Butyrylcholinesterase Predicts Cardiac Mortality in Young Patients with Acute Coronary Syndrome

Background

The incidence of acute coronary syndrome (ACS) in young people (≤65 years) is continuously rising. While prognostic factors in ACS are well-investigated less attention has been paid to their age-dependent prognostic value and their particular relevance in younger patients. The aim of our study was to assess the age-dependent prognostic impact of butyrylcholinesterase (BChE).

Methods

Retrospective cohort study including 624 patients with ACS. Patients were stratified by age into equal groups (n = 208) corresponding to “young patients” (45–64 years), "middle-aged patients” (65–84 years) and “old patients” (85–100 years). Cox regression hazard analysis was used to assess the influence of BChE on survival.

Results

After a mean follow-up time of 4.0 (interquartile range [IQR] 2.0–6.4) years, 154 patients (24.7%) died due to a cardiac cause. In the overall cohort, BChE was indirectly associated with cardiac mortality-free survival (adjusted hazard ratio (HR): 0.70 (95% confidence interval [CI] 0.53–0.93, p = 0.01). The primary-analysis of BChE by age strata showed the strongest effect in the age group 45–64 years with an adjusted HR per 1-SD of 0.28 (95% CI 0.12–0.64, p = 0.003), a weaker association with mortality in middle aged (65–84 years: adjusted HR per 1-SD 0.66 [95% CI: 0.41–1.06], p = 0.087), and no association in older patients (85–100 years: adjusted HR per 1-SD 0.89 [95% CI: 0.58–1.38], p = 0.613).

Conclusion

BChE is a strong predictor for cardiac mortality specifically in younger patients with ACS aged between 45 and 64 years. No significant association of BChE with cardiac-mortality was detected in other age classes.     

Outcomes of Acute Chest Syndrome in Adult Patients with Sickle Cell Disease: Predictors of Mortality

Adults with sickle cell disease(SCD) are a growing population. Recent national estimates of outcomes in acute chest syndrome(ACS) among adults with SCD are lacking. We describe the incidence, outcomes and predictors of mortality in ACS in adults. We hypothesize that any need for mechanical ventilation is an independent predictor of mortality.

Methods

We performed a retrospective analysis of the Nationwide Inpatient Sample(2004–2010),the largest all payer inpatient database in United States, to estimate the incidence and outcomes of ACS needing mechanical ventilation(MV) and exchange transfusion(ET) in patients >21 years. The effects of MV and ET on outcomes including length of stay(LOS) and in-hospital mortality(IHM) were examined using multivariable linear and logistic regression models respectively. The effects of age, sex, race, type of sickle cell crisis, race, co-morbid burden, insurance status, type of admission, and hospital characteristics were adjusted in the regression models.

Results

Of the 24,699 hospitalizations, 4.6% needed MV(2.7% for <96 hours, 1.9% for ≥96 hours), 6% had ET, with a mean length of stay(LOS) of 7.8 days and an in-hospital mortality rate(IHM) of 1.6%. There was a gradual yearly increase in ACS hospitalizations that needed MV(2.6% in 2004 to 5.8% in 2010). Hb-SS disease was the phenotype in 84.3% of all hospitalizations. After adjusting for a multitude of patient and hospital related factors, patients who had MV for <96 hours(OR = 67.53,p<0.01) or those who had MV for ≥96 hours(OR = 8.73,p<0.01) were associated with a significantly higher odds for IHM when compared to their counterparts. Patients who had MV for ≥96 hours and those who had ET had a significantly longer LOS in-hospitals(p<0.001).

Conclusion

In this large cohort of hospitalized adults with SCD patients with ACS, the need for mechanical ventilation predicted higher mortality rates and increased hospital resource utilization. Identification of risk factors may enable optimization of outcomes.     

