斑点追踪成像技术评价非心肌梗死性冠心病患者左室应变及扭转运动的价值研究

目的应用二维斑点追踪成像(STI)技术评价非心肌梗死性冠心病患者左室应变及扭转运动的特点和规律。方法选取未发生心肌梗死的冠心病患者30例(冠心病组)和正常成人30例(正常组),应用STI技术分析左室二维应变、二尖瓣水平旋转角度及旋转率、心尖水平的旋转角度及旋转率、左室整体扭转角度及扭转率。结果冠心病组与正常组比较,基底水平及乳头肌水平的前室间隔、前壁,心尖水平的前室间隔、前壁、后室间隔收缩期纵向峰值应变降低(P0.05);心尖水平前间隔、前壁的收缩期圆周峰值应变降低(P0.05);基底水平前室间隔、前壁,乳头肌水平前壁的收缩期径向峰值应变降低(P0.05);左室整体扭转角度及扭转率,心尖及瓣环水平的旋转角度及旋转率绝对值均较正常组降低,其中左室整体扭转率组间比较差异有统计学意义(P0.05)。结论非心肌梗死性冠心病患者相应节段心肌的应变及扭转运动已受到影响,应用二维STI技术可以准确评价非心肌梗死性冠心病患者的左室应变及扭转运动,为临床诊断冠心病提供有价值的参考。     

超声斑点追踪技术评价冠状动脉介入治疗术前后左室心肌周向收缩功能

目的 应用超声斑点追踪成像(STI)评价冠心病患者冠状动脉介入治疗术(PCI)前后左室心肌周向收缩功能.方法 对31例冠心病患者PCI术前、术后3个月及28例正常人应用超声心动图仪获取高帧频二维图像,测量左心室基底水平、乳头肌水平及心尖部水平的收缩期圆周应变(CS).结果 在对照组中,同一水平比较,室间隔心肌的收缩期CS高于其他各个室壁.与对照组比较,PCI术前部分节段心肌收缩期CS减低(P＜0.05),且与冠状动脉造影左前降支病变分布范围相一致;与PCI术前比较,术后3个月相应节段心肌收缩期CS改善(P＜0.05),且与对照组比较无统计学差异(P＞0.05).结论 STI能够定位和定量诊断节段性室壁运动异常,评价局部心肌周向收缩功能改善情况.     

速度向量成像技术评价肥厚型心肌病心脏扭转运动

目的 应用超声心动图速度向量成像(VVI)技术对肥厚型心肌病(HCM)患者心脏扭转运动(cardiac twist)进行初步分析,探讨HCM患者在左室射血分数(LVEF)正常时心脏局部和整体扭转功能是否已有改变.方法 对30例HCM患者(其中左室流出道梗阻13例)和33例正常人(对照组)行常规超声心动图检查,测量LVEF、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、每搏量(SV)等.采用VVI技术测量左室基底部腱索水平、乳头肌水平和心尖水平收缩期心内膜下心肌和心外膜下心肌的最大旋转角度、峰值旋转速率、圆周应变(circumferential strain,CS)、圆周应变率(circumferential strain rate,CSR)、径向应变(radial strain,RS)、径向应变率(radial strain rate,RSR);测定舒张期峰值解旋转速率和解扭转率,以分析两组的心脏旋转和扭转运动.结果 HCM组与正常组相比,LVEF差异无统计学意义,LVEDV、LVESV、SV明显减低,心内膜下心肌的左室扭转角度、CS较正常人明显增高,心外膜下心肌的旋转速率、解旋转速率、CS、CSR均明显减低(P＜0.05),HCM组左室三个短轴水平的RS、RSR均明显低于对照组(P＜0.01);舒张期解扭转率低于对照组.HCM组分组资料显示:左室流出道梗阻组患者心外膜下心肌的旋转速率、解旋转速率、CS、CSR进一步减低.结论 HCM患者心脏整体扭转角度较正常人增大,局部心肌圆周方向变形能力下降,左室流出道梗阻加剧局部心功能的损伤.     

