[Objective] To investigate the effects of Xuefu Zhuyu Capsule on blood glucose,blood pressure and carotid intima-media thickness（CIMT） in patients with coronary heart disease and angina pectoris,and the relationship between blood pressure and CIMT.[Methods] The 474 patients with coronary heart disease and angina pectoris were selected and divided into treatment group and control group according to whether they took Xuefu Zhuyu Capsule. The difference of baseline data was adjusted through propensity score matching to study the difference of blood glucose,blood lipid,blood pressure and CIMT between the two groups. The association between blood pressure and CIMT was analyzed,and multiple linear regression analysis was performed with CIMT as the dependent variable,blood pressure classification as the independent variable,and sex,age,smoking,alcohol consumption,triglycerides（TG）,total cholesterol（TC）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C）,glycated hemoglobin（HbA1c）,fasting plasma glucose（FPG） as covariates. [Results] There were significant differences in TG,TC,LDL-C,HbA1c,FPG,blood pressure and CIMT between the treatment group and control group（P＜0.05）. Compared with patients with normal blood pressure,hypertension was positively associated with CIMT（P＜0.05）. At the same time,there was a significant difference between hypertension grade 2 and CIMT（P＜0.05）. [Conclusion] Xuefu Zhuyu Capsule combined with conventional treatment of Western medicine can effectively reduce TG,TC,LDL-C,HbA1c,FPG,blood pressure and reduce CIMT in patients with angina pectoris of coronary heart disease,and hypertension is significantly associated with CIMT.

胸痛救治单元是一个紧跟新时代发展特点、面向基层、改善民生的全新概念.建设胸痛救治单元的主要动因在于基层医疗机构诊疗水平不高、医疗资源匮乏;诊疗流程烦琐重叠、救治缺乏有效对接;公众防治意识不强、胸痛急救教育弱化等现实不足.笔者认为,胸痛救治单元高质量发展需要优化胸痛诊疗流程,实现救治标准统一;建立快速联动机制,增强救治整体效能;统筹配置医疗资源,助推分级诊疗落地;规划引领全民健康,提升自救防控能力.

[目的]通过网络药理学和分子对接方法分析芪参益气滴丸(QSYQ)治疗急性冠脉综合征(ACS)的有效成分、作用靶点和通路,探讨其作用机制.[方法]利用TCMSP、Batman平台,检索QSYQ有效成分及相应作用靶点,通过GeneCards、OMIM、TTD平台筛选疾病相关靶点,并获得QSYQ和急性心肌梗死、不稳定型心绞痛共同靶点,利用STRING平台构建靶点网络图、PPI网络图,利用DAVID平台进行GO功能和KEGG通路富集分析,再根据AutodockTools1.5.6软件进行分子对接.[结果]共筛选出QSYQ治疗急性心肌梗死、不稳定型心绞痛有效成分130个,潜在作用靶点36个,关键靶点7个,发现一氧化氮生物合成过程的正调控、对缺氧的反应、细胞对脂多糖的反应等生物学功能及肿瘤坏死因子(TNF)信号通路、核因子-κB(NF-κB)信号通路、NOD样受体信号通路、缺氧诱导因子1(HIF-1)信号通路等在QSYQ治疗ACS起到较为关键的作用.[结论]QSYQ主要活性成分有木犀草素、槲皮素、人参皂苷rh2、丹参酮ⅡA,通过多靶点多通路发挥治疗ACS的作用.

目的:探讨在他汀类药物应用基础上短期内使用依洛尤单抗能否降低急性冠状动脉综合征(ACS)患者经皮冠状动脉介入术(PCI)术后主不良心血管事件(MACEs)的发生风险.方法:回顾性分析2019年1月—2019年10月于同济大学附属第十人民医院CCU收治的128例ACS患者为研究对象,根据是否使用依洛尤单抗分为试验组(41例)和对照组(87例),收集并比较两组患者人口统计学信息、实验室检查、基本临床信息、超声心动图结果、冠状动脉造影结果、基线血脂水平和PCI术后1个月血脂水平.对所有患者进行6个月随访,比较两组患者6个月MACEs发生情况,采用Kaplan-Meier生存分析法比较两组患者6个月随访期间MACEs和再发心肌梗死累积发生率.结果:试验组患者PCI术后1个月低密度脂蛋白胆固醇(LDL-C)水平显著低于对照组0.83(0.54,1.54)mmol/L∶ 1.71(0.98,2.30)mmol/L,P=0.004].经过6个月随访,试验组5例(12.2％)发生MACEs,对照组13例(14.9％)发生MACEs.两组患者在MACEs、死亡、卒中、靶血管再灌注等方面差异无统计学意义(P＞0.05);其中试验组再发心肌梗死0例.对照组再发心肌梗死9例(10.3％),差异有统计学意义(P = 0.027).Kaplan-Meier生存分析显示两组患者累积再发心肌梗死发生率差异有统计学意义(Log-Rank检验P = 0.039).结论:ACS患者在他汀类药物应用基础上短期内使用依洛尤单抗能有效地降低LDL-C水平,同时能降低ACS患者PCI术后6个月再发心肌梗死风险.