Predictors of Acute Respiratory Distress Syndrome in Patients with Paraquat Intoxication

Introduction

Paraquat poisoning is characterized by acute lung injury, pulmonary fibrosis, respiratory failure, and multi-organ failure, resulting in a high rate of mortality and morbidity. The objectives of this study were to identify predictors of acute respiratory distress syndrome (ARDS) in cases of paraquat poisoning and determine the association between these parameters.

Materials and Methods

In total, 187 patients were referred for management of intentional paraquat ingestion between 2000 and 2010. Demographic, clinical, and laboratory data were recorded. Sequential organ failure assessment (SOFA) and Acute Kidney Injury Network (AKIN) scores were collected, and predictors of ARDS were analyzed.

Results

The overall mortality rate for the entire population was 54% (101/187). Furthermore, the mortality rate was higher in the ARDS patients than in the non-ARDS patients (80% vs. 43.80%, P<0.001). Additionally, the ARDS patients not only had higher AKIN_48-h scores (P<0.009), SOFA_48-h scores (P<0.001), and time to ARDS/nadir PaO₂ (P=0.008) but also suffered from lower nadir PaO₂ (P<0.001), nadir AaDO₂ (P<0.001), and nadir eGFR (P=0.001) compared to those in the non-ARDS patients. Moreover, pneumomediastinum episodes were more frequent in the ARDS patients than in the non-ARDS patients (P<0.001). A multivariate Cox regression model revealed that blood paraquat concentrations (P<0.001), SOFA_48-h scores (P=0.001), and steroid and cyclophosphamide pulse therapies (P=0.024) were significant predictors of ARDS. The cumulative survival rates differed significantly (P<0.001) between patients with SOFA_48-h scores <3 and SOFA_48-h scores ≥3, with a sensitivity of 95.8%, specificity of 58.4%, and overall correctness of 67.6%. Finally, the area under the receiver operating characteristic (AUROC) analysis showed that SOFA_48-h scores (P<0.001) had a better discriminatory power than blood paraquat concentrations (P=0.01) for predicting ARDS.

Conclusions

The analytical results indicate that SOFA_48-h scores, blood paraquat concentrations, and steroid and cyclophosphamide pulse therapies are significantly associated with ARDS complications after paraquat intoxication.     

Predictors of Operative Mortality for Coronary Bypass Grafting in Patients with Ischemic Heart Disease

Predictors for operative mortality (OM) were studied in 172 consecutive patients (pts) undergoing coronary artery grafts (CAG) for angina pectoris.Seventy eight pts had Class IV angina; of the 147 patients given propranolol, 41 were gradually withdrawn from propranolol and finally discontinued 24 hours before surgery, and 106 were abruptly withdrawn from propranolol 24 hours before CAG; 20 pts had left main coronary disease; 156 pts had cardiopulmonary bypass (CPB) time shorter than 20 minutes, and 16 pts had a CPB longer than 120 minutes.The operative mortality was 5.2% (9/172) for the entire group. Class IV angina (OM 7%), abrupt propranolol withdrawal (OM 6.6%), left main coronary artery disease (OM 25%), and CPB longer than 120 minutes (OM 50%), all significantly increased OM. These variables were interdependent, however, as many pts belonged to several predictor categories, combinations of predictors were examined, in order to more accurately predict the risk of individual pts. The combination of left main coronary artery disease and CPB longer than 120 minutes; and Class IV angina and CPB longer than 120 minutes were significantly associated with higher operative mortality.We conclude that Class IV angina, abrupt propranolol withdrawal, left main coronary artery disease and prolonged CPB are potent, interdependent predictors of OM in pts undergoing CAG. Consideration of these predictors, alone and in combination, allows effective prediction of OM for CAG in patients with stable angina pectoris.     

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。     

Mortality from Acute Myocardial Infarction Before and After Establishment of a Coronary Care Unit

A retrospective study of the mortality rate of acute myocardial infarction in two groups of patients treated before and after a coronary care unit was established showed no difference between them. Though it is difficult to compare two series retrospectively so far there are no well controlled studies to demonstrate clearly the value of coronary care units.     

