简介：BackgroundItiswellknownthattherewasasignificantlinkbetweenpreproceduralbloodglucoselevelsandshort-termandlong-termadverseoutcomesinpatientsundergoingelectivePCI.However,theroleofpre-proceduralbloodglucoselevelsasapredictorofadverseeventsinCKDpatientswhounderwentPCIoutofestablisheddiabeteshasyettobeidentified.MethodsInourstudy,weconductedaprospectivestudyof331acutecoronarysyndrome(ACS)patientswithCKDwhounderwentPCIoutofestablisheddiabetes.Patientsweredividedintotwogroupsbasedonpre-proceduralglucoselevels(hypoglycemia<7.0mmol/L;hyperglycemia≥7.0mmol/L).Allpatientswerefollowedupprospectivelyformajoradversecardiovascularevents(MACEs)andmortalityfor6months.ResultsInourcohort,hyperglycemiapatientsreportedahigherincidenceofin-hospitalmortalitythanhypoglycemiapatients(7.5%vs.0%,P<0.001).Hyperglycemiapatientsreportedasignificantlyhigherrateof6-monthMACEs(10%vs.2.4%,P=0.007),allcausemortality(7.5%vs.1.6%,P=0.015),andcardiovascularmortality(6.2%vs1.6%,P=0.041)comparedwithhypoglycemiapatientswithpre-proceduralglucoselevels<7.0mmol/L.Multivariateanalysisdisclosedthatapre-proceduralglucoselevel≥7.0mmol/LwasasignificantindependentpredictorofMACEs(OR=2.53,95%CI1.68-17.15,P=0.004),allcausemortality(OR=4.6,95%CI1.10-18.84,P=0.036),andcardiovascularmortality(OR=6.2,95%CI1.53-24.94,P=0.011)at6monthsinpatientsafterPCI.ConclusionThestudysuggestedthatpre-proceduralglucoselevelsareassociatedwithshort-termcardiovascularoutcomeCKDpatientswhounderwentPCIwithoutestablisheddiabetesinthesettingofACS.

简介：ObjectivesToobservetheeffectsoftelmisartanandrosiglitazoneandexplorethemechanismonearlyatherogenesisinmaleratswithtype2diabetesmellitus.MethodsFortymaleSDratswererandomlyandequallydividedintofourgroups:controlgroup,type2diabetesmellitusgroup,telmisartangroupandrosiglitazonegroup.HighlipidandhighglucosewereusedforinducingDMinSDrats.Theratswereraisedforsixteenweeks.TC,TG,LDL-CandBG,PGIweremeasured.Theaortaewerecollectedforhistopathlogicalandimmunohistochemicalstudies.Immunohisto-chemistrywasusedtoanalyzetheexpressionofPPAR-γ,VCAM-1andICAM-1inthearterialvesselwall.ResultsComparedwiththecontrolgroup,thelevelofTC,TG,LDL-C,andBGinbloodwereincreasedsignificantly(P<0.01)intype2Diabeticgroup.ThetelmisartanandrosiglitazonetreatmentdecreasedbloodTC,TG,LDL-CandBG.TheexpressionofPPAR-γintype2diabeticgroup,telmisartanandrosiglitazonegroupshadsignificantdifferencescomparedwiththecontrolgroup,buttherewasn'tanysignificantdifferences(P>0.05)amongthosethreegroups.ExpressionofVCAM-1,ICAM-1andthemonocytesinfilitratingintotheintimaoftheaortastelmisartanandrosiglitazoregroupwassignificantlylowerthanthoseindiabeticgroup(P<0.01).Theendothelialdamageoftheaortaeintehnisartanandrosiglitazonegroupwaslessseverethanthatindiabetesmellitusgroup.ConclusionTelmisartanandrosiglitazonecanpreventearlyatherogenesisthroughalleviatingthedamagetothearterialwallbyincreasingtheactivationofPPAR-γandinhibitingtheVCAM-1,ICAM-1expressionandthemonocytesinfilitratingintothearterialwall.

