华蟾素注射液减轻表柔比星心脏毒性的临床研究

目的观察华蟾素注射液减轻表柔比星化疗引起的心脏毒性作用。方法将常规应用含表柔比星方案化疗的乳腺癌、恶性淋巴瘤患者84例随机分为对照组和治疗组。在化疗的同时,治疗组给予华蟾素注射液每日静脉输注,2周为1疗程,治疗2个疗程;对照组不采取其他治疗。观察化疗前后Karnofsky评分、临床证候、心脏毒副反应、心电图、左室射血分数及心肌酶的变化。结果与对照组相比,治疗组明显改善Karnofsky评分（P〈0.01）,降低表柔比星化疗引起的临床中医证候评分（P〈0.01）;可显著减少心脏毒副反应（P〈0.05）,降低心电图异常改变的发生率（P〈0.05）,提高左室射血分数（P〈0.01）。结论华蟾素注射液可以减少表柔比星化疗引起心脏毒性,改善心功能。     

负载表柔比星壳聚糖微球瘤内注射治疗小鼠肝移植瘤疗效观察

目的观察负载表柔比星的壳聚糖微球瘤内注射治疗荷肝癌小鼠皮下移植瘤的效果。方法采用W/O型乳化—固化法制备表柔比星—壳聚糖微球,扫描电镜观察壳聚糖微球的表面形态、粒径大小。紫外分光光度计分析载药微球的包封率、载药量及药物累积释放率。将18只H22皮下肝癌荷瘤小鼠分成3组,分给予以下治疗：瘤内注射生理盐水、瘤内注射表柔比星、瘤内注射载药微球,监测荷瘤小鼠肿瘤体积变化,计算抑瘤率。结果壳聚糖微球平均粒径约为105μm,粒径大小较一致,包封率约为80%,载药率约为11%,2周的累积释放率为84%。瘤内注射表柔比星、负载表柔比星的壳聚糖微球组的平均抑瘤率分别为10%、31%。结论表明壳聚糖微球是一种有效的表柔比星局部缓释剂型,瘤内注射负载表柔比星的壳聚糖微球治疗肝癌有较强的抑瘤作用。     

紫杉醇联合表柔比星与CAF方案治疗晚期乳腺癌的对比

全世界每年约有120万妇女发生乳腺癌,有50万妇女死于乳腺癌,在西欧、北美等发达国家,乳腺癌发病率占女性恶性肿瘤首位〔1〕。中国主要城市10年来乳腺癌发病率增长了37%,死亡率增长了38.9%,农村死亡率增长了39.7%。以上海为例,1972年,上海女性乳腺癌发病率为每10万人中有17     

键合表柔比星纳米胶束对Walker-256细胞株的增殖抑制作用

目的 考察聚乳酸碳酸酯键合表柔比星纳米胶束(EPI-NPs)在体外的释药特点及对Walker-256肿瘤细胞株的增殖抑制作用.方法 应用透析法制备化学键合的EPI-NPs,并用动态激光光散射(DLS)测定其粒径,扫描电镜观察其形态,绘制药物体外释放曲线,通过MTT法测定和比较EPI-NPs与表柔比星(EPI)对Walker-256细胞株的增殖抑制作用,并用激光共聚焦显微镜检测Walker-256细胞对纳米胶束的摄取情况.结果 键合药具有良好的缓释性,释放率随pH值降低而提高;与游离EPI相比较,键合药对Walker-256细胞株增殖的抑制更明显,随药物作用时间和浓度的增大,抑制率逐渐增高.结论 利用酸降解腙键合成的EPI-NPs具有良好的细胞内缓释性和细胞毒性.     

