血浆纤维蛋白原在冠心病发病中的作用

本文测定正常人82名、经冠状动脉造影诊断的冠心病(CHD)患者46例、急性心肌梗塞(AMI)患者15例的血浆纤维蛋白原含量。正常男女两性间无显著差别(p>0.05),随年龄增长有增高趋势(p>0.05)。AMI组和CHD组的血浆纤维蛋白原明显高于正常对照组(p<0.01,p<0.05)。CHD患者的血浆纤维蛋白原含量与冠脉狭窄枝数有密切关系。提示血浆纤维蛋白原在冠心病的发病中可能有重要作用。     

The pattern of injury in fatal pedal cycle accidents and the possible benefits of cycle helmets.

OBJECTIVE: To establish the number of fatal pedal cycle accidents occurring in the Sheffield and Barnsley area, UK, and to investigate the possible benefits of helmet wearing by cyclists. DESIGN: All medicolegal investigations into fatal road traffic accidents in the areas of Sheffield and Barnsley (total population 757,300) were reviewed to identify cases in which pedal cyclists had died. The necropsy reports of the cases were compared with those of an equal number of controls (pedestrians and motor vehicle occupants) which were matched by sex, age and year of death. RESULTS: 28 deaths occurred in the last 15 years giving a mortality of 0.25/100,000 per annum, which is lower than the rate for the UK as a whole (0.43/100,000), but in five cases the accidents which eventually led to death occurred outside the area under study. These deaths represented 3.3% of road traffic deaths between 1979 and 1993. Over 80% of both cases and controls had severe head injuries, but the controls had suffered more fatal injuries to other parts of the body. None of the cyclists had worn helmets and, in order to assess the maximum possible benefit of helmet wearing, it was assumed that a helmet would have saved all those who only had head injuries. It was found that helmets might have saved 14 lives in 15 years. A similar calculation based on the controls suggests that if all pedestrians and vehicle occupants had worn helmets, 175 lives might have been saved in the same period. CONCLUSIONS: There is no justification for compelling cyclists to wear helmets without taking steps to improve the safety of all road users.     

血浆纤维蛋白原在冠心病发病中的作用

目的探讨血浆纤维蛋白原在冠心病发病中的作用。方法测定正常人82名、经冠状动脉造影诊断的冠心病(CHD)患者46例、急性心肌梗死(AM I)患者15例的血浆纤维蛋白含量。结果正常男女两性间无显著差别(P>0.05),随着年龄增长有增高趋势(P>0.05)。AM I组和CHD组的血浆纤维蛋白原明显高于正常对照组(P<0.01,P<0.05)。CHD患者的血浆纤维蛋白原含量与冠脉狭窄支数有密切关系。结论血浆纤维蛋白原在冠心病的发病中可能起重要作用。     

Statin-treated familial hypercholesterolemia patients with coronary heart disease and pronounced atherosclerosis do not have more brain lesions than healthy controls in later middle age

Background: Clinically silent brain lesions detected with magnetic resonance imaging (MRI) are associated with increased risk for stroke, while stroke risk is controversial in familial hypercholesterolemia (FH).

Purpose: To determine whether the occurrence and size of clinically silent brain lesions in FH patients with coronary heart disease (CHD) is higher than in neurologically healthy controls without CHD.

Material and Methods: Brain MRI (1.5T) was performed on 19 DNA-test-verified FH patients with CHD and on 29 cardiovascularly and neurologically healthy controls, all aged 48 to 64 years. All patients were on cardiovascular medication. Intracranial arteries were evaluated by MR angiography. Infarcts, including lacunas, and white matter T2 hyperintensities (WMHI), considered as signs of small vessel disease, were recorded. A venous blood sample was obtained for assessment of risk factors. Carotid and femoral intima-media thicknesses (IMT), assessed with ultrasound, were indicators of overall atherosclerosis.

