Objective:To investigate the effect of circular RNA cerebellar degeneration-related protein 1 antisense (circCDR1as) on the proliferation, migration and invasion of human pulmonary artery smooth muscle cells (HPASMCs) and its mechanism.Methods:HPASMCs were cultured in vitro, and after hypoxia induction, the expression of circCDR1as was interfered, microRNA-135a-5p (miR-135a-5p) was inhibited or overexpressed and Janus kinase 2 (JAK2) was overexpressed in cells. The expression of circCDR1as and miR-135a-5p in cells was detected by real-time quantitative polymerase chain reaction (RT-qPCR). The protein expression of JAK2, signal transducer and activator of transcription 3 (STAT3) in cells was detected by Western blotting. Results:The expression levels of circCDR1as and the ratio of phosphorylated JAK2 (p-JAK2)/JAK2 and phosphorylated STAT3 (p-STAT3)/STAT3 in hypoxic group were significantly higher than those in normoxia group (1.98±0.07 vs. 1.01±0.05, 0.62±0.06 vs. 0.18±0.04, 0.56±0.05 vs. 0.15±0.03), and the expression level of miR-135a-5p was significantly lower than that in normoxia group (0.52±0.05 vs. 1.00±0.04, t=27.620, 14.946, 17.223, 18.362, P<0.05). The expression level of circCDR1as, p-JAK2/JAK2, p-STAT3/STAT3 ratio and cell viability, number of migrating cells, and number of invasive cells in si-circCDR1as group were significantly lower than those in si-NC group (0.41±0.05 vs. 1.02±0.06, 0.41±0.05 vs. 0.61±0.05, 0.38±0.03 vs. 0.54±0.04, 0.42±0.04 vs. 0.73±0.06, 75.64±17.95 vs. 145.38±26.42, 68.96±16.82 vs. 121.05±24.80), and the expression level of miR-135a-5p was significantly higher than that in si-NC group (1.73±0.06 vs. 1.03±0.05, t=19.131, 6.928, 7.838, 10.530, 5.348, 4.258, 21.954, P<0.05). Conclusion:CircCDR1as can activate JAK2/STAT3 signal pathway by targeting the inhibition of miR-135a-5p expression, and promote the proliferation, migration and invasion of HPASMCs induced by hypoxia.

Objective:To analyze the relationship between serum microRNA (miR)-146a, miR-499 and new onset atrial fibrillation after off-pump coronary artery bypass grafting (OPCABG) in patients with coronary heart disease (CHD).Methods:A Total of 118 patients with CHD treated in the First Affiliated Hospital of Zhengzhou University from August 2019 to August 2021 were selected as the research subjects. All patients were treated with OPCABG, and were observed for 7 days after operation. The patients with atrial fibrillation during the observation period were included in the occurrence group, and those without atrial fibrillation served as the non-occurrence group. The levels of serum miR-146a and miR-499 were measured the next day after admission, and general information of the two groups was asked and recorded. The relationship between serum miR-146a, miR-499 and new onset atrial fibrillation after OPCABG in patients with CHD was analyzed by independent sample t-test and the Logistic regression analysis. Results:Among the included 118 patients with CHD, 28 cases developed atrial fibrillation after OPCABG, accounting for 23.73%. After comparison of the general data and laboratory indicators between the two groups, the eligible variables were included. The Logistic regression analysis showed that serum miR-146a and miR-499 levels were significantly increased in the occurrence group as compared with those in the non-occurrence group (1.36±0.18 vs. 1.24±0.16, 2.13±0.22 vs. 1.95±0.18) ( t=3.439, 4.487, P<0.05). The receiver operating characteristic (ROC) curve was drawn and showed that the area under the curve (AUC) of serum miR-146a and miR-499 alone and combined to predict atrial fibrillation after OPCABG in patients with CHD were 0.788, 0.815 and 0.860 respectively, which had certain predictive value. Conclusion:The overexpression of serum miR-146a and miR-499 is related to atrial fibrillation after OPCABG in patients with CHD. The preoperative detection of both levels can predict the risk of postoperative atrial fibrillation.

