减阻剂减轻大鼠离体心脏缺血/再灌注损伤的作用

目的 应用减阻剂聚氧化乙烯（polyethylene oxide,PEO）减轻大鼠离体心脏缺血/再灌注（I/R）损伤的作用。方法 Wistar大鼠50只随机分为5组,制备Langendorff离体心脏I/R模型,分为对照组、I/R组、缺血-低剂量PEO再灌注组（低剂量组）、缺血-中剂量PEO再灌注组（中剂量组）、缺血-高剂量PEO再灌注组（高剂量组）。通过多导生理记录仪记录灌注心脏的左心室最大收缩压峰值（LVPSP）、左室舒张末压峰值（LVEDP）、左室内压等容相最大上升及下降速率（+dp/dtmax,-dp/dtmax）、心率、冠脉流量。检测冠脉流出液的乳酸脱氢酶（lactate dehydrogenase,LDH）的含量。结果 再灌注30 min及60 min后,中剂量及高剂量的PEO对I/R心肌的LVPSP、LVEDP、+dp/dtmax、-dp/dtmax均有明显改善作用（P<0.05）。中剂量及高剂量PEO在维持离体心脏的心率方面优于低剂量组和I/R组（P<0.05）,冠脉流出液的容积增加（P<0.05）。应用中剂量及高剂量的PEO灌注后,冠脉流出液中LDH含量明显下降（P<0.05）。结论 PEO作为减阻剂,减低Langendorff离体心脏I/R系统的流体阻力,改善离体心脏的收缩及舒张功能,增加冠脉流出液量,减少心肌细胞损伤,抑制心肌细胞凋亡,对心肌I/R损伤的治疗提供新的研究思路。     

三羟异黄酮对家兔缺血/再灌注心肌细胞凋亡的影响

目的研究三羟异黄酮(genistein,GST)对家兔缺血/再灌注损伤(I/R)心肌细胞凋亡的影响.方法阻断家兔心脏左冠状动脉前降支45 min,再灌注180 min引起心肌I/R损伤,在心肌缺血后5 min耳缘静脉注射GST(1.0 mg/kg),应用DNA片段原位末端标记法(TUNEL染色),DNA凝胶电泳和流式细胞仪(FCM)观测心肌细胞凋亡.结果琼脂糖凝胶电泳显示I/R组心肌DNA呈云梯状改变,而GST I/R组无此改变.与I/R组比较,GST I/R组缺血心肌凋亡细胞明显减少(TUNEL染色).流式细胞仪测定I/R组及GST I/R组缺血心肌凋亡率分别为(19.36±1.85)%和(5.46±1.12)%.I/R组的缺血心肌Fas和Bax蛋白表达较非缺血心肌高(P＜0.01),Bcl-2/Bax比例较非缺血心肌低(P＜0.01);而在GST I/R组,Fas和Bax蛋白表达较I/R组的低(P＜0.01),Bcl-2/Bax比例较I/R组高(P＜0.01).结论 GST可减少家兔心肌细胞凋亡,其机制与调控凋亡相关基因Fas、Bax和Bcl-2的蛋白表达有关.     

虎杖苷通过PKC对大鼠离体缺血再灌注心肌的保护作用

目的:研究虎杖苷(polydatin,PD)对大鼠离体缺血/再灌注(I/R)心肌的保护作用。方法:将40只SD大鼠随机分为4组,包括I/R组,PD(I/R+PD)组,虎杖苷+蛋白激酶C(PKC)阻断剂(I/R+PD+chelerythrine)组和PKC阻断剂(I/R+chelerythrine)组。采用Langendorff灌流法建立离体心肌I/R模型,缺血40 min,再灌注共40 min,分别测量再灌20 min以及再灌40 min时心功能和酶学指标包括:心率、左室收缩压(LVDP)、左室舒张末压(LVEDP)、心室内压最大变化速率(±dp/dtmax)及磷酸激酶(PK)、乳酸脱氢酶(LDH)浓度。结果:心肌I/R可引起心脏功能I/R+PD组±dp/dtmax的恢复率明显回升(P0.05),同时,LVEDP、LVDP等指标也有明显改善(P0.05),LDH、PK浓度在复灌20和40 min时明显低于I/R组(P0.05)。说明PD能部分抑制再灌注期PK和LDH的漏出。PD还能够显著提高I/R心肌的超氧化物歧化酶(SOD)水平,并且降低丙二醛(MDA)水平,发挥心肌保护作用。应用PKC抑制剂chelerythrine则可以消除PD的上述作用。结论:PD可能通过PKC蛋白信号转导通路对I/R心肌发挥保护作用。     

