血清抵抗素水平在冠状动脉支架内再狭窄中意义的研究

分析冠状动脉支架术后支架内再狭窄患者血清中抵抗素及γ干扰素(INF-γ)、白细胞介素(IL)-2、IL-4、IL-10的水平变化,探讨这种变化在冠状动脉支架术后支架内再狭窄中的意义.应用酶联免疫吸附法(ELISA)测定45例冠状动脉内支架植入术后合并支架内再狭窄患者血清中抵抗素、INF-γ、IL-2、IL-4、IL-10的浓度,并与无冠心病患者45例、未行支架植入术的冠心病患者45例及行支架术但是无支架内狭窄患者128例进行比较(入选病例血糖水平均正常).未行介入治疗组血清中抵抗素、INF-γ、IL-2、IL-4、IL-10的浓度与无冠心病组无差异.支架术后但无支架内狭窄的患者与无冠心病组无差异.冠状动脉内支架植入术后合并支架内再狭窄患者血清中抵抗素、INF-γ、IL-2高于无冠心病者、植入支架未狭窄者、未植入支架者,而IL-4、IL-10低于无冠心病者植入支架未狭窄者、未植入支架者.支架内狭窄患者血清中抵抗素水平增高,并能引发Th1/Th2水平失衡,在支架内再狭窄的发生、发展中起重要作用.     

短期应用草酸艾司西酞普兰对心肌梗死冠状动脉支架植入术后焦虑的疗效观察

为缓解冠状动脉支架植入术患者继发焦虑及评估抗焦虑药物应用时程,本研究对160例冠状动脉支架术后继发焦虑患者随机分为两组,研究组加用草酸艾司西酞普兰治疗10周,采用汉密尔顿焦虑量表及心肌梗死后生活质量问卷对两组患者随访12个月,发现草酸艾司西酞普兰短期治疗可显著减少患者的焦虑评分(P0.05);且患者6个月内生活质量明显提高;同时,仅有11例患者在草酸艾司西酞普兰停药12个月内再发焦虑,且焦虑评分与治疗前无差异(P0.05)。因此短期应用草酸艾司西酞普兰可有效改善冠状动脉支架术后患者的焦虑症状及生活质量。     

药物洗脱支架内血栓的危险因素及预防措施

分析并探讨经皮冠状动脉介入术后药物洗脱支架内血栓形成的危险因素及预防措施。回顾性分析2016年1月～2017年1月在郑州大学第一附属医院行PCI术并植入药物洗脱支架患者共1 335例,其中发生支架内血栓形成的患者为31例,男性20例,女性11例(男女比例约为2∶1),其中急性支架内血栓形成患者3例,亚急性血栓患者11例,晚期血栓9例,极晚期血栓8例,有29例患者治愈出院,有2例患者经抢救无效死亡。同时随机抽取同时段内在同等环境下行PCI术且未发生支架内血栓的患者200例作为对照。药物洗脱支架内血栓发生率低但死亡率极高,男性、既往心肌梗死、心功能不全等是PCI术后药物洗脱支架内血栓形成的重要危险因素。     

阻塞性睡眠呼吸暂停低通气综合征与冠状动脉支架再狭窄关系的研究

探讨冠状动脉内支架再狭窄与阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的关系及其机制.选择冠状动脉支架植入术后患者172例,其中43例确诊患OSAHS者为研究组,129例无OSAHS的患者为对照组.支架术后第3年行冠状动脉造影术,同时检测患者静脉血中TNF-α、IL-6、IL-4、IL-5、IL-10水平.OSAHS患者7例发生支架内再狭窄,比率16.26%,明显高于对照组6例,比率5.67%（P〈0.01）;OSAHS患者血清中TNF-α、IL-6浓度高于对照组（P〈0.01）;IL-4、IL-5、IL-10水平低于对照组（P〈0.01）.合并OSAHS的患者,支架再狭窄的发生率高于非OSAHS患者,而OSAHS引发的炎症介质水平改变及炎症反应失衡可能与支架再狭窄有关.     