目的 分析二尖瓣成形术治疗二尖瓣关闭不全(MI)的早期临床效果.方法 选取2019年1月至2020年1月于郑州大学第一附属医院心外科因MI行二尖瓣成形术的94例患者.所有患者手术均为同一主刀团队开展.收集患者的临床资料以及术前、术后3个月、术后6个月、术后1 a超声心动图指标,包括二尖瓣返流程度、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心房舒张末期内径(LAEDD).结果 在94例患者中,1例(1.1％)患者因术后低心排综合征治疗无效死亡,2例(2.1％)患者因术后出血行开胸探查止血术,术后顺利出院,其余患者术后均顺利出院.术后随访3个月、6个月、1 a时,出现中度及以上二尖瓣返流的患者占比为6.5％、7.6％、5.4％.随访终点时,心功能分级降低(P<0.05).随访终点时,LVEF高于术前,LVEDD、LAEDD均小于术前(P<0.05).结论 二尖瓣成形术治疗MI的临床效果明确.

目的 分析同种异体原位心脏移植治疗终末期心脏病患者的效果.方法 回顾性收集郑州大学第一附属医院心血管外科13例同种异体原位心脏移植患者的临床资料,分析供心获取与保护、受者术前评估与维持治疗、感染的预防与治疗、免疫抑制剂的应用、术后并发症的治疗等情况.结果 13例心脏移植手术,供心冷缺血时间10～360(200.8±38.0)min,手术时间244～616(345.7±33.4)min,体外循环时间94～205(196.7±22.4)min,主动脉阻断时间35～102(74.4±6.8)min.术后外科重症监护病房住院时间5～91(29.1±7.4)d,围手术期死亡2例,1例死于多器官衰竭,1例死于感染性休克.随访时1例死于移植物衰竭.术后1个月心功能均达到纽约心脏协会(NYHA)心功能分级Ⅰ～Ⅱ级,超声心动图检查左室射血分数为58％～65％[(62.7±5.6)％],术后6个月左室射血分数为58％～66％[(62.4±0.7)％],余存活患者恢复良好.结论 心脏移植是治疗终末期心脏病的首选方案.随着心脏移植技术的成熟,围手术期管理的优化,患者生存率提高,生活质量得到改善,临床效果良好.

Objective:To explore the relationship between serum microRNA (miR)-335 and miR-193b levels and prognosis in patients with coronary heart disease (CHD) after coronary artery bypass grafting (CABG).Methods:106 patients with CHD admitted to Central China Fuwai Hospital, Zhengzhou University from June 2018 to June 2020 were selected as the research subjects, all patients were treated with CABG, the patients were followed up for 12 months after operation, according to the prognosis of patients (whether adverse cardiovascular events occurred), they were divided into a poor prognosis group and a good prognosis group. The serum levels of miR-335 and miR-193b at admission were detected and compared between the two groups, the relationship between the serum levels of miR-335 and miR-193b at admission and the prognosis of patients with CHD after CABG was analyzed.Results:Among 106 patients with CHD after CABG treatment and follow-up, 34 cases had adverse cardiovascular events, accounting for 32.08%; the levels of cholesterol (TC) (6.02±0.87) mmol/L, triglyceride (TG) (1.87±0.40) mmol/L in poor prognosis group were higher than those in good prognosis group (4.45±0.62) mmol/L, (1.53±0.31) mmol/L, and the levels of miR-335 (0.55±0.29), miR-193b (0.46±0.25) were lower than those in good prognosis group (0.81±0.27), (0.76±0.24), the differences were statistically significant ( t=10.577, 4.940, 4.571, 5.869, P<0.05); there was no statistical significant difference in other data between the two groups ( P>0.05); after the single Logistic regression analysis, the P value was relaxed to <0.1, the eligible factors were included, and the multiple logistic regression model was established, the results showed that the overexpression of TC ( B=3.666, odds ratio ( OR)=39.106, 95% confidence interval ( CI): 8.551-178.831), TG ( B=2.888, OR=17.959, 95% CI: 4.516-71.423) might be a risk factor for the prognosis of patients with CHD after CABG ( OR>1, P<0.05), the high expression of miR-335 ( B=-3.324, OR=0.036, 95% CI: 0.007-0.190), miR-193b ( B=-5.068, OR=0.006, 95% CI: 0.001-0.054) levels might be a protective factor for the prognosis of patients with CHD after CABG ( OR<1, P<0.05); the ROC curve was drawn, and the results showed that the area under curve (AUC) of serum miR-335 and miR-193b levels at admission in predicting poor prognosis of patients with CHD after CABG treatment were all >0.70, which had certain predictive value, when the cut-off values of serum miR-335 and miR-193b at admission were 0.640 and 0.660, the best predictive value could be obtained. Conclusion:The serum levels of miR-335 and miR-193b are closely related to the prognosis of patients with CHD after CABG, the combined detection of the two is helpful to monitor the prognosis of patients with CHD.

