目的:探讨吲哚布芬联合氯吡格雷预防冠状动脉旁路移植术(CABG)后大隐静脉桥血管再狭窄的临床疗效及安全性.方法:回顾性分析2019年1月～2020年12月某院收治的接受CABG术患者84例作为研究对象,根据术后接受抗血小板药物方案分为A组(n=34)和B组(n=50),A组患者术后给予吲哚布芬联合氯吡格雷治疗,B组给予阿司匹林联合氯吡格雷治疗.对患者展开为期1年的随访,对比两组患者随访期间大隐静脉桥血管再狭窄率、不良心血管事件和不良反应发生情况;对比两组患者手术前和随访结束时凝血功能指标.结果:A组患者大隐静脉桥血管再狭窄率(5.89％)与B组(8.00％)相比无统计学差异(P>0.05);随访期间,A组患者不良心血管事件发生率(2.94％)与B组(6.00％)相比无统计学差异(P>0.05);A组患者不良事件发生率(5.89％)低于B组(22.00％,P<0.05);两组患者术后1年纤维蛋白原(FIB)、D-二聚体(D-dimer)均降低,而血小板计数(PLT)升高(P<0.05).结论:相较于阿司匹林,吲哚布芬联合氯吡格雷预防CABG术后大隐静脉桥血管再狭窄的临床疗效更好且安全性较高.

Objective:To investigate the changes of hemodynamics, inflammation and blood gas after coronary artery bypass grafting under beating and cardiopulmonary bypass.Methods:The clinical data of 136 patients with coronary heart disease who underwent coronary artery bypass grafting in our hospital from June 2018 to June 2020 were analyzed retrospectively. According to the circulation mode, they were divided into non-stop beating group (68 cases) and cardiopulmonary bypass group (68 cases). The patients in the off-pump group were treated with off-pump coronary artery bypass grafting under cardiopulmonary bypass, and those in the off-pump group were treated with off-pump coronary artery bypass grafting under cardiopulmonary bypass. The changes of cardiac function, pulmonary function, hemodynamics and inflammation were analyzed.Results:The operation time, ICU stay time and hospitalization time [(185.65±22.91) min, (2.74±1.037) d and (7.48±2.22) d] in the non-stop beating group were significantly shorter than those in the cardiopulmonary bypass group [(223.77±36.97) min, (5.06±1.79) d and (11.67±3.52) d, t=5.036, 9.196, 13.198, P<0.05]. CK-MB and cTnI levels [(26.03±4.81) U/L and (7.86±2.51) μg/L] were significantly lower in the non-stop beating group than those in the cardiopulmonary bypass group [(43.44±5.85) U/L, (8.81±1.76) μg/L, t=18.971, 2.530, P<0.05]. The postoperative MVP [(76.88±2.63) mmHg (1 mmHg=0.133 kPa)] in the non-stop beating group was significantly lower than that in the cardiopulmonary bypass group [(66.99±2.91) mmHg, t=18.971, P<0.05]. The postoperative LVSWI [(27.25±1.93) g/(m·m 2)] in the non-stop beating group was significantly smaller than that in the cardiopulmonary bypass group [(22.62±1.56) g/(m·m 2), t=15.399, P<0.05]. The postoperative RVSWI in the non-stop beating group [(4.45±1.32) g/(m·m 2)] was significantly smaller than that in the cardiopulmonary bypass group [(2.97±0.93) g/(m·m 2), t=7.470, P<0.05]. The levels of interleukin (IL)-1β and tumor necrosis factor-α (TNF-α) in the non-stop beating group [(49.12±6.53) and (44.96±4.98) pg/ml] was significantly lower than those in the cardiopulmonary bypass group [(75.36±6.41) and (52.59±7.96) pg/ml, t=23.68, 6.703, P<0.05]. The lung compliance and airway resistance [(447.28±46.87) and (0.63±0.03) kPa/(L·S)] in the beating group were significantly lower than those in the cardiopulmonary bypass group [(667.09±39.45) and (0.87±0.05) kPa/(L·S), t=29.460, 35.390, P<0.05]. Conclusion:Compared with coronary artery bypass grafting under cardiopulmonary bypass, patients with beating coronary artery bypass grafting have rapid recovery of cardiopulmonary function, stable hemodynamics and low level of inflammation.

