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。     

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。     

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.     

老年冠状动脉严重狭窄患者血浆miRNA-195表达及其与侧支循环形成的关系

目的探讨老年冠状动脉严重狭窄患者血浆miRNA-195表达及其与侧支循环形成的关系。方法 68例老年冠心病患者作为老年冠心病组,入组患者均经冠状动脉造影检查且冠状动脉狭窄程度达95%以上,根据Rentrop分级将其分为侧支良好亚组(Rentrop分级≥2)32例和侧支不良亚组(Rentrop分级≤1)36例;另选取同期72例体检健康者作为对照组。采用RT-PCR检测两组的血浆miR-195表达水平,采用酶联免疫吸附试验(ELISA)检测血清中血管内皮生长因子(VEGF)的浓度,相关性应用Pearson相关分析,影响因素采用多因素Logistic回归进行分析,采用受试者工作特征(ROC)曲线分析血浆miR-195水平对冠状动脉侧支循环形成的辨别能力。结果老年冠心病组血浆中miRNA-195及VEGF表达水平均明显低于对照组(P0.05),且侧支不良亚组明显低于侧支良好亚组和对照组(P0.05)。Pearson相关性分析结果提示,血浆miRNA-195表达水平与老年冠状动脉严重狭窄患者侧支循环呈正相关(r=0.615,P=0.003)。多因素Logistic回归分析提示,血浆miRNA-195水平和Gensini积分是影响老年冠状动脉严重狭窄患者侧支循环的危险因素。血浆miRNA-195判断老年冠状动脉严重狭窄患者侧支循环形成的灵敏度为83.29%,特异度为94.76%。结论 miRNA-195在老年冠状动脉严重狭窄患者血浆中表达水平相对较低,且侧支不良亚组明显低于侧支良好亚组,其可能成为辨别老年冠状动脉侧支循环形成的一个评价指标。     

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。     

冠心病合并糖尿病患者血浆SDF-1水平及与冠状动脉侧支循环的相关性研究

目的 探讨冠心病合并糖尿病（DM）患者血浆基质细胞衍生因子-1（SDF-1）水平及与冠状动脉侧支循环的关系。方法纳入79例拟诊冠心病并行冠状动脉造影（CAG）的患者。根据CAG结果分为：正常对照组（n=26）及冠心病组（n=53）。冠心病组又根据患者是否合并DM分为：合并DM亚组（n=21）与未合并DM亚组（n=32）。采用ELISA法检测患者血浆中SDF-1的水平;用Rentrop分级系统对冠状动脉侧支血管形成进行评级。比较各组患者血浆SDF-1的水平,并对冠心病患者SDF-1的水平与Rentrop分级进行直线相关分析。结果冠心病组患者血浆SDF-1水平低于对照组,两组差异有统计学意义（P〈0.05）;冠心病合并DM亚组SDF-1水平低于未合并DM亚组,两亚组间差异亦有统计学意义（P〈0.05）。合并DM亚组冠脉侧支循环形成率为33.3%,低于未合并DM亚组冠脉侧支循环的形成率（75.0%）,两亚组侧支循环形成率有统计学差异（P〈0.05）。冠心病组患者SDF-1水平与Rentrop的分级呈正相关（r=0.508,P〈0.01）。结论冠心病合并DM患者血浆中SDF-1水平及侧支循环形成的能力降低,SDF-1水平与冠状动脉侧支循环形成的能力呈正相关。     

严重冠心病患者血清碱性成纤维细胞生长因子与冠状动脉侧支循环的相关性

目的探讨冠状动脉严重狭窄患者血清碱性成纤维细胞生长因子浓度与冠状动脉侧支循环形成、冠状动脉粥样硬化程度的关系。方法根据冠状动脉造影结果连续入选80例冠状动脉严重狭窄患者,按照Rentrop分级方法对冠状动脉侧支循环进行分级:0级26例,1级22例,2级18例,3级14例,采用酶联免疫吸附法检测血清碱性成纤维细胞生长因子浓度,并应用Gensini积分系统评价冠状动脉粥样硬化病变程度。结果冠状动脉侧支循环0级组碱性成纤维细胞生长因子血清水平为20.75±6.89 ng/L,1级组为22.04±5.18 ng/L,2级组为27.32±6.14ng/L,3级组为32.27±12.04 ng/L,随着侧支循环分级的增加,碱性成纤维细胞生长因子血清水平也相应增高(P<0.05);Spearman相关分析发现,冠状动脉侧支循环分级与碱性成纤维细胞生长因子血清水平呈正相关(P<0.01)。结论在冠状动脉严重狭窄的冠心病患者中,冠状动脉侧支循环形成良好患者碱性成纤维细胞生长因子血清浓度高于冠状动脉侧支循环形成不良患者;碱性成纤维细胞生长因子血清浓度与冠状动脉侧支循环分级呈正相关。     

