冠心病患者血清IGF—I浓度检测的临床意义

目的探讨血清IGF-I浓度检测对估价冠心病患者左室功能及冠脉侧支循环状况的临床意义。方法应用放射免疫分析法检测4l例冠心病患者和15例正常人的血清IGF-I浓度;冠心病患者均行选择性冠状动脉造影,按Ren-trop法对侧支循环分级;左室造影测左室射血分数(LVEF)。结果冠心病患者组血清IGF-I浓度与正常对照组比较无显著性差异[(107.92±44.74)n/mL vs(113.05±33.65)n/mL,P＞0.05]。冠心病组中,IGF-I水平≥120 ng/mL的A亚组LVEF及Rentrop侧支循环分级均显著高于IGF-I水平＜ 120 ng/mL的B亚组(LVEF 0.62±0.13 vs 0.5l±0.12,P＜0.01;Rentrop 1.56±0.96 vs 0.12±0.33,P＜0.001)。IGF-I水平与LVEF(r=0.45,P＜0.001)及Rentrop侧支循环分级(r=0.74,P＜0.001)均呈显著正相关。结论较高的IGF-I水平可能提示冠心病患者有较好的左室功能和冠脉侧支循环;血清IGF-I浓度检测可作为估价冠心病患者左室功能及冠脉侧支循环状况的指标。     

肌酐正常的冠心病患者肾小球滤过率对冠状动脉侧支循环的影响及危险因素

目的:探讨肌酐正常范围的冠心病患者肾小球滤过率对冠状动脉(冠脉)侧支循环的影响及相关的危险因素。方法:连续入选我院心内科导管室2013-05至2014-04行冠脉造影结果示严重血管狭窄(狭窄程度≥95%)且肌酐正常的患者194例。根据造影侧支循环Rentrop分级将患者分为冠脉侧支循环不充分组(Rentrop分级0~1级,共1 13例)和冠脉侧支循环充分组(Rentrop分级2~3级,共81例),记录患者的年龄、性别、既往史、血肌酐值、空腹血糖、血脂水平等,通过肾脏疾病膳食改良(MDRD)研究公式估测肾小球滤过率(eGFR),采用多因素Logistic回归模型分析冠脉侧支循环不充分与eGFR的相关性。结果:在血清肌酐正常的范围内,eGFR水平在冠脉侧支循环不充分组较冠脉侧支循环充分组更低[(78.7±20.5)ml/(min·1.73 m~2)vs(89.6±3.2)ml/(min·1.73 m~2),P=0.012],冠脉侧支循环不充分组的空腹血糖值[(7.5±3.4)mmol/L vs(6.7±2.8)mmol/L,P=0.003]、高敏C反应蛋白(hs-CRP)水平[(2.7±0.8)/mg/L vs(2.3±0.6)mg/L,P=0.029]较冠脉侧支循环充分组更高,Gensini评分(7.7±3.9 vs 9.1±5.0,P=0.004)较冠脉侧支循环充分组更低,差异有统计学意义。多因素Logistic回归分析显示,eGFR(OR:0.19,95%CI:0.14~0.22,P=0.027)、hs-CRP(OR:1.58,95%CI:1.24~2.44,P=0.028)、Gensini评分(OR:0.98,95%CI:0.97~0.99,P0.00 1)、空腹血糖(OR:1.21,95%CI:1.06~1.41,P=0.002)是冠脉侧支循环不充分的独立危险因素。结论:肌酐正常范围内的冠心病患者肾小球滤过率是冠脉侧支循环不充分的重要预测因素。     

急性心肌梗死患者梗死相关冠脉侧支循环形成的影响因素

目的 研究急性心肌梗死(AMI)时影响冠脉侧支循环(CCC)形成的因素。方法 共入选142例就诊我院的首次AMI患者,均在AMI发作1 d内行冠状动脉造影术(CAG),依照Rentrop侧支循环分级,分为侧支循环良好组(良好组:侧支循环Ⅱ、Ⅲ级)和侧支循环不良组(不良组:侧支循环0、Ⅰ级),将两组患者的临床资料和冠脉造影资料进行对比分析。结果 冠脉侧支循环形成与糖尿病呈负相关,与梗死前心绞痛病程(>3个月)及冠脉病变支数呈正相关,而与年龄、性别、吸烟史、血脂水平、高血压病等无关。结论 梗死前心绞痛病程(>3个月)、冠脉病变支数是AMI患者形成侧支循环的有利因素,糖尿病不利于侧支循环形成。     

