目的:本研究旨在研究经皮冠状动脉介入术(PCI)治疗左主干病变合并肾功能轻度下降患者的预后.方法:入选北京安贞医院行PCI治疗左主干病变合并肾小球滤过率(eGFR)＞60mL·min-1·1.73m-2的患者,分为两组:CKD1期(肾功能正常组):eGFR＞90mL·min-1·1.73m-2,CKD2 期(肾功能轻度下降组):eGFR 在 60～89 mL·min-1·1.73m-2之间.研究终点包括全因死亡/心肌梗死/卒中联合终点、全因死亡、心肌梗死、卒中、再次血运重建.结果:共入选患者801例,CKD1期410例,CKD2期391例,随访时间中位数5.6(4.4,6.8)年,校正前CKD1期和CKD2期两组间不良事件发生率如下:全因死亡/心肌梗死/卒中(7.3％vs.14.8％,P=0.001)、全因死亡(3.2％vs.8.2％,P=0.002)、卒中(1.5％vs.4.1％,P=0.032)、心肌梗死(4.6％vs.6.9％,P=0.202)、再次血运重建(23.9％vs.22.8％,P=0.995).Cox 多因素校正分析后,校正后各终点差异与校正前趋势相同.结论:肾功能轻度下降的左主干病变患者行PCI治疗较肾功能正常的患者预后差.

目的:探讨左主干病变合并慢性肾脏病(CKD)患者血运重建术的预后.方法:入选北京安贞医院行经皮冠状动脉介入术(PCI)或者冠状动脉旁路移植术(CABG)治疗的无保护左主干病变合并慢性肾脏病患者240例,其中PCI组121例,CABG组119例.研究终点为全因死亡、心肌梗死、卒中、再次血运重建.结果:随访时间中位数6.1(5.1,8.0)年,两组全因死亡发生率(PCI 29.8％vs.CABG 34.5％)、心源性死亡率(PCI 24.0％vs.CABG 21.8％)和心肌梗死发生率(PCI 15.7％vs.CABG 10.9％)两组间差异无统计学意义.PCI组卒中发生率显著低于CABG组(1.7％vs.14.3％,P＜0.05),PCI组再次血运重建发生率显著高于CABG组(24.8％vs.15.1％P=0.002).结论:左主干病变合并CKD血运重建术的预后较差,PCI和CABG全因死亡和心肌梗死发生率相当,PCI组卒中发生率显著低于CABG而再次血运重建高于CABG.

目的:本研究旨在对比经皮冠状动脉介入术(PCI)和冠状动脉旁路移植术(CABG)治疗高龄(≥65岁)无保护左主干病变(ULMCA)的长期预后.方法:入选2003年1月至2009年7月,北京安贞医院行PCI或CABG治疗的高龄(≥65岁)ULMCA患者427例(210例行PCI置入药物洗脱支架,217例行CABG),研究终点包括全因死亡、心肌梗死、再次血运重建、卒中、心源性死亡/心肌梗死/卒中联合硬终点以及主要不良心脑血管事件(MACCE,包括心原性死亡、非致命性心肌梗死、卒中及再次血运重建的联合终点).Cox比例风险模型用以计算风险比(HR)及95％可信区间(CI),及多因素分析.结果:随访时间7.0(5.2,8.1)年,校正前结果显示,心源性死亡/心肌梗死/卒中联合硬终点发生率CABG组显著高于PCI组(HR=1.544,95％CI:1.003～2.375,P=0.048).卒中发生率CABG组显著高于PCI组(HR=3.089,95％CI:1.332～7.162,P=0.009).再次血运重建发生率PCI组显著高于CABG组(HR=0.278,95％CI:0.159～0.486,P＜0.001).全因死亡率两组间差异无统计学意义(HR=1.545,95％CI:0.951～2.510,P=0.079).非致命性心肌梗死发生率两组间差异无统计学意义(HR=0.619,95％CI:0.314～1.222,P=0.167).MACCE发生率两组间差异无统计学意义(HR=0.770,95％CI:0.550～1.079;P=0.129).经Cox多因素分析校正后,CABG组心源性死亡/心肌梗死/卒中联合硬终点发生率仍显著高于PCI组(P=0.048),CABG组卒中发生率显著高于PCI组(P=0.011),PCI组MACCE发生率显著高于CABG组(P=0.027),主要由于PCI组较CABG组显著升高的再次血运重建率(P＜0.001),死亡、心肌梗死经校正后两组间差异无统计学意义.结论:CABG较PCI治疗高龄ULMCA患者的卒中发生率及心源性死亡、卒中、心肌梗死联合终点发生率显著升高,PCI组再次血运重建率显著升高.

