血管紧张素Ⅱ受体拮抗剂对亚裔患者心血管保护作用——JIKEI HEART研究解读

2006年9月,巴塞罗那欧洲心脏病年会暨世界心脏病大会(ESC/WCC2006)公布了JIKEI HEART试验的最新研究成果。JIKEI HEART研究是日本最大规模的心血管临床试验之一,同时也是亚洲地区最大规模的心血管试验之一。之前已有许多的临床试验(VALUE、Val-HeFT、VALIANT试验等)证明,氢氯噻     

人白介素1β转换酶全长的基因克隆及重组质粒构建

以ＥＢ病毒转化的正常人外周血８淋巴细胞为原料，应用逆转录聚合酶链（ＲＴ－ＰＣＲ）技术扩增出编码白介素１β转换酶的全长ｃＤＮＡ，并将此基因定向克隆入真核表达载体ＰＣＩ中，通过转化子的筛选得到了带有插入片断的阳性克隆，经限制性内切酶物理图谱分析及核苷酸测序表明，克隆得到的基因与文献报道的完全一致，从而完成了ＩＣＥ重组质粒的构建。本工作为进一步深入研究ＩＣＥ对细胞凋亡的诱导效应奠定了实验基础。     

特发性扩张型心肌病相关GATA6基因新突变的识别

目的:识别特发性扩张型心肌病(DCM)相关GATA6基因新突变。方法:入选132例特发性DCM患者和220名健康对照者,收集其临床资料和外周静脉血,使用DNA纯化试剂盒抽提基因组DNA,采用聚合酶链反应试剂扩增GATA6基因的整个编码区,应用循环测序试剂盒对扩增的GATA6基因片段进行测序,将所测序列与Nucleotide数据库中的GATA6基因序列进行对比分析以识别GATA6基因突变。应用MUSCLE和MutationTaste在线系统评估突变氨基酸进化上的保守性和突变的致病性。结果:通过序列分析发现1例散发性DCM患者的GATA6基因新变异c.1165GT,相当于p.E389X突变,在220名健康对照者中没有检测出该无义突变。跨物种GATA6蛋白序列比对分析表明,被改变的氨基酸在物种进化上完全保守,致病性预测显示该GATA6基因突变具有致病性。结论:发现散发性DCM相关GATA6基因新突变,扩大了DCM相关GATA6基因突变谱。     

单次高负荷量阿托伐他汀对PCI围手术期心肌标志物及心肌梗死的影响

目的:观察经皮冠状动脉介入(PCI)治疗前服用80mg阿托伐他汀能否降低围手术期心肌标志物水平及心肌梗死的发生率。方法:173例择期PCI冠心病患者随机分为两组:阿托伐他汀组予冠心病基础药物治疗,并在PCI前12h给予单次高负荷剂量(80mg)阿托伐他汀;对照组仅予基础药物治疗。PCI后18h测肌钙蛋白I(TnI)、肌酸激酶同工酶(CK-MB)。结果:术后阿托伐他汀组CK-MB和TnI水平显著低于对照组[分别为(2.76±4.63)ng/ml对(10.53±24.39)ng/ml,P0.01和(0.14±0.19)ng/ml对(1.31±4.31)ng/ml,P0.05];阿托伐他汀组术后CK-MB和TnI升高大于正常上限3倍者显著少于对照组(分别为2.3%对16.3%,P0.01和24.1%对48.8%,P0.01)。结论:对于稳定型心绞痛及心肌标志物水平正常的不稳定型心绞痛患者,介入术前给予单次80mg阿托伐他汀能显著降低围术期心肌标志物水平以及由此反映的围术期心肌梗死的发生率。     

冠状动脉造影模糊病变的血管内超声影像分析

目的 探讨血管内超声(IVUS)对冠状动脉造影病因不确定的模糊病变的价值.方法 从2009年7月至2010年3月连续选取25例诊断性冠状动脉造影或冠状动脉介入术后造影提示存在模糊病变者,模糊病变定义为血管造影上局部的造影剂密度降低,并排除明确的内膜撕裂、夹层、血栓或狭窄(＞50%)等情况,对其行IVUS检查,根据检查结果选择相应的处理策略.结果 25例患者所有管腔横截面积(CSA)均＞4.0 mm2.12例模糊病变位于前降支,6例位于右冠状动脉,5例位于回旋支,2例位于左主干.IVUS影像分析结果2例正常或接近正常,10例为钙化,5例为斑块破裂,3例为偏心斑块,2例为血栓,2例为夹层,1例为内膜下血肿.对其中的7例患者行支架置入术.所有患者住院期间无心血管事件发生.结论 近一半的血管造影模糊病变与管壁钙化或偏心的钙化斑块有关,IVUS能有效识别造成模糊病变的不同病变性质,避免了不必要的支架置入.

Abstract：

Objective To identify the causes of coronary angiographic hazy lesions by intravascular ultrasound (IVUS) to avoid inappropriate stenting. Methods Twenty-five cases with hazy regions on coronary angiogram were consecutively identified from July 2009 to March 2010. Hazy regions were defined by coronary arteriongraphy as reduced contrast density without a clearly defined intimal tear, dissection,thrombus,or stenosis ( ＞ 50% ). This cohort of patients were subsequently underwent IVUS examinations and treated according to the results of IVUS. Results The lumen CSAs were settled as ＞ 4. 0 mm2 in all examinations. Among all 25 cases,hazy lesions were located in left anterior descending in 12 patients, right coronary artery in 6 patients, left circumflex in 5 patients, and left main artery in 2 patients. According to the IVUS findings, 2 cases showed absolutely normal or near-normal arterial wall structure image, 10 cases showed calcified plaque,5 cases showed plaque rupture,3 cases showed eccentric plaque ,2 cases showed thrombosis formation,2cases showed dissection,1 case showed subintimal hematoma. Seven patients received stent implantation, and the rest accepted medical therapy. There were no in-hospital MACEs reported among all patients. Conclusion Nearly half of the coronary arteriongraphic hazy lesions were caused by calcified plaque. IVUS can distinguish calcified plaques from intimal tears, thrombus and other underlying etiologies,and help to avoid unnecessary stenting.