NT-proBNP与急性冠脉综合征患者冠脉病变程度及预后的关系

目的:探讨N末端脑钠肽原(NT-pro BNP)与急性冠脉综合征(ACS)患者冠脉病变程度及预后的关系。方法:选择2012年1月至2015年6月我院收治的ACS患者400例为研究对象,根据病情症状的不同将患者分为不稳定心绞痛(UA)组和急性心肌梗死(AMI)组,各200例,另选同期200例非ACS患者作为对照组,比较各组患者的NT-pro BNP水平及ACS患者的心功能情况,并比较ACS患者的冠脉造影结果,通过Syntax评分系统评价冠脉病变,随访6-12个月,对比各组患者的主要心血管不良事件(MACE)发生率,通过上述比较及分析,研究ACS患者NT-pro BNP与冠脉病变程度及预后的关系。结果:AMI组及UA组患者的NT-pro BNP水平明显高于对照组,且AMI组患者的NT-pro BNP水平明显高于UA组,差异有统计学意义(P0.05);AMI组患者的冠脉病变Syntax积分高于UA组,差异有统计学意义(P0.05);冠脉病变Syntax积分≥33分的ACS患者的NT-pro BNP水平高于Syntax积分0-22分的患者,差异有统计学意义(P0.05);同时双支病变和三支病变患者的Syntax积分及NT-pro BNP水平高于单支病变患者,差异有统计学意义(P0.05);随访6-12个月发生MACE患者的NT-pro BNP水平明显高于未发生MACE者,差异有统计学意义(P0.05)。Pearson相关性分析显示,患者的冠脉病变程度与NT-pro BNP及Syntas积分均呈正相关(r=0.667,0.842;P0.05)。患者随访6-12个月MACE发生率与NT-pro BNP及Syntas积分也呈正相关(r=0.708,0.821;P0.05)。结论:ACS患者的冠脉病变程度及预后与其NT-pro BNP水平具有较好的相关性,值得临床关注。     

血清同型半胱氨酸、叶酸、维生素B12水平与冠状动脉病变严重程度的相关性分析

摘要 目的：探讨血清同型半胱氨酸(homocysteine, Hcy)、叶酸、维生素B12水平与冠状动脉病变严重程度的相关性。方法：选取经冠脉造影检查确诊的稳定期冠心病患者220例为研究组,并以同期健康查体志愿者100例为对照组。检测和比较两组血清Hcy、叶酸、维生素B12和N -末端脑钠肽前体(N-terminal brain natriuretic peptide precursor,NT-proBNP)水平。研究组根据冠脉造影情况进行SYNTAX评分评价,通过心脏超声检查检测左室射血分数(left ventricular ejection fraction,LVEF),确定冠脉病变严重程度。比较研究组SYNTAX低分组(1～22分)、中分组(23～32分)和高分组(≥33分)患者上述各指标水平,并分析研究组血清Hcy、叶酸、维生素B12水平与其血清NT-proBNP 水平、SYNTAX评分和LVEF的关系。结果：与对照组比较,研究组血清Hcy和NT-proBNP水平升高而血清叶酸、维生素B12水平降低(P＜0.05)。研究组SYNTAX评分和LVEF分别为(28.76±6.58)分和(47.33±8.66)%,SYNTAX中分和高分患者血清Hcy和NT-proBNP水平高于SYNTAX低分患者而血清叶酸、维生素B12水平和LVEF则低于SYNTAX低分患者,SYNTAX高分患者血清Hcy和NT-proBNP水平高于SYNTAX中分患者而血清叶酸、维生素B12水平和LVEF则低于SYNTAX中分患者(P＜0.05)。Pearson线性相关分析结果显示研究组血清Hcy水平与其血清NT-proBNP 水平、SYNTAX评分均呈正相关(r=0.881,0.793,P＜0.05),与其LVEF则呈负相关(r=-0.876,P＜0.05);而其血清叶酸、维生素B12水平与其血清NT-proBNP 水平、SYNTAX评分均呈负相关(叶酸：r=-0.786,-0.825;维生素B12：r=-0.884,-0.818,P＜0.05),与其LVEF则呈正相关(r=0.893,0.859,P＜0.05)。结论：血清Hcy是冠心病的重要危险因素,其水平随着冠状动脉病变程度加重而升高;血清叶酸、维生素B12是冠心病的保护因素,其水平随着冠状动脉病变程度加重而降低。     

