血清GDF-15、hs-cTnT对冠状动脉旁路移植术后新发房颤及近期主要心血管事件的预测效能研究

摘要 目的：分析血清生长分化因子15（GDF-15）、高敏心肌肌钙蛋白T（hs-cTnT）对冠状动脉旁路移植术后新发心房颤动（房颤）及近期主要心血管事件的预测效能。方法：选择自2020年1月至2022年1月在我院行冠状动脉旁路移植术的140例冠心病患者作为研究对象,根据术后是否新发房颤,分为房颤组（46例）和非房颤组（94例）。检测两组术前血清GDF-15、hs-cTnT水平,使用多因素Logistic回归分析血清GDF-15、hs-cTnT与术后新发房颤的关系;随访6个月,观察主要心血管事件发生情况,通过受试者工作特征曲线下面积（AUC）评价血清GDF-15、hs-cTnT对术后新发房颤及近期主要心血管事件的预测效能。结果：两组患者年龄、性别、体重指数等一般资料比较无差异（P＞0.05）;房颤组SYNTAX积分高于非房颤组,差异有统计学意义(P＜0.05);房颤组血清GDF-15、hs-cTnT水平均高于非房颤组（P＜0.05）;经多因素Logistic回归分析,SYNTAX积分、血清GDF-15、hs-cTnT均是冠状动脉旁路移植术后新发房颤的独立预测因素（P＜0.05）;经ROC曲线分析,血清GDF-15联合hs-cTnT预测冠状动脉旁路移植术后新发房颤的AUC为0.933,大于SYNTAX积分的0.790,预测近期主要心血管事件的AUC为0.925,大于SYNTAX积分的0.750（P＜0.05）。结论：血清GDF-15联合hs-cTnT对冠状动脉旁路移植术后新发房颤及近期主要心血管事件均具有良好的预测效能,值得临床予以重视。     

血清ApoB/ApoA1比值、TG/HDL-C比值、LDH及ALP水平与冠心病患者冠状动脉病变严重程度的关系及其预测价值分析

摘要 目的：探讨血清载脂蛋白B（ApoB）/载脂蛋白A1（ApoA1）比值、三酰甘油（TG）/高密度脂蛋白胆固醇（HDL-C）比值、乳酸脱氢酶（LDH）及碱性磷酸酶（ALP）水平与冠心病（CHD）患者冠状动脉病变严重程度的关系及其预测价值。方法：选取2019年1月-2021年12月因胸痛来我院检查并收治的185例患者,根据检查结果是否为CHD分为CHD组（120例）和对照组（65例）,根据Gensini评分将CHD组分为轻度狭窄亚组36例、中度狭窄亚组55例、重度狭窄亚组29例。入院后检测血清ApoB/ApoA1比值、TG/HDL-C比值、LDH及ALP水平。采用Spearman相关系数分析CHD患者血清ApoB/ApoA1比值、TG/HDL-C比值、LDH、ALP水平与Gensini评分的相关性,采用多因素Logistic回归分析CHD的影响因素;受试者工作特征（ROC）曲线分析血清ApoB/ApoA1比值、TG/HDL-C比值、LDH及ALP水平对CHD的预测价值。结果：与对照组比较,CHD组吸烟、饮酒、高血压、糖尿病比例和血清总胆固醇（TC）、TG、低密度脂蛋白胆固醇（LDL-C）、ApoB、ApoB/ApoA1比值、TG/HDL-C比值、LDH、ALP水平升高,HDL-C、ApoA1水平降低（P＜0.05）。轻度、中度、重度狭窄亚组血清ApoB/ApoA1比值、TG/HDL-C比值、LDH及ALP水平依次升高（P＜0.05）。CHD患者血清ApoB/ApoA1比值、TG/HDL-C比值、LDH、ALP水平与Gensini评分呈正相关（P均＜0.001）。多因素Logistic回归分析显示,高血压、血清ApoB/ApoA1比值、TG/HDL-C比值、LDH、ALP水平升高为CHD的独立危险因素（P＜0.05）。ROC曲线分析显示,血清ApoB/ApoA1比值、TG/HDL-C比值、LDH及ALP水平联合预测CHD的曲线下面积大于单独预测（P＜0.05）。结论：血清ApoB/ApoA1比值、TG/HDL-C比值、LDH、ALP水平与CHD患者冠状动脉病变严重程度有关,且联合预测CHD的价值较高。     