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简介：ObjectivesTostudyclinicalandcoronaryangiographicfindingsinpatientswithbothcoronaryheartdiseases(CHD)andtype2diabetesmellitus(T2DM).Methods215patientswithCHDconfirmedbycoronaryangiographywereinvolvedinthisstudy.Thepatientsweredividedintotwogroups:74CHDpatientswithT2DM(meanage64.7±8.2years,male/female47/27),and141CHDpatientswithoutT2DM(meanage66.2±9.2years,male/female100/41).Theclinicalfeaturesandthedatafromselectivecoronaryangiographieswerecomparedbetweentype2diabeticandnon-diabeticCHDpatients.ResultsComparedtonon-diabeticCHDpatients,thepatientswithbothCHDandT2DMsufferedmorefromacutemyocardialinfarction,silentischemiaandseverearrhythmias(P＜0.01,P＜0.05),andhadhigherserumtriglyceridesandapo-lipoproteinB,alongwithincreasedserumuricacid(P＜0.01,P＜0.05),increasedleftventricularenddiastolicdiameter(P＜0.01),anddecreasedleftventricularejectionfraction(P＜0.001).Comparedtonon-diabeticCHDpatients,thepatientswithbothCHDandT2DMsufferedmorefromtriplevesseldisease(P＜0.01),severecoronaryarterystenosis,completeocclusionsanddiffuselesions(P＜0.001).ConclusionsSevereclinicalmanifestation,leftventriculardysfunction,diffuseorcomplicatedlesionsofcoronaryarteriesweremorecommoninpatientswithbothCHDandT2DM,itsuggeststhatthetype2diabeticCHDpatientshavepoorprognosis.

简介：BackgroundThiazolidinediones(TZDs)notonlyimproveinsulinresistance,loweringbloodsugar,alsohasanti-atheroscleroticeffect.However,whethertheprotectiveeffectoncardiovascularpioglitazoneisstillcontroversial.MethodsTotally98patientswithcoronarydiseaseanddiabetesmellituswererandomlydividedintopioglitazonegroup(n=48)receivingconventionaltherapyandpioglitazone(15mg/day),andcontrolgroup(n=50)merelyreceivingconventionaltherapy.Thepatientswerefollowedupfor12months.TheplasmalevelofPlasminogenactivatorInhibitor1(PAI-1)andP-selectinweredetectedatbaselineandaftertreatmentfor12monthsbyELISA,andmajoradversecardiacevents(MACE)werestudied.ResultsPioglitazonetherapyfor12monthswasassociatedwithasignificantdecreaseofPAI-1[(7.9±1.4vs4.2±0.5)ng/mL,P<0.05]andP-selectin[(16.6±6.8vs12.4±3.6)ng/mL,P<0.05],MACEwassignificantlylowerinthepioglitazonegroupthaninthecontrolgroup[acutecoronarysyndrome(ACS):32.0%vs10.4%,P<0.05;targetvesselrevascularization:22.0%vs6.3%,P<0.05].ConclusionsPioglitazonecaneffectivelyreducetheplasmalevelofPAI-1,P-selectinandtheoccurrenceofMACEinpatientswithcoronaryheartdiseaseanddiabetesmellitus.

简介：ObjectivesTostudythestatusoffibrinolyticinhibitioninpatientsofacutecoronarysyndrome(ACS)complicatedwithtypeⅡdiabetesmellitus(NIDDM)andtoevaluatetheeffectoffibrinolyticinhibitiontotheclinicalprognosis.MethodsTypeⅡdiabetesmellituswasdefinedbyADA1997/WH01998criteria.Thesubjectsweredividedintotreatmentgroupsthatincluded39patientsofACSwith20casesofacutemyocardiacinfarction(AMI),36patientsofACS+NIDOMwith20casesofAMI.Twentycasesofhealthypeoplewererandomizedtocontrolgroup.Theplasmaleveloftissuetypeplasminogenactivator(t-PA),plasminogenactivatorin-hibitortype-1(PAI-1)andplasmaD-dimerweredetectedbyusingelisatechnique.TheindexofstatueinfibrinolysiswasdetectedwiththeplasmalevelofD-dimerandtherateofPAI-1/D-dimerinpercentage.ThisindexwasusedtoevaluatethefibrinolyticinhibitionandtheclinicaloutcomeinallthepatientswithAMIintreatmentgroups.TheclinicaloutcomeinpatientswithAMIconsistedoftherateofreperfusion,theincidencesofreinfarction,severi-ousarrhythmia,pumpfailureanddeathintheearlyperiodofAMI.ResultsTheplasmalevelofPAI-1andD-dimerwashigherinthetwotreatmentgroupsthanthatinthecontrolgroup(P<0.01).TheplasmalevelofPAI-1significantlyhigherinACS+NIDDMpatientsthanthatinACS(P<0.05),buttheplasmalevelofD-dimerraisedfrombasiclevelwassignificanflylowerinACS+NIDDMthanthatinACS(P<0.05).TherateofPAI-1/D-dimerinpercentagewassignificantlyhigherinACS+NIDDMthanthatinACSorincontrolgroup(P<0.01).ForAMIpatientsintwotreatmentgroups,therateofreperfusionafterthethrorabolytictherapywassignifi-candylowerinACS+NIDDMthanthatinACS(P<0.01).TherateofincidencesinpumpfailurewassignificantlyhigherinACS+NIDDMthanthatinACStoo(P<0.05).Themorbidityofseveriousarrhythmia,re-infarctionandthemortalitywerealsohigherinACS+NI

