普通人群急性心肌梗死患者MEF2A第11外显子的基因变异研究

目的研究MEF2A基因第11外显子在普通急性心肌梗死(简称心梗)患者中的变异情况。方法应用聚合酶链反应-单链构象多态性(PCR-SSCP)和DNA测序技术检测263例散发急性心梗和207例非冠心病个体MEF2A基因第11外显子的基因序列,并比较其异同。结果按SSCP电泳条带的多少和泳动距离将标本分类后,随机选取200例病例组和101例对照组进行DNA直接测序,共发现4个多态位点:A位点,8290-8319CAG重复序列,呈长度多态,导致翻译产物421-430之间谷氨酰胺q个数呈4～15个不等;B位点:8320-8334呈ccgccgccaccaccg和ccgccaccaccg两种多态,导致翻译产物431-435脯氨酸p个数为4～5个不等;C位点,同义变异8334G→A;D位点,同义变异8382G→T。4个多态位点在病例组和对照组之间无差异。本实验未发现MEF2A基因第11外显子上的突变。结论普通急性心梗人群MEF2A基因第11外显子存在4个多态位点,但这些多态位点似乎与心梗的发病无关。     

Relation of obesity to acute myocardial infarction in Japanese patients.

BACKGROUND: It remains uncertain whether obesity is an independent risk factor for coronary heart disease in young adults, as well as adults, in Japan. METHODS AND RESULTS: In the present study, 1,260 cases of acute myocardial infarction (AMI) and 3,775 community controls were recruited from the AMI-Kyoto Multi-Center Risk Study and Kyoto Citizen's Health and Nutrition Study, respectively. Obesity and other risk factors were retrospectively examined between cases and controls in each subgroup of young males (20-40 years), middle-aged males or females (40-60 years), older males or females (60-80 years), and very old males or females (80-100 years). In young, middle-aged, and older males, as well as in older females, cases had a higher body mass index (BMI) than controls. In young males, as well as in middle-aged and older females, cases had a higher prevalence of smoking than controls. Except for very old males, the prevalences of hypercholesterolemia, hypertension, and diabetes mellitus were higher in each subgroup of cases than in controls. Multivariate logistic regression analysis revealed that obesity (BMI >or=25) was an independent risk for AMI in young and middle-aged males, but not in females, whereas smoking was an independent risk for AMI in middle-aged and older females as well as in older males. CONCLUSIONS: Obesity is significantly associated with AMI, independent of the classic coronary risk factors, in young and middle-aged males. These findings support the current emphasis on controlling obesity to prevent coronary events in young Japanese male adults.     

Beta-blockers prevent cardiac events in Japanese patients with myocardial infarction.

BACKGROUND: Although the favorable effects of beta-blockers in the treatment of myocardial infarction (MI) have been repeatedly demonstrated in Western countries, administration of this drug has been limited in Japan. METHODS AND RESULTS: The study group of 1,896 patients with MI was retrospectively divided into 1,029 patients treated by beta-blockers and 867 not treated by beta-blockers, and the incidences of cardiac events, consisting of recurrent MI, death because of worsening heart failure, and sudden death, and cardiovascular events, comprising cardiac events and stroke, were compared in both groups. There were 45 cardiac events (4.4%, 30.1 patients/1,000 patients. year) among the beta-blocker group, which was significantly less than the 56 cardiac events (6.5%, 52.3 patients/1,000 patients. year) among the no-beta-blocker group (p<0.05). The total mortality was 92 (8.9%, 61.6 patients/1,000 patients. year) and 124 (14.3%, 115.8 patients/1,000 patients. year), respectively, and cardiac death occurred in 42 (4.1%, 28.1 patients/1,000 patients. year) and 53 (6.1%, 49.5 patients/1,000 patients. year), respectively, indicating that both these events occurred significantly less in the beta-blocker group (p<0.01 and p<0.05). CONCLUSIONS: Beta-blockers prevent cardiac events in Japanese patients with MI. However, a placebo-controlled, double-blind, multicenter, clinical trial conducted on a large scale in Japan would further contribute more precise information of the useful effects of beta-blockers.     

Acute myocardial infarction in young Japanese adults.

