Effect of Shenmai injection combined with antiplatelet drugs on the plaque property and inflammatory response in patients with non-ST-segment elevation ACS

Objective: To investigate the effect of Shenmai injection combined with antiplatelet drugs on the plaque property and inflammatory response in patients with non-ST-segment elevation ACS. Methods: A total of 142 patients with non-ST-segment elevation ACS who were treated in the hospital between June 2015 and September 2017 were divided into control group (n=71) and Shenmai injection group (n=71) by random number table method. Control group received antiplatelet drugs based on routine treatment, and Shenmai injection group received Shenmai injection combined with antiplatelet drugs on the basis of routine treatment. The differences in serum contents of plaque property-related indexes and inflammatory factors were compared between the two groups before and after treatment. Results: Before treatment, there was no significant difference in serum contents of metabolism indexes, lipid indexes, cell adhesion molecules and inflammatory factors between the two groups. After 1 week of treatment, serum metabolism indexes Hcy and UA contents of Shenmai injection group were lower than those of control group;serum lipid indexes ox-LDL and Lp-PLA2 contents were lower than those of control group;serum adhesion molecules sVCAM-1 and sICAM-1 contents were lower than those of control group;serum inflammatory factors IL-1β, IL-6, IL-17 and IL-23 contents were lower than those of control group. Conclusion: Adjuvant Shenmai injection therapy can further stabilize the plaques and inhibit the systemic inflammatory response in patients with non-ST-segment elevation ACS.

Effects of omeprazole or pantoprazole on platelet function in non-ST-segment elevation acute coronary syndrome patients receiving clopidogrel

Background: This study evaluated the effect of omeprazole or pantoprazole on platelet reactivity in non-STsegment elevation acute coronary syndrome(NSTE-ACS) patients receiving clopidogrel.Methods: Consecutive patients with NSTE-ACS(n =620) from general hospital of Shenyang Military Command were randomized to the omeprazole or pantoprazole(20mg/d) group(1:1), and received routine dual antiplatelet treatment. Patients' reversion rate of adenosine diphosphate-induced platelet aggregation(ADP-PA) was assessed at baseline, 12 to 24 h after administration of medication, and after 72 h of percutaneous coronary intervention(PCI). The primary endpoint of the study was platelet reactivity assessed with ADP-PA at 30 days after PCI. Adverse events(AEs) were recorded for 30-day and 180-day follow-up periods.Results: There were no significant differences between both the groups in platelet response to clopidogrel at 12–24h after drug administration(54.09%±18.90% vs. 51.62%±19.85%, P=0.12), 72 h after PCI(52.15%±19.45% vs. 49.66%±20.05%, P=0.18), and 30 days after PCI(50.44%±14.54% vs. 48.52%±15.08%, P=0.17). The rate of AEs did not differ significantly between groups during the 30-day(15.2% vs. 14.8%, P=0.91) and 180-day(16.5% vs. 14.5%, P=0.50) follow-up periods after PCI.Conclusion: The addition of omeprazole or pantoprazole to clopidogrel did not restrict the effect of platelet aggregation by reducing the conversion of clopidogrel. Compared with clopidogrel alone, pantoprazole-clopidogrel and omeprazoleclopidogrel combinations did not increase the incidence of adverse clinical events during 30-day and 180-day follow-up periods after PCI.

Invasive versus conservative strategy in consecutive patients aged 80 years or older with non-ST-segment elevation myocardial infarction: a retrospective study in China

Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10–1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56–8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77–6.75, P = 0.0003), 3.02 (95% CI: 1.52–6.01, P = 0.0017), 2.93 (95% CI: 1. 46–5.86, P = 0.0024) and 2.47 (95% CI: 1.20–5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.

