目的 使用超声心动图评估沙库巴曲缬沙坦钠(angiotensin receptor-neprilysin inhibitor,ARNI)对心力衰竭患者左心室逆重构和舒张功能逆转的影响,并探讨沙库巴曲缬沙坦钠对舒张功能不全分级及早期心功能逆转的影响.方法 收集2019年1-12月于首都医科大学附属北京朝阳医院就诊的心力衰竭患者176例,服用沙库巴曲缬沙坦钠者归为ARNI治疗组79例、服用血管紧张素转化酶抑制剂或血管紧张素Ⅱ受体阻滞剂的归为对照组97例.ARNI治疗组与对照组均采用心力衰竭的常规治疗,通过比较两组患者基线超声心动图和用药后3个月超声心动图的各种参数和纽约心脏协会(New York Heart Association,NYHA)心力衰竭分级,探讨沙库巴曲缬沙坦钠对舒张功能不全分级的影响在心力衰竭患者早期心功能逆转中的作用.结果 两组入组前的临床基本情况和基线超声心动图结果均衡可比(P＞0.05).心脏超声左心室重构指标及左心室射血分数(left ventricular ejection fraction,LVEF)改善:用药后3个月,治疗组LVEF较对照组有所升高,但差异无显著性[(42.4±11.8)%比(39.2±9.7)%,t=2.803,P=0.08].但治疗组治疗前后LVEF的变化差值、左心室舒张末内径变化差值及左心室收缩末内径变化差值均较对照组差异有显著性(P＜0.05).心脏超声舒张功能指标及舒张功能障碍分级比较:用药后3个月,治疗组二尖瓣E峰和A峰比值、舒张早期二尖瓣血流速度与舒张早期二尖瓣环运动速度的比值较对照组有所降低(P＜0.05).治疗组舒张功能不全等级较对照组有所下降(χ2=7.518,P=0.023).治疗组较对照组舒张功能分级逆转率明显升高(40.5%比25%,χ2=4.557,P=0.033).治疗3个月后,治疗组较对照组NYHA分级逆转率明显升高(73.6%比43.5%,χ2=13.21,P=0.01).其中治疗组中,舒张功能分级逆转组和非逆转组NYHA改善的比较,分别为46.6%和 34.1%(χ2=2.498,P=0.041),差异有显著性.结论 通过心脏超声评价沙库巴曲缬沙坦钠对心力衰竭患者舒张功能不全分级的逆转,与治疗早期心功能NYHA分级的逆转相关,提示尽早启动ARNI治疗干预舒张功能不全,可能对患者临床结局获益更早.

Background: The optimal revascularization strategy for non-left anterior descending coronary artery Aims: This study aimed to compare the outcomes of the drug-coated balloon (DCB) and drug-eluting stent (DES) strategies in patients with non-small non-LAD lesions undergoing one-stop HCR. Methods: A total of 141 consecutive patients with multivessel coronary artery disease (MVCAD) undergoing one-stop HCR between June 1, 2018 and March 1, 2022 were retrospectively included in this study. In-hospital outcomes and mid-term major adverse cardiovascular and cerebrovascular events (MACCE) were observed. Kaplan-Meier curve analysis was used to evaluate the MACCE-free survival rate. The Cox proportional hazard model was used to identify risk factors of mid-term MACCE. Results: Thirty-eight and 103 patients received only DCB or DES therapy, respectively, in this study. There were no significant differences in demographic characteristics and laboratory parameters between the two groups. The in-hospital MACCE rate in the DES group was numerically higher than that in the DCB group (9.7% vs. 5.3%, respectively), but the difference was not statistically significant (P = 0.4). The incidence of MACCE after patients'discharge was significantly higher in the DES group (22% vs. 5.3%, respectively, P = 0.02) during a median follow-up of 20 months. In multivariable Cox proportional hazard analysis, DCB therapy was independently associated with reduced risk of midterm MACCE (hazard ratio, 0.21; 95% confidence interval, 0.06-0.91; P = 0.04). Conclusion: For patients with MVCAD undergoing one-stop HCR, DCB therapy may be the optimal revascularization strategy for non-small non-LAD coronary artery lesions with a significantly lower rate of mid-term MACCE.

