慢性缺氧大鼠心肌HSP47 mRNA的表达及其与PⅠCP和PⅢNP含量的相关性研究

目的探讨慢性缺氧大鼠心肌HSP47 mRNA表达与血清Ⅰ型前胶原C端原肽(PⅠCP)、Ⅲ型前胶原N端原肽(PⅢNP)含量及心肌纤维化的相关性。方法模拟缺氧环境,建立慢性缺氧大鼠模型。将40只SD大鼠随机分为5组,每组8只。对照组不给于缺氧处理(A组),各慢性缺氧组大鼠分别缺氧7 d(B组)、14 d(C组)、21 d(D组)、28 d(E组)。采用实时荧光定量PCR(q-PCR)检测心肌中热休克蛋白(HSP47)mRNA的表达量;运用酶联免疫吸附测定(ELISA)方法检测血清及心肌中PⅠCP、PⅢNP的浓度;采用HE和MASSON染色法对对照组和慢性缺氧组大鼠进行组织切片染色。结果与对照组比较,模型组的HSP47 mRNA表达量增多(P0.01),血清和心肌的PⅠCP、PⅢNP浓度升高(P0.01);心肌HSP417 mRNA的表达与血清和心肌的PⅠCP、PⅢNP含量呈正相关(P0.05);HE和MASSON染色显示慢性缺氧组心肌组织广泛纤维化。结论在慢性缺氧条件下HSP47 mRNA的表达量与PⅠCP、PⅢNP浓度正相关,提示HSP47作为心肌胶原分子伴侣在慢性缺氧所致心肌纤维化中起一定作用。     

Klotho基因转染骨髓间充质干细胞移植对慢性心力衰竭大鼠心肌纤维化的影响

目的观察Klotho基因(抗衰老基因)修饰的骨髓间充质干细胞(BMSC)移植对慢性心力衰竭大鼠心肌纤维化的影响。方法分离、培养、扩增大鼠骨髓间充质干细胞。慢病毒介导Klotho转染至BMSC中,逆转录-聚合酶链反应(RT-PCR)检测BMSC中Klotho mRNA的表达。制备大鼠慢性心力衰竭模型,随机分为正常对照组、模型对照组、增强型绿色荧光蛋白-BMSC组(EGFP-BMSC组)、EGFP-Klotho-BMSC组。细胞移植28天后多普勒超声检测心功能,荧光显微镜观察细胞存活及分布,HE染色观察心肌组织病理变化。Masson染色检测心肌胶原沉积含量和心肌纤维化程度。结果 Klotho转染BMSC后,BMSC中Klotho mRNA表达明显增多(P0.05)。移植28天后超声心动图结果显示,与EGFP-BMSC组及模型对照组比较,EGFP-Klotho-BMSC组左心室射血分数(LVEF)提高(P0.05)。EGFP-BMSC组及EGFP-Klotho-BMSC组心肌纤维化程度较模型对照组减轻(P0.05),EGFP-KlothoBMSC组较EGFP-BMSC组心肌纤维化改善更为明显(P0.05)。结论 Klotho基因联合BMSC治疗可进一步抑制心肌纤维化,减少心肌间质胶原沉积,改善心功能。     

