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1.
Objective:Percutaneous coronary intervention(PCI) triggers an acute inflammatory response,while sirolimus is known to have anti-inflammatory properties;the inflammatory system response to PCI after sirolimus-eluting stent placement remains unclear.The purpose of this study is to determine the changes in high sensitive C-reactive protein(hs-CRP) and apelin after PCI procedure and drug-eluting stent implantation in patients with and without reduced left ventricular systolic function.Methods:Forty-eight consecutive patients undergoing PCI at the Beijing Anzhen Hospital between July and September 2006 were recruited.Sirolimus-eluting stents were employed in all patients.Blood samples were drawn immediately before and 24 h after the procedure.Plasma hs-CRP and apelin levels were determined by enzyme immunoassay.Results:Paired t-test revealed a significant increase in both hs-CRP and apelin post-procedure(P=0.006 and P0.0001,respectively).Patients with reduced left ventricular ejection fraction(LVEF) had significantly lower baseline apelin levels compared to those with normal ventricular function [(46.8±10.8) vs.(72.0±8.4) pg/ml,P0.001].However,apelin increased to a level similar to the level of those with normal left ventricular systolic function 24 h after the PCI procedure [(86.7±11.6) vs.(85.1±6.1) pg/ml,P=0.72].Conclusions:hs-CRP and apelin levels increased after PCI and sirolimus-eluting stent implantation.Patients with impaired left ventricular systolic function had significantly lower baseline apelin levels,which increased significantly after PCI.  相似文献   

2.
To describe the long-term clinical outcomes of patients with autosomal dominant polycystic kidney disease (ADPKD) who are on peritoneal dialysis (PD) therapy. We performed a retrospective matched-cohort analysis comparing the clinical outcomes of 30 ADPKD patients with those of 30 non-diabetic patients who had bilateral small kidneys between July 1 2007 and July 31 2014. The patient groups were matched by age, gender, and time of PD initiation. There were no significant differences in the demographic or biochemical parameters, comorbid conditions, residual glomerular filtration rate, or Charlson comorbidity score at the beginning of PD. The median renal volume was 1315 ml for the ADPKD group and 213 ml for the control group. Patients with ADPKD had similar 3-year patient survival (90.6% versus 86.3%, P=0.807) and technique survival (89.2% versus 74.3%, P=0.506) compared with non-ADPKD patients. Also, there was no significant difference in the peritonitis-free survival between the ADPKD and control groups (P=0.22), and rates of peritonitis were similar (0.19 versus 0.21 episodes per patient-year, P=0.26). No differences were observed in the incidence of PD-related complications, such as hernia and dialysate leak. ADPKD is not a contraindication for PD, and a subgroup of ADPKD patients with relatively small kidney volume can be treated using PD.  相似文献   

3.
Astragalus mongholicus (AM) derived from the dry root of Astragalus membranaceus Bge. var. mongolicus (Bge.) Hsiao is a widely used traditional Chinese medicine. The present study investigated the potential role of AM on renal fibrosis on a rat model of unilateral ureteral obstruction (UUO). We divided 48 Sprague-Dawley rats randomly into 4 groups: sham-operated group (Sham), untreated UUO group, AM-treated (10 g/(kg.d)) UUO group, and losartan-treated (20 mg/(kg.d)) UUO group as positive control. Haematoxylin & eosin (HE) and Masson staining were used to study the dynamic histological changes of the kidneys 7 and 14 d after operation. The expressions of fibronectin (FN), type I collagen (coII), hepatocyte growth factor (HGF), transforming growth factor-pi (TGF-βl), and a-smooth muscle actin (a-SMA) were analyzed by real-time polymerase chain reaction (PCR), immunohistochemistry staining, and Western blot. Results show that, similar to losartan, AM alleviated the renal damage and decreased the deposition of FN and colI from UUO by reducing the expressions of TGF-pi and a-SMA (P<0.05), whereas HGF increased greatly with AM treatment (P<0.05). Our findings reveal that AM could retard the progression of renal fibrosis. The renoprotective effect of AM might be related to inhibition of myofibroblast activation, inducing of HGF and reducing of TGF-β1 expression.  相似文献   

