前蛋白转化酶枯草溶菌素9基因多态性的106进展

前蛋白转化酶枯草溶菌素9(PCSK9)是近年来新发现的一种与调节胆固醇代谢密切相关蛋白,属前蛋白转化酶家族。PCSK9可通过调节低密度脂蛋白胆固醇(LDLC)水平进而影响冠状动脉粥样硬化性心脏病、外周血管病、脑血管病、神经系统疾病及糖尿病等疾病的风险。近来研究表明,PCSK9基因多态性位点双向调节胆固醇水平。认识这些多态性位点,对于评估疾病严重性、预后或药物治疗反应有重要临床意义。本文就PCSK9基因多态性及其临床研究进展做一综述。     

保持载瘤动脉通畅的椎动脉夹层动脉瘤治疗：附28例报告

目的:探讨保持载瘤动脉的椎动脉夹层动脉瘤治疗方法及效果。方法:回顾性分析2013年1月—2018年10月28例接受保持载瘤动脉通畅治疗的颅内椎动脉夹层动脉瘤患者的临床资料。结果:28例患者中,未破裂12例,破裂16例,平均年龄(51.8±7.5)岁。28例患者手术技术成功率为100%。5例未破裂患者采用单纯2枚及2枚以上支架植入,术后即刻造影显示动脉瘤内造影剂滞留,随访造影发现动脉瘤消失或动脉瘤明显变小,Raymond分级Ⅰ级3例(3/5),Ⅱ级例2(3/5)。另外23例患者采用2枚重叠支架辅助弹簧圈栓塞,术后即刻造影显示,动脉瘤Raymond分级Ⅰ级11(11/23)例,Raymond分级Ⅱ级5(5/23)例,Raymond分级Ⅲ级7(7/23)例,其中19例(19/23)获随访(14.5±7.9)个月。随访造影发现动脉瘤Raymond分级Ⅰ级16例(16/19),Raymond分级Ⅱ级3例(3/19),无Raymond分级Ⅲ级病例。16例破裂患者中,2例发生支架内血栓形成或术后穿支事件,给予溶栓治疗后消退。预后mRS评分≤2分27例(27/28),≥3分1例(1/28)。结论:保持载瘤动脉通畅,多支架或多支架辅助弹簧圈栓塞椎动脉夹层动脉瘤可以获得较好的临床结果。     

侵及颈总动脉病变的手术治疗

目的探讨侵及颈总动脉病变的手术方法及注意事项。方法分析11例资料完整的患者资料,包括喉癌喉3/4切除术后复发1例,结核性颈总动脉瘤破裂大出血1例,医源性颈总动脉瘤1例,颈动脉体瘤3例,甲状腺癌侵及颈总动脉1例,颈部肿瘤侵及颈总动脉2例,颈总动脉离断伤1例,气性坏疽1例。结果上述病例中,2例完成肿瘤切除,颈总动脉重建;2例术中应用Shunt转流管,完成肿瘤切除;1例颈外伤,行颈总动脉结扎;1例医源性颈总动脉瘤患者,行动脉瘤切除,颈总动脉修补;甲状腺癌患者分离颈总动脉并切除部分气管侧壁完成肿瘤切除及应用颈前肌气管修补;2例颈部肿瘤保留颈总动脉切除肿瘤;1例气性坏疽患者颈部切开减压。结论侵及颈总动脉病变的手术治疗,主要有下列3种形式：①切除肿瘤及颈总动脉、颈动脉重建;②切除肿瘤及颈总动脉,颈总动脉结扎;③分离颈总动脉切除肿瘤。     

Prognostic Value of Renal Function for Cardiac Events in Patients Without Significant Stenosis on Coronary Computed Tomography Angiography

This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant (< 50%) CAD was reviewed in three cardiac centers. The MACEs including cardiac death, non-fatal myocardial infarction (MI), unstable angina and late (> 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 ± 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m²) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.

Graphical Abstract

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复发性和首发性脑梗死患者头颈部CT血管成像特点分析

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