肺炎衣原体与不稳定性心绞痛相关性的临床研究

目的　探讨肺炎衣原体感染与不稳定性心绞痛 (UAP)发病的关系。方法　UAP、稳定性心绞痛 (SAP)各 30例及正常对照组 2 0名。检测肺炎衣原体特异性抗体IgG、IgM滴度 ,肿瘤坏死因子α(TNFα)、C反应蛋白 (CRP)水平 ,组织型纤溶酶原激活剂 (tPA )及其抑制物 1(PAI 1)活性。结果　 (1)UAP组TNFα、CRP和PAI 1较SAP组和对照组升高 ;(2 ) 3组肺炎衣原体 IgG阳性率分别为 83.3%、6 0 %和 35 %,UAP组高于SAP组和对照组。IgM阳性率组间比较差异无显著性意义 ;(3)IgG阳性组TNFα、CRP、PAI 1及TG、TC、LDL C均显著高于阴性组 ,tPA低于阴性组。IgM阳性组和阴性组各参数比较差异无显著性意义。结论　肺炎衣原体慢性感染与UAP发生有关 ,其参与UAP的机制可能是 :肺炎衣原体感染诱导TNFα和CRP产生 ,促进PAI 1活性表达、降低tPA活性 ,并干扰血浆脂质代谢 ,从而促进UAP发生。     

Development and validation of risk score for ACS in China:prognostic value in-hospital and interaction with revascularization

Objective:To develop a simple risk score of in-hospital major adverse cardiac events including all-cause mortality,new or recurrent MI(myocardial infarction),and evaluate the efficacy about revascularization on patients with different risk.Methods:The basic characteristics,diagnosis,therapy and in-hospital outcomes of 1512 ACS patients from GRACE study(global registry of acute coronary events)of China were collected to develop a risk score model by multivariable stepwise logistic regression.The goodness of fit and the discriminative power of the final model were assessed respectively.The best cut-off value for the risk score was used to assess the impact of revascularization for STEMI and NSTEACS on in-hospital outcomes.Results:(1)The following 6 independent risk factors accounted for about 92.5% of the prognostic information:age ≥80 years(4 points),SBP ≤90 mm Hg(6 points),DBP≥90 mm Hg(2 points),Killip Ⅱ(3 points),Killip Ⅲ or Ⅳ(9 points),cardiac arrest during presentation(4 points),ST-segment elevation(3 points)or depression(5 points)or combination of elevation and depression(4 points)on electrocardiogram at presentation.(2)CHIEF risk model was excellent with Hosmer-Lemeshow goodness-0f-fit test of 0.673 and c statistics of 0.776.(3)1301 ACS patients previously enrolled in GRACE study were divided into 2 groups with the best cut-off value of 5.5 points.Both STEMI(61.7% vs 78.3%,P=0.000)and NSTEACS(42.0% vs 62.3%,P=0.000)patients with the risk score more than 5.5 points have lower revascularization rate,However,the impact of revascularization on in-hospital MACE of higher risk subsets was stronger than lower risk subsets(P=0.02 and 0.04,respectively).Conclusion:The risk score provides excellent ability to predict in-hospital death or(re)MI quantitatively and accurately.Patients underwent revascularization with risk score greater than 5.5 have lower incidence rate of endpoint.