脑梗死患者血清髓过氧化物酶和妊娠相关血浆蛋白A与颈动脉易损斑块的相关性

目的探讨脑梗死患者血清髓过氧化物酶(MPO)和妊娠相关血浆蛋白A(PAPP-A)水平与颈动脉易损斑块的相关性。方法 52例存在颈动脉斑块的脑梗死患者行颈动脉斑块高分辨率MRI检查,根据斑块影像学特征分组。应用酶联免疫吸附法测定血清MPO和PAPP-A水平。结果不稳定性斑块组和不稳定性斑块破裂组血清MPO和PAPP-A水平高于稳定性斑块组(P<0.05或P<0.01)。不稳定性斑块未破裂组血清MPO水平高于稳定性斑块组(P<0.05),不稳定性斑块破裂组PAPP-A水平高于不稳定性斑块未破裂组(P<0.01)。不稳定性斑块未破裂组与不稳定性斑块破裂组之间血清MPO水平差异无显著性,不稳定性斑块未破裂组与稳定性斑块组之间血清PAPP-A水平差异无显著性。血清MPO和PAPP-A水平与斑块易损程度呈正相关关系(P<0.01)。结论血清MPO和PAPP-A水平可以反映颈动脉粥样硬化斑块的稳定性及破裂性。     

活化T细胞核因子c1检测联合血管内超声在冠心病风险评价中的作用

目的以血管内超声(IVUS)分析为参照,探讨活化T细胞核因子c1(NFATc1)对不稳定性斑块的预测意义。方法 183例冠心病患者根据IVUS结果分为不稳定性斑块组(98例)和稳定性斑块组(85例),另选46例冠状动脉造影结果阴性患者为对照组。流式细胞术检测淋巴细胞内NFATc1表达水平,通过受试者工作曲线(ROC)分析其对不稳定性斑块的诊断意义。结果冠心病患者NFATc1水平明显高于对照组,其中不稳定性斑块组NFATc1水平高于稳定性斑块组,NFATc1受试者工作曲线下面积为0.796,P=0.01,最佳界值平均荧光强度为17.5。结论 NFATc1是不稳定性斑块的活动性指标,能够评价冠心病风险,从而进一步预测急性冠状动脉事件的发生。     

冠状动脉重构的血管内超声研究

目的：探讨冠状动脉重构在冠心病发生中的作用以及与临床表现之间的关系。方法：73例冠心病患者,根据临床表现分为急性心肌梗死(AMI)组,共27例；不稳定性心绞痛(UAP)组,共22例；稳定性心绞痛(SAP)组,共24例。对“罪犯”病变进行血管内超声(IVUS)检查,测定重构指数,确定重构方向,并进行分组对比研究。结果：正性重构在急性心肌梗死组最常见,其次为不稳定性心绞痛组,稳定性心绞痛组最少见。相反,负性重构在稳定性心绞痛组最常见,其次为不稳定性心绞痛组,急性心肌梗死组最少见。正性重构病变有较大的外弹力膜面积、斑块面积和斑块负担。结论：正性重构与急性冠状动脉综合症的发生有关,负性重构易引起心绞痛的发生却使斑块趋于稳定。     

45例急性冠状动脉综合征患者血液中基质金属蛋白酶含量变化

目的探讨基质金属蛋白酶(MMP)与冠状动脉粥样硬化斑块稳定性的相关性。方法急性冠状动脉综合征(ACS)患者在入院即刻、入院一周、出院时,测定血浆MMP浓度,并与对照组比较分析。结果ACS组血清MMP浓度明显高于对照组,且差异有统计学意义。结论MMP与冠状动脉斑块不稳定性呈密切相关,可望作为冠状动脉斑块不稳定性的参考指标。     

乙酰肝素酶与动脉粥样硬化

乙酰肝素酶(heparanase,HPA)是哺乳动物体内唯一降能解细胞外基质中硫酸乙酰肝素蛋白多糖的β-D-葡萄糖醛酸内切酶.近年来的相关研究表明,HPA与动脉粥样硬化斑块的形成和发展密切相关,并且与斑块从稳定向不稳定的转化有关.文章就HPA在动脉粥样硬化进展过程中促进斑块内炎症反应、与蛋白水解酶协同作用以及参与血液高凝状态等方面的相关研究进展进行了综述.     

