目的 探讨冠状动脉慢性完全闭塞病变(CTO)患者在经皮冠状动脉介入(PCI)治疗后非闭塞病变进展的危险因素.方法 回顾性分析2017年9月至2018年9月于首都医科大学附属北京安贞医院行PCI治疗后12个月内进行第2次冠状动脉造影的90例患者.依据非闭塞病变进展情况分为未进展组(61例)和进展组(29例).比较2组临床资料并分析与非闭塞病变进展相关的危险因素.结果 进展组替格瑞洛使用率高于未进展组,氯吡格雷和血管紧张素转换酶抑制剂使用率均低于未进展组,差异均有统计学意义(均P ＜0.05).进展组C反应蛋白、二磷酸腺苷(ADP)途径血小板聚集率高于未进展组[2.76(1.19,5.92) mg/L比0.95(0.45,3.11) mg/L、(52±15)％比(40±17)％],差异均有统计学意义(均P＜0.05).进展组置入支架总长度短于未进展组,差异有统计学意义(P＜0.05).偏相关分析结果显示,ADP途径血小板聚集率水平与非闭塞病变进展呈正相关(r=0.351,P＜0.001).以ADP途径血小板聚集率水平30％为界值预测非闭塞病变进展为最佳,其敏感度和特异度分别为86.2％和68.9％.结论 ADP途径血小板聚集率可能是CTO介入治疗后非闭塞病变进展的预测因素.血小板功能监测和充分的抗血小板治疗对接受复杂PCI的患者是十分必要的.

Objective To analyze the relation between fasting blood glucose and nonculprit vessel lesion (NCL) progression after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).Methods Clinical data of 192 patients who were diagnosed of AMI from January 2016 to December 2017 and had reexamination of coronary angiography before June 2018 in Beijing Anzhen Hospital,Capital Medical University were analyzed.They were divided into NCL progression group (82 cases) and NCL progression-free group(110 cases).Basic information and the correlation between fasting blood glucose and NCL progression were analyzed.Results Levels of body mass index,serum creatinine,fasting blood glucose,glycated serum albumin,glycated hemoglobin and homocysteine in NCL progression group were significantly higher than those in NCL progression-free group(all P ＜ 0.05).Logistic regression showed that fasting blood glucose(odds ratio =1.274,95％ confidence interval:1.077-1.505,P=0.005) and serum creatinine (odds ratio =1.020,95％ confidence interval:1.002-1.038,P =0.027) were independent predictors of NCL progression.Partial correlation analysis showed that fasting blood glucose was positively correlated with NCL progression (r =0.231,P =0.001).Receiver operating characteristic curve showed that the boundary point of fasting blood glucose to predict NCL progression was 5.715 mmol/L;the sensitivity was 74.4％ and the specificity was 46.4％.Conclusion Fasting blood glucose is valuable in the prediction of NCL progression and risk stratification after PCI in patients with AMI.