Objective To discuss the influence of diabetes on percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in treatment of unprotected left main coronary artery (LMCA) disease. Methods The data of patients with coronary heart disease (CHD) was analyzed retrospectively from Jan. 2003 to Jul. 2007, and the patients (n=922) were divided into PCI group (n=465) and CABG group (n=457) according to therapies. The incidence of adverse events, including death, myocardial infarction and re-revascularization, were compared between 2 groups and diabetic group and non-diabetic group respectively.Results The follow-up median was 7.1 y. After adjusting with multiple factors, PCI group and CABG group, whether or not patients with diabetes, had no statistical difference in mortality (P=0.41 in diabetic group,P=0.25 in non-diabetic group), and in risks of death, myocardial infarction and stroke (HR=0.79,P=0.40 in diabetic group,HR=0.82,P=0.35 in non-diabetic group). The incidence of re-revascularization was significantly higher in PCI group than that in CABG group (HR=2.11,P=0.02 in diabetic group,HR=2.37,P<0.001 in non-diabetic group). The risk of stroke was significantly higher in CABG group than that in PCI group (HR=0.23,P=0.02 in diabetic group,HR=0.40,P=0.02 in non-diabetic group).Conclusion Diabetes is not an independent influencing factor on revascularization strategies selection in treatment of unprotected LMCA disease.

Objectives To investigate the effects of intensive rosuvastatin on arotid atherosclerotic plaques and hs-CRP & IL6 in old patients with coronary heart disease.Methods 125 aged patients with CAD were randomly divided into two groups, the intensive group(n=65) was treated with normal therapy and rosuvastatin 10mg, the control group(n=60) was treated with normal therapy. The serous high sensitive C-reactive protein(hs-CRP) and interleukin 6(IL-6) were monitored before and after treatment for one month, the carotid atherosclerotic plaques were assessed by ultrasonography before and after treatment for six months.Results After 1 month of treatment, the levels of hs-CRP and IL-6 were significantly decreased compared with the control group and before the treatment in the intensive rosuvastatin group(P<0.01). After 6 months, the intima thickness of bilateral carotid artery was significantly decreased as well as the carotid artery plaque area was obviously smaller in the intensive rosuvastatin group, and had significantly difference(P<0.01).Conclusions Intensive rosuvastatin could significantly decrease the level of hs-CRP and IL-6, improve the carotid intima state of aged patients with coronary heart disease(CHD), and decrease the carotid atherosclerotic plaques.

