经颅多普勒超声检测糖尿病患者脑动脉血流变化

目的:应用经颅多普勒超声仪检测糖尿病患者颅内动脉状况了解糖尿病患者脑血流动力学改变情况。方法:测量20例单纯糖尿病患者、26例糖尿病伴微血管病变患者与25例正常对照组MCA、ACA、BA的Vs、Vm值对比;并计算PI值。进行有微血管病变组与单纯糖尿病组进行组内对比。结果:研究组的搏动指数均高于对照组,两组间有显著差异(P<0.01)。微血管并发症组患者的MCA、ACA、BA的VS、Vm明显高于单纯糖尿病组(P<0.01),尤以Vs显著。结论:PI、Vs对糖尿病脑血管病变有良好的敏感性,TCD检测对预防糖尿病并发脑血管病的发生,判断预后,指导早期医学干预有重要意义。     

经颅多普勒检测评估无脑血管病的老年患者脑底动脉环的侧支循环能力

目的 探讨经颅脉的交通前多普勒检测(TCD)评估老年患者脑底动脉环的侧支循环能力。方法 对80例老年无脑血管病患者，在颈总动脉压迫试验时TCD检测前交通动脉和后交通动段血流速度变化。结果 31％患者的前交通动脉和两侧后交通动脉均开放，构成一个血流动力学完整的脑底动脉环。93％患者的脑底动脉环前部开放。61％脑底动脉环后部发育异常，阻碍了侧支血流从基底动脉到颈内动脉。结论 TCD检测有助于了解脑底动脉环的侧支循环能力。     

冠状动脉慢血流现象研究进展

冠状动脉（冠脉）慢血流现象是在冠脉造影过程中发现的冠脉血流灌注延迟现象，但没有结构性的冠脉疾病作为基础，因其预后的不确定性，近几年来越来越引起介入医生的关注，而其病因、发病机制、临床诊治、疾病预后等尚缺少大量研究的支持，本文将就该现象的相关研究现状作综述。     

原发性高血压患者经颅多谱勒脑动脉血流变化特征分析

目的 探讨原发性高血压患者脑动脉血流变化特征及其影响因素,为高血压防治提供依据。方法 对29名原发性高血压患者和16名健康人进行了经颅彩色多普勒脑血流成像技术（TCI）监测分析,观察大脑中动脉（MCA）的收缩期血流速度（Vs)平均血流速度（Vm)、舒张期血流速度（Vd)、搏动指数（PI）、阻力指数（RI）的变化特征,并与收缩压（SBP）、舒张压（DBP）、平均动脉压（MBP）、脉压进行了直线相关分析。结果 与健康对照组相比,高血压组患者收缩压（SBP）、舒张压（DBP）、平均动脉压（MBP）、脉压和体重指数（BMI）及PI、RI均明显升高（P＜0．01）;高血压组中DBP与Vs,Vm,Vd,PI,RI呈明显正相关（P＜0．05）,脉压与Vs,Vm,Vd及PI呈明显正相关（P＜0．05）。SBP、MBP均与脑血流指标相关不明显（P＞0．05）。结论 高血压患者脑动脉血流变化特征主要表现为PI和RI的显著升高,舒张压和脉压是影响脑血流变化的两个主要因子。TCI是一种简便的、有价值的检查方法。     

冠状动脉慢血流现象的研究进展

<正>随着生活水平提高,冠心病患者人数在逐年攀升,冠状动脉造影检查已成为诊断冠心病的金标准。在冠状动脉造影检查中,存在一种血管形态几乎正常却出现血流灌注延迟的现象,Tambe等~([1])于1972年初次发现,并命名为冠状动脉慢血流现象。但由于对该现象相关研究较少,目前仍没有形成系统定论。研究表明慢血流现象发生率约为7%。本文将针对慢血流现象从概念、诊断标准、临床特点、病理机制、危险因素、治疗方案等方面进行综合分析。     

