氟碳乳剂稀释血液对心肌梗死范围的影响

急性心肌缺血早期,设法减少心脏的耗氧量,或增加冠脉侧支供氧量,可挽救边缘缺血区心肌,缩小心肌梗死范围。本室前一阶段的研究结果表明,用氟碳乳剂行轻度血液稀释,可明显改善边缘缺血区心肌氧的供需矛盾。但关于氟碳乳剂对心肌梗死范围的影响,现有研究结果颇不一致。为了进一步阐明氟碳乳剂的抗心肌缺血作用,本实验观察了狗急性心肌缺血早期用氟碳乳剂行轻度等容血液稀释对心肌梗死范围的影响。     

狗急性心肌缺血早期冠脉侧支血流量与血液流变学变化的关系

本实验在14只麻醉开胸狗身上观察了急性心肌缺血早期冠脉侧支血流量与血液流变学变化的关系。动物均分为两组:Ⅰ组,在不控制血压的情况下,观察心肌缺血早期单位压力差下冠脉侧支血管流量(CVC)的变化;Ⅱ组,在保持主动脉血压不变的条件下,根据 Wyatt 等公式计算流经缺血区末梢血管的有效侧支血流量(ECF)。实验结果表明,阻断冠脉血流30min时,低切变率下全血比粘度已明显增高,随后继续增加,60min 时Ⅰ、Ⅱ两组分别较对照值增高19.0%和11.4%(均为P<0.01)。血液粘度增高时,CVC 仅轻度降低(p>0.05),但 ECF却随着血液粘度的增高而逐渐明显降低,缺血60min 时较对照值降低12.1±2.6%(P<0.01)。血液粘度变化与 ECF 变化之间呈明显负相关(r=-0.796,p<002)。上述结果提示,心肌缺血早期血液流变学的异常变化虽然对冠脉侧支血管的血流阻力影响较小,但却使流经缺血区末梢血管的有效侧支血流量明显减少而加重心肌缺血。     

主养草鱼高密度池塘溶氧收支平衡的研究

采用原位生态学的方法测定广东省中山市9口主养草鱼高密度池塘中浮游植物光合作用产氧量、水柱呼吸耗氧量、底泥呼吸耗氧量和鱼呼吸耗氧量, 并用数学模型计算增氧机增氧量及用差减法计算大气扩散作用引起的得氧或失氧, 对高密度养殖池塘中溶氧收支平衡状况进行了研究。结果显示: 在水深为1.5-2.0 m的主养草鱼高密度池塘中, 光合作用产氧量随着水深的增加而显著降低(P0.05), 底层出现负值呈现氧债现象。水呼吸耗氧量在表层、中层和底层之间没有显著差异(P0.05)。表层水光合作用产氧量显著大于水呼吸耗氧量(P0.05), 而中层和底层水光合作用产氧量却显著小于水呼吸耗氧量(P0.05)。在主养草鱼高密度池塘溶氧的收入中, 浮游植物光合作用产氧量、增氧机增氧量和大气扩散溶入氧量分别占总溶氧来源的44.7%、42.3%和13.0%, 机械增氧作用已接近光合作用, 成为溶氧来源的主要贡献者; 在池塘溶氧的支出中, 水呼吸、鱼呼吸和底泥呼吸耗氧量分别占总耗氧量的45.9%、45.0%和9.1%, 鱼呼吸耗氧与水呼吸耗氧相当, 成为水体中氧气的主要消耗者。结果表明在草鱼高密度养殖过程中, 合理使用机械增氧是池塘溶氧管理的有效措施。       

小卷蛾线虫脱水休眠的形态与耗氧量

报道了小卷蛾线虫 Steinernema carpocapsae (BJ品系)在高渗液中脱水进入休眠的形态变化和耗氧量。结果表明：脱水线虫的形态变化与耗氧量相关,线虫在高渗液第30 h内,脱水程度越强,耗氧量越低。线虫脱水进入休眠从形态上分为螺旋、鞘壁分离和侧线弯曲三个阶段。在螺旋阶段脱水线虫代谢开始减慢,耗氧量较对照减少了14%。在鞘壁分离阶段脱水线虫开始进入休眠,耗氧量较对照减少了65%,加水后线虫在10 min内100%复苏。在侧线弯曲阶段Ⅰ脱水线虫进入了深度休眠,耗氧量较对照减少了79%,加水后在30 min内100%复苏。     

