经胸微创封堵治疗心室间隔缺损的学习曲线

目的 通过评估食管超声(TEE)引导下经胸微创封堵治疗心室间隔缺损(VSD)不同阶段的手术效果,探讨该技术的学习曲线.方法 回顾性分析2007年4月至2008年10月由同一手术组连续完成的60例TEE引导下经胸微创封堵治疗VSD患者的病历资料.按手术时间先后顺序依次分为4组(A、B、C、D组),每组15例,比较各组手术时间、术中出血量、中转开胸率、手术并发症以及术后住院时间,分析不同阶段的手术效果.结果 各组平均年龄、性别、体重及VSD类型等差异均无统计学意义(P＞0.05).A、B、C、D组手术时间分别为(29.6±9.6)、(27.4±9.2)、(20.0±8.2)和(17.1±7.2)min,A组和B组均明显长于C组和D组(均P＜0.01),而C组和D组之间差异无统计学意义(P=0.366);A、B、C、D组术中出血量[(59.7±13.4)m1],明显多于C组[(40.3±7.4)ml和(36.3±8.9)ml],A组和B组均明显多于C组和D组(P＜0.01),而C组和D组之间差异无统计学意义(P=0.287);手术并发症、中转开胸率以及术后住院时间比较,差异均无统计学意义(P＞0.05).结论 经胸微创封堵治疗VSD的学习曲线大约为30例.

Abstract：

Objective To evaluate the clinical results of minimally invasive transthoracic device closure of ventricular septal defect (VSD) without cardiopulmonary bypass (CPB) under transesophageal echocardiography (TEE) guidance and to analyze the learning curve of this kind of operation. Methods Clinical data of a consecutive series of 60 VSD patients from April 2007 to October 2008 were reviewed. The patients were divided equally into 4 groups ( group A, B, C, D, n = 15 in each group). The operative time, quantity of bleeding, ratio of converting to intracardiac repair, complications and hospital stay were compared among the 4 groups. Results There was no difference among the 4 groups in terms of age, gender, body weight and the type of VSDs ( P ＞ 0.05). While the operative time in group A (29.6 ± 9.6) min and group B (27.4 ± 9.2) min were significantlylonger than that in group C (20.0 ± 8.2 min, P ＜ 0.01 ) and group D ( 17.1 ± 7.2 min, P ＜ 0. 01 ), there was no difference between group C and D (P=0.366). The quantity of bleeding in group A (59.7 ± 13.4)ml and group B (54.3 ±9.9)ml were more than that in group C (40.3 ± 7.4ml, P ＜ 0. 001 ) and group D ( 36.3 ± 8.9 ml, P ＜ 0. 001 ), but no difference was shown between group C and D ( P= 0.366). No difference was shown regarding complications, ratio of converting to intracardiac repair, and hospital stay between the 4 groups. Conclusion The learning curve of minimally invasive transthoracic device closure of VSD without CPB under TEE guidance is approximately 30 cases.     

Effect of α-asarone on ethanol-induced learning and memory impairment in mice and its underlying mechanism

OBJECTIVE To investigate the effect ofα-asarone on ethanol-impaired cognitive ability and explore the underlying mechanism in mice. METHODS A mouse model of impaired learning and memory was created by ethanol(2.0 g · kg~(-1), ig). α-Asarone(7.5, 15 and 30 mg·kg~(-1), ip) was delivered 10 min prior to ethanol administration. After 40 min, the locomotor activity of mice with learning and memory impairment was evaluated by the open field test and the behavioral effect of α-asarone was evaluated using the novel object recognition test.Glutamate(Glu) and γ-aminobutyric acid(GABA) levels in the hippocampus were determined by ELISA, and the proteins expression levels of hippocampal α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid(AMPA) receptor(Glu R2), N-methyl-D-aspartic acid(NMDA)receptor(NMDAR2 B), synaptophysin I(SYNΙ), glutamate transporter type 1(GLT-1) and calcium/calmodulindependent protein kinaseⅡ(Ca MKⅡ) were detected by Western blotting. RESULTS There was no significant difference in the horizontal or vertical locomotor activity between the ethanol and normal groups or the 7.5, 15 and 30 mg·kg~(-1)α-asarone groups[F(5, 48)=0.6536, P>0.05; F(5, 49)=1.995, P>0.05]. The recognition index in the ethanol group was significantly decreased as compared with that in the normal group[F(5, 46) =6.739, P<0.05]and was markedly increased in the α-asarone groups as compared with that in the ethanol group(P<0.05), with the exception of the 7.5 mg · kg~(-1)α-asarone group(P>0.05). The hippocampal Glu: GABA ratio in mice was significantly elevated in the ethanol group as compared with that in the normal group(33.42±0.8972 vs 30.79±0.2102, P<0.05) and significantly lower in the α-asarone groups(31.99±0.4986 vs. 33.42±0.8972; 30.97±0.1757 vs. 33.42±0.8972; 30.83 0.1723 vs. 33.42±0.8972, P<0.05). The expression levels of GluR2, NMDAR2B, pSYNⅠand p Ca MKII were significantly higher in the ethanol group as compared with those in the normal group(P<0.05) and obviously lower in the α-asarone groups(P<0.05), with the exception of GluR2, NMDAR2B and pCaMKⅡ in the 7.5 mg·kg~(-1)α-asarone group(P>0.05).And the expression level of GLT-1 was significantly lower in the ethanol group as compared with that in the normal group(P<0.05) and obviously higher in the α-asarone groups(P<0.05). CONCLUSION Pretreatment with α-asarone significantly improved the learning and memory impairment. A possible underlying mechanism is regulation of the calcium signaling cascade to correct functioning of related proteins, and thus, maintain the level of Glu.     

