目的 分析非瓣膜型心房颤动(NVAF)患者行射频消融术(RFA)后循环中血小板活化和内皮功能障碍的影响.方法 从2018年10月至2019年10月的35例NVAF患者(AF-术前组、AF-术后组)和30例正常窦性心律(NSR对照组)受试者中抽取静脉血样.流式细胞术测定血小板的激活、线粒体跨膜电位(Δψm)去极化以及循环中血小板和内皮细胞微颗粒(MPs).ELISA分析血浆中血管性血友病因子(vWF)和内皮素-1(ET-1)水平.评估NVAF患者PMPs、EMPs与CHA2DS2-VASc评分的关系.结果 与NSR对照组相比,AF-术前组血小板激活和线粒体去极化Δψm明显增加(P=0.0004,P<0.0001).与AF术前相比,AF-术后组血小板激活和线粒体去极化Δψm明显减弱(P=0.0126,P<0.0001).AF-术前组PMPs、EMPs、vWF和ET均明显高于与AF-术后或NSR对照组(P均<0.0001).PMPs数量与CHA2DS2-VASc评分呈正相关(r=0.6725,P<0.0001),而EMPs数量与CHA2DS2-VASc评分无显著性差异(r=0.1216,P=0.4864).结论 NVAF可伴有血小板异常活化、凋亡和内皮功能障碍.活化血小板释放的PMPs增加可能与NVAF预后发生血栓栓塞有关.

目的:探讨阵发性心房颤动(PAF)导管射频消融术(RFCA)后复发的相关独立危险因素以及多指标联合评估模型在预测RFCA后PAF复发中的价值.方法:回顾性分析于2017年1月—2018年10月在苏州大学附属第一医院心内科行首次RFCA的PAF患者186例,收集患者的一般临床资料、血清学资料、超声心动图资料、消融方式及口服药物资料等,并构建3种指标左心房内径(LAD)、中性粒细胞与淋巴细胞比值(NLR)及术后早期复发(ERAF)]联合的新评估模型,术后随访12个月,记录复发情况.采用二元Logistic回归分析建立预测模型,用受试者工作特性(ROC)曲线和曲线下面积(AUC)评估预测效率,最后用MedCalc软件的Z检验比较不同指标的AUC.结果:38例(20.43％)复发(复发组),148例(79.57％)无复发(未复发组).两组LAD、NLR、ERAF、红细胞分布宽度(RDW)、总胆固醇(TC)、甲状腺素(T4)以及白细胞(WBC)差异有统计学意义(P＜0.05).多因素分析显示:LAD(OR = 1.227,95％CI:1.090～1.382,P = 0.001)、NLR(OR = 2.020,95％CI:1.295～3.151,P=0.002)、ERAF(OR = 16.886,95％CI:5.698～50.037,P＜0.001)是PAF术后复发的独立危险因素.LAD、NLR及ERAF预测PAF术后复发的AUC分别为0.773、0.758和0.767.LAD、NLR及ERAF预测PAF复发的敏感度和特异度分别为0.730和0.741、0.865和0.585、0.595和0.939.LAD+NLR+ERAF联合评估模型预测PAF术后复发的AUC为0.902,敏感度为0.865,特异度为0.837.结论:本研究显示,LAD、NLR和ERAF是RFCA后PAF复发的独立危险因素,LAD+NLR+ERAF联合评估模型对RFCA后PAF复发风险的评估效能高于任何单一指标,其对PAF术后复发的预测更可靠.

目的 探讨特发性室性早搏(室早)的发生与自主神经机制之间的关系.方法 采用单中心回顾性研究方法,选择24 h动态心电图记录到频发室早(≥10000次/d或室早负荷≥10％)的156例特发性室早患者(室早组)和同期健康体检者84例(对照组)为研究对象.根据24 h动态心电图检查结果,计算心率变异性指标rMSSD、pNN50、高频功率(HF)、标准化的高频功率(HFnorm)、低频功率(LF)与HF的比值(LF/HF).比较两组自主神经张力间的差异,并分析室早负荷与自主神经张力变化的关系.结果 与对照组相比,室早组患者rMSSD、pNN50、HF和HFnorm均明显增加(P<0.01),LF/HF显著降低(P<0.01).室早组患者24 h室早负荷与rMSSD、pNN50和HF呈正相关(相关系数分别为0.492、0.425、0.372,P<0.01),而与LF/HF呈负相关(相关系数为-0.206,P<0.05);其中28.8％(45/156)的患者每小时室早负荷与每小时HFnorm呈正相关,16.0％(25/156)的患者与每小时LF/HF呈正相关,53.8％(84/156)的患者与每小时HFnorm和每小时LF/HF均无相关性.结论 部分特发性室早的发生与交感和(或)迷走神经张力变化相关.

