背景 急性冠脉综合征(ACS)患者经皮冠状动脉介入术(PCI)后发生缺血性事件与血小板功能有关,而血小板糖蛋白Ⅱb/Ⅲa、P选择素可以反映血小板功能,且其对PCI后接受双重抗血小板治疗的ACS患者发生缺血性事件的预测价值尚不明确.目的 分析血小板糖蛋白Ⅱb/Ⅲa、P选择素对PCI后接受双重抗血小板治疗的ACS患者发生缺血性事件的预测价值.方法 选取2016年6月至2017年3月航天中心医院收治的PCI后接受双重抗血小板治疗的ACS患者141例为研究对象.收集患者一般资料,PCI后第3天检测患者血小板糖蛋白Ⅱb/Ⅲa、P选择素.分别于患者治疗后1、6、12、24个月对其进行电话随访,随访终点为患者发生缺血性事件,随访截止日期为2019-04-01.采用多因素Logistic回归分析探讨PCI后接受双重抗血小板治疗的ACS患者发生缺血性事件的影响因素;采用受试者工作特征(ROC)曲线分析血尿素氮(BUN)和血小板糖蛋白Ⅱb/Ⅲa、P选择素及其联合对PCI后接受双重抗血小板治疗的ACS患者发生缺血性事件的预测价值.结果 141例患者中,有3例后续诊断为癌症、14例失访,最终共纳入124例患者.随访结束时,共有25例患者发生了缺血性事件.发生缺血性事件患者年龄、BUN和血小板糖蛋白Ⅱb/Ⅲa、P选择素高于未发生缺血性事件患者(P<0.05).多因素Logistic回归分析结果显示,BUN〔OR=1.233,95％CI(1.062,1.431)〕及血小板糖蛋白Ⅱb/Ⅲa〔OR=1.045,95％CI(1.008,1.084)〕、P选择素〔OR=1.031,95％CI(1.004,1.060)〕是PCI后接受双重抗血小板治疗的ACS患者发生缺血性事件的影响因素(P<0.05).ROC曲线分析结果显示,BUN及血小板糖蛋白Ⅱb/Ⅲa、P选择素预测PCI后接受双重抗血小板治疗的ACS患者发生缺血性事件的曲线下面积(AUC)分别为0.622〔95％CI(0.474,0.770)〕、0.711〔95％CI(0.584,0.839)〕、0.608〔95％CI(0.475,0.741)〕,最佳截断值分别为6.850 mmol/L、21.1％、3.4％,灵敏度分别为0.444、0.857、0.762,特异度分别为0.816、0.581、0.488.BUN联合血小板糖蛋白Ⅱb/Ⅲa、BUN联合血小板P选择素和三者联合预测PCI后接受双重抗血小板治疗的ACS患者发生缺血性事件的AUC分别为0.806〔95％CI(0.719,0.894)〕、0.691〔95％CI(0.556,0.827)〕和0.819〔95％CI(0.737,0.902)〕,灵敏度分别为0.870、0.739和0.826,特异度分别为0.678、0.697和0.768.结论 血小板糖蛋白Ⅱb/Ⅲa、P选择素对PCI后接受双重抗血小板治疗的ACS患者发生缺血性事件有一定预测价值,且其与BUN联合的预测价值更高.

Objective:To explore the effect of virtual reality technology in teaching cardiovascular diseases.Methods:This study uses an experimental control method. From July 2018 to September 2019, forty students of grade 2014 and grade 2015 in the Department of medicine of Peking University who were taught circulatory diseases of internal medicine were randomly divided into two groups with 20 students in each. The experimental group was taught by virtual reality technology, and the control group was taught by traditional teaching method. After the end of teaching , questionnaire survey and systematic knowledge examination were used to evaluate the effect of different teaching methods.Results:The experimental group was more interested in the new teaching method and more active in learning than the students in the control group. The students in experimental group believed that virtual reality technology did help them to understand knowledge, and build capacity to solve clinical problems, [(4.15 ± 0.67) vs. (3.40 ± 1.09), (3.85 ± 0.74) vs. (2.90 ± 0.97), (3.85 ± 0.75) vs. (3.25 ± 1.07)]. The difference between two groups was significant (all P<0.05). The scores of the knowledge test in the experimental group were higher than those in the control group[(85.65 ± 6.11) vs. (80.05 ± 9.08)], and the difference was statistically significant ( P<0.05). Conclusions:The virtual reality technology can stimulate students' learning interest for circulatory diseases, and foster clinical reasoning, and improve teaching quality.

