血清脂蛋白(a)、胆红素水平与冠状动脉病变程度关系研究

目的 检测冠心病(CHD)患者的血清脂蛋白(a)和胆红素水平,并探讨其与CHD的关系.方法 对196例疑诊冠心病而接受冠状动脉造影的患者检测血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白(a)[Lp(a)]、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL).根据冠状动脉狭窄情况分为非冠心病组(冠状动脉狭窄小于50%,52例)、单支病变组(仅有一支冠状动脉分支狭窄大于或等于50%,53例)和多支病变组(有一支以上冠状动脉分支狭窄大于或等于50%,91例).分析影响冠状动脉病变的相关因素及冠状动脉病变程度与血脂、胆红素的关系.结果 各组间LDL-C、Lp(a)水平依次呈递增趋势,差异有统计学意义(P＜0.05)各组间间接胆红素水平呈依次递减趋势,多支病变组与非冠心病组、单支病变组差异有统计学意义(P＜0.05).单因素logistic回归结果表明血清脂蛋白(a)、间接胆红素均为影响冠状动脉病变的因素(回归系数分别2.125、-1.557,P＜0.01).进一步多因素logistic回归分析表明脂蛋白(a)对冠状动脉病变的影响要弱于低密度脂蛋白胆固醇、甘油三酯(0R值分别为1.238、5.031、3.996,95%CI分别为1.069-6.322、2.457-12.356、2.785-14.764).结论 血清Lp(a)水平升高、IBIL水平降低是CHD发病及病变程度的危险因素. Abstract： Objective To investigate the association of Lipoprotein (a) and bilirubin with coronary heart disease(CHD). Methods One hundred and ninty -six patients undergone coronary angiography and completed clinical examination of TC, TG, HDL - C, LDL - C, Lp ( a), TBIL, DBIL, IBIL were divided into the without coronary diseases group ( coronary artery stenosis ＜50% ,52 cases) ,the single vessel disease group(with only one vessel stenosis ≥50% ,53 cases) and the multi -vessel disease group (with more than one vessel stenosis ≥50% ,91 cases)according to the coronary angiographic results. The correlative factors of coronary lesion and the relationship between Lipid,bilirubin and the severity of coronary lesion were analyzed. Results Higher levels of LDL - C and Lp(a) were found in the single vessel disease group and in the multi -vessel disease group compared with the without coronary disease group, significant difference was found in the LDL- C and Lp(a) level among the 3 groups(P＜0.05). The levels of IBIL were lower in the single vessel disease group and in the multi -vessel disease group compared with the without coronary disease group,significant difference was found in indirect bilirubin level in the multi -vessel disease group compared with in the without coronary disease group and in the single vessel disease group(P＜0.05). Single factor logistic regression showed that Lp (a) and indirect bilirubin are both correlation factors with coronary lession (r =2. 125 and - 1. 557, P ＜0.01 respectively). Advanced multi - factor logistic regression showed weaker correlation of Lp (a) with coronary lesion compared with LDL - C and TG (OR = 1. 238,5.031 and 3.996,95% CI1.069 - 6.322,2.457 - 12.356,2.785 - 14.764 respectively). Conclusions High level of Lp(a) and Low level of IBIL in human significantly influence the severity of coronary heart disease(CHD).     

探讨血清视黄醇结合蛋白4与冠心病的相关性

目的 观察冠心病患者血清视黄醇结合蛋白4(RBP4)水平,并探讨RBP4与冠心病的关系.方法 64例冠心病患者分为急性心肌梗死(AMI)组10例,不稳定型心绞痛(UAP)组42例,稳定型心绞痛(SAP)组12例,另选择21例冠状动脉造影结果正常者为对照组.采用酶联免疫吸附法(ELISA)测定血清RBP4水平.结果 血清RBP4在AMI和UAP组中高于SAP组和对照组,差异有统计学意义(P＜0.05),在SAP组与对照组之间差异无统计学意义(P＞0.05);血清RBP4在单支、双支、三支病变组中均高于对照组(P＜0.05),但在单支、双支与三支病变组之间差异均无统计学意义(P＞0.05).结论 RBP4可作为预测斑块稳定性的标志物,为冠心病危险分层及采取积极干预措施提供依据,但不能反映冠状动脉狭窄程度及范围. Abstract： Objective To investigate the serum retinol - binding protein 4 ( RBP 4 ) of coronary heart disease (CHD)patients and evaluate whether plasma macrophage migration inhibitory factor were associated with CHD. Methods Sixty -four patients with CHD were divided into the acute myocardial infarction (AMI) group ( n = 10), the unstable angina pectoris (UAP) group ( n = 42) and the stable angina pectoris(SAP) ( n = 12),21 normal subjests without CHD diagnosed by CAG served as the control group. The serum level of RBP4 measured by enzyme linked immune sorbent assay (ELISA). Results The serum level of RBP4 were higher in AMI and UAP group thai in SAP group and control group ( P ＜ 0. 05 ). The mean level of RBP4 in SAP group was not differently significantly, compared with that in control ( P ＞ 0. 05 ) ;The mean level of in single, double and three vessel lesion group were higher than that in control group (P ＜0. 05 ),but the serum levels of RBP4 among single, double and three were not significant different ( P ＞ 0. 05).Conclusions RBP4 may act as one of vulnerable plaques,we can take active to stabilize vulnerable plaques and decrease the occurrence of cardiac events,but may not reflect the severity of artery stenosis.     

