冠脉狭窄时心肌收缩、舒张功能及血流灌注三者的关系

目的 应用新型的速度向量成像(VVI)结合心肌声学造影(MCE)评价冠脉狭窄时心肌收缩、舒张功能及血流灌注三者之间的关系.方法 不同程度冠脉(前降支)狭窄的实验犬模型8只,在冠脉狭窄前后于静息和多巴酚丁胺负荷时,取左室短轴图像进行VVI分析并行MCE,测量心肌血流量(A·β值)和短轴圆周方向上收缩期(Srsys)和舒张期峰值应变率(Srdia).结果 静息下,只有当重度冠脉狭窄时,其供血区的Srsys、Srdia和A·β值才均低于狭窄前(-1.1±0.50 vs-1.62±0.50,1.19±0.48 vs 1.75±0.51,0.4±0.21 vs 0.80±0.47,P<0.05).负荷时,与狭窄前相比,狭窄冠脉供血区的Srsys、Srdia和A·β值随冠脉狭窄程度的加重而改变,呈递减关系(-4.31±1.14 vs -3.20±0.98 vs.1.18±0.64,4.51±1.13 vs 3.39±0.98 vs 1.37±0.64,3.54±1.95 vs 1.81±0.89 vs 0.82±0.42,P<0.05).无论静息还是负荷时,Srsys和Srdia(r静息=0.88,r负荷=0.96,P<0.01),Srsys和A·β(r静息=0.55,r负荷=0.71,P<0.01)以及Srdia和A·β(r静息=0.57,r负荷=0.72,P<0.01)间均呈良好相关性.结论 VVI和MCE结合能够用于动态评价短轴心肌节段舒缩功能和血流灌注的变化情况,且VVI通过对心肌舒缩功能的评价能在一定的程度上反映心肌血流灌注的情况.     

国产左心声学造影剂与Albunex的药代动力学对比研究

目的：评价国产左心声学造影剂5%声振白蛋白蛋溶液在声学造影效果及安全性方面与国外同类产品Albunex有无不同。方法：两种造影剂均设置为高、低剂量组（0.08ml/kg、0.22ml/kg)，经小猎犬外周静脉注射，注射顺序以随机方法分配。共观察6条犬在造影剂注射前后左室声学显影效果及造影剂对犬血流动力学变化的影响。结果：两种造影剂在低剂量时左室显影率均为83.3%，高剂量时均为100%。左室内膜节段增强效果、左室显影持续时间均随造影剂剂量增加而增加（P＜0.05)；但两种造影剂同剂量之间比较无差别（P＞0.05)。造影剂的肺转运时间与造影剂剂量高低无关。两种造影剂对实验犬血流动力学及心电图均无影响。结论：国产左心声学造影剂5%声振白蛋白溶液的超声造影效果及对犬血流动力学的影响均与国外同类产品Albunex相似。     

心肌超声造影实时三平面法的应用

目的探讨超声实时三平面法心肌超声造影临床应用的初步效果。方法在20例患者中，经外周静脉弹丸式注射全氟显超声造影剂，进行超声实时三平面法心肌超声造影，观察三平面法各个切面中左室显影等级及造影剂空间分布情况，记录各个节段心肌显影效果。结果20例患者左室显影等级均为3级，造影剂空间分布均匀，心内膜边界显示清晰；所有患者左室壁心肌均获得了满意的显影效果。结论临床应用超声实时三平面法进行心肌超声造影，能从多个切面和角度同时观察各个节段心肌显影的效果。     

低渗非离子型造影剂碘佛醇在冠脉造影中的临床观察

目的观察低渗非离子型造影剂碘佛醇在冠脉造影中的安全性及效果。方法对本院应用碘佛醇行冠脉造影的1 000例患者进行分析,观察应用造影剂碘佛醇前后不良反应发生率、肾功能、心率、血压、心电图变化。结果 1 000例造影均能顺利完成显影,且显影清晰。30例发生轻度不良反应,1例发生造影剂肾病,心率、血压、心电图无明显变化(P>0.05)。结论造影剂碘佛醇能满足冠脉造影的临床应用,效果好,不良反应事件低,安全性高,目前不失为冠脉造影首选造影剂。     

