先天性肥厚性幽门狭窄的临床影像学诊断和手术近期效果

目的 为了准确地诊断出先天性肥厚性幽门狭窄以采取有效治疗方法。方法 分析了先天性肥厚性幽门狭窄３０例的临床特征和影像学特点，手术疗效。结果 ３０例均能通过Ｘ线钡餐和Ｂ超检查确诊右上腹触及橄榄样肿块是本症特征。２８例手术获得满意疗效。结论 采用Ｒａｍｓｔｅｄｔ幽门环肌切开术治疗先天性肥厚性幽门狭窄可获得满意的近、远期效果。     

不同剂量罗沙坦对高血压大鼠冠状动脉壁肥厚的逆转作用

为研究罗沙坦对高血压冠状动脉壁肥厚的逆转作用。将１６周大鼠分为自发性高血压大鼠（ＳＨＲ）组、ＳＨＲ口服大剂量罗沙坦组「１５ｍｇ／（ｋｇ／ｄ）」、ＳＨＲ口服小剂量罗沙坦组「０．７５ｍｇ／（ｋｇ．ｄ）」和正常血压大鼠（ＷＫＹ）组,饲养１０周,结果显示大剂量罗沙坦治疗显著降低ＳＨＲ的收缩压,降低冠状动脉壁横截面积、横截面积与内径比,提高最大冠状动脉流量小剂量罗沙坦治疗对ＳＨＲ的收缩压,外径〉２００ｕｍ冠     

缬沙坦治疗高血压病并逆转左心室肥厚改善心功能的临床研究

目的评估缬沙坦治疗高血压病的降压效果、安全性与逆转高血压心肌肥厚和改善心功能的疗效。方法以氨氯地平为对照药物，在老年性轻、中度高血压患者中进行随机、平行对照的临床研究。结果缬沙坦组患者治疗4周总有效率为60．8％（45／74），降压幅度15．6／10．9mmHg；治疗24周后总有效率为78．4％（54／74）．降压幅度21．1／17．9mmHg。缬沙坦组治疗24周后在逆转高血压心肌肥厚中取得满意的疗效，能显著逆转左室肥厚（LVH），左室后壁厚度（PWT），室间隔厚度（IVST），降低左室重量指数（LVMI），且缬沙坦组能有效地改善心功能．经治疗后患者的心脏每分输出量（CO）、左室射血分数（LVEF）、舒张早期与舒张晚期峰值流速的比值（E／A）、E峰减速度（Ede）均不同程度得到改善；缬沙坦组患者血尿酸、C-反应蛋白较治疗前明显下降，不良反应率为8．1％．主要是面红、头昏及心悸。心率、血生化、肝肾功能无明显变化。结论缬沙坦降压疗效好，且能逆转左心室肥厚，改善心功能，不良反应少，可作为治疗老年性轻、中度高血压伴左心室肥厚的一线药物。     

大鼠左心室肥厚模型研究概况

对近几年有关左心室肥厚的动物模型研究资料整理、总结，主要有压力负荷型、容量负荷型、肾性高血压型等大鼠心肌肥厚模型，同时也归纳了离体心肌细胞肥厚模型研究方法，以期为左心室肥厚的病因病机研究、临床诊疗方法及开发有效的防治药物提供理论参考。     

