酒精性心肌病发病机制研究进展

长期大量饮酒可引起心脏进行性扩大、并发各种心律失常和心力衰竭,以此为特征的心肌病变称为酒精性心肌病。研究发现,酒精性心肌病的发病与线粒体功能障碍和循环变化、炎症反应、细胞凋亡、B族维生素缺乏、代谢紊乱、氧化应激损伤等机制相关,线粒体功能障碍、氧化应激损伤与细胞凋亡成为近几年研究的重点。本文主要阐述酒精性心肌病发病机制研究的进展情况。     

原发性心肌病与心力衰竭

心肌病(cardiomyopathy)是指除高血压性心脏病、冠状动脉粥样硬化性心脏病、心脏瓣膜病、先天性心血管疾病和肺源性心脏病等以外的、以心肌病变为主要表现的一组疾病[1]。1995年世界卫生组织及国际心脏病学会工作组将心肌病定义为伴心功能障碍的心肌疾病,并将其分为原发性心肌病和继发性心肌病[2]。近年,随着对心肌病的研究不断深入,心肌病的分类也几经改动,我国2007年制定的     

老年心肌病心力衰竭的诊治

心肌病是导致老年人心力衰竭和死亡的主要疾病之一.近年,随着检查诊断技术的发展和社会老龄化的进展,老年人心肌病的检出率明显增高.该病是由包括遗传因素在内的各种病因引起的一组非均质的心肌病变,包括心脏机械和电活动的异常,常表现为心室不适当的肥厚或扩张.     

儿童先天性心脏病心力衰竭的再同步化治疗

有关成人充血性心力衰竭心脏再同步化治疗的研究表明,合理选择患者是关键,根据超声心动图评价的心肌机械活动不同步优于以QRS时限为标准。本文综述了儿童先天性心脏病心力衰竭再同步化治疗的条件和再同步化治疗在此类患者中的应用价值。     

糖尿病心肌病的病理及发病机制研究进展

<正> 1972年Rubler等首先提出糖尿病心肌病(diabetic cardiomyopathy,DCM)的概念,之后的临床、流行病学以及实验研究均表明,DCM并非继发于冠心病、高血压或其他已知的心血管疾病,而是糖尿病(diabetes mellitus,DM)状态下一组独立的心肌病变。目前DCM的定义为排除心脏瓣膜病、先天性心脏病、高血压、酒精中毒和冠心病等后,由DM导致的心肌原发性代谢障碍性改变和微血管病变所引起的心脏病。DM从多个方面损害心肌,导致了DCM的发生与发展,但确切机制仍未完全阐明。现就DCM的病理改变以及发病机制的研究进展作一综述。1 DCM的病理改变1.1 心肌细胞病变DM可导致心脏质量增加,病程较长的DM患者不论是否合并心力衰竭,心脏均有增大。可见心肌细胞肥大,肌丝扭曲,心肌内三酰甘油、胆固醇及糖原含量增加,严重者有局灶性坏死和纤维化。心肌细胞超微结构可见,肌原纤维收缩     

老年舒张性心力衰竭发病机制研究进展

舒张性心力衰竭(DHF)是指一组以具有心力衰竭的症状和体征、左心室射血分数正常而舒张功能异常为特征的临床综合征.流行病学研究表明,心力衰竭患者中30%～50%属于DHF,65岁以下人群DHF患病率小于1%,而65岁以上人群的患病率大于5%[1].很多基础性的疾病,如高血压病、冠心病、糖尿病、肥厚型心肌病、心肌淀粉样变性等,可通过不同机制(引起心肌肥厚、心肌纤维化、心肌缺血和心肌浸润性病变等)导致心脏舒张功能不全和DHF,老龄所带来的心血管的生理变化也是其中一个重要的独立因素[1].我们就目前老年DHF的发病机制方面的研究进展进行综述.     

趋化因子CXCL16在心力衰竭发病机制中的研究进展

心力衰竭(HF)是心血管疾病死亡率增加的重要原因,尽管新的治疗方案不断引进,但HF患者的死亡率仍很高.随着研究的进展,人们发现HF的病理生理过程不仅受神经内分泌系统影响,而且与炎症细胞因子的调控密切相关,而趋化因子是炎症发生、发展的过程中重要的促炎细胞因子.在众多趋化因子家族中,CXC亚族是近年来研究的热点,其中CXCL16是既能以分泌又能以膜结合形式存在的趋化因子,在心血管疾病中作用受到越来越多学者的关注,但在HF中却鲜有报道.     

