Abstract:心血管疾病(CVD)是全球发病率和死亡率的主要原因,约占全球死亡人数的三分之一,其中冠心病是CVD的主要临床类型。经皮冠状动脉介入治疗(PCI)作为冠心病患者重要的再血管化治疗策略,近年来在手术策略、新型介入设备研发、相关指南更新等方面取得重大突破。尽管相关的治疗和管理得到了改善,冠心病患者的残留风险依然较大,临床预后仍不容乐观。为此,本文总结了近年来冠心病患者PCI术的相关研究进展,以期进一步指导其治疗,改善其预后。

Abstract:目的 评价冠状动脉多支病变(MVD)患者接受经皮冠状动脉介入治疗(PCI)实现部分血运重建(IR)后短期生活质量的改善程度。方法 连续纳入2018年4月—2019年11月在西京医院心血管内科成功行PCI的冠心病患者590例。依据冠状动脉造影(CAG)表现分为单支病变(SVD)组(n＝138)和MVD组(n＝452)。术前48 h应用SF-12量表和西雅图心绞痛量表(SAQ)对患者进行面对面的问卷调查,并且记录患者院内的基线数据包括年龄、性别、体质量指数(BMI)、血压、心率、主要诊断、既往病史、实验室数据及术后用药情况；术后1个月采用SF-12量表和SAQ进行电话随访问卷调查。通过比较两组患者PCI术前、术后量表得分来评价PCI对MVD患者部分血运重建后1个月的生活质量改善程度。结果 与SVD组相比,MVD组患者年龄更大、急性冠状动脉综合征(ACS)发生率更高且患者有糖尿病史和脑血管病史的比例更高；空腹血糖、心肌肌钙蛋白I(cTnI)和N端脑钠肽前体(NT-proBNP)水平更高,术中造影剂用量更多(P＜0.05)；术后1个月,两组主要不良心血管事件(MACE)发生率相似(P＞0.05)、NYHA心功能分级都显著改善(P＜0.05),且两组患者PCI术后SF-12量表和SAQ的各个维度得分都较术前有显著升高,即患者的心绞痛症状和生活质量都出现了明显改善(P＜0.05)。结论 成功PCI治疗对MVD患者实现IR后短期生活质量有显著改善。

Abstract:目的 探讨影响冠状动脉慢性完全闭塞病变PCI术后(CTO-PCI)患者发生主要不良心血管事件(MACE)的独立危险因素,为辅助制定临床决策提供参考依据。方法 回顾性分析1 415例符合冠状动脉慢性完全闭塞病变的PCI术后患者的临床和随访资料。运用R3.6.2和易侕软件对数据建立MFP模型、全因素Cox回归模型(full model)以及逐步回归模型(stepwise model),获得影响冠状动脉慢性完全闭塞病变PCI术后患者发生MACE的独立危险因素。根据ROC曲线下面积(AUC)、一致性指数(C-index)及校准曲线(calibration curve)来评价3种模型的预测能力,最终建立列线图预测模型。结果 MFP模型、全因素Cox回归模型和逐步回归模型均显示心率、高血压、吸烟、lg(脑钠肽)[lg(BNP)]是冠状动脉慢性完全闭塞病变患者PCI术后出现MACE的独立预后因素(P＜0.05)。三种预测模型的AUC分别为0.77、0.77和0.78,一致性指数分别为0.72、0.73和0.73。不同随访时间点对应的AUC值均在0.7～0.8之间波动,最终确定逐步回归模型是最佳预测模型,具有良好的预测效能。基于逐步回归模型中的吸烟(HR＝1.6,5%CI:1.09～3.45,P＝0.021 5)、心率(HR＝1.3,5%CI:1.01～1.04,P＝0.002 3)、高血压(HR＝1.2,5%CI:1.21～3.03,P＝0.005 4)和lg(BNP)(HR＝3.1,5%CI:1.72～5.26,P＝0.000 1)这些变量,最终构建了预后列线图预测模型。结论 心率、高血压、吸烟和lg(BNP)是冠状动脉慢性完全闭塞病变PCI术后患者MACE发生的独立预后因素,根据这些预后因素构建的列线图模型可量化评估患者的预后。

