不同干细胞来源的外泌体在缺血性心脏病中的促血管新生作用

缺血性心脏病是指各种原因造成心肌供血量不足,导致氧气和营养物质供应不足,引起各种心脏功能障碍.促血管新生是治疗缺血性心脏病的一个关键因素.越来越多的研究表明,干细胞来源的外泌体作为一种细胞间相互作用的媒介,为缺血性心脏病的治疗提供了新的可能.现对各种干细胞来源的外泌体在治疗缺血性心脏病中促血管新生作用及机制做一综述.     

外泌体miRNA在肿瘤进展中的作用及其可能机制

外泌体是一种生物纳米小囊泡、直径约30~100 nm,机体中几乎所有类型的细胞均可以合成、分泌、释放。最新研究发现,外泌体中包含多种功能蛋白质、mRNA和microRNAs （miRNAs）等,在细胞间进行物质传递和信息交流过程中起着非常重要的作用。而肿瘤细胞分泌的相关外泌体miRNA,对肿瘤的发生、发展、侵袭转移等生...     

外泌体在心房颤动中的作用研究进展

心房颤动是临床上最常见的快速性心律失常之一,常引起脑卒中、冠心病、心力衰竭、肢体动脉栓塞等严重并发症,是导致患者不良预后的重要因素.外泌体是细胞释放的30～150 nm大小的双层脂质囊泡,携带蛋白质、核酸和脂质等生物活性物质;其作为信息传递的媒介,在细胞间通讯中起着关键作用.近年研究发现外泌体广泛参与心血管疾病的病理生...     

外泌体在肝细胞癌发生进展及诊断治疗中的作用

外泌体是一种介导细胞间信息交流的功能载体,通过传递功能活性物质(如蛋白质、脂质、RNA分子、循环DNA等)在细胞间发挥作用,主要集中在免疫监测和肿瘤发生进展中方面.最近,越来越多的研究关注于外泌体在肝细胞癌(hepatocellular carcinoma,HCC)中的作用,除了诊断HCC外,还与发生和发展的机制包括血管生成和免疫逃逸等密切相关.因此,我对外泌体在HCC发生发展、诊断和治疗中的最新实验和临床研究数据做一综述.外泌体通过调节肿瘤微环境的耐受状态来调节免疫反应和肿瘤抑制,说明其在治疗HCC中具有作为靶点和药物载体的实用性和潜在可行性.未来将进一步阐明外泌体作为肝癌患者筛查、诊断和治疗靶点的确切作用和可靠性.     

外泌体miRNA在心血管疾病诊断及治疗中的研究进展

外泌体是由脂质膜双层包围的小囊泡(直径为30～150 nm),它们携带各种分子,包括蛋白质、脂质、mRNA和其他RNA物种,例如长的非编码RNA、环状RNA和microRNA.microRNA是内源性非编码RNA分子,是一种蛋白质生物合成的重要调节剂.越来越多的证据表明外泌体microRNA广泛参与心血管疾病的发生和发...     

外泌体及外泌体微小RNA在肺动脉高压中的作用与机制

<正>肺动脉高压(pulmonary hypertension,PH)是一种以进行性血管狭窄和平均肺动脉压升高为特征的慢性致死性疾病,随着病程的进展,常导致右心衰竭和死亡。其中肺血管重塑是PH的关键病理变化,包括肺血管细胞的增殖和凋亡异常,远端肺动脉的肌化,细胞外基质蛋白的沉积和血管周围的炎症。目前治疗PH尽管能够缓解临床症状,但仍不足以逆转PH的进展并提高生存率,迫切需要新的治疗方法。微小RNA(microRNA,miRNA)是一类具有不同功能和调节活性的非编码RNA,已经在许多疾病中进行了大量研究。外泌体(exosomes,EXOs)是纳米载体,能够将不同的货物(例如miRNA)转移至受体细胞。越来越多的证据表明,外泌体     