目的 探讨急性ST段抬高型心肌梗死(STEMI)患者主动脉瓣硬化(AVS)与经皮冠状动脉介入治疗(PCI)后无复流的关系,并对发生无复流的影响因素进行分析.方法 连续纳入2019年1月至2019年12月本院收治的117例初诊急性STEMI患者,均接受急诊冠状动脉造影和PCI治疗.根据是否发生PCI术后无复流、是否存在AVS对患者进行分组.比较各组患者的临床资料,并通过多因素Logistic回归分析影响急性STEMI患者PCI术后发生无复流的因素.结果 本研究中,28例患者PCI术后发生无复流(无复流组),89例未发生(正常血流组);23例患者的心脏超声提示AVS(AVS组),94例未提示AVS(非AVS组).无复流组患者的年龄、AVS占比及SYNTAX积分高于正常血流组,吸烟占比低于正常血流组,差异具有统计学意义(P<0.05).AVS组患者PCI术后无复流发生率显著高于非AVS组,差异具有统计学意义(P<0.05).多因素Logistic回归分析结果显示,年龄、AVS、SYNTAX积分是影响急性STEMI患者PCI术后发生无复流的独立危险因素(P<0.05).结论 在行PCI术的急性STEMI患者中,AVS与PCI术后无复流关系密切,因此,临床上针对STEMI合并AVS患者应给予有效干预.

目的 分析急性心肌梗死患者新发房颤的危险因素.方法 急性心肌梗死住院期间新发房颤者92例(房颤组),无房颤的急性心肌梗死患者127例(对照组),收集并比较两组患者年龄、性别、吸烟史、入院诊断、既往病史、Killip分级、入院心率血压、住院周期、住院结局、心脏彩超、胸痛组套、生化全套、冠脉造影等资料,采用Logis-tic回归分析法对急性心肌梗死患者新发房颤的危险因素进行分析.结果 房颤组患者男61例、女32例,年龄(74.10士10.29)岁,吸烟者42例,高血压史72例、糖尿病史39例,中风史8例,Killip分级I级39例、Ⅱ级24例、Ⅲ级12例、Ⅳ级18例,左心室射血分数(LVEF)44.54％±9.72％,左房内径(43.14±6.91)mm,氨基末端脑钠肽前体(NT-proBNP) 8310.46(1840.00,11300.00) pg/mL,肌酸激酶同工酶135.17(28.90,176.27) ng/mL,心率(86.09±22.22)次/分,住院时间(13.13 ±7.91)天,住院期间死亡10例,谷氨酰转肽酶(GGT) 57.80(21.00,76.00)U/L,直接胆红素(8.97±4.26) μmol/L,肌酐(109.39±89.66) μmol/L,尿酸(414.84±169.47) μmol/L,尿素(8.83±5.11)mmol/L,超敏C-反应蛋白(10.82 ±4.74) mg/L,血钾(4.11-±0.58) mmol/L,甘油三酯(1.20±0.69) mmol/L,总胆固醇(4.11±1.09) mmol/L,低密度胆固醇(2.49±0.92) mmol/L,多支病变55例,回旋支病变51例;对照组患者男108例、女19例,年龄(62.57±13.20)岁,吸烟者84例,高血压史78例、糖尿病史27例、中风史8例,Killip分级Ⅰ级96例、Ⅱ级21例、Ⅲ级7例、Ⅳ级3例,LVEF 49.09％±9.25％,左房内径(39.74±5.20) mm,NT-proBNP3646.89(414.00,4337.00) pg/mL,肌酸激酶同工酶150.63(30.77,218.60) ng/mL,心率(80.29±17.30)次/分,住院时间(10.39 ±5.19)天,住院期间死亡5例,GGT 43.93 (20.00,46.00) U/L,直接胆红素(7.78±4.60) μmol/L,肌酐(90.90±80.63) μmol/L,尿酸(373.86±132.89)μmol/L,尿素(6.73±4.49) mmol/L,超敏C-反应蛋白(8.48±5.16) mg/L,血钾(3.91±0.38) mmol/L,甘油三酯(1.52±1.00) mmol/L,总胆固醇(4.49±1.14) mmol/L,低密度胆固醇(2.85 ±0.91) mmol/L,多支病变60例,回旋支病变50例;两组患者以上资料相比,P均＜0.05.年龄(OR=1.090 3,95％ CI为1.053 7～1.1284,P＜0.000 1)、GGT(OR=1.010 5,95％ CI为1.0025 ～1.018 6,P=0.010 0)、左房内径(OR=1.090 7,95％ CI为1.025 1～1.160 5,P=0.006 0)、LVEF(OR=0.004 5,95％ CI为0.000 1 ～0.340 7,P=0.014 0)是急性心肌梗死患者新发房颤的独立影响因素.结论 年龄、GGT、左房内径、LVEF是急性心肌梗死患者新发房颤的独立危险因素.

