冠心病血浆脂联素水平与纤溶活性的关系

目的 观察冠心病病人血浆脂联素、纤溶酶原激活物抑制物-1(plasminogen activator inhibitor-1,PAI-1)水平的变化及其临床意义.方法 冠心病151例,分为稳定型心绞痛组、不稳定型心绞痛组和急性心肌梗死组.健康体检者50名为对照组.采用酶联免疫吸附测定法测定血浆脂联素、PAI-1浓度.结果 ①血浆脂联素浓度:冠心病组显著低于对照组(P＜0.01);稳定型心绞痛组与对照组比较差异无统计学意义(P＞0.05);不稳定型心绞痛组和急性心肌梗死组显著低于对照组和稳定型心绞痛组(P＜0.01);②血浆PAI-1浓度:冠心病组显著高于对照组(P＜0.01);稳定型心绞痛组组与对照组比较差异无统计学意义(P＞0.05);不稳定型心绞痛组和急性心肌梗死组显著低于对照组和稳定型心绞痛组(P＜0.01).③冠心病病人血浆脂联素浓度与血浆PAI-1浓度相关系数为(r=-0.750,P＜0.01).结论 低脂联素水平可能是冠心病的发病因素之一,血浆脂联素水平可能有助于反映冠心病斑块的稳定性;低脂联素水平可能通过减低纤溶活性而参与急性冠状动脉综合征的发生发展过程.     

血浆vaspin浓度与急性冠脉综合征的相关性

目的通过检测血浆丝氨酸蛋白酶抑制剂vaspin在不稳定型心绞痛(UAP)、急性非ST抬高心肌梗死(NSTEMI)和急性ST抬高心肌梗死(STEMI)患者中的浓度,探究vaspin与急性冠脉综合征(ACS)的相关性。方法选择ACS患者及对照组共200例,所有的入选患者均经冠状动脉造影检查。初次确诊的ACS患者共150例,其中不稳定型心绞痛(UAP)组50例、NSTEMI患者50例和STEMI患者50例;同期住院的对照组50例为经冠状动脉造影检查排除冠心病者。测定各组血浆中vaspin浓度、记录患者的一般情况并结合患者收缩压、舒张压、血常规、血糖、血脂、高敏C反应蛋白(hs-CRP)水平等临床资料进行统计学分析。结果 UAP组、NSTEMI组、STEMI组血浆vaspin浓度显著低于对照组(P0.05);NSTEMI组、STEMI组血浆vaspin浓度显著低于UAP组(P0.05);NSTEMI组、STEMI组血浆vaspin浓度无显著差异(P0.05)。在冠心病患者中血浆vaspin浓度随患者血管病变支数增多而降低,Logistic回归分析示冠状动脉病变支数与血浆vaspin浓度呈负相关(r=-0.351,P0.01)。结论 vaspin的血浆浓度越低,主要不良心脏事件发生率越高。血浆vaspin浓度可以成为ACS的一个新的指标。     

冠心病患者血浆Alarin水平变化及其与冠状动脉病变严重程度的关系

目的　测定冠心病患者血浆Alarin水平,研究其与冠状动脉狭窄程度及其他临床指标的相关性。　方法　采用酶联免疫法测定48例急性心肌梗死患者、74例稳定型心绞痛患者及34例正常对照者血浆Alarin水平,分析三组间Alarin表达差异;根据造影结果对冠状动脉狭窄程度进行Gensini评分,分析Alarin与Gensini评分及其他临床指标的相关性。　结果　急性心肌梗死组、稳定型心绞痛组血浆Alarin水平明显高于正常对照组（P<0.05）,急性心肌梗死组与稳定型心绞痛组之间差异无显著性（P>0.05）。冠心病患者血浆Alarin水平与Gensini评分、低密度脂蛋白水平明显正相关（P<0.05）。结论　血浆Alarin水平在冠心病急性心肌梗死患者及稳定型心绞痛患者中明显增高,且其水平与冠状动脉狭窄程度及低密度脂蛋白水平呈正相关,提示Alarin很可能参与了冠心病的发生发展,是冠心病发病机制中的一个重要因子。     

