自发高血压大鼠左心室心肌胶原含量与舒张功能的相关性研究

目的测定自发高血压大鼠(SHR)左心室心肌胶原含量和舒张功能的参数,探讨二者的相关性,并揭示它们的增龄性改变。方法雄性SHR共30只(8、14周和20周各8只,32周6只),行组织多普勒成像(TDI)检测左心室舒张功能。处死后取左心室心肌,用羟脯氨酸试剂盒测定羟脯氨酸含量;反转录-聚合酶链反应(RT-PCR)检测Ⅰ型和Ⅲ型胶原的mRNA表达。结果 TDI显示,二尖瓣环舒张早期速度(Ea)随增龄减低(P0.05),二尖瓣环舒张早期与晚期速度比值(Ea/Aa)32周比8周时减低(P0.01),左心室等容舒张时间(TVRT)随增龄延长(P0.05),Tei指数随增龄增加(P0.05)。心肌羟脯氨酸含量、Ⅰ型和Ⅲ型胶原的mRNA表达随增龄均增加(均为P0.05)。羟脯氨酸含量、Ⅰ型和Ⅲ型胶原mRNA表达与TDI指标Ea、Ea/Aa均早负相关(r=-0.713～-0.431,P0.001～0.05),与IVRT均呈正相关(r=0.427～0.721,P0.001～0.01),与Tei指数均呈正相关(r=0.413～0.576,P0.001～0.01)。结论 SHR左心室心肌胶原含量呈增龄性增加,舒张功能呈增龄性降低,二者具有相关性。     

二尖瓣环运动速度在冠状动脉病变患者心室功能评价中的应用

随机选取因胸痛而行冠状动脉（冠脉）造影检查的患者56例,根据冠脉造影结果,41例确诊冠心病的患者被分为1支病变组、2支病变组和3支病变组,另外15例排除冠心病者作为对照组。采用组织多普勒成像技术测定各组二尖瓣环室间隔、心室侧壁、前壁与下壁四个位点的收缩期、舒张早期和晚期组织运动速度,比较对照组与各病变组二尖瓣环收缩期（Sa）、舒张早期（Ea）、舒张晚期（Aa）组织运动速度和Ea/Aa。结果显示,对照组与各病变组之间的Sa与Aa相比,P均〉0.05,Ea和Ea/Aa相比,P均〈0.05;三个病变组的Sa、Ea、Aa和Ea/Aa相比,P均〉0.05。认为冠心病患者心室舒张功能先于收缩功能受损,采用组织多普勒成像技术检测二尖瓣环组织运动速度,可为评价冠脉病变患者的心室功能提供参考依据。     

稳心颗粒对大鼠心肌肥厚的影响及作用机制研究

目的 观察稳心颗粒对大鼠心肌肥厚的影响,并探讨其相关机制.方法 将30只大鼠随机分为对照组、异丙肾上腺素(ISO)组和ISO +稳心颗粒组,每组10只.检测心脏质量/体质量(HW/BW)及左室质量/体质量(LVW/BW),观察心肌细胞β-连环蛋白(β-catenin)及c-myc蛋白的变化被观察.结果 与对照组比较,ISO组大鼠HW/BW和 LVW/BW明显增加(P<0.05),β-catenin及c-myc蛋白表达明显增加(P<0.05);与ISO组比较,ISO+稳心颗粒组大鼠HW/BW和 LVW/BW明显降低(P<0.05),β-catenin及c-myc蛋白表达明显减少(P<0.05).结论 稳心颗粒可明显减轻大鼠心肌肥厚,这可能与β-catenin及c-myc蛋白表达的变化有关.     

