肥大型运动心脏与慢性压力超负荷病理心脏心功能判别

用超声心动图法对24名力量性专业运动员、33名正常人及21名慢性压力超负荷心脏病患者进行了研究。结果发现:运动心脏组及心脏病组的心脏形态结构指标均显著大于正常心脏组,心脏病组更为显著,且泵功能及心缩功能指标几乎均不低于正常心脏组,甚至有超常现象;而心舒功能指标心脏病组全部均显著低于正常心脏组,运动心脏组也大部显著低于正常心脏组而向心脏病组倾斜。据此认为:(1)肥厚型心脏的高排量,不能除外病理心脏高代偿期的可能性。(2)以“心肌肥厚”为主要特征的肥大型运动心脏与以“大容积”为主要特征的大容积型运动心脏一样,均存在其生理-病理阈限的现实可能性。     

阶梯式进行性急性低氧时Starling效应对左心室搏血效率的影响

为探讨急性低氧时 Starling 效应对左室搏血效率的影响,在12条麻醉开胸狗上进行了实验。给狗依次吸入氧分压为84、64、52mmHg 的氧氮混合气体和纯氮气造成急性低氧。我们将心泵急性低氧反应分为稳态调节、剧烈动员和衰竭三个阶段。在Starling 效应开始持续发动以前,心泵处于稳态调节阶段、左室舒张期末直径(LVEDD)、在室压力(LVP)、每搏输出量(SV)、每搏外功(W)、与每搏外功功率峰值(N_(max))等稳定于对照水平,略有波动。搏血效率指数(I_(BEE)=SV/N_(max))也稳定于对照水平。稳态调节阶段持续时间的长短与心泵能耐受低氧的程度和时间呈正相关(r=0.83,P<0.001)。在剧烈动员阶段,左室舒张期末直径进行性地迅速增大,从对照时的 51.55±1.09mm(M±SE)增至54.60±1.63mm(P<0.01)。同时,LVP、SV、W、N_(max)等泵功能指标也明显上升,形成一个显著高于对照值的峰(各指标与对照相比,均P<0.01)。此时,搏血效率指数仍维持于对照水平(P>0.05)。此结果表明;剧烈动员阶段时 Starlins效应的发动和维持,并未降低搏血效率,有利于心泵功能代偿。     

急性低氧时狗左、右心室“力效应”的比较观察

在麻醉开胸狗上,于急性逐步加重低氧条件下,同步记录左、右心室压、压力变化率(dp/dt)等指标,观察左、右心室“力效应”动态变化过程。结果表明,急性低氧时,肺动脉升压效应与低氧程度呈正相关;左、右心室“力效应”并非同步。当左室“力效应”由增强转为减弱时,右室仍处于“力效应”增强过程,而且左室(-dp/dt_max)的减小先于(dp/dt_max)。严重低氧一旦使右室出现“力效应”减弱时,则标志着心泵功能崩溃。这些结果提示左室泵丧失代偿并非继发于肺动脉高压导致的右室负荷过重;心室舒张期力学的改变在心泵对急性低氧的反应上甚为重要,可用左心室进行性的“力效应”减弱作为判断心泵对急性低氧不能耐受的一项指标。     

急性低氧时的Starling效应及心包的影响

为确定 Starling效应在心泵急性低氧反应中的地位,以及心包对此反应的影响,把17条雄狗,分别在心包切开(A 组)和缝合(B 组)条件下进行实验。在连续、依次吸入空气、氧分压为89、70和55mmHg 的常压氧-氮混合气各30min,并最后吸入氮气时,分别记录不同低氧状况下的左室前后径超声图、左室压力,dp/dt,右室压力或主动脉压力和第二导联心电图。结果表明,重度低氧时,左室舒张期末直径显著增大,A组由对照值3.88±0.15cm(M±SE)增大至4.22±0.18cm(P<0.01);B组由3.53±0.13cm增至3.67±0.12cm(P<0.01),并伴以每搏直径变化的明显增大(A 组由对照值的4.4±0.2mm增至4.9±0.2mm P<0.05;B 组由3.2±0.1mm 增至3.8±0.2mm P<0.01)。左室压力-直径环在重度低氧时显著右移,环体面积不缩小。说明重度低氧时,Starling 效应对心脏搏血功能的调节具有重要作用。在严重低氧导致左室收缩压进行性降低时,迅速切开心包可有利于心泵功能的改善,提示,心包对 Starling 效应的充分发挥有限制作用。     