Results: On intracranial MR angiography, three patients showed irregular walls or narrowed lumens in intracranial carotid arteries. No silent infarcts appeared, and no differences in numbers or sizes of WMHIs between groups were recorded. Patients had greater carotid and femoral IMTs, and a greater number of carotid and femoral plaques. Cholesterol-years score, level of low-density lipoprotein (LDL) cholesterol, and level of high-sensitivity C-reactive protein (hsCRP) of the FH-North Karelia patients were higher than those of the controls, while the level of high-density lipoprotein (HDL) cholesterol in controls was higher.

Conclusion: FH patients with CHD and adequate cardiovascular risk-factor treatment showed no difference in the amount or size of clinically silent brain lesions compared to controls, despite patients' more severe atherosclerosis.     

老年冠心病患者颈动脉内-中膜厚度的超声测定（附60例报告）

目的通过分析颈动脉内-中膜厚度与老年冠心病的关系,探讨颈动脉超声在老年冠心病诊断中的临床意义。方法将60例入选的老年冠心病患者分为稳定型心绞痛（SA）组,不稳定型心绞痛（UA）组,急性心肌梗死（AMI）组,每组20例,并设立对照组20例,分别给予超声检测颈动脉内-中膜厚度（IMT）,进行分析比较。同时对48例老年冠心病患者进行冠脉造影检查,根据造影结果分为正常组11例,单支病变组16例,多支病变组21例,比较不同组间IMT水平的差异。结果老年冠心病患者颈动脉IMT较正常对照组有显著增厚（P〈0.01）,且在冠心病不同严重程度组中颈动脉IMT也存在一定的差异。对冠脉造影正常组与单支病变、多支病变组间IMT进行比较,结果也存在统计学差异（P〈0.05）。结论通过颈动脉超声测定颈动脉IMT水平,对老年冠心病的预测具有一定的临床意义。     

Importance of personality traits and psychosocial factors for the development of coronary heart disease

BACKGROUND/AIM: Numerous studies have provided clear and convincing evidence that psychosocial factors contribute to the pathogenesis and expression of coronary heart disease (CHD). These factors have been related to the following psychosocial domains: personality factors and character traits, depression, anxiety, social isolation and chronic life stress. The aim of this study was to estimate the influence of personality traits and psychosocial risk factors for the development of coronary heart disease. METHODS: The investigation was conducted as observational cross-sectional (case-control) study. Based on medical records all subjects were divided into two groups: the group of patients with CHD (61 participants), and the control group of 41 healthy participants. All participants fulfilled the Eysenck Inventory Questionnaire, Paykel stress scale and Bortner scale of A-B self-estimation. RESULTS: The participants with CHD were shown to have lower education than healthy participants, but were comparable by gender, age and place of residence. According to the Bortner scale, most participants with CHD expressed type A personality, whereas most healthy participants expressed types B and AB. The patients with CHD achieved higher scores on the Paykel stress scale of life events, and they had the higher level of neurotic and psychotic tendencies, as well as the lower level of extroversion compared to the healthy participants. Multivariate logistic regression model identified chronic stress (odds ratio 1.018; 95% confidence interval 1.007-1.028) as an important predictor for the occurrence of coronary heart disease, when adjusted for age, gender, nourishment and blood pressure. On the other side, the lower risk for the occurrence of CHD was observed among the participants who had the higher level of extroversion (odds ratio 0.859; 95% confidence interval 0.636-0.902). CONCLUSION: Chronic stress and introversion can be considered important risk factors for the development of coronary heart disease, independent of other predictors such as obesity and hypertension, supporting the biopsychosocial model of the occurrence of coronary heart disease.     

平板运动试验对冠心病诊断的临床价值

目的通过对照冠脉造影(CAG)结果,探讨平板运动试验(TET)对冠心病诊断的临床价值。方法选取100例可疑冠心病(CHD)患者,回顾性分析TET及CAG结果。结果 100例患者中TET阳性68例,CAG结果真阳性42例;TET阴性32例,CAG结果假阴性10例。与CAG对照得出TET检出冠心病的灵敏度为80.8%(42/52),特异性为45.8%(22/48),准确度为64%(64/100)。结论 TET有较高的灵敏性和准确度,能够较准确地评估冠心病严重程度及治疗效果。     

