腹主动脉缩窄小鼠心脏结构和功能的动态变化*

目的: 探讨腹主动脉缩窄小鼠在向心衰发展的过程中心脏结构和功能的动态变化。方法: 健康雄性昆明小鼠,随机分为模型组、假手术组和对照组。模型组采用腹主动脉缩窄的方法制备慢性心力衰竭小鼠模型,假手术组只分离出腹主动脉但不结扎,对照组不做任何处理。模型组组内分为2周组、4周组、6周组和8周组,每组10只。观察各组小鼠行为学表现、心电图、超声心动图和心肌组织病理学的变化。结果: 模型组与对照组相比:模型组小鼠术后2周开始出现行为学改变并且仅有2周组小鼠出现IVSS降低(P＜0.05);术后4周开始出现病理性J波、EF降低(P＜0.05)、IVSD增加(P＜0.05)和心肌损伤;术后6周开始出现LVPWD和LVPWS增加(P＜0.05);术后8周开始出现LV mass corrected增加(P＜0.05)。各组小鼠心率、R幅值、T幅值、ST段、PR间期、QT间期、QTc等数据差异均无显著性。结论: 腹主动脉缩窄导致小鼠出现心衰的过程中出现了EF降低、室间隔肥厚、病理性J波、左室后壁肥厚以及左室质量增加等变化。     

小鼠主动脉狭窄后不同时期心室肌细胞后除极和触发活动的变化

目的：探讨小鼠主动脉狭窄后不同时期心室肌细胞后除极和触发活动的变化及可能的机制。方法：复制小鼠主动脉狭窄模型后,取小鼠心脏,采用玻璃微电极技术,记录左心室乳头肌动作电位早后除极（EAD）、迟后除极（DAD）和触发活动情况,以及灌流低钾或异丙肾上腺素溶液后,所诱发后除极触发活动的变化。结果：①与同时期对照组比较,小鼠乳头肌动作电位APD90模型组2周和5周组保持不变,9周和13周明显延长。②在记录的30min时间内,模型组9周和13周动物出现EAD和DAD,而对照组以及模型组2周和5周动物未出现EAD和DAD。③低钾或异丙肾上腺素诱发EAD和DAD的发生率,模型组显著高于同期对照组,并且模型组动物的发生率随着时间进行性增加。结论：小鼠主动脉狭窄后,心肌细胞EAD、DAD以及触发活动逐渐增多,心肌细胞的电不稳定性逐渐增加。     

高脂饮食引起小鼠心律失常及心肌纤维化

目的不良饮食方式导致的相关疾病,如肥胖和血脂异常是心律失常的(arrhythmia)重要因素。然而,这些疾病与心律失常的确切关系尚未得到充分确认。本研究中,我们通过高脂饮食(high fatty diet,HFD)动物模型评估了HFD与小鼠心律失常与心肌纤维化的关系。方法将成年雄性C57BL/6J小鼠分为标准饮食组(STD,12%脂肪)和高脂肪饮食组(HFD;50%脂肪)两组。10周后进行在体心电图测试,随后采集心脏组织进行生化及组织学测定。结果HFD可引起小鼠室性心动过速(ventricular tachycardia),QT间期(QT interval duration)显著延长,心房传导速度(atrial conduction velocity)显著降低,右心房动作电位持续时间(action potential duration)延长。组织学和生化分析表明,HFD增加小鼠心脏组织的纤维化程度,并导致炎症。结论HFD可导致小鼠心律失常和心肌纤维化。     

小白鼠或主动脉缩窄术

目的：探讨小鼠心肌肥厚模型中手术的关键性技术问题。方法：小鼠麻醉后右侧第三肋间开胸,用自制过线器在升主动脉下穿线,连同主动脉一起结扎在２６ｇ针头上,退出针头,使升主动脉周长缩小的约１／３。结果：术后５周,小鼠成活率为７０％,左心室／体重明显大于对照组,动物不出现心包炎。结论：此方法简便有效,重复性好,得到的模型便于研究离体肥厚心脏的功能和分离心肌细胞。     

