Autophagy is a conserved cellular process crucial for recycling cytoplasmic components and maintaining cellular homeostasis in eukaryotes. During autophagy, the formation of a protein complex involving AUTOPHAGY-RELATED PROTEIN 6 (ATG6) and phosphatidylinositol 3-kinase is pivotal for recruiting proteins involved in phagophore expansion. However, the intricate molecular mechanism regulating this protein complex in plants remains elusive. Here, we aimed to unravel the molecular regulation of autophagy dynamics in Arabidopsis thaliana by investigating the involvement of the scaffold proteins 14-3-3λ and 14-3-3κ in regulating the proteolysis of ATG6. Phenotypic analyses revealed that 14-3-3λ and 14-3-3κ overexpression lines exhibited increased sensitivity to nutrient starvation, premature leaf senescence, and a decrease in starvation-induced autophagic vesicles, resembling the phenotypes of autophagy-defective mutants, suggesting the potential roles of 14-3-3 proteins in regulating autophagy in plants. Furthermore, our investigation unveiled the involvement of 14-3-3λ and 14-3-3κ in the RING finger E3 ligase SINAT1-mediated ubiquitination and destabilization of ATG6 in vivo. We also observed repressed turnover of ATG6 and translocation of GFP-ATG6 to mCherry-ATG8a-labelled punctate structures in the autophagy-defective mutant, which suggesting that ATG6 is probably a target of autophagy. Additionally, 14-3-3λ and 14-3-3κ interacted with Tumor necrosis factor Receptor Associated Factor 1a (TRAF1a) to promote the stability of TRAF1a in vivo under nutrient-rich conditions, suggesting a feedback regulation of autophagy. These findings demonstrate that 14-3-3λ and 14-3-3κ serve as scaffold proteins to regulate autophagy by facilitating the SINAT1-mediated proteolysis of ATG6, involving both direct and indirect mechanisms, in plants. 14-3-3 proteins regulate autophagy by directly or indirectly binding to ATG6 and SINAT1 to promote ubiquitination and degradation of ATG6. 14-3-3 proteins are involved in modulating autophagy dynamics by facilitating SINAT1-mediated ubiquitination and degradation of ATG6.

Both hypertension and type 2 diabetes are attributable to premature death, cardiovascular and kidney diseases with largely overlapping population. Followed the GRADE approach, this expert consensus aimed to reduce the cardiovascular and kidney death and disability due to hypertension and minimize the treatment burden in adults with type 2 diabetes. Through online survey and discussion, a multidisciplinary team comprehensively prioritized seven key guideline questions. Informed by the evidence synthesis and online discussion, the team developed 12 recommendations under the GRADE Evidence-to-decision (EtD) framework. The recommendations covered the screening of hypertension in adults diagnosed with type 2 diabetes but not hypertension and the monitoring, lifestyle interventions, and medications in those diagnosed with type 2 diabetes and hypertension.

Preamble Hypertension is one of the most common chronic dis-eases and the primary risk factor for stroke,myocardial infarction and even cardiovascular death.More than half of the elderly population has high blood pressure.El-derly people are a unique group,and strategies for the prevention,diagnosis,evaluation,and treatment of hy-pertension in elderly individuals differ significantly from those in the general population.