右冠状动脉造影剂滞留对心率的影响

目的 观察右冠状动脉造影剂滞留对患者心率的影响.方法 选取经冠状动脉造影确定的右冠状动脉造影剂滞留患者22例,同时选取27例左冠状动脉前降支造影剂滞留和18例冠脉造影正常患者作为对照,测定三组患者的静息心率.结果 右冠状动脉造影剂滞留患者较左冠状动脉前降支造影剂滞留、冠脉造影正常患者静息情况下心率明显减慢(造影术前63.7±7.7次/分 vs 70.4±7.5次/分,72.5±8.7次/分,P＜0.05;造影术后62.1±6.5次/分 vs 72.0±6.7次/分,73.1±7.2次/分,P＜0.05).结论 右冠状动脉造影剂滞留可造成窦房结动脉供血不足,导致心率减慢.     

国产左心声学造影剂与Albunex的药代动力学对比研究

目的　评价国产左心声学造影剂５％声振白蛋白溶液在声学造影效果及安全性方面与国外同类产品Ａｌｂｕｎｅｘ有 无不同。方法　两种造影剂均设置为高、低剂量组（０．０８ｍｌ／ｋｇ、０．２２ｍｌ／ｋｇ）,经小猎犬外周静脉注射,注射顺序以随机方 法分配。共观察６条犬在造影剂注射前后左室声学显影效果及造影剂对犬血流动力学变化的影响。结果　两种造影剂 在低剂量时左室显影率均为８３．３％,高剂量时均为１００％。左室内膜节段增强效果、左室显影持续时间均随造影剂剂量 增加而增加（Ｐ＜０．０５）;但两种造影剂同剂量之间比较无差别（Ｐ＞０．０５）．造影剂的肺转运时间与造影剂剂量高低无关。两 种造影剂对实验犬血流动力学及心电图均无影响。结论国产左心声学造影剂５％声振白蛋白溶液的超声造影效果及 对犬血流动力学的影响均与国外同类产品Ａｌｂｕｎｅｘ相似。     

心肌声学造影评价冠状动脉狭窄0～Ⅱ级冠心病患者的价值

目的应用心肌声学造影评价冠状动脉造影显示冠状动脉狭窄程度在0~Ⅱ级的心绞痛患者的价值。方法选取具有典型心绞痛的临床表现并排除其它疾病,经冠状动脉造影检测冠状动脉狭窄程度为0~Ⅱ级的冠心病住院患者50例,经心肌声学造影(MCE)的同时应用超声心动图得到以下参数:造影剂峰值密度(A)、心肌血流速率(β)、心肌血流容积(MBF MBF=A×β)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、射血分数(EF)、舒张早期峰值血流速度(Emax)、舒张晚期峰值血流速度(Amax)、舒张早期峰值血流速度与舒张晚期峰值血流速度比值(Emax/Amax)、舒张早期血流延迟时间(Dt)。采用定量分析的方法利用统计学方法对相应节段的心肌灌注情况和心脏功能与正常对照组进行比较。结果与正常对照组比较,心绞痛组β及MFB均显著下降β(0.85±0.25和1.47±036),P0.01;MBF(24.45±6.54和45.35±6.25),P0.05,心脏超声心动图在LVEDD、LVSED、EF、Emax、Amax、Emax/Amax、Dt等参数无明显差别(P≥0.05)。结论有明显心绞痛临床表现而冠状动脉造影示冠状动脉狭窄程度0~Ⅱ级的冠心病患者较正常人血流速度减慢的基础上存在着微循环的损伤,但是并没有导致心脏收缩功能异常。MCE可为具有典型的心绞痛表现而冠状动脉造影示冠状动脉狭窄程度在0~Ⅱ级冠心病患者诊断提供了新的诊断依据。     

肾脏循环灌注对比超声声学特征

目的探讨肾脏循环灌注对比超声声学显像特点。方法对10条杂种犬注射全氟显声学造影剂进行肾脏对比超声检查。结果肉眼下基础状态肾皮质至肾髓质、肾髓质由外至内呈渐进式显影。计算机视频分析示基础状态下皮质血管容积、血流速度、血流量均大于髓质，皮质和髓质血流速度的差异显著大于血管容积的差异。结论肾脏对比超声检查为研究肾脏循环提供了一个窗口。     

