冠心病合并代谢综合征临床检测指标与冠状动脉病变程度的关系

目的:分析冠心病合并代谢综合征患者临床检测指标与冠状动脉痛变程度的相关关系.方法:选取2006-2007年在我院经冠状动脉造影诊断为冠心病的患者212例,按代谢综合征诊断标准分为代谢综合征组和非代谢综合征组,比较两组相关检测指标及冠状动脉造影结果,并分析冠状动脉病变与各指标之间的相关性.结果:冠心痛合并代谢综合征组的体重指数(BMI)、腹围、收缩压、舒张压、空腹血糖(FBG)、甘油三酯、高敏C反应蛋白(hsCRP)及冠状动脉病变积分均高于非代谢综合征组.而高密度脂蛋白(HDL)水平低于非代谢综合征组;冠状动脉Gensini积分与年龄、吸烟、BMI、腹围、收缩压、舒张压、FBG、低密度脂蛋白、hsCRP呈正相关,与HDL和载脂蛋白A1呈负相关.结论:冠心病合并代谢综合征患者,其相关危险因素均较非代谢综合征患者严重,冠状动脉病变血管数目更多、病变程度更重,我们更应对其进行早期全面的综合干预.     

血清对氧磷酶1活性与冠心病及其病变程度的关系

目的观察和探讨中国人血清对氧磷酶1(PON-1)活性与冠状动脉粥样硬化性心脏病及其病变程度的关系。方法分光光度法测定入选研究对象(包括非冠心病61例,冠心病151例)的血清PON-1活性;以冠状动脉造影结果作为分组依据,并分析PON-1活性与冠状动脉病变支数、Gensini评分的关系,并对影响冠心病Gensini评分的影响因子进行多因素分析。结果冠心病组血清PON-1活性明显低于对照组,(1.95±0.12)vs(2.28±0.13)(t=17.25,P<0.01);血清PON-1活性单支病变组明显高于双支、三支病变组(2.02±0.15)vs(1.95±0.11)vs(1.91±0.11)(F=9.356,P<0.05);而双支和三支病变组比较差异无统计学意义(P=0.13);血清PON-1活性与Gensini评分间呈负相关(rs=-0.315,P<0.01);PON-1活性、年龄、体质量指数(BMI)、性别、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)与冠状动脉病变的程度相关(P<0.05)。结论冠心病患者血清PON-1活性水平明显降低,随着病变程度加重,血清PON-1活性水平降低,二者呈负相关关系。     

冠状动脉钙化积分与冠状动脉疾病及全因性死亡相关性的Meta分析

目的系统评价冠状动脉钙化积分(CACS)与冠状动脉疾病(CAD)及全因死亡事件相关性。方法计算机检索Pubmed、The Cochrane Library、EMbase、CKNI、WanFang Data数据库,搜集CACS与CAD及全因性死亡(All-cause mortality)相关性的队列研究,检索时限从建库至2020年6月。由2名资料员提取文献并进行评价纳入研究的偏倚风险后,采用Stata 14.0软件进行Meta分析。结果纳入11个队列研究,包括59143例被研究者。Meta结果显示:与CACS<10相比,CACS≤100组[HR=2.46,95%CI(1.77,3.41),P=0.000,I^(2)=55.5%]、100     

不同心血管支架材料对老年冠心病患者内皮素和血管再狭窄的影响

背景:支架置入是治疗冠心病的有效方法。目的:探讨不同心血管支架材料对老年冠状动脉粥样硬化性心脏病患者血管狭窄及血管内皮素含量的影响。方法:由第一作者应用计算机检索维普数据网1995-01/2011-06文章。检索关键词为"心血管支架,老年冠心病,内皮素,血管再狭窄"。结果与结论:单纯球囊扩张治疗老年冠心病患者漫性血管病变、血管壁损伤、血栓形成、炎性刺激的各种生长因子和细胞因子的产生较中青年明显增多,术后中远期靶血管再狭窄率比中青年高;金属裸支架置入降低了单纯球囊扩张靶血管再狭窄的发生率及血栓形成、各种生长因子和细胞因子的产生,改善了中远期靶血管再狭窄率;药物支架有效制止了血管弹性回缩和负性重塑,使老年冠心病支架置入中远期靶血管再狭窄率显著下降,减少了并发症的发生,改善了老年冠心病患者的生活质量。     

