中国冠状动脉粥样硬化性心脏病患者MEF2A基因的新突变研究

目的研究冠状动脉粥样硬化性心脏病（简称冠心病）患者MEF2A基因在中国人群突变情况。方法应用聚合酶链反应．单链构象多态性（polymerase chain reaction-single strand conformation polymorphism，PCR-SSCP）和DNA测序技术检测156例散发性冠心病（coronary artery disease，CAD）患者及93名健康人MEF2A基因第11外显子。结果在SSCP泳动异常标本中进行DNA直接测序后发现1例患者MEF2A基因147130（C→A）错义突变（P431Q）、147191（G→T）同义变异以及147108-147128位点21个碱基缺失而导致了7个氨基酸（424QQQQQQQ430）丧失。另有两例患者仅在147108-147128位点发现上述同样的21个碱基缺失而无错义突变和同义变异的改变。健康对照组未发现此错义与缺失突变，却发现存在同样的同义变异。结论冠心病患者在MEF2A基因第11外显子存在新的突变，此突变可能为病理性突变。     

颈动脉超声对冠状动脉粥样硬化性心脏病评估价值研究

目的:探讨颈动脉超声对冠状动脉粥样硬化性心脏病评估价值。方法:选择2018年2月至2019年9月的疑似冠心病患者107例进行研究。患者入组后均行冠状动脉造影剂颈动脉超声检查,根据冠状动脉造影结果将患者分为阴性组(n=33)、单支病变组(n=31)、双支病变组(n=27)及三支病变组(n=16)。对比各组血管内中膜厚度(Intimate-media thickness,IMT))、脉搏波传导速度(Pulse wave velocity,PWV)及硬度指数β(Lβ),并将颈动脉超声参数与冠状动脉病变程度进行相关性分析进行相关性分析。以ROC法评估各指标诊断价值。结果:不同组患者IMT、PWV及Lβ对比差异均具有统计学意义,且均随病变严重程度增加而增加(P0.05)。各颈动脉超声参数与冠状动脉病变支数呈显著正相关关系(P0.05)。ROC分析结果显示:联合诊断灵敏度和特异度均显著高于单独诊断(P0.05)。结论:颈动脉超声检查IMT、PWV及Lβ对冠状动脉心脏病均有较高的诊断灵敏度、特异度,联合诊断后灵敏度、特异度更高。     

RAGE基因多态性与冠状动脉粥样硬化性心脏病患者MHR比值和心率变异的相关性分析

目的:探讨晚期糖基化终产物受体(receptor of advanced glycation end products, RAGE)基因多态性与冠状动脉粥样硬化性心脏病(简称冠心病)患者单核细胞/高密度脂蛋白胆固醇比值(monocyte-to-HDL cholesterol ratio,MHR)和心率变异的...     

冠状动脉粥样硬化性心脏病临证处方活血化瘀药运用规律分析

目的:应用方剂计量学方法探讨现代医家对冠心病医治过程中活血化瘀药物的运用规律.方法:对现代医家医治冠心病的临证处方中的活血化瘀药使用方剂计量学方法进行频数、构成比和同用度分析.探讨医治冠心病的高频活血化瘀药及临证处方中活血化瘀药的应用规律.结果:高频活血化瘀药依次为丹参,桃仁,红花,当归,川芎.含有 2 味活血化瘀药的处方最多,占比高达 18.01％.平均每方含 2.36 味活血化瘀药.活血化瘀药的性味以苦、温、辛、甘为主,归经以肝经、心经、心包经为主.主要症状依次为胸闷,胸痛,心悸,怔仲、短气、气喘、胸痞、呕吐、头晕、恶心.桃仁,红花,当归,赤芍同用度指数高,其中以桃仁、红花同用度指数最大.丹参、姜黄的同用度指数最小.冠心病急性期活血化瘀药多以破血消徵为主,如三棱,莪术,土鳖虫.缓解期活血化瘀药以活血通络,养血和血为主,如当归,川芎,丹参.结论:本文运用方剂计量学方法对众多医家医治冠心病进行经验提取,剖析活血化瘀药的应用规律,为该病辨证、分期、用药提供科学依据.     