实时超声心肌声学造影对冠心病患者心肌灌注的临床研究

目的应用实时心肌声学造影半定量评价冠心病患者心肌灌注状况和心肌微循环状况。方法 20例冠脉造影左前降支冠脉狭窄>75%以上的冠心病患者和20例健康对照组行静息状态下实时心肌声学造影检查,并进行左室显影效果评分及造影声像半定量分析,来评价冠心病患者心肌灌注状况和心肌微循环状况。结果 MCE技术不但可对左室显影效果及心肌造影进行直观评价,而且能同时显示心肌增厚率和室壁运动,可以作为评价冠心病患者心肌血流灌注及心肌微血管病变的最佳选择。结论心肌超声造影有望成为冠心病的常规检查方法。     

CT冠脉钙化积分与核素心肌显像的相关性分析

目的 分析64排螺旋CT 冠状动脉血管成像(CTA)与静息门控99Tcm-MIBI心肌灌注显像患者定量分析结果的相关性.方法 选择66例接受99Tcm-MIBI静息门控心肌灌注显像及64排螺旋CT冠脉CTA检查的住院患者,对纳入对象进行冠状动脉钙化积分(CACS)与静息门控心肌灌注左心室定量分析结果进行相关性对比分析.结果 冠脉钙化积分与静息门控心肌灌注显像左心室心肌灌注总积分(QPS)、收缩末期容积(ESV)、舒张末期容积(EDV)、射血分数(EF)、室壁增厚率、室壁运动总积分无相关关系.冠脉钙化积分与左心室高峰充盈率(PFR)呈负相关关系(r=-0.28,P<0.05).冠脉钙化积分10～400分组与>400分组静息左心室射血分数差异有统计学意义(P<0.05),冠脉钙化积分0～9分组与>400分组左心室静息心肌灌注总积分差异有统计学意义(P<0.05).结论 除左心室高峰充盈率外,冠脉钙化积分与核素静息门控心肌灌注显像左心室定量分析结果,不存在统计学意义上的相关性.     

QUANTITATIVE ASSESSMENT OF MYOCARDIAL PERFUSION DEFECTS WITH REAL-TIME THREE-DIMENSIONAL MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY

QUANTITATIVE assessment of perfusion defectswith myocardial contrast echocardiography(MCE)could be a promising tool in the evalu-ation of patients with coronary artery disease·With the im-provement of microbubble contrast media and correspond-ing develop…     

超声心动图观察左室肥厚对评价高血压心肌微血管病变的价值

OBJECTIVE: To investigate the value of the echocardiographic observation of the left ventricular hypertrophy (LVH) in diagnosing myocardial microvascular damage in patients with essential hypertension (EH). METHODS: After intravenous injection with Quanfuxian (a contrast agent consisting of albumin and C3F8 prepared by Nanfang Hospital), the values of A (the maximum number of microbubbles accumulating in the local tissues for assessing the density of local microvessels), beta (the filling velocity of contrast agent for evaluating local blood flow velocity) and A x beta (the product of A and beta for estimating local myocardial blood flow) at rest and after dipyridamole injection were measured by intermittent harmonic imaging with myocardial contrast echocardiography (MCE). The ratios of A and beta along with the microvascular coronary flow velocity reserve (CFVR) were also calculated. RESULTS: Compared with the control group, the rest values of A, beta and A.beta in EH patients were higher, especially in those with LVH. After dipyridamole injection, the values of A, beta, A x beta and the ratios of A and beta, along with CFVR as well, were significantly lowered (P <0.01), and the reductions were especially obvious in LVH cases. As the hypertension exacerbated, the values of A and A x beta tended to increase in positive correlation with systolic and diastolic blood pressure (P <0.01), while the ratio of A and CFVR were decreased, the latter was inversely correlated with diastolic blood pressure (r=-0.55, P <0.01). Positive correlations were noted of the values of A and A x beta with the left ventricular mass and left ventricular mass index (P <0.01). CONCLUSION: EH patients, especially those with LVH, are characterized by increased rest myocardial microvascular blood flow, impaired myocardial microvascular flow reserve and endothelium independent vasodilation relaxing ability, and reduced capillary density, and these conditions tend exacerbate as the disease worsens. Microvascular function impairment should be suspected when complication of LVH arises in the EH patients. As a new important noninvasive technique, MCE can be a promising modality for diagnosing microvascular disease in essential hypertension.     

