ABSTRACT
Objective To investigate the efficacy and safety of enhanced external counter pulsation(EECP) in treatment of coronary heart disease in patients aged 80 years and older.Methods The 336 consecutive elderly patients with coronary heart disease were treated in our hospital from May 2016 to October 2017 in a prospective study.The 168 coronary heart disease patients aged 80 years and older were divide into a control group(n=84)receiving conventional therapy(anti-platelet drugs,angiotensin converting enzyme inhibitors,angiotensin-receptor blocker,β-blockers,calcium antagonists,nitrates,statins),and EECP group(n =84) receiving enhanced external counter pulsation 0.5 h/time,2 times per day,36 days as a course as add-on therapy to conventional therapy.And 168 patients aged 60～ 79 years received the same therapy as those in EECP group.After one course of EECP treatment,the therapeutic effects were evaluated by Seattle angina questionnaire (SAQ)and Pittsburgh sleep quality index(PSQI),and the incidence of major adverse cardiovascular events and readmission rate were compared between groups of the EECP vs.control group and group of patients aged 60-79 years.Results The scores of SAQ and PSQI were better in the EECP group than in the control group after one course of EECP treatment,as follows:physical limitation(35.7 ±10.7 vs.26.0 ± 12.1),anginal stability (53.3 ± 22.9 vs.33.9 ± 18.9),anginal frequency (39.6 ± 6.5 vs.30.4 ± 21.1),treatment satisfaction(38.0±6.0 vs.33.7±4.7),subjective sleep quality(1.0±0.7 vs.2.5± 0.7),sleep latency(1.3±0.6 vs.2.4±0.5),sleep duration(0.9±0.6 vs.2.3±0.6),habitual sleep efficiency(1.1 ± 0.6 vs.2.5 ± 0.6),sleep disturbances (1.2 ± 0.4 vs.2.2 ± 0.6),use of sleeping medication(1.2±0.6 vs.2.2±0.6),and daytime dysfunction score was 1.3 ±0.5 vs.2.3 ±0.6 (P ＜0.01).The incidence of major adverse cardiovascular events was lower in the EECP group(31.0％,26/84)than in the control group(66.7 ％,56/84)(P＜0.05).At 1,3,6,12 months after EECP treatment,there was no significant difference in the incidence of major adverse cardiovascular events and readmission rate between patients aged 60-79 years vs.80 years and over(P＞ 0.05).Conclusions EECP treatment is relatively safe and effective for coronary heart disease patients aged 80 years and older.
ABSTRACT
α1-Antitrypsin (α1-AT) belongs to serine protease inhibitor (Serpin) superfamily and is the main protease inhibitor in human circulation. It can inhibit many proteases to protect tissues from digradation. The mutant Z (Glu342Lys) of α1-AT predisposes to the early onset of emphysema due to decreased functional α1-AT in the lung and to neonatal hepatitis due to accumulation of α1-AT polymers in the endoplasmic reticulum of hepatocytes, which disrupts the balance between protease and protease inhibitors. This paper reviews recent research progress on the pathogenic mechanism and the prognosis of α1-antitrypsin deficiency.