B型钠尿肽在急性冠脉综合征患者早期诊断中的应用

目的：分析急性冠脉综合征（ACS）患者早期B型钠尿肽（BNP）水平的差异，评估BNP在早期诊断中的作用。方法：入选末次症状发作至就诊时间均〈6h的ACS患者221例．分为ST段抬高心肌梗死（STEMI）组（n=83）、非ST段抬高心肌梗死（NSTEMI）组（n=69）和不稳定性心绞痛（UA）组（n=69）。所有患者在入院即刻测定BNP水平，发病12h内测定肌钙蛋白Ⅰ（TnⅠ）。比较不同组间BNP的差别及BNP与TnⅠ的相关性。结果：UA、NSTEMI和STEMI患者基础血浆BNP浓度依次升高（分别为13．9pg／ml、34．9pg／ml和64．2pg／ml）（组间比较P〈0．01），且STEMI和NSTEMI患者BNP水平与TnⅠ正相关（叫分别为0．724和0．675，P均〈0．01）。BNP≥100pg／ml对NSTEMI诊断阳性预测值达83．3％。结论：ACS患者早期BNP水平升高．对早期鉴别NSTEMI和UA有一定价值．     

血浆肌钙蛋白I与脑钠肽浓度在心绞痛患者中的相关性研究

目的 研究冠心病患者血浆脑钠肽（BNP）浓度的差异,急性冠脉综合征（ACS）患者血浆BNP浓度与肌钙蛋白I（cTnI）的相关性,并探讨BNP对ACS危险分层的价值.方法 用酶联免疫吸附法（ELISA）检测了78例ACS患者、42例稳定型心绞痛（SAP）及30例非冠心病健康对照组的血浆cTnI、BNP水平,分析ACS组患者血浆BNP与cTnI的关系;随访120例冠心病患者60 d,观察终点为心肌梗死新发或再发、出现或心衰恶化和心源性猝死.结果 血浆BNP在ACS组（138.10±4.85）pg/ml明显高于SAP组（30.62±1.08）pg/ml及对照组（29.27±1.45）pg/ml（P均〈0.05）.SAP组和对照组BNP浓度差异无统计学意义（P＞0.05）.ACS中cTnI阳性组血浆BNP浓度（152.21±1.86）pg/ml高于cTnI阴性组（78.10±1.85）pg/ml（P〈0.01）,血浆BNP浓度与cTnI浓度呈正相关（r=0.57,P〈0.05）.120例冠心病患者中BNP〉80 pg/ml组较BNP≤80 pg/ml组有更高的心肌梗死新发或再发率以及心衰发生或恶化率.结论 ACS组血浆BNP浓度升高,并与cTnI呈正相关;BNP对ACS患者近期预后有重要的临床价值,可作为危险分层的指标.     

急性冠脉综合征介入治疗后脑钠肽水平与心血管事件关系探讨

目的:探讨急性冠状动脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)术后48h血浆脑钠肽(BNP)水平变化与近、远期心血管事件关系。方法:对92例ACS患者常规进行术前和术后治疗并规范化行PCI术,术后48h行BNP测定,A组血浆BNP水平>80pg/ml,B组血浆BNP水平<80pg/ml;观察两组住院期间及术后6个月心血管事件发生率。结果:A组住院期间心血管事件发生率明显高于B组(P<0.01);但两组术后6个月心血管事件发生率无明显差异(P>0.05)。结论:ACS患者行PCI术,术后48hBNP浓度仅能预测近期预后而对远期预后无明显的预测作用。     

BNP对行急诊冠状动脉介入治疗患者预后价值的应用

目的:观察ST段抬高的急性心肌梗死(STEAMI)患者接受急诊直接冠状动脉介入治疗(PCI)后的脑利钠肽(BNP)水平对长期预后价值的应用。方法:连续入选2009年1月～2011年1月之间,发病后12小时之内接受急诊直接PCI治疗的ST段抬高的急性心肌梗死患者184例,采用荧光免疫抗原抗体结合方法测定发病后24小时血浆BNP水平。根据BNP浓度分为3组:A组<100pg/mL,B组100～400pg/mL,C组>400pg/mL。收集住院期间的临床资料,并随访1年。结果:①冠状动脉造影结果中B组、C组多支血管病变比例明显高于A组(P<0.01)。②1年内病死率C组明显高于A、B组(P<0.01),进行多因素logistic回归分析,血浆BNP浓度是AMI后1年病死率的独立预测因子。结论:接受急诊直接冠状动脉介入治疗的ST段抬高的急性心肌梗死患者的早期血浆脑利钠肽水平可作为1年后病死率的预测因子。     