N-羧甲基壳聚糖微泡超声造影剂的制备与性能评价

目的制备N-羧甲基壳聚糖微泡超声造影剂,观察其基本特征及对动物肝脏超声显影效果。方法采用(油/水)/油复合乳液-溶剂蒸发法制备微泡超声造影剂,通过光学显微镜和扫描电镜观察微泡的大小、形态及粒径分布,通过股动脉注射0·5ml该超声造影剂到动物体内,观察动物肝脏超声显影效果。结果N-羧甲基壳聚糖微泡为空心球形结构,分散均匀,形状规则,粒径在2~3μm,壁厚为250~300nm。该造影剂对动物肝脏超声显影效果明显增强。结论N-羧甲基壳聚糖微泡可作为一种性能较好的超声造影剂。     

Binding of targeted microbubble contrast agent to choriocarcinoma cells in vitro]

OBJECTIVE: To observe the cell binding characteristics of SonoVue microbubbles targeting choriocarcinoma cells and provide evidence for clinical ultrasonic localization of the tumor utilizing the microbubbles. METHODS: The targeted microbubbles were prepared by conjugating anti-HCG antibody with the SonoVue microbubbles and added in choriocarcinoma cells or endometrial stromal cells to compare the cell binding rate of the agents under optical microscope and with flow cytometry. RESULTS: Flow cytometry demonstrated a binding rate of 77.6% between the SonoVue microbubbles and anti-HCG antibody. Light microscopy showed that the total rosette formation rate of the choriocarcinoma cells exposed to the targeted microbubble bearing anti-HCG antibody reached (87.8-/+6.3)%, significantly higher than that of the endometrial stromal cells [(9.4-/+1.7)%, P<0.05]. The binding rate of the targeted microbubbles with the choriocarcinoma cells before and after PBS washing were (85.4-/+4.7)% and (83.1-/+3.8)% (P>0.05), respectively, suggesting strong stability of the binding. The binding rate was 81.0% according to the results of flow cytometry. CONCLUSION: The targeted microbubbles as a contrast agent can efficiently bind to the choriocarcinoma cells in vitro with a stability sufficient to resist the blood flow.     

肾脏循环灌注对比超声声学特征

目的 探讨肾脏循环灌注对比超声声学显像特点。方法 对10条杂种犬注射全氟显声学造影剂进行肾脏对比超声检查。结果 肉眼下基础状态肾皮质至肾髓质、肾髓质由外至内呈渐进式显影。计算机视频分析示基础状态下皮质血管容积、血流速度、血流量均大于髓质,皮质和髓质血流速度的差异显著大于血管容积的差异。结论 肾脏对比超声检查为研究肾脏循环提供了一个窗口。     

心肌块学造影评价双嘧达莫和多巴酚丁胺对冠状动脉微循环的影响

目的　对比评价双嘧达莫和多巴酚丁胺对心肌血流量 (MBF)和心肌血流容积 (MBV)的影响及 2种药物负荷心肌声学造影 (MCE)探测静息无血流限制性冠状动脉 (简称冠脉 )狭窄的能力。方法　以安放“水膨胀”式缩窄器的方法建立 13只慢性多支冠脉狭窄闭胸犬。术后 7～ 10d ,在静息、双嘧达莫 (0 .5 6mg/kg)和峰值剂量多巴酚丁胺 (30～ 40 μg·kg-1·min-1)负荷下 ,以放射性微球测定MBF和以MCE测定平台声强度 (Ⅵ ,相当于MBV)和微泡速度 (β)。 结果　 2种药物引起MBF的增加差异无显著意义 (P >0 0 5 )。 2种药物间比较 ,平台VI的增加以多巴酚丁胺明显 (P <0 .0 5 ) ;β的增加则以双嘧达莫为明显 (P <0 .0 5 )。但正常与异常冠脉供血区的平台Ⅵ比值、β比值 ,2种药物间比较差异无显著意义 (P >0 0 5 ) ,且诱出的心肌灌注缺损也相近。平台Ⅵ比值、β比值与放射性微球测定的MBF比值均呈直线正相关 (P <0 .0 0 0 1)。结论　在慢性冠脉狭窄中 ,虽然双嘧达莫和多巴酚丁胺对MBV的影响不同 ,但它们诱出MBF储备的程度相近。因此 ,2种药物负荷MCE定量冠脉狭窄的能力相同。     

Usefulness of dobutamine stress myocardial contrast echocardiography for assessing coronary artery disease

