Early diagnostic value of carotid artery ultrasound parameters combined with epicardial adipose layer thickness in coronary heart disease

BACKGROUND Coronary heart disease is associated with coronary atherosclerosis indicated by carotid intima-media thickness(CIMT)thickening and altered vascular elasticity.The epicardial adipose layer can secrete proinflammatory factors that promote the formation of coronary atherosclerosis.Thus,the epicardial fat layer thickness(EAT)may also predict coronary heart disease.AIM To determine the role of common carotid artery ultrasound parameters and EAT in the early diagnosis of coronary artery disease.METHODS Based on coronary angiography,patients with newly suspected coronary heart disease were divided into case(n=107)and control(n=41)groups.The carotid ultrasound parameters,including vascular stiffness(β),elastic coefficient(EP),pulse wave conduction velocity(PWV-β),CIMT,and EAT were compared between the case and control groups and among patients with different lesion numbers in the case group.Pearson correlation was used to evaluate the early diagnostic value of EAT,common carotid artery elasticity,and CIMT for coronary heart disease.RESULTS EP,β,PWV-β,CIMT,and EAT were significantly higher in the case group compared with the levels in the control group(all P<0.001).In the case group,lesions were detected in one vessel in 34 patients,two vessels in 38 patients,and three vessels in 35 patients.Within the case group,β,EP,PWV-β,CIMT,and EAT levels significantly increased with an increased number of lesions(all P<0.001).EAT positively correlated withβ,EP,PWV-β,and CIMT(all P<0.01).The area under the curve for diagnosing coronary heart disease using EAT combined with CIMT and carotid elasticity was 0.893,and the sensitivity and specificity were 0.890 and 0.837.CONCLUSION EAT correlated well with changes in carotid artery elasticity and CIMT in patients with coronary heart disease.The combination of EAT,carotid artery elasticity,and CIMT facilitates the early diagnosis of coronary heart disease.

Treatment of Coronary Heart Disease from the Perspective of Liver Controlling Dispersion

The liver is in charge of distributing and regulating the movement of qi throughout the whole body,coordinating the transportation and transformation of the internal organs in the middle part of the body,promoting the biochemical circulation of qi,blood,and body fluids,and regulating emotions.Liver dysfunction can disrupt the transportation and transformation of qi,blood,and body fluids,causing phlegm turbidity,blood stasis,and other unwanted symptoms.Poor regulation of emotion further aggravates the accumulation of pathological substances,resulting in the obstruction of heart vessels,and ultimately coronary heart disease(CHD).Through regulating lipid metabolism,inflammatory reaction,vasoactive substances,platelet function,neuroendocrine,and other factors,liver controlling dispersing qi plays a comprehensive role in the prognosis of atherosclerosis,the primary cause of CHD.Therefore,it is recommended to treat CHD from the perspective of liver-controlling dispersion.

Ultrasound features of carotid atherosclerosis in patients with coronary heart disease and their correlation with disease severity

Objective:To study the ultrasound features of carotid atherosclerosis in patients with coronary heart disease and their correlation with disease severity. Methods:180 patients with coronary heart disease treated in our hospital between December 2010 and December 2015 were collected as observation group and divided into single-vessel disease group (n=50), double-vessel disease group (n=72) and triple-vessel disease group (n=58) according to the degree of coronary artery stenosis;50 healthy subjects receiving physical examination in our hospital during the same period were selected as control group. Carotid ultrasound was used to measure carotid atherosclerosis parameters, cardiac color Doppler ultrasound was used to detect cardiac function parameters, enzyme-linked immunosorbent assay (ELISA) was used to detect serum endothelial function indexes, and Pearson test was used to analyze the correlation between carotid ultrasound parameters and the cardiac function as well as endothelial function. Results:Carotid ultrasound parameters stiffness (β), elastic modulus (Ep), arterial compliance (AC) and pulse wave velocity (PWVβ) value of observation group were higher than those of control group, and with the increase of coronary artery lesion severity, the changes ofβ, Ep, AC and PWVβvalue increased (P<0.05);cardiac function parameters left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) value of observation group were higher than those of control group while left ventricular ejection fraction (LVEF) value was lower than that of control group, and with the increase of coronary artery lesion severity, the changes of LVEDD, LVESD and LVEF value increased (P<0.05);endothelial function indexes endothelin-1 (ET-1) and von willebrand factor (vWF) levels of observation group were higher than those of control group while nitric oxide (NO) level was lower than that of control group, and with the increase of coronary artery lesion severity, the changes of ET-1, vWF and NO levels increased (P<0.05). Carotid ultrasound parameterβ, Ep, AC and PWVβvalue in patients with coronary heart disease were directly correlated with the levels of cardiac function parameters and endothelial function indexes. Conclusions:The ultrasound parameter levels of carotid atherosclerosis in patients with coronary heart disease are directly correlated with the disease severity and can be used as the noninvasive and reliable means for early judgment of the disease.

