急性冠脉综合征患者血浆纤维蛋白原含量与冠脉病变的相关性

目的 探讨急性冠脉综合征(ACS)患者血浆纤维蛋白原(FIB)含量与冠状动脉狭窄程度的相关性.方法 检测37例不稳定型心绞痛(UAP)患者及28例急性心肌梗死(AMI)患者静脉血中FIB含量,与同期冠状动脉造影所显示的冠状动脉狭窄程度进行对比分析.结果 ACS患者FIB随着冠脉狭窄程度变化而变化,冠脉越狭窄,FIB含量越高,不同冠脉狭窄程度组FIB含量比较,差异显著(P均<0.05).ACS患者纤维蛋白原含量与冠脉狭窄程度呈正相关.结论 FIB含量的检测对ACS患者的血管病变程度评价和指导治疗具有重要临床价值.     

52例A型行为急性冠脉综合征患者的护理

冠心病是 2 0世纪中后期危害人类健康最严重的疾病之一 ,其病死率高 ,发病率也有逐年增高趋势。自 1970年美国加州心脏病专家ｉｅｄｍａｎ和Ｒｏｓｅｎｍａｎ提出Ａ型行为的人 ,即动作快、竞争意识强、易激怒、暴躁气愤和缺乏耐心、对他人敌意、冲锋陷阵式的工作 ,可作为冠心病     

急性冠脉综合征的血运重建术

急性冠脉综合征有适应证病例或者药物治疗失败患者，无疑应行冠状动脉血运重建术，早期溶栓后使再通率明显升高，支架术在降低狭窄上至少在大血管中应用已取得成功，药物涂层包被支架防治再狭窄初期结果令人满意，急诊CABG仅适应用于介入术失败者或多支病变患者     

急性冠脉综合征及其综合治疗策略

急性冠脉综合征(ACS)指由冠状动脉粥样硬化性心脏病引起的，与增加心脏原因死亡，心肌梗死及不稳定性心绞痛危险性相关的一组临床症状，是一组冠状动脉粥样硬化斑块破裂、血栓形成或血管痉挛而致急性或亚急性心肌缺血的临床综合征。其范围涵盖了不稳定性心绞痛(UA)、非ST段抬高型心肌梗死(NSTEMI)和ST段抬高型急性心肌梗死(STEMI)。     

急性冠脉综合征住院患者心理应激源及各类需求调查

目的:调查急性冠脉综合征(ACS)住院患者心理应激源及各类需求。方法:选择近期在我院心血管内科住院ACS患者79例,40例同期住院的稳定型心绞痛患者为对照组。入选对象分别接受了杨德森编制的生活事件量表和各类需求调查问卷评估。结果:心理应激源评估中,ACS组遭遇的负性事件刺激量、家庭事件刺激量、工作事件刺激量、社交事件刺激量和精神刺激总量均明显高于对照组(P均<0.01)。需求评估中,ACS组的生理需求、心理需求、精神需求等各方面评分和需求总分均明显高于对照组(P均<0.05~0.01)。结论:ACS患者遭遇各类生活事件刺激量较大,各类需求较明显。     

吸烟与维吾尔族、汉族急性冠脉综合征类型相关性分析

急性冠脉综合征（acute coronary syndrome,ACS）是冠状动脉粥样硬化性心脏病的急危重症。主要是因各种冠心病易患因素应激及炎症因子参与导致的不稳定冠状动脉粥样斑块发生破裂,以致局部血栓形成,心肌急性缺血导致的临床综合征^[1]。包括急性心肌梗死（AMI）和不稳定型心绞痛（UAP）两种临床状态。     

急性冠脉综合征患者冠状动脉造影分析

目的　初步探讨急性冠脉综合征 (ACS)患者冠脉病变特点。方法　对 1 35例ACS患者的冠状动脉造影结果进行分析 ,对其病变特点进行研究。结果　ACS患者病变血管数量为无显著病变为 4例 ,单支病变 5 7例 ,双支病变 4 4例 ,三支病变 30例 ;所累及的血管分别为 :左主干 (LM) 3例 ,左前降支 (LAD) 1 0 1例 ,回旋支 (LCX) 5 4例 ,右冠状动脉 (RA) 74例 ;病变形态特征为 :A型病变 5 3例 ,B型病变 1 0 1例 ,C型病变 32例 ,完全闭塞型病变为 4 9例 ;病变狭窄程度为 :轻度狭窄 4 4例 ,中度狭窄 72例 ,重度狭窄 81例 ,完全闭塞型病变为 4 9例。结论　冠状动脉造影目前是评价冠脉病变的最好方法。     