Effect of total flavonoids of Rosa rugosa on PI3K/AKT pathway and endoplasmic reticulum stress apoptosis in rats with cerebral ischemia-reperfusion injury北大核心CSCD

Aim To investigate the effects of total flavonoids from Rosa rugosa (TFR) on cerebral ischemia reperfusion injury (CIRI) in rats, and to investigate whether TFR inhibited neuronal apoptosis by regulating phosphoinositide 3-kinase/protein kinase B (PI3K/AKT) signaling pathway and endoplasmic reticulum stress (ERS) pathways. Methods SD rats were randomly divided into sham operation group, model group, low-dose group (50 mg · kg -1 · d -1), medium-does group (100 mg · kg -1 · d -1), and high-does group (200 mg· kg -1 · d -1). The injury model of middle cerebral artery occlusion/reperfusion (MCAO/R) was prepared following suture method. Neurobehavioral changes, cerebral infarct size and brain tissue water content were detected 24 h after surgery. HE and Nissl staining were performed to observe pathological indicators. TUNEL staining was used to detect the apoptosis of ischemic nerve cells in brain. Western blot was used to detect the protein levels of Bcl-2, Bax, and cleaved Caspase-3, PI3K, p-PI3K, AKT, p-AKT, GRP78, CHOP and Caspase-12. Results Compared with MCAO/R group, the rats in medium-dose group and high-dose group showed improvement in the neurobehavioral function, decrease in the cerebral infarction area and the degree of cerebral edema, and reduction of the pathological damage of cerebral cortex. Moreover, there was a significantly decrease in the apoptosis rate of nerve cells in medium-dose group and high-dose group. The expression of anti-apoptotic protein Bcl-2 increased, and the pro-apoptotic protein Bax and cleaved-Caspase-3 decreased, the expression of pPI3K/PI3K, p-Akt/AKT increased, and the expression of ERS-related protein GRP78, CHOP, Caspase-12 decreased. Conclusions TFR can inhibit neuronal apoptosis by regulating the PI3K/AKT signaling pathway and ERS pathway, thus playing a protective role in CIRI rats. © 2023 Publication Centre of Anhui Medical University. All rights reserved.     

Effect of N-acetylcysteine on Nrf2, heme oxygenase-1 and γ-glutamate cysteine synthetase in rats with chronic hepatic injury北大核心CSCD