目的 探讨中性粒细胞/血小板计数比值(NPR)对冠心病监护室(CCU)接受连续性肾脏替代治疗(CRRT)的心血管疾病危重患者预后的评估价值.方法 本研究为回顾性队列研究,纳入2017年1月至2021年6月在首都医科大学附属北京朝阳医院CCU接受CRRT的172例患者.根据患者住院期间生存情况分为生存组81例和死亡组91例,比较两组的临床资料,采用logistic回归模型分析死亡相关的预测因子.结果 通过精简模型得到与接受CRRT的患者住院期间全因死亡明显相关的9个因素,包括年龄、性别、高血压病史、诊断(非冠心病/不稳定性心绞痛/急性心肌梗死)、冠状动脉旁路移植术史、射血分数、收缩压、血滤前的肌酐水平和NPR.其中,NPR与接受CRRT的CCU患者的住院死亡明显相关(OR=3.60,95％CI:1.40～11.34,P=0.009).结论 本组资料显示,NPR对于接受CRRT的心血管疾病危重患者预后有一定的预测价值.

Myocardial infarction is one of the common types of coronary heart disease in the clinic. Its morbidity, lethality and disability are high, and it has become a serious threat to human health. At present, it is shown that in the early stage of acute myocardial infarction, myocardial cells are mainly apoptotic, suggesting that effectively blocking myocardial apoptosis in the early stage of myocardial infarction is of great significance for reducing tissue necrosis in the infarcted area. Recent studies have shown that NG nano-protein complexes have a better therapeutic effect on acute myocardial infarction and can inhibit left ventricular remodeling in patients with acute myocardial infarction. However, there are few studies on the effect of NG nano-protein complexes on myocardial cell apoptosis after ischemia. This study used a rat model of acute myocardial infarction to analyze its effect on apoptotic proteins of myocardial cells in rats with acute myocardial infarction in order to provide a certain theoretical basis for its clinical application. In this study, 45 SD rats were randomly divided into a sham operation group, a myocardial infarction group, and a NG nano-protein complex group, with 15 in each group. The sham operation group only underwent thoracotomy, and received normal saline gavage postoperatively; the myocardial infarction group and the NG nano-protein complex group were ligated to the left anterior descending coronary artery of the rat to establish an acute myocardial infarction model, and were performed separately treatment with saline and NG nanoprotein complexes. Finally, we conclude that this nano-protein complex can significantly reduce the expression level of myocardial apoptosis-related proteins in rats with acute myocardial infarction, and is of great significance in inhibiting the apoptosis of acute myocardial infarction cells.

目的:探讨冠心病患者血清维生素D[由25-羟基维生素D3(25(OH)D3)评估]水平与冠状动脉侧支循环的关系.方法:根据冠状动脉造影结果入选至少有一个主要冠状动脉有慢性闭塞病变的冠心病患者171例.按Rentrop分级法进行冠状动脉侧支循环分级,根据冠状动脉侧支循环发展程度,将患者分为两组:冠状动脉侧支循环不良组(n=81)和冠状动脉侧支循环良好组(n=90).采用电化学发光免疫分析法测定25(OH)D3水平.结果:与冠状动脉侧支循环良好组相比,冠状动脉侧支循环不良组患者的25(OH)D3水平较低,脂蛋白(a)[LP(a)]水平较高,他汀类药物、血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)的使用率均较低(P均<0.05).随着Rentrop分级的增加,25(OH)D3水平显著升高(P=0.025).多因素Logistic回归分析显示血清25(OH)D3水平是侧支循环良好的独立预测因子(OR=1.099,95％CI:1.004～1.204;P=0.040).经倾向评分配比后,25(OH)D3仍是侧支循环良好的独立预测因子(OR=1.137,95％CI:1.007～1.285;P=0.039).结论:对于冠状动脉慢性闭塞的冠心病患者,血清25(OH)D3水平升高与冠状动脉侧支循环的形成有关,提示25(OH)D3可能对促进冠状动脉侧支循环的形成有潜在的作用.