卡托普利逆转压力负荷增加大鼠左室重构的机理研究

目的观察卡托普利逆转压力负荷增加大鼠左室重构的作用及其机理。方法36只雄性Wistar大鼠随机分为假手术组、模型组、卡托普利组。建立腹主动脉狭窄所致充血性心力衰竭左室重构大鼠模型 ,观察左室质量指数 (LVMI) ,采用免疫组织化学染色方法观察心肌Ⅰ、Ⅲ型胶原的改变 ,采用RT-PCR方法观察心肌Ⅰ型和Ⅲ型胶原mRNA的表达 ,并采用放射免疫分析方法检测血浆和心肌血管紧张素Ⅱ (AngⅡ ) ,血浆心钠素 (ANF) ,血清醛固酮 (ALD)水平。结果模型组LVMI、Ⅰ型胶原、Ⅲ型胶原、Ⅰ型胶原mRNA表达明显高于假手术组 (P<0.001,P<0.01 ,P<0.05) ,卡托普利组LVMI、Ⅰ型胶原、Ⅲ型胶原、Ⅰ型胶原mRNA表达与模型组比明显下降 (P<0.05 ,) ;模型组Ⅲ型胶原mRNA与假手术组比较有显著升高(P<0.05) ,卡托普利组较模型组下降无显著差异(P>0.05)。模型组血浆AngⅡ、左室心肌AngⅡ、血浆ANF和血清醛固酮水平较假手术组显著升高 (P<0.001 ,P<0.01) ,卡托普利组明显降低血浆AngⅡ、左室心肌AngⅡ、血浆ANF和血清醛固酮水平 (P<0.01 ,P<0.001)。结论压力负荷增加大鼠心肌Ⅰ和Ⅲ型胶原及其mRNA的表达增加 ,具有左室重构的改变。卡托普利降低压力负荷增加大鼠心肌Ⅰ和Ⅲ型胶原及其mRNA的表达 ,具有逆转左室重构的作用。卡托普利逆转左     

中西药结合逆转高血压左心室肥厚及对左室功能的影响

目的：选择原发性高血压病1—2级合并左心室肥厚的60例患者,分为补阳还五汤合温胆汤和开博通组30例,对照组开博通组30例,治疗6个月。运用超声心动图（UCG）、测血压和临床观察等手段,观察上述治疗对临床症状改善、血压下降、左室肥厚的逆转和左室舒张功能的疗效与作用。结果：中西药疗法能有效地使血压下降,总有效率93．33％,从而有效地预防和减轻靶器官的损害;能有效地减少室间隔及左室后壁厚度,使心室腔径缩小,左室重量指数下降;随着左室肥厚的逆转,左室舒张功能明显改善,SV与CO显著增加且与LVMI的下降呈正相关;对临床症状的改善明显优于对照组。可见,通过中西药结合辨证治疗能改善与高血压病有关的各种血液动力学和神经体液调节机制,达到降压、逆转左室肥厚、改善左室功能的作用。     

cDNA芯片法筛选压力负荷型心肌肥厚相关基因

应用cDNA芯片技术筛选腹主动脉绑扎后4周大鼠的压力负荷型心肌肥厚相关基因。在反转录来自假手术及腹主动脉绑扎（4周）的大鼠心肌细胞RNA的过程中，用α－^33P-dATP进行探针的标记。然后将探针与微阵列尼龙腹杂交，高严谨度洗涤后分析杂交图谱。通过所获某种特定基因信号的相对强度来比较其对照及腹主动脉绑扎的大鼠心肌组织中表达水平的差异。结果显示有235个基因片段在两组之间信号差别在3倍以上，其中5倍以上差异的基因有55个，而在这55个基因中有26个基因功能未知。所得差异自然包括TGFβ受体III，raf,ARF,clk2等重要的信号传导分子与心肌肥厚的发生密切相关。     

压力超负荷性心肌肥厚发病机制的研究

目的:探讨α1、β受体阻断剂派唑嗪(Prazosin,Pra)、心得安(Propra-nolol,Pro)及钙离子拮抗剂尼群地平(Nitrendipine,Nit)在压力超负荷性心肌肥厚发病学中的意义。方法:采用Pra、Pro和Nit治疗大鼠腹主动脉缩窄所致左室肥厚(LVH)。结果:Pra和Nit能抑制早期肥厚心肌c-fosmRNA表达,6周后Pra组和Nit组较LVH组之BP,LVW/BW均显著下降,同时心脏舒张功能改善,Na+-K+ATPase活性增强;而Pro不能有效改善LVH。结论:Pra和Nit治疗成功预防了心肌肥厚的发生,而Pro不能。提示儿茶酚胺参与压力超负荷性心肌肥厚的形成,其效应不仅涉及后负荷的高低,也可通过α1肾上腺素能受体而不是β肾上腺素能受体对心肌产生直接性致肥大作用,同时钙离子可作为第二信使参与引起心肌细胞肥大的信息传递。     

