高脂血症和冠心病患者血管舒张功能的无创性检测

观察高脂血症冠心病患者内皮依赖性血管舒张功能,探讨其临床意义。选择混合高脂血症患者20例,冠心病患者30例（按病变程度分为冠心病I组和II组）和对照组20例,按照Celermajer设计的方法,用高分辨超声测定右肱动脉内皮依赖性舒张功能,结果发现反应性充血右肱动脉扩张变化百分数高脂组,冠心病I组和II组比对照组明显下降（P＜0．05,P＜0．01,P＜0．01）,冠心病I组,II组比高脂组明显下降（P＜0．05,P＜0．01）,[冠心病II组比1组降低（P＜0．01）,含服硝酸甘油后四组动脉内径均有不同程度扩张,但冠心病I组,II组比对照组,高脂组动脉扩张明显减少（均P＜0．01）,冠心病I组,II组间无明显差异,对照组,高脂组间也无明显差异,以上提示,随着动脉粥样硬化的逐渐发展加重,内皮依赖性血管舒张功能逐渐降低,肱动脉的内皮依赖性血管舒张功能与冠状动脉及外周动脉粥样硬化的严重程度相关联;该高分辨超声测定血管内皮舒张功能的方法可靠,易行。     

普伐他汀对Ⅱ型糖尿病并发冠心病患者肱动脉内皮舒张功能的影响

目的:探讨普伐他汀对Ⅱ型糖尿病并发冠心病患者肱动脉内皮舒张功能的影响。方法:45例Ⅱ型糖尿病并发冠心病患者随机分为常规治疗组和普伐他汀治疗组,治疗4周前后均抽静脉血测定血脂,采用高分辨超声法检测治疗前后肱动脉内皮依赖性舒张功能（FMD）和非内皮依赖性舒张功能（NMD）。结果:普伐他汀治疗4周后肱动脉FMD（6.32±0.35）%较治疗前（2.50±0.21）%显著改善（P<0.05）,而肱动脉NMD无显著性差异（P>0.05）。结论:短期口服普伐他汀（40 mg/d）对Ⅱ型糖尿病并发冠心病患者受损的血管内皮功能有改善作用。     

培垛普利对冠心病患者经皮冠状动脉介入术后肱动脉内皮功能障碍的影响

目的探讨培垛普利对经皮冠状动脉介入（PCI）操作所诱发的肱动脉内皮功能不全的影响。方法实行PCI的冠心病患者62例,随机分为2组,培垛普利组31例,对照组31例,应用高频超声探头分别测量2组PCI术前及术后的肱动脉基础内径、反应性充血内径、含服硝酸甘油后内径,计算肱动脉血流介导的舒张反应（FMD）,并运用多普勒技术测定血流速度峰值,最后比较2组间及组内上述参数的差异。超声测量于PCI术前2h和术后30min内完成。结果培垛普利组的FMD明显改善[（5．9±0．3）％术前vs（7．7±0．4）％术后PCI,P〈0．0013,而对照组明显恶化[（6．0±0．5）％术前vs（4．8±0．6）％术后PCI,P〈0．0013。两组硝酸甘油介导的血管舒张反应及反应性充血血流速度峰值均无明显变化。结论培垛普利可改善PCI介导的肱动脉内皮功能不全。     

冠状动脉慢血流现象与血管内皮功能紊乱有相关性

目的 探讨冠状动脉慢血流（CSF）现象与血管内皮功能的相关性。方法 选取2012年10月~2013年10月在济宁市第一人民医院心内科住院,经冠状动脉造影（CAG）证实为CSF且无冠状动脉狭窄、冠状动脉畸形及血栓形成的患者60例作为慢血流组,同时随机选取同期CAG证实血流正常且无冠状动脉狭窄、冠状动脉畸形及血栓形成的患者20例作为对照组。通过高分辨率多普勒超声仪测定两组患者的基础肱动脉内径（D0）、肱动脉内皮依赖血流量介导的舒张反应(FMD)及非内皮依赖的硝酸甘油介导的舒张反应（NID）,以此反应两组患者的血管内皮功能。对慢血流组与对照组患者的性别、年龄、体质量指数（BMI）、吸烟比例、血脂、空腹血糖、血压、血管内皮功能指标进行组间比较和相关性分析。结果 慢血流组与对照组在年龄、BMI、空腹血糖、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）、舒张压水平等方面均无统计学差异;慢血流组吸烟比例（63% vs. 25%）、收缩压水平〔(126±12)mmHg vs.(119±13)mmHg〕均高于对照组（P<0.05）;慢血流组男性比例（78% vs. 30%）显著高于对照组（P<0.01）;慢血流组与对照组相比D0、NID无统计学差异;慢血流组FMD显著低于对照组〔(6.3±1.3)% vs.(10.2±1.9)%,P<0.01〕,其平均血流帧数与FMD呈明显负相关（r=-0.70,P<0.01）。结论 冠状动脉慢血流现象与内皮功能紊乱有相关性。     