Abstract:目的 探讨血小板平均体积(MPV)/血小板计数(PC)比值与接受经皮冠状动脉介入治疗(PCI)的冠心病患者长期预后的关系。方法 采用回顾性队列研究,选取2008年1月—2016年12月在新疆医科大学第一附属医院诊治的冠心病PCI术后患者的一般资料,包括入院血小板参数、生化数据、心血管疾病相关危险因素等资料。设定随访终点:全因死亡(ACM)、心血管死亡(CM)、出血事件、主要不良心血管事件(MACE),并进行电话随访。最终纳入6 046例患者,选取患者入院MPV/PC比值,利用ROC曲线评估患者MPV/PC值的最佳临床截点后进行分组,应用多因素Cox回归分析比较不同组别与远期预后的相关性。结果 基线资料分析表明,与MPV/PC低值组相比,MPV/PC高值组全因死亡率(6.4%比4.5%,P＝0.001)、心源性死亡率(5.6%比3.4%,P＜0.001)、MACE事件发生率(15.8%比11.5%,P＜0.001)显著升高。多因素Cox回归分析显示,与MPV/PC低值组相比,MPV/PC高值组全因死亡风险增加46.6%(HR＝1.466,95%CI:1.159～1.852,P＝0.001),心源性死亡增加64.7%(HR＝1.647,95%CI:1.271～2.137,P＜0.001),MACE发生率增加31.8%(HR＝1.318,95%CI:1.138～1.527,P＜0.001)。结论 MPV/PC比值升高显著增加PCI术后不良事件的发生率,其水平的升高是全因死亡及心源性死亡的独立危险因素。

Abstract:甲状腺功能与心血管系统密切相关。无论是临床甲状腺功能减退还是亚临床甲状腺功能减退均会增加动脉粥样硬化的发生风险,而包括激素治疗及降脂治疗在内的治疗方法在残余风险控制方面效果不尽人意。除高血压、高脂血症等经典发病机制外,近年来对甲状腺功能减退相关动脉粥样硬化的研究发现了一些新的发病机制,包括细胞凋亡和细胞自噬。本文拟对这些机制作一综述,以期寻找新的甲状腺功能减退相关动脉粥样硬化防治思路。

Abstract:Aim To study the effect and mechanism of modified Naotaifang on cerebral ischemia-reperfusion injury of rats by activating SIRT1. Methods Male SD rats were randomly divided into control group, model group, JWF group and JWF+EX527 group. The model of cerebral ischemia-reperfusion injury was established by suture embolization.JWF group was given gavage of modified naotaifang for 14 days, JWF+EX527 group was given gavage of modified naotaifang and intraperitoneal injection of EX527 for 14 days. The differentces of neural function scores, inflammatory factor interleukin-1β(IL-1β), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), the expression of Bcl-2, Bax, silent information regulator 1 (SIRT1), nuclear factor-κB(NF-κB) and forkhead box O1(FoxO1) among the four groups were compared. Results Compared with the control group, the neural function scores, the levels of IL-1β, IL-6, TNF-α in serum and brain tissues, the expression of Bax, NF-κB, FoxO1 in brain tissues increased significantly, and the expression of Bcl-2, SIRT1 in brain tissues reduced significantly in the model group(P＜0.05). Compared with the model group, the neural function scores, the levels of IL-1β, IL-6, TNF-α in serum and brain tissues, the expression of Bax, NF-κB, FoxO1 in brain tissues deceased significantly, and the expression of Bcl-2, SIRT1 in brain tissues increased significantly in JWF group(P＜0.05). Compared with JWF group, the neural function scores, the levels of IL-1β, IL-6, TNF-α in serum and brain tissues, the expression of Bax, NF-κB, FoxO1 in brain tissues increased significantly, and the expression of Bcl-2, SIRT1 in brain tissues reduced significantly in JWF+EX527 group(P＜0.05). Conclusion Modified Naotaifang can reduce the cerebral ischemia-reperfusion injury, and activating SIRT1 and then inhibiting NF-κB-mediated inflammatory response, FoxO1-mediated apoptosis was the possible mechanism.

