Assessment of Cardiac Autonomic Function by Using Heart Rate Turbulence in Behcet’s Disease

Behcet’s disease (BD) is a chronic inflammatory disorder that can affect many systems in the body. Cardiac involvement increases the risk of cardiovascular mortality and occurs in 1%-5% of patients with BD. Ventricular arrythmias are believed to be the cause of this increased risk of cardiovascular mortality and it is also thought to be related with cardiac autonomic dysfunction. Heart rate turbulence (HRT) is a new predictor of cardiac autonomic activity. HRT is an independent and powerful predictor of mortality. In this study, we investigated the cardiac autonomic activity which can be determined by HRT in patients with BD. Forty patients with BD (20 men, mean age: 40 ± 9 years, range: 27-55 years) were diagnosed according to the International Study Group Criteria (ISGC) and gender and age matched healthy volunteers (20 men, mean age: 39 ± 8 years, range: 26-56 years) were included in this study. All of the participants (patients and controls) underwent 24 hours Holter electrocardiogram. HRT parameters, turbulence onset (TO) and turbulence slope (TS) were calculated with HRT (View Version 0.60-0.1 of Software Program). There were no significant differences in TO and TS values between patients with BD and control subject (TO-BD: 0.014 ± 0.03, TO-Control: 0.011 ± 0.04;TS-BD: 7.88 ± 4.9, TS-Control: 9.42 ± 6.7 respectively). Although increased cardiovascular mortality rates in BD have been shown in many studies, HRT values—detecting the risk of sudden death—do not seem to be altered in this disease.

Factors Leading to a Dramatic Fall in Coronary Heart Disease Death Rates in Los Angeles County

This paper provides commentary on some of the factors leading to a dramatic fall in heart disease death rates and the 42-year period (1968-2010) documented on the accompanying table.

Using of spectral analysis of heart rate variability for increasing reliability of bicycle ergometry results

The aim was to study the suitability of the heart rate variability (HRV) spectral parameters for evaluations of bicycle ergometry results in coronary heart disease (CHD) patients. Methods. Our study included 243 male CHD patients aged 49±8 years. The coronary atherosclerosis was assessed by coronary angiography. The results of bicycle ergometry, Doppler echocardio-graphy and HRV spectral analysis were also analyzed. The duration of each stage of bicycle ergometry was 3 min, the initial load value was 25 W. Dynamic load continued until the patient had reached 75% of heart rate from his maximal age level. The maximal level of load achieved (i.e. load tolerance) was taken into consideration. We calculated sensitivity (Se), specificity (Sp), likelihood ratios of positive (LR+) and negative (LR-) bicycle ergometry results. Results. All patients had similar clinical characteristics. LR+ become maximal under the moderate load tolerance. LR- are maximal in the CHD patients with high load tolerance. Thus, the excessiveness of false-negative results of bicycle ergometry is in CHD patients with high load tolerance. Reliability of results of bicycle ergometry increased under using assessments of low-frequency (LF) range power of HRV spectrum. Conclusions. Thus,the using of LF range power of HRV spectrum increases reliability of bicycle ergometry (or other load tests) results in CHD patients.

Resting heart rate control and prognosis in coronary artery disease patients with hypertension previously treated with bisoprolol:a subgroup analysis of the BISO-CAD study

Background:Resting heart rate(RHR)is considered as a strong predictor of total mortality and hospitalization due to heart failure in hypertension patients.Bisoprolol fumarate,a second-generation beta-adrenoreceptor blockers(β-blocker)is commonly prescribed drug to manage hypertension.The present study was to retrospectively evaluate changes in the average RHR and its association with cardiovascular outcomes in bisoprolol-treated coronary artery disease(CAD)patients from the CAD treated with bisoprolol(BISO-CAD)study who had comorbid hypertension.Methods::We performed ad-hoc analysis for hypertension sub-group of the BISO-CAD study(n=866),which was a phase IV,multination,multi-center,single-arm,observational study carried out from October 2011 to July 2015 across China,South Korea,and Vietnam.Multivariate regression analysis was used to identify factors associated with incidence of composite cardiac clinical outcome(CCCO),the results were presented as adjusted odds ratio(OR)along with 95%confidence interval(CI)and adjusted P value.Results::A total of 681 patients(mean age:64.77±10.33 years)with hypertension from BISO-CAD study were included in the analysis.Bisoprolol improved CCCOs in CAD patients with comorbid hypertension,with RHR<65 and<70 beats/min compared with RHR≥65 and≥75 beats/min,respectively,in the efficacy analysis(EA)set.In addition,it lowered RHR in both intent-to-treat(ITT)and EA groups after 6,12,and 18 months of treatment.Further,RHR 70 to 74 beats/min resulted in significantly higher risk of CCCOs EA set of patients(adjusted OR:4.34;95%CI:1.19-15.89;P=0.03).Also,events of hospitalization due to acute coronary syndrome were higher when RHR 69 to 74 beats/min compared to RHR<69 beats/min in ITT patients.Conclusion::Bisoprolol can effectively reduce RHR in Asian CAD patients with comorbid hypertension and hence,improve CCCO without affecting their blood pressure.

