目的 分析ST段抬高型心肌梗死(STEMI)病人经皮冠状动脉介入术(PCI)术后院内主要不良心血管事件(MACE)的影响因素.方法 选取2017年9月—2020年9月在陆军军医大学第二附属医院接受PCI治疗的126例STEMI病人,根据术后院内MACE发生情况分为MACE组和非MACE组.比较两组一般资料、实验室检查资料、影像学检查资料差异.采用Logistic回归模型分析MACE的影响因素并生成联合预测模型,采用受试者工作特征(ROC)曲线分析不同指标对MACE的预测价值.结果 16例病人发生MACE,发生率为12.70％.MACE组单核细胞计数(MO)、中性粒细胞计数(NEUT)、低密度脂蛋白胆固醇(LDL-C)、血糖(FBG)、C反应蛋白(CRP)、心肌肌钙蛋白I(cTnI)、磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、单核细胞/高密度脂蛋白胆固醇比值(MHR)、C反应蛋白/清蛋白比值(CAR)高于非MACE组,差异均有统计学意义(P<0.05或P<0.01).Logistic回归分析结果显示,NLR、PLR、MHR是MACE的影响因素,NLR、PLR、MHR的回归方程为-14.304+1.668×NLR+0.028×PLR+7.429×MHR.ROC曲线分析结果显示,NLR、PLR、MHR及NLR、PLR联合MHR对MACE具有预测价值,且NLR、PLR联合MHR的预测价值优于单一指标.结论 NLR、PLR、MHR增加与STEMI病人PCI术后院内MACE有关,NLR、PLR联合MHR对院内MACE具有较好的预测价值.

目的:探讨匹伐他汀纳米微球修饰内皮祖细胞对损伤血管再内皮化的作用及机制.方法:培养内吞匹伐他汀纳米微球的内皮祖细胞,移植至鼠颈动脉损伤模型,CCK-8检测损伤血管中膜平滑肌细胞增殖情况,1周后伊文思蓝染色观察血管再内皮化,2周后HE染色观察损伤血管新内膜增生.结果:内吞匹伐他汀纳米微球的内皮祖细胞移植后3d,荧光显微镜可见损伤处内皮祖细胞聚集,其中匹伐他汀纳米微球组内皮祖细胞归巢数高于匹伐他汀单药组(P=0.025).与匹伐他汀单药组相比较,匹伐他汀纳米微球组可明显抑制损伤血管平滑肌细胞增殖(P=0.013),内皮祖细胞移植可抑制损伤内膜增生,促使局部血管再内皮化,匹伐他汀纳米微球组效果明显(P=0.043、0.024).结论:匹伐他汀纳米微球可被内皮祖细胞吞噬,更有益于内皮祖细胞归巢至损伤部位,同时可抑制局部平滑肌细胞增殖,有效抑制内膜增生及促血管再内皮化.

Insulin resistance (IR) is the pivotal link between metabolic disorders and atherosclerosis (AS). Insulin resistance plays an important role in the initiation and progression of atherosclerosis, and its underlying mechanism involves complex pathophysiological processes including endothelial injury, inflammatory reaction, and oxidative stress. Insulin resistance markers presented the potential association of metabolic risk with atherosclerosis and the detection of insulin resistance markers may support strategy development for the clinical management of cardiovascular diseases.

