血清基质金属蛋白酶-2与冠心病的相关性分析

目的:探讨冠心病患者血清基质金属蛋白酶-2(MMP-2)的表达水平及与冠状动脉内径狭窄程度的相关关系.方法:通过ELISA法检测冠心病患者(n=24)和正常对照组(n=25)血清MMP-2水平,并分析冠心病患者MMP-2水平与冠状动脉内径狭窄程度的相关关系.结果:冠心病患者和健康对照组血清MMP-2表达水平依次为(48.92±14.86)ng/mL和(25.77±8.82)ng/mL,差异具有显著性(t=6.663,P=0.001);冠心病患者的MMP-2水平与冠状动脉内径狭窄程度之间存在明显相关关系(P＜0.01).结论:冠心病患者血清的MMP-2水平有明显的升高,并且MMP-2水平与冠状动脉内径狭窄程度关系密切,可能参与了冠心病的发生发展过程.     

冠心病患者人体成分的测定与回顾性分析

目的:探讨肥胖与冠心病的相关性.方法:随机整样选取体检人员中175例男性冠心病患者(冠心痛组)及175例健康男性(对照组),应用生理电阻抗分析(bioelectrical impedance analysis,BIA)进行人体成分测定,并对测定结果进行统计分析.结果:(1)冠心病组与对照组的人体成份组成比较,体脂肪(BF)、体脂百分数(BF%)、腰臀脂肪比(WHR)在冠心病组明显升高(P＜0.05),下肢非脂肪物质(LBM)明显下降(P＜0.05);(2)以BF%作为标准,冠心病组的肥胖率明显高于对照组(P＜0.01);(3)多因素逐步回归分析显示,冠心病与BF%、WHR、下肢LBM具有显著的回归效果,且WHR的偏回归系数最大.结论:肥胖是冠心病的危险因素之一,在冠心病的发病中起着重要作用.冠心痛与肥胖,特别是中央型肥胖关系密切.     

冠心病患者冠脉支架术后发生再狭窄的危险因素回归分析

目的:探讨冠心病患者冠脉支架手术后发生再狭窄的危险因素,为提高临床治疗效果和改善预后提供指导。方法:回顾性分析2014年1月至2015年12月我院收治的226例行冠脉支架手术的冠心病患者临床病历资料,采用SPSS21.0分析冠脉再狭窄的发生情况及危险因素。结果:51例冠心病患者冠脉支架术后发生冠脉再狭窄(22.57%)。单因素分析显示,不同吸烟史、糖尿病史、脂蛋白a(Lp(a))水平、空腹血糖、尿素氮(BUN)、总胆红素、术前病变狭窄程度、植入支架支数、长度以及直径组冠心病患者的冠脉再狭窄发生率比较,差异有统计学意义(P0.05)。多因素Logistic回归分析,吸烟史、糖尿病史、Lp(a)水平、术前病变狭窄程度、植入支架支数、长度是冠心病患者冠脉支架术后再狭窄发生的独立危险因素,OR分别为2.261、1.944、3.593、2.798、2.449、3.823,差异有统计学意义(P0.05),植入支架直径是冠脉再狭窄发生的保护因素,OR为0.261,差异有统计学意义(P0.05)。结论:冠脉植入支架的总长度、数量,术前病变的狭窄程度、Lp(a)水平、糖尿病以及吸烟是冠心病患者冠脉支架术后发生再狭窄的独立危险因素,临床应不断优化支架并根据再狭窄的危险因素采取针对性的防治措施。     

Venous Graft Surgery in Treatment of Coronary Heart Disease

Sixty-seven patients have had aortocoronary venous graft bypass surgery by one surgeon for the relief of symptoms of severe coronary heart disease, including eight emergency operations. The overall operative, hospital, and late mortality was low in patients with favourable myocardial function and no previous myocardial infarction. There was a 7% mortality in patients with a normal preoperative chest radiogram, 8% mortality when the left ventricular end-diastolic pressure was normal preoperatively, and a 5% mortality in patients who had normal left ventricular angiograms. The overall mortality in all elective operations for cardiac pain resistant to medical treatment was 15·8%. 89% of survivors improved; 67% are pain-free. Exercise tolerance in survivors is increased by 135%, atrial pacing results are improved by 10%. Left ventricular end-diastolic pressure is unchanged. Left ventricular function on angiography is improved. The improvement in left ventricular function assessed objectively correlates positively with vein-graft patency, as does freedom from angina pectoris.     