慢病毒载体过表达Klotho基因对骨髓间充质干细胞在慢性心衰大鼠心肌中存活率的影响

目的 探讨以重组慢病毒为载体转染Klotho基因（抗衰老基因）对SD大鼠心肌中骨髓间充质干细胞（bone marrow Mesenchymal stem cells,BMSCs）存活率及其可能的机制。方法 全骨髓贴壁培养法体外培养SD大鼠BMSCs;以重组慢病毒为载体将KLotho基因转染至大鼠BMSCs,用RT-PCR鉴定BMSCs中Klotho基因mRNA的表达;腹腔连续注射异丙肾上腺素建立SD大鼠心衰模型;并随机分为3组,即EGFP-Klotho-BMSCs组（慢性心衰SD大鼠尾静脉注射Klotho基因修饰的BMSCs）,EGFP-BMSCs组（慢性心衰SD大鼠尾静脉注射空载慢病毒转染的BMSCs）,生理盐水组（慢性心衰SD大鼠尾静脉注射与等容积的生理盐水）。细胞移植治疗4周后,在荧光显微镜下观察各组大鼠心肌组织绿色荧光蛋白的表达情况,RT-PCR检测各组大鼠心肌组织中Klotho基因的表达。结果 ①全骨髓贴壁法成功培养及传代BMSCs;②以重组慢病毒为载体成功将Klotho基因转染到BMSCs,荧光显微镜下第4天的细胞转染效率达70%~80%以上;③RT-PCR结果表明与EGFP-BMSCs组比较,EGFP-Klotho-BMSCs组的BMSCs中Klotho基因表达明显增多（P<0.05）;④干细胞移植4周后,EGFP-Klotho-BMSCs组和EGFP-BMSCs组大鼠心肌组织中仍可见EGFP绿色荧光表达,且EGFP-Klotho-BMSCs组心肌组织中绿色荧光表达数量较EGFP-BMSCs组显著增多。结论 转染Klotho基因可有效提高BMSCs在SD大鼠心肌中的存活率,其可能的机制为Klotho基因具有抗细胞凋亡及改变心肌内环境的作用。     

高血压大鼠心脏肥厚过程中心肌细胞凋亡心肌纤维化动态观察

目的探讨SHR心脏肥厚进展阶段心肌细胞凋亡、心肌纤维化及左室重构特点及其相互关系.方法分别采用末端脱氧核糖核苷酸转移酶介导dUTP缺口末端标记(TUNEL)、放射免疫测定及病理检查方法对16周龄、24周龄、32周龄SHR心肌细胞凋亡指数(APOI)、心肌胶原容积分数(CVF)和心肌血管周围胶原面积(PVCA)、血浆和组织血管紧张素Ⅱ检测,并以同龄Wister大鼠作对照.结果与同龄正常血压Wistar大鼠比较,SHR各周龄组收缩压明显增高、心脏肥厚指标心脏重量(HW)、左室重量(LVW)、左室重量指数(LVW/BW)均显著增加;各周龄组SHR心肌细胞APOI显著增加,各周龄组间无显著性差异;各周龄组SHR大鼠血浆、心肌组织AngⅡ明显增高;24、32周龄SHR的CVF和PVCA显著增加;SHR心肌组织AngⅡ分别与APOI、CVF呈显著正相关,APOI与CVF呈显著正相关.结论心肌细胞凋亡与心肌纤维化参与SHR代偿性心脏肥厚阶段心脏重构病理过程,组织AngⅡ是导致SHR代偿性心脏肥厚阶段心肌细胞凋亡与心肌纤维化的重要机制之一.     

Klotho基因在慢性心力衰竭患者心肌中的表达

目的探讨慢性心力衰竭(CHF)患者心肌组织中Klotho基因的表达及其与心肌纤维化的关系。方法心肌组织样本取材于2013年8月至2014年8月在成都军区昆明总医院心脏外科建立体外循环的60例CHF患者,按照纽约心脏联合会(NYHA)心功能分级将其分为:NYHAⅠ级组、Ⅱ级组、Ⅲ级组,每组患者各20例。运用实时荧光定量反转录-聚合酶链反应(RT-PCR)检测Klotho基因表达量,同时采用酶联免疫吸附测定(ELISA)方法检测上述60例患者血清中Ⅰ型C端胶原前肽(PⅠCP)的浓度。并对正常心肌组织及CHF患者心肌组织进行HE染色。结果(1)HE染色显示CHF患者心肌胶原增生;(2)与NYHAⅠ级组比较,Klotho基因在NYHAⅡ级、NYHAⅢ级组的心肌组织中表达明显减少(均P0.05),且在NYHAⅢ级组中的表达较NYHAⅡ级组明显减少(P0.05);(3)NYHAⅢ级组患者血清中PⅠCP的含量高于Ⅱ级、Ⅰ级组(均P0.05),NYHAⅡ级组高于Ⅰ级组(P0.05)。结论 CHF患者心肌组织Klotho基因的表达减少可能与随着心功能恶化,其抗衰老作用及抗心肌纤维化作用逐渐减弱有关。     