补充叶酸及B族维生素对冠心病患者血管内皮功能的影响

目的探讨在常规治疗基础上补充叶酸及B族维生素是否能改善冠心病（CHD）患者的血管内皮功能。方法经冠脉造影检查至少一支冠状动脉狭窄≥50%的连续CHD患者87例,在包括阿司匹林及他汀类调脂药等的常规治疗基础上随机分为两组。试药组（45例）:在常规治疗的基础上加服叶酸15 mg/d;维生素B630 mg/d;维生素B1275μg/d;对照组（42例）:常规治疗。治疗半年,于治疗前后采用HP SONOS 5500型彩色超声显像仪和3.0117.0 MHZ的线阵探头,分别测量患者休息时、反应性充血后肱动脉内径。比较治疗前后内皮依赖性血管舒张功能（flow-mediated dilation,FMD）的变化。结果治疗前,试药组与对照组间肱动脉基础内径[（4.2±0.5）mmvs（4.6±0.4）mm]及反应充血引起的肱动脉内径变化差异无统计学意义[（3.9±0.9）%vs（4.1±0.5）%]。半年后两组患者反应充血引起的肱动脉内径变化均较自身治疗前明显改善[试药组（3.9±0.9）%vs（15.5±5.4）%,P<0.01;对照组[（4.1±5）%vs（14.0±6.3）%,P<0.01],但两组反应充血引起的肱动脉内径变化差异无统计学意义[（15.5±5.4）%vs（14.0±6.3）%]。结论含阿司匹林及他汀类调脂药的CHD常规治疗能明显改善CHD患者的血管内皮功能,在常规治疗基础上补充叶酸及B族维生素对改善CHD患者血管内皮功能的作用不优于CHD常规治疗。     

银杏叶提取物对健康老年人冠脉血流的改善作用

目的 探讨内皮依赖性血管舒张功能在银杏叶提取物改善健康老年人冠状动脉血流中的作用.方法 60例冠状动脉造影正常的健康老年人分为银杏叶提取物注射液治疗组和对照组（各30例）,两组均于用药前、后采用高分辨力血管超声无创检测冠状动脉左前降支（LAD）血流流速和血流介导的肱动脉内皮依赖性血管舒张（FMD）功能的变化.结果 银杏叶提取物显著增加健康老年人LAD舒张期峰值流速（DPV）,收缩期峰值流速（SPV）和舒张期时间速度积分（DTVI）（P< 0.01）,同时肱动脉FMD显著升高（P< 0.01）;而对照组LAD血流流速（DPV,SPV和DTVI）和肱动脉FMD无明显变化（P> 0.05）.Pearson相关分析显示,银杏叶提取物治疗后健康老年人LAD血流流速（DPV,SPV和DTVI）的增加与肱动脉FMD的改善呈正相关（P< 0.05）.结论　银杏叶提取物可增加健康老年人LAD血流流速,其机制可能与改善内皮依赖性血管舒张功能有关.     

