应用64排螺旋CTA超早期诊断基底动脉尖综合征的临床研究

目的 观察64排螺旋全身血管成像检查(CTA)超早期诊断基底动脉尖综合征的临床价值。方法 选取2017年1月～2019年1月到我院接受治疗的80例基底动脉尖综合征患者,随机分为检查组和对照组,每组40例,两组病例入院后均立即行64排螺旋头颅CT检查,检查组同时进行CTA检查,分析CTA诊断结果,结合检查结果给予对应治疗,对比两组患者治疗前后NIHSS评分及ADL评分,随访患者病死率。结果 CTA诊断结果显示,40例基底动脉尖综合征中基底动脉狭窄占比最高,为62.5%(25/40),其次为基底动脉瘤,占15.0%(6/40);两组间神经功能缺损程度评分(NIHSS)、日常生活活动评分(ADL)对比,治疗前无差异,治疗后检查组明显改善,差异有统计学意义(P0.05);检查组死亡率为5.0%低于对照组的12.5%,差异有统计学意义(P0.05)。结论 64排螺旋CTA能够检出早期基底动脉尖综合征,为早期发现病灶并及时治疗提供参考,有利于提升患者预后,具有较高诊断价值。     

Left Main Coronary Atresia in a Child with Absent Pulmonary Valve Syndrome: Early Entrapment of an Innocent Bystander

Atresia of the left main coronary artery is a rare anomaly that, if left untreated, has an unfavorable outcome. We hereby report left main coronary artery atresia in a child with tetralogy of Fallot with absent pulmonary valve and discuss the possible developmental basis of the association.     

Percutaneous Closure of Atrial Septal Defects in Patients with an Aberrant Retroaortic Coronary Artery: Is It Safe?

Coexistence of an ostium secundum type atrial septal defect and a coronary artery anomaly with an aberrant retroaortic course is a rare congenital anomaly that may potentially complicate percutaneous atrial septal defects (ASD) closure. If the anterosuperior rim of the defect is deficient, the abnormally located coronary artery may be compressed or distorted by the implanted device causing myocardial ischemia, arrhythmias, and eventually sudden cardiac death. Due to the potential occurrence of these fatal cardiac events, diagnosis of an aberrant coronary artery with a retroaortic course must be established before percutaneous ASD closure. In this report, two patients with this rare association are described in whom percutaneous closure of the defect was feasible and uneventful. The importance of a careful periprocedural, noninvasive echocardiographic coronary artery imaging is emphasized, and the rational for percutaneous atrial septal defect closure in this unusual anatomic arrangement is proposed.     

对比增强超声在颈动脉斑块内血管新生评价中的应用

近年来,有关颈动脉粥样硬化的研究已转向易损斑块内新生血管方面,对比增强超声评估斑块内新生血管已成为判断斑块稳定性的新技术之一.文章就对比增强超声的原理及其在颈动脉粥样硬化新生血管形成和易损斑块评估方面的应用进行了综述.     

Simvastatin attenuates the endothelial pro-thrombotic shift in saphenous vein grafts induced by Advanced glycation endproducts

Background

Advanced glycation endproducts (AGEs) and its receptors (RAGEs) are heterogeneous signaling proteins associated to diabetes and responsible of endothelial alterations leading to atherosclerosis progression and graft failure. The aim of this study was to investigate the role of statin in reducing AGEs related endothelial damage.

Methods

Endothelial cell(EC) obtained from leftovers of saphenous vein grafts of non-diabetic patients were incubated with AGEs (2 and 20 μM) and subsequently treated with Simvastatin. Neutrophils (PNM) adherence, ROS production and RAGE and peroxisome proliferator-activated receptors-gamma (PPAR-γ) expression were analyzed. As clinical validation of the in vitro findings, ECs of diabetic patients in optimized glycaemic control administered with a 3 weeks Simvastatin regimen were similarly processed.

Results

Simvastatin blunted the rise in PMN adhesion and ROS generation following stimulation of saphenous vein EC culture with AGEs in vitro. This effect was time dependent and was associated to an increase in PPAR-γ induction paralleled by a decrease in RAGEs expression. Parallely, data from diabetic patients administered with Simvastatin showed a similar significant reduction in PNM adhesion and ROS generation. Simvastatin treatment significantly decreased RAGEs expression in ECs from diabetic patients and determined a slight increase in PPAR-γ expression but the latter failed to reach statistical significance. Interference in the function of these two crucial pathways might be at the root of the statin antinflammatory and antithrombotic effect in the context of AGEs-associated damage.

Conclusions

Despite the recently raised warning on the use of statins in the diabetic population, this study elucidates their cornerstone position in endothelial homeostasis of saphenous grafts in patients with controlled diabetes.     

Ankle-brachial index as a predictor of coronary disease events in elderly patients submitted to coronary angiography

OBJECTIVES:

To correlate the importance of the ankle-brachial index in terms of cardiovascular morbimortality and the extent of coronary arterial disease amongst elderly patients without clinical manifestations of lower limb peripheral arterial disease.

METHODS:

We analyzed prospective data from 100 patients over 65 years of age with coronary arterial disease, as confirmed by coronary angiography, and with over 70% stenosis of at least one sub-epicardial coronary artery. We measured the ankle-brachial index immediately after coronary angiography, and a value of <0.9 was used to diagnose peripheral arterial disease.

