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白色手术室September 13 文献翻译3、Altered Creatine Kinase Adenosine Triphosphate Kinetics in Failing Hypertrophied Human Myocardium 人体心肌肥大衰竭时三磷酸腺苷肌酸激酶动力学改变 Background— The progression of pressure-overload left ventricular hypertrophy (LVH) to chronic heart failure (CHF) may involve a relative deficit in energy supply and/or delivery. Methods and Results— We measured myocardial creatine kinase (CK) metabolite concentrations and adenosine triphosphate (ATP) synthesis through CK, the primary energy reserve of the heart, to test the hypothesis that ATP flux through CK is impaired in patients with LVH and CHF. Myocardial ATP levels were normal, but creatine phosphate levels were 35% lower in LVH patients (n=10) than in normal subjects (n=14, P<0.006). Left ventricular mass and CK metabolite levels in LVH were not different from those in patients with LVH and heart failure (LVH+CHF, n=10); however, the myocardial CK pseudo first-order rate constant was normal in LVH (0.36±0.04 s–1 in LVH versus 0.32±0.06 s–1 in normal subjects) but halved in LVH+CHF (0.17±0.06 s–1, P<0.001). The net ATP flux through CK was significantly reduced by 30% in LVH (2.2±0.7 µmol • g–1 • s–1, P=0.011) and by a dramatic 65% in LVH+CHF (1.1±0.4 µmol • g–1 • s–1, P<0.001) compared with normal subjects (3.1±0.8 µmol • g–1 • s–1). Conclusions— These first observations in human LVH demonstrate that it is not the relative or absolute CK metabolite pool sizes but rather the kinetics of ATP turnover through CK that distinguish failing from nonfailing hypertrophic hearts. Moreover, the deficit in ATP kinetics is similar in systolic and nonsystolic heart failure and is not related to the severity of hypertrophy but to the presence of CHF. Because CK temporally buffers ATP, these observations support the hypothesis that a deficit in myofibrillar energy delivery contributes to CHF pathophysiology in human LVH. 背景：负荷过大引起的左心室心肌肥大发展为慢性心力衰竭的过程可能涉及能量供应或/和运输的相对不足。 方法和结果：我们测量了心肌中肌酸激酶的代谢浓度和由肌酸激酶生成的作为心脏原始能量储备的ATP，以此来检验在患有左心室肥大和心力衰竭病人体内经由肌酸激酶的ATP流量不正常这一假说。在患有左心室肥大的病人（n=10）体内，心肌中ATP水平正常，而磷酸肌酸的水平比正常人（n＝14，P<0.006）低35％。左心室包块和肌酸激酶代谢水平在患有左心室肥大的病人体内和在同时患有左心室肥大及慢性心力衰竭的病人体内(LVH+CHF, n=10)并没有不同之处；但是，患有左心室肥大的病人体内(0.36±0.04 s–1，正常人为0.32±0.06 s–1） 心肌肌酸激酶拟第一动力代谢率常数正常，但在同时患有左心室肥大和慢性心力衰竭的病人体内仅为一半(0.17±0.06 s–1, P<0.001)。与正常人相比，在患有左心室肥大的患者体内，经由肌酸激酶的ATP净流量明显下降了30％(2.2±0.7 µmol • g–1 • s–1, P=0.011)，而在同时患有左心室肥大和慢性心力衰竭的病人体内则下降了60％(1.1±0.4 µmol • g–1 • s–1, P<0.001)，正常人体内这一数值为(3.1±0.8 µmol • g–1 • s–1)。 结论：这些对人体左心室心机肥大的直接观察表明区分衰竭性和非衰竭性心肌肥大的标准在于ATP通过肌酸激酶转化的动力，而不是相对或者绝对肌酸激酶代谢池的变化。还有，ATP动力不足的表现在收缩性和非收缩性心肌肥大中相似，与慢性心力衰竭有关，而与心机肥大的严重程度无关。因为肌酸激酶暂时的缓冲了ATP，这些观察结果支持了心肌纤维能量运输不足促使人体左心室肥大向慢性心力衰竭转变的假说 September 12 心血管翻译Diffusion Tensor Magnetic Resonance Imaging Mapping the Fiber Architecture Remodeling in Human Myocardium After Infarction 扩散张量磁共振成像技术测绘出人类心肌梗死后纤维结构重塑 Background— Diffusion tensor magnetic resonance imaging (DT-MRI) provides a means for nondestructive characterization of myocardial architecture. We used DT-MRI to investigate changes in direction-dependent water diffusivity to reflect alterations in tissue integrity (trace apparent diffusion coefficients [ADCs] and fractional anisotropy [FA]), as well as indicators of remodeling of fiber helix angles, in patients after myocardial infarction. 