冠状动脉的慢血流现象

在冠状动脉造影检查中对于血流速度的判断是判断心脏血流灌注的一个重要指标。严重的冠状动脉狭窄、溶栓治疗后、冠状动脉成型术后、冠状动脉造影术中冠状动脉内气体栓塞都会导致冠状动脉血流速度减慢,有些冠状动脉血流减慢还与冠状动脉痉挛、冠状动脉扩张、心肌病、瓣膜病、结缔组织病有关,但以上这些原因导致冠状动脉血流减慢具有不同的病理生理机制和临床意义。早在1972年Tambe等首先报道了部分有胸痛症状的病例,他们的冠状动脉造影显示冠状动脉没有上述病变但血流速度明显减慢。此后随着冠状动脉造影的普及,这种现象逐渐引起了人们的重视。     

原发性高血压患者经颅多谱勒脑动脉血流变化特征分析

目的探讨原发性高血压患者脑动脉血流变化特征及其影响因素,为高血压防治提供依据.方法对29名原发性高血压患者和16名健康人进行了经颅彩色多普勒脑血流成像技术(TCI)监测分析,观察大脑中动脉(MCA)的收缩期血流速度(Vs)、平均血流速度(Vm)、舒张期血流速度(Vd)、搏动指数(PI)、阻力指数(RI)的变化特征,并与收缩压(SBP)、舒张压(DBP)、平均动脉压(MBP)、脉压进行了直线相关分析.结果与健康对照组相比,高血压组患者收缩压(SBP)、舒张压(DBP)、平均动脉压(MBP)、脉压和体重指数(BMI)及PI、RI均明显升高(P<0.01);高血压组中DBP与Vs、Vm、Vd、PI、RI呈明显正相关(P<0.05),脉压与Vs、Vm、Vd及PI呈明显正相关(P<0.05).SBP、MBP均与脑血流指标相关不明显(P>0.05).结论高血压患者脑动脉血流变化特征主要表现为PI和RI的显著升高,舒张压和脉压是影响脑血流变化的两个主要因子.TCI是一种简便的、有价值的检查方法.     

冠状动脉慢血流现象的临床特点分析

目的探讨冠状动脉慢血流现象(CSFP)的临床意义。方法入选病例分两组:冠脉慢血流现象组(39例)和冠状动脉血流正常组(27例),所有病例均行冠脉造影检查,并除外心肌病、瓣膜病及其他类型心脏病,在行冠脉造影检查时发现慢血流,均于冠脉内注射硝酸甘油0.2mg,测量注射前后的血流速度,入选病例均行运动负荷试验及静息心电图检查。结果冠状动脉慢血流现象组注射硝酸甘油后血流速度明显增快,P<0.05;冠脉慢血流组无心绞痛发作时,静息心电图异常发生与血流正常组无差异,P>0.05,心绞痛发作时,静息心电图异常发生高于冠脉血流正常组,P<0.05,运动负荷阳性率高于冠脉血流正常组,P<0.05。结论冠状动脉慢血流现象在冠脉造影中比较常见,可能是一种缺血性心脏病新的发病机制,有待进一步验证。     

低密度脂蛋白胆固醇在冠状动脉慢血流发生中的作用

目的探讨低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)在冠状动脉慢血流现象(slow coronary flow phenomenon,SCFP)发生中的作用。方法选择2006年7月至2012年6月在潮州市中心医院就诊,行冠状动脉造影的患者中冠状动脉无明显狭窄且合并有SCFP的38例作为SCFP组。同时,选取经造影检查未合并SCFP且冠状动脉无明显狭窄的患者40例作为对照组。采用酶联免疫分析化法定量测定血清LDL-C浓度,比较两组不同危险因素亚组男、女血清LDL-C浓度。结果 SCFP组吸烟、合并糖尿病、合并高血压及同型半胱氨酸增高亚组男、女LDL-C浓度均高于对照组,差异有统计学意义(P>0.05)。结论血清LDL-C在SCFP发生中有促进作用。     

