不同剂量替格瑞洛治疗ST段抬高型心肌梗死患者的有效性和安全性:基于倾向性评分匹配

背景双联抗血小板治疗是接受直接经皮冠状动脉介入治疗(PPCI)的ST段抬高型心肌梗死(STEMI)患者治疗的基础。阿司匹林联合替格瑞洛是STEMI患者抗血小板治疗的首选方案,与氯吡格雷相比,其能够更快、更有效地抑制血小板,并改善预后。但是尚缺乏在接受PPCI治疗的STEMI患者中应用减量替格瑞洛的研究。目的基于倾向性评分匹配(PSM)的方法,对比分析不同剂量替格瑞洛治疗STEMI患者的有效性和安全性。方法连续选取2019年6月—2021年5月在河北医科大学第二医院心血管内五科行PPCI并接受替格瑞洛治疗的STEMI患者为研究对象。根据应用替格瑞洛的维持剂量将患者分为减量组(60例:替格瑞洛60 mg/次,2次/d)和标准组(180例:替格瑞洛90 mg/次,2次/d)。采用PSM法对两组患者进行1∶1匹配,匹配变量包括性别、年龄、既往病史、入院时Killip分级和介入治疗相关参数等,最终减量组和标准组各纳入54例患者。分别于出院1、3、6个月时,对两组患者进行随访,记录和比较两组患者血小板功能相关参数和临床事件的发生情况。结果PSM后两组患者基线资料、介入治疗参数和住院期间主要不良心血管事件发生率比较,差异均无统计学意义(P>0.05)。基线时,两组患者血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)比较,差异均无统计学意义(P>0.05);减量组患者血小板聚集率(PAR)低于标准组(P<0.05)。出院时,减量组患者MPV高于标准组,PDW低于标准组(P<0.05)。出院1个月时,两组患者PLT、MPV、PDW、PAR比较,差异均无统计学意义(P>0.05)。出院3个月时,减量组患者PDW高于标准组(P<0.05)。出院6个月时,减量组患者MPV高于标准组(P<0.05)。减量组患者出院前后PLT、PAR比较,标准组患者出院前后PLT、PDW比较,差异均无统计学意义(P>0.05)。减量组、标准组患者出院时MPV高于基线,减量组患者出院时PDW低于基线,标准组患者出院时PAR低于基线(P<0.05)。减量组患者出院1、3、6个月MPV低于出院时,PDW高于出院时(P<0.05);标准组患者1、3、6个月PAR低于基线,高于出院时(P<0.05)。两组患者随访期间主要不良心血管事件、严重出血事件发生率比较,差异均无统计学意义(P>0.05)。结论在接受PPCI的STEMI患者中替格瑞洛60 mg治疗是安全有效的。

Research progress on the correlation between aqueous humor components and pathogenesis and postoperative complications in patients with different types of cataracts

Aqueous humor provides the necessary nutrition for the lens and transports the metabolites in the eye.It was a liquid that can directly reflect the microenvironment in the eye'and it can be easily obtained during the operation.This review intended to analyze the components of aqueous humor in patients with different types of cataracts'so as to reflect the pathogenesis and development of the disease'evaluate the incidence of postoperative complications and provide reference value for the surgical design of sequential cataract surgery.The aqueous humor components of different types of cataracts showed different degrees of inflammation'oxidative stress and extracellular matrix remodeling.The biomarker of early neuropathy in diabetic cataract was neural cell adhesion molecule-1(NCAM1).Transforming growth factor-β(TGF-β)was the evaluation factor of disease development in patients with pseudoexfoliation syndrome.The relationships between postoperative complications of different types of cataracts and aqueous humor components were as follows:Macular edema after diabetic cataract surgery was associated with tumor necrosis factor-alpha;capsular contraction after high myopic cataract surgery was related to monocyte chemoattractant protein-1(MCP-1)and TGF-β2;Klotho and glutathione S-transferase P 1(GSTP1)were associated with high intraocular pressure after primary open-angle glaucoma complicated by cataract surgery;capsular contraction after retinitis pigmentosa complicated by cataract surgery was associated with matrix metalloproteinases;pro-inflammatory cytokines and fibroblast growth factor 4 in the aqueous humor of congenital cataracts were associated with posterior capsular opacification after surgery.Granulocyte colony stimulating factor 3 and MCP-1 were the main cytokines mediating the pain of the second eye in the binocular sequential cataract surgery short interval(1 wk)'while MCP-1 mediated pain in the long interval(6 wk).The second eye after binocular sequential cataract surgery had a higher level of proinflammatory factors.The components of aqueous humor in patients with different types of cataracts were related to the pathogenesis and postoperative complications of the disease.Monitoring the components of the aqueous humor could help better understand the intraocular microenvironment of different types of cataracts and provide a reference for predicting the development of the disease and implementing relevant targeted therapy.