4.
AMI患者PCI术后BNP相关分析及应用研究   总被引：2，自引：0，他引：2  
目的:观察PCI术对AMI患者血浆中BNP的水平变化,探讨PCI对AMI患者预后的影响.方法:采用快速荧光免疫测定法对50例AMI患者PCI治疗前、治疗后7d内每日同一时间取静脉血进行BNP的测定和50例对照组血浆BNP水平进行检测.结果:AMI患者血浆BNP在行PCI术后与对照组比较有显著性差异(P<0.05),PCI治疗后呈明显下降趋势.结论:AMI患者经PCI治疗血浆BNP水平变化说明PCI术对改善AMI患者的预后有重要意义.  相似文献   

5.
Slight elevations in cardiac troponin I and T are frequently observed after percutaneous coronary intervention (PCI). Contrast-induced acute kidney injury (CI-AKI) is a complex syndrome induced by exposure to intravascular contrast media (CM). Currently, the relationships between the CM, pre-existing kidney insufficiency, CI-AKI, and myonecrosis after elective PCI are unclear. To investigate the relationship between CI-AKI and post-procedural myonecrosis (PMN) after PCI, we analyzed 327 non-ST-segment elevation acute coronary syndrome subjects undertaking elective PCI. The levels of cardiac troponins (cTns), cTnI and cTnT, at baseline and on at least one occasion 18–24 h after PCI were measured. We also recorded serum levels of creatinine (SCr) and the urine albumin:creatinine ratio (ACR) before coronary angiography, and 24–48 h and 48–72 h after contrast administration. A post-procedure increase in cTns was detected in 16.21% (53/327) of subjects with cTns levels >99th to 599th percentile upper reference limit (URL). Twenty-seven patients (8.26%) developed CI-AKI. CI-AKI occurred more often in subjects with PMN than in those without PMN (20.8% versus 5.8%, respectively, P=0.001). Multiple logistic regression analysis revealed that pre-existing microalbuminuria (MA) was an important independent predictor of PMN (OR: 3.31; 95% CI: 1.26–8.65, P=0.01). However, there was no correlation between the incidence of CI-AKI and PMN (OR: 2.38; 95% CI: 0.88–6.46, P=0.09). We conclude that pre-existing MA was not only an important independent predictor of CI-AKI but also of PMN.  相似文献   

6.

Objective

Mitral valve disease tends to be treated with anterolateral minithoracotomy (ALMT) rather than median sternotomy (MS), as ALMT uses progressively smaller incisions to promote better cosmetic outcomes. This meta-analysis quantifies the effects of ALMT on surgical parameters and post-operative outcomes compared with MS.

Methods

One randomized controlled study and four case-control studies, published in English from January 1996 to January 2013, were identified and evaluated.

Results

ALMT showed a significantly longer cardiopulmonary bypass time (P=0.001) and aortic cross-clamp time (P=0.05) compared with MS. However, the benefits of ALMT were evident as demonstrated by a shorter length of hospital stay (P<0.00001). According to operative complications, the onset of new arrhythmias following ALMT decreased significantly as compared with MS (P=0.05); however, the incidence of peri-operative mortality (P=0.62), re-operation for bleeding (P=0.37), neurologic events (P=0.77), myocardial infarction (P=0.84), gastrointestinal complications (P=0.89), and renal insufficiency (P=0.67) were similar to these of MS. Long-term follow-up data were also examined, and revealed equivalent survival and freedom from mitral valve events.

Conclusions

Current clinical data suggest that ALMT is a safe and effective alternative to the conventional approach and is associated with better short-term outcomes and a trend towards longer survival.  相似文献   