吡格列酮降低胰岛素抵抗非糖尿病患者冠脉支架内再狭窄的研究

研究吡格列酮对胰岛素抵抗非糖尿病患者冠脉支架内再狭窄的影响,探讨其作用机制.选择60例接受冠脉支架植入并发胰岛素抵抗非糖尿病患者,随机分为吡格列酮组和对照组.吡格列酮组在常规治疗基础上给予6个月吡格列酮15mg/d.结果显示吡格列酮组支架内再狭窄率明显降低(P＜0.05),血清hsCRP、瘦素和ET-1水平显著降低和血清脂联素水平显著升高(P＜0.05),管腔狭窄面积与血清脂联素呈显著负相关,与胰岛素抵抗指数、瘦素、内皮素、C反应蛋白水平呈显著正相关.因此,吡格列酮能降低胰岛素抵抗非糖尿病患者冠脉支架内再狭窄,加强了支架的保护作用.     

急性心肌梗死复杂冠脉病变延迟支架植入治疗策略

目前我国临床实践中,急性心肌梗死的急诊介入治疗几乎均以一次性植入支架为手术终点。然而急性心肌梗死患者常伴有复杂冠脉病变,此类患者一次性植入支架常出现“慢血流”或“无复流”现象,导致心肌微循环灌注障碍,直接影响患者的预后。本文从临床策略的角度出发,探讨此类患者急诊冠脉介入治疗中延迟植入支架治疗的策略及可行性。     

冠脉CTA后中性粒细胞和淋巴细胞的比值与远期肾功能的相关性研究

既往研究发现中性粒细胞与淋巴细胞的比值升高与冠脉造影对比剂肾病发生具有相关性,然而中性粒细胞与淋巴细胞的比值升高是否对患者远期肾功能恶化具有预测价值,目前相关研究较少。本研究入选于我院行冠脉CTA检查患者338例,根据冠脉CTA前患者中性粒细胞与淋巴细胞的比值,将患者分为正常组,轻度升高组及明显升高组,并进行十二个月随访,终点事件为GFR下降超过12mL/min或最终GFR小于60mL/min。研究结果表明中性粒细胞与淋巴细胞的比值升高是冠脉CTA后患者发生远期肾功能不全的危险因素。     

家庭支持对冠状动脉支架术后患者预后影响的研究

为了探讨家庭支持对冠状动脉支架术(PCI)后患者心理压力和生命质量的影响,将89例PCI术后患者按家庭支持自评量表,分为高、中和低家庭支持组。应用SAS自评量表、SDS自评量表及SF-36生命质量问卷,比较其抑郁、焦虑以及生命质量的水平。结果显示:三组间抑郁、焦虑及生命质量有明显差别,差异有统计学意义(P0.01);生理职能维度中,中与高家庭支持组差异无统计学意义(P0.05),而低家庭支持组分别与中及高家庭支持组比较,差异均有统计学意义(P0.05);社会功能维度中,低与中家庭支持组差异无统计学意义(P0.05),而高家庭支持组分别与低及中家庭支持组比较,差异均有统计学意义(P0.01)。NO水平比较显示,高支持组NO水平,高于其他组(P0.01)。因此,家庭支持与冠状动脉支架术后患者的心理压力和生命质量相关,可能和NO等血管活性介质水平有关。     

左主干合并右冠状动脉慢性阻塞性病变行PCI的有效性和安全性分析

观察左主干病变合并右冠状动脉慢性完全闭塞(CTO)的患者行个体化经皮冠状动脉介入治疗(PCI)的有效性和安全性。回顾性分析2009年1月~2014年8月,沈阳军区总医院心内科因左主干病变合并右冠状CTO病变行PCI术的患者。共入选46例患者,每位患者平均置入支架数(2.3±1.3)个,支架平均长度(29.52±6.98)mm,支架平均直径(3.61±0.42)mm。其中左主干病变行介入治疗手术成功率100%,右冠状动脉CTO病变行介入治疗手术成功率93.5%,总成功率95.7%,手术过程中无严重并发症,住院期间无急性血栓形成、无急诊冠状动脉旁路移植术(CABG)。术后心功能(左室内径、左室射血分数)较前均有改善。随访期间[平均随访时间:(14.48±15.01)个月],发生7例靶血管血运重建(其中2例CABG),主要不良心脏事件发生率15.2%。左主干病变合并右冠状动脉CTO病变采用个体化策略的冠脉介入治疗,可改善患者临床症状,同时无严重并发症发生。这提示对于左主干病变合并右冠状动脉CTO行PCI术是安全可行的。     