伊贝沙坦和培垛普利对大鼠压力负荷性心肌肥厚的影响

目的:探讨钙调神经磷酸酶和钙泵活性在大鼠压力负荷性心肌肥厚时的变化及伊贝沙坦和培垛普利对它们的影响。方法:40只雄性SD大鼠随机分为5组。除假手术组外,其余4组大鼠采用腹主动脉部分结扎法造成压力负荷性心肌肥厚模型,术后1周分别用下列药物开始灌胃:假手术组和对照组生理盐水2mL·kg^-1·d^-1,伊贝沙坦组20mg·kg^-1·d^-1,培垛普利组2mg·kg^-1·d^-1及联合用药组(培垛普利2mg·kg^-1·d^-1,伊贝沙坦20mg·kg^-1·d^-1)。用药6周后检测左室质量指数、心肌细胞横径、心肌钙调神经磷酸酶及钙泵活性,免疫组化测定心肌钙调神经磷酸酶的表达。结果:联合用药组LVMI显著低于对照组及单用伊贝沙坦或培垛普利药组,各用药组TDM及钙调神经磷酸酶活性显著低于对照组,对照组心肌肌浆网钙泵活性显著低于其他各组,联合用药组钙泵活性明显高于单独用药组。免疫组化显示对照组心肌组织钙调神经磷酸酶表达显著高于其他各组。相关分析显示LVMI与TDM、CaN均呈显著正相关,与钙泵活性呈负相关。结论:伊贝沙坦和培垛普利可抑制钙调神经磷酸酶活性,增加心肌肌浆网钙泵活性,联合应用对减轻心肌肥厚有协同作用。     

压力负荷性左室肥厚大鼠心肌钠钙交换体和肌浆网钙泵的表达

目的 观察压力负荷性左室肥厚大鼠心功能异常及心肌钠钙交换体(NCX)和肌浆网钙泵(SERCA2a)的表达变化.方法 缩窄大鼠腹主动脉制备压力负荷性心肌肥厚模型,测定在体血流动力学及左室重量指数(LVWI),用RT-PCR和Western blot法检测左室组织NCX及SERCA2a的表达.结果 与假手术组相比,模型大鼠左室收缩压(LVSP)及左室舒张末压(LVEDP)均显著升高(P<0.01,P<0.001);左室重量指数显著增加(P<0.001)及左室NCX mRNA表达上调(P相似文献   

Cinnamaldehyde attenuates pressure overload-induced cardiac hypertrophy

Background: Cinnamaldehyde is a major bioactive compound isolated from the leaves of Cinnamomum osmophloeum. Studies have demonstrated that cinnamaldehyde has anti-bacterial activity, anti-tumorigenic effect, immunomodulatory effect, anti-fungal activity, anti-oxidative effect, anti-inflammatory and anti-diabetic effect. It has been proven that Cinnamaldehyde improves ischemia/reperfusion injury of pre-treatment. However, little is known about the effect of cinnamaldehyde on cardiac hypertrophy. Methods: Aortic banding (AB) was performed to induce cardiac hypertrophy in mice. Cinnamaldehyde premixed in diets was administered to mice after one week of AB. Echocardiography and catheter-based measurements of hemodynamic parameters were performed at week 7 after starting cinnamaldehyde (8 weeks after surgery). The extent of cardiac hypertrophy was evaluated by pathological and molecular analyses of heart samples. Meanwhile, the effect of cinnamaldehyde on myocardial hypertrophy, fibrosis and dysfunction induced by AB was investigated, as was assessed by heart weigh/body weight, lung weight/body weight, heart weight/tibia length, echocardiographic and haemodynamic parameters, histological analysis, and gene expression of hypertrophic and fibrotic markers. Results: Our data demonstrated that echocardiography and catheter-based measurements of hemodynamic parameters at week 7 revealed the amelioration of systolic and diastolic abnormalities by cinnamaldehyde intervention. Cardiac fibrosis in AB mice was also decreased by cinnamaldehyde. Moreover, the beneficial effect of cinnamaldehyde was associated with the normalization in gene expression of hypertrophic and fibrotic markers. Further studies showed that pressure overload significantly induced the activation of extracellular signal-regulated kinase (ERK) signaling pathway, which was blocked by cinnamaldehyde. Conclusion: Cinnamaldehyde may be able to retard the progression of cardiac hypertrophy and fibrosis, probably via blocking ERK signaling pathway.     