简介：BackgroundPatientswithunstableanginapectorisanddiabetesmellitusareverycommon.Whentheyreceiveinterventionaltherapy,contrastagentscancauserenalinjuryandplateletactivation.Alprostadilhasbeenshowntodecreaseinflammationandmicrovascularresistance.Thereisnoanyreportontheprotectioneffectsofalprostadilonrenalinjuryandtheplateletactivationduringcardiacinterventionaltherapy.MethodsAtotalof57patientsweredividedintotwogroups,alprostadilgroup(n=35)andnormalgroupn=22).BUN(bloodureanitrogen)andSCr(serumcreatine)weremeasuredastherenalfunctionparameters.GFR(glomerularfiltrationrate)wascalculatedbytheMDRDformula.Plateletparameters:PLT(plateletcount,109),PDW(plateletdistributionwidth,fL),MPV(meanplateletvolume,fL),PLCR(largeplateletscaleratio,%)weremeasuredastheplateletactivationindex.TtestandChi-squaretestwereusedasstatisticalmethods,andP<0.05wasconsideredstatisticallysignificant.ResultsInthealprostadilgroup,SCrwas71.1±13.8μmol/Land65.9±12.6μmol/L,beforeandafterinterventionaltherapy(P<0.05).BUNwas5.68±1.79mmol/Land3.86±1.19mmol/L(P<0.001),beforeandafterinterventionaltherapy.Intheplatelettests,MPVwasseemedtobetheonlyusefulplateletparameter,beforeandafterinterventionaltherapy(11.8±1.8fLand11.1±1.2fL,P<0.05),whilethePLT(109/L),PDW(fl),PLCR(%)didn'tshowanysignificantdifference.Inthenormalgroup,allthesetests'resultsdidn'tsignificantlychangeafterinterventionaltherapy.ConclusionsThepatientswiththeunstableanginapectorisanddiabetesmellitushaveontheriskofrenalfunctiondamageandplateletactivationwhenundertakingcardiacinterventionaltherapy.Alprostadilprotectsrenalfunctionandalleviatesplateletactivation.

简介：ObjectivesTocomparethedifferenteffectsoflatesuccessfulreperfusionwithPCIonleftventricularfunctionanditsrelationshipwithviablemyocardiumafteracuteanteriorwallmyocardialinfarctioninpatientswithorwithoutdiabetes.MethodsAtotalof125consecutivesubjectswithacuteanteriorwallmyocardialinfarctionwereselected,anddividedintodiabetesmellitus(DM)group(n=43)andNon-DMgroup(n=82)accordingtoWHOdiabetesdiagnosiscriteria.AllpatientsreceivedsuccessfulPCIat12±8daysfromonset.Ischemicviablemyocardiumwasdetectedwithlow-dosedobutamineechocardiography,andleftventricularfunctionandwallmotionabnormalitywerealsoassessedwithechocardiographybeforePCI.ThedataofclinicalmanifestationsandangiogramsbeforeandafterPCIwereanalyzed.Levelsofcreatininekinase-MB(CK-MB),andtroponinT(TnT)beforePCI,6hoursand24hoursafterPCIwereassessed.Allpatientsreceivedclinicandechocardiographyfollow-upfor6months.ResultsHigherrateofTIMI2flow,andlowerrateofTIMI3flowinDMgroupweredemonstratedimmediatelyafterPCI,andtherateofserumCK-MBand/orTnTlevelswerehigherinDMgroup,comparedwithNon-DMgroup(P<0.05).63%ofDMpatientsand56%ofnon-DMpatientshadviablemyocardiumbeforePCI(P>0.05).Therewerenosignificantdifferencesofleftventricularejectionfraction(LVEF),leftventricularenddiastolicvolumeindex(LVEDVI),leftventricularendsystolicvolumeindex(LVESVI),andwallmotionscore(WMS)betweentwogroupsatbaselinebeforePCI(P>0.05).Aftersixmonths,WMSwasdecreasedandLVEFwasincreasedinNon-DMgroup,buttheWMSandtheLVEFdidnotchanged,andtheLVEDVIwasincreasedinDMgroupcomparedwithbaseline;theLVEDVI,LVESVI,LVEF,andWMSweresignificantlydifferentbetweentwogroups(P<0.05orP<0.01).ConclusionsComparedwithnon-diabetics,delayedsuccessfulrevascularizationwithPCIindiabeticspatientwithacutemyocardialinfarctionhaslessbenefitialeffectontheimprovementoflatephasel

