冠心病心气虚与非心气虚证间左心形态及功能表现

[目的]比较胸痹(冠心病)心气虚与非心气虚患者左心形态及功能方面的差异。[方法]回顾分析1998~1999年就诊的184例冠心病患者的临床资料,由中医师按病例记载的临床证候分为心气虚组和非心气虚组,再比较两组患者超声测量的数据特点。[结果]心气虚组与非心气虚组的左室射血分数和心肌缺血程度仍在正常值范围,心气虚组的射血分数为(61.0±15.1)%,非心气虚组为(66.62±12.67)%,两组比较差异有显著性(t=2.754,P<0.01);心肌缺血程度两组间比较也有显著性差异(秩和检验Uc=53.99,P<0.0005)。超声测量左室腔和左心房大小、左室心肌厚度、左室每搏量、心输出量、心肌缺血范围,结果两组间差异无统计学意义。[结论]心气虚并非等同于临床上的心功能不全,超声测量虽在正常范围内,但射血分数表现为正常低值者,对胸痹(冠心病)的病程进展的判断可能有所帮助。     

The Effects of Calcium Supplementation on Verified Coronary Heart Disease Hospitalization and Death in Postmenopausal Women: A Collaborative Meta‐Analysis of Randomized Controlled Trials

Calcium supplementation, particularly with vitamin D, has been an approved public health intervention to reduce fracture risk. Enthusiasm for this intervention has been mitigated by meta‐analyses suggesting that calcium supplementation with or without vitamin D increases myocardial infarction (MI) risk; however, concern has been raised over the design of these meta‐analyses. We, therefore, undertook a meta‐analysis of randomized controlled trials with placebo or no‐treatment control groups to determine if these supplements increase all‐cause mortality and coronary heart disease (CHD) risk including MI, angina pectoris and acute coronary syndrome, and chronic CHD verified by clinical review, hospital record, or death certificate in elderly women. The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases were searched from January 1, 1966, to May 24, 2013, for potentially eligible studies, reference lists were checked, and trial investigators were contacted where additional unpublished data were required. The search yielded 661 potentially eligible reports of which 18 met the inclusion criteria and contributed information on 63,563 participants with 3390 CHD events and 4157 deaths. Two authors extracted the data independently with trial data combined using random‐effects meta‐analysis to calculate the relative risk (RR). Five trials contributed CHD events with pooled relative RR of 1.02 (95% confidence interval [CI], 0.96–1.09; p = 0.51). Seventeen trials contributed all‐cause mortality data with pooled RR of 0.96 (95% CI, 0.91–1.02; p = 0.18). Heterogeneity among the trials was low for both primary outcomes (I² = 0%). For secondary outcomes, the RR for MI was 1.08 (95% CI, 0.92–1.26; p = 0.32), angina pectoris and acute coronary syndrome 1.09 (95% CI, 0.95–1.24; p = 0.22) and chronic CHD 0.92 (95% CI, 0.73–1.15; p = 0.46). In conclusion, current evidence does not support the hypothesis that calcium supplementation with or without vitamin D increases coronary heart disease or all‐cause mortality risk in elderly women. © 2014 American Society for Bone and Mineral Research.     

莪术油对动脉损伤大鼠血管成形术后再狭窄的抑制作用

【目的】探讨莪术油对血管成形术后再狭窄的防治作用。【方法】建立大鼠颈动脉球囊导管损伤模型,采用计算机图像分析再狭窄病灶的形态学和组织学变化,对假手术组、莪术油组和模型组共25只大鼠进行研究。【结果】术后 14d,模型组出现血管内膜增厚及新生内膜面积增大,管腔面积和内、外弹力板周长缩小,与假手术组比较有非常显著性差异(P<0.01);莪术油组最大内膜厚度及新生内膜面积比模型组减少,而管腔面积和内、外弹力板周长增加(P<0.01);与假手术组比无显著性差异(P>0.05)。【结论】莪术油可抑制大鼠损伤动脉内膜增生和血管重构,有防治血管成形术后再狭窄作用。     

循经感传治疗胸痹的临床研究

应用声电针激发感传气至病所的方法治疗冠心病３０例，临床疗效和心电图疗效均优于药物对照组（Ｐ＜０．０５）。循经感传治疗能显著改善患者的左心功能状态和心肌复极电位，降低血液粘度。动物实验表明，声电针＂内关＂穴区能明显减轻家兔急性缺血心肌超微结构损伤的程度，改善缺血心肌的心电图，其机理可能与包括心钠素在内的心脏内分泌系统参与的全身性调整有关。     

Knowledge and attitude towards personal health care and menopause among women with ischemic heart disease undergoing coronary angiography

The aim of this study was to assess the knowledge ,perception ,and attitude towards personal health care and menopause among women with ischemic heart disease. The study population consisted of 100 menopausal women attending the cardiac unit for coronary angiography. All women completed a 20-item questionnaire ,covering information on health-care habits ,life style and attitude towards menopause. About half of the study population had ever smoked ,were overweight ,had never tried to lose weight and did not exercise regularly. The majority regularly underwent screening mammography ,Pap smear and lipid profile measurement. There was a positive statistically significant correlation between years of education and having annual mammography ,Pap smear and lipid profile ,performing breast self-examinations and taking an annual vacation. Sixty eight per cent of the study population had never used hormone replacement therapy (HRT) ,13.2% had used HRT in the past and 18.8% were currently using HRT. There was a negative statistically significant correlation between use of HRT and age and number of children ,and a positive statistically significant correlation between use of HRT and having an annual Pap smear and mammography scan. Only a relatively small percentage of the study population safeguarded their health care or used HRT. We believe that stronger efforts are needed to promote good health-related behaviors for these women.     

