^99mTc-CPF制备及实验研究

目的 探讨炎症显像剂^99mTc-环丙沙星（^99mTc-CPF）在小鼠体内分布的特点，评价其作为新型炎症显像剂的价值。方法 制备^99mTc-CPF，并测定其放化纯度和标记率。制作小白鼠炎症模型。并经尾静脉注入0．1ml ^99mTc-CPF，分别于0．5、1、4、6、12h处死小白鼠，取血样和部分器官组织。测量其放射性。结果 ^99mTc-CPE标记率〉90％。室温下6h内化合物的放化纯稳定。小白鼠炎症组织与正常组织的放射性比值高，注射后1、4、6、12h，炎症组织与对侧正常组织比值分别为3．48、4．30、4．17、4．16．^99mTc-CPF主要由肝脏代谢、经肾脏排泄。血液清除较快。结论 ^99mTc-CPE是一种灵敏度高的炎症灶显像剂。且制备方法简单、方便。     

家猪壁冠状动脉观测及与犬壁冠状动脉比较

目的为壁冠状动脉比较解剖学积累资料，为选择动物模型提供依据。方法家猪心脏塑化染料灌注，10％甲醛溶液固定，大体解剖显示壁冠状动脉，测量数据，并与既往文献报道的犬的壁冠状动脉分析比较。结果家猪壁冠状动脉出现率为50．0％，前室间支、后室间支壁冠状动脉出现率为15．0％、27．5％。前室间支壁冠状动脉近端径（1．96±0．71）mm，远端径（1．52±0．80）mm，长度（9．19±6．58）mm。总壁冠状动脉长度（9．20±4．99）mm。一支血管上可出现1-2处的壁冠状动脉壁。壁冠状动脉可以扭曲和发出细小的分支血管。结论家猪可以作为动物模型研究壁冠状动脉，但犬比家猪更为适合。     

缺血预适应对心肌微循环内皮功能的保护作用

目的 探讨缺血预适应对心肌微循环内皮功能的作用。方法 复制套扎前降支冠状动脉犬模型。缺血预适应组先给予缺血5min，灌注5min，反复4次，然后缺血1h，再灌注2h；缺血再灌注组给予缺血1h后再灌注2h；两组分别于基础、缺血1h、再灌注2h采集冠状窦血对比分析一氧化氮和内皮素水平，并于再灌注2h对比分析注射乙酰胆碱前后心肌声学造影强度变化，最后用Evan氏兰和TIC双染。结果（1）正常心肌注药后声学强度增强，而缺血心肌反而下降，与再灌注组相比，预适应组缺血区心肌声学强度下降程度显著减轻（P〈0．01）；（2）两组缺血后一氧化氮水平均显著下降（P〈0．01），再灌注2h下降更为明显（P〈0．05），然而预适应组缺血1h与再灌注2h下降程度均小于再灌注组（P〈0．05）；（3）预适应组于缺血1h、再灌注2h内皮素水平比基础有所下降，再灌注组与基础比反而呈升高趋势，但未达统计学水准（P〉0．05），两组相比，预适应使缺血1h和再灌注2h的ET水平显著下降（P〈0．05）。结论 缺血预适应对心肌微循环内皮依赖性舒血管反应及一氧化氮和内皮素水平的调节具有保护效应。     

99mTc-MIBI显像可预测乳腺癌新辅助化疗的反应性

目的探讨根据乳腺^99mTc-MIBI显像的表现，预测乳腺癌新辅助化疗反应性的临床价值。方法对43例Ⅱ、Ⅲ期的乳腺癌患者，手术前行乳腺癌^99mTc-甲氧基异丁基异睛（^99mTc-MIBI）早期显像和延迟显像。对显像阳性的肿块计算感兴趣区与对侧正常相应部位放射性计数比值，以早期摄取比值（EUR）和延迟摄取比值（DUR）计算滞留指数（RI），之后行2周期的FAC方案化疗。结果在^99mTc-MIBI显像RI≥0组，化疗的有效率为83.3％（25／30），在RI〈0组化疗的有效率23．1％（3／13），两组间差异有显著的统计学意义（P〈0．01）。结论乳腺^99mTc-MIBI显像可以预测新辅助化疗的反应性，指导个性化化疗方案的选择。     