背景：扩散张量磁共振成像技术（DT-MRI）提供了一种对心肌结构的无损伤性鉴定方法。我们使用DT-MRI技术研究心肌梗死后病人体内具有方向依赖性的水的扩散率，以此来反映组织完整性的改变（微表面扩散系数[ADCS]和分次各向异性[FA]），同时也可作为纤维螺旋重塑的指示信息。 Methods and Results— Thirty-seven patients (35 men, 2 women; median age, 59) after acute myocardial infarction (median interval from onset, 26 days) were enrolled. DT-MRI was performed at the midventricular level to measure trace ADC, FA, and helix angles of myofibers. Helix angles were grouped into left-handed helical fibers, circumferential fibers, and right-handed helical fibers. Measurements were correlated with viability and regional wall motion assessed by contrast-delay-enhancement and cine MRI, respectively. The infarct zone showed significantly increased trace ADC and decreased FA than the remote zone. The percentage of left-handed helical fibers increased from the remote zone (mean±SD, 13.3±5.8%) to the adjacent zone (19.2±9.7%) and infarct zone (25.8±18.4%) (MANOVA, P=0.004). The percentage of right-handed helical fibers decreased from the remote zone (35.0±9.0%) to the adjacent zone (25.5±11.5%) and infarct zone (15.9±9.2%) (P<0.001). Multiple linear regression showed that the percentage of left-handed helical fibers of the infarct zone was the strongest correlate of infarct size and predictor of ejection fraction. 方法与结果：三十七名病人（男性35人，女性2人，平均年龄59岁）在急性心肌梗死病发后（病发后平均间隔为26天）进行了注册。DT-MRI在室中水平实施来测量微ADCS,FA以及肌纤维的螺旋角。螺旋角被分为左手螺旋纤维，环形纤维和右手螺旋纤维。测量结果分别与相差延迟增强MRI和运动MRI对生存力以及局部心壁运动的测量有关。梗死区与远端相比，微ADCS明显增加而FA减少。从远端到近端再到梗死区，左手螺旋纤维的比例增加（13.3±5.8%～19.2±9.7%～25.8±18.4%，方差多变量分析, P=0.004）。同时从远端到近端再到梗死区，右手螺旋纤维的比例逐渐下降（35.0±9.0%～25.5±11.5%～15.9±9.2%，P<0.001）。多线性退化表明梗死区左手螺旋纤维的比例与梗死的面积和射血分数最为相关。 Conclusions— In vivo DT-MRI of postinfarct myocardium revealed a significant increase in trace ADC and a decrease in FA, indicating altered tissue integrity. The redistribution of fiber architecture correlated with infarct size and left ventricular function. This technique may help us understand structural correlates of functional remodeling after infarction. 结论：梗死后活体内心肌DT-MRI显示微表面扩散系数明显增加而分次各向异性减弱，提示组织完整性发生改变。纤维组织的重新分布于梗死的面积和左心室的功能相一致。这项技术可能帮助我们理解梗死后组织重塑与功能恢复之间的关系。 September 09 第三篇翻译稿（完成于9.6）9.6翻译（注：附带图片欠缺） MRI On the Cheap and On the Go 磁共振成像价格下降，趋于普及 When we hear the term “MRI,” most of us probably think of a special treatment room in a hospital with a huge doughnut-shaped machine that costs a lot of money and makes a lot of noise. Researchers with the U.S. Department of Energy’s Lawrence Berkeley National Laboratory (Berkeley Lab) are looking to change that perception with the successful testing of a laser-based MRI technique that would make the technology compact and portable, relatively cheap, and quiet. 提到“磁共振成像”，绝大多数人都会想到医院里特别治疗室里面的那台油煎饼状，费用高昂而且噪声很大的巨大机器。