杏丁注射液对不稳定性心绞痛患者hs-CRP及血流变的影响

目的：探讨杏丁注射液对不稳定性心绞痛（UAP）患者超敏C反应蛋白（hs-CRP）及血流变的影响。方法：将85例UAP的住院患者,随机分成治疗组43例（常规治疗（杏丁注射液25 mL静点,1次/d）,对照组42例（常规治疗（复方丹参注射液20 mL静点,1次/d）,治疗前及治疗1疗程后分别检测血液流变学指标及hs-CRP水平。结果：治疗组治疗后血浆粘度、血小板聚集率、全血粘度低切、全血粘度高切均下降,纤维蛋白原含量减少,hs-CRP水平降低。与治疗前比较有极显著差异（P〈0.01）,和对照组治疗后比较有显著差异（P〈0.05）。结论：UA患者常规治疗基础上加用杏丁注射液可以逆转血液流变学异常,具有抗炎作用,降低AM I的发生率和猝死率,值得临床推广应用。     

Network meta-analysis of nine large cardiovascular outcome trials of new antidiabetic drugs

The aim of this network meta-analysis (NMA) was to indirectly compare the cardiovascular (CV) safety of new antidiabetic medications in patients with type 2 diabetes mellitus (T2DM).Data synthesisA search of the Embase and MEDLINE databases was conducted systematically to identify cardiovascular outcome trials (CVOTs) of new antidiabetic medications (DPP-4 inhibitors, GLP-1 agonists and SGLT-2 inhibitors) in patients with T2DM. The primary outcomes were the composite endpoint of CV death, nonfatal MI, and nonfatal stroke (MACE), death from CV causes, nonfatal MI, nonfatal stroke and death from any cause. Hospitalization for HF and unstable angina were evaluated as secondary endpoints. A total of 9 trials, including 87,162 patients, met the eligibility criteria and were retained for the analysis.The NMA results showed no significant differences among the DPP-4 inhibitors (sitagliptin, alogliptin, and saxagliptin) in any of the CV endpoints. Similarly, no significant changes were seen in the NMA among the GLP-1 receptor agonists nor the SGLT-2 inhibitors. The pairwise meta-analysis showed that DPP-4 inhibitors have a CV safety profiled comparable to placebo. GLP-1 agonists on the other hand, showed significant reduction in MACE (RR 0.92; 95% CI 0.87–0.97), death from CV causes (RR = 0.88; 95% CI 0.80–0.97), and death from any cause (RR = 0.89; 95% CI 0.82–0.96). SGLT-2 inhibitors showed significant reduction in hospitalization for heart failure events (RR 0.72; 95% CI 0.6–0.86) compared to placebo.ConclusionThis meta-analysis has shown that new antidiabetic medications do not impose any additional CV risk. The indirect comparison among the medications of each class resulted in no significant changes regarding CV endpoints and death from any cause.     

心可舒片剂合用单硝酸异山梨酯注射液治疗稳定型心绞痛的临床研究

目的 观察心可舒片剂合用单硝酸异山梨酯注射液治疗稳定型心绞痛的临床疗效.方法 97例稳定型心绞痛患者随机分为对照组（48例）和治疗组（49例）,对照组给予单硝酸异山梨酯注射液20 mg微泵注射（6～8 mg/h）,1次/日;治疗组在对照组基础上加服心可舒4片,3次/日,疗程均为2周.观察治疗前后临床症状、24小时动态心电图和血脂水平变化.结果 两组患者临床症状显著改善;24小时内心肌缺血发作次数及缺血时间明显减少（P〈0.01）,且治疗组疗效更为明显（P〈0.05）,其血脂水平也有降低趋势.结论 心可舒片剂合用单硝酸异山梨酯注射液治疗稳定型心绞痛,在减少心肌缺血发作次数及缺血时间方面,较单用单硝酸异山梨酯有更好的疗效.     

