瓜蒌通脉丸对急性心肌缺血大鼠左心室功能及心肌结构的影响

目的探讨瓜蒌通脉丸对异丙肾上腺素（ISO）诱导急性心肌缺血损伤大鼠左心室功能及心肌结构的保护作用。方法皮下注射ISO,复制大鼠急性心肌缺血模型,观察瓜蒌通脉丸对急性心肌缺血大鼠标准Ⅱ导联心电图ST段、血清乳酸脱氢酶（LDH）、肌酸磷酸激酶（CK）及左心室功能的影响,同时观察各组心肌结构的变化。结果与模型组相比,瓜蒌通脉丸能明显抑制ISO引起的ST段位移（P〈0.05）,改善左室收缩压（LVESP）、左室舒张末期压（LVEDP）和左室内压最大上升及下降速率（±dp/dtmax）,降低血清LDH、CK含量,以瓜蒌通脉丸高剂量组作用显著（P〈0.05或P〈0.01）。结论瓜蒌通脉丸能明显减轻急性心肌缺血大鼠的心肌损伤,改善左心室功能及心肌结构。     

瓜蒌通脉丸对异丙肾上腺素诱导大鼠急性心肌缺血损伤的保护作用及机制

目的研究瓜蒌通脉丸对异丙肾上腺素（ISO）诱导大鼠急性心肌缺血损伤的影响。方法皮下注射ISO制备大鼠急性心肌缺血损伤模型,观察瓜蒌通脉丸对大鼠心电图ST段、乳酸脱氢酶（LDH）含量、肌酸磷酸激酶（CK）含量、丙二醛（MDA）含量、超氧化物歧化酶（SOD）活性、一氧化氮（NO）含量、一氧化氮合酶（NOS）活性的影响。结果与正常对照组比,模型对照组心电图ST段位移增加,LDH、CK、MDA含量明显升高,SOD活性、NO含量、NOS活性明显降低;经药物干预后,各治疗组可明显抑制ST段位移,降低LDH、CK和MDA的含量,升高SOD活性、NO含量、NOS活性。结论瓜蒌通脉丸可能是通过改善心电图ST段的变化,调节LDH、CK、MDA、SOD、NO、NOS水平来对抗ISO所致大鼠急性心肌缺血损伤,对缺血心肌起到保护作用。     

前列地尔对异丙肾上腺素致急性心肌缺血损伤大鼠心电图和血清心肌酶的影响

目的:观察前列地尔(PGE1)预处理对异丙肾上腺素(ISO)诱导的急性心肌缺血损伤大鼠心电图和血清心肌酶的影响。方法:45只Wistar大鼠随机分为3组,即正常对照组、模型损伤组、PGE1治疗组,每组15只。正常对照组不给予任何处理;模型损伤组、PGE1治疗组皮下注射ISO10mg/kg复制大鼠急性心肌损伤模型;PGE1治疗组预先给予尾静脉注射PGE1,剂量为5μg·kg-1·d-1,每天1次,连续3d,于末次给药24h后皮下注射10mg/kgISO。24h后记录各组心电图变化,测定并比较血清乳酸脱氢酶(LDH)、肌酸磷酸激酶(CK)水平。结果:与正常对照组相比,模型损伤组大鼠心电图ST段明显抬高,血清LDH、CK水平明显升高(P<0.01)。与模型损伤组相比,预先静脉注射PGE1可对抗ISO所致心肌缺血大鼠心电图ST段的异常抬高(P<0.05),并降低血清LDH和CK的水平(P<0.01)。结论:PGE1可有效抑制急性心肌缺血损伤大鼠ST段的抬高和调节心肌酶活性,保护心肌细胞膜结构完整性,从而保护缺血损伤心肌。     

补心软脉颗粒对大鼠急性心肌缺血损伤的保护作用

目的观察补心软脉颗粒对异丙肾上腺素(ISO)大鼠心肌缺血损伤的保护作用。方法采用四肢根部和背部皮下多点注射ISO制备大鼠急性心肌缺血模型,观察补心软脉颗粒对心电图ST段位移的影响,并测定血清LDH、CK活性及心肌病理学形态。结果补心软脉颗粒对ISO所致心肌缺血大鼠心电图ST段,心肌损伤酶学指标(LDH、CK)和组织病理学均有明显的改善作用。结论补心软脉颗粒通过增强机体对心肌缺血的耐受力,稳定细胞膜,减少心肌坏死范围起到保护心肌的作用。     

