目的 探讨静息心电图ST-T改变与急性左心衰短期、长期预后的相关性.方法 选择急性左心衰患者88例,所有患者均给予静息心电图检查,记录ST-T改变情况,随访患者的短期、长期预后并进行相关性分析.结果 在88例患者中,短期预后良好74例(84.1％);长期预后发生主要心血管不良事件11例(12.5％),其中心源性休克8例,心源性死亡3例.短期预后良好患者的静息心电图ST-T异常率明显低于短期预后不佳患者(P＜0.05);长期预后心血管不良事件患者的静息心电图ST-T异常率明显高于非心血管不良事件患者(P＜0.05).Speasman分析显示静息心电图ST-T异常率与短期预后、长期预后均存在相关性(P＜0.05).多因素Logistic回归分析显示静息心电图ST-T异常率为影响短期预后、长期预后的重要危险因素(P＜0.05).结论 急性左心衰多伴随有静息心电图ST-T异常,短期预后、长期预后均有待改善,静息心电图ST-T改变与急性左心衰短期、长期预后均存在相关性.

目的 探讨紫杉醇/比伐卢定复合物(络风宁0号)对体外培养的人冠状动脉平滑肌细胞(HCASMC)和人冠状动脉内皮细胞(HCAEC)增殖的影响,为新一代中药单体复合药物涂层球囊(DCB)的研发提供依据.方法 将HCASMC和HCAEC体外培养并传代至4～6代,根据药物干预分为紫杉醇(1 μmol/L)组和紫杉醇/比伐卢定(PB)组,其中PB组所采用为1 μmol/L紫杉醇配伍不同浓度比伐卢定(1/256、1/128、1/64、1/32、1/16、1/8、1/4、1/2和1 mg/ml),48 h后用MTT法检测各组HCASMC和HCAEC细胞的增殖活力,以筛选出紫杉醇与比伐卢定之间的最佳配比,抑制HCASMC增殖的同时不影响甚至促进HCAEC增殖,为内皮友好型中药单体复合DCB的研发提供实验数据支持.结果 同紫杉醇组相比,PB组中紫杉醇配伍低浓度比伐卢定(1/256 mg/ml)即可增强紫杉醇对HCASMC增殖的抑制作用,该作用随比伐卢定浓度增高而增强,呈浓度依赖关系,差异有统计学意义(P＜0.05);紫杉醇配伍低浓度比伐卢定(1/256和1/128 mg/ml)时对HCAEC增殖无影响(P＞0.05),但比伐卢定浓度＞1/128 mg/ml时对HCAEC的抑制作用较紫杉醇组增强,呈浓度依赖关系,差异有统计学意义(P＜0.05).结论 1 μmol/L紫杉醇配伍1/128 mg/ml比伐卢定相较于单纯应用紫杉醇,体外培养的HCASMC相对增殖活性进一步下降至75%左右,同时HCAEC增殖活性不受影响,二者合用体现了中药配伍增效减毒的作用,可为新型内皮友好型中药单体复合DCB的研发提供思路和依据.

目的 探讨风速对冠状动脉粥样硬化性心脏病(冠心病)心血管事件的影响.方法 收集铜川地区2017～2018年650例冠心病患者的临床资料和同期气象资料、环境污染资料,回顾性分析风速与心血管事件的相关性.结果 650例冠心病患者累计发生心血管事件754次,包括心源性死亡9例、非致命性心肌梗死59例、不稳定型心绞痛506例、急性心力衰竭50例、卒中85例.单因素分析显示,日均风速与心血管事件显著相关(OR=1.58,95％CI:1.02～2.45).多因素Logistic回归分析显示,相对于低风速(0.70～1.90 m/s),中等风速(2.00～2.60 m/s)发生心血管事件的风险显著增加(OR=3.29,95％CI:1.49～7.26).结论 一定范围的风速增高会增加冠心病患者心血管事件风险.

目的 分析血清脑源性神经营养因子(BDNF)和糖类蛋白125(CA125)水平对急性心肌梗死( AMI)患者病情及预后的评估价值.方法 选取2016年12月—2018年6月北京中医药大学孙思邈医院心血管内科收治的AMI患者136例作为研究组,选取同期门诊健康体检正常者50例作为健康对照组.采用酶联免疫吸附法检测血清BDNF水平,电化学发光免疫分析法检测CA125水平.随访1年记录不良心血管事件发生情况,比较不良心脏事件亚组和无不良心脏事件亚组患者血清BDNF和CA125水平.采用Logistic回归分析急性心肌梗死患者预后影响因素.结果 研究组心率及血清 BDNF、CA125、c-TnI、BNP 水平均高于健康对照组( t =10. 196、22. 142、12. 302、7. 301、49. 705,P均＜0. 001).随访1年发生心脏不良事件38例(27. 94% ),不良心脏事件亚组患者血清BDNF、CA125水平均高于无不良心脏事件亚组患者(t=3. 258、4. 496,P均＜0. 001). BDNF预测AMI患者1年不良心血管事件发生率的ROC曲线下面积(AUC)为0. 871,当BNDF截点值为3. 87 ng/ml时预测AMI患者1年不良心血管事件敏感度为84. 1% ,特异度为82. 9% ,约登指数为0. 670. CA125的AUC为0. 746,当CA125截点值为42. 54 U/ml时预测AMI患者1年不良心血管事件的敏感度为83. 2% ,特异度为81. 5% ,约登指数为0. 647. Logistic回归分析结果显示,高龄(OR=1. 89,95% CI 1. 02～3. 51)、心率快(OR=1. 77,95% CI 1. 06～2. 95)、高水平BDNF( OR=4. 76,95% CI 2. 38～9. 56)、高水平CA125(OR=3. 49,95% CI 1. 71～7. 12)、高水平cTnI( OR=3. 80,95% CI 1. 654～8. 750)、高水平BNP (OR=4. 90,95% CI 2. 23～10. 77)为AMI后不良心血管事件的危险因素.结论 AMI患者血清BDNF、CA125水平明显增高,且高水平BDNF、CA125是AMI患者发生不良预后的风险因素,提示二者可作为评估AMI患者病情及预后的预测因子.