胰岛素抵抗大鼠心脏间质和心肌细胞变化的实验研究

目的探讨胰岛素抵抗(IR)对心肌组织的损伤作用。方法6月龄Wistar大鼠,分为正常对照组和IR组,正常血糖胰岛素钳夹技术(EICT)测定各组大鼠IR,葡萄糖输注速率(GIR)表示IR情况;测量大鼠心脏重量(HW)和体重(BW)并计算心脏重量与体重之比(HW/BW);原位末端酶标记法(TUNEL)检测各组大鼠心肌细胞凋亡情况;观察心脏微细结构和心肌细胞超微结构;免疫组化检测心脏间质Ⅰ、Ⅲ型胶原水平。结果IR组大鼠GIR明显低于正常对照组(P<0.01),HW及HW/BW高于正常对照组,心肌细胞凋亡增多(P<0.01),GIR与心肌细胞凋亡指数呈负相关(r=-0.7452,P<0.05),心脏间质Ⅰ、Ⅲ型胶原水平增加(Ⅰ型胶原P<0.05,Ⅲ型胶原P<0.01);光镜和电镜可见IR组大鼠心肌组织发生损伤性改变。结论胰岛素抵抗可损伤心肌组织,导致心脏肥大、心肌细胞凋亡、心脏间质纤维化。     

高血压大鼠心脏肥厚过程中心肌细胞凋亡心肌纤维化动态观察

目的 探讨SHR心脏肥厚进展阶段心肌细胞凋亡、心肌纤维化及左室重构特点及其相互关系。方法 分别采用末端脱氧核糖核苷酸转移酶介导dUTP缺口末端标记（TUNEL）、放射免疫测定及病理检查方法对16周、24周龄、32周龄SHR心肌细胞凋亡指数（APOI）、心肌胶原容积分数（VF）和心肌血管周围胶原面积（PVCA）、血浆和组织血管紧张素Ⅱ检测,并以同龄Wister大鼠作对照。结果 与同龄正常血压Wistar大鼠比较,SHR各周龄组收缩压明显增高、心脏肥厚指标心脏重量（HW）、左室重量（LVW）、左室重量指数（LVW/BW) 显著增加;各周龄组SHR心肌细胞APOI显著增加,各周龄组间无显著性差异;各周龄组SHR大鼠血浆、心肌组织Ang Ⅱ明显增高;24、32周龄SHR的CVF和PVCA显著增加;SHR心肌组织Ang Ⅱ分别与APOI、CVF呈显著正相关,APOI与CVF呈显著正相关。结论 心肌细胞凋亡与心肌纤维化参与SHR代偿性心脏肥厚阶段心脏重构病理过程,组织Ang Ⅱ是导致SHR代偿性心脏肥厚阶段心肌细胞凋亡与心肌纤维化的重要机制之一。     

连续灌注不停跳心脏移植对供心的保护作用

目的 通过建立大鼠同种异位供心停跳心脏移植模型与连续血液灌注供心不停跳心脏移植模型,探讨连续灌注不停跳心脏移植对供心的影响.方法 建立大鼠同种异位连续灌注心脏不停跳心脏移植模型（不停跳移植组）和改良Heron法建立大鼠异位心脏移植模型（停跳移植组）.移植成功后2h检测受体外周血肌酸激酶同工酶（CK-MB）和心肌肌钙蛋白I（cTnI）含量,测定供心心肌脂质过氧化终产物丙二醛（MDA）、过氧化物歧化酶（SOD）含量,电镜观察心肌结构变化,并观察心肌凋亡情况.结果 连续灌注心脏不停跳移植组受体外周血CK-MB及cTnI含量低于停跳移植组,差异有统计学意义（P＜0.05）.与停跳移植组比较,不停跳移植组心肌MDA含量相对较少,SOD含量相对较多,心肌细胞凋亡指数较小,差异均有统计学意义（P＜0.05）.不停跳移植组心肌线粒体等结构损伤相对较轻.结论 心脏不停跳技术能有效减轻心脏移植供心的脂质过氧化反应,保护心肌线粒体,抑制心肌细胞凋亡,可减轻心脏移植供心的再灌注损伤.     