不同临床分级帕金森病多巴胺转运蛋白显像研究

目的了解不同Hoehn＆Yahr（H—Y）分级帕金森病（Parkinson’s Disease，PD）患者及正常对照者纹状体对^99Tc^m-TRODAT-1的摄取能力，并进行纹状体／小脑的半定量分析。方法58例PD患者，其中男性24例，女性34例，年龄23～80岁（H—Y1级13例，1．5级9例，2级15例，2．5级10例，3级7例，4级4例）。对照组13例，其中男性7例，女性6例。年龄44～72岁。进行^99Tc^m-TRODAT-1SPECT／CT脑断层融合显像。结果对照组双侧纹状体特异性摄取^99Tc^m-TRODAT-1差异无统计学意义（P=0．604＞0．05）。对照组与不同H—Y分级PD患者纹状体／小脑的放射性计数比值差异均有显著统计学意义；H—Y分级为2．5级与3级PD患者（P=0．146）、3级与4级PD患者（P=0．284）间无统计学意义，其余不同H—Y分级PD患者组间纹状体／小脑的放射性计数比值之间差异均有显著统计学意义。H—Y分级为1级、1．5级、2级和2．5级的PD患者发病肢体对侧与同侧纹状体／小脑的放射性计数比值有显著统计学意义,发病肢体对侧纹状体摄取^99Tc^m-TRODAT-1减低更为明显。H—Y分级为3级和4级的PD患者发病肢体对侧与同侧纹状体／小脑的放射性计数比值均明显减低，二者无明显差异。结论PD患者临床症状的轻重与多巴胺和DAT特异性结合的下降程度相关。^99Tc^m-TRODAT-1SPECT脑显像有助于PD的早期诊断。     

^99Tc^m-MIBI阳性显像诊断甲状腺癌的临床价值

目的 以临床病理学为基础，分析评价^99Tc^m-MIBI阳性显像诊断甲状腺癌的临床价值。方法 对105例甲状腺癌患者行早期和延迟甲状腺阳性显像，并对其影像学特征进行分析比较。结果 105例甲状腺癌中，^99Tc^m-MIBI阳性显像乳头状癌阳性有43例（82．7％），假阴性有9例（17．3％），灵敏度为82．7％；滤泡状癌阳性有37例（86．1％），假阴性有6例（14．0％），灵敏度为86．1％；其它类型阳性有5例（50．0％），假阴性有5例（50．0％），灵敏度为50．0％。其中乳头状癌组和滤泡状癌组灵敏度无明显差异（P〉0．05），但二者均高，于其它类型组（P〈0．05）。结论 ^99Tc^m-MIBI阳性显像对甲状腺癌诊断具有重要的临床价值。     

纳络酮对缺血再灌注心肌微循环血流量及其超微结构变化的影响

本文观察了纳络酮对犬缺血和再灌注心肌微循环血流量及其超微结构变化的影响。结果表明：心肌缺血再灌注时微循环血流量明显降低（P＜0．01），但再灌注早期（5min），心肌微循环血流量接近正常，缺血40min，再灌注30min，毛细血管周围组织严重水肿，内皮高度肿胀，管腔狭窄，甚至闭塞；纳络酮治疗缺血和再灌注早期，心肌微循环血流量明显增加（P＜0．01）；毛细血管周围组织水肿及管腔狭窄程度明显轻于缺血再灌注组。提示：纳络酮可减轻缺血再灌注心肌的水肿程度，增加微循环血量，推迟“无再流现象”的发生。     