Study on the relationship between Lp-PLA2, D- dimer and Galectin-3 and atherosclerotic vulnerable plaque in patients with coronary heart disease

Objective: To explore the relationship and clinical value of serum phospholipase A2 (Lp-PLA2), d-dimers, and serum galectin-3 (galectin-3) with atherosclerotic vulnerable plaques in coronary artery patients with coronary heart disease. Methods: A total of 248 patients who underwent coronary angiography (CAG) and intravascular ultrasound (IVUS) in our hospital from June 2017 to September 2018 were selected and divided into vulnerable plaque group (89), stable plaque group (89) and control group (70) according to the examination results. The serum levels of Lp-PLA2, d-dimer and galectin-3 in three groups were compared, as well as their correlation with the detection parameters. To evaluate the clinical value of Lp-PLA2, d-dimer and galectin-3 in patients with coronary heart disease (CHD) with atherosclerotic vulnerable plaque. Results: Serum Lp-PLA2, d-dimer and galectin-3 levels were significantly different from the three groups (P<0.05), and the control group < stable plaque group <vulnerable plaque group (P<0.05). Correlation analysis showed that Lp-PLA2, d-dimer and galectin-3 were significantly positively correlated with plaque area, plaque load, necrotic core and calcified tissue (P<0.01), and negatively correlated with fibrous lipid and fibrous tissue (P<0.01). ROC curve showed that Lp-PLA2, d-dimer and galectin-3 had certain predictive value for vulnerable coronary atherosclerotic plaques (AUC=0.939, 0.977, 0.920, P<0.01), and the three combinations (AUC=0.986, P<0.01) had higher predictive value. Conclusion: Serum Lp-PLA2, d-dimer and galectin-3 are significantly correlated with coronary atherosclerotic vulnerable plaques in patients with coronary heart disease, with high sensitivity and specificity, which can be used for the diagnosis and treatment of early atherosclerotic vulnerable plaques.

Correlation between levels of serum FKN and clinical index in patients with coronary atherosclerotic heart disease

Objective: To investigate the correlation and clinical significance between the serum Fractalkine (FKN) and interleukin-6 (IL-6), C-reactive protein (CRP), BNP, CK, CK-MB, TC, TG, LDL-C, HDL-C levels in patients with coronary atherosclerotic heart disease (CHD). Methods: A total of 95 cases of patients with coronary heart disease were admitted to the Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, March 2016 to December 2016, including 52 patients with stable angina pectoris (SAP) and 43 patients with Acute coronary syndrome (ACS), 45 matched healthy subjects were collected. The Serum levels of FKN were detected by ELISA. The correlation and significance of FKN and clinical indexes were analyzed. Results: (1) the levels of serum FKN, IL-6, CRP, BNP, CK, CK-MB, TC, TG, LDL-C in the SAP group and ACS group were significantly higher than those in the control group, HDL-C were significantly decreased. Compared with SAP group, serum FKN level was significantly increased and IL-6, CRP, BNP, CK and CK-MB levels were significantly increased in ACS group, TC, TG, LDL-C, HDL-C levels were not significant difference between SAP group and ACS group. (2) Correlation analyses showed that there was a significant positive correlation between FKN levels and IL-6, CRP, BNP, CK, CK-MB, LDL-C, significant Negative correlation between FKN levels and HDL-C, weakly positive correlation between FKN levels and TC, and no correlation between FKN levels and TG. Conclusions: The serum levels of FKN in patients with CHD are significantly increased, which are closely related to the inflammatory reaction and can be used as biomarker of CHD for early diagnosis and prognosis.