内皮微粒与冠心病相关性研究

目的:探讨血浆内皮微粒(EMP)与冠心病的相关性。方法:冠心病组367例,其中稳定型心绞痛(SA)119例,急性冠状动脉综合征(ACS)248例,后者含不稳定型心绞痛(UA)158例,急性心肌梗死(AMI)90例。非冠心病组166例。ELISA法测定血浆ET-1,流式微球技术检测血浆EMP。结果:冠心病组ET-1、EMP水平升高,呈正相关(r=0.233,P=0.001)。ACS组EMP(547.405)显著高于非冠心病组(148.185)及SA组(429.890),亚组分析中UA组EMP(551.660)升高最为显著;冠心病冠状动脉病变支数与EMP无明显相关;AMI患者EMP与BNP、TnT、TnI间无明显相关;EMP与ACS患者短期预后相关(r=0.280,P<0.01)。结论:血浆EMP水平可反映冠心病内皮功能障碍,与冠心病的发生、冠状动脉斑块的不稳定性有关。     

急性冠状动脉综合征与血浆基质金属蛋白酶1、3及组织型基质金属蛋白酶抑制物2关系的临床研究

目的:探讨基质金属蛋白酶(MMP)1、3及组织型基质金属蛋白酶抑制物2(TIMP2)水平改变与急性冠状动脉综合征(ACS)及非ACS之间的关系,为临床早期诊治ACS提供客观指标。方法:230例于2008-01至2011-06行冠状动脉(冠脉)造影的心内科住院患者,依临床及冠脉造影分组:ACS组98例,包括不稳定型心绞痛亚组61例、急性心肌梗死亚组37例;非ACS组81例,包括稳定型心绞痛亚组49例、冠脉慢性完全闭塞亚组32例;对照组51例(正常冠脉)。于冠脉造影后抽动脉血检测血浆MMP1、MMP3、TIMP2水平。结果:与对照组比较,MMP1在ACS组及非ACS组均明显增高(P均<0.001);MMP3在ACS组显著增高(P<0.01),非ACS组无明显增高(P>0.05);TIMP2在非ACS组中显著增高(P均<0.01)。与非ACS组比较,ACS组MMP1、MMP3增高及TIMP2降低差异均有统计学意义(P均<0.05)。亚组分析中,与对照组相比,各亚组MMP1水平增高(P<0.05～0.001);MMP3在不稳定型心绞痛亚组及急性心肌梗死亚组均显著增高,TIMP2在稳定型心绞痛亚组及冠脉慢性完全闭塞亚组均显著性增高(P均<0.001),差异均有统计学意义。结论:ACS及非ACS患者血浆MMP1水平增高提示MMP1可能与冠心病发生有关;MMP3水平仅于ACS患者中增高提示MMP3可能为ACS发生的重要影响因素;TIMP2水平增高只出现于非ACS患者提示TIMP2增高可能有益于斑块的稳定性。     

急性冠状动脉综合症患者血清肿瘤坏死因子-α变化的临床意义

目的探讨肿瘤坏死因子-α(TNF-α)在急性冠状动脉综合征(ACS)患者血清中浓度变化及其意义。方法选取40例ACS患者,其中不稳定型心绞痛(UAP)患者19例,急性心肌梗死(AMI)患者21例。60例非ACS患者,其中稳定型心绞痛(SAP)患者21例,陈旧性心肌梗死(OMI)患者19例。冠状动脉造影正常者20例为正常对照组,采用放射免疫法测定上述病例的血清TNF-α浓度。结果SAP、UAP、AMI、OMI患者血清TNF-α浓度均显著高于正常对照组。ACS组血清TNF-α水平显著高于非ACS组;AMI组血清TNF-α水平显著高于UAP组;SAP组与OMI组血清TNF-α水平无显著性差异;SAP与UAP患者冠状动脉狭窄程度比较无显著性差异。结论TNF-α参与冠心病的形成,并且在ACS的发病中起重要作用。检测血清TNF-α浓度将有助于诊断和预测ACS的发生、发展和预后。     