BACKGROUND: The prevalence and clinical manifestations of acute myocardial infarction (AMI) in young patients in Japan have not been fully investigated. METHODS AND RESULTS: In the present study, 1651 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and June 2004. Of these, the clinical background, risk factors, angiographic findings, acute results of primary percutaneous coronary intervention (PCI) and in-hospital outcomes for 27 young patients <40 (young group), and 338 non-young patients 60相似文献   

Sex differences of risk factors for acute myocardial infarction in Japanese patients.

BACKGROUND: Acute myocardial infarction (AMI) is prevalent and has serious consequences including re-infarction and death. Although the risk factors for AMI have been extensively studied in Western countries, they are less well documented in Japan. To determine the risk factors for AMI, we performed a case-control study in unselected patients with AMI. METHODS AND RESULTS: Risk factors were assessed in 1,925 consecutive patients with a first AMI (age, 28-103 years old; men, 1,353; women, 572), who were admitted to one of the major institutes in Japan, and in 2,279 age-and sex-matched population-based controls. Hypertension (odds ratio (OR), 4.80; 95% confidence interval (CI), 3.80 to 5.95; p < 0.01), diabetes (OR, 3.44; 95% CI, 2.50 to 4.75; p < 0.01), current smoking (OR, 3.39; 95% CI, 2.78 to 4.18; p < 0.01), family history (OR, 1.84; 95% CI, 1.30 to 2.62; p < 0.01), and hypercholesterolemia (OR, 1.28; 95% CI, 1.00 to 1.62; p < 0.05) were all independent risk factors for AMI. However, obesity (OR, 1.13; 95% CI, 0.92 to 1.50; NS) was not. Hypertension (OR, 4.80; 95% CI, 3.80 to 6.02; p < 0.01), current smoking (OR, 4.00; 95% CI, 3.02 to 5.00; p < 0.01), and diabetes (OR, 2.9; 95% CI, 2.00 to 4.04; p < 0.01) were all independent risk factors for AMI in men. In contrast, only current smoking (OR, 8.22; 95% CI, 3.98 to 18.88; p < 0.01), diabetes (OR, 6.12; 95% CI, 3.78 to 12.02; p < 0.01), and hypertension (OR, 5.04; 95% CI, 2.92 to 7.52; p < 0.01) were independent risk factors for AMI in women. Hypercholesterolemia was an independent risk factor for AMI in men (OR, 1.52; 95% CI, 1.00 to 1.98; p < 0.05), but not in women. CONCLUSIONS: Hypertension, diabetes, current smoking, family history and hypercholesterolemia are associated with AMI in Japanese patients, and the importance of the risk factors for AMI differs between men and women. Hypertension, current smoking, diabetes and family history are the most important risk factors in men, whereas current smoking, diabetes, hypertension and family history are the most important risk factors in women. Hypercholesterolemia is an independent risk factor for AMI in men, but not in women. To the best of our knowledge, this is the first clinical study to define the relative importance of risk factors for AMI in Japanese patients.     

Assessment of coronary reserve in patients after myocardial infarction

Clinical data were compared with results of stress tests (veloergometry and transesophageal cardiac pacing) in 320 patients 1.5-2 months after myocardial infarction. Severity of angina was classified as functional class 0, I, II, III and IV in 78 (24.4%), 162 (50.6%), 64 (20%), 12 (3.75%), and 4 (1.25%) patients, respectively. Characteristics of coronary reserve by exercise test and transesophageal pacing considerably differed mostly in patients with class 0 and I and were practically identical in patients with class III and IV angina. Pearson's coefficient of correlation was the highest between clinical data and results of transesophageal pacing. It was lower between results of pacing and veloergometry and the lowest between clinical data and results of veloergometry. Values of Pearson's coefficient of correlation rose with increase of functional class of angina from 0.38 to 0.88. All methods analyzed in this study were reliable for estimation of degree of lowering of coronary reserve in patients with high functional class of angina. However in patients without angina or with class I angina additional methods were required and transesophageal cardiac pacing appeared to be a preferable technique for assessment of level of coronary reserve in these patients.     

