促红细胞生成素对高糖环境诱导下体外培养心脏成纤维细胞的影响

目的探讨促红细胞生成素(EPO)对高糖环境诱导过程中体外培养的乳鼠心脏成纤维细胞(CF)增殖及其表型转化的影响。方法用乳鼠原代细胞培养CF,在促进CF细胞表型转化的过程中,选用高糖培养基进行诱导,添加EPO进行干预。将同一批CF细胞随机分为3组:对照组(5.5 mmol/L葡萄糖)、高糖组(25 mmol/L葡萄糖)、高糖+EPO组(25 mmol/L葡萄糖,20 k U/L EPO)。采用免疫组织化学法鉴定CF,酶联免疫吸附法检测Ⅰ型、Ⅲ型胶原含量,Western blot检测纤维化指标α-平滑肌肌动蛋白(α-SMA)的表达。结果免疫组织化学染色结果为纤维连接蛋白、波形蛋白阳性,α-肌动蛋白阴性,证实培养的细胞为心脏成纤维细胞。与对照组比较,高糖组Ⅰ型、Ⅲ型胶原表达量都明显增加(P0.01),而高糖+EPO组Ⅰ型、Ⅲ型胶原表达量都显著低于高糖组(P0.01)。高糖组α-SMA表达较对照组明显增高(P0.05),而高糖+EPO组α-SMA表达较高糖组明显降低(P0.05)。结论高糖环境下能有效的诱导CF发生表型转化,而EPO能够逆转在高糖环境作用下诱导发生的心肌纤维化。     

Erythropoietin inhibits angiotensin Ⅱ induced cardiomyocyte hypertrophy in vitro via activating PI3K/Akt-eNOS pathway

Objective To explore the effect of erythropoietin (EPO) on angiotensin Ⅱ (Ang Ⅱ) induced neonatal rat cardiomyocyte hypertrophy and the association with PI3K/Akt-eNOS signaling pathway. Methods Cardiomyocytes were isolated from new-born Sprague-Dawley rats and stimulated by Ang Ⅱ in vitro. The cell surface area and mRNA expression of atrial natriuretic factor (ANF) of cardiomyocytes were determined in the presence and absence of various concentrations of EPO, phosphatidylinositol 3'-kinase (PI3K) inhibitor LY294002 and nitric oxide synthase (NOS) inhibitor L-NAME. Intracellular signal molecules, such as Akt, phosphorylated Akt, eNOS and phosphorylated eNOS protein expressions were detected by western blot. Nitric oxide (NO) level in the supernatant of cultured cardiomyocytes was assayed by NO assay kit. Results EPO (20 U/ml) significantly inhibited Ang Ⅱ induced cardiomyocyte hypertrophy as shown by decreased cell surface area and ANF mRNA expression (all P ＜0.05). EPO also activated Akt and enhanced the expression of eNOS and its phosphorylation (all P ＜ 0.05), increased the NO production (P ＜0.01). These effects could be partially abolished by cotreatment with LY294002 or L-NAME (all P ＜ 0.05). Conclusion EPO attenuates Ang Ⅱ induced cardiomyocytes hypertrophy via activating PI3K-Akt-eNOS pathway and promoting NO production.     

二氮嗪减轻兔心肌缺血再灌注损伤后的心肌细胞凋亡

目的探讨二氮嗪对兔心脏缺血再灌注损伤过程中心肌细胞凋亡和心肌细胞bcl-2和bax基因表达的影响.方法24只兔随机分成假手术组(P组)、缺血再灌注组(IR组)、缺血预适应组(IP组)和二氮嗪组(DP组).阻断和松开左冠脉前降支制作缺血再灌注模型,缺血5 min/再灌注5 min连续3次循环诱导预适应.DP组在缺血前缓慢静脉注射二氮嗪3 mg/kg.再灌注结束后测算左室心肌梗死面积,取缺血区心肌行TUNEL法检测心肌凋亡细胞和免疫组化检测bcl-2和bax蛋白的表达.结果DP组和IP组梗死面积明显小于IR组(P＜0.001).凋亡细胞百分数DP组(34±5)%和IP组(32±6)%较IR组(56±8)%显著减少(P＜0.001).和IR组相比,bcl-2表达在IP组和DP组明显升高(P均＜0.01),bax基因表达在IP组和DP组则明显降低(P均＜0.001).结论二氮嗪能通过调节bcl-2和bax的表达来减轻兔心肌缺血再灌注损伤后的心肌细胞凋亡.     