The laboratory methods and results cannot be replicated and the western blot images in Figures 3 and 4 are not original. Reference: Chaoyuan Zhou, Qintao Cui, Guobao Su, Xiaoliang Guo, Xiaochen Liu, Jie Zhang. MicroRNA-208b Alleviates Post-Infarction Myocardial Fibrosis in a Rat Model by Inhibiting GATA4. Med Sci Monit, 2016; 22: 1808-1816. DOI: 10.12659/MSM.896428.

目的 观察体外循环深低温停循环(DHCA)下Stanford A型主动脉夹层手术中不同流量顺行选择性脑灌注(ASCP)对术后认知功能障碍的影响.方法 选取新乡医学院第一附属医院2019年9月至2020年12月Stanford A型主动脉夹层并实施手术的患者60例,所有患者均在CPB DHCA+ASCP下行主动脉置换术.按ASCP流量不同分为三组,低流量组(L组,3 ml·kg-1·min-1),中流量组(M组,5 ml·kg-1·min-1),高流量组(H组,7 ml·kg-1·min-1).分别于术前(T0)、停循环5 min(T1)、复温至36℃时(T2)、术后24 h(T3)、术后48 h(T4)、术后72 h(T5),采集静脉血测定血清中神经特异性烯醇化酶(neuro-specific enolase,NSE)与S-100?蛋白浓度,记录苏醒和拔管时间.拔管后3天(T6)、7天(T7)及出院后1月(T8)以简易智能精神状态量表(MMSE)和蒙特利尔评估表(MoCA)评估其认知功能.术中用NIRS监测脑氧饱和度(rSO2)值,间断监测血气分析记录乳酸水平和术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生率.结果 三组患者在一般情况和转机前血红蛋白水平以及转机时间、升主动脉阻断时间、脑灌注时间均无明显差异(P>0.05);rSO2水平:T1、T2、T3时刻M组和H组均高于L组,P<0.05;T4和T5时刻三组rSO2水平无差别,P>0.05;血乳酸水平:T1、、T2时刻L组乳酸水平明显高于M组和H组P<0.05;T0,T3,T4,T5时刻组内比较无明显差异,P>0.05;S100β蛋白水平:T1、T2、T3、T4时刻M组S100β蛋白水平明显低于L和H组,P<0.05,H组S100β蛋白水平明显低于L组,P<0.05;NSE水平:T1、T2、T3、T4时刻M组NSE水平明显低于L组和H组,P<0.05;M组的POCD发生率在T6、T7、T8时刻均明显低于L组和H组,P<0.05.结论 选择性脑灌注采用5 ml·kg-1·min-1有较好的神经系统保护作用,可满足深低温停循环下脑灌注,减少术后认知功能障碍的发生率和神经系统并发症.

Background:To analyze the change and clinical significance of cortisol, B-type brain natriuretic peptide (BNP), and prostacyclin-2 (PGE-2) levels in premature infants with patent ductus arteriosus (PDA).Methods: A total of 67 cases of premature infants admitted to our hospital from January 2018 to April 2020 were included, all of whom developed PDA (PDA group).According to the presence or absence of symptoms, they were divided into the symptomatic group (28 cases) and the asymptomatic group (39 cases).In addition, 62 premature infants without PDA who were born in our hospital during the same period were selected as the control group.The expression levels of cortisol, BNP, and PGE-2 in infants in different groups and between infants with symptoms and without symptoms were analyzed, along with the risk factors leading to PDA in preterm infants.The value of cortisol, BNP, and PGE-2 in the diagnosis of PDA in premature infants was also analyzed.Results: Compared with the control group, cortisol in the PDA group was significantly decreased (P<0.05), while the levels of BNP and PGE-2 were significantly increased (P<0.05).The cortisol level in the asymptomatic group was significantly higher than that in the symptomatic group, while the levels of BNP and PGE-2 were opposite, and the differences were statistically significant (P<0.05).Logistic regression analysis showed that birth weight <1,200 g, decreased cortisol, increased BNP, and increased PGE-2 were independent risk factors leading to PDA in preterm infants, and the differences were statistically significant (P<0.05).Receiver operating characteristic (ROC) curve showed that the sensitivity and specificity of cortisol+BNP+PGE-2 in the diagnosis of PDA in premature infants were 75.60% and 73.10%, respectively.The area under the curve (AUC) value was 0.759 (95% CI: 0.611-0.859),which was significantly higher than the AUC values of the 3 tests alone (P<0.05). Conclusions:The expression of cortisol decreased in premature infants with PDA, while the levels of BNP and PGE-2 significantly increased.Dynamic detection of the changes in these levels can provide an important reference for the early diagnosis of PDA and for the assessment of disease progression.

