间硝苯啶与硝苯啶对急性心肌缺血大鼠左心室舒张功能的影响

结扎大鼠冠脉引起T值延长,-dP/dt_(max)和-dP/dt_(max)·LVSP~(-1)降低、LVEDP抬高等心肌舒张功能降低的改变。预先分别iv M-Nif,Nif 15μg/kg均能不同程度地改善急性缺血心肌的舒张功能,其中M-Nif作用较强。此外,iv M-Nif尚有一过性增强舒张功能的作用。     

培哚普利对心肌梗塞后心力衰竭大鼠左室舒张功能的影响

观察了培哚普利（Ｐｅｒ）对心肌梗塞（ＭＩ）后心力衰竭（ＨＦ）大鼠左室舒张功能的影响。与对照组相比，Ｐｅｒ处理４ｗｋ大鼠左室舒张末压降低，左室压最大下降速率增高，等容舒张时间常数（Ｔ值）缩短伴心、肺重量明显减轻。心肌组织超氧化物歧化酶（ＳＯＤ）活力增高，丙二醛及Ｃａ２＋含量降低。提示Ｐｅｒ对ＭＩ后左室舒张功能有保护作用，其机制可能与保护ＳＯＤ活性，减少脂质过氧化及Ｃａ２＋超载有关。     

Relationship between the course of depression symptoms and the left ventricular mass index and left ventricular filling pressure in chronic haemodialysis patients

Aim: Multiple measurements of depression symptoms over time were more predictive of cardiovascular mortality than a single time measurement performed at baseline. The aim of this study is to evaluate the association of the course of depression symptoms, based on repeated assessments of depression symptoms over time, with left ventricular mass index (LVMI) and left ventricular filling pressure (LVFP) in patients on haemodialysis (HD). Methods: The level of depression symptoms in 61 patients on HD were prospectively assessed using the Beck Depression Inventory (BDI) at baseline and at three intervals (5, 10, 15 months). Doppler echocardiographic examinations were performed at the end of follow up. Results: At the end of follow up, the patients were divided into three groups according to their course of depression symptoms: non‐depression (n = 21), intermittent depression (n = 23) and persistent depression (n = 17). LVMI and LVFP were significantly increased in the persistent depression symptoms group compared to those of the non‐depression symptoms group and the intermittent depression symptoms group. Persistent depression symptoms were independently associated with LVMI (β‐coefficient = 0.347, P = 0.017) and LVFP (β‐coefficient = 0.274, P = 0.048) after adjustment for age, sex, systolic blood pressure, diastolic blood pressure, diabetes and interdialytic weight gain. Conclusion: In our study, persistent depression symptoms were associated with left ventricular hypertrophy and diastolic dysfunction. Our data may provide a more complete understanding of cardiovascular risk associated with depression symptoms in patients on HD.     

脓毒症心肌损伤后心脏舒缩功能的动态变化

目的 探讨心脏舒张、收缩功能和心肌损伤指标对脓毒症患者动态变化和预后判断的作用。 方法 收集脓毒症患者70 例。根据28 d 的预后分为生存组和死亡组。分别于入重症医学科（ICU）第1 和3 天应用床旁心脏超声测量二尖瓣舒张早期充盈峰速度E 峰（E）与舒张晚期充盈峰速度A 峰（A）、二 尖瓣环舒张早期速度（e’）的比值,将E/e’及E/A 作为评估左心室舒张功能的指标;测量左心室射血分 数（LVEF）作为评估左心室收缩功能的指标。监测第1 和3 天心肌损伤标志物肌钙蛋白（cTnI）及肌酸激 酶同工酶（CK-MB）水平。通过Logistic 回归方法,对可能影响脓毒症预后的危险因素进行分析。结果 两 组患者于入ICU 第3 天的E/e’高于第1 天（P <0.05）,LVEF 低于第1 天（P <0.05）;死亡组第1 和3 天 的E/e’高于生存组（P <0.05）。两组第3 天的cTnI、CK-MB 高于第1 天（P <0.05）,死亡组第3 天的 cTnI 高于生存组（P <0.05）。Logistic 回归分析显示,E/e’[Ol ^ R=1.534,（95% CI ：1.116,1.982）,P =0.003]、 cTnI[Ol ^ R=1.120,（95% CI ：0.907,1.432）,P =0.039] 是影响脓毒症患者28 d 预后的危险因素。结论 脓毒症 患者存在心肌损伤,心脏舒张及收缩功能发生了动态变化,且高死亡风险脓毒症患者心脏舒缩功能及心肌损 伤明显加重。E/e’、cTnI 能预测脓毒症患者的预后。     

Ratio of left atrial to left ventricular size: an anatomical marker of the diastolic left ventricular pressure-volume relationship

BACKGROUND: Classification of diastolic heart function is best defined by the degree of leftward and upward shift of the diastolic pressure-volume relationship (DPVR). Direct measurement of DPVR, however, requires invasive techniques. Increased left atrial (LA) size is a marker of left ventricular (LV) diastolic hypertension, and so, the LA/LV diameter ratio has the potential to mark the degree of upward and leftward shift in the LV-DPVR. We thus investigated the association of this novel marker with exposures known to induce diastolic dysfunction and with clinical evidence of diastolic dysfunction. METHODS AND RESULTS: Reports from 7,803 patients undergoing maximal exercise stress echocardiography were reviewed. Increased LA/LV diameter ratio predicted diminished exercise capacity (P < 0.001) in a multivariate regression analysis. Increased LA and decreased LV diameters were each independently associated with exercise capacity (P < 0.001, both). Increased LA/LV diameter ratio was associated with hypertension (P = 0.001), diabetes (P = 0.03) and with increased severity of LV hypertrophy (P< 0.001). Those with LA/LV diameter ratio > or = 1.0 were more likely to use loop diuretics, odds ratio = 2.5 [95% CI, 1.4, 4.5], compared to those with lower ratio values. CONCLUSIONS: Increased LA/LV diameter ratio was observed in subjects with hypertension, diabetes and LV hypertrophy. Increased ratio predicted worse exercise capacity and was associated with more frequent loop diuretic use. These data are consistent with the hypothesis that this ratio is a noninvasive marker of the LV-DPVR.     

早期原发性高血压患者血管内皮功能研究

[目的]观察早期原发性高血压患者肱动脉内皮功能状态和血管活性物质的变化。[方法]对40例早期原发性高血压患者(早期高血压组)和40例健康对照者(对照组),以高分辨率超声测定肱动脉血流介导内皮依赖性舒张功能(FMD),并检测血一氧化氮(NO)、降钙素基因相关肽(CGRP)、血浆内皮素(ET-1)、假性血管性血友病因子(VWF)的变化。[结果]早期原发性高血压组的FMD和NO、CGRP降低,ET-1、VWF升高,与健康对照组相比差异有统计学意义(P﹤0.05)。血NO水平变化与FMD的变化一致(r=0.511,P﹤0.01)。[结论]原发性高血压患者在早期已发生肱动脉内皮依赖性舒张功能降低,与NO水平下降有关。