急性心肌梗死并发症不稳定型心绞痛的治疗

不稳定型心绞痛一般认为即反复发作的休息时疼痛,其时间、性质及频繁程度较一般心绞痛更严重,心电图可出现ST-T改变。不稳定型心绞痛也可以由以前可预测的劳累性心绞痛型心绞痛转变为休息时心绞痛。大部分急性心肌梗死(AMI)都有不适的前驱症状,但另一方面不稳定型心绞痛的死亡率较高。     

白细胞计数评价急性心肌梗死和不稳定型心绞痛预后的价值

评价炎症的特征有许多技术 ,已经发现 C反应蛋白升高对急性心肌梗死 (AMI)和其他的急性冠脉事件的发展是一个有力的危险因素 ,并且对评价不稳定型心绞痛的预后有重要价值。再有 ,简单、常见的检测炎症的方法是白细胞 (WBC)计数。先前在 AMI溶栓和介入治疗的研究中观察到 ,伴有 WBC升高者 ,有较高的 AMI的复发率和病死率 ,本文认为 WBC计数也可用于对 AMI及不稳定型心绞痛的危险分层上。近期报道了用 Orbofiban治疗不稳定冠脉综合征试验结果 ,概括统计在 1997年 10月 16日～ 1998年 11月 5日 2 9个国家 888所医院住院治疗的 10 2 8…     

急性心肌梗死患者血清甲状腺激素水平及临床意义

目的 观察急性心肌梗死(AMI)患者血清甲状腺激素水平及临床意义。方法采用放射免疫分析法(RIA)对43例AMI患者治疗前后及40例正常对照者测定甲状腺激素水平。结果 AMI患者治疗前与正常对照组比较无论心力衰竭组或无心力衰竭组T3水平明显降低,rT3明显升高,尤以心力衰竭组T3、rT3改变更为显著,而T4及TSH无明显改变,AMI治疗后与治疗前比较T3明显升高.rT3明显下降。结论 血清T3及rT3水平变化对AMI患者病情及预后的判断有一定的临床价值。     

不稳定型心绞痛

不稳定型心绞痛荣烨之，朱向阳不稳定型心绞痛（ＵｎｓｔａｂｌｅＡｎｇｉｎａ，ＵＡ）亦称为梗塞前综合征、急性冠状动脉机能不全或冠脉中间状态综合征，一般包括初发型心绞痛、恶化型心绞痛、卧位型心绞痛、梗塞后心绞痛和变异型心绞痛。ＵＡ是一种严重并具有潜在危险的...     

老年急性心肌梗死患者甲状腺激素水平的变化及临床意义

目的探讨老年急性心肌梗死患者甲状腺激素水平的变化及临床意义。方法选择老年急性心肌梗死患者(A组)146例,老年稳定性心绞痛患者(B组)106例,健康体检者(C组)100例,采用化学发光免疫分析法测定甲状腺激素水平。结果 A组的三碘甲状腺原氨酸(T3)、促甲状腺素激素(TSH)显著低于B组和C组(P0.01);急性ST段抬高(STEMI)组T3显著低于非STEMI(NSTEMI)组(P0.01);老老年急性心肌梗死(A2组)T3显著低于老年急性心肌梗死组(A1组)(P0.01)。结论老年急性心肌梗死患者T3、TSH水平显著下降,T3水平的测定可以用于判断病情的严重程度。     

心外膜脂肪组织厚度与冠状动脉狭窄程度的相关性及对不稳定型心绞痛、急性心肌梗死的影响

目的 探讨心外膜脂肪组织厚度与冠状动脉狭窄程度的相关性及对不稳定型心绞痛、急性心肌梗死的影响.方法 对298例符合入选标准的对象,心脏彩色多普勒超声心动图测量心外膜脂肪组织厚度,冠脉造影测量冠状动脉狭窄程度,用SPSS 17.0软件进行数据分析心外膜脂肪组织厚度与冠状动脉狭窄程度的相关性.266例按非冠心病（对照组）、不稳定型心绞痛、急性心肌梗死人群分三组,分别为91例、79例、96例,比较三组患者心外膜脂肪组织厚度.结果 心外膜脂肪组脂肪组织厚度与冠状动脉狭窄程度呈正相关（Kendall＆#39;8 r=0.132,P=0.004,Spearman＆#39;s r=0.171,P=0.003）;心外膜脂肪组织厚度三组比较差异有统计学意义（x2=13.03,v=2,P=0.001）.结论 心外膜脂肪组织厚度与冠状动脉狭窄程度呈正相关,在对照组和不稳定型心绞痛、急性心肌梗死人群中有明显差异.     

