兔舒张性心力衰竭模型的建立

探索建立兔舒张性心力衰竭（DHF）模型的方法。采用腹主动脉缩窄法建立兔压力负荷性心肌肥厚模型,通过超声心动图监测和左心导管检查测定左室舒张末压和松弛时间常数。结果显示腹主动脉内径减少40－50％的实验兔术后8周室间隔和左室后壁明显增厚,左室舒张末压明显升高,松弛时间常数明显延长,电镜下可见其肌原纤维排列紊乱,肌节结构模糊,闰盘结构不连续,模糊,线粒体数量明显增多,丛状聚集,肌浆网肿胀,破裂,数目减少,结论为本研究成功地建立了DHF动物模型,为进一步研究DHF的发病机制,诊断和治疗提供了可靠的实验对象。     

不同左心室舒张末压慢性射血分数保留性心力衰竭患者超声心动图参数差异分析

目的:研究不同左心室舒张末压（LVEDP）慢性射血分数保留性心力衰竭（HFpEF）患者超声心动图参数变化情况,进一步探讨不同测量方法预测LVEDP升高的效能。方法:纳入2018年7月至2020年4月收治的96例HFpEF患者为研究对象,均接受左心导管检查,于舒张末期测量LVEDP。按照LVEDP实时测值,将入选患者分为A组（35例,LVEDP正常,实时测值≤15 mmHg）和B组（61例,LVEDP升高,实时测值>15 mmHg）。比较两组超声心动图参数差异,包括左心室射血分数（LVEF）、左心房容积指数（LAVI）、三尖瓣反流最大流速（TRmax）、二尖瓣口舒张早期血流速度（E）/二尖瓣口舒张晚期血流速度（A）、E峰减速时间（DT）、A峰持续时间（A-dur）、肺静脉收缩期S波流速（PVs）、舒张早期D波流速（PVd）、PVs/PVd、心房收缩期肺静脉逆向A波流速（PVa）、心房收缩期肺静脉逆向A波血流时间（Pva-dur）、心房收缩期肺静脉逆向血流时间与二尖瓣心房收缩期血流时间的差值（PvaD-AD）、二尖瓣环舒张早期平均运动速度（e）、二尖瓣环侧壁舒张早期运动速度（elat）、二尖瓣环间隔处舒张早期运动速度（esep）、E/e、E/elat、E/esep。将超声心动图中有统计学意义的参数按测量方法的不同分为LAVI、频谱多普勒相关参数（TRmax、PVa、Pva-dur、PvaD-AD）及组织多普勒相关参数（e、elat、esep、E/e、E/elat、E/esep）3个组。采用受试者工作特性曲线（ROC）对比分析这3组参数独立预测LVEDP升高的效能,且进一步对比分析LAVI联合频谱多普勒相关参数及LAVI联合频谱多普勒相关参数预测LVEDP升高的敏感度和特异度。结果:A组LAVI、TRmax、PVa、Pva-dur、PvaD-AD、E/e、E/elat、E/esep显著低于B组（P<0.05）,e、elat、esep显著高于B组（P<0.05）,LVEF、E/A、DT、A-dur、PVs、PVd、PVs/PVd与B组比较差异均无统计学意义（P>0.05）。经ROC曲线分析,预测LVEDP升高的效能最高的是频谱多普勒相关参数（TRmax、PVa、Pva-dur、PvaD-AD）诊断,其次是组织多普勒相关参数（e、elat、esep、E/e、E/elat、E/esep）,最后是LAVI。对比LAVI与频谱多普勒各参数联合诊断及LAVI与组织多普勒各参数联合诊断,以LAVI与频谱多普勒各参数联合诊断LVEDP升高的效能更高。结论:超声心动图多参数的综合应用对HFpEF患者LVEDP升高具有一定预测效能。     