联合检测MCP-1、RANTES趋化因子在ACS诊治中的变化及意义

目的:通过联合检测冠心病患者血清MCP-1、RANTES水平,与传统的hs-CRP相比较,研究联合检测MCP-1、RANTES趋化因子在诊治急性冠状动脉综合征(ACS)中的价值。探讨联合检测多种趋化因子对ACS早期识别、危险分层、预后评估的意义。方法:选取冠心病患者240例,正常对照组60例。冠心病患者分ACS组180例以及稳定型心绞痛(SAP)组60例。所有患者行冠状动脉造影(CAG)检查,冠状动脉狭窄程度采用Genisin评分;酶联免疫法测定MCP-1、RANTES及hs-CRP浓度。结果:MCP-1、RANTES、hs-CRP、血糖及LDL-C浓度ACS组较SAP组和正常对照组升高,HD     

急性冠状动脉综合征患者血浆蛋白氧化产物升高的机制及意义

目的通过检测急性冠状动脉综合征患者体内晚期蛋白氧化产物、丙二醛的水平来探讨氧化应激损伤与冠状动脉粥样硬化斑块发生发展的关系。方法入选73例急性心肌梗死(46例择期和27例急诊冠状动脉介入治疗)、49例不稳定型心绞痛及21例非冠心病患者,均经造影证实。于入院即刻2、4 h和48 h采集外周静脉血标本。紫外荧光光度法测定晚期蛋白氧化产物浓度;硫代巴比妥酸光度法测定丙二醛浓度。结果晚期蛋白氧化产物浓度在急性心肌梗死择期冠状动脉介入治疗组、不稳定型心绞痛组较非冠心病组明显升高(P<0.05);急性心肌梗死择期冠状动脉介入治疗组各时间点晚期蛋白氧化产物浓度较急性心肌梗死急诊冠状动脉介入治疗组高(P<0.01);急性心肌梗死择期冠状动脉介入治疗组与不稳定型心绞痛组差异无统计学意义(P>0.05);急性心肌梗死择期冠状动脉介入治疗组晚期蛋白氧化产物浓度与低密度脂蛋白呈正相关[r=0.370(入院即刻)、r=0.422(入院24 h)、r=0.559(入院48 h)]。与非冠心病组对应各时间点丙二醛浓度比较,急性心肌梗死择期冠状动脉介入治疗组、急诊冠状动脉介入治疗组升高(P<0.05),而与不稳定型心绞痛组比较无统计学差异。结论急性冠状动脉综合征患者血浆中晚期蛋白氧化产物、丙二醛浓度显著升高。氧化应激可能是急性冠状动脉综合征发生发展过程中的重要环节,晚期蛋白氧化产物、丙二醛是反映体内氧化应激水平较好的血清学指标。     

冠心病患者测定血清脂联素的临床意义及相关性研究

目的 探讨血清脂联素(APN)联合C反应蛋白(CRP)、肌钙蛋白两种炎症指标在冠心病中的作用及其相关性.方法 选取正常对照组30名、稳定型心绞痛(SA)组23例、急性冠脉综合征(ACS)组63例,将ACS患者再分为不稳定型心绞痛(UA)患者31例及急性心肌梗死患者(AMI)32例两组.分别检测各组CRP、肌钙蛋白I(cTnI)及全部样本血清脂联素的水平.结果 CRP水平ACS组与SAP组比较有统计学意义(P<0.01),血清APN水平ACS组明显低于SAP组和对照组(P<0.01),cTnI水平ACS组明显高于SAP组(P<0.01).ACS组血清APN与CRP呈负相关(r=-0.516,P<0.05),而与其他指标无相关.SA组APN与其他指标亦无显著相关.结论 脂联素在冠心病中有一定保护作用,其水平显著降低可预测ACS的发生及发展,动态监测血清APN水平有可能成为诊断冠心病、观察病情、判断预后的一个指标.     

