基质金属蛋白酶与心肌间质重构

在心力衰竭的进展过程中，心室重构起主要作用。心室重构包括心肌实质重构和心肌间质重构，心肌间质重构是指成纤维细胞增生、纤维化以及细胞外基质胶原网的量和组成的变化。基质金属蛋白酶（MMPs）是一种能特异地降解细胞外基质成分的Zn^2 依赖的酶家族，心肌中的MMPs能够降解心脏中所有的基质成分，是心肌间质重构中基质降解的推动力量。MMPs的表达与活性受到肿瘤坏死因子-α、白介素－1β、血管紧张素Ⅱ、内皮素以及金属蛋白酶组织型抑制物等因子的调控。通过直接或间接的方法调节MMPs的活性，可以改变心肌间质重构过程，从而最终改变心力衰竭的进程。     

心肌纤维化的研究进展

心肌纤维化是指在心肌的正常组织结构中胶原纤维过量积聚、心脏组织中胶原浓度显著升高或胶原成分发生改变。这种病理变化在多种心血管疾病中存在 ,现认为其与心律失常、心功能障碍甚至心脏性猝死密切相关。近年来人们在这方面进行了很多研究 ,取得了系列成果 ,现综述如下。1　心肌纤维化的分类、特点以及评估方法心肌纤维化是一种连续变化的过程 ,根据有无心肌细胞缺失、坏死和瘢痕形成可分为反应性纤维化和修复性纤维化 ,前者根据病变特点又分为间质纤维化和血管周围纤维化 ;后者主要表现为心肌细胞坏死和瘢痕形成 ,并可有心脏功能的异常…     

GATA4对心脏结构影响研究进展

正心脏结构改变是多种心脏疾病发生的病理学基础,心肌肥大、心肌纤维化是心脏重构的危险因素。心肌细胞中的基因表达受各种核的调节转录因子,共同激活或抑制的相互作用。锌指蛋白GATA4是一种参与心肌肥大、心肌纤维化的核转录因子,响应于诸如涉及交感神经和肾素-血管紧张素系统的肥大刺激,同时增加氧化应激、促进炎症导致心肌纤维化,从而影响心脏的结构改变,增加心脏重构     

心肌成纤维细胞转分化与糖尿病心肌病的研究进展

糖尿病心肌病是一种以心肌结构和功能重构为特征的特异性心肌病,其发生不依赖于高血压、冠状动脉病变和其他心脏疾病。心肌纤维化是糖尿病心肌病发展末期的病理特征之一,是预后不良的有力证据。其中,心肌成纤维细胞转分化在糖尿病心肌病的心肌纤维化发展过程中可能起关键作用。心肌成纤维细胞转分化涉及多种复杂的纤维生成途径,共同激活成纤维细胞从而促进心肌纤维化。目前,心肌成纤维细胞转分化在糖尿病心肌病中的发生机制尚未被广泛认知,该文重点叙述了糖尿病心肌病心肌纤维化发展过程中心肌成纤维细胞转分化的分子机制。     

心肌纤维化在心力衰竭中的临床意义

心肌组织包括心肌细胞及间质两部分，心肌重构时，除心肌细胞发生改变外(表型变化，体积增大，收缩蛋白类型改变)，心肌间质亦增殖，其结果产生大量的胶原，使心肌结构紊乱，加重心功能不全，目前已认识到心肌间质(ECM)纤维化是心室舒张功能不全的重要原因，另一方面因冠状动脉血管壁周围纤维增生和管壁增厚，使冠状循环储备和供血降低，进而促使心肌细胞的死亡和纤维化，是难治性心衰的组织病理基础，故防止ECM增生和改建，已是临床防治心衰的重要措施。     