OBJECTIVE To observe the effect of N-acetylcysteine on nuclear factor-eythroid 2 related factor 2(Nrf2), heme oxygenase-1 (HO-1) and γ-glutamate cysteine synthetase(γ-GCS) in rats with chronic hepatic injury. METHODS The rats were divided into normal control and model groups. 25% CCI4olive oil solutiond mL·kg-1) was given by subcutaneous injection to induce a chronic hepatic injury rat model, 3 times a week, for 4 weeks. At the end of the 4th week, rats with chronic hepatic injury were equally divided into 5 groups: NAC 45, 90 and 180 mg·kg-1 groups, glutathione (GSH) 54 mg·kg-1 group (positive model group) and model group. Normal control and model groups were given the same volume of sterilized normal sodium, once a day, for 4 weeks. At the end of the 8th week, all the rats were sacrificed. The levels of glutamate pyruvate transaminase(GPT), glutamic oxaloacetic transaminase (GOT) in serum and superoxide dismutase(SOD), malondialdehyde (MDA), glutathione (GSH) and hydroxyproline(Hyp) in hepatic tissue were detected. Liver histopathological changes were observed. Immunohistochemistry was used to detect the expression of Nrf2, HO-1 and y-GCS in hepatic tissue. The mRNA levels of Nrf2, HO-1 and γ-GCS in the liver were detected by realtime PCR. RESULTS Compared with normal control group, levels of GPT, GOT, MDA and Hyp were raised(P<0.01), while protein expresssion of Nrf2 and HO-1 and γ-GCS, levels of SOD and GSH had no statistical difference. There was extensive adipose degeneration in hepatic cells in model group, and round vacuoles of different size were seen in hepatic tissue. Some hepatic cells developed edema, and portal areas were infiltrated with inflammatory cells. Compared with normal control group, GPT and GOT in serum, SOD, GSH and Hyp in hepatic tissue in NAC groups were decreased(P<0.05, P< 0.01). Compared with positive control group, Hyp in hepatic tissue declined obviously in NAC 45, 90 and 180 mg· kg-1 groups (P<0.01). Nrf2 expression in NAC 45 mg· kg-1 groups increased obviously (P<0.01). Compared with NAC 45 mg· kg-1 group, Nrf2 expression in NAC 90 and 180 mg· kg-1 groups declined (P<0.05, PO.01). CONCLUSION Low-dose broncholysin could protect against oxidative stress and prevent chronic hepatic injury by regulating the expression of Nrf2, HO-1 and γ-GCS.     

4′-甲基-7-(2-羟基-3-异丙胺基-丙氧基)-黄酮盐酸盐对冠脉血流和家兔实验性心肌梗塞的影响

SIPI-549 is a new cOmpound. In Langendorff's isolated rabbit heart, SIPI-549 significantly increased coronary blood flow (p<0.01), but did not change themyocardium contractibility and heart rate. A study of the uptake of ~(86)Rb by the mouse heart showed a significant increase of nutritional blood flow in the SIPI-549 treated group (p<0.05). On intact dogs, SIPI-549 also showed a significant increase of coronary blood flow (p<.05) and decrease of coronary resistance (p<0.01), but no change of cardiac output and blood presure was observed.In the model of myocardial infarction by high level double-ligation of the anterior descending branch of the left coronary in rabbits, iv SIPI-549 (4.1 mg/kg) significantly reduced the ΣST, NST and NO The size of infarct myocardium was significantly reduced (p<0.05) 24 h after ligation of the coronary artery Similar results were found in the propranolol (1 mg/kg) group. However, no obvious difference between the two groups was observed.     

3种药物治疗妊娠中期外阴阴道假丝酵母菌病的疗效比较

Objective To observe the clinical therapeutic effect of the treatment on vulvovaginal candidiasis (VVC) in the mid trimester of pregnancy with three species of drug (Clotrimazole,Macmirorcomplex, Baofukang Shuan). Methods 83 women diagnosed with VVC in the mid trimester of pregnancy were divided into three groups: Group A with 30 cases, treated with Clotrimazole for twice; Group B with 28 cases, treated with Macmirorcomplex for 6 days; Group C with 25 cases, treated with Baofukang Shuan for 8 days. Observed the clinical effect, the microbes therapeutic effect and the adverse effect of the treatment with three species of drug. Results (1)The clinical cure rate of Group A was 86.67% and the fungal negative rate was 93.33%. The clinical cure rate of Group B was 57.14% and the fungal negative rate was 75%. The clinical cure rate of Group C was 60% and the fungal negative rate was 40%. There were no adverse effect to be found in the three groups. (2) The clinical cure rate and curative rate of Group A were significantly higher than those of Group B and Group C( P＜0,05 ),but there were no difference in Group B and Group C ( P＞ 0.05 ). The V VC scores of the three groups were significantly descended compared with those of pretherapy ( P＜ 0.01 ), but there were no difference of the curative rate about microbes therapeutic effect in the three groups ( P＞ 0.05 ).Conclusion The three drugs for VVC in pregnancy are all effective and no serious adverse effect. Clotrimazole has better clinical therapeutic effect than Macmirorcomplex and Baofukang Shuan.     