目的 探讨血清微小RNA-206(miR-206)、微小RNA-590-3p(miR-590-3p)水平与室性心律失常患者预后的关系.方法 选取2016年7月至2019年2月于河北燕达医院住院治疗的117例室性心律失常患者(室性心律失常组),同期选取104例健康体健者作为对照组.采用实时荧光定量PCR(qRT-PCR)检测两组血清中miR-206和miR-590-3p水平;分析室性心律失常患者血压、血脂水平与血清miR-206、miR-590-3p水平的相关性;比较室性心律失常患者不同预后组血清miR-206和miR-590-3p水平;分析室性心律失常患者预后不良的影响因素.结果 室性心律失常组与对照组的性别、年龄、体质指数、肌酐、高血压、高脂血症和吸烟比例比较,差异均无统计学意义(均为P>0.05).室性心律失常组的miR-206、miR-590-3p、收缩压、舒张压、总胆固醇、三酰甘油和低密度脂蛋白胆固醇水平显著高于对照组,而高密度脂蛋白胆固醇水平低于对照组(均为P<0.05).室性心律失常患者miR-206与miR-590-3p水平呈正相关,且与收缩压、舒张压、总胆固醇、三酰甘油和低密度脂蛋白胆固醇水平呈正相关,与高密度脂蛋白胆固醇水平呈负相关(均为P<0.05).预后不良组患者的血清miR-206和miR-590-3p水平均显著高于预后良好组(均为P<0.05);miR-206升高(OR=6.98,95％CI:2.96～16.45,P=0.001)、miR-590-3p升高(OR=7.07,95％CI:4.33～11.54,P=0.002)和总胆固醇升高(OR=6.27,95％CI:4.38～8.97,P=0.008)是室性心律失常患者预后不良的危险因素,高密度脂蛋白胆固醇升高(OR=0.42,95％CI:0.21～0.84,P=0.004)是室性心律失常患者预后不良的保护因素.结论 室性心律失常患者血清miR-206和miR-590-3p水平升高与预后不良密切相关,可作为评估预后的参考指标.

Objective To investigate the relationship between serum thyroid-stimulating hormone and blood lipid in the population with normal thyroid function. Methods A total of 2 754 participants who underwent a medical examination at the Medical Center of Beijing Chao-yang Hospital were selected as research subjects between April 2018 and April 2019. The free triiodothyronine (FT3), free thyroxine (FT4), TSH, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipid Protein cholesterol (LDL-C) levels were tested. TSH, FT3, and FT4 were all within the reference range. General clinical data and lipid levels were compared between male and female populations. The participants were divided into three groups. TSH of the normal high value group was higher than 1.69 while that of the normal low value group was lower than 1.0. The range between 1.0 and 1.9 is defined as the normal median group. The differences of serum lipid levels in different populations were compared under different TSH levels. Multiple linear regression was to analyze the correlation between TSH level and various lipid levels. Results The proportion of smoking, hypertension and diabetes of the male population, and BMI, FT3, FT4, TG levels of the male population were significantly higher than those of the female population, while the age, TSH, TC, HDL-C of the male population were significantly lower than those of the female population (P<0.01). In the total population, the HDL-C level in the TSH normal high value group was higher than the normal median group and the TC level in the TSH normal high value group was higher than in the normal median group and the normal low value group (P<0.05). In the female population, the levels of TG in the normal high value group and the normal median group were higher than in the normal low value group and it was higher in the normal high value group than in the normal median group (P<0.05). The multiple linear regression analysis showed that the TSH level was positively correlated with TC and TG and this correlation was independent of thyroid hormone (β=0.056, P=0.010; β=0.075, P=0.004). Conclusions In the population with normal thyroid function, TSH level was positively correlated with TC and TG. The increase in TSH level within the normal range may be a risk factor for the elevated blood lipids. Key words: Thyrotropin; Blood lipids; Total cholesterol; Triglycerides