目的 系统评价心宝丸联合常规西药治疗慢性心力衰竭伴窦性心动过缓的有效性和安全性.方法 计算机检索中国医学文献数据库(SinoMed)、维普数据库(VIP)、中国期刊全文数据库(CNKI)和万方数据库(WanFang Data)以及英文数据库PubMed、The Cochrane Library,搜集心宝丸治疗慢性心力衰竭伴窦性心动过缓的相关随机对照试验(RCT),检索时限均从建库至2019年4月.由2名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析.结果 共纳入5个RCT,包括486例患者.Meta分析结果 显示:在常规西药治疗基础上联用心宝丸,可有效改善慢性心力衰竭伴窦性心动过缓患者的NYHA心功能分级(RR=1.23,95％CI:1.14～1.32,P<0.00001)、提高左室射血分数(MD=6.85,95％CI:4.00～9.71,P<0.00001)、增加24 h平均心率(MD=11.69,95％CI:8.03～15.34,P<0.00001)、增加心输出量(MD=0.58,95％CI:0.40～0.76,P<0.00001)、增加心脏每搏输出量(MD=3.72,95％CI:2.33～5.11,P<0.00001)、改善6 min步行试验(MD=26.83,95％CI:13.65～40.02,P<0.0001)、降低N末端B型利钠肽原水平(MD=-0.24,95％CI:-0.33～-0.14,P<0.00001)、减小左室舒张末期内径(MD=-2.23,95％CI:-3.45～-1.00,P=0.0004)、减小左室收缩末期内径(MD=-2.35,95％CI:-3.42～-1.28,P<0.0001).结论 研究表明心宝丸联合常规西药可改善慢性心力衰竭伴窦性心动过缓患者的心功能并提高心率.受纳入研究的数量和质量的限制,本研究结论 尚需开展更多高质量研究予以证实.

Objective To investigate the influence factors of serum stimulating hormone levels and coronary atherosclerosis in postmenopausal women.Methods During January 2015 to January 2016 in our hospital,300 cases of healthy postmenopausal women were selected to study,to collect the general clinical data and blood biochemical index,300 patients were divided into the health group (n =272) and the coronary atherosclerosis (n =28).To compare the general data of the two groups,and analyze serum thyroid hormone levels and related factors the general index of correlation and influence of serum thyroid hormone level,and regression analysis in healthy postmenopausal women's risk of coronary atherosclerosis risk factors by univariate and multivariate logistic.Results The TSH,age,SBP,fasting blood glucose,total bilirubin,total cholesterol,high-density lipoprotein,low density lipoprotein and triglyceride in coronary atherosclerosis group were significantly higher than those in healthy group(t =4.953,3.459,3.242,4.553,6.075,4.263,4.563,3.562,5.035,P=0.000,0.015,0.026,0.004,0.000,0.002,0.001,0.012,0.000).;the serum TSH levels were positively correlated with age,triglycerides (r=0.148,0.169,P =0.020,0.008),and negatively correlated with high density lipoprotein (r=-0.145,P =0.024);multiple regression analysis showed that age,high density lipoprotein and triglycerides significantly effected serum TSH levels (P＜0.05);multivariate logistic regression analysis showed that age and TSH levels are risk factors of coronary atherosclerosis in healthy postmenopausal women (OR=1.109,1.304,95％CI:1.024-1.197,1.024-1.678,P=0.013,0.034).Conclusion The healthy postmenopausal women with increased serum thyrotropin levels significantly increased risk of coronary atherosclerosis,it was worthy of clinical attention.

目的 分析替罗非班对冠心病不稳定型心绞痛患者的治疗效果.方法 选择我院收治的113例冠心病不稳定型心绞痛患者,根据入院顺序分为观察组(58例,介入治疗+常规药物治疗+替罗非班治疗)与对照组(55例,介入治疗+常规药物治疗),对比两组治疗效果、治疗前、后氧自由基指标、炎症因子水平、心绞痛发作频率、左心射血分数、血浆黏度.结果 观察组的治疗总有效率显著高于对照组(P<0.05);治疗后,两组SOD水平均升高,MDA、IL-6、TNF-α水平均降低,且观察组优于对照组(P<0.05);治疗后,两组心绞痛发作频率及血浆黏度均降低,左心射血分数均升高,且观察组优于对照组(P<0.05).结论 替罗非班在冠心病不稳定型心绞痛的治疗中具有显著意义,值得推广与应用.