miR-214在大鼠心肌缺血再灌注损伤及缺血后适应中的表达及机制探讨

目的探讨miR-214在心肌缺血再灌注损伤及缺血后适应心脏保护作用中的变化及可能机制。方法 30只雄性SD大鼠随机分为假手术组、缺血再灌注组和缺血后适应组。通过颈动脉插管测定不同组的血流动力学指标,采用伊文思兰和TTC染色法测定缺血和梗死面积,并通过实时定量PCR方法测定再灌注2h缺血心肌miR-214及预测的靶基因HIF1AN(hypoxia-inducible factor1alpha subunit inhibitor)的变化。结果与大鼠心肌缺血再灌注组相比,缺血后适应处理可以显著改善再灌注后左室收缩压(LVSP)、左室舒张末期压(LVEDP)、左室内压最大上升速率(+dp/dtmax)以及最大下降速率(-dp/dtmax),并降低了心肌梗死面积;与假手术组相比,心肌缺血再灌注组大鼠心肌组织缺血区的miR-214表达显著下调,缺血后适应组心肌组织缺血区miR-214的表达较缺血再灌注组明显升高;通过生物信息学分析预测miR-214在HIF1AN的3'-UTR上存在结合位点,与假手术组相比,HIF1AN mRNA水平在缺血再灌注组中显著增加,而缺血后适应组与缺血再灌组相比,HIF1AN的mRNA水平显著减...     

雷诺嗪对豚鼠离体心肌缺血-再灌注损伤心功能的保护作用

目的 探讨雷诺嗪对豚鼠离体缺血-再灌注模型的心功能保护及其作用机制.方法通过离体Langendorff模型灌流方法,观察雷诺嗪对血流动力学改变和心肌钙离子含量变化的作用.结果雷诺嗪可增加缺血再灌注心肌 LVDP、+dp/dtmax和-dp/dtmax水平,减少再灌注末心肌组织Ca2+含量;R1、R2与I/R组相比较,P＜0.05,P＜0.05,P＜0.05,R1与R2组比较P＜0.05.结论雷诺嗪可改善心脏收缩、舒张功能,防止心肌细胞钙超载,并且呈剂量依赖性.     

不同浓度硝酸甘油对心脏缺血/再灌注的作用及ALDH2的作用

目的 探讨不同浓度硝酸甘油(GTN)对离体大鼠心脏缺血/再灌注损伤的作用,进一步分析线粒体乙醛脱氢酶2(ALDH2)在其中的作用.方法 采用离体大鼠心脏Langendorff灌流方法,局部结扎冠状动脉左前降支30 min,复灌30 min复制缺血/再灌注模型.实验分五组,正常对照组,单纯缺血/再灌注组,GTN低浓度组(10 -8 mol/L GTN),中浓度组(10-7 mol/L GTN)及高浓度组(2×10 -6 mol/L GTN).测定心室动力学指标和复灌期间冠脉流出液中乳酸脱氢酶( lactate dehydrogenase,LDH)含量,RT-PCR测定左心室前壁心尖组织线粒体ALDH2基因mRNA表达水平.结果 与单纯缺血/再灌注组相比,GTN低浓度组左心室发展压(LVDP)、室内压最大上升/下降速率(±dp/dtmax)均增高,左心室舒张末压(LVEDP)降低,中浓度组无明显差异,高浓度组LVDP和±dp/dtmax均降低;LVEDP增高.与缺血/再灌注组相比,正常对照组和低浓度GTN组心肌组织ALDH2 mRNA表达增高,中浓度无明显差异,高浓度组大鼠心肌ALDH2 mRNA表达降低.结论 低浓度GTN可对抗心肌缺血/再灌注损伤,高浓度GTN加重损伤,中浓度GTN对损伤影响不大,此现象可能与不同浓度GTN引起心肌ALDH2的释放量不同有关.     