目的 比较缝合线成形术和人工瓣环成形术治疗三尖瓣关闭不全(TR)的临床效果.方法 收集2012年2月至2019年3月于郑州大学第一附属医院接受三尖瓣成形术治疗的1005例患者的临床资料.患者均在接受其他心脏疾病手术的同时接受三尖瓣成形术治疗.根据手术方式将患者分为缝合线组(483例,48.1％)和成形环组(522例,51.9％).分别于术前、术后1个月、术后1a和术后2a行心脏超声心动图检查,比较两组三尖瓣反流程度和右心房横径.结果 与术后1 a比较,缝合线组和成形环组术后2 a三尖瓣反流程度进展(P<0.05).术前、术后1个月,成形环组TR分级较缝合线组严重(P<0.05);术后1 a和术后2 a,成形环组TR分级与缝合线组比较,差异无统计学意义(P>0.05).两组4个时间点的右心房横径随着时间推移均逐渐缩小,并且两相邻时间点的缩小差异有统计学意义(P<0.05).术前、术后1个月和术后1 a,成形环组右心房横径大于缝合线组(P<0.05).术后2 a,成形环组右心房横径与缝合线组比较,差异无统计学意义(P>0.05).结论 缝合线成形术和成形环成形术两种技术对TR均具有良好的短期效果.随着时间的推移,缝合线成形术较成形环成形术退变快,人工瓣环成形术是更理想的三尖瓣成形技术.

Objective:To explore the establishment of a canine model of acute atrial fibrillation using acetylcholine.Methods:From January 2018 to June 2019, 20 healthy adult hybrid dogs were selected and provided by animal experimental center of Zhengzhou University. The dogs were 1-2 years old and weighed [(14.82±3.67) kg]. The different concentrations of acetylcholine were given. At each acetylcholine concentration, the subjects were given 3 bursts of stimulation, and the induction number and duration of atrial fibrillation were recorded. The effective atrial refractory period with different acetylcholine dose and stimulation sites was measured and recorded, simultaneously.Results:Totally, 20 experimental canine models of acute atrial fibrillation were successfully established with different durations of atrial fibrillation, and the atrial refractory period in the stimulated sites was shortened along with the dose increase of acetylcholine [(118.31±7.68) ms vs. (77.38±8.21) ms, t=15.672, P<0.05]. The average concentration of acetylcholine in experimental dogs reaching the maximum duration of atrial fibrillation was (94.00±23.02) μg/(kg·min), and the longest average duration of atrial fibrillation was (894.80±122.82) s. It was found that at a certain dose of acetylcholine, the duration of atrial fibrillation increased with the increase of acetylcholine dose, but when the acetylcholine dose exceeded a certain dose, the duration of atrial fibrillation decreased alternatively with the increase of acetylcholine dose, which revealed relationship between the duration of atrial fibrillation and the concentration of acetylcholine. Conclusion:The application of Ladder-type acetylcholine can successfully establish acute atrial fibrillation models in canine with different durations of atrial fibrillation.

