LDL-C/HDL-C、apoB/apoA1比值与冠心病的相关分析

目的探讨低密度脂蛋白胆固醇(LDL-C)/高密度脂蛋白胆固醇(HDL-C)、载脂蛋白B(apoB)/载脂蛋白A1(apoA1)比值与冠心病的相关性。方法分析147例经冠脉造影确诊的冠心病病人(冠心病组)及102例冠脉造影阴性者(对照组)的常规血脂及冠脉造影结果,计算LDL-C/HDL-C、apoB/apoA1比值及冠脉Gensini积分。结果冠心病组LDL-C/HDL-C、apoB/apoA1比值显著高于对照组(P0.01),冠心病组血脂比值的异常率均明显高于单项血脂的异常率。LDL-C/HDL-C、apoB/apoA1比值与冠脉狭窄程度呈正相关(P0.01)。结论 LDL-C/HDL-C、apoB/apoA1比值对冠心病的早期预防和诊断有较大的临床价值,优于各单项血脂指标。     

红细胞分布宽度对冠心病再狭窄的预测作用及其与脂质的关系

目的 探讨红细胞分布宽度对冠心病再狭窄的预测作用及其与脂质的关系。方法 回顾性分析2018年1月至2020年1月因冠心病在我院接受经皮冠状动脉介入治疗（PCI）术以及于术后12个月复查的94例患者的临床资料,根据结果分为支架内再狭窄（ISR）组（27例）和非ISR组（67例）。检测患者红细胞分布宽度（RDW）和脂质各指标水平,分析各指标与冠心病的关系。结果 非ISR组的RDW值小于ISR组（P<0.05）。ISR组甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、非高密度脂蛋白胆固醇（non-HDL-C）、载脂蛋白A1(apoAl)和载脂蛋白B(apoB)/apoA1比值均高于非ISR组（P<0.05）。Logistic回归分析结果显示RDW、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、apoA1和apoB为冠心病患者术后ISR的危险因素（P<0.05）。apoA1、RDW和HDL-C的灵敏度均较高,non-HDL-C、apoB以及apoA1/apoB的特异度均较高。结论 冠心病患者PCI术后,不仅要重视控制LDL-C水平,还要重视根据RDW、non-HDL...     

hsCRP、apoB/apoA1、血脂表达与早发冠心病急性冠脉综合征的关系

目的观察hsCRP、apoB/apoA1、血脂表达与早发冠心病急性冠脉综合征的关系。方法采用随机平行对照方法纳入2014年2月至2018年2月于清远市人民医院收治的110例早发冠心病急性冠脉综合征患者为观察组,另选取因胸痛同期住院经冠状动脉造影证实冠脉病变为阴性的118例非冠心病患者为对照组。统计两组患者一般资料,抽取空腹肘静脉血,采用全自动生化分析仪检测血脂载脂蛋白A1(apoA1)、载脂蛋白B(apoB)、超敏C反应蛋白(hsCRP)及血糖(GLU)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、非高密度脂蛋白胆固醇(non-HDL-C)、尿酸(UA)、血肌酐(Scr)水平。采用多因素Logistic回归分析法分析早发冠心病急性冠脉综合征的独立影响因素,分析hsCRP、apoB/apoA1、血脂表达与早发冠心病急性冠脉综合征的关系。结果两组年龄、体质指数(BMI)、UA及糖尿病病史所占比例比较差异无统计学意义(P0.05);观察组男性、吸烟史、饮酒史、冠心病家族史、高血压病史所占比例显著高于对照组(P0.05),且Scr、GLU水平显著高于对照组(P0.05)。两组LDL-C、apoB水平比较差异无统计学意义(P0.05);观察组血清hsCRP、TC、TG、non-HDL-C、apoB/apoA1水平显著高于对照组(P0.05),apoA1、HDL-C水平显著低于对照组(P0.05)。多因素Logistic回归分析结果显示,除男性、吸烟史、冠心病家族史外,hsCRP、TG、HDL-C、non-HDL-C、apoA1、apoB/apoA1均为早发冠心病急性冠脉综合征的独立影响因素(P0.05)。结论 hsCRP、TG、non-HDL-C、apoB/apoA1在早发冠心病急性冠脉综合征患者外周血中水平明显升高,apoA1、HDL-C在其外周血中明显降低,上述因子可作为该病预测指标。     