不同心血管支架材料对老年冠心病患者内皮素和血管再狭窄的影响

背景：支架置入是治疗冠心病的有效方法。目的：探讨不同心血管支架材料对老年冠状动脉粥样硬化性心脏病患者血管狭窄及血管内皮素含量的影响。方法：由第一作者应用计算机检索维普数据网1995-01/2011-06文章。检索关键词为＂心血管支架,老年冠心病,内皮素,血管再狭窄＂。结果与结论：单纯球囊扩张治疗老年冠心病患者漫性血管病变、血管壁损伤、血栓形成、炎性刺激的各种生长因子和细胞因子的产生较中青年明显增多,术后中远期靶血管再狭窄率比中青年高;金属裸支架置入降低了单纯球囊扩张靶血管再狭窄的发生率及血栓形成、各种生长因子和细胞因子的产生,改善了中远期靶血管再狭窄率;药物支架有效制止了血管弹性回缩和负性重塑,使老年冠心病支架置入中远期靶血管再狭窄率显著下降,减少了并发症的发生,改善了老年冠心病患者的生活质量。     

Cost-effectiveness of paclitaxel-coated balloon angioplasty and paclitaxel-eluting stent implantation for treatment of coronary in-stent restenosis in patients with stable coronary artery disease

Background  

Recent studies have demonstrated the safety and efficacy of drug-coated balloon (DCB) angioplasty for the treatment of coronary in-stent restenosis (ISR). The cost-effectiveness of this practice is unknown.     

Markers of eosinophilic inflammation and risk prediction in patients with coronary artery disease

BACKGROUND: The eotaxin family comprises three distinct peptides (eotaxin, eotaxin-2 and eotaxin-3) which have been implicated in eosinophilic inflammation. In vitro and clinical studies suggest that eotaxins could play a role in vascular inflammation, but no data are available on their prognostic significance in patients with angiographically documented coronary artery disease (CAD). MATERIALS AND METHODS: Baseline plasma samples were obtained from 1014 patients with documented CAD. We tested the predictive effect of markers of eosinophilic inflammation and C-reactive protein (CRP) on death from cardiovascular causes and nonfatal myocardial infarction over a 2.7-4.1-year follow-up period. RESULTS: Unexpectedly, lower eotaxin-3 concentrations were observed in patients with adverse cardiovascular events, whereas both eotaxin and eotaxin-2 showed no association with risk. After adjustment for most potential confounders, patients in the upper-quartile of eotaxin-3 levels had a 0.42 hazard-ratio (95% CI, 0.29-0.61, P < 0.001) for adverse events compared with subjects in the lower-quartile. The highest risk of future cardiovascular events was observed in subjects with combined elevation of CRP and reduction of eotaxin-3; 4.4 hazard-ratio (95% CI, 2.1-9.5, P < 0.001). Importantly, receiver-operating-characteristic curves analysis suggested a superior prognostic value of eotaxin-3 compared with CRP for predicting cardiac events in patients with CAD. CONCLUSIONS: Low levels of eotaxin-3 are an independent predictor of future adverse cardiovascular events in patients with CAD and may be useful for risk stratification.     

老年冠心病患者血清尿酸、Cys C及γ-GGT的水平及其与冠状动脉病变程度的相关性探究

目的分析老年冠状动脉粥样硬化心脏病(简称冠心病)患者血清尿酸、胱抑素C(Cys C)及γ-谷氨酰转肽酶(γ-GGT)的水平及临床意义。方法选择该院收治的132例冠心病患者和52例体检健康者,比较各组血清尿酸、Cys C及γ-GGT水平。结果冠心病稳定型心绞痛(SAP)组、不稳定型心绞痛(UAP)组、急性心肌梗死(AMI)组血清尿酸、Cys C及γ-GGT均高于健康对照组,且AMI组血清尿酸、Cys C及γ-GGT高于SAP组及UAP组(P<0.05)。多支病变组血清尿酸、Cys C及γ-GGT高于双支病变组及单支病变组(P<0.05)。重度狭窄组血清尿酸、Cys C及γ-GGT高于轻度狭窄组(P<0.05)。冠心病患者血清尿酸、Cys C及γ-GGT与Gensini积分均呈正相关(r=0.531、0.598、0.485,均P<0.05)。结论血清尿酸、Cys C及γ-GGT有利于冠心病临床分型的鉴别,且和冠状动脉病变支数和狭窄程度密切相关。     