Triggering the succinate receptor GPR91 enhances pressure overload-induced right ventricular hypertrophy

Background: Pulmonary arterial hypertension (PAH) leads to pressure overload in the right ventricle (RV) and induces right ventricular hypertrophy (RVH). GPR91 is an orphan G-protein-coupled receptor (GPCR) that has been characterized as a receptor for succinate, which increases in RVH; however, its role remains unknown. Methods and results: We studied succinate-GPR91 signaling in a pulmonary arterial banding (PAB) model of RVH in the SD rats due to pressure overload. We report that GPR91 was located in cardiomyocytes. We found that the expressions of GPR91 and p-Akt in the RV significantly increased in the PAB model compared with the sham. In the PAB rats, the treatment of succinate further increased the p-Akt levels and aggravated RVH in vivo. In in vitro studies, succinate stimulated the up-regulation of the hypertrophic gene marker anp. All these effects were inhibited by the antagonist of PI3K, wortmannin, both in vivo and in vitro. Finally, we found that the GPR91-PI3K/Akt axis was also up-regulated compared with the sham in human RVH. Conclusions: Our results suggest that succinate-GPR91 is involved in RVH via PI3K/Akt signaling in vivo and in vitro. GPR91 may be a novel therapeutic target for RVH induced by pressure overload.     

二甲双胍对压力超负荷大鼠心肌肥厚的影响

目的:探讨二甲双胍(MET)对高血压大鼠心肌肥厚的影响及其机制。方法:制作腹主动脉缩窄(TAC)大鼠高血压心肌肥厚模型,术后1周随机分为5组(每组8只),灌胃给药8周:sham组:假手术,予蒸馏水2mL;TAC组:TAC大鼠,予蒸馏水2mL;MET组:TAC大鼠,予MET300mg·kg-1.d-1;MN组:TAC大鼠,同时给予MET300mg·kg-1.d-1和NG-硝基-L-精氨酸甲酯(L-NAME,NOS抑制剂)50mg·kg-1.d-1;NAME组:TAC大鼠,予L-NAME50mg·kg-1.d-1。处理8周后测定超声心动图、血流动力学、心肌组织学、心肌AMP激活的蛋白激酶(AMPK)及内皮型一氧化氮合酶(eNOS)的水平及活性。结果:处理8周后,TAC组大鼠左心室室壁厚度、心脏重量/体重(HW/BW)以及左心室心肌血管周围纤维化及心肌间质纤维化程度较sham组显著升高,给予MET300mg·kg-1.d-18周后,左心室肥厚及心肌纤维化显著减轻,心肌收缩及舒张功能改善(P0.05)。同时给予NOS抑制剂L-NAME则显著抑制MET上述效应。MET组大鼠左心室心肌p-AMPKαThr172和p-eNOSSer1177水平以及心肌及血清一氧化氮水平较TAC组显著升高。结论:长期给予MET治疗,显著抑制压力负荷高血压大鼠心肌肥厚及心肌纤维化程度,同时心功能改善。其机制可能与MET激活AMPK-eNOS信号通路有关。     