The Association between Triglyceride/High-Density Lipoprotein Cholesterol Ratio and All-Cause Mortality in Acute Coronary Syndrome after Coronary Revascularization

Aims

High triglycerides (TG) and low high-density lipoprotein cholesterol (HDL-C) are cardiovascular risk factors. A positive correlation between elevated TG/HDL-C ratio and all-cause mortality and cardiovascular events exists in women. However, utility of TG to HDL-C ratio for prediction is unknown among acute coronary syndrome (ACS).

Methods

Fasting lipid profiles, detailed demographic data, and clinical data were obtained at baseline from 416 patients with ACS after coronary revascularization. Subjects were stratified into three levels of TG/HDL-C. We constructed multivariate Cox-proportional hazard models for all-cause mortality over a median follow-up of 3 years using log TG to HDL-C ratio as a predictor variable and analyzing traditional cardiovascular risk factors. We constructed a logistic regression model for major adverse cardiovascular events (MACEs) to prove that the TG/HDL-C ratio is a risk factor.

Results

The subject’s mean age was 64 ± 11 years; 54.5% were hypertensive, 21.8% diabetic, and 61.0% current or prior smokers. TG/HDL-C ratio ranged from 0.27 to 14.33. During the follow-up period, there were 43 deaths. In multivariate Cox models after adjusting for age, smoking, hypertension, diabetes, and severity of angiographic coronary disease, patients in the highest tertile of ACS had a 5.32-fold increased risk of mortality compared with the lowest tertile. After adjusting for conventional coronary heart disease risk factors by the logistic regression model, the TG/HDL-C ratio was associated with MACEs.

Conclusion

The TG to HDL-C ratio is a powerful independent predictor of all-cause mortality and is a risk factor of cardiovascular events.     

Impact of Coronary Dominance on In-Hospital Outcomes after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome

Objective

This study evaluated the manner in which coronary dominance affects in-hospital outcomes of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).

Background

Previous studies have shown that left dominant coronary anatomies are associated with worse prognoses in patients with coronary artery disease.

Methods

Data were analyzed from 4873 ACS patients undergoing PCI between September 2008 and April 2013 at 14 hospitals participating in the Japanese Cardiovascular Database Registry. The patients were grouped based on diagnostic coronary angiograms performed prior to PCI; those with right- or co-dominant anatomy (RD group) and those with left-dominant anatomy (LD group).

Results

The average patient age was 67.6±11.8 years and both patient groups had similar ages, coronary risk factors, comorbidities, and prior histories. The numbers of patients presenting with symptoms of heart failure, cardiogenic shock, or cardiopulmonary arrest were significantly higher in the LD group than in the RD group (heart failure: 650 RD patients [14.7%] vs. 87 LD patients [18.8%], P = 0.025; cardiogenic shock: 322 RD patients [7.3%] vs. 48 LD patients [10.3%], P = 0.021; and cardiopulmonary arrest: 197 RD patients [4.5%] vs. 36 LD patients [7.8%], P = 0.003). In-hospital mortality was significantly higher among LD patients than among RD patients (182 RD patients [4.1%] vs. 36 LD patients [7.8%], P = 0.001). Multivariate logistic regression analysis revealed that LD anatomy was an independent predictor for in-hospital mortality (odds ratio, 1.75; 95% confidence interval, 1.06–2.89; P = 0.030).

Conclusion

Among ACS patients who underwent PCI, LD patients had significantly worse in-hospital outcomes compared with RD patients, and LD anatomy was an independent predictor of in-hospital mortality.     