美国能源部劳伦斯伯克利实验室（伯克利实验室）里的研究人员正在试图通过对基于激光的磁共振成像技术的检验来使这项技术浓缩而且变得轻便，价格下降，噪声也会减少，以此来改变对磁共振成像的传统观念。 “We have developed a novel approach for the detection of MRI based on optical atomic magnetometry,” said chemist Alexander Pines, one of the world’s leading authorities on NMR/MRI technology. Pines holds a joint appointment as a chemist with Berkeley Lab’s Materials Sciences Division and with UC Berkeley, where he is the Glenn T. Seaborg Professor of Chemistry. “Our technique provides a viable alternative for MRI detection with substantially enhanced sensitivity and time resolution for various situations where traditional MRI is not optimal.” “我们已经找到了一条探测基于旋光原子磁力测定的磁共振成像的新奇途径，”化学家Alexander Pines说，他是全世界NMR/MRI 技术领域中的一位领导性权威，既是伯克利实验室材料科学部的化学家，也是英国伯克利实验室的化学权威，“我们的技术为磁共振成像探测提供了丰富的选择，使它的灵敏度和时间分辨能力获得实质性的提高，可以在传统磁共振成像不能作为最佳措施的情况下使用。” Pines led the development of this new MRI technique along with Dmitry Budker, who holds a joint appointment with Berkeley Lab’s Nuclear Science Division and UC Berkeley’s Physics Department. Shoujun Xu, a member of Pines’ research group, conducted the MRI measurements. The three were co-authors of a paper about this technique which appeared in the Aug 22 edition of the Proceedings of the National Academy of Science (PNAS). Other authors of the PNAS paper were Valeriy Yashchuk, Marcus Donaldson and Simon Rochester. Pines 同Dmitry Budker一起促进了这项新的磁共振成像技术的发展，后者同时在伯克利实验室原子核科学部和英国伯克利实验室物理部任职。Shoujun Xu作为Pines研究组里的成员之一，负责管理磁共振成像的测量工作。这三个人作为联合作者在国家学院科学进展杂志8月22号期刊上发表了一篇关于这项技术的文章，其他联合作者为Valeriy Yashchuk, Marcus Donaldson 和 Simon Rochester 。 MRI, which stands for magnetic resonance imaging, and its sister technology, nuclear magnetic resonance (NMR) spectroscopy, are based on a property of atomic nuclei with an unpaired proton or neutron called “spin.” Such nuclei spin on an axis like miniature tops, giving rise to a magnetic moment, which means the nuclei act as if they were bar magnets with a north and south pole. When exposed to an external magnetic field, these spinning "bar magnets" attempt to align their axes along the lines of magnetic force. Since the alignment is not exact, the result is a wobbling rotation, or “precession,” that’s unique to each type of atom. 磁共振成像（MRI）和它的孪生技术核磁共振光谱法都是建立在带有一个未配对的质子或中子的原子核的自旋特性的基础上的。这种原子核像缩微的陀螺围绕一根轴线自旋，产生磁性，像具有S极和N极的磁铁棒一样。当这些自旋的磁铁棒暴露在外部磁场中时，它们就试图将自己的轴线按照磁场力的方向排成直线。由于这种排列并不精确，所以结果就是原子不规则的旋转，或者称为“先行”，对于每一个原子都是不同的。 If, while exposed to the magnetic field, the precessing nuclei are also hit with a radiofrequency (rf) pulse, they will absorb and re-emit energy at specific frequencies according to their rate of precession. When the rf pulse is combined with magnetic field gradients, a spatially encoded signal is produced that can be detected and translated into images. 当暴露在外界磁场中的时候，旋进的原子核也会被射频脉冲击中，它们会吸收并且根据旋进率再释放特殊频率的能量。当射频脉冲与磁场梯度联合起来时，我们可以探测到一个空间编码信号的产生并且将它转变成图像。 