Objective:To investigate the relationship between preoperative high-sensitivity C-reactive protein (Hs-CRP) levels and clinical outcomes of patients undergoing off-pump coronary artery bypass graft (OPCABG) surgery.Methods:We prospectively selected 123 patients who received OPCABG at Beijing Anzhen Hospital from January 2019 to October 2019, and collected relevant preoperative and postoperative data. Patients were divided into a normal Hs-CRP group(78 cases) and an elevated Hs-CRP group(45 cases)according to the cutoff value (2 mg/L) of Hs-CRP level. The data of the two groups were compared, and regression analysis was performed on the postoperative data with differences to define independent factors.Results:The leukocyte count in the Hs-CRP group was significantly higher than that in the normal Hs-CRP group[(6.5±1.6)×10 9/ml vs. (7.4±2.1) ×10 9/ml, t=-2.839, P=0.005]. In the elevated Hs-CRP group, proportion of patients with atrial post-CABG atrial fibrillation (38% vs. 19%, χ2=5.100, P=0.024), duration of hospitalization[(21.2±7.1)days vs.(16.0±4.6)days, t=-4.469, P=0.000], hospital costs[(143.1±30.7)×10 3 yuan vs. (123.7±21.8)×10 3 yuan, t=-4.090, P=0.000]were significantly higher than those in the normal Hs-CRP level group. Smoking ( OR=1.660, 95% CI: 1.186-1.993, P=0.031) and Hs-CRP ( OR=1.170, 95% CI: 1.050-1.294, P=0.007) were independent risk factors for post-CABG atrial fibrillation. Hs-CRP ( B=0.436, 95% CI: 0.197-0.675, P=0.000) and left ventricular ejection fraction (LVEF, B=-0.180, 95% CI: -0.289--0.071, P=0.001) were independent influencing factors of duration of hospitalization. Hypertension ( B=-11.256, 95% CI: -20.670--1.842, P=0.020), Hs-CRP( B=1.235, 95% CI: 0.217-2.254, P=0.018) and LVEF ( B=-1.168, 95% CI: -1.634--0.702, P=0.000) were independent influencing factors of hospital costs. Conclusion:The preoperative Hs-CRP level of OPCABG is an independent influencing factor of post-CABG atrial fibrillation, duration of hospitalization and hospital costs. This finding lays the foundation for Hs-CRP combined with other indicators to accurately predict the prognosis of OPCABG and screen high-risk patients.

Objective To investigate the changes in the expression levels of serum glutathione peroxidase 3(GPX3)and aquaporin 9(AQP9)in pregnant women with gestational diabetes mellitus(GDM)and their relationships with pregnancy outcomes.Methods A total of 200 pregnant women with GDM(GDM group)and 200 healthy pregnant women(control group)were enrolled as study subjects.The GDM group was further divided into adverse pregnancy outcome(APO)subgroup(n=22)and favorable pregnancy outcome subgroup(n=178)based on pregnancy outcomes.The expres-sion levels of serum GPX3 and AQP9 were detected by enzyme-linked immunosorbent assay.Multivari-ate Logistic regression analysis was used to screen for influencing factors of APO in GDM pregnant women.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive perform-ance of serum GPX3 and AQP9 expression levels for APO in GDM pregnant women.Results Com-pared with the control group,the serum GPX3 expression level was decreased,and the serum AQP9 ex-pression level was increased in the GDM group(P＜0.05).The incidence of APO among the 200 GDM pregnant women was 11.00％(22/200).Compared with the favorable pregnancy outcome subgroup,the APO group had higher levels of homeostasis model assessment-insulin resistance index(HOMA-IR),fasting blood glucose,glycated hemoglobin(HbA1c),and AQP9,and lower levels of GPX3(P＜0.05).Multivariate Logistic regression analysis revealed that elevated HOMA-IR,HbA1c,and AQP9 were independent risk factors for APO in GDM pregnant women(P＜0.05),while elevated GPX3 was an independent protective factor(P＜0.05).The ROC curve showed that the areas under the curve(AUCs)for predicting APO in GDM pregnant women were 0.784(95％CI,0.673 to 0.881)for serum GPX3 alone,0.788(95％CI,0.687 to 0.894)for serum AQP9 alone,and 0.906(95％CI,0.805 to 0.972)for their combination,with the AUC for the combined prediction being greater than that for individual prediction(P＜0.05).Conclusion The serum GPX3 expression level is de-creased,and the serum AQP9 expression level is increased in GDM pregnant women.Both serum GPX3 and AQP9 are independent influencing factors for APO,and their combined prediction has a higher value for APO in GDM pregnant women.