Objective To investigate the clinical effect of compound Danshen dropping pills therapy in patients with congestive hearts failure, and to analysis its effect on the plasma pro-BNP. Methods Ninety-two patients with congestive hearts failure were randoly divided into control group and observation group, each group 46 cases. The control group were treatment by routine western medicine, and the observation group were treatment by compound Danshen dropping pills 10 pills one time, 3 times one day, one course of the treatment of each group is six months . Then observed and recorded the level of the plasma pro-BNP before and one, three, six months after treatment, the clinical effect and the adverse reaction . Results In the control group,six months after treatment, the level of the plasma pro-BNP was significantly lower than that before treatment, a statistically significant difference . In observation group, three and six months after treatment, these levels of the plasma pro-BNP were significantly lower than those before treatment, and also significantly lower than those in the control group, a statistically significant difference . Six months after treatment, the total efficacy rates of the observation group (91.3%) was significantly higher than that in the control group (76.1%), a statistically significant difference . Conclusion Compound Danshen dropping pills can effectively reduce the level of the plasma pro-BNP, enhance the clinical effect, safe and reliable.

Objective:Toanalyze the difference of plasma lipoprotein associated phospholipase A2 (LP-PLA2) and matrix metalloproteinase-9 (MMP-9) levels in patients with different severity of coronary artery disease and the impact of percutaneous coronary intervention (PCI),investigating the role and clinical significance of two inflammatory factors in the occurrence and development of coronary artery disease.Methods:150 patients with acute coronary syndrome (ACS),128 patients with stable angina pectoris (SAP) and 100 healthy subjects were divided into ACS group,SAP group and control group.The plasma levels of MMP-9 and LP-PLA2 were compared between the three groups,and changes of plasma MMP-9 and LP-PLA2 levels before and after PCI treatment were compared in the ACS group.Results:Compared with the control group,the plasma MMP-9 and LP-PLA2 levels in the SAP and the ACS group were significantly higher (P ＜ 0.05);and compared with the SAP group,those of the ACS group were significantly higher (P ＜ 0.05).Compared with preoperative,the plasma MMP-9 and LP-PLA2 levels in the ACS group were significantly lower (P ＜ 0.05).There was a significant positive correlation between MMP-9 and LP-PLA2 in the ACS group (r=0.617,P ＜ 0.05),and no correlation in the SAP group and the control group (P ＞ 0.05).Conclusions:Plasma MMP-9 and LP-PLA2 levels may be correlated with the severity of coronary artery disease,which have some clinical values in predicting ACS high risk population and evaluating the curative effect.

Objective:To study the effect of calcification on rat aortic induced by warfarin(WFN).Methods:The aortic calcification was induced by WFN(3.0 mg/g) in rats.Rats were divided into three groups randomly:Control group,6 W Calcification group and 12 W Calcification group.O-cresol peptide complex ketone colorimetric method and Von Kossa staining was used to detect the calcification formation.Using doable immunofluorescent labeling with TUNEL and DAPI,Vascular Smooth Muscle Cell(VSMC)apoptosis in rats were observed with a laser confocal microscope.The expression levels of Gas 6 in VSMC was determined by Western blot.Results:The calcium nodule,calcium deposition and VSMC apoptosis in calcification group were higher than Control group,but the level of Gas 6 protein expression was decreasing.The apoptosis and calcification has significant correlation(R2= 0.8853,P 0.0001).Conclusion:WFN treatment may induce aortic calcification via decreasing the level of Gas 6 protein in experimental rats.

AIM:To investigate the etiologies and mortalities in patients with chronic heart failure during the years of 1990,2000 and 2010.METHODS:Hospital records with a diagnosis of congestive heart failure during these 3 years were analyzed.RESULTS:In the 2 476 cases under study,the mean age was( 60 ± 17) years and the mean ages for 1990,2000 and 2010 were,respectively,( 52 ± 16) years,( 59 ± 17) years and( 64 ± 15) years,with an increasing tendency( P < 0.05).Significant etiological changes showed that the rate of coronary heart disease rose from 35.6% to 49.2%,whereas rheumatic valvular heart diseases declined from 35.2% to 16.6%( P < 0.05).During these 3 years,mortality rates were,respectively,6.9%,4.5% and 5.1% and the mortalities of heart failure in 2000 and 2010 were lower than in 1990( P < 0.05).The mortality of heart failure decreased most dramatically in the last 10 years.CONCLUSION:Coronary heart disease,hypertension,diabetes mellitus and rheumatic valvular heart disease are the primary diseases causing heart failure during the period from 19902010,with the former three diseases exhibiting an upward trend and the last one a downward trend.The mortality exhibits a downward trend and decreases most significantly in patients with coronary heart disease.