[目的]探讨强心方(由温阳活血利水方药组成)对慢性心力衰竭大鼠的治疗机制.[方法]从72只大鼠中选取60只大鼠建立慢性心力衰竭模型,感染死亡5只.将55只成功造模的大鼠按体质量分为模型组,卡托普利组,强心方低、中、高剂量组,每组11只.另取11只大鼠设为假手术组,仅切口穿线不结扎.建模第1天,强心方低、中、高剂量组大鼠分别灌胃3.96、7.92、15.84(生药)g·kg-1·d-1的强心方混悬液,卡托普利组大鼠灌胃10 g/mL的卡托普利.假手术组和模型组分别灌胃等体积生理盐水溶液.每日1次,连续4周.采用酶联免疫吸附法(ELISA)检测血清中单磷酸腺苷(AMP)、二磷酸腺苷(ADP)、三磷酸腺苷(ATP)含量,考马斯亮蓝法检测心肌组织Na+-K+ATP酶、Ca2+-Mg2+ATP酶活性,苏木素-伊红(HE)染色法观察心肌组织病理形态,免疫荧光法检测心肌组织自噬蛋白微管相关蛋白轻链3Ⅱ(LC3-Ⅱ)阳性表达情况,蛋白免疫印迹(Western Blot)法检测心肌组织中p38丝裂原活化蛋白激酶(p38MAPK)、磷酸化p38MAPK(p-p38MAPK)及过氧化物酶体增殖物激活受体(PPAR)-γ蛋白表达.[结果](1)与假手术组比较,模型组血清ATP含量和心肌组织Na+-K+ATP酶活性、Ca2+-Mg2+ATP酶活性降低,血清ADP、AMP含量升高(P<0.05);与模型组比较,强心方各剂量组和卡托普利组血清ATP含量和心肌组织Na+-K+ATP酶活性、Ca2+-Mg2+ATP酶活性升高,血清ADP、AMP含量降低(P<0.05).(2)HE染色结果:模型组大鼠心肌组织纤维排列紊乱或断裂,强心方各剂量组与卡托普利组大鼠心肌组织损伤改善.(3)与假手术组比较,模型组心肌组织LC3-Ⅱ阳性表达率升高(P<0.05);与模型组比较,强心方低、中、高剂量组和卡托普利组LC3-Ⅱ阳性表达率降低(P<0.05).(4)与假手术组比较,模型组心肌组织p38MAPK、p-p38MAPK蛋白表达水平升高,PPAR-γ蛋白表达水平降低(P<0.05);与模型组比较,强心方各剂量组和卡托普利组心肌组织p38MAPK、p-p38MAPK蛋白表达水平降低,PPAR-γ蛋白表达水平升高(P<0.05).此外,强心方高剂量组上述各指标与卡托普利组比较,差异均无统计学意义(P>0.05).[结论]强心方可能通过抑制p38MAPK活化及促进PPAR-γ蛋白表达进而增强心肌线粒体能量代谢,减少心肌细胞自噬,从而起抗慢性心力衰竭的作用.

To compare the effects of paclitaxal-coated balloon (PCB) versus conventional balloon (CB) on side branch (SB) lesion and cardiovascular outcomes in patients with de novo true bifurcation lesions. In total, 219 patients with de novo true bifurcation lesions were enrolled and divided into PCB group (102 cases) and CB group (117 cases) according to angioplasty strategy in SB. Drug-eluting stent (DES) was implanted in main vessel (MV) for each subject. All subjects underwent a 12-month follow-up for late lumen loss (LLL), restenosis, and major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI). MACEs included cardiac death, nonfatal myocardial infarction, and unstable angina requiring admission. There were no differences in diameter, minimum lumen diameter (MLD), and stenosis for bifurcation lesions between the two groups before and immediately after PCI (P > 0.05). After 12-month follow-up, no differences occurred in MV-MLD and MV-LLL between the two groups (P > 0.05); SB-MLD in PCB group was higher than that in CB group (1.97 ± 0.36 mm vs. 1.80 ± 0.43 mm, P = 0.007); SB-LLL in PCB group was lower than that in CB group (0.11 ± 0.18 mm vs. 0.19 ± 0.25 mm, P = 0.024). Multivariate COX analyses indicated that PCB group had lower MACE risk than CB group (HR = 0.480, 95%CI 0.244–0.941, P = 0.033). PCB could decrease SB-LLL and MACE risk in patients with de novo true coronary bifurcation lesion 12 months after single-DES intervention.

镁离子是自然界中广泛存在且人体必需的重要无机离子,作为体内300 多个酶促反应中的辅助因子,参与了ATP生成、核苷酸合成、葡萄糖代谢和脂质氧化等重要生理过程[1].它也是体内仅次于钾的第二重要阳离子,是保证肌肉收缩、神经传导、骨骼强度、血压控制、心电稳定的重要基础[1].成人每公斤体重约含400 mg镁,其中50％ ～60％储存于骨骼,其余则分布于心肌、骨骼肌和软组织中;血清镁所占比例很小,约为体内镁含量的1％,且与骨骼进行交换以保证血清镁浓度的稳定[2].人体可以从不同类型的食物中获取镁,绿叶蔬菜、豆类、谷物和坚果的镁含量较高,猪肉、家禽及鱼的含量则较为适中.此外,饮用水也是人体日常镁摄入的重要来源,镁含量30～50 mg/L[3].

