扩张型心肌病伴心力衰竭患者肝细胞生长因子与心功能的相关性研究

目的 探讨扩张型心肌病伴心力衰竭患者血清肝细胞生长因子（HGF）浓度与心功能分级的关系.方法 纳入2011年至2013年扩张型心肌病伴心力衰竭患者63例作实验组,进一步按照NYHA心功能分级分为Ⅰ级组（n=15）、Ⅱ级组（n=16）、Ⅲ级组（n=15）和Ⅳ级组（n=17）,纳入同期健康志愿者32例作对照组.采用酶联免疫吸附法（ELISA）测定HGF浓度,电化学发光法测定血清N端脑钠肽前体（NT-proBNP）浓度,行心脏超声检查左心室舒张末期内径（LVEDD）和左心室射血分数（LVEF）,并采用线性回归分析血清HGF浓度和上述指标的相关性.结果 实验组各亚组的HGF浓度、NT-proBNP浓度、LVEDD值均高于对照组,差异有统计学意义（P＜0.05）,且心力衰竭程度越重,上述指标值越高,各组两两之间均存在统计学差异（P＜0.05）;实验组各亚组LVEF值均低于对照组,差异有统计学意义（P＜0.05）;血清HGF浓度与NT-proBNP浓度和LVEDD均呈正相关,相关系数分别为0.79和0.73,与LVEF值负相关,相关系数为-0.69（P均＜0.05）.结论 扩张型心肌病伴心功能不全患者血清HGF浓度和心功能不全的严重程度相关,对判断心功能不全严重程度有帮助.     

扩张型心肌病伴心衰患者肝细胞生长因子浓度与心功能的关系

目的探讨扩张型心肌病伴心衰患者血清肝细胞生长因子（HGF）浓度与心功能的关系。方法检测试验组扩张型心肌病伴心功能不全患者（NYHA心功能Ⅰ级15例、Ⅱ级16例、Ⅲ级15例、Ⅳ级17例）和26名健康对照者血清HGF浓度、NT—proBNP浓度、LVEDD值和LVEF值,比较各组各项指标的差异;同时探讨血清HGF浓度和上述指标的相关性。结果HGF浓度、NT—proBNP浓度、LVEDD值和LVEF值对照组分别为（323±29）pg／ml、（251±102）pg／ml、（42±7）mm和（57±11）％;NYHA心功能Ⅰ级组分别为（492±47）pg／ml、（973±112）pg／ml、（50±6）mm和（50±7）％;NYHA心功能Ⅱ级组分别为（607±68）pg／ml、（1229±214）pg／ml、（54±9）mm和（48±9）％;NYHA心功能Ⅲ级组分别为（662±94）pg／ml、（4208±1562）pg／ml、（59±16）mm和（42±7）％;NYHA心功能Ⅳ级组分别为（1028±135）pg／ml、（6963±2129）pg／ml、（66±19）mm和（38±6）％,各组间比较差异均有统计学意义（P〈0．05）.血清HGF浓度和NT—proBNP浓度呈正相关,相关系数为0．79;血清HGF浓度和LVEDD值呈正相关,相关系数为0．73;血清HGF浓度和LVEF值呈负相关,相关系数为-0．69。结论扩张型心肌病伴心功能不全患者血清HGF浓度和心功能不全的严重程度有关,可以作为心功能不全严重程度的预测因子。     

卡维地洛治疗扩张型心肌病严重心力衰竭

目的探讨卡维地洛在扩张型心肌病合并心力衰竭治疗中的应用。方法扩张型心肌病慢性心力衰竭58例,随机分为对照组及治疗组,对照组29例行常规强心、利尿、扩血管治疗,治疗组29例在常规治疗基础上加用卡维地洛,治疗12个月,观察心功能改善、病死率、心力衰竭恶化住院率。结果两组心功能均明显改善,左心室收缩末期容量、左心室舒张末内径、舒张末室间隔厚度、左心室后壁厚度明显缩小,左心室射血分数增大。对照组和卡维地洛组在治疗的改善情况1个月分别为11/29和11/29;6个月为15/29和17/29,12个月为18/29和24/29。结论在常规心力衰竭治疗基础上加用卡维地洛可明显改善扩张型心肌病合并心力衰竭患者的心功能,减少病死及心力衰竭恶化住院病例。     

