曲美他嗪对改善原发性扩张性心肌病患者心功能的疗效观察

目的观察在常规治疗的基础上加用曲美他嗪对改善原发性扩张性心肌病心功能的影响和安全性。方法将46例符合诊断标准的原发性扩张性心肌病患者,随机分为A组和B组,每组23例,A组给予常规治疗,B组在常规治疗的基础上加用曲美他嗪20 mg,3次/d,两组疗程均为16周。比较两组治疗前后的临床疗效、心胸比、左室射血分数(LVEF)等。结果B组再住院率明显降低,心功能改善优于A组(P<0.01),LVEF改善B组明显优于A组(P<0.05)。结论曲美他嗪对改善原发性扩张性心肌病心功能的疗效优于一般常规药物治疗。曲美他嗪可作为治疗原发性扩张性心肌病的辅助药物。     

卡维地洛治疗缺血性心肌病心力衰竭的临床观察

目的探讨B受体阻滞剂卡维地洛对缺血性心肌病心力衰竭患者心功能、QT离散度及室性心律失常（VA）的干预作用。方法选择缺血性心脏病心力衰竭132例,随机分为对照组和治疗组（每组66例）,对照组给予常规治疗（ACEI／ARb、利尿剂、地高辛）;治疗组在对照组治疗的基础上,加用卡维地洛。两组均治疗6个月。治疗前后应用24h动态心电图观察QTd、QTcd、室性心律失常的发生情况,多普勒超声心动图观察左室射血分数（LVEF）、左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）。结果治疗6个月后,治疗组QTd、QTcd及VA发生率均较对照组治疗后显著降低（P〈0．05）,LVEDD和LVESD与对照组治疗后比较明显缩小（P〈0．05）,LVEF较对照组治疗后明显提高（P〈0．05）。结论缺血性心肌病患者长期应用卡维地洛可显著降低QTd、QTcd及VA发生率,改善心功能,改善预后。     

氯沙坦联合卡托普利对收缩性心力衰竭影响的观察

目的：观察氯沙坦联合卡托普利对高血压合并收缩性心力衰竭左心功能的影响。方法：将高血压伴心功能Ⅲ～Ⅳ级60例，分为观察组（氯沙坦加卡托普利组）和对照组（卡托普利组）各30例，比较两组6个月内血压、心功能分级及超声心动图的变化。结果：两组治疗后比较，血压无显著差异（P〉0．05），左心功能及左室结构差异显著（P〈0．05）。结论：氯沙坦联合卡托普利在改善左室功能和结构方面优于单用卡托普利。     

中药泡足联合前列地尔治疗糖尿病下肢动脉硬化闭塞症临床观察

目的观察中药泡足联合前列地尔治疗糖尿病下肢动脉硬化闭塞症的临床疗效。方法将入选的60例2型糖尿病合并下肢动脉硬化闭塞症患者随机分为治疗组和对照组各30例。对照组在糖尿病常规治疗基础上给予前列地尔治疗,治疗组在对照组治疗基础上加用具有益气活血祛瘀通络的中药方剂泡足治疗,治疗2周后观察临床疗效,并采用彩色多普勒超声检查比较两组治疗前后股浅动脉、胫后动脉、足背动脉的血管内径、血流量变化。结果治疗组总有效率为93．3％,对照组临床总有效率为80．0％,两组比较差异有显著性意义（P〈0．05）,治疗组优于对照组。治疗组治疗后股浅动脉、足背动脉血管内径及峰值流速、血流量与治疗前比较明显增加,差异均有显著性意义（P〈0．05）。结论中药泡足联合前列地尔可以改善2型糖尿病下肢动脉血管内径及血流量,临床用于治疗糖尿病下肢硬化闭塞症有较好疗效。     

银杏叶片联合前列地尔治疗脑梗塞64例临床分析

目的探讨银杏叶片联合前列地尔治疗脑梗塞的临床效果。方法选择我院收治的64例脑梗塞患者为研究对象,采用随机数字表法随机分为对照组和观察组。两组均给予常规治疗,对照组在常规治疗的基础上加用维脑路通治疗,观察组在常规治疗的基础上加用银杏叶片＋前列地尔治疗。比较两组的治疗效果及治疗过程中不良反应发生情况。结果观察组总有效率显著高于对照组,差异有统计学意义（P〈0．05）。结论银杏叶片联合前列地尔治疗脑梗塞疗效确切,安全性好,值得临床推广应用。     

