左主干起源于右冠状动脉窦（附2例报告并文献复习）

目的:分析左主干起源于右冠状动脉窦的临床特征,提高对左主干起源于右冠状动脉窦的认识和诊断.方法:回顾分析2例左主干起源于右冠状动脉窦的临床病例并对文献进行回顾分析.结果:左主干起源于右冠状动脉窦是一种罕见的先天性冠脉畸形,这种畸形可分为良性或恶性,主要根据异常左冠状动脉与主动脉和肺动脉之间的关系.对于可能引起猝死或严重心肌缺血患者,应进行冠状动脉旁路移植术.2例患者左主干起源于右冠状动脉窦,其中1例左主干走行于主动脉与肺动脉之间,1例走行于主动脉前方,这2例未进行预防性外科手术,目前预后良好.结论:左主干起源于右冠状动脉窦是罕见的冠脉畸形,应注意鉴别是良性或是恶性,确定下一步治疗方案.     

多巴酚丁胺^99m锝心肌断层显象评价冠状动脉介入性治疗的效果

用多巴酚丁胺９９ｍ锝－ＭＩＢＩ（ｍｅｔｈｏｘｙｉｓｏｂｕｔｙｌｎｉｔｒｉｌｅ）心肌断层显象（Ｄｏｂｕ－ＥＣＴ）评价冠心病介入性治疗的效果。方法对３２例冠心病患者在冠状动脉介入治疗的术前、术后３～６个月行多巴酚丁胺心肌显象。多巴酚丁胺以５～４０μｇ．ｋｇ－１／ｍｉｎ，每级剂量间隔３分钟。在最大剂量时注射７４０ＭＢｑ９９ｍ锝－ＭＩＢＩ，１小时后行心肌断层显象。２４小时后再注射等量３９９ｍ锝－ＭＩＢＩ行静态心肌显象。结果术前显示１１６个异常室壁节段，术后显示７９个节段缺血消失或缺血改善，术前心肌显象有明显可逆性心肌缺损节段，治疗有效率为７５％；而术前仅呈固定缺损节段，治疗有效率为４３．８％（Ｐ＜０．０１）。术前心脏断层显象有明显可逆心肌缺损病例，７７．８％（２１／２７）术后心肌缺血消失或改善，２２．２％（６／２７）心肌缺血无改善或缺血范围扩大，其中５例经冠状动脉造影证实原有扩张部位再狭窄。结论多巴酚丁胺９９ｍ锝－ＭＩＢＩ心肌显象可用于评价冠心病介入性治疗的效果，在随访中可发现再狭窄，进一步指导治疗     

单支冠状动脉畸形的急性心肌梗死及介入治疗

病例1,患者男,55岁。因突发心前区疼痛6小时不缓解到我院急诊室,心电图胸前V1-2导联呈QS波,V3-5导联呈rS波,V1-5导联ST段明显抬高0.2~0.6mV。II、III、aVF导联呈qR波伴ST段抬高0.1mV。诊断为急性前壁心肌梗死。急诊行冠状动脉造影及冠状动脉介入治疗,穿刺右股动脉,插入6F动脉鞘管,先用6FJL4.0造影导管行左冠脉造影,结果示前降支近段次全闭塞。在行急诊冠状动脉造影中前降支近中段完全闭塞,回旋支远端粗大(图1)。用6FJR4.0造影导管在行右冠状动脉造影时未能找到右冠开口及右冠状动脉,然后仔细观察左冠状动脉,发现回旋支远端粗大并…     

光学相干断层成像在冠心病介入治疗中的应用价值

光学相干断层成像(Optical coherence tomography,OCT)是一种新的高分辨率断层成像模式,它将光学技术与超灵敏探测器合为一体,应用现代计算机图像处理,发展成为一种新兴的断层成像诊断技术。自2001年开始国外首次报道OCT技术在人体冠状动脉内获得高清晰图像以来,OCT技术在冠心病介入领域中应用报道逐渐增多,目前备受国内外专家的高度关注。     

加强基层培训,不断提高对非ST段抬高型急性冠状动脉综合征的诊治水平

简要介绍《非ST段抬高型急性冠状动脉综合征基层诊疗指南(2019年)》制订的背景和涵盖内容。基层医疗机构医师应熟悉心肌损伤标志物肌钙蛋白(cTn)检测在非ST段抬高型急性冠状动脉综合征早期诊断中的重要性,重视其早期评估和危险分层,规范治疗策略,以改善长期预后。     