电阻抗法在急性冠脉综合征患者中的应用

目的:探讨电阻抗法测定血小板聚集功能在冠心病患者中的应用。方法:通过电阻抗法对486名急性冠脉综合征的患者检测,所有患者分别于服药前和服药后第4天抽取肘静脉血,采血后1小时内用全血阻抗法测定三磷酸腺苷(ADP)和花生四烯酸(AA)诱导的血小板聚集率;其中50例患者出现氯吡格雷抵抗,28例患者出现阿司匹林抵抗。结果:通过电阻抗法测定的抗血小板药物抵抗的发生率(10.29%)与文献报道的一致;在原来抗血小板药物基础增加西洛他唑或者增加氯吡格雷的剂量都能明显改善血小板药物抵抗,随着服药时间的增加血小板药物抵抗呈下降趋势;大剂量氯吡格雷组相比西洛他唑组在改善氯吡格雷抵抗更明显,差异有统计学意义(P0.05)。结论:电阻抗法测定血小板聚集功能方便快捷、安全可靠,更方便指导临床用药。     

Cross-Reacting Antibacterial Auto-Antibodies Are Produced within Coronary Atherosclerotic Plaques of Acute Coronary Syndrome Patients

Coronary atherosclerosis, the main condition predisposing to acute myocardial infarction, has an inflammatory component caused by stimuli that are yet unknown. We molecularly investigated the nature of the immune response within human coronary lesion in four coronary plaques obtained by endoluminal atherectomy from four patients. We constructed phage-display libraries containing the IgG1/kappa antibody fragments produced by B-lymphocytes present in each plaque. By immunoaffinity, we selected from these libraries a monoclonal antibody, arbitrarily named Fab7816, able to react both with coronary and carotid atherosclerotic tissue samples. We also demonstrated by confocal microscopy that this monoclonal antibody recognized human transgelin type 1, a cytoskeleton protein involved in atherogenesis, and that it co-localized with fibrocyte-like cells transgelin+, CD68+, CD45+ in human sections of coronary and carotid plaques. In vitro fibrocytes obtained by differentiating CD14+ cells isolated from peripheral blood mononuclear cells also interacted with Fab7816, thus supporting the hypothesis of a specific recognition of fibrocytes into the atherosclerotic lesions. Interestingly, the same antibody, cross-reacted with the outer membrane proteins of Proteus mirabilis and Klebsiella pneumoniae (and possibly with homologous proteins of other enterobacteriaceae present in the microbiota). From all the other three libraries, we were able to clone, by immunoaffinity selection, human monoclonal antibodies cross-reacting with bacterial outer membrane proteins and with transgelin. These findings demonstrated that in human atherosclerotic plaques a local cross-reactive immune response takes place.     

替格瑞洛在急性冠脉综合征患者经皮冠状动脉介入治疗术后的应用价值

目的:评价替格瑞洛在急性冠脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后的应用价值。方法:将我院收治的565例成功行PCI的急性冠脉综合征(acute coronary syndrome,ACS)患者随机分为2组:氯吡格雷组253例,术后口服氯吡格雷75 mg、QD;替格瑞洛组312例,术后口服替格瑞洛首剂180 mg,维持量90mg、BID。两组患者术后常规口服阿司匹林100 mg、QD。研究主要终点为主要不良心血管事件(major adverse cardiovascular events,MACE),包括全因死亡、靶血管血运重建和脑梗塞;次要终点为TIMI主要出血(定义为血红蛋白下降50 g/L或颅内出血有关的临床显著出血事件)。结果:565例患者平均随访12个月,替格瑞洛组MACE发生率低于氯吡格雷组(3.8%vs.8.7%,P0.05),两组TIMI主要出血事件发生率比较,差异无统计学意义(2.9%vs.3.2%,P0.05)。结论:替格瑞洛能明显减少PCI术后主要不良心血管事件,并不增加主要出血。     

Inflammation Activation Contributes to Adipokine Imbalance in Patients with Acute Coronary Syndrome