急性心肌梗死患者Q—Tc间期延长的意义

为了探讨急性心肌梗死心电图Q-Tc值延长的临床意义,本文分析了42例急性心肌梗死患者的体表12-导联心电图,结果显示：心律失常组Q-Tc间期较对照组显著延长;大面积梗死组的Q-Tc间期及心律失常的发生率均大于小面积梗死组。提示急性心肌梗死的Q-Tc间期与室性心律失常之间有密切的关系。     

大鼠胸主动脉缩窄诱导心肌肥厚模型的建立

目的建立大鼠胸主动脉部分缩窄诱导心肌肥厚动物模型。方法雄性SD大鼠30只,随机分为两组：胸主动脉缩窄组20只和同期假手术组10只。在右无名动脉和左颈总动脉之间将主动脉结扎于8G针头上,随后将针头退出即可。术后10周,采用超声心动图检测心脏、观察心脏的大体剖面以及HE染色、测量心肌肥厚指数评价心肌肥厚的效果。结果术后10周,肉眼观：模型组心脏体积明显大于对照组。M型超声示：模型组较假手术组缩短分数下降,左室内径和室壁厚度明显增加。超声测量结果示：模型组与假手术组比较：室间隔厚度增加明显（2.527±0.269 vs.1.943±0.1）mm,（P〈0.01）;后壁厚度增加明显（2.492±0.242 vs.1.902±0.076）mm,（P〈0.01）;缩短分数略减小（49±7.681 vs.55.7±9.828）（P〉0.05）;左室舒张末期内径、左室收缩末期内径及射血分数均无明显变化。心脏肥厚指数明显增大（3.196±0.11 vs.1.785±0.099）,P〈0.01。结论胸主动脉缩窄可以导致大鼠心肌肥厚,为研究心室肥厚、心肌功能障碍以及心肌重构提供了一个很好的模型。     

改良气管插管法在小鼠心肌梗死模型制备中的应用

目的：小鼠心肌梗死模型制备中采用改良气管插管方法,提高模型制备成功率。方法：小切口暴露小鼠气管,直视下进行经口气管插管,左冠状动脉前降支结扎制备心肌梗死模型,观察、记录小鼠心脏颜色和心电图、术后14d存活情况和心肌组织病理学变化。结果：采用改良气管插管,成功完成40只小鼠心肌梗死模型制作,均可见冠状动脉结扎后,心室前壁颜色变暗,心电图Ⅱ导联ST段明显抬高。除去手术过程中意外死亡,术后14d存活27只,心肌梗死小鼠实际成活率达到87．1％。开胸后,肉眼可见模型组小鼠左室心腔明显扩大,心室壁变薄;病理切片HE染色,镜下可见心肌纤维断裂溶解,心肌细胞坏死,大量炎性细胞浸润。结论：在小鼠心肌梗死模型制备中,采用改良气管插管法,操作简单、易行、创伤小,模型制备成功率高。     

心电图计分法定量评价糖尿病小型猪心肌梗死面积

目的探讨简便的Wagner心电图QRS评分结果与糖尿病小型猪急性心肌梗死面积的相关性。方法巴马小型猪12只,随机分为糖尿病组（n=6）和正常组（n=6）。一次性静脉注射STZ（150mg／kg）的方法建立小型猪糖尿病模型,分别在给药前、给药后1周、2周和3周,采集血液,监测血糖,空腹血糖持续增高（FBG≥7．0retool／L）者认为建模成功;其次,定位结扎糖尿病组和正常对照组小型猪冠脉左前降支第1和第2对角支之间部位,并在缺血10rain、30min、1h、48h后查心电图,行QRS心电图计分;然后利用心肌组织Evan’sblue和TTC染色计算梗死心肌体积;分析QRS心电图计分与心肌梗死体积的相关性。结果所有动物急性心肌缺血病理变化明显,48h后都有病理性Q波形成,糖尿病组QRS评分明显较对照组高（6．9±2．4VS．4．1±1．8,P〈0．05）;病理染色结果显示其梗死面积明显比对照组大（29．2±5．1％vs．15．3±3．4％,P〈0．05）,二者相关系数为0．92。结论糖尿病心肌急性缺血更容易导致心肌组织坏死,梗死面积明显比对照组大;心电图检测判断心梗面积与病理情况下心梗面积相关性良好。     

