冠心病伴牙周炎患者牙周状况及龈下菌斑的研究

目的   探讨牙周炎伴有冠心病患者龈下菌斑中牙周致病菌的分布,分析慢性牙周炎对冠状动脉硬化性心脏病的影响。方法   随机抽取无冠心病史慢性牙周炎患者43例,设为对照组,其中男25例、女18例;冠心病合并慢性牙周炎患者40例,设为实验组,其中男23例、女17例。记录牙周指数：探诊深度（PD）、探诊出血（BOP）、附着丧失（AL）,研究两组之间牙周指数的关系;采集龈下菌斑,采用实时定量聚合酶链反应（real time PCR）方法,检测5种常见牙周致病细菌：伴放线放线杆菌（Aa）、牙龈卟啉单胞菌（Pg）、中间普氏菌（Pi）、福赛拟杆菌（Bf）和齿垢密螺旋体（Td）,分析两组细菌统计学差异。结果   两组之间牙周指数BOP、PD、AL经统计学分析,P＜0.05,差异有统计学意义;两组实时定量数据经统计学处理,Pg的P均＜0.05,差异有统计学意义;Aa、Pi、Bf及Td的P均＞0.05,差异无统计学意义。结论   伴有冠心病的牙周炎患者,其牙周指数均较无冠心病史牙周炎患者严重;龈下菌斑中Pg含量高的牙周炎患者冠心病的发病率高。     

Relationship between coronary atherosclerotic stenosis and cerebral atherosclerotic stenosis

To investigate the relationship between severity of cerebrovascular atherosclerosis stenosis and that of coronary atherosclerosis stenosis.Methods Cerebral angiography and coronary angiography were performed in 34 patients who had coronary disease with cerebral ischemia.Patients were divided into 3 subgroups according to the degree ofstenosis on angiography,concomitant diseases,risk factors and biochemical data.Results The follow-up study showed that the incidence of cardiac and cerebrovascular death increased significantly in patients with moderate to severe stenosis of coronary and cerebral arteries;the severity of stenosis in the coronary artery parallels that in the solitary carotid artery,or dual carotid and vertebral arteries.Conclusions Patients with coronary and cerebral artery stenosis,especially those with multi-risk factors,such as hypertension,diabetes and cigarette smoking,should receive intensive treatment to reduce cardiac and cerebrovascular events.(J Geriatr Cardiol 2008;5:227-229)     

温阳散瘀方联合贝前列素钠片治疗下肢动脉粥样硬化性闭塞症的临床研究

目的观察温阳散瘀方辅助贝前列素钠片治疗下肢动脉粥样硬化性闭塞症的效果。方法采用简单随机抽样方法从2016年3月至2018年4月于该院接受诊治的下肢动脉粥样硬化性闭塞症患者中选取86例纳入研究,依据随机数字表法进行分组,对照组43例患者接受贝前列素钠片治疗,研究组43例患者接受温阳散瘀方联合贝前列素钠片治疗,治疗6周后评价两组临床疗效,测定两组患者血脂水平、踝肱指数(ABI)、6min步行试验(6-MWT)、无痛行走距离、超敏C反应蛋白(hs-CRP)以及血液流变学相关指标。结果研究组临床总有效率(88.37%)明显高于对照组(69.77%),差异有统计学意义(P<0.05);治疗后两组患者总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平均明显下降(P<0.05),且组间比较差异有统计学意义(P<0.05);治疗后研究组ABI、6-MWT、无痛行走距离和hs-CRP水平均明显优于对照组(P<0.05);治疗后两组血液流变学相关指标均明显下降(P<0.05),且组间比较差异有统计学意义(P<0.05)。结论温阳散瘀方辅助贝前列素钠片应用于下肢动脉粥样硬化性闭塞症的临床治疗,在平衡血脂水平、改善血液流变学相关指标方面效果明显,可有效改善ABI、6-MWT、无痛行走距离和hs-CRP等指标,增进疗效。     

Protruding atherosclerotic aortic plaques and dyslipidaemia: correlation to subtypes of ischaemic stroke.