目的 分析高龄急性非ST段抬高型心肌梗死(NSTEMI)患者的临床特征,评估PCI的安全性及有效性.方法 回顾性纳入2017年1月～2020年12月于航天中心医院心脏医学部住院的高龄(≥80岁)NSTMI患者139例,分为PCI组72例和保守治疗组67例,分析患者临床特征,比较2组临床结局.结果 PCI组肌酐、eGFR≤30 m l/(min·1.7 3 m2)及使用低分子肝素比例明显低于保守治疗组,eGFR及使用阿司匹林比例明显高于保守治疗组(P＜0.05),2组全球急性冠状动脉事件注册评分均＞140分,但无统计学差异(P＞0.05).PCI组院内病死率、出院随访1个月复合终点事件发生率及病死率明显低于保守治疗组(P＜0.05).调整混杂因素后多因素分析显示,年龄、Killip分级Ⅲ～Ⅳ级、cTnI、肌酐是高龄NSTEMI患者全因死亡的危险因素(95％CI:0.805～0.989,P=0.030;95％CI:1.049～2.521,P=0.030;95％CI:0.990～1.063,P=0.004;95％CI:0.938～1.023,P=0.013).结论 对于高龄NSTEMI患者,PCI治疗相对于药物保守治疗可显著降低死亡事件及临床复合终点事件的发生.

目的 探讨八段锦对急性心肌梗死患者经皮冠状动脉腔内血管成形术(PTCA)后Ⅰ期心脏康复的影响.方法 选取2018年10月—2019年10月于航天中心医院心脏医学中心住院的急性心肌梗死后成功接受PTCA手术、低-中危GRACE评分患者84例,随机分为实验组43例和对照组41例.实验组在PTCA术后第1～5天进行改良八段锦训练,第6～14天进行常规八段锦训练;对照组术后第1～14天逐步进行床上被动活动、床旁站立、室内步行等活动.记录2组患者治疗前及治疗5 d、14 d后静息心血管反应参数[晨起进食前安静状态下的心率(HR)、收缩压(SBP)、两项乘积(RPP)]、中国心血管病人生活质量评定问卷(CQQC)评分;检测2组治疗前及治疗14 d后超声心动图指标[左室射血分数(LVEF)、左室舒张末期内径(LVDd)]、血清氨基末端B型钠尿肽原(NT-proBNP)水平;治疗14 d后进行心肺运动试验,计算代谢当量(MET);统计2组治疗期间主要心血管不良事件.结果 治疗5 d后,实验组HR、SBP、RPP均明显降低(P均<0.05),2组CQQC评分均明显升高(P均<0.05),且治疗14 d后实验组上述指标及对照组CQQC评分改善情况均优于治疗5 d后(P均<0.05);组间比较,实验组治疗5 d、14 d后的HR、RPP和治疗14 d后的SBP均明显低于同期对照组(P均<0.05),治疗5 d、14 d后的CQQC评分均明显高于同期对照组(P均<0.05).治疗14 d后,2组患者LVEF、LVDd均无明显变化(P均>0.05),2组患者血清NT-proBNP水平均明显降低(P均<0.05),且实验组明显低于对照组(P<0.05);治疗14 d后,实验组MET明显高于对照组(P<0.05).治疗中2组均无严重不良心血管事件发生.结论 八段锦能够安全有效地提高PTCA术后Ⅰ期康复患者的心脏功能和运动耐力,改善患者生活质量.

