一种新的心肌梗塞面积的测量方法及实验验证

这种方法以计测心肌梗塞面积的数学模型电动力学原理为依据,用Frank导联体系的正交心电图取得所需数据计算心梗面积.在狗的心肌梗塞模型上证明(1)用这种方法计算得到的梗塞面积在较大范围内(1～13cm~2)与染色后直接测得的梗塞面积密切相关.心肌损伤时r=0.97(P<0.01);心肌坏死时r=0.92(P<0.05).(2)由经纬角(φ,θ)能比较准确的判断梗塞部位.(3)经纬角(φ,θ)与方位角(α、β、γ)联合分析,又可判知梗塞是发生在心内模下还是心外模下.     

骨髓基质细胞移植促进心肌梗塞后血管新生机制的研究

目的:通过研究不同时期心肌梗塞区血管生长因子的表达,探讨骨髓基质细胞移植促进心肌梗塞后血管新生的机制.方法:将急性心肌梗塞大鼠随机分为2组.实验组在梗塞后28 d,将同种异体骨髓基质细胞注射到心肌梗塞区.对照组仅注射无血清的培养液.在梗塞后的不同时期取标本动态观察梗塞区VEGF、bFGF的表达和血管新生状况.结果:骨髓基质细胞移植入梗塞区后主要分化为成纤维细胞和血管内皮细胞.实验组心肌梗塞区新生毛细血管数目较对照组明显增加(14±4.7/HPF vs 6±2.4/HPF P＜0.05).对照组梗塞区VEGF和bFGF的表达在梗塞后7 d达高峰,28 d开始下降,第42 d和56 d时表达明显下降.而实验组二者的表达在心肌梗塞后第42 d和56 d明显高于对照组.结论:骨髓基质细胞通过分化为内皮细胞以及促进梗塞区VEGF和bFGF的持续高表达,对血管新生起积极作用.     

局灶性脑缺血再灌损伤时神经细胞内Ca~(2+)时空动态变化的实验研究

本文用插线法制作局灶性脑缺血／再灌损伤模型,利用激光共聚焦扫描显微镜观察活体脑片细胞内Ｃａ２＋的分布及动态变化,结果表明：（１）缺血／再灌时间不同,梗塞面积不同,缺血４小时梗塞面积占同侧半球的１６．３％,缺血４小时再灌２０小时梗塞面积增加到２５．９％,缺血２４小时梗塞面积占同侧半球的６０．４％。（２）本文首次观察到在缺血４小时纹状体区域的Ｃａ２＋变化明显高于皮层,并且再灌后皮层及纹状体区域Ｃａ２＋的含量明显增加     

介入治疗成人非创伤性股骨头缺血性坏死的疗效分析

目的：分析介入治疗对于成人非创伤性股骨头缺血性坏死的疗效。方法：采用介入方法治疗95例共117髋非创伤性股骨头缺血性坏死。对比介入治疗前后DSA造影分型结果及血供异常例数。结果：117患髋中,Ia型的31病髋中,11髋（35．48％）介入治疗后动脉主干再通;Ib型的27髋中,24髋（88．89％）介入治疗后分支再通;II型的11髋中,5髋（45．45％）实质期股骨头缺损面积缩小;III型的10髋中,8髋（80．00％）静脉期见股骨头浓密染色明显减轻;Ⅳ型的33髋中,28髋（84．85％）可见动脉主干再通、分支增粗、实质期股骨头缺损面积缩小和静脉期股骨头染色减轻等。治疗前117病髋异常率为95．73％。经过介入治疗后,异常率为30．77％。治疗后异常率明显低于治疗前异常率（P〈0．01）。结论：介入治疗可有效改善非创伤性股骨头缺血性坏死血供异常,增加股骨头血供,具有操作简单、创伤小、疗效确切等优点。关键阗：股骨头缺血性坏死;介入治疗;数字减影血管造影     