[目的]观察芪参益气滴丸对冠心病经皮冠状动脉介入治疗(PCI)术后气虚血瘀证患者中医症状积分、西雅图心绞痛量表的变化.[方法]纳入2019年3月—2019年10月在天津市胸科医院心内科确诊为冠心病PCI术后气虚血瘀证的患者164例,分为对照组、试验组,每组各82例.对照组给予标准的冠心病二级预防方案进行治疗,试验组在对照组治疗方案的基础上,加用芪参益气滴丸,观察疗程均为1个月.观察指标包括患者的基线资料、中医症状积分、西雅图心绞痛评价量表.[结果]中医症状积分方面,经治疗后,试验组患者在胸痛、胸闷、心悸、气短、唇舌紫暗的评分及总分均明显低于对照组(P<0.05或P<0.01).西雅图心绞痛量表方面,经治疗后,试验组患者在躯体受限程度、心绞痛稳定状况、心绞痛发作情况、治疗满意程度方面均明显低于对照组(P<0.01).聚类分析及Pearson相关分析显示,躯体受限程度与主证气短、神疲乏力呈较明显的正相关,治疗满意程度、疾病认知程度与次证口唇紫暗呈较明显的正相关(P<0.05或P<0.01).[结论]芪参益气滴丸可明显提高PCI术后患者临床疗效,对气虚血瘀证患者的中医症状、生活质量有明显改善,结合中医症状积分及西雅图心绞痛量表分析,可为临床辨证及使用芪参益气滴丸治疗气虚血瘀证冠心病提供参考.

[目的]探索冠心病稳定型心绞痛痰瘀互结证患者、气阴两虚证患者与健康人中医证候评价量表异同.[方法]通过多中心、小样本、精细化临床研究,纳入7家临床单位124例受试者,因未完成访视脱失7例,最终纳入受试者117例,其中冠心病痰瘀互结证患者38例,在西医常规治疗的基础上加服丹蒌片治疗,气阴两虚证患者39例,在西医常规治疗的基础上加服通脉养心丸治疗,健康人40例不予干预.比较冠心病患者0、4、8、12周、健康人第0周《冠心病痰瘀互结证中医证候评价量表》评分情况.[结果]1)冠心病痰瘀互结证患者第4、8、12周时,各症状评分及舌下脉络青紫情况较0周不同程度降低(P<0.05或P<0.01).2)冠心病气阴两虚证患者第4、8、12周时,各症状评分较0周有所下降(P<0.05或P<0.01).3)与健康人比较,冠心病痰瘀互结证患者各项评分具有统计学差异(P<0.01),冠心病气阴两虚证患者各症状评分及舌质紫暗、舌下脉络青紫、脉弦、脉涩情况具有统计学差异(P<0.05或P<0.01),冠心病两组患者各时点比较,部分指标及舌脉情况存在不同程度差异.4)冠心病痰瘀互结证患者0、8周时,身重、口黏腻、苔腻、脉滑、舌有瘀斑瘀点聚为一类,脉弦、舌质紫暗、舌下脉络青紫、脉涩、口唇青紫、面色晦暗聚为一类;冠心病气阴两虚证患者0、8周时,胸闷、胸痛、身重、口黏腻、口唇青紫、面色晦暗聚为一类,舌有瘀斑瘀点、舌质紫暗、脉涩聚为一类.[结论]冠心病稳定型心绞痛痰瘀互结证与气阴两虚证患者经治疗后,《冠心病痰瘀互结证中医证候评价量表》中相关症状表现均有所改善,且不同证型的表现不同.《冠心病痰瘀互结证中医证候评价量表》可以为进一步临床诊断冠心病稳定型心绞痛痰瘀互结证提供一定参考.

ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)是心血管疾病最为凶险的类型之一.《中国心血管病报告2018》概要指出,STEMI的发病率及死亡率逐年上升,并呈年轻化趋势[1].现阶段STEMI再灌注治疗主要有两种方法,分别是药物溶栓治疗和直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI).

目前天津市通过国家认证的胸痛中心已经达到27家,密度全国第一,市区平均5公里就可以找到一家通过国家认证的胸痛中心,远郊区县至少有一家国家级胸痛中心,形成了一个完善的胸痛救治网络体系.天津市胸科医院2014年10月成立、2015年1月正式通过国家第三批认证,是天津市首家胸痛中心,在多年的工作中积累了丰富的经验.今天我们就院内PCI绿色通道的建设和大家谈谈我们的经验.

胸痛中心是改善心血管疾病预后、降低死亡率的关键.当前胸痛中心建设已在全国广泛开展,但在基层尤其是县级医院进展缓慢,其原因在于基层医院医疗水平与设备相对落后.因此国家有关部门亟需采取有效措施,切实保障县级医院胸痛中心建设已成为当务之急.

心血管疾病有起病急、进展快、病死率高的特点,治疗效果具有明显的时间依赖性.胸痛中心的建立是为急性胸痛为主要临床表现的急危重症患者提供的快速诊疗通道和规范化流程.在当前优质医疗资源紧缺的状况下,利用新一代互联网技术,开展远程医疗,解决时间和空间的局限,促使三级医院与120急救中心、社区医生获得有效连通,使胸痛患者得到更及时、更高水平的专业救治,实现院前、院内、院后患者救治的互联互通、无缝对接,从而第一时间发现、第一时间干预,最大限度地减少胸痛患者的救治时间,提高救治率,降低死亡率,改善患者预后.

目的探讨男性患者危险因素与冠状动脉造影的关系。方法选择拟诊冠心病行冠状动脉造影术的患者12 294例,其中7 102例男性为A组,5192例女性为B组,应用冠状动脉造影观察冠状动脉病变特点。结果男性患者的阳性率高于女性,且病变较重。男性多具有吸烟习惯,女性多合并糖尿病和高脂血症。结论不同性别的患者冠状动脉病变特征和危险因素不同,男性更易发生心脏病。

Objective:To explore the relationship between aortic pulse pressure(PP)and creatinine clearance rate(Ccr) in patients with essential hypertension.Methods:Three hundred sixty-five patients with essential hypertension were enrolled and underwent coronary angiography.The aortic blood pressure was measured during angiography.Patients were divided into group A(PP≤60 mm Hg) and group B(PP 60 mm Hg).Indexes such as age,body weight,glucose,lipids,blood urea nitrogen,uric acid and creatinine were measured.The level of Ccr was calculated by Cockcroft-Gault equations,and the relationship was analyzed between PP and Ccr was analyzed by partial correlation analysis.Results:In group B the age(61.62±9.17) years old,systolic blood pressure(157.05±20.12) mm Hg,pulse pressure(47.17±10.75) mm Hg were significantly higher than those of group A.However,the level of Ccr was significantly lower in group B(81.34 ±30.33) mL/min than that of group A(98.38±30.82) mL/min(t = 2.199,P 0.01).The positive correlation was gained between age and aortic pulse pressure(r = 0.237,P 0.001).The negative correlation was proved between aortic pulse pressure and Ccr(r =-0.234,P 0.001).Aortic pulse pressure was lower and negatively correlated with Ccr after deducing influence of age factors(r =-0.104,P = 0.045).Conclusion:There was a limited value to determine the renal dysfunction by aortic blood pressure.

Objective To observe characteristics of coronary angiography in different age groups of patients and analyze the risk factors and the characteristics of lesions.Methods 12 294 patients with suspected coronary heart disease(CHD) and undergoing coronary angiography were enrolled. The patients were divided into group A(6 520 cases60 years old) and group B(5 774 ca ses≥60 years old).The clinical and angiography details were recorded and retrospectively analyzed. Results Males were more common in group A.Most patients in group A had smoking habit and family history of CHD,while most patients in group B had medical history of hypertension, diabetes and hyperlipidemia.Single vessel disease was more common in group A,compared with more multiple vessel disease in group B.Conclusion Different age groups of patients have different characteristics of lesions and risk factors,indicating that different emphases showld be put on prevention of CHD for patients of different ages.