超声心动图对左心室舒张性心力衰竭的评价

目的 探讨超声心动图在评价左心室舒张性心力衰竭（DHF）中的应用价值。方法 回顾性分析2012年1月—2013年10月42例DHF患者（DHF组）的临床资料,并取同时期心脏超声检查正常42人作为对照组。全部对象均采用IE33超声诊断仪常规测量左心房前后径及左右径、左心室射血分数（LVEF）,频谱多普勒测量二尖瓣舒张早期流速峰值（E峰）、二尖瓣舒张晚期流速峰值（A峰）、E峰/A峰比值、E峰减速时间（DT）,组织-频谱多普勒测量二尖瓣环舒张早期运动速度（E′峰）和二尖瓣环舒张晚期运动速度（A′峰）,并测定E峰/E′峰比值等。结果 DHF组患者的左心房前后径及左右径均大于对照组,差异均有统计学意义（P值均〈0.01）。DHF患者中女性患者左心房前后径及左右径低于男性,差异均有统计学意义（P值均〈0.01）;DHF组患者E峰/A峰比值高于对照组,A峰、DT、LVEF低于对照组,差异均有统计学意义（P值均〈0.01）;2组E峰差异无统计学意义（P值均〉0.05）。DHF组E′峰和A′峰低于对照组,差异均有统计学意义（P值均〈0.01）;正常对照组E峰/ E′峰比值均〈8,而DHF组E峰/E′峰比值均〉8,差异有统计学意义（P〈0.01）。结论 超声心动图二尖瓣频谱多普勒和组织-频谱多普勒测量二尖瓣环运动速度可以辅助左心室DHF的诊断。     

兔舒张性心衰和收缩性心衰模型建立及间质重构的比较

目的 比较兔舒张性心衰（DHF）和收缩性心衰（SHF）模型间心功能和间质重构的差异。方法 采用腹主动脉缩窄术建立DHF模型,用腹主动脉缩窄术联合破主动脉瓣术建立SHF模型,用心超和血流动力学检测心功能,用羟脯氨酸法测定心肌胶原含量,天狼猩红染色（PSR）测定胶原面积(CA)、容积分数（CVF）及Ⅰ/Ⅲ型胶原的面积比值。结果 与对照（control）组相比,DHF组心肌明显肥厚,僵硬度增加,心室舒张功能异常但射血分数（EF值）正常,间质胶原含量、面积、容积分数及Ⅰ/Ⅲ型面积比值均显著升高;SHF组心腔明显扩大,心室收缩功能异常,间质胶原含量、面积及容积分数明显升高,但Ⅰ/Ⅲ型面积比值下降（P<0.05或P<0.01）。结论 成功构建了可以代表不同临床类型两种不同心衰模型,为以后的实验研究提供了技术支持。     

超声心动图在胎儿先心病诊断中的应用价值

目的研究超声心动图在胎儿先心病产前诊断中的临床应用价值。方法自2007年6月至2008年5月对5312例孕妇进行产前系统彩色多谱勒超声筛查,对心脏病高危胎儿应用超声心动图对其心脏进行检查。结果在彩色多谱勒超声筛查中发现心脏病高危胎儿413例。对心脏病高危胎儿应用超声心动图对其心脏进行检查,诊断为先心病的胎儿为31例,产后追踪随访及尸检确诊的先心病共38例,超声心动图诊断产前检出率为81.6%,漏诊率18.4%。结论超声心动图对产前诊断胎儿先心病具有重要的临床价值。     

便携式超声心动图仪在急诊中的临床应用价值

目的 探讨便携式超声心动图仪在急诊中对协助急危重症的诊断、鉴别诊断及监测治疗相关急症诊疗中的应用价值.方法 回顾性分析武警北京市总队第二医院2011年12月至2012年10月行急诊床旁超声心动图检查的120例病例.结果 120例患者通过便携式超声心动图仪检出95例异常超声心动图改变,诊断阳性率为79.1％.95例病例中有45例冠心病,床旁超声检出32例,超声检测的准确率为71％,10例心脏瓣膜病,床旁超声检出9例,准确率为90％,12例高血压性心脏、6例各种原因引起的心功能不全、4例心肌病、4例心包积液,急诊床旁超声检出准确率为100％,5例主动脉夹层准确率为80％,6例先天性心脏病准确率为83.3％,3例肺栓塞通过急诊床旁超声均未检出.结论 便携式超声心动图仪检查方便、较为准确,对心脏相关急症的诊治具有重要的临床应用价值.     

