促红细胞生成素通过抑制转化生长因子-β1对心肌重构的影响

心肌重构是很多心脏疾病共同的病理改变,在临床上日益受到关注。转化生长因子（transforming growthfactor,TGF）-β1可以通过其下游的信号传导通路,对心肌重构的发生和发展起作用。促红细胞生成素（erythropoietin,EPO）可通过抑制TGF-β1的部分作用影响心肌重构。本文对TGF-β1在心肌重构中作用的可能机制及EPO对其的干预作用做一综述。     

不同他汀类药物标准剂量对稳定性斑块的影响

目的探讨不同他汀类药物标准剂量对稳定性斑块的影响。方法入选经冠状动脉造影和血管内超声检查确定为稳定性斑块的135例患者,分为3组：辛伐他汀20mg组47例,阿托伐他汀20mg组45例,瑞舒伐他汀10mg组43例。随访3-6个月,观察给予不同他汀类药物标准剂量的3组血清低密度脂蛋白-胆固醇（10wdensitvlipoprotein-cholesterol,LDL—C）、高密度脂蛋白-胆固醇（highdensitylipoprotein—cholesterol,HDL．C）、高敏C反应蛋白（high—sensitivityC．reactionprotein,hs—CRP）浓度变化及斑块坏死核所占百分比、斑块体积的动态变化。结果3组血清LDL—C、HDL—C、hs．CRP浓度及斑块坏死核所占百分比、斑块体积的基线资料比较,差异无统计学意义（P〉0．05）。随访3-6个月后,他汀类药物标准剂量治疗的3组血清LDL．C浓度与基线相比均有明显下降,均达标（P〈0．01）,且瑞舒伐他汀最优,阿托伐他汀其次,辛伐他汀最后（P均〈0．01）。辛伐他汀组血清HDL-C浓度与基线比较。差异无统计学意义（P〉0．05）,但阿托伐他汀组、瑞舒伐他汀组明显高于基线,差异有统计学意义（P=0．001．P=0．048）,且两组间比较,差异无统计学意义（P=0．852）。辛伐他汀组血清hs—CRP浓度与基线比较,差异无统计学意义（P〉0．05）,但阿托伐他汀组、瑞舒伐他汀组明显低于基线,差异有统计学意义（P=0．015,P=0．025）．且两组间比较,差异无统计学意义（P=0．411）。通过血管内超声虚拟组织成像技术（intravascularuhrasound—virtualhistology,IVUS—vH）检测,斑块坏死核所占百分比在辛伐他汀组明显高于基线,差异有统计学意义（16．33％-＋15．38％眦7．87％-＋1．04％,P〈0．01）;阿托伐汀组治疗后与基线相比,斑块坏死核所占百分比明显减少,差异有统计学意义（6．64％±3．25％帆7．91％±1．27％,P=0．007）;瑞舒伐他汀组斑块坏死核所占百分比与基线相比,差异无统计学意义（P=0．133）。斑块体积在辛伐他汀组治疗前、后比较,差异无统计学意义（P=O．286）;但阿托伐他汀组、瑞舒伐他汀组斑块体积明显低于基线,差异有统计学意义[（28．65±10．77）mm。vs．（33．31±10．75）mm3,P=0．041;（30．69_＋8．12）mm3ys．（36．337-＋12．15）mm。,P=0．013],且治疗后两组体积比较,差异有统计学意义（P=0．322）。结论不同种类他汀类药物标准剂量对稳定性斑块疗效不同：对于LDL—C,辛伐他汀、阿托伐他汀、瑞舒伐他汀标准剂量治疗后均可达标;阿托伐他汀、瑞舒伐他汀能升高HDL—C,降低hs—CRP;辛伐他汀无遏制斑块向不稳定进展的作用,阿托伐他汀有促进斑块稳定,逆转斑块的作用,瑞舒伐他汀可阻止斑块进展及逆转斑块的作用。     