闭塞性冠状动脉病变侧支循环形成的影响因素及其临床意义

目的 :探讨闭塞性冠状动脉 (冠脉 )病变侧支循环形成的影响因素及其临床意义。　　方法 :冠脉造影证实 1～ 2支冠脉亚闭塞或完全闭塞病人共 68例 ,根据侧支循环情况将其分为A组 (3 1例 ,侧支循环 0～ 1级 )和B组 (3 7例 ,侧支循环 2～ 3级 ) ,对 2组病人部分临床资料进行对比分析。　　结果 :A组病人中吸烟史、心肌梗死及糖尿病史、室壁运动异常者及室壁瘤形成率、ST段降低 (∑ST)者及平均心率均高于B组 ,有显著性差异 (P <0 0 5～ 0 0 1) ;而A组病人中原发性高血压史、心绞痛史、定期使用肝素和长期用 β受体阻滞剂者及左心室射血分数 (LVEF)却低于B组 ,有显著性差异 (P <0 0 5～ 0 0 1)。　　结论 :①吸烟及糖尿病对侧支循环的形成不利 ,应强调戒烟及控制血糖的重要性 ;②肝素有利于侧支血管形成 ,对于不能介入或冠状动脉旁路移植术治疗的病人尤为必要 ;③心率慢可能促进侧支循环形成 ,故提倡使用 β受体阻滞剂。     

单核细胞趋化因子1、碱性成纤维细胞因子与冠脉侧支循环的关系

目的:探讨冠心病患者血清单核细胞趋化因子1(MCP-1)、碱性成纤维细胞因子(bFGF)浓度与冠脉侧支形成的关系。方法:根据冠脉造影结果入选80例冠脉严重狭窄的患者,按Rentrop方法冠脉侧支分级:0级(26例),1级(22例),2级(18例),3级(14例),采用酶联免疫法检测患者血清MCP-1、bFGF浓度。结果:(1)0级、1级冠脉侧支组患者的MCP-1血清水平[(69.765±32.640)pg/ml、(78.975±37.028)pg/ml]均明显低于2、3级冠脉侧支组患者的[(116.289±30.814)pg/ml、(129.194±45.808)pg/ml],P均0.05;0级、1级冠脉侧支组患者的bFGF血清水平[(20.745±6.888)pg/ml、(22.041±5.175)pg/ml]均显著低于2、3级冠脉侧支组患者的[(27.322±6.136)pg/ml、(32.265±12.038)pg/ml],P0.05～0.01;(2)Spearman相关分析显示:冠脉侧支分级与MCP-1、bFGF血清水平呈明显正相关(r=0.526,0.484,P均0.01)。结论:在严重的冠心病患者中,MCP-1、bFGF血清浓度与冠脉侧支分级呈明显正相关,提示MCP-1、bFGF有促进冠脉侧支循环形成的作用。     

严重冠脉狭窄患者血清二甲基精氨酸水平与侧支循环形成的关系

目的 探讨严重冠脉狭窄患者侧支循环形成与否与血清二甲基精氨酸(ADMA)浓度的关系.方法 经冠状动脉造影收集主要冠脉至少有一支狭窄程度在95%以上的123例冠心病患者,测定其血清ADMA浓度.采用Rentrop方法对冠状动脉侧支循环进行分级,0级为侧支循环未形成组(n=63),1~3级为侧支循环形成组(n=60).结果 侧支循环未形成组血清ADMA浓度(2.43±0.78)μmol/L显著高于侧支循环形成组(1.95±0.72)μmol/L(P＜0.01).结论 严重冠脉狭窄患者血清ADMA浓度与侧支循环形成有关.     