多普勒组织成像技术评价血运重建对急性心肌梗死患者心功能的影响

目的 应用多普勒组织成像(DTI)评价血运重建对急性心肌梗死(AMI)患者心功能的影响.方法 对65例AMl患者分别予以常规强化内科保守治疗(常规治疗组,20例)和在此基础上的血运重建治疗(血运重建组,45例).应用二维超声心动图和DTI分别观察两组AMI后1周、3个月及6个月的左室射血分数(LVEF)、二尖瓣血流舒张早期流速与心房收缩期流速的比值(VE/VA)、二尖瓣环6个位点节段的二尖瓣环收缩期运动速度峰值(Sa)、舒张早期运动速度峰值(Ea)和舒张晚期运动速度峰值(Aa).20名健康人为对照组.结果 常规治疗组和血运重建组各时点亚组的LVEF、VE/VA、Sa和Ea及常规治疗组3个月和6个月亚组的Ea/Aa均小于对照组(P<0.05),血运重建组3个月、6个月亚组的Sa、Ea和6个月亚组的LVEF较常规治疗组显著升高(P<0.05),而两组同时点各亚组间的VE/VA、Aa及Ea/Aa比较,差异无统计学意义(P>0.05).结论 血运重建是改善AMI后左室收缩、舒张功能的重要手段.DTI技术在评价AMI后心脏整体收缩、舒张功能变化方面较二维超声心动图更为敏感.     

血清脂联素对高血压患者心肌背向散射积分和左室心肌质量的影响

目的探讨血清脂联素(APN)对高血压患者心肌背向散射积分和左室心肌质量的影响。方法高血压患者88例为高血压组,健康体检者80例为对照组,取空腹肘静脉血测定葡萄糖(GLU)、甘油三酯(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),采用放射免疫法取血浆测定APN水平及超敏C反应蛋白(hs-CRP),HP Sonos 5500型超声诊断仪测定背向散射积分(IBS)周期变化幅度(CVIB),并计算平均CVIB(ACVIB)。利用脉冲多普勒超声心动图,测定左室功能相关指标。结果与对照组比较,高血压组APN水平明显降低,hs-CRP水平明显升高(均P<0.01);与对照组比较,高血压组二尖瓣口峰值流速(E/A)、舒张早晚期运动速度(Ea)、舒张晚期运动速度(Ea/Aa)、舒张早期左室内血流传播速度(Vp)、ACVIB值显著降低,E峰下降时间(DT)、等容舒张时间(IVRT)显著增大(P<0.05);高血压患者E/A、DT、IVRT、Ea、Ea/Aa、Vp与左室心肌ACVIB的变化呈高度相关性(P<0.05)。结论 APN可作为评价高血压患者的重要检测指标;ACVIB的降低与心肌功能的减退密切相关,观察左室心肌ACVIB的变化,可用于评估高血压患者的左室功能。     

缬沙坦对压力超负荷下心脏多聚二磷酸腺苷核糖合成酶活性的影响

目的:观察缬沙坦对慢性压力超负荷下左心室心肌多聚二磷酸腺苷(ADP)核糖合成酶(PARP)活性、心脏形态及心功能的影响.方法:Wistar雄性大鼠34只随机分为假手术组(sham组)10只、腹主动脉缩窄组(AC组)12只、腹主动脉缩窄加缬沙坦干预结扎组(Val组)12只.术后24周行心脏超声和血流动力学检查,并取左心室心肌检测PARP活性.结果:与sham组比较,AC组PARP活性显著增强(P＜0.01),左心室质量/体重(LVW/BW)显著升高(P＜o.05),左心室射血分数显著降低(P＜o.05);与AC组比较,Val组PARP活性显著减弱(P＜0.01),LVW/BW显著降低(P＜0.05),左心室射血分数明显升高(P＜0.05).结论:缬沙坦可抑制压力负荷下心室肌PARP过度激活,并减轻心室重构及心功能的损害.     

阿托伐他汀对1型糖尿病心肌病大鼠心肌纤维化的作用及机制探讨

目的观察阿托伐他汀对1型糖尿病心肌病(DCM)大鼠心肌纤维化的作用,并探讨其可能的机制。方法将50只Wistar大鼠随机分为A、B组各15只和C、D组各10只,A、B组腹腔注射链尿佐菌素(STZ)70 mg/kg造模,C、D组腹腔注射等体积柠檬酸缓冲液。B、D组给予阿托伐他汀5 mg/kg灌胃1次/d,A、C组给予等体积生理盐水灌胃。监测大鼠体质量、空腹血糖,造模8周时超声检测心脏左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室后壁厚度(LVPWD)、短轴缩短率(FS)、射血分数(EF);取心脏组织,计算心脏重量与体质量的比值(HW/BW),Masson染色观察心肌组织纤维化,Western bolt法检测心肌组织中的表皮生长因子受体(EGFR)蛋白。结果造模2周后开始,A、B组体质量较C、D组显著降低(P均<0.05),空腹血糖明显升高(P均<0.01);造模8周时,与C、D组比较,A组LVESD、LVPWD、HW/BW增加(P均<0.05),EF值降低(P均<0.05),B组较A组LVESD、LVPWD、HW/BW、EF值变化程度小(P均<0.05);Masson染色可见A组心肌纤维细胞增生明显,B组较A组增生减少(P<0.05)。A、B组心肌组织EGFR蛋白表达水平高于C、D组(P均<0.05),B组表达水平低于A组(P<0.01)。结论阿托伐他汀能够减轻DCM大鼠心肌纤维化,该作用与其降低心肌组织中EGFR蛋白表达有关。     