目的 比较二尖瓣成形术(MVP)与置换术(MVR)治疗重度缺血性二尖瓣关闭不全(IMR)的效果.方法 选取2011年1月至2017年1月郑州大学第一附属医院收治的78例冠心病合并重度IMR患者,根据治疗方式分为MVP组(46例)和MVR组(32例).MVP组患者接受冠状动脉旁路移植术(CABG)联合MVP治疗,MVR组患者接受CABG联合MVR治疗.术后定期随访,比较两组患者围手术期指标,采用经胸超声心动图(TTE)检测术前、出院时、末次随访的左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、二尖瓣反流情况等.结果 MVP组围手术期死亡3例(6.5％),MVR组围手术期死亡2例(6.25％).围手术期,MVP组患者主动脉阻断时间、体外循环时间、冠脉移植血管数、呼吸机辅助时间、入住ICU时间、住院时间、IABP使用率、ECMO使用率、死亡率与MVR组比较,差异无统计学意义(P>0.05).73例(93.6％)患者顺利出院,包括MVP组43例和MVR组30例,出院后随访1.5～5 a.出院时,MVP组二尖瓣反流发生率和LVEF均高于MVR组,差异有统计学意义(均P<0.05).出院时,两组LVEDD比较,差异无统计学意义(P>0.05).随访过程中,MVP组死亡3例,失访1例,MVR组死亡1例,失访0例,MVP组和MVR组死亡率分别为7.0％(3/43)、3.3％(1/30).两组患者死亡率比较,差异无统计学意义(P>0.05).末次随访,MVP组二尖瓣反流发生率高于MVR组,差异有统计学意义(P<0.05).末次随访,MVP组LVEF、LVEDD与MVR组比较,差异无统计学意义(P>0.05).结论 可采用CABG联合MVP或CABG联合MVR治疗冠心病合并重度IMR,但CABG联合MVP治疗后再发二尖瓣关闭不全的可能性较大.

目的:比较行不同成形术治疗风湿性二尖瓣病变合并功能性三尖瓣关闭不全的外科疗效.方法:选取风湿性二尖瓣病变合并功能性三尖瓣关闭不全患者119例,按照治疗方法将患者分为对照组、三尖瓣人工环植入成形术组(成形环组)以及三尖瓣缝线成形术(缝线组),分别统计患者年龄、性别、手术方式、术前及术后心功能分级等指标,采用t检验对患者术前、术后2周以及术后6个月心脏各腔内径进行统计学分析.结果:患者行三尖瓣人工环植入成形术以及三尖瓣缝线成形术治疗后,心脏各腔内径均明显缩小,成形环组患者术后心脏内径缩小最显著,行三尖瓣缝线成形术患者次之.术前成形环组左心房、右心房以及右心室内径较对照组扩大明显(P＜0.05);术前缝线组左心房、右心房以及右心室内径较对照组扩大明显(P＜0.05);术前成形环组与缝线组右心房、右心室内径组间无明显差异;术后2周以及术后6个月三组间左心房内径无明显差异(P＞0.05).术后2周成形环组以及缝线组右心房以及右心室内径仍大于对照组(P＜0.05),术前成形环组与缝线组组间无显著差异.术后6个月成形环组右心房以及右心室内径较缝线组显著缩小(P＜0.05),成形环组和对照组间无明显差异.结论:治疗风湿性二尖瓣病变合并功能性三尖瓣关闭不全的方法中,三尖瓣人工环植入成形术效果优于三尖瓣缝线环缩术.

目的 探讨核因子-κB (NF-κB)在体外培养离体的公猪主动脉瓣膜间质细胞(AVIC)钙化过程中表达的变化.方法 体外培养公猪AVIC,镜下观察其形态,应用免疫荧光染色法对AVIC进行鉴定.将AVIC分为对照组和实验组,对照组AVIC在标准培养基中培养2周,实验组AVIC在钙化诱导液中培养2周.光学显微镜下对钙化结节行茜素红染色,并进行计数;应用Western blot检测2组AVIC中NF-κB蛋白表达水平.结果 成功分离并体外培养了离体的公猪AVIC,免疫荧光结果显示,α-平滑肌肌动蛋白及波形蛋白染色阳性,血管性血友病因子染色阴性.实验组AVIC自发形成钙结节数及AVIC中NF-κB表达水平均较对照组显著增高(P＜0.05).结论 钙化后公猪AVIC中NF-κB表达水平增高,NF-κB可能与主动脉瓣膜钙化的发生有关.

