Employing a random forest model to forecast the likelihood of coronary artery lesions in Kawasaki disease: a study centered on four biomarkers

Background:Kawasaki disease is an acute immune vasculitis,which is more common in children under 5 years old.Kawasaki disease mainly affects the cardiovascular system,especially the coronary arteries.Once coronary artery damage occurs,it can significantly impact the patient’s prognosis.Therefore,in some countries and regions,Kawasaki disease has become a common acquired heart disease.Methods:First,univariate analysis was conducted on each predictive factor.Then,Least Absolute Shrinkage and Selection Operator and random forest algorithms were used to screen all predictive factors,and the prediction model was evaluated using receiver operating characteristic curve,calibration curve,and Decision Curve Analysis.Results:This study,based on data from 228 Kawasaki disease patients,utilized a random forest model to identify four predictive factors:white blood cell count,creatine kinase isoenzyme MB,albumin,and neutrophil count.These factors were used to construct a prediction model,which achieved an area under the curve of 0.743.Conclusions:We developed a forest plot based on white blood cell count,creatine kinase isoenzyme MB,albumin,and neutrophil count to effectively predict the occurrence of coronary artery lesions in Kawasaki disease.

A Meta-analysis of the Biomarkers Associated with Coronary Artery Lesions Secondary to Kawasaki Disease in Chinese Children

The biomarkers associated with coronary artery lesions （CAL） secondary to Kawasaki disease （KD） in Chinese children were investigated by using Meta-analysis. We searched documents published from January 1997 to December 2009 from medical electronic databases. According to inclusion and exclusion criteria, eligible full-text papers were identified. We conducted a comprehensive quantitative analysis by using Stata10.0 statistical software package to assess the heterogeneity among the documents, calculated the summary effect and analyze publication bias and sensitivity. A total of 92 documents and 16 biomarkers were identified. All documents were case-control studies, and included 2398 patients in CAL group and 5932 patients in non-CAL （NCAL） group. The Meta-analysis showed that the levels of platelet count, platelet hematocrit （PCT）, neutrophils count, platelet distribution width （PDW）, mean platelet volume （MPV）, erythrocyte sedimentation rate （ESR）, cardiac troponin Ⅰ （cTnI）, and endothelin-1 （ET-1） in CAL group were significantly higher than those in NCAL group, and serum albumin （Alb） and hemoglobin （Hb） levels were significantly lower in CAL group （all P〈0.05）. White blood cell （WBC） count, serum sodium, matrix metalloproteinase 9 （MMP-9）, total cholesterol （TC）, hematocrit （HCT） and CD3＋T lymphocytes percentage had no statistically significant difference between the two groups. In conclusion, our results indicated that the 10 biomarkers including platelet count, neutrophils count, PCT, PDW, MPV, ESR, cTnI, ET-1, Alb and Hb were associated with CAL, and may be involved in the pathogenesis of CAL. The biomarkers of WBC count, serum sodium, MMP-9, TC, HCT, and CD3＋T lymphocytes percentage bore no relationship with the development of CAL among Chinese children with KD.

Drug-coated balloons for treating de novo lesions in large coronary vessels:A case report

BACKGROUND Percutaneous transluminal coronary angioplasty,while an effective intervention,can frequently lead to acute occlusion with severe consequences.Although clinical trials have demonstrated the efficacy of drug-coated balloons(DCB)in treating acute coronary artery occlusion and in preventing restenosis,there has been limited exploration on the use of DCB in treating de novo lesions in large vessels.Currently,DCB are only recommended for patients with small vessel lesions and in-stent restenosis lesions,those at high risk of bleeding,and other special groups of patients.CASE SUMMARY This report presents a case of successful drug-coated balloon treatment of de novo lesions in large coronary vessels.Postoperatively,the patient demonstrated favorable recovery,with subsequent examination results revealing no significant differences from the previous examination.CONCLUSION The successful treatment of the patient in our case highlights the potential of DCB in the treatment of de novo lesions in large coronary vessels.