两种不同剂量辛伐他汀对冠心病患者血管内皮功能的影响

目的探讨辛伐他汀10 mg与20 mg不同剂量对冠心病患者血管内皮功能作用的影响。方法共入选66例冠心病患者,随机分为对照组、辛伐他汀10 mg组和辛伐他汀20 mg组,治疗8周。采用超声法检测血流介导的肱动脉内皮依赖性舒张功能,同时观察血脂水平的变化。结果辛伐他汀治疗8周后,10 mg和20 mg辛伐他汀呈剂量依赖性显著降低血总胆固醇和低密度脂蛋白胆固醇水平(总胆固醇分别降低18.3%和29.3%;低密度脂蛋白胆固醇分别降低25.3%和35.4%;P<0.05)。对照组治疗8周后血脂水平无明显变(P>0.05)。10 mg和20 mg辛伐他汀均可显著改善肱动脉内皮依赖性舒张功能(10 mg辛伐他汀组为3.51%±4.03%比7.46%±5.90%;20mg辛伐他汀组为3.89%±3.97%比7.98%±6.16%;P均<0.01)。但两组之间肱动脉内皮依赖性舒张功能的变化值比较差异无显著性(P>0.05),且肱动脉内皮依赖性舒张功能的改善与血总胆固醇和低密度脂蛋白胆固醇水平的降低不相关。对照组肱动脉内皮依赖性舒张功能虽有轻度增加,但无统计学意义。辛伐他汀治疗后肱动脉内径和肱动脉对硝酸甘油的反应均无显著改变。结论10 mg和20 mg辛伐他汀治疗8周后,可显著改善冠心病患者血管内皮功能,但该作用在这2种剂量之间无显著不同,可能独立于调脂作用之外。     

原发性高血压合并高尿酸血症患者血管内皮依赖性舒张功能变化及临床意义

目的探讨原发性高血压（EH）合并高尿酸血症患者血管内皮依赖性舒张功能的变化及意义。方法选择EH患者30例、EH合并高尿酸血症患者60例及健康体检者30例,采用无创性高分辨超声技术检测三组休息、反应性充血、舌下含服硝酸甘油（GTN）后肱动脉内径的变化。结果EH及EH合并高尿酸血症患者肱动脉血流介导性扩张百分比明显低于正常组（P〈0．05）,EH合并高尿酸血症患者下降更明显（P〈0．01）;舌下含服GTN后EH合并高尿酸血症组肱动脉内径变化与正常对照组比较有统计学差异（P〈0．05）,EH组与正常对照组之间无统计学差异。结论EH合并高尿酸血症患者存在血管内皮依赖性舒张功能失调,高尿酸血症可加重血管内皮依赖性舒张功能的损害。     

高分辨力超声评价川崎病急性期肱动脉内皮功能及维生素C的作用

目的研究川崎病(KD)急性期肱动脉内皮依赖性血管舒张(EDD)功能及快速经静脉输注维生素C的作用。方法应用高分辨力超声分别测定KD急性期患者及对照组反应性充血介导的肱动脉内径百分变化率,并测定快速经静脉输注维生素C后反应性充血介导的肱动脉内径百分变化率。结果KD急性期组反应性充血介导肱动脉内径百分变化率明显低于对照组(P<0.01),其中并发冠状动脉扩张者与未并发冠状动脉扩张者间差异无统计学意义(P>0.05)。KD急性期患者快速经静脉输注维生素C后反应性充血介导肱动脉内径百分变化率较前明显增加(P<0.01)。结论KD急性期外周动脉内皮功能减低,经静脉快速输注大剂量维生素C可以改善KD急性期外周动脉内皮功能。     

老年女性冠心病患者颈动脉粥样硬化和血管内皮依赖性舒张功能的探讨

目的　观察老年女性冠心病患者颈动脉内中膜厚度 (IMT)、粥样斑块发生率及肱动脉内皮依赖性舒张功能的情况。方法　用高分辨超声技术对 89例老年女性行肱动脉血流介导的舒张功能 (FMD)、IMT及颈动脉粥样斑块的检测。结果　老年女性冠心病组FMD较对照组明显减弱 ,分别为 (3.5± 3.1) %及 (7.6± 3.5 ) % ,P <0 .0 0 1,老年女性冠心病组及对照组IMT分别为 (0 .88± 0 .2 0 )mm及 (0 .6 5± 0 .2 3)mm ,颈动脉粥样斑块发生率分别为 6 2 .2 %及11.4 % ,两组比较差异具有显著性意义 ,P <0 .0 0 1。结论　老年女性冠心病患者存在着严重的血管内皮依赖性舒张功能障碍以及颈动脉粥样硬化 ,颈动脉B超及肱动脉血流介导的舒张功能对老年女性冠心病患者有一定的预测价值。     