冠状动脉慢血流患者脉搏波传导速度的变化

目的研究冠状动脉慢血流(coronary slow flow,CSF)现象与臂踝脉搏波传导速度(brachial-ankle pulse wave velocity,ba PWV)的相关关系。方法选择64例因胸痛入住福建医科大学附属第二医院拟诊为冠心病并行冠状动脉造影(CAG)显示心外膜主要冠状动脉无明显病变的病例。根据校正的TIMI血流计帧法(c TFC)计算各支冠状动脉的TIMI帧数。冠状动脉平均帧数大于27帧定义为CSF,将患者分为CSF组(n=28例)和正常血流(NCF)对照组(n=36例)。应用t检验和卡方检验比较两组患者各项临床资料的差异,并采用二分类Logistic回归分析法对相关因素进行分析。结果两组患者中年龄、性别、高血压、糖尿病、吸烟史、血脂水平、空腹血糖水平、血浆纤维蛋白原的水平差异均无统计学意义,而CSF组的ba PWV及ba PWV%均显著高于NCF组(1746.29±342.51)vs(1516.99±269.47)cm/s,(P0.01);(26.13±19.09)vs(12.29±19.23),(P0.01)。二分类Logistic回归分析表明ba PWV和性别是影响CSF的危险因素(OR=8.40、9.69)。结论 CSF组ba PWV水平升高,提示CSF存在冠状动脉粥样硬化。性别(男性)和升高的ba PWV是CSF发生的危险因素,ba PWV可用于CSF高危人群的筛查。     

Inverse correlation between coronary and retinal blood flows in patients with normal coronary arteries and slow coronary blood flow

Background

The “Slow Coronary Flow” (SCF) phenomenon in the presence of angiographically normal coronaries is attributed to microvascular and endothelial dysfunction. The microcirculation can be non-invasively assessed by measuring retinal blood flow velocity.The aim of the present study was to evaluate the efficacy of the “Retinal Functional Imager” (RFI) device as a noninvasive method of diagnosing patients with slow coronary flow.

Methods

Coronary blood flow velocity assessed by corrected TIMI Frame Count and retinal arterioles blood flow assessed by RFI were measured in 28 consecutive patients with normal coronary arteries. The patients were divided into 2 groups: a slow coronary flow (SCF) and a normal coronary flow (NCF) groups.

Results

Inverse correlation was found between retinal and coronary blood flows so that higher retinal arterial flow velocity was observed in the SCF group (3.8 ± 1.1 mm/s vs. 2.9 ± 0.61 mm/s, respectively, p = 0.022). RFI provided 73% sensitivity and 77% specificity for diagnosing SCF using ROC analysis. Additionally, patients with SCF had higher values of serum LDL cholesterol (104.7 ± 18.93 mg/dl vs. 81.55 ± 14.62 mg/dl in NCF, p = 0.005), Glucose (96.9 ± 23.0 mg/dl vs. 83.55 ± 9.7 mg/dl in NCF, p = 0.024), and lower percentage of statin consumption (40.0% vs. 76.9% in NCF, p = 0.049).

Conclusions

Slow coronary blood flow can be non-invasively diagnosed with Retinal Functional Imager. Patients with normal coronary arteries and slow coronary blood flow have high retinal arteriolar blood flow. Early non-invasive diagnosis of SCF might help detect individuals who are at higher risk to develop coronary atherosclerosis, and to provide them with early preventive measures.     

Decreased plasma concentrations of adiponectin in patients with slow coronary flow

Adiponectin has multiple protective effects on vascular endothelium through anti-inflammatory and anti-atherogenic properties. Recent data suggested that endothelial activation and inflammation may contribute to the pathogenesis of slow coronary flow (SCF). Therefore, we investigated whether adiponectin plasma concentrations were decreased in patients with SCF compared to subjects with normal coronary flow. The study population consisted of 35 patients with angiographically documented SCF in all three coronary arteries and 35 sex- and age-matched cases with normal coronary flow. Coronary flow rates of all participants were determined by Thrombolysis in Myocardial Infarction (TIMI) frame count. Plasma adiponectin concentrations were measured by an enzyme-linked immunosorbent assay method using commercially available adiponectin kits. There were no statistically significant differences between the patients with SCF and the subjects with normal coronary flow in terms of demographic characteristics and cardiovascular risk factors (P > 0.05). Plasma adiponectin concentrations of patients with SCF were found to be significantly lower than those with normal coronary flow (4.77 ± 3.86 mg/ml vs 10.8 ± 6.60 mg/ml, P = 0.001, respectively). Plasma adiponectin levels were correlated significantly and inversely with mean TIMI frame count in patients with SCF (r = −0.441, P = 0.008). Furthermore, the Receiver Operator Characteristics curve of adiponectin concentrations showed that an adiponectin <4.6 mg/ml is associated with SCF with a sensitivity of 68.6%, specificity of 82.9%, positive predictive value of 80.0%, and negative predictive value of 72.5%. Our findings suggest that endothelial inflammation may play a role in the pathogenesis of SCF phenomenon.     