目的 探讨心脏瓣膜术联合冠状动脉旁路移植对心脏瓣膜病患者心肌损伤的影响.方法 选取2017年10月—2018年10月在新乡医学院第一附属医院治疗的心脏瓣膜病患者72例,依据入院时间单双数分为对照组和研究组.对照组进行心脏瓣膜术联合冠状动脉旁路移植非同期手术治疗;研究组进行心脏瓣膜术联合冠状动脉旁路移植同期手术治疗.比较两组心肌损伤指标水平、术后相关指标、不良事件发生状况及术后心功能指标水平.结果 两组T0、T1、T2时的心肌肌钙蛋白I(cTnI)、血清肌酸激酶同功酶MB(CK-MB)及N末端B型脑钠肽(NT-proBNP)在不同时间、不同组间及变化趋势上有差异(P<0.05).两组体外循环前cTnI、CK-MB、NT-proBNP水平比较,差异无统计学意义(P>0.05);血运重建后cTnI、CK-MB水平均持续升高,研究组低于对照组;同时两组T0、T1时的NT-proBNP水平无变化,研究组T2时的NT-proBNP水平低于对照组(P<0.05).两组呼吸机应用时间、重症加强护理病房监护时间及住院时间与比较,差异有统计学意义(P<0.05),研究组较对照组少.两组不良事件总发生率比较,差异有统计学意义(P<0.05),研究组较对照组低.两组术前心功能指标比较,差异无统计学意义(P>0.05).两组术后左心室射血分数、左心室舒张末期前后径、左心室收缩末期前后径及心胸比等心功能指标比较,差异有统计学意义(P<0.05),研究组受损程度低于对照组.结论 心脏瓣膜术联合冠状动脉旁路移植是心脏瓣膜病患者治疗的有效方式.2种术式同期进行,有利于降低对患者心肌损伤的影响.术前积极改善患者心肺功能能够加强心肌保护,缩短心肌缺血时间,避免术后感染,有利于降低不良事件的发生概率,提升患者心功能指标水平,对促进患者康复有重要意义.

This study sought to investigate whether reactive oxygen species (ROS)-generating reduced nicotinamide adenine dinucleotide phosphate oxidase 2 (Nox2) contributes to calcific aortic valve disease (CAVD) or whether celastrot, a natural Nox2 inhibitor, may provide potential therapeutic target for CAVD. CAVD is an active and cellular-driven fibrocalcific process characterized by differentiation of aortic valvular interstitial cells (AVICs) toward an osteogenic-tike phenotype. ROS levels increase in calcified aortic valves, white the sources of ROS and their roles in the pathogenesis of CAVD are elusive. The rotes of Nox2 and the effects of celastrot were studied using cultured porcine AVICs in vitro and a rabbit CAVD model in vivo. Nox2 proteins were significantly upregutated in human aortic valves with CAVD. In vitro, Nox2 was markedly induced upon stimulation of AVICs with osteogenic medium, along with the increases in ROS production and calcium nodule formation. Celastrol significantly decreased calcium deposition of AVICs by 35%, with a reduction of ROS generation. Knockdown of endogenous Nox2 substantially suppressed AVIC calcification by 39%, the inhibitory effect being similar to celastrot treatment. Mechanistically, either celastrot treatment or knockdown of Nox2 significantly inhibited glycogen synthase kinase 3 betag/beta-catenin signaling, leading to attenuation of fibrogenic and osteogenic responses of AVICs. In a rabbit CAVD model, administration of celastrot significantly reduced aortic valve ROS production, fibrosis, calcification, and severity of aortic stenosis, with less left ventricular dilatation and better preserved contractile function. Upregutation of Nox2 is critically involved in CAVD. Cetastrol is effective to alleviate CAVD, likely through the inhibition of Nox2-mediated glycogen synthase kinase 3 beta/beta-catenin pathway in AVICs. Crown Copyright (C) 2020 Published by Elsevier on behalf of the American College of Cardiology Foundation.