Apelin-13在自发性高血压大鼠心肌组织的表达及其与心肌肥厚和心功能的关系

目的观察Apelin-13在自发性高血压大鼠(SHR)心肌组织的表达改变,探讨其与心肌肥厚和心功能的关系。方法选取清洁级4周龄和20周龄雄性自发性高血压大鼠和WKY(Wistar-Kyoto)大鼠,按周龄及种属分为4组,每组8只。分别测定无创尾动脉血压及心脏质量指数;超声心动图和血流动力学系统评估心室重构和心功能;HE染色评价心肌细胞及排列情况。Western blot法检测心肌组织Apelin-13、APJ的蛋白表达。结果 1Apelin-13、APJ在SHR心肌组织中呈低表达(P0.05),20周龄SHR较4周龄SHR更明显(P0.05)。2 SHR的收缩压(SBP)、左心室舒张期末压(LVEDP)、心脏质量指数(HW/BW)、心室质量指数(LVW/BW)、舒张期室间隔厚度(IVSD)和左心室舒张期末后壁厚度(LVWPd)明显升高(P0.05),左心室舒张期末内径(LVEDd)、左心室射血分数(EF)、左心室短轴缩短率(FS)和左心室压力最大下降速率(-dp/dtmax)明显降低(P0.05);心肌细胞明显肥大、排列紊乱。20周龄SHR与4周龄SHR相比,上述指标改变更加明显(P0.05)。3心肌组织Apelin-13与IVSD、HW/BW、LVW/BW以及LVEDd、LVEDP呈负相关(P0.05),与EF、FS和-dp/dtmax呈正相关(P0.05)。结论 Apelin-13在SHR心肌组织中呈低表达,其与心肌肥厚指标呈负相关,与心功能呈正相关,提示其可能影响高血压的左心室心肌肥厚和心功能。     

氨基末端B型脑利钠肽前体与急性脑梗死患者左心室舒张功能的相关性分析

目的分析氨基末端B型脑利钠肽前体(NT-pro BNP)与急性脑梗死患者左心室舒张功能的相关性。方法选取2013年3月—2016年3月宝鸡市中心医院收治的急性脑梗死患者273例作为观察组,按梗死灶直径大小分为大面积梗死组(直径5 cm)54例、中面积梗死组(直径3~5 cm)118例、小面积梗死组(直径3 cm)101例;按缺血性脑卒中TOAST分型分为大动脉粥样硬化型(LAA)组91例、心源性栓塞型(CE)组57例、小动脉闭塞型(SAO)组80例、其他明确病因型(SOE)组17例、不明病因型(SUE)组28例。另选取同期在宝鸡市中心医院体检健康者232例作为对照组。检测所有受试者NT-pro BNP、左心室等容舒张时间(IVRT)、充盈早期左房室瓣环运动速度峰值/充盈晚期左房室瓣环运动速度峰值(Ea/Aa)及左房室瓣环左心房收缩期组织运动速度(A'值)等,NT-pro BNP与IVRT、Ea/Aa的相关性分析采用Pearson相关性分析。结果观察组患者NT-pro BNP高于对照组,IVRT长于对照组,Ea/Aa低于对照组(P0.05);两组受试者A'值比较,差异无统计学意义(P0.05)。Pearson相关性分析结果显示,观察组患者NT-pro BNP与IVRT呈正相关(r=0.33,P=0.02),与Ea/Aa呈负相关(r=-0.37,P=0.01)。大面积梗死组、中面积梗死组患者NT-pro BNP与IVRT呈正相关(r值分别为0.39、0.28,P0.05),与Ea/Aa呈负相关(r值分别为-0.41、-0.30,P0.05);小面积梗死组患者NT-pro BNP与IVRT(r=0.20)、Ea/Aa(r=-0.25)无直线相关关系(P0.05)。LAA组、CE组患者NT-pro BNP与IVRT呈正相关(r值分别为0.29、0.42,P0.05),与Ea/Aa呈负相关(r值分别为-0.31、-0.39,P0.05);SAO组、SOE组和SUE组患者NT-pro BNP与IVRT(r值分别为0.22、0.24、0.20)、Ea/Aa(r值分别为-0.23、-0.21、-0.25)无直线相关关系(P0.05)。结论 NT-pro BNP与急性脑梗死患者IVRT、Ea/Aa存在相关关系,临床可通过检测NT-pro BNP水平以评估急性脑梗死患者左心室舒张功能损伤情况,且其对大面积梗死及TOAST分型为LAA、CE型患者的评估价值较高。     

