普罗布考对冠心病合并糖尿病患者经皮冠状动脉介入术后对比剂肾病的影响

目的:观察普罗布考对冠心病合并糖尿病患者经皮冠状动脉介入术(PCI)后对比剂肾病(CIN)的预防作用,探讨其可能机制。方法:将90例择期行PCI的冠心病合并糖尿病患者随机分为治疗组(46例)及对照组(44例)。治疗组在常规治疗基础上,于术前3~5 d开始服用普罗布考0.5g/次,2次/d。入院时及术后24、48、72 h测定血肌酐(SCr)和胱抑素C(Cys C)水平,检测患者术前及术后3 d血超敏C反应蛋白(hs CRP)、脂质过氧化物(MDA)、一氧化氮(NO)、内皮素-1(ET-1)水平变化。结果:治疗组CIN发生率显著低于对照组(6.5%vs 15.9%,P0.05);治疗组术后3d hs CRP、MDA及ET-1水平低于对照组(P0.05),而术后3 d血浆NO水平高于对照组(P0.05)。结论:普罗布考能抑制PCI术后炎症反应,减轻脂质过氧化损伤,改善内皮功能,预防CIN发生。     

普罗布考对经皮冠状动脉介入治疗术后造影剂肾病的预防作用

目的:探讨普罗布考对经皮冠状动脉介入治疗(PCI)术后造影剂肾病(CIN)的预防作用及其可能机制。方法:入选行PCI术患者共250例,随机将其分为普罗布考组125例和对照组125例。2组均给予足量水化,普罗布考组每日给予普罗布考500mg每天2次口服,对照组仅给予常规治疗。观察2组患者PCI术前及术后48~72h血尿素氮(BUN)、肌酐(Scr)、肾小球滤过率(eGFR)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、丙二醛(MDA)的变化,记录2组患者CIN发生情况。CIN定义为Scr水平较原有基础升高25%或者绝对值升高44.2μmol/L以上。结果:2组PCI术前血BUN、Scr、eGFR、CRP、IL-6、MDA差异无统计学意义(P0.05)。2组术后72h血Scr、CRP、IL-6、MDA均较术前增高;术后72h,普罗布考组CRP、IL-6、MDA水平低于常规组,eGFR高于对照组(P0.05或P0.01)。普罗布考组有3例发生CIN,CIN发生率为2.4%;对照组有12例发生CIN,发生率为9.6%,差异有统计学意义(χ2=5.75,P0.05)。多元Logistic回归分析结果显示普罗布考是CIN独立保护因素(OR=0.079,95%CI:0.009~0.725,P=0.025)。结论:普罗布考对降低PCI术后CIN的发生具有保护作用,可能与普罗布考抗氧化应激及抗炎症反应有关。     

普罗布考对非ST段抬高急性冠脉综合征经皮冠脉介入治疗相关心肌损伤的影响

目的:探讨普罗布考对非ST段抬高急性冠脉综合征(NSTEACS)经皮冠脉介入治疗相关心肌损伤的影响。方法:96例择期行PCI的NSTEACS患者随机分为治疗组和对照组,每组48例,治疗组在常规治疗基础上,术前(3~5)d服普罗布考,0.5/次,2次/d,至术后30 d。测术前12 h及术后1 d血CK-MB、cTnI浓度,术前及术后3 d hsCRP、MDA浓度。观察术后30 d主要心血管事件发生情况。结果:2组术后血CK-MB、cTnI及MDA、hsCRP水平均较术前高(P0.05),但治疗组CK-MB、cTnI、MDA、hsCRP水平低于对照组(均P0.05)。结论:普罗布考降低NSTEACS患者PCI术后CK-MB、cTnI、hsCRP、MDA水平,抑制炎症、抗氧化,有心肌保护作用。     