替米沙坦通过JAK/STAT通路对大鼠心肌缺血再灌注损伤的保护作用

目的探讨JAK-STAT通路的主要成员STAT1和STAT3在心肌缺血再灌注(I/R)损伤过程中激活的功能作用及AT1受体拮抗剂替米沙坦抗心肌I/R损伤的受体后机制。方法采用Langendorff离体心肌I/R模型,65只雄性Wistar大鼠分为5组,每组13只:正常对照组、I/R组、AG490组、替米沙坦预处理组、替米沙坦后处理组。动态监测LVDP和dp/dtmax;免疫印迹法检测p-STAT1,p-STAT3的蛋白表达;TTC染色计算心肌梗死面积;TUNNEL法检测心肌细胞凋亡指数(AI),RT-PCR法检测Bcl-2、Bax的mRNA表达。结果与I/R组比,JAK阻断剂AG490、替米沙坦预处理及后处理均能缩小心肌梗死面积(P<0.01),降低心肌细胞AI(P<0.01),改善心功能,使LVDP和dp/dtmax均明显升高(P<0.01),而使p-STAT1和p-STAT3的蛋白表达明显减少(P<0.01和P<0.05),以p-STAT1表达降低更为明显,p-STAT1与p-STAT3比值下调,Bax mRNA表达显著减少(P<0.01),而Bcl-2 mRNA表达增多(P<0.05)。结论替米沙坦具有抗心肌I/R损伤作用,其机制与阻断JAK-STAT通路,下调促凋亡基因Bax,上调抑制凋亡基因Bcl-2有关。     

龙血竭总黄酮对新西兰兔心肌缺血/再灌注损伤作用的研究

目的研究龙血竭总黄酮对新西兰兔心肌缺血/再灌注损伤的保护作用。方法将30只新西兰兔随机分为三组,每组10只。采用结扎新西兰兔左冠状动脉前降支法,建立心肌缺血/再灌注损伤模型。观察心肌组织HE染色的结构变化,测量左心室内压最大上升速率(+dp/dtmax),检测心肌肌酸激酶同工酶(CK-MB)。结果龙血竭处理组心肌组织结构明显好于缺血/再灌注组;缺血/再灌注组和龙血竭处理组+dp/dtmax均明显低于假手术组(P0.01),龙血竭处理组+dp/dtmax高于缺血/再灌注组(P0.01);缺血/再灌注组CK-MB水平明显高于假手术组(P0.01),龙血竭处理组CK-MB水平高于假手术组(P0.05),并低于缺血/再灌注组(P0.01)。结论龙血竭总黄酮能够改善心肌缺血/再灌注损伤,保护心肌组织结构,稳定细胞膜结构,减少心肌CK-MB漏出,提高缺血/再灌注损伤模型心肌的收缩功能。     

高压氧预处理对缺血-再灌注诱导的糖尿病大鼠心功能的影响

目的 探讨高压氧预处理对糖尿病大鼠心功能的影响.方法 雄性Wistar大鼠30只,糖尿病造模成功后随机分为糖尿病对照组,糖尿病缺血-再灌注组,糖尿病高压氧预处理组,采用Langendorff离体心脏灌流方法,记录左室收缩压(LVSP)、左心室内压最大上升速率(+dp/dtmax)、左室舒张末压最大下降速率(-dp/dtmax);采用氯化三苯基四氮唑染色法检测心肌梗死面积.结果 与I/R组比较,高压氧预处理组LVSP、+dp/dtmax、-dp/dtmax显著增高(P＜0.05);心肌梗死面积显著降低(56.05% vs 40.30%).结论 高压氧预处理可改善糖尿病大鼠离体心脏的心功能,缩小心肌梗死面积.     