血肌酐与非ST段抬高急性冠脉综合征冠脉病变程度及其预后

目的:研究血清肌酐(serum creatinine,SCr)与非ST段抬高急性冠脉综合征(non-ST-elevation acute coronary syndrome,NSTE-ACS)患者冠脉病变程度及其预后的关系。方法:对293例患者进行回顾性分析,依据冠脉造影结果分为NSTE-ACS组和非冠心病组。根据Gensini积分系统,评价NSTE-ACS患者冠脉病变程度,并将患者分为轻度病变组、中度病变组和重度病变组。检测患者SCr水平,应用SPSS16.0分析SCr与NSTE-ACS患者冠脉病变程度及其预后关系。结果:(1)与非冠心病组相比,NSTE-ACS患者SCr较高(P0.05);其中,重度冠脉病变NSTE-ACS患者SCr水平尤高(P0.001)。(2)SCr是NSTE-ACS冠脉病变的危险因子;SCr与NSTE-ACS冠脉病变程度呈正相关(r=0.263,P0.000);SCr与NSTE-ACS主要心血管不良事件(Major Adverse Cardiovascular Events,MACE)呈正相关(r=0.183,P0.01)。结论:SCr是NSTE-ACS患者冠脉病变的独立危险因子,且与NSTE-ACS患者预后相关。SCr对于NSTE-ACS的诊疗有潜在临床价值。     

急性冠脉综合征患者NLR、MPV与Gensini评分的相关性分析

目的:探讨急性冠脉综合征(Acute Coronary Syndrome,ACS)患者的中性粒细胞/淋巴细胞(Neutrophils/lymphocyte,NLR)、平均血小板体积(Mean platelet volume,MPV)与Gensini评分的相关性。方法:将156例ACS患者依据冠状动脉造影结果分为单支病变组、双支病变组及三支病变组,比较各组间NLR、MPV、Gensini评分及一般临床资料,并分析不同指标之间的相关性。结果:与双支病变组、单支病变组相比较,三支病变组吸烟、糖尿病、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、尿酸(uric acid,UA)、NLR、MPV、Gensini评分均显著升高(P0.05);与单支病变组相比较,双支病变组吸烟、糖尿病、LDL-C、HDL-C、UA、NLR、MPV、Gensini评分均显著升高(P0.05);三组间年龄、性别、高血压、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、肌酐(creatinine,Cr)比较差异均无统计学意义(P0.05)。Pearson相关性分析表明:NLR、MPV与Gensini评分均呈正相关(r=0.482、0.702, P0.05)。结论:ACS患者MPV和NLR与冠状动脉病变程度呈显著正相关,可有效评估冠状动脉狭窄程度。     

血小板/淋巴细胞比值评估急性冠脉综合征冠脉病变严重程度的临床价值

目的:探讨血小板淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)评估急性冠脉综合征(acute coronary syndrome,ACS)冠脉病变严重程度中的临床价值。方法:回顾性分析2015年3月至2017年3月在南京市第一医院心血管内科行冠脉造影的168例ACS患者的临床资料,其中不稳定型心绞痛(unstable angina,UA)52例,非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)54例,ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)62例,根据冠脉造影结果进行Gensini评分,采用Spearman相关分析对PLR和Gensini评分进行相关性分析。结果:三组白细胞总数、淋巴细胞计数以及LDL比较差异均有统计学意义(P0.05),STEMI组白细胞总数、淋巴细胞计数明显高于UA组及NSTEMI组,LDL显著低于UA组及NSTEMI组,且NSTEMI组白细胞总数、淋巴细胞计数明显高于UA组,LDL显著低于UA组。此外,NSTEMI和STEMI组PLR和Gensini评分显著均高于UA组(P0.05)。Spearman相关性分析显示PLR与Gensini评分呈正相关(r=0.2205,P=0.0114)。多元逐步回归分析结果显示PLR和白细胞总数均是Gensini评分的影响因素。结论:PLR在评估ACS患者冠脉病变严重程度中具有一定的价值,其值越高,冠脉病变越重。     