目的 探讨建立急救绿道APP管理模式对急性ST段抬高型心肌梗死(ASTEMI)患者救治的影响.方法 选取航天中心医院心脏医学部急救绿道APP管理模式建立之前2017年6月至2018年6月收治的ASTEMI患者87例为对照组,急救绿道APP管理模式成立之后2018年7月至2019年7月收治的ASTEMI患者108例为观察组.比较两组发病至首次医疗救治时间、入院后首份心电图完成时间、入门-球囊(D2B)时间、住院期间心力衰竭发生率、住院时长、住院期间死亡率、住院期间平均花费.结果 两组发病至首次医疗救治时间比较差异无统计学意义(P>0.05);观察组入院后首份心电图完成时间较对照组缩短,有统计学差异(P<0.01);观察组D2B时间较对照组缩短(P<0.01);观察组住院期间心力衰竭发生率较对照组明显降低(P<0.05);住院期间死亡率两组比较无统计学差异(P>0.05);观察组住院时长较对照组降低(P<0.01),观察组住院期间平均花费较对照组明显降低(P<0.05).结论 采用急救绿道APP模式管理ASTEMI患者进一步提高了ASTEMI再灌注治疗的水平,缩短了心肌总缺血时间,减少患者住院时长,降低医疗支出,临床实践中简便,易于推广,实用性强.

Objective:To analyze the differences in the evaluation of online teaching outcome of Peking University medical undergraduates at different learning stages and different learning weeks during the epidemic of COVID-19, and to explore effective strategy to improve the online teaching outcome of medical students.Methods:From February 17, 2020 to March 15, 2020, 644 undergraduates in 2016-2019 grade majoring in five-year and eight-year clinical medicine, five-year and eight-year stomatology, five-year preventive medicine were selected as the research objects, who were in the three stages of medical preparatory, basic medicine and clinical medicine of Peking University and engaged in online learning. Questionnaire survey method was used to investigate the online teaching effect of students in different stages and learning weeks.Results:Students from pre-medicine, pre-clinical and clinical learning stage have increases in their satisfaction. Meanwhile, the quality of communication with faculty decreases significantly( F=10.393, P<0.01). With the advancement of online teaching and learning weeks, the communication between students and teachers has increased significantly, but student’ interest in learning has decreased significantly (all P <0.01). Conclusions:The online learning outcomes of medical undergraduates vary with different learning stages and in different online learning weeks. It is necessary to adopt a targeted teaching method so as to improve the online learning outcome of students.

Objective To evaluate the safety and efficacy of drug coated balloon in small coronary arteries. Methods A total of 38 coronary heart disease patients who would undergo percutaneous coronary intervention were enrolled in the study and randomly divided into Drug Coated Balloon (DCB) group (18 cases) and Cutting Balloon Angioplasty (CBA) group (20 cases). The immediate outcomes and long-term efficacy were investigated respectively. Results There was no significant difference in clinical data between the two groups before surgery. There were no coronary perforation, pericardial tamponade and acute thrombosis in the two groups. There was no significant difference between the two groups in minimal lumen diameter (MLD) before and after the operation. The MLD in the follow-up angiography group was significantly better than the CBA group in the DCB group (P<0.05). There was no death or non-lethal during the follow-up period. Sexual myocardial infarction, revascularization cases. Conclusion The immediate outcomes between DCB and CBA were similar in small coronary arteries angioplasty, however, the long-term efficacy of DCB is better than CBA.

Objective To compare the protective effect of double dose trimetazidine versus standard dose in patients with unstable angina and received PCI. Methods From September 2014 to June 2015,150 unstable angina pectoris patients who underwent PCI in our hospital were enrolled in this study. All the patients were randomized into two groups:the study group (patients given trimetazidine 40 mg tid 24 hours before operation) and the control group (patients given trimetazidine 20 mg tid 24 hours before operation). All patients received standard secondary prevention therapies of coronary heart disease. Comparison in the rates of angina pectoris attacks, ECG changes after PCI, levels of cardiac troponin I ( cTnI), myoglobin (Mb), creatine kinase isoenzyme ( CK-MB) and hs-CRP before and 12 hours after PCI was investigated between the 2 groups. Results Baseline data were comparable in the 2 groups. Rates of adverse drug reaction were lower in the control group, but the difference was not statistically significant (6. 7% vs. 2. 7% , P = 0. 439). There was no statistical difference between the two groups before PCI in terms of levels of cTNI and hs-CRP but was significantly lowered in the study group after PCI as compared to the control (both P < 0. 05 after PCI). The levels of CK-MB and Mb in the study group were lower than those in the control group after PCI, but the difference was not statistically significant. The rates of angina pectoris attacks and the changes in ST-T were less in the study group as compared to the control group without statistical significance. Conclusions Unstable angina pectoris patients receiving double dose of trimetazidine before PCI may enhance myocardial protection and reduce PCI related myocardial injury.