目的 探究银杏内酯(BB)对心肌缺血再灌注(MI/R)模型大鼠心肌组织的影响.方法 采用结扎大鼠左冠状动脉前降支30 min制备MI/R模型,按分组分别ig给予BB 2,4和8 mg·kg-1,连续4周.记录各组大鼠心率(HR),检测心肌梗死面积.用试剂盒检测血液中肌酸激酶MB型同工酶(CK-MB)及乳酸脱氢酶(LDH)浓度,HE染色观察心肌组织损伤,TUNEL染色检测心肌细胞凋亡率.ELISA法检测心肌组织超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-Px)活性和丙二醛(MDA)含量;检测外周血白细胞介素1β(IL-1β)、肿瘤坏死因子α(TNF-α)和IL-10浓度.免疫组化检测Ki67及IL-6表达水平,Western印迹法检测心肌组织中Bcl-2、Bax、活化的胱天蛋白酶3、转录因子NF-E2相关因子2(Nrf2)、血红素氧合酶(HO-1)、NAD(P)H醌脱氢酶1(NQO1)、NF-κB P65、磷酸化NF-κB抑制蛋白(p-IκBα)和IκBα激酶(p-IKK)蛋白表达水平.结果 与正常对照组比较,MI/R模型组大鼠心肌梗死面积百分比及外周血中CK-MB和LDH浓度显著增加(P<0.01),HR下降(P<0.01),心肌组织出现心肌纤维断裂及炎性浸润现象.与MI/R模型组比较,MI/R模型+BB 2,4和8 mg·kg-1组中心肌梗死面积百分比及CK-MB和LDH浓度显著降低(P<0.05),心率上升(P<0.05),心肌组织纤维排列趋向规则,炎症细胞浸润明显减少损伤明显减轻.与正常对照组比较,MI/R模型组凋亡细胞百分比及Ki67阳性细胞百分比、Bax及活化的胱天蛋白酶3表达显著增加(P<0.01),Bcl-2表达显著减少(P<0.01).与MI/R模型组比较,MI/R模型+BB 2,4和8 mg·kg-1组中Ki67阳性细胞百分比和Bcl-2表达显著增加(P<0.05),凋亡细胞百分比、Bax和活化的胱天蛋白酶3表达显著减少(P<0.05).MI/R可降低大鼠心肌组织中SOD及GSH-Px活性(P<0.01),提高MDA浓度(P<0.01),BB可减弱MI/R对SOD,GSH-Px和MDA的影响(P<0.05,P<0.01).与正常对照组比较,MI/R模型组大鼠外周血中IL-1β,TNF-α和IL-10浓度及心肌组织中IL-6阳性细胞百分比显著升高(P<0.01).与MI/R模型组比较,MI/R模型+BB 2,4和8 mg·kg-1组中IL-1β,TNF-α浓度和IL-6阳性细胞百分比显著降低(P<0.05),IL-10浓度显著升高(P<0.01).此外,MI/R模型组大鼠心肌组织中的Nrf2,HO-1和NQ1蛋白表达水平显著降低(P<0.01);NF-κB P65,p-IKK和p-IκBα1蛋白表达水平显著升高(P<0.01),BB可有效逆转MI/R对这些信号通路蛋白的作用(P<0.05,P<0.01).结论 BB可通过抗炎及抗氧化对MI/R大鼠产生保护作用.

目的 探讨风湿性心脏病(RHD)患者二尖瓣瓣膜中辅助性T细胞(Th)17及Th22细胞的表达及临床意义.方法 选择新乡医学院第一附属医院心血管外科2016年5月至2017年5月确诊的40例RHD患者为观察组,另选择30例非风湿性心脏瓣膜病变患者为对照组.获取2组患者的瓣膜组织,应用流式细胞仪检测瓣膜组织中Th17及Th22细胞在CD4+T细胞中的比例;采用实时荧光定量反转录聚合酶链反应(qRT-PCR)检测瓣膜组织中白细胞介素(IL)-17和IL-22 mRNA的相对表达量;采用酶联免疫吸附试验检测瓣膜细胞培养上清液中IL-17和IL-22的水平.结果 观察组患者二尖瓣瓣膜组织中Th17和Th22细胞占CD4+T细胞的比例分别为(3.95±0.81)％和(3.24±0.68)％,对照组患者二尖瓣瓣膜组织中Th17和Th22细胞占CD4+T细胞的比例分别为(1.34±0.25)％和(0.83±0.20)％,观察组患者二尖瓣瓣膜组织中Th17和Th22细胞占CD4+T细胞的比例显著高于对照组(P<0.05).观察组患者瓣膜组织中IL-17及IL-22 mRNA相对表达量分别为5.03±1.43和4.67±1.12,对照组患者瓣膜组织中IL-17及IL-22 mRNA相对表达量分别为2.38±1.03和1.98±1.34,观察组患者二尖瓣瓣膜组织中IL-17、IL-22 mRNA相对表达量显著高于对照组(P<0.05).观察组患者细胞培养上清液中IL-17和IL-22水平分别为(25.39±3.86)、(20.10±4.15)g·L-1,对照组患者细胞培养上清液中IL-17和IL-22水平分别为(8.34±2.13)、(10.13±2.15)g·L-1;观察组患者细胞培养上清液中IL-17、IL-22水平显著高于对照组(P<0.05).结论 RHD患者二尖瓣瓣膜中Th17及Th22细胞比例及相应细胞因子的表达均明显升高,其在该疾病的发生、发展中可能起一定的促进作用.

