CXC chemokine ligand 12 (CXCL12) is a kind of small molecular polypeptide substance that can move cells towards specific parts. It is widely distributed in heart, skeletal muscle, liver, brain and so on. Current studies believe that CXCL12 plays a role in the formation and progression of cardiovascular diseases by binding to CXC chemokine receptor 4 (CXCR4) and atypical chemokine receptor 3 (ACKR3), but the mechanism is not very clear, and even some contrary experimental results appear. This review mainly discusses the role of CXCL12-CXCR4/ACKR3 axis in atherosclerosis, myocardial infarction, and myocardial remodeling, in order to explore the inflammatory mechanism in the development of coronary heart disease and provide a basis for further research of clinical drugs.
To declare the clinical value of lowing serum LDL-C level in coronary heart disease by reviewing the history of its clinical trials in the last 4 decades.
【摘要】 目的 通過建立活體大鼠心肌缺血再灌注模型，模擬人類冠心病，研究聚合血紅蛋白（PolyHb）在心肌缺血再灌注中的保護作用，探究PolyHb在冠心病領域中的保護和治療作用。 方法 將45只Sprague-Dawley（SD）大鼠隨機分成3組:實驗組（15只）、對照組（15只）、假手術組（15只），建立大鼠心肌缺血模型。實驗組建立動物模型后，結扎冠狀動脈35 min，并于結扎后5 min，通過SD大鼠尾靜脈按1 mL/min的速度注射1 mL（100 g/L）的PolyHb溶液。缺血完成后開放灌注120 min。對照組建立動物模型，結扎冠狀動脈35 min，并于結扎后5 min，通過SD大鼠尾靜脈按1 mL/min的速度注射1 mL生理鹽水。缺血完成后開放灌注120 min。假手術組僅建立動物模型，但不結扎冠狀動脈，也不再灌注。比較3組SD大鼠的血流動力學參數左室內壓最大上升和下降速率、心肌酶（血清肌酸激酶、乳酸脫氫酶）及病理學檢查（梗死心肌占總心肌面積的百分比），來衡量PolyHb的作用。 結果 與對照組比較，用PolyHb處理的實驗組可增強再灌注時左室內壓最大上升和下降速率（Plt;0.05），減少血液中血清肌酸激酶和乳酸脫氫酶的含量（Plt;0.05），并明顯減少心肌梗死面積百分比（Plt;0.05）。 結論 在心肌缺血的SD大鼠中，PolyHb可以有效的降低缺血再灌注損傷，從而達到心肌保護作用。【Abstract】 Objective To investigate the protective effect of polymerized hemoglobin (PolyHb) for myocardial ischemia-reperfusion and explore the field of polymerized hemoglobin in the protection and treatment of human coronary heart disease, by simulating human coronary heart disease and establishing myocardial ischemia-reperfusion model in living rats. Methods Forty-five Sprague-Dawley (SD) rats were randomly divided into 3 groups: experimental group (n=15), control group (n=15), and sham operation (SHAM) group (n=15). Rat models of myocardial ischemia-reperfusion were established. For the rats in the experimental group, we ligated their left coronary artery for 35 minutes, and injected 1 mL (100 g/L) PolyHb solution into their body at a speed of 1 mL/min 5 minutes later. After ischemia was completed, reperfusion was performed for 120 minutes. The procedures carried out for the rats in the control group were exactly the same except that the PolyHB solution was replaced by 1 mL saline solution. Ligation of the artery and reperfusion were not performed on the rats in the SHAM group. Hemodynamic parameters (maximal rising and falling rates of left ventricular pressure), enzymes (serum creatine kinase, lactate dehydrogenase) and results of histopathologic examinations (percentage of myocardial infarction area over the total myocardial area) were measured and compared among the three groups to evaluate the function of PolyHb. Results Compared with the control group, the experimental group treated with PolyHb had higher maximum rising and falling rates of left ventricular pressure (Plt;0.05), lower blood levels of creatine kinase and lactate dehydrogenase (Plt;0.05), and lower percentage of myocardial infarction area over the total myocardial area (Plt;0.05). Conclusion Polymerized hemoglobin can effectively reduce the ischemia-reperfusion injury and achieve myocardial protection in SD rats with myocardial ischemia.