AIMS: To evaluate whether thoracic aortic plaques together with dyslipidaemia are related to ischaemic stroke, and if so, to which of the subtypes of stroke. METHODS AND RESULTS: We performed transoesophageal echocardiography in 50 patients with acute ischaemic stroke and in 401 controls. The aorta was divided into two segments: (1) the proximal, proximal to the left subclavian artery, and (2) the distal aorta. Protruding plaques (Intima > or =4 mm in thickness) in the proximal aorta were detected in 14 of the 50 patients (28%) with stroke, and in 53 of the 401 controls (13%) (P<0.01). Plaque score in the proximal aorta (2.1 +/- 1.8 vs 0.9 +/- 0.7; P<0.05), low-density lipoprotein cholesterol level (3.60 +/- 0.85 vs 2.87 +/- 0.72 mmol/l; P<0.05), and apolipoprotein B/A-I ratio (0.98 +/-0.17 vs 0.73 +/- 0.16; P<0.005) were higher in patients with athero-thrombotic than in cardioembolic stroke. The score in the proximal aorta correlated with low-density lipoprotein cholesterol level (r=0.44, P<0.005) and apolipoprotein B/A-I ratio (r=0.40, P<0.01). CONCLUSION: Severe plaques in the proximal aorta together with dyslipidaemia are seen more frequently in patients with atherothrombotic stroke. Lipid analysis may contribute to the prediction and the treatment of the patients who are at high risk for atherothrombotic stroke.     

Gender differences in acute coronary syndromes: focus on the women with ACS without an obstructing culprit lesion

Introduction: The etiologies of acute coronary syndromes (ACS) in women expand beyond the traditional paradigm of obstructive epicardial atherosclerotic disease and plaque rupture. Fundamental differences in pathobiology and presentation can partially explain the gender disparity in ACS diagnosis and management, but there is also much we do not know about the spectrum of coronary artery disease in women.

Areas covered: This review seeks to explain some key differences between men and women in terms of risk factors, pathophysiology, and clinical presentations, as well as identify areas where more data are needed, focusing on women presenting with ACS but without a culprit lesion to explain their presentation. Literature search was undertaken with PubMed and Google Scholar.

Expert commentary: Women with acute coronary syndromes but without plaque rupture or obstructive epicardial atherosclerosis can be difficult to diagnose and manage. Improving care in this underdiagnosed and undertreated population will require early identification of at risk patients, development of better diagnostic strategies, and standardized implementation of guideline-based therapies.     

Transmission Risk from Imported Plasmodium vivax Malaria in the China–Myanmar Border Region

Malaria importation and local vector susceptibility to imported Plasmodium vivax infection are a continuing risk along the China–Myanmar border. Malaria transmission has been prevented in 3 border villages in Tengchong County, Yunnan Province, China, by use of active fever surveillance, integrated vector control measures, and intensified surveillance and response.     

颈动脉硬化斑块超声造影评估

目的：探讨颈动脉硬化斑块超声造影的临床价值。方法：将171例患者分成急性脑梗塞组、有症状组、无症状组,进行常规超声检查和斑块超声造影,根据斑块超声造影增强强度进行定性和半定量比较。结果：3组患者在斑块回声强度、斑块内血流信号和溃疡性斑块上有显著差异（P<0.01）;患者颈动脉斑块CEUS增强分级在3组间无显著差异（P>0.01）;颈动脉斑块超声造影增强定量测值比较,EI值和Ratio比值在急性脑梗塞组与有症状组间没有显著差异（P>0.01）,但在急性脑梗塞组与无症状组、有症状组与无症状组间有显著差异（P<0.01）。结论：超声造影对患者颈动脉硬化斑块稳定性的评估提供了较可靠的方法,与常规超声的联合应用大大提高超声诊断率,对脑卒中患者的筛查和指导临床治疗将大有裨益。     

Systematic Coronary Risk Evaluation (SCORE): JACC Focus Seminar 4/8

Clinical estimation of the combined effect of several risk factors is unreliable and this resulted in the development of a number of risk estimation systems to guide clinical practice. Here, after defining general principles of risk estimation, the authors describe the evolution of the European Society of Cardiology’s (ESC) Systematic COronary Risk Evaluation (SCORE) risk estimation system and some learnings from the data. They move on to describe the establishment of the ESC’s Cardiovascular Risk Collaboration and outline its proposed research directions. First among these is the evolution of SCORE 2, which provides updated, calibrated risk estimates for total cardiovascular events for low, moderate, high, and very high-risk regions of Europe. The authors conclude by considering that the future of risk estimation may be to express risk as years of exposure to a cardiovascular risk factor profile rather than risk over a fixed time period, such as 10 years, and how advances in genetics may permit individualized lifetime risk estimation from childhood on.