氯吡格雷防治动脉粥样硬化缺血性疾病的研究进展

氯吡格雷防治动脉粥样硬化斑块破裂后血栓形成尤其是冠状动脉疾病及其经皮冠脉介入性治疗有了充足的临床试验证据,对于粥样斑块的形成和发展的相关依据正在进行,现就氯吡格雷全面预防和治疗动脉粥样硬化缺血性疾病的研究进展作一综述。     

氯吡格雷对兔髂腹动脉球囊损伤后内膜增生的影响和机制研究

目的探讨抗血小板药氯吡格雷对兔髂腹动脉球囊损伤后内膜增生的影响和机制。方法37只新西兰兔随机分为正常对照组(7只)、模型组(10只)、氯吡格雷组(10只)和阿托伐他汀组(10只)。检测血脂和高敏C反应蛋白(hs-CRP)。观察动脉病理形态学改变,测量内膜、中膜厚度和面积,原位杂交检测血小板源性生长因子(PDGF)mRNA在髂动脉的表达,免疫组织化学染色测定凋亡蛋白bcl-2和bax的表达。结果与模型组比较,氯吡格雷组血清hs-CRP浓度、内膜/中膜厚度比、内膜/中膜面积比显著减少(P<0.05);髂动脉PDGFmRNA的表达明显降低(P<0.05),bcl-2表达下降不明显,bax表达明显升高,bcl-2/bax比值明显降低(P<0.05),氯吡格雷对血脂无明显影响。结论氯吡格雷减轻兔髂腹动脉球囊损伤后血管内膜增生,机制与降低动脉炎症反应,抑制PDGF表达和促进细胞凋亡有关。     

铊-201心肌显像诊断老年人代谢综合征并发冠心病的研究

目的 探讨单光子发射型计算机体层摄影术（铊201核素心肌显像）对老年人代谢综合征并发冠心病的临床诊断价值.方法 前瞻性地将102例疑诊冠心病的老年患者分为代谢综合征组52例和非代谢综合征（对照组）50例,分别进行负荷的铊-201核素心肌显像和冠状动脉造影检查,计算两组患者铊-201核素心肌显像诊断结果的敏感性和特异性.结果 老年代谢综合征患者组铊-201核素心肌显像诊断敏感性84%、特异性35%,对照组敏感性78%、特异性52%.两组敏感性差异无统计学意义,特异性差异有统计学意义（P＜0.05）.结论 老年代谢综合征并发冠心病患者的铊-201核素心肌显像特异性较低.     

N-乙酰半胱氨酸对老年冠心病患者造影剂肾病的保护作用

目的:探讨N-乙酰半胱氨酸对老年冠心病患者造影剂肾病是否具有保护作用.方法:将2007年3月～2008年5月行冠状动脉介入治疗的年龄≥65岁的冠心病患者120例随机分为观察组和对照组.两组在水化治疗基础上,分别于应用造影剂前、后24小时,每日2次口服N-乙酰半胱氨酸泡腾片1 200 mg或安慰剂.比较两组造影后48小时及5天时血尿素、肌酐、肌酐清除率和尿β2微球蛋白、尿N-乙酰β-氨基葡萄糖苷酶(NAG)、自由水清除率以及造影剂肾病发生率等.结果:应用造影剂后48小时及5天的观察结果显示,观察组肾小球功能指标(尿素、肌酐、肌酐清除率)和肾小管功能指标(尿β2微球蛋白、尿NAG、自由水清除率)均显著优于对照组.观察组发生造影剂肾病3例(5.0%),对照组发生7例(11.7%),两组比较差异有统计学意义(P＜0.05).结论:N-乙酰半胱氨酸对老年冠心病患者造影剂肾病具有一定的预防保护作用.     