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。     

ST段抬高型心肌梗死冠状动脉侧支循环形成良好与不良患者微循环阻力指数和心功能的比较

目的比较ST段抬高型心肌梗死患者冠状动脉侧支循环形成良好和不良的微循环阻力指数(index of microcirculatory resistance,IMR)以及心功能指标。方法选择2012年1月~2014年3月在青岛市市立医院心内科住院的ST段抬高型心肌梗死错过血运重建时间(12 h),15 d后行冠状动脉造影及经皮冠状动脉介入治疗(PCI)的患者34例,其中男性28例,女性6例,年龄31~82岁(63.0±12.4)岁。按照Rentrop分级将所有患者分为侧支循环形成良好组(A组,Rentrop:2~3级,n=19)和侧支循环形成不良组(B组,Rentrop:0~1级,n=15)。所有入选者均行冠状动脉造影和置入支架,后测定IMR,于术前及术后3个月测定左室舒张末期内径(LVEDD)、左室射血分数(LVEF)。结果两组患者年龄、性别比例、高血压、糖尿病和陈旧性心肌梗死比较,差异无统计学意义(P均0.05)。与B组比较,A组IMR降低,(32.0±7.6)vs.(21.2±4.5),差异有统计学意义(P0.01)。A组PCI术后3个月较术前LVEF增加,差异有统计学意义(P0.05)。B组PCI术后3个月较术前LVEDD增加,差异有统计学意义(P0.05)。与A组比较,B组PCI术后3个月LVEDD[(47.4±2.4)mm vs.(53.6±5.0)mm]增加,LVEF[(56.5±3.3)%vs.(46.1±8.8)%]下降,差异有统计学意义(P0.05)。所有患者的冠状动脉侧支分级与IMR呈负相关(r=-0.601,P0.001);IMR与PCI术后3个月的LVEDD呈正相关(r=0.842,P0.01),与PCI术后3个月的LVEF呈负相关(r=-0.830,P0.01)。结论 ST段抬高型心肌梗死冠状动脉侧支循环形成不良患者较良好患者更易出现微循环功能障碍,PCI后心功能更差。     

冠心病病人血清尿酸水平与冠状动脉病变稳定性、内皮功能及侧支循环形成的关系探讨

目的探讨冠心病病人血清尿酸水平与冠状动脉病变稳定性、内皮功能及侧支循环形成的关系。方法将2014年9月—2017年10月在廊坊市人民医院接受冠状动脉造影并确诊为冠心病病人134例作为病例组,根据心绞痛发作次数及症状分为稳定型心绞痛61例(稳定组)和不稳定型心绞痛73例(不稳定组);根据Rentrop分级分为侧支循环良好组(55例)和侧支循环不良组(79例);同时选取冠状动脉造影正常病人100例作为对照组。检测所有病人血清尿素、内皮素-1(ET-1)、一氧化氮(NO)和血栓调节蛋白(TM)水平,探讨病例组血清尿素与ET-1、NO、TM及Rentrop分级关系,分析冠状动脉病变稳定性和侧支循环形成的危险因素。结果病例组血清尿酸、ET-1和TM水平均高于对照组(P0.05),血清NO水平低于对照组(P0.05);不稳定组血清尿酸水平高于稳定组(P0.05);侧支循环不良组血清尿酸水平高于侧支循环良好组(P0.05)。病例组血清尿酸水平与ET-1、TM呈正相关(r=0.569,P=0.008;r=0.514,P=0.012),与血清NO、Rentrop分级呈负相关(r=-0.601,P=0.000;r=-0.647,P=0.000)。血清尿酸水平是影响冠心病冠状动脉病变稳定性和侧支循环形成的独立危险因素。结论冠心病病人血清尿酸水平升高,与冠状动脉病变稳定性、内皮功能及侧支循环形成密切相关。     

