Plasma osteopontin levels are elevated in non-ST-segment elevation acute coronary syndromes

BACKGROUND: The regions of ruptured atherosclerotic plaques have numerous macrophages. Osteopontin that modulates macrophage function has been shown in atherosclerotic plaques. We aimed to study the plasma levels of osteopontin in patients with unstable angina or non-ST-seg ment elevation myocardial infarction (NSTEMI) and the rela tionship between osteopontin and the extent of the coronary artery disease (CAD). METHODS: We studied 65 patients with unstable angina or NSTEMI, 25 patients with stable angina and 18 patients as the control group. The extent of coronary artery stenosis was determined by the number of vessels with >50% stenosis. Plasma osteopontin concentrations were measured from the blood samples that were drawn immediately after admission to the emergency department in unstable angina/NSTEMI patients and before the coronary angiograph in the stable angina and control groups. RESULTS: The plasma osteopontin concentration was (495 118 ng/ml) significantly higher in the patients with unstable angina/NSTEMI compared to the stable angina group (319 106 ng/ml) and control group (125+/-54 ng/ml) (p=0.0001 The plasma osteopontin levels were lower in the patients with stable angina pectoris who had one-vessel disease compared to those with two-vessel disease (p=0.01). How ever, in the unstable angina/NSTEMI group, the plasma osteopontin levels were statistically not different among the patients with one-vessel, and two-vessel and three-vessel disease (p=NS). There was no correlation between the plasma osteopontin levels and the extent of coronary stenosis. CONCLUSIONS: The plasma osteopontin levels are elevatedin patients with unstable angina/NSTEMI, but there appears to be no correlation with the extent of CAD. These results ma suggest that osteopontin may have a role in the pathobiology of ACS.     

血府逐瘀汤加减治疗气滞血瘀型冠心病心绞痛的疗效研究

目的 观察血府逐瘀汤治疗气滞血瘀型冠心病心绞痛的临床疗效。方法 从我院2016年1月~2017年6月收治的气滞血瘀型冠心病心绞痛患者中抽取70例展开研究,依照双色球随机模式分为两组,各35例。对照组患者采用常规硝苯地平、普萘洛尔治疗,观察组患者采用血府逐瘀汤加减治疗,观察两组疗效、血流动力学及血脂水平。结果 治疗后,观察组总有效率为95.71%,高于对照组的68.57%,差异有统计学意义（P＜0.05）;血流动力学方面,观察组患者血浆比黏度、全血比黏度及红细胞压积水平改善幅度均优于对照组,差异有统计学意义（P＜0.05）;治疗后观察组TG、TC、LDL-C、HDL-C改善幅度均优于对照组,差异有统计学意义（P＜0.05）;两组治疗期间均未见明显不良反应,差异无统计学意义（P＞0.05）。结论 对气滞血瘀型冠心病心绞痛患者采用血府逐瘀汤治疗可有效提高治疗效果,促进患者血液流变学、血脂水平改善,不增加不良反应。     

