血清ACE2水平在冠心病发生发展中的变化

目的:通过检测血清血管紧张素转换酶2(ACE2)水平,分析ACE2与冠心病(CHD)不同病程之间的相关性,探讨其在CHD发生发展中的变化规律。方法:选取非CHD对照组样本85例,CHD样本174例,并按照冠状动脉狭窄严重程度分成轻度(50%)狭窄组(ls-CHD组)、中度(50%~75%)狭窄组(ms-CHD组)和严重(≥75%)狭窄组(ss-CHD组)。通过ELISA检测所有样本血清中ACE2水平,统计分析CHD不同病程下的ACE2水平,从而探讨血清ACE2水平与CHD发生发展间的关系。结果:ls-CHD、ms-CHD和ss-CHD组血清ACE2水平均高于非CHD组,并且随着冠状动脉狭窄严重程度的加深而上升。男性血清ACE2水平要比女性的高。单一性别内,ls-CHD、ms-CHD和ss-CHD组血清ACE2水平均高于非CHD组,并有显著性差异。回归分析发现性别、糖尿病、CHD与血清ACE2水平相关,并且性别和CHD是血清ACE2水平的独立影响因素。结论:男性血清ACE2水平高于女性;与非CHD患者相比,CHD患者血清ACE2水平升高;在CHD发生发展过程中,血清ACE2水平随CHD病情的恶化而持续升高。     

Are Canadian Inuit at increased genetic risk for coronary heart disease?

 The Keewatin Inuit of the Northwest Territories of Canada have a very low age-adjusted mortality rate from coronary heart disease. We hypothesized that this apparent protection from disease has a genetic basis. We determined the prevalence of the disease-associated alleles of five candidate genes for atherosclerosis-related phenotypes. Surprisingly, four of the five alleles studied, namely AGT T235, FABP2 T54, PON R192 and APOE E4, were significantly more frequent in a sample of 175 Keewatin Inuit than among a representative control sample of whites living in the region. The high frequencies of these disease-associated alleles suggests either that they have no relationship with disease susceptibility in the Inuit, or that some unmeasured genetic and/or environmental factors mitigate disease susceptibility that is associated with these alleles. This highlights the difficulty in extrapolating findings from one population to another. Also, very modest genotype-phenotype associations were observed between APOE genotype (P=0.016) and plasma low-density lipoprotein cholesterol concentration and between FABP2 genotype and plasma 2-h postprandial glucose concentration (P=0.048). The relationship between APOE alleles and plasma low-density lipoprotein cholesterol was the same as has been previously reported in many study samples. However, the relationship between FABP2 alleles and plasma 2-h postprandial glucose concentrations was the opposite to that reported in other studies. This suggests that differences in environment, such as the type of fatty acid consumed, interacts with functional differences in gene products involved in candidate metabolic pathways to produce phenotypic differences. Received: 5 August 1996 / Accepted: 21 January 1997     

冠心病患者血浆LCAT水平与HDL亚类组成的关系

 目的： 探讨冠心病 (coronary heart disease, CHD) 患者血浆卵磷脂胆固醇酰基转移酶 (lecithin cholesterol acyltransferase, LCAT) 与高密度脂蛋白 (high-density lipoprotein, HDL) 亚类分布的关系。方法：采用双向电泳-免疫印记法分析了73例正常对照者和144例冠心病患者HDL亚类的组成、含量及分布特征,用酶联免疫法测定其LCAT浓度。冠心病患者按血浆LCAT浓度进行四分位数（19.22、36.39和55.32 mg/L）分层（Q1：LCAT<19.22 mg/L; Q2：19.22≤LCAT<36.39 mg/L; Q3：36.39≤LCAT<55.32 mg/L; Q4：LCAT≥55.32 mg/L）。结果：随着LCAT浓度的降低,冠心病患者血浆总胆固醇（TC）、甘油三酯（TG）水平和载脂蛋白B-100/A-I(apoB-100/A-I)比值呈增加趋势,高密度脂蛋白胆固醇（HDL-C）和apoA-I水平呈减少趋势。与最高四分位数组相比,第三、第二和最低四分位数组中preβ1-HDL含量增加,HDL2a和HDL2b含量减少 (P<0.05或P<0.01)。与正常TC组比较,高TC组LCAT浓度降低,且preβ1-HDL含量增加,HDL2a 和HDL2b含量减少(P<0.01)。直线相关和多元回归分析中发现,血浆LCAT水平与preβ1-HDL浓度呈负相关,与HDL2a和HDL2b浓度呈正相关。结论：CHD患者血浆HDL颗粒呈变小趋势,并且随着LCAT水平的降低,其HDL颗粒的变小程度更加明显。     