急性低氧下心泵“力效应”与心电、心肌乳酸的变化

用“心力环”表达心泵的“力效应”,以侧位肢体导联心电图来检测心脏传导系统的反应,在10条麻醉开胸狗上,观察了急性低氧条件下心泵的力学变化和心电活动演变过程的联系。在急性低氧早期,“心力环”即开始增大和“心力效率”(SV/FL_o)降低时,心电传导时间和心室复极化过程均没有明显改变(P>0.05)。直到以“心力环”环体减小及“心力效率”增加为特征的心泵衰竭出现时,才呈现心室复极化过程的明显缺氧性改变:ST_(Ⅱ)段抬高(P<0.05),T_(Ⅱ)波振幅显著增加(P<0.01);并伴以心率明显地降低(P<0.05)。在10条狗中有4条发生室性早搏或室颤等明显心率紊乱,它们均出现于“心力环”环体显著减小的严重泵衰竭时。另有8条狗在相似的实验条件下的结果表明,心泵衰竭时心肌乳酸含量明显高于对照组(P<0.05)。本研究结果提示,心泵“力效应”变化在急性低氧过程中发生得较早。这样,在评价心泵对急性低氧的耐受性上,心泵“力效应”比心脏电活动更为敏感。     

核苷(酸)类似物治疗代偿性乙肝肝硬化疗效预测模型

目的:建立影响核苷(酸)类似物治疗代偿性乙肝肝硬化疗效的预测模型。方法:204例代偿性乙肝肝硬化患者给予核苷(酸)类似物治疗,治疗48周后随机选取136例作为建模组,68例作为验证组,根据治疗效果将建模组又分为代偿组87例,失代偿组49例,对影响代偿组与失代偿组预后的相关因素进行单因素及Cox回归分析,建立预测方程。结果:多因素Cox比例风险回归分析得出实际较优模型:h(t、x)=h0(t)exp(0.5502_(X16)+0.3247_(X19)-0.0149_(X8)-0.0130_(X11)-0.0125_(X14)),由模型可知ALT(X8)、胆红素(X11)、PT(X14)、透明质酸(X16)、肝硬度值(X19)对核苷(酸)类似物治疗代偿性乙肝肝硬化的预后影响较大;代偿性乙肝肝硬化发展成为失代偿性乙肝肝硬化的概率模型(P)=1/[1+e-h(t、x)],受试者工作特征(ROC)曲线下面积(AUC)为0.8519,回归模型预测能力良好。验证组中失代偿性乙肝肝硬化组ALT、胆红素、PT阳性,透明质酸200μg/L,肝硬度值25k Pa比例均高于代偿性乙肝肝硬化组,差异比较有统计学意义(P0.05)。结论:核苷(酸)类似物可有效抑制代偿性乙肝肝硬化患者HBV-DNA病毒复制,并促进HBe Ag转阴,但其治疗效果受ALT、胆红素、PT、透明质酸、肝硬度值等的影响。     

膀胱功能代偿系统的研究

本文对截瘫病人膀胱功能障碍的重建机理和方法进行了综合分析,对临床上解决膀胱功能代偿的各种途径加以比较,提出膀胱功能代偿系统-膀胱控制器的新设计,它将会使我国广大的膀胱功能障碍患者受益。     

狗在急性低氧后复氧过程中的心脏功能损伤

六条在心脏上装有高精度压力传感器及微型超声测距探头的慢性实验狗,经两个星期的手术恢复期后,于Halothane麻醉下,给予低氧气体吸入,使动脉血氧饱和度从对照时的99.8±0.1％降到60.7-4.4％。低氧时,左心室功能随着动脉血氧饱和度的下降,表现为中度低氧时增强、严重低氧时减弱的变化。复氧时,出现与低氧时不相同的左心室功能异常,如心动过速、严重心律紊乱、后负荷增高、舒张期末室壁厚度显著增加,室壁舒-缩厚度差减小、室壁舒缩的不匀质性以及极低的心肌顺应性等。这些结果表明,在急性低氧后的复氧过程中,左心室功能存在着一种“复氧损伤”。     

FoxO1在胰岛β细胞代谢灵活性受损及失代偿进程中的作用

葡萄糖及脂肪酸是胰岛β细胞的关键代谢底物,葡萄糖刺激胰岛β细胞分泌胰岛素是维持机体血糖稳态平衡的关键。胰岛素抵抗发生时,β细胞对能量代谢底物的选择失调,加速胰岛β细胞由代偿到胰岛β细胞失代偿的进程,是肥胖胰岛素抵抗最终发展为2型糖尿病的始动因素。核转录因子FoxO1属于Fox家族成员,在胰腺内广泛表达,在β细胞的代谢,发育,增殖过程中发挥着重要的调节作用。鉴于FoxO1在维持胰岛β细胞功能中的关键作用,现着重对FoxO1在胰岛β细胞代谢灵活性受损及失代偿过程发生中的作用调节进行阐述。为其作为调控胰岛β细胞功能的关键靶点提供参考。     

