老年冠心病凝血纤溶活性变化的研究

为探讨D-二聚体(D-dimer,DD)、纤维蛋白原(fibrinogen,Fg)、凝血酶原时间(prothrombin time,PT)、活化部分凝血激酶时间(activated partial thromboplastin time,APTT)在老年冠心病患者中的变化及相互关系,本研究测定了50例健康老年人和80例冠心病患者血浆中DD、Fg含量及PT、APTT,并进行比较分析.     

蒙古族冠心病患者血浆纤溶活性的研究

目的研究蒙古族冠心病(CHD)发病与血浆纤溶活性变化的关系。方法分别采集32例蒙古族CHD患者、30例蒙古族无CHD者(对照组),41例汉族CHD患者、55例汉族正常人(对照组)晨起空腹静脉血,肝素抗凝后冷冻保存。t-PA、PAI-1含量通过酶联免疫吸附双抗体法(ELISA);Fbg通过抗原-抗体复合物法测定。结果蒙古族CHD组、蒙古族对照组、汉族CHD组、汉族正常组的年龄与Fbg、t-PA、PAI-1无相关性。无论是蒙古族CHD组还是汉族CHD组血浆PAI-1、PAI-1/t-PA值均比无CHD的对照组低,而Fbg、t-PA值比较均无统计学意义;蒙古族CHD组的t-PA、PAI-1/t-PA值较汉族CHD组低,Fbg值高,而PAI-1无统计学意义;在蒙古族CHD组与汉族正常组比较中,Fbg、PAI-1、PAI-1/t-PA有意义;而两个对照组之间的比较,只发现t-PA、PAI-1/t-PA有统计学意义。结论CHD患者血浆纤溶活性降低,主要与PAI-1水平增高有关;蒙古族CHD患者较汉族CHD患者血浆纤溶活性降低,主要与t-PA水平降低及Fbg水平增高有关;蒙古族对照组较汉族对照组血浆纤溶活性降低,主要与t-PA水平降低有关。     

纤溶活性在2型糖尿病冠心病的研究

目的观察2型糖尿病（DM）无血管病变组（A组）43例与DM并冠心病组（B组）41例及对照组（C组）40例的纤溶活性。方法测定124例患者的组织纤溶酶原激活物（tPA）、纤溶酶原激活抑制物-1（PAI-1）,并对A组追踪观察上述指标2年。结果①PAI-1在A、B组都高于C组;B组高于A组;②tPA在A、B组都低于C组;B组低于A组,上述差异都有统计学意义（P〈0．05或P〈0．01）。结论①DM发生临床血管病变前即有纤溶异常,发生血管病变则改变更显著。②上述指标可作为反映DM血管病变的预测及监测指标。     

冠心病患者运动诱发急性心肌缺血时纤溶功能的改变

经冠状动脉造影确诊的冠心病（ＣＨＤ）患者１８例，对照组１１例，采用平板运动试验诱发急性心肌缺血，检测运动前后纤溶功能的改变。结果表明：①ＣＨＤ患者运动试验阳性亚组（１２例）及其中有运动诱发胸痛者运动前或运动后的血浆纤维蛋白原（Ｆｇ）、纤溶酶原激活剂抑制物（ＰＡＩ）活性水平均显著高于相应的阴性亚组、对照组及无胸痛者，并且其ＰＡＩ活性约高出对照组基础水平１倍以上；②ＣＨＤ患者运动试验阴性亚组运动前或运动后的血浆ＰＡＩ活性及运动后血浆Ｆｇ水平均高于对照组基础水平。本研究提示，ＣＨＤ患者纤溶系统存在严重缺陷，其基础水平纤溶活性显著降低（特别是血浆ＰＡＩ活性显著增高）者易在剧烈活动因素诱发下发作急性心肌缺血和（或）心绞痛；平板运动试验结合Ｆｇ、组织型纤溶酶原激活剂及ＰＡＩ的检测可能有助于对ＣＨＤ诊断时的参考。     

冠心病患者纤溶活性,血小板功能及内皮素在运动前后的变化？…

目的 研究冠心病患者在运动前后纤溶活性，血小板活化状态及血管内皮功能的变化。方法 根据冠状动脉造影结果，选择冠心病患者（ＣＨＤ组）３７例，分为单支及多支病变组，另选健康人２７例为对照组（Ｃ组），采用次极量运动试验观察上述部分指标在运动前后的变化，结果 （１）运动前，组织型纤溶酶原激活剂（ｔＰＡ）纤溶酶原激活剂抑制因子－１（ＰＡＩ－１）活性，血浆５－羟色胺（５－ＨＴ）水平及血小板５－ＨＴ２Ａ受体密度     

