急诊冠脉支架植入患者不同血糖水平与术后再狭窄发生率的相关性探讨

目的探讨急诊冠脉支架植入患者的血糖水平与术后再狭窄发生率的相关性。方法采用回顾性分析方法 ,选取在2014年1月—2016年5月间收入该院诊断为冠心病患者并进行急诊冠状动脉内支架植入术的340例患者,对患者血糖及各项指标价差数据与术后再狭窄发生率进行统计学计算。结果 340例患者共植入365枚支架,其中132例(151枚支架)发生术后再狭窄,经6个月随访,再狭窄率为41.3%,根据患者病史及血糖水平分为正常糖耐量(NGT)、糖调节异常(GIR)及糖尿病组(DM),糖调解异常组、糖尿病组再狭窄水平明显高于血糖正常组(P0.05),差异具有统计学意义。结论冠心病和并糖尿病患者冠脉病变常累及多支,入院时血糖水平是急诊冠状动脉支架植入术后再狭窄的独立危险因素。     

血浆脑钠尿肽水平与冠状动脉支架植入术后再狭窄有关

目的:探讨冠心病患者血浆脑钠尿肽(BNP)水平与冠状动脉支架内再狭窄的关系。方法:选择317例接受冠状动脉支架植入术(PCI)以及术后1年内再次接受冠状动脉造影(CAG)检查的患者,分为再狭窄和无再狭窄组,分别在PCI术前、出院前和复查CAG前测定血浆BNP水平,两组患者分别比较相应的BNP水平。结果:再狭窄组PCI术前、出院前及复查CAG前的BNP水平与无再狭窄组分别进行比较,差异有统计学意义(P0.05),多因素logistic回归分析结果,血浆BNP水平是预测再狭窄的独立危险因子(均P0.01)。结论:血浆BNP水平与PCI术后再狭窄密切相关,有可能作为再狭窄的有用预测指标。     

冠心病患者应用紫杉醇与国产雷帕霉素洗脱支架的随机对照研究

目的:观察冠心病患者应用雷帕霉素洗脱支架与紫杉醇洗脱支架后临床不良心血管事件的发生率。方法:本研究为随机开放平行对照研究,共入选患者168例,雷帕霉素支架组83例,紫杉醇支架组85例。两组患者在年龄,性别组成,吸烟比例,糖尿病比例,血压水平,总胆固醇水平,冠状动脉病变支数,冠状动脉病变积分(Gensini法),左心室射血分数均无统计学上的差异。术后严格要求患者服用阿司匹林和噻氯匹定或氯比格雷9个月。通过门诊或电话随访术后患者临床不良心血管事件的发生率,部分患者进行了冠状动脉造影复查。结果:平均随访10.6个月,失访患者3例(包括2例雷帕霉素支架组患者与1例紫杉醇支架组患者),失访率为1.79%。在随访的81例雷帕霉素支架组共7例(8.64%)发生了临床不良心血管事件。在随访到的84例紫杉醇支架组8例(9.52%)患者发生了不良心血管事件。以上2组患者不良心血管事件发生率差异无统计学意义(卡方检验P>0.05)。雷帕霉素支架组冠状动脉造影再狭窄率为200%(3/15),紫杉醇支架组冠状动脉造影再狭窄率为25%(6/24),两组之间无统计学差异(P>0.05)。结论:短期临床随访结果表明,冠心病患者应用雷帕霉素洗脱支架与紫杉醇洗脱支架临床心血管事件的发生率较低,两组无统计学差异。冠状动脉造影复查两组再狭窄率无统计学差异     

药物涂层球囊(DCB)在治疗冠状动脉药物涂层支架内再狭窄病变中的疗效

目的探究冠状动脉药物涂层支架内再狭窄病变(ISR)患者接受药物涂层球囊(DCB)治疗的效果。方法以冠状动脉药物涂层支架内再狭窄病变患者30例(时间所选为2018年1月至2019年2月),作为此次研究对象,将其简单化分组,对照组行药物洗脱支架(DES)治疗,实验组行DCB治疗,对比2组冠状动脉药物涂层支架内再狭窄病变患者治疗的结果。结果实验组冠状动脉药物涂层支架内再狭窄病变患者的再狭窄、MACE发生率均低于对照组(P0.05);实验组MLD值高于对照组,其LL值低于对照组,差异有统计学意义(P0.05)。结论冠状动脉药物涂层支架内再狭窄病变患者接受DCB治疗,具有较好的安全性以及有效性。     