时间紧迫感与冠心病的相关性研究

[目的]探讨冠心病病人的个性特征，明确时间紧迫感与冠心病的相关性，为调整病人的心理健康水平提供依据.[方法]采用随机抽样的方法，使用PSACIV行为评定量表对252例冠心病病人和384例健康者进行问卷调查，分析各行为因子与冠心病的关系。[结果]两组A型行为的时间勿忙感（TH）因子，时间紧迫感、活动速度亚因子差异有统计学意义。[结论]冠心病病人存在明显的个性特征，有较强的时间紧迫感和较快活动速度。     

Combined magnetic resonance coronary artery imaging,myocardial perfusion and late gadolinium enhancement in patients with suspected coronary artery disease

Background

Cardiovascular Magnetic Resonance (CMR) imaging offers methods for the detection of ischemia and myocardial infarction as well as visualization of the coronary arteries (MRCA). However, a direct comparison of adenosine perfusion (PERF), late gadolinium enhancement (LGE) and MRCA or the results of their combination has not been performed. Aim of the study was to evaluate the feasibility/diagnostic performance of rest/stress perfusion, late gadolinium enhancement and MRCA and their combination in patients with suspected coronary artery disease (CAD) in comparison to invasive angiography.

Methods

Fifty-four patients (60 ± 10 years, 35 men, CAD 48%) underwent CMR including MRCA (steady state free precession, navigator whole heart approach, spatial resolution 0.7 × 0.7 × .0.9 mm, trigger delay and temporal resolution adjusted individually), stress PERF (adenosine 140 μg/min/kg), rest PERF (SSFP, 3 short axis, 1 saturation prepulse per slice) and LGE (3D inversion recovery technique) using Gd-BOPTA. Images were analyzed visually. Stenosis >50% in invasive angiography was considered significant.

Results

Mean study time was 68 ± 11 minutes. Sensitivity for PERF, LGE, MRCA and the combination of PERF/LGE and PERF/LGE/MRCA was 87%, 50%, 91%, 88% and 92%, respectively and specificity 88%, 96%, 46%, 88% and 56%, respectively. If image quality of MRCA was excellent (n = 18) the combination of MRCA/PERF/LGE yield a sensitivity of 86% and specificity of 91%. However, no test or combination improved diagnostic performance significantly compared to PERF alone.

Conclusion

In patients with CAD, the combination of stress PERF, LGE and MRCA is feasible. When compared to invasive angiography, adenosine stress perfusion outperforms CMR coronary angiography in direct comparison and yields the best results with non-significant improvement in combination with LGE and significant deterioration in combination with MRCA. MRCA may be of additional value only in a minority of patients with excellent image quality.     

时间紧迫感与冠心病的相关性研究

[目的]探讨冠心病病人的个性特征,明确时间紧迫感与冠心病的相关性,为调整病人的心理健康水平提供依据。[方法]采用随机抽样的方法,使用PSACIV行为评定量表对252例冠心病病人和384例健康者进行问卷调查,分析各行为因子与冠心病的关系。[结果]两组A型行为的时间勿忙感(TH)因子,时间紧迫感、活动速度亚因子差异有统计学意义。[结论]冠心病病人存在明显的个性特征,有较强的时间紧迫感和较快活动速度。     

冠心病患者自我护理能力与社会支持的相关性调查

目的 探讨冠心病患者社会支持对其自我护理能力的影响,为提高冠心病患者的自我护理能力提供依据.方法 为描述性研究方法,采用自我护理能力测定量表(ESCA)、社会支持评定量表(SSRS)对94例冠心病患者进行调查,并分析其相关性.结果 冠心病患者的社会支持与自我护理能力总分及自理技能、自理责任感、健康知识维度呈正相关(P<0.05).结论 社会支持影响冠心病患者的自我护理能力,社会支持度越高的患者,自理责任感越强,健康知识掌握越好,自我护理技能越高,自我护理能力水平越高.     