超声心动图在诊断二尖瓣脱垂中的应用价值

目的 探讨超声心动图在诊断二尖瓣脱垂中的应用价值,特别探讨超声心动图对二尖瓣脱垂疾病的诊断以及二尖瓣脱垂部位的定位。方法 对2010年1月~2015年3月我院52例超声心动图诊断并手术证实的二尖瓣脱垂患者的二维超声、M型超声及彩色多普勒血流显像资料进行回顾性分析,对比术前超声心动图对二尖瓣脱垂的诊断与手术所见。 结果 52例二尖瓣脱垂患者,前叶病变25例,后叶病变20例,双叶病变7例,误诊1例,诊断符合率为98.07%。结论 超声心动图对二尖瓣脱垂疾病的诊断及定位脱垂部位具有很好的应用价值。     

超声心动图在诊断主动脉弓离断中的应用价值

目的 探讨主动脉弓离断的超声心动图特征,以提高对该疾病的认识及诊断能力。方法 回顾性分析我院16例经手术、心血管造影及双源CT证实的主动脉弓离断的超声特征。结果 超声心动图正确诊断11例（68.75%）均为A型;误诊5例（31.25%）,其中3例IAA-A型,2例IAA-B型;主动脉弓离断超声心动图特征为:主动脉弓与降主动脉之间的连续性中断,升主动脉发育不良,肺动脉明显扩张,明显增宽肺动脉通过未闭动脉导管与降主动脉连接。结论 超声心动图是诊断主动脉弓离断的首选方法,在超声检查中发现肺动脉明显扩张,升主动脉发育不良,并且肺动脉高压与心内畸形不匹配者,应警惕主动脉弓离断可能,仔细探查主动脉弓,若主动脉及分支显示不清,联合MRI、CT检查可提高诊断率。     

造影超声心动图在心脏肿瘤诊断中的应用价值

心脏肿瘤的临床诊断、治疗决策和预后判断高度依赖超声心动图等影像学检查.常规超声心动图对心脏肿瘤与心脏非肿瘤性占位病变的鉴别以及对心脏肿瘤的良、恶性鉴别能力有限.造影超声心动图利用微气泡进行血流示踪,能使心脏占位显示得更为清晰,提高了超声对心脏肿瘤的诊断准确率;心肌声学造影技术(MCE)还能观察占位内部的血供情况,从而有助于定性诊断心脏肿瘤的良恶性,有重要的临床应用价值.     

电刺激脊髓损伤模型兔肛周皮肤调控神经源性膀胱内压

背景：以往研究表明通过不同频率电刺激阴部神经及其分支会抑制膀胱逼尿肌的过度活动,从而治疗神经源性膀胱,基于此,能否通过电刺激阴部神经分支来抑制逼尿肌过度活动呢？ 目的：探讨电刺激脊髓损伤兔肛周皮肤调控神经源性膀胱内压可行性。 方法：选择成年雌性兔10只,在T9-T10水平横断脊髓,饲养4周后开始进行实验,电刺激采用一对钩状电极刺激肛门周围的皮肤,在膀胱内插入双腔球囊导管注入生理盐水,测量膀胱内压力。 结果与结论：当膀胱灌注量高于排尿容积阈值时,以低于10 Hz的频率电刺激肛周,会显著抑制膀胱逼尿肌过度活动;当膀胱灌注量低于排尿容积阈值时,刺激频率在20-50 Hz时,会引起膀胱收缩。最佳抑制刺激    (6 Hz)能显著增加膀胱容积(30±10)%,最佳的兴奋刺激(25 Hz)能引起大幅度(超过25 cm H2O即24.5 kPa)、长时间(20 s)的膀胱收缩。结果表明电刺激脊髓损伤兔肛周皮肤可以有效调控神经源性膀胱压力。  中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程     