Heart rate distribution and predictors of resting heart rate after initiation of beta-blocker treatment in patients with coronary artery disease： REsults of Sympathetic Evaluation And Research of China （RESEARCH） study

Background The importance of heart rate as secondary prevention strategies for patients with coronary artery disease （CAD） is emphasized by multiple guidelines. However, limited information is available on the heart rate distribution and the change patterns of resting heart rate when initiating beta-blocker therapy among Chinese patients with CAD. Methods The REsults of Sympathetic Evaluation And Research of China （RESEARCH） study is a multi-centre, prospective, observational study involving 147 centers in 23 cities across China. All eligible beta-blocker naive patients were prescribed with metroprolol succinate. Initial dosage and target heart rate were selected at the discretion of their physicians in charge according to their usual institutional practice. The heart rate distribution and the change patterns of resting heart rate after initiation of beta-blocker therapy were observed. Results The majority of patients （63.6%） were prescribed with 47.5 mg metroprolol succinate. At baseline, there were only 17.4% of patients whose heart rate was less than 70 beats per minute, and the proportion reached 42.5% and 79.1%, one month and two months after initiation of beta-blockers, respectively. Multivariate linear regression analysis showed that baseline heart rate （B=0.900, SE=0.006, t=141.787, P〈0.0001） and the dosage （B=-0.007, SE=0.002, t=-3.242, P=0.001） were independent predictors of resting heart rate 2 months after beta-blocker therapy. Conclusions Resting heart rate is not optimally controlled in a broadly representative cohort of Chinese outpatients with CAD even after initiation of β-blocker therapy, and baseline heart rate and the dosage of beta-blocker are both independent predictors of resting heart rate after β-blocker therapy.

基于心率变异性分析的中医防治冠状动脉粥样硬化性心脏病近十年研究进展

冠状动脉粥样硬化性心脏(简称“冠心病”)作为全球致死率最高的疾病,是诱导恶性心血管事件发生的主要疾病因素,已带来巨大的经济和医疗负担,有效防治冠心病成为当前的首要任务。冠状动脉粥样硬化是冠心病形成的主要病理过程,与自主神经系统调控失衡密切相关,心率变异性作为检测心脏自主神经病变的常用指标,具有无创、操作简便等诸多优点,已广泛应用于临床和科研中。心率变异性的降低常用于预测全因死亡和恶性心血管事件的发生。近年来,中医药被报道可有效并特异性地改善心率变异性。本文概括心率变异性与冠心病的相互关系,综述近年来基于心率变异性分析的中医药干预冠心病临床效果,以期为冠心病相关的中医药研究与临床治疗提供参考。

Clinical Significance of Abnormal Heart Rate Recovery after Treadmill Exercise Test in Patients With Coronary Artery Disease

