目的 观察左西孟旦治疗急性ST段抬高型心肌梗死(STEMI)合并心力衰竭患者的临床疗效及其对血流动力学的影响.方法 选取STEMI伴心力衰竭患者108例,入院时按抽签结果分为对照组52例和研究组56例.两组均行急诊经皮冠状动脉介入治疗及常规治疗,研究组在上述治疗的基础上加用左西孟旦,疗程5d.观察两组治疗前后中心静脉压(CVP)、平均肺动脉压力(MPAP)、肺毛细血管楔压(PCWP)、心输出量(CO)、心脏指数(CI)、平均动脉压(MAP)、体循环阻力(SVR)、左室射血分数(LVEF)、N末端B型尿钠肽原(NT-proBNP)及心功能分级的变化.结果 与治疗前比较,两组患者治疗后CVP、MPAP、PCWP、SVR、NT-proBNP均下降,CO、CI、LVEF均升高,并且研究组上述指标改善程度优于对照组(P<0.05).研究组临床疗效优于对照组(P<0.05).结论 在常规治疗的基础上加用左西孟旦治疗STEMI合并心力衰竭临床效果好,能显著改善患者的心功能和血流动力学.

Objective To analyze the relationship of oxidized low density lipoprotein (ox-LDL) and homocysteine (Hcy) with coronary in-stent restenosis (ISR),and to discuss the clinical predictors of ISR after rapamycin-eluting coronary stent implantation.Methods A total of 400 patients,who had received rapamycin-eluting coronary stent implantation,were enrolled in this study.According to follow-up coronary angiography findings,the patients were divided into ISR group and non-ISR group.Plasma ox-LDL and Hcy levels were tested before percutaneous coronary intervention (PCI) as well as at the time of follow-up coronary angiography.Multivariate logistic regression analysis was used to evaluate ISR-related clinical parameters,angiographic features and surgical factors.Results ISR group had 48 patients and non-ISR group had 352 patients,the clinical incidence rate of ISR was 13.6％.Compared with non-ISR group,the plasma ox-LDL and Hcy levels tested before stent implantation and at the time of follow-up coronary angiography were strikingly increased,the differences were statistically significant (P＜0.05).The results of multivariate logistic regression analysis showed that the independent correlative factors for ISR included hypertension (OR=1.12,95％CI:1.02-3.92;P=0.033),diabetes (OR=2.61,95％CI:1.93-4.26;P=0.016 0),Hcy (OR=2.45,95％CI:1.57-4.48;P=0.036),ox-LDL (OR=2.18,95％CI:1.45-4.96;P=0.006),taking statins (OR=0.50,95％CI:0.26-0.82;P=0.013),smoking (OR=5.62,95％CI:4.13-7.18;P=0.002),coronary artery disease (OR=3.32,95％CI:2.12-5.34;P=0.017),coronary bifurcation lesion (OR=3.51,95％CI:2.36-5.58;P=0.021),chronic total occlusion (OR=2.01,95％CI:1.22-4.84;P=0.014),reference vessel diameter (OR=0.25,95％CI:0.12-0.62;P=0.001),preoperative vascular stenosis degree (OR=2.06,95％ CI:1.21-4.32;P=0.024),stent diameter (OR=0.20,95％CI:0.10-0.53;P=0.001) and stent length (OR=2.60,95％CI:1.22-4.84;P=0.036).Conclusion Clinically,ISR is not an uncommon finding in patients who have received rapamycin-eluting coronary stent implantation.This study indicates that hypertension,diabetes,Hcy,ox-LDL,taking statins,smoking,coronary artery disease,coronary bifurcation lesion,chronic total occlusion,reference vessel diameter,preoperative vascular stenosis degree,stent diameter and stent length are the independent factors for ISR.Long-term use of statins can reduce the risk of ISR.

Objectives To assess the value of lead aVR in diagnosing the severity of coronary artery disease in non-STelevation acute coronary syndrome(ACS) compared with coronary angiographic outcome. Methods General information, electrocardiogram, color doppler echocardiography and coronary angiographic outcomes of 625 cases with non-STelevation ACS were analyzed. Results Among 625 patients with non-ST-elevation ACS, 537 had no ST-elevation in aVR, 58 had minor(0.05-0.1 mm) ST-elevation in aVR and 30 had major(0.1 mm) ST-elevation in aVR, their left ventricular ejection fraction(LVEF) were 53.6% ±7.2%, 50.2% ±6.8% and 48.2% ±6.4%, respectively(P =0.003); malignant arrhythmia(ventricular tachycardia or ventricular fibrillation) rates were 3.4%,8.6% and 13.3%, respectively(P = 0.008); mortality rates were 2.2%, 5.2% and 10%, respectively(P =0.026); incidences of left main and(or) three-vessel disease(LM / 3-vd) were 24.8%, 37.9% and 56.7%, respectively(P0.0005). Conclusions STelevation in aVR can be useful in the early identification of LM / 3-vd in patients with non-ST-elevation ACS, and it should be highly valued.

