阿奇霉素治疗不稳定型心绞痛的疗效及其对近期心脏事件的影响

近来流行病学研究发现 ,肺炎衣原体感染与动脉粥样硬化及冠心病密切相关。炎症反应促使冠状动脉内不稳定斑块发生破裂 ,继发血小板活化与血栓形成 ,是不稳定型心绞痛 ( UAP)的主要发病机制 [1]。国外研究显示 ,大环内酯类抗生素治疗 UAP和非 Q波心肌梗死有效 [2 ] ,但国内文献报道极少。本研究旨在探讨阿奇霉素对 UAP的疗效及其对近期心脏事件的影响 ,为冠心病的二级预防寻找新途径。现报告如下。1　资料与方法1 .1　临床资料　对 2 0 0 0～ 2 0 0 2年我院收治的 96例UAP患者进行观察 ,患者均符合以下条件 :1心绞痛发作每周超过 3次 ,…     

阿托伐他汀治疗不稳定型心绞痛的临床观察

为研究不稳定型心绞痛患者应用阿托伐他汀对心脏事件的影响 ,选择 10 4例不稳定型心绞痛 (UAP)患者分为高脂血症组 (n=32 ) ,血脂正常组 (n=72 )。血脂正常组又随机分为对照组 36例 ,阿托伐他汀治疗组 36例。高脂血症组和治疗组皆接受阿托伐他汀治疗。用药前、用药后 4周、12周分别查血脂、C反应蛋白、肝功、肾功、心肌酶、血常规 ,同时观察记录心脏事件的发生情况。结果显示 :高脂血症组和治疗组治疗后 4周、12周血脂较治疗前明显下降 (P<0 .0 1) ,对照组治疗前、治疗后 4周、12周血脂无显著变化。与对照组比较 ,心脏事件的发生明显下降。高脂血症组和治疗组比较则无差异。因此 ,无论血脂高低 ,不稳定型心绞痛患者早期应用阿托伐他汀可降脂、降低心脏事件的发生     

肌钙蛋白Ⅰ和肌红蛋白在不稳定型心绞痛中的变化和近期预后判断

目的对不稳定型心绞痛(UA)患者进行近期预后判断.方法对UA患者进行肌钙蛋白Ⅰ(cTnI)和肌红蛋白(Mb)的定量测定并进行动态观察,同时进行心肌酶CK MB和CK的对照试验.结果根据cTnI峰值水平将47例UA患者分为cTnI正常组和升高组,两组间的一般临床特征除心绞痛分级以外,其余各项均无显著性差异(P＞0.05);cTnI正常组和升高组之间,心脏事件的发生率为4.2%和39.1%,有显著性差异(P＜0.01);cTnI低危水平和高危水平之间,心脏事件的发生率为26.6%和62.5%,也有显著性差异(P＜0.05);cTnI的动态演变与发生心脏事件密切相关(P＜0.05);在对UA患者的预后判断中,cTnI和Mb的灵敏度为90%和100%,阴性似然比为0.16和0,表明cTnI和Mb检测结果正常时发生心脏事件的可能性很小;在校正了UA患者发生心脏事件的20多个危险因子后,cTnI的相对危险度优势比为9.284,不仅是完全独立的危险因子,而且是因果相关性强度最大的危险因子.结论cTnI联合Mb检测是评估UA患者近期预后的良好指标,其灵敏度和特异性能得到最佳体现;cTnI是独立的、因果相关性强度最大的危险因子.     