CD133+细胞联合人脐血干细胞在心力衰竭小鼠中的作用

BACKGROUND: Currently, conventional treatment methods for heart failure are all ineffective. OBJECTIVE: To explore the combined effects of human umbilical cord stem cells and CD133+ cells in mice with heart failure, providing a new insight into the treatment of heart failure. METHODS: Full-term newborn umbilical cord from vaginal delivery was collected to isolate CD133+ cells and human umbilical cord stem cells using lymphocyte separation medium method. Twenty Balb/C nude mice were randomly subjected to mononuclear cell injection (mononuclear cell group) or injection of CD133+ cells combined with human umbilical cord stem cells (combined group) via the tail vein after establishing heart failure models. RESULTS AND CONCLUSION: Fourteen days after injection, the body weight and liver, heart and lung mass of mice were significantly larger in the combined group than the mononuclear cell group (P < 0.05). After 30 days, myocardial cells arranged regularly in the combined group, but disorderly in the mononuclear cell group; compared with the mononuclear cell group, the average area of myocardial collagen fibers was significantly decreased in the combined group (P < 0.05), and the level of serum matrix metalloproteinase-9 was also significantly lower in the combined group (P < 0.05). Masson staining showed that blue-stained collagen fibers in the combined group were less but arranged neatly; however, in the mononuclear cell group, the number of collagen fibers that arranged irregularly was increased to different extents. To conclude, the combined use of CD133+ cells and human umbilical cord stem cells has desired outcomes in the treatment of heart failure in mice, indicating a higher clinical value. 中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

人脐血单个核细胞中CD133+细胞移植治疗心力衰竭的评价

BACKGROUND:Cell purification can eliminate the biological variability of cells, providing new insight into cell regeneration therapy. OBJECTIVE:To study the Influence of CD133⁺ cells on human umbilical cord blood mononuclear cell transplantation for treatment of heart failure. METHODS:Human cord blood mononuclear cells were isolated using lymphocyte separation medium method, and CD133⁺ and CD133^- cells were sorted using immunomagnetic beads at a cell density of 1×10⁸/L. Forty Sprague-Dawley rats were randomized into five groups: sham group, model group, CD133⁺ cell group, CD133^- cell group and mononuclear cell group. Animal models of heart failure were made using intraperitoneal injection of isoproterenol in all the groups except for the sham group. Rats in the CD133⁺ cell group and CD133^- cell group were given 1 mL CD133⁺ cells plus 1 mL PBS and 1 mL CD133^- cells plus 1 mL PBS via the tail vein, respectively. Rats in the mononuclear cell group were given 1 mL CD133⁺ cells plus 1 mL CD133^- cells via the tail vein, and those in the sham and model groups given 2 mL PBS via the tail vein. After 4 weeks, cardiac pathology, degree of myocardial fibrosis and colonization of CD133⁺ cells in myocardial tissues were observed. RESULTS AND CONCLUSION:Hematoxylin-eosin staining showed that myocardial tissues arranged disorderly in the model group, but regularly in the sham group; myocardial disorders were mildest in the CD133⁺ cell group, successively followed by the mononuclear cell group, and severest in the CD133^- cell group and model group. Masson staining showed that in the model group, collagen fibers were proliferated, arranged irregularly and even broken, while in the sham group, the collagen fibers were less in number and arranged in order. Additionally, there was less reduction in collagen fibers and milder myocardial disorders in the CD133⁺ cell group compared with the other groups. Area of collagen fibers was increased significantly in all the groups except for the sham group (P < 0.05), but this increment was the minimal in the CD133⁺ cell group. Findings from immunohistochemistry and immunofluorescence staining showed that there were no CD133⁺ cells in the myocardial tissues of rats. Therefore, our data indicate that compared with the mononuclear cell transplantation, CD133⁺ cell transplantation exerts superiorities in relieving myocardial damage and reducing myocardial fibrosis. However, CD133⁺ cells are not colonized in the myocardial tissue after transplantation.     