人心脏缺血预处理对非同一缺血部位心肌的保护作用

观察在双支经皮冠状动脉腔内成形术（PTCA）中缺血预处理对非同一缺血部位心肌的作用。14例患者均为两支冠状动脉（冠脉）病变。分别观察两支冠脉成形时心绞痛程度、狭窄冠脉相关导联心电图最大ST段抬高幅度和发生时间双冠状窦静脉血浆和血清中血栓素B2（TXB2）和6-酮─前列腺素F1α（6－keto－PGF1α）浓度。观察到两支冠脉狭窄程度及PTCA参数无明显差别，但第二支冠脉PTCA时心绞痛积分及发生时间和心电图最大ST段抬高幅度及发生时间均显著低于或迟于第一支冠脉PTCA时（P＜0.05）。第二文冠脉PTCA前后血浆6－keto－PGF1α水平均高于第一支（P＜0．05）。提示缺血预处理可以保护非同一缺血部位的心肌，其机制可能同前列环素的改变有关。     

纳洛酮对缺血/再灌注损伤家兔心肌前列腺素代谢产物及再灌注血流的影响

目的 观察纳洛酮对缺氧心肌组织再灌注血流及前列腺素代谢产物生成的影响。方法 30只新西兰大白兔随机分为：再灌注组10只，结扎冠状动脉左前降支1h再开放4．5h；纳洛酮组10只，手术过程同前，同时静注纳洛酮；假手术组10只，手术过程同前，不结扎前降支动脉。用激光多谱勒血流测定仪测定再灌注组及纳洛酮组结扎前、后及稃灌注4．5h后缺血区心肌再灌注血流量：放射免疫法测定各组再灌注4．5h后的血浆6-酮-前列腺素F1α血栓素B，含量。结果 （1）结扎前，再灌注组及纳洛酮组局部心肌组织血流无差别；再灌注后，两组血流均较前下降，再灌注组的缺血区血流量明显低于纳洛酮组（P〈0．01）。（2）再灌注后，再灌注组、纳洛酮组血浆血栓素B1含量及血栓素B2／6-酮-前列腺素F1α比值显著高于假手术组，再灌注组又高于纳洛酮组，各组间血浆6．酮．前列腺素F1α含量无显著性差异。结论 纳洛酮可以抑制缺血／再灌注后家兔心肌血栓素B2的生成。改善再灌注部位血流。     

肾缺血预处理后急性心肌梗死大鼠炎症反应的变化及机制

目的观察肾缺血预处理后急性心肌梗死大鼠心肌梗死面积和早期炎症反应变化,探究其在心肌保护中的作用机制。方法将72只健康雄性成年sD大鼠随机分为三大组,①对照组（NC,n=8）;②急性心肌梗死组（AMI,n=32）;③肾缺血预处理组（RIP,n=32）;各组大鼠分别在急性心肌梗死后2．4、6、12h四个时间点处死取材。术中以MS-4000生物信号采集处理系统监测并记录大鼠Ⅱ导联心电图,确定心肌梗死模型成功。Even’s蓝-Trc染色推测心肌梗死面积;HE染色观察心肌病理变化。双抗体夹心（ELISA）法测定血清白介素8（IL-8）和白介素10（IL-10）的含量;RT-PCR测定缺血区心肌组织IL-10mRNA和IL-8 mRNA表达情况。结果RIP组12h梗死部位重量（Is）和缺血危险区（AAR）重量比值（IS／AAR）（46．18±6．15）％较AMI组（66．44±19．24）％明显减小（P〈0．05）。RIP组与AMI组比较,心梗后2、4、6h浸润白细胞数目无明显差异（P〉0．05）,仅在12h时减少（P〈0．05）,外周血白细胞计数在12h有明显差异（P〈0．05）,血清IL．8浓度各时间点无明显差异（P〉0．05）。血清IL-10含量仅见4h升高差异明显（P〈0．05）。缺血心肌IL．8mRNA表达普遍降低,其中在6h和12h IL-8 mRNA明显降低（P〈0．05）。缺血心肌IL-10 mRNA表达普遍降低,但同时间点间无明显差异（P〉0．05）。结论经肾缺血预处理后12h急性缺血心肌中浸润的白细胞减少,急性心肌梗死面积缩小,全身炎症反应减轻,提示肾缺血预处理对急性心肌缺血有保护作用。     