超声心动图对成人心脏室间隔与升主动脉前壁夹角改变相关因素的研究

目的 :探讨超声心动图检查成人心脏室间隔与升主动脉前壁夹角改变的相关因素及其发生机制。方法 :选择年龄 >18岁的健康人 10 0例 ;临床确诊的高血压病患者 10 0例 ;隐匿型冠心病、心绞痛患者 60例 ,然后应用彩超仪测量有关数据 ,最后将有关资料输入计算机应用Excel程序处理。结果 :成人心脏室间隔与升主动脉前壁夹角改变与性别、年龄、体型、体重指数无关 (P >0 .0 5 ) ;而与高血压病、冠心病的左室舒张功能减退、左室重构及升主动脉内径增宽等因素有关 (P <0 .0 1)。结论 :室间隔与升主动脉前壁夹角变小可作为高血压病心肌受损、冠心病早期超声诊断的参考指标     

Can patients with coronary heart disease go to high altitude?

Tourism to high altitude is very popular and includes elderly people with both manifest and subclinical coronary heart disease (CHD). Thus, risk assessment regarding high altitude exposure of patients with CHD is of increasing interest, and individual recommendations are expected despite the lack of sufficient scientific evidence. The major factor increasing cardiac stress is hypoxia. At rest and for a given external workload, myocardial oxygen demand is increased at altitude, particularly in nonacclimatized individuals, and there is some evidence that blood-flow reserve is reduced in atherosclerotic coronary arteries even in the absence of severe stenosis. Despite a possible imbalance between oxygen demand and oxygen delivery, studies on selected patients have shown that exposure and exercise at altitudes of 3000 to 3500?m is generally safe for patients with stable CHD and sufficient work capacity. During the first days at altitude, patients with stable angina may develop symptoms of myocardial ischemia at slightly lower heart rate x blood-pressure products. Adverse cardiac events, however, such as unstable angina coronary syndromes, do not occur more frequently compared with sea level except for those who are unaccustomed to exercise. Therefore, training should start before going to altitude, and the altitude-related decrease in exercise capacity should be considered. Travel to 3500?m should be avoided unless patients have stable disease, preserved left ventricular function without residual capacity, and above-normal exercise capacity. CHD patients should avoid travel to elevations above 4500?m owing to severe hypoxia at these altitudes. The risk assessment of CHD patients at altitude should always consider a possible absence of medical support and that cardiovascular events may turn into disaster.     

Methoxyisobutylisonitrile (MIBI) Tc 99m SPECT to establish a correlate to coronary flow reserve, the perfusion reserve, from global and regional myocardial uptake after exercise and rest

With 99mTc-MIBI SPECT and a 4 h exercise (E: 150 MBq iv) and rest (R; 800 MBq iv) protocol, global and regional left ventricular (LV) myocardial uptake was determined in 70 patients with angiographically confirmed coronary heart disease (CHD) and in 10 controls. The aim was to establish an E/R ratio as a correlate to coronary vascular reserve, representing perfusion reserve (PR). E/R ratios, obtained from total LV myocardium or from normal or impaired regions, were greater than 1.19 under all conditions, indicating the presence of higher flow during exercise than at rest (even in areas of low flow). Global PR separated (P less than 0.01) controls (1.63 +/- 0.21; mean +/- SD) from severely diseased patients (1.29 +/- 0.14 in 2- or 3-vessel disease) only. Improved differential diagnosis was gained from calibrating the regional E/R ratio to regional differences (E minus R) of uptake. For the left ventricle regional PRs (RPR) for 25 ROIs of the target, framing the myocardium, were determined. RPR at the regional maximum of 99mTc-MIBI uptake was similar in both controls (1.66) and patients (1.63), indicating a high probability of meeting some areas with functionally normal perfusion in patients with CHD. RPR allowed sufficient separation (P less than 0.025) concerning the degree of coronary artery stenosis (RPR in occlusion, 0.26; stenosis greater than 75%, 0.39; less than 75%, 0.56). In controls, the overall value for RPR was 1.14 +/- 0.28 (P less than 0.001). LV global PR and RPR were useful in separating patients with CHD vs controls and in classifying the severity of vascular stenosis.     