Combinative approach of transzonular triamcinolonemoxifloxacin and perioperative drops to minimize postoperative complications of cataract surgery

AIM: To investigate the effectiveness of combinationtherapy with transzonular triamcinolone-moxifloxacin andconventional perioperative drops in reducing postoperativecomplications of cataract surgery. METHODS: Electronic medical records of cataractsurgery patients (single surgeon) were reviewed fromJanuary 2018 to September 2021. The rate of postoperativecomplications including prolonged and/or recurrentpostoperative inflammation, endophthalmitis, cystoid macularedema (CME), and intraocular pressure (IOP) was comparedbetween the patients receiving combinative therapy andpatients receiving drops only. RESULTS: Totally 596 patients and 1057 eyes(Combinative-Therapy group 493 and Drop-Only group 564)were included in this study. Using combination therapyreduced the relative risk of postoperative inflammationby 26.9% (16.6% Combinative-Therapy vs 22.7% Drop-Only, P=0.013). The incidence of endophthalmitis was 0in Combinative-Therapy group vs 0.5% in Drop-Only group(relative risk reduction 100%), although not statisticallysignificant (P=0.10). The incidence of severe IOP spikeswas not significantly different between Combinative-Therapy (2.4%) and Drop-Only (1.6%) groups (P=0.33).The relative risk of postoperative CME was 51.4% less inthree months follow up visit in Combinative-Therapy group,although not statistically significant (P=0.07). The visualoutcome 1-month postop. (best corrected visual acuity) wassignificantly better in Combinative-Therapy (logMAR 0.10)compared to Drop-Only (logMAR 0.14) groups (P=0.02) whilethe baseline visual acuity was not significantly different. CONCLUSION: The combinative approach oftranszonular triamcinolone-moxifloxacin plus perioperativeeyedrops is an effective method to minimize postoperativeinflammation, with better visual outcomes. It couldpotentially reduce the risk of postoperative endophthalmitisand CME (near-significant P-values;larger studies couldanalyze better considering low incidence).

Pain perception enhancement in consecutive secondeye phacoemulsification cataract surgeries under topical anesthesia

Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery.Consecutive phacoemulsification under topical anesthesia has been the routine procedure for cataract surgery.However,patients often grumbled that they felt more painful during the second-eye surgery compared to the first-eye surgery.The intraoperative pain experience has negative influence on satisfaction and willingness for second-eye cataract surgery of patients with bilateral cataracts.Intraoperative ocular pain is a complicated process induced by the nociceptors activation in the peripheral nervous system.Immunological,neuropsychological,and pharmacological factors work together in the enhancement of intraoperative pain.Accumulating published literatures have focused on the pain enhancement during the secondeye phacoemulsification surgeries.In this review,we searched PubMed database for articles associated with pain perception differences between consecutive cataract surgeries published up to Feb.1,2024.We summarized the recent research progress in mechanisms and interventions for pain perception enhancement in consecutive secondeye phacoemulsification cataract surgeries.This review aimed to provide novel insights into strategies for improving patients’intraoperative experience in second-eye cataract surgeries.

Surgical approaches to correct corneal astigmatism at time of cataract surgery: a mini-review

Among refractive errors,astigmatism is the most common optical aberration,where refraction changes in different meridians of the eye.It causes blurred vision at any distance and includes corneal,lenticular,and retinal astigmatism.Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism,for example,a large size surgery incision.The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery.Nowadays,three surgical approaches can be used.By placing a sutureless clear corneal incision on the steep meridian of the cornea,a preoperative corneal astigmatism less than 1.0 D can be corrected.Single or paired peripheral corneal relaxing incisions(PCRIs)provide 1.0-3.0 D corneal astigmatism correction.PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism,if more than 2.0 D,the risk of overcorrection and irregular astigmatism is increased.When toric intraocular lenses(IOLs)are unavailable in markets,PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism.Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism.Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D.These approaches can be used alone or in combination.

Causal association between 25-hydroxyvitamin D status and cataract development:A two-sample Mendelian randomization study

BACKGROUND Vitamin deficiencies are linked to various eye diseases,and the influence of vitamin D on cataract formation has been noted in prior research.However,detailed investigations into the causal relationship between 25-(OH)D status and cataract development remain scarce.AIM To explore a possible causal link between cataracts and vitamin D.METHODS In this study,we explored the causal link between 25-(OH)D levels and cataract development using Mendelian randomization.Our analytical approach included inverse-variance weighting(IVW),MR-Egger,weighted median,simple mode,and weighted mode methods.The primary analyses utilized IVW with random effects,supplemented by sensitivity and heterogeneity tests using both IVW and MR-Egger.MR-Egger was also applied for pleiotropy testing.Additionally,a leave-one-out analysis helped identify potentially impactful single-nucleotide polymorphisms.RESULTS The analysis revealed a positive association between 25-(OH)D levels and the risk of developing cataracts(OR=1.11,95%CI:1.00-1.22;P=0.032).The heterogeneity test revealed that our IVW analysis exhibited minimal heterogeneity(P>0.05),and the pleiotropy test findings confirmed the absence of pleiotropy within our IVW analysis(P>0.05).Furthermore,a search of the human genotype-phenotype association database failed to identify any potentially relevant risk-factor single nucleotide polymorphisms.CONCLUSION There is a potential causal link between 25-(OH)D levels and the development of cataracts,suggesting that greater 25-(OH)D levels may be a contributing risk factor for cataract formation.Further experimental research is required to confirm these findings.

