100例冠心病的颈动脉彩色多普勒超声分析

目的 探讨冠状动脉粥样硬化心脏病变的颈动脉超声改变与其相关性，以及与血脂的关系。方法 对82例冠心病、18例心肌梗塞患和正常对照组20人的颈动脉作彩色多普勒超声检查以及血液中血脂测定。结果 91．5％冠心病人和100％心肌梗塞病人存在血管内膜-中层(IMT)增厚，斑块和管腔狭窄等变化。斑块以颈总动脉分叉处(BIF)多见、以硬斑为主。血脂检查示LDL-C增高和ApoAⅠ下降。结论 冠状动脉病变与颈动脉粥样硬化密切相关。测定血液中LDL-C和ApoAⅠ的含量，可作为提示颈动脉粥样硬化的危险因素。     

Coronary atherosclerosis in cases of coronary death as compared with that occurring in the populatiom. A study of a medico-legal autopsy series of coronary deaths and violent deaths.

The severity of coronary atherosclerosis at autopsy was studied in two series comprising 169 cases of coronary death and 231 people who died of violent causes. In the former the fatal attack lasted less than 24 hours from the onset of symptoms in 70% of cases. In only three men did the terminal attack last more than 24 hours, while in the remaining 28% of cases, although death was not witnessed these were also likely to have been sudden deaths. A recent infarct with or without an old myocardial infarct was found at autopsy in 47% of cases and an old infarct alone in 34%. In 19% of coronary deaths no recent or old infarct was detected. The surface areas of the atherosclerotic lesions were assessed in arterial specimens by pointcounting. The degree of stenosis was estimated visually. The mean extent of raised lesions and clacification and the median value of stenosis score, which expressed the degree of stensosi in the coronary arterial tree, were significantly higher in all age groups in persons who died of coronary heart disease than in those who died violently. A marked overlapping between the individuals in the two series was, however, found in both for the exent of raised lesions and the severity of stenosis score. Raised lesions in coronary patients were calcified to about the same extent as those in persons ten years older in the series of violent deaths. Coronary atherosclerosis was most severe in coronary patients who had had symptomatic heart disease and had an old myocardial infarct and least severe in those in whome sudden death was the first manifestation of coronary heart disease from violent deaths as regards the extent of the raised lesions or prevalence of occlusion. The degree of coronary stenosis in coronary patients was closely related to the total extent of advanced coronary atherosclerosis.     

Management of hyperlipidemia in patients with vascular disease.

Atherosclerosis contributing to cardiovascular disease is the leading cause of death in the United States. It is also the major cause of peripheral arterial disease (PAD). Although there is substantial evidence that aggressive treatment of hyperlipidemia improves the outcome of patients with coronary artery disease (CAD), relatively little attention has been directed toward lipid control in patients with PAD. The National Cholesterol Education Program (NCEP) has established guidelines for treatment of lipids in patients with atherosclerotic disease. The purpose of this study was to determine the effectiveness of current lipid management practices in patients electively admitted for peripheral vascular surgery and to explore methods to improve compliance with NCEP guidelines. The past medical/surgical history, risk factors for atherosclerosis, and medication regimen including lipid medications were obtained from a retrospective review of the medical records of 105 consecutive patients scheduled for an elective vascular procedure. Lipid profiles were obtained as part of their routine preoperative assessment and the results were compiled and compared with established NCEP guidelines to determine the level of compliance in our PAD population. Eighty-five of the 105 patients had lipid profiles recorded in the medical record. Only 42% of patients were at or below the recommended goal of less than 100 mg/dL for low-density lipoprotein (LDL). Greater than half of patients had previous diagnosis of atherosclerosis or had previous bypass including coronary artery bypass surgery. Despite the strong emphasis on lipid reduction, especially LDL cholesterol, only a minority of patients admitted for peripheral vascular surgery were at the recommended NCEP goal. More aggressive evaluation and treatment of lipid disorders in patients with PAD seems warranted.     