Exercise preconditioning attenuates pressure overload-induced pathological cardiac hypertrophy

Pathological cardiac hypertrophy, a common response of the heart to a variety of cardiovascular diseases, is typically associated with myocytes remodeling and fibrotic replacement, cardiac dysfunction. Exercise preconditioning (EP) increases the myocardial mechanical load and enhances tolerance of cardiac ischemia-reperfusion injury (IRI), however, is less reported in pathological cardiac hypertrophy. To determine the effect of EP in pathological cardiac hypertrophy, Male 10-wk-old Sprague-Dawley rats (n=30) were subjected to 4 weeks of EP followed by 4-8 weeks of pressure overload (transverse aortic constriction, TAC) to induce pathological remodeling. TAC in untrained controls (n=30) led to pathological cardiac hypertrophy, depressed systolic function. We observed that left ventricular wall thickness in end diastole, heart size, heart weight-to-body weight ratio, heart weight-to-tibia length ratio, cross-sectional area of cardiomyocytes and the reactivation of fetal genes (atrial natriuretic peptide and brain natriuretic peptide) were markedly increased, meanwhile left ventricular internal dimension at end-diastole, systolic function were significantly decreased by TAC at 4 wks after operation (P < 0.01), all of which were effectively inhibited by EP treatment (P < 0.05), but the differences of these parameters were decreased at 8 wks after operation. Furthermore, EP treatment inhibited degradation of IκBα, and decreased NF-κB p65 subunit levels in the nuclear fraction, and then reduced IL2 levels in the myocardium of rats subject to TAC. EP can effectively attenuate pathological cardiac hypertrophic responses induced by TAC possibly through inhibition of degradation of IκB and blockade of the NF-κB signaling pathway in the early stage of pathological cardiac hypertrophy.     

Therapeutic effect on left ventricular hypertrophy by different antihypertensive drugs

Left ventricular hypertrophy (LVH) constitutes a powerful independent risk factor in hypertensive heart disease. Although initially the wall stress, i.e., left ventricular afterload, remains normal, the coronary reserve is diminished due to disturbances in the microcirculation. This is also shown in the commonly present silent ischemia episodes in Holter monitoring. LVH also causes ventricular dilation and heart failure. Apart from systolic wall stress LVH is modulated by the trophic effects of the sympathetic nervous system and angiotensin II and genetic factors. Long-term antihypertensive treatment must therefore focus on regression of both LVH and the microvascular abnormalities. A step approach for the treatment of the LVH has been recommended on the basis of the experience of this working group with calcium antagonists and ACE inhibitors, whereas the place of -blockers is as yet unclear. Preliminary data indicate that coronary flow rescue can also be improved after chronic antihypertensive treatment.     