50岁以下冠心病患者冠脉病变特点及其危险因素的研究

目的：分析探讨50岁以下冠心病患者的冠状动脉（冠脉）病变特点及危险因素。方法：将生活于北京地区的128例50岁以下因冠心病或怀疑冠心病而行冠脉造影的患者，根据造影结果分为冠心病组（70例）和非冠心病组（58例），除分析其冠脉病变特点外，并将其危险因素对照分析。结果：前降支受累率最高，为78．6％。男性多支病变多于女性（P＜0．05）。冠心病家族史在两组间有显著差异（P＜0．05）。载脂蛋白A1（apoA1)、总胆固醇与高密度脂蛋白比值（TC／HDL）及载脂蛋白A1与载脂蛋白B比值（apoA1/apoB)在两组间均有显著差异（P＜0．05）。结论：冠脉病变男性重于女性，冠心病家族史是重要危险因素。apoA1和TC／HDL及apoA1/apoB对预测冠心病有一定意义。     

女性血浆脂蛋白(a)与冠状动脉病变的关系

目的:探讨女性血浆脂蛋白(a)[Lp(a)]水平与冠状动脉病变程度及范围的关系。方法:72例女性根据冠状动脉造影结果,分为冠心病组和非冠心病组,测定Lp(a)、TC、TG、HDL-C、LDL-C、载脂蛋白A(apoA)、载脂蛋白B(apoB)的血浆浓度。结果:冠心病组患者中血浆Lp(a)水平明显高于非冠心病组患者(P<0.05);血浆Lp(a)水平在冠状动脉闭塞及多支病变患者中显著升高。结论:女性血浆Lp(a)水平与冠状动脉粥样病变的程度及范围有关,是病变严重程度的一个预测因素。     

冠心病患者血脂、脂蛋白及载脂蛋白测定的临床意义

本文对48例冠心病患者及36例正常人的血脂、脂蛋白及载脂蛋白进行了对比分析。结果表明,冠心病患者血清甘油三酯水平高于正常对照组(P<0.001),血浆高密度脂蛋白(HDL—C)低于对照组(P<0.05)。载脂蛋白A(apoA)在冠心病组显著降低(P<0.01),总胆固醇、载脂蛋白B(apoB)两组无显著差异(P>0.05),冠心病组apoB/apoA比值高于正常对照组(P<0.05).     

普伐他汀和美托洛尔对冠心病患者血清脂联素及相关指标的影响

目的研究冠心病患者应用普伐他汀和美托洛尔后血清脂联素及相关指标的变化。方法冠心病患者112例,分为:常规用药组28例;普伐他汀组25例;美托洛尔组32例;普伐他汀及美托洛尔联合组;27例。测定空腹血糖（FPG）、胰岛素（FINS）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和血清脂联素（APN）水平,并计算胰岛素敏感性指数（ISI）。2月后复查上述生化指标。结果普伐他汀组用药后APN,ISI升高（P<0.05）,FINS,TC,TG,LDL-C降低（P<0.05,P<0.01,P<0.05,P<0.05）;美托洛尔组用药后APN,TC升高（P<0.05）,ISI降低（P<0.05）;联合用药组用药后APN,ISI,HDL-C升高（P<0.01,P<0.05,P<0.05）,FINS,TC,TG,LDL-C降低（P<0.05,P<0.01,P<0.01,P<0.05）。联合用药组与普伐他汀组、美托洛尔组比较,APN,HDL-C升高更显著（P<0.05）,TG,LDL-C降低更显著（P<0.05）;与美托洛尔组比较,TC降低更显著（P<0.01）,ISI升高更显著（P<0.01）;与普伐他汀组比较,TC,ISI差异无显著性。结论普伐他汀和美托洛尔可以提高冠心病患者血清APN水平,降低冠心病危险因素,联合应用于冠心病患者在改善胰岛素敏感性、调脂及提高血清APN水平方面,优于单独用药。     

载脂蛋白A-I／载脂蛋白B值对急性冠脉综合征患者的临床预测价值

目的探讨不同血脂成分及载脂蛋白A-I（apolipoproteinA-I,apoA-I）／载脂蛋白B（apolipoprotein B,apoB）值对急性冠状动脉（冠脉）综合征的临床预测价值。方法收集586例胸痛患者行冠脉造影术的资料,其中急性冠脉综合征组426例,另外160例造影阴性者为对照组。测定并比较两组三酰甘油（TG）,总胆固醇（TC）,高密度脂蛋白胆固醇（HDL-C）,低密度脂蛋白胆固醇（LDL-C）,apoA-I／apoB值及冠脉Gensini积分。结果急性冠脉综合征组apoA-I／apoB值明显高于对照组,差异有统计学意义（P〈0．05）。apoA-I／apoB值与冠脉病变支数负相关（r=0．152．P=0．031）。结论apoA-I／apoB值是急性冠脉综合征强有力的预测因子,且优于其他血脂指标。     

apoB/apoA1与冠状动脉病变的相关性分析

目的探讨载脂蛋白B(apoB)、载脂蛋白A1(apoA1)、apoB/apoA1与冠状动脉狭窄程度的相关性。方法共收集304例行冠脉造影术的病人,其冠脉病变的严重程度用冠脉病变支数及Gensini积分表示,分析其血脂水平及载脂蛋白与冠脉病变的关系。结果冠脉病变组中总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)与冠脉病变Gensini积分呈正相关,高密度脂蛋白胆固醇(HDL-C)、apoA1与冠脉病变Gensini积分呈负相关。TC、LDL-C与冠脉病变支数呈正相关,apoA1与冠脉病变支数呈负相关。结论冠心病病人的血清载脂蛋白与其冠脉病变程度密切相关,以apoA1对冠脉病变的预测性最强。     