血清E-选择素和血清C-反应蛋白在急性冠状动脉综合征患者中的变化及意义

目的:观察血清E选择素、血清C反应蛋白(CRP)水平在急性冠状动脉综合征(ACS)患者中的变化,并探讨其与斑块稳定性的关系。方法:30例ACS患者(ACS组)、24例稳定型心绞痛(SAP)患者(SAP组)及30例冠状动脉造影阴性者(对照组)作为入选对象,均以酶联免疫吸附法(ELISA)检测其E选择素,免疫速率散射测浊法测定其CRP水平。结果:ACS组血清E选择素、CRP水平显著高于SAP组(P<0.01)和对照组(P<0.01)。结论:血清E选择素、CRP可能与ACS发病有关,并反映斑块的不稳定性。     

不稳定性心绞痛患者循环血单核细胞产生明胶酶A、B的变化

目的观察不稳定性心绞痛(UA)患者循环血单核细胞产生明胶酶A、B(MMP2、MMP9)的变化,探讨其在斑块稳定性心绞痛(SA)和UA发病中的作用.方法应用酶联免疫分析试剂盒,测定21例不稳定性心绞痛(UA组)、25例稳定性心绞痛(SA组)及18例健康者(正常对照组)循环血单核细胞培养上清液中MMP2、MMP9含量及经皮冠状动脉腔内成形术(PTCA)、心肌缺血发作前后MMP2、MMP9的变化.结果UA组MMP2、MMP9均显著高于正常对照组,有非常显著性差异(P＜0.001).PTCA术后,UA组MMP2、MMP9较术前增加(P＜0.01～0.001),均有非常显著性差异.结论UA患者循环血单核细胞产生MMP2、MMP9增加,并可能直接参与UA的发病过程.     

乙酰肝素酶在胃癌组织中的表达及其与临床病理特征的关系

目的 探讨乙酰肝素酶在胃癌组织中的表达及其与临床病理特征的关系.方法 应用免疫组化方法检测60例胃癌术后组织标本及正常组织中乙酰肝素酶的表达,分析乙酰肝素酶表达与胃癌临床病理特征的关系.结果 胃癌组织中存在乙酰肝素酶蛋白的表达,并定位于肿瘤细胞质中.60例胃癌组织中有40例乙酰肝素酶表达阳性(40/60,66.7％),正常组织有1例表达阳性(1/10,10％),两组间差异显著(P ＜0.05).乙酰肝素酶蛋白在胃癌中的表达与患者性别、年龄、肿瘤直径无关(P＞0.05),与组织学分级、TNM分期、淋巴结转移相关(P＜0.05).结论 乙酰肝素酶在胃癌中高表达,与胃癌进展程度和恶性行为相关,对胃癌的发生、发展起促进作用,可为临床治疗和诊断提供一定依据.     

急性脑梗死患者血清PAPP-A水平与颈动脉粥样硬化斑块的相关性

目的探讨急性脑梗死患者妊娠相关血浆蛋白A(PAPP-A)水平与颈动脉粥样硬化斑块的关系。方法应用彩色多普勒超声检查79例急性脑梗死组患者和64例正常对照者的颈动脉斑块及内膜中膜厚度(IMT),同时检测血清PAPP-A水平;将急性脑梗死患者依据颈动脉超声检查结果分为颈动脉无斑块组15例,稳定性斑块组20例,不稳定性斑块组44例,比较各组血清PAPP-A水平。结果急性脑梗死斑块检出率、不稳定性斑块检出率及IMT均显著高于正常对照组(P0.01),血清PAPP-A水平高于正常对照组(P0.05)。在急性脑梗死患者中,不稳定性斑块组血清PAPP-A水平显著高于稳定性斑块组和无斑块组,稳定性斑块组血清PAPP-A水平显著高于无斑块组(P0.01)。线性相关分析显示,急性脑梗死组患者IMT与血清PAPP-A水平有明显相关性(r=0.718,P0.01)。结论颈动脉粥样硬化斑块及其稳定性与脑梗死发生有密切关系;PAPP-A与颈动脉粥样硬化密切相关,可能是不稳定性粥样硬化斑块的血清标志物。     

