高血压病患者心肌灌注断层显像的相关因素研究

目的探讨高血压病患者心肌灌注断层显像的结果和多种临床因素的关系.方法将97例高血压病患者的心肌灌注断层显像结果同患者的年龄、性别、体重指数、患高血压病的时间、有无抗高血压治疗,有无高血压家族史,患者的血清葡萄糖、肌酐、尿素氮、甘油三酯、胆固醇、脉搏、收缩压、舒张压、脉压差、平均动脉压、患者是否吸烟、饮酒进行非条件Logistic回归分析.结果患高血压病的时间(βi=0.4914,P=0.0017)、吸烟(βi=3.5022,P=0.0176)、高胆固醇血症(βi=1.6147,P=0.0194)是高血压病患者并发心肌缺血的危险因素.结论高血压痛患者戒烟、治疗高胆固醇血症,可降低其并发心肌缺血的风险.     

牛黄栀子配伍对大鼠局灶性脑缺血再灌注不同时段神经生长因子（NGF）含量的影响

目的:通过检测牛黄、栀子配伍对大鼠局灶性脑缺血再灌注不同时段神经生长因子(NGF)含量的影响,探讨治疗缺血性中风在该作用环节不同时段的作用特点,研究其配伍阻抑脑缺血级联反应的时序特征。方法:用线栓法建立大鼠大脑中动脉缺血再灌注模型,观察牛黄、栀子及二者配伍对缺血再灌注24小时和72小时两个时段大鼠脑组织NGF含量的影,响。结果:缺血再灌注损伤可明显抑制脑组织NGF的表达,从而削弱了机体的自身保护机制;再灌注24小时,牛黄、栀子均可促进NGF的表达,而二者配伍后作用明显降低:再灌注72小时,牛黄的作用不显著,栀子可明显增强NGF的表达,二者配伍与栀子的作用相当,未显示出明显的配伍效应。结论:中药配伍的作用不是简单的效应累加,而是依据作用环节及作用时间的不同表现为不同的时空特征。     

血利钾心停搏液和双向灌注心肌保护的实验研究

目的 通过与三种经典心肌保护方法比较，探讨含血利多卡因高钾(血利钾)心停搏液和双向灌注心肌保护法的心肌保护作用。方法 犬20只，随机分成四组(n=5)，分别用晶体心停搏液(CGI)、冷稀释血心停搏液(CG2)、常温稀释血心停搏液(CG3)及血利钾心停搏液(EG)。每组均经历120min心脏缺血。观察心脏停搏情况、冠状静脉窦回流血量及心肌酶浓度、心肌细胞内钙离子(Ca^2 )和丙二醛(MDA)及三磷酸腺苷(ATP)含量、心肌形态学改变。结果 ①实验组(EG)心脏停搏时间短，心停搏液用量少，冠状静脉血流量及心肌氧摄取率在缺血前后无明显变化；②血清心肌酶水平各组间无显著差异；③EG再灌注心肌Ca^2 超负荷及ATP含量下降较CG3明显，与CG2相似；④EG再灌注心肌MDA水平较CGI显著降低。⑤心肌形态学改变各组间无显著差异。结论 血利钾心停搏液和双向灌注具有确切的心肌保护作用。     

参附注射液对大鼠缺血再灌注小肠细胞Bax、Bcl-2及c-myc蛋白表达的影响

目的　探讨参附注射液对大鼠缺血再灌注小肠细胞Bax、Bcl 2及c myc蛋白表达的影响及它们与肠细胞凋亡的内在联系。方法　健康SD大鼠 36只随机分为 3组 ,空白对照组 (S组 )、缺血再灌注 +生理盐水组 (IR +NS组 )、缺血再灌注 +参附注射液组 (IR +SF组 ) ,每组 12只。采用钳闭肠系膜前动脉制备小肠缺血再灌注模型。免疫组化检测Bax、Bcl 2及c myc蛋白的表达 ,每组选 2 4个视野分别测量光密度值 (OD值 )。TUNEL法检测凋亡的小肠细胞并计算凋亡指数。结果　IR +NS组BaxOD值明显高于S组 (P <0 .0 1) ,IR +SF组BaxOD值明显低于IR +NS组 (P <0 .0 1) ,且低于S组 (P <0 .0 5 )。IR +NS组Bcl 2OD值高于S组 (P <0 .0 5 ) ,且IR +SF组Bcl 2OD值高于S组 (P <0 .0 1) ,但IR +NS组与IR +SF组比较无显著差异。IR +NS组c mycOD值明显高于S组 (P<0 .0 1) ,且明显高于IR +SF组 (P <0 .0 1)。IR +NS组细胞凋亡指数明显高于S组和IR +SF组 (P <0 .0 1) ,而IR +SF组高于S组 (P <0 .0 5 )。结论　参附注射液增加小肠组织Bcl 2蛋白的表达 ,降低Bax及c myc蛋白的表达 ,抑制小肠细胞凋亡 ,保护缺血再灌注小肠。     