培哚普利对老年慢性心力衰竭患者内皮细胞结构和功能的影响

目的：探讨老年慢性心力衰竭（CHF）患者内皮细胞结构和功能的变化,并观察培哚普利对其影响。方法：286例老年CHF患者随机分为2组,培哚普利治疗组（Pe组）及常规治疗组（sham组）,测定2组患者治疗前后及正常对照组血液中循环内皮细胞（CEC）、一氧化氮（NO）和内皮素（ET）含量。结果：2组患者治疗后心功能均有明显改善（P〈0．05）,Pe组改善更明显（P〈0．01）。CHF患者血中CEC和ET明显增加（P〈0．05）,NO浓度明显下降（P〈0．05）,它们的变化程度与心衰严重程度相一致。治疗后各指标均有明显的改善,CEC和ET明显下降（P〈0．05）,NO浓度明显升高（P〈0．05）,但Pe组改善更明显（P〈0．05）。结论：老年CHF患者内皮细胞的结构和功能明显受损,培哚普利能改善CHF患者内皮细胞的结构和功能,保护内皮细胞,同时明显改善老年CHF患者的心功能。     

前列地尔联合奥拉西坦治疗急性脑梗死的临床疗效

目的 探讨前列地尔联合奥拉西坦治疗急性脑梗死的疗效及安全性。方法 选取80 例急性脑梗死患者,随机分为对照组和治疗组,在常规治疗的基础上,对照组给予前列地尔注射液治疗,治疗组在对照组的基础上加用奥拉西坦注射液治疗,两组均连续治疗2 w,观察两组治疗前后美国国立卫生研究院卒中量表（ NIHSS）及巴塞尔（ Barthel）指数评分结果、血清中CRP 的浓度及安全性。结果 治疗后,治疗组NIHSS 评分明显低于对照组（ P 〈 0. 05）;Barthel 评分明显高于对照组（P〈0.05）;治疗7 d、14 d后,治疗组血清CRP浓度明显低于对于对照组（P〈0.05）;两组均未出现严重不良反应。结论在常规治疗的基础上,采用前列地尔联合奥拉西坦治疗急性脑梗死,可显著提高患者的生活自理能力,降低血清中CRP的浓度,提高临床治疗的效果,且安全、可靠,具有较大的临床借鉴意义。     

葛根素对肾动脉狭窄患者内皮素及血管紧张素Ⅱ影响临床观察

目的：观察葛根素对动脉粥样硬化性肾动脉狭窄（ARAS）患者血浆内皮素（ET）及血管紧张素Ⅱ（AngⅡ）浓度的影响。方法：将动脉粥样硬化性肾动脉狭窄57例随机分为观察组30例，对照组27例。对照组采用常规治疗，观察组在常规治疗基础上加用葛根素，对照组加用丹参注射液，比较两组对ET及AngⅡ浓度的影响。结果：观察组治疗后ET及AngⅡ浓度均有显著下降（P〈0．05，P〈0．01）。结论：葛根素具有降低ET及AngⅡ浓度的作用。     

稳心颗粒对缺血性心肌病QTc离散度影响的研究

目的：观察常规治疗加稳心颗粒对缺血性心肌病（ICM）患者心功能及QTc间期和QTc离散度的影响。方法：将ICM伴心功能不全86例随机分为观察组和对照组各43例。对照组采用常规药物治疗;观察组在常规药物治疗的基础上,加用无糖型稳心颗粒,每次5g,每天3次。均治疗4周。观察两组治疗前后心功能分级及QTc间期和QTc离散度的变化。结果：观察组治疗后心功能改善率为62.8%,对照组为48.8%;两组心功能改善率比较,差异显著（P〈0.05）。观察组QTc间期和QTc离散度较对照组显著缩短（P〈0.05）。结论：在常规治疗基础上加用稳心颗粒,可明显改善ICM伴心功能不全患者的心功能,缩短患者QTc间期和QTc离散度。     

左卡尼汀治疗老年冠心病心衰的疗效观察

目的评价左卡尼汀（L-CN）对心病慢性心力衰竭的治疗效果。方法选择80例冠心病心衰患者,随机分为两组,每组40例：对照组予利尿剂、硝酸酯类药物、B受体阻滞剂、血管紧张素转化酶抑制剂或血管紧张素受体拮抗剂治疗;治疗组在此基础上加用左卡尼汀3．0g／d静点。1次／d,疗程15d。观察治疗前后心功能状况、左室射血分数、左室舒张末径及E／A等心功能参数的变化,并观察药物不良反应。结果①两组治疗后均有效;②治疗组的总有效率高于对照组（P〈0．05）,心功能改善更为鼎著（P〈0．05）,且未见不良反应。结论冠心病心衰患者短期适量补充外源性左卡尼汀有益于改善心功能。     

