自体外周血干细胞移植治疗急性心肌梗死安全性的观察

目的　观察经皮经腔冠状动脉内移植自体外周血干细胞 (PBSC)治疗急性心肌梗死 (AMI)的可行性与安全性。方法　患者入院后在常规急性心肌梗死治疗 (药物与介入治疗 )基础上给予包涵体型G CSF(商品名惠尔血 ) 30 0～ 6 0 0 μg/d皮下注射 ,连续 5d ;或分泌型G CSF(商品名金磊赛强 ) ,6 0 0 μg/d皮下注射 ,连用 5d。第 6d经美国Baxter公司生产的CS30 0 0PLUS血细胞分离机 ,分离外周血干细胞悬液 5 0mL ,采集后干细胞未做任何处理 ,常规经皮经腔导管技术建立梗死相关动脉 (IRA)通道 ,利用over the Wire球囊封闭IRA ,并将分离的PBSC经Over the Wire导管中心腔注入IRA。在外周血干细胞动员时观察有无骨痛 ,乏力 ,皮疹 ,发热 ,胃肠道反应 (恶心、呕吐、便秘 ) ,心绞痛或心衰加重及一些少见的并发症 :自发性脾破裂、严重化脓性感染、高凝状态、自身免疫性疾病等发生 ;在外周血干细胞分离及采集过程中观察有无低钙性口周麻木、抽搐 ,迷走神经反应性面色苍白、晕厥 ,低血容量性面色苍白、晕厥 ,心绞痛发作 ,心衰加重等 ;在自体外周血干细胞经冠状动脉内回输过程中可出现心律失常 ,如 :窦性心动过缓 (球囊封堵所致 )、窦性停搏 (窦停 )或三度房室传导阻滞 (AVB) (球囊刺激支架近端引起严重的冠脉痉挛所致 )、室颤     

Vectorcardiographic evaluation of diabetic cardiomyopathy and of its contributing factors

Summary In order to investigate the prevalence of vectorcardiographic bites, expression of small areas of fibrosis, atrophy or degeneration of the myocardium, we studied, using the vectorcardiograms (VCG) of 101 diabetic patients (35 with insulin-dependent and 66 with non-insulin-dependent diabetes mellitus, aged from 25 to 60 years, without hypertension, coronary artery disease, or intraventricular conduction defects) and 228 normal control subjects, matched for age and sex. The prevalence of bites was 38.6% in diabetic patients and 10.0% in the control group (p<0.001). Diabetic patients were also subdivided into groups according to age, sex, metabolic control, risk factors for coronary heart disease, type of diabetes, duration of diabetes and diabetic microangiopathy. No correlation was found between any of the variables investigated nor of a combination of these, and the presence of bites. We conclude that VCG is a sensitive test for cardiac involvement in diabetic patients but that it cannot be used to identify any specific factor able to influence the onset and evolution of this involvement.     

Prolongation of tension on reoxygenation following myocardial hypoxia: a possible role for mitochondria in muscle relaxation.

The mechanism for tension prolongation during reoxygenation following myocardial hypoxia was investigated. It was found that prior addition of isoproterenol, reserpine, quinidine, lidocaine and insulin or a change in pH, temperature, stimulation rate, preload or duration of hypoxia did not qualitatively alter the appearance of the phenomenon. On reoxygenating hypoxic preparations in the presence of 5, 10 or 20% oxygen, tension prolongation was clearly present when little increase in isometric tension was evident. Inhibition of glycolysis by iodoacetate did not alter the appearance of the phenomenon during reoxygenation. Three respiratory inhibitors, antimycin A, rotenone and cyanide, at concentrations which did not prevent an increase in isometric tension during recovery from myocardial hypoxia, all completely prevented the appearance of tension prolongation. Two uncouplers of oxidative phosphorylation, 2–4 dinitrophenol and carbonyl cyanide m-chlorophenyl hydrazone at concentrations large enough to lead to mechanical deterioration despite the presence of oxygen, failed to prevent the appearance of tension prolongation upon reoxygenation. It is concluded that myocardial respiratory activity, independent of ability to generate high energy phosphate, appears capable of altering the duration of mechanical events during reoxygenation of hypoxic heart muscle.     

心肌细胞凋亡的信号传导机制研究

细胞凋亡在心血管疾病发病机制中扮演了重要角色 ,细胞凋亡信号的异常表达使心肌细胞数量不断减少 ,其中含有 BH3( Bcl-2 Homology3 )结构域的凋亡促进分子 (如 Bax,Bid,BNIP3等 )在凋亡信号传导途径中发挥了重要作用。     

心脏再同步治疗慢性心力衰竭的疗效评价及无反应原因分析

Objective To investigate the effect of cardiac resynchronization therapy (CRT) and the problem of non-response to CRT in patients with chronic heart failure. Methods Twenty patients[(64±10.9) yrs,5 women, 15men] underwent CRT. Conventional echocardiography was performed in each patient before implantation and at 6 months post implantation. Results The clinical response rate was 60% and echocardio-graphic response rate was 55% at 6 month follow-up. Average EF increased 10%. Three patients died and 1 pa-tient was found to have increased left electrode thresholds. One electrode dislocation occurred and recannulation was required. Four patients had no response to CRT. The response rate to CRT was lower in patients with a nar-row QRS or ischemic cardiomyopathy. Conclusion CRT is an effective treatment for chronic heart failure pa-tients. Non-response to CRT may berelated to the cause of heart failure and narrow QRS.     

