心力衰竭(心衰)为复杂、多因素疾病,为多种心脏疾病发展的终末阶段,以心脏收缩、舒张障碍为主要病理特点,在老年群体中高发,且住院率、死亡率极高,对病人生命安全及正常生活影响巨大.心衰的诊断与治疗受到社会的广泛关注.microRNA是由22～25个核苷酸组成的内源性非编码单链RNA,参与机体细胞增殖、分化、凋亡、迁移、侵袭等多种生理病理过程,在心血管系统疾病的发生与发展过程中发挥重要作用[1].microRNA 499具有敏感的心肌特异性,极有可能成为心衰诊断的生物标志物,受到了研究者的注意[2].本研究检测了老年心衰病人血清 microRNA 499的表达水平,分析其与N 末端 B 型利钠肽原( N terminal pro B type natriuretic peptide,NT-proBNP )、同型半胱氨酸(homocysteine,Hcy)的关系,以期探讨血清microRNA 499在老年心衰诊断中的临床价值.现报道如下.

目的 探讨舒肝解郁胶囊治疗稳定型心绞痛伴发轻中度焦虑抑郁患者的临床疗效.方法 将80例稳定型心绞痛合并轻中度焦虑抑郁患者按照随机数字表法分为研究组与对照组,各40例.两组均给予常规治疗,研究组在此基础上给予舒肝解郁胶囊治疗,观察12周.治疗前后采用汉密顿焦虑量表及汉密顿抑郁量表评定两组焦虑抑郁情绪,比较两组临床疗效、心血管不良事件发生率及不良反应发生率.结果 治疗后两组汉密顿焦虑量表及汉密顿抑郁量表评分均显著低于治疗前(P<0.01),研究组显著低于对照组(P<0.01),研究组焦虑及抑郁症状治疗总有效率显著高于对照组(P<0.01).研究组心血管不良事件发生率显著低于对照组(P<0.05),两组不良反应发生率比较差异无统计学意义(P>0.05).结论 舒肝解郁胶囊治疗稳定型心绞痛伴发轻中度焦虑抑郁患者疗效显著,能降低心血管不良事件发生率,安全性高,值得推广应用.

目的:探讨对矽肺导致的心血管疾病应用克矽平和柠檬酸铝治疗,分析其临床应用效果.方法 :选取2017年5月-2019年7月我院收治的200例矽肺导致的心血管疾病患者,均接受克矽平和柠檬酸铝治疗,分析临床治疗效果.结果 :治疗后,患者心搏出量(SV)、每分搏出量(CO)、心搏指数(SVI)及心脏指数(CI)均较治疗前提高;患者心肌收缩力指数(HI)、C波波幅、Q-Z间期均较治疗前提高;患者Q-B间期(PEP)、B-X间期(LVET)、PEP/LVET比值均较治疗前升高,差异有统计学意义(P＜0.05).结论: 针对矽肺导致的心血管疾病患者应用克矽平和柠檬酸铝,可有效改善其心功能,一定程度上提高其预后.

目的:探讨miR-146a对心力衰竭大鼠的保护作用及对心肌细胞的影响,并探讨其可能机制.方法:随机选择6只SPF级不进行起搏处理的SD大鼠为假手术组(A组),剩余大鼠构建心力衰竭大鼠模型,随机分为模型组(B组)、转染miR-146a抑制剂腺病毒的心力衰竭大鼠(C组)、转染未携带miR-146a抑制剂腺病毒的心力衰竭大鼠(D组),每组6只,观察对心力衰竭大鼠的影响.qRT-PCR测定大鼠心肌组织miR-146a的表达,小动物超声成像系统检测大鼠的心脏超声心动图,HE染色及TUNEL法观察大鼠心肌的病变程度及心肌细胞的凋亡情况,Western印迹检测心肌细胞PI3K、p-PI3K、Akt、p-Akt、Cleaved caspase-3和Cleaved caspase-9的表达.结果:B组大鼠心肌组织中miR-146a的表达水平明显较A组上调(P<0.05);C组大鼠心肌组织中miR-146a的表达水平明显较B组下调(P<0.05);C组大鼠LVEF、LVFS明显较B组上升(P<0.05);C组大鼠心肌病变程度明显较B组改善;C组大鼠心肌细胞凋亡率明显较B组下降(P<0.05);C组大鼠心肌组织Cleaved caspase-3、Cleaved caspase-9蛋白的表达水平明显较B组下调(P<0.05);C组大鼠PI3K、Akt蛋白的磷酸化水平明显较B组高(P<0.05).结论:miR-146a在心力衰竭大鼠心肌组织中呈高表达.miR-146a可能通过抑制PI3K/Akt信号通路发挥其促进心肌细胞凋亡的作用,进而促进疾病的发生与进展.