急性冠状动脉综合征患者妊娠相关血浆蛋白A的变化

目的:观察急性冠状动脉综合征(ACS)患者妊娠相关血浆蛋白A(PAPP-A) 水平的变化.方法:冠状动脉造影(CAG)证实的冠心病患者80例,分为ACS组(53例) 、稳定型心绞痛(SA)组(27例),以23例CAG正常者为正常对照组;测定各组患者入院时外周血清PAPP-A水平, 分析不同组别间及ACS组、SA组中冠状动脉病变不同程度者PAPP-A水平的变化,并分析PAPP-A水平与TnT、CK-MB的相关性.结果:①ACS组的PAPP-A水平显著高于正常对照组和SA组(P＜0.01),正常对照组与SA组之间及ACS组中不稳定型心绞痛和急性心肌梗死亚组PAPP-A水平比较差异均无统计学意义(P＞0.05);②PAPP-A水平与CK-MB、TnT水平无显著相关;③ACS组、SA组中冠状动脉病变不同程度亚组PAPP-A水平比较差异均无统计学意义(P＞0.05).结论:检测PAPP-A水平对ACS早期诊断可能有一定的意义,但冠状动脉病变程度与PAPP-A水平无显著相关.     

Comparison of clinical characteristics and prognosis in Taiwanese patients with coronary vasospastic angina pectoris without significant fixed coronary artery disease versus patients with significant fixed coronary artery disease and either stable angina pectoris or acute coronary syndromes

BACKGROUND: Limited information is available comparing the clinical characteristics and prognosis for patients with coronary vasospastic angina in the absence of hemodynamically significant coronary artery disease (CAD) (defined as >50% stenosis) versus patients with significant fixed CAD presenting with either stable angina pectoris (SAP) or acute coronary syndromes (ACS). METHODS: Patients who underwent cardiac catheterization for suspected ischemic heart disease between August 1999 and February 2003 were followed clinically. For patients without hemodynamically significant CAD, a provocation test for coronary vasospasm was undertaken using a step-wise dose of intracoronary ergonovine administration. RESULTS: A total of 1134 patients were enrolled in the final analysis and stratified into 4 diagnostically distinct groups: control group (n = 239; mild CAD without coronary vasospasm); vasospasm group (n = 284; coronary vasospastic angina pectoris without hemodynamically significant CAD); SAP group (n = 110; hemodynamically significant CAD with SAP); ACS group (n = 501; hemodynamically significant CAD with ACS). Comparison of these 4 groups revealed that the ACS patients were more likely to be male, current smokers, and have hypercholesterolemia. In addition, this group had a significantly higher incidence of typical angina pectoris, 3-vessel CAD, and lower left ventricular ejection fraction. Between-group comparison revealed that vasospasm patients had a significantly higher incidence of early morning angina pectoris. Multivariate analysis showed that current smoking was the most independent risk factor associated with the diagnosis of coronary vasospastic angina pectoris in patients without hemodynamically significant CAD. During a median follow-up period of 49 months, recurrent angina pectoris was noted in patients from the control (n = 6; 3%), SAP (n = 9; 8%), vasospasm (n = 30, 11%), and ACS groups (n = 92; 18%); with nonfatal myocardial infarction identified during follow-up in the SAP (n = 5; 5%), vasospasm (n = 3; 1%), and ACS groups (n = 37; 7%). In addition, 29 and 3 cardiac deaths occurred in the ACS and SAP groups, respectively, whereas there were no such mortalities in the control and vasospasm groups. CONCLUSIONS: Early morning angina pectoris and cigarette smoking were the most common clinical characteristics in patients with coronary vasospasm. These patients had an excellent prognosis despite the possibility of recurrences of vasospastic angina pectoris.     

Decrease in plasma adiponectin concentrations in patients with variant angina pectoris.

BACKGROUND: Plasma adiponectin is decreased in patients with coronary artery diseases, especially in patients with acute coronary syndrome (ACS). However, the correlation between plasma adiponectin and variant angina pectoris (VAP) has not been verified. Plasma adiponectin concentrations between VAP and other coronary artery diseases was compared in the present study. The association between plasma adiponectin concentration and VAP was also investigated. METHODS AND RESULTS: Plasma adiponectin concentrations in the VAP group (n=101) were compared with those of the ACS group (n=117), the stable angina pectoris group (n=108), and the normal coronary group (n=81). Plasma adiponectin concentrations in VAP and ACS were significantly lower than that of the normal coronary group (6.6+/-5.4 vs 5.2+/-4.0 vs 9.0 +/-6.2 microg/ml, p<0.001, respectively). Multivariate analysis indicated that plasma adiponectin (odds ratio (OR) 0.735, 95% confidence interval (CI) 0.621-0.855, p=0.011), smoking (OR 2.012, 95% CI 1.210-3.880, p=0.020), and age (OR 0.976, 95% CI 0.957-0.997, p=0.022) correlated independently with the development of VAP. CONCLUSIONS: Our results suggest that a decrease in plasma adiponectin concentration might be associated with the development of VAP.     