BACKGROUND Prealbumin is considered to be a useful indicator of nutritional status. Furthermore, it has been found to be associated with severities and prognosis of a range of diseases. However, limited data on the association of baseline prealbumin level with outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI) are available. METHODS We analyzed 2313 patients admitted for acute STEMI between October 2013 and December 2020. In-hospital outcomes and mortality during the 49 months (interquartile range: 26–73 months) follow-up period were compared between patients with the low prealbumin level (< 170 mg/L) and those with the high prealbumin level (≥ 170 mg/L). RESULTS A total of 114 patients (4.9%) died during hospitalization. After propensity score matching, patients with the low prealbumin level than those with the high prealbumin level experienced higher incidences of heart failure with Killip class III (9.9% vs. 4.4%, P = 0.034), cardiovascular death (8.4% vs. 3.4%, P = 0.035) and the composite of major adverse cardiovascular events (19.2% vs. 10.3%, P = 0.012). Multivariate logistic regression analysis identified that the low prealbumin level (< 170 mg/L) was an independent predictor of in-hospital major adverse cardiovascular events (odds ratio = 1.918, 95% CI: 1.250–2.942, P = 0.003). The cut-off value of prealbumin level for predicting in-hospital death was 170 mg/L (area under the curve = 0.703, 95% CI: 0.651–0.754, P < 0.001; sensitivity = 0.544, specificity = 0.794). However, after multivariate adjustment of possible confounders, baseline prealbumin level (170 mg/L) was no longer independently associated with 49-month cardiovascular death. After propensity score matching, Kaplan-Meier survival curves revealed consistent results. CONCLUSIONS Decreased prealbumin level closely related to unfavorable short-term outcomes. However, after multivariate adjustment and controlling for baseline differences, baseline prealbumin level was not independently associated with an increased risk of long-term cardiovascular mortality in STEMI patients.

Object detection has been widely used with in-depth study and research. However, there are discrepancies and conflicts between multiple models in object detection. This paper mainly studies dynamic image segmentation methods based on detection federated learning algorithms according to the above background. The proposed method uses a WordTree structure to combine labels from different datasets and uses conditional probabilities for hierarchical classification. At the same time, this paper applies the weighted box fusion (WBF) method to replace the traditional non-maximum suppression (NMS) method to improve the accuracy and recall ratio of object detection and image segmentation. The comparison and analysis of this paper with other model integration methods show that the proposed method is very effective and has important research importance in object detection and image segmentation.

BACKGROUND:Acute kidney injury (AKI) after coronary angiography (CAG) and primary percutaneous coronary intervention (PPCI) is frequently observed, and often interpreted as contrast induced-AKI. This study aimed to investigate the incidence, predictors and outcomes of AKI in acute ST-segment elevation myocardial infarction (STEMI) patients undergoing emergent CAG/PPCI using the control group of STEMI patients who were not exposed to contrast agents within the first 72 h.METHODS:We performed a retrospective analysis of 1670 STEMI patients. Of them, 673 patients underwent emergent CAG/PPCI, and 997 patients treated with thrombolysis or no reperfusion therapy who were not exposed to contrast material during the first 72 h. AKI was defined as an increase of serum creatinine ≥ 44.2 mmol/L or ≥ 25% from baseline within 72 h. Patents were then followed up for the occurrence of all-cause mortality for 40 months (interquartile range: 24-55 months).RESULTS:After propensity score matching, 505 pairs of patients were matched. Overall, the incidence of AKI was 27.4%, and AKI rates were not significantly different in patients with and without emergent CAG/PPCI procedure (27.5% vs. 27.3%, P = 0.944). Multivariate logistic regression analysis identified that the independent predictors of AKI were female, elevated interleukin-6 level, decreased lymphocyte count, left ventricular ejection fraction < 50% and use of diuretics in patients with emergent CAG/PPCI. Patients with AKI than those without AKI experienced higher incidence of acute heart failure with Killip class III (9.4% vs. 3.3%, P = 0.005; 15.2% vs. 6.8%, P = 0.003, respectively) and mortality (5.8% vs. 1.4%, P = 0.014; 12.3% vs. 4.6%, P = 0.002, respectively) in patients with and without emergent CAG/PPCI. Multivariate Cox regression analysis confirmed that AKI was independently associated with long-term mortality rate at 40 months follow-up in patients with and without emergent CAG/PPCI (HR = 1.867, 95% CI: 1.086-3.210, P = 0.024; HR = 1.700, 95% CI: 1.219-2.370, P = 0.002, respectively).CONCLUSIONS:Approximately 27.0% of STEMI patients experience AKI, which is strongly associated with an increased short- and long-term mortality regardless of emergent CAG/PPCI procedure. The development of AKI is mainly related to female gender, inflammation reaction, heart failure and use of diuretics in STEMI patients undergoing emergent CAG/PPCI.

