123I-MIBG心肌显像预测依那普利对扩张型心肌病患者治疗效果的临床价值

目的:探讨123I-MIBG心肌显像在治疗前预测依那普利对扩张型心肌病(DCM)患者治疗效果的临床价值. 方法:对24例DCM患者于依那普利治疗前行早期(20 min)及延迟(3 h)123I-MIBG心肌显像,采用心/上纵隔(H/M)比和心脏放射性洗脱率(WR)作为相对半定量计数分析,与超声心功能参数进行对比.根据123I-MI-BG心肌显像延迟相的H/M分为3组:延迟H/M≥1.7为组Ⅰ,1.5＜延迟H/M＜1.7为组Ⅱ,延迟H/M≤1.5为组Ⅲ.组Ⅰ和组Ⅱ在平均治疗4.5个月后重复以上检查. 结果:治疗前3组间超声心功能参数比较均无统计学差异.治疗后组Ⅰ的左室射血分数(LVEF)和左室收缩末径(LVDs)明显改善,早期H/M和延迟H/M均明显改善(P＜0.05),而WR无明显变化.治疗后组Ⅱ的延迟H/M明显改善(P＜0.05),而早期H/M和WR均无明显变化,心功能参数也无改善.组Ⅰ和组Ⅱ患者均能耐受依那普利治疗,而组Ⅲ患者均不能耐受依那普利治疗. 结论:123I-MIBG心肌显像在治疗前预测依那普利对DCM患者的治疗效果方面有一定价值.     

123I-MIBG心肌显像预测依那普利对扩张型心肌病患者治疗效果的临床价值

目的：探讨^123Ⅰ-MIBG心肌显像在治疗前预测依那普利对扩张型心肌病（DCM）患者治疗效果的临床价值。方法：对24例DCM患者于依那普利治疗前行早期（20min）及延迟（3h）^123Ⅰ-MIBG心肌显像，采用心／上纵隔（H／M）比和心脏放射性洗脱率（WR）作为相对半定量计数分析，与超声心功能参数进行对比。根据^123Ⅰ-MIBG心肌显像延迟相的H／M分为3组：延迟H／M≥1．7为组Ⅰ，1．5〈延迟H／M〈1．7为组Ⅱ，延迟H／M≤1．5为组Ⅲ。组Ⅰ和组Ⅱ在平均治疗4．5个月后重复以上检查。结果：治疗前3组间超声心功能参数比较均无统计学差异。治疗后组Ⅰ的左室射血分数（LVEF）和左室收缩末径（LVDs）明显改善，早期H／M和延迟H／M均明显改善（P〈0、05），而WR无明显变化。治疗后组Ⅱ的延迟H／M明显改善（P〈0．05），而早期H／M和WR均无明显变化，心功能参数也无改善。组Ⅰ和组Ⅱ患者均能耐受依那普利治疗，而组Ⅲ患者均不能耐受依那普利治疗。结论：^123Ⅰ-MIBG心肌显像在治疗前预测依那普利对DCM患者的治疗效果方面有一定价值。     