体外心脏震波对大鼠心肌梗死后心肌凋亡的影响

目的研究体外心脏震波治疗(CSWT)对大鼠心肌梗死后(MI)心肌细胞凋亡及凋亡蛋白的影响。方法结扎大鼠左冠状动脉前降支建立大鼠急性心肌梗死模型,随机分为假手术(Sham)组(n=10)、MI组(n=10)及CSWT组(n=10)。CSWT治疗4 w后,取各组心肌样本进行TUNEL检测观察心肌细胞凋亡,Masson染色观察心肌纤维化,Western印迹检测Bax、Bcl-2和Caspase-3蛋白表达。结果与Sham组相比,MI和CSWT组心肌细胞凋亡指数及纤维化程度均增高,Bax和Caspase-3表达显著上调,Bcl-2表达明显下调(P0.05);而CSWT组较MI组,心肌细胞凋亡指数及纤维化程度均降低,Bax和Caspase-3表达下调,Bcl-2则表达上调(P0.05)。结论大鼠心肌梗死后心肌凋亡明显增加,体外心脏震波可抑制大鼠心肌梗死后细胞凋亡,减轻左心室纤维化。     

氯沙坦对高血压大鼠心肌MMP-2、Ⅲ型胶原和JNK1/2表达的影响

目的研究Ⅲ型胶原、基质金属蛋白酶-2(matrix metalloproteinases-2, MMP-2)和JNK1/2在高血压大鼠心肌组织中的表达及氯沙坦干预后3者的变化,探讨氯沙坦逆转心室重构的药理机制.方法采用SD大鼠建立两肾一夹型(Goldblatt)高血压模型,将大鼠随机分为对照组、高血压组和氯沙坦治疗组.采用鼠尾动脉测压法记录每周血压变化,实验末切取心脏,并计算心脏与体重比值.免疫组织化学方法测定心脏组织中的Ⅲ型胶原、基质金属蛋白酶-2和JNK1/2表达.结果左肾动脉结扎术后大鼠收缩压升高,心脏体重比值增加,心肌间质Ⅲ型胶原、基质金属蛋白酶-2、心肌细胞JNK1/2表达增多.氯沙坦治疗能显著降低大鼠收缩压,降低心脏体重比值,并且使心肌间质Ⅲ型胶原、基质金属蛋白酶-2、心肌细胞JNK1/2表达减少.结论两肾一夹型高血压大鼠重构心肌中MMP-2、Ⅲ型胶原、JNK1/2表达升高.氯沙坦能有效逆转心肌肥厚或心室重构,这一效应与其降低心肌中高表达的MMP-2,Ⅲ型胶原、JNK1/2有关.     

Cardiac perforation with tamponade during cardiac catheterization

Among 6,675 adult patients undergoing cardiac catheterization in our institution, three patients developed cardiac perforation and tamponade (incidence 0.04%). Two perforations involved the left atrium, and one the right atrium. Tamponade developed in the three patients. Hemodynamic confirmation of tamponade was available in two patients. Pericardiocentesis was performed in all three patients. Two patients required emergency surgery. All patients recovered.     

Cardiac Involvement of Adult T Cell Leukemia/Lymphoma

Adult T-cell leukemia/lymphoma (ATL) is a refractory T-cell lymphoma with variable clinical profiles, commonly exhibiting extra-nodal involvement. The myocardial involvement of ATL is often detected at an autopsy; however, the development of a symptomatic cardiac mass due to ATL is extremely rare. We herein report a 65-year-old man with ATL who developed cardiac symptoms due to a rapidly enlarging left ventricular mass soon after the initiation of systemic chemotherapy. We also summarize previously reported cases of symptomatic ATL with cardiac involvement.     