INTRODUCTION:The renin-angiotensin system is associated with blood pressure regulation, inflammation, oxidative stress and insulin resistance. It can decrease intracellular oxidative stress. Stimulation with H2O2 leads to increased oxidative stress and activation of the AKT/mTOR pathway. However, the role of renin-angiotensin system inhibitors in oxidative stress-induced endothelial cell dysfunction and H2O2-induced AKT activation remains unclear.MATERIAL AND METHODS:Human coronary artery endothelial cells (HCAECs) were used. The cells were treated with H2O2, captopril, the AKT inhibitor MK-2206, and the AKT activator SC79, either separately, or in combination. p53 and ICAM-1 expression, and p-eNOS, p-Akt and mTOR activation were measured by Western blot. Cell viability was assessed by MTT assay. Levels of reactive oxygen species (ROS) were assayed by flow cytometry. Proliferation was monitored by BrdU labeling, while cell migration and invasion were determined by wound healing and Transwell assays, respectively.RESULTS:The renin-angiotensin system inhibitor captopril reversed H2O2-induced oxidative stress and apoptosis in HCAECs. Co-treatment with captopril and the AKT inhibitor MK-2206 reduced the H2O2-induced P53 and ICAM-1 protein expression (p < 0.05). The proliferation, migration and invasion of HCAECs were significantly enhanced by co-treatment with captopril and MK-2206 (p < 0.05).CONCLUSIONS:The study revealed the protective effect of captopril against H2O2-induced endothelial cell dysfunction through the AKT/mTOR pathway, and its enhancement of cell survival. These findings provide new insights into the protective effects of captopril and novel therapeutic approaches to treatment of cardiovascular disease.

目的 提出一种新型卷积递归神经网络血压模型(convolutional recurrent neural network-blood pressure,CRNN-BP),解决使用脉搏波波形进行血压测量模型中存在的特征点难以提取和鲁棒性较低的问题,提高血压模型普适性和精度.方法 该模型首先使用卷积网络层自动提取脉搏波的波形特征;其次使用递归网络层依据连续心动周期血压变化关系对波形特征进行校正;最后使用全连接网络层预测出当前的血压值.结果 使用MIMIC数据集中人体真实生理信息对模型进行验证,收缩压和舒张压的平均绝对误差分别为2.71 mmHg和1.41 mmHg.模型精度相比于未使用递归网络层的模型CNN-BP和使用全部脉搏波波形点的传统血压回归模型更有优势,且符合AAMI和BHS标准.结论 CRNN-BP有效地提取了脉搏波的波形特征,并提升了模型的精度和鲁棒性.

传统使用脉搏波测量血压的方法存在准确率较低和特征点难以提取的问题.针对这些问题,本研究首先提出脉搏波分解算法,将脉搏波分解为三个钟型波复合的形式,由此获取到准确的脉搏波传播时间;之后提出混合特征卷积神经网络模型ABP－net,该模型将脉搏波传播时间特征和使用一维卷积自动提取的脉搏波波形特征相结合对动脉血压进行预测.最后使用ABP－net对MIMIC III中15个患者的血压进行预测.实验结果表明,ABP－net能够有效地提取脉搏波波形特征而且对血压的预测精度更高.