Twelve-year outcomes after revascularization for ostial/shaft lesions in unprotected left main coronary artery

Objective To evaluate a very long-term clinical outcomes of patients treated with coronary artery bypass grafting(CABG) and percutaneous coronary intervention(PCI) with drug-eluting stents(DES) for ostial/shaft lesions in unprotected left main coronary artery(ULMCA). Methods & Results A total of 472 patients with isolated ostial/shaft lesions in ULMCA were enrolled, who received DES implantation or underwent CABG between January 2003 and July 2009 in Beijing Anzhen Hospital. The major endpoints of this study were death, repeat revascularization, non-procedural myocardial infarction(MI) and stroke. The median follow-up was twelve years(interquartile range: 9.4–14.0 years) in the overall patients. There were no significant differences of incidence of death(23.3% vs. 25.6%, P = 0.227), repeat revascularization(27.3% vs. 28.4%, P = 0.423), non-procedural MI(20.0% vs. 14.5%, P = 0.561), and stroke(6.1% vs. 9.3%, P = 0.255) between PCI and CABG groups before multivariate adjusting. After adjusting covariates with multivariate Cox hazard regression model, there were still no significant differences between PCI and CABG groups. Conclusions During the median follow-up of twelve years, we found that PCI with DES was as effective and safe as CABG in patients with left main ostial/shaft lesion in this observational study.

Secondary coronary artery ostial lesions:Three case reports

BACKGROUND Atherosclerosis is one of the main causes of coronary artery ostial lesions seen clinically.Secondary coronary artery ostial lesions are rare,and cases reported previously were associated with syphilitic vasculitis and aortic dissection.Here,we report three rare cases of secondary coronary ostial lesions.Due to their rareness,these lesions can easily be neglected,which may lead to misdiagnosis and missed diagnosis.CASE SUMMARY We present three patients with acute myocardial infarction and unstable angina caused by secondary coronary artery ostial lesions.In Case 1,coronary angiography(CAG)revealed 90%stenosis of the left main coronary ostium.Chest contrast computed tomography(CT)suggested thymic carcinoma invading the left main coronary ostium.Coronary artery bypass grafting and tumor resection were performed.In Case 2,echocardiography revealed a sinus of Valsalva aneurysm(SVA)-like dilatation.CAG showed a right coronary sinus giant aneurysm and complete obstruction of the right coronary artery(RCA)ostium.Aortic contrast CT confirmed these findings.The Bentall procedure was performed.In Case 3,CT CAG identified an anomalous origin of the right coronary artery(AORCA)from the left sinus of Valsalva coursing between the aorta and pulmonary trunk,causing severe RCA ostium stenosis by compression.Surgical correction of the AORCA was performed.CONCLUSION The cases reported here suggest that we should consider other causes of coronary ostial lesions other than atherosclerosis.

PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY FOR COMPLICATED CORONARY ARTERY LESIONS

Objective To research the effect of percutaneous transluminalcoronary angioplasty (PTCA) on treating complicated artery lesions.Methods Type B or type C of complicated coronary artery lesionswere confirmed by selective coronary angingraphy in 16 cases with coronaryheart disease.Gruentzig’s method was used in carring out PTCA.Results Fifteen of sixteen and thirty-two of thirty-five parts ofcoronary artery lesions were dilated successfully,the success rate was 93.7%and 88.5%,respectively.In failed four parts of PTCA,three parts werebecause of the guilding wire or the balloon failed to pass the narrow arterythrough,the other one was unable to be performed for the occurrencedsevere arrthymia during the procedure.Four stents were implantend foracute accident.Symptoms of the successful cases were improved ordisappeared after PTCA.Conclusion PTCA is also fit in treating complicated coronary arterylesions and has a better therapeutic effect,but it has more complications andrun more risks relatively.

Echocardiography in Diagnosis and Prevention of the Coronary Artery Lesions in Kawasaki Disease

Kawasaki disease (muco-cutaneous lymph node syndrome, MCLS) was first reported by Kawasaki in 1967. It was characteried by nonvascular polymorphous rash, fever, ulcer in oral mucosa, edema of hands of feet, cervix lymphadenopathy and desquamations in peripheral extremities. Because of unknown pathogens, no lab examination was available as a single easily recognized diagnostic marker; the diagnosis is

