茶多酚对大鼠心脏乳头肌收缩功能的影响

绿茶提取物茶多酚(TP)具有众多的生物活性，如抑制动脉粥样硬化，减轻心肌缺血再灌注损伤，清除自由基和抗衰老，增强心肌收缩力等作用。本研究探讨TP对正常及糖尿病大鼠离体右心室乳头肌收缩功能的影响，现报道如下。     

非洛地平对再灌注损伤心肌的保护作用（摘要）

非洛地平对再灌注损伤心肌的保护作用（摘要）中国人民解放军第三军医大学西南医院心内科司良毅张远慧赵学王国超对心肌缺血再灌注家兔用新型钙拮抗剂非洛地平进行干预实验，以评价其对再灌注损伤（ＲＩ）的保护作用并探讨其作用机制。１材料与方法实验家兔４２只，...     

锌对缺血再灌注损伤家兔心肌金属硫蛋白-1基因表达的影响

目的研究锌对家兔心肌缺血再灌注损伤的保护作用。方法采用RT-PCR技术,检测分析金属硫蛋白-1(MT-1)基因在家兔缺血再灌注损伤心肌的表达及锌对其基因表达的调节。结果各组家兔心肌组织中均有MT-1基因的表达,缺血再灌注组MT-1基因的表达较正常对照组明显下降(P<0.01),补锌再灌注组MT-1基因的表达较缺血再灌注组明显上调(P<0.01)。结论锌对家兔心肌缺血再灌注损伤的分子机制中,调节其心肌组织中MT-1基因转录水平的表达可能是一条重要途径。     

家兔心肌缺血再灌注时中性粒细胞胞浆游离钙,MDA,SOD变化规…

通过对比观察青、老年家兔心肌缺血再灌注时外周血中性粒细胞胞浆游离钙、丙二醛及超氧化物歧化酶的变化规律，探索上述变化对老年兔心肌缺血再灌注损伤的影响特征，并寻找一种可替代心肌组织标本作为判断再灌注损伤的检测指标。５年龄及６月龄家兔实验性心肌缺血３０分钟、再灌注３０、９０、３６０分钟，分别取外周血ＰＭＮｓ及心肌组织测定ＭＤＡ、ＳＯＤ、ＰＭＮ和心肌组织钙。青、老年组，ＭＤＡ于缺血期均明显升高，至再灌注时     

心先安对家兔缺血再灌注心肌Q-Td的影响

制备家兔心肌缺血再灌注模型,观察心先安（MAC）对其心肌Q-T离散度（QTd）的影响。结果显示,MAC可发挥。AMP的心肌保护作用,改善损伤心肌细胞膜的生理功能,降低再灌注后心肌QTd,从而降低恶性心律失常的发生。     

人尿激肽释放酶(SK-827)对兔心肌缺血/再灌注损伤的保护作用

为探讨人尿激肽释放酶ＳＫ－８２７对心肌缺血再灌注损伤是否具有保护作用，制备了离体家兔心脏灌注模型，利用生物化学技术测定了流出液中肌红蛋白和乳酸脱氢酶含量及心肌组织丙二醛和ＡＴＰ含量。结果发现，ＳＫ－８２７对心肌缺血再灌注损伤具有明显的保护作用：它使冠状动脉流量增加（Ｐ＜０．０１）；细胞内肌红蛋白和乳酸脱氢酶漏出减少（Ｐ＜０．０１）；心肌丙二醛含量减少和心肌ＡＴＰ储备增加。这些结果提示激肽释放酶ＳＫ－８２７对治疗心肌缺血／再灌注损伤具有潜在的应用价值。     

心肌缺血再灌注损伤防治研究进展

通过溶栓、冠脉动脉(冠脉)搭桥以及冠脉介入是治疗急性心肌梗死的有效方法。但在改善心肌血供的同时可能加重单纯心肌缺血所造成的损伤，即所谓的再灌注损伤。采取措施防治心肌缺血再灌注损伤对促进心肌细胞存活具有重要意义。很多研究结果表明药物因子对心肌缺血再灌注损伤具有防治作用，其中包括自由基清除剂、钙通道阻滞剂、中性粒细胞抑制     