Clinical efficacy of femtosecond laser-assisted phacoemulsification in diabetic cataract patients

BACKGROUND Diabetic patients with cataracts encounter specific difficulties during cataract surgery due to alterations in microcirculation,blood supply,metabolism,and the microenvironment.Traditional phacoemulsification may not fully tackle these issues,especially in instances with substantial preoperative astigmatism.The utilization of femtosecond laser-assisted phacoemulsification,in conjunction with Toric intraocular lens(IOL)implantation,offers a potentially more efficient strategy.This research seeks to evaluate the efficacy and possible complications of this approach in diabetic cataract patients.AIM To investigate the clinical efficacy and complications of femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation in diabetic cataract patients,comparing it with traditional phacoemulsification methods.METHODS This retrospective study enrolled 120 patients with diabetes cataract from May 2019 to May 2021.The patients were divided into two groups:the control group underwent traditional phacoemulsification and Toric IOL implantation,while the treatment group received Len Sx femtosecond laser-assisted treatment.Outcome measures included naked eye vision,astigmatism,high-level ocular phase difference detection,clinical efficacy,and complication.RESULTS There were no significant preoperative differences in astigmatism or naked eyesight between the two groups.However,postoperative improvements were observed in both groups,with the treatment group showing greater enhancements in naked eye vision and astigmatism six months after the procedure.High-level corneal phase difference tests also indicated significant differences in favor of the treatment group.CONCLUSION This study suggests that femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation appears to be more effective in enhancing postoperative vision in diabetic cataract patients compared to traditional methods offering valuable insights for clinical practice.

Efficacy of recombinant human epidermal growth factor plus sodium hyaluronate eye drops in diabetic dry eye post-cataract surgery

BACKGROUND Dry eye syndrome(DES)after diabetic cataract surgery can seriously affect the patient’s quality of life.Therefore,effective alleviation of symptoms in patients with this disease has important clinical significance.AIM To explore the clinical effect of recombinant human epidermal growth factor(rhEGF)plus sodium hyaluronate(SH)eye drops on DES after cataract surgery in patients with diabetes.METHODS We retrospectively evaluated 82 patients with diabetes who experienced DES after cataract surgery at Tianjin Beichen Hospital,Affiliated Hospital of Nankai University between April 2021 and April 2023.They were classified into an observation group(42 cases,rhEGF+SH eye drops)and a control group(40 cases,SH eye drops alone),depending on the different treatment schemes.The therapeutic efficacy,dry eye symptom score,tear film breakup time(TFBUT),basic tear secretion score[assessed using Schirmer I test(SIt)],corneal fluorescein staining(FL)score,tear inflammatory markers,adverse reactions during treat-ment,and treatment satisfaction were compared between the two groups.RESULTS Therapeutic efficacy was higher in the observation group compared with the control group.Both groups showed improved TFBUT and dry eye,as well as improved SIt and FL scores after treatment,with a more pronounced improvement in the observation group.Although no marked differences in adverse reactions were observed between the two groups,treatment satisfaction was higher in the observation group.CONCLUSION rhEGF+SH eye drops rendered clinical benefits to patients by effectively ameliorating dry eye and visual impairment with favorable efficacy,fewer adverse reactions,and high safety levels.Thus,this treatment should be promoted in clinical practice.

Clinical Observation of Recombinant Bovine Basic Fibroblast Growth Factor Eye Gel Combined with Tobramycin Dexamethasone Eye Drops in the Treatment of Dry Eye Syndrome in Patients after Cataract Surgery

Objective:To evaluate the therapeutic effect of recombinant bovine basic fibroblast growth factor(rbFGF)eye gel combined with tobramycin-dexamethasone(TOB-Dex)eye drops on dry eye syndrome(DES)after cataract surgery.Methods:86 patients with DES after cataract surgery,admitted from November 2021 to November 2023,were randomly divided into groups.The observation group included 43 patients treated with rbFGF eye gel combined with TOB-Dex eye drops.The reference group included 43 patients treated with TOB-Dex eye drops alone.Multiple indicators,including total effective rate and clinical symptom scores,were compared between the two groups.Results:The total effective rate in the observation group was higher than in the reference group(P<0.05).Before treatment,there were no differences in clinical symptom scores,serum factors,or disease severity scores between the two groups(P>0.05).Three weeks after treatment,the observation group had lower clinical symptom scores,serum factors,and disease severity scores compared to the reference group(P<0.05).The adverse reaction rate in the observation group was lower than in the reference group(P<0.05).Conclusion:rbFGF eye gel combined with TOB-Dex eye drops can improve the clinical efficacy for patients with DES after cataract surgery,alleviate disease symptoms,reduce inflammatory responses,and have fewer adverse reactions.