Circadian Variation of Cardiac Performance in Coronary Heart Disease

To study the circadian variation of cardiac performance in patients with coronary heart disease, three exercise tests on a bicycle crgometer were performed during the active part of the day (10 a.m., 2 p.m. and 6 p.m.), recording ST-segment depression and pulmonary capillary wedge pressure. Ten male patients with angiographically documented coronary heart disease underwent bicycle ergometry during placebo and during nitrate therapy (placebo controlled, double-blind crossover 2 × 20 mg IS-5-MN and 1 × 120 mg ISDN sustained release). During placebo as well as during nitrate therapy there was a gradual decrease of cardiac performance during the day, documented by the increase in ST-depression and pulmonary capillary wedge pressure at equal work loads. High nitrate concns led to a significant reduction of both ST-depression and preload with a marked circadian-phase dependency of cardiovascular effects.     

Circadian Variation of Cardiac Performance in Coronary Heart Disease

To study the circadian variation of cardiac performance in patients with coronary heart disease, three exercise tests on a bicycle crgometer were performed during the active part of the day (10 a.m., 2 p.m. and 6 p.m.), recording ST-segment depression and pulmonary capillary wedge pressure. Ten male patients with angiographically documented coronary heart disease underwent bicycle ergometry during placebo and during nitrate therapy (placebo controlled, double-blind crossover 2 × 20 mg IS-5-MN and 1 × 120 mg ISDN sustained release). During placebo as well as during nitrate therapy there was a gradual decrease of cardiac performance during the day, documented by the increase in ST-depression and pulmonary capillary wedge pressure at equal work loads. High nitrate concns led to a significant reduction of both ST-depression and preload with a marked circadian-phase dependency of cardiovascular effects.     

冠心病和高血压病的免疫机制进展

冠心痛和高血压病的发病机制比较复杂.近来的一些研究已证实,在冠心病和高血压病的病程进展中,包括靶器官损害、动脉粥样硬化形成、急性冠脉综合征的发生、缺血性心脏损害的进展等方面,免疫系统的激活包括自身免疫反应起着重要作用.冠心病和高血压病的免疫机制研究进展可能为其提供新的治疗措施.     

Modelling Future Coronary Heart Disease Mortality to 2030 in the British Isles

Objective

Despite rapid declines over the last two decades, coronary heart disease (CHD) mortality rates in the British Isles are still amongst the highest in Europe. This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking and physical activity levels, dietary salt and saturated fat intakes on future CHD mortality in three countries: Northern Ireland (NI), Republic of Ireland (RoI) and Scotland.

Methods

CHD mortality models previously developed and validated in each country were extended to predict potential reductions in CHD mortality from 2010 (baseline year) to 2030. Risk factor trends data from recent surveys at baseline were used to model alternative future risk factor scenarios: Absolute decreases in (i) smoking prevalence and (ii) physical inactivity rates of up to 15% by 2030; relative decreases in (iii) dietary salt intake of up to 30% by 2030 and (iv) dietary saturated fat of up to 6% by 2030. Probabilistic sensitivity analyses were then conducted.

Results

Projected populations in 2030 were 1.3, 3.4 and 3.9 million in NI, RoI and Scotland respectively (adults aged 25–84). In 2030: assuming recent declining mortality trends continue: 15% absolute reductions in smoking could decrease CHD deaths by 5.8–7.2%. 15% absolute reductions in physical inactivity levels could decrease CHD deaths by 3.1–3.6%. Relative reductions in salt intake of 30% could decrease CHD deaths by 5.2–5.6% and a 6% reduction in saturated fat intake might decrease CHD deaths by some 7.8–9.0%. These projections remained stable under a wide range of sensitivity analyses.

Conclusions

Feasible reductions in four cardiovascular risk factors (already achieved elsewhere) could substantially reduce future coronary deaths. More aggressive polices are therefore needed in the British Isles to control tobacco, promote healthy food and increase physical activity.     