扩张型心肌病心脏移植受者心脏病理学观察及微血管内皮细胞的表达及分布

目的:观察扩张型心肌病(DCM)心脏移植受者心脏病理学特点及微血管内皮细胞的表达及分布,初步探讨内皮细胞与心肌纤维化的作用。方法:以2012年1月至2017年6月期间,本院收治的10例因DCM终末期行心脏移植患者的受者心脏作为研究对象。对照组采用来自法医鉴定中心的非疾病死亡的正常成年人尸检心脏标本6例。采用HE染色、Masson三色组织化学染色观察DCM病理学改变,采用免疫组织化学方法检测CD34和α-SMA,观察微血管内皮细胞在DCM患者心肌组织中的表达。结果:(1)光镜下,终末期DCM的主要病理改变是心肌细胞退行性变,心肌间质纤维化;(2)通过透射电镜观察发现终,末期DCM主要改变是心肌退行性变,心肌肌原纤维Z线排列不规则,部分心肌细胞核肥大,心肌肌原纤维灶性溶解,心肌间质水肿,线粒体增多,线粒体肿胀空泡化,可见髓鞘样结构,心肌间质毛细血管内皮细胞胞质肿胀,细胞连接消失,吞饮小泡减少;(3)两组心肌组织中均有微血管内皮细胞分布,DCM中CD34表达明显低于对照组,α-SMA的表达明显高于对照组。结论:DCM中血管内皮细胞的超微结构变化,可能导致其功能改变,内皮细胞可能通过内皮间质细胞转化参与了DCM中心肌纤维化。     

心肌梗死后心脏修复与心肌细胞再生的研究进展

心肌梗死后组织缺血缺氧,坏死,导致一个多相的修复过程,受损的组织由成纤维细胞和肌成纤维细胞产生纤维瘢痕所取代。非梗死的心室壁反应性重塑,包括间质和血管周围纤维化,导致心室壁几何、生物力学、生化等发生改变。虽然最初的修复性纤维化对防止心室壁破裂至关重要,但是过度的纤维化反应导致心功能进行性损害,最终导致心功能衰竭。近年来研究表明,心脏具有可塑性,恢复受损心脏功能,促进梗死心肌修复是心血管疾病治疗的重要目标。为此,人们不断探索新的治疗手段,再生治疗给心肌梗死治疗带来了新的希望,本文对目前心肌梗死的修复性及反应心肌纤维化的机制进行总结,探讨诱导成纤维细胞和肌成纤维细胞转化为心肌细胞,以及心肌细胞再生的潜力,对目前现有和未来抑制心肌纤维化治疗策略进行综述。     

卡托普利对自发性高血压大鼠心肌肥厚和心肌纤维化的效应（摘要）

卡托普利对自发性高血压大鼠心肌肥厚和心肌纤维化的效应（摘要）陈义汉龚兰生最近，一些学者认为高血压左室肥厚向心力衰竭发展的决定因素是心肌胶原的过度沉积，即心肌纤维化，而不是心肌细胞本身，故防止或逆转心肌纤维化可能有助于维护心脏功能。本实验探讨卡托普利（...     

他汀类药物对心脏胶原的影响及其抗纤维化作用

心脏功能不仅取决于心肌细胞本身的舒缩功能，同时还取决于细胞外基质成分，特别是心肌胶原纤维，其不仅具有支持和连接作用，而且在协调心肌力的传递、信息的传导、营养物质的输送等方面具有重要作用。心肌胶原网络的异常将影响心脏的收缩、舒张功能和正常心肌的电生理，还能导致心力衰竭的发生。心肌纤维化是众多心血管疾病的终末期改变，而心脏胶原的异常是心肌纤维化形成的基础，故抑制心脏胶原的增生，逆转心肌纤维化成为改善心血管疾病预后的关键。他汀类药物不仅可以明显改善血脂水平，而且可以通过多种途径和机制来抑制心脏胶原增生和逆转心肌纤维化。已有证据表明他汀类药物可以逆转心肌纤维化。     

骨桥蛋白与心肌纤维化关系的研究进展

<正>心肌纤维化(myocardial fibrosis,MF)是指心脏细胞外基质(extracellular matrix,ECM)中胶原纤维过量积聚,胶原浓度显著升高或胶原成分发生改变。ECM作为心肌细胞骨架能感应和传递各种刺激信号,参与心肌损伤修复和重构。作为ECM非结构蛋白一员的骨桥蛋白是公认的促纤维化因子。近年来,大量临床试验和基因改造动物实验为骨桥蛋白在MF中的作用提供了新证据。本文综述了骨桥蛋白与MF     

La fibrosis intersticial miocárdica en la era de la medicina de precisión. El fenotipado basado en biomarcadores para un tratamiento personalizado