Comparison of serum levels of inflammatory markers in patients with coronary vasospasm without significant fixed coronary artery disease versus patients with stable angina pectoris and acute coronary syndromes with significant fixed coronary artery disease

Serum levels of inflammatory markers (interleukin-6, monocyte chemoattractant protein-1, soluble intercellular adhesion molecule-1, soluble vascular adhesion molecule-1, and C-reactive protein) were measured at baseline in serum samples from 189 patients who were admitted for coronary angiography because of suspected ischemic heart disease. Median duration of follow-up was 28 months. Patients in our sample were enrolled in 4 diagnostic groups: no hemodynamically significant coronary artery disease (CAD) and no coronary vasospasm (control group, n = 32), hemodynamically significant CAD and stable angina pectoris (SAP group, n = 34), coronary vasospastic angina pectoris without hemodynamically significant CAD (vasospasm group, n = 31), and acute coronary syndrome (ACS) and hemodynamically significant CAD (ACS group, n = 92). Overall, the level of serum inflammatory markers was highest in the ACS group and lowest in the control group, with intermediate values observed in the SAP and vasospasm groups, with the exception of soluble intercellular adhesion molecule-1, the level of which was highest in the vasospasm group. Multivariate analysis showed that log (interleukin-6) was independently associated with a diagnosis of coronary vasospastic angina pectoris in patients without hemodynamically significant CAD (odds ratio 8.48, p = 0.027). Patients in the ACS group had a significantly lower survival rate compared with the other 3 groups but without an independent predictor that could be identified in this patient cohort. Recurrent angina pectoris occurred with similar rates in the SAP, vasospasm, and ACS groups. The independent predictor for recurrent angina pectoris was treatment that did not include clopidogrel (odds ratio 3.88, p = 0.007). In conclusion, the results of this study suggest that inflammation can exist in coronary vasospasm without hemodynamically significant CAD.     

脂联素与冠心病类型和心血管危险因素的关系

目的:明确冠心病(CHD)患者脂联素(APN)水平是否下降,确定低APN血症是否是CHD的危险因素及APN水平与CHD类型和心血管危险因素间的关系。方法:117例研究对象分为对照组(CO)、稳定型心绞痛组(SAP)和急性冠状动脉综合征(ACS)组。SAP、ACS组与CO组进行比较了解CHD患者APN水平;比较不同类型患者的APN水平以确定APN水平与CHD类型间的关系;经logistic回归分析确定低APN血症是否是CHD的危险因素;比较合并某一心血管危险因素者与不合并者的APN水平,了解心血管危险因素对APN水平的影响。结果:CO组、SAP组、ACS组3组比较APN呈降低趋势(10.61±3.38,6.98±3.18,4.59±3.69,P0.05);逐步logistic回归分析结果显示低APN血症(OR值=0.788,p=0.041)、高胆固醇血症(OR值=5.096,p=0.009)为CHD患病的独立危险因素;超重或肥胖、血脂异常、男性、吸烟、合并3个及3个以上危险因素的CHD患者APN水平降低(P0.05),合并高血压和糖尿病者APN水平无明显下降。结论:CHD患者APN水平下降,ACS患者APN水平较SAP患者进一步下降。低APN血症是CHD的危险因素。肥胖、吸烟、男性、血脂异常可使APN水平下降,且合并心血管危险因素多者APN水平进一步降低。     

Prostaglandin I2 half-life regulated by high density lipoprotein is decreased in acute myocardial infarction and unstable angina pectoris