目的 比较体外循环下心脏不停搏冠状动脉旁路移植术(On-PBH)与非体外循环心脏不停搏冠状动脉旁路移植术(OPCABG)治疗冠状动脉粥样硬化性心脏病(CHD)合并左心室功能不全(LVD)患者的早期疗效.方法 回顾性分析2015年1月至2017年6月新乡医学院第一附属医院收治的88例CHD合并LVD患者的临床资料,其中行On-PBH 37例(On-PBH组),行OPCABG 51例(OPCABG组).比较2组患者血运重建结果、手术时间、呼吸机辅助时间、心脏外科重症监护病房(CSICU)人住时间、术中输血量、主动脉内球囊反搏术(IABP)置入率、术后并发症发生率、术后血管活性药物应用情况、术后住院时间、住院费用、术后3个月内心绞痛复发率、心功能恢复情况.结果 2组患者平均移植血管数比较差异无统计学意义(P＞0.05).On-PBH组患者手术时间、呼吸机辅助时间、CSICU时间、术后住院时间长于OPCABG组(P＜0.05),术中输血量、IABP置入率、术后并发症发生率、住院费用高于OPCABG组(P＜0.05);2组患者术后血管活性药物应用率、术后3个月内心绞痛复发率比较差异均无统计学意义(P＞0.05).2组患者术前左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD)比较差异无统计学意义(P＞0.05),术后3个月LVEF较术前显著增高(P＜0.01),LVEDD较术前显著降低(P＜0.01).术后3个月,OPCABG组患者LVEF高于On-PBH组(P＜0.05),LVEDD低于On-PBH组(P＜0.05);LVEF≤40％者术后3个月与术前LVEF差值、LVEDD差值高于40％＜ LVEF≤50％者(P＜0.01,P＜0.05).结论 On-PBH和OPCABG均可明显改善CHD合并LVD患者的早期心功能,但是OPCABG较On-PBH早期疗效更显著;左心室功能越差的患者从血运重建治疗中获益越大.

BACKGROUND Myocardial infarction affects the health of many people. Post-infarction myocardial fibrosis has attracted much attention, but details of the mechanism remain elusive. In this study, the role of microRNA-208b (miR-208b) in modulating post-infarction myocardial fibrosis and the related mechanism were investigated. MATERIAL AND METHODS A rat model of myocardial infarction induced by ligating the left anterior descending artery was used to analyze the expression and roles of miR-208b by overexpression with the lentivirus vector of pre-miR-208b. Myocardial function was assessed and the expression of fibrosis-related factors type I collagen (COL1) and ACTA2 (alias αSMA) was detected. Myocardial fibroblasts isolated from newborn rats were transfected with luciferase reporter vectors containing wild-type or mutant Gata4 3' UTR to verify the relationship between Gata4 and miR-208b. We then transfected the specific small interference RNA of Gata4 to detect changes in COL1 and ACTA2. RESULTS miR-208b was down-regulated in hearts of model rats (P<0.01). Overexpressing miR-208b improved myocardial functions, such as reducing the infarction area (P<0.05) and promoting LVEF and LVFS (P<0.01), and inhibited COL1 and ACTA2 (P<0.01). Luciferase reporter assay proved Gata4 to be the direct target of miR-208b, with the target sequence in the 3'UTR. Inhibiting GATA4 resulted in the down-regulation of COL1 and ACTA2, suggesting that the role of miR-208b was achieved via regulating GATA4. CONCLUSIONS This study demonstrates the protective function of miR-208b via GATA4 in post-infarction myocardial fibrosis, providing a potential therapeutic target for treating myocardial fibrosis.