彩色多普勒评价高血压左心室舒张功能的价值

目的　探讨多普勒组织成像 (DTI)技术评价高血压病 (EH)患者左心室舒张功能的价值 ,以寻求一种可靠、客观的评价高血压左心室舒张功能的新方法。方法　采用放免法测定 2 0例正常人和 4 2例 EH患者 (伴心肌肥厚者2 0例和不伴心肌肥厚者 2 2例 )的血清 I型前胶原 (PC )和 型前胶原 (PC )的浓度。用 DTI法检测正常人及 EH患者二尖瓣环舒张早期运动速度 (Ea)、舒张晚期运动速度 (Aa)及 Ea/Aa,并用二尖瓣血流多普勒法检测舒张期血流速度 E、A及 E/A,比较两种方法测值与血清 PC 、PC 型前胶原的相关性。结果　 1.EH患者非左心室肥厚(non- L VH )组及左心室肥厚 (L VH )组二尖瓣口血流参数、二尖瓣环 DTI参数均明显低于正常对照组 (P<0 .0 1) ;2 .EH患者 non- L VH组与 L VH组间 E、E/A无明显差异 (P>0 .0 5 ) ,但 L VH组 Ea、Ea/Aa明显低于 non- L VH组(P<0 .0 5 ) ;3.EH患者 non- L VH组血清 PC 、PC 与 E/A及 Ea/Aa均呈负相关 ;而 L VH组血清 PC 、PC 与Ea/Aa亦呈负相关 ,与 E/A无明显相关。结论　 DTI能更准确定量高血压患者二尖瓣环舒张期运动速度的改变 ,DTI法检测二尖瓣环运动速度之比与反应心肌纤维化程度的血清 PC 、PC 浓度相关良好 ,有利于舒张功能受损程度的判断 ,优于传统的二尖瓣口血流法。     

磷酸肌酸对早期舒张功能障碍的疗效(英文)

目的:探讨磷酸肌酸钠(CP,里尔统)治疗心肌早期舒张功能障碍的疗效。方法:心肌舒张功能障碍患者138例,分为磷酸肌酸钠组(109例)常规治疗组(29例),所有患者均进行常规治疗。磷酸肌酸组在常规治疗的基础上,给予CP2g+5%葡萄糖或0.9%的氯化钠100ml静脉滴注,轻度舒张功能减低者每天1次,中度舒张功能减退者每天2次,连续7～14d为1疗程。采用彩色多普勒超声心动图检测二尖瓣口舒张早期峰值流速(E)、二尖瓣口舒张晚期峰值流速(A),二尖瓣环舒张早期速度峰值(Ea)、二尖瓣环舒张晚期速度峰值(Aa),计算E/A比值,Ea/Aa比值和E/Ea比值,对比治疗前后两组临床症状、体征及彩色多普勒超声心动图各指标改善情况。结果:治疗后两组患者所有症状和体征均有明显的改善(P0.05～0.01),且磷酸肌酸钠组临床显效率(96.2%)明显高于常规治疗组的57.1%(P0.01)。磷酸肌酸钠组E/A比值(81.65%∶10.34%)、Ea/Aa比值(83.49%∶13.79%)、E/Ea比值(92.86%∶12.00%)的显效率均显著高于常规治疗组的(P均0.01)。结论:磷酸肌酸钠对于改善心脏舒张功能和病情有显著疗效。     