investigate the correlation between body mass index ( BMI) and serum level of uric acid (UA) in physical examination subjects. Methods A total of 1 514 physical examination subjects older than 18 years old from Beijing Chaoyang Hospital were selected in the study. They were divided into normal, overweight and obesity group according to BMI. The correlation between UA and BMI, triglyceride (TG) and other metabolic indicators were analyzed. Logistic regression was used to analyze the risk factors for hyperuricemia. Results UA in the subjects increased with the increasing of BMI and the difference in BMI groups was statistically significant. UA was significantly positively correlated with BMI, TG, fasting insulin (FINS), and homeostasis model assessment insulin resistance index (HOMA-IR). Male (OR=3.02), overweight and obesity (OR=1.51 and 2.59), higher TG (OR=1.62) and raised low-density lipoprotein cholesterol ( LDL-C, OR=2.23) were risk factors for hyperuricemia ( all P<0.05). Conclusions UA is significantly positively correlated with BMI, TG, FINS and HOMA-IR. Male, overweight and obesity, the high TG and the high LDL-C are risk factors for hyperuricemia.

目的:比较住院期间经皮冠状动脉介入治疗(PCI)部分血运重建(IRA-only)和完全血运重建(CR)治疗急性ST段抬高型心肌梗死(STEMI)合并多支冠状动脉病变患者的远期预后.方法:回顾性分析2008年1月至2011年7月发病12 h内到达北京朝阳医院心脏中心并接受急诊PCI的592例合并多支冠状动脉病变的STEMI患者,在住院期间择期干预非罪犯血管为CR组(n=341),择期PCI平均延迟(5.2±2.2)天;未干预非罪犯病变的患者为IRA-only组(n=251).所有患者置入药物洗脱支架.比较两组患者远期预后,其中主要不良心脑血管事件(MACCE)包括全因死亡、再发心肌梗死、脑卒中以及再次冠状动脉血运重建.结果:两组临床基线特征相似,具备可比性.随访7～10年,平均随访(105.0±13.6)个月期间,CR组MACCE发生率与IRA-only组无显著差异(21.2％vs 26.0％,P=0.26),两组死亡、脑卒中及再发心肌梗死无显著差异,IRA-only组仅再次血运重建率显著高于CR组(21.5％vs 14.8％,OR=1.48,95％CI:1.01～2.18,P=0.04),主要表现在非罪犯血管再次血运重建率较高(14.6％vs 5.7％,OR=2.69,95％CI:1.54～4.69,P<0.001).结论:对于已经接受急诊PCI合并多支血管病变的STEMI患者,住院期间择期干预非罪犯病变血管未降低远期MACCE.

<br> Objective: To explore the impact of different atorvastatin doses on platelet function and highreactivity in patients with acute ST-elevation myocardial infarction (STEMI) after emergent percutaneouscoronary intervention (PCI) therapy. <br> Methods:A total of 120 STEMI patients with emergent PCI therapy were randomly divided into 2 groups:Standard group, the patients received atorvastatin 20 mg/day and Intensive group, the patientsreceived atorvastatin 40 mg/day, all patients were treated for 7 days. n=60 in each group. Blood lipids and biochemistry were examined before PCI and 7 days after atorvastatin treatment respectively;platelet fibrin clot strength induced by ADP (MAADP), AA and ADP induced platelet inhibition rate were measured by thrombelastography (TEG) test. <br> Results: With 7 days treatment, compared with Standard group, Intensive group showed decreased MAADP (38.40±17.40) mm vs (45.70±14.50) mm, P<0.05. On day 7 of atorvastatin treatment, compared with Standard group, Intensive group had reduced occurrence rate of high ADP reactivity (18.3%vs 31.7%), P<0.05. The occurrence rate of high AA reactivity was similar between 2 groups (13.3%vs 18.3%), P>0.05. The patients were followed-up for 3 months and the end point events including unstable angina, non-fatal MI, in-stent restenosis, in-stent thrombosis, and cardiovascular death or target vessel revascularization were similar between 2 groups, P>0.05. <br> Conclusion: Early stage and short term administration of high dose atorvastatin could obviously inhibit platelet activity in STEMI patients after emergent PCI;such intensive atorvastatin treatment had no reduction on end point events in 3 months follow-up period.