阿司匹林抗血小板相关基因多态性在汉族NSTEMI患者人群中的分布

目的:分析汉族非ST段抬高型心肌梗死(NSTEMI)患者人群中与阿司匹林抗血小板药理作用相关的GPⅢa PLA2(rs5918)、PEAR1(rs12041331)和PTGS1(rs10306114)基因的基因型结果及等位基因分布特征,为汉族NSTEMI患者的个体化治疗提供参考。方法:选取2016年1月~2022年12月首都医科大学附属北京潞河医院收治的汉族NSTEMI患者107例为研究对象。采用荧光染色原位杂交的方法对GPⅢa PLA2(rs5918)、PEAR1(rs12041331)和PTGS1(rs10306114)3个基因多态性位点进行检测分型,研究分析其基因型频率分布及等位基因分布情况,并分析汉族NSTEMI患者人群与1000 Genomes数据库中部分人群相关等位基因的分布是否存在统计学差异。结果:汉族NSTEMI患者人群中,GPⅢa PLA2(rs5918)位点上基因型频率为TT 97.20%、TC 2.80%、CC 0%,等位基因频率为T 98.60%、C 1.40%;PEAR1(rs12041331)位点上基因型频率为GG 42.06%、GA 44.86%、AA 13.08%,等位基因频率为G64.49%、A 35.51%;PTGS1(rs10306114)位点上基因型均为AA(100%),未见AG或GG型。结论:在汉族NSTEMI患者人群中,与阿司匹林抗血小板药理作用相关的GPⅢa PLA2(rs5918)位点上突变少见,PTGS1(rs10306114)位点上未见突变,这2个多态性位点上均以野生型纯合子为主,而PEAR1(rs12041331)位点上突变多见。本研究中部分结果与既往报道或相关数据库中收录的其他人群类似,也有部分结果与既往报道或其他人群存在明显差异。

地中海饮食模式和急性非ST段抬高型心肌梗死发生风险的关系研究

目的探讨地中海饮食模式与急性非ST段抬高型心肌梗死(NSTEMI)发生风险的相关性。方法本研究是一项单中心大型病例对照研究。收集2017年1月至2020年12月在首都医科大学附属北京安贞医院首次确诊为急性NSTEMI的患者600例作为急性NSTEMI组。根据年龄、性别进行1∶1匹配选取同期本院体检中心健康体检者600人作为对照组。比较2组一般资料。根据饮食频率调查问卷计算出改良地中海饮食评分(AMEDS)。将所有受试者按AMEDS分为AMEDS<4分组、AMEDS 4~5分组和AMEDS≥6分组。分析总体及不同AMEDS组的急性NSTEMI发生风险,分析AMEDS中不同种类食物与急性NSTEMI发生风险的相关性。结果急性NSTEMI组有高血压病、糖尿病病史的患者比例、收缩压、体重指数、目前吸烟者比例均高于对照组,家庭收入≥120000元/年的比例、AMEDS均低于对照组,差异均有统计学意义(均P<0.05)。相对于AMEDS<4分组的受试者而言,AMEDS 4~5分组以及AMEDS≥6分组受试者急性NSTEMI发生风险明显降低(调整年龄、性别、受教育年限、家庭年收入、病史、体重指数、血压、血红蛋白、生活方式等多个协变量后的多因素分析比值比=0.72,95%置信区间:0.53~0.94,P=0.031;比值比=0.62,95%置信区间:0.47~0.84,P=0.008)。将患者按年龄和性别进行分层,多因素回归分析后发现,随AMEDS增加,急性NSTEMI发生风险降低的趋势在男性和年龄<60岁的人群依然存在(均P<0.05),在女性和≥60岁的人群中,趋势差异无统计学意义(均P>0.05),同时分层之间交互性分析后差异均无统计学意义(均P>0.05)。AMEDS食物种类分析结果显示,蔬菜、鱼类降低急性NSTEMI发生风险,红肉或加工肉类增加其发生风险(比值比=0.51,95%置信区间:0.42~0.66,P<0.001;比值比=0.75,95%置信区间:0.59~0.94,P=0.010;比值比=1.51,95%置信区间:1.21~1.90,P<0.001)。结论地中海饮食模式和急性NSTEMI的发生相关,改良地中海饮食的高依从性可能降低急性NSTEMI的发生风险。