预防性针刺足三里穴对冷应激大鼠胃粘膜损伤的影响

目的：探讨预防性针刺不同疗程足三里穴对应激大鼠胃粘膜损伤的保护作用的内在机制。方法：雄性SD大鼠40只，随机分为空白对照组、应激组、电针1d组、电针3d组、电针5d组，每组8只。利用激光多普勒血流仪测定胃粘膜血流量，用放免分析法测定各组大鼠血浆ET，PGE2的变化，用生化法测定NO的含量，并计算各组溃疡指数（UI）。结果：应激组与空白对照组比较，GMBF明显下降，UI明显上升（P〈0．01），而血浆PGE2、NO水平下降。ET水平上升（P〈0．05）。电针1d组与应激组比较，GMBF上升，UI下降（P〈0．01）；血浆PGE2、NO水平上升（P〈0．01或P〈0．05），ET水平下降（P〈0．05）。电针5d组与电针1d组比较，GMBF、POE2、NO上升更职显，而UI则职显下降（P〈0．05）。电针3d组与电针1d组、电针5d组指标比较，无明显统计学意义。电针1、3、5d组之间指标ET血浆水平无明显统计学意义。结论：预防性针刺足三里穴对应激大鼠胃粘膜损伤具有保护作用，且具有时间一剂量效应。其机制可能与词节机体内血浆ET、NO、PGE2的水平有关。     

心脏MRI在扩张型心肌病中的应用价值

目的 探讨1.5T心脏磁共振成像(CMRI)在扩张型心肌病(DCM)中的应用价值.方法 选取DCM患者45例及健康对照者25例,均进行CMRI检查,通过LGE序列判断左心室有无心肌纤维化将DCM组患者分为LGE(+)组和LGE(-)组,测如下结构及功能参数:LVEDD、LVESD、LVEDV、LVESV、LVEF、LV...     

曲美他嗪联合芪苈强心胶囊治疗扩张型心肌病临床观察

目的探讨曲美他嗪联合芪苈强心胶囊治疗扩张型心肌病(DCM)的临床疗效。方法将116例DCM患者分为对照组和治疗组。对照组58例采用常规治疗;治疗组58例在对照组治疗的基础上加用曲美他嗪和芪苈强心胶囊治疗。观察治疗前后临床症状和体征,记录NYHA分级和6 min步行试验(6MWT),超声心动图测定左室舒张末内径(LVEDD)、左室射血分数(LVEF)、二尖瓣舒张早期血流峰值速度(E)与二尖瓣舒张晚期血流峰值速度(A)之比(E/A)。结果治疗组总有效率、显效率分别为89.7%和50.0%,显著高于对照组的74.1%和25.9%(P<0.05和P<0.01);治疗后治疗组患者的LVEDD、LVEF、E/A较对照组明显改善,6MWT距离明显延长(P<0.05,P<0.01);治疗组患者的心功能及临床症状的改善均较对照组显著(P<0.05),未见严重的不良反应。结论目前在对DCM尚无明显有效药物治疗的情况下使用曲美他嗪、芪苈强心胶囊治疗DCM有较好的临床疗效。     

全方位M型超声Tei指数测量对早期酒精性心肌损害左室功能的评价

目的:采用全方位M型(free angle motion mode,FAM)超声测量左心室Tei指数及等容收缩指数(心室等容收缩时间/射血时间,ICT/ET)、等容舒张指数(心室等容舒张时间/射血时间,IRT/ET)等相关参数,评价早期酒精性心肌损害左室功能的变化。方法:收集45例不饮酒健康男性作为A组(正常对照组);另收集91例饮酒者分为3组:B组36例,每日饮白酒80~150g或啤酒1 000~1 500mL,每周3~5d,饮酒史10年;C组30例,饮酒史10年,其他条件同B组;D组25例,每日饮白酒≥150g或啤酒≥2 000mL,每周3~5d,饮酒史10年,饮酒量符合酒精性心肌病诊断标准。对4组行常规超声检查,测定左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs)、舒张末期室间隔厚度(IVSTd)、舒张末期左室后壁厚度(LVPWTd)、左室射血分数(LVEF)、舒张早期血流峰值速度(E)与舒张晚期血流峰值速度(A)比值(E/A)及FAM参数,获得左室Tei指数及ICT/ET、IRT/ET等相关参数。结果:各常规超声参数A组与B组间差异无统计学意义(P均0.05);C组LVDd、LVDs、IVSTd、LVPWTd、LVEF与A、B组比较差异均无统计学意义(P均0.05);C组E/A与A、B组比较差异均有统计学意义(P均0.01);D组各常规超声参数与A、B、C组比较差异均有统计学意义(P均0.01)。Tei指数在A组及B、C组间差异有统计学意义(P均0.05),在D组与A、B组间差异有统计学意义(P均0.01),在D组与C组间差异有统计学意义(P0.05)。除A、B组间ICT/ET差异无统计学意义外(P0.05),C、D组ICT/ET、IRT/ET值均大于A、B组(P均0.05),同时D组ICT/ET、IRT/ET值亦大于C组(P均0.05)。结论:应用FAM技术测量左室Tei指数并结合ICT/ET、IRT/ET等相关参数可作为全面评价早期酒精性心肌损害左室功能变化的手段之一。     