血管内超声在冠心病左主干病变介入诊疗中的指导价值研究

目的应用血管内超声(IVUS)进行指导,分析冠状动脉造影(CAG)在冠状动脉左主干病变介入诊治时的局限和不足,为左主干病变的诊断和经皮冠状动脉介入治疗(PCI)提供有价值的信息。方法入组冠心病左主干病变患者60例,分为左主干口部及体部组和左主干远段分又组,每组各30例。联合应用IVUS和CAG评估病变、指导介入治疗及评估支架置入效果等,分析两组间的差异。结果两组中GAG测量的左主干平均参考直径、最小管腔直径及最小管腔面积均小于IVUS测量结果,差异均有统计学意义(均为P0.05)。左主干口部及体部病变组中8例(26.7%)CAG判断结果与IVUS差异明显;CAG与IVUS指导下左主干远段分叉的支架策略差异较大,不相符者达30%。两组中IVUS指导的支架置入后扩张的比例均明显高于CAG指导下的比例(P0.05)。结论与IVUS相比,CAG不能精确诊断冠心病左主干病变,指导左主干病变PCI治疗的准确性也有限,建议冠心病左主干病变患者的介入诊治应常规联合应用IVUS进行指导。     

药物洗脱支架治疗后冠状动脉再狭窄相关因素的分析

目的探讨药物洗脱支架治疗后冠状动脉再狭窄与临床和造影的相关因素。方法入选416例冠状动脉造影(CAG)资料完整的冠心病患者,男性328例,女性88例,共置入支架470枚,按照CAG结果分为再狭窄组59例和无再狭窄组357例,平均造影随访时间(7．91±2．37)个月。结果再狭窄组CAG示61枚支架发生再狭窄(13．0％),女性、既往冠状动脉旁路移植术(CABG)病史、慢性闭塞(CTO)病变病史、最大球囊释放压力、置入支架长度与术后再狭窄相关(P<0．05);置入支架血管直径与再狭窄高度相关(OR=0．61,95％CI:0．43～0．82,P< 0．01)。结论女性、既往CABG病史、CTO病变、血管直径、置入支架长度是支架术后再狭窄的危险因素,而糖尿病史等与再狭窄无关。     

国产与进口药物洗脱支架治疗前降支开口病变的临床疗效比较

目的:比较国产与进口药物洗脱支架治疗前降支开口病变的临床疗效。方法:回顾性分析95例前降支开口病变的患者置入国产支架(国产支架组,n=68)和进口支架(进口支架组,n=27),所有患者均行临床随访,部分患者进行了冠状动脉造影(CAG)复查。结果:国产支架组的急性心肌梗死患者多于进口支架组,但无统计学差异(46%vs.33%)。两组的介入成功率均为100%。国产支架组的冠脉钙化率、偏心斑块率和C型病变率均高于进口支架组(分别为20%vs.4%;14%vs.0%;28%vs.7%,均P0.05)。两组CAG随访的支架内和血管段再狭窄率无统计学差异;两组的主要不良事件发生率也无统计学差异。结论:国产药物洗脱支架治疗前降支开口病变是安全的,与进口药物洗脱支架具有相似的良好疗效。     

血清糖化白蛋白与内源性分泌型糖基化终产物受体比值对冠心病合并糖尿病患者冠状动脉支架内再狭窄评估

目的探索血清糖化白蛋白(GA)与内源性分泌型糖基化终产物受体(esRAGE)比值对糖尿病冠状动脉支架内再狭窄风险临床评估的价值。方法选择住院行冠状动脉支架植入术的冠心病合并糖尿病患者共60例(其中男41例、女19例),根据支架术后随访复查冠状动脉造影结果有无支架内再狭窄分成两组:冠心病合并2型糖尿病支架内再狭窄组(再狭窄组,n=25)、冠心病合并2型糖尿病无支架内再狭窄组(无再狭窄组,n=35),分别检测血清esRAGE与GA水平,计算GA/esRAGE比值。结果 esRAGE水平再狭窄组明显低于无再狭窄组(0. 19±0. 07 vs.0. 26±0. 08,P 0. 01),差异有统计学意义。GA/esRAGE比值在再狭窄组明显高于无再狭窄组(1. 26±0. 58 vs. 0. 90±0. 32,P 0. 01),差异有统计学意义。而GA水平在两组间差异无统计学意义(P 0. 05)。结论 GA与esRAGE比值对预测冠心病合并糖尿病患者支架术后再狭窄有重要临床意义。     