从体表电位分布图中提取陈旧性心肌梗塞诊断信息的研究

如何从体表电位分布图（ＢｏｄｙＳｕｒｆａｃｅＰｏｔｅｎｔｉａｌＭａｐｐｉｎｇｓ：ＢＳＰＭ）中得到有价值的诊断特征或信息是将ＢＳＰＭ技术应用于临床的重要研究课题之一。基于计算机心脏仿真模型,详细研究了ＢＳＰＭ中能够对陈旧性心肌梗塞的发生部位与范围进行准确诊断的特征与信息。研究结果表明：ＱＲＳ期间正常ＢＳＰＭ中为正电位、陈旧性心肌梗塞ＢＳＰＭ中为负电位的导联分布区域与出现Ｑ波的导联分布区域是陈旧性心肌梗塞发生部位较准确、可靠的定位信息;可以用正常ＢＳＰＭ为正电位、而梗塞ＢＳＰＭ为负电位的导联区域的面积或导联数来识别陈旧性心肌梗塞的发生范围或大小。     

超声组织定征估测心肌梗塞范围

背景:超声组织定征(UTC)能够区分正常与梗塞心肌。梗塞心肌的背向散射积分增加和心动图期依赖的背向散射变异消失。背向散射的周期性变异与局部心肌的收缩功能密切相关,而后者是心肌缺血的一个标志。本研究拟对一个假设进行检测:描记心室壁的超声周期性散射,并以此估计心肌梗塞区的范围。方法与结果:对12只麻醉的狗,开胸,完全阻塞冠状动脉前降支4小时,使之产生透壁性心肌梗塞。图形显示背向散射积分Rayleigh5心动周期依赖的散射变异、散射的周期性变异类型、用作描记风险区的大小。采用2、3、4triphenyltrazolium chloride(TTC)和专利蓝染料染色,以估测梗塞区的大小和梗塞风险区域。梗塞大小与可能梗塞区域的比率,由UTC和TTC确定,其相关良好(r=0.862,y=23.7±0.792x)。梗塞大小和风险区域的相关系数也较好(梗塞区r=0.736,y=12.3±0.737x,风险区r=0.714,y=5.80±1.012x)。然而,UTC低估了梗塞区和风险区的大小。结论:超声组织定征可以提供一个可行的、无创伤性的估测心肌梗塞大小的方法。     

缺糖缺氧对体外培养海马神经元的影响

目的：观察缺糖缺氧诱导的培养海马神经元损伤。方法：取培养12d的海马神经元,在缺糖缺氧条件下分别培养0．5～4h后取出,换原神经元培养液在常氧条件下继续培养24h。用0．4％台盼蓝染色,检测神经元坏死,并用TUNEL法检测神经元凋亡,计算存活、坏死和凋亡神经元所占百分率。同时用图像分析仪测定存活、坏死和凋亡神经元的胞体面积、周长和等园直径。结果：培养的海马神经元急性缺糖缺氧后0．5～4h,随缺糖缺氧时间的延长,坏死神经元逐渐增多,缺糖缺氧后0．5～2h再恢复糖和氧供应后24h,凋亡神经元明显增多。图像分析的结果表明,坏死神经元的胞体面积、周长和等园直径均明显大于凋亡神经元。结论：缺糖缺氧可引起海马神经元严重损伤,在急性缺糖缺氧后0．5～4h引起的神经元死亡以坏死为多见,但在缺糖缺氧后0．5～2h再恢复糖和氧供应后24,神经元死亡则以凋亡为多见。     

蓬勃发展中的西澳大利亚生物技术

Nature 2004年129卷6991期增刊A18页报道：西澳大利亚是澳大利亚联邦的一个州。其面积为2．5百万平方公里（一百万平方英里）,海岸线长13500公里,地跨亚热带和温带,是全世界最大的生物群落分布地之一,也是全世界最大的礁群系统之一。     

心得安对实验性心肌梗塞大鼠心肌膜β受体的影响

本文采用受体放射自显影术,以银粒数的分布与数量变化作为观察指标,对β受体阻滞剂心得安治疗实验性急性心肌梗塞(AMI)大鼠的心肌膜β肾上腺素能受体(β受体)的影响进行研究.左冠状动脉前降支(LAD)结扎后一周引起心肌梗塞区内[3H]DHA结合位点数显著降低,在非梗塞区亦降低.结扎LAD应用心得安(100ug/kg)治疗一周后梗塞区[3H]DHA结合位点数明显回升,而非梗塞区则进一步降低.引人注目的是,心得安治疗后,[3H]DHA结合位点数在梗塞区/非梗塞区的比值由LAD结扎时的0.24上升为0.87,接近于假手术对照组的0.97.结果证明,心得安是直接作用于心脏的β受体,可能还通过调整了梗塞区与非梗塞区β受体的平衡,改善了心室的顺应性和提高了梗塞心脏的收缩协同作用.从而对AMI的心脏起到保护和治疗作用.     