血清Hcy表达评估桥本氏甲状腺炎合并冠心病患者突发心绞痛的临床意义

目的 探讨血清Hcy表达评估桥本氏甲状腺炎合并冠心病患者突发心绞痛的临床意义.方法 选取本院于2015年1月至2016年10月收治老年桥本氏甲状腺炎合并冠心病患者80例作为研究对象,根据是否突发心绞痛分为心绞痛组38例和非心绞痛组42例.测定和对比两组患者血清同型半胱氨酸(Hcy)、甲状旁腺激素(PTH)、促甲状腺激素 (TSH)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)表达.冠状动脉造影测定和比较两组不同冠状动脉狭窄分级人数和冠状动脉狭窄率.相关性分析Hcy表达与各检测指标关系.结果 心绞痛组患者Hcy、TC、LDL-C和TG表达显著高于非心绞痛组患者(P<0.05),而PTH、TSH和HDL-C表达显著低于非心绞痛组患者(P<0.05),心绞痛组冠状动脉狭窄C级患者人数显著高于非心绞痛组(χ2=3.872,P=0.037),冠状动脉狭窄率显著高于非心绞痛组(P<0.05),Hcy与TC、TG、LDL-C和冠状动脉狭窄率表达呈正相关(P<0.05),与HDL-C、PTH和TSH呈负相关(P<0.05).以甲状腺炎合并冠心病患者是否突发心绞痛为因变量,将年龄、Hcy、TC、TG、HDL-C、LDL-C、PTH、TSH、CAS为自变量,引入多因素Logistic回归模型,结果显示,Hcy、TC、TG、HDL-C、LDL-C、TSH、CAS均是突发心绞痛的危险因素(P<0.05),选择多因素Logistic回归模型分析中OR值>1的因素做ROC曲线分析,ROC曲线面积(AUC)表现为Hcy>TC>TG>LDL-C>CAS>HDL-C>TSH,Hcy诊断的敏感性低于CAS、TG、TC、HDL-C,而特异性则最高,临界值在25.57.结论 高表达Hcy是HT合并冠心病患者突发心绞痛的高风险因素,应对此类患者及时采取相应治疗手段.     

Decreased coronary reserve: a mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteries

The pathogenesis of angina pectoris in patients with aortic stenosis and normal coronary arteries remains uncertain. Using a specially designed Doppler probe, we measured the maximal velocity of coronary blood flow in the left-anterior descending coronary artery at the time of elective open-heart surgery in 14 patients with aortic stenosis and left ventricular hypertrophy (13 had angina) and in 8 controls without left ventricular hypertrophy. The ratio peak velocity of coronary blood flow, after a 20-second occlusion, to resting velocity was decreased by more than 50 per cent (P less than 0.05) in the patients with aortic stenosis. In 7 of the patients this ratio was decreased by more than 75 per cent. Studies of the velocity of coronary blood flow in vessels perfusing the right ventricle in these patients showed only mild abnormalities. These data demonstrate a selective and marked decrease in coronary reserve to the hypertrophied left ventricle in patients with severe aortic stenosis. The impairment in coronary reserve is probably an important contributor to the pathogenesis of angina pectoris in these patients.     

不稳定心绞痛患者血浆IL-18、PTX3水平与冠脉病变程度的关系

目的：研究冠状动脉粥样硬化性心脏病不稳定心绞痛患者血浆白介素18（Interleukin 18,IL-18）、正五聚蛋白3（Pentraxin 3,PTX3）水平与冠脉病变程度的关系。方法：将136例不稳定心绞痛患者纳入试验,登记所有患者临床特征并测定入院时血浆中IL-18、PTX3水平。继之,对所有患者行冠脉造影并使用gensini评分系统对冠脉病变程度进行评估。根据所有患者gensini评分结果将患者分成低gensini积分（low gensini score,LGS）组（gensini积分〈27分）、中gensini积分（medium gensini score,MGS）组（gensini积分27~38分）、高gensini积分（high gensini score,HGS）组（gensini积分〉38分）,分析比较三组间患者的临床特征和IL-18、PTX3水平差异。结果：HGS组吸烟、糖尿病、高脂血症患者比例显著高于MGS及LGS组,MGS组高血压患者比例显著高于LGS组。HGS组IL-18、PTX3水平显著高于MGS组及LGS组;MGS组IL-18、PTX3水平显著高于LGS组。结论：不稳定心绞痛患者入院时血浆IL-18、PTX3水平能够反映冠脉病变的严重程度;入院时循环中IL-18、PTX3水平越高,冠脉病变越严重。     