冠心病患者血浆脂联素炎性反应因子与冠状动脉病变程度的相关性

目的探讨冠心病患者脂联素（APN）和炎性反应因子水平及其与冠状动脉病变程度的关系。方法经冠状动脉造影确诊冠心病患者85例,冠状动脉病变程度用病变血管支数和Gensini积分表示,包括冠脉病变支数单支病变28例,双支病变35例,三支病变22例;Gensini积分4～18分16例,～29分13例、～48分13例,～176分13例,对照组20例经冠状动脉造影排除冠心病。测定血糖（FPG）、脂类、体质量指数（BMI）、血清脂联素、高敏c反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）和白细胞介素-1β（IL-1β）。结果冠心病患者血清APN水平显著低于对照组,而hs-CRP、TNF—α均高于健康对照组。血清APN与hs-CRP、TNF—α、IL—1β均成负相关（P〈0．05）。结论脂联素的减少与冠心病的发生、发展以及冠状动脉粥样硬化斑块的不稳定性有一定的关系,可能通过拮抗炎性反应因子对血管的损伤来保护血管内皮抗动脉粥样硬化反应。     

血浆同型半胱氨酸水平与早发冠心病患者冠脉病变特点的相关性分析

目的分析血浆同型半胱氨酸(Hcy)水平与早发冠心病患者冠脉病变特点的相关性。方法将209例早发冠心病患者设为早发冠心病组,同时选取100例非早发冠心病患者做对照组。根据冠脉病变支数将早发冠心病组分为单支病变组、双支病变组、三支病变组。分析早发冠心病患者的病变程度与Hcy水平的相关性。结果早发冠心病组血浆Hcy水平高于对照组(P<0.05)。早发冠心病组三个亚组的血浆Hcy水平随着病变累及支数增加呈上升趋势(P<0.05)。早发冠心病组的冠脉病变程度与血浆Hcy水平呈正相关(P<0.01)。结论早发型冠心病患者的血浆Hcy水平与其冠状动脉血管病变严重程度呈正相关。     

大动脉僵硬度与冠脉病变严重性的相关研究

目的：探讨大动脉僵硬度与冠脉病变严重程度的相关性。方法：选择2006年1月一2007年12月疑诊为冠心病人院患者637例，所有入选患者均进行颈股脉搏波传导速度（c—FPwV）检测，评价动脉僵硬度。行冠脉造影评价冠永病变严重程度。根据c—FPwV水平分为三组：I组（C—FPWV0～10．0，220例），Ⅱ组（C—FPWV10．1～13．0，242例），Ⅲ组（C—FPWV≥13．1，175例），观察患者临床特征。结果：各组间比较，Ⅲ组年龄偏大，糖尿病，心肌梗死和高血压病史多，C型病变和三支病变常见，多因素Logistic分析冠脉病变严重程度和C—FPWV呈正相关联，相对危险性（OR）为1．51（95％CI1．017～2．241）。结论：CFPWV是最为经典的评价动脉僵硬度的方法，与冠脉病变的严重程度密切相关，可作为心血管疾病的一个危险信号，指导早期干预，为心血管疾病独立强有力预测因子，对冠心病防治有广泛应用前景。     

彩色多普勒超声对心绞痛患者颈动脉病变的初步分析

目的通过应用彩色多普勒超声诊断仪分析心绞痛患者颈动脉病变的特点,探讨其诊断冠心病的临床价值。方法选择行冠状动脉造影的心绞痛患者85例,根据冠脉造影结果分为0支病变组,1支病变组及多支病变组。测量颈总及颈内动脉后壁的内膜内表面到中膜外表面的距离（IMT）,同时注意观察动脉粥样硬化斑块的位置、数量及斑块性质等。结果颈动脉分叉处IMT值各组间均有显著性差异。颈内动脉IMT值在0支病变组与1支病变组间没有显著性差异,但两者均与多支病变组有显著性差异。颈动脉粥样硬化斑块积分各组间均有显著性差异。冠状动脉积分与颈动脉分叉处IMT值及冠状动脉积分与颈动脉硬化斑块积分之间均呈显著性相关。结论通过超声检查观察颈动脉粥样硬化病变的程度可预测冠状动脉病变的情况,对疑有冠心病的患者具有较好的筛选及预测价值。     

