Objective To observe the effect of trimetazidine on coronary heart disease combined with arrhythmia. Methods Eighty-one patients were randomly divided into treatment group(n = 42) and control group(n = 39). Patients in the control group received routine therapy and patients in the treatment group took trimetazidine orally 20 mg three times per day on the basis of routine therapy. Resting electrocardiogram(ECG),Holter,blood routine,urine routine,liver function and renal function were detected before and after treatment. Changes of resting ECG and Holter were used to evaluate the curative effect. Present symptoms and the results of laboratory examinations were used to evaluate the adverse reactions. Results Compared with the control group,the ischemic ST-T of ECG improved signifi cantly and the numbers of arrhythmia decreased signifi cantly in the treatment group(P 0.05). There was no difference in the adverse reactions between two groups. Conclusion Trimetazidine may be used effectively and safely in patients with coronary heart disease complicating arrhythmia.

目的探讨伊贝沙坦改善原发性高血压患者左室肥厚(LVH)和胰岛素抵抗的作用及关系。方法入选18例新发且未经药物治疗的原发性高血压患者,给予伊贝沙坦治疗24周。结果伊贝沙坦治疗后与治疗前比较,血压、左室质量指数[LVMI(124±13比141±18)g/m2,P<0.01]、稳态模式评估(HOMA)指数(1.5±0.6比2.3±0.5,P<0.01)和血浆氨基末端脑钠素前体(NTproBNP)水平[(368±40比531±49)pmol/L,P<0.01]显著降低。LVMI下降百分比与HOMA指数及NTproBNP改变之间有显著的相关性(r=0.87,P<0.01;r=0.69,P<0.05)。逐步回归分析显示HOMA指数下降百分比是LVMI和NTproBNP降低的独立预测因素。结论伊贝沙坦能改善原发性高血压患者LVH,这可能与改善胰岛素抵抗相关。

例1患者男性,82岁.临床诊断:冠心病.动态心电图(图1)示窦性心律,心率100次/min时P-R间期0.20s,QRS时间0.16s,MV1导联R波切迹,MV5导联S波增宽,为完全性右束支传导阻滞.

Objective To determine whether the raised serum uric acid(UA)level is the independent risk factor for coronary artery disease(CAD).Methods A retrospective study was performed including 118 consecutive CAD patients(male 94,female 24)with average age of(65.79±10.03)and 67 normal angiography patients(male 43,female 24)with average age of(60.75±11.98).All the patients were performed coronary angiography from September 2003 to March 2004.In CAD group,36 cases were stable angina pectoris,28 were unstable angina and 54 were acute myocardial infarction.A fasting blood samples were collected for measurement of serum UA,blood cholesterol,and so on.And all patients were carefully inquired for their history including smoking and hypertension.Results Although raised serum UA was observed in CAD patients(372.31±100.28)mmol/L vs(340.08±81.58)mmol/L(P=0.028),logistic analysis suggested serum UA was not an independent risk factor for CAD.And there was no difference of UA among subgroups in CAD patients.Conclusion The raised serum UA may be a marker of atherosclerosis and is not an independent predictor for CAD.