目的 探讨尼可地尔联合前列地尔治疗顽固性心绞痛的临床效果及对患者血流动力学、氧化应激指标的影响.方法 选择2016年1月至2018年1月苏州市高新区人民医院收治的110例顽固性心绞痛患者为研究对象,按照随机数字表法分为观察组和对照组,每组各55例.两组患者均给予常规支持治疗,对照组在常规支持治疗基础上给予前列地尔治疗,观察组在对照组基础上增加尼可地尔治疗.随访2周,比较两组患者的疗效、不良反应发生率、血流动力学指标、氧化应激指标的差异.结果 观察组治疗总有效率为90.91％(50/55)高于对照组治疗总有效率76.36％(42/55),差异有统计学意义(P<0.05).治疗2周后观察组患者的血流动力学指标(包括全血黏度、血浆黏度、纤维蛋白的水平)改善情况均优于对照组,差异有统计学意义(P<0.05).治疗后观察组患者的丙二醛(MDA)、肌酸激酶同工酶(CK-MB)、超氧化物歧化酶(SOD)水平降低幅度均高于对照组,差异有统计学意义(P<0.05).观察组药物不良反应发生率为14.55％(8/55)高于对照组的9.09％(5/55),但差异无统计学意义(P>0.05).结论 尼可地尔联合前列地尔能够改善顽固性心绞痛患者的血流动力学指标,降低患者机体的氧化应激水平,提高顽固性心绞痛的治疗有效率.

目的 观察冷冻消融和射频消融环肺静脉电隔离后对阵发性心房颤动(PAF)患者心肌肌钙蛋白I(cTnI)和C反应蛋白(CRP)的影响.方法 选取PAF患者102例,冷冻组有42例,射频组有60例,所有患者均于术前、术后3～4 h测定血清cTnI和CRP并对其进行比较.术后随访3个月,比较早期复发与未复发患者的cTnI和CRP水平.结果 所有患者术前cTnI和CRP均在正常范围.两组患者术后cTnI和CRP均升高,与术前相比差异有显著性(P<0.001).与射频组相比,冷冻组术后cTnI和CRP水平升高幅度更大(P<0.05).术后3个月随访,共复发31例(30.4％),其中冷冻组15例(35.7％),射频组16例(26.7％),两者复发率无明显差异(P>0.05).射频组术后复发的患者CRP水平明显高于未复发的患者(P<0.05).结论 冷冻消融较射频消融对心肌损伤程度更大;射频消融术后CRP较高可能与早期复发相关.