Background Quantitatively assessing myocardial perfusion and its reserve is of great importance for the diagnosis and stratification of patients with coronary artery disease (CAD), and represents an important goal of myocardial contrast echocardiography. In this study we sought to test the usefulness of low dose dobutamine stress real-time myocardial contrast echocardiography (RT-MCE) in the assessment of CAD, and to explore the relationship between perfusion reserve and contractile reserve.Methods Twenty-six patients with suspected or clinical diagnosed CAD were enrolled and underwent RT-MCE at baseline and under low dose dobutamine stress, and subsequent coronary angiography. RT-MCE images were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion and its reserve. Results At baseline, significant differences in beta (0.28±0.12, 0.25±0.09, 0.22±0.06, 0.20±0.07 respectively, P＜0.01) and A×beta (1.37±0.46, 1.28±0.47, 1.13±0.37, 0.91±0.32, respectively, P＜0.01) were observed among four segment groups with graded coronary artery stenosis severity (normal; 30%-69% stenosis; 70%-90% stenosis; and beyond 90% stenosis), but not observed in parameter A. When under stress, significant differences in A (5.73±1.28, 5.63±1.01, 4.96±0.81, 4.57±0.62, respectively, P＜0.01), beta (0.67±0.17, 0.55±0.19, 0.32±0.13, 0.25±0.08, respectively, P＜0.01) and A×beta (3.81±1.20, 3.11±1.17, 1.59±0.82, 1.12±0.37, respectively, P＜0.01) were observed among the formerly mentioned groups. Graded decreases in A reserve (1.20±0.53, 1.11±0.16, 0.98±0.12, 0.99±0.13, respectively, P＜0.01), beta reserve (2.65±1.07, 2.32±0.82, 1.44±0.40, 1.29±0.34,respectively, P＜0.01) and A×beta reserve (3.05±1.63, 2.59±1.01, 1.42±0.44, 1.27±0.34, respectively, P＜0.01) could also be observed with increasing coronary stenosis severity. In five segments groups scored by WMS (1-5), concordance between contractile function and myocardial perfusion could be found both at rest (beta: 0.28±0.11, 0.22±0.08, 0.21±0.05, 0.17±0.05, 0.19±0.06, respectively, P＜0.01; A×beta: 1.29±0.48, 0.98±0.45, 0.94±0.29, 0.76±0.30, 0.92±0.32, respectively, P＜0.01) and under stress (beta: 0.59±0.20, 0.35±0.15, 0.27±0.08, 0.17±0.05, 0.20±0.05, respectively, P＜0.01; A×beta: 3.07±1.38, 1.62±0.82, 1.28±0.40, 0.78±0.24, 0.93±0.22, respectively, P＜0.01). This concordance is also valid in terms of the reserves, and the MCE parameters in segments with ameliorated contractile function are significantly higher than in those without. Conclusions Quantitative RT-MCE in conjunction with dobutamine stress shows promise in identifying and stratifying CAD and in exploring the perfusion-contractile correlation. Chin Med J 2005; 118(21):1766-1772     

超声微泡造影剂对大鼠骨骼肌毛细血管通透性的影响

目的 研究治疗剂量超声破坏微泡造影剂对大鼠骨骼肌毛细血管通透性的影响.方法 以伊文思蓝(EB)为指示剂,18只清清级SD大鼠,随机均分为EB组(E)、EB 超声组(E U)和EB 超声 微泡组(E U M)共3组进行实验.给予相同参数条件的超声进行照射,经颈动脉输/不输入微泡造影剂,在体荧光显微镜下观察EB外溢情况并行视觉评分;使用标准曲线和分光光度法测量各组大鼠脊斜肌中EB的含量.结果 E U M组镜下可见微血管周嗣EB外溢,视觉评分等级为2级.显著高于E组(0级)及E U组(0-1级)(P<0.05).E组及E U组两者相比无显著性差异(P>0.05).E U M组脊斜肌中EB含量为(51.57±3.89)μg/g,比E组[(28.99±4.67)vg/g]及E U组[(30.99±4.11)μg/g]明显增加(P<0.05).E组及E U组两者相比无显著性差异(P>0.05).结论 超声介导微泡造影剂破坏可使脊斜肌组织毛细血管通透性增加.可能是超声微泡造影剂增强基因转染的主要机制之一.