尿微量白蛋白与冠心病支架植入术后1年再狭窄的相关性

目的:分析尿微量白蛋白（MAU）与冠心病患者行支架植入术后1年支架内再狭窄的相关性。方法: 收集2009年3月~2011年6月我科139例冠心病经皮冠状动脉介入治疗患者,支架植入术前检测患者MAU,术后1年根据患者冠状动脉造影结果分为再狭窄组和未狭窄组。结果: 再狭窄组患者MAU水平［(59±16) mg/L］显著高于未狭窄组患者［(39±15) mg/L］ （P<0.05）;再狭窄组中单支病变［(40±3) mg/L］、两支病变［(55±5) mg/L］和三支病变［(82±11) mg/L］患者MAU水平比较差异有统计学意义（P<0.05）。结论: 冠心病患者支架植入术后1年支架内再狭窄与患者支架术前的MAU水平相关,MAU是支架术后再狭窄的很好预测指标。     

幽门螺杆菌和外周血中嗜酸性粒细胞与冠心病相关性分析

目的 探讨幽门螺杆菌(Hp)感染和外周血中嗜酸性粒细胞(EOS)与冠状动脉粥样硬化性心脏病(CAD)的相关性。方法 根据冠脉造影(CAG)的结果,将520例患者分成对照组257例和冠心病组263例。冠心病组根据血管病变的支数再分为:单支冠脉病变组患者95例、双支冠脉病变组患者80例、多支冠脉病变组患者88例。所有病例均行尿素13C-呼气试验、血浆Hp抗体测定及血常规中EOS计数水平,并计算冠心病组Gensini积分;同时收集白细胞计数、血糖水平、高敏C反应蛋白、高同型半胱氨酸等指标,评价Hp感染值、EOS水平与冠心病的相关性。结果 (1)两组患者吸烟、年龄、低密度脂蛋白、高敏C反应蛋白、高同型半胱氨酸比较有统计学差异(P0.05);(2)冠心病组Hp感染值、Gensini积分明显高于对照组(P0.05),EOS水平低于对照组(P0.05);(3)病变血管数增加,Hp感染值及Gensini积分也随着升高(P0.05),而EOS水平是降低的(P0.05);(4)Hp感染值与Gensini积分呈正相关(r=0.891,P0.01),EOS水平与Gensini积分有相关性(r=-0.723,P0.01),Hp感染值与EOS呈负相关(r=-0.826,P0.01)。结论 Hp感染值和EOS水平对冠心病有一定的预测价值。     

幽门螺杆菌对冠心病患者血清同型半胱氨酸的影响

目的探讨幽门螺杆菌(Hp)与冠心病的关系及对血清同型半胱氨酸(Hcy)的影响。方法应用酶联免疫吸附实验法测定冠心病组(242例)及非冠心病组(88例)血清Hp抗体(HpIgG),比较两组HpIgG阳性率。应用放射免疫法测定冠心病组Hcy、叶酸(Fol)、维生素(Vit)B12,并对其HpIgG阳性组与HpIgG阴性组进行对比分析。结果冠心病组血清HpIgG阳性率明显高于非冠心病组(53.3%比38.6%,P<0.05);冠心病患者HpIgG阳性组血清Hcy浓度明显高于HpIgG阴性组(P<0.05);而两组Fol、VitB12水平无明显差异。结论Hp感染与冠心病发病有关;Hp可能通过升高Hcy水平、从而促进冠心病发生。     

Review of coronary artery disease in patients with infrarenal abdominal aortic aneurysm.