老年急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后延长应用替格瑞洛对临床转归的影响

目的探讨老年(年龄≥65岁)急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后延长应用替格瑞洛对临床转归的影响。方法纳入2018年2月至2021年2月在秦皇岛市第一医院行PCI后接受替格瑞洛+阿司匹林双联抗血小板治疗(DAPT)的≥65岁急性STEMI患者105例(应用DAPT评分系统评估均≥2分),在阿司匹林长期用药基础上,根据患者服用替格瑞洛时间不同分为对照组(n=37,使用时间为PCI治疗后1年)与观察组(n=68,在对照组基础上再延长替格瑞洛治疗1年),其中观察组根据延长应用替格瑞洛的剂量不同又分为2个亚组,即观察A组(n=40,标准剂量,90 mg/次,每日2次)和观察B组(n=28,小剂量,45 mg/次,每日2次)。比较3组患者急诊PCI术后心肌梗死溶栓治疗(TIMI)3级血流、心电图完全回落比例、血栓弹力图中的血小板功能(MA)、二磷酸腺苷诱导的血小板聚集率;随访1年,主要不良心脑血管事件(MACCE)、出血事件发生情况。采用SPSS 25.0软件进行数据分析。根据数据类型,组间比较采用t检验、χ^(2)检验。结果PCI术后,观察A、B组的TIMI 3级血流患者比例显著高于对照组(χ^(2)=4.699、4.353;P=0.030、0.036),而观察A组与观察B组组间差异无统计学意义。PCI治疗后2年,观察A、B组血栓弹力图中的MA值、二磷酸腺苷诱导的血小板聚集率明显低于对照组(t=8.752、6.524;均P<0.001),但观察A组、观察B组比较差异无统计学意义。随访1年,3组总MACCE发生率比较差异有统计学意义(χ^(2)=4.354;P=0.039),其中观察组A、B组MACCE发生率均显著低于对照组(χ^(2)=4.769、5.082;P=0.028、0.024),但观察A组与观察B组间差异无统计学意义;3组患者出血事件发生率差异均无统计学意义。结论老年(≥65岁)STEMI患者(DAPT评分≥2分)PCI后延长应用替格瑞洛可能降低主要不良心脑血管事件发生率,且小剂量(45mg/次)替格瑞洛并未增加出血发生的风险,仍需长期随访观察进一步证实。

三种冠状动脉内灌注用药方案对高血栓负荷急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后心肌灌注及短期预后的影响

目的探讨三种冠状动脉内灌注用药方案对高血栓负荷急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后心肌灌注及短期预后的影响。方法前瞻性、单中心、随机对照研究。纳入2017年3月至2021年8月焦作市人民医院心内科高血栓负荷STEMI患者150例,按照分层区组随机化原则等分为三组各50例。A组:尼可地尔+替罗非班靶血管灌注;B组:尿激酶原+替罗非班靶血管灌注;C组:尼可地尔+尿激酶原+替罗非班靶血管灌注。于PCI术前、术后即刻检测记录梗死相关动脉(IRA)的心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌灌注分级(TMPG)、校正的TIMI血流帧数(CTFC);于PCI术前、术后24 h记录心电图的ST段回落幅度;记录IRA开通后24 h内Curtis-Walker评分及恶性心律失常例数;于PCI术前、术后0 h、12 h、24 h、3 d及7 d检测血清高敏肌钙蛋白I(hs-cTnI);于PCI术前、术后24 h及7 d检测丙二醛(MDA)、超氧化物歧化酶(SOD);于PCI术前、术后7 d、术后1个月、术后6个月及术后12个月检测左心室射血分数(LVEF)。随访记录患者住院期间及出院后30 d内的出血事件及术后12个月内主要不良心血管事件(MACE)。结果(1)PCI术后即刻,C组患者的TIMI血流分级、TMPG均优于A组(Z=-16.610,P=0.023;Z=-18.400,P=0.015)和B组(Z=-15.130,P=0.046;Z=16.550,P=0.035);C组患者的CTFC帧数低于A组(P<0.001)和B组(P=0.001)。(2)PCI术后,C组患者的血清hs-cTnI水平低于A组和B组(均为P<0.001)。(3)PCI术后,C组患者的MDA水平低于A组和B组(均为P<0.001),SOD水平高于A组(P=0.004)和B组(P=0.024)。(4)PCI术后24 h,C组患者的ST段回落幅度大于A组(P=0.003)和B组(P=0.012),Curtis-Walker评分及恶性心律失常发生率低于A组(P=0.008、0.015)和B组(P=0.014、0.034)。(5)PCI术后,C组患者的LVEF水平高于A组和B组(均为P<0.001)。(6)住院期间及出院后30 d内,三组患者均未发生大出血,少量出血和微量出血的发生率比较无统计学差异(χ^(2)=1.385,P=0.500);术后12个月内,C组患者的MACE发生率低于A组和B组(χ^(2)=7.400,P=0.025)。结论尼可地尔+尿激酶原+替罗非班靶血管灌注具有协同作用,可有效改善STEMI患者PCI术后的心肌灌注,减轻术后心肌损伤和氧化应激损伤,促进ST段回落,降低恶性心律失常发生率,有效促进心功能恢复,减少心血管不良事件,且不增加术后出血。

血清成纤维细胞生长因子21和脂肪酸结合蛋白4检测对急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后心力衰竭的预测价值