目的 观察左西孟旦治疗慢性充血性心力衰竭(CHF)的临床效果.方法 选取慢性CHF病人156例,随机分为实验组及对照组各78例.在常规治疗的基础上,实验组给予左西孟旦治疗,对照组给予多巴酚丁胺治疗.治疗2周后,观察比较两组NYHA心功能分级、左心室射血分数(LVEF)、每搏心输出量(SV)、血清N末端脑钠肽(NTpro-BNP)、尿素氮(BUN)、肌酐(Cr)、电解质等的变化.结果 与对照组比较,实验组治疗前后心功能分级、NTpro-BNP、LVEF、SV的变化差异有显著意义(Z=3.02,t=2.62～232.13,P＜0.05).结论 左西孟旦治疗慢性CHF,可显著改善心功能,提高LVEF和SV,降低NTpro-BNP水平.

目的 探讨体外反搏(EECP)对女性慢性心力衰竭(CHF)患者PCI术后的疗效及安全性.方法 选择53例CHF 行PCI术的绝经后女性患者,随机分为EECP组和药物治疗组.EECP组在常规药物基础上加做EECP 8周,药物治疗组只进行常规药物治疗.两组患者治疗前、后均检测6 min步行距离及Tei指数.结果 两组6 min步行距离(m)(589.00±47.17、556.00±48.17)及Tei指数(0.38±0.11、0.45±0.12)与治疗前(465.50±41.80、467.75±40.76,0.57±0.12、0.56±0.13)相比差异均有统计学意义(P＜0.01),两组之间比较差异有统计学意义(P＜0.05).结论 EECP可提高女性CHF患者PCI术后的心肌缺氧能力,改善心功能,提高运动耐量,值得临床推广.

Objective:To explore the application of psycho-cardiology medical mode in patients with myocardial infarction complicated emotional disorder.Methods:Hospitalized patients with myocardial infarction were assessed with Zung self-rating anxiety scale(SAS) and self-rating depression scale(SDS).A total of 61 cases with emotional disorder were selected and randomly divided into routine treatment group(n=31,received routine medication) and intervention group(n=30,received intervention of psycho-cardiology medical mode based on routine medication).Tests were done after six weeks and changes of scores of the two groups before and after therapy were statistically analyzed.Results: Compared with routine treatment group,total scores of SAS [(49.42±6.72) scores vs.(41.03±6.33) scores] and SDS [(51.90±6.76) scores vs.(44.33±6.91) scores] significantly decreased in intervention group(P0.01 all).Conclusion: Psycho-cardiology medical mode can treat myocardial infarction and solve psychological problems of patients,and is conducive to comprehensive rehabilitation of patients.

目的观察急性冠脉综合征（ACS）患者血浆IL-17、高敏C反应蛋白（hs-CRP）水平和脉搏波传导速度（PWV）,并探讨其临床意义。方法入选的30例ACS患者中有急性心肌梗死（AM I）14例、不稳定型心绞痛（UAP）16例,另择稳定型心绞痛（SAP）20例、健康对照者10例。采用ELISA法检测IL-17水平,胶乳增强免疫透射比浊法检测血浆hs-CRP水平,动脉硬化检测仪检测PWV。结果 AM I和UAP患者LL-17明显高于SAP和健康对照者（P＜0.01）;各冠心病患者血浆hs-CRP水平、PWV值均高于健康对照者（P＜0.05）。hs-CRP与IL-17、PWV均呈正相关（r=0.696、0.652,P＜0.05）。结论 ACS患者血浆IL-17、hs-CRP水平、PWV值均升高;IL-17可能参与动脉粥样斑块不稳定和ACS的发病;PWV值有望成为预测动脉粥样硬化程度的有效指标。

Objective To compare the therapeutic effect and safety of Ramipril,Irbesartan and Ramipril combined with Irbesartan for treatment of heart failure and angina pectoris.Methods 90 patients with heart failure and stable angina pectoris treated with conventional therapy were randomly assigned to group A(treated only with Ramipril)、group B(treated only with Irbesartan) and group C(treated with both Ramipril and Irbesartan) for 8 weeks to observe the therapeutic effect and safety.The changes of NYHA class、blood electrolytes、liver and renal function、12-lead electrocardiogram and echocardiography were examined before and after treatment.Results The angina pectoris attacks、Nitroglycerin dosage、ST segment move down、brain natriuretic peptide(BNP)、the indexes of echocardiography were improved more significantly after treatment in group C than the two other groups(P0.05),the frequency of adverse reaction of three groups was similar(P0.05).Conclusions Not only does the therapeutic effect of Ramipril combined with Irbesartan for treatment for heart failure and angina pectoris surpass that of Ramipril or Irbesartan alone,but also it is a safe medicine.