肌钙蛋白I和肌红蛋白在不稳定型心绞痛中的变化和近期预后判断

目的　对不稳定型心绞痛 ( UA)患者进行近期预后判断。方法　对 U A患者进行肌钙蛋白 I( c Tn I)和肌红蛋白 ( Mb)的定量测定并进行动态观察 ,同时进行心肌酶 CK-MB和 CK的对照试验。结果　根据 c Tn I峰值水平将 47例 UA患者分为 c Tn I正常组和升高组 ,两组间的一般临床特征除心绞痛分级以外 ,其余各项均无显著性差异 ( P>0 .0 5 ) ;c Tn I正常组和升高组之间 ,心脏事件的发生率为 4.2 %和 39.1% ,有显著性差异 ( P<0 .0 1) ;c Tn I低危水平和高危水平之间 ,心脏事件的发生率为 2 6.6%和 62 .5 % ,也有显著性差异 ( P<0 .0 5 ) ;c Tn I的动态演变与发生心脏事件密切相关 ( P<0 .0 5 ) ;在对 UA患者的预后判断中 ,c Tn I和 Mb的灵敏度为 90 %和 10 0 % ,阴性似然比为 0 .16和 0 ,表明 c Tn I和 Mb检测结果正常时发生心脏事件的可能性很小 ;在校正了 U A患者发生心脏事件的 2 0多个危险因子后 ,c Tn I的相对危险度优势比为 9.2 84,不仅是完全独立的危险因子 ,而且是因果相关性强度最大的危险因子。结论　c Tn I联合 Mb检测是评估 UA患者近期预后的良好指标 ,其灵敏度和特异性能得到最佳体现 ;c Tn I是独立的、因果相关性强度最大的危险因子     

心脏康复对稳定型心绞痛患者预后的影响

目的探讨心脏康复对稳定型心绞痛(SAP)患者预后的影响。方法 139例SAP患者随机分成心脏康复治疗组(66例)和对照组(73例),心脏康复组进行踏车运动和常规药物治疗4个月,对照组实行常规药物治疗。测定试验前后血浆C-反应蛋白(CRP)、白介素-6(IL-6)、血栓素A2(TXA2)、低密度脂蛋白胆固醇(LDL-C)水平,并随访两组间心血管事件的发生率。结果两组治疗后较治疗前血浆CRP、IL-6、TXA2、LDL-C水平均有下降;心脏康复组血浆CRP、IL-6水平较常规药物治疗组下降更明显(均为P0.05);两组治疗后均随访1年,心源性死亡、再次急性心肌梗死的发生率差异无统计学意义;心脏康复治疗组需血运重建者更少(6.3%比20.0%)(P0.05)。结论心脏康复对SAP患者预后有明显改善;减轻炎症反应可能是改善SAP患者预后的一个重要机制。     

辛伐他汀对不稳定型心绞痛患者血脂和炎症指标的影响

目的 观察辛伐他汀治疗不稳定型心绞痛患者15天后血脂、高敏C反应蛋白、一氧化氮、丙氨酸氨基转移酶和肌酸激酶的变化.方法 将98例不稳定型心绞痛患者随机分为20 mg/d辛伐他汀组(34例)、40 mg/d辛伐他汀组(32例)和时照组(32例);所有病例均测定治疗前及治疗15天后血脂、高敏C反应蛋白、一氧化氮、丙氨酸氨基转移酶和肌酸激酶的变化.结果 辛伐他汀治疗组治疗前后比较以及与对照组比较,血脂、高敏C反应蛋白明显下降(P<0.05),且40 mg/d组下降更明显;辛伐他汀治疗后两组丙氨酸氨基转移酶水平升高,但均未超出正常值3倍;一氧化氮和肌酸激酶治疗前后差异无显著性.结论 在不稳定型心绞痛早期使用较大剂量辛伐他汀治疗15天,可明显且安全地减轻炎症,降低血脂.     

心可舒片治疗不稳定型心绞痛的疗效及对血脂的影响

目的探讨心可舒片治疗不稳定型心绞痛的临床疗效和血脂影响。方法将63例心绞痛患者随机分为常规治疗组（对照组,31例）和心可舒片治疗组（治疗组,32例）。分别于治疗前及治疗后12周、24周测定血清总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）水平;并于治疗前和治疗12周、24周后采集12导联心电图。结果治疗组总有效率为90.6%,优于对照组的74.2%（P〈0.05）。治疗12周、24周后,两组血清TG水平有明显降低（P〈0.05）,治疗组血清TC和LDL-C较治疗前亦有明显降低（P〈0.05）,12周、24周后治疗组LDL-C降低较对照组更为明显（P〈0.05）。结论心可舒片能有效协助降脂,改善临床症状,提高不稳定型心绞痛患者治疗效果。     

