某些冠心病危险因子与冠心病相关性的研究

目的　研究血浆中活化凝血因子Ⅶ (FⅦa)、血浆纤维蛋白原 (Fig)和血清脂蛋白 (a) [LP(a) ]与冠心病及冠状动脉狭窄程度的关系。方法　观察 10 0例冠心病患者 ,检测血浆FⅦa、Fig和血清LP(a)水平 ,并进行冠状动脉造影检查 ,评估冠状动脉狭窄程度、支数与上述检测结果的相关性。结果　冠心病组血浆FⅦa、Fig、血清LP(a)浓度明显高于正常对照组 (P <0 0 5 )。血浆中FⅦa、Fig及血清LP(a)浓度与冠状动脉狭窄程度、冠状动脉病变支数密切相关 (P <0 0 5 ) ;经Logistic回归分析显示 ,FⅦa、Fig、LP(a)为冠心病发生的独立危险因子 (OR =1 17、OR =1 12及OR =1 0 8,P <0 0 5 )。结论　血浆FⅦa、Fig和血清LP(a)水平与冠心病的发生密切相关 ,血浆FⅦa、Fig水平及血清LP(a)水平与冠心病的发展及严重程度显著相关 ,为冠心病发生的独立危险因子。     

Effect of heart valve prostheses on hemolytic processes in patients with acquired heart diseases

Parameters of intravascular hemolysis (erythrocyte count, hemoglobin concentration and circulating blood volume, acid erythrograms, plasma free hemoglobin and haptoglobin levels) were examined in 44 patients with acquired heart diseases controlled with the aid of bioprostheses. As shown by 2 years' follow-up, successfully implanted mitral and aortal bioprostheses did not significantly affect the activity of intravascular hemolysis. Yet developing stenosis and incompetence of the bioprostheses may be accompanied with a significant intravascular hemolysis.     

The future of catheterization in acquired heart valve diseases

The value of routine catheterization and angiography in the investigation of acquired valvular disease is currently under debate. In many cases, echocardiography provides enough information, even for pre-operative assessment of the heart disease. However, the pre-operative assessment of the valvular disease requires an estimation of the severity of the valvular lesion and a study of left ventricular performance. In older patients, associated coronary artery disease also has to be evaluated. Finally, in patients who have been treated surgically, the disorders related to recurrence of their valvular disease or to the dysfunction of their valvular prosthesis also have to be identified. Each of these aspects has to be considered; this requires a very thorough clinical evaluation of the symptoms and signs and a combination of investigations, consisting of echocardiography, haemodynamic studies and angiography.     

5192例女性冠状动脉造影的特征及危险因素分析

目的探讨拟诊冠心病女性患者危险因素与冠脉造影结果的关系及其与男性患者的差异。方法入选于天津市胸科医院拟诊冠心病行冠脉造影术的患者12 294例,其中男性7102例,女性5 192例,应用冠脉造影观察冠脉病变特点。结果女性患者的冠脉造影阳性率低于男性(60.21%比78.54%),且病变较轻。男性组(65.70%)多具有吸烟习惯,女性组多合并糖尿病和高脂血症(分别为14.64%和44.92%)。结论不同性别的患者冠脉病变特征和危险因素不同,女性冠脉造影的阴性率较高。     

Indications for heart valve replacement

Proper evaluation of the patient with valvular heart disease begins with a thorough history and physical examination. Today, sophisticated noninvasive tests--especially echocardiography with color flow Doppler imaging--complement the information gained at cardiac catheterization. Information previously available only through cardiac catheterization can now be obtained from these noninvasive techniques. Serial evaluations can be performed, which are important in managing lesions of borderline hemodynamic significance and in avoiding subclinical deterioration of left ventricular contractility. Improvements in surgical expertise and intraoperative myocardial preservation allow postoperative improvement for patients with aortic stenosis and aortic insufficiency despite the presence of left ventricular systolic dysfunction. Many traditional indicators of a poor operative result in aortic insufficiency appear less reliable today. Consequently, these indicators should never be viewed in isolation or be given preeminence over clinical judgment. The long-term results following aortic valvuloplasty have been disappointing. However, mitral valvuloplasty--for technically suitable types of mitral stenosis--is an attractive alternative to surgery. Echocardiography may be helpful in selecting patients best suited for this technique. The timing of valve replacement in mitral insufficiency is made difficult by the altered loading conditions which can mask underlying contractile dysfunction. In this regard, the use of end-systolic measurements (e.g., end-systolic stress-volume ratio) more accurately characterized left ventricular contractility. When mitral insufficiency patients with left ventricular systolic dysfunction require surgery, valve repair appears superior to traditional mitral valve replacement. With valve repair, the postoperative left ventricular ejection fraction is usually higher, as left ventricular contractile reserve is better maintained.     