7.
Astragalus mongholicus (AM) derived from the dry root of Astragalus membranaceus Bge. var. mongolicus (Bge.) Hsiao is a widely used traditional Chinese medicine. The present study investigated the potential role of AM on renal fibrosis on a rat model of unilateral ureteral obstruction (UUO). We divided 48 Sprague-Dawley rats randomly into 4 groups: sham-operated group (Sham), untreated UUO group, AM-treated (10 g/(kg·d)) UUO group, and losartan-treated (20 mg/(kg·d)) UUO group as positive control. Haematoxylin & eosin (HE) and Masson staining were used to study the dynamic histological changes of the kidneys 7 and 14 d after operation. The expressions of fibronectin (FN), type I collagen (colI), hepatocyte growth factor (HGF), transforming growth factor-β1 (TGF-β1), and α-smooth muscle actin (α-SMA) were analyzed by real-time polymerase chain reaction (PCR), immunohistochemistry staining, and Western blot. Results show that, similar to losartan, AM alleviated the renal damage and decreased the deposition of FN and colI from UUO by reducing the expressions of TGF-β1 and α-SMA (P<0.05), whereas HGF increased greatly with AM treatment (P<0.05). Our findings reveal that AM could retard the progression of renal fibrosis. The renoprotective effect of AM might be related to inhibition of myofibroblast activation, inducing of HGF and reducing of TGF-β1 expression. Project (No. 30170437) supported by the National Natural Science Foundation of China  相似文献   

8.
Our intent is to examine the predictive role of Charlson comorbidity index （CCI） on mortality of patients with type 2 diabetic nephropathy （DN）. Based on the CCI score, the severity of comorbidity was categorized into three grades： mild, with CCI scores of 1-2; moderate, with CCI scores of 3-4; and severe, with CCI scores 〉5. Factors influencing mortality and differences between groups stratified by CCI were determined by logistical regression analysis and one-way analysis of variance （ANOVA）. The impact of CCI on mortality was assessed by the Kaplan- Meier analysis. A total of 533 patients with type 2 DN were enrolled in this study, all of them had comorbidity （CCI score 〉1）, and 44.7% （238/533） died. The mortality increased with CCI scores： 21.0% （50/238） patients with CCI scores of 1-2, 56.7% （135/238） patients with CCI scores of 3-4, and 22.3% （53/238） patients with CCI scores 〉5. Logistical regression analysis showed that CCI scores, hemoglobin, and serum albumin were the potential predictors of mortality （P〈0.05）. One-way ANOVA analysis showed that DN patients with higher CCI scores had lower levels of hemoglobulin, higher levels of serum creatinine, and higher mortality rates than those with lower CCI scores. The Kaplan-Meier curves showed that survival time decreased when the CCI scores and mortality rates went up. In con- clusion, CCI provides a simple, readily applicable, and valid method for classifying comorbidities and predicting the mortality of type 2 DN. An increased awareness of the potential comorbidities in type 2 DN patients may provide insights into this complicated disease and improve the outcomes by identifying and treating patients earlier and more effectively.  相似文献   

9.
INTRODUCTION Left ventricular hypertrophy has been thought to be the principal predicators of predisposing risk factor of cardiac morbidity and mortality (Devereux, 1995; Levy et al., 1990). The pathogenesis that mediates cardiac hypertrophy is poorly understood. Cardiachypertrophy can be induced by hemodynamic over-load, ischemic disease, neurohumoral factors and intrinsic defects in cardiac structural protein genes (Sadoshima and Izumo, 1997; Vikstrom and Lein-wand, 1996). Another in…  相似文献   

10.
Objective: The beneficial effect of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has been well established, but there is the problem of no-reflow phenomenon which is an adverse prognostic factor in primary PCI. In the present study the effect of a distal protection device (PercuSurge GuardWire; GW) on epicardial blood flow and myocardial perfusion was evaluated. Methods and Results: Patients with AMI were randomly divided into 2 groups, the GW and the control groups. The GW group included 52 patients with AMI who underwent primary PCI with GW protection and the control group included 60 patients who underwent primary PCI without GW protection. Epicardial blood flow in the infarct-related artery (IRA) and myocardial perfusion were evaluated according to the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade (MBG). We found TIMI score of 3 was obtained significantly more frequently in the GW group (96%) than in the control group (80%). The MBG score of 3 was obtained also significantly greater in the GW group (65%) than in the control group (33%). Conclusion: Primary PCI with GW protection can significantly improve epicardial blood flow and myocardial perfusion.  相似文献   