稳定性不稳定性心绞痛冠状动脉斑块形态和狭窄程度的对比研究

目的：探讨稳定性心绞痛、不稳定性心绞痛及急性心绞痛及急性心肌梗死发生的病理形态基础及其差异。方法：选取临床及心电图确认的稳定性心绞痛和死于急性心肌梗死的不稳定性心绞痛死亡病例的心脏作为研究材料,将冠状动脉剥离后固定、脱钙,然后连续取材,光镜观察两组冠状动脉斑块的形态、狭窄程度及血栓形成情况。结果：１５例稳定性心绞痛共取材８８９个块中,８４．０％为稳定斑块,斑块没有或仅有很小的脂质坏死中心,表面被覆的纤维帽较厚;而不稳定斑块（指斑块脂质坏殛中心超过４０％,表面被覆的纤维帽也较薄）仅占１６．０％。２０例伴有急性心肌梗死的不稳定性心绞痛共１２１０个取材块中,稳定斑块占６９．０％,与稳定性心绞痛组比较差异有显性（Ｐ〈０．０１）。冠状动脉各分支狭窄程度两组间差异无显性（Ｐ〉０．０５）。２０例伴有心肌梗死的不稳定性心绞     

Anatomic-ultrasound correlations for intraoperative open chest imaging of coronary artery atherosclerotic lesions in human beings

This study was performed to further validate a method for intraoperative ultrasound imaging of coronary arteries. Ultrasound images of coronary atherosclerotic lesions were compared with anatomic specimens of the coronary arteries obtained from open chest human subjects. The anatomic specimens were derived from four cardiac transplant recipients, accepted as candidates for transplantation because they had severe diffuse atherosclerotic disease, and one patient who died in the early postoperative period after a coronary artery bypass procedure. Twenty-six ultrasonically imaged atherosclerotic areas of the coronary arteries in these patients were compared with formalin-fixed and decalcified anatomic specimens. Specific ultrasound appearances for atherosclerotic lesions were observed, including 1) discrete (focal) stenosing fibrous/atheromatous plaques; 2) diffuse nonobstructive fibrous/atheromatous disease (detectable even in anatomically small vessels); 3) complete occlusion by fibrous/atheromatous lesions or organizing thrombus; and 4) "shadowing," an ultrasound pattern characteristic of significant calcification within atherosclerotic plaques. As part of this study, a new 12 MHz water path probe was evaluated for coronary artery scanning. The new probe allowed improved access to coronary arteries and increased detail of anatomic visualization. Both the performance of the new high resolution probe and the knowledge gained by the anatomic correlations obtained in this study should aid the development of intraoperative coronary artery scanning for surgical localization of atherosclerotic disease during coronary bypass surgery.     

颈动脉粥样硬化与冠心病关系的探讨

目的:研究颈动脉粥样硬化与冠心病的关系.方法: 超声检查205例冠心病(冠心病组)和41例风湿性心脏病或其它体检患者(非冠心病组)的颈动脉,测量血管的直径、内-中膜的厚度(intima-media thickness, IMT),血流的速度等参数,观察斑块的有无及形成情况,了解颈动脉粥样硬化与冠心病以及非冠心病患者的关系.结果:确诊冠心病的患者205例中颈动脉超声有病变者195例,占 95.12%.其中冠状动脉三支病变者97例中颈动脉有病变者96例,达98.97%.41例非冠心病患者中颈动脉有病变者 11例,占26.83%,颈动脉无病变者30例,占73.17%.结论:冠心病和颈动脉粥样硬化存在着明显的相关性,颈动脉超声诊断技术对诊断冠心病有重要意义.     

The role of ultrasonography of the peripheral arteries in diagnosing coronary artery disease

Atherosclerosis develops simultaneously in multiple arterial beds, that creates opportunity to diagnose of coronary artery disease. Aim of the study was the evaluation of association between atherosclerotic involvement of peripheral arteries assessed by ultrasound and significant coronary artery disease revealed by angiography. Study included 410 patients, (73% males), mean age 56.0 +/- 9.5 year scheduled for coronary angiography. During ultrasound examination of common carotid and common femoral arteries arterial wall intima-media (IMT) thickness and atherosclerotic plaques presence were assessed. Significant coronary artery disease (CAD) was diagnosed with coronary angiography as diameter stenosis > 50%. Intimo-media thickness (IMT) of common carotid arteries did not differ between groups with and without significant coronary artery disease (right 6.6 vs 6.4 mm, p = ns, left 6.9 vs 6.6 mm, p = ns) but in common femoral arterial was greater in patients with coronary artery disease (right 8.2 vs 7.1 mm, p < 0.005, left 7.9 vs 7.1 mm, p = 0.03). Atherosclerotic plaques in carotid and femoral arteries was detected more often in CAD patients (90.1% vs 34.6%, p < 0.0001). Positive predictive value for CAD diagnosis with detection of plaque in carotid or femoral artery was 93% and negative prognostic value for exclusion CAD after plaque exclusion in all arteries was 61%. Search for atherosclerotic plaques in ultrasound examination of peripheral arteries may facilitate CAD diagnosis in selected patients groups.     

