二维超声检测冠心病患者颈动脉粥样硬化病变

对103例经选择性冠状动脉造影的患者作双侧颈动脉超声检查，探讨了颈动脉超声检查的方法学以及颈动脉粥样硬化斑块的好发部位和超声分型，发现颈动脉粥样硬化斑块好发于颈动脉分叉处，以左侧多见，且多为扁平斑；颈动脉粥样硬化与冠状动脉粥样硬化之间有着密切的相关关系，冠状动脉病变支数越多，其颈动脉粥样硬化斑块积分也越高，不同冠状动脉病变组之间有非常显著的差异（P＜0．001）。     

心肌桥合并冠状动脉粥样硬化患者的临床特点

目的探讨心肌桥合并冠状动脉粥样硬化患者的临床及冠脉造影特征。方法收集2005-2009年在我院经选择性冠状动脉造影证实的42例心肌桥患者的临床资料,根据造影结果将患者分为单纯性心肌桥组（19例）与心肌桥合并冠状动脉粥样硬化组（23例）,分析比较两组临床特点和造影结果。结果两组在性别及冠心病危险因素上差异无统计学意义,但心肌桥合并冠状动脉粥样硬化狭窄组存在2个或2个以上冠心病危险因素的概率要明显高于单纯心肌桥组。冠状动脉粥样硬化多发生于邻近心肌桥部位,其临床上多表现为急性冠脉综合征。结论心肌桥可能导致其邻近部位发生冠状动脉粥样硬化损伤并加速其进展。心肌桥合并冠状动脉粥样硬化患者可能发生更为严重的临床事件。     

原发性高血压左室肥厚患者冠状动脉粥样硬化狭窄特点

目的:探讨原发性高血压(EH)伴左室肥厚(LVH)患者冠状动脉粥样硬化狭窄特点。方法:选择经过冠状动脉造影的EH患者566例,伴LVH者140例(LVH组),与单纯EH患者426例(对照组)对比分析冠状动脉粥样硬化狭窄的部位、狭窄的程度、狭窄的范围等的差异。结果:LVH组与对照组比较,LVH组患者发生冠状动脉粥样硬化狭窄的概率明显升高(P<0.01),其危险性增加5.09倍。同时,LVH组发生左前降支冠状动脉粥样硬化狭窄概率显著高于对照组(P<0.01),在其他部位冠状动脉粥样硬化狭窄程度2组比较差异无统计学意义(P>0.05)。LVH组冠状动脉狭窄患者运动平板试验的心肌缺血检出率为33.1%(42/127),而对照组冠状动脉狭窄患者的心肌缺血检出率为12.5%(35/280),P<0.05。在传统冠状动脉粥样硬化危险因素中,只有血压与LVH存在协同效应(P<0.05)。结论:EH伴LVH患者冠状动脉粥样硬化狭窄发生率显著升高,左前降支是主要狭窄部位,而且更易于发生心肌缺血。     

白介素-33在心血管系统中的研究进展

冠状动脉粥样硬化是脉管系统常见的慢性疾病，以血管壁慢性炎症为特征。小鼠冠状动脉粥样硬化模型中发现Th1细胞是冠状动脉粥样硬化发病中关键的病理因素。     

颈动脉粥样硬化兔模型的建立

动脉粥样硬化是一种全身性疾病,以动脉分叉、分支开口及血管弯曲的凸面为病变的好发部位.Fusari等采用血管造影的方法检查了1000例因腹主动脉或颈动脉粥样硬化需要手术患者的冠状动脉,其中720例患者（72%）因腹主动脉粥样硬化需要手术,238例患者（24%）因颈动脉粥样硬化需要手术,42例患者（42%）同时因以上两种原因需要手术.     

冠状动脉疾患中血管收缩和固定心外膜血管狭窄的协同关系

传统认为冠状动脉狭窄是被动性固定损害,对作用于血管的刺激物无反应。然而,某些粥样硬化狭窄的冠状动脉发生痉挛的事实,使这看法有所改变。而且,冠状动脉痉挛似乎好发于心外膜冠状血管有硬化斑块的部位.麦角新碱激发的冠状动脉痉挛主要发生在粥样硬化处附近。这些临床发现提示,     

冠状动脉钙化的形成、检测及治疗新进展

<正>冠状动脉粥样硬化性心脏病(冠心病)的基本病理变化是冠状动脉粥样硬化[1-3]。冠状动脉钙化是指钙盐在冠状动脉血管壁的异味沉积,常发生在动脉粥样硬化斑块的部位,是冠状动脉粥样硬化病变的重要标志。冠状动脉钙化可导致血管僵硬度增加,顺应性降低,心肌灌注受损。临床研究显示,冠状动脉钙化与更高的不良事件发生率相     

