Objective To analyze the clinical and angiographic characteristics associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention(PCI).Methods One hundred and sixty eight patients ...Objective To analyze the clinical and angiographic characteristics associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention(PCI).Methods One hundred and sixty eight patients who underwent percutaneous revascularization and 6 month follow up angiography were recruited from 2001 to 2002, in which Fifty nine patients with angiographic restenosis ( ≥50% diameter stenosis) were analyzed. Multivariate analysis evaluated 24 clinical and angiographic variables, comparing those with and without angina. Results Restenosis occurred in 32 patients with clinical silence (55%) and 27 patients with angina. Male sex ( P =0.03 ), absence of antianginal therapy with nitrates ( P =0.002 ) ,greater reference diameter after the procedure ( P =0.04 ), greater reference diameter at follow up (P=0.01), and less lesion severity at 6 months ( P =0.04 ) were univariate predictors of asymptomatic restenosis. By multivariate analysis, only male, greater reference diameter at follow up, and less lesion severity at 6 months were associated with restenosis without angina.Conclusions Approximately half of patients with angiographic restenosis have no symptoms. The only multivariate predictors of silent restenosis at 6 months were male sex, greater reference diameter at follow up, and less lesion severity on follow up angiography.展开更多
Objectives Clopidogrel is a prodrug that has to be converted to an active metabolite by hepatic cytochrome P450(CYP) isoenzymes to inhibit platelet aggregation.Individualvariability of platelet inhibition by clopidogr...Objectives Clopidogrel is a prodrug that has to be converted to an active metabolite by hepatic cytochrome P450(CYP) isoenzymes to inhibit platelet aggregation.Individualvariability of platelet inhibition by clopidogrel suggests a possibility for genetic factors having a significant influence on clopidogrel responsiveness.In this study,we sought to determine the association between the single nucleotide polymorphism of CYP 2C19 681G】A and the occurrence of clopidogrel resistance(CR) in Chinese.Methods The study enrolled 614 hospitalized patients who underwentsuccessful percutaneouscoronary intervention with drug-eluting stents were received the treatmentwith dual antiplatelet regimen(aspirin plus clopidogrel).All patients received loading doses of 600 mg clopidogrel and 300 mg aspirin.20μmol/L ADP-induced platelet aggregation ratio(PAR ) was assessed 24 h after clopi- dogrel administration.The maximum residual PAR≥70%was defined as CR.Genomic DNA was extracted from whole blood samples according to standard protocols,the single nucleotide polymorphism of the CYP2C19 681G】A was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in all the patients.Results CR was found in 126 patients(20.5%).There was CYP2C19 681G】A polymorphism in the study population.The frequencies of the three kinds of genotypes(GG,GA,A A) in CR group and non-CR (NCR)group were 32.5%,47.6%,19.8%and 48.0%, 45.0%,7.0%,respectively.The frequency of AA genotype was significantly higher in NCR group than that in CR group (OR =3.03,95%CI:1.889～5.784,P=0.003).The A allele carriers were more likely to develop clopidogrel resistance compared with that of G allele carriers(OR=1.85,95%CI: 1.392～2.459,P=0.002).Conclusions CYP2C19 681G/A polymorphism is associated with the risk of CR,and the A allele carriers may be a possible genetic susceptibility factor for patients with CR.展开更多