不稳定型心绞痛伴抑郁患者抗抑郁治疗对其预后的影响

目的　观察不稳定型心绞痛伴抑郁患者抗抑郁治疗对其预后的影响。方法　将 42例不稳定型心绞痛伴抑郁患者随机分为抗抑郁治疗组和对照组各 2 1例 ,治疗组在常规药物治疗基础上予心理治疗及加服抗抑郁药氟西汀(百忧解 ,美国礼来药厂 ) 2 0mg/d ,疗程为 12周。结果　治疗组心肌缺血明显改善 ,心绞痛复发率及发生急性心肌梗死比例低 ,与对照组比较 ,有显著差异 (P <0 .0 5 )。结论　抗抑郁治疗能明显改善不稳定型心绞痛伴抑郁患者的近期预后     

法舒地尔对不稳定型心绞痛患者血清IL-6水平的影响

目的探讨IL-6在不稳定型心绞痛(UAP)患者中的作用及法舒地尔对其的影响。方法选择冠心病患者80例。稳定型心绞痛(SAP)组20例,男12例,女8例;UAP组60例,男36例,女24例。将UAP组分为低、中、高危险组,其中低危险组20例,男13例,女7例;中危险组20例,男11例,女9例;高危险组20例,男12例,女8例。将UAP组配对分成:常规治疗组及法舒地尔治疗组,其中常规治疗组30例,男18例,女12例;法舒地尔治疗组30例,男18例,女12例。同时将20例健康正常人作为正常对照组,男15例,女5例。UAP组患者均给予扩冠、抗凝、调脂等常规治疗,法舒地尔治疗组加用法舒地尔注射液,即将该药2 m l加入生理盐水50 m l静脉滴注,每日2次,疗程14天。正常对照组、所有病例入选前及UAP患者治疗后于清晨取肘静脉血,采取双抗体夹心ABC-ELISA法测定血清IL-6水平。结果治疗前UAP组血清IL-6水平均高于SAP组和正常对照组(P0.01),SAP组血清IL-6水平均略高于正常对照组(P0.05)。在UAP组治疗前,高危险组患者血清IL-6水平均高于中危险组和低危险组(P0.01),中危险组患者血清IL-6水平均高于低危险组(P0.05)。法舒地尔治疗组治疗后血清IL-6水平均低于治疗前(P0.01),常规治疗组治疗后血清IL-6水平均低于治疗前(P0.05),法舒地尔治疗组治疗后血清IL-6水平均低于常规治疗组治疗后(P0.05)。结论患者外周血中IL-6表达水平与病情严重程度相关;法舒地尔具有抑制UAP患者血清IL-6水平升高的作用;并且可通过抗炎途径治疗UAP。     

不稳定型心绞痛患者血清尿酸水平增高

为探讨血清尿酸水平与冠状动脉粥样斑块稳定性之间的关系 ,检测 33例不稳定型心绞痛患者、2 4例稳定型心绞痛患者和 33例正常对照者外周血清尿酸水平 ,并进行对比分析。结果发现 ,不稳定型心绞痛患者血清尿酸水平 (40 3± 115mmol L)明显高于稳定型心绞痛患者 (32 0± 81mmol L)和对照者 (312± 6 7mmol L ,P <0 .0 1) ,而稳定型心绞痛患者与对照者相比无显著性差异。结果提示 ,血清尿酸水平与冠状动脉粥样斑块稳定性密切相关 ,有可能作为评价冠心病斑块稳定性的分子生物化学标志物。     

不同剂量阿斯匹林对不稳定型心绞痛病人的预后影响

目的：观察阿斯匹林对不稳定型心绞痛病人的疗效。方法：对不稳定型心绞痛病人，每日服用阿斯匹林75mg（20例）、150mg（26例）、300mg（30例），随访三个月。采用抗人血活性血小板α颗粒膜蛋白140（GMP－140）特异单克隆抗体125I-SZ－51，测定三组治疗前、后血小板膜表面GMP－140分子数，常规记录血小板数，并与20名健康人比较。结果；阿斯匹林治疗后，血小板膜表面GMP—140分子数明显降低，而血小板数升高。随药物剂量的增加，二者变化程度增大（P＜0.01）。当剂量达300mg时，前者低于健康人组（P＜0．005），后者已达到健康人水平（P＜0．05），三组近期副作用差别无显著性。结论：每日300mg阿斯匹林对不稳定型心绞痛的预后较好。     