The association of metabolic health obesity with incidence of carotid artery plaque in Chinese adults

Background and aimsWe aimed to evaluate the association between different obese phenotypes with carotid artery plaque (CAP) event.Method and resultsThe current retrospective cohort study was performed in 32,778 Chinese adults (19,221 men and 13,557 women, aged 41.9 ± 11.0 years). Obese phenotypes were assessed based on baseline body mass index (<24.0 vs. ≥24.0 kg/m²) and metabolic characteristics (health vs. unhealth). All the participants were further classified into four groups: metabolic health and normal weight (MHNW), metabolic unhealth and normal weight (MUHNW), metabolic health and overweight (MHO), and metabolic unhealth and overweight (MUHO). Ultrasound B-mode imaging was annually performed to evaluate CAP throughout the study. We have identified 2142 CAP cases during 5-year follow-up. Comparing with the MHNW group, the hazard ratios for the risk of incident CAP was 2.44 (95% CI:1.92 and 3.09) for the MUHNW group, 1.52 (95% CI:1.06 and 2.18) for the MHO group, and 1.8 (95% CI:1.4 and 2.33) for the MUHO group. The association was more pronounced in young adults (<65 y) than that in aged adults (≥65 y). Sensitivity analysis generated similar results with the main analysis.ConclusionMUHNW, MHO, and MUHO were associated with the risk of CAP.     

Adiponectin and vulnerable atherosclerotic plaques

High-risk plaques that are vulnerable to rupture demonstrate distinct morphological characteristics. They are differentiated from the lesions responsible for stable coronary artery disease by their large necrotic cores, thin-inflamed fibrous caps, and positive remodeling. Adiponectin is an adipocytokine that is reduced in obesity and type 2 diabetes. Hypoadiponectinemia has been associated with an increased risk of coronary artery disease and acute coronary syndrome in several though not all studies. The involvement of adiponectin provides clues to the inflammatory and atherogenic mechanisms associated with pathological coronary disease progression.     

Clinical significance of lipoprotein(a) in carotid plaque types and ischemic stroke in the elderly

Background:   The relationship between lipoprotein(a) (Lp(a)) and ischemic stroke is still controversial in the elderly. The purpose of the present paper was to evaluate the significance of Lp(a) in the development of extracranial carotid lesions and ischemic stroke.
Methods:   A total of 371 elderly subjects, studied with carotid ultrasonography (US) and brain computed tomography (CT), was stratified into two groups according to serum Lp(a) levels: the normal Lp(a) and high Lp(a) (>40 mg/dL) groups. Carotid plaques were divided into three types based on the US echogenicity: hypoechoic, hyperechoic, and heterogeneous plaques. Low-density areas (LDA) on brain CT images were classified into three groups depending on their distribution: basal ganglionic, cortical and only leuko-araiosis types.
Results:   The incidence of bilateral carotid lesions and the ratios of hypoechoic and heterogeneous plaques were significantly higher in the high Lp(a) group than in the normal Lp(a) group. Both the mean height and length of plaque were also greater in the high Lp(a) group. Mean Lp(a) levels were significantly elevated in cases with hypoechoic and heterogeneous types, compared to the cases without lesions. Higher mean Lp(a) levels were seen in cases with any kind of LDA than in normal subjects on CT, but there was no significant difference in the incidence of each LDA between the two groups.
Conclusions   These findings indicate that serum Lp(a) is strongly related to carotid lesions, especially hypoechoic and heterogeneous plaque types, in Japanese elderly patients. This suggests that Lp(a) could promote the formation of lipid-rich atheromatous plaque with intraplaque hemorrhage or superimposed thrombi. Serum Lp(a) also seemed to be a risk for all types of LDA.     

速度向量成像技术评价颈总动脉粥样硬化斑块力学状态的研究

目的 应用速度向量成像(VVI) 技术评价颈总动脉壁粥样硬化斑块运动特性及斑块力学的临床价值.方法 对36例动脉粥样硬化斑块患者和对照组30例正常人双侧颈总动脉进行超声检查;并检测出颈总动脉内中膜厚度(IMT),结合同步心电图描记,取颈总动脉长轴、短轴二维图像进行动态存储,运用VVI软件进行脱机分析,计算颈动脉壁粥样斑块部位的运动速度、应变和应变率,并与正常组动脉壁运动参数进行比较.结果颈总动脉粥样斑块处运动速度、应变及应变率低于无斑块处;斑块基底部速度、应变及应变率低于斑块表面;斑块组颈动脉IMT及运动速度均高于正常对照组(P<0.5),软斑块收缩期最大运动速度、最大应变率分别高于硬斑块组,肩部运动速度、应变率高于帽顶部(P<0.5).结论 VVI 技术可用于颈总动脉管壁斑块运动速度、应变及应变率的分析,为研究颈总动脉斑块形成机理和稳定性,提供新的方法.     