冠心病患者指纹类型的分析

目的探讨冠心病与指纹类型的关系。方法采用体质测量法,分析了宁夏汉族男性群体272例(冠心病患者136例,正常对照人群136例)指纹类型的出现频率,并比较其差异性。结果冠心病患者组双手斗型纹(W)出现频率均高于正常对照组,且差异有显著性(P0.01),两组斗型纹(W)出现频率递减顺序均为ⅣⅠⅡⅢⅤ;冠心病患者组斗型纹(W)6的出现频率显著高于正常对照组(P0.05)。结论斗型纹(W)出现频率可能是冠心病早期筛查的重要指标之一。     

An HphI polymorphism in the E-selectin gene is associated with premature coronary artery disease

An increased expression of E-selectin has been observed in the arterial endothelium interacting with lymphocytes and macrophages in human atherosclerotic lesions. We examined whether a polymorphism in the E-selectin gene, due to a G to T mutation (G98T) in the untranslated region of exon 2, was associated with premature coronary artery disease (CAD). Other lipid and nonlipid risk factors including a Ser to Arg (S128R) substitution in the E-selectin gene were also assessed. In patients with premature CAD (men < or = 45 years old and women < or =55 years old, N = 51) who underwent an elective diagnostic coronary arteriography, the frequency of the mutation was significantly higher than in controls (N = 50, 0.22 vs. 0.10, p = 0.024). After controlling for other CAD risk factors (plasma total cholesterol, triglyceride, LDL-apolipoprotein B. cigarette smoking and the S128R mutation) by multiple logistic analysis, the G98T mutation in the E-selectin gene was still a significant predictor of premature CAD [p = 0.022, odds ratio (95%, CI)= 3.58 (1.20-10.67)].     

A systematic review of computer-based softwares for educating patients with coronary heart disease

OBJECTIVE: To evaluate the use of computer-based softwares for educating patients with coronary heart disease. METHODS: A systematic electronic search for randomised controlled trials and comparison studies published from 1999 to the end of 2005 using the MEDLINE (1999-2005), EMBASE (1999-2005) and CINAHL (1999-2005) was carried out. Articles including the reference lists in the following journals were hand-searched: Patient Education and Counselling and Patient Counselling and Health Education. RESULTS: A total of 487 articles were identified. Based on a review of abstracts, five studies fulfilled the inclusion criteria of the review. A scoring sheet was used to assess the papers' quality. All studies reported significantly increased knowledge in patients using the educational software when compared to standard education. The difference in knowledge between the intervention and control groups remained high even at 6 months follow up. Furthermore, patients reported high satisfaction with the educational programs. CONCLUSION: Despite there only being five studies that met the inclusion criteria, this review supports the successful use of computer software to increase knowledge in patients with coronary heart disease. The reviewed articles reveal that computer-based education has an important role in increasing patients' knowledge about their condition. PRACTICAL IMPLICATIONS: It is commonly reported that patients want more information about their illness. This study shows that computer-based education can be a useful, acceptable to patients and effective way to deliver education about coronary heart disease.     

急性冠状动脉综合征介入治疗前后脑钠肽变化及对临床预后的判断

目的通过测定急性冠状动脉综合征患者介入治疗前后血浆脑钠肽（BNP）水平的变化,探讨急性冠状动脉综合征介入治疗（PCI）对急性冠状动脉综合征患者血浆BNP变化及对临床病情和预后的判断。方法冠心病介入治疗（PCI）168例,分为存活组（143例）和死亡组（25例）;对存活组患者随访至6个月分别测定血浆BNP及死亡、再入院率,超声心动图检查（UCG）左室射血分数（LVEF）。结果PCI术后血浆BNP水平比术前明显降低,从术前的血BNP浓度在（176±27）ng／L逐渐升高,至术后6个月降低到（98±6）ng／L,与术前相比差异具有统计学意义（P〈0．05）。死亡组患者术前血BNP浓度水平比存活组明显升高（P〈0．05）。存活组和死亡组LVEF[（57．0±14．1）％比（31．0±15．0）％,P〈0．01]有统计学意义,Logistic多变量逐步回归分析显示,BNP是预测ACS患者PCI治疗预后的独立预测因子,且与LVEF呈负相关。结论PCI可降低ACS患者血液BNP水平,但术前BNP水平,常提示预后不良     