非ST段抬高急性冠状动脉综合征患者介入治疗的性别差异

目的 比较非ST段抬高急性冠状动脉综合征患者介入治疗的性别差异.方法 为多中心随机研究,在全国24家医院,根据入选标准将非ST段抬高的急性冠状动脉综合征患者随机分配至早期介入组(24 h内接受冠状动脉造影)和延迟介入组(36 h后接受冠状动脉造影).分别观察介入治疗后不同性别的主要终点事件(180 d随访时死亡、心肌梗死、卒中的复合终点),次要终点事件(180 d随访时死亡、心肌梗死、难治性缺血、卒中、再次血运重建).结果 共有815例患者入选,其中男性545例,女性270例.男性和女性患者主要终点和次要终点事件发生率差异无统计学意义(P＞0.05).男性患者早介入组主要终点事件发生率明显低于延迟介入组(分别为7.1%、14.8%,P=0.00);两组次要终点事件发生率,即180 d随访时死亡、心肌梗死或难治性心肌缺血发生率分别为12.5%、21.2%,差异有统计学意义(P=0.00);另一个次要终点事件发生率,即180 d随访时死亡、心肌梗死、卒中、难治性心肌缺血或再次血运重建发生率分别为26.8%、32.4%,两组差异无统计学意义(P＞0.05).女性早期介入组和延迟介入组间主要终点事件发生率(分别为12.6%、14.3%,P＞0.05)和两个次要终点事件发生率(分别为18.5%、23.5%,P＞0.05;28.5%、27.7%,P＞0.05)差异均无统计学意义.结论 男性和女性非ST段抬高急性冠状动脉综合征患者介入治疗的疗效和安全性无明显差异;但男性患者早期介入治疗可减少心肌梗死的发生率,女性患者早期和延迟介入治疗均无明显差异.     

急性右心室心肌梗死并左心室下壁、前壁梗死经皮冠状动脉介入治疗对脑利钠肽水平及心室重构的影响

摘 要： 目的 进一步探讨急性右心室心肌梗死并左心室下壁、前壁梗死直接和延迟经皮冠状动脉介入治疗(PCI)对血浆脑利钠肽(BNP)水平及心室重构的影响。方法 急性右心室心肌梗死并左心室下壁、前壁梗死患者207例,分为急性右心室梗死并左心室下壁梗死组和急性右心室梗死并左心室前壁梗死组。分别比较二组患者PCI治疗前血浆BNP水平、心肌酶、血流动力学及冠状动脉病变特点;比较直接和延迟PCI治疗前后血浆BNP水平、左室射血分数（LVEF）、左室舒张末期内径（LVEDd）变化的意义。结果 急性右心室心肌梗死并左心室前壁梗死组PCI治疗前血浆BNP水平高、肌酸激酶(CK) 峰值及肌酸激酶同工酶(CK-MB)峰值高、肺动脉收缩压高、梗死相关冠状动脉狭窄程度及2支病变发生率高与急性右心室心肌梗死并左心室下壁梗死组比较差异有统计学意义(P <0.05)。直接和延迟PCI治疗后均能使血浆BNP水平及LVEDd较术前下降(P<0.05),但直接PCI治疗术后血浆BNP水平更低、LVEDd改善更明显(P<0.05)。未行PCI治疗的死亡发生率明显高于行直接PCI及延迟PCI治疗的患者,差异有统计学意义(P<0.05)。结论 急性右心室心肌梗死并左心室前壁梗死血浆BNP水平高,梗死相关冠状动脉病变严重;直接PCI治疗后心室重构改善明显,血浆BNP水平下降显著;未行PCI治疗的患者死亡率高。     