Obtaining a spatially encoded MRI signal from a sample depends upon polarizing the spins of its precessing nuclei so that an excess points in one direction, either “up” or “down.” Conventional MRI technology uses an exceptionally strong external magnetic field to produce a detectable signal. The stronger the magnetic field, the stronger the signal, which means a large and expensive cryogenic high-field magnet. 从样本中获得一个空间编码的MRI信号是由样本内旋进原子核的自旋极性决定的，因为这样会产生过量的信号指向一个方向，“向上”或者是“向下”。传统的磁共振技术使用一个特别强的外部磁场来产生一个可探测的信号。磁场越强，信号越强，这相当于一个庞大昂贵并且产低温的***度磁铁。 A smaller magnet results in less polarization and a weaker MRI signal, which therefore requires a more sensitive means of signal detection. One alternative being explored is the use of SQUIDs (superconducting quantum interference devices), which can detect the faintest of magnetic signals but must be cooled to a temperature of near absolute zero. This requirement makes SQUIDs expensive and somewhat tricky devices to use. It also limits the situations in which they can be effectively deployed. 如果磁铁比较小，那么产生的极性和MRI信号就弱，这样就要求有更高敏感度的信号探测工具。一个处于开发中的选择就是超导量子干扰仪器（SQUIDs）的使用,这种仪器可以探测到极微弱的磁场信号，但是必须被冷却到接近绝对零度。这一要求使得SQUIDs的使用变得昂贵而且困难，同时也限制了它们能够被有效利用的情况。 The alternative MRI technology being developed by Pines, Xu, Budker and their colleagues is also highly sensitive to low-field magnetic signals but offers the enormous advantage of being operable at room temperatures. 另一种由Pines, Xu, Budker 和他们的同事发现的MRI技术也对低强度磁场信号有很高的灵敏度，但是，这一技术可以在室温下进行操作，因而具有很大的优势。 Said Xu, “Our technique has comparable sensitivity with SQUIDs, but the fact that it does not require superconducting magnets or cryogenics significantly reduces the cost and maintenance of the apparatus, and opens the technology up to a broader range of applications. Furthermore, our technique has simple electronics that can be easily integrated into detector arrays.” Shoujun Xu说：“我们的技术拥有可以与SQUIDs相比的灵敏度，但是这一技术不需要超导磁体或者低温产生装置，这样就使得仪器的成本和维修费用显著降低，而且这一技术的应用前景也相对更加广阔。更重要的是我们的技术中含有简单的电子元件可以很容易的被整合到探测芯片当中。” This new laser-based approach to MRI is derived from two technological advances. One, developed by the Pines’ research group, physically separates the two basic steps of MRI, signal encoding and detection. Physically separating these two steps enables each to be optimized for sensitivity. The other advance, developed by the Budker research group, is a highly sensitive atomic magnetometer that’s based on a phenomenon called “nonlinear magneto-optical rotation.” With this magnetometer, a sample of alkali atoms featuring a single unpaired electron is vaporized in a glass cell. The unpaired electron makes the atoms themselves act like spinning bar magnets, with a magnetic moment three orders of magnitude stronger than that of precessing nuclei. 这种新的建立在激光基础上的磁共振显影途径是从两个技术性进步发展而来的。其中一个是由Pines的研究组建立的，通过物理的方法将磁共振显影的两个基本步骤分开，即信号编码与探测。将这两个步骤通过物理方法分开可以使各自的灵敏度达到最优水平。另一个进步，是由Budker研究小组建立起来的，是一个建立在非线性磁场旋光转动现象的基础上的高度灵敏的原子磁力计。通过这个磁力计，一个带有未配对电子的碱性原子在玻璃小室中气化。这一未配对电子使得原子自身像自旋的磁铁棒一样，在磁性环境中比旋进的原子核的强度高了三个级别。 A beam of laser light “pumps” the atoms so that their spins are polarized, then “probes” the polarized atoms for an MRI signal. 一束激光将原子泵出，使得它们的自旋带有极性，然后探测拥有极性的原子来产生MRI信号。 