Risk of coronary arterial lesions in immunoglobulin resistant Kawasaki disease

Objective: High-dose intravenous immunoglobulin (IVIG) decreases the risk for development of coronary arterial lesions (CAL) in Kawasaki disease (KD) while patients resistant to IVIG have higher risk. This study is aimed to investigate an additional therapy affects the risk for CAL in IVIG resistant KD. Design: The information from 11,510 children with KD was collected by the nationwide survey (2003-2004) in Japan. The secondary therapeutic strategies for IVIG resistant KD were an additional IVIG dose, steroids or both. The incidence of CAL was compared among 4 groups: G1, children responded to initial IVIG;G2, IVIG resistant patients receiving an additional IVIG dose;G3, IVIG resistant patients receiving additional steroids;G4, IVIG resistant patients receiving an additional IVIG dose plus steroids. CAL was assessed at 30th day of illness using ultrasound echocardiography. Results: 2229 patients (19.4%) were resistant to initial IVIG. Incidence of CAL was significantly lower in children responding to initial IVIG than in IVIG resistant patients (1.9% and 11.0%, respectively;odd’s ratio 6.3). The incidences of CAL in an each additional therapy group were as follows: G2: 6.7%, G3: 9.7%, G4: 22.2%. The risk for CAL was significantly higher in G4 as compared with G2 and G3. Giant aneurysmal formation (GA) was more frequently developed in G3 and G4 consisting of the patients receiving steroids (G1: 0.03%, G2: 0.63%, G3: 4.3%, G4: 3.7%). Conclusion: The incidence of CAL was considerably high in IVIG resistant KD and an additional therapy by steroids may increase the risk for GA.

Reevaluation of the Efficacy of Intravenous Gammaglobulin in the Prevention and Treatment of Coronary Artery Lesion in Kawasaki Disease

In order to objectively evaluate the efficacy of intravenous gammaglobulin (IVIG) in the prevention and treatment of coronary artery lesion (CAL) in Kawasaki disease (KD) and the related factors influencing the IVIG efficacy, 314 children with KD were reviewed retrospectively and comparatively and were divided into IVIG plus aspirin group and ASA group. The occurrence and restoration of CAL in these two groups as well as many laboratory and clinical indexes including average hospital stay (days), total fever duration, defervescence time, platelet count, erythrocyte sedimentation rate, C reactive protein etc. were observed. The incidence of CAL was 39.5 % in the children with KD. In the IVIG+ASA group, the incidence of CAL was 34.3 % and 56.0 % in ASA group respectively (P<0.001). The incidence of CAL was reduced in the group in which 2.0 g/kg or 1.0 g/kg IVIG was administered as compared with the group in which IVIG was administered at a dose ≤0.6 g/kg or ≥3.0 g/kg (P<0.05). CAL occurred less frequently when IVIG was administered at 3-10 days of the course than that when IVIG was administered ≤3 days or >10 days (P<0.05). About 13.4 % of the CAL treated with IVIG was not recovered at the 12 th month of the course, mostly in the groups in which only ASA was administered and IVIG treatment was started 10 days later. The hospital stay (days), defervescence time, total fever duration, platelet count, erythrocyte sedimentation rate and C reactive protein were significantly reduced in IVIG+ASA group as compared with those in the ASA group (P<0.05). IVIG treatment can remarkably shorten the course of patients with KD and decrease the incidence of CAL, but the efficacy of IVIG in the prevention and treatment of KD disease is not as expected by people, therefore, reevaluation of the practical efficacy of IVIG is required.

A Case Summary of the Application of a Drug-eluting Stent Combined with a Drug-Coated Balloon in Left Main Coronary Artery Disease

Objective:To evaluate the clinical efficacy of a drug-eluting stent(DES)combined with a drug-coated balloon(DCB)in the treatment of left main coronary artery bifurcation lesions.Methods:A retrospective analysis was conducted on the clinical data of eight patients with left main coronary artery bifurcation lesions treated with a DES combined with a DCB who were admitted to our hospital from July 2016 to July 2017.These eight patients all underwent DES treatment for their left main coronary artery and left anterior descending coronary artery lesions,and DCB treatment at the ostium of the left circumflex artery;six of the patients underwent surgical procedures under the guidance of intravascular ultrasonography.Immediate postoperative angiography was used to evaluate the patency of the diseased vessels,and the restenosis rate at the 6-month follow-up after the operation and the incidence of serious clinical events within 6 months were assessed as well.Results:The use of a DES combined with a DCB in the treatment of left main coronary artery bifurcation lesions had a low restenosis rate(left main coronary artery(8.4±5.3)%,left anterior descending coronary artery(18.2±5.0)%,left circumflex artery(30.5±16.5)%).No serious clinical events occurred in any patients.Conclusion:A DES combined with a DCB is a safe and effective interventional treatment for left main artery coro-nary bifurcation lesions.