Aim of this study was to investigate the potential effects of sildenafil on the function of endothelial cells from patients with congenital heart disease with pulmonary hypertension (CHDPH). Patients who are diagnosed as CHD with PH (n=30) or without PH (n=30), and 30 healthy persons (control) were enrolled in this study. The 30 CHDPH cases were separated into two groups, one was given aspirin while the other received aspirin and sildenafil. An ELISA assay was used to detect the biological indexes for endothelial cells. Furthermore, 24 male New Zealand white rabbits were used to construct the CHDPH model. The signal pathway-related protein expression was analyzed using RT-PCR and western blotting. Compared to that in healthy people, levels for flowmediated dilatation (FDM), NO, and adiponectin (APN) were significantly decreased while endothelin (ET-1) was significantly increased in CHD patients, while their levels were drastically changed in CHDPH patients (P<0.01). Besides, no significant differences for expression levels including FDM, APN, NO, and ET-1 was observed in CHDPH patients receiving aspirin. But the levels for FDM, APN, NO, and ET-1 were significantly changed in CHDPH patients after treatment with sildenafil for 3 months (P<0.01). The mRNA and protein levels for JNK1/2, MAPK, and NF-κB were significantly increased in CHDPH rabbits compared to the control (P<0.01), but their levels were significantly suppressed by the sildenafil application compared to the CHDPH group (P<0.01). Taken together, our study suggested that sildenafil may play a protective role on endothelial function via suppressing the JNK and NF-κB signal pathways in CHDPH patients.

目的 探讨冠状动脉旁路移植术(CABG)治疗ST段抬高心肌梗死(STEMI)的最佳手术时机以及术后死亡的危险因素.方法 回顾性分析213例行CABG的血流动力学稳定的STEMI患者临床资料,根据心肌梗死发生至手术时间将患者分为A组(心肌梗死后7 ～14 d)60例,B组(心肌梗死后15 ～ 21 d)72例,C组(心肌梗死后≥22 d)81例,比较3组患者临床资料、术中及术后情况、死亡情况等,并采用logistic回归分析对可能影响STEMI患者住院期间CABG术后死亡的因素进行单因素及多因素分析.结果 213例患者死亡8例,占3.8％,死因为循环衰竭4例,多器官功能衰竭2例,肾衰竭2例.A组、B组、C组发病距手术时间分别为(10.9±1.9)d、(18.2±2.0)d和(27.3±4.4)d(P ＞0.05).A组、B组、C组的病死率分别为5.0％ (3/60)、4.2％ (3/72)、2.47％ (2/81),组间比较差异无统计学意义(P＞0.05).女性、左心室射血分数＜0.45、磷酸肌酸激酶(CK) 750 U/L为STEMI患者住院期间CABG术后死亡的独立危险因素(P＜0.05),心肌梗死距离手术时间与术后死亡无关(P＞0.05).结论 血流动力学稳定的STEMI患者心肌梗死发生7d后任何时间段行冠脉旁路移植术都是安全的,女性、左心室射血分数＜0.45、CK＞ 750 U/L可能是影响STEMI患者住院期间CABG术后死亡的风险因素.

Objective To study the curative effect of drug therapy and cardiac muscle relaxation on patients with symptomatic myocardial bridge. Methods Fifty patients with obvious symptoms of angina pectoris who were di-agnosed with myocardial bridge by coronary angiography from June 2012 to June 2014 in our hospital with heart func-tion of gradeⅡtoⅣby CCS were divided into 2 groups:treatment group (n=26) was treated with cardiac muscle re-laxation and control group (n=24) was treated with beta blockers and/or calcium antagonist (CCB). After 1 year of follow-up,the outcome was observed in patients with myocardial infarction, death, target vessel remodeling and CCS score>2. Results The baseline characteristics of the two groups (including gender,age,CCS grades,hypertension and diabetes) were not significantly different ( P>0. 05 );there was no significant differences between the two groups re-garding lesion vessel diameter and compression ratio (P>0. 05). After an average 12-month follow-up,the treatment group was significantly lower on the end-point incidence than control group (P<0. 05). Conclusion Cardiac muscle relaxation has better prognosis for patients with symptomatic myocardial bridge than the conservative drug treatment.