阿司匹林联合辛伐他汀治疗骨质疏松的实验研究

目的通过实验求证小剂量的阿司匹林和辛伐他汀两种药物联合应用,能否改善骨质密度,防治骨质疏松,为临床绝经后骨质疏松(postmenopause osteoporosis,PMOP)治疗用药提供理论依据。方法选取3个月大的雌性SD大鼠70只,随机选取10只为A组:假手术组,SPF实验室正常喂养,余60只行手术去除双侧卵巢,SPF实验室喂养12周后行Micro-CT检测确定建模成功。随后将去势大鼠随机均分成5组:B组10只,予生理盐水5 mg/(kg·d)灌喂;C组10只,予阿司匹林9 mg/(kg·d)灌喂;D组10只,予辛伐他汀10 mg/(kg·d)灌喂;E组10只,予阿司匹林4.5 mg/(kg·d)+辛伐他汀5 mg/(kg·d)灌喂;F组10只,予碳酸钙10 mg+维生素D3 2 IU/(kg·d)灌喂。药物灌喂12周后,对6组大鼠分别进行定位骨密度(bone mineral density BMD)检测及骨组织形态学观察,同时进行对比分析。结果大鼠绝经后骨质疏松经过药物灌喂12周,E组(阿司匹林联合辛伐他汀组)大鼠股骨BMD检测结果高于B、C、D和F组(P <0.05),与A组最为接近;股骨髁部HE染色(×40)显示:A组骨小梁排列紧密,粗细均匀;B、C、D组骨小梁明显断裂,数目减少,E组骨小梁形态接近A组,F组形态较B、C、D组有所改善。结论小剂量的阿司匹林和辛伐他汀两种药物联合应用能改善大鼠绝经后骨质密度,防治骨质疏松。为临床PMOP治疗用药提供了实验依据,在防治心血管疾病的同时可减少或部分替代抗骨质疏松药物,减轻过度用药不良反应,减轻治疗费用,具有重大的社会经济意义。     

Protective effect of oxysophoridine on cerebral ischemia and reperfusion injury in mice

OBJECTIVE The purpose of this study was to obseve the protective effects of OSR(oxysophoridine,OSR) on cerebral ischemia and reperfusion injury in mice and to explore its possible protective mechanism.METHODS ICR mice were divided into a sham-operated group,a vehicle group,OSR(62.5,125,250 mg·kg-1) groups and a nimodipine(6 mg·kg-1) group.I.p.administration of OSR(62.5,125,250 mg·kg-1) in OSR groups for 7 d,ig administration of nimodipine(6 mg·kg-1) in nimodipine group for 7 d,ip administration of the same volume saline in sham-operated group and vehicle group for 7 d.Mice models of focal cerebral ischemia and reperfusion injury were established by occlusion of the right middle cerebral artery for 2 h followed by 24 h reperfusion except the sham-operated group.After 24 h of reperfusion,mice were tested for neurological deficit scores with the method of Bederson′s score,the cerebral infarct volume were assessed with the method of TTC staining in mice,the brain water content were determined by dry/wet weight method and the cerebral index were counted in mice,the levels of adenosine-triphosphate(ATP),maleic dialdehydle(MDA),glutathione peroxidase(GSH-PX),superoxide dismutase(SOD),catalase(CAT),nitric oxide(NO),nitric oxide synthase(NOS) and lactate dehydrogenase(LDH) in the brain tissues were measured with the method of spectrophotometry.RESULTS Compare to the model group,OSR(125,250 mg·kg-1) and nimodipine(6 mg·kg-1)reduced the neurological deficits scores(P<0.01) and the cerebral infarct volume(P<0.05).Compare to the model group,OSR(62.5,125,250 mg·kg-1) and nimodipine(6 mg·kg-1)reduced the brain water content(P<0.01).Compare to the model group,OSR(125,250 mgp·kg-1) and nimodipine(6 mg·kg-1)reduced the cerebral index(P<0.05).Compare to the model group,OSR(62.5,125,250 mg·kg-1) and nimodipine(6 mg·kg-1)reduced the contents of MDA,NO(P<0.01) and increased the contents of ATP(P<0.01).Compare to the model group,OSR(62.5,125,250 mg·kg-1) and nimodipine(6 mg·kg-1)enhanced the activities of SOD,GSH-PX,LDH and CAT(P<0.01),also decreased the activity of NOS(P<0.01).CONCLUSION OSR has significant protective effects of cerebral ischemia and reperfusion injury in mice,the effective mechanism of OSR might relate to the alleviation of oxidative stress.     