Changes of thyroid hormone levels in the progression of coronary arteriosclerosis

The study concerned changes in the levels of thyroid hormones (T3, T4) and their proportional relations in the serum of peripheral venous blood of patients with ischemic heart disease (IHD) with reference to severity of coronary and myocardial insufficiency and clinical symptoms. Thyroid hormones (TH) were examined in patients with stenosing atherosclerosis of the coronary arteries with incipient angina pectoris (IAP), acute myocardial infarction (AMI), chronic IHD before and after MI and postinfarction myocardial dysfunction (PIMD) depending on severity of coronary atherosclerosis. The findings were compared to hemodynamic and metabolic myocardial parameters, severity of coronary atherosclerosis assessed at coronaroangiography. It is shown that TH concentrations depend on efficiency of coronary circulation and characteristics of myocardial metabolism. IHD patients have isometric TH levels before MI, conversion of T4 into T3 being inhibited. After MI and development of PIMD at the compensation stage T4 and T3 levels lowered under control levels. This reflects intensity and pattern of metabolic processes in the myocardium. In intact myocardial function T4/T3 in the above patients was above the control levels because of high concentration of serum T4. In development of acute coronary syndrome the level of T3 fell while that of T4 went up due to suppression of its deiodination.     

High frequency of aspirin resistance in patients with acute coronary syndrome

Aspirin is widely used for secondary prevention of cardiovascular disease, but is not effective for all patients. This phenomenon is called as aspirin resistance. Although the prognosis is worse in patients who develop acute coronary syndrome (ACS) while using aspirin, the frequency of aspirin resistance in these patients has not been evaluated. We aimed to evaluate the frequency of aspirin resistance in patients with ACS and to determine its relationship with the angiographic severity and extent of the associated coronary artery disease. The present study included 104 patients with ACS (75 men, 60.4 +/- 10.8 years) who were hospitalized while using aspirin for at least last 7 days and 100 patients with stable coronary artery disease (73 men, 57.6 +/- 10.6 years), documented by coronary angiography, history of revascularization or myocardial infarction (MI), and the use of aspirin for last 7 days. The latter group had no MI or ACS for last 3 months. Platelet function was assessed with PFA-100, which simulates primary homeostasis at injured blood vessels. Coronary angiography was performed in 83 cases of the patients with ACS during hospital stay. Aspirin resistance is more prevalent in patients with ACS (40.3%) when compared with stable coronary artery disease patients (27%). The difference was statistically significant (p = 0.04). The ACS patients with aspirin resistance were older and had severe myocardial damage. However, there were no significant differences in angiographic severity and extent of coronary artery disease between aspirin-resistant and aspirin-sensitive patients. Frequency of aspirin resistance is higher in patients who develop ACS while using aspirin than that in patients with stable coronary artery disease.     

血清IL-8与外周血白细胞总数检测的临床意义

目的探讨血清白细胞介素(IL)-8水平和外周血白细胞总数与冠心病病情及冠状动脉病变程度的关系。方法 296例老年冠心病患者按临床诊断分为3组:急性心肌梗死(AMI)组100例、不稳定性心绞痛(UAP)组100例、稳定性心绞痛(SAP)组96例和健康对照组100例。用酶联免疫吸附试验检测各组血清IL-8的水平,并比较各组间的差异。同时对冠心病患者的外周血WBC总数变化及其与血清IL-8水平进行直线相关分析。结果 AMI组、UAP组及SAP组的血清IL-8水平均高于健康对照组(P0.05);AMI组、UAP组IL-8水平明显高于SAP组;AMI组和UAP组结果相似;冠心病患者血清IL-8与外周血WBC总数变化呈正相关。结论血清IL-8升高可能是老年患者冠状动脉粥样硬化的标志,参与了冠心病的发病过程,血清IL-8水平与冠状动脉病变程度密切相关。     

Evidence for maximal treatment of atherosclerosis: drastic reduction of cholesterol and fibrinogen restores vascular homeostasis.

