目的:通过分析青年急性心肌梗死(AMI)患者不同程度Killip分级的血尿酸(SUA)等临床资料的特点,探讨青年AMI患者Killip分级严重程度相关影响因素.方法:连续入选2016年12月1日至2018年12月31日经首都医科大学附属北京安贞医院急诊科收住的45岁以下成年AMI患者430例,采用心功能Killip分级评估全部青年患者发生AMI时住院期间心力衰竭的严重程度.依据Killip分级,分为Killip低分级组(Killip分级Ⅰ级),设为对照组;和Killip高分级组(Killip分级Ⅱ～ Ⅳ级)设为试验组.比较2组间各项临床指标差异,分析SUA与Killip分级程度的相关性,采用Logistic回归方法分析青年AMI患者Killip分级严重程度的相关影响因素.结果:试验组SUA水平和心率(HR)明显高于对照组[(448.50±66.06)vs.(386.51,±58.01) μmol/L和(83.86±14.53)vs.(73.97±15.50)次/min](均P＜0.01).青年AMI患者SUA水平与Killip分级严重程度呈直线正相关(r=0.618,P＜0.001).Logistic回归分析结果提示,SUA水平升高、HR增快和舒张压(DBP)增高是青年AMI患者出现Killip分级心功能严重恶化的重要危险因素(OR=1.050,95％CI:1.355～8.127,P=0.035;OR=1.053,95％CI:1.020～1.087,P=0.003和OR=1.075,95％CI:1.008～1.145,P=0.026).结论:青年急性心肌梗死患者住院期间SUA水平与Killip分级严重程度密切相关,SUA水平升高是Killip分级严重程度的重要危险因素.

回顾性分析2018年1月—2020年8月首都医科大学附属北京安贞医院风湿免疫科治疗的白塞综合征患者20例的临床及影像学检查资料.20例患者中,男4例,女16例,平均年龄41.2岁,平均病程17.0年.超声、CT及MR检查发现心血管系统受累13例,主要表现为主动脉瓣脱垂并重度关闭不全,主动脉瘤、主动脉假性动脉瘤、主动脉溃疡、主动脉分支血管狭窄或闭塞等;肺栓塞2例,下肢静脉血栓1例.全部患者均接受激素和/或免疫抑制剂治疗.3例行主动脉瓣置换术,术后随访6个月,发生瓣周漏1例并行二次Bentall术治疗,主动脉瓣下假性动脉瘤1例,无异常1例.2例行腹主动脉腔内隔离术治疗,术后随访1年,发现支架周围脓肿1例,支架远端假性动脉瘤1例.结果提示白塞综合征累及心血管系统时表现多样,早期诊断及手术治疗困难.临床联合应用多种无创心血管影像学检查手段,可为白塞综合征患者心血管系统受累的诊断、治疗、随访及预后评估提供全面的心血管病变影像学信息.

目的 分析大动脉炎(Takayasu arteritis,TA)患者主动脉壁中有无淋巴细胞和浆细胞的表达,了解适应性免疫细胞是否参与TA的发病.方法 对阜外医院行外科手术治疗的8例诊断为TA患者进行回顾性研究,研究其大动脉壁石蜡包埋组织切片免疫组织化学染色,计数CD20+B细胞,CD138+浆细胞以及CD4+T细胞的数量.结果 8例TA患者男女比例1:1,平均年龄(34.5±15.78)岁,病程平均为(46.13±37.47)个月.8例TA患者中,6例动脉壁中可见大量CD4+辅助T细胞和/或CD20+B细胞灶性浸润,3例见CD138+浆细胞灶性浸润,此3例患者红细胞沉降率均增高.结论 TA大动脉壁内有辅助T细胞、B细胞和浆细胞浸润,提示适应性免疫反应,包括体液免疫反应参与了TA发病.