病态窦房结综合征合并阵发性心房颤动的射频消融治疗

目的探讨病态窦房结综合征患者合并阵发性房颤的射频消融治疗效果。方法 7例病态窦房结综合征合并阵发性房颤患者,术前动态心电图诊断为病态窦房结综合征,24小时内有数次停搏及多次阵发房颤发作,其中有5例患者停搏均发生在房颤终止时,2例停搏与房颤发作无明显关联。接受环肺静脉前庭电隔离术。术后动态心电图随访。结果该7例患者,有2例房颤复发,1例再次接受手术并成功,1例拒绝再次手术。动态心电图提示有4例(考虑为快慢综合征)心动过缓明显好转,2例(考虑为慢快综合征)房颤发作明显减少但是心动过缓无改善,接受心脏永久起搏器置入治疗。此7例患者术前与术后1个月最大心率、最小心率、平均心率比较,最小心率、平均心率术后较术前增加,最大心率术后较术前无明显变化。结论快慢型病态窦房结综合征合并阵发性房颤患者对房颤射频消融治疗效果较好,大部分患者术后心动过缓明显改善,而不需要置入心脏永久起搏器。     

西洛他唑对乳鼠心肌细胞缺氧/复氧损伤的保护作用

目的:研究西洛他唑(Cilostazol,CIL)对乳鼠心肌细胞缺氧/复氧(hypoxia/reoxygenation,H/R)损伤的影响及机制。方法:①分离培养SD乳鼠心肌细胞,建立H/R模型。心肌细胞随机分4组:对照组;H/R组,缺氧2 h,复氧4 h;H/R CIL组,缺氧前1 h予以CIL(10μmol.L-1)随即缺氧2 h,复氧4 h;H/R CIL Wort mannin(H/R CIL W)组,CIL处理前30 min予磷脂酰肌醇-3激酶(phosphatidylinositol-3 kinase PI3K)特异性抑制剂——渥曼青霉素(Wort mannin 0.1μmol.L-1);②检测各组培养液中乳酸脱氢酶、肌酸激酶同工酶含量,流式细胞术检测心肌细胞凋亡率,Western blot检测丝氨酸/苏氨酸蛋白激酶(Akt)及磷酸化丝氨酸/Akt(p-Akt)的表达。结果:CIL明显抑制H/R损伤导致的心肌细胞凋亡,并使p-Akt/Akt比值明显增加;Wort mannin可使p-Akt/Akt比值明显减少,抑制CIL的抗凋亡作用。结论:H/R损伤可导致心肌细胞凋亡,CIL可能通过PI3K-Akt途径发挥抗凋亡作用。     

急诊经桡动脉冠脉介入治疗急性冠脉综合征中应用替罗非班的有效性和安全性

目的评估盐酸替罗非班对急性冠脉综合征(ACS)患者急诊经皮冠状动脉介入治疗(PCI)时防治无复流现象的作用以及安全性。方法 116例ACS患者随机分为盐酸替罗非班组和对照组,观察两组PCI术后TIMI血流级别、24 h肌钙蛋白T(CTnT)水平、24 h及30 d复合心血管终点事件发生率及出血情况。结果替罗非班组和对照组PCI术后TIMI 3级血流发生率分别为96.8%和88.9%,TIMI 0～2级血流发生率分别为3.2%和11.1%,P均<0.05。替罗非班组24 h CTnT水平较对照组降低(P<0.05),主要复合终点心血管事件发生率较对照组降低(P<0.05)。两组均无严重出血事件发生。结论盐酸替罗非班能明显降低ACS患者PCI术后无复流现象的发生,并改善无复流现象程度。     

Erythropoietin inhibits angiotensin Ⅱ induced cardiomyocyte hypertrophy in vitro via activating PI3K/Akt-eNOS pathway