131碘-间位碘代苄胍心肌显像探测急性心肌梗死后心脏交感神经分布和活力的变化

目的通过心脏交感神经受体显像探测急性心肌梗死(AMI)后心脏交感神经的分布和活力。方法 AMI组12例,男性11例,女性1例,年龄42～68岁,平均年龄(48±9)岁。对照组6名,男性4名,女性2名,年龄40～66岁,平均年龄(47±6)岁,为健康受试者。AMI组在AMI后2周、3个月及6个月时均行~(131)碘-间位碘代苄胍(~(131I-MIBG)受体显像及~(99m)锝-甲氧基异丁基异腈(~(99m)Tc-MIBI)心肌灌注显像(MPI),对照组在1周内完成~(131)I-MIBG受体显像及~(99m)Tc-MIBI MPI。分析~(131)I-MIBG及~(99m)TC-MIBI显像相同部位心肌节段的放射性分布,并利用感兴趣区(ROI)技术测定心肌与纵隔放射性比值(H/M)及MIBG的洗脱率(WR)。结果 (1)AMI组~(131)I-MIBG显像的放射性稀疏-缺损节段数为32个,而~(99m)Tc-MIBI显像的仪为24个。(2)AMI组在AMI后2周、3个月及6个月和对照组的~(131)I-MIBG显像H/M比值为(1.45±0.20)、(1.65±0.16)、(1.70±0.17)和(2.70±0.32),WR为32%、19%、15%和9.5%。AMI组各时间点的H/M和WR与对照组比较差异均有统计学意义(均为P0.05);AMI组2周分别与3个月和6个月比较,差异均有统计学意义(均为P0.05)。结论 AMI后交感神经受损区域明显大于MPI所显示的受损区域。AMI后心肌交感神经受体下调,表现为MIBG摄取减低;体内交感神经紧张度增高,表现为MIBG滞留时间短、洗脱率高。AMI后3～6个月内交感神经有不同程度的恢复。     

氯沙坦钾、依那普利叶酸片治疗扩张型心肌病慢性心衰的疗效及对患者血清细胞因子及心肌纤维化的影响

目的探讨氯沙坦钾与依那普利叶酸片治疗对扩张型心肌病(DCM)慢性心衰患者血清细胞因子及心肌纤维化的影响。方法选取2016年10月至2017年9月我院收治的DCM慢性心衰患者66例作为研究对象,采用随机数字表法分为依那普利叶酸片组(A组)和氯沙坦钾组(B组)各33例。检测比较两组患者治疗前后血清细胞因子及心肌纤维化指标;采用彩色多普勒超声测定比较两组患者的左室射血分数(LVEF)水平;比较两组患者的临床治疗效果及不良反应发生情况。结果治疗3个月后,两组患者血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、血清Ⅲ型前胶原(PCⅢ)、透明质酸(HA)、层黏连蛋白(LN)水平均显著降低、转化生长因子-β_1(TGF-β_1)显著升高,A组患者各指标水平均明显优于B组(LN水平除外),差异均具有统计学意义(P0.05);两组患者LVEF水平均显著提高,A组患者LVEF水平显著高于B组,差异有统计学意义(P0.05);A组患者治疗总有效率(93.94%)略高于B组(84.85%),但差异无统计学意义(P0.05)。治疗过程中,A组患者的不良反应发生率(3.03%)明显低于B组(24.24%),差异具有统计学意义(P0.05)。结论氯沙坦钾与依那普利叶酸片治疗DCM慢性心衰患者的临床疗效相当;与氯沙坦钾比较,依那普利叶酸片缓解患者炎症反应、改善心功能及降低心肌纤维化作用更为突出,治疗安全性更高。     

葡萄糖-胰岛素-氯化钾溶液对慢性缺血性左室功能不全的治疗作用

醛固酮能阻止去甲肾上腺素摄取和促发心肌重构,醛固酮受体拮抗剂螺内酯却能改善扩张型心肌病(DCM)患者的左室(LV)重构,但其对心脏交感神经活性的作用尚未清楚。本文拟螺内酯对DCM患者心脏交感神经活性以及LV重构的可能作用进行了评价。对象与方法 30例DCM患者,男17例,女13例,平均年龄65±15岁,心功能属NYHAⅡ～Ⅲ级。研究前均已接受了ACEI、袢利尿剂、或地高辛和血管扩张剂治疗。研究中分为随机加服螺内酯(25mg/d)的治疗组和未加服螺内酯的对照组各15例,疗程半年。并于治疗前后分别经放射性~(123)Ⅰ-标志     