Objective:To investigate the changes of tumor necrosis factor α(TNFα) expression and the relationship between TNFα and cardiac function during the progression of left ventricular remodeling in an experimental model of rat myocardial infarction(MI). Methods: Ninety male Sprague Dawley rats were randomly divided into sham-operated and MI groups. Rats in MI group were induced by ligation of the anterior descending coronary artery and were subdivided into 1 d,7 d,14 d,28 d and 42 d groups. Sham-operated animals underwent the same surgical procedure without ligation. Heart function and left ventricular remodeling were studied by echocardiography and hemodynamics. The expression of TNFα mRNA was assessed by reverse transcription-polymerase chain reaction. Results: From day 14 after operation,left ventricular end-diastolic diameter(LVEDD) began to increase in MI group,and fractional shortening(FS) and left ventricular ejection fraction(LVEF) began to decrease; both the increase and decrease reached the maximal on day 42 after operation. From day 1 after operation,left ventricular end-diastolic pressure(LVEDP) began to increase, and left ventricular(LV) pressure maximal rate of rise and fall (dp/dt_(max) and (dp/dtmin)) began to decrease; both increase and decrease reached the maximal on day 42 after operation. TNFα began to express on day 1 after MI, reached peak on day 7, and began to decrease thereafter; there was significant differences between MI group and sham-operated group.The expression of TNFα was positively correlated with LVEDD(r=0.94,P0.01) and negatively with FS,LVEF,dp/dt_(max) and dp/dtmin(r=-0.91,-0.89,-0.800 and -0.85,respectively,P0.05). Conclusion: TNFα expression is associated with ventricular remodeling and cardiac function during the progression of left ventricular remodeling in rat MI model. TNFα may play an important role in promoting ventricular remodeling and heart dysfunction.

目的:观察冠心病患者应用雷帕霉素洗脱支架与紫杉醇洗脱支架后临床不良心血管事件的发生率.方法:本研究为随机开放平行对照研究,共入选患者168例,雷帕霉素支架组83例,紫杉醇支架组85例.两组患者在年龄,性别组成,吸烟比例,糖尿病比例,血压水平,总胆固醇水平,冠状动脉病变支数,冠状动脉病变积分(Gensini法),左心室射血分数均无统计学上的差异.术后严格要求患者服用阿司匹林和噻氯匹定或氯比格雷9个月.通过门诊或电话随访术后患者临床不良心血管事件的发生率,部分患者进行了冠状动脉造影复查.结果:平均随访10.6个月,失访患者3例(包括2例雷帕霉素支架组患者与1例紫杉醇支架组患者),失访率为1.79%.在随访的81例雷帕霉素支架组共7例(8.64%)发生了临床不良心血管事件.在随访到的84例紫杉醇支架组8例(9.52%)患者发生了不良心血管事件.以上2组患者不良心血管事件发生率差异无统计学意义(卡方检验P>0.05).雷帕霉素支架组冠状动脉造影再狭窄率为20%(3/15),紫杉醇支架组冠状动脉造影再狭窄率为25%(6/24),两组之间无统计学差异(P>0.05).结论:短期临床随访结果表明,冠心病患者应用雷帕霉素洗脱支架与紫杉醇洗脱支架临床心血管事件的发生率较低,两组无统计学差异.冠状动脉造影复查两组再狭窄率无统计学差异.

AIM: To investigate the gene expression difference of cytokines and related mediators in(peripheral) blood mononuclear cells(PBMC) between chronic heart failure(CHF) patients and healthy subjects,and identify the imbalance in the cytotokine network in CHF.METHODS: Total RNA was extracted from PBMCs of CHF patients and healthy subjects and transcripted to single,two stranded cDNA and cRNA.Two probes were labled with cy3 and cy5 fluorescence,mixed and hybridized with the gene chip.The hybridizing signals were deetected by laser scanner and analysed with and ImaGene 3.0 software.RESULTS: Among the 365 cytokines and related mediator genes in the gene chip,34 were upregulated and 2 downregulated in CHF patients.The regulated genes included several members of tumor necrosis factor(TNF) superfamily,chemokines/-receptors,members of the transforming growth factor superfamily.Of the TNF superfamily members,lymphotoxin,TNFSF5,TNFSF7,TNFSF10,TNFRSF13B,and TRAIL-R4 were upregulated,while TNFRSF10C(TRAIL-R3) was downregulated.(CONCLUSION): There are significant differences in gene expressions of cytokines and related mediators in PBMCs between CHF patients and healthy subjects and the imbalance in the cytokine network in CHF.In particular, the enhanced expression of several members in the TNF superfamily may play a potential pathogenic role in CHF.