中青年扩张型心肌病伴心力衰竭患者心功能的临床研究

目的探讨青年人扩张型心肌病伴或不伴心力衰竭与心脏功能关系及临床意义。方法对我院扩张型心肌病伴有心力衰竭患者65例（心力衰竭组）和不伴有心力衰竭患者58例（非心力衰竭组）给予超声心动图、心电图检查。比较两组心脏的大小、功能以及发生心律失常的情况。结果①心力衰竭组的左心室收缩末内径（LVESd）、左心室舒张末内径（LVEDd）、左心房内径（LAD）、左心室射血分数（LVEF）,左心室短轴缩短分数（LVFS）与非心力衰竭组比较,差异有统计学意义（P〈0.01）。②心力衰竭组在心电图上的QRS时限、肢导低电压、异常Q波、ST-T改变的比例略高于非心力衰竭组,差异无统计学意义（P〉0.05）。心力衰竭组的房性心律失常、室性心律失常和传导阻滞发生率与非心力衰竭组比较,差异有统计学意义（P〈0.01）。③心力衰竭组患者入院时心脏功能Ⅲ级、Ⅳ级分别占58.4%、21.5%。两组经住院治疗后,心脏功能较入院时明显改善（P〈0.05）。结论扩张型心肌病伴心力衰竭、心律失常时,LVEDd明显增大,LVEF显著降低,并与心脏功能有一定的相关性。早期诊断和治疗,除去心力衰竭诱发因素,能够改善心脏功能,提高患者的生活质量,改善预后。     

卡维地洛治疗扩张型心肌病心力衰竭患者的疗效

目的：观察卡维地洛治疗扩张型心肌病心力衰竭患者的临床疗效。方法：选择扩张型心肌病心力衰竭患者82例,采用随机分组的方法分为卡维地洛组（42例）和常规治疗组（40例）,卡维地洛组在常规治疗基础上加用卡维地洛3．125～25mg2次／d。比较两组左室舒张期末内径（LVEDd）、左室收缩期末内径（LVEsd）、左房内径（LAD）、左室射血分数（LVEF）、6min步行距离（6MWD）等指标变化情况。结果：治疗6个月后,两组患者心功能均有改善,卡维地洛组总有效率显著高于常规治疗组（90．5％比72．5％,P〈0．05）;两组治疗后患者的LVEDd、LVESd、LVEF及6MWD均有显著改善（P〈0．05）,且与常规治疗组比较,卡维地洛组治疗后患者的LVEDd[（59．1±9．6）mm比（54．2±10．2）mm]、LVESd[（46．1±8．7）mm比（41．4±12．2）mm]显著缩小,LVEF[（42．1±10．5）％比（48．4±9．6）％]及6MWD[（264．52±51．23）m比（309．26±45．24）m]显著增加（P均〈0．05）。结论：在常规治疗基础上加用卡维地洛可明显改善扩张型心肌病心力衰竭患者的疗效。     

卡维地洛治疗扩张型心肌病心力衰竭的疗效

扩张型心肌病（DCM）主要特征是单侧或双侧心脏扩大，心肌收缩功能减退，常发生心力衰竭（HF）。本文旨在探讨新一代β受体阻滞剂卡维地洛对DCM并发HF的临床疗效。     

米力农治疗扩张型心肌病心力衰竭的疗效观察

目的观察米力农注射液静脉滴注治疗扩张型心肌病心力衰竭的疗效。方法回顾性分析50例扩张型心肌病心力衰竭的治疗,其中治疗组25例,用米力农注射液静脉滴注强心治疗,配合利尿、扩血管药物治疗;对照组25例,予洋地黄类药物强心治疗,配合利尿、扩血管药物治疗。结果治疗组总有效率88%,对照组总有效率60%,χ2=5.093,P<0.05。结论米力农是磷酸二酯酶抑制剂,治疗扩张型心肌病心力衰竭疗效显著,是一种较好的强心药物。     