An overview of new pharmacological treatments for cerebrovascular dysfunction after experimental subarachnoid hemorrhage

Cerebral vasospasm and the resulting cerebral ischemia occurring after subarachnoid hemorrhage (SAH) are still responsible for the considerable morbidity and mortality in patients affected by cerebral aneurysms. Mechanisms contributing to the development of vasospasm, abnormal reactivity of cerebral arteries and cerebral ischemia after SAH have been intensively investigated in recent years. It has been suggested that the pathogenesis of vasospasm is related to a number of pathological processes, including endothelial damage, smooth muscle cell contraction resulting from spasmogenic substances generated during lyses of subarachnoid blood clots, changes in vascular responsiveness and inflammatory or immunological reactions of the vascular wall.A great deal of experimental and clinical research has been conducted in an effort to find ways to prevent these complications. However, to date, the main therapeutic interventions remain elusive and are limited to the manipulation of systemic blood pressure, alteration of blood volume or viscosity, and control of arterial dioxide tension.Even though no single pharmacological agent or treatment protocol has been identified which could prevent or reverse these deadly complications, a number of promising drugs have been investigated. Among these is the hormone erythropoietin (EPO), the main regulator of erythropoiesis. It has recently been found that EPO produces a neuroprotective action during experimental SAH when its recombinant form (rHuEPO) is systemically administered.This topic review collects the relevant literature on the main investigative therapies for cerebrovascular dysfunction after aneurysmal SAH. In addition, it points out rHuEPO, which may hold promise in future clinical trials to prevent the occurrence of vasospasm and cerebral ischemia after SAH.     

小剂量阿司匹林对缺血性脑血管病患者血小板聚集功能的影响

目的 :观察小剂量阿司匹林 (ASA)对ICVD患者血小板聚集功能的影响。方法 :用花生四烯酸 (AA ,5 0 0 μmol·L-1)、二磷酸腺苷 (ADP ,5 μmol·L-1)、肾上腺素 (EPN ,5 μmol·L-1)和胶原 (COL ,2 μg·mL-1)做诱导剂检测ICVD患者服用不同剂量ASA组 ( 2 5、5 0和10 0mg·d-1)的血小板聚集率。结果 :各ASA组对AA、COL诱导聚集的变异系数较大。对AA诱导聚集无显著抑制者的比例分别为2 5mg·d-1组 44 4%、5 0mg·d-1组 2 9 6%、10 0mg·d-1组 2 9% ,其中 5 0mg·d-1组中合并糖尿病的例数较显著抑制者中多。结论 :ICVD患者中小剂量ASA作用个体差异较大 ,部分与自身危险因素有关。提示临床中ASA的效果需要实验室检测并应个体化     

针刺对缺血再灌注大鼠海马脑源性神经营养因子mRNA的影响

目的 探讨针刺对缺血再灌注大鼠海马内脑源性神经营养因子（BONF）基因表达的影响，推测针刺改善缺血再灌注的可能机制。方法 采用4-血管阴断法制备大鼠全脑缺血再灌注模型，电针刺激百会、肾俞、足三里穴后，利用RT-PCR检测BDNF mRNA。结果 正常组大鼠海马BDNF mRNA表达极低，缺血再灌注组大鼠海马BDNF mRNA表达明显增高，治疗15d的针刺1、2组大鼠海马BDNF mRNA表达较缺血再灌注组更高，及早治疗且治疗时间为20d的针刺3组大鼠海马BDNF mRNA表达较降低。结论 缺血再灌注大鼠海马BDNF水平增高有利于损伤的神经元存活、恢复；针刺促进脑内细胞分泌内源性BDNF可能是针刺有效治疗缺血再灌注的机制之一。     

Prevalence of silent myocardial ischemia in asymptomatic individuals with subclinical atherosclerosis detected by electron beam tomography