血浆内脏脂肪素水平与冠状动脉粥样硬化程度的相关性

目的 研究血浆内脏脂肪素水平是否与冠状动脉粥样硬化严重程度存在相关性.方法 62名患者接受冠状动脉造影检查,按造影结果 分为对照组13例和冠状动脉硬化组49例,并采用Gensini积分系统评估冠状动脉粥样硬化严重程度,将冠状动脉粥样硬化组患者分为轻度和重度冠状动脉粥样硬化组二个亚组.ELISA法检测各组血浆内脏脂肪素水平,比色法检测血脂水平.结果 与对照组比较,冠状动脉粥样硬化组血浆内脏脂肪素水平显著升高;重度冠状动脉粥样硬化组血浆内脏脂肪素水平显著高于轻度冠状动脉粥样硬化组;血浆内脏脂肪素水平与冠状动脉Gensini积分呈正相关(r=0.359;P<0.01).结论 血浆内脏脂肪素水平与冠状动脉粥样硬化严重程度相关,提示内脏脂肪素可能参与了冠状动脉粥样硬化的发生发展.     

颈动脉粥样硬化和肱动脉内皮功能与冠状动脉病变的关系

目的 探讨颈动脉不同部位内膜中膜厚度及斑块积分,反应性充血后肱动脉血管内径变化与冠状动脉粥样硬化程度的关系,从而为临床筛查冠状动脉粥样硬化积累新的临床资料与经验.方法 入选对象31例,依冠状动脉积分分为高、中、低三组,对每组对象行超声检测颈动脉不同部位内膜中膜厚度和肱动脉血流介导的血管舒张功能.结果 颈动脉各部位内膜中膜厚度与冠状动脉粥样硬化病变程度呈正相关,且分叉处的内膜中膜厚度与冠心病有更强的相关性(r=0.679,P<0.01);颈动脉粥样斑块积分与冠状动脉粥样硬化病变程度呈正相关,颈动脉分叉处最易形成斑块(P<0.05);肱动脉血管内皮舒张功能与冠状动脉粥样硬化病变程度呈负相关(r=-0.646,P<0.01).硝酸甘油诱导的非内皮依赖性血管舒张功能在三组间虽呈现逐渐减弱的趋势,但未达到统计学差异(P>0.05).结论 颈动脉内膜中膜厚度及肱动脉血流介导的血管舒张功能测定可较好地反映冠状动脉硬化程度.     

脑梗死与颈动脉粥样硬化斑块的相关性分析

目的探讨脑梗死与颈动脉粥样硬化斑块的相关性。方法对55例脑梗死病人进行颈动脉彩色多普勒超声检查,观察其斑块的部位、性质以及粥样硬化斑块的回声强度、部位、数目等。结果脑梗死病人颈动脉粥样硬化斑块检出率为85.5%;斑块的好发部位为颈总动脉分叉处、颈总动脉主干;复发性脑梗死病人颈动脉粥样硬化斑块检出率达100.0%;脑梗死病人的颈动脉粥样硬化斑块多为不稳定性斑块。结论脑梗死的发生与颈动脉粥样硬化斑块密切相关,不稳定性斑块是引起脑梗死的主要危险因素之一。     

心肌桥对冠状动脉粥样硬化的作用

目的:探讨心肌桥与冠状动脉粥样硬化病变之间的关系。方法:回顾性分析冠脉造影术中检出的心肌桥患者92例的冠脉病变与临床资料。结果:1500例冠脉造影患者检出心肌桥92例,检出率6.1%;心肌桥近段冠状动脉粥样硬化病变发生率71.7%,远段冠状动脉粥样硬化病变发生率10.9%,两者差异有显著性（P<0.01）。结论:心肌桥可能导致冠状动脉心肌桥近段冠脉粥样硬化病变。     

Diffuse aneurysmal and obstructive coronary artery disease: A do-not-intervene patient

Coronary artery aneurysms are uncommon but potentially hazardous entities found on a small percentage of coronary angiograms. The best management strategy remains to be determined; the coexistence of obstructive coronary artery disease is the main determinant of prognosis.We report the case of a middle-aged woman with mixed aneurysmal and obstructive coronary artery disease presenting as an acute myocardial infarction, probably due to atherosclerosis. The unusual severity and complexity of the angiographic presentation of this case, with involvement of all major coronary arteries, raises important issues in terms of the patient's treatment options.     