经静脉心肌声学造影评价心肌梗死后存活心肌的价值

目的　探讨经静脉心肌声学造影 (MCE)对心肌梗死后存活心肌的诊断价值。方法　 2 4例心肌梗死患者用二维超声评价室壁运动情况 ,同时经静脉进行MCE ,以 3个月后静态超声心动图左室心肌节段性运动改善为依据评价MCE对心肌梗死后存活心肌的诊断价值。结果　在 2 4例病人的 384个心肌节段中 ,运动异常节段 184个。在运动异常的 184个节段中 ,MCE1分 39段 ,0 5分 5 0段 ,0分 95段。 3个月复查 79个节段有运动改善 ,其中 39段来自MCE1分的心肌 ,4 0段来自MCE0 5分的心肌。MCE对预测心肌梗死后室壁运动改善的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为 :10 0 %、89 7%、84 8%、10 0 %和 94 6 %。结论　MCE能比较准确地预测心肌梗死后心肌的存活性     

Illness attribution among Japanese patients with acute myocardial infarction

OBJECTIVE: The purpose of this study was to describe causal attribution of acute myocardial infarction (AMI) in Japanese patients. DESIGN: A cross-sectional study design was used. SETTING: The setting for this study was 5 hospitals in urban areas in Japan. SAMPLE: A convenience sample of 155 patients admitted with AMI was used. MEASURES: Causal attribution was assessed by a semi-structured interview. Known risk factors were assessed by medical record review and patient interview. RESULTS: Twenty-two different primary causes for AMI were identified. Patients most commonly cited smoking, stress, and diet as risk factors. Except for smoking, Japanese patients did not identify their cardiac risk factors as a cause of their AMI. Controlling for sociodemographic characteristics, patients with a recorded history of coronary heart disease were significantly less likely to attribute their cardiac risk factors to their AMI (P <.05). CONCLUSIONS: Effective education and counseling of patients after an AMI must be coupled with their view of what factors put them at risk for future AMIs.     

MEF2A第11号外显子四个特殊变异位点的生物学活性研究

目的建立MEF2A蛋白细胞学定位和转录激活活性的体外检测体系,探讨MEF2A第11号外显子四个特殊变异位点的生物学意义。方法构建含绿色荧光蛋白（green fluorescent protein, GFP）报告基因真核表达载体的MEF2A野生型融合表达质粒pEGFP-MEF2A和变异型融合表达质粒pEGFP-MEF2A-Mut;通过脂质体介导的方法将以上质粒转染到Hela和293T细胞,用荧光显微镜检测绿色荧光蛋白的定位表达情况。构建含HRC基因启动子/增强子序列的萤火虫荧光素酶报告基因表达质粒pGL3-HRC enhancer,将该质粒与野生型MEF2A cDNA表达质粒pCDNA-MEFcDNA,或变异型MEF2A cDNA表达质粒pCDNA-MEFcDNA-Mut,以及海肾荧光素酶质粒pRL-TK,用脂质体转染法共转染于293T细胞,Western blot检测MEF2A蛋白的表达,双荧光素酶报告基因检测系统测定荧光素酶报告基因的表达。结果本研究建立的细胞学定位和转录激活活性检测体系均可有效检测MEF2A蛋白的生物学活性;与野生型MEF2A蛋白相比,四种MEF2A特殊变异蛋白的细胞学定位和转录激活活性均无显著性差异。结论本研究发现的MEF2A基因第11号外显子四个含特殊变异位点的MEF2A变异蛋白不会影响其细胞学定位和转录激活的生物学活性。     

急性心肌梗死经皮冠状动脉介入治疗后心肌灌注的方法评价

目的　联合应用TIMI心肌灌注分级 (TMP)、校正的TIMI画面记帧 (CTFC)、心电图ST段变化 (sumSTR)方法评价急性心肌梗死 (AMI)急诊经皮冠状动脉介入治疗 (PCI)后心肌灌注程度 ,探讨心肌灌注程度对临床预后的影响。方法　 77例AMI患者PCI后即刻采用TMP CTFC、TMP sumSTR、CTFC sumSTR三种联合方法评价心肌灌注程度 ,PCI术后 1个月检查双核素心肌灌注显像 ,记录 6个月心脏事件。结果　评价心肌灌注程度 ,与双核素心肌灌注显像对比 ,TMP sumSTR敏感性 86 7%、特异性 85 7%、准确性 86 2 % ;TMP CTFC敏感性 80 %、特异性 77 1%、准确性 78 5 % ;多变量回归分析TMP 0 / 1级 sumSTR <30 %为 6个月心脏事件的独立危险因子 (OR=2 1 5 ,95 %可信区间 2 7～ 6 5 7,P =0 0 0 3) ;Kaplan Meier分析曲线显示TMP sumSTR方法评价的心肌灌注不良组 6个月心脏事件高于心肌灌注良好组 (P <0 0 5 )。结论　TMP sumSTR、TMP CTFC能更好的评价心肌灌注程度 ;TMP sumSTR可预测 6个月心脏事件。     