基于决策树的代偿期和失代偿期肝硬化自动诊断的方法

决策树方法因结构简单、便于理解和具有较高的分类精度而在数据挖掘中被广泛采用.本文利用改进的决策树算法C4.5从201例肝硬化病例中自动地提取相应的肝硬化状态识别规则,得到决策树分类模型并归纳出代偿性肝硬化和失代偿性肝硬化的诊断规则,识别正确率为84.6%.实验结果表明决策树能较好的自动从肝硬化病例中归纳出代偿性和失代偿性肝硬化的诊断规则.     

慢性缺氧对大鼠心室功能和ATP酶活性的影响

将大鼠置于不同模拟海拔高度低压舱内4d,观察其左、右心室功能代偿与失代偿的某些生物化学基础。结果表明,5000m中度缺氧4d使左、右心室功能、重量、心肌蛋白含量及Ca~(2 )-ATP酶活性均有不同程度的增高。提示机体在整体、心脏器官及心肌细胞分子各个水平的代偿机制均有加强。8000m重度缺氧4d后,左室重量增加,dp/dt_(max)与蛋白含量均下降,肌原纤维ATP酶活性则保持中度缺氧的代偿水平,提示左心功能似已受到损害。与此同时,右室蛋白含量虽也明显减少,但其ATP酶活性则继续增高,dp/dt_(max)未出现下降,表明右心功能仍具有相当的代偿能力。从而支持我们关于在短期内因供氧严重不足而造成的左室心肌的直接损伤作用大于右室心肌的推论。     

Cardiac pump function of the isolated rat heart at two modes of energy deprivation and effect of adrenergic stimulation

The contractile function of the isolated rat heart and high energy phosphate content were evaluated under conditions of depressed energy supply caused by disturbances either in mitochondrial ATP production or ATP-phosphocreatine transformation. Amytal (0.3 mM), an inhibitor of mitochondrial respiration, or iodoacetamide (IAA, 0.1 mM) reducing in this dose creatine kinase activity to 19% of the initial level, were used, respectively. Myocardial ATP content remained unaffected in both groups and PCr content decreased to 37% only in amytal-treated group. Very similar alterations in cardiac pump function during volume load were observed in both treated groups; maximal cardiac output was significantly less by 30%, cardiac pressure-volume work by 38–40%, left ventricular (LV) systolic pressure by 24–29%, and LV +dP/dt by 36–39%. In contrast, the extent of decreased LV distensibility was different, a curve relating LV filling volume and end-diastolic pressure was shifted up and to the left much more prominently after IAA treatment. Heart rate was decreased by 24% only in amytal-treated group. Results indicate that a decreased myocardial distensibility is a dominating feature in the acute cardiac pump failure caused by an inhibition of myocardial creatine kinase. Isoproterenol (0.1 M) substantially increased heart rate and pressure-rate product in IAA-treated hearts but failed to increase cardiac work probably due to its inability to improve myocardial distensibility.     

Effect of adaptation to hypoxia on the working capacity and energy of skeletal muscles

The authors studied the working capacity and heat formation of the skeletal muscles during contraction in rats--control and those adapted to hypoxia. The force of contraction, the work and fatigueability of the muscles, as well as elevation of the muscle temperature as a result of contraction were determined under conditions of indirect muscle electrostimulation. Hypoxia adaptation failed to influence the force of muscle contraction and the work performed. However, hypoxia led to reduction of the temperature effect of the muscle contraction per unit of the work performed. This pointed to increase of the efficiency of the muscle work in hypoxia adaptation. Fatigueability of the muscles in "hypoxic" rats was elevated. Changes in the energy of the muscle contraction in hypoxia and cold adaptation were different.     