蛇床子素后处理对大鼠心肌急性缺血/再灌注损伤的保护作用

目的观察蛇床子素后处理对大鼠心肌急性缺血／再灌注损伤的作用。方法采用结扎左冠状动脉前降支制备在体大鼠急性心肌缺血／再灌注损伤模型。30只雄性Wistar大鼠随机分为伪手术（Sham）组、缺血／再灌注（I／R）组和缺血／再灌注＋蛇床子素后处理（Ost）组。采用BL-410生物信号记录分析系统记录大鼠左心室收缩压（LVSP）、左心室舒张末压（LVEDP）及左心室压力上升和下降最大速率（＋dp／dtmax）等心功能数据。实验结束后腹主动脉采血,采用ELISA方法检测血清肌酸激酶同工酶（CK—MB）、肌钙蛋白I（cTnI）含量,应用透视电镜对左室心尖部心肌组织超微结构进行形态学观察。结果与Sham组相比,I／R组大鼠心肌超微结构发生明显改变,心脏收缩、舒张功能显著降低,血清CK—MB及cTnI含量均显著增高。与I／R组比较,Ost组大鼠心肌超微结构损伤明显减轻,心功能明显改善,血清CK—MB及cTnI含量显著降低。结论蛇床子素后处理对急性心肌缺血／再灌注所致的大鼠心肌损伤具有保护作用。     

The cardiac component of cardiac cachexia

Background Recent evidence suggests the importance of noncardiac mechanisms in the genesis of the syndrome of cardiac cachexia. This raises the question of the relative role of the heart itself in this syndrome. This study sought to assess the cardiac dimensions, mass, and function and changes in these parameters over time in patients with chronic heart failure with and without cachexia. Methods Doppler echocardiography was performed in 28 patients with nonedematous weight loss (>7.5% over a period of >6 months) compared with 56 matched patients without weight loss in a ratio of 1:2 (age 71 ± 13 vs 67 ± 8 years, P = .07; New York Heart Association class 2.9 ± 0.7 vs 2.6 ± 0.6, P = .08). In 18 cachectic and 35 noncachectic patients with previous echocardiographic recordings, we analyzed the changes in left ventricular (LV) dimensions and mass over time. Results Cardiac dimensions including LV diastolic (69 ± 9 mm vs 67 ± 13 mm) and systolic cavity diameter (58 ± 11 mm vs 55 ± 15 mm), LV mass (480 ± 180 g vs 495 ± 190 g), and LV systolic and diastolic function including fractional shortening (16% ± 10% vs 18% ± 10%), isovolumic relaxation time (29 ± 22 ms vs 36 ± 27 ms), and E/A ratio (2.7 ± 1.6 vs 3.3 ± 2.9) did not differ between cachectic and noncachectic patients (all P > .1). By analyzing changes in LV mass over time, we found an increase (>20%) in 2 (11%) cachectic and 14 (40%) noncachectic patients and a decrease in LV mass (>20%) in 9 (50%) cachectic and 8 (23%) noncachectic patients (χ² test, P < .05). Conclusions Although no specific cardiac abnormality could be detected echocardiographically in cachectic patients compared with patients with noncachectic chronic heart failure in a cross-sectional study, over time a significant loss of LV mass (>20%) occurs more frequently in patients with cardiac cachexia. (Am Heart J 2002;144:45-50.)     

心脏骤停和心脏性猝死

心脏性猝死(SCD)是目前社会关注的热点问题.2005年WHO的数据表明,在全球死于心脑血管疾病的约1700万人群中,40%～50%是SCD.SCD虽然有多种定义,但目前一般认为是在1 h内出现的由于心血管原因导致的非预期死亡事件或无目击者的死亡事件.心脏骤停(SCA)不等同于SCD,SCA如果救治失败会引起真正的SCD.     