16层螺旋CT冠状动脉图像质量评估

目的量化评估16层螺旋CT冠状动脉各分支图像质量,探讨冠状动脉CT成像的临床应用效果。方法采用16层螺旋CT对102例患者行回顾性心电门控冠状动脉成像,男60例,女42例,平均年龄（57．8±9．4）岁,平均心率（62．8±10．2）次／min。心率〈60次／min（n=40）为I组,60～70次／min（n=35）为Ⅱ组,〉70次／min（n=27）为Ⅲ组。4条冠状动脉分支（左主干、左前降支、左回旋支、右冠状动脉）分别用于图像质量分析。扫描原始数据以间隔10％在20％～80％时相分别回顾性重建冠状动脉图像,用横断面、曲面重建、容积再现等方法对冠状动脉显示率评估。用曲面重建方法测量冠状动脉各分支长度及近段和远段对比噪声比。结果①冠状动脉各分支平均显示长度：左主干（10．9±3．0）mm,左前降支（130．3±29．7）mm,左回旋支（82．8±19．8）mm,右冠状动脉（150．5±27．5）mm;②Ⅰ组60％和70％为最佳时相图像质量优,Ⅱ组60％时相为最佳时相图像质量优,Ⅲ组RCA较优的时相为40％,LM、LAD、LCX较优时相为60％。③所有冠状动脉分支平均对比噪声比10．9±3．2。结论16层螺旋CT有较好质量的冠状动脉图像,心率和时相影响冠状动脉的成像质量。     

Distribution of coronary blood flow in the left ventricular wall of dogs evaluated by the uptake of Xe-133.

The distribution of coronary blood flow was estimated in anesthetized dogs by counting the activity in tissue blocks of the left ventricular free wall immediately after bolus injection of Xe-133 into the aortic root. No differences in the uptake of isotope were observed between the apex and the base of the heart; between areas supplied by the anterior descending and circumflex branches of the left coronary artery; or between the endo- and epicardial halves of the wall. In most experiments a bolus injection of the isotope into the left coronary artery was followed by a difference in activity between areas supplied by the left anterior descending and left circumflex branches. This indicated inadequate mixing of blood and isotope in the main stem of the artery. The uneven distribution did not result in differences between the epi- and endocardial activity concentrations. The results from one normal, anesthetized dog in which tissue activities were measured after constant rate infusion of Xe-133 into the left coronary artery for 8 min were in accordance with the general assumption of equal epi- and endocardial volumes of distribution (values of lambda).     

Distribution of Coronary Blood Flow in the Left Ventricular Wall of Dogs Evaluated by the Uptake of Xe-133

The distribution of coronary blood flow was estimated in anesthetized dogs by counting the activity in tissue blocks of the left ventricular free wall immediately after bolus injection of Xe-133 into the aortic root. No differences in the uptake of isotope were observed between the apex and the base of the heart; between areas supplied by the anterior descending and circumflex branches of the left coronary artery; or between the endo- and epicardial halves of the wall. In most experiments a bolus injection of the isotope into the left coronary artery was followed by a difference in activity between areas supplied by the left anterior descending and left circumflex branches. This indicated inadequate mixing of blood and isotope in the main stem of the artery. The uneven distribution did not result in differences between the epi- and endocardial activity concentrations. The results from one normal, anesthetized dog in which tissue activities were measured after constant rate infusion of Xe-133 into the left coronary artery for 8 min were in accordance with the general assumption of equal epiand endocardial volumes of distribution (values of Zs).     