Objective To explore clinical characteristics of large vessel involvements in patients with Behcet's disease(BD).Methods Totally 141 patients with BD fiom January 1991 to December 2011 in Beijing Anzhen Hospital,Capital Medical University and Peking University People's Hospital were retrospectively enrolled;36 patients had large vascular lesions.General information and laboratory examination results were recorded.Features of vascular lesions were analyzed.Results Constituent ratios of male,surgical operation,cyclophosphamide application,nervous system impairment,C-reactive protein increasing and antinuclear antibody positive in large vascular lesion group(36 cases) were significantly higher than those in non-large vascular lesion group(105 cases) [44.4％ (16/36) vs 33.3％ (35/105),33.3％ (12/36) vs 0.0％ (0/105),36.1％ (13/36) vs 11.4％ (12/105),30.6％ (11/36) vs 8.6％ (9/105),55.2％ (16/29) vs 32.6％ (28/86),24.0％ (6/25) vs 6.0％ (5/84)] (P ＜ 0.05);leukocyte count and neutrophil count in large vascular lesion group were significantly higher than those in non-large vascular lesion group[8(7,11) × 109/L vs 7(5,10) × 109/L,6.5(4.8,9.6) × 109/L vs 4.5 (3.0,6.3) × 109/L] (P ＜ 0.05);constituent ratio of non-steroid anti-inflammatory drug application in large vascular lesion group was significantly lower than that in non-large vascular lesion group[13.9％ (5/36) vs 42.9％(45/105)] (P ＜ 0.05).Twenty-two patients (61.1％) had arterial lesions;intracranial artery was the main involvement [22.2％ (8/36)];the proportion of arterial lesions in female was significantly higher than that in male [57.1％ (4/36) vs 13.8％ (4/36)] (P ＜ 0.05);true/false aneurysm accounted for the largest proportion [36.1％ (13/36)] and all occurred in male[44.8％ (13/29)].The incidence of arterial thrombosis/embolism in female was significantly higher than that in male [85.7 ％ (6/7) vs 20.7％ (6/29)] (P ＜ 0.05).Nineteen patients (52.8％) had venous lesions;lower limb vein was the main involvement [33.3％ (12/36)];venous thrombus accounted for the largest proportion[41.7％ (15/36)].Conclusion Clinical of large vascular lesions of Behcet's disease including different characteristics of men and women,increasing white blood cell count and neutrophil count,frequently involved the intracranial artery and venous,often expressed as a true / false aneurysm and venous thrombosis has significance for diagnosis and treatment of the disease.

Objective To investigate clinical features of cardiac damage in patients with Takayasu's Arteritis(TA) in different genders.Methods Clinical data of 82 patients with TA from January 2004 to January 2015 in Beijing Anzhen Hospital,Capital Medical University were analyzed retrospectively.Cardiac impairment was assessed by imaging examination;general data,clinical manifestations,laboratory indicators,vascular involvements,clinical classification and echocardiographic findings were analyzed in TA patients with cardiac damage.Results There were 63.4％ (52/82) of TA complicated with cardiac damage,including 6 males and 46 females.The onset age and the duration between onset and diagnosis had no significant differences between male and female (P ＞ 0.05).The proportion of upper limbs blood pressure difference ≥ 10 mmHg in male was significantly lower than that in female [1/6 vs 73.9％ (34/46)] (P ＜ 0.05).The proportion of C-reactive protein elevation in male was significantly higher than that in female[6/6 vs 50.0％ (23/46)] (P ＜0.05).The proportion of erythrocyte sedimentation rate elevation had no significant difference between male and female(P ＞ 0.05).The incidence of left subclavian artery stenosis or occlusion in male was significantly lower than that in female [0/6 vs 69.6％ (32/46)] (P ＜ 0.05).The clinical classification had no significant difference between male and female(P ＞ 0.05).The left ventricular ejection fraction in male was lower and the incidence of left ventricular diastolic dysfunction was higher than those in female [(54 ± 15) ％ vs (64 ± 9) ％,6/6 vs 32.6％ (15/46)] (P ＜ 0.05).The incidence of myocardial lesions in male was significantly higher than that in female [2/6 vs 4.3％ (2/46)] (P ＜ 0.05).Conclusion Cardiac damage in male patients with TA mainly manifests myocardial lesions and left ventrictdar diastolic dysfunction;it in female patients mainly manifests left subclavian artery lesions.