目的 探讨胆红素、血尿酸水平与冠状动脉粥样硬化狭窄程度的关系.方法 选取2015年1月～2016年12月在泗洪县人民医院住院行冠脉造影患者461例作为研究对象,详细记录所有研究对象实验室生化指标及相关临床资料.根据患者的冠脉造影结果 ,分析非冠心病组(对照组)和冠心病组两组患者血清胆红素及血尿酸水平,并对患者相关临床资料,包括吸烟史、年龄、性别、血压、血脂、血糖等指标进行统计学分析.结果冠心病组中总胆红素水平明显低于对照组,而血尿酸浓度高于对照组,组间比较,差异有统计学意义(P<0.05);冠心病组中合并有吸烟、高血压、高脂血症、糖尿病的患者人数要明显高于非冠心病组,组间比较,差异有统计学意义(P<0.05);冠状动脉粥样硬化程度与血尿酸呈正相关,与总胆红素水平呈负相关,组间比较,差异有统计学意义(P<0.05).结论 在冠心病患者中,血TBIL和UA的水平可反映患者冠脉病变严重程度,其中UA水平与冠脉病变的严重程度和病变支数存在正相关,而TBIL水平与之负相关.

OBJECTIVE:To compare therapeutic efficacy of rosuvastatin vs. atorvastatin for blood lipid,atherosclerosis and vascular endothelial vasodilation in patients with coronary heart disease(CHD). METHODS:A total of 150 CHD inpatients select-ed from cardiovascular medicine department of our hospital during Jan. 2014-Dec. 2015 were divided into rosuvastatin group (72 cases)and atorvastatin group(78 cases)according to lottery method. All patients were adjusted to living habits,given antiplatelet and blood pressure regulating drugs and other basic treatment. At the same time,rosuvastatin group was given Rosuvastatin calcium tablets 10 mg,po,once a night;atorvastatin group was given Atorvastatin calcium tablets 20 mg,po,once a night. Both groups received treatment for 6 months. The levels of blood lipid indexes (TC,TG,HDL-C,LDL-C),IMT,Crouse scores,Gensini scores and the changes of brachial artery diameter(D)were compared between 2 group before and after treatment. The occurrence of ADR was recorded. RESULTS:Before treatment,there was no statistical significance in above indexes between 2 groups(P>0.05). After treatment,the levels of TC,TG,LDL-C,IMT,Crouse scores and Gensini scores in 2 groups were decreased signifi-cantly,while the levels of HDL-C and D values were increased significantly,compared to before treatment;the levels of TC,TG, LDL-C,Crouse score and Gensini score in rosuvastatin group were significantly lower than atorvastatin group,and D value was significantly higher atorvastatin group,with statistical significance(P<0.05). There was no statistical significance in the levels of HDL-C or IMR between 2 groups (P<0.05). During treatment,dizziness occurred in a patient of rosuvastatin group and relieved spontaneously. Four patients in each group had slight elevation of transaminase,and could be reduced to normal after liver protec-tion treatment. CONCLUSIONS:Rosuvastatin shows more significant therapeutic efficacy than that of atorvastatin in reducing blood lipid,improving AS and vascular endothelial vasodilation in CHD patients with good satety.

Objective To investigate the relationship between total atrial conduction time(TATC) and recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation (RFCA).Methods 116 patients with paroxysmal atrial fibrillation who underwent RFCA from 2012 to 2014 were enrolled in this study,when patients were in sinus rhythm before RFCA,TACT was estimated by measuring the time delay between the onset of the P-wave in lead Ⅱ of the surface electrocardiogram and the peak A-wave on the tissue Doppler tracing of the left atrial lateral wall (PA-TDI duration),3 cardiac cycles were measured and their mean values were determined.Clinical success was assessed after 3-month blanking period and all patients were follow-up for 6 months.According to the results of the follow-up,the patients were divided into recurrent group and unrecurrentgroup.Results In the end of follow-up period,29 patients(25％) suffered from recurrent AF.Univariate analysis showed that the mean TACT of the recurrent group of patients was longer than that of the unrecurrent group of patients[(144 ± 23) ms vs (124 ± 20) ms,P ≥ 0.001].Multivariable analysis revealed that TACT was an independent risk factor responsible for the recurrence of AF(OR=1.045,95 ％CI 1.021-1.073,P≥0.001).Conclusion TACT can be used to predict the recurrence of paroxysmal atrial fibrillation after RFCA.