冠心病患者尿MHPG·SO＿4、皮质醇和白细胞介素测定

为了解应激状态下机体的神经递质──内分泌─—免疫系统功能的变化规律，我们对一组冠心病住院患者的尿ＭＨＰＧ、血浆皮质醇及白细胞介素Ⅱ进行观察，结果发现冠心病亚型、病程、焦虑情绪及不同行为模式均影响其神经──内分泌──免疫反应。其中，尿ＭＨＰＧ与血浆皮质醇变化趋势一致，而ＩＬ－２则与皮质醇相反。对于这类心血管病患者，尿ＭＨＰＧ不如皮质醇及ＩＬ２敏感。     

冠心病家族史青少年载脂蛋白E、B的基因多态性

目的 探讨青少年载脂蛋白E(apolipoprotein E，apoE)、apoB基因多态性对冠心病的遗传易感性。方法 应用聚合酶链反应—限制性片段长度多态性技术，对244名健康汉族大学生(冠心病家族史阳性者109人，阴性者135人)的apoE、apoB XbaI、apoB 3’可变数目串联重复序列(variable number of tandem repeat ，VNTR)基因型进行分析。结果 阳性组的e4、x^ 、VNTR—B(hypervariable element，HVE＞38)等位基因频率显著高于阴性组(P＜0．05)，且与血总胆固醇、低密度脂蛋白—胆固醇、aPoBl00水平升高有显著相关(P＜0．05)。结论 apoE的e4、apoB Xba I的x^ 、apoB3’VNTR的VNTR—B可能为冠心病的重要遗传标记。     

Acute hemodynamic effects of carvedilol in comparison with propranolol in patients with coronary heart disease

In a randomized, double-blind study oral doses of 50 mg carvedilol (Dilatrend) were compared with 40 mg propranolol in 16 male patients with coronary heart disease, CHD [12 without significant stenoses following percutaneous transluminal coronary angioplasty (PTCA), 4 with multivessel disease]. Bicycle ergometry in the supine position was performed before and 80 min after drug application; measurements were done at rest, during and after exercise. Clinically, the total exercise time and the onset of angina and exhaustion were noted, while the investigated hemodynamic parameters were heart rate, systemic and pulmonary pressures and resistances, cardiac index, and lower limb blood flow. Clinically, carvedilol improved the exercise tolerance more than propranolol as regards angina and exhaustion. Hemodynamically, carvedilol did not lead, as the classic betablocker propranolol does, to an increase in systemic or pulmonary resistance, to a decrease in cardiac output, or to an increase of the pulmonary capillary wedge pressure during exercise, but instead caused opposite changes. In contrast to propranolol, the post exercise lower limb blood flow had increased significantly. The differences in action between the two betablockers can be explained by the vasodilating properties of carvedilol. Due to these acute effects, carvedilol may be preferred to propranolol in the treatment of CHD patients with hypertension, peripheral occlusive artery disease, and/or coronary vasospasm.     

肾素-血管紧张素系统基因多态性与糖尿病及合并肾病的关系

目的探讨血管紧张素I转换酶(ACE)基因及血管紧张素原(AGT)基因与2型糖尿病(DM)及合并糖尿病肾病(DN)的相关性。方法分别用PCR、突变基因分离聚合酶链反应(MS-PCR)技术对195例2型DM患者和136例正常对照者的ACEI/D与AGTM235T多态性进行检测。结果(1)DM组ACE-DD基因型和D等位基因频率均比对照组显著增高(P<0.001)。(2)DN(+)组ACE基因型和等位基因频率与DN(-)组比较无显著性差异。(3)AGT基因型分布与等位基因频率在3组中均无显著性差异。(4)联合分析ACE-DD型及AGT-TT型对DN(+)、DN(-)的OR分别为4.17和3.16;均高于单基因DD型及TT型的OR值。结论(1)ACEDD基因型和D等位基因可能是广西地区人群2型DM的易感因素。(2)未发现ACEI/D或AGTM235T多态性单一因素与2型DM患者中DN的发生有关联。(3)ACE-DD基因型与AGTM235T-TT基因型在2型DM及DN发生中有协同作用。     

Assessing coronary heart disease in women

Coronary heart disease (CHD) is a leading cause of mortality in women worldwide. However CHD is still considered to be a male disease and it is likely to be under-diagnosed in women since symptoms are different in women and diagnostic tests may be less specific or sensitive. This review examines the symptoms and risk factors for CHD in women. The role of invasive and non-invasive tests together with their prognostic implications as well as indications for coronary revascularization will be discussed. New research should focus on the role of gender differences in CHD and trials specifically designed to study women.     