In the process of establishing a less invasive assessment strategy for coronary artery disease (CAD) in patients with infrarenal abdominal aortic aneurysm (AAA), the incidence of CAD and the surgical and mid-term outcomes were reviewed. From January 1994 through September 2001, 94 elective surgical repairs of AAA were carried out. Preoperative coronary angiography showed 43 patients (45.7%) had CAD: 29 (67.4%) were asymptomatic, 23 had single-vessel disease (1VD), 12 had 2VD and 8 had 3VD. Of the 43 patients with CAD, 19 (44.2%) underwent coronary interventional therapy before aortic surgery (11 percutaneous transluminal coronary angioplasty (PTCA), 8 coronary artery bypass grafting). Eight asymptomatic patients underwent coronary interventional therapy. None of the patients died of cardiac causes or experienced a postoperative cardiac event. During the follow-up period, 10 late deaths occurred: 7 patients with CAD, and 3 cerebrovascular or cardiac deaths. There was no statistical difference in the survival rate between the groups with and without CAD. Two patients with CAD underwent PTCA during the follow-up period. The findings confirm the need for a less invasive assessment strategy of CAD that does not overlook asymptomatic myocardial ischemia, because the incidence of CAD in patients with AAA is high.     

One-year clinical outcome after emergency hospitalisation for suspected acute coronary syndrome -- a comparative analysis with respect to angiographic findings

INTRODUCTION: Among patients with suspected acute coronary syndromes (ACS) referred for urgent coronary angiography there are some with normal angiograms. AIM: To compare, with respect to angiographic findings, one-year clinical outcomes in patients hospitalised for suspected ACS. METHOD: Between January 2001 and December 2003 emergency angiography was performed in 1169 patients. It revealed no significant coronary lesions in 97 (8.3%) cases, of these 40 being women and 57 men with a mean age of 55+/-15 yrs (Group 1). Sixty consecutive patients with ACS (20 women and 40 men with a mean age of 54+/-9 yrs) and significant coronary artery disease (CAD) confirmed by angiography were the study controls (Group 2). Demographic data, CAD risk factors, angiographic findings, ECG and echocardiographic data as well as laboratory test results were analysed. In a long-term follow-up, the prevalence of recurrent angina and all-cause mortality were assessed. RESULTS: There were no significant differences in patients' demographics between the two groups with the exception of arterial hypertension, which was more frequent in group 1. In group 1 the diagnosis of ACS was established in 14.5% cases, X syndrome in 14.4%, Prinzmetal angina in 4.1%, myocarditis in 6.1% and pulmonary thromboembolization in 5.1%. A definite diagnosis was not related to the cardiovascular disease in 36%. No complications were observed in the late follow-up of group 1 patients. CONCLUSIONS: Apparently normal angiograms are relatively common in patients referred for emergency coronary angiography. In patients without significant CAD on their angiograms the clinical outcome is favourable, without major adverse cardiovascular events in the long-term follow-up.     

The value of hemodynamic changes induced by carotid sinus massage on the diagnosis of coronary artery disease

The aim of this study is to investigate the value of hemodynamic changes induced by carotid sinus massage (CSM) on the diagnosis of coronary artery disease (CAD). A total 108 patients (mean age, 54 +/- 10 years, range 33-70) who had no significant stenosis in the carotid artery by duplex ultrasonography (USG) and no history of syncope were included in this study. Carotid sinus massage was performed before coronary angiography with monitoring of electrocardiography and blood pressure. The patients were divided into three groups according to response to CSM: group 1 patients had a decrease in blood pressure or < 10 beats/minute (bpm); group 2 patients had a decrease between 10 and 20 bpm; and group 3 patients had > 20 mm Hg decrease in blood pressure or > 20 bpm. Coronary angiography was performed after CSM in all patients. There was single-vessel disease (VD) in 23 cases, two-VD in 24 cases, and three-VD in 35 cases. Coronary angiography results were normal in 26 cases. The changes in systolic and diastolic blood pressures and heart rate before and after CSM correlated with number of VD. These changes were highest in patients with three-VD, but lowest in patients with normal coronary angiography. The number of diseased vessels and total coronary artery score were lowest in group 1, but highest in group 3. The specificity and sensitivity of CSM-induced > 10 mm Hg in blood pressure (BP) or > 10 bpm changes in heart rate in the diagnosis of CAD were 85% and 71%, respectively. The positive and negative predictive values were 93% and 49%, respectively in the diagnosis of CAD. At the end of this study, we concluded that CSM induced the fall in blood pressure and heart rate and was correlated with number of diseased vessels and the score of coronary artery disease. As dichotomized values, the decrease of > 10 mm Hg in blood pressure and/or > 10 bpm has highest specificity, sensitivity, and positive predictive value in the diagnosis of CAD.     