Inflammation can be activated as a defensive response by the attack of acute coronary syndrome (ACS) for ischemic tissue injury. The aim of the present study was to investigate the impact of ACS-activated inflammation on adipokine imbalance and the effects of statins on the crosstalk between inflammation and adipokine imbalance during ACS. In this study, 586 subjects were categorized into: (1) control group; (2) SA (stable angina) group; and (3) ACS group. Circulating levels of hs-CRP, adiponectin and resistin were measured by ELISA. Furthermore, forty C57BL/6 mice were randomized into: sham, AMI, low-statin (atorvastatin, 2 mg/kg/day) and high-statin (atorvastatin, 20 mg/kg/day) group. After 3 weeks, AMI models were established by surgical coronary artery ligation. Circulating levels and adipose expressions of adiponectin and resistin were assessed in animals. Besides, we investigate the effects of atorvastatin on ox-LDL-induced adipokine imbalance in vitro. As a result, we found that ACS patients had higher hs-CRP and resistin levels and lower adiponectin levels. Our correlation analysis demonstrated hs-CRP concentrations were positively correlated with resistin but negatively with adiponectin levels in humans. Our animal findings indicated higher circulating hs-CRP and resistin levels and lower adiponectin levels in AMI mice. Atorvastatin pre-treatment dose-dependently decreased hs-CRP and resistin levels but increased adiponectin levels in mice. The consistent findings were observed about the adipose expressions of resistin and adiponectin in mice. In study in vitro, ox-LDL increased cellular resistin expressions and otherwise for adiponectin expressions, which dose-dependently reversed by the addition of atorvastatin. Therefore, our study indicates that the ACS attack activates inflammation leading to adipokine imbalance that can be ameliorated by anti-inflammation of atorvastatin.     

The Value and Distribution of High-Density Lipoprotein Subclass in Patients with Acute Coronary Syndrome

Background

High-density lipoprotein (HDL) enhances cholesterol efflux from the arterial wall and exhibits potent anti-inflammatory and anti-atherosclerosis (AS) properties. Whether raised HDL levels will clinically benefit patients with acute coronary syndrome (ACS) and the value at which these effects will be apparent, however, is debatable. This study examined the HDL subclass distribution profile in patients with ACS.

Methods

Plasma HDL subclasses were measured in 158 patients with established ACS and quantified by two-dimensional gel electrophoresis and immunoblotting. ACS diagnosis was based on symptoms of cardiac ischemia, electrocardiogram (ECG) abnormalities, speciality cardiac enzyme change along with presence of coronary heart disease (CHD) on coronary angiography.

Results

The small-sized preβ₁-HDL, HDL_3b, and HDL_3a levels were significantly higher, and the large-sized HDL_2a and HDL_2b levels were significantly lower in patients with ACS than in those with stable angina pectoris (SAP) and in normal control subjects. Meanwhile, with an elevation in the low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), body mass index (BMI), and blood pressure (BP), and the reduction in the high density lipoprotein cholesterol (HDL-C) levels, the HDL_2b contents significantly decreased and the preβ₁-HDL contents significantly increased in patients with ACS. The correlation analysis revealed that the apolipoprotein (apo)A-I levels were positively and significantly with all HDL subclasses contents; plasma total cholesterol (TC) and fasting plasma glucose (FPG) levels were inversely associated with HDL_2a, and HDL_2b. Moreover, the FPG levels were positively related to HDL_3c, HDL_3b, and HDL_3a in ACS patients.

Conclusion

The HDL subclass distribution profile remodeling was noted in the patients with ACS. Plasma lipoprotein and FPG levels, BP, and BMI play an important role in the HDL subclass metabolism disorder for patients with ACS. The HDL subclass distribution phenotype might be useful as a novel biomarker to assist in the risk stratification of patients with ACS.     

磺达肝癸钠在65岁以上急性心肌梗死患者中的临床应用研究

目的:对比磺达肝癸钠(商品名:安卓,葛兰素史克)与那曲肝素(商品名:速碧林,葛兰素史克)在65岁以上急性心肌梗死患者中的有效性和安全性.方法:入选急性心肌梗死住院患者84例随机分为实验组(安卓2.5 mg每天一次皮下注射7天,n=45)和对照组(速碧林,5000 IU(0.4 ML),每天2次皮下注射7天,n=39),随访1个月.对比实验组和对照组抗凝效果.比较两组住院期间及治疗1个月内心源性死亡发生率及出血发生率.结果:(1)实验组与对照组相比,在治疗1周,心源性死亡发生率显著降低,两者差异有统计学意义(P＜0.05).1个月时,两组比较无统计学意义(P＞0.05)(2)出血发生率,实验组较对照组显著降低,轻中度出血发生率有统计学意义(P＜0.05).严重出血发生率有统计学意义(P＜0.05).结论:在急性心肌梗死患者治疗中,磺达肝癸钠与那曲肝素相比更安全有效.     