Obiective:To observe changes of plasma soluble P-selectin, TNF-α and IL-6 in patientswith acute myocardial infarction (AMI) and effects of early reperfusion therapy on them. Method:The plasma sP-selectin, TNF-α and IL-6 were measured at the time of 6, 12, 24, 48, 72 hours afterAMI onset in 26 patients admitted within 6 hours after symptom onset. All patients were given antithrombus and successful reperfusion therapy at the time of admission . And the concentration of those in 21 patients with stable angina pectoris and 20 normal controls demonstrated by coronary angiography were also measured. Result:①The level of sP-selectin was higher significantly within 6 hours of symptom onset in patients with AMI than those in patients with stable angina and controls [ (177.6±20.1)μg/L vs (75.4±6.8) μg/L vs (67.9±7.7) μg/L , P 0.01]. The levels of sP-selectin reached their peak after 12 hours of symptoms onset (4 hours after reperfusion therapy successfully) in patients with AMI [(226.2±33.6) μg/L ,P 0.01], and decreased significantly at 24 hours of symptoms onset, but still higher than that in controls (P 0.05). There was no difference between the levels of sP-selectin at 48 and 72 hours of symptoms onset in AMI patients and those in controls. ②The TNF-α and IL-6 increased at 6 hours, climaxed at 24 hours, and were still high at 72 hours after the symptoms onset in patients with AMI. ③The levels of sP-selectin was correlated significantly with those of TNF-α and IL-6 at 6 hours of symptoms onset in AMI patients (r=0.74,P 0.01;r=0.68,P 0.01). Conclusion:sP-selectin increase significantly after 6 hours of symptoms onset in patients with AMI. Levels of sP-selectin reach their peak soon after early antithrombus and reperfusion therapy and decreaes significantly at 24 hours of AMI onset. But early reperfusion therapy do not affect TNF-α and IL-6.

OBJECTIVE:To investigate the effects of pravastatin, fosinopril and their combination on ventricular remodeling, cardiac function, tumor necrosis factor-alpha (TNF-alpha) mRNA expression, and matrix metalloproteinases (MMPs) activities after myocardial infarction (MI) in rats. METHODS:Acute myocardial infarction (AMI) was established by ligation of the anterior descending coronary artery in male Sprague-Dawly (SD) rats. Twenty-four hours after the procedure, the 48 surviving rats were grouped randomly as AMI control, fosinopril (10 mg.kg(-1).d(-1)), pravastatin (20 mg.kg(-1).d(-1)) and a combined use of the 2 drugs. Sham-operated group (n = 8) was taken randomly as non-infarction control. Six weeks after treatment with the drugs by gastric gavage, heart function and left ventricular remodeling were assessed. Left ventricular weight (LVW)/body weight (BW) ratio was determined. The relative expression of myocardium TNF-alpha mRNA was assessed by reverse transcription-polymerase chain reaction. Left ventricular myocardium MMPs activities were assessed by Zymography. RESULTS:There were no significant differences among the four AMI groups in infarction size (P > 0.05). In comparison with the AMI group, left ventricular end-diastolic pressure, left ventricular end-diastolic diameter, LVW/BW all decreased significantly (P < 0.05 - 0.01); while dp/dtmax, dp/dtmin, fractional shortening (FS) and ejection fraction (EF) increased significantly in all three drug-treated groups (P < 0.05 - 0.01); increments of FS, LVEF and dp/dtmax were more evident in the combination group than either the fosinopril or pravastatin group (P < 0.05). The levels of TNF-alpha mRNA in AMI rats treated with fosinopril, pravastatin and their combination reduced 29%, 26% and 33%, respectively (P < 0.01); MMP-2 activity reduced 25%, 30% and 35%, respectively (P < 0.01); MMP-9 activity reduced 20%, 18% and 24%, respectively (P < 0.01). There were no significant differences in other variables among the 3 treatment groups (P > 0.05). CONCLUSION:Pravastatin, fosinopril and their combination showed favorable effects on left ventricular remodeling after AMI in rats and demonstrated improved cardiac function. The combined treatment group yielded better results in the context of improving left ventricular systolic function. These effects could be relevant to the attenuation of increased MMP-2 and MMP-9 activities and left ventricular expression of TNF-alpha.