外泌体在心血管疾病诊断和治疗中的作用研究进展

外泌体为大小在30～100 nm之间,是由分泌前细胞内的多泡体反向出芽而产生的纳米级囊泡。从功能上看,外泌体能够封装和传送各种生物活性分子并释放到细胞外空间,通过细胞间通讯从而影响邻近及远处的细胞功能。不仅如此,外泌体组成成分和生物含量也会随之变化,因此其还可作为细胞功能变化或疾病的指示子。近年多项研究表明,外泌体在心血管疾病的发生发展过程中发挥着重要的作用,因此可能成为心血管疾病诊断和治疗的重要切入点。本文将从外泌体的产生和对心血管疾病诊断及治疗的潜力等方面进行综述。     

外泌体源性miRNA在纤维化疾病中的作用机制及其相关信号通路研究进展

纤维化是以细胞外基质异常增多或过度沉积为特征的病理过程,可导致器官、组织结构受损甚至器官衰竭.外泌体通过分泌蛋白质、脂质和核酸等生物信息进行细胞间通信,其携带的微小RNA(miRNA)在纤维化疾病中发挥重要作用.外泌体源性miRNA能够通过多种信号通路介导成纤维细胞增殖分化、间充质细胞转化及细胞凋亡,进而在纤维化疾病中...     

糖尿病足溃疡修复中外泌体miRNA作用机制的研究进展

糖尿病足溃疡（DFU）是DM严重并发症。外泌体（Exos）携带的miRNA是DFU伤口闭合过程中血管生成的重要调节剂,在调节DFU进展中发挥重要作用。本文综述Exos中的miRNA在DFU修复中作用机制的研究进展。     

Stress Doppler echocardiography in the evaluation of ischemic heart disease

Doppler echocardiography enables convenient, noninvasive evaluation of global, systolic performance at rest and during exercise. Early studies suggested that Doppler parameters of systolic function were sensitive to exercise-induced myocardial ischemia and could identify patients with severe coronary artery disease. Subsequent investigation, however, has identified several factors in addition to myocardial ischemia that can significantly influence exercise Doppler study results. Thus, in order to obtain reliable information, the many factors that can influence Doppler measurements of aortic flow velocity and acceleration must be accounted for. Further work in this area is likely to produce results that encourage greater application of this technique in experimental and clinical research. At present, the role of stress Doppler echocardiography in the evaluation of ischemic heart disease remains uncertain.     

雌激素与缺血性心脏病

以往的临床观察证实 ,生育年龄的女性缺血性心脏病的发病率和死亡率明显低于同龄男性。绝经后的妇女服用雌激素与不服用雌激素相比 ,前者心脏病事件少于后者。尽管临床的观察结果还有争议 ,越来越多的临床前期研究表明 ,雌激素对缺血性心脏病具有保护作用。研究结果显示 ,雌激素和其受体调节器是通过减少炎性反应在缺血/再灌注引起心肌损伤时起保护作用的。本文作者就近年的一些研究结果作一综述 ,并就雌激素替代治疗处理心肌缺血及再灌注损伤进行探讨。     

干细胞治疗缺血性心脏病的分子影像评价

缺血性心脏病(IHD)是目前世界范围内致病和致死的主要原因之一,干细胞(SC)作为一项潜在的治疗手段,成为当今实验室研究的热点,然而在研究过程中,遇到诸多问题:如SC在体的存活率不高及功能发挥不理想等。分子影像,包括多种多样的成像技术,一方面可以非侵入性的观察细胞,另一方面通过较长时间追踪细胞的转归和分化情况,指导优化SC治疗效果。本文将从以下3个方面介绍近年来在分子影像技术SC治疗IHD上的进展及突破:SC移植后在体内存活增殖的分子影像评估;移植SC在体功能的分子成像;针对SC治疗安全性的分子成像。最后,我们对分子影像的应用提出设想和展望。     

The effects of captopril on training in patients with ischemic heart disease.