冠心病后抑郁与室性心律失常的相关性研究

１０３例冠心病人完成精神状况检查和量表评定，并接受２４小时Ｈｏｌｔｅｒ监测。结果发现２１例病人符合轻性或重性抑郁的诊断。阵发性室性心动过速（ＶＴ）发生率在抑郁组（２８．５％）显著高于非抑郁组（３．７％）。抑郁组病人心脏变异性（ＨＲＶ）明显低于非抑郁病人（６５．５±３８．６与９４．６±２９．９ｍｓ，Ｐ＜０．０９）。抑郁病人吸烟率及婚姻状况不良者高于非抑郁病人。应用多因素Ｌｏｇｉｓｔｉｃ回归分析，抑郁作为危险因素对ＶＴ的发生具有显著影响。本文结果可部分解释冠心病后抑郁患者心源性死亡率增加的原因。     

Plasma brain natriuretic peptide levels in coronary heart disease with preserved systolic function

Abstract. We evaluated the circulating levels of brain natriuretic peptide (BNP) in stable angina, unstable angina, and myocardial infarction relating hormone levels to extension of coronary disease and number of vessels involved after angiographic examination. We studied 86 patients consecutively undergoing angiographic coronary examination and echocardiographic evaluation for coronary heart disease. These included 15 control subjects (group 0), 21 with stable angina (group I), 26 with unstable angina (group II), and 24 with non-Q myocardial infarction (group III). Patients with heart failure, a history of myocardial infarction, or recent myocardial damage with electrocardiographic S-T elevation were excluded. BNP levels in patients with unstable angina and myocardial infarction were significantly increased with respect to the group with stable angina (P<0.01). There were no differences between the groups with unstable angina and myocardial infarction. Analysis of peptide levels in relation to the number of involved vessels demonstrated a significant increase in patients with three-vessel disease compared with subjects with one or two vessels involved (P<0.03); among subjects with mono-vessel disease, patients with left descendent anterior stenosis had a moremarked BNP elevation than subjects with stenosis in other regions (P<0.01). Hence, BNP levels appear to be elevated in coronary disease, especially in acute coronary syndromes, even in the absence of systolic dysfunction. BNP levels also seem to be related to the severity of coronary atherosclerosis and number of vessels involved. BNP could prove a novel marker for risk stratification, not only in heart failure but also in coronary heart disease.     

Nocturnal myocardial ischemia and cardiac arrhythmia in patients with sleep apnea with and without coronary heart disease

Summary To study the effect of apnea and hypoventilation-induced hypoxemia on the heart, we carried out polysomnographic recordings over; 4 nights with electrocardiographic tracings in 30 patients with and without coronary heart disease. Evaluations of the data were based on the 2nd and 4th nights. In six subjects, five with coronary heart disease, we found 85 episodes of nocturnal ischemia, mainly during REM sleep (83.5%), high apnea activity, and sustained and progressive hypoxemia. Complex ventricular ectopy was observed in 14/13 patients (nights 2/4) and repetitive ventricular ectopy in 5/3. There was no significant difference in the quality and quantity of ventricular ectopy during wake and sleep states between the CHD group and the control group. In one patient ventricular bigeminy was observed only at a threshold of SaO₂ below 60%. Bradyarrhythmia was made evident in four subjects from the CHD group and correlated mainly with apnea activity. We suppose that patients with sleep apnea and CHD are at cardiac risk because coronary heart disease can be aggravated by insufficient arterial oxygen supply due to cumulative phases of apnea and hypoventilation. The reduced hypoxic tolerance of the heart may lead to myocardial ischemia: and increased electrical instability.Abbreviations AI apnea index (apnea episodes per hour) - bpm beats per minute (heart rate) - CHD coronary heart disease - NREM non-rapid eye movement - PVC premature ventricular contraction - REM rapid eye movement - SRBD sleep-related breathing disorders     

镁离子与冠心病关系的研究进展

镁离子(Mg2+)为细胞内含量最多的二价阳离子.人体内Mg2+的主要来源为饮食摄人,主要经回肠吸收,肾脏为其重要排泄器官.机体中Mg2+浓度受多种因素调节,如甲状旁腺激素、降钙素、去甲肾上腺素和肾上腺素等多种激素都影响镁的转运.近年来研究发现细胞膜上瞬时受体电位阳离子通道M7 (transient receptor potential cation channel subfamily M member 7,TRPM7)和M6(TRPM6)对机体Mg2+稳态的调控起重要作用,其介导的Mg2+电流亦有重要生理作用[1-2].     

