冠状动脉CTA定量评估稳定型心绞痛患者斑块进展及其在心血管事件中的预测价值

本文对非创伤性血管成像技术(CTA)定量评估稳定型心绞痛患者的冠状动脉斑块进展及其在心血管事件中的预测价值进行了分析。选取2017年1月~2017年12月我院心血管科142例因新发症状或症状加重随访行两次冠状动脉CT血管造影(CCTA)的稳定型心绞痛患者作为研究对象,根据后期随访患者是否有主要不良心脏事件发生进行分组,其中82例发生主要不良心脏事件的患者作为观察组,60例未发生主要不良心脏事件的患者作为对照组,定量评估稳定型心绞痛患者斑块的进展情况。结果显示:观察组患者有糖尿病、高血脂、吸烟史的比例均高于对照组,差异有统计学意义(P<0.05)。两组随访CCTA总体斑块负荷率、冠状动脉直径狭窄率比较差异有统计学意义(P<0.05);两组斑块进展方面,脂质斑块负荷率、纤维斑块负荷率、钙化斑块负荷率、总体斑块负荷率、冠状动脉直径狭窄率比较差异有统计学意义(P<0.05)。通过多因素Logisitic回归分析,脂质斑块负荷进展与基线高血脂有关(P<0.05),总体斑块负荷进展与基线高血脂具有相关性(P<0.05),冠状动脉直径狭窄率进展与糖尿病、高血脂、吸烟史具有相关性(P<0.05)。本文证实了CCTA检查是检测稳定型心绞痛患者斑块负荷进展的一种有效方法,且心血管危险因素能加快稳定型心绞痛患者负荷进展。     

基于双源CT血管造影技术评估MMP-9、PAF及Lp-PLA2与冠状动脉斑块性质的关系

冠状动脉粥样硬化性心脏病是威胁健康的常见病之一,本研究选取我院2017年2月~2018年12月确诊的206例冠心病患者,其中急性冠脉综合征(acute coronary syndrome,ACS)患者114例(ACS组)、稳定型心绞痛(stable angina pectoris,SAP)患者92例(SAP组),用双源CT血管造影技术检测患者的斑块性质,并检测了血清明胶酶B(MMP-9)、血小板活化因子(PAF)及脂蛋白相关磷脂酶2(Lp-PLA2)浓度,分析MMP-9、PAF及Lp-PLA2与斑块性质间的关系。结果显示,ACS组患者斑块面积和偏心指数均大于SAP组(P<0.05);ACS组患者血清MMP-9、PAF及Lp-PLA2的水平均高于SAP组(P<0.05);ACS组患者易损斑块的比例明显高于SAP组(P<0.05)。所有易损斑块患者血清MMP-9、PAF及Lp-PLA2的水平均高于稳定斑块的患者,且差异具有统计学意义(P<0.05)。患者冠状动脉斑块偏心指数与血清MMP-9、PAF及Lp-PLA2浓度呈正相关关系(P<0.05)。因此,通过双源CT血管造影技术观察冠状动脉粥样硬化斑块性质,结合血清MMP-9、PAF及Lp-PLA2浓度,可以对患者的病情进行评估。血清MMP-9、PAF及Lp-PLA2浓度与斑块的性质及不稳定性有关,可为预测患者冠状动脉斑块性质提供参考。     

Investigation of the Chemical Differences between Native and Bypass Coronary Artery Plaques from the Same Heart Using Cross Polarization Magic Angle Spinning Nuclear Magnetic Resonance (CP/MAS-NMR)