Efficacy of carvedilol treatment on cardiac function and cardiac sympathetic nerve activity in patients with dilated cardiomyopathy: comparison with metoprolol therapy.

Carvedilol and metoprolol have been reported to be effective in the treatment of patients with chronic heart failure. However, to our knowledge, there have been no studies comparing the effects of the 2 drugs on cardiac function, including cardiac sympathetic nerve activity. METHODS: We compared 15 patients with dilated cardiomyopathy (DCM) who were receiving carvedilol (group A) with 15 patients with DCM who were receiving metoprolol (group B). Before and after 1 y of treatment, cardiac (123)I-metaiodobenzylguanidine ((123)I-MIBG) uptake was assessed using the total defect score (TDS) and the heart-to-mediastinum (H/M) activity ratio from the delayed images. The New York Heart Association (NYHA) class and echocardiographic left ventricular ejection fraction (LVEF) also were assessed. RESULTS: In both groups, the TDS decreased (in group A, from 25 +/- 14 to 16 +/- 14, P < 0.01; in group B, from 27 +/- 9 to 19 +/- 10, P < 0.01), the H/M increased (in group A, from 1.67 +/- 0.31 to 2.01 +/- 0.36, P < 0.01; in group B, from 1.68 +/- 0.21 to 1.93 +/- 0.32, P < 0.01), the LVEF increased (in group A, from 31% +/- 10% to 48% +/- 10%, P < 0.01; in group B, from 28% +/- 9% to 47% +/- 15%, P < 0.01), and the NYHA functional class improved (in group A, from 2.9 +/- 0.3 to 1.7 +/- 0.5, P < 0.01; in group B, from 2.8 +/- 0.6 to 1.7 +/- 0.6, P < 0.01). The change in LVEF was mildly correlated with the change in the TDS in group A (r = 0.41) as well as in group B (r = 0.53). In the patients with a favorable response in the TDS or H/M, the NYHA class improved more than in the patients without a favorable response (P < 0.05). CONCLUSION: Carvedilol treatment can improve cardiac function, symptoms, and cardiac sympathetic nerve activity in patients with DCM to a similar extent as metoprolol treatment. The improvement of cardiac function and symptoms is related to the improvement of cardiac sympathetic nerve activity.     

Prediction of cardiac events in patients with dilated cardiomyopathy using <Superscript>123</Superscript>I-BMIPP and <Superscript>201</Superscript>Tl myocardial scintigraphy

Objective Various clinical trials for dilated cardiomyopathy (DCM) have demonstrated that the prognosis as well as cardiac function is improved by the administration of beta-blocker therapy. On the other hand, ¹²³I-betamethyl-p-iodophenyl-pentadecanoic acid (BMIPP) reflects myocardial fatty acid metabolism and is considered to be a more sensitive tracer than perfusion tracers. In this study, the efficacy of DCM for the evaluation of myocardial damage and the prediction of cardiac events was studied using ¹²³I-BMIPP and ²⁰¹TI (Tl) myocardial scintigraphy. Methods Study subjects comprised 33 DCM patients, divided into a cardiac event group (event, n = 9) and an event-free group (event free, n = 24). An extent score (ES) and severity score (SS) were calculated for each BMIPP image. BMIPP and Tl images were divided into 17 segments, and total defect scores (TDS) were calculated for each. The TDS of the BMIPP and Tl images were compared with score differences greater than or equal to 4 and less than 4 defined as mismatch and non-mismatch, respectively. Results The TDS of BMIPP was significantly higher in the event group than in the event-free group (P < 0.05). The ES and SS were significantly higher in the event group than in the event-free group (P < 0.01). The comparison in the 2 × 2 contingency tables showed that the occurrence of non-mismatch was significantly higher in the event-free group (χ² test; P < 0.01). The ES of BMIPP was a significant predictor of cardiac events in the multivariate analysis (P < 0.01). Conclusions These results suggest that the ES for BMIPP is useful as a predictor of cardiac events in DCM.     