Objective:Discuss the clinical characteristics of Cardiovascular Behcet's disease with cardiac valve.Methods:Clinical data of 35 patients with Cardiovascular Behcet's disease with cardiac valve admitted to Peking Anzhen Hospital in the last 10 years was retrospectively analyzed.Results:Patients with male 29 cases,female 6 cases,onset age between the ages of 21 to 57.Patients with 23 (65.7％)cases involving the aortic valve;In patients with preoperative diagnosis of 14 cases once operation,4(22.2％)cases twice operation,1 case without operation,2 cases died,4 cases happen perivalvular leakage after the first operation;Preoperative uncertain diagnosis of 4 cases once operation,8 cases twice operation,4 case three times operation,3 cases died,16 (100％)cases happen perivalvular leakage after the first operation;perivalvular leakage of hormone therapy in patients with 8 cases,21 cases not on hormone therapy;perivalvular leakage not occurring in 25 patients with hormone therapy is not 0 of hormone therapy on patients.Conclusion:The mostly point of the patients of Cardiovascular Behcet's disease with cardiac valve is diagnose definitudly before the operation,and treated in evidence.It is happened perivalvular leakage easily after the operation without system medical treated and dangered the life of the patients.The treatment of hormone can efficiencily reduce the perivalvular leakage after operation.

目的 探讨不同性别类风湿关节炎(RA)患者的临床特点.方法 选择61例男性RA患者和83例女性RA患者为研究对象,记录2组患者的一般资料、心血管疾病危险因素、有无间质性肺病、有无冠状动脉粥样硬化性心脏病及RA相关药物使用情况,并检测血清血脂、空腹血糖、超敏C反应蛋白(hs-CRP)及同型半胱氨酸(Hcy)水平,比较2组患者各指标的差异.通过Spearman秩相关分析确定不同性别RA患者各生物化学指标与hs-CRP的相关性.结果 男性RA患者吸烟率显著高于女性(P＜0.01);冠状动脉粥样硬化性心脏病发病率显著高于女性(P＜0.05).男性RA患者血清总胆固醇、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平均显著低于女性(P＜0.01);hs-CRP水平显著高于女性(P＜0.05);Hcy水平显著高于女性(P＜0.01).男、女性RA患者HDL-C与hs-CRP水平均呈负相关(r=-0.253,P=0.049;r=-0.414,P=0.000).结论 RA是一种高度异质性疾病,男性较女性疾病活动度高,心血管受累问题突出,病情相对较重.对男性RA患者更应积极干预相关因素,减少心血管不良事件的发生.

Objective To investigate correlations of serum 25-hydroxyvitamin D [25-(OH)-D] with blood lipid metabolism and coronary artery disease(CAD) in patients with rheumatoid arthritis(RA).Methods Totally 132 patients with RA who had coronary arteriongraphy from January 2014 to March 2016 in Beijing Anzhen Hospital,Capital Medical University were enrolled as RA group,which were further divided into 2 subgroups:group A(81 cases,complicated with CAD) and group B (51 cases,without CAD).Other 25 healthy people matched in age and sex were selected as control group.Serum levels of 25-(OH)-D were analyzed.The correlation between 25-(OH)-D and blood lipid components and the risk factor of CAD were analyzed.Results The serum level of 25-(OH)-D in RA group was significantly lower than that in control group[(15 ± 8)μg/L vs (25 ± 7)μg/L] (P ＜0.01),the serum level of 25-(OH)-D in group B was significantly lower than that in group A[(13 ± 7)μg/L vs(16 ±9)μg/L] (P ＜0.01).In RA group and group A,serum 25-(OH)-D was negatively correlated with total cholesterol(TC) and low density lipoprotein cholesterol(LDL) (RA group:r =-0.213 and-0.215,P =0.014 and 0.013;group A:r =-0.229 and-0.248,P =0.039 and 0.025);there was no correlation in control group and group B(P ＞ 0.05).Serum 25-(OH)-D ＜ 30 μg/L was an independent risk factor of CAD in RA group(odds ratio:0.86,95％ confidence interval:0.75-1.00,P ＜ 0.05).Conclusions The serum level of 25-(OH)-D is negatively correlated with TC and LDL in RA patients without CAD.The serum level of 25-(OH)-D ＜30 μg/L is an independent risk factor of CAD in RA patients.