Risk factors for the complication of cerebral infarction in Japanese patients with acute myocardial infarction

The incidence and risk factors for cerebral infarction in Japanese patients with acute myocardial infarction were evaluated. Seven (5.0%) of 140 patients with acute myocardial infarction suffered from cerebral infarction during their initial hospitalization. The incidence was slightly higher than those reported in Western countries. Anterior wall myocardial infarction and a past history of cerebrovascular disease were considered to be probable risk factors for the complication. A beneficial effect of anticoagulant therapy in preventing cerebral infarction in cases of acute myocardial infarction with those risk factors is suggested.     

Assessment of acute myocardial infarction in Japan by the Japanese Coronary Intervention Study (JCIS) Group.

BACKGROUND: Until now, large-scale nationwide surveys of acute myocardial infarction (AMI), such as those performed in Europe and America, have not been performed in Japan. Therefore, in 2000 the Japanese Coronary Intervention Study (JCIS) group conducted a nationwide survey on the incidence of AMI in Japan. METHODS AND RESULTS: Questionnaires were collected from 8,268 facilities throughout Japan. The total annual number of patients with AMI was 66,459 (52.4 patients/10(5) population), and the AMI incidence rate in Japan was approximately 25% of that in the United States. Most facilities with AMI patients treated less than 50 AMI patients annually, and that number was 45.0% of total AMI patients. The incidence of AMI patients was highest in Kochi, Kumamoto, and Wakayama prefectures, and lowest in Yamanashi, Saitama and Shiga prefectures. The ratio of the highest incidence to the lowest incidence was 2.0. A significant correlation was observed between the mean age of the prefectural population, as a coronary risk factor, and the incidence of AMI. CONCLUSIONS: The incidence of AMI in Japan is approximately 25% that in the United States and it varies considerably among the prefectures, one of the causes being the difference in the mean age. This provides important information for assessing the guidelines for Japanese patients with AMI.     

Aldehyde dehydrogenase 2 gene is a risk factor for myocardial infarction in Japanese men.

In epidemiological studies, moderate alcohol consumption has been consistently associated with a reduced risk of myocardial infarction (MI). About half of Japanese show an extremely high sensitivity to alcohol (ethanol), which is due to a missense mutation from glutamic acid (Glu) to lysine (Lys) at codon 487 in an isoenzyme of aldehyde dehydrogenase (ALDH2) with a low Km. We obtained a preliminary result that subjects homozygous for the Lys 487 allele had higher risk for myocardial infarction. The purpose of the present study was to assess this hypothesis by employing a larger cohort of subjects with MI. The experimental group consisted of 342 male subjects with demonstrated MI who were selected randomly from our outpatient clinic. As controls, we employed 1,820 male subjects with no cardiovascular complications who were selected from the Suita Study. All subjects provided their written informed consent to participate in the genetic analyses. Subjects with MI were older and had higher body mass index, higher prevalence of diabetes mellitus, higher prevalence of smoking habit, higher prevalence of the Lys/Lys genotype (homozygous for Lys 487 allele), and lower high density lipoprotein (HDL) cholesterol level (HDL-C). The ALDH2 genotype affected the level of alcohol consumption, and HDL-C. Multiple logistic analyses indicated that the odds ratio of the Lys/Lys genotype to the Lys/Glu+Glu/Glu genotype was 1.56 (p=0.0359). Inclusion of HDL-C as one of the independent variables downplayed the importance of the ALDH2 genotype. This may indicate that the ALDH2 genotype affects MI via its effects on HDL-C. In conclusion, the ALDH2 Lys/Lys genotype is a risk factor for myocardial infarction in Japanese men due to its influence on HDL cholesterol level.     