黄芩苷衍生物对异丙肾上腺素致大鼠急性心肌缺血损伤的保护作用

目的研究黄芩苷衍生物对异丙肾上腺素（isoproterenol,ISO）致大鼠急性心肌缺血的保护作用及机制。方法采用ISO腹腔注射诱导大鼠急性心肌缺血模型,检测黄芩苷衍生物对心肌缺血损伤后大鼠血清肌酸激酶（creatinekinase,CK）、谷草转氨酶（aspartate aminotransferase,AST）、乳酸脱氢酶（lactate dehdrogenase,LDH）活性;心肌组织匀浆中超氧化物歧化酶（superoxide dismutase,SOD）、Na＋-K＋-ATPase、Ca2＋-Mg2＋-ATPase活性及丙二醛（malondialde-hyde,MDA）含量,并进行心肌病理组织学检查。结果黄芩苷衍生物90 mg/kg及180 mg/kg可显著对抗ISO所致的心电图ST段异常偏移;降低血清中CK、AST及LDH活性及心肌匀浆中MDA含量,提高SOD、Na＋-K＋-ATPase及Ca2＋-Mg2＋-ATPase的活性;减轻缺血心肌的病理损伤程度。结论黄芩苷衍生物对ISO所致的大鼠急性心肌缺血有显著的保护作用。     

丹酚酸B对实验性大鼠急性心肌缺血的保护作用

目的：观察注射丹酚酸B对异丙肾上腺素(ISO)诱导的急性心肌缺血大鼠模型的保护作用。方法：采用腹腔注射ISO方法复制大鼠急性心肌缺血模型,观察丹酚酸B对大鼠心电图及心肌组织形态学的影响,检测血清中乳酸脱氢酶(LDH)、肌酸激酶(CK)、超氧化物歧化酶(SOD)和丙二醛(MDA)的含量。结果：丹酚酸B l0,5mg／kg能有效对抗心电图ST段下移,T波的升高,显著降低血清中LDH、CK和MDA的含量,升高血清中SOD的含量(与模型组比较P<0．01,P<0．05)。结论：丹酚酸B对ISO诱导大鼠急性心肌缺血有较好的保护作用。     

蕨麻对大鼠缺血心肌的保护作用及其血清差异蛋白表达的影响

【目的】研究蕨麻乙醇提取物对大鼠结扎冠状动脉所致急性心肌缺血损伤的保护作用及其差异蛋白质表达谱的影响。【方法】选取雄性SD大鼠随机分为手术对照组,模型组,盐酸地尔硫卓组(diltiazem,30 mg/kg),蕨麻乙醇提取物7.2、3.6、1.8 g/kg干预组。连续灌胃10 d后,结扎在体大鼠冠状动脉致急性心肌缺血损伤模型。缺血时间持续30 min。记录各处理组动物心电图,左心室收缩压LVSP,左心室舒张末期压LVEDP及左室内压最大变化速率(±dp/dt max);取血清检测乳酸脱氢酶(LDH)、肌酸激酶(CK)含量;用强阴离子交换芯片(SAX-2)及弱阳离子交换芯片(WCX-2)结合表面增强激光解析电离飞行时间质谱技术分析大鼠急性心肌缺血损伤后不同处理组血清中蛋白质表达谱的改变。【结果】冠状动脉结扎致心肌缺血后,心电图ST段出现抬高,蕨麻醇提物7.2和3.6 g/kg组显著抑制了急性心肌缺血损伤导致的大鼠心电图ST段升高(P<0.05)。蕨麻醇提物各剂量组的各项心功能指标[左心室收缩压LVSP,左心室舒张末期压LVEDP及±dp/dt均优于模型组(P<0.05)]。心肌缺血后,血清中LDH和CK含量显著升高,蕨麻醇提物各剂量组血清中LDH和CK均显著降低(P<0.05)。蛋白质芯片结果显示:WCX-2芯片共获得338个血清蛋白质峰;SAX-2芯片共获得348个血清蛋白质峰。缺血30 min,模型组质/荷(M/Z)比为4 972 Da的蛋白质相对含量明显高于对照组(P<0.01),蕨麻干预后,该蛋白质峰随药物浓度升高而降低,至高剂量组时降至对照组水平,呈现出明显的剂量依赖关系,提示4 972Da蛋白质可能是蕨麻抗心肌缺血损伤的药物作用靶点之一,有待进一步研究证实。【结论】蕨麻乙醇提取物能够显著保护急性心肌缺血所致心肌损伤,改善心脏功能。不同剂量蕨麻干预后,心肌损伤后异常表达的蛋白质(4 972 Da)剂量依赖性下降。     