Autopsy and postmortem examination case study on genetic risk factors for cardiac death: polymorphisms of endothelial nitric oxide synthase gene Glu298Asp variant and T-786C mutation, human paraoxonase 1 (PON1) gene and alpha2beta-adrenergic receptor gene

BACKGROUND/AIM: The Glu298Asp variant in exon 7 and T-786C mutation in the 5'-flanking region of the endothelial nitric oxide synthase (eNOS) gene, paraoxonase I gene (PON1), and alpha2beta-adrenergic receptor gene (alpha2beta-AR) have been reported to be genetic risk factors for coronary heart disease (CHD). The aim of this study was to investige the effects of these four genetic polymorphisms on the probability of death due to CHD, using data obtained from medico-legal autopsies. METHODS: Blood samples from three groups: healthy controls, dead cases with CHD and without CHD (the latter as a control for dead cases) were used. After DNA extraction, genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) test. RESULTS: The frequency of the T allele in Glu298Asp variant in the dead cases with CHD was significantly higher than that in the healthy control (p < 0.001, OR = 4.47) and that in the dead cases without CHD (p < 0.001, OR = 7.62). The gene frequency of PON1 was significandy different (p = 0.007) between dead cases with and without CHD, and was also significantly different (p = 0.025) between the healthy control and dead cases without CHD. The gene frequency of PON1 was not significantly different (p = 0.401) between the healthy controls and dead cases with CHD. Hence this gene was not associated with death due to CHD. The other polymorphisms (T-786C mutation, alpha2beta-AR) also showed no effect on death due to CHD. CONCLUSION: The polymorphism of Glu298Asp eNOS gene in dead cases may be useful for determining the cause of death in CHD cases in the Japanese population.     

运动试验中变时性功能检测对诊断冠心病的意义

 目的 探讨运动试验中变时性功能检测对冠心病的诊断价值.方法 对68例冠脉造影者在平板运动试验中变时性功能指标的变化进行测量,将冠脉造影阳性(冠心病组)与冠脉造影正常组、冠心病组中ST段压低者与ST段压低伴变时性功能不良者进行对比分析.结果 冠心病患者运动后最大心率、变时性指数以及运动后心率恢复明显低于冠脉正常组(P＜0.05和P＜0.01), ST段压低伴变时性功能不良诊断冠心病的敏感性、特异性和阳性预测值均比ST段压低明显增高(P＜0.05和P＜0.01).结论 平板运动试验中变时性功能变化的观察与分析,是诊断冠心病的一种新的、有价值的无创性方法.     

多种无创性检测指标的变化与老年冠心病患者相关性研究

目的：探讨多种无创检测指标与老年冠心病（CHD）的相关性。方法：64例冠心病患者随机分为单支组及多支组,32名健康体检者作对照组,检测并分析血液各生物化学指标及动脉硬度指标。结果：CHD患者NO水平显著低于对照组（P〈0.05）,而内皮素-1（ET-1）水平显著高于对照组（P〈0.05）,其中多支组ET-1水平显著高于单支组（P〈0.05）。各组间超敏C反应蛋白（hs-CRP）水平差异无统计学意义（P〉0.05）。CHD患者肱-踝脉搏波传导速度（baPWV）显著高于对照组（P〈0.05）,其中多支组baPWV显著高于单支组（P〈0.05）。CHD发病风险与ET-1、baPWV呈显著相关性（P〈0.05）,而与血NO水平、hs-CRP无明显相关（P〉0.05）。结论：老年人冠状动脉内皮功能受损和动脉弹性降低与CHD发生密切相关,ET-1和baPWV可作为预测老年冠状动脉病变程度的重要指标。     

Glomerular filtration rate in endurance athletes.