To evaluate the values of abnormal heart rate recovery （HRR） after treadmill exercise test in patients with coronary artery disease （CAD）. Methods One hundred and seventy-eight consecutive cases of suspected CAD who underwent symptom-limited treadmill exercise test （TET） and coronary angiography （CAG） were enrolled and divided into normal and abnormal HRR group based on the status of the values of HRR one or two minutes after TET. The clinical characteristics, TET parameters and CAG results of the two groups were compared attempted to assess the value of HRR on patients with CAD. Results （ 1 ） The cases of smoking, diabetes mellitus （DM） and ST segment deviation at rest in abnormal HRR group were more significantly than those in normal HRR group （ all P 〈 0. 05 ）. （2） The subjects of abnormal HRR usually had higher basal heart rate, more cases exhibited ST segment abnormality and or exercise-limited angina during or after TET（P 〈 0. 01 and P 〈 0. 05, respectively）, but lower level of peak heart rate attained （ P 〈 0. 05 ） than those in normal group. The values of metabolism equivalents and duration of TET between the two groups displayed phenomenal difference （ P 〈 0. 05 ）. There were more samples acquired moderate to high level of Duke test score and chronotropic incompetence in the group of abnormal HRR, compared to the normal HRR group （P 〈 0. 01 ）. （3） The cases of negative CAG results in the group of normal and abnormal HRR group were 73 （66. 97 % ） and 24 （34. 78 % ）. Cases of significant coronary lesions （ at least one major coronary vessel ≥ 50 % stenosis） amongst the subgroup of positive CAG were 36 （ 33.03 % ） and 45 （65.22 % ）, severe coronary lesions （ three-vessel, left main or the equivalents of left main） were 10 （9. 17 % ） and 17 （24. 64 % ） for normal and abnormal HRR respectively （P 〈 0. 01 ）. Accordingly, the Gensini scores in the subunit of abnormal HRR increased. （4）Linear correlation analysis indicate there was a negative correlation between the values of HRR in the first and second minutes and indices of severity of CAD （ all P 〈 0. 01 ）. The analysis of auxiliary diagnostic value of abnormal HRR indicated the annexed HRR standard had higher negative predictive value. Conclusions The status of HRR after TET are not only influenced by the clinical factors related to the cardiac autonomic function, but also associated with the extent of CAD. （ S Chin J Cardiol 2009 ; 10（1）：1-8）

康欣口服液联合阿托伐他汀治疗中老年冠心病心肌缺血的效果分析

目的:分析康欣口服液联合阿托伐他汀治疗中老年冠心病心肌缺血的效果。方法:选取2021年7月—2023年7月中国中医科学院广安门医院收治的74例中老年冠心病心肌缺血患者作为研究对象,应用随机数字表法分为两组,各37例。对照组采用阿托伐他汀治疗,观察组在对照组基础上应用康欣口服液治疗。比较两组治疗效果。结果:治疗后,两组ST段压低总次数少于治疗前,且观察组少于对照组,两组ST段压低总时间短于治疗前,且观察组短于对照组,差异有统计学意义(P<0.05)。治疗后,两组24 h正常RR间期标准差、24 h每5 min正常RR间期平均值标准差高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。治疗后,两组心输出量、左心室射血分数高于治疗前,且观察组高于对照组,两组B型利钠肽水平低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。结论:康欣口服液联合阿托伐他汀治疗中老年冠心病心肌缺血的效果显著,可提高心率变异性,改善心功能及ST段偏移情况。

冠心病患者双抗血小板治疗反应性与CYP2C19基因型的关系

目的 分析冠心病患者双抗血小板治疗反应性与细胞色素P4502C19(CYP2C19)基因型的关系。方法 选择2021年3月至2023年2月在池州市第二人民医院接受经皮冠脉介入术(PCI)治疗的96例冠心病患者,术后均接受双联抗血小板治疗。根据血小板抑制率将患者分为抗血小板治疗高反应组(n=53)和低反应组(n=43),比较两组CYP2C19基因型、一般资料及血液生化指标,采用Logisic回归分析冠心病患者双抗血小板反应性与CYP2C19基因型的关系。结果 低反应组CYP2C19快代谢型比例低于高反应组,中间代谢型比例高于低反应组,差异有统计学意义(P<0.05)。低反应组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)高于高反应组,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,CYP2C19基因型、高水平LDL是冠心病患者发生抗血小板治疗抵抗的危险因素(P<0.05)。结论 冠心病双抗血小板治疗反应性与CYP2C19基因型关系密切,CYP2C19慢代谢型与高水平LDL是冠心病患者发生双抗血小板治疗抵抗的危险因素,检测CYP2C19基因型或有利于指导冠心病抗血小板治疗。