滁菊总黄酮对异丙肾上腺素致大鼠急性心肌缺血的影响

目的观察滁菊总黄酮对异丙肾上腺素(ISO)致急性心肌缺血模型大鼠的保护作用。方法将大鼠皮下注射ISO复制大急性心肌缺血模型,观察滁菊总黄酮对模型大鼠心电,血清肌酸激酶(CK)、乳酸脱氢酶(LDH)、心肌组织超氧物歧化酶(SOD)、过氧化氢酶(CAT)和丙二醛(MDA)含量的影响。结果滁菊总黄酮能够抑制急性心肌缺血模型大鼠心电图J点抬高,降低血清CK、LDH活性,升高心肌组织SOD、CAT活性,降低MDA含量。结论滁菊总黄酮对ISO致心肌缺血模型大鼠有保护作用。     

加味丹参饮对大鼠实验性心肌缺血损伤的影响

目的研究加味丹参饮对大鼠实验性心肌缺血损伤的影响及部分作用机制。方法采用结扎冠状动脉左前降支的大鼠心肌缺血模型,观察加味丹参饮高、中、低剂量(8.24g/kg、4.12g/kg、2.06g/kg)对造模后大鼠心电图ST段心肌组织的损伤情况以及血清CK、AST、LDH水平、血浆中MDA含量和SOD、GSH-Px活性的影响。结果与造模组比较加味丹参饮高剂量组Ⅱ导联心电图ST段升高幅度明显下降(P<0.05);各加味丹参饮组对AST、LDH、MDA升高和SOD活性下降均有显著的抑制作用(P<0.01),且高剂量组对血清CK的升高、GSH-Px活性下降亦有显著的抑制作用(P<0.05);光镜观察显示加味丹参饮可明显改善心肌结构的损伤。结论加味丹参饮可明显减轻大鼠心肌缺血损伤程度,对实验性心肌缺血具有显著的保护作用,这与其抗过氧化作用密切相关。     

加减瓜蒌薤白半夏汤改善缺血心肌细胞钙超载的实验研究

目的 观察加减瓜蒌薤白半夏汤对大鼠缺血心肌细胞游离钙、心电图及血清CK-MB的影响。方法 以加减瓜蒌薤白半夏汤灌胃，应用激光共聚焦显微镜(LSCM)对异丙基肾上腺素(ISP)诱发的大鼠急性心肌缺血损伤模型细胞内游离Ca^2 进行了定位、定量检测，并检测血清磷酸肌酸激酶(CK-MB)含量及心电图ST段的变化。结果 急性缺血组大鼠心肌细胞内Ca^2 、血清CK-MB含量及心电图ST段的位移与对照组比较，差别均有显著性意义；应用大、小剂量加减瓜蒌薤白半夏汤后心肌细胞内Ca^2 含量与急性缺血组比较差别有显著性意义，血清CK-MB含量、心电图ST段的位移与急性缺血组比较差别亦有显著性意义。结论 加减瓜蒌薤白半夏汤可显著抑制缺血心肌细胞Ca^2 超载．减轻心肌损伤．对缺血心肌组织有显著的保护作用。     

Evaluation of Myocardial Viability after Myocardial Infarction with Intravenous Real-time Myocardial Contrast Echocardiography

The myocardial viability after myocardial infarction was evaluated by intravenous myocardial contrast echocardiography. Intravenous real-time myocardial contrast echocardiography was performed on 18 patients with myocardial infarction before coronary revascularization. Follow-up echocardiography was performed 3 months after coronary revascularization. Segmental wall motion was assessed using 18-segment LV model and classified as normal, hypokinesis, akinesis and dyskinesis. Viable myocardium was defined by evident improvement of segmental wall motion 3 months after coronary revascularization. Myocardial perfusion was assessed by visual interpretation and divided into 3 conditions： homogeneous opacification; partial or reduced opaciflcation or subendocardial contrast defect; contrast defect. The former two conditions were used as the standard to define the viable myocardium. The results showed that 109 abnormal wall motion segments were detected among 18 patients with myocardial infarction, including 47 segments of hypokinesis, 56 segments of akinesis and 6 segments of dyskinesis. The wall motion of 2 segments with hypokinesis before coronary revascularization which showed homogeneous opacification, 14 of 24 segments with hypokinese and 20 of 24 segments with akinese before coronary revascularization which showed partial or reduced opaciflcation or subendocardial contrast defect was improved 3 months after coronary revascularization. In our study, the sensitivity and specificity of evaluation of myocardial viability after myocardial infarction by intravenous real-time myocardial contrast echocardiography were 94.7% and 78.9%, respectively. It was concluded that intravenous real-time myocardial contrast echocardiography could accurately evaluate myocardial viability after myocardial infarction.     