急性心肌梗死患者纤溶活性的变化

急性心肌梗死（ＡＭＩ）的发生,９０％是由冠脉内粥样斑块破裂血栓形成引起［１］。而血栓形成与纤溶系统的活性改变密切相关,其中组织型纤溶酶原激活剂（ｔ－ＰＡ）及其抑制物（ＰＡＩ－１）对调节纤溶活性起着决定性的作用［２］。为此,本研究对１８例ＡＭＩ患者的纤溶活性做了初步观察。 对象和方法 １．研究对象 选择发病２４小时内符合１９７９年ＷＨＯ诊断标准的ＡＭＩ患者１８例,为我院住院患者,年龄（５６．２ ±１０．５）岁,男１４例,女４例,正常对照组１８例,均经体检。ＥＣＧ等证实无心肺肝等疾病者,男１５例,女３例…     

体外反搏对冠心病患者内皮素及组织型纤溶酶原活性的影响

应用体外反搏（ＥＣＰ）治疗４０例冠心病患者，按病情分为３组，急性心肌梗死５例，不稳定型心绞痛１３例，稳定型心绞痛２２例。观察ＥＣＰ前后内皮源性血管活性物质内皮素０１（ＥＴ－１）、组织型纤溶酶原激活物（及其抑制剂（ＰＡＩ－１），结果显示，反搏后ＥＴ－１含量、ＰＡＩ－１活性明显下降；ｔ－ＰＡ活性明显回升。提示ＥＣＰ治疗冠心病除血流动力学、血液流变学等因素外，还可改变内皮源性血管活性物质的活性，从而对Ｅ     

不稳定性心绞痛患者凝血和纤溶活性的动态变化

不稳定性心绞痛患者凝血和纤溶活性的动态变化陈纪林徐义枢孙继良赵秀文于全俊吴元陈在嘉斑块破裂诱发局部非闭塞性血栓形成虽然是不稳定性心绞痛的主要诱因［１～３］，但并非惟一因素。本研究通过对１５例恶化劳力型心绞痛和１０例自发型心绞痛患者凝血和纤溶活性的动态...     

冠心病患者抗凝与纤溶功能的改变及其临床意义

目的：探讨冠心病患者凝血、抗凝与纤溶功能的改变及临床意义。方法：应用发色底物法及胶乳增强的免疫比浊法分别测定不同类型的冠心病患者160例及健康对照者80例血浆抗凝血酶（AT）、组织型纤溶酶原激活剂（t-PA）、纤溶酶原激活抑制物-1（PAI-1）及D-二聚体（D-dimer）的活性或含量水平,并进行比较分析。结果：与对照组比较,冠心病患者AT、t-PA的活性显著降低,PAI-1、D-dimer的活性或含量水平显著增高（P〈0.05或P〈0.01）;与稳定性心绞痛患者组比较,不稳定性心绞痛组及心肌梗死组AT、t-PA、PAI-1、D-dimer的活性或含量水平亦有显著性改变（P〈0.05或P〈0.01）。结论：冠心病患者特别是不稳定性心绞痛及心肌梗死患者存在高凝状态及纤溶活性亢进。     

Study of Coronary Artery Disease in Single Aortic Valvular Disease

Objectives To analyze the results of coronary angiographies (CAG) in patients with single aortic valvular heart disease; To study the relationship between aortic valve diseases and coronary artery disease (CAD). Methods 105 patients with single aortic valvular heart disease before surgery underwent angiography. The data of clinical characteristics and angiographies were analyzed. Results 51 patients had symptoms of angina pectoris among 105 patients with single aortic valvular heart disease. Seven of them were confirmed coronary artery disease by angiographies. Although the incidence of angina in aortic valve stenosis group was significantly higher than that in aortic valve regurgitation, the probability of combination of CAD in aortic valve stenosis group was similar to the later. However, the probability of combination of CAD in degenerative aortic valve group was significantly higher than the groups of rheumatic, congenitally bicuspid aortic valves, and other causes (p < 0.01 ). Conclusions Angina pe     

红细胞分布宽度对冠心病患者预后的价值研究

目的探讨红细胞分布宽度(RDW)对冠心病(CAD)患者预后的价值。方法收集本院2008年3月—2010年5月155例因CAD住院的患者,并进行冠状动脉造影以明确诊断。根据入院24h的首次RDW,按照其中位数(13.7%)将患者分为两组:A组(RDW≤13.7%,n=78)和B组(RDW>13.7%,n=77),比较两组患者住院期间及出院1年内发生再次心肌梗死、新发心力衰竭、心源性死亡等不良心血管事件的差异。结果 B组发生再次心肌梗死、新发心力衰竭、心源性死亡发生率均高于A组,差异有统计学意义(P<0.05)。结论 RDW对CAD预后有一定价值,RDW水平较高的CAD患者预后较差。     