尼可地尔预防经皮冠状动脉介入治疗患者造影剂相关急性肾损伤的研究进展

随着影像学和经皮冠状动脉介入治疗的快速发展, 造影剂的应用也越来越广泛, 造影剂相关急性肾损伤也成为临床最常见的急性肾损伤病因之一。造影剂相关急性肾损伤严重威胁患者的健康以及会给患者带来更大的经济负担, 因此预防造影剂相关急性肾损伤的发生尤为重要。尼可地尔是一种临床中常见的血管舒张药物, 广泛应用于心绞痛的治疗, 具有对抗氧化应激、抗细胞凋亡、抗炎症和扩张血管等作用, 被认为能有效预防造影剂相关急性肾损伤。但目前关于尼可地尔预防造影剂相关急性肾损伤的疗效研究仍缺少更深入的研究。     

二十二碳六烯酸增加大鼠冠状动脉平滑肌细胞大电导钙离子激活钾离子流的机制

Objective To investigate the mechanism of enhanced large conductance calciumactivated potassium channel currents (BK) in coronary smooth muscle cells (SMCs) by docosahexaenoic acid (DHA). Methods Coronary SMCs were isolated by enzyme digestion. Potassium channels in coronary SMCs were identified by applications of different potassium blockers. Effects of DHA and its metabolite 16,17-epoxydocosapentaenoic acid (16,17-EDP) on BK channels in the absence and presence of cytochrome P450 epoxygenase inhibitor SKF525A were studied by patch clamp in whole-cell configuration. Results BK channels were widely distributed in SMCs, and BK currents in normal SMCs accounted for (64.2±2.7)%of total potassium currents(n =20). DHA could activate BK channels, and its 50% effective concentration (EC50) was (0.23±0.03)μmol/L, however, the effect of DHA on BK channels was abolished after SMCs were incubated with cytochrome P450 epoxygenase inhibitor SKF525A. 16,17-EDP, a metabolite of DHA, could reproduce the effects of DHA on BK channels, and its EC50 was (19.7± 2.8) nmol/L.Conclusion DHA and metabolites can activate BK channels and dilate coronary arteries through activating cytochrome P450 epoxygenase pathway.     

急性心肌梗死介入术后无复流患者血清补体4a水平和血小板聚集率的变化

目的 探讨急性心肌梗死(AMI)经皮冠状动脉介入治疗(PCI)术后无复流患者血清补体4a(C4a)水平和血小板聚集率的变化.方法 入选行PCI的AMI患者119例,其中介入术后冠状动脉无复流患者(无复流组)28例,冠状动脉恢复血流患者(复流组)91例和疑似冠心病而行冠状动脉造影检查结果正常者(对照组)30例.检测对照组冠状动脉造影前和无复流组、复流组介入术前30 min,术后即刻、30 min、1 h、2 h、半年的C4a水平和血小板聚集率,并观察其变化.结果 无复流组、复流组和对照组术前30 min C4a水平差异无统计学意义.无复流组和复流组术前30 min血小板聚集率均高于对照组(P均＜0.05).无复流组术后即刻、30min和1 h C4a水平和血小板聚集率均高于术前和术后2 h、半年,同时也均高于复流组术后即刻、30 min和1 h(P均＜0.05).复流组不同时间的C4a水平和血小板聚集率差异无统计学意义.无复流组术后即刻、30 min和1 h,C4a水平与血小板聚集率呈正相关(r值分别为0.91、0.79和0.60,P均＜0.01).结论 C4a水平和血小板聚集率在AMI患者PCI术后早期短暂升高.

