不同诊断标准下农村老年人高尿酸血症患病率及影响因素分析

目的 探究在高尿酸血症(HUA)不同诊断标准下,辽宁省农村老年人HUA的患病率及影响因素。方法 本文纳入2017年9月至2018年5月辽宁省2个乡镇65岁及以上老年人2016例,分别根据流行病学标准(男性>420μmol/L,女性>360μmol/L)和指南标准(>420μmol/L)诊断HUA,并对其患病率、伴随疾病、实验室检查等结果进行比较,再通过多因素logistic回归,分析老年人HUA的影响因素。结果 (1)根据流行病学标准诊断HUA 102例,患病率5.1%;根据指南标准诊断HUA 60例,患病率3.0%。与血尿酸(SUA)正常组相比,HUA组:高体重指数(BMI)、大腰围、低估算肾小球滤过率(eGFR)、高三酰甘油(TG)、冠心病、糖尿病、房颤、血脂异常、肾功能不全、超重肥胖、中心性肥胖的比例更高。(2)根据性别进行亚组分析,指南标准下,65~69岁、70~74岁、缺乏运动、冠心病、高血压、糖尿病、血脂异常、卒中、超重肥胖、中心性肥胖者中,男性HUA患病率均高于女性。而流行病学标准下患病率均无性别差异。(3)多因素分析显示,冠心病、心房颤动、肾功能不全、超重肥胖、中心性肥胖、高三酰甘油或血脂异常为HUA的影响因素,指南标准下增加了男性。结论 不同诊断标准下,辽宁省农村老年人HUA患病率差异较大,按照指南标准各组患病率性别差异明显,因此流行病学研究中,流行病学标准优于指南标准。无论哪种诊断标准,老年HUA的影响因素差异不大。

Effect of high-dose rosuvastatin loading before percutaneous coronary intervention in female patients with non-ST-segment elevation acute coronary syndrome

Background Early loading statin therapy before percutaneous coronary intervention （PCI） is associated with reduced mortality and periprocedural myocardial injury. The aim of this study was to study the effect of rosuvastatin loading therapy before PCI in female patients with non-ST-segment elevation acute coronary syndrome （NSTEACS）. Methods Consecutive 117 female patients with NSTEACS were randomly assigned to either the group of rosuvastatin loading before PCI （20 mg 12 hours before angioplasty procedure, with a further 10 mg dose 2 hours before procedure, the loading dose group, n=59） or the no rosuvastatin treatment group before PCI （control group, n=58）. Periprocedural myocardial injury, periprocedural changes of high sensitivity C-reactive protein （hs-CRP）, interleukin （IL）-l, IL-6, and tumor necrosis factor （TNF）-a in serum and the incidence of major adverse cardiac events （MACE） 3 months and 6 months later were assessed. Results The incidence of periprocedural myocardia~ injury was higher in control group than loading dose group （CKMB： 10.17% vs. 25.86%, P=0.027; Troponin I： 11.86% vs. 29.31%, P=-0.019）. MACE occurred in 1.69% of patients in loading dose group and 12.07% of those in control group 3 months after procedure （P=-0.026）, 3.39% vs. 17.24% at 6 months （P=-0.014）. The levels of hs-CRP, IL-1, IL-6, and TNF-c（ in serum were not significantly different between the two groups before PCI, but after PCI they were significantly higher in control group.Conclusions High-dose rosuvastatin loading before PCI significantly reduced periprocedural myocardial injury and periprocedural inflammation cytokines release and improved 3-month and 6-month clinical outcomes in female patients with NSTEACS who underwent PCI.

Prospective multi-center study of female patients with ST-elevation myocardial infarction in Liaoning province, China