磁共振心肌灌注成像预估急性心肌梗死疗效的临床研究

目的 :采用磁共振 (MR)首过灌注成像分析急性心肌梗死 (AMI)心肌首过灌注特点 ,评价病变心肌组织血流灌注治疗效果。方法 :AMI患者 16例 ,正常对照组 8例。采用TurboFLASH序列行MR首过灌注及延迟成像扫描 ,绘制左心室各壁心肌信号强度 时间曲线 ,分析病变心肌信号强度 时间曲线特点。结果 :AMI未溶栓者首过不强化 ,延迟扫描信号强度高于正常心肌 ,曲线上升时间、上升斜率、峰值时间和对比增强率明显低于正常心肌 ,峰值信号强度仅为正常心肌的 (5 4 .5± 12 .0 ) %。溶栓再灌注者首过及延迟均强化 ,延迟扫描时病变心肌信号强度高于正常心肌 ,信号强度 时间曲线仅曲线上升时间延长 ,峰值信号强度可达正常心肌的 (90 .8±13.0 ) %。结论 :TurboFLASH序列可反映心肌首过灌注 ,分析心肌首过灌注有助于评价病变心肌血流灌注情况 ,评价溶栓疗效     

Japanese patients with acute myocardial infarction who present without chest pain

Previous studies have suggested that patients with acute myocardial infarction (AMI) who presented without chest pain had an unfavorable prognosis due to undertreatment. Despite this, few studies have been conducted on the topic, particularly in Japan. The present analysis aimed at determining whether Japanese AMI patients without chest pain are undertreated and experience higher mortality during hospitalization. Data from the Tokai Acute Myocardial Infarction Study II sample were used, which is a prospective study of all consecutive patients admitted to the 15 acute care hospitals in the Tokai region with the diagnosis of AMI from 2001 to 2003. Data on baseline and procedural characteristics and hospital outcome were collected. Differences in the baseline and procedural characteristics and clinical outcomes between patients presenting with and without chest pain were assessed. We evaluated a total of 1,769 patients who presented with chest pain and 452 who did not. The patients with AMI in the absence of chest pain were older and were more likely to have worse clinical conditions than those with chest pain. They were more likely to be undertreated, although the probability of vasopressor use was higher. The patients without chest pain had a significantly higher in-hospital mortality rate than those with chest pain. According to multivariate analysis, however, chest pain was not identified as an independent predictor of in-hospital death. The results suggest that the higher in-hospital mortality rate among Japanese AMI patients without chest pain could be accounted for by differences in clinical conditions.     

Effect of beta-blockers on the mortality of Japanese patients with myocardial infarction

BACKGROUND: After a myocardial infarction, a higher prevalence of coronary vasospastic response has been reported in the Japanese population than in the Caucasian population. Beta-blockers may exacerbate coronary vasospasm. However, beta-blockers are given to Japanese patients after an acute myocardial infarction, though the mortality benefit is unknown. Thus, we investigated the mortality benefit of beta-blockers given to Japanese patients after an acute myocardial infarction. METHODS: We prospectively studied consecutive patients with a first myocardial infarction admitted to the coronary care unit of Kansai Medical University Hospital, Osaka, Japan from May 1994 through the end of 2001. Patients who died during hospitalization or who were referred for coronary artery bypass graft surgery were excluded. The association of beta-blocker use with mortality after discharge was assessed by a proportional hazards regression analysis. RESULTS: There were 546 patients and 400 (73.3%) patients were treated with beta-blockers at the time of discharge from hospital. During a mean follow-up of 2 years, 46 (8.4%) patients died. Beta-blocker therapy was associated with a reduced mortality after adjustment for age, gender, Q wave myocardial infarction, reperfusion therapy during acute phase, Killip functional class, serum creatinine level, cardiovascular risk factors, and medications (hazard ratio=0.51, 95% confidence interval=0.27 to 0.95). CONCLUSIONS: Contrary to the concern that beta-blocker therapy might induce coronary vasospasm and reduce survival, beta-blocker therapy improved survival after discharge in Japanese patients with a first myocardial infarction.