OBJECTIVE: The interpretation of biochemical testing in sportsmen requires caution. Although creatinine-based estimates of glomerular filtration rate (GFR) overcome some shortcomings of serum creatinine, there is scarce information on their use in endurance athletes. DESIGN: We evaluated GFR, estimated by the recommended Modification of Diet in Renal Disease (MDRD) equation in athletes. PARTICIPANTS: Seventy-six professional male cyclists, 71 amateur male cyclists, and 65 healthy sedentary matched controls were included in the study. RESULTS: The mean serum creatinine level was significantly higher in the sedentary subjects (81 microM) than in amateur (75 microM; P < 0.001) and professional cyclists (72 microM; P < 0.001), and it was also marginally higher in amateur than in professional cyclists (P = 0.049). The mean estimated GFR value increased throughout the three subgroups, being significantly lower in the sedentary population (98 mL.min.[1.73 m]) than in the subgroups of amateur (109 mL.min.[1.73 m]; P < 0.001) and professional cyclists (113 mL.min.[1.73 m]; P < 0.001), but it did not differ between amateur and professional cyclists (P = 0.116). The average intensity of daily physical exercise, but not the body mass index, was inversely associated with serum creatinine and positively associated with the estimated GFR. CONCLUSIONS: The MDRD equation should be used with caution in athletes, and it should consider intensity and type of physical exercise.     

Effects of Ten Weeks of Cardiac Rehabilitation on Blood Clotting and Risk Factors

In brief: This study investigated the effects of a ten-week cardiac rehabilitation program on selected coronary heart disease (CHD) and blood clotting risk factors in 14 cardiac patients. Comparisons of before and after program values showed a significant reduction in body weight, diastolic blood pressure, and triglyceride concentration. Mileage covered per exercise session increased significantly. Serum cholesterol, systolic blood pressure, and resting heart rate values showed moderate but nonsignificant positive changes. Results of this study suggest that ten weeks of cardiac rehabilitation can enhance certain CHD risk factors while reducing others. However, a cardiac patient may require years of rehabilitation with careful attention to diet and medication to effectively reduce risk factors.     

运动诱发心肌缺血时心肌电复极的变化

目的 :了解冠心病患者给予运动负荷诱发心肌缺血对心肌复极离散度 (QTcd)的影响。方法 :经冠脉造影术证实的 4 9例冠心病患者与 38例造影阴性的对照组 ,进行活动平板试验 ,记录运动前后 12导联心电图、血压 ,检测QTcd并作分析比较。结果 :冠心病患者运动诱发心肌缺血 ,其运动时间、运动高峰时心率、心率的增加值、心脏作功指数均小于对照组 ,运动高峰时QTcd较运动前明显增大 (P <0 0 1)。结论 :冠心病患者心脏储备下降 ,运动耐量减小 ,运动中心肌复极离散度增大 ,电生理差异性增加。建议可将QTcd作为康复运动的观察指标之一。     

冠心病患者检测超敏C-反应蛋白与总胆固醇、高密度脂蛋白的临床意义

目的探讨超敏C-反应蛋白(hs-CRP)及总胆固醇(TC)/高密度脂蛋白(HDL-C)检测对冠心病的临床诊断价值。方法将130例冠状动脉造影结果正常者和132例经冠状动脉造影证实为冠心病(CHD)患者,分为对照组及冠心病组,均检测血浆超敏C-反应蛋白和TC、HDL-C水平。比较两组hs-CRP及TC/HDL-C升高与冠心病及冠状动脉病变程度的相关性。结果冠心病组患者的hs-CRP、TC、HDL-C水平明显高于对照组。另外,hs-CRP水平在冠状动脉2支以上病变组显著高于单支病变组。结论 hs-CRP与心血管疾病密切相关,且与病变的严重程度呈正相关。联合检测hs-CRP、TC、HDL-C对冠心病的诊断符合率高,对于一些无法开展冠状动脉造影的基层医院诊断冠心病有意义。     