目的 探讨心肌挽救指数(MSI)与老年女性ST段抬高型心肌梗死(STEMI)患者心功能的关系.方法 选取2016年9月～2019年12月首都医科大学宣武医院心内科行急诊PCI的老年STEMI患者163例,按性别分为男性组105例和女性组58例,比较2组术后24 h及1年LVEF、术后5～7 d MSI及术后1年主要不良心血管事件(MACE)发生率,比较MSI和LVEF对发生心力衰竭的预测价值.结果 与男性组比较,女性组年龄、高血压、糖尿病、3支血管病变、体质量指数、LDL-C、MACE及HF发生率明显升高,吸烟、可挽救心肌体积、MSI及术后24 h、1年LVEF明显降低,差异有统计学意义(P<0.05,P<0.01).年龄>70岁、急诊PCI术后24 h LVEF<40％及MSI<0.5是老年女性急诊PCI术后发生心力衰竭的独立危险因素(P<0.05).MSI预测老年女性发生心力衰竭的临界值为0.39,敏感性为84.4％,特异性为92.3％,曲线下面积(AUC)为0.911(95％CI:0.838～0.984,P<0.01),优于急诊PCI术后24 h LVEF,其AUC为0.728(95％CI:0.547～0.909,P<0.05).结论 老年女性STEMI患者急诊PCI术后更易发生心力衰竭,MSI对心力衰竭的预测价值优于急诊PCI术后24 h LVEF.

ATG1/ATG13, a core kinase complex regulator in the macroautophagy/autophagy machinery during autophagosome formation, is modulated in a sophisticated manner by posttranslational ubiquitination to determine proper autophagy levels in eukaryotic cells. However, the mechanisms that regulate the stability and activity of this complex remain elusive. We recently identified two negative regulators of autophagy, 14-3-3λ and 14-3-3k, that help redundantly regulate autophagy by directly associating with SINAT and ATG13s. The specific interaction between the molecular adaptors 14-3-3λ and 14-3-3κ and phosphorylated ATG13a is crucial for SINAT-mediated ubiquitination and degradation of ATG13a, and for maintenance of the ATG1-ATG13 complex. Consistent with the function of 14-3-3s in autophagy, the 14-3-3λ 14-3-3κ double mutant exhibits enhanced tolerance to nutrient deprivation with constitutive induction of autophagy. These findings demonstrate that 14-3-3λ and 14-3-3k coordinate with SINATs to regulate both the homeostasis of ATG13 phosphorylation and the induction of autophagy in plants.

Background Although the relationship of either hemoglobin or red blood cell distribution width (RDW) with contrast-induced nephropathy (CIN) has been reported individually. To date, no studies have evaluated the predictive value of hemoglobin-to-red blood cell distribution width ratio (HRR) for CIN. Methods A total of 1658 elderly patients with ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI) were retrospectively screened. Preoperative complete blood count was collected and the HRR was calculated as the ratio of hemoglobin to RDW. CIN was defined as an absolute ≥0.5 mg/dL (44.2 μmol/L) or a relative ≥25% increase in creatinine level at 72 h after contrast administration. Univariate and multivariate regression analysis were conducted to determine the effective predictors for CIN. The ROC curve analysis was plotted to determine the optimal cutoff value for HRR in predicting CIN. Results The overall incidence of CIN was 8.38%. The HRR was significantly lower in the CIN group compared with the non-CIN group (0.87 ± 0.15 vs 1.24 ± 0.23, p < 0.001). After multivariate regression analysis was performed, HRR was noted to be an effective predictor for the development of CIN (OR 1.617, 95% CI 1.439–2.706, p = 0.014), along with age, creatinine, eGFR, hs-CRP and contrast volume. An optimal cutoff value of 0.94 or lower for HRR was identified with 82.4% sensitivity and 63.5% specificity to predict CIN. Conclusion Lower HRR on admission was an effective predictor for CIN in elderly patients with STEMI undergoing emergency PCI. HRR may be a convenient, economical and reliable biomarker for risk stratification.