肾神经在肾缺血预处理对麻醉家兔心脏保护中的作用

在氨基甲酸乙酯麻醉家兔上,观察肾脏缺血预处理(RIP)对缺血-再灌注心肌的影响,旨在证实RIP对心肌有无保护效应,并明确肾神经在其中的作用。所得结果如下(1)在心脏45min缺血和180min再灌注过程中,血压、心率和心肌耗氧量呈进行性下降;心外膜电图ST段在缺血期明显抬高,再灌注过程中逐渐恢复到基础对照值。心肌梗塞范围占缺血心肌的55.80±1.25%。(2)RIP时心肌梗塞范围为36.51±2.8%,较单纯心肌缺血-再灌注显著减少(P<0.01),表明RIP对心肌有保护作用。(3)肾神经切断可取消RIP对心肌的保护效应,但肾神经切断本身对单纯缺血-再灌注所致的心肌梗死范围无明显影响。(4)肾缺血(10min)时,肾传入神经放电活动由0.14±0.08增至0.65±0.12imp/s(P<0.01)。(5)预先应用腺苷受体拮抗剂8-苯茶碱可明显减弱肾缺血所激活的肾传入神经活动,提示肾传入活动的增强是由肾缺血产生的腺苷所介导。以上结果表明,肾短暂缺血-再灌注所诱发的肾神经传入活动在RIP心肌保护效应中起重要作用。     

牛磺酸对乳鼠心肌细胞内钙浓度的影响

研究低氧、复氧对乳鼠心肌细胞内钙离子浓度的影响,以及牛磺酸在模拟心肌缺血/再灌注(I/R)过程中对细胞内钙的调节作用。采用SD大鼠乳鼠进行心肌细胞培养,建立模拟I/R模型。以Fluo-4/AM荧光指示剂负载,应用激光共聚焦显微镜技术(confocal laser scanning microscope,CLSM)检测心肌细胞钙离子浓度的变化。对照组心肌细胞内钙离子荧光强度(23.71±2.37U)较低;低氧180 min后复氧即刻,钙离子荧光强度开始增加(57.52±8.31U),复氧180 min后钙离子荧光强度(71.13±4.74U)显著增高(P<0.01vs对照组)。而牛磺酸组细胞内钙离子荧光强度较模拟I/R组显著降低[(42.42±4.17U)vs(71.13±4.74U),P<0.01]。心肌细胞缺血/缺氧导致Ca2+超载;模拟I/R Ca2+超载加剧,而牛磺酸有明显减轻心肌细胞模拟I/R时Ca2+超载的作用。     