11.
The aim of this study was to understand the characteristics of blood pressure(BP)variability in subjects with diabetic nephropathy(DN),and identify the probable predictors affecting BP variability.Fifty-one chronic kidney disease(CKD)-hypertensive patients without diabetes(NDN group)and sixty type 2 diabetic patients with overt DN(DN group)were enrolled in this study.The values of short-term BP variability were obtained from 24 h ambulatory BP monitoring(ABPM).Variance analysis or nonparametric analysis revealed that 24-h systolic BP variability and nighttime systolic BP variability of the DN group were significantly higher than those of the NDN group[(12.23±3.66)vs.(10.74±3.83)mmHg,P<0.05;(11.23±4.82)vs.(9.48±3.69)mmHg,P<0.05].Then the patients of the DN group were divided into two groups according to glycated hemoglobin(HbA1c)level:Group A(HbA1c<7%)and Group B(HbA1c≥7%),and the t-test showed that patients in Group B had larger 24-h diastolic,daytime diastolic,and nighttime systolic/diastolic BP variability compared with Group A.In the DN group,partial correlation analysis revealed that HbA1c exhibited a strong association with 24-h diastolic,daytime diastolic,nighttime systolic and diastolic BP variability(P<0.001,P<0.001,P<0.05,and P<0.001,respectively).Taken together,larger short-term BP variability was detected in hypertensive type 2 diabetic patients with overt nephropathy and renal insufficiency.It may imply that the optimal BP variability level could benefit from a better glycaemic control.  相似文献   

12.
AMI患者PCI术对血浆BNP水平变化的初步临床观察   总被引：1，自引：0，他引：1  
目的:观察PCI术对AMI患者血浆中BNP的水平变化,初步探讨PCI对AMI患者预后的影响.方法:采用快速荧光免疫测定法对20例AMI患者PCI治疗前后和20例对照组血浆BNP水平进行检测.结果:AMI患者血浆BNP在AMI患者PCI术与对照组比较有显著性差异(P＜0.05),PCI治疗后呈明显下降趋势.结论:AMI患者PCI治疗血浆BNP水平变化说明PCI术能对改善AMI患者的预后有重要意义.  相似文献   

13.
目的：观察急性肾功能衰竭（ARF）家兔心肌匀浆自由基、一氧化氮的变化，探讨心肌损伤的体液机制。方法：60只家兔均分为四组（n=15）。ARF模型1组：皮下注射1％HgCl2（1．3ml／kg．bw）；ARF模型2组：肌肉注射50％甘油（10ml／kg．bw）；以等量生理盐水代替HgCl2和甘油作为对照1、2组。24h后，所有动物颈总动脉放血备检，并选择固定位置。制备10％心肌匀浆。经Aeroset型全自动生化分析仪测定血清反映肾功能的生化指标。检测心肌匀浆丙二醛（MDA）、超氧化物歧化酶（SOD）、一氧化氮（NO）及其合酶（NOS）的变化。结果：与相应对照组比较，ARF模型1、2组心匀浆SOD活性下降、MDA含量升高（P〈0．05），ARF模型1、2组心匀浆NO含量增强、NOS及iNOS活性增强（P〈0．05～0．01）。结论：ARF家兔心肌损伤的机制与自由基损伤及NO升高有关。  相似文献   

14.
Objective: Malignant middle cerebral artery (MCA) infarction is characterized by mortality rate of up to 80%. The aim of this study was to determine the value of decompressive craniectomy in patients presenting malignant MCA infarction compared with those receiving medical treatment alone. Methods: Patients with malignant MCA infarction treated in our hospital between January 1996 and March 2004 were included in this retrospective analysis. The National Institute of Health Stroke Scale (NIHSS) was used to assess neurological status on admission and at one week after surgery. All patients were followed up for assessment of functional outcome by the Barthel index (BI) and modified Rankin Scale (RS) at 3 months after infarction. Results: Ten out of 24 patients underwent decompressive craniectomy. The mean interval between stroke onset and surgery was 62.10 h. The mortality was 10.0% compared with 64.2% in patients who received medical treatment alone (P<0.001). The mean NIHSS score before surgery was 26.0 and 15.4 after surgery (P<0.001). At follow up, patients who underwent surgery had significantly better outcome with mean BI of 53.3, RS of 3.3 as compared to only 16.0 and 4.60 in medically treated patients. Speech function also improved in patients with dominant hemispherical infarction. Conclusion: Decompressive craniectomy in patients with malignant MCA infarction improves both survival rates and functional outcomes compared with medical treatment alone. A randomized controlled trial is required to substantiate those findings.  相似文献   