Neuregulin-1β对压力超负荷心肌肥大大鼠治疗作用及机制的研究

 目的：研究神经调节蛋白 1β（NRG-1β）对压力超负荷所致大鼠心肌肥大的治疗作用并探讨其机制。方法：Wistar雄性大鼠采用腹主动脉缩窄的方法复制心肌肥大模型。术后8周,将模型动物随机分成模型（model）组、NRG-1β治疗组（尾静脉注射NRG-1β,10 μg·kg-1·d-1）和NRG-1β+赫赛汀(Herceptin, HERCE)治疗组（尾静脉注射NRG-1β的同时给予注射HERCE 10 μg·kg-1·d-1）。假手术（sham）组除不以银夹缩窄腹主动脉外,其余操作同腹主动脉缩窄组。7　d后分别采用心动超声、血流动力学评价心功能;Masson染色观察心肌组织的超微结构;放射免疫法检测心肌组织中血管紧张素II（Ang II）,酶联免疫吸附法测定心肌组织中肿瘤坏死因子 α（TNF-α）的变化;RT-PCR法检测心肌中bcl-2和bax mRMA表达的改变。结果：（1）心动超声显示,和模型组比较,NRG-1β组左室射血分数(LVEF)及短轴缩短率(LVFS)升高,左室收缩末内径(LVESD)及舒张末内径(LVEDD)减小（P<0.01）。（2）血流动力学检测显示,NRG-1β治疗组左室收缩末压(LVESP)和左室内压最大上升和下降速率(±dp/dtmax)均明显高于模型组（P<0.01）;左室舒张末压(LVEDP)低于模型组（P<0.01）。（3）与模型组比较,NRG-1β组心肌胶原容积分数（CVF）下降,心肌中Ang II和TNF-α明显减少,bcl-2 mRNA表达显著升高,而bax mRNA表达下降（P<0.01）。（4）NRG-1β+ HERCE治疗组与模型组相比各项指标无明显改变（P>0.05）。结论：NRG-1可以减少压力超负荷大鼠心肌Ang II和TNF-α的生成,从而减轻Ang II和TNF-α介导的心肌间质重构; NRG-1可通过上调bcl-2 mRNA表达、下调bax mRNA表达,抑制心肌细胞的凋亡,改善压力超负荷大鼠的心功能,进而在心肌肥大的过程中发挥作用。     

卡维地洛对肥厚心肌能量代谢转换和结构重塑的作用研究

目的：研究卡维地洛对压力负荷性大鼠左室肥厚心肌中链脂酰辅酶A脱氢酶（MCAD）、肌型肉碱棕榈酰转移酶（M-CPT-I）和胶原结合蛋白（colligin）基因/蛋白表达变化的干预作用，阐明肥厚心肌能量代谢“胚胎型再演”和左室重塑的分子基础及卡维地洛心肌保护作用的可能机制。方法： 取健康雄性Wistar大鼠行腹主动脉缩窄（CAA）复制左室肥厚模型，取术后4周的大鼠随机分为腹主动脉缩窄（CAA）组和卡维地洛12周干预（CAR）组，设假手术（sham）组作为对照，以上每组均为12只，观察各组大鼠各项指标的变化。结果： （1）CAA组大鼠左心室湿重/体重、平均动脉压高于sham组；血清和心肌游离脂肪酸含量大于sham组；左室心肌M-CPT-I、MCAD mRNA的表达低于sham组，而colligin基因和蛋白表达高于sham组；（2）卡维地洛治疗12周后能逆转上述各项指标的变化。结论： （1）肥厚心肌脂肪酸的利用减少，能量代谢呈“胚胎型再演”， M-CPT-I和MCAD基因表达下调，可能是导致能量代谢“胚胎型再演”的分子基础；（2）卡维地洛能增加线粒体脂肪酸氧化关键酶M-CPT-I和MCAD基因的表达，促进心肌对脂肪酸的利用，对肥厚心肌能量代谢“胚胎型再演”有抑制作用；（3）卡维地洛抑制压力负荷诱导的colligin蛋白表达，抑制心肌纤维化。对心肌能量代谢模式和心室重塑的保护作用可能是卡维地洛治疗心力衰竭的重要作用机制。     

心肌肥厚大鼠左室组织中肌醇磷脂途径特征

本研究观察了心肌肥厚大鼠左室组织中肌醇磷脂途径特征。对大鼠行腹主动脉部分缩窄术制作心肌肥厚模型 ,术后 10d处死动物测全心重 体重比值 ,以免疫印迹法测左室组织Gαq 11和PLC β3 蛋白含量 ,以放免法测左室组织 1,4,5 三磷酸肌醇 (IP3 )含量。结果显示术后 10d时腹主动脉部分缩窄 (CA)组大鼠全心重 体重比值明显高于假手术 (SO)组 (P <0 0 1) ,二组大鼠左室组织Gαq 11和PLC β3 蛋白含量无显著差异 ,CA组左室组织IP3 浓度明显高于SO组 (P <0 0 5 )。上述结果提示肌醇磷脂途径可能参与压力超负荷性心肌肥厚病理过程