幽门螺杆菌感染对冠心病患者氧化低密度脂蛋白及颈动脉硬化的影响

目的探讨幽门螺杆菌(Hp)感染对冠心病患者氧化低密度脂蛋白(oxLDL)及颈动脉硬化的影响及其可能的发病机制。方法选择2006年12月至2007年12月冠心病住院患者159例,其中男115例,女44例,年龄30～88岁,平均(63±10)岁,近期无感染性疾病及慢性炎症性疾病,有典型的心绞痛病史及心电图的改变,冠状动脉造影均显示至少1支冠状动脉管腔内径狭窄≥50%。采用呼气试验来检测患者是否感染Hp,并根据结果将冠心病患者分为3组:阴性感染组,轻度感染组和重度感染组,使用彩色超声检测患者颈动脉内膜中层厚度(IMT)及颈动脉斑块,同时测定血浆高敏C反应蛋白(hsCRP)、尿酸、纤维蛋白原、oxLDL和血脂水平。结果 3组间胆固醇、低密度脂蛋白胆固醇(LDL-C)、hsCRP及oxLDL水平比较,差异均有统计学意义(均为P0.05),且在重度感染组水平最高;阴性感染组、轻度感染组和重度感染组IMT分别为(0.91±0.21)mm、(1.03±0.40)mm和(1.21±0.51)mm,3组间比较,差异有统计学意义(P0.05)。结论 Hp感染能增加冠心病患者颈动脉粥样硬化的风险,并且重度感染可能会伴随更高的风险,Hp感染可能通过影响脂质代谢、加速LDL氧化和激活炎症反应来促进颈动脉粥样硬化发展。     

Body iron stores and coronary atherosclerosis assessed by coronary angiography

BACKGROUND AND AIM: Epidemiological studies have suggested an association between higher body iron stores and coronary artery disease (CAD), but recent trials have reported conflicting data on the role of ferritin in CAD. To assess these findings, we examined the association between serum ferritin and the angiographic extent of coronary atherosclerosis in consecutive patients referred for coronary angiography. METHODS AND RESULTS: We studied 100 consecutive white subjects (41 women and 59 men; mean age 63.7 +/- 11.0 years) who underwent coronary angiography. The data collected at baseline included conventional risk factors for coronary artery disease (CAD), lipid and fasting total homocysteine levels, serum ferritin levels and transferrin saturation, and clinical characteristics. Serum ferritin levels and transferrin saturation (serum iron concentration divided by total iron-binding capacity) were used as measures of the amount of circulating iron available to tissues. Two experienced cardiologists blinded to the clinical and laboratory data reviewed the angiographic cinefilms, and defined the angiographic severity of CAD on the basis of the sum of three vessel scorring systems. The risk of CAD assessed by coronary angiography was not related to ferritin concentrations or transferrin saturation levels. The estimated relative risk of CAD for the fifth vs the first quintile of serum ferritin was 0.83 (95% CI: 0.63-1.24). Forty of the 100 patients had no or minimal CAD (group A; score 0-3), 33 moderate CAD (group B; score 4-8) and 27 severe CAD (group C; score > 8): the serum ferritin levels in the three groups were respectively 165 +/- 126, 167 +/- 121 and 164 +/- 110 ng/ml, and did not represent an independent risk factor for CAD (p = 0.98). Transferrin saturation in the three groups was 22.9 +/- 10%, 21 +/- 9% and 19.9 +/- 10%, with no significant relationship to the severity of CAD (p = 0.23). The presence of angiographic CAD was associated with patient age (p = 0.048), male gender (p < 0.01), high lowdensity lipoprotein cholesterol levels (p = 0.02), low high-density lipoprotein cholesterol levels (p = 0.02), high plasma fibrinogen levels (p < 0.01) and high fasting total homocysteine levels (p = 0.04). CONCLUSION: In patients referred for coronary angiography, higher ferritin concentrations and transferrin saturation levels were not associated with an increased extent of coronary atherosclerosis.     