Kinetics of Calcium Accumulation in Acute Myocardial Ischemic Injury

The effect of ischemic injury on calcium uptake by dog myocardial cells was investigated in tissue damaged by transient or permanent occlusion of the circumflex branch of the left coronary artery. Tracer doses of ⁴⁵CaCl₂ were given at selected intervals before or after occlusion, and tissue uptake was measured in damaged and control left ventricular myocardium. No significant uptake of ⁴⁵Ca occurred after 60 minutes of ischemia produced by permanent occlusion of a coronary artery. However, 40 minutes of ischemia followed by 10 minutes of arterial reflow resulted in an 18-fold increase in Ca uptake in the injured tissue. Tissue ⁴⁵Ca increased linearly up through 10 minutes of arterial reflow but did not increase further with an additional 10 minutes of reflow. Myocardium reversibly injured by 10 minutes of ischemia followed by 20 minutes of arterial reflow did not accumulate excess ⁴⁵Ca. Calcium uptake is assumed to be an active process associated with mitochondrial accumulation of calcium into dense intramitochondrial granules of calcium phosphate. The uptake is a feature of irreversible cellular injury, but occurs only when arterial blood flow is present. The mechanism of the uptake has not been established. It appears to be related to defects in cellular permeability or mitochondrial function.     

广州市儿童医院2001至2004年川崎病患儿冠状动脉损害的特点及随访

目的 探讨广州市儿童医院2001至2004年川崎病（KD）患儿冠状动脉损害的发生及恢复期变化特点。方法 采用彩色多普勒超声心动图检查广州市儿童医院收治的KD患儿，对伴冠状动脉损害者进行随访，KD患儿恢复期接受三磷腺苷负荷超声心动图检查。按急性期冠状动脉扩张的程度，将KD患儿分为冠状动脉扩张组、中小型冠状动脉瘤组和巨大型冠状动脉瘤组，分别比较其发病及变化特点。结果 共纳入KD患儿356例，冠状动脉损害发生率为41．3％（147／356）；巨大型和中小型冠状动脉瘤组确诊前发热时间明显长于冠状动脉扩张组[（18．5±12．0）d、（12．9±8．2）dw（7．4±3．6）d，P均〈0．01）]。有119例（81．0％，119／147）冠状动脉损害患儿定期门诊随访。随访2年，超声心动图显示冠状动脉扩张组72例患儿冠状动脉全部恢复正常；中小型冠状动脉瘤组77．8％（28／36）患儿冠状动脉恢复正常；巨大型冠状动脉瘤组11例患儿无一例恢复正常。40例冠状动脉有损害的KD患儿恢复期三磷腺苷负荷超声心动图检查结果显示中小型和巨大型冠状动脉瘤组室壁运动异常、冠状动脉血流储备下降的发生率显著高于冠状动脉扩张组（P〈0．05）。结论 KD患儿急性期冠状动脉扩张损害为一过性；大部分中小型冠状动脉瘤改变可恢复；巨大型冠状动脉瘤造成的损害可长期存在。超声心动图和三磷腺苷负荷超声心动图对追踪观察KD冠状动脉损害的变化及心肌供血有重要帮助。     

Measurement of regional myocardial perfusion using collimated miniature radiation detectors and the method of 133-Xenon washout

A new approach to the measurement of local myocardial perfusion based on the application of highly-collimated miniature cadmium telluride radiation detectors to measure washout of 133-Xenon from well-defined tissue volumes is presented. Single-hole collimators with length/diameter ratios of 1 (L=4 mm, D=4 mm) and 4 (L=12 mm, D=3 mm) were employed as prototype designs. The probe field of view was characterized theoretically using a spherical model of the myocardium in conjunction with experimental point source response measurements for each collimator. Method evaluation using two medium resolution collimators (L/D=1) was effected by performing left main and circumflex coronary artery perfusion studies at controlled but variable flows in the dog heart. An excellent correlation (r>0.99) between actual and estimated perfusion determined from 65 washout curves over the flow range 0.38 to 3.18 ml/min/gm was demonstrated. The ability to resolve regional flow differences was verified by measuring tracer washout from circumflex and left anterior descending regions of the myocardium, using two high resolution collimators (L/D=4), in a preparation where the left main coronary artery was cannulated and a snare was placed around the circumflex coronary artery to selectively reduce flow to that region.     