Myocardial interstitial fibrosis is a constant pathological finding in structural heart diseases of various etiologies that evolve with heart failure. Although fibrosis facilitates heart failure progression, until now no therapeutic strategy has been developed that ensures its reversal. A possible explanation for this may lie in the vision of myocardial interstitial fibrosis as a homogeneous lesion instead of a heterogeneous lesion in which different phenotypes can be distinguished using appropriate criteria. In addition, the notion that the heterogeneity of myocardial interstitial fibrosis may be cardiac disease-specific must be also considered when approaching this entity. Therefore, we propose that myocardial interstitial fibrosis represents a true challenge for transitioning from usual care to biomarker-based personalized treatment and precision medicine in heart failure. As a proof-of-concept, in this review we discuss the phenotyping of myocardial interstitial fibrosis in patients with heart failure attributable to hypertensive heart disease based on its histomolecular alterations and provide evidence of the prognostic relevance of the resulting stratification. Furthermore, we discuss the available information on some circulating biomarkers and certain pharmacological agents useful for noninvasive identification and personalized treatment, respectively, of those phenotypes.     

心血管疾病中心肌纤维化与自噬的相关性研究进展

心肌纤维化是由多种病理因素导致心脏疾病发展至一定阶段所具有的共同病理改变,是心室重构的主要原因。心肌纤维化与高血压性心脏病、缺血性心肌病、肥厚性心肌病、扩张性心肌病、病毒性心肌炎及糖尿病心肌病等多种心血管疾病密切相关。自噬在心肌细胞的存活及其维持心肌的收缩功能等方面起着重要作用,有研究显示自噬与心肌纤维化存在一定的联系。本文就心肌纤维化的发病机制及自噬在各种心血管疾病中的作用做一综述,旨在为心肌纤维化的防治提供更为特异和有效的作用靶点。     

Current understanding of fibrosis in genetic cardiomyopathies

Myocardial fibrosis is the excessive deposition of extracellular matrix proteins, including collagens, in the heart. In cardiomyopathies, the formation of interstitial fibrosis and/or replacement fibrosis is almost always part of the pathological cardiac remodeling process. Different forms of cardiomyopathies show particular patterns of myocardial fibrosis that can be considered as distinctive hallmarks. Although formation of fibrosis is initially aimed to be a reparative mechanism, in the long term, on-going and excessive myocardial fibrosis may lead to arrhythmias and stiffening of the heart wall and subsequently to diastolic dysfunction. Ultimately, adverse remodeling with progressive myocardial fibrosis can lead to heart failure. Not surprisingly, the presence of fibrosis in cardiomyopathies, even when subtle, has consistently been associated with complications and adverse outcomes. In the last decade, non-invasive in vivo techniques for visualization of myocardial fibrosis have emerged, and have been increasingly used in research and in the clinic. In this review, we will describe the epidemiology, distribution, and role of myocardial fibrosis in genetic cardiomyopathies, including hypertrophic, dilated, arrhythmogenic, and non-compaction cardiomyopathy, and a few specific forms of genetic cardiomyopathies.     

Myocardial fibrosis: biomedical research from bench to bedside

Myocardial fibrosis refers to a variety of quantitative and qualitative changes in the interstitial myocardial collagen network that occur in response to cardiac ischaemic insults, systemic diseases, drugs, or any other harmful stimulus affecting the circulatory system or the heart itself. Myocardial fibrosis alters the architecture of the myocardium, facilitating the development of cardiac dysfunction, also inducing arrhythmias, influencing the clinical course and outcome of heart failure patients. Focusing on myocardial fibrosis may potentially improve patient care through the targeted diagnosis and treatment of emerging fibrotic pathways. The European Commission funded the FIBROTARGETS consortium as a multinational academic and industrial consortium with the primary aim of performing a systematic and collaborative search of targets of myocardial fibrosis, and then translating these mechanisms into individualized diagnostic tools and specific therapeutic pharmacological options for heart failure. This review focuses on those methodological and technological aspects considered and developed by the consortium to facilitate the transfer of the new mechanistic knowledge on myocardial fibrosis into potential biomedical applications.     