According to Budker, instead of the multimillion dollar costs of a conventional MRI system, this alternative MRI technology would cost only a few thousand dollars to implement. 据Budker所说，与花费数百万美元的传统MRI系统相比，这种MRI技术的应用只花费几千美元。 “Our system is fundamentally simple and does not involve any single expensive component,” Budker said. “We anticipate that the whole apparatus will become quite compact and deployable as a battery-powered portable device.” “我们的系统本质上是很简单的而且不包含任何单个的昂贵组件，”Budker说“我们预计整套仪器会变得相当紧凑并且像电池供电的可移动仪器一样的应用。” In the MRI system that the Berkeley researchers tested, the fluid to be imaged, water, was passed through two small cells for signal encoding, then transported to a U-shaped detection area for interrogation by a pair of Budker’s magnetometers. The magnetometers were oriented so that they detected the MRI signal with opposite signs. This configuration dramatically improved the signal-to-noise ratio, enabling the researchers to detect an MRI signal from microliters of water in 0.1 second without the presence of a strong magnet. 在伯克利实验室研究人员测试的MRI系统中，被造影的液体，水，流过两个小槽来进行信号编码，然后被运送到一个U型的探测区接受一对Budker’s磁力计的检测。磁力计被定向放置因此他们可以检测拥有相反标记的MRI信号。这种配位极大地提高了信噪比率，使得研究人员可以不使用强磁铁在0.1秒内从几微升水中探测到一个MRI信号。 “We are continuing to optimize our system, in both sensitivity and detection efficiency, to make this technique suitable for microfluidics and biological objects with sizes in the micrometer regime,” said Xu. “In addition, further consolidation of the apparatus is underway so that the whole setup becomes portable and therefore can be conveniently utilized as an in-line analytical instrument for monitoring chemical reactions and biological processes.” “我们还在继续将我们的系统在灵敏度和探测效率方面进行最优化，以使得这项技术适用于测微制度下的微流量生物对象。” Shoujun Xu说。“另外，仪器之间的进一步整合也已经开始，这样整套设备变得轻便从而作为一个用于监测化学反应和生物过程的同轴分析仪器更加易于使用。 －－－－－－－－－－－－－－－－－－－－－－－－－－－ Shoujun Xu, a member of the research group of Berkeley Lab chemist and NMR/MRI expert Alexander Pines, conducted the measurements that demonstrated a new low-cost, portable MRI technology. Shoujun Xu，伯克利实验室化学家、NMR/MRI专家Alexander Pines研究组的成员之一，处理了一组显示一项新的低廉轻便的MRI技术的测量数据 This volume of water was imaged using an MRI technology based on remote sensing and optical atomic magnetometry. It was developed under the leadership of Berkeley Lab scientists Alexander Pines and Dmitry Budker 通过使用建立在遥感和旋光原子磁场仪基础上的MRI技术测定了以下剂量的水。这一技术是在伯克利实验室科学家Alexander Pines和Dmitry Budker的领导下建立起来的。 Dmitry Budker is a staff scientist with Berkeley Lab’s Nuclear Sciences Division and a professor of physics at UC Berkeley. Dmitry Budker是伯克利实验室原子核科学部的科学家成员以及英国伯克利实验室的物理教授。 September 02 第二篇翻译稿（完成于9.3日凌晨1：30）Skeletonized Internal Thoracic Artery Harvest Reduces Pain and Dysesthesia and Improves Sternal Perfusion After Coronary Artery Bypass Surgery
Background— Observational studies suggest that skeletonization of the internal thoracic artery (ITA) can improve conduit flow and length and reduce deep sternal infections and postoperative pain. We performed a randomized, double-blind, within-patient comparison of skeletonized and nonskeletonized ITAs in patients undergoing coronary surgery.