超声对颈动脉内-中膜厚度与冠心病相关性研究

目的 评价颈动脉内-中膜厚度(IMT)与冠心病主要危险因素的相关性.方法 随机抽取在阜外医院门诊体检的自然人群共769名,应用超声检测颈动脉内膜内表面到中膜外表面的距离即IMT,其中IMT≥1.2 mm时定义为斑块,注意观察颈动脉斑块测值、位置、数量及性质等,同时研究其与冠心病的相关性.结果 颈动脉各取样点IMT值,左、右两侧之间差异无统计学意义(左侧各取样点均值分别为[(0.69±0.14)、(0.68±0.15)、(1.29±0.25)、(0.64±0.14)mm;右侧各取样点均值分别为(0.68±0.15)、(0.67±0.14)、(1.30±0.24)、(0.65±0.13)mm;t=1.35、1.34、0.83、1.47,P均＞0.05)].双侧颈总动脉近段IMT值平均为(0.67±0.14)mm,双侧颈动脉分叉处IMT平均值为(1.30±0.24)mm,两者比较,差异有统计学意义(t=3.55,P＜0.01);双侧颈总动脉远段IMT平均值为(0.68±0.14)mm,与双侧颈动脉分叉处比较,差异有统计学意义(t=3.16,P＜0.01);双侧颈内动脉近段IMT平均值为(0.65±0.13)mm,与双侧颈动脉分叉处比较,差异有统计学意义(t=3.28,P＜0.01).男性颈动脉斑块阳性率(45.4%,189/417)高于女性(29.2%,103/352,χ2=20.91,P＜0.01),＞45～55岁组男性颈动脉斑块发生率(67.6%,84/124)明显高于女性(39.6%,46/115,χ2=18.51,P＜0.01),而35～45岁、>55岁组颈动脉斑块发生率在不同性别间差异无统计学意义,同性别内颈动脉斑块阳性率均随年龄增加而显著增高(女性3个年龄组分别为7.1%、36.9%和86.4%,χ2=19.31,P＜0.01;男性3个年龄组分别为10.5%、67.6%和89.6%,χ2=21.45,P＜0.01).年龄、高血压病、吸烟、糖尿病、高血脂症及冠心病家族史是男性颈动脉IMT值增加及斑块发生的危险因素(OR=1.09、1.39、1.46、1.92、1.45、1.48,P均<0.05);而女性颈动脉IMT值增加及斑块发生则同年龄、高血压病、糖尿病和冠心病家族史有关(OR=1.12、2.58、1.46、1.45,P均＜0.05).结论 颈动脉IMT值与冠心病主要危险因素显著相关,颈动脉IMT值可预测冠心病的发生.     

冠心病患者血清载脂蛋白与D-二聚体的变化及其相关性

目的:观察冠心病患者血清载脂蛋白AI(ApoAI)、载脂蛋白B(ApoB)与血浆D-二聚体(DD)水平的变化特点,并探讨它们之间的关系。方法:对124例CHD患者和26例正常人采用免疫散射比浊法测定ApoAI、ApoB浓度,ELISA法测定DD水平。结果:不同类型的冠心病患者中,其DD水平和Apo浓度有所不同(F=44.2,126.3,29.6,P均<0.01),其中急性心肌梗死(AMI)和不稳定性心绞痛(UAP)组患者ApoB浓度、DD水平均显著高于对照组(P<0.01);陈旧性心肌梗死(OMI)和稳定性心绞痛(SAP)组患者ApoB浓度高于对照组,ApoAI浓度低于对照组(P<0.01),但DD水平无改变(P>0.05)。124例冠心病患者相关分析显示:ApoB与DD呈显著正相关,ApoAI与DD呈显著负相关(P<0.001)。结论:冠心病患者存在载脂蛋白代谢异常,AMI、UAP组患者DD水平增高,且载脂蛋白与DD水平有密切关系。     

Deficiency of a leukocyte surface glycoprotein (LFA-1) in two patients with Mo1 deficiency. Effects of cell activation on Mo1/LFA-1 surface expression in normal and deficient leukocytes.

