心肌梗塞后左室压对激光心肌血管重建术效应影响的实验研究

为探索左室压是否为影响激光心肌血管重建术（ＬＭＲ）的重要因素，将家兔５０只，随机分为四组，分别用结扎左室支、结扎左室支后升高左室压、结扎左室支后激光心肌血管重建术（ＬＭＲ）、结扎左室支后升高左室压加ＬＭＲ处理。结果，单用ＬＭＲ或升高左室压加ＬＭＲ均可使ＥＥＣＧＳＴ段抬高的平均值（ＳＴ↑）、ＳＴ段异常抬高的标测点数（ＮＳＴ↑）显著降低，使ＳＴ段抬高总值（∑ＳＴ）回降率加快，说明心肌缺血性损伤的程度和范围减轻；左室支结扎６小时时，心肌Ｎ－ＢＴ染色也显示心肌梗塞范围（ＳＭＩ）明显缩小、残存心肌范围（ＳＲＭ）增加，与没有ＬＭＲ的其他两组相比有显著差异（Ｐ＜０．０５）。在升高左室压的情况下施行ＬＭＲ，上述各项指标改善更为明显，显著优于单用ＬＭＲ组（Ｐ＜０．０５），说明左室压是影响ＬＭＲ效果的关键因素之一。     

急性心肌梗死延迟PTCA对心肌灌注的影响

目的：研究急性心肌梗死延迟经皮冠状动脉腔内成形术（PTCA）及支架植入对心肌灌注的影响。方法：56例初次争民性心肌梗死患者随机分为PTCA及支架植入组（治疗组，30例）和常规药物治疗组（对照组，26例），治疗组在急性心肌梗死后15－30d行延迟PTCA及支架植入治疗，治疗组于术前1－3d，对照组于急性心肌梗死后15－30d行SPECT心肌灌注显像，1和6个月各复查SPECT检查1次。结果：治疗组术后1和6个月梗死区缺血程度均较术前明显改善（P＜0．01），术后差异无显著性（P＞0．05）。对照组第2、3次检查示心肌缺血均较第1次稍有改善，但差异均无显著性（P＞0．05），治疗组对照组心肌缺血明显改善（P＜0．05）。结论：急性心肌梗死患者延迟PTCA及支架植入能使梗死相关血管再通，血运重建，改善心肌缺血程度。     

断层相位分析定位预激旁道的方法学探讨

应用门控心血池断层显像相位分析定位预激旁道（ＡＣＰ），分析了影响图像重建、心室切面选择和相位分析的主要因素，讨论了建立平行于并最近房室环水平的心室短轴切面的关键步骤。５例Ｗｏｆｆ－Ｐａｒｋｉｎｓｏｎ－Ｗｈｉｔｅ（Ｗ－Ｐ－Ｗ）综合征患者手术前进行了本检查，结果与手术时心外膜标测完全相符，表明本方法能客观、清晰和准确地定位ＡＣＰ。     

蒺藜总皂甙对TNF-α及IL-1β诱导内皮细胞粘附的抑制作用

目的：观察蒺藜总皂甙（ｇｒｏｓｓｓａｐｏｎｉｎｓｆｒｏｍ ＴｒｉｂｕｌｕｓｔｅｒｒｅｓｔｒｉｓＬ,ＧＳＴＴ） 对肿瘤坏死因子－ α（ＴＮＦ－ α） 、白细胞介素－１β（ＩＬ－１β） 诱导的培养新生牛脑微血管内皮细胞（ＣＭＥＣ） 粘附大鼠血单核细胞（ＭＮＣ） 及中性粒细胞（ＰＭＮ） 的影响。方法：用ＴＮＦ－α和ＩＬ－１β分别诱导传代的ＣＭＥＣ,计粘附ＭＮＣ及ＰＭＮ的细胞数,并计算粘附率。结果：ＣＭＥＣ 经ＴＮＦ－ α处理４ｈ 后,ＣＭＥＣ与ＭＮＣ及ＰＭＮ的粘附率,分别增加到３１．３±０．５％ 和３２．１±０．５％ （对照组分别为１２ ．５±０ ．２％ 和１３ ．８±０ ．４ ％） ,经ＩＬ－１β处理２ｈ 后,则分别为４４．５ ±１．０ ％ 和４４．８ ±０．７ ％ （ 对照组分别为１２ ．９ ±０．６ ％ 和１４．７ ±０．６％ ）。在ＴＮＦ－ α（ＩＬ－ １β） 处理前,用ＧＳＴＴ与ＣＭＥＣ共孵育,预处理２ｈ,则ＧＳＴＴ可剂量依赖性地抑制ＴＮＦ－ α和ＩＬ－ １β的作用。结论：ＧＳＴＴ可抑制ＣＭＥＣ 与ＰＭＮ及ＭＮＣ的粘附。     