患者男,56岁.因反复胸部隐痛3个月入院.外院心电图示完全性左束支传导阻滞(CLBBB),且行非同日法99 Tcm-甲氧基异丁基异腈(MIBI)运动负荷(次极量运动)及静息心肌断层显像.运动负荷显像示左心室前间壁、间隔后半段及下壁呈缺损状改变,而静息显像时缺损区则表现为正常分布(图1),诊断为前间壁、间隔后半段及下壁缺血可疑.入本院后:体格检查无阳性体征,超声心动图、心电图及冠状动脉造影正常,平板运动试验阴性.遂即重复进行99 Tcm-MIBI运动负荷及静息心肌断层显像,均未见异常.故排除冠心病的诊断,拟诊间歇性CLBBB.

Objective To investigate the genes differentially expression in peripheral blood mononuclear cells(PBMC) between patients with chronic heart failure(CHF) and healthy controls using a gene array.Methods Total RNAs were extracted from PBMC harvested from CHF patients and healthy controls.Two cDNA probes for chronic heart failure(CHF) and healthy controls were synthesized from totol RNAs by in vitro reverse transcriptional reaction and labeled with cy3 and cy5 respectively.Two probes were simultaneous hybridized with a gene array(the above mentioned).The hybridization signals were obtained.Results The total of 133 genes has differentially expression in PBMC between patients with CHF and healthy controls,the number of over-and lower-expressed genes were 102 and 21,respectively.These genes encode for adhesion molecules,heat shock proteins,and proteins associated with signal transduction,cell cycles,and apoptosis.Conclusion PBMC from CHF patients and from controls showed different expression profile.The findings presented herein may have clinical significance for the development of CHF and provide a foundation for the further investigation of molecular pathogenesis of CHF.

目的:探讨血清尿酸水平与不同病因慢性心力衰竭(心衰)患者左心室收缩和舒张功能的相关性.方法:138例慢性心衰患者根据病因分为缺血性心脏病组、扩张性心肌病组和高血压合并心衰组.研究3组患者血清尿酸水平与心脏多普勒超声收缩、舒张功能指标的关系.彩色多普勒超声指标包括二尖瓣E峰和A峰速度、E/A值、左心室容积、左心室射血分数、等容舒张时间、心房压力波传递时间(A-Ar间期).E/A值<1或等容舒张时间>100 ms代表左心室主动松弛受损(ALVAR),根据患者有无ALVAR来比较其与血清尿酸水平的关系.结果:138例患者中有ALVAR 者39例,无ALVAR 者99例.血清尿酸水平有ALVAR者较无ALVAR者有极显著性差异(0.49±0.12 mmol/L比 0.39±0.07 mmol/L,P<0.01);缺血性心脏病组和高血压合并心衰组血清尿酸水平均高于扩张性心肌病组,有显著性差异(0.44±0.13 mmol/L比0.34±0.08 mmol/L,P<0.01;0.42±0.15 mmol/L比0.34±0.08 mmol/L,P<0.05).血清尿酸水平与E峰速度(r=-0.23,P<0.05)、E/A值(r=-0.21,P<0.05)、等容舒张时间(r=0.28,P<0.01)均相关;但与 A-Ar间期、左心室容积、左心室射血分数无相关性.Logistic回归分析显示血清尿酸水平升高是ALVAR较强的预测因素.结论:血清尿酸水平升高和慢性心衰舒张功能异常相关.黄嘌呤氧化酶抑制剂有可能改善慢性心衰舒张功能.

