踝臂指数与冠脉病变关系的研究

踝臂指数（Ankle—brachial index,ABI）常用于下肢外周动脉病（Perip heral arterial disease,PAD）的诊断,近年研究显示踝臂指数（ABI）降低对预测心血管事件的发生和死亡也具有很高的价值。本研究对进行选择性冠状动脉造影（Coronary arteriography,CAG）患者同时测量踝臂指数,探讨踝臂指数与冠状动脉病变程度的关系。     

踝臂指数与冠状动脉旋磨术的相关研究

目的探讨踝臂指数(ABI)在冠状动脉严重钙化旋磨治疗患者中的意义。方法回顾性分析149例行经皮冠状动脉旋磨(CRA)治疗的不稳定型心绞痛(UA)患者,按ABI检查结果分为ABI正常组(0.9≤ABI≤1.4)96例和ABI降低组(ABI<0.9)53例,分析患者冠状动脉造影(CAG)及CRA治疗资料。结果 ABI降低组左室射血分数低于ABI正常组;ABI降低组使用平均旋磨头个数、预扩球囊数、后扩球囊数、旋磨血管并发症高于ABI正常组,组间比较差异有统计学意义(P<0.05)。结论与ABI正常组相比,ABI降低组的冠状动脉血管腔狭窄程度重,行CRA时,旋磨头、预扩张球囊、后扩张球囊等耗材数量及旋磨血管并发症增加。     

踝臂指数和无症状颅内动脉狭窄的相关性

 目的 研究踝臂指数(ABI)和无症状颅内动脉狭窄(ICAS)的相关性。方法 随机抽取5206名研究对象,进行问卷调查、体格检查、实验室检查及经颅多普勒超声(TCD)、ABI检测。颅内动脉狭窄依据经颅多普勒(TCD)诊断;ABI分类依据 2011 ACCF/AHA 指南: 异常ABI(ABI≤0.90), 临界ABI(0.91～0.99),正常ABI(1.00～1.40)。ABI与ICAS的相关性采用多因素 logistic 回归分析。结果 临界ABI(0.91～0.99)(OR=1.364,95%CI:1.024～1.818)和异常ABI(ABI≤0.90)(OR=1.890, 95%CI:1.345～2.658)均与无症状颅内动脉狭窄相关。进一步分组研究显示:在男性中, ABI≤0.90与ICAS密切相关(OR=2.143,95%CI:1.419～3.235) ,但在女性中,两者则无明显相关性。在60岁以上人群中,临界ABI(0.91～0.99)及ABI≤0.90均与ICAS的发生密切相关,OR值分别为1.963(95%CI:1.252～3.079)和2.771(95%CI:1.788～4.293),但在60岁以下人群中临界ABI及异常ABI均与ICAS无关。结论 在无症状人群中,ABI可以作为颅内动脉狭窄的风险评估指标,但其检测价值因不同性别及年龄而不同。
     

高海拔地区联合踝臂指数与彩超筛查糖尿病下肢血管病变的意义

目的：探讨青海西宁地区踝臂指数（ankle brachial index,ABI）联合彩超（CDFI）筛查糖尿病下肢血管病变的意义。方法：选取2012年12月—2014年2月在我院体检中心体检的西宁地区2型糖尿病人群150例和147例非糖尿病人群进行ABI检测,对ABI≤0.9、ABI≥1.3异常者同时进行双下肢血管彩超检查,并进行对照分析。结果：150例糖尿病组中ABI异常检出18例,占总数的12.00%,在147例非糖尿病组中ABI异常检出9例,占总数的6.12%,两组ABI异常检出率比较差异有统计学意义（P〈0.05）;ABI异常经下肢血管彩超证实有病变的糖尿病组7例（38.89%）,非糖尿病组1例（11.11%）,两组比较存在显著差异（P〈0.01）。结论：联合踝臂指数与下肢血管彩超在早期筛查糖尿病下肢血管病变中有重要的指导意义。     

脉搏波速和踝臂指数在冠心病及其危险因素检测中的临床应用进展

随着人们生活水平的提高，生活方式和习惯的改变，动脉硬化性疾病发病率逐年提高。冠心病是动脉粥样硬化发展引起器官损害的结果，是全身动脉硬化性疾病的一部分，对人类健康危害极大。早期发现动脉粥样硬化临床前期病变（preclinieal atherosclerosis，PCA）并进行及时有效的干预，是控制心血管疾病与事件的关键和根本措施。     

不稳定型心绞痛患者胰岛素抵抗与血脂代谢变化的临床分析

１对象与方法６１例冠心病住院患者,无糖尿病、高血压病史,体重指数＜２５,肝肾功能检查正常,按ＷＨＯ标准分为：①不稳定性心绞痛组（ＵＡ）：２９例,平均年龄５５．６岁,男２０例,女９例;②稳定性心绞痛组（ＳＡ）：３２例,平均年龄５６．２岁,男２３例,女９...     