糖尿病患者急性心肌梗死后早期血脂变化

目的分析糖尿病患者急性心肌梗死（AMI）后早期血脂水平变化。方法连续入选318例AMI住院患者,检测入院后24h内血脂水平。根据患者是否合并2型糖尿病分为AMI非糖尿病组（n=238）及AMI糖尿病组（n=80）,比较两组患者血脂水平差异。结果两组患者AMI早期,除载脂蛋白A（apoA）外,总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白B（apoB）水平均无统计学差异（P均〉0.05）。结论糖尿病患者急性心肌梗死后早期,除apoA外,血脂水平与非糖尿病患者无显著差异。     

Provisional T-stenting and kissing balloon in the treatment of coronary bifurcation lesions: results of the French multicenter "TULIPE" study.

BACKGROUND: In previous prospective studies, a strategy of (a) stenting of the main branch, (b) provisional T-stenting of the side branch, and (c) final kissing balloon inflation, was associated with high success and low target lesion revascularization (TLR) rates on the long-term. OBJECTIVES: To examine the performance of this strategy in a multicenter study. METHODS: Consecutive patients were treated at 14 French medical centers for de novo coronary bifurcation lesions with the same technique used. Immediate results and clinically-driven TLR at 7 months were examined. RESULTS: The mean reference diameters of the main and side branches were 3.2 +/- 0.6 mm and 2.4 +/- 0.5 mm, respectively. The side branch was stented in 34% of patients. A <30% residual stenosis in the main branch was achieved in 99%, <50% in the side branch in 90%, and both in 89% of procedures. The in-hospital major adverse cardiovascular event were a Q-wave and 5 non-Qwaves MI (0.54% and 2.7%). At 7 months of follow-up, 3 patients (1.76%) had died, 1 suffered a non-Q-wave MI (0.59%), and 28 (15.88%) underwent TLR. By multivariate analysis, a lower left ventricular ejection fraction (OR: 0.934), moderate calcifications (OR: 7.86), and non-use of the "jailed" wire technique (OR: 4.26) were associated with reinterventions during follow-up. CONCLUSIONS: A strategy of provisional T-stenting with a tubular stent and final kissing balloon angioplasty for the treatment of coronary bifurcation lesions was safe and associated with a low TLR rate at 7 months. This strategy should be applicable to the new era of drug eluting stents.     

Grading the angiographic extent of collateral filling

Angiography frequently demonstrates a collateral circulation in severe coronary artery disease. An easily applicable method to quantify collateral flow might be a useful adjunct for the assessment of the hemodynamic effects of coronary artery disease. The purpose of this study was to validate a visual scaling of the extent of angiographic collateral filling by comparison with flowmeter- and microsphere-derived measurements of collateral flow. In 12 open-chest dogs, collaterals from the circumflex artery were angiographically visualized (n = 80) by creating acute critical left anterior descending artery occlusion. The extent of collateral filling was graded in four levels from 0 = no visible filling to 3 = complete epicardial filling. Collateral filling correlated with the change in flow of the collateral supplying circumflex artery (Q; r = 0.84) which was + 5.3 ±4.6% with grade 1, + 9.1 ±3.5% with grade 2 and + 14.6 ±4.7% with grade 3 (p < 0.01). In parallel, coronary flow reserve decreased from 4.1 ±0.8 with grade 0 to 2.9 ±0.2 with grade 3 (p < 0.01). Colored microspheres were injected subselectively into the circumflex artery of 9 dogs (45 injections). The ratio of microspheres counted in the collateralized myocardium of the left anterior descending artery to the total number injected increased from 0.6 ±0.9% for grade 0 to 17.1 ±2.8% with grade 3 (p < 0.01). Absolute collateral flow derived from microsphere counts averaged 5.5 ±0.9 ml/min with grade 3 and closely correlated with collateral filling grade (r = 0.88). Semiquantitative grading of angiographic collateral filling in response to acute coronary occlusion in a canine model correlates with an increase in collateral source artery flow, absolute collateral flow and a decrease in source artery flow reserve. These data suggest that this scale might be a simple but useful adjunct tool to assess the hemodynamic significance of a collateral circulation.This work was supported by a grant from the NLHBI 1 R01 HL40865. Dr. Schuhlen is the recipient of a grant from the Deutsche Forschungsgemeinschaft (#Schu657/1-1 and 1–2).     