风湿性瓣膜病患者冠状动脉疾病预测指标的研究

目的 :研究风湿性瓣膜病患者冠状动脉心脏病 (CHD)的冠状动脉病变分布及CHD预测指标。方法 :对 6 78例风湿性瓣膜病患者行冠状动脉造影检查 ,左右冠状动脉管腔狭窄≥ 70 %、左主干管腔狭窄≥ 5 0 %判定为CHD。结果 :发现并发有CHD患者 (CHD组 ) 86例 ,平均年龄大于非CHD患者 (非CHD组 ) ,多支病变 4 8例(5 5 .81% )。CHD组中家族史、糖尿病、高胆固醇血症多于非CHD患者。有无心绞痛症状与是否并发CHD无明显相关 ,各种瓣膜病变CHD的发生率相似。结论 :CHD家族史、糖尿病、高胆固醇血症是风湿性瓣膜病患者进行冠状动脉造影检查的指征 ,心绞痛不是风湿性瓣膜病患者并发CHD的预测指标     

Relationships between intravascular ultrasonographic findings and coronary risk factors in patients with normal coronary angiography

OBJECTIVES: Indicators of ischemic heart disease were studied for the practice of preventive medicine. METHODS: Intravascular ultrasonography was performed in 97 patients with no abnormalities by left anterior descending artery angiography. Coronary risk factors were evaluated based on the relationship between plaque formation and lipoprotein levels. RESULTS: Plaque was observed in 81% of patients. The relationship between mean plaque area(%) and the low-density lipoprotein/high-density lipoprotein(LDL/HDL)ratio was examined. Mean plaque area(%) was significantly higher at LDL/HDL < or = 2.5 than at LDL/HDL > 2.5. The border of significant change level of mean plaque area(%)was LDL/HDL = 2.5. There was a good correlation between mean plaque area (%) and LDL/HDL (r = 0.65, p < 0.01). Mean plaque area (%) at LDL/HDL 2.5 was calculated at 15%. Patients with coronary risk factors had LDL/HDL lower than 2.5 at mean plaque area of 15%. CONCLUSIONS: Maintaining LDL/HDL at 2.5 is very important for preventive medicine. However, LDL/HDL should be managed at under 2.5 in patients with coronary risk factors.     

2008例男女冠心病患者冠状动脉病变与危险因素的临床分析

目的探讨男女冠心病患者冠状动脉病变的差异及其危险因素。方法回顾性分析临床可疑冠心病行冠状动脉造影确诊2008例的病历资料。按性别为2组,男性组1332例,女性组676例,冠状动脉病变程度用病变部位、支数、分型及病变Gensini总积分表示。分析两组患者冠状动脉病变的特点并就高血压、糖尿病、血脂异常和吸烟等危险因素进行比较。结果①男性组单支（26．2％）比例低于女性组（41．7％）,而双支病变（33．0％）和三支病变（40．8％）比例均高于女性组（分别为25．9％和32．4％,P〈0．05）。②男性组前降支和右冠状动脉病变发生率（87．5％和67．0％）明显高于女性组（79．6％和54．7％,P〈0．05）。③两组A型病变率最高。女性组A型病变发生率高于男性组,而B型和C型病变分别低于男性组。④女性组高血压和糖尿病高于男性组,吸烟、饮酒和血脂异常低于男性组（P〈0．05）。⑤男性患者Gensini总积分高于女性患者（P=0．000）。结论男性患者以三支病变为主,女性患者以单支病变为主;男性患者冠脉病变程度比女性患者重;女性患者高血压和糖尿病为主要危险因素,男性患者血脂异常、吸烟和饮酒为主要危险因素。     

女性冠状动脉性心脏病危险因素分析

目的 探讨女性冠状动脉性心脏病(冠心病)患者的危险因素,同时了解这些危险因素与冠状动脉血管病变支数的相关关系.方法 分析了景德镇市第一人民医院2005年9月～2008年1月接受冠状动脉造影共139例女性住院患者的临床资料,根据冠状动脉造影结果 分成两组:冠心病组(n=49)及对照组(n=90).分别收集下列参数:吸烟、月经状况、原发性高血压病、糖尿病的人数比例,血清三酰甘油、尿酸、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇及脂蛋白a浓度,进行比较分析,并和血管病变支数进行logistic多元回归分析.结果 三酰甘油和脂蛋白A在冠心病组高于对照组,高密度脂蛋白浓度低于对照组,差异有统计学意义[(2.4±2.4)mmol/L vs.(1.7±0.7)mmol/L,P<0.05;(3438.0±4393.0)αmg/Lvs.(1436.0±1287.0)αmg/L,P<0.05; (1.1±0.31)mmol/L vs.(1.3±0.9)mmol/L,P<0.05].logistic多元回归分析显示,空腹血糖与冠状动脉的病变血管支数相关(β=1.579,P=0.015).结论 原发性高血压、糖尿病、三酰甘油、高密度脂蛋白、脂蛋白A是本组女性冠心病患者的危险因素,且糖尿病是惟一与女性冠状动脉病变支数相关的危险因子.     

