经导管主动脉瓣置换术后心肌损伤的荟萃分析

目的:系统评价经导管主动脉瓣置换术后心肌损伤的发生率及预测因子。方法:全面检索PubMed、Springer、Elsevier-SDOL、EMbase、SSCI、CNKI、VIP、中国生物医学文献数据库、万方数据资源系统,收集2009年1月至2015年11月发表的主动脉瓣置换术后心肌损伤的研究文献。利用疾病患病率或发病率质量准则评价文献质量,运用Comprehensive Meta-Analysis 2.0软件进行荟萃分析。结果:最终纳入9个研究,均为非随机对照研究,共包含2 423例接受经导管主动脉瓣膜置换术的严重主动脉瓣狭窄患者。术后心肌损伤的总体发生率为20.5%(95%CI:18.5~22.7)。经导管主动脉瓣膜置换术后发生心肌损伤的独立预测因子包括:经心尖途径、早期手术经验不足、瓣膜栓塞或需要置入第2个瓣膜、大出血或致命性出血、冠状动脉粥样硬化性心脏病病史、手术时间、术前存在肾功能不全。结论:经导管主动脉瓣置换术后心肌损伤的总体发生率高达20.5%,可能对预后产生不良影响,应当针对其预测因子进行早期干预以改善患者预后。     

血浆半乳糖凝集素3检测在急性冠脉综合征患者的应用价值

目的探讨半乳糖凝集素3(Galectin-3)作为炎性标志物评价冠状动脉斑块稳定性的可行性。方法连续入选74名急性心肌梗死患者和115名不稳定心绞痛患者。所有患者均接受冠脉动脉造影检查。造影前抽取桡动脉血,检测血浆中Galectin-3和C反应蛋白(CRP)表达水平。结果急性心肌梗死组中Galectin-3和CRP血浆表达水平显著高于不稳定心绞痛组(P0.05),Galectin-3与CRP表达呈正相关性。Galectin-3和CRP诊断急性心肌梗死的AUC差异无统计学意义(P0.05)。结论急性心肌梗死患者血浆中Galectin-3表达水平显著升高,对心血管损伤的炎性反应更敏感。     

64层螺旋CT联合心肌酶检查应用于急性心源性胸痛诊断的临床价值分析

目的研究分析64层螺旋CT联合心肌酶检查应用于急性心源性胸痛诊断的临床价值。方法随机选取2008年2月~2011年3月我院收治的45例急性心源性胸痛患者作为治疗组,抽取同期来我院体检中心进行检查的45例健康者作为对照组,对照组单纯给予MSCTA(64层螺旋CT血管成像)进行检查。治疗组在此基础上联合血清心肌酶检查,观察两组患者的诊断情况。结果治疗组患者经MSCTA联合心肌酶检查诊断急性心源性胸痛特异性为100%,敏感性为95.56%,显著高于对照组93.33%、86.67%,组间差异显著,具有统计学意义(P0.05);经MSCTA分辨钙化粥样斑块CT值为(341.65±308.42)HU,非钙化粥样斑块CT值为(59.88±67.93)HU,差异显著,具有统计学意义(P0.05)。结论 64层螺旋CT联合心肌酶检查应用于诊断急性心源性胸痛效果良好,准确率较高,同时对判断冠状动脉斑块与狭窄性质具有积极的意义。     

β-受体阻滞剂对高血压患者房颤发生的预防作用

目的:研究高血压患者出现心房颤动(AF)前预防使用β-受体阻滞剂的作用及意义。方法:对高血压患者治疗组128例和对照组128例进行24小时动态心电图及实验室检查,并对结果进行分析。结果:AF发生例数两组比较差异无统计学意义(P>0.05),治疗组血清PⅠCP、PCⅢ及TGF-β1水平明显低于对照组(P<0.05)。结论:β-受体阻滞剂通过阻断自主神经以逆转心肌纤维化减少AF发生,实现对高血压患者房颤发生的预防作用。     