Abstract:目的 探讨杜仲多糖对氧化型低密度脂蛋白(ox-LDL)诱导的血管平滑肌细胞(VSMC)增殖及迁移的影响。方法 体外培养大鼠VSMC,用ox-LDL及不同浓度的杜仲多糖处理。甲基噻唑基四唑法检测细胞增殖；酶联免疫吸附试验检测白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)的水平；Transwell实验检测细胞迁移；划痕实验检测划痕愈合率；Western blot检测转化生长因子β1(TGF-β1)/Smad信号通路相关蛋白Smad2/3、p-Smad2/3的表达。结果 ox-LDL处理VSMC后,细胞周期蛋白D1(Cyclin D1)、细胞周期蛋白依赖激酶2(CDK2)、p-Smad2/3蛋白水平显著升高(P＜0.05),细胞培养上清液中IL-6、TNF-α水平显著升高(P＜0.05),细胞活力显著升高(P＜0.05),迁移细胞数、划痕愈合率显著增高(P＜0.05)；杜仲多糖处理后可明显逆转ox-LDL对VSMC增殖及迁移的作用(P＜0.05)；添加TGF-β1后,Cyclin D1、CDK2、p-Smad2/3蛋白水平显著升高(P＜0.05),IL-6、TNF-α水平显著升高(P＜0.05),细胞活力显著升高(P＜0.05),迁移细胞数显著增多(P＜0.05)。结论 杜仲多糖可能通过抑制TGF-β1/Smad信号通路的活化从而抑制ox-LDL诱导的VSMC增殖及迁移。

Abstract:目的 构建人血管内皮细胞低氧复氧损伤模型,作为心肌组织慢复流的体外研究模型。方法 设定三气培养箱的混合气中5%O₂为低氧培养条件,二氧化碳培养箱(95%空气、5%CO₂)中的培养条件为复氧条件。将对数生长期的人脐静脉内皮细胞(HUVEC)随机分为5组,分别置于三气培养箱(90%N₂、5%CO₂、5%O₂)中处理不同时间(0、4、8、16及32 h)。挑选出最佳低氧处理时间后,再将随机分组的细胞进行不同时间(0、1、2、3、4、5及6 h)的复氧处理。Western blot检测低氧诱导因子1α(HIF-1α)的蛋白表达；显微镜下观察细胞形态学变化；CCK-8法检测细胞存活率；酶联免疫吸附法测定乳酸脱氢酶(LDH)活性以反映细胞损伤情况。结果 与对照组相比,实验组HUVEC的HIF-1α蛋白表达随低氧处理时间的延长而增高(P＜0.01)；细胞密度在低氧处理的短时间内会适应性增加,从16 h开始降低；细胞存活率的变化趋势与细胞密度一致(P＜0.01)；LDH活性则在低氧4 h时升高,低氧8 h时回落,低氧16 h时又重新回升(P＜0.01)。复氧后,细胞密度与细胞存活率的变化随时间呈现先降低后升高的趋势(P＜0.05)；LDH活性则随时间呈现先升高后降低的趋势,峰值出现于复氧3 h(P＜0.01)。实验结果表明,低氧16 h为最佳低氧处理时间,复氧3 h为最佳复氧处理时间。结论 本研究建立了稳定可靠的HUVEC低氧复氧损伤模型,为心肌组织缺血再灌注后慢复流的体外实验研究奠定了基础。

Abstract:Aim To study the effect of remote ischemic postconditioning (RIPostC) on the clinical prognosis of patients with ST-segment elevation myocardial infarction (STEMI) who received direct percutaneous coronary intervention (PCI) and to evaluate the health economics. Methods A total of 309 patients with STEMI diagnosed in the First Affiliated Hospital of Xinjiang Medical University from February 2016 to October 2018 were enrolled in this prospective study.According to the random number table, the patients were divided into two groups:the RIPostC group (n＝155) and the control group (n＝154). Patients in RIPostC group completed three rounds of ischemic postconditioning of lower extremities before direct PCI. The area under creatine kinase isoenzyme (CK-MB), major adverse cardiac events (MACE) and direct medical expenses were compared between the two groups. The average out-of-hospital follow-up was 1.5 years. The incidence of out-of-hospital MACE and the direct medical expenses of re-admission were compared between the two groups. Results The cumulative release of CK-MB within 48 hours after admission in the RIPostC group was lower than that in the control group (P＜0.05). The incidence of total MACE in the RIPostC group was lower than that in the control group (P＜0.05). The incidence of out-of-hospital total MACE in the RIPostC group was lower than that in the control group (P＜0.05), and the out-of-hospital mortality rate was lower than that in the control group (P＜0.05). The cumulative incidence of MACE events in the two groups was compared by Kaplan-Meier curve. The results showed that the Kaplan-Meier curve was significantly separated 50 days after PCI, and the cumulative incidence of out-of-hospital total MACE in the RIPostC group was lower than that in the control group (P＜0.05). The direct medical expenses during hospitalization and re-admission in the RIPostC group were lower than those in the control group (P＜0.05), respectively. Conclusion As an adjuvant therapy in the treatment of PCI, RIPostC can not only improve the clinical prognosis of patients with STEMI, but also reduce the economic burden of patients.

