吸烟冠心病病人的冠脉造影分析

目的：初步探讨吸烟冠心病病人的冠脉造影血管形态和血流特点.方法：2004年3月至2014年7月就诊于赤峰学院附属医院心内科,行冠脉造影确诊为冠心病的524例病人.吸烟组243例(男114例,女29例),年龄39～76岁,平均(53.53±9.35)岁,吸烟年限5～52年,平均(29.35±8.38)年.同期选取不吸烟的患者281例（男149例,女32例）年龄42～79岁,平均(54.78±8.63)岁,作为对照组.比较两组间冠脉造影的冠脉形态和血流特点的差异.结果：吸烟组与对照组在冠脉瘤样扩张和PTCA相关的冠脉慢血流发生率差异显著,吸烟组35例（14.4％）有冠脉瘤样扩张;对照组6例（2.1％）(P<0.001);吸烟组有53例(21.8％)有PTCA相关冠脉慢血流现象,对照组有7例(2.5％)(P<0.001).结论：吸烟患者冠脉瘤样扩张较多发,且PTCA相关冠脉慢血流现象的发生率较高.     

冠脉合并肾动脉狭窄同期血运重建术比单纯冠脉介入更能减轻左室肥厚（英文）

目的:研究经皮肾动脉支架术(PTRAS)能否在冠脉介入(PCI)基础上进一步改善冠心病合并肾动脉狭窄患者的左室肥厚(LVH)及减少主要心血管不良事件的发生。创新点:本研究对集中入选全身动脉粥样硬化这类高危患者(冠心病合并肾动脉狭窄(CADARAS))临床诊治进行研究,有别于既往对单纯的肾动脉狭窄(RAS)人群的研究,且入选标准使用选择性动脉造影以排除其他诊断手段可能带来的假阴性或假阳性,并对冠脉狭窄进行血运重建以解决心肌灌注问题,再对PTRAS进行评价;有别于既往对PTRAS较为保守的建议,本研究发现对于CADARAS患者,肾动脉狭窄的血运重建应该更加积极,RAS的介入治疗可能是该类患者一个重要的治疗靶点。方法:将入选的228名CADARAS患者,分为收缩功能保留性心衰-I(HFp EF-I)组(PCIPTRAS)以及HFpE F-II组(单纯PCI),术后随访至少两年。随访发现,两组的左室重量指数(LVMI)均较基线明显下降,且HFp EF-I组下降幅达大于HFpE F-II组(Δ=(32.80±12.62)g/m2 vs.Δ=(18.52±8.17)g/m2,P0.001),回归分析发现PTRAS与LVMI的下降及不良事件的发生减少密切相关。结论:对于CADARAS并HFpE F患者,同期行PCI及PTRAS可较单纯PCI进一步减轻LVH及降低心血管不良事件发生。对该类高危患者,可予以积极的肾动脉狭窄血运重建治疗。     

老年急性冠脉综合征79例临床分析

目的:探讨老年急性冠脉综合征的临床特点,为临床诊治该病提供参考依据。方法:收集2003～2007年79例老年急性冠脉综合征患者,74例老年稳定性心绞痛患者临床资料,比较两组的基线情况。结果:老年急性冠脉综合征组并存高血压、糖尿病、脑梗死,高FG、高hs-CRP者与老年稳定性心绞痛组比较明显增多,血脂明显升高;心律失常的严重程度明显增高,心功能不良程度明显加重。结论:高血压、糖尿病、脑血管病,高FG、高hs-CR、高血脂症及心律失常等与老年急性冠脉综合征密切相关,临床诊治该病应考虑其易患因素,早期诊断和及时治疗,可降低患者的病死率。     