腹型肥胖对急性冠脉综合征患者冠状动脉病变严重程度的影响

目的:研究腹型肥胖对急性冠脉综合征(ACS)患者冠状动脉病变严重程度的影响。方法:选择2012年4月至2013年4月在我院接受治疗的ACS患者120例,根据腰围身高比(RWH)将患者分为无腹型肥胖者60例(对照组,RWH0.5)及腹型肥胖者60例(观察组,RWH0.5)。测量所有患者的基本参数,计算RWH,利用冠脉造影判断冠脉病变的支数和程度,根据Gensini评分法对冠脉造影结果进行评价,分析冠脉病变范围、Gensini积分和RWH的相关性。结果:观察组的收缩压(SBP)、空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)及Gensini积分水平均显著高于对照组,差异均有统计学意义(均P0.05)。观察组的高密度脂蛋白(HDL-C)水平显著低于对照组,差异有统计学意义(P0.05)。双支病变的RWH及Gensini积分水平显著高于单支病变,三支病变的RWH及Gensini积分水平显著高于单支病变及双支病变,差异均有统计学意义(均P0.05)。根据Spearman法分析相关性可知,冠脉病变范围、Gensini积分和RWH均呈正相关(r=0.635,0.739;P=0.000,0.000)。结论:ACS患者RWH水平增高与冠脉病变的严重程度关系密切,有效控制腹型肥胖对于降低心血管类疾病发病率以及降低冠脉病变的程度具有重要意义。     

心外膜脂肪厚度与冠脉病变严重程度的相关性研究

目的:探讨心外膜脂肪组织(Epicardial adipose tissue,EAT)厚度与冠状动脉病变严重程度的相关性。方法:收集167名符合纳入标准的患者,根据冠状动脉造影(coronary arteriography,CAG)结果分2组:正常冠脉组(65例)及冠心病冠脉病变组(≥1支冠状动脉病变狭窄程度≥50%)(102例)。同期经胸超声心动图测量EAT厚度,并依据CAG图像计算Gensini评分、Syntax评分。结果:冠脉正常组和冠心病病变组EAT厚度分别为(3.89±0.2 mm)、(6.19±1.19 mm),冠心病病变组显著高于冠脉正常组(P0.001)。进一步分析EAT的厚度分别为5 mm、5-7 mm和7 mm时,Gensini评分分别为:7.21±7.73,37.80±29.55和62.77±27.26;Syntax评分分别为:7.13±7.70,19.71±7.27和24.95±4.31。EAT的厚度与Gensini评分(r=0.621;P0.001)、Syntax评分(r=0.689;P0.001)呈正相关。结论:心外膜脂肪组织厚度与冠状动脉狭窄的复杂程度评分Gensini评分、Syntax评分呈正相关。     

