Tp-e间期、P波离散度对室性心律失常病情的预测价值

摘要 目的：探讨Tp-e间期、P波离散度(Pd)对室性心律失常病情的预测价值。方法：2016年6月到2018年6月选择在本院诊治的心绞痛患者110例,所有患者都给予动态心电图检查,记录Tp-e间期、Pd值与室性心律失常发生情况。随访患者的心绞痛复发情况,并判定预测价值。结果：在110例患者中,发生室性心律失常48例(失常组),发生率为43.6 %,其中偶发室早21例、频发室早19例、室早4例、心室颤动3例、室性心动过速1例。失常组的Tp-e间期、Pd值都显著高于非失常组(P<0.05)。随访至今,失常组的心绞痛复发率为45.8 %,显著低于对照组的8.1 %(P<0.05)。在失常组中,单因素与多因素logistics回归分析显示Tp-e间期、Pd都为影响患者心绞痛复发的重要因素(P<0.05)。ROC曲线分析显示Tp-e间期、Pd预测心绞痛复发的敏感性与特异性都在85.0 %以上。结论：心绞痛合并室性心律失常患者多伴随有Tp-e间期、Pd增加,也会增加患者的复发率,Tp-e间期、Pd对预测室性心律失常复发情况具有重要价值。     

Diagnostic approach in patients with angina and no obstructive coronary artery disease: emphasising the role of the coronary function test

BackgroundMany patients with angina do not have obstructive coronary artery disease (CAD), also referred to as “Ischaemia with No Obstructive Coronary Arteries“ (INOCA). Coronary vascular dysfunction is the underlying cause of this ischaemic heart disease in as much as 59–89% of these patients, including the endotypes of coronary microvascular dysfunction and epicardial coronary vasospasm. Currently, a coronary function test (CFT) is the only comprehensive diagnostic modality to evaluate all endotypes of coronary vascular dysfunction in patients with INOCA.ObjectiveIn this paper we discuss the relevance of performing a CFT, provide considerations for patient selection, and present an overview of the procedure and its safety.MethodsWe reviewed the latest published data, guidelines and consensus documents, combined with a discussion of novel original data, to present this point of view.ResultsThe use of a CFT could lead to a more accurate and timely diagnosis of vascular dysfunction, identifies patients at risk for cardiovascular events, and enables stratified treatment which improves symptoms and quality of life. Current guidelines recommend considering a CFT in patients with INOCA and persistent symptoms. The safety of the procedure is comparable to that of a regular coronary angiography with physiological measurements. Non-invasive alternatives have limited diagnostic accuracy for the identification of coronary vascular dysfunction in patients with INOCA, and a regular coronary angiography and/or coronary computed tomography scan cannot establish the diagnosis.ConclusionsA complete CFT, including acetylcholine and adenosine tests, should be considered in patients with INOCA.Supplementary InformationThe online version of this article (10.1007/s12471-020-01532-9) contains supplementary material, which is available to authorized users.     

The enhancement of stability of p53 in MTBP induced p53–MDM2 regulatory network

We have modeled an MTBP-MDM2–p53 regulatory network by integrating p53–MDM2 autoregulatory model (Proctor and Gray, 2008) with the effect of a cellular protein MTBP (MDM2 binding protein) which is allowed to bind with MDM2 (Brady et al., 2005). We study this model to investigate the activation of p53 and MDM2 steady state levels induced by MTBP protein under different stress conditions. Our simulation results in three approaches namely deterministic, Chemical Langevin equation and stochastic simulation of Master equation show a clear transition from damped limit cycle oscillation to fixed point oscillation during a certain time period with constant stress condition in the cell. This transition is the signature of transition of p53 and MDM2 levels from activated state to stabilized steady state levels. We present various phase diagrams to show the transition between unstable and stable states of p53 and MDM2 concentration levels and also their possible relations among critical value of the parameters at which the respective protein level reach stable steady states. In the stochastic approach, the dynamics of the proteins become noise induced process depending on the system size. We found that this noise enhances the stability of the p53 steady state level.     