急性冠状动脉综合征和稳定型心绞痛患者血清胆红素水平及分析

有关急性冠状动脉综合征 (ACS) ,包括急性心肌梗死 (AMI)和不稳定型心绞痛 (UAP)患者血清胆红素的浓度变化的研究不多 ,本文通过回顾分析近几年的临床资料 ,对此作初步探讨。1　对象与方法2 0 0 0～ 2 0 0 3年住院冠心病患者共 1 2 0例 ,均符合 1 979年WHO诊断标准 ,分为 3组 :稳定型心绞痛 (SAP)组 38例 ,男 2 8例 ,女 1 0例 ,年龄 45～ 81( 5 2± 1 0 )岁。ACS组 82例 ,其中UAP者 42例 ,男32例 ,女 1 0例 ,年龄 38～ 78( 5 1 .2± 1 1 .2 )岁 ;AMI者 40例 ,男 32例 ,女 8例 ,年龄 35～ 75 ( 5 3± 1 1 .6)岁。正常对照组 45例 ,…     

不稳定型心绞痛和非ST段抬高心肌梗死血运重建患者的临床资料分析

目的 :了解因不稳定型心绞痛 (UAP)或非ST段抬高心肌梗死 (NSTEMI)住院并接受血运重建患者的临床特点和治疗情况。方法 :对SUNDAY(TheStrategiesforUA/NSTEMIandDelayofAngioplastyRegistry)研究中注册的 2 0 0 0年 1月～ 2 0 0 2年 12月间因UAP或NSTEMI接受血运重建治疗的 74 2例患者的临床资料进行分析。结果 :74 2例中 ,UAP患者 70 9例 (95 .6 % ) ,NSTEMI患者 33例 (4 .4 % ) ;有高血压、糖尿病病史的患者分别占 6 1.5 %和 19.5 %。 70 %的患者为多支血管或左主干病变。抗血小板药物和 β受体阻滞剂、低分子肝素、早期他汀类药物的应用率分别 >90 %、4 4 .7%、6 3.9%。 74 2例中 ,5 9.0 %的患者经皮冠状动脉介入治疗 ,成功率98.6 % ;4 1.0 %的患者经外科搭桥治疗 ,成功率为 99.3%。 8例 (1.1% )在住院期间死亡。多因素Logistic回归分析发现 ,高血压 (OR =2 .95 ,95 %CI :1.15～ 7.5 6 ,P <0 .0 5 )、血清肌酐水平升高 (OR =3.0 4 ,95 %CI :1.0 5～ 8.87,P <0 .0 5 )、左室功能降低 (OR =1.0 4 ,95 %CI :1.0 0～ 10 .7,P <0 .0 5 )以及女性患者 (OR =2 .70 ,95 %CI :1.18～ 6 .19,P <0 .0 5 )是院内不良事件发生的独立危险因素。结论 :接受血运重建的UAP和NSTE MI患者冠状动脉病变复杂 ,近 70 %的患     

应用纤溶酶治疗不稳定型心绞痛及急性非Q波心肌梗死

目的观察纤溶酶治疗不稳定型心绞痛(UAP)及急性非Q波心肌梗死病人的临床效果。方法将78例UAP及急性非Q波心肌梗死病人随机分成两组,对照组予常规治疗,治疗组在常规治疗的基础上加用纤溶酶100U静脉输注,两组治疗均为2周。观察心绞痛缓解、缺血性心电图改善及复合终点事件的发生率。结果治疗组心绞痛缓解、缺血性心电图改善总有效率分别为82.5%和75.0%,复合终点事件的发生率5.0%;对照组心绞痛缓解缺血心电图改善总有效率分别为60.5%和44.7%,复合终点事件的发生率为15.8%,两组总有效率及复合终点事件发生率比较有统计学意义(P<0.05)。结论纤溶酶治疗UAP及非Q波心肌梗死疗效好,副反应少,安全有效。     

