细胞粘附分子与急性冠脉综合征

本文对细胞粘附分子在急性冠脉综合征发病机制中的作用作一综述,并对有关粘附分子方面的治疗作了简要介绍.     

130例男性与劳力相关的急性冠脉综合征临床分析

急性冠状动脉综合征(ACS)包括不稳定心绞痛,非S-T段抬高心急梗死和ST段抬高心急梗死。急性冠状动脉综合征(ACS)的主要病理机制是动脉粥样斑块破裂和血栓形成。     

急性冠脉综合征与炎症

急性冠脉综合征是心血管内科的常见病。炎症对急性冠脉综合征的发生 ,发展 ,预后起重要作用。冠状动脉粥样斑块局部的炎症细胞浸润导致斑块破裂被认为是急性冠脉综合征的最基本原因之一 ;同时全身性炎症也是急性冠脉综合征原因之一 ,测定某些炎症指标可以预测急性冠脉综合征的发生及预后。     

急性冠脉综合征的急救与护理

目的 探讨急性冠脉综合征的观察与急救护理措施.方法 对2009年12月～2010年10月72例急性冠脉综合征患者加强了病人的急救措施,给予积极治疗的同时,及时采用多功能心电监护仪监测心率、心律、呼吸、血压及病情变化,注意饮食与通便,做好治疗用药护理及心理护理,预防并发症,并加强康复训练指导.结果 72例患者经及时抢救,70例患者恢复正常生活,2例因广泛前壁心肌梗死合并心律失常、心衰而死亡.结论 通过严密监测及护理,减少了并发症的发生,明显提高了患者抢救成功率.护士娴熟的专业知识,精湛的专业技术和良好的心理素质可以促使ACS病人康复,提高病人生存质量.     

胎盘生长因子与急性冠脉综合征病变范围关系的研究

目的观察急性冠脉综合征（ACS）不同冠脉病变范围和程度患者的血清胎盘生长因子（PIGF）的浓度变化,以探讨PIGF水平在ACS的临床意义。方法所选57例ACS患者,按冠脉造影结果分为单支、双支、三支冠脉病变组并测算其反映冠脉病变程度的lenkins积分,对比分析ACS不同冠脉病变范围和程度血清PIGF的变化。结果血清PIGF浓度：冠脉病变三支组22例PIGF36．03±9．71ng／L,双支组16例39．87±10．59ng／L,单支组19例38．33±14．82／ml,任两组间均无显著差异（P〉0．05）;lenkins积分0-7分组23例PIGF浓度40．22±13．17ng／L。8—15分组27例PIGF浓度36．63±10．57ng／L。16-32分组7例PIGF浓度34．99±9．04ng／L,任两组间均无显著差异（P〉0．05）。结论ACS患者血清PIGF水平是反映冠状动脉粥样硬化斑块失稳定或斑块破裂的一个炎性生物标志物,与冠脉病变范围和程度无关。     

急性冠脉综合征人群背景因素与预后关系

急性冠脉综合征是严重危害人类健康的重大疾患。在我国,由于人们的生活水平提高,但是健康观念相对滞后,导致急性冠脉综合征高发。本文就急性冠脉综合征人群背景因素与预后关系的研究进展予以综述,以期为急性冠脉综合征的发病机制和防治提供科学依据。     

NT-proBNP在急性冠脉综合征中的研究

目的：N端脑钠素前体（N-terminal pro-B-type natriuretic peptide,NT-proBNP）在ST抬高型急性冠脉综合征（STelevation acute coronary syndrome,STE-ACS）及非ST抬高型急性冠脉综合征（non-STelevationacute coronary syndrome,NSTE-ACS）中比较分析。方法：62名伴有急性胸痛和诊断非稳定绞痛或急性心肌梗死的患者（〉killip Ⅱ型以上患者排除在外）,分别测定NT-proBNP、肌酸激酶-MB（creatine kinase-MB,CK-MB）、心肌钙蛋白I（troponin Ⅰ,TnI）。结果：CK-MB,及TnI在STE-ACS患者中明显高于NSTE-ACS,相反,NTpro-BNP在NSTE-ACS中明显高于STE-ACS患者,尤其在疾病发作3h内。结论：NT-proBNP是心肌缺血的早期诊断标志物,它在心肌损伤的早期就明显升高,尤其是在NSTE-ACS患者中。     