血管内碎石术在非ST段抬高型急性冠状动脉综合征合并钙化病变患者经皮冠状动脉介入治疗术中的有效性和安全性

目的观察血管内碎石术(intravascular lithotripsy,IVL)在非ST段抬高型急性冠状动脉综合征(non-segment elevation acute coronal syndrome,NSTE-ACS)合并钙化病变患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术中的临床疗效。方法回顾性分析2022年10月至2023年4月期间在焦作市人民医院和焦作市煤业集团中央医院接受IVL治疗的所有患者。收集患者的人口统计学特征、临床数据、手术操作具体数据及相关并发症,观察IVL的有效性和安全性。结果43例患者在此期间接受IVL辅助PCI,年龄(67.77±7.21)岁。76.7%的患者为不稳定型心绞痛,23.3%的患者为急性非ST段抬高型心肌梗死患者。26例(60.5%)为原位病变,11例(25.6%)为支架内再狭窄,6例(13.9%)为支架膨胀不全“补救”治疗。手术成功率为100%。支架植入/DCB后狭窄率为(3.372±4.040)%,最小管腔面积为(9.416±0.940)mm^(2)。围术期有1例患者出现慢血流,围术期主要心血管不良事件(MACE)发生率为16.7%,均为手术相关性心肌梗死,共7例。术后30 d无MACE发生。结论IVL是一种安全有效的修饰冠状动脉钙化以实现支架充分膨胀的新方法。

血清硫酸吲哚酚、簇集蛋白与急性冠脉综合征患者冠状动脉病变的关系及对短期预后的预测价值

目的探讨血清硫酸吲哚酚(IS)、簇集蛋白(Clusterin)与急性冠脉综合征(ACS)患者冠状动脉病变的关系及对短期预后的预测价值。方法选择2021年6月至2022年10月郑州大学第一附属医院收治的120例ACS患者为研究对象(ACS组),另选择同期本院80名体检健康的志愿者作为对照组。采用酶联免疫吸附法检测ACS组患者和对照组受试者的血清IS、Clusterin水平。根据冠状动脉病变支数将ACS患者分为单支病变组(n=43)、双支病变组(n=49)、多支病变组(n=28),另根据Gensini积分将ACS患者分为轻度病变组(n=37)、中度病变组(n=48)、重度病变组(n=35),并根据院内短期预后将ACS患者分为预后良好组(n=85)和预后不良组(n=35)。通过单因素及多因素logistic回归分析ACS患者短期预后不良的影响因素,采用受试者操作特征(ROC)曲线分析血清IS、Clusterin水平对ACS患者短期预后不良的预测价值。结果ACS组患者的血清IS、Clusterin水平显著高于对照组(P<0.05)。单支病变组、双支病变组、多支病变组患者的血清IS、Clusterin水平依次升高(P<0.05)。轻度病变组、中度病变组、重度病变组患者的血清IS、Clusterin水平依次升高(P<0.05)。120例ACS患者短期预后不良发生率为29.17%(35/120)。单因素分析显示,ACS类型、Gensini评分、KILLIP分级、冠状动脉病变支数、IS、Clusterin与ACS患者短期预后有关(P<0.05)。多因素logistic回归分析显示,Gensini评分升高、IS升高、Clusterin升高、KILLIP分级≥Ⅲ级、冠状动脉多支病变为ACS患者短期预后不良的独立危险因素(P<0.05)。血清IS水平预测ACS患者短期预后不良的ROC曲线下面积(AUC)为0.747(95%置信区间:0.529~0.946),灵敏度为71.43%,特异度为74.12%,准确度为73.33%,约登指数为0.455;血清Clusterin水平预测ACS患者短期预后不良的AUC为0.693(95%置信区间:0.439~0.951),灵敏度为68.57%,特异度为70.59%,准确度为7.00%,约登指数为0.392;血清IS与Clusterin水平联合预测ACS患者短期预后不良的AUC为0.825(95%置信区间:0.687~0.968),灵敏度为82.86%,特异度为83.53%,准确度为83.33%,约登指数为0.664。结论血清IS、Clusterin水平升高与ACS患者冠状动脉病变程度加重和短期预后不良有关,二者联合对ACS患者短期预后不良的预测价值较高。