温阳复脉益心加减方联合铜砭刮痧治疗老年冠心病并发心律失常疗效研究

目的:探究温阳复脉益心加减方联合铜砭刮痧治疗老年冠心病并发心律失常的临床价值。方法:选取冠心病并发心律失常患者94例,依据简单随机数字表法分为中西医组、西医组,各47例。西医组口服胺碘酮、美托洛尔,中西医组在西医组基础上采取温阳复脉益心加减方联合铜砭刮痧,两组均治疗1个月。统计两组治疗前后中医证候积分、临床疗效、心率、短阵室性心动过速数量、室性早搏数量、校正QT间期(QTc)、QT离散度(QTd)、不良反应发生情况。结果:治疗后两组胸闷气短、心悸不安、眩晕、自汗懒言、神疲乏力、形寒肢冷、面色白评分较治疗前下降,且中西医组低于西医组,差异有统计学意义(均P<0.05)。中西医组治疗总有效率93.62%高于西医组78.72%,差异有统计学意义(均P<0.05)。治疗后两组静息心率、24 h最快心率、24 h最慢心率、24 h平均心率、24 h总心率较治疗前增高,且中西医组高于西医组,差异有统计学意义(均P<0.05)。治疗后两组短阵室性心动过速数量、室性早搏数量少于治疗前,且中西医组少于西医组,差异有统计学意义(均P<0.05)。治疗后两组QTc、QTd较治疗前降低,且中西医组低于西医组,差异有统计学意义(均P<0.05)。中西医组不良反应发生率6.38%与西医组10.64%比较,差异无统计学意义(P>0.05)。结论:温阳复脉益心加减方联合铜砭刮痧治疗老年冠心病并发心律失常可改善心率,缓解临床症状,提升治疗效果,且较安全。

琥珀酸美托洛尔联合银杏达莫注射液对冠心病心绞痛患者心率变异性、血液流变学的影响

目的探讨银杏达莫注射液联合琥珀酸美托洛尔对冠心病心绞痛患者水平的影响。方法选取济南市第四人民医院2019年7月-2021年7月收治的冠心病心绞痛患者80例,随机数字表法将其分为对照组(38例)和观察组(42例)。对照组采用银杏达莫注射液治疗;观察组在对照组基础上给予琥珀酸美托洛尔治疗。比较2组治疗前后心绞痛发作次数与持续时间、血清炎症因子水平、24 h动态血压、心率变异性(heart rate variabiliby,HRV)、血液流变学指标;比较治疗后2组临床治疗效果、不良反应。结果治疗后,观察组心绞痛发作次数、持续时间、6 min步行测试距离与对照组相比较,发作次数持续较短、距离较长(P<0.05);治疗后,2组血清肿瘤坏死因子α(TNF-α)、细胞间黏附分子-1(ICAM-1)、C-反应蛋白(CRP)水平相比均低于治疗前,HRV比较均高于治疗前,且观察组明显优于对照组(P<0.05);治疗后,2组的24 h动态血压、纤维蛋白原、血浆黏度、全血低切黏度、全血高切黏度差值相比均低于治疗前,且观察组均低于对照组,差异具有统计学意义(P<0.05)。结论经琥珀酸美托洛尔联合银杏达莫注射液对早期冠心病心绞痛患者进行治疗后,降低患者血黏度,减少患者的发作次数与持续时间,HRV均升高,血液流变学指标、24 h动态血压水平均降低,血清炎症因子得到抑制,防止病情进一步的发展,临床效果较为显著。

探讨参松养心胶囊联合美托洛尔缓释片治疗老年冠心病室性期前收缩的临床疗效

目的探究老年冠状动脉粥样硬化性心脏病(简称冠心病)室性期前收缩采取参松养心胶囊联合美托洛尔缓释片的治疗效果。方法随机选取2021年6月-2023年6月淄博市中医医院收治的100例冠心病室性期前收缩患者为研究对象,按照不同治疗药物分成单一组与联合组,每组50例。单一组的患者采取美托洛尔缓释片进行治疗,联合组的患者采取美托洛尔缓释片联合参松养心胶囊进行治疗。比较两组患者不同用药之后的治疗效果、血压、不良反应等情况。结果联合组患者的治疗总有效率为88.00%,高于单一组的72.00%,差异有统计学意义(χ^(2)=4.000,P<0.05)。治疗后,联合组患者的心率、血压水平、室性期前收缩次数低于单一组,差异有统计学意义(P均<0.05)。两组不良反应比较,差异无统计学意义(P>0.05)。结论采取参松养心胶囊联合美托洛尔缓释片能够有效地提高患者的治疗效果,改善患者的心率以及血压水平,降低室性期前收缩次数,且联合用药方式安全性较高。