血液流变性检测在冠心病心绞痛分型诊断中的价值

目的:探讨血液流变性改变对冠心病心绞痛发病机制及分型诊断的作用。方法:用全自动血液粘度仪测定稳定型心绞痛(SAP)46例、不稳定型心绞痛(UAP)86例、正常对照组40例的血液流变学指标。结果:SAP和UAP患者的全血高切粘度、全血低切粘度、血浆粘度、红细胞压积、全血高切还原粘度、全血低切还原粘度、血浆纤维蛋白原含量和红细胞聚集指数均高于对照组(P<0.01),且UAP组高于SAP组(P<0.01);SAP和UAP的红细胞变形指数均低于对照组(P<0.01),且UAP组低于SAP组(P<0.01)。结论:冠心病心绞痛患者存在血液流变性异常,UAP的异常程度更严重。血液流变学指标检测在冠心病心绞痛的分型诊断中有重要参考价值。     

血浆NT-proBNP水平与冠心病严重程度和预后的相关性分析

目的 分析血浆氨基末端B型脑钠肽前体(N-terminal B-type natriuretic peptide precursor,NT-proBNP)与冠心病严重程度及预后的相关性.方法 收集医院2015年1月至2017年6月收治的200例冠心病患者的临床资料,选择同期来医院体检的50例正常健康人作为对照组,入院后均测定NT-proBNP水平,比较冠心病患者与正常健康人NT-proBNP水平的差异及不同病情严重程度、不同预后冠心病患者血浆NT-proBNP水平的差异,分析血浆NT-proBNP水平与冠心病严重程度及预后的关系.结果 对照组NT-proBNP水平低于冠心病患者(P＜0.05),急性心肌梗死(acute myocardial infarction,AMI)、不稳定型心绞痛(unstable angina,UAP)患者NT-proBNP水平明显高于稳定型心绞痛(stable angina pectoris,SAP)患者(P＜0.05),AMI患者血浆NT-proBNP水平又高于UAP患者(P＜0.05);狭窄程度为Ⅱ～Ⅳ级患者血浆NT-proBNP水平高于Ⅰ级患者(P＜0.05),Ⅲ～Ⅳ级患者血浆NT-proBNP水平又高于Ⅱ级(P＜0.05),Ⅳ级患者血浆NT-proBNP水平又高于Ⅲ级患者,比较差异均有统计学意义(P＜＜0.05);主要不良心脏事件(major adverse cardiac events,MACE)组患者血浆NT-proBNP水平明显高于无MACE组,比较差异有统计学意义(P＜0.05);冠心病狭窄程度、MACE事件发生率与血浆NT-proBNP水平呈正相关(r=0.721、0.896,P均＜0.05).结论 冠心病患者血浆NT-proBNP水平明显升高,且随冠心病严重程度的上升,血浆NT-proBNP水平升高,且其水平升高通常提示不良预后.     

冠心病患者FFA水平与冠脉病变程度的相关性分析

目的 探讨冠心病(CHD)患者游离脂肪酸(FFA)水平与冠脉病变程度的关系.方法 选取我院接诊的具备完整病例资料的433例CHD患者为研究对象,另纳入我院同期健康体检者90例为对照组,比较不同类型、冠脉不同狭窄支数和不同冠脉病变Gensini积分CHD患者的FFA水平,分析FFA与冠脉病变程度的相关性.结果 CHD组与对照组甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(APOA1)、FFA比较,差异均有统计学意义(P<0.05),不稳定型心绞痛(UAP)、稳定型心绞痛(SAP)和急性心肌梗死(AMI)组FFA水平均显著高于对照组(P<0.05),UAP组和SAP组FFA水平比较,差异无统计学意义(P>0.05);AMI组FFA水平显著高于UAP组和SAP组(P<0.05);FFA水平随着冠脉狭窄支数和冠脉病变Gensini积分的增加而升高(P<0.05);FFA水平与冠脉病变Gensini积分呈正相关(r=0.309,P<0.05);FFA水平与冠脉狭窄支数呈正相关(r=0.265,P<0.05);FFA>0.57mmol/L是冠脉病变的独立危险因素.结论 CHD患者FFA水平与冠脉病变Gensini积分、冠脉狭窄支数呈正相关,FFA>0.57mmol/L是冠脉病变的独立危险因素,治疗过程中应监测和控制FFA水平.     