BACKGROUND:Hypertension is one of the most challenging public health problems worldwide. Previous studies suggested that the Songling Xuemaikang capsule (SXC)-a Chinese herbal formula-was effective for essential hypertension. However, the efficacy of SXC monotherapy for hypertension remains unclear. We aimed to compare the blood pressure (BP)-lowering efficacy and safety of SXC versus losartan in patients with essential hypertension. METHODS:In this multicenter, randomized, double-blind, noninferiority trial in China, patients 18 to 65 years of age with mild essential hypertension were randomly allocated to receive either SXC or losartan for 8 weeks. The primary outcome was the change in sitting diastolic BP from baseline to 8 weeks, with a predefined noninferiority margin of -2.5 mm Hg. RESULTS:Of the 755 patients who entered a 2-week run-in period, 628 patients (327 women and 301 men; mean [SD] age, 52.6 [9.2] years) were randomly assigned to the SXC (n=314) or losartan (n=314) group. The primary analysis based on the intention-to-treat principle showed that the change in diastolic BP from baseline to 8 weeks was similar between the SXC and losartan groups (-7.9 [8.0] versus -8.1 [7.9]). The lower boundary of 95% CI (mean difference, -0.24 [95% CI, -1.51 to 1.03]) was above the margin of -2.5 mm Hg, showing noninferiority. Results were consistent with per-protocol analysis. SXC produced greater improvements in total hypertension symptom score (-5.7 [4.2] versus -5.0 [4.0]; P=0.020) and total cholesterol (-0.1 [1.0] versus 0.1 [1.2]; P=0.025). There were no differences between groups in the other BP and patient-reported outcomes. Incidence and severity of adverse events were similar between groups. CONCLUSIONS:SXC was well tolerated and demonstrated noninferior to losartan in BP lowering in patients with mild hypertension. SXC might be an alternative for mild hypertension, particularly for patients with a preference for natural medicine. REGISTRATION:URL: www.chictr.org.cn; Unique identifier: ChiCTR-IPR-16008108.

目的 探究PBL联合CBL教学法在高血压教学中的应用效果,为提高现代医学教育质量提供参考依据.方法 选择2021年3月20日-2021年5月31日在某院实习的64名临床医学系学生为研究对象,采用随机数字法将其分为实验组和对照组,实验组采用PBL联合CBL教学法,对照组采用传统教学模式;通过比较2组学生实习结束后的临床考核成绩和调查问卷评价2种教学方法的应用效果.结果 实验组总成绩(84.25±5.62 vs 75.58±6.05)分、理论知识成绩(45.19±6.42 vs 39.53±5.84)及病例分析成绩(39.72±4.28 vs 35.96±6.27)分均高于对照组,差异有统计学意义(P＜0.05).与对照组比较,实验组更容易激发学生学习兴趣(96.9％vs 78.1％)、增强自主学习意识(90.6％vs 68.8％)、提高医患沟通能力(93.8％vs 75.0％)和培养临床思维(87.5％vs 62.5％),教学满意度高于对照组(96.9％vs 81.3％),差异有统计学意义(P＜0.05).结论 在高血压教学中,采用PBL联合CBL教学法能够显著提高实习学生的临床考核成绩和教学满意度,有助于改善教学质量.

