和常规剂量瑞舒伐他汀组(常规剂量组,术前2d、术后均10mg/d)46例。采用免疫磁珠法筛选出CD4T淋巴细胞,荧光定量PCR检测PDCD4mRNA表达;蛋白免疫印迹法检测PDCD4蛋白相对表达量;酶联免疫法检测血清TNF-α水平。结果与PCI前比较,负荷剂量组PCI后PDCD4mRNA和PDCD4蛋白相对表达量明显降低(P<0.05)。PCI后常规剂量组较负荷剂量组TNF-α水平明显升高[(14.62±2.45)ng/L vs(9.51±1.93)ng/L,P<0.05]。结论负荷剂量瑞舒伐他汀可以通过抑制CD4T淋巴细胞PDCD4的表达,从而减少PCI术后心肌的炎性反应。     

Improvements in balloon aortic valvuloplasty: Closure devices for large artery access

Objectives : To prospectively compare the efficacy and procedural safety of the radial versus femoral route for cardiac catheterization during uninterrupted warfarin therapy. Background : The optimal treatment strategy for cardiac catheterization in patients receiving long‐term oral anticoagulation has not been defined. Increasing evidence suggests the feasibility and safety of catheterization without warfarin interruption. However, the relative safety and efficacy of the radial and femoral access in fully anticoagulated patients are unknown. Methods : Fifty‐six consecutive patients on chronic warfarin treatment with international normalized ratio (INR) between 1.8 and 3.5 were randomized to undergo coronary angiography, alone, or followed by percutaneous coronary intervention (PCI), via the femoral (n = 29) or radial route (n = 27). Procedural success, in‐hospital major adverse cardiac and cerebrovascular events, access‐site, and bleeding complications were recorded. Results : The two groups were well balanced with similar clinical characteristics at baseline. There were no significant differences in preprocedural antiplatelet therapy or in INR levels between the radial and femoral group (2.62 ± 0.7 vs. 2.48 ± 0.6, respectively, P = 0.63). Procedural success was achieved in all femoral patients, whereas one patient in the radial group (3.7%) required crossover to femoral access. Eight patients from the femoral and 10 patients from the radial group successfully underwent PCI. Access‐site complications occurred only in patients who underwent PCI: three (37.5%) in the femoral versus none in the radial group (P = 0.034). Conclusion : The radial access is as efficacious and safe as the femoral route for coronary angiography in fully anticoagulated patients, but is likely to result in fewer access‐site complications in patients who also undergo PCI. © 2010 Wiley‐Liss, Inc.     

华法令和肠溶阿司匹林防治高龄不稳定型心绞痛的疗效对比

目的探讨华法令和肠溶阿司匹林用于预防不稳定型心绞痛患者发生急性心肌梗死和心脏性死亡的疗效。方法应用统一人群分组对照群组研究的方法,在本院住院和门诊的高龄患者中随机挑选服用阿司匹林(ASA300mg/d)者73例,服用华法令(WFR2～5mg/d)者82例,并随访12个月。结果用药14d后,WFR组患者心绞痛改善率明显高于ASA组(86.6%vs67.1%),P<0.01。随访12个月期间,复合终点事件(非致死性急性心肌梗死和心脏性死亡)WFR组明显低于ASA组(9.8%vs26.0%),P<0.01。结论华法令防治不稳定型心绞痛的近期和远期疗效显著,优于阿司匹林组,小剂量应用副作用小,值得推广。     

单侧椎动脉闭塞患者的血流动力学变化

目的 通过颈动脉彩色多普勒血流成像和经颅多普勒超声联合检测评价单侧椎动脉闭塞后健侧椎动脉、基底动脉的血流动力学变化与后循环缺血发生的关系.方法 选择经DSA证实的单侧椎动脉闭塞患者96例,根据MRI结果分为后循环缺血患者(有症状组,n=50)和无后循环缺血患者(无症状组,n=46),采用颈动脉彩色多普勒血流成像和经颅多普勒超声联合检查健侧椎动脉颅外段管径、健侧椎动脉颅内段和基底动脉收缩期峰值流速及舒张末期流速. 结果有症状组经DSA证实存在颈深动脉、颈升动脉及颈外动脉分支等吻合支代偿者11例(占22.0%),无症状组存在吻合支代偿者12例(占26.1%),两组间吻合支建立的比率无显著性差异(P>0.05);无症状组健侧椎动脉管径(3.54±0.47 mm)明显大于有症状组(3.25±0.45 mm,P<0.01);无症状组健侧椎动脉颅内段收缩期峰值流速和舒张末期流速明显高于有症状组 (87.09±35.47 cm/s和35.85±18.03 cm/s比70.60±31.04 cm/s和27.32±11.75 cm/s,P<0.05);无症状组基底动脉收缩期峰值流速和舒张末期流速也明显高于有症状组 (89.54±35.56 cm/s和37.35±19.34 cm/s比72.98±25.95 cm/s和29.52±11.56 cm/s,P<0.05). 结论单侧椎动脉闭塞后健侧椎动脉的管径、收缩期峰值流速、舒张末期流速与基底动脉的收缩期峰值流速、舒张末期流速血流参数的异常与后循环缺血症状的发生具有密切相关性.     