急性冠脉综合征患者GRACE评分与心功能及冠脉病变的关系研究

目的:探讨全球急性冠状动脉疾病登记(GRACE)风险评分与急性冠脉综合征(ACS)患者心功能及冠脉病变的关系。方法:回顾性分析2015年4月至2017年6月我院收治的276例ACS患者的临床资料,根据GRACE评分结果进行分组,GRACE评分140分者作为高危组(93例),GRACE评分109~140分者作为中危组(96例),GRACE评分109分者作为低危组(87例),比较三组的一般资料、生化指标、心功能指标、冠脉病变严重程度,采用Spearman相关系数分析GRACE评分与心功能指标和冠脉病变严重程度的相关性。结果:高危组和中危组男性所占比例、年龄、高血压比例、载脂蛋白-B(Apo-B)、空腹血糖(FBG)、纤维蛋白原(FIB)、胱抑素-C(Cys-C)、同型半胱胺酸(Hcy)、左心房前后径(LAAP)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、多支血管病变所占比例以及重度狭窄和完全闭塞所占比例高于低危组,且高危组高于中危组,差异均有统计学意义(P0.05);高危组和中危组三酰甘油(TG)、载脂蛋白-A(Apo-A)、左心室射血分数(LVEF)低于低危组,且高危组低于中危组,差异均有统计学意义(P0.05)。Spearman相关系数分析显示,GRACE评分与LAAP、LVESD、LVEDD、冠脉病变血管支数、狭窄程度呈正相关关系(P0.05),GRACE评分与LVEF水平呈负相关关系(P0.05)。结论:GRACE评分越高,ACS患者的心功能越差,冠脉病变越严重,GRACE评分可以反映ACS患者的心功能水平和冠脉病变的严重程度。     

新型血栓抽吸装置在经皮冠脉介入术中的应用

目的:评价新型手工血栓抽吸装置在经皮冠脉介入术中的应用价值。方法:38例冠心病患者在冠脉造影发现病变含有高血栓负荷后,采用新型ZEEK经皮血栓抽吸装置手工抽吸血栓,然后按照常规方法行经皮冠脉介入治疗。术前术后采用冠脉造影TIMI血流分级、心肌灌注显像分级和血栓积分评价血栓抽吸装置的有效性。结果:38例患者中26例患者术前罪犯血管为完全闭塞,12例患者为次全闭塞病变,病变血管血栓抽吸后血栓积分较术前显著下降(3．2±0．7vsl．5±0．2,P＜0．01),冠脉TIMI血流分级显著好转(0．8±0．5vs2．1±0．4,P＜0．01),心肌灌注显像分级显著提高(0．7±0．5vsl．9±0．4,P＜0．01),35例患者即刻植入支架。38例患者在血栓抽吸治疗中无1例出现严重并发症。结论:新型手工血栓抽吸装置可以在急性心肌梗死患者中安全应用,并能有效降低血栓积分,改善冠脉血流,提高支架植入成功率,有助于达到理想的再灌注治疗效果,值得推广应用。     

冠心病合并高血压患者左室质量指数与冠脉病变严重程度的相关性分析

目的:探讨冠心病合并高血压患者左室质量指数(LVMI)与冠脉病变严重程度的相关性。方法:选取在我院住院的冠心病合并高血压患者168例为研究对象,所有患者入院后均行心脏超声检查,按照LVMI水平的中位数将患者分为A组(LVMI≥115.71g/m~2,n=82例)和B组(LVMI115.71g/m~2,n=86例);比较两组的实验室检查指标与冠脉病变支数及Gensini积分差异。利用多元线性回归方程分析影响Gensini积分的相关因素。结果:与B组比较,A组患者收缩压(SBP)、甘油三酯(TG)、B型脑钠肽(BNP)、血清肌酐(Scr)较高(P0.05);A组中Gensini积分亦高于B组(P0.05),三支病变的比例高于B组(P0.05);Gensini积分高分组LVMI高于中分组及低分组(P0.05),中分组高于低分组(P0.05);Pearson相关性分析显示:Gensini积分与LVMI呈现正相关(P0.05),亦与SBP、TG、Scr、BNP呈正相关(P0.05);多元线性回归分析显示:LVMI是Gensini积分增高的独立危险因素(P0.05)。结论:冠心病合并高血压患者LVMI增高与冠脉病变严重程度具有一定正相关性,可能是影响患者冠脉病变严重程度的独立危险因素。     

Retinol binding protein 4 levels relate to the presence and severity of coronary artery disease