血浆活化凝血因子Ⅶ及其基因多态性与老年人冠状动脉粥样硬化性心脏病的相关分析

目的探讨血浆活化因子Ⅶ(activated coagubtionfactorⅦ,F7a)水平及其基因的MspⅠ多态性与老年人冠状动脉粥样硬化性心脏病的关系。方法采用候选基因及病例-对照的方法,以聚合酶链反应及限制性片段长度多态性分析技术,对108例老年冠状动脉粥样硬化性心脏病患者(冠状动脉粥样硬化性心脏病组)及120名年龄、性别匹配的健康人(正常对照组)行F7基因的MspⅠ多态性分析并确定基因型,同时采用重组可溶性组织因子法(rSTF2-219)测定血浆F7a水平。结果(1)老年冠状动脉粥样硬化性心脏病组血浆F7a水平显著高于正常对照组(2.88±0.62vs2.58±0.60μg/L,P<0.05),Logistic回归分析显示,血浆F7a水平与老年人冠状动脉粥样硬化性心脏病的危险性独立相关(OR1.21,P<0.05)。(2)F7基因型频率分布符合Hardy-Weinberg平衡,基因型及等位基因频率分布在两组间差异无统计学意义(P>0.05)。(3)两组血浆F7a水平均与F7基因多态性显著相关,RR基因型血浆F7a水平显著高于Q等位基因携带者(P<0.05)。结论血浆F7a水平增高是老年人冠状动脉粥样硬化性心脏病发病的独立危险因素,F7a水平受其基因的MspI多态性影响。     

冠状动脉粥样硬化性心脏病患者载脂蛋白(a)五核苷酸重复序列基因多态性的初步研究

目的　探讨载脂蛋白 (a) [apolipoprotein(a) ,apo(a) ]五核苷酸重复序列 (pentanucleotiderepeats,PNR)基因多态性与中国汉族人冠状动脉粥样硬化性心脏病 (简称冠心病 )发病的关系。方法　应用聚合酶链反应结合聚丙烯酰胺凝胶电泳和硝酸银染色 ,对 15 3名中国汉族正常人和 16 5例冠心病患者apo(a) PNR基因多态性进行了分析。结果　冠心病组 apo(a) PNR(TTTTA) 5/8基因型频率 (0 .188)和(TTTTA) 5等位基因频率 (0 .115 )显著高于正常对照组 (0 .0 39,0 .0 2 6 ) ,差异有显著性 (P <0 .0 1,P<0 .0 5 )。结论　apo(a) PNR基因多态性与人群易患冠心病有关 ,可能在一定程度上参与了冠心病的发生和发展过程。     

PAI-1基因多态性与冠状动脉粥样硬化性心脏病患者预后的相关性研究

目的 研究汉族人群纤溶酶原激活物抑制物-1(plasminogen activator inhibitor-1,PAI-1)基因4G/5G多态性与冠心病(coronary artery disease,CAD)患者主要不良心脏事件(major adverse cardiovascular event,MACE)及冠脉病变严重程度的关联.方法 应用聚合酶链反应-限制性片段长度多态性分析155例冠心病患者及190名正常人PAI-l基因的4G/5G多态性,随访患者是否发生MACE,并分析PAI-1基因4G/5G多态性与冠脉病变的关联.结果 (1)冠心病组4G/4G型频率(58/155,37.42%)明显高于对照组(52/190,27.37%),差异有统计学意义(P＜0.01).(2)PAI-1基因4G/4G型频率在MACE组(40/81,49.38%)均明显高于无MACE组(18/74,23.42%),差异有统计学意义(P＜0.01);(3)冠心病患者中PAI-1基因4G/4G型频率在多支病变组(30/47,44.77%)明显高于单支病变组(9/37,24.32%),差异有统计学意义(P＜0.05).结论 携带PAI-l基因4G/4G基因型易患冠心病,易侵犯多支冠状动脉.     

CD14启动子-159位点基因多态性与冠状动脉粥样硬化性心脏病的相关性研究

目的研究湖北地区汉族人群CD14启动予-159（C→T）多态性分布，探讨该多态性与冠状动脉粥样硬化性心脏病（冠心病）的相关性。方法应用聚合酶链反应-限制性片段长度多态性技术对湖北地区汉族162例冠心病患者及196名正常对照组者CD14基因启动子-159位点进行基因型分析。结果CD14启动子-159位点基因型频率和等位基因频率在冠心病组和对照组间比较差异有统计学意义，（基因型：X^2=0．654，P〈0．05，CT vs CC，OR=1．245，95％CI：1．001～1．473，TT vs CC，OR=2．374，95％CI：2．012～2．649；等位基因：X^2=0．547，P〈0．05，TvsC，X^2=0、547，P〈0、05，OR=3．105，95 ％CI：2．493～3．539）：CD14启动子-159位点基因型频率和等位基因频率在非心肌梗塞组和心肌梗塞组间比较差异有统计学意义（基因型：X^2=0．782，P〈0．05，CF vs CC，OR=2．375，95％CI：2．017～2．689，TT vs CC．OR=3．459，95％CI：3．003～3．846；等位基因：X^2=2．374，P〈0．05，T vs C，X^2=2．374，P〈0．05，OR=4．011，95％CI：3．814～4．279），然而，我们没有发现往冠心病狭窄血管支数之间存存差异。结论CD14启动子-159（C→T）基因多态性中的T等位基因可能是心肌梗塞的遗传学风险因素。     