Ultrasound assessment of carotid artery elasticity in patients with coronary heart disease and its correlation with plaque stability and platelet function

Objective:To study the ultrasound assessment of carotid artery elasticity in patients with coronary heart disease and its correlation with plaque stability and platelet function. Methods: Patients with stable angina pectoris, patients with unstable angina pectoris and healthy volunteers were selected and included in SAP group, UAP group and control group respectively. Carotid ultrasonography was conducted to determine single point pulse wave velocity (PWVβ);serum and peripheral blood samples were collected to determine plaque stability-related indexes and platelet function-related indexes.Results:Carotid artery PWVβlevel, serum ICTP, MMP1, MMP3, MMP7, CatK, CD62p and CD63 contents as well as peripheral blood PAR1 and LOX1 expression of SAP group and UAP group were significantly higher than those of control group, and carotid artery PWVβ level, serum ICTP, MMP1, MMP3, MMP7, CatK, CD62p and CD63 contents as well as peripheral blood PAR1 and LOX1 expression of UAP group were significantly higher than those of SAP group;peripheral blood PAR1 and LOX1 expression as well as serum CD62p, CD63, ICTP, MMP1, MMP3, MMP7, CatK, CD62p and CD63 contents of coronary heart disease patients with high PWVβ levels were significantly higher than those of coronary heart disease patients with low PWVβ levels. Conclusion:The carotid artery elasticity ultrasound parameter PWVβ has assessment value for the plaque stability and platelet function in patients with coronary heart disease angina pectoris.

The correlation of serum PDGF and Ang-2 contents with atherosclerotic plaque features in patients with coronary heart disease

Objective:To study the correlation of serum PDGF and Ang-2 contents with atherosclerotic plaque features in patients with coronary heart disease.Methods: A total of 80 patients with coronary heart disease who were treated in our hospital between January 2013 and April 2016 were collected as the observation group, and 50 healthy subjects who received medical examination in our hospital during the same period were selected as the normal control group. Serum PDGF and Ang-2 contents of two groups of patients were detected, and the observation group were further divided into the high PDGF group and low PDGF group (n = 40) as well as the high Ang-2 group and low Ang-2 group (n = 40) according to the median of PDGF and Ang-2 contents. Ultrasonic contrast technology was used to assess the atherosclerotic plaque characteristics in patients with coronary heart disease.Results: Serum PDGF and Ang-2 contents of observation group were significantly higher than those of control group;ultrasound parameters P and AUC levels of high PDGF group were higher than those of low PDGF group while Tp and MTT levels were lower than those of low PDGF group;ultrasound parameters P and AUC levels of high Ang-2 group were higher than those of low Ang-2 group while Tp and MTT levels were lower than those of low Ang-2 group.Conclusion:Serum PDGF and Ang-2 contents increase in patients with coronary heart disease and are negatively correlated with the atherosclerotic plaque stability.