Takayasu’s arteritis (TAK) is a type of large vessel vasculitis which involves the aorta and its major branches. Interleukin (IL)-9 or IL-9-producing Th9 cells were found to be involved in pathogenesis of autoimmune arteritis such as giant cell arteritis, but IL-9 or Th9 cells in TAK were not well known. Here, this study aims to analyze the levels of serum IL-9 and their major source Th9 cells in TAK. With the help of cytometric bead array (CBA), a total of 21 patients with TAK were examined for serum levels of cytokines IL-4, IL-6, IL-8, IL-17, IL-10, TNF-α, IFN-γ, and IL-9. Flow cytometry techniques were used to examine the frequencies of Th9 cells from peripheral blood mononuclear cells (PBMCs) for 11 patients with active TAK and 10 healthy controls. Higher serum levels of serum IL-6 (P < 0.05), TNF-α (P < 0.05), and IL-9 level (P < 0.05) were observed in TAK patients compared to those of healthy controls. Higher frequencies of CD4+ IL-9+ T cells and CD4+ PU.1+ T cells in PBMCs and IL-9+ PU.1+ T cells in CD4+ T cells were observed in active TAK patients than those in healthy controls (all P < 0.01). The levels of IL-9 had a positive correlation with ESR (r = 0.975, P = 0.015) in these cases. Our data suggested that Th9 cells and IL-9 could possibly be involved in the pathogenesis of TAK.

Objective To investigate the relative factors of coronary artery disease (CAD) in middle-aged and elderly patients with rheumatoid arthritis (RA).Methods Clinical data of 136 middle-aged and elderly patients with RA from January 2013 to December 2014,including 76 cases with CAD (observation group) and 60 cases without CAD (control group),were analyzed retrospectively.The gender,age,cause of RA,hypertension,diabetes mellitus,dyslipidemia,smoking and medications were recorded;the body mass index (BMI),systolic blood pressure (SBP) and diastolic blood pressure (DBP),the serum levels of triglyceride,total cholesterol,high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C),fasting blood glucose (FBG),high-sensitive C-reactive protein (hs-CRP) and homocysteine (Hcy) were detected.Above indexes were compared between groups,and multivariate Logistic regression analysis was performed to aaalyze the independent predictors of CAD in middle-aged and elderly patients with RA.Results The course of RA was significantly longer,the proportion of hypertension was significantly higher,the usage rates of glucocorticoid hormone and hydroxychloroquine (HCQ) were significantly lower in observation group than those in control group [(15 ± 9) years vs (10±10) years,65.8％ (50/76)vs41.7％ (25/60),23.7％ (18/76)vs46.7％ (28/60),5.3％ (4/76)vs 23.3％ (14/60),P ＜ 0.01].The serum levels of total cholesterol,LDL-C,HDL-C was significantly lower,the level of Hcy was significantly higher in observation group than those in control group [(4.2 ± 1.0) mmol/L vs (4.8±0.9) mmol/L,(2.5 ±0.8) mmol/L vs (2.9±0.8) mmol/L,(1.06±0.30) mmol/L vs (1.20± 0.33) mmol/L,(17 ±8) μmol/L vs (14 ±7) μmol/L] (P ＜0.01 or P ＜0.05).Logistic regression analysis showed that the cause of RA and hypertension were independent risk factors of CAD,the usage of HCQ was a protective factor of CAD in middle-aged and elderly patients with RA [odds ratio:1.054,2.629,0.118;95％ confidence interval:1.009-1.101,1.201-5.755,0.029-0.484].Conclusions Longer cause of RA and hypertension are independent risk factors of CAD,HCQ usage is a protective factor of CAD in middle-aged and elderly patients with RA;actively correcting the immune disorder is of great importance for preventing cardiovascular adverse events in middle-aged and elderly patients with RA.