阿托伐他汀对冠状动脉血流缓慢患者冠状动脉血流储备的影响

目的 探讨冠状动脉血流缓慢患者冠状动脉血流储备(CFR)的改变以及阿托伐他汀对这类患者CFR的影响.方法 入选有胸痛症状但冠状动脉造影结构正常的冠状动脉血流缓慢患者91例,分为治疗组(51例)和无治疗组(40例).治疗组给予阿托伐他汀20 mg治疗8周.另选26例冠状动脉造影正常且运动试验阴性的无心脏疾患者为正常对照组.治疗前后测定治疗组和无治疗组的血脂以及利用腺苷负荷超声记录左前降支远端血流频谱,并评价CFR.结果 (1)冠状动脉血流缓慢者接受阿托伐他汀8周治疗后总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)较无治疗组及正常对照组明显减低[TC:(3.83±0.80)mmol/L比(5.30±1.18)mmol/L和(5.32±1.17)mmol/L,均P＜0.05:LDL=C:(2.26±0.64)mmol/L比(3.28±0.85)mmol/L和(3.30±0.82)mmol/L,均P＜0.05].(2)给予阿托伐他汀前,治疗组与无治疗组CFR(分别为2.32±0.30和2.25±0.33)均低于正常对照组(3.15±0.34,P＜0.05);8周后,治疗组冠状动脉血流速度(CFV)[(26.06±3.22)cm/s]较无治疗组[(29.02±3.36)cm/s]及治疗前静息状态[(28.43±3.40)cm/s]低(均P＜0.05),最大冠状动脉扩张状态CFV高于无治疗组和对照组[分别为(77.63±8.96)、(65.17±7.22)和(64.58±6.26)cm/s,P＜0.05],CFR低于治疗前和无治疗组(分别为3.07±0.29、2.28±0.35和2.32±0.30,P＜0.05),且与正常对照组差异均无统计学意义.结论 冠状动脉血流缓慢患者CFR明显减低,短期阿托伐他汀在调脂的同时可以有效改善其CFR.     

The relation between coronary flow rate, plasma endothelin-1 concentrations, and clinical characteristics in patients with normal coronary arteries

BACKGROUND: Coronary slow flow (CSF) is characterized by delayed opacification of epicardial arteries in the absence of occlusive disease. In the present study, we aimed to investigate the relation between coronary flow rate, plasma endothelin-1 (ET-1) concentrations, and clinical characteristics in patients with normal coronary arteries. METHODS: The study population included 77 patients with angiographically normal coronary arteries who underwent coronary angiography on suspicion of ischemic heart disease due to typical chest pain or ischemic findings on treadmill exercise test or myocardial scintigraphy. Based on the Thrombolysis In Myocardial Infarction frame count (TFC), patients were grouped into those with normal coronary flow and those with slow coronary flow. RESULTS: Forty-eight (61.5%) patients were found to have CSF. Plasma ET-1 concentrations were significantly higher with the presence of CSF (P=.03). There were significant differences between plasma ET-1 concentrations, and mean TFC, TFC for left anterior descending coronary artery (LAD), TFC for left circumflex coronary artery (CX), and TFC for right coronary artery separately in patients with and without CSF (P=.033, P<.001, P<.001, P<.001, and P<.001, respectively). Mean TFC, TFC for LAD, and TFC for CX, and ET-1 concentrations were significantly higher in smokers than in nonsmokers (P<.001, P<.001, P=.004, and P=.033, respectively). However, logistic regression analysis suggested that ET-1 concentration was not an independent determinant of CSF. CONCLUSIONS: Although there is a significant relation between ET-1 concentrations and coronary flow rate, ET-1 concentrations are not sufficient to determine the presence of CSF. Smoking is strongly associated with CSF, TFC, and increased ET-1 concentrations.     