冠状动脉粥样硬化性心脏病细胞问黏附分子1基因K469E多态性的研究

OBJECTIVE: To study the linkage between K469E polymorphism of intercellular adhesion molecule 1(ICAM1) gene with ICAM1 plasma level and coronary heart disease (CHD) in Han population of China. METHODS: One hundred and sixty-four controls without CHD and 160 patients with CHD were enrolled in our study. By nested PCR with allele-specific oligonucleotide primers, all patients and controls were genotyped for the ICAM1 polymorphism. And the ICAM1 plasma level was measured by ELISA. RESULTS: In the patients with CHD, both K allele frequency and the plasma level of ICAM1 were higher than those in control (P<0.05). The individual with K allele had higher plasma level of ICAM1 than that without K allele (344.34+/-128.59 microg/L vs 303.54+/-108.74 microg/L, P=0.008). K allele enhanced the risk of CHD (P<0.01, OR=2.158, 95%CI: 1.250-3.727). There was the K allele cooperation with smoking in influencing the risk of CHD. CONCLUSION: There is the polymorphism of ICAM1 K469E gene in Han population of China, and the K allele may be a genetic factor influencing the risk of CHD.     

心脏超声斑点成像技术对冠状动脉粥样硬化性心脏病的诊断价值分析

目的 探讨三维超声斑点追踪成像技术(3D-STI)对冠状动脉粥样硬化性心脏病(CHD)的诊断价值。方法 选取我院疑似CHD的患者128例,患者均采用三维超声心动图进行检查,获取心脏的三维全容积动态图,并以3D-STI对心脏三维全容积动态图进行分析。根据冠状动脉造影的检查结果将患者分成正常组、轻度组、中度组及重度组,比较各组患者的年龄、性别、左心房内径(LAD)、左心室舒张末期内径(LVEDD)、舒张期室间隔厚度(IVST)、左心室心肌质量(LV_mass)、左心室射血分数(LVEF)及三维LVEF(3D-LVEF),测量各组患者左心室整体长轴收缩期峰值应变(GLS)、左心室整体圆周收缩期峰值应变(GCS)、左心室整体径向收缩期峰值应变(GRS)、左心室整体面积收缩期峰值应变(GAS)、GAS变化率(GAS rate)及三维左心室整体应变(3D-Strain),并分析3D-STI各参数对CHD的诊断价值。结果 128例患者中,27例冠状动脉正常(正常组)、32例冠状动脉轻度狭窄(轻度组)、37例冠状动脉中度狭窄(中度组)、32例冠状动脉重度狭窄(重度组)。重度组患者的...     

冠心病患者心率变异性分析

目的研究冠心病患者心率变异（HRV）的变化规律及临床意义。方法选择50例无心律失常冠心病患者（冠心病组）、30例伴心律失常冠心病患者（心率失常组）与52例正常成人自愿者（正常组）进行24h动态心电图HRV指标比较研究。结果与正常组比较,冠心病患者SDNN、SDANN、RMSSD、PNN50和HF指标均降低,LF指标升高,具有显著差异。伴心律失常与无心律失常冠心病患者比较,HRV指标异常变化趋于恶化。结论冠心病患者心脏自主神经调节功能受到损害,迷走神经活性减弱,交感神经活动占优势。     

Change in heart rate and heart rate variability during treatment for depression in patients with coronary heart disease

OBJECTIVE: Major depression is a common problem in patients with coronary heart disease (CHD) and is associated with an increased risk for cardiac morbidity and mortality. It is not known whether treating depression will improve medical prognosis in patients with CHD. Depression is also associated with elevated heart rate and reduced heart rate variability (HRV), which are known risk factors for cardiac morbidity and mortality that may explain the increased risk associated with depression. The purpose of this study was to determine whether treatment for depression with cognitive behavior therapy (CBT) is associated with decreased heart rate or increased HRV. METHODS: Thirty depressed patients with stable CHD, classified as either mildly or moderately to severely depressed, received up to 16 sessions of CBT. The 24-hour heart rate and HRV were measured in these patients and in 22 medically comparable nondepressed controls before and after treatment of the depressed patients. RESULTS: Average heart rate and daytime rMSSD (reflecting mostly parasympathetic activity) improved significantly in the severely depressed patients, but remained unchanged in the mildly depressed and the control patients. However, only rMSSD improved to a level comparable to the control patients. None of the remaining indices of HRV showed improvement. CONCLUSIONS: The results suggest that treating depression with CBT may reduce heart rate and increase short-term HRV. Thus, CBT may have a beneficial effect on a risk factor for mortality in depressed patients with coronary heart disease. A randomized, controlled study is needed to confirm these findings.     