目的探究血清成纤维细胞生长因子21(FGF21)和脂肪酸结合蛋白4(FABP4)检测对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后心力衰竭的预测价值。方法选取2020年9月至2022年9月内蒙古医科大学附属医院接诊的113例STEMI患者为研究对象,依据PCI术后1年是否发生心力衰竭(心衰),将其分为心衰组(n=32)和非心衰组(n=81)。应用ELISA法测定血清FGF21、FABP4表达水平,比较两组血清FGF21、FABP4水平,多因素logistic回归分析影响STEMI患者PCI术后发生心力衰竭的相关因素,ROC曲线评估血清FGF21、FABP4水平对STEMI患者PCI术后心力衰竭发生的预测价值。结果心衰组心率次数、C反应蛋白(CRP)、心肌肌钙蛋白(cTnI)、N末端B型利钠肽原(BNP)、利尿剂使用比例均显著高于非心衰组,左心室射血分数(LVEF)显著低于非心衰组(P<0.05)。心衰组血清FGF21、FABP4表达水平均明显高于非心衰组[(228.37±33.07)ng/L比(185.68±25.52)ng/L、(34.26±5.51)ng/ml比(26.87±4.67)ng/ml,t=7.345、7.195,P<0.05]。血清FGF21(95%CI 1.371~8.191)、FABP4(95%CI 1.176~4.090)及发病到至导丝通过时间(95%CI 1.058~8.157)是影响STEMI患者PCI术后发生心力衰竭的危险因素(OR>1,P<0.05),LVEF(95%CI 0.473~0.913)是保护因素(OR<1,P<0.05)。血清FGF21、FABP4单独及二者联合预测STEMI患者PCI术后发生心力衰竭的曲线下面积(AUC)分别为0.828、0.856、0.934,二者联合优于单一(Z二者联合-FGF21=1.971、Z二者联合-FABP4=2.417,P=0.048、P=0.015)。结论STEMI患者PCI术后发生心力衰竭血清FGF21、FABP4水平均明显升高,二者联合对STEMI患者PCI术后发生心力衰竭的风险具有更高的预测价值。

ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后左心室整体长轴应变损减对远期预后的影响

目的:评估ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后左心室整体长轴应变(GLS)损减对远期预后的影响。方法:入选2020年9月至2023年8月我院已完成罪犯血管PCI,并于住院期间完成超声心动图斑点追踪的STEMI患者156例。去除基线时心力衰竭(Killip心功能分级Ⅱ~Ⅳ级)患者18例,最终观察138例患者。应用斑点追踪技术检测GLS。根据约登指数将患者分为GLS>-11.7%组(n=57)及GLS≤-11.7%组(n=81)。比较两组患者基线资料及超声心动图特点。对患者进行21(13,28)个月的随访,比较两组患者心力衰竭事件率。结果:入院时GLS>-11.7%组患者肌钙蛋白I(TnI)峰值显著高于GLS≤-11.7%组[85 160(31 297,214 226)pg/ml vs. 34 942(13 571,92 713)pg/ml,P<0.001]、罪犯血管分布差异亦有统计学意义(P<0.001)。超声心动图显示,GLS>-11.7%组患者较GLS≤-11.7%组患者左心室射血分数(LVEF)更低[(49.2±8.3)%vs.(60.1±8.7)%,P<0.001],节段性室壁运动异常比例更高(100%vs. 90.1%,P=0.015)。随访期间GLS>-11.7%组的LVEF及GLS均有恢复趋势,但整体仍逊于GLS≤-11.7%组(P均<0.001)。中位随访21(13,28)个月期间,校正年龄、性别、罪犯血管分布、TnI峰值后,GLS>-11.7%组患者心力衰竭风险显著增加(HR=9.123,95%CI:1.720~43.394,P=0.009)。结论:STEMI患者PCI后,GLS相对损减严重的患者远期心力衰竭风险升高。

急性ST段抬高型心肌梗死合并心脏破裂的列线图模型建立

[目的]分析急性ST段抬高型心肌梗死(STEMI)患者发生心脏破裂(CR)的风险因素,并依此构建急性STEMI患者合并CR的列线图模型。[方法]通过宁夏医科大学总医院大数据研究平台、医院信息系统检索连续纳入2015年1月—2019年12月急性STEMI患者5412例,其中合并CR的91例患者为CR组,5321例未合并CR患者为非CR组。运用LASSO回归、单因素及多因素Logistic回归分析急性STEMI患者合并CR的风险因素,并建立CR的列线图预测模型。分别运用受试者工作特征曲线、Hosmer-Lemeshow检验、临床决策曲线分析法(DCA)对建立的列线图模型进行验证和评估。[结果]LASSO回归结果显示年龄、女性、高血压病史、首次医疗接触时间、休克指数、Killip分级、白细胞计数、D二聚体、乳酸、前壁心肌梗死、24 h内服用β受体阻滞剂、24 h内服用血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)药物、急诊PCI共13个变量为CR的风险因素(P<0.05)。把筛选出的13个风险因素分别进行单因素及多因素Logistic回归分析,结果提示年龄、Killip分级、首次医疗接触时间、白细胞计数、未行急诊PCI、24 h内未服用ACEI/ARB药物是急性STEMI患者合并CR的风险因素。依据上述6个风险变量建立急性STEMI合并CR列线图模型。该列线图模型内部验证前后ROC曲线下面积分别为0.946(95%CI:0.927~0.961)、0.947(95%CI:0.927~0.959),灵敏度分别为0.957、0.904,特异度分别为0.858、0.876,说明该模型具有较好的区分度。运用Hosmer-Lemeshow检验证明该模型的预测价值和实际观测值之间的偏差没有统计学意义(χ^(2)=12.70,P=0.122),说明列线图模型具有较好的校准度。DCA曲线提示模型的预测概率阈值在0.00~0.40之间,临床净获益最高,说明具有较好的临床效能。[结论]本研究建立的列线图模型有较好的区分度、校准度和临床效能,能有效预测急性STEMI合并CR的发生概率,为临床诊疗工作提供一定帮助,以期降低CR发生率。