扩张型心肌病的分期及其临床意义

目的 :探讨扩张型心肌病 (DCM)的临床分期 ,评价 DCM不同阶段干预治疗的效果。方法 :将来自国内16所医院的 DCM患者 2 2 1例 ,按 NYHA心功能分级标准进行临床分期 :无心力衰竭 (心衰 )期 ,心衰期和心衰晚期。采用随机单盲安慰剂对照试验 ,在心衰治疗基础上 ,加用地尔硫 6 0 m g/ d或安慰剂 ,借助心肌病分期方案 ,评价地尔硫对 DCM的干预试验。结果 :单纯治疗心衰对于 DCM无心衰期患者的心功能参数没有显著性影响 ,心衰期患者心功能参数均明显减退 ,心衰晚期患者心功能参数无明显变化。加用地尔硫治疗 DCM,能够显著改善无心衰期和心衰期患者的心功能参数 ,而心衰晚期患者心功能参数无明显改善。预后分析发现安慰剂组需要反复住院治疗人数和病死率均显著高于地尔硫组。结论 :对 DCM进行临床分期 ,有助于疾病的早期诊断和全面评价干预试验 ,具有临床实用价值。应用地尔硫对 DCM早期干预 ,将改变 DCM自然进程 ,提高患者生活质量和生存率。     

双核素心肌显像对急性心肌梗死患者延迟经皮冠状动脉介入治疗的指导意义

目的利用18F-氟代脱氧葡萄糖(~(18)F-FDG)和~(99)Tcm-甲氧基异丁基异腈(~(99)Tcm-MIBI)双核素心肌灌注/代谢显像技术,评估急性心肌梗死(acute myocardial infarction,AMI)患者存活心肌数量对延迟经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后心功能改善的影响。方法纳入40例AMI延迟PCI治疗的患者,术前根据~(18)F-氟代脱氧葡萄糖和~(99)Tcm-甲氧基异丁基异腈双核素心肌灌注/代谢显像结果分为心肌存活组和无心肌存活组。入院一周后行延迟PCI治疗,比较两组间PCI治疗后患者心功能改变情况。结果心肌存活组术前左心室舒张末期容量(left ventricular end-diastolic volume,LVEDV)、左心室收缩末期容量(left ventricular end-systolic volume,LVESV)为(134.5±25.3)mL及(63.7±12.2)mL,术后均显著下降,分别降至(120.6±18.7)mL及(52.3±16.4)mL,差异有统计学意义(P0.05)。左心室射血分数(left ventricular ejection fraction,LVEF)和左心室短轴缩短率(left ventricular fractional shortening,LVFS)则由(40.6±5.4)mL和13.8%±3.0%升至(48.3±2.7)mL和22.4%±2.3%,差异有统计学意义(P0.05)。血浆中脑钠肽浓度由(3227.8±108.2)ng/mL降至(724.7±91.3)ng/mL,差异有统计学意义(P0.05)。无心肌存活组术前与术后比较,上述各参数均差异无统计学意义(P0.05)。结论通过双核素心肌显像技术判断AMI患者剩余存活心肌数量,可预测AMI延迟PCI治疗后心功能改善情况,对AMI延迟PCI治疗具有指导意义。     

依那普利叶酸片改善H型高血压左室肥厚患者的心功能

目的观察依那普利叶酸片改善H型高血压左室肥厚患者心功能的作用。方法纳入160例H型高血压左室肥厚患者,随机分为依那普利组(n=80)和依那普利叶酸片组(依叶组)。治疗12个月后,观察两组患者血压、心功能及血浆同型半胱氨酸(Hcy)水平的变化。结果 1两组患者治疗后收缩压(SBP)、舒张压(DBP)与治疗前比较,均有非常显著性降低(P0.01),治疗后两组患者间SBP、DBP比较均有统计学差异(P均0.05),且依叶组降血压效果更明显。2治疗后,依叶组患者血浆Hcy水平与治疗前相比显著降低(P0.01),依那普利组患者血浆Hcy水平与治疗前相比有明显降低(P0.05);两组患者治疗后血浆Hcy水平比较有显著统计学差异(P0.01),且依叶组血浆Hcy水平降低更明显。3两组患者治疗后左室舒张早期二尖瓣血流峰速度(E)及晚期血流峰速度(A)比值(E/A)及左室射血分数(LVEF)值与治疗前比较均显著升高(P0.01),治疗后两组患者间E/A值、LVEF值比较均有统计学差异(P0.05),且依叶组升高效果更明显。结论依那普利叶酸片能更好的降低H型高血压左室肥厚患者血压及血浆Hcy水平,改善左室的舒张及收缩功能。     