目的 探究慢病毒介导微RNA-375-3p(miR-375-3p)过表达对慢性心力衰竭(CHF)大鼠心脏重塑的影响.方法 腹腔注射5 mg/(kg·d)异丙肾上腺素构建CHF大鼠模型;超声检查仪检查收缩末期左心室内径(LVIDs)、舒张末期左心室内径(LVIDd)、缩短分数(FS)和射血分数(EF);HE染色观察心肌组织病理变化;Masson染色观察心肌组织胶原纤维沉积情况;实时荧光定量PCR(RT-qPCR)法检测miR-375-3p、转化生长因子-β1(TGF-β1)mRNA和Smad3 mRNA相对表达量;蛋白质免疫印迹(West-ern blotting)法检测TGF-β1、Samd蛋白水平.结果 miR-375-3p过表达可抑制CHF引起的LVIDd、LVIDs水平升高,EF、FS水平降低.miR-375-3p过表达可抑制CHF引起的TGF-β1、Samd3表达,从而保护心肌组织,抑制心肌胶原纤维沉积.结论 miR-375-3p过表达对CHF有一定的保护作用,其机制可能与调控TGF-β1、Samd3表达有关.

目的 探讨家庭医生服务模式对心房颤动(AF)患者华法林抗凝治疗的依从性及预后的影响.方法 选取2017年5月至2018年3月期间重庆两江新区第一人民医院收治的72例AF患者,应用随机数字法分为观察组和对照组,各36例,对照组患者给予常规健康宣教和随访,观察组实施家庭医生制服务模式.比较两组干预6个月后AF患者华法林抗凝知识问卷和抗凝依从性问卷总分,国际标准化比值(INR)的达标率和并发症发生情况.结果 观察组患者出院后6个月的华法林抗凝知识问卷、依从性问卷总分和INR达标率均显著高于对照组,差异均有统计学意义(t/x2=3.495、3.036、4.385,P＜0.05).两组患者的出血和血栓并发症发生率比较,差异均无统计学意义(x2=2.683、1.636,P＞0.05). 结论 家庭医生制服务模式能显著提高AF患者华法林抗凝知识的知晓率和治疗依从性,改善INR的达标状况,但不会影响短期内并发症的发生率.

目的 探索家庭药师制服务模式对心房颤动(AF)患者服用抗凝药物华法林治疗的依从性及预后的影响.方法 选取重庆两江新区第一人民医院于2017年6月—2019年6月收治的120例AF患者为研究对象,按随机数字表法将其分为对照组(56例)和观察组(64例),对照组患者给予常规健康宣教和随访,观察组实施家庭药师制服务模式.比较两组患者干预1年后的华法林抗凝知识问卷得分、服药依从性问卷得分、国际标准化比值(INR)的达标率和并发症发生情况.结果 出院后1年,观察组华法林抗凝知识问卷得分、服药依从性问卷得分和INR达标率均高于对照组(均P<0.05);观察组的出血和血栓并发症发生率低于对照组(P<0.05).结论 家庭药师制服务模式能提高AF患者华法林抗凝知识的知晓率、治疗依从性和INR的达标率,同时可以降低患者出血及血栓并发症的发生率.

目的 探讨恩替卡韦联合乳酸杆菌治疗乙肝肝硬化的临床效果以及对患者肠道菌群的影响.方法 选择本院2016年2月至2018年2月收治的乙肝肝硬化失代偿期患者76例作为研究对象,采用随机数表法将其分为实验组和对照组每组38例,给予对照组恩替卡韦治疗,给予实验组恩替卡韦联乳酸杆菌治疗,治疗6个月,评估两组患者肝功能恢复情况以及肠道目的菌群情况.结果 实验组患者厌食、腹胀以及乏力改善率均明显高于对照组(P＜0.05);两组患者治疗前各项肝功能指标无明显差异(P＞0.05),治疗后,实验组ALT、TBIL、AST均明显低于对照组(P＜0.05);两组治疗前各个菌群数目无明显差异(P＞0.05),治疗后,实验组患者乳酸杆菌、双歧杆菌数目明显高于对照组(P＜0.05),肠球菌、肠杆菌明显低于对照组(P＜0.05).结论 恩替卡韦联合乳酸杆菌治疗乙肝肝硬化可显著改善患者症状以及肝功能,对改善肠道菌群效果明显,适合在临床上推广应用.