Objective To study the efficacy and safety of drug-coated balloon (DCB) in interventional therapy for distal graft anastomosis lesions following coronary artery bypass grafting (CABG).Methods Twenty-eight patients with distal graft anastomosis lesions following CABG were divided into observational group (n=16) and control group (n=12).The patients in observational group received DCB therapy and traditional ballon pretreatment of target lesions in case of need while those in control group received traditional ballon dilation therapy.The patients were followed up for 6 months,during which the operation efficacy,long-term outcome and incidence of cardiovascular events were recorded.Results No coronary perforation,pericardial tamponade and acute thrombus occurred in two groups during the interventional therapy.No sigflificant difference was found in the operation success rate between the two groups (87.5％ vs 91.7％,P=1.000) and in the instant minimal lumen diameter (MLD) between the two groups before and after operation (P＞0.05).The MLD was significantly longer in observational group than in control group (1.9±0.3 mm vs 1.6±0.3 mm,P=0.021).No cardiaogenic death,nonfatal myocardial infarction and revascularization occurred in two groups during the follow-up period.Conclusion DCB is effective and safe for distal graft anastomosis lesions following CABG.

Objective To evaluate the safety and efficacy of drug-coated balloon in small branch ostial lesions of coronary arteries (Medina type 0,0,1 lesion).Methods A total of 48 patients were enrolled in the study and they were randomly divided into the Drug-Coated Balloon (DCB) angioplasty group (22 cases) and the Cutting Balloon (CB) angioplasty group (26 cases).They underwent percutaneous coronary intervention (PCI) with either DCB or with CB in small branch ostial lesions of coronary arteries respectively,The immediate outcomes and long-term efficacy were investigated.Results There were no statistical differences between the two groups in baseline clinical date before PCI.There were no coronary perforation,pericardial tamponade,acute thrombotic events in the two groups.There was no significant difference in minimal lumen diameter (MLD) immediately after PCI between the two groups.During followup angiography,the MLD in the DCB group was significantly larger than in the CB group [(1.8 ± 0.2) mm vs.(1.5 ± 0.3) mm,P =0.006].There were no death,nonfatal myocardial infarction or revascularization recorded in the groups during 6 months of follow-up.Conclusion The immediate outcomes between DCB and CB were similar in small branch ostial lesions for coronary arteries angioplasty.The long-term efficacy of DCB angioplasty is better than CB angioplasty.

Objective To explore the job burnout of medical graduates in standardized training and ana -lyze the relationship between psychological capital and occupation burnout ,so as to provide reference for the devel-opment of standardized training program .Methods The Maslach Burnout Inventory -General Survey (MBI -GS), the psychological capital scale in Chinese version and the Occupation pressure index scale in Chinese Edition (OSI -PRC)were used to investigate the 536 medical graduates who are receiving standardized training .Results ①Compared with the MBI referenced values ,the scores of emotional exhaustion(EE)in MBI -GS of the graduates who received standardized training were higher , while the scores in individual achievement (IA)were lower(P <0.05);②The score of hope, optimism, resilience and efficacy in psychological capital scale was respectively nega -tively correlated with score of emotional exhaustion and depersonalization in MBI -GS(P <0.05),while positively correlated with personal accomplishment in MBI -GS;③The score of hope, optimism, resilience and efficacy in psychological capital scale was respectively negatively correlated with the score of psychological pressure , physical pressure and occupational stress of OSI -PRC(P <0.05).Conclusion The medical graduates who receive stand -ardized training have job burnout, which is related to their psychological capital level .The role of psychological capital should be paid attention to in the course of the regulation , so as to reduce the occupational stress and reduce the job burnout and prevent the brain drain .