三种心电图标准对疑似ACS合并完全性左束支传导阻滞时被视为STEMI等危征的诊断价值

目的 探讨使用三种心电图诊断标准对急诊科拟诊为急性冠脉综合征(ACS)患者合并完全性左束支传导阻滞(CLBBB)时被视为ST段抬高型心肌梗死(STEMI)等危征,最终经急诊冠脉造影证实发生急性心肌梗死的诊断能力。方法 回顾性分析41例在急诊科拟诊为ACS合并CLBBB的患者,均经急诊完善冠脉造影后收入心内科重症监护单元(CCU),最终诊断分为AMI组(n=15)和非AMI组(n=26),分别使用巴塞罗那标准、Sgarbossa标准和Smith标准对两组患者心电图进行评测,绘制各诊断标准受试者工作特征(ROC)曲线,并得出ROC曲线下面积(AUC),分别计算敏感度(SEN)、特异度(SPE)、阳性预测值(PPV)、阴性预测值(NPV)和准确度(CP),并进行解读。结果 巴塞罗那标准对在急诊科拟诊为ACS患者合并CLBBB时,经急诊冠脉造影证实诊断并治疗的AMI的AUC为0.947(P<0.001),其SEN、SPE、PPV、NPV、CP分别为92.9%、92.0%、86.7%、95.8%、92.3%;Sgarbossa≥3标准诊断AMI的AUC为0.647(P=0.120),其SEN、SPE、PPV、NPV、CP分别为35.7%、96.0%、83.3%、72.7%、74.4%;Sgarbossa≥2标准诊断AMI的AUC为0.604(P=0.273),其SEN、SPE、PPV、NPV、CP分别为42.9%、84.0%、60.0%、72.4%、69.2%;SmithⅢ标准诊断AMI的AUC为0.795(P=0.002),其SEN、SPE、PPV、NPV、CP分别为71.4%、92.0%、83.3%、85.2%、84.6%;SmithⅣ标准诊断AMI的AUC为0.656(P=0.099),其SEN、SPE、PPV、NPV、CP分别为50.0%、84.0%、63.6%、75.0%、71.8%;SmithⅤ标准诊断AMI的AUC为0.614(P=0.228),其SEN、SPE、PPV、NPV、CP分别为28.6%、96.0%、80.0%、70.6%、71.8%。巴塞罗那标准对在急诊科拟诊为ACS患者合并CLBBB时经急诊冠脉造影证实,诊断AMI的AUC、SEN、SPE、PPV、NPV、CP均高于Sgarbossa标准和Smith标准(P<0.001)。结论 急诊科拟诊为ACS合并CLBBB的患者中,应用心电图的巴塞罗那标准诊断AMI具有准确、简洁、实用的特点。

重组人脑钠肽与硝酸甘油对非ST段抬高ACS伴AHF患者心肌缺血及心功能水平的影响

目的比较重组人脑钠肽(rhBNP)与硝酸甘油(NIT)对非ST段抬高急性冠脉综合征(ACS)伴急性心力衰竭(AHF)患者心肌缺血及心功能水平的影响。方法将92例ST段抬高ACS伴AHF患者随机分为rhBNP组与NIT组,每组46例,在常规治疗基础上,rhBNP组采用重组人脑钠肽治疗,NIT组采用硝酸甘油治疗。统计两组治疗前后血压、血清N端脑钠肽前体(NT-proBNP)、肌酐(Cr)水平、Killip分级、心绞痛发作情况、心功能及超声心动图指标,并统计两组患者治疗期间的不良反应发生情况和心脏不良事件。结果治疗后两组患者收缩压(SBP)、舒张压(DBP)、心率(HR)、动脉血氧分压(PaO_2)、NT-proBNP、Cr各项指标水平均较治疗前显著下降(P<0.05),其中SBP、DBP、HR、PaO_2、NT-proBNP等5项指标水平在治疗后24 h、72 h组间比较均有统计学意义(P<0.05),rhBNP组下降更为显著,Cr未表现有明显组间差异(P>0.05);治疗72 h两组患者的Killip分级、心绞痛发作次数及总导联数(NST)与数值总和(∑ST)均较治疗前显著改善(P<0.05),且改善效果均以rhBNP组更为明显,与NIT组比较有统计学意义(P<0.05);治疗1周,两组患者的左室射血分数(LVEF)均较治疗前显著升高(P<0.05),左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)较治疗前显著减小(P<0.05),且治疗1周后组间比较rhBNP组明显好于NIT组(P<0.05);治疗期间各项不良反应及随访1月的心脏不良事件(MACE)的发生率均为NIT组高于rhBNP组,其中低血压、低钾血症、低钠血症及3类MACE事件发生率的组间比较无统计学意义(P<0.05),头痛与室性心律失常的发生率组间比较有统计学意义(P<0.05)。结论静脉应用重组人脑钠肽治疗非ST段抬高ACS伴AHF可显著改善患者的心肌缺血及心功能水平。