川崎病患儿冠状动脉血流储备测定与影像形态学诊断的对照研究

目的评价持续冠状动脉病变对川崎病（KD）患儿冠状动脉血液动力学的影响,探讨冠状动脉血流储备（CFR）检测在KD患儿冠状动脉病变远期随访中的应用价值。方法选择因胸痛、心悸以及各类偶发早搏的患儿为对照组,KD并发持续左冠状动脉病变患儿为KD组,均予以ATP160μg·kg^-1·min^-1持续静脉注射,共6min。运用经胸多普勒超声心动图（TTDE）检测冠状动脉左前降支（LAD）在ATP注射前后的舒张期峰值流速（PDV）及平均流速（MDV）,并通过计算比值得出相应CFR（PDV）和CFR（MDV）值。结果对照组纳入25例,CFR（PDV）和CFR（MDV）值均与年龄呈显著正相关（r=0.596,0.591,P=0.002,0.002）;〈2岁、-8岁和〉8岁组的CFR（PDV）95%参考值范围分别为≥1.22、≥1.94和≥2.22。KD组纳入8例,静息状态下PDV和MDV值分别为（50.0±15.07）cm.s^-1和（35.16±11.52）cm.s^-1,显著高于对照组（P=0.004,0.015）;而CFR（PDV）和CFR（MDV）值明显降低,分别为（1.67±0.38）cm.s^-1和（1.69±0.47）cm.s^-1（P=0.002,0.018）。与对照组比较,KD组7/8例（87.5%）患儿CFR（PDV）值显著降低。结论持续冠状动脉病变可导致KD患儿CFR值显著降低,TTDE检测患儿CFR具无创、安全和便捷的优点,对于KD冠状动脉病变的长期随访与临床诊断治疗策略的选择具有指导意义。     

小儿左冠状动脉异常的矫治术麻醉管理方法探讨

目的分析小儿起源于肺动脉的左冠状动脉异常矫治手术的麻醉特点,为今后开展类似手术提供可行的麻醉管理方法。方法回顾性分析2006年3月至2010年7月本院20例小儿起源于肺动脉的左冠状动脉异常矫治术的麻醉管理方法。结果采用静吸复合全麻,术中均未出现急性心衰或心梗,CPB时间为58～204（80.6±44.4）min,主动脉阻断时间为25～125（53.4±32.2）min,开放主动脉后均自动复跳,适时应用血管活性药物,以保证麻醉平稳,停CPB时SBP为（78.6±8.0）mmHg,DBP为（45.4±3.5）mmHg,HR为（130.8±10.5）次/min,术中无死亡及麻醉并发症。1例术后第2天死于严重低心排综合征,死亡率为5%,其余痊愈出院。结论小儿左冠状动脉异常矫治术以静吸复合全麻的方法 ,辅以严密监测,尽力维持血流动力学稳定,积极采取各种措施避免加重心肌缺血的麻醉管理方法是正确可行的,可以推广应用于术前有心功能损害的手术。     

Myocardial myoglobin following coronary artery occlusion. An immunohistochemical study

To evaluate morphologic changes and myoglobin content in normal, ischemic and necrotic myocardium, the authors studied human (n = 13) and dog (n = 28) myocardium by triphenyltetrazolium chloride staining, light and electron microscopy, periodic acid-Schiff stain for glycogen loss, and by an immunoperoxidase technique. Myocardium from autopsied patients with infarction 10-24 hours old showed loss of myoglobin from necrotic fibers. Dogs with infarcts after 3 hours or more of coronary occlusion showed myoglobin loss in fibers shown to be necrotic. In 4 dogs with 50% reduction in left main coronary artery flow for 3 hours, which demonstrated ischemia without necrosis (glycogen loss with no triphenyl tetrazolium chloride evidence of necrosis), myoglobin staining in myocardial sections was similar to nonischemic and positive control tissues. By comparison of immunoperoxidase staining with concomitant study by light and electron microscopy and histochemistry, loss of myoglobin from necrotic myocardium was demonstrated, while ischemic but not necrotic fibers stained normally. These findings indicate that necrosis is necessary for myoglobin loss from myocardium to be detected by this immunoperoxidase technique.