Mo1, a phagocyte surface glycoprotein heterodimer, is involved in a number of phagocyte adhesion functions such as binding and ingestion of serum-opsonized particles, zymosan-induced degranulation, and superoxide generation. Deficiency of this antigen in humans has been associated with increased susceptibility to recurrent bacterial infections. The beta subunit of Mo1 is shared by another surface glycoprotein named LFA-1, which is involved in lymphocyte proliferation, cytolytic T cell, and natural killing activities. Two unrelated patients with Mo1 deficiency were found to be deficient in LFA-1 as well as in the common beta subunit. Investigation of lymphocyte functions in these two patients revealed normal mixed leukocyte culture-generated cytolytic T cell and natural killing activities and significantly reduced proliferative response to phytohemagglutinin. LFA-1-deficient cells also proliferated in response to soluble antigen and different alloantigens. These responses were partially blocked by anti-LFA-1 antibody. Whereas LFA-1 was undetectable by immunofluorescence and immunoprecipitation on the patients' resting T cells, significantly reduced (approximately 5% of normal) but detectable amounts of the heterodimeric LFA-1 antigen were found on mitogen and alloantigen-activated T cells. On granulocytes, Mo1 surface expression was also dependent on the state of cellular activation. The amount of surface Mo1 present on resting normal granulocytes increased by 3-10-fold following exposure to stimuli that induced degranulation, suggesting the presence of a major intracellular pool for this antigen. Analysis of subcellular fractions from granulocytes showed that intracellular Mo1 is located primarily in the specific granule fraction. Activated granulocytes had little or no increase in their surface expression of LFA-1 antigen. Deficient granulocytes had significantly increased numbers of Mo1 antigen expressed on the surface following stimulation with calcium ionophore (1 microM). However, the amount expressed continued to be significantly reduced compared with normal cells. Quantitation of surface Mo1 on granulocytes exposed to calcium ionophore (1 microM) showed that both parents in one family but only the mother in the other family had significantly reduced levels of Mo1, suggesting heterogeneity in the inheritance of this disorder. Whereas LFA-1 deficiency on lymphocytes was associated with normal alloantigen-induced cytolytic T cell and natural killing activities in these two patients, functions which were in part dependent on small amounts of detectable LFA-1 antigen, the Mo1 deficiency state led to significant defects in phagocyte adhesion functions. Hence, the clinical symptoms associated with this combined deficiency state reflect a more profound phagocyte than lymphocyte disorder.     

颈动脉及下肢动脉粥样硬化与冠心病相关性的研究进展

冠状动脉疾病(CAD)发病率逐年升高,及早发现CAD及对其不良预后高危人群加以早期干预,能够改善患者预后.颈动脉及下肢动脉粥样硬化与CAD的发生发展及预后之间存在重要关系.联合评价颈动脉和下肢动脉粥样硬化不仅能够辅助识别CAD并反映其严重程度,还能够预测CAD患者及心肌血运重建患者术后发生不良心血管事件的风险,以完善高...     

Hyperinsulinemia in patients with microvascular coronary artery lesion as a possible diagnostic criterion of coronary heart disease

The purpose of the study was to investigate the character of clinical and functional manifestations of ischemic cardiac dysfunction in patients with idiopathic coronary microangiopathy, and their correlation with insulin level, as a possible diagnostic criterion of coronary heart disease (CHD). The subjects were 115 men, including 35 individuals (mean age 41.8 +/- 1.2 years) with microvascular form (MVF) of coronary artery lesion, 60 patients with CHD with postinfarction cardiosclerosis (PICS), and 20 healthy individuals. Patients with glucose tolerance disorder, diabetes mellitus, arterial hypertension, and other severe pathology were not included in the study. The diagnostic tests included selective coronaroventriculography with right ventricle endomyocardium biopsy, and myocardial perfusion scintigraphy. Parameters of coronary, intracardial and system hemodynamics were evaluated; insulin and glucose serum levels were measured at rest and during stress-tests with physical exercise. Endocardial biopsy in MVF patients found plastic insufficiency of the endothelium of hemocapillars, prearteriols and cardiomyocytes. Alterations in the parameters of metabolism, intracardial and system hemodynamics, and physical exercise tolerance were found to be comparable in MVF and PICS patients. Insulin level at rest in both groups was equal to that in the control group. At threshold physical load during veloergometry insulin levels in MVF and PICS patients demonstrated comparable elevation (222.8% and 201%, respectively; p < 0.05-0.01). Glucose concentrations in patients with microangiopathy decreased by 28% (p < 0.05), while in patients with CHD it increased significantly by 27.3% (p < 0.05). The study shows that structural and functional lesion of hemocapillar endothelium underlies cardiac syndrome X It results in perfusion ability impairment, chronic hypoxia, impairment of myocardial contractility under the conditions of physical activity. Hyperinsulinemia, manifesting when ischemia is induced, is not caused by insulinresistence. Probably, it presents and adaptive and compensatory reaction to increase of myocardial glucose requirement, and may be one of early CHD markers.     