目的:评价SYNTAX积分Ⅱ (SYNTAX score Ⅱ,SS-Ⅱ)对冠状动脉3支病变患者,经皮冠状动脉介入治疗后5年死亡率的预测意义.方法:连续人选2007年1月至2008年12月,北京安贞医院心内科,经冠状动脉造影明确为3支病变且需行经皮冠状动脉介入治疗(PCI)治疗的患者共573例,进行回顾性研究.根据冠状动脉造影结果并结合临床因素计算患者的SS-Ⅱ,根据SS-Ⅱ数值的三分位法将患者进行分组:SS-Ⅱ低分组(0～20)、中分组(21 ～31)和高分组(≥32).主要终点是术后5年全因死亡率.用Kaplan-Meier法进行生存分析,用Cox比例风险模型进行单因素、多因素分析,评价SS-Ⅱ预测PCI术后预后的价值.结果:全部入选患者SS-Ⅱ为(27.6±9.0)分.5年的全因死亡率为4.4％,在SS-Ⅱ低分组、中分组和高分组患者中分别为1.6％、3.2％和8.6％,差异有统计学意义(P =0.003).心源性死亡率在三组中的差异也有统计学意义(分别为0.5％、1.9％和5.2％,P =0.014),而非心源性死亡率的差异无统计学意义.校正其他可能混杂因素后,SS-Ⅱ是冠状动脉3支病变PCI术后5年死亡率的独立预测因素(HR =2.45,95％CI 1.38～4.36,P =0.002).随SS-Ⅱ增加,患者PCI术后5年心肌梗死、再次血运重建和MACCE发生率也升高,差异均有统计学意义.5年脑卒中发生率尽管随SS-Ⅱ增加而升高,但差异无统计学意义.结论:SS-Ⅱ是冠心病3支病变患者PCI术后5年死亡率的独立预测因素,临床上可为复杂冠心病患者介入治疗提供一种危险分层工具.

Objective To study the expressions of cholesterol efflux genes in peripheral blood leukocytes in hypertensive patients.Methods The patients [hypertension group,n=13, male 7, female 6 and average age=(66.54 ±11.72)] and health cases [control group,n=11, male 8, female 3 and average age=(62.36±9.27)] were chosen from Mar. 2013 to May 2013. The mRNA expressions of apolipoprotein A1 (ApoA1), ATP binding cassette transporter A1 (ABCA1) and ATP binding cassette transporter G1 (ABCG1) in peripheral blood leukocytes were detected by using real-time fluorescence quantitative polymerase chain reaction (RT-PCR) in 2 groups.Results Compared with control group, ABCA1 mRNA expression decreased [(2.38±0.82)vs. (0.47±0.20)] and ApoAI mRNA expression also decreased [(2.19±0.86)vs. (0.11±0.06)] in hypertension group (allP<0.05). The expression of ABCG1 mRNA had no statistical difference between 2 groups (P>0.05).Conclusion The decreased expressions of cholesterol efflux genes in peripheral blood leukocytes may be one of mechanisms of hypertension resulting in atherosclerosis in hypertensive patients.

目的 比较心脏起搏装置在植入术后不同缝合方式对患者伤口愈合的影响,为不同手术切口缝合提供临床依据.方法 回顾性分析2012年1月到2012年11月接受心脏起搏装置植入患者.以缝合方式不同将患者分为传统组(采用皮下缝合)和改良组(采用皮内缝合).比较两组间手术缝合时间,住院时间,术后感染事件以及瘢痕形成因素.结果 改良组较传统组住院时间短[(3.3±0.7)d vs (7.1±0.9)d,P=0.102].瘢痕形成率低(0.6％ vs 2.7％ P=0.049).感染发生率无差异.结论 改良皮内缝合较传统皮下缝合住院周期减少,医疗成本降低,患者满意度增加.

目的 探讨2型糖尿病(T2DM)合并高血压患者血清网膜素、脂联素及内脂素水平的变化.方法 102例T2DM患者,根据是否合并高血压分为T2DM合并高血压组(n=50)和T2DM无高血压组(n=52).检测2组患者的空腹血糖(FBG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平;并检测糖耐量试验(OGTT)2 h后的血糖(2hBG)、胰岛素(2hINS)水平及空腹和OGTT 2 h后网膜素、脂联素、内脂素水平.结果 2组患者血脂、FBG、FINS、2hBG、2hINS水平及胰岛素抵抗指数(HOMA-IR)比较,差异无统计学意义(P＞0.05).2组患者空腹网膜素、脂联素及内脂素水平与OGTT后2h比较,差异无统计学意义(P＞0.05).T2DM合并高血压组患者空腹及OGTT后2h网膜素和脂联素水平低于T2DM无高血压组(P＜0.05),内脂素水平高于T2DM无高血压组(P＜0.05).血清内脂素水平与HOMA-IR和FINS呈正相关(P＜0.05);血清网膜素和脂联素水平与HOMA-IR和FINS呈负相关(P＜0.05).结论 T2DM合并高血压患者血清网膜素、脂联素及内脂素水平明显改变,且与胰岛素抵抗有一定的相关性.