[Objective] To analyze the effect of psychological capital on the concept of nursing specialty,job satisfaction and turnover intention in standardized training nurses,provide a reference for making standardized training programs.[Methods]Totally 493 nurses who were accepting the standardization training were collected as the objectives and evaluated with the psychological capital scale in Chinese version,the concept of nursing specialty and the job satisfaction scale.Combined with their turnover intention,the effect of psychological capital on the concept of nursing specialty,job satisfaction and turnover intention was analyzed in standardized training nurses.[Results]The nurses′ professional self-concept score and the proportion of positive professional attitude in high level psychological capital group were higher than those in low level group,and the differences were statistically significant (P＜0.05).The job satisfaction score in high level psychological capital group was higher than that in w level group,while the turnover intention score and the proportion of having turnover intention were lower than those in low level group,and the differences were statistically significant (P＜0.05).Correlation analysis showed that the scores of hope,optimism,tenacity and efficiency of the psychological capital scale was positively correlated with the job satisfaction(P＜0.05),while negatively correlated with the turnover intention (P＜0.05).[Conclusion]High level psychological capital can promote the concept of nursing specialty and job satisfaction,and reduce the turnover intention in standardized training nurses.

Objective To investigate the condition of awareness of emergency intravenous infusion style in medical staffs in part of third-grade class-A hospital in Beijing area, analyze the causes of insufficient of intraosseous infusion in China, to provide the basis for the development of the intraosseous infusion technology. Method 420 clinical medical staffs in emergency department, ICU and other departments in 8 hospitals in Beijing area, cognitive situation and the degree of trust about intraosseous infusion and central venous infusion were counted and analyzed through questionnaire. Result Awareness rate of intraosseousinfusion was only 32.6% (137/420) in medical staffs, and awareness rate of central venous infusion was 97.4% (409/420). The indications and the operation process of intraosseous infusion were known by only 4.0%(17/420) and 3.8%(16/420) in the medical staff;and the contraindications of intraosseous infusion were known by 22.6%(95/420). There were only 49.5%(208/420) medical staffs trust the intraosseous infusion. The average awareness rate of intraosseous infusion in the medical staffs of the other department [26.9%(52/193)] was less than that in emergency department [40.8% (42/103)] (P < 0.05); the awareness of intraosseous infusion from junior titles to senior titles tended to increase especially in emergency department and ICU, trend test had statistically significant difference (respectively, P=0.002, P<0.001);the awareness rate of intraosseous infusion among senior medical staffs in different departments was also different, the analysis found the awareness rate of intraosseous infusion in the senior medical staffs of other department [31.7%(13/41)] was less than that in the senior staffs of ICU [72.7%(8/11)] and emergency department [66.7%(4/6)];when the peripheral venous puncture are not successful twice, 70.7%(297/420) of the medical staffs would consider central venous infusion, 22.1%(93/420) would try the peripheral venous puncture again, only 4.1%(17/420) of the medical staffs would try the way of intraosseous infusion. And this technology was started only in 1 hospital among the total 8 hospitals. Conclusion The awareness rate of intraosseous infusion in Chinese medical staffs and carry-out rate in the hospital is very low, it is urgent to strengthen the relevant knowledge propaganda and training.