Stability of autoantibodies and their relation to genetic and metabolic markers of Type I diabetes in initially unaffected schoolchildren

Aims/hypothesis. To study temporal changes in positivity for autoantibodies associated with Type I (insulin-dependent) diabetes mellitus and the relations between these antibodies, HLA-DQB1-risk markers and first-phase insulin response (FPIR) in non-diabetic schoolchildren.¶Methods. The stability of the antibody status over 2 years was assessed in 104 schoolchildren initially positive for islet cell antibodies (ICA) or antibodies to the 65 000 M_r isoform of the glutamic acid decarboxylase (GADA) or both and in 104 antibody-negative control children matched for sex, age and place of residence. All children were also studied for their first-phase insulin response and HLA-DQB1 alleles on the second occasion.¶Results. On the second occasion 3 of the 98 initially ICA-positive children, 3/13 of those positive for antibodies to the IA-2 protein (IA-2A), 1/17 GADA-positive and 2/7 of those positive for insulin autoantibodies (IAA) tested negative for these antibodies. Children with IA-2A, GADA, IAA and multiple ( ≥ 2) antibodies had significantly lower first-phase insulin responses than the control children. In contrast, these responses did not differ between subjects with and without specific HLA-DQB1-risk alleles or genotypes. Of the six subjects with a considerably reduced first-phase insulin response three had multiple antibodies on both occasions but none of them had a DQB1 genotype conferring increased diabetes risk. Two subjects progressed to Type I diabetes within 3.4 years of follow-up, both of them having multiple antibodies and a considerably reduced first-phase insulin response but neither of them having a DQB1-risk genotype.¶Conclusions/interpretation. Positivity for diabetes-associated autoantibodies is a relatively stable phenomenon in unaffected schoolchildren, although conversion to seronegativity can occur occasionally. Our observations also indicate that DQB1 alleles associated with decreased susceptibility to Type I diabetes do not protect from impaired beta-cell function or from progression to overt disease in initially unaffected schoolchildren. [Diabetologia (2000) 43: 457–464]     

老年人亚临床心功能不全及其相关因素研究

目的　了解老年人亚临床心功能不全与部分因素的相关性及其治疗时机的选择。方法　以超声心动图检查 2 0 6例老年住院病人(其中男 1 72例 ,女 34例 ) ,年龄 70～ 94岁 (平均 80 .2 6± 5.52岁 ) ,观察 RVDd、 LVIDd、 L VIDs、 IVSd、 IVSs、 MVE- F、 AOroot、 SV、 FS、L VEF、 LVmass、HR等 1 2个指标 ,运用 SPSS统计软件 ,分析上述参数与病人的年龄、性别、身高、体重的相关性。结果　性别与 AOroot、SV呈负相关 (即男性编码 0 ,女性编码 1 ;男性 AOroot、 SV大于女性 ) ;年龄与 RVDd、 L VIDd、 IVSs呈负相关 ;身高与 IVSs、 SV呈正相关 ;体重与 RVDd、IVSs、SV呈正相关。结论　老年人心脏功能随增龄而减退 ,主要表现在舒张功能指标的下降 ,部分收缩功能指标与性别、身高、体重相关 ;在 LVEF<50 %的病例中 73.1 5%基本无临床症状 (心功能评定为 NYHA ～ 级 ) ,因此认为老年人存在亚临床心功能不全     

Sudden cardiac death during nighttime hours

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The association of diabetic microvascular and macrovascular disease with cutaneous circulation in patients with type 2 diabetes mellitus

Aims

To study the impact of diabetic neuropathy, both peripheral sensorimotor (DPN) and cardiac autonomic neuropathy (CAN), on transcutaneous oxygen tension (TcPO₂) in patients with type 2 diabetes mellitus (T2DM).

Left ventricular performance and autonomic dysfunction in patients with long-term insulin-dependent diabetes mellitus

Cardiac autonomic neuropathy (CAN) is a very frequent complication of insulin-dependent mellitus type 1, affecting the sympathetic or parasympathetic sections or both. The different impairment in the two sections might modify left ventricular function early. To evaluate this relationship, we studied 61 patients (mean age 39.6±7 years) with type 1 diabetes for more than 10 years, without coronary artery disease (CAD; negative ergometric stress test) and without other pathologies that could interfere with ventricular function. All patients underwent MONO-, 2-dimensional and Doppler echocardiographic examination and radionuclide angiography with⁹⁹Tc (RNA). According to the outcome of the Ewing tests, patients were divided into two groups: group A with two or more tests altered (26 patients with CAN) and group B with one or no tests altered (35 patients without CAN). No significant differences between the two groups were found in the systolic function parameters with either technique. In contrast, a pattern of abnormal relaxation was found for the diastolic function parameters: in group A a decrease in E-wave velocity and its time-velocity integral and an increase in A-wave and its time-velocity integral were detected with echocardiography. Moreover, RNA showed a reduced peak filling rate and an increased isovolumic relaxation time. When compared with normal values, an abnormal diastolic filling, defined as two independent echocardiography plus one RNA variable impairment, was found in 15 patients (57.6%) in group A and in only 4 patients (11.4%) in group B (P<0.001). Our findings suggest an early involvement of diastolic function in patients with CAN.