冠心病患者体外反搏治疗时肾素血管紧张素系统与指脉的关系

【目的】观察冠心病患者在体外反搏(ECP)治疗前后循环血液中肾素血管紧张素系统与指脉的变化，分析它们之间的关系，探讨ECP防治冠心病的机制。【方法】对20例1个月内发生心肌梗死或心绞痛的患者进行了ECP治疗，同时监测指脉波参数。分别于第1次反搏前、3个疗程结束时采血，用放免及紫外分光光度法检测血液中肾素活性、血管紧张素Ⅱ(angiotensinⅡ，ANGⅡ)质量浓度及血管紧张素转换酶(angiotensin-converting enzyme，ACE)活性。【结果】指脉波呈上升趋势，但组间无统计学意义。1个疗程后，肾素活性与ANGⅡ浓度高于反搏前；2个疗程后，ANGⅡ降至反搏前水平，ACE低于反搏前；3个疗程后，肾素活性降至反搏前水平，ANGⅡ与ACE低于反搏前。血浆ANGⅡ水平与指脉波成负相关关系。【结论】体外反搏对血流动力学的改善作用可能是其抑制肾素血管紧张素系统的机制之一。     

生物医学工程学与临床医学的交融

2006年5月13—14日，首届国际体外反搏学术交流会在中国广州市成功召开，标志着体外反搏的发展进入了一个充满机遇和挑战的新阶段。体外反搏是生物医学工程学的一个分支，是工程学原理在临床医学中的具体应用。本文介绍体外反搏在国内外近40年的发展历程，并结合我国近年来生物医学工程学科的进展作一概述，期望为我国生物医学工程学科与临床学科的结合与可持续发展带来一些启示。     

Early Exercise Promotes Angiogenic Response in Mice Model of Myocardial Infarction

INTRODUCTIONExercise and physical activity is known to preventthe development of coronary artery disease (CAD) andreduce symptoms in patients with establishedcardiovascular disease[1]. Moreover, a recent meta-analysis of 48 randomized trials of cardiac rehabili-tation[2] showed that compared with usual care, cardiacrehabilitation reduced total mortality by 20% andcardiac mortality by 26%.The precise mechanisms by which exercise therapyimproves mortality in patients with coronary heartdis…     

328例细菌性腹泻的病原及药敏试验结果分析

本文报道我院1983～1987年收治经细菌学证实的腹泻患者328例进行回顾性分析,以了解本地区近年来常见肠道传染病的病原学及其药物敏感性,为防治本病提供依据 328例患者中,男性219例,女性109例;最小年龄2月,最大81岁,其中以1～10岁居多(约占1/3)共分离肠道致病菌383株,其中福氏痢疾杆菌175株(45.7％),副大肠杆菌126株(32.9％),变形杆菌44株(11.5％)志贺氏痢疾杆菌24株(6.3％)其他14株(3.7％。包括宋氏痢疾杆菌5株,鲍氏痢疾杆菌2株,沙门氏菌3株,致病性大肠杆菌4株)。在所有     

增强型体外反搏对早期动脉粥样硬化斑块局部应力环境影响的实验与仿真研究

采用动物实验与数值仿真相结合的方法,研究增强型体外反搏（EECP）对发生早期粥样硬化斑块动脉的局部应力水平的影响,评价临床中该疗法增加粥样硬化斑块失稳的风险。首先以35月龄左右雄性猪2头为实验体,进行反搏前后状态的基础血流动力学在体测量,反搏压介于0.025～0.04MPa;进而建立血流动力学数值仿真模型,模拟斑块出现及生长过程中,EECP对其局部应力水平及应力震荡特性的影响。模拟计算结果显示,EECP使动脉的应力水平及应力震荡特性均有显著增加;早期小规模斑块的存在令局部应力水平进一步提升,但将降低应力的震荡水平。EECP使两实验体的动脉内压峰值水平最高提升10.62%及16.18%,此时若动脉存在斑块（H=0.2D）,其局部壁面切应力（WSS）峰值水平将分别提高135.54%及235.71%,震荡剪切指数（OSI）达到0.083及0.069。由于反搏产生的高舒张压明显提升了斑块的局部应力水平,同时反搏的“双脉冲”作用模式使动脉的OSI水平大幅增加,我们推测其慢性作用可能会促进斑块本身疲劳的进程,从而对斑块的稳定性产生不利影响;但EECP对心动周期里壁面切应力水平的提升可能对斑块本身的发展具有抑制作用。     

External counterpulsation attenuates hypertensive vascular injury through enhancing the function of endothelial progenitor cells