急性冠脉综合征（Acute Coronary Syndrome）

一、基本概念(The basal concept):指主要是由于冠状动脉严重粥样硬化导致持续性狭窄或间断性冠脉痉挛引起心肌缺血性损伤,在此病理基础上甚至进一步引起冠脉内血栓形成严重者引起急性心肌梗塞(AMI)或心源性猝死所致的临床综合征。 二、主要内容:(一)不稳定型心绞痛(Unstable Angina);(二)急性心肌梗塞(Acuts Myocardial Infarction)包括有Q波     

血栓在急性冠脉综合征发病机制中的作用

急性冠脉综合征 (Ａｃｕｔｅｃｏｒｏｎａｒｙｓｙｎｄｒｏｍｅｓ，ＡＣＳ)包括不稳定性心绞痛 (ｕｎｓｔａｂｌｅａｎｇｉｎａ,ＵＡ)、急性心肌梗死 (Ａｃｕｔｅｍｙｏｃａｒｄｉａｌｉｎｆａｒｃｔｉｏｎ ,ＡＭＩ)和猝死 (ｓｕｄｄｅｎｃａｒｄｉａｃｄｅａｔｈ ) ［１］。多数急性冠脉事件系由冠状动脉狭窄并不十分严重的斑块破裂和继发血栓形成所致 ,斑块破裂可由血液动力学、生物力学因素 (包括血压及脉压、心脏收缩和管壁应力变化、冠脉血管痉挛、斑块内毛细血管出血等 )及介入手术机械外力间接或直接损伤所致［３］。１动脉粥样硬化…     

血浆纤维蛋白原与急性冠脉综合征的相关性研究

目的 探讨血浆纤维蛋白原（FIB）水平与急性冠脉综合征（ACS）的相关性。方法 150例入选者，随机分为两组，病变组100例为ACS患者，对照组50例为正常体检人群，均测定血浆FIB。结果 QFIB在病变组显著高于对照组（P〈0．01）；②急性心肌梗死（AMI）组中，FIB显著高于不稳定型心绞痛（UA）组（P〈0．01）；③发生心脏事件患者（UA组出现AMI，心力衰竭，心源性休克，心源性死亡），FIB水平更高。结论 血浆FIB水平与ACS呈正相关，说明血浆FIB在冠脉粥样斑块的形成、稳定性及继发血栓方面有重要意义，是ACS的危险因素，且对评价病情轻重、估计预后有作用。     

急性冠脉综合征患者pentraxin-3与纤维蛋白原的变化

目的： 了解急性冠脉综合征患者炎性指标pentraxin-3与血栓指标纤维蛋白原（FIB）的变化。方法: 回顾性研究35例急性心肌梗死患者、27例不稳定心绞痛患者及15例健康体检者，所有研究对象清晨空腹抽血，检测其血浆pentraxin-3、FIB水平，并进行比较。结果: 急性冠脉综合征患者血pentraxin-3、FIB水平明显高于健康体检者，差异显著(P<0.01)；急性心肌梗死组高于不稳定性心绞痛组，差异显著(P<0.05)。Pentraxin-3浓度与FIB浓度之间存在正相关关系(P<0.01)。结论: 作为炎性指标pentraxin-3与血栓指标纤维蛋白与冠心病发生急性冠脉综合征相关，且两者相辅相成，可能共同促进急性冠脉综合征的发生。     

Effect of atorvastatin therapy on borderline vulnerable lesions in patients with acute coronary syndrome

Introduction

It is still controversial whether borderline lesions with a vulnerable plaque should be stented early or simply treated pharmacologically. No data exist concerning the potential effects of statin therapy on borderline vulnerable lesions in patients with acute coronary syndrome (ACS).