GDF-15、HDL-C及cTnI检测联合CRUSADE评分在NSTE-ACS预后评估中的应用

目的探讨生长分化因子-15(GDF-15)、高密度脂蛋白胆固醇(HDL-C)及肌钙蛋白Ⅰ(cTnI)检测联合出血风险(CRUSADE)评分评估非ST段抬高的急性冠状动脉综合征(NSTE-ACS)预后的预测价值。方法选取2015年1月至2018年1月本院住院部治疗的102例NSTE-ACS患者设为观察组,根据CRUSADE评分分为低危组(n=34)、中危组(n=36)、高危组(n=32),选取同期110例体检的健康者为对照组。对比各组GDF-15、HDL-C及cTnI水平及不同预后的患者CRUSADE评分。随访3年,比较3组心肌缺血事件发生率、出血事件发生率及预后生存率,分析GDF-15、HDL-C及cTnI水平联合CRUSADE评分对NSTE-ACS患者预后死亡的预测价值。结果 GDF-15、cTnI水平:对照组<低危组<中危组<高危组,HDL-C水平:对照组>低危组>中危组>高危组,差异均有统计学意义(P<0.05)。高危组GDF-15及cTnI水平显著高于中危组及低危组,HDL-C水平明显低于中危组及低危组,差异有统计学意义(P<0.05),3组GDF-15、HDL-C及cTnI水平比较差异具有统计学意义(P<0.05)。高危组心肌缺血事件发生率、出血事件发生率均显著高于中危组及低危组,差异有统计学意义(P<0.05)。GDF-15及cTnI高表达、HDL-C低表达、CRUSADE评分≥41分的患者死亡率更高(P<0.05)。GDF-15、HDL-C、c TnI水平、CRUSADE评分及四者联合检测RCC曲线下面积分别为:0.839、0.803、0.876、0.938、0.978,各指标曲线下面积以联合检测最大。结论 NSTE-ACS患者GDF-15、HDL-C、cTnI水平呈异常表达状态,三者检测联合CRUSADE评分评估NSTE-ACS患者预后死亡的价值较高。

参麦注射液联合抗血小板药物对非ST段抬高ACS患者斑块性质、炎症反应的影响

目的:探讨参麦注射液联合抗血小板药物对非ST段抬高ACS患者斑块性质、炎症反应的影响。方法;选择在本院接受治疗的非ST段抬高ACS患者142例,随机分为对照组、参麦注射液组各71例。对照组在常规治疗基础上加入抗血小板药物,参麦注射液在常规治疗基础上加入参麦注射液联合抗血小板药物。对比治疗前、治疗1周后两组血清中斑块性质相关指标、炎症因子含量的差异。结果:治疗前,两组血清中代谢指标、脂质指标、细胞黏附分子、炎症因子含量的差异无统计学意义。治疗1周后,参麦注射液组血清代谢指标中Hcy、UA的含量较对照组低;血清中脂质指标ox-LDL、Lp-PLA2的含量较对照组低;血清中黏附分子sVCAM-1、sICAM-1的含量较对照组低;血清中炎症因子IL-1β、IL-6、IL-17、IL-23的含量较对照组低。结论:非ST段抬高ACS患者接受参麦注射液辅助治疗,可进一步稳定斑块并抑制全身炎症反应。