Usefulness of meta-[123I]iodobenzylguanidine myocardial scintigraphy for predicting cardiac events in patients with dilated cardiomyopathy who receive long-term beta blocker treatment

OBJECTIVE: Large-scale clinical trials have demonstrated that beta blocker therapy improves the prognosis of dilated cardiomyopathy (DCM), but cardiac events sometimes occur even in patients showing favourable response to the therapy. In this study, the usefulness of meta-iodobenzyguanidine (MIBG) in predicting cardiac events was investigated in DCM patients successfully receiving long-term treatment with beta blockers. METHODS: The subjects were 53 patients with DCM (including 10 women; mean age, 56.5+/-10.9 years) who could continue beta blocker therapy for more than 6 months. MIBG was performed within 1 year of commencing the therapy. The extent score, severity score and washout rate were obtained from single photon emission computed tomography images. At the same time, left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameters were measured by echocardiography. The endpoints were cardiac events (cardiac death and admission to hospital due to heart failure or arrhythmia), and patients were observed for an average of 1314+/-986 days (150-4100 days). RESULTS: Cardiac events occurred in nine patients during the observation period. The multivariate statistical analysis demonstrated that the delayed extent score was the strongest significant predictive factor, (hazard ratio 1.036, P<0.01). while LVEF was not a predictive factor. Both the improvement of LVEF and MIBG were significant predictive factors. The improvement of washout rate was the strongest. CONCLUSION: Parameters of MIBG but not of LVEF were useful in predicting cardiac events in DCM patients whose condition had been successfully stabilized by the introduction of beta blockers.     

Impairment of cardiac neuronal function in childhood dilated cardiomyopathy: an 123I-MIBG scintigraphic study.

Abnormalities of norepinephrine uptake have been found to reflect impairment of cardiac adrenergic neuronal function in adults with heart failure. To our knowledge, no data on childhood dilated cardiomyopathy (DCM) are available. The aim of this study was to assess the cardiac neuronal function using 123I-metaiodobenzylguanidine (MIBG) scintigraphy in children with idiopathic DCM. METHODS: We studied 26 patients (mean age, 44+/-50 mo) with DCM and left ventricular dysfunction and 12 control subjects (mean age, 49+/-65 mo) with normal left ventricular function. All subjects underwent planar cardiac imaging after intravenous injection of 20-75 MBq 123I-MIBG. A static anterior view was acquired 4 h after injection. The heart-to-mediastinum count ratio was measured as described previously. RESULTS: On the basis of a reduction of the heart-to-mediastinum count ratio, cardiac neuronal uptake of 123I-MIBG was significantly decreased in patients with DCM compared with cardiac uptake in control subjects (172%+/-34% versus 277%+/-14%; P<0.0001). A significant correlation was found between left ventricular ejection fraction and 123I-MIBG cardiac uptake in patients with DCM (y = 2.5x + 113.3; r = 0.80; P<0.0001). CONCLUSION: Cardiac adrenergic neuronal function is impaired in children with idiopathic DCM. 1231-MIBG cardiac scintigraphy is a useful tool to assess cardiac neuronal function in childhood DCM.     

Anti-tachycardia therapy can improve altered cardiac adrenergic function in tachycardia-induced cardiomyopathy

We investigated whether anti-tachycardia therapy might improve the altered cardiac adrenergic and systolic function in tachycardia-induced cardiomyopathy (TC) in contrast to dilated cardiomyopathy (DCM). The subjects were 23 patients with heart failure, consisting of 8 patients with TC (43.6 +/- 10.0 yrs) and 15 with DCM (45.3 +/- 8.2 yrs). TC was determined as impairment of left ventricular function secondary to chronic or very frequent arrhythmia during more than 10% of the day. All patients were receiving anti-tachycardia treatment. Cardiac 123I-MIBG uptake was assessed as the heart/mediastinum activity ratio (H/M) before and after treatment. LVEF was also assessed. In the baseline study, H/M and LVEF showed no difference between TC and DCM (2.21 +/- 0.44 vs. 2.10 +/- 0.42, 35.3 +/- 13.1 vs. 36.0 +/- 10.9%, respectively). After treatment, the degree of change in H/M and LVEF differed significantly (0.41 +/- 0.34 vs. 0.08 +/- 0.20, 20.5 +/- 14.4 vs. -2.1 +/- 9.6%, p < 0.01). In TC, heart failure improved after a shorter duration of treatment (p < 0.05). In conclusion, anti-tachycardia therapy can improve altered cardiac adrenergic function and systolic function in patients with TC over a shorter period than in those with DCM.