采用经胸高频超声观察大鼠心脏结构与功能的增龄性改变

目的 应用高频超声测定Wistar大鼠心脏结构和功能,探讨其增龄性改变的规律.方法 选用1、2、5、12、20月龄的雄性健康Wistar大鼠60只(每组12只),各组大鼠分别行经胸超声心动图检查,测定心脏结构与功能参数,最后处死大鼠取左心室称质量.结果 随增龄左心房内径、舒张末期左心室内径、室间隔及左心室后壁厚度、左心室心肌质量均增加(P<0.05),超声评估左心室质量与解剖称左心室质量结果呈正相关(r=0.78,P<0.01),各组左心室射血分数、短轴缩短率差异无统计学意义(均P>0.05);等容舒张时间随增龄延长(P<0.01);组织多普勒二尖瓣环舒张早期峰值(Ea)自2月龄后开始随增龄逐渐下降,舒张晚期峰值(Aa)呈上升趋势,Ea/Aa在1、2、5月龄组>1,12、20月龄组<1.多因素分析结果显示,月龄是左心房内径、舒张末期左心室内径、二尖瓣环舒张早期峰值的影响因素.结论 高频超声能够评价大鼠的心脏结构与功能的改变;老龄大鼠心房、心室内径均增加,左心室壁增厚,收缩功能无明显改变,而舒张功能已减低.     

Prospective comparison of three enoxaparin dosing regimens to achieve target anti-factor Xa levels in hospitalized, medically ill patients with extreme obesity

Enoxaparin is commonly used to prevent venous thromboembolism(VTE) [1,2] but has not been well-studied in patients with extreme obesity,a population at high risk for VTE. We prospectively compared three enoxaparin dosing regimens for the achievement of goal peak anti-Factor Xa levels in medically ill patients (n 5 31) with extreme obesity (body mass index (BMI) ? 40 kg/m2). Patients were assigned to receive fixed-dose (FD) enoxaparin 40 mg daily (QDay, n 5 11), weight based,lower-dose (LD) enoxaparin 0.4 mg/kg QDay (n 5 9), or weight based,higher-dose (HD) enoxaparin 0.5 mg/kg QDay (n 5 11). The average BMI and weight of the entire cohort was 62.1 kg/m2 (range40.5–82.4) and 176 kg (range 115–256 kg) and did not differ between groups. Peak anti-Factor Xa levels were significantly higher in the HD group compared to either LD or FD groups. Patients in the HD group achieved target anti-Factor Xa levels more frequently than the LD and FD groups (P < 0.05). Peak anti-Factor Xa levels did not correlate with age, weight, BMI, or creatinine clearance, demonstrating the predictability of weight-based enoxaparin dosing. There were no adverse events (e.g., bleeding, thrombosis, thrombocytopenia). To our knowledge this is the first prospective comparative study demonstrating that in extremely obese, medically ill patients enoxaparin 0.5 mg/kg QDay is superior to FD and LD enoxaparin for the achievement of target anti-Factor Xa levels.     

The principal results of the International Immune Tolerance Study: a randomized dose comparison

The International Immune Tolerance Study was a multicenter, prospective, randomized comparison of high-dose (HD; 200 IU/kg/d) and low-dose (LD; 50 IU/kg 3 times/week) factor VIII regimens in 115 "good-risk," severe high-titer inhibitor hemophilia A subjects. Sixty-six of 115 subjects reached the defined study end points: success, n = 46 (69.7%); partial response, n = 3 (4.5%); and failure, n = 17 (25.8%). Successes did not differ between treatment arms (24 of 58 LD vs 22/57 HD, P = .909). The times taken to achieve a negative titer (P = .027), a normal recovery (P = .002), and tolerance (P = .116, nonsignificant) were shorter with the HD immune tolerance induction (ITI). Peak historical (P = .026) and on-ITI (P = .002) titers were correlated inversely with success, but only peak titer on ITI predicted outcome in a multivariate analysis (P = .002). LD subjects bled more often (odds ratio, 2.2; P = .0019). The early bleed rate/month was 0.62 (LD) and 0.28 (HD; P = .000 24), decreasing by 90% once negative titers were achieved. Bleeding was absent in 8 of 58 LD versus 21 of 57 HD subjects (P = .0085). One hundred twenty-four central catheter infections were reported in 41 subjects (19 LD); infection frequency did not differ between the treatment arms. Neither bleeding nor infection influenced outcome. Although it was stopped early for futility and safety considerations, this trial contributed valuable data toward evidence-based ITI practice.     