四维自动左室定量分析技术评估2型糖尿病患者早期左室整体及节段收缩功能

应用四维自动左室定量分析技术(4D-LVQ)评价2型糖尿病患者早期左室收缩功能的改变。方法选取左室结构正常、左室射血分数(LVEF)≥50%的2型糖尿病患者60例(糖尿病组),体检健康者30例为对照组,经胸采集标准心尖四腔心切面,应用4D-LVQ软件于心尖四腔切面的舒张末期和收缩末期勾画心内膜,系统自动重建左室立体图以及左室纵向应变(LS)、圆周应变(CS)、径向应变(RS)、面积应变(ACR)的分节段牛眼图。结果 1糖尿病组左室整体ACR小于对照组(P0.05)。2与对照组比较,糖尿病组LS在中间段后侧壁、后壁,心尖段侧壁、后壁,ACR在中间段前侧壁、后侧壁、后壁,心尖段侧壁、后壁,CS在基底段前侧壁、后侧壁,中间段后侧壁、后壁,心尖段侧壁、后壁,RS在中间段后侧壁、后壁,心尖段后壁均减小(均P0.05)。3整体LS、CS、ACR与LVEF呈负相关(r分别为-0.768、-0.801、-0.826,P0.05),整体RS与LVEF呈正相关(r=0.819,P0.05)。4整体ACR与整体LS、CS呈正相关(r分别为0.720、0.953,P0.05),整体ACR与整体RS呈负相关(r=-0.673,P0.05)。结论 2型糖尿病患者早期左室心肌收缩功能已经受损,4D-LVQ软件可以较为全面地评估左室整体及局部心肌功能,尤其是ACR是一种更为敏感参数。     

超声斑点追踪技术对心肌梗死患者左心室扭转角度的研究

目的 应用超声斑点追踪技术测量心肌梗死患者基底部、心尖部旋转角度及扭转角度,探讨心肌梗死患者扭转角度的变化.方法 45例正常人及45例心肌梗死患者,分别记录左室短轴(基底部、心尖部)高帧频图像,应用二维应变软件测量各个节段及整体旋转角度(心尖与基底部旋转角度之差值).45例心肌梗死患者根据左室收缩功能分为两组:左室射血分数(LVEF)正常组(LVEF≥50%,23例)和LVEF减低组(LVEF＜50%,22例).结果 心肌梗死患者LVEF减低组心尖部整体旋转角度与对照组对比差异有统计学意义[(2.72±1.72)°对(10.62±3.11)°,P＜0.001],左室整体水平扭转角度与对照组对比差异有统计学意义[(19.46±7.71)°对(27.09±16.42)°,P＜0.001],基底部旋转角度与正常对照组差异无统计学意义.心肌梗死患者LVEF正常组与对照组对比,心尖部各节段及整体旋转角度、扭转角度差异均无统计学意义.左室扭转角度与LVEF有显著相关性(r=0.63,P＜0.05).结论 超声斑点追踪技术可测量心肌的旋转及扭转角度.心肌梗死患者心尖部旋转角度及整体水平扭转角度明显减低,并与室壁运动异常部位及LVEF有一定关系.     

三维斑点追踪技术评价正常成人左室三维扭转功能的初步研究

目的 探讨三维斑点追踪成像新技术评价正常成人左室三维扭转功能的可行性及其正常参考值和影响因素.方法 采用三维斑点追踪成像技术测定102例正常成人的左室心肌旋转运动,获得以下指标:(1)左室基底段、中间段和心尖段平均旋转角度(rotation);(2)左室整体扭转度(twist);(3)左室整体扭力(torsion).结果 左室心尖段旋转度显著高于中间段和基底段,而中间段扭转度显著高于基底段.正常成人左室整体扭转度为10.58°±3.52°,左室整体扭力为(2.04°±0.76°)/cm.性别、年龄、体质量指数、血压、血糖、血脂等常见因素均与左室扭转功能无明显相关性.结论 三维斑点追踪技术评价左室扭转功能耗时较短,具有高度可行性,可望成为评价左室扭转功能的有效新手段.     

超声斑点追踪显像技术评价健康人左室心肌整体和局部扭转运动特征的临床初步研究

目的 运用超声斑点追踪显像技术(STI)评价健康人左室心肌节段和整体扭转运动特征.方法 运用STI技术对35例正常人左室心尖、乳头肌和心底水平整体和节段旋转角度进行测量,计算并记录左窒整体及节段扭转角度峰值(peak-tw)和达峰时间(time to peak-tw),从而定量分析心动周期中左室整体和节段扭转特征.结果 正常人心室扭转特征为:收缩期,心尖部呈逆时针方向旋转,心底部呈顺时针方向旋转,心室逆时针方向扭转;舒张期,心室反向解旋;心肌各节段室壁对整体扭转贡献由心尖至心底递减.结论 斑点跟踪显像技术可以无创性地评估左室整体及节段心肌扭转,具有良好重复性,为临床评价左室心功能提供一种敏感而可靠的新方法.     