Ultrasound screening of multifocal atherosclerosis: markers for coronary heart disease

Background and Objective The frequency of multifocal atherosclerosis (MFA) in patients with coronary heart disease (CHD) has not been thoroughly studied. The purpose of our study was to perform ultrasound screening for MFA in patients with coronary atherosclerosis and make evaluation of the sensitivity and significance of different atherosclerosis markers. Methods Using Color Dupplex Ultrasound (CDU), we studied 32 clinically healthy persons and 87 patients of the city of B with clinical data for CHD where we also performed coronarography. Results In patients with coronary atherosclerosis we found high frequency of carotid atherosclerosis (93%) and peripheral artery disease (PAD) (81%). We established verifiable thickening of the intima-media (IMT) of the common carotid artery (CCA) and common femoral artery (CFA) in patients with CHD. There is a correlation between the frequency of carotid and femoral stenoses and CHD proven by coronarography. Patients with CHD had a high relative risk to develop carotid (RR = 5) and peripheral atherosclerosis (RR=3.5) and high frequency of asymptomatic stenoses and thromboses of the internal carotid artery (86.9%) and femoral artery (78.3%), as well as aneurisms of the abdominal aorta (8.1%). Markers for CAD with high sensitivity were the atherosclerotic plaques of ICA (0.93) and CFA (0.81) as well as IMT of the CFA (0.84). Conclusions MFA are common among patients with CHD. Ultrasound diagnosis is the method of choice for simultaneous non-invasive screening of carotid, peripheral and MFA and provides sensitive markers for coronary atherosclerosis. The most sensitive and specific markers for CHD are the combination of the IMT and atherosclerotic plaques of CCA, ICA and CFA (100% sensitivity and 0.92 specificity).

Coronary heart disease-related fatigue:risk factors,assessment and treatments

Coronary atherosclerotic heart disease is a disease of myocardial ischemia and hypoxia,which often presents as chest pain,dyspnea,cold sweat and fatigue.Fatigue is the subjective experience of patients,which is easy to be ignored,and will lead to the decline of patients’quality of life and physical activity level,etc.,with a high incidence and great harm.The purpose of this paper was to review the concept,risk factors,assessment tools and intervention measures of coronary atherosclerotic heart disease fatigue in order to provide a reference for identifying and improving the fatigue of coronary atherosclerotic heart disease.

The Study on the Correlation Between Plasma Adiponectin Level and Coronary Heart Disease

Objectives To investigate the relationship between plasma adiponectin level and coronary heart disease （CHD）, and some established cardiovascular risk factors and to probe its probable pathogenesis which adiponectin results in CHD. Methods The levels of plasma adiponectin, fasting plasma insulin （FINS）, C-reactive protein （CRP） and P-selectin were measured by ELISA, plasma ET-1 was measured by radioimmunoassay （RIA） in 75 male patients with CHD and 30 healthy male people. Body mass index （BMI）, waist / hip ratio （WHR） and insulin resistance index （Homa-IR） were calculated respectively. Results （1）The plasma adiponectin levels in CHD group were lower compared with control group[（5.18±2.57）mg / L vs（8.94±2.59）mg / L, P〈 0.001 ], there was no significant difference of plasma adiponectin levels in CHD sub-groups （P 〉 0.05）.（2） Based on multinominal stepwise logistic regression analysis, adiponectin was one of significant and independent risk factors for CHD. （3） Multivariate liner stepwise regression analysis showed that adiponectin had significant correlation with BMI and TG, BMI and TG were independent factors influencing on plasma adiponectin levels. （4） Pearson correlation analysis indicated plasma adiponectin levels were inversely related to FINS levels , Homa-IR, CRP, P-selectin and ET-1. Conclusions （ 1 ）Plasma adiponectin levels are lower in CHD patients compared the control subjects, there are no significant difference of plasma adiponectin levels in patients with SAP, UAP and AMI. （2） Plasma adiponectin levels are relative with CHD. Hypoadiponectinemia is an independent risk factor for CHD. （3）Established cardiovascular risk factors such as BMI and TG have an obvious influence on adiponectin. （4）The probable pathogenesis by which adiponectin involves in CHD is suggested that adiponectin relates to insulin resistance, inflammatory reaction and dysfunction of vessel endothelium.