脂类、冠脉内皮与冠心病的研究进展

冠心病的基础医学和临床医学的研究突飞猛进，即使是传统的研究内容也引进许多新技术、新概念．脂类代谢及冠脉内皮研究在国内外研究进展较大且临床应用中取得一定效果．     

血脂比值与冠脉狭窄程度的相关分析

目的探讨冠心病患者的血脂比值和单项血脂与冠脉狭窄严重程度的相关性。方法对已行冠状动脉造影的阳性病人(最少有一支血管狭窄≥50%)的各项血脂及其比值进行检测,并与其冠脉狭窄程度进行相关分析。结果①在单项血脂中,TG、CHO、LDL、LP(a)均与冠脉狭窄程度呈正相关,而HDL和apoA与冠脉狭窄程度呈负相关。②在血脂比值中,CHO/HDL、apoB/apoA TG/apoA、CHO/apoA LDL/apoA值均随冠脉狭窄程度加重而增加,且差异有显著性意义。③血脂比值比单项血脂反映CAD的敏感度更高。结论:对于CAD患者,血脂比值反映冠脉狭窄的严重程度较单项血脂更敏感更早期。     

32例非体外循环冠脉搭桥术的麻醉处理

非体外循环冠脉搭桥术（OPCAB）的广泛开展，为冠心病病人带来福音。其独特的血流动力学特点对麻醉的处理提出更高的要求。OPCAB手术的麻醉对保证手术的成功实施至关重要，本文总结32例OPCAB手术的麻醉处理体会。现报道如下。     

冠心病合并糖尿病患者非体外冠脉搭桥术麻醉分析

目的:探讨冠心病合并糖尿病患者非体外冠脉搭桥术麻醉管理方法.方法:38例冠心病合并糖尿病患者在静吸复合麻醉下行非体外冠脉搭桥术(OPCABG).术中采用持续泵注1∶1胰岛素控制血糖.记录术前、劈胸骨后、搭前降支后、关胸各时段的血液动力学改变和血糖值.结果:38例患者术中虽然血压有所波动,但保持了较稳定的心率.手术开始后患者中心静脉压(CVP)普遍较低.劈胸骨等强烈刺激后患者血糖比术前明显升高(P<0.05),经过处理后逐渐降低.结论:OPCABG应注重围术期血糖监测,合并糖尿病患者围术期应精确控制血糖,补充容量,维持水电解质酸碱平衡,有利于维持稳定的血液动力学.     

经桡动脉途径行冠脉介入300例临床分析

目的:探讨经桡动脉途径进行冠脉介入的可行性和安全性.方法:采用回顾性调查的方法对本院2002.9～2005.3月300例经桡动脉途径完成冠脉介入临床资料进行统计分析.结果:行冠状动脉造影术182例,行冠脉介入治疗118例,桡动脉穿刺成功率为99.3%.结论:经桡动脉途径进行冠脉介入是可行的和安全的,并发症少,痛苦少.     

静息心电图正常的冠心病冠脉严重狭窄2例

1　病例介绍例 1:患者男 ,6 5岁 ,间断性心前区疼痛 13年加重半年。 1990年 3月劳累后出现心前区疼痛、憋气、不伴头晕、呕吐、腹痛、腹泻及放射痛 ,口服硝酸甘油症状可缓解 ,曾先后在多家医院诊断为 :“冠心病、心绞痛”。近半年上述症状加重 ,并伴有左肩、左后背心放射痛 ,偶有压榨样痛及出汗 ,每次发作数秒数分钟不等 ,每次发作时心电图均大致正常。既往有高血压、高脂血症和糖尿病史。查体 :T36 .6℃ ,P96次 /min ,R19次 /min ,BP15 6 /94mmHg(1mmHg =0 .133kPa) ,体型稍肥胖 ,双肺呼吸音清 ,未闻及干湿性罗音 ,心率 :96次 /min ,律…     

Screening for significant atherosclerotic renal artery stenosis with a regression model in patients undergoing transradial coronary angiography/intervention