冠心病患者颈动脉粥样硬化与内皮舒张功能的超声检测及临床意义

目的　探讨颈动脉粥样硬化病变的发生与冠心病的关系 ,研究冠心病患者内皮功能的变化。方法　应用高频超声检测 1 2 0例住院接受冠脉造影患者的颈动脉内中膜厚度 (IMT)及粥样硬化斑块 ,同时检测肱动脉血流介导和硝酸甘油 (GTN)引起的舒张反应。结果　根据冠状动脉造影结果将 1 2 0例患者分为冠心病组 (90例)和对照组 (30例 ) ,冠心病组IMT明显大于对照组 ,但不同病变支数的冠心病患者之间无差异。冠心病组颈动脉硬化斑块的检出率 (以分叉部为最高 ,其次为颈总动脉和颈内动脉 )明显高于对照组 ,且与冠脉病变的严重程度有关。总胆固醇、低密度脂蛋白、胆固醇水平及高血压、糖尿病发病率在冠心病组中明显高于对照组。冠心病组的肱动脉基础内径略大于对照组 ,但差异无统计学意义 (P >0 0 5 )。冠心病组由血流介导和硝酸甘油引起的肱动脉舒张反应均明显低于对照组(P <0 0 1 )。结论　颈动脉粥样硬化严重程度与冠心病发生呈正相关。颈动脉超声检测对冠心病有一定的预测价值。颈动脉超声及血管内皮功能检查不仅可能为早期发现、预防和治疗冠心病提供依据 ,还可能作为监测和评估病情变化的指标     

Frequency of the VO2max plateau phenomenon in world-class cyclists

We aimed to determine the frequency of the VO2max plateau phenomenon in top-level male professional road cyclists (n = 38; VO2max [mean +/- SD]: 73.5 +/- 5.5 ml.kg(-1).min(-1)) and in healthy, sedentary male controls (n = 37; VO2max: 42.7 +/- 5.6 ml.kg(-1).min(-1)). All subjects performed a continuous incremental cycle-ergometer test of 1-min workloads until exhaustion. Power output was increased from a starting value of 25 W (cyclists) or 20 W (controls) at the rate of 25 W.min(-1) (cyclists) or 20 W.min(-1) (controls) until volitional exhaustion. We measured gas-exchange and heart rate (HR) throughout the test. Blood concentrations of lactate (BLa) were measured at end-exercise in both groups. We defined maximal exercise exertion as the attainment of a respiratory exchange rate (RER) >or= 1.1; HR > 95 % age-predicted maximum; and BLa > 8 mmo.l(-1). The VO2max plateau phenomenon was defined as an increase in two or more consecutive 1-min mean VO2 values of less than 1.5 ml.kg(-1).min(-1). Most cyclists met our criteria for maximal exercise effort (RER > 1.1, 100 %; 95 % predicted maximal HR [HRmax], 82 %; BLa > 8 mmol.l(-1), 84 %). However, the proportion of cyclists attaining a V.O (2max) plateau was considerably lower, i.e., 47 %. The majority of controls met the criteria for maximal exercise effort (RER > 1.1, 100 %; predicted HRmax, 68 %; BLa > 8 mmol. l(-1), 73 %), but the proportion of these subjects with a VO2max plateau was only 24 % (significantly lower proportion than in cyclists [p < 0.05]). Scientists should consider 1) if typical criteria of attainment of maximal effort are sufficiently stringent, especially in elite endurance athletes; and 2) whether those humans exhibiting the VO2max plateau phenomenon are those who perform an absolute maximum effort or there are additional distinctive features associated with this phenomenon.     

老年高血压病合并冠心病心率变异性分析

目的 探讨老年高血压病合并冠心病患者的自主神经活动特点。方法 对59例原发性高血压、54例冠心病和38例原发性高血压合并冠心病患者与34例健康老年人的心率变异性进行对比研究。结果 高血压组和冠心病组与对照组除高血压组的R－R间期标准差的平均数外，其余参数差异均有显著性（P＜0．05）；高血压合并冠心病组与对照组比较，参数差异极有显著性（P＜0．01）；但不同疾病组间比较，差异均无显著性（P＞0．05）。结论 高血压病和冠心病患者的自主神经活动受损，当高血压病合并冠心病时这种受损更加明显。其迷走神经张力降低、交感神经紧张性相对增高是导致老年患者心率变异性减低的主要原因。