Proteomics analysis of coronary atherosclerotic heart disease with different Traditional Chinese Medicine syndrome types before and after percutaneous coronary intervention

OBJECTIVE: To investigate the underlying protein molecular mechanisms of "Qi stagnation and blood stasis syndrome"(QS) and "Qi deficiency and blood stasis syndrome"(QD), as two subtypes of coronary artery disease(CAD) in Traditional Chinese Medicine(TCM),following percutaneous coronary intervention(PCI).METHODS: In this study, a total of 227 CAD patients with QS and 211 CAD patients with QD were enrolled;all participants underwent PCI. Label-free quantification proteomics were employed to analyze the changes in serum in two subtypes of CAD patients before and 6 months after PCI, aiming to elucidate the intervention mechanism of PCI in treating CAD characterized by two different TCM syndromes.RESULTS: Biochemical analysis revealed significant changes in tumor necrosis factor-α, high density lipoprotein cholesterol, blood stasis clinical symptoms observation, and Gensini levels in both patient groups post-PCI;Proteomic analysis identified 79 and 95 differentially expressed proteins in the QS and QD patient groups, respectively, compared to their control groups.complement C8 alpha chain, complement factor H,apolipoprotein H, apolipoprotein B, plasminogen,carbonic anhydrase 2, and complement factor Ⅰ were altered in both comparison groups. Furthermore,enrichment analysis demonstrated that cell adhesion and connectivity-related processes underwent changes in QS patients post-PCI, whereas lipid metabolism-related pathways, including the peroxisome proliferator-activated receptor signaling pathway and extracellular matrix receptor interaction, underwent changes in the QD group.The protein-protein interaction network analysis further enriched 52 node proteins, including apolipoprotein B,lipoprotein(a), complement C5, apolipoprotein A4,complement C8 alpha chain, complement C8 beta chain,complement C8 gamma chain, apolipoprotein H,apolipoprotein A-Ⅱ, albumin, complement C4-B,apolipoprotein C3, among others. The functional network of these proteins is posited to contribute to the pathophysiology of CAD characterized by TCM syndromes.CONCLUSION: The current quantitative proteomic study has preliminarily identified biomarkers of CAD in different TCM subtypes treated with PCI, potentially laying the groundwork for understanding the protein profiles associated with the treatment of various TCM subtypes of CAD.

Clinical Study on Effect of Garlicin in Stabilizing the Carotid Artery Atherosclerotic Plaque in Patients with Primary Hypertension and Coronary Artery Disease

Objective： To investigate the effect of garlicin in treating carotid artery atherosclerotic plaque （OAAP） in patients with primary hypertension and coronary heart disease （PHT-OHD）. Methods： Seventynine patients with PHT-OHD were randomly divided into the treated group （39 patients） treated with garlicin and fosinopril and the control group （40 patients） treated with fosinopril alone. The change of OAAP was evaluated by high frequency ultrasonic examination every six months, and the changes of intercellular adhesion molecule-1 （IOAM-1） and high sensitive O-reactive protein （hs-ORP） were measured by ELISA, with the observation proceeding for 52 weeks totally. Results： By the end of the experiment, the number of complex plaques, Orouse integrals, intima-media thickness, serum IOAM-1 and hs-ORP were significantly lower in the treated group than those in the control group with significant difference （P〈0.05）. Conclusion： Garlicin could stabilize CAAP to a certain extent and shows a definite vascular protective effect in patients with PHT-CHD.