急性缺血心肌炎症与再灌注

近20年来,随着经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的发展,相关的研究日益增多,许多研究显示炎症反应在行PCI治疗的患者的预后中发挥着很大的作用。PCI术后患者心肌再灌注的疗效日益引起人们的关注,尤其是再灌注无复流的危害和重要性,如何控制炎症因子(如hs-CRP,IL-6,TNF-α等)的水平,以有益于行PCI术的患者,需要更多一些前瞻性研究去观察。     

不稳定心绞痛患者超敏C 反应蛋白水平与病变血管支数的关系

目的:探讨超敏c反应蛋白(hs-CRP)水平对于不稳定心绞痛(UA)患者多支血管病变的诊断价值。方法:回顾性选取不稳定心绞痛患者据其动脉造影结果分为单支病变组、多支病变组均行超敏c反应蛋白检测并比较两组的差异,在阳性结果基础上行ROC曲线分析。结果:1.单支病变组、多支病变组hs-CRP存在显著差异;2.ROC曲线下面积>0.5。结论:针对于不稳定心绞痛患者其超敏c反应蛋白水平与病变血管支数关系密切,对于临床诊断有一定价值。     

参元益气活血胶囊联合心痛贴穴位贴敷对不稳定性心绞痛气虚血瘀证患者脂代谢和氧化应激的影响

摘要 目的：观察参元益气活血胶囊联合心痛贴穴位贴敷对不稳定性心绞痛（UA）气虚血瘀证患者脂代谢和氧化应激的影响。方法：按照随机数字表法将2020年3月~2022年9月期间首都医科大学附属北京中医医院收治的100例UA患者分为对照组（常规西医治疗和心痛贴穴位贴敷）和研究组（对照组的基础上接受参元益气活血胶囊治疗），各为50例。对比两组中医证候积分、心绞痛发作次数和持续时间、脂代谢指标[总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）]、氧化应激指标[超氧化物歧化酶（SOD）、丙二醛（MDA）]、心功能指标[左心室射血分数（LVEF）、心输出量（CO）、左心室舒张末期内径（LVEDD）]。结果：两组治疗4周后胸痛、胸闷、气短、心悸、神倦乏力、自汗、不寐评分均下降，且研究组均低于对照组（P<0.05）。两组治疗4周后心绞痛发作次数减少，持续时间缩短，且研究组改善幅度大于对照组（P<0.05）。两组治疗4周后TG、TC、LDL-C下降，HDL-C升高，且研究组改善幅度大于对照组（P<0.05）。两组治疗4周后SOD升高，MDA下降，且研究组改善幅度大于对照组（P<0.05）。两组治疗4周后LVEF、CO升高，LVEDD下降，且研究组改善幅度大于对照组（P<0.05）。结论：参元益气活血胶囊联合心痛贴穴位贴敷治疗UA气虚血瘀证患者，可减少心绞痛发作次数，缩短持续时间，促进临床症状改善，改善心功能、脂代谢和氧化应激水平。     

Further evidence for the contribution of the vascular endothelial growth factor gene in coronary artery disease susceptibility

Coronary artery disease (CAD) receives intensive attentions in the research of cardiovascular diseases, due to its high incidence and severe impact on the quality of life vascular endothelial growth factor (VEGF), a potent angiogenic and vascular permeability factor, has been strongly implicated in the pathogenesis of CAD. Genetic markers in different regions of the VEGF gene have a plausible role in modulating the risk of CAD. To identify the markers contributing to the genetic susceptibility to CAD, we examined the potential association between CAD and 10 single nucleotide polymorphisms (SNPs, rs699947, rs1570360, rs2010963, rs833068, rs3024997, rs3025000, rs3025010, rs3025020, rs3025030, rs3025039) of the VEGF gene using the MassARRAY system. Participants included 242 CAD patients and 253 healthy controls from a Chinese Han Population (He'nan Province, China). The allelic or genotypic frequencies of the rs699947 (5′ untranslated regions, 5′UTR) and rs2010963 (5′UTR) polymorphisms in the CAD patients were significantly different from those in the healthy controls. The CAD patients had significantly higher frequency of the rs699947 A allele (χ² = 11.141, P = 0.001, OR = 1.665, 95% CI = 1.232–2.250) and rs2010963 C allele (χ² = 13.593, P = 0.0002, OR = 1.611, 95% CI = 1.249–2.077). Strong linkage disequilibrium was observed in the rs699947–rs1570360–rs2010963 haplotype block (D’ > 0.9). Significantly more C–G–C haplotypes (P = 0.040) and significantly fewer C–G–G haplotypes (P = 0.0004) were found in the CAD patients. The possible association of rs699947 and rs2010963 with CAD risks warrant confirmation in independent case–control studies and may be informative for future investigations on the pathogenesis of CAD.     