Embolization complicating coronary angioplasty in the presence of an intracoronary thrombus

Two cases of coronary occlusion and subsequent embolization during percutaneous coronary angioplasty (PTCA) are described. Prior to PTCA, angiographic evidence of intracoronary thrombus was present. Abrupt reclosure after dilation was treated by successful redilation. However, coronary embolization of thrombus debris occurred downstream in one patient and into an adjacent coronary branch in the second patient.     

非罪犯冠脉斑块研究的进展

加强冠心病的二级预防是目前防控急性冠脉综合征（ACS）的重要手段。本文对ACS与非罪犯冠脉斑块的关系作了综述。     

LAD-right ventricular fistula complicating PTCA: Another case

Coronary perforation caused by percutaneous transluminal coronary angioplasty (PTCA) occurs rarely and most often leads to communication to the pericardial space. We report a case where PTCA caused a coronary artery rupture and fistulization to the right ventricular outflow tract. Cathet. Cardiovasc. Diagn. 42:34–36, 1997. © 1997 Wiley-Liss, Inc.     

Treatment of ruptured coronary aneurysm with a novel covered stent

Coronary artery aneurysms are relatively rare but have been diagnosed with increasing frequency since the advent of coronary arteriography. Their reported incidence varies from 1.5% to 5% with male dominance and a predilection for the right coronary artery (RCA), accounting for over 40% of all cases. The most common etiology amongst adults remains atherosclerosis accounting for 50% of coronary aneurysms. We describe the first use of a novel flexible pericardium covered stent for successful treatment of a ruptured coronary aneurysm in 76 year old lady. © 2008 Wiley‐Liss, Inc.     

Techniques for palmaz-schatz stent deployment in lesions with a large side branch

Palmaz-Schatz coronary stent implantation in lesions with a large side branch are reported. The first case describes how to manage plaque shifting after stent implantation. The second and third cases demonstrate a kissing balloon predilatation and stent dilatation technique of a bifurcational lesion. The final case demonstrates a stent implantation technique through the stent struts of a previously deployed stent.     

Is short-stay coronary angioplasty safe?

Percutaneous transluminal coronary angioplasty (PTCA) is usually performed as an inpatient procedure and the patients are monitored for several days afterward. Over a 13-month period, in 91 of 373 PTCA procedures, the clinical condition of the patient did not necessitate inpatient status before PTCA. PTCA was done the day of admission and discharge planned the following. Overall hospital stay was planned as less than 24 hours. PTCA was done in one vessel in 62 patients, two vessels in 24, three vessels in 3, and four vessels in 2 patients. PTCA was initially successful (less than 50% residual stenosis) in 85 patients (93%). In one of these, acute occlusion occurred the next morning and urgent bypass surgery was done. PTCA failed in 6 patients who left the catheterization laboratory with unchanged coronary anatomy. Bypass surgery was performed that day in 2 patients, on another admission in 1 patient, and medical therapy continued in the other 3 patients. Of the 88 patients not receiving same admission bypass surgery, 84 (95%) were discharged in less than 24 h. Hospitalization was prolonged (1-5 days) in 4 patients. This was because of nonobstructive dissection treated with heparin for approximately 24 h in 2 patients; a catheterization site hematoma in 1 patient, and post-PTCA noncardiac chest pain in another. No patient had inhospital myocardial infarction or death. The only late complication was in a patient treated with heparin and monitored for 2 days; 3 weeks later angina returned and he died suddenly. These data suggest PTCA can safely be done in selected patients with both single and multivessel disease in a short stay inhospital setting.(ABSTRACT TRUNCATED AT 250 WORDS)     

Angiographic demonstration of coronary sinus thrombosis: A potential consequence of trauma to the coronary sinus

Abnormalities of the coronary sinus are rarely encountered. A case is presented demonstrating for the first time the angiographic appearance of coronary sinus thrombosis. This may have been the result of surgical trauma during mitral valve replacement or inadvertent cannulation of the coronary sinus during right heart catheterization or pacemaker insertion. Although the clinical significance of coronary sinus thrombosis is uncertain, obstruction of coronary sinus blood flow should not be deleterious because of multiple anastomoses between the coronary sinus system and the anterior cardiac veins. Difficulty in cannulating the coronary sinus for physiologic studies should suggest the possibility of coronary sinus thrombosis, especially in patients who have undergone mitral valve replacement. This may be confirmed by observing the venous phase of selective left coronary arteriography. Finally, coronary sinus thrombosis may be important as a source of pulmonary emboli. The prevalence of this serious complication requires further study.     

Coronary arteriovenous-arterial fistula

A case of multiple arteriovenous fistulae is described in an adult with coronary artery disease. One of these fistulae drained into the anterior interventricular vein, which in turn communicated with and perfused an obstructed left anterior descending coronary artery.