Abstract:Aim To explore the effect of regional collaborative treatment network on the treatment efficiency of acute ischemic stroke (AIS). Methods With network information as the core and 120 first aid as the link, the AIS regional collaborative treatment network of 8 community hospitals under the jurisdiction of Affiliated Hospital of Jiangsu University was established. The changes in AIS treatment efficiency, treatment effects and economic indicators before the implementation of the regional collaborative treatment network (pre-implementation group, 180 cases) and after implementation (post-implementation group, 218 cases) were compared. Results Compared with the pre-implementation group, the proportion of intravenous thrombolysis in the time window of AIS patients in the post-implementation group was significantly increased (31.2% vs. 2.8%, P＜0.05), and the time from admission to intravenous thrombolysis (door-to-needle time, DNT) was significantly shortened [(58.7±11.3) min vs. (101.6±14.5) min, P＜0.05], the proportion of head CT completed within 45 min of emergency was significantly increased (61.9% vs. 32.8%, P＜0.05). The mortality rate during hospitalization was lower in the post-implementation group than the pre-implementation group (5.5% vs. 8.3%, P＜0.05). Compared with the pre-implementation group, the number of hospitalization days in the post-implementation group was significantly shortened, and hospitalization expenses were significantly reduced (P＜0.05). Compared with the pre-implementation group, the daily living ability score (Barthel index) after 1 month in the post-implementation group was significantly increased, and the NIHSS score was significantly decreased (P＜0.05). Conclusion The implementation of regional coordinated treatment network can significantly improve the treatment efficiency of AIS, improve the clinical prognosis of patients, and reduce the economic burden. It is an effective measure to enhance the treatment ability of AIS.

Abstract:Aim To summarize the experience of one-stage surgical treatment of aortic coarctation (CoA) combined with ventricular septal defect (VSD) with extended end-to-side anastomosis in recent years. Methods The data from 208 cases with CoA combined with VSD admitted to hospital between January 2010 to October 2017 were collected and analyzed. There were 137 boys and 71 girls, the median age was 54 (5～730) days, the median weight was 4.0 (1.8～9.9) kg. Extended end-to-side anastomosis was used to correct the CoA, and the VSD was repaired simultaneously by an incision through median sternotomy. All operations were performed by the same group of surgeons. The data were analyzed by SPSS 20.0. Results Early death occurred in 6 cases (2.9%) and late death occurred in 3 cases (1.4%).Recoarctation developed in 16 cases (7.7%) and reoperation occurred in 19 cases (9.1%). The level of brain natriuretic peptide (BNP) increased remarkably before operation but showed no obvious change after operation. After operation, transcoarctation gradient pressure was reduced, and the transcutaneous oxygen saturation, C-reactive protein (CRP), lactate and creatinine were increased. Preoperative hypertension existed in 104 cases (53.0%), and after operation, blood pressure returned to the baseline level in 30 cases (28.8%) and continued to rise in 35 cases (33.7%). Higer transcoarctation gradient was the risk factor for postoperative recoarctation. Conclusions Correcting the CoA combined with VSD simultaneously with extended end-to-side anastomosis by an incision through median sternotomy was effective and safe, and the outcomes of immediate and medial-term were satisfactory, with low rates of mortality and recoarctation. Higer transcoarctation gradient pressure was the risk factor for postoperative recoarctation.