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。

补心宁神汤治疗心绞痛合并广泛性焦虑障碍的效果观察

目的观察补心宁神汤治疗心绞痛合并广泛性焦虑障碍的临床效果。方法选择2021年1月至2023年1月中国中医科学院望京医院急诊科收治的心绞痛合并广泛性焦虑障碍患者180例,按照随机数字表法分为观察组和对照组,每组90例。对照组采用常规西药治疗方案进行心绞痛规范化治疗、未针对焦虑用药;观察组在对照组的基础上针对焦虑加用补心宁神汤治疗;2组均治疗4周。比较2组治疗前后广泛性焦虑筛查量表(GAD-7)、躯体症状群量表(PHQ-15)评分,心绞痛发作频率和持续时间,左心室射血分数,中医证候评分,以及治疗期间不良反应发生情况。结果治疗后观察组GAD-7和PHQ-15评分、心绞痛发作频率和持续时间、中医证候评分均明显低于/短于对照组、左心室射血分数高于对照组[(0.9±0.7)分比(3.4±1.4)分、(1.1±1.0)分比(3.7±2.1)分、(2.1±0.9)次/周比(4.1±1.2)次/周、(2.2±1.2)min/次比(4.8±2.2)min/次、(2.6±1.9)分比(8.9±2.9)分、(55±6)%比(51±7)%],差异均有统计学意义(均P<0.05)。在整个治疗过程中2组均未出现明显不良反应。结论补心宁神汤可有效缓解心绞痛合并广泛性焦虑障碍患者的症状,安全性良好。

补阳还五汤联合坐位八段锦治疗冠心病搭桥术患者的临床疗效及对其心功能、炎症因子、应激指标的影响

目的 观察补阳还五汤联合坐位八段锦治疗冠心病搭桥术患者的临床疗效及对其心功能、炎症因子、应激指标的影响。方法 选取2020年6月—2023年6月期间江苏省苏北人民医院心脏大血管外科收治的300例冠状动脉搭桥手术患者,采用随机数字表法分为对照组和试验组,每组各150例。对照组按常规处理,试验组在常规治疗方法基础上,予补阳还五汤联合坐位八段锦治疗,均治疗3周。观察比较两组患者临床疗效,治疗前后中医证候积分、心肌损伤标志物[氨基末端脑利钠肽前体(N terminal pro B type natriuretic peptide,NT-proBNP)、心肌肌钙蛋白I(Cardiac troponin I,cTnI)、肌酸激酶同工酶(Creatine kinase isoenzymes,CK-MB)、肌红蛋白(Myoglobin,Mb)],心脏超声检查指标[左心室舒张末期内径(Left ventricular end diastolic diameter,LVEDD)、左室舒张末期容积(Left ventricular end-diastolic volume,LVEDV)、左室射血分数(Left ventricular ejection fraction,LVEF)、心脏指数(Cardiac index,CI)]、炎性指标[超敏C反应蛋白(hypersensitive C-reactive proteinhs,CRP)、肿瘤坏死因子α(Tumour necrosis factor-α,TNF-α)]及应激指标[皮质醇(Cortisol,COR)、胱抑素C(Cystatin C,Cys C)]。结果 治疗后试验组临床总有效率92.00%(138/150)明显高于对照组81.33%(122/150),差异有统计学意义(P<0.05)。治疗后两组患者中医证候评分均较治疗前降低,差异有统计学意义(P<0.05);且试验组中医证候评分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者心肌损伤标志物NT-proBNP、cTnI及CK-MB含量均较治疗前明显降低,差异有统计学意义(P<0.05);且试验组心肌损伤标志物NT-proBNP、cTnI及CK-MB含量均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者LVEDD和LVEDV指标均较治疗前降低,LVEF和CI指标均较治疗前升高,差异有统计学意义(P<0.05);且试验组LVEDD和LVEDV指标均明显低于对照组,LVEF和CI指标均明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者炎性指标hs-CRP、TNF-α含量均较治疗前降低,差异有统计学意义(P<0.05);且试验组炎性指标hs-CRP、TNF-α含量均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者应激指标COR、 CysC水平均较治疗前降低,差异有统计学意义(P<0.05);且试验组应激指标COR、 CysC水平均明显低于对照组,差异有统计学意义(P<0.05)。结论 在常规西药治疗的基础上给予补阳还五汤联合坐位八段锦,可明显改善冠心病搭桥术患者心功能,减轻炎症及应激反应。

