目的 探讨 H 型高血压与心血管介入术后对比剂肾病(CIN)的发生是否存在相关性.方法 回顾性分析湖北省中西医结合医院 2020 年 5 月～2021 年 8 月期间接受心血管介入治疗的 342 例原发性高血压患者的临床资料.根据血清同型半胱氨酸(Hcy)水平分为 H 型高血压组(Hcy≥10μmol/L,共计 206 例)和非 H 型高血压组(Hcy<10μmol/L,共计 136 例),比较患者的临床基线资料、术后肾功能血清肌酐(Scr)、估算的肾小球滤过率(eGFR)及CIN发生率的差异,并采用 Logistic回归分析探讨心血管介入术后发生 CIN 的危险因素.结果 342 例患者心血管介入术后共发生 CIN 24 例,占比7.02％.H 型高血压组的CIN发生率(9.71％)高于非 H 型高血压组(2.94％),差异有统计学意义(P<0.05).术后,H 型高血压组血清 Scr 水平高于非 H 型高血压组,eGFR 低于非 H 型高血压组,差异均有统计学意义(P<0.05).多因素Logistic回归分析显示:与非 H 型高血压组对比,H 型高血压组发生CIN的风险显著增加(OR=1.189,95％CI:1.023～1.383,P =0.024).结论 H 型高血压可能是心血管介入后CIN发生的潜在危险因素.

目的:研究血脂控制水平、红细胞分布宽度(RDW)及内皮素-1(ET-1)与冠心病患者经皮冠状动脉介入(PCI)术后支架内再狭窄(ISR)的关系.方法:选取2016年1月至2019年1月在我院行PCI术的冠心病患者108例作为研究对象,于术后3～12个月行冠状动脉造影,根据造影结果将患者分为ISR组17例和非ISR组91例.于行冠状动脉造影前检测血脂[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]水平、RDW、ET-1水平,分析血脂控制水平、RDW及ET-1与冠心病患者PCI术后ISR的关系.结果:ISR组冠状动脉造影前TC、TG、LDL-C水平明显高于非ISR组,差异有统计学意义(P<0.05);ISR组RDW、ET-1水平明显高于非ISR组,差异有统计学意义(P<0.05).Logistic多因素回归分析结果显示,TC未下降、LDL-C未达标(冠状动脉造影前控制在1.8mmoL/L)是冠心病患者术后ISR的危险因素(P<0.05),TG未下降、HDL-C未升高不是冠心病患者术后ISR的危险因素(P﹥0.05);RDW、ET-1是冠心病患者术后ISR的危险因素(P<0.05).结论:冠心病患者PCI术后TC未下降、LDL-C未达标、高水平RDW、ET-1是术后ISR的高危因素,检测TC、LDL-C、RDW、ET-1水平有助于评估ISR的发生风险.

目的 观察沙库巴曲缬沙坦联合芪苈强心胶囊治疗扩张型心肌病心力衰竭的临床疗效.方法 选取2017年10月—2019年1月湖北省中西医结合医院心内科收治的扩张型心肌病心力衰竭病人86例,根据随机数字表法分为对照组(41例)与观察组(45例).两组均按心力衰竭指南采用常规治疗,对照组给予沙库巴曲缬沙坦钠片治疗,观察组采用沙库巴曲缬沙坦联合芪苈强心胶囊治疗,两组均治疗8周.比较两组临床疗效,观察两组治疗前后6 min步行试验(6MWT)、左室射血分数(LVEF)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、N-末端脑钠肽前体(NT-proBNP)及明尼苏达生活质量评分(MLHFQ)变化.结果 观察组临床疗效总有效率为95.6％,高于对照组的87.8％(P<0.05).治疗后,观察组6MWT、LVEF大于对照组,LVESD、LVEDD、NT-proBNP、MLHFQ评分小于对照组,差异均有统计学意义(P<0.05).结论 沙库巴曲缬沙坦联合芪苈强心胶囊能有效改善扩张型心肌病心力衰竭病人临床症状、心功能,抑制心肌重构,提高生活质量.

目的 探讨急性心肌梗死(AMI)冠脉严重程度与骨桥蛋白(OPN)的相关性.方法 回顾性分析2016年9月～2017年12月我院收治的急性心肌梗死患者127例,根据OPN水平分为高OPN组65例和低OPN组62例,比较两组患者基础资料及多元线性分析OPN与冠脉严重程度的影响因素.结果 两组年龄、TG、TC、HDL-C、LDL-C及Gensini积分比较,差异有统计学意义(>0.05);两组性别、既往史、左室射血分数、药物治疗比较,差异无统计学意义(<0.05).多元线性回归结果表明,OPN、年龄、LDL-C和HDL-C为Genisi积分的独立影响因素.结论 OPN与AMI患者冠脉病变严重程度独立相关,可评估急性心肌梗死冠脉病变严重程度.