Long-term Prognosis of Patients with Acute non-ST-segment Elevation Myocardial Infarction undergoing Different Treatment Strategies

Background： In cardiology, it is controversial whether different therapy strategies influence prognosis after acute coronary syndrome. We examined and compared the long-term outcomes of invasive and conservative strategies in patients with non-ST-segment elevation myocardial infarction （NSTEMI） and characterized the patients selected for an invasive approach. Methods： A total of 976 patients with acute NSTEMI were collected from December 2006 to October 2012 in the First Affiliated Hospital of Dalian Medical University Hospital. They are divided into conservative strategy （586 patients） and invasive strategy （390 patients） group. Unified tbllow-up questionnaire was performed by telephone contact （cut-off date was November, 2013）. The long-term clinical events were analyzed and related to the different treatment strategies. Results： The median follow-up time was 29 months. Mortality was 28.7% （n = 168） in the conservative group and 2.1% （n = 8） in the invasive management at long-term clinical follow-up. The secondary endpoint （the composite endpoint） was 59.0% （n = 346） in the conservative group and 30.3% （n = 118） in the invasive management. Multivariate analysis showed that patients in the conservative group had higher all-cause mortality rates than those who had the invasive management （adjusted risk ratio [RR] = 7.795; 95% confidence interval [CI]： 3.796 16.006, P 〈 0.001）, and the similar result was also seen in tile secondary endpoint （adjusted RR ： 2.102; 95% （7： 1.694-2.610, P 〈 0.001 ）. In the subgroup analysis according to each Thrombolysis in Myocardial Infarction risk score （TRS）, log-rank analysis showed lower mortality and secondary endpoint rates in the invasive group with the intermediate and high-risk patients （TRS 3-7）. Conclusions： An invasive strategy could improve long-term outcomes for NSTEMI patients, especially for intermediate and high-risk ones （TRS 3- 7）.

The association between admission systolic blood pressure and 1-year mortality in patients with non-ST-segment elevation acute coronary syndrome

Background In patients with acute coronary syndrome（ACS）, lower admission systolic blood pressure（SBP）levels infer a worse prognosis. However, the predictive potential of admission SBP on 1-year mortality has not fully elucidated in patients with non-ST-segment elevation ACS（NSTEACS）. Methods We enrolled 1325 patients to investigate the association between admission SBP in patients hospitalized for NSTEACS. We analyzed the association between admission SBP and 1-year mortality. Admission SBP was categorized as low（〈110 mm Hg）, normal（110-140 mm Hg）, high（141-160 mm Hg）, and very high（〉160 mm Hg）. Results Compared with patients with normal admission SBP, those with low SBP had a significantly increased hazard ratios（HRs） for 1-year mortality of 3.03（P〈0.05）, while patients with high and very high admission SBP had no significantly increased HRs for 1-year mortality. Conclusion Low admission SBP, but not elevated admission SBP, is a strong independent predictor of 1-year mortality in patients with NSTEACS.

Comparison Between Upstream Tirofiban and Downstream Tirofiban in Patients With Non-ST-segment Elevation Acute Coronary Syndromes at High-risk Undergoing Percutaneous Coronary Interventions:Efficacy and Safety