Lp-PLA2与急性冠脉综合征

脂蛋白相关磷脂酶A2(Lipoprotein-associated phospholipase A2, Lp-PLA2)是一种相对较新兴起的特定血管炎性介质,是心脏大血管疾病和代谢相关性疾病的相关生物学标记物,本文综述了近年来有关Lp-PLA2在急性冠脉综合征中的潜在作用的研究进展。     

治疗前血清和肽素浓度与急性冠状动脉综合征预后的相关性研究

目的：研究治疗前血清和肽素浓度与急性冠状动脉综合征预后之间的关系。方法：收集因胸痛（发病时间〈5h）疑诊ACS患者98例,检测治疗前血清和肽素浓度,并随访其主要心血管不良事件6个月,分析二者之间的关系。结果：随访6月期间内,共有36．7％（36／98）的患者发生MACE,其治疗前血浆和肽素水平为（445．6±98．2）pg／mL,未发生MACE者治疗前血浆和肽素水平（120．2±45．3）Pg／mL,二者相比较差异具有统计学意义（P〈0．05）。对急性冠脉综合征治疗前血浆和肽素对6月内主要心血管不良事件发生之间的预测价值进行ROC分析,结果具有统计学意义（P〈0．05）;在血浆和肽素〉475．2pg／mL时,灵敏度为91．2％,特异度为85．9％。单支、双支及三支冠脉病变患者血清和肽素水平分别为（0．47±0．12）μg／L、（0．77±0．28）μg／L及（1．24±0．52）μg／L,且两两比较差异具有统计学意义（P〈0．05）。经Pearson相关分析,血清和肽素水平与冠状动脉病变支数呈正相关（P〈0．05）。结论：急性冠脉综合征治疗前和肽素水平与冠状动脉狭窄程度相关,能够提示主要心血管不良事件的发生风险,值得临床进一步推广研究。     

基质金属蛋白酶-9与急性冠脉综合征

在冠心病发生发展过程中,炎症和免疫反应具有重要意义.急性冠脉综合征(acutecoronary syndrome,ACS)是冠心病的严重临床表现形式,其发病基础是动脉粥样硬化.基质金属蛋白酶(matrix metalloproteinases,MMPs)可以降解细胞外基质(extracellular matrix,ECM),在动脉粥样硬化血管基质重建、不稳定斑块破裂引发ACS及血管重建术后再狭窄等过程发挥重要作用,其表达增加被认为是导致急性冠脉综合征的主要原因之一[1].     

Kounis syndrome: allergic acute coronary syndrome

Kounis syndrome is defined as a group of acute coronary syndromes that manifests as unstable vasospastic or nonvasospastic angina,and even as acute myocardial infarction triggered by the release of inflammatory mediators following an allergic insult.1 Kounis syndrome is a rare and complex syndrome.Instant treatment decisions need to be made once it happens.Here,we defined a case of severe Kounis syndrome,culminating in acute coronary syndrome,as a result of an acute allergic reaction,which was likely related to iodinated contrast media or dextran-40 use.     

髓过氧化物酶与急性冠状动脉综合征的相关性研究

目的 探讨血浆髓过氧化物酶(MPO)水平与急性冠状动脉综合征(ACS)的相关性.方法 分别测定29例急性冠状动脉综合征(ACS)、27例稳定型心绞痛(SAP)和31例对照者的血浆MPO、心肌肌钙蛋白Ⅰ(cTnⅠ)、高敏C反应蛋白(hs-CRP)等指标,对MPO与hs-CRP、cTnⅠ、冠脉病变支数、冠脉狭窄程度的相关性进行分析.结果 ACS组血浆MPO浓度[(2.37±1.68)ng·ml-1]高于SAP组[(0.70±0.37)ng·ml-1](P＜0.01)和对照组[(0.94±1.48)ng·ml-1](P＜0.001),SAP组与对照组之间血浆MPO浓度差异无统计学意义(P=0.68);ACS组患者MPO水平与hs-CRP呈正相关(r=0.31,P=0.039),与cTnⅠ无相关性(r=0.30,P＞0.05);3组血浆MPO浓度与冠脉病变支数无相关性(r=0.15,P＞0.05),与冠脉狭窄程度呈正相关(r=0.52,P＜0.001).结论 血浆MPO水平与斑块的不稳定性有关,MPO可以作为不稳定型斑块的早期识别标志物,用于ACS的早期诊断;血浆MPO水平增高与冠脉病变的严重程度显著相关.     