To investigate the prostaglandin I2 (PGI2) half-life regulated by high density lipoprotein (HDL) in patients with coronary artery disease (CAD), we determined the stability of PGI2 and serum apolipoprotein A-I (Apo A-I) and apolipoprotein A-II (Apo A-II) levels in four age-matched groups of patients: controls (n = 17), angina pectoris (n = 18), unstable angina pectoris (n = 17), myocardial infarction (n = 19) (acute phase, 3.6 +/- 1.7 hours from onset; subacute phase, 75 +/- 15 hours from onset in the same patients). Serum PGI2 half-life and total serum Apo A-I levels were lower in the CAD group than in the control group. PGI2 was least stable in patients with unstable angina and the acute phase of myocardial infarction. In these patients, the molar ratio of Apo A-I to Apo A-II and HDL-associated Apo A-I levels were decreased, and free Apo A-I levels were increased. After in vitro incubation of HDL with increasing amounts of Apo A-II, Apo A-I in HDL was displaced by Apo A-II, with the parallel decrease in stability of PGI2. Free Apo A-I cannot stabilize PGI2. HDL-associated Apo A-I, whose amount is affected by Apo A-II, stabilized PGI2 and correlated well with stability of PGI2 in patients with CAD and control patients. Decreased PGI2 half-life may play an important role in the pathogenesis of atherosclerosis and thrombus formation in the coronary arteries, especially thrombus formation during an acute coronary event.     

C-反应蛋白与冠心病关系的研究

目的：探讨高敏C-反应蛋白（hs—CRP）水平与冠状动脉疾病的关系。方法：对经冠状动脉造影确诊或有明确心肌梗塞的冠心病患者82例和同期经冠状动脉造影证实冠状动脉无狭窄的正常对照者43例进行对照研究。所有研究对象在入院初或病情稳定48h后采清晨空腹静脉血，应用微粒子增强透射免疫分析法测定血浆hs—CRP水平。结果：冠心病组的血浆hs—CRP水平显著高于对照组（P〈0．001）；在冠心病组中，急性冠脉综合征（ACS）组（42例）的hs—CRP水平显著高于稳定型心绞痛（SAP）组（40例）（P〈0．001），SAP组的hs—CRP水平也显著高于对照组（P〈0.01）。单支病变（19例）、双支病变（23例）、三支及左主干病变（30例）组的hs—CRP水平均显著高于对照组（P分别〈0.01，〈0.001和〈0.001）。以人群血浆hs—CRP水平的第90分位值3mg／L为截点，将冠心病组中行冠脉造影的对象分为低hs—CRP水平组和高hs—CRP水平组，可见后者多支病变（包括双支病变和三支及左主干病变）的例数（n=36）显著多于前者（n=17）（P〈0．05）。结论：高敏C-反应蛋白水平可反映冠状动脉疾病及其病变的严重程度。     

急性冠状动脉综合征患者血清脂联素和踝臂指数的变化及其相关性的研究

目的观察急性冠状动脉综合征(ACS)患者血清脂联素(APN)水平和踝臂指数(ABI)值的变化及其与ACS的相关性,评估APN和ABI在ACS发生中的价值。方法依据临床表现及冠状动脉(冠脉)造影等检查,将69例冠心病患者分为ACS组(44例)与稳定型心绞痛(SAP)组(25例),其中按狭窄所累及的血管病变支数分为:单支病变组(25例),双支病变组(20例),三支病变组(24例);根据Gensini积分分为:1～30分组(48例)、≥30分组(21例);选取冠脉造影阴性者(22例)为对照(NC)组。比较各组间APN、ABI的差异。结果 (1)APN水平、ABI值ACS组均明显低于SAP组和NC组(均为P<0.05)。(2)APN水平、ABI值随着冠脉病变支数的增加均逐渐下降,相关分析提示APN、ABI值均与病变支数呈负相关(分别为r=-0.733,P<0.01;r=-0.632,P<0.01)。(3)APN水平、ABI值随着冠脉Gensini积分的增加均逐渐下降,相关分析提示APN、ABI值与Gensini积分均呈负相关(分别为r=-0.640,P<0.01;r=-0.697,P<0.01)。(4)ACS患者血清APN与ABI值呈正相关(r=0.622,P<0.01)。结论血清APN水平、ABI值随着冠脉病变程度的加重和病变范围的扩大而降低,APN和ABI值越低,冠脉病变程度可能越严重,病变范围可能越广。     