目的 探讨冠状动脉造影(CAG)联合血流储备分数(FFR)在2型糖尿病女性冠心病患者介入治疗中的临床应用价值.方法 选取2014年1月至2015年7月在航天中心医院接受CAG检查、证实至少有1处冠状动脉狭窄＞70％、拟置入支架治疗的女性患者60例,均确诊为2型糖尿病,随机分为观察组28例和对照组32例.观察组共42处病变均应用压力导丝行心肌FFR测定,仅在FFR≤0.80的病变中置入药物洗脱支架(DES);对照组共51处病变常规置入DES.比较两组患者冠心病危险因素情况、置入支架数,手术后12个月主要不良心血管事件(MACE,包括全因死亡、非致死性心肌梗死、再次血运重建及因心脏原因再入院)发生率及心绞痛再发率.结果 观察组28例患者,FFR≤0.80的有12例患者18处病变共置入DES 19枚;对照组32例患者51处病变共置入DES48枚.观察组平均住院费用[(2.43±1.02)万元比(5.54±2.11)万元,P=0.005]、平均置入支架数[(0.68±0.64)枚比(1.49 ±0.88),P=0.032]、平均手术时间[(58.4±18.1)min比(68.4 ±21.2)min,P=0.041]及平均对比剂用量[(148.8±32.0) ml比(197.9±45.4) ml,P=0.028]均少于对照组,差异均有统计学意义.随访12个月,观察组再发心绞痛4例(14.3％),MACE事件2例(7.1％);对照组再发心绞痛4例(12.5％),MACE事件3例(9.3％),两组再发心绞痛和MACE的发生率比较,差异均无统计学意义(均P ＞0.05).结论 2型糖尿病女性冠心病患者介入治疗中联合应用CAG和FFR监测,可减少术中支架置入数量及对比剂用量,且并不增加近期不良心血管事件的发生率.

Objective To explore the effect with a ward round model of psychocardiacology medical application in the clinical teaching,so that can bring up medical talented person with more comprehensive,higher quality and more capable.Methods Select 40 clinical medicine of undergraduates for five-year program interns who practice in the cardiology department of Aerospace Clinical Medical School of Beijing University as the research objects,they are divided into experimental group and contrast group randomly,The contrast group students participate in regular operation model and the experimental group students participate in the psychocardiacology ward round model.Evaluating the teaching effect through questionnaire survey and examination.Results Questionnaire shows,according to the results of the experimental group students think the psychocardiacology ward round model can improve the patient's anxiety,depression,this kind of teaching method can improve the students' interest in learning and communication ability,and also can help to further popularize the psychocardiacology.Comparing the examination of two groups of students,the experimental group students' test scores are higher than the contrast group students,P ＜ 0.05,which has statistically significant.Investigation by two groups of interns in patients with anxiety,depression,the score of the experimental group is less than that of the contrast group,P ＜ 0.05,which has statistical significance.Conclusions Internship clinical teaching of cardiology,the psychocardiacology medicine ward round model of teaching method is superior to the traditional medical model.

Objective To evaluate the safety and efficacy of bivalirudin during perioperation of percutaneous coronary intervention (PCI) in patients older than 80 years old with acute coronary syndrome. Methods A total of 64 patients were randomly divided into two groups, respectively received heparin(n=32), or bivalirudin (n=32). We compared the activated coagulation time (ACT), procedural success rate, bleeding rate between two groups. Results The two groups ACT, PCI success rates are not statistically different, No signiifcant difference in the incidence of mild hemorrhage which is 4 (12.5%) for heparin and 1(3.1%) for bivalirudin and severe bleeding which is 2 (6.2%) for heparin and 0 for bivalirudin. However there are signiifcant differences in the overall incidence of bleeding between the two groups with lower incidence of beeding in the bivalirudin group than the heparin group (P<0.05). Conclusions Bivalirudin has comparable anticoangulation effect as heparin during perioperation of percutaneous coronary intervention (PCI) among patients older than 80 years of age with acute coronary syndrome with lower bleeding incidence than heparin dose.