硒与丹参酮IIA磺酸钠对兔心肌缺血再灌注损伤心肌组织脂质过氧化的影响

目的观察硒与丹参酮ⅡA磺酸钠合用对家兔心肌缺血再灌注损伤心肌组织脂质过氧化的影响。方法将26只家兔随机分成4组,即假手术组、缺血再灌注组、丹参酮ⅡA磺酸钠组(DS-201)和硒 DS-201组。分别检测血浆CK、LDH含量和心肌组织的SOD、GSH-Px活力、MDA含量。结果DS-201组、硒 DS-201组血浆中CK、LDH含量和心肌组织MDA含量与缺血再灌注组相比均显著降低(P<0.01);硒 DS-201组与DS-201组相比。血浆CK、LDH含量和心肌组织MDA含量显著降低(P<0.01)。DS-201组、硒 DS-201组心肌组织匀浆中T-SOD活力与缺血再灌注组相比均显著升高(P<0.05),但硒 DS-201组与DS-201组相比,心肌组织匀浆中T-SOD活力没有显著性差异。DS-201组与缺血再灌注组相比心肌组织中GSH-Px活力无显著性差异。但硒 DS-201组心肌组织中GSH-Px活力与缺血再灌注组(P<0.01)、DS-201组(P<0.01)及假手术组(P<0.05)相比,均显著升高。结论硒与丹参酮ⅡA磺酸钠合用对家兔心肌缺血再灌注损伤具有明显的保护作用,并且优于丹参酮ⅡA磺酸钠。其作用机制与提高SOD、GSH-Px活性,清除自由基,抑制脂质过氧化反应有关。     

卡维地洛在心肌缺血再灌注损伤中的作用

卡维地洛是第三代肾上腺素β受体阻滞剂，具有非选择性β受体阻滞和选择性α1受体阻滞活性。在防治心肌缺血再灌注损伤，促进心肌细胞存活方面具有重要作用。本文就卡维地洛在心肌缺血再灌注损伤防治中的肾上腺受体阻滞、抗氧化和自由基清除、心肌保护等主要作用作一综述。     

心痛灵滴丸预适应对兔心肌缺血再灌注损伤保护作用的研究

目的：探讨心痛灵滴丸预适应对兔心肌缺血再灌注损伤的保护作用。方法：采用冠状动脉粥样硬化(AS)家兔在体心肌缺血再灌注损伤模型，观察心痛灵滴丸预适应对兔心肌组织形态结构和脂质过氧化的影响。结果：心痛灵滴丸预适应能减轻缺血再灌注时心肌组织及细胞超微结构的形态学损伤，能显著提高兔血清超氧化物歧化酶(SOD)活性，降低血清丙二醛(MDA)含量，而且能加强缺血预适应对兔心肌缺血再灌注损伤的保护作用。结论：心痛灵滴丸预适应能诱导缺血预适应样心脏保护作用，其机制可能与清除氧自由基、抑制脂质过氧化反应有关。     

Myocardial Viability Detected by Myocardial Contrast Echocardiography—Prognostic Value in Patients after Myocardial Infarction

Objective: This study aimed to assess the role of myocardial contrast echocardiography (MCE) as a predictor of cardiac events and death in patients with acute myocardial infarction (AMI). Methods: Eighty‐six patients underwent primary percutaneous coronary angioplasty for AMI. Segmental perfusion was estimated by MCE in real time at mean 5 days after PCI using low MI (0.3) after 0.3–0.5 ml bolus injection of intravenous Optison. MCE was scored semiquantitatively as: (1) normal perfusion (homogenous contrast effect), (2) partial perfusion (patchy myocardial contrast enhancement), (3) lack of perfusion (no visible contrast effect). A contrast score index (CSI) was calculated as the sum of MCE scores in each segment divided by the total number of segments. The patients were followed up for cardiac events and death. Results: A CSI of >1.68 was taken to be a predictor of cardiac events and death. Death occurred only in patients with CSI >1.68. Patients with CSI >1.68 had a significantly (P = 0.03) higher incidence of cardiac death or cardiac events (75%) compared to those with CSI <1.68 (27%). The absence of residual perfusion within the infarct zone was an independent predictor of death and cardiac events (P = 0.02). Conclusions: The absence of residual myocardial viability in the infarct zone supplied by an infarct‐related artery is a powerful predictor of cardiac events in patients after AMI. (Echocardiography 2010;27:430‐434)     

心脏放射免疫显像进展

心脏放射免疫显像是将放射免疫显像用于心脏疾病诊断的技术。现就该技术在心肌梗死、心脏移植后排异反应、心肌炎及其它心脏疾病中的诊断作概要综述。     

心肌声学密度定量分析检测高血压心肌纤维化

目的观察原发性高血压患者心肌声学密度和血清Ⅲ型前胶原末端肽(PⅢNP)含量的变化情况,以评估心肌声学密度定量分析技术检测高血压心肌纤维化的临床价值。方法入选原发性高血压患者75例(高血压组),另选健康体检者75例为对照组。应用超声心动图测量声学密度各项值,采用放免法测定PⅢNP的浓度。结果高血压组的声学强度(CAI)显著高于健康对照组(P<0·01),而高血压组的背向散射积分周期变化值(CVIB)(室间隔6·07±0·85,左室后壁7·00±1·15)显著低于健康对照组(室间隔8·60±3·12,左室后壁11·85±3·06,P<0·05);高血压组血清PⅢNP含量(109·9±7·5)μg/L显著高于健康对照组[(43·9±5·9)μg/L,P<0·01];血清PⅢNP与室间隔和左室后壁声学强度呈显著正相关(P<0·01),与室间隔和左室后壁CVIB呈显著负相关(P<0.01)。结论心肌声学密度定量分析技术是检测高血压心肌纤维化的一项可靠技术。     