阿托伐他汀联合普罗布考对冠状动脉介入治疗术后造影剂肾病的预防作用

目的探讨阿托伐他汀联合普罗布考治疗对经皮冠状动脉介入治疗(PCI)术后造影剂肾病(CIN)的预防作用、安全性及可能机制。方法入选2013年2月至2015年6月于天津市胸科医院心内科行择期PCI术的冠状动脉性心脏病(冠心病)患者共330例,按随机数字表法随机分为3组:常规剂量阿托伐他汀组(A组,n=110)、强化剂量阿托伐他汀组(B组,n=110)、常规剂量阿托伐他汀联合普罗布考组(C组,n=110)。A组:术前1d开始给予阿托伐他汀20mg,1次/晚;B组:术前1d开始给予阿托伐他汀40mg,1次/晚;C组:术前1d开始给予阿托伐他汀20mg,1次/晚和普罗布考250mg,3次/d。3组患者均于PCI术后4d开始仅给予阿托伐他汀20mg,1次/晚。收集3组患者的基本资料、造影剂用量,并记录PCI术前及术后72h的血清肌酐、血尿素氮、估算的肾小球滤过率(eGFR)、高敏C反应蛋白(hsCRP)、丙二醛、丙氨酸氨基转移酶(ALT)水平的变化。记录3组患者CIN发生情况、住院期间阿托伐他汀及普罗布考的不良反应。结果 3组患者术前基线资料差异无统计学意义(P0.05)。B组和C组CIN发生率低于A组(1.8%,2.7%比10.0%,均P0.05);B组与C组CIN发生率差异无统计学意义(P0.05)。PCI术后72h,A组患者的肌酐、尿素氮水平较术前升高,eGFR水平较术前下降(均P0.05);B组、C组患者的肌酐、尿素氮水平低于A组[(80.99±16.65),(81.79±17.96)比(93.30±20.97)μmol/L;(5.78±0.92),(6.05±1.29)比(6.18±1.08)mmol/L],eGFR水平高于A组[(78.80±26.04),(75.42±20.81)比(69.39±22.81)mL/(min·1.73m~2),均P0.05]。PCI术后,3组患者的hsCRP、丙二醛水平较术前升高(均P0.05);B组和C组患者的hsCRP、丙二醛水平低于A组。多因素Logistic回归分析显示强化他汀(OR=0.093,95%CI0.016~0.533,P=0.008)及他汀联合普罗布考(OR=0.252,95%CI 0.068~0.931,P=0.039)是CIN的保护因素;住院期间,3组患者均未出现明显肝损害、肌无力等不良事件。结论强化剂量阿托伐他汀及常规剂量阿托伐他汀联合普罗布考均能降低CIN的发生率,并且有良好的安全性,其机制可能与抑制炎症、氧化应激反应有关。     

冠心合剂对冠心病患者PCI术后血清NO、ET-1水平的影响

目的观察冠心合剂对冠心病患者PCI术后血清一氧分氮(NO)、内皮素-1(ET-1)水平的影响。方法选取新近冠脉造影阳性且植入支架的冠心病患者,随机分为对照组和治疗组。分别给予基础治疗和基础治疗加冠心合剂治疗,治疗一周后,Elisa法测定两组血清中NO、ET-1水平。结果治疗组治疗后NO水平升高,ET-1水平降低明显,与治疗前及对照组治疗后比较差异有统计学意义(P<0.05);两者术后与术前相比,NO和ET水平两组间差异无统计学意义(P>0.05)。结论冠心合剂能够升高冠心病患者PCI术后血清NO,并降低ET-1水平。     

替格瑞洛在NSTEMI病人PCI术后的应用效果及对氧化应激相关因子和内皮功能的影响

目的探讨非ST段抬高型急性心肌梗死(NSTEMI)经皮冠状动脉介入手术(PCI)病人采用替格瑞洛治疗的临床价值。方法选取我院2016年3月—2017年10月拟实施PCI手术治疗的106例NSTEMI病人,采用随机数字表法分为观察组与对照组,各53例。观察组给予替格瑞洛,对照组给予氯吡格雷;对比两组术后TIMI血流分级、血清超氧化物歧化酶(SOD)、丙二醛(MDA)、内皮细胞特异性分子-1(ESM-1)、内皮素1(ET-1)、一氧化氮(NO)、血浆假性血友病因子(vWF)、不良心血管事件的发生率。结果 PCI术后,观察组TIMI血流分级2级10例(18.87%),3级43例(81.13%),对照组TIMI 2级14例(26.42%),3级39例(73.58%),差异无统计学意义(P0.05);治疗前,两组SOD、MDA、ESM-1、ET-1、NO、vWF水平比较,差异无统计学意义(P0.05);治疗后,观察组SOD、NO水平高于对照组(P0.05),MDA、ESM-1、ET-1、vWF水平低于对照组(P0.05);治疗后,两组SOD、NO水平较治疗前均升高(P0.05),MDA、ESM-1、ET-1、vWF水平较治疗前均显著降低(P0.05);PCI术后3个月,观察组的不良心血管事件发生率低于对照组(P0.05)。结论采用替格瑞洛治疗NSTEMI PCI后病人,在保证心肌灌注的基础上,有利于进一步减轻血管内皮损伤,降低氧化应激反应程度,降低不良心血管事件的发生率。     