冠心病合并糖尿病患者晚期糖基化终产物测定分析

目的 探讨血清晚期糖基化终产物(AGEs)水平在冠心病(CAD)合并糖尿病(DM)患者中的意义.方法 诊断明确的CAD合并DM患者82例,根据冠状动脉造影结果分为单支病变组、双支病变组及3支病变组,分别测定血清AGEs,空腹血糖(FPG)、血脂,计算体质量指数(BMI),对3组间AGEs、FPG、血脂、BMI进行比较.结果 AGEs水平随冠状动脉病变支数增加而增高,单支病变组(35.86±11.28)ng/L,双支病变组(43.52±17.29)ng/L,3支病变组(62.09±14.23)ng/L,差异有统计学意义(P<0.05);Spearman相关分析显示,AGEs与总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、FPG均呈正相关(P<0.05);多元逐步线性回归分析显示,LDL-C、FPG与AGEs独立相关.结论 AGEs促进DM患者冠状动脉粥样硬化的发展,控制FPG及LDL-C可能延缓此作用.     

The pathogenesis of coronary artery disease. A possible role for methionine metabolism.

Homocystinuria, an abnormality of methionine metabolism is associated with severe vascular disease in infancy and childhood. Homocysteine is formed during the metabolism of methionine and accumulations of this and of cysteine-homocysteine mixed disulfide in the plasma indicate a partial block in the methionine degradation pathway. Methionine metabolism was investigated in 25 patients aged under 50 with angiographically proved coronary artery disease and in 22 control patients, of whom 17 had normal coronary arteries at angiography and 5 were healthy volunteers. After an overnight fast, venous blood was drawn before and 4 h after oral L-methionine, 100 mg/kg. Plasma methionine levels at 4 h were not different in the two groups, but there were significant differences in the levels of cysteine-homocysteine mixed disulfide. This was detected in 5 of 22 in the noncoronary group and in higher concentration in 17 of 25 coronary patients (P less than 0-01). Age, weight, height, body-mass index, glucose tolerance, fasting serum urate, and triglycerides were not different, but serum cholesterol was higher in the coronary patients (P lessthan 0.01). These results suggest a reduced ability to metabolise homocysteine in some patients with premature coronary artery disease when this pathway is stressed.     

Impact of advanced exercise ECG analysis on cost of coronary artery disease management

Background Conventional analysis of exercise electrocardiogram (EX‐ECG) has limited accuracy. This study aims to evaluate the potential impact of improving EX‐ECG accuracy on costs of diagnosis and number of misdiagnoses of coronary artery disease (CAD). Methods A decision‐tree model was simulated including sequential application of diagnostic procedures for suspected CAD. The model was structured in two main branches (presence or absence of CAD). A probabilistic sensitivity analysis was then performed for several combinations of improvement in test sensitivity and specificity. Results A clear trend in cost reduction was observed at improving EX‐ECG specificity (about 8–8.5 million dollars, corresponding to a 5.6–7.6% reduction according to the prevalence level). Wrong diagnoses counted for 9–13% of test. Improvements in test parameters lead to reductions in wrong diagnoses, especially when increasing specificity (8.8–12.5%). Conclusions A proper improvement in EX‐ECG sensitivity and specificity would have a relevant impact on the costs of CAD management, while reducing the number of misdiagnoses.