BackgroundThe previous studies have showed that serum retinol binding protein 4 (RBP4) levels increase in metabolic disorders which are closely associated with cardiovascular diseases (CVD). However, the human studies investigating the role of RBP4 in CVD are conflicted. Therefore, we aimed to evaluate the relationship between RBP4 with the presence and severity of coronary artery disease (CAD) in this study.Methods55 patients with presenting acute coronary syndrome (ACS) and 43 control subjects who had various cardiovascular risk factors with normal coronary artery on coronary angiography were included in this study. The serum RBP4 concentrations were measured using ELISA method, clinically and anatomically score models were used to assess the severity of coronary lesion.ResultsSerum RBP4 levels were significantly higher in patients with ACS compared to the without ACS (68.40 ± 47.94 mg/L vs. 49.46 ± 13.64 mg/L; p = 0.014). RBP4 was correlated with GENSINI and SYNTAX I score (r = 0.286 p = 0.034; r = 0.403 p = 0.002 respectively). However, there was no relationship between RBP4 and GRACE score.ConclusionsThe serum RBP4 levels increase in patients with CAD and its increased levels may be correlated with CAD severity.     

Uric acid levels are associated with endothelial dysfunction and severity of coronary atherosclerosis during a first episode of acute coronary syndrome

The role of serum uric acid in coronary artery disease has been extensively investigated. It was suggested that serum uric acid level (SUA) is an independent predictor of endothelial dysfunction and related to coronary artery lesions. However, the relationship between SUA and severity of coronary atherosclerosis evaluated via endothelial dysfunction using peripheral arterial tone (PAT) and the reactive hyperhemia index (RHI) has not been investigated during a first episode of acute coronary syndrome (ACS). The aim of our study was to address this point. We prospectively enrolled 80 patients with a first episode of ACS in a single-center observational study. All patients underwent coronary angiography, evaluation of endothelial function via the RHI, and SUA measurement. The severity of the coronary artery lesion was assessed angiographically, and patients were classified in three groups based on the extent of disease and Gensini and SYNTAX scores. Endothelial function was considered abnormal if RHI?<?1.67. We identified a linear correlation between SUA and RHI (R² =?0.66 P <?0.001). In multivariable analyses, SUA remained associated with RHI, even after adjustment for traditional cardiovascular risk factors and renal function. SUA was associated with severity of coronary artery disease. SUA is associated with severity of coronary atherosclerosis in patients with asymptomatic hyperuricemia. This inexpensive, readily measured biological parameter may be useful to monitor ACS patients.     

Endothelial dysfunction occurs in peripheral circulation patients with acute and stable coronary artery disease

Atherosclerosis is a diffuse, systemic process. In addition, acute coronary syndromes (ACS) are associated with inflammatory marker elevations that are hypothesized to affect the function of nonculprit coronary as well as peripheral vessels. We investigated whether femoral vascular reactivity and/or fibrinolytic capacity are impaired in ACS patients over and above any dysfunction associated with stable coronary artery disease. Patients undergoing diagnostic coronary angiography (n = 42 total, 14 patients/group) were recruited into three groups as follows: 1) stable coronary syndromes (SAP group), 2) ACS as defined by rest angina with ECG changes and troponin rise (ACS group), and 3) angiographically normal coronary arteries (control group). After diagnostic coronary angiography, femoral artery endothelial and smooth muscle function were assessed by infusing acetylcholine (ACh) and nitroglycerin (GTN), and tissue-type plasminogen activator (t-PA) release across the femoral circulation was measured as the difference between arterial and venous concentrations before and after ACh and GTN stimulation. There were no significant differences between groups in relevant baseline characteristics apart from significantly higher C-reactive protein levels and reduced net t-PA release in the ACS group at baseline (P < 0.05). The ACS and SAP groups had equivalent angiographic severity of coronary artery disease. Endothelium-dependent dilatation was significantly higher in control individuals (14.9 +/- 9.1%; P < 0.001) compared with either stable patients (2.3 +/- 8.1%) or those with unstable syndromes (2.6 +/- 8.9%, who were similar to each other; P = not significant). Although baseline t-PA release was impaired in the ACS patients (0.09 +/- 0.06 compared with 0.39 +/- 0.33 and 0.49 +/- 0.56 ng/ml; P = 0.03), stimulation of t-PA release by ACh and GTN occurred only in the control subjects and not in the ACS or SAP patients. Coronary artery disease is associated with impaired endothelium-dependent dilatation and impaired stimulation of t-PA release in the systemic circulation. These aspects of endothelial dysfunction, however, were equally severe in acute and chronic coronary syndrome patients.     