Material and methods

Fifty patients with ACS whose culprit lesions were classified as “borderline lesions” were enrolled. All patients were treated with atorvastatin (20 mg) for 12 months. Intravascular ultrasound (IVUS) was performed and matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), and high-sensitive C-reactive protein (hsCRP) levels were measured at baseline and 12-month follow-up.

Results

At 12-month follow-up, we found: 1) IVUS revealed that minimal lumen cross-sectional area (CSA) increased but plaque/media (P&M) area and plaque burden decreased. A total of 25 soft plaques (50%) were transformed into fibrous plaques. 2) ApoB, MMP-9 and hsCRP levels decreased, but TIMP-1 level increased. 3) Stepwise multivariate linear regression analysis showed that the independent predictors for changes in P&M area/year were the decrease in MMP-9 and hsCRP levels.

Conclusions

Atorvastatin therapy stabilized borderline vulnerable plaques and reversed atherosclerosis progression in patients with ACS. Reversal of this progression was accompanied by a decrease in the levels of plasma MMP-9 and hsCRP. Changes in MMP-9 and hsCRP could predict vulnerable plaque stabilization.     

Gender-based differences in the management and prognosis of acute coronary syndrome in Korea

Purpose

Gender-based differences exist in the characteristics, management, and prognosis of acute coronary syndrome (ACS). However, their impact on prognosis remains unclear. We aimed to identify factors causing these differences in Koreans.

Materials and Methods

We examined 6,636 ACS patients (66.2% males) visiting 72 Korean hospitals between April-2007 and December-2008. Gender-based differences in clinical demographics, therapy, and outcomes were analyzed over 6 months.

Results

Women were older than men [mean (standard deviation, SD) age, 67.6 (9.8) vs. 60.6 (11.2) years; p<0.001]; had higher rates of hypertension, diabetes mellitus, and lack of exercise (p<0.001 for all); and lower rates of obesity, familial history of cardiovascular disease (CVD), and smoking (p<0.05 for all). Atypical symptoms were more common in women (20.5% vs. 15.1% in men, p<0.001), whereas myocardial infarction with ST-segment elevation was less common (17.1% vs. 27.8%, p<0.001). Mean (SD) time lapse from symptom onset to arrival at hospital was longer in women [11.44 (18.19) vs. 8.26 (14.89) hours in men, p<0.001], as was the duration of hospitalization [7.58 (7.61) vs. 7.04 (7.72) days, p=0.007]. Fewer women underwent revascularization procedures, including thrombolytic therapy, balloon angioplasty, stent implantation, and coronary artery bypass grafting (79.4% vs. 83.3% men, p<0.001). No significant differences were observed in CVD-related death, recurrent ACS, stroke, refractory angina, or rehospitalization for angina.

Conclusion

Female ACS patients were older than male subjects and had more atypical presentation. They arrived at the hospital later than men and had longer hospital stays, but less often required revascularization therapy. However, no gender-based differences were noted in ACS-related mortality and morbidity.     