HrEF、TEF与心功能分级的相关性及其对冠心病新发心房颤动的预测价值

目的 探究左室射血分数(LVEF)与心率的比值(HrEF)、LVEF与心电图QRS波时程(QRSd)的比值(TEF)与心功能分级的相关性,并分析HrEF、TEF对冠心病(CHD)新发心房颤动(AF)的预测价值。方法 选取2020年10月至2022年8月于该院就诊的82例CHD患者作为研究对象,按照是否新发AF分为AF组(16例)和非AF组(66例),另根据美国纽约心脏病学会(NYHA)分级分为Ⅰ级组(10例)、Ⅱ级组(28例)、Ⅲ级组(37例)、Ⅳ级组(7例)。所有患者均进行LVEF及心电图检查,记录并比较Ⅰ~Ⅳ级组患者LVEF、QRSd、心率、HrEF、TEF,比较AF组与非AF组HrEF及TEF。采用Spearman相关分析LVEF、QRSd、心率、HrEF、TEF与NYHA分级的相关性。绘制受试者工作特征(ROC)曲线分析HrEF、TEF对CHD新发AF的预测价值。结果 QRSd、心率比较均为Ⅰ级组<Ⅱ级组<Ⅲ级组<Ⅳ级组,差异均有统计学意义(P<0.05)。LVEF、HrEF及TEF比较均为Ⅰ级组>Ⅱ级组>Ⅲ级组>Ⅳ级组,差异均有统计学意义(P<0.05)。Spearman相关分析结果显示,CHD患者LVEF、HrEF、TEF与NYHA分级均呈负相关(r=-0.518、-0.625、-0.634,P<0.05)。QRSd、心率与NYHA分级均呈正相关(r=0.513、0.527,P<0.05)。AF组HrEF、TEF均低于非AF组,差异均有统计学意义(P<0.05)。ROC曲线分析显示,2项指标联合预测CHD新发AF的曲线下面积(AUC)为0.874,高于HrEF(AUC为0.817)、TEF(AUC为0.718)单独预测。结论 HrEF、TEF与CHD患者心功能分级有相关性,且HrEF、TEF对CHD新发AF的预测价值较高,可为临床诊疗提供参考依据。

血管内超声技术对冠心病介入治疗患者心功能及术后残余狭窄率的影响

目的 探究血管内超声技术(IVUS)对冠心病(CHD)介入治疗患者心功能及术后残余狭窄率的影响。方法 选取2022年1月至2023年12月我院收治的96例CHD患者,按照单双数原则,两组轮流抽取,最终各48例。前者、后者分别在冠状动脉造影(CAG)、IVUS引导下经皮冠状动脉介入治疗(PCI)。对比两组手术成功率、心功能指标、术后相关指标、临床结局。结果 两组手术成功率、心功能指标、心肌梗死发生率、再次PCI发生率相比,差异无统计学意义(P>0.05);观察组支架扩张时最大球囊压力、最大管腔直径、最小管腔直径均大于对照组,术后残余狭窄率、因心绞痛住院发生率、亚急性血管闭塞发生率均低于对照组(P<0.05)。结论 血管内超声技术对冠心病介入治疗效果甚佳,有效改善患者心功能,降低术后残余狭窄率。

冠心病患者入院体重指数与静息心率的关系研究

目的评估冠心病患者入院体重指数(BMI)与静息心率(RHR)的关系。方法收集深圳市人民医院2018年1月至2021年12月2533例冠心病患者的原始数据。排除BMI(n=914)、入院时RHR(n=155)变量数据缺失及其他协变量缺失资料(n=122)的患者,最终纳入1342例冠心病患者。采用单变量和多变量回归模型评价BMI和RHR之间的关系,为了确定BMI和RHR之间的关联,进行分层分析和交互检验,最后通过调整潜在混杂因素后的平滑曲线拟合探讨BMI和RHR之间的关系。结果BMI与入院时的RHR呈负相关(校正后的β=-0.50,95%CI-0.67~-0.33,P<0.001)。以BMI的最低组作为参考,RHR随着BMI的增加而下降(β=-1.96,95%CI-3.55~-0.37,P=0.016;β=-3.45,95%CI-5.13~-1.76,P<0.001;β=-5.35,95%CI-7.13~-3.57,P<0.001),趋势性检验P<0.001。然而,BMI和RHR之间存在非线性关系。BMI<27.6 kg/m^(2)调整后的回归系数为-0.70(95%CI-0.93~-0.48,P<0.001),而BMI≥27.6 kg/m^(2)则为0.11(95%CI-0.37~0.59,P=0.649)。结论在冠心病患者入院时,BMI与RHR呈显著负相关,存在饱和效应。