患者,女性,41岁.因半h内晕厥2次入院.患者由坐位变为立位时突发晕厥,伴四肢抽搐、双眼上翻,无口吐白沫、二便失禁等.约2～3 min自行醒转,呕吐胃内容物1次,非喷射性.随即送医院,途中再次发生晕厥1次.

目的检测血尿酸水平升高是否为冠心病的独立预测因子.方法采用回顾性分析选择经冠状动脉造影证实的连续性冠心病患者118例(稳定性心绞痛36人,不稳定性心绞痛28人,急性心肌梗死54人),年龄(65.79±10.03)岁,其中男94人,女24人;同期冠脉造影正常的连续性入院患者67例作为对照组,年龄(60.75±11.98)岁,其中男43人,女24人.入院第2天清晨取空腹12小时静脉血进行血尿酸、血脂等各种生化检查,详细询问包括吸烟、高血压等病史.入院期间行冠脉造影检查.结果冠心病组血尿酸水平高于对照组,(372.31±100.28)mmol/L vs(340.08±81.58)mmol/L(P=0.028),冠心病组之间血尿酸水平并无差异.但logistic回归分析显示血尿酸并非冠心病的独立危险因素.结论血尿酸水平升高可能只是动脉粥样硬化的一个标志,而非冠心病的独立危险因素.

患者男性,56岁.因反复胸部隐痛三月于2003年12月入院.胸痛与体力活动无关,可持续几分钟到十几分钟.

Objective: To assess whether collected QT interval(QTc) might correlate with QT dispersion(QTd), QRS duration and echocardiographic variables in patients with chronic heart failure (CHF). Method: QTc and QTd were measured on simultaneous recording 12-lead electrocardiograms in 126 patients with an Left ventricular ejection fraction 45% and QTc was related to QTd , QRS duration, clinical and echocardiographic variables. Result: QTc interval correlated significantly with age (r= 0.21,P 0.01), left ventricular end diastolic dimensions(LVEDD) (r= 0.26,P 0.01), left atrial diameter(LAD) (r= 0.24,P 0.01), QRS duration (r= 0.37, P 0.01), QTd (r= 0.41,P 0.01) , FS (r=- 0.28, P 0.01) and Left ventricular ejection fraction (LVEF)(r=- 0.33, P 0.01). QTc was not found be associated with E/A ratio, isovolumic relaxation time (IVRT). Multiple liner regression indentified QTd, QRS duration and LVEF to be the independent correlates of QTc.Conclusion: QTc is related to a variety of variables, which have important prognostic implications in patients with CHF. The biological relationships of QTc and QTd need further investigations.

Objective To evaluate the effect of tranilast on neointimal proliferation and remodeling of rabbit iliac artery after balloon injury.Methods Twenty four rabbits were randomly divided into 3 groups including sham-operated group, control group, and treatment group. Balloon catheter was used to induce injury to the iliac artery of rabbits in control group and treatment group. Tranilast was given to the rabbits in treatment group (300 mg·kg -1) once a day from 3 days before operation to 28 days after operation, and then local vessels were harvested for pathological analysis and immunohistochemical staining. Automatic image analysis system was used to detect the changes of intimal thickness, medial thickness, luminal area, external elastic lamina (EEL) cross-sectional area and the proliferation index of proliferating cell nuclear antigen (PCNA). Results The intimal thickness was decreased in treatment group compared with control group. The luminal area and EEL cross-sectional area were significantly larger in treatment group than those in control group. No significant difference was found between treatment group and control group in medial thickness. The proliferation index of PCNA was significantly reduced in treatment group compared with control group. Conclusions Tranilast signifcantly inhibited neointimal hyperplasia and prompted compensatory artery dilation during remodeling of rabbit iliac artery after balloon injury. The effect on neointimal hyperplasia may be partly attributed to the inhibition of vascular smooth muscle cell proliferation.