The protecting effects and mechanism of betaine hydrochloride on hepatic ischemia-reperfusion injury in rats

Objective To study the protecting effects and mechanism of betaine hydrochloride on hepatic ischemia-reperfusion injury in rats.Methods Fourty SD rats were randomly divided into 5 groups(8 animals in each group):sham-operated control group(A),hepatic ischemia-reperfusion group(B),200 mg·kg-1 400 mg·kg-1 800 mg·kg-1 betaine hydrochloride+hepatic ischemia-reperfusion group(C、D、E).betaine hydrochloride was administered to animals byoral route in group C、D、E for 7 days before ischemia.A、B group was administered with NS.Made the animal model of part hepatic ischemia-reperfusion.Serum alanine aminotransferase(ALT),aspartate aminotransferase(AST)levels in the blood and themalondialdehyde(MDA),superoxide dismutase(SOD),protein content in hepatic tissue were determined after the liver had been reperfused for 24 hours;the hepatic tissue was examined under lightmicroscope and the cell apoptosis was demonstrated with flow cytometry.Results ALT,AST,MDA increased and SOD decreased significantly in B group when compared those in the A group(P<0.05),Hepatic apoptosis was significantly increased;ALT,AST,MDA decreased and SOD increased significantly in betaine hydrochloride 200 mg·kg-1(C)group when compared those in the B group(P<0.05).Hepatic apoptosis was significantly lower,The histologic changes of the liver tissue under lightmicroscope in the C group was more easer than in the I/R group(B).Conclusions Betaine hydrochloride has the ability to scavenge oxygen free radical(OFR),reduce lipid peroxidation and inhibition of apoptosis.So it can protect the rats liver damaged by ischemia-reperfusion.     

地尔硫卓在非体外循环下冠状动脉旁路移植术中的应用

目的 评价地尔硫卓在非体外循环冠状动脉旁路移植术(OPCABG)中的临床效果.方法 接受OPCABG的40例冠心病患者,随机均分为两组,麻醉诱导后分别泵注地尔硫卓1～3μg·kg-1·min-1(A组)或硝酸甘油0.5～2.0μg·kg-1·min-1(B组).记录诱导前、用药30 min、移植血管远端吻合中、出手术室前4个时点的血流动力学指标;术后24、48h采血测量血清肌酸激酶同工酶(CK-MB)和肌钙蛋白T(cTnT).结果 与B组比较,A组术中血流动力学较为稳定(P<,0.05);A组术后24 h和48 h血清CK-MB[(24.32±42.75)U/L vs.(39.37±35.50)U/L和(21.50±14.12)U/L vs.(35.40±46.59)U/L]和cTnT[(0.17±0.23)ng/ml vs.(0.32±0.28)ng/ml和(0.20±0.25)ng/ml vs.(0.37±0.48)ng/ml]水平均明显低于B组(P<0.05).结论 在OPCABG手术期间使用地尔硫卓能显著降低心肌氧耗,提供较好的心肌保护,无明显不良反应.     

