Clinical characteristics,GRACE score,TIMI score and prognosis of patients with type 2 diabetes mellitus complicated with acute coronary syndrome

Objective:To analyze the clinical characteristics of patients with type 2 diabetes mellitus(T2DM)with acute coronary syndrome(ACS),the global registry of acute coronary events(GRACE)score,the thrombolysis in myocardial infarction(TIMI)score and clinical prognosis.Method:The study was a retrospective one-center observational study,continuous inclusion of 600 ACS patients diagnosed by coronary angiography in our hospital from October 2018 to July 2019.Collect general clinical data,laboratory examination results,imaging data and interventional treatment data of all patients.Were divided into:T2DM with ACS group(group DA)and non-T2DM with ACS(group NDA)according to whether or not they were associated with T2DM.According to the GRACE、TIMI score,the two groups were divided into high risk group,middle risk group and low risk group.All patients underwent coronary angiography to calculate the number of vascular lesions and Gensini scores.Design questionnaire,after discharge to 2 groups of patients by telephone or outpatient follow-up average of 10 months,statistics of the occurrence of MACE events.Result:Among the 600 patients included in the study,362 were male(60.3%)and 238 were female(39.7%)with mean age(64.7±10.3)years.The baseline data showed that the G、TG、UA、CR levels were higher in the DA group than in the NDA group;the proportion of men was lower than in the NDA group.The results of coronary angiography showed that the Gensini score of DA group was higher than that of NDA group,and the proportion of single lesion was lower than that of NDA group.The binary Logistic regression analysis suggested that age and CRP were independent risk factors for MACE events in patients with T2DM.GRACE risk stratification showed that the proportion of high risk group in DA group was significantly higher than that in NDA group,and there was no significant difference between low and middle risk group.TIMI risk stratification showed that the proportion of high risk group in DA group was significantly higher than that in NDA group,while the proportion of low and middle risk group was lower than that in NDA group.The ROC curve shows that the area(AUC)below the ROC curve that GRACE、TIMI score predicted the occurrence of MACE events in patients with T2DM and ACS was 0.707 and 0.586.Conclusion:Patients with T2DM and ACS had higher clinical risk stratification than without T2DM.GRACE score compared with the TIMI score had better predictive value for the occurrence of MACE events after discharge of T2DM with ACS patients.

Changes of NLRP1-ASC-Caspase-1 signaling pathways in peripheral blood monocytes from patients with atrial fibrillation

Objective:To detect the expression of(Peripheral blood mononuclear cells,PBMCs)NLRP3 signal pathway in peripheral blood monocytes of patients with chronic heart failure,and to explore the expression of NLRP3 signal pathway and its induced inflammatory response in PBMCs of patients with different types of chronic heart failure.Methods:patients with chronic heart failure(NYHAⅡ~Ⅳ),Ⅱ(nude 20),Ⅲ(nude 20)andⅣ(nude 20)admitted to our hospital from 2019 to 2020 were selected,and 20 normal subjects were selected as the control group.The peripheral venous blood of all subjects was collected,and the plasma and monocytes were extracted respectively.The monocytes were identified by magnetic beads sorting.The mRNA and protein expression levels of NLRP3,ASC and Caspase-1 in PBMCs were detected by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR)and Western blot,and the level of interleukin-1β(IL-1β)in plasma was detected by enzyme-linked immunosorbent assay((ELISA)).Results:compared with the normal control group,the expression of NLRP3,ASC,Caspase-1 protein and mRNA in PBMCs of patients with gradeⅡ,ⅢandⅣincreased.Compared with patients with gradeⅡ,the expression of these indexes increased in patients with gradeⅢandⅣ.Compared with patients with gradeⅢ,the expression of these indexes increased in patients with gradeⅣ.Compared with the normal control group,the plasma levels of IL-1βin patients with gradeⅡ,ⅢandⅣwere higher than those in patients with gradeⅡ,ⅢandⅣ(P<0.05).The expression of these indexes in patients with gradeⅢandⅣwas higher than that in patients with gradeⅢ(P<0.05).Conclusion:the results suggest that NLRP3-ASC-Caspase-1 signal pathway may cause chronic inflammation in patients with heart failure and play a role in the progression of chronic heart failure.

The correlation between MFAP4 and recurrence and clinical outcome of atrial fibrillation after radiofrequency catheter ablation