美托洛尔治疗扩张型心肌病心力衰竭的临床观察

我们6年来应用倍他乐克(美托洛尔,Metoprolol)治疗扩张型心肌病(DCM)心力衰竭26例,取得较为满意的疗效,报道如下:资料与方法病例选择　收集1991年以来DCM患者46例,随机分成两组:观察组26例(男14,女12),年龄35～66岁。对照组20例(男13,女7),年龄37～62岁。46例均按WHO/ISFC1980年诊断标准确诊,均有充血性心力衰竭(CHF)。心功能NYHA分级:观察组级5例,级12例,级9例;对照组级5例,级11例,级4例。观察组患者均无窦性心动过缓、度以上房室传导阻滞、低血压等倍他乐克治疗禁忌证。全部病例在治疗前后进行了心电图、胸片、心脏超声等检查。…     

倍他乐克治疗扩张型心肌病心力衰竭的临床观察

扩张型心肌病是一种原因不明的心肌疾病 ,以左心室或双心室扩张并伴收缩功能受损为特征 ,常表现为进行性心力衰竭 ,心律失常 ,血栓栓塞 ,猝死 ,预后差。我们 5年来应用倍他乐克( Betaloc)治疗扩张型心肌病 ( DCM)心力衰竭 32例 ,取得较为满意疗效 ,现报道如下 :1　资料与方法1 .1　观察对象 :选择我院 1 995年 1月至 2 0 0 0年2月住院扩张型心肌病患者 (排除低血压 ,窦性心动过缓 ,房室传导阻滞 ,合并支气管哮喘及不能忍受 β受体阻滞剂治疗者。) 5 0例 ,心功能按NYHA (纽约心脏病协会 )分级为 — 级并射血分数 ( LVEF) <0 .4。年龄 …     

卡维地洛治疗扩张型心肌病心力衰竭疗效观察

目的　评价第三代 β受体阻滞剂卡维地洛治疗扩张型心肌病 (DCM)心力衰竭的临床疗效。方法　 6 2例 DCM心力衰竭患者在接受常规治疗 (洋地黄、利尿剂、血管紧张素转换酶抑制剂 )病情稳定后 ,随机分为卡维地洛组和美多心安组。均从小剂量 (卡维地洛组 ,2 .5 m g bid;美多心安组 ,6 .2 5 m g bid)缓慢递增。检测治疗前后 DCM患者左心室功能和结构的变化以及血液中内皮素 - 1(ET- 1)、心钠素 (ANP)和血管紧张素 (Ang )的改变。结果　治疗 6个月后 ,两组心脏功能分级均明显改善 ,左心室射血分数 (L VEF)、短轴缩短率 (FS)、左心室射血前期与射血时间比(PEP/ L VET)、舒张早期峰值血流速度 (PFVE)、舒张早期峰值血流速度与舒张晚期峰值血流速度比 (PFVE/ PF-VA)均明显增加 ,卡维地洛组较美多心安组 L VEF增加更为明显。两组左心房内径 (L AD)、左心室收缩末期内径(L VSD)、左心室舒张末期内径 (L VDD)明显减小 ,卡维地洛组 L VSD减小较美多心安组更明显。治疗后血浆中ET- 1、ANP和 Ang 均明显降低。结论　卡维地洛和美多心安都能够改善 DCM心力衰竭患者左心室收缩和舒张功能 ,逆转左心室重构 ,卡维地洛较美多心安疗效更佳。     

Prognostic Significance of Circulating Levels of Hepatocyte Growth Factor in Patients with Chagas' Disease and Idiopathic Dilated Cardiomyopathy