基于老年综合评估结果指导治疗对老年冠心病患者心功能、脂代谢和生活质量的影响

摘要 目的：探讨基于老年综合评估结果指导（CGA）治疗对老年冠心病患者心功能、脂代谢和生活质量的影响。方法：本次研究将2020年6月-2022年1月在江苏省人民医院心血管内科接受治疗的106例老年冠心病患者,采用随机数字法将其随机分为对照组（常规药物治疗,53例）与研究组（对照组的基础上结合CGA治疗,53例）。对比两组疗效、心功能、脂代谢和生活质量相关情况。结果：研究组的临床总有效率为94.34%,明显高于对照组的79.25%（P<0.05）。研究组治疗3个月后左心室舒张期末内径（LVEDD）、左心室收缩期末内径（LVESD）低于对照组,左心室射血分数（LVEF）高于对照组（P<0.05）。研究组治疗3个月后高密度脂蛋白胆固醇（HDL-C）高于对照组,甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）低于对照组（P<0.05）。研究组治疗3个月后病情、体力、医疗状况、一般生活、社会心理状况、工作状况各维度评分高于对照组（P<0.05）。研究组的住院期间心脏不良事件总发生率低于对照组（P<0.05）。结论：基于CGA治疗老年冠心病,可有效改善心功能、脂代谢,降低住院期间不良事件发生率,提高患者的生活质量。     

Ultrastructural localization of nitric oxide synthase and endothelin in coronary and pulmonary arteries of newborn rats

This is the first report on the ultrastructural distribution of nitric oxide synthase and endothelin immunoreactivities in the coronary and pulmonary arteries of newborn Wistar rats. The distribution of nitric oxide synthase and endothelin was investigated using pre-embedding peroxidase-antiperoxidase immunocytochemistry. In both arteries examined, positive labelling for nitric oxide synthase was localized both in the endothelium and smooth muscle, whereas positive labelling for endothelin was localized in the endothelium exclusively. In the coronary artery, approximately 80% and 55% of the endothelial cells examined were positive for nitric oxide synthase and endothelin, respectively, whereas in the pulmonary artery, 77% and 60% of the endothelial cells were positive for nitric oxide synthase and endothelin, respectively. These findings indicate that nitric oxide synthase and endothelin are colocalized in some of the endothelial cells of the newborn rat. In the endothelium, nitric oxide synthase and endothelin immunoreactivities were distributed throughout the cell cytoplasm and in association with the membranes of intracellular organelles. In smooth muscle, a relationship of nitric oxide synthase immunoreactivity to endoplasmic reticulum was observed in the pulmonary artery. In summary, in the newborn rat, endothelial cells of the coronary and pulmonary artery are rich in nitric oxide synthase (neuronal isoform) and endothelin, and it is suggested therefore that they may be substantially involved in vasomotor control of the cardiac and pulmonary circulation during early stages of postnatal development.     

Neuropeptide Y modulates the action of vasodilator agents in guinea-pig epicardial coronary arteries

Recently, we have demonstrated that guinea-pig epicardial coronary arteries are supplied by numerous nerve fibres containing neuropeptide Y (NPY) immunoreactivity. However, examination of vasomotor responses revealed that NPY did not elicit a contractile response in these arteries. In contrast, acetylcholine (ACh), calcitonin gene-related peptide (CGRP), substance P and vasoactive intestinal polypeptide (VIP) all relaxed precontracted arteries. In the present study, we have used histochemical, immunohistochemical and in vitro pharmacological techniques, in order to further investigate the possible role of NPY in guinea-pig epicardial coronary arteries. A double-immunofluorescence staining technique revealed that CGRP and substance P were co-localized in nerve fibres distinct from those displaying NPY immunoreactivity. Furthermore, using a method combining immunofluorescence and histochemical techniques, we observed that putative cholinergic nerve fibres (identified by their acetylcholinesterase content) and NPY-immunoreactive nerve fibres are two different nerve populations. An in vitro pharmacological method demonstrated that NPY markedly inhibited the relaxant responses mediated by ACh, VIP, substance P and isoprenaline but had no effect on CGRP. These results suggest that NPY-containing nerves associated with guinea-pig epicardial coronary arteries may be predominantly involved in modulating the action of vasodilator agents.     