植物神经系统在心肌梗塞中的作用

本文系统介绍关于心肌梗塞时植物神经系统作用方面的研究进展。心肌梗塞时交感-儿茶酚胺活性增高,副交感神经兴奋性也同时提高。前者可使梗塞范围扩大,心室功能下降加剧及心律失常发生率增加,而后者对心肌梗塞具有保护作用。文中详细叙述上述作用的病理生理机制,并说明临床使用β阻滞剂及阿托品的原则及其原理。此外,心室壁感受器反射是心肌梗塞发生时机体的一种保护性机制。     

肾缺血预处理对心脏缺血／再灌注损伤的保护作用

目的：探讨肾缺血预处理对家兔心脏缺血／再灌注（I／R）损伤的影响及意义。方法：32只大耳白家兔随机分为假手术（SO）、心脏I／R、经典缺血预处理（CIPC）及肾缺血预处理（RIPC）4组。观察各组心肌梗塞面积、左室舒缩功能、心脏超微结构及心律失常发生率的变化。结果：CIPC、RIPC组,心肌梗塞面积、再灌性心律失常发生率较I／R组明显降低,左室舒缩功能明显恢复（P＜0.01）,心脏超微结构损伤明显减轻。结论：RIPC可诱导出与CIPC类似的心脏保护效应。     

Chinese medicinal formula Guan-Xin-Er-Hao protects the heart against oxidative stress induced by acute ischemic myocardial injury in rats

Guan-Xin-Er-Hao (GXEH) is a Chinese medicine formula for treating ischemic heart diseases (IHD) and has a favorable effect. Our aim was to examine whether or not acute oral GXEH could protect the heart against myocardial infarction and apoptosis in acute myocardial ischemic rats. If so, we would explain the antioxidative mechanism involved. The left anterior descending coronary artery was occluded to induce myocardial ischemia in hearts of Sprague-Dawley rats. At the end of the 3 h ischemic period (or 24 h for infarct size), we measured the myocardial infarct size, myocardial apoptosis and the activities of antioxidative enzymes. GXEH reduced infarct size, myocardial apoptosis and the serum level of malondialdehyde (MDA), increased the activities of total antioxidant capacity (T-AOC), superoxide dismutase (SOD) and GSH-peroxidase (GPX) activities and the serum level of glutathione (GSH). GXEH exerts significant cardioprotective effects against acute ischemic myocardial injury in rats, likely through its antioxidation and antilipid peroxidative properties, and thus may be used as a promising agent for both prophylaxis and treatment of IHD.     

The differential indicator method of determining the areas of ischemia and necrosis in experimental myocardial infarct in rats

Valid method for estimation of relationship between ischemic and infarct sizes was elaborated. The method is based on separate determination of Evans blue and formazan in injured and intact areas of myocardium for later calculation of myocardial ischemic and necrotic zones. The procedure ensures high level of accuracy and reproducibility of experimental data because of intrinsic control.     

Mitochondrial ATP dependent potassium channels mediate non-ischemic preconditioning by tachycardia in dogs

Brief episodes of tachycardia without myocardial ischemia prior to a coronary occlusion decrease myocardial infarct size in dogs. This non-ischemic preconditioning is mediated by adenosine. Because ischemic preconditioning is mediated through ATP dependent potassium channels, particularly the mitochondrial ones, we studied whether non-ischemic preconditioning is also mediated through these channels. In anesthetized dogs heart rate was kept constant at 120 cycles/min and aortic pressure changes were damped. Myocardial infarction was induced by occlusion of the anterior descending coronary artery for 60 min and reperfusion for 270 min. In a control group the infarct size (necrotic volume/risk region volume × 100) was 15.8 ± 1.5%. Preconditioning with five periods of tachycardia, 5 min in duration each at 213 cycles/min with intervening periods of 5 min of basal heart rate at 120 cycles/min, reduced the infarct size by 45.6% (p < 0.05) with respect to the control group. This effect was completely reverted by the blockade of ATP dependent potassium channels with glibenclamide or 5 hydroxydecanoate (a specific blocker of mitochondrial ATP dependent potassium channels) prior to preconditioning. These effects were not due to differences in collateral flow, risk region size or hemodynamic variables between the groups. These results show that mitochondrial ATP dependent potassium channels mediate non-ischemic preconditioning by tachycardia in dogs.     