磷酸肌酸钠对急性冠状动脉综合征患者经皮冠状动脉介入术后心肌的保护作用

目的近年来,经皮冠状动脉介入术(percutaneous coronary intervention,PCI)广泛应用于临床,如何有效减轻心肌再灌注损伤是一项需要解决的问题。文中旨在观察磷酸肌酸钠(creatine phosphate,CrP)对急性冠状动脉综合征(acute cor-onary syndrome,ACS)患者PCI术后的心肌保护作用。方法 180例ACS患者成功行PCI术后随机分为治疗组90例[男53例、女37例,平均年龄(63.6±12.4)岁]和对照组90例[男56例、女34例,平均年龄(65.3±12.6)岁]。对照组于PCI术前、术后只给予ACS常规药物治疗,治疗组在常规药物治疗基础上于PCI术后静脉应用CrP治疗5 d。监测所有患者术前及术后血清中磷酸肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)、乳酸脱氢酶(lactate dehydrogenase,LDH)、肌钙蛋白T(troporin T,cTnT)、超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdenyde,MDA)及一氧化氮(nitric oxide,NO)含量变化。结果治疗组术后血清中SOD含量明显高于对照组[41.2(10.3～168.2)pg/ml vs 32.4(10.5～96.8)pg/ml,P<0.01)];而血清MDA、LDH、CK-MB含量均明显低于对照组[3.22(1.00～7.84)pg/ml vs 3.67(0.58～9.82)pg/ml;156.2(84.0～703.5)U/L vs 176.5(94.0～983.7)U/L;11.0(5.0～104.0)U/L vs 14.5(5.0～196.5)U/L,P<0.01)];2组术后血清中cTnT及NO含量变化无明显差异[1.25(0.01～8.5)ng/ml vs 1.37(0.01～9.2)ng/ml;165.5(22.5～437.7)μmol/L vs159.6(20.3～414.4)μmol/L,P>0.05)]。结论 CrP对ACS患者PCI术后心肌具有一定保护作用。     

Association between serum resistin level and cardiovascular events in postmenopausal women with acute coronary syndrome undergoing percutaneous coronary intervention

Background As an adipocytokine,resistin has been proposed as a link between inflammation,metabolic disorder and atherosclerosis.The aim of the study is to evaluate whether serum resistin is associated ...     

脑钠肽、高敏C反应蛋白对ACS患者PCI术中冠状动脉无复流的影响

目的 探讨血浆脑钠肽(NBP)、高敏C反应蛋白(hs-CRP)水平对急性冠脉综合征(ACS)患者冠状动脉介入术(PCI)发生术中冠状动脉无复流的影响.方法 选择2014年6月至2016年12月在广元市第一人民医院接受PCI手术治疗的113例ACS患者,按照PCI手术是否发生术中冠状动脉无复流分为血流正常组78例与无复流组35例,比较两组患者术前、术后血浆NBP、hs-CRP水平,分析血浆NBP、hs-CRP水平与冠状动脉无复流的相关性.结果 术前血流正常组患者的BNP、hs-CRP水平分别为(91.82±30.21)pg/mL、(2.57±0.75)mg/L,术后分别为(91.31±28.05)pg/mL、(2.76±0.56)mg/L;无复流组患者术前分别为(122.36±30.83)pg/mL、(3.08±0.72)mg/L,术后分别为(155.72±47.64)pg/mL、(3.83±1.26)mg/L,手术前和手术后,血流正常组患者的BNP和hs-CRP水平均低于无复流组,差异均具有统计学意义(P<0.05);且无复流组患者手术后的BNP水平和hs-CRP水平均高于手术前,差异均具有统计学意义(P<0.05);经Pearson相关分析结果显示,血浆BNP及hs-CRP水平与PCI术后无复流之间呈高度正相关(r=0.752、0.805,P<0.05).结论 较高水平BNP、hs-CR能够诱导急性冠脉综合征患者PCI手术发生术中冠状动脉无复流,对于高水平的BNP、hs-CR急性冠脉综合征患者,应早期干预,以降低BNP、hs-CR水平,减少PCI术中冠状动脉无复流的发生.     

Predictive factors of recurrent angina after acute coronary syndrome： the global registry acute coronary events from China （Sino-GRACE）