卡托普利联合倍他乐克治疗心力衰竭92例

1资料与方法 1.1一般资料选择我院1998年1月-2002年6月住院的慢性充血性心力衰竭(CHF)病人178例,心力衰竭史2年以上,心功能Ⅱ级或Ⅱ级以上.其中男性95例,女性83例,年龄32岁～76岁,平均51.6岁.     

酒精性心肌病发病机制研究新进展

<正>酒精性心肌病(alcoholic cardiomyopathy,ACM)是指长期大量酒精摄入所导致的以心脏扩大、心律失常和充血性心力衰竭为特征的心肌病变;1995年世界卫生组织及国际心脏病学会联合会(WHO/ISFC)工作组关于心肌病的定义和分类的报道中将ACM列为特异性心肌病中的过敏性和中毒反应所致的心肌病。在发达国家和许多发展中国家(包括中国)ACM的患病率逐年上升,严重威胁人类的健康,     

慢性心力衰竭合并心律失常发病机制研究进展

慢性心力衰竭(chronic heart failure,CHF,简称心衰)是一种进行性的病变,一旦起始,即使没有新的心肌损害,临床亦处于稳定阶段,仍可自身不断发展[1].心衰患者在疾病发展过程中可并发不同类型心律失常,其中以房颤最多见且与预后密切相关,另外还可合并室性早搏、室性心动过速等.据现有资料表明,心衰合并房颤的发病率为40.6％,合并室性早搏为20.4％,合并室性心动过速为6.6％[2].心衰并发室性心律失常是心脏性猝死的主要原因,占总死亡率的40％～50％[1].因此有效防治慢性心衰合并心律失常,降低心源性猝死率具有重要的临床意义.本文将重点讨论慢性心力衰竭合并心律失常常见发病机制.     

The pathogenesis of heart failure in infants with congenital heart disease.

BACKGROUND: The clinical symptoms of heart failure in infants with left-to-right shunts are thought to be explained by well-known hemodynamic disturbances such as pulmonary hypertension and overcirculation, but previous studies have not, thus far, found the expected correlations with hemodynamic and clinical parameters. Based on the neurohormonal model of heart failure, we hypothesised that the clinical symptoms of infants with left-to-right shunts are also related to neurohormonal disorders. METHODS: We compared various neurohormonal and hemodynamic parameters measured invasively in 70 infants with left-to-right shunts to the respiratory rate and gain in weight over a corresponding period of time. Heart rate correlated significantly with respiratory rate (r = 0.62***, p < 0.001) and gain in weight (r = -0.31*, p = 0.015), but more conventional measures of severity, such as the ratio of pulmonary to systemic flows, failed to show comparable correlations with clinical symptoms. Respiratory rate was related to levels of norepinephrine (r = 0.47***, p < 0.001) and plasma renin activity (r = 0.65***, p < 0.001). The important impact of autonomic imbalance on respiratory rate was underlined by an analysis of variability of heart rate in 26 infants that showed significantly reduced values for the domains of time and frequency. We were not able to find a conclusive multiple regression model with which to explain the symptom "failure to thrive". CONCLUSIONS: A increased heart rate, reduced variability in heart rate, and elevated levels of norepinephrine and renin are significant predictors of clinical symptoms such as tachypnea in infants with congenital cardiac malformations. The neurohormonal hypothesis, in which heart failure is interpreted not only as a hemodynamic derangement but also as a neurohormonal disorder, may be valid for infants with congenital cardiac malformations.     

先天性心脏病患儿围术期急性心力衰竭正性肌力药物治疗研究进展

先天性心脏病(congenital heart disease,CHD)围术期最常见及最严重的并发症是低心排血量综合征(low cardiac output syndrome,LCOS),而导致LCOS的最主要原因即为急性心力衰竭.因此,需要使用正性肌力药物调整患儿心肌收缩力及心脏前、后负荷.本文将对CHD患儿围术期急...     