重复远程缺血后适应对急性缺血心肌中骨髓间充质干细胞移植的影响

目的探讨在大鼠急性心肌缺血模型中重复远程缺血后适应对骨髓间充质干细胞(MSC)经心肌注射移植存留率的影响。方法结扎成年雌性SD大鼠的左前降支诱导心肌缺血。雄性SD大鼠来源的骨髓MSC培养至第三代。大鼠缺血30 min后开放结扎的冠状动脉,并经缺血心肌边缘注射4×106个骨髓间充质细胞。60只心肌缺血大鼠随机平均分为再灌注对照(IR)组、远程缺血后适应(RIPo C)组、重复远程缺血后适应(r RIPo C)组和CXCR4抗体拮抗(CXCR4-Ab)组。远程缺血后适应在后肢上实行4个周期5 min缺血和再灌注。重复远程缺血后适应在后肢上每3 d实行4个周期5 min缺血和再灌注。CXCR4抗体拮抗(CXCR4-Ab)组在行r RIPo C前经腹腔注射CXCR4特异的抗体。1个月以后,进行心功能评价、免疫组化寻找标记的细胞、聚合酶联反应检测Y染色体拷贝数计算心肌中细胞存留率,采用方差分析和独立t检验进行统计学分析。结果重复远程缺血后适应的细胞移植组显著改善缺血心脏的左室短轴缩短分数[r RIPo C(25.90±4.33)﹪,RIPo C(20.60±3.50)﹪,IR(16.60±3.20)﹪,CXCR4-Ab(20.00±3.23)﹪,F=11.422,P=0.000]和左室收缩末期内径[r RIPo C(5.24±0.51)mm,RIPo C(5.77±0.44)mm,IR(6.15±0.33)mm,CXCR4-Ab(5.78±0.33)mm,F=8.159,P=0.000]。免疫组化发现重复远程缺血后适应组的心脏内细胞滞留率更高,PCR检测MSC滞留比例[r RIPo C(2.33±0.46)﹪,RIPo C(1.85±0.50)﹪,IR(1.42±0.27)﹪,F=8.189,P=0.000];特异CXCR4抗体阻断降低重复远程缺血后适应诱导的心脏内高细胞滞留率[r RIPo C(2.33±0.46)﹪,CXCR4-Ab(1.82±0.36)﹪,n=10,P=0.014]和心脏收缩功能改善[r RIPo C(25.90±4.33)﹪,CXCR4-Ab(20.00±3.23)﹪,P=0.003]。结论重复远程缺血后适应较单次远程缺血后适应提高经心肌注射移植的骨髓MSC在心脏中的移植存留率。CXCR4受体在重复远程缺血后适应后期诱导的心肌高移植存留率中发挥重要作用。     

缺血后功能低下大鼠心肌钙与水含量的变化及高渗甘露醇的影响

缺血后心室功能减低(myocardial stunning)的发生机制迄今尚不明了。本实验以 Lang-cndorff 法在离体灌流的大鼠心脏,研究了全心缺血20min 及再灌注40min 后心肌 Ca~(2+)、Na~+K~+、Mg~(2+)及 H_2O 含量的变化,以及高渗甘露醇对缺血后功能低下心肌的影响。实验发现:(1)缺血/再灌注后心肌组织中 Ca~(2+),H_2O 的含量与非缺血组相比分别增加42%(P<0.01)及7.6%(P0.05)。(2)于再灌注同时给予12%高渗甘露醇可明显改善缺血后心室功能:再灌注40min 时,心率-左室压乘积恢复达缺血前的85%,而不给甘露醇仅恢复66.3%(p<0.01);高渗甘露醇同时消除了缺血后功能低下心肌中 Ca~(2+)超负荷与心肌水肿,此现象提示缺血/再灌注引起的肌膜非特异性通透性改变,很可能是钙进入细胞内的路径之一。本研究结果表明,心肌 Ca~(2+)超负荷及轻度心肌水肿参与了缺血后心室功能低下,高渗甘露醇在离体大鼠心脏可明显改善缺血后功能低下心肌的功能,此作用至少部分是由于其具有减低心肌钙与水含量的效应。     

后适应缺血时间窗的选择对小鼠心肌再灌注损伤的影响

目的 探讨后适应对小鼠心肌再灌注损伤的影响以及不同缺血时间窗的后适应心脏保护作用的差异 .方法 96只成年C57/BL小鼠随机分为缺血时间30、45 min和60 min的三组,每组又分为后适应和缺血再灌注两种处理.通过开胸结扎左冠状动脉造成急性心肌梗死 ,在完全再灌注早期给予反复短暂再通/闭塞的缺血后适应.采用Evans blue和TTC染色的方法确定缺血心肌和梗死心肌面积,并测定血清的心肌酶含量、心肌超氧化物歧化酶 (SOD) 活性与丙二醛 (MDA) 水平以及血流动力学指标.结果 缺血30 min后适应组、缺血45 min后适应组心肌梗死面积分别比相同缺血时间的再灌注对照组减少53.1%和31.2%,差异均具有统计学意义(P<0.01),缺血后适应可明显降低血清心肌酶、提高心肌SOD的活性以及改善血流动力学的恶化;缺血60 min后适应组梗死心肌面积无明显降低, 差异无统计学意义(P＞0.05).结论 小鼠心肌处于轻中度水平的缺血损伤,在恢复冠脉血流的早期施行缺血后适应可以有效地减少心肌再灌注损伤,但随着缺血时间的延长,心肌保护作用就明显减弱或消失.     