心电图的临床应用分析及诊断标准

心电图主要是用于反应患者心脏的异常和不规则的电活动,心电图对各种心律失常以及传导阻滞具有重要意义。在心肌梗死和心肌肥厚的时候,心电图可以判断心肌梗死的部位、范围、观察心梗的进展情况和判断右心室、左心室肥厚,心电图对心肌梗死和心肌肥厚的诊断具有极大的帮助,在诊断患者患有心肌炎、肯尼丁和洋地黄等药物过敏、心包炎、发作时心绞痛、血钾过高或者是过低等疾病时,心电图具有较大的诊断意义。心电图临床应用的诊断标准主要是观察心电图的基本组成即P波、P-R间距、QRS波群、ST-T改变以及T波的改变,从而判断患者所患有的疾病。     

高脂血症对大鼠心电图的影响及其作用机制

目的：探讨在高脂血症状态下,大鼠心电图的变化情况,及高胆固醇血症对心肌电生理特性影响的机制。方法：将20只Wistar大鼠随机分为空白对照组和高脂饮食组,喂养10周后,检测大鼠的血脂水平、心电图和室颤阈值,并通过全细胞膜片钳记录心室肌细胞的ICa,L;利用组织病理学方法评价对照组及高脂饮食组的大鼠动脉粥样硬化的程度。结果：高脂饮食组的大鼠血脂水平与对照组相比明显增高（P〈0．01）;在高脂饮食组的大鼠动脉血管管壁中,可见广泛分布的粥样硬化斑块。在高脂饮食组的大鼠心电图中,室颤阈值为（4．23±0．12）V,明显低于对照组（12．80±6．34）V,P〈0．05。高脂饮食组大鼠的QTe间期（94±16）ms,与对照组（67±12）ms相比明显延长,P〈0．05。高脂饮食组大鼠的心室肌细胞的ICa,L密度为（12．83±3．28）pA／pF,与对照组（9．21±2．16）pA／pF相比明显高,P〈0．05。结论：高脂饮食后,大鼠的心电图有明显变化,QTe间期延长;高胆固醇血症能明显增加大鼠心肌细胞的ICa,L的,延长复极时程,降低室颤阈值。     

Subject-specific profiles of QT/RR hysteresis

The time lag of the QT interval adaptation to heart rate changes (QT/RR hysteresis) was studied in 40 healthy subjects (18 females; mean age, 30.4+/-8.1 yr) with 3 separate daytime (>13 h) 12-lead electrocardiograms (ECG) in each subject. In each recording, 330 individual 10-s ECG segments were measured, including 100 segments preceded by 2 min of heart rate varying greater than +/-2 beats/min. Other segments were preceded by a stable heart rate. In segments preceded by variable rate, QT/RR hysteresis was characterized by lambda parameters of the exponential decay models. The intrasubject SDs of lambda values were compared with the intersubject SD of the individual means. The lambda values were also correlated to individually optimized parameters of heart rate correction. Intrasubject SDs of lambda were substantially smaller than the population SD of individual means (0.390+/-0.197 vs. 0.711, P<0.0001). The lambda values were unrelated to the QT/RR correction parameters. When compared with the corrected QT (QTc) for averaged RR intervals in 10-s ECGs and with the averaged RR intervals in 2-min history, QTc for QT/RR hysteresis led to a substantially smaller SD of QTc values (11.4+/-2.00, 6.33+/-1.31, and 4.66+/-0.85 ms, respectively, P<0.0001). Thus the speed with which the QT interval adapts to heart rate changes is highly individual with intrasubject stability and intersubject variability. QT/RR hysteresis is independent of the static QT/RR relationship and should be considered as a separate physiological process. The combination of individual heart rate correction with individual hysteresis correction of the QT interval is likely to lead to substantial improvements of cardiac repolarization studies.     