BACKGROUND: Electron beam tomography coronary calcium imaging is an evolving technique for the early detection of coronary atherosclerosis, and recent studies have established its prognostic value in asymptomatic individuals. The relationship of coronary artery calcium scores (CAC) to obstructive coronary artery disease (CAD) has been poorly studied but is clinically relevant because it determines which individuals are likely to benefit from revascularization procedures. Hence, we prospectively evaluated the prevalence of myocardial ischemia in asymptomatic patients with cardiovascular risk factors and subclinical atherosclerosis. METHODS AND RESULTS: We studied 864 asymptomatic patients with no previous CAD but with cardiovascular risk factors, referred for electron beam tomography coronary calcium imaging to our institution over an 18-month period. From this group, 220 consecutive patients (85% men; mean age, 61 +/- 9 years; age range, 31-84 years) with moderate to severe atherosclerotic disease (coronary calcium score > or =100 Agatston units) were prospectively evaluated by technetium 99m sestamibi single photon emission computed tomography (SPECT). Patients were followed up (mean follow-up, 14 months) and data regarding their subsequent clinical management recorded. Of the 220 patients, 119 had moderate atherosclerosis (CAC score of 100-400 Agatston units) and 101 had severe atherosclerosis (CAC score > or =400 Agatston units). Abnormal SPECT findings were seen in 18% of patients with moderate atherosclerosis (n = 21) and 45% of patients with severe atherosclerosis (n = 45). Increasing severity of atherosclerosis was related to increasing ischemic burden (summed difference score = 1 +/- 0.2 for CAC score of 100-400 Agatston units and 3.2 +/- 0.5 for CAC score > or =400 Agatston units). In a multivariate linear regression model incorporating risk factors, CAC was the only predictor of silent ischemia. CONCLUSION: In comparison to previously published data, we detected a higher prevalence of silent ischemia even in patients with moderate coronary atherosclerosis (18%). This may reflect the differing risk factor profile of our patient population. When coronary calcium screening is used to preselect asymptomatic patients with cardiovascular risk factors for myocardial perfusion imaging, the optimum coronary calcium score threshold will depend on the population prevalence of risk factors and asymptomatic obstructive CAD.     

大鼠心肌缺血再灌注时心肌细胞凋亡caspase-3活性变化规律及药物对其影响

目的　探讨大鼠心肌缺血再灌注 (Ischemiareperfusion ,IR)不同时相的心肌细胞凋亡、caspase 3活性变化规律及caspase 3抑制剂Ac DEVD CHO的影响。方法　Wistar大鼠 12 2只 ,设立IR组 ,IR +Ac DEVD CHO组和假手术对照组并分设缺血 3 0min后再灌注 1、3、6、12、2 4h 5个时相点 ;以缺口末端标记法 (TUNEL)标记凋亡细胞 ,用荧光分析法检测caspase 3活性 ,行TTC染色测定心肌梗死范围。结果　心肌细胞凋亡与caspase 3活性随心肌再灌注不同时相而变化 ,心肌细胞凋亡指数 (Apoptosisindex ,AI)与caspase 3活性于再灌注 12h最高 [AI :( 3 4 83± 9 3 5 ) % ;caspase 3活性 :( 1 3 4±0 2 ) ] ,其后基本维持在平台状态 ;心肌梗死范围随IR时间逐渐增加 ,至 2 4h仍未见下降趋势 ,三者间呈显著正相关 (P <0 0 5 )。IR +Ac DEVD CHO组上述指标虽也明显增高 ,但比IR组明显减小 (P <0 0 5 )。结论　Caspase 3激活及心肌细胞凋亡参与了心肌缺血再灌注损伤过程 ,Ac DEVD CHO减轻心肌缺血再灌注损伤可能部分与其抑制心肌细胞凋亡有关。     

急性缺血性脑血管疾病的药物序贯治疗

目的:探讨药物的序贯治疗对急性缺血性脑血管病的治疗效果。方法:随机分成去纤酶、奥扎格雷钠、盐酸丁格地尔序贯治疗组和使用肠溶阿斯匹林、复方丹参针对照组,治疗组和对照组在治疗前后作神经功能评估,患者的生活能力状态评价及脑循环血流变化的测定。结果:治疗组显效率76.1%,有效率8.7%,总有效率84.8%,对照组显效率23.5%,有效率14.7%,总有效率38.2%(P<0.05)。结论:药物序贯治疗急性缺血性脑血管病比常规治疗疗效显著。