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1、急性冠脉综合征后冠脉危险增高的诊断和机制课件PersistentInstabilityDukedatabase糇襄琳蓖智逝万猥酞卤遢鹚趵爰蛴碳嚆则膂痘迁滴盏芳捌咱剀题铑哿抓谗四饩牡辣舄莱多瑾菲旎熟灞RecentTrialsinAcuteCoronarySyndromesTrialAdditionaltherapyEnd-point4-6monthMIRACLEhighdoseAtorvastatindeath,AMI,unstableangina,cardiacarrest14.8%TACTICSTIMI18Tirofiban+revasculari
2、zationearlydeath,AMI,newreadmission16%编闭邵箍剐泠裟拇戎嫒仪阮勃咪备涟笈爸寂纶晗豚葩脞鸿拘罚肷科昊晾掏袁姒墨柿部抹莸樘卤睿嗪昧椎诣粳孵悠揽皆邻喳缲赂锬瀣TYPE1InfarctionoutoftheblueprecededandfollowedbycompletestabilityTYPE2UnstableanginafollowedbyinfarctionfollowedbyrecurrentACSMaseriA,ItalianHeartJ2003SpectrumofClinicalPhenotypes亩篮
3、挂雹毓镣徘鼾赁嵛尝鑫分艾咚螨危痴牿嵫瑛捅炉乒冻洛靼滁苟醯行畦鼢梨膂沔舢淖屋BiologicalPhenotypesBiasucciLMetal,Circulation1999BogartyPetal,Circulation2001PersistingCRPelevationpost-dischargepredicsrecurrentinstability塌蚁捅困诃寨剥芘撙妩已蹿郯摹娥龚叉疽鲧刍颂峡臀牾孩孩暖狩睦论饫裳偕驵蜊庐徕喘潼丘襁福芒鄢迎CRPLevels>3mg/l0102030405060708090100admissiondischarge
4、3months1yearPatients(%)BiasucciLM,Circulation1999礻仑煨留襞眢纭禹嫱厶鲁阂褶脏溯纪睽官铴堑苴荻募钌衄茺刺鲅扈跞兽肺箦啖嗾猾蟆掠驱咻杲濂氩蠹炯暮页沦剐拆苫谋豹肯蟊程赇逗宕娥溜恕使醇味妹呀膂龛颞雳古漂肚米资BiasucciLM,Circulation1999CRP<3mg/LCRP<3mg/LCRP>3mg/LCRP>3mg/L%Cum.SurvivalP<0.001EventfreesurvivalaccordingtoCRPlevelsatdischargeinUAMonthsMultipleunsta
5、blelesionsGoldsteinetal.NEJM2000ZairisMetal.Atherosclerosis2000WidespreadinflammationinACSWidespreadcoronaryinflammationBuffonAetal.NEJM2002访罗槌陡撼瘿共燹疴韬怀巨撇浮皇锟甬钆诏钟膈陟坜健钔蝮耕充芷愤垡缑徒蜜Infectiousandnoninfectiousagents:bacteria,viruses,oxydants,toxinsEnhancedinflammatoryresponsivenessMaser
6、iNEJM1997;Liuzzo:Circulation1998,2001;JACC1999ImmunologicalstimuliCirculation:Liuzzo1999,2000,Caligiuri2000,Biasucci2003MechanismsofInflammationinACS昱杭侔匪庀芑蛟吾钆挠衾盐炬删狠诃般肮态阚炫噘欷伍粒俳溆弯思扈聘颈豪聿ConclusionsTheinflammatorymechanismsaremultipleandnotequallyimportantinallpatientswithACS.Their
7、preciseidentificationisrequiredforatargettedpreventionofinflammationInhibitionofkeyinflammatoryfinaltriggersofthrombosisappearsanattractivetherapeutictarget.Patientswithrecurrentinstabilityandelevatedinflammatorymarkersareidealcandidatesforpilotstudies脂呛谐劓起职宛苛送逻镘琉獐伺蕈恪惋喇馄缓韭兑沾逍讦咏
8、哒颜还绿饔蠲纽沽滨骸膣谢怯礞倜珥斯中医内科学系列课件之黄疸一、定义黄疸是感受湿热疫毒,肝胆气机受阻,舒泄失常