Comparison of coronary flow velocity and regional myocardial perfusion for functional evaluation of coronary artery disease in the setting of angioplasty

Two essentially different methods for physiological evaluation of coronary artery disease were compared in the setting of angioplasty and related to quantitative coronary angiography. Forty-five patients, referred for percutaneous transluminal coronary angioplasty (PTCA), were examined by digital subtraction angiography (DSA) and by coronary flow velocity measurements distal to the target stenosis. Before PTCA, hyperemic mean transit time (HMTT) was correlated with % area stenosis r = 0.56*, coronary flow velocity reserve (CFVR) r = 0.58* and with CFVR_N (CFVR normalized to a mean blood pressure of 100 mmHg) r = 0.68*. The correlation between CFVR and % area stenosis was r |l= 0.72* (*P < 0.001). After PTCA, all correlations between these measurements disappeared. HMTT and CFVR remained abnormal in 18% and 32 % of the patients, respectively. Pre-PTCA, distal coronary flow velocity measurements were reasonably well related to the assessment of regional myocardial perfusion. Flow velocity parameters, however, were better related to angiographic stenosis parameters. After PTCA, HMTT showed a more consistent improvement compared to CFVR. Flow velocity measurements appear to be more useful for the evaluation of local coronary stenoses, whereas the assessment of regional myocardial perfusion by DSA may be used for a more general evaluation of vessel territories. Cathet. Cardiovasc. Diagn. 45:16‒24, 1998. © 1998 Wiley-Liss, Inc.     

91例冠心病患者的冠状动脉病变及侧支循环分布特点

目的：探讨冠心病患的冠状动脉病变及侧支循环分布的特点。方法：选择91例冠状动脉造影(CAG)阳性的病人，按CAG结果，分析阳性组总体及单支、双支、三支病变组的冠脉病变血管的分布、侧支循环形成的比例及二的关系。结果：(1)冠心病的冠脉病变以累及左前降支(LAD)最多，且常合并其他血管病变；其次为右冠(RCA)、左回旋支(LCX)，而对角支(Dig)及左主干(LM)累及最少；(2)侧支循环的建立与病变部位有关，其中RCA病变形成侧支循环比例最高，其次为LCX和LAD。此外，虽然随病变冠脉支数增加侧支循环建立的比例有递增趋势，但三组间比较无统计学意义。结论：(1)冠脉病变以左前降支最多见；(2)右冠病变最易形成侧支循环。     

Effects of slow coronary artery flow on P-wave dispersion and atrial electromechanical coupling

Aim

Slow coronary flow (SCF) is characterized by angiographically normal coronary arteries with delayed opacification of the distal vasculature. The purpose of this study was to evaluate atrial electromechanical couplings and P-wave dispersion (Pd) reflecting intraatrial and interatrial conduction delays in SCF patients and the relationship between these parameters and Thrombolysis in Myocardial Infarction (TIMI) frame count.

Methods

Thirty-four patients with SCF and 40 controls were enrolled. From 12-lead surface electrocardiograms, Pd was calculated. Atrial electromechanical coupling (PA), intraatrial, and interatrial electromechanical delay were measured with tissue Doppler imaging.