丹红注射液对不稳定型心绞痛血管内皮功能及心功能的影响

目的 观察丹红注射液对不稳定型心绞痛血管内皮功能及心功能的临床疗效.方法 78例不稳定型心绞痛患者随机分为两组,即对照组和治疗组,每组39例.对照组给予采用常规内科治疗,治疗组在此基础上加用丹红注射液.治疗结束后对两组患者的血管内皮功能及心功能改善情况进行观察.结果 (1)血管内皮功能:与治疗前比较,两组患者NO、FMD显著升高,ET显著下降,差异有统计学意义(P<0.05),且治疗组改善更为明显(P<0.05);(2)心功能:治疗组总有效率(94.87%)显著高于对照组(76.92%),两组比较差异有统计学意义(P<0.05).结论 丹红注射液通过改善血管内皮功能和心功能以达到治疗不稳定型心绞痛的目的,值得临床推广.     

青年与老年不稳定型心绞痛临床特征、冠脉病变特点及预后情况比较

目的探讨青年与老年不稳定型心绞痛患者危险因素、冠脉病变特点以及预后的区别。方法回顾性分析2012年入住我院的不稳定型心绞痛患者,按照年龄将≤45岁者分为青年组(n=257),将≥65岁者分为老年组(n=320),比较两组患者危险因素、冠脉病变特点以及预后情况。结果青年组的糖尿病、原发性高血压、HDL-C显著低于老年组(P<0.01),但BMI、TC、LDL-C、吸烟率、家族史显著高于老年组(P<0.05或P<0.01);青年组患者的单支病变比率显著高于老年组(P<0.05),但老年组三支血管病变和侧支循环比率要显著高于青年组(P<0.01);青年单支和双支病变组患者术后12个月各主要心脑血管事件的发生率低于或略低于老年组,差异无统计学意义,但三支血管病变时主要不良事件发生率显著高于老年组。结论肥胖、血脂异常、吸烟、家族史是青年患者的危险因素;青年患者单支病变较多,预后较老年患者好,但三支血管病变时预后比老年患者差。     

银杏达莫注射液对老年2型糖尿病并周围血管病变患者踝臂指数的影响

目的：对照观察银杏达莫注射液和复方丹参注射液对老年2型糖尿病患者踝臂指数的影响。方法：60例老年2型糖尿病患者随机分为两组,实验组（34例）,在常规控制血糖的基础上,每日静脉滴注银杏达莫注射液20mL溶入生理盐水250mL中静滴,连续14d。对照组（26例）,基础治疗同实验组,并予复方丹参注射液250mL静滴,连续14d。于治疗前及治疗后14d检测踝臂指数。结果：两组踝臂指数治疗前无显著差异（P〉0.05）,治疗后14d,两组踝臂指数均有下降,实验组前后对比有显著差异（P〈0.01）,对照组治疗前后无显著差异（P〉0.05）,实验组与对照组比较下降幅度较大,有显著差异（P〈0.01）。结论：银杏达莫注射液对2型糖尿病合并周围血管病变有较好的治疗作用。     

不稳定型心绞痛患者血浆蛋白标记物的蛋白质组学筛选

目的 分析冠心病不稳定型心绞痛(UAP)与稳定型心绞痛(SAP)患者血浆中的差异蛋白质,筛选可能与UAP早期诊断密切相关的血浆蛋白标记物.方法 分别收集2014年6月-2015年4月南方医科大学第三附属医院UAP及SAP血浆标本各60例,另收集体检科收集的血浆标本作为正常对照组(n=60).随机取对照组(n=10)、UAP组(n=10)与SAP组(n=10)空腹血浆标本各100μl,分别等量混合成3组样本,去除血浆高丰度蛋白后,利用双向差异凝胶电泳(DIGE)技术进行蛋白分离,经差异软件分析后,采集UAP和SAP之间变化2倍以上的差异蛋白质点,利用基质辅助激光解吸电离-飞行时间/飞行时间质谱(MALDI-TOF/TOF MS)对差异蛋白点进行鉴定.每组随机选取40份血浆样本,选取UAP特异性差异蛋白进行ELISA验证.结果 UAP与SAP组患者血浆相比较,共筛选出10个表达量差异2倍以上的差异蛋白点,包括9个上调蛋白点,1个下调蛋白点.经质谱鉴定后,表达上调的蛋白包括纤维蛋白原γ链(FGG)、补体C4-B(C4B)、免疫球蛋白κ链C结构域(IGKC)和血红蛋白α亚基(HBA1);表达下调的蛋白是结合珠蛋白(HP).与对照组比较后,在这些差异蛋白中共找到2个UAP特异性相关蛋白,即IGKC和HP.选取IGKC进行ELISA验证,结果表明,与对照组和SAP组相比较,UAP组样本中IGKC特异性表达上调(P<0.05),与DIGE验证结果一致.结论 筛选到UAP特异性相关蛋白IGKC和HP,IGKC有可能成为UAP早期筛查及诊断的特异性生物标记物.     