两种急诊血运重建方法对老年急性心肌梗死预后影响的临床观察

目的：：评价急诊经皮冠状动脉介入治疗(PCI)和静脉溶栓治疗对老年急性心肌梗死预后的影响。方法：我科203例老年 AMI患者,32例患者接受常规治疗(对照组),98例接受静脉溶栓治疗(溶栓组),73例行急诊PCI治疗(PCI组)。比较3组血管再通率、左心室射血分数(LVEF)和病死率。结果：溶栓组梗死相关血管再通率为66.3%,PCI组为97.3%(P<0.01)。住院期间,对照组、溶栓组及 PCI 组间 LVEF 差异均有显著性(P<0.05)。3组患者住院期间病死率分别为9.4%、7.1%和4.1%,对照组与溶栓组、溶栓组与P C I组间比较差异不显著(P>0.05),但PCI组与对照组比较,P<0.05。溶栓再通和 PCI 成功患者住院期间 LVEF和心肌缺血发生率(分别为16.9%和8.5%),差异均有显著性(P<0.05);住院期间病死率(1.5%和2.8%)无明显差异(P>0.05)。3组患者平均随访时间分别为(3.1±2.5)年、(3.6±2.4)年和(3.4±2.3)年,随访期间心梗再发率分别为23.1%、13.8%和7.4%,心肌缺血事件发生率分别为73.1%、55.2%和19.1%,需要再次行血运重建率分别为61.5%、42.5%和11.8%,LVEF值分别为0.456±0.121、0.568±0.132和0.615±0.115,病死率分别为15.4%、9.2%和5.9%,PCI组各项指标均优于对照组和溶栓组(P<0.05或P<0.01)。结论：老年 AMI患者急诊PCI治疗的近期和远期预后优于溶栓治疗。     

尼克酰胺磷酸核糖转移酶对心肌缺血/再灌注的影响研究进展

背景 尼克酰胺磷酸核糖转移酶(nicotinamide phosphoribosyltransferase,NAMPT)是合成烟酰胺腺嘌呤二核苷酸(nicotinamide adenine dinucleotide,NAD)的限速酶.NAMPT可存在于细胞内和细胞外,它们的作用不尽相同.NAMPT在心血管系统中发挥着重要作用,但在心肌缺血/再灌注(ischemia/reperfusion,I/R)中的作用尚存争议. 目的 进一步了解NAMPT的心血管作用及对心肌I/R的影响. 内容 就目前研究对NAMPT的来源及潜在的心血管作用、细胞内NAMPT(intracellular NAMPT,iNAMPT)及细胞外NAMPT(extracellular NAMPT,eNAMPT)、以及对心肌I/R的影响作一综述. 趋向 促进对NAMPT的作用及机制的了解,NAMPT有望成为治疗心肌I/R损伤的新靶点.     

Are there gender differences in left ventricular remodeling after myocardial infarction in rats?

Objective

An unclear issue is whether gender may influence at cardiac remodeling after myocardial infarction (MI). We evaluated left ventricle remodeling in female and male rats post-MI.

Methods

Rats were submitted to anterior descending coronary occlusion. Echocardiographic evaluations were performed on the first and sixth week post-occlusion to determine myocardial infarction size and left ventricle systolic function (FAC, fractional area change). Pulsed Doppler was applied to analyze left ventricle diastolic function using the following parameters: E wave, A wave, E/A ratio. Two-way ANOVA was applied for comparisons, complemented by the Bonferroni test. A P≤=0.05 was considered significant.

Results

There were no significant differences between genders for morphometric parameters on first (MI [Female (FE): 44.0±5.0 vs. Male (MA): 42.0±3.0%]; diastolic [FE: 0.04±0.003 vs. MA: 0.037±0.005, mm/g] and systolic [FE: 0.03±0.0004 vs. MA: 0.028±0.005, mm/g] diameters of left ventricle) and sixth (MI [FE: 44.0±5.0 vs. MA: 42.0±3.0, %]; diastolic [FE: 0.043±0.01 vs. MA: 0.034±0.005, mm/g] and systolic [FE: 0.035±0.01 vs. MA: 0.027±0.005, mm/g] of LV) week. Similar findings were reported for left ventricle functional parameters on first (FAC [FE: 34.0±6.0 vs. MA: 32.0±4.0, %]; wave E [FE: 70.0±18.0 vs. MA: 73.0±14.0, cm/s]; wave A [FE: 20.0±12.0 vs. MA: 28.0±13.0, cm/s]; E/A [FE: 4.9±3.4 vs. MA: 3.3±1.8]) and sixth (FAC [FE: 29.0±7.0 vs. MA: 31.0±7.0, %]; wave E [FE: 85.0±18.0 vs. MA: 87.0±20.0, cm/s]; wave A [FE: 20.0±11.0 vs. MA: 28.0±17.0, cm/s]; E/A [FE: 6.2±4.0 vs. MA: 4.6±3.4]) week.