2型糖尿病患者血清糖化白蛋白水平与冠脉侧支循环的关系研究

目的：探讨2型糖尿病患者血清糖化白蛋白水平与冠脉侧支循环的关系,并与非糖尿病患者作比较。方法：入选连续434例稳定型心绞痛伴1支或以上冠脉完全阻塞的患者,其中糖尿病组317例,非糖尿病组117例。检测空腹血清糖化白蛋白（GA）和糖化血红蛋白（HbA1c）水平,并用Rentrop计分法评估阻塞远端来自对侧冠脉提供的侧支循环情况（Rentrop 0或1分为侧支循环不佳,2或3分为侧支循环良好）。结果：在总的437例患者中,侧支循环不佳患者的GA[（20.9±6.3）%对（18.6±5.5）%,P〈0.001]和HbA1c[（6.9±1.0）%对（6.7±1.1）%,P〈0.05]显著高于侧支循环良好患者。糖尿病组中,侧支循环不佳患者（118例）较侧支循环良好者（199例）血清GA水平明显增高,为（21.2±6.5）%对（18.7±5.6）%,P〈0.001;但HbA1c水平相似,为（7.0±1.1）%对（6.8±1.3）%,P=0.27。GA与Rentrop计分呈显著负相关（r=-0.28,P〈0.001）,但HbA1c与其无关（r=-0.10,P=0.09）。在预测冠脉侧支循环不佳方面,GA的曲线下面积较HbA1c明显增大（0.64对0.58）。在非糖尿病组,GA和HbA1c水平与冠脉侧支循环状态无关。多因素分析发现,年龄〉65岁、女性、非高血压、高脂血症和肾功能减退是预测糖尿病和非糖尿病患者冠脉侧支循环不佳的独立危险因素。经校正混杂因素后,GA〉18.3%仍然较HbA1c〉7%更为敏感地预测糖尿病患者冠脉侧支循环不佳。结论：血清GA水平增高是2型糖尿病患者冠脉侧支循环形成不佳的重要原因之一。     

Association of paraoxonase activity and coronary collateral flow

OBJECTIVES: Paraoxonase is a high-density lipoprotein-bound antioxidant enzyme that inhibits atherosclerosis and endothelial dysfunction. Coronary collateral flow is a crucial clinical entity with significant impact on the cardiovascular morbidity and mortality. This study sought to determine the relationship between the degree of angiographically visible coronary collateral circulation and serum paraoxonase activity. METHODS: The study population included 98 patients (mean age=57.9+/-10.1 years, 65 men) with angiographically documented total occlusion in one of the major coronary arteries. Development of collaterals was classified by Rentrop's method. Patients were defined as having poorly developed collaterals for Rentrop grades 0 and 1 or well-developed collaterals for Rentrop grades 2 and 3. Serum paraoxonase and arylesterase activities were measured spectrophotometrically. RESULTS: Statistically significant differences between well and poorly developed collateral groups in respect to serum low-density lipoprotein cholesterol level (P=0.046), and serum paraoxonase (P=0.001), and arylesterase (P=0.014) activities were present. Serum low-density lipoprotein cholesterol level (chi=4.15, beta=-0.347, P=0.032) and serum paraoxonase activity (chi=10.43, beta=0.008, P=0.022) were independent predictors of well-developed coronary collateral flow. Serum paraoxonase activity gradually increased from collateral grade 0 to collateral grade 3 (analysis of variance P=0.003). Serum paraoxonase (r=0.362 and P<0.001) and arylesterase (r=0.245 and P=0.015) activities were both correlated with collateral flow grade. CONCLUSION: Findings of this study suggest that serum paraoxonase activity is independently associated with the degree of coronary collateral flow and reduced serum paraoxonase activity might represent a biochemical marker of impaired coronary collateral flow.     

Usefulness of serum tryptase level as an independent biomarker for coronary plaque instability in a Chinese population

Tryptase and chymase are unique mast cell proteases that are essential in atherogenesis. This study establishes a link between serum tryptase and chymase levels and human coronary heart diseases (CHD) in a cohort of 270 subjects. Serum tryptase levels were significantly higher in patients with substantial CHD than in those without substantial CHD (substantial CHD vs. unsubstantial CHD: 7.81 ± 0.52 ng/mL vs. 6.11 ± 0.51 ng/mL, P=0.002). After subgrouping the substantial CHD patients into those with acute myocardial infarction (AMI) and those with unstable or stable angina pectoris (UAP or SAP), we demonstrated that serum tryptase levels were nearly doubled in AMI patients as compared with unsubstantial CHD patients (11.13 ± 1.55 ng/mL vs. 6.11 ± 0.51 ng/mL, P<0.01), and significantly higher than in UAP patients (7.19 ± 0.62 ng/mL, P<0.05) or SAP patients (6.80 ± 0.94 ng/mL, P<0.05). Although Spearman's correlation test showed that serum tryptase correlated significantly with age (P=0.014) and weakly with fasting glucose (P=0.084), total cholesterol (P=0.071), low-density lipoprotein (P=0.063), and triglyceride (P=0.058), serum tryptase levels remained significantly higher in substantial CHD patients than in unsubstantial CHD patients in a multiple linear regression test after adjusting for all these confounders (P=0.008). Serum chymase levels were also higher in AMI patients (27.64 ± 7.57 ng/mL) or UAP patients (24.62 ± 8.06 ng/mL) than in SAP patients (15.20 ± 0.81 ng/mL) or unsubstantial CHD patients (16.84 ± 0.56 ng/mL), although such differences were not statistically significant. Spearman's correlation test revealed that serum chymase levels correlated significantly only with fasting glucose levels (P=0.019), and CHD status did not affect chymase levels before and after adjusting for all confounders. Our observations suggest that serum tryptase is an independent biomarker for coronary plaque stability in this Chinese population.     