Objective: Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated whether the presence of significant ARAS (luminal diameter narrowing ≥70%) could be predicted using a logistic regression model before coronary angiography/intervention. Methods: Initially, we developed a logistic regression model for detecting significant ARAS based upon clinical and angiographic features and biochemical measurements in a cohort of 1 813 patients undergoing transfemoral coronary and renal angiography. This model was then prospectively applied to an additional 495 patients who received transradial renal angiography to ascertain its predictive accuracy for the presence of significant ARAS. Results: Multivariate regression analysis revealed that older age (≥65 years), resistant hypertension, type 2 diabetes, creatinine clearance (Ccr) ≤60 ml/min, and multivessel coronary disease were independent predictors for significant ARAS. A logistic regression model for detecting ARAS by incorporating conventional risk factors and multivessel coronary disease was generated as: P/(1−P)=exp(−2.618+1.112[age≥65 years]+1.891[resistant hypertension]+0.453[type 2 diabetes]+0.587[Ccr≤60 ml/min]+2.254[multivessel coronary disease]). When this regression model was prospectively applied to the additional 495 patients undergoing transradial coronary and renal angiography, significant ARAS could be detected with a sensitivity of 81.2%, specificity of 88.9%, and positive and negative predictive accuracies of 53.8% and 96.7%, respectively. Conclusions: The logistic regression model generated in this study may be useful for screening for significant ARAS in patients undergoing transradial coronary angiography/intervention.     

Interleukin-17 and acute coronary syndrome

Inflammation plays an important role in atherosclerosis, which is also crucial for acute coronary syndrome (ACS). Recent studies have revealed that interleukin (IL)-17, which was regarded as a pro-inflammatory cytokine, has a dual function in the progress of ACS. In this review, we sum up both experimental and clinical studies on the relevance of IL-17 to atherosclerosis and its complications, and summarize the research progress on the effect of IL-17 on the atherosclerotic plaque stability and ACS onset. Although the studies are controversial and the mechanism remains unclear, we highlight the knowledge of the role of IL-17 in ACS and elucidate its potential mechanism.     

Current status and development of percutaneous coronary intervention in China

##正##Dr.Gruntzig et al.(1979) successfully completed the world's first percutaneous coronary intervention (PCI),a percutaneous transluminal coronary     

Systematic comparison of the effectiveness of radial artery and saphenous vein or right internal thoracic artery coronary bypass grafts in non-left anterior descending coronary arteries

Coronary artery bypass grafting surgery is increasingly being carried out on patients with multi-vessel coronary artery disease, but the best grafting candidate for non-left anterior descending coronary arteries is unclear. This research sought to systematically compare the efficacies and safeties of coronary bypass with radial artery and other available grafts. A systematic literature retrieval was performed for all clinical trials comparing the outcomes of coronary artery bypass surgery with radial artery and other grafts in PubMed, EMBASE, and the Cochrane Library. Seven eligible clinical studies, comparing radial artery and great saphenous vein grafts, were found between 1966 and 2010: one prospective non-randomized and six prospective randomized trials. The pooling analysis obtained a relative risk of 0.507 (P<0.05) of graft occlusion in radial arteries compared with great saphenous veins. There was a significantly lower infection rate in arms (i.e., harvest sites for radial arteries) relative to legs (harvest sites for veins), with a pooled relative risk of 0.140 (P<0.05). From the reports on mortality after follow-up ranging from one year to six years, there was no significant difference in mortality between the two graft types (P=0.927). In addition, four cohort controlled trials for radial and right internal thoracic artery grafts were included. The radial graft was associated with less cardiac related events relative to the right internal thoracic artery graft (P=0.014), but with comparable mortality and comparable rates of repeat percutaneous transluminal coronary angioplasty. Subjects with radial arteries seemed to have a lower occlusion rate and a lower graft harvest site infection rate than those with great saphenous veins. Moreover there were fewer cardiac related events with radial arteries relative to the right internal thoracic artery grafts. More studies are needed to confirm these findings concerning the favorable outcomes of coronary artery bypass grafting with radial arteries on long-term patency and mortality.     