Perception of risk for coronary heart disease in women undergoing coronary angiography

BACKGROUND: Even though coronary heart disease (CHD) is the leading cause of death among women in the United States, most women underestimate their risk of developing CHD. DESIGN: Survey to examine the relationship between women's recollection of being told they were at risk for CHD and the presence of risk factors. SETTING/PARTICIPANTS: A convenience sample of 450 women undergoing coronary angiography at 1 university hospital. MAIN OUTCOME MEASURES: Self-recollection of being told one was at risk for CHD and presence of CHD risk factors. RESULTS: Most women (83.6%) had 3 or more risk factors, 12.2% had 1 or 2 risk factors, and 0.9% had no risk factors. Only 35% of women recalled being told that they were at risk for CHD. Few relationships were found between being told one was at risk for CHD and the presence of individual risk factors. No difference was found in the mean number of risk factors among women who did and did not recall being told they were at risk. In logistic regression analysis, only 5% of the variance in recollection of being told one was at risk was predicted, with only age, education, and having a high cholesterol level significantly contributing to the equation. CONCLUSIONS: Even though women may not remember conversations with their health care provider about CHD risk, the possibility that risk factors were not adequately assessed cannot be discounted. Patient-provider conversations about CHD risk factors should be encouraged as the first step toward successful risk reduction.     

Coronary angiography in the preoperative exploration of non-ischemic acquired valve diseases]

One hundred and fifty-nine patients with aortic valve disease (86 cases), mitral valve disease (58 cases) or mitral and aortic disease (15 cases) underwent a pre-operative haemodynamic study, including coronary arteriography either as a routine (age greater than 50 years) or because of chest pains. Coronary arteriography is easy to do during left heart catheterisation and nowadays carries minimal risk. In the cases of chest pains, it showed stenotic lesions of the coronary vessels in 22% of patients with aortic valve disease and in 35% of those with mitral disease. In the absence of angina, coronary arteriography showed no evidence of coronary artery disease in the cases of mitral regurgitation and of aortic valve disease. In contrast, it showed stenotic lesions in three cases of mitral stenosis. In the whole of the series, coronary artery disease proved a contra-indication to surgery in three cases, and was an indication for aorta-coronary by-pass grafting, in addition to valve surgery, in seven other cases. In the absence of angina, coronary arteriography has only a slight influence on the decision to operate. It does however give additional security, which justifies its routine use in patients over 50 years of age, particularly those with mitral valve disease.     

Echocardiography in the preoperative diagnosis of acquired heart valve diseases

With the aim of minimizing the risk and stress of an invasive diagnostics, 102 patients with acquired heart valve diseases were examined by two-dimensional echocardiography combined with pulsed Doppler technique. The results were compared with those obtained at invasive diagnostics in 91 and/or during surgery in 52 of the patients studied. In the group of operated patients the sensitivity of non-invasive diagnostics was 89.5%, specificity 97.2%; analogous data for patients not subjected to surgery were 91.8% and 93.8%, respectively. The results of the study show that in the majority of patients with acquired valvular disease a complete preoperative invasive investigation is not necessary. Only in patients over 50 years of age the intended valve replacement should be preceded by additional coronarographic examination, as in 6.8% of cases--even without kinetic disturbances at rest--a haemodynamically important stenosis was found on at least one coronary artery.     

Clinical estimation of coronary risk factors with special reference to coronary arteriographic findings

The relationship between coronary risk factors and the severity of coronary artery stenosis (coronary score: CS) was estimated in 225 male subjects (aged 29-82 years, median 60 years old) who had undergone coronary arteriography for suspected coronary heart disease. CS was positively related to age, and levels of fasting blood sugar, uric acid, total cholesterol, low density lipoprotein cholesterol, and apolipoprotein B. Alcohol consumption, apolipoprotein AI and AII levels were inversely correlated to CS. Although, the level of CS was significantly higher in diabetics and hypertensives than in non-diabetics and non-hypertensives, the difference of CS level between diabetics and non-diabetics was more remarkable than that between hypertensives and non-hypertensives. Furthermore the ratio of Apo-B/Apo-AI was the most sensitive index of coronary artery stenosis rather than conventional atherogenic indices such as (TC-HDL-C)/HDL-C. Correlation between CS and the ratio of Apo-B/Apo-AI was positively and closely associated with aging, and this positive relationship was observed even in non-drinkers, heavier drinkers, non-diabetics and non-hypertensives. The reweighted least squares based on the least median of squares regression analysis indicated that about 27% of the variation in CS could be accounted for by age, complication of diabetes mellitus, complication of hypertension and the ratio of Apo-B/Apo-AI. These results indicate that the ratio of Apo-B/Apo-AI is a more sensitive parameter of the severity of coronary artery stenosis than any other atherogenic index. Further, aging, complication of diabetes mellitus, complication of hypertension and an increased level of the ratio of Apo-B/Apo-AI were responsible factors for the severity of coronary arteriosclerosis in male subjects.     