RESULTS:

The patients'' average age was 77.4 years. The most prevalent risk factor was hypertension (96%), and the median late follow-up appointment was 28.9 months. The ankle-brachial index was <0.9 in 47% of the patients, and a low index was more prevalent in patients with multiarterial coronary disease compared to patients with uniarterial disease in the same group. Using a bivariate analysis, only an ankle-brachial index of <0.9 was a strong predictive factor for cardiovascular events, thereby increasing all-cause deaths and fatal and non-fatal acute myocardial infarctions two- to three-fold.

CONCLUSION:

In elderly patients with documented coronary disease, a low ankle-brachial index (<0.9) was associated with the severity and extent of coronary arterial disease, and in late follow-up appointments, a low index was correlated with an increase in the occurrence of major cardiovascular events.     

128层螺旋CT联合心电门控技术在支气管动脉成像中的应用

目的：探讨128层螺旋CT联合心电门控扫描技术在支气管动脉成像中的临床应用价值。方法：回顾性分析我院124例次胸部CT血管成像（CTA）数据,其中72例次行常规胸部CTA扫描数据列入对照组,52例次采用心电门控技术扫描数据列入观察组,对比分析观察两组支气管动脉的开口位置、走行、与相邻组织之间的解剖关系以及支气管动脉显示的清晰度。结果：对照组中33．33％（24／72）支气管动脉显示较清晰,58．33％（42／72）支气管动脉显示模糊,8．33％（6／72）没有发现支气管动脉;观察组52例次支气管动脉全部显示,其中86．54％（45／52）支气管动脉显示清晰,13．46％（7／52）支气管动脉显示模糊。结论：128层螺旋CT联合心电门控扫描技术与常规胸部血管成像相比,能更清晰地显示支气管动脉开口位置、形态、走行及其与相邻组织的关系,对支气管动脉源性疾病的治疗,特别是介入治疗术前评估有重要的临床应用价值。     

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。     

内皮型一氧化氮合酶和N5，N10-亚甲基四氢叶酸还原酶基因多态性与苏皖地区汉族人群早发冠心病易感性的相关关系

目的 探讨内皮型一氧化氮合酶(eNOS)基因第7外显子G894T突变和N5,N10-亚甲基四氢叶酸还原酶(MTHFR)基因C677T突变与苏皖地区汉族人群早发冠心病(PCAD)发病的关系.方法 采用病例对照研究的方法,应用聚合酶链反应-限制性片长多态性(PCR-RFLP)技术,分别检测131例PCAD患者(PCAD组)和131例年龄、性别相匹配的无冠心病者(对照组)的eNOS和MTHFR基因的单核苷酸多态性,判定其基因型并统计各基因型及等位基因的频率.结果 eNOS基因G894T多态性在PCAD组和对照组中的基因型分布(x2=2.072,P=0.355)和T等位基因频率(x2=0.727,P=0.394)差异均无统计学意义.MTHFR基因C677T基因型在PCAD组CT和TT型分布均高于对照组(x2 =14.290,P=0.001),T等位基因频率亦高于对照组(x2=16.339,P =0.000),差异有显著性(P＜0.05).Logistic回归分析显示,携带MTHFR基因C677TTT基因型是PCAD发病的独立危险因素.结论 eNOS基因G894T多态性可能与苏皖地区汉族人群PCAD发病无关;MTHFR基因677C/T多态性的TT基因型可能增加苏皖地区汉族人群PCAD的患病风险,T等位基因可能是PCAD的遗传易感基因.     

达肝素对载脂蛋白E基因缺陷小鼠肾动脉粥样硬化病变的影响

目的在动脉粥样硬化模型鼠中,观察达肝素对肾动脉粥样硬化病变进展及对植物血凝素样氧化型低密度脂蛋白受体1(LOX-1)和血管内皮生长因子(VEGF)的表达影响,探讨达肝素可能的抗动脉粥样硬化机制。方法以6周龄雄性C57BL/6J小鼠24只为对照,随机分为普通饲料组及高脂饲料组。雄性6周龄载脂蛋白E基因缺陷(Apo E-/-)小鼠36只,均予高脂饲料喂养至12周龄,随机分为模型组、低剂量肝素组[达肝素钠100 IU/(kg.d)]、高剂量肝素组[达肝素钠200 IU/(kg.d)],皮下注射连续4周(16周龄)后各组随机取6只处死。分离肾动脉,制成石蜡切片行HE及免疫组织化学染色,观察斑块情况及LOX-1蛋白的表达。用RT-PCR方法,检测肾动脉LOX-1 mRNA及VEGF mRNA的表达。用Western Blot分析法,检测肾动脉中LOX-1蛋白的表达。剩余小鼠继续原方案喂养4周(20周龄)后处死,肾动脉石蜡切片行HE染色,观察斑块情况。结果 Apo E-/-模型组在16周龄时出现轻度肾动脉粥样硬化。低剂量及高剂量达肝素均抑制肾动脉粥样硬化的形成(P<0.05)。Apo E-/-模型组LOX-1 mRNA、VEGF mRNA及LOX-1蛋白的表达水平较C57BL/6J普通饲料组的表达水平明显升高(P<0.05)。低剂量及高剂量达肝素治疗后,LOX-1 mRNA、VEGF mRNA及LOX-1蛋白的表达水平表达较模型组明显下降(P<0.05)。结论达肝素钠可能通过抑制LOX-1蛋白及VEGF表达的途径,抑制肾动脉粥样硬化的进展。