心肌桥对冠状动脉内皮细胞形态和粥样硬化的作用

目的 观察壁冠状动脉及其近段内皮细胞形态和内皮下组织特征，探讨心肌桥导致的血流动力学变化对动脉粥样硬化形成的影响。方法 用肝素-生理盐水和4％戊二醛溶液冲洗4例有心肌桥的新鲜人尸左冠状动脉，取壁冠状动脉近段、壁冠状动脉段、壁冠状动脉远段，扫描电镜观察其血管内皮细胞和基膜特征。结果 冠状动脉近段内皮细胞多呈扁平状或卵圆形，表面粗糙，有“虫啄样”缺损，细胞容易脱落。壁冠状动脉内皮细胞呈细长梭形，表面可有微绒毛和桥样结构，壁冠状动脉内皮细胞的形态指数低于其近段和远段的形态指数。结论 壁冠状动脉内皮细胞受到心肌桥压迫导致血流切变力增高产生适应性反应，对内皮细胞有保护作用，而其近段内皮细胞由于切变力较低容易被损伤，成为动脉粥样硬化发生的基础。     

Relation of coronary artery disease and cerebrovascular disease with atherosclerosis of the thoracic aorta in the general population.

The association between clinical coronary artery disease, cerebrovascular disease, and aortic atherosclerosis has not been examined in the general population. Transesophageal echocardiography was performed in 581 subjects, a random sample of the Olmsted County (Minnesota) population aged >/=45 years, participating in the Stroke Prevention: Assessment of Risk in a Community (SPARC) study. The frequency and severity of atherosclerosis of the thoracic aorta were determined in the population and the association between clinical coronary artery disease, cerebrovascular disease, and aortic atherosclerosis was examined. Previous myocardial infarction, angina pectoris, and coronary artery bypass surgery were significantly associated with aortic atherosclerosis, adjusting for age and gender (p 4-mm thick, ulcerated plaques, or mobile debris), adjusting for age and gender (p <0.05). Age, smoking, pulse pressure, previous myocardial infarction (odds ratio [OR] 4.67; 95% confidence interval [CI] 1.42 to 15.40), and coronary artery bypass surgery (OR 5.12; 95% CI 1.01 to 26.01) were independently associated with aortic atherosclerosis. Among subjects with atherosclerosis, age, smoking, pulse pressure, hypertension treatment, and coronary artery disease (OR 2.50; 95% CI 1.18 to 5.30) were independently associated with complex atherosclerosis. Weak associations were observed between previous ischemic stroke, transient ischemic attack, and aortic atherosclerosis, associations that were not significant after age- and gender-adjustment (p >0.2). Thus, coronary artery disease is strongly associated with aortic atherosclerosis and complex atherosclerosis in the general population. Cerebrovascular disease is weakly associated with aortic atherosclerosis, thereby questioning the overall importance of aortic atherosclerosis in the pathogenesis of cerebrovascular events in the general population.     

冠状动脉造影检查对心肌桥的诊断价值

目的 探讨冠状动脉造影检查对心肌桥诊断的应用,研究心肌桥和冠状动脉粥样硬化的相关性.方法 收集1523例患者冠状动脉造影检查资料,分析心肌桥检出率,观察心肌桥的发生位置、壁冠状动脉收缩期狭窄程度、心肌桥血管合并粥样斑块的位置、斑块处管腔狭窄程度.结果 全部1523例患者中,201例患者检查结果正常,1225例患者检出粥样斑块,231例患者检出心肌桥.心肌桥检出率为15.2％,共检出心肌桥235处.心肌桥位置：右冠状动脉1处,左主干1处,旋支1处,对角支3处,左前降支229处,以左前降支中段多见,壁冠状动脉收缩期轻度狭窄为主.纯心肌桥97例.134例患者心肌桥血管合并粥样斑块144处,斑块位置：心肌桥近端111处,心肌桥段19处,心肌桥远端14处.心肌桥近端血管粥样硬化较心肌桥段、心肌桥远端发生率高,但粥样斑块的形成与壁冠状动脉收缩期的狭窄程度无显著相关（P＞0.05）.结论 心肌桥多见于左前降支中段血管,壁冠状动脉收缩期多为轻度狭窄,血管合并粥样硬化,多见于心肌桥前端,但粥样斑块的形成与壁冠状动脉收缩期狭窄程度无明显相关性.冠状动脉造影检查对心肌桥及心肌桥合并粥样硬化的诊断有重要价值.     