简介：BackgroundMonocytetohighdensitylipoproteinratio(MHR)hasbeenconsideredasanovelparameterrelatedwithadverserenalandcardiovascularoutcomes.InthisstudyweinvestigatedtheassociationofMHRwithmajoradverseclinicalevents(MACEs)inpatientswithtype2diabetesmellitus(T2DM)undergoingelectivepercutaneouscoronaryintervention(PCI).MethodsConsecutiveT2DMpatientstreatedwithelectivePCIwereprospectivelyrecruitedbetweenJuly2008-January2016inDepartmentofCardiologyofPanyuCentralHospital.Subjectswerecategorizedintotwogroups:aspatientswhodevelopedMACEs(MACEs+)andpatientswhodidnotdevelopMACEs(MACEs-)duringhospitalization.MACEsweredefinedasthecompositeendpoints,includingall-causemortality,oracuteheartfailure,ortargetvesselrevascularization,orstrokeorrecurrentangina.ResultsAtotalof418patientswereincludedinthestudy.64patientsdevelopedMACEs(15.3%).IntheMACEs(+)patients,monocyteswerehigher(1.12[0.78-1.42]vs.0.72[0.68-0.92]109/L,P<0.01)andHDLcholesterollevelswerelower(0.87[0.72-1.21]vs.0.96[0.81-1.11]mmol/L,P<0.01).Inaddition,MHRwassignificantlyhigherintheMACEs(+)group(1.12[0.91-2.09]vs.0.73[0.54-0.93]109mmol/L,P<0.01).ThecutoffvalueofMHRforpredictingMACEswas22,withasensitivityof81%andaspecificityof75.1%(areaunderthecurve0.79,P<0.001).Inmultivariatelogisticregressionanalysis,MHRremainedanindependentfactorcorrelatedwithMACEs(OR=3.97,95%CI=1.38-11.5,P<0.01).ConclusionHigherMHRlevelsmaypredictMACEsdevelopmentafterelectivePCIinT2DMpatients.

简介：BackgroundTheearlyendothelialdysfunctionofcarotidarteryinpatientswithtype2diabetesmellitus(T2DM)hasbeenrecognized.However,thefeasibilityandsignificanceofcarotidarteryendothelialdysfunctiondetectedbyultrasoundradio-frequencytechnologyhasbeenseldomstudied.MethodsThe2Dultrasoundimagesofthebilateralcommoncarotidarteriesfrom112casesofT2DMpatientsand50casesofnormalsubjectsinourhospitalwerecollectedtomeasureintima-mediathicknessmeans(IMTm),end-systolicinnerdiameter(Ds),end-diastolicinnerdiameter(Dd),resistanceindex(RI),pulseindex(PI),andthesystole/diastoleratio(S/D).Wealsoobservedthevariationoftheintima-mediathickness(IMT)aswellastheelasticityindexesofthecommoncarotidartery,suchasthecompliancecoefficient(CC),elasticitycoefficient(β),pulsewavevelocity(PWV)andaugmentationindex(AIx)throughinstrumentswithbuilt-inultrasoundradio-frequencytechniques,includingquantitativeintima-mediathickness(QIMT)andquantitativeanalysisofarterialstiffness(QAS).Thedifferencesoftheabove-mentionedparametersbetweenthetwogroupswereanalyzed.ResultsTherewerenostatisticallysignificantdifferencesinIMTm,Ds,Dd,RI,PIandS/DraitoofthecommoncarotidarteriesbetweengroupT2DMandthenormalgroup(P>0.01).Theβ,PWVandAIxingroupT2DMwereremarkablyhigherthanthoseinthecontrolgroup,withCCvaluebeingsignificantlylowerthanthelater(P<0.01or0.05).ConclusionUltrasoundradio-frequencytechniqueoffersearlierandmoreeffectiveevaluationofcarotidarteryendothelialdysfunctioninT2DMpatientswhencomparedwithconventional2Dultrasound,establishingimagingfoundationfortheearlypreventionandtreatmentofcardio-cerebrovascularcomplicationsinT2DMpatients.