Background Many patients with acute coronary syndrome （ACS） develop recurrent angina （RA） during hospitalization. The aim of this non-randomized, prospective study was to investigate the predictive factors of RA in unselected patients with ACS enrolled in the global registry acute coronary events （GRACE） during hospitalization in China.Methods Between March 2001 and October 2004., enrolled were 1433 patients with ACS, including ST segment elevation myocardial infarction （662, 46.2%）, non-ST segment elevation myocardial infarction （239, 16.7%） and unstable angina （532, 37.1%）. The demographic distribution, medical history and clinical data were collected to investigate the predictive factors of RA by Logistic regression. Results During hospitalization 275 （19.2%） patients were documented with RA including unstable angina （53.2%）, non- ST segment elevation myocardial infarction （27.5%）, ST segment elevation myocardial infarction （19.3%）. A comorbidity of dyslipidemia, prior angina, percutaneous coronary intervention （PCI） within 6 months was more common in patients with RA, P〈0.05. In the patients with RA, a significantly higher proportion of patients with acute pulmonary edema was observed, 23 （8.4%） versus 43 （3.7%）, P=0.001. Acute renal failure was present in 8 （2.9%） of patients with RA versus 19 （1.6%） of patients without RA, P=0.165. Hemorrhagic events were present in 6 （2.2%） of patients with RA versus 8 （0.7%） of patients without RA, ventricular tachycardia/ventricular fibrillation events in 12 patients （4.3%） versus 22 patients （1.9%）, congestive heart failure in 69 patients （25.0%） versus 94 patients （8.1%）, myocardial re-infarction in 28 patients （10.1%） versus 15 patients （1.3%）, P〈0.05, respectively. A lower proportion of patients with RA underwent in-hospital PCI 687 （59.3%） versus 114 （41.5%）, P=0.000. A higher proportion of patients with RA received heparin, 260 （94.5%） versus 1035 （89.4%）     

应变率成像对急性心肌梗死经皮冠状动脉介入治疗术后局部心肌功能的评价

目的应用应变率成像技术评价早期、延期的经皮冠状动脉介入治疗(PCI)对急性心肌梗死患者局部心肌功能的影响。方法将30例ST段抬高型急性心肌梗死患者分为早期PCI组、延期PCI组,在PCI术前及术后1周、1个月、3个月分别测定收缩期、舒张早期、舒张晚期的应变率峰值(SR)。结果早期PCI组:PCI术后1个月及3个月的收缩期应变率峰值(SRS)、舒张早期应变率峰值(SRE)和舒张晚期应变率峰值(SRA)与术前间差异均有统计学意义(P<0.01);延期PCI组:术后3个月的SRE与术前间差异有统计学意义(P<0.05)。结论应变率成像可定量评价急性心肌梗死患者早期、延期PCI后局部心肌功能的变化。     

心肌梗死455例PCI后临床疗效观察

目的:观察评价不同时期心肌梗死(MI)患者经皮冠状动脉介入治疗(PCI)后即刻疗效及远期疗效. 方法:对1988-04/2001-12住西京医院的455例经PTCA(经皮冠状动脉腔内成形术)或(和)支架术并在术前已明确诊断的MI患者进行1 mo～8 a的随访. 其中69例为急性MI(AMI)后直接PCI或溶栓后补救性PCI;263例为AMI后2 mo内择期PCI和123例陈旧性MI(OMI,MI时间大于2 mo)后的PCI. 结果:在66例单纯球囊扩张术及389例结合支架术或直接支架术中,手术成功率98.5%,2例术中死亡,3例行冠状动脉旁路移植术. 382例随访1 mo,无症状存活率87.7%,死亡12例. 129例随访2～8 a,无症状存活52.7%,死亡10例. 71例有症状复查冠脉造影中,30例发生再狭窄. 结论:MI患者PCI即刻疗效好,远期无事件存活率52.7%,AMI伴多支病变或心源性休克是术后早期死亡的主要原因. 大于2 mo以上的MI患者也能在PCI中获益.     

Intensive cholesterol lowering with statin improves the outcomes of percutaneous coronary intervention in patients with acute coronary syndrome