尼可地尔对慢性稳定性冠心病患者经皮冠状动脉介入术后血管内皮功能及血清高敏C反应蛋白水平的影响

目的探讨尼可地尔对慢性稳定性冠心病患者经皮冠状动脉介入(PCI)治疗术后血管内皮功能及血清高敏C反应蛋白(hs-CRP)水平的影响。方法将90例慢性稳定性冠心病患者随机分为对照组和研究组各45例,对照组患者PCI手术治疗前后均给予常规治疗,研究组患者在对照组基础上口服尼可地尔治疗,两组患者疗程为6个月,比较两组患者血管内皮功能和血清hs-CRP水平变化。结果与术前1 d比较,两组患者术后1 d的血流介导性舒张功能(FMD)和一氧化氮(NO)降低,血清内皮素(ET-1)和hs-CRP水平升高;术后1、6个月FMD和NO水平升高,ET-1和hs-CRP水平降低(P0.05)。研究组术后1、6个月FMD和NO较同期对照组明显升高,ET-1和hs-CRP水平明显降低(P0.05)。研究组心绞痛发生、支架内再狭窄和出现心血管事件例数明显低于对照组(P0.05)。结论尼可地尔治疗慢性稳定性冠心病患者PCI术后可明显改善患者血管内皮功能、缓解血管炎症反应,预后较好。     

依达拉奉在冠心病患者造影剂肾病中的保护作用

目的研究依达拉奉是否对冠心病患者造影剂肾病具有保护作用。方法将126例拟行冠脉造影的冠心病患者分为两组。对照组(64例)予以常规冠心病药物治疗;治疗组在常规治疗基础上术前当天开始静滴依达拉奉(30 mg,2次/天)至术后3 d。观察两组患者术前24 h及术后24 h、48 h、72 h的血清肌酐(SCr)、尿素氮(BUN)、血清超氧化物歧化酶(SOD)和丙二醛(MDA)水平。结果治疗组与对照组在冠脉造影术前24 h肾功能无统计学意义(P0.05),术后24 h两组肌酐、尿素氮无明显变化(P0.05)。术后48 h及72 h两组肌酐、尿素氮水平均较术前明显升高(P0.05),但治疗组在术后48 h及72 h肾功能损害明显轻于对照组(P0.05)。治疗组与对照组在冠脉造影术前24 h及术后24 h SOD及MDA活动性无明显变化(P0.05),但治疗组在术后48 h及72 h SOD活性明显增加(P0.05),而MDA活性明显降低(P0.05)。对照组CIN发生7例(10.9%),治疗组CIN发生1例(1.6%),两组间比较有统计学意义(P0.05)。结论依达拉奉对冠心病患者造影剂肾病具有保护作用。     

苦碟子注射液对行经皮冠状动脉介入治疗的急性心肌梗死患者的影响

目的探讨苦碟子注射液对行经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者的影响。方法选取2015年7月—2016年7月在新疆心脑血管病医院心血管内科行PCI的AMI患者124例,采用随机数字表法分为对照组和观察组,每组62例。对照组患者PCI前行常规治疗,观察组患者在对照组基础上给予苦碟子注射液;两组患者均持续用药至PCI后2周。比较两组患者PCI后1 h TIMI分级、PCI后1周ST段回落情况、随访6个月主要不良心血管事件(MACE)发生情况、PCI前及PCI后1 h心肌损伤标志物[肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(c Tn I)]、PCI前及PCI后2周氧化应激反应指标[丙二醛(MDA)、超氧化物歧化酶(SOD)]及血清内皮素1(ET-1)水平。结果观察组患者中PCI后1 h TIMI分级3级者所占比例高于对照组(P0.05);两组患者PCI后1周ST段回落50%者所占比例比较,差异无统计学意义(P0.05);观察组患者随访6个月MACE发生率低于对照组(P0.05)。两组患者PCI前血清CK-MB、c Tn I水平比较,差异无统计学意义(P0.05);PCI后1 h观察组患者血清CK-MB、c Tn I水平低于对照组(P0.05)。两组患者PCI前血清MDA、SOD水平比较,差异无统计学意义(P0.05);PCI后2周观察组患者血清MDA水平低于对照组,血清SOD水平高于对照组(P0.05)。两组患者PCI前血清ET-1水平比较,差异无统计学意义(P0.05);PCI后2周观察组患者血清ET-1水平低于对照组(P0.05)。结论苦碟子注射液能有效改善AMI患者PCI后心肌灌注,减轻心肌损伤及氧化应激反应,降低血清ET-1水平及MACE发生率。     