急性冠脉综合征患者介入术后可视化血液流变性与血小板功能的相关性分析

 目的:应用可视化血液流变性检测仪（MC-FAN）并结合血小板功能指标的检测,观察急性冠脉综合征(ACS)介入术后患者血液流变性的变化特点,并探讨患者血液流变性可视化结果与血小板功能指标的相关性。方法:纳入74例ACS介入术后1～3年的患者,21例健康者为健康对照组,应用MC-FAN检测2组人群的血液通过模拟人体毛细血管的时间（MC-FAN TT）和比较不同时段的结果,同时检测血小板聚集性、血小板黏附性、血小板P-选择素、血小板衍生生长因子BB和血管假性血友病因子指标,观察ACS介入术后患者的MC-FAN 结果与血小板功能的相关性。结果:与健康对照组相比,ACS介入术后患者的血流MC-FAN TT延长(P<0.01),红细胞变形能力减弱,白细胞附壁及血小板的黏附、聚集相对增多;ACS介入术后患者的血小板最大聚集率、血小板黏附率、血小板P-选择素水平及血小板衍生生长因子BB水平均高于健康对照组（P<0.01）;2组间血管假性血友病因子差异无统计学意义（P>0.05）。组内相关性分析显示：MC-FAN TT与血小板功能存在相关性,其中10 μL MC-FAN TT和30 μL MC-FAN TT与P-选择素呈正相关（r=0.601,P<0.01;r=0.334,P<0.01）;60 μL MC-FAN TT与血小板最大聚集率呈正相关（r=0.527,P<0.01）;100 μL MC-FAN TT与血小板黏附率呈正相关（r=0.815,P<005）。结论:ACS介入术后患者的可视化血液流变性及血小板功能异常,MC-FAN TT与血小板功能存在相关性,MC-FAN检测仪可客观地评价介入术后患者血液流动的状态。     

白介素-18与急性冠状动脉综合征

动脉粥样硬化斑块的不稳定导致冠心病特殊疾病谱——急性冠状综合征的发生。炎症机制在动脉粥样硬化斑块的发生、发展中扮演重要角色。近年来，不断有研究证实前炎症因子白介素-18密切参与了此过程，并且与急性冠状动脉综合征的发生有着极强的关联。     

rs501120位点基因型与糖尿病合并急性冠脉综合征病情进展的关联研究

目的 调查rs501120位点不同基因型糖尿病合并初发急性冠脉综合征患者急性冠脉综合征的再发生状况,以了解rs501120位点基因多态性与冠状动脉病变进展程度及斑块不稳定的关系.方法 选取2型糖尿病合并初发急性冠脉综合征患者902例,采用TaqMan-MGB探针检测rs50112位点的单核苷酸多态性(single nucleotide polymorphism,SNP),从中选取年龄与性别相匹配的TT型、TC型与CC型病例各205例,随访观察3年,调查不同基因型人群急性冠脉综合征再发生状况.结果 TT基因型人群急性冠脉综合征再发生率较CC型显著升高(TT vs CC,OR=1.7,95％CI:1.1～2.7,P=0.02),TT基因型人群心肌梗死发生率较CC型升高,差异有统计学意义(TT vs CC,OR=1.9,95％CI:1.2～3.2,P=0.007).经Logistic回归分析去除混杂因素后,TT基因型人群对比CC基因型人群仍有显著升高的急性冠脉综合征再发风险(OR=1.6,95％CI:1.05～3.6,P=O.03).结论 rs501120位点基因多态性可能与冠状动脉病变进展程度及斑块不稳定相关.     

Frailty for predicting all-cause mortality in elderly acute coronary syndrome patients: A meta-analysis

BackgroundFrailty has been identified as a risk factor for mortality in patients with acute coronary syndrome (ACS). This meta-analysis aimed to evaluate the association between frailty and all-cause mortality outcome in patients with ACS.MethodsPubmed and Embase databases were searched up to September 26, 2018 for the observational studies evaluating the association between frailty and all-cause mortality in elderly ACS patients. Outcome measures were in-hospital death, short-term all-cause mortality (≤6 months),and long-term all-cause mortality (≥12 months).The impact of frailty on all-cause mortality was summarized as hazard ratios (HR) with 95% confidence intervals (CI) for the frail versus nonfrail patients.ResultsA total of 9 cohort studies involving 2475 elderly ACS patients were included. Meta-analysis showed that ACS patients with frailty had an increased risk of in-hospital death (HR 5.49; 95% CI 2.19–13.77), short-term all-cause mortality (HR 3.56; 95% CI 1.96–6.48), and long-term all-cause mortality (HR 2.44; 95% CI 1.92–3.12) after adjustment for confounding factors. In addition, prefrailty was also associated with an increased all-cause mortality (HR 1.65; 95% CI 1.01–2.69).ConclusionsThis meta-analysis demonstrates that frailty independently predicts all-cause mortality in elderly ACS patients. Elderly ACS patients should be assessed the frailty status for improving risk stratification.     