Background In cardiology, it is controversial whether gender influences prognosis after acute myocardial infarction （MI）. We examined the 30-day and 1-year prognosis for female patients with ST-elevation myocardial infarction （STEMI） in Liaoning province, and we analyzed factors that influenced these outcomes. Methods This was a prospective, multicenter, observational study in which patient data were collected by questionnaire at the time of diagnosis and at approximately 30 days and 1 year later by telephone inquiries. Patients were diagnosed with STEMI between June 1, 2009 and June 1, 2010 at any of the 20 hospitals that gave treatment representative of current STEMI treatment in Liaoning Province. Unified follow-up questionnaire was used to visit the STEMI patients. Results We analyzed data from a total of 1429 consecutive patients with STEMI in Liaoning province. Female patients were older （70.0 vs. 60.3, P 〈0.001） and were less likely to receive emergency reperfusion therapy than male ones （39.2% vs. 58.0%, P 〈0.001）. Female gender was associated with higher unadjusted 30-day mortality rates （HR=2.118, 95%C/： 1.572-2.854, P 〈0.001） and higher unadjusted 1-year mortality rates （HR=2.174, 95%C/： 1.659-2.848, P 〈0.001）. Multivariate Cox regression analysis showed that female gender was not an independent predictor of 30-day mortality rates （HR=1.273, 95%C/： 0.929-1.745, P=0.133） nor of 1-year mortality rates （HR=1.112, 95%C/： 0.831-1.487, P=0.475）. Conclusions Women with STEMI appear to be at increased risk of 30-day and 1-year mortality compared with male STEMI patients, but this difference may be explained by older age and less frequent receipt of reperfusion therapy among the women.

Myocardial infarction in a patient with systemic lupus erythematosus and antiphospholipid syndrome

This case report we presented aims to report a-31-year-old man with systemic lupus erythematosus （SLE） and antiphospholipid syndrome （APS） who developed myocardial infarction （MI） and also aims to discuss the possible mechanisms. The results showed that traditional risk factors alone do not cause coronary heart disease with SLE, and SLE-related factors influence the atherogenic process. We found that although SLE patients with acute MI benefit from percutaneous coronary intervention （PCI） therapy, it is very important to choose the reasonable antithrombotic strategies in patients with SLE and APS undergoing PCI who require oral anticoagulant therapy.

Gender disparity in early death after ST-elevation myocardial infarction

Background Females with acute myocardial infarction （AMI） have a higher risk of adverse outcomes because of receiving less evidence-based medical care. Our aim was to investigate the gender disparity in early death after ST- elevation myocardial infarction （STEMI） in the current era. Methods A total of 1429 consecutive patients with STEMI in the Liaoning district were analyzed. We compared hospital care and cardiac event data by sex for in-patients with acute STEMI within 24 hours of symptom onset. Results In the emergency reperfusion group （n=754）, in-hospital mortality occurred in 4.2% of the males and 11.2% of the females （P=-0.001）. In the non-emergency reperfusion group （n=675）, in-hospital mortality occurred in 13.0% of the males and 22.9% of the females （P=-0.001）. Multivariate Logistic regression analysis revealed female sex as an independent risk factor of death for STEMI patients during hospitalization （OR=1.691, P=0.007）. After controlling for patients who died within 24 hr after admission, female sex was no longer an independent risk factor （OR=1.409, P=0.259）. Conclusion Female sex was an independent risk factor for in-hospital mortality of STEMI patients, which is explained by an excess of very early deaths.

Multi-link Vision and MiniVision stent registry in Asian patients with coronary artery disease:a prospective,multi-center study

Background Recent studies have showed that the fine mesh stents are associated with a significant reduction in both clinical and angiographic re-stenosis of the coronary arteries. To maintain a very satisfactory radio-opacity using the stents, Guidant of the USA has designed a new type of bare metal stents （BMS）-Multi-link （ML） Vision / ML MiniVision stents. The clinical outcomes of Asian patients with coronary artery disease （CAD） after implanting the Multi-link Vision or MiniVision stent were investigated in this study. Methods An observational, prospective, multi-center, non-randomized post marketing registry was conducted to demonstrate the efficacy of the BMS- ML Vision / ML MiniVision stents. The primary end point of the registry was clinical target lesion revascularization （TLR） at a 6-month follow-up. The major secondary end points included the rate of major adverse cardiac events （MACE） and serious adverse events （SAE） in hospital and at 6 months; and the rate of clinical TLR as a function of the type of angina. A total of 429 Asian people with 449 lesions from 14 centers were selected for this study, The average reference diameter of the lesions was （3.0±0.5） mm, and the mean length was （15.7±5.0） mm. Results The successful rate of the procedure was 99.3%. Twenty-five percent of the lesions were treated by direct stenting without pre-dilation. Eighty-six percent of the lesions were implanted with ML Vision stent. After the 6-month follow-up, the rate of clinical TLR was 1.4%. The MACE, SAE and target vessel revascularization （TVR） were 6.8%, 3.5% and 1.4% respectively. Conclusion The current registry showed the excellent 6-month clinical outcomes of ML Vision/ML MiniVision stents in Asian patients with CAD.