Postconditioning fails to improve no reflow or alter infarct size in an open-chest rabbit model of myocardial ischemia-reperfusion

Postconditioning (PoC) with brief intermittent ischemia after myocardial reperfusion has been shown to lessen some elements of postischemic injury including arrhythmias and, in some studies, the size of myocardial infarction. We hypothesized that PoC could improve reflow to the risk zone after reperfusion. Anesthetized, open-chest rabbits were subjected to 30 min of coronary artery occlusion followed by 3 h of reperfusion. In protocol 1, rabbits were randomly assigned to the control group (n = 10, no further intervention after reperfusion) or to the PoC group, which consisted of four cycles of 30-s reocclusions with 30 s of reperfusion in between starting at 30 s after the initial reperfusion (4 x 30/30, n = 10). In protocol 2, rabbits were assigned to the control group (n = 7) or the PoC group, which received PoC consisting of four cycles of 60-s intervals of ischemia and reperfusion starting at 30 s after the initial reperfusion (4 x 60/60, n = 7). No reflow was determined by injecting thioflavine S (a fluorescent marker of capillary perfusion), risk zone by blue dye, and infarct size by triphenyltetrazolium chloride. In protocol 1, there were no statistical differences in hemodynamics, ischemic risk zone, or infarct size (35 +/- 6% of the risk zone in the PoC group vs. 29 +/- 4% in the control group, P = 0.38) between the groups. Similarly, in protocol 2, PoC failed to reduce infarct size compared with the control group (45 +/- 4% of the risk zone in the PoC group vs. 42 +/- 6% in the control group, P = 0.75). There was a strong correlation in both protocols between the size of the necrotic zone and the portion of the necrotic zone that contained an area of no reflow. However, PoC did not affect this relationship. PoC did not reduce infarct size in this model, nor did it reduce the extent of the anatomic zone of no reflow, suggesting that this intervention may not impact postreperfusion microvascular damage due to ischemia.     

Melatonin does not prevent the protection of ischemic preconditioning in vivo despite its antioxidant effect against oxidative stress

Free radicals are involved in the protective mechanism of preconditioning (PC), whereas antioxidant compounds abolish this benefit. Melatonin is a hormone with antioxidant properties. The aim of our study was to evaluate the effect of melatonin on infarct size in ischemic preconditioning in vivo. We randomly divided 33 male rabbits into four groups and subjected them to 30 min of myocardial ischemia and 3 h of reperfusion with the following prior interventions: (i) no intervention, (ii) iv melatonin at a total dose of 50 mg/kg, (iii) PC with two cycles of 5 min ischemia and 10 min reperfusion, and (iv) combined melatonin and PC. In a second series of experiments, another antioxidant agent N-acetylcysteine (NAC) was used in a control and in a PC group. Myocardial infarct size was determined and blood samples were drawn at different time points for the determination of lipid peroxidation products, total superoxide dismutase (SOD) activity, and (1)H-NMR spectra to evaluate the changes in the metabolic profile. Melatonin showed no effect on myocardial infarct size in the group of sustained ischemia (42.9 +/- 3.6% vs 47.4 +/- 4.9%) and it did not attenuate the reduction of myocardial infarct size in the PC group (13.6 +/- 2.4% vs 14.0 +/- 1.7%). A similar effect was found in NAC-treated groups (44.8 +/- 3.4% vs 14.3 +/- 1.3%). Lipid peroxidation product levels were significantly elevated in the control and PC groups, whereas melatonin decreased them in both groups. The SOD activity was enhanced in the PC group compared to controls; melatonin kept SOD activity unchanged during ischemia/reperfusion and enhanced its activity when it was combined with PC. Melatonin did not change the metabolic profile of the control and PC groups. Melatonin does not prevent the beneficial effect of ischemic PC on infarct size despite its antioxidant properties.     