PON基因簇潜在功能多态位点与冠心病的关联研究

在中国汉族人群PON基因簇序列筛查研究基础上,系统探讨PON基因簇所有潜在功能多态位点与国人冠心病的关系,以期明确PON基因簇序列变异是否国人冠心病的遗传危险因素。随机入选1997～1999年期间阜外心血管病医院病房收治的经冠状动脉造影确诊和/或有明确急性心肌梗塞病史男性冠心病患者474例及年龄(±2岁)匹配的男性健康对照475例。PCR产物直接测序法鉴定PON1基因-1076A/G、-908G/C、-831G/A、-162G/A、-126G/C和-107C/T多态基因型;等位基因特异性扩增方法鉴定PON2基因的A148G和S311C多态;PCR RFLP方法鉴定PON1基因R160G、Q192R和PON3基因-133C/A多态。单变量分析显示192Q, 160R,-162A和311C等位基因频率在病例组中显著高于对照组。以这4个多态性位点作为自变量的多元Logis tic回归分析发现仅R160G和-162G/A多态仍然与冠心病显著关联(P值分别为0.0054和0.0002),并独立于冠心病传统危险因素。不同多态组合的单体型分析进一步证实了单一SNP分析的结果,只有包含160R或-162A 等位基因的单体型在病例组中的频率显著高于对照组。中国北方汉族人群中,PON1基因-162G/A和R160G多态与冠心病独立关联,提示PON1基因可能是冠心病易感基因。     

Disparity between Leaf and Root Symptoms and Crop Losses Associated with Cassava Brown Streak Disease in Four Countries in Eastern Africa

Cassava brown streak disease is endemic to the coastal regions of East Africa, and from around 2004, the disease resurged and became epidemic in the Great Lakes Region, where it continues to spread. In both these areas, cassava brown streak disease (CBSD) leaf symptoms occur at high incidences. However, it is the associated symptom of root rot (necrosis) in the starch‐bearing tissues that renders the root unfit for human consumption. Because the extent of root necrosis is not known until the crop is harvested and surveys require destructive sampling, root symptoms are much less frequently assessed than are the above‐ground symptoms on the leaves and stems. Surveys were undertaken in selected villages in Tanzania, Kenya, Uganda and Malawi to assess the incidence of CBSD leaf symptoms and the incidence and severity of root symptoms, to estimate the impact of the disease on household food security and on cassava processing. CBSD leaf symptoms were recorded at high incidences (40–90% in individual fields) in all fields visited throughout East Africa, but root necrosis incidence was lower than would be expected from the high incidence of leaf symptoms. Severe root necrosis at high incidence was found only on a few varieties, usually grown to a limited extent. It appears that varieties that are prone to root necrosis are being abandoned in favour of those with a lower propensity to develop root necrosis after infection by the virus.     

血清同型半胱氨酸水平与冠心病相关性的临床分析

目的:分析血清同型半胱氨酸(Hcy)水平与冠心病(CHD)的临床相关性,提高对CHD的防治水平.方法:选择2011年2月～2012年6月在我院就诊且确诊为CHD的患者82例,按照患者CHD的类型、冠状动脉病变支数和狭窄程度进行分组后,检测和比较患者血清Hcy水平,并分析其与冠心病严重程度、冠状动脉病变支数和狭窄程度的相关性.结果:血清Hey水平与CHD的严重程度、冠状动脉病变支数和冠状动脉狭窄程度均呈显著正相关(r=0.716,r=0.738,r=0.802,P＜0.05).结论:血清Hcy水平与CHD的发生发展密切相关,通过动态检测患者血清Hcy水平可有助于预测CHD病变的发展并评估患者的预后.     

The Health Equity and Effectiveness of Policy Options to Reduce Dietary Salt Intake in England: Policy Forecast