Grading the angiographic extent of collateral filling

Angiography frequently demonstrates a collateral circulation in severe coronary artery disease. An easily applicable method to quantify collateral flow might be a useful adjunct for the assessment of the hemodynamic effects of coronary artery disease. The purpose of this study was to validate a visual scaling of the extent of angiographic collateral filling by comparison with flowmeter- and microsphere-derived measurements of collateral flow. In 12 open-chest dogs, collaterals from the circumflex artery were angiographically visualized (n = 80) by creating acute critical left anterior descending artery occlusion. The extent of collateral filling was graded in four levels from 0 = no visible filling to 3 = complete epicardial filling. Collateral filling correlated with the change in flow of the collateral supplying circumflex artery (Q; r = 0.84) which was + 5.3 ±4.6% with grade 1, + 9.1 ±3.5% with grade 2 and + 14.6 ±4.7% with grade 3 (p < 0.01). In parallel, coronary flow reserve decreased from 4.1 ±0.8 with grade 0 to 2.9 ±0.2 with grade 3 (p < 0.01). Colored microspheres were injected subselectively into the circumflex artery of 9 dogs (45 injections). The ratio of microspheres counted in the collateralized myocardium of the left anterior descending artery to the total number injected increased from 0.6 ±0.9% for grade 0 to 17.1 ±2.8% with grade 3 (p < 0.01). Absolute collateral flow derived from microsphere counts averaged 5.5 ±0.9 ml/min with grade 3 and closely correlated with collateral filling grade (r = 0.88). Semiquantitative grading of angiographic collateral filling in response to acute coronary occlusion in a canine model correlates with an increase in collateral source artery flow, absolute collateral flow and a decrease in source artery flow reserve. These data suggest that this scale might be a simple but useful adjunct tool to assess the hemodynamic significance of a collateral circulation.This work was supported by a grant from the NLHBI 1 R01 HL40865. Dr. Schuhlen is the recipient of a grant from the Deutsche Forschungsgemeinschaft (#Schu657/1-1 and 1–2).     

Provisional T-stenting and kissing balloon in the treatment of coronary bifurcation lesions: results of the French multicenter "TULIPE" study.

BACKGROUND: In previous prospective studies, a strategy of (a) stenting of the main branch, (b) provisional T-stenting of the side branch, and (c) final kissing balloon inflation, was associated with high success and low target lesion revascularization (TLR) rates on the long-term. OBJECTIVES: To examine the performance of this strategy in a multicenter study. METHODS: Consecutive patients were treated at 14 French medical centers for de novo coronary bifurcation lesions with the same technique used. Immediate results and clinically-driven TLR at 7 months were examined. RESULTS: The mean reference diameters of the main and side branches were 3.2 +/- 0.6 mm and 2.4 +/- 0.5 mm, respectively. The side branch was stented in 34% of patients. A <30% residual stenosis in the main branch was achieved in 99%, <50% in the side branch in 90%, and both in 89% of procedures. The in-hospital major adverse cardiovascular event were a Q-wave and 5 non-Qwaves MI (0.54% and 2.7%). At 7 months of follow-up, 3 patients (1.76%) had died, 1 suffered a non-Q-wave MI (0.59%), and 28 (15.88%) underwent TLR. By multivariate analysis, a lower left ventricular ejection fraction (OR: 0.934), moderate calcifications (OR: 7.86), and non-use of the "jailed" wire technique (OR: 4.26) were associated with reinterventions during follow-up. CONCLUSIONS: A strategy of provisional T-stenting with a tubular stent and final kissing balloon angioplasty for the treatment of coronary bifurcation lesions was safe and associated with a low TLR rate at 7 months. This strategy should be applicable to the new era of drug eluting stents.     

Embolization complicating coronary angioplasty in the presence of an intracoronary thrombus

Two cases of coronary occlusion and subsequent embolization during percutaneous coronary angioplasty (PTCA) are described. Prior to PTCA, angiographic evidence of intracoronary thrombus was present. Abrupt reclosure after dilation was treated by successful redilation. However, coronary embolization of thrombus debris occurred downstream in one patient and into an adjacent coronary branch in the second patient.     