Objective To study the correlation between monocyte/high density lipoprotein ratio (MHR) and the degree of coronary artery lesions,and to investigate the value of MHR in predicting the extent of coronary artery disease.Methods Patients with coronary heart disease (CHD) were assigned into two groups,group A (Gensini ＜ 30,n =55) and group B (Gensini ≥ 30,n =55).The correlation of coronary lesions with MHR and its value of predicting high Gensini scores were analyzed.Results MHR of group B was noticeably higher than group A (P ＜ 0.05).Correlation analysis showed that MHR was positively correlated with the Gensini score (r =0.495,P ＜0.001).Multivariate Logistic analysis showed that diabetes and MHR were independent risk factors for high Gensini score,while direct bilirubin (DBil) was the protective one.The area under MHR of ROC curve was 0.767 (95％ CI:0.681 to 0.854).And when the critical value of MHR was 9.45,the diagnostic efficiency reached the highest,with the sensitivity of 80％,and the specificity of 60％.Conclusions The more severe degree of coronary artery lesion is,the higher level of MHR will be.And MHR can be an important reference index to predict coronary artery lesion.

Objective To investigate the effectiveness of radiofrequency catheter ablation(RFCA)in the treatment of paroxysmal atrial fibrillation(PAF)patients with different kinds of sinus node dysfunction(SND).MethodsTwo hundred and twenty-eight patients with PAF under RFCA were analyzed.All patients were divided into 4 groups on the basis of Holter before RFCA.PAF with tachycardia-bradycardia syndrome(TBS)without bradycardia-tachycardia syndrome(BTS)as group 1;PAF with BTS without TBS as group 2;PAF with TBS with BTS as group 3;PAF without TBS without BTS as group 4.All patients were followed up for 12 months after RFCA.The recurrence rate of atrial fibrillation(AF)and the rate of implantation pacemaker(PM)were compared.The long RR interval value(MRRI)and the times of RR interval>2 s during 24 h were compared on the basis of Holter of preoperative and postoperative 3 months.ResultsAll patients had been followed up for 12 months.The recurrence rate of AF of group 2 was significantly higher than that of group 1,group 3,and group 4(61.5％vs.34.8％P<0.05,61.5％vs.33.3％P<0.05,61.5％vs.23.9％P<0.05),while there was no significant difference among group 1,group 3,and group 4.PM rate of group 2 was significantly higher than that of group 1,group 3,and group 4(46.2％vs.8.7％P<0.05,46.2％vs.16.7％P<0.05,46.2％vs.0,P<0.05),while there was no significant difference among group 1,group 3,and group 4.For CPVI only,AF recurrence rate of group 2 was significantly higher than that of group 1,group 3 and group 4(80.0％vs.40.0％P<0.05,80.0％vs.33.3％P<0.05,80.0％vs.26.1％P<0.05).For CPVI+ additional ablation,AF recurrence rate of group 2 was significantly higher than that of group 1,group 3 and group 4(50.0％vs.22.2％P<0.05,50.0％vs.33.3％P<0.05,50.0％vs.11.1％P<0.05).Through COX regression analysis we found that the risk of AF recurrence in the patients of PAF combined with BTS but without TBS was higher(RR=3.671,95％CI 1.651～8.160,P=0.001),and the risk of PM was higher,too(RR=36.158,95％CI 6.453～202.595,P=0.000).Conclusion RFCA is the preferred treatment for the patients of PAF combined with TBS without BTS and PAF combined with TBS and BTS.Otherwise,it is better to select PM combined with anti-arrhythmic drug for the patients of PAF combined with BTS without TBS.