磁共振心肌灌注成像评价心肌梗死PTCA治疗前后心肌存活

目的 评价磁共振心肌灌注成像(MRMPI) 检测心肌梗死存活心肌的作用. 方法 选择心肌梗死患者51 例.采用1.5 T MR扫描仪,反转恢复快速小角度激励( IR-turbo FLASH) 序列,全部患者均在静脉注射钆喷替酸葡甲胺(Gd-DTPA) 0.1 mmol/kg、MRMPI 首过期及5~30 min 延迟期成像.21 例行静息、负荷99锝单光子发射计算机体层摄影术( single photon emission computed tomography, SPECT) 进行对照研究.首过期行短轴面成像,延迟期行短轴面及长轴面成像.结果 51例心肌梗死患者,42 例(82.3%) 首过期显示灌注减低;50 例(98%) 延迟增强.在21例168个心肌段SPECT诊断无活性心肌段48个,MRMPI 示梗死区均有延迟增强,SPECT诊断存活心肌段120 个,MRMPI 示97段无延迟增强.以静息、负荷99m锝SPECT 作为参考标准,MRMPI 的敏感度、特异度分别为100%、80.8%. 结论 MRMPI 可有效地检测心肌梗死的存活和非存活心肌,以及其程度和范围.     

Acute myocardial infarction: myocardial salvage assessment

Primary coronary revascularization by means of percutaneous coronary intervention(PCI)is a highly effective treatment of acute myocardial infarction re-establishing coronary perfusion and stopping the ongoing necrosis in the dependent myocardium.Single-photon emission computed tomography(SPECT)is the most widely used modality assessing myocardial salvage as the difference between the acute perfusion defect before intervention and the remaining scar size measured in a second scan several days after the event.SPECT allows quantification of area at risk(AAR)and final infarct size(FIS)by tracer injection prior to revascularization and after 1 month,respectively.SPECT provides the most validated measure of myocardial salvage and has been utilized in multiple randomizedclinical trials.However,SPECT is logistically challenging,expensive,and includes radiation exposure.More recently,a large number of studies have suggested that cardiac magnetic resonance(CMR)can determine salvage in a single examination by combining measures of myocardial oedema in the AAR exposed to ischaemia reperfusion with FIS quantification by late gadolinium enhancement.     

Acute myocardial infarction due to myocardial bridge

Myocardial bridge (MB) is regarded as a common anatomic variant rather than a congenital condition anomaly,defined as the intramyocardial course of a portion of the coronary artery.It was first mentioned by Rayman in 1737 and first described by Grainicianu in the early 1920s.The current gold standard for diagnosing     

超声检测心内外膜下跨壁速度梯度在心肌缺血诊断中的应用

目的：探讨跨壁速度梯度（MVG）在诊断心肌缺血中的应用价值。方法：检测38例冠心病患者（病例组）和28例健康志愿者（对照组）心尖四腔观、两腔观各节段心肌收缩期跨壁速度梯度（MVG-L＋）、舒张期跨壁速度梯度（MVG—L-）。结果：对照组MVG—L＋和MVG—L-由基底段、中间段至心尖段差异无显著性意义。病例组缺血节段的MVG-L＋和MVG—L-较对照组相应节段明显降低。结论：MVG可定量评价局部心肌运动状态，为临床心功能评价提供有效指标。     