目的:对置入国产雷帕霉素支架(Firebird)的冠心病患者,12个月双联抗血小板(DAPT)后继续延长DAPT时间能否获益进行分析.方法:回顾性分析2007年1月至2009年12月,于北京安贞医院心内科置入Firebird支架的患者,按照DAPT的时间,分为12个月停用DAPT组和＞12个月DAPT组,通过门诊或电话随访,评价术后患者死亡、心肌梗死、脑卒中联合终点发生率,靶血管再次血运重建发生率.结果:共入选患者1 073例,随访平均(29.4±6.2)个月,按照排除标准筛选后共955例患者纳入分析,12个月停用DAPT患者410例,＞12个月DAPT组患者545例.12个月停用DAPT和＞12个月DAPT组死亡/心肌梗死/脑卒中发生率分别为5.2和1.6,P=0.016,多因素校正后,12个月停用DAPT组仍较＞12个月DAPT组显著增加死亡/心肌梗死/脑卒中风险(HR=3.56,95％CI:1.18～10.8,P=0.025).结论:对于置入Firebird的患者,与12个月时停用DAPT仅使用阿司匹林比较,12个月后继续使用DAPT显著降低不良事件风险.

Objective To evaluate the influence of chronic renal dysfunction on prognosis of patients with ST-segment elevated myocardial infarction(STEMI) undergoing primary percutaneous coronary intervention(PCI).Methods Data of 743 STEMI patients undergoing primary PCI in Beijing Anzhen hospital were retrospectively collected.Patients were divided into the renal dysfunction group and control group according to estimated glomerular filtration rate(eGFR) < or ≥60 mL·min-1·1.73 m-2.Clinical characteristics,lesion characteristics and prognostic outcomes were compared between the two groups.Results Compared with control group,patients in renal dysfunction group were elder and less male patients,there were more patients with heart failure,hypertension,diabetus mellitus,previous myocardial infarction history,multiple vascular disease and cardiac inadequacy(Killip′s grade≥2)in renal dysfunction group(P<0.05).Major adverse cardiovascular event(MACE) rate and death rate were higher in renal dysfunction group than control group during the period of hospital stay and after following up for 2 years(P<0.05).The results of Logistic multifactor regression analysis showed that,eGFR<60 mL·min-1·1.73 m-2,age≥70 years,Killip′s grade≥2,diabetus mellitus,previous myocardial infarction history and multiple vascular disease were independent predictors of 2-year death(P<0.05),and the corrected relative risk of eGFR<60 mL·min-1·1.73 m-2 was 1.93(95%CI=1.24-4.56,P=0.01).Conclusion Prognosis of STEMI patient undergoing primary PCI combined with chronic renal dysfunction is bad.Estimated GFR<60 mL·min-1·1.73 m-2 is the strongest risk factor for unfavourable prognosis of the STEMI patients who undergo primary PCI.

目的比较西罗莫司药物洗脱支架和金属裸支架治疗冠心病患者的远期安全性。方法选择北京安贞医院2000年1月至2004年8月置入金属裸支架的冠心病患者505例,与2004年1月至2005年1月置入西罗莫司洗脱支架的984例冠心病患者进行历史性对照分析,比较两组患者支架术后随访2年的死亡、支架内血栓、非致死性心肌梗死发生率。结果两组患者在合并吸烟、高血压、高血脂、糖尿病所占比例及冠状动脉病变支数方面差异均无统计学意义。西罗莫司洗脱支架组患者平均年龄较大、分叉病变比例高、置入支架平均直径小且平均支架长度较长。临床随访2年,两组患者生存率、支架内血栓、非致死性心肌梗死及死亡/非致死性心肌梗死发生率方面差异均无统计学意义（分别为99.3%、1.3%、1.1%、1.8%和98.3%、1.7%、1.7%、3.5%,P＞0.05）。结论西罗莫司洗脱支架和金属裸支架在冠心病患者中应用的远期安全性相似。