^125—BMIPP检测缺血和再灌注区存活心肌及其与局部血流的关系

目的 通过犬心肌梗死及缺血再灌注模型，观察碘标β－甲基碘苯酯十五烷酸（ＢＭＩＰＰ）检测缺血区存活与坏死心肌的作用及其与局部血流的关系。方法 １２条实验犬结扎左回旋支冠状动脉后分成２组，即单纯缺血组与缺血再灌注组。静脉注射＾１２５Ｉ－ＢＭＩＰＰ和＾９９Ｔｃ＾ｍ－右旋糖酐微球（ＴＭ），３０ｍｉｎ后处死实验犬，摘除心脏，分别进行ＥＶＡＮＳ蓝和ＮＢＴ染色，确定正常，缺血和坏死心肌范围，并分别测定同一组织块     

GIK对急性缺血/再灌注犬心肌损伤的影响

目的比较GIK（葡萄糖-胰岛素-钾）和GK（葡萄糖-钾）对犬在体急性心肌缺血/再灌注（MI/R）血液流变性和心肌损伤的影响,讨论胰岛素在GIK保护心肌缺血中的作用。方法采用定量缺血的方法制备犬急性MI/R模型,再灌注GIK、GK或生理盐水4 h后,抽取冠状静脉窦血,比较各组的红细胞压积（HCT）、全血高切粘度（ηbh）、全血低切粘度（ηbl）、血浆乳酸脱氢酶（LDH）、肌酸激酶CK）和梗死区面积的变化。结果 GIK组与另两组相比,再灌注后ηbh、ηbl、TK、HCT均有明显的改变（P〈0.05）。GIK明显降低心肌梗死后LDH和CK活性（P〈0.05）,心肌梗死范围减少（P〈0.05）。结论 GIK可改善MI/R犬血液流变学特性,降低全血黏度;减轻心肌损伤,显著地缩小急性心肌梗死范围,并减轻梗死程度,胰岛素是GIK中的关键成分。     

镁盐对犬心肌缺血—再灌注损伤的保护作用

建立整体犬急性心肌缺血－再灌注模型，在心肌缺血后再灌注前静脉滴注硫酸镁（ＭｇＳＯ４），以观察镁盐对再灌注区心肌组织超氧化物歧化酶（ＳＯＤ）活性的脂质过氧化反应代谢产物－丙二醛（ＭＤＡ）含量的影响，着重分析与血清肌本乡磷酸激酶（ＣＰＫ）水平和心肌超微结构病变的关系。     

海洛因依赖对T淋巴细胞核仁区酸性非组蛋白表达的影响

目的：细胞核仁形成区（ＮＯＲｓ）主要由核糖体ＲＮＡ基因组成,位于此区调控ｒＲＮＡ转录的酸性非组蛋白可被硝酸银染色（Ａｇ－ＮＯＲｓ）,Ａｇ－ＮＯＲｓ变化反映了细胞代谢调控异常及细胞功能受到影响。本研究观察海洛因依赖患者外周血Ｔ淋巴细胞Ａｇ－ＮＯＲｓ及与解毒有关的胎盘型谷胱甘Ｓ－转移酶（ＧＳＴ－π）表达,分析海洛因依赖对Ｔ细胞代谢乃至功能的影响。方法：利用北京开隆公司提供的ＫＬ型免疫图像分析系统检测Ｔ     

平面位相分析定位房室旁路价值再评价

平面位相分析定位房室旁路价值再评价沃金善，杨洪霞，诸骏仁，李志善，赵惠扬，陈可靖，陈绍亮对１９例Ｗｏｌｆｆ－Ｐａｒｋｉｎｓｏｎ－Ｗｈｉｔｅ（Ｗ－Ｐ－Ｗ）综合征病人进行核素位相分析，对照电生理检查或心外膜标测定位，重新评价平面位相分析在房室旁路定位诊断...     