非罪犯冠脉斑块研究的进展

加强冠心病的二级预防是目前防控急性冠脉综合征（ACS）的重要手段。本文对ACS与非罪犯冠脉斑块的关系作了综述。     

Treatment of ruptured coronary aneurysm with a novel covered stent

Coronary artery aneurysms are relatively rare but have been diagnosed with increasing frequency since the advent of coronary arteriography. Their reported incidence varies from 1.5% to 5% with male dominance and a predilection for the right coronary artery (RCA), accounting for over 40% of all cases. The most common etiology amongst adults remains atherosclerosis accounting for 50% of coronary aneurysms. We describe the first use of a novel flexible pericardium covered stent for successful treatment of a ruptured coronary aneurysm in 76 year old lady. © 2008 Wiley‐Liss, Inc.     

Techniques for palmaz-schatz stent deployment in lesions with a large side branch

Palmaz-Schatz coronary stent implantation in lesions with a large side branch are reported. The first case describes how to manage plaque shifting after stent implantation. The second and third cases demonstrate a kissing balloon predilatation and stent dilatation technique of a bifurcational lesion. The final case demonstrates a stent implantation technique through the stent struts of a previously deployed stent.     

Is short-stay coronary angioplasty safe?

Percutaneous transluminal coronary angioplasty (PTCA) is usually performed as an inpatient procedure and the patients are monitored for several days afterward. Over a 13-month period, in 91 of 373 PTCA procedures, the clinical condition of the patient did not necessitate inpatient status before PTCA. PTCA was done the day of admission and discharge planned the following. Overall hospital stay was planned as less than 24 hours. PTCA was done in one vessel in 62 patients, two vessels in 24, three vessels in 3, and four vessels in 2 patients. PTCA was initially successful (less than 50% residual stenosis) in 85 patients (93%). In one of these, acute occlusion occurred the next morning and urgent bypass surgery was done. PTCA failed in 6 patients who left the catheterization laboratory with unchanged coronary anatomy. Bypass surgery was performed that day in 2 patients, on another admission in 1 patient, and medical therapy continued in the other 3 patients. Of the 88 patients not receiving same admission bypass surgery, 84 (95%) were discharged in less than 24 h. Hospitalization was prolonged (1-5 days) in 4 patients. This was because of nonobstructive dissection treated with heparin for approximately 24 h in 2 patients; a catheterization site hematoma in 1 patient, and post-PTCA noncardiac chest pain in another. No patient had inhospital myocardial infarction or death. The only late complication was in a patient treated with heparin and monitored for 2 days; 3 weeks later angina returned and he died suddenly. These data suggest PTCA can safely be done in selected patients with both single and multivessel disease in a short stay inhospital setting.(ABSTRACT TRUNCATED AT 250 WORDS)     

LAD-right ventricular fistula complicating PTCA: Another case

Coronary perforation caused by percutaneous transluminal coronary angioplasty (PTCA) occurs rarely and most often leads to communication to the pericardial space. We report a case where PTCA caused a coronary artery rupture and fistulization to the right ventricular outflow tract. Cathet. Cardiovasc. Diagn. 42:34–36, 1997. © 1997 Wiley-Liss, Inc.     

Angiographic demonstration of coronary sinus thrombosis: A potential consequence of trauma to the coronary sinus

Abnormalities of the coronary sinus are rarely encountered. A case is presented demonstrating for the first time the angiographic appearance of coronary sinus thrombosis. This may have been the result of surgical trauma during mitral valve replacement or inadvertent cannulation of the coronary sinus during right heart catheterization or pacemaker insertion. Although the clinical significance of coronary sinus thrombosis is uncertain, obstruction of coronary sinus blood flow should not be deleterious because of multiple anastomoses between the coronary sinus system and the anterior cardiac veins. Difficulty in cannulating the coronary sinus for physiologic studies should suggest the possibility of coronary sinus thrombosis, especially in patients who have undergone mitral valve replacement. This may be confirmed by observing the venous phase of selective left coronary arteriography. Finally, coronary sinus thrombosis may be important as a source of pulmonary emboli. The prevalence of this serious complication requires further study.     

Coronary arteriovenous-arterial fistula

A case of multiple arteriovenous fistulae is described in an adult with coronary artery disease. One of these fistulae drained into the anterior interventricular vein, which in turn communicated with and perfused an obstructed left anterior descending coronary artery.