Methods and Results— Patients (n=48) undergoing bilateral ITA harvest were randomized to receive 1 skeletonized and 1 nonskeletonized ITA. Intraoperatively, ITA flow was assessed directly and with a Doppler flow probe before and after topical application of papaverine. ITA harvest time and conduit length were recorded. A blinded assessment of pain (visual analog scale) and dysesthesia (physical examination) was performed at discharge, at 2 weeks, and at a 3-month follow-up. Sternal perfusion was assessed with nuclear imaging (n=7). Skeletonization required longer ITA harvest times (27±1 versus 24±1 minutes; P=0.04). There was a trend toward increased ITA length in the skeletonized group (18.2±0.3 versus 17.7±0.3 cm; P=0.09). In situ ITA flow was lower in skeletonized arteries (7.4±0.9 versus 10.1±1.0 mL/min; P=0.01) and increased significantly after ITA division and papaverine application. Postanastomotic flows were similar between groups. Skeletonization was associated with decreased pain at the 3-month follow-up and a reduction in major sensory deficits at the 4-week and 3-month (17% versus 50%; P=0.002) follow-ups. Baseline adjusted sternal perfusion was significantly greater by 17±6% (P=0.03) on the skeletonized side.
Conclusions— Skeletonization results in reduced postoperative pain and dysesthesia and increased sternal perfusion at follow-up but does not produce increased conduit flow. ITA skeletonization may be a strategy for reducing morbidity after CABG.
骨骼化的胸廓内动脉采集术减少了冠状动脉搭桥手术后疼痛和感觉迟钝的发生，并增长了胸骨内灌流量
背景：观测研究表明胸廓内动脉的骨骼化可以改善导管内血流量和导管长度，并减少胸廓深部感染以及术后疼痛。我们在接受了冠状动脉手术的胸扩内动脉骨骼化患者及未发生骨骼化的患者之间进行了一次随即双盲的对比。
方法与结果：接受双侧胸廓内动脉采集手术的患者（n＝48）随即植入一根骨骼化和一根非骨骼化的胸廓内动脉。在手术过程中，胸廓内动脉的流量经过直接测量以及局部应用帕帕非林前后通过多普勒血流探针测量。胸廓内动脉的采集时间以及导管长度都记录了下来。在手术刚刚结束，手术后两周，手术后三个月的时候分别对疼痛（通过直观类比标度测量）和感觉迟钝（通过生理检查测量）进行了一次非针对性的检测。胸骨内灌流通过核成像技术进行测量（n＝7）。骨骼化的一组要求有更长的胸廓内动脉采集时间（27±1分钟，相对于24±1分钟，P=0.04）。在骨骼化一组中，胸廓内动脉的长度有增长的迹象（18.2±0.3厘米，相对于17.7±0.3厘米，P＝0.09）。在正常体位下骨骼化的胸扩内动脉中血流量降低（7.4±0.9毫升每分钟，相对于10.1±1.0毫升每分钟，P＝0.01），但在胸廓内动脉分支处及应用了帕帕非林后出现显著的增加。在两组患者中，吻合支后血流量基同。在胸廓内动脉骨骼化的患者中，三个月后疼痛降低，并且在手术后四个星期到三个月的时间内出现感觉迟钝有所减少（17％相对于50％，P=0.002）。同时对于这些患者，基线调节后的胸骨内灌流量明显增加（增长幅度为17±6%，P=0.03）。
结论：胸扩内动脉的骨骼化使得术后疼痛及感觉迟钝的发生减少，并且增加了随后的胸骨内灌注量，但它并不能使得导管内血流量增加。胸扩内动脉骨骼化可能作为一项降低冠状动脉旁路移植术后发病率的手段而发挥作用。
September 01 第一次参加专业翻译(9.1晚10点31分)这次是我第一次参与丁香园的翻译工作，深刻的感到自己英语尤其是专业英语的不足，下定决心，将翻译持之以恒，锻炼自己。
Health Services and Outcomes Research
