氧化应激对心衰大鼠心肌细胞凋亡的影响及卡维地洛的干预作用

目的:研究氧化应激对心衰心肌细胞凋亡的影响及卡维地洛的疗效.方法:构建心衰人鼠模型,随机分为心衰组,卡维地洛组.药物干预4周,测心功能指标、氧化代谢指标、心肌细胞凋亡率(AI).结果:心衰氧化应激与AI相关,AI与心功能恶化和度平行并与左心室质量指数(LVMl)有关,(P均＜0.05);卡维地洛改善心功能,纠正氧化失恒,降低LVMI、右心室质量指数(RVMI),AI下降(P均＜0.05).结论:氧化应激促进心肌细胞凋亡,细胞凋亡参与心室重构并提示心衰预后.卡维地洛改善心功能,机制可能与其抗氧化应激、抗细胞凋亡、逆转心室重构有关.     

卡维地洛防治急性心肌梗死后左心室重构的临床研究

目的:为比较卡维地洛与卡托普利防治急性心肌梗死(AMI)后左心室重构的效果.方法:将122名AMI患者随机分为卡维地洛组52例,卡托普利组50例,常规治疗组20例,分别于治疗后1周、6个月采用心脏多普勒超声测定室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室舒张末内径(LVDd),计算左室重量指数(LVMI),同时测定左室射血分数(LVEF)及舒张早期左室充盈最大速率(E峰)与心房收缩期最大速率(A峰).结果:卡维地洛组和卡托普利组与常规治疗组比较均可使IVST、LVPWT变薄(P＜0.01),LVDd缩小(P＜0.01),LVMI降低(P＜0.01).卡维地洛组和卡托普利组均可增加LVEF、降低A/E峰比值,与常规治疗组比较1周时P＜0.05,6个月时P＜0.01.结论:卡维地洛具有良好的防治AMI后左室重构效果.     

卡维地洛对冠心病心力衰竭患者心室重构和心功能的影响

目的　探讨卡维地洛对冠心病心力衰竭患者心室重构及心功能的影响。方法　冠心病心力衰竭患者 80例 ,左室射血分数≤ 45 % ,心功能Ⅱ～Ⅲ级 ,常规治疗基础上随机分为治疗组和对照组 ,治疗 6个月 ,观察卡维地洛对心室重构、心功能的影响。结果　经过 6个月治疗 ,与对照组相比 ,卡维地洛组左室射血分数明显升高 (P <0 .0 1) ,左室收缩末容量指数、左室舒张末容量指数、左室重量指数均显著降低 (P <0 .0 1)。结论　在常规治疗的基础上 ,应用卡维地洛能显著改善冠心病心力衰竭患者的心功能 ,改善心室重构     

卡维地洛和美托洛尔对左室舒张功能及心室重塑影响的对比观察

目的探讨卡维地洛与美托洛尔两种不同类型的β-受体阻滞剂对充血性心力衰竭患者左室舒张功能和心室重塑的影响。方法将68例充血性心力衰竭患者在常规治疗心力衰竭(心衰)基础上随机分为卡维地洛组(A组35例)和美托洛尔组(B组33例),应用超声心动图分别于治疗前、治疗6个月后、12个月后测量左心室舒张早期充盈峰速度(E峰)、左心室舒张晚期充盈峰速度(A峰)、E/A、左心室舒张早期充盈峰减速时间(EDT)、E波流速积分(Ei)以及室间隔厚度(IVS)、左室后壁厚度(IVPW)、左室重量指数(LVMI)、左室球径指数(LVGI)。结果随访59例(A组30例、B组29例)发现:①治疗6个月时,两组的E峰、A峰、E/A、LVMI、LVGI均较治疗前差异有高度显著性(P<0.01);A组LV-MI、LVGI较B组显著减少(P<0.05或0.01)。②治疗12个月时两组的E峰、A峰、E/A、LVMI、LVGI、IVS、LVPW均较治疗前明显改善(P<0.01或0.05);A组的E峰、LVMI、LVGI、LVPW较B组差异有显著性(P<0.01或0.05)。结论卡维地洛在改善左心室舒张功能和心室重塑方面较美托洛尔更显著,治疗充血性心力衰竭更有优势。     

卡维地洛治疗高血压并慢性心力衰竭的疗效观察

目的:观察卡维地洛对高血压并慢性心力衰竭(CHF)患者的心功能影响及临床疗效.方法:选择高血压并高心病或冠心病82例,心功能Ⅱ～Ⅳ级的患者,随机分为两组,常规组(40例),给与控制血压、利尿、转换酶抑制剂(ACEI)、洋地黄治疗.卡维地洛组(42例),在常规治疗基础上加用卡维地洛(20mg Bid×180天).结果:卡维地洛组临床显效率(57.1%),总有效率(92.8%),较常规组显著提高(P＜0.05).卡维地洛组与常规组治疗前后,心率、血压、左室舒张末期直径、左室收缩末期直径、左室射血分数、心输出量、E/A、等容舒张期时间均有显著改善(卡维地洛组P＜0.01,常规组P＜0.05),且卡维地洛组上述指标改善更明显(P＜0.01或P＜0.05).结论:卡维地洛显著改善高血压并慢性心力衰竭患者的心功能,是一种安全有效的治疗方法.     