Transluminal laser irradiation of coronary arteries in live dogs: an angiographic and morphologic study of acute effects

In vivo coronary transluminal laser irradiation, using energies known to vaporize atherosclerotic plaques and thrombi, was performed in normal coronary arteries of 5 anesthetized mongrel dogs. A 200-mu core silica optical fiber with a radiopaque tip was advanced through a catheter to either the left anterior descending or circumflex coronary arteries. Coronary artery perforation occurred during manipulation of the fiber in 1 dog. In 4 dogs, argon laser radiation was delivered at 1-second intervals. A total of 45 different sites were irradiated in 8 coronary arteries. In 5 of these arteries 1 W was used and in the 3 other arteries 2 W were used. Coronary angiography showed perforation of 5 of these 8 arteries. Two arteries were perforated using 1 W and 3 using 2 W. Within 30 minutes, 3 dogs with perforation died of cardiac tamponade. In all 4 dogs postmortem examination showed perivascular blood extravasation around all 8 lased coronary arteries. Transluminal lasing of normal dog coronary arteries using delivery systems and energies similar to those known to vaporize atherosclerotic plaques and thrombi resulted in arterial perforation, frequently followed by cardiac tamponade.     

Contrast enhancement of coronary atherosclerotic plaque: a high-resolution, multidetector-row computed tomography study of pressure-perfused, human ex-vivo coronary arteries

OBJECTIVES: The objective of this study was to investigate the effect of contrast injection on atherosclerotic coronary plaque attenuation measured using multidetector-row computed tomography. BACKGROUND: Recent multidetector-row computed tomography studies have described the characterization of coronary atherosclerotic plaque on the basis of Hounsfield unit values. The influence of contrast injection on the attenuation of individual plaque components, however, is unknown. METHODS: Using a pressurized perfusion system, 10 human coronary arteries were examined postmortem with multidetector-row computed tomography and histology. Pre-enhanced, peak-enhanced, and delayed enhanced multidetector-row computed tomography images were acquired during continuous perfusion of the vessel. A total of 37 focal atherosclerotic plaques were identified. Vessel wall attenuation was measured from multidetector-row computed tomography images during all three enhancement phases. On the basis of the histology, plaques were categorized as noncalcified (predominantly fibrous or predominantly fibrofatty), mixed calcified (calcified fibrous or calcified necrotic core), or densely calcified. The mean Hounsfield unit was compared among contrast phases for all plaques and in plaque subgroups. RESULTS: We observed contrast enhancement of atherosclerotic plaques within the vessel wall. For noncalcified plaques including both fibrous and fibrofatty plaques, the mean Hounsfield unit of the vessel wall during and after contrast injection exceeded the mean value before injection (t-test, P<0.002). CONCLUSION: The present study demonstrates that intra-arterial injection of iodinated contrast agent results not only in luminal enhancement but also in atherosclerotic plaque enhancement in pressure-perfused coronary arteries imaged ex vivo. Plaque enhancement should be considered when characterizing plaque components on the basis of Hounsfield unit with multidetector-row computed tomography.     

Morphological aspects of the development and course of coronary atherosclerosis

The study was undertaken to examine coronary arteries from 548 subjects aged 0-69 years who had died from various causes. It was shown that just within the first year of life there was a marked musculo-elastic hyperplasia of the arterial intima, which was of fibrous nature in adults. The changes in the intima contributed to the development of stenosing atherosclerosis. The atherosclerotic plaques of the coronary arteries showed extensive necrotic foci with their subsequent calcification ("lamina-like" type). Changes causing diminished plaque stenoses (ruptures or tears of their fibrous cover, infiltration of the latter with cellular elements, necroses and delipidization of the plaques) were common in the significantly stenosing atherosclerotic plaques.     