Acute coronary syndrome. An acute inflammatory syndrome

Atherosclerosis begins with the accumulation of small lipoprotein particles within arterial intima. These particles coalesce together and are modified and then they induce localized endothelial inflammation, thereby attracting leukocytes. Scavenger receptors over the surface of monocytes bind to the modified low density lipoprotein particles, which transform into foam cells that become a source for further inflammatory cytokines. The level of inflammation is heightened in ruptured coronary plaques. In patients dying of an acute myocardial infarction, the level of inflammation is heightened in all lesions in the coronary tree. The inflammatory reaction in acute coronary syndrome is not confined to cellular immunity, but also encompasses humoral immunity. High sensitivity CRP hs-CRP measures systemic inflammation, and at low levels it has emerged as a strong predictor of adverse cardiovascular events. It is mainly used to further stratify the intermediate-risk patients. Many other molecules have shown promise as markers for increased inflammation and increased risk of adverse cardiac events. That risk may be additive in nature, and some studies suggest that inflammatory markers can also predict response to various treatment strategies during acute coronary syndromes.     

Contemporary management of acute coronary syndrome

This review focuses on the modern management of the non-ST elevation acute coronary syndromes (unstable angina and non-ST elevation myocardial infarction). Patients with these syndromes are at varying degrees of risk of (re)infarction and death. This risk can be reliably predicted by clinical, electrocardiographic, and biochemical markers. Aspirin, clopidogrel, heparin (unfractionated or low molecular weight), and anti-ischaemic drugs should be offered to all patients, irrespective of the predicted level of risk. Patients at high risk should also receive a glycoprotein IIb/IIIa receptor inhibitor and should undergo early coronary arteriography with a view to percutaneous or surgical revascularisation. Lower risk patients should undergo non-invasive testing. When inducible myocardial ischaemia is exhibited coronary arteriography should follow. When non-invasive testing is negative, a conservative management strategy is safe.     

炎症反应与急性冠脉综合征的关系

<正>20世纪40年代人们首次发现炎症反应和急性冠脉综合征(acute coronary syndrome,ACS)相关。1943年,Lofstrom发现急性心肌梗死(acute myocardial infarction,AMI)患者体内表达一种和C反应蛋白(C-reactive protein,CRP)相关的物质。1956年Boltax和Fischel[1]发现AMI患者红细胞沉降率(erythrocyte sed-     

老年急性冠脉综合征的介入治疗

目的探讨65岁以上急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)的临床疗效。方法82例平均年龄(72.5±7.5)岁的老年ACS患者,男58例,女24例,所有患者均行冠脉造影证实病变,根据造影结果对“病变血管”进行经皮冠状动脉成形术和/或支架置入术。结果82例中,79例介入治疗成功,成功率为96.3%;138处靶病变,133处治疗成功,成功率为96.4%。支架完全覆盖靶病变,扩张满意,血管腔残余狭窄<20%,TIMI血流3级达到率96%。病变直径狭窄由89.5%±8.6%减轻至3.2%±8.6%(P<001)。结论老年ACS患者及早、充分、持续地开通“病变血管”,恢复前向血流,可挽救濒临坏死的心肌,挽救生命,防止左心室重构,明显改善老年ACS患者的近期和远期预后。     

Disseminated tuberculosis presenting as acute coronary syndrome

Tuberculosis is a major public health problem in Bangladesh. Though tuberculosis is common but acute myopericarditis can rarely be caused by tuberculosis infection. A case of disseminated tuberculosis presenting with features of acute coronary syndrome is presenting here. A 26 years old man was admitted for severe central chest pain for 2 days and fever for 2 months. His ECG showed ST segment elevation in chest leads, V1 to V4 with elevated Troponin I and high ESR. Chest X-Ray depicted an enlarged cardiac shadow. Echocardiography demonstrated multiple dynamic cavitary lesions involving interventricular septum as well as anterior wall of the left ventricle within myocardium with moderate pericardial effusion with trivial mitral regurgitation. A CT scan of chest with contrast revealed multiple calcific communicating cavities within endocardium and myocardium involving interventricular septum and anterior wall of the left ventricle of heart and multiple cavitary lesions in the mid zone of left lung with bilateral mild pleural effusion. The patient made an excellent recovery on management of acute coronary syndrome and on antitubercular therapy.     

辛伐他汀治疗急性冠脉综合征患者的临床观察

目的:探讨急性冠脉综合征(ACS)患者住院早期(24～48h)应用不同剂量国产辛伐他汀后对血清C反应蛋白(CRP)、纤维蛋白原(FDP)的影响以及血脂的变化及其临床意义。方法:连续入选ACS 120例患者,随机分为3组:辛伐他汀40mg组(40例)、20mg组(40例)及对照组(40例)。他汀类两组均于入院24～48h内给予辛伐他汀治疗,比较3组入院时、入院后8周高敏C反应蛋白(hsCRP)、FDP和血脂的变化。结果:治疗8周后辛伐他汀20、40mg组血清总胆固醇(TC)、低密度脂蛋白-胆固醇(LDL-L)、hsCRP、FDP水平较治疗前及对照组明显降低(P均<0.05),且40mg组改变更明显(P<0.05)。结论:早期应用辛伐他汀可明显降低ACS患者的炎症及凝血反应,40mg作用明显优于20mg。