Background The incidence of no reflow phenomenon limits the clinical outcomes of percutaneous coronary intervention （PCI）. This randomized controlled study was designed to evaluate the immediate protective effects of intensive statin pretreatment on myocardial perfusion and myocardial ischemic injury during PCI.
Methods Altogether 228 patients with acute coronary syndrome （ACS） were randomly assigned to standard statin group （SS group, n=115） and intensive statin group （IS group, n=-113）. Patients in the SS group received 20 mg simvastatin and patients in the IS group received 80 mg simvastatin for 7 days before PCI. Thrombolysis in myocardial infarction （TIMI） flow grade （TFG）, corrected TIMI frame count （CTFC） and TIMI myocardial perfusion grade （TMPG） of the intervened vessel were recorded before and after stent deployment. Creatine kinase （CK） isoenzyme MB, troponin I and plasma level of high sensitive-C reactive protein （hs-CRP）, P-selectin and intercellular adhesion molecule （ICAM） were measured before and 24 hours after the procedure.
Results The TFG after stent deployment was significantly improved with less TIMI 0-1 and more TIMI 3 blood flow in the IS group than in the SS group （all P〈0.05）. Patients with no reflow phenomenon were less in the IS group （P〈0.001）. The CTFC was lower in the IS group than in the SS group （P 〈0.001）. TMPG was also improved in the IS group than in the SS group （P=0.001）. Although PCI caused a significant increase in CK-MB 24 hours after the procedure, the elevated CK-MB value was lower in the IS group than in the SS group （18.74±8.41 vs 21.78±10.64, P=0.018）. Similar changes were also found in troponin I （0.99±1.07 in the IS group vs 1.47±1.54 in the SS group, P=0.006）. CK-MB elevation occurred in 27.8% （32/115） of the patients in the SS group vs 15.9% （18/113） in the IS group （P=-0.030）. Myocardial necrosis was detected in 4.4% （5/115） of the patients in the SS group, whereas 0.9% （1/113） in the IS group （P=0.341）. But no myocardial infarction was found. Similarly, the patients with increased level of troponin I were much more in the SS group （36.5%, 42/115） than in the IS group （19.5%, 22/113） （P=0.04）. Among them, myocardial necrosis was detected in 13.0% （15/115） of the patients in the SS group, while 4.4% （5/113） in the IS group （P=-0.021）. Myocardial infarction was found in 4.4% （5/115） of the patients in the SS group and 0.9% （1/113） in the IS group （P=0.213）.
Conclusions Intensive statin pretreatment for 7 days before PCI can further improve myocardial blood perfusion, protect the myocardium from ischemic injury. These effects are associated with the lowered levels of hs-CRP, P-selectin and ICAM.     

急性心肌梗死患者B型钠尿肽水平与病情及预后的相关性

目的探讨急诊急性心肌梗死患者B型钠尿肽（B-type natriuretic peptide, BNP）水平与病情及预后的相关性。方法选取急诊急性心肌梗死并急诊行经皮冠状动脉造影术（ coronary artery angiography, CAG）的患者127例,根据其手术前BNP水平分为A、B组,A组42例,其BNP≥250pg/ml,B组85例,其BNP〈250pg／ml,对两组患者的辅助治疗情况进行比较,并随访6个月,记录并比较主要不良心脏事件（ Major Adverse Cardiovascular Events,MACE）、病死率的差异。同时分析BNP水平与冠脉病变严重程度、Killip心功能分级相关性。结果与B组患者相比,A组患者半年病死率高、辅助治疗比例高,两组患者病死率、辅助治疗比例有明显差别（P=0．027,P=0．006）,半年内MACE发生率无明显差异。术前BNP水平与Killip心功能分级、冠脉病变支数具有相关性（rs=0．355,P〈0．0001;rs=0．289,P=0．001）。结论急性心肌梗死患者术前急诊检测BNP水平,对预测病变严重程度、辅助治疗可能性、半年病死率等有较好的临床价值。     

不同性别老老年心肌梗死患者血脂水平及冠脉病变严重程度差异的分析

目的:探讨不同性别80岁及以上急性心肌梗死患者的血脂特点以及冠脉病变严重程度。方法:连续入选2012年1月-2017年12月于天津医科大学第二医院心脏科住院治疗的急性心肌梗死（包括STEMI和non-STEMI）患者（大于80岁）201人,其中男性组106例,平均年龄为（83.11±3.11）岁,女性组95例,平均年龄为（82.54±2.16）岁,依据冠状动脉造影进行Gensini评分,比较不同性别患者病史、血脂水平及病变严重程度。结果:老老年女性ACS患者的LDL（3.12±1.01 vs 2.71±1.03）、HDL（1.22±0.65 vs 1.00±0.30）、TC（4.75±1.37 vs 4.14±1.07）、TG（1.37±0.61 vs 1.00±0.42）均高于男性组,具有统计学意义（P＜0.05）。老老年男性ACS患者吸烟史（32.08% vs 17.89%）,饮酒史（22.64% vs 0.03%）比率高于女性患者,具有统计学意义（P＜0.05）,不同性别老老年心肌梗死患者的高血压及糖尿病患病率未见显著差异（P=0.178,P=0.499）,冠脉造影Gensini评分结果显示老老年ACS患者血管病变严重程度并无显著差异（P=0.412）。结论:老老年心肌梗死患者病变严重程度并无明显差异,而血脂紊乱存在性别差异,男性患者血脂更为理想,对老老年冠心病的降血脂治疗需要依据患者性别合理用药。     

