Systemic inflammation in unstable angina is the result of myocardial necrosis

OBJECTIVES: We investigated whether the source of the acute phase response in unstable angina (UA) lay within the culprit coronary plaque or distal myocardium. BACKGROUND: An inflammatory response is an important component of the acute coronary syndromes. However, its origin and mechanism remain unclear. METHODS: In 94 stable patients undergoing coronary angiography, the relationship between systemic levels of tumor necrosis factor (TNF)-alpha, interleukin-6 (IL-6) and C-reactive protein (CRP) and extent of atherosclerosis was studied. The temporal relationship between these markers and troponin T (TnT) was determined in 91 patients with UA. Cytokine levels were measured in the aortic root and coronary sinus of 36 unstable patients. RESULTS: There was no relationship found between stable coronary atherosclerosis and inflammatory marker levels. Compared with this group, admission levels of IL-6 (3.6 +/- 0.3 ng/ml vs. 10.7 +/- 1.7 ng/ml, p < 0.05) and CRP (2.3 +/- 0.1 mg/l vs. 4.6 +/- 0.6 mg/l, p < 0.05) were elevated in patients with UA. In this group, IL-6 and CRP remained elevated in those who subsequently experienced major adverse cardiac events. This inflammatory response occurred in parallel to the appearance of TnT. Both TNF-alpha (19.2 +/- 3.4 ng/ml vs. 17.1 +/- 3.3 ng/ml, p < 0.001) and IL-6 (10.3 +/- 1.4 ng/ml vs. 7.7 +/- 1.1 ng/ml, p < 0.01) were elevated in the coronary sinus compared with aortic root in patients with UA. This was principally observed in those who were TnT positive. There was no cytokine gradient across the culprit plaque. CONCLUSIONS: There is an intracardiac inflammatory response in UA that appears to be the result of low-grade myocardial necrosis. The ruptured plaque does not appear to contribute to the acute phase response.     

通脉降脂颗粒对冠状动脉成形术后血脂、血流变的影响*

[目的]观察通脉降脂颗粒对于冠状动脉成形术（VTCA）后实验性高脂血症大鼠血脂、血流变的影响。[方法]选择Wistar雄性大鼠60只，随机分为6组，除空白组以外每组予以高脂饲料喂养3周，并提前1周予以灌胃给药，然后进行PTCA术造模，造模后持续给药3周，取血采集样本。[结果]在胆固醇、甘油三酯方面，模型组与空白组相比较均有统计学差异（P〈0．05），证明模型制造成功；模型组和通脉降脂预防组比较有统计学差异（P〈0．05）。在血浆黏度、血小板聚集率方面，空白组和模型组之间有统计学差异（P〈0．05），而通脉降脂和模型组比较两组有统计学差异（P〈0．05）。[结论]通脉降脂颗粒对PTCA术后再狭窄具有一定的预防作用，同时对于肝肾功能无损害。     

急性心肌梗塞的不同治疗方法临床疗效观察

目的急性心肌梗塞患者接受不同治疗的临床疗效及远期预后。方法153例ST段抬高性急性心肌梗塞患者,30例接受直接PTCA冠脉支架术治疗,45例接受延迟PTCA冠脉支架术治疗,36例尿激酶静脉溶栓术,42例未再灌注治疗。对所有患者随访12￣24个月,观察住院期间和随访期间的临床不良事件和超声心动图的变化。结果1.PTCA冠脉支架术可缩短平均住院时间(P<0.05),再灌注治疗较减少复合终点事件(P<0.05)。2.平均随访12.5±3.7个月时,平均住院时间,延迟组与直接组比较无显著性差异,但较静脉溶栓组、内科药物治疗组则明显缩短住院时间。住院期间四组患者各项心脏事件均无显著性差异;但在复合终点事件发生率方面,各再灌注组明显低于未再灌注治疗组(P<0.05),而且直接组与溶栓组有明显差别(P<0.05)。平均随访12.5±3.7个月时,四组患者在死亡、不稳定性心绞痛、再梗和严重卒中发生率方面无明显差异;但在心力衰竭方面,各PTCA冠脉支架术组与未再灌注治疗有统计学意义;在复合终点事件发生率方面,各再灌注组明显低于未再灌注治疗组(P<0.05),而且直接组与溶栓组有明显差别(P<0.05)。住院期间平均住院二周左右的超声心动结果显示,各再灌注组LVEF、Fs明显低于未再灌注治疗组,直接组且明显高于静脉溶栓组(P<0.05)。随访期间,各再灌注组LVEF、Fs、LVDd、LAD与未再灌注治疗组有明显差别(P<0.05);而且各再灌注组间的LVEF、Fs、LVDd均有统计学意义(P<0.05)。结论再灌注治疗直接PTCA冠脉支架术应作为急性心肌梗塞治疗的首选,而延迟PTCA冠脉支架术应尽量提前。     