Changes in left ventricular diastolic function in coronary artery disease with and without angina pectoris assessed from exercise ventriculography

In 11 normals and 43 patients with coronary artery disease left ventricular (LV) diastolic pressure–volume (P–V) curves were obtained from biplane ventriculograms and simultaneous high fidelity pressure measurements. During exercise ventriculography 20 patients had angina pectoris (group B), and 16 patients were asymptomatic (group A). At rest there were no akinetic segments in 28 patients (group C), and an akinetic segment was found in 15 (group D). With different total work loads (951 ± 134 and 2100 ± 245 kpm in groups B and A), LV minimal and end-diastolic pressures and corresponding ventricular volumes increased to a similar extent in patients with and without angina during exercise ventriculography. With comparable work loads (1,296±221 and 1,494±195 kpm in groups C and D) the mean increase in diastolic pressure and volume was larger in group D, which corresponded to the more depressed LV resting function. Shifts in the diastolic P–V relationship with exercise were quantitated from the constants a and b of the linear log P–V relationship. In the control group, a and b did not change significantly, but in all CAD groups a significant decrease in a and a significant increase in b were observed during exercise. These changes were more pronounced in groups B and D, but were statistically significant in group A, too. While no patient with angina had an unchanged diastolic P–V relationship, as many as 12 patients had significant P–V shifts in the absence of angina. Eight of these were expected to develop myocardial ischemia with exercise as judged from their coronary artery stenosis and ventriculograms. A similar correlation was found for the diastolic P–V alterations and the exercise ECG. Fourteen patients without any ST-segment change during exercise showed significant P–V shifts, while no patient with signs of ischemia in the ECG had an unchanged P–V curve. We conclude that LV diastolic function is more sensitive to myocardial ischemia than both angina pectoris and the exercise ECG. An inappropriate increase in LV filling pressure with exercise probably reflects myocardial ischemia even in the absence of angina pectoris and ST-segment depression in the ECG.     

强化阿托伐他汀对冠状动脉介入治疗的心肌保护作用

目的探讨经皮冠状动脉介入治疗(PCI)前给予强化他汀治疗对心肌损伤的保护作用及其临床应用价值。方法100例不稳定型心绞痛患者随机分为他汀治疗组(51例)和对照组(49例),他汀治疗组在PCI前接受3～7d的阿托伐他汀40mg/d的治疗,对照组在PCI前不使用他汀类药物;两组患者均接受其他常规治疗,且在PCI后均接受他汀类药物治疗。比较他汀治疗组与对照组在PCI前后心肌损伤标记物及相关炎性标记物的变化;并通过1个月的随访,观察对患者主要心脏不良事件(预后)的影响。结果他汀治疗组PCI后血肌钙蛋白T(TnT)升高与肌酸激酶MB(CK-MB)升高的发生率均为17.6%,低于对照组的24.5%和32.7%,但差异无统计学意义(P均>0.05);两组不良反应的发生率相似;PCI后两组患者血白细胞及高敏C反应蛋白的变化相似;随访1个月,两组均未发生死亡、心肌梗死及再次冠脉血运重建等主要心脏不良事件。结论PCI前给予强化他汀治疗的安全性良好,并有潜在降低PCI后心肌损伤发生的可能;他汀类药物对PCI前后白细胞及高敏C反应蛋白的变化无明显影响。     

Effects of drug-eluting stents on systemic inflammatory response in patients with unstable angina pectoris undergoing percutaneous coronary intervention

Inflammatory markers are elevated in acute coronary syndromes, and are also known to play a crucial role in the pathogenesis of neointimal proliferation and stent restenosis. Drug-eluting stents (DESs) have been shown to decrease stent restenosis in different studies. In this study, we aimed to investigate the effect of treatment with DESs on systemic inflammatory response in patients with unstable angina pectoris who underwent percutaneous coronary intervention (PCI). We compared plasma high-sensitivity C-reactive protein (hsCRP), human tumor necrosis factor α (Hu TNF-α), and interleukin 6 (IL-6) levels after DES (dexamethasone-eluting stent [DEXES], and sirolimuseluting stent [SES]) implantation with levels after bare metal stent (BMS) implantation. We performed PCI with a single stent in 90 patients (62 men; 59 ± 9 years of age; n = 30 in the BMS group, n = 30 in the DEXES group, n = 30 in the SES group) who had acute coronary syndrome. Plasma hsCRP, Hu TNF-α, and IL-6 levels were determined before intervention and at 24 h, 48 h, and 1 week after PCI. The results were as follows. Plasma hsCRP levels at 48 h (11.19 ± 4.54, 6.43 ± 1.63 vs 6.23 ± 2.69 mg/l, P = 0.001) after stent implantation were significantly higher in the BMS group than in the DES group; this effect persisted for 7 days (P = 0.001). Plasma Hu TNF-α levels at each time point were higher in the SES group than in the BMS and DEXES groups (P < 0.05). The time course of Hu TNF-α values was similar in all groups. Although IL-6 levels at baseline and at 24 and 48 h showed no statistically significant difference between the study groups, postprocedural values at 7 days were slightly statistically significant in the SES group (P = 0.045). Drug-eluting stents showed significantly lower plasma hsCRP levels after PCI compared with BMSs. This may reflect the potent effects of DESs on acute inflammatory reactions induced by PCI.