老年患者股动脉粥样硬化的病理学特点与冠状动脉和颈动脉粥样硬化的比较

目的　探讨老年患者股动脉粥样硬化的病理学特点 ,并与同一个体的冠状动脉、颈动脉粥样硬化进行比较。方法　收集我院老年尸体解剖病例 15例。将所有病例之两侧股动脉、颈动脉及左冠状动脉前降支进行连续取材 ,光镜下观察三者动脉粥样硬化病变的形态学、病变分布情况 ,并对动脉粥样硬化程度进行评分。结果　在老年患者中 ,股动脉粥样硬化病变以晚期斑块尤其是复合病变为主 ,与颈动脉、冠状动脉粥样硬化相似。右股动脉的斑块检出率达 93.3%。与左冠状动脉前降支比较 ,股动脉和颈动脉粥样硬化的范围较小 ,程度较轻。三者在动脉粥样硬化程度和范围上无相关性。结论　股动脉和颈动脉粥样硬化可作为研究冠状动脉粥样硬化发生的间接指标。但在同一个体 ,不能用股动脉、颈动脉粥样硬化评估冠状动脉动脉粥样硬化的程度和范围。     

Atherosclerotic involvement of coronary branch vessels

The atherosclerotic involvement of coronary branch vessels (first diagonal, first septal, posterior descending, left and right marginals, conus and the vessels supplying the conduction system) was investigated in 450 apparently healthy subjects aged 11–55 years who died of accidental causes. In subjects 35–55 years old, 1 out of every 3 persons with atherosclerotic plaques in the major coronary arteries also had atherosclerotic plaques in coronary branch vessels; the respective relation for fatty streaks was 1 out of every 12 subjects, for intimal necrotic areas 1 out of every 7 subjects and for incorporated microthrombi 1 out of every 9 subjects. One out of every 3 subjects 51–55 years old had more than 50% lumen reduction in the undistended major coronary arteries, compared to 1 out of every 6 subjects in undistended coronary branch vessels. A small subgroup (8.2%) showed more severe stenotic lesions in coronary branch vessels than in coronary major arteries. The atherosclerotic plaques of coronary branch vessels appeared as ‘underdeveloped’, lacking a thick fibrohyaline cap, a large detritus cavity, abundant lipid deposition, cholesterol crystals, basal vascularization, intraplaque hemorrhage, ulceration, calcification, occlusive thrombosis. On the other hand the stenotic character of these plaques was often severe (more than 75% lumen reduction). The questionable value of the estimation of the ischemic significance of a coronary stenosis in the absence of available data on the development of a compensatory collateral circulation is discussed.     

老年患者股动脉和颈动脉及冠状动脉粥样硬化斑块稳定性的比较

目的　探讨股动脉、颈动脉、冠状动脉粥样硬化斑块的稳定性。方法　收集我院老年尸体解剖病例 15例 ,将所有病例的两侧股动脉、两侧颈动脉、左冠状动脉前降支进行连续取材 ,常规病理检查 ,部分节段行α 平滑肌肌动蛋白、CD6 8、bax染色。结果　股动脉粥样硬化斑块中的平滑肌细胞、巨噬细胞数量与颈动脉相近。与冠状动脉比较 ,股动脉粥样硬化斑块中的平滑肌细胞相对多 ,巨噬细胞相对少 ;bax在巨噬细胞的表达多 ,在平滑肌细胞的表达少。结论　平滑肌细胞、巨噬细胞数量的不同导致了 3种动脉粥样硬化斑块不同的稳定性。股动脉中的粥样硬化斑块较冠状动脉更稳定。     

液氮冻伤术建立动脉粥样硬化斑块兔模型

目的创建一种操作简单、经济实用的动脉粥样硬化斑块动物模型。方法 15只健康纯种雄性新西兰白兔实施右颈总动脉内膜液氮冻伤术,结合高脂饲料喂养,术后8周处死动物,取出双侧颈总动脉对比,经病理形态学、免疫组织化学和生化检测观察动脉粥样硬化斑块形成情况。结果 8周后,所有兔右颈总动脉均可见大量动脉粥样硬化斑块形成,而左颈总动脉均无斑块形成;兔血清中脂质水平明显升高(P<0.01);所建立的斑块在组织结构、细胞构成、生长特征和脂质沉积方面与人类斑块相似。结论液氮冻伤术能快速建立典型的动脉粥样硬化斑块模型,从而为研究动脉粥样硬化相关的心脑血管疾病提供一个简便、高效的新型动物模型。