Objective To compare and evaluate fractional flow reserve (FFR) by intravenous infusion of adenosine 5’-triphosphate (ATP) through femoral veins and hand dosal veins. To find the feasibility of measuring FFR through ATP infusion at hand dosal veins. Methods A total of 27 patients receiving coronary angiography (CAG) were enrolled. FFR was measured by intravenous injection of ATP through femoral veins and hand dosal veins separately in 31 stenosed coronary arteries. Results A linear correlation between ATP infusion measuring FFR through femoral and hand dosal veins was observed. Heart rates, PR intervals and side effects were of no difference between the 2 routes of ATP infusion (P=0.79, P=0.56, P=0.85). It indicated that ATP infusion[160μg/(kg·min)]measuring FFR through hand dosal veins was compatable to which measuring FFR though femoral veins (y=0.945x+0.0043, R2=0.904, P=0.001). Compared with ATP infusion by femoral vein[from (53.7±15.8) s to (58.2±11.6) s], the time to FFR by infusion ATP measurement by hand dosal veins was longer[(48.7±17.9) s, P=0.015]. Conclusions The FFR measurement through ATP infusion at hand dosal veins has similar results with the FFR measured by femoral veins ATP infusion.

目的：应用彩色多普勒超声对原发性高血压患者叶间动脉血流动力学参数进行检测，并联合实验室敏感指标尿N‐乙酰‐β‐D氨基葡萄糖苷酶（N A G酶），评价该技术在原发性高血压患者早期肾损害中的诊断价值。方法以24 h尿蛋白定量及尿NAG酶为判断标准，将32例原发性高血压患者分为无早期肾损害组（n＝17）及早期肾损害组（n＝15），另选择20名健康志愿者作为对照组，所有受检者进行双肾叶间动脉频谱多普勒的测量，获取收缩期最高流速（PSV ）、舒张期末流速（EDV ）、阻力指数（RI）。结果无早期肾损害组与对照组比较，PSV、EDV、RI差异无统计学意义（P＞0．05）；早期肾损害组与对照组、无早期肾损害组比较，EDV减低，RI增大，差异均有统计学意义（P＜0．05）。结论叶间动脉血流动力学参数联合尿NAG酶，可敏感地发现原发性高血压患者的早期肾损害。

Objective To observe the expression and localization of IgM in mice normal myocardium and fibrotic myocardial tissue. Methods C57BL/10 mice were divided into 3 groups: normal group, sham group and test group (4 mice in each group). The test group was injected with angiotensin II while the sham group was injected with saline for 14 d through a micro pump post in the back hypodermal. Then the mice were killed, Western Blot and immunohistochemistry staining were taken to detect IgM. Results IgM was detected in normal mice heart tissue and fibrotic heart tissue. Comparing the fibrosis group with the sham group, IgM expression were up-regulated in myocardial cells. In the fibrosis area, the staining seems to be disappear. Conclusions IgM is expressed in mice heart tissue and the expression of IgM may related to myocardial fibrosis. Key words: Fibrosis; Immunoglobulin M; κchain

目的 评价肾功能损伤不同阶段高尿酸血症[SUA男性＞417μ mol/L(7.0mg/ml),女性＞357μmol/L(6.0mg/ml)]与冠状动脉狭窄程度的相关性.方法 随机入选北京航天中心医院心脏中心收治的214例经选择性冠状动脉造影检查确诊的冠心病患者,根据eGFR值对慢性肾脏病(CKD)患者进行分组,分析患者的血尿酸值、临床特点、血清肌酐、炎症因子和其他一些代谢相关变量；根据简化的MDRD公式计算估算肾小球滤过率；慢性肾脏疾病定义为eGFR＜ 60ml/(min·1.73m2)3个月以上,有或无肾脏损伤；根据冠状动脉造影结果计算Gensini评分评价冠状动脉狭窄程度.结果 CKD患者占38.3％(82例).eGFR与冠脉狭窄程度负相关(r=-0.536,P＜0.001)；而CKD患者中血尿酸值与冠状动脉狭窄程度正相关(r=0.26,P=0.001).CKD的独立危险因素包括:SUA水平(OR=1.22,95％ CI 1.09～1.37,P＜ 0.001)、年龄(OR=1.11,95％CI 1.10～1.14,P＜ 0.001)、冠状动脉狭窄程度(OR=0.83,95％CI 0.79～0.85,P＜ 0.001)与高血压病史(OR=1.90,95％CI 1.40～2.60,P＜0.001).结论 CKD患者中高尿酸血症是促进冠状动脉血管病变加重的重要因素,且在肾脏病的不同阶段均起作用.