Objective To explore the effect of erythropoietin (EPO) on angiotensin Ⅱ (Ang Ⅱ) induced neonatal rat cardiomyocyte hypertrophy and the association with PI3K/Akt-eNOS signaling pathway. Methods Cardiomyocytes were isolated from new-born Sprague-Dawley rats and stimulated by Ang Ⅱ in vitro. The cell surface area and mRNA expression of atrial natriuretic factor (ANF) of cardiomyocytes were determined in the presence and absence of various concentrations of EPO, phosphatidylinositol 3'-kinase (PI3K) inhibitor LY294002 and nitric oxide synthase (NOS) inhibitor L-NAME. Intracellular signal molecules, such as Akt, phosphorylated Akt, eNOS and phosphorylated eNOS protein expressions were detected by western blot. Nitric oxide (NO) level in the supernatant of cultured cardiomyocytes was assayed by NO assay kit. Results EPO (20 U/ml) significantly inhibited Ang Ⅱ induced cardiomyocyte hypertrophy as shown by decreased cell surface area and ANF mRNA expression (all P ＜0.05). EPO also activated Akt and enhanced the expression of eNOS and its phosphorylation (all P ＜ 0.05), increased the NO production (P ＜0.01). These effects could be partially abolished by cotreatment with LY294002 or L-NAME (all P ＜ 0.05). Conclusion EPO attenuates Ang Ⅱ induced cardiomyocytes hypertrophy via activating PI3K-Akt-eNOS pathway and promoting NO production.     

EPO通过抑制心肌细胞凋亡保护糖尿病心肌病大鼠的心功能

目的探讨促红细胞生成素(erythropoietin,EPO)对糖尿病心肌病(diabetes cardiomyopathy,DCM)大鼠心脏的保护作用及机制。方法将25只SD大鼠随机分为3组:对照组(n=5)、DCM组(n=10)、DCM+EPO组(n=10),DCM组及DCM+EPO组应用链脲佐菌素60 mg/kg一次性腹腔注射构建DCM大鼠模型,饲养4周后,DCM+EPO组另外给予rhEPO 2 000 U/kg腹腔注射。行心脏超声心动图检测心功能,心肌HE染色、电镜检查,TUNEL染色测定细胞凋亡,Western Blot检测Caspase-3的表达,RT-PCR检测Bcl-2及Bax的mRNA的相对表达量。结果与对照组比较,DCM组和DCM+EPO组心功能降低(P<0.01),rh EPO能改善DCM+EPO组的心功能(P<0.01)。与对照组比较,DCM组及DCM+EPO组心肌细胞凋亡指数明显增加(P<0.001),rh EPO能改善DCM+EPO组的心肌细胞凋亡(P<0.001)。DCM组大鼠心肌的Caspase-3的蛋白表达量较正常组增加(P&l... 更多     

文山地区开展社区心脏康复的必要性及现状

随着社会经济的发展,人类生活方式的改变,心血管疾病发病率及死亡率是逐渐上升的,为降低其发病率及死亡率,必须采取预防防治手段,研究表明,心脏康复可以使心血管疾病患者从中获益,而心脏康复是一个长期持续性综合的过程,所以,开展社区心脏康复是一个发展趋势。本文主要从国内外开展社区心脏康复的现状、开展社区心脏康复的优点及必然趋势等方面进行研究,旨在总结出在文山地区开展社区心脏康复存在的问题及解决办法。     

平均心率与持续性心房颤动经导管射频消融术后复发的相关研究

目的:探讨患者平均心率与持续性房颤经导管射频消融术后复发的关系。方法:入选持续性房颤患者80例,术前心脏彩超测定左心房前后径,动态心电图测定平均心率等指标;经导管射频消融手术后进行3、12、18个月随访。结果:1复发组较未复发组术前平均心率慢,房颤病史长,两者差异有统计学意义(P0.01);2术前,术后3、12、18个月左心房前后径比较,复发组F=2.809,差异有统计学意义(P0.05),术后18个月较术前左心房前后径增大;未复发组F=4.882,差异有统计学意义(P0.01),术后12、18个月较术前、术后3个月左心房前后径缩小;3术前平均心率与房颤病史做Spearman相关性分析,差异有统计学意义(r=-0.542,P0.01);4随访18个月对房颤复发危险因素做多因素logistic回归分析,最终平均心率、左心房前后径、房颤病史进入回归模型,平均心率回归系数负值,左心房前后径、房颤病史回归系数正值。结论:平均心率慢的持续性房颤患者经导管射频消融术后复发率高,此类患者不建议尝试射频消融治疗。