辛伐他汀改善急性心肌梗死后心室重塑与心功能的实验研究

目的:观察辛伐他汀对急性心肌梗死后大鼠心室重塑及心功能的影响,并探讨其可能的机制.方法:结扎大鼠冠状动脉前降支造成心肌梗死模型,给予辛伐他汀干预.8周后,测定心脏重量指数、血流动力学指标、心肌及血液中总-氧化氮合酶(NOS)、诱导型一氧化氮合酶(iNOS)活性,并与假手术组比较.结果:心肌梗死组大鼠右室重量指数(RVWI)、左室重量指数(LVWI)升高(P<0.01),外周动脉压(APS)、舒张压(APD)均降低,心率增快(P<0.01).左室收缩压(LVSP)和心室收缩期室内压上升速率( dp/dtmax),心室舒张期室内压下降速率(-dp/dtmax)下降(P<0.01),左室舒张末压(LVEDP)升高(P<0.01).血清和心肌NOS、iNOS活性下降(P<0.01).辛伐他汀干预组较心肌梗死组(M组)RVWI、LVWI下降(P<0.01),APS、APD、LVSP、 dp/dtmax、-dp/dtmax均回升(P<0.01),LVEDP回落(P＜0.01);血清和心肌NOS、iNOS活性升高.结论:辛伐他汀减轻左室重塑,改善心功能.     

卡维地洛与美托洛尔对慢性心力衰竭患者长期疗效比较

目的:观察两种β受体阻滞剂卡维地洛与美托洛尔对慢性充血性心力衰竭(CHF)的长期疗效.方法:慢性充血性心力衰竭患者65例,随机分为卡维地洛组32例,美托洛尔组33例,随访6个月,比较两组的心功能改善情况.结果:卡维地洛组及美托洛尔用药后两组患者左心室舒张末期内径(LVEDd)、左心室收缩期内径(LVEDs)、右心室内径(RVD)、左心房内径(LAD)显著缩小(均为P＜0.01);左心室射血分数(LVEF)显著增加(卡维地洛组P＜0.01,美托洛尔组P＜0.05),且卡维地洛对LVEDs、RVD、LVEF的改善作用更优于美托洛尔(LVEDs、RVD均为P＜0.01,LVEF为P＜0.05).结论:卡维地洛及美托洛尔均能明显改善心功能,提高生活质量,且卡维地洛疗效优于美托洛尔.     

卡维地洛对糖尿病伴急性心肌梗死患者心功能不全的疗效观察

目的 评价卡维地洛治疗糖尿病伴心肌梗死患者心功能不全的疗效和安全性.方法 将66例糖尿病心肌梗死合并心力衰竭的患者,随机分为卡维地洛组和对照组,在同对照组一样控制血糖,治疗心肌梗死合并心功能不全,卡维地洛组在治疗组的标准用药基础上从小剂量开始用卡维地洛,逐步增加至目标剂量进行治疗,测定两组治疗前、后临床心功能分级、血压、心率、左心室功能及肾功能和血糖、血脂水平.结果 两组治疗后左室舒张末期内径(LVEDd)、左室收缩末期内径(LVEDs)均减小(P＜0.05),左心室射血分数(LVEF)及心输出量(CO),短轴缩短率(FS)均有提高(P＜0.05或P＜0.01),但舒张功能均无改善(P＞0.05).结论 卡维地洛治疗糖尿病伴心肌梗死患者心功能不全安全、有效,同时能改善糖代谢和肾功能.     

卡维地洛对老年充血性心力衰竭患者心功能和细胞因子的影响

目的:观察卡维地洛对老年充血性心力衰竭(CHF)患者心功能的改善和对细胞因子的影响.方法:老年CHF患者45例随机分为心力衰竭常规治疗组(n=22)和卡维地洛治疗组(n=23),后者在常规抗心力衰竭治疗基础上加用卡维地洛,疗程6个月.两组治疗前和治疗3个月、6个月分别测定左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)和6 min步行距离.测定健康对照组(n=30)和两组心衰患者治疗前和治疗6个月血浆肿瘤坏死因子(TNF-α)、白细胞介素(IL)-1β和IL-6的浓度.结果:老年CHF患者用卡维地洛治疗6个月后,LVEDD、LVESD、LVEF和6min步行距离的改善均优于常规治疗组(P＜0.01,P＜0.05).心衰患者3种细胞因子血浆浓度均高于对照组(P＜0.001),卡维地洛治疗后细胞因子的下降明显优于常规抗心力衰竭治疗(P＜0.01).结论:卡维地洛可明显改善老年CHF患者心功能,提高运动耐量,改善左室重构,降低细胞因子TNF、IL-1和IL-6的浓度.     

重组人脑利钠肽联合硝酸甘油对慢性心力衰竭患者心室重构及心功能的影响

目的探讨重组人脑利钠肽联合硝酸甘油对慢性心力衰竭患者心室重构及心功能的影响。方法将2016年5月至2018年2月收治的98例慢性心力衰竭患者,按随机双盲法分为对照组49例及观察组49例。对照组给予硝酸甘油治疗,观察组在此基础上给予重组人脑利钠肽治疗。比较两组患者心室重构指标及心功能指标。结果治疗后4周,两组左室舒张末期内径(LVEDD)、左室间隔厚度(IVST)及左室质量指数(LVMI)均升高(P<0.05),但观察组上述指标低于对照组,差异有统计学意义(P<0.01);治疗后4周,两组左室内径缩短率(LVFS)、左室射血分数(LVEF)、左室舒张时间(IVRT)均升高(P<0.05),且观察组高于对照组,差异有统计学意义(P<0.01)。结论重组人脑利钠肽联合硝酸甘油治疗慢性心力衰竭,能够有效抑制心室重构,改善患者心脏舒缩功能,值得临床推广。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.