Relation of myocardial bridge to myocardial infarction: a meta-analysis

Background Small case series have suggested an association of coronary myocardial bridge （MB） with myocardial infarction （MI）.However,the relationship between MB and major adverse cardiac events （MACE） remains largely unknown.The aim of this study was to assess the relationship between MB and MACE involving MI.Methods We performed a systematic search of MEDLINE,PreMEDLINE,and all EMB Reviews as well as a reference list of relevant articles according to the SPICO （Study design,Patient,Intervention,Control-intervention,and Outcome） criteria using the following keywords：myocardial bridging,myocardial bridge,intramural coronary artery,mural coronary artery,tunneled coronary artery,coronary artery overbridging,etc.Bibliographies of the retrieved publications were additionally hand searched.Studies were included for the meta-analysis if they satisfied the following criteria：（1） they evaluate the association of MB with cardiovascular endpoint event; （2） they included individuals with MB and those without MB; 3） they excluded individuals with obstructive coronary artery disease （CAD）.Studies were reviewed by a predetermined protocol including quality assessment.Dates were pooled using a random effect model.Results Seven observational studies that followed 5 486 patients eligible for the enrolled criteria were included from 7 136 initially identified articles.The prevalence of MB was 24.8％ （1 363/5 486）.During 0.5-7.0 years of follow-up of this cohort of population,crude outcome rates were 8.0％ in the MB group and 7.7％ in the non-MB group.The odds ratio of overall MACE and MI were 1.34 （95％ confidence interval （CI）：0.57-3.17,P=0.51,n=7 studies） and 2.75 （95％ CI：1.08-7.02,P ＜0.03,n=5 studies） respectively for subjects of MB compared to non-MB.Conclusion Relationship between MB and MI appears to be a real one,although the study did not reveal a connection of MB to MACE,suggesting whether the necessity of antiplatelet therapy needs to be further studied in a larger cohort of patients with MB prospectively.     

心肌声学造影对急性心梗PCI术后心肌灌注的评价

目的:通过心肌声学造影(MCE)对急性心梗经皮冠状动脉支架术(PCI)后心肌灌注的情况进行判断,了解其对左心功能及左室重构的影响.方法:采用病例对照的研究方法,根据PCI术后1周的MCE检查,将急性心梗患者分为灌注正常组、灌注稀疏组和灌注缺失组,并随访检查3个月、6个月的左室射血分数(LVEF)及左室舒张末内径(LVDd)的变化情况,比较组内及组间不同时段LVEF与LVDd的变化.结果:PCI术后3个月灌注稀疏组LVEF恢复到正常;灌注缺损组PCI术后LVEF的平均水平随时间变化而逐渐降低;灌注缺损组患者的LVEF低于灌注稀疏组和灌注正常组(P<0.05);术后6个月灌注缺损组LVDd平均水平高于灌注正常组和灌注稀疏组(P<0.05),灌注缺损组随时间的变化左室内径逐渐增大(P<0.05).结论:急性心梗患者PCI术后心肌微循环较差时,其左室射血分数降低,左室内径增大;MCE有利于对急性心梗患者PCI术后左心功能及左室重构评估.     

超声心肌造影技术对心肌梗塞患者心肌微循环的定量评价

目的：探讨超声心肌造影技术在心肌梗塞(简称心梗)患者心肌微循环灌注改变中的应用价值。方法：对30例急性心梗患者进行超声心动图及心肌造影检查,观察患者梗塞区域(AMI组,同时以患者非梗塞区域为自身对照组)心肌微循环灌注并以CPS造影软件进行分析。结果：心肌梗塞患者梗塞区域心肌微循环灌注开始时间(AT)、达峰时间(APT)较同一切面内的非梗塞区域明显延长（P<0.05）,梗塞区域造影剂灌注的峰值强度(PI)及灌注速度(β)均明显低于同一切面内的非梗塞区域（P<0.05）。结论：超声心肌造影技术可以定量评价心梗患者心肌微循环灌注,具有重要的临床应用价值。     

急性心肌梗死心肌蛋白检测的临床评价

目的探讨心肌损伤标志物心肌蛋白检测在急性心肌梗死(AcuteMyocardialInfarction,AMI)诊断时的应用价值,减少急性心肌梗死漏诊、误诊发生率。方法测定35例AMI病人在发病的第4小时、8小时、24小时,5天等四个时间段的血清肌钙蛋白(IcTnI)、肌钙蛋白T(cTnT)及肌红蛋白(Mb)浓度,和对照组30例健康者体检时的血清相应项目数据对比并进行统计学处理。结果AMI患者发病后4￣8小时血清cTnI、cTnT开始上升,24小时达到峰值,5天仍维持在较高水平,其浓度以及阳性率与正常对照组比较均有显著性差异(P<0.05);而血清Mb在4￣8小时上升幅度更大,但24小时后浓度以及阳性率与正常对照组比较差异不显著(P>0.05)。结论在心肌梗死的早期诊断指标中,Mb的优势明显;cTnI、TnT可用于AMI的早期诊断,但更适用于那些因就诊时间较晚、心肌酶已正常的心梗病人。三者联测可更早、更可靠地提高心肌梗死诊断的准确率。