“一站式”冠状动脉杂交手术治疗冠状动脉多支病变的临床应用

“一站式”冠状动脉杂交手术(HCR)是将微创冠状动脉旁路移植术与经皮冠状动脉介入治疗这两种传统的再血管化方式相结合而组成的一种新型再血管化的治疗方式。与传统的再血管化治疗方式相比,“一站式”HCR具有手术效果更确切、创伤更小、风险更低、术后恢复更快、并发症更少和不良事件发生率更低等优势,是传统外科手术与介入导管治疗技术为顺应疾病的发展及患者自身的需要而实现的有机结合,其实施充分体现了一体化诊疗过程中内外结合的思想,形成了互利共赢、共同发展的新局面,为冠状动脉多支病变的诊疗策略提供了新的思路。本文将对“一站式”HCR的发展及临床应用现状进行综述,旨在提高广大临床工作者对该术式的认识,进一步促进该术式的应用推广。

准分子激光冠状动脉斑块消蚀术治疗复杂冠状动脉病变的临床观察

目的:探讨准分子冠状动脉斑块消蚀术(ELCA)治疗复杂冠状动脉病变的安全性和有效性。方法:回顾性分析2018年5月至2023年8月在我院采用ELCA治疗的50例(53处病变)复杂冠状动脉病变患者,观察ELCA的疗效和安全性,术后对患者进行定期随访,观察主要不良心脑血管事件发生的情况。结果:53处病变中4处因重度钙化,0.9 mm激光导管未能通过,ELCA治疗成功率为92.5%(49/53)。ELCA术后1处病变靶血管严重夹层、2处病变残余病变仍>30%,PCI手术即刻成功率为86.8%(46/53)。术后24 h有1例患者出现急性支架内血栓形成,急诊行血栓抽吸术后恢复,其余患者围术期无并发症发生。术后随访7(5~10)月,1例患者在术后1周因急性脑梗死致死,其余患者未发生主要不良心脑血管事件。结论:ELCA是治疗高阻力复杂冠状动脉病变的一种安全、有效的介入手段。

血乳酸、乳酸清除率与急性心肌梗死患者冠状动脉病变严重程度及预后相关性分析

目的探究血乳酸、乳酸清除率与急性心肌梗死(AMI)患者冠状动脉病变严重程度及预后的相关性。方法选取2022年11月—2023年12月收治的150例AMI作为研究对象,所有患者入院后行动脉血乳酸检查,根据入院时乳酸水平分为对照组(乳酸正常)66例与观察组(乳酸升高)84例,2组均进行冠状动脉造影检查,比较2组一般资料、冠状动脉病变严重程度、预后情况,并采用多因素Logistic回归分析探究乳酸与AMI患者冠状动脉病变严重程度及预后的关系。结果观察组吸烟、高血压病、糖尿病比例以及B型脑钠肽、肌钙蛋白、血乳酸水平高于对照组,左心室射血分数、乳酸清除率低于对照组(P<0.05,P<0.01);观察组单支病变比例低于对照组,多支病变比例高于对照组(P<0.05);观察组主要心血管不良事件总发生率高于对照组(P<0.05)。多因素Logistic回归分析结果显示:AMI患者冠状动脉病变支数(OR=3.271;95%CI:1.487,7.192;P=0.003)、预后(OR=2.622;95%CI:1.233,5.577;P=0.013)与乳酸升高有关。结论血乳酸水平、乳酸清除率与AMI患者冠状动脉病变严重程度、预后存在密切联系,入院时乳酸水平检测有利于临床对AMI病情与预后进行判断。