目的：观察达比加群酯在心房颤动（AF）患者在导管射频消融（RFCA）术后应用的有效性和安全性。

目的:观察导管射频消融(RFCA)治疗阵发性心房颤动(PAF)伴快-慢综合征(TBS)的疗效.方法:回顾性分析行RFCA治疗的PAF患者118例,依据术前24h动态心电图(Holter)结果分为3组:PAF伴TBS为第1组(16例);PAF伴窦房结功能不良(SND)但不伴TBS为第2组(12例);单纯PAF为第3组(90例).比较术后各组的房颤(AF)复发率、起搏器(PM)植入率、术前及术后3个月的Holter中的最长RR间期(MRRI)值.结果:平均随访12个月,第1组的AF复发率和PM植入率与第3组无差异(P＞0.05);第2组在AF复发率和PM植入率上均显著高于第1组(P＜0.05)和第3组(P＜0.05).第1组术前的MRRI(MRRI0)显著高于第2、3组(P＜0.05);第1组术后3个月的MRRI(MRRI3)与第3组相比无统计学差异(P＞0.05).结论:PAF伴TBS患者,无论是否合并SND,均可选择行RFCA;而PAF伴SND,但不伴TBS的患者,应首选PM植入加药物治疗.

Objective To investigate the effect of statins on high sensitive C reactive protein (hs-CRP) and blood lipids in the patients with coronary heart disease(CHD). Methods A total of 1 340 patients with suspected CHD by coronary arterial angiography and PCI in necessity in our hospital from January to December 2015 were selected and divided into the taking statins group(236 cases) and the non-taking statins group(1 104 cases)according to the clinical disease history and angiography results;then the latter was further divided into the control group(358 cases,normal coronary artery),coronary atherosclerosis group(238 cases,coronary arterial stenosis degree<50%) and stable angina group(172 cases,coronary arterial stenosis degree 50%~75%without giving PCI) and unstable angina conducting PCI group(110 cases,coronary arterial stenosis degree 50%~75%with PCI) and unstable angina group(225 cases,coronary arterial stenosis degree>75%with PCI). The levels of serum hs-CRP,LDL-C, HDL-C,TC and TG were compared among different groups. Results The levels of hs-CRP,LDL-C,HDL-C,TC and TG in the taking statins group were significantly lower than those in the non-taking statins group,moreover the hs-CRP level was significantly lower than that in the stable angina group,stable angina-PCI group and unstable angina group,the differences were statistically significant(P<0.05),but the differences had no statistical difference compared with the control group and coronary atherosclerosis group(P>0.05);the LDL-C and TC levels in the taking statins group were significantly lower than those in the non-taking statins subgroups,while the HDL-C level was significantly lower than that in the control group and coronary atherosclerosis group ,the TG level was significantly lower than that in the control group ,coronary atherosclerosis group and unstable angina group ,the differ-ences were statistically significant(P<0.05). Conclusion Statins not only reduce the level of LDL-C significantly,but also signif-icantly reduce the level of hs-CRP,thus alleviate the inflammatory reaction.

目的：观察75岁以上老年阵发性心房颤动（PAF）患者行导管射频消融（RFCA）的安全性和有效性。

目的：观察分析术前心率减速力（DC）与阵发性心房颤动（PAF）患者导管射频消融（RFCA）术后心房颤动（AF）复发的相关性。

目的：观察压力导管（SmartTouch导管）在阵发性心房颤动（PAF）行环肺静脉电隔离（CPVI）中应用的安全性和有效性。

目的：观察阵发性心房颤动（PAF）导管射频消融（RFCA）术后心房颤动（AF）复发的患者第二次行RFCA的过程及结果，初步探讨PAF患者RFCA术后AF复发的原因。

目的 探讨上腔静脉电隔离(SVCI)在环肺静脉电隔离(CPVI)治疗阵发性心房颤动(PAF)的作用.方法 回顾分析导管射频消融(RFCA)的PAF患者103例,依据电生理检查及RFCA的结果分为:单纯CPVI组和CP-VI+ SVCI组,随访1年以上,观察AF复发率及并发症情况.结果 人选103例患者共消融120人次,其中11例消融2次,3例消融3次.综合电生理检查及RFCA结果进行分组:单纯CPVI组88例、CPVI+ SVCI组15例.随访期间,共计81例成功,累积成功率78.6％;CPVI+SVCI组13例成功,累积成功率86.7％;单纯CPVI组68例成功,累积成功率77.3％.CPVI+ SVCI组术后有1例患者出现膈神经损伤,术后3个月未恢复.结论 SVC是常见的AF触发灶之一,SVCI有助提高行CPVI的PAF患者的消融成功率.