血管回声跟踪技术诊断2型糖尿病患者动脉早期硬化

目的 探讨血管回声跟踪(echo-tracking,ET)技术对2型糖尿病患者早期动脉硬化的应用价值.方法 在ET模式下,采集30例正常人和54例2型糖尿病患者的股动脉的二维超声图像,测量双侧股动脉内-中膜厚度(IMT).应用ET技术检测弹性指标β、Eρ、AC、AI及PWVβ.按照股动脉IMT是否＜1.0 mm将糖尿病患者分为A(IMT＜1.0 mm) 组和B(IMT≥1.0 mm) 组.结果 A组及B组股动脉弹性指标β、Eρ、PWVβ均较对照组显著增高(P<0.05),AC值显著降低(P<0.05).B组股动脉弹性指标β、Eρ、PWVβ较A组也显著增高,统计学有显著性差异(P<0.05).结论 糖尿病患者存在动脉硬化的病理改变,而且在形态学变化之前就有动脉弹性的减低.ET技术可以在动脉粥样硬化的形态学改变出现之前早期发现动脉硬化.     

Prognostic Implications of Plaque Characteristics and Stenosis Severity in Patients With Coronary Artery Disease

BackgroundAlthough the presence of ischemia is a key prognostic factor in patients with coronary artery disease, the presence of high-risk plaque characteristics (HRPC) is also associated with increased risk of cardiovascular events. Limited data exist regarding the prognostic implications of combined information on physiological stenosis severity assessed by fractional flow reserve (FFR) and plaque vulnerability by coronary computed tomography angiography (CTA)–defined HRPC.ObjectivesThe current study aimed to evaluate the: 1) association between physiological stenosis severity and coronary CTA-defined HRPC; and 2) prognostic implications of coronary CTA-defined HRPC according to physiological stenosis severity in patients with coronary artery disease.MethodsA total of 772 vessels (299 patients) evaluated by both coronary CTA and FFR were analyzed. The presence and number of HRPC (minimum lumen area <4 mm², plaque burden ≥70%, low attenuating plaque, positive remodeling, napkin-ring sign, or spotty calcification) were assessed using coronary CTA images. The risk of vessel-oriented composite outcome (VOCO) (a composite of vessel-related ischemia-driven revascularization, vessel-related myocardial infarction, or cardiac death) at 5 years was compared according to the number of HRPC and FFR categories.ResultsThe proportion of lesions with ≥3 HRPC was significantly decreased according to the increase in FFR values (58.6%, 46.5%, 36.8%, 15.7%, and 3.5% for FFR ≤0.60, 0.61 to ≤0.70, 0.71 to ≤0.80, 0.81 to ≤0.90, and >0.90, respectively; overall p value <0.001). Both FFR and number of HRPC showed significant association with the estimated risk of VOCO (p = 0.008 and p = 0.023, respectively). In the FFR >0.80 group, lesions with ≥3 HRPC showed significantly higher risk of VOCO than those with <3 HRPC (15.0% vs. 4.3%; hazard ratio: 3.964; 95% confidence interval: 1.451 to 10.828; p = 0.007). However, there was no significant difference in the risk of VOCO according to HRPC in the FFR ≤0.80 group. By multivariable analysis, the presence of ≥3 HRPC was independently associated with the risk of VOCO in the FFR >0.80 group.ConclusionsPhysiological stenosis severity and the number of HRPC were closely related, and both components had significant association with the risk of clinical events. However, the prognostic implication of HRPC was different according to FFR. Integration of both physiological stenosis severity and plaque vulnerability would provide better prognostic stratification of patients than either individual component alone, especially in patients with FFR >0.80. (Clinical Implication of 3-vessel Fractional Flow Reserve [3V FFR-FRIENDS study]; NCT01621438)