目的 比较光学相干层析成像(optical coherence tomography,OCT)和血管内超声(intravascular ultrasound,IVUS)指导下计划性旋磨处理严重冠状动脉钙化病变的安全性、有效性.方法 回顾性分析2016-03/2017-03月作者医院行计划性旋磨治疗的冠状动脉严重钙化病变122例,根据术中使用OCT或IVUS指导,分为OCT指导组57例,IVUS指导组65例,比较两组术中即刻和住院期间并发症、术后6个月主要不良心脑血管事件(major adverse cardiac and cerebrovascular events,MACCE)的发生率.结果 两组患者在临床一般资料、冠状动脉病变及钙化特征上差异均无统计学意义(P＞0.05);术中OCT指导组发生冠状动脉痉挛、发现支架贴壁不良及使用后扩发生率高于IVUS指导组,组间比较差异具有统计学意义(P＜0.05);随访6个月后,组间MACCE的发生率比较差异均无统计学意义(P＞0.05).结论 OCT和IVUS均可用于指导冠状动脉严重钙化病变的计划性旋磨治疗,与IVUS相比,OCT可发现更多支架贴壁不良、增加后扩次数.

冠状动脉旁路移植术(coronary artery bypass grafting,CABG)是20世纪人类医学史上的重大应用之一[1-2].目前严重冠状动脉粥样硬化病变行CABG取得了良好的疗效,但是对搭桥手术后桥血管再狭窄及闭塞病变再处理提出了更高要求[3].CABG术后10％～20％患者因心绞痛复发而复查冠状动脉造影[4].继续外科搭桥手术对钙化病变冠脉难以实行,本文探索CABG术后桥血管闭塞重新对病变冠脉行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的疗效以及安全性,现报告如下.

Objective To investigate the correlation between serum C reactive protein(CRP),ESR,interleukin-17(IL-17),IL-23,IL-25 levels and Crohn disease.Methods 41 patients with Crohn disease receiving diagnosis and treatment in our department from July 2006 to July 2011 were selected(CD group).At the same time,43 healthy subjects receiving the healthy examination were selected as the control group.Samples of their ulnar vein blood were collected at early morning and were placed into EDTA tubes.The samples were immediately centrifuged and the supernatant solution was obtained.Enzyme-linked immunosorbent assay(ELISA)was used to detect the serum IL-17,IL-23,and IL-25 levels of both groups.Immune turbidimetry was used to detect the serum CRP concentrations,and the level of serum ESR was detected by tube Winchester.Results The levels of CRP,ESR,IL-17,and IL-23 in the CD group significantly increased compared with those in the control group,and the differences between the two groups were significant(P<0.01).In the CD group,the levels of CRP,ESR,IL-17,and IL-23 became higher along with the increase of severity of CD(P<0.01),while the level of IL-25 decreased along with the increase of the severity of CD(P<0.01).Conclusion There is a close correlation between levels of CRP,ESR,IL-17,IL-23,and IL-25 and CD.IL-17 and IL-23 have obvious promotion effect on inflammation,which leads to the deterioration.But IL-25 has the effect of inhibiting inflammation.The defect of IL-25 expression will lead to the deterioration.

Objective To investigate the effects and safety of nitroprusside sodium combined with dopamine in the treatment of congestive heart failure complicated by hypotension.Methods 112 patients with congestive heart failure complicated by hypotension were randomly divided into control group and research group with 56 ones in each group.The control group received the oxygen inhalation and the conventional treatment with diuretic and aminophylline.The research group received the treatment with nitroprusside sodium and dopamine based on the treatment received by the control group.Two weeks after the treatment,comparison and analysis were made in the clinical curative effects and safety between the two groups.Results After the treatment,LVEF in the research group significantly increased and the NT-proBNP significantly decreased compared with those in the control group(P<0.05).The total effective rate in the research group(82.14%)significantly was higher than that in the control group(62.50%)(P<0.05).No obvious side effect was observed in the two groups.Conclusion Nitroprusside sodium combined with dopamine have good clinical curative effects and safety in treatment of congestive heart failure complicated by hypotension.