牛磺酸对家兔缺血/再灌注心肌细胞凋亡的影响

目的:研究牛磺酸(Tau)对家兔缺血/再灌注损伤心肌细胞凋亡的影响.方法:阻断家兔心脏左冠状动脉前降支45 min,再灌注180 min引起心肌缺血/再灌注损伤,在心肌缺血前5 min耳缘静脉注射牛磺酸(200mg/kg),应用DNA片段原位末端标记法 (TUNEL染色),DNA凝胶电泳和流式细胞仪(FCM)观测心肌细胞凋亡.结果:琼脂糖凝胶电泳显示损伤对照组(I/R) 心肌DNA呈云梯状改变,而Tau I/R组无此改变.与损伤对照组(I/R) 比较,Tau I/R组缺血心肌凋亡细胞明显减少(TUNEL染色).流式细胞仪测定I/R组及Tau I/R组缺血心肌凋亡率分别为17.66%±1.54%和4.86%±1.23%.I/R组的缺血心肌Fas和Bax蛋白表达较非缺血心肌高 (P<0.01),Bcl-2/Bax比例较非缺血心肌低(P<0.01);而在Tau I/R组,Fas和Bax蛋白表达较I/R组的低 (P<0.01),Bcl-2/Bax比例较I/R组高(P<0.01).结论:牛磺酸可减少I/R家兔心肌细胞凋亡,其机制与调控凋亡相关基因 Fas,Bax和Bcl-2的蛋白表达有关.     

Adenosine and cardioprotection during reperfusion – an overview

Ischemic heart disease includes a number of entities that have been grouped in accordance with physiopathology and evolutive criteria. In recent years new ischemic syndromes have been described. Within the new ischemic syndromes, ventricular post-ischemic dysfunction – also known as stunned myocardium – is worth mentioning. In this route, several studies have suggested that reperfusion per se could cause cellular injury (reperfusion injury). In previous years, a protective effect on the injury caused by ischemia and reperfusion in the heart has been attributed to adenosine. These effects have been documented in different experimental in vivo and in vitro models. Thus, the administration of exogenous adenosine, or agonists of adenosine receptors prior to ischemia reduces the size of the infarction, improves the recovery of the ventricular function during reperfusion (attenuating stunning) and prolongs the time period to the ischemic contracture. However, focusing on a potential therapeutic application, it is of the utmost importance to find this protection and learn the mechanisms involved when procedures are applied during early reperfusion.We showed that adenosine, administered from the beginning of reperfusion, attenuated systolic and diastolic (myocardial stiffness) alterations of the stunned myocardium. This protective effect was mediated by the activation of A₁ adenosine receptors, and without modification on infarct size. According to some authors, adenosine can decrease the release of endothelin, during early reperfusion, and reduce an overload of Ca²⁺ that could cause a cellular lesion. Finally, ischemic preconditioning involves a series of intracellular events that are initiated with the activation of the A1 receptor, and end at the sensitive K⁺ ATP channels of the mitochondria. The phosphorylation and opening of these channels would cause the protective effect. Activation of this specific mechanism during reperfusion has not been studied extensively.     

犬实验性急性心肌梗塞早期心肌细胞膜脂流动性的改变

为了解急性心肌梗塞(AMI)时心肌细胞膜脂流动性(LFU)的变化,用荧光分光光度计偏振法测定了20只实验性AMI早期犬的心肌细胞LFU。结果表明,AMI早期心肌细胞LFU与正常组比较明显降低(P<0.01),其降低程度与心肌缺血时间长短和心肌细胞损伤程度有关。LFU在冠状动脉(CA)结扎后1min时即出现降低,与心外膜电图S—T段弓背向上损伤性改变同时发生,而明显早于外周血清肌酸磷酸激酶(CPK)和谷草转氨酶(AST)以及心肌组织病理形态学的改变,后者在CA结扎后240min出现变化。因此,LFU可作为AMI早期反映心肌细胞缺血损伤及其程度的一种敏感标志。     

