心房颤动患者右心房L型钙通道变化同心肌细胞结构改变的关系

目的：探讨心房颤动（房颤）的发生、房颤转复后窦性心律的维持与相关细胞结构和超微结构变化的关系.方法：53例心外科手术患者,其中窦性心律者26例（窦律组）,房颤患者27例（房颤组）.术前行超声心动图检查.手术中取右心房组织,石蜡包埋制作病理切片,HE染色后测定细胞直径.电镜检查超微结构变化.提取组织mRNA,逆转录-聚合酶链反应（RT-PCR）方法测定L-钙通道α1亚基的基因转录水平.结果：同窦律组比较,房颤组L-钙通道α1亚基mRNA水平降低,细胞直径增加,心肌出现不同程度的肌溶解现象.细胞直径同心房大小呈正相关,L-钙通道α1亚基mRNA水平与细胞直径呈负相关.结论：L-型钙通道α1亚基表达变化同房颤后细胞结构改变有关.     

心房颤动患者右心房肌闰盘重构的研究

目的：探讨心房颤动（房颤）患者右心房肌细胞间闰盘相关蛋白表达变化与房颤发生并维持的意义。方法：心外科患者53例，其中房颤患者27例（房颤组），窦性心律患者26例（窦律组），在建立体外循：吓前取右心房组织。分别将心房组织提取mRNA和制作病理组织切片，部分组织送电镜检查。用RT—PCR方法检查Cx40、Cx43mRNA表达变化，用免疫组化方法检测Cx43、N-钙黏素的分布变化。结果：两组患者Cx40、Cx43mRNA表达无变化，免疫组化结果显示房颤组缝隙连接、N-钙黏素分布发生不均一，光镜、电镜证实房颤组缝隙连接发生侧边化分布明显。结论：闰盘相关蛋白表达改变在房颤的维持中发挥重要作用。     

3H-鹅去氧胆酸在小鼠体内的吸收、分布和排泄的研究

20μci of ³H--CDCA was given to each normal healthy mouse for study of its absorption, distribution and excretion. Appreciable amount of radioactivity was detected in the blood 15 minutes after administration. Peak value appeared after 6 hours, while a certain level of radioactivity was still detected 12 hours after administration. After continuous administration for three days, the radioactivity in blood could be raised 20 times. Higher radioactivity level was found in bile, intestine and liver. The radioactivity decreased very slowly in intestine.The radioactivity was evidently increased in the intestine, liver and particularly in the bile after continuous administration for three or seven days.Furthermore, repeated administration caused the weight of the bile to increase, the gall bladder was enlarged. Thus it is clear that CDCA has an apparent choleretic action. Within 24 hours after the stomach feeding of ³H—CDCA, the total excretion of radioactivity in feces and urine was 33.9%.     

急性心肌梗死后延迟PTCA对左室功能的影响

目的：评价延迟性经皮冠状动脉腔内成形术（PTCA）对急性心肌梗死后左心功能和心脏事件的影响。方法i86例急性心肌梗死患者平均1周后接受PTCA治疗（介入组），并在住院和随访期间行超声心动图检查及记录心脏事件的发生率，且与30例行药物治疗者（对照组）进行比较。结果：介入组术前29例心功能不全患者和57例心功能正常患者6个月后左室舒张末内径和左室射血分数均有提高，心脏事件发生率低，且与对照组比较心功能也有改善，差别有统计学意义。前壁心肌梗死和梗死相关动脉的开通是心功能的独立预测因子。结论：延迟性PTCA能改善心肌梗死患者的左心功能，减低近中期心衰的发生。     

The efficacy of probucol combined with hydration in preventing contrast-induced nephropathy in patients with coronary heart disease undergoing percutaneous coronary intervention: a multicenter,prospective, randomized controlled study

Purpose

To investigate the preventive effect of probucol combined with hydration on contrast-induced nephropathy (CIN) in patients with coronary heart disease undergoing percutaneous coronary intervention (PCI).