穿心莲内酯对盲肠结扎穿孔诱导的脓毒症大鼠心肺功能和炎症损伤的保护作用

摘要：目的　探究穿心莲内酯对盲肠结扎穿孔（CLP）诱导的脓毒症大鼠心肺功能和炎症损伤的保护作用。方法　75只SD大鼠随机分为假手术组（A组）、脂多糖模型组（B组）、CLP组（C组）、CLP+低剂量穿心莲内酯组（D组）和CLP+高剂量穿心莲内酯组（E组）,每组15只。A组仅进行开腹、分离盲肠及关腹手术;B组采用脂多糖腹腔注射建立脓毒症模型,C、D、E组行CLP手术诱导脓毒症,D、E组建模后分别腹腔注射10 mg/kg和20 mg/kg穿心莲内酯。比较各组大鼠心率（HR）、左心室射血分数（LVEF）;采用酶联免疫吸附试验（ELISA）检测心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶MB（CK-MB）;比较各组大鼠肺损伤评分;采用血气分析仪检测氧分压［p（O2）］,计算动脉血氧分压/吸入气氧浓度［PaO2/FiO2］;取左肺组织计算湿/干质量（W/D）比值;HE染色观察心肺损伤情况;Western blot检测心肺组织中半胱氨酸天冬氨酸蛋白酶3（Caspase）-3、Caspase-9、B淋巴细胞瘤-2（Bcl-2）、Bcl-2相关X蛋白（Bax）和P65蛋白的表达;ELISA检测外周血中白细胞介素（IL）-6、肿瘤坏死因子（TNF-α）、IL-1β、中性粒细胞趋化因子1（CINC-1）水平;使用全自动血细胞分析仪检测中性粒细胞（NEU）水平。结果　与A组相比,B、C组大鼠HR、LVEF、p（O2）和PaO2/FiO2均显著降低,cTnl、CK-MB、肺损伤评分、肺W/D比值、心肺组织中Caspase-3和Caspase-9蛋白表达、Bax/Bcl-2比值、CINC-1、NEU、IL-6、IL-1β、TNF-α和p-P65/P65水平均显著升高（P＜0.05）。与C组相比,D、E组以上指标变化均相反（P＜0.05）;HE染色示,D、E组大鼠心肌肌纤维断裂溶解减少,肌细胞核溶解、固缩显著减少,肺间质中性粒细胞浸润减轻、肺泡间隔增厚、细胞水肿显著改善。结论　穿心莲内酯可以缓解CLP诱导的脓毒症大鼠体内炎症反应并改善大鼠心肺功能,同时抑制凋亡蛋白的表达,保护大鼠心肺组织。     

冠心病患者血浆β内啡肽动态变化及其临床意义

目的 探讨冠心病患者血浆β内啡肽(β-EP)水平动态变化及临床意义.方法 动态检测急性心肌梗死(AMI)22例和心绞痛(AP)36例患者(冠心病组)血浆β-EP、血清肌钙蛋白T(cTnT)和肌酸激酶同工酶(CK-MB),并行超声心动图左心室舒张末期内径(LVEDD)、收缩末期内径(LVESD)和射血分数(LVEF)测定,临床心功能评定.其结果与20例健康体检者为对照组(C组)比较.结果 冠心病组AMI发病、AP入院发作后12、24、48、96 h及7 d血β-EP、cTnT、CK-MB水平均显著高于C组(P＜0.05);均于12 h内开始升高,24 h达峰值,7 d内逐渐下降;三项指标均随心功能不全升级而升高.血β-EP与cTnT、CK-MB水平及LVEDD、LVESD旱正相关(P＜0.05或P＜0.01),与LVEF值呈负相关(P＜01.05).结论 血浆β-EP水平可作为冠心病急性事件和心功能状况的辅助监测指标.     

冷晶体、常温充氧晶体及温血停搏液的心肌保护作用

目的 评价冷晶体停搏液、常温充氧晶体停搏液、温血停搏液对离体鼠心灌注心肌的保护作用。方法 40只SD大鼠随机分为对照组（A组）、冷晶体停搏液组（B组）、常温充氧晶体停搏液组（C组）和温血停搏液组（D组）。测定心肌酶学即肌酸磷酸激酶（CK）和肌酸磷酸激酶同功酶（CK-MB）、心肌含水量、心肌细胞内三磷酸腺苷（ATP）的含量,并观察心肌超微结构的变化。结果 B组CK、CK-MB的释放较C、D组多;B组心肌细胞ATP含量较C、D组少;心肌细胞内线粒体的损伤B组比C、D组重。结论 温血停搏液对离体鼠心的心肌保护是有效可行的。     