益欣康泰胶囊对键康人肝、肾功能的影响和对慢性乙型肝炎及肝功能异常患者的疗效观察

目的：观察益欣康泰胶囊对健康人肝、肾功能的影响和对慢性乙型肝炎及肝功能异常患者的治疗效果。方法：对居住在海拔３３００ｍ 地区坚持服药且资料完整的４０７ 例健康人和８３ 例慢性乙型肝炎及肝功能异常患者分别进行了服药４０ 天，８０ 天后麝香草酚混浊度试验（ＴＴＴ）、谷丙转氨酶（ＡＬＴ）、谷草转氨酶（ＡＳＴ）、尿素氮（ＢＵＮ）和乙型肝炎表面抗原（ＨＢｓＡｇ）的检测。结果：该药对健康人服药前后的肝、肾功能各项指标无明显影响（Ｐ＞ ００５）；４６ 例慢性乙型肝炎患者经益欣康泰胶囊治疗８０ 天后，有９ 例ＨＢｓＡｇ 转为阴性，转阴率为１９６％ ，其余３７ 例患者的ＨＢｓＡｇ 仍为阳性，但血清中ＨＢｓＡｇ 的ＯＤ值（吸光度）呈现了不同程度的下降（Ｐ＜ ００１）；另外，在服药前有ＡＬＴ、ＡＳＴ和ＴＴＴ异常升高者经治疗后均有明显降低（Ｐ＜ ００１）。结论：表明该药对健康人肝、肾功能无明显影响并且对慢性乙型肝炎及肝功能异常患者有较好的疗效     

Myocardial damage size assessment in the zone of infarction for indicating rescue percutaneous coronary intervention

BACKGROUND: The most important predictors of subsequent patients outcome after acute myocardial infarction (AIM) are infarct size, left ventricular ejection fraction, left ventricular volumes and presence and extent of residual myocardial ischemia. All of these variables can be directly determined through scintigraphic approaches. The presence and extent of myocardial ischemia are strong pre dictors for fatal and nonfatal cardiac events and improve risk statification beyound the information gleaned from clinical variables. CASE REPORT: We presented a case of 66-years-old male with myocardial infarction of anteroseptal localization. Myocardial perfusion imaging (MPI) detected a large zone of residual ischemia (culprit lesion) within infarction zone. It has an important role in risk stratification after myocardial infarction, and indicates subsequent therapeutic decision making, in this case rescue percutaneous coronary intervention (PCI). After PCI we followed the therapy effect by MPI, and we found practically normal perfusion with minimal zone of defect perfusion in the apex. CONCLUSION: Myocardial perfusion imaging has an important role in the initial evaluation and risk stratification of patients surviving myocardial infarction. It also plays a major role in guiding subsequent therapeutic decision making, and in monitoring the benefits of these therapeutic measures.     

Detectability of diagonal branch disease by 201TlCl exercised myocardial scintigraphy]

The detectability of diagonal branch disease in 10 patients (five with angina pectoris, five with myocardial infarction) with isolated diagonal branch lesions (more than 75% luminal stenosis in coronary angiography) was reviewed. In exercised 201TlCl myocardial scintigraphy, chest pain occurred in four of 10 patients, electrocardiographic change indicating myocardial ischemia was seen in four, and diagonal branch lesion was detected in only four patients by planar images. In contrast, diagonal branch lesions were detected in 10 of 10 patients by SPECT (single photon emission computed tomography). In planar images, perfusion defects appeared high in the anterolateral, posterolateral, and anterior walls of the left ventricle. In SPECT images they appeared high in the anterior to anterolateral wall. The extent of diagonal branch lesions could be quantitatively evaluated by coronary territory maps developed from unfolded maps of exercised SPECT. The mean ratio of the extent of diagonal branch lesion to left anterior descending branch territory was 24.7%, and the extent of myocardial infarction was significantly larger than that of angina pectoris (p < 0.05). In conclusion, SPECT is useful for detecting diagonal branch lesions and can quantitatively show the extent of these lesions by coronary territory map.     