CCTA-AI联合FFR-CT诊断冠状动脉狭窄病变的应用价值研究

目的评估计算机断层扫描血管成像(CCTA)与人工智能(AI)联合心肌灌注分数(FFR-CT)对冠状动脉狭窄病变的诊断价值。方法选择于2022年1月至2023年2月到南阳市中心医院接受诊治的80例疑似冠状动脉狭窄病变患者作为观察对象。所有患者均接受CCTA以及冠状动脉造影(CAG)检查,其检查的间隔时间应在14天内,然后通过AI软件自动对CCTA的图像进行重建和计算,同时计算FFR-CT的数值。计算人工智能辅助的心脏计算机断层扫描(CCTA-AI)联合FFR-CT诊断的敏感度、特异度、准确度、阳性预测值和阴性预测值。结果80例患者经CAG检查确诊,72例患者为冠状动脉狭窄病变,占比为90%;8例患者为非冠状动脉狭窄病变,占比为10%。CCTA-AI联合FFR-CT检查的敏感度、特异度、阳性预测值、阴性预测值、准确度以及AUC值均高于CCTA-AI、FFR-CT单独检查,差异有统计学意义(P<0.05)。结论采用CCTA-AI联合FFR-CT检查诊断冠状动脉狭窄病变具有较高的诊断效能,其敏感度及特异度均得到显著提高。

动态心电图及sST2、PAI-1在川崎病伴发冠脉损伤诊断中的研究

目的探讨动态心电图及可溶性人基质裂解素-2(sST2)、纤溶酶原激活物抑制物-1(PAI-1)在川崎病伴发冠脉损伤诊断中的意义。方法研究对象选取2018年1月至2024年1月郑州大学第一附属医院收治的102例川崎病患儿,根据患儿是否伴发冠脉损伤分为两组,其中损伤组40例,未损伤组62例。比较两组患儿的临床病例资料[性别、年龄、身体质量指数(BMI)、发热持续时间、白细胞计数、25-羟维生素D3(25-(OH)D_(3))、血红蛋白、血小板计数、肌酸激酶同工酶(CK-MB)、氨基末端脑利钠肽前体(NT-proBNP)、C反应蛋白(CRP)、sST2、PAI-1]及动态心电图异常率,通过多因素分析川崎病伴发冠脉损伤的影响因素,绘制ROC曲线评价不同指标对川崎病患儿伴发冠脉损伤的诊断价值。结果损伤组患儿的发热持续时间、血小板计数、CRP、CK-MB、NT-proBNP、sST2、PAI-1水平高于未损伤组,25-(OH)D_(3)水平低于未损伤组,差异具有统计学意义(P<0.05)。损伤组患儿的动态心电图异常率为60.00%,未损伤组患儿的动态心电图异常率为16.13%,损伤组高于未损伤组,差异具有统计学意义(P<0.05)。二元Logistic分析结果显示,发热持续时间、25-(OH)D_(3)、血小板计数、CRP、CK-MB、NT-proBNP、sST2、PAI-1、动态心电图异常是川崎病患儿伴发冠脉损伤的影响因素(P<0.05)。以sST2、PAI-1、动态心电图异常及3项指标联合应用作为变量绘制诊断川崎病伴发冠脉损伤的ROC曲线,sST2的AUC为0.789,PAI-1的AUC为0.729,动态心电图异常的AUC为0.719,联合检测的AUC为0.978。结论动态心电图及sST2、PAI-1水平诊断川崎病是否伴发CAL具有较高的诊断价值。