冠状动脉内麦角新碱激发试验的临床应用

目的 :探讨选择性麦角新碱冠状动脉痉挛激发试验 (EMPT)方法学 ,诊断冠心病冠状动脉痉挛的特异性和敏感性。　　方法 :用选择性冠状动脉造影方法分别向左、右冠状动脉内注射麦角新碱生理盐水 ,测量注药及注入硝酸异山梨酯后冠状动脉管径变化 ,求出冠状动脉缩窄率 (EPCNR)。对 35例患者进行了选择性麦角新碱负荷试验 ,1组为 2 0例不典型胸痛、无心电图 ST- T改变、冠状动脉造影正常的患者。 2组为 15例有胸痛伴心电图 ST段上抬或下降 ,其中 13例有2 0 %～ 5 0 %冠状动脉狭窄患者。　　结果 :1组 2 0例患者左前降支、右冠状动脉管径变化显著 ,但 EPCNR均小于 5 0 %。 2组 15例患者 EPCNR均大于5 0 % ,其中 7例诱发出了冠状动脉的 10 0 %闭塞。　　结论 :EPCNR在 5 0 %时诊断冠状动脉痉挛的特异性、敏感性最高。当选择性麦角新碱给药诱发出冠状动脉 10 0 %痉挛性闭塞时 ,小剂量硝酸异山梨酯冠状动脉内注射可立即使其缓解 ,安全性大。     

Off-pump Coronary Endarterectomy and Bypass Grafting in Patients With Diffuse Coronary Artery Disease

Coronary artery bypass grafting (CABG) and percutaneous coronary intervention are effective therapeutic modalities for patients with ischemic heart disease. However, many patients referred for CABG nowadays had experienced failed percutaneous intervention…     

复杂冠状动脉病变的腔内成形术

本文报道5例不同类型复杂冠状动脉病变腔内成形术。对于位于血管分叉处的病变,采用了双导丝技术;对于引起急性心肌梗塞的高度狭窄血管采用自灌注球囊扩张;对于完全闭塞且病变较长的血管,采用较硬的标准直头导引钢丝导入尔后逐段扩张的办法;对于术中出现的内膜剥离,采用了自灌注球囊导管行长时间低压修补。术后血管再通,残余狭窄为0～10％。因此,认为只要针对不同情况,采用不同方法,PTCA成功率可望提高。     

Study of the Correlation between Plasma Homocysteine and Coronary Artery Disease

Objectives This paper isto investigate the correlation between plasma total ho-mocysteine (tHcy) and coronary artery disease(CAD).Methods Using high performance liquid chromato-graph to determine the level of plasma tHcy in 215cases, and they were selective coronare angiography.107 cases were determined to have CAD with at leastone vessel was narrowed <50%. 108 cases were non-narrowed, and they were listed as controls. Their 10parameters such as sex, age, body height, body weightand blood lipid etc. were no statistical difference be-tween two groups. Results The plasma tHcy 11.20(±5.56) μmol/L of the CAD group and 11.46(±5.50) ofthe control group, between them there was no statisti-cal difference (P>0.5). 12.17 (±6.25)μmol/L tHcyconcentration of the male was significant higher than9.60(±5.10) of the female (P<0.001). ConclusionsNone of correlation between the plasma tHcy andCAD can be found, and the tHcy of male is higherthan that of female.     

ICD Therapy in Coronary Artery Disease

Abstract 25 years after the first coronary artery patient received an implantable cardioverter defibrillator (ICD), many randomized controlled trials on prophylactic ICD therapy have been conducted. Taken together, these trials allow an evidence-based approach to primary prevention of sudden cardiac death in patients after a myocardial infarction. Patients with chronic ischemic cardiomyopathy, a long history of heart failure, and an ejection fraction of 0.30 benefit from preventive device therapy and are thus candidates for prophylactic defibrillator implantation. For this purpose, a single-chamber device appears to be appropriate, since there have been no prospective studies showing convincing clinical benefit by adding an atrial lead. For similar patients who have additional intraventricular conduction delays, a biventricular ICD must be considered. However, this decision must be based on individual considerations until more data from prospective trials become available. Prophylactic ICD therapy should not be used in patients with recent myocardial infarction. There is convincing evidence that ICD benefit in coronary patients accrues after a considerable time having elapsed from the most recent infarct, presumably at least 6 months or perhaps longer.