Methods

A total of 641 patients undergoing PCI were randomly assigned to either a probucol group (probucol 500 mg twice daily and hydration; n = 321) or a control group (hydration only; n = 320). The primary endpoint was the incidence of CIN, defined as an increase in serum creatinine (Scr) by ≥ 44.2 μmol/L or ≥ 25% within 72 h after the administration of contrast agent. Secondary endpoints were changes in Scr, cystatin-C (Cys-C), creatinine clearance rate (Ccr), C-reactive protein (CRP), superoxide dismutase (SOD), and glutathione (GSH) within 72 h, and major adverse events during hospitalization or the 14-day follow-up period.

Results

The incidence of CIN was 4.0% (13/321) in the probucol group and 10.9% (35/320) in the control group. The probucol group had lower Cys-C and higher Ccr at 48 and 72 h after PCI compared with the control group. At 48 and 72 h following the operation, Cys-C and CRP were lower in the probucol group compared with the control group, but Ccr, SOD, and GSH were higher. There were no differences in the incidence of major adverse events during hospitalization or the 14-day follow-up between the groups. Multivariate logistic regression analysis showed that probucol was an independent protective factor for CIN.

Conclusions

Probucol combined with hydration more effectively decreased the incidence of CIN in patients with coronary heart disease undergoing PCI compared with hydration alone.

     

直接与择期经皮冠状动脉腔内成形加支架术治疗AMI效果比较

目的；比较直接与择期经皮冠状动脉腔内成形加支架术（PTCA＋STENT）中再灌注性心律失常发生率及术后左室功能。方法：103例急性心肌梗死（AMI）患者，分为2组：A组64例行择期PTCA＋STENT术。B组39例在发病12h内行直接PTCA＋STENT术，术中冠状动脉造影（CAG定位梗死相关动脉（IRA），多导心电生理仪监护再灌注性心律常，根据心律失常不同类型给予相应处理。术后10－20d作超声心动图，对比左心室射血分数（LVEF）以评价心功能。结果：（1）首次CAG显示A组IRA81支，其中左前降支（LAD）42支，右冠状动脉（RCA）25支，左回旋支（LCX）14支。B组IRA有44支，其中LAD24支，RCA12支，LCX8支。2组冠状动脉分支阻塞率差异无显著性（P＞0.05）。（2）A，B2组行PTCA＋STENT术中再灌注性心律失常发生率：A组为25％（16／64），心室颤动发生率为16％（10／64）。B组为79％（31／39），其中心室颤动发生率为54％（21／39），2组比较差异有显著性（均为P＜0.05）。2组心室颤动患者行电除颤后均转复为窦性心率。（3）住院10－20d行二维超声心动图检查显示，LVEF≥60％者，A组为64%（41／64），B组为90％（35／39）（P＜0.05)。结论：AMI患者行直接PTCA＋STENT术与择期PTCA＋STENT术相比较，再灌注性心律失常明显增多；但急性期过后，患者心肌功能恢复较好。     

Preventive Cardioprotection of Erythropoietin Against Doxorubicin-induced Cardiomyopathy