冠脉内移植自体骨髓单个核细胞对猪急性心肌梗死后心功能的影响

目的探讨冠脉内移植自体骨髓单个核细胞（BM—MNCs）对猪急性心肌梗死后心功能的影响。方法实验动物分为冠脉内移植BM—MNCs组（n=6）及冠脉对照组（n=5）,移植细胞数2×10^8。移植后4周观察心功能变化及冠脉侧支循环形成情况。结果冠脉内BM—MNCs移植后4周移植组左室射血分数[LVEF：（65．84±4．94）％]及短轴缩短率[FS：（43．21±5．49）％]明显高于对照组[LVEF：（47．21±6．32）％,FS：（27．31±4．07）％]（P〈0．01）,而左室舒张末压[LVDEP：（7．94±4．57）mmHg]明显低于对照组[（22．56±5．97）mmHg]（P〈0．01）,左室舒张末期内径[LVEDd：（27．27±2．38）mm]低于对照组[（37．82±6．96）mm]（P〈0．05）;移植组冠脉侧支循环形成较对照组明显;移植后1周血清bFGF及VEGF浓度明显高于对照组及术前水平（P〈0．01）。结论经冠脉移植BM—MNCs有助于改善左室收缩功能及舒张功能,有助于减轻心室重构。     

冠心病患者血清IGF-I浓度检测的临床意义

目的探讨血清IGF-I浓度检测对估价冠心病患者左室功能及冠脉侧支循环状况的临床意义。方法应用放射免疫分析法检测4l例冠心病患者和15例正常人的血清IGF-I浓度;冠心病患者均行选择性冠状动脉造影,按Ren-trop法对侧支循环分级;左室造影测左室射血分数(LVEF)。结果冠心病患者组血清IGF-I浓度与正常对照组比较无显著性差异[(107.92±44.74)n/mLvs(113.05±33.65)n/mL,P＞0.05]。冠心病组中,IGF-I水平≥120ng/mL的A亚组LVEF及Rentrop侧支循环分级均显著高于IGF-I水平＜ 120ng/mL的B亚组(LVEF0.62±0.13vs0.5l±0.12,P＜0.01;Rentrop1.56±0.96vs0.12±0.33,P＜0.001)。IGF-I水平与LVEF(r=0.45,P＜0.001)及Rentrop侧支循环分级(r=0.74,P＜0.001)均呈显著正相关。结论较高的IGF-I水平可能提示冠心病患者有较好的左室功能和冠脉侧支循环;血清IGF-I浓度检测可作为估价冠心病患者左室功能及冠脉侧支循环状况的指标。     

高敏C反应蛋白、血浆脑钠肽与急性冠脉综合征严重程度的关系

目的探讨急性冠脉综合征（ACS）患者冠状动脉粥样硬化程度与高敏C反应蛋白（hs-CRP）、血浆脑钠肽（BNP）的相关性。方法选择143例冠心病患者分为稳定型心绞痛（SA）组、不稳定型心绞痛（UA）组和急性心肌梗死（AMI）组。采用Leaman积分法评价冠脉病变的严重程度,同时测定患者血浆BNP、hs-CRP水平和左室射血分数（LVEF）,分析血浆BNP、hs-CRP水平与冠心病临床严重程度及冠脉造影Leaman积分之间的关系。结果ACS各组hs-CRP、BNP值、冠脉Leaman积分均显著高于稳定型心绞痛组,ACS各组LVEF低于SA组,AMI组hs-CRP、BNP显著高于不稳定型心绞痛组（P〈0.01）。ACS组血浆BNP水平与LVEF呈负相关（r=-0.499 0,P〈0.01）,与血管病变支数呈正相关（r=0.347 0,P〈0.05）,与冠脉积分呈正相关（r=0.798 4,P〈0.01）。结论ACS患者血浆BNP、hs-CRP与冠脉病变程度存在相关性,BNP、hs-CRP水平可反映心肌受损的程度。     