负荷心肌灌注显像在心肌桥临床应用中的研究进展

负荷心肌灌注显像通过检测核素在心肌的分布,明确心肌缺血的部位和程度,因此,它能够评价冠状动脉心肌桥是否影响心肌供血及影响程度。负荷心肌灌注显像具有敏感性及特异性较高,且相对价廉、安全无创等优点,在评价心肌桥导致的心肌缺血及缺血的程度范围、判断预后及指导下一步治疗中具有重要的临床价值及应用前景。     

Assessment of Myocardial Viability in Patients With Postischemic Left Ventricular Dysfunction: Role of Myocardial Contrast Echocardiography

The distinction between viable and nonviable dysfunctional left ventricular (LV) segments after acute myocardial infarction is very important, because revascularization increases survival only in patients with viable myocardial tissue. Recent studies have highlighted a mismatch between two highly specific investigations for viability assessment: dobutamine echocardiography, which measures inotropic reserve, and myocardial contrast echocardiography (MCE), which measures microvascular perfusion. Viability and functional reserve are not synonymous. Maintenance of microvascular perfusion, independently of functional reserve, attenuates left ventricular remodelling, reduces the risk of major cardiac events, and increases survival. MCE provides similar perfusion information as myocardial blush, but image quality is much higher. Quantitative analysis of digital data provides more accurate diagnostic MCE information than qualitative analysis of video signal intensity. In a recent study relating MCE findings to histologic data, MCE-derived quantitative data were closely correlated with microvascular density and capillary area, and inversely correlated with collagen content. One of the contrast agents routinely used for MCE is SonoVue, a second generation microbubble contrast agent, which is characterized by high response to ultrasound energy, ease of destruction at high energy, and strong harmonic signal at low energy. Recommendations for the assessment of postischemic LV dysfunction: routine use of MCE, followed by dobutamine echocardiography if perfusion is documented. If MCE is negative, revascularization is not indicated; if both tests are positive, revascularization is strongly recommended; if they are discordant, useful information can be obtained by assessing the extent of ²⁰¹T1 viability. (ECHOCARDIOGRAPHY, Volume 20, Supplement 1, 2003)     

Myocardial stunning in man

Myocardial stunning refers to the contractile dysfunction that occurs following an episode of acute ischaemia, despite the return of normal blood flow. The phenomenon was initially identified in animal models, where it has been very well characterised, and there was initial doubt about whether a similar syndrome occurred in humans, and if it did, whether it was of any clinical relevance. This article outlines the conditions that must be met to diagnose myocardial stunning and why it has been difficult to confirm its presence in humans. The clinical scenarios where it has now been clearly identified and those others where it may also occur and be of clinical importance are also reviewed.     

急性心肌梗死心肌组织再灌注评价方法

急性心肌梗死后心肌组织再灌注程度与左心室功能和临床预后密切相关,因此,及时、准确的评估心肌梗死后心肌组织灌注水平对患者有着重要的意义.现就评价心肌组织再灌注的方法及应用做一综述.     

左-卡尼汀对缺血心肌的保护作用

左-卡尼汀又名肉碱,是脂肪酸进行β-氧化必不可少的载体。正常情况下,心肌能量总需量的60%～90%由游离脂肪酸进行β-氧化所提供。心肌细胞缺血缺氧时,氧化磷酸化功能下降,内源性左-卡尼汀合成障碍,引起心肌的一系列代谢改变。近年来研究认为左-卡尼汀通过不同的机制对缺血心肌具有保护作用。     

Transesophageal Echocardiographic Study of Right Atrial Myocardial Infarction and Myocardial Viability

In order to determine the effects of dobutamine on right atrial wall movement, two groups were studied using transesophageal echocardiography. Group A included six patients without ischemic heart disease. Group B included six patients with infarction of the inferior wall of both ventricles and abnormal wall movement of the right atrium. In group A, an increase in the amplitude of right atrial movement was observed with dobutamine at doses of 5 and 10 μ/kg per minute. In group B, infusion of dobutamine did not modify wall akinesis in three patients with right atrial infarction; in the remaining three, alterations of segmental atrial movement were evident, and their responses to dobutamine were related to the patency of right atrial coronary branches. The following conclusions were reached: (1) dobutamine has a positive inotropic effect on atrial myocardium; (2) right atrial ischemia appears in the echocardiogram as altered segmental or global wall movement; (3) dobutamine can be used in the evaluation of atrial myocardial viability.     

心肌桥最新研究进展

心肌桥是一种先天性解剖变异,临床意义一直是一个讨论和争议话题。以往认为心肌桥是一种良性解剖变异,目前越来越多的研究表明,心肌桥可导致急性心肌缺血、心肌梗死、心律失常甚至心源性猝死。因此,临床医生应该提高对心肌桥的认识,根本上理解心肌桥的发病机制及病理生理,及时发现与心肌桥有关的临床表现,早期诊断心肌桥,正确掌握心肌桥的治疗原则。现就心肌桥最新研究结果予以概述,目的在于提高对心肌桥的认识,优化心肌桥患者的治疗。