This article summarizes the clinical and biochemical evidence for maximal treatment of atherosclerosis by a simultaneous 60% to 70% reduction of plasma low-density lipoprotein cholesterol (LDL cholesterol), fibrinogen, and lipoprotein a concentrations with heparin-mediated extracorporeal LDL/fibrinogen precipitation (HELP) apheresis and statins. Apheresis has proven efficient and safe in the treatment of more than 1,000 patients since 1984 and has been applied in children and adults for the treatment of homozygous and heterozygous familial hypercholesterolemia, coronary artery disease, ischemic cardiomyopathy, generalized atherosclerosis, or transplant-associated arteriosclerosis after cardiac transplantation. Simultaneous removal of the main atherogenic plasma compounds has an immediate impact on myocardial and peripheral vasomotion by increasing myocardial blood flow, coronary flow reserve, cerebral CO2-reactivity, and muscle oxygen tension. Removal of fibrinogen and cholesterol reduces plasma viscosity by 20% and erythrocyte aggregation by 60% which gives rise to applying the HELP apheresis in various microcirculatory disorders. Pilot studies on acute retinal ischemia, critical limb ischemia, and sudden hearing loss confirm this observation.     

急性心肌梗死患者脂蛋白（a）与冠状动脉病变程度的关系

目的探讨急性心肌梗死（AMI）患者血浆脂蛋白（a）[Lp（a）]与冠状动脉病变程度的关系。方法对136例AMI患者进行血脂检测及冠状动脉造影检查,按血浆Lp（a）水平分为低Lp（a）组（〈300 mg/L,46例）和高Lp（a）组（≥300 mg/L,90例）,比较两组血清Lp（a）浓度及冠状动脉病变特点的差异,应用logistic回归分析及逐步回归分析,观察以上指标与冠状动脉狭窄程度的相关性。结果高Lp（a）组Gensini积分、多支病变构成比例、梗死相关动脉（IRA）闭塞率分别为（145.6±36.2）分、58.9%、86.7%,高于低Lp（a）组（96.8±21.7）分、23.9%、56.5%;高Lp（a）组梗死相关动脉心肌梗死溶栓治疗试验（TIMI）积分为（1.58±0.88）分,低于低Lp（a）组的（2.31±1.07）分（P〈0.05）;回归分析发现,Lp（a）是冠状动脉病变程度I、RA闭塞率和TIMI评分的主要影响因素（P〈0.05或〈0.01）。结论 AMI患者血浆Lp（a）水平,与冠状动脉狭窄程度,IRA血流量、闭塞率及密切相关。     

Added value of CT myocardial perfusion imaging

Multidetector CT angiography (MDCTA) has become an accurate, noninvasive test for the diagnosis of coronary atherosclerosis. Studies have established a good sensitivity and an excellent negative predictive value for the diagnosis of coronary stenoses of 50% or greater severity. However, MDCTA is more limited in patients with disease with a lower specificity and positive predictive value for predicting atherosclerosis causing myocardial ischemia. Although radionuclide myocardial perfusion imaging (MPI) has been the mainstay for evaluating the presence of myocardial ischemia and scar in patients at risk for coronary artery disease, contrast-enhanced multidetector CT (MDCT) alone, with or without vasodilator stress, has the potential to provide both anatomical and functional information on coronary atherosclerosis and its impact on myocardial perfusion. We review the current status of MDCT MPI, including its advantages, limitations, and pitfalls.     