Objective:To explore anti-platelet/anti-coagulation treatment and their influence on prognosis in advanced aged patients with acute coronary syndrome (ACS)complicated atrial fibrillation (AF)after percutaneous coronary intervention (PCI).Methods:A total of 204 advanced aged ACS + AF patients treated in our heart center were se-lected.All patients received CHA2 DS2 Vasc score assessment,male had score ≥2 scores and female had score ≥3 scores.A total of 160 cases received dual anti-platelet therapy combined anticoagulant treatment of warfarin,and they were randomly divided into low intensity group [n=80,international normalized ratio (INR)remained 1.8~2.3]and high intensity group (n=80,INR remained 2.3~2.8),both groups were followed up for 18 months.Inci-dence rates of major adverse cardiovascular and cerebrovascular events (MACCE),ischemic and hemorrhage events were observed.Results:Both groups were followed up for a mean 18 months,and there were no significant differ-ence in all-cause mortality,incidence rates of MACCE and fatal hemorrhage between two groups,P > 0.05 all.Compared with low intensity group,there were significant rise in incidence rates of severe hemorrhage (3.8% vs. 12.5%),P <0.05.Conclusion:Low intensity warfarin anticoagulant therapy can effectively reduce incidence rates of MACCE and ischemic events,and incidence rate of hemorrhage events is low in advanced aged ACS + AF pa-tients after PCI.

1 临床资料 主诉:间断胸闷、心悸15年,加重1天. 现病史:患者女性,81岁,15年前无明显诱因出现胸闷,伴心悸,与情绪激动或体力活动无关,持续约10分钟可自行缓解,15年来上述症状反复发作,未正规诊治,入院前1天外院行24h动态心电图示窦性心动过缓,窦性停搏,交界性逸搏,交界性逸搏心律,偶发室性早搏(图一);故就诊我院. 患者发病来精神尚可,食欲、睡眠差,二便正常,体重近期无明显变化. 既往史:高血压病史10年; 入院前7天曾在我科行冠脉造影检查提示左前降支中段管壁不规则;诊断冠状动脉粥样硬化;无糖尿病、脑血管病.

Coronary plaque rupture is the most common cause of acute coronary syndrome.However, the timely biomarker-based diagnosis of plaque rupture remains a major unmet clinical challenge.Balloon dilatation and stent implantation during percutaneous coronary intervention (PCI) could cause plaque injury and rupture.Here we aimed to assess the possibility of circulating microRNAs (miRNAs) as biomarkers of acute coronary plaque rupture by virtue of the natural model of PCI-induced plaque rupture.Stable coronary artery disease patients underwent PCI with single stent implantation were recruited and a three-phase approach was conducted in the present study: (i) profiling of plasma miRNAs in a group of patients before (0 h) and after balloon dilatation for 1 h (1 h vs. 0 h), (ii) replication of significant miRNAs in the second group of patients (1 h vs. 0 h), (iii) validation of a multi-miRNAs panel in the third group of patients (0.5 h, 1 h vs. 0 h).Out of 24 miRNAs selected for replication, 6 miRNAs remained significantly associated with plaque rupture.In the validation phase, combinations of miR-483-5p and miR-451a showed the highest area under the receiver-operating-characteristic curve (AUC) (0.982; CI: 0.907-0.999) in patients with plaque rupture for 0.5 h; combinations of miR-483-5p and miR-155-5p showed the highest AUC (0.898; CI: 0.790-0.962)after plaque rupture for 1 h.In conclusion, using a profiling-replication-validation model, we identified 3 miRNAs including miR-155-5p, miR-483-5p and miR-451a, which may be biomarkers for the early identification of plaque rupture.

抗血小板治疗在急性心肌梗死治疗中占有十分重要的地位,但对于血小板减少症患者应用抗血小板药物需谨慎.通过分析急性心肌梗死伴抗凝剂相关假性血小板减少症1例,为如何识别抗凝剂相关的假性血小板减少症提供建议,避免错误停用抗血小板药物.

黄连素又名小檗碱,近年来通过动物实验和临床研究证明黄连素在治疗心血管疾病方面有较好的应用前景,本文就黄连素在心血管疾病方面的应用进行综述总结,期望为黄连素在治疗心血管疾病方面的临床实践及进一步开发应用提供理论依据及参考.

通过从医院评审标准(2011版)中摘取与病案信息管理技术有关的条款.介绍三级综合医院评审标准(2011版)中与病案信息管理技术有关的条款、数据,唤起医院管理者在日常工作中的关注度及医务人员的责任感,增加医疗机构全体职工对病案信息管理技术在医院评审中的利用度.病案信息管理技术及病案信息数据在医院等级评审中被广泛利用,起到其他评审技术无法替代的作用.

