MMP-9、IL-6与急性冠脉综合征相关性的研究

目的观察急性冠状动脉综合征(ACS)中基质金属蛋白酶-9(MMP-9)、白细胞介素-6(IL-6)的水平变化,探讨二者之间的关系。方法选ACS患者50例,其中不稳定性心绞痛患者28例,急性心肌梗死患者22例及正常对照组50例,采用酶联免疫吸附试验(ELISA)测定血浆MMP-9、IL-6水平,分析MMP-9与IL-6的相关性。结果ACS患者血浆MMP-9水平显著高于对照组(P<0.01),ACS患者血浆IL-6水平显著高于对照组(P<0.01)。ACS患者血浆MMP-9与IL-6呈显著的正相关(r=0.55,P<0.01)。结论ACS患者血浆MMP-9、IL-6水平明显升高,与不稳定粥样斑块破裂密切相关,两者共同作用促使ACS发生。     

冠心病患者血清可溶性OX40配体和CRP水平的临床意义

目的探讨不同类型冠心病患者血清可溶性OX40配体(sOX40L)和C反应蛋白(Creactive protein,CRP)水平的临床意义。方法分别采用ELISA法和免疫透射比浊法检测458例疑似或诊断为冠心病患者血清sOX40L和CRP的浓度,采用冠脉造影术和ACC/AHA评分法判定冠状动脉病变程度。结果急性冠脉综合征(ACS)组患者血清sOX40L和CRP水平及冠脉评分均明显高于稳定型心绞痛(SAP)组和正常对照(CT)组(P<0.01);sOX40L与CRP及冠脉评分均呈正相关(P<0.01),CRP与冠脉评分亦呈正相关(P<0.01)。结论血清sOX40L和CRP水平与冠心病患者的病情严重程度及冠状动脉病变程度密切相关,sOX40L有望与CRP一样,作为炎症指标预测冠心病的发生和预后。     

C反应蛋白对冠脉病变稳定性评估

目的探讨C反应蛋白(CRP)与冠脉病变稳定性的关系。方法选择稳定性心绞痛25例,不稳定性心绞痛35例,入院后即刻0、6、24、48h和7d检验CRP和肌钙蛋白(TnT),根据患者是否发生心脏不良事件(MACE)进行分类研究。结果不稳定性心绞痛患者CRP的水平明显高于稳定性心绞痛患者,P<0.01,发生心脏不良事件的患者其CRP和TnT水平在任何时点均高于未发生者,P<0.01。结论 C反应蛋白与冠脉病变稳定性相关,CRP和TnT联合检验可用于急性冠脉综合症的危险分层。     

vWF与冠心病的关系

目的测定冠心病患者的血管性血友病因子(von Willebrand Factor,vWF)水平,探讨vWF与冠心病的关系。方法本研究共纳入119例确立性冠心病患者和83名健康对照者。取冠心病患者(包括急性冠脉综合征亚组、稳定型心绞痛亚组)和健康对照者血液各5mL,用酶联免疫吸附法测定2组血vWF:Ag浓度,比较vWF在冠心病患者及各亚组间的关系。结果 (1)冠心病组血浆vWF:Ag水平明显高于对照组(126.73%±53.16%)VS(72.53%±48.52%),(P<0.05)。(2)稳定型心绞痛(SAP)亚组血浆vWF水平与对照组差异无统计学意义(91.37%±31.33%)VS(72.53%±48.52%),(P>0.05)。(3)急性冠脉综合征(ACS)亚组血浆vWF水平(169.24%±40.12%)较稳定型心绞痛亚组(91.37%±31.33%)、对照组(72.53%±48.52%)明显升高(P<0.05)。结论 vWF:Ag水平在冠心病患者中增高,尤其在急性冠脉综合征患者中明显增高,是冠心病的危险因素。     

基质金属蛋白酶MMP-2及MMP-9在淋巴系肿瘤中的表达

目的探讨基质金属蛋白酶ProMMP-2、MMP-2、ProMMP-9和MMP-9与淋巴系肿瘤的相关性。方法应用明胶酶谱(SDS-PAGE Zymograph)和计算机蛋白定量测定系统,对62名淋巴系肿瘤患者(初发组35名,复发组12名,缓解组15名)和20名正常人,测定其血清中ProMMP-2、MMP-2、ProMMP-9和MMP-9的表达水平。结果初发组、复发组患者血清中ProMMP-2、MMP-2和MMP-9的表达水平明显高于缓解组和对照组。而初发组、复发组患者血清中ProMMP-9表达水平与缓解组和对照组差异无显著意义;初发组患者血清中ProMMP-2、MMP-2、ProMMP-9和MMP-9表达水平与复发组相比差异无显著意义。缓解组患者血清中ProMMP-2、MMP-2、ProMMP-9和MMP-9表达水平与对照组差异无显著意义。结论MMP-2和MMP-9与淋巴组织恶性肿瘤发生及发展呈正相关;ProMMP-2、MMP-2和MMP-9可作为判断病情及评价治疗效果的指标;为进一步研制相关MMP抑制剂及为淋巴组织肿瘤治疗提供新的靶向位点奠定了基础。     

