药膳疗法联合中医经络推按对冠心病心绞痛病人生活质量的影响

[目的]探讨药膳疗法联合中医经络推按对冠心病心绞痛病人生活质量的影响.[方法]将400例冠心病心绞痛病人按照随机数字分组法分为对照组、经络推按组、药膳组、经络推按＋药膳组,每组100例.对照组予常规护理,其他三组在对照组的基础上分别给予经络推按、药膳、经络推按＋药膳治疗.采用健康状况调查问卷（SF-36）及西雅图心绞痛量表（ASQ）评价病人的生活质量.[结果]治疗后4组SF-36和SAQ各维度得分显著高于治疗前,差异有统计学意义（P〈0.05）.经络推按＋药膳组治疗后SF-36和SAQ各维度得分显著高于其他3组,组间比较差异有统计学意义（P〈0.05）.[结论]中医经络推按联合药膳治疗可以显著提高冠心病心绞痛病人的生活质量.     

Autotransplantation of mesenchymal stromal cells from bone-marrow to heart in patients with severe stable coronary artery disease and refractory angina — Final 3-year follow-up

Background

The study assessed long-term safety and efficacy of intramyocardial injection of autologous bone-marrow derived mesenchymal stromal cells (BMMSCs) in patients with severe stable coronary artery disease (CAD) and refractory angina.

Methods

Thirty-one patients with severe stable CAD and refractory angina were included. Patients had reversible myocardial ischemia and no further revascularization options. Autologous BMMSCs were isolated, culture expanded and stimulated with vascular endothelial growth-factor to facilitate endothelial differentiation. BMMSCs were injected into an ischemic, viable region of the myocardium. Patients were followed for 3 years.

Results

We found significant clinical improvements in exercise time (p = 0.0016), angina class (CCS) (p < 0.0001), weekly number of angina attacks (p < 0.0001) and use of nitroglycerine from (p = 0.0017). In the Seattle Angina Questionnaire there were significant improvements in physical limitation score, angina stability score, angina frequency score and quality of life score (all p < 0.0001). When comparing all hospital admissions from 3 years before to 3 years after treatment, we observed highly reduced admission rates for stable angina (p < 0.0001), revascularization (p = 0.003) and overall cardiovascular disease (p < 0.0001). No early or late side-effects of the treatment were observed.

Conclusions

The final 3-year follow-up data after intramyocardial injection of autologous BMMSCs, in patients with severe CAD and refractory angina, demonstrated sustained clinical effects, reduced hospital admissions for cardiovascular disease and excellent long-term safety. The results indicate that autotransplantation of BMMSCs to the heart does not only improve symptoms but also slows down disease progression.     

Effect of insulin resistance associated with compensatory hyperinsulinemia on the long-term prognosis in patients with vasospastic angina

Background

Insulin resistance associated with compensatory hyperinsulinemia plays a significant role in the pathogenesis of cardiovascular diseases, including vasospastic angina (VSA). However, the effects of insulin resistance associated with hyperinsulinemia on the long-term prognosis in patients with VSA remain unclear.

Methods

A total of 265 selected patients with VSA and 56 control subjects with atypical chest pain were enrolled in the present study. Patients with VSA had a positive acetylcholine (ACh) provocation test with normal coronary angiograms, and control subjects had a negative ACh test and normal coronary angiograms. A 75-g oral glucose tolerance test was performed, and the plasma glucose and immunoreactive insulin (IRI) levels were measured before, and 30 min and 120 min (IRI 120) after the 75-g glucose load.

Results

During the median follow-up period of 90.0 months, thirty-one patients developed cardiac events, including 6 sudden cardiac deaths and 25 readmissions for acute coronary syndrome. Cardiac events occurred in 38.9% of the patients with an IRI 120 ≥ 80 μU/ml and only 1.6% of the patients with an IRI 120 < 80 μU/ml (log rank 77.220, p < 0.001). A multivariate analysis showed that an IRI 120 ≥ 80 μU/ml (hazard ratio 27.49, 95% confidence interval: 4.66–162.10, p < 0.001) was an independent predictor of cardiac events.

Conclusions

These data indicate that insulin resistance associated with compensatory hyperinsulinemia increases the risk of cardiac events in VSA patients.     