Abstract:Aim To observe the correlation between serum C1q tumor necrosis factor related protein 3 (CTRP3), total myocardial ischemia burden (TIB) and myocardial ischemia in patients with coronary heart disease (CHD) and hypertension. Methods The clinical data of CHD patients with hypertension admitted to our hospital from January 2018 to December 2018 were retrospectively analyzed. Among them, 32 patients without myocardial ischemia were included in the non-myocardial ischemia group, and 80 patients with myocardial ischemia were included in the myocardial ischemia group. The level of serum CTRP3 and TIB were compared between the two groups, and the correlation between CTRP3 and TIB was analyzed. The influencing factors of myocardial ischemia in patients with CHD and hypertension, and the predictive value of CTRP3 and TIB for myocardial ischemia in patients with CHD and hypertension were analyzed. Results Compared with non-myocardial ischemia group, CTRP3 was lower and TIB was higher in myocardial ischemia group, and the differences were statistically significant (P＜0.05). After bivariate Spearman correlation test, serum CTRP3 level was negatively correlated with TIB (r＝－0.665, P＜0.001). Linear regression analysis showed that CTRP3 and TIB might be the influencing factors of myocardial ischemia in patients with CHD and hypertension (P＜0.05). ROC curve analysis showed that the area under curve of CTRP3 and TIB in predicting myocardial ischemia in patients with CHD and hypertension was 0.942 and 0.913 respectively, which had higher predictive value. ConclusionSerum CTRP3 and TIB are closely related to myocardial ischemia in CHD patients with hypertension, which have high predictive value for myocardial ischemia in CHD patients with hypertension.

Abstract:Aim To explore the predictive value of CT blend sign and island sign combined with CT enhanced leakage sign in the early hematoma enlargement in patients with intracerebral hemorrhage(ICH). Methods Patients with blend sign and island sign hematoma enlargement risk factors in ICH baseline CT scan within 6 hours were scanned by CT enhanced arterial phase and delayed 3 min scan. The patients were divided into two groups according to the presence of leakage sign:leakage sign positive group and leakage sign negative group. The clinical data were collected and compared between groups, and the relationship with hematoma enlargement was analyzed. In addition, the influencing factors of early hematoma enlargement were analyzed by Logistic regression analysis, and the predictive value of early hematoma enlargement in ICH was evaluated.Results The admission GCS score of the group with positive leakage sign was significantly lower than that of the group with negative leakage sign(P＜0.05). The volume of hematoma in the group with positive leakage sign was significantly larger than that in the group with positive leakage sign. Logistic regression analysis showed that blend sign, island sign and leakage sign were the main risk factors for early hematoma enlargement. The sensitivity and specificity of blend sign and island sign combined with leakage sign in predicting early hematoma enlargement in acute ICH were 94.29% and 97.22%, respectively. Conclusion CT plain scan blend sign and island sign combined with CT enhanced leakage sign have high predictive value for early hematoma enlargement in ICH.

Abstract:Calcified aortic valve disease is a common cardiovascular disease. With the aging of the population, it becomes a major medical burden. Valve replacement is the main treatment of the disease, but the elderly group has a high risk of operation and a high incidence of complications. There are still no drugs to prevent or slow the progression of the disease. It has been found that lipoprotein (a) plays a key role in the pathophysiology of valvular calcification. The increase of lipoprotein (a) level is an important risk factor for calcified aortic valve disease and can increase the risk of aortic stenosis. This article reviews the pathological mechanism of lipoprotein (a) involved in calcified aortic valve disease, and the therapy of calcified aortic valve disease.

Abstract:Pulmonary arterial hypertension(PAH) is a vascular disease with rapid progression, poor prognosis, and high mortality. Studies have shown that pulmonary vascular remodeling is an important pathophysiological basis for the development of PAH. The proliferation and hypertrophy of pulmonary artery smooth muscle cells are the key pathological changes of pulmonary vascular remodeling in PAH. In PAH, pulmonary vascular smooth muscle cells transformed from a contractile phenotype to a synthetic phenotype of proliferative state, mainly manifested as proliferation and hypertrophy of pulmonary vascular smooth muscle cells. These pathological changes eventually lead to vascular lumen narrow and tube wall stiffness, promoting the occurrence and development of PAH. The purpose of this review is to elaborate the mechanism of pulmonary artery smooth muscle cells in pulmonary vascular remodeling in PAH and to provide new targets and strategies for clinical prevention and treatment of PAH.

Abstract:Coronary heart disease has become a serious harm to human health, endothelial dysfunction is closely related to the occurrence and development of coronary heart disease, and metabolism of glucose disorder cannot be ignored in endothelial dysfunction. This article focuses on glucose metabolism, expounds vascular endothelial glucose metabolism in normal state, and highlights the effect of coronary heart disease on endothelial glucose metabolism as well as the research methods of glucose metabolism.