促红细胞生成素衍生物螺旋B表面肽对表柔比星所致大鼠心肌损伤的影响

目的探讨促红细胞生成素(EPO)衍生物螺旋B表面肽(HBSP)对表柔比星(EPI)所致大鼠心肌损伤的影响。方法健康雄性Wistar大鼠40只,随机分为4组,对照(CON)组、EPI处理(EPI)组、EPI+EPO组和EPI+HBSP组。血涂片进行细胞计数;酶联免疫吸附试验(ELISA)检测大鼠心肌中肌钙蛋白(cTn)I含量;苏木素-伊红(HE)染色检测心肌病理损伤程度;免疫组化方法检测心肌组织中caspase-3和Bcl-xl的蛋白表达情况。结果与CON组比较,EPI组大鼠红细胞、白细胞及血小板计数明显减少,cTnI水平明显升高,心肌细胞排列紊乱、心肌纤维化、凋亡细胞数量明显增加,心肌组织中Caspase-3蛋白表达明显升高,Bcl-xl蛋白表达明显降低(P<0.05);与EPI组比较,EPI+EPO组大鼠红细胞计数明显增多,而EPI+HBSP组无明显变化;EPI+EPO组及EPI+HBSP组cTnI水平明显降低,心肌细胞排列、心肌纤维化程度、凋亡细胞数量明显减少,心肌组织中Caspase-3蛋白表达明显降低,Bcl-xl蛋白表达明显升高(P<0.05)。结论 HBSP可减轻EPI所致大鼠的心肌损伤程度,改善心脏功能,从而起到心脏保护作用。     

肥厚型心肌病的超声心动图及心电图分析

目的观察肥厚型心肌病的心电图和超声心动图特点。方法对临床确诊的32例肥厚型心肌病患者心电图、超声心动图资料进行回顾性分析。结果所有患者心电图均有异常,以ST-T改变、左室高电压和异常Q波为多见。Q波深度与室间隔厚度、ST压低深度与心尖部室壁厚度均呈正相关,而T波深度与心尖部室壁厚度无相关性,但与心尖部和室间隔的室壁厚度差呈正相关,左房大小与平均室壁厚度呈正相关。结论在肥厚型心肌病中,心电图和超声心动图中的许多异常指标具有相关性,两者结合可提高本病诊断率。     

芪苈强心胶囊防治表柔比星所致乳腺癌患者心脏毒性的临床疗效观察

目的 研究芪苈强心胶囊防治表柔比星所致乳腺癌患者心脏毒性的临床疗效。方法 依次选取2020年2月至2021年12月在我院完成包含表柔比星联合环磷酰胺（EC）方案进行手术后化疗8个疗程的乳腺癌患者88例,随机分为研究组和对照组,各44例。对照组在进行术后辅助化疗的同时予以常规对症支持治疗,研究组患者在对照组治疗的基础上予以芪苈强心胶囊口服。分别在化疗前及完成第4、8个疗程化疗后进行脑钠肽前体（NTproBNP）、6 min步行距离（6MWD）、左室射血分数（LVEF）、左室收缩末期内径（LVESD）和左室舒张末期内径（LVEDD）的测定和比较;观察和记录两组患者心力衰竭和芪苈强心胶囊相关不良反应的发生情况。结果 研究组完成第4、8个疗程化疗后,NT-proBNP低于同期对照组,LVEF、6MWD高于同期对照组,差异有统计学意义（P<0.05）,与本组化疗前比较差异无统计学意义（P>0.05）;对照组在结束第4、8个疗程化疗时,LVEF、6MWD较本组化疗前下降,差异有统计学意义（P<0.05）;研究组及对照组LVESD、LVEDD化疗前后及组间比较差异无统计学意义（P&...     

扩张型心肌病心衰治疗前后心电图及超声心动图改变

目的 探讨超声心动图（UCG）、心电图（ECG）对扩张型心肌病（DCM）治疗前后的临床意义。方法 分别测量患者治疗前后的ECG及UCG心功能改变。结果 心律失常中以房颤（Af）发生率最高,多以细颤波为主,房性期前收缩次之。QT离散度（QTd）在心衰控制后明显下降（P〈0.05）,心律失常在治疗后从46.66%下降到29.9%。治疗前后的射血分数（EF）及短轴缩短率（FS）有显著差异（P〈0.05）,提示收缩功能改善。结论 DCM在UCG上显示,各腔室扩大及室壁运动减弱为主要表现,对诊断和治疗有一定的特异性和临床意义。ECG为治疗前后提供心肌缺血改善及心律失常的检测提供一定参考数据。     