冠心病患者血浆Jagged1蛋白与冠状动脉侧支循环形成的关系

目的:探讨冠心病患者血浆中Jagged1蛋白水平与冠状动脉侧支循环(CCC)形成的关系。方法:根据冠状动脉造影结果入选我院左前降支、左回旋支或右冠状动脉中至少有一支血管直径狭窄≥95%的冠心病患者89例(冠心病组)和造影结果无明显异常的患者30例(正常对照组)。根据Rentrop分级评分将冠心病组患者再分成侧支循环良好亚组(Rentrop分级≥2级,n=42)与侧支循环不良亚组(Rentrop分级≤1级,n=47)。采用酶联免疫吸附法检测所有入选患者血浆中Jagged1蛋白及血管内皮生长因子(VEGF)的浓度,并进行相关性分析。结果:与正常对照组相比,冠心病组患者血浆Jagged1蛋白[(38.74±10.60)ng/L vs(23.04±8.97)ng/L]及VEGF[(113.98±30.80)pg/L vs(72.73±14.55)pg/L]水平均明显升高(P均0.01)。侧支循环良好亚组与侧支循环不良亚组比血浆Jagged1蛋白[(46.77±8.49)ng/L vs(31.56±6.26)ng/L]及VEGF[(128.10±20.24)pg/L vs(92.43±21.09)pg/L]水平均显著升高(P均0.01)。冠心病患者血浆Jagged1蛋白与VEGF水平呈正相关(r=0.730,P0.01)。多元回归分析显示,Jagged1蛋白(OR=1.318,P=0.000)和VEGF(OR=1.043,P=0.043)是影响CCC形成的独立预测因素。结论:侧支循环良好亚组血浆Jagged1蛋白水平较侧支循环不良亚组明显升高,表明Jagged1蛋白在CCC形成过程中可能起重要作用,这为冠心病患者临床治疗提供新的研究方向。     

Pseudoaneurysm of coronary artery following rupture of coronary artery during coronary angioplasty.

Rupture of the coronary artery is a rare complication of percutaneous transluminal coronary angioplasty (PTCA). We describe a case of coronary artery rupture during PTCA resulting in the formation of a coronary artery pseudoaneurysm. The pseudoaneurysm was successfully treated by percutaneous spring-coil embolization of the coronary artery.     

Percutaneous coronary intervention of bifurcation coronary disease

Bifurcation coronary artery disease is a frequent problem faced by interventional cardiologists and it affects approximately 15-20% of patients undergoing percutaneous coronary intervention (PCI). The application of drug-eluting stents (DES) technology to prevent restenosis after PCI represents one of the success stories in cardiology, but DES have not resolved the bifurcation PCI challenge. Bifurcation PCI remains associated with higher procedural failure and worse outcomes compared with PCI of non-bifurcated lesions even in DES era. A dependable strategy for PCI of bifurcation lesions has yet to be established, which is likely due to the paucity of studies evaluating the anatomical intricacies of the bifurcation as well as the lack of large scale randomized therapeutic trials. Further, bifurcation has many anatomical variants and it is unlike that one technique will fit all. Currently, we are left with the option of a tailor-made strategy for each patient and bifurcation anatomy and make the most of the limited evidence available to support our therapeutic decisions. In this review, we attempted to describe the current understanding of bifurcation anatomy and corresponding PCI strategies.     

Atherosclerosis of coronary arteries, coronary heart disease and sudden coronary death

Correlation between the severity of coronary atherosclerosis, thrombosis and sudden cardiac death was examined in 721 autopsied cases. Severe coronary atherosclerosis with stenosis was found in most of them; however a similar grade of atherosclerosis was discovered in patients with ischaemic heart disease not dying suddenly. Acute coronary thrombosis in the studied subjects was diagnosed post mortem in about 20 percent of those who died suddenly. Other studies indicate frequencies between 4-93%. There was no consistent time dependence.     