Objective:To investigate the correlation between Microfibrillar-associated protein 4(MFAP4)and recurrence and clinical outcome of atrial fibrillation(AF)after radiofrequency catheter ablation(RFCA).Methods:A total of 101 patients with AF admitted to our department from December 2018 to January 2020 were treated with RFCA.The average follow-up period was(11.91±0.38)months.They were divided into recurrence group and non-recurrence group according to whether they had recurrence of AF.The levels of MFAP4,transforming growth factor-β1(TGF-β1),cardiac ultrasound indexes,body mass index(BMI)and major cardio-cerebral vascular events were compared between the two groups.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of MFAP4 for recurrence of AF after RFCA.Results:The levels of MFAP4,TGF-β1,left atrial diameter(LAD)and BMI in the recurrent group were higher than those in the non-recurrent group(P<0.05).The left ventricular ejection fraction(LVEF)in the recurrent group was lower than that in the non-recurrent group(P<0.05).The levels of MFAP4,TGF-β1 and LAD in the patients of recurrent paroxysmal AF and persistent AF after RFCA were higher than those in the respective non-recurrent patients(P<0.05).MFAP4 was positively correlated with TGF-β1 and LAD(P<0.05).Logistic regression analysis showed that MFAP4,TGF-β1,and LAD were independent risk factors for recurrence of AF after RFCA.The ROC curve analysis showed that the area under the ROC curve of MFAP4 for predicting recurrence of AF after RFCA was 0.888(P=0.000),and the optimal cut-off value was 19.295ng/ml,with a sensitivity of 77.3%and a specificity of 77.2%.The incidence of readmission and total adverse events in recurrence group was significantly higher than that in non-recurrence group(P<0.05).Conclusions:MFAP4 was significantly increased in patients with recurrence after RFCA of AF,which was one of the independent risk factors for recurrence after RFCA of AF,and had certain clinical application value.

Significance of changes of serum ICAM-1 and LDH activity in different severity of vascular lesions of coronary heart disease

Objective:To analyze the relationship between serum ICAM-1,lactate dehydrogenase(LDH)and coronary heart disease(CHD)by clinical detection of serum ICAM-1 and LDH Objective to investigate the relationship between the severity of different types of coronary artery stenosis(CHD)and its role in the progression of CHD.Methods:180 patients with chest pain and coronary angiography were selected,including 145 patients with CHD diagnosed by coronary angiography and 35 patients without abnormal coronary angiography(control group).The 145 patients with CHD were further divided into mild partial stenosis group(a-chd,stenosis development≤49%),moderate partial stenosis group(b-chd,stenosis development 50%~74%)and severe partial stenosis group(c-chd,stenosis development≥75%).The levels of ICAM-1 and LDH in serum of patients were detected by ELISA,and the differences of ICAM-1 and LDH activities in different degrees of coronary artery disease and control group were statistically analyzed.Results:in the control group,HDL was higher than that in the c-chd group(P<0.05),neutrophils in the control group was lower than that in the c-chd group(P<0.05);ICAM-1,LDH and Gensini scores in the a-chd group,b-chd group and c-chd group were higher than those in the control group(P<0.05-P<0.01),and gradually increased with the aggravation of different coronary artery stenosis processes(P<0.05-P<0.01).The levels of serum ICAM-1 and LDH increased significantly with the increase of the number of CHD lesions(P<0.01).The levels of ICAM-1 and LDH were positively correlated with Gensini score(LDH r=0.409,P<0.01 and ICAM-1 r=0.463,P<0.01).The levels of ICAM-1 and neutrophils were positively correlated(r=0.208,P<0.01).The levels of LDH and ICAM-1 were negatively correlated with HDL(LDH r=-0.184,P<0.05 and ICAM-1)There was a negative correlation between LDH and total protein(r=-0.218,P<0.01),and a positive correlation between ICAM-1 and LDH(r=0.441,P<0.01).Conclusion:the levels of serum ICAM-1 and LDH gradually increase with the aggravation of different coronary artery stenosis,and there is a certain linear relationship between them.

Mycophenolate mofetil plus prednisone for inducing remission of Henoch-Sch?nlein purpura nephritis: a retrospective study

Objective： The treatment of Henoch-Schonlein purpura （HSP） with moderate proteinuria remains con- troversial. We retrospectively analyzed the efficacy of immune suppressants, with a particular emphasis on myco- phenolate mofetil （MMF）. Methods： Ninety-five HSP patients with moderate proteinuria （1.0-3.5 g/24 h） after at least three months of therapy with angiotensin-converting enzyme inhibitor （ACEI） or angiotensin receptor blocker （ARB） were divided into three groups： an MMF group （n=33） that received MMF 1.0-1.5 g/d combined with prednisone （0.4-0.5 mg/（kg.d））, a corticosteroid （CS） group （n=31） that received full-dose prednisone （0.8-1.0 mg/（kg.d））, and a control group （n=31）. Patients in the MMF and CS groups continued to take ACEI or ARB at the original dose. The patients in the control group continued to take ACEI or ARB but the dose was increased by （1.73±0.58）-fold. The patients were followed up for 6-78 months （median 28 months）. Results： The baseline proteinuria was higher in the MMF group （（2.1±0.9） g/24 h） than in the control group （（1.6±0.8） g/24 h） （P=0.039）. The proteinuria decreased sig- nificantly in all groups during follow-up, but only in the MMF group did it decrease significantly after the first month. At the end of follow-up, the proteinuria was （0.4±0.7） g/24 h in the MMF group and （0.4±0.4） g/24 h in the CS group, significantly lower than that in the control group （（0.9±1.1） g/24 h）. The remission rates in the MMF group, CS group, and control group were respectively 72.7%, 71.0%, and 48.4% at six months and 72.7%, 64.5%, and 45.2% at the end of follow-up. The overall number of reported adverse events was 17 in the MMF group, 30 in the CS group, and 6 in the control group （P〈0.001）. Conclusions： MMF with low-dose prednisone may be as effective as full-dose prednisone and tend to have fewer adverse events. Therefore, it is probably superior to conservative treatments of adult HSP patients with moderate proteinuria.