Complexity of the autonomic heart rate control in coronary artery occlusion in patients with and without prior myocardial infarction

Autonomic nervous system (ANS) is governed by complex interactions arising from feedback loops of nonlinear systems that operate over a wide range of temporal and spatial scales, enabling the organism to adapt to stress, metabolic changes and diseases. This study is aimed to assess multifractal and nonlinear characteristics of the ANS during ischemic events provoked by a prolonged percutaneous coronary intervention (PCI) procedure. Eighty-seven patients from the STAFF III database were used. Patients were classified into 2 groups: (1) with prior myocardial infarction (MI) and (2) without MI (noMI). R–R signals during three 3-min stages of the procedures were analyzed using multifractal and surrogate data techniques. Multifractal indices increased significantly from the pre-inflation stage to the post-deflation stage. These variations were more marked for the noMI group. Multifractal changes significantly correlated with both the decreased parasympathetic and the increased sympathetic modulations accounted by classical linear indices. Multifractal measures resulted to be a more powerful indicator than linear HRV indices in quantifying the ischemia-induced changes. Right coronary artery (RCA) occlusions provoke greater multifractal reactions throughout the PCI procedure. Our findings suggest reduced complex multifractal and nonlinear reactions of ANS activity in patients with prior MI in comparison to the noMI group, possibly due to degradation in the complexity of control mechanism of heart rate generation.     

Effect of the cholinesterase inhibitor donepezil on cardiac remodeling and autonomic balance in rats with heart failure

In an earlier study we demonstrated the beneficial effect of direct vagal electrical stimulation on cardiac remodeling and survival. In the study reported here, we attempted to reproduce the effect of vagal enhancement through the administration of an acetylcholinesterase inhibitor, donepezil. A rat model of heart failure following extensive healed myocardial infarction was used. Compared to their nontreated counterparts, rats given donepezil (5 mg/kg/day) in their drinking water had a smaller biventricular weight (3.40 ± 0.13 vs. 3.02 ± 0.21 g/kg body weight, P < 0.05), and maximal rate of rise (3256 ± 955 vs. 3822 ± 389 mmHg/s, P < 0.05) and the end-diastolic value (30.1 ± 5.6 vs. 23.2 ± 5.7 mmHg, P < 0.05) of left ventricular pressure were improved. Neurohumoral factors were suppressed in donepezil-treated rats (norepinephrine 1885 ± 1423 vs. 316 ± 248 pg/ml, P < 0.01; brain natriuretic peptide 457 ± 68 vs. 362 ± 80 ng/ml, P < 0.05), and the high-frequency component of heart rate variability showed a nocturnal increase. These findings indicated that donepezil reproduced the anti-remodeling effect of electrical vagal stimulation. Further studies are warranted to evaluate the clinical usefulness of donepezil in heart failure.     

Alteration of cardiac autonomic functions in patients with major depression: a study using heart rate variability measures

BACKGROUND: Depression is associated with greater cardiac morbidity and mortality. One of the contributory factors for this may be altered cardiac autonomic activity in depression. However, cardiac autonomic involvement in depression remains controversial because of methodological issues. In this study, alteration of cardiac autonomic functions was studied in drug-naive patients with major depression without co-morbidity. Heart rate variability, a sensitive measure of neurocardiac autonomic regulation was used in addition to conventional methods of measuring cardiac autonomic functions. METHODS: We recruited 40 patients suffering from major depression, diagnosed based on DSM-IV-TR criteria. Their cardiac autonomic functions were measured using both conventional and heart rate variability measures. These were compared with those of age- and gender-matched healthy controls. RESULTS: Patients with major depression showed significantly lesser Valsalva ratio, maximum/minimum ratio and greater sympathovagal balance than healthy controls indicating decreased parasympathetic and increased sympathetic activity. CONCLUSIONS: Depression is associated with alteration of cardiac autonomic tone towards decreased parasympathetic activity and an increased sympathetic activity. It is possible that a common neurobiological dysfunction contributes to both depression and cardiac autonomic changes in the illness.     