Tissue Doppler imaging adds incremental value in predicting exercise capacity in patients with congestive heart failure

Left ventricular (LV) systolic and diastolic parameters derived from Doppler echocardiography have been used widely to predict functional capacity but diastolic filling is affected by various factors. Tissue Doppler imaging (TDI) that records systolic and diastolic velocities within the myocardium and at the corners of the mitral annulus, has been shown to provide additional information about regional and global LV function. The goal of this study was to examine whether TDI-derived parameters add incremental value to other standard Doppler echocardiographic measurements in predicting exercise capacity. The study enrolled 59 consecutive patients with stable congestive heart failure (CHF). The etiology of heart failure was coronary artery disease in 42 patients and dilated cardiomyopathy in 17. Twenty-three age-matched healthy subjects were recruited as controls. Conventional echocardiographs and TDI were obtained. Early (Ea) and late (Aa) diastolic and systolic (Sa) mitral annulus velocities, the Ea/Aa and E/Ea ratios, were measured by pulsed wave TDI placed at the septal side of the mitral annulus and results were compared with results of cardiopulmonary exercise testing. Systolic and early diastolic velocities of mitral annulus were decreased and the E/Ea ratio was increased in the restrictive group as compared to controls (P = 0.02, P = 0.03, P < 0.001, respectively) but there was no significant difference in late diastolic velocity and the Ea/Aa ratio between the restrictive group and controls. The average peak VO₂ of the patients were 14.9 ± 4.9 ml/min per kg. Achieved peak VO₂ of the patients with E/Ea ratio ≤7.5 was 17.4 ± 5 vs 12.2 ± 3 ml/min per kg for those with E/Ea >7.5 (P < 0.001). Interestingly, the patients with the nonrestrictive pattern and E/Ea ratio >7.5 had reduced exercise capacity, as did the group with restrictive LV filling patterns (12.8 ± 3.3 vs 12.9 ± 4.0 ml/min per kg, P = 0.9). Similarly, there was no significant difference in the mean exercise capacity between the patients with a nonrestrictive pattern vs restrictive pattern with E/Ea ratio ≤7.5 (16.1 ± 5.0 vs 15.4 ± 5.1 ml/min per kg, P = 0.78). Univariate analysis demonstrated that the peak Sa (r = 0.30, P = 0.03), peak Ea (r = 0.38, P = 0.004) and peak Aa (r = 0.35, P = 0.009) correlated significantly with maximum exercise capacity. No relationship was observed between the Ea/Aa ratio and peak VO₂ (r = −0.09, P = 0.48). By multivariate analysis, including age and heart rate, the E/Ea ratio was found to be an independent prognostic factor at peak VO₂ (P < 0.001. In contrast, the comparison of the maximum transmitral early diastolic velocity and the mitral annulus TDI velocity, that is E/Ea ratio, had strong correlation with peak VO₂ (r = −0.46, P < 0.001). Receiver operating characteristic (ROC) analysis was performed for prediction of limited exercise capacity from the E/Ea ratio. An E/Ea ratio ≤7.5 was able to predict peak VO₂ ≤14 ml/min per kg with a sensitivity of 84% and a specificity of 74%. If restrictive pattern or an E/Ea ratio >7.5 was used, 21 out of 24 patients in the reduced exercise capacity group were identified with 16 false positives in the preserved exercise capacity group (P = 0.001). Mitral annular systolic and diastolic velocities of TDI were associated with cardiopulmonary exercise capacity in patients with LV systolic dysfunction. Index of the E/Ea ratio was found to be the most powerful predictor of peak oxygen uptake.     