血栓心脉宁胶囊对大鼠实验性心肌梗死的保护作用

 目的研究血栓心脉宁胶囊对大鼠实验性心肌梗死的保护作用.方法通过结扎大鼠左冠状动脉前降支(Leftanterior descending coronary artery,LAD)建立急性心肌梗死模型,观察血栓心脉宁胶囊对实验性心肌梗死的影响及其作用机制.结果血栓心脉宁胶囊2、4g/kg灌胃7 d,对急性心肌梗死24h大鼠,可明显缩小梗死面积,降低血清CK、LDH活性及脂质过氧化物(Lipid peroxidation,LPO)含量,提高超氧化物歧化酶(SOD)活性,并能使血浆血栓素A2(TXA2)水平明显下降,前列环素(PGI2)水平及PGI2/TXA2比值明显增高,亦可使心肌梗死区游离脂肪酸(FFA)含量明显降低.结论血栓心脉宁胶囊对急性心肌缺血具有明显保护作用,可能与其增强抗氧化酶活性,减少自由基对心肌的氧化损伤,纠正心肌缺血时FFA代谢紊乱及PGI2/TXA2平衡失调等机制有关.     

Early markers of myocardial ischemia: from the experimental model to forensic pathology cases of sudden cardiac death

The goal of this study was to assess whether early markers of myocardial ischemia, identified in a previous experimental work, can be applied in forensic pathology cases of sudden, ischemic cardiac death. These markers include desphosphorylated connexin 43 (Cx43), JunB, TUNEL assay, myoglobin, and troponin T. Fourteen cases of sudden cardiac death with gross and/or histological signs of myocardial infarction and 14 cases of sudden cardiac death with signs of early ischemia at histology and positive immunoreactions for fibronectin and C5b-9 were investigated. The control group was represented by 15 hanging (global hypoxia) cases. Immunohistochemical reactions were classified into four degrees and compared among groups. Cx43 and JunB were significantly more expressed in hanging than in ischemia/infarction, but they showed a different distribution in the tissue (sub-endocardial in ischemia/infarction, diffuse in hanging) and a different intensity of the signal. TUNEL assay was significantly more expressed in the group of early ischemia than in myocardial infarction. Myoglobin and troponin T did not show any significantly different expression among the three groups. Depletion markers have a limited application in forensic cases, and this is mostly because positive (depleted) areas are difficult to distinguish from artifactually paler areas. Nuclear markers (JunB and TUNEL), on the other hand, require a well-trained eye and a high magnification in order to be distinguished. Cx43, JunB, and TUNEL assays were confirmed to be early, sensitive markers for myocardial ischemia. Nonetheless, they are not specific, as they are expressed in global hypoxia as well, but with a different tissular distribution.

     

Effect of perfusion pattern and imaging sequence on gated perfusion SPECT evaluation of myocardial stunning.