螺内酯对心肌梗死大鼠血流动力学及血清TGF-β1的影响

目的 研究螺内酯对大鼠心肌梗死后血清转化生长因子-β1(TGF-β1)的影响.方法 结扎SD大鼠冠状动脉前降支,建立心肌梗死模型,将术后存活24 h大鼠随机分为两组:螺内酯(MIS)组给予螺内酯20 mg/(kg·d)溶于2 ml生理盐水灌胃,连续4周;心肌梗死(MI)对照组给予等体积的生理盐水,穿针但不结扎前降支的作为假手术组,给予等体积的生理盐水,4周末行血流动力学测定,同时断尾取血测血清TGF-β1含量.结果 与假手术组相比,4周末AMI组血清TGF-β1含量显著升高(P＜0.01),左室舒张末压(LVEDP)显著增加(P＜0.01),左室内压最大收缩速率(+dp/dtmax)显著下降(P＜0.01).与AMI组相比,4周末螺内酯组血清TGF-β1含量显著下降(P＜0.01),LVEDP显著下降(P＜0.01),而+dp/dtmax显著增加(P＜0.01).结论 螺内酯可能通过抑制TGF-β1产生而改善心功能,抑制心肌纤维化. Abstract： Objective To observe the effects of aldactone on blood serum TGF - β1 in acute myocardial infarction rats. Methods Rats surviving 24 h after AMI induced by left anterior descending branch ligation were randomized to aldactone and control group compared with sham - operated group. The aldactone group was given aldactone 20 mg/( kg · d) , the MI control group and sham -operated group were given an equal volume of saline, continued for 4 weeks. At the end of 4th week,the hemodynamics change was detected, then tails to take blood and measure the serum TGF - β1.Results Compared with the sham - operated rats,the serum TGF - β1 level and the LVEDP of the AMI rats were significantly elevated at the end of the 4th week ( P ＜0.01 ) , while the + dp/dtmax were significantly reduced ( P ＜0.01 ) compared with the AMI control group, the serum TGF - β1 level and the LVEDP of the aldactone group rats decrease significantly at the end of the 4th week (P ＜ 0.01 ) ,while the + dp/dtmax were significantly elevated ( P ＜ 0.01 ). The difference had statistical significance. Conclusions Aldactone may improve the cardiac fibrosis and inhibit myocardial fibrosis by inhibiting the production of the TGF - β1.     

肾阻力指数指导下的水化治疗预防造影剂肾病的临床研究

目的:探讨冠心病合并慢性肾功能不全患者水化治疗的方案。方法:选择冠心病合并慢性肾功能不全拟行冠状动脉造影术的患者286例,随机分为标准水化组(143例,50%)和肾阻力指数指导下的水化组(143例,50%),观察围手术期心肾功能的主要指标变化及3个月主要不良事件发生率。结果:肾阻力指数指导下水化治疗组水化液体量高于对照组(P0.05),造影剂肾病、血液透析、全因死亡的发生率低于对照组(P0.05)。结论:肾阻力指数指导下的水化治疗能够有效减少冠心病合并慢性肾功能不全患者造影剂肾病的发生。     