Results

Maximum P-wave duration (Pmax) and Pd were higher in SCF patients than those of controls (109.2 ± 9.3 vs 92.3 ± 13.5 milliseconds; P < .0001 and 50.4 ± 9.4 vs 34.4 ± 8.9 milliseconds; P < .0001). Atrial electromechanical coupling at the left lateral mitral annulus (lateral PA), septal mitral annulus (septal PA), and right ventricular tricuspid annulus (RV PA) were significantly higher in SCF patients than controls (68.1 ± 8.1 vs 52.6 ± 7.3 milliseconds; P < .0001; 49.3 ± 9.8 vs 38.2 ± 5.3 milliseconds; P < .0001; 47.5 ± 9.0 vs 37.6 ± 4.6 milliseconds, P < .0001, respectively). Interatrial electromechanical delay (lateral PA − RV PA) was significantly longer in SCF patients (20.6 ± 9.1 vs 15.0 ± 6.0 milliseconds; P = .0002). A positive correlation was detected between circumflex coronary artery TIMI frame count and interatrial electromechanical delay (r = 0.45; P < .01).

Conclusions

Prolongation of interatrial electromechanical delay, Pmax, and Pd suggest that SCF might contribute to development of adverse functional and electrophysiologic atrial characteristics in these patients.     

舟山市冠状动脉血流缓慢患者临床特点回顾性分析

目的探讨舟山地区冠状动脉血流缓慢（slow coronary flow,SCF）患者的临床特点。方法回顾性分析舟山普陀人民医院2009年1月到2011年12月间所有行冠状动脉造影检查患者的资料,入选临床有胸痛等心肌缺血症状,冠状动脉造影结果显示心外膜冠状动脉无明显病变但存在血流缓慢的患者共13例（SCF组）。对照组为同期冠状动脉造影结果显示心外膜冠状动脉正常且血流正常的患者13例。记录所有研究对象的资料,包括生活习惯,造影结果及血脂浓度等,并作统计学分析,结果SCF组的年龄小于对照组[（54．6±6．2）vs ．（59．2±7．1）vs,P〈0．05],嗜烟史发生率高于对照组[61．5％（8／13）vs．46．2％（6／13）,P〈0．05],差异有统计学意义。SCF、组低密度脂蛋白胆固醇浓度高于对照组[（3．01±0．76）mmol／L vs．（2．43±0．57）mmol／L,P〈0．05],高密度脂蛋白胆固醇低于对照组[（1．45±0．62）mmol／Lm（1．04±0．30）mmol／L,P〈0．05],差异有统计学意义。SCF最多累及的血管为右冠状动脉,最常见的血管受累情况为三支血管同时存在SCF,包括左前降支、左回旋支及右冠状动脉。结论年轻的吸烟患者更容易发生SCF。与正常人相比,SCF患者更易出现脂代谢紊乱。     

Adiponectin produced in coronary circulation regulates coronary flow reserve in nondiabetic patients with angiographically normal coronary arteries

BACKGROUND: Epicardial adipose tissue expresses adiponectin protein, and its expression is significantly lower in patients with severe coronary artery disease (CAD) than in those without CAD. Transcoronary adiponectin levels are significantly decreased in nondiabetic but not in diabetic patients with CAD. Adiponectin is also an important adipocytokine that is linked to insulin resistance and reduces coronary microvascular function. HYPOTHESIS: Adiponectin may play a significant role in the localized coronary circulation. The present study examines the local dynamics of adiponectin in the coronary circulation in nondiabetic individuals with normal coronary arteries and the relationship between adiponectin and coronary microvasculature function. METHODS: We examined 22 consecutive nondiabetic patients whose coronary arteries were angiographically normal. Plasma levels of adiponectin were measured in blood samples that were simultaneously collected from the orifice of the left coronary artery (LCA) and the great cardiac vein (GCV). To evaluate the function of the coronary microcirculation, we measured coronary flow velocity at maximal hyperemia using a Doppler wire. Coronary flow reserve (CFR) was obtained from the ratio of hyperemia to the baseline coronary flow velocity. RESULTS: Plasma adiponectin levels in the GCV (median 6.95 microg/ml) were significantly higher than those in the LCA (median 6.60 microg/ml, p < 0.0005). The difference in plasma adiponectin levels between GCV and LCA significantly correlated with CFR (R = 0.451, p < 0.05). CONCLUSIONS: Adiponectin is locally produced in the coronary circulation. This protein may participate in modulating the coronary circulation of nondiabetic patients with angiographically normal coronary arteries.