Sodium-induced cardiac aldosterone synthesis causes cardiac hypertrophy

High sodium intake causes cardiac hypertrophy independently of increases in blood pressure. Aldosterone is synthesized in extraadrenal tissues such as blood vessels, brain, and heart. Effects of 8 weeks of high sodium intake on cardiac aldosterone synthesis, as well as cardiac structure, mass, and aldosterone production, levels of mRNA coding for aldosterone synthase (CYP11B2) and the angiotensin II AT1 receptor, were studied in normotensive Wistar-Kyoto (WKY) rats. Isolated rat hearts were perfused for 2 hr, and the perfusate was analyzed by high-performance liquid chromatography and mass spectrometry. Aldosterone synthase activity was estimated from the conversion of [14C]deoxycorticosterone to [14C]aldosterone. Levels of mRNA for CYP11B2 and AT1 receptor were determined by competitive polymerase chain reactions. A high sodium intake for 8 weeks produced left ventricular hypertrophy without elevation of blood pressure. Plasma aldosterone concentrations and plasma renin concentrations were decreased by high sodium intake. Aldosterone production, activity of aldosterone synthase, and expression of mRNA for CYP11B2 and AT1 receptor were increased in hearts of rats with high sodium intake. These results suggest that high sodium intake increases cardiac aldosterone synthesis, which may contribute to cardiac hypertrophy independently of the circulating renin-angiotensin-aldosterone system.     

Analysis of cardiac symptoms preceding cardiac arrest

Prodromal symptoms and cardiac history were examined in 227 patients with coronary artery disease who were successfully resuscitated after out-of-hospital cardiac arrest. Cardiac arrest was sudden—with either no symptoms or symptoms for less than 1 hour—in 71% of the patients. Nonsudden death—death occurring after more than 1 hour of symptoms—occurred in 29% of the patients. A history of cardiovascular disease was present in 85% of patients with sudden cardiac arrest and in 83% with nonsudden arrest. Cardiac arrest occurred without symptoms in 38% of the patients with sudden cardiac arrest and was the first expression of coronary artery disease in 4% of the entire study group. This study indicates that cardiac arrest usually occurs with symptoms and almost always in the setting of a history of cardiovascular disease.     

Occult cardiac lymphoma presenting with cardiac tamponade

Subxiphoid pericardiostomy is the procedure of choice for treatment of a pericardial effusion with tamponade. We report a case in which this procedure not only failed to reveal the presence of an occult malignancy, but also resulted in a recurrent symptomatic effusion.     

Acute cardiac tamponade due to cardiac actinomycosis

Cardiac actinomycosis occurs in less than 2 percent of the patients with infections due to Actinomyces israelii. We describe the findings in a patient with acute cardiac tamponade who survived through pericardial drainage and aggressive medical therapy. Although uncommon, this disorder is important to recognize because it is curable with current medical and surgical therapy.     

External cardiac pacing during in-hospital cardiac arrest

External noninvasive cardiac pacing offers a rapid and simple method of pacing the heart during an emergency. It has been suggested that early use of cardiac pacing for bradycardia or asystole may improve survival in patients who have cardiac arrest. To investigate this possibility 58 consecutive episodes of cardiac arrest occurring on the medical wards or emergency room. Twenty-six episodes underwent external noninvasive pacing for bradycardia or asystole refractory to standard drugs. Only 2 patients survived, and survival could be directly attributed to pacing in only 1 of them. Of the 32 episodes not undergoing pacing, 23 had transient asystole or bradycardia, 13 of which rapidly responded to medications. The 17 cases (53%) not undergoing pacing survived. In conclusion, when bradycardia or asystole during cardiac arrest fails to respond to standard pharmacologic measures, it is an indicator of severe myocardial damage, and attempts at cardiac pacing rarely improve survival.     

Noninvasive transcutaneous cardiac pacing in prehospital cardiac arrest

This study evaluated the efficacy of prehospital external cardiac pacing in cardiac arrest patients. From October 1984 to June 1985, 91 patients were paced. Mean time from cardiac arrest to advanced life support (ALS) intervention in this metropolitan-rural ALS system was 14.5 minutes. Electrical capture occurred in 85 (93%), mechanical capture (pulses) occurred in ten (11%), and a measurable blood pressure occurred in three (3%) of the 91 patients. Despite a high rate of electrical capture, palpable pulses were produced only in 11%, and no patients survived to be discharged from the hospital. There was no difference in the frequency of electrical capture, palpable pulses, or outcome for patients receiving pharmacologic intervention before or after pacing. Likewise there was no difference in the frequency of electrical capture, palpable pulses, or outcome for patients receiving ALS therapy within or after ten minutes of their arrest. Although we found that external cardiac pacing was easily used in the prehospital setting, pacing did not result in any increase in survival in cardiac arrest patients.