负荷量阿托伐他汀对不稳定型心绞痛患者冠状动脉介入治疗后近期心血管事件的影响

目的观察负荷量阿托伐他汀对不稳定型心绞痛(unstable angina,UA)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后近期心肌损伤、心肌灌注和心血管事件的影响。方法选取2009年11月至2011年10月在江门市五邑中医院行PCI治疗的UA患者56例,按电脑随机数字表法分为治疗组28例和对照组28例。治疗组在术前7 d给予负荷量阿托伐他汀40 mg/d,术后两组均给予阿托伐他汀10 mg/d治疗。分别于术前,术后24 h、3 d检测血清心肌型肌酸激酶同工酶(MB isoenzyme of creatine kinase,CK-MB)、血肌钙蛋白(troponin I,TnI)、一氧化氮(nitric oxide,NO)浓度;术前、术后即刻评估TMI心肌灌注分级(TMImyocardial perfusion,TMP)情况,并记录术后随访3个月的主要心血管事件。结果两组术后24 h血CK-MB、TnI浓度明显升高,术后3 d较前有所下降;治疗组血清CK-MB、TnI浓度均低于对照组,差异均有统计学意义(P=0.037,P=0.046);两组术后NO水平明显升高,以治疗组升高更为显著,差异有统计学意义(P=0.049);PCI治疗前、后治疗组TMP 0/1级的发生率低于同期对照组,差异均有统计学意义(P=0.017,P=0.019);术后随访3个月,治疗组心血管事件发生率10.7%低于对照组21.4%,治疗组整体发生主要心血管事件的病情程度轻于对照组,差异均有统计学意义(P<0.05)。结论 PCI治疗前给予负荷量阿托伐他汀能改善UA患者术后心肌血流灌注,减少心肌损伤,可能降低术后3个月内心血管事件发生率及减轻病情严重程度,从而改善患者的预后。     

曲美他嗪治疗不稳定型心绞痛的疗效分析

目的　观察曲美他嗪与传统药物相结合治疗对冠心病不稳定型心绞痛患者心肌缺血的保护作用。方法　将 60例冠心病不稳定型心绞痛患者随机分成两组 ,治疗组 3 0例 ,除用硝酸酯类、β-阻滞剂等传统药物治疗外 ,加用曲美他嗪 2 0 mg,每日 3次口服。对照组 3 0例接受传统药物治疗 ,连续观察 4周。观察两组患者心绞痛发作次数、心电图缺血性 ST-T的疗效及血压、心率的变化。结果　治疗组心绞痛发作次数较对照组明显减少分别为 [( 3 .2± 1.4)次 ,( 5 .7± 1.6)次 ]两组比较 P<0 .0 5 ,心电图缺血性 ST-T改善的疗效明显好于对照组 ,P<0 .0 5 ,而两组的心率、血压变化无明显差异。结论　曲美他嗪作为一种影响代谢的药物 ,对改善心肌缺血有良好的效果 ,且方法简便 ,疗效显著 ,安全可靠 ,易于接受。     

Risk stratification and prognosis of patients with recent onset angina

We prospectively assessed coronary artery disease and natural history in a series of 104 patients (99 males, mean age 52 +/- 8 years) admitted with recent onset angina (defined as a history of angina of less than 1 month duration). Coronary angiography showed one-vessel disease in 31, two-vessel disease in 22 and three-vessel disease in 14; 37 patients had normal coronary arteries. After a mean follow-up of 36 (range 1 to 52) months, one patient died, 13 sustained a myocardial infarction and 21 underwent surgery. The univariate analysis showed four of 12 clinical features derived from clinical history and data from CCU (exertional angina (P less than 0.001), and recurrence of angina (P less than 0.05)) to be associated with the presence of coronary artery disease. These clinical features were termed clinical risk characteristics. Three-year probability of medical events (death or acute myocardial infarction) for patients with 0-1 clinical risk characteristics was 0 and that of combined events (need for revascularization with or without a preceding medical event) 0.11, whereas patients with 2 or more risk characteristics had probabilities of 0.27 and 0.49, respectively. Multivariate analysis identified the number of clinical risk characteristics as the only independent predictor of medical events (P less than 0.002) and a positive thallium stress test (P less than 0.0001), the number of clinical risk characteristics (P less than 0.002) and the number of involved arteries (P less than 0.002), as independent predictors of combined events.(ABSTRACT TRUNCATED AT 250 WORDS)     