扩张型心肌病抗心肌抗体的临床观察及其针对性治疗

目的:探讨扩张型心肌病(DCM)的发病机制,观察针对抗心肌抗体进行免疫学治疗的临床疗效和预后.方法:对2001年1月-2007年12月入院治疗的DCM患者(747例)的病史、诊治过程、随访情况进行回顾性分析.结果:747例中抗心肌抗体阳性者527例(70.55%),随访时间为0.9-7.2年,抗心肌线粒体ADP/ATP载体抗体阳性患者(A组)治疗后平均左室舒张末期内径(LVEDd)为(62.53±9.17)mm,左室射血分数(LVEF)为(37.65±11.15)%;抗β1-肾上腺素能受体抗体(抗β1-受体抗体)阳性患者(B组)治疗后LVEDd (61.35±5.68)mm, LVEF (40.65±12.78)%;抗ADP/ATP载体抗体和抗β1-受体抗体均阳性患者(C组)治疗后LVEDd(61.28±7.72)mm, LVEF(38.35±7.05)%.3组与治疗前比较LVEDd差异均有统计学意义(P<0.05)、NYHA心功能分级均改善Ⅰ～Ⅱ级.结论:自身免疫是DCM的常见致病因素,针对抗ADP/ATP载体抗体使用地尔硫和针对抗β1-受体抗体使用美托洛尔治疗DCM均可明显改善患者心脏功能及心室重构,改善预后.     

磁共振成像对冠心病陈旧性心肌梗死所致心功能不全的诊断及干细胞移植疗效评价的应用

目的 评价磁共振成像(MRI)在冠心病陈旧性心肌梗死合并心功能不全患者诊断中的价值,并分析干细胞移植手术的疗效.方法 20例冠心病陈旧性心肌梗死患者,男18例,女2例,年龄(59.5±10.1)岁,半均分成2组(每组10例),干细胞移植组行冠状动脉旁路移植术(CABG)+干细胞移植,对照组仅行CABG术,术前均行心脏MRI及双核素单光子发射计算机断层(SPECT)进行存活心肌显像检查,术后6个月复查心脏MRI.用MRI评价干细胞移植后左心功能改善及心脏MRI延迟增强显像判断左室存活心肌的准确性.结果 两组左室射血分数(LVEF)均有明显改善,但手术前后变化值比较差异无统计学意义.干细胞移植组左室舒张末期容积(LVEDV)手术前后变化值为(9.91±39.50)ml,与对照组的(-22.34±31.35)ml比较,差异有统计学意义(P＜0.05);干细胞移植组窒壁增厚率变化值高于对照组(11.40%±11.53%比2.27%±7.20%,P＜0.05),其余两组心功能参数变化值比较差异均无统计学意义.心脏MRI延迟增强显像与氟-18-脱氧葡萄糖(18F-FDG)心肌代谢存活心肌显像具有较好的一致性,Kappa=0.446(P＜0.001).以18F-FDG SPECT心肌代谢显像为金标准,心脏MRI延迟增强显像敏感度为68.3%,特异度为92.5%.结论 MRI能够准确判断冠心病陈旧性心肌梗死患者左室容积和功能,对心肌梗死后存活心肌的判断具有同18F-FDG SPECT相近的特异性,但敏感件略低.MRI可用于心肌十细胞移植前诊断与移植后早期疗效的判定.     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.