“Polarizing” microplegia improves cardiac cycle efficiency after CABG for unstable angina

Background

Myocardial protection during coronary artery bypass grafting (CABG) for unstable angina (UA) still represents a major challenge, ought to the risk for further ischemia/reperfusion injury. Few studies investigate the biochemical, hemodynamic and echocardiographic results of microplegia (Mic) in UA.

Methods

Eighty UA-patients undergoing CABG were randomized to Mic (Mic-Group) or standard 4:1 blood Buckberg-cardioplegia (Buck-Group). Troponin-I and lactate were sampled from coronary sinus at reperfusion (T1), and from peripheral blood preoperatively (T0), at 6 (T2), 12 (T3) and 48 (T4) hours. Cardiac index (CI), indexed systemic vascular resistances (ISVR), Δp/Δt, cardiac cycle efficiency (CCE), and central venous pressure (CVP) were collected preoperatively (T0), and since Intensive Care Unit (ICU)-arrival (T1) to 24 h (T5). Echocardiographic E-wave (E), A-wave (A), E/A, peak early-diastolic TDI-mitral annular-velocity (Ea), and E/Ea investigated the diastolic function and Wall Motion Score Index (WMSI) the systolic function, preoperatively (T0) and at 96 h (T1).

Results

Mic-Group showed lower troponin-I and lactate from coronary sinus (p = .0001 for both) and during the postoperative course (between-groups p = .001 and .0001, respectively). WMSI improved only after Mic (time-p = .001). Higher CI Δp/Δt and CCE (between-groups p = .0001), with comparable CVP and ISVR (p = N.S.) were detected after Mic. Diastolic function improved in both groups, but better after Mic (between-groups p = .003, .001, and .013 for E, E/A, and Ea, respectively). Mic resulted in lower transfusions (p = .006) and hospitalization (p = .002), and a trend towards lower need/duration of inotropes (p = .04 and p = .041, respectively), and ICU-stay (p = .015).

Conclusion

Microplegia attenuates myocardial damage in UA, reduces transfusions, improves postoperative systo-diastolic function, and shortens hospitalization.     

银杏达莫注射液治疗不稳定型心绞痛76例疗效评估

目的：分析探讨银杏达莫注射液治疗不稳定型心绞痛的临床疗效.方法：将152例不稳定型心绞痛患者,按照随机数字表法分为观察组和对照组各76例,对照组患者给予内科常规西药治疗,观察组患者给予西药治疗联合银杏达莫注射液治疗,观察两组心绞痛缓解情况、心电图及血液流变学指标的变化.结果：观察组心绞痛总有效率为88.16%,对照组总有效率为80.26%,两组比较差异有统计学意义（P〈0.05）;治疗后两组患者血液流变学各指标均较治疗前明显好转,与对照组比较,观察组改善的更明显（P〈0.05）.结论：银杏达莫注射液治疗不稳定型心绞痛具有较好的临床疗效,值得临床推广应用.     

安肺补肾平喘方对稳定期COPD患者的临床疗效观察

目的 观察自拟安肺补肾平喘方对稳定期Ⅰ级、Ⅱ级COPD患者的临床疗效.方法 将符合诊断标准100例COPD患者随机分为治疗组与对照组.予对照组患者沙美特罗替卡松、氨茶碱片治疗,治疗组以安肺补肾平喘方治疗.两组均以3个月为1疗程.观察比较两组患者1秒钟用力呼气容积（FEV1）、1秒钟用力呼气容积/用力肺活量（FEV1/FVC）、COPD中医证候积分、圣乔治呼吸问卷（SGRQ）积分变化.结果 治疗过程中两组患者各脱落2例.治疗结束后,治疗组总有效率97.92%,对照组91.67%,两组比较,差异有统计学意义（P＜0.05）;两组FEV1、FEV1/FVC均有改善,与治疗前比较,差异有统计学意义（P＜0.05）,治疗组治疗后优于对照组,但组间差异无统计学意义（P＞0.05）;治疗组中医证候与SGRQ积分与治疗前比较,差异均有统计学意义（P＜0.01）,且优于对照组（P＜0.05）.结论 安肺补肾平喘方对稳定期I级、II级COPD患者疗效良好,可有效改善其肺功能及生活质量.     