The aim of this study was to determine the effect of perfusion defect and imaging sequence on the evaluation of myocardial stunning with gated perfusion SPECT. METHODS: A dynamic mathematic cardiac torso phantom was used to create 100 gated SPECT simulations (50 stress-rest and 50 rest-stress sequences) with a wide range of perfusion defects. No segmental wall motion abnormalities were created. After generating projection images, 2 additional acquisitions were simulated by thresholding the projected data to 25% and 75% of the maximum. Finally, gated SPECT projections were grouped by 2s to generate 2 series of phantoms corresponding to stress-rest and rest-stress imaging sequences. For each sequence, the first dataset was the 25% thresholded gated SPECT. Both 75% thresholded and 100% signal intensity were used as a second dataset. Each simulated gated SPECT image differed from others in the extent of myocardial scar or ischemia, but all had the same end-diastolic volume (EDV) (125 mL), end-systolic volume (ESV) (48 mL), and ejection fraction (EF) (62%). Left ventricular perfusion and function were each assessed using validated software. RESULTS: Mean stress EDV was decreased when compared with rest-simulated data (111 +/- 4.7 and 112.4 +/- 4.8 mL, respectively; P < or = 0.05), and mean stress ESV was increased when compared with rest-simulated data (44 +/- 4.2 and 42.7 +/- 4 mL, respectively; P < 0.02). The resulting mean stress EF was decreased in the same comparison (60.3% +/- 3.1% and 62% +/- 2.7%, respectively; P = 0.0001). After multivariate analysis, the difference between stress and rest EF was significantly influenced by myocardial infarction (P = 0.0027), severe extent of myocardial ischemia (P = 0.0017), and imaging sequence (P < 0.0001). A > or =5% decrease in EF on stress SPECT (i.e., myocardial stunning) was significantly associated with the stress-rest sequence (chi(2) = 26; P < 0.0001). CONCLUSION: Perfusion defects and imaging sequence had significant effects on the evaluation of myocardial stunning using gated perfusion SPECT.     

多巴酚丁胺~(99m)Tc-MIBI心肌断层显像对检测心肌梗塞后残余心肌缺血的价值

目的：评价多巴酚丁胺９９ｍＴｃ－甲氧基异丁基异晴心肌断层显像（Ｄｏｂｕ－ＥＣＴ）检测心肌梗塞后残余心肌缺血的价值。材料与方法：６２例心肌梗塞患者在行冠状动脉造影时进行多巴酚丁胺心肌断层显像检查。结果：Ｄｏｂｕ－ＥＣＴ对心肌梗塞后残余心肌缺血检出率为７７％，高于多巴酚丁胺心电图负荷试验（Ｄｏｂｕ－ＥＣＧ）。无论是１支，还是２支或３支血管病变，Ｄｏｂｕ－ＥＣＴ对心肌梗塞后残余心肌缺血的检出率均高于Ｄｏｂｕ－ＥＣＧ（５６％，４％；８６％，２７％；１００％，４７％；Ｐ＜０．０１）。２１例急性心肌梗塞行溶栓治疗患者残余心肌缺血率为６７％，低于未行溶栓治疗患者（７２％）或陈旧性心肌梗塞患者（９４％），但差异无显著性。Ｄｏｂｕ－ＥＣＴ对非梗塞区心肌缺血的检出率为５６％。结论：多巴酚丁胺９９ｍＴｃ－甲氧基异丁基异晴心肌显像能够识别心肌梗塞后有无残余心肌缺血及其部位和范围。     

Prognostic value of stress myocardial perfusion imaging in octogenarian population

BACKGROUND: The prognostic value of myocardial perfusion imaging (MPI) in the very elderly population has not been addressed specifically. The aim of this study was to examine the characteristics of the octogenarian population referred for MPI and the prognostic value of the procedure in terms of patient gender. METHODS: The study sample consisted of 162 consecutive patients (61 women, 101 men) of mean age 83 +/- 3 years (range, 80-90) who underwent stress MPI. The duration of follow-up was 45+/-12 months. Outcome measures were cardiac-related death, and nonfatal myocardial infarction (MI). RESULTS: Thirty-one major cardiac events (19%) were recorded, including 26 cardiac deaths and 5 MI events, in 6 of the 61 women (10%) and 25 of the 101 men (25%) (p < 0.03). The univariate predictors of cardiac death or MI, except of known coronary artery disease (CAD), were MPI variables: left ventricular (LV) dilatation, increased lung uptake, abnormal scan, and the presence and extent of myocardial ischemia. However, the only predictors for major cardiac events were: LV dilatation (OR = 6.9, 95% CI 2.7-17.4, p < 0.0001) and ischemia by scan (OR = 2.75, 95% CI 1.09-6.96, p < 0.03). The Kaplan Meier curve demonstrated significant differences in survival between patients with or without LV dilatation and patients with or without ischemia. CONCLUSIONS: LV dilatation and myocardial ischemia were useful predictors of cardiac death and MI in octogenarian patients with CAD or with suspicion of CAD.     