益气活血化痰方对冠状动脉介入术后慢血流病人血管内皮功能和炎症反应的改善作用

目的观察益气活血化痰方对冠状动脉介入术后慢血流病人血管内皮功能和炎症反应的影响。方法将40例病人随机分为治疗组和对照组,各20例。对照组给予常规冠心病二级预防药物治疗;治疗组在常规冠心病二级预防药物治疗基础上加用益气活血化痰中药,每日1剂,治疗3个月。观察两组基线和治疗后的血清学标志物一氧化氮(NO)、内皮素-1(ET-1)、超敏C反应蛋白(hsCRP)、可溶性CD40配体(sCD40L)水平变化。结果两组病人基线血清学标志物比较差异无统计学意义(P0.05),两组治疗后NO较基线明显升高,ET-1、hsCRP、sCD40L水平较基线均有所下降,差异均有统计学意义(P0.05),两组治疗后NO、ET-1、hsCRP、sCD40L水平及与基线的差值比较差异有统计学意义(P0.05)。结论益气活血化痰方可改善冠状动脉介入术后慢血流病人血管内皮功能,减轻炎症反应。     

Right coronary artery coronary sinus fistula with coronary sinus ostium stenosis

Coronary artery fistula (CAF) is a rare anomaly of the coronary artery. The draining site of a right coronary artery (RCA) fistula may usually be the right ventricle, right atrium, or pulmonary artery. Here, we present a patient with right coronary artery to coronary sinus fistula (RCACSF) complicated by aneurysmal dilatation of the coronary sinus (CS) and stenosis of CS ostium.     

Atherosclerosis of coronary arteries, coronary heart disease and sudden coronary death

Correlation between the severity of coronary atherosclerosis, thrombosis and sudden cardiac death was examined in 721 autopsied cases. Severe coronary atherosclerosis with stenosis was found in most of them; however a similar grade of atherosclerosis was discovered in patients with ischaemic heart disease not dying suddenly. Acute coronary thrombosis in the studied subjects was diagnosed post mortem in about 20 percent of those who died suddenly. Other studies indicate frequencies between 4-93%. There was no consistent time dependence.     

Iatrogenic coronary artery stenosis following coronary stenting

We present 6-month follow-up of 435 patients undergoing stent deployment. Forty-four patients were referred because of myocardial ischemia related to the stented artery. In six of these patients (14%), the stented vessel revealed a new proximal lesion separated from the stented portion, which warranted further intervention. It is felt that these new lesions are related to the stenting technique as a result of local trauma induced from the guiding catheter. Cathet. Cardiovasc. Intervent. 46:393–397, 1999. © 1999 Wiley-Liss, Inc.     

Pseudoaneurysm of coronary artery following rupture of coronary artery during coronary angioplasty.

Rupture of the coronary artery is a rare complication of percutaneous transluminal coronary angioplasty (PTCA). We describe a case of coronary artery rupture during PTCA resulting in the formation of a coronary artery pseudoaneurysm. The pseudoaneurysm was successfully treated by percutaneous spring-coil embolization of the coronary artery.     

Percutaneous coronary intervention of bifurcation coronary disease

Bifurcation coronary artery disease is a frequent problem faced by interventional cardiologists and it affects approximately 15-20% of patients undergoing percutaneous coronary intervention (PCI). The application of drug-eluting stents (DES) technology to prevent restenosis after PCI represents one of the success stories in cardiology, but DES have not resolved the bifurcation PCI challenge. Bifurcation PCI remains associated with higher procedural failure and worse outcomes compared with PCI of non-bifurcated lesions even in DES era. A dependable strategy for PCI of bifurcation lesions has yet to be established, which is likely due to the paucity of studies evaluating the anatomical intricacies of the bifurcation as well as the lack of large scale randomized therapeutic trials. Further, bifurcation has many anatomical variants and it is unlike that one technique will fit all. Currently, we are left with the option of a tailor-made strategy for each patient and bifurcation anatomy and make the most of the limited evidence available to support our therapeutic decisions. In this review, we attempted to describe the current understanding of bifurcation anatomy and corresponding PCI strategies.