目的 探讨基质金属蛋白酶9(MMP9)与冠状动脉介入治疗术后对比剂肾病(CIN)发生的相关性.方法 以择期冠状动脉介入治疗患者145例,分为CIN组22例与非CIN组123例.采用酶联免疫吸附法(ELISA)测定入院时血浆MMP-9含量.应用对比剂48～～ 72 h内血肌酐值较基线值绝对值升高超过44.2μmol/L或者较原值相对升高25％以上,且无其他原因可解释的肾功能损害则判定为对比剂肾病.结果 CIN组MMP-9、BUN、CRP、D-D高于非CIN组(2.22±0.75)vs(1.34±1.01),P=0.001;(7.44±2.13)vs(5.28±1.99),P=0.021;(9.21±3.56) vs(5.07±3.18),P=0.033;(5.21±1.44)vs(4.62±1.67),P=0.025),GFR低于非CIN组(77.61±21.87) vs(96.54±34.21),P=0.021;logistics多因素回归分析提示MMP-9是CIN发生的独立危险因素之一(OR,1.08;95％ CI,1.02～1.16;P=0.000).结论 MMP-9为冠脉介入治疗术后CIN发生的独立危险因素,可作为CIN发生的重要预测指标.

Objective:To explore therapeutic effect and safety of cilostazol combined clopidogrel +aspirin on aged pa‐tients after percutaneous coronary intervention (PCI) .Methods :A total of 100 aged patients with coronary heart disease undergoing PCI were randomly divided into routine treatment group (n=52 ,received aspirin and clopidogrel antiplatelet therapy) and cilostazol group (n= 48 ,received cilostazol therapy based on routine treatment group ) . Turbidimetry was used to measure platelet aggregation rate (PAR );PAR and mean platelet volume (MPV ) were compared between two groups before ,one week and one month after PCI .All subjects were followed up for six months ,incidence rates of major adverse cardiovascular events (MACE) and hemorrhage events were compared be‐tween two groups .Results:There were no significant difference in MPV and PAR between two groups before PCI . Compared with routine treatment group ,PAR significantly reduced [one week after PCI :(48.7 ± 6.3)% vs .(43.5 ± 5.7)% ,one month after PCI :(46.8 ± 5.8)% vs .(42.4 ± 5.4)% ] in cilostazol group , P<0.05 both . After six-month follow-up ,there was no significant difference in total incidence rate of MACE (16.7% vs .17.3% ) be‐tween cilostazol group and routine treatment group , P>0.05;incidence rate of hemorrhage in cilostazol group was significantly lower than that of routine treatment group (6.25% vs .19.23% , P< 0.01) .Conclusion:Compared with clopidogrel+aspirin therapy ,cilostazol combined clopidogrel+aspirin can more significantly inhibit platelet ag‐gregation ,and significantly reduce hemorrhage events ,so they are safe and effective in aged patients with coronary heart disease undergoing PCI .

Objective: To study the predictive value of combination scores of leukocyte and platelet counts (COL-P) for in-hospital mortality in patients with acute ST segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) treatment. Methods: A total of 660 STEMI patients with emergent PCI in our hospital from 2009-11 to 2013-08 were retrospectively studied. The patients were divided into 3 groups according to COL-P scores: COL-P0 group,n=283, COL-P1 group,n=319 and COL-P3 group,n=58. The relationship between the in-hospital mortality and COL-P scores was analyzed among different groups. Results: There were 88/660 in-hospital death. The patients in death group had the higher white blood cell count and lower platelet count than those in survival group, bothP<0.01. Logistic regression analysis indicated that compared with COL-P0 group, the COL-P scores at COL-P1 level (OR 4.346, 95% CI 2.134-8.850,P<0.001) and COL-P2 level (OR 10.126, 95% CI 4.061-25.250,P<0.001) were the independent risk factors for in-hospital death in STEMI patients after emergent PCI. The in-hospital mortality in COL-P0, COL-P1 and COL-P2 groups were at 4.9%, 15.4% and 43.1% respectively, allP<0.001. Conclusion: COL-P score was useful for predicting the in-hospital mortality in STEMI patients after emergent PCI, while the long term mortality estimation should be further studied.