随着高血压发病率增高及糖尿病患者的增多，冠状动脉粥样硬化性心脏病发生率逐年上升〔1〕。在该疾病发病过程中，脂质在冠状动脉内膜沉积导致的粥样硬化斑块是引起冠状动脉狭窄的主要因素。由于该类患者多存在多支血管病变且狭窄程度不完全相同，因而对于病变较轻患者可以采用支架植入缓解冠脉狭窄程度并促进术后恢复〔2〕。杂交手术是在进行左乳内动脉（ LIMA）吻合于左前降支（ LAD）的LIMA-LAD旁路移植手术的同时植入药物涂层支架处理非前降支病变，具有较高的远期通。率〔3〕，且有助于缩短手术时间，提高了患者冠脉的通。率，近年来在国内逐渐获得应用。

Obejective To study the relation between epicardial adiponectin level and coronary ar‐tery lesion in CHD patients .Methods One hundred and sixty eight CHD and valvular disease (VD) patients admitted to our hospital were divided into CHD group (n=86) and VD group(n=82) .Patients in CHD group were further divided into <30 lesion score group (n=23) ,30-90 le‐sion score group (n=35)and >90 lesion score group (n=28) .Epicardial adipose tissue and serum samples were taken from the patients .Their serum adiponectin level was measured and adipokine mRNA expression was detected by ELISA and RT‐PCR ,respectively .Results The serum adi‐ponectin level was significantly lower in CHD group than in VD group (9 .1 ± 3 .1 mg/L vs 13 .5 ± 3 .9 mg/L ,P<0 .05) ,<30 lesion score group ,30 -90 lesion score group and >90 lesion score group (12 .3 ± 4 .8mg/L ,9 .1 ± 4 .5 mg/L ,7 .2 ± 5 .1 mg/L ,P< 0 .05) .The adiponectin mRNA expression level was significantly lower in CHD group than in VD group (P<0 .05) .Conclusion The serum epicardial adiponectin level decreases with the severity of coronary lesions in elderly CHD patients .

目的：观察改良超滤联合血液回收对老年患者心脏瓣膜置换术的临床效果和预后的影响。方法82例老年心脏瓣膜置换术患者随机分为对照组和研究组，分别采用常规手术和改良超滤联合血液回收的方法手术。观察两组术后并发症发生率、死亡率、心功能、出血量、库血用量、血细胞比容、血小板计数、凝血酶原时间、D－二聚体水平、活化全血凝固时间、高敏 C反应蛋白（ hsCRP）、同型半胱氨酸（ Hcy）、糖类抗原（ CA）125、B型钠尿肽（BNP）、左室射血分数（LVEF）等指标的差异。结果研究组术后并发症发生率显著低于对照组（χ2＝5．47，P＜0．05）；术后24 h出血量、库血用量、血细胞比容、术后24 h尿量及呼吸机辅助时间均显著少于对照组（t＝2．36、2．29、2．18、2．21、2．19，P＜0．05）；与治疗前比较，研究组和对照组hsCRP、LVEF、D－二聚体、PLT均有显著性改变（ t＝2．27、2．13、2．09、2．45、2．58、2．64、2．19、2．06，均 P＜0．05）；治疗后研究组 hsCRP、D－二聚体、术后6 h出血量与对照组均有统计学意义（t＝2．34、2．25、2．11，P＜0．05）。结论改良超滤联合血液回收在老年心脏瓣膜置换手术中可减少早期出血量及异体输血量，可以改善术后老年患者的早期预后及老年心脏瓣膜置换手术的心功能，减轻炎症反应，减少并发症发生。

目的 分析直接经皮冠状动脉介入(PCI)治疗术前负荷剂量阿托伐他汀对急性心肌梗死患者近期预后的影响.方法 根据是否直接行PCI术将85例未使用他汀类药物的ST段抬高型心肌梗死患者分组,对照组术前无他汀类药物预处理,强化组术前予阿托伐他汀,观察术后血流灌注情况和术后30 d内心血管不良事件发生情况.结果 强化组TIMI血流3级发生率86.05%高于对照组的66.67%,CTFC低于对照组,TMPG高于对照组,P＜0.05或P＜0.01;强化组心血管不良事件发生率6.98%与对照组9.52%比较,P＞0.05.结论 直接行PCI术前强化他汀治疗能够通过稳定血管内斑块、减少远端血栓和微血管痉挛等机制改善冠脉血流和心肌灌注,且不增加心血管不良事件发生率.