Objective To explore manifestations and risk factors of cardiac involvement in patients with Takayasu's arteritis (TA).Methods Data of 55 TA patients complicated with cardiac injury among 85 TA patients,including clinical manifestations and results of physical,laboratory,imaging examination,were retrospectively analyzed.The cardiac injury was assessed by echocardiography and coronary CT angiography CT.Relative clinical data of TA patients complicated with cardiac injury were compared withTA patients without cardiac injury.Results In the 55 patients,47 were female and 8 were male.The time of confirmed diagnosis in TA patients with cardiac injury was significantly later [36 (9,168)months vs 12 (6,24) months],compared with that in TA patients without cardiac injury;meanwhile chest pain and blood pressure difference ＞ 10 mmHg between right-to-left sides were more like to occur [27.3％ (15/55) vs 6.7％ (2/30),69.1％ (38/55) vs 46.7％ (14/30)] (P ＜ 0.05).The proportions of patients with increased erythrocyte sedimentation rate and C reactive protein were not statistically different between TA patients with or without cardiac injury [63.6％ (35/55) vs 56.7％ (17/30),58.2％ (32/55) vs 53.3％ (16/30)] (P ＞ 0.05).In TA patients with cardiac injury,there were 13 of type Ⅰ (23.6％),11 of type Ⅱ (20.0％),28 of type Ⅲ (50.9％),1 of type Ⅰ +Ⅳ (1.8％),2 of type Ⅲ+ Ⅳ (3.6％);30 patients (54.5％) had hypertensive heart disease,including 18 of renal arterial stenosis or occlusion the onset hypersension were of (28 ± 14) years,which was younger than those without renal arterial involvement [(44 ± 14) years] (P ＜ 0.05);6 patients (10.9％) had old of age cardiomyopathy,showing a lower left ventricular ejection fraction and a younger onset age compared with patients without acardiomyopathy [(34±8)％vs (66±7)％,(15±13) years vs (25±11) years] (P＜0.05);36 patients (65.5％) had valvular disease;9 patients (16.4％) had coronary artery disease;7 patients (12.7％) had pulmonary hypertension with rest pulmonary arterial systolic pressure of (62 ± 22) mmHg,but there was no manifestation of right heart failure.Multivariate analysis showed that higher CRP was an independent risk factor of pulmonary hypertension [odds ratio(OR) =0.082,95％ confidence interval (CI):0.007-0.965,P ＜ 0.05],mitral valve regurgitation (OR =0.192,95％ CI:0.040-0.929,P ＜ 0.05) and tricuspid regurgitation (OR =0.093,95％ CI:0.011-0.761,P ＜ 0.05).Conclusion Cardiac involvement is not rare in TA;special attention should be paid to the cardiac manifestation,and early diagnosis and treatment can reduce cardiac injury.

Objective To explore the clinical features of Takayasu's arteritis (TA) complicated with pulmonary arterial hypertension (PAH).Methods Clinical manifestations,lab data and imaging findings of 85 TA inpatients from January 2004 to January 2014 were retrospectively analyzed.The clinical data were compared between patients with PAH and without PAH.Results Seven patients (8.2％) had PAH,including 6 females and 1 male.Seven patients had pulmonary artery involved but without PAH and their onset age and time of diagnosis were significantly different from those TA patients with PAH [(33 ±7) years vs (25 ±3) years,(19 ±8) months vs (55 ±41) months] (P ＜0.05).In patients with PAH,4 cases had chest/back pain and anhelation after exercise as initial symptoms;the involved vessels were mainly subclavian artery (5 cases),pulmonary artery (4 cases) and aorta (4 cases);according to angiographic classification,1 case was type Ⅱ,2 cases were type Ⅲ,1 case was type Ⅱ + Ⅳ,2 cases were type Ⅲ + Ⅳ,1 case was type Ⅰ + Ⅳ;6 cases had pulmonary stenosis;6 cases had valve lesions;the average pulmonary arterial systolic pressure was (62 ± 22) mmHg.Regarding drug treatment,single corticosteroid treatment was given in 2 cases;corticosteroid combined with cyclophosphamide,asprin and leflunomide were given in 1 case;tripterygium combined with asprin were given in 1 case;single antiplatelet therapy was given in 3 cases;the level of C reactive protein and erythrocyte sedimentation rate were both abnormally increased [(16 ±4) mg/L,(45 ±7) mm/1 h].Compared with patients without PAH,patients with PAH were more prone to anhelation after exercise,weakness,and there were more involvement of pulmonary artery,ascending aorta and aortic arch but less dizziness [57.1％ (4/7) vs 20.5％ (16/78),71.4％ (5/7) vs 34.6％ (27/78),57.1％ (4/7)vs9.0％ (7/78),28.6％ (2/7)vs9.0％ (7/78),28.6％ (2/7)vs3.8％(3/78),0.0％ (0/7) vs 64.1％ (50/78)] (P＜0.05).Conclusion PAH is a serious complication of TA when the pulmonary arterial is involved;the pulmonary artery pressure should be paid attention in those with anhelation after exercise,weakness,and involvement of pulmonary artery,ascending aorta and aortic arch;active treatment of the primary disease helps reduce the pulmonary artery systolic pressure.