目的 探讨乌拉地尔注射液对合并有高血压的老年女性急性射血分数保留性心力衰竭(HFpEF)的疗效.方法 选取合并高血压的老年女性急性HFpEF患者68例,随机分为硝酸甘油注射液组34例和乌拉地尔注射液组34例,进行血液及超声心动图检查.分析乌拉地尔注射液对合并高血压的老年女性急性HFpEF的疗效.结果 乌拉地尔注射液组收缩压在治疗72 h和7 d后下降较硝酸甘油注射液组明显(P<0.05).2组舒张压和心率在各个时间点差异无统计学意义(P>0.05).乌拉地尔注射液组中的NT-proBNP较硝酸甘油注射液组在72 h时有所降低,但差异无统计学意义(P>0.05),在治疗7 d时乌拉地尔注射液组的NT-proBNP较硝酸甘油注射液组的NT-proBNP下降更明显(P<0.05).LVEF在2组中都随时间略有上升,但2组患者各时间点差异无统计学意义(P>0.05).结论 乌拉地尔注射液能在很好地控制血压同时不会引起反射性心率变化,说明乌拉地尔可以改善合并有高血压的老年女性急性HFpEF患者心脏功能.

目的 探究急性心肌梗死患者住院期间合并急性脑梗死的发生率及其危险因素.方法 选择2014年1月 ～12月首都医科大学宣武医院收治的306例急性心肌梗死(AMI)患者,回顾性分析其住院期间合并急性脑梗死(ACI)发生情况,收集患者的一般临床资料和相关实验室指标,采用logistic多因素回归分析相关危险因素.结果 48例AMI患者住院期间发生ACI,AMI+ACI组患者的年龄、吸烟史、高血压、糖尿病、外周血管病史,以及肌酸激酶同工酶水平均高于AMI组,差异具有统计学意义(P<0.05).Logistic多因素回归分析显示,年龄、吸烟、高血压、糖尿病均为AMI患者住院期间合并ACI的危险因素.结论 在AMI治疗过程中,应密切关注高龄、长期吸烟、高血压和糖尿病患者的病情变化,尽可能降低AMI患者住院期间发生ACI的风险.

Background Although the relationship of either hemoglobin or red blood cell distribution width (RDW) with contrast-induced nephropathy (CIN) has been reported individually. To date, no studies have evaluated the predictive value of hemoglobin-to-red blood cell distribution width ratio (HRR) for CIN. Methods A total of 1658 elderly patients with ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI) were retrospectively screened. Preoperative complete blood count was collected and the HRR was calculated as the ratio of hemoglobin to RDW. CIN was defined as an absolute ≥0.5 mg/dL (44.2 μmol/L) or a relative ≥25% increase in creatinine level at 72 h after contrast administration. Univariate and multivariate regression analysis were conducted to determine the effective predictors for CIN. The ROC curve analysis was plotted to determine the optimal cutoff value for HRR in predicting CIN. Results The overall incidence of CIN was 8.38%. The HRR was significantly lower in the CIN group compared with the non-CIN group (0.87 ± 0.15 vs 1.24 ± 0.23, p < 0.001). After multivariate regression analysis was performed, HRR was noted to be an effective predictor for the development of CIN (OR 1.617, 95% CI 1.439–2.706, p = 0.014), along with age, creatinine, eGFR, hs-CRP and contrast volume. An optimal cutoff value of 0.94 or lower for HRR was identified with 82.4% sensitivity and 63.5% specificity to predict CIN. Conclusion Lower HRR on admission was an effective predictor for CIN in elderly patients with STEMI undergoing emergency PCI. HRR may be a convenient, economical and reliable biomarker for risk stratification.