Background Vascular injury is a landmark of hypertension and external counterpulsation(ECP) has been identified as a non-invasive treatment to restore the capacity of endothelial cells. However, the effect of ECP on blood pressure lowering in hypertension and the potential mechanism remain unknown. Methods We measured the ambulatory blood pressure(AMBP)and flow-mediated endothelial dilation(FMD) in the essential hypertensive patients who were randomly assigned to ECP group(n = 20) or control group(n = 20). We also evaluated in vitro migration and adhesion function of endothelial progenitor cells(EPCs). Furthermore, multivariate analysis was performed to determine the actual correlation between EPC function and FMD. Results Compared with the control, ECP group exhibited decreased systolic [(133.2 ± 4.9) mm Hg vs.(139.3 ± 6.4) mm Hg, P 0.05] and diastolic [(83.4 ± 4.5) mm Hg vs.(89.5 ± 7.6) mm Hg, P 0.05] blood pressure and increased FMD value[(8.87 ± 2.46) % vs.(7.51 ± 2.32)%, P 0.01]. In addition, the migration [(47.3 ± 6.4)/hpf vs.(33.4 ± 5.1) hpf,P 0.05] and adhesion [(45.1 ± 5.5)/hpf vs.(28.4 ± 3.9) hpf, P 0.05] function of EPCs in ECP group were improved significantly, while no change was observed in the control. Both migration(OR = 0.47, 95% CI: 0.27-0.64, P 0.05) and adhesion(OR = 0.44, 95% CI:-0.0034-0.0012, P 0.05) of EPCs correlated with FMD. After multivariate analysis, the migration(β = 3.37, 95% CI: 1.67-5.33, P 0.05) and adhesion(β = 3.98, 95% CI:1.12-6.43, P 0.05) function still independently correlated to FMD. Conclusions The present study demonstrates for the first time that ECP decreases both systolic and diastolic blood pressure and increases FMD value in hypertension. The fall in endogenous EPCs repair capacity might be an important mechanism of hypertensive vascular injury and could be restored by ECP.     

冠状动脉瘤样扩张的研究进展

冠状动脉瘤样扩张首次报道于 1983年[1,2 ] ,随着冠状动脉造影技术及冠脉介入治疗的推广普及 ,有关冠状动脉瘤样扩张的报道逐年增多 ,但是冠状动脉瘤样扩张发生的机制及其对人体的影响尚未清楚 ,本文就近年来冠状动脉瘤样扩张的病因、发病机理、治疗及预后等作一综述。1　冠状动脉瘤样扩张的定义冠状动脉瘤样扩张是指冠状动脉局部或弥漫性扩张。多数学者赞同冠状动脉瘤样扩张指冠状动脉局部管径扩大超过邻近正常段或其管径大于正常值上限的1.5倍[3 7] 。管径的测量有两种方法 ,即ＱＣＡ系统(Ｑｕａｎｔｉｔａｔｉｖｅｃｏｒｏｎａｒｙａｎ…     

预防治疗心脑血管病的新发现

随着人类寿命的延长,冠心病、心绞痛、心肌梗死、中风等心脑血管病的死亡率已达到人类总死亡率的63.6%。这些心脑血管病均由动脉的粥样硬化所致。近年研究表明,动脉粥样病变的根源是血管内壁的“内皮细胞”受损,功能不正常,胆固醇中的低密度脂蛋白(LDL)乘虚而入,在血管壁逐渐形成“粥样斑块”,引起血管狭窄和堵塞。因此,要防治心脑血管病必需从保护和修复血管内皮细胞着手。     

The Relationships between Serum Concentration of IGF-I and Left Ventricular Function as well as Coronary Collateral Circulation in Patients with Coronary Artery Disease

Objective To investigate therelationships between serum concentration of insulin -like growth factor - I (IGF-I) and left ventricular function as well as coronary collateral circulation in patients with coronary artery disease (CAD) . Methods In 41 patients with CAD and 15 control subjects without CAD, the concentrations of serum IGF - I were measured using radioimmunoassay. The relationships between the concentration of serum IGF - I and Leaman coronary artery score, Rentrop grade of coronary collateral circulation, left ventricular ejection fraction (LVEF) as well as left ventricular wall motion Cortina score were assessed. Results 1. There was no significant difference in the mean level of serum IGF -I between the CAD group and the control group (107. 92±44.74 ng/ml vs 113.05 ±33. 65 ng/ml, P> 0. 05), but the IGF - I concentrations in the subgroup with collateral circulation were significantly greater than that in the control group (147. 33 ±29. 92 ng/ml vs 113. 05±33. 65 ng/ml, P < 0. 01) or in