急性心肌梗死患者甲状腺激素水平与冠状动脉病变严重程度相关性研究

目的:探讨急性心肌梗死患者甲状腺激素水平与冠状动脉病变严重程度及心脏功能的关系。方法:选取甲状腺功能正常的急性心肌梗死患者341例,检测促甲状腺激素(TSH)水平,游离三碘甲状腺原氨酸(FT3),游离四碘甲状腺原氨酸(FT4),血脂水平,高敏C反应蛋白,统计住院期间严重心血管事件率(严重心律失常、心源性休克、急性左心功能衰竭及死亡)。超声心动图检查左心室射血分数,左心室舒张功能。根据FT3三分位分为FT3 1.16～2.25 pg/ml组113例、FT3 2.26～2.81 pg/ml组114例、FT3 2.82～4.02 pg/ml组114例。224例行冠状动脉造影评估冠状动脉病变严重程度患者,根据病变血管支数分为单支病变患者70例和多支(≥2支)病变患者154例。结果:FT3 2.82～4.02 pg/ml组与FT3 1.16～2.25 pg/ml组比高敏C反应蛋白明显下降、左心室舒张功能指标E/A(左心室舒张早期二尖瓣口血液流速/左心室舒张末期流速)值增高、严重心血管事件率下降,差异有统计学意义(P<0.05或0.01)。多支病变患者TSH、FT4、FT3均较单支病变患者降低,但只有FT3差异有统计学意义(P<0.05)。Logis-tic多元回归分析显示,在校正了年龄、性别、吸烟史及高血压史、糖尿病史、血脂水平、高敏C反应蛋白水平后,FT3下降仍是冠状动脉多支病变独立危险因素(风险比为0.65,P<0.05)。结论:甲状腺功能正常的急性心肌梗死患者FT3水平与心脏舒张功能、严重心血管事件率及冠状动脉病变严重程度密切相关,FT3可作为反映心肌梗死患者病情的一项重要指标。     

不稳定性心绞痛和急性心肌梗塞肌钙蛋白T变化的比较

目的 :比较不同急性冠状动脉综合征患者肌钙蛋白 T(Tn T)变化。　　方法 :不稳定性心绞痛 (UAP)、Q波型和非 Q波型急性心肌梗塞 (AMI)患者于急诊就诊时、住院后第 2、第 3和第 6日取血测定 Tn T水平。　　结果 :35 %的 UAP患者 Tn T表现为升高 ,其升高的幅度 (均 <3.0 ng/ ml)明显 <非 Q波型 AMI(2 4% >3.0 ng/ml)和 Q波型 AMI(90 % >3.0 ng/ ml) ,且一般 3天后即转为阴性 ,而 AMI患者 6天后多数仍为阳性。非 Q波型 AMI和Q波型 AMI急诊就诊时 Tn T的阳性率分别为 79.1%和 90 .7% ,住院后第 2日均达 10 0 % ,均明显高于同时间谷草转氨酶和肌酸激酶同工酶的阳性率 ,两组 Tn T阳性在持续时间上相似 ,但在升高幅度上有明显的区别。再灌注治疗可能会影响 Q波型 AMI患者 Tn T的自然变化规律。　　结论 :UAP患者 Tn T的变化与非 Q波型 AMI和 Q波型 AMI有显著的不同。     

肝硬化严重程度与甲状腺激素水平相关关系

目的探讨肝硬化严重程度与甲状腺激素水平的相关关系。方法选取2009年6月～2012年6月肝硬化患者148例(已排除了合并原发性甲亢、甲减以及影响甲状腺激素水平的其它相关因素者,既往均无干扰素治疗史),其中Child-Pugh A级57例,Child-Pugh B级50例,Child,Pugh C级41例,均进行甲状腺激素水平检测。结果Child-Pugh A级57例患者中甲状腺激素水平异常者15例,占26.3%,Child-Pugh B级50例患者中甲状腺激素水平异常者34例,占68.0%,Child-Pugh C级41例患者中甲状腺激素水平异常者40例,占97.6%,且以TT3(血清总三碘甲状腺原氨酸)下降为主。结论肝硬化患者血清甲状腺激素水平明显低于正常人,以TT3(血清总三碘甲状腺原氨酸)下降为主,且甲状腺激素TT3降低程度与肝硬化病情的严重程度呈正相关。     