目的:研究C反应蛋白、脂蛋白(a)及血清尿酸的检测对冠心病的临床诊断价值.方法:取我院2012年以来收治的经冠状动脉造影后确诊为冠心病的100例患者作为观察组,同时取100位同年龄段健康体检志愿者作为对照组,两组全部进行C反应蛋白、脂蛋白(a)及血清尿酸的检测并对比化验结果.结果:观察组患者C反应蛋白、脂蛋白(a)及血清尿酸化验结果明显高于对照组志愿者,且化验结果与患者冠状动脉病变范围关系成正相关,观察组患者异常率较高.结论:C反应蛋白、脂蛋白(a)及血清尿酸的检测对冠心病的诊断具有十分重要的意义.

目的:观察合并完全性右束支传导阻滞(CRBBB)的急性前壁心肌梗死(AAMI)的临床特点.方法:回顾性分析316例AAMI患者,将合并新发CRBBB患者43例作为观察组,50例不合并束支传导阻滞的AAMI患者作为对照组,分析两组患者一般资料、冠状动脉造影、心脏彩超、Killip分级以及血液生化指标的差异.结果:两组患者一般情况及并发症比较无明显差异(P>0.05),平均Killip分级观察组为1.63±0.93,对照组为1.22±0.62(P=0.013).左室射血分数(LVEF)观察组为(41.6±4.2)%,对照组为(48.2±4.4)%(P=0.001).肌酸激酶同工酶(CKMB)峰值观察组为(276.6±63.5)U/L,对照组为(171.5±29.4)U/L(P<0.001).肌钙蛋白I峰值(TNI)观察组为(11.01±2.39)μg/L,对照组为(6.03±1.52)μg/L(P<0.001).冠脉造影结果观察组前降支近段病变(26/43,60.5%),对照组前降支近段病变(15/50,30%)(P=0.003).结论:合并CRBBB的AAMI患者多为前降支近段病变,心肌梗死面积更大、心功能更差,应对这些患者尽早采取再灌注治疗以改善预后.

目的 探讨高血压患者大动脉硬化与血清胰岛素样生长因子-1(IGF-1)表达水平的相关性.方法 对120例2～3级高血压患者行动态血压监测和动脉硬化检测,根据脉搏波传导速度(PWV)检测结果,分为动脉硬化组68例和非动脉硬化组52例,分别检测其血清IGF-1表达水平.结果 与非动脉硬化组相比,动脉硬化组IGF-1表达水平明显增高(P＜0.01),动脉硬化组高血压患者的PWV 与IGF-1呈正相关(r=0.661,P=0.01).结论 IGF-1与高血压大动脉硬化密切相关,参与其发病过程.

Objective To investigate the relationship between insulin-like growth factor-1(IGF-1) and insulin resistance in patients with isolated systolic hypertension.Methods There were 102 cases with isolated systolic hypertension in hypertension group,and 50 healthy cases were in the control group,the serum levels of insulin-like growth factor-1,glucose,insulin and lipid were detected respectively. Results Compared with the control group,the insulin-like growth factor-1 and the blood pressure levels of hypertension group were significantly higher,there was obvious insulin resistance,IGF-1 level and insulin sensitivity index was negatively correlated.Conclusion The level of insulin-like growth factor-1 was increased in isolated systolic hypertension,IGF-1 levels and insulin sensitivity index was negatively correlated.

目的:探讨阿托伐他汀对高血压病患者胰岛素样生长因子-1(IGF-1)及胰岛素抵抗的影响。方法:2级或2级以上高血压病患者110例,随机分为对照组和阿托伐他汀治疗组各55例,前者给予常规降压治疗,后者除常规降压治疗外还给予阿托伐他汀20 mg/d治疗4周,治疗前后分别检测IGF-1、血糖、胰岛素及血脂水平。结果:与治疗前相比,治疗4周后两组病人收缩压和舒张压明显下降,阿托伐他治疗组血清总胆固醇(TC)、低密度脂蛋白(LDL-C)、IGF-1均明显降低(均P<0.01).而高密度脂蛋白(HDL)和胰岛素敏感指数(ISI)明显增高(P<0.05);治疗4周后与对照组相比.阿托伐他治疗组血清TC、LDL-C和IGF-1明显下降(均P<0.01),ISI明显增高(P<0.01)。结论:阿托伐他汀能显著降低高血压病患者血清IFG 1和血脂水平,并改善胰岛素抵抗。