IGF-1、PAPP-A在稳定型心绞痛及急性心肌梗死患者中的变化及意义

目的探讨稳定型心绞痛及急性心肌梗死患者血清中胰岛素样生长因子-1(IGF-1)和妊娠相关蛋白A(PAPP-A)的变化及意义。方法采用酶联免疫吸附法(ELISA)分别对急性心肌梗死(AMI),稳定型心绞痛(SAP)患者及正常对照组,进行血清IGF-1、PAPP-A水平测定。结果AMI组中IGF-1、PAPP-A明显高于SAP和对照组(P<0.01),对照组中IGF-1明显高于SAP组(P<0.05),SAP组中PAPP-A的浓度与对照组比较无明显差异(P<0.05),无统计学意义。结论IGF-1与PAPP-A参与动脉硬化粥样斑块的发生发展过程。     

急性冠脉综合征患者血浆溶血磷脂酸水平观察

目的观察急性冠脉综合征(ACS)患者血浆中溶血磷脂酸(LPA)水平的变化。方法将急性冠脉综合征分为急性心肌梗死(AMI)组和不稳定心绞痛(UA)组。其中急性心梗组98例,不稳定心绞痛组92例,测定治疗前及抗血小板活化、抗凝诊疗后1周时血浆溶血磷脂酸值,并设立健康体检者286例作为对照组,测定血浆中溶血磷脂酸值。结果两组患者血浆LPA水平均高于对照组(2.48±0.5)umol/L,(4.56±0.65)umol/L,(3.63±0.16)umol/L,P值<0.01)。结论作为体内凝血和血栓形成过程早期释放的分析标记物LPA在急性冠脉综合征早期的病情预测及指导合理及时应用抗血小板活化,抗凝治疗药物筛选方面可能有一定的临床应用价值。     

急性冠脉综合症脑钠肽浓度变化及意义

目的观察不同类型急性冠脉综合征(ACS)患者血清脑钠肽(BNP)浓度差异并探讨其意义。方法患者进行体检和心电检查,冠脉造影,急性心肌梗死组(AMI):包括ST段抬高性心梗(STEMI)50例,非ST段抬高性心梗(NSTEMI)60例。不稳定心绞痛(UAP)54例。胸痛6h内测定血清BNP。和对照组36例(冠脉造影狭窄<50%)比较,各组间对照。结果STEMI,NSTEMI,UAP,对照组BNP浓度为403.2394±186.95,198.5560±75.5121,101.1079±38.4051,15.024±10.696。AMI组BNP高于UAP组(P<0.05),UAP组BNP高于对照组(P<0.05).STEMI组BNP高于NSTEMI组(P<0.05),且AMI组BNP与肌钙蛋白相关。结论BNP能用于ACS早期诊断一个指标。     

小剂量尿激酶联合奥扎格雷钠在老年急性冠脉综合征患者中的应用

目的探讨小剂量尿激酶联合奥扎格雷钠治疗老年急性冠脉综合征的疗效。方法40例老年急性冠脉综合征患者随机分为对照组和试验组,对照组给予常规抗凝、抗血小板、扩血管、减轻心脏负荷、调脂等治疗,试验组在对照组用药的基础上增加小剂量尿激酶和奥扎格雷钠长期联合使用。结果2组患者治疗后心绞痛症状较治疗前明显减轻;与对照组相比,试验组治疗后的显效率和总有效率均明显增加(P<0.05);与对照组相比,试验组出血发生率无明显增加。结论小剂量尿激酶和奥扎格雷钠长期联合治疗老年急性冠脉综合征患者是安全的且有效缓解心绞痛临床症状并改善心电图ST段的变化。     

C反应蛋白在急性冠脉综合征中的临床意义

目的探讨C反应蛋白(CRP)与急性冠脉综合征(Acute coronary syndromesACS的)关系。方法测定经冠脉造影确诊的冠心病患者60例(其中急性冠脉综合征患者30例,非急性冠脉综合征的冠心病患者30例)和冠脉造影排除冠心病患者30例的血CRP浓度。结果ACS患者组(A组)血CRP浓度为(14.53±16.87)mg/dL;非ACS患者组(B组)血CRP浓度为(4.07±4.56)mg/dL;对照组(C组)血CRP浓度为(3.67±4.43)mg/dL,A组与B组之间CRP浓度有显著性差异(P<0.001);B组与C组之间CRP浓度无显著性差异。结论急性冠脉综合征患者血CRP浓度明显升高,提示炎症反应与急性冠脉综合征密切相关,CRP浓度测定可作为急性冠脉综合征的监测指标。     