Morphological observations of tumors in cardiac conduction system

Tumors of the cardiac conduction system(CCS) have rarely been reported. The CCS from 198 cardiac-related deaths(Group Ⅰ) ,and 838 deaths from non-cardiovascular diseases or trauma(Group Ⅱ) ,were studied. Sampling was done of the sinoatrial node(SAN) and atrio-ventricular node(AVN) along their long axis of each node as a single block and the His bundle(HB) perpendicular to its long axis in 2-4 blocks. Five-micron serial sections were made;tissue slices were taken intermittently,every 20th from the SAN,every 10th from the AVN,and every 30th from the HB and bundle branches(BB) ,by continuous slices three times. Tumors in the CCS were found in 12 cases(1.155 %) ,where 10(0.965%) were primary tumors,and 2(0.193%) were metastatic tumors. The primary tumors included 4 fibromata compressing the HB(0.386 %) ,4 hemangiomata(0.386%) ,1 AVN tumor(0.097 %) ,and 1 rhabdomyoma(0.097 %) . In 8 of the 10 cases,the tumors were located in the AVN or HB. The metastatic tumors originated from lymphocytic leukemia and malignant lymphoma(histiocytic type) in lung,and were all found in the SAN. Of the 12 cases,2 were from the group Ⅰ. Tumors in the CCS are the smallest tumors in different parts of the body,which can cause sudden death.     

Calcified mass in the right atrium extending into the inferior vena cava with pulmonary artery embolization. Typical or atypical myxoma?

Cardiac masses are divided into neoplastic and non-neoplastic. They usually represent a diagnostic challenge given their relative rarity, their infrequent symptoms, and the overall difficulty with dynamic imaging of the heart. While echocardiography is useful in the initial evaluation of a suspected mass, cardiac magnetic resonance (CMR) imaging is the best imaging modality to characterize cardiac tumors due to its superior tissue characterization and its higher contrast resolution. For neoplastic, primary cardiac tumors are rare (0.05%). Atrial myxoma is the most common cardiac (50%) mass. About 75%-80% of myxoma are seen in the left atrium. Atypical myxoma is a term describing myxoma arising in other nonleft atrial locations. 20%-25% myxomas arise from the right atrium and 5% or less from the ventricles. We present a case of a 59-year-old female patient presenting with severe dyspnea. Her chest noncontrast CT showed a calcified mass lesion in the right atrium extending into the inferior vena cava. She underwent cardiac MRI for better tissue characterization. The cardiac MRI revealed a very irregular, highly spiculated, heavily calcified, heterogeneous, and nonenhancing lesion within the right atrium extending into the inferior vena cava. Via dynamic imaging, no evidence of mobile components was present. Via T1, T2 along with pre- and postcontrast imaging, the mass was confirmed to be calcified without a fibrotic component or evidence of thrombus. The above findings raised the possibility of atypical myxoma.     

Cardiac chloroma or cardiac myeloid sarcoma: Case Report

Chloroma or myeloid sarcoma is rare extramedullary tumor composed of immature myeloid cells that may occur in association with or during or even before the course of adult myelodysplastic or myeloproliferative diseases. It may involve different organs including the orbit, skin, lymph nodes, bone, gastrointestinal tract, breast, central nervous system, and lung. Cardiac involvement with MS is an exceedingly rare finding. We report a very rare case of left ventricular cardiac chloroma accidentally discovered by transthoracic echocardiography (TTE) and confirmed by cardiac magnetic resonance (CMR) in an old aged male patient with acute myeloid leukemia (AML) French‐American‐British (FAB)‐class M5. Unfortunately, shortly after a prompt start of AML palliative chemotherapy protocols, the patient died due to massive intracranial hemorrhage (ICH).     

Mobile cardiac catheterization: Comparison with outpatient and inpatient catheterization at tertiary facilities

The study group included 1,553 consecutive patients from areas serviced by our mobile catheterization laboratories: 719 procedures were performed in the mobile unit at their local hospitals, 277 were performed at a tertiary hospital with less than a 24 hr hospital stay, and 557 were performed at a tertiary hospital as inpatients. The indications for mobile catheterization were predominantly atypical chest pain, angina pectoris, or positive treadmill stress test, whereas patients with less than 24 hr hospitalization at the tertiary center had their catheterization performed for additional reasons. The majority of the inpatient indications were for recent myocardial infarction or unstable angina. Using the American College of Cardiology/American Heart Association (ACC/AHA) criteria for outpatient catheterization, the mobile catheterizations were performed safely with a complication rate of only 0.7% compared to a complication rate of 3.1% for inpatients demonstrating that a low risk group of patients can be prospectively identified and catheterized safely in the mobile setting. An extremely high risk group of patients with ongoing unstable angina and recent myocardial infarction was also identified which should undergo catheterization only at a tertiary center.