Objectives: Hepatocyte growth factor (HGF) plays an important role in the improvement in cardiac function and remodeling in a variety of cardiovascular diseases. It is also a strong predictor of mortality in some heart failure (HF) patients. However, its prognostic value in patients with Chagas' disease (CD) or idiopathic dilated cardiomyopathy (DCM) remains to be investigated. Methods and Results: In this prospective cohort study, HGF concentrations were measured in patients with CD (n = 91), DCM (n = 47), and control subjects (n = 25). While no difference was detected for patients with New York Heart Association class I-II, HGF was significantly increased in advanced HF patients (New York Heart Association class III-IV) in both CD and DCM groups, compared with healthy subjects. There was a strong correlation between HGF and left ventricular ejection fraction in CD patients. However, there was no correlation in patients with DCM. Despite its strong correlation with left ventricular ejection fraction in CD patients, HGF failed to predict mortality and necessity for heart transplant in both CD and DCM patients. Conclusions: Although HGF can be significantly increased in advanced HF patients with CD and DCM, its prognostic value for endpoints is minor. Therefore, the formerly described predictive power for HGF in HF might be restricted to specific etiologies of HF.     

参麦注射液治疗扩张型心肌病心力衰竭疗效观察

目的观察参麦注射液治疗扩张型心肌病心力衰竭的疗效。方法选择扩张型心肌病心力衰竭患者80例,分为对照组和治疗组。对照组给予常规药物治疗,治疗组在常规药物治疗基础上加用参麦注射液。结果两组治疗后较治疗前临床症状以及心脏彩超各参数(射血分数、左室内径)以及6min步行试验均有改善。治疗后两组相比差别有统计学意义(P<0.05)。结论参麦注射液可有效治疗扩张型心肌病心力衰竭,安全性较高,无明显不良反应。     

Immunoadsorption Therapy for Patients with Dilated Cardiomyopathy and Heart Failure

Several autoantibodies directed against cardiac cellular proteins including G-protein-linked receptors, contractile proteins and mitochondrial proteins, have been identified in patients with dilated cardiomyopathy (DCM). Among these autoantibodies, anti-β1-adrenoreceptor (AR) antibodies have long been discussed in terms of their pathogenetic role in DCM. Anti-β1-AR antibody-positive patients with DCM showed significant deterioration of NYHA functional class as well as reduced cardiac function compared to those in autoantibody-negative patients. Various studies with a limited number of patients indicate that the use of immunoadsorption to eliminate immunoglobulin G (IgG) significantly improves cardiac performance and clinical status in heart failure patients. Since removal of autoantibodies of the IgG3 subclass induces hemodynamic improvement and an increase in the left ventricular ejection fraction, antibodies belonging to IgG3 such as anti-β1-AR antibodies might play an important role in reducing cardiac function in patients with DCM. According to a recent report, however, the effect of hemodynamic improvement by immunoadsorption threapy was similar among patients who were positive and negative for anti-β1-AR antibodies, indicating that the beneficial effects of immunoadsorption might be not directly associated with the selective elimination of the β1-AR autoantibodies. Immunoadsorption therapy is a new therapeutic option for patients with DCM and heart failure, but further investigations are required to elucidate the specific antigens of cardiac autoantibodies responsible for the hemodynamic effects.Key Words: Cardiomyopathy, adrenoreceptor, autoantibody, immunoadsorption, heart failure.     

肝细胞生长因子在心力衰竭中的研究进展

肝细胞生长因子具有潜在的多种生物学活性,包括致有丝分裂作用、形态形成作用、造血作用、心肌肥大、血管生成、抗凋亡、抗纤维化及组织再生作用。这将对心力衰竭产生保护作用。现就其在心力衰竭中作用及其机制进行探讨。     