血管内超声参数联合microRNA-206评估非ST段抬高型急性心肌梗死患者病变严重程度及预后的价值

目的探讨血管内超声(IVUS)参数联合microRNA-206(miR-206)评估非ST段抬高型急性心肌梗死(NSTEAMI)患者病变严重程度及预后的价值。方法选取2019年3月-2021年4月河北北方学院附属第一医院收治的105例NSTEAMI患者,所有患者行经皮冠状动脉介入术(PCI),根据病变严重程度将患者分为单支病变组(55例)、双支病变组(32例)、多支病变组(18例)。对比不同病变程度患者IVUS参数、血清miR-206,分析IVUS参数、血清miR-206与NSTEAMI患者病变严重程度的相关性。随访2年,根据是否发生MACE分为发生组与非发生组。对比发生组与非发生组的临床资料,采用多因素逐步Logistic回归模型分析NSTEAMI患者发生主要不良心脏事件(MACE)的影响因素。绘制受试者工作特征(ROC)曲线,评估IVUS参数、血清miR-206预测NSTEAMI患者发生MACE的效能。结果多支病变组斑块负荷、斑块面积、重构指数、偏心指数、血清miR-206相对表达量均高于单支、双支组(P<0.05),且双支病变组均高于单支病变组(P<0.05)。Pearson相关性分析结果显示,血管外弹力膜面积与NSTEAMI患者病变严重程度无相关性(r=0.271,P=0.325);斑块负荷、斑块面积、重构指数、偏心指数、血清miR-206与NSTEAMI患者病变严重程度呈正相关(r=0.416、0.382、0.423、0.507和0.394,均P=0.000)。随访2年,失访2例,剩余103例患者中32例(31.07%)发生MACE,71例(68.93%)未发生MACE。发生组多支病变、血运未重建占比、斑块负荷、斑块面积、重构指数、偏心指数、血清miR-206相对表达量均高于非发生组(P<0.05),淋巴细胞计数、血红蛋白水平均低于非发生组(P<0.05)。多因素逐步Logistic回归分析结果显示:多支病变[OR=3.466(95%CI:1.523,7.884)]、血运未重建[OR=2.776(95%CI:1.220,6.315)]、斑块负荷[OR=3.155(95%CI:1.387,7.177)]、重构指数[OR=3.842(95%CI:1.689,8.740)]、偏心指数[OR=4.166(95%CI:1.831,9.477)]、血清miR-206[OR=4.500(95%CI:1.978,10.236)]为NSTEAMI患者发生MACE的危险因素(P<0.05)。ROC曲线结果显示,斑块负荷、重构指数、偏心指数、血清miR-206四者联合预测NSTEAMI患者发生MACE的敏感性为88.52%(95%CI:0.674,0.957),特异性为92.86%(95%CI:0.713,0.968),曲线下面积为0.900(95%CI:0.812,0.953)。结论IVUS参数(斑块负荷、重构指数、偏心指数)、血清miR-206在评估NSTEAMI患者病变严重程度与预后中具有重要价值,且四者联合具有更高的预测价值。