老年冠心病患者支架内再狭窄危险因素分析

目的 探讨老年冠心病患者冠脉支架术后支架内再狭窄(ISR)的危险因素.方法 选取2016年1月-2019年12月在复旦大学附属华东医院心内科行经皮冠状动脉支架植入术,并于术后12个月常规复查冠脉造影的老年冠心病患者共208例作为研究对象,根据是否发生ISR,他们被分为ISR组(24例)和非ISR组(184例),比较2组...     

Screening for psychosocial risk factors in patients with coronary heart disease-recommendations for clinical practice.

Psychosocial risk factors like low socio-economic status, chronic family or work stress, social isolation, negative emotions (e.g., chronic depression or acute anxiety), and negative personality patterns such as Type-D-pattern or hostility, may contribute significantly to the development and adverse outcome of coronary heart disease. Therefore, systematic screening for psychosocial risk factors in cardiological practice is recommended in order to initiate adequate intervention strategies, e.g., to involve additional psychosocial counselling or treatment. Reliable methods to assess psychosocial risk factors are: (1) standardized, structured interviews; (2) standardized questionnaires, and (3) 'single-item' questions to be included into the cardiologists' clinical interviews. While structured interviews should be restricted to trained professionals, questionnaires are easily to administer, and have frequently been used in the field of cardiology. 'Single item' questions are sufficiently reliable and the most timesaving way to screen for psychosocial factors. For clinical practice, a two-step evaluation is recommended: firstly, cardiologists should include 'single-item' questions into their routine interview and/or use questionnaires in order to screen for a potential problem. Secondly, if problems are indicated, patients should be passed to qualified professionals for structured clinical interview. Instruments of all three methods are briefly presented, and implications for further treatment are discussed.     

中年女性患者冠状动脉造影的临床特点分析

目的 分析中年女性冠心病临床危险因素、冠状动脉造影及介入治疗特点,评价冠心病发病、危险因素构成、冠状动脉造影及介入治疗方面年龄和性别的差异.方法 入选1998年1月1日至2006年12月30日9年间在我院临床疑诊冠心病、年龄40～79岁、行冠状动脉造影的住院患者5685例.根据年龄分为中年组(40～59岁)和老年组(60～79岁),根据性别分为女性组和男性组.以同龄男性及老年女性为对照,回顾性分析冠心病危险因素在中年女性的分布情况、冠心病的检出率、冠状动脉病变及介入治疗特点、肾动脉造影及介入治疗特点.结果 ①中年女性与同龄男性比较:血脂异常患病率女性(75.68%)显著低于男性(88.80%)(P<0.01);高血压患病率女性(59.42%)显著高于男性(50.66%)(P<0.01);糖尿病患病率女性(30.47%)与男性(33.42%)差异无统计学意义(P=0.98);陈旧心肌梗死患病率女性(11.48%)显著低于男性(42.50%)(P<0.01);脑卒中患病率女性(5.01%)与男性(4.77%)差异无统计学意义(P=0.82);肾功能下降患病率女性(1.71%)低于男性(2.87%)(P=0.07).冠状动脉造影冠心病检出率女性(36.64%)显著低于男性(69.10%)(P<0.001);在冠心病患者中,冠状动脉受累血管数量及严重程度中年女性组比男性轻(P<0.01);介入治疗比例(58.87%)低于男性(67.08%)(P<0.01).肾动脉狭窄检出率女性(8.62%)高于男性(4.97%)(P<0.05).②中年女性与老年女性比较:血脂异常、高血压、糖尿病、陈旧心梗、脑卒中、肾功能不全患病率,冠状动脉造影阳性率,冠状动脉病变受累血管数量及严重程度,冠状动脉介入治疗比例,肾动脉狭窄检出率均显著低于老年女性组(P<0.01).结论 在临床疑诊冠心病而行冠状动脉造影的患者中,中年女性血脂异常、陈旧心梗患病率、冠心病检出率、冠状动脉病变受累血管数量及严重程度、介入治疗比例显著低于同龄男性及老年女性.