强化他汀治疗对急性冠脉综合征患者PCI术后心肌灌注及炎症因子的影响

目的探讨强化他汀治疗对急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）术后心肌灌注及炎症因子的影响。方法将120例ACS行PCI治疗的患者随机分为对照组与观察组,给予58例对照组患者PCI术前1周20 mg/d阿托伐他汀口服,62例观察组患者于PCI术前1周开始口服40 mg/d阿托伐他汀。比较两组服药前及PCI术后血清炎症因子、心肌灌注分级（TMPG）和不良反应。结果 PCI术后12 h两组血清超敏C反应蛋白（hs-CRP）、IL-6及IL-8水平均显著升高,但观察组上述炎症因子水平显著低于对照组（P〈0.01）;术后观察组心肌灌注分级（TMPG）Ⅱ、Ⅲ级比例显著高于对照组（P〈0.01）;观察组与对照组不良反应发生率分别为21.0%和19.0%,差异无统计学意义（P〉0.05）。结论强化他汀治疗可显著降低ACS患者PCI术后急性炎症反应,显著改善心肌灌注,且不增加不良反应。     

比伐卢定对急性冠脉综合征患者介入术后出血影响的临床分析

目的评价国产注射用比伐卢定和普通肝素在急性冠状动脉综合征(ACS)患者冠状动脉介入术(PCI)后的出血风险。方法择期行PCI的ACS患者95例,随机分为肝素组(n=46)和比伐卢定组(n=49),其中肝素组脱落5例,比伐卢定组脱落3例,2组各剔除6例。2组分别采用国产注射用比伐卢定和肝素抗凝。于用药前和停药后1 h测定凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(Fib),并比较试验期间各项凝血指标的变化。PCI术后随访30 d比较2组患者出血事件发生率和主要心血管不良事件(MACE)发生率。结果 2组患者基线资料相当,比伐卢定组和肝素组用药前和停药后1 h凝血指标无显著性差异(P>0.05)。PCI术后30 d内2组出血事件发生率、MACE发生率及不良反应比较差异无统计学意义(P均>0.05)。结论与常规肝素抗凝相比,比伐卢定在PCI术中抗凝效果安全稳定。     

Effects of upstream tirofiban versus downstream tirofiban on myocardial damage and 180-day clinical outcomes in high-risk acute coronary syndromes patients undergoing percutaneous coronary interventions

Background For patients with moderate to high-risk acute coronary syndromes （ACS） who undergo early, invasive treatment strategies, current guidelines recommend the usage of glycoprotein （GP） lib/Ilia inhibitors as an upstream treatment for a coronary care unit or as an downstream provisional treatment for selected patients who are undergoing percutaneous coronary intervention （PCI）. The relative advantage of either strategy is unknown. The purpose of this study was to evaluate the effects of upstream tirofiban versus the effects of downstream tirofiban on myocardial damage and 180-day major adverse cardiovascular events （MACE） after PCI in high-risk non-ST-segment elevation ACS （NSTE-ACS） undergoing PCI. Methods From July 2006 to July 2007, 160 high-risk NSTE-ACS undergoing PCI were randomized to receive upstream （within 4-6 hours before coronary angiography） tirofiban or downstream （the guidewire crossing the lesion） tirofiban, to evaluate the extent of myocardial damage after PCI by quantitatively and qualitatively analyzing the value of cardiac troponin I （cTnl） as well as MB isoenzyme of creatine kinase （CK-MB） before and after PCI. The incidences of 24-hour, 3-day, 7-day, 30-day and 180-day MACE after PCI were followed up and the rates of bleeding complications and thrombocytopenia during tirofiban administration were recorded. Results The peak release and cumulative release of cTnl levels within 48 hours after PCI were significantly lower with upstream tirofiban than downstream tirofiban （0.45 vs 0.63 and 0.32 vs 0.43, respectively; P 〈0.05）. Post-procedural cTnl elevation within 48 hours was significantly less frequent among patients who received the upstream tirofiban than those who received the downstream tirofiban （66.3% vs 87.5%, P 〈0.05）. The peak and cumulative release of CK-MB levels as well as post-procedural CK-MB elevation within 48 hours after PCI were not significantly different between the two groups （16 vs 14,5 vs 3 and 26.3% vs 36.3%, respectively; P 〉0.05）. The incidences of 24-hour, 3-day, and 7-day MACE after PCI were the same between the two groups （0 vs 0, 0 vs 0 and 1.25% vs 1.25%, respectively）. Although the incidences of 30-day and 180-day MACE after PCI were not statisticially different between the two groups, the incidences were consistently lower with upstream tirofiban （3.75% vs 6.25% and 12.99% vs 16.67%; P 〉0.05）. Aging （OR=1.164, P 〈0.001）, hypertension （OR=4.165, P=0.037） and type 2 diabetes （OR=13.628, P 〈0.001） were independent risk factors of MACE. The timing of administrating the tirofiban （OR=2.416, P=-0.153） plays an extensive role in the incidence of MACE. The incidences of major and minor bleeding complications as well as mild thrombocytopenia during the administration of tirofiban were similar between the two groups （2.50% vs 1.25%, 1.25% vs 1.25% and 1.25% vs 1.25%, respectively; P 〉0.05）. Conclusions Based on the pretreatment with aspirin and clopidogrel, upstream tirofiban was associated with attenuated minor myocardial damage and the tendency of reducing incidences of 180-day MACE after PCI among high-risk NSTE-ACS patients undergoing PCI. Aging, hypertension and type 2 diabetes were independent risk factors of MACE in high-risk NSTE-ACS patients undergoing PCI associated with tirofiban.     