尿微量蛋白联合尿酶测定对高血压病肾损害的临床意义

[目的]探讨尿微量蛋白的检测对高血压病早期肾损害的诊断价值.[方法]分别对高血压病组与健康对照组做尿微量蛋白mAlb,IgG以及NAG的测定,结果两组作对比.[结果]高血压病组的尿微量蛋白mAlb,IgG,NAG明显高于对照组(P<0.01).[结论]尿微量蛋白联合尿酶测定可作为高血压病早期肾损伤诊断的敏感指标.     

Coronary arterial spasm in single right coronary artery

We presented a case of anomalous single-coronary artery detected incidentally during routine coronary angiography. A 32-year-old male Chinese patient presented with recurrent pre-syncope and six episodes of syncope. Coronary angiography and coronary-computed tomography (CT)-angiography performed by a dual-source computed tomography (DSCT) revealed that the patient had a single large right coronary artery. A moderately large branch originated from the proximal part of the single right coronary artery and extended to the left, passing the anterior to the pulmonary artery, and divided into the anterior descending artery branch and circumflex branch at the base of the left auricular appendage. The episodes of the syncope were suspected to be caused by coronary arterial spasm, so this patient was on a regimen of 30 mg of diltiazem every 6 h and had no recurrence of syncope during follow-up.     

Effects of taurine and housing density on renal function in laying hens

This study investigated the putative protective effects of supplemental 2-aminoethane sulfonic acid (taurine) and reduced housing density on renal function in laying hens. We randomly assigned fifteen thousand green-shell laying hens into three groups: a free range group, a low-density caged group, and a high-density caged group. Each group was further divided equally into a control group (C) and a taurine treatment group (T). After 15 d, we analyzed histological changes in kidney cells, inflammatory mediator levels, oxidation and anti-oxidation levels. Experimental data revealed taurine supplementation, and rearing free range or in low-density housing can lessen morphological renal damage, inflammatory mediator levels, and oxidation levels and increase anti-oxidation levels. Our data demonstrate that taurine supplementation and a reduction in housing density can ameliorate renal impairment, increase productivity, enhance health, and promote welfare in laying hens.     

滋阴潜阳法对高血压大鼠的降压作用初探

目的观察滋阴潜阳法对模型大鼠的降压作用,探讨滋阴潜阳法发挥调节的作用机制.方法随机分为模型组、滋阴潜阳组、氯沙坦组、假手术组和正常对照组共5组,每组10只大鼠.结果血压变化:造模后2周,与假手术组相比,模型组大鼠动脉收缩压(SBP)明显升高,有统计学意义(P＜0.05).经过4周的用药,与模型组相比,氯沙坦组和滋阴潜阳组大鼠SBP明显降低,有统计学意义(P＜0.05).模型组与假手术组比较,胸腺、脾脏中淋巴细胞(少量的巨噬细胞)IL-6均表达显著升高(P＜0.001).滋阴潜阳组和氯沙坦组与模型组比较,IL-6的表达明显下调(P＜0.01).结论滋阴潜阳法能降低肾性高血压大鼠的血压,下调胸腺和脾脏中淋巴细胞IL-6表达可能是其降压机制之一.     

Nicotinamide N-methyltransferase protein expression in renal cell cancer

Objective: To understand the function of nicotinamide N-methyltransferase (NNMT) protein as tumor biomarker in renal carcinoma. Methods: Recombinant NNMT protein was used to prepare monoclonal antibodies by hybridoma technique. The diagnostic and prognostic function of NNMT protein in renal carcinoma was evaluated by analyzing 74 renal cancer tissues through immunohistochemical staining for NNMT by using the prepared antibodies. Results: Two hybridomas named 2F8 and 1E7 stably secreting the monoclonal antibodies were isolated successfully, and characters such as isotypes and specificity were determined. NNMT protein was significantly up-regulated in renal cancer and significantly associated with tumor histology and ages. The univariate survival analysis demonstrated that the pT-status, high levels of NNMT, and distant metastasis were significant prognosticators. Conclusion: NNMT is over-expressed in a large proportion in renal cell cancers. High NNMT expression is significantly associated with unfavorable prognosis. However, the prognostic value of NNMT needs further verification in larger sample sizes.