QT interval prolongation and decreased heart rates after intravenous bolus oxytocin injection in male and female conscious rabbits

The aim of this study was to evaluate changes in heart rate (HR), QT and RR intervals and corrected QT (QTc) values in conscious male and female New Zealand rabbits which intravenously received oxytocin (OXT) at different dosages. Animals were divided into 6 equal groups: group I (n = 6 male, received 0.75 U OXT per animal); group II (n = 6 male, received 1.5 U OXT per animal); group III (n = 6 male, received 3 U OXT per animal); group IV (n = 6 female, received 0.75 U OXT per animal); group V (n = 6 female, received 1.5 U OXT per animal); group VI (n = 6 female, received 3 U OXT per animal). ECG recording were taken from all animals before injection and then at 2, 4, 6, 8, 10, 15 and 20 min of OXT administration. QT and RR intervals obtained at 2 min of OXT administration were significantly prolonged in all groups (p < 0.05) with one exception that is the 1.5 U OXT injected female group where only QT interval did not change. The prolongation of QT and RR intervals persisted for 20 min in 1.5 U OXT injected male group while only QT interval prolongation was obvious for 20 min in 3 U OXT injected female group as for the other groups the prolonged interval were observed for 8-10 min and then returned to baseline values. Generally, a significant prolongation of QTc was noticed in both male and female rabbits at the 2 and 4 min in all groups and bradycardia was noticed at 2 min of OXT administration in all groups. Heart beats returned to normal values in all groups after 8 min of OXT administration. The change of HR, RR, QT and QTc was gender- but not dose-dependent (p < 0.001). The male rabbits were more sensitive to OXT effect then female rabbits. In conclusion, OXT used in therapeutic dosages decreased heart rate and prolonged QT and QTc intervals. Although cardiovascular effect of OXT are of short duration, its use in patient with risk factors for malignant arrhythmias requires more attention.     

QT interval and QT dispersion before and after diet therapy in patients with simple obesity

To evaluate whether a disordered QT interval and its dispersion in obese patients, if any, may be improved by therapeutic weight reduction, 36 obese patients admitted to our university hospital were examined over a 5-year period from April 1, 1992 to March 31, 1997. Participants included 18 males and 18 females whose mean age +/- SD was 28 +/- 9 and 33 +/- 14 years, respectively, and whose mean body mass index +/- SD was 35 +/- 5 and 38 +/- 6 kg/m2, respectively. Thirty-six control patients were matched in age and gender with the obese patients. All the obese patients were treated with behavioral therapy together with very-low-calorie conventional Japanese diet (VLCD: 370 kcal/day). A standard 12-lead electrocardiogram (ECG) revealed longer maximum (445 +/- 32 msec, mean +/- SD) and minimum (388 +/- 29 msec) heart rate corrected QT intervals (QTc intervals) in the obese group than in the control group (P < 0.0001 for each). QTc dispersion, defined as the difference between maximum and minimum QTc intervals derived from 12-lead ECG, was greater in the obese group (57 +/- 19 msec) than in the control group (32 +/- 13 msec) (P < 0.0001). Both the maximum and minimum QTc intervals in the obese patients were shortened, respectively, to 434 +/- 28 msec and 377 +/- 29 msec (P < 0.05 for each) with no significant change in either QTc dispersion, QRS voltage, or QRS duration following weight reduction. The coefficient value from the linear regression line between QT interval and RR interval in the obese group was less than in the control group. Together, the results show that obesity per se causes both a prolongation of QTc interval and an increase in QTc dispersion, and that weight reduction improves the prolonged QTc interval observed in obese patients.     