静脉移植骨髓间充质干细胞对心肌病心力衰竭心功能的影响

BACKGROUND:Bone marrow mesenchymal stem cell transplantation can effectively improve decreased cardiac function caused by heart failure, but there is a lack of research about the effect in bone marrow mesenchymal stem cell transplantation on cardiac function in heart failure induced by cardiomyopathies. OBJECTIVE:To explore the effect of bone marrow mesenchymal stem cell transplantation on cardiac function in patients with cardiomyopathies accompanied by heart failure. METHODS:Totally 40 Sprague-Dawley rats were enrolled, and bone marrow mesenchymal stem cells were isolated from 10 rats, and the remaining rats were equivalently randomized into normal, model and stem cell transplantation groups. Then rats in the model and stem cell transplantation groups were given intraperitoneal injection of hydrochloric acid doxorubicin to prepare cardiomyopathy-induced heart failure models. At 7 days after modeling, the stem cell transplantation group was treated with bone marrow mesenchymal stem cells through intravenous transplantation, and the model group was treated with equal amount of DMEM medium. Four weeks later, cardiac function of each rat was detected, and the cell survival and differentiation were observed by immunofluorescence method. RESULTS AND CONCLUSION:At 4 weeks after transplantation, compared with normal and stem cell transplantation groups, the left ventricular systolic pressure and maximum rise/fall rate of left ventricular pressure were significantly decreased, but the left ventricular end diastolic pressure significantly increased in the model group (P < 0.05). And there was no significant difference between the normal group and the stem cell transplantation group (P > 0.05). High and dense fluorescence intensity was observed in the host myocardium immediately after transplantation. Subsequently, the fluorescence intensity and density decreased at 4 weeks, but the cell migration could be found, and some cells expressed cardiac troponin T. These results show that intravenous transplantation of bone marrow mesenchymal stem cells can improve cardiac function in rats with heart failure due to cardiomyopathies. Besides, the transplanted cells can survive in the host, and differentiate into cardiomyocyte-like cells.     

Statin therapy blunts inflammatory activation and improves prognosis and left ventricular performance assessed by Tissue Doppler Imaging in subjects with chronic ischemic heart failure: results from the Daunia Heart Failure Registry

BACKGROUND:

A limited number of studies have used Tissue Doppler Imaging (TDI) to evaluate the effect of statin therapy on left ventricular dysfunction in patients with chronic heart failure. In this work, we aimed to determine whether statin administration influenced prognosis, inflammatory activation and myocardial performance evaluated by Tissue Doppler Imaging in subjects enrolled in the Daunia Heart Failure Registry, a local registry of patients with chronic heart failure.

METHODS:

This study retrospectively analyzed 353 consecutive outpatients with chronic heart failure (mean follow-up 384 days), based on whether statin therapy was used. In all patients, several Tissue Doppler Imaging parameters were measured; circulating levels of interleukin (IL)-6, IL-10 and C-reactive protein were also assayed.

RESULTS:

Statin administration in 128 subjects with ischemic heart disease was associated with a lower incidence of adverse events (rehospitalization for HF 15% vs. 46%, p<0.001; ventricular arrhythmias 5% vs. 21%, p<0.01; cardiac death 1% vs. 8%, p<0.05), lower circulating levels of IL-6 (p<0.05) and IL-10 (p<0.01), lower rates of chronic heart failure (p<0.001) and better Tissue Doppler Imaging performance (E/E'' ratio 12.82±5.42 vs. 19.85±9.14, p<0.001; ET: 260.62±44.16 vs. 227.11±37.58 ms, p<0.05; TP: 176.79±49.93 vs. 136.7±37.78 ms, p<0.05 and St: 352.35±43.17 vs. 310.67±66.46±37.78 ms, p<0.05).

CONCLUSIONS:

Chronic ischemic heart failure outpatients undergoing statin treatment had fewer readmissions for adverse events, blunted inflammatory activation and improved left ventricular performance assessed by Tissue Doppler Imaging.     

Current strategies for preventing renal dysfunction in patients with heart failure: a heart failure stage approach

Renal dysfunction is common during episodes of acute decompensated heart failure, and historical data indicate that the mean creatinine level at admission has risen in recent decades. Different mechanisms underlying this change over time have been proposed, such as demographic changes, hemodynamic and neurohumoral derangements and medical interventions. In this setting, various strategies have been proposed for the prevention of renal dysfunction with heterogeneous results. In the present article, we review and discuss the main aspects of renal dysfunction prevention according to the different stages of heart failure.     

