640CT冠状动脉成像在基础心率高及快速心律失常中的应用价值研究

目的:640CT在无心率(律)控制下对基础心率(HR)高及快速性心律失常(心房纤颤、频发早搏)患者行冠脉CTA的图像质量分析,并与冠脉造影诊断符合率的研究,进一步扩大冠脉CTA的适应症。方法:前瞻性入选2011年8月30日至2014年1月30日期间,不控制心率行冠脉CTA的212例患者,将患者按心室率分成3组(≤65次/min,65⁸0次/min,≥80次/min);比较3组患者图像质量;同时对212例患者行冠脉造影,对比3组患者冠脉CTA与冠脉造影的诊断符合率;并评价快速性心律失常(心室率快的房颤、频发早搏)患者图像质量与冠脉造影诊断符合率。结果:3组患者共212例,3组图像质量未见明显统计学意义;212例患者冠脉CTA与冠脉造影检查对比,敏感度、特异度、阳性预测值、阴性预测值、诊断符合率无明显统计学意义;其中心率在≥80次/min以上的基础心率高及心律失常(心房纤颤、频发早搏)组中,灵敏度96%,特异度99%,阳性预测值98%,阴性预测值99%,诊断符合率99%;快速性心律失常(心房纤颤、频发早搏)亚组中,图像质量与前3组未见明显统计学意义,敏感度96%,特异度99%,阳性预测值96%,阴性预测值99%,诊断符合率99%。结论:640CT成为冠心病中危以上人群的一种更为精准的初筛手段;尤其成为基础心率高(≥80次/min)及快速性心律失常(心房纤颤、频发早搏)患者一种无创、经济、可靠、准确的冠心病诊断方法。     

辛伐他汀联合依折麦布对男性冠心病患者睾酮水平

目的：评估辛伐他汀联合依折麦布对男性冠心病患者睾酮水平的影响,同时观察二者联用对患者糖代谢的影响。方法：选取本院2013年6月至2014年6月门诊及住院患者90例查取随机数字表法随机分为2组,试验组予辛伐他汀40 mg/d联合依折麦布10 mg/d治疗,对照组单用辛伐他汀40 mg/d治疗,疗程12周。观察2组患者治疗前后睾酮（testosterone,T）、空腹血糖（fasting blood glucose,FBG）、糖化血红蛋白（glycosylated hemoglobin A1c,HbA1c）的变化及药物不良反应。结果：2组各指标在基线时无统计学差异（P ＞0.05）。经过12周的治疗,2组总胆固醇（total cholesterol,TC）和低密度脂蛋白（low-density lipopro－tein-cholesterol,LDL-C）水平较基线均有明显下降（P＜0.05）,其中治疗组较对照组下降更为明显（P＜0.05）。试验组的睾酮水平有轻微下降（P=0.085）,而对照组未见明显变化,2组之间比较无差异。2组患者的FBG及HbA1c较治疗前无明显改变。不良反应方面,2组之间没有明显差别（P ＞0.05）,不良反应大都发生在治疗初期且较轻微,无需停药都能缓解。结论：辛伐他汀40 mg/d联合依折麦布10 mg/d能够更好的降低冠心病男性患者的LDL-C水平,且对患者的睾酮水平无明显影响,短期内未见二者联用对患者糖代谢有不良影响。     

Relationship between hemoglobin Alc and contrast-induced acute renal injury in patients with type 2 diabetes mellitus undergoing cardiac catheterization

Background There were few studies to explore the relationship between hemoglobin A1c (HbA1c)and contrast-induced acute renal injury (CI-AKI)in patients with type 2 diabetes mellitus (T2DM). Methods Two hundred seventy-nine patients with T2DM undergonging elective cardiac catheterization from Dongguan Kanghua Hospital were recruited. Patients were classified into quartiles based on HbA1c ( < 6.30%, 6.30- 6.70%, 6.71-7.70, and > 7.70%). Baseline data, CI-AKI incidence and in-hospital outcomes were compared between the groups. Logistic regression was used to assess the relationship between HbA1c and CI-AKI. Results CI-AKI occurred in 26 (9.3%)patients. CI-AKI incidences of HbA1c quartiles were 4.6 % (3 / 65), 2.8%(2 / 71), 12.3%(9 / 73) and 17.1%(12 / 70) (P = 0.003), respectively. There were no significant differences in in-hospital death or required renal replacement therapy among the four groups. Univariate logistic analysis showed that HbA1c was related with CI-AKI (OR = 1.319, 95%CI:1.078-1.615, P = 0.007). Multivariate analysis found that after adjusting eGFR < 60 ml / min / 1.73 m 2 , age > 70 years and anemia, HbA1c ≥7% was still a significant independent risk factor for CI-AKI in patients with T2DM. Conclusions HbA1c is significantly associated with CI-AKI. HbA1c ≥7% may increase the risk of CI-AKI in patients with T2DM undergoing elective cardiac catheterization.     