左心室重构对扩张型心肌病心力衰竭近期死亡的意义

目的:研究左心室重构指标对扩张型心肌病心力衰竭近期死亡的估测价值.方法:随机选取扩张型心肌病心力衰竭患者103例,于入选当时行常规经胸心脏彩色多普勒超声心动图检查,测量左心房内径(LADs),左心室内径,左心室射血分数,球形指数等指标.所有患者随访1～12个月,平均(6.57±3.53)个月,记录死亡事件(死亡者为死亡组)及存活时间(存活者为存活组).对比死亡与存活者上述各指标的差异,并采取相关分析和多因素分析法筛选与近期死亡密切相关的指标.结果:在随访过程中,死亡21例,其中死于心力衰竭者17例.死亡组的患者其左心房收缩末期内径及左心室舒张末期内径明显扩大,球形指数-1显著大于存活组,有显著性差异(P＜0.05),同时收缩功能障碍和心功能分级也明显重于存活组.经Cox多因素回归分析,与生存时间相关的指标只有心功能分级(B＝0.833,P=0.024),LADs(B＝0.073,p=0.028)和球形指数-1 (B＝1.401,p=0.028),其中球形指数-1的相关性最大.结论:心功能分级、左心房收缩末期内径及左心室球形指数-1对扩张型心肌病心力衰竭的近期死亡有重要预测价值,其中评价左心室形态的球形指数-1价值最大,而衡量左心室大小及收缩功能的指标对近期死亡并无影响.     

扩张性心肌病并心力衰竭患者双室同步起搏治疗对心率变异性的影响

观察双室同步起搏对扩张性心肌病并心力衰竭 (简称心衰 )患者心功能及心率变异性 (HRV)的影响。选择1 5例扩张性心肌病并顽固心衰患者 ,置入双室起搏器 ,观察心功能、HRV及血浆丙二醛、一氧化氮、内皮素 1、血管紧张素 Ⅱ的变化。结果 :心功能NYHA分级从术前 3.32± 0 .31级提高为 2 .1 8± 0 .33级 ,左室射血分数由 0 .2 9± 0 .0 3增至 0 .36± 0 .0 3(P <0 .0 5 ) ;2 4h正常RR间期均值标准差、相邻RR间期差值均方根、相邻RR间期差值 >5 0ms占正常RR间期数的百分比、总功率、低频及高频波段功率分别由 73± 8.1ms、4 1± 8.0ms2 、5 .3%± 1 .5 %、1 0 2 4± 4 1 3ms2 、1 1 5± 35ms2 及 4 8± 1 5ms2 增至 1 0 7± 1 3ms、70± 1 1ms2 、1 1 .3%± 3.4 %、1 92 1± 4 84ms2 、1 94± 35ms2 及 91± 2 9ms2 (P均 <0 .0 1 ) ;血浆丙二醛、内皮素 1分别由 4 31± 37nmol/L、83.1± 2 1ng/L降至 32 3± 2 9nmol/L、6 7.3± 1 6ng/L ,一氧化氮由 38.1± 7.6 μmol/L增至 5 1 .3± 9.2 μmol/L(P均 <0 .0 1 ) ,血管紧张素 Ⅱ无变化 (P >0 .0 5 )。结论 :同步起搏改善扩张性心肌病心衰患者心功能及HRV。     

InSync 8040起搏器在充血性心力衰竭治疗中的初步应用

观察InSync 80 40起搏器治疗扩张型心肌病 (DCM)伴充血性心力衰竭 (CHF)的疗效。 8例DCM伴CHF患者 ,男 7例、女 1例。其中伴完全性左束支阻滞 6例 ,左前分支阻滞、右室起搏后宽QRS波 (>0 .2 0s)各 1例。通过冠状静脉窦置入 2 187电极起搏左室 ,右房电极和左、右室电极分别与InSync 80 40起搏器A、V1、V2 孔相连接。术后起搏阈值 3.75± 0 .6 (3.0～ 5 .0 )V。患者CHF的症状明显改善 ,术后左室舒张末径、左室射血分数、左室短轴缩短率、心胸比例较术前均有改善 (分别为 6 6 .1± 6 .93mmvs 72 .5± 8.1mm、0 .374± 0 .0 31vs 0 .2 81± 0 .0 5 3、19.8%± 2 .2 %vs12 .2 %± 2 .7%、0 .5 9± 0 .4vs 0 .6 4± 0 .2 0 ;P均 <0 .0 5 )。结论 :初步临床应用表明 ,以InSync 80 40起搏器行双心室同步起搏治疗CHF疗效肯定     

Physical Exercise in Patients with Heart Failure Due to Myocarditis and Dilated Cardiomyopathy