The effect of NADP+ on cardiomyocyte electrophysiological properties of C57BL/6 and mdx mice

We have studied the influence of NADP⁺ on routine electrocardiography (ECG) in 6-month-old C57BL/6 and mdx mice. The animals were anesthetized by ether before ECG recording. ECG registration was carried out at a speed of 100 mm/s. The first ECG recording was made before intraperitoneal NADP⁺ injection in a dose of 13 or 80 mg/kg. The second ECG recording was made 10 min after NADP⁺ injection. Anesthesia was then terminated. The mice were occasionally anesthetized 45–60 min later, and the third ECG was recorded 1 h after injection of NADP⁺. ECG recording was carried out at a speed of 100 mm/s in standard leads I, II, and III and unipolar leads AvR, AvL, and AvF. Values of standard ECG characteristics, such as the P wave and the intervals PQ, QT, RR, and the QRS complex, were measured in milliseconds in standard lead II. We did not observe any differences between ECG magnitudes of 2- to 3-month-old C57BL/6 and mdx mice during trial experiments. Mice of both strains had a sinus rhythm in their heart rate. The QRS complex in mdx mice had a tendency to be larger than in C57BL/6 mice. Heart rates fluctuated between 722 ± 22 and 681 ± 21 beats per minute. The effect of NADP⁺ was studied in 6-month-old male mice. The increase in the RR interval and the decline in heart rate from 697 ± 21 to 461 ± 23 and 491 ± 28 beats per min for C57BL/6 mice (p < 0.01) and from 722 ± 28 beats per minute to 454 ± 31 beats per min for mdx mice were registered 10 min after NADP⁺ injection at a dose of 80 mg/kg. The increase in the RR interval can be explained by an increase in the QT interval. A statistically significant reduction in the QT interval leading to a diminished RR interval was observed in mdx mice 1 h after NADP⁺ injection. NADP⁺ at a dose of 13 mg/kg did not significantly change the ECG properties in mdx mice. ECG of mdx mice was characterized by negative repolarization of the T wave in 37% of all leads. The amount of leads with negative T-wave repolarization decreased up to 3% 1 h after NADP⁺ injection in dose of 80 mg/kg. The results have shown that cytomembranes of ventricular cardiac myocytes and the degree of oxidative stress are the main targets of the action of NADP⁺ in C57BL/6 and mdx mouse hearts.     

清醒状态昆明小鼠随日龄变化的心电图分析

目的研究不同日龄小鼠心电图变化规律,进行初步分析,为小鼠正常及疾病状态下心功能研究提供参考。方法采用标准双极肢体导联(Ⅰ,Ⅱ,Ⅲ)和加压肢体导联(aVR,aVL,aVF),对非麻醉状态的309只不同日龄昆明小鼠行心电图分析。结果记录正常昆明小鼠的心电图参数及形态。心律为窦性心律,平均心率(428.96±93.62)(254～789)次/min。平均RR间期在小鼠1、7、14日龄到成年,从1日龄的(138.89±3.85)ms降到7日龄的(116.75±5.48)ms,14日龄的(109.22±5.06)ms。在14、21、28、35、60日龄小鼠心电图RR间期与1日龄相比均有统计学差异(14、21、28、35日龄、成年小鼠R-R间期差异无统计学意义)。平均PR,QRS,QT,JT间期随着小鼠日龄的增长呈进行性缩短。平均Q-T间期从(46.66±3.56)ms(1日龄)减少到(40.40±3.46)ms(7日龄),(28.22±1.92)ms(14日龄)。14、21、28、35日龄,成年小鼠和1日龄相比差异均有统计学意义(14、21、28、35日龄、成年小鼠Q-T间期差异无统计学意义)。1日龄小鼠的J-S-T段抬高明显,14日龄明显降低,35日龄接近基线甚至消失,类似成年小鼠心电图。结论昆明小鼠随日龄的心电图变化可为评价小鼠心脏的发育及药物干预对心电信号的影响提供一定的参考。     

Cardiac-specific overexpression of SCN5A gene leads to shorter P wave duration and PR interval in transgenic mice

The Cardiac sodium channel gene SCN5A plays a critical role in cardiac electrophysiology and its mutations, either gain- or loss-of-functions, are associated with lethal arrhythmias. In this study, we investigated the effect of overexpression of SCN5A on the cardiac phenotype in a transgenic mouse model (TG-WT L10). Compared to NTG mice, heart rate, QRS duration, and QT intervals remained unchanged in TG-WT mice. Moreover, no spontaneous ventricular arrhythmias were detected in TG-WT hearts. Despite these results, a mild, irregular cardiac phenotype was observed in TG-WT mice. The P wave and PR interval were significantly shorter in TG-WT compared with NTG mice (P, 8.8+/-0.8 ms vs. 12.6+/-0.9 ms; PR, 12.5+/-2 ms vs. 33.5+/-0.7 ms). Furthermore, spontaneous premature atrial contractions were often detected in TG-WT mice. These results suggest that the expression level of the SCN5A gene is a determinant for the length of the P wave duration and PR interval on electrocardiograms (ECG).     