Objectives To compare the efficacy and safety of upstream tirofiban with downstream tirofiban in patients with non- ST-segment elevation acute coronary syndromes （NSTE-ACS） at high-risk undergoing percutaneous coronary intervention （PCI）. Methods Two hundred and four patients with NSTE-ACS at high-risk undergoing PCI were randomized to upstream （4 -6 hours before coronary angiography） tirofiban or downstream （with the guidewire crossing the lesion） tirofiban. We evaluated myocardial damage after PCI by qualitatively analyzing cardiac troponin I （cTnI） and MB isoenzyme of creatine kinase （CK-MB）. Platelet aggregation inhibition and thrombolysis in myocardial infarction （TIMI） flow grade were assessed. The incidences of major adverse cardiac events （MACE） at 24-hour, 90-day and 180-day after PCI were followed up. The incidences of bleeding complications and thrombocytopenia during tirofiban administration were recorded. Results There were 102 patients with NSTE-ACS randomly assigned to upstream group and downstream group respectively. The peak serum levels of cTnI within 48 hours after PCI were significantly lower with upstream tirofiban than downstream tirofiban （0.34 vs 0. 61 ; P 〈 0.05 ）. Post-procedural cTnI elevation within 48 hours was significantly less frequent among patients who received upstream tirofiban than downstream tirofiban （63 % vs 82%, P 〈 0. 05 ）. The peak serum levels of CK-MB as well as post-procedural CK-MB elevation within 48 hours after PCI were not significantly different between the two groups （ 15 vs 18 and 38% vs 43% ; respectively; P 〉 0. 05 ）. ECG changes and the inhibition of platelet aggregation between two groups were similar （ P 〉 0.05 ）. Although the inci- dences of MACE at 90-day and 180-day after PCI were not statistically different, they were consistently lower with upstream tirofiban （3 % vs 6% and 6% vs 16% ; P 〉 0.05 ）. The incidences of bleeding complications and thrombocyto- penia were similar in the two groups （ 11% vs 9% ; P 〉 0.05 ）. Conclusions Among patients with NSTE-ACS at high-risk undergoing PCI, upstream tirofiban is associated with attenuated myocardial damage without increasing complications. （ S Chin J Cardiol 2009; 10（4） ： 179 -185）

GRACE评分对非ST段抬高性急性冠状动脉综合征患者远期预后的评估价值

目的明确全球急性冠状动脉事件注册（GRACE）评分对非sT段抬高性急性冠状动脉综合征（NSTE—ACS）患者出院后的远期预后评估价值。方法连续随访分析2009—01-2014—01住院诊断为NSTE—ACS的患者共895例，计算其GRACE评分。按照冠状动脉造影检查后采取的治疗方案分为三组：单纯药物治疗组（Drug组，n=463）、支架组（Stent组，n=371）和冠状动脉旁路移植术（CABG组，n=61）。生存分析采用Kaplan—Meier法；用Cox比例风险模型进行分析。计算ROC曲线下面积（AUC）评估GRACE评分对患者出院后发生心血管不良事件（MACE）的预测价值。结果研究完成随访895例，随访中位数为4．02年。在GRACE评分低危组（0—88分）、中危组（89—118分）、高危组（〉118分）中，MACE发生率分别为14．01％、36．16％及38．02％，组间比较差异有统计学意义（P〈0．01），低危组的MACE发生率相对较低。总MACE发生率在Drug组、Stent组、CABG组发生率分别为22．89％、42．43％及45．90％，组间比较差异有统计学意义（P〈0．001）。Drug组MACE发生率要低于Stent组和CABG组（P〈0．001）。ROC曲线分析发现，GRACE评分对Drag组远期预后具有诊断能力[AUC=0．676，95％CI（0．622，0．730），P〈0．01]；而对Stent组联合CABG组的远期预后无诊断能力[AUC=0．567，95％CI（0．512，0．622），P=0．17]。Cox比例回归显示，GRACE评分对NSTE—ACS的长期预后评估有重要价值。结论GRACE评分对NSTE—ACS的远期预后评估有重要价值。GRACE评分由于未将冠状动脉影像纳入而导致其预测价值下降，其对单纯药物治疗的NSTE—ACS患者远期预后（≥6个月）能够较准确的评估，但对冠状动脉支架或CABG治疗术后患者的远期预后无评估能力。

Early aggressive versus initially conservative treatment in elderly patients with non-ST-segment elevation acute coronary syndromeaTitle and subTitle Breakaaaaaaaa randomized controlled trial

Abstract Objectives The authors sought to describe the association between post-procedural bleeding and long-term recurrent bleeding, major adverse cardiac events （MACE）, and mortality among older patients undergoing per-cutaneous coronary intervention （PCI）.