冠状动脉256排CT与冠状动脉造影对冠心病的诊断比较

目的冠状动脉256排CT成像技术与冠状动脉造影检查对冠状动脉粥样硬化性心脏病的诊断比较。方法选取2013年5月至2014年5月内蒙古兴安盟人民医院心血管内科疑似冠心病患者50例,其中男性29例,女性21例,年龄37~68岁。先行冠状动脉256排CT扫描及图像后处理,后行冠状动脉造影检查,将两结果进行对比分析。结果以冠状动脉狭窄≥50%者为阳性。冠状动脉256排CT诊断冠心病灵敏度为40.00%,特异度98.18%,阳性预测值88.89%,阴性预测值81.82%,正确指数38.18%,符合率82.67%,KAPPA值46.28%。结论冠状动脉造影诊断冠心病准确性优于冠状动脉CT。冠状动脉CT可对冠心病患者进行初筛诊断。     

Percutaneous transluminal coronary angioplasty of coronary artery embolism

A 35-yr-old woman with known valvular heart disease presented with acute myocardial infarction. Angiography demonstrated a totally occluded distal left anterior descending coronary artery. Though initially successful, angioplasty ultimately failed to maintain arterial patency, leaving a more distal total occlusion after several balloon inflations. In spite of this, PTCA possibly provided a more localized infarction via a peripheral mobilization of the embolus.     

经桡动脉穿刺冠状动脉复杂病变的介入治疗

目的　探讨复杂冠状动脉病变经桡动脉穿刺途径行介入治疗的成功率和并发症。方法　 184例复杂冠状动脉病变的冠心病心绞痛患者中 ,经桡动脉穿刺组 4 6例 ,对照组为经股动脉穿刺者 138例 ,观察两组手术成功率、术后并发症等情况。结果　经桡动脉组手术成功率为 92 .2 % ,与经股动脉组 (94 .9% )相比无明显差异 (P>0 .0 5 )。但术后与穿刺有关的并发症发生率 ,经桡动脉组明显少于经股动脉组 (10 .8% vs 2 8.3% ,P<0 .0 5 ) ;术后卧床时间也明显短于经股动脉穿刺组 (P<0 .0 1)。而经桡动脉组从穿刺开始至指引导管放置成功所需的时间长于经股动脉组(P<0 .0 5 )。结论　经选择的冠状动脉复杂病变经桡动脉途径介入治疗具有较高的成功率。经桡动脉途径术后与穿刺有关的并发症发生率低。     

Clinical trials of coronary revascularization: coronary angioplasty vs. coronary bypass grafting

In the absence of diabetes mellitus, rates of survival and of survival free of myocardial infarction (MI) are almost identical among patients with multivessel disease assigned to percutaneous transluminal coronary angioplasty (PTCA) versus those assigned to coronary artery bypass grafting (CABG) after 6.5 to 8 year follow-up period. Additional revascularization occurs 2.5 to 4.5 times more frequently in PTCA-treated than in CABG-treated patients and prevalence of angina is no longer statistically different between the two treatment groups. The excess health care costs of bypass surgery, which are important early after revascularization, almost disappear 5 to 8 years later. In patients with single vessel disease, survival free of MI is also comparable in both treatment groups at 5 years. Additional revasculariztion occurs two to four times more often in PTCA-treated than in CABG-treated patients and prevalence of angina does not differ between the two treatment groups. Thus, in nondiabetic patients with multivessel disease, the choice of a revascularization strategy rests on the patient's and treating physician's preference between the invasive nature of bypass surgery and the risk of recurrent procedures. In patients with single vessel disease, these long-term data suggest that bypass surgery is at least as safe and effective as coronary angioplasty and therefore may be a treatment option in selected cases.     

Right coronary artery coronary sinus fistula with coronary sinus ostium stenosis

Coronary artery fistula (CAF) is a rare anomaly of the coronary artery. The draining site of a right coronary artery (RCA) fistula may usually be the right ventricle, right atrium, or pulmonary artery. Here, we present a patient with right coronary artery to coronary sinus fistula (RCACSF) complicated by aneurysmal dilatation of the coronary sinus (CS) and stenosis of CS ostium.     

冠脉微循环与冠心病

冠心病急性心肌梗死的再灌注治疗是现代医学发展的里程碑,它使被动、保守治疗转为积极、主动的血运重建,随着包括静脉溶栓、冠状动脉内溶栓、经皮冠状动脉腔内成形术(PTCA)、冠状动脉内支架置入术以及冠状动脉搭桥术等再灌注治疗技术的成熟、普及,挽救了无数患者的生命.