Quantitative relationship between plasma potassium levels and QT interval in beagle dogs

The aim of the current study was to establish the quantitative relationship between plasma potassium concentrations and the QT interval of the electrocardiogram in dogs. Furosemide, a potent diuretic, was given at increasing doses (5-60 mg/kg) to five male and five female beagle dogs. Electrocardiogram (ECG) was recorded three times each day, simultaneous to blood sampling for measurement of plasma potassium. Furosemide treatment produced a clear hypokalaemia, which was associated with an increase in QT and corrected QT intervals (QTc) duration. On average, the slopes of the negative linear correlation between potassium plasma levels and QT or QTc were steeper in females than in males. These results show that a decrease in potassium plasma level may explain a concomitant increase in QT duration in a toxicity study in dogs, in particular if potassium values are decreased below 3.3 mmol/L. Correction of QT interval for K+ plasma level has, therefore, been established separately for males and females. A global formula correcting QT for K+ and heart rate simultaneously was established. Hypokalaemia was also associated with changes in the morphology of the T wave recorded in CV5RL, in particular, with a flattening and/or a notching of the wave (appearance of a second peak), biphasic aspect or inversion of polarity. These changes are probably related to an increased heterogeneity of repolarization between different populations of cardiomyocytes. In conclusion, hypokalaemia is quantitatively associated with an increase in QT and QTc duration in dogs. The relationship is apparently stronger for females than for males. A formula may be used to correct QT for potassium plasma level.     

Issues in QT interval measurement

The QT interval, apart from clinical implications is crucial for safety assessment of new drugs under development. A QTc prolongation of even 10 msec in a study group is a warning signal for a new drug. There are various issues involved in the measurement of the QT interval especially regarding the ending of the T wave and different morphological pattern of T-U complex. The other issue is significant spontaneous variability in the QT interval, resulting in spurious QT prolongation and unnecessary concern.To minimize all these confounding factors, all clinical trials for assessing QT interval prolongation should be randomized and double blinded with appropriate control groups including placebo. ECG measurements should be done by trained readers with electronic calipers at ECG core Lab. ECGs should be compared with multiple baseline values with multiple, time-matched on-treatment values.     

基于自相关模式的动态心电图RR间期数据处理方法的研究

目的：在动态心电图分析过程中,确定RR间期,对于分析心电信息起着非常重要的作用。但是,临床上,实际检测的记录中,不可避免地受到外界很多的干扰,由于这些干扰信息的存在,使得准确定位RR间期变得非常困难。本课题拟在干扰情况下,提取心电表达的最大信息,达到准确定位RR间期的目的。方法：本研究运用自相关模式数据处理方法有效地提升了主峰、次峰强度间的差别,从而为更好地判断RR间期以及埋藏在噪音之中的QRS波信息提供了可能的方法。结果：我们用了自相关模式数据处理的方法获得了以下信息：（1）对于干扰小的心电信息,主峰与次峰间的强度比值由2.7倍提升到7.7倍。（2）对于干扰大的心电信息,即那些主峰已经被现有Holter处理软件及医生人工判断都认为不可以使用的数据,因为这些数据主峰强度明显小于次峰强度（主峰/次峰〈1）,经过我们的方法处理后,可以使主峰强度与次峰强度之比提升到1.5（主峰/次峰〉1.5）,从而使得RR间期可以进行清晰分辨。结论：在心电信息受到干扰的情况下,它的RR间期很难判断,运用本研究使用的自相关模式数据处理方法,能够提升动态心电图中主峰与次峰的强度比值,提高人工判断RR间期的准确性。所以,基于自相关模式的动态心电图RR间期数据处理方法是行之有效的。