非ST段抬高型急性冠脉综合征患者血清Hcy水平和GRACE评分与冠状动脉病变的相关性

目的探讨非ST段抬高型急性冠脉综合征(NSTE-ACS)患者血清同型半胱氨酸(Hcy)水平和全球急性冠状动脉事件注册(GRACE)评分与冠状动脉病变严重程度的关系。方法选取2015年1月至2016年1月就诊于湖南省人民医院符合纳入标准的NSTE-ACS患者116例,其中非ST段抬高型心肌梗死(NSTEMI)组49例,不稳定型心绞痛(UAP)组67例,入院后所有患者均进行GRACE评分,同时第2天清晨空腹采集肘静脉血检测Hcy,与48例非冠心病患者进行对照比较,分析Hcy水平与GRACE评分的关联性以及Hcy水平和GRACE评分与冠脉病变支数的关系。结果 1 NSTE-ACS患者血清Hcy水平、GRACE评分与非冠心病组比较差异有统计学意义,UAP组、NSTEMI组Hcy水平分别为(16.3±5.7)μmol/L和(19.6±4.6)μmol/L,明显高于非冠心病组的(11.3±2.7)μmol/L;UAP组、NSTEMI组GRACE评分分别为(108.9±21.0)分和(133.4±26.3)分,明显高于非冠心病组的(99.0±16.0)分,差异均具有统计学意义(P<0.05);2 NSTE-ACS患者血清Hcy水平随GRACE危险程度增加而显著升高,低危组、中危组、高危组Hcy水平分别为(12.7±3.1)μmol/L、(18.4±5.2)μmol/L、(22.4±5.1)μmol/L,差异具有统计学意义(P<0.05);相关性分析结果显示,NSTE-ACS患者血清Hcy水平与GRACE评分呈明显正相关(r=0.546,P<0.01);3 NSTE-ACS患者Hcy水平和GRACE评分与冠脉病变支数相关,三支血管病变组中Hcy水平、GRACE评分高于双支血管病变组,双支血管病变组高于单支血管病变组,差异均有统计学意义(P<0.05)。结论 NSTE-ACS患者Hcy水平与GRACE评分密切相关,结合Hcy水平测定与GRACE危险评分可提高对NSTE-ACS的预测,且一定程度上能反映冠状动脉病变程度,对NSTE-ACS早期介入治疗风险和预后评估有重要价值。

Distribution of gene polymorphisms associated with aspirin antiplatelet in the Han NSTEMI population

Objective:To analyze the genotype and allele distribution characteristics of GPⅢa PLA2(rs5918),PEAR1(rs12041331),and PTGS1(rs10306114)genes related to the antiplatelet pharmacological effects of aspirin,providing reference for individualized treatment of Chinese Han NSTEMI patients.Methods:A total of 107 Han patients with NSTEMI in Beijing Luhe Hospital affiliated to Capital Medical University from January 2016 to December 2022 were selected as the research subjects.The genotypes of GPⅢa PLA2(rs5918),PEAR1(rs12041331)and PTGS1(rs10306114)were detected by fluorescence staining in situ hybridization.The frequency distribution and allele distribution of genotype were analyzed.The results were analyzed whether there were statistical differences in the distribution of related alleles between the Han NSTEMI population and some populations in the 1000 Genomes database.Results:In the Han NSTEMI population,the genotype frequencies of GPⅢa PLA2(rs5918)locus were TT 97.20%,TC 2.80%and CC 0%,the allele frequencies were T 98.60%and C 1.40%.The genotype frequencies of PEAR1(rs12041331)locus were GG 42.06%,GA 44.86%and AA 13.08%,the allele frequencies were G 64.49%and A 35.51%.The genotypes at the PTGS1(rs10306114)locus were all AA(100%),no AG or GG genotype was found.Conclusion:In the NSTEMI population of Han nationality,the mutation at GPⅢa PLA2(rs5918)site related to aspirin antiplatelet pharmacology is rare,and there is no mutation at PTGS1(rs10306114)site.Wild homozygotes are dominant in these two gene loci,while mutations in PEAR1(rs12041331)are more common.Some of the findings in this study are similar to those in previous reports or other populations included in the relevant database;however,some results differ from previous reports or other populations。