丹红注射液治疗不稳定型心绞痛的临床研究

目的观察丹红注射液治疗不稳定型：心绞痛的临床疗效。方法将160例不稳定型心绞痛患者随机分为治疗组和对照组,各80例。两组均采用常规治疗,治疗组加用丹红注射液。观察治疗前和治疗2周后临床症状、血流动力学指标、血小板聚集率及高敏C反应蛋白（hsCRP）变化。结果治疗组在临床症状、血流动力学、血小板聚集率及hsCRP改善均优于对照组。结论丹红注射液治疗不稳定型心绞痛疗效鼹著。     

两种药物对介入治疗的UAP患者炎症因子和血脂的影响

目的:研究瑞舒伐他汀和辛伐他汀对不稳定型心绞痛行冠状动脉介入治疗术(PCI)的患者高敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)及血脂水平的影响。方法:将90例行PCI治疗的不稳定性心绞痛患者随机分为瑞舒伐他汀组和辛伐他汀组(每组45例),分别于给药前,PCI术前,PCI术后24h,PCI术后3周。测定血清hs-CRP和IL-6浓度及血脂水平。结果:PCI术后3周,两组血清hs-CRP和IL-6浓度明显降低(P<0.05)。TC和低密度脂蛋白(LDL-C)水平明显下降,高密度脂蛋白(HDL-C)明显上升(P<0.05),但瑞舒伐他汀组较辛伐他汀组TC和LDL-C水平下降及HDL-C水平上升更明显。结论:瑞舒伐他汀和辛伐他汀对行PCI术的不稳定型心绞痛患者具有明显的调脂及降低血清炎症因子的作用,其中瑞舒伐他汀调脂作用更强。     

达肝素钠联合阿托伐他汀钙治疗不稳定型心绞痛临床分析

目的探讨达肝素钠联合应用阿托伐他汀治疗不稳定型心绞痛的临床疗效。方法将126例不稳定型心绞痛患者随机分为观察组和对照组各63例。观察组在对照组用药基础上给予给予达肝素钠5 000 U皮下注射,每12 h 1次,连用7 d。同时给予阿托伐他汀60 mg嚼服(刚入院时),此后每晚睡前口服20 mg,连续服用两周,14 d一个疗程。检测两组患者治疗前后心电图的变化及血脂的测定,在治疗过程中要注意患者皮肤黏膜及内脏是否有出血情况,观察其安全性。结果观察组的总有效率为92.19%,对照组的总有效率为79.03%,两组比较差异有统计学意义(P<0.05)。同时,观察组治疗后总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)均较其治疗前有明显下降,差异有统计学意义(P<0.01或P<0.05),而对照组治疗前后血脂的各项观察指标比较,差异无统计学意义(P>0.05)。结论达肝素钠联合阿托伐他汀治疗不稳定型心绞痛疗效显著,无不良反应,值得推广应用。     

Left atrial area index predicts adverse cardiovascular events in patients with unstable angina pectoris

Background The left atrial size has been considered as a useful marker of adverse cardiovascular outcomes. However, it is not well known whether left atrial area index (LAAI) has predictive value for prognosis in patients with unstable angina pectoris (UAP). This study was aimed to assess the association between LAAI and outcomes in UAP patients. Methods We enrolled a total of 391 in-hospital patients diagnosed as UAP. Clinical and echocardiographic data at baseline were collected. The patients were followed for the development of adverse cardiovascular (CV) events, including hospital readmission for angina pectoris, acute myocardial infarction (AMI), congestive heart failure (CHF), stroke and all-cause mortality. Results During a mean follow-up time of 26.3 ± 8.6 months, 98 adverse CV events occurred (84 hospital readmission for angina pectoris, four AMI, four CHF, one stroke and five all-cause mortality). In a multivariate Cox model, LAAI [OR: 1.140, 95% CI: 1.016–1.279, P = 0.026], diastolic blood pressure (OR: 0.976, 95% CI: 0.956–0.996, P = 0.020) and pulse pressure (OR: 1.020, 95% CI: 1.007–1.034, P = 0.004) were independent predictors for adverse CV events in UAP patients. Conclusions LAAI is a predictor of adverse CV events independent of clinical and other echocardiographic parameters in UAP patients.