Plasma lipid peroxides: relationships to cardiovascular risk factors and prevalent cardiovascular disease

BACKGROUND: The epidemiology of plasma lipid peroxides, which may play a role in atherogenesis, has not been well defined. AIM: To study the relationships of plasma lipid peroxides to cardiovascular risk factors in a random population sample. DESIGN: Random, age- and sex-stratified population sample. METHODS: We studied 739 men and women aged 25-74 years. Lipid peroxides were assayed by the thiobarbituric acid (TBA) assay for malondialdehyde (MDA) in stored plasma samples. RESULTS: Lipid peroxide levels increased with age. In men, lipid peroxides were significantly associated with smoking habit. Lipid peroxides correlated with non-fasting serum triglycerides (r = 0.33; p < 0.0001) in both sexes. Weaker associations were observed for cholesterol, high-density lipoprotein cholesterol (inversely), body mass index, fibrinogen and white cell count; as well as an inverse association with serum vitamin C in men. DISCUSSION: These findings clarify the relationships of plasma lipid peroxides to cardiovascular risk factors; and are consistent with the hypothesis that lipid peroxidation may be one mechanism through which several risk factors may promote cardiovascular disease.     

The clinical observation of the platelet parameters in patients with acute myocardial infarction in plateau北大核心CSCD

Objective To investigate the clinical value of platelet parameters in patients with acute myocardial infarction(AMI) in plateau. Methods A total of 72 patients diagnosed as acute myocardial infarction in our department from January 2016 to June 2017 were enrolled into this study. Clinical data and outcomes were analyzed. Platelet parameters were measured within 24 h after AMI occurrence.The relationship between platelet distribution width (PDW), mean platelet volume (MPV), and the severity of disease, infarct size as well as short-term prognosis were further investigated. Results Compared with control group, PDW and MPV were positively correlated with the severity of disease (PPDW=0.039, PMPV=0.038) and infarct size (rPDW=0.305, P=0.009; rMPV=0.263, P=0.025). The AUC of PDW was 0.827, optimal operating point (OOP) was 16.3%, the AUC of MPV was 0.813, OOP was 13.1 fl, the AUC of GRACE was 0.865, OOP was 145. Conclusions PDW and MPV could be regarded as laboratory index to evaluate the severity of disease, infarct size, pathological changes of coronary artery and short-term prognosis of acute myocardial infarction in plateau. © 2018 Chinese Medical Association. All rights reserved.     

高频超声探查颈动脉预测冠状动脉病变

目的以颈动脉为窗口，探讨颈动脉与冠状动脉硬化间关系。方法用高频超声探查冠状动脉多支病变组，一支病变组与对照组的颈动脉内中膜厚度值(IMT)，斑块分级。结果三组IMT值及斑块分级存在显著差异。以斑块存在为预测冠脉病变的阳性指标，敏感性为83％，持异性为77％。1ogistic回归分析发现斑块为预测冠状动脉粥样硬化性。0脏病(CAHD)的最有效的阳性指标。结论高频超声探查颈动脉可预测冠状动脉病变的存在及严重程度。     

冠心病患者分泌型磷脂酶A2、sOX40L的变化水平及与冠状动脉病变的相关性

目的探讨人血液分泌型磷脂酶A2（sPLA2）和sOX40L水平与冠心病及冠状动脉病变严重程度和稳定性的关系。方法根据临床表现、心电图、心肌酶检测和冠状动脉造影结果确诊冠心病患者67例（冠心病组）,非冠心病患者21例（非冠心病组）。分别组成冠心病组和对照组。冠心病患者再分别根据临床类型、冠状动脉病变支数、Gensini积分进行分组。所有患者在造影前均测定sPLA2和sOX40L水平、血脂等指标。结果冠心病患者sPLA2（67．80±16．82）kU／L和sOX40L（226．35±69．06）ng／L显著高于对照组sPLA2（54．78±11．75）kU／L和sOX40L（155．97±52．48）ng／L（均P〈0．01）。急性冠状动脉综合征组患者sPLA2（69．70±16．02）kU／L和sOX40L（275．63±89．06）ng／L均显著高于稳定型心绞痛组sPLA2（61．59±11．64）kU／L,sOX40L（162．34±34．46）ng／L（均P〈0．01）;sPLA2与sOX40L呈正相关（r=0．632,P〈0．05）。sPLA2和sOX40L水平随着冠状动脉病变支数和Gensini积分的增加而升高。结论sPLA2和sOX40L水平能反映冠状动脉粥样硬化病变的严重程度,与冠状动脉病变稳定性相关。     

Studies of lipid peroxidation products in cerebrospinal fluid and serum in multiple sclerosis and other conditions.

