急性冠脉综合征患者生活事件与冠状动脉粥样硬化斑块稳定性的相关性研究：抑郁的中介作用

背景　急性冠脉综合征（ACS）主要由不稳定斑块形成及破裂所致。研究表明,生活事件可增加ACS的发生风险,然而生活事件是否可通过影响斑块稳定性导致ACS的发生,目前尚不清楚。同时研究证实,生活事件可引起个体抑郁的负性情绪,且抑郁与斑块稳定性密切相关,然而抑郁是否在生活事件与斑块稳定性间发挥中介作用尚未明确。目的　探究ACS患者发病前1年内生活事件与冠状动脉粥样硬化斑块稳定性的关系,以及抑郁在其中的中介作用。方法　选取2018年9月-2019年4月于哈尔滨市某三级甲等医院心血管内科行冠状动脉造影首次确诊为ACS的患者311例为研究对象。采用生活事件量表（LES）、抑郁自评量表（SDS）调查其发病前1年内生活事件及抑郁的发生情况。同时采用光学相干断层成像技术（OCT）测量患者冠状动脉粥样硬化斑块稳定性,OCT指标包括薄纤维帽粥样硬化斑块（TCFA）（TCFA以纤维帽厚度、脂质核心角度衡量）、斑块破裂、富脂质斑块、血栓、巨噬细胞及胆固醇结晶。结果　165例（53.1%）患者发病前1年内发生生活事件,67例（21.5%）患者存在抑郁。多因素Logistic 回归分析结果显示,生活事件是TCFA〔OR=1.029,95%CI（1.016,1.043）,P<0.001〕、斑块破裂〔OR=1.022,95%CI（1.010,1.034）,P<0.001〕、富脂质斑块〔OR=1.018,95%CI（1.005,1.031）,P=0.005〕、血栓〔OR=1.032,95%CI（1.014,1.050）,P=0.001〕、胆固醇结晶〔OR=1.013,95%CI（1.002,1.024）,P=0.025〕的独立影响因素。Spearman秩相关分析显示,生活事件与SDS评分（rs=0.461,P<0.01）、脂质核心角度（rs=0.385,P<0.01）呈正相关,与纤维帽厚度呈负相关（rs=-0.465,P<0.01）;SDS评分与脂质核心角度呈正相关（rs=0.406,P<0.01）,与纤维帽厚度呈负相关（rs=-0.494,P<0.01）。路径分析及Bootstrap检验中介效应显示,抑郁在生活事件与斑块纤维帽厚度〔β=-0.117,95%CI（-0.157,-0.089）,P<0.01〕及脂质核心角度〔β=0.114,95%CI（0.070,0.173）,P<0.01〕之间起中介作用。结论　发病前1年内生活事件与冠状动脉粥样硬化斑块稳定性密切相关,且抑郁在其中发挥中介作用。因此,早期筛查经历生活事件及发生抑郁的个体,有助于识别斑块不稳定的高危人群,及时实施心理干预有利于减缓不稳定斑块的发生进程,将ACS的防治关口前移。     

急性冠脉综合征的血管内超声研究

目的:探讨急性冠脉综合征(ACS)易损斑块的血管内超声(IVUS)特点。方法:在35例ACS(其中不稳定性心绞痛24例,急性心肌梗死11例)和23例稳定性心绞痛患者中进行冠状动脉IVUS检查,测量病变部位的血管外弹力膜面积(EEMA)、斑块面积(PA)及斑块负荷(PA),并计算斑块的偏心指数(EI)及血管的重构指数(RI)。结果:在58例患者中发现,16例ACS患者和5例稳定性心绞痛患者发生斑块破裂;与稳定性心绞痛组比较,不稳定心绞痛的斑块具有较大的偏心性(P<0.05),EEMA、PA、PB、RI明显大于前者,具有显著的统计学意义(P均<0.001)。结论IVUS能够准确地识别ACS易损斑块及其破裂和血栓形成。     