川崎病合并冠状动脉损伤患者血液流变特性分析

目的:探讨川崎病合并冠状动脉损伤患者血液流变特性。方法:对我院20例川崎病合并冠状动脉损伤患者(冠状动脉损伤组)、25例川崎病无冠状动脉损伤患者(川崎病对照组)和28例健康体检者(正常对照组)的血液流变学检测指标进行比较分析。结果:冠状动脉损伤组全血粘度、血浆粘度、红细胞刚性指数等均显著高于对照组。HCT显著低于对照组。结论:检测血液流变性可作为川崎病合并冠状动脉损伤早期临床辅助诊断指标之一。     

Development of blood examination method of serum amyloid A and LDL complex, and clinical application to prediction of cardiovascular event

In recent years, it has been reported that the acute-phase proteins C-reactive protein(CRP) and serum amyloid A(SAA), the sera levels of which are elevated in inflammation, are also elevated in coronary artery disease such as acute myocardial infarction. Also, high-sensitivity CRP assay is thought to be useful in predicting the prognosis of coronary heart disease. While investigating complexes of acute-phase proteins and low-density lipoprotein(LDL), we found a complex of LDL and SAA(SAA/LDL complex). The SAA/LDL complex in blood are formed from LDL and HDL by an oxidation reaction. Therefore, we developed an ELISA using anti-human SAA antibody and anti-human apoB, and determined a new method for measuring SAA/LDL complex in sera. We evaluated SAA/LDL complex as a new marker for prediction of prognosis in addition to the ordinary markers in consecutive 140 patients with stable coronary heart disease who had at least 1 coronary artery stenosis more than 50% in diameter at the diagnostic coronary angiography. Of these 140 patients, 2 developed fatal myocardial infarction, 2 cerebral infarction, and 17 angina pectoris requiring coronary revascularization therapy during 1 year and 6 months after blood examinations. The SAA/LDL complex value in this EVENT group of 21 patients was significantly higher than that in the control group of 119 individuals. High-sensitivity CRP (hs-CRP) assay and SAA measurement showed no significant difference between the 2 groups. The SAA/LDL complex reflects intravascular inflammation directly and can be a new marker more sensitive than hs-CRP or SAA for prediction of prognosis in patients with stable coronary artery disease.     

红细胞聚集增高与纤维蛋白原的关系及其对心绞痛患者发病的影响

目的 :探讨红细胞聚集改变与纤维蛋白原的关系及其对心绞痛发病的影响。方法 :测定 80例不稳定性心绞痛患者和 40例健康人的红细胞聚集指数 (光密度法 )、红细胞变形指数 (激光衍射法 )、血浆及全血粘度 (旋转式粘度计 )和纤维蛋白原 (双缩脲法 )。结果 :不稳定性心绞痛患者红细胞聚集指数和全血粘度 ( 4 0s- 1 )及纤维蛋白原浓度均高于对照组 (P均 <0 .0 1～ 0 .0 5 ) ,且红细胞聚集指数与纤维蛋白原呈直线正相关 ,与全血粘度 ( 4 0s- 1 )无相关性。结论 :纤维蛋白原含量增加是红细胞聚集增强的主要原因之一 ;红细胞聚集能力增强导致血液高粘滞 ,与心绞痛发作有关 ;选择 10s- 1 以下切变率测定低切全血粘度 ,利于观察全血粘度与红细胞聚集的关系     

Unstable angina pectoris. Experience with an acute revascularization program

One year's experience of an acute revascularization program for unstable angina pectoris is presented. In the total material of 63 patients, significant coronary artery stenosis was found in 61 and normal coronary arteries in two. Coronary artery bypass grafting was performed in 39 patients (62%) and percutaneous transluminal angioplasty in nine (14%). There were two perioperative myocardial infarctions and one hospital death. Thirteen patients were not eligible for revascularization. At follow-up (14-26 months) 60 patients were still alive (95%). In the revascularization group, one patient had died, but of the remaining 46 patients, 30 (65%) were free of angina pectoris, and in addition six had only minor symptoms.     