目的:确定先天性心脏病活动期感染性心内膜炎(active infective endocarditis,AIE)的手术指征.方法:于2003-2011年从71个机构数据库中调查并采集247例患有感染性心内膜炎的儿童及成人先天性心脏病(congenital heart disease,CHD)患者数据,其中74例(30％)进行了AIE手术治疗.回顾性分析患者的年龄、性别、感染心内膜炎前对CHD的诊断、致病微生物和感染部位等数据.结果:与AIE手术治疗必要性显著相关的指标是感染性心内膜炎(infective endocarditis,IE)病发前对心脏异常的诊断缺乏、主动脉辩IE、瓣周脓肿、心力衰竭以及抗生素发生变化.逐步逻辑回归方程分析结果表明瓣周脓肿、心力衰竭以及抗生素改变是先天性心脏病患者进行AIE手术治疗必要性的独立决定因素.结论:对IE合并CHD的患者而言,当心力衰竭、瓣周脓肿或抗生素变化发生时,手术可作为治疗AIE的一种手段.

目的 研究家猪主动脉瓣间质细胞(AVIC)体外钙化诱导过程中基质谷氨酸蛋白(MGP)的变化.方法 处死健康成年雄性家猪6只,取下心脏,分离、培养AVIC,并进行细胞表型鉴定.取2～5代AVIC,分为在标准培养基中培养的对照组与在钙化诱导培养基(标准培养基内加入钙化诱导剂)中培养的钙化诱导组,分别采用茜素红染色及Western blot、半定量聚合酶链反应技术检测2组细胞在1、7、14 d的钙化情况及MGP在蛋白及mRNA水平的表达情况.结果 对照组细胞在7、14 d出现少量钙化结节[每孔(2.38 ±0.97)个、(9.47±1.59)个],钙化诱导组细胞在7、14 d出现明显钙化结节[每孔(37.55 ±6.70)个、(78.29 ±9.14)个];钙化诱导组细胞在7、14 d钙化情况明显高于对照组(P＜0.05).在7、14 d,钙化诱导组细胞内活化型MGP蛋白水平及MGP mRNA表达水平明显低于对照组(P＜0.05).结论 在钙化诱导条件下,AVIC内钙化抑制剂MGP抑制钙化能力下调.

目的 探讨冠状动脉旁路移植术(CABG)治疗ST段抬高心肌梗死(STEMI)的最佳手术时机以及术后死亡的危险因素.方法 回顾性分析213例行CABG的血流动力学稳定的STEMI患者临床资料,根据心肌梗死发生至手术时间将患者分为A组(心肌梗死后7 ～14 d)60例,B组(心肌梗死后15 ～ 21 d)72例,C组(心肌梗死后≥22 d)81例,比较3组患者临床资料、术中及术后情况、死亡情况等,并采用logistic回归分析对可能影响STEMI患者住院期间CABG术后死亡的因素进行单因素及多因素分析.结果 213例患者死亡8例,占3.8％,死因为循环衰竭4例,多器官功能衰竭2例,肾衰竭2例.A组、B组、C组发病距手术时间分别为(10.9±1.9)d、(18.2±2.0)d和(27.3±4.4)d(P ＞0.05).A组、B组、C组的病死率分别为5.0％ (3/60)、4.2％ (3/72)、2.47％ (2/81),组间比较差异无统计学意义(P＞0.05).女性、左心室射血分数＜0.45、磷酸肌酸激酶(CK) 750 U/L为STEMI患者住院期间CABG术后死亡的独立危险因素(P＜0.05),心肌梗死距离手术时间与术后死亡无关(P＞0.05).结论 血流动力学稳定的STEMI患者心肌梗死发生7d后任何时间段行冠脉旁路移植术都是安全的,女性、左心室射血分数＜0.45、CK＞ 750 U/L可能是影响STEMI患者住院期间CABG术后死亡的风险因素.