在TACE术中应用奥沙利铂联合表柔比星治疗肝癌患者疗效观察

目的 探讨在经导管动脉化疗栓塞术（TACE）中应用奥沙利铂联合表柔比星治疗晚期肝癌患者的临床疗效。方法 78例晚期肝癌患者被分成两组,39例对照组在行TACE介入时应用奥沙利铂与吉西他滨治疗,39例观察组则应用奥沙利铂联合表柔比星治疗。两组患者均完成4个周期治疗,并于第4周期治疗完成后观察临床疗效。结果 观察组治疗有效率为84.62%,明显高于对照组的64.10%（x²=25.19,P<0.05）。在治疗4周期后,观察组死亡1例,对照组死亡2例; 观察组治疗前血清IL-2、TNF-α和IFN-γ水平分别为（52.9±6.1）μg/ml、（44.2±9.7） U/ml和（15.0±2.2） U/ml,治疗后则升高至（72.0±11.6） μg/ml、（65.6±13.2）U/ml和（26.1±5.9） U/ml （P<0.05）,对照组患者血清细胞因子水平有类似变化,但治疗后升高不及观察组明显;观察组不良反应发生率为43.59%,明显低于对照组71.79%（x²=26.22,P<0.05）。结论 相比奥沙利铂联合吉西他滨而言,奥沙利铂联合表柔比星治疗晚期肝癌患者能提高临床疗效,且不良反应少。     

The role of speckle tracking echocardiography in assessment of lipopolysaccharide-induced myocardial dysfunction in mice

Background

Sepsis-induced myocardial dysfunction is a common and severe complication of septic shock. Conventional echocardiography often fails to reveal myocardial depression in severe sepsis due to hemodynamic changes; in contrast, decline of strain measurements by speckle tracking echocardiography (STE) may indicate impaired cardiac function. This study investigates the role of STE in detecting lipopolysaccharide (LPS)-induced cardiac dysfunction with mouse models.

Methods

We evaluated cardiac function in 20 mice at baseline, 6 h (n=10) and 20 h (n=10) after LPS injection to monitor the development of heart failure induced by severe sepsis using 2-D and M-mode echocardiography. Ejection fraction (EF) and fractional shortening (FS) were measured with standard M-mode tracings, whereas circumferential and radial strain was derived from STE. Serum biochemical and cardiac histopathological examinations were performed to determine sepsis-induced myocardial injury.

Results

Left ventricular (LV) myocardial function was significantly reduced at 6 h after LPS treatment assessed by circumferential strain (−14.65%±3.00% to −8.48%±1.72%, P=0.006), whereas there were no significant differences between 6 and 20 h group. Conversely, EF and FS were significantly increased at 20 h when comparing to 6 h (P<0.05) accompanied with marked decreases in EF and FS 6 h following LPS administration. Consistent with strain echocardiographic results, we showed that LPS injection leaded to elevated serum level of cardiac Troponin-T (cTnT), CK-MB and rising leucocytes infiltration into myocardium within 20 h.

Conclusions

Altogether, these results demonstrate that, circumferential strain by STE is a specific and reliable value for evaluating LPS-induced cardiac dysfunction in mice.     

Comparison of coronary flow velocities between patients with obstructive and nonobstructive type hypertrophic cardiomyopathy: noninvasive assessment by transthoracic Doppler echocardiography

BACKGROUND: We aimed to compare coronary flow velocity (CFV) measurements of patients with nonobstructive (NHCM) and obstructive hypertrophic cardiomyopathy (HOCM) by using transthoracic Doppler echocardiography (TTDE). METHODS AND RESULTS: In 11 patients with NHCM and 26 with HOCM, CFV in the distal left anterior descending (LAD) coronary was measured by TTDE (3.5 MHz) under the guidance of color Doppler flow mapping in addition to standard 2D and Doppler echocardiography. The results were compared with 24 normal participants who had no evidence of cardiac disease. Peak diastolic velocity of LAD was also higher in NHCM and HOCM than controls (52 +/- 14 cm/sec and 54 +/- 20 cm/sec vs 41 +/- 11 cm/sec, respectively, P < 0.01). The analysis of systolic velocities revealed abnormal flow patterns in 16 (61%) patients with HOCM (12 systolic-reversal flow and 4 no systolic flow) and 6 (54%) (5 reversal flow and 1 zero flow) patients with NHCM (-11 +/- 30 cm/sec and -13 +/- 38 cm/sec, vs 24 +/- 9 cm/sec, respectively, P < 0.001). Linear regression analysis demonstrated no correlation between intraventricular pressure gradient and coronary flow velocities in HOCM patients. However, there were significant positive and negative correlations between septal thickness and diastolic and systolic velocities, respectively (r = 0.50, P < 0.002, and r =-0.43, P < 0.005). CONCLUSION: We conclude that the coronary flow velocity abnormalities are independent from the type of hypertrophic cardiomyopathy.     