随着医学教育要求的不断提高，近年来研究及实践的热点多围绕着“标准化病人（Standardized Patients，SP）教学”、“以问题为中心的（Problem-Based Learning，PBL）教学法”以及“模拟医学教学（Simulation Based Medical Education，SBEM）”的教学模式展开。将这三种模式有机的结合并应用于风湿病教学中，可以很大程度地发挥各种教学模式的优点，充分调动医学生学习的主观能动性，强化培养学生对于风湿病诊疗方面正确的临床思维，从而提高解决各种临床问题的能力。

Objective To evaluate the level and clinical siguificance of serum 25-hydroxyvitamin D in patients with rheumatoid arthritis (RA).Methods Totally 108 untreated RA patients (RA group) and 49 healthy people (control group) from January 2014 to January 2015 were enrolled.According to the disease activity score in 28 joints (DAS28),patients in RA group were divided into remission stage group (＜ 2.6 scores,42 cases) and active stage group (＞3.2 scores,66 cases).The levels of serum 25-(OH)-D were measured and compared among groups.The correlations between 25-(OH)-D level and relative indicators were analyzed.Results The level of serum 25-(OH)-D in RA group was significantly lower than that in control group [(13 ±7) μg/L vs (26 ± 5) μg/L] (P ＜ 0.01).There were negative correlations between serum 25-(OH)-D level and C reactive protein (CRP),erythrocyte sedimentation rate (ESR),DAS28 score in RA group (r =-0.361,r =-0.280,r =-0.275,P ＜ 0.01).The level of serum 25-(OH)-D was not significantly different between remission group and active group (P ＞0.05).The serum 25-(OH)-D level was negatively correlated with CRP,ESRandDAS28 score (r=-0.467,r=-0.245,r=-0.499,P＜0.05) in active stage group but not in remission stage group (P ＞0.05).In active stage group,the 25-(OH)-D levels in males and females were not significantly different;it was negatively correlated with CRP,ESR,DAS28 in females (r =-0.529,r =-0.373,r=-0.572,P＜0.05),but not in males in RA patients (P＞0.05).Conclusion The 25-(OH)-D level in serum is reduced in patients with RA and it is negatively correlated with disease activity,especially in female patients;serum 25-(OH)-D level can be as a marker of monitoring the disease activity in RA patients.

目的:探讨类风湿关节炎(RA)合并冠心病患者的临床特点.方法:入选接受冠状动脉造影检查的RA患者47例,根据冠状动脉造影情况分为单纯RA组(31例)和RA合并冠心病组(16例);收集入选患者临床资料及冠状动脉造影结果进行回顾性病例-对照分析,并通过Logistic回归分析确定RA患者发生冠心病的危险因素.结果:RA合并冠心病组患者血清同型半胱氨酸(Hcy)水平、免疫球蛋白E(IgE)水平及甲氨蝶呤服用率较单纯RA组明显升高,空腹血糖水平较单纯RA组低,差异均有统计学意义(P＜0.05);Hcy是RA发生冠心病的独立危险因素(OR=1.583,95％ CI:1.070～2.342,P＜0.05).结论:RA合并冠心病患者体内存在高Hcy血症较单纯RA更加普遍,且Hcy是RA发生冠心病的独立危险因素;IgE水平升高是RA合并冠心病的另一个血清学特点.

Objective To investigate the clinical characteristics of non-atherosclerotic(NA) coronary artery disease(CAD) and the result of 2 years follow-up.Methods Twenty-four patients with NA-CAD among 967 patients with coronary artery disease aged between 18 and 45 years were selected and retrospectively analyzed.Results(1)Ratio of male(M) and female(F) was 7:5 in 24 patients(2.48% of 967 patients),the average age was(41.62±2.68) years.(2) In female group,the period from onset to be diagnosed clearly was longer than that in male group(42.86% vs 0.00%,P0.05).The incidence of myocardial infarction(MI) or segmental wall motion abnormalities was lower in female group than that in male group(10.00% vs 50.00%,P0.05),the left ventricular end diastolic dimension(LVEDD) in female group was shorter than that of male group [(44.90±4.58)mm vs(51.83±7.51)mm,P0.05].(3)They shared similar features between patients aged 18-40 years and whom aged 41-45 years.But in patients aged between 41 and 45 years,the ratio of MI in male group was higher than that in female group(50.00% vs 0.00%,P0.05),and LVEDD in male group was bigger than that in female group[(51.56±5.05)mm vs(46.14±4.30) mm,P0.05].(4) Coronary angiogram showed most coronary artery disease were single-vessel morbid change,especially left anterior descending branch(50.00%) was more likely to be involved.(5) All of the 24 patients achieved clinical remission after percutaneous transluminal coronary intervention(PCI).No major adverse cardiac events were observed during their hospitalization and 2 years follow-up.(6) Three patients underwent the screening of rheumatic diseases during the follow-up,2 patients of them were diagnosed as systemic vasculitis keeping remission in the following 2 years.Conclusion Patients with NA-CAD were not rare in clinic.and most of it had development at the age of 40 years old.The ratio of female was higher compared with that in traditional atherosclerotic CAD patients;in female patients,the onsets were relatively occult and the manifestations were not serious;single-vessel involvement was more likely to be found;given the PCI of NA-CAD,the short-term outcome was good.It is suggested that systemic vasculitis may be one of the causes of NA-CAD.For young female with suspected CAD,exclude non-atherosclerotic diseases such as vasculitis should be recommended.