15.
碎裂QRS波对急性心肌梗死患者的短期预后评估(英文)简   总被引：2，自引：1，他引：1  
This study is aimed to investigate the clinical significance and the short-term prognostic value of frag- mented QRS （fQRS） for patients with acute myocardial infarction （AMI）. Three hundred patients with AMI were tested with retrospective analysis on the patients＇ clinical information, hospitalized treatment, fQRS onset time, location of lesions, and other relevant data, in order to assess the relationship between the presence of fQRS and its prognosis. The rates of malignant cardiac arrhythmia, left ventricular systolic dysfunction （LVSD）, and mortality in the positive fQRS group were 13.6%, 29.2%, and 23.7%, respectively, with all showing a p value 〈0.05. For the ST segment elevation myocardial infarction （STEMI） subgroup, all the rates showed significant differences with a p value 〈0.01, while for the non-STEMI （NSTEMI） subgroup showed no significant differences. In patients with a positive fQRS, there were no differences in malignant cardiac arrhythmia between patients with and without percutaneous coronary in- tervention （PCI） （p〉0.05）. As for the LVSD and mortality, the p values between patients with and without PCI were 0.031 and 0.000, respectively, suggesting statistical significance. The results imply that AMI patients with positive fQRS especially for the patients with STEMI had higher rates of malignant cardiac arrhythmia, LVSD, and mortality than the non-fQRS group. Patients of AMI with positive fQRS, who underwent early revascularization, could lower the incidence of the cardiovascular event. In addition, the presence of fQRS could be used as an indication of early in- tervention treatment for patients.  相似文献   

16.
Objective: Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated whether the presence of significant ARAS (luminal diameter narrowing ≥70%) could be predicted using a logistic regression model before coronary angiography/intervention. Methods: Initially, we developed a logistic regression model for detecting significant ARAS based upon clinical and angiographic features and biochemical measurements in a cohort of 1 813 patients undergoing transfemoral coronary and renal angiography. This model was then prospectively applied to an additional 495 patients who received transradial renal angiography to ascertain its predictive accuracy for the presence of significant ARAS. Results: Multivariate regression analysis revealed that older age (≥65 years), resistant hypertension, type 2 diabetes, creatinine clearance (Ccr) ≤60 ml/min, and multivessel coronary disease were independent predictors for significant ARAS. A logistic regression model for detecting ARAS by incorporating conventional risk factors and multivessel coronary disease was generated as: P/(1−P)=exp(−2.618+1.112[age≥65 years]+1.891[resistant hypertension]+0.453[type 2 diabetes]+0.587[Ccr≤60 ml/min]+2.254[multivessel coronary disease]). When this regression model was prospectively applied to the additional 495 patients undergoing transradial coronary and renal angiography, significant ARAS could be detected with a sensitivity of 81.2%, specificity of 88.9%, and positive and negative predictive accuracies of 53.8% and 96.7%, respectively. Conclusions: The logistic regression model generated in this study may be useful for screening for significant ARAS in patients undergoing transradial coronary angiography/intervention.  相似文献   

17.
目的:研究慢性肾功能衰竭患者血浆脂蛋白(a)与纤溶活性的关系.方法:应用酶联免疫吸附法分别测定58例慢性肾功能衰竭患者及51名健康对照者的血浆脂蛋白(a)浓度,并以底物显色法测定其组织型纤溶酶原激活剂(tPA)及其抑制物(PAI)活性.结果:慢性肾功能衰竭患者血浆脂蛋白(a)浓度和PAI活性明显升高,tPA活性明显降低;脂蛋白(a)浓度与血浆尿素氮水平、PAI活性均呈正相关;脂蛋白(a)浓度与tPA活性呈负相关.结论:肾功能对血浆脂蛋白(a)浓度起一定的调节作用,脂蛋白(a)水平的升高与纤溶活性低下有关.  相似文献   