Artificial Selection for Whole Animal Low Intrinsic Aerobic Capacity Co-Segregates with Hypoxia-Induced Cardiac Pump Failure

Oxygen metabolism is a strong predictor of the general health and fitness of an organism. In this study, we hypothesized that a divergence in intrinsic aerobic fitness would co-segregate with susceptibility for cardiovascular dysfunction. To test this hypothesis, cardiac function was assessed in rats specifically selected over nineteen generations for their low (LCR) and high (HCR) intrinsic aerobic running capacity. As an integrative marker of native aerobic capacity, run time to exhaustion between LCR and HCR rats had markedly diverged by 436% at generation nineteen of artificial selection. In vivo assessment of baseline cardiac function by echocardiography and catheter-based conductance micromanometry showed no marked difference in cardiac performance. However, when challenged by exposure to acute hypoxia, cardiac pump failure occurred significantly earlier in LCR rats compared to HCR animals. Acute cardiac decompensation in LCR rats was exclusively due to the development of intractable irregular ventricular contractions. Analysis of isolated cardiac myocytes showed significantly slower sarcomeric relaxation and delayed kinetics of calcium cycling in LCR myocytes compared to HCR myocytes. This study also revealed that artificial selection for low native aerobic capacity is a novel pathologic stimulus that results in myosin heavy chain isoform switching in the heart as shown by increased levels of β-MHC in LCR rats. Together, these results provide evidence that alterations in sub-cellular calcium handling and MHC isoform composition are associated with susceptibility to compensatory cardiac remodeling and hypoxia induced pump failure in animals with low intrinsic aerobic capacity.     

急性低氧下钙阻断剂对左,右心泵功能的影响

在20条麻醉开胸狗上,用RM-6000多道仪同步记录左心室内峰压(LVP)、左室压力变化率(L+dP/dt_(max))、右心室内峰压(RVP)、右室压力变化率(R±dp/dt_(max))、肺动脉压力(P_(Pa))、主动脉血流每搏峰值(Fa)、心率(HR)等各项生理指标,观察钙通道阻断剂Nife-dipine,Diltiazem和Verapamil对左、右心室功能影响。在钙通道阻断剂处理后,左室的LVP,L±dp/dt_(max)下降,而Fa增加;右室的RVF,R±dp/dt_(max)和P_(Pa)均有升高趋势,显示钙通道阻断剂对左、右心泵功能的影响不同。这可能提示左、右心室功能对钙离子的依赖程度不同。在急性低氧状态下,此三种钙阻断剂均使急性低氧引起LVP的增加反应消失,Fa增加明显,Verapamil和Diltiazem有减轻急性低氧引起的RVP和P_(Pa)的增压作用。从这些钙通道阻断剂对左右心泵功能影响的比较来看,Diltiazem比Verapamil和Nifedipine对急性低氧状态下的心泵功能有较好的作用。     

血管钠肽对中度低氧诱导的心肌细胞蛋白合成有抑制作用

实验探讨了心房钠尿肽家族新成员血管钠肽（vasonatrin peptide,VNP)对中度低氧诱导的心肌细胞蛋白合成的影响,在培养的新生大鼠心肌细胞上,用四唑盐（MTT）比色实验,总蛋白含量测定和^3H-亮氨酸掺入实验等方法观察细胞数和蛋白合成情况,并用放免法测定VNP对细胞内环鸟苷酸（cGMP)和环腺苷酸（cAMP)以及培养上清液中内皮素含理的影响,探讨VNP的作用机制,结果显示,重度低氧24h,心肌细胞数和蛋白合成均降低,而中度低氧显著增加蛋白的合成,具有促心肌细胞肥大的作用,VNP浓度依赖性地抑制中度低氧诱导的心肌细胞蛋白合成增加,并且升高细胞内cGMP水平,降低低氧诱导的培养上清液中内皮素的含量,结果提示,VNP抑制中度低氧诱导的新生大鼠心肌细胞蛋白合成增加,该作用与其升高细胞内cGMP浓度、降低低氧诱导的内皮素合成和/或释放增加有关。     

Hypoxia in early pregnancy induces cardiac dysfunction in adult offspring of Rattus norvegicus, a non-hypoxia-adapted species

Environmental stresses such as hypoxia can alter the development of the fetus that are manifested later in life, but the impact of early maternal hypoxia (MH) on cardiac performance, coronary flow and catecholamine responsiveness in adult offspring is less clear. The effects of exposure to chronic hypoxia (FIO(2)=0.12) in early intrauterine development (days E1-10) on cardiac performance of the adult offspring were estimated using the Langendorff-perfused rat heart. Cardiac dysfunction is presented as increased end-diastolic volume, with decreased ventricular stiffness in both male and female adult offspring (P<0.01 for both). While developed pressures were preserved in female MH rats, males demonstrated a decrease in systolic function, estimated as peak developed pressure (P<0.01). Challenge with dobutamine (300nM), an adrenergic positive inotrope, increased cardiac work for control rats (P<0.01 for male and female rats) but not in MH-male rats. Coronary flow was reduced (P<0.01) and SERCA2 protein expression increased (2-fold, P<0.05) in female offspring, while eNOS protein levels were increased (2.5-fold, P<0.05) in females. This suggests gender-specific differences in compensatory responses to early MH, with female rats increasing calcium turnover to improve contractility and increasing coronary flow through increased expression of eNOS protein, partially restoring coronary perfusion while male rats show little compensation.     