强化阿托伐他汀治疗对ACS患者血脂水平的短期影响

目的:观察强化阿托伐他汀治疗对急性冠脉综合征(ACS)患者血脂水平的短期影响。方法:收集100例ACS患者,入院当天(the day of admission,D0)、入院第一天(the first day,D1)及入院第二天(The Second Day,D2)分别给予阿托伐他汀80mg治疗,入院D0立即采血化验血脂参数包括总胆固醇(total cholesterol,TC)、低度脂蛋白(LDL-cholesterol,LDL-C)、高密度脂蛋白(HDL-cholesterol,HDL-C)、甘油三酯(triglycerides,TG),分别在D1和D2晨起空腹复查。结果:总胆固醇的平均基线水平为5.24±0.07(D0),低密度脂蛋白为3.26±0.07,高密度脂蛋白胆固醇为1.07±0.07,甘油三酯为1.31±0.07。口服阿托伐他汀80毫克后第一天早晨,TC水平下降6.1%(D1)(与D0相比P0.001),第二日下降13.2%(D2)(与D0相比P0.001),LDL-C下降5.8%(D1)(DO与D1相比,P0.001)和15.6%(D2)(DO与D2相比,P0.001);HDL-C下降7.5%(D1)(DO与D1相比,P0.001)和12.1(D2)(DO与D2相比,P0.001);相反TG水平升高20.6%(D1)(DO与D1相比,P0.001)和25.5%(D2)(DO与D2相比,P0.001)。结论:强化他汀治疗对ACS患者血脂短期的影响与长期的影响是不同的,TC,LDL和HDL在短期内是下降的,而TG是升高的。     

Cardiac Troponin I in Non- Acute Coronary Syndrome Patients with Chronic Kidney Disease

Objective

The aim of this study was to assess the results of troponin I (cTnI) in non- acute Coronary Syndrome (ACS) patients with chronic kidney disease (CKD). We also examined the risk factors for elevated cTnI in non-ACS patients with CKD and whether stage 5 CKD modifies the associations of elevated cTnI and the risk factors in non-ACS patients with CKD.

Methods

A retrospective study was performed. Logistic regression models were used.

Results

293 non-ACS patients with CKD were included in the current study. 43.34% non-ACS patients with CKD have an elevated cTnI level and 5.12% have an elevated cTnT level in MI range. In CKD patients without ACS and heart failure, only 26.03% (38/146) patients have an elevated cTnT level. In adjusted analyses, age, diastolic blood pressure and congestive heart failure is associated with an elevated cTnI level in non-ACS patients with CKD. Congestive heart failure is associated with an elevated cTnI level in non-ACS patients with CKD (OR 2.30, 95% CI 1.08,4.88, P=0.03). Stage 5 CKD does not modify the association of congestive heart failure and an elevated cTnI level.

Conclusion

43.34% non-ACS patients with CKD and 26.03% CKD patients without ACS and congestive heart failure have an elevated cTnI level. Congestive heart failure is associated with an elevated cTnI level in non-ACS patients with CKD. Stage 5 CKD does not modify the association of congestive heart failure and an elevated cTnI level.     