基于细胞焦亡探讨补阳还五汤配方颗粒对病毒性心肌炎小鼠心肌纤维化的抑制作用

目的:探讨补阳还五汤对病毒性心肌炎(VMC)小鼠心肌纤维化抑制作用与细胞焦亡的关系。方法:将雄性BALB/c小鼠随机分为对照组、模型组,以及补阳还五汤低、高剂量组(6,36 g·kg^-1·d^-1),每组9只。除对照组外,其余各组小鼠均单次腹腔注射柯萨奇B3病毒复制VMC模型。造模成功后,对照组和模型组小鼠均灌胃等容生理盐水,各给药组小鼠均灌胃相应药液,每日1次,连续28 d,于实验过程中观察各组小鼠的一般情况。以病毒接种当日为第0天,分别于第7、14、28天检测其心脏质量与体质量比值(HW/BW);采用苦味酸天狼猩红染色法观察其心肌组织中Ⅰ、Ⅲ型胶原蛋白的分布情况,并计算Ⅰ型/Ⅲ型胶原蛋白比值;Tunel染色检测心肌细胞凋亡率,并计算凋亡指数;于第30天时,采用Western blot法检测其心肌组织中NLRP3、Caspase-1蛋白的相对表达量。结果:与对照组比较,模型组小鼠出现烦躁、拱背、对刺激反应减轻、体质量减轻甚至精神萎靡等现象;HW/BW、Ⅰ/Ⅲ型胶原蛋白比值(第7~28天各时间点)、心肌细胞凋亡指数,以及心肌组织中NLRP3、Caspase-1的相对表达量均显著升高(P＜0.05);与模型组比较,各给药组小鼠上述症状具有不同程度改善,其HW/BW(第7天除外)、Ⅰ/Ⅲ型胶原蛋白比值(第7天除外)、心肌细胞凋亡指数(补阳还五汤低剂量组第7天除外),以及NLRP3、Caspase-1的相对表达量的相对表达量均显著降低(P＜0.05)。结论:补阳还五汤通过抑制心肌胶原蛋白增生,调节Ⅰ/Ⅲ型胶原蛋白比值,抑制NLRP3、Caspase-1的表达,发挥对VMC心肌纤维化的抑制作用。     

心肌酶检测在宫内窘迫新生儿心肌损伤中的诊断价值分析

目的：探讨心肌酶检测在宫内窘迫新生儿心肌损伤中的临床价值。方法：选取宫内窘迫54例、窒息48例、宫内窘迫合并窒息45例以及正常新生儿50例,分别设为A、B、C、D组。所有患儿均于出生后24h内抽取2ml股静脉血,分别测定乳酸脱氢酶（LDH）、α-羟丁酸脱氢酶（HBDH）、肌酸激酶（CK）以及肌酸激酶同工酶（CK-MB）的血清心肌酶谱。结果：与正常对照组D组相比,A、B、C3组患儿LDH、HBDH、CK以及CK-MB均明显增高（P〈0.05）;A、B、C3组之间两两比较,心肌酶谱各项差异不明显（P〉0.05）。结论：宫内窘迫新生儿可通过检测心肌酶诊断心肌损伤,为临床及时给予营养心肌,改善心功能治疗提供参考。     

冷温血停搏液联合灌注在儿童先天性心脏病中的应用研究

目的 评价冷温血停搏液联合灌注在儿童先天性心脏病(CHD)手术中对心肌的保护作用,探讨更有效的心肌保护方法。方法 将24例儿童先天性心脏病病人随机分为两组:温血组(A组,n=12),采用温血诱导心脏停搏、冷血维持与终末温血灌注进行心肌保护;冷血组(B组,n=12),采用冷氧合血停搏液进行心肌保护。两组间主动脉阻断时间无明显差异;体外循环前(T1)、主动脉开放1h(T2)、主动脉开放6h(T3)、主动脉开放12h(T4)、主动脉开放24h(T5)分别抽血测定乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK—MB)、心肌肌钙蛋白T(cTnT)。结果 体外循环前两组间含量无差异。主动脉开放后LDH、CK—MB、cTnT含量较体外循环前明显升高(P<0.01),T4、T5时点B组,LDH、CK—MB含量较A组明显升高(P<0.05),T3～T5时点B组cTnT含量较A组明显升高(P<0.05)。结论 冷温血停搏液联合灌注对儿童先天性心脏病病人的心肌保护作用优于冷血心脏停搏液。     

肌钙蛋白T、肌酸激酶同工酶对小儿病毒性心肌炎的诊断价值

目的探讨血清心肌肌钙蛋白T（cTnT）和肌酸激酶同工酶（CK-MB）在小儿病毒性心肌炎诊断中的临床价值。方法检测48例小儿病毒性心肌炎患者入院时及治疗2周后的cTnT及CK—MB并与同期45例非心肌炎小儿检测结果对比分析。结果人院时小儿病毒性心肌炎的血清cTnT及CK-MB水平和阳性率均明显高于非心肌炎小儿（均P〈0．05）;治疗2周后血清cTnT及CK．MB水平和阳性率均明显下降（均P〈0．05）。结论心肌肌钙蛋白T（cTnT）和肌酸激酶同工酶（CK—MB）联合检测在小儿病毒性心肌炎诊断中具有重要的临床价值。     