急性脑损伤致心肌损害中心肌G蛋白表达的改变

目的建立动物急性脑损伤(acute brain injury,ABI)模型,观察心肌Gs蛋白α亚基(αsubunite of Gs,Gsα)和Gq蛋白α亚基(αsubunite of Gq,Gqα)的变化,探讨Gs和Gq在急性脑损伤致心肌损伤中的作用及其β1肾上腺素受体阻断剂(adrenalinβ1receptor blocker,β1-ARB)和5-羟色胺受体2A阻断剂(5-hydroxytryptamine 2A receptor blocker,5-HT2ARB)对G蛋白的影响。方法复制Wistar大鼠ABI模型(n=8)。采用数字表法随机分为正常组(NORM)、假手术对照组(SHAM)、急性脑损伤模型组(ABI)、β1-ARB组(BETA)和5-HT2ARB组(KETA组)。利用RT-PCR方法测定Gsα和GqαmRNA表达;通过Western blotting方法测定Gsα和Gqα蛋白表达。结果与正常对照组(NORM:100%)相比,SHAM组、ABI组和BETA组GsαmRNA表达分别为(92.6±24)%、(39.7±30)%和(80.1±12)%。ABI组GsαmRNA表达比SHAM组显著降低(P<0.05),预先应用β1-ARB的BETA组GsαmRNA表达比ABI组增高(P<0.05),而与SHAM组比差异无统计学意义(P>0.05);与正常对照组(NORM:100%)相比,SHAM组、ABI组和BETA组Gqα蛋白表达分别为(105±30)%、(110±14)%和(107±23)%,各组之间Gqα蛋白表达差异无统计学意义(P>0.05)。结论 ABI组GsαmRNA和Gsα蛋白表达水平于脑损伤后显著降低。提示急性脑损伤致心肌损伤的发生可能与抑制Gs蛋白介导的信号转导通路有关,Gs蛋白可能以Gsα蛋白表达量改变的方式参与了急性脑损伤致心肌损伤的发生过程。     

颈动脉高分辨磁共振成像预测冠心病的价值

目前心血管疾病（cardiovascular disease,CVD）在美国已成为死亡的主要原因[1],其发病率在国内也逐年升高并呈年轻化趋势,且死亡率已超过肿瘤,成为严重危害人民健康的第一杀手,其中最常见的病种为冠心病.研究发现,急性心血管事件的元凶超过2/3发生于非显著狭窄性病变,由斑块破裂造成[2],因此血管壁病变而不是血管腔病变才是各种心脑血管病发生和发展的基础[3].对于动脉轻度狭窄的患者,仅了解血管的狭窄程度己不能全面反映病变的严重程度,对动脉粥样硬化斑块成分分析及稳定性的判断逐渐受到人们的重视.     

稳定性冠心病的风险评估

稳定性冠心病是指疾病保持相对稳定状态,但可以随时因斑块破裂或侵蚀而变为不稳定导致急性冠脉事件。文章介绍合理使用评价稳定性冠心病风险的各种方法,提高对稳定性冠心病临床诊治能力。     

光学相干断层扫描比较不稳定性和稳定性心绞痛患者粥样硬化斑块特征

Objective To compare the characterization of coronary atherosclerotic plaques in patients with unstable angina pectoris (UAP) and stable angina pectoris (SAP) by optical coherence tomography (OCT). Methods OCT was performed in 47 patients (23 UAP and 24 SAP) undergoing coronary angiography. Lipid-rich plaque (defined by ≥ 2 quandrants of the cross-section area), thin cap fibroatheroma (TCFA), thickness of fibrous cap, plaque rupture, calcification and thrombus visualized by OCT were compared between UAP and SAP patients. Results OCT imaging was successfully in 44 out of 47 patients (22 UAP, 22 SAP). Proportion of lipid-rich plaques was similar between UAP and SAP groups [91% (20/22) vs, 73% (16/22),P =0. 741]. The minimum thickness of fibrous cap in the UAP group was significantly thinner than that in SAP group [(69.5±34.7) μm vs. (141.1±68.5) μm, P = 0.000] and the rate of fibrous cap erosion in the UAP group was significantly higher than that in the SAP group [59% (13/22) vs. 9% (2/22), P=0.000]. Percents of TCFA [73% (16/22) vs. 14% (3/22) ,P = 0.000] and plaque rupture [50% (11/22) vs.9% (2/22) , P = 0.003] were significantly higher in UAP group compared those in SAP group. Incidence of thrombus and calcification were similar between two groups. Conclusions OCT imaging can clearly define plaque characterization of coronary atherosclerosis. UAP patients have thinner fibrous cap, higher incidences of fibrous cap erosion, plaque rupture and TCFA compared patients with SAP.     

光学相干断层扫描比较不稳定性和稳定性心绞痛患者粥样硬化斑块特征

Objective To compare the characterization of coronary atherosclerotic plaques in patients with unstable angina pectoris (UAP) and stable angina pectoris (SAP) by optical coherence tomography (OCT). Methods OCT was performed in 47 patients (23 UAP and 24 SAP) undergoing coronary angiography. Lipid-rich plaque (defined by ≥ 2 quandrants of the cross-section area), thin cap fibroatheroma (TCFA), thickness of fibrous cap, plaque rupture, calcification and thrombus visualized by OCT were compared between UAP and SAP patients. Results OCT imaging was successfully in 44 out of 47 patients (22 UAP, 22 SAP). Proportion of lipid-rich plaques was similar between UAP and SAP groups [91% (20/22) vs, 73% (16/22),P =0. 741]. The minimum thickness of fibrous cap in the UAP group was significantly thinner than that in SAP group [(69.5±34.7) μm vs. (141.1±68.5) μm, P = 0.000] and the rate of fibrous cap erosion in the UAP group was significantly higher than that in the SAP group [59% (13/22) vs. 9% (2/22), P=0.000]. Percents of TCFA [73% (16/22) vs. 14% (3/22) ,P = 0.000] and plaque rupture [50% (11/22) vs.9% (2/22) , P = 0.003] were significantly higher in UAP group compared those in SAP group. Incidence of thrombus and calcification were similar between two groups. Conclusions OCT imaging can clearly define plaque characterization of coronary atherosclerosis. UAP patients have thinner fibrous cap, higher incidences of fibrous cap erosion, plaque rupture and TCFA compared patients with SAP.