Objective To study the curative effect of drug therapy and cardiac muscle relaxation on patients with symptomatic myocardial bridge. Methods Fifty patients with obvious symptoms of angina pectoris who were di-agnosed with myocardial bridge by coronary angiography from June 2012 to June 2014 in our hospital with heart func-tion of gradeⅡtoⅣby CCS were divided into 2 groups:treatment group (n=26) was treated with cardiac muscle re-laxation and control group (n=24) was treated with beta blockers and/or calcium antagonist (CCB). After 1 year of follow-up,the outcome was observed in patients with myocardial infarction, death, target vessel remodeling and CCS score>2. Results The baseline characteristics of the two groups (including gender,age,CCS grades,hypertension and diabetes) were not significantly different ( P>0. 05 );there was no significant differences between the two groups re-garding lesion vessel diameter and compression ratio (P>0. 05). After an average 12-month follow-up,the treatment group was significantly lower on the end-point incidence than control group (P<0. 05). Conclusion Cardiac muscle relaxation has better prognosis for patients with symptomatic myocardial bridge than the conservative drug treatment.

Objective To investigate the divergence of cibenzoline and disopyramide in the treatment of paroxysmal atrial fibrillation after cardiovascular surgery.Methods 118 patients who had postoperative paroxysmal AF lasting ≥ 30 min were randomly assigned to receive either intravenous cibenzoline (70 mg,n =60) or disopyramide (50 mg,n =58) for terminating postoperative paroxysmal AF.Multivariate logistic regression was used to adjust several covariates and to generate adjusted odds ratios (OR) to identify clinical factors to increase the termination efficacy of intravenous cibenzoline and disopyramide.Results The success rate of intravenous cibenzoline therapy 46.67％ (28/60) was significantly higher than that of intravenous disopyramide therapy [24.13％ (14/58),P ＜ 0.05].The significant variables for the termination of paroxysmal AF after intravenous cibenzoline therapy were pretreatment with oral β-adrenergic blockers (OR =8.224,P ＜ 0.05) and smaller left atrial dimensions (OR =0.879,P ＜ 0.05).Conclusion The efficacy of intravenous cibenzoline for the termination of postoperative paroxysmal AF was more satisfactory than that of disopyramide,especially in patients with pre-administration of oral β-adrenergic blockers and those with smaller left atrium.

目的 分析心脏直视手术术后手术部位感染的相关风险因素,为临床预防和控制术后手术部位感染提供科学依据.方法 回顾性分析新乡医学院第一附属医院心血管外科2011年1月～2014年10月进行直视下心脏手术患者1623例,其中术后手术部位感染83例,与同期未发生手术部位感染的患者按1∶2配比法进行相关危险因素分析,涉及的风险因素包括性别、年龄、体重指数、吸烟、糖尿病、手术时间等,数据使用SSPS 22.0软件分析.结果 全部1623例心脏直视手术后手术部位感染患者83例,感染率为5.11％,其中切口浅表部位、深部及纵隔内感染率分别为80.72％、18.07％及1.2％.多因素条件Logistic回归分析认为,手术时间(＞2.5 h)、术后ICU时间(＞2 d)、术后发热(术后3d,≥38.5℃)是手术部位感染的独立相关因素(P＜0.05).结论 强化无菌操作、减少手术时间、改进术后患者ICU治疗与护理可减少手术部位感染发生率,患者术后ICU停留时间增加和术后发热可能成为手术部位感染的预测或诊断指标.