Lipid peroxides were measured in cerebrospinal fluid (CSF) and sera from patients with multiple sclerosis (MS) or other conditions and from control subjects. In serum, visible fluorescence, A240nm, and free and protein-bound thiobarbituric acid (TBA)-reactive substances were significantly greater in MS patients than in control subjects. No such differences were observed in CSF. There was no correlation between lipid peroxides and disease severity or relapse time. We observed a significant positive correlation between CSF protein-bound TBA-reactive substances and CSF protein, suggesting that production of the former depends on protein concentration. A significant negative correlation between free TBA-reactive substances in serum and ultraviolet fluorescence indicated that production of free TBA-reactive substances may be associated with decreased production of fluorescent lipid peroxides. This study provides evidence for increased lipid peroxidation in serum but not CSF from MS patients, suggesting that either there is no increase in CSF lipid peroxidation in MS patients or that CSF lipid peroxides are rapidly removed, possibly by binding to CSF proteins that can be reabsorbed into the blood.     

胰岛素敏感性和血脂水平与冠状动脉病变程度相关性

目的：探讨冠心痛患者胰岛素敏感性和血脂水平与冠状动脉病变范围及程度的关系。方法：检测100例冠状动脉造影阳性患者（冠心病组）、50例冠状动脉造影阴性患者（阴性组）和50例健康者（对照组）的空腹血脂、血糖、胰岛素浓度及胰岛素敏感性指标。分别以冠状动脉狭窄分数和病变冠状动脉支数为因变量,血脂、血糖、胰岛素和胰岛素敏感性指标为自变量,进行单元直线相关分析和多元逐步回归分析。结果：冠心病组与对照组除总胆固醇、血糖外,血脂、胰岛素和胰岛素敏感性差异均有统计学意义（P〈0．05）;冠心病组仅有高密度脂蛋白和胰岛素敏感性指数明显低于阴性纽（P〈0．05）。冠心病纽胰岛素和胰岛素敏感性指数与冠状动脉狭窄分数显著相关（r=0．25,P〈0．05;r=-0．32,P〈0．01）,病变冠状动脉支数与任何自变量无相关性。逐步回归分析显示,胰岛素敏感性指数与冠状动脉病变程度独立相关。结论：冠心病存在胰岛素抵抗、高胰岛素血症和血脂尤其是高密度脂蛋白异常,均为冠心病发病危险因素;胰岛素敏感性指数是影响冠状动脉病变程度独立影响因子。     

冠心病患者血浆脂联素水平变化的探讨

目的 探讨冠心病患者血浆脂联素（Adiponectin）水平的变化及与动脉粥样硬化发生的关系。方法 选择冠心病（CAD）患者40例作为实验组，其中急性冠脉综合征（ACS）20例，包括急性心肌梗死（AMI）11例．不稳定性心绞痛（UA）9例．稳定性心绞痛（SAP）20例；选择排除心血管系统疾病的健康体检者20例作为对照组．分别采血测定血浆脂联素水平，比较冠心病组与对照组血浆脂联素水平有无差异。结果 ACS组血浆脂联素水平低于SAP组和对照组．有显著性差异（P〈0．05，P〈0．001），SAP组与对照组相比差异无统计学意义（P〉0．05）。结论 脂联素与冠脉病变稳定性显著相关，脂联素水平可做为预测病情，诊断冠心病的一个指标。