冠心病血管内皮功能、颈动脉硬化与冠脉病变的关系

目的：观察冠心病（CAD）患者内皮依赖性舒张功能及颈动脉粥样硬化的状况及与冠状动脉病变的相关性。方法：选经冠状动脉造影确诊为CAD的患者106例（观察组），冠状动脉造影证实无冠状动脉狭窄的健康者40例（正常对照组），采用二维超声检测肱动脉内皮依赖性和非依赖性舒张功能及颈动脉粥样硬化病变。颈动脉粥样硬化斑块积分采用Sutton法，并与冠状动脉病变程度进行对比分析。结果：CAD组内皮依赖性血管舒缩功能（FMD）比正常对照组明显降低（P〈0．01），内皮非依赖性血管舒缩功能与正常对照组比较无显著性差异（P〉0．05）；CAD组颈动脉内膜中层厚度（IMT），斑块积分显著高于正常对照组（P〈0．01）。FMD与冠脉病变程度呈负相关（r=-0．651，P〈0．001），颈动脉IMI及斑块积分与冠脉病变程度呈正相关（r=0．871，0．702，P〈0．001）。结论：内皮细胞功能障碍和颈动脉粥样硬化与冠状动脉粥样硬化的病变相平行。     

冠状动脉粥样硬化性心脏病合并糖尿病患者冠状动脉病变与C反应蛋白的相关性研究

目的 探讨冠状动脉粥样硬化性心脏病(简称冠心病)合并糖尿病患者冠状动脉病变程度与高敏C反应蛋白(hsCRP)的关系.方法 接受冠状动脉造影枪杏的患者161例进入此研究,冠心病但血糖正常组52例,冠心病伴有糖耐量异常组24例,冠心病合并2型糖尿病组85例.记录各组临床资料、冠状动脉造影评分,并检测各组患者血浆hsCRP水平.结果 冠心病合并2型糖尿病组冠状动脉造影评分明显高于血糖正常组,差异有统计学意义(P＜0.01);冠心病合并2型糖尿病组患者hsCRP水平明显高于血糖正常组(P＜0.01).冠状动脉造影评分与hsCRP水平之间呈正相关(r=0.309).结论 冠心病合并糖尿病患者的冠状动脉病变严重程度与血浆hsCRP水平正相关.     

冠心病患者肾动脉狭窄的发生率及其危险因素分析

目的:探讨冠心病患者动脉硬化性肾动脉狭窄的发病情况及其危险因素。方法:对62例临床诊断或怀疑冠心病的患者在冠状动脉造影和心室造影后行常规肾动脉造影,同时调查动脉粥样硬化的常见危险因素及血肌酐水平与肾动脉狭窄(RAS)的关系。结果:经冠状动脉造影证实的46例冠心病患者中,RAS的发生率为34.8％,显著高于冠状动脉造影完全正常者的6.3％(5/16),P相似文献   

Predictive value of mitral annular calcification for the diagnosis of coronary artery disease in patients with dilated cardiomyopathy

Mitral annulus calcification (MAC) is an independent predictor of coronary artery disease (CAD). The present study was designed to determine whether an association exists between MAC and CAD in patients with dilated cardiomyopathy. Among the 286 patients with MAC on echocardiographic examination who underwent coronary angiography, 55 patients with echocardiographic findings of dilated cardiomyopathy (group I) were compared to 60 age-matched controls without MAC and an echocardiographic diagnosis of dilated cardiomyopathy (group II) who underwent coronary angiography during the same time. There were no differences in echocardiographic findings between two groups. The prevalence of CAD was higher in group I when compared to group II (74% vs 28%, p<0.001). With regard to severity of CAD, two-vessel, three-vessel, and left main coronary artery disease were found to be significantly frequent in group I (p<0.001). Multivariate analysis revealed that MAC (p=0.001), diabetes mellitus (p=0.048), and history of anginal chest pain (p=0.009) are the independent predictors for the presence of CAD in patients with dilated cardiomyopathy. In conclusion, MAC may be a marker for the presence of coronary artery disease in patients with dilated cardiomyopathy.