交流变压变频调速电梯的技术探讨和研究

随着社会经济的迅猛发展和城市化进程的加速,高层建筑、超高层建筑如雨后春笋般涌现,电梯自然成为城市高层和大型公共建筑中不可或缺的设备之一。高层建筑数量的增加对电梯的需求量也在逐渐增大,同时对电梯性能的要求也在不断提高。对于一部电梯而言,其性能主要取决于电动机转速的调控能力,这包括稳定停车、平稳启动和平滑加减速等,以满足大众对于舒适、快捷乘坐体验的需求。

基于虚拟仪器的曳引式电梯节能效果检测方法

为提高曳引式电梯的节能检测能力,文中提出一种基于虚拟仪器的曳引式电梯的节能效果检测方法。构建曳引式电梯的节能参数解析模型,结合非正弦激励损耗分析方法,得到感应电动机驱动曳引式电梯的能量分布关系。根据能量分布关系分析曳引式电梯的节能参数与剩余损耗算式之间的函数关系,采用简化静态Preisach模型推导出曳引式电梯的节能效果的偏置小磁滞参数。考虑偏置小磁滞融合参数,通过检测相电流峰值点获得曳引式电梯的功率损耗和电能增益参数,采用Energetic磁滞模型,得到交流曳引式电梯的电动机转矩信息参数,根据参数估计结果,实现对曳引式电梯的节能效果检测。实验结果表明,采用本文方法进行曳引式电梯节能效果检测的可靠性和检测性能较好,提高了曳引式电梯节能效果的可视化交互和管理能力。

现代电梯供配电设计分析

根据目前电梯技术的发展情况,介绍不同类型电梯的应用现状,分析现代电梯相关电气技术参数,并结合某典型常用电梯分析其功率、电流、工作制等的计算和选择,提出电梯电源开关和线路、变压器计算容量选择等供配电设计的合理做法。

Relationship between serum vasoactive factors and plaque morphology in patients with non-ST-segment elevated acute coronary syndrome

Background Vasoactive factors have been reported to correlate with vulnerable plaque and acute coronary syndrome （ACS）. This study aimed to investigate the relationship between vasoactive factors and plaque morphology in patients suffering from non-ST-segment elevated ACS. Methods From April 2007 to April 2009, 124 consecutive patients suffering from non-ST-segment elevated ACS who had received coronary angiography （CAG） and intravascular ultrasound （IVUS） in the People＇s Liberation Army General Hospital and Beijing Anzhen Hospital were enrolled in this study. Three serum vasoactive factors, plasma soluble vascular endothelial growth factor receptor-1 （sFIt-1）, placental growth factor （PLGF） and interleukin-18 （IL-18）, were measured by enzyme-linked-immunosorbent serologic assay of the patients. The levels of vasoactive factors were compared between vulnerable plaque group and stable plaque group, and between unstable angina pectoris （UAP） group and non-ST-segment elevation acute myocardial infarction （NSTE-AMI） group. The relationship between the plaque morphology and levels of vasoactive factors was analyzed. Results The levels of vasoactive factors were similar between the UAP group （69 patients） and NSTE-AMI group （55 patients）. The levels of sFIt-1 and PLGF in the vulnerable plaque group were significantly higher than those in the stable plaque group. The level of IL-18 was correlated positively with plaque morphology. Multivariate Logistic regression analysis showed that the level of PLGF was an independent risk factor for vulnerable plaque （OR=2.115, 95%Cl 1.415-5.758, P=0.018）. Using the ROC curve, PLGF was a significant factor for the diagnosis of vulnerable plaque （the diagnostic point was 26.3 ng/L, the proportion of square area under the ROC curve was 0.799, 95%C/0.758-0.839, P 〈0.001 ; the sensitivity of PLGF under the ROC curve was 86%, and the specificity 63%）. Conclusion Both IL-18 and PLGF are biomarkers for vulnerable plaques and helpful to predict vulnerable plaque.