Biphasic changes in relaxation following reperfusion after myocardial ischemia

The present study provides evidences of left ventricular diastolic alterations following reperfusion in a model of global ischemia. Isolated perfused rabbit and rat hearts, were subjected to ischemia for 15 and 20 min respectively, followed by 30 min of reperfusion. In rabbit heart at the end of the reperfusion period, isovolumic left ventricular developed pressure (LVDP) and +dP/dt_max stabilized at 55 ± 3% and 60 ± 2% of preischemic values respectively and, in rat heart LVDP = 61 ± 8% and +dP/dt_max = 57 ± 9% of preischemic values. Stunned heart was then obtained from both species. Left ventricular end diastolic pressure (LVEDP) values stabilized at the end of reperfusion period at values higher than preischemic conditions in both species (38.9 ± 4.4 mmHg and 30.3 ± 3.1 mmHg in rabbit and rat respectively). The time constant of relaxation (T) increased early in reperfusion in both species, but then decreased and stabilized at the end of reperfusion period at values lower than preischemic values. The ratio between both maximal velocities (+P/-P), also showed a transitory impairment in relaxation, followed by normalization and stabilization at values lower than preischemic values. This biphasic pattern in relaxation was detected in both species. The changes in relaxation were dissociated from the diastolic compliance and could be the result of a transitory calcium overload and/or sarcoplasmic reticulum dysfunction. The faster myocardial relaxation at the end of reperfusion period is consistent with the decreased myofilament sensitivity, which characterizes the stunned myocardium.     

The relation between myocardial blush grade and myocardial contrast echocardiography: which one is a better predictor of myocardial damage?

Background. Myocardial blush grade (MBG) and myocardial contrast echocardiography (MCE) are both indices for myocardial perfusion in patients with ST-elevation acute myocardial infarction (STEMI). We aimed to compare MBG with MCE in the infarct-related artery segment for assessing infarct size in patients with STEMI treated with primary percutaneous coronary intervention (PCI).Methods. 43 patients underwent successful (postprocedural TIMI flow 3) primary PCI for STEMI. MBG was assessed at the end of the PCI procedure and MCE was assessed 1.7±1.8 days after PCI. Enzymatic infarct size was estimated by measurementof enzyme activities by using lactate dehydrogenase (LDH) as the referenceenzyme. Cumulative enzyme release (LDHQ₄₈) from at least five serial measurements up to 48 hours after symptom onset was calculated. Also peak creatine kinase, CK-MB and peak LDH were measured.Results. MBG 0/1, 2 and 3 were observed in 14, 12 and 17 patients, respectively, and was compared with tertiles of MCE. We found a parallel correlation between both MBG and MCE and LDHQ₄₈. However, there was no correlation between MCE and MBG. Patients with both normal MCE and a normal MBG had least myocardial damage and those with both impaired MCE and an impaired MBG had most myocardial damage.Conclusion. Both MBG and MCE are good predictors of infarct size in STEMI patients treated with PCI. However, these markers are not mutually related, possibly due to time-related changes in myocardial perfusion. Combining these two markers may yield a more accurate prediction of final myocardial damage. (Neth Heart J 2010;18:25-30.)     

白细胞与心肌缺血的关系

炎症是引发心血管疾病的一个重要的危险因子.白细胞数量增多的患者更容易患上急性心肌梗塞、急性冠状动脉等疾病.对临床上白细胞数量高的数据与疾病预测之间的关系,这其中可能有几种机制.测量白细胞的数量和亚群可能是区分急性血管疾病患者危险程度的一种更好的方法.     

缓激肽在骨骼肌缺血预适应对猪心肌坏死和凋亡中的作用

目的：研究缓激肽在骨骼肌缺血预适应对心肌坏死和心肌凋亡保护中可能的作用：方法：采用非开胸法建立猪心脏缺血／再灌注（I／R）模型,通过球囊堵塞左股动脉造成骨骼肌短暂缺血,使用缓激肽（BK）的B2受体拮抗剂烟酸已可碱（HOE-140）以及外源BK进行干预。分别观察各组对心肌坏死和凋亡的影响。结果：远端预处理后心肌坏死范围明显缩小,凋亡率明显降低：预处理前使用HOE-140可使对坏死范围的保护作用明显减弱;心肌I／R前使用外源BK注射,可缩小心肌梗死范围。但HOE-140及外源BK对以上凋亡指标无影响．结论：骨骼肌远端预适应可减少心肌坏死和心肌凋亡、BK可能参与对坏死面积的保护．但不参与对凋亡的保护作用。     