Myocardial bridges in man: Clinical correlations and angiographic accentuation with nitroglycerin

Little is known of the clinical significance of myocardial bridges, which may be recognized angiographically as systolic coronary artery narrowing (SCAN). A retrospective review of a 1 year's experience (313 consecutive coronary arteriograms) revealed 5 patients with SCAN, an incidence of 1.6%. SCAN involved the proximal and/or middle segments of the left anterior descending coronary artery in all patients. It is of particular note that the administration of nitroglycerin noticeably accentuated the SCAN phenomenon in each of 3 patients to whom it was administered. Four of the 5 patients had left ventricular hypertrophy due to hypertrophic car-diomyopathy (2), aortic stenosis (1), and hypertension (1). All 5 patients with the SCAN phenomenon had anginal chest pains, and critical obstructive coronary atherosclerosis was observed in only 2 cases. The other 3 patients showed, otherwise, normal coronary arteriograms. Thus, myocardial bridges appear to be angiographically manifest predominantly in patients with cardiac hypertrophy. Nitroglycerin, which accentuates SCAN, might be useful as a provocative test to enhance the angiographic recognition of this phenomenon. The possible role of myocardial bridges in the production of myocardial ischemia warrants further investigation.     

非冠状动脉粥样硬化性心肌梗死11例分析

目的探讨非冠状动脉硬化性心肌梗死诊治。方法我院近2年收治非冠状动脉硬化性心肌梗死11例,每例行超声心动图、左室造影和冠状动脉造影检查,分析其临床特征。结果11例非冠状动脉硬化性心肌梗死患者冠状动脉造影检查均未发现局限性狭窄或斑块。结论非冠状动脉硬化性心肌梗死应尽早冠脉造影,对因治疗。     

Myocardial bridging is associated with coronary atherosclerosis in the segment proximal to the site of bridging

BackgroundMyocardial bridging is a common finding on multi-detector computed tomography (MDCT). The segment proximal to a myocardial bridge is frequently atherosclerotic, although the tunneled segment is spared. This study aimed to investigate whether myocardial bridging identified by MDCT is an independent risk factor for coronary atherosclerosis.Methods and resultsPatients (n = 188) with suspected coronary disease underwent MDCT using a 40-detector or 64-detector instrument. We reviewed the baseline characteristics (age, body mass index, smoking history, presence of hypertension, dyslipidemia, and diabetes mellitus) and the results of MDCT angiography. Two radiologists evaluated the coronary artery for myocardial bridging and coronary atherosclerosis and made a diagnosis by consensus. Significant independent risk factors for coronary atherosclerosis were investigated by multivariate logistic regression analysis. We identified 50 bridges in the middle segment of the left anterior descending artery (LAD). There were no patients with significant stenosis in the tunneled segment. Multivariate analysis showed that age, diabetes mellitus, and myocardial bridging in the mid-LAD were significantly associated with coronary atherosclerosis in the proximal LAD (p < 0.05). Age, diabetes mellitus, and the absence of myocardial bridging in the mid-LAD were significantly associated with coronary atherosclerosis in the mid-LAD (p < 0.05).ConclusionThe segment proximal to a segment with myocardial bridging is frequently involved in atherosclerosis, although the tunneled segment is spared. Myocardial bridging in the mid-LAD is an independent risk factor for coronary atherosclerosis in the proximal LAD.     

Periostin蛋白与冠状动脉粥样硬化性心脏病关系的研究进展

Periostin是一种细胞外基质蛋白,与冠状动脉粥样硬化性心脏病之间有着密切的关系,可参与动脉粥样硬化的形成、血管损伤修复及急性心肌梗死的修复。现就目前periostin蛋白与冠状动脉粥样硬化性心脏病相关研究进行综述。     

An unpleasant surprise in the setting of primary percutaneous coronary intervention: diffuse and severe vessel ectasia with acute thrombosis of the distal right coronary artery in a patient with acute inferior myocardial infarction.

Coronary artery ectasia is defined as a > 1.5-fold dilation of the coronary artery compared to the diameter of adjacent normal segments. It must be distinguished from discrete aneurysms that appear in areas adjacent to coronary artery stenosis. It is usually considered a variant of coronary atherosclerosis. Dilated segments are thought to modify the rheology of blood, sluggish or turbulent flow predisposing to myocardial ischemia and its sequelae, including myocardial infarction and sudden death. We report the case of a 52-year-old man, light smoker, with arterial hypertension and family history of coronary artery disease, who was referred to our coronary care unit for an inferior ST-elevation acute myocardial infarction and presented with severe and diffuse vessel ectasia and right coronary thrombosis at coronary angiography.