冠心病患者血清血管紧张素样蛋白5水平变化及临床意义

目的:分析冠心病患者血清血管生成素样蛋白5(ANGPTL5)水平变化及与冠心病糖脂代谢紊乱的相关性。方法:纳入2019-01-2019-12本院就诊的疑似冠心病患者239例,根据冠脉造影结果分为冠心病组(n=156)和非冠心病组(n=83)。酶联免疫吸附试验检测所有患者血清ANGPTL5的表达水平,分析血清ANGPTL5水平与冠心病患者糖脂水平、冠脉病变支数等临床参数的相关性。结果:与非冠心病组相比,冠心病组患者血清ANGPTL5水平明显升高(P<0.01)。随着冠脉病变支数增加,冠心病患者ANGPTL5水平升高,三支病变组水平最高(P<0.05)。合并糖尿病或高脂血症的冠心病患者的血清ANGPTL5水平较未合并糖尿病或高脂血症的冠心病患者明显升高,差异具有统计学意义(P<0.05)。相关性分析显示,冠心病患者血清ANGPTL5水平与空腹血糖(FPG)(r=0.339,P<0.01)、甘油三酯(TG)(r=0.354,P<0.01)、极低密度脂蛋白胆固醇(VLDL-C)(r=0.188,P<0.05)水平均呈正相关。多因素Logistic回归显示ANGPTL5是冠心病的危险因素(OR=1.998,95%CI:1.440-2.773,P<0.01)。校正混杂因素(性别、年龄、空腹血糖和血脂)后血清ANGPTL5水平升高仍是冠心病的危险因素(OR=1.916,95%CI:1.155-3.177,P<0.01)。结论:冠心病患者血清ANGPTL5水平升高,且与冠心病患者糖脂代谢状况和冠脉病变支数有关。

非对比增强全心冠状动脉磁共振血管成像在儿童川崎病冠状动脉病变中的应用

目的通过对比超声检查,分析非对比增强全心冠状动脉磁共振血管成像(NCE-CMRA)技术评估冠状动脉方面的优势,探讨该技术诊断儿童川崎病冠状动脉病变的价值。资料与方法回顾性分析2017年6月—2021年6月兰州大学第二医院经临床确诊的41例川崎病患儿的NCE-CMRA及超声资料。对比超声与NCE-CMRA对冠状动脉的显示能力,分析NCE-CMRA技术的成像特点,总结NCE-CMRA显示的冠状动脉病变范围、程度等影像学特征。结果41例患儿NCE-CMRA检查整体血管节段显示率为75.6%;超声整体节段显示率为46.3%,两种技术差异有统计学意义(χ^(2)=59.04,P<0.001)。针对冠状动脉中、远段的显示,NCE-CMRA较超声具有明确的显像优势(χ^(2)=57.98、161.47,P<0.001)。41例患儿中,25例(200节段)冠状动脉受损,94个节段表现为不同程度扩张,其中巨大冠状动脉瘤8段(8.6%),中型冠状动脉瘤35段(37.2%),小型冠状动脉瘤或冠状动脉扩张51段(54.2%)。结论NCE-CMRA技术能够客观、清晰地显示儿童冠状动脉,准确反映川崎病所致冠状动脉受损程度,在诊断和评估儿童川崎病冠状动脉病变方面具有重要临床意义。

合并右冠状动脉慢性闭塞的复杂左主干行经皮冠状动脉介入治疗疗效的初步探讨

目的:初步分析合并右冠状动脉(右冠)慢性完全闭塞(CTO)的复杂左主干病变经皮冠状动脉介入治疗(PCI)的疗效。方法:连续纳入2019年1月至2022年12月在湖南省人民医院住院的所有复杂左主干病变患者90例。根据患者冠状动脉造影血管病变情况分为合并右冠CTO的复杂左主干病变(观察组,n=30)及右冠未发生CTO的复杂左主干病变(对照组,n=60),对患者的临床基线数据、术中情况、造影结果、术后随访结果进行分析。结果:90例患者中男性58例(64.4%)。两组间临床基线资料(P均>0.05)、左主干病变情况(P=1.000)、左主干钙化情况(P=0.249)、术前TIMI血流分级(P=1.000)差异均无统计学意义。观察组与对照组比较,术中无复流发生率(3.3%vs.5.0%,P=1.000)、低血压发生率(10.0%vs.8.3%,P=1.000)、心包积液发生率(3.3%vs.0%,P=0.333)、血管内超声(IVUS)使用率(86.7%vs.90.0%,P=0.635)、术中使用循环辅助装置(P=0.699)、术中冠状动脉旋磨率(26.7%vs.21.7%,P=0.597)差异均无统计学意义。中位随访时间为14.50(11.83,15.85)个月,观察组与对照组比较,复发心绞痛、急性心肌梗死、再次血运重建、心力衰竭再入院、心原性死亡等主要不良心血管事件(MACE)发生率(31.0%vs.32.1%,P=1.000)差异均无统计学意义。结论:对于基础疾病多,无法耐受冠状动脉旁路移植术,合并右冠CTO的复杂左主干病变的患者行PCI可能是一种可行的方法。