冠心病患者同型半胱氨酸、脑钠肽与冠脉病变的相关性

目的：探讨冠心病（CHD）患者同型半胱氨酸（Hcy）、脑钠肽（BNP）与冠状动脉病变程度的关系及临床意义。方法：选择CHD患者80例,根据临床表现,心电图变化及心肌损伤标志物水平分为急性心肌梗死组（AMI组）,不稳定型心绞痛组（UAP组）和稳定型心绞痛组（SAP组）,并设正常对照组58例,测定所有研究对象血浆Hcy、BNP水平,并进行组间对比。结果：AMI、UAP组及SAP组血浆Hcy[（26.72±4.62）μmol/L比（20.28±4.05）μmol/L比（15.34±3.93）μmol/L]、BNP[（480.27±70.84）pg/ml比（312.25±62.54）pg/ml比（215.78±68.27）pg/ml]水平均明显高于正常对照组的[（11.27±3.58）μmol/L,（35.14±17.12）pg/ml],各组间比较差异均有显著性（P均〈0.05）;随着冠状动脉病变Gensini评分的增加,Hcy、BNP浓度明显升高（P〈0.05）。结论：冠心病患者血浆同型半胱氨酸、脑钠肽水平明显升高,与冠状动脉病变程度有关。     

老年急性冠脉综合征患者炎症负荷指标与可溶性CD40L表达分析

目的分析老年急性冠脉综合征（ACS）患者炎症负荷指标与可溶性CD40配体（CD40L）表达的相关性。方法连续选择近期来我院就诊的老年胸痛患者149例,均接受选择性冠状动脉造影检查,结合临床表现分为急性心肌梗死组（AMI,39例）、不稳定型心绞痛组（UAP,45例）、稳定型心绞痛组（SAP,30例）和排除冠心病组（对照组,35例）,同时抽血检测血清CD40L和高敏C反应蛋白（hsCRP）水平。结果老年UAP和AMI患者血清CD柏L和hsCRP水平均高于SAP组和对照组（P均〈0．05～0．01）,老年ACS患者血清CD40L和hsCRP水平存在明确相关性（P〈0．01）。结论老年ACS患者存在显著的炎症负荷指标与可溶性CD40L水平增高,两者血清浓度表达明显相关;CD40L通路可能是传递炎症负荷信息的重要途径。     

冠心病患者血浆正五聚蛋白-3、血清超敏C-反应蛋白与血脂的相关性

目的：通过分别检测冠心病患者及正常人的血浆正五聚蛋白-3（PTX3）、血清超敏C-反应蛋白（hs—CRP）及各项血脂水平,探讨血浆PTX3水平在各组间的差异以及血浆PTX3、血清hs—CRP与血脂的相关性。方法：入选经冠脉造影正常的40例患者为对照组;冠脉造影确诊为冠心病的60例,分为稳定型心绞痛（SAP）组,20例;不稳定型心绞痛（UAP）组,20例;急性心肌梗塞（AMI）组,20例。分别检测各组入院第2d的血浆PTX3、血清h～CRP及各项血脂水平。血浆PTX3和血清hs—CRP水平取对数后均服从正态分布。对所得数据进行单因素方差分析、两变量相关分析及多元线性回归分析。结果：UAP组和AMI组患者的血浆PTX3对数水平显著高于SAP组和对照组的（P均〈0．05）;SAP组与对照组之间差异元显著性（P〉0．05）;UAP组和AMI组之间差异有显著性（P％0．05）。患者血浆PTX3对数水平与低密度脂蛋白－胆固醇（LDL-C）水平存在正相关（r＝0．641。P〈0．05）,与总胆固醇（TC）、甘油三酯（TG）及高密度脂蛋白－胆固醇（HDL—C）无线性相关（P均〉0．05）;而血清hs—CRP对数水平与TG、TC、LDL—C呈正相关．且与HDL-C呈负相关（r值分别为0．325、0．228、0．625、－0．312,P均〈0．05）。患者血浆PTX3对数水平与血清hs—CRP对数水平呈正相关（r=0．729,P〉0．05）。多元线性回归分析显示血浆PTX－3和LDL—C的相关性优于血清hs—CRP和LDL—C的（B=0．492,P=0．001：β＝0．382,P=0．03）。结论：血浆PTX3水平与血清hs-CRP水平呈正相关,PTX3是心血管疾病的独立危险因素,其与LDL—C的相关性优于hs—CRP。