右冠状动脉起源于左主干5例临床分析

目的：分析右冠状动脉起源于左主干的临床特征，探讨其与心肌缺血的关系。方法：回顾分析5例右冠状动脉起源于左主干的临床资料及相关文献。结果：（1）本组5例患者中，女性1例，男性4例，年龄27～70岁。（2）临床表现主要为胸痛、胸闷等心绞痛症状，除1例老年患者外，其余4例病人都有典型的心绞痛症状和缺血心电图变化。（3）冠状动脉造影示3例合并严重冠状动脉粥样硬化，给予冠状动脉搭桥术，术后随访2月～6年无明显不适；另2例冠状动脉无明显病变，药物治疗后仍有劳累性心绞痛发作，其中1例半年后猝死。结论：右冠状动脉起源于左主干是一种罕见的冠脉畸形，对存在严重心肌缺血的患者应进行预防性冠状动脉搭桥术或介入治疗，预防不良事件的发生。     

冠心病A型行为干预前后血液指标检测

目的：冠心病A型行为干预前后的有关血液指标变化的对比研究。方法：将128例冠心病患者随机分为观察组和对照组,区别在于加不加心理行为干预,其他临床常规治疗相同。干预与治疗前后均观测有关血液指标并对比,进行统计学处理。结果：观察组比对照组下列指标有显著性或非常显著性差异：A型行为改善（P＜0．01）;血清胆固醇（TC）降低（P＜0.05）;全血及血浆粘度降低（P＜0．05）;血浆肾上腺素（E）及去甲肾上腺素（NE）降低（P＜0.01）。给论：冠心病患者进行A型行为干预有助于改善有关血液指标,同时可缓解心绞痛症状,ECGST－T好转。     

Inflammation in variant angina: Is there any evidence?

Variant angina, defined as spontaneous angina pectoris associated with transient ST-segment elevation, has proved to be caused usually by episodic coronary spasm since Prinzmetal and his associates described a form of angina quite different from classic Heberden angina pectoris in 1959. Currently, coronary artery spasm is defined as reversible coronary stenosis, which limits coronary blood flow under resting conditions, and it plays an important role in ischemic heart disease, particularly in variant angina. Data available in respect of coronary vasospasm showed that it is closely related to atherosclerotic coronary artery disease, since intravascular ultrasound studies reveal atherosclerotic plaques in almost any spastic segment. Risk factors for coronary artery disease and coronary vasospasm, however, differ profoundly. Cigarette smoking is the only established risk factor. Although several candidates and predisposing factors, such as serotonin, histamine, thromboxane, and endothelin, have been described, the mediators and the pathogenesis of the disease remain unknown. There are abundant studies that inflammation plays an important role in the initiation, development as well as evolution of atherosclerosis, suggesting that atherosclerosis is an inflammation disease. The evidence regarding the role of inflammatory pathways in different clinical entities of coronary artery disease has significantly been accumulated. And also, primary studies have showed that inflammation may be a contributor for variant angina or vasospastic coronary disease is at least partially driven by inflammation. Although much more research is obviously needed, primary evidence provide us with some direction for that research.     

阿托伐他汀对不稳定心绞痛患者内皮素-1和一氧化氮的影响

目的:观察阿托伐他汀治疗不稳定型心绞痛疗效及其对内皮素-1(endothelin-1,ET-1)和一氧化氮(nitric oxide,NO)的影响.方法:将不稳定型心绞痛患者随机分为治疗组(n=45)和对照组(n=45),2组均给予同样的常规治疗,治疗组加用阿托伐他汀,均治疗2个月后观察治疗前后心绞痛疗效,检测ET-1...     