心可舒胶囊联合氯吡格雷对冠心病心绞痛患者血管内皮功能、血液流变学及炎症因子的影响

摘要 目的：观察心可舒胶囊联合氯吡格雷对冠心病心绞痛患者血管内皮功能、血液流变学及炎症因子的影响。方法：选取2020年3月~2021年10月期间中国人民解放军东部战区总医院收治的92例冠心病心绞痛患者。按照信封抽签法分为对照组（46例）和观察组（46例）。对照组患者接受氯吡格雷治疗,观察组接受心可舒胶囊联合氯吡格雷治疗,对比两组疗效、血管内皮功能、血液流变学、炎症因子、心绞痛发作频率、硝酸甘油用量、心绞痛发作持续时间及不良反应。结果：与对照组相比,观察组治疗1个月后的临床总有效率更高（P<0.05）。与对照组相比,观察组治疗1个月后全血黏度、血浆比黏度、红细胞聚集指数更低（P<0.05）。与对照组相比,观察组治疗1个月后内皮素-1（ET-1）更低,一氧化氮（NO）更高（P<0.05）。与对照组相比,观察组治疗1个月后白介素-6（IL-6）、超敏C反应蛋白（hs-CRP）、单核细胞趋化蛋白-1（MCP-1）更低（P<0.05）。与对照组相比,观察组治疗1个月后心绞痛发作频率、硝酸甘油用量更少,心绞痛发作持续时间更短（P<0.05）。两组不良反应发生率组间对比无统计学差异（P>0.05）。结论：心可舒胶囊联合氯吡格雷可改善冠心病心绞痛患者临床症状,改善血管内皮功能和血液流变学,降低炎症因子水平,效果显著。     

冠心舒通胶囊联合尼可地尔对冠心病稳定型心绞痛心血瘀阻型患者心功能、血液流变学和炎症因子的影响

摘要 目的：观察冠心舒通胶囊联合尼可地尔在冠心病稳定型心绞痛心血瘀阻型患者中的应用价值。方法：根据随机数字表法,将广州中医药大学附属重庆北碚中医院2021年1月~2021年12月期间收治的冠心病稳定型心绞痛患者108例分为对照组（尼可地尔治疗,n=54）和观察组（冠心舒通胶囊联合尼可地尔治疗,n=54）。对比两组临床疗效、炎症因子水平、硝酸甘油片用量、西雅图心绞痛量表评分、中医证候总积分、血液流变学指标、心功能、不良反应。结果：治疗后,观察组的临床总有效率高于对照组（P<0.05）。治疗后,观察组西雅图心绞痛量表评分高于对照组,硝酸甘油片使用量少于对照组,中医证候总积分低于对照组（P<0.05）。治疗后,观察组左心室射血分数（LVEF）、心脏指数（CI）、左心室短轴缩短分数（LVFS）高于对照组（P<0.05）。治疗后,观察组全血黏度、血浆黏度及红细胞比容低于对照组（P<0.05）。治疗后,观察组白介素-1（IL-1）、肿瘤坏死因子-α（TNF-α）、髓过氧化物酶（MPO）、C反应蛋白（CRP）水平低于对照组（P<0.05）。两组不良反应发生率组间对比,无统计学差异（P>0.05）。结论：尼可地尔与冠心舒通胶囊联合治疗可提高冠心病稳定型心绞痛心血瘀阻型患者的治疗效果,改善其心功能和血液流变学,降低炎症因子水平,具有一定临床应用价值。     

Carvedilol modifies antioxidant status of patients with stable angina

The aim of this study was to evaluate the effect of carvedilol on the enzymatic antioxidative defence and plasma antioxidative activity in patients with stable angina. The study comprised 30 patients, aged 37–49 years with stable angina. Patients received carvedilol in escalating doses of 12.5 mg/24 h, 25 mg/24 h, and 50 mg/24 h for 4 weeks each. The control group was matched for age and gender, and consisted of 12 healthy volunteers, aged 39-49 years. Blood samples were collected from the cubital vein before and 4, 8 and 12 weeks after the therapy from the patients and once from the control group. For all the subjects, the superoxide dismutase (SOD-1), glutathione peroxidase (GSH-Px), catalase (CAT) activities in the erythrocytes and the antioxidant activity of the blood plasma were determined. The enzymatic antioxidative defence was significantly decreased in patients with stable angina in comparison to the healthy subjects. During the carvedilol therapy, an increase in the SOD-1, GSH-Px and CAT activities was observed. Moreover, 8 and 12 weeks after carvedilol therapy, the GSH-Px activity did not differ significantly from that observed in the group of healthy subjects. Carvedilol also increased the plasma antioxidative activity in patients with stable angina, but its level remained significantly lower than in the control group. In conclusion, carvedilol enhances antioxidant defense mechanisms in patients with chronic stable angina pectoris.