阿托伐他汀钙片治疗急性冠脉综合征的临床疗效

目的:探讨阿托伐他片汀治疗急性冠脉综合征(ACS)的临床疗效。方法:选择2013年3月至2013年12月我院收治的156例ACS患者,按随机字数表法分为实验组和对照组各78例,两组均采取常规治疗,实验组在此基础上加用阿托伐他汀钙片,对照组则用辛伐他汀滴丸。对比两组治疗效果及心血管事件发生率。结果:两组治疗后总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、血清高敏C反应蛋白(hs-CRP)、纤维蛋白原(Fg)和尿酸水平均明显下降,且实验组下降更明显,比较差异均有统计学意义(P0.05);治疗期间实验组心血管事件发生率率为8.97%(7/78),显著低于对照组的24.36%(19/78),比较差异均有统计学意义(P0.05)。结论:阿托伐他汀片治疗ACS的临床效果优于辛伐他汀滴丸,能有效降低心血管事件的发生,值得的临床推广。     

急性冠脉综合征患者r-GGT、Hs-CRP水平变化研究

目的：比较急性冠脉综合征患者与健康人血清中γ- 谷氨酰转移酶（γ-GGT）、高敏C- 反应蛋白（Hs-CRP）浓度,探究其水平 变化与急性冠脉综合征的相关性。方法：选取我院心血管科收治的急性冠脉综合征患者60 例。根据病情的不同,分为不稳定型心 绞痛组30 例和急性心肌梗死组30 例,选取同期进行健康体检的健康人30 例,作为对照组。对三组患者血清中γ-GGT 与 Hs-CRP 水平进行比较。结果：①三组患者血清γ-GGT、Hs-CRP 水平比较：患者血清γ-GGT 水平比较,不稳定型心绞痛组及急性心 肌梗死组显著高于对照组,且急性心肌梗死组显著高于不稳定型心绞痛组,差异有统计学意义（P＜0.05）;患者血清Hs-CRP 水平 比较,不稳定型心绞痛组及急性心肌梗死组显著高于对照组,且急性心肌梗死组显著高于不稳定型心绞痛组,差异有统计学意义 （P＜0.05）;②单支、双支、三支病变组与冠脉64 排螺旋CT 检查阴性组酌-GGT、Hs-CRP水平比较：单支、双支、三支病变组血清中 γ-GGT、Hs-CRP水平明显高于冠脉64 排螺旋CT 检查阴性对照组,差异有统计学意义（P<0.05）;血清中 γ-GGT、Hs-CRP浓度在 单支、双支、三支病变组中与病变支数成正向相关。结论：急性冠脉综合征患者血清γ-GGT、Hs-CRP水平显著高于正常值,临床上 可根据两者水平变化,进行早期诊断,同时由于血清γ-GGT、Hs-CRP变化较为敏感,可根据观测两者水平,判断冠状动脉病变的 严重程度,对急性冠脉综合征患者的早期诊断、病情预测有着重要意义,值得临床广泛应用。     

替罗非班对老年急性冠脉综合征患者血清 sCD40L水平的影响

目的：观察替罗非班对老年急性冠脉综合征(ACS)患者血清可溶性CD40 配体(sCD40L)水平的影响。方法：将120 例老年 ACS患者,按照临床治疗方法分为非介入组(60 例)和介入组(60 例)。每组患者再随机分为两个亚组：对照组和替罗非班组。非介 入组中的对照组应用阿司匹林、氯吡格雷、低分子肝素等常规药物治疗;替罗非班组则在对照组常规治疗的基础上加用盐酸替罗 非班持续治疗72 h。介入组应用PCI,其中对照组在PCI 术前嚼服阿司匹林和氯吡格雷,低分子肝素皮下注射,术中鞘内注射肝 素;替罗非班组在常规治疗的同时,于PCI术前10 min 开始以10 滋g/kg 的替罗非班冠状动脉内注射。各组患者均在治疗前及治 疗后48 h采用酶联免疫吸附测定(ELISA)法测定血清sCD40L水平。结果：介入组和非介入组的替罗非班组患者治疗后48 h的血 清sCD40L浓度较治疗前明显降低,差异有统计学意义(P<0. 05)。结论：替罗非班可以降低ACS患者的血清sCD40L水平,从而发 挥除抗栓以外的抗炎作用。