老年急性ST段抬高型心肌梗死患者左心室血栓形成的影响因素及其Nomogram风险预测模型构建

目的探讨老年急性ST段抬高型心肌梗死(STEMI)患者左心室血栓(LVT)形成的影响因素,并构建Nomogram风险预测模型。方法将华中科技大学同济医学院附属同济医院2020年1月至2023年12月收治的873例急性STEMI患者以7∶3分为训练集(n=611)和验证集(n=262)。根据训练集患者LVT发生情况分为非LVT组(n=549)和LVT组(n=62)。多因素logistic回归分析急性STEMI患者发生LVT的影响因素;利用R软件rms程序包构建预测急性STEMI患者LVT发生风险的Nomogram模型,并通过ROC及Hosmer-Lemeshow检验验证其预测效能。结果与非LVT组比较,LVT组血红蛋白(Hb)[(131.15±15.99)g/L比(143.28±16.71)g/L]和左心室射血分数(LVEF)[(39.99±5.01)%比(45.24±6.69)%]明显较低(t=5.441、5.991,P<0.05),合并室壁瘤(37.10%比20.40%)、基线心肌梗死溶栓治疗(TIMI)血流分级0级(59.68%比44.81%)、未形成冠状动脉侧支循环(88.71%比72.13%)以及未进行急诊经皮冠状动脉介入治疗(PCI)或药物溶栓的占比(69.35%比48.82%)明显较高(χ^(2)=9.022、4.953、7.921、9.403,P<0.05)。多因素Logistic回归显示,Hb(OR=0.948)和LVEF(OR=0.868)为急性STEMI患者发生LVT的保护因素(P<0.05),合并室壁瘤(OR=6.812)、基线TIMI血流分级0级(OR=6.884)、未形成冠状动脉侧支循环(OR=7.273)、未进行急诊PCI或药物溶栓(OR=4.173)为其独立危险因素(P<0.05)。ROC分析显示,训练集AUC为0.871(95%CI 0.830~0.912),验证集为0.838(95%CI 0.731~0.945);Hosmer-Lemeshow检验中训练集χ^(2)=11.379,P=0.181,验证集χ^(2)=11.261,P=0.187。结论急性STEMI患者LVT的发生与Hb、LVEF、室壁瘤、基线TIMI分级、冠状动脉侧支循环形成及是否接受急诊PCI或药物溶栓密切相关,基于这些因素构建的Nomogram预测模型区分度及一致性良好,有助于临床预测。

不同剂量他汀类药物对经皮冠状动脉介入治疗的老年ST段抬高型急性心肌梗死患者的影响

目的 探讨不同剂量阿托伐他汀、瑞舒伐他汀、辛伐他汀对接受经皮冠状动脉介入治疗(PCI)的老年ST段抬高型急性心肌梗死(STEMI)患者的影响。方法 前瞻性选取接受PCI的180例STEMI患者作为研究对象,采用随机数字表法分为A组、B组、C组、D组、E组、F组,每组30例。A组口服低剂量辛伐他汀,B组口服高剂量辛伐他汀,C组口服低剂量阿托伐他汀,D组口服高剂量阿托伐他汀,E组口服低剂量瑞舒伐他汀,F组口服高剂量瑞舒伐他汀。比较各组患者血清炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)]、心肌损伤标志物[肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白T(cTnT)、N末端脑钠肽前体(NT-proBNP)]、心功能指标[左心室射血分数(LVEF)、心脏指数(CI)、心排血量(CO)]水平、ST段回落情况及不良心血管事件、不良反应发生情况。结果 术后1 d、术后1个月时,A组、B组、C组、D组、E组、F组的IL-6、hs-CRP、TNF-α水平均依次降低,差异有统计学意义(P<0.05);术后1 d、术后1个月时,A组、B组、C组、D组、E组、F组的cTnT、CK-MB、NT-proBNP水平均依次降低,差异有统计学意义(P<0.05);术后1个月时,A组、B组、C组、D组、E组、F组的LVEF、CO、CI均依次升高,差异有统计学意义(P<0.05);A组、B组、C组、D组、E组、F组的ST段回落者占比依次升高,差异有统计学意义(P<0.05);各组患者不良心血管事件总发生率、不良反应总发生率比较,差异均无统计学意义(P>0.05)。结论 低剂量、高剂量的阿托伐他汀、瑞舒伐他汀、辛伐他汀应用于PCI术后STEMI患者,均可有效减轻炎症反应,改善心肌功能,促进ST段回落,其中高剂量瑞舒伐他汀效果最佳。

氯吡格雷联合替格瑞洛对急性ST段抬高型心肌梗死患者OCT指标的影响

目的基于光学相干断层成像(OCT)指标探讨氯吡格雷联合替格瑞洛对急性ST段抬高型心肌梗死(STEMI)患者动脉粥样硬化斑块稳定性的影响。方法回顾性选取江苏省滨海县人民医院2020年1月至2023年1月收治的急性STEMI患者105例,根据治疗方案的不同分为常规组(52例)和联合组(53例)。两组患者均予氯吡格雷治疗,联合组患者加用替格瑞洛,均治疗12个月。结果联合组患者的总有效率为84.91%,显著高于常规组的65.38%(P<0.05)。治疗后,联合组患者的最小纤维帽厚度显著大于常规组(P<0.05),脂质弧度显著小于常规组(P<0.05),且联合组的改善幅度均显著大于常规组(P<0.05);两组患者的最小管腔面积无显著差异(P>0.05),但联合组最小管腔面积增大量显著高于常规组(P<0.05);两组患者的全血黏度、血浆黏度、血细胞比容均显著降低(P<0.05),且联合组均显著低于常规组(P<0.05)。联合组患者的不良反应发生率为5.66%,显著低于常规组的19.23%(P<0.05)。结论氯吡格雷联合替格瑞洛治疗急性STEMI的临床疗效良好,可改善患者动脉粥样硬化斑块的稳定性,促进血管功能恢复,且安全性良好。