基于CT血管成像的血流储备分数对肺癌的诊断价值

目的:探讨基于CT血管成像的血流储备分数对肺癌淋巴结转移的诊断价值。方法:2018年1月到11月选择在本院进行诊治的肺癌患者60例,所有患者都给予常规CT检查与CT血管成像,记录成像特征与相关血流储备分数-血流量(blood flow,BF)、血容量(blood volume,BV)、平均通过时间(mean transit time,MTT),判断诊断价值。结果:在60例患者中,病理确诊为淋巴结转移20例,非淋巴结转移40例。转移组的毛刺征、分叶征、棘突征、空泡征等CT征象发生率显著高于非转移组(P0.05)。转移组的肺动脉BF、BV值显著低于非转移组(P0.05),MTT值显著高于非转移组(P0.05)。在60例患者中,Spearman相关分析显示淋巴结转移与MTT成显著正相关性(P0.05),与BF、BV值成显著负相关性(P0.05)。结论:CT血管成像在肺癌中的应用能反映患者的血流储备分数状况,有利于判断患者的淋巴结转移情况,有很好的应用价值。     

超微血流成像术用于肾移植患者术后评估的临床价值分析

目的:探讨超微血流成像术用于肾移植患者术后评估的临床价值。方法:选取我院2019年2月-2019年8月收治的60例肾移植患者的临床资料,根据术后恢复情况分为A、B、C三组,A组(27例,术后肾功能恢复良好)、B组(20例,术后发生过敏肾功能异常病变但治疗后肾功恢复正常)、C组(13例,术后血肌酐水平持续增高肾功能异常者),三组均采用超微血管流成像术检测血管指数,比较不同组患者的血管指数并分析其与血肌酐水平的关系。结果:三组患者的肾移植长径、前后径、左右径、皮质厚度、叶间动脉阻力指数比较无显著差异(P0.05)。C组患者的肾皮质血管指数(23.34±6.03%)明显低于A组(33.23±3.45%)、B组(31.23±4.23%)(P0.05)。肾功能异常患者肾皮质的血管指数较低,且随着血肌酐水平的升高而下降,两者呈显著负相关(r=-0.23,P0.05)。结论:超声微血流成像术用于肾移植患者术后评估可较好地反映肾皮质血供及术后肾功能的变化。     

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。     

1D-CADCapsNet: One dimensional deep capsule networks for coronary artery disease detection using ECG signals

PurposeCardiovascular disease (CVD) is a leading cause of death globally. Electrocardiogram (ECG), which records the electrical activity of the heart, has been used for the diagnosis of CVD. The automated and robust detection of CVD from ECG signals plays a significant role for early and accurate clinical diagnosis. The purpose of this study is to provide automated detection of coronary artery disease (CAD) from ECG signals using capsule networks (CapsNet).MethodsDeep learning-based approaches have become increasingly popular in computer aided diagnosis systems. Capsule networks are one of the new promising approaches in the field of deep learning. In this study, we used 1D version of CapsNet for the automated detection of coronary artery disease (CAD) on two second (95,300) and five second-long (38,120) ECG segments. These segments are obtained from 40 normal and 7 CAD subjects. In the experimental studies, 5-fold cross validation technique is employed to evaluate performance of the model.ResultsThe proposed model, which is named as 1D-CADCapsNet, yielded a promising 5-fold diagnosis accuracy of 99.44% and 98.62% for two- and five-second ECG signal groups, respectively. We have obtained the highest performance results using 2 s ECG segment than the state-of-art studies reported in the literature.Conclusions1D-CADCapsNet model automatically learns the pertinent representations from raw ECG data without using any hand-crafted technique and can be used as a fast and accurate diagnostic tool to help cardiologists.