Objective To investigate the relation between glycosylated hemoglobin(HbA1c) and severity of coronary atherosclerotic heart disease(CHD) in elderly non-diabetic patients.Methods A total of 150 elderly non-diabetic patients (≥ 80 years old) who were diagnosed of CHD by coronary angiography were consecutively enrolled from January 2016 to July 2017 in Beijing Anzhen Hospital,Capital Medical University;112 cases meeting the inclusion criteria were divided into 3 groups according to severity of CHD:single vessel disease group (group A,n =33),double vessels disease group (group B,n =43) and three vessels disease/left main disease group(group C,n =36).According to HbA1c level,the patients were divided into Q 1 group(HbA1 c ≤5.6％,n=35),Q2 group(5.7％ ≤HbA1c≤5.9％,n =34),Q3 group(6.0％ ≤HbA1c≤6.2％,n =25) andQ4 group(6.3％ ≤HbA1c≤6.5％,n=18).Relation between HbA1c level and severity of CHD was analyzed by logistic regression;the predictive value of HbA1c for coronary multivessel disease was analyzed by the receiver operating characteristic (ROC) curve.Results HbA1 c level in group C was significantly higher than that in group A and group B [(6.0 ± 0.4) ％ vs (5.6 ± 0.3) ％,(5.8 ± 0.4) ％] (P ＜ 0.05).Logistic regression analysis showed that Q1 group and Q2 group had less risk of three vessel disease or left main disease compared to group Q4 (odds ratio =0.036,95％ confidence interval:0.003-0.399,P =0.007;odds ratio =0.050,95％ confidence interval:0.005-0.497,P =0.011).ROC curve analysis showed that HbA1c had a good value in prediction of coronary multivessel disease(group B and group C);the area under curve was 0.758 (95％ confidence interval:0.668-0.848,P ＜ 0.001);HbA1 c =5.85％ showed the best predictive value;the sensitivity was 0.633 and the specificity was 0.879.Conclusion There is a close relation between HbA1c level and severity of CHD in elderly non-diabetic patients.

Objective To investigate the relation between platelet to lymphocyte ratio(PLR) and severity of coronary heart disease(CHD) in young patients.Methods A total of 378 young patients diagnosed of CHD in Beijing Anzhen Hospital,Capital Medical University from January 2016 to July 2017 were included.According to the SYNTAX score,the patients were divided into low risk group (SYNTAX score ≤ 22,n =299) and high risk group(SYNTAX score ＞ 22,n =99).Coronary angiography results,clinical records,the relation between PLR and CHD severity were analyzed.Results Diabetes ratio,fasting blood glucose,glycated albumin,PLR and neutrophil to lymphocyte ratio in high risk group were significantly higher than those in low risk group(P ＜ 0.05).PLR was positively related to the SYNTAX score(r =0.235,P ＜ 0.001).Logistic regression showed that PLR was an independent predictive factor of CHD severity (odds ratio =1.010,95％ confidence interval:1.003-1.017,P =0.005).Receiver operating characteristic curve showed that PLR =132.97 was an optimal predictor of CHD severity(P =0.005);the sensitivity was 43.0％ and the specificity was 78.6％.Conclusion PLR is an independent predictor of the severity of CHD in young patients.

Objective:To study expression of β-tubulin in non-infarction related coronary arteries and intervention mechanism of ramipril in rabbits.Methods:Myocardial ischemia-reperfusion model of rabbit was prepared,smooth muscle cells in non-infarction related arteries were divided into 4 groups(10 samples in each group) at random:① hyperlipidemia control group,②myocardium infarction group,③ myocardium infarction reperfusion group,④myocardium infarction reperfusion and ramipril invention group.immunohistochemistry analytical method was used to analysis for β-tubulin in non-infarction related arteries.Expression of β-tubulin in each group was analysised.Results:The thickness of atherosclerotic plaque in myocardium ischemia reperfusion group was more than that in myocardium ischemia group(113.61 ± 25.67) vs.(35.42 ± 11.19) μm(P ＜0.0001),the thickness of atherosclerotic plaque in myocardium infarction reperfusion and ramipril invention group was less than that in myocardium infarction reperfusion group(82.79 ± 17.24)vs.(113.61 ±25.67) μm,P ＜ 0.001),expression of β-tubulin in myocardium infarction reperfusion group was higher than that in myocardium infarction group,(413.61 ± 50.46) vs.(83.15 ± 21.1 2) (P ＜ 0.0001),expression of β-tubulin in myocardium infarction reperfusion and ramipril invention group was lower than that in myocardium infarction reperfusion group (312.79 ± 37.33) vs.(413.61 ± 50.46) (P ＜ 0.0001).Conclusion:Non-infarction related arteries may progress after primary PCI,it may be involved in β-tubulin,ramipril may inhibit progression of non-infarction related arteries by decreasing expression of β-tubulin.