急性冠状动脉综合征患者血清C反应蛋白、脑钠尿肽、D-二聚体的水平变化及其临床意义

目的探讨血清C反应蛋白（C-reactive protein,CRP）、脑钠尿肽（brain natrium peptide,BNP）和D-二聚体在急性冠状动脉综合征（acute coronary syndrome,ACS）患者中的水平变化及其在ACS发生、发展中的意义。方法选取我院诊断为ACS的患者102例,其中急性心肌梗死（acute myocardial infarction,AMI）患者40例,不稳定型心绞痛患者（unstable angina pectoris,UAP）62例。选取同期住院的稳定型心绞痛（stable angina pectoris,SAP）患者50例,并选取同期健康体检者50例作为对照组。采用免疫透射比浊法测定CRP含量,采用ELISA方法检测BNP含量和D-二聚体含量。并对结果数据进行统计学分析。结果与对照组及SAP组比较,ACS患者CRP、BNP、D-二聚体水平明显升高（P〈0.01）;其中AMI患者上述指标水平明显高于UAP患者（P〈0.01或P〈0.05）。结论 ACS患者血清CRP、BNP、D-二聚体水平明显升高,检测血清CRP、BNP、D-二聚体水平对ACS的辅助诊断、疗效观察及预后判断具有重要价值。     

主动脉弓曲率对主动脉夹层手术方式的影响

目的探讨主动脉弓曲率对主动脉夹层术式的影响。方法对东莞康华医院2009年1月至2018年3月施行的主动脉夹层腔内隔绝术32例患者的资料进行回顾性分析。覆膜支架释放成功后进行主动脉数字减影血管造影(DSA),术后行螺旋三维计算机断层扫描(CT),分别评估有无内漏及内漏的大小,决定内漏的处理。术后随访3～36个月。分析不同主动脉弓曲率对术式的影响。结果主动脉弓曲率大组与主动脉弓曲率小组之间内漏患者比例及术式比较,差异有统计学意义(P0.05)。结论主动脉弓曲率过大可以引起主动脉支架的前跳、后跳移位及内漏等各种不良事件的产生。     

Relationship between postoperative mean systolic blood pressure and contrast-induced nephropathy in patients undergoing cardiac catheterization

Background There were few studies to explore the relationship between postoperative mean systolic blood pressure (PMSBP) within 6 h after cardiac catheterization and contrast-induced nephropathy (CIN). Methods From June 2010 to February 2013, 299 consecutive patients undergoing cardiac catheterization were recruited. Patients were classified into quartiles based on PMSBP ( < 112, 112-120, 121-131, and > 132 mmHg). Baseline data, CIN incidence and in-hospital outcomes were compared between the groups. Logistic regression was used to assess the relationship between PMSBP and CIN. Results CIN occurred in 26(8.7%) patients. The incidence of CIN in PMSBP quartiles were 15.3% (11 / 72), 15.1% (11 / 73), 2.4% (2 / 82) and 2.8% (2 / 72) (P = 0.001) respectively. There were no significant difference in in-hospital death , renal replacement therapy and intra-aortic balloon pump (IABP) support between the groups (P > 0.05). Univariate logistic regression analysis showed that PMSBP was significantly associated with CIN (OR = 0.956, 95% CI: 0.928-0.986, P = 0.004). Multivariate logistic regression analysis found that after adjusting baseline estimate glomerular filtration rate, age > 75 years and acute myocardial infarction, PMSBP < 120 mmHg was still an independent risk factor for CIN (OR = 5.049, 95% CI:1.820-14.009, P = 0.002). Conclusions Lower PMSBP was significantly associated with an increased risk of CIN. PMSBP < 120 mmHg was an independent risk factor for CIN. Intensive blood-pressure control after cardiac catheterization might increase the risk of CIN.     

原发性高血压与急性心肌梗死患者经皮冠状动脉介入治疗后发生对比剂肾病的关系

目的 探讨原发性高血压（高血压）与急性心肌梗死患者经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗后发生对比剂肾病（contrast-induced nephropathy,CIN）的关系.方法 连续入选2010年1月至2014年2月就诊于东莞康华医院拟行PCI治疗的398例急性心肌梗死患者.观察PCI治疗前及术后48～72 h的血清肌酐浓度.采用Logistics回归分析评估临床因素与CIN的相关性.结果 398例患者中,52（13.1％）例发生CIN,其中高血压209例（52.5％）.Logistics回归分析显示,校正年龄＞75岁、基线估算肾小球滤过率＜60 mL·min-1· 1.73 m.、左心室射血分数＜40％、围术期低血压、贫血、糖尿病、对比剂剂量＞300 mL、主动脉内球囊反搏辅助循环、钙离子拮抗剂及急诊PCI治疗后,高血压是CIN的独立危险因素（OR =4.39,95％CI：2.04～9.46,P＜0.001）.结论 急性心肌梗死患者的高血压与PCI治疗后CIN显著相关,术前识别患者的高血压可能有助于识别CIN高危患者.