右心室发育不良综合征误诊误治导致死亡一例

患者女性,2岁.因发现心脏杂音2年入院.体检心尖部可闻及3/6级收缩期杂音.心脏彩色超声心动图示:膜部室间隔缺损约4 mm;左心房内径20 mm,左心室舒张末期内径41 mm,右心室内径10.3 mm.诊断先天性心脏病室间隔缺损,接受介入封堵治疗.     

乳鼠心室细胞在不同处理的封堵器材料上生长的体外研究

目的 通过在体外观察乳鼠心室细胞在不同处理的室间隔缺损封堵器材料上的生长情况,探讨室间隔缺损介入封堵治疗后影响封堵器表面愈合填补的因素.方法 根据室间隔缺损封堵器材料是否有胶原蛋白涂层,将实验分为涂层组和非涂层组,各组又分为3个亚组,分别给予表皮生长因子(EGF组)、5-溴脱氧尿苷(BrdU组)处理及不额外处理(对照组).乳鼠心室肌组织分别与不同处理的封堵器材料(1 cm×2 cm)进行培养,观察组织块开始搏动时间,细胞开始爬行时间,封堵器材料表面生长的细胞种类、含晕及胰岛素样生长因子的含量.结果 (1)涂层组和非涂层组间组织块开始搏动时间差异无统计学意义.亚组中BrdU组开始搏动时间早于EGF组及对照组(P<0.05).(2)涂层组细胞开始爬行时间早于非涂层组(P<0.05).亚组中EGF组开始爬行时间最早(P<0.05).(3)在封堵器材料上生长的细胞包括内皮细胞、成纤维细胞和心肌细胞.内皮细胞含量在EGF组最高,成纤维细胞含量在BrdU组最高,心肌细胞含昔BrdU组与对照组均高于EGF组(P<0.05).(4)各组胰岛素样生长因子的阳性率均在培养的第7天达到最高值.结论 胶原蛋白涂层促进细胞爬行,EGF促进内皮细胞的生长,BrdU可在不影响心肌细胞生长的状态下促进成纤维细胞的生长.     

STEMI患者炎症反应水平及罪犯斑块特征与PCI术前TIMI血流分级的关系

目的明确ST段抬高型心肌梗死(STEMI)患者的炎症反应水平及罪犯斑块形态特征与经皮冠状动脉介入治疗(PCI)术前心肌梗死溶栓(TIMI)血流分级的关系。方法本研究为回顾性研究。选取1268例PCI术前对罪犯斑块行光学相干断层成像(OCT)检查的STEMI患者,按照TIMI血流分级分为TIMI 0~1组964例(76.0%)和TIMI 2~3组304例(24.0%)。收集2组的基线临床资料;采集血样检测炎症反应标志物高敏C反应蛋白(hsCRP)、心肌损伤标志物及血脂等指标;行心脏超声检测左心室射血分数;行冠状动脉造影及OCT检查,收集梗死相关动脉的病变长度、狭窄程度,有无复杂病变,以及罪犯斑块类型、狭窄程度及易损性相关指标并比较。采用多因素logistic回归模型分析TIMI 0~1级的独立相关因素,并确定其最佳截断值。结果1268例STEMI患者年龄为(57.6±11.4)岁,男性923例(72.8%)。与TIMI 2~3组相比,TIMI 0~1组患者年龄较大,N末端B型钠尿肽原水平较高,左心室射血分数及肌钙蛋白I水平较低,hsCRP水平较高[5.16(2.06,11.78)mg/L比3.73(1.51,10.46)mg/L],且斑块破裂亚组中TIMI 0~1组患者hsCRP水平较高(P均<0.05)。冠状动脉造影结果显示与TIMI 2~3组相比,TIMI 0~1组梗死相关动脉为右冠状动脉的比例较高,血管病变长度更长,最小管腔直径更小,直径狭窄度更大(P均<0.05)。OCT显示TIMI 0~1组罪犯斑块破裂发生率(75.8%比61.2%)和斑块易损性高于TIMI 2~3组,斑块易损性更高表现为平均脂质角度更大[(241.27±46.78)°比(228.30±46.32)°],薄纤维帽粥样硬化斑块更多(72.4%比57.9%),具有更多的巨噬细胞聚集(84.4%比70.7%)和胆固醇结晶(39.1%比25.7%);最小血流面积更小[1.3(1.1~1.7)mm²比1.4(1.1~1.9)mm²]且血流面积狭窄更严重[(78.2±10.6)%比(76.3±12.3)%,P均<0.05]。多因素分析结果显示,平均脂质角度>255.55°、胆固醇结晶、病变长度>16.14 mm和hsCRP>3.29 mg/L是STEMI患者TIMI血流分级降低(TIMI 0~1级)的独立相关因素。结论斑块易损性和炎症反应与STEMI患者PCI术前TIMI血流分级降低密切相关。     

乳鼠心室细胞在不同处理的封堵器材料上生长的体外研究

Objective To observe the effects of collagen-coating, epidermal growth factor (EGF), Bromodeoxyuridine (BrdU) on growth and function of neonatal ventricular cardiomyocytes in transcatheter closure device patches in vitro. Methods Neonatal ventricular cardiomyocytes were cultured with transcatheter closure device patches (1 cm × 2 cm) coated with or without collagen and treated with 10% FBS (control), EGF (20 ng/ml), BrdU (0.1 mmol/L), respectively. In vitro ventricular cardiomyocytes growth and function as well as IGF-I content were determined. Results (1) The beginning time of ventricular cardiomyocytes beating on patches was similar in collagen-coated and uncoated patches treated with PBS, EGF or BrdU, respectively (P > 0.05). The cell beating time was significantly earlier in Brdu group than in PBS and EGF groups (all P < 0.05). (2) Time of cultured cell covering on patches was significantly earlier in coated patches than those uncoated patches in PBS, EGF and BrdU treated groups (all P < 0.05). The ventricular cardiomyocytes covering time on patches was significantly earlier in EGF group than that in PBS and BrdU groups (all P < 0.05). (3) Ventricular cardiomyocytes types survived on patches included endothelial cells, fibroblasts and myocytes. The highest content of endothelial cells was evidenced in EGF group and the highest content of fibroblasts was found in Brdu group. Myocytes content was similar between PBS and BrdU groups (P > 0.05) and significantly higher than that in EGF group (all P < 0.05). (4) IGF-I peaked at the seventh culture day in all groups (all P < 0.01). Conclusions Ventricular cardiomyocytes covering on patches could be enhanced by collagen coating. EGF could promote endothelial cells growth while Brdu could stimulate fibroblasts growth on patches.