经皮冠状动脉成形术(PTCA)治疗急性心肌梗死合并心源性休克30例的疗效观察

目的观察急性心肌梗死合并心源性休克患者行急诊PTCA手术的疗效和其对心功能的影响。方法急性心肌梗死合并心源性休克患者68例,PTCA组30例,溶栓组38例。分析各组患者的临床特征,比较两组患者的住院时间、住院及随访期间不良心血管事件发生率、心功能恢复情况。观察PTCA组年龄、心梗病史、心肌灌注分级、高血压、糖尿病与死亡率的相关性。结果PTCA组较溶栓组血管开通率明显增高,PTCA组住院时间、不良心血管事件发生率、左室射血分数均好于溶栓组。PTCA组患者年龄、心梗病史、心肌灌注分级与死亡率呈正相关。结论PTCA治疗急性心肌梗死合并心源性休克患者是安全、有效的方法。年龄、心梗病史、心肌灌注分级是PTCA手术后患者死亡率的预测因素。     

急性心肌梗死急诊PTCA加支架术的护理体会

总结临床急性心肌梗死急诊PTCA支架术的临床病例资料,术前护理、术后护理经验.降低了病人的死亡率和医疗费用,缩短了康复时间.     

炙甘草汤对PTCA术后心律失常P选择素内皮素CRP影响临床研究

目的:了解炙甘草汤对冠心病经皮冠状动脉成形术(PTCA)术后P选择素、内皮素、CRP变化的影响,阐明炙甘草汤抗心律失常机制。方法:将40例患者随机分为炙甘草汤组和倍他乐克组,观察患者P选择素、内皮素、CRP的变化。结果:炙甘草汤可显著降低P选择素、内皮素、CRP的水平,与倍他乐克组比较有显著性差异(P<0.05)。结论:炙甘草汤抗PTCA术后心律失常的作用机制可能与抗血小板活化、保护内皮细胞有关。     

心理干预对经皮穿刺冠状动脉成形术及支架植入术患者生活质量影响的探讨

目的：了解心理干预经皮穿刺冠状动脉成形术（PTCA）及支架植入术（SI）术后冠心病患者的情绪障碍,探讨心理干预对经PTCA及支架植入患者生活质量的影响和效果。方法：采用生活质量评定问卷（GQOL-74）对56例PTCA及支架植入术诊疗患者在术前、术后进行测查,通过不同心理方法进行心理干预。结果：干预组与对照组比较,患者干预后的生活质量改善程度明显优于未经干预的患者（P〈0.05）。结论：心理干预能提高PTCA及支架植入术患者生活质量。     

Myocardial revascularization in patients with end-stage renal disease: Comparison of percutaneous transluminal coronary angioplasty and coronary artery bypass grafting

Background: Ischemic heart disease is the major cause of death inpatients with end-stage renal disease. The high prevalence of coronary artery disease results in a rising number of dialysis patients requiring myocardial revascularisation. Objective: The objective of this study was to compare the outcomes of recurrent angina, myocardial infarction, rate of reinterventions and cardiovascular death following percutaneous coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) inpatients with end-stage renal disease. Patients and methods: In a retrospective investigation 40 patients with chronic renal failure undergoing primarily PTCA and 65 patients undergoing CABG were included. Both groups were comparable for gender, duration on dialysis and the number of cardiovascular risk factors per patient. Patients undergoing PTCA were younger (53 ± 12 years vs. 57 ± 8 years; p < 0.05) and more often diabetics (30% vs. 14%; p < 0.05). Results: Most patients in both groups had a multi-vessel disease (95% in the CABG group vs. 74% in the PTCA group), in the CABG group there were significantly more patients with a triple-vessel disease (62% with vs. 40%in the PTCA group; p < 0.01), PTCA was primarily successful in 95% of the patients while complete revascularization was achieved in 88% of patients undergoing CABG. The perioperative mortality after CABG was 4.8% as compared to none after interventional revascularisation. The cumulative freedom of angina after 6, 12 and 24 months after intervention was significantly lower after PTCA (54%, 40%, 29%) than after bypass grafting (97%, 94%, 90%, p < 0.001). The frequency of reinterventions following PTCA was significantly higher compared to patients following CABG (p < 0.001). After PTCA 15 patients needed further revascularisations, 8 of them underwent CABG, whereas after CABG only two patients required additional myocardial revascularisation. There was no significant difference in the overall mortality between both groups; the survival rate after 12 and 24 months was 95% and 82% after PTCA and 93% and 86% after CABG, respectively. Condition: Although patients receiving CABG had a more severe coronary artery disease the overall mortality was comparable and clinical and functional outcome was improved compared to patients after coronary angioplasty. This revised version was published online in June 2006 with corrections to the Cover Date.     

兔髂动脉血管内照射的实验方法

目的用改进型后装治疗机进行血管内放疗的可行性研究。资料与方法用兔髂动脉行血管成形术,制成血管狭窄模型,用改进型后装治疗机及微型放射源１９２Ｉｒ进行兔髂动脉内放疗,预防血管成形术后再狭窄。结果６０只兔分为３组。１）放疗１０Ｇｙ组;２）放疗１８Ｇｙ组;３）对照组,只做球囊扩张血管损伤,不做放疗。放疗组及对照组均１００％成功。结论改进型后装治疗机在兔髂动脉扩张术后照射,安全可行。