Role of aldehyde dehydrogenase 2 Glu504lys polymorphism in acute coronary syndrome

This study aimed to investigate the association of the aldehyde dehydrogenase 2 (ALDH2) Glu504Lys polymorphism, which exists in 30-50% of East Asians, and risk of acute coronary syndrome (ACS). We enrolled 1092 unrelated Han Chinese, including 546 with ACS and 546 age- and sex-matched controls. Subjects with ALDH2 mutant genotypes showed significantly higher ACS than did controls (46.7% versus 31.9%, P < 0.001). Logistic regression analysis revealed the ALDH2 mutant independently associated with ACS (odds ratio [OR] 1.95, 95% confidence interval [CI]: 1.31-2.92, P = 0.001), but the association was weaker on adjusting for alcohol consumption (OR 1.82, 95% CI: 1.23-2.70, P = 0.003). Similar results were found in a subgroup analysis of patients with primary ST-segment elevation myocardial infarction (STEMI). The ALDH2 mutant was significantly associated with level of high-sensitivity C-reactive protein (hs-CRP) in patients with ACS (P = 0.002) and in controls (P = 0.009) and number of circulating endothelial progenitor cells (EPCs) (P = 0.032); furthermore, inclusion of hs-CRP level and EPCs number as independent variables in regression analysis reduced the importance of ALDH2 polymorphism in ACS or primary STEMI. However, ALDH2 polymorphism was not associated with number of coronary arteries with significant stenosis, Gensini score or flow-mediated dilation of the brachial artery. Our results suggest that ALDH2 mutation is a genetic risk marker for ACS, which is explained in part by alcohol consumption, inflammation and number of circulating EPCs.     

Effects of coronary ischemia on lung fluid balance in conscious sheep

It has been suggested that coronary ischemia increases extravascular lung water. To determine whether pulmonary microvascular permeability is increased by coronary ischemia, we measured pulmonary hemodynamics, lung lymph flow (QL), and lymph-to-plasma protein concentration ratio (L/P) in 12 sheep with chronic lung lymph fistulas. Studies were done in 3 groups: in group 1 (n = 7) a marginal branch of the left circumflex artery (Lcx) was occluded, in group 2 (n = 5) left atrial pressure (Pla) was mechanically raised by 10 mmHg, and in group 3 (n = 5) Lcx was occluded and Pla was raised by 10 mmHg. In group 1, coronary occlusion increased QL (4.6 +/- 0.4 to 8.3 +/- 2.6 ml/h) without changes in L/P. In group 2, elevated Pla increased QL (5.1 +/- 1.2 to 10.1 +/- 3.0 ml/h) with decreases in L/P (0.71 +/- 0.02 to 0.61 +/- 0.02). In group 3, coronary occlusion with elevated Pla caused a further increase in QL (5.0 +/- 1.5 to 16.9 +/- 4.6 ml/h) without significant decreases in L/P (0.71 +/- 0.01 to 0.65 +/- 0.06). Lung lymph concentrations of 6-keto-prostaglandin F1 alpha (a degradation product of prostacyclin) increased transiently after coronary occlusion. These results indicate that coronary occlusion can increase transcapillary protein transport in lungs of conscious sheep and simultaneously increase prostacyclin production in the lung.     