关于大学生弱势群体的伦理社会处境分析及教育对策

随着高校招生规模的不断扩大，大学生中弱势群体的绝对数量也大大增加，成为高校必须正视、重视和关注的特殊群体。本文分析了这一特殊群体面临的两大伦理社会处境，及为维护高校稳定，关心大学生弱势群体对其加强伦理道德教育提出的对策。     

不稳定性心绞痛患者血清C-反应蛋白测定的临床意义

目的：探讨不稳定性心绞痛患者血清C-反应蛋白（CRP）测定的临床意义。方法：选择60例临床诊断为不稳定性心绞痛的患者为观察组，60例稳定性心绞痛患者为对照组。所有研究对象均采用免疫投射比浊法测定血清CRP水平，并比较其与不同类型冠心病斑块稳定性之间的关系。结果：不稳定性心绞痛患者组血清CRP水平明显高于稳定性心绞痛患者。结论：血清CRP水平与不同类型冠心病斑块稳定性有关。     

Compound48/80对载脂蛋白E基因敲除小鼠颈总动脉套环诱导斑块的影响

目的采用肥大细胞脱颗粒剂———Compound 48/80作用于颈总动脉套环的载脂蛋白E基因敲除小鼠,以探讨肥大细胞脱颗粒对动脉粥样硬化斑块的影响及其可能作用机制。方法载脂蛋白E基因敲除小鼠高脂高胆固醇饲料喂养,行右颈总动脉套环术后分为实验组和对照组,分别腹腔注射Compound 48/80或D-hank’s。第4次注射后30 min,安乐死,取材。全自动生物化学分析仪测定血清中脂质含量,比色法测定血清中类胰蛋白酶活性,苏木素—伊红染色观察颈总动脉病理改变,甲苯胺蓝肥大细胞染色,免疫组织化学检测平滑肌肌动蛋白和巨噬细胞特异性抗原在斑块内的表达。结果Compound 48/80对血清脂质水平无明显影响。Compound 48/80明显刺激肥大细胞脱颗粒(80.6%±17.8%比13.5%±4.1%,P<0.01),升高血清中类胰蛋白酶活性(0.57±0.13 u/L比0.36±0.10 u/L,P<0.05)。套环能加速颈总动脉斑块形成(未套环侧颈总动脉斑块面积均为0,套环侧颈总动脉均有斑块形成),Compound 48/80增大套环侧颈总动脉斑块最大横截面积(58 500±7 500μm2比8 600±2 800μm2,P<0.01),并使管腔最大狭窄程度加重(81%±15%比41%±12%,P<0.05)。Compound 48/80使颈总动脉斑块内α平滑肌肌动蛋白表达量增加(1 219±364 iu比522±137 iu,P<0.05)和巨噬细胞特异性抗原表达量增加(426±133 iu比169±38 iu,P<0.05)。结论套环能加速载脂蛋白E基因敲除小鼠颈总动脉斑块形成。Compound 48/80使套环侧颈总动脉斑块最大横截面积和颈总动脉最大狭窄程度增加,其机制可能与其刺激肥大细胞脱颗粒促使平滑肌细胞增殖和巨噬细胞聚集有关。     

走罐联合消疕2号方治疗血瘀型斑块状银屑病临床疗效及对相关细胞因子的影响

目的 观察走罐疗法联合消疕2号方治疗血瘀证斑块状银屑病的有效性、安全性及对辅助性T细胞(Th17)细胞因子的影响.方法 60例斑块状银屑病(血瘀证)患者作为研究对象,随机分为治疗组30例和对照组30例.对照组内服消疕2号方治疗,治疗组在对照组的基础上加用走罐疗法.比较2组患者治疗前后银屑病皮损面积及严重程度指数(PAS...     