颈动脉狭窄合并冠心病同期外科治疗的疗效分析:单中心经验

目的总结同期颈动脉血运重建手术及冠状动脉血运重建手术治疗颈动脉狭窄合并冠心病患者的单中心临床经验。方法回顾性分析2008年1月至2020年1月中日友好医院心脏血管外科收治的54例颈动脉狭窄合并冠心病患者资料,其中同期行颈动脉内膜剥脱术(carotid endarterectomy,CEA)+冠状动脉搭桥术(coronary artery bypass grafting,CABG)38例,同期行颈动脉支架植入术(carotid artery stenting,CAS)+CABG 16例。结果手术成功率100%。围手术期内出现小卒中3例,短暂性脑缺血发作4例,术后短暂低血压8例,术后高灌注综合征3例,二次开胸3例,心肌梗死4例;无围手术期死亡病例。同期CEA+CABG组与同期CAS+CABG组的手术时间、术中出血量、围手术期输血量、神经系统并发症和循环系统并发症发生率差异均无统计学意义(P>0.05)。48例患者获得随访,随访时间29~140个月,平均(89.8±35.6)个月,因心肌梗死和心功能不全死亡患者各1例。结论同期CEA+CABG与同期CAS+CABG治疗颈动脉狭窄合并冠心病患者均安全有效。

冠心病合并颈动脉狭窄的危险因素及动脉斑块性质分析

目的 分析冠心病合并颈动脉狭窄(CAS)的患病率、危险因素及颈动脉斑块的性质。方法 回顾性连续纳入2019年3月至2024年2月首都医科大学附属北京友谊医院收治的经冠状动脉造影确诊为冠心病并同期行颈动脉超声检查的患者。根据任一主要冠状动脉狭窄程度≥50%定义为冠心病,颈动脉狭窄程度≥50%定义为CAS。明确冠心病合并CAS的患病率、严重程度及颈动脉斑块特征,采用多因素Logistic回归分析对冠心病联合CAS的共病危险因素进行分析。结果 共纳入冠心病患者1 062例,其中合并CAS患者130例,冠心病合并CAS的患病率为12.24%。年龄、既往短暂性脑缺血发作(TIA)/脑卒中、吸烟和冠脉多支病变是冠心病合并CAS的独立危险因素(P<0.05),且随冠脉狭窄程度增加CAS程度加重(P<0.05)。CAS组患者颈动脉斑块回声以混合回声为主,斑块钙化及溃疡的比率明显高于无CAS组(P<0.05)。结论 冠心病合并CAS的患病率为12.24%,年龄、既往短暂性脑缺血发作/脑卒中、吸烟和冠脉多支病变是冠心病合并CAS的独立危险因素;颈动脉斑块多有钙化和溃疡,需要加强对可控危险因素的预防。对冠心病患者特别是手术患者应积极行颈动脉血管检查。

瑞舒伐他汀联合芪参益气滴丸治疗高血压病合并冠状动脉粥样硬化性心脏病疗效及对动脉斑块的影响

目的探讨瑞舒伐他汀联合芪参益气滴丸治疗高血压病合并冠状动脉粥样硬化性心脏病的疗效及对动脉斑块的影响。方法选择2021年1月—2021年12月120例高血压病合并冠状动脉粥样硬化性心脏病患者作为研究对象,采用随机数字法平均分为观察组与对照组,两组患者均给予抗血小板聚集及瑞舒伐他汀稳定斑块等治疗措施,观察组在此基础上联合芪参益气滴丸治疗。比较两组患者临床疗效,心功能、血脂水平、颈动脉斑块及不良反应发生情况。结果观察组总有效率明显高于对照组(P<0.05)。随之治疗时间延长,两组患者左心射血分数(left ventricular ejection fractions,LVEF)及左心室收缩末内径(left ventricular end-diastolic dimension,LVEDD)均逐渐改善(P<0.05);治疗后14 d、3月观察组LVEF及LVEDD均高于对照组(P<0.05)。两组患者治疗后甘油三酯、血清总胆固醇、低密度脂蛋白胆固醇、同型半胱氨酸、C-反应蛋白均逐渐改善(P<0.05);治疗后3个月、6个月观察组甘油三酯、血清总胆固醇、低密度脂蛋白胆固醇、同型半胱氨酸、C-反应蛋白低于对照组(P<0.05)。两组患者治疗后颈动脉内中膜厚度(carotid intima-media thickness,IMT)及不稳定斑块比例逐渐降低(P<0.05);治疗后3个月、6个月观察组IMT急不稳定斑块比例低于对照组(P<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论瑞舒伐他汀联合芪参益气滴丸可以更好地促进高血压病伴颈动脉硬化急性心肌梗死患者恢复,更快使血脂异常达标,更有效地抑制颈动脉不稳定斑块形成,且并未增加不良反应。

