Objective To study the risk factors of hyperuricemia in patients with mild coronary artery stenosis. Methods The clinical data of 267 patients, who underwent coronary angiography, were collected and classified into the hyperuricemia group (58.5±8.0 years) and the normal control group (57.3±9.9 years). The coronary artery diameter stenosis of all the patients was lower than 50%. Results Elevated levels of body mass index (BMI), serum creatinine, triglyceride, low level of high-density lipoprotein, and history of hypertension or diabetes mellitus were significantly correlated with increased prevalence of hyperuricemia in patients with mild coronary artery stenosis. Multivariate logistic regression models found that the risk factors were diabetes mellitus (OR=1.999, 95%CI 1.087 to 3.678) , BMI (OR=1.110, 95%CI 1.009 to 1.221), hypertriglyceridemia (OR=1.237, 95%CI 1.023 to 1.496), and serum creatinine (OR=1.026, 95%CI 1.008 to 1.045). Conclusion Diabetes mellitus, BMI, hypertriglyceridemia and serum creatinine are independent risk factors of hyperuricemia in patients with mild coronary artery stenosis.
目的 应用128层螺旋CT冠状动脉成像，探讨冠状动脉不同成分斑块与狭窄程度的诊断价值。 方法 对2010年3月－2012年10月150例临床拟诊冠心病及确诊冠心病患者的128层螺旋CT冠状动脉成像检查，冠状动脉影像表现由两位心血管CT诊断医师独立判断冠状动脉斑块成分及测量冠状动脉狭窄程度。应用Circulation血管分析软件，分析冠状动脉斑块成分与狭窄程度之间的相关性。 结果 150例患者中，共发现319处斑块，其中软斑块104处，纤维、混合斑块103处，钙化斑块112处。冠状动脉轻度狭窄114处中，钙化斑块86处 （75.4%）；冠状动脉中度狭窄113处中，纤维、混合斑块75处（66.3%）；冠状动脉重度狭窄92处中，软斑块68处（73.9%）。 结论 128层螺旋CT冠状动脉成像能够有效检测患者冠状动脉斑块的成分及准确判断冠状动脉狭窄程度。
目的 探讨64 排螺旋CT冠状动脉成像（CTA）在冠状动脉狭窄诊断中的应用价值。 方法 选取2010年8月－2012 年8月间收治的90例临床诊断或疑似冠心病患者，所有患者均先实施64排螺旋CT冠状动脉CTA，然后所有患者实施常规冠状动脉造影，对比不同诊断方法的诊断结果，评估两种诊断方法对于冠状动脉狭窄的准确率及精确度。 结果 64 排螺旋CT冠状动脉CTA检出1处明显狭窄者36例，冠状动脉造影检出1处明显狭窄者36例，两组检查方法诊断冠状动脉狭窄对比，差异无统计学意义（P＞0.05）。冠状动脉CTA诊断灵敏度为86.12%，特异度为94.21%，阳性预测值为80.33%，阴性预测值为97.11%，冠状动脉造影诊断灵敏度为72.19%，特异度为84.65%，阳性预测值为71.35%，阴性预测值为87.41%。冠状动脉CTA的诊断准确率高于冠状动脉造影，差异有统计学意义（P＜0.05）。 结论 64 排螺旋CT冠状动脉CTA诊断冠状动脉狭窄的准确度及灵敏度都较高，对早期轻度狭窄诊断灵敏度优于传统动脉造影，对于辅助患者治疗具有重要作用，值得在临床推广应用。
ObjectiveTo compare mid-to long-term outcomes of selective coronary venous bypass grafting (SCVBG) using internal mammary artery (IMA) grafts and great saphenous vein (GSV) grafts for surgical treatment of diffuse right coronary artery atherosclerosis. MethodsWe retrospectively analyzed clinical data of 75 patients undergoing SCVBG in Beijing Anzhen Hospital from January 2003 to December 2012. GSV was used as grafts for SCVBG in 54 patients (GSV group), and IMA was used as grafts for SCVBG in 21 patients (IMA group). All the patients were followed up in November 2013. Their survival condition, recent relapse rate of angina, recent echocardiographic results and coronary CT angiography (CTA) were analyzed. ResultsOverall survival rate of IMA group was slightly higher than that of GSV group (100.0% vs. 83.3%), but survival curves showed no statistical difference in survival rate between the 2 groups (P=0.055). Coronary CTA showed significant blockage in GSV grafts and middle cardiac vein in patients in GSV group (n=39), while IMA grafts and middle cardiac vein in patients in IMA group (n=18) were mostly visible and patent (P < 0.001). Left ventricular ejection fraction (LVEF) of the 2 groups were significantly higher than preoperative values, but there was no statistical difference between the 2 groups. ConclusionCompared with SCVBG using GSV, SCVBG using IMA can significantly improve mid-to long-term patency of the grafts and middle cardiac vein, and is an efficacious procedure for diffuse right coronary artery atherosclerosis.
For coronary artery diseases, imaging diagnosis is usually used to guide the treatment. However, it can only reflect the geometric characteristics of the disease but does not determine the hemodynamically significant stenosis. This study was aimed to investigate the relationship between angiographic and functional severity of coronary artery stenosis and to improve the diagnostic value of imaging. 39 patients with 55 stenosis vessels were included in this study. The correlation between FFR and stenosis rate was analyzed with the medical statistical analysis method, and the influence of the position of stenosis and coronary dominant type on the correlation was discussed. By regression analysis, the stenosis rate of left anterior descending artery of right dominant type showed a significant correlation with FFR value (r≈0.79, P < 0.000 1) after grouping with position and the dominant type. Due to the significance of a value of the FFR < 0.80 in determining inducible ischemia, the diagnostic accuracy of myocardial ischemia by the stenosis rate increased from 70.9% to 82.8% after grouping. Sensitivity (from 72.2% to 78.6%) and specificity (from 70.3% to 86.7%) were also significantly improved. This study indicates that the position of stenosis and the coronary dominant type are significant influence factors on the correlation between FFR and stenosis rate. Consideration of these two factors in the diagnosis of myocardial ischemia by imaging will be helpful to improve the effectiveness of diagnosis.