随着高血压发病率增高及糖尿病患者的增多，冠状动脉粥样硬化性心脏病发生率逐年上升〔1〕。在该疾病发病过程中，脂质在冠状动脉内膜沉积导致的粥样硬化斑块是引起冠状动脉狭窄的主要因素。由于该类患者多存在多支血管病变且狭窄程度不完全相同，因而对于病变较轻患者可以采用支架植入缓解冠脉狭窄程度并促进术后恢复〔2〕。杂交手术是在进行左乳内动脉（ LIMA）吻合于左前降支（ LAD）的LIMA-LAD旁路移植手术的同时植入药物涂层支架处理非前降支病变，具有较高的远期通。率〔3〕，且有助于缩短手术时间，提高了患者冠脉的通。率，近年来在国内逐渐获得应用。

Obejective To study the relation between epicardial adiponectin level and coronary ar‐tery lesion in CHD patients .Methods One hundred and sixty eight CHD and valvular disease (VD) patients admitted to our hospital were divided into CHD group (n=86) and VD group(n=82) .Patients in CHD group were further divided into <30 lesion score group (n=23) ,30-90 le‐sion score group (n=35)and >90 lesion score group (n=28) .Epicardial adipose tissue and serum samples were taken from the patients .Their serum adiponectin level was measured and adipokine mRNA expression was detected by ELISA and RT‐PCR ,respectively .Results The serum adi‐ponectin level was significantly lower in CHD group than in VD group (9 .1 ± 3 .1 mg/L vs 13 .5 ± 3 .9 mg/L ,P<0 .05) ,<30 lesion score group ,30 -90 lesion score group and >90 lesion score group (12 .3 ± 4 .8mg/L ,9 .1 ± 4 .5 mg/L ,7 .2 ± 5 .1 mg/L ,P< 0 .05) .The adiponectin mRNA expression level was significantly lower in CHD group than in VD group (P<0 .05) .Conclusion The serum epicardial adiponectin level decreases with the severity of coronary lesions in elderly CHD patients .

目的：观察改良超滤联合血液回收对老年患者心脏瓣膜置换术的临床效果和预后的影响。方法82例老年心脏瓣膜置换术患者随机分为对照组和研究组，分别采用常规手术和改良超滤联合血液回收的方法手术。观察两组术后并发症发生率、死亡率、心功能、出血量、库血用量、血细胞比容、血小板计数、凝血酶原时间、D－二聚体水平、活化全血凝固时间、高敏 C反应蛋白（ hsCRP）、同型半胱氨酸（ Hcy）、糖类抗原（ CA）125、B型钠尿肽（BNP）、左室射血分数（LVEF）等指标的差异。结果研究组术后并发症发生率显著低于对照组（χ2＝5．47，P＜0．05）；术后24 h出血量、库血用量、血细胞比容、术后24 h尿量及呼吸机辅助时间均显著少于对照组（t＝2．36、2．29、2．18、2．21、2．19，P＜0．05）；与治疗前比较，研究组和对照组hsCRP、LVEF、D－二聚体、PLT均有显著性改变（ t＝2．27、2．13、2．09、2．45、2．58、2．64、2．19、2．06，均 P＜0．05）；治疗后研究组 hsCRP、D－二聚体、术后6 h出血量与对照组均有统计学意义（t＝2．34、2．25、2．11，P＜0．05）。结论改良超滤联合血液回收在老年心脏瓣膜置换手术中可减少早期出血量及异体输血量，可以改善术后老年患者的早期预后及老年心脏瓣膜置换手术的心功能，减轻炎症反应，减少并发症发生。

Objective To study the association between 10 single nucleotide polymorphisms (SNP) of the vascular endothelial growth factor gene (VEGF) and the risk of coronary artery disease (CAD).Methods We examined the potential association between CAD and 10 single nucleotide polymorphisms (SNP,rs699947,rs1570360,rs2010963,rs833068,rs3024997,rs3025000,rs3025010,rs3025020,rs3025030 and rs3025039) of the VEGF gene using the MassARRAY system.Participants included 242 CAD patients and 253 healthy controls from a Chinese Han Population.Results The CAD patients had significantly higher frequency of the rs699947 A allele [27.3％ vs.18.4％,x2 =11.141,P ＜ 0.01,odds ratio (OR) =1.665,95％ confidence interval (CI):1.232-2.250] and rs2010963 C allele (47.9％ vs.36.4％,x2=13.593,P＜0.01,OR=1.611,95％ CI:1.249-2.077).Conclusion These findings point to a role for VEGF polymorphism in CAD in a Chinese Han population,and may be informative for future investigations on the pathogenesis of CAD.