ObjectiveTo systematically review whether or not obstructive sleep apnea hypopnea syndrome (OSAHS) increases the incidence of atrial fibrillation in coronary artery disease patients.MethodsPubMed, EMbase, The Cochrane Library, SinoMed, CNKI, VIP and WanFang Data databases were searched for studies on the relationship between OSAHS and the incidence of atrial fibrillation in coronary artery disease patients from inception to July 2nd, 2018. Two reviewers independently screened literatures, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsIn total, 11 cohort studies were included, involving 709 in exposed group and 975 in non-exposed group. The results of meta-analysis indicated that OSAHS was associated with the incidence of atrial fibrillation in coronary artery disease patients (RR=2.01, 95%CI 1.72 to 2.36, P<0.000 01). The subgroup analysis showed that OSAHS of PSG diagnosis increased the risk of the incidence of atrial fibrillation in coronary artery disease patients (RR=2.40, 95%CI 1.84 to 3.12, P<0.000 01); moderate and severe OSAHS of PSG diagnosis had higher risk of the incidence of atrial fibrillation in coronary artery disease patients (RR=3.73, 95%CI 2.51 to 5.53, P<0.000 01); high risk OSAHS of Berlin questionnaire assessment increased the incidence of atrial fibrillation in CAD patients (RR=1.56, 95%CI 1.27 to 1.92, P<0.000 1).ConclusionThe current evidence indicates that OSAHS is associated with an increased risk of atrial fibrillation in coronary artery disease patients. Due to the limitation of quality and quantity of the included studies, more large-scale and fine quality research are needed to warrant the accuracy of conclusion above.
Objective To study the characteristics of endothelin(ET) and hemodynamics parameters in patients with coronary artery disease (CAD) in perioperative period and aim to find out some rules and useful suggestions for clinical trial. Methods Fortyseven patients were divided into 5 groups: patients undergoing coronary artery bypass grafting (CABG) and resection of left ventricular aneurysm(CABG+LVAN group),patients undergoing classical CABG(CABG group), patients undergoing offpump coronary artery bypass grafting (OPCAB group), patients undergoing transmyocardial laser revascularization (TMLR group), and group control, patients undergoing mitral valve replacement because of rheumatic heart disease(RHD). The ET was measured in the following time: before operation, before aortic clamping(or before revascularization or before TMLR), aortic declamping(or just after revascularization or just TMLR), 3 h, 6 h, 24 h after reperfusion. CI was measured before operation, 3 h, 6 h and 24 h after reperfusion, respectively. Results ET Compared in each group: in CABG+LVAN group, it significantly increased when aortic declamping (69.93±7.20 pg/ml),at 3 h (89.99±5.76 pg/ml),6 h (60.94±8.69 pg/ml) and, 24 h (6899±10.30 pg/ml) after reperfusion than that beforeoperation (40.17±13.37 pg/ml，Plt;0.05); in CABG group, ET significantly increased when reperfusion(66.59±4.86 pg/ml), at 3 h (95.97±10.72 pg/ml), 6 h (61.51±765 pg/ml) and, 24 h (57.85±6.34 pg/ml) after reperfusion than that beforeoperation(43.22±9.13 pg/ml，Plt;0.05); in OPCAB group, ET increased significantly when reperfusion(66.47±5.90 pg/ml) than that beforeoperation(44.80±6.51 pg/ml，Plt;0.05), and then returned to normal level; in TMLR group,there is no difference before and after operation; in control group, ET increased significantly after operation. ET compared between different groups: ET level was higher in CABG group than that in OPCAB group at 3 h after reperfusion(95.97±10.72 pg/ml vs.59.72±4.81 pg/ml,Plt;0.05). Although CI significantly increased after myocardial reperfusion in all groups, the CI was significantly higher in OPCAB group than that in CABG group at 3 h after reperfusion(3.25±0.05 pg/ml vs. 2.17±0.46 L/min·m2,Plt;0.05). Conclusions In patients with CAD, the ET increases after operation, but the increasing levels are different among the different groups. In patients with OPCAB, the changes of ET and hemodynamics are mild, and heart function recovers quickly, so OPCAB is a very good choice for CAD surgical therapy if the indications are suitable; In patients with classical CABG, the changes of ET are obvious, and the heart function recovers a little bit slowly, but they all can return to normal level at 24 h after operation; TMLR is a good supplement for CAD therapy.