Preventing effect of astragalus polysaccharide on cardiotoxicity induced by chemotherapy of epirubicin: A pilot study

To assess the clinical effect of astragalus polysaccharide in preventing cardiotoxicity induced by chemotherapy of epirubicin. Two hundred forty-eight patients with breast cancer or malignant lymphoma were randomly divided into the experimental group (EG) (n = 124) and the control group (CG) (n = 124). The EG received chemotherapy regimen containing anthracycline epirubicin and astragalus injection, while CG received only chemotherapy regimen containing anthracycline epirubicin. We detected myocardial function (cardiac troponin I [cTnI], creatine kinase isoenzyme [CK-MB], left ventricular ejection fraction [LVEF], and the ratio of mitral annular diastolic peak velocity to atrial systolic velocity [E/A]) and incidences of cardiotoxicity to assess cardiac function, they were compared at before the first treatment course (T₁), end of the second course (T₂) and 6-month follow-up. We also detected proinflammatory cytokines (IL-6 and TNF-α), reactive oxygen species and antioxidant enzymes, glutathione peroxidase (GPx), and superoxide dismutase (SOD) aimed to discover potential mechanism. There were no statistical significances in differences of LVEF and E/A between 2 groups (P > .05) at T₁ and T₂, while levels of LVEF and E/A of EG were significant higher than those of the CG at 6 month follow-up, with statistically significant differences (P < .05). At T₁, there were no statistical significances in differences of cTnI and CK-MB between 2 groups (P > .05); at T₂ and 6 months follow-up, the cTnI, and CK-MB levels of EG was significantly lower than those of the CG, with statistically significant differences (P < .05). The incidence of cardiotoxicity of EG was 15% (17/113), which was significant lower than that of the CG (60%, 66/110), with statistically significant difference (P < .05). Moreover, the level of TNF-α, GPx, and SOD did not show significant difference (P > .05). The data in this pilot study suggested that astragalus polysaccharide may be an effective therapy for preventing cardiotoxicity induced by chemotherapy of epirubicin. Furthermore, larger, placebocontrolled, perspective studies are needed to assess the efficacy of astragalus injection treatment for preventing cardiotoxicity induced by chemotherapy of epirubicin.     

Mitral regurgitation: comprehensive assessment by echocardiography

Two-dimensional and Doppler echocardiography have become the major modalities for the assessment of mitral regurgitation. The combined use of these techniques provides information regarding the morphology of the valvular apparatus as well as the severity of regurgitation. Transesophageal and three-dimensional echocardiography provide a more-detailed evaluation of valve morphology, which can be valuable in determining suitability for valve repair. In patients with severe mitral regurgitation, echocardiographic assessment of ventricular size and function plays a critical role in determining the optimal timing of surgery.     

An evaluation of two-dimensional echocardiography in the diagnosis of hypertrophic cardiomyopathy

Various anatomical and functional features of hypertrophic cardiomyopathy are analyzed in view of the data provided by two-dimensional echocardiography. Measurement of septal thickness is crucial, and is best done by a combination of M-Mode and 2-D echo. Two types of systolic anterior movement of the mitral valve (SAM) are observed and are related to the degree of subvalvular gradient. The specificity of these patterns of SAM is analyzed. The functional anatomy of the mitral valve in relation to the presence and degree of mitral regurgitation shows that although the presence and type of SAM are important, there are other causes of mitral regurgitation in hypertrophic cardiomyopathy unrelated to SAM. We emphasize the fact the 2-D echo cannot "diagnose" hypertrophic cardiomyopathy except when cardiac hypertrophy plus SAM involving the body of the mitral valve is seen; in the remaining cases, 2-D echo confirms/suggests the clinical diagnosis.     