实时三维超声评价肥厚型心肌病患者左室心肌节段容积与收缩功能的变化

目的采用实时三维超声心动图(RT-3DE)评价肥厚型心肌病(HCM)患者左室节段心肌容积与收缩功能的变化。方法非高血压性HCM患者22例为HCM组,体检健康者22例为对照组,于心尖四腔观RT-3DE获得左室17节段的容积-时间曲线和左室射血分数(LVEF)-时间曲线,分析左室节段收缩功能参数:舒张末期容积(EDV)、收缩末期容积(ESV)和LVEF。结果与对照组比较,HCM组左房前后径和室间隔厚度增大,基底段水平前间隔、后间隔,乳头肌水平前壁、前间隔,心尖段水平前壁、间隔LVEF均降低,基底段水平、心尖段间隔及下壁的节段ESV减小(均P<0.05)。两组节段EDV与节段LVEF无相关性;对照组乳头肌及心尖段水平室间隔的ESV与LVEF呈负相关(r值分别为-0.477,-0.501,P<0.05);HCM组乳头肌水平下壁、侧壁和心尖段下壁、下侧壁ESV与LVEF呈负相关(r值分别为-0.549、-0.426、-0.441、-0.424,P<0.05)。结论无任何临床症状的非高血压性HCM患者左室节段心肌功能隐匿性受损,局部异常肥厚节段心肌的收缩功能明显减低;非肥厚区心肌节段容积变化影响节段LVEF。     

斑点追踪技术评价右心室压力负荷对左心室心肌力学的影响北大核心CSCD

目的应用斑点追踪技术评价右室压力负荷增加对左室心肌力学的影响,早期发现肺动脉高压患者左室功能的变化,为临床早期干预提供依据。方法肺动脉高压患者74例为病例组,据肺动脉收缩压（PASP）分为轻、中、重度组,分别以A、B、C组标识,对照组为年龄、性别相匹配的健康志愿者40例。均行超声心动图检查,测量常规超声心动图参数及左室各节段收缩期纵向、径向、环向峰值应变（LS、RS、CS）,计算左室整体收缩期纵向、径向、环向应变（GLS、GRS、GCS）,游离壁（侧壁＋后壁）及室间隔（前间隔＋后间隔）总体LS、RS、CS;测量基底段、心尖段心肌旋转角度峰值及达峰时间。分析并比较各组测量结果。结果①左室射血分数（LVEF）：A、B、C组较对照组无明显减低（P〉0．05）;②左室游离壁和室间隔整体LS、RS、CS以及左室GLS、GRS、GCS：B、C组低于正常对照组及A组,C组低于B组（P〈0．05）;③左室基底段及心尖段旋转角度：B、C组低于正常对照组及A组,C组低于B组（P〈0．05）;④A组GLS、GRS、GCS,游离壁及室间隔整体LS、RS、CS与正常对照组比较。差异无统计学意义（P〉0．05）,但A组左室基底段旋转角度低于正常对照组（P〈0．05）。结论右室压力负荷增高可导致左室心肌力学受损,左室应变的改变早于LVEF。左室应变随右室压力负荷增高逐渐减低。左室基底段旋转角度能发现轻度肺动脉高压患者左室心肌力学的变化,较其他应变参数敏感。     

斑点追踪超声心动图评价扩张型心肌病患者左心扭转

目的 应用超声斑点追踪成像技术评价扩张型心肌病(DCM)患者左心扭转及左心扭转与左心收缩功能的关系.方法 获取31例DCM患者与30例正常人的标准短轴左心室二尖瓣水平、乳头肌水平、心尖水平的图像,应用超声斑点追踪技术测量短轴各个水平收缩期整体峰值圆周应变,并测量二尖瓣水平、心尖水平心室的旋转角度.比较DCM组及正常组的收缩期整体峰值圆周应变和旋转角度、达到旋转角度峰值时间百分比,以及最大圆周应变、扭转与左心室射血分数的关系.结果 与正常人相比,DCM患者收缩期短轴左心室二尖瓣水平、乳头肌水平、心尖水平整体最大圆周应变及旋转角度明显低于正常组(P＜0.01),心尖部达峰值角度时间较正常人提前.且左心室短轴各水平总体收缩期圆周应变峰值均与患者的左室射血分数呈正相关,左心室扭转与患者的左室射血分数呈正相关.结论 DCM患者的左心旋转收缩功能显著受损,超声斑点追踪技术可以准确反映左心室收缩功能,对DCM左心收缩功能的判断具有重要价值.     

Neurophysiology at the Shanghai Institute of Physiology

On July 4, 1980 a small group of neurosurgeons visited the Shanghai Institute of Physiology. They met primarily with neurophysiologists who are actively investigating the neural mechanism of acupuncture analgesia. These studies are being done at the levels of the peripheral nerve, spinal cord, basal ganglia, thalamus and cortex. These studies are briefly summarized and a bibliography of acupuncture related publications is appended.     

The studies of hemoglobinopathies and thalassemia in China--the experiences in Shanghai Institute of Medical Genetics.