Objective To evaluate the accuracy of 64-slice spiral CT in detecting coronary artery stenosis.MethodsPatients with or highly suspected coronary artery disease(n=60)were studied by 64-slice spiral CT,one day before invasive coronary angiography(ICA).Data obtained from CT and ICA were compared.Results Of the 780 segments,712 met the requirements for assessment,in which,13 segments were evaluated in each patient;68 segments failed to evaluate due to severe calcifications and motion artifacts.Based on the gold standards of ICA,the accuracy in detection of coronary segment stenosis was 75%,81%,88% vs 50%,50%-75% and 75%,respectively.Specificity was 97%.Conclusion 64-slice spiral CT is an useful method to evaluate and screen coronary artery stenosis with high accuracy.

Objective To Observe the efficacy and safety of Ramipril combined with valsartan in treating hypertensive patients with diabetic nephropathy.Methods 97 hypertensive patients with diabetic nephropathy under the well control of blood glucose were included in this study.All cases were randomly divided into two groups: treatment group included 48 cases given Ramipril combined with valsartan;control group included 49 cases only given Ramipril.Urinary albumin excretion rate(UAER),blood urea nitrogen(BUN),serum creatinine(SCr),systolic blood pressure(SBP) and diastolic blood pressure(DBP)were measured for all cases before and after 24 weeks' therapy.Results According to ABP and OBP,all cases' blood pressure in both two groups was significantly lowed after treatments(P0.01).There was no significant difference between two groups(P0.05).UAER,BUN and SCr in both groups were markedly reduced after treatment(P0.05).Furthermore,UAER and SCr were reduced more in treatment group than in Control group(P0.05).Conclusions It is an effective and safe way to treat hypertensive patients with diabetic nephropathy to use Ramipril combined with valsartan.The protective effect on kidneys is independent from the influence on blood pressure.

①目的观察曲美他嗪治疗老年稳定型劳累性心绞痛的疗效及安全性. ②方法选择老年稳定型劳累性心绞痛患者53例,随机分为曲美他嗪组和对照组.两组用药前后观察每周心绞痛发作的次数;每周硝酸甘油含片的消耗剂量;心率及心率和收缩压的乘积;运动诱发心绞痛发作所需的时间;运动后ST段下降≥0.1 mm所需的时间;运动持续时间;血生化检验. ③结果曲美他嗪组心绞痛的发作次数、每周硝酸甘油含片的消耗剂量、运动诱发心绞痛发作所需的时间及ST段下降≥0.1mm所需的时间较治疗前有明显差异(P<0.05),与对照组比较差异显著(P<0.05),未出现不良反应.④结论曲美他嗪可提高老年稳定型劳累性心绞痛患者的心肌耐缺氧能力,改善缺血症状,从而提高患者的运动耐量,改善生活质量,且用药安全,值得临床推广应用.

①目的探讨冠心病心肌缺血发作时心脏自主神经活动的特点.②方法对50例冠心病心肌缺血病人与40例正常人的心率变异性(HRV)各指标进行检测分析.③结果冠心病组SDNN、SDANN、RMSSD、PNN50、HF显著低于对照组(t=3.175～4.512,P<0.01),LF/HF显著高于对照组(t=3.268,P<0.01).心肌缺血发作时HF显著低于ST段压低后1 h(t=3.375,P<0.01),LF、LF/HF显著高于ST段压低后1 h(t=3.210、3.925,P<0.01).④结论冠心病病人的自主神经活动受损,迷走神经张力减弱,而交感神经张力相对亢进,发生恶性心律失常的危险性增加.冠心病病人短暂性心肌缺血与HRV密切相关.