Conclusion

Gender does not influence left ventricle remodeling post-MI in rats.     

Melatonin protects testes against lithium‐pilocarpine‐induced temporal lobe epilepsy in rats: a time course study

Male dysfunction is common in patients with temporal lobe epilepsy (TLE). We evaluated whether melatonin, as a supplement, can play a positive role in reducing the epileptogenesis imposing abnormalities of spermatozoa and testes in epileptic rats. Status epilepticus was induced based on the TLE lithium‐pilocarpine model. Two patterns of melatonin were administered to the epileptic animals along the mean durations of latent (14 days) and chronic (60 days) phases. Sperm parameters, different antioxidant enzyme levels, germ cell apoptosis, body and relative sex organ weights were evaluated in all groups 60 days following SE induction. Chronic TLE caused a significant reduction in sperm parameters. In the testis, the reduced level of antioxidant enzymes was accompanied by a significant increase in malondialdehyde concentration. The presence of oxidant condition in the testes of epileptic animals caused expanded apoptosis in the germ cell layer. Moreover, the amount of weight gain in epileptic animals was more prominent. Melatonin administration was able to improve sperm motility by increasing the total antioxidant level. There was also a significant reduction in the spermatogenic cell line apoptosis and the extra weight gain of melatonin‐treated animals. Melatonin supplementation might be considered as an acceptable cotreatment in epileptic patients.     

定量组织速度成像评价心肌梗死患者左心室舒张不同步性及整体舒张功能

目的探讨应用定量组织速度成像技术(QTVI)评价心肌梗死患者左心室非同步舒张运动的意义。方法获取60例心肌梗死患者及40例正常人的标准心尖部左室长轴、两腔和四腔观组织速度图像,离线分析左心室6个壁基底段、中间段和心尖段共18个位点及左心室各壁二尖瓣环的组织速度曲线,测量心电图QRS波起始点至各位点心肌舒张早期峰值速度(Ea)的时限(TQ-E)。计算同一节段6个壁间TQ-E的最大差值(Inter-ΔTQ-E)、同一壁内3个节段间TQ-E的最大差值(Intra-ΔTQ-E)及左心室18个位点间TQ-E的最大差值(Max-ΔTQ-E)。计算左心室各壁二尖瓣环Ea与舒张晚期峰值速度(Aa)比值的平均值(Ea/Aa′)。并利用常规超声心动图测定心肌梗死患者左室整体舒张末容积(EDV)、收缩末容积(ESV)、射血分数(LVEF)。结果与正常人相比,心肌梗死组EDV、ESV均明显升高,心肌梗死组EF明显降低,心肌梗死患者的Inter-ΔTQ-E、Intra-ΔTQ-E、Max-ΔTQ-E均明显延长,Ea/Aa′明显降低。心肌梗死患者中,Max-ΔTQ-E与Ea/Aa′均呈显著负相关;与EDV及ESV呈显著正相关;与EF呈显...     

阿托伐他汀对心肌梗死后大鼠基质金属蛋白酶-2及微小RNA-21的作用

目的 观察阿托伐他汀对心肌梗死后大鼠基质金属蛋白酶(MMP)-2、微小RNA(miRNA,miR)-21表达的影响.方法 选取140只Wistar大鼠建立急性心肌梗死模型,分为假手术组、对照组、阿托伐他汀低剂量组和高剂量组,进行左室重量指数、心肌胶原容积分数、miRNA-21及MMP-2 mRNA表达测定.结果 阿托伐他汀治疗组左室重量指数、心肌胶原容积分数、梗死周边区miR-21 、MMP-2 mRNA的表达均降低(P＜0.05);各组梗死周边区miR-21表达量与MMP-2 mRNA水平呈正相关(r对照组=0.611,P＜0.05;r阿托伐他汀低剂量组=0.502,P＜0.05;r阿托伐他汀低剂量组=0.541,P＜0.05).结论 阿托伐他汀能降低梗死周边区MMP-2和miR-21的表达,发挥减轻心室重构的作用.