We studied a group of 30 patients to determine the effect of captopril on the exercise training response after a period of training in patients with ischemic heart disease but without cardiac failure. The study was a double-blind placebo-controlled comparison of captopril and placebo. The patients studied were 28 men and 2 women, mean age 53.6 +/- 6.9 years. All were 8 to 12 weeks postmyocardial infarction or coronary artery bypass surgery. These patients underwent an organized exercise training program consisting of exercise training sessions 3 times weekly for a period of 8 weeks. On commencement and completion of the program patients were assessed for exercise tolerance using submaximal exercise stress testing. Patients were assessed in the untreated state. Both groups showed a statistically significant training effect with increased exercise duration, decreased heart rate for equal workload, increased energy expenditure, and reduced functional aerobic impairment. There was no statistically significant change in systolic blood pressure, but the captopril group alone showed a significant reduction in diastolic blood pressure (p less than 0.001). The change in heart rate at rest over the 8-week period was not significant in both groups. In summary, this study shows that treatment with captopril does not affect the exercise training response in patients with ischemic heart disease undergoing an organized exercise training program.     

内皮细胞在缺血性心脏病及心力衰竭中的作用

内皮细胞是上皮细胞的一种,广泛分布于心、血管和淋巴管腔面,在人体生理稳态中参与止血、血管调节、血管生成等重要过程.近年来有研究发现,内皮细胞除上述作用外,还促进了缺血性心脏病等多种疾病的病理进展,并且表现出独特的多向分化能力,其中内皮间质转分化能力与心肌纤维化及心力衰竭关系密切.本文主要探讨血管内皮细胞生理特点及在缺血...     

Effect of aprindine on heart rate variability indices in patients with ischemic heart disease

BACKGROUND: Decreased heart rate variability indices (HRV) are associated with untoward outcome of patients with ischemic heart disease (IHD). Most class I antiarrhythmic agents decrease HRV, but aprindine (a new class I antiarrhythmic agent) is reported to increase HRV in patients without ischemia. HYPOTHESIS: The study was undertaken to determine whether apridine might increase HRV in patients with IHD. METHODS: To investigate the effect of aprindine on HRV in patients with IHD, we performed 24-h ambulatory electrocardiogram (ECG) at the end of placebo and aprindine (60 mg daily) treatment phases on 38 patients with IHD and at least isolated premature ventricular contractions (PVC). The study protocol utilized a single blind, 4-week, placebo-controlled design. Heart rate variability from ambulatory ECG included SDNN (ms), SDANN (ms), SD (ms), rMSSD (ms), pNN50 (%); frequency analysis of HRV consisting of total (ms, 0.01-1.00 Hz), low (ms, 0.04-0.15 Hz), and high (ms, 0.15-0.40 Hz) components. RESULTS: Study patients were divided into three groups according to the severity of IHD and antiarrhythmic efficacy of aprindine. Group 1 consisted of 15 patients with angina with single-vessel disease, and Group 2 was composed of 10 patients with either multivessel disease or post myocardial infarction; PVCs decreased in both groups as result of aprindine treatment. Group 3 consisted of 13 patients who showed no decreased PVC after aprindine treatment. RMSSD increased, and pNN50 and high-frequency spectra tended to increase in Group 1, while SD, rMSSD, pNN50, and total and low-frequency spectra decreased in Group 3; no significant changes were observed in Group 2. Aprindine significantly augments vagal activity, as reflected by the increase of rMSSD, pNN50, and high-frequency spectra in mild IHD. CONCLUSION: These salutary effects are less in more severe IHD, but aprindine does not aggravate HRV. Thus, if there are salutary effects on arrhythmias and no proarrhythmic effects, aprindine could be prescribed to patients with IHD without concern about decreasing HRV.     

微小RNA-缺血性心脏病治疗新的靶点

当前,缺血性心脏病（IHD）是世界主要死亡原因之一。IHD是指因冠状动脉不同程度的受阻引起冠状血流和心肌耗氧需求之间不平衡而导致的心肌损害,最终形成充血性心力衰竭。心脏缺血损伤后,非缺血部位的心肌出现心肌重构,如心肌间质纤维化和心肌肥厚。心肌的重构过程可使心脏功能进一步恶化,更容易诱发心律失常。微小RNA(microRNAs,miRNAs)是一类长约22个核苷酸的非编码小分子RNA,通过与靶蛋白 mRNA 3′端非编码区的不完全互补结合,抑制靶 mRNA 转录后的表达。最近大量研究显示,miRNA 在心脏病理、生理过程中发挥着重要的调控作用,尤其与心肌梗死和梗死后心脏重构的发生、发展密切相关。本文将从miRNAs在IHD中的调控作用进行阐述,并探讨以miRNAs为靶点改善IHD患者的临床转归。     