不稳定性心绞痛患者介入治疗前后T波峰末间期、QT离散度的变化及意义

目的探讨经皮冠状动脉介入治疗（PCI）对不稳定性心绞痛（UA）患者T波峰末间期（Tpeak-Tendinterval,Tp-Te间期）和QT离散度（QTd）的影响及其与室性心律失常（VA）的关系。方法纳入UA患者62例,分别于入院时、PCI术后第1天及术后第7天测算其12导联体表心电图最长Tp-Te间期、QTd值,记录人院24h及PCI术后第7天VA的发生情况。所有患者采用手术前后自身对照,比较所有患者手术前后Tp-Te、QTd及VA发生率等指标：根据冠脉造影结果．把UA患者进一步分为三组：单支血管病变组、双支病变组和1-支病变组,对二三组患者PCI术前后TD-Te、QTd及VA发生率等指标进行分析比较。结果与单支血管病变组相比,双支病变组和三支病变组Tp-Te间期、QTd值均增大（P〈0．05）;与PCI术前相比,单支血管病变组及双支病变组PCI术后24h和第7天rrp-Te间期、QTd值均减小（均P〈0．05）,三支血管病变组术后第7天Tp-Te间期、QTd值也均减小（均P〈0．05）,但PCI术后24hTp-Te间期、QTd值变化不明显（P〉0．05）。与入院24h相比,PCI术后第7天VA的发生率（20．97％vs8．06％）降低（P〈0．05）。结论PCI术可降低UA患者的Tp-Te间期、QTd值．从而降低UA患者VA的发生率。     

hs—cRP及Lox-1在不稳定型心绞痛患者危险分层诊断中的意义

目的研究不稳定型心绞痛（UAP）患者不同危险分层血清超敏C反应蛋白（hs—CRP）及血清凝集素样氧化低密度脂蛋白受体-1（Lox-1）的浓度及临床意义。方法根据危险分层将UAP患者分为低危、中危、高危3个亚组,分别测定稳定型心绞痛（SAP）患者21例、UAP患者47例、对照组（健康者）28例的血清hs—CRP及Lox-1浓度。结果UAP组、SAP组、对照组血清hs—CRP及Lox-1浓度两两比较差异有统计学意义（P〈0．01）。UAP低危组、中危组、高危组hs—CRP及Lox-1浓度两两比较差异有统计学意义（P〈0．01或P〈0．05）;线性相关分析hs—CRP与Lox-1的浓度呈正相关（r=0．795,P〈0．01）。结论血清hs—CRP及Lox-1浓度随UAP危险程度增加而升高,两者的浓度变化呈正相关。测定血清hs—CRP及Lox-1浓度对UAP高危患者的筛选、治疗及预后判断有重要临床价值。     

银杏叶注射液治疗冠心病不稳定型心绞痛疗效观察

目的:观察银杏叶注射液治疗冠心病不稳定型心绞痛的疗效及安全性。方法:将60例冠心病不稳定型心绞痛患者随机分为两组各30例,治疗组应用银杏叶注射液,对照组除不用银杏叶注射液外,其余治疗同治疗组。结果:治疗组显效19例,有效9例,有效率93.3%;对照组显效12例,有效10例,有效率73.3%。两组有效率比较差异有统计学意义(χ2=4.32,P<0.05)。结论:银杏叶注射液治疗冠心病不稳定型心绞痛疗效显著。     

冠心病中医证候疗效评价研究

目的:探讨以证候为内容的冠心病中医疗效评价方法,并验证可靠性。方法:以100 mm刻度法及综合评价层次分析法(AHP)为数学工具,以"综合集成研讨厅"为研讨方式,共取57个中医症状量化值为底层指标,以11个基本证候为第二层次指标,以实证与虚证为第三层次指标,以证候总评分为顶层指标,初步构建了以证候为内容的冠心病层次分析综合疗效评价方法。并在临床上与心绞痛评分、西雅图心绞痛评分、生存质量(SF-36)等进行了相关性对比研究,对模型的可靠性进行了验证。结果:冠心病证候总评分与心绞痛评分、西雅图心绞痛评分、SF-36有显著的相关性。结论:构建的以证候为内容的冠心病中医综合疗效评价方法可评价冠心病的轻重程度。