Abstract：

Objective To observe serum C4a and platelet aggregation rates changes in acute myocardial infarction (AMI) patients before and after percutaneous coronary intervention (PCI)and association with the development of no-reflow phenomenon. Methods From June 2006 to August 2009, 119 AMI patients underwent PCI (28 cases of no-reflow group, 91 cases of reflow group)and 30 subjects with suspected coronary heart diseases and normal coronary angiography results (control group) were enrolled in this study. C4a and platelet aggregation rate were measured at 30 minutes before PCI, immediately after PCI,30 minutes,l hour,2 hour, and 6 months post PCI in AMI patients and at before coronary angiography in control subjects. Results The levels of serum C4a at 30 minutes prior to PCI in control, no-reflow, and reflow groups were similar(P ＞0. 05). Platelet aggregation rate at 30 minutes prior to PCI was significantly higher in no-reflow group and reflow group than in control group ( all P ＜ 0. 05 ). Serum C4a and platelet aggregation rates were significantly higher in no-reflow group at immediate, 30 minutes and 1 hour after PCI than at 30 minutes prior to PCI, two hours and 6 months after PCI ( all P ＜ 0. 05), and were significantly higher than in reflow group at immediate, 30 minutes and 1 hour after PCI ( all P ＜ 0. 05 ). Serum C4a and platelet aggregation rates were similar at different time points in reflow group ( all P ＞ 0. 05 ). The levels of C4a in no-reflow group at immediate, 30 minutes and 1 hour after PCI were positively correlated with platelet aggregation rates (r=0. 91,0. 79 ,0. 60 ,respectively ,all P＜0.01). Conclusion The transient increase on levels of C4a and platelet aggregation rate early post PCI are verified in no-reflow patients with AMI undergoing PCI.     

护士站的故事

护士站的故事南京医科大学９６护干班（２１００２９）郭素峡传闻我们站要来一位护士—某局长的千金，是站长亲自“要”来的，所有人都毫不怀疑站长的眼光，更不会怀疑护士站即将一片生机盎然。其实，在听到这个消息的时候，护士站已经一片生机了，那几天，几乎所有人的脸...     

自发性冠状动脉夹层3例

自发性冠状动脉夹层（ SCAD）是发病率低、病死率高的冠状动脉疾病，临床表现取决于冠状动脉夹层的程度和对血流的阻碍情况，目前尚无SCAD的诊治指南。为提高对本病的认识，现将我院收治的3例SCAD分析报告如下。     

间隙性连接蛋白37基因1019C/T多态性与经皮冠状动脉介入术后支架内再狭窄的相关性研究

目的 评估无锡地区人群间隙性连接蛋白37(Connexin 37,CX37)基因1019C/T多态性与经皮冠状动脉介入术(percutaneous coronary intervention,PCI)术后支架内再狭窄的相关性.方法 532例PCI术后在我院复查冠脉造影的冠心病患者,按造影结果分为支架内再狭窄组(67例)和无支架内再狭窄组(465例),501名健康人群作为正常对照组,均采用基因测序技术对CX37基因1019C/T多态性位点基因型进行检测,比较3组人群中基因型及等位基因分布差异.结果 (1)在冠心病组与正常对照组比较中,C等位基因及C等位基因携带者(CC+TC)基因型频率冠心病组明显高于正常对照组(C等位基因:57.05％ vs.41.32％,P＜0.01;C等位基因携带者:79.32％ vs.65.47％,P＜0.01)；与TT纯合子相比,(CC+TC)基因型冠心病患病风险显著增加(OR=2.03,95％ CI∶1.53～2.80).对性别进行亚组分析显示,无论男性还是女性人群中冠心病组C等位基因携带者频率均显著高于正常对照组(男性:79.63％ vs.72.45％,P=0.02;女性:78.00％ vs.51.50％,P＜0.01),C等位基因携带者冠心病患病风险明显高于TT型(男性:OR=1.48,95％CI:1.06～2.09;女性:OR=3.34,95％CI∶1.90～5.86).(2)与无支架内再狭窄组相比,支架内再狭窄组C等位基因频率及C等位基因携带者分布频率均显著升高(C等位基因频率:72.39％ vs.54.84％,P＜0.01；CC+TC型:89.55％ vs.77.85％,P=0.027).与TT纯合子相比,C等位基因携带者支架内再狭窄患病风险升高2.44倍(95％ CI∶1.08～5.50).性别亚组分析表明,男性人群中支架内再狭窄组C等位基因携带者频率高于无支架内再狭窄组(92.86％ vs.77.66％,P=0.008),C等位基因携带者发生支架内再狭窄的风险是TT型的3.74倍(95％ CI∶1.32～10.64),而在女性人群中两组间(CC+TC)基因型分布频率无统计学意义(P=0.655).结论 CX37 C等位基因不仅与冠心病的发生发展有关联,而且与男性PCI术后支架内再狭窄的发生发展相关.     