慢性完全闭塞病变行经皮冠状动脉介入治疗对供血动脉定量血流分数的影响

目的探讨冠状动脉慢性完全闭塞(CTO)病变成功行经皮冠状动脉介入治疗(PCI)对其供血动脉定量血流分数(QFR)的影响。方法入选上海交通大学医学院附属瑞金医院2017年7月至2021年1月成功行PCI的单支CTO病变且供血血管符合QFR计算标准的患者30例。分别于CTO病变血管开通前后应用不同的血流模型,即固定血流模型和对比剂血流模型,对供血血管进行QFR评估,观察CTO-PCI前后QFR值的变化,并收集患者的临床基线资料,分析其影响QFR值变化的因素。结果CTO-PCI术后供血血管对比剂血流QFR值显著高于术前[(0.74±0.17)比(0.69±0.19),P<0.001],且冠状动脉侧支循环Rentrop分级是预测QFR变化值的独立预测因素(β=0.36,P=0.043)。结论CTO-PCI术后供血血管QFR值是显著升高的,且与Rentrop侧支循环分级相关。     

冠状动脉侧支循环形成与血管生成素1和2的相关性研究

目的探讨冠状动脉严重狭窄患者的冠状动脉侧支循环(CCC)形成与血清血管生成素1(Ang-1)和2(Ang-2)浓度的关系。方法入选冠状动脉造影示左前降支、左回旋支和右冠状动脉中至少1支狭窄≥90%的患者67例,按照Rentrop分级方法,对CCC进行分级:0级22例,1级17例,2级18例,3级10例;采用酶联免疫吸附法检测患者血清Ang-1、Ang-2浓度;应用Gensini积分系统评价患者的冠状动脉粥样硬化病变程度。结果 0和1级组(冠状动脉侧支形成不良)血清Ang-1水平[(622.59±47.75)ng/L和(728.00±35.82)ng/L]明显低于2和3级组[冠状动脉侧支形成良好,(984.39±88.34)ng/L和(1169.80±48.18)ng/L,均为P<0.01];而0和1级组血清Ang-2水平[(798.23±70.48)ng/L和(732.35±36.26)ng/L]明显高于2和3级组[(562.56±81.85)ng/L和(450.80±41.19)ng/L,均为P<0.01]。CCC分级与血清Ang-1浓度呈正相关(r偏=0.81,P<0.01),与血清Ang-2浓度呈负相关(r偏=-0.69,P<0.01)。血清Ang-1浓度与Gensini积分呈正相关(r偏=0.29,P<0.05),血清Ang-2浓度与Gensini积分无相关性(P>0.05)。结论冠状动脉严重狭窄患者,随着血清Ang-1浓度增加或(和)Ang-2浓度下降,其侧支循环越发达,Ang-1可能促进了CCC的生成,而Ang-2可能抑制了CCC的生成。     

绝经后女性冠心病患者血清脂蛋白(a)的研究

目的 :研究脂蛋白 (a) [L p(a) ]与绝经后女性冠心病 (CH D)的关系 ,并初步探讨内源性雌激素对血清 L p(a)水平的影响。方法 :采用 EL ISA法测定 5 2例绝经后女性 CHD患者及 48例健康者的血清 L p(a)浓度 ,并测定了其中 40例 CHD患者和 30例健康者的雌激素水平。结果 :CHD组平均 L p(a)浓度显著高于对照组 [(2 5 2 .9± 31.5 )∶ (12 9.2± 2 0 .0 ) mg/L ,P <0 .0 1],且与冠状动脉病变支数相关 ,r =0 .398,P <0 .0 0 1;而血清 L p(a)浓度与雌二醇水平未见显著关联。结论 :血清 L p(a)水平的增加是 CHD的独立危险因子 ,也是冠状动脉病变严重程度的一个预测因素 ,其浓度与内源性雌激素水平无关。     