Is myocardial stress perfusion MR-imaging suitable to predict the long term clinical outcome after revascularization?

Introduction

Aim of our study was to evaluate, whether myocardial ischemia or myocardial infarction (MI) depicted by myocardial stress perfusion MR imaging (SP CMR) can predict the clinical outcome in patients with coronary artery disease (CAD).

Materials and method

220 patients were included. Myocardial perfusion was assessed at stress and at rest, using a 2D saturation recovery gradient echo sequence (SR GRE) and myocardial viability by late gadolinium enhancement magnetic resonance images (LGE CMR). MR-images were assessed in regard of presence and extent of MI and ischemia. Patients were monitored for major adverse cardiac events (MACE) (monitoring period: 5–7 years). MACE were correlated with the initial results of SP CMR.

Results

Ischemia was found in 143 patients, MI in 107 patients. Number of MACE was in patients with normal SP CMR 0 (51 patients), with ischemia 21 (62 patients), with MI 14 (26 patients), with ischemia and MI 52 (81 patients). In all patients with severe MACE (MI, death) and in 63 of those with recurring symptoms LGE CMR revealed MI at baseline.

Conclusion

Negative SP CMR indicates low risk for MACE. In patients with stress induced ischemia, MACE might occur even after myocardial revascularization. The presence of MI proved by LGE CMR is associated with a significantly increased risk for MACE.     

四项指标联合检测对急性心肌梗死早期诊断价值的探讨

目的探讨心肌肌钙蛋白I(cTnI)、肌红蛋白(Myo)、肌酸激酶同工酶(CK-MB)以及超敏C-反应蛋白(hs-CRP)四项指标的联合检测在急性心肌梗死诊断中的临床应用价值。方法对40例急性心肌梗死患者(A组),35例不稳定型心绞痛患者(B组)和50例健康体检者(C组)在首诊(胸痛发作4 h之内)时进行cTnI、Mb、CK-MB和hs-CRP检测,比较它们各自及联合检测时对急性心肌梗死诊断的敏感性。结果急性心肌梗死患者血中cTnI、Myo、CK-MB和hs-CRP水平显著高于不稳定型心绞痛患者和对照组,差异有显著统计学意义(P<0.01),且急性心肌梗死患者血中cTn I、Myo、CK-MB和hs-CRP水平高于不稳定型心绞痛患者(P<0.05)。cTnI、Myo、CK-MB、hs-CRP及四项指标联合测定急性心肌梗死的阳性率分别为75%、82.5%、65%、87.5%和97.5%。结论 cTnI、Myo、CK-MB和hs-CRP对急性心肌梗死诊断有重要临床意义,联合检测可以提高急性心肌梗死诊断的灵敏度,具有较高临床价值。     

DSA冠状动脉狭窄与MRI相应供血区心肌缺血、坏死程度的对比分析

目的 探讨MRI所检出的心肌缺血和坏死与供血冠状动脉狭窄程度的关系。资料与方法 47例在1周内完成MRI心脏检查与DSA冠状动脉造影检查,判断心肌有无缺血和心肌坏死的程度,并与DSA结果对照分析两者关系。结果 随着DSA冠状动脉狭窄程度的增加,MRI检出相应供血区心肌有缺血改变的阳性率也逐渐增加,两者非常显著相关（P〈0．0001）。在冠状动脉狭窄程度〉70％的56支血管中,MRI仅有2处（3．6％）未检出缺血改变。随着DSA冠状动脉狭窄程度的增加,MRI检出相应供血区心肌有坏死改变的阳性率也逐渐增加．两者亦非常显著相关（P〈0．001）,在冠状动脉狭窄程度〉80％的39支血管中,MRI检出有不同程度心肌坏死改变的共27处（69、2％）,在冠状动脉狭窄程度〉90％的22支血管中,MRI检出有不同程度心肌坏死改变的共17处（77．3％）,其中透壁心肌坏死改变共11处（50％）。结论 MRI检查可清晰显示心肌缺血、坏死的位置、程度,其结果与DSA冠状动脉情影结果密切相关．两者的一致性较高且有百相支持和补充作用．