Changes of monocyte subsets in patients with acute coronary syndrome and correlation with myocardial injury markers

Objective: To explore the changes of peripheral blood monocytes subsets in acute coronary syndrome (ACS) and its clinical significance. Methods: A total of 68 ACS patients and 27 healthy subjects (HS) were enrolled. Monocyte subset analysis was performed using flow cytometry: CD14++CD16-(Mon1), CD14++CD16+ (Mon2), and CD14+CD16++ (Mon3). Results: 1. The number of Mon1 and Mon3 were significantly increased in ACS patients compared with HS (P<0.05) and Mon2 decreased in ACS patients (P<0.05). 2. The number of Mon1, Mon2, Mon3 was positively correlated with WBC count (P<0.05). The Mon2% was negatively correlated with the serum levels of LDH, CK, CK-MB (P<0.05). The number of Mon1, Mon3 was positively correlated with the serum levels of LDH, CK, CK-MB (P<0.05). Conclusion: The changes in different subsets of monocytes may be associated with pathogenesis of ACS and myocardial injury. The findings might be useful in the assessment of myocardial injury.     

High sensitivity cytokine detection in acute coronary syndrome reveals up-regulation of Interferon Gamma and Interleukin-10 post Myocardial Infarction

Inflammation is an important element in the development and destabilization of atherosclerotic plaque. Using a high sensitivity multiplex assay, previously untested in the context of atherosclerotic disease, we determined serum concentrations of GM-CSF, IFNγ, IL-1β, IL-2, IL-10, IL-12p70, TNF α, IL-6, and IL-8 in 48 Myocardial Infarction (MI) patients, 14 Unstable Angina (UA) patients and 12 healthy controls. IFNγ levels were significantly higher in MI compared to UA (p = 0.0091) and Control groups (p = 0.0014). IL-10 also showed higher expression levels between MI, UA groups and Controls (p = 0.0299).This up-regulation may reflect the extent of plaque instability and/or rupture in MI patients.Our observations provide evidence that IFNγ and IL-10 merit further investigation in atherosclerotic disease states as potential markers of disease and therapeutic targets.     

心肌脂肪酸结合蛋白浓度对急性冠脉综合征临床转归的预测价值

目的：探讨血浆心肌脂肪酸结合蛋白（H-FABP）浓度对急性冠脉综合征（ACS）患者临床预后的预测价值。方法：连续入选172例住院的ACS患者,于出现胸痛6 h内测定H-FABP浓度,并随访1年,以再发心血管事件（包括心脏性死亡、非致命性心肌梗死、非致命性心力衰竭及反复心绞痛发作住院）作为研究终点。结果：经过1年随访,共有47例患者发生心血管事件,其中心脏性死亡6例,非致命性心肌梗死9例,非致命性心力衰竭11例,反复心绞痛发作住院21例。心血管事件组H-FABP浓度较无心血管事件组显著增高（P<0.01）;H-FABP浓度增高（>中位数12.5 μg/L）组患者出现心血管事件明显增加（36例 vs 11例,P<0.01）;Cox比例风险模型多因素逐步分析显示H-FABP浓度增高是ACS患者再发心血管事件的独立危险因子（RR=5.430,P<0.01;95% CI 2.587-11.398）。结论：H-FABP浓度增高的ACS患者再发心血管事件风险显著增加,H-FABP浓度增高可能是ACS患者预后的独立预测因子。