先天性心脏病并发肺动脉高压的研究进展

由于先天性心脏病（先心病）并发肺动脉高压（PAH）患者的死亡率和致残率均较高,人们重新审视了先心病并发PAH的流行病学特征及分类,并探索新的治疗手段,发掘新的能够反映PAH严重程度及预后的生物学标志物,为先心病并发PAH诊治水平的提高开辟了广阔的前景。     

非编码RNA在先天性心脏病中的研究进展

先天性心脏病是心血管结构及心电传导系统先天性畸形疾病的总称,是常见并且严重的出生畸形。随着最新分子生物学及遗传生物学的深入研究,越来越多的证据表明 非编码RNA 与先天性心脏病的发生、发展相关。本文将就目前国内、外非编码RNA 与先天性心脏病的关系的研究进展进行综述。     

Circulating endothelin in children with congenital heart disease.

OBJECTIVE--To evaluate whether circulating endothelin, a peptide that is thought to play a part in mediating vascular tone, might be high in pulmonary hypertensive congenital heart disease. DESIGN--A prospective study with a radioimmunoassay technique to estimate urinary and plasma endothelin concentrations. SETTING--A supraregional referral centre for patients with congenital heart disease. PATIENTS--The 12 hour urinary endothelin concentration in young children with an increased pulmonary blood flow (n = 24, median age eight months) were compared with those in children with right ventricular outflow tract obstruction (n = 14, median age 1.5 years) and with those in healthy controls (n = 16, median age 1.8 years). The concentrations were also measured in adolescents with irreversible pulmonary vascular disease (n = 17, median age 18 years) and compared with those in controls of similar age (n = 19, median age 18.5 years). Also the plasma concentrations in the left atrium and pulmonary artery were measured in young children with either high (n = 11, median age 10.8 months) or low (n = 5, median age 1.0 year) pulmonary blood flow, in the peripheral arterial and venous blood of young children with either high (n = 13, median age 10.8 months) or low (n = 6 median age 1.9 years) pulmonary blood flow, and in the peripheral venous blood of seven healthy young children (median age 1.7 years). RESULTS--The urinary excretion of endothelin was similar in young children of a similar age, whether they had high, low, or normal pulmonary blood flow. Also, urinary endothelin excretion in older patients with irreversible pulmonary vascular disease was similar to that in normal subjects of similar age. Urinary endothelin excretion in normal young children, however, was significantly greater than that in normal older subjects (p = 0.0001). There was no transpulmonary or arteriovenous difference detected in either children with high or low pulmonary blood flow, and plasma concentrations sampled from the left atrium, pulmonary artery, and systemic artery and vein were similar in both groups. CONCLUSION--There was no evidence to implicate circulating endothelin in the pathogenesis of pulmonary vascular disease.     

AMPK与心力衰竭发病机制和治疗的研究进展

心力衰竭（heart failure,HF）作为心血管疾病的终末阶段,是一种复杂的临床综合征,主要表现为心脏的收缩和舒张功能障碍。虽然治疗HF的药物在不断更新,但其病死率仍维持在较高水平,因此人们需要不断探索HF新的治疗靶点。近年来的研究表明单磷酸腺苷活化蛋白激酶（AMP-activated protein kinase,AMPK）参与HF的发生发展,可调控HF时的心肌代谢、心肌纤维化、氧化应激等。现对AMPK保护HF的机制及其相关药物的研究进展作一综述。     

Nutritional status of children with congenital heart disease.

OBJECTIVE--To assess the nutritional status of children with congenital heart disease. DESIGN--Six anthropometric, 24 biochemical, and five haematological markers of nutritional wellbeing were measured in children with congenital heart disease. SETTING--The west of Scotland. PATIENTS--48 children admitted consecutively for surgical correction of congenital heart disease. MAIN OUTCOME MEASURES--Height, weight, and triceps and subscapular skin fold thicknesses were considered abnormal if they were below the third centile compared with standard reference data for age matched British children. Mid-arm circumference and arm muscle circumference were considered abnormal if they fell below the fifth centile compared with standard data. Biochemical and haematological data were compared with age matched and locally validated laboratory normals. RESULTS--A marked degree of undernutrition was evident in all children; 52% had weight less than the third centile, 37% were below the third centile for height, and 12.5% were below the third centile for triceps skin fold thickness and 18.8% for subscapular skin fold thickness. Mid-arm circumference and arm muscle circumference were below the fifth centile in 20.1% and 16.7% of children respectively. Five or more of the 29 biochemical and haematological measurements were abnormal in 83.3% of patients; 10 or more were abnormal in 12.5% of patients. CONCLUSIONS--Children with congenital heart disease are frequently undernourished, irrespective of the nature of cardiac defect and the presence or absence of cyanosis.