Cardiac autonomic function evaluated by the heart rate turbulence method was not changed in obese patients without co-morbidities

Obese subjects are more prone to sudden deaths and arrhythmias than non-obese subjects. Heart rate turbulence (HRT) impairment reflects cardiac autonomic dysfunction, in particular impaired baroreflex sensitivity and reduced parasympathetic activity. Our aim was to evaluate the cardiac autonomic function in obesity by the HRT method. Ninety obese subjects and 112 healthy subjects were included in the study. Twenty-four hours ambulatory electrocardiograms were recorded and Holter recordings were analyzed. HRT parameters, turbulence onset (TO) and turbulence slope (TS), were calculated with HRT View Version 0.60-0.1 software program. HRT were calculated in 43 obese and 43 control subjects who had at least one ventricular premature beat in their Holter recordings. We excluded 47 obese patients and 69 control subjects who showed no ventricular premature beats in their Holter recordings from the statistical analysis. There were no significant differences in TO and TS between obese and control subjects (TO obese: -1.6 +/- 2.2%, TO control: -2.1 +/- 2.6%, p>0.05; TS obese: 8.2 +/- 5.2, TS control: 10.1 +/- 6.7, p>0.05, respectively). HRT parameters seem to be normal in obese patients without comorbidities.     

Efficiency of refracterin in patients with chronic cardiac insufficiency caused by coronary heart disease

Composite preparation refracterin administered in a dose of 300 mg/day for 3 days in addition to routine therapy significantly improved the results of treatment of severe cardiac insufficiency of ischemic genesis compared to placebo. Improvement of clinical status of patients is determined by positive dynamics of systolic and diastolic functions of the left ventricle. Translated fromByulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 138, No. 7, pp. 79–82, July, 2004     

Nocturnal myocardial ischemia and cardiac arrhythmia in patients with sleep apnea with and without coronary heart disease

Summary To study the effect of apnea and hypoventilation-induced hypoxemia on the heart, we carried out polysomnographic recordings over; 4 nights with electrocardiographic tracings in 30 patients with and without coronary heart disease. Evaluations of the data were based on the 2nd and 4th nights. In six subjects, five with coronary heart disease, we found 85 episodes of nocturnal ischemia, mainly during REM sleep (83.5%), high apnea activity, and sustained and progressive hypoxemia. Complex ventricular ectopy was observed in 14/13 patients (nights 2/4) and repetitive ventricular ectopy in 5/3. There was no significant difference in the quality and quantity of ventricular ectopy during wake and sleep states between the CHD group and the control group. In one patient ventricular bigeminy was observed only at a threshold of SaO₂ below 60%. Bradyarrhythmia was made evident in four subjects from the CHD group and correlated mainly with apnea activity. We suppose that patients with sleep apnea and CHD are at cardiac risk because coronary heart disease can be aggravated by insufficient arterial oxygen supply due to cumulative phases of apnea and hypoventilation. The reduced hypoxic tolerance of the heart may lead to myocardial ischemia: and increased electrical instability.Abbreviations AI apnea index (apnea episodes per hour) - bpm beats per minute (heart rate) - CHD coronary heart disease - NREM non-rapid eye movement - PVC premature ventricular contraction - REM rapid eye movement - SRBD sleep-related breathing disorders     

Task-induced ST segment depression, ectopic beats, and autonomic responses in coronary heart disease patients

The relationship between psychologically induced autonomic responses, ST segment depression, and ectopy was examined in patients with coronary artery disease (CAD) and controls. Both groups underwent a battery of performance tasks and interviews. Performance tasks were selected to yield predictable sympathetic and vagal responses. Autonomic activation in response to stimuli was documented using heart rate, blood pressure, and vascular indices. ST segment depression was observed in a significant portion of the sample. In subjects with CAD, ST segment depression, but not ectopy, was specifically associated with mental arithmetic. In this task, autonomic changes occurred, suggesting beta sympathetic activation. The prevalence of ST segment depression during mental arithmetic declined when a task-inducing brief, phasic vagal activation was combined with the mental arithmetic. Ectopic beats were not associated with a specific task among either patients or controls. The results supported the importance of psychologically induced autonomic response for the precipitation and inhibition of ST segment depression in patients with CAD.     

冠心病患者指纹类型的分析

目的探讨冠心病与指纹类型的关系。方法采用体质测量法,分析了宁夏汉族男性群体272例(冠心病患者136例,正常对照人群136例)指纹类型的出现频率,并比较其差异性。结果冠心病患者组双手斗型纹(W)出现频率均高于正常对照组,且差异有显著性(P0.01),两组斗型纹(W)出现频率递减顺序均为ⅣⅠⅡⅢⅤ;冠心病患者组斗型纹(W)6的出现频率显著高于正常对照组(P0.05)。结论斗型纹(W)出现频率可能是冠心病早期筛查的重要指标之一。