microRNAs与心血管疾病

microRNAs(miRNAs)是一类长21~25 nt的非编码内源性蛋白质的RNAs,它们在转录后水平调控基因的表达,包括细胞增殖、分化和凋亡等一系列生理进程,影响生物体的生长发育,并与多种疾病相关。随着研究人员对microRNAs参与疾病的发病机制的研究,可能为人类某些疾病的治疗开辟一条新的途径。该文总结miRNAs在调控心血管疾病发生作用方面的研究成果,并对miRNA与心肌肥厚、心肌纤维化、心肌梗死、高血压、心率失常等的关系进行综述和展望。     

右美托咪定对高血压心肌肥厚患者围术期心肌的保护作用

目的：观察右美托咪定（DEX）对高血压心肌肥厚患者心肌的保护作用。方法：将符合诊断标准54例患者随机分为两组（n=27）：DEX组（D组）和对照组（C组）。D组于麻醉诱导前15 min给予负荷剂量右美托咪定1 μg/kg,静脉泵注10 min,随后维持剂量0.5 μg/（kg·h）至手术结束。C组相应时间泵注等量生理盐水。两组患者麻醉前2 h连接Holter记录仪,静息平卧连续记录1 h作为基础值,其后连续记录24 h。并在T0（诱导前）、T1（手术开始1 h）、T2（术后4 h）、T3（术后12 h）、T4（术后24 h）五个时间点采集血样测定缺血修饰白蛋白（IMA）和血清肌钙蛋白I（cTnI）。观察并记录两组患者手术时间、出血量和心血管并发症等临床指标。结果：D组在T1、T2、T3时IMA水平均明显低于C组（P<0.05）,在T1、T2、T3、T4时cTnI水平均明显低于C组（P<0.05）,Holter显示D组ST段缺血样改变和复杂室性心律失常明显低于C组（P<0.05）。结论：DEX可以减轻高血压心肌肥厚患者围术期心肌损伤,减少ST段缺血样改变和复杂室性心律失常的发生率,具有一定的心肌保护作用。     

江浙蝮蛇抗栓酶对兔缺血心肌电生理学变化的影响

本研究观察了江浙蝮蛇抗栓酶(svate)对缺血心肌电生理学变化的影响。结果表明,静脉注射svate,使阻断冠脉后兔血小板聚集功能和心脏电生理各指标变化明显减轻。缺血50min时,血小板聚集率仅增加4±13％,静息电位减小15.8±0.1％,动作电位幅度降低17.8±0.1％,复极化50％和90％时程分别缩短12.3±0.1％及延长4±0.1％,不应期差值为4.2±7.8％,室颤阈(VFT)降低15.4±8.1％,与单纯阻断组各参数的百分率变化相比,p值均<0.01,证明svate具有改善有效不应期和提高VFT的作用。     

Non-ischemic myocardial preconditioning

The reduction of infarct size produced by brief ischemic episodes prior to a sustained occlusion of a coronary artery, called ischemic preconditioning, is a well known phenomenon that occurs in several species, but its mechanism is still under investigation. Recent reports support the idea that this protection can also be obtained by non-ischemic maneuvers like distention of the left ventricle and metabolic stimulation of myocardial cells. The features of non-ischemic preconditioning (temporal limitation, second window, tolerance development, remote preconditioning and efficiency of the protection), as opposed to those of ischemic preconditioning, are still to be determined. Neither is it known if non-ischemic preconditioning occurs in humans. From a physiological point of view the protective effect of an increase in metabolic rate of the heart means a constant feed-back mechanism in the myocardial cell that counteracts the presumptive damage consequent to the increase in metabolism. Therefore, in the presence of a sudden coronary occlusion the metabolic rate of the heart immediately before the occlusion would have a dual role of increasing the degree of ischemia and of protecting against it.