BACKGROUND: In the past two decades, a large-scale survey of hemoglobinopathies and thalassemia was carried out in mainland China, involving nearly one million people in 28 provinces. The incidences of hemoglobin (Hb) variants, alpha-thalassemia and beta-thalassemia were 0.33%, 2.64% and 0.66%, respectively. The chemical structural analysis identified 67 Hb variants. Among them, 20 are new variants. The analysis of the alpha-globin gene organization in 111 HbH patients showed 76 cases (68.5%) were of the deletion type, 8 had Hb Constant Spring and the other cases were of non-deletion type. The results of the molecular characterization of more than 200 beta-thalassemia alleles showed that the most common types of beta-thalassemia mutations in China are CD 41/42 (-4 bp), IVS-II-nt.654 C-->T, CD 17 A-->T, CD 71/72 (+A) and -28 A-->G. METHODS: To explore the simple method for molecular diagnosis of beta-thalassemia, multiplex allele-specific amplification (MAS-PCR) was used that could simultaneously detect the above five common types of beta-thalassemia mutations. RESULTS: Based on the molecular analysis of beta-thalassemia intermedia, beta-thalassemia homozygotes or compound heterozygotes combined with alpha-thalassemia, as well as the conjunctive abnormalities of beta-thalassemia heterozygote with triplicated haplotype of alpha-globin genes, were the most common cause of thalassemia intermedia in China. We also used the RT-PCR quantitation method to show that the most common beta-thalassemia allele, IVS-II-nt.654 C-->T, still produced a small amount (about 15%) of normally spliced beta-globin mRNA, therefore, causing beta+-thalassemia. In clinical trials of hydroxyurea (HU) treatment for beta-thalassemia patients, we found that HU may enhance the expression of the beta-globin gene in some patients, leading to an alleviation of clinical symptoms. In the studies of the reversal of aberrant splicing of IVS-II-nt.654 C-->T allele by the antisense approach, we constructed a mammalian expression vector that can produce an antisense RNA targeting against the aberrant splice sites of IVS-II-nt.654 C-->T pre-mRNA. CONCLUSIONS: The results indicated that the antisense RNA produced from the vector could efficiently suppress the aberrant splicing pattern and restore the correct splicing pathway in vitro and in vivo, leading to the improvement of globin chain biosynthesis in thalassemia cells.     

骨肉瘤患者疾病不确定感现状的研究

目的调查骨肉瘤患者疾病不确定感的现状,为制订减轻骨肉瘤患者不确定感的干预措施提供依据。方法选择2010年1月—2011年12月入住上海市2所3级综合性教学医院的骨肉瘤患者101例,采用Mishel疾病不确定感量表(中文版)(MUIS)进行问卷调查。结果 101例骨肉瘤患者疾病不确定感的平均得分为(73.09±12.09)分;不同人口学和疾病学因素的疾病不确定感得分均处于中等水平。结论骨肉瘤患者普遍存在疾病不确定感,临床医护人员应注重对患者疾病不确定感程度的评估,并依据评估结果制订针对性的干预措施。     

Detection of prosthetic mitral valve leak: a comparative study using transesophageal echocardiography, transthoracic echocardiography, and auscultation

Paravalvular leakage is a major complication of prosthetic valve dysfunction. Sixty-one subjects with valvular heart disease who had received prosthetic mitral valve replacement 5 months to 5 years before (43 received a porcine prosthesis and 18 received Bjork-Shiley valve prostheses) were evaluated for this complication. Careful auscultation was performed by two experienced cardiologists followed by transthoracic and transesophageal echocardiography. Physiologic leaks were detected in all Bjork-Shiley valves, but in only 30% of porcine valves using transesophageal echocardiography. These regurgitant jets were flame-like, with mean low velocities of 50 +/- 12.3 cm/sec and 48 +/- 18.2 cm/sec in the two types of valves. Neither transthoracic echocardiography nor auscultation could detect physiological regurgitant jets. Ten cases with paravalvular leak were detected by transesophageal echocardiography and subsequently demonstrated by left ventriculography (7 porcine, 3 Bjork-Shiley valves). Pathologic regurgitant jets were seen as high-velocity, systolic-retrograde turbulent flow across the prosthesis. However, only 6 cases of prosthetic valve dysfunction were detected by transthoracic echocardiography, 4 cases of mild paravalvular leakage went undetected. Thirteen of the 61 subjects had an apical systolic murmur and suspected prosthetic valve leakage; in 10 of the 13 cases the findings corresponded to those obtained by transesophageal echocardiography. In 3 cases of double valve replacement with Bjork-Shiley valves the magnitude of the leakage was overestimated by auscultation.