CT Findings in People Who Were Environmentally Exposed to Asbestos in Korea

Asbestos related pleuropulmonary disease has been emerging health problem for recent years. It can cause variable clinical symptoms and radiological abnormalities. However, there has been no report for their characteristics in subjects who were environmentally exposed to asbestos. We reviewed the CT images of 35 people who were environmentally exposed to asbestos in Chungnam province, Korea. The study result showed high incidence of pleural plaque and pulmonary fibrosis on chest CT (94% and 77%, respectively). The common CT findings of lung parenchymal lesions were as follows: centrilobular opacities (94%), subpleural dot-like or branching opacities (80%), interlobular septal thickening (57%), intralobular interstitial thickening (46%), parenchymal bands (43%) and subpleural curvilinear line (29%). There were no significant differences in the prevalence of pulmonary fibrosis and pleural plaques according to sex, age and duration of exposure. In conclusion, pleural plaque and pulmonary fibrosis are common asbestos-related CT finding in the exposed people. Asbestos related lung parenchymal CT findings in the participants with environmental exposure show similar to those observed in the occupational exposure.     

Gastrointestinal and Hepatic Manifestations of COVID-19: Evolving Recognition and Need for Increased Understanding in Vulnerable Populations

The novel coronavirus, SARS-CoV-2, has caused a global pandemic with high morbidity and mortality. It was first observed to cause a severe acute respiratory syndrome. However, gastrointestinal and hepatic manifestations have been increasingly recognized.Gastrointestinal symptoms include diarrhea, epigastric pain, nausea, and vomiting. Diarrhea is the most common GI manifestation of SARS-CoV-2 and can present without or without respiratory symptoms. Patients with GI symptoms have been associated with longer duration of illness and may be associated with more severe illness. Mechanism of diarrhea is thought to be related to direct viral cytotoxicity occurring when the SARS-CoV-3 enters GI cells via the ACE-2 receptor. Inflammatory response and cytokine release likely contributes to symptoms.SARS-CoV-2 can cause hepatic injury. Studies have shown mild to moderate elevation of liver enzymes. The pattern of liver abnormalities can be hepatocellular, cholestatic or mixed. Patients with severe infection have significantly higher rates of liver injury and worse outcomes. Proposed mechanisms for injury include immune mediated systemic inflammatory response, direct cytotoxicity from viral replication and hypoxia-reperfusion dysfunction.Recent data suggests that GI and hepatic injury may be under-recognized manifestation of SARS-CoV-2 infection. Patients with diarrhea and liver disease may have a worse prognosis. The rapidly evolving literature continues to reveal a growing body of information which enables updated guidance for management. More investigation is needed which focuses on vulnerable patients, including the elderly, those with underlying illness, as well as, racial and ethnic minorities.     

复发性和首发性脑梗死患者头颈部CT血管成像特点分析

目的 通过比较复发性脑梗死与首发性脑梗死患者CT血管成像（CTA）的特点,探讨复发性脑梗死患者可能的影响因素。方法 回顾分析140例复发性脑梗死患者和235例首发性脑梗死患者头颈部CTA检查结果,比较两组患者头颈部血管病变的特点。结果 复发性脑梗死患者头颈部动脉狭窄发生率明显高于首发性脑梗死患者（90.0%比64.7%;P＜0.01）,复发性脑梗死患者头颈部动脉中、重度狭窄发生率高于首发性脑梗死患者（分别为34.9%和45.2%比19.7%和15.8%;P＜0.01）,复发性脑梗死患者头颈部动脉斑块发生率明显高于首发性脑梗死患者（91.4%比66.4%;P＜0.01）,复发性脑梗死患者头颈部动脉软斑、溃疡斑发生率明显高于首发性脑梗死患者（分别为36.3%和48.0%比22.7%和37.3%;P＜0.05）。结论 复发性脑梗死与头颈部动脉狭窄及狭窄程度和不稳定性斑块有关,动脉狭窄的程度和斑块性质可能是引起复发性脑梗死的原因之一。