炎症因子基因多态性与冠状动脉粥样硬化性心脏病的相关性

目的 研究中国南方汉族人群炎症因子基因多态性与冠状动脉粥样硬化性心脏病(简称冠心病)的相关性.方法 采用基质辅助激光解吸电离飞行时间质谱技术对283例经冠状动脉造影确诊的冠心病患者和176名对照者的5个炎症因子的基因多态性进行检测,评估不同基因型和等位基因与冠心病患病风险的关联性.结果 在受检测的5个炎症因子[乳腺癌易感基因1相关蛋白( BRCA1-associated protein,BRAP)、去整合素-金属蛋白酶8、中间a胰蛋白酶抑制因子H3、白细胞介素-15和环氧化酶-2]中,BRAP基因的270T/C及90A/G多态性在冠心病组与对照组间的差异有统计学意义,其等位基因和基因型的分布频率符合Hardy-Weinberg平衡(分别为:x2=0.878,P＞0.05;x2=0.776,P＞0.05).冠心病组BRAP 270C等位基因和90G等位基因频率高于对照组(分别为:29.51％vs.21.31％,P=0.006;30.04％ vs.21.31％,P=0.004).Logistic回归分析提示,BRAP 270CC和90GG基因型携带者患冠心病的发病风险高于BRAP 270TT和90AA基因型携带者(分别为:OR=4.51,95％CI:1.41～14.45,P=0.011;OR=5.09,95％CI:1.60～16.26,P=0.006),且该关联独立于性别、年龄、吸烟、高血压、糖尿病及血清总胆固醇、低密度脂蛋白胆固醇水平等风险因素之外.没有证据表明其余单核苷酸多态性与冠心病易感性相关.结论 BRAP基因内含子270T/C和外显子90A/G多态性可能是中国南方汉族人群冠心病发病的风险因素之一.     

冠心病与病毒感染的相关性探讨

目的 探讨冠心病与病毒感染的相关性,为治疗冠心病患者发生病毒感染提供相应临床依据.方法 以回顾性分析的方式,选取我院2013年5月到2014年5月期间收治的冠心病患者的临床资料55例,作为观察组;并选取同期于我院接受体检的健康人群52例,作为对照组.对两组人群均分别进行巨细胞病毒(HCMV)、流感病毒(Ⅳ)、呼吸道合胞病毒(RSV)、单纯疱疹病毒(HSV)以及柯萨奇病毒(CoxV)的感染率检测,并进一步分析观察组患者的病毒感染类型.结果 观察组与对照组人群的HCMV-IgM阳性率以及Ⅳ-IgM阳性率比较差异均具有统计学意义(P＜0.05);观察组中,急性冠心病患者与慢性冠心病患者的HCMV感染率比较差异具有统计学意义(P＜0.05);冠心病患者中,有34.5％的患者存在多种病毒混合感染.结论 冠心病的发生与病毒感染有着十分密切的联系,冠心病患者更容易发生病毒感染,且大多数为多种病毒混合感染,其中急性冠心病更易发生HCMV感染.     

C-反应蛋白对冠心病的临床预测价值

目的 观察C-反应蛋白（C—RP）对冠心病及其严重程度的预测价值。方法 冠心病（CHD）组83人，其中急性心肌梗死（AMI）30例，不稳定型心绞痛（UA）组23例，稳定型心绞痛（SA）组30例。对照组60例，C—RP含量测定采用免疫比浊法。结果 AMI组、UA组、SA组C—RP显著高于对照组；AMI组、UA组显著高于SA组。结论 C—RP是预测冠心病的一个敏感指标，同时对预测冠心病的严重程度有一定的预测价值。     

Gender differences in risk factors for coronary heart disease

Coronary heart disease (CHD), traditionally considered a male disease, is also a major threat to women. This review article addresses independent risk factors for CHD that are specific for women as well as non-gender-specific risk factors and how their effects differ between men and women.