带有caspase富集功能域的凋亡抑制因子对急性病毒性心肌炎小鼠心肌的保护作用

目的 研究急性病毒性心肌炎（AVMC）小鼠的带有caspase富集功能域的凋亡抑制因子（ARC）的表达及对心肌的保护。方法 将60只成功建立AVMC模型的小鼠随机分为ARC反义寡核苷酸组（A组）、ARC错义寡核苷酸组（B组）和生理盐水对照组（C组）,每组20只。分期分别采集标本测定外周血心肌钙蛋白T（cTnT）、心肌钙蛋白I（cTnI）、肌酸激酶（CK）、肌酸激酶同功酶（CK-MB）水平和ARC、动力相关蛋白1（Drp1）表达等数据。结果 造模后第7、14、21天,3组外周血cTnT、cTnI、CK、CK-MB水平差异有统计学意义（P<0.05）,C组与B组相近（P>0.05）,但均低于A组（P<0.05）。造模后第7天,3组ARC与Drp1蛋白表达水平差异有统计学意义（P<0.05）,C组ARC表达与B组相近（P>0.05）,但均高于A组（P<0.05）,C组Drp1蛋白表达与B组相近（P>0.05）,但均低于A组（P<0.05）;造模后第14、21天3组ARC与Drp1蛋白表达水平差异无统计学意义（P>0.05）。结论 小鼠发生AVMC后高表达的ARC可抑制心肌细胞凋亡,对心肌组织有保护作用。     

水杨酸钠对顺铂所致耳毒性的保护作用

目的探讨水杨酸钠（SS）是否对顺铂（CDDP）所致的豚鼠耳毒性具有保护作用。方法将48只豚鼠随机分为4组：A组（对照组）、B组（SS组）、C组（CDDP组）、D组（SS＋CDDP组）,每组12只。对每组豚鼠右耳测用药前、后听性脑干反应（ABR）阈值;每组随机取6只耳蜗,通过免疫组化测定各组耳蜗螺旋神经节细胞（SGC）中Caspase-3的表达情况。结果 A组与B组用药后ABR阈值、SGC的Caspase-3表达量比较差异均无显著统计学意义（P〉0.05）;C、D组用药后ABR阈值、SGC的Caspase-3表达量明显高于A、B组（P〈0.05）;D组用药后ABR阈值、SGC的Caspase-3表达量明显低于C组（P〈0.05）。结论水杨酸钠对顺铂所致的耳毒性具有一定的保护作用。     

康艾注射液对曲妥珠单抗心肌毒性的抑制作用及机理研究

目的研究康艾注射液对曲妥珠单抗所致心肌毒性的抑制作用和机制。方法将50只雌性SD大鼠随机分为1个对照组(n=10)、1个模型组(n=10)和3个研究组(n=10),模型组隔天一次经尾静脉注射曲妥珠单抗(50.4 mg·kg^-1)造模,共注射7次;研究组造模后按低、中、高三个剂量10,20,30 mL·kg^-1隔天2次注射康艾注射液,共处理7 d;对照组连续14 d注射相应体积的曲妥珠单抗专用溶剂。各组大鼠均利用超声影像仪检查心功能变化,通过测定血清中肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、心肌肌钙蛋白I(cTnI)、N末端钠尿肽原(NT-pro BNP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)的浓度评价心肌受损的程度;ELISA法检测心肌组织中Bcl-2、Bax的表达量,酶解荧光法和比色法分别检测Calpain-1(钙蛋白酶)和Caspase-3的活性,研究康艾注射液保护心肌细胞机制;检测丙二醛(MDA)的含量和超氧化物歧化酶(SOD)的活性考察心肌氧化应激的情况。结果与模型组相比,研究组大鼠左室射血分数(LVEF)、左室短轴缩短率(LVFS)均显著较高(P<0.05);血清中CK-MB、LDH、cTnI、NT-pro BNP、TNF-α、IL-6的含量、心肌细胞中Bax的表达量、生成MDA的水平以及Calpain-1和Caspase-3的活性均显著低于模型组(P<0.05),与此同时Bcl-2的表达量和SOD的活性均显著高于模型组(P<0.05),各项指标变化均与康艾注射液剂量呈正相关性。结论康艾注射液可降低曲妥珠单抗所致的心肌毒性,其机制可能是通过改善心肌血液供应,抑制炎症反应、钙离子超载,低氧化应激损伤发挥保护心肌细胞的作用。