The plaque deposits in bypass arteries and native arteries from the same heart have been studied using solid state cross polarization nuclear magnetic resonance (CP/MAS NMR). Both ¹³C and ³¹P signals were observed. The samples are of interest because plaque in native arteries may have deposited during the lifetime of the patient. However, plaque in the bypass occurred since bypass surgery. It has been observed that the mature plaque in native arteries was more calcified than that in bypass arteries, especially if the latter had not matured to become significant in size. Results showed that the concentrations of carboxylate carbons present in cholesterol esters were similar in native and bypass arteries. However, the areas of the ¹³C peaks of the carboxylate compared to the sum of areas of all other ¹³C arteries indicated that the carboxylate was attached to five or six other carbons. From this we can calculate that the carboxylate to other carbon ratio in the remainder must be 1:4 or 1:3. This indicates large quantities of other organic compounds in the deposits. Studies of ³¹P showed that phosphorus existed primarily as hydroxyapatite in the crystalline native plaque. However, a large proportion existed as organic phosphorus in the bypass plaque. In addition, we studied the interactions of calcium with homocysteine and cholesterol. Calcium-homocysteine and cholesterol-homocysteine precipitates were characterized using ¹³C solid state NMR. Results showed that calcium appeared to interact with sulphur in the homocysteine which seemed to form dimers and polymers.     

Estimating the convergence rate for eigenfrequencies of anisotropic plates with variable thicknessEstimation du taux de convergence des valeurs propres des plaques anisotropes,avec épaisseur variable

Estimates of the differences between rescaled eigenvalues of the spectral problem for a thin anisotropic plate and eigenvalues of its two-dimensional models are obtained with bounds expressed in terms of the plate's thickness and attributes of the limit eigenvalue. To cite this article: S.A. Nazarov, C. R. Mecanique 330 (2002) 603–607.     

高分辨MRI 3D黑血技术诊断颈动脉斑块的研究

本研究探讨高分辨磁共振成像(MRI)3D黑血技术判断颈动脉斑块位置及预测脑卒中的应用价值。选取缺血性脑卒中患者68例(观察组),同时选取健康体检者50例作为对照组,给予高分辨MRI 3D黑血技术检查,分析两组黑血技术参数差异,同时采用ROC曲线分析参数预测脑卒中的价值。共检出颈动脉粥样硬化斑块82处;高分辨MRI 3D黑血技术颈动脉斑块检出率为95.12%;观察组颈动脉血管总面积(TVA)、管壁面积(WA)及管壁标准化指数(NWI)明显高于对照组(P<0.05);观察组缺血侧TVA明显高于非缺血侧(P<0.05);TVA、WA及NWI预测脑卒中的ROC曲线下面积分别为0.801、0.825和0.842(P<0.05)。高分辨MRI 3D黑血技术判断颈动脉斑块位置有较好的价值,颈动脉定量指标在脑卒中预测中有一定应用价值。     

牙菌斑有机酸的气相色谱-质谱分析

采用ＧＣ／ＭＳ联用技术分析了正常人牙菌斑内有机酸成分。发现了１４种有机酸,其中有８种直链饱和脂肪酸、４种直链非饱和脂肪酸、２种芳香酸。含量最多的是Ｃ１６∶０,Ｃ１８∶０,Ｃ１８∶１３种脂肪酸。其中苯乙酸、苯丙酸及十五碳酸等３种成分是第１次在牙菌斑中检测出。     

主动脉弓及分支血管内非稳态血流分析

运用流体力学中的三维非定常Navier-Stokes方程作为血液流动的控制方程,并采用计算流体力学方法对人体主动脉弓及分支血管内非Newton(牛顿)血液黏度模型下血流进行瞬态数值模拟.分析了一个心动周期内不同时刻血流动力学特征参数的分布对动脉粥样硬化斑块形成的影响,并与Newton血液黏度模型下的血管壁面压力和壁面切应力特征参数进行对比.结果表明:与Newton血液模型相比,非Newton血液模型下血流分布更符合真实血流特性;在心动收缩期,分支血管外侧壁附近存在面积较大的低速涡流区,该区域内血管壁面压力与壁面切应力具有较大的变化量,血液中的血小板、脂质和纤维蛋白等易沉积,血管内壁易疲劳损伤并发生血管重构,促使动脉粥样硬化斑块形成;而在心动舒张期,分支血管内血流速度分布均匀,血管壁面压力与壁面切应力变化量较小,血管壁受到较小的应力作用,对动脉粥样硬化斑块形成的作用较小.