Stent implantation for a totally occluded right coronary artery in a six-year-old boy after Kawasaki disease: a case report

Introduction

Coronary stenting has previously been considered to be less feasible in children under 12 years old due to the limitation of vascular access. We report the case of a six-year-old boy who successfully underwent stent implantation for his totally occluded right coronary artery.

Case presentation

A Taiwanese boy aged six years and nine months old was found to have giant aneurysms after an acute episode of Kawasaki disease. An angiography revealed that his middle right coronary artery was totally occluded. A 0.014-inch guidewire was advanced to cross the totally occluded site. After pre-dilating the middle portion of his right coronary artery with a 1.5 mm balloon, stenting of his right coronary artery was accomplished using a 2.5 × 28 mm and a 2.5 × 18 mm bare metal stent. A final angiography demonstrated no residual stenosis or dissection.

Conclusion

Coronary stenting could be a therapeutic option for children as young as six years old. Close follow-up is mandatory because the long-term outcome is still unclear, especially in a small child.     

冠脉PCI治疗后血浆脂蛋白相关磷脂酶A2与基质金属蛋白酶-9水平的变化及临床意义

目的:探讨冠脉经皮冠状动脉介入(PCI)治疗后血浆脂蛋白相关磷脂酶A2(LP-PLA2)与基质金属蛋白酶-9(MMP-9)水平的变化及其临床意义。方法:选择150例急性冠脉综合征(ACS)患者、128例稳定型心绞痛(SAP)患者及100例健康者分为作为ACS组、SAP组及对照组。比较三组入院时血浆MMP-9、LP-PLA2水平及ACS组经PCI治疗前后血浆MMP-9、LP-PLA2水平的变化。结果:与对照组比较,SAP组与ACS组的血浆MMP-9、LP-PLA2水平均明显增高(P0.05);与SAP组比较,ACS组明显增高(P0.05)。与术前比较,ACS组术后血浆MMP-9、LP-PLA2水平明显降低(P0.05)。MMP-9与LP-PLA2在ACS组血浆中呈显著正相关(r=0.617,P0.05),在SAP组与对照组中无相关性(P0.05)。结论:冠脉病变程度越严重,血浆MMP-9和LP-PLA2水平更高;PCI治疗后冠脉斑块趋于稳定,血浆MMP-9和LP-PLA2水平降低,且二者有相关性,提示MMP-9和LP-PLA2参与冠状动脉粥样硬化的发病与发展,且对预测ACS高危人群及评价疗效有一定的临床价值。     

不同病情冠心病患者血清心型脂肪酸结合蛋白与颈动脉内膜中层厚度的关系分析

目的:探讨不同病情冠心病患者血清心型脂肪酸结合蛋白(H-FABP)与颈动脉内膜中层厚度(IMT)的关系。方法:选择内蒙古科技大学包头医学院第一附属医院老年科收治的冠心病患者60例,其中稳定型心绞痛(SAP)和急性冠脉综合征(ACS)各30例,根据冠状动脉病变支数将患者分为单支病变组19例、双支病变组19例和多支病变组22例;根据患者冠状动脉血管狭窄程度分为轻度病变组22例、中度病变组17例和重度病变组21例,选择同期健康体检者30例作为对照组。比较各组颈动脉IMT及血清H-FABP水平,并分析其相关性。结果:ACS组颈动脉IMT及血清H-FABP水平显著高于SAP组和对照组,SAP组颈动脉IMT及血清H-FABP水平显著高于对照组(P<0.05)。不同冠状动脉病变支数、病变程度冠心病患者颈动脉IMT及血清H-FABP水平整体比较差异有统计学意义(P<0.05),多支病变组和双支病变组血清H-FABP水平比较无统计学意义(P>0.05)。Spearman相关分析显示,冠心病患者血清H-FABP水平与颈动脉IMT呈正相关(r=0.754,P<0.05)。结论:冠心病患者血清H-FABP水平与颈动脉IMT异常升高,其水平随冠状动脉病变程度加重而升高,且两者呈正相关。