目的:系统评价中医药治疗冠心病PCI术后合并焦虑和(或)抑郁的临床疗效与安全性。方法:计算机检索中国知网、万方、维普、中国生物医学文献数据库(CMB)、PubMed、Web of Science、Cochrane Library数据库,纳入自建库至2020年11月前公开...目的:系统评价中医药治疗冠心病PCI术后合并焦虑和(或)抑郁的临床疗效与安全性。方法:计算机检索中国知网、万方、维普、中国生物医学文献数据库(CMB)、PubMed、Web of Science、Cochrane Library数据库,纳入自建库至2020年11月前公开发表的中医药治疗冠心病PCI术后合并焦虑和(或)抑郁的中英文随机对照研究(randomized controlled trials,RCTs),运用Cochrane偏倚风险工具和改良后的Jadad量表对纳入文献进行质量评价,采用RevMan 5.3、Stata16.0软件进行Meta分析。结果:共计纳入23篇随机对照试验,包括1837例研究对象,其中中医药治疗组917例,对照组920例,组间基线情况一致,具有可比性。Meta分析结果显示,中医药治疗在提高临床总有效率[OR=2.34,95%CI(1.61,3.40),P<0.00001],中医证候疗效[OR=5.19,95%CI(2.74,9.86),P<0.00001],降低汉密尔顿焦虑量表HAMA评分[SMD=-0.96,95%CI(-1.78,-0.14),P=0.02]、汉密尔顿抑郁量表HAMD评分[SMD=-1.10,95%CI(-1.79,-0.41),P=0.002]、SAS自评量表评分[SMD=-1.20,95%CI(-1.75,-0.65),P<0.0001]及SDS自评量表评分[SMD=-1.14,95%CI(-1.62,-0.65),P<0.00001]等指标上均优于对照组,其差异具有统计学意义(P<0.05)。结论:在术后常规西医治疗方案基础上联用中医药干预可以进一步提高冠心病PCI术后合并焦虑和(或)抑郁患者的临床疗效且具有良好的安全性。限于本研究所纳入的文献质量总体一般,因此上述结论有待今后进一步开展高质量临床随机对照双盲试验加以证实。展开更多
文摘Objective To analyze the clinical and angiographic characteristics associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention(PCI).Methods One hundred and sixty eight patients who underwent percutaneous revascularization and 6 month follow up angiography were recruited from 2001 to 2002, in which Fifty nine patients with angiographic restenosis ( ≥50% diameter stenosis) were analyzed. Multivariate analysis evaluated 24 clinical and angiographic variables, comparing those with and without angina. Results Restenosis occurred in 32 patients with clinical silence (55%) and 27 patients with angina. Male sex ( P =0.03 ), absence of antianginal therapy with nitrates ( P =0.002 ) ,greater reference diameter after the procedure ( P =0.04 ), greater reference diameter at follow up (P=0.01), and less lesion severity at 6 months ( P =0.04 ) were univariate predictors of asymptomatic restenosis. By multivariate analysis, only male, greater reference diameter at follow up, and less lesion severity at 6 months were associated with restenosis without angina.Conclusions Approximately half of patients with angiographic restenosis have no symptoms. The only multivariate predictors of silent restenosis at 6 months were male sex, greater reference diameter at follow up, and less lesion severity on follow up angiography.
文摘Objectives Clopidogrel is a prodrug that has to be converted to an active metabolite by hepatic cytochrome P450(CYP) isoenzymes to inhibit platelet aggregation.Individualvariability of platelet inhibition by clopidogrel suggests a possibility for genetic factors having a significant influence on clopidogrel responsiveness.In this study,we sought to determine the association between the single nucleotide polymorphism of CYP 2C19 681G】A and the occurrence of clopidogrel resistance(CR) in Chinese.Methods The study enrolled 614 hospitalized patients who underwentsuccessful percutaneouscoronary intervention with drug-eluting stents were received the treatmentwith dual antiplatelet regimen(aspirin plus clopidogrel).All patients received loading doses of 600 mg clopidogrel and 300 mg aspirin.20μmol/L ADP-induced platelet aggregation ratio(PAR ) was assessed 24 h after clopi- dogrel administration.The maximum residual PAR≥70%was defined as CR.Genomic DNA was extracted from whole blood samples according to standard protocols,the single nucleotide polymorphism of the CYP2C19 681G】A was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in all the patients.Results CR was found in 126 patients(20.5%).There was CYP2C19 681G】A polymorphism in the study population.The frequencies of the three kinds of genotypes(GG,GA,A A) in CR group and non-CR (NCR)group were 32.5%,47.6%,19.8%and 48.0%, 45.0%,7.0%,respectively.The frequency of AA genotype was significantly higher in NCR group than that in CR group (OR =3.03,95%CI:1.889～5.784,P=0.003).The A allele carriers were more likely to develop clopidogrel resistance compared with that of G allele carriers(OR=1.85,95%CI: 1.392～2.459,P=0.002).Conclusions CYP2C19 681G/A polymorphism is associated with the risk of CR,and the A allele carriers may be a possible genetic susceptibility factor for patients with CR.
