缺血性心脏病作为心力衰竭的主要病因,具有患病人数多,再入院率和死亡率高的特点。近期研究发现,肠道菌群在心血管发病因素中发挥着重要的作用,肠道菌群失调时,肠道屏障功能发生障碍、肠道内有害菌如肠杆菌门、志贺氏菌和变形菌数量增加...缺血性心脏病作为心力衰竭的主要病因,具有患病人数多,再入院率和死亡率高的特点。近期研究发现,肠道菌群在心血管发病因素中发挥着重要的作用,肠道菌群失调时,肠道屏障功能发生障碍、肠道内有害菌如肠杆菌门、志贺氏菌和变形菌数量增加,厚壁菌门和乳酸杆菌门丰度减少,肠道内脂多糖、肿瘤坏死因子、干扰素γ增加,短链脂肪酸、白介素-10减少,加剧了全身炎症状态,可提高缺血性心肌病的发病率。因此重视肠道菌群在缺血性心肌病中的作用,通过及时调节肠道菌群,在心衰前期减少危险因素或在患心衰后防止病变加重,提高生活质量,这与中医“治未病”中未病先防,已病防传思想不谋而合,本文将从“治未病”角度探讨重视肠道菌群对缺血性心肌病的价值。As the main cause of heart failure, ischemic heart disease is characterized by a large number of patients, high readmission rates and high mortality. Recent studies have found that intestinal flora plays an important role in cardiovascular pathogenesis. When intestinal flora is disturbed, intestinal barrier function is impaired, the number of intestinal harmful bacteria such as Enterobacteria, Shigella and Proteobacteria increases, the abundance of firmicutes and Lactobacilli decreases, and intestinal lipopolysaccharides, tumor necrosis factor and interferon γ increase. The decrease of short-chain fatty acids and interleukin-10 can aggravate the systemic inflammatory state and increase the incidence of ischemic cardiomyopathy. Therefore, to pay attention to the role of intestinal flora in ischemic cardiomyopathy, through timely regulation of intestinal flora, reduce risk factors in the early stage of heart failure or prevent disease aggravation after heart failure, and improve the quality of life, which coincides with the idea of preventing disease before disease and preventing disease after disease in traditional Chinese medicine. This paper will discuss the value of paying attention to intestinal flora in ischemic cardiomyopathy from the perspective of “treating disease without disease”.展开更多
文摘缺血性心脏病作为心力衰竭的主要病因,具有患病人数多,再入院率和死亡率高的特点。近期研究发现,肠道菌群在心血管发病因素中发挥着重要的作用,肠道菌群失调时,肠道屏障功能发生障碍、肠道内有害菌如肠杆菌门、志贺氏菌和变形菌数量增加,厚壁菌门和乳酸杆菌门丰度减少,肠道内脂多糖、肿瘤坏死因子、干扰素γ增加,短链脂肪酸、白介素-10减少,加剧了全身炎症状态,可提高缺血性心肌病的发病率。因此重视肠道菌群在缺血性心肌病中的作用,通过及时调节肠道菌群,在心衰前期减少危险因素或在患心衰后防止病变加重,提高生活质量,这与中医“治未病”中未病先防,已病防传思想不谋而合,本文将从“治未病”角度探讨重视肠道菌群对缺血性心肌病的价值。As the main cause of heart failure, ischemic heart disease is characterized by a large number of patients, high readmission rates and high mortality. Recent studies have found that intestinal flora plays an important role in cardiovascular pathogenesis. When intestinal flora is disturbed, intestinal barrier function is impaired, the number of intestinal harmful bacteria such as Enterobacteria, Shigella and Proteobacteria increases, the abundance of firmicutes and Lactobacilli decreases, and intestinal lipopolysaccharides, tumor necrosis factor and interferon γ increase. The decrease of short-chain fatty acids and interleukin-10 can aggravate the systemic inflammatory state and increase the incidence of ischemic cardiomyopathy. Therefore, to pay attention to the role of intestinal flora in ischemic cardiomyopathy, through timely regulation of intestinal flora, reduce risk factors in the early stage of heart failure or prevent disease aggravation after heart failure, and improve the quality of life, which coincides with the idea of preventing disease before disease and preventing disease after disease in traditional Chinese medicine. This paper will discuss the value of paying attention to intestinal flora in ischemic cardiomyopathy from the perspective of “treating disease without disease”.
文摘目的研究成人先天性细小冠状动脉瘘(small coronary artery fistula,sCAF)的临床和冠状动脉造影特点,并探讨依据直径分型新标准。方法回顾性分析2003年9月至2017年12月昆明医科大学附属延安医院收治接受冠状动脉造影的成人先天性sCAF患者的临床表现、冠状动脉造影及血流动力学等资料。分析瘘道直径与是否接受手术治疗的关系,评估瘘道直径水平预测sCAF手术治疗的可能性,并计算界值。结果研究入选158例sCAF患者,女66例(41.77%),男92例(58.23%),年龄(44.94±17.35)岁,4例(2.53%)有先天性心脏病家族史,11例(6.96%)合并其他先天性心脏病。胸闷等疑似心绞痛发作和心悸等心律失常发作是主要症状,二者共占36.70%,心房颤动为最常见的心律失常表现形式(8.86%)。左冠状动脉前降支-肺动脉瘘是最多见的瘘道(41.14%),其次为右冠状动脉-肺动脉瘘(25.32%)。大部分瘘道呈不同程度迂曲,且合并局限性狭窄和(或)扩张,继发病变最多见是动脉瘤形成(38.61%)。瘘道直径为(2.78±1.14)mm,肺动脉平均压(pulmonary artery mean pressure, PAMP)为(16.66±5.63)mmHg(1 mmHg=0.133 kPa),肺循环和体循环流量比值(flow ratio of pulmonary to systemic, Qp/Qs)为1.07±0.13。以瘘道直径中位数分组,直径较大组需要手术可能性较大(P<0.05)。Logistic回归分析结果显示sCAF瘘管直径与是否需要手术治疗正相关。受试者工作特征曲线分析结果显示最佳界值为2.91 mm(敏感性为78.6%,特异性为85.3%)。结论成人先天性细小冠状动脉瘘自具特点,起源于左冠状动脉前降支及瘘入肺动脉最多见,瘘道直径2.91 mm可作为细小分型的潜在最佳界值。