Quantitation of fibrosis of the heart in chronic obstructive pulmonary disease with and without cor pulmonale

This study examined the hearts of 55 patients dying of chronic obstructive pulmonary disease, with and without cor pulmonale, quantitated histologically the degree of myocardial fibrosis in the left and right ventricle, and determined the relationship to associated disease states. Comparison has been made to a control group of 17 patients free of cardiopulmonary disease. Patients with associated and advanced ischemic heart disease, as proved by marked atherosclerosis and myocardial infarction, have significantly increased myocardial fibrosis throughout all layers of the left ventricular wall in comparison to control patients or patients with chronic obstructive pulmonary disease free of associated cardiac disease. Right ventricular fibrosis was not significantly increased; however, one case showed a marked degree of fibrosis related to myocardial infarction. Subdivision of patients with chronic obstructive pulmonary disease into groups with definite anatomic right ventricular hypertrophy, a clinical diagnosis of cor pulmonale, or with chronic hypoxemia failed to show any difference in the percentage of myocardial fibrosis of the ventricles among these groups. Increased fibrosis of the right or left ventricle in patients with chronic obstructive pulmonary disease, therefore, is not related to the degree of myocardial hypertrophy pathologically, the hypoxemic state, or clinical heart failure, but to ischemic heart disease with myocardial infarction.     

肠道菌群代谢产物与心肌纤维化关系的研究进展

心肌纤维化(MF)以细胞外基质积聚、成纤维细胞活化、转化为肌成纤维细胞为特征,是心脏损伤后心脏重构的特征之一,MF包括两种基本类型:反应性纤维化和修复性纤维化,在心室重构的过程中,两种纤维化常合并存在,MF可导致充血性心力衰竭、恶性心律失常和猝死,成为心室重构持续发展和难以逆转的重要原因.一些研究表明,肠道菌群代谢产物...     

Morphological features of hypertrophic cardiomyopathy with congestive heart failure and a small left ventricular cavity

To clarify the morphologic basis of marked congestive heart failure in cases of hypertrophic cardiomyopathy with a small left ventricular cavity, the size of myocytes, the extent of myocardial fiber disarray and fibrosis were quantitatively evaluated in two autopsied cases. Compared with the control hypertrophic cardiomyopathy, both cases had larger myocytes and less fibrosis, and one of them had markedly extensive myocardial fiber disarray. Probably, the hypertrophy of the myocytes or myocardial fiber disarray or both rather than myocardial fibrosis are important in the pathogenesis of severe congestive heart failure in these cases.     

聚乙二醇-过氧化氢酶在小鼠心肌肥厚和损伤中的保护作用

目的观察聚乙二醇-过氧化氢酶在异丙肾上腺素所致小鼠心肌肥厚和损伤中的保护作用。方法以异丙肾上腺素建立C57BL/6小鼠心肌肥厚和心肌损伤的模型,通过二氢乙啶染色、蛋白质印迹法、实时定量逆转录聚合酶链反应、Masson Trichrome染色等实验,检测聚乙二醇-过氧化氢酶在异丙肾上腺素所致小鼠心肌肥厚和损伤模型中对氧自由基生成、细胞凋亡、心肌纤维化、超氧化物歧化酶1(SOD-1)表达的影响。结果小鼠异丙肾上腺素皮下注射后,发生心肌肥厚和缺血损伤,心肌组织氧自由基生成明显升高,SOD-1的表达明显降低,心肌细胞凋亡增加,发生心肌纤维化,与对照组对比差异有统计学意义(均为P<0.01);与异丙肾上腺素处理组比较,聚乙二醇-过氧化氢酶(30 000 U.kg-1.d-1)预处理组心肌肥厚改善,氧自由基生成明显降低,SOD-1水平明显提高,细胞凋亡减少,心肌纤维化降低,差异有统计学意义(均为P<0.05)。结论抗氧化剂聚乙二醇-过氧化氢酶可以有效进入心肌组织,抑制氧自由基生成、减少心肌细胞凋亡和心肌纤维化,对异丙肾上腺素诱导的小鼠心肌肥厚和损伤具有保护作用。     

过氧化物酶体增殖物激活受体与心肌纤维化的研究进展

心肌纤维化是冠心病、高血压、心肌病等多种常见心脏疾病向终末期心脏病发展的一个必然过程，如何减缓和逆转纤维化对改善患者的预后，降低死亡率具有重要的意义。过氧化物酶体增殖物激活受体是一类广泛分布于各种组织中的核转录因子，在调节糖脂的再分布等代谢过程中发挥重要作用。其被激活后能够通过影响胶原代谢、RAS系统、细胞因子以及炎症反应等途径减缓心肌纤维化的进展。本文主要讨论了过氧化物酶体增殖物激活受体与心肌纤维化的一些新进展。