目的 评估CHADS2、CHA2DS2-VASc和自行改良的CHA2DS2-VASc-LA2评分对经食管超声(TEE)检出左心房或左心耳血栓(LAT)的预测价值.方法 纳入2007年6月至2012年6月在我科拟行射频消融术且术前TEE检查、心脏多层CT扫描等相关临床资料完整的非瓣膜性心房颤动(NVAF)患者,共203例,其中TEE提示LAT者39例(血栓组),未检出LAT者164例(对照组).对患者的一般情况、既往病史、入院时检查、CHADS2评分和CHA2DS2-VASc评分进行单因素分析和多因素logistic回归分析,根据logistic回归分析结果,将独立预测因素左心房容积指数(LAVI)≥32 mL/m2记为2分,加入CHA2DS2-VASc评分中组合成新的评分方案CHA2DS2-VASc-LA2.绘制受试者工作特征曲线(ROC),比较CHADS2、CHA2DS2-VASc和CHA2DS2-VASc-LA2评分方案对NVAF患者LAT形成的预测价值.结果 对CHADS2、CHA2DS2-VASc及CHA2DS2-VASc-LA2三种评分进行ROC曲线检测,发现CHADS2诊断价值偏低(AUC=0.661,P=0.002),CHA2DS2-VASc和CHA2DS2-VASc-LA2诊断价值中等(AUC=0.731,P＜0.001; AUC=0.771,P＜0.001).使用CHA2DS2-VASc-LA2评分后血栓组CHADS2评分为0分的3例低危患者分值均有上升,血栓组中无CHA2DS2-VASc-LA2评分为0分者.结论 CHA2DS2-VASc-LA2评分较CHADS2、CHA2DS2-VASc评分系统能更好地预测NVAF低危人群的LAT形成,CHA2DS2-VASc-LA2评分为0分者可避免常规的TEE检查.

Objective To investigate the potential association between serum lipids and atrial fibrillation(AF).Methods Five hundred and ninety-eight patients with AF including 295 patients with paroxysmal AF(PAF) and 303 patients with non-paroxysmal AF(NPAF) were enrolled,and 596 non-AF patients with hypertension and diabetes were served as control.Primary clinical and laboratory data including white blood cell count(WBC),neutrophilic granulocyte ratio,liver function,blood lipids,blood glucose,renal function,thyroid function,electrocardiograph(ECG) / Holter-ECG and echocardiograph were collected in all patients.

OBJECTIVE:To analyze the efficacy and safety of intra-aortic balloon pump (IABP) therapy in patients with acute myocardial infarction(AMI) based on the meta-analysis.METHODS:Eligible published randomized controlled clinical research (RCT) were retrieved in the Pubmed, EMBase, Cochrane, China biological medical literature, Wanfang, VIP and CNKI database from 1980 to April 2, 2012. The analysis was performed with the software of RevMan 5.1.RESULTS:Thirteen RCTs with 1958 patients (AMI with IABP therapy, n = 970,without IABP therapy, n = 988) were included. The 30-day mortality between the two groups was similar (RR = 0.77, 95%CI 0.58-1.03, P = 0.08), but the 30-day mortality in the cardiac shock subgroup was significantly lower in IABP group than in without IABP group (RR = 0.65, 95%CI 0.44-0.97, P = 0.04). The 6-month mortality was significantly lower in IABP group than in without IABP group (RR = 0.72, 95%CI 0.55-0.94, P = 0.02). The incidence of major bleeding was significantly higher in IABP group than in without IABP group (RR = 1.43, 95%CI 1.16-1.75, P < 0.01).CONCLUSION:IABP therapy is effective to reduce earlier mortality post AMI, particularly for patients with cardiac shock.

AIM: To explore the role of placental growth factor(PLGF) in the process of angiotensin Ⅱ(Ang Ⅱ)-induced activation of cardiac fibroblasts(CFs).METHODS: Primary culture and identification of CFs from neonatal Sprague-Dawley rats were performed.The method of fluorescence immunocytochemistry was employed to observe the expression of alpha-smooth muscle actin(α-SMA).Real-time PCR and Western blotting were used to determine mRNA and protein levels.The cell proliferation was observed by WST-1 assay.RESULTS: Compared with control group,the PLGF expression at mRNA and protein levels in Ang II-treated CFs was significantly increased,whereas the mRNA expression of PLGF was decreased in the CFs treated with telmisartan and Ang Ⅱ.Treatment with PLGF induced the proliferation of CFs and increased the protein expression of α-SMA.Treatment with PLGF for 60 min significantly increased the protein levels of p-ERK1/2 in the CFs.Compared with Ang Ⅱ group,the proliferation of CFs was depressed and the protein expression of α-SMA was attenuated in Ang II+anti-PLGF group.The mRNA expression levels of type Ⅰ and type Ⅲ collagens were also down-regulated.CONCLUSION: PLGF might be involved in the process of Ang Ⅱ-induced proliferation of CFs and fibrosis.

Objective:To systematically evaluate the efficacy and safety of everolimus-eluting stents(EES)versus sirolimus-eluting stents(SES)in the treatment of patients with coronary artery disease undergoing percutaneous coronary intervention. Methods:Databases such as PubMed,EMbase,Cochrane Library and CNKI were searched to collect all the randomized controlled trials(RCTs)of EES versus SES in patients with coronary artery disease from 2000 to 2012. After the data extraction and methodological quality evaluation, Meta analysis was conducted with RevMan 5.0 software. Results:A total of 10 RCTs were included. Among 12 937 patients involved, 6 378 were in EES group while the other 6 559 were in SES group. Results of Meta analysis showed that EES was superior to SES in reducing definite stent thrombosis rates(OR=0.47,95%CI=0.26 to 0.85,P=0.01). In contrast,there were no significant differences between EES and SES in target-lesion revascularization rates(OR=0.85,95%CI=0.70 to 1.03,P=0.11),target-vessel revascularization rates(OR=0.92,95%CI=0.77 to 1.09,P=0.33),cardiac death rates(OR=0.91,95%CI=0.69 to 1.20,P=0.52),incidences of major adverse cardiac event(OR=0.89,95%CI=0.78 to 1.02,P=0.09)and recurrence rates of myocardial infarction(OR=0.95,95%CI=0.75 to 1.19,P=0.63). Conclusions:EES is more effective than SES in reducing the rate of definite stent thrombosis.