目的 探索中性粒细胞/高密度脂蛋白胆固醇比值(NHR)对老年高血压合并急性左心力衰竭(心衰)患者30 d主要不良心血管事件(MACE)的预测价值.方法 选择首都医科大学宣武医院急诊科收治的老年高血压合并急性左心衰患者162例,根据血清NHR三分位水平分为低水平组(NHR＜3.73),中水平组(3.73≤NHR＜5.86)和高水平组(NHR≥5.86),每组54例,30 d随访时,记录MACE,用Kaplan-Meier生存曲线分析,用多因素Cox回归分析,ROC曲线分析.结果 30 d随访时,低水平组MACE发生率低于中水平组和高水平组(7.41％vs 12.96％和27.78％,P=0.012);Kaplan-Meier生存曲线示,高水平组MACE发生时间早,发生率最高(Plog rank=0.013).多因素Cox回归分析示,NHR是患者30 d发生MACE的独立预测因素(OR=1.185,95％CI:1.044～1.344,P=0.008).ROC曲线分析示,NHR有预测24、48和72 h心衰好转及30 d发生MACE的价值(P＜0.05,P＜0.01).结论 NHR对老年高血压合并急性左心衰患者病情转归及30 d发生MACE有一定的预测价值.

BackgroundThe effect of a single transradial guiding catheter (STGC) for culprit vessel percutaneous coronary intervention (PCI) first on door-to-balloon (D2B) time remains unclear. Materials and methodsBetween February 2017 and July 2019, 560 patients with ST-elevation myocardial infarction (STEMI) were randomized into either the STGC group (n = 280) or the control group (n = 280) according to direct culprit vessel PCI with a STGC. In the STGC group, a dedicated transraidal guiding catheter (6F either MAC3.5 or JL3.5) was used for the treatment of electrocardiogram (ECG)-guided culprit vessel first and later contralateral angiography. In the control group, a universal diagnostic catheter (5F Tiger II) was used for complete coronary angiography, followed by guiding catheter selection for culprit vessel PCI. The primary endpoint was D2B time, and the secondary endpoint included catheterization laboratory door-to-balloon (C2B), procedural, fluoroscopy times, and major adverse cardiac events (MACE) at 30 days. ResultsThe median D2B time was significantly shorter in the STGC group compared to the control group (53.9 vs. 58.4 min; p = 0.003). The C2B, procedural, and fluoroscopy times were also shorter in the STGC group (C2B: 17.3 vs. 24.5 min, p < 0.001; procedural: 45.2 vs. 49.0 min, p = 0.012; and fluoroscopy: 9.7 vs. 11.3 min, p = 0.025). More patients achieved the goal of D2B time within 90 min (93.9% vs. 87.1%, p = 0.006) and 60 min (61.4% vs. 51.1%, p = 0.013) in the STGC group. Radial artery perforation (RAP) was significantly reduced in the STGC group compared with the control group (0.7% vs. 3.2%, P = 0.033). MACE at 30 days was similar (2.5% vs. 4.6%, P = 0.172) between the two groups. ConclusionECG-guided immediate intervention on culprit vessel with a STGC can reduce D2B, C2B, procedural, and fluoroscopy times (ECG-guided Immediate Primary PCI for Culprit Vessel to Reduce Door to Device Time; NCT03272451).

Ethnopharmacological relevance: Danhong injection (DHI),which is extracted from Salviae miltiorrhizae and Flos carthami,has been widely prescribed to patients with unstable angina pectoris (UAP) in China. However, a high quality clinical trial is needed. Aim of the study: To determine whether DHI can relieve symptoms of transient myocardial ischemia in patients with unstable angina pectoris. Materials and methods: A double-blind, placebo-controlled, randomized clinical trial was conducted in nine hospitals in China. Inpatients with UAP with blood stasis syndrome (BSS) were randomized 1:1 to receive DHI or placebo. The primary outcome was improvement rate in the quantification score of angina pectoris. Secondary outcomes included blood stasis syndrome scale, nitrates use, electrocardiogram recordings, PCI procedures, Seattle Angina Questionnaire (SAQ) and biochemical indexes. Results: 160 participants were enrolled and 159 were analyzed. There was no significant difference in primary outcome as compared with control group at the end of 7-day treatment, but significant difference at 28-day follow up (70.53% [95% CI, 59.97-81.09%] and 54.34% [95% CI, 42.68-65.99%]; P = 0.0423). The BSS score was significantly lower in the DHI group than that in the control group at day 28 (6.49 [6.96] vs 10.53 [9.07], P = 0.0034). In addition, DHI was significantly superior to placebo in the angina stability score of SAQ (91.10 [17.37] versus 78.21 [22.08], P < 0.001). There were no significant differences in other secondary outcome measures. Conclusions: A small decrease in the total effective rate and an increase in the angina stability score were observed 28 days after implementation of DHI in UAP with a total blood stasis syndrome score decrease, but the efficacy was not observed at day 7. The findings support that DHI may potentially relieve clinical symptoms and can benefit angina stability. Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02007187.