白细胞介素37过表达促进急性心肌梗死患者外周血内皮祖细胞的增殖和迁移北大核心CSCD

目的:探究白细胞介素(IL)-37对急性心肌梗死患者外周血内皮祖细胞(EPCs)增殖和迁移的影响和机制。方法:从6例急性心肌梗死患者和6例年龄性别差异无统计学意义的同期进行体检的健康志愿者外周血中分离并培养EPCs。检测IL-37 mRNA和蛋白表达水平。将急性心肌梗死患者EPCs随机分成3组:对照组、pcDNA3.1组和IL-37组。其中对照组不进行任何处理,pcDNA3.1组和IL-37组分别使用Lipofectamine3000试剂转染pcDNA3.1质粒和pcDNA3.1-IL-37质粒。CCK-8检测细胞活力,Transwell检测迁移细胞数目,qRT-PCR检测IL-37和基质金属蛋白酶(MMP)9 mRNA表达水平,Western blot检测IL-37、增殖细胞核抗原(PCNA)、MMP9、磷酸化-Akt(p-Akt)、Akt、p-mTOR、mTOR、p-p70S6K、p70S6K、p-ERK1/2和ERK1/2蛋白水平表达。结果:与健康志愿者相比,IL-37在急性心肌梗死患者外周血EPCs中表达上调(P<0.01)。与对照组相比,IL-37组中细胞活力、迁移细胞数目和IL-37、PCNA、MMP9表达以及p-Akt/Akt、p-mTOR/mTOR、p-p70S6K/p70S6K均增加,差异具有统计学意义(P<0.05);但pcDNA3.1组中以上指标差异均无统计学意义(P>0.05)。与对照组相比,p-ERK1/2/ERK1/2在IL-37组和pcDNA3.1组中差异均无统计学意义(P>0.05)。结论:IL-37过表达促进急性心肌梗死患者外周血EPCs的增殖和迁移,其可能通过激活Akt/mTOR通路发挥作用,与ERK1/2通路无关。     

冠心病患者替格瑞洛相关呼吸困难预测因素的分析

目的:探讨冠心病(CHD)经皮冠状动脉介入治疗(PCI)患者在服用替格瑞洛期间发生呼吸困难的预测因素。方法:选择293例行PCI服用替格瑞洛的CHD患者,58例(19.8%)发生替格瑞洛相关呼吸困难(A组),235例(80.2%)未发生替格瑞洛相关呼吸困难(B组);2组在年龄、性别、吸烟、贫血方面,差异有统计学意义(P0.05);与未发生出血事件的患者相比,发生出血事件的患者呼吸困难的发生率明显升高(35.3%∶16.5%,单因素分析OR=1.973,P=0.035)。多因素logistic回归分析显示年龄、吸烟、贫血、出血事件与呼吸困难发生呈正相关。结果:结论:PCI治疗的CHD患者应用替格瑞洛出现替格瑞洛相关呼吸困难的风险较高,年龄、吸烟、贫血、出血事件为发生呼吸困难的预测因素。     

原发性高血压患者胰岛素抵抗与血管紧张素Ⅱ的相关性

目的 探讨原发性高血压(EH)患者胰岛素抵抗与血管紧张素Ⅱ(AngⅡ)、左室重构的相关性.方法 收集120例EH患者,根据HOMA-IR公式计算的胰岛素抵抗指数将其分为两组:胰岛素抵抗组(IR)、非胰岛素抵抗组(N-IR),测量并比较两组间电解质、血脂、血肌酐清除率、AngⅡ、左室射血分数、左室质量指数(LVMI)水平.结果 LVMI、AngⅡ水平IR组均明显高于N-IR组(P＜0.05).结论 EH患者胰岛素抵抗与血AngⅡ水平有关,并可能与左室重构有关. Abstract： Objective To investigate the relationship between insulin resistance and angiotensin Ⅱ , the left ventricular remodeling in patients with essential hypertension(EH). Methods According to the insulin resistance index, 120 cases of EH were divided into two groups: insulin resistance group (IR), non- insulin resistant group (N-IR). And the electrolyte, blood lipids, creatinine clearance rate, Ang Ⅱ , left ventricular ejection fraction and left ventricular mass index (LVMI) were measured and the results were compared between the two groups. Results LVMI and Ang Ⅱ levels of IR group were significantly higher than those of N - IR group ( P ＜ 0.05). Conclusions Insulin resistance is related with the levels of Ang Ⅱ , and may be related with left ventricular remodeling.     

参麦注射液联合美托洛尔治疗心力衰竭临床研究

目的：观察参麦注射液联合美托洛尔治疗心力衰竭的临床疗效。方法：选择80例心力衰竭患者为研究对象，按随机数字表法分为2组各40例。研究组采用参麦注射液联合美托洛尔治疗，对照组仅使用美托洛尔治疗，连续治疗14 d。治疗后比较2组临床疗效，并比较2组治疗前后心功能指标及血清高迁移率族蛋白B1 (HMGB1)、晚期糖基化终产物受体（RAGE）、N端脑钠肽前体（NT-proBNP）表达水平。门诊及电话随访12个月，比较2组心血管事件发生情况。结果：研究组治疗总有效率95.00%，高于对照组72.50%(P<0.05)。治疗前，2组左心室舒张末期内径（LVEDD）、左心室收缩期末期内径（LVESD）、左心室射血分数（LVEF）比较，差异无统计学意义（P>0.05）；治疗后，2组LVEDD、LVESD降低（P<0.05）,LVEF升高（P<0.05），且研究组LVEDD、LVESD低于对照组（P<0.05）,LVEF高于对照组（P<0.05）。治疗前，2组血清HMGB1、RAGE、NT-proBNP水平比较，差异无统计学意义（P>0.05）；治疗后，2组血清...