Objective To study the safety and efficacy of percutaneous coronary intervention(PCI) through radial artery and femoral artery approach in aged female patients with coronary heart disease. Methods Retrospective analysis of clinical data of 332 patients older than 75 years was done.The patients were divided into 2 groups:radial artery group and femoral artery group.Results Of the 332 patients,96 received PCI treatment.The rate of 3-vessel lesion was 39.7% and 47.4% and the rate of bifurcation lesion was 60.3% and 52.6% in radial artery group and femoral artery group respectively.Compared with radial artery group,the operation time was longer, peripheral vessel injury was significantly increased (P < 0.05),the postoperative observation time and bed-rest time were significantly prolonged,incidences of pseudoaneurysm and lower limb venous thrombosis were signifieantly increased,and incidence of punctured artery occlusion was significantly decreased (P < 0.05) in femoral artery group.Conclusions Radial approach PCI in senile women with coronary heart disease reduced the vascular complications in high-risk population. PCI improves the long-term survival rate of patients and can be done in the elderly with low mortality rate and acceptable long-term outcomes.

目的:评价高龄冠心病患者冠状动脉介入治疗的安全性和临床效果。方法:96例高龄冠心病患者,经冠状动脉造影检查冠状动脉狭窄≥75%而行支架植入术,观察生化指标,比较桡动脉、股动脉途径介入治疗的疗效。结果:高龄冠心病患者合并高血压、糖尿病比例分别为76.1%,39.6%。术后B型钠尿肽、花生四烯酸、二磷酸腺苷较术前改善(P<0.05)。冠状动脉造影显示桡动脉、股动脉入径组钙化病变、分叉病变比例分别为51.7%/60.3%,52.6%/52.6%,桡动脉入径组外周血管损伤较股动脉入径组低(6.89%∶23.7%)(P<0.01),手术时间、术后观察时间较股动脉入径组短(P<0.05或<0.01)。结论:高龄患者选择桡动脉介入术可减少局部血管并发症,冠状动脉血运重建术可显著提高老年患者远期生存率和生活质量,近期治疗风险小,病死率低。

AIM: To study the clinical characteristics and pathological changes in coronary artery in patients with recurrent myocardial ischemia after coronary artery bypass grafting(CABG).METHODS: Data were retrospectively reviewed in 247 patients who had recurrent myocardial ischemia after CABG and underwent percutaneous coronary intervention(PCI).Patients were divided into two groups: diabetes mellitus(DM) group and non-DM groups.RESULTS: The ratio of recurrent myocardial ischemia was higher and PBG and HbAl were significantly higher in DM group(P0.05).A significant difference was observed in blood vessel changes and types of PCI stent(P0.05).Long-term ratio of the AMI was higher in DM group(11.9%) compared with that in non-DM group(5.1%)(P0.05) and the revascularization rate was also higher in DM group(22.4%) than the rate(15.3%) in non-DM group(P0.05).CONCLUSION: Recurrent myocardial ischemia after CABG is high in patients with diabetes mellitus along with severe coronary vessel involvement and complications.

Objective To identify the causes of recurrent angina pectoris after coronary artery bypass grafting.Methods Five hundred and forty-five patients with recurrent angina pectoris after coronary artery bypass grafting and receiving coronary angiography were retrospectively analyzed.Results Of 545 patients,156 suffered from diabetes mellitus(28.6%).The time of the recurrent angina pectoris was shorter than that of the patients without diabetes mellitus(P0.05).Medicinal therapy was performed in 266 patients(48.8%),PCI was reperformed in 247 patients(45.3%),and coronary artery bypass grafting was reperformed in 32 patients.Coronary angiography showed 37.5% occlusion in left internal mammary artery in patients recurrent within 1 month after coronary artery bypass grafting,16.3% stenosis and 15.2% occlusion in saphenous vein graft and 15.3% stenosis in left internal mammary in 1 year.After 1 year,occlusion mainly occurred in saphenous vein graft.Conclusion Risk factors for arteriosclerosis and the type of bypass graft influence the necessity and tendency for repeat coronary therapy.