目的 应用光学相干断层成像(OCT)观察经皮桡动脉冠状动脉介入术后老年急性冠状动脉综合征(ACS)患者桡动脉粥样硬化(RAA)斑块特点,探讨RAA斑块形成的危险因素.方法 回顾性分析2019年3月～2020年3月首都医科大学附属北京潞河医院心内科经桡动脉路径行OCT指导下冠状动脉造影和(或)介入治疗且术毕即刻完成桡动脉OCT的ACS患者124例,根据年龄分为老年组53例(≥60岁)和中青年组71例(＜60岁).经皮桡动脉冠状动脉介入术将鞘管回撤至距穿刺点2 cm处,并对桡动脉近段、中段和远段行OCT检查,比较2组RAA斑块检出率、分布和斑块特征,采用多因素logistic回归分析RAA斑块的危险因素.结果 124例患者中,检出RAA斑块46例(37.1％).老年组RAA斑块检出率明显高于中青年组(56.6％vs22.5％,P＜0.01),近段(34.0％vs 14.1％,P＜0.01)和远段(43.4％vs9.9％,P＜0.01)受累比例较中青年组更高.老年组纤维、脂质及钙化斑块检出率明显高于中青年组(P＜0.05,P＜0.01).多因素logistic回归分析显示,年龄≥60岁(OR=4.275,95％CI:1.929～9.474,P＜0.01)和糖尿病(OR=2.726,95％CI:1.148～6.475,P＜0.05)为 RAA 斑块形成的独立危险因素.结论 桡动脉OCT发现老年ACS患者容易发生RAA斑块,增龄和糖尿病是RAA斑块形成的危险因素.

目 的 探讨1997～2006年和2009～2018年老年急性ST段抬高型心肌梗死(STEMI)患者临床特征、治疗及院内结局的变化趋势.方法 选取1997～2006年和2009～2018年首都医科大学宣武医院心脏内科收治的老年STEMI患者1808例,其中1997～2006年老年STEMI患者636例(病例1组),2009～2018年老年STEMI患者1172例(病例2组).专业培训人员采用标准化表格提取患者基本临床特征、住院期间的治疗、并发症及预后.结果 与病例1组比较,病例2组年龄、≥75岁、高血压、糖尿病、心肌梗死、血运重建、目前吸烟比例明显升高,入院心率、舒张压水平明显降低,差异有统计学意义(P＜0.05,P＜0.01).与病例1组比较,病例2组冠状动脉造影、PCI、服用阿司匹林、P2Y12受体抑制剂、他汀类和β1受体阻滞剂比例明显升高,静脉溶栓比例明显降低,差异有统计学意义(P＜0.01).与病例1组比较,病例2组住院期间心源性休克、心脏破裂或猝死及全因病死率明显降低(4.0％vs 7.4％,2.0％vs 6.3％,9.0％vs 13.1％,P＜0.01).结论 20年来老年 STEMI 患者合并心血管疾病危险因素比例增加,PCI及指南推荐药物应用比例增加,住院期间不良心脏事件发生率及病死率明显降低.