18.
Objective:The aim of this study is to investigate if dual-source computed tomography(DSCT) could guide the percutaneous coronary intervention(PCI) of chronic total occlusion(CTO).Methods:We enrolled patients who were confirmed to have at least one native coronary artery CTO by DSCT before they underwent selective PCI in the period from December 2007 to October 2008.A CTO was defined as an obstruction of a native coronary artery with no luminal continuity.The CT-guided PCI procedure involved placing CT and fluoroscopic images side-by-side on the screen.DSCT images were analyzed for location,segment,plaque characteristics,calcification,and proximal lumen diameter of the CTO before PCI.The guidewire was advanced and manipulated under CT guidance.The PCI was carried out and the results were compared.Results:Seventy-four CTOs were assessed.PCI was successful in 57 cases of CTOs(77.0%).According to the results,CTOs were divided into two groups:successful-PCI and failed-PCI.All coronary artery paths of CTOs were clearly recognized by DSCT.In the successful-PCI group,soft plaques were detected much more often than those in the failed-PCI group,but fibrous and calcified plaques were seen more often in the failed-PCI group.Calcification severity in CTO segments showed a significant difference between the groups(P=0.014).Calcified plaques were detected in 20(35.1%) lesions in the successful-PCI group.More than 70% of the failures were calcified plaques,of which there were two arc-calcified and one circular-calcified lesions.Occlusions were longer in the failed-PCI group than those in the successful-PCI group [(38.8±25.0) vs.(18.0±15.3) mm,respectively,P0.01].Fewer guidewires were used in the successful-PCI group compared with the failed-PCI group(1.7±1.0 vs.2.5±0.9,respectively,P0.01).The logistic regression analysis indicated that predictors of recanalization of CTOs included occlusion length(P=0.0035,risk ratio(RR)=0.93) and calcification severity(P=0.05,RR=0.27).Multi-linear trends analysis showed that the factors affecting procedural time were CTO location(P=0.0141) and occlusion length(P=0.0035).Conclusions:DSCT could delineate the path of CTOs and characterize plaques.The outcomes of PCI were related to thrombolysis in myocardial infarction(TIMI) flow grade,CTO characteristics,severity of calcified plaques,and the length of occlusive segments.Occlusion length and calcification severity were independent predictors of CTOs.Occlusion length and CTO segments could also help to estimate the duration of interventional procedures.  相似文献   

19.
Aluminum nitride （AlN）/borosilicate glass composites were prepared by the tape casting process and hot-press sintered at 950 ℃ with AIN and SiO2-B203-ZnO-Al2O3-Li2O glass as starting materials. We characterized and analyzed the variation of the microstructure, bulk density, porosity, dielectric constant, thermal conductivity and thermal expansion coefficient （TEC） of the ceramic samples as a function of AIN content. Results show that AIN and SiO2-B2O3-ZnO-Al2O3-Li2O glass can be sintered at 950 ℃, and ZnAI204 and Zn2SiO4 phase precipitated to form glass-ceramic. The performance of the ceramic samples was determined by the composition and bulk density of the composites. Lower AlN content was found redounding to liquid phase sintering, and higher bulk density of composites can be accordingly obtained. With the increase of porosity, corresponding decreases were located in the dielectric constant, thermal conductivity and TEC of the ceramic samples. When the mass fraction of AlN was 40%, the ceramic samples possessed a low dielectric constant （4.5-5.0）, high thermal conductivity （11.6 W/（m.K）） and a proper TEC （3.0× 10^-6 K^-1 which matched that of silicon）. The excellent performance makes this kind of low temperature co-fired ceramic a promising candidate for application in the micro-electronics packaging industry.  相似文献   

20.
目的:探讨后适应对接受直接经皮冠状动脉介入(PCI)治疗的急性ST段抬高性心肌梗死(STEMI)患者心血管不良事件的影响。创新点:进一步明确后适应处理对STEMI患者临床预后的影响。方法:对符合入选标准的随机对照临床试验进行meta分析。结论:缺血后适应显著降低ST段抬高性心肌梗死患者心衰风险。  相似文献   

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