强化降脂与介入治疗在冠心病二级预防中的效果比较

目的 探讨比较强化降脂与介入治疗治疗在冠心病二级预防中的效果。方法 选取2009年1月至2010年1月于我院进行治疗的120例冠心病患者为研究对象,将其随机分为A组(强化降脂组)60例和B组(介入治疗组)60例,后将2组患者的心肌梗死发生率、心绞痛发生率、再次住院率及治疗前及治疗后1个月及3个月的血脂、血清hs-CRP、UA水平进行检测及比较。结果 经研究比较发现,A组的心肌梗死发生率、心绞痛发生率、再次住院率均低于B组,A组治疗后1个月及3个月的血清TG、TC及LDL-C、hs-CRP、UA水平均明显低于B组,而血清HDL-C的水平则高于B组,P均<0.05,均有显著性差异。结论 强化降脂治疗在冠心病二级预防中的效果较好,值得临床推广及应用。     

丹芎通脉颗粒治疗冠心病心绞痛的临床研究

目的对丹芎通脉颗粒治疗冠心病心绞痛的疗效及安全性作出评价。方法采用随机对照,治疗组(A组)171例口服丹芎通脉颗粒(每次2袋,2次/d),对照组(B组)75例给予参芍胶囊口服(每次4袋,2次/d)。4周后进行心绞痛、主要症状、心电图、总有效率及毒副作用评估。结果治疗组心绞痛总有效率96.49%,明显优于对照组77.34%(P<0.01);治疗组心电图总有效率73.10%,明显优于对照组48.00%(P<0.01);治疗组对轻、中、较重度患者均有很好疗效。结论丹芎通脉颗粒治疗冠心病心绞痛疗效确切,无毒副作用。     

Ambient fine particulate air pollution triggers ST-elevation myocardial infarction, but not non-ST elevation myocardial infarction: a case-crossover study

Background

We and others have shown that increases in particulate air pollutant (PM) concentrations in the previous hours and days have been associated with increased risks of myocardial infarction, but little is known about the relationships between air pollution and specific subsets of myocardial infarction, such as ST-elevation myocardial infarction (STEMI) and non ST-elevation myocardial infarction (NSTEMI).

Methods

Using data from acute coronary syndrome patients with STEMI (n?=?338) and NSTEMI (n?=?339) and case-crossover methods, we estimated the risk of STEMI and NSTEMI associated with increased ambient fine particle (<2.5 um) concentrations, ultrafine particle (10-100 nm) number concentrations, and accumulation mode particle (100-500 nm) number concentrations in the previous few hours and days.

Results

We found a significant 18% increase in the risk of STEMI associated with each 7.1 μg/m³ increase in PM_2.5 concentration in the previous hour prior to acute coronary syndrome onset, with smaller, non-significantly increased risks associated with increased fine particle concentrations in the previous 3, 12, and 24 hours. We found no pattern with NSTEMI. Estimates of the risk of STEMI associated with interquartile range increases in ultrafine particle and accumulation mode particle number concentrations in the previous 1 to 96 hours were all greater than 1.0, but not statistically significant. Patients with pre-existing hypertension had a significantly greater risk of STEMI associated with increased fine particle concentration in the previous hour than patients without hypertension.

Conclusions

Increased fine particle concentrations in the hour prior to acute coronary syndrome onset were associated with an increased risk of STEMI, but not NSTEMI. Patients with pre-existing hypertension and other cardiovascular disease appeared particularly susceptible. Further investigation into mechanisms by which PM can preferentially trigger STEMI over NSTEMI within this rapid time scale is needed.     

MicroRNAs in Acute ST Elevation Myocardial Infarction—A New Tool for Diagnosis and Prognosis: Therapeutic Implications

Despite diagnostic and therapeutic advances, coronary artery disease and especially its extreme manifestation, ST elevation myocardial infarction (STEMI), remain the leading causes of morbidity and mortality worldwide. Early and prompt diagnosis is of great importance regarding the prognosis of STEMI patients. In recent years, microRNAs (miRNAs) have emerged as promising tools involved in many pathophysiological processes in various fields, including cardiovascular diseases. In acute coronary syndromes (ACS), circulating levels of miRNAs are significantly elevated, as an indicator of cardiac damage, making them a promising marker for early diagnosis of myocardial infarction. They also have prognostic value and great potential as therapeutic targets considering their key function in gene regulation. This review aims to summarize current information about miRNAs and their role as diagnostic, prognostic and therapeutic targets in STEMI patients.     