Exercise enhances myocardial ischemic tolerance via an opioid receptor-dependent mechanism

Exercise increases serum opioid levels and improves cardiovascular health. Here we tested the hypothesis that opioids contribute to the acute cardioprotective effects of exercise using a rat model of exercise-induced cardioprotection. For the standard protocol, rats were randomized to 4 days of treadmill training and 1 day of vigorous exercise (day 5), or to a sham exercise control group. On day 6, animals were killed, and global myocardial ischemic tolerance was assessed on a modified Langendorff apparatus. Twenty minutes of ischemia followed by 3 h of reperfusion resulted in a mean infarct size of 42 +/- 4% in hearts from sham exercise controls and 21 +/- 3% (P < 0.001) in the exercised group. The cardioprotective effects of exercise were gone by 5 days after the final exercise period. To determine the role of opioid receptors in exercise-induced cardioprotection, rats were exercised according to the standard protocol; however, just before exercise on days 4 and 5, rats were injected subcutaneously with 10 mg/kg of the opioid receptor antagonist naltrexone. Similar injections were performed in the sham exercise control group. Naltrexone had no significant effect on baseline myocardial ischemic tolerance in controls (infarct size 43 +/- 4%). In contrast, naltrexone treatment completely blocked the cardioprotective effect of exercise (infarct size 40 +/- 5%). Exercise was also associated with an early increase in myocardial mRNA levels for several opioid system genes and with sustained changes in a number of genes that regulate inflammation and apoptosis. These findings demonstrate that the acute cardioprotective effects of exercise are mediated, at least in part, through opioid receptor-dependent mechanisms that may include changes in gene expression.     

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。     

Dose-Response to Cytoskeletal-Antigen Specific Immunoliposome Therapy for Preservation of Myocardial Viability and Function in Langendorff Instrumented Rat Hearts

Background: Treatment with Cytoskeketal-antigen Specific ImmunoLiposomes (CSIL) has resulted in the preservation of cell and organ viability and function. The current study investigates whether CSIL-intervention is dose-dependent in Langendorff instrumented adult rat hearts undergoing global ischemia. Method and Results: Rat hearts undergoing experimental global ischemic insult for 25 minutes were treated with CSIL, IgG-liposomes (IgG-L), plain-liposomes (PL) or placebo. Infarct sizes were assessed by histochemical staining method and quantitated by computer planimetry. Mean infarct size of CSIL treated globally ischemic rat hearts was about 5 times smaller than that of control hearts (P ≤ 0.02). Recovery to normal heart function was achieved with CSIL therapy at 1 mg antimyosin antibody dose, where as significant decreases in functional recovery were seen in hearts treated with 0.5 and 0.2 mg antimyosin antibody doses Dose-dependent preservation of cardiac function, and reduction in infarct sizes in CSIL treated hearts were concordant with ultrastructural evidence. Conclusions: Treatment of globally ischemic rat hearts with CSIL results in significant preservation of function and dramatic decrease in acute myocardial infarct size in a dose dependent process.     

犬心肌缺血早期血小板聚集功能和冠脉侧支循环的改变

本实验在18只麻醉开胸犬观察了急性心肌缺血早期血小板聚集功能和冠脉侧支循环功能的变化。实验结果如下:阻断冠脉后心肌缺血区血液中血小板聚集率(PAgR)增大,血小板计数(PC)减少。缺血50min时,PAgR增大58.7±5.6％,PC减少39.5±23.6％,与对照值有明显差异(均为P<0.01)。与此同时,在控制血压条件下,心肌缺血早期单位压力差下冠脉侧支血流量的变化与对照值无明显差异,而根据Wyatt等公式计算的流经缺血区末梢血管的有效侧支血流量明显降低,缺血50min时较对照值降低23.5±9.7％(P<0.05)。PAgR变化与有效侧支血流量改变呈明显负相关(r=-0.887,P<0.01);冠脉侧支指数与梗塞范围呈明显负相关(r=-0.847,P<0.01)。阻断冠脉前静脉注射血小板聚集功能抑制剂阿斯匹林,可明显减轻上述各项参数的异常变化。这些结果提示,心肌缺血早期血小板聚集功能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小,进而扩大梗塞范围。