One-year prognosis in patients hospitalized with a history of unstable angina pectoris

The prognosis during 1 year of follow-up in 715 patients admitted to one single hospital due to suspected acute myocardial infarction (AMI) with a history of unstable angina pectoris immediately preceding hospitalization is described. AMI developed in 192 patients (27%) during the first three days and in 255 patients (38%) during the first year. The mortality during hospitalization was 7% (50 patients) and during 1 year 19% (130 patients). Of the nonsurvivors, 54% died of AMI, 28% of congestive heart failure, and 20% of cardiogenic shock. Based on simple clinical parameters on admission to the emergency room, risk indicators for death during the following year could be identified as follows, in the order of significance: high age (p < 0.001), ST-segment depression on admission (p < 0.001), and a history of diabetes mellitus (p < 0.05). At admission to the emergency room, risk indicators for development of AMI during the following year were as follows: initial degree of suspicion of AMI (p < 0.001), electrocardiographic signs of acute ischemia on admission (p < 0.001), ST-segment elevation on admission (p < 0.01), age (p < 0.05), and lack of a previous history of chronic stable angina pectoris (p < 0.05). We conclude that, among patients admitted to hospital due to suspected AMI with a history of unstable angina pectoris immediately preceding hospitalization, 38% developed a confirmed infarction and 19% died during the following year.     

Effect of leukocytosis at initial examination on prognosis in patients with primary unstable angina

BACKGROUND: Leukocytosis with acute myocardial infarction at initial examination predicts adverse prognosis, but it is unknown whether it predicts outcome in patients with primary unstable angina. METHODS AND RESULTS: We studied 414 consecutive patients with unstable angina admitted through the emergency department to telemetry and intensive care units of an urban academic hospital. To study primary unstable angina, we excluded 134 patients with precipitants (eg, urosepsis, pneumonia) that may cause leukocytosis. Of 280 patients, 96 (34%) had leukocytosis (leukocyte count >10,000 per microL) at initial examination. A total of 30 patients (11%) died and 47 (17%) died or had nonfatal myocardial infarction within 12 months of initial examination. In a univariate Cox model, patients with leukocytosis had a hazard ratio (HR) of 2.6 (95% confidence interval [CI] 1.3-5.4) for death by 1 year. In a multivariate Cox model the only significant predictors of 1-year death were congestive heart failure at initial examination (HR 7.8; 95% CI 2.8-22) and elevated creatinine (HR 2.7; 95% CI 1.3-5.7); in this model, the relation between leukocytosis and prognosis was markedly attenuated (HR 1.4; 95% CI 0.6-2.9). The adjusted HR for leukocytosis was 1.3 (95% CI 0. 7-2.3) for death or nonfatal MI by 1 year. CONCLUSIONS: Leukocytosis at initial examination is associated with adverse prognosis in patients with primary unstable angina. However, the association is confounded by other important predictors of prognosis. Leukocytosis may be a marker of stress associated with more severe cases of unstable angina or comorbid conditions.     