共济失调毛细血管扩张突变基因缺陷对小鼠心肌梗死后心脏重塑的影响

目的 观察共济失调毛细血管扩张突变基因(ataxia telangiectasia mutated,ATM)单倍体缺陷对小鼠心肌梗死后心脏重塑的影响,并探讨其相关机制.方法 将ATM单倍体基因缺陷小鼠(ATM+/-)和同窝野生型小鼠(ATM+/+)通过结扎冠状动脉左前降支建立心肌梗死模型,同时设立假手术组.术后7 d,...     

Serum Small Dense Low-density Lipoprotein Concentrations are Elevated in Patients with Significant Coronary Artery Stenosis and are Related to Features of the Metabolic Syndrome

Serum small dense low-density lipoprotein (sd-LDL) concentrations were measured in patients with angiographically defined coronary artery disease (CAD) and compared to concentrations in healthy subjects. Five hundred and seventy patients with stable CAD were divided into CAD? and CAD+ based on angiography. Patients in whom stenosis was <50?% in diameter were classified as having a ??normal?? angiogram (CAD?), otherwise the patients were allocated to the CAD+ group. The CAD+ group was further subcategorized into single-, double- and triple-vessel disease (VD). Serum sd-LDL concentrations were significantly lower in controls compared with CAD+ and CAD? patients (P?<?0.001). Moreover, CAD+ patients had higher concentrations of sd-LDL than CAD? patients (P?<?0.01). sd-LDL levels were not significantly associated with severity of CAD defined by the number of stenosed coronary arteries (P?=?0.245). All participants were also categorized into subgroups with or without metabolic syndrome. Subjects with metabolic syndrome had higher levels of sd-LDL than subjects without metabolic syndrome (P?<?0.01). Multiple linear regressions showed that in CAD patients, triacylglycerol, total-cholesterol, body mass index, and waist circumferences were the most important determinants of serum sd-LDL concentrations. We found that sd-LDL levels were significantly higher in patients presenting with symptoms of CAD. Moreover, patients with significant stenosis of their coronary arteries (>50?% stenosis) had higher levels of sd-LDL compared to patients without significant lesions.     

Analytical evaluation of two automatic methods to measure blood CK-MB mass and troponin I

The lack of standardization of methods to measure cardiac markers for coronaria ischaemia, particularly troponin, led us to perform an analytical evaluation of two new immunoassays to quantify CK-MB mass and troponin I using the Dimension RxL automatic analyser. The reliability and analytical intervals of the methods were studied as well as reference values (0.010- 0.228 mug l(-1) for troponin I, 0.20-3.90 mg mug l(-1) for CK-MB mass) and cuto inverted exclamation mark values (0.77 mug l(-1) for troponin I, 5 mug l(-1) for CK-MB mass) established. The cutoff values were established from 37 patients with acute myocardial infarction and from 20 with unstable angina. The absence of method cross-reactivity was corroborated using myocardial, brain and skeletal muscle tissue. Both methods were highly specific and showed good reliability and practicability in the diagnosis of coronaria ischaemia after 6 h of precordial pain.     

Cardioprotective effects of glycyrrhizic Acid against isoproterenol-induced myocardial ischemia in rats

The aim of the present study was to look into the possible protective effects of glycyrrhizic acid (GA) against isoproterenol-induced acute myocardial infarction in Sprague-Dawley rats. The effect of three doses of glycyrrhizic acid in response to isoproterenol (ISO)-induced changes in 8-isoprostane, lipid hydroperoxides, super oxide dismutase and total glutathione were evaluated. Male Sprague-Dawley rats were divided into control, ISO-control, glycyrrhizic acid alone (in three doses-5, 10 and 20 mg/kg BW) and ISO with glycyrrhizic acid (in three doses) groups. ISO was administered at 85 mg/kg BW at two consecutive days and glycyrrhizic acid was administered intraperitoneally for 14 days. There was a significant increase in 8-isoprostane (IP) and lipid hydroperoxide (LPO) level in ISO-control group. A significant decrease in total superoxide dismutase (SOD) and total glutathione (GSH) was seen with ISO-induced acute myocardial infarction. Treatment with GA significantly increased SOD and GSH levels and decreased myocardial LPO and IP levels. Histopathologically, severe myocardial necrosis and nuclear pyknosis and hypertrophy were seen in ISO-control group, which was significantly reduced with GA treatment. Gycyrrhizic acid treatment proved to be effective against isoproterenol-induced acute myocardial infarction in rats and GA acts as a powerful antioxidant and reduces the myocardial lipid hydroperoxide and 8-isoprostane level.