12导联动态心电图与常规心电图对冠心病伴发心律失常的评估价值

目的探究12导联动态心电图对冠心病患者伴发心律失常检出率及诊断效能。方法招募我院2021年4月~2023年4月139例冠心病患者纳入研究,根据是否伴发心律失常分为研究组(93例,伴发心律失常)和对照组(46例,不伴发心律失常),两组均接受12导联动态心电图、常规心电图检查。比较两组心律失常及心电异常检出率、窦性R-R期间总体标准差(SDNN),使用受试者(ROC)曲线分析SDNN诊断冠心病伴发心律失常的效能。结果研究组心律失常、室性早搏成对、室性早搏二、三联律、房性早搏二、三联律、短阵室上速检出率均高于对照组(P<0.05),两组房室传导阻滞、房性早搏、室性早搏检出率未见明显差异(P>0.05);研究组SDNN小于对照组,差异有统计学意义(P<0.05);ROC曲线显示:SDNN诊断冠心病伴发心律失常的曲线下面积(AUC)为0.639。结论12导联动态心电图可明确心电异常类型,同时记录SDNN有助于鉴别冠心病伴发心律失常,存在较高诊断效能。

Urinary albumin excretion rate is correlated with severity of coronary artery disease in elderly type 2 diabetic patients

Background Coronary heart disease is the main complication of type 2 diabetes mellitus; its incidence is closely related to microalbuminuria. The aim of this study was to investigate the correlation between the urinary albumin excretion rate and the incidence and severity of coronary heart disease in elderly type 2 diabetes mellitus patients. Methods A total of 612 hospitalized type 2 diabetes mellitus patients aged 60 years or older, who were given coronary angiography for diagnosis of possible coronary heart disease, participated. Their urinary albumin excretion rate was measured, and the severity of coronary artery stenosis was quantified with the Gensini scoring system to analyze the incidence of coronary heart disease and the severity of coronary artery stenosis. The optimal urinary albumin excretion rate predictive value for coronary heart disease incidence in elderly type 2 diabetes mellitus patients was determined. Results The incidence of coronary heart disease, the number of patients with coronary vascular disease and the Gensini scores were significantly different between the microalbuminuria group and the normal atbuminuria group （P 〈0.05）. The urinary albumin excretion rate was independently correlated with the occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients （odds ratio （OR） =1.058, P 〈0.0001,95% confidence interval （CI）： 1.036-1.080）. Urinary albumin excretion rate and the Gensini score were independently correlated in elderly type 2 diabetes mellitus patients （β=0.476, P 〈0.0001）. The best predictive value of urinary albumin excretion rate was 10.45 tJg/min for elderly type 2 diabetes mellitus patients. The area under the curve was 0.764, with a sensitivity and specificity of 70.0% and 72.2%, respectively. Conclusions The occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients with microalbuminuria was higher than that in patients with normal albuminuria, and the severity of the disease also increased in patients with microalbuminuria. In elderly type 2 diabetes mellitus patients, urinary albumin excretion rate was positively correlated with the incidence and severity of coronary heart disease and was also an independent factor contributing to coronary heart disease.

Plasma hemoglobin concentration was related to estimated glomerular filtration rate in elderly patients with ischemic cardiomyopathy

Objectives To study the relationship between plasma hemoglobin concentration and estimated glomerular filtration rate （eGFR） in elderly patients with ischemic cardiomyopathy （ICM）.Methods Clinical data of patients with coronary heart disease who were discharged from The First Affiliated Hospital,Chongqing Medical University between 2005 and 2007 were analyzed retrospectively. Echocardiography results,plasma hemoglobin and creatinine concentration were abstracted from the medical records.The study included 235 Chinese Hart patients with age 60 years and older with angiography confirmed coronary heart disease,silent myocardial ischemia or angina pectoris,of whom 154 had ICM defined as left ventricular end-diastolic diameter （LVDd）,male≥56 mm,female≥51 mm （63. 51±7.70 mm） measured by M-mode echocardiography.The differences in plasma hemoglobin concentration were analyzed retrospec- tively between patients with and without ICM,and between patients with an eGFR【60 ml·min-1·1.73m-2 and those with an eGFR≥60 ml·min-1·1.73m-2.Results There were no significant differences in plasma hemoglobin concentration and eGFR between ICM and non-ICM group (118.49±20.52 g·L-1 vs.115.80±23.32 g·L-1 and 75.13±24.21 ml·min-1·1.73m-2 vs.79.09±28.41 ml·min- 1·1.73m-2,respectively,both P】0.05).However,in both ICM and non-ICM groups,plasma hemoglobin concentration was lower in those with an eGFR【60 ml·min-1·1.73m-2 compared with compared with those with an eGFR≥60 ml·min-1·1.73m-2 group (112. 29±18.61 g·L-1 vs.119.92±20.74L-1,P【0.05);plasma hemoglobin concentration was related positively to eGFR.Conclusions There were no significant changes in plasma hemoglobin concentration and eGFR;however,plasma hemoglobin concentration was related to eGFR significantly positively in elderly patients with ICM due to coronary heart