Ultrastructure of platelets before and during atrial stimulation

Summary We studied 15 patients with strain-induced angina pectoris performing an ultrastructural analysis of platelets withdrawn simultaneously from the aorta and coronary sinus. In coronary sinus blood, all platelets exhibited shape changes with pseudopod formation but without degranulation.In the aortic blood we observed on average fewer shape changes of the platelets. During tachycardia stress, shape change formation did not increase in most patients. In three patients however, micro-aggregation of the platelets was observed only in the aortic blood. These patients had a paucity of risk factors. They also had fewer critical coronary artery stenoses compared with the other patients. We conclude that there may be minority among the patients with angina pectoris exhibiting hyper-aggregation of the platelets.     

冠状动脉病变程度与血浆B型利钠肽对冠心病的影响因素

目的 探讨冠心病患者冠状动脉病变程度与血浆B型利钠肽的关系。方法 选择我院2017年1月~8月住院的冠心病患者54例为A组,同时选择冠脉血管无狭窄的患者26例作为B组,收集所有研究对象的年龄、性别、血糖、血脂、血压、血浆脑钠肽（BNP）浓度、冠状动脉的病变部位及程度等临床资料,观察不同程度冠状动脉病变患者的血浆BNP水平。结果 血浆BNP水平A组较B组升高,统计学意义显著（P＜0.001）。Logistic回归分析显示,年龄、BNP水平、舒张压是冠状动脉狭窄的独立危险因素。在A1、A2及A3组中随着Gensini评分增加,血浆BNP水平逐渐升高,Gensini评分与血浆BNP水平呈明显的正相关（r=0.594,P＜0.05）。结论 血浆BNP参与了冠状动脉狭窄的病理生理过程,是冠状动脉病变的独立危险因素之一;血浆BNP的水平能一定程度上的反映冠脉病变程度。     

盐酸法舒地尔对心绞痛患者冠状动脉慢血流的疗效

目的:观察盐酸法舒地尔治疗冠状动脉慢血流(CSFP)心绞痛的疗效。方法:将72例冠状动脉造影发现CSFP的心绞痛患者随机分为观察组和对照组,每组36例,均给予心绞痛常规治疗,观察组在常规治疗基础上静脉滴注盐酸法舒地尔60mg,1次/天,每月治疗10天,连续3个月。3个月后复查冠脉造影TIMI血流并观察心绞痛缓解情况,比较两组差异。结果:观察组心绞痛改善总有效率88.89%,与对照组(72.22%)相比,差异无统计学意义(P>0.05);观察组治疗前后TIMI计帧值(25.63±4.02 vs 31.67±5.32)差异有统计学意义(P<0.05),而对照组(30.73±5.14 vs 32.05±8.02)无明显差异(P>0.05)。观察期间未发现不良反应。结论:盐酸法舒地尔可改善CSFP并缓解心绞痛症状。     

冠心病心绞痛患者血浆同型半胱氨酸水平与 中医证候要素痰、瘀的回归性研究

目的 研究冠心病心绞痛患者血浆同型半胱氨酸水平与中医证候要素痰、瘀的回归性。方法 收集冠心病心绞痛患者共227例,检测血浆同型半胱氨酸,采集四诊信息并按中医证候要素痰、瘀进行辨证积分分类,并对四组指标采用2×2析因分析及线性回归分析。结果 冠心病患者各证候要素组间Hcy水平依次为:痰瘀互结组＞血瘀组＞痰浊组＞无痰无瘀组;以Hcy为应变量,痰证积分（≥20部分）为自变量做一元线性回归可知,冠心病患者血浆Hcy水平与痰证积分≥20的部分呈线性相关;以Hcy为应变量,瘀证积分为自变量做一元线性回归可知,冠心病患者血浆Hcy水平与瘀证积分成线性相关,即瘀证积分越高,Hcy水平越高。结论 Hcy水平与中医证素“痰”“瘀”皆存在线性相关,Hcy可作为评估冠心病患者“痰”证严重程度的客观化指标,并可作为中医冠心病中医“瘀”证辨证的客观化指标。