Athletes' heart and echocardiography: athletes' heart

Sudden death of competitive athletes is rare. However, they continue to have an impact on both the lay and medical communities. These deaths challenge the perception that trained athletes represent the healthiest segment of modern society. There is an increasing frequency of such reported deaths worldwide and the visibility of this issue is underlined by the high-profile nature of each case. Differential diagnosis between pathological and the physiologic (nonpathological) responses to high levels of physical training has become clinically more important. The purpose of this review is to highlight the main echocardiograph characteristics related to different types of training/sports participation and to highlight already recognized and newer concepts in their clinical assessment.     

Contrast-enhanced echocardiography for the diagnosis of apical hypertrophic cardiomyopathy

The echocardiographic diagnosis of apical hypertrophic cardiomyopathy can be difficult in patients with poor acoustic windows. However, contrast-enhanced echocardiography can provide better images in these patients and lead to the correct diagnosis. We present a patient with apical hypertrophic cardiomyopathy who was diagnosed using contrast-enhanced echocardiography. The use of contrast-enhanced echocardiography for the diagnosis of apical hypertrophic cardiomyopathy in patients with poor acoustic windows is discussed and the experience in the literature reviewed.     

Role of prenatal echocardiography in the study of hypertrophic cardiomyopathy in the fetus

The increased incidence of hypertrophic cardiomyopathy in children of diabetic mothers has already been demonstrated, but its prenatal diagnosis has not yet been extensively studied. The purpose of this prospective study was to evaluate the frequency, severity, and echocardiographic features of fetal hypertrophic cardiomyopathy in a population with several indications for prenatal echocardiography. From March 1987 to April 1991, 283 fetuses were submitted to comprehensive prenatal echocardiography, including M-mode measurements, cross-sectional imaging, Doppler studies, and color flow mapping. One hundred seventy-six were pregnancies complicated by previous or gestational diabetes. The diagnosis of disproportionate septal hypertrophy was made in 39 fetuses (mean septal thickness 7.12 +/- 1.6 mm), at a mean gestational age of 32 weeks. Diabetes mellitus was present in 36 of these pregnancies (92.3%). In four cases, nonimmune hydrops was detected. A systolic anterior motion of the mitral valve was present in three fetuses, but only one showed a gradient across the left ventricular outflow tract. Postnatal echocardiographic examination in 27 babies did not show false positivity. In ten cases, spontaneous regression of the septal hypertrophy was shown. There were three neonatal deaths, unrelated to the myocardial disease. We concluded that transient hypertrophic cardiomyopathy is a frequent entity, especially when associated with diabetes during gestation, being a potential cause for nonimmune hydrops. Fetal echocardiography is the method of choice for its prenatal diagnosis and should always be indicated in diabetic mothers.     

负荷超声对扩张型心肌病与缺血性心肌病鉴别诊断价值初探

目的　观察扩张型心肌病 (DCM)及缺血性心肌病 (ICM)患者在多巴酚丁胺负荷超声心动图 (DSE)中的室壁运动规律。方法　 18例心脏扩大、心力衰竭患者微泵滴注多巴酚丁胺、按 5 μg/ (kg·min)、10 μg/ (kg·min)、2 0 μg/ (kg·min)、30 μg/ (kg·min)、4 0 μg/ (kg·min)的顺序递增 ,每个剂量持续 3分钟。全程连续观察超声心动图并记录。全部患者同期行冠脉造影检查。结果　①随药物剂量逐级递增 ,DCM患者左室舒张末径缓慢缩小、左室射血分数持续增加 ;ICM患者左室舒张末径无明显变化 ,左室射血分数仅在低剂量时增加。②高剂量时节段室壁运动异常在DCM患者中占14 % ,在ICM患者中占 80 %。二者比较有显著差异 (P <0 0 1)。③根据高剂量时节段室壁运动异常预测ICM ,其敏感性 80 % ,特异性 87% ,阳性预测值 88% ,阴性预测值 77%。结论　DSE试验有助于临床对DCM及ICM的鉴别诊断。