米利酮对正常与心功能不全大鼠离体心肌作用的比较

目的和方法 :本试验通过肌张力测定和心肌细胞内cAMP蛋白结合分析法观察了不同剂量的米利酮对正常大鼠与心功能不全大鼠左心乳头肌的正性肌力作用。结果 :在正常大鼠与心功能不全大鼠米利酮均有肯定的正性肌力作用。在常规剂量组 ,心衰组心肌收缩力增加的幅度低于对照组 (P <0 .0 5 ) ,但在大剂量下两组心肌收缩力的增长的百分率相似 (P >0 .0 5 )。cAMP检测发现心衰组大鼠心肌细胞内cAMP水平低于对照组 ,常规剂量与高剂量米利酮作用下cAMP均明显升高 (P <0 0 1) ,但两个剂量组之间比较无显著差异 (P >0 0 5 )。实验还发现心衰组给予大剂量药物时正性肌力作用先于cAMP的升高。结论 :米利酮对病变和正常心肌的正性肌力作用存在一定差异 ,由于大鼠心功能不全发生后心肌细胞的病理改变 ,该药的正性肌力作用可能有其它机制参与。     

Effect of changes in arterial oxygen content on circulation and physical performance.

To evaluate the effect of different levels of arterial oxygen content on hemodynamic parameters during exercise nine subjects performed submaximal bicycle or treadmill exercise and maximal treadmill exercise under three different experimental conditions: 1) breathing room air (control); 2) breathing 50% oxygen (hyperoxia); 3) after rebreathing a carbon monoxide gas mixture (hypoxia). Maximal oxygen consumption (Vo2 max) was significantly higher in hyperoxia (4.99 1/min) and significantly lower in hypoxia (3.80 1/min) than in the control experiment (4.43 1/min). Physical performance changes in parallel with Vo2 max. Maximal cardiac output (Qmax) was similar in hyperoxia as in control but was significantly lower in hypoxia mainly due to a decreased stroke volume. A correlation was found between Vo2 max and transported oxygen, i.e., Cao2 times Amax, thus suggesting that central circulation is an important limiting factor for human maximal aerobic power. During submaximal work HR was decreased in hyperoxia and increased in hypoxia. Corresponding Q values were unchanged except for a reduction during high submaximal exercise in hyperoxia.     

Balancing tissue perfusion demands: cardiovascular dynamics of Cancer magister during exposure to low salinity and hypoxia

Decapod crustaceans inhabit aquatic environments that are frequently subjected to changes in salinity and oxygen content. The physiological responses of decapod crustaceans to either salinity or hypoxia are well documented; however, there are many fewer reports on the physiological responses during exposure to these parameters in combination. We investigated the effects of simultaneous and sequential combinations of low salinity and hypoxia on the cardiovascular physiology of the Dungeness crab, Cancer magister. Heart rate, as well as haemolymph flow rates through the anterolateral, hepatic, sternal and posterior arteries were measured using a pulsed-Doppler flowmeter. Summation of flows allowed calculation of cardiac output and division of this by heart rate yielded stroke volume. When hypoxia and low salinity were encountered simultaneously, the observed changes in cardiac properties tended to be a mix of both factors. Hypoxia caused a bradycardia, whereas exposure to low salinity was associated with a tachycardia. However, the hypoxic conditions had the dominant effect on heart rate. Although hypoxia caused an increase in stroke volume of the heart, the low salinity had a more pronounced effect, causing an overall decrease in stroke volume. The patterns of haemolymph flow through the arterial system also varied when hypoxia and low salinity were offered together. The resulting responses were a mix of those resulting from exposure to either parameter alone. When low salinity and hypoxia were offered sequentially, the parameter experienced first tended to have the dominant effect on cardiac function and haemolymph flows. Low salinity exposure was associated with an increase in heart rate, a decrease in stroke volume and cardiac output, and a concomitant decrease in haemolymph flow rates. Subsequent exposure to hypoxic conditions caused a slight decrease in rate, but other cardiovascular variables were largely unaffected. In contrast, when low salinity followed acclimation to hypoxic conditions, apart from an increased heart rate, there were no other cardiovascular changes associated with the low salinity episode. The implications of these changes in cardiovascular dynamics are discussed in relation to physiological mechanisms and the ecology of decapod crustaceans, in hypoxic or low salinity environments.