Objective To investigate the changes in the expression levels of serum glutathione peroxidase 3(GPX3)and aquaporin 9(AQP9)in pregnant women with gestational diabetes mellitus(GDM)and their relationships with pregnancy outcomes.Methods A total of 200 pregnant women with GDM(GDM group)and 200 healthy pregnant women(control group)were enrolled as study subjects.The GDM group was further divided into adverse pregnancy outcome(APO)subgroup(n=22)and favorable pregnancy outcome subgroup(n=178)based on pregnancy outcomes.The expres-sion levels of serum GPX3 and AQP9 were detected by enzyme-linked immunosorbent assay.Multivari-ate Logistic regression analysis was used to screen for influencing factors of APO in GDM pregnant women.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive perform-ance of serum GPX3 and AQP9 expression levels for APO in GDM pregnant women.Results Com-pared with the control group,the serum GPX3 expression level was decreased,and the serum AQP9 ex-pression level was increased in the GDM group(P＜0.05).The incidence of APO among the 200 GDM pregnant women was 11.00％(22/200).Compared with the favorable pregnancy outcome subgroup,the APO group had higher levels of homeostasis model assessment-insulin resistance index(HOMA-IR),fasting blood glucose,glycated hemoglobin(HbA1c),and AQP9,and lower levels of GPX3(P＜0.05).Multivariate Logistic regression analysis revealed that elevated HOMA-IR,HbA1c,and AQP9 were independent risk factors for APO in GDM pregnant women(P＜0.05),while elevated GPX3 was an independent protective factor(P＜0.05).The ROC curve showed that the areas under the curve(AUCs)for predicting APO in GDM pregnant women were 0.784(95％CI,0.673 to 0.881)for serum GPX3 alone,0.788(95％CI,0.687 to 0.894)for serum AQP9 alone,and 0.906(95％CI,0.805 to 0.972)for their combination,with the AUC for the combined prediction being greater than that for individual prediction(P＜0.05).Conclusion The serum GPX3 expression level is de-creased,and the serum AQP9 expression level is increased in GDM pregnant women.Both serum GPX3 and AQP9 are independent influencing factors for APO,and their combined prediction has a higher value for APO in GDM pregnant women.

Objective:To investigate the effect and mechanism of obstructive sleep apnea hypopnea syndrome(OSAHS) on nocturnal angina in patients who undergo coronary artery bypass grafting(CABG).Methods:According to the inclusion criteria and exclusion criteria, this prospective observational study included 76 patients who underwent CABG at Beijing Anzhen Hospital affiliated to Capital Medical University from January 2018 to December 2018. Patients included 60 males and 16 females, mean aged(61.4±7.3) years, BMI(25.7±2.3) kg/m 2. Portable sleep respiration monitoring and bedside ECG monitoring were performed before surgery. According to the apnea index(AHI), patients were divided into mild or no OSAHS group(AHI<15, 35 patients) and moderate to severe OSAHS group(AHI≥15, 41 patients). Baseline data, hematologic examination, degree of coronary stenosis, sleep breathing examination, night time heart rate and incidence of atrial fibrillation, and nocturnal angina were compared between the two group. Results:Combined with mild or no OSAHS group, moderate to severe OSAHS group had a significantly higher syntax-score(47.3±10.6 vs 35.1±6.8), a significantly higher proportion of coronary diffuse lesions(53.7% vs 31.4%), a significantly faster heart rate[(94.3±21.5)times/min vs(74.8±10.0) times/min], a significantly higher proportion of nocturnal angina(29.2% vs 2.9%). The differences were statistically significant( P<0.05). Binary logistic regression analysis showed that the fastest heart rate at night significantly affected the occurrence of nocturnal angina in CABG patients( OR=1.320, 95% CI: 1.084-1.607, P=0.006), the syntax-score, the fastest heart rate at night significantly affected the degree of OSAHS in CABG patients( OR=1.269, 95% CI: 1.094-1.473, P=0.002; OR=1.066, 95% CI: 1.004-1.131, P=0.036). Two linear regression showed a significant linear correlation between AHI with the fastest heart rate and syntax-score at night( R2=0.576, P<0.001; R2=0.658, P<0.001). Conclusion:OSAHS can significantly aggravate the degree of coronary artery stenosis in CABG patients, and further increase the incidence of nocturnal angina by significantly increasing nighttime heart rate.

Objective:To investigate the predictive value of preoperative left atrial diameter in postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) in patients with coronary artery disease (CAD) and its influencing factors.Methods:This study was a prospective observational study. A total of 113 patients with CABG surgery were enrolled in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2020 to December 2020. Preoperative coronary angiography, echocardiography and blood test were finished. The number of graft vessel was counted during the operation. The occurrence of POAF was confirmed by electrocardiogram or electrocardiograph monitoring after surgery. The preoperative baseline data, blood test, perioperative complications and other indicators of patients with or without POAF were compared.Results:According to the inclusion criteria and exclusion criteria, 90 patients undergoing CABG were enrolled in the study[71 males and 19 females, aged from 42 to 75, mean age (62±8)years old]. The incidence of POAF was 27.8%(25 cases). The left atrial diameter[40(36-43)mm vs. 35(33-37)mm, P=0.00]and troponin I[4.76(0.87-13.60)ng/ml vs. 1.48(0.56-4.52)ng/ml, P=0.04] in patients with POAF were significantly higher than that in patients without POAF. Compared to patients without POAF, POAF significantly increased the incidence of stroke[4(16%) vs. 0(0), P=0.01], ICU stay[67(24-96) days vs. 22(19-41) days, P=0.00] and hospital stay[21(19-24) days vs. 16(14-24) days, P=0.05]. Binary logistic regression showed that left atrial diameter was significantly correlated with the occurrence of POAF ( OR=1.9, 95% CI: 1.39-2.79, P<0.001). ROC curve analysis showed that 40 mm of left atrial diameter was a predictor of POAF( AUC=0.82, sensitivity 52%, specificity 100%, P<0.001). Linear regression analysis showed that left atrial diameter was significantly positively correlated with hypersensitive C-reactive protein ( Beta=0.24, 95% CI: 0.00-0.26, P=0.043). Conclusion:POAF significantly increased the incidence of stroke after CABG. Preoperative left atrial diameter is an independent predictor for POAF, which is closely related to the systemic inflammatory response.