Cognitive Distortion and Functional Impairment in Patients Undergoing Cardiac Rehabilitation

This study examined the influence of cognitivedistortion (e.g., catastrophizing, overgeneralization)on functional impairment among coronary heart disease(CHD) patients undergoing outpatient cardiacrehabilitation. Forty-two CHD patients completed a versionofthe Cognitive Errors Questionnaire (CEQ; Lefebvre,1981) shortly after hospital discharge at the initiationof the rehabilitation program. Functional impairmentwas assessed both pre- and postrehabilitation usingscales from the Sickness Impact Profile (SIP; Bergner etal., 1981) and a measure of peak exercise performance.Consistent with prediction, patients' CEQ scores were significantly associated withresidualized change in two areas of illness-relatedfunctional impairmentafter controlling for diseaseseverity and prerehabilitation levels of functioning.Patients endorsing a high number of cognitive errors onthe CEQ reported greater impairmentin mobility andpoorer social functioning after completion of therehabilitation program relative to patients making a low number of cognitive errors. CEQ scores did notsignificantly predict changes in impairment in homemanagement or recreational activity or in peak exerciseperformance. These findings provide further evidence that cognitive constructs might be useful inunderstanding individual differences in functionalrehabilitation in medical populations and may haveimplications for the design of cardiac rehabilitationprograms.     

Short Poster Abstracts

Abstract

Evaluation of vascular responses to metallic stent implantation is essential in the setting of vascular disease. Study of the vascular response to stent implantation has been hampered by difficulties in sectioning metal and tissue without distortion of the tissue stent interface. Physical removal of the metal prior to processing frequently results in loss of arterial architecture, and current methods of embedding in resin have multiple drawbacks including expense, toxic or hazardous solution components, stent displacement and slow turnaround time.     

祛瘀消斑胶囊对冠心病血脂及血小板活性的影响

[目的]探讨祛瘀消斑胶囊（主要由水蛭、大黄、海藻、山楂、莪术等中药组成）对冠心病患者血脂及血小板活性的影响。[方法]采用随机单盲法将62例冠心病患者分为对照组（31例）及中药组（31例），对照组予西药常规治疗，中药组加服祛消瘀斑胶囊，观察两组治疗前后血清总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL－C）及血液活化血小板α颗粒膜蛋白（GMP－140）的含量变化。[结果]祛瘀消斑胶囊治疗10周后，血液GMP－140，血清TC、TG含量均不同程度地下降，与自身治疗前及对照组治疗后比较差异均有显著性（P＜0.05或P＜0.01)；而血清HDL－C则变化不明显（P＞0.05)。[结论]祛瘀消斑胶囊可降低血脂，改善血小板功能，对冠心病的预防与治疗有一定的积极作用。     

丽参注射液对老年男性冠心病肾虚患者性激素的影响

本研究观察了３２例经丽参注射液治疗前后老年男性冠心病肾虚患者雌二醇（Ｅ２）、睾酮（Ｔ）及Ｅ２／Ｔ的变化。结果表明：肾阳虚和肾阴虚两组Ｔ均降低（Ｐ＜０．０５～０．０１）；肾阴虚组Ｅ２、Ｅ２／Ｔ升高，而肾阳虚组Ｅ２则降低（Ｐ＜０．０１）。治疗后随着肾虚症状改善两组Ｔ均回升，肾阴虚组Ｅ２、Ｅ２／Ｔ回落，肾阳虚组Ｅ２回升（Ｐ＜０．０１），均接近对照组水平。提示老年男性冠心病肾虚患者阴阳失调与性激素紊乱有关，主要表现在血清Ｔ浓度的降低和Ｅ２水平的升高或降低；人参既可调整阴阳改善肾虚症状又可逆转性激素变化，在提高Ｔ水平的同时，对Ｅ２有很好的双向调节作用，有助于人体内环境雌雄性激素的平衡     

糖尿病冠心病的中医证候与血管紧张素Ⅰ转换酶基因多态性关系的探讨

【目的】探讨血管紧张素Ⅰ转换酶(ACE)基因插入与缺失(I/D)多态位点与糖尿病冠心病中医证候的关系。【方法】用聚合酶链反应(PCR)-2％琼脂凝胶电泳法,捡测了52名糖尿病冠心病患者人血ACE基因I/D多态性,根据中医辨证,将其分为血瘀和肾阳虚2个亚组,并与41名正常人作比较。【结果】糖尿病冠心病组DD型频率和D等位基因频率均高于正常组(分别P<0.01和P<0.05);在糖尿病冠心病中,血瘀组的ID型频率高于肾阳虚组(P<0.01),而DD型频率却低于肾阳虚组(P<0.05),2组 I、D等位基因频率分布未见显著性差异,并均以D等位基因占优势。【结论】ACE基因I/D多态性分布与糖尿病冠心病的发病和病情转归预后有关,D型等位基因可能是糖尿病冠心病,尤其是肾阳虚衰型发生的内在因素。