血清PAI-1、RBP4水平对急性ST段抬高型心肌梗死患者PCI后无复流的预测价值

目的探讨血清纤溶酶原激活物抑制剂1(PAI-1)、视黄醇结合蛋白4(RBP4)水平对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后无复流的预测价值。方法选取129例STEMI患者为STEMI组,根据PCI后心肌梗死溶栓治疗血流分级分为无复流组38例和复流组91例,另选取同期55例体检健康者为对照组。收集STEMI患者临床资料,采用酶联免疫吸附法检测血清PAI-1、RBP4。采用受试者工作特征(ROC)曲线分析血清PAI-1、RBP4水平对STEMI患者PCI后无复流的预测价值。结果与对照组比较,STEMI组血清PAI-1、RBP4水平升高(P均<0.05)。与复流组比较,无复流组血清PAI-1、RBP4水平升高(P均<0.05)。多因素Logistic回归分析结果显示,年龄增加和低密度脂蛋白胆固醇、PAI-1、RBP4升高为STEMI患者PCI后无复流的独立危险因素(P均<0.05),左心室射血分数升高为保护因素(P<0.05)。ROC曲线分析显示,血清PAI-1、RBP4水平预测STEMI患者PCI后无复流的曲线下面积大于PAI-1、RBP4单独预测(P均<0.05)。结论STEMI患者血清PAI-1、RBP4水平升高与PCI后无复流有关,血清PAI-1联合RBP4预测PCI后无复流的价值较高。

Effect of Danlou Tablet(丹蒌片) on Peri-procedural Myocardial Injury among Patients undergoing Percutaneous Coronary Intervention for Non-ST Elevation Acute Coronary Syndrome:A Study Protocol of A Multicenter,Randomized,Controlled Trial

Background： It has been shown that administration of statins reduced the risk of peri-procedural myocardial damage. However, it remains unclear whether Chinese medicine Danlou Tablet （~）~）, similar to statins, may protect patients undergoing percutaneous coronary intervention （PCI） from peri-procedural myocardial damage. Objective： To demonstrate the hypothesis whether treatment with Danlou Tablet would improve clinical outcome in patients undergoing selective PCI with non-ST elevation acute coronary syndrome （NSTE-ACS） in China. Methods： Approximately 220 patients with unstable angina or non-ST-segment elevation myocardial infarction undergoing PCI will be enrolled and randomized to Danlou Tablet treatment （4.5 g/day for 2 days before intervention, with a further 4.5 g/day for 90 days thereafter） or placebo. All patients will not receive Danlou Tablet before procedure. The primary end point is to evaluate the incidence of cardiac death, myocardial infarction or unplanned re-hospitalization and revascularization after 30 days in patients undergoing selective PCI treated with Danlou Tablet compared with placebo. Secondary endpoints include the incidence of peri-procedural myocardial injury, 3-month clinical outcomes, the quality of life and Chinese medicine syndromes assessment. Conclusion： This study protocol will provide important evidence of Danlou Tablet treatment on the peri-procedural myocardial injury in patients with NSTE-ACS undergoing selective PCI, which may support a strategy of routine Danlou Tablet therapy to improve the clinical outcomes.