低密度脂蛋白、碱性磷酸酶联合颈动脉超声对冠状动脉粥样硬化性心脏病的预测价值

目的利用低密度脂蛋白(LDL)、碱性磷酸酶(ALP)联合颈动脉超声的方法,预测冠状动脉粥样硬化性心脏病(CHD)发生风险。方法选取2020年1月至2022年12月江门市中心医院收治的105例CHD患者为研究对象,另选取105例非CHD患者作为对照组,两组均行颈动脉超声检查,观察两组LDL、ALP及颈动脉超声指标的差异。采用logistic回归分析CHD的影响因素,通过ROC曲线分析LDL、ALP联合颈动脉超声对CHD风险的预测价值。结果单因素分析结果显示,CHD与双侧颈动脉斑块平均厚度(avr_CIMT)、左侧颈动脉斑块内膜中层厚度(LCIMT)、右侧颈动脉斑块内膜中层厚度(RCIMT)、左侧颈动脉斑块长度(LCPL)、左侧颈动脉斑块乘积(LCPT)、左侧颈动脉斑块厚度(LCPH)、右侧颈动脉斑块长度(RCPL)、右侧颈动脉斑块乘积(RCPT)、右侧颈动脉斑块厚度(RCPH)、双侧颈动脉斑块最大厚度(max_CPH)、双侧颈动脉斑块最大长度(max_CPL)、双侧颈动脉斑块积分(cPS)、ALP、手术风险评分(SRS)、Framingham风险评分(FRS)、LDL有关,差异有统计学意义(P<0.05);logistic回归模型进行多因素分析结果显示,max_CPH(β=0.009,OR=1.981,95%CI:0.882~1.987),max_CPL(β=0.342,OR=2.241,95%CI:0.098~2.901),cPS(β=0.456,OR=1.521,95%CI:0.501~1.554),avr_CIMT(β=0.320,OR=0.784,95%CI:0.523~0.967),LDL(β=0.152,OR=2.431,95%CI:0.386~2.450),ALP(β=0.254,OR=1.324,95%CI:0.230~2.412)是CHD的独立危险因素(P<0.05)。结论利用LDL、ALP联合颈动脉超声的方法,可提高对CHD患者发生的预测效能。

LncRNA SNHG5在冠状动脉粥样硬化性心脏病患者外周血中的表达及临床意义

目的探讨长链非编码RNA SNHG5(lncRNA SNHG5)在冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease,CAHD)患者外周血中的表达及临床意义。方法收集受试者的临床资料,通过逆转录-聚合酶链反应(qRT-PCR)测定对照组(n=82)和CAHD组(n=78)受试者外周血中lncRNA SNHG5的表达,通过单多因素Logistic回归分析法探究影响CAHD的独立危险因素,通过受试者工作特征(ROC)曲线分析lncRNA SNHG5在CAHD中的诊断价值。结果与对照组相比,CAHD组受试者外周血中lncRNA SNHG5的表达水平显著降低(P<0.05);lncRNA SNHG5在心功能Ⅰ级-Ⅳ级CAHD患者外周血中的表达水平逐渐降低各级间差异P<0.05,隔级间差异P<0.01。高血压、高血脂及lncRNA SNHG5表达水平为CAHD的独立危险因素。lncRNA SNHG5诊断CAHD的ROC曲线下面积为0.872,灵敏度为78.2%,特异度为97.60%。结论lncRNA SNHG5可能是潜在的诊断CAHD的生物标志物。