血小板活化功能检测在急性心肌梗死及不稳定性心绞痛时的临床初步应用

目的：观察急性心肌梗死和不稳定性心绞痛患者血小板的活化状态并探讨其临床意义。方法：分别采用抗人活化型血小板α－颗粒膜蛋白－１４０（ＧＭＰ－１４０）及血小板膜糖蛋白Ⅱｂ／Ⅲａ（ＧＰⅡｂ／Ⅲａ）的特异性单克隆抗体，以放射免疫法测定１７例急性心肌梗死和１５例不稳定性心绞痛患者血小板的活化状态，并将其与心肌酶、心肌梗死和缺血面积作相关分析。结果：急性心肌梗死组和不稳定性心绞痛组血小板ＧＭＰ－１４０数目明显高于正常对照组（Ｐ＜０．０１）。ＧＭＰ－１４０与血清肌酸激酶及其ＭＢ同工酶、血清乳酸脱氢酶（ＬＤＨ）、心肌梗死和缺血面积均呈正相关（Ｐ＜０．０５）。急性心肌梗死组和不稳定性心绞痛组血小板膜ＧＰⅡｂ／Ⅲａ分子数均明显高于正常对照组（Ｐ＜０．０５），但两组分子数与心肌梗死和缺血面积均不具有相关性。结论：血小板活化的检测在急性冠状动脉缺血时有一定应用价值     

Contemporary Treatment of Unstable Angina and Non-ST-Segment-Elevation Myocardial Infarction (Part 2)

In Part 1 of this review, we discussed how plaque rupture is the most common underlying cause of most cases of unstable angina/non-ST-segment-elevation myocardial infarction (UA/NSTEMI) and how early risk stratification is vital for the timely diagnosis and treatment of acute coronary syndromes (ACS). Now, in Part 2, we focus on the medical therapies and treatment strategies (early conservative vs early invasive) used for UA/NSTEMI. We also discuss results from various large randomized controlled trials that have led to the contemporary standards of practice for, and reduced morbidity and death from, UA/NSTEMI.In summary, ACS involving UA/NSTEMI is associated with high rates of adverse cardiovascular events, despite recent therapeutic advances. Plaque composition and inflammation are more important in the pathogenesis of ACS than is the actual degree of arterial stenosis. As results from new trials challenge our current practices and help us develop the optimal treatment strategy for UA/NSTEMI patients, the cornerstones of contemporary treatment remain early risk stratification and aggressive medical therapy, supplemented by coronary angiography in appropriately selected patients.An early-invasive-treatment strategy is of most benefit to high-risk patients, whereas an early-conservative strategy is recommended for low-risk patients. Adjunctive medical therapy with acetylsalicylic acid, clopidogrel or another adenosine diphosphate antagonist, glycoprotein IIb/IIIa inhibitors, and either low-molecular-weight heparin or unfractionated heparin, in the appropriate setting, further reduces the risk of ischemic events secondary to thrombosis. Short- and long-term inhibition of platelet aggregation should be achieved by appropriately evaluating the risk of bleeding complications in these patients.Key words: Abciximab, acute coronary syndrome/therapy, angina, unstable/drug therapy/therapy, angina pectoris, angioplasty, transluminal, percutaneous coronary, angiotensin-converting enzyme inhibitors, aspirin/administration & dosage, calcium channel blockers, clinical trial as topic, clopidogrel, dalteparin, drug therapy, combination, enoxaparin, eptifibatide, evidence-based medicine, fondaparinux, heparin, immunoglobulin Fab fragments, meta-analysis as topic, multicenter study as topic, multivariate analysis, myocardial infarction, myocardial revascularization, nitroglycerin/therapeutic use, platelet aggregation inhibitors, platelet glycoprotein GPIIb-IIIa complex, prodrugs/therapeutic use, proton pumps, randomized controlled trials as topic, review, risk assessment, stents, thrombolytic therapy, ticlopidine, treatment outcome, vasodilator agentsAcute coronary syndrome (ACS) refers to the array of clinical signs and symptoms produced by acute myocardial ischemia, including unstable angina (UA), non-ST-segment-elevation myocardial infarction (NSTEMI), and ST-segment-elevation myocardial infarction (STEMI).¹ Each condition shares common pathophysiologic origins related to the instability and rupture of atherosclerotic vulnerable plaques.² Unstable angina and NSTEMI are differentiated one from the other primarily by their severity—whether the ischemia is prolonged enough to lead to structural myocardial damage and to the release of detectable markers of myocardial injury, most commonly troponin I, troponin T, or creatine kinase MB.³For the past 20 years, the optimal treatment strategy for UA/NSTEMI patients has been an area of great debate: should initial treatment be invasive or conservative? Despite the debate, it is now widely accepted that the initial medical therapy for patients with suspected ACS should include relieving the ischemia and preventing further myocardial damage. How clinicians go about this is largely dictated by the initial risk assessment and continued patient monitoring in a controlled environment. Hemodynamically unstable patients with refractory ischemic pain are monitored in a critical care environment and are taken to the cardiac catheterization laboratory as soon as possible. Most patients'' conditions stabilize after a brief period of medical therapy, at which time they can be further triaged according to ACS guidelines.⁴In Part 1 of this review, we discussed how plaque rupture/fissuring is the most common underlying pathophysiologic cause of most UA/NSTEMI cases and how early risk stratification is vital for the timely diagnosis and treatment of ACS. Now, in Part 2, we focus on the medical therapies and treatment strategies (early conservative vs early invasive) used for UA/NSTEMI. We also discuss results from various large randomized controlled trials that we believe have led to the contemporary standards of practice for, and reduced morbidity and death from, UA/NSTEMI.     