Objective To compare the clinical features of Takayasu' s arteritis(TA)patients in different gender and improve the diagnosis level of TA in male.Methods The data of fifty-three TA patients which were treated in Anzhen Hospital from January 2010 to December 2011 were analyzed retrospectively.Results(1)The onset age was(35±11)years old in male patients and was(28±11)years old in female patients,there was no statistic difference between different gener(P >0.05).(2)The common primary symptoms were dizziness(52.8%),chest pain / suppression(35.8%),and intermittent lameness(32.1%)and chest pain / suppression was easily found in male patients than in female patients(63.6% vs 28.6%,P<0.05).(3)The common signs were pulseless / reduced radial artery pulse(71.0%),elevated blood pressure(60.4%)and blood pressure difference>10 mmHg(40.7%,1 mmHg=0.133 kPa).(4)Male patients had more frequencies with abnormal renal indexes(72.7% vs 33.3%,P=0.018).(5)Based on image classification,the common subsets were type Ⅴ(43.4%),typeⅠ(22.6%)and typeⅡa(13.2%),there was no statistic difference of clinical typing between male and female(P>0.05).Moreover,diffuse arteries lesions were more in male patients than in female individuals(90.9% vs57.1%,P>0.05).(6)There was no significant difference of complication between the male patients and female patients(P >0.05).Conclusion Male patients with TA have late onset age,more aortic valve and aortic arch / ascending aorta lesions,more arteries involvements,some of which bear abnormal renal functions than female TA patients.

Objective To explore the clinical features of takayasu's arteritis (TA) in over 40 years old patients.Methods We retrospectively analyzed manifestations and tests in 53 TA patients.Results Onset age in 17％ patients was over 40.Fever and chest pain were found in first-visit over 40 years old patients (P ＜ 0.05).Laboratory tests showed no differences between young and middle age patients.Patients over 40 had less renal artery,abdominal aortic and multiple vascular involvement (P ＜ 0.05).Thoracic aorta involvement was an independent risk factor of elevated blood pressure (P ＜ 0.05) ; ascending aorta involvement was an independent risk factor of aortic regurgitation (P ＜ 0.01) and combined aneurysm formation (P ＜ 0.05).Conclusion Early diagnosis and treatment are important for TA in over 40 years old patients.

Objective:To investigate the clinical features,diagnosis and prognosis of influencza A(H1N1) virus infection in 2009.Methods:The clinical data of 98 patients with influenza A(H1N1) admitted into Beijing Anzhen Hospital Affiliated to Capital Medical University and 5 critically ill patients with same diseases in other hospitals from August 2009 to January 2010 were retrospectively analyzed,and related literatures were reviewed.Results:In the group of cases,the average age was(31.06±13.43) years,and the main clinical manifestations presented fever(100%),cough(88.3%) and chill(81.6%),etc.The mortality rate of severe and critically ill patients was 22.2%.The most common complications was bacterial infection and acute respiratory distress syndrome as well as multively.Organ dysfunction syndrome,and the incidences was 85.7%,57.1% and 28.6%,respectively there was significant relation between chronic underlying diseases and presence of severe cases.Conclusion:The influenza A(H1N1) often occur in young adults,main clinical characteristics present respiratory tract symptoms.In severe cases,there may be double infection,coagulation disorder,respiratory alkalosis and hypoxemia or respiratory failure,which happen easily in existence of chronic underlying diseases.