冠心病患者药物支架的合理应用

药物支架的出现使冠脉成形术产生了质的飞跃,合理地应用药物支架将对患者带来福音。但是药物支架同样有中、晚期血栓形成,再狭窄等弊病。介入医生应从药物支架的适应证、禁忌证,支架操作的技术层面及中国国情,价/效比几个方面详细考虑应用药物支架的得失,遵循指南的建议,使患者获益并保证手术安全是最基本的要求。     

The effects of anxiety and depression on in vitro fertilisation outcomes of infertile Chinese women

The object was to assess anxiety and depression during in vitro fertilisation (IVF) treatment and determine IVF-related psychological factors in infertile Chinese women. The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate anxiety and depression among 842 patients, respectively. A univariate analysis was used to compare variables among three SAS groups and three SDS groups. Anxiety and depression were both represented in 21.3% of the cases. Patients <35 years tended to be more anxious. In women <35 years, the SDS scores were higher with lower educational backgrounds and female or couple’s infertility, while the SAS scores were higher in female or couple’s infertility. In older ones, the SDS scores were higher in those with lower educational backgrounds and longer time for infertility, while the SAS scores were higher in those with lower educational backgrounds. In SAS groups 1–3, the embryo availability was 5.0 (3.0–8.0), 5.0 (3.0–8.0), and 3.0 (2.0–4.5) (p = .013); and the fertilisation rate was 91.9, 90.4, and 81.8% (p < .001), respectively. We concluded that infertile women experience anxiety and depression during IVF treatment, especially in women <35 years. Younger women with female infertility would be more anxious and depressive while higher education can protect them from depression. In older ones, they would experience more depressive with longer time for infertility and be less anxious and depressive with higher education. Anxiety affects the fertilisation rate and embryo availability.     

平板运动试验结合颈动脉斑块检测诊断冠心病

探讨平板运动试验(TET)结合颈动脉斑块检测在诊断冠心病的临床意义。对166例疑诊冠心病患者进行冠状动脉造影(CAG),TET,颈动脉斑块检查,以CAG的诊断结果为金标准,分析TET,颈动脉斑块检查,TET结合颈动脉斑块检查诊断冠心病的敏感度、特异度。比较三者诊断冠心病的敏感度、特异度。三者敏感度分别为71.4%、64.3%、96.0%。特异度分别为65%、60.0%、82.4%。后者较前两者敏感度、特异度P<0.05。TET结合颈动脉斑块检查可显著提高冠心病的诊断率,不失为CAG前的筛选方法。     

中青年冠心病患者冠脉介入治疗后精神心理改变及影响因素调查分析

应用焦虑、抑郁自评量袁对84例行冠脉介入治疗的中青年冠心病患者分别进行术前、术后3个月的问卷调查,分析其变化的影响因素后进行综合评价。发现此类人群大多有焦虑、抑郁倾向,其发病率与性别有关而与年龄无关;其影响因素与对疾病的认识、医疗保险、家庭结构有一定相关性。     

Life Satisfaction and Positive Adjustment as Predictors of Emotional Distress in Men With Coronary Heart Disease

This two-wave longitudinal study examines the ability of life satisfaction and adjustment strategies to predict anxious and depressive symptoms in coronary heart disease male patients. Studies have shown that most heart attack survivors report these symptoms, which may worsen the prognosis of the disease. At Time 1, immediately after the first cardiac episode, eighty-eight men reported their life satisfaction levels, adjustment strategies used, and anxious and depressive symptoms experienced. At Time 2, six months later, sixty-three of those patients reported only their anxious and depressive symptoms again. The results showed that, after controlling for demographic variables, anxious and depressive symptoms at Time 1 were predicted by positive adjustment and life satisfaction. At Time 2, after controlling for both demographic variables and Time 1-emotional symptoms, none of the psychological variables predicted anxious symptoms, while depressive symptoms were only predicted by life satisfaction. It is concluded that an adequate level of life satisfaction may help to decrease emotional distress, both short and long term, while the use of positive adjustment strategies is especially important immediately after diagnosis.     

Succeeding competently: towards an anti-luck condition for achievement

Achievements are among the things that make a life good. Assessing the plausibility of this intuitive claim requires an account of the nature of achievements. One necessary condition for achievement appears to be that the achieving agent acted competently, i.e. was not just lucky. I begin by critically assessing existing accounts of anti-luck conditions for achievements in both the ethics and epistemology literature. My own proposal is that a goal is reached competently (and thus an achievement), only if the actions of the would-be-achiever make success likely, and that this is the reason why she acts that way.     