Plasma catecholamines and ischemic heart disease

Plasma levels of norepinephrine and epinephrine were measured in 84 patients aged 56 +/- 9 (mean +/- SD) years with chronic ischemic heart disease (IHD), anterior acute myocardial infarction (AMI), posterior AMI, acute or chronic IHD associated with various types of electrical instability and in the control subjects. During the first day of hospitalization, plasma epinephrine levels were higher in patients with AMI in both localizations and chronic IHD in comparison with control values. There were no significant differences in plasma epinephrine levels among these groups of patients. However, in the same time period, plasma norepinephrine concentrations in patients with chronic IHD and posterior AMI did not differ from the control values; in patients with anterior AMI they reached by approximately 60% higher values than in the control group. Moreover, all myocardial lesions showing different types of electrical instability were associated with increased plasma levels of both norepinephrine and epinephrine. In conclusion, high plasma levels of epinephrine may result from sympathoadrenal activation. High plasma levels of norepinephrine in patients with anterior AMI and no change in patients with posterior AMI suggest a rather myocardial than an extramyocardial origin of plasma norepinephrine level in anterior AMI. Norepinephrine released from the ischemic area might contribute to the electrical instability of the myocardium and generation of dysrrhythmias.     

Increased ventricular sialylation in patients with heart failure secondary to ischemic heart disease

Background: Elevated serum sialic acids are associated with increased cardiovascular mortality, but sialic acid levels have not been studied in cardiac tissue. Methods: Myocardial samples were obtained at the time of transplantation from 23 patients (age 54 ± 12 years) with heart failure secondary to ischemic heart disease and 16 patients (age 51 ± 7 years) with idiopathic dilated cardiomyopathy (DCM). A control group comprised postmortem samples obtained from 14 patients (age 70 ± 5 years) who died of non-cardiovascular causes. Ventricular sialylation was quantitated using the sialic acid-specific lectins Maackia amurensis agglutinin (MAA) and Sambucus nigra agglutinin (SNA) using a chemiluminescence assay. Results are expressed as the percentage (± standard error of the mean) of the binding of lectin to a standardized control sample of human myocardium. Results: Ventricular sialylation recognized by MAA was 55 ± 7% in patients with heart failure secondary to ischemic heart disease compared with 26 ± 7% for DCM (p = 0.006) and 32 ±8% for controls (p = 0.04), and that recognized by SNA was 69 ± 7% in patients with heart failure secondary to ischemic heart disease compared with 42 ± 6% for DCM (p = 0.006) and 38 ± 7% for controls (p = 0.006). No significant difference in ventricular sialylation was observed between patients with DCM and controls. Conclusion: Myocardial levels of sialic acids are significantly increased in patients with heart failure secondary to ischemic heart disease compared with patients with idiopathic dilated cardiomyopathy and controls. Our findings are important in view of recent reports of an association between serum sialic acid concentration and cardiovascular mortality and require further investigation.     

Stable ischemic heart disease in the older adults

Ischemic heart disease (IHD) is caused by atherosclerotic and/or thrombotic obstruction of coronary arteries. Clinical spectrum of IHD expands from asymptomatic atherosclerosis of coronary arteries to acute coronary syndromes (ACS) including unstable angina, acute myocardial infarction (non-ST elevation myocardial infarction and ST elevation myocardial infarction). Stable IHD (SIHD) refers to patients with known or suspected IHD who have no recent or acute changes in their symptomatic status, suggesting no active thrombotic process is underway. These patients include those with i) recent-onset or stable angina or ischemic equivalent symptoms, such as dyspnea or arm pain with exertion; ii) post-ACS stabilized after revascularization or medical therapy; and iii) asymptomatic IHD diagnosed by abnormal stress tests or imaging studies. This review summarizes clinical features and management of SIHD in the older adult. ACS in older adults is not considered in this review.