Objective?To explore the glucometabolic state of angiographically documented inpatients with coronary artery disease (CAD) but without diagnosed diabetes mellitus (DM). Methods?The study recruited 449 patients, who were performed a coronary angiography as well as an oral glucose tolerance test (OGTT) when admitted in the cardiovascular medical ward in our hospital from January 2007 to May 2009. According to the results of coronary angiography, the patients were divided into a coronary artery disease (CAD) group and a non-coronary artery disease (non-CAD) group, and abnormal glucose metabolism (AGM) status was compared between the two groups. Results?The random plasma glucose (RPG) and fasting plasma glucose (FPG) had no significant differences (P values were 0.249 and 0.444, respectively) in the two groups, while the OGTT 2-hour plasma glucose (2hPG) was much higher in the CAD group, with a significant difference (Plt;0.001) compared with the non-CAD group. The CAD group had a prevalence of AGM up to 74.0%, of which 32.1% were newly diagnosed DM patients, and 39.0% were impaired glucose tolerance (IGT) patients, much higher than that in the non-CAD group, respectively, there being a significant difference (P=0.006). Logistic regression analyses revealed that the risk of IGT and newly diagnosed DM was 1.6 times (OR=1.603, 95% CI 1.023 to 2.512, P=0.04) and 2.3 times (OR=2.292, 95% CI 1.391 to 3.777, P=0.001) as much as that in non-CAD patients, respectively; when adjusted for the factors such as hypertension, dyslipidemia, BMI, hs-CRP, and other factors, CAD patients still had a higher risk of newly diagnosed DM (OR=1.852, 95%CI 1.064 to 3.223, P=0.029), compared with the non-CAD patients. Conclusion?AGM is common in the admitted patients with CAD but undiagnosed diabetes, most of whom need an OGTT to be diagnosed timely and accurately. OGTT should be considered to be a routine inspection item to diagnose AGM in the inpatients with CAD; if possible, all hospitalized patients with cardiovascular disease should be performed an OGTT routinely.
目的:評價國產腺苷臨床應用安全性及腺苷負荷心肌灌注顯像對冠心病的診斷價值。方法:對51例臨床疑診冠心病患者,分別靜脈注射腺苷,注射3min末,靜脈注射核素顯像劑99TcmMIBI 925 MBq,1～1.5h行心肌灌注斷層顯像,分析患者在腺苷注入后的血流動力學改變、副作用發生情況。經半年以上隨訪排除或確診冠心病,評價腺苷負荷心肌灌注顯像對冠心病的診斷價值。結果:腺苷輸注后,86.3%(44/51) 患者出現各種副作用,停藥后均很快緩解。腺苷負荷試驗心肌灌注顯像診斷冠心病的敏感性90.9%,特異性71.4%,準確性88.2%,陽性預測值95.2%,陰性預測值55.6%。結論:國產腺苷可安全地應用于負荷心肌灌注顯像。腺苷負荷心肌灌注顯像診斷冠心病敏感性較高,具有重要的臨床應用價值。
目的:通過冠脈造影探討心電圖對冠心病的診斷價值。方法:對226例可疑冠心病患者進行心電圖與冠脈造影進行對比分析。結果:心電圖診斷冠心病的靈敏度為 86.49％,特異度為 65.38％,假陽性率為3462％,假陰性率為 13.51％。心電圖隨著冠狀動脈病變支數增加而檢出冠心病的陽性率增高。結論:心電圖是臨床診斷冠心病最快捷、簡便、經濟而無創的有效方法,但仍存在一定的局限性。
Abstract： Objective To study the difference of gene expression profile of bone marrow mesenchymal stem cells （MSCs） cultured in vitro from coronary heart disease patient with or without diabetes mellitus by Affymetrix Gene array. Methods One male patient at age of 53 years with coronary heart disease and diabetes mellitus was included in this study with the diagnosis of coronary heart disease and type 2 diabetes mellitus. Another male patient at age of 51 years with coronary heart disease without diabetes mellitus was also included in this study with the diagnosis of coronary heart disease. MSCs of the two patients were isolated and purified by the methods of density gradient centrifugation with lymphocyte separation medium for human and adherent filtration. The MSCs expression profile of cytokines and signal transduction genes were examined by Affymetrix gene array. Results There were 27 functional protein genes expression in the patient with coronary heart disease and diabetes mellitus relating to cell apoptosis, cytokine, and signal transduction. Among them, the expression of 13 functional genes, including TNFRSF10B, TNFRSF21, NGF, CAV2, ITGA8, TNS1, ITGA2, AKT3, MBP, MAP2, INHBA, FST, PLA2G5, increased significantly in the patient with coronary heart disease and diabetes mellitus. However, the expression level of 14 genes, including EPR1, BIRC5, HELLS, BCL2, HGF, CASP1, SEPP1, ITGA9, MAP2K6, RUNX3, TGFBR2, RUNX2, CTNNB1, CDC42, decreased significantly. Conclusion The gene expression profile of bone marrow MSCs from coronary heart disease patient with diabetes mellitus is significantly different from the patient with coronary heart disease patient without diabetes mellitus.