急性心肌梗死患者血浆结合珠蛋白的变化及其意义

目的探讨急性心肌梗死(AMI)患者血浆结合珠蛋白(Hp)的变化及其与冠状动脉狭窄的严重程度的相关性。方法 AMI并行冠状动脉造影术检查的患者98例,非冠心病的健康体检者90例作为对照组,检测血浆Hp浓度,对比AMI组与对照组血浆Hp浓度的差别;分析AMI患者血浆Hp浓度与冠状动脉病变支数及Gensini积分的相关性。结果 AMI组的血浆Hp浓度明显高于对照组,差异有统计学意义(P0.01)。双支病变、三支病变AMI患者的Hp浓度明显高于单支病变AMI患者的Hp浓度,差异有统计学意义(P0.05);Gensini积分30的AMI患者Hp浓度明显高于Gensini积分30的患者,差异有统计学意义(P0.05)。AMI患者Hp血浆浓度与Gensini积分有显著性正相关(P0.05)。结论 Hp水平的升高与AMI的发生有关,Hp水平与AMI患者冠状动脉狭窄的严重程度有关。     

急性ST段抬高型心肌梗死患者骨膜蛋白水平变化的临床意义

目的通过检测急性ST段抬高型心肌梗死(STEAMI)患者和非冠心病患者骨膜蛋白(PN)水平,探讨PN水平与STEAMI患者心功能、短期预后的关系。方法选取2014年5月至2014年9月住院并行冠状动脉介入治疗的50例STEAMI患者为观察组,非冠心病住院患者36例作为对照组。检测血浆PN水平和其他指标。观察组患者针对临床终点事件随访6个月。收集数据后进行统计学分析。结果观察组PN水平明显高于对照组(45.43±40.10 mg/L比10.25±11.64 mg/L,P0.0001)。观察组PN水平与Killip分级呈正相关(r=0.531,P0.0001),与LVEF呈负相关(r=-0.342,P0.05)。随访6个月后,观察组PN水平与不稳定型心绞痛、心力衰竭及复合临床终点事件发生率呈正相关(均P0.05)。结论 STEAMI患者高PN水平可能预示着较差的左心室收缩功能和心肌梗死后半年内更容易发生不良心血管事件。     

QT Interval in Patients with Unstable Angina and Non‐Q Wave Myocardial Infarction

Background: Non‐Q wave mvocardial infarction (NQMI) and unstable angina (UAP) have similar clinical presentations and similar ST‐T changes on the electrocardiogram. The purpose of this study was to assess whether changes in QT interval might help differentiating between these entities. Methods: The QT intervals of 52 patients hospitalized with NQMI were compared to those of 52 patients hospitalized for UAP. All patients had repeated ECG for at least 4 days. Results: Maximal QTc in patients with NQMI was significantly longer than in patients with UAP (475 vs 439 ms, P < 0.0001). QTc on the admission ECG was 450 ms in patients with NQMI compared to 417 ms in UAP P < 0.005). QTc > 460 ms was present in 48% patients with NQMI and in 19% of UAP patients. Maximal QT prolongation was observed within 36 hours of admission with return to normal within 96 hours. QT dispersion was within normal range, being longer in patients with NQMI than patients with UAP (55 vs 43 ms, P < 0.003). QT prolongation was not associated with increased frequency of arrhythmia. The cause of QT prolongation in NQMI may be related to the damage of subendocardial layer exposing the M cells layer which markedly prolong action potential duration. Conclusion: Transient QT prolongation is observed in about half of patients with NQMI. These ECG changes may help differentiating between patients with NQMI and UAP already on admission. A.N.E. 2002;7(4):343–348