Objectives Cardiac function might be altered with the change of different pacing atrioventricular delay(PAVD)in congestive heart failure patients implanted with dual-chamber pacemaker,though little is known if it exerts the same effect in those with normal left ventricle function as well as the potential effect on diastolic function.The aim of this study is to assess both the systolic and diastolic function alteration in different PAVD with echocardiography.Methods Forty complete atrioventicular block patients receiving permanent dual-chamber pacemaker with right ventrieular pacing were assessed by conventional 2D and color-tissue Doppler Imaging echocardiography when programmed to different PAVD.The optimized PAVD was defined as the maximal cardiac output(CO).Results CO Was significantly affected by PAVD and mean optimal PAVD was (155.7±20.4)ms with around 70%optimized at 150 ms and 175 ms.Septal annulus E'and E/E'as well as Tei index were also improved at the optimized PAVD.Conclusion Optimizing PAVD could be in favorable of both systolic and diastolic function,suggesting the individual and long-term follow-up facilitate the maximal benign effect to those with DDD pacemaker.

Objective:To assess electrocardiographic changes in patients with pulmonary embolism and some of them complicated with coronary artery disease.Method:To retrospect the electrocardiography(ECG) changes in 70 patients hospitalized in the department of cardiology from Jan.2003 to July 2005.50 of them were complicated with CAD.All diagnosis in them were confirmed by ventilation-perfusion scanning and coronary angiography.Result:ECG abnormal rate is 70.0%.The rate of P pulmonale,S_ⅠQ_ⅢT_Ⅲ,right bronch block and precardial T wave inversion is 22.9%.Comparing the ECG abnormal rate between PE and PE complicated with CAD patients,there was not statistically significant difference(χ2=2.99 P=0.084).Conclusion:The ECG alone has very limited value in confirming PE diagnosis.

Objective To report the primary experiences on the diagnosis and treatment of 4 patients with short QT syndrome (SQTS). Methods To review the diagnosis and treatment of 4 SQTS patients,and two of them were successfully treated with catheter ablation. Results One patient died suddenly in the hospi-tal. One patient was treated with quinidine. Two patients underwent radiofrequency catheter ablation, and no symptom and ventricular tachyarrhythmia was founded during follow-up of 3 years and 4 months respective-ly. Conclusion In patients with short QT syndrome, the QT intervals varies in wide range. The catheter abla-tion is effective to eliminate ventricular tachyarrhythmia and to prevent sudden death. Catheter ablation probably is one of effective treatment for SQTS patients.

Objective To study the coronary artery pathological changes and clinical characteristics of elder patients with coronary heart disease complicated with diabetes mellitus.Methods One thousand one hundred and two elder patients with coronary heart disease were divided into the group complicated with diabetes mellitus(DM group) and group not complicated with diabetes mellitus(No-DM).The clinical and coronary angiographic data were analyzed between two groups.Results In DM group,the ratio of hypertension and obesity was much higher(P0.05),serum triglyceride increased and high density lipoprotein-cholesterol decreased(P0.05),blood glucose and uric acid were significantly higher(P0.05),two-and three-vessel diseases of coronary artery,long stenotic lesion and bifurcation lesion were more prevalent than those in the No-DM group(P0.05).The patients in DM group should be implanted more and smaller and longer stents than the No-DM group.Conclusion The coronary heart disease elder patients with diabetes mellitus have more multi-vessel lesions and much greater extent and much severe coronary vessel involvement.More coronary heart disease elder patients with diabetes mellitus need percutaneous coronary intervention.