心脏舒张功能障碍逆转的临床探讨

目的：探讨心脏舒张功能障碍的逆转。方法：入选我院舒张功能障碍的病人223例,随机分为常规治疗组,给予丹参滴注液16g,1次/d;磷酸肌酸钠组：在常规治疗组基础上给予磷酸肌酸钠静脉滴注（轻度舒张功能障碍每日给药2.0g,中重度舒张功能障碍给药2.0g,2次/d）,并采用彩色多普勒超声心动图观察二尖瓣口舒张早期峰值流速（E）、二尖瓣口舒张晚期峰值流速（A）、二尖瓣环舒张早期速度峰值（Ea）、二尖瓣环舒张晚期速度峰值（Aa）,计算E/A值,Ea/Aa值,E/Ea值。连续治疗14d,并根据治疗前后临床症状、体征及彩色多普勒超声心动图各指标改善情况评价疗效。结果：治疗后,与常规治疗组比较,磷酸肌酸钠组患者的症状、体征显效率（53.8%比98.2%,62.5%比92.0%）,综合疗效的显效率（11.43%比82.97%）,E/A值[（0.82±0.15）比（1.20±0.24）]、Ea/Aa值[（0.88±0.23）比（1.56±0.31）]显著提高,E/Ea值[（9.89±3.15）比（5.84±2.12）]显著降低,P均〈0.01。结论：舒张功能障碍早期发现和干预是可以逆转的,磷酸肌酸钠有显著的治疗作用,是逆转舒张功能障碍的首选药物。     

多普勒组织速度成像和实时三维超声心动图评价中晚期肝硬化患者左心室舒张功能的研究

目的探讨应用多普勒组织速度成像（TVI）及实时三维超声心动图（RT-3DE）技术定量评价中晚期肝硬化患者左心室舒张功能的临床应用价值。方法检测中晚期肝硬化患者32例，正常对照组20例，应用多普勒组织速度成像技术检测室间隔及侧壁的二尖瓣环舒张早期峰值速度（Ea），舒张晚期峰值速度（Aa），并计算Ea/Aa比值，将两个位置的平均值作为平均Ea，Aa和Ea/Aa值。应用实时三维超声心动图进行时间-容积曲线分析，测量左室舒张末容积（EDV）、收缩末容积（ESV）、左室射血分数（LVEF）和左室最大充盈速率（PFR）。结果肝硬化组平均Ea降低、平均Aa增高，Ea/Aa比值降低，与对照组比较差异有显著性意义（P〈0.05）。实时三维参数EDV、ESV、和LVEF两组间比较无显著性差异（P〉0.05），与对照组比较PFR明显降低，差异有显著性意义（P〈0.05）。结论肝硬化高动力循环状态下，多普勒组织速度成像及实时三维超声心动图可以对肝硬化患者左室舒张功能减低进行综合的评价，是简便、实用的检测方法。     

Effects of genetic variation in adducin on left ventricular diastolic function as assessed by tissue Doppler imaging in a Flemish population

BACKGROUND: We investigated the possible association between left ventricular diastolic function and the ADD1 Gly460Trp and ADD3 IVS11 +386A>G polymorphisms alone and in combination. METHODS: In a family-based population study (473 subjects; 50.5% women; mean age 50.5 years), we measured early (Ea) and late (Aa) diastolic peak velocities of the mitral annulus by tissue Doppler imaging. In multivariate-adjusted analyses, we investigated phenotype-genotype associations, while accounting for confounders and family structure. RESULTS: Lateral Ea/Aa ratio was higher in ADD1 Trp allele carriers than in GlyGly homozygotes (1.51 vs. 1.40; P = 0.005) and was lower in ADD3 A allele carriers than in GG homozygotes (1.42 vs. 1.55; P = 0.005). The effects of ADD1 on the lateral Ea and Ea/Aa weakened with older age (P < 0.05). The best fitting model for lateral Ea and Ea/Aa included ADD1, ADD3, and the three-way interaction term of both genes with age. Below the age of 50 years, the lateral Ea/Aa ratio was higher in ADD1 Trp allele carriers than in GlyGly homozygotes (1.91 vs. 1.73; P = 0.006), particularly in the presence of ADD3 GG homozygosity (2.46 vs. 1.80; P = 0.0008). In older subjects, these phenotype-genotype associations were not significant (P > 0.20). Transmission of the ADD1 Trp allele to offspring was associated with higher lateral Ea (+0.91; P = 0.026) and Ea/Aa ratio (+0.23; P = 0.0008). CONCLUSION: Our population-based study demonstrated that left ventricular diastolic relaxation is modulated by genetic variation in ADD1 and ADD3. This association was more prominent in younger subjects in whom longstanding environmental factors and ageing are less likely to mask genetic effects.     