Introduction Doxorubicin (DOX) is a highly effective chemotherapeutic agent related to dose-dependent cardiomyopathy. Recent evidence suggests that erythropoietin (EPO) can play a protective role in cardiovascular diseases by non-erythropoietic effects. In the present study, we tested the hypothesis that EPO may protect against DOX-induced cardiomyopathy through anti-apoptotic mechanisms both in vitro and in vivo. Materials and methods Isolated neonatal Wistar rat cardiomyocytes were treated with vehicle, DOX with or without EPO, or EPO. Twenty-four hours later, the cells were used to determine cardiomyocyte apoptosis (TUNEL assay). Cardiomyopathy was induced in Wistar rats by intraperitoneal injections (IP) of DOX (2.5 mg/kg, six times for 2 weeks). EPO (2,500 U/kg, six times for 2 weeks) was administered simultaneously in the DOX+EPO group and the EPO group. Two weeks after the last administration, cardiac function was evaluated by echocardiography and invasive haemodynamic measurements. Rats were then sacrificed for histological and TUNEL analyses, with immunological detection for cardiac Troponin-T (cTnT), α-actinin, Bax and Bcl-2. Results EPO significantly ameliorated DOX-induced apoptosis of cultured cardiomyocytes as demonstrated by TUNEL assay. In the rat model, cardiac function significantly decreased in the DOX group. In contrast, the DOX+EPO group showed considerable improvement in cardiac function, inhibition of cardiomyocyte apoptosis, reduction of fibrosis, as well as up-regulation of Bcl-2 protein expression. Conclusions Our results suggest that EPO exerts preventive cardioprotective effects on DOX-induced cardiomyopathy via anti-apoptotic pathways. The up-regulation of Bcl-2 protein expression may contribute to this.     

射频导管消融治疗特发性室性心动过速(附20例报告)

目的 特发性室性心动过速(IVT)的射频消融(RFCA)研究。方法共收集20例临床诊断IVT患者,男性14例。女性6例,年龄40.5±12.5(21～66)岁,病史7.8±8.8(1～22)年,心动过速时R—R间期为:309±69(240～430)ms。心动过速时心电图呈右束支传导阻滞(RBBB)型8例。左束支传导阻滞(LBBB)型,且Ⅱ、Ⅲ、avF主波向上12例。对20例患者进行心电生理检查及射频消融治疗。结果 20例均获成功,术后1例起源左心室后间隔,1例起源于右心室流出道之室性心动过速分别于术后第3、7天复发,余无室性心动过速复发,亦无并发症。结论RF—CA治疗IVT成功率高,RFCA关键在于靶点标测和标测方法的选择。     

低水平高密度脂蛋白胆固醇是经皮冠脉介入术后急性肾损伤的危险因素

目的 探讨低水平高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)与冠心病患者经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后对比剂诱导的急性肾损伤(contrast induced-acute kidney injury,CI-AKI)的关系.方法 选取天津市胸科医院心内科2009年1月至2011年5月行PCI术的冠心病患者共1500例,于术前及术后72 h内测定其血肌酐水平.入选标准:均为汉族人群,年龄及性别不限;排除标准:既往有恶性肿瘤、泌尿系统感染、肾脏切除手术、腹膜或血液透析治疗或术前两周内曾应用过对比剂.CI-AKI定义为应用对比剂后24 ～ 72 h血清肌酐水平较原有基础升高超过25％或绝对值升高44.2 μmol/L以上,并排除其他影响肾功能的原因.低水平HDL-C定义为HDL-C＜1.04 mmol/L.应用单因素分析及多元Logistic回归分析确定CI-AKI及低水平HDL-C的危险因素.结果 在1500例行PCI术的冠心病患者中,共有246例(16.4％)发生了CI-AKI,低水平HDL-C组与正常水平HDL-C组的CI-AKI发病率分别为21.5％和13.3％ (P＜0.01).进一步分析发现,伴有慢性肾脏疾病者,CI-AKI发病率在低水平HDL-C组与正常水平HDL-C组分别为39.8％和26.5％(P＜0.05),而在不伴有慢性肾脏疾病者分别为9.7％和17.7％(P＜0.01),差异均具有统计学意义.多元Logistic回归分析显示,低水平HDL-C是冠心病患者PCI术后CI-AKI发生的危险因素,超重、吸烟及贫血是该类患者低水平HDL-C的预测因子.结论 与HDL-C水平正常者相比,低水平HDL-C者PCI术后CI-AKI的发病率显著升高.无论是否伴有慢性肾脏疾病,低水平HDL-C均是冠心病患者PCI术后发生CI-AKI的危险因素.超重、吸烟及贫血是低水平HDL-C的预测因子.