The effect of collateral circulation on left ventricular systolic function

BACKGROUND: Conflicting reports exist on the influence of coronary collateral circulation on preservation of left ventricular systolic function. The aim of this study was to assess the effect of coronary collateral circulation on left ventricular systolic function in coronary artery disease. METHODS: Seventy-one consecutive patients having left anterior descending arteries with proximal or near-proximal stenosis of at least 95% (excluding 100%) were included in the study. The coronary collateral circulation to left anterior descending artery was evaluated with regard to its effects on left ventricular systolic function. RESULTS: Among the 71 patients, 46 patients were found to have a coronary collateral circulation grade of >or=1 (group 1), whereas the remaining 25 patients had coronary collateral circulation grade of 0 (group 2). The mean value of left ventricular function score in group 1 was higher than that of group 2 (3.69+/-2.34 vs. 2.00+/-1.55, P=0.002), whereas the mean value of left ventricular ejection fraction in group 1 was lower than that of group 2 (44.67+/-12.05 vs. 54.32+/-10.22, P=0.001). The value of coronary collateral circulation grade was found to be positively correlated with the value of left ventricular function score (P=0.01, r=0.3), and negatively correlated with the value of left ventricular ejection fraction (P=0.01, r=-0.3). CONCLUSION: Coronary collateral circulation to the severely stenotic left anterior descending artery was not found to have an improving effect on left ventricular systolic function. In contrast with the previous studies demonstrating the coronary collateral circulation-associated preservation of left ventricular systolic function, presence of coronary collateral circulation was found to accompany or be associated with impairment of left ventricular systolic function. The grade of coronary collateral circulation was also found to be positively correlated with the severity of left ventricular systolic dysfunction. Further research on larger patient populations based on a long-term follow-up is warranted to investigate this issue.     

磷酸肌酸钠对冠心病心力衰竭患者左室射血分数及血浆氨基末端脑钠肽原的影响

目的观察磷酸肌酸钠对冠心病心力衰竭患者左室射血分数（LVEF）及血浆氨基末端脑钠肽原（NT-proBNP）的影响。方法冠心病心力衰竭患者96例,随机分为对照组48例和治疗组48例。对照组给予常规抗心衰药物如洋地黄制剂、利尿剂、ACEI、血管扩张剂及B受体阻滞剂等治疗;治疗组在此基础上加用磷酸肌酸钠2．0g,静脉滴注,1次／d,疗程2周。观察治疗前及治疗后患者的左室射血分数及血浆NT-proBNP水平。结果治疗组治疗后与治疗前相比LVEF明显提高[（45．2±5．8）％比（38．4±6-3）％,P〈0．05],血浆NT-pmBNP水平显著降低[（2317．5±128．5）ng／L比（398．4±78．5）ng／L,P〈0．05]。对照组治疗后LVEF亦有所提高[（41．1±6．1）％比（37．3±5．2）％],但差异无统计学意义（p〉O．05）,血浆NT—proBNP水平降低[（762．8±63．9）ng／L比（2512．4±136．2）ng／L,P〈0．05]。治疗后治疗组LVEF明显高于对照组[（45．2±5．8）％比（41．1±6．1）％,P〈0．05],而NT-proBNP水平显著低于对照组[（398．4±78．5）ng／L比（762．8±63．9）ng／L,P〈0．05]。结论磷酸肌酸钠治疗冠心病心力衰竭可改善患者心功能,提高左室射血分数,降低血浆NT-proBNP水平。     

降糖速率对2型糖尿病合并冠心病患者左心功能影响

目的 研究降糖速率对2型糖尿病患者左心功能变化的影响.方法 对132例2型糖尿病患者和135例2型糖尿病合并冠心病患者强化降糖治疗,分析不同降糖速率下左心室射血分数(LVEF)、左心室舒张早、晚期充盈速度比(E/A)变化.结果 2型糖尿病组降糖速率≤6 mmol·L-1·-1及2型糖尿病合并冠心病组降糖速率≤4 mmol·L-1·d-1时LVEF较降糖前显著升高(P＜0.05);2型糖尿病合并冠心病组降糖速率＞4 mmol·L-1·d-1时LVEF较降糖前显著降低(P＜0.05),但随访时LVEF升高,亚组间比较差异无统计学意义(P＞0.05).各亚组内比较降糖后E/A均升高(P＜0.05).结论 2型糖尿病合并冠心病患者降糖速率过快会导致左心功能受损;血糖长期良好控制会修复降糖速率过快对左心功能的损伤.不论有无冠心病,降糖速率如何,强化降糖后最终左心舒张功能均改善.