Objective To obtain the difference between the thickness of macular ganglion cell complex(mGCC) and retinal never fiber layer(pRNFL) in healthy men,patients with early manifest glaucoma(EMG),and patients with glaucomaevolutum using Fourier-domain optical coherence tomography(FD-OCT),and then evaluate and analyze the diagnosibility of it and other parameters for glaucoma.Methods 41 healthy men(56 eyes),36 patients(42 eyes) with EMG and 35 patients with glaucomaevolutum were recruited as normal group,EMG group and glaucomaevolutum group,respectively.The thicknesses of mGCC and pRNFL were measured using FDOCT,and the parameters were analyzed statistically.Area under receiver operating characteristic curve(AUROC) of the parameters were also obtained.Then diagnobility of the parameters were analyzed.Results The thicknesses of mGCC and pRNFL at all parts gradually decreased as glaucoma degree aggravating,all parameters were significantly different from each other(All P < 0.01).The superior,average and inferior thicknesses of mGCC were correlated with those of pRNFL in all three groups(r = 0.443,0.693,0.615,0.833,0.725,0.818,0.840,0.658 and 0.904,respectively)(All P < 0.01).AUROC of all pRNFL and mGCC parameter but nasal pRNFL thickness(P = 0.102) of normal group and EMG group were significantly different from each other(All P < 0.01).AUROC of all pRNFL and mGCC parameters of normal group and glaucoma group(two glaucoma groups) were significantly different from each other(pRNFL: 0.941 ± 0.020,mGCC: 0.920 ± 0.022,All P < 0.01).The diagnosibility of all pRNFL and mGCC parameters were not significantly different from each other(All P > 0.05) Conclusion The diagnosibility of pRNFL and mGCC thickness for EMG were comparable.The measurement of mGCC thickness is a good supplementary examination to pRNFL thickness measurement.

Objective To explore the immunogenicity of tissue-engineering blood vessels constructed by acellular guinea pig' s arteries planted with rat' s mesenchymal stem cells (MSCs).Methods One hundred and sixty healthy clonic masculine clean Sprague-Dawley (SD) rats weighing 200-250 g were selected,and randomly devided into 4 groups receiving transplanttion of different samples in the operation (group A:tissue-engineering blood vessels transplanted with rat' s MSCs,n =40 ; group B:acellular guinea pig' s arteries,n =40; group C:fresh guinea pig' s arteries,n =40; group D:sham operation,n =40).Eight rats of each group were executed on the 3rd,7th,15th,30th,and 60th day after the operation,and the rats' serum and the grafts were obtained.The concentrations of anti-guninea pig' s arteries IgG and complement C3 in serum were determined by using enzyme linked immunosorbent assay (ELISA).Results The concentrations of anti-guinea pig' s arteries IgG were increased in groups A,B and C.On the 3rd day post-opration,there were no significant differences among all those groups.They were significantly higher on the 7th,15th and 30th day postoperation in group A [ ( 116.63 ± 9.72),( 123.79 ±9.12),(110.76 ± 12.44) mg/L] and group B [(112.77 ±9.63),(122.54±17.15),(116.23 ±16.49) mg/L] than those in groupD [(98.41±16.49),(102.54±10.61),(97.73 ±9.71) mg/L](P ＜ 0.05).There were no differences on the 60th day post-operation among groups A,B and D (P ＞0.05).On the 7th,15th,30th,and 60th day post-operation,the concentrations in group C [ (121.14 ±6.75),(138.03±17.70),(141.09±18.93),(133.28 ±16.13) mg/L] were higher than those in groups A,B and D (P ＜ 0.05).There were no significant differences between groups A and B (P ＞0.05).The complement C3 level was decreased in groups A,B,and C.On the 3rd day post-opration,there were no significant differences among all those groups.On the 7th,15th,30th and 60th day post-operation,C3 levels in groupC [(130.38±16.85),(106.58±11.62),(105.25±10.71),(113.84±11.05) mg/L] were lower than those in group A [ ( 152.61 ± 21.84),( 130.94 ± 16.55),( 127.71 ±15.10),(134.79±16.20) mg/L],group B [(153.10 ± 15.81),(135.24 ±24.56),(125.18 ±11.88),(137.25±21.17) mg/L] and group D [(154.45 ±19.69),(161.74±23.78),(153.33±24.41 ),( 156.90 ± 22.20) mg/L] (P ＜ 0.05 ).They were lower in groups A and B than in group D on the 15th,30th and 60th day post-operation (P ＜ 0.05). There were no significant differences between groups A and B (P ＞ 0.05 ).Conclusion ( 1 ) The anti-guinea pig' s arteries IgG and complement C3 change in the serum after the operation in rats; (2) Tissue-engineering blood vessels and acellular guinea pig' s arteries have weaker immunogenicity than fresh guinea pig' s arteries ; (3) The method to transplant allogeneic BMSC onto acellular hetergeneic arteries can decrease the immunogenicity obviously.This method may be an appropriate way to construct tissue-engineering blood vessels.