Background: Inconsistent findings have reported on parathyroid hormone (PTH) concentration and cardiovascular or all-cause mortality. Objective: To investigate whether elevated PTH concentration was an independent predictor for cardiovascular or all-cause mortality in the general population by conducting a meta-analysis based on prospective studies.Method: We searched Cochrane Library, Pubmed, and Embase databases up to June 2015. Only prospective studies evaluating serum PTH concentration and cardiovascular or all-cause mortality were included. Pooled adjust risk ratio (RR) and corresponding 95% confidence intervals (CI) were calculated for the highest vs. lowest PTH concentration.Results: Ten studies with 31,616 subjects were identified and analyzed. Compared the highest to the lowest PTH concentration, elevated serum PTH concentration increased the risk of all-cause mortality (RR 1.19; 95% CI 1.08-1.30) but not for cardiovascular mortality (RR 1.26; 95% CI 0.96-1.66). Subgroup analyses indicated that cardiovascular mortality risk appeared to be more pronounced among men (RR 1.68; 95% CI 1.05-2.67).Conclusions: Elevated PTH concentration is an independent predictor of all-cause mortality. Elevated serum PTH concentration appears to increase risk of cardiovascular mortality among men. (C) 2016 Elsevier B.V. All rights reserved.

Objective To evaluate the significance of dilatation of aortic root and aortic artery in primary hypertension patients. Methods A total of 174 hypertensive subjects with aortic root and aortic artery dilation(echocardiography confirmed)were enrolled in this study from December 2007 to August 2009, 70 patients with normal aortic root and aortic artery diameters were enrolled as control group with age and sex matched.Clinical characteristics and echocardiographic parameters were compared between two groups.Results Compared with the control group,the prevalence of smoking[47.3%(82/174)vs.31.4%(22/70)],dyslipidemia [52.7%(91/174)vs.44.3%(31/70))and atherosclerosis[54.1%(94/174)vs. 42.9%(30/70)]were higher in aortic root and aortic artery dilation group(all P<0.05).The diameter of left atrial [(39.1 ±5.9)mm vs.(37.8 ±6.5)mm],inter-ventricular septum(IVS)[(11.6 ±5.5)mm vs. (10.7 ±2.7)mm]and E/Em[(9.3 ±3.8)vs.(7.8 ±2.9)was statistically higher in aortic root and aortic artery dilation group than control group(all P<0.05);while E peak velocity[(72 ±14)cm/s vs.(75 ±16) cm/s),Em[(7.7 ±2.7) cm/s vs.(9.4 ±2.6) cm/s) and E/A[(0.86 ±0.29) vs.(1.03 ±0.30)] was significantly lower in aortic root and aortic atery dilation group than those in control group ( all P<0.05 ) . Logistic regression analysis demonstrated that age, IVS, E/A and E/Em were the independent factors for aortic root and aortic artery dilatation.Conclusions Hypertensive patients with aortic root and aortic artey dilatation often have multiple cardiovascular risk factors and abnormalities of cardiac structure and function.

心血管病已经成为中国居民的首要死因.其中,半数为急性冠状动脉综合征(acute coronary syndrome,ACS)所致.现已经阐明,动脉粥样硬化斑块破裂引起血小板激活、黏附和聚集,致使冠状动脉血栓形成,是ACS发病的关键机制.因此,抗血小板是ACS药物治疗的基石.近年来,随着大量临床试验的展开和新型抗血小板药物的临床应用,抗血小板治疗领域取得许多新的突破.

<正>1病例资料患者男性,47岁。主因"间断胸痛12 d"入院。患者入院前12 d,于夜间睡眠中突发胸痛,位于心前区,手掌大小范围,无放射痛,持续不缓解。5 h后于当地医院就诊,诊断"急性前壁心肌梗死",负荷剂量阿司匹林及氯吡格雷口服,并予"尿激酶150万U"溶栓。此后,患者于日常体力活动时仍间断出现胸痛,位于心前区,手掌大小范围,无放射痛,每