3、The Economic Burden of Angina in Women With Suspected Ischemic Heart Disease Background— Coronary angiography is one of the most frequently performed procedures in women; however, nonobstructive (ie, <50% stenosis) coronary artery disease (CAD) is frequently reported. Few data exist regarding the type and intensity of resource consumption in women with chest pain after coronary angiography. Methods and Results— A total of 883 women referred for coronary angiography were prospectively enrolled in the National Institutes of Health–National Heart, Lung, and Blood Institute–sponsored Women’s Ischemia Syndrome Evaluation (WISE). Cardiovascular prognosis and cost data were collected. Direct (hospitalizations, office visits, procedures, and drug utilization) and indirect (out-of-pocket, lost productivity, and travel) costs were estimated through 5 years of follow-up. Among 883 women, 62%, 17%, 11%, and 10% had nonobstructive and 1-vessel, 2-vessel, and 3-vessel CAD, respectively. Five-year cardiovascular death or myocardial infarction rates ranged from 4% to 38% for women with nonobstructive to 3-vessel CAD (P<0.0001). Five-year rates of hospitalization for chest pain occurred in 20% of women with nonobstructive CAD, increasing to 38% to 55% for women with 1-vessel to 3-vessel CAD (P<0.0001). The volume of repeat catheterizations or angina hospitalizations was 1.8-fold higher in women with nonobstructive versus 1-vessel CAD after 1 year of follow-up (P<0.0001). Drug treatment was highest for those with nonobstructive or 1-vessel CAD (P<0.0001). The proportion of costs for anti-ischemic therapy was higher for women with nonobstructive CAD (15% versus 12% for 1-vessel to 3-vessel CAD; P=0.001). For women with nonobstructive CAD, average lifetime cost estimates were $767 288 (95% CI, $708 480 to $826 097) and ranged from $1 001 493 to $1 051 302 for women with 1-vessel to 3-vessel CAD (P=0.0003). Conclusions— Symptom-driven care is costly even for women with nonobstructive CAD. Our lifetime estimates for costs of cardiovascular care identify a significant subset of women who are unaccounted for within current estimates of the economic burden of coronary heart disease.
疑似缺血性心脏病女性患者的心绞痛经济负担 背景：冠状动脉造影术是在女性患者中最常采用的手术步骤，但是非梗阻性冠状动脉疾病（并发感染性心内膜炎，狭窄度<50%）的发生时有报道。但是关于患有胸痛的妇女经过冠状动脉造影术之后对营养合剂消化吸收的类型和强度，这方面的数据十分稀少。 方法及结果：共有883名与冠状动脉造影术相关的妇女由女性缺血综合征评价活动赞助预先在国家健康研究所（国家心肺及血液研究所）注册。由此获得了关于心血管疾病的预后以及开销数据,在接下来的5年内，对于直接花费（住院，就诊，手术以及用药）和间接花费（误工，生产力下降，交通）作出了估计。在883名妇女中，非梗阻性/一级/二级/三级冠状动脉疾病的比率分别是62％、17％、11％、10％。五年内从非梗阻性到三级冠状动脉疾病的女性患者中发生心血管疾病死亡或者心肌梗死的比率为4％到38％（P<0.0001），五年中非梗阻性冠状动脉疾病女性患者因为胸痛而住院的几率为20％，而此几率在一级到三级患者中增长到38％～55％（P<0.0001）。一年以后非梗阻性冠状动脉疾病患者插管以及因心绞痛而住院的数量比一级冠状动脉疾病患者多1.8倍（P<0.0001）。对于这两种类型的患者，药物治疗的费用是最高的（P<0.0001）。防缺血疗法花费所占的比率方面，非梗阻性冠状动脉疾病患者最高（15％，相对于一级到三级冠状动脉患者的12%，P＝0.0001），对于非梗阻性冠状动脉疾病的女性患者，一生的平均医疗开销为767，288美元（95％CI,从708，480美元到826，097美元），对于一级到三级冠状动脉疾病女性患者，平均医疗开销从1，001，493美元到1，051，302美元不等（P＝0.0003）。 结论：即使是对患有非梗阻性冠状动脉疾病的女性患者，与她们的疾病症状相对应的护理也是相当昂贵的。通过对一生中心血管疾病护理的开销的评估，我们可以分辨出这样一个类别的妇女，对当前冠状动脉心脏病所造成的经济负担她们并不具有一个合乎时宜的估计。
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