血清学指标对不稳定斑块的诊断价值

目的以血管内超声-虚拟组织学（intravascularunltrasound-virtualhistology，IVUS-VH）分析为参照，观察血清学指标对不稳定斑块的预测意义。方法纳入69例冠状动脉粥样硬化性心脏病（冠心病）患者，于人院后检测各项血清学指标后，行冠状动脉造影及IVUS-vH分析斑块性质，通过受试者工作曲线（ROC）分析各项指标对不稳定斑块的诊断意义以及联合检测血清学指标对不稳定斑块的诊断符合率。结果心脏型脂肪酸结合蛋白（heart-typefattyacid-bindingprotein，HFAP）、超敏C反应蛋白（high-sensitivityC-reactiveprotein，hs-CRP）、肌钙蛋白（cardiactroponin，cTnI）受试者工作曲线下面积分别为0．833、0．692、0．647，P均〈0．05。HFAP、hs-CRP、cTnI联合检测对不稳定斑块诊断的符合率为93．75％；HFAP及hs-CRP联合检测对不稳定斑块诊断的符合率为63．16％；hs-CRP及cTnI联合检测对不稳定斑块诊断的符合率64．52％；HFAP及cTnI联合检测对不稳定斑块诊断的符合率为66．67％。结论对不稳定斑块诊断，单项检测时HFAP最优，其次为cTnI，最后为hs-CRP；HFAP、cTnI、hs-CRP三者联合检测优于任意两者联合。     

冠状动脉平滑肌细胞大电导钙离子激活钾通道电流的特点

Objective To investigate characteristics of large conductance Ca2+ -activated K+ currents ( BK currents) in normal rat coronary smooth muscle cells. Methods Coronary smooth muscle cells were isolated by enzyme digestion. Potassium channels in coronary smooth muscle cells were identified by applications of different potassium blockers. BK currents were recorded by patch clamp in whole ce11 and single channel configuration,respectively. BK currents amplitude and conductance were calculated. Voltage-sensitive and calciumsensitive characteristics of BK currents and changes with IBTX,a specific blocker,were observed. Results BK currents in normal smooth muscle cells accounted for 65% ± 4% of total potassium currents( n = 12), BK current conductance was (258 ± 42) pS ( n = 6), and current densities were ( 275 ± 40 ) pA/pF at voltage 150 mV ( n = 8). Open probabilities ( NP0 ) of BK channels at calcium 1 μmol/L in external solution and test potentials at 0,20,40,60,80,100,120,140 and 160 mV were 0,0. 0002,0. 0016 ± 0. 0005,0. 0283 ± 0. 0081,0. 05694 ±0. 0102,0. 3533 ± 0. 0514,1. 4922 ± 0. 1578,2. 5975 ± 0. 3632, and 4. 6041 ± 0. 7834, respectively (P＜0.05,n =5). NP0 of BK channels at test potential 60 mV,and calcium in external solution at 0,0. 001,0. 01,0. 1,1,10,50 and 100 μmol/L were 0,0.0001,0.0031 ± 0.0008,0.0042 ± 0.0090,0.0808 ± 0.0105,0.7591 ±0. 1274,2.7242 ±0.4612,and 3.2366 ±0.5728,respectively(P ＜0.05,n =6). Conclusion BK channels are widely distributed in normal coronary smooth muscle cells, have voltage-sensitive and calcium-sensitive characteristics, and play an important role in regulation of coronary vascular tension.