Effects of Ethanol on Temporal Recovery of Auditory-Evoked Potentials in Individuals at Risk for Alcoholism

The present investigation examined the effects of placebo (P), low dose (LD), and high dose (HD) ethanol on auditory event-related potential (AEP) recovery functions in a group of males at high risk to develop alcoholism (HR; n = 23, mean = 22.3 years) and a low risk (LR; n = 27, mean = 23.0 years) control group. Condition order was randomized, with one condition (P, LD, or HD) per day and a minimum 1-day interval between conditions. For each subject, both blood alcohol levels (BALs) measured via breathalyzer, and event-related potentials recorded with the entire 10/20 International System, were assessed prior to and at mean intervals of 20, 60, 90, and 130 min after P, LD, or HD administration. A series of binaural auditory stimuli with randomly interposed interstimulus intervals of 0.5, 1.0, and 10.0 sec were used to elicit the N100 and P200 components of the AEP. Between-groups comparisons indicated that ethanol elicited risk group differences in recovery functions not present at baseline. The differences were manifested in the HR group as larger decrements in P200 amplitude during the ascending blood alcohol curve (acute sensitivity) and more rapid returns of both N100 and P200 to baseline levels during the descending blood alcohol curve (acute tolerance). These findings support Newlin and Thomson's (1990) Differentiator Model, suggesting that LR and HR individuals are differentially sensitive to the effects of ethanol.     

缬沙坦与U0126对大鼠心房纤维化和缝隙连接蛋白40重构的影响

目的 探讨缬沙坦与U0126对血管紧张素Ⅱ(angiotensin Ⅱ,Ang Ⅱ)诱导的大鼠心房纤维化和缝隙连接蛋白40( connexin 40,Cx40)重构的影响.方法 将32只雄性SD大鼠随机分为空白对照组(A组)、盐酸异丙基肾上腺素( isopreterenol,ISO)+二甲基亚砜(DMSO)组(B组)、ISO+U0126组(C组,U0126溶于DMSO中)、ISO+缬沙坦+DMSO组(D组).给药28 d后处死大鼠取心肌组织,放射免疫法测Ang Ⅱ含量;HE和Masson染色法观察纤维化程度即胶原容积分数(CVF);免疫组化法测定磷酸化丝裂原活化蛋白激酶激酶1/2(P-MEK1/2)、磷酸化细胞外信号调节激酶1/2( P-ERK1/2)以及Cx40的表达.结果 B、C、D组中Ang Ⅱ含量较A组明显升高[分别为(368.243±6.283)ng/L、(357.175±5.944) ng/L、(359.908±2.496) ng/L比(250.380±4.261) ng/L,P＜0.01];A组CVF(9.025 ±0.456)％,显示无心房纤维化;C组和D组较B组心房纤维化程度明显减弱[CVF分别为(10.260±0.525)％、(10.238 ±0.524)％比(78.710±1.587)％,P＜0.01],C组和D组之间差异无统计学意义(P＞0.05);B组较A组中P-MEK1/2(0.311±0.007比0.203±0.009,P＜0.01)和P-ERK1/2含量明显增加(0.259±0.003比0.173±0.006,P＜0.01),而C组和D组中含量较B组明显减少(P-MEK1/2分别为0.212±0.004、0.213±0.005比0.311±0.007,P＜0.01;P-ERK1/2分别为0.178±0.004、0.175 ±0.007比0.259±0.003,P＜0.01),C组和D组之间差异无统计学意义(P＞0.05);B组较A组Cx40含量明显减少(0.199±0.007比0.241±0.004,P＜0.01)且分布紊乱,C组和D组中含量较B组减少程度明显减轻(分别为0.239±0.037、0.235±0.006比0.199±0.007,P＜0.01)且部分呈线性分布于闰盘,C组和D组之间差异无统计学意义(P＞0.05).结论 心肌组织中Ang Ⅱ含量长期升高可能参与心房纤维化的形成和Cx40重构,缬沙坦与U0126通过抑制ERK通路的不同位点,在改善心房纤维化程度和Cx40重构方面发挥相似的作用.