心肌梗死患者急诊经皮冠状动脉介入术后脑钠肽的变化及临床特征

目的探讨ST 抬高型心肌梗死（STEMI）和非ST 抬高型心肌梗死（NSTEMI）急诊经皮冠状动脉介入术（PCI）后脑钠肽（BNP）的变化和临床特征。方法选取2015 年1 月-2015 年12 月急诊入住该院的首发急性心肌梗死患者126 例。根据患者入院心电图变化分为STEMI 组72 例和NSTEMI 组54 例,并根据冠脉造影结果,分为1 支冠脉病变组、2 支冠脉病变组和3 支冠脉病变组。选取正常患者20 例为对照组,测定患者入院后24 h及术后7 d的BNP 水平,比较各组间BNP水平的变化及其临床特征。结果入院后24 h 1 支病变组、2 支病变组和3 支病变组的STEMI 组的BNP 水平均高于NSTEMI 组,差异有统计学意义（P <0.05）。术后7 d 1 支病变组的STEMI 组和NSTEMI 组的BNP 水平比较差异无统计学意义（P >0.05）,2 支病变组、3 支病变组的STEMI 组的BNP 水平低于NSTEMI 组,差异有统计学意义（P <0.05）。结论急性心肌梗死患者急诊PCI 后BNP 水平的变化及相关临床特征,有助于更为准确的判断病情、进行危险分层和评估长期的预后等。     

Elevated plasma apolipoprotein AV in acute coronary syndrome is positively correlated with triglyceride and C-reactive protein

Background Increased triglyceride （TG） occurs in patients with acute coronary syndrome （ACS）, and apolipoprotein AV （apoAV） has been shown to lower TG levels. In the present study, we investigated plasma apoAV level and its relationship with TG and C-reactive protein （CRP） in ACS patients. Methods A total of 459 subjects were recruited and categorized into control group （n=-116）, stable angina （SA） group （n=115）, unstable angina group （n=116） and acute myocardial infarction group （n=112）. Plasma apoAV level was measured by a sandwich ELISA assay. Results Compared with controls （（100.27±22.44） ng/ml）, plasma apoAV was decreased in SA patients （（76.54±16.91） ng/ml） but increased in patients with unstable angina （（330.89±66.48） ng/ml, P 〈0.05） or acute myocardial infarction （（368.66±60.53） ng/ml, P 〈0.05）. Inverse correlations between apoAV and TG were observed in the control or stable angina groups （r= -0.573 or-0.603, respectively, P 〈0.001）, whereas positive correlations were observed in the patients with unstable angina or acute myocardial infarction （r=0.696 or 0.690, respectively, P 〈0.001）. Furthermore, a positive relationship between apoAV and CRP was observed in the ACS patients but not in the non-ACS subjects. Conclusion The plasma apoAV concentration is increased and positively correlates with TG and CRP in ACS patients.