BackgroundPublic health action to reduce dietary salt intake has driven substantial reductions in coronary heart disease (CHD) over the past decade, but avoidable socio-economic differentials remain. We therefore forecast how further intervention to reduce dietary salt intake might affect the overall level and inequality of CHD mortality.MethodsWe considered English adults, with socio-economic circumstances (SEC) stratified by quintiles of the Index of Multiple Deprivation. We used IMPACT_SEC, a validated CHD policy model, to link policy implementation to salt intake, systolic blood pressure and CHD mortality. We forecast the effects of mandatory and voluntary product reformulation, nutrition labelling and social marketing (e.g., health promotion, education). To inform our forecasts, we elicited experts’ predictions on further policy implementation up to 2020. We then modelled the effects on CHD mortality up to 2025 and simultaneously assessed the socio-economic differentials of effect.ResultsMandatory reformulation might prevent or postpone 4,500 (2,900–6,100) CHD deaths in total, with the effect greater by 500 (300–700) deaths or 85% in the most deprived than in the most affluent. Further voluntary reformulation was predicted to be less effective and inequality-reducing, preventing or postponing 1,500 (200–5,000) CHD deaths in total, with the effect greater by 100 (−100–600) deaths or 49% in the most deprived than in the most affluent. Further social marketing and improvements to labelling might each prevent or postpone 400–500 CHD deaths, but minimally affect inequality.ConclusionsMandatory engagement with industry to limit salt in processed-foods appears a promising and inequality-reducing option. For other policy options, our expert-driven forecast warns that future policy implementation might reach more deprived individuals less well, limiting inequality reduction. We therefore encourage planners to prioritise equity.     

Population Assessment of Future Trajectories in Coronary Heart Disease Mortality

Background

Coronary heart disease (CHD) mortality rates have been decreasing in Iceland since the 1980s, largely reflecting improvements in cardiovascular risk factors. The purpose of this study was to predict future CHD mortality in Iceland based on potential risk factor trends.

Methods and findings

The previously validated IMPACT model was used to predict changes in CHD mortality between 2010 and 2040 among the projected population of Iceland aged 25–74. Calculations were based on combining: i) data on population numbers and projections (Statistics Iceland), ii) population risk factor levels and projections (Refine Reykjavik study), and iii) effectiveness of specific risk factor reductions (published meta-analyses). Projections for three contrasting scenarios were compared: 1) If the historical risk factor trends of past 30 years were to continue, the declining death rates of past decades would level off, reflecting population ageing. 2) If recent trends in risk factors (past 5 years) continue, this would result in a death rate increasing from 49 to 70 per 100,000. This would reflect a recent plateau in previously falling cholesterol levels and recent rapid increases in obesity and diabetes prevalence. 3) Assuming that in 2040 the entire population enjoys optimal risk factor levels observed in low risk cohorts, this would prevent almost all premature CHD deaths before 2040.

Conclusions

The potential increase in CHD deaths with recent trends in risk factor levels is alarming both for Iceland and probably for comparable Western populations. However, our results show considerable room for reducing CHD mortality. Achieving the best case scenario could eradicate premature CHD deaths by 2040. Public health policy interventions based on these predictions may provide a cost effective means of reducing CHD mortality in the future.     

心脏植物神经功能测定与冠心病的关系

目的探讨测定植物神经功能与冠心病的关系。方法用评分法对１４５例临床上诊断冠心病患者及１４８例非冠心病患者进行心脏植物神经功能测定。结果冠心病组阳性率占７８．６％,非冠心病组阳性率占０．０２％。经统计学处理,Ｐ＜０．００５,差异非常显著。对植物神经功能异常冠心病患者随访５年,其中１３例行冠脉造影,均有不同程度的冠脉狭窄。８例非冠心病植物神经功能可疑,正常患者冠脉造影,结果没有１例冠脉狭窄。结论心脏植物神经功能测定对冠心病的诊断、预后与临床有一定的关系和意义。     

冠心病患者数量皮纹学特征波动性不对称的研究

本文研究了宁夏汉族男性256例(正常: 128例; 冠心病患者: 128例) 双手数量皮纹学特征及其波动性不对称, 比较了其均值的差异性。结果表明: 1)冠心病患者组与正常对照组相比较, 指纹嵴线数、指纹总嵴线数及a-b嵴线数均值均低于正常对照组; 2)冠心病患者组双手atd角及a-b间距均值均高于对照组, 双手atd角表现为显著增高(P<0.05), 右手a-b嵴线数均值表现为患者组低于对照组, 有显著性差异(P<0.01); 3)冠心病患者组数量皮纹性状波动性不对称水平与对照组在FAⅡ(a-b嵴线数, P<0.01)及FAⅤ(atd角, P<0.05)两项上表现出显著增高; 冠心病患者组a-b嵴线数FA分布在|R-L|≥7组显著增高(P<0.05)。