Immediate and late prognosis in patients with unstable angina under medical treatment

The study was undertaken to examine 221 patients with unstable angina (UA) in the acute period and repeatedly on average of 5.3 years later. Myocardial infarction and sudden coronary death were regarded as unfavorable outcomes of UA. Out of all the patients included into the study, 33 (15%) developed myocardial infarction on days 2-28 of hospital stay, which resulted in death in 7 patients; 6 more patients died suddenly. The hospital mortality rate was 5.8%. Of 175 patients discharged from the unit, 31 developed myocardial infarction in the late period, 1 case ended with a fatal outcome, sudden coronary death was observed in 32 cases. The mortality rates by years were the following: 10.2% within the first year, 17.4% for 3 years, and 28.2% for 5 years. The choice of a complex of initial signs mostly significant for defining the risk for complications with the use of Cox's model of proportional risks indicated that the outcome of UA was affected by the following significant factors: 1) ST segment depression in the leads V4-V6; 2) duration of aggravated condition; 3) duration of coronary heart disease; 4) the number of resting anginal episodes; 5) a patient's fitness on his admission to hospital; 6) a history of arterial hypertension; 7) negative T waves in the leads V4-V5.     

Rho激酶抑制剂对不稳定型心绞痛患者疗效的观察

目的 观察Rho激酶抑制剂（法舒地尔）对不稳定型心绞痛患者的疗效及其对血浆高敏C-反应蛋白（high-sensitivity C-reactive protein,hs-CRP）、白细胞介素-1（interleukin-1,IL-1）浓度的影响.方法将 58例经冠状动脉造影证实的不稳定型心绞痛患者分为常规治疗组和法舒地尔治疗组.常规治疗组（n=28）给予常规药物治疗（阿司匹林、低分子肝素、β-受体阻断药、他汀类药物、硝酸酯类和钙离子拮抗剂等）;法舒地尔治疗组（n=30）在常规治疗基础上加用法舒地尔60 mg,加入0.9％氯化钠溶液250 mL每天1次,静脉注射14d.观察并比较两组治疗后总有效率及其血浆中hs-CRP和IL-1浓度.结果 法舒地尔治疗组治疗14 d后总有效率明显高于常规治疗组,差异有统计学意义（P＜0.05）.两组治疗后血浆hs-CRP和IL-1浓度较治疗前降低,差异有统计学意义（P＜火0.05）;但法舒地尔组改变较常规治疗组更为明显,差异有统计学意义（P＜0.05）.结论 法舒地尔可能通过阻止组织因子的表达和凝血酶的形成,抑制粥样硬化病变的炎性反应,从而稳定斑块,减少急性心脏缺血事件的发生.     

阿托伐他汀对不稳定型心绞痛患者炎症因子影响的研究

目的研究阿托伐他汀对不稳定型心绞痛(UA)患者高敏C-反应蛋白(hs-CRP)、肿瘤坏死因子α(TNFα)和肌钙蛋白(cTnI)的影响。方法选择2004年1月至2005年1月来我院就诊的126例UA患者为研究对象,随机分为两组:对照组62例,常规药物治疗(抗凝、硝酸酯类、β受体阻断剂、血管紧张素转换酶抑制剂和钙拮抗剂等)16周;阿托伐他汀干预组64例,在常规治疗基础上加用阿托伐他汀,每日80mg,治疗16周。分别于药物治疗前、治疗后16周采集空腹静脉血,测定血清hs-CRP、TNFα、cTnI浓度及血脂。结果药物治疗后,阿托伐他汀干预组血清hs-CRP、TNFα和cTnI浓度明显低于同期对照组(P<0.05)。结论阿托伐他汀降低UA患者血清hs-CRP、TNFa和cTnI浓度,从而降低ACS患者急性期病死率,改善心肌缺血症状,降低心血管事件的发生率。     

C反应蛋白对不稳定型心绞痛患者预后的评价作用

目的探讨血清C反应蛋白(CRP)水平对不稳定型心绞痛(UAP)患者预后的评价作用。方法观察UAP58例,稳定型心绞痛69例作为对照组,两组均在住院后24h内采集静脉血,测血清CRP水平,出院后随访6个月,两组进行对比分析。结果UAP组CRP明显高于对照组,且UAP组在随访过程中发生急性心肌梗死(AMI)、心脏性死亡及其它心脏事件者CRP均高于对照组。除心脏性死亡外,均有统计学差异。结论CRP在UAP患者中均有不同程度增高,且发生AMI、心脏性死亡及其它心脏事件者的CRP更进一步增高。提示CRP对UAP患者的预后有一定的预测价值。