β受体阻滞剂是冠心病中的重要一线治疗药物

冠心病的治疗包括三个层面：血管重建治疗解决局部狭窄;改善生活方式是基础;全面合理的药物治疗是核心。而β受体阻滞剂又是重要的一线治疗药物,不仅能降低动脉粥样硬化及急性冠脉综合征的发生发展,还能有效预防、缓解心绞痛发生,改善梗死后左室重构和心功能;降低心肌再梗死率,降低心性猝死和病死率。临床上应用β受体阻滞剂的时机和剂量非常重要。     

ST段抬高心肌梗死中氯吡格雷的合理应用

ST段抬高心肌梗死是冠心病的严重类型,其病理生理基础是斑块破裂及继发的血小板活化和聚集,并发展到血栓使冠状动脉完全闭塞。阿司匹林通过抑制血栓素A2的合成而抑制血小板聚集,但血小板的聚集仍可通过非血栓素A2依赖途径产生,而氯吡格雷正是通过非血栓素A2途径了抑制血小板的活化和聚集,在ST段抬高心肌梗死治疗中能显著改善患者的预后,且安全性和耐受性好。     

变异性心绞痛患者心率变异性与冠状动脉病变关系的研究

研究变异性心绞痛患者 ST 段抬高对心率变异性的影响。回顾性分析122例变异性心绞痛患者 ST 段抬高幅度及持续时间对心率变异性的影响;心率变异性与冠状动脉病变及病变支数、狭窄程度有相关性。结果心率变异性在 ST 段抬高≥0．4mv 患者中较 ST 段抬高＜0．4mv 患者中明显降低（P＜0．05）;其在 ST 段抬高持续时间≥3min 患者中较 ST 段抬高持续时间＜3min 患者中明显降低（P＜0．05）;其在冠状动脉狭窄≥50％患者中较冠状动脉狭窄＜50％患者中明显降低（P＜0．05）;心率变异性在多支较单支病变明显降低（P ＜0．05）,单支病变狭窄程度≥75％较50％～75％者明显降低（P＜0．05）。提示变异性心绞痛患者自主神经系统受损程度与冠状动脉缺血严重程度,缺血持续时间密切相关,心率变异性能一定程度反映变异性心绞痛患者冠状动脉病变严重程度。     

Depression Screening,Assessment, and Treatment for Patients with Coronary Heart Disease: A Review for Psychologists

Depression prevalence is between 15% and 20% in coronary heart disease patients, such as those with angina, or after a myocardial infarction or coronary artery bypass graft surgery. The presence of depression places a coronary heart disease patient at twofold higher risk for further major cardiac events and death, as well as poor quality of life and early exit from the labour force. As a consequence, several learned societies, including the National Heart Foundation of Australia, have published guidelines that recommend questionnaire screening to improve identification and management strategies for depression in coronary heart disease patients. Psychologists in hospitals, community settings, and private practice can have a key role in the realisation of the National Heart Foundation of Australia's aims. We review the recent guidelines and outline implications for psychologists to identify and manage depression in coronary heart disease patients. The evidence reviewed suggests that cognitive‐behavioural therapy and problem‐solving therapy are frontline non‐pharmacological interventions for depression in CHD patients.     

Social support group attendance is related to blood pressure, health behaviours, and quality of life in the Multicenter Lifestyle Demonstration Project

Changes in coronary risk factors, health behaviours, and health-related quality of life (HRQOL) were examined by tertiles of social support group attendance in 440 patients (21% females) with coronary artery disease. All patients participated in the Multicenter Lifestyle Demonstration Project (MLDP; eight hospital sites in the USA), an insurance-covered multi-component cardiac prevention program including dietary changes, stress management, exercise and group support for 1 year. Significant improvements in coronary risk factors, health behaviours, and HRQOL were noted at 1 year. Several of these improvements (i.e. systolic blood pressure, health behaviours, HRQOL) were related to social support group attendance, favoring those who attended more sessions. The associations between support group attendance to systolic blood pressure and to four HRQOL subscales (bodily pain, social functioning, mental health, and the mental health summary score) remained significant when controlling for changes in health behaviours, but dropped to a non-significant level for the HRQOL subscales 'physical functioning', 'general health' and 'role-emotional'. These results suggest an independent relationship of social support group attendance to systolic blood pressure while improvements in quality of life may be in part due to improved health behaviours facilitated by increased social support group attendance.