单纯环肺静脉前庭隔离术治疗持续性心房颤动:单中心三年随访结果

Objective To report the long-term outcome of catheter radiofrequency ablation treatment for patients with persistent atrial fibrillation (PerAF) and discuss the impact of PerAF duration and the termi-nation on the therapeutic outcome. Methods Eight-six consecutive PerAF patients underwent circumferential pulmonary vein antrum isolation (CPVAI) only were included in this study. Based on PerAF duration, patients were divided into two groups: short term (≤1 year, n =47) and long term (> 1 year, n =39). Results The mean follow-up period was 25-50 (36 ± 8) months. During the follow-up period, the success rate after single procedure was 30. 2% (26/86). Late recurrence phenomenon, defined as atrial tachyarrhythmias relapsed 1 year later, was observed in 9 patients (10.5%). The long-term success rate in the short term group was signifi-cantly higher than that in long term group (42.5% vs 15.4% ,P <0.01). During the first procedure, atrial fi-brillation converted into sinus rhythm or atrial tachycardia occurred in 29 patients (33.7%). Compared with the another 57 patients, the long-term outcome of these patients was much better (48.3% vs 21.1% ,P < 0.01). Redo procedures were pedormed in 24 patients (27.9%), which increased the total success rate at 3 years follow-up to 41.9% (36/86). Conclusion The long-term outcome treated with CPVAI in patients with PerAF is still unsatisfactory. In addition, the late recurrence is common. Shorter term of PerAF and terminated by ablation indicate that those patients might get more benefit from the CPVA1 treatment.     

心力衰竭大鼠ACE/ACE2相互负向调节及卡维地洛的作用

目的 探讨心肌梗死后心力衰竭大鼠心肌组织血管紧张素转化酶（angiotensin converting enzyme,ACE）与ACE2相互负向调节及卡维地洛的作用。方法 结扎大鼠左冠状动脉前降支复制心肌梗死后心力衰竭模型,随机分为心力衰竭组,卡维地洛组和假手术组;喂养2个月后检测血流动力学指标,计算左心室质量指数;放射免疫法测定心肌组织和血浆血管紧张素Ⅱ,逆转录聚合酶链反应检测心肌组织ACE和ACE2mRNA表达;蛋白质免疫印迹法检测心肌组织ACE和ACE2蛋白表达。结果 心力衰竭组大鼠循环和心肌组织血管紧张素Ⅱ水平明显升高（P〈0.01）,心肌组织ACE和ACE2的mRNA和蛋白表达均增强（P〈0.05,P〈0.01）,ACE/ACE2升高。卡维地洛组大鼠血流动力学指标改善（P〈0.01）,心肌组织血管紧张素Ⅱ水平下调（P〈0.05）,心肌组织ACE mRNA和蛋白表达下降（P〈0.01）,ACE2 mRNA和蛋白表达显著增强（P〈0.01）,ACE/ACE2降低。结论 心力衰竭大鼠心肌组织ACE和ACE2表达上调,ACE/ACE2升高;卡维地洛抑制ACE表达,增强ACE2表达,ACE/ACE2比值下降。     

美托洛尔长期治疗对慢性心力衰竭患者心肌重构和炎性细胞因子的影响

目的:研究β受体阻滞剂美托洛尔对慢性心力衰竭患者心肌重构和血浆肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）和白细胞介素-6（IL-6）的影响。方法:选取96例心力衰竭患者,左室射血分数（LVEF）≤45%,心功能（NYHA）ⅡⅣ级,随机分为美托洛尔组和常规治疗组各48例,给于洋地黄、利尿剂、硝酸盐类及血管紧张素转换酶抑制剂（ACEI）治疗,美托洛尔组在此基础上加用美托洛尔6.25 mg,2次/d,并逐渐加量,至最大剂量100 mg,2次/d;或最大耐受剂量。治疗6月后,观察比较两组治疗前后心率、血压、心功能、心胸比率、超声心动图变化,用双抗体夹心ELISA法测定美托洛尔组治疗前后血浆TNF-α、IL-1β和IL-6的变化。结果:美托洛尔平均剂量127 mg/d,美托洛尔组和常规治疗组治疗后心功能改善（3.1±0.7vs1.5±0.6,P<0.01;3.0±0.7vs2.0±0.4,P<0.01）、LVEF提高[（34.3±7.8）%vs（46.1±10.5）%,P<0.01;（36.2±5.9）%vs（39.9±5.5）%,P<0.01]。美托洛尔组左室舒张末内径（LVEDD）比治疗前显著减小（68.0±10.6 mmvs63.6±10.4 mm,P<0.01）、心胸比率降低（0.61±0.08vs0.58±0.07,P<0.05）;美托洛尔组血浆TNF-1、IL-1β和IL-6显著降低（53±23vs35±14;32±12vs20±4;50±21vs21±11 pg/m l,P<0.01）。结论:在慢性心力衰竭常规治疗基础上加用β1受体阻滞剂美托洛尔安全有效,可以改善心功能,逆转心肌重构,降低血浆主要细胞因子水平。     

阿奇霉素联合布地奈德治疗支原体肺炎的疗效分析

目的探讨临床应用阿奇霉素联合布地奈德治疗支原体肺炎的疗效。方法按照随机数字表法将100例支原体肺炎患儿分成观察组与对照组,各50例。对照组单用阿奇霉素治疗,先行静脉滴注5-7 d,病情控制后停药4 d后改为口服,1次/d,7 d为一个疗程。观察组在对照组的基础上联合应用布地奈德混悬液,采取雾化吸入法,0.5-1 mg/次,2次/d,5 min/次,7 d为一个疗程,两组患者均治疗3个疗程,随后比较两组疗效、住院时间及咳嗽消失时间。结果经治疗,两组治疗的总有效率差异无统计学意义（P〉0.05）,住院时间及咳嗽消失时间,观察组要显著短于对照组（P〈0.05）,两组不良反应情况比较,观察组中3例患者出现恶心、呕吐症状,对照组1例,差异无统计学意义（P〉0.05）。结论阿奇霉素联合布地奈德治疗支原体肺炎,能够显著改善咳嗽症状,减少住院时间,可推广使用。     

心肌细胞外钙内流对PTEN表达的影响

目的探讨血管紧张素Ⅱ(AngⅡ)介导的心肌细胞外钙内流对PTEN mRNA和蛋白表达的影响。方法新生Wistar乳鼠原代培养。用不同浓度的AngⅡ(10-8~10-5mol/L)促进心肌细胞外钙内流,特异的钙敏感指示剂Fur-2/AM测定心肌细胞内钙浓度([Ca2+]i)。逆转录酶链式反应(RT-PCR)、Western blot分别检测PTEN mRNA和蛋白表达。结果AngⅡ在10-8~10-5mol/L浓度范围内能浓度依赖性促进心肌细胞外钙内流;心肌细胞外钙内流的增加能升高其PTEN mRNA和蛋白表达。结论心肌细胞内钙升高在促进心肌肥厚的同时,激活了PTEN的表达,可能对细胞内钙负荷所致的心肌肥厚起负反馈调节作用,PTEN是一内源性心肌肥厚抑制因子。