大株红景天治疗高龄老年人不稳定型心绞痛临床分析

目的探讨大株红景天治疗高龄老年人不稳定型心绞痛的临床疗效。方法将64例患者随机分为对照组30例和治疗组34例,对照组釆用常规治疗;治疗组在常规治疗的基础上,加用大株红景天注射液10 ml＋5%葡萄糖液或生理盐水250 ml,静脉滴注,1次/d,10 d为1疗程。结果治疗组心绞痛、心功能及心电图明显改善,两组比较有统计学差异（P〈0.05）。结论大株红景天注射液辅助治疗老年人不稳定型心绞痛疗效显著,安全性高。     

Prognostic value of quantitative stress myocardial perfusion imaging in unstable angina patients with negative cardiac enzymes and no new ischemic ECG changes

Background. Limited data are available on the value of quantitative stress myocardial perfusion imaging (MPI) in patients with unstable angina. In this report we sought to study the long-term prognostic value of quantitative stress MPI in patients hospitalized with unstable angina with no new ischemic electrocardiographic changes and negative cardiac enzymes. Methods and Results. The study population consisted of 136 patients who were hospitalized at the Methodist Hospital, Houston, Tex, with unstable angina and subsequently underwent MPI before discharge. Cox proportional hazards (regression) analysis was performed to identify clinical and MPI predictors of hard cardiac events (death or nonfatal myocardial infarction). During a mean follow-up of 31 ± 17 months, 20 patients (15%) sustained either cardiac death (n = 12) or nonfatal myocardial infarction (n = 8). The significant multivariate predictors of cardiac events were the total perfusion defect size (P = .002), the presence of reversible perfusion defects (P = .01), and the presence of multiple perfusion defects (P = .03). The perfusion defect size was significantly larger in patients with events than in those without events (21% ±20% vs 12% ± 14%, P = .002). Kaplan-Meier analysis showed that cardiac events were much more likely to develop in patients with defects involving 15% or more of the left ventricle than in those with defects involving less than 15% of the left ventricle (P = .003). Conclusions. In patients hospitalized with unstable angina with no new ischemic electrocardiographic changes and negative cardiac enzymes, quantitative stress MPI provides powerful prognostic information that can be used in the risk stratification of these patients. (J Nucl Cardiol 2005;12:32-6.)     

某部飞行员踝臂指数的测定及临床意义

 目的 测定飞行员踝臂指数(ankle brachial pressure index,ABI)并探讨其临床意义.方法 选择某部125名飞行员,按年龄分为≤30岁、30～39岁及≥40岁3组,每一年龄段再按是否吸烟分为两组,分别测定ABI、收缩压、舒张压、体重指数.对比各年龄段吸烟组与非吸烟组飞行员ABI,分别计算ABI与年龄、飞行时间的直线相关系数.结果 (1)≤30岁和30～39岁飞行员吸烟组臂踝脉搏波传导速度与非吸烟组比较差异无统计学意义(P＞0.01);(2)≥40岁组飞行员吸烟组ABI较非吸烟组显著降低(P＜0.01);(3)pearson相关分析表明,ABI与年龄、飞行时间呈正相关(P＜0.01).结论 ≥40岁飞行员吸烟组与非吸烟组ABI差异具有统计学意义,年龄、飞行时间与ABI显著相关.     

Differences in coronary artery disease by CT angiography between patients developing unstable angina pectoris vs. major adverse cardiac events

Objective

CT angiography (CTA) has prognostic value in patients. But it is unknown whether differences in atherosclerosis by CTA predict the development of unstable angina pectoris (UAP) vs. major adverse cardiac events (MACE).