脂肪来源细胞在缺血性心脏病中的应用

 脂肪来源细胞（褐色脂肪来源细胞、脂肪干细胞和去分化脂肪细胞）可分化成心肌样细胞,移植后可改善心梗后心功能,降低心室重塑,有可能成为最有潜力的治疗缺血性心脏病的干细胞来源。     

超声心动图对胎儿先天性心脏病产前诊断价值的Meta分析

目的探讨超声心动图用于胎儿先天性心脏病（CHD）的产前诊断价值。方法检索Cochrane图书馆、PubMed、OVID、Springer数据库、中国期刊全文网、万方数据库和中国生物医学文献数据库（从1990年1月至2009年1月）中的文献,按照诊断试验的严格纳入标准筛选文献,提取纳入文献的特征信息。采用Meta-DiSc1.4软件进行Meta分析,检验异质性,并根据异质性结果选择相应的效应模型。对所有文献予以加权定量合并,计算敏感度和特异度及其95%CI。绘制汇总受试者工作特征（SROC）曲线,并计算曲线下面积（AUC）,最后进行敏感度分析。结果共纳入文献18篇,检查胎儿77939例。7篇文献采用基本心脏超声检查（BCEE）筛查胎儿CHD,研究间具异质性,采用随机效应模型,汇总敏感度、特异度和SROCAUC分别为41.7%、99.9%和0.9787。12篇文献采用扩展心脏超声检查（ECEE）筛查胎儿CHD,研究间具异质性,采用随机效应模型,汇总敏感度、特异度和SROCAUC分别为66.9%,99.9%和0.9956。ECEE的敏感度显著高于BCEE（χ2=63.93,P〈0.05）。对BCEE和ECEE筛查胎儿CHD的文献进行分层和敏感度分析,两种检查方法在妊娠中至晚期筛查胎儿CHD的敏感度均高于妊娠中期（χ2分别为5.47和39.37,P均〈0.05）;ECEE筛查存在CHD低危因素孕妇的胎儿CHD的敏感度低于所有孕妇和存在CHD高危因素孕妇胎儿的敏感度,差异有统计学意义（χ2分别为81.82和156.58,P均〈0.05）;ECEE筛查所有孕妇与存在CHD高危因素孕妇的胎儿CHD的敏感度差异无统计学意义（χ2=1.67,P〉0.05）。结论超声心动图对胎儿CHD的诊断敏感度较高,适用于早期筛查胎儿CHD,但仍需进一步前瞻性、多中心的研究对胎儿筛查人群和超声切面的选择等方面进行卫生经济学评估,探讨适合中国国情的胎儿CHD的最优化超声筛查操作规范。     

舒张性心力衰竭兔Ca2+调控蛋白mRNA和蛋白质的表达

目的:探讨心肌细胞内Ca²⁺超负荷以及Ca²⁺调控蛋白在舒张性心力衰竭(DHF)发生中的作用。方法:采用RT-PCR和Westernblot技术测定实验兔Ca²⁺调控蛋白mRNA和蛋白质表达的变化。结果:⑴DHF兔心肌细胞内Ca²⁺含量显著高于假手术组(P＜0.01);⑵DHF兔SRCa²⁺-ATPase活性明显低于假手术组(P＜0.01);⑶DHF兔SRCa²⁺-ATPase和细胞膜L型Ca²⁺通道的mRNA水平明显低于假手术组(P＜0.05),而磷酸受纳蛋白、兰尼碱受体和肌集钙蛋白的mRNA转录无明显差异(P＞0.05);⑷DHF兔SRCa²⁺-ATPase的蛋白质表达明显低于假手术组(P＜0.05);磷酸受纳蛋白的相对含量与假手术组无明显差异(P＞0.05)。结论:SRCa²⁺-ATPase的mRNA和蛋白质表达减低以及细胞膜L型Ca²⁺通道mRNA转录减低是导致心肌细胞内Ca²⁺超负荷及DHF发生的重要因素。