BACKGROUND: Sudden cardiac death of suspected healthy young athletes is a rare, but deeply moving event. Usually, the affected person has been completely free of symptoms. Commonly, unrecognized inflammatory, hypertrophic or dilated cardiomyopathies are the most frequent causes. All therapeutic principles of angiotensin-converting-enzyme (ACE) inhibition, beta-blockade, and diuretics in heart failure aim to unload the heart. During physical activity increased sympathetic tonus and loading conditions for the heart point into the opposite direction. This raises the question to what extent physical activity in patients with myocarditis, dilated cardiomyopathy or heart failure in general is tolerable. SYNOPSIS: Several experimental studies revealed disadvantages of physical exercise during acute myocarditis leading to an increase in mortality. On the other hand, several small trials in men demonstrate an improvement of physical fitness and quality of life attributed to controlled supervised exercise training in patients with heart failure without assessment of mortality. Dilated cardiomyopathy was diagnosed in one third of these patients. There was no biopsy confirmation of these conditions. The other two thirds of patients suffered from ischemic heart diseases. CONCLUSION: Since the borderline between inflammatory heart disease and noninflammatory or postinflammatory dilated cardiomyopathy is difficult to determine, abstention from physical training during and shortly after inflammatory heart disease is recommended, because it is known that viral persistence or autoimmune processes could last for several months.     

Changes of Plasma Levels of Brain Natriuretic Peptide in Patients With Chronic Heart Failure before and after Carvedilol Treatment

To investigate the changes of plasma brain natriuretic peptide (BNP) concentrations in patients with chronic heart failure (CHF) before and after carvedilol treatment. Methods Plasma BNP concentrations of patients with CHF (n=56) before and after carvedilol treatment and of normal controls (n=60) were measured with specific radioimmunoassay. Left ventricular ejection fraction of patients with CHF before and after carvedilol was measured with 99mTc gated cardiac blood pool scintigraphy. Results The results showed that plasma BNP concentrations of patients with CHF were significantly higher than that of normal controls [(222.65±78.52) ng·L-1 vs. (38.82±15.31) ng·L-1, P<0.01]. Plasma BNP concentrations had a significant negative correlation with left ventricular ejection fractions (r=-0.68,P<0.01). After three months treatment of carvedilol, plasma BNP concentrations fell to (79.65±69.52) ng·L-1(P<0.01), left ventricular ejection fractions increase from 34.41%±4.54% to 46.51%±5.38%(P<0.01). Conclusions These results indicate that plasma BNP concentrations are increased in patients with CHF, and markedly increased according to the severity of heart failure classified by NYHA classification. Carvedilol can markedly decrease plasma BNP concentrations and improve left ventricular function in patients with CHD.     

Changes of Plasma Levels of Brain With Chronic Heart Failure before Natriuretic Peptide in Patients and after Carvedilol Treatment

Objectives To investigate the changes of plasma brain natriuretic peptide （BNP） concentrations in patients with chronic heart failure （CHF） before and after carvedilol treatment. Methods Plasma BNP concentrations of patients with CHF （n = 56） before and after carvedilol treatment and of normal controls （n = 60） were measured with specific radioimmunoassay. Left ventricular ejection fraction of patients with CHF before and after carvedilol was measured with 99mTc gated cardiac blood pool scintigraphy. Results The results showed that plasma BNP concentrations of patients with CHF were significantly higher than that of normal controls [ （222. 65 ± 78.52） ng·L^-1 vs. （38.82 ± 15.31 ） ng·L^-1 , P 〈 0. 01 1. Plasma BNP concentrations had a significant negative correlation with left ventricular ejection fractions （r=-0. 68 ,P 〈 0. 01 ）. After three months treatment of carvedilol, plasma BNP concentrations fell to （79. 65 ±69.52 ）ng·L^-1 （P 〈 0. 01 ）, left ventricular ejection fractions increase from 34. 41% ± 4. 54% to 46. 51% ± 5.38 % （P 〈 0. 01 ）. Conclusions These results indicate that plasma BNP concentrations are increased in patients with CHF, and markedly increased according to the severity of heart failure classified by NYHA classification. Carvedilol can markedly decrease plasma BNP concentrations and improve left ventricular function in patients with CHD.