Methods

We followed patients undergoing CTA as part of their acute chest pain work-up. Primary outcome was the development of UAP or MACE (cardiac death, myocardial infarction, revascularization) during a minimum follow-up of 12-months. CTAs were assessed for extent and composition of coronary plaque and stenosis. Ordinal regression with a 3-level outcome (no events, UAP, MACE) was applied.

Results

Among 315 patients, 22 developed UAP and 31 MACE. While UAP patients had higher atherosclerosis burden with respect to all assessed features compared to patients with no events (p ≤ 0.02), only mixed plaque extent was significantly different between UAP and MACE patients (p = 0.02). The odds ratio was 4.55 for being in a higher disease-level comparing patients with low extent to those with no mixed plaque, and 3.02 comparing patients with high to those with low. These findings remained after adjustments for potential confounders.

Conclusion

The extent of mixed coronary plaque is different between patients who develop UAP vs. MACE, supporting the hypothesis that it is a more culprit morphology.     

辛伐他汀对不稳定型心胶痛患者血小板CD62P、单核细胞和血小板CD40L表达的影响

目的探讨辛伐他汀对不稳定型心胶痛患者血小板CD62P、单核细胞和血小板CD40L的影响。方法将68例不稳定型心胶痛患者随机分成辛伐他汀组（34例）和常规治疗组（34例），比较治疗前及治疗8周后血小板CD62P、单核细胞和血小板CD40L的变化情况。结果两组治疗后血小板CD62P、单核细胞和血小板CD40L较治疗前明显降低（P〈0．05或P〈0．01）。治疗后辛伐他汀组血小板CD62P、单核细胞和血小板CD40L较常规治疗组明显降低（P〈0．05）。结论在治疗8周后，辛伐他汀可明显改善不稳定型心胶痛患者的血小板活化功能并显示其抗炎作用。     

Subgroup characteristics of patients with chronic ankle instability in primary care

ObjectivesTo examine clinical and radiological characteristics of participants with an ankle sprain in general practice, classified into subgroups of a previously described chronic ankle instability (CAI) model.DesignCross-sectional study.Methods206 participants, who visited their general practitioner with a lateral ankle sprain 6–12 months before inclusion, completed a questionnaire, physical examination, radiography and magnetic resonance imaging. They were classified into three subgroups of the previously described CAI-model: mechanical instability (MI), perceived instability (PI) and recurrent sprains (RS). Regression analyses were applied to evaluate differences in subgroup characteristics.ResultsA total of 192 participants were eligible to be classified into the model. Of these participants, 153 participants were classified into the subgroups and 39 could not be classified. With overlap between the subgroups and patients falling into more than one subgroup, 59 were classified having MI, 145 having PI and 30 having RS. Participants with RS and PI were more often sports participants (OR 6.83;95%CI 1.35–34.56 and OR 4.44;95%CI1.06–18.63 respectively) than participants without RS and PI. Participants with MI more often had a tenderness on palpation of the anterior talofibular ligament (OR 4.09;95%CI 1.91–8.72) and a KL-score ≥ 1 in the talonavicular joint on X-ray (OR 2.24;95%CI 1.09–4.58), compared to participants without MI.ConclusionsSports participation, tenderness on palpation of the anterior talofibular ligament and early signs of osteoarthritis were variables that discriminated between subgroups of CAI. However, further research is mandatory in order to examine the usefulness of the CAI model in relation to prognosis and suitable intervention.     

绝经前后急性心肌梗死患者冠状动脉病变及相关危险因素研究

 目的 探讨绝经前后急性心肌梗死(acute myocardial infarction,AMI)患者冠状动脉病变及相关危险因素.方法 回顾性分析2005-01至2010-01解放军总医院收治的女性AMI患者246例,根据是否绝经及绝经年限进行分组,对冠状动脉造影结果及冠心病危险因素进行对比分析.结果 (1)绝经前组阻塞性病变的比例低于绝经后各组(P＜0.05);各组前降支病变比例均高于其他位置病变(P＜0.01);绝经年限与冠状动脉阻塞性病变的发生有相关性(P=0.024,OR=0.697).(2)绝经前组HDL-C平均水平高于绝经后各组(P＜0.05);绝经前组高尿酸血症者比例低于绝经后各组(P＜0.05);绝经前组有早发冠心病家族史者比例高于绝经后各组(P＜0.01);绝经年限与高尿酸血症有相关性(P=0.031,OR=0.767).结论 绝经前后女性AMI的冠状动脉病变及危险因素有所不同,应根据不同生理阶段女性冠心病的发病特点,做好女性冠心病的早期预防和诊治工作.