Effect of Acupuncture at Acupoints Neiguan(PC 6)and Ximen(PC 4)on the Left Cardiac Function in the Patients with Coronary Heart Disease

目的:探讨针刺内关与郄门穴对冠心病患者每博心输出量及左心室排血的峰值流速的影响。方法:60例冠心痛患者分为内关组和郄门组,分别在运针3 min 后和留针20 min 后测试每博心输出量,左心室排血的峰值流速。再与针刺前得测试结果相比较。结果:46例患者针刺3 min 后 Q 值和VP 值较针刺前上升。留针20 min 后,34例患者 Q 值和 VP 值全部上升。结论:针刺内关和郄门可增强左心室壁的收缩能力,使心脏的每博输出量增加,改善冠心病患者的心肌缺血状态。

2型糖尿病合并冠状动脉硬化患者心率变异性与中医证型相关性分析

目的:探讨2型糖尿病合并不同程度冠状动脉硬化患者心率变异性与中医辨证分型的相关性。方法:回顾性分析成人2型糖尿病患者中行动态心电图检查的患者进行分组,单纯2型糖尿病组(糖尿病组)102例为对照组,2型糖尿合并冠状动脉硬化组(冠状动脉硬化组)84例,2型糖尿病合并冠心病组(冠心病组)81例。采用3导7电极记录器行24 h长程采样检测HRV时域及频域指标,并辨证分型为气阴两虚、阴阳两虚、湿热内蕴、血脉瘀阻四组证型。比较三组间心率变异性(HRV)时域和频域指标、四组证型的差异以及两者的相关性。结果:三组间糖尿病病程、体重指数(BMI)、糖化血红蛋白(HbA1c)、促甲状腺激素(TSH)、心脏射血分数(EF)值比较,差异无统计学意义(P>0.05)。与糖尿病组比较,冠状动脉硬化组及冠心病组的SDNN、SDANN、W、LF、LF/HF均较糖尿病组下降,差异有统计学意义(P<0.05);冠状动脉硬化组与冠心病组下降程度相当,差异无统计学意义(P>0.05)。2型糖尿病合并不同冠脉硬化程度辨证分型,分为气阴两虚、阴阳两虚、湿热内蕴、血脉瘀阻四组证型例数分别在三组进行比较,与糖尿病组比较,湿热内蕴证在冠状动脉硬化组及冠心病组所占比例较低,且冠心病组低于冠状动脉硬化组;血脉瘀阻证在冠心病组所占比例较高,且冠心病组高于冠状动脉硬化组,差异有统计学意义(P<0.05),其余两组证型差异无统计学意义(P>0.05)。Pearson结果显示,三组间心率变异性与气阴两虚、阴阳两虚两证型无相关性,湿热内蕴证与SDNN(r=0.211,P=0.001)、W(r=0.185,P=0.002)、LFP(r=0.212,P=0.001)呈正相关;血脉瘀阻证与SDNN(r=-0.175,P=0.004)、W(r=-0.123,P=0.044)、LFP(r=-0.15,P=0.014)呈负相关。结论:2型糖尿病患者中,不论冠状动脉硬化的严重程度均可增加心率变异性下降的风险;冠状动脉硬化程度越高,血脉瘀阻证占比越高,湿